Dr. ninevetch cruz vs.

ca
On March 22, 1991, prosecution witness, Rowena Umali De Ocampo,
accompanied her mother to the Perpetual Help Clinic and General Hospital
situated in Balagtas Street, San Pablo City, Laguna. They arrived at the said
hospital at around 4:30 in the afternoon of the same day. [9] Prior to March 22,
1991, Lydia was examined by the petitioner who found a "myoma" [10] in her
uterus, and scheduled her for a hysterectomy operation on March 23, 1991.
[11] Rowena and her mother slept in the clinic on the evening of March 22, 1991

as the latter was to be operated on the next day at 1:00 o'clock in the afternoon.
[12] According to Rowena, she noticed that the clinic was untidy and the window

and the floor were very dusty prompting her to ask the attendant for a rag to
wipe the window and the floor with.[13] Because of the untidy state of the clinic,
Rowena tried to persuade her mother not to proceed with the operation. [14] The
following day, before her mother was wheeled into the operating room, Rowena
asked the petitioner if the operation could be postponed. The petitioner called
Lydia into her office and the two had a conversation. Lydia then informed
Rowena that the petitioner told her that she must be operated on as scheduled.
[15]

Rowena and her other relatives, namely her husband, her sister and two
aunts waited outside the operating room while Lydia underwent operation. While
they were waiting, Dr. Ercillo went out of the operating room and instructed them
to buy tagamet ampules which Rowena's sister immediately bought. About one
hour had passed when Dr. Ercillo came out again this time to ask them to buy
blood for Lydia. They bought type "A" blood from the St. Gerald Blood Bank and
the same was brought by the attendant into the operating room. After the lapse
of a few hours, the petitioner informed them that the operation was finished. The
operating staff then went inside the petitioner's clinic to take their snacks. Some
thirty minutes after, Lydia was brought out of the operating room in a stretcher
and the petitioner asked Rowena and the other relatives to buy additional blood
for Lydia. Unfortunately, they were not able to comply with petitioner's order as
there was no more type "A" blood available in the blood bank. Thereafter, a
person arrived to donate blood which was later transfused to Lydia. Rowena
then noticed her mother, who was attached to an oxygen tank, gasping for
breath. Apparently the oxygen supply had run out and Rowena's husband
together with the driver of the accused had to go to the San Pablo District
Hospital to get oxygen. Lydia was given the fresh supply of oxygen as soon as it
arrived.[16] But at around 10:00 o'clock P.M. she went into shock and her blood
pressure dropped to 60/50. Lydia's unstable condition necessitated her transfer
to the San Pablo District Hospital so she could be connected to a respirator and
further examined.[17] The transfer to the San Pablo City District Hospital was
without the prior consent of Rowena nor of the other relatives present who found
out about the intended transfer only when an ambulance arrived to take Lydia to
the San Pablo District Hospital. Rowena and her other relatives then boarded a
tricycle and followed the ambulance.[18]

MTCC found the following circumstances as sufficient basis to conclude that she was
indeed negligent in the performance of the operation:
"x x x, the clinic was untidy, there was lack of provision like blood and oxygen to
prepare for any contingency that might happen during the operation. The manner and the
fact that the patient was brought to the San Pablo District Hospital for reoperation
indicates that there was something wrong in the manner in which Dra. Cruz conducted
the operation. There was no showing that before the operation, accused Dr. Cruz had
conducted a cardio pulmonary clearance or any typing of the blood of the patient. It was
(sic) said in medical parlance that the "abdomen of the person is a temple of surprises"
because you do not know the whole thing the moment it was open (sic) and surgeon
must be prepared for any eventuality thereof. The patient (sic) chart which is a public
document was not presented because it is only there that we could determine the
condition of the patient before the surgery. The court also noticed in Exh. "F-1" that the
sister of the deceased wished to postpone the operation but the patient was prevailed
upon by Dra. Cruz to proceed with the surgery. The court finds that Lydia Umali died
because of the negligence and carelessness of the surgeon Dra. Ninevetch Cruz because
of loss of blood during the operation of the deceased for evident unpreparedness and for
lack of skill, the reason why the patient was brought for operation at the San Pablo City
District Hospital. As such, the surgeon should answer for such negligence. With respect
to Dra. Lina Ercillo, the anaesthesiologist, there is no evidence to indicate that she
should be held jointly liable with Dra. Cruz who actually did the operation."[23]

The RTC reiterated the abovementioned findings of the MTCC and upheld
the latter's declaration of "incompetency, negligence and lack of foresight and
skill of appellant (herein petitioner) in handling the subject patient before and
after the operation."[24] And likewise affirming the petitioner's conviction, the
Court of Appeals echoed similar observations',

the SC said the elements of reckless imprudence are: (1) that the offender does or fails
to do an act; (2) that the doing or the failure to do that act is voluntary; (3) that it be without
malice; (4) that material damage results from the reckless imprudence; and (5) that there is
inexcusable lack of precaution on the part of the offender, taking into consideration his
employment or occupation, degree of intelligence, physical condition, and other
circumstances regarding persons, time and place.

in litigations involving medical negligence, the plaintiff has the burden of establishing
appellant's negligence and for a reasonable conclusion of negligence, there must be proof of
breach of duty on the part of the surgeon as well as a casual connection of such breach and
the resulting death of his patient. [33] In Chan Lugay v. St Luke's Hospital, Inc.,[34] where the
attending physician was absolved of liability for the death of the complainant's wife and
newborn baby,
Immediately apparent from a review of the records of this case is the absence of any
expert testimony on the matter of the standard of care employed by other physicians of good
standing in the conduct of similar operations. The prosecution's expert witnesses in the
persons of Dr. Floresto Arizala and Dr. Nieto Salvador, Jr. of the National Bureau of
Investigation (NBI) only testified as to the possible cause of death but did not venture to
illuminate the court on the matter of the standard of care that petitioner should have
exercised.
DR. NINEVETCH CRUZ is hereby ACQUITTED of the crime of reckless
imprudence resulting in homicide but is ordered to pay the heirs of the deceased
Lydia Umali the amount of FIFTY THOUSAND PESOS (P50,000.00) as civil
liability, ONE HUNDRED THOUSAND PESOS (P100,000.00) as moral
damages, and FIFTY THOUSAND PESOS (P50,000.00) as exemplary
damages.

Private respondents De Los Santos Medical Center, Dr. Orlino Hosaka and Dr. Perfecta
Gutierrez move for a reconsideration of the Decision, dated December 29, 1999, of this Court
holding them civilly liable for petitioner Erlinda Ramos comatose condition after she delivered
herself to them for their professional care and management.

titioner Erlinda Ramos, a was advised to undergo an operation for the removal of a stone
in her gall bladder (cholecystectomy). She was referred to Dr. Hosaka, a surgeon, The
operation was scheduled for June 17, 1985 at 9:00 in the morning at private respondent De
Los Santos Medical Center (DLSMC). Dr. Hosaka recommended to them the services of Dr.
Gutierrez. as anaaesthesiologist.

Petitioner Erlinda was admitted to the DLSMC the day before the scheduled operation. By
7:30 in the morning of the following day, petitioner Erlinda was already being prepared for
operation. Upon the request of petitioner Erlinda, her sister-in-law, Herminda Cruz, who was
then Dean of the College of Nursing at the Capitol Medical Center, was allowed to accompany
her inside the operating room.
At around 9:30 in the morning, Dr. Hosaka had not yet arrived so Dr. Gutierrez tried to get in
touch with him by phone. Thereafter, Dr. Gutierrez informed Cruz that the operation might be
delayed due to the late arrival of Dr. Hosaka. In the meantime, the patient, petitioner Erlinda
said to Cruz, "Mindy, inip na inip na ako, ikuha mo ako ng ibang Doctor."
By 10:00 in the morning, when Dr. Hosaka was still not around, petitioner Rogelio already
wanted to pull out his wife from the operating room. He met Dr. Garcia, who remarked that he
was also tired of waiting for Dr. Hosaka. Dr. Hosaka finally arrived at the hospital at around
12:10 in the afternoon, or more than three (3) hours after the scheduled operation.
Cruz, who was then still inside the operating room, heard about Dr. Hosakas arrival. While
she held the hand of Erlinda, Cruz saw Dr. Gutierrez trying to intubate the patient. Cruz heard
Dr. Gutierrez utter: "ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang
tiyan." Cruz noticed a bluish discoloration of Erlindas nailbeds on her left hand. She (Cruz)
then heard Dr. Hosaka instruct someone to call Dr. Calderon, another anesthesiologist. When
he arrived, Dr. Calderon attempted to intubate the patient. The nailbeds of the patient
remained bluish, thus, she was placed in a trendelenburg position a position where the
head of the patient is placed in a position lower than her feet. At this point, Cruz went out of
the operating room to express her concern to petitioner Rogelio that Erlindas operation was
not going well.
Cruz quickly rushed back to the operating room and saw that the patient was still in
trendelenburg position. At almost 3:00 in the afternoon, she saw Erlinda being wheeled to the
Intensive Care Unit (ICU). The doctors explained to petitioner Rogelio that his wife had
bronchospasm. Erlinda stayed in the ICU for a month. She was released from the hospital
only four months later or on November 15, 1985. Since the ill-fated operation, Erlinda
remained in comatose condition until she died on August 3, 1999.
Petitioners filed with the Regional Trial Court of Quezon City a civil case for damages

after due trial, the court a quo rendered judgment in favor of petitioners. the trial court
found that private respondents were negligent in the performance of their duties to Erlinda.
On appeal by private respondents, the Court of Appeals reversed the trial courts decision and
directed petitioners to pay their "unpaid medical bills" to private respondents.
Petitioners filed with this Court a petition for review on certiorari. Court promulgated the
decision which private respondents now seek to be reconsidered. The dispositive portion of
said Decision states:
WHEREFORE, the decision and resolution of the appellate court appealed from are
hereby modified so as to award in favor of petitioners, and solidarily against private
respondents the following: 1) P1,352,000.00 as actual damages computed as of the
date of promulgation of this decision plus a monthly payment of P8,000.00 up to the
time that petitioner Erlinda Ramos expires or miraculously survives; 2) P2,000,000.00
as moral damages, 3) P1,500,000.00 as temperate damages; 4) P100,000.00 each
exemplary damages and attorneys fees; and 5) the costs of the suit.2
In his Motion for Reconsideration, private respondent Dr. Hosaka submits the following as
grounds therefor:
I
THE HONORABLE SUPREME COURT COMMITTED REVERSIBLE ERROR WHEN IT
HELD RESPONDENT DR. HOSAKA LIABLE ON THE BASIS OF THE "CAPTAIN-OF-THE-
SHIP" DOCTRINE.
II
THE HONORABLE SUPREME COURT ERRED IN HOLDING RESPONDENT DR. HOSAKA
LIABLE DESPITE THE FACT THAT NO NEGLIGENCE CAN BE ATTRIBUTABLE TO HIM.
III
ASSUMING WITHOUT ADMITTING THAT RESPONDENT DR. HOSAKA IS LIABLE, THE
HONORABLE SUPREME COURT ERRED IN AWARDING DAMAGES THAT WERE
CLEARLY EXCESSIVE AND WITHOUT LEGAL BASIS.3
Private respondent Dr. Gutierrez, for her part, avers that:
 A. THE HONORABLE SUPREME COURT MAY HAVE INADVERTENTLY
OVERLOOKED THE FACT THAT THE COURT OF APPEALS DECISION DATED 29
MAY 1995 HAD ALREADY BECOME FINAL AND EXECUTORY AS OF 25 JUNE 1995,
THEREBY DEPRIVING THIS HONORABLE COURT OF JURISDICTION OVER THE
INSTANT PETITION;
B. THE HONORABLE SUPREME COURT MAY HAVE INADVERTENTLY
OVERLOOKED SEVERAL MATERIAL FACTUAL CIRCUMSTANCES WHICH, IF
PROPERLY CONSIDERED, WOULD INDUBITABLY LEAD TO NO OTHER
CONCLUSION BUT THAT PRIVATE RESPONDENT DOCTORS WERE NOT GUILTY
OF ANY NEGLIGENCE IN RESPECT OF THE INSTANT CASE;
B.1 RESPONDENT DOCTOR PERFECTA GUTIERREZ HAS SUFFICIENTLY
DISCHARGED THE BURDEN OF EVIDENCE BY SUBSTANTIAL PROOF OF
HER COMPLIANCE WITH THE STANDARDS OF DUE CARE EXPECTED IN
HER RESPECTIVE FIELD OF MEDICAL SPECIALIZATION.
B.2 RESPONDENT DOCTOR PERFECTA GUTIERREZ HAS SUFFICIENTLY
DISCHARGED THE BURDEN OF EVIDENCE BY SUBSTANTIAL PROOF OF
HER HAVING SUCCESSFULLY INTUBATED PATIENT ERLINDA RAMOS
C. THE SUPREME COURT MAY HAVE INADVERTENTLY PLACED TOO MUCH
RELIANCE ON THE TESTIMONY OF PETITIONERS WITNESS HERMINDA CRUZ,
DESPITE THE EXISTENCE OF SEVERAL FACTUAL CIRCUMSTANCES WHICH
RENDERS DOUBT ON HER CREDIBILITY
D. THE SUPREME COURT MAY HAVE INADVERTENTLY DISREGARDED THE
EXPERT TESTIMONY OF DR. JAMORA AND DRA. CALDERON
E. THE HONORABLE SUPREME COURT MAY HAVE INADVERTENTLY AWARDED
DAMAGES TO PETITIONERS DESPITE THE FACT THAT THERE WAS NO
NEGLIGENCE ON THE PART OF RESPONDENT DOCTOR.4
Private respondent De Los Santos Medical Center likewise moves for reconsideration on the
following grounds:
I
THE HONORABLE COURT ERRED IN GIVING DUE COURSE TO THE INSTANT PETITION
AS THE DECISION OF THE HONORABLE COURT OF APPEALS HAD ALREADY BECOME
FINAL AND EXECUTORY
II
THE HONORABLE SUPREME COURT ERRED IN FINDING THAT AN EMPLOYER-
EMPLOYEE [RELATIONSHIP] EXISTS BETWEEN RESPONDENT DE LOS SANTOS
MEDICAL CENTER AND DRS. ORLINO HOSAKA AND PERFECTA GUTIERREZ
III
THE HONORABLE SUPREME COURT ERRED IN FINDING THAT RESPONDENT DE LOS
SANTOS MEDICAL CENTER IS SOLIDARILY LIABLE WITH RESPONDENT DOCTORS
IV
THE HONORABLE SUPREME COURT ERRED IN INCREASING THE AWARD OF
DAMAGES IN FAVOR OF PETITIONERS.5
In the Resolution of February 21, 2000, this Court denied the motions for reconsideration of
private respondents Drs. Hosaka and Gutierrez. They then filed their respective second
motions for reconsideration. The Philippine College of Surgeons filed its Petition-in-

Intervention contending in the main that this Court erred in holding private respondent Dr.
Hosaka liable under the captain of the ship doctrine. According to the intervenor, said doctrine
had long been abandoned in the United States in recognition of the developments in modern
medical and hospital practice.6 The Court noted these pleadings in the Resolution of July 17,
2000.7
On March 19, 2001, the Court heard the oral arguments of the parties, including the
intervenor. Also present during the hearing were the amicii curiae: Dr. Felipe A. Estrella, Jr.,
Consultant of the Philippine Charity Sweepstakes, former Director of the Philippine General
Hospital and former Secretary of Health; Dr. Iluminada T. Camagay, President of the
Philippine Society of Anesthesiologists, Inc. and Professor and Vice-Chair for Research,
Department of Anesthesiology, College of Medicine-Philippine General Hospital, University of
the Philippines; and Dr. Lydia M. Egay, Professor and Vice-Chair for Academics, Department
of Anesthesiology, College of Medicine-Philippine General Hospital, University of the
Philippines.
The Court enumerated the issues to be resolved in this case as follows:
1. WHETHER OR NOT DR. ORLINO HOSAKA (SURGEON) IS LIABLE FOR
NEGLIGENCE;
2. WHETHER OR NOT DR. PERFECTA GUTIERREZ (ANESTHESIOLOGIST) IS
LIABLE FOR NEGLIGENCE; AND
3. WHETHER OR NOT THE HOSPITAL (DELOS SANTOS MEDICAL CENTER) IS
LIABLE FOR ANY ACT OF NEGLIGENCE COMMITTED BY THEIR VISITING
CONSULTANT SURGEON AND

On March 19, 2001, the Court heard the oral arguments of the parties, including the intervenor. Also
present during the hearing were the amicii curiae: Dr. Felipe A. Estrella, Jr., Consultant of the Philippine
Charity Sweepstakes, former Director of the Philippine General Hospital and former Secretary of Health;
Dr. Iluminada T. Camagay, President of the Philippine Society of Anesthesiologists, Inc. and Professor and
Vice-Chair for Research, Department of Anesthesiology, College of Medicine-Philippine General Hospital,
University of the Philippines; and Dr. Lydia M. Egay, Professor and Vice-Chair for Academics, Department
of Anesthesiology, College of Medicine-Philippine General Hospital, University of the Philippines.

Dr. Gutierrez claim of lack of negligence on her part is belied by the records of the case. It has been
sufficiently established that she failed to exercise the standards of care in the administration of anesthesia
on a patient. Dr. Egay enlightened the Court on what these standards are:

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

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.
 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. Wrong intubation by gutieerrrez resuklted to bluish nails and
paglaki ng tyan. Res ipas loquitor.

DR. hhosaka:

For his part, Dr. Hosaka mainly contends that the Court erred in finding him negligent as a surgeon by
applying the Captain-of-the-Ship doctrine argues that the trend in United States jurisprudence has been to
reject said doctrine in light of the developments in medical practice. He points out that anesthesiology and
surgery are two distinct and specialized fields in medicine and as a surgeon, he is not deemed to have
control over the acts of Dr. Gutierrez. As anesthesiologist .

Dr. Hosaka cites the case of Thomas v. Raleigh General Hospital,34 which involved a suit filed by a
patient who lost his voice due to the wrongful insertion of the endotracheal tube preparatory to the
administration of anesthesia The Supreme Court of Appeals of West Virginia held that the surgeon could
not be held liable for the loss of the patients voice, considering that the surgeon did not have a hand in the
intubation of the patient. The court rejected the application of the "Captain-of-the-Ship Doctrine," citing the
fact that the field of medicine has become specialized such that surgeons can no longer be deemed as
having control over the other personnel in the operating room .

This contention fails to persuade.

That there is a trend in American jurisprudence to do away with the Captain-of-the-Ship doctrine does not
mean that this Court will ipso facto follow said trend. Due regard for the peculiar factual circumstances
obtaining in this case justify the application of the Captain-of-the-Ship doctrine.

First, it was Dr. Hosaka who recommended to petitioners the services of Dr. Gutierrez

Second, Dr. Hosaka himself admitted that he was the attending physician of Erlinda. Thus, when
Erlinda showed signs of cyanosis, it was Dr. Hosaka who gave instructions to call for another
anesthesiologist and cardiologist to help resuscitate Erlinda.37

Third, it is conceded that in performing their responsibilities to the patient, Drs. Hosaka and Gutierrez
worked as a team. Their work cannot be placed in separate watertight compartments because their duties
intersect with each other.3

That they were working as a medical team is evident from the fact that Dr. Hosaka was keeping an eye
on the intubation of the patient by Dr. Gutierrez, and while doing so, he observed that the patients nails
had become dusky and had to call Dr. Gutierrezs attention thereto

It is equally important to point out that Dr. Hosaka was remiss in his duty of attending to petitioner
Erlinda promptly, for he arrived more than three (3) hours late for the scheduled operation.

The unreasonable delay in petitioner Erlindas scheduled operation subjected her to

continued starvation and consequently, to the risk of acidosis, As explained by Dr. Camagay, the
patients anxiety usually causes the outpouring of adrenaline which in turn results in high blood pressure or
disturbances in the heart rhythm .

Dr. Hosaka cannot now claim that he was entirely blameless of what happened to Erlinda. His conduct
clearly constituted a breach of his professional duties to Erlinda: he had two prior operations...

court found that dlsmc is not liable becaseu the four fold test were not satisfied :
 1. selection and engagement of services; (2) payment of wages; (3) the power to hire and fire;
and (4) the power to control not only the end to be achieved, but the means to be used in reaching
such an end.

Facts:
Jorge Reyes has been suffering from recurring fever with chills for around days.
Home medication afforded him no relief so he went to Mercy Community Clinic. He was
then attended by Dr. Marlyn Rico.
Since typhoid fever was common at that time, the Widal test was performed and he was
found positive for typhoid.
Thereafter, Dr. Marlyn Rico indorse Jorge Reyes to Dr. Marvie Blanes.
Suspecting that that Jorge had typhoid fever, Dr. Marvie Blanes ordered that Jorge be
tested for compatibility with chloromycetin, an antibiotic. Such test was conducted by
Nurse Pagente.
As there was no adverse reaction, Dr. Blanes administered 500 mg of the antibiotic.
Another dose was given 3 hours later.
Subsequently, Jorge Reyes developed high fever and experienced vomiting and
convulsions. He then turned blue due to deficiency in oxygen cyanosis and died. The
cause of death was stated to be ventricular arrhythmia secondary to hyperpyrexia and
typhoid fever.
The heirs of Reyes filed with the RTC a complaint for damages against Sisters of Mercy,
Sister Rose Palacio, Dr. Blanes, Dr. Rico and Mercy Community Clinic contending that
the death of Jorge was due to the wrongful administration of chloromycetin. (NOTE:
Petitioners action is for medical malpractice.)
RTC ruled in favor of the respondents. The CA affirmed in toto the RTC decision. Hence,
this appeal.
Petitioners contend that:
Dr. Marlyn Rico hastily and erroneously relied upon the Widal test, diagnosed
Jorges illness as typhoid fever, and immediately prescribed the administration of
the antibiotic chloromycetin
Dr. Marvie Blanes erred in ordering the administration of the second dose of 500
milligrams of chloromycetin barely 3 hours after the first was given.
Testimony presented: That of Dr. Apolinar Vacalares, (Chief Pathologist of the Northern
Mindanao Training Hospital) who performed an autopsy on the body Dr. Vacalares
testified that Reyes did not die of typhoid fever but of shock undetermined, which could
be due to allergic reaction or chloromycetin overdose.

Issue: WON there was medical malpractice. NO

Held:

Dr. Apolinar Vacalares is not a specialist of typhoid fever and he is thus not qualified to
prove that Dr. Marlyn Rico erred in her diagnosis.
While petitioners presented Dr. Apolinar Vacalares as an expert witness, we do not find him to
be so as he is not a specialist on infectious diseases like typhoid fever. Furthermore, although
he may have had extensive experience in performing autopsies, he admitted that he had yet
to do one on the body of a typhoid victim at the time he conducted the postmortem on Jorge
Reyes. It is also plain from his testimony that he has treated only about three cases of typhoid
fever.

The two doctors presented by respondents clearly were experts on the subject
They vouched for the correctness of Dr. Marlyn Ricos diagnosis. Dr. Peter Gotiong, a
diplomate whose specialization is infectious diseases and microbiology and an associate
professor at the Southwestern University College of Medicine and the Gullas College of
Medicine, testified that he has already treated over a thousand cases of typhoid fever.

According to him, when a case of typhoid fever is suspected, the Widal test is normally used,
and if the 1:320 results of the Widal test on Jorge Reyes had been presented to him along
with the patients history, his impression would also be that the patient was suffering from
typhoid fever. As to the treatment of the disease, he stated that chloromycetin was the drug of
choice. He also explained that despite the measures taken by respondent doctors and the
intravenous administration of two doses of chloromycetin, complications of the disease could
not be discounted.

Respondents also presented the testimony of Dr. Ibarra T. Panopio who is a member of the
Philippine and American Board of Pathology, an examiner of the Philippine Board of
Pathology, and chief pathologist at the MetroCebu Community Hospital, Perpetual Succor
Hospital, and the Andres Soriano Jr. Memorial Medical Center.

He stated that, as a clinical pathologist, he recognized that the Widal test is used for typhoid
patients, although he did not encourage its use because a single test would only give a
presumption necessitating that the test be repeated, becoming more conclusive at the second
and third weeks of the disease.

He corroborated Dr. Gotiongs testimony that the danger with typhoid fever is really the
possible complications which could develop like perforation, hemorrhage, as well as liver and
cerebral complications.

Dr. Rico was not negligent in administering the 2 doses of 500 g of chloromycetin
The chloromycetin was likewise a proper prescription is best established by medical authority.
Even if the deceased suffered from an anaphylactic shock, this, of itself, would not yet
establish the negligence of the appellee-physicians for all that the law requires of them is that
they perform the standard tests and perform standard procedures. The law cannot require
them to predict every possible reaction to all drugs administered.

The practice of medicine requires the highest degree of diligence

The practice of medicine is a profession engaged in only by qualified individuals. It is a right
earned through years of education, training, and by first obtaining a license from the state
through professional board examinations. Such license may, at any time and for cause, be
revoked by the government. In addition to state regulation, the conduct of doctors is also
strictly governed by the Hippocratic Oath, an ancient code of discipline and ethical rules which
doctors have imposed upon themselves in recognition and acceptance of their great
responsibility to society. Given these safeguards, there is no need to expressly require of
doctors the observance of extraordinary diligence.
As it is now, the practice of medicine is already conditioned upon the highest degree of
diligence. And, as we have already noted, the standard contemplated for doctors is simply the
reasonable average merit among ordinarily good physicians. That is reasonable diligence for
doctors or, as the Court of Appeals called it, the reasonable skill and competence . . . that a
physician in the same or similar locality . . . should apply.

There are thus four elements involved in medical negligence cases, namely: duty,
breach, injury, and proximate causation
Petitioners action is for medical malpractice. This 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
have done, or that he or she did something that a reasonably prudent physician or surgeon
would not have done, and that the failure or action caused injury to the patient.

The doctrine of Res Ipsa Loquitor is not applicable in this case.

Was there a physician-patient relationship between the respondent doctors and Jorge
Reyes? Yes.
Respondents were thus duty-bound to use at least the same level of care that any reasonably
competent doctor would use to treat a condition under the same circumstances. It is breach of
this duty which constitutes actionable malpractice.

As to this aspect of medical malpractice, the determination of the reasonable level of care and
the breach thereof, expert testimony is essential. Inasmuch as the causes of the injuries
involved in malpractice actions are determinable only in the light of scientific knowledge, it has
been recognized that expert testimony is usually necessary to support the conclusion as to
causation.

The doctrine of res ipsa loquitor is not applicable in the case at bar
Though expert testimony is usually needed to prove malpractice, where common knowledge
and experience teach that the injury would not have occurred if due care had been exercised,
the doctrine of res ipsa loquitur can be invoked to establish negligence.

Hence, in cases where the res ipsa loquitur is applicable, the court is permitted to find a
physician negligent upon proper proof of injury to the patient, without the aid of expert
testimony, where the court from its fund of common knowledge can determine the proper
standard of care. Where common knowledge and experience teach that a resulting injury
would not have occurred to the patient if due care had been exercised, an inference of
negligence may be drawn giving rise to an application of the doctrine of res ipsa loquitur
without medical evidence, which is ordinarily required to show not only what occurred but how
and why it 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.

There is nothing unusual about the death of Jorge Reyes (absence of 1st requisite that
the accident was of a kind which does not ordinarily occur unless someone is
negligent)
In this case, while it is true that the patient died just a few hours after professional medical
assistance was rendered, there is really nothing unusual or extraordinary about his death.

Prior to his admission, the patient already had recurring fevers and chills for five days
unrelieved by the analgesic, antipyretic, and antibiotics given him by his wife. This shows that
he had been suffering from a serious illness and professional medical help came too late for
him.

It must be conceded that the doctrine of res ipsa loquitur can have no application in a suit
against a physician or a 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 particcular
diagnosis was not correct, or why any particular scientific treatment did not produce the
desired result.

A.M. No. 2005-08-SC December 9, 2005

SAMUEL R. RUEZ, JR., Complainant,
vs.
MARYBETH V. JURADO, Respondent.
DECISION
AZCUNA, J.:
It is unfortunate that this administrative case involves co-workers in this Court. Complainant, Samuel R.
Ruez, Jr. (Ruez, Jr.), is Chief of the Clearance Section, Checks Disbursement Division of the FMO-OCA
and is the son of the aggrieved party, Samuel V. Ruez, Sr. (Ruez, Sr.), Driver I for the Motorpool,
Property Division of the OCA. Respondent is Dr. Marybeth V. Jurado (Dr. Jurado), Medical Officer IV of the
Medical and Dental Services. All three were working for the Court at the time of the incident in issue.
The parties agree that on January 12, 2005, at around 4:20 p.m., Ruez, Sr. arrived by himself at this
Courts clinic complaining of dizziness. His blood pressure and pulse rate were taken by the reception
nurse and were registered at 210/100 mmHg and 112 beats a minute, respectively. What transpired next is
disputed. Ruez, Jr. alleged that despite his fathers medical condition, he was merely advised to go to a
hospital and then allowed to walk out of the clinic on his own. Dr. Jurado, on the other hand, maintained
that after being informed of Ruez, Sr.s blood pressure and heart rate, she instructed the nurse to
administer one tablet of Capoten 25mg, an emergency drug that quickly lowers a patients blood pressure.
She then informed Ruez, Sr. that he will be taken to the hospital, after which she immediately instructed
the ambulance driver, Mr. Jacinto, to stand by for hospital conduction. Minutes later, after having
taken Capoten and being given a chance to rest, Ruez, Sr. stood up and walked out saying, "Doktora,
hanap lang ho ako ng kasama." Dr. Jurado said she waited for him to return but he failed to show up. She
asked Mr. Almarza, a nurse at the clinic, to look for Ruez, Sr. but he was unable to locate him.
Runez left wand went home. Na emergency sa MDH then pinauwi along the way nagsuka ulit
at naconfine at nakitaan ng blood clot. In the morning he had a stroke and eventually died.
Son runez jr. filed complaint against dr. jurado regarding the alleged lack of attention given to his
father by Dr. Jurado. Specifically, he claims that Dr. Jurado merely advised his father to go to the hospital
and then allowed him to travel to Manila Doctors Hospital despite the availability of an ambulance at the
disposal of the clinic
 Atty. Candelaria recommends that Dr. Jurado be held liable for simple neglect of duty and suspended
for one (1) month and (1) day. She further recommends that, in light of what happened, Dr. Prudencio
Banzon, SC Senior Staff Officer, Medical and Dental Services, be directed to prepare a flexi-time schedule
(until 5:30 p.m.) for all doctors and nurses in the clinic to enable it to provide immediate and proper
attention in case of any emergency medical situation.
The Court does not agree that the acts or omission of Dr. Jurado amount to simple neglect of duty. Simple
neglect of duty is defined as failure to give proper attention to a task expected of an employee resulting
from either carelessness or indifference4 or signifies a disregard of duty resulting from carelessness or
indifference.5 In Philippine Retirement Authority,6 it was stated, "The Court has decided the following, inter
alia, as constituting the less grave offense of Simple Neglect of Duty: delay in the transmittal of court
records, delay in responding to written queries, and delay of more than one (1) year and seven (7) months
in furnishing a party with a copy of the courts decision."

how do we determine what acts are expected of Dr. Jurado? Atty. Candelarias report cites the
applicable yardstick: a physician or surgeon is expected to apply in his practice
of medicine that degree of care and skill which is ordinarily employed by
the profession, generally, and under similar conditions.
The Court does not agree that the acts or omission of Dr. Jurado amount to simple neglect of duty.
Simple neglect of duty is defined as failure to give proper attention to a task expected of an employee
resulting from either carelessness or indifference4 or signifies a disregard of duty resulting from
carelessness or indifference

Therefore, to find Dr. Jurado liable for simple neglect of duty the Court has to be convinced that those
in the medical profession were also expected to act in the manner illustrated by Atty. Candelaria, i.e., to
exert all efforts to determine the whereabouts of Ruez, Sr., inform his relatives or turn his case over to a
doctor who was available after office hours.

We are persuaded that Dr. Jurado fulfilled such a standard when she treated Ruez, Sr. inside the
clinic. But what of Dr. Jurados conduct after Ruez, Sr. left the clinic and failed to return?
It has been held that a patient cannot attribute to a physician damages resulting from his own failure to
follow his advice, even though he was ignorant of the consequences which would result from his failure. 10 If
a patient leaves the hospital contrary to instructions, the physician is not liable for subsequent events

Dr. Jurado relied on Ruez, Sr.s representation that he would return in order to be brought to the
hospital but made no undertaking to wait for him beyond the clinic hours or to look for him if he did not
return. Thus, when Ruez, Sr. failed to show up as of closing time, and could not be found by the male
nurse who looked for him at her instructions, Dr. Jurado had reason to think that he had decided to
disregard her medical advice, which he in fact did when he and Ruez, Jr. decided to go to the hospital on
their own. Ruez, Sr., still of sound mind, had the right to accept or ignore his doctors recommendation