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appropriate, all that a patient must do is prove a nexus between the particular act or
omission complained of and the injury sustained while under the custody and management
of the defendant without need to produce expert medical testimony to establish the
standard of care.
Dr. Ninevetch Cruz v. CA and Lydia Umali
1997 / Francisco / Petition for review on certiorari of a CA decision
Standard of conduct > Experts > Medical professionals
FACTS
Medical malpractice suit type of claim which a victim has available to him/her to redress a
wrong committed by a medical professional which has caused bodily harm; most often brought
as a civil action for damages under NCC 2176 or a criminal case under RPC 365, with which a
civil action for damages is impliedly instituted.
Lydia Umali was examined by Dr. Cruz who found a myoma [benign tumor] in her uterus, and
scheduled her for a hysterectomy operation [removal of uterus] on 23 Mar 1991. Rowena
Umali de Ocampo accompanied her mother to the hospital a day before the operation, and they
spent the night there. Rowena noticed that the clinic was untidy, so she tried to persuade her
mother not to proceed with the operation. The following day, Rowena asked Dr. Cruz if the
operation could be postponed, but Lydia told her daughter that Dr. Cruz said that the operation
must go on as scheduled.
While Lydias relatives were waiting, Dr. Ercillo (anesthesiologist) told them to
buy tagamet ampules, and Rowenas sister went out to buy some. An hour later, Dr. Ercillo
asked them to buy blood for Lydia, so they did. A few hours later, the operation was finished, but
later, Dr. Cruz asked the family to buy additional blood, but there was no more type A blood
available in the blood bank. A person arrived to donate blood which was later transfused to
Lydia. Rowena noticed that her mother was gasping for breathapparently, the oxygen supply
had run out, so the family went out to buy oxygen. Later in the evening, she went
into shock and her blood pressure dropped. She was then transferred to another hospital so
she could be connected to a respirator and further examined. However, this transfer was
without the consent of the relatives, who only found out about it when an ambulance came
to take Lydia to the other hospital.
In the new hospital, she was re-operated upon by Dr. Cruz and Dr. Ercillo because blood
was oozing out from her incision. They summoned Dr. Angeles, Ob-Gyne head of the new
hospital, but when he arrived, Lydia was already in shock and possibly dead (BP: 0/0). Dr.
Angeles told Drs. Cruz and Ercillo that there was nothing he could do. Lydia died while Dr.
Cruz was closing her abdominal wall. Immediate cause of death is shock; disseminated
intravascular coagulation (DIC) as antecedent cause.
Dr. Cruz and Dr. Ercillo were charged with reckless imprudence and negligence
resulting in homicide of Lydia Umali. The Municipal Trial Court in Cities (MTCC) found Dr.
Ercillo not guilty for insufficiency of evidence against her, but held Dr. Cruz responsible for
Umalis death. RTC and CA affirmed MTCC.
Manifestation of negligence
untidiness of clinic
vessel that became loose. The findings of the doctors do not preclude the probability that a
clotting defect (DIC) caused the hemorrhage and consequently, Lydias death.
The Court has no recourse but to rely on the expert testimonies that substantiate Dr. Cruz
allegation that the cause of Lydias death was DIC, which cannot be attributed to Dr. Cruz fault
or negligence. This probability was unrebutted during trial.
FACTS:
April 4, 1984: Natividad Agana was rushed to the Medical City General Hospital because
of difficulty of bowel movement and bloody anal discharge. Dr. Miguel Ampil diagnosed her
to be suffering from cancer of the sigmoid.
April 11, 1984: Dr. Ampil performed an anterior resection surgery on Natividad and
found that the malignancy in her sigmoid area had spread on her left ovary, necessitating the
removal of certain portions of it
Dr. Ampil obtained the consent of Natividads husband, Enrique Agana to perform
hysterectomy.
After a couple of days, Natividad consulted both Dr. Ampil and Dr. Fuentes about
the excruciating pain in her anal region. Dr. Ampil recommended that she consult an
oncologist.
May 9, 1984: The Aganas went to the United States to seek further treatment and was
told she was FREE from cancer.
August 31, 1984: Natividad's daughter found a piece of gauze protruding from her
vagina. Dr. Ampil proceeded to her house and extracted by hand a piece of gauze measuring
1.5 inches in width and assuring that the pain will vanish.
When the pain intensified, Nativided went to Polymedic General Hospital where Dr.
Ramon Gutierrez found a foul-smelling gauze measuring 1.5 inches in width which badly
infected her vaginal vault which formed a recto-vaginal fistula forcign her stool to excrete
through the vagina.
February 16, 1986: Natividad died so she was substituted by her children
RTC: PSI solidarily liable with Dr. Ampil and Dr. Fuentes for damages for negligence
and malpractice
CA: absolved Dr. Fuentes upon the same advise from the PRC Board of Medicine for
failure to show that he placed the guages or concealed the fact from Natividad
ISSUE: W/N Dr. Fuentes may be held liable under the principle of res ipso loquitor
surgeons used gauzes as sponges to control the bleeding of the patient during the
surgical operation
immediately after the operation, the nurses who assisted in the surgery noted in
their report 2 sponges lacking
2 gauzes were extracted from the same spot of the body of Mrs. Agana
element 3 "control and management of the thing which caused the injury" to be wanting
Dr. Fuentes performed the surgery and thereafter reported and showed his work to
Dr. Ampil who allowed Dr. Fuentes to leave the operating room
Under the "Captain of the Ship" rule, the operating surgeon is the person in
complete charge of the surgery room and all personnel connected with the operation
not a rule of substantive law, hence, does not per se create or constitute an
independent or separate ground of liability, being a mere evidentiary rule
mere invocation and application of the doctrine does not dispense with the
requirement of proof of negligence
Art. 2176. Whoever by act or omission causes damage to another, there being fault or
negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no
pre-existing contractual relation between the parties, is called a quasi-delict and is governed
by the provisions of this Chapter.
ART. 2180. The obligation imposed by Article 2176 is demandable not only for ones
own acts or omissions, but also for those of persons for whom one is responsible.
The owners and managers of an establishment or enterprise are likewise responsible for damages
caused by their employees in the service of the branches in which the latter are employed or on
the occasion of their functions.
Employers shall be liable for the damages caused by their employees and household helpers
acting within the scope of their assigned tasks even though the former are not engaged in any
business or industry.