Cases for Medical Malpractice

7/23/2019 Cases for Medical Malpractice

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Legal Medicine Medical Negligence Digest by Bianca Beltran

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[G.R. No. 118231. July 5, 1996]

BATIQUINvs. COURT OF APPEA!

At present, the primary objective of the medical profession is

the preservation of life and maintenance of the health of thepeople!

FACTS

Dr Bati"#in $as a %esident &hysician at the Negros 'rienta&rovincial (ospital, D#mag#ete )ity *he $as also the Actg (eadof the Department of 'bstetrics and +ynecology at the said(ospital

"#$. %&ll'()$, a married $oman, $u*+&'- '#$'l/ o 0#.B)&u& /o# #'))l 4)#'as the latters private patient 'nemorning, 0#. B)&u&, $ith the assistance of Dr Doris -eresita *y,also a %esident &hysician at the same (ospital, ). and '% N#rseArlene Diones and some st#dent n#rses '#/o#+'- ) $&+l'4'$)#') section o "#$. %&ll'()$ and after /0 min#tes "#$.%&ll'()$ -'l&'#'- '# #$ 4&l-, %achel Acogido -hereafter,&lainti remained con2ned at the (ospital d#ring $hich she $as

reg#larly visited by Dr Bati"#in

*oon after leaving the (ospital "#$. %&ll'()$ *'() o $u7'#)*-o+&)l )&$)- 4o+l)&'- o/ *'&( /''#&$ *he alsograd#ally lost her appetite, so she cons#lted Dr Bati"#in at thelatters polyclinic $ho prescribed for her certain medicines T')*-o+&)l )&$ )- /''# ' o #'4u##&( -'$&' '+'-&4)&o$ )-+&&$'#'- *y 0#. B)&u& 3hen the painsbecome #nbearable and she $as rapidly losing $eight shecons#lted Dr Ma *al#d 4ho at the (oly )hilds (ospital inD#mag#ete )ity

Dr Ma *al#d 4ho fo#nd Mrs 5illegas to be feverish, pale and$as breathing fast 6pon e7amination she felt an abdominal massone 2nger belo$ the #mbilic#s $hich she s#spected to be either at#mor of the #ter#s or an ovarian cyst, either of $hich co#ld becancero#s *he had an 78ray ta9en of Mrs 5illegas chest,


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abdomen and 9idney *he also too9 blood tests of &lainti Ablood co#nt sho$ed that Mrs 5illegas had an infection inside herabdominal cavity -he res#lt of all those e7aminations impelled Dr4ho to s#ggest that Mrs 5illegas s#bmit to another s#rgery to

$hich the latter agreed' 0#. :o o''- ' )*-o+' o/ "#$. %&ll'()$ $'

/ou- ;&&$


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a$ay as told by her to Defendant -he fail#re of the &laintis toreconcile these t$o dierent versions serve only to $ea9en theirclaim against Defendant Bati"#in

RTC 8 held in favor of the petitioners herein

CA reversed the decision It deemed Dr. Khos positivetestimony to defnitely establish that a piece o rubber was oundnear private respondent Villegas uterus..t f#rther noted the factthat 5illegas can no longer bear children beca#se her #ter#s andovaries $ere removed by Dr 4ho is not ta9en into consideration asit not sho$n that the removal of said organs $ere the direct res#ltof the r#bber left by the appellee Dr Bati"#in near the #ter#s3hat is establishe is that the r#bber left by appellee ca#se

infection, placed the life of appellant ?lotilde in jeopardy ad ca#sedappelants fear, $orry and an7iety

ISSUE

3hether or not the testimony of Dr 4ho sho#ld be givencredence

Ruling

Weagree with the Court o ppeals -he phrase relied #pon bythe trial co#rt does not negate the fact that Dr 4ho sa$ a piece ofr#bber in private respondent 5illegas abdomen, and that she sentit to a laboratory and then to )eb# )ity for e7amination by apathologist Not even the &athologists %eport, altho#gh devoid ofany mention of a piece of r#bber, co#ld alter $hat Dr 4hosa$ ?#rthermore, Dr 4hos 9no$ledge of the piece of r#bber

co#ld not be based on other than 2rst hand

Altho#gh hearsay, Dr Bati"#ins claim $as not objected to, andhence, the same is admissible b#t it carries no probativeval#e Nevertheless, ass#ming other$ise, Dr Bati"#ins statementcannot belie the fact that Dr 4ho fo#nd a piece of r#bber nearprivate respondent 5illegas #ter#s And even if $e $ere to do#btDr 4ho as to $hat she did to the piece of r#bber 'n this score, it


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is perfectly reasonable to believe the testimony of a $itness $ithrespect to some facts and disbelieve his testimony $ith respect toother facts And it has been aptly said that even $hen a $itness isfo#nd to have deliberately falsi2ed in some material partic#lars, it

is not re"#ired that the $hole of his #ncorroborated testimony berejected, b#t s#ch portions thereof deemed $orthy of belief maybe credited

)onsidering that $e have assessed Dr 4ho to be a credible$itness, herpositive testimonythat a piece of r#bber $as indeedfo#nd in private respondent 5illegas abdomenEprevails over thenegative testimonyin favor of the petitioners

As s#ch, the r#le of res ipsa lo!uiturcomes to fore -his )o#rt

has had occasion to delve into the nat#re and operation of thisdoctrine@

Res ipsa loquitur -he thing spea9s for itself %eb#ttablepres#mption or inference that defendant $as negligent, $hicharises #pon proof that theE instr#mentality ca#sing inj#ry $as indefendants e7cl#sive control, and that the accident $as one $hichordinary does not happen in absence of negligence "es ipsalo!uituris aE r#le of evidence $hereby negligence of theE alleged

$rongdoer may be inferred from theE mere fact that theEaccident happened provided theE character of theE accident andcirc#mstances attending it lead reasonably to belief that in theEabsence of negligence it $o#ld not have occ#rred and that thing$hich ca#sed inj#ry is sho$n to have been #nder theEmanagement and control of theE alleged $rongdoer 6nderthisE doctrine the happening of an inj#ry permits an inferenceof negligence $here plainti prod#ces s#bstantial evidence that

theE inj#ry $as ca#sed by an agency or instr#mentality #ndertheE e7cl#sive control and management of defendant, and thatthe occ#rrence sicE $as s#ch that in the ordinary co#rse of things$o#ld not happen if reasonable care had been #sed

777 777 777

-he doctrine of #r$es ipsa lo!uituras a r#le of evidence is pec#liarto the la$ of negligence $hich recogni=es thatprima


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acienegligence may be established $itho#t direct proof andf#rnishes a s#bstit#te for speci2c proof of negligence -hedoctrine is not a r#le of s#bstantive la$, b#t merely a mode ofproof or a mere proced#ral convenience -he r#le, $hen

applicable to the facts and circ#mstances of a partic#lar case, isnot intended to and does not dispense $ith the re"#irement ofproof of c#lpable negligence on the party charged .t merelydetermines and reg#lates $hat shall beprimaacieevidencethereof and facilitates the b#rden of plainti of proving a breach ofthe d#ty of d#e care -he doctrine can be invo9ed $hen and only$hen, #nder the circ#mstances involved, direct evidence is absentand not readily available

.n the instant case, all the re"#isites for reco#rse to the doctrineare present ?irst, the entire proceedings of the cesarean section$ere #nder the e7cl#sive control of Dr Bati"#in .n this light, theprivate respondents $ere bereft of direct evidence as to the act#alc#lprit or the e7act ca#se of the foreign object 2nding its $ay intoprivate respondent 5illegas body, $hich, needless to say, doesnot occ#r #nless thro#gh the intervention of negligence *econd,since aside from the cesarean section, private respondent 5illegas

#nder$ent no other operation $hich co#ld have ca#sed theoending piece of r#bber to appear in her #ter#s, it stands toreason that s#ch co#ld only have been a by8prod#ct of thecesarean section performed by Dr Bati"#in -he petitioners, inthis regard, failed to overcome the pres#mption of negligencearising from resort to the doctrine of res ipsa lo!uitur Dr Bati"#inis therefore liable for negligently leaving behind a piece of r#bberin private respondent 5illegas abdomen and for all the adverseeects thereof

A$ ) )l ;o#-, &$ Cou# #'&'#)'$ &$ #'4o(&&o o/' &)l #ol' ' +'-&4)l #o/'$$&o l)y$ & ' l&'$ o/' 'ol', )- !)'>$ 4o+'ll&( &'#'$ o ')4+')$u#'$ o #o'4 ' u*l&4 /#o+ =' o'&)lly-')-ly '7'4$ o/ &4o+''4' )- &(o#)4' & o$' ;o;oul- u-'#)' o #') ou# *o-&'$ )- +&-$ /o# -&$')$'o# #)u+).= I-''-, ) y$&4&) &$ *ou- o $'#' '


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&'#'$ o/ &$ )&'$ =;& ' (#')'$ o/ $ol&4&u-',(&&( '+ )l;)y$ &$ *'$ )l' )- $&ll.= T#ou( '#o#&ou$ 4o-u4, ' '&&o'# '-)('#'- ' l&/' o/Flo&l-' %&ll'()$, & &ol)&o o/ '# #o/'$$&o>$ #&(&-

'&4)l 4o-' )- & 4o#)'&o o/ ' l'()l $)-)#-$$' /o# /o# #o/'$$&o)l$, & ' (''#)l, )- +'+*'#$ o/' +'-&4)l #o/'$$&o, & )#&4ul)#.

?EREFORE, the challenged decision of 11 May 1GG/ of the)o#rt of Appeals in )A8+% )5 No ;HI01 is hereby A??.%MJD intoto

)osts against the petitioners

!O OR0ERE0.


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FE CA@AO


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$o#ld see9 admission at the LM), petitioner immediately called thehospital to anticipate the arrival of Jditha and ordered thro#gh thetelephone the medicines Jditha needed to ta9e, $hich the n#rsescarried o#tO petitioner visited Jditha d#ring her ro#ndsO she performed

an internal e7amination on Jditha and she discovered that the latterscervi7 $as already open, th#s, petitioner disc#ssed the possible D)proced#re, sho#ld the bleeding become more prof#seO she cond#ctedanother internal e7amination on Jditha, $hich revealed that thelatters cervi7 $as still openO Jditha persistently complained of hervaginal bleeding and her passing o#t of some meaty mass in theprocess of #rination and bo$el movementO th#s, petitioner advisedJditha to #ndergo D) proced#re $hich the respondents consented

toO petitioner $as very vocal in the operating room abo#t not beingable to see an abort#sO ta9ing the $ords of Jditha to mean that she$as passing o#t some meaty mass and clotted blood, she ass#medthat the abort#s m#st have been e7pelled in the process of bleedingO it$as Jditha $ho insisted that she $anted to be dischargedO petitioneragreed, b#t she advised Jditha to ret#rn for chec98#p $hich the latterfailed to do

&etitioner contended that it $as Jdithas gross negligence

and


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bleeding, an #ltra8so#nd $as performed #pon her and the res#lt of the*onogram -est reveals a morbid fet#s b#t did not specify $here thefet#s $as located 'bstetricians $ill ass#me that the pregnancy is$ithin the #ter#s #nless so speci2ed by the *onologist $ho cond#cted

the #ltra8so#nd %espondent Dr LasamC cannot be fa#lted if she $asnot able to determine that complainant Jditha is havingan ectopic pregnancy interstitial -he D) cond#cted on Jditha isnecessary considering that her cervi7 is already open and so as to stopthe prof#se bleeding *imple c#rettage cannot remove a fet#s if thepatient is having an ectopic pregnancy, since ectopic pregnancy ispregnancy conceived o#tside the #ter#s and c#rettage is done only$ithin the #ter#s -herefore, a more e7tensive operation needed in

this case of pregnancy in order to remove the fet#sA')l o PRC -'4&$&o8 reversing the 2ndings of the Boardand revo9ing petitioners a#thority or license to practice her professionas a physician

&etitioner bro#ght the matter to the )A in a &etition for %evie$#nder %#le /; of the %#les of )o#rt &etitioner also d#bbed herpetition as one for certiorari#nder %#le F0 of the %#les of )o#rt -he)A held that the &etition for %evie$ #nder %#le /; of the %#les of )o#rt

$as an improper remedy, as the en#meration of the !uasi&'udicialagencies in %#le /; is e7cl#sive ("C is not among the !uasi&'udicial bodies whose 'udgment or fnal orders are sub'ect o a petitionor reviewto the C, th#s, the petition for revie$ of the &%) Decision,2led at the )A, $as improper )iting *ection :F of %ep#blic Act %ACNo :;I: or the Medical Act of 1G0G, the )A held that the plain, speedyand ade"#ate remedy #nder the ordinary co#rse of la$ $hichpetitioner sho#ld have availed herself of $as to appeal to the 'Qce of

the &resident

ISSUE

13(J-(J% '% N'- &%) )'MM.--JD +%A5J AB6*J '?D.*)%J-.'N .N %J5'4.N+ &J-.-.'NJ%* L.)JN*J -'&%A)-.)J MJD.).NJ 3.-('6- AN JR&J%- -J*-.M'NS -'


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*6&&'%- .-* )'N)L6*.'N A* -' -(J )A6*J '?%J*&'NDJN- JD.-(A %AM'LJ-J* .N6%SO

:3(J-(J% '% N'- &%) )'MM.--JD AN J5JN +%A5J%

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-(J )A6*J '? %J*&'NDJN- JD.-(A* .N6%S, A* 3JLL A*-(J -J*-.M'NS '? -(J JR&J%- 3.-NJ** A6+6*-'MANAL', MD OANDE

;3(J-(J% '% N'- &%) )'MM.--JD +%A5J AB6*J '?

D.*)%J-.'N .N MA4.N+ )'N)L6*.'N* '? ?A)-* -(A- 3J%JN'- 'NLS 6N*6&&'%-JD BS J5.DJN)J B6- 3J%J A)-6ALLS)'N-%A%S -' J5.DJN)J 'N %J)'%D

RULING

Anent the s#bstantive merits of the case, petitioner "#estionsthe &%) decision for being $itho#t an e7pert testimony to s#pport itsconcl#sion and to establish the ca#se of Jdithas inj#ry &etitioneravers that in cases of medical malpractice, e7pert testimony isnecessary to s#pport the concl#sion as to the ca#se of the inj#ry

Medical malpractice is a partic#lar form of negligence $hichconsists in the fail#re of a physician or s#rgeon to apply to his practiceof medicine that degree of care and s9ill $hich is ordinarily employed

by the profession generally, #nder similar conditions, and in li9es#rro#nding circ#mstances .n order to s#ccessf#lly p#rs#e s#ch aclaim, a patient m#st prove that the physician or s#rgeon either failedto do something $hich a reasonably pr#dent physician or s#rgeon$o#ld not have done, and that the fail#re or action ca#sed inj#ry to thepatient


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)here are our elements involved in medical negligence cases*duty% breach% in'ury and pro+imate causation

A physician8patient relationship $as created

$hen Jditha employed the services of thepetitioner As Jdithas physician, petitioner $as d#ty8bo#nd to #se atleast the same level of care that any reasonably competent doctor$o#ld #se to treat a condition #nder the same circ#mstances -hebreach of these professional d#ties of s9ill and care, or their improperperformance by a physician s#rgeon, $hereby the patient is inj#red inbody or in health, constit#tes actionable malpractice As to this aspectof medical malpractice, the determination of the reasonable level of

care and the breach thereof, e7pert testimony is essential ?#rther,inasm#ch as the ca#ses of the inj#ries involved in malpractice actionsare determinable only in the light of scienti2c 9no$ledge, it has beenrecogni=ed that e7pert testimony is #s#ally necessary to s#pport theconcl#sion as to ca#sation

.n the present case, respondents did not present any e7perttestimony to s#pport their claim that petitioner failed to do something$hich a reasonably pr#dent physician or s#rgeon $o#ld have done

&etitioner, on the other hand, presented the testimony ofDr A#g#sto M Manalo, $ho $as clearly an e7pert on the s#bject

+enerally, to !ualiy as an e+pert witness% one must haveac!uired special ,nowledge o the sub'ect matter about which he or

she is to testiy% either by the study o recogni-ed authorities on thesub'ect or by practical e+perience.

?rom the e7pert $itness testimony, it is clear that the D)proced#re $as cond#cted in accordance $ith the standard practice,$ith the same level of care that any reasonably competent doctor


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$o#ld #se to treat a condition #nder the same circ#mstances, and thatthere $as nothing irreg#lar in the $ay the petitioner dealt $ith Jditha

Medical malpractice, in o#r j#risdiction, is often bro#ght as a civil

action for damages #nder Article :1KF of the )ivil )ode -he defensesin an action for damages, provided for #nder Article :1KG of the )ivil)ode are@

Art :1KG ' ' l)&&7$ o; '(l&('4' ;)$' &++'-&)' )- #o&+)' 4)u$' o/ &$ &Hu#y, '4)o #'4o'# -)+)('$. B#t if his negligence $as only

contrib#tory, the immediate and pro7imate ca#se of theinj#ry being the defendants lac9 of d#e care, the plaintimay recover damages, b#t the co#rts shall mitigate thedamages to be a$arded

(ro+imate causehas been defned as that which% in natural andcontinuous se!uence% unbro,en by any ecient intervening cause%produces in'ury% and without which the result would not have occurred.

An inj#ry or damage is pro7imately ca#sed by an act or a fail#re to act,$henever it appears from the evidence in the case that the act oromission played a s#bstantial part in bringing abo#t or act#ally ca#singthe inj#ry or damageO and that the inj#ry or damage $as either a directres#lt or a reasonably probable conse"#ence of the act or omission

.n the present case, the )o#rt notes the 2ndings of the Board ofMedicine@

3hen complainant $as discharged on #ly ;1,1GG/, herein #'$o-' )-&$'- '# o #'u#o Au(u$ , 199 o# /ou# -)y$ )/'# '0C. T&$ )-&$' ;)$ 4l')# & 4o+l)&)$0&$4)#(' !''.(o$ever, 4o+l)&) /)&l'- o -o$o. -his being the case, the chain of contin#ity as re"#ired in


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order that the doctrine of pro7imate ca#se can be validlyinvo9ed $as interr#pted ?)- $' #'u#'-, '#'$o-' 4oul- )' ')+&'- '#o#ou(ly.7 7 7 Jmphases s#ppliedC

Also, in the testimony of Dr Manalo, he stated f#rther that

ass#ming that there $as in fact a misdiagnosis, the same $o#ld havebeen recti2ed if Jditha follo$ed the petitioners order to ret#rn for achec98#p Dr Manalo stated@

G#)&( ) ' o*$'#&4&)


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Z All the laryngoscope B#t if . remember right some$here inthe re8direct, a certain la$yer, yo# $ere as9ed that yo# did a2rst attempt and the "#estion $as did yo# $ithdra$ thet#beX And yo# said yo# never $ithdre$ the t#be, is that

rightXA Ses

Z Ses And so if yo# never $ithdre$ the t#be then there $asno, there $as no insertion of the t#be d#ring that 2rstattempt No$, the other thing that $e have to settle here is $hen cyanosis occ#rred, is it recorded in the anesthesiarecord $hen the cyanosis, in yo#r recording $hen did thecyanosis occ#rX

A sicC

Z .s it a standard practice of anesthesia that $hatever yo# dod#ring that period or from the time of ind#ction to the timethat yo# probably get the patient o#t of the operating roomthat every single action that yo# do is so recorded in yo#ranesthesia recordX

A . $as not able to record everything . did not have time

anymore beca#se . did that after the, $hen the patient $asabo#t to leave the operating room 3hen there $as secondcyanosis already that $as the interr#ptedC

Z 3hen $as the 2rst cyanosisX

A -he 2rst cyanosis $hen . $as interr#ptedC

Z 3hat time, more or lessX

A . thin9 it $as 1:@10 or 1:@1F

Z 3ell, if the record $ill sho$ yo# started ind#ction at 1:@10XA Ses, So#r (onor

Z And the 2rst medication yo# gave $as $hatX

A -he 2rst medication, no, 2rst the patient $as o7ygenated foraro#nd one to t$o min#tes

Z Ses, so, that is abo#t 1:@1;X


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A Ses, and then, . as9ed the resident physician to start givingthe pentothal very slo$ly and that $as aro#nd one min#te

Z *o, that is abo#t 1:@1; no, 1:@10, 1:@1KX

A Ses, and then, after one min#te another o7ygenation $as

given and after interr#ptedC

Z 1:@1IX

A Ses, and then after giving the o7ygen $e start themenorc#re $hich is a rela7ant After that rela7antinterr#ptedC

Z After that rela7ant, ho$ long do yo# $ait before yo# do anymanip#lationX

A 6s#ally yo# $ait for t$o min#tes or three min#tesZ *o, if o#r estimate of the time is acc#rate $e are no$ more

or less 1:@1G, is that rightX

A Maybe

Z 1:@1G And at that time, $hat $o#ld have been done to thispatientX

A After that time yo# e7amine the, if there is rela7ation of the

ja$ $hich yo# p#sh it do$n$ards and $hen . sa$ that thepatient $as rela7 beca#se that monorc#re is a rela7ant, yo#cannot int#bate the patient or insert the laryngoscope if it isnot 9eeping him rela7 *o, my 2rst attempt $hen . p#t thelaryngoscope on . sa$ the trachea $as deeply interiorly *o,$hat . did as9 mahirap ata ito ah! *o, . removed thelaryngoscope and o7ygenated again the patient

Z *o, more or less yo# attempted to do an int#bation after the

2rst attempt as yo# claimed that it $as only the laryngoscopethat $as inserted

A Ses

Z And in the second attempt yo# inserted the laryngoscopeand no$ possible int#bationX

A Ses


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the time $hen mayroon ba 9ayong hin#got sa t#be, . do notremember the page no$, b#t it seems to me it is there *o,that it $as on the second attempt that interr#ptedC

A . $as able to int#bate

Z And this is more or less abo#t $hat time 1:@:1X

A Maybe, . cannot remember the time, *ir

Z '9ay, ass#ming that this $as done at 1:@:1 and loo9ing atthe anesthesia records from 1:@:H to 1:@;H there $as norecording of the vital signs And can $e pres#me that at thisstage there $as already some problems in handling thepatientX

A Not yetZ B#t $hy are there no recordings in the anesthesia recordX

A . did not have time

Z Ah, yo# did not have time, $hy did yo# not have timeX

A Beca#se it $as so fast, . really at this j#nct#re the $itnessis la#ghingC

Z No, . am j#st as9ing %emember . am not here not to pin

point on anybody . am here j#st to more or less clarifycertainty more ore less on the record

A Ses, *ir

Z And so it seems that there $ere no recording d#ring thatspan of ten 1HC min#tes ?rom 1:@:H to 1:@;H, and goingover yo#r narration, it seems to me that the cyanosisappeared ten 1HC min#tes after ind#ction, is that rightX

A SesZ And that is after ind#ction 1:@10 that is 1:@:0 that $as the

2rst cyanosisX

A Ses

Z And that the 1:@:0 is after the 1:@:HX

A 3e cannot interr#ptedC


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Z (#$ag ho 9ayong ma9#$an, $e are j#st trying to enlighten,. am j#st going over the record ano, 9#ng mali ito 9#$an eh diano *o, ganoon po ano, that it seems to me that there is norecording from 1:@:H to 1:@;H, so, . am j#st $ondering $hy

there $ere no recordings d#ring the period and then of co#rsethe second cyanosis, after the 2rst cyanosis . thin9 that $asthe time Dr (osa9a came inX

A No, the 2rst cyanosis interr#ptedC:;E

3e cannot th#s give f#ll credence to Dr +#tierre= synopsis inlight of her admission that it does not f#lly reUect the events thattranspired d#ring the administration of anesthesia on Jrlinda Aspointed o#t by Dr Jstrella, there $as a ten8min#te gap in Dr

+#tierre= synopsis, ie, the vital signs of Jrlinda $ere notrecorded d#ring that time -he absence of these data ispartic#larly signi2cant beca#se, as fo#nd by the trial co#rt, it $asthe absence of o7ygen s#pply for fo#r /C to 2ve 0C min#tes thatca#sed Jrlindas comatose condition

'n the other hand, the )o#rt has no reason to disbelieve thetestimony of )r#= As $e stated in the Decision, she is competentto testify on matters $hich she is capable of observing s#ch as,

the statements and acts of the physician and s#rgeon, e7ternalappearances and manifest conditions $hich are observable by anyone:/E)r#=, Jrlindas sister8in8la$, $as $ith her inside theoperating room Moreover, being a n#rse and Dean of the )apitolMedical )enter *chool of N#rsing at that, she is not entirelyignorant of anesthetic proced#re )r#= narrated that she heard Dr+#tierre= remar9, ng hirap ma&intubate nito% mali yata angpag,a,apaso,. 7 lumala,i ang tiyan! *he observed that the

nailbeds of Jrlinda became bl#ish and thereafter Jrlinda $asplaced in trendelenb#rg position:0E)r#= f#rther averred that shenoticed that the abdomen of Jrlinda became distended:FE

-he cyanosis bl#ish discoloration of the s9in or m#co#smembranes ca#sed by lac9 of o7ygen or abnormal hemoglobin inthe bloodC and enlargement of the stomach of Jrlinda indicate thatthe endotracheal t#be $as improperly inserted into the esophag#sinstead of the trachea )onse"#ently, o7ygen $as delivered not to
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over the acts of Dr +#tierre= As anesthesiologist, Dr +#tierre= isa specialist in her 2eld and has ac"#ired s9ills and 9no$ledge inthe co#rse of her training $hich Dr (osa9a, as a s#rgeon, does notpossess;1E(e states f#rther that c#rrent American j#rispr#dence

on the matter recogni=es that the trend to$ards speciali=ation inmedicine has created sit#ations $here s#rgeons do not al$ayshave the right to control all personnel $ithin the operating room,;:Eespecially a fello$ specialist;;E

Dr (osa9a cites the case of )homas v. "aleigh Feneral2ospital%;/E$hich involved a s#it 2led by a patient $ho lost hisvoice d#e to the $rongf#l insertion of the endotracheal t#bepreparatory to the administration of anesthesia in connection $ith

the laparotomy to be cond#cted on him -he patient s#ed both theanesthesiologist and the s#rgeon for the inj#ry s#ered byhim -he *#preme )o#rt of Appeals of 3est 5irginia held that thes#rgeon co#ld not be held liable for the loss of the patients voice,considering that the s#rgeon did not have a hand in the int#bationof the patient -he co#rt rejected the application of the )aptain8of8the8*hip Doctrine,! citing the fact that the 2eld of medicine hasbecome speciali=ed s#ch that s#rgeons can no longer be deemed

as having control over the other personnel in the operatingroom .t held that aEn assignment of liability based on act#acontrol more realistically reUects the act#al relationship $hiche7ists in a modern operating room!;0E(ence, only theanesthesiologist $ho inserted the endotracheal t#be into thepatients throat $as held liable for the inj#ry s#ered by the latter

-his contention fails to pers#ade

-hat there is a trend in American j#rispr#dence to do a$ay $ith

the )aptain8of8the8*hip doctrine does not mean that this )o#rt$ill ipso actofollo$ said trend D#e regard for the pec#liarfact#al circ#mstances obtaining in this case j#stify the applicationof the )aptain8of8the8*hip doctrine ?rom the facts on record it canbe logically inferred that Dr (osa9a e7ercised a certain degree of,at the very least, s#pervision over the proced#re then beingperformed on Jrlinda
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?irst, it $as Dr (osa9a $ho recommended to petitioners theservices of Dr +#tierre= .n eect, he represented to petitionersthat Dr +#tierre= possessed the necessary competence ands9ills Drs (osa9a and +#tierre= had $or9ed together since

1GKK 3henever Dr (osa9a performed a s#rgery, he $o#ldal$ays engage the services of Dr +#tierre= to administer theanesthesia on his patient;FE

*econd, Dr (osa9a himself admitted that he $as the attendingphysician of Jrlinda -h#s, $hen Jrlinda sho$ed signs of cyanosis,it $as Dr (osa9a $ho gave instr#ctions to call for anotheranesthesiologist and cardiologist to help res#scitate Jrlinda;KE

-hird, it is conceded that in performing their responsibilities to

the patient, Drs (osa9a and +#tierre= $or9ed as a team -heir$or9 cannot be placed in separate $atertight compartmentsbeca#se their d#ties intersect $ith each other ;IE

3hile the professional services of Dr (osa9a and Dr +#tierre=$ere sec#red primarily for their performance of acts $ithin theirrespective 2elds of e7pertise for the treatment of petitionerJrlinda, and that one does not e7ercise control over the other,they $ere certainly not completely independent of each other so

as to absolve one from the negligent acts of the other physician-hat they $ere $or9ing as a medical team is evident from the

fact that Dr (osa9a $as 9eeping an eye on the int#bation of thepatient by Dr +#tierre=, and $hile doing so, he observed that thepatients nails had become d#s9y and had to call Dr +#tierre=sattention thereto -he )o#rt also notes that the co#nsel for Dr(osa9a admitted that in practice, the anesthesiologist $o#ld alsohave to observe the s#rgeons acts d#ring the s#rgical process and

calls the attention of the s#rgeon $henever necessary;GEin theco#rse of the treatment -he d#ties of Dr (osa9a and those of Dr+#tierre= in the treatment of petitioner Jrlinda are therefore not asclear8c#t as respondents claim them to be 'n the contrary, it is"#ite apparent that they have a common responsibility to treat thepatient, $hich responsibility necessitates that they call eachothers attention to the condition of the patient $hile the otherphysician is performing the necessary medical proced#res


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.t is e"#ally important to point o#t that Dr (osa9a $as remiss inhis d#ty of attending to petitioner Jrlinda promptly, for he arrivedmore than three ;C ho#rs late for the sched#ledoperation-he cholecystectomy$as set for #ne 1K, 1GI0 at G@HH

am, b#t he arrived at DL*M) only at aro#nd 1:@1H pm .nrec9less disregard for his patients $ell being, Dr (osa9asched#led t$o proced#res on the same day, j#st thirty min#tesapart from each other, at dierent hospitals -h#s, $hen the 2rstproced#re protoscopyC at the *ta -eresita (ospital did notproceed on time, Jrlinda $as 9ept in a state of #ncertainty at theDL*M)

-he #nreasonable delay in petitioner Jrlindas sched#led

operation s#bjected her to contin#ed starvation and conse"#ently,to the ris9 of acidosis,/HEor the condition of decreased al9alinity ofthe blood and tiss#es, mar9ed by sic9ly s$eet breath, headache,na#sea and vomiting, and vis#al dist#rbances/1E-he long periodthat Dr (osa9a made Jrlinda $ait for him certainly aggravated thean7iety that she m#st have been feeling at the time .t co#ld besafely said that her an7iety adversely aected the administrationof anesthesia on her As e7plained by Dr )amagay, the patients

an7iety #s#ally ca#ses the o#tpo#ring of adrenaline $hich in t#rnres#lts in high blood press#re or dist#rbances in the heart rhythm@

D% )AMA+AS@

7 7 7 &re8operative medication has three mainf#nctions@ 'ne is to alleviate an7iety *econd is to dry #p thesecretions and -hird is to relieve pain No$, it is veryimportant to alleviate an7iety beca#se an7iety is associated$ith the o#tpo#ring of certain s#bstances formed in the body

called adrenalin 3hen a patient is an7io#s there is ano#tpo#ring of adrenalin $hich $o#ld have adverse eect onthe patient 'ne of it is high blood press#re, the other is thathe opens himself to dist#rbances in the heart rhythm, $hich$o#ld have adverse implications *o, $e $o#ld li9e toalleviate patients an7iety mainly beca#se he $ill not be incontrol of his body there co#ld be adverse res#lts to s#rgery
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and he $ill be opened #pO a 9nife is going to open #p hisbody 7 7 7/:E

Dr (osa9a cannot no$ claim that he $as entirely blameless of$hat happened to Jrlinda (is cond#ct clearly constit#ted a

breach of his professional d#ties to Jrlinda@)(.J? 6*-.)J@

-$o other points -he 2rst, Doctor, yo# $ere tal9ing abo#tan7iety, $o#ld yo# consider a patients stay on the operatingtable for three ho#rs s#Qcient eno#gh to aggravate ormagnify his or her an7ietyX

D% )AMA+AS@

Ses)(.J? 6*-.)J@

.n other $ords, . #nderstand that in this partic#lar case that$as the case, three ho#rs $aiting and the patient $as alreadyon the operating table interr#ptedC

D% )AMA+AS@

Ses

)(.J? 6*-.)J@3o#ld yo# therefore concl#de that the s#rgeon contrib#ted tothe aggravation of the an7iety of the patientX

D% )AMA+AS@

-hat this operation did not ta9e place as sched#led is alreadya so#rce of an7iety and most operating tables are very narro$and that patients are #s#ally at ris9 of falling on the Uoor so

there are restraints that are placed on them and they arenever, never left alone in the operating room by themselvesspecially if they are already pre8medicated beca#se they maynot be a$are of some of their movement that they ma9e$hich $o#ld contrib#te to their inj#ry

)(.J? 6*-.)J@

.n other $ords d#e diligence $o#ld re"#ire a s#rgeon to comeon timeX
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D% )AMA+AS@

. thin9 it is not even d#e diligence it is co#rtesy

)(.J? 6*-.)J@

)o#rtesyD% )AMA+AS@

And care

)(.J? 6*-.)J@

D#ty as a matter of factX

D% )AMA+AS@

Ses, So#r (onor/;E

Dr (osa9as irresponsible cond#ct of arriving very late for thesched#led operation of petitioner Jrlinda is violative, not only ofhis d#ty as a physician to serve the interest of his patients $iththe greatest solicit#de, giving them al$ays his best talent ands9ill,!//Eb#t also of Article 1G of the )ivil )ode $hich re"#ires aperson, in the performance of his d#ties, to act $ith j#stice andgive everyone his d#e

Anent private respondent DL*M)s liability for the res#lting

inj#ry to petitioner Jrlinda, $e held that respondent hospital issolidarily liable $ith respondent doctors therefor #nder Article:1IH of the )ivil )ode/0Esince there e7ists an employer8employeerelationship bet$een private respondent DL*M) and Drs+#tierre= and (osa9a@

.n other $ords, private hospitals, hire, 2re and e7ercise real controlover their attending and visiting cons#ltant! sta 3hilecons#ltants! are not, technically employees, 7 7 7 the controle7ercised, the hiring and the right to terminate cons#ltants allf#l2ll the important hallmar9s of an employer8employeerelationship, $ith the e7ception of the payment of $ages .nassessing $hether s#ch a relationship in fact e7ists, the controltest is determining 7 7 7/FE

DL*M) ho$ever contends that applying the fo#r8fold test indetermining $hether s#ch a relationship e7ists bet$een it and the


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respondent doctors, the inescapable concl#sion is that DL*M)cannot be considered an employer of the respondent doctors

.t has been consistently held that in determining $hether anemployer8employee relationship e7ists bet$een the parties, the

follo$ing elements m#st be present@ 1C selection and engagementof servicesO :C payment of $agesO ;C the po$er to hire and 2reOand /C the po$er to control not only the end to be achieved, b#tthe means to be #sed in reaching s#ch an end/KE

DL*M) maintains that 2rst, a hospital does not hire or engagethe services of a cons#ltant, b#t rather, accredits the latter andgrants him or her the privilege of maintaining a clinic and


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)ommittee thereof, $hich is composed of the heads of the vario#sspecialty departments s#ch as the Department of 'bstetrics and+ynecology, &ediatrics, *#rgery $ith the department head of thepartic#lar specialty applied for as chairman -he )redentials

)ommittee then recommends to DL*M)s Medical Director or(ospital Administrator the acceptance or rejection of the applicantphysician, and said director or administrator validates thecommittees recommendation0:E*imilarly, in cases $here adisciplinary action is lodged against a cons#ltant, the same isinitiated by the department to $hom the cons#ltant concernedbelongs and 2led $ith the Jthics )ommittee consisting of thedepartment specialty heads -he medical director


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s#rvives0;E.n addition thereto, the )o#rt a$arded temperatedamages of 'ne Million ?ive (#ndred -ho#sand &esos&1,0HH,HHHHHC in vie$ of the chronic and contin#ing nat#re ofpetitioner Jrlindas inj#ry and the certainty of f#rther pec#niary

loss by petitioners as a res#lt of said inj#ry, the amo#nt of $hich,ho$ever, co#ld not be made $ith certainty at the time of theprom#lgation of the decision -he )o#rt j#sti2ed s#ch a$ard inthis manner@

'#r r#les on act#al or compensatory damages generally ass#methat at the time of litigation, the inj#ry s#ered as a conse"#enceof an act of negligence has been completed and that the cost canbe li"#idated (o$ever, these provisions neglect to ta9e into

acco#nt those sit#ations, as in this case, $here the res#lting inj#rymight be contin#ing and possible f#t#re complications directlyarising from the inj#ry, $hile certain to occ#r, are diQc#lt topredict

.n these cases, the amo#nt of damages $hich sho#ld be a$arded,if they are to ade"#ately and correctly respond to the inj#ryca#sed, sho#ld be one $hich compensates for pec#niary lossinc#rred and proved, #p to the time of trialO andone $hich $o#ld

meet pec#niary loss certain to be s#ered b#t $hich co#ld not,from the nat#re of the case, be made $ith certainty .n other$ords, temperate damages can and sho#ld be a$arded on top ofact#al or compensatory damages in instances $here the inj#ry ischronic and contin#ing And beca#se of the #ni"#e nat#re of s#chcases, no incompatibility arises $hen both act#al and temperatedamages are provided for -he reason is that these damagescover t$o distinct phases

As it $o#ld not be e"#itableand certainly not in the bestinterests of the administration of j#sticefor the victim in s#chcases to constantly come before the co#rts and invo9e their aid insee9ing adj#stments to the compensatory damages previo#slya$ardedtemperate damages are appropriate -he amo#nt givenas temperate damages, tho#gh to a certain e7tent spec#lative,sho#ld ta9e into acco#nt the cost of proper care
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.n the instant case, petitioners $ere able to provide only home8based n#rsing care for a comatose patient $ho has remained inthat condition for over a decade (aving premised o#r a$ard forcompensatory damages on the amo#nt provided by petitioners at

the onset of litigation, it $o#ld be no$ m#ch more in step $ith theinterests of j#stice if the val#e a$arded for temperate damages$o#ld allo$ petitioners to provide optimal care for their loved onein a facility $hich generally speciali=es in s#ch care -hey sho#ldnot be compelled by dire circ#mstances to provide s#bstandardcare at home $itho#t the aid of professionals, for anything less$o#ld be grossly inade"#ate 6nder the circ#mstances, an a$ardof &1,0HH,HHHHH in temperate damages $o#ld therefore be

reasonable

0/E

(o$ever, s#bse"#ent to the prom#lgation of the Decision, the)o#rt $as informed by petitioner %ogelio that petitioner Jrlindadied on A#g#st ;, 1GGG00E.n vie$ of this s#pervening event, thea$ard of temperate damages in addition to the act#al orcompensatory damages $o#ld no longer be j#sti2ed since theact#al damages a$arded in the Decision are s#Qcient to cover themedical e7penses inc#rred by petitioners for the patient (ence,

only the amo#nts representing act#al, moral and e7emplarydamages, attorneys fees and costs of s#it sho#ld be a$arded topetitioners

?EREFORE, the assailed Decision is hereby modi2ed asfollo$s@

1C &rivate respondent De Los *antos Medical )enter is herebyabsolved from liability arising from the inj#ry s#ered by petitionerJrlinda %amos on #ne 1K, 1GI0O

:C &rivate respondents Dr 'rlino (osa9a and Dr &erfecta+#tierre= are hereby declared to be solidarily liable for the inj#rys#ered by petitioner Jrlinda on #ne 1K, 1GI0 and are ordered topay petitioners

aC &1,;0:,HHHHH as act#al damagesO

bC &:,HHH,HHHHH as moral damagesO

cC &1HH,HHHHH as e7emplary damagesO
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dC &1HH,HHHHH as attorneys feesO and

eC the costs of the s#it

!O OR0ERE0.

Davide% Gr.% C.G.% :Chairman;% (uno%and

Hnares&4antiago%GG.% conc#r


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G.R. No. 16366 !''+*'# 26, 2L12

0R. PE0RO 0ENNI! CERENO, )- 0R. !ANTO!

AFE,&etitioners,vs

COURT OF APPEA!, !POU!E! 0IOGENE! !. OA%ERE )-

FE R. !ERRANO,%espondents

D J ) . * . ' N

PERE,8.5

Before the )o#rt is a &etition for %evie$ on )ertiorari 1#nder %#le

/0 of the %#les of )o#rt see9ing the ann#lment and setting aside

of the :1 ?ebr#ary :HH0 decision:of the )o#rt of Appeals )AC in

)A8+% )5 No F0IHH .n the assailed decision, the )A aQrmed

in toto the decision of the %egional -rial )o#rt % -)C, Branch ::,

Nag a )ity 2nding herein petitioners Dr &edro Dennis )ereno Dr

)erenoC and Dr *antos Wafe Dr WafeC liable for damages

)#lled from the records are the follo$ing antecedent facts@

At abo#t G@10 in the evening of 1F *eptember 1GG0, %aymond *

'lavere %aymondC, a victim of a stabbing incident, $as r#shed to

the emergency room of the Bicol %egional Medical )enter B%M)C

-here, %aymond $as attended to by N#rse Arlene Balares N#rse

BalaresC and Dr %#el Levy %eal#yo Dr %eal#yoC the emergency

room resident physician

*#bse"#ently, the parents of %aymondthe spo#ses Deogenes

'lavere DeogenesC and ?e % *erranoarrived at the B%M) -hey

$ere accompanied by one Andre$ 'lavere, the #ncle of %aymond
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After e7tending initial medical treatment to %aymond, Dr %eal#yo

recommended that the patient #ndergo >emergency e+ploratory

laparotomy> Dr %eal#yo then re"#ested the parents of %aymond

to proc#re 0HH cc of type >'> blood needed for the operation

)omplying $ith the re"#est, Deogenes and Andre$ 'lavere $entto the &hilippine National %ed )ross to sec#re the re"#ired blood

At 1H@;H &M, %aymond $as $heeled inside the operating room

D#ring that time, the hospital s#rgeons, Drs Wafe and )ereno,

$ere b#sy operating on g#nshot victim )harles Mal#l#y8on

Assisting them in the said operation $as Dr %osalina -atad Dr

-atadC, $ho $as the only senior anesthesiologist on d#ty at B%M)that night Dr -atad also happened to be the head of

Anesthesiology Department of the B%M)

#st before the operation on Mal#l#y8on $as 2nished, another

emergency case involving Lilia Ag#ila, a $oman $ho $as giving

birth to triplets, $as bro#ght to the operating room

At 1H@0G &M, the operation on )harles Mal#l#y8on $as 2nishedBy that time, ho$ever, Dr -atad $as already $or9ing $ith the

obstetricians $ho $ill perform s#rgery on Lilia Ag#ila -here being

no other available anesthesiologist to assist them, Drs Wafe and

)ereno decided to defer the operation on %aymond

Drs Wafe and )ereno, in the meantime, proceeded to e7amine

%aymond and they fo#nd that the latters blood press#re $as

normal and >nothing in him $as signi2cant>;Dr )ereno reported

that based on the 7ray res#lt he interpreted, the U#id inside the

thoracic cavity of %aymond $as minimal at aro#nd :HH8;HH cc

At 11@10 &M, Deogenes and Andre$ 'lavere ret#rned to the

B%M) $ith a bag containing the re"#ested 0HH cc type >'> blood

-hey handed over the bag of blood to Dr %eal#yo
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After Dr -atad 2nished her $or9 $ith the Lilia Ag#ila operation,

petitioners immediately started their operation on %aymond at

aro#nd 1:@10 AM of 1K *eptember 1GG0 6pon opening of

%aymonds thoracic cavity, they fo#nd that ;,:HH cc of blood $as

stoc9ed therein -he blood $as evac#ated and petitioners fo#nd ap#nct#re at the inferior pole of the left l#ng

.n his testimony, Dr )ereno stated that considering the loss of

blood s#ered by %aymond, he did not immediately transf#se

blood beca#se he had to control the bleeders 2rst/

Blood $as 2nally transf#sed on %aymond at 1@/H AM At 1@/0

AM, $hile the operation $as on8going, %aymond s#ered a

cardiac arrest -he operation ended at 1@0H AM and %aymond

$as prono#nced dead at :@;H AM

%aymonds death certi2cate0indicated that the immediate ca#se

of death $as >hypovolemic shoc,> or the cessation of the

f#nctions of the organs of the body d#e to loss of bloodF

)laiming that there $as negligence on the part of those $ho

attended to their son, the parents of %aymond, on :0 'ctober

1GG0, 2led before the %-), Branch ::, Naga )ity a complaint for

damagesKagainst N#rse Balares, Dr %eal#yo and attending

s#rgeons Dr )ereno and Dr Wafe

D#ring trial, the parents of %aymond testi2ed on their o$n behalf

-hey also presented the testimonies of Andre$ 'lavere and oneLoira 'ira, the a#nt of %aymond 'n the other hand, Dr )ereno,

Dr %eal#yo, N#rse Balares and *ec#rity +#ard Diego %eposo

testi2ed for the defense 'n reb#ttal, the parents of %aymond

presented Dr -atad, among others
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'n 10 'ctober 1GGG, the trial co#rt rendered a decisionIthe

dispositive portion of $hich reads@

3(J%J?'%J, premises considered, this )o#rt hereby renders

j#dgment@

1 Dismissing the case against Dr %#el Levy %eal#yo and

Arlene Balares for lac9 of meritO

: 'rdering defendants Dr *antos Wafe and Dr Dennis )ereno

to pay the heirs of %aymond 'lavere, jointly and severally the

follo$ing amo#nts@

1 & 0H,HHHHH for the death of the victimO

: & 10H,HHHHH as moral damagesO

; & 1HH,HHHHH as e7emplary damagesO

/ & ;H,HHHHH for attorneys feesO and

0 )ost of s#itG

7 7 7 7

-he trial co#rt fo#nd petitioners negligent in not immediately

cond#cting s#rgery on %aymond .t noted that petitioners have

already 2nished operating on )harles Mal#l#y8on as early as 1H@;H

in the evening, and yet they only started the operation on

%aymond at aro#nd 1:@10 early morning of the follo$ing day -he

trial co#rt held that had the s#rgery been performed promptly,

%aymond $o#ld not have lost so m#ch blood and, therefore, co#ld

have been saved1H

-he trial co#rt also held that the non8availability of Dr -atad after

the operation on Mal#l#y8on $as not a s#Qcient e7c#se for the
http://www.lawphil.net/judjuris/juri2012/sep2012/gr_167366_2012.html#fnt8http://www.lawphil.net/judjuris/juri2012/sep2012/gr_167366_2012.html#fnt9http://www.lawphil.net/judjuris/juri2012/sep2012/gr_167366_2012.html#fnt10http://www.lawphil.net/judjuris/juri2012/sep2012/gr_167366_2012.html#fnt8http://www.lawphil.net/judjuris/juri2012/sep2012/gr_167366_2012.html#fnt9http://www.lawphil.net/judjuris/juri2012/sep2012/gr_167366_2012.html#fnt10


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petitioners to not immediately operate on %aymond .t called

attention to the testimony of Dr -atad herself, $hich disclosed the

possibility of calling a standby anesthesiologist in that sit#ation

-he trial co#rt opined that the petitioners co#ld have j#st

re"#ested for the standby anesthesiologist from Dr -atad, b#t theydid not

Lastly, the trial co#rt fa#lted petitioners for the delay in the

transf#sion of blood on %aymond

'n appeal, the )A in a decision dated :1 ?ebr#ary :HH0 aQrmed

in toto the j#dgment rendered by the %-) 2nding herein

petitioners g#ilty of gross negligence in the performance of their

d#ties and a$arding damages to private respondents

(ence, this petition for revie$ on certiorari#nder %#le /0 of the

%#les of )o#rt assailing the )A decision on the follo$ing gro#nds@

1 -(A- -(J )A J%%JD .N %6L.N+ -(A- &J-.-.'NJ%* 3J%J

+%'**LS NJ+L.+JN- .N -(J &J%?'%MAN)J '? -(J.%D6-.J*O

: -(A- -(J )A J%%JD .N N'- )'N*.DJ%.N+ -(J B.)'L

%J+.'NAL MJD.)AL )JN-J% A* AN .ND.*&JN*ABLJ &A%-S

AND *6B*.D.A%.LS L.ABLJ *('6LD &J-.-.'NJ%* BJ ?'6ND

L.ABLJ ?'% DAMA+J*O and

; -(A- -(J )A J%%JD .N N'- ?.ND.N+ -(J A3A%D '?M'%AL AND JRJM&LA%S DAMA+J* A* 3JLL A* A--'%NJS*

?JJ* JR'%B.-AN- '% JR)J**.5J

3e grant the petition

.t is $ell8settled that #nder %#le /0 of the %#les of )o#rt, only

"#estions of la$ may be raised -he reason behind this is that this


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K1

)o#rt is not a trier of facts and $ill not re8e7amine and re8eval#ate

the evidence on record11?act#al 2ndings of the )A, aQrming that

of the trial co#rt, are therefore generally 2nal and concl#sive on

this )o#rt -his r#le is s#bject to the follo$ing e7ceptions@ 1C the

concl#sion is gro#nded on spec#lations, s#rmises or conject#resO:C the inference is manifestly mista9en, abs#rd or impossibleO ;C

there is grave ab#se of discretionO /C the j#dgment is based on a

misapprehension of factsO 0C the 2ndings of fact are conUictingO

FC there is no citation of speci2c evidence on $hich the fact#al

2ndings are basedO KC the 2ndings of absence of fact are

contradicted by the presence of evidence on recordO IC the

2ndings of the )A are contrary to those of the trial co#rtO GC the)A manifestly overloo9ed certain relevant and #ndisp#ted facts

that, if properly considered, $o#ld j#stify a dierent concl#sionO

1HC the 2ndings of the )A are beyond the iss#es of the caseO and

11C s#ch 2ndings are contrary to the admissions of both

parties1:.n this case, 3e 2nd e7ceptions 1C and /C to be

applicable

-he type of la$s#it $hich has been called medical malpractice or,

more appropriately, medical negligence, is that type of claim

$hich a victim has available to him or her to redress a $rong

committed by a medical professional $hich has ca#sed bodily

harm .n order to s#ccessf#lly p#rs#e s#ch a claim, a patient m#st

prove ) ) ')l 4)#' #o&-'#, & +o$ 4)$'$ ) y$&4&),

'&'# /)&l'- o -o $o+'&( ;&4 ) #')$o)*ly #u-'

')l 4)#' #o&-'# ;oul- )' -o', o# ) ' o# $'

-&- $o+'&( ) ) #')$o)*ly #u-' #o&-'# ;oul-

o )' -o'O and that the /)&lu#' o# )4&o 4)u$'- &Hu#y o

' )&'1;*tated other$ise, the complainant m#st prove@ 1C

that the health care provider, either by his act or omission, had
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been negligent, and :C that s#ch act or omission pro7imately

ca#sed the inj#ry complained of

-he best $ay to prove these is thro#gh the opinions of e7pert

$itnesses belonging in the same neighborhood and in the samegeneral line of practice as defendant physician or s#rgeon -he

deference of co#rts to the e7pert opinion of "#ali2ed physicians

stems from the formers reali=ation that the latter possess #n#s#al

technical s9ills $hich laymen in most instances are incapable of

intelligently eval#ating, hence, the indispensability of e7pert

testimonies1/

+#ided by the foregoing standards, 3e dissect the iss#es at hand

(etitioners @ot @egligent

-he trial co#rt 2rst imp#ted negligence on the part of the

petitioners by their fail#re to perform the operation on %aymond

immediately after 2nishing the Mal#l#y8on operation .t rejected as

an e7c#se the nonavailability of Dr -atad -he trial co#rt relied onthe testimony of Dr -atad abo#t a >E"1C protocol> that introd#ces

the possibility that a standby anesthesiologist co#ld have been

called #pon -he pertinent portions of the testimony of Dr -atad

provides@

Z@ Aside from yo# and Dr %ebancos, $ho $as the standby

anesthesiologistX

A@ 3e have a protocol at the Bicol Medical )enter to have a

cons#ltant $ho is on call

Z@ (o$ many of themX

A@ 'ne


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K;

Z@ 3ho is sheX

A@ Dra ?lores

Z@ 3hat is the 2rst nameXA@ %osalina ?lores

Z@ .s she residing in Naga )ityX

A@ .n )amaligan

Z@ *he is on call anytime $hen there is an emergency case to be

attended to in the Bicol Medical )enterX

A@ Ses sir10

Dr -atad f#rther testi2ed@

Z@ Alright sicC, considering that yo# said yo# co#ld not attend to

%aymond 'lavere beca#se another patient $as coming in the

person of Lilia Ag#ila, did yo# not s#ggest to Dr )ereno to call thestandby anesthesiologistX

A@ -hey are not ones to do that -hey have no right to call for the

standby anesthesiologist

Z@ -hen, $ho sho#ld call for the standby anesthesiologistX

A@ .t is me if the s#rgeon re"#ested

Z@ B#t in this case, the s#rgeon did not re"#est yo#X

A@ No .t is their prerogative

Z@ . j#st $ant to 9no$ that in this case the s#rgeon did not re"#est

yo# to call for the standby anesthesiologistX


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K/

A@ No sir1F

?rom there, the trial co#rt concl#ded that it $as the d#ty of the

petitioners to re"#est Dr -atad to call on Dr %osalina ?lores, the

standby anesthesiologist *ince petitioners failed to do so, theirinability to promptly perform the operation on %aymond becomes

negligence on their part

-his )o#rt does not agree $ith the aforesaid concl#sion

=irst -here is nothing in the testimony of Dr -atad, or in any

evidence on the record for that matter, $hich sho$s that the

petitioners $ere a$are of the >E"1C protocol> that the hospital9eeps a standby anesthesiologist available on call .ndeed, other

than the testimony of Dr -atad, there is no evidence that proves

that any s#ch >E"1C protocol> is being practiced by the hospitals

s#rgeons at all

Jvidence to the eect that petitioners 9ne$ of the >E"1C

protocol> is essential, especially in vie$ of the contrary assertionof the petitioners that the matter of assigning anesthesiologists

rests $ithin the f#ll discretion of the B%M) Anesthesiology

Department 3itho#t any prior 9no$ledge of the >E"1C protocol,>

3e 2nd that it is "#ite reasonable for the petitioners to ass#me

that matters regarding the administration of anesthesia and the

assignment of anesthesiologists are concerns of the

Anesthesiology Department, $hile matters pertaining to the

s#rgery itself fall #nder the concern of the s#rgeons )ertainly, 3e

cannot hold petitioners acco#ntable for not complying $ith

something that they, in the 2rst place, do not 9no$

4econd Jven ass#ming e+ gratia argumenti that there is s#ch

>E"1C protocol> and that petitioners 9ne$ abo#t it, 3e 2nd that

their fail#re to re"#est for the assistance of the standby


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K0

anesthesiologist to be reasonable $hen ta9en in the proper

conte7t -here is simply no competent evidence to the contrary

?rom the testimony of Dr -atad herself, it is clear that the matter

of re"#esting for a standby anaesthesiologist is not $ithin the f#lldiscretion of petitioners -he >E"1C protocol> described in the

testimony re"#ires the petitioners to co#rse s#ch re"#est to Dr

-atad $ho, as head of the Department of Anesthesiology, has the

2nal say of calling the standby anesthesiologist

As revealed by the facts, ho$ever, after the Mal#l#y8on operation,

Dr -atad $as already assisting in the Lilia Ag#ila operation Drs

Wafe and )ereno then proceeded to e7amine %aymond and they

fo#nd that the latters blood press#re $as normal and >nothing in

him $as signi2cant>1KDr )ereno even concl#ded that based on

the 78ray res#lt he interpreted, the U#id inside the thoracic cavity

of %aymond $as minimal at aro#nd :HH8;HH cc *#ch 2ndings of

Drs )ereno and Wafe $ere never challenged and $ere #nreb#tted

+iven that Dr -atad $as already engaged in another #rgentoperation and that %aymond $as not sho$ing any symptom of

s#ering from major blood loss re"#iring an immediate operation,

3e 2nd it reasonable that petitioners decided to $ait for Dr -atad

to 2nish her s#rgery and not to call the standby anesthesiologist

anymore -here is, after all, no evidence that sho$s that a pr#dent

s#rgeon faced $ith similar circ#mstances $o#ld decide other$ise

(ere, there $ere no e7pert $itnesses presented to testify that the

co#rse of action ta9en by petitioners $ere not in accord $ith those

adopted by other reasonable s#rgeons in similar sit#ations

Neither $as there any testimony given, e7cept that of Dr -atads,

on $hich it may be inferred that petitioners failed to e7ercise the

standard of care, diligence, learning and s9ill e7pected from


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KF

practitioners of their profession Dr -atad, ho$ever, is an e7pert

neither in the 2eld of s#rgery nor of s#rgical practices and

diagnoses (er e7pertise is in the administration of anesthesia and

not in the determination of $hether s#rgery o#ght or not o#ght to

be performed

Another gro#nd relied #pon by the trial co#rt in holding petitioners

negligent $as their fail#re to immediately transf#se blood on

%aymond *#ch fail#re allegedly led to the event#al death of

%aymond thro#gh >hypovolemic shoc,> -he trial co#rt relied on

the follo$ing testimony of Dr -atad@

Z@ .n this case of %aymond 'lavere $as blood transf#sed to him

$hile he $as inside the operating roomX

A@ -he blood arrived at 1@/H am and that $as the time $hen this

blood $as hoo9ed to the patient

7 7 7 7

Z@ &rior to the arrival of the blood, yo# did not re"#est for bloodX

A@ . re"#ested for blood

Z@ ?rom $homX

A@ ?rom the attending physician, Dr %eal#yo

Z@ 3hat time $as thatX

7 7 7 7

A@ G@;H

7 7 7 7


77/136


KK

Z@ (ad this blood been given to yo# before the operation yo#

co#ld have transf#sed the blood to the patientX

A@ 'f co#rse, yes

Z@ And the blood $as transf#sed only after the operationX

A@ Beca#se that $as the time $hen the blood $as given to #s

7 7 7 7

Z@ (ave yo# monitored the condition of %aymond 'lavereX

A@ . monitored the condition d#ring the time $hen . $o#ldadminister anesthesia

Z@ 3hat time $as thatX

A@ 11@/0 already

Z@ 3hat $as the condition of the blood press#re at that timeX

A@ FH


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KI

A@ ?rom the s#rgeon According to Dr Wafe there $as only 0HH cc

b#t still for cross8matching1I

?rom the aforesaid testimony, the trial co#rt r#led that there $as

negligence on the part of petitioners for their fail#re to have theblood ready for transf#sion .t $as alleged that at 11@10 &M, the

0HH cc of blood $as given to Dr %eal#yo by %aymonds parents At

11@/0 &M, $hen Dr -atad $as as9ing for the blood, ;H min#tes

had passed Set, the blood $as not ready for transf#sion as it $as

still being cross8matched1G.t too9 another t$o ho#rs before blood

$as 2nally transf#sed to %aymond at 1@/H AM of 1K *eptember

1GG0

Again, s#ch is a mista9en concl#sion

=irst, the alleged delay in the cross8matching of the blood, if there

$as any, cannot be attrib#ted as the fa#lt of the petitioners -he

petitioners $ere never sho$n to be responsible for s#ch delay .t is

highly #nreasonable and the height of inj#stice if petitioners $ere

to be sanctioned for lapses in proced#re that does not fall $ithintheir d#ties and beyond their control

4econd, Dr )ereno, in his #nchallenged testimony, aptly e7plained

the apparent delay in the transf#sion of blood on %aymond before

and d#ring the operation

Before the operation, Dr )ereno e7plained that the reason $hy no

blood transf#sion $as made on %aymond $as beca#se they didnot then see the need to administer s#ch transf#sion, vi-@

Z@ No$, yo# stated in yo#r aQdavit that prior to the operation yo#

$ere informed that there $as 0HH cc of blood available and $as

still to be cross8matched 3hat time $as that $hen yo# $ere

informed that 0HH cc of blood $as d#e for crossmatchingX


79/136


KG

A@ . am not s#re of the time

Z@ B#t certainly, yo# learned of that fact that there $as 0HH cc of

blood, $hich $as d#e for crossmatching immediately prior to the

operationX

A@ Ses, sir

Z@ And the operation $as done at 1:@10 of *eptember 1KX

A@ Ses, sir

Z@ And that $as the reason $hy yo# co#ld not #se the blood

beca#se it $as being crossmatchedX

A@ No, sir -hat $as done only for a fe$ min#tes 3e did not

transf#se at that time beca#se there $as no need T'#' &$ )

'4'$$&y o #)$/u$' *loo- ;' ;' $); '#' &$ (#o$$

*l''-&( &$&-' ' *o-y :HJmphasis s#ppliedC

D#ring the operation, on the other hand, Dr )ereno $as already

able to discover that ;,:HH cc of blood $as stoc9ed in the thoracic

cavity of %aymond d#e to the p#nct#re in the latters left l#ng

Jven then, ho$ever, immediate blood transf#sion $as not feasible

beca#se@

Z@ No$ considering the loss of blood s#ered by %aym#nd

'lavere, $hy did yo# not immediately transf#se blood to the

patient and yo# $aited for /0 min#tes to elapse before transf#singthe bloodX

A@ I -&- o #)$/u$' *loo- *'4)u$' I )- o 4o#ol '

*l''-'#$. I/ you ;&ll #)$/u$' *loo- Hu$ ' $)+' '

*loo- ) you #)$/u$' ;&ll *' lo$. A/'# ')4u)&o o/

*loo- )- '#' &$ o +o#' *l''-&([


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IH

Z@ .t too9 yo# /0 min#tes to evac#ate the bloodX

A@ -he evac#ation did not ta9e /0 min#tes

Z@ *o $hat $as the ca#se of the delay $hy yo# only transf#seblood after /0 min#tesX

A@ ' )' o loo /o# $o+' o'# l'$&o$. I -o'$ o +')

) ;' you $l&4' ' 4'$ you ;&ll $'' ' l'$&o$

)l#')-y:1

Jmphasis s#ppliedC

Again, the foregoing testimonies of Dr )ereno $ent #nchallenged

or #nreb#tted -he parents of %aymond $ere not able to present

any e7pert $itness to disp#te the co#rse of action ta9en by the

petitioners

Causation @ot (roven

.n medical negligence cases, it is settled that the complainant has

the b#rden of establishing breach of d#ty on the part of the

doctors or s#rgeons .t m#st be proven that s#ch breach of d#ty

has a ca#sal connection to the res#lting death of the patient::A

verdict in malpractice action cannot be based on spec#lation or

conject#re )a#sation m#st be proven $ithin a reasonable medical

probability based #pon competent e7pert testimony

-he parents of %aymond failed in this respect Aside from theirfail#re to prove negligence on the part of the petitioners, they also

failed to prove that it $as petitioners fa#lt that ca#sed the inj#ry

-heir ca#se stands on the mere ass#mption that %aymonds life

$o#ld have been saved had petitioner s#rgeons immediately

operated on himO had the blood been cross8matched immediately

and had the blood been transf#sed immediately -here $as,


81/136


I1

ho$ever, no proof presented that %aymonds life $o#ld have been

saved had those things been done -hose are mere ass#mptions

and cannot g#arantee their desired res#lt *#ch cannot be made

basis of a decision in this case, especially considering that the

name, rep#tation and career of petitioners are at sta9e

-he )o#rt #nderstands the parents grief over their sons

death>wphi>-hat not$ithstanding, it cannot hold petitioners

liable .t $as noted that %aymond, $ho $as a victim of a stabbing

incident, had m#ltiple $o#nds $hen bro#ght to the hospital 6pon

opening of his thoracic cavity, it $as discovered that there $as

gross bleeding inside the body -h#s, the need for petitioners tocontrol 2rst $hat $as ca#sing the bleeding Despite the sit#ation

that evening ie n#mero#s patients being bro#ght to the hospital

for emergency treatment considering that it $as the height of the

&e\afrancia ?iesta, it $as evident that petitioners e7erted earnest

eorts to save the life of %aymond .t $as j#st #nfort#nate that the

loss of his life $as not prevented

.n the case of Dr. Cru- v. C, it $as held that >dEoctors are

protected by a special la$ -hey are not g#arantors of care -hey

do not even $arrant a good res#lt -hey are not ins#rers against

mishaps or #n#s#al conse"#ences ?#rthermore, they are not

liable for honest mista9e of j#dgment[>:;

-his )o#rt aQrms the r#ling of the )A that the B%M) is not an

indispensible party -he core iss#e as agreed #pon by the partiesand stated in the pre8trial order is $hether petitioners $ere

negligent in the performance of their d#ties .t pertains to

acts


82/136


I:

B%M) cannot be considered an indispensible party $itho#t $hom

no 2nal determination can be had of an action:/

IN T?E IG?T OF T?E FOREGOING, the instant &etition for

%evie$ on )ertiorari is hereby GRANTE0.-he )o#rt of Appealsdecision dated :1 ?ebr#ary :HH0 in )A8+% )5 No F0IHH is

hereby RE%ER!E0 and !ET A!I0E. No costs

*' '%DJ%JD

JO!E PORTUGA PERE

Associate #stice


83/136


I;

R'u*l&4 o/ ' P&l&&'$

*#preme )o#rt

Manila

-(.%DD.5.*.'N

0R. E""ANUE JARCIA,

JR.)- 0R. "ARIOU

BA!TAN,

&etitioners,

8 vers#s 8

G.R. No. 18926

&resent@

)A%&.',VG.%

&J%AL-A,VV cting

Chairperson%

ABAD,

&J%JW,VVV and

MJND'WA,GG.

&rom#lgated@

?ebr#ary 10, :H1:
http://sc.judiciary.gov.ph/jurisprudence/2012/february2012/187926.htm#_ftn1http://sc.judiciary.gov.ph/jurisprudence/2012/february2012/187926.htm#_ftn2http://sc.judiciary.gov.ph/jurisprudence/2012/february2012/187926.htm#_ftn3http://sc.judiciary.gov.ph/jurisprudence/2012/february2012/187926.htm#_ftn1http://sc.judiciary.gov.ph/jurisprudence/2012/february2012/187926.htm#_ftn2http://sc.judiciary.gov.ph/jurisprudence/2012/february2012/187926.htm#_ftn3


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I/

PEOPE OF

T?EP?IIPPINE!,

%espondent

7 888888888888888888888888888888888888888888888888888888888888888888888888888888888888888 7

0 E C I ! I O N

"EN0OA,8.S

/ven early on% patients have consigned their lives to

the s,ill o their doctors. )ime and again% it can be said

that the most important goal o the medical proession is

the preservation o lie and health o the people.

Corollarily% when a physician departs rom his sacred duty

and endangers instead the lie o his patient% he must be

made liable or the resulting in'ury. )his Court% as this

case would show% cannot and will not let the act go

unpunished.

-his is a petition for revie$ #nder %#le /0 of the %#les of )o#rt

challenging the A#g#st :G, :HHI Decision of the )o#rt ofAppeals :C;%and its May 1G, :HHG %esol#tion in )A8+% )% No:G00G, dismissing the appeal and aQrming in totothe #ne 1/,:HH0 Decision of the %egional -rial )o#rt, Branch /;, Manila :")C;,2nding the acc#sed g#ilty beyond reasonable do#bt of simpleimpr#dence res#lting to serio#s physical inj#ries


85/136


I0

T?E FACT!

Belinda *antiago :1rs. 4antiago;lodged a complaint $ith theNational B#rea# of .nvestigation :@EI;against the petitioners, DrJmman#el arcia, r :Dr. Garcia;and Dr Marilo# Bastan :Dr.Eastan;, for their alleged neglect of professional d#ty $hichca#sed her son, %oy Alfonso *antiago :"oy Gr.;, to s#er serio#sphysical inj#ries 6pon investigation, the NB. fo#nd that %oy r $ashit by a ta7icabO that he $as r#shed to the Manila Doctors (ospital

for an emergency medical treatmentO that an R8ray of the victimsan9le $as orderedO that the R8ray res#lt sho$ed no fract#re asread by Dr arcia? that Dr Bastan entered the emergencyroom :/";and, after cond#cting her o$n e7amination of thevictim, informed Mrs *antiago that since it $as only the an9le that$as hit, there $as no need to e7amine the #pper legO that eleven11C days later, %oy r developed fever, s$elling of the right legand misalignment of the right footO that Mrs *antiago bro#ght him

bac9 to the hospitalO and that the R8ray revealed a right mid8tibialfract#re and a linear hairline fract#re in the shaft of the bone

-he NB. indorsed the matter to the 'Qce of the )ity&rosec#tor of Manila for preliminary investigation &robable ca#se$as fo#nd and a criminal case for rec9less impr#dence res#lting toserio#s physical inj#ries, $as 2led against Dr arcia, Dr Bastanand Dr &amittan,0Ebefore the %-), doc9eted as )riminal )ase NoH181GFF/F

'n #ne 1/, :HH0, the %-) fo#nd the petitioners g#ilty

beyond reasonable do#bt of the crime of 4imple Imprudence

"esulting to 4erious (hysical In'uries.-he decretal portion of the

%-) decision reads@
http://sc.judiciary.gov.ph/jurisprudence/2012/february2012/187926.htm#_ftn8http://sc.judiciary.gov.ph/jurisprudence/2012/february2012/187926.htm#_ftn8


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IF

3(J%J?'%J, premises considered, the )o#rt 2nds

acc#sed 0R. E""ANUE JARCIA, JR.and 0R.

"ARIOU BA!TAN+6.L-S beyond reasonable do#bt of

the crime of *.M&LJ .M&%6DJN)J %J*6L-.N+ -'

*J%.'6* &(S*.)AL .N6%.J* and are hereby sentenced to

s#er the penalty of ONE 1 "ONT? )- ONE 1 0A@

o TO 2 "ONT?!and to indemnify M%* BJL.NDA

*AN-.A+' the amo#nt of ];,I0HHH representing medical

e7penses $itho#t s#bsidiary imprisonment in case of

insolvency and to pay the costs

.t appearing that Dr &amittan has not been

apprehended nor vol#ntarily s#rrendered despite $arrant

iss#ed for her arrest, let $arrant be iss#ed for her arrest

and the case against her be A%)(.5JD, to be reinstated

#pon her apprehension

*' '%DJ%JD

-he %-) e7plained@

After a thoro#gh and in depth eval#ation of the

evidence add#ced by the prosec#tion and the defense,this co#rt 2nds that the evidence of the prosec#tion is the

more credible, concrete and s#Qcient to create that

moral certainty in the mind of the )o#rt that acc#sed

herein areE criminally responsible -he )o#rt believes

that acc#sed are negligent $hen both failed to e7ercise


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IK

the necessary and reasonable pr#dence in ascertaining

the e7tent of inj#ry of Alfonso *antiago, r

(o$ever, the negligence e7hibited by the t$o

doctors does not appro7imate negligence of a rec9less

nat#re b#t merely amo#nts to simple

impr#dence *imple impr#dence consists in the lac9 of

preca#tion displayed in those cases in $hich the damage

impending to be ca#sed is not the immediate nor the

danger clearly manifest -he elements of simpleimpr#dence are as follo$s

1 that there is lac9 of preca#tion on the part

of the oenderO and

: that the damage impending to be ca#sedis not immediate of the danger is not clearly

manifest

)onsidering all the evidence on record, -he )o#rt

2nds the acc#sed g#ilty for simple impr#dence res#lting

to physical inj#ries 6nder Article ;F0 of the %evised

&enal )ode, the penalty provided for is arresto mayor inits minim#m period

Dissatis2ed, the petitioners appealed to the )A


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II

As earlier stated, the )A aQrmed the %-) decision in toto

-he A#g#st :G, :HHI Decision of the )A pertinently reads@

-his )o#rt holds conc#rrently and 2nds the foregoingcirc#mstances s#Qcient to s#stain a j#dgment of

conviction against the acc#sed8appellants for the crime of

simple impr#dence res#lting in serio#s physical

inj#ries -he elements of impr#dence are@ 1C that the

oender does or fails to do an actO :C that the doing or

the fail#re to do that act is vol#ntaryO ;C that it be

$itho#t maliceO /C that material damage res#lts from the

impr#denceO and 0C that there is ine7c#sable lac9 of

preca#tion on the part of the oender, ta9ing into

consideration his employment or occ#pation, degree of

intelligence, physical condition, and other circ#mstances

regarding persons, time and place

3hether or not Dr arcia and Dr Bastan hadcommitted an ine7c#sable lac9 of preca#tion! in the

treatment of their patient is to be determined according

to the standard of care observed by other members of

the profession in good standing #nder

similar circ#mstances, bearing in mind the advanced

state of the profession at the time of treatment or the

present state of medical science .n the case of 3eonilaFarcia&"ueda v. (ascasio, the *#preme )o#rt stated that,

in accepting a case, a doctor in eect represents that,

having the needed training and s9ill possessed by

physicians and s#rgeons practicing in the same 2eld, he

$ill employ s#ch training, care and s9ill in the treatment

of his patients (e therefore has a d#ty to #se at least


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IG

the same level of care that any other reasonably

competent doctor $o#ld #se to treat a condition #nder

the same circ#mstances

.n litigations involving medical negligence, the

plainti has the b#rden of establishing acc#sed8

appellants negligence, and for a reasonable concl#sion of

negligence, there m#st be proof of breach of d#ty on the

part of the physician as $ell as a ca#sal connection of

s#ch breach and the res#lting inj#ry of his patient -he

connection bet$een the negligence and the inj#ry m#stbe a direct and nat#ral se"#ence of events, #nbro9en by

intervening eQcient ca#ses .n other $ords, the

negligence m#st be the pro7imate ca#se of the

inj#ry Negligence, no matter in $hat it consists, cannot

create a right of action #nless it is the pro7imate ca#se of

the inj#ry complained of -he pro7imate ca#se of an

inj#ry is that ca#se $hich, in nat#ral and contin#o#s

se"#ence, #nbro9en by any eQcient intervening ca#se,

prod#ces the inj#ry and $itho#t $hich the res#lt $o#ld

not have occ#rred

.n the case at bench, the acc#sed8appellants

"#estioned the imp#tation against them and arg#ed that

there is no ca#sal connection bet$een their fail#re todiagnose the fract#re and the inj#ry s#stained by %oy

3e are not convinced


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GH

-he prosec#tion is ho$ever after the ca#se $hich

prolonged the pain and s#ering of %oy and not on the

fail#re of the acc#sed8appellants to correctly diagnose the

e7tent of the inj#ry s#stained by %oy

?or a more logical presentation of the disc#ssion,

$e shall 2rst consider the applicability of the doctrine

of res ipsa lo!uitur to the instant case "es ipsa

lo!uitur is a Latin phrase $hich literally means the thing

or the transaction spea9s for itself -he doctrine of res

ipsa lo!uituris simply a recognition of the post#late that,as a matter of common 9no$ledge and e7perience, the

very nat#re of certain types of occ#rrences may j#stify an

inference of negligence on the part of the person $ho

controls the instr#mentality ca#sing the inj#ry in the

absence of some e7planation by the acc#sed8appellant

$ho is charged $ith negligence .t is gro#nded in the

s#perior logic of ordinary h#man e7perience and, on the

basis of s#ch e7perience or common 9no$ledge,

negligence may be ded#ced from the mere occ#rrence of

the accident itself (ence, res ipsa lo!uitur is applied in

conj#nction $ith the doctrine of common 9no$ledge

-he speci2c acts of negligence $as narrated by

Mrs *antiago $ho accompanied her son d#ring thelatters ordeal at the hospital *he testi2ed as follo$s@

?iscal ?ormoso@


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G1

Z@ No$, he is an intern did yo# not cons#lt

the doctors, Dr arcia or Dra &amittan to

con2rm $hether yo# sho#ld go home or

notX

A@ Dra &amittan $as inside the c#bicle of

the n#rses and . as9ed her, yo# let #s go

home and yo# dont even clean the $o#nds

of my son

Z@ And $hat did she tellE yo#X

A@ -hey told me they $ill call a residentdoctor, sir

7 7 7 7 7 7 7 7 7

Z@ 3as there a resident doctor $hoE cameX

A@ Ses, *ir Dra Bastan arrived

Z@ Did yo# tell her $hat yo# $ant on yo# to

be doneX

A@ Ses, sir

Z@ 3hat did yo# tellE herX

A@ . told her, sir, $hile she $as cleaning the$o#nds of my son, are yo# not going to 78

ray #p to the 9nee beca#se my son $as

complaining pain from his an9le #p to the

middle part of the right leg


92/136


G:

Z@ And $hat did she tell yo#X

A@ According to Dra Bastan, there is no need

to 78ray beca#se it $as the an9le part that

$as r#n over

Z@ 3hat did yo# do or tell herX

A@ . told her, sir

Documents

Cases for Medical Malpractice