Cases in Legal Medicine

Republic of the Philippines
SUPREME COURT
Manila
EN BANC
G.R. No. 176389 January 18, 2011
ANTONIO LEJANO, Petitioner,
vs.
PEOPLE OF THE PHILIPPINES, Respondent.
x - - - - - - - - - - - - - - - - - - - - - - -x
G.R. No. 176864
PEOPLE OF THE PHILIPPINES, Appellee,

vs.
HUBERT JEFFREY P. WEBB, ANTONIO LEJANO, MICHAEL A. GATCHALIAN, HOSPICIO FERNANDEZ,
MIGUEL RODRIGUEZ, PETER ESTRADA and GERARDO BIONG, Appellants.
RESOLUTION
ABAD, J.:
On December 14, 2010 the Court reversed the judgment of the Court of Appeals (CA) and acquitted the accused
in this case, Hubert Jeffrey P. Webb, Antonio Lejano, Michael A. Gatchalian, Hospicio Fernandez, Miguel
Rodriguez, Peter Estrada, and Gerardo Biong of the charges against them on the ground of lack of proof of their
guilt beyond reasonable doubt.
On December 28, 2010 complainant Lauro G. Vizconde, an immediate relative of the victims, asked the Court to
reconsider its decision, claiming that it "denied the prosecution due process of law; seriously misappreciated the
facts; unreasonably regarded Alfaro as lacking credibility; issued a tainted and erroneous decision; decided the
case in a manner that resulted in the miscarriage of justice; or committed grave abuse in its treatment of the
evidence and prosecution witnesses."1
But, as a rule, a judgment of acquittal cannot be reconsidered because it places the accused under double
jeopardy. The Constitution provides in Section 21, Article III, that:
Section 21. No person shall be twice put in jeopardy of punishment for the same offense. x x x
To reconsider a judgment of acquittal places the accused twice in jeopardy of being punished for the crime of
which he has already been absolved. There is reason for this provision of the Constitution. In criminal cases, the
full power of the State is ranged against the accused. If there is no limit to attempts to prosecute the accused for
the same offense after he has been acquitted, the infinite power and capacity of the State for a sustained and
repeated litigation would eventually overwhelm the accused in terms of resources, stamina, and the will to fight.
As the Court said in People of the Philippines v. Sandiganbayan: 2
[A]t the heart of this policy is the concern that permitting the sovereign freely to subject the citizen to a second
judgment for the same offense would arm the government with a potent instrument of oppression. The provision
therefore guarantees that the State shall not be permitted to make repeated attempts to convict an individual for
an alleged offense, thereby subjecting him to embarrassment, expense, and ordeal and compelling him to live in
a continuing state of anxiety and insecurity, as well as enhancing the possibility that even though innocent he
may be found guilty. Society’s awareness of the heavy personal strain which a criminal trial represents for the
individual defendant is manifested in the willingness to limit the government to a single criminal proceeding to
vindicate its very vital interest in the enforcement of criminal laws.3
1
Of course, on occasions, a motion for reconsideration after an acquittal is possible. But the grounds are
exceptional and narrow as when the court that absolved the accused gravely abused its discretion, resulting in
loss of jurisdiction, or when a mistrial has occurred. In any of such cases, the State may assail the decision by
special civil action of certiorari under Rule 65.4
Here, although complainant Vizconde invoked the exceptions, he has been unable to bring his pleas for
reconsideration under such exceptions. For instance, he avers that the Court "must ensure that due process is
afforded to all parties and there is no grave abuse of discretion in the treatment of witnesses and the
evidence."5 But he has not specified the violations of due process or acts constituting grave abuse of discretion
that the Court supposedly committed. His claim that "the highly questionable and suspicious evidence for the
defense taints with serious doubts the validity of the decision" 6 is, without more, a mere conclusion drawn from
personal perception.
Complainant Vizconde cites the decision in Galman v. Sandiganbayan 7 as authority that the Court can set aside
the acquittal of the accused in the present case. But the government proved in Galman that the prosecution was
deprived of due process since the judgment of acquittal in that case was "dictated, coerced and scripted." 8 It was
a sham trial. Here, however, Vizconde does not allege that the Court held a sham review of the decision of the
CA. He has made out no case that the Court held a phony deliberation in this case such that the seven Justices
who voted to acquit the accused, the four who dissented, and the four who inhibited themselves did not really go
through the process.
Ultimately, what the complainant actually questions is the Court’s appreciation of the evidence and assessment
of the prosecution witnesses’ credibility. He ascribes grave error on the Court’s finding that Alfaro was not a
credible witness and assails the value assigned by the Court to the evidence of the defense. In other words,
private complainant wants the Court to review the evidence anew and render another judgment based on such a
re-evaluation. This is not constitutionally allowed as it is merely a repeated attempt to secure Webb, et al’s
conviction. The judgment acquitting Webb, et al is final and can no longer be disturbed.
WHEREFORE, the Court DENIES for lack of merit complainant Lauro G. Vizconde’s motion for reconsideration
dated December 28, 2010.
For essentially the same reason, the Court DENIES the motions for leave to intervene of Fr. Robert P. Reyes,
Sister Mary John R. Mananzan, Bishop Evangelio L. Mercado, and Dante L.A. Jimenez, representing the
Volunteers Against Crime and Corruption and of former Vice President Teofisto Guingona, Jr.
No further pleadings shall be entertained in this case.
SO ORDERED.
ROBERTO A. ABAD
Associate Justice
WE CONCUR:
I vote to grant the M.R.

RENATO C. CORONA
Chief Justice
No part, prior inhibition

CONCHITA CARPIO MORALES
ANTONIO T. CARPIO
Associate Justice
Associate Justice
No part due to relastionship to a party No part; filed pleading as Sol Gen

PRESBITERO J. VELASCO, JR. ANTONIO EDUARDO B. NACHURA
Associate Justice Associate Justice
I vote to grant the motion for reconsideration Same vote as J. Villarama
2
TERESITA J. LEONARDO-DE CASTRO ARTURO D. BRION
DIOSDADO M. PERALTA LUCAS P. BERSAMIN

No part I vote to grant the motion for reconsideration

MARIANO C. DEL CASTILLO MARTIN S. VILLARAMA, JR.
JOSE PORTUGAL PEREZ JOSE CATRAL MENDOZA

See concurring Opinion

MARIA LOURDES P. A. SERENO
Associate Justice
CERTIFICATION
Pursuant to Section 13, Article VIII of the Constitution, it is hereby certified that the conclusions in the above
Resolution had been reached in consultation before the case was assigned to the writer of the opinion of the
Court.
RENATO C. CORONA
Chief Justice
Footnotes
1
Private Complainant’s Motion for Reconsideration, p. 8.
2
G.R. Nos. 168188-89, June 16, 2006, 491 SCRA 185.
3
Id. at 207.
4
Castro v. People, G.R. No. 180832, July 23, 2008, 559 SCRA 676, 683-684.
5
Supra note 1, at 7.
6
Id. at 12.
7
228 Phil. 42 (1986).
8
Id. at 89.
The Lawphil Project - Arellano Law Foundation
CONCURRING OPINION
SERENO, J.:
3
The Motion for Reconsideration assails the majority for failing to uphold the trial court’s conclusions. The simple
fact is that the evidence tends to demonstrate that Hubert Webb is innocent. The simple fact also is that the
evidence demonstrates that not only had Jessica Alfaro failed to substantiate her testimony, she had
contradicted herself and had been contradicted by other more believable evidence. The other main prosecution
witnesses fare no better. This is the gist of the Decision sought to be reconsidered. While this Court does not
make a dispositive ruling other than a pronouncement of "guilt" or "non-guilt" on the part of the accused, the
legal presumption of innocence must be applied in operative fact. It is unfortunate that statements were made
that sought to dilute the legal import of the majority Decision. A pronouncement of this Court that the accused
has not been proven to be guilty beyond reasonable doubt cannot be twisted to mean that this Court does not
believe in the innocence of the accused when the reasoning of the Court demonstrates such belief. A careful
reading of the majority Decision, as well as the concurring opinions, is required to determine whether the
accused were acquitted solely because there was lingering doubt as to their guilt of the crime charged or
whether the accused were acquitted not only because of doubt as to their guilt but also because the evidence
tends to establish their innocence. In the case of Hubert Webb, the evidence tends to establish his innocence.
On the other hand, the testimony of Jessica Alfaro was wholly rejected by the majority as not believable.
In his Motion for Reconsideration, private complainant asserts that this Court should have respected the trial
court’s resolve to give full credence to the testimony of Jessica Alfaro. While as a general rule, a trial judge’s
findings as to the credibility of a witness are entitled to utmost respect as he has had the opportunity to observe
their demeanor on the witness stand, this holds true only in the absence of bias, partiality, and grave abuse of
discretion on the part of the judge.1 The succeeding discussion demonstrates why this Court has no choice but
to reject the trial court’s findings.
The mistaken impression that Alfaro was a credible witness was, in significant measure, perpetrated by the trial
court’s inappropriate and mismatched attribution of rights to and duties of the accused vis-a-vis the principal
witness in a criminal proceeding. As discussed in the promulgated Decision of the Court in this case, the trial
court failed to recognize the accused’s right to be presumed innocent. Instead, the trial court’s Decision indicated
a preconceived belief in the accused’s guilt, and as a corollary, that witness Alfaro was telling the truth when she
testified to the accused’s guilt. In excessively protecting Alfaro, the trial court improperly ascribed to her the right
reserved for an accused. It also unreasonably imposed severe limitations on the extent of the right of the
defense to cross-examine her.
During Alfaro’s cross examination, the defense counsel tried to impeach her credibility by asking her about her
28 April 1995 Affidavit, which markedly differs from her 22 May 1995 Affidavit. The prosecution objected and
moved that the questions be expunged from the records on the basis of the inadmissibility of the evidence
obtained allegedly without the assistance of counsel, pursuant to Article III Section 12(1) and (3) of the 1987
Constitution.2 This constitutional right, however, is a right reserved solely for the accused or a "person under
investigation for the commission of an offense." The prosecution’s objection had no legal basis because Alfaro
was clearly not the accused in the case. Alfaro was a witness who had a legal duty to "answer questions,
although his (her) answer may tend to establish a claim against him (her)." 3 Notwithstanding this, the lower court
sustained the prosecution’s objection.
The law does not confer any favorable presumption on behalf of a witness. It is precisely due to the absence of
any legal presumption that the witness is telling the truth that he/she is subjected to cross-examination to "test
his accuracy and truthfulness and freedom from interest or bias, or the reverse, and to elicit all important facts
bearing upon the issue."4 The Rules provide that "the witness may be cross-examined by the adverse party as to
any matters stated in the direct examination, or connected therewith, with sufficient fullness and freedom."5] A
witness may be impeached "by contradictory evidence, by evidence that his general reputation for truth, honesty,
or integrity is bad, or by evidence that he has made at other times statements inconsistent with his present
testimony."6
The right to cross-examine a witness is a matter of procedural due process such that the testimony or deposition
of a witness given in a former case "involving the same parties and subject matter, may be given in evidence
against the adverse party" provided the adverse party "had the opportunity to cross-examine him." 7
Notwithstanding the right of the accused to fully and freely conduct a thorough cross examination, the trial court
set undue restrictions on the defense counsel’s cross examination of Alfaro, effectively denying the accused
such right. The length of the cross-examination is not as material in the determination of the credibility of the
witness as much as whether such witness was fully tested by the defense when demanded to be tested on
4
cross-examination – for honesty by contradictory evidence of a reputation for dishonesty, for inconsistency, or
for possible bias or improper motive.
To establish Alfaro’s bias and motive for testifying in the case, the defense counsel sought to ask Alfaro about
her brother, Patrick. Alfaro admitted that Patrick was a drug addict and had been arrested once by the NBI for
illegal possession of drugs, but that he was presently in the United States. The theory of the defense was that
Patrick’s liberty was part of a deal that Alfaro had struck with the NBI in exchange for her services. When
defense counsel inquired about the circumstances of Patrick’s departure for the United States, the prosecution
objected to the questions on the ground of irrelevance. Respondent judge sustained the objection, thus
foreclosing a significant avenue for testing Alfaro’s "freedom from interest or bias."
The defense counsel tried to cross-examine Alfaro regarding her educational attainment as stated in her sworn
statements. The defense presented her college transcript of records to prove that she only enrolled for a year
and earned nine (9) academic units, contrary to her claim that she finished second year college. Notably, Alfaro
misrepresented her educational attainment in both of her affidavits – her 28 April 1995 Affidavit which she
claimed was executed without assistance of counsel, and her subsequent 22 May 1995 Affidavit which was
admittedly executed with the assistance of counsel. Apparently, Alfaro’s lie under oath about her educational
attainment persisted even after being given counsel’s assistance in the execution of the second affidavit, as well
as more time to contemplate the matter. Unfortunately, the lower court sustained the prosecution’s objection to
the question on the ground of irrelevance when the line of testing could have tested Alfaro's penchant for
"accuracy and truthfulness."
Ironically, notwithstanding the trial court’s disallowance of the defense’s attempts to impeach Alfaro's character,
and the rule that "(e)vidence of the good character of a witness is not admissible until such character has been
impeached,"8 the trial court allowed the prosecution to present Atty. Pedro Rivera 9 to testify positively on Alfaro’s
character. Worse yet, the trial court disallowed the defense from presenting Atty. Rivera’s earlier statement to
impeach the latter’s credibility; again, this was disallowed on the ground of immateriality. When a proffer of
evidence10 was made by the defense following such disallowance, the trial court struck the proffer from the
record on the ground that it was allegedly improper on cross-examination.
The notion that witness Alfaro was able to withstand her cross examination appears sustainable in large part
because her cross examination was so emasculated by the trial court’s inordinate protection of her, which went
so far as to improperly accord her the right reserved for an accused. Taken together with repeated instances of
unwarranted exertion of effort to wipe the record clean of some entries that cast doubt on Alfaro’s credibility, the
trial court’s actions show that it had a bias towards upholding the truthfulness of Alfaro’s testimony.
The trial court’s treatment of documentary evidence also suffered from mismatched ascription – discarding legal
presumptions without evidence to the contrary while giving evidentiary weight to unsubstantiated speculation.
For instance, in rejecting Webb’s alibi defense, the trial court used mere speculation that the accused’s family
influenced the production of false entries in official documents to defeat the legal presumption of said
documents’ accuracy and regularity of issuance. Notably, the United States Immigration and Naturalization
Service (US INS) Certification, which confirmed that Webb was in the United States from March 1991 until
October 1992, was authenticated by no less than the Office of the U.S. Attorney General and the U.S. State
Department. Furthermore, this official certification of a sovereign state. having passed through formal diplomatic
channels, was authenticated by the Department of Foreign Affairs. As discussed in the main decision, such
official documents as the authenticated U.S. INS Certification enjoy the presumption of accuracy of the entries
therein.11 Official documents are not infallible, but the presumption that they are accurate can only be overcome
with evidence. Unfortunately, in the mind of the trial court, pure conjecture and not hard evidence was allowed to
defeat a legal presumption.
Clearly, the trial court’s decision in this case was, in significant measure, the product of switched attributions as
to who should enjoy certain rights and what should be presumed under the law. This behavior on the part of the
trial court and the effect it had on the factual conclusions on the credibility of Jessica Alfaro and on the presence
of Hubert Webb in the Philippines at the time of the commission of the crime cannot be upheld.
MARIA LOURDES P. A. SERENO

Associate Justice
5
Footnotes
1
People v. Dizon, G.R. Nos. 126044-45, 2 July 1999, 309 SCRA 669.
2
"SEC. 12. (1) Any person under investigation for the commission of an offense shall have the right to be
informed of his right to remain silent and to have competent and independent counsel preferably of his
own choice. If the person cannot afford the services of counsel, he must be provided with one. These
rights cannot be waived except in writing and in the presence of counsel.
x x x x x x x x x
"(3) Any confession or admission obtained in violation of this or the preceding section shall be
inadmissible in evidence against him."
3
Rules of Court, Rule 132. Section 3.
4
Rules of Court, Rule 132, Section 6.
5
6
7
8
9
Notably, in the Motion for Reconsideration in Intervention filed by the Volunteers Against Crime and
Corruption (VACC), Fr. Roberto Reyes, Sister Mary John Mananzan and Bishop Evangelio Mercado,
they attach a copy of Atty. Pedro Rivera's Affidavit to once again resuscitate Alfaro's credibility.
Rules of Court, Rule 132, Section 40 provides that "(i)f documents or things offered in evidence are
10
excluded by the court, the offeror may have the same attached to or made part of the record. If the
evidence excluded is oral, the offeror may state for the record the same and other personal
circumstances of the witness and the substance of the proposed testimony."
11
Citing Antillon v. Barcelona, 37 Phil. 148 (1917).
G.R. No. 159132 December 18, 2008
FE CAYAO-LASAM, petitioner,
vs.
SPOUSES CLARO and EDITHA RAMOLETE, respondents.*
DECISION
AUSTRIA-MARTINEZ, J.:
Before the Court is a Petition for Review on Certiorari under Rule 45 of the Rules of Court filed by Dr. Fe Cayao-
Lasam (petitioner) seeking to annul the Decision1 dated July 4, 2003 of the Court of Appeals (CA) in CA-G.R. SP
No. 62206.
The antecedent facts:
6
On July 28, 1994, respondent, three months pregnant Editha Ramolete (Editha) was brought to the Lorma
Medical Center (LMC) in San Fernando, La Union due to vaginal bleeding. Upon advice of petitioner
relayed via telephone, Editha was admitted to the LMC on the same day. A pelvic sonogram 2 was then
conducted on Editha revealing the fetus’ weak cardiac pulsation. 3 The following day, Editha’s repeat pelvic
sonogram4 showed that aside from the fetus’ weak cardiac pulsation, no fetal movement was also appreciated.
Due to persistent and profuse vaginal bleeding, petitioner advised Editha to undergo a Dilatation and Curettage
Procedure (D&C) or "raspa."
On July 30, 1994, petitioner performed the D&C procedure. Editha was discharged from the hospital the
following day.
On September 16, 1994, Editha was once again brought at the LMC, as she was suffering from vomiting and
severe abdominal pains. Editha was attended by Dr. Beatriz de la Cruz, Dr. Victor B. Mayo and Dr. Juan V.
Komiya. Dr. Mayo allegedly informed Editha that there was a dead fetus in the latter’s womb. After, Editha
underwent laparotomy,5 she was found to have a massive intra-abdominal hemorrhage and a ruptured uterus.
Thus, Editha had to undergo a procedure for hysterectomy 6 and as a result, she has no more chance to bear a
child.
On November 7, 1994, Editha and her husband Claro Ramolete (respondents) filed a Complaint 7 for Gross
Negligence and Malpractice against petitioner before the Professional Regulations Commission (PRC).
Respondents alleged that Editha’s hysterectomy was caused by petitioner’s unmitigated negligence and
professional incompetence in conducting the D&C procedure and the petitioner’s failure to remove the fetus
inside Editha’s womb.8 Among the alleged acts of negligence were: first, petitioner’s failure to check up, visit or
administer medication on Editha during her first day of confinement at the LMC; 9 second, petitioner
recommended that a D&C procedure be performed on Editha without conducting any internal examination prior
to the procedure;10 third, petitioner immediately suggested a D&C procedure instead of closely monitoring the
state of pregnancy of Editha.11
In her Answer,12 petitioner denied the allegations of negligence and incompetence with the following
explanations: upon Editha’s confirmation that she would seek admission at the LMC, petitioner immediately
called the hospital to anticipate the arrival of Editha and ordered through the telephone the medicines Editha
needed to take, which the nurses carried out; petitioner visited Editha on the morning of July 28, 1994 during her
rounds; on July 29, 1994, she performed an internal examination on Editha and she discovered that the latter’s
cervix was already open, thus, petitioner discussed the possible D&C procedure, should the bleeding become
more profuse; on July 30 1994, she conducted another internal examination on Editha, which revealed that the
latter’s cervix was still open; Editha persistently complained of her vaginal bleeding and her passing out of some
meaty mass in the process of urination and bowel movement; thus, petitioner advised Editha to undergo D&C
procedure which the respondents consented to; petitioner was very vocal in the operating room about not being
able to see an abortus;13 taking the words of Editha to mean that she was passing out some meaty mass and
clotted blood, she assumed that the abortus must have been expelled in the process of bleeding; it was Editha
who insisted that she wanted to be discharged; petitioner agreed, but she advised Editha to return for check-up
on August 5, 1994, which the latter failed to do.
Petitioner contended that it was Editha’s gross negligence and/or omission in insisting to be discharged on July
31, 1994 against doctor’s advice and her unjustified failure to return for check-up as directed by petitioner that
contributed to her life-threatening condition on September 16, 1994; that Editha’s hysterectomy was brought
about by her very abnormal pregnancy known as placenta increta, which was an extremely rare and very
unusual case of abdominal placental implantation. Petitioner argued that whether or not a D&C procedure was
done by her or any other doctor, there would be no difference at all because at any stage of gestation before
term, the uterus would rupture just the same.
On March 4, 1999, the Board of Medicine (the Board) of the PRC rendered a Decision, 14 exonerating petitioner
from the charges filed against her. The Board held:
Based on the findings of the doctors who conducted the laparotomy on Editha, hers is a case of Ectopic
Pregnancy Interstitial. This type of ectopic pregnancy is one that is being protected by the uterine
muscles and manifestations may take later than four (4) months and only attributes to two percent (2%)
of ectopic pregnancy cases.
7
When complainant Editha was admitted at Lorma Medical Center on July 28, 1994 due to vaginal
bleeding, an ultra-sound was performed upon her and the result of the Sonogram Test reveals a morbid
fetus but did not specify where the fetus was located. Obstetricians will assume that the pregnancy is
within the uterus unless so specified by the Sonologist who conducted the ultra-sound. Respondent (Dr.
Lasam) cannot be faulted if she was not able to determine that complainant Editha is having an ectopic
pregnancy interstitial. The D&C conducted on Editha is necessary considering that her cervix is already
open and so as to stop the profuse bleeding. Simple curettage cannot remove a fetus if the patient is
having an ectopic pregnancy, since ectopic pregnancy is pregnancy conceived outside the uterus and
curettage is done only within the uterus. Therefore, a more extensive operation needed in this case of
pregnancy in order to remove the fetus.15
Feeling aggrieved, respondents went to the PRC on appeal. On November 22, 2000, the PRC rendered a
Decision16 reversing the findings of the Board and revoking petitioner’s authority or license to practice her
profession as a physician.17
Petitioner brought the matter to the CA in a Petition for Review under Rule 43 of the Rules of Court. Petitioner
also dubbed her petition as one for certiorari18 under Rule 65 of the Rules of Court.
In the Decision dated July 4, 2003, the CA held that the Petition for Review under Rule 43 of the Rules of Court
was an improper remedy, as the enumeration of the quasi-judicial agencies in Rule 43 is exclusive.19 PRC is not
among the quasi-judicial bodies whose judgment or final orders are subject of a petition for review to the CA,
thus, the petition for review of the PRC Decision, filed at the CA, was improper. The CA further held that should
the petition be treated as a petition for certiorari under Rule 65, the same would still be dismissed for being
improper and premature. Citing Section 2620 of Republic Act (R.A.) No. 2382 or the Medical Act of 1959, the CA
held that the plain, speedy and adequate remedy under the ordinary course of law which petitioner should have
availed herself of was to appeal to the Office of the President. 21
Hence, herein petition, assailing the decision of the CA on the following grounds:
1. THE COURT OF APPEALS ERRED ON A QUESTION OF LAW IN HOLDING THAT THE

PROFESSIONAL REGULATION[S] COMMISSION (PRC) WAS EXCLUDED AMONG THE QUASI-
JUDICIAL AGENCIES CONTEMPLATED UNDER RULE 43 OF THE RULES OF CIVIL PROCEDURE;
2. EVEN ASSUMING, ARGUENDO, THAT PRC WAS EXCLUDED FROM THE PURVIEW OF RULE 43

OF THE RULES OF CIVIL PROCEDURE, THE PETITIONER WAS NOT PRECLUDED FROM FILING A
PETITION FOR CERTIORARI WHERE THE DECISION WAS ALSO ISSUED IN EXCESS OF OR
WITHOUT JURISDICTION, OR WHERE THE DECISION WAS A PATENT NULLITY;
3. HEREIN RESPONDENTS-SPOUSES ARE NOT ALLOWED BY LAW TO APPEAL FROM THE

DECISION OF THE BOARD OF MEDICINE TO THE PROFESSIONAL REGULATION[S]
COMMISSION;
4. THE COURT OF APPEALS COMMITTED GRAVE ABUSE OF DISCRETION IN DENYING FOR

IMPROPER FORUM THE PETITION FOR REVIEW/PETITION FOR CERTIORARI WITHOUT GOING
OVER THE MERITS OF THE GROUNDS RELIED UPON BY THE PETITIONER;
5. PRC’S GRAVE OMISSION TO AFFORD HEREIN PETITONER A CHANCE TO BE HEARD ON

APPEAL IS A CLEAR VIOLATION OF HER CONSTITUTIONAL RIGHT TO DUE PROCESS AND HAS
THE EFFECT OF RENDERING THE JUDGMENT NULL AND VOID;
6. COROLLARY TO THE FOURTH ASSIGNED ERROR, PRC COMMITTED GRAVE ABUSE OF

DISCRETION, AMOUNTING TO LACK OF JURISDICTION, IN ACCEPTING AND CONSIDERING THE
MEMORANDUM ON APPEAL WITHOUT PROOF OF SERVICE TO HEREIN PETITIONER, AND IN
VIOLATION OF ART. IV, SEC. 35 OF THE RULES AND REGULATIONS GOVERNING THE
REGULATION AND PRACTICE OF PROFESSIONALS;
7. PRC COMMITTED GRAVE ABUSE OF DISCRETION IN REVOKING PETITIONER’S LICENSE TO

PRACTICE MEDICINE WITHOUT AN EXPERT TESTIMONY TO SUPPORT ITS CONCLUSION AS TO
THE CAUSE OF RESPONDENT EDITHAT [SIC] RAMOLETE’S INJURY;
8
8. PRC COMMITTED AN EVEN GRAVER ABUSE OF DISCRETION IN TOTALLY DISREGARDING
THE FINDING OF THE BOARD OF MEDICINE, WHICH HAD THE NECESSARY COMPETENCE AND
EXPERTISE TO ESTABLISH THE CAUSE OF RESPONDENT EDITHA’S INJURY, AS WELL AS THE
TESTIMONY OF THE EXPERT WITNESS AUGUSTO MANALO, M.D. ;[and]
9. PRC COMMITTED GRAVE ABUSE OF DISCRETION IN MAKING CONCLUSIONS OF FACTS THAT

WERE NOT ONLY UNSUPPORTED BY EVIDENCE BUT WERE ACTUALLY CONTRARY TO
EVIDENCE ON RECORD.22
The Court will first deal with the procedural issues.
Petitioner claims that the law does not allow complainants to appeal to the PRC from the decision of the Board.
She invokes Article IV, Section 35 of the Rules and Regulations Governing the Regulation and Practice of
Professionals, which provides:
Sec. 35. The respondent may appeal the decision of the Board within thirty days from receipt thereof to
the Commission whose decision shall be final. Complainant, when allowed by law, may interpose an
appeal from the Decision of the Board within the same period. (Emphasis supplied)
Petitioner asserts that a careful reading of the above law indicates that while the respondent, as a matter of right,
may appeal the Decision of the Board to the Commission, the complainant may interpose an appeal from the
decision of the Board only when so allowed by law.23 Petitioner cited Section 26 of Republic Act No. 2382 or
"The Medical Act of 1959," to wit:
Section 26. Appeal from judgment. The decision of the Board of Medical Examiners (now Medical Board)
shall automatically become final thirty days after the date of its promulgation unless the respondent,
during the same period, has appealed to the Commissioner of Civil Service (now Professional
Regulations Commission) and later to the Office of the President of the Philippines. If the final decision is
not satisfactory, the respondent may ask for a review of the case, or may file in court a petition for
certiorari.
Petitioner posits that the reason why the Medical Act of 1959 allows only the respondent in an administrative
case to file an appeal with the Commission while the complainant is not allowed to do so is double jeopardy.
Petitioner is of the belief that the revocation of license to practice a profession is penal in nature. 24
The Court does not agree.
For one, the principle of double jeopardy finds no application in administrative cases. Double jeopardy attaches
only: (1) upon a valid indictment; (2) before a competent court; (3) after arraignment; (4) when a valid plea has
been entered; and (5) when the defendant was acquitted or convicted, or the case was dismissed or otherwise
terminated without the express consent of the accused. 25 These elements were not present in the proceedings
before the Board of Medicine, as the proceedings involved in the instant case were administrative and not
criminal in nature. The Court has already held that double jeopardy does not lie in administrative cases. 26
Moreover, Section 35 of the Rules and Regulations Governing the Regulation and Practice of Professionals
cited by petitioner was subsequently amended to read:
Sec. 35. The complainant/respondent may appeal the order, the resolution or the decision of the Board
within thirty (30) days from receipt thereof to the Commission whose decision shall be final and
executory. Interlocutory order shall not be appealable to the Commission. (Amended by Res. 174, Series
of 1990).27 (Emphasis supplied)
Whatever doubt was created by the previous provision was settled with said amendment. It is axiomatic that the
right to appeal is not a natural right or a part of due process, but a mere statutory privilege that may be exercised
only in the manner prescribed by law.28 In this case, the clear intent of the amendment is to render the right to
appeal from a decision of the Board available to both complainants and respondents.
9
Such conclusion is bolstered by the fact that in 2006, the PRC issued Resolution No. 06-342(A), or the New
Rules of Procedure in Administrative Investigations in the Professional Regulations Commission and the
Professional Regulatory Boards, which provides for the method of appeal, to wit:
Sec. 1. Appeal; Period Non-Extendible.- The decision, order or resolution of the Board shall be final
and executory after the lapse of fifteen (15) days from receipt of the decision, order or resolution without
an appeal being perfected or taken by either the respondent or the complainant. A party aggrieved by
the decision, order or resolution may file a notice of appeal from the decision, order or resolution
of the Board to the Commission within fifteen (15) days from receipt thereof, and serving upon the
adverse party a notice of appeal together with the appellant’s brief or memorandum on appeal, and
paying the appeal and legal research fees. x x x29
The above-stated provision does not qualify whether only the complainant or respondent may file an appeal;
rather, the new rules provide that "a party aggrieved" may file a notice of appeal. Thus, either the complainant or
the respondent who has been aggrieved by the decision, order or resolution of the Board may appeal to the
Commission. It is an elementary rule that when the law speaks in clear and categorical language, there is no
need, in the absence of legislative intent to the contrary, for any interpretation. 30 Words and phrases used in the
statute should be given their plain, ordinary, and common usage or meaning. 31
Petitioner also submits that appeals from the decisions of the PRC should be with the CA, as Rule 43 32 of the
Rules of Court was precisely formulated and adopted to provide for a uniform rule of appellate procedure for
quasi-judicial agencies.33 Petitioner further contends that a quasi-judicial body is not excluded from the purview
of Rule 43 just because it is not mentioned therein. 34
On this point, the Court agrees with the petitioner.
Sec. 1, Rule 43 of the Rules of Court provides:
Section 1. Scope. - This Rule shall apply to appeals from judgments or final orders of the Court of Tax
Appeals, and from awards, judgments, final orders or resolutions of or authorized by any quasi-
judicial agency in the exercise of its quasi-judicial functions. Among these agencies are the Civil
Service Commission, Central Board of Assessment Appeals, Securities and Exchange Commission,
Office of the President, Land Registration Authority, Social Security Commission, Civil Aeronautics
Board, Bureau of Patents, Trademarks and Technology Transfer, National Electrification Administration,
Energy Regulatory Board, National Telecommunications Commission, Department of Agrarian Reform
under Republic Act No. 6657, Government Service Insurance System, Employees Compensation
Commission, Agricultural Inventions Board, Insurance Commission, Philippine Atomic Energy
Commission, Board of Investments, Construction Industry Arbitration Commission, and voluntary
arbitrators authorized by law. (Emphasis supplied)
Indeed, the PRC is not expressly mentioned as one of the agencies which are expressly enumerated under
Section 1, Rule 43 of the Rules of Court. However, its absence from the enumeration does not, by this fact
alone, imply its exclusion from the coverage of said Rule. 35 The Rule expressly provides that it should be applied
to appeals from awards, judgments final orders or resolutions of any quasi-judicial agency in the exercise of its
quasi-judicial functions. The phrase "among these agencies" confirms that the enumeration made in the Rule is
not exclusive to the agencies therein listed. 36
Specifically, the Court, in Yang v. Court of Appeals,37 ruled that Batas Pambansa (B.P.) Blg. 12938 conferred

upon the CA exclusive appellate jurisdiction over appeals from decisions of the PRC. The Court held:
The law has since been changed, however, at least in the matter of the particular court to which appeals
from the Commission should be taken. On August 14, 1981, Batas Pambansa Bilang 129 became
effective and in its Section 29, conferred on the Court of Appeals "exclusive appellate jurisdiction over all
final judgments, decisions, resolutions, orders or awards of Regional Trial Courts and quasi-judicial
agencies, instrumentalities, boards or commissions except those falling under the appellate jurisdiction
of the Supreme Court. x x x." In virtue of BP 129, appeals from the Professional Regulations
Commission are now exclusively cognizable by the Court of Appeals.39 (Emphasis supplied)
10
Clearly, the enactment of B.P. Blg. 129, the precursor of the present Rules of Civil Procedure, 40 lodged with the
CA such jurisdiction over the appeals of decisions made by the PRC.
Anent the substantive merits of the case, petitioner questions the PRC decision for being without an expert
testimony to support its conclusion and to establish the cause of Editha’s injury. Petitioner avers that in cases of
medical malpractice, expert testimony is necessary to support the conclusion as to the cause of the injury. 41
Medical malpractice is a particular form of negligence which consists in the failure of a physician or surgeon to
apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession
generally, under similar conditions, and in like surrounding circumstances. 42 In order to successfully pursue such
a claim, a patient must prove that the physician or surgeon either failed to do something which a reasonably
prudent physician or surgeon would not have done, and that the failure or action caused injury to the patient. 43
There are four elements involved in medical negligence cases: duty, breach, injury and proximate causation. 44
A physician-patient relationship was created when Editha employed the services of the petitioner. As Editha’s
physician, petitioner was duty-bound to use at least the same level of care that any reasonably competent doctor
would use to treat a condition under the same circumstances. 45 The breach of these professional duties of skill
and care, or their improper performance by a physician surgeon, whereby the patient is injured in body or in
health, constitutes actionable malpractice.46 As to this aspect of medical malpractice, the determination of the
reasonable level of care and the breach thereof, expert testimony is essential. 47 Further, inasmuch as the causes
of the injuries involved in malpractice actions are determinable only in the light of scientific knowledge, it has
been recognized that expert testimony is usually necessary to support the conclusion as to causation. 48
In the present case, respondents did not present any expert testimony to support their claim that petitioner failed
to do something which a reasonably prudent physician or surgeon would have done.
Petitioner, on the other hand, presented the testimony of Dr. Augusto M. Manalo, who was clearly an expert on
the subject.
Generally, to qualify as an expert witness, one must have acquired special knowledge of the subject matter
about which he or she is to testify, either by the study of recognized authorities on the subject or by practical
experience.49
Dr. Manalo specializes in gynecology and obstetrics, authored and co-authored various publications on the
subject, and is a professor at the University of the Philippines. 50 According to him, his diagnosis of Editha’s case
was "Ectopic Pregnancy Interstitial (also referred to as Cornual), Ruptured." 51 In stating that the D&C procedure
was not the proximate cause of the rupture of Editha’s uterus resulting in her hysterectomy, Dr. Manalo testified
as follows:
Atty. Hidalgo:
Q: Doctor, we want to be clarified on this matter. The complainant had testified here that the D&C was
the proximate cause of the rupture of the uterus. The condition which she found herself in on the second
admission. Will you please tell us whether that is true or not?
A: Yah, I do not think so for two reasons. One, as I have said earlier, the instrument cannot reach
the site of the pregnancy, for it to further push the pregnancy outside the uterus. And, No. 2, I was
thinking a while ago about another reason- well, why I don’t think so, because it is the triggering factor
for the rupture, it could have–the rupture could have occurred much earlier, right after the D&C or a few
days after the D&C.
Q: In this particular case, doctor, the rupture occurred to have happened minutes prior to the
hysterectomy or right upon admission on September 15, 1994 which is about 1 ½ months after the
patient was discharged, after the D&C was conducted. Would you tell us whether there is any relation at
all of the D&C and the rupture in this particular instance?
11
A: I don’t think so for the two reasons that I have just mentioned- that it would not be possible
for the instrument to reach the site of pregnancy. And, No. 2, if it is because of the D&C that rupture
could have occurred earlier.52 (Emphases supplied)
Clearly, from the testimony of the expert witness and the reasons given by him, it is evident that the D&C
procedure was not the proximate cause of the rupture of Editha’s uterus.
During his cross-examination, Dr. Manalo testified on how he would have addressed Editha’s condition should
he be placed in a similar circumstance as the petitioner. He stated:
Atty. Ragonton:
Q: Doctor, as a practicing OB-Gyne, when do you consider that you have done a good, correct and
ideal dilatation and curettage procedure?
A: Well, if the patient recovers. If the patient gets well. Because even after the procedure, even after
the procedure you may feel that you have scraped everything, the patient stops bleeding, she feels well,
I think you should still have some reservations, and wait a little more time.
Q: If you were the OB-Gyne who performed the procedure on patient Editha Ramolete, would it be
your standard practice to check the fetal parts or fetal tissues that were allegedly removed?
A: From what I have removed, yes. But in this particular case, I think it was assumed that it was part of
the meaty mass which was expelled at the time she was urinating and flushed in the toilet. So there’s no
way.
Q: There was [sic] some portions of the fetal parts that were removed?
A: No, it was described as scanty scraping if I remember it right–scanty.
Q: And you would not mind checking those scant or those little parts that were removed?
A: Well, the fact that it was described means, I assume that it was checked, ‘no. It was described
as scanty and the color also, I think was described. Because it would be very unusual, even
improbable that it would not be examined, because when you scrape, the specimens are right
there before your eyes. It’s in front of you. You can touch it. In fact, some of them will stick to the
instrument and therefore to peel it off from the instrument, you have to touch them. So,
automatically they are examined closely.
Q: As a matter of fact, doctor, you also give telephone orders to your patients through telephone?
A: Yes, yes, we do that, especially here in Manila because you know, sometimes a doctor can also be
tied-up somewhere and if you have to wait until he arrive at a certain place before you give the order,
then it would be a lot of time wasted. Because if you know your patient, if you have handled your patient,
some of the symptoms you can interpret that comes with practice. And, I see no reason for not
allowing telephone orders unless it is the first time that you will be encountering the patient. That
you have no idea what the problem is.
Q: But, doctor, do you discharge patients without seeing them?
A: Sometimes yes, depending on how familiar I am with the patient. We are on the question of
telephone orders. I am not saying that that is the idle [sic] thing to do, but I think the reality of present
day practice somehow justifies telephone orders. I have patients whom I have justified and then all
of a sudden, late in the afternoon or late in the evening, would suddenly call they have decided that they
will go home inasmuch as they anticipated that I will discharge them the following day. So, I just call and
ask our resident on duty or the nurse to allow them to go because I have seen that patient and I think I
have full grasp of her problems. So, that’s when I make this telephone orders. And, of course before
giving that order I ask about how she feels.53 (Emphases supplied)
12
From the foregoing testimony, it is clear that the D&C procedure was conducted in accordance with the standard
practice, with the same level of care that any reasonably competent doctor would use to treat a condition under
the same circumstances, and that there was nothing irregular in the way the petitioner dealt with Editha.
Medical malpractice, in our jurisdiction, is often brought as a civil action for damages under Article 2176 54 of the
Civil Code. The defenses in an action for damages, provided for under Article 2179 of the Civil Code are:
Art. 2179. When the plaintiff’s own negligence was the immediate and proximate cause of his
injury, he cannot recover damages. But if his negligence was only contributory, the immediate and
proximate cause of the injury being the defendant’s lack of due care, the plaintiff may recover damages,
but the courts shall mitigate the damages to be awarded.
Proximate cause has been defined as that which, in natural and continuous sequence, unbroken by any efficient
intervening cause, produces injury, and without which the result would not have occurred. 55 An injury or damage
is proximately caused by an act or a failure to act, whenever it appears from the evidence in the case that the act
or omission played a substantial part in bringing about or actually causing the injury or damage; and that the
injury or damage was either a direct result or a reasonably probable consequence of the act or omission. 56
In the present case, the Court notes the findings of the Board of Medicine:
When complainant was discharged on July 31, 1994, herein respondent advised her to return on
August 4, 1994 or four (4) days after the D&C. This advise was clear in complainant’s Discharge
Sheet. However, complainant failed to do so. This being the case, the chain of continuity as required
in order that the doctrine of proximate cause can be validly invoked was interrupted. Had she returned,
the respondent could have examined her thoroughly.57 x x x (Emphases supplied)
Also, in the testimony of Dr. Manalo, he stated further that assuming that there was in fact a misdiagnosis, the
same would have been rectified if Editha followed the petitioner’s order to return for a check-up on August 4,
1994. Dr. Manalo stated:
Granting that the obstetrician-gynecologist has been misled (justifiably) up to thus point that
there would have been ample opportunity to rectify the misdiagnosis, had the patient returned, as
instructed for her follow-up evaluation. It was one and a half months later that the patient sought
consultation with another doctor. The continued growth of an ectopic pregnancy, until its eventual
rupture, is a dynamic process. Much change in physical findings could be expected in 1 ½ months,
including the emergence of suggestive ones.58
It is undisputed that Editha did not return for a follow-up evaluation, in defiance of the petitioner’s advise. Editha
omitted the diligence required by the circumstances which could have avoided the injury. The omission in not
returning for a follow-up evaluation played a substantial part in bringing about Editha’s own injury. Had Editha
returned, petitioner could have conducted the proper medical tests and procedure necessary to determine
Editha’s health condition and applied the corresponding treatment which could have prevented the rupture of
Editha’s uterus. The D&C procedure having been conducted in accordance with the standard medical practice, it
is clear that Editha’s omission was the proximate cause of her own injury and not merely a contributory
negligence on her part.
Contributory negligence is the act or omission amounting to want of ordinary care on the part of the person
injured, which, concurring with the defendant’s negligence, is the proximate cause of the injury. 59 Difficulty seems
to be apprehended in deciding which acts of the injured party shall be considered immediate causes of the
accident.60 Where the immediate cause of an accident resulting in an injury is the plaintiff’s own act, which
contributed to the principal occurrence as one of its determining factors, he cannot recover damages for the
injury.61 Again, based on the evidence presented in the present case under review, in which no
negligence can be attributed to the petitioner, the immediate cause of the accident resulting in Editha’s
injury was her own omission when she did not return for a follow-up check up, in defiance of petitioner’s
orders. The immediate cause of Editha’s injury was her own act; thus, she cannot recover damages from
the injury.
Lastly, petitioner asserts that her right to due process was violated because she was never informed by either
respondents or by the PRC that an appeal was pending before the PRC. 62 Petitioner claims that a verification
13
with the records section of the PRC revealed that on April 15, 1999, respondents filed a Memorandum on Appeal
before the PRC, which did not attach the actual registry receipt but was merely indicated therein. 63
Respondents, on the other hand avers that if the original registry receipt was not attached to the Memorandum
on Appeal, PRC would not have entertained the appeal or accepted such pleading for lack of notice or proof of
service on the other party.64 Also, the registry receipt could not be appended to the copy furnished to petitioner’s
former counsel, because the registry receipt was already appended to the original copy of the Memorandum of
Appeal filed with PRC.65
It is a well-settled rule that when service of notice is an issue, the rule is that the person alleging that the notice
was served must prove the fact of service. The burden of proving notice rests upon the party asserting its
existence.66 In the present case, respondents did not present any proof that petitioner was served a copy of the
Memorandum on Appeal. Thus, respondents were not able to satisfy the burden of proving that they had in fact
informed the petitioner of the appeal proceedings before the PRC.
In EDI-Staffbuilders International, Inc. v. National Labor Relations Commission,67 in which the National Labor
Relations Commission failed to order the private respondent to furnish the petitioner a copy of the Appeal
Memorandum, the Court held that said failure deprived the petitioner of procedural due process guaranteed by
the Constitution, which could have served as basis for the nullification of the proceedings in the appeal. The
same holds true in the case at bar. The Court finds that the failure of the respondents to furnish the petitioner a
copy of the Memorandum of Appeal submitted to the PRC constitutes a violation of due process. Thus, the
proceedings before the PRC were null and void.
All told, doctors are protected by a special rule of law. They are not guarantors of care. They are not insurers
against mishaps or unusual consequences 68 specially so if the patient herself did not exercise the proper
diligence required to avoid the injury.
WHEREFORE, the petition is GRANTED. The assailed Decision of the Court of Appeals dated July 4, 2003 in
CA-GR SP No. 62206 is hereby REVERSED and SET ASIDE. The Decision of the Board of Medicine dated
March 4, 1999 exonerating petitioner is AFFIRMED. No pronouncement as to costs.
SO ORDERED.
Lasam vs. Sps. Ramolete G.R. No. 159132

December 8, 2008
Facts:
On July 1994, respondent three months pregnant Editha Ramolete was

brought to the Lorma Medical Center (LMC) to vaginal bleeding. A pelvic
sonogram was then conducted on Editha revealing the fetus weak cardiac
pulsation. Editha’s repeat pelvic sonogram showed that aside from the fetus
weak cardiac pulsation, no fetal movement was also appreciated. Due to
persistent and profuse vaginal bleeding, petitioner Dr. Fe Cayao-Lasam advised
Editha to undergo a Dilatation and Curettage Procedure (D&C) or raspa which
the petitioner performed.
14
On September 1994, Editha was brought again to LMC due to vomiting and
severe abdominal pains. One of the attending physician, Dr. Mayo allegedly
informed Editha that there was a dead fetus in her womb. Editha underwent
laparotomy where she was found to have a massive intra-abdominal
hemorrhage and a ruptured uterus. Editha had to undergo a procedure for
hysterectomy and as a result, she has no more chance to bear a child.
On November 1994, Editha and her husband Claro Ramolete filed a Complaint
for Gross Negligence and Malpractice against petitioner before the PRC.
Respondents alleged that Editha’s hysterectomy was caused by petitioners

unmitigated negligence and professional incompetence in conducting the
D&C procedure and the petitioners failure to remove the fetus inside Editha’s
womb. Petitioner denied the allegations of negligence and incompetence
On March 1999, Board of Medicine of the PRC exonerated petitioner from the
charges filed against her. Feeling aggrieved, respondents went to the PRC on
appeal. On November 2000, the PRC reversed the findings of the Board and
revoked petitioners authority or license to practice her profession as a
physician. Petitioner brought the matter to the CA but was dismissed on the
ground of being improper and premature.
Issue: WON there was medical malpractice in the case?
Held: There was no medical malpractice in the case.
Medical malpractice is a particular form of negligence which consists in the

failure of a physician or surgeon to apply to his practice of medicine that
degree of care and skill which is ordinarily employed by the profession
generally, under similar conditions, and in like surrounding circumstances. In
order to successfully pursue such a claim, a patient must prove that the
physician or surgeon either failed to do something which a reasonably prudent
physician or surgeon would not have done, and that the failure or action
caused injury to the patient.
15
There are four elements involved in medical negligence cases: duty, breach,
injury and proximate causation.
From the testimony of the expert witness and the reasons given by him, it is
evident that the D&C procedure was not the proximate cause of the rupture of
Editha’s uterus. Further in the testimony, it is clear that the D&C procedure was
conducted in accordance with the standard practice, with the same level of
care that any reasonably competent doctor would use to treat a condition
under the same circumstances, and that there was nothing irregular in the way
the petitioner dealt with Editha.
Medical malpractice is often brought as a civil action for damages under Article
2176 of the Civil Code. The defenses in an action for damages, provided for
under Article 2179 of the Civil Code are:
Art. 2179. When the plaintiffs own negligence was the immediate and
proximate cause of his injury, he cannot recover damages. But if his negligence
was only contributory, the immediate and proximate cause of the injury being
the defendants lack of due care, the plaintiff may recover damages, but the
courts shall mitigate the damages to be awarded.
It is also undisputed that Editha did not return for a follow-up evaluation, in
defiance of the petitioners advise. Editha omitted the diligence required by the
circumstances which could have avoided the injury. The omission in not
returning for a follow-up evaluation played a substantial part in bringing about
Editha’s own injury. Had Editha returned, petitioner could have conducted the
proper medical tests and procedure necessary to determine Editha’s health
condition and applied the corresponding treatment which could have
prevented the rupture of Editha’s uterus. The D&C procedure having been
conducted in accordance with the standard medical practice, it is clear that
Editha’s omission was the proximate cause of her own injury and not merely a
contributory negligence on her part.
G.R. No. 126297 January 31, 2007
16
PROFESSIONAL SERVICES, INC., Petitioner,
vs.
NATIVIDAD and ENRIQUE AGANA, Respondents.
x-----------------------x
G.R. No. 126467 January 31, 2007
NATIVIDAD (Substituted by her children MARCELINO AGANA III, ENRIQUE AGANA, JR., EMMA AGANA
ANDAYA, JESUS AGANA, and RAYMUND AGANA) and ENRIQUE AGANA, Petitioners,
vs.
JUAN FUENTES, Respondent.
x- - - - - - - - - - - - - - - - - - - -- - - - x
G.R. No. 127590 January 31, 2007
MIGUEL AMPIL, Petitioner,
vs.
NATIVIDAD AGANA and ENRIQUE AGANA, Respondents.
DECISION
SANDOVAL-GUTIERREZ, J.:
Hospitals, having undertaken one of mankind’s most important and delicate endeavors, must assume the grave
responsibility of pursuing it with appropriate care. The care and service dispensed through this high trust,
however technical, complex and esoteric its character may be, must meet standards of responsibility
commensurate with the undertaking to preserve and protect the health, and indeed, the very lives of those
placed in the hospital’s keeping.1
Assailed in these three consolidated petitions for review on certiorari is the Court of Appeals’ Decision 2 dated
September 6, 1996 in CA-G.R. CV No. 42062 and CA-G.R. SP No. 32198 affirming with modification the
Decision3 dated March 17, 1993 of the Regional Trial Court (RTC), Branch 96, Quezon City in Civil Case No. Q-
43322 and nullifying its Order dated September 21, 1993.
The facts, as culled from the records, are:
On April 4, 1984, Natividad Agana was rushed to the Medical City General Hospital (Medical City Hospital)
because of difficulty of bowel movement and bloody anal discharge. After a series of medical examinations, Dr.
Miguel Ampil, petitioner in G.R. No. 127590, diagnosed her to be suffering from "cancer of the sigmoid."
On April 11, 1984, Dr. Ampil, assisted by the medical staff 4 of the Medical City Hospital, 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 the consent of Natividad’s husband,
Enrique Agana, to permit Dr. Juan Fuentes, respondent in G.R. No. 126467, to perform hysterectomy on her.
After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the operation and closed the
incision.
However, the operation appeared to be flawed. In the corresponding Record of Operation dated April 11, 1984,
the attending nurses entered these remarks:
"sponge count lacking 2
"announced to surgeon searched (sic) done but to no avail continue for closure."
17
On April 24, 1984, Natividad was released from the hospital. Her hospital and medical bills, including the
doctors’ fees, amounted to P60,000.00.
After a couple of days, Natividad complained of excruciating pain in her anal region. She consulted both Dr.
Ampil and Dr. Fuentes about it. They told her that the pain was the natural consequence of the surgery. Dr.
Ampil then recommended that she consult an oncologist to examine the cancerous nodes which were not
removed during the operation.
On May 9, 1984, Natividad, accompanied by her husband, went to the United States to seek further treatment.
After four months of consultations and laboratory examinations, Natividad was told she was free of cancer.
Hence, she was advised to return to the Philippines.
On August 31, 1984, Natividad flew back to the Philippines, still suffering from pains. Two weeks thereafter, her
daughter found a piece of gauze protruding from her vagina. 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.
Dr. Ampil’s assurance did not come true. Instead, the pains intensified, prompting Natividad to seek treatment at
the Polymedic General Hospital. While confined there, Dr. Ramon Gutierrez detected the presence of another
foreign object in her vagina -- a foul-smelling gauze measuring 1.5 inches in width which badly infected her
vaginal vault. A recto-vaginal fistula had formed in her reproductive organs which forced stool to excrete through
the vagina. Another surgical operation was needed to remedy the damage. Thus, in October 1984, Natividad
underwent another surgery.
On November 12, 1984, Natividad and her husband filed with the RTC, Branch 96, Quezon City a complaint for
damages against the Professional Services, Inc. (PSI), owner of the Medical City Hospital, Dr. Ampil, and Dr.
Fuentes, docketed as Civil Case No. Q-43322. 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.
Meanwhile, Enrique Agana also filed with the Professional Regulation Commission (PRC) an administrative
complaint for gross negligence and malpractice against Dr. Ampil and Dr. Fuentes, docketed as Administrative
Case No. 1690. The PRC Board of Medicine heard the case only with respect to Dr. Fuentes because it failed to
acquire jurisdiction over Dr. Ampil who was then in the United States.
On February 16, 1986, pending the outcome of the above cases, Natividad died and was duly substituted by her
above-named children (the Aganas).
On March 17, 1993, the RTC rendered its Decision in favor of the Aganas, finding PSI, Dr. Ampil and Dr.
Fuentes liable for negligence and malpractice, the decretal part of which reads:
WHEREFORE, judgment is hereby rendered for the plaintiffs ordering the defendants PROFESSIONAL
SERVICES, INC., DR. MIGUEL AMPIL and DR. JUAN FUENTES to pay to the plaintiffs, jointly and severally,
except in respect of the award for exemplary damages and the interest thereon which are the liabilities of
defendants Dr. Ampil and Dr. Fuentes only, as follows:
1. As actual damages, the following amounts:
a. The equivalent in Philippine Currency of the total of US$19,900.00 at the rate of P21.60-
US$1.00, as reimbursement of actual expenses incurred in the United States of America;
b. The sum of P4,800.00 as travel taxes of plaintiffs and their physician daughter;
c. The total sum of P45,802.50, representing the cost of hospitalization at Polymedic Hospital,
medical fees, and cost of the saline solution;
2. As moral damages, the sum of P2,000,000.00;
3. As exemplary damages, the sum of P300,000.00;
18
4. As attorney’s fees, the sum of P250,000.00;
5. Legal interest on items 1 (a), (b), and (c); 2; and 3 hereinabove, from date of filing of the complaint
until full payment; and
6. Costs of suit.
SO ORDERED.
Aggrieved, PSI, Dr. Fuentes and Dr. Ampil interposed an appeal to the Court of Appeals, docketed as CA-G.R.
CV No. 42062.
Incidentally, on April 3, 1993, the Aganas filed with the RTC a motion for a partial execution of its Decision,
which was granted in an Order dated May 11, 1993. Thereafter, the sheriff levied upon certain properties of Dr.
Ampil and sold them for P451,275.00 and delivered the amount to the Aganas.
Following their receipt of the money, the Aganas entered into an agreement with PSI and Dr. Fuentes to
indefinitely suspend any further execution of the RTC Decision. However, not long thereafter, the Aganas again
filed a motion for an alias writ of execution against the properties of PSI and Dr. Fuentes. On September 21,
1993, the RTC granted the motion and issued the corresponding writ, prompting Dr. Fuentes to file with the
Court of Appeals a petition for certiorari and prohibition, with prayer for preliminary injunction, docketed as CA-
G.R. SP No. 32198. During its pendency, the Court of Appeals issued a Resolution 5 dated October 29, 1993
granting Dr. Fuentes’ prayer for injunctive relief.
On January 24, 1994, CA-G.R. SP No. 32198 was consolidated with CA-G.R. CV No. 42062.
Meanwhile, on January 23, 1995, the PRC Board of Medicine rendered its Decision 6 in Administrative Case No.
1690 dismissing the case against Dr. Fuentes. The Board held that the prosecution failed to show that Dr.
Fuentes was the one who left the two pieces of gauze inside Natividad’s body; and that he concealed such fact
from Natividad.
On September 6, 1996, the Court of Appeals rendered its Decision jointly disposing of CA-G.R. CV No. 42062
and CA-G.R. SP No. 32198, thus:
WHEREFORE, except for the modification that the case against defendant-appellant Dr. Juan Fuentes is hereby
DISMISSED, and with the pronouncement that defendant-appellant Dr. Miguel Ampil is liable to reimburse
defendant-appellant Professional Services, Inc., whatever amount the latter will pay or had paid to the plaintiffs-
appellees, the decision appealed from is hereby AFFIRMED and the instant appeal DISMISSED.
Concomitant with the above, the petition for certiorari and prohibition filed by herein defendant-appellant Dr.
Juan Fuentes in CA-G.R. SP No. 32198 is hereby GRANTED and the challenged order of the respondent judge
dated September 21, 1993, as well as the alias writ of execution issued pursuant thereto are hereby NULLIFIED
and SET ASIDE. The bond posted by the petitioner in connection with the writ of preliminary injunction issued by
this Court on November 29, 1993 is hereby cancelled.
Costs against defendants-appellants Dr. Miguel Ampil and Professional Services, Inc.
SO ORDERED.
Only Dr. Ampil filed a motion for reconsideration, but it was denied in a Resolution 7 dated December 19, 1996.
Hence, the instant consolidated petitions.
In G.R. No. 126297, PSI alleged in its petition that the Court of Appeals erred in holding that: (1) it is estopped
from raising the defense that Dr. Ampil is not its employee; (2) it is solidarily liable with Dr. Ampil; and (3) it is not
entitled to its counterclaim against the Aganas. PSI contends that Dr. Ampil is not its employee, but a mere
consultant or independent contractor. As such, he alone should answer for his negligence.
19
In G.R. No. 126467, the Aganas maintain that the Court of Appeals erred in finding that Dr. Fuentes is not guilty
of negligence or medical malpractice, invoking the doctrine of res ipsa loquitur. They contend that the pieces of
gauze are prima facie proofs that the operating surgeons have been negligent.
Finally, in G.R. No. 127590, Dr. Ampil asserts that the Court of Appeals erred in finding him liable for negligence
and malpractice sans evidence that he left the two pieces of gauze in Natividad’s vagina. He pointed to other
probable causes, such as: (1) it was Dr. Fuentes who used gauzes in performing the hysterectomy; (2) the
attending nurses’ failure to properly count the gauzes used during surgery; and (3) the medical intervention of
the American doctors who examined Natividad in the United States of America.
For our resolution are these three vital issues: first, whether the Court of Appeals erred in holding Dr. Ampil
liable for negligence and malpractice; second, whether the Court of Appeals erred in absolving Dr. Fuentes of
any liability; and third, whether PSI may be held solidarily liable for the negligence of Dr. Ampil.
I - G.R. No. 127590
Whether the Court of Appeals Erred in Holding Dr. Ampil
Liable for Negligence and Malpractice.
Dr. Ampil, in an attempt to absolve himself, gears the Court’s attention to other possible causes of Natividad’s
detriment. He argues that the Court should not discount either of the following possibilities: first, Dr. Fuentes left
the gauzes in Natividad’s body after performing hysterectomy; second, the attending nurses erred in counting
the gauzes; and third, the American doctors were the ones who placed the gauzes in Natividad’s body.
Dr. Ampil’s arguments are purely conjectural and without basis. Records show that he 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 (Dr.
Fuentes’) work and found it in order.
The glaring truth is that all the major circumstances, taken together, as specified by the Court of Appeals,
directly point to Dr. Ampil as the negligent party, thus:
First, it is not disputed that the surgeons used gauzes as sponges to control the bleeding of the patient
during the surgical operation.
Second, immediately after the operation, the nurses who assisted in the surgery noted in their report that
the ‘sponge count (was) lacking 2’; that such anomaly was ‘announced to surgeon’ and that a ‘search
was done but to no avail’ prompting Dr. Ampil to ‘continue for closure’ x x x.
Third, after the operation, two (2) gauzes were extracted from the same spot of the body of Mrs. Agana
where the surgery was performed.
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. 8 To put it simply, such act is
considered so inconsistent with due care as to raise an inference of negligence. There are even legions of
authorities to the effect that such act is negligence per se.9
Of course, the Court is not blind to the reality that there are times when danger to a patient’s life precludes a
surgeon from further searching missing sponges or foreign objects left in the body. But this does not leave him
free from any obligation. 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. The ruling in Smith v. Zeagler 10 is explicit, thus:
20
The removal of all sponges used is part of a surgical operation, and when a physician or surgeon fails to remove
a sponge he has placed in his patient’s body that should be removed as part of the operation, he thereby leaves
his operation uncompleted and creates a new condition which imposes upon him the legal duty of calling the
new condition to his patient’s attention, and endeavoring with the means he has at hand to minimize and avoid
untoward results likely to ensue therefrom.
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. Had he been more candid,
Natividad could have taken the immediate and appropriate medical remedy to remove the gauzes from her body.
To our mind, what was initially an act of negligence by Dr. Ampil has ripened into a deliberate wrongful act of
deceiving his patient.
This is a clear case of medical malpractice or more appropriately, medical negligence. 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. 11 Simply put, the elements
are duty, breach, injury and proximate causation. 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 cause12 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.
II - G.R. No. 126467
Whether the Court of Appeals Erred in Absolving
Dr. Fuentes of any Liability
The Aganas assailed the dismissal by the trial court of the case against Dr. Fuentes on the ground that it is
contrary to the doctrine of res ipsa loquitur. According to them, the fact that the two pieces of gauze were left
inside Natividad’s body is a prima facie evidence of Dr. Fuentes’ negligence.
We are not convinced.
Literally, res ipsa loquitur means "the thing speaks for itself." It is 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.13 Stated differently, where the thing which caused the injury, without the fault of the injured, is under
the exclusive control of the defendant and the injury is such that it should not have occurred if he, having such
control used proper care, it affords reasonable evidence, in the absence of explanation that the injury arose from
the defendant’s want of care, and the burden of proof is shifted to him to establish that he has observed due
care and diligence.14
From the foregoing statements of the rule, the requisites for the applicability of the doctrine of res ipsa loquitur
are: (1) the occurrence of an injury; (2) the thing which caused the injury was under the control and management
of the defendant; (3) the occurrence was such that in the ordinary course of things, would not have happened if
those who had control or management used proper care; and (4) the absence of explanation by the defendant.
Of the foregoing requisites, the most instrumental is the "control and management of the thing which caused the
injury."15
We find the element of "control and management of the thing which caused the injury" to be wanting. Hence, the
doctrine of res ipsa loquitur will not lie.
It was duly established that Dr. Ampil was the lead surgeon during the operation of Natividad. He requested the
assistance of Dr. Fuentes only to perform hysterectomy when he (Dr. Ampil) found that the malignancy in her
21
sigmoid area had spread to her left ovary. Dr. Fuentes performed the surgery and thereafter reported and
showed his work to Dr. Ampil. The latter examined it and finding everything to be in order, allowed Dr. Fuentes
to leave the operating room. Dr. Ampil then resumed operating on Natividad. He was about to finish the
procedure when the attending nurses informed him that two pieces of gauze were missing. A "diligent search"
was conducted, but the misplaced gauzes were not found. Dr. Ampil then directed that the incision be closed.
During this entire period, Dr. Fuentes was no longer in the operating room and had, in fact, left the hospital.
Under the "Captain of the Ship" rule, the operating surgeon is the person in complete charge of the surgery room
and all personnel connected with the operation. Their duty is to obey his orders. 16 As stated before, Dr. Ampil
was the lead surgeon. In other words, he was the "Captain of the Ship." That he discharged such role is evident
from his following conduct: (1) calling Dr. Fuentes to perform a hysterectomy; (2) examining the work of Dr.
Fuentes and finding it in order; (3) granting Dr. Fuentes’ permission to leave; and (4) ordering the closure of the
incision. To our mind, it was this act of ordering the closure of the incision notwithstanding that two pieces of
gauze remained unaccounted for, that caused injury to Natividad’s body. Clearly, the control and management of
the thing which caused the injury was in the hands of Dr. Ampil, not Dr. Fuentes.
In this jurisdiction, res ipsa loquitur is not a rule of substantive law, hence, does not per se create or constitute
an independent or separate ground of liability, being a mere evidentiary rule. 17 In other words, mere invocation
and application of the doctrine does not dispense with the requirement of proof of negligence. Here, the
negligence was proven to have been committed by Dr. Ampil and not by Dr. Fuentes.
III - G.R. No. 126297
Whether PSI Is Liable for the Negligence of Dr. Ampil
The third issue necessitates a glimpse at the historical development of hospitals and the resulting theories
concerning their liability for the negligence of physicians.
Until the mid-nineteenth century, hospitals were generally charitable institutions, providing medical services to
the lowest classes of society, without regard for a patient’s ability to pay. 18 Those who could afford medical
treatment were usually treated at home by their doctors. 19 However, the days of house calls and philanthropic
health care are over. The modern health care industry continues to distance itself from its charitable past and
has experienced a significant conversion from a not-for-profit health care to for-profit hospital businesses.
Consequently, significant changes in health law have accompanied the business-related changes in the hospital
industry. One important legal change is an increase in hospital liability for medical malpractice. Many courts now
allow claims for hospital vicarious liability under the theories of respondeat superior, apparent authority,
ostensible authority, or agency by estoppel. 20
In this jurisdiction, the statute governing liability for negligent acts is Article 2176 of the Civil Code, which reads:
Art. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to
pay for the damage done. Such fault or negligence, if there is no pre-existing contractual relation between the
parties, is called a quasi-delict and is governed by the provisions of this Chapter.
A derivative of this provision is Article 2180, the rule governing vicarious liability under the doctrine of respondeat
superior, thus:
ART. 2180. 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.
x x x x x x
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 assigned tasks even though the former are not engaged in any business or industry.
22
x x x x x x
The responsibility treated of in this article shall cease when the persons herein mentioned prove that they
observed all the diligence of a good father of a family to prevent damage.
A prominent civilist commented that professionals engaged by an employer, such as physicians, dentists, and
pharmacists, are not "employees" under this article because the manner in which they perform their work is not
within the control of the latter (employer). In other words, professionals are considered personally liable for the
fault or negligence they commit in the discharge of their duties, and their employer cannot be held liable for such
fault or negligence. In the context of the present case, "a hospital cannot be held liable for the fault or negligence
of a physician or surgeon in the treatment or operation of patients." 21
The foregoing view is grounded on the traditional notion that the professional status and the very nature of the
physician’s calling preclude him from being classed as an agent or employee of a hospital, whenever he acts in
a professional capacity.22 It has been said that medical practice strictly involves highly developed and specialized
knowledge,23 such that physicians are generally free to exercise their own skill and judgment in rendering
medical services sans interference. 24 Hence, when a doctor practices medicine in a hospital setting, the hospital
and its employees are deemed to subserve him in his ministrations to the patient and his actions are of his own
responsibility.25
The case of Schloendorff v. Society of New York Hospital 26 was then considered an authority for this view. The
"Schloendorff doctrine" regards a physician, even if employed by a hospital, as an independent contractor
because of the skill he exercises and the lack of control exerted over his work. Under this doctrine, hospitals are
exempt from the application of the respondeat superior principle for fault or negligence committed by physicians
in the discharge of their profession.
However, the efficacy of the foregoing doctrine has weakened with the significant developments in medical care.
Courts came to realize that modern hospitals are increasingly taking active role in supplying and regulating
medical care to patients. No longer were a hospital’s functions limited to furnishing room, food, facilities for
treatment and operation, and attendants for its patients. Thus, in Bing v. Thunig, 27 the New York Court of
Appeals deviated from the Schloendorff doctrine, noting that modern hospitals actually do far more than provide
facilities for treatment. Rather, they regularly employ, on a salaried basis, a large staff of physicians, interns,
nurses, administrative and manual workers. They charge patients for medical care and treatment, even
collecting for such services through legal action, if necessary. The court then concluded that there is no reason
to exempt hospitals from the universal rule of respondeat superior.
In our shores, the nature of the relationship between the hospital and the physicians is rendered inconsequential
in view of our categorical pronouncement in Ramos v. Court of Appeals 28 that for purposes of apportioning
responsibility in medical negligence cases, an employer-employee relationship in effect exists between hospitals
and their attending and visiting physicians. This Court held:
"We now discuss the responsibility of the hospital in this particular incident. The unique practice (among private
hospitals) of filling up specialist staff with attending and visiting "consultants," who are allegedly not hospital
employees, presents problems in apportioning responsibility for negligence in medical malpractice cases.
However, the difficulty is more apparent than real.
In the first place, hospitals exercise significant control in the hiring and firing of consultants and in the conduct of
their work within the hospital premises. Doctors who apply for ‘consultant’ slots, visiting or attending, are
required to submit proof of completion of residency, their educational qualifications, generally, evidence of
accreditation by the appropriate board (diplomate), evidence of fellowship in most cases, and references. These
requirements are carefully scrutinized by members of the hospital administration or by a review committee set up
by the hospital who either accept or reject the application. x x x.
After a physician is accepted, either as a visiting or attending consultant, he is normally required to attend
clinico-pathological conferences, conduct bedside rounds for clerks, interns and residents, moderate grand
rounds and patient audits and perform other tasks and responsibilities, for the privilege of being able to maintain
a clinic in the hospital, and/or for the privilege of admitting patients into the hospital. In addition to these, the
physician’s performance as a specialist is generally evaluated by a peer review committee on the basis of
mortality and morbidity statistics, and feedback from patients, nurses, interns and residents. A consultant remiss
23
in his duties, or a consultant who regularly falls short of the minimum standards acceptable to the hospital or its
peer review committee, is normally politely terminated.
In other words, private hospitals, hire, fire and exercise real control over their attending and visiting ‘consultant’
staff. While ‘consultants’ are not, technically employees, x x x, the control exercised, the hiring, and the right to
terminate consultants all fulfill the important hallmarks of an employer-employee relationship, with the exception
of the payment of wages. In assessing whether such a relationship in fact exists, the control test is determining.
Accordingly, on the basis of the foregoing, we rule that for the purpose of allocating responsibility in medical
negligence cases, an employer-employee relationship in effect exists between hospitals and their attending and
visiting physicians. "
But the Ramos pronouncement is not our only basis in sustaining PSI’s liability. Its liability is also anchored upon
the agency principle of apparent authority or agency by estoppel and the doctrine of corporate negligence which
have gained acceptance in the determination of a hospital’s liability for negligent acts of health professionals.
The present case serves as a perfect platform to test the applicability of these doctrines, thus, enriching our
jurisprudence.
Apparent authority, or what is sometimes referred to as the "holding
out" theory, or doctrine of ostensible agency or agency by estoppel, 29 has its origin from the law of agency. It
imposes liability, not as the result of the reality of a contractual relationship, but rather because of the actions of
a principal or an employer in somehow misleading the public into believing that the relationship or the authority
exists.30 The concept is essentially one of estoppel and has been explained in this manner:
"The principal is bound by the acts of his agent with the apparent authority which he knowingly permits the agent
to assume, or which he holds the agent out to the public as possessing. The question in every case is whether
the principal has by his voluntary act placed the agent in such a situation that a person of ordinary prudence,
conversant with business usages and the nature of the particular business, is justified in presuming that such
agent has authority to perform the particular act in question. 31
The applicability of apparent authority in the field of hospital liability was upheld long time ago in Irving v. Doctor
Hospital of Lake Worth, Inc.32 There, it was explicitly stated that "there does not appear to be any rational basis
for excluding the concept of apparent authority from the field of hospital liability." Thus, in cases where it can be
shown that a hospital, by its actions, has held out a particular physician as its agent and/or employee and that a
patient has accepted treatment from that physician in the reasonable belief that it is being rendered in behalf of
the hospital, then the hospital will be liable for the physician’s negligence.
Our jurisdiction recognizes the concept of an agency by implication or estoppel. Article 1869 of the Civil Code
reads:
ART. 1869. Agency may be express, or implied from the acts of the principal, from his silence or lack of action,
or his failure to repudiate the agency, knowing that another person is acting on his behalf without authority.
In this case, PSI publicly displays in the lobby of the Medical City Hospital the names and specializations of the
physicians associated or accredited by it, including those of Dr. Ampil and Dr. Fuentes. We concur with the
Court of Appeals’ conclusion that it "is now estopped from passing all the blame to the physicians whose names
it proudly paraded in the public directory leading the public to believe that it vouched for their skill and
competence." Indeed, PSI’s act is tantamount to holding out to the public that Medical City Hospital, through its
accredited physicians, offers quality health care services. By accrediting Dr. Ampil and Dr. Fuentes and publicly
advertising their qualifications, the hospital created the impression that they were its agents, authorized to
perform medical or surgical services for its patients. As expected, these patients, Natividad being one of them,
accepted the services on the reasonable belief that such were being rendered by the hospital or its employees,
agents, or servants. The trial court correctly pointed out:
x x x regardless of the education and status in life of the patient, he ought not be burdened with the defense of
absence of employer-employee relationship between the hospital and the independent physician whose name
and competence are certainly certified to the general public by the hospital’s act of listing him and his specialty in
its lobby directory, as in the case herein. The high costs of today’s medical and health care should at least exact
24
on the hospital greater, if not broader, legal responsibility for the conduct of treatment and surgery within its
facility by its accredited physician or surgeon, regardless of whether he is independent or employed." 33
The wisdom of the foregoing ratiocination is easy to discern. Corporate entities, like PSI, are capable of acting
only through other individuals, such as physicians. If these accredited physicians do their job well, the hospital
succeeds in its mission of offering quality medical services and thus profits financially. Logically, where
negligence mars the quality of its services, the hospital should not be allowed to escape liability for the acts of its
ostensible agents.
We now proceed to the doctrine of corporate negligence or corporate responsibility.
One allegation in the complaint in Civil Case No. Q-43332 for negligence and malpractice is that PSI as owner,
operator and manager of Medical City Hospital, "did not perform the necessary supervision nor exercise diligent
efforts in the supervision of Drs. Ampil and Fuentes and its nursing staff, resident doctors, and medical interns
who assisted Drs. Ampil and Fuentes in the performance of their duties as surgeons." 34 Premised on the doctrine
of corporate negligence, the trial court held that PSI is directly liable for such breach of duty.
We agree with the trial court.
Recent years have seen the doctrine of corporate negligence as the judicial answer to the problem of allocating
hospital’s liability for the negligent acts of health practitioners, absent facts to support the application of
respondeat superior or apparent authority. Its formulation proceeds from the judiciary’s acknowledgment that in
these modern times, the duty of providing quality medical service is no longer the sole prerogative and
responsibility of the physician. The modern hospitals have changed structure. Hospitals now tend to organize a
highly professional medical staff whose competence and performance need to be monitored by the hospitals
commensurate with their inherent responsibility to provide quality medical care. 35
The doctrine has its genesis in Darling v. Charleston Community Hospital. 36 There, the Supreme Court of Illinois
held that "the jury could have found a hospital negligent, inter alia, in failing to have a sufficient number of
trained nurses attending the patient; failing to require a consultation with or examination by members of the
hospital staff; and failing to review the treatment rendered to the patient." On the basis of Darling, other
jurisdictions held that a hospital’s corporate negligence extends to permitting a physician known to be
incompetent to practice at the hospital.37 With the passage of time, more duties were expected from hospitals,
among them: (1) the use of reasonable care in the maintenance of safe and adequate facilities and equipment;
(2) the selection and retention of competent physicians; (3) the overseeing or supervision of all persons who
practice medicine within its walls; and (4) the formulation, adoption and enforcement of adequate rules and
policies that ensure quality care for its patients. 38 Thus, in Tucson Medical Center, Inc. v. Misevich,39 it was held
that a hospital, following the doctrine of corporate responsibility, has the duty to see that it meets the standards
of responsibilities for the care of patients. Such duty includes the proper supervision of the members of its
medical staff. And in Bost v. Riley,40 the court concluded that a patient who enters a hospital does so with the
reasonable expectation that it will attempt to cure him. The hospital accordingly has the duty to make a
reasonable effort to monitor and oversee the treatment prescribed and administered by the physicians practicing
in its premises.
In the present case, it was duly established that PSI operates the Medical City Hospital for the purpose and
under the concept of providing comprehensive medical services to the public. Accordingly, it has the duty to
exercise reasonable care to protect from harm all patients admitted into its facility for medical treatment.
Unfortunately, PSI failed to perform such duty. The findings of the trial court are convincing, thus:
x x x PSI’s liability is traceable to its failure to conduct an investigation of the matter reported in the nota bene of
the count nurse. Such failure established PSI’s part in the dark conspiracy of silence and concealment about the
gauzes. Ethical considerations, if not also legal, dictated the holding of an immediate inquiry into the events, if
not for the benefit of the patient to whom the duty is primarily owed, then in the interest of arriving at the truth.
The Court cannot accept that the medical and the healing professions, through their members like defendant
surgeons, and their institutions like PSI’s hospital facility, can callously turn their backs on and disregard even a
mere probability of mistake or negligence by refusing or failing to investigate a report of such seriousness as the
one in Natividad’s case.
25
It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance of the Medical City
Hospital’s staff, composed of resident doctors, nurses, and interns. As such, it is reasonable to conclude that
PSI, as the operator of the hospital, has actual or constructive knowledge of the procedures carried out,
particularly the report of the attending nurses that the two pieces of gauze were missing. In Fridena v. Evans, 41 it
was held that a corporation is bound by the knowledge acquired by or notice given to its agents or officers within
the scope of their authority and in reference to a matter to which their authority extends. This means that the
knowledge of any of the staff of Medical City Hospital constitutes knowledge of PSI. Now, the failure of PSI,
despite the attending nurses’ report, to investigate and inform Natividad regarding the missing gauzes amounts
to callous negligence. Not only did PSI breach its duties to oversee or supervise all persons who practice
medicine within its walls, it also failed to take an active step in fixing the negligence committed. This renders PSI,
not only vicariously liable for the negligence of Dr. Ampil under Article 2180 of the Civil Code, but also directly
liable for its own negligence under Article 2176. In Fridena, the Supreme Court of Arizona held:
x x x In recent years, however, the duty of care owed to the patient by the hospital has expanded. The emerging
trend is to hold the hospital responsible where the hospital has failed to monitor and review medical services
being provided within its walls. See Kahn Hospital Malpractice Prevention, 27 De Paul . Rev. 23 (1977).
Among the cases indicative of the ‘emerging trend’ is Purcell v. Zimbelman, 18 Ariz. App. 75,500 P. 2d 335
(1972). In Purcell, the hospital argued that it could not be held liable for the malpractice of a medical practitioner
because he was an independent contractor within the hospital. The Court of Appeals pointed out that the
hospital had created a professional staff whose competence and performance was to be monitored and
reviewed by the governing body of the hospital, and the court held that a hospital would be negligent where it
had knowledge or reason to believe that a doctor using the facilities was employing a method of treatment or
care which fell below the recognized standard of care.
Subsequent to the Purcell decision, the Arizona Court of Appeals held that a hospital has certain inherent
responsibilities regarding the quality of medical care furnished to patients within its walls and it must meet the
standards of responsibility commensurate with this undertaking. Beeck v. Tucson General Hospital, 18 Ariz. App.
165, 500 P. 2d 1153 (1972). This court has confirmed the rulings of the Court of Appeals that a hospital has the
duty of supervising the competence of the doctors on its staff. x x x.
x x x x x x
In the amended complaint, the plaintiffs did plead that the operation was performed at the hospital with its
knowledge, aid, and assistance, and that the negligence of the defendants was the proximate cause of the
patient’s injuries. We find that such general allegations of negligence, along with the evidence produced at the
trial of this case, are sufficient to support the hospital’s liability based on the theory of negligent supervision."
Anent the corollary issue of whether PSI is solidarily liable with Dr. Ampil for damages, let it be emphasized that
PSI, apart from a general denial of its responsibility, failed to adduce evidence showing that it exercised the
diligence of a good father of a family in the accreditation and supervision of the latter. In neglecting to offer such
proof, PSI failed to discharge its burden under the last paragraph of Article 2180 cited earlier, and, therefore,
must be adjudged solidarily liable with Dr. Ampil. Moreover, as we have discussed, PSI is also directly liable to
the Aganas.
One final word. Once a physician undertakes the treatment and care of a patient, the law imposes on him certain
obligations. In order to escape liability, he must possess that reasonable degree of learning, skill and experience
required by his profession. At the same time, he must apply reasonable care and diligence in the exercise of his
skill and the application of his knowledge, and exert his best judgment.
WHEREFORE, we DENY all the petitions and AFFIRM the challenged Decision of the Court of Appeals in CA-
G.R. CV No. 42062 and CA-G.R. SP No. 32198.
Costs against petitioners PSI and Dr. Miguel Ampil.
SO ORDERED.
26
PROFESSIONAL SERVICES, INC., vs.
NATIVIDAD and ENRIQUE AGANA G.R. No.
126297 January 31, 2007
Facts:
Natividad Agana was rushed to the Medical City Hospital because of difficulty
of bowel movement and bloody anal discharge. Dr. Miguel Ampil, diagnosed
her to be suffering from “cancer of the sigmoid.” Dr. Ampil, assisted by the
medical staff of the Medical City Hospital, 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 the consent of Natividad’s husband, Enrique Agana,
to permit Dr. Juan Fuentes, to perform hysterectomy on her.
After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over,
completed the operation and closed the incision. However, the operation
appeared to be flawed. After a couple of days, Natividad complained of
excruciating pain in her anal region. She consulted both Dr. Ampil and Dr.
Fuentes about it. They told her that the pain was the natural consequence of
the surgery.
Two weeks after Natividad returned from the United States to seek further
treatment, her daughter found a piece of gauze protruding from her vagina.
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.
Dr. Ampil’s assurance did not come true. Instead, the pains intensified,
prompting Natividad to seek treatment at the Polymedic General Hospital.
While confined there, Dr. Ramon Gutierrez detected the presence of another
foreign object in her vagina — a foul-smelling gauze measuring 1.5 inches in
width which badly infected her vaginal vault. A recto-vaginal fistula had formed
27
in her reproductive organs which forced stool to excrete through the vagina.
Another surgical operation was needed to remedy the damage.
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.
Pending the outcome of the above 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.
The Court of Appeals rendered its Decision dismissing the case against Dr.
Fuentes with Dr. Ampil liable to reimburse Professional Services, Inc., whatever
amount the latter will pay or had paid to the plaintiffs.
Issues: Whether or not PSI may be held solidarily liable for the negligence of
Dr. Ampil.
Held: Yes, PSI is solidarily liable for the negligence of Dr. Ampil. In Ramos v.
Court of Appeals, the court held that private hospitals, hire, fire and exercise
real control over their attending and visiting ‘consultant’ staff. While
‘consultants’ are not, technically employees, the control exercised, the hiring,
and the right to terminate consultants all fulfill the important hallmarks of an
employer-employee relationship, with the exception of the payment of wages.
The court held that for the purpose of allocating responsibility in medical
negligence cases, an employer-employee relationship in effect exists between
hospitals and their attending and visiting physicians.
In addition to the pronouncement in Ramos vs CA, Its liability is also anchored

upon the agency principle of apparent authority or agency by estoppel and the
doctrine of corporate negligence.
28
Apparent authority, or what is sometimes referred to as the “holding out”
theory, or doctrine of ostensible agency or agency by estoppel, imposes
liability, not as the result of the reality of a contractual relationship, but rather
because of the actions of a principal or an employer in somehow misleading
the public into believing that the relationship or the authority exists.
In this case, PSI publicly displays in the lobby of Hospital the names and
specializations of the physicians associated or accredited by it, including those
of Dr. Ampil and Dr. Fuentes. It is now estopped from passing all the blame to
the physicians whose names it proudly paraded in the public directory leading
the public to believe that it vouched for their skill and competence. PSI’s act is
tantamount to holding out to the public that Medical City Hospital, through its
accredited physicians, offers quality health care services. By accrediting Dr.
Ampil and Dr. Fuentes and publicly advertising their qualifications, the hospital
created the impression that they were its agents, authorized to perform
medical or surgical services for its patients. As expected, these patients,
Natividad being one of them, accepted the services on the reasonable belief
that such were being rendered by the hospital or its employees, agents, or
servants.
Under the doctrine of corporate negligence or corporate responsibility, PSI as

owner, operator and manager of Medical City Hospital, did not perform the
necessary supervision nor exercise diligent efforts in the supervision of Drs.
Ampil and Fuentes and its nursing staff, resident doctors, and medical interns
who assisted Drs. Ampil and Fuentes in the performance of their duties as
surgeons. Premised on the doctrine of corporate negligence, the trial court
held that PSI is directly liable for such breach of duty.
In the present case, it was duly established that PSI operates the Medical City
Hospital for the purpose and under the concept of providing comprehensive
medical services to the public. Accordingly, it has the duty to exercise
reasonable care to protect from harm all patients admitted into its facility for
medical treatment. Unfortunately, PSI failed to perform such duty.
It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with
the assistance of the Medical City Hospital’s staff, composed of resident
29
doctors, nurses, and interns. As such, it is reasonable to conclude that PSI, as
the operator of the hospital, has actual or constructive knowledge of the
procedures carried out, particularly the report of the attending nurses that the
two pieces of gauze were missing. In Fridena v. Evans, it was held that a
corporation is bound by the knowledge acquired by or notice given to its
agents or officers within the scope of their authority and in reference to a
matter to which their authority extends. This means that the knowledge of any
of the staff of Medical City Hospital constitutes knowledge of PSI. Now, the
failure of PSI, despite the attending nurses’ report, to investigate and inform
Natividad regarding the missing gauzes amounts to callous negligence. Not
only did PSI breach its duties to oversee or supervise all persons who practice
medicine within its walls, it also failed to take an active step in fixing the
negligence committed. This renders PSI, not only vicariously liable for the
negligence of Dr. Ampil under Article 2180 of the Civil Code, but also directly
liable for its own negligence under Article 2176.
PSI, apart from a general denial of its responsibility, failed to adduce evidence
showing that it exercised the diligence of a good father of a family in the
accreditation and supervision of Dr. Ampil. In neglecting to offer such proof,
PSI failed to discharge its burden under the last paragraph of Article 2180 and,
therefore, must be adjudged solidarily liable with Dr. Ampil.
30

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Republic of the Philippines

G.R. No. 176389 January 18, 2011

G.R. No. 176864

PEOPLE OF THE PHILIPPINES, Appellee,

As the Court said in People of the Philippines v. Sandiganbayan: 2

No further pleadings shall be entertained in this case.

I vote to grant the M.R.

No part, prior inhibition

No part due to relastionship to a party No part; filed pleading as Sol Gen

I vote to grant the motion for reconsideration Same vote as J. Villarama

DIOSDADO M. PERALTA LUCAS P. BERSAMIN

No part I vote to grant the motion for reconsideration

JOSE PORTUGAL PEREZ JOSE CATRAL MENDOZA

See concurring Opinion

The Lawphil Project - Arellano Law Foundation

MARIA LOURDES P. A. SERENO

G.R. No. 159132 December 18, 2008

The antecedent facts:

1. THE COURT OF APPEALS ERRED ON A QUESTION OF LAW IN HOLDING THAT THE

2. EVEN ASSUMING, ARGUENDO, THAT PRC WAS EXCLUDED FROM THE PURVIEW OF RULE 43

3. HEREIN RESPONDENTS-SPOUSES ARE NOT ALLOWED BY LAW TO APPEAL FROM THE

4. THE COURT OF APPEALS COMMITTED GRAVE ABUSE OF DISCRETION IN DENYING FOR

5. PRC’S GRAVE OMISSION TO AFFORD HEREIN PETITONER A CHANCE TO BE HEARD ON

6. COROLLARY TO THE FOURTH ASSIGNED ERROR, PRC COMMITTED GRAVE ABUSE OF

7. PRC COMMITTED GRAVE ABUSE OF DISCRETION IN REVOKING PETITIONER’S LICENSE TO

9. PRC COMMITTED GRAVE ABUSE OF DISCRETION IN MAKING CONCLUSIONS OF FACTS THAT

The Court will first deal with the procedural issues.

The Court does not agree.

On this point, the Court agrees with the petitioner.

Sec. 1, Rule 43 of the Rules of Court provides:

Specifically, the Court, in Yang v. Court of Appeals,37 ruled that Batas Pambansa (B.P.) Blg. 12938 conferred

A: No, it was described as scanty scraping if I remember it right–scanty.

Q: But, doctor, do you discharge patients without seeing them?

Lasam vs. Sps. Ramolete G.R. No. 159132

On July 1994, respondent three months pregnant Editha Ramolete was

Respondents alleged that Editha’s hysterectomy was caused by petitioners

Issue: WON there was medical malpractice in the case?

Held: There was no medical malpractice in the case.

Medical malpractice is a particular form of negligence which consists in the

G.R. No. 126297 January 31, 2007

G.R. No. 126467 January 31, 2007

G.R. No. 127590 January 31, 2007

The facts, as culled from the records, are:

"sponge count lacking 2

1. As actual damages, the following amounts:

2. As moral damages, the sum of P2,000,000.00;

3. As exemplary damages, the sum of P300,000.00;

Hence, the instant consolidated petitions.

I - G.R. No. 127590

Whether the Court of Appeals Erred in Holding Dr. Ampil

Liable for Negligence and Malpractice.

II - G.R. No. 126467

Whether the Court of Appeals Erred in Absolving

Dr. Fuentes of any Liability

We are not convinced.

III - G.R. No. 126297

Whether PSI Is Liable for the Negligence of Dr. Ampil

Apparent authority, or what is sometimes referred to as the "holding

We now proceed to the doctrine of corporate negligence or corporate responsibility.

We agree with the trial court.

Costs against petitioners PSI and Dr. Miguel Ampil.

In addition to the pronouncement in Ramos vs CA, Its liability is also anchored

Under the doctrine of corporate negligence or corporate responsibility, PSI as