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* FIRST DIVISION.
585
586
Same; Same; Same; Same; When the doctrine of res ipsa loqui-
tur is availed by the plaintiff, the need for expert medical testimony
is dispensed with because the injury itself provides the proof of
negligence.Although generally, expert medical testimony is relied
upon in malpractice suits to prove that a physician has done a
negligent act or that he has deviated from the standard medical
procedure, when the doctrine of res ipsa loquitur is availed by the
plaintiff, the need for expert medical testimony is dispensed with
because the injury itself provides the proof of negligence. The
reason is that the general rule on the necessity of expert testimony
applies only to such matters clearly within the domain of medical
science, and not to matters that are within the common knowledge
of mankind which may be testified to by anyone familiar with the
facts. Ordinarily, only physicians and surgeons of skill and
experience are competent to testify as to whether a patient has been
treated or operated upon with a reasonable degree of skill and care.
However, testimony as to the statements and acts of physicians and
surgeons, external appearances, and manifest conditions which are
observable by any one may be given by non-expert witnesses.
Same; Same; Same; Same; Res ipsa loquitur is not a rigid or
ordinary doctrine to be perfunctorily used but a rule to be cautiously
applied depending upon the circumstances of each case.Despite
the fact that the scope of res ipsa loquitur has been measurably
enlarged, it does not automatically apply to all cases of medical
negligence as to mechanically shift the burden of proof to the
defendant to show that he is not guilty of the ascribed negligence.
Res ipsa loquitur is not a rigid or ordinary doctrine to be
perfunctorily used but a rule to be cautiously applied, depending
upon the circumstances of each case. It is generally restricted to
situations in malpractice cases where a layman is able to say, as a
matter of common knowledge and observation, that the
consequences of professional care were not as such as would
ordinarily have followed if due care had been exercised.
Same; Same; Same; Same; Res ipsa loquitur is not available in
a malpractice suit if the only showing is that the desired result of an
operation or treatment was not accomplished.It must be conceded
that the doctrine of res ipsa loquitur can have no application in a
suit against a physician or surgeon which involves the merits of a
diagnosis or of a scientific treatment. The physician or surgeon is
not required at his peril to explain why any particular diagnosis
was not correct, or why any particular scientific treatment did not
produce
587
588
KAPUNAN, J.:
589
Plaintiff Erlinda Ramos was, until the afternoon of June 17, 1985, a
47-year old (Exh. A) robust woman (TSN, October 19, 1989, p. 10).
Except for occasional complaints of discomfort due to pains
allegedly caused by the presence of a stone in her gall bladder (TSN,
January 13, 1988, pp. 4-5), she was as normal as any other woman.
Married to Rogelio E. Ramos, an executive of Philippine Long
Distance Telephone Company, she has three children whose names
are
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1 In the United States alone, a great number of people die every year as a
result of medical mishaps. The 13 December 1999 issue of TIME MAGAZINE
featured an article on medical negligence entitled Doctors Deadly Mistakes
which is quoted in part: It is hardly news that medical professionals make
mistakeseven dumb, deadly mistakes. What is shocking is how often it
happens. Depending on which statistics you believe, the number of Americans
killed by medical screw-ups is somewhere between 44,000 and 98,000 every
yearthe eighth leading cause of death even by the more conservative figure,
ahead of car crashes, breast cancer and AIDS. More astonishing than the huge
numbers themselves, though, is the fact that public health officials had known
about the problem for years and hadnt made a concerted effort to do something
about it.
2 Cholecystectomy is the surgical excision of the gall bladder.
3 CA Rollo, pp. 129-140.
4 Records, pp. 270-279.
590
591
592
593
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5 Id. at 270-275.
6 Docketed as Civil Case No. Q-46885.
594
595
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596
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10 Id. at 195.
597
II
III
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11 Rollo, p. 19.
12 Id. at 91-98.
598
599
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14 Africa, et al. vs. Caltex (Phil.), Inc., et al., 16 SCRA 449, 454 (1966).
15 57B Am Jur 2d, supra note 13 at 499.
16 Ibid.
17 Id. at 502.
18 Ibid.
19 Id.
600
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20 Id. at 503.
21 Voss vs. Bridwell, 364 P2d 955, 970 (1961) citing Worden v. Union
Gas System, 182 Kan. 686, 324 P.2d 501; Lamb v. Hartford Accident and
Indemnity Co., Primm v. Kansas Power & Light Co., 173 Kan. 443, 249
P.2d 647.
22 St. Johns Hospital and School of Nursing vs. Chapman, 434 P.2d
160, 166 (1967).
23 57B Am Jur 2d, supra note 13, at 513.
24 It is the 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. (Garcia-Rueda vs. Pascasio, 278 SCRA 769, 778 [1997]).
25 Voss vs. Bridwell, supra note 21.
601
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602
31
occurred. When the doctrine is appropriate, all that the
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. Resort to res ipsa loquitur is
allowed because there is no other way, under usual and
ordinary conditions, by which the patient can obtain
redress for injury suffered by him.
Thus, courts of other jurisdictions have applied the
doctrine in the following situations: leaving of a foreign 32
object in the body of the patient after an operation,
injuries sustained on a healthy part of the33 body which was
not under, or in the area, of treatment, removal of the 34
wrong part of the body when another part was intended,
knocking out a tooth while a patients 35
jaw was under
anesthetic for the removal of his tonsils, and loss of an eye
while the patient plaintiff was under the influence of
anesthetic, 36during or following an operation for
appendicitis, among others.
Nevertheless, despite the fact that the scope of res ipsa
loquitur has been measurably enlarged, it does not
automatically apply to all cases of medical negligence as to
mechanically shift the burden of proof to the defendant to
show that he is not guilty of the ascribed negligence. Res
ipsa loquitur is not a rigid or ordinary doctrine to be
perfunctorily used but a rule to be cautiously applied,
depending upon the circumstances of each case. It is
generally restricted to situations in malpractice cases
where a layman is able to say, as a matter of common
knowledge and observation, that the consequences of
professional care were not as such as would37ordinarily have
followed if due care had been exercised. A distinction
must
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603
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38 Id. at 968.
39 Rhodes vs. De Haan, 337 P. 2d. 1043, 1047 (1959).
40 Voss vs. Bridwell, supra note 21, at 968.
41 Sanders vs. Smith, 27 So. 2d 889, 893 (1946).
42 Ibid.
43 Voss vs. Bridwell, supra note 21.
604
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44 Id. at 971.
605
606
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607
ATTY. PAJARES:
Q: In particular, what did Dra. Perfecta Gutierrez do, if
any on the patient?
A: In particular, I could see that she was intubating the
patient.
Q: Do you know what happened to that intubation process
administered by Dra. Gutierrez?
ATTY. ALCERA:
She will be incompetent Your Honor.
COURT:
Witness may answer if she knows.
A: As I have said, I was with the patient, I was beside the
stretcher holding the left hand of the patient and all of
a sudden I heard some remarks coming from Dra.
Perfecta
608
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609
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610
49
unnecessary. We take judicial notice of the fact that
anesthesia procedures have become so common, that even
an ordinary person can tell if it was administered properly.
As such, it would not be too difficult to tell if the tube was
properly inserted. This kind of observation, we believe,
does not require a medical degree to be acceptable.
At any rate, without doubt, petitioners witness, an
experienced clinical nurse whose long experience and
scholarship led to her appointment as Dean of the Capitol
Medical Center School of Nursing, was fully capable of
determining whether or not the intubation was a success.
She had extensive clinical experience starting as a staff
nurse in Chicago, Illinois; staff nurse and clinical
instructor in a teaching hospital, the FEU-NRMF; Dean of
the Laguna College of Nursing in San Pablo City; and then 50
Dean of the Capitol Medical Center School of Nursing.
Reviewing witness Cruz statements, we find that the same
were delivered in a straightforward manner, with the kind
of detail, clarity, consistency and spontaneity which would
have been difficult to fabricate. With her clinical
background as a nurse, the Court is satisfied that she was
able to demonstrate through her testimony what truly
transpired on that fateful day.
Most of all, her testimony was affirmed by no less than
respondent Dra. Gutierrez who admitted that she
experienced difficulty in inserting the tube into Erlindas
trachea, to wit:
ATTY. LIGSAY:
Q: In this particular case, Doctora, while you were
intubating at your first attempt (sic), you did not
immediately see the trachea?
DRA. GUTIERREZ:
A: Yes sir.
Q: Did you pull away the tube immediately?
A: You do not pull the . . .
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51 TSN, November 15, 1990, p. 11.
52 TSN, October 9, 1990, p. 13.
53 STOELTING and MILLER, BASICS OF ANESTHESIA, 103 (1994).
54 Ibid.
612
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613
ATTY. LIGSAY:
Q: Would you agree, Doctor, that it is good medical
practice to see the patient a day before so you can
introduce yourself to establish good doctor-patient
relationship and gainthe trust and confidence of the
patient?
DRA. GUTIERREZ:
A: As I said in my previous statement, it depends on the
operative procedure of the anesthesiologist and in my
case, with elective cases and normal cardio-pulmonary
clearance like that, I usually dont do it except on
emergency
58
and on cases that have an abnormalities
(sic).
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614
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615
ATTY. LIGSAY:
Q: In your line of expertise on pulmonology, did you have
any occasion to use pentothal as a method of
management?
DR. JAMORA:
A: We do it in conjunction with the anesthesiologist when
they have to intubate our patient.
Q: But not in particular when you practice pulmonology?
A: No.
Q: In other words, your knowledge about pentothal is
based only on what you have read from books and not
by your own personal application of the medicine
pentothal?
A: Based on my personal experience also on pentothal.
Q: How many times have you used pentothal?
A: They used it on me. I went into bronchospasm during
my appendectomy.
Q: And because they have used it on you and on account
of your own personal experience you feel that you can
testify on pentothal here with medical authority?
A: No. That61
is why I used references to support my
claims.
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623
VOL. 321, DECEMBER 29, 1999 623
Ramos vs. Court of Appeals
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79 Whoever by act or omission causes damage to another, there being
fault or negligence, is obliged to pay for the damage done.
624
625
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626
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83 Id. at 327-328.
627
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84 Id. at 328.
628
Judgment modified.
629
o0o