MEDICAL PROFESSIONALS / MEDICAL MALPRACTICE CASES
44. Regina Capanzana was brought to petitioner hospital for (1) Whether or not
an emergency C-section. On that same day, she gave
OUR LADY OF birth to a baby boy. 13 hours after her operation, Regina
LOURDES complained of a headache, a chilly sensation,
HOSPITAL vs restlessness, and shortness of breath. She asked for
SPOUSES oxygen and later became cyanotic. After undergoing an x-
CAPANZANA ray, she was found to be suffering from pulmonary
edema. She was eventually transferred to the Intensive
G.R. No. 189218 Care Unit, where she was hooked to a mechanical
ventilator.
When her condition still showed no improvement, Regina
was transferred to the Cardinal Santos Hospital. The
doctors thereat found that she was suffering from
rheumatic heart disease mitral stenosis with mild
pulmonary hypertension, which contributed to the onset
of fluid in her lung tissue (pulmonary edema). This
development resulted in cardiopulmonary arrest and,
subsequently, brain damage. Regina lost the use of her
speech, eyesight, hearing and limbs.
Respondent spouses Capanzana filed a complaint for
damages against petitioner hospital, along with co-
defendants: Dr. Miriam Ramos, an
obstetrician/gynecologist; Dr. Milagros Joyce Santos, an
anesthesiologist; and Jane Does, the nurses on duty
stationed on the second floor of petitioner hospital on 26-
27 December 1997.
Respondents imputed negligence to Drs. Ramos and
Santos for the latter's failure to detect the heart disease of
Regina, resulting in failure not only to refer her to a
cardiologist for cardiac clearance, but also to provide the
appropriate medical management before, during, and
after the operation. They further stated that the nurses
were negligent for not having promptly given oxygen, and
that the hospital was equally negligent for not making
available and accessible the oxygen unit on that same
hospital floor at the time.
RTC Ruling
RTC rendered judgment, finding no negligence on the part
of Dr. Ramos or Dr. Santos. It found that the medical
community's recognized standard practices in attending
to a patient in connection with a C-section had been duly
observed by the doctors.
On the other hand, the trial court found that negligence
on the part of the nurses contributed to the injury of
(1) YES, the nurses on duty were negligent.
the nurses on duty
were negligent. To recall, the records, including petitioner's Nurses' Notes, indisputably show that
Regina complained of difficulty in breathing before eventually showing signs of
YES cyanosis. We agree with the courts below in their finding that when she was gasping
for breath and turning cyanotic, it was the duty of the nurses to intervene
immediately by informing the resident doctor. Had they done so, proper oxygenation
(2) Whether or not
could have been restored and other interventions performed without wasting
petitioner hospital
valuable time. That such high degree of care and responsiveness was needed cannot
may be held liable for
be overemphasized - considering that according to expert medical evidence in the
its nurses’
negligence. records, it takes only five minutes of oxygen deprivation for irreversible brain
damage to set in. Indeed, the Court has emphasized that a higher degree of
caution and an exacting standard of diligence in patient management and
YES
health care are required of a hospital's staff, as they deal with the lives of
patients who seek urgent medical assistance. It is incumbent upon nurses to
take precautions or undertake steps to safeguard patients under their care from any
possible injury that may arise in the course of the latter's treatment and care.
In this regard, the court found that there was a delay in the administration of
oxygen to the patient, caused by the delayed response of the nurses of petitioner
hospital. They committed a breach of their duty to respond immediately to the needs
of Regina, considering her precarious situation and her physical manifestations of
oxygen deprivation.
It was clear that the oxygen tank came late because the request for it from the
nurses also came late. Had the nurses exercised certain degree of promptness and
diligence in responding to the patient's call for help[,] the occurrence of "hypoxic
encephalopathy" could have been avoided since lack or inadequate supply of oxygen
to the brain for 5 minutes will cause damage to it.
Regina suffered from brain damage, particularly hypoxic encephalopathy, which is
caused by lack of oxygen in the brain. And the proximate cause of the brain damage
was the delay in responding to Regina's call for help and for oxygen.
(2) YES, petitioner is directly liable for the negligence of its nurses under Article
2180 in relation to Article 2176 of the Civil Code.
For the negligence of its nurses, petitioner is thus liable under Article 2180 in
relation to Article 2176 of the Civil Code. Under Article 2180, an employer like
petitioner hospital may be held liable for the negligence of its employees based on its
responsibility under a relationship of patria potestas. The liability of the employer
under this provision is "direct and immediate; it is not conditioned upon a prior
recourse against the negligent employee or a prior showing of the insolvency of that
employee." The employer may only be relieved of responsibility upon a showing that
it exercised the diligence of a good father of a family in the selection and supervision
of its employees. The rule is that once negligence of the employee is shown, the
burden is on the employer to overcome the presumption of negligence on the latter's
part by proving observance of the required diligence.
In the instant case, there is no dispute that petitioner was the employer of the
 Regina. It found that they failed to respond immediately
when Regina was experiencing shortness of breath. It
took the nurses more or less 10 minutes after being
informed of the condition of Regina before they checked
on her, called for the resident doctor, and requested
oxygen.
On the issue of whether petitioner hospital could be held
liable for the negligence of its nurses, the RTC ruled that
the hospital was able to discharge the burden of proof
that it had exercised the diligence of a good father of a
family in the selection and supervision of its employees.
Consequently, only the nurses were held liable to pay
damages. However, since the trial court acquired
jurisdiction only over Ballano among those on duty on
that day, she was the only one held liable.
nurses who have been found to be negligent in the performance of their duties. This
fact has never been in issue. Hence, petitioner had the burden of showing that it
exercised the diligence of a good father of a family not only in the selection of the
negligent nurses, but also in their supervision.
After a careful review of the records, we find that the preponderance of evidence
supports the finding of the CA that the hospital failed to discharge its burden of
proving due diligence in the supervision of its nurses and is therefore liable for their
negligence. It must be emphasized that even though it proved due diligence in the
selection of its nurses, the hospital was able to dispose of only half the burden it
must overcome.
Indeed, whether or not the diligence of a good father of a family has been exercised
by petitioner is a matter of proof, which under the circumstances in the case at bar
has not been clearly established. The Court finds that there is not enough evidence
on record that would overturn the presumption of negligence.

CA Ruling

The CA upheld the ruling of the RTC absolving the

Doctors involved but modified the assailed decision
regarding the liability of Ballano. Contrary to the trial
court, the CA held that there was no showing whether
Ballano, who was later identified as a midwife, was
negligent in attending to the needs of Regina. Further, it
was not shown whether Ballano was even one of the
nurses on duty who had attended to Regina. The
appellate court also noted that the execution of health
care procedures and essential primary health care is a
nurse's (not a midwife's) duty.

The CA further ruled that petitioner hospital should be

held liable based on the doctrine of corporate
responsibility. Accordingly, the CA awarded to
respondents exactly the same amounts decreed by the
RTC. This time, however, instead of Ballano, petitioner
hospital was deemed directly liable to pay for those
amounts.

Only petitioner hospital filed a Motion for

Reconsideration, which the CA denied. Hence, this
petition.

45. CASUMPANG & Print

SAN JUAN DE
DIOS HOSPITAL vs
CORTEJO

46. Dr. Jaime Cruz engaged the services of St. Lukes Medical 1.Whether Dr. Agas 1. In the case at hand, Dr. Cruz failed to show that the DOJ gravely abused its
 Center (SLMC) for a medical check-up. He underwent
DR. CRUZ vs. stool, urine, bloody and other body fluid tests. He was
AGAS, JR. then sent to the Gastro-Enterology Department for a
scheduled gastroscopy and colonoscopy. The specialist
G.R. No. 204095 assigned to him was absent, so he gave the colonoscopy
June 15, 2015 results to the attending female anesthesiologist.
Thereafter he underwent the procedure, but when he
woke up he felt something was wrong. He felt dizzy, cold
MENDOZA, J. clammy perspiration and pain in his abdomen, and when
he tried to urinate he collapsed. He tried to consult the
specialist who treated him, but was nowhere to be found.
He then found his cardiologist,
Dra. Agnes Del Rosario who observed his condition and
referred him to the surgical department which suspected
that he had a hemorrhage.
Dr. Cruz agreed, and upon waking up in the ICU, he
found that 6-8 inches of his colon was missing. It was
found out that there was a tear in the colonic wall which
caused the bleeding. During his recuperation, despite the
painkillers, he was in under so much pain. Dr. Cruz
claimed that
Dr. Felicismo Agas admitted that he was the one who
conducted the colonoscopy procedure, but insisted that
nothing was wrong. Dr. Cruz was discharged from SLMC,
nevertheless he complained of having a hard time
digesting his food, he had to be fed every 2 hours because
he easily got full, and had fresh blood stools every time he
moved his bowel, and had lost his appetite and had
gastric acidity. He claimed that he was in good condition
prior to the surgery.
Dr. Cruz filed a complaint for serious physical injuries,
through reckless imprudence and medical malpractice
against Dr. Agas before office of the prosecutor.
Dr. Agas had countered that Dr. Cruz failed to prove the
basic elements of reckless impudence or medical
negligence. Furthermore, the procedure was conducted
properly considering there did not manifest any
significant adverse reaction or body resistance during the
procedures. Finally he had added certifications and sworn
statements by the: Assistant Medical Director for
Professional Services, the Director of the Institute of
Digestive Diseases, the anesthesiologist, and the hospital
nurse that testified that the intraperonial bleeding was
immediately managed and cure. The office of the
prosecutor however dismissed the case, Dr. Cruz
appealed of the DOJ which likewise dismissed the case.
is guilty of reckless discretion in finding that there was lack of probable cause and dismissing the
imprudence and complaint against Dr. Agas for Serious Physical Injuries through Reckless
medical negligence. Imprudence and Medical Malpractice.
NO A medical negligence case can prosper if the patient can present solid proof
that the doctor, like in this case, either failed to do something which a
2.Whether the reasonably prudent doctor would have done, or that he did something that a
doctrine of Res Ipsa reasonably prudent doctor would not have done, and such failure or action
Loquitur is caused injury to the patient.
applicable in the
case at hand 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
NO 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. Simply put, the elements are duty, breach, injury and proximate causation.
In this case, Dr. Cruz has the burden of showing the negligence or recklessness of
Dr. Agas. Although there is no dispute that Dr. Cruz sustained internal hemorrhage
due to a tear in the serosa of his sigmoid colon, he failed to show that it was caused
by Dr. Agas’ negligent and reckless conduct of the colonoscopy procedure. In other
words, Dr. Cruz failed to show and explain that particular negligent or reckless act
or omission committed by Dr. Agas. Stated differently, Dr. Cruz did not demonstrate
that there was “inexcusable lack of precaution” on the part of Dr. Agas.
2) NO.
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.
In this case, the Court agrees with Dr. Agas that his purported negligence in
performing the colonoscopy on Dr. Cruz was not immediately apparent to a layman
to justify the application of res ipsa loquitur doctrine.
Dr. Agas was able to establish that the internal bleeding sustained by Dr. Cruz was
due to the abnormal condition and configuration of his sigmoid colon which was
beyond his control considering that the said condition could not be detected before a
colonoscopic procedure.
Dr. Agas adequately explained that no clinical findings, laboratory tests, or
diagnostic imaging, such as x-rays, ultrasound or computed tomography (CT) scan
of the abdomen, could have detected this condition prior to an endoscopic
 The case was then elevated to the CA which also
dismissed the case, hence this petition.
47. Sometime in 1985, petitioner Erlinda Ramos was advised
to undergo an operation for the removal of a stone in her
RAMOS VS CA gall bladder (cholecystectomy).
GR NO 24354 She was referred to Dr. Hosaka, a surgeon, who agreed to
APRIL 11, 2002 perform the operation on her. The operation was
scheduled for June 17, 1985 at 9:00 in the morning at
private respondent De Los Santos Medical Center
KAPUNAN, J. (DLSMC).
Since neither petitioner Erlinda nor her husband,
petitioner Rogelio, knew of any anesthesiologist, Dr.
Hosaka recommended to them the services of Dr.
Gutierrez.
Petitioner Erlinda was admitted to the DLSMC the day
before the scheduled operation. By 7:30 in the morning of
the following day, petitioner Erlinda was already being
prepared for operation. Upon the request of petitioner
Erlinda, her sister-in-law, Herminda Cruz, who was then
Dean of the College of Nursing at the Capitol Medical
Center, was allowed to accompany her inside the
operating room.
At around 9:30 in the morning, Dr. Hosaka had not yet
arrived so Dr. Gutierrez tried to get in touch with him by
phone. Thereafter, Dr. Gutierrez informed Cruz that the
operation might be delayed due to the late arrival of Dr.
Hosaka. In the meantime, the patient, petitioner Erlinda
said to Cruz, "Mindy, inip na inip na ako, ikuha mo ako ng
ibang Doctor."
By 10:00 in the morning, when Dr. Hosaka was still not
around, petitioner Rogelio already wanted to pull out his
wife from the operating room. He met Dr. Garcia, who
remarked that he was also tired of waiting for Dr. Hosaka.
Dr. Hosaka finally arrived at the hospital at around 12:10
in the afternoon, or more than three (3) hours after the
procedure.
On the other hand, in the present case, the correlation between petitioner’s injury,
i.e., tear in the serosa of sigmoid colon, and the colonoscopy conducted by
respondent to the petitioner clearly requires the presentation of an expert opinion
considering that no perforation of the sigmoid colon was ever noted during the
laparotomy. It cannot be overemphasized that the colonoscope inserted by the
respondent only passed through the inside of petitioner’s sigmoid colon while the
damaged tissue, i.e., serosa, which caused the bleeding, is located in the outermost
layer of the colon. It is therefore impossible for the colonoscope to touch, scratch, or
even tear the serosa since the said membrane is beyond reach of the colonoscope in
the absence of perforation on the colon.
1. WON Dr. Orlino 1. For his part, Dr. Hosaka mainly contends that the Court erred in finding him
hosaka (surgeon) is negligent as a surgeon by applying the Captain-of-the-Ship doctrine.
liable for negligence;
Dr. Hosaka argues that the trend in United States jurisprudence (Thomas vs.
YES Raleigh) has been to reject said doctrine in light of the developments in medical
practice. He points out that anesthesiology and surgery are two distinct and
2. WON Dr. Perfecta specialized fields in medicine and as a surgeon, he is not deemed to have control
Gutierrez over the acts of Dr. Gutierrez.
(anesthesiologist) is
liable for negligence This contention fails to persuade.
YES That there is a trend in American jurisprudence to do away with the Captain-of-the-
Ship doctrine does not mean that this Court will ipso facto follow said trend. Due
3. WON the hospital regard for the peculiar factual circumstances obtaining in this case justify the
is liable for any act of application of the Captain-of-the-Ship doctrine. From the facts on record it can be
negligence committed logically inferred that Dr. Hosaka exercised a certain degree of, at the very least,
by their visiting supervision over the procedure then being performed on Erlinda.
consultant surgeon
and anesthesiologist. Dr. Hosaka's irresponsible conduct of arriving very late for the scheduled
operation of petitioner Erlinda is violative, not only of his duty as a physician "to
YES serve the interest of his patients with the greatest solicitude, giving them always his
best talent and skill," but also of Article 19 of the Civil Code which requires a
4. What are the person, in the performance of his duties, to act with justice and give every one
appropriate award his due.
for damages.
Dr. Hosaka cannot now claim that he was entirely blameless of what happened to
Erlinda. His conduct clearly constituted a breach of his professional duties to
Erlinda.
2. Pertaining to private respondent Dr. Gutierrez. Unfortunately, Dr. Gutierrez’ claim
of lack of negligence on her part is belied by the records of the case. It has been
sufficiently established that she failed to exercise the standards of care in the
administration of anesthesia on a patient.
Dr. Gutierrez omitted to perform a thorough preoperative evaluation on Erlinda.
Respondent Dra. Gutierrez’ act of seeing her patient for the first time only an
scheduled operation.
Cruz, who was then still inside the operating room, heard
about Dr. Hosaka’s arrival. While she held the hand of
Erlinda, Cruz saw Dr. Gutierrez trying to intubate the
patient. Cruz heard Dr. Gutierrez utter: "ang hirap ma-
intubate nito, mali yata ang pagkakapasok. O lumalaki
ang tiyan." Cruz noticed a bluish discoloration of
Erlinda’s nailbeds on her left hand. She (Cruz) then heard
Dr. Hosaka instruct someone to call Dr. Calderon,
another anesthesiologist. When he arrived, Dr. Calderon
attempted to intubate the patient. The nailbeds of the
patient remained bluish, thus, she was placed in a
trendelenburg position – a position where the head of the
patient is placed in a position lower than her feet. At this
point, Cruz went out of the operating room to express her
concern to petitioner Rogelio that Erlinda’s operation was
not going well.
Cruz quickly rushed back to the operating room and saw
that the patient was still in trendelenburg position. At
almost 3:00 in the afternoon, she saw Erlinda being
wheeled to the Intensive Care Unit (ICU). The doctors
explained to petitioner Rogelio that his wife had
bronchospasm. Erlinda stayed in the ICU for a month.
She was released from the hospital only four months later
or on November 15, 1985. Since the ill-fated operation,
Erlinda remained in comatose condition until she died on
August 3, 1999.
Petitioners filed with the RTC Quezon City a civil case for
damages against private respondents. After due trial, the
court a quo rendered judgment in favor of petitioners.
Essentially, the trial court found that private respondents
were negligent in the performance of their duties to
Erlinda.
On appeal by private respondents, the Court of Appeals
reversed the trial court’s decision and directed petitioners
to pay their "unpaid medical bills" to private respondents.
Petitioners filed with this Court a petition for review on
certiorari. The dispositive portion of the Decision states:
WHEREFORE, the decision and resolution of the
appellate court appealed from are hereby modified so as
to award in favor of petitioners, and solidarily against
private respondents the following: 1) P1,352,000.00 as
actual damages computed as of the date of promulgation
of this decision plus a monthly payment of P8,000.00 up
to the time that petitioner Erlinda Ramos expires or
miraculously survives; 2) P2,000,000.00 as moral
damages, 3) P1,500,000.00 as temperate damages; 4)
hour before the scheduled operative procedure was, therefore, an act of
exceptional negligence and professional irresponsibility. The measures
cautioning prudence and vigilance in dealing with human lives lie at the core of the
physician’s centuries-old Hippocratic Oath. Her failure to follow this medical
procedure is, therefore, a clear indicia of her negligence.
The injury incurred by petitioner Erlinda does not normally happen absent any
negligence in the administration of anesthesia and in the use of an endotracheal
tube. As was noted in our Decision, the instruments used in the administration of
anesthesia, including the endotracheal tube, were all under the exclusive control of
private respondents Dr. Gutierrez and Dr. Hosaka.
3. Anent private respondent DLSMC’s liability for the resulting injury to petitioner
Erlinda, we held that respondent hospital is solidarily liable with respondent
doctors therefor under Article 2180 of the Civil Code since there exists an employer-
employee relationship between private respondent DLSMC and Drs. Gutierrez and
Hosaka:
DLSMC however contends that applying the four-fold test in determining whether
such a relationship exists between it and the respondent doctors, the inescapable
conclusion is that DLSMC cannot be considered an employer of the respondent
doctors.
After a careful consideration of the arguments raised by DLSMC, the Court finds
that respondent hospital’s position on this issue is meritorious. There is no
employer-employee relationship between DLSMC and Drs. Gutierrez and Hosaka
which would hold DLSMC solidarily liable for the injury suffered by petitioner
Erlinda under Article 2180 of the Civil Code.
Neither is there any showing that it is DLSMC which pays any of its consultants for
medical services rendered by the latter to their respective patients. Moreover, the
contract between the consultant in respondent hospital and his patient is separate
and distinct from the contract between respondent hospital and said patient.
Further, no evidence was adduced to show that the injury suffered by petitioner
Erlinda was due to a failure on the part of respondent DLSMC to provide for hospital
facilities and staff necessary for her treatment.
For these reasons, we reverse the finding of liability on the part of DLSMC for
the injury suffered by petitioner Erlinda.
4. Finally, the Court also deems it necessary to modify the award of damages to
petitioners in view of the supervening event of petitioner Erlinda’s death. In
the assailed Decision, the Court awarded actual damages of One Million Three
Hundred Fifty Two Thousand Pesos (P1,352,000.00) to cover the expenses for
petitioner Erlinda’s treatment and care from the date of promulgation of the
Decision up to the time the patient expires or survives. In addition thereto, the Court
awarded temperate damages of One Million Five Hundred Thousand Pesos
(P1,500,000.00) in view of the chronic and continuing nature of petitioner Erlinda’s
injury and the certainty of further pecuniary loss by petitioners as a result of said
injury, the amount of which, however, could not be made with certainty at the time
 P100,000.00 each exemplary damages and attorney’s
fees; and 5) the costs of the suit.
In a Motion for Reconsideration filed by private
respondents, the Supreme Court in the Resolution of
February 21, 2000, denied the motions for
reconsideration of private respondents Drs. Hosaka and
Gutierrez. They then filed their respective second motions
for reconsideration.
The Philippine College of Surgeons filed its Petition-in-
Intervention contending in the main that this Court erred
in holding private respondent Dr. Hosaka liable under the
captain of the ship doctrine. According to the intervenor,
said doctrine had long been abandoned in the United
States in recognition of the developments in modern
medical and hospital practice.The Court noted these
pleadings in the Resolution of July 17, 2000.
On March 19, 2001, the Court heard the oral arguments
of the parties, including the intervenor. Also present
during the hearing were the amicii curiae:
1. Dr. Felipe A. Estrella, Jr., Consultant of the Philippine
Charity Sweepstakes, former Director of the Philippine
General Hospital and former Secretary of Health;
2. Dr. Iluminada T. Camagay, President of the Philippine
Society of Anesthesiologists, Inc. and Professor and Vice-
Chair for Research, Department of Anesthesiology, College
of Medicine-Philippine General Hospital, University of the
Philippines; and
3. Dr. Lydia M. Egay, Professor and Vice-Chair for
Academics, Department of Anesthesiology, College of
Medicine-Philippine General Hospital, University of the
Philippines
48. On December 28, 1991, respondent Dr. Carlos Gerona,
an orthopedic surgeon at the Vicente Gullas Memorial
of the promulgation of the decision. The Court justified such award in this manner:
Our rules on actual or compensatory damages generally assume that at the time
of litigation, the injury suffered as a consequence of an act of negligence has been
completed and that the cost can be liquidated. However, these provisions neglect to
take into account those situations, as in this case, where the resulting injury might
be continuing and possible future complications directly arising from the injury,
while certain to occur, are difficult to predict.
In these cases, the amount of damages which should be awarded, if they are to
adequately and correctly respond to the injury caused, should be one which
compensates for pecuniary loss incurred and proved, up to the time of trial; and one
which would meet pecuniary loss certain to be suffered but which could not, from
the nature of the case, be made with certainty.
In other words, temperate damages can and should be awarded on top of actual
or compensatory damages in instances where the injury is chronic and continuing.
And because of the unique nature of such cases, no incompatibility arises when
both actual and temperate damages are provided for. The reason is that these
damages cover two distinct phases.
The amount given as temperate damages, though to a certain extent speculative,
should take into account the cost of proper care.
In the instant case, petitioners were able to provide only home-based nursing care
for a comatose patient who has remained in that condition for over a decade. Under
the circumstances, an award of P1,500,000.00 in temperate damages would
therefore be reasonable.
However, subsequent to the promulgation of the Decision, the Court was informed
by petitioner Rogelio that petitioner Erlinda died on August 3, 1999. In view of this
supervening event, the award of temperate damages in addition to the actual or
compensatory damages would no longer be justified since the actual damages
awarded in the Decision are sufficient to cover the medical expenses incurred
by petitioners for the patient. Hence, only the amounts representing actual, moral
and exemplary damages, attorney’s fees and costs of suit should be awarded to
petitioners.
WHEREFORE, the assailed Decision is hereby modified as follows:
(1) Private respondent De Los Santos Medical Center is hereby absolved from
liability arising from the injury suffered by petitioner Erlinda Ramos on June 17,
1985;
(2) Private respondents Dr. Orlino Hosaka and Dr. Perfecta Gutierrez are hereby
declared to be solidarily liable for the injury suffered by petitioner Erlinda on June
17, 1985 and are ordered to pay petitioners—
(a) P1,352,000.00 as actual damages;
(b) P2,000,000.00 as moral damages;
(c) P100,000.00 as exemplary damages;
(d) P100,000.00 as attorney’s fees; and
(e) the costs of the suit. SO ORDERED.
1. WON the Court of We affirm the assailed CA decision.
Appeals erred in
SPS. BONTILAO Hospital, treated petitioners' son, eight (8)-year-old Allen reversing the The trial court erred in applying the doctrine of res ipsa loquitur to pin liability on
VS. DR. GERONA Key Bontilao (Allen), for a fractured right wrist. decision of the RTC respondent for Allen's death.
Respondent administered a "U-splint" and immobilized by dismissing the
G.R. No. 176675, Allen's wrist with a cast, then sent Allen home. complaint in so far Res ipsa loquitur is a rebuttable presumption or inference that the defendant was
September 15, as the surgeon, Dr. negligent.
2010 On June 4, 1992, Allen re-fractured the same wrist and Carlos Gerona is
was brought back to the hospital. The x-ray examination concerned [after] The presumption only arises upon proof that the instrumentality causing injury was
showed a complete fracture and displacement of the bone, concluding that he is in the defendant's exclusive control, and that the accident was one (1) which
with the fragments overlapping each other. Respondent not solidarily liable ordinarily does not happen in the absence of negligence. It is a rule of evidence
performed a closed reduction procedure, with Dr. Vicente with his co- whereby negligence of the alleged wrongdoer may be inferred from the mere fact that
Jabagat (Dr. Jabagat) as the anesthesiologist. Then he defendant, Dr. the accident happened, provided that the character of the accident and
placed Allen's arm in a plaster cast to immobilize it. He Vicente Jabagat, the circumstances attending it lead reasonably to the belief that in the absence of
allowed Allen to go home after the post reduction x-ray anesthesiologist, in negligence it would not have occurred and that the thing which caused injury is
showed that the bones were properly aligned, but advised the absence of any shown to have been under the management and control of the alleged wrongdoer.
Allen's mother, petitioner Sherlina Bontilao (Sherlina), to negligent act on his However, res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used
bring Allen back for re-tightening of the cast not later part. but a rule to be cautiously applied, depending upon the circumstances of each case.
than June 15, 1992. In malpractice cases, the doctrine is generally restricted to situations where a
NO layman is able to say, as a matter of common knowledge and observation, that the
Allen, however, was brought back to the hospital only on consequences of professional care were not as such as would ordinarily have
June 1992. By then, because the cast had not been re- 2. WON the Court of followed if due care had been exercised.
tightened, a rotational deformity had developed in Allen's Appeals erred when
arm. The x-ray examination showed that the deformity it misappreciated In other words, as held in Ramos v. Court of Appeals, the real question is whether or
was caused by a re-displacement of the bone fragments, essential facts of the not in the process of the operation, any extraordinary incident or unusual event
so it was agreed that an open reduction surgery will be case that led to its outside of the routine performance occurred which is beyond the regular scope of
conducted on June 24, 1992 by respondent, again with findings that professional activity in such operations, and which, if unexplained, would
Dr. Jabagat as the anesthesiologist. Doctrine of Res Ipsa themselves reasonably speak to the average man as the negligent cause or causes of
Loquitur as applied the untoward consequence.
On the said date, Sherlina was allowed to observe the in the Ramos case is
operation behind a glass panel. Dr. Jabagat failed to not applicable in the Moreover, we note that in the instant case, the instrument which caused the
intubate the patient after five (5) attempts so anesthesia instant case damage or injury was not even within respondent's exclusive management and
was administered through a gas mask. Respondent control as Dr. Jabagat was exclusively in control and management of the anesthesia
asked Dr. Jabagat if the operation should be postponed NO and the endotracheal tube.
given the failure to intubate, but Dr. Jabagat said that it
was alright to proceed. Respondent verified that Allen The doctrine of res ipsa loquitur allows the mere existence of an injury to justify a
was breathing properly before proceeding with the presumption of negligence on the part of the person who controls the instrument
surgery. As respondent was about to finish the suturing, causing the injury, provided that the following requisites concur:
Sherlina decided to go out of the operating room to make
a telephone call and wait for her son. Later, she was 1. The accident is of a kind which ordinarily does not occur in the absence of
informed that her son had died on the operating table. someone's negligence;
The cause of death was "asphyxia due to congestion and 2. It is caused by an instrumentality within the exclusive control of the
edema of the epiglottis." defendant or defendants; and
Aside from criminal and administrative cases, petitioners 3. The possibility of contributing conduct which would make the plaintiff
filed a complaint for damages against both respondent responsible is eliminated.
and Dr. Jabagat in the RTC of Cebu City alleging
negligence and incompetence on the part of the doctors. Here, the respondent could only supervise Dr. Jabagat to make sure that he was
performing his duties. But respondent could not dictate upon Dr. Jabagat the
RTC decided in favor of the petitioners. It held that the particular anesthesia to administer, the dosage thereof, or that it be administered in
doctrine of res ipsa loquitur was applicable in establishing any particular way not deemed appropriate by Dr. Jabagat.
respondent's liability. According to the RTC, asphyxia or
cardiac arrest does not normally occur in an operation on
Respondent's specialization not being in the field of anesthesiology, it would be
a fractured bone in the absence of negligence in the
dangerous for him to substitute his judgment for Dr. Jabagat's decisions in matters
administration of anesthesia and the use of an
that fall appropriately within the scope of Dr. Jabagat's expertise.
endotracheal tube. The trial court held that respondent
and Dr. Jabagat were solidarity liable for they failed to
 prove that they were not negligent. The trial court
likewise said that respondent cannot shift the blame
solely to Dr. Jabagat as the fault of the latter is also the
fault of the former, respondent being the attending
physician and being equally in care, custody and control
of Allen
Aggrieved, respondent appealed the trial court's decision
to the CA. Dr. Jabagat, for his part, no longer appealed
the decision.

The CA reversed the RTC's ruling. It held that the doctrine

of res ipsa loquitur does not apply for it must be
satisfactorily shown that (1) the accident is of a kind
which ordinarily does not occur in the absence of
someone's negligence; (2) the plaintiff was not guilty of
contributory conduct; and (3) the instrumentality which
caused the accident was within the control of the
defendant.

The CA held that while it may be true that an Open

Reduction and Internal Fixation or ORIF could not
possibly lead to a patient's death unless somebody was
negligent, still what was involved in this case was a
surgical procedure with all risks attendant, including
death.

49. Corazon Nogales (Corazon) was pregnant of her 4th child
and was under the exclusive prenatal care of Dr. Oscar
NOGALES vs. Estrada (Dr. Estrada). On her last trimester of pregnancy,
CAPITOL Dr. Estrada noted an increase in Corazon’s blood
MEDICAL CENTER pressure and development of leg edema which may lead to
a dangerous complication of pregnancy.
G.R. No. 142625
December 19, When Corazon started experiencing mild labor pains, she
2006 and his husband Rogelio opted to see Dr. Estrada for
examination, and the latter advised them to admit
Corazon to the Capitol Medical Center (CMC). Short after
Corazon’s bag of water ruptured, she started to
experience convulsions. Dr. Estrada and another
physician in the name of Dr. Villaflor began extracting the
baby, which allegedly torn a piece of cervical tissue of the
patient. After the baby was taken out of the womb,
Corazon began to manifest moderate vaginal bleeding
which rapidly became profuse. Despite efforts to revive
the patient, Corazon died. The cause of which was
“hemorrhage, post-partum.”
Rogelio Nogales, et al. (petitioners) filed a complaint for
damages against CMC, Dr. Estrada, and the other
involved medical personnel of the hospital (Dr. Villaflor,
Dr. Uy, Dr. Enriquez, Dr. Lacson, Dr. Espinola, and a
certain Nurse J. Dumlao) for the death of Corazon,
charging CMC with negligence in the selection and
supervision of defendant physicians and hospital staff.
Whether CMC is Art. 2180. The obligation imposed by article 2176 is demandable not only for one’s
vicariously liable for own acts or omissions, but also for those of persons for whom one is responsible. x x
the negligence of Dr. xx
Estrada.
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
YES not engaged in any business or industry. 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.
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.
In general, a hospital is not liable for the negligence of an independent contractor-
physician. There is, however, an exception to this principle. The hospital may be
liable if the physician is the “ostensible” agent of the hospital. This is known as the
“doctrine of apparent authority.” In Gilbert v. Sycamore Municipal Hospital, the
Illinois Supreme Court explained the doctrine of apparent authority in this wise:
Under the doctrine of apparent authority a hospital can be held vicariously liable for
the negligent acts of a physician providing care at the hospital, regardless of whether
the physician is an independent contractor, unless the patient knows, or should
have known, that the physician is an independent contractor. The elements of the
action have been set out as follows:
 The RTC (Manila) rendered judgment finding Dr. Estrada
solely liable for damages. In ruling the same, the Court
finds no legal justification to find the other impleaded
physicians and hospital personnel civilly liable.
Upon appeal, petitioners claimed that aside from Dr.
Estrada, the remaining respondents should be held
equally liable for negligence, pointing out the extent of
each respondent’s alleged liability.
The CA affirmed the decision of the trial court and on
ruling the same, the Court of Appeals applied the
“borrowed servant” doctrine considering that Dr. Estrada
was an independent contractor who was merely exercising
hospital privileges. This doctrine provides that once the
surgeon enters the operating room and takes charge of
the proceedings, the acts or omissions of operating room
personnel, and any negligence associated with such acts
or omissions, are imputable to the surgeon. While the
assisting physicians and nurses may be employed by the
hospital, or engaged by the patient, they normally become
the temporary servants or agents of the surgeon in charge
while the operation is in progress, and liability may be
imposed upon the surgeon for their negligent acts under
the doctrine of respondeat superior. Hence, the petition.
50. Natividad Agana was rushed to the Medical City Hospital
because of difficulty of bowel movement and bloody anal
PSI VS. AGANA discharge. Dr. Miguel Ampil, diagnosed her to be suffering
from “cancer of the sigmoid.” Dr. Ampil, assisted by the
G.R. NO. 126297, medical staff of the Medical City Hospital, performed an
JANUARY 31, anterior resection surgery on Natividad. He found that the
2007, G.R. NO. malignancy in her sigmoid area had spread on her left
126297 ovary, necessitating the removal of certain portions of it.
FEBRUARY 2, Thus, Dr. Ampil obtained the consent of Natividad’s
2010 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
“For a hospital to be liable under the doctrine of apparent authority, a plaintiff must
show that: (1) the hospital, or its agent, acted in a manner that would lead a
reasonable person to conclude that the individual who was alleged to be negligent
was an employee or agent of the hospital; (2) where the acts of the agent create the
appearance of authority, the plaintiff must also prove that the hospital had
knowledge of and acquiesced in them; and (3) the plaintiff acted in reliance upon the
conduct of the hospital or its agent, consistent with ordinary care and prudence.” x
xxx
The doctrine of apparent authority essentially involves two factors to determine the
liability of an independent-contractor physician: The first factor focuses on the
hospital’s manifestations and is sometimes described as an inquiry whether the
hospital acted in a manner which would lead a reasonable person to conclude that
the individual who was alleged to be negligent was an employee or agent of the
hospital. In this regard, the hospital need not make express representations to the
patient that the treating physician is an employee of the hospital; rather a
representation may be general and implied. The second factor focuses on the
patient’s reliance. It is sometimes characterized as an inquiry on whether the
plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent
with ordinary care and prudence.
Whether or not PSI PSI is solidarily liable for the negligence of Dr. Ampil. In Ramos v. Court of Appeals,
may be held the court held that private hospitals, hire, fire and exercise real control over their
solidarily liable for attending and visiting ‘consultant’ staff. While ‘consultants’ are not, technically
the negligence of Dr. employees, the control exercised, the hiring, and the right to terminate consultants
Ampil. 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
YES 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.
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
 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.
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.
51. Petitioner Dr. Milagros L. Cantre is the attending
physician of respondent Nora S. Go. Nora gave birth to
DR. CANTRE vs. her fourth child, a baby boy. However, Nora suffered
SPS. GO profuse bleeding inside her womb due to some parts of
the placenta which were not completely expelled from her
G.R. NO. 160889, womb after delivery. Consequently, Nora suffered
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 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.
Whether or not The Hippocratic Oath mandates physicians to give primordial consideration to their
petitioner is liable for patients' well-being, and if a doctor fails to live up to this precept, he is accountable
the injury suffered by for his acts. This notwithstanding, courts face a unique restraint in adjudicating
respondent Nora Go. medical negligence cases because physicians are not guarantors of care, and they
never set out to intentionally cause injury to their patients. HOWEVER, intent is
immaterial in these cases because where negligence exists and is proven, it
APRIL 27, 2007 hypovolemic shock, resulting in a drop in her blood
pressure to "40" over "0." Petitioner and the assisting
resident physician performed various medical procedures
QUISUMBING, J. to stop the bleeding and to restore Nora’s blood pressure.
Her blood pressure was frequently monitored with the use
of a sphygmomanometer. While petitioner was massaging
Nora’s uterus for it to contract and stop bleeding, she
ordered a droplight to warm Nora and her baby. 4 Nora
remained unconscious until she recovered.
While in the recovery room, her husband, respondent
John David Z. Go noticed a fresh gaping wound two and a
half (2 ½) by three and a half (3 ½) inches in the inner
portion of her left arm, close to the armpit. 5 He asked the
nurses what caused the injury. He was informed it was a
burn. Forthwith, John David filed a request for
investigation.6 In response, the medical director of the
hospital called petitioner and the assisting resident
physician to explain what happened. Petitioner said the
blood pressure cuff caused the injury.
John David brought Nora to the National Bureau of
Investigation for a physical examination, which was
conducted by medico-legal officer Dr. Floresto Arizala, Jr. 7
The medico-legal officer later testified that Nora’s injury
appeared to be a burn and that a droplight when placed
near the skin for about 10 minutes could cause such
burn.8 He dismissed the likelihood that the wound was
caused by a blood pressure cuff as the scar was not
around the arm, but just on one side of the arm. 9
Nora’s injury was referred to a plastic surgeon for skin
grafting.10 Her wound was covered with skin sourced from
her abdomen, which consequently bore a scar as well.
About a year after, scar revision had to be performed at
the same hospital.11 The surgical operation left a healed
linear scar in Nora’s left arm about three inches in length,
the thickest portion rising about one-fourth (1/4) of an
inch from the surface of the skin. The costs of the skin
grafting and the scar revision were shouldered by the
hospital.12
Unfortunately, Nora’s arm would never be the same. Aside
from the unsightly mark, the pain in her left arm remains.
When sleeping, she has to cradle her wounded arm. Her
movements now are also restricted. Her children cannot
play with the left side of her body as they might
accidentally bump the injured arm, which aches at the
slightest touch.
Thus, respondent spouses filed a complaint 13 for damages
against petitioner, Dr. Abad, and the hospital.
YES automatically gives the injured a right to reparation for the damage caused.
In cases involving medical negligence, the doctrine of res ipsa loquitur allows the
mere existence of an injury to justify a presumption of negligence on the part of the
person who controls the instrument causing the injury, provided that the following
requisites concur:
1. The accident is of a kind which ordinarily does not occur in the absence
of someone’s negligence;
2. It is caused by an instrumentality within the exclusive control of the
defendant or defendants; and
3. The possibility of contributing conduct which would make the plaintiff
responsible is eliminated.18
As to the first requirement, the gaping wound on Nora’s arm is certainly not an
ordinary occurrence in the act of delivering a baby, far removed as the arm is from
the organs involved in the process of giving birth. Such injury could not have
happened unless negligence had set in somewhere.
Second, whether the injury was caused by the droplight or by the blood pressure
cuff is of no moment. Both instruments are deemed within the exclusive control of
the physician in charge under the "captain of the ship" doctrine. This doctrine holds
the surgeon in charge of an operation liable for the negligence of his assistants
during the time when those assistants are under the surgeon’s control. 19 In this
particular case, it can be logically inferred that petitioner, the senior consultant in
charge during the delivery of Nora’s baby, exercised control over the assistants
assigned to both the use of the droplight and the taking of Nora’s blood pressure.
Hence, the use of the droplight and the blood pressure cuff is also within petitioner’s
exclusive control.
Third, the gaping wound on Nora’s left arm, by its very nature and considering her
condition, could only be caused by something external to her and outside her
control as she was unconscious while in hypovolemic shock. Hence, Nora could not,
by any stretch of the imagination, have contributed to her own injury.
Petitioner’s defense that Nora’s wound was caused by the constant taking of her
blood pressure does not absolve her from liability. The medical practice is to deflate
the blood pressure cuff immediately after each use. Otherwise, the inflated band can
cause injury to the patient similar to what could have happened in this case. Thus,
if Nora’s wound was caused by the blood pressure cuff, then the taking of Nora’s
blood pressure must have been done so negligently as to have inflicted a gaping
wound on her arm,20 for which petitioner cannot escape liability under the "captain
of the ship" doctrine.
The argument that the failed plastic surgery was not intended as a cosmetic
procedure, but rather as a measure to prevent complication does not help her case.
It does not negate negligence on her part.
Based on the foregoing, the presumption that petitioner was negligent in the
 The trial court rendered in favor of the plaintiffs and
against the defendants.
Petitioner, Dr. Abad, and the hospital all appealed to the
Court of Appeals, which affirmed with modification the
trial court decision. Petitioner’s motion for reconsideration
was denied by the Court of Appeals. Hence, the instant
petition.
52. Respondent, Ranida D. Salvador, started working as a
trainee in the Accounting Department of Limay Bulk
GARCIA, JR. vs Handling Terminal, Inc. As a prerequisite for regular
SALVADOR 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) test and issued the test result indicating
that Ranida was "HBs Ag: Reactive." The result bore the
name 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 B, a liver disease. Thus, based on the medical
report submitted by Sto. Domingo, the Company
terminated Ranida’s 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, Ranida underwent 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,
exercise of her profession stands unrebutted. In this connection, the Civil Code
provides:
ART. 2176. Whoever by act or omission causes damage to another, there being fault
or negligence, is obliged to pay for the damage done.…
ART. 2217. Moral damages include physical suffering, mental anguish, fright,
serious anxiety, besmirched reputation, wounded feelings, moral shock, social
humiliation, and similar injury. Though incapable of pecuniary computation, moral
damages may be recovered if they are the proximate result of the defendant’s
wrongful act or omission.
Clearly, under the law, petitioner is obliged to pay Nora for moral damages suffered
by the latter as a proximate result of petitioner’s negligence.
Dr. Cantre has been Nora's ob-gyne for her past 3 deliveries, and this is the first
time that Dr. Cantre is being held liable for damages due to negligence in the
practice of her profession. She promptly took care of the wound before infection set
in. Since Nora was in a critical condition at that time, saving her life became Dr.
Cantre's elemental concern. Still, her good intentions characteristics do not justify
negligence.
WON Garcia should Owners and operators of clinical laboratories have the duty to comply with statutes,
be held liable liable as well as rules and regulations, purposely promulgated to protect and promote the
for damages to the health of the people by preventing the operation of substandard, improperly
respondents for managed and inadequately supported clinical laboratories and by improving the
issuing an incorrect quality of performance of clinical laboratory examinations. Their business is
HBsAG test result. impressed with public interest, as such, high standards of performance are expected
from them.
YES
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.
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.
The Supreme Court ruled 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 by Ma. Ruby C. Calderon, a licensed Medical
Technologist. Second, Garcia conducted the HBsAG test of respondent Ranida
without the supervision of defendant-appellee Castro. Last, the disputed HBsAG test
 and this time, the Anti-HBs test conducted on her
indicated a "Negative" result. Ranida also underwent
another HBs Ag test at the Bataan Doctors Hospital using
the Micro-Elisa 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 who requested her to undergo another similar
test before her re-employment would be considered. Thus,
CDC conducted another HBs 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) interpreted the
delayed reaction as positive or reactive. Thereafter, the
Company rehired Ranida.
result was released to respondent Ranida without the authorization of defendant-
appellee Castro.
Garcia may not have intended to cause the consequences which followed after the
release of the HBsAG test result. 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.
DISPOSITIVE: Respondents won. Affirmed the CA’s ruling.

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.

Garcia denied the allegations of gross negligence and

incompetence and reiterated the scientific explanation for
the "false positive" result of the first HBs Ag test. On the
other hand, 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.

TC: Dismissed the complaint for insufficiency of evidence.

CA: Reversed the trial court’s ruling. Ordered Garcia to

pay Ranida moral damages, exemplary damages and
attorney’s fees. CA also 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.

53. Rowena Umali de Ocampo (Rowena) accompanied her WON Dra. Cruz is The elements of reckless imprudence are: (1) that the offender does or fails to do an
mother to the Perpetual Help Clinic and General Hospital guilty of reckless act; (2) that the doing or the failure to do that act is voluntary; (3) that it be without
DR. CRUZ vs. in San Pablo City to have her examined. It was found out imprudence resulting malice; (4) that material damage results from the reckless imprudence; and (5) that
COURT OF that her mother, Lydia de Ocampo (Lydia), had myoma in in the death of there is inexcusable lack of precaution on the part of the offender, taking into
APPEALS and her uterus and was scheduled for a hysterectomy patient Lydia. consideration his employment or occupation, degree of intelligence, physical
LYDIA UMALI operation. Rowena and her mother slept in the clinic to condition, and other circumstances regarding persons, time and place. In this case,
await the operation the next day. Rowena noticed that the NO there is absence of the 4th element: that the injury to the person or property was a
G.R. No. 122445 clinic was untidy and the floor and windows very dusty,
November 18, she thus tried to convince her mother to transfer
1997 hospitals to which the latter refused.
FRANCISCO, J. The operation proceeded and during which Rowena was
tasked by Dr. Lina Ercillo (Ercillo) to get additional blood
packs and Tagamet ampules to which she immediately
procured. After the operation, additional blood and
oxygen tank were required. The procurement of the
oxygen tank was too late and Rowena’s mother was put
into “shock”. Lydia had to be transferred to a better
hospital, and was done so without notice and consent to
Rowena. When Lydia was wheeled into the operating room
of San Pablo District Hospital, Dr. Bartolome Angeles
(Angeles) arrived upon call and saw that Lydia has blood
coming out from her abdominal incision and saw that she
was in shock and that her blood pressure was already at
0/0. Dr. Angeles informed Dr. Ercillo and Rowena that it
was too late and that there was nothing he could to save
the patient. A death certificate was issued which stated
that the immediate cause of death was Disseminated
Intravascular Coagulation (DIC) as the antecedent cause.
A case was filed before the MTCC of San Pablo City
against Dra. Ninevetch Cruz and Dra. Lina Ercillo for
reckless imprudence resulting to homicide. The court
finds that Lydia Umali died because of the negligence and
carelessness of the surgeon Dra. Ninevetch Cruz because
of loss of blood during the operation of the deceased for
evident unpreparedness and for lack of skill, the reason
why the patient was brought for operation at the San
Pablo City District Hospital. As such, Dra. Cruz should
answer for such negligence. With respect to Dra. Lina
Ercillo, the anaesthesiologist, there is no evidence to
indicate that she should be held jointly liable with Dra.
Cruz who actually did the operation.
The RTC reiterated the abovementioned findings of the
MTCC and upheld the latter's declaration of
"incompetency, negligence and lack of foresight and skill
of appellant (herein petitioner) in handling the subject
patient before and after the operation."
consequence of the reckless imprudence.
Whether or not a physician has committed an "inexcusable lack of precaution" in
the treatment of his patient is 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,
In accepting a case, 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…
xxxx
All three courts below bewail the inadequacy of the facilities of the clinic and its
untidiness; the lack of provisions such as blood, oxygen, and certain medicines; the
failure to subject the patient to a cardio-pulmonary test prior to the operation; the
omission of any form of blood typing before transfusion; and even the subsequent
transfer of Lydia to the San Pablo Hospital and the reoperation performed on her by
the petitioner. But while it may be true that the circumstances pointed out by the
courts below seemed beyond cavil to constitute reckless imprudence on the part of
the surgeon, this conclusion is still best arrived at not through the educated
surmises nor conjectures of laymen, including judges, but by the unquestionable
knowledge of expert witnesses. For whether a physician or surgeon has exercised
the requisite degree of skill and care in the treatment of his patient is, in the
generality of cases, a matter of expert opinion. xxxx It must be remembered that
when the qualifications of a physician are admitted, as in the instant case, there is
an inevitable presumption that in proper cases he takes the necessary precaution
and employs the best of his knowledge and skill in attending to his clients, unless
the contrary is sufficiently established. This presumption is rebuttable by expert
opinion which is so sadly lacking in the case at bench.
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 a causal
connection of such breach and the resulting death of his patient.
In this case, the testimonies of Dr. Arizala (who conducted the autopsy) and Dr.
Salvador, establish hemorrhage or hemorrhagic shock as the cause of death.
However, as likewise testified to by the expert witnesses in open court, hemorrhage
or hemorrhagic shock during surgery may be caused by several different factors.
Among the different factors, it is significant to state that the autopsy conducted by
Dr. Arizala on the body of Lydia did not reveal any untied or unsutured cut blood
vessel nor was there any indication that the tie or suture of a cut blood vessel had
become loose thereby causing the hemorrhage.
On the other hand, the findings of all three doctors do not preclude the probability
that DIC caused the hemorrhage and consequently, Lydia's death. DIC which is a
clotting defect creates a serious bleeding tendency and when massive DIC occurs as
a complication of surgery leaving raw surface, major hemorrhage occurs. As testified
to by defense witness, Dr. Bu C. Castro, hemorrhage due to DIC "cannot be

54. On July 1994, respondent three months pregnant Editha
Ramolete was brought to the Lorma Medical Center (LMC)
CAYAO-LASAM vs. to vaginal bleeding. A pelvic sonogram was then
RAMOLETE conducted on Editha revealing the fetus weak cardiac
pulsation. Editha’s repeat pelvic sonogram showed that
GR. No. 159132l aside from the fetus weak cardiac pulsation, no fetal
Dec. 18, 2008 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.
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 petitioner’s 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 petitioner’s 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.
prevented, it will happen to anyone, anytime."
This Court has no recourse but to rely on the expert testimonies. The probability
that Lydia's death was caused by DIC was unrebutted during trial and has
engendered in the mind of this Court a reasonable doubt as to the petitioner's guilt.
Thus, her acquittal of the crime of reckless imprudence resulting in homicide.
However, petitioner is still civilly liable, particularly for moral and exemplary
damages
WON there was There was no medical malpractice in the case.
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
NO 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.
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.

55. The petitioners, Peter Lucas and his family, is suing
respondent, Dr. Prospero Ma. C. Tuaño, for damages due
LUCAS vs. DR. to medical malpractice on the grounds that Tuaño was
TUAÑO negligent intreating Lucas’ conjunctivitis or “sore eyes”
which led to glaucoma which in turn made him irritable
G.R. No. 178763.  and unable to support his family.
April 21, 2009.
Lucas consulted Tuaño when he had severe pain in his
CHICO-NAZARIO,  right eye to which the respondent performed an ocular
J. routine examination where he diagnosed Lucas to be
suffering conjunctivitis or “sore eyes” which developed
Epidemic Kerato Conjunctivitis (EKC), a viral infection to
which Tuaño prescribed a steroid-based eye drop called
Maxitrol which Lucas was using before.
Lucas couldn’t get a hold of Maxitrol so Tuaño suggested
Blephamide instead which was also steroid-based and
Lucas later used Maxitrol when it became available.
Later on, Fatima Lucas, the wife, found out from the
accompanying literature of the medicine that prolonged
use of steroid-based medication can result to glaucoma.
Lucas’s right eye pain reduced for a while but later on
returned and it became severe that Tuaño referred him to
another ophthalmologist, Dr. Manuel B. Agulto, for a
second opinion to which Dr. Maniel Agulto wrote a letter
to Tuaño stating the Lucas sustained significant
glaucoma damage.
Medical malpractice - 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 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 - that which, in natural and continuous sequence, unbroken by
any efficient intervening cause, produces injury, and without which the result would
not have occurred.
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.
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.
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.
W/N Respondent is The Supreme Court ruled that respondent, Dr. Prospero Ma. C. Tuaño, is not guilty
liable for damages as of medical malpractice.
a result of his alleged
gross negligence. The Supreme Court emphasizes that in order for medical malpractice to be proven, a
medical expert should be a witness to attest to the accused’s medical malpractice.
NO. Petitioner’s complaint for damages is merely based on a statement in the literature
of Maxitrol identifying the risks of its use and Dr. Agulto’s comment.
In this type of suit, the patient or his heirs, in order to prevail, is required to prove
by preponderance of evidence that the physician failed to exercise that degree of
skill, care, and learning possessed by other persons in the same profession; and that
as a proximate result of such failure, the patient or his heirs suffered damages. Just
as with the elements of duty and breach of the same, in order to establish the
proximate cause [of the injury] by a preponderance of the evidence in a medical
malpractice action, the patient must similarly use expert testimony, because the
question of whether the alleged professional negligence caused the patient‘s injury is
generally one for specialized expert knowledge beyond the knowledge of the average
layperson; using the specialized knowledge and training of his field, the expert‘s role
is to present to the court a realistic assessment of the likelihood that the physician‘s
alleged negligence caused the patient‘s injury. The medical expert set as standard
and when there is failure to present one, the courts have no standard by which to
gauge the basic issue of breach thereof by the physician or surgeon.
The deference of courts to the expert opinion of qualified physicians or surgeons
stems from the former‘s realization that the latter possess unusual technical skills
which laymen in most instances are incapable of intelligently evaluating; hence, the
indispensability of expert testimonies.
 The Regional Trial Court denied the petitioners’ claim for
damages due to insufficient evidence proving Tuaño’s
medical malpractice in treating Lucas because they failed
to present a medical expert that could support their claim
that what Tuaño did was indeed medical malpractice.
Petitioners appealed to the Court of Appeals to which the
court affirmed the Regional Trial Court’s decision. Hence,
the petitioners appealed to the Supreme Court.
56. On June 2, 1992, Gerald Albert Gercayo (Gerald) was
born with an imperforate anus. Hence, two days after his
SOLIDUM VS. birth, he underwent colostomy which enabled him to
PEOPLE OF THE excrete through a colostomy bag attached to the side of
PHILIPPINES his body.
G.R. NO. 192123, Three years later or on May 17, 1995, he was admitted at
MARCH 10, 2014 the Ospital ng Maynila for a pull-through operation. The
surgical team consisted of Dr. Resurreccion, Dr. Luceo,
Dr. Valea, and Dr. Tibio. The anesthesiologists included
Dr. Abella, Dr. Razon and herein Petitioner Dr. Solidum.
It was during the said operation that Gerald experienced
bradycardia or an abnormally slow heart rate of less than
60 beats per minute.
He subsequently went into a coma which lasted for two
weeks. When he regained consciousness after a month,
he could no longer see, hear, or move.
Ma. Luz Gercayo (Luz) lodged a complaint for reckless
imprudence resulting in serious physical injuries against
the attending physicians.
The RTC found Dr. Solidum guilty beyond reasonable
doubt of reckless imprudence resulting to serious
physical injuries. The CA affirmed the conviction of Dr.
Solidum.
The qualifications of a physician are taken into account and there is inevitable
presumption that he takes the necessary precaution and employs the best of his
knowledge and skill in attending to his clients, unless the contrary is sufficiently
established. Therefore, a medical expert as a witness in essential in medical
malpractice cases to give light to the errors of the accused. Also, it serves as a
reminder for people in the medical field to be cautious and take the necessary
precautions when attending to their clients to avoid medical malpractice.
Whether or not the TORTS: applicability of the Doctrine of Res Ipsa Loquitur
doctrine of res ipsa
loquitur applies in The Court held that the application the doctrine of res ipsa loquitur in the case at
this case? bar is inappropriate.
Res ipsa loquitur is literally translated as he thing or the transaction speaks for
itself. Jarcia, Jr. v. People, G.R. No. 187926 laid down that, here the thing which
Whether the CA causes injury is shown to be under the management of the defendant, and the
correctly affirmed the accident is such as in the ordinary course of things does not happen if those who
conviction of Dr. have the management use proper care, it affords reasonable evidence, in the
Solidum for criminal absence of an explanation by the defendant, that the accident arose from want of
negligence? care.
Hence, the requisites for the doctrine to apply are as follows: (1) the accident was of
the kind that does not ordinarily occur unless someone is negligent; (2) the
instrumentality or agency that caused the injury was under the exclusive control of
the person charged; and (3) the injury suffered must not have been due to any
voluntary action or contribution of the person injured.
Elements 2 and 3 were present in the case at bar. However, the first element was
undeniably wanting.
TORTS: elements of medical negligence
The Prosecution failed to prove the existence of the elements of reckless imprudence
beyond reasonable doubt. Gaid v. People, G.R. No. 171636 defined negligence as the
failure to observe for the protection of the interests of another person that degree of
care, precaution, and vigilance that the circumstances justly demand, whereby such
other person suffers injury.
The following are the elements of medical negligence: (1) the duty owed by the
physician to the patient, as created by the physician-patient relationship, to act in
accordance with the specific norms or standards established by his profession; (2)
the breach of the duty by the physician failing to act in accordance with the
applicable standard of care; (3) the causation, i.e., there must be a reasonably close
and causal connection between the negligent act or omission and the resulting
injury; and (4) the damages suffered by the patient.
Most medical malpractice cases are highly technical, therefore, witnesses with
special medical qualifications must impart the knowledge necessary to render a fair

57. On January 15, 1999, Rosit figured in a motorcycle
accident. The X-ray soon taken the next day at the Davao
ROSIT vs DAVAO Doctors Hospital (DDH) showed that he fractured his jaw.
DOCTORS Rosit was then referred to Dr. Gestuvo, a specialist in
HOSPITAL mandibular injuries. During the operation, Dr. Gestuvo
used a metal plate fastened to the jaw with metal screws
GR No. 210445, to immobilize the mandible.
December 7, 2015
As the operation required the smallest screws available,
Dr. Gestuvo cut the screws on hand to make them
smaller. Dr. Gestuvo knew that there were smaller
titanium screws available in Manila, but did not so inform
Rosit supposing that the latter would not be able to afford
the same.
Following the procedure, Rosit could not properly open
and close his mouth and was in pain. X-rays done on
Rosit two (2) days after the operation showed that the
fracture in his jaw was aligned but the screws used on
him touched his molar. Given the X-ray results, Dr.
Gestuvo referred Rosit to a dentist. The dentist who
checked Rosit, Dr. Pangan, opined that another operation
is necessary and that it is to be performed in Cebu.
In Cebu, Dr. Pangan removed the plate and screws thus
installed by Dr. Gestuvo and replaced them with smaller
titanium plate and screws. Dr. Pangan also extracted
Rosit’s molar that was hit with a screw and some bone
fragments. Three days (3) after the operation, Rosit was
able to eat and speak well and could open and close his
mouth normally.
and just verdict. In the case at bar, there were no witnesses with special medical
qualifications in anesthesia presented. Hence, it is difficult to assess whether the
first three elements of medical negligence were present.
CRIMINAL LAW: subsidiary liability pursuant to Article 103 of the Revised
Penal Code
Ospital ng Maynila could not be held civilly liable because it was not a party to the
case. To hold it so would be to deny it due process of law. Furthermore, before it can
be held subsidiary liable, the conditions therefor must first be established:(1) it must
be a corporation engaged in any kind of industry; (2) defendant must be shown to be
an employee of the corporation engaged in industry for profit; and (3) defendant
must be insolvent.
Applying the conditions in the case at bar, Ospital ng Maynila cannot be held
subsidiary liable because: (1) Ospital ng Maynila, being a public hospital, was not
engaged in industry conducted for profit but purely in charitable and humanitarian
work; (2) Dr. Solidumwas not an employee of Ospital ng Maynila but a consultant;
and (3) Dr. Solidum was not insolvent.
Whether the The Court have further held that resort to the doctrine of res ipsa loquitur as an
appellate court exception to the requirement of an expert testimony in medical negligence cases may
correctly absolved be availed of if the following essential requisites are satisfied: (1) the accident was of
Dr. Gestuvo from a kind that does not ordinarily occur unless someone is negligent; (2) the
liability instrumentality or agency that caused the injury was under the exclusive control of
the person charged; and (3) the injury suffered must not have been due to any
NO voluntary action or contribution of the person injured.
In its assailed Decision, the CA refused to acknowledge the application of the res
ipsa loquitur doctrine on the ground that the foregoing elements are absent. In
particular, the appellate court is of the position that post-operative pain is not
unusual after surgery and that there is no proof that the molar, Dr. Pangan
removed, is the same molar that was hit by the screw installed by Dr. Gestuvo in
Rosit’s mandible. Further, a second operation was conducted within the 5-week
usual healing period of the mandibular fracture so that the second element cannot
be considered present. Lastly, the CA pointed out that the X-ray examination
conducted on Rosit prior to his first surgery suggests that he had “chronic
inflammatory lung disease compatible,” implying that the injury may have been due
to Rosit’s peculiar condition, thus effectively negating the presence of the third
element.
After careful consideration, this Court cannot accede to the CA’s findings as it is at
once apparent from the records that the essential requisites for the application of
the doctrine of res ipsa loquitur are present.
The first element was sufficiently established when Rosit proved that one of the
screws installed by Dr. Gestuvo struck his molar. It was for this issue that Dr.
Gestuvo himself referred Rosit to Dr. Pangan. In fact, the affidavit of Dr. Pangan
presented by Dr. Gestuvo himself before the trial court narrated that the same molar
struck with the screw installed by Dr. Gestuvo was examined and eventually
operated on by Dr. Pangan. Dr. Gestuvo cannot now go back and say that Dr.
On his return to Davao, Rosit demanded that Dr. Gestuvo
reimburse him for the cost of the operation and the Pangan treated a molar different from that which was affected by the first operation.
expenses he incurred in Cebu amounting to P140,000, as
well as for the P50,000 that Rosit would have to spend for
Clearly, had Dr. Gestuvo used the proper size and length of screws and placed the
the removal of the plate and screws that Dr. Pangan
same in the proper locations, these would not have struck Rosit’s teeth causing him
installed. Dr. Gestuvo refused to pay. Thus, Rosit filed a
pain and requiring him to undergo a corrective surgery.
civil case for damages and attorney’s fees with the RTC
against Dr. Gestuvo and DDH.
Dr. Gestuvo knew that the screws he used on Rosit were too large as, in fact, he cut
the same with a saw. He also stated during trial that common sense dictated that
The RTC freed DDH from liability on the ground that it
the smallest screws available should be used. More importantly, he also knew that
exercised the proper diligence in the selection and
these screws were available locally at the time of the operation. Yet, he did not avail
supervision of Dr. Gestuvo, but adjudged Dr. Gestuvo
of such items and went ahead with the larger screws and merely sawed them off.
negligent. Dr. Gestuvo was order to pay Rosit the
Even assuming that the screws were already at the proper length after Dr. Gestuvo
following:
cut the same, it is apparent that he negligently placed one of the screws in the
wrong area thereby striking one of Rosit’s teeth.
• P140,199.13 representing reimbursement of actual
expenses incurred by plaintiff in the operation and re-
In any event, whether the screw hit Rosit’s molar because it was too long or
operation of his mandible;
improperly placed, both facts are the product of Dr. Gestuvo’s negligence. An
• P29,068.00 representing reimbursement of the filing
average man of common intelligence would know that striking a tooth with any
fees and appearance fees;
foreign object much less a screw would cause severe pain. Thus, the first essential
• P150,000.00 as and for attorney’s fees;
requisite is present in this case.
• P50,000.00 as moral damages;
• P10,000.00 as exemplary damages; and
• the costs of the suit. Anent the second element for the res ipsa loquitur doctrine application, it is
sufficient that the operation which resulted in the screw hitting Rosit’s molar was,
Unlike the RTC, the CA ruled that the res ipsa loquitur indeed, performed by Dr. Gestuvo. No other doctor caused such fact.
principle is not applicable and that the testimony of an
expert witness is necessary for a finding of negligence. Lastly, the third element that the injury suffered must not have been due to any
voluntary action or contribution of the person injured was satisfied in this case. It
The appellate court also gave credence to Dr. Pangan’s was not shown that Rosit’s lung disease could have contributed to the pain. What is
letter stating the opinion that Dr. Gestuvo did not commit clear is that he suffered because one of the screws that Dr. Gestuvo installed hit
gross negligence in his emergency management of Rosit’s Rosit’s molar.
fractured mandible.
Clearly then, the res ipsa loquitur doctrine finds application in the instant case and
no expert testimony is required to establish the negligence of defendant Dr. Gestuvo.

Petitioner was deprived of the opportunity to make an “informed consent”

There are four essential elements a plaintiff must prove in a malpractice action
based upon the doctrine of informed consent: “(1) the physician had a duty to
disclose material risks; (2) he failed to disclose or inadequately disclosed those risks;
(3) as a direct and proximate result of the failure to disclose, the patient consented
to treatment she otherwise would not have consented to; and (4) plaintiff was
injured by the proposed treatment.” The gravamen in an informed consent case
requires the plaintiff to “point to significant undisclosed information relating to the
treatment which would have altered her decision to undergo it.”

The four adverted essential elements above are present here.

First, Dr. Gestuvo clearly had the duty of disclosing to Rosit the risks of using the
larger screws for the operation. This was his obligation as the physician undertaking
 the operation.

Second, Dr. Gestuvo failed to disclose these risks to Rosit, deciding by himself that
Rosit could not afford to get the more expensive titanium screws.

Third, had Rosit been informed that there was a risk that the larger screws are not
appropriate for the operation and that an additional operation replacing the screws
might be required to replace the same, as what happened in this case, Rosit would
not have agreed to the operation. It bears pointing out that Rosit was, in fact, able to
afford the use of the smaller titanium screws that were later used by Dr. Pangan to
replace the screws that were used by Dr. Gestuvo.

Fourth, as a result of using the larger screws, Rosit experienced pain and could not
heal properly because one of the screws hit his molar. This was evident from the fact
that just three (3) days after Dr. Pangan repeated the operation conducted by Dr.
Gestuvo, Rosit was pain-free and could already speak. This is compared to the one
(1) month that Rosit suffered pain and could not use his mouth after the operation
conducted by Dr. Gestuvo until the operation of Dr. Pangan.

Without a doubt, Dr. Gestuvo is guilty of withholding material information which

would have been vital in the decision of Rosit in going through with the operation
with the materials at hand. Thus, Dr.Gestuvo is also guilty of negligence on this
ground.

Dr. Pangan’s Affidavit is not admissible. The belief of Dr.P angan whether Dr.
Gestuvo is guilty of negligence or not will not bind the Court. The Court must weigh
and examine such testimony and decide for itself the merits thereof.

WHEREFORE, the instant petition is GRANTED. The CA Decision dated January 22,
2013 and Resolution dated November 7, 2013 in CA-G.R. CV No. 00911-MIN are
hereby REVERSED and SET ASIDE. Further, the Decision dated September 14,
2004 of the Regional Trial Court, Branch 33 in Davao City in Civil Case No. 27,345-
99 is hereby REINSTATED and AFFIRMED.

58. Dr. Ninevetch Cruz was an aesthesiologist and surgeon in WON a physician has In the recent case of Leonila Garcia-Rueda v. Wilfred L. Pacasio, et. al., this
in perpetual C Help Clinic and General Hospital. LYDIA committed an Court stated that in accepting a case, a doctor in effect represents that, having the
CRUZ vs CA & Umali, deceased respondent, was her patient who was "inexcusable lack of needed training and skill possessed by physicians and surgeons practicing in the
LYDIA UMALI accompanied by respondent’s daughter Umali. precaution" in the same field, he will employ such training, care and skill in the treatment of his
treatment of his patients. He therefore has a duty to use at least the same level of care that any other
She was examined by Dr. Cruz and found a "myoma" in patient is to be reasonably competent doctor would use to treat a condition under the same
her uterus and was thereafter scheduled for hysterectomy determined circumstances.
operation. according to the
standard of care It is in this aspect of medical malpractice that expert testimony is essential to
observed by other establish not only the standard of care of the profession but also that the
Rowena and her mother slept in the clinic and noticed the
members of the physician's conduct in the treatment and care falls below such standard. Further,
untidiness if the clinic. Rowena tried to pursuade her
profession in good inasmuch as the causes of the injuries involved in malpractice actions are
mother to postponed the operation.
standing 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.
When Lydia asked Dr. Cruz, the latter informed that she
had must be operated. Thereafter, the operation
 proceeded while the relatives of Lydia where waiting, Dr.
Ercilla instructed them to buy a blood for Lydia.
After lapse of hours, they were informed that the
operation was finished. But again instructed to buy a
blood, unfortunately there were no blood A in the blood
bank of the clinic. Rowena noticed that her mother was
attached to an oxygen tank, gasping for breath.
Apparently, the oxygen run out of supply and Rowena
had to go to another hospital to get oxygen.
Lydia was given fresh supply of oxygen but later she went
into shock had unstable condition which necessitated her
to transfer to San Pablo District Hospital. Such was
without prior consent of Rowena nor of other relatives.
Thereafter, she was re-operated but Dr. Angeles, Head of
Obstetrics and Gynecology Department informed them
that there was nothing he can do as Lydia was already in
shock as her blood pressure was 0/0.
MTCC found Dr. Cruz and Dr. Ercilla guilty of negligence.
The RTC reiterated the abovementioned findings of the
MTCC and upheld the latter's declaration of
"incompetency, negligence and lack of foresight and skill
of appellant (herein petitioner) in handling the subject
patient before and after the operation." And likewise
affirming the petitioner's conviction, the Court of Appeals
echoed similar observations. hence, this case.
59. Mrs. Villegas was under the prenatal care of Dr. Batiquin.
BATIQUIN VS. Sept. 21, 1988, Dr. Batiquin with Dr. Doris Sy and OR
COURT OF Nurse Arlene Diones and some student nurses performed
APPEALS a simple caesarean section on Mrs. Villegas.
258 SCRA 334, Soon after leaving the Hospital Mrs. Villegas began to
JULY 05, 1996 suffer abdominal pains and complained of being feverish.
She also gradually lost her appetite, so she consulted Dr.
Batiquin at the latter’s polyclinic who prescribed for her
certain medicines . . . which she had been taking up to
December, 1988.
The abdominal pains and fever kept on recurring and
bothered Mrs. Villegas no end despite the medications
administered by Dr. Batiquin. When the pains became
unbearable and she was rapidly losing weight she
consulted Dr. Ma. Salud Kho at the Holy Child’s Hospital
in Dumaguete City on January 20, 1989.
When Dr. Kho opened the abdomen of Mrs. Villegas she
NO
For whether a physician or surgeon has exercised the requisite degree of skill and
care in the treatment of his patient is, in the generality of cases, a matter of expert
opinion. The deference of courts to the expert opinion of qualified physicians stems
from its realization that the latter possess unusual technical skills which laymen in
most instances are incapable of intelligently evaluating. Expert testimony should
have been offered to prove that the circumstances cited by the courts below are
constitutive of conduct falling below the standard of care employed by other
physicians in good standing when performing the same operation
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 a casual
connection of such breach and the resulting death of his patient.
In Chan Lugay v. St Luke's Hospital, Inc., where the attending physician was
absolved of liability for the death of the complainant's wife and newborn baby, this
court held that: "In order that there may be a recovery for an injury, however, it
must be shown that the 'injury for which recovery is sought must be the legitimate
consequence of the wrong done; the connection between the negligence and the
injury must be a direct and natural sequence of events, unbroken by intervening
efficient causes.'
In other words, the negligence must be the proximate cause of the injury. For,
'negligence, no matter in 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
not have occurred.''
WON Dr. Batiquin is The doctrine of res ipsa loquitur as a rule of evidence is peculiar to the law of
liable negligence which recognizes that prima facie negligence may be established without
direct proof and furnishes a substitute for specific proof of negligence.
YES
The doctrine is not a rule of substantive law, but merely a mode of proof or a mere
procedural convenience.
The rule, when applicable to the facts and circumstances of a particular case, is not
intended to and does not dispense with the requirement of proof of culpable
negligence on the party charged. It merely determines and regulates what shall be
prima facie evidence thereof and facilitates the burden of plaintiff of proving a breach
of the duty of due care. The doctrine can be invoked when and only when, under the
circumstances involved, direct evidence is absent and not readily available.
In the instant case, all the requisites for recourse to the doctrine are present.
First, the entire proceedings of the caesarean section were under the exclusive
control of Dr. Batiquin. In this light, the private respondents were bereft of direct
evidence as to the actual culprit or the exact cause of the foreign object finding its
way into private respondent Villegas’s body, which, needless to say, does not occur
unless through the intervention of negligence.
found whitish-yellow discharge inside, an ovarian cyst on
each of the left and right ovaries which gave out pus, dirt
and pus behind the uterus, and a piece of rubber material
on the right side of the uterus embedded on [sic] the
ovarian cyst, 2 inches by 3/4 inch in size. This piece of
rubber material which Dr. Kho described as a “foreign
body” looked like a piece of a “rubber glove” . . . and
which is [sic] also “rubber-drain like” It could have been a
torn section of a surgeon’s gloves or could have come from
other sources. And this foreign body was the cause of the
infection of the ovaries and consequently of all the
discomfort suffered by Mrs. Villegas after her delivery on
September 21, 1988.
The case was filed against the petitioner but the piece of
rubber allegedly found near private respondent’s uterus
was not presented in court. Dr. Ma. Salud Kho testified
that she sent it to a pathologist in Cebu City for
examination, but it was not mentioned in the
pathologist’s Surgical Pathology Report. Aside from Dr.
Kho’s testimony, the evidence which mentioned the piece
of rubber are a Medical Certificate, a Progress Record, an
Anesthesia Record, a Nurse’s Record, and a Physician’s
Discharge Summary
Second, since aside from the caesarean section, private respondent Villegas
underwent no other operation which could have caused the offending piece of
rubber to appear in her uterus, it stands to reason that such could only have been a
by-product of the caesarean section performed by Dr. Batiquin. The petitioners, in
this regard, failed to overcome the presumption of negligence arising from resort to
the doctrine of res ipsa loquitur. Dr. Batiquin is therefore liable for negligently
leaving behind a piece of rubber in private respondent Villegas’s abdomen and for all
the adverse effects thereof.
As a final word, this Court reiterates its recognition of the vital role the medical
profession plays in the lives of the people, and the State’s compelling interest to
enact measures to protect the public from “the potentially deadly effects of
incompetence and ignorance in those who would undertake to treat our bodies and
minds for disease or trauma.” Indeed, a physician is bound to serve the interest of
his patients “with the greatest of solicitude, giving them always his best talent and
skill.” Through her tortious conduct, the petitioner endangered the life of Flotilde
Villegas, in violation of her profession’s rigid ethical code and in contravention of the
legal standards set forth for professionals, in general, and members of the medical
profession, in particular.

RTC, however, regarded these documentary evidence as

mere hearsay, “there being no showing that the person or
persons who prepared them are deceased or unable to
testify on the facts therein stated. Except for the Medical
Certificate (Exhibit “F”), all the above documents were
allegedly prepared by persons other than Dr. Kho, and
she merely affixed her signature on some of them to
express her agreement thereto . . . .” RTC also refused to
give weight to Dr. Kho’s testimony regarding the subject
piece of rubber as Dr. Kho “may not have had first-hand
knowledge” thereof. Thus, RTC held in favor of the
petitioners but was subsequently reversed by CA.