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FE CAYAO-LASAM,
- versus SPOUSES CLARO and
EDITHA RAMOLETE,
FACTS
Respondent, three months pregnant Editha Ramolete (Editha)
was brought to the Lorma Medical Center (LMC) in San Fernando, La
Union due to vaginal bleeding. Upon advice of petitioner
relayed via telephone, Editha was admitted to the LMC on the
same day. A pelvic sonogram was then conducted on Editha revealing
the fetus weak cardiac pulsation. The following day, Edithas repeat
pelvic sonogram showed that aside from the fetus weak cardiac
pulsation, no fetal movement was also appreciated. Due to
persistent
and
profuse
vaginal
bleeding,
petitioner
advised Editha to undergo a Dilatation and Curettage
Procedure (D&C) or raspa. Petitioner performed the D&C
procedure. Editha was discharged from the hospital the following day.
Editha was once again brought at the LMC, as she was
suffering from vomiting and severe abdominal pains. Editha was
attended by Dr. Beatriz de la Cruz, Dr. Victor B. Mayo and Dr. Juan V.
Komiya. Dr. Mayo allegedly informed Editha that there was a
dead
fetus
in
the
latters
womb. After, Editha underwent laparotomy, she was found to
have a massive intra-abdominal hemorrhage and a ruptured
uterus. Thus, Editha had to undergo a procedure for
hysterectomy and as a result, she has no more chance to bear
a child.
Editha and her husband Claro Ramolete (respondents) filed a
Complaint for Gross Negligence and Malpractice against petitioner
before the Professional Regulations Commission (PRC).
Petitioner denied the allegations of negligence and incompetence
with the following explanations: upon Edithas confirmation that she
bleeding, an ultra-sound was performed upon her and the result of the
Sonogram Test reveals a morbid fetus but did not specify where the
fetus was located. Obstetricians will assume that the pregnancy is
within the uterus unless so specified by the Sonologist who conducted
the ultra-sound. Respondent (Dr. Lasam) cannot be faulted if she was
not able to determine that complainant Editha is having
an ectopic pregnancy interstitial. The D&C conducted on Editha is
necessary considering that her cervix is already open and so as to stop
the profuse bleeding. Simple curettage cannot remove a fetus if the
patient is having an ectopic pregnancy, since ectopic pregnancy is
pregnancy conceived outside the uterus and curettage is done only
within the uterus. Therefore, a more extensive operation needed in
this case of pregnancy in order to remove the fetus.
Appeal to PRC decision - reversing the findings of the Board
and revoking petitioners authority or license to practice her profession
as a physician.
Petitioner brought the matter to the CA in a Petition for Review
under Rule 43 of the Rules of Court. Petitioner also dubbed her
petition as one for certiorari under Rule 65 of the Rules of Court. The
CA held that the Petition for Review under Rule 43 of the Rules of Court
was an improper remedy, as the enumeration of the quasijudicial agencies in Rule 43 is exclusive. PRC is not among the quasijudicial bodies whose judgment or final orders are subject of a petition
for review to the CA, thus, the petition for review of the PRC Decision,
filed at the CA, was improper. Citing Section 26 of Republic Act (R.A.)
No. 2382 or the Medical Act of 1959, the CA held that the plain, speedy
and adequate remedy under the ordinary course of law which
petitioner should have availed herself of was to appeal to the Office of
the President.
ISSUE
1. WHETHER OR NOT PRC COMMITTED GRAVE ABUSE OF
DISCRETION IN REVOKING PETITIONERS LICENSE TO
PRACTICE MEDICINE WITHOUT AN EXPERT TESTIMONY TO
CAUSE
OF
RULING
Anent the substantive merits of the case, petitioner questions
the PRC decision for being without an expert testimony to support its
conclusion and to establish the cause of Edithas injury. Petitioner
avers that in cases of medical malpractice, expert testimony is
necessary to support the conclusion as to the cause of the injury.
Medical malpractice is a particular form of negligence which
consists in the failure of a physician or surgeon to apply to his practice
of medicine that degree of care and skill which is ordinarily employed
by the profession generally, under similar conditions, and in like
surrounding circumstances. In order to successfully pursue such a
claim, a patient must prove that the physician or surgeon either failed
to do something which a reasonably prudent physician or surgeon
would not have done, and that the failure or action caused injury to the
patient.
would use to treat a condition under the same circumstances, and that
there was nothing irregular in the way the petitioner dealt with Editha.
Medical malpractice, in our jurisdiction, is often brought as a civil
action for damages under Article 2176 of the Civil Code. The defenses
in an action for damages, provided for under Article 2179 of the Civil
Code are:
Art. 2179. When the plaintiffs own negligence was
the immediate and proximate cause of his injury, he
cannot recover damages. But if his negligence was only
contributory, the immediate and proximate cause of the
injury being the defendants lack of due care, the plaintiff
may recover damages, but the courts shall mitigate the
damages to be awarded.
Proximate cause has been defined as that which, in natural and
continuous sequence, unbroken by any efficient intervening cause,
produces injury, and without which the result would not have occurred.
An injury or damage is proximately caused by an act or a failure to act,
whenever it appears from the evidence in the case that the act or
omission played a substantial part in bringing about or actually causing
the injury or damage; and that the injury or damage was either a direct
result or a reasonably probable consequence of the act or omission.
In the present case, the Court notes the findings of the Board of
Medicine:
When complainant was discharged on July 31,
1994, herein respondent advised her to return
on August 4, 1994 or four (4) days after the
D&C. This advise was clear in complainants
Discharge Sheet. However, complainant failed to do
so. This being the case, the chain of continuity as required in
ROGELIOP. NOGALES,
- versus CAPITOL MEDICAL CENTER,
DR. OSCAR ESTRADA,
DR. ELY VILLAFLOR,
DR. ROSA UY,
DR. JOEL ENRIQUEZ,
DR. PERPETUA LACSON,
DR.NOE
ESPINOLA,
and
December 19, 2006
NURSEJ. DUMLAO
Promulgated:
FACTS
Pregnant with her fourth child, Corazon Nogales
(Corazon) was under the exclusive prenatal care of Dr.
Oscar Estrada (Dr. Estrada) beginning on her fourth month of
pregnancy or as early as December 1975. While Corazon was
on her last trimester of pregnancy, Dr. Estrada noted an
increase in her blood pressure and development of leg
edema indicating preeclampsia, which is a dangerous
complication of pregnancy.
Around midnight of 25 May 1976, Corazon started to
experience mild labor pains prompting Corazon and
Rogelio Nogales (Spouses Nogales) to see Dr. Estrada at
his home. After examining Corazon, Dr. Estrada advised
her
immediate
admission
to
the Capitol Medical Center (CMC).
hospital could not be held liable for its failure to intervene in the
relationship of physician-patient between defendant physician and
plaintiff.
On the liability of the other respondents, the Court of
Appeals applied the borrowed servant doctrine considering that
Dr. Estrada was an independent contractor who was merely
exercising hospital privileges. This doctrine provides that once the
surgeon enters the operating room and takes charge of the
proceedings, the acts or omissions of operating room personnel,
and any negligence associated with such acts or omissions, are
imputable to the surgeon. While the assisting physicians and
nurses may be employed by the hospital, or engaged by the
patient, they normally become the temporary servants or agents
of the surgeon in charge while the operation is in progress, and
liability may be imposed upon the surgeon for their negligent acts
under the doctrine of respondeat superior.
The Court of Appeals concluded that since Rogelio engaged
Dr. Estrada as the attending physician of his wife, any liability for
malpractice must be Dr. Estradas sole responsibility.
While it found the amount of damages fair and
reasonable, the Court of Appeals held that no interest could be
imposed on unliquidated claims or damages.
ISSUE
Whether CMC is vicariously liable for the negligence of Dr.
Estrada.
RULING
details. Specifically, the employer (or the hospital) must have the
right to control both the means and the details of the process by
which the employee (or the physician) is to accomplish his task.
The Court finds no single evidence pointing to CMCs
exercise of control over Dr. Estradas treatment and
management of Corazons condition. Throughout Corazons
pregnancy, she was under the exclusive prenatal care of Dr.
Estrada. At the time of Corazons admission at CMC and during
her delivery, it was Dr. Estrada, assisted by Dr. Villaflor, who
attended to Corazon. There was no showing that CMC had a part
in diagnosing Corazons condition. While Dr. Estrada enjoyed staff
privileges at CMC, such fact alone did not make him an employee
of CMC. CMC merely allowed Dr. Estrada to use its facilities when
Corazon was about to give birth, which CMC considered an
emergency. Considering these circumstances, Dr. Estrada is not an
employee of CMC, but an independent contractor.
The question now is WHETHER CMC IS AUTOMATICALLY
EXEMPT FROM LIABILITY CONSIDERING THAT DR. ESTRADA
IS AN INDEPENDENT CONTRACTOR-PHYSICIAN.
General Rule: A hospital is not liable for the
negligence of an independent contractor-physician.
Exception: The hospital may be liable if the physician is
the ostensible agent of the hospital.
This exception is also known as the doctrine of apparent
authority. Under the doctrine of apparent authority a hospital
can be held vicariously liable for the negligent acts of a physician
providing care at the hospital, regardless of whether the physician
is an independent contractor, unless the patient knows, or should
have known, that the physician is an independent contractor.
part, releases CMC and its employees from any and all claims
arising from or by reason of the treatment and operation.
The documents do not expressly release CMC from liability for
injury to Corazon due to negligence during her treatment or
operation. Neither do the consent forms expressly exempt CMC
from liability for Corazons death due to negligence during such
treatment or operation. Such release forms, being in the nature of
contracts
of
adhesion,
are
construed
strictly
against
hospitals. Besides, a blanket release in favor of hospitals from
any and all claims, which includes claims due to bad faith or gross
negligence, would be contrary to public policy and thus void.
Even simple negligence is not subject to blanket release in
favor of establishments like hospitals but may only mitigate
liability depending on the circumstances. [58] When a person
needing urgent medical attention rushes to a hospital, he cannot
bargain on equal footing with the hospital on the terms of
admission and operation. Such a person is literally at the mercy
of the hospital. There can be no clearer example of a contract of
adhesion than one arising from such a dire situation. Thus, the
release forms of CMC cannot relieve CMC from liability for the
negligent medical treatment of Corazon.
On the Liability of the Other Respondents
Despite this Courts pronouncement in its 9 September
2002
Resolution that the filing of petitioners Manifestation
confined petitioners claim only against CMC, Dr. Espinola, Dr.
Lacson, and Dr. Uy, who have filed their comments, the Court
deems it proper to resolve the individual liability of the remaining
respondents to put an end finally to this more than two-decade old
controversy.
[59]
a)
b)
c)
d)
e)
f)
versus -
FACTS
PSI, together with Dr. Miguel Ampil and Dr. Juan Fuentes, was
impleaded by Enrique Agana and Natividad Agana (later
substituted by her heirs), in a complaint for damages for the
injuries suffered by Natividad when Dr. Ampil and Dr. Fuentes
neglected to remove from her body two gauzes which were used
in the surgery they performed on her on at the Medical City
General Hospital. PSI was impleaded as owner, operator and
manager of the hospital.
RTC held PSI solidarily liable with Dr. Ampil and Dr. Fuentes
for damages.
RULING
This Court holds that PSI is liable to the Aganas, not under
the principle of respondeat superior for lack of evidence of an
employment relationship with Dr. Ampil but under the principle
of ostensible agency for the negligence of Dr. Ampil
and, pro hac vice, under the principle of corporate
negligence for its failure to perform its duties as a
hospital.
While in theory a hospital as a juridical entity cannot practice
medicine, in reality it utilizes doctors, surgeons and medical
practitioners in the conduct of its business of facilitating medical
and surgical treatment. Within that reality, three legal
relationships crisscross: (1) between the hospital and the doctor
practicing within its premises; (2) between the hospital and the
patient being treated or examined within its premises and (3)
between the patient and the doctor. The exact nature of each
the
Civil
Code
or
the
principle
of respondeat
directly
xx xx xx
As priorly stated, private respondents maintained
specific work-schedules, as determined by petitioner
through its medical director, which consisted of 24-hour
shifts totaling forty-eight hours each week and which were
strictly to be observed under pain of administrative
sanctions.
That
petitioner
exercised
control
over
respondents gains light from the undisputed fact
that in the emergency room, the operating room, or
any department or ward for that matter,
respondents' work is monitored through its nursing
supervisors, charge nurses and orderlies. Without
the approval or consent of petitioner or its medical
director, no operations can be undertaken in those
areas. For control test to apply, it is not essential
for the employer to actually supervise the
performance of duties of the employee, it being
enough that it has the right to wield the power.
hospital, they being merely consultants without any employeremployee relationship and in the capacity of independent
contractors. The Aganas never questioned such finding.
In fine, as there was no dispute over the RTC finding that PSI
and Dr. Ampil had no employer-employee relationship, such finding
became final and conclusive even to this Court. There was no
reason for PSI to have raised it as an issue in its petition. Thus,
whatever discussion on the matter that may have ensued was
purely academic.
Nonetheless, to allay the anxiety of the intervenors,
the Court holds that, in this particular instance, the
concurrent finding of the RTC and the CA that PSI was not
the employer of Dr. Ampil is correct. Control as a
determinative
factor
in
testing
the
employer-employee
relationship between doctor and hospital under which the hospital
could be held vicariously liable to a patient in medical negligence
cases is a requisite fact to be established by preponderance of
evidence. Here, there was insufficient evidence that PSI exercised
the power of control or wielded such power over the means and
the details of the specific process by which Dr. Ampil applied his
skills in the treatment of Natividad. Consequently, PSI cannot
be held vicariously liable for the negligence of Dr. Ampil
under the principle of respondeat superior.
appropriate,
special
issues
for
this
particular
patient. There are needs for special care after surgery
and if it so it must be written down there and a request
must be made known to proper authorities that such and
such care is necessary. And the request for medical
evaluation if there is an indication. When we ask for a
cardio-pulmonary clearance it is not in fact to tell them if
this patient is going to be fit for anesthesia, the decision
to give anesthesia rests on the anesthesiologist. What
we ask them is actually to give us the functional capacity
of certain systems which maybe affected by the
anesthetic agent or the technique that we are going to
use. But the burden of responsibility in terms of selection
of agent and how to administer it rest on the
anesthesiologist.
The conduct of a preanesthetic/preoperative evaluation prior to
an operation, whether elective or emergency, cannot be
dispensed with. Such evaluation is necessary for the formulation of
a plan of anesthesia care suited to the needs of the patient
concerned.
Pre-evaluation for anesthesia involves taking the patients
medical history, reviewing his current drug therapy, conducting
physical
examination,
interpreting laboratory
data,
and
determining the appropriate prescription of preoperative
medications as necessary to the conduct of anesthesia.
Physical examination of the patient entails not only evaluating
the patients central nervous system, cardiovascular system and
lungs but also the upper airway. Examination of the upper airway
would in turn include an analysis of the patients cervical spine
mobility, temporomandibular mobility, prominent central incisors,
deceased or artificial teeth, ability to visualize uvula and the
thyromental distance.
Nonetheless, Dr. Gutierrez omitted to perform a thorough
preoperative evaluation on Erlinda. As she herself admitted, she
saw Erlinda for the first time on the day of the operation itself, one
hour before the scheduled operation. She auscultated the
patients heart and lungs and checked the latters blood pressure
to determine if Erlinda was indeed fit for operation. However, she
did not proceed to examine the patients airway. Had she been
able to check petitioner Erlindas airway prior to the operation, Dr.
Gutierrez would most probably not have experienced difficulty in
intubating the former, and thus the resultant injury could have
been avoided. As we have stated in our Decision:
In the case at bar, respondent Dra. Gutierrez admitted that she
saw Erlinda for the first time on the day of the operation itself, on
17 June 1985. Before this date, no prior consultations with, or preoperative evaluation of Erlinda was done by her. Until the day of
the operation, respondent Dra. Gutierrez was unaware of the
physiological make-up and needs of Erlinda. She was likewise not
properly informed of the possible difficulties she would face during
the administration of anesthesia to Erlinda. Respondent Dra.
Gutierrez act of seeing her patient for the first time only an hour
before the scheduled operative procedure was, therefore, an act of
exceptional negligence and professional irresponsibility. The
measures cautioning prudence and vigilance in dealing with
human lives lie at the core of the physicians centuries-old
Hippocratic Oath. Her failure to follow this medical procedure is,
therefore, a clear indicia of her negligence.
Further, there is no cogent reason for the Court to reverse its
finding that it was the faulty intubation on Erlinda that caused her
comatose condition. There is no question that Erlinda became
comatose after Dr. Gutierrez performed a medical procedure on
her. Even the counsel of Dr. Gutierrez admitted to this fact during
the oral arguments:
CHIEF JUSTICE:
Mr. Counsel, you started your argument saying that this
involves a comatose patient?
ATTY. GANA:
Yes, Your Honor.
CHIEF JUSTICE:
A
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And at that point, you made a remark, what remark did you
make?
I said mahirap ata ito when the first attempt I did not see
the trachea right away. That was when I (interrupted)
That was the first attempt?
Yes.
What about the second attempt?
On the second attempt I was able to intubate right away
within two to three seconds.
At what point, for purposes of discussion without accepting
it, at what point did you make the comment na mahirap ata
to intubate, mali ata ang pinasukan
I did not say mali ata ang pinasukan I never said that.
Well, just for the information of the group here the remarks I
am making is based on the documents that were forwarded to
me by the Supreme Court. That is why for purposes of
discussion I am trying to clarify this for the sake of
enlightenment. So, at what point did you ever make that
comment?
Which one, sir?
The mahirap intubate ito assuming that you (interrupted)
Iyon lang, that is what I only said mahirap intubate
(interrupted)
At what point?
When the first attempt when I inserted the laryngoscope for
the first time.
So, when you claim that at the first attempt you inserted
the laryngoscope, right?
Yes.
But in one of the recordings somewhere at the, somewhere
in the transcript of records that when the lawyer of the other
party try to inquire from you during the first attempt that was
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DR. CAMAGAY:
I think it is not even due diligence it is courtesy.
CHIEF JUSTICE:
Courtesy.
DR. CAMAGAY:
And care.
CHIEF JUSTICE:
Duty as a matter of fact?
DR. CAMAGAY:
Yes, Your Honor.[43]
Dr. Hosaka's irresponsible conduct of arriving very late for the
scheduled operation of petitioner Erlinda is violative, not only of
his duty as a physician to serve the interest of his patients with
the greatest solicitude, giving them always his best talent and
skill,[44] but also of Article 19 of the Civil Code which requires a
person, in the performance of his duties, to act with justice and
give everyone his due.
Anent private respondent DLSMCs liability for the resulting
injury to petitioner Erlinda, we held that respondent hospital is
solidarily liable with respondent doctors therefor under Article
2180 of the Civil Code[45]since there exists an employer-employee
relationship between private respondent DLSMC and Drs.
Gutierrez and Hosaka:
In other words, private hospitals, hire, fire and exercise real control
over their attending and visiting consultant staff. While
consultants are not, technically employees, x x x the control
exercised, the hiring and the right to terminate consultants all
fulfill the important hallmarks of an employer-employee
relationship, with the exception of the payment of wages. In
assessing whether such a relationship in fact exists, the control
test is determining. x x x[46]
DLSMC however contends that applying the four-fold test in
determining whether such a relationship exists between it and the
In the instant case, petitioners were able to provide only homebased nursing care for a comatose patient who has remained in
that condition for over a decade. Having premised our award for
compensatory damages on the amount provided by petitioners at
the onset of litigation, it would be now much more in step with the
interests of justice if the value awarded for temperate damages
would allow petitioners to provide optimal care for their loved one
in a facility which generally specializes in such care. They should
not be compelled by dire circumstances to provide substandard
care at home without the aid of professionals, for anything less
would be grossly inadequate. Under the circumstances, an award
of P1,500,000.00 in temperate damages would therefore be
reasonable.[54]
However, subsequent to the promulgation of the Decision, the
Court was informed by petitioner Rogelio that petitioner Erlinda
died on August 3, 1999.[55] In view of this supervening event, the
award of temperate damages in addition to the actual or
compensatory damages would no longer be justified since the
actual damages awarded in the Decision are sufficient to cover the
medical expenses incurred by petitioners for the patient. Hence,
only the amounts representing actual, moral and exemplary
damages, attorneys fees and costs of suit should be awarded to
petitioners.
WHEREFORE, the assailed Decision is hereby modified as
follows:
(1) Private respondent De Los Santos Medical Center is hereby
absolved from liability arising from the injury suffered by petitioner
Erlinda Ramos on June 17, 1985;
(2) Private respondents Dr. Orlino Hosaka and Dr. Perfecta
Gutierrez are hereby declared to be solidarily liable for the injury
suffered by petitioner Erlinda on June 17, 1985 and are ordered to
pay petitioners
(a)
P1,352,000.00 as actual damages;
(b)
P2,000,000.00 as moral damages;
(c)
P100,000.00 as exemplary damages;
(d)
P100,000.00 as attorneys fees; and
(e)
the costs of the suit.
SO ORDERED.
Davide, Jr., C.J., (Chairman), Puno, and Ynares-Santiago,
JJ., concur.
After Dr. Tatad finished her work with the Lilia Aguila operation,
petitioners immediately started their operation on Raymond at
around 12:15 A.M. of 17 September 1995. Upon opening of
Raymonds thoracic cavity, they found that 3,200 cc of blood was
stocked therein. The blood was evacuated and petitioners found a
puncture at the inferior pole of the left lung.
In his testimony, Dr. Cereno stated that considering the loss of
blood suffered by Raymond, he did not immediately transfuse
blood because he had to control the bleeders first.4
Blood was finally transfused on Raymond at 1:40 A.M. At 1:45
A.M., while the operation was on-going, Raymond suffered a
cardiac arrest. The operation ended at 1:50 A.M. and Raymond
was pronounced dead at 2:30 A.M.
Raymonds death certificate5 indicated that the immediate cause
of death was "hypovolemic shock" or the cessation of the
functions of the organs of the body due to loss of blood.6
Claiming that there was negligence on the part of those who
attended to their son, the parents of Raymond, on 25 October
1995, filed before the RTC, Branch 22, Naga City a complaint for
damages7 against Nurse Balares, Dr. Realuyo and attending
surgeons Dr. Cereno and Dr. Zafe.
During trial, the parents of Raymond testified on their own behalf.
They also presented the testimonies of Andrew Olavere and one
Loira Oira, the aunt of Raymond. On the other hand, Dr. Cereno,
Dr. Realuyo, Nurse Balares and Security Guard Diego Reposo
testified for the defense. On rebuttal, the parents of Raymond
presented Dr. Tatad, among others.
Court is not a trier of facts and will not re-examine and re-evaluate
the evidence on record.11 Factual findings of the CA, affirming that
of the trial court, are therefore generally final and conclusive on
this Court. This rule is subject to the following exceptions: (1) the
conclusion is grounded on speculations, surmises or conjectures;
(2) the inference is manifestly mistaken, absurd or impossible; (3)
there is grave abuse of discretion; (4) the judgment is based on a
misapprehension of facts; (5) the findings of fact are conflicting;
(6) there is no citation of specific evidence on which the factual
findings are based; (7) the findings of absence of fact are
contradicted by the presence of evidence on record; (8) the
findings of the CA are contrary to those of the trial court; (9) the
CA manifestly overlooked certain relevant and undisputed facts
that, if properly considered, would justify a different conclusion;
(10) the findings of the CA are beyond the issues of the case; and
(11) such findings are contrary to the admissions of both
parties.12 In this case, We find exceptions (1) and (4) to be
applicable.
The type of lawsuit which has been called medical malpractice or,
more appropriately, medical negligence, is that type of claim
which a victim has available to him or her to redress a wrong
committed by a medical professional which has caused bodily
harm. In order to successfully pursue such a claim, a patient must
prove that a health care provider, in most cases a physician,
either failed to do something which a reasonably prudent
health care provider would have done, or that he or she
did something that a reasonably prudent provider would
not have done; and that the failure or action caused injury to
the patient.13 Stated otherwise, the complainant must prove: (1)
that the health care provider, either by his act or omission, had
Q: Who is she?
A: Dra. Flores.
Q: What is the first name?
A: Rosalina Flores.
Q: Is she residing in Naga City?
A: In Camaligan.
Q: She is on call anytime when there is an emergency case to be
attended to in the Bicol Medical Center?
A: Yes sir.15
Dr. Tatad further testified:
Q: Alright (sic), considering that you said you could not attend to
Raymond Olavere because another patient was coming in the
person of Lilia Aguila, did you not suggest to Dr. Cereno to call the
standby anesthesiologist?
A: They are not ones to do that. They have no right to call for the
standby anesthesiologist.
Q: Then, who should call for the standby anesthesiologist?
A: It is me if the surgeon requested.
Q: But in this case, the surgeon did not request you?
A: No. It is their prerogative.
Q: I just want to know that in this case the surgeon did not request
you to call for the standby anesthesiologist?
A: No sir.16
From there, the trial court concluded that it was the duty of the
petitioners to request Dr. Tatad to call on Dr. Rosalina Flores, the
standby anesthesiologist. Since petitioners failed to do so, their
inability to promptly perform the operation on Raymond becomes
negligence on their part.
This Court does not agree with the aforesaid conclusion.
First. There is nothing in the testimony of Dr. Tatad, or in any
evidence on the record for that matter, which shows that the
petitioners were aware of the "BRMC protocol" that the hospital
keeps a standby anesthesiologist available on call. Indeed, other
than the testimony of Dr. Tatad, there is no evidence that proves
that any such "BRMC protocol" is being practiced by the hospitals
surgeons at all.
Evidence to the effect that petitioners knew of the "BRMC
protocol" is essential, especially in view of the contrary assertion
of the petitioners that the matter of assigning anesthesiologists
rests within the full discretion of the BRMC Anesthesiology
Department. Without any prior knowledge of the "BRMC protocol,"
We find that it is quite reasonable for the petitioners to assume
that matters regarding the administration of anesthesia and the
assignment of anesthesiologists are concerns of the
Anesthesiology Department, while matters pertaining to the
surgery itself fall under the concern of the surgeons. Certainly, We
cannot hold petitioners accountable for not complying with
something that they, in the first place, do not know.
Second. Even assuming ex gratia argumenti that there is such
"BRMC protocol" and that petitioners knew about it, We find that
their failure to request for the assistance of the standby
Q: Had this blood been given to you before the operation you
could have transfused the blood to the patient?
A: Of course, yes.
Q: And the blood was transfused only after the operation?
A: Because that was the time when the blood was given to us.
xxxx
Q: Have you monitored the condition of Raymond Olavere?
A: I monitored the condition during the time when I would
administer anesthesia.
Q: What time was that?
A: 11:45 already.
Q: What was the condition of the blood pressure at that time?
A: 60/40 initial.
Q: With that kind of blood pressure the patient must have been in
critical condition?
A: At the time when the blood pressure was 60/40 I again told Dr.
Cereno that blood was already needed.
Q: With that condition, Doctor, that the patient had 60/40 blood
pressure you did not decide on transfusing blood to him?
A: I was asking for blood but there was no blood available.
Q: From whom did you ask?
A: From the surgeon. According to Dr. Zafe there was only 500 cc
but still for cross-matching.18
From the aforesaid testimony, the trial court ruled that there was
negligence on the part of petitioners for their failure to have the
blood ready for transfusion. It was alleged that at 11:15 P.M., the
500 cc of blood was given to Dr. Realuyo by Raymonds parents. At
11:45 P.M., when Dr. Tatad was asking for the blood, 30 minutes
had passed. Yet, the blood was not ready for transfusion as it was
still being cross-matched.19 It took another two hours before blood
was finally transfused to Raymond at 1:40 A.M. of 17 September
1995.
Again, such is a mistaken conclusion.
First, the alleged delay in the cross-matching of the blood, if there
was any, cannot be attributed as the fault of the petitioners. The
petitioners were never shown to be responsible for such delay. It is
highly unreasonable and the height of injustice if petitioners were
to be sanctioned for lapses in procedure that does not fall within
their duties and beyond their control.
Second, Dr. Cereno, in his unchallenged testimony, aptly explained
the apparent delay in the transfusion of blood on Raymond before
and during the operation.
Before the operation, Dr. Cereno explained that the reason why no
blood transfusion was made on Raymond was because they did
not then see the need to administer such transfusion, viz:
Q: Now, you stated in your affidavit that prior to the operation you
were informed that there was 500 cc of blood available and was
still to be cross-matched. What time was that when you were
informed that 500 cc of blood was due for crossmatching?
THIRDDIVISION
- versus -
PEREZ,*** and
MENDOZA, JJ.
Promulgated:
February 15, 2012
PEOPLE OF
THEPHILIPPINES,
Respondent.
x --------------------------------------------------------------------------------------- x
DECISION
MENDOZA, J.:
THE FACTS
2.
Q:
A:
Q:
A:
xxx
xxx
Q:
A:
Q:
A:
Yes, sir.
Q:
A:
Q:
A:
Q:
A:
Q:
A:
None, sir.
xxx
A:
A:
Q:
xxx
Q:
xxx
xxx
xxx
was
discussed
then
by
A:
2.
condition
may
worsen
without
proper
medical
attention. As junior residents who only practice general
surgery and without specialization with the case
consulted before them, they should have referred the
matter to a specialist. This omission alone constitutes
simple imprudence on their part. When Mrs. Santiago
insisted on having another x-ray of her child on the upper
part of his leg, they refused to do so. The mother would
not have asked them if they had no exclusive control or
prerogative to request an x-ray test. Such is a fact
because a radiologist would only conduct the x-ray test
upon request of a physician.
The testimony of Mrs. Santiago was corroborated
by a bone specialist Dr. Tacata. He further testified based
on his personal knowledge, and not as an expert, as he
examined himself the child Roy. He testified as follows:
Fiscal Macapagal:
Q:
A:
A:
negligence complained of. The Court is also of the view that the CA
erred in applying the doctrine of res ipsa loquitur in this particular
case.
As to the Application of
The Doctrine of Res Ipsa Loquitur
Q:
Will you please tell us, for the record, doctor, what is
your specialization?
A:
Q:
A:
Q:
A:
Q:
A:
Q:
A:
Q:
And when you say spiral, doctor, how long was this
fracture?
A:
Q:
A:
Q:
A:
Q:
A:
Q:
A:
The mother.
Q:
A:
Q:
A:
xxxx
A:
xxx
Q:
You also said, Doctor, that Dr. Jarcia and Dra. Bastan
are not even an orthopedic specialist.
A:
xxxx
Q:
A:
Q:
A:
Q:
A:
Yes, sir.
Q:
A:
xxxx
Q:
A:
would not, and could not, be enough basis to hold one criminally
liable; thus, a reasonable doubt as to the petitioners guilt.
Dr. Jarcia and Dr. Bastan cannot pass on the liability to the taxi
driver who hit the victim. It may be true that the actual, direct,
immediate, and proximate cause of the injury (fracture of the leg
bone or tibia) of Roy Jr. was the vehicular accident when he was hit
by a taxi. The petitioners, however, cannot simply invoke such
fact alone to excuse themselves from any liability. If this would be
so, doctors would have a ready defense should they fail to do their
job in attending to victims of hit-and-run, maltreatment, and other
crimes of violence in which the actual, direct, immediate, and
proximate cause of the injury is indubitably the act of the
perpetrator/s.
(1)
(2)
(3)
(4)
with interest at the rate of 6% per annum from the date of the
filing of the Information. The rate shall be 12% interest per
annum from the finality of judgment until fully paid.
SO ORDERED.
EN BANC
DR. RUBI LI,
Petitioner,
- versus -
SPOUSES
REYNALDO
Promulgated:
and LINA SOLIMAN, as
parents/heirs
of
June 7, 2011
deceased
Angelica
Soliman,
Respondents.
x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x
DECISION
VILLARAMA, JR., J.:
see any discoloration on Angelicas face, nor did she notice any
difficulty in the childs breathing. She claimed that Angelica
merely complained of nausea and was given ice chips.
On August 22, 1993, at around ten oclock in the morning,
upon seeing that their child could not anymore bear the pain,
respondents
pleaded
with
petitioner
to
stop
the
chemotherapy. Petitioner
supposedly
replied: Dapat
15
Cosmegen pa iyan. Okay, lets observe. If pwede na, bigyan uli ng
chemo. At this point, respondents asked petitioners permission
to bring their child home. Later in the evening, Angelica passed
black stool and reddish urine. Petitioner countered that there was
no record of blackening of stools but only an episode of loose
bowel movement (LBM). Petitioner also testified that what
Angelica complained of was carpo-pedal spasm, not convulsion or
epileptic attack, as respondents call it (petitioner described it in
the vernacular as naninigas ang kamay at paa). She then
requested for a serum calcium determination and stopped the
chemotherapy. When Angelica was given calcium gluconate, the
spasm and numbness subsided.
The following day, August 23, petitioner yielded to
respondents request to take Angelica home. But prior to
discharging Angelica, petitioner requested for a repeat serum
calcium determination and explained to respondents that the
chemotherapy will be temporarily stopped while she observes
Angelicas muscle twitching and serum calcium level. Take-home
medicines were also prescribed for Angelica, with instructions to
respondents that the serum calcium test will have to be repeated
after seven days. Petitioner told respondents that she will see
Angelica again after two weeks, but respondents can see her
anytime if any immediate problem arises.
However, Angelica remained in confinement because while
still in the premises of SLMC, her convulsions returned and she
also had LBM. Angelica was given oxygen and administration of
calcium continued.
WHEREFORE,
the
instant
appeal
is
hereby
GRANTED. Accordingly, the assailed decision is hereby
modified to the extent that defendant-appellee Dr. Rubi Li
is ordered to pay the plaintiffs-appellants the following
amounts:
1.
2.
3.
4.
SO ORDERED.
Petitioner filed a motion for partial reconsideration which the
appellate court denied.
Hence, this petition.
Petitioner assails the CA in finding her guilty of negligence in
not explaining to the respondents all the possible side effects of
the chemotherapy on their child, and in holding her liable for
actual, moral and exemplary damages and attorneys
fees. Petitioner emphasized that she was not negligent in the prechemotherapy procedures and in the administration of
chemotherapy treatment to Angelica.
On her supposed non-disclosure of all possible side effects
of chemotherapy, including death, petitioner argues that it was
foolhardy to imagine her to be all-knowing/omnipotent. While the
theoretical side effects of chemotherapy were explained by her to
the respondents, as these should be known to a competent
doctor, petitioner cannot possibly predict how a particular
patients genetic make-up, state of mind, general health and body
constitution would respond to the treatment. These are obviously