Professional Documents
Culture Documents
Ynares-Santiago (Chairperson), Chico-Nazario, Nachura Judgment Rendered in Accordance With Compromise Agreement
Ynares-Santiago (Chairperson), Chico-Nazario, Nachura Judgment Rendered in Accordance With Compromise Agreement
SO ORDERED.
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 1/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
* THIRD DIVISION.
174
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 2/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
175
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 3/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
176
177
Same; Same; Same; The mere fact that the patient does not get
well or that a bad result occurs does not in itself indicate failure to
exercise due care.—We cannot but agree with Dr. Tuaño’s
assertion that when a doctor sees a patient, he cannot determine
immediately whether the latter would react adversely to the use
of steroids; all the doctor can do is map out a course of treatment
recognized as correct by the standards of the medical profession.
It must be remembered that a physician is not an insurer of the
good result of treatment. The mere fact that the patient does not
get well or that a bad result occurs does not in itself indicate
failure to exercise due care.The result is not determinative of the
performance [of the physician] and he is not required to be
infallible.
Same; Same; Same; The critical and clinching factor in a
medical negligence case is proof of the causal connection between
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 5/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
178
179
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 7/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
180
CHICO-NAZARIO, J.:
In this petition for review on certiorari1 under Rule 45 of
the Revised Rules of Court, petitioners Peter Paul Patrick
Lucas, Fatima Gladys Lucas, Abbeygail Lucas and Gillian
Lucas seek the reversal of the 27 September 2006 Decision2
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 8/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
181
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 9/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
/eye-health/eye-health-conjunctivitis).
6 The generic name of Spersacet-C ophthalmic drops is Sulfacetamide.
It is prescribed for the treatment and prophylaxis of conjunctivitis due to
susceptible organisms; corneal ulcers; adjunctive treatment with systemic
sulfonamides for therapy of trachoma
(http://www.merck.com/mmpe/lexicomp/sulfacetamide.html).
7 Epidemic kerato conjunctivitis is a type of adenovirus ocular
infection. (http://emedicine.medscape.com/article/1192751-overview).
182
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 10/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
183
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 11/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
day for five (5) days; two (2) times a day for five (5) days;
and then just once a day.13
Several days later, on 18 October 1988, Peter went to
see Dr. Tuaño at his clinic, alleging severe eye pain, feeling
as if his eyes were about to “pop-out,” a headache and
blurred vision. Dr. Tuaño examined Peter’s eyes and
discovered that the EKC was again present in his right eye.
As a result, Dr. Tuaño told Peter to resume the maximum
dosage of Blephamide.
Dr. Tuaño saw Peter once more at the former’s clinic on
4 November 1988. Dr. Tuaño’s examination showed that
only the periphery of Peter’s right eye was positive for
EKC; hence, Dr. Tuaño prescribed a lower dosage of
Blephamide.
It was also about this time that Fatima Gladys Lucas
(Fatima), Peter’s spouse, read the accompanying literature
of Maxitrol and found therein the following warning
against the prolonged use of such steroids:
WARNING:
Prolonged use may result in glaucoma, with damage to the
optic nerve, defects in visual acuity and fields of vision, and
posterior, subcapsular cataract formation. Prolonged use may
suppress the host response and thus increase the hazard of
secondary ocular infractions, in those diseases causing thinning of
the cornea or sclera, perforations have been known to occur with
the use of topical steroids. In acute purulent conditions of the eye,
steroids may mask infection or enhance existing infection. If these
products are used for 10 days or longer, intraocular pressure
should be routinely monitored even though it may be difficult in
children and uncooperative patients.
Employment of steroid medication in the treatment of herpes
simplex requires great caution.
xxxx
_______________
184
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 12/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
ADVERSE REACTIONS:
Adverse reactions have occurred with steroid/anti-infective
combination drugs which can be attributed to the steroid
component, the anti-infective component, or the combination.
Exact incidence figures are not available since no denominator of
treated patients is available.
Reactions occurring most often from the presence of the anti-
infective ingredients are allergic sensitizations. The reactions due
to the steroid component in decreasing order to frequency are
elevation of intra-ocular pressure (IOP) with possible
development of glaucoma, infrequent optic nerve damage;
posterior subcapsular cataract formation; and delayed wound
healing.
Secondary infection: The development of secondary has
occurred after use of combination containing steroids and
antimicrobials. Fungal infections of the correa are particularly
prone to develop coincidentally with long-term applications of
steroid. The possibility of fungal invasion must be considered in
any persistent corneal ulceration where steroid treatment has
been used.
Secondary bacterial ocular infection following suppression of
host responses also occurs.”
_______________
185
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 13/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
com/script/main/art.asp?articlekey=4014).
18 Exhibit “1-a”; Records, p. 618-A.
19 Normal IOP is measured in millimeters of Mercury (Hg).
20 See note 19.
21 The generic name of Diamox, for oral administration, is
acetazolamide. This medication is a potent carbonic anhydrase inhi-bitor,
effective in the control of fluid secretion (http://www.drugs.
com/pro/diamox.html).
22 The active ingredient of Normoglaucon is Metipranolol
hydrochloride. It is used for the reduction of intraocular pressure in
patients with glaucoma (open, closed angle) in situations in which
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 14/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
186
_______________
O.D).
27 Laser Trabeculoplasty is a kind of surgery which uses a very focused
beam of light to treat the drainage angle of the eye. This surgery makes it
easier for fluid to flow out of the front part of the eye, decreasing pressure
in the eye (http://www.med.nyu.edu/health
wise).
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 15/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
28 According to Peter, after seeing Dr. Tuaño on the 15th of December
1988, he next saw him on the 17th of the same month. Per Exhibit 1-a, the
patient’s index card, however, after the 15th of December 1988, Peter’s
next visit was on the 23rd of the same month.
29 Exhibit “1-a”; Records, p. 618-A.
187
_______________
188
_______________
plus/ency/article/003880.htm).
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 17/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
34 Funduscopy is the examination of the back part of the eye’s interior (fundus);
also known as ophthalmoscopy.
35 Zeiss Gonioscopy (indirect gonioscopy) is the visualization of the anterior
chamber angle of the eyes undertaken using a Zeiss lens. It is essential to
determine the mechanism responsible for impeding aqueous flow
(http://www.glaucomaworld.net/english/019/e019a01.html).
36 Peripheral Anterior Synechiae.
37 Timolol Maleate is a generic name of a drug in ophthalmic dosage form used
in treatment of elevated intraocular pressure by reducing aqueous humor
production or possibly outflow (http://www.umm.edu/altmed/drugs/timolol-
125400.htm).
38 B.I.D. is the abbreviation of the Latin phrase bis in di´e, meaning “twice a
day” (http://medical-dictionary.thefreedictionary.com/B.I.D).
189
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 18/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
asp?articlekey=24516).
190
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 19/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
emedicine.medscape.com/article/1205298-print).
46 As evidenced by a Marriage Contract between Peter and Fatima;
Records, p. 340.
47 As evidenced by the child’s Certificate of Live Birth; id., at p. 341.
191
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 20/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
192
_______________
53 Id.
54 Id., at p. 82.
55 Answer, p. 6; id., at p. 38.
193
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 22/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
56 Id.
57 Id.
58 Id.
59 Answer, p. 13; id., at p. 45.
60 Id.
194
_______________
195
“[D]id not present any medical expert to testify that Dr. Tuano’s
prescription of Maxitrol and Blephamide for the treatment of
EKC on Peter’s right eye was not proper and that his palpation of
Peter’s right eye was not enough to detect adverse reaction to
steroid. Peter testified that Dr. Manuel Agulto told him that he
should not have used steroid for the treatment of EKC or that he
should have used it only for two (2) weeks, as EKC is only a viral
infection which will cure by itself. However, Dr. Agulto was not
presented by [petitioners] as a witness to confirm what he
allegedly told Peter and, therefore, the latter’s testimony is
hearsay. Under Rule 130, Section 36 of the Rules of Court, a
witness can testify only to those facts which he
_______________
65 Id.
66 Rollo, p. 68.
196
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 25/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
I.
THE COURT OF APPEALS COMMITTED GRAVE
REVERSIBLE ERROR IN AFFIRMING THE DECISION OF
THE TRIAL COURT DISMISSING THE PETITIONERS’
COMPLAINT FOR DAMAGES AGAINST THE RESPONDENT
ON THE GROUND OF INSUFFICIENCY OF EVIDENCE;
II.
THE COURT OF APPEALS COMMITTED GRAVE
REVERSIBLE ERROR IN DISMISSING THE PETITIONERS’
COMPLAINT FOR DAMAGES AGAINST THE RESPONDENT
ON THE GROUND THAT NO MEDICAL EXPERT WAS
PRESENTED BY THE PETITIONERS TO PROVE THEIR
CLAIM FOR MEDICAL NEGLIGENCE AGAINST THE
RESPONDENT; AND
_______________
67 Id., at p. 67.
68 Id., at p. 66.
197
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 26/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
III.
THE COURT OF APPEALS COMMITTED GRAVE
REVERSIBLE ERROR IN NOT FINDING THE RESPONDENT
LIABLE TO THE PETITIONERS’ FOR ACTUAL, MORAL AND
EXEMPLARY DAMAGES, ASIDE FROM ATTORNEY’S FEES,
COSTS OF SUIT, AS A RESULT OF HIS GROSS
NEGLIGENCE.69
_______________
69 Id., at p. 23.
70 Civil Service Commission v. Maala, G.R. No. 165253, 18 August
2005, 467 SCRA 390, 398.
71 Alfaro v. Court of Appeals, 416 Phil. 310, 317; 363 SCRA 799, 806
(2001).
198
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 27/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
73 Id.
199
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 29/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
74 Id., at p. 26.
75 Amended Complaint, p. 6; Records, p. 81.
200
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 30/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
201
_______________
202
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 32/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
84 Dr. Cruz v. Court of Appeals, 346 Phil. 872, 884-885; 282 SCRA 188,
201 (1997).
85 http://www.druglib.com/druginfo/maxitrol/.
86 Court of Appeals Decision, p. 17; Rollo, p. 66.
203
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 33/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
willsglaucoma.org/supportgroup/20030827.php).
88 TSN, 7 February 1997, p. 17; Rollo, p. 66.
204
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 34/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
205
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 35/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
206
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 36/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
95 Id.
96 Id.
97 Cup to Disc ratio.
207
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 37/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
_______________
208
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 38/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
“In civil cases, the party having the burden of proof must
establish his case by a preponderance of evidence. In determining
where the preponderance or superior weight of evidence on the
issues involved lies the court may consider all the facts and
circumstances of the case, the witnesses’ manner of testifying,
their intelligence, their means and opportunity of knowing the
facts to which they are testifying, the nature of the facts to which
they testify, the probability or improbability of their testimony,
their interest or want of interest, and also their personal
credibility so far as the same legitimately appear upon the trial.
The court may also consider the number of witnesses, though the
preponderance is not necessarily with the greater number.”
_______________
101 Jison v. Court of Appeals, 350 Phil. 138, 173; 286 SCRA 495, 532
(1998), citing Vicente J. Francisco, Revised Rules of Court in the
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 39/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
209
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 40/41
2/12/22, 10:41 PM SUPREME COURT REPORTS ANNOTATED VOLUME 586
https://central.com.ph/sfsreader/session/0000017eee6223cf74b33f63000d00d40059004a/t/?o=False 41/41