Our lady of Lourdes Hospital vs.

Capanzana

OUR LADY OF LOURDES HOSPITAL, Petitioner vs. SPOUSES ROMEO AND REGINA CAPANZANA, Respondents
G.R. No. 189218

Facts:
Regina Capanzana was pregnant with her third child. A week before her scheduled caesarean section (C-section),
she went into active labor and was brought to Our Lady of Lourdes Hospital for an emergency C-section. She went
into a pre-operative examination done by Dr. Ramos and Dr. Santos. They proceeded with the operation after
having found Regina fit for anesthesia. The operation was successful and she gave birth to a baby boy.
Thirteen hours after her operation, Regina complained of a headache, a chilly sensation, restlessness and
shortness of breath. She asked for oxygen and later became cyanotic. After undergoing x-ray, she was found to be
suffering from pulmonary edema. Since her condition showed no improvement, she was transferred to the
Cardinal Santos Hospital. The doctors in said hospital found that she was suffering from rheumatic heart disease
mitral stenosis with mild pulmonary hypertension, which contributed to the onset of Fluid in her lung tissue
(pulmonary edema). This development resulted in cardio-pulmonary arrest and, subsequently, brain damage.

Regina lost the use of her speech, eyesight, hearing and limbs. Due to this, spouses Capanzana filed a complaint for
damages against Our Lady of Lourdes Hospital along with Dr. Ramos, Dr. Santos and the nurses on duty stationed
on the second floor. During the course of the proceedings, Regina died and was substituted by her heirs.

The RTC found no negligence on the part of Dr. Ramos and Dr. Santos as they were compliant of the standard
practices in attending to a patient during a C-Section. The court reasoned that the primary cause of Regina’s
vegetative state, amniotic fluid embolism, was not within the control of the doctor to anticipate. The Court,
however, found the nurses on duty liable for their failure to immediately administer the oxygen. This failure having
contributed to the onset of hypoxic encephalopathy.

The Court held that the Our Lady of Lourdes Hospital is free from liability as it was able to discharge the burden of
proof that it had exercised the diligence of a good father of a family in the selection and supervision of its
employees. On appeal, the CA affirmed the ruling of the RTC except as to the liability of the midwife (Ballano) and
the Our Lady of Lourdes Hospital. It was found that while there was evidence to prove that petitioner hospital
showed diligence in its selection and hiring processes, there was no evidence to prove that it exercised the
required diligence in the supervision of its nurses.

Issue:
Whether Our Lady of Lourdes Hospital is liable for damages due to its failure to exercise due diligence in the
supervision of its nurses.
Ruling:
YES. The plaintiff must show the following elements by a preponderance of evidence: duty of the health
professional, breach of that duty, injury of the patient, and proximate causation between the breach and the
injury.

The Negligence of the Nurses

The SC found that there was sufficient evidence to prove that the nurses were negligent. When Regina was gasping
for breath and turning cyanotic, it was the duty of the nurses to intervene immediately by informing the resident
doctor. Had they done so, proper oxygenation could have been restored and other interventions performed
without wasting valuable time.
According to the expert witness, the occurrence of “hypoxic encephalopathy” could have been avoided since lack
or inadequate supply of oxygen to the brain for 5 minutes will cause damage to it. It was found that the nurses
took 10- 15 minutes to respond to the call of Regina’s niece before going to the room. Also, it took about 20
minutes before the oxygen arrived. Another instance of negligence was the delay in the removal of Regina’s
consumed dextrose which caused Regina discomfort. The nurses only attended to her after being called twice.

In Ramos, the SC defined “Proximate cause” 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. It is
the dominant, moving or producing cause.

Applying the above definition to the facts in the present case, the omission of the nurses — their failure to check
on Regina and to refer her to the resident doctor and, thereafter, to immediately provide oxygen — was clearly the
proximate cause that led to the brain damage suffered by the patient. The liability of the hospital The Our Lady of
Lourdes hospital is liable under Article 2180 in relation to Article 2176 of the Civil Code. Under Article 2180, an
employer may be held liable for the negligence of its employees based on its responsibility under a relationship of
patria potestas. The liability of the employer under this provision is “direct and immediate; it is not conditioned
upon a prior recourse against the negligent employee or a prior showing of the insolvency of that employee.” The
employer may only be relieved of responsibility upon a showing that it exercised the diligence of a good father of a
family in the selection and supervision of its employees. The SC held that the hospital sufficiently proved due
diligence in the selection of the nurses. The nurses undergo a series of examination, orientation, training, on the
job observation and evaluation before they are hired as regular employees. However, it failed to prove due
diligence in their supervision. The formulation of a supervisory hierarchy, company rules and regulations, and
disciplinary measures upon employees in case of breach, is indispensable. However, to prove due diligence in the
supervision of employees, it is not enough for an employer such as petitioner to emptily invoke the existence of
such a formulation. What is more important is the actual implementation and monitoring of consistent compliance
with the rules. In this case, it was found that there is failure on the part of the hospital to sanction the tardiness of
the nurses which shows an utter lack of actual implementation and monitoring of compliance with the rules and
ultimately of supervision over its nurses. Also, on the nights subject of the present controversy, there is failure to
show who were the actual nurses on duty and who was supervising these nurses due to the conflicting accounts on
the documents of the hospital. All these negate the due diligence on the part of the nurses, their supervisors, and
ultimately, the hospital. Thus, petitioner was held liable for damages.

PROFESSIONAL SERVICES, INC., vs. NATIVIDAD and ENRIQUE AGANA G.R. No. 126297 January 31, 2007

Facts:

Natividad Agana was rushed to the Medical City Hospital because of difficulty of bowel movement and bloody anal
discharge. Dr. Miguel Ampil, diagnosed her to be suffering from “cancer of the sigmoid.” Dr. Ampil, assisted by the
medical staff of the Medical City Hospital, performed an anterior resection surgery on Natividad. He found that the
malignancy in her sigmoid area had spread on her left ovary, necessitating the removal of certain portions of it. Thus,
Dr. Ampil obtained the consent of Natividad’s husband, Enrique Agana, to permit Dr. Juan Fuentes, to perform
hysterectomy on her.

After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the operation and closed the
incision. However, the operation appeared to be flawed. After a couple of days, Natividad complained of excruciating
pain in her anal region. She consulted both Dr. Ampil and Dr. Fuentes about it. They told her that the pain was the
natural consequence of the surgery.
Two weeks after Natividad returned from the United States to seek further treatment, her daughter found a piece
of gauze protruding from her vagina. Upon being informed about it, Dr. Ampil proceeded to her house where he
managed to extract by hand a piece of gauze measuring 1.5 inches in width. He then assured her that the pains
would soon vanish.

Dr. Ampil’s assurance did not come true. Instead, the pains intensified, prompting Natividad to seek treatment at
the Polymedic General Hospital. While confined there, Dr. Ramon Gutierrez detected the presence of another
foreign object in her vagina — a foul-smelling gauze measuring 1.5 inches in width which badly infected her vaginal
vault. A recto-vaginal fistula had formed in her reproductive organs which forced stool to excrete through the vagina.
Another surgical operation was needed to remedy the damage.

Natividad and her husband filed with the RTC a complaint for damages against the Professional Services, Inc. (PSI),
owner of the Medical City Hospital, Dr. Ampil, and Dr. Fuentes. They alleged that the latter are liable for negligence
for leaving two pieces of gauze inside Natividad’s body and malpractice for concealing their acts of negligence.

Pending the outcome of the above cases, Natividad died and was duly substituted by her children (the Aganas). The
RTC rendered its Decision in favor of the Aganas, finding PSI, Dr. Ampil and Dr. Fuentes liable for negligence and
malpractice.

The Court of Appeals rendered its Decision dismissing the case against Dr. Fuentes with Dr. Ampil liable to reimburse
Professional Services, Inc., whatever amount the latter will pay or had paid to the plaintiffs.

Issues: Whether or not PSI may be held solidarily liable for the negligence of Dr. Ampil.

Held: Yes, PSI is solidarily liable for the negligence of Dr. Ampil. In Ramos v. Court of Appeals, the court held that
private hospitals, hire, fire and exercise real control over their attending and visiting ‘consultant’ staff. While
‘consultants’ are not, technically employees, 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. The court held that for the purpose of allocating responsibility in medical negligence cases, an employer-
employee relationship in effect exists between hospitals and their attending and visiting physicians.

In addition to the pronouncement in Ramos vs CA, Its liability is also anchored upon the agency principle of apparent
authority or agency by estoppel and the doctrine of corporate negligence.

Apparent authority, or what is sometimes referred to as the “holding out” theory, or doctrine of ostensible agency
or agency by estoppel, imposes liability, not as the result of the reality of a contractual relationship, but rather
because of the actions of a principal or an employer in somehow misleading the public into believing that the
relationship or the authority exists.

In this case, PSI publicly displays in the lobby of Hospital the names and specializations of the physicians associated
or accredited by it, including those of Dr. Ampil and Dr. Fuentes. It is now estopped from passing all the blame to
the physicians whose names it proudly paraded in the public directory leading the public to believe that it vouched
for their skill and competence. PSI’s act is tantamount to holding out to the public that Medical City Hospital, through
its accredited physicians, offers quality health care services. By accrediting Dr. Ampil and Dr. Fuentes and publicly
advertising their qualifications, the hospital created the impression that they were its agents, authorized to perform
medical or surgical services for its patients. As expected, these patients, Natividad being one of them, accepted the
services on the reasonable belief that such were being rendered by the hospital or its employees, agents, or servants.

Under the doctrine of corporate negligence or corporate responsibility, PSI as owner, operator and manager of
Medical City Hospital, did not perform the necessary supervision nor exercise diligent efforts in the supervision of
Drs. Ampil and Fuentes and its nursing staff, resident doctors, and medical interns who assisted Drs. Ampil and
Fuentes in the performance of their duties as surgeons. Premised on the doctrine of corporate negligence, the trial
court held that PSI is directly liable for such breach of duty.

In the present case, it was duly established that PSI operates the Medical City Hospital for the purpose and under
the concept of providing comprehensive medical services to the public. Accordingly, it has the duty to exercise
reasonable care to protect from harm all patients admitted into its facility for medical treatment. Unfortunately, PSI
failed to perform such duty.

It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance of the Medical City
Hospital’s staff, composed of resident doctors, nurses, and interns. As such, it is reasonable to conclude that PSI, as
the operator of the hospital, has actual or constructive knowledge of the procedures carried out, particularly the
report of the attending nurses that the two pieces of gauze were missing. In Fridena v. Evans, it was held that a
corporation is bound by the knowledge acquired by or notice given to its agents or officers within the scope of their
authority and in reference to a matter to which their authority extends. This means that the knowledge of any of
the staff of Medical City Hospital constitutes knowledge of PSI. Now, the failure of PSI, despite the attending nurses’
report, to investigate and inform Natividad regarding the missing gauzes amounts to callous negligence. Not only
did PSI breach its duties to oversee or supervise all persons who practice medicine within its walls, it also failed to
take an active step in fixing the negligence committed. This renders PSI, not only vicariously liable for the negligence
of Dr. Ampil under Article 2180 of the Civil Code, but also directly liable for its own negligence under Article 2176.

PSI, apart from a general denial of its responsibility, failed to adduce evidence showing that it exercised the diligence
of a good father of a family in the accreditation and supervision of Dr. Ampil. In neglecting to offer such proof, PSI
failed to discharge its burden under the last paragraph of Article 2180 and, therefore, must be adjudged solidarily
liable with Dr. Ampil

Nogales vs Capitol Medical Center

GR No. 142625 December 19, 2006

Facts: Pregnant with her fourth child, Corazon Nogales, who was then 37 y/o was under the exclusive prenatal care
of Dr. Oscar 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
edemas indicating preeclampsia which is a dangerous complication of pregnancy. Around midnight of May 26, 1976,
Corazon started to experience mild labor pains prompting Corazon and Rogelio Nogales to see Dr. Estrada at his
home. After examining Corazon, Dr. Estrada advised her immediate admission to Capitol Medical Center (CMC).
Upon her admission, an internal examination was conducted upon her by a resident-physician. Based on the doctor’s
sheet, around 3am, Dr. Estrada advised for 10mg valium to be administered immediately by intramuscular injection,
he later ordered the start of intravenous administration of syntociron admixed with dextrose, 5% in lactated ringer’s
solution, at the rate of 8-10 micro-drops per minute. When asked if he needed the services of anesthesiologist, he
refused. Corazon’s bag of water ruptured spontaneously and her cervix was fully dilated and she experienced
convulsions. Dr. Estrada ordered the injection of 10g of magnesium sulfate but his assisting Doctor, Dr. Villaflor, only
administered 2.5g. She also applied low forceps to extract Corazon’s baby. In the process, a 10 x 2.5cm piece of
cervical tissue was allegedly torn. The baby came out in an apric, cyanatic weak and injured condition. Consequently
the baby had to be intubated and resuscitated. Corazon had professed vaginal bleeding where a blood typing was
ordered and she was supposed to undergo hysterectomy, however, upon the arrival of the doctor, she was already
pronounced dead due to hemorrhage.

Issue: Whether or not in the conduct of child delivery, the doctors and the respondent hospital is liable for
negligence.

Held: Yes. In general, a hospital is not liable for the negligence of an independent contractor-physician. There is,
however an exception to this principle. 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.

For a hospital to be liable under the doctrine of apparent authority, a plaintiff must show that 1.) the hospital, or its
agent, acted in a manner that would lead a reasonable person to conclude that the individual who was alleged to be
negligent was an employee or agent of the hospital; 2.) Where the acts of the agent create the appearance of
authority, the plaintiff must also prove that the hospital had knowledge of and acquired in them; and 3.) the plaintiff
acted in reliance upon the conduct of the hospital or its agent, consistent with ordinary care and prudence.

Borrowed servant doctrine provides that once a surgeon enters the operating room and takes charge of the acts or
omissions of operating room personnel and any negligence associated with each 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
 Alano vs Magud-Logmao
GR No. 1755540 April 7, 2014

Facts: At around 9:50pm of March 1, 1988, Arnelito Logmao then 18 y/o, was brought to the East Avenue Medical
Center (EAMC) in Quezon City by two sidewalk vendors, who allegedly saw the former fall from the overpass near
the Farmer’s Market in Cubao, Quezon City. The patient’s data sheet identified the patient as Angelito Lugmoso of
Boni Ave., Mandaluyong. However, the clinical abstract prepared by Dr. Paterno F. Cabrera, the surgical resident on-
duty at the emergency room of EAMC, stated the patient is Angelito Logmao. Dr. Cabrera reported that Logmao was
drowsy with alcoholic breath, was conscious and coherent; that the skull x-ray showed no fracture; that at around
4:30am of March 2, 1988, Logmao developed generalized seizures and was managed by the neuro-surgeon resident
on-duty; that the condition of Logmao progressively deteriorated and he was intubated and ambu-bagging support
was provided; that admission to the ICU and mechanical ventilation support became necessary, but there was no
vacancy at the ICU and all the ventilation units were being used by other patients; that a resident physician of NKTI,
who was rotating at EAMC, suggested that Logmao be transferred to NKTI; and that after arrangements were made,
Logamo was transferred to NKTI at 10:10am. At the NKTI, the name Angelito Logmao was recorded as Angelito
Lugmoso. Lugmoso was immediately attended to and given the necessary medical treatment. As Lugmoso had no
relatives around, Jennifer Misa, transplant coordinator was asked to locate his family by enlisting police and media
assistance. Dr. Enrique Ona, chairman of the Department of Surgery, observed that severity of the brain injury of
Lugmoso manifested symptoms of brain death. He requested the laboratory section to conduct tissue typing and
tissue cross-matching examination, so that should Lugmoso expire despite the necessary care and medical
management and he would be found to be a suitable organ donor and his family would consent to organ donation,
the organs thus donated could be detached and transplanted promptly to any compatible beneficiary. The identity
of Lugmoso was verified by Misa from EAMC and she was furnished the patient’s data sheet. She then contacted
several radio and television stations to request for air time for the purpose of locating the family of Angelito Lugmoso
of Boni Ave., Mandaluyong who was confined at NKTI with severe head injury after allegedly falling from the Cubao
overpass, as well as police station no. 5 Eastern Police District. Lugmoso was pronounced brain dead on March 3,
1988 7:00am. Two hours later, Dr. Ona was informed that EEG recording exhibited a flat tracing thereby confirming
his brain death. He was found to be a suitable donor of the heart, kidneys, pancreas, and liver, and after the extensive
search, no relatives were found. Dr. Ona then requested the removal of the specific organs of Lugmoso from the
herein petitioners, Dr. Alano, the director of NKTI who thereafter issued a memorandum stating that only after the
requirements of RA 349 as amended by PD 856 was complied, they can remove the specified organs of Lugmoso.
Lugmoso’s remains was brought at La Funeraria Oro. A press release made by NKTI announcing a double organ
transplant led to the findings of the relatives of Lugmoso.

Issue: Whether or not the removal of Lugmoso’s organs were valid.

Held: Yes. The internal organs of the deceased were removed only after he had been declared brain dead; thus the
emotional pain suffered by respondent due to the death of her son cannot be in any way be attributed to petitioner.
Neither can the court find evidence or second to show that respondent’s emotional suffering at the sight of the pitful
state in which she found her son’s lifeless body be categorically attributed to petitioner’s conduct.

Thus, there can be no cavil that petitioners employed reasonable means to disseminate notifications intended to
reach the relatives of the deceased. The only question that remains pertains to the sufficiency of time allotted for
notices to reach the relatives of the deceased.

If respondent failed to immediately receive notice of her son’s death because the notices did not properly state the
name or identity of the deceased, fault cannot be laid at petitioner’s door. The trial and appellate courts found that
it was the EAMC, who recorded the wrong information regarding the deceased’s identity to NKTI. The NKTI could
not have obtained the information about his name from the patient, because as found by the lower courts, the
deceased was already unconscious by the time he was brought to NKTI

Dela Torre vs Imbuido

GR No. 192973 September 29, 2014

Facts: At around 3:00pm of February 3, 1992, Carmen was brought to Divine Spirit General Hospital’s operating room
for her caesarian section operation, which was to be performed by Dr. Nestor. By 5:30pm, of the same day, Pedrito
was informed by his wife’s delivery of a baby boy. In the early morning of February 4, 1992, Carmen experienced
abdominal pains and difficulty in urinating. She was diagnosed to be suffering from urinary tract infection (UTI), and
was prescribed medication by Dr. Norma. On February 10, 1992, Pedrito noticed that Carmen’s stomach was getting
bigger, but Dr. Norma dismissed the patient’s condition as mere fratulence. When Carmen’s stomach still grow
bigger despite medications, Dr. Norma advised Pedrito of the possibility of a second operation on Carmen. Dr.
Norma, however, provided no details on its purpose and the doctor who would perform it. At around 3:00pm on
February 12, 1992 Carmen had her second operation. Later in the evening, Dr. Norma informed Pedrito that
“everything was going on fine with his wife.” The condition of Carmen, however, did not improve. It instead
worsened that on February 13, 1992, she vomited dark red blood. At 9:30pm of the same day, Carmen died. Per her
death certificate upon information provided by the hospital, the immediate cause of Carmen’s death was cardio-
respiratory arrest secondary to cerebro vascular accident, hypertension and chronic nephritis induced by pregnancy.
An autopsy report prepared by Dr. Partilano, medico-legal officer designate of Olongapo City, however, provided
 that the cause of Carmen’s death was shock due to peritonitis severe with multiple intestinal adhesions; status post
caesarian section and exploratory laparotomy. Pedrito claimed in his complaint that the respondents failed to
exercise the degree of diligence required of them as members of the medical profession, and were negligent for
practicing surgery on Carmen in the most unskilled, ignorant, and cruel manner.

Issue: Whether or not respondents were liable for medical malpractice that resulted to Carmen’s death.

Held: No. 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, or his or her family as in this case, must prove that healthcare
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 failure or action caused injury to the patient.

Four essential elements must be established namely: 1.) duty; 2.) breach; 3.) injury and 4.) proximate causation. All
four elements must be present in order to find the physician negligent and thus, liable for damages.

For the trial court to give weight to Dr. Partilano’s report, it was necessary to show first Dr. Partilano’s specialization
and competence to testify on the degree of care, skill and diligence needed for the treatment of Carmen’s case.
Considering that it was not duly established that Dr. Partilano practiced and was an expert on the fields that involved
Carmen’s condition, he could not have accurately identified the said degree of care, skill and diligence and the
medical procedure, that should have been applied.

Sunday, July 22, 2012

Cantre v. Sps. Go

Dr. Milagros Cantre v. Sps. John David and Nora Go

2007 / Quisumbing / Petition for review on certiorari of CA decision and resolution

FACTS

Nora Go gave birth to her 4th child. Two hours later, she suffered profuse bleeding inside her womb due to some
placenta parts which were not completely expelled after delivery. She then suffered hypovolemic shock, so her BP
dropped to 40/0. Dr. Milagros Cantre, an Ob-Gyne specialist and Nora's attending physician, together with an
assisting resident physician, performed various medical procedures to stop the bleeding and to restore Nora's BP.
While Dr. Cantre was massaging Nora's uterus for it to contract and stop bleeding, she ordered a droplight to warm
Nora and her baby. At that time, she was unconscious.

While in the recovery room, Nora's husband John David noticed a fresh gaping wound (2 1/2 x 3 1/2 in) in the
inner portion of her left arm near the armpit. When he asked the nurses about the cause of the injury, he was
informed that it was due to a burn. John David filed a request for investigation. Dr. Cantre said that what caused the
injury was the blood pressure cuff. John David brought Nora to the NBI for a physical examination. The medico-legal
said that the injury appeared to be a burn and that a droplight when placed near the skin for about 10 minutes could
cause such burn. He dismissed the likelihood that the wound was caused by a blood pressure cuff since the scar was
not around the arm, but just on one side of the arm. Nora's injury was referred to a plastic surgeon for skin grafting.
However, her arm would never be the same--the surgery left an unsightly scar, her movements are restricted, and
the injured arm aches at the slightest touch.

Sps. Go filed a complaint for damages against Dr. Cantre, the medical director, and the hospital. In the RTC, parties
have rested their respective cases, but the court admitted additional exhibits [consist mostly of medical records
produced by the hospital during trial pursuant to a subpoena duces tecum] offered by Sps. Go, which were not
testified to by any witness. RTC ruled in favor of the spouses. CA affirmed RTC with modification (complaint dismissed
with respect to the medical director and the hospital; only moral damages awarded).

ISSUES AND HOLDING

1. WON the questioned additional exhibits are admissible in evidence. YES

2. WON Dr. Cantre is liable for the injury suffered by Nora Go. YES
RATIO
Preliminary discussion

Dr. Cantre's counsel admitted the existence of the additional exhibits when they were formally offered for admission
by the RTC. In any case, given the circumstances of this case, a ruling on Dr. Cantre's negligence may be made based
on the res ipsa loquitur doctrine even in the absence of the additional exhibits.

Backgrounder

The Hippocratic Oath mandates physicians to give primordial consideration to their patients' well-being, and if a
doctor fails to live up to this precept, he is accountable for his acts. This notwithstanding, courts face a unique
restraint in adjudicating medical negligence cases because physicians are not guarantors of care, and they never
set out to intentionally cause injury to their patients. HOWEVER, intent is immaterial in these cases
because where negligence exists and is proven, it automatically gives the injured a right to reparation for the
damage caused.

Res ipsa loquitur x Medical negligence cases

In medical negligence cases, the doctrine of res ipsa loquitur allows the mere existence of an injury to justify a
presumption of negligence on the part of the person who controls the instrument causing the injury, provided that
the following requisites concur:

1. Accident is of a kind which ordinarily does not occur absent someone's negligence
 Wound not an ordinary occurrence in the act of delivering a baby; could not have happened unless
negligence set in somewhere
2. Caused by an instrumentality within defendant's exclusive control
 It doesn't matter WON the injury was caused by the droplight or by the blood pressure cuff, since
both are within the exclusive control of the physician in charge [Dr. Cantre] under the captain of the
ship doctrine [surgeon in charge of an operation is held liable for his assistants' negligence during the time
when they are under the surgeon's control].
3. Possibility of contributing conduct which would make plaintiff responsible is eliminated
 Wound could only be caused by something external to and outside the control of Nora since she
was unconscious while in hypervolemic shock.
On Dr. Cantre's other arguments + what would have been her saving grace
 BP cuff defense does not afford her an escape. The medical practice is to deflate the cuff immediately after
use, or else, it could cause an injury similar to what happened to Nora. If the wound was caused by the constant
taking of BP, it must have been done so negligently as to inflict a gaping wound.
 The argument that the failed plastic surgery was a measure to prevent complication (and not intended as a
cosmetic procedure) does not negate negligence on Dr. Cantre's part.
 Dr. Cantre has been Nora's ob-gyne for her past 3 deliveries, and this is the first time that Dr. Cantre is being
held liable for damages due to negligence in the practice of her profession. She promptly took care of the wound
before infection set in. Since Nora was in a critical condition at that time, saving her life became Dr. Cantre's
elemental concern. Still, her good intentions characteristics do not justify negligence.
NCC provisions applied
 NCC 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged
to pay for the damage done. [...]
 NCC 2217. Moral damages include physical suffering, mental anguish, fright, serious anxiety, besmirched
reputation, wounded feelings, moral shock, social humiliation, and similar injury. Though incapable of pecuniary
computation, moral damages may be recovered if they are the proximate result of the defendant's wrongful act or
omission. [200k moral damages awarded]

Lasam vs. Sps. Ramolete G.R. No. 159132 December 8, 2008

Facts:

On July 1994, respondent three months pregnant Editha Ramolete was brought to the Lorma Medical Center
(LMC) to vaginal bleeding. A pelvic sonogram was then conducted on Editha revealing the fetus weak cardiac
pulsation. Editha’s 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 Dr. Fe Cayao-Lasam
advised Editha to undergo a Dilatation and Curettage Procedure (D&C) or raspa which the petitioner performed.

On September 1994, Editha was brought again to LMC due to vomiting and severe abdominal pains. One of the
attending physician, Dr. Mayo allegedly informed Editha that there was a dead fetus in her womb. Editha
underwent laparotomy where she was found to have a massive intra-abdominal hemorrhage and a ruptured
uterus. Editha had to undergo a procedure for hysterectomy and as a result, she has no more chance to bear a
child.

On November 1994, Editha and her husband Claro Ramolete filed a Complaint for Gross Negligence and
Malpractice against petitioner before the PRC.

Respondents alleged that Editha’s hysterectomy was caused by petitioners unmitigated negligence and
professional incompetence in conducting the D&C procedure and the petitioners failure to remove the fetus inside
Editha’s womb. Petitioner denied the allegations of negligence and incompetence
On March 1999, Board of Medicine of the PRC exonerated petitioner from the charges filed against her. Feeling
aggrieved, respondents went to the PRC on appeal. On November 2000, the PRC reversed the findings of the Board
and revoked petitioners authority or license to practice her profession as a physician. Petitioner brought the
matter to the CA but was dismissed on the ground of being improper and premature.

Issue: WON there was medical malpractice in the case?

Held: There was no medical malpractice in the case.

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.

There are four elements involved in medical negligence cases: duty, breach, injury and proximate causation.

From the testimony of the expert witness and the reasons given by him, it is evident that the D&C procedure was
not the proximate cause of the rupture of Editha’s uterus. Further in the testimony, it is clear that the D&C
procedure was conducted in accordance with the standard practice, with the same level of care that any
reasonably competent doctor 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 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.

It is also undisputed that Editha did not return for a follow-up evaluation, in defiance of the petitioners advise.
Editha omitted the diligence required by the circumstances which could have avoided the injury. The omission in
not returning for a follow-up evaluation played a substantial part in bringing about Editha’s own injury. Had Editha
returned, petitioner could have conducted the proper medical tests and procedure necessary to determine
Editha’s health condition and applied the corresponding treatment which could have prevented the rupture of
Editha’s uterus. The D&C procedure having been conducted in accordance with the standard medical practice, it is
clear that Editha’s omission was the proximate cause of her own injury and not merely a contributory negligence
on her part.
 DR. FERNANDO P. SOLIDUM, Petitioner,
vs.

PEOPLE OF THE PHILIPPINES, Respondent.

Facts:
Gerald Albert Gercayo (Gerald) was born on June 2, 1992 with an imperforate anus. Two days after his birth,
Gerald underwent colostomy, a surgical procedure to bring one end of the large intestine out through the
abdominal wall, enabling him to excrete through a colostomy bag attached to the side of his body.

On May 17, 1995, Gerald, then three years old, was admitted at the Ospital ng Maynila for a pull-through
operation. Dr. Leandro Resurreccion headed the surgical team, and was assisted by Dr. Joselito Luceño, Dr.
Donatella Valeña and Dr. Joseph Tibio. The anesthesiologists included Dr. Marichu Abella, Dr. Arnel Razon and
petitioner Dr. Fernando Solidum (Dr. Solidum). During the operation, Gerald experienced bradycardia, and went
into a coma. His coma lasted for two weeks, but he regained consciousness only after a month. He could no longer
see, hear or move.

Agitated by her son’s helpless and unexpected condition, Ma. Luz Gercayo (Luz) lodged a complaint for reckless
imprudence resulting in serious physical injuries with the City Prosecutor’s Office of Manila against the attending
physicians.

On July 19, 2004, the RTC and CA rendered its judgment finding Dr. Solidum guilty beyond reasonable doubt of
reckless imprudence resulting in serious physical injuries and ordering her to indemnify, jointly and severally with
the Ospital ng Maynila, private complainant Luz Gercayo, for damages.

Issue:
Whether Ospital ng Maynila shall be held jointly and severally liable with Dr. Solidum with regard to
indemnification for damages

Ruling:
No. The judgment was flawed in logic and in law.

In criminal prosecutions, the civil action for the recovery of civil liability that is deemed instituted with the criminal
action refers only to that arising from the offense charged. It is puzzling, therefore, how the RTC and the CA could
have adjudged Ospital ng Maynila jointly and severally liable with Dr. Solidum for the damages despite the obvious
fact that Ospital ng Maynila, being an artificial entity, had not been charged along with Dr. Solidum. The judgment
rendered against Ospital ng Maynila void was the product of grave abuse of discretion amounting to lack of
jurisdiction.

The Ospital ng Maynila was not at all a party in the proceedings. Hence, its fundamental right to be heard was not
respected from the outset. The R TC and the CA should have been alert to this fundamental defect. Verily, no
person can be prejudiced by a ruling rendered in an action or proceeding in which he was not made a party. Such a
rule would enforce the constitutional guarantee of due process of law.

Moreover, Ospital ng Maynila could be held civilly liable only when subsidiary liability would be properly
enforceable pursuant to Article 103 of the Revised Penal Code. But the subsidiary liability seems far-fetched here.
The conditions for subsidiary liability to attach to Ospital ng Maynila should first be complied with. Firstly, pursuant
to Article 103 of the Revised Penal Code, Ospital ng Maynila must be shown to be a corporation “engaged in any
kind of industry.” The term industry means any department or branch of art, occupation or business, especially
one that employs labor and capital, and is engaged in industry. However, Ospital ng Maynila, being a public
hospital, was not engaged in industry conducted for profit but purely in charitable and humanitarian work.
Secondly, assuming that Ospital ng Maynila was engaged in industry for profit, Dr. Solidum must be shown to be an
employee of Ospital ng Maynila acting in the discharge of his duties during the operation on Gerald. Yet, he
definitely was not such employee but a consultant of the hospital. And, thirdly, assuming that civil liability was
adjudged against Dr. Solidum as an employee (which did not happen here), the execution against him was
unsatisfied due to him being insolvent