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568 SUPREME COURT REPORTS ANNOTATED


Garcia, Jr. vs. Salvador

*
G.R. No. 168512. March 20, 2007.

ORLANDO D. GARCIA, JR., doing business under the


name and style 1COMMUNITY DIAGNOSTIC CENTER
and BU CASTRO, petitioners, vs. RANIDA D. SALVADOR
and RAMON SALVADOR, respondents.

Health Care Providers; Torts; Quasi-Delicts; Appeals; Whether


a person is negligent or not is a question of fact which the Supreme
Court cannot pass upon in a petition for review on certiorari which
is limited to reviewing errors of law; For health care providers, the
test of the existence of negligence is—did the health care provider
either fail to do something which a reasonably prudent health care
provider would have done, or that he or she did something that a
reasonably prudent health care provider would not have done, and
that failure or action caused injury to the patient.—We note that
the issues raised are factual in nature. Whether a person is
negligent or not is a question of fact which we cannot pass upon in
a petition for review on certiorari which is limited to reviewing
errors of law. Negligence is the failure to observe for the
protection of the interest of another person that degree of care,
precaution and vigilance which the circumstances justly demand,
whereby such other person suffers injury. For health care
providers, the test of the existence of negligence is: did the health
care provider either fail to do something which a reasonably
prudent health care provider would have done, or that he or she
did something that a reasonably prudent health care provider
would not have done; and that failure or action caused injury to
the patient; if yes, then he is guilty of negligence. Thus, the
elements of an actionable conduct are: 1) duty, 2) breach, 3)
injury, and 4) proximate causation.

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Same; Same; Same; Owners and operators of clinical


laboratories have the duty to comply with statutes, as well as rules
and regulations, purposely promulgated to protect and promote the
health of the people by preventing the operation of substandard,
improperly managed and inadequately supported clinical
laboratories and by improving the quality of performance of
clinical laboratory examina-

_______________

* THIRD DIVISION.

1 Did not appeal from the Decision of the Court of Appeals.

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Garcia, Jr. vs. Salvador

tions.—Owners and operators of clinical laboratories have the


duty to comply with statutes, as well as rules and regulations,
purposely promulgated to protect and promote the health of the
people by preventing the operation of substandard, improperly
managed and inadequately supported clinical laboratories and by
improving the quality of performance of clinical laboratory
examinations. Their business is impressed with public interest, as
such, high standards of performance are expected from them.

Same; Same; Same; Violation of a statutory duty is


negligence.—Violation of a statutory duty is negligence. Where
the law imposes upon a person the duty to do something, his
omission or non-performance will render him liable to whoever
may be injured thereby.

Same; Same; Same; Statutes; The Clinical Laboratory Law


(R.A. No. 4688); The Philippine Medical Technology Act of 1969
(R.A. No. 5527); Revised Rules and Regulations Governing the
Registration, Operation and Maintenance of Clinical Laboratories
in the Philippines (DOH Adm. Order No. 49-B, Series of 1988); A
clinical laboratory must be administered, directed and supervised

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by a licensed physician authorized by the Secretary of Health, like


a pathologist who is specially trained in methods of laboratory
medicine; that the medical technologist must be under the
supervision of the pathologist or a licensed physician; and that the
results of any examination may be released only to the requesting
physician or his authorized representative upon the direction of the
laboratory pathologist.—It is clear that a clinical laboratory must
be administered, directed and supervised by a licensed physician
authorized by the Secretary of Health, like a pathologist who is
specially trained in methods of laboratory medicine; that the
medical technologist must be under the supervision of the
pathologist or a licensed physician; and that the results of any
examination may be released only to the requesting physician or
his authorized representative upon the direction of the laboratory
pathologist. These rules are intended for the protection of the
public by preventing performance of substandard clinical
examinations by laboratories whose personnel are not properly
supervised. The public demands no less than an effective and
efficient performance of clinical laboratory examinations through
compliance with the quality standards set by laws and
regulations.

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570 SUPREME COURT REPORTS ANNOTATED

Garcia, Jr. vs. Salvador

Same; Same; Same; Administrative Law; Power of Control


and Supervision; Words and Phrases; “Supervision and control”
means the authority to act directly whenever a specific function is
entrusted by law or regulation to a subordinate; direct the
performance of duty; restrain the commission of acts; review,
approve, revise or modify acts and decisions of subordinate
officials or units.—Castro’s infrequent visit to the clinical
laboratory barely qualifies as an effective administrative
supervision and control over the activities in the laboratory.
“Supervision and control” means the authority to act directly
whenever a specific function is entrusted by law or regulation to a
subordinate; direct the performance of duty; restrain the
commission of acts; review, approve, revise or modify acts and
decisions of subordinate officials or units.

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Same; Same; Same; Art. 20 of the Civil Code provides the


legal basis for the award of damages to a party who suffers
damage whenever one commits an act in violation of some legal
provision.—Article 20 of the New Civil Code provides:
Art.20.Every person who, contrary to law, willfully or negligently
causes damage to another, shall indemnify the latter for the
same. The foregoing provision provides the legal basis for the
award of damages to a party who suffers damage whenever one
commits an act in violation of some legal provision. This was
incorporated by the Code Commission to provide relief to a person
who suffers damage because another has violated some legal
provision.

PETITION for review on certiorari of the decision and


resolution of the Court of Appeals.

The facts are stated in the opinion of the Court.


     Bu C. Castro for petitioners.
     Albert D. Rebosa co-counsel for petitioners.
     Emiliano S. Pomer for respondents.

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Garcia, Jr. vs. Salvador

YNARES-SANTIAGO, J.:
2
This is a petition for review under Rule 45 of the 3Rules of
Court assailing the February 27, 2004 Decision of the
Court of Appeals in CA-G.R. CV No. 58668 finding
petitioner Orlando D. Garcia liable4 for gross negligence;
and its June 16, 2005 Resolution denying petitioner’s
motion for reconsideration.
On October 1, 1993, respondent Ranida D. Salvador
started working as a trainee in the Accounting Department
of Limay Bulk Handling Terminal, Inc. (the Company). As
a prerequisite for regular employment, she underwent a
medical examination at the Community Diagnostic Center
(CDC). Garcia who is a medical technologist, conducted the
HBs Ag (Hepatitis B Surface Antigen) test5
and on October
22, 1993, CDC issued the test result indicating that
Ranida was “HBs Ag: Reactive.” The result bore the name

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and signature of Garcia as examiner and the rubber stamp


signature of Castro as pathologist.
When Ranida submitted the test result to Dr. Sto.
Domingo, the Company physician, the latter apprised her
that the findings indicated that she is suffering from
Hepatitis
6
B, a liver disease. Thus, based on the medical
report submitted by Sto. Domingo, the Company
terminated Ranida’s
7
employment for failing the physical
examination.
When Ranida informed her father, Ramon, about her
ailment, the latter suffered a heart attack and was confined
at the Bataan Doctors Hospital. During Ramon’s
confinement,

_______________

2 Rollo, pp. 7-45.


3 Id., at pp. 48-63. Penned by Associate Justice Marina L. Buzon and
concurred in by Associate Justices Sergio L. Pestaño and Aurora Santiago-
Lagman.
4 Id., at pp. 46-47.
5 Records, p. 186.
6 Id., at p. 199.
7 Id., at p. 187.

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Garcia, Jr. vs. Salvador

Ranida underwent8
another HBs Ag test at the said hospital
and the result indicated that she is non-reactive. She
informed Sto. Domingo of this development but was told
that the test conducted by CDC was more reliable because
it used the Micro-Elisa Method.
Thus, Ranida went back to CDC for confirmatory
testing, and this time, the Anti-HBs
9
test conducted on her
indicated a “Negative” result.
Ranida also underwent another HBs Ag test at the
Bataan Doctors Hospital using the Micro-Elisa 10
Method.
The result indicated that she was non-reactive.
Ranida submitted the test results from Bataan Doctors
Hospital and CDC to the Executive Officer of the Company
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who requested her to undergo another similar test before


her re-employment would be considered. Thus, CDC
conducted another HBs 11
Ag test on Ranida which indicated
a “Negative” result. Ma. Ruby G. Calderon, Med-Tech
Officer-in-Charge of CDC, issued a Certification correcting
the initial result and explaining that the examining
medical technologist (Garcia)12 interpreted the delayed
reaction as positive or reactive.
Thereafter, the Company rehired Ranida. 13
On July 25, 1994, Ranida and Ramon filed a complaint
for damages against petitioner Garcia and a purportedly
unknown pathologist of CDC, claiming that, by reason of
the erroneous interpretation of the results of Ranida’s
examination, she lost her job and suffered serious mental
anxiety, trauma and sleepless nights, while Ramon was
hospitalized and lost business opportunities.

_______________

8 Id., at p. 188.
9 Id., at p. 189.
10 Id., at p. 190.
11 Id., at p. 192.
12 Id., at p. 209.
13 Id., at pp. 1-7.

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Garcia, Jr. vs. Salvador

On September
14
26, 1994, respondents amended their
complaint by naming Castro as the “unknown
pathologist.”
Garcia denied the allegations of gross negligence and
incompetence and reiterated the scientific explanation for
the “false positive” result of the first HBs15 Ag test in his
December 7, 1993 letter to the respondents.
For his part, Castro claimed that as pathologist, he
rarely went to CDC and only when a case was referred to
him; that he did not examine Ranida; and that the test
results bore only his rubber-stamp signature.

16
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16
On September 1, 1997, the trial court dismissed the
complaint for failure of the respondents to present
sufficient evidence to prove the liability of Garcia and
Castro. It held that respondents should have presented Sto.
Domingo because he was the one who interpreted the test
result issued by CDC. Likewise, respondents should have
presented a medical expert to refute the testimonies of
Garcia and Castro regarding the medical 17
explanation
behind the conflicting test results on Ranida.
Respondents appealed to the Court of Appeals which
reversed the trial court’s findings, the dispositive portion of
which states:

“WHEREFORE, the decision appealed from is REVERSED and


SET ASIDE and another one entered ORDERING
defendantappellee Orlando D. Garcia, Jr. to pay plaintiff-
appellant Ranida D. Salvador moral damages in the amount of
P50,000.00, exemplary damages in the amount of P50,000.00 and
attorney’s fees in the
18
amount of P25,000.00.
SO ORDERED.”

_______________

14 Id., at pp. 45-51.


15 Id., at pp. 31-41.
16 CA Rollo, pp. 51-61. Penned by Judge Lorenzo R. Silva, Jr.
17 Id., at p. 59.
18 Rollo, p. 63.

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Garcia, Jr. vs. Salvador

The appellate court found Garcia liable for damages for


negligently issuing an erroneous HBs Ag result. On the
other hand, it exonerated Castro for lack of participation in
the issuance of the results.
After the denial of his motion for reconsideration, Garcia
filed the instant petition.
The main issue for resolution is whether the Court of
Appeals, in reversing the decision of the trial court,

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correctly found petitioner liable for damages to the


respondents for issuing an incorrect HBsAG test result.
Garcia maintains he is not negligent, thus not liable for
damages, because he followed the appropriate laboratory
measures and procedures as dictated by his training and
experience; and that he did everything within his
professional competence to arrive at an objective, impartial
and impersonal result.
At the outset, we note that the issues raised are factual
in nature. Whether a person is negligent or not is a
question of fact which we cannot pass upon in a petition for
review
19
on certiorari which is limited to reviewing errors of
law.
Negligence is the failure to observe for the protection of
the interest of another person that degree of care,
precaution20
and vigilance which the circumstances justly
demand, whereby such other person suffers injury. For
health care providers, the test of the existence of negligence
is: did the health care provider either fail to do something
which a reasonably prudent health care provider would
have done, or that he or she did something that a
reasonably prudent health care provider

_______________

19 Estacion v. Bernardo, G.R. No. 144723, February 27, 2006, 483 SCRA
222, 231.
20 Child Learning Center, Inc. v. Tagorio, G.R. No. 150920, November
25, 2005, 476 SCRA 236, 242.

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would not have done; 21


and that failure or action caused
injury to the patient; if yes, then he is guilty of negligence.
Thus, the elements of an actionable conduct are: 1) duty,
2) breach, 3) injury, and 4) proximate causation.
All the elements are present in the case at bar.
Owners and operators of clinical laboratories have the
duty to comply with statutes, as well as rules and
regulations, purposely promulgated to protect and promote

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the health of the people by preventing the operation of


substandard, improperly managed and inadequately
supported clinical laboratories and by improving the 22
quality of performance of clinical laboratory examinations.
Their business is impressed with public interest, as such,
high standards of performance are expected from them.
In F.F. Cruz and Co., Inc. v. Court of Appeals, we found
the owner of a furniture shop liable for the destruction of
the plaintiff’s house in a fire which started in his
establishment in view of his failure to comply with an
ordinance which required the construction of a firewall. In
Teague v. Fernandez, we stated that where the very injury
which was intended to be prevented by the ordinance has
happened, non-compliance with the ordinance was not only
an act23of negligence, but also the proximate cause of the
death.
In fine, violation of a statutory duty is negligence.
Where the law imposes upon a person the duty to do
something, his omission or non-performance will render
him liable to whoever may be injured thereby.
Section 2 of Republic Act (R.A.) No. 4688, otherwise
known as The Clinical Laboratory Law, provides:

_______________

21 Garcia-Rueda v. Pascasio, 344 Phil. 323, 331; 278 SCRA 769, 778
(1997).
22 Department of Health (DOH) Administrative Order 49-B (1988), Sec.
3.
23 Cipriano v. Court of Appeals, 331 Phil. 1019, 1025; 263 SCRA 711,
717 (1996).

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576 SUPREME COURT REPORTS ANNOTATED


Garcia, Jr. vs. Salvador

“Sec. 2. It shall be unlawful for any person to be professionally in-


charge of a registered clinical laboratory unless he is a licensed
physician duly qualified in laboratory medicine and authorized by
the Secretary of Health, such authorization to be renewed
annually.

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No license shall be granted or renewed by the Secretary of


Health for the operation and maintenance of a clinical laboratory
unless such laboratory is under the administration, direction and
supervision of an authorized physician, as provided for in the
preceding paragraph.”

Corollarily, Sections 9(9.1)(1), 11 and 25(25.1)(1) of the


DOH Administrative Order No. 49-B Series of 1988,
otherwise known as the Revised Rules and Regulations
Governing the Registration, Operation and Maintenance of
Clinical Laboratories in the Philippines, read:

“Sec. 9. Management of the Clinical Laboratory:

9.1 Head of the Clinical Laboratory: The head is that person who
assumes technical and administrative supervision and control of the
activities in the laboratory.
For all categories of clinical laboratories, the head shall be a licensed
physician certified by the Philippine Board of Pathology in either
Anatomic or Clinical Pathology or both provided that:
(1) This shall be mandatory for all categories of freestanding clinical
laboratories; all tertiary category hospital laboratories and for all
secondary category hospital laboratories located in areas with sufficient
available pathologist.

xxxx
Sec. 11. Reporting: All laboratory requests shall be considered
as consultations between the requesting physician and
pathologist of the laboratory. As such all laboratory reports on
various examinations of human specimens shall be construed as
consultation report and shall bear the name of the pathologist or
his associate. No person in clinical laboratory shall issue a report,
orally or in writing, whole portions thereof without a directive
from the pathologist or his authorized associate and only to the
requesting physician or his

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Garcia, Jr. vs. Salvador

authorized representative except in emergencies when the results


may be released as authorized by the pathologist.
xxxx

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Sec. 25. Violations:


25.1 The license to operate a clinical laboratory may be
suspended or revoked by the Undersecretary of Health for
Standards and Regulation upon violation of R.A. 4688 or the rules
and regulations issued in pursuance thereto or the commission of
the following acts by the persons owning or operating a clinical
laboratory and the persons under their authority.

(1) Operation of a Clinical Laboratory without a certified pathologist or


qualified licensed physician authorized by the Undersecretary of Health
or without employing a registered medical technologist or a person not
registered as a medical technologist in such a position.”

And Section 29(b) of R.A. No. 5527, otherwise known as


The Philippine Medical Technology Act of 1969, reads:

“Section 29. Penal Provisions.—Without prejudice to the provision


of the Medical Act of 1959, as amended relating to illegal practice
of Medicine, the following shall be punished by a fine of not less
than two thousand pesos nor more than five thousand pesos, or
imprisonment for not less than six months nor more than two
years, or both, in the discretion of the court:
xxxx
(b) Any medical technologist, even if duly registered, who shall
practice medical technology in the Philippines without the
necessary supervision of a qualified pathologist or physician
authorized by the Department of Health;”

From the foregoing laws and rules, it is clear that a clinical


laboratory must be administered, directed and supervised
by a licensed physician authorized by the Secretary of
Health, like a pathologist who is specially trained in
methods of laboratory medicine; that the medical
technologist must be under the supervision of the
pathologist or a licensed physician; and that the results of
any examination may be released only to
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578 SUPREME COURT REPORTS ANNOTATED


Garcia, Jr. vs. Salvador

the requesting physician or his authorized representative


upon the direction of the laboratory pathologist.

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These rules are intended for the protection of the public


by preventing performance of substandard clinical
examinations by laboratories whose personnel are not
properly supervised. The public demands no less than an
effective and efficient performance of clinical laboratory
examinations through compliance with the quality
standards set by laws and regulations.
We find that petitioner Garcia failed to comply with
these standards.
First, CDC is not administered, directed and supervised
by a licensed physician as required by law, but 24by Ma.
Ruby C. Calderon, a licensed Medical Technologist. In the
License to Open and Operate a Clinical Laboratory for the
years 1993 and 1996 issued by Dr. Juan R. Nañagas, M.D.,
Undersecretary for Health Facilities, Standards and
Regulation, defendant-appellee
25
Castro was named as the
head of CDC. However, in his Answer with Counterclaim,
he stated:

“3. By way of affirmative and special defenses, defendant


pathologist further avers and plead as follows:

Defendant pathologist is not the owner of the Community Diagnostic


Center nor an employee of the same nor the employer of its employees.
Defendant pathologist comes to the Community Diagnostic Center when
and where a problem is referred to him. Its employees are licensed under
the Medical Technology Law (Republic Act No. 5527) and are certified by,
and registered with, the Professional Regulation Commission after
having passed their Board Examinations. They are competent within the
sphere of their own profession in so far as conducting laboratory
examinations and are allowed to sign for and in behalf of the clinical
laboratory. The defendant pathologist, and all pathologists in general,
are hired by laboratories

_______________

24 Records, p. 193.
25 Id., at pp. 456-457.

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for purposes of complying with the rules and regulations and orders
issued by the Department of Health through the Bureau of Research and
Laboratories. Defendant pathologist does not stay that long period of
time at the Community Diagnostic Center but only periodically or
whenever a case is referred to him by the laboratory. Defendant
pathologist does not appoint or select the employees of the laboratory nor
26

does he arrange or approve their schedules of duty.”

Castro’s infrequent visit to the clinical laboratory barely


qualifies as an effective administrative supervision and
control over the activities in the laboratory. “Supervision
and control” means the authority to act directly whenever a
specific function is entrusted by law or regulation to a
subordinate; direct the performance of duty; restrain the
commission of acts; review, approve, revise or 27
modify acts
and decisions of subordinate officials or units.
Second, Garcia conducted the HBsAG test of respondent
Ranida without the supervision of defendant-appellee
Castro, who admitted that:

“[He] does not know, and has never known or met, the plaintiff-
patient even up to this time nor has he personally examined any
specimen, blood, urine or any other tissue, from the plaintiff-
patient otherwise his own handwritten signature would have
appeared in the result and not merely 28
stamped as shown in
Annex “B” of the Amended Complaint.”

Last, the disputed HBsAG test result was released to


respondent Ranida without 29
the authorization of
defendantappellee Castro.
Garcia may not have intended to cause the consequences
which followed after the release of the HBsAG test result.

_______________

26 Id., at pp. 72-73.


27 Jalandoni v. Drilon, 383 Phil. 855, 868; 327 SCRA 107, 118 (2000).
28 Records, p. 73.
29 Id.

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However, his failure to comply with the laws and rules


promulgated and issued for the protection of public safety
and interest is failure to observe that care which a
reasonably prudent health care provider would observe.
Thus, his act or omission constitutes a breach of duty.
Indubitably, Ranida suffered injury as a direct
consequence of Garcia’s failure to comply with the mandate
of the laws and rules aforequoted. She was terminated
from the service for failing the physical examination;
suffered anxiety because of the diagnosis; and was
compelled to undergo several more tests. All these could
have been avoided had the proper safeguards been
scrupulously followed in conducting the clinical
examination and releasing the clinical report.
Article 20 of the New Civil Code provides:

“Art. 20. Every person who, contrary to law, willfully or


negligently causes damage to another, shall indemnify the latter
for the same.”

The foregoing provision provides the legal basis for the


award of damages to a party who suffers damage whenever 30
one commits an act in violation of some legal provision.
This was incorporated by the Code Commission to provide
relief to a person who suffers31damage because another has
violated some legal provision.
We find the Court of Appeals’ award of moral damages
reasonable under the circumstances bearing in mind the
mental trauma suffered by respondent Ranida who thought
she was afflicted by Hepatitis B, making
32
her “unfit or
unsafe for any type of employment.” Having established
her right to moral damages, we see no reason to disturb the
award of exemplary

_______________

30 Carpio v. Valmonte, G.R. No. 151866, September 9, 2004, 438 SCRA


38, 47-48.
31 Sanco, Cezar S., Torts and Damages (1994), Volume II, p. 748.
32 Records, p. 199.

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Garcia, Jr. vs. Salvador

damages and attorney’s fees. Exemplary damages are


imposed, by way of example or correction for the public
good, in addition to moral,
33
temperate, liquidated or
compensatory damages, and attorney’s fees may be
recovered when,
34
as in the instant case, exemplary damages
are awarded.
WHEREFORE, the Decision of the Court of Appeals in
CAG.R. CV No. 58668 dated February 27, 2004 finding
petitioner Orlando D. Garcia, Jr. guilty of gross negligence
and liable to pay to respondents P50,000.00 as moral
damages, P50,000.00 as exemplary damages, and
P25,000.00 as attorney’s fees, is AFFIRMED.
SO ORDERED.

     Austria-Martinez, Chico-Nazario and Nachura, JJ.,


concur.
     Callejo, Sr., J., On Leave.

Judgment affirmed.

Notes.—Our jurisprudence is wanting as to the definite


scope of “corporate tort.” (Naguiat vs. National Labor
Relations Commission, 269 SCRA 564 [1997])
Although no law requires the passing of psychological
and physical tests prior to employment, such circumstance
would certainly be a reliable indicator of the exercise of due
diligence. (Sanitary Steam Laundry, Inc. vs. Court of
Appeals, 300 SCRA 20 [1998])

——o0o——

_______________

33 Civil Code, Article 2229.


34 Civil Code, Article 2208.

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