RAMOS vs HOSAKA CASE

THE CASE:

The events that have taken place in this case were, that Erlinda Ramos, the patient
was diagnosed to have gall bladder stone and was scheduled for an elective
cholecystectomy at Delos Santos Medical Center by Dr. Hosaka, the surgeon, and
Dra. Gutierrez, the anesthesiologist of choice by Dr. Hosaka.

Pre-operative/pre-anesthetic evaluation was not done by Dra. Gutierrez, hence

alternative anesthetic plans were not considered.

When Erlinda was already scheduled and prepped for surgery, Dr. Hosaka was late
for several hours. Soon after arriving at the operating room, Dra. Gutierrez started to
intubate the patient but apparently there was difficulty in intubating the patient. Dra.
Gutierrez had difficulty inserting the endotracheal tube.

There was faulty inserting the endotracheal tube as manifested in the bluish
discoloration of the patient's nailbeds. The faulty insertion of the tube resulted into
cascades of neurologic events, leading to brain injury, resulting to a comatose state of
patient Ramos.

ISSUES and DOCTRINES INVOLVED in this CASE:

The court found that Dr. Hosaka was negligent in ignoring and failing to ensure and
carry out proper pre-operative measures. He was seriously remiss in his professional
duties towards his surgical team and to his patient. He was charged with negligent
under the Doctrine of Captain of the Ship for falling short being the surgical team
leader.

Captain of the Ship Doctrine is the legal doctrine which holds that, during an
operation in the operating room, a surgeon of record is liable for all actions conducted
in the course of the operation.

On the other hand, Dra. Gutierrez was found guilty under the Doctrine of Proximate
Cause, for a faulty intubation resulting to a series of neurologic events resulting to
brain damage and as a consequence, comatose state of the patient. In Law, a
Proximate Cause is an event sufficiently related to an injury that the courts deem the
event to be the cause of that injury.
For omitting to do pre-operative evaluation, Dra. Gutierrez failed to have a decisive,
alternative anesthetic plan thus she was not able to address any issue or condition that
were pertinent in her anesthetic management thus resulting into a total fiasco.
INSIGHT:

The standard of care of every surgeon and anesthesiologist is to evaluate patient pre-
operatively for an elective surgical procedure. In instances where surgical cases or
procedures are of emergency situation, wisdom dictates that it is an urgency to act and
do whatever deem necessary to perform, bearing in mind always to do with caution
and to do no harm.

Pre-operative evaluation and assessment is the cornerstone of safe surgical and

anesthetic practice. The important elements are identification of specific problems
that may be associated with the procedure, as well as those related to any comorbid
conditions, and formulation of a plan of care.

As in all areas of anesthesia, preoperative assessment also allows the patient to better
understand the role of anesthesiologist and provides time for delivering information to
the patient and addressing any patient's concern. Any deficits, anatomical,
physiologic, or neurological should be documented and comorbid conditions be
identified.

Pre-operative evaluation provides an assessment of medical risk and the identification

of measures to reduce that risk. Consultants need to have a clear understanding of
their role in patient care.

The most important information obtained in pre- anesthetic evaluation comes from a
thorough, accurate, and focused history and physical examination.

Pre -operative assessment is an important standard point that helps formulate

anesthetic plan. The success of surgical procedure lies in a well-organized strategic
plan arising from a pre-operative/pre-anesthetic evaluation of patient.