a) Fortune Express, Inc. vs. CA, G.R. No.

119756 March 18, 1999

FACTS:
On November 18, 1989, a bus of Fortune Express, Inc. was involved in an accident with a
jeepney resulting in the death of several passengers of the jeepney, including two Maranaos.
Upon investigation, it was found that the owner of the jeepney was a Maranao and that certain
Maranaos were planning to take revenge on the petitioner by burning some of its buses. The
Philippine Constabulary then informed Diosdado Bravo, operations manager of Fortune
Express, Inc. of the threat. However, Bravo assured him that the necessary precautions would
be taken to insure the safety of lives and property.
A few days after, three armed Maranaos who pretended to be passengers, seized and burned a
bus of Fortune Express Inc.. During such attack, the passengers were demanded to get off from
the bus. However, Atty. Caorong went back to the bus to retrieve something. When he
discovered that the armed men were planning to kill the bus driver, he pleaded with them to
spare the bus driver’s life. Unfortunately, they did not heed to his request and was instead shot
by the armed men. Although the other passengers managed to bring Atty. Caorang to a
hospital, he died while undergoing operation.
The widow of Atty. Caorang, Paulie Caorang, and their minor children filed a suit for breach of
contract of carriage in the Regional Trial Court of Iligan City. However, the RTC dismissed the
complaint. It held that the death of Atty. Caorong was an unexpected and unforeseen
occurrence over which Fortune Express Inc. had no control.
On appeal, however, the Court of Appeals reversed the decision. It held that Fortune Express
Inc. never adopted even a single safety measure for the protection of its paying passengers.
Hence, this appeal filed by Fortune Express, Inc. It contended that Atty. Caorong was guilty of
contributory negligence in returning to the bus to retrieve something.

ISSUE: Whether or not Atty. Caorong was guilty of contributory negligence?

RULING:
NO. The Supreme Court held that Atty. Caorong did not act recklessly. The intended targets of
the violence were Fortune Express, Inc. and its employees, not its passengers. The assailant's
motive was to retaliate for the loss of life of two Maranaos as a result of the collision between
petitioner's bus and the jeepney in which the two Maranaos were riding. Mananggolo, the leader
of the group which had hijacked the bus, ordered the passengers to get off the bus as they
intended to burn it and its driver. The armed men actually allowed Atty. Caorong to retrieve
something from the bus. What apparently angered them was his attempt to help the driver of the
bus by pleading for his life. He was playing the role of the good Samaritan. The court ruled that
this act cannot be considered an act of negligence, let alone recklessness.
b) Ramos vs. CA, GR No.124354, December 29, 1999

FACTS:
Erlinda Ramos was a robust and normal woman, except for occasional complaints of discomfort
due to pains allegedly caused by the presence of stones in her gall bladder. Through the
intercession of a mutual friend, Dr. Buenviaje, she and her husband Rogelio met for the first
time with Dr. Orlino Hozaka, the defendant, who advised her to get a cholecystectomy. Rogelio
asked Dr. Hozaka to get a good anesthesiologist which the latter agreed.
On June 17, 1985, Erlinda was brought into the operating room of the Delos Santos Medical
Center for the operation. Despite being late for a couple of hours, Dr. Hozaka eventually arrived
which prompted the operation to begin. Dr. Perfecta Gutierrez, the other defendant and
anesthesiologist, started to intubate Erlinda. However, since there was a bluish discoloration on
the nailbeds of Erlinda, Dr. Hosaka called for Dr. Calderon, another anesthesiologist. Despite
being intubated by Dr. Calderon, Erlinda was taken to the ICU.
Two days after, Dr. Hosaka informed Rogelio that something went wrong with the intubation.
Thereafter, Doctors Gutierrez and Hosaka explained that the patient had bronchospasm.
Eventually, Erlinda stayed at the ICU for months before being released. However, since the
operation, she had been in a comatose condition and suffered brain damage as a result of the
absence of oxygen in her brain for four to five minutes. Moreover, she was also diagnosed to be
suffering from "diffuse cerebral parenchymal damage".
On January 8, 1986, the Spouses Ramos filed a civil case for damages with the Regional Trial
Court of Quezon City against Delos Santos Medical Center, Dr. Orlino Hosaka and Dra.
Perfecta Gutierrez||| alleging negligence in the management and care of Erlinda Ramos.
The Regional Trial Court then rendered judgment in favor of petitioners. It held that the
defendants were guilty of, at the very least, negligence in the performance of their duty to
plaintiff-patient Erlinda Ramos. The private respondents then interposed an appeal to the Court
of Appeals which reversed the findings of the RTC and dismissed the complaint. Hence, the
present petition was filed by the Spouses Ramos.

ISSUE: Whether or not the doctrine of res ipsa loquitur applies in the case?

RULING:
YES. The Court found the doctrine of res ipsa loquitur to be applicable in the case. It held that
the damage sustained by Erlinda in her brain prior to a scheduled gall bladder operation
presents a case for the application of res ipsa loquitur
Res ipsa loquitur is a Latin phrase which literally means "the thing or the transaction speaks for
itself." The phrase "res ipsa loquitur" is a maxim for the rule that the fact of the occurrence of an
injury, taken with the surrounding circumstances, may permit an inference or raise a
presumption of negligence, or make out a plaintiff's prima facie case, and present a question of
fact for defendant to meet with an explanation.  Where the thing which caused the injury
complained of is shown to be under the management of the defendant or his servants and the
accident is such as in ordinary course of things does not happen if those who have its
management or control use proper care, it affords reasonable evidence, in the absence of
explanation by the defendant, that the accident arose from or was caused by the defendant's
want of care.
In the present case, Erlinda submitted herself for cholecystectomy and expected a routine
general surgery to be performed on her gall bladder. On that fateful day she delivered her
person over to the care, custody and control of private respondents who exercised complete
and exclusive control over her. At the time of submission, Erlinda was neurologically sound and,
except for a few minor discomforts, was likewise physically fit in mind and body. However,
during the administration of anesthesia and prior to the performance of cholecystectomy she
suffered irreparable damage to her brain. Thus, without undergoing surgery, she went out of the
operating room already decerebrate and totally incapacitated. Obviously, brain damage, which
Erlinda sustained, is an injury which does not normally occur in the process of a gall bladder
operation.

c) Layugan vs. IAC, G.R. No. 73998 November 14, 1988

FACTS:
On May 15, 1979, Pedro T. Layugan and a companion were repairing the tire of a cargo truck
parked along the National Highway. The truck of Godofredo Isidro, which was driven recklessly
by Daniel Serrano, bumped Layugan. As a result, Layugan was injured and hospitalized. Thus,
he filed an action for damages against Godofredo Isidro.
Defendant Isidro admitted his ownership of the vehicle involved in the accident driven by Daniel
Serrano. He alleged that the proximate cause of the incident was the failure of the driver of the
parked truck in installing the early warning device. He posited that any immobile object along
the highway, like a parked truck, poses serious danger to a moving vehicle which has the right
to be on the highway. Hence, he argued that the driver of the parked car should be liable for
damages sustained by his truck. He further alleged that plaintiff being a mere bystander and
hitchhiker, must suffer all the damages he incurred.
On May 29, 1981, a third-party complaint was filed by Isidro against his insurer, the
Travellers Multi Indemnity Corporation. He argued that the third-party defendant is liable to the
former for contribution, indemnity and subrogation by virtue of their contract under an insurance
policy. In its Answer, Travellers Multi Indemnity Corporation argued that the accident in question
was approximately caused by the carelessness and gross negligence of the plaintiff.
The trial court rendered its decision in favor of plaintiff. It ordered defendant to pay
damages while the third party defendant was ordered to indemnify the defendant. The
Intermediate Appellate Court then reversed the decision of the trial court and dismissed the
complaint, the third-party complaint, and the counter-claims of both appellants. Hence, this
petition.

ISSUE: Whether or not the Intermediate Appellate Court acted correctly in applying the
doctrine of res ipsa loquitur?
RULING:
NO. The Supreme Court held that the respondent court committed reversible error in applying
the doctrine of res ipsa loquitur. This doctrine is stated thus: "Where the thing which causes
injury is shown to be under the management of the defendant, and the accident is such as in
the ordinary course of things does not happen if those who have the management use proper
care, it affords reasonable evidence, in the absence of an explanation by the defendant, that the
accident arose from want of care." 
Whether the cargo truck was parked along the road or on half the shoulder of the right side of
the road would be of no moment taking into account the warning device consisting of the lighted
kerosene lamp placed three or four meters from the back of the truck. But despite this warning
which we rule as sufficient, the Isuzu truck driven by Daniel Serrano, an employee of the private
respondent, still bumped the rear of the parked cargo truck. As a direct consequence of such
accident the petitioner sustained injuries on his left forearm and left foot. His left leg was later
amputated from below the knee when gangrene had set in. ||| 
The private respondent is sued under Art. 2176 in relation to Art. 2180, paragraph 5, of the Civil
Code. In the latter, when an injury is caused by the negligence of a servant or employee there
instantly arises a presumption of law that there was negligence on the part of the master or
employer either in the selection of the servant or employee, or in supervision over him after
selection, or both. Such presumption is juris tantum and not juris et de jure and consequently,
may be rebutted. If follows necessarily that if the employer shows to the satisfaction of the court
that in the selection and in the supervision he has exercised the care and diligence of a good
father of a family, the presumption is overcome and he is relieved from liability. 
In the case, there is paucity of proof that Isidro exercised the diligence of a good father of a
family in the selection of his driver, Daniel Serrano, as well as in the selection of his mechanic, if
any, in order to insure the safe operation of his truck and thus prevent damage to others. It is
clear that the driver did not know his responsibilities because he apparently did not check his
vehicle before he took it on the road. If he did he could have discovered earlier that the brake
fluid pipe on the right was cut, and could have repaired it and thus the accident could have been
avoided. Moreover, to our mind, the fact that the private respondent used to instruct his driver to
be careful in his driving, that the driver was licensed, and the fact that he had no record of any
accident, as found by the respondent court, are not sufficient to destroy the finding of
negligence of the Regional Trial Court given the facts established at the trial.

d) Professional Services Inc. (PSI) v. Agana, G.R. No. 126297, 31 January 2007
FACTS:
On April 4, 1984, Natividad Agana was rushed to the Medical City General Hospital
because of difficulty of bowel movement and bloody anal discharge. After a series of medical
examinations, Dr. Miguel Ampil diagnosed her to be suffering from "cancer of the sigmoid."
Thereafter, Dr. Ampil performed an anterior resection surgery on Natividad. He found
that the malignancy in her sigmoid area had spread on her left ovary, necessitating the removal
of certain portions of it. Thus, Dr. Ampil obtained consent to perform a hysterectomy. However,
the operation appeared to be flawed since two sponges were lacking in the record of the
operation.
 After a couple of days, Natividad complained of excruciating pain in her anal region
wherein she was told was a natural consequence of the surgery. Eventually, a piece of gauze
was found protruding from the vagina of Natividad. Upon being informed about it, Dr. Ampil
proceeded to her house where he managed to extract by hand a piece of gauze measuring 1.5
inches in width. He then assured her that the pains would soon vanish.
Unfortunately, the pains intensified, prompting Natividad to seek treatment at the
Polymedic General Hospital. While confined there, the presence of another foreign object in her
vagina was found which badly infected her vaginal vault. A recto-vaginal fistula had then formed
in her reproductive organs which forced stool to excrete through the vagina. Hence, another
surgical operation was needed to remedy the damage. Thus, in October 1984, Natividad
underwent another surgery.
Subsequently, Natividad and her husband filed with the RTC a complaint for damages
against the Professional Services, Inc. (PSI), owner of the Medical City Hospital, Dr. Ampil, and
Dr. Fuentes. They alleged that the latter are liable for negligence for leaving two pieces of
gauze inside Natividad's body and malpractice for concealing their acts of negligence. During
the pendency of the cases, Natividad died and was duly substituted by her children, the Aganas.
The RTC rendered its Decision in favor of the Aganas, finding PSI, Dr. Ampil and Dr.
Fuentes liable for negligence and malpractice. Aggrieved, PSI, Dr. Fuentes and Dr. Ampil
interposed an appeal to the Court of Appeals. The Court of Appeals then affirmed the decision
appealed from and dismissed the appeal. Since Dr. Ampil’s motion for reconsideration was
denied, the present petition was filed.
Dr. Ampil argues that the Court should not discount that either Dr. Fuentes left the
gauzes in Natividad's body after performing hysterectomy; the attending nurses erred in
counting the gauzes; and the American doctors were the ones who placed the gauzes in
Natividad's body.

ISSUE: Whether or not the Court of Appeals erred in holding Dr. Ampil liable for negligence and
malpractice?

RULING:
NO. The Supreme Court found all major circumstances directly point to Dr. Ampil as the
negligent party. It held that Dr. Ampil did not present any evidence to prove that the American
doctors were the ones who put or left the gauzes in Natividad's body. Neither did he submit
evidence to rebut the correctness of the record of operation, particularly the number of gauzes
used. As to the alleged negligence of Dr. Fuentes, we are mindful that Dr. Ampil examined his
work and found it in order.
An operation requiring the placing of sponges in the incision is not complete until the
sponges are properly removed, and it is settled that the leaving of sponges or other foreign
substances in the wound after the incision has been closed is at least prima facie negligence by
the operating surgeon.  Even if it has been shown that a surgeon was required by the urgent
necessities of the case to leave a sponge in his patient's abdomen, because of the dangers
attendant upon delay, still, it is his legal duty to so inform his patient within a reasonable time
thereafter by advising her of what he had been compelled to do. This is in order that she might
seek relief from the effects of the foreign object left in her body as her condition might
permit. Here, Dr. Ampil did not inform Natividad about the missing two pieces of gauze. Worse,
he even misled her that the pain she was experiencing was the ordinary consequence of her
operation.
This is a clear case of medical malpractice or more appropriately, medical negligence.
To successfully pursue this kind of case, a patient must only prove that a health care provider
either failed to do something which a reasonably prudent health care provider would have done,
or that he did something that a reasonably prudent provider would not have done; and that
failure or action caused injury to the patient. 
Dr. Ampil, as the lead surgeon, had the duty to remove all foreign objects, such as
gauzes, from Natividad's body before closure of the incision. When he failed to do so, it was his
duty to inform Natividad about it. Dr. Ampil breached both duties. Such breach caused injury to
Natividad, necessitating her further examination by American doctors and another surgery. That
Dr. Ampil's negligence is the proximate cause of Natividad's injury could be traced from his act
of closing the incision despite the information given by the attending nurses that two pieces of
gauze were still missing. That they were later on extracted from Natividad's vagina established
the causal link between Dr. Ampil's negligence and the injury. And what further aggravated such
injury was his deliberate concealment of the missing gauzes from the knowledge of Natividad
and her family. cEaCAH

|||  
e) Borromeo vs. Family Care Hospital, Inc. GR No. 191018, January 25, 2016

FACTS:
Carlos Borromeo, was the husband of the late Lilian V. Borromeo. Lilian was a patient of the
Family Care Hospital, Inc. under the care of respondent Dr. Ramon Inso. On July 13, 1999,
Carlos brought his wife to the Family Care Hospital because she had been suffering from acute
pain at the lower stomach area and fever for two days. Dr. Inso suspected that Lilian might be
suffering from acute appendicitis. Thus, he ordered Lilian's confinement for testing and
evaluation. However, the tests were not conclusive enough to confirm that she had appendicitis.
Meanwhile, Lilian's condition did not improve.
On July 15, 1999, Dr. Inso decided to conduct an exploratory laparotomy on Lilian because of
the findings on her abdomen and his fear that she might have a ruptured appendix. During the
operation, Dr. Inso confirmed that Lilian was suffering from acute appendicitis. He then
proceeded to remove her appendix which was already infected and congested with pus.
The operation was successful and Lilian's appearance and vital signs improved. However, a few
hours after, Lilian’s condition deteriorated despite receiving blood transfusions and various
drugs. Dr. Inso then suspected that Lilian had Disseminated Intravascular Coagulation (DIC)
since petechiae were developing in various parts of her body. Dr. Inso then informed Carlos that
Lilian would have to be transferred to another hospital since the hospital did not have an ICU.
Lilian was then taken to Muntinlupa Medical Center (MMC) while Dr. Inso closely followed with
his own vehicle. Unfortunately, Lilian passed away despite efforts to resuscitate her.
During the autopsy, the medico legal concluded that the cause of Lilian's death was
hemorrhage due to internal bleeding. This prompted Carlos to file a complaint for damages
against Family Care and against Dr. Inso for medical negligence.
The RTC rendered its decision in favor of Carlos Borromeo. It held that Dr. Inso was negligent in
using a single suture on the repair site causing Lilian's death by internal hemorrhage. It applied
the doctrine of res ipsa loquitur, holding that a patient's death does not ordinarily occur during
an appendectomy.
The respondents elevated the case to the Court of Appeals which dismissed the complaint and
reversed the RTC’s decision. The CA held that there was no causal connection between the
alleged omission of Dr. Inso to use a double suture and the cause of Lilian's death. It denied the
applicability of the doctrine of res ipsa loquitur because the element of causation between the
instrumentality under the control and management of Dr. Inso and the injury that caused Lilian's
death was absent; the respondents sufficiently established that the cause of Lilian's death was
DIC. Hence, the present petition for review on certiorari.

ISSUE: Whether or not the doctrine of res ipsa loquitur is applicable in the case?

RULING:
No. The Supreme Court held that the petitioner cannot invoke the doctrine of res ipsa
loquitur to shift the burden of evidence onto the respondent. Res ipsa loquitur, literally, "the
thing speaks for itself;" is a rule of evidence that presumes negligence from the very nature of
the accident itself using common human knowledge or experience.
The application of this rule requires: (1) that the accident was of a kind which does not
ordinarily occur unless someone is negligent; (2) that the instrumentality or agency which
caused the injury was under the exclusive control of the person charged with negligence; and
(3) that the injury suffered must not have been due to any voluntary action or contribution from
the injured person. The concurrence of these elements creates a presumption of negligence
that, if unrebutted, overcomes the plaintiff's burden of proof.
The rule is not applicable in cases such as the present one where the defendant's
alleged failure to observe due care is not immediately apparent to a layman. These instances
require expert opinion to establish the culpability of the defendant doctor. It is also not
applicable to cases where the actual cause of the injury had been identified or established. 
The court ruled that the petitioner failed to present sufficient convincing evidence to
establish: (1) the standard of care expected of the respondent and (2) the fact that Dr. Inso fell
short of this expected standard. Hence, it found no reversible error in the CA's dismissal of the
complaint on appeal. 

f) Casumpang vs. Cortejo, GR Nos. 171127, 171217, and 171228, March 11, 2015
FACTS:
On April 22, 1988, Mrs. Jesusa Cortejo brought her 11-year old son, Edmer, to the Emergency
Room of the San Juan de Dios Hospital (SJDH) because of difficulty in breathing, chest pain,
stomach pain, and fever.  Dr. Ramoncito Livelo initially examined Edmer and diagnosed him
with "bronchopneumonia."  Thereafter, Mrs. Cortejo was assigned to Dr. Noel Casumpang who
confirmed the initial diagnosis of "Bronchopneumonia." 
Since Mrs. Cortejo was doubting the diagnosis, she advised Dr. Casumpang that Edmer had a
high fever, and had no colds or cough. She also alerted him of traces of blood found in Edmer’s
septum. However, Dr. Casumpang merely insisted that Edmer was suffering from
bronchopneumonia.
Dr. Dr. Ruby Sanga-Miranda, a resident physician, also examined Edmer. Since Edmer was
vomiting blood, she suspected that he might be suffering from dengue. Dr. Miranda then called
Dr. Casumpang regarding the condition of Edmer. Thereafter, the latter was subjected to a
series of tests wherein it showed he was suffering from "Dengue Hemorrhagic Fever." Since the
ICU in the hospital was full, Edmer was transferred to Makati Medical Center where he died a
few hours after. His Death Certificate indicated the cause of death as Hypovolemic
Shock/hemorrhagic shock.
Believing that Edmer's death was caused by the negligent and erroneous diagnosis of his
doctors, Cortejo instituted an action for damages against SJDH, and its attending physicians,
Dr. Casumpang and Dr. Miranda before the RTC of Makati City.
The RTC ruled in favor of Cortejo. It held that the petitioning doctors were negligent, It also
observed that based on Edmer's signs and symptoms, his medical history and physical
examination, and also the information that the petitioning doctors gathered from his family
members, dengue fever was a reasonably foreseeable illness; yet, the doctors failed to take a
second look, much less, consider these indicators of dengue. The court also held SJDH
solidarily liable with the doctors for damages.
Upon appeal to the Court of Appeals, it affirmed the ruling of the RTC. It held that SJDH and its
attending physicians failed to exercise the minimum medical care, attention, and treatment
expected of an ordinary doctor under like circumstances. Since the motion for reconsideration
was denied, the present consolidated petitions were filed.
Dr. Casumpang contends that he gave his patient medical treatment and care to the best of his
abilities, and within the proper standard of care required from physicians under similar
circumstances. He claims that his initial diagnosis of bronchopneumonia was supported by the
chest x-ray result. Dr. Miranda also alleged that she exercised prudence in performing her
duties as a physician, underscoring that it was her professional intervention that led to the
correct diagnosis of "Dengue Hemorrhagic Fever." She also argued that there is no causal
relation between the alleged erroneous diagnosis and medication for "Bronchopneumonia," and
Edmer's death due to "Dengue Hemorrhagic Fever”.
On the other hand, SJDH disclaims liability by asserting that Dr. Casumpang and Dr. Miranda
are mere independent contractors and "consultants" (not employees) of the hospital. SJDH
alleges that since it did not exercise control or supervision over the consultants' exercise of
medical profession, there is no employer-employee relationship between them, and
consequently, Article 2180 of the Civil Code does not apply.

ISSUES:
(1) Whether or not Dr. Casumpang is liable for negligence?
(2) Whether or not Dr. Miranda is liable for negligence?

RULINGS:
(1) YES. The Supreme Court found Dr. Casumpang liable for negligence. It held that evidence
on record established that in confirming the diagnosis of bronchopneumonia,
Dr. Casumpang selectively appreciated some and not all of the symptoms presented, and
failed to promptly conduct the appropriate tests to confirm his findings. In sum,
Dr. Casumpang failed to timely detect dengue fever, which failure, especially when
reasonable prudence would have shown that indications of dengue were evident and/or
foreseeable, constitutes negligence.
Apart from failing to promptly detect dengue fever, Dr. Casumpang also failed to promptly
undertake the proper medical management needed for this disease. The standard medical
procedure once the patient had exhibited the classic symptoms of dengue fever should
have been: oxygen inhalation, use of analgesic, and infusion of fluids or dextrose;  and
once the patient had twice vomited fresh blood, the doctor should have ordered: blood
transfusion, monitoring of the patient every 30 minutes, hemostatic to stop bleeding, and
oxygen if there is difficulty in breathing. 
Dr. Casumpang failed to measure up to these standards. The evidence strongly suggests
that he ordered a transfusion of platelet concentrate instead of blood transfusion. The
tourniquet test was only conducted after Edmer's second episode of bleeding, and the
medical management did not include antibiotic therapy and complete physical examination.
(2) NO. The Supreme Court held that Dr. Miranda was not independently negligent. Although
she had greater patient exposure, and was subject to the same standard of care applicable
to attending physicians, it believed that a finding of negligence should also depend on
several competing factors, among them, her authority to make her own diagnosis, the
degree of supervision of the attending physician over her, and the shared responsibility
between her and the attending physicians.
Residents operate merely as subordinates who usually defer to the attending physician on
the decision to be made and on the action to be taken. The attending physician, on the
other hand, is primarily responsible for managing the resident's exercise of duties. While
attending and resident physicians share the collective responsibility to deliver safe and
appropriate care to the patients, it is the attending physician who assumes the principal
responsibility of patient care. Because he/she exercises a supervisory role over the
resident, and is ultimately responsible for the diagnosis and treatment of the patient, the
standards applicable to and the liability of the resident for medical malpractice is
theoretically less than that of the attending physician. These relative burdens and
 distinctions, however, do not translate to immunity from the legal duty of care for residents,
or from the responsibility arising from their own negligent act.
Dr. Miranda likewise duly reported to Dr. Casumpang, who admitted receiving updates
regarding Edmer's condition. There is also evidence supporting Dr. Miranda's claim that she
extended diligent care to Edmer. However, during Edmer's second episode of bleeding, she
failed to immediately examine and note the cause of the blood specimen. Like
Dr. Casumpang, she merely assumed that the blood in Edmer's phlegm was caused by
bronchopneumonia. Nevertheless, her failure to discern the import of Edmer's second
bleeding does not necessarily amount to negligence as the respondent himself admitted
that Dr. Miranda failed to examine the blood specimen because he washed it away. In
addition, considering the diagnosis previously made by two doctors, and the uncontroverted
fact that the burden of final diagnosis pertains to the attending physician, the Court believed
that Dr. Miranda's error was merely an honest mistake of judgment influenced in no small
measure by her status in the hospital hierarchy; hence, she should not be held liable for
medical negligence. 

g) Solidum vs. People, GR No. 192123, March 10, 2014

FACTS:
Gerald Albert Gercayo was born with an imperforate anus. Two days after his birth, he
underwent colostomy, a surgical procedure to bring one end of the large intestine out through
the abdominal wall, enabling him to excrete through a colostomy bag attached to the side of his
body. 
On May 17, 1995, Gerald, then three years old, was admitted at the Ospital ng Maynila
for a pull-through operation.  Dr. Leandro Resurreccion headed the surgical team, and was
assisted by Dr. Joselito Luceño, Dr. Donatella Valeña and Dr. Joseph Tibio. The
anesthesiologists included Dr. Marichu Abella, Dr. Arnel Razon and petitioner Dr. Fernando
Solidum. During the operation, Gerald experienced bradycardia and went into a coma which
lasted for two weeks. Upon regaining consciousness after a month, he could no longer see,
hear or move. 
Gerald’s mother, Ma. Luz Gercayo, lodged a complaint for reckless imprudence resulting
in serious physical injuries with the City Prosecutor's Office of Manila against the attending
physicians. However, the City Prosecutor's Office filed an information solely against Dr.
Solidum, the anesthesiologist who administered the anesthesia on Gerald.
The RTC rendered its judgment finding Dr. Solidum guilty beyond reasonable doubt of
reckless imprudence resulting to serious physical injuries. Upon appeal, the CA affirmed the
conviction of Dr. Solidum. It held that  there was not a hint that the nature of the operation itself
was a causative factor in the events that finally led to hypoxia. Thus, it attributed the accident to
a failure in the proper administration of anesthesia, the gravamen of the charge in this case. Dr.
Solidum filed a motion for reconsideration, but the CA denied his motion. Hence, the present
appeal.

ISSUES:
(1) Whether or not the doctrine of res ipsa loquitur was applicable?
 (2) Whether or not Dr. Solidum was liable for criminal negligence?  |||

RULINGS:

(1) NO. The Supreme Court considered the application of the doctrine of res ipsa
loquitur inappropriate. Res ipsa loquitur is literally translated as "the thing or the
transaction speaks for itself." The doctrine res ipsa loquitur means that "where the thing
which causes injury is shown to be under the management of the defendant, and the
accident is such as in the ordinary course of things does not happen if those who have
the management use proper care, it affords reasonable evidence, in the absence of an
explanation by the defendant, that the accident arose from want of care”. In order to
allow resort to the doctrine, therefore, the following essential requisites must first be
satisfied, to wit: (1) the accident was of a kind that does not ordinarily occur unless
someone is negligent; (2) the instrumentality or agency that caused the injury was under
the exclusive control of the person charged; and (3) the injury suffered must not have
been due to any voluntary action or contribution of the person injured.

In the case, the Court ruled that although the second and third elements were present,
considering that the anesthetic agent and the instruments were exclusively within the
control of Dr. Solidum, and that the patient, being then unconscious during the operation,
could not have been guilty of contributory negligence, the first element was undeniably
wanting. Luz delivered Gerald to the care, custody and control of his physicians for a
pull-through operation.

Except for the imperforate anus, Gerald was then of sound body and mind at the time of
his submission to the physicians. Yet, he experienced bradycardia during the operation,
causing loss of his senses and rendering him immobile. Hypoxia, or the insufficiency of
oxygen supply to the brain that caused the slowing of the heart rate, scientifically termed
as bradycardia, would not ordinarily occur in the process of a pull-through operation, or
during the administration of anesthesia to the patient, but such fact alone did not prove
that the negligence of any of his attending physicians, including the anesthesiologists,
had caused the injury. In fact, the anesthesiologists attending to him had sensed in the
course of the operation that the lack of oxygen could have been triggered by the vago-
vagal reflex, prompting them to administer atropine to the patient. 

(2) NO. The Supreme Court acquitted Dr. Fernando P. Solidum of the crime of reckless
imprudence resulting to serious physical injuries. It ruled that the prosecution did not
prove the elements of reckless imprudence beyond reasonable doubt because the
circumstances cited by the CA were insufficient to establish that Dr. Solidum had been
guilty of inexcusable lack of precaution in monitoring the administration of the anesthetic
agent to Gerald. 

In the medical profession, specific norms or standards to protect the patient against
unreasonable risk, commonly referred to as standards of care, set the duty of the
physician to act in respect of the patient. Unfortunately, no clear definition of the duty of
a particular physician in a particular case exists. As a result, the standard of medical
care of a prudent physician must be determined from expert testimony in most cases;
and in the case of a specialist (like an anesthesiologist), the standard of care by which
the specialist is judged is the care and skill commonly possessed and exercised by
similar specialists under similar circumstances. The specialty standard of care may be
higher than that required of the general practitioner. 

The standard of care is an objective standard by which the conduct of a physician sued
for negligence or malpractice may be measured, and it does not depend, therefore, on
any individual physician's own knowledge either. In attempting to fix a standard by which
a court may determine whether the physician has properly performed the requisite duty
toward the patient, expert medical testimony from both plaintiff and defense experts is
required. The judge, as the trier of fact, ultimately determines the standard of care, after
listening to the testimony of all medical experts. 
Here, the Prosecution presented no witnesses with special medical qualifications in
anesthesia to provide guidance to the trial court on what standard of care was
applicable. It would consequently be truly difficult, if not impossible, to determine
whether the first three elements of a negligence and malpractice action were attendant.

Dr. Solidum was criminally charged for "failing to monitor and regulate properly the levels
of anesthesia administered to said Gerald Albert Gercayo and using 100% halothane
and other anesthetic medications."  However, the foregoing circumstances, taken
together, did not prove beyond reasonable doubt that Dr. Solidum had been recklessly
imprudent in administering the anesthetic agent to Gerald.