G.R. No. 118231 July 5, 1996DR. VICTORIA L.

BATIQUIN and ALLAN BATIQUIN

vs.
COURT OF APPEALS, SPOUSES QUEDO D.ACOGIDO and FLOTILDE G. VILLEGAS

FACTS:
In September 21, 1988 Dr. Batiquin, with the assistance of Dr. Doris Teresita Sy and O.R. Nurse ArleneDiones and some student
nurses performed a simple caesarean section on Mrs. Villegas at the NegrosOriental Provincial Hospital. after leaving the
Hospital Mrs. Villegas began to suffer abdominal pains andcomplained of being feverish. The abdominal pains and fever kept
on recurring and bothered Mrs.Villegas no end despite the medications administered by Dr. Batiquin. When the pains
becameunbearable and she was rapidly losing weight she consulted Dr. Ma. Salud Kho at the Holy Child'sHospital in
Dumaguete City on January 20, 1989. Blood test shown that Mrs. Villegas had an infectioninside her abdominal cavity.
Thereafter Dr. Kho suggested to Mrs. Villegas to submit to another surgeryto which the latter agreed.When Dr. Kho opened the
abdomen of Mrs. Villegas she found a "foreign body" looked like a piece of a"rubber glove". . . and which
"rubber-drain like". . . . It could have been a torn section of asurgeon's gloves or could have come from other sources. And this
foreign body was the cause of theinfection of the ovaries and consequently of all the discomfort suffered by Mrs. Villegas after herdelivery
on September 21, 1988.

ISSUE:

Whether or not a doctor may be held liable for damages for alleged negligence in the conduct ofan operation on the ground of
finding a foreign object inside the body of the patient in a subsequentoperation.
HELD:
Yes. The rule of res ipsa loquitur comes to fore. This Court has had occasion to delve into the nature andoperation of this doctrine:
This doctrine [res ipsa loquitur] is stated thus: "Where the thing which causes injury isshown to be under the management
of the defendant, and the accident is such as in theordinary course of things does not happen in those who have the
management use proper care, it affords reasonable evidence, in the absence of an explanation by thedefendant, that
the accident arose from want of care.
In the instant case, all the requisites for recourse to the doctrine are present. First, the entireproceedings of the caesarean section were
under the exclusive control of Dr. Batiquin. In this light, theprivate respondents were bereft of direct evidence as to the actual
culprit or the exact cause of theforeign object finding its way into private respondent Villegas's body, which, needless to say, does
notoccur unless through the intersection of negligence. Second, since aside from the caesarean section,private respondent Villegas
underwent no other operation which could have caused the offending pieceof rubber to appear in her uterus, it stands to reason
that such could only have been a by-product of thecaesarean section performed by Dr. Batiquin. The petitioners, in
this regard, failed to overcome thepresumption of negligence arising from resort to the doctrine of
res ipsa loquitur
Dr. Batiquin istherefore liable for negligently leaving behind a piece of rubber in private respondent Villegas'sabdomen
and for all the adverse effects thereof.

RAMOS vs. COURT OF APPEALS

G.R. No. 124354. December 29, 1999.

FACTS:
Erlinda Ramos underwent a surgical procedure to remove stone from her gall bladder (cholecystectomy). They hired
Dr. Hosaka, a surgeon, to conduct the surgery at the De Los Santos Medical Center (DLSMC). Hosaka assured them
that he would find a good anesthesiologist. But the operation did not go as planned, Dr. Hosaka arrived 3 hours late for
the operation, Dra. Gutierrez, the anesthesiologist “botched” the administration of the anesthesia causing Erlinda to go
into a coma and suffer brain damage. The botched operation was witnessed by Herminda Cruz, sister in law of Erlinda
and Dean of College of Nursing of Capitol Medical Center.

The family of Ramos (petitioners) sued the hospital, the surgeon and the anesthesiologist for damages. The petitioners
showed expert testimony showing that Erlinda's condition was caused by the anesthesiologist in not exercising
reasonable care in “intubating” Erlinda. Eyewitnesses heard the anesthesiologist saying “Ang hirap ma-intubate nito,
mali yata ang pagkakapasok. O lumalaki ang tiyan.”

Diagnostic tests prior to surgery showed that Erlinda was robust and fit to undergo surgery.

The RTC held that the anesthesiologist ommitted to exercise due care in intubating the patient, the surgeon was
remiss in his obligation to provide a “good anesthesiologist” and for arriving 3 hours late and the hospital is liable for
the negligence of the doctors and for not cancelling the operation after the surgeon failed to arrive on time. The
surgeon, anesthesiologist and the DLSMC were all held jointly and severally liable for damages to petitioners. The CA
reversed the decision of the Trial Court.

ISSUES: Whether or not the private respondents were negligent and thereby caused the comatose condition of
Ramos.

HELD:

Yes, private respondents were all negligent and are solidarily liable for the damages.

RATIO:

Res ipsa loquitur – a procedural or evidentiary rule which means “the thing or the transaction speaks for itself.” It is a
maxim for the rule that the fact of the occurrence of an injury, taken with the surrounding circumstances, may permit
an inference or raise a presumption of negligence, or make out a plaintiff’s prima facie case, and present a question of
fact for defendant to meet with an explanation, where ordinarily in a medical malpractice case, the complaining party
must present expert testimony to prove that the attending physician was negligent.

This doctrine finds application in this case. On the day of the operation, Erlinda Ramos already surrendered her
person to the private respondents who had complete and exclusive control over her. Apart from the gallstone problem,
she was neurologically sound and fit. Then, after the procedure, she was comatose and brain damaged—res ipsa
loquitur!—the thing speaks for itself!

Negligence – Private respondents were not able to disprove the presumption of negligence on their part in the care of
Erlinda and their negligence was the proximate cause of her condition. One need not be an anesthesiologist in order to
tell whether or not the intubation was a success. [res ipsa loquitur applies here]. The Supreme Court also found that
the anesthesiologist only saw Erlinda for the first time on the day of the operation which indicates unfamiliarity with the
patient and which is an act of negligence and irresponsibility.
The head surgeon, Dr. Hosaka was also negligent. He failed to exercise the proper authority as the “captain of the
ship” in determining if the anesthesiologist observed the proper protocols. Also, because he was late, he did not have
time to confer with the anesthesiologist regarding the anesthesia delivery.

The hospital failed to adduce evidence showing that it exercised the diligence of a good father of the family in hiring
and supervision of its doctors (Art. 2180). The hospital was negligent since they are the one in control of the hiring and
firing of their “consultants”. While these consultants are not employees, hospitals still exert significant controls on the
selection and termination of doctors who work there which is one of the hallmarks of an employer-employee
reationship. Thus, the hospital was allocated a share in the liability.

Cruz vs Court of Appeals

GR No. 122445 November 18, 1997

Facts:

On March 22, 1991, prosecution witness, Rowena Umali de Ocampo, accompanied her mother to the Perpetual Help
Clinic and General Hospital situated in Balagtas Street, San Pablo City, Laguna. They arrived at the said hospital at
around 4:30 in the afternoon of the same day. Prior to March 22, 1991, Lydia was examined by the petitioner who
found a “Myoma” in her uterus, and scheduled her for a hysterectomy operation on March 23, 1991. Rowena and her
mother slept in the clinic on the evening of March 22, 1991 as the latter was to be operated on the next day at 1pm.
According to Rowena, she noticed that the clinic was untidy and the windows and the floor were very dusty prompting
her to ask the attendant fora rag to wipe the window and floor with. Prior to the operation, Rowena tried to convince
her mother to not proceed with the operation and even asked petitioner for it to be postponed, however it still pushed
through after the petitioner told Lydia that operation must be done as scheduled. During the operation, the assisting
doctor of the petitioner, Dr. Ercillo went out of the operating room and asked that tagmet ampules be bought which
was followed by another instruction to buy a bag of blood. After the operation, when Lydia came out of the OR, another
bag of blood was requested to be bought, however, the same was not bought due to unavailability of type A from the
blood bank. Thereafter a person arrived to donate blood which was later transferred to Lydia. Rowena then noticed her
mother, who was attached to an oxygen tank, gasping for breathe apparently, the oxygen tank is empty, so her
husband and petitioner’s driver bought an oxygen. Later, without the knowledge of Lydia’s relatives,she was decided
by the doctors to be transferred to San Pablo District Hospital were she was supposed to be re-operated. After Lydia
experienced shocks, she died.
Issue:

Whether or not petitioner has been negligent which caused the death of Lydia Umali.
Held:

Yes. Whether or not a physician has committed an “inexcusable lack of precaution” in the treatment of his patient to be
determined according to the standard of care observed by other members of the profession in good standing under
similar circumstances bearing in mind the advanced state of the profession at the time of treatment or the present
state of medical science. A doctor in effect represents that, having the needed training and skill possessed by
physicians and surgeons practicing in the same field, he will employ such training, care and skill in the treatment of his
patients. He therefore has a duty to use at least the same level of care that any other reasonably competent doctor
would use to treat a condition under the same circumstances. It is in this aspect of medical malpractice that expert
testimony is essential to establish not only the standard of care of the profession but also that the physician’s conduct
in the treatment and care falls below such standard. Further, in as much 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 the conclusion as to causation.
In litigations involving medical negligence, the plaintiff has the burden of establishing appellant’s negligence and for a
reasonable conclusion of negligence, there must be proof of breach of duty on the part of the surgeon as well
as causal connection of such breach and the resulting death of his patient.
In order that there may be recovery for an injury, however, it must be shown that the injury for which recovery is sought
must be legitimate consequence of the wrong done; the connection between the negligence and the injury must be a
direct and natural reference of events, unbroken by intervening efficient causes. In other words, the negligence must
be the proximate cause of the injury. For negligence, no matter what it consists, cannot create a right of action unless
it is the proximate cause of the injury complained of and the proximate cause of an injury is that cause, which in
natural and continuous sequence, unbroken by any efficient intervening cause, produces the injury and without which
the result would have occurred.
GARCIA-RUEDA vs. PASCASIO

FACTS:

Florencio V. Rueda, husband of petitioner Leonila Garcia-Rueda, underwent surgicaloperation at the UST hospital for
the removal of a stone blocking his ureter. He was attended byDr. Domingo Antonio, Jr. who was the surgeon, while
Dr. Erlinda Balatbat-Reyes was
thea n a e s t h e s i o l o g i s t . S i x h o u r s a f t e r t h e s u r g e r y , h o w e v e r , F l o r e n c i o d i e d o f c o m p l i c a t i o n s o
f "unknown cause," according to officials of the UST Hospital.Not satisfied with the findings of the hospital, petitioner
requested the National Bureau ofInvestigation (NBI) to conduct an autopsy on her husband's body. Consequently, the
NBI ruled thatFlorencio's death was due to lack of care by the attending physician in administering
anaesthesia.Pursuant to its findings, the NBI recommended that Dr. Domingo Antonio and Dr. Erlinda Balatbat-Reyes
be charged for Homicide through Reckless Imprudence before the Office of the CityProsecutor.During the
preliminary investigation, what transpired was a confounding series of eventswhich we shall try to
disentangle. The case was initially assigned to Prosecutor Antonio M. Israel,who had to inhibit himself because he
was related to the counsel of one of the doctors. As a result,the case was re-raffled to Prosecutor Norberto G. Leono
who was, however, disqualified on motionof the petitioner since he disregarded prevailing laws and
jurisprudence regarding preliminaryinvestigation. The case was then referred to Prosecutor Ramon O. Carisma,
who issued a resolutionrecommending that only Dr. Reyes be held criminally liable and that the complaint
against Dr.Antonio be dismissed.The case took another perplexing turn when Assistant City Prosecutor
Josefina SantosSioson, in the "interest of justice and peace of mind of the parties," recommended that the case
bere-raffled on the ground that Prosecutor Carisma was partial to the petitioner. Thus, the case wastransferred
to Prosecutor Leoncia R. Dimagiba, where a
volte face o c c u r r e d a g a i n w i t h t h e endorsement that the complaint against Dr. Reyes
be dismissed and instead, a correspondinginformation be filed against Dr. Antonio. Petitioner filed a motion for
reconsideration, questioningthe findings of Prosecutor
Dimagiba.Pending the resolution of petitioner's motion for reconsideration regarding ProsecutorDimagiba's
resolution, the investigative "pingpong" continued when the case was again assigned toanother prosecutor,
Eudoxia T. Gualberto, who recommended that Dr. Reyes be included in
thecriminal information of Homicide through Reckless Imprudence. While
the recommendation ofProsecutor Gualberto was pending, the case was transferred to Senior State Prosecutor
GregorioA. Arizala, who resolved to exonerate Dr. Reyes from any wrongdoing, a resolution which
wasapproved by both City Prosecutor Porfirio G. Macaraeg and City Prosecutor Jesus F.
Guerrero.Aggrieved, petitioner filed graft charges specifically for violation of Section 3(e) ofRepublic Act
No. 30193 against Prosecutors Guerrero, Macaraeg, and Arizala for manifest
partialityin favor of Dr. Reyes before the Office of the Ombudsman. However, on July 11, 1994, theOmbudsman
issued the assailed resolution dismissing the complaint for lack of evidence.In fine, petitioner assails the exercise
of the discretionary power of the Ombudsman toreview the recommendations of the government
prosecutors and to approve and disapprove thesame. Petitioner faults the Ombudsman for, allegedly in grave
abuse of discretion, refusing to findthat there exists probable cause to hold public respondent City Prosecutors liable
for violation ofSection 3(e) of R.A. No. 3019.

ISSUE: Whether or not expert testimony is necessary to prove the negligent act of the respondent.

HELD:

In accepting a case, a doctor in effect represents that,

having the needed training andskill possessed by physicians and surgeons practicing in the same field,
he will employ such

training, care and skill in the treatment of his patients. He therefore has a duty to use atleast the same
level of care that any other reasonably competent doctor would use to treat acondition under the same circumstances.
It is in this aspect of medical malpractice that experttestimony is essential to establish not only the standard of care of
the profession but also that thephysician's conduct in the treatment and care falls below such standard. Further,
inasmuch as thecauses of the injuries involved in malpractice actions are determinable only in the light of
scientificknowledge, it has been recognized that
expert testimony is usually necessary to support theconclusion as to causation.
Immediately apparent from a review of the records of this case is the absence of anyexpert testimony
on the matter of the standard of care employed by other physicians of goodstanding in the conduct of similar
operations. The prosecution's expert witnesses in the persons ofDr. Floresto Arizala and Dr. Nieto Salvador, Jr. of the
National Bureau of Investigation (NBI) onlytestified as to the possible cause of death but did not venture to illuminate
the court on the matterof the standard of care that petitioner should have exercised.The better and more logical
remedy under the circumstances would have been to appeal theresolution of the City Prosecutors dismissing
the criminal complaint to the Secretary of Justiceunder the Department of Justice's Order No. 223, otherwise
known as the "1993 Revised Rules onAppeals From Resolutions In Preliminary Investigations/Reinvestigations," as
amended byDepartment Order No. 359, Section 1 of which provides:Sec. 1.
What May Be Appealed
. — Only resolutions of the Chief
StateProsecutor/Regional State Prosecutor/Provincial or City Prosecutor dismissing acriminal complaint
may be the subject of an appeal to the Secretary of Justiceexcept as otherwise provided in Section
4 hereof.What action may the Secretary of Justice take on the appeal? Section 9 of Order No. 223states: "The
Secretary of Justice may reverse, affirm or modify the appealed resolution." On theother hand, "He may
motu proprio
or on motion of the appellee, dismiss outright the appeal onspecified grounds."In exercising his discretion
under the circumstances, the Ombudsman acted within hispower and authority in dismissing the
complaint against the Prosecutors and this Court will notinterfere with the same.Petition is dismissed

Carillo vs. People of the Philippines

FACTS:

The deceased, Catherine Acosta, a 13 year old girl, daughter of spouses Domingo and Yolanda Acosta, complained to
her father at about 10:30 o'clock in the morning of May 31, 1981 of pains in the lower part of her abdomen. Catherine
was then brought to Dr. Elva Peña. Dra. Peña called for Dr. Emilio Madrid and the latter examined Catherine Acosta.
According to Dr. Madrid, his findings might be appendicitis. Then Dr. Peña told Catherine's parents to bring the child to
the hospital in Baclaran so that the child will be observed. At the Baclaran General Hospital, a nurse took blood
sample form the child. The findings became known at around 3:00 o'clock in the afternoon and the child was
scheduled for operation at 5:00 o'clock in the afternoon. The operation took place at 5:45 p.m. because Dr. Madrid
arrived only at that time. When brought inside the operating room, the child was feeling very well and they did not
subject the child to ECG (electrocardiogram) and
X-ray. The appellant Dr. Emilio Madrid, a surgeon, operated on Catherine. He was assisted by appellant, Dr. Leandro
Carillo, an anesthesiologists.

During the operation, while Yolanda Acosta, Catherine's mother, was staying outside the operating room, she "noticed
something very unfamiliar." The three nurses who assisted in the operation were going in and out of the operating
room, they were not carrying anything, but in going out of the operating room, they were already holding something.
Yolanda asked one of the nurses if she could enter the operating room but she was refused.
At around 6:30 p.m., Dr. Emilio Madrid went outside the operating room and Yolanda Acosta was allowed to enter the
first door.

The appendicitis (sic) was shown to them by Dr. Madrid, because, according to Dr. Madrid, they might be wondering
because he was going to install drainage near the operating (sic) portion of the child.
When asked, the doctor told them the child was already out of danger but the operation was not yet finished.

It has also been established that the deceased was not weighed before the administration of anesthesia on her.

When Catherine remained unconscious until noontime the next day, a neurologist examined her and she was
diagnosed as comatose. Three (3) days later, Catherine died without regaining consciousness.

ISSUE:

Whether or not Dr. Carillo is guilty of the crime of simple negligence resulting in homicide.

HELD:

Simple negligence, penalized under what is now Article 365 of the Revised Penal Code, is defined as "a mere lack of
prevision in a situation where either the threatened harm is not immediate or the danger not openly visible." Put in a
slightly different way, the gravamen of the offense of simple negligence is the failure to exercise the diligence
necessitated or called for the situation which was not immediately life-destructive but which culminated, in the present
case, in the death of a human being three (3) days later. In the case at bar, we consider that the chain of
circumstances above noted, namely: (1) the failure of petitioner and Dr. Madrid to appreciate the serious post-surgery
condition of their patient and to monitor her condition and provide close patient care to her; (2) the summons of
petitioner by Dr. Madrid and the cardiologist after the patient's heart attack on the very evening that the surgery was
completed; (3) the low level of care and diligence exhibited by petitioner in failing to correct Dr. Madrid's prescription of
Nubain for post-operative pain; (4) the extraordinary failure or refusal of petitioner and Dr. Madrid to inform the parents
of Catherine Acosta of her true condition after surgery, in disregard of the requirements of the Code of Medical Ethics;
and (5) the failure of petitioner and Dr. Madrid to prove that they had in fact exercised the necessary and appropriate
degree of care and diligence to prevent the sudden decline in the condition of Catherine Acosta and her death three
(3) days later, leads the Court to the conclusion, with moral certainty, that petitioner and Dr. Madrid were guilty of
simple negligence resulting in homicide.

Reyes Vs. Sisters Of Mercy

Facts:

Jorge Reyes has been suffering from recurring fever with chills for around days.
Home medication afforded him no relief so he went to Mercy Community Clinic. He was then attended by Dr. Marlyn
Rico. Since typhoid fever was common at that time, the Widal test was performed and he was found positive for
typhoid.
Thereafter, Dr. Marlyn Rico indorse Jorge Reyes to Dr. Marvie Blanes.
Suspecting that that Jorge had typhoid fever, Dr. Marvie Blanes ordered that Jorge be tested for compatibility with
chloromycetin, an antibiotic. Such test was conducted by Nurse Pagente.
As there was no adverse reaction, Dr. Blanes administered 500 mg of the antibiotic. Another dose was given 3 hours
later.
Subsequently, Jorge Reyes developed high fever and experienced vomiting and convulsions. He then turned blue
due to deficiency in oxygen – cyanosis – and died. The cause of death was stated to be “ventricular arrhythmia
secondary to hyperpyrexia and typhoid fever.”
The heirs of Reyes filed with the RTC a complaint for damages against Sisters of Mercy, Sister Rose Palacio, Dr.
Blanes, Dr. Rico and Mercy Community Clinic contending that the death of Jorge was due to the wrongful
administration of chloromycetin. (NOTE: Petitioner’s action is for medical malpractice.)
RTC ruled in favor of the respondents. The CA affirmed in toto the RTC decision. Hence, this appeal.
Petitioners contend that:
Dr. Marlyn Rico hastily and erroneously relied upon the Widal test, diagnosed Jorge’s illness as typhoid fever,
and immediately prescribed the administration of the antibiotic chloromycetin
Dr. Marvie Blanes erred in ordering the administration of the second dose of 500 milligrams of chloromycetin
barely 3 hours after the first was given.

Testimony presented: That of Dr. Apolinar Vacalares, (Chief Pathologist of the Northern Mindanao Training Hospital)
who performed an autopsy on the body – Dr. Vacalares testified that Reyes did not die of typhoid fever but of shock
undetermined, which could be due to allergic reaction or chloromycetin overdose.

Issue: WON there was medical malpractice.

Held:

NO
Dr. Apolinar Vacalares is not a specialist of typhoid fever and he is thus not qualified to prove that Dr. Marlyn Rico
erred in her diagnosis.
While petitioners presented Dr. Apolinar Vacalares as an expert witness, we do not find him to be so as he is not a
specialist on infectious diseases like typhoid fever. Furthermore, although he may have had extensive experience in
performing autopsies, he admitted that he had yet to do one on the body of a typhoid victim at the time he conducted
the postmortem on Jorge Reyes. It is also plain from his testimony that he has treated only about three cases of
typhoid fever.

The two doctors presented by respondents clearly were experts on the subject
They vouched for the correctness of Dr. Marlyn Rico’s diagnosis. Dr. Peter Gotiong, a diplomate whose specialization
is infectious diseases and microbiology and an associate professor at the Southwestern University College of Medicine
and the Gullas College of Medicine, testified that he has already treated over a thousand cases of typhoid fever.
According to him, when a case of typhoid fever is suspected, the Widal test is normally used, and if the 1:320 results of
the Widal test on Jorge Reyes had been presented to him along with the patient’s history, his impression would also
be that the patient was suffering from typhoid fever. As to the treatment of the disease, he stated that chloromycetin
was the drug of choice. He also explained that despite the measures taken by respondent doctors and the intravenous
administration of two doses of chloromycetin, complications of the disease could not be discounted.

Respondents also presented the testimony of Dr. Ibarra T. Panopio who is a member of the Philippine and American
Board of Pathology, an examiner of the Philippine Board of Pathology, and chief pathologist at the MetroCebu
Community Hospital, Perpetual Succor Hospital, and the Andres Soriano Jr. Memorial Medical Center.

He stated that, as a clinical pathologist, he recognized that the Widal test is used for typhoid patients, although he did
not encourage its use because a single test would only give a presumption necessitating that the test be repeated,
becoming more conclusive at the second and third weeks of the disease.

He corroborated Dr. Gotiong’s testimony that the danger with typhoid fever is really the possible complications which
could develop like perforation, hemorrhage, as well as liver and cerebral complications.

Dr. Rico was not negligent in administering the 2 doses of 500 g of chloromycetin
The chloromycetin was likewise a proper prescription is best established by medical authority. Even if the deceased
suffered from an anaphylactic shock, this, of itself, would not yet establish the negligence of the appellee-physicians
for all that the law requires of them is that they perform the standard tests and perform standard procedures. The law
cannot require them to predict every possible reaction to all drugs administered.

The practice of medicine requires the highest degree of diligence

The practice of medicine is a profession engaged in only by qualified individuals. It is a right earned through years of
education, training, and by first obtaining a license from the state through professional board examinations. Such
license may, at any time and for cause, be revoked by the government. In addition to state regulation, the conduct of
doctors is also strictly governed by the Hippocratic Oath, an ancient code of discipline and ethical rules which doctors
have imposed upon themselves in recognition and acceptance of their great responsibility to society. Given these
safeguards, there is no need to expressly require of doctors the observance of “extraordinary” diligence.
As it is now, the practice of medicine is already conditioned upon the highest degree of diligence. And, as we have
already noted, the standard contemplated for doctors is simply the reasonable average merit among ordinarily good
physicians. That is reasonable diligence for doctors or, as the Court of Appeals called it, the reasonable “skill and
competence . . . that a physician in the same or similar locality . . . should apply.”

There are thus four elements involved in medical negligence cases, namely: duty, breach, injury, and proximate
causation
Petitioner’s action is for medical malpractice. This 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 have done, or that he or she did something that a
reasonably prudent physician or surgeon would not have done, and that the failure or action caused injury to the
patient.

The doctrine of Res Ipsa Loquitor is not applicable in this case.

Was there a physician-patient relationship between the respondent doctors and Jorge Reyes? Yes.
Respondents were thus 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. It is breach of this duty which constitutes actionable
malpractice.

As to this aspect of medical malpractice, the determination of the reasonable level of care and the breach thereof,
expert testimony is essential. 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.

The doctrine of res ipsa loquitor is not applicable in the case at bar
Though expert testimony is usually needed to prove malpractice, where common knowledge and experience teach
that the injury would not have occurred if due care had been exercised, the doctrine of res ipsa loquitur can be invoked
to establish negligence.

Hence, in cases where the res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon
proper proof of injury to the patient, without the aid of expert testimony, where the court from its fund of common
knowledge can determine the proper standard of care. Where common knowledge and experience teach that a
resulting injury would not have occurred to the patient if due care had been exercised, an inference of negligence may
be drawn giving rise to an application of the doctrine of res ipsa loquitur without medical evidence, which is ordinarily
required to show not only what occurred but how and why it occurred.

When the doctrine is appropriate, all that the patient must do is prove a nexus between the particular act or omission
complained of and the injury sustained while under the custody and management of the defendant without need to
produce expert medical testimony to establish the standard of care.

There is nothing unusual about the death of Jorge Reyes (absence of 1st requisite that the accident was of a kind
which does not ordinarily occur unless someone is negligent)
In this case, while it is true that the patient died just a few hours after professional medical assistance was rendered,
there is really nothing unusual or extraordinary about his death.

Prior to his admission, the patient already had recurring fevers and chills for five days unrelieved by the analgesic,
antipyretic, and antibiotics given him by his wife. This shows that he had been suffering from a serious illness and
professional medical help came too late for him.

It must be conceded that the doctrine of res ipsa loquitur can have no application in a suit against a physician or a
surgeon which involves the merits of a diagnosis or of a scientific treatment. The physician or surgeon is not required
at his peril to explain why any particular diagnosis was not correct, or why any particular scientific treatment did not
produce the desired result.