[G.R. No. 130547.

October 3, 2000]
LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, a! "#or$ LLOYD a! %R&S'&NE, a(( $)ra"e! REYES,
re*re$ete! b+ t,e#r "ot,er, LEAH ALESNA REYES, petitioners, vs. S&S'ERS O- .ER/Y HOS0&'AL,
S&S'ER ROSE 0ALA/&O, DR. .AR1&E 2LANES, a! DR. .ARLYN R&/O,respondents.
D E / & S & O N
.ENDO3A, J.4
This is a petition for review of the decision
[1]
of the Court of Appeals in CA-G.R. CV No. 3!!1 affir"in# the decision
of the Re#ional Trial Court$ %ranch &'$ Ce(u Cit) which dis"issed a co"plaint for da"a#es filed () petitioners
a#ainst respondents.
The facts are as follows*
+etitioner ,eah Alesna Re)es is the wife of the late -or#e Re)es. The other petitioners$ na"el)$ Rose Nahd.a$
-ohnn)$ ,lo)d$ and /ristine$ all surna"ed Re)es$ were their children. 0ive da)s (efore his death on -anuar) 1$ 1213$
-or#e had (een sufferin# fro" a recurrin# fever with chills. After he failed to #et relief fro" so"e ho"e "edication he
was ta4in#$ which consisted of anal#esic$ antip)retic$ and anti(iotics$ he decided to see the doctor.
5n -anuar) 1$ 1213$ he was ta4en to the 6erc) Co""unit) Clinic () his wife. 7e was attended to () respondent 8r.
6arl)n Rico$ resident ph)sician and ad"ittin# ph)sician on dut)$ who #ave -or#e a ph)sical e9a"ination and too4
his "edical histor). :he noted that at the ti"e of his ad"ission$ -or#e was conscious$ a"(ulator)$ oriented$
coherent$ and with respirator) distress.
[;]
T)phoid fever was then prevalent in the localit)$ as the clinic had (een
#ettin# fro" 1! to ;< cases of t)phoid per "onth.
[3]
:uspectin# that -or#e could (e sufferin# fro" this disease$ 8r.
Rico ordered a =idal Test$ a standard test for t)phoid fever$ to (e perfor"ed on -or#e. %lood count$ routine
urinal)sis$ stool e9a"ination$ and "alarial s"ear were also "ade.
[>]
After a(out an hour$ the "edical technician
su("itted the results of the test fro" which 8r. Rico concluded that -or#e was positive for t)phoid fever. As her shift
was onl) up to !*<< p.".$ 8r. Rico indorsed -or#e to respondent 8r. 6arvie %lanes.
8r. 6arvie %lanes attended to -or#e at around si9 in the evenin#. :he also too4 -or#e?s histor) and #ave hi" a
ph)sical e9a"ination. ,i4e 8r. Rico$ her i"pression was that -or#e had t)phoid fever. Anti(iotics (ein# the accepted
treat"ent for t)phoid fever$ she ordered that a co"pati(ilit) test with the anti(iotic chloro")cetin (e done on
-or#e. :aid test was ad"inistered () nurse -osephine +a#ente who also #ave the patient a dose of tri#lo(e. As she
did not o(serve an) adverse reaction () the patient to chloro")cetin$ 8r. %lanes ordered the first five hundred
"illi#ra"s of said anti(iotic to (e ad"inistered on -or#e at around 2*<< p.". A second dose was ad"inistered on
-or#e a(out three hours later .ust (efore "idni#ht.
At around 1*<< a.". of -anuar) 2$ 1213$ 8r. %lanes was called as -or#e?s te"perature rose to >1@C. The patient also
e9perienced chills and e9hi(ited respirator) distress$ nausea$ vo"itin#$ and convulsions. 8r. %lanes put hi" under
o9)#en$ used a suction "achine$ and ad"inistered h)drocortisone$ te"poraril) easin# the patient?s
convulsions. =hen he re#ained consciousness$ the patient was as4ed () 8r. %lanes whether he had a previous
heart ail"ent or had suffered fro" chest pains in the past. -or#e replied he did not.
[!]
After a(out 1! "inutes$
however$ -or#e a#ain started to vo"it$ showed restlessness$ and his convulsions returned. 8r. %lanes re-applied the
e"er#enc) "easures ta4en (efore and$ in addition$ valiu" was ad"inistered. -or#e$ however$ did not respond to the
treat"ent and slipped into c)anosis$ a (luish or purplish discoloration of the s4in or "ucous "e"(rane due to
deficient o9)#enation of the (lood. At around ;*<< a.".$ -or#e died. 7e was fort) )ears old. The cause of his death
was AVentricular Arr)the"ia :econdar) to 7)perp)re9ia and t)phoid fever.B
5n -une 3$ 1213$ petitioners filed (efore the Re#ional Trial Court of Ce(u Cit) a co"plaint
[]
for da"a#es a#ainst
respondents :isters of 6erc)$ :ister Rose +alacio$ 8r. 6arvie %lanes$ 8r. 6arl)n Rico$ and nurse -osephine
+a#ente. 5n :epte"(er ;>$ 1213$ petitioners a"ended their co"plaint to i"plead respondent 6erc) Co""unit)
Clinic as additional defendant and to drop the na"e of -osephine +a#ente as defendant since she was no lon#er
connected with respondent hospital. Their principal contention was that -or#e did not die of t)phoid fever.
[3]
&nstead$
his death was due to the wron#ful ad"inistration of chloro")cetin. The) contended that had respondent doctors
e9ercised due care and dili#ence$ the) would not have reco""ended and rushed the perfor"ance of the =idal Test$
hastil) concluded that -or#e was sufferin# fro" t)phoid fever$ and ad"inistered chloro")cetin without first
conductin# sufficient tests on the patient?s co"pati(ilit) with said dru#. The) char#ed respondent clinic and its
directress$ :ister Rose +alacio$ with ne#li#ence in failin# to provide adeCuate facilities and in hirin# ne#li#ent doctors
and nurses.
[1]
Respondents denied the char#es. 8urin# the pre-trial conference$ the parties a#reed to li"it the issues on the
followin#* D1E whether the death of -or#e Re)es was due to or caused () the ne#li#ence$ carelessness$ i"prudence$
and lac4 of s4ill or foresi#ht on the part of defendantsF D;E whether respondent 6erc) Co""unit) Clinic was
ne#li#ent in the hirin# of its e"plo)eesF and D3E whether either part) was entitled to da"a#es. The case was then
heard () the trial court durin# which$ in addition to the testi"onies of the parties$ the testi"onies of doctors as e9pert
witnesses were presented.
+etitioners offered the testi"on) of 8r. Apolinar Vacalares$ Chief +atholo#ist at the Northern 6indanao Trainin#
7ospital$ Ca#a)an de 5ro Cit). 5n -anuar) 2$ 1213$ 8r. Vacalares perfor"ed an autops) on -or#e Re)es to
deter"ine the cause of his death. 7owever$ he did not open the s4ull to e9a"ine the (rain. 7is findin#s
[2]
showed
that the #astro-intestinal tract was nor"al and without an) ulceration or enlar#e"ent of the nodules. 8r. Vacalares
testified that -or#e did not die of t)phoid fever. 7e also stated that he had not seen a patient die of t)phoid fever
within five da)s fro" the onset of the disease.
0or their part$ respondents offered the testi"onies of 8r. +eter Gotion# and 8r. &(arra +anopio. 8r. Gotion# is a
diplo"ate in internal "edicine whose e9pertise is "icro(iolo#) and infectious diseases. 7e is also a consultant at the
Ce(u Cit) 6edical Center and an associate professor of "edicine at the :outh =estern Gniversit) Colle#e of
6edicine in Ce(u Cit). 7e had treated over a thousand cases of t)phoid patients. Accordin# to 8r. Gotion#$ the
patient?s histor) and positive =idal Test results ratio of 1*3;< would "a4e hi" suspect that the patient had t)phoid
fever. As to 8r. Vacalares? o(servation re#ardin# the a(sence of ulceration in -or#e?s #astro-intestinal tract$ 8r.
Gotion# said that such h)perplasia in the intestines of a t)phoid victi" "a) (e "icroscopic.7e noted that since the
to9ic effect of t)phoid fever "a) lead to "enin#itis$ 8r. Vacalares? autops) should have included an e9a"ination of
the (rain.
[1<]
The other doctor presented was 8r. &(arra +anopio$ a "e"(er of the A"erican %oard of +atholo#)$ e9a"iner of the
+hilippine %oard of +atholo#) fro" 1231 to 1221$ fellow of the +hilippine :ociet) of +atholo#ist$ associate professor
of the Ce(u &nstitute of 6edicine$ and chief patholo#ist of the Andres :oriano -r. 6e"orial 7ospital in Toledo
Cit). 8r. +anopio stated that althou#h he was partial to the use of the culture test for its #reater relia(ilit) in the
dia#nosis of t)phoid fever$ the =idal Test "a) also (e used. ,i4e 8r. Gotion#$ he a#reed that the 1*3;< ratio in
-or#e?s case was alread) the "a9i"u" () which a conclusion of t)phoid fever "a) (e "ade. No additional
infor"ation "a) (e deduced fro" a hi#her dilution.
[11]
7e said that 8r. Vacalares? autops) on -or#e was inco"plete
and thus inconclusive.
5n :epte"(er 1;$ 1221$ the trial court rendered its decision a(solvin# respondents fro" the char#es of ne#li#ence
and dis"issin# petitioners? action for da"a#es. The trial court li4ewise dis"issed respondents? counterclai"$ holdin#
that$ in see4in# da"a#es fro" respondents$ petitioners were i"pelled () the honest (elief that -or#e?s death was
due to the latter?s ne#li#ence.
+etitioners (rou#ht the "atter to the Court of Appeals. 5n -ul) 31$ 1223$ the Court of Appeals affir"ed the decision
of the trial court.
7ence this petition.
+etitioners raise the followin# assi#n"ent of errors*
&. T7H 75N5RA%,H C5GRT 50 A++HA,: C566&TTH8 A RHVHR:&%,H HRR5R =7HN &T RG,H8 T7AT T7H
85CTR&NH 50 RES IPSA LOQUITUR &: N5T A++,&CA%,H &N T7H &N:TANT CA:H.
&&. T7H 75N5RA%,H C5GRT 50 A++HA,: C566&TTH8 RHVHR:&%,H HRR5R =7HN &T 6A8H AN
GN05GN8H8 A::G6+T&5N T7AT T7H ,HVH, 50 6H8&CA, +RACT&CH &: ,5=HR &N &,&GAN C&TI.
&&&. T7H 75N5RA%,H C5GRT 50 A++HA,: GRAVH,I HRRH8 =7HN &T RG,H8 05R A ,H::HR :TAN8AR8
50 CARH AN8 8HGRHH 50 8&,&GHNCH 05R 6H8&CA, +RACT&CH &N &,&GAN C&TI =7HN &T A++RHC&ATH[8]
N5 85CT5R?: NHG,&GHNCH &N T7H TRHAT6HNT 50 -5RGH RHIH:.
+etitioner?s action is for "edical "alpractice. This is a particular for" of ne#li#ence which consists in the failure of a
ph)sician or sur#eon to appl) to his practice of "edicine that de#ree of care and s4ill which is ordinaril) e"plo)ed ()
the profession #enerall)$ under si"ilar conditions$ and in li4e surroundin# circu"stances.
[1;]
&n order to successfull)
pursue such a clai"$ a patient "ust prove that the ph)sician or sur#eon either failed to do so"ethin# which a
reasona(l) prudent ph)sician or sur#eon would have done$ or that he or she did so"ethin# that a reasona(l)
prudent ph)sician or sur#eon would not have done$ and that the failure or action caused in.ur) to the patient.
[13]
There
are thus four ele"ents involved in "edical ne#li#ence cases$ na"el)* dut)$ (reach$ in.ur)$ and pro9i"ate causation.
&n the present case$ there is no dou(t that a ph)sician-patient relationship e9isted (etween respondent doctors and
-or#e Re)es. Respondents were thus dut)-(ound to use at least the sa"e level of care that an) reasona(l)
co"petent doctor would use to treat a condition under the sa"e circu"stances. &t is (reach of this dut) which
constitutes actiona(le "alpractice.
[1>]
As to this aspect of "edical "alpractice$ the deter"ination of the reasona(le
level of care and the (reach thereof$ e9pert testi"on) is essential. &nas"uch as the causes of the in.uries involved in
"alpractice actions are deter"ina(le onl) in the li#ht of scientific 4nowled#e$ it has (een reco#niJed that e9pert
testi"on) is usuall) necessar) to support the conclusion as to causation.
[1!]
Res Ipsa Loquitur
There is a case when e9pert testi"on) "a) (e dispensed with$ and that is under the doctrine of res ipsa loquitur. As
held in Ramos v. Court of Appeals*
[1]
Althou#h #enerall)$ e9pert "edical testi"on) is relied upon in "alpractice suits to prove that a ph)sician has done a
ne#li#ent act or that he has deviated fro" the standard "edical procedure$ when the doctrine of res ipsa loquitor is
availed () the plaintiff$ the need for e9pert "edical testi"on) is dispensed with (ecause the in.ur) itself provides the
proof of ne#li#ence. The reason is that the #eneral rule on the necessit) of e9pert testi"on) applies onl) to such
"atters clearl) within the do"ain of "edical science$ and not to "atters that are within the co""on 4nowled#e of
"an4ind which "a) (e testified to () an)one fa"iliar with the facts. 5rdinaril)$ onl) ph)sicians and sur#eons of s4ill
and e9perience are co"petent to testif) as to whether a patient has (een treated or operated upon with a reasona(le
de#ree of s4ill and care. 7owever$ testi"on) as to the state"ents and acts of ph)sicians and sur#eons$ e9ternal
appearances$ and "anifest conditions which are o(serva(le () an) one "a) (e #iven () non-e9pert
witnesses. 7ence$ in cases where the res ipsa loquitur is applica(le$ the court is per"itted to find a ph)sician
ne#li#ent upon proper proof of in.ur) to the patient$ without the aid of e9pert testi"on)$ where the court fro" its fund
of co""on 4nowled#e can deter"ine the proper standard of care. =here co""on 4nowled#e and e9perience teach
that a resultin# in.ur) would not have occurred to the patient if due care had (een e9ercised$ an inference of
ne#li#ence "a) (e drawn #ivin# rise to an application of the doctrine of res ipsa loquitur without "edical evidence$
which is ordinaril) reCuired to show not onl) what occurred (ut how and wh) it occurred. =hen the doctrine is
appropriate$ all that the patient "ust do is prove a ne9us (etween the particular act or o"ission co"plained of and
the in.ur) sustained while under the custod) and "ana#e"ent of the defendant without need to produce e9pert
"edical testi"on) to esta(lish the standard of care. Resort tores ipsa loquitor is allowed (ecause there is no other
wa)$ under usual and ordinar) conditions$ () which the patient can o(tain redress for in.ur) suffered () hi".
Thus$ courts of other .urisdictions have applied the doctrine in the followin# situations* leavin# of a forei#n o(.ect in
the (od) of the patient after an operation$ in.uries sustained on a health) part of the (od) which was not under$ or in
the area$ of treat"ent$ re"oval of the wron# part of the (od) when another part was intended$ 4noc4in# out a tooth
while a patient?s .aw was under anesthetic for the re"oval of his tonsils$ and loss of an e)e while the patient was
under the influence of anesthetic$ durin# or followin# an operation for appendicitis$ a"on# others.
[13]
+etitioners asserted in the Court of Appeals that the doctrine of res ipsa loquitur applies to the present case (ecause
-or#e Re)es was "erel) e9periencin# fever and chills for five da)s and was full) conscious$ coherent$ and a"(ulant
when he went to the hospital. Iet$ he died after onl) ten hours fro" the ti"e of his ad"ission.
This contention was re.ected () the appellate court.
+etitioners now contend that all reCuisites for the application of res ipsa loquitur were present$ na"el)* D1E the
accident was of a 4ind which does not ordinaril) occur unless so"eone is ne#li#entF D;E the instru"entalit) or a#enc)
which caused the in.ur) was under the e9clusive control of the person in char#eF and D3E the in.ur) suffered "ust not
have (een due to an) voluntar) action or contri(ution of the person in.ured.
[11]
The contention is without "erit. =e a#ree with the rulin# of the Court of Appeals. &n the Ramos case$ the Cuestion
was whether a sur#eon$ an anesthesiolo#ist$ and a hospital should (e "ade lia(le for the co"atose condition of a
patient scheduled for cholec)stecto").
[12]
&n that case$ the patient was #iven anesthesia prior to her operation. Notin#
that the patient was neurolo#icall) sound at the ti"e of her operation$ the Court applied the doctrine of res ipsa
loquitur as "ental (rain da"a#e does not nor"all) occur in a #all(lader operation in the a(sence of ne#li#ence of
the anesthesiolo#ist. Ta4in# .udicial notice that anesthesia procedures had (eco"e so co""on that even an
ordinar) person could tell if it was ad"inistered properl)$ we allowed the testi"on) of a witness who was not an
e9pert. &n this case$ while it is true that the patient died .ust a few hours after professional "edical assistance was
rendered$ there is reall) nothin# unusual or e9traordinar) a(out his death. +rior to his ad"ission$ the patient alread)
had recurrin# fevers and chills for five da)s unrelieved () the anal#esic$ antip)retic$ and anti(iotics #iven hi" () his
wife. This shows that he had (een sufferin# fro" a serious illness and professional "edical help ca"e too late for
hi".
Respondents alle#ed failure to o(serve due care was not i""ediatel) apparent to a la)"an so as to .ustif)
application of res ipsa loquitur. The Cuestion reCuired e9pert opinion on the alle#ed (reach () respondents of the
standard of care reCuired () the circu"stances. 0urther"ore$ on the issue of the correctness of her dia#nosis$ no
presu"ption of ne#li#ence can (e applied to 8r. 6arl)n Rico.

As held in Ramos*
. . . . Res ipsa loquitur is not a ri#id or ordinar) doctrine to (e perfunctoril) used (ut a rule to (e cautiousl) applied$
dependin# upon the circu"stances of each case. &t is #enerall) restricted to situations in "alpractice cases where a
la)"an is a(le to sa)$ as a "atter of co""on 4nowled#e and o(servation$ that the conseCuences of professional
care were not as such as would ordinaril) have followed if due care had (een e9ercised. A distinction "ust (e "ade
(etween the failure to secure results$ and the occurrence of so"ethin# "ore unusual and not ordinaril) found if the
service or treat"ent rendered followed the usual procedure of those s4illed in that particular practice. &t "ust (e
conceded that the doctrine of res ipsa loquitur can have no application in a suit a#ainst a ph)sician or a sur#eon
which involves the "erits of a dia#nosis or of a scientific treat"ent. The ph)sician or sur#eon is not reCuired at his
peril to e9plain wh) an) particular dia#nosis was not correct$ or wh) an) particular scientific treat"ent did not
produce the desired result.
[;<]
Specific Acts of Negligence
=e turn to the Cuestion whether petitioners have esta(lished specific acts of ne#li#ence alle#edl) co""itted ()
respondent doctors.
+etitioners contend that* D1E 8r. 6arl)n Rico hastil) and erroneousl) relied upon the =idal test$ dia#nosed -or#e?s
illness as t)phoid fever$ and i""ediatel) prescri(ed the ad"inistration of the anti(iotic chloro")cetinF
[;1]
and D;E 8r.
6arvie %lanes erred in orderin# the ad"inistration of the second dose of !<< "illi#ra"s of chloro")cetin (arel)
three hours after the first was #iven.
[;;]
+etitioners presented the testi"on) of 8r. Apolinar Vacalares$ Chief
+atholo#ist of the Northern 6indanao Trainin# 7ospital$ Ca#a)an de 5ro Cit)$ who perfor"ed an autops) on the
(od) of -or#e Re)es. 8r. Vacalares testified that$ (ased on his findin#s durin# the autops)$ -or#e Re)es did not die
of t)phoid fever (ut of shoc4 undeter"ined$ which could (e due to aller#ic reaction or chloro")cetin overdose. =e
are not persuaded.
-#r$t. =hile petitioners presented 8r. Apolinar Vacalares as an e9pert witness$ we do not find hi" to (e so as he is
not a specialist on infectious diseases li4e t)phoid fever. 0urther"ore$ althou#h he "a) have had e9tensive
e9perience in perfor"in# autopsies$ he ad"itted that he had )et to do one on the (od) of a t)phoid victi" at the ti"e
he conducted the post"orte" on -or#e Re)es. &t is also plain fro" his testi"on) that he has treated onl) a(out three
cases of t)phoid fever. Thus$ he testified that*
[;3]
ATTI. +A:CGA,*
K =h)L 7ave )ou not testified earlier that )ou have never seen a patient who died of t)phoid feverL
A &n autops). %ut$ that was when & was a resident ph)sician )et.
K %ut )ou have not perfor"ed an autops) of a patient who died of t)phoid feverL
A & have not seen one.
K And )ou testified that )ou have never seen a patient who died of t)phoid fever within five da)sL
A & have not seen one.
K 7ow "an) t)phoid fever cases had )ou seen while )ou were in the #eneral practice of "edicineL
A &n our case we had no widal test that ti"e so we cannot consider that the t)phoid fever is li4e this and li4e
that. And the widal test does not specif) the ti"e of the t)phoid fever.
K The Cuestion is* how "an) t)phoid fever cases had )ou seen in )our #eneral practice re#ardless of the cases now
)ou practiceL
A & had onl) seen three cases.
K And that was wa) (ac4 in 12>L
A =a) (ac4 after ") trainin# in G+.
K Clinicall)L
A =a) (ac4 (efore ") trainin#.
7e is thus not Cualified to prove that 8r. 6arl)n Rico erred in her dia#nosis. %oth lower courts were therefore correct
in discardin# his testi"on)$ which is reall) inad"issi(le.
&n Ramos$ the defendants presented the testi"on) of a pul"onolo#ist to prove that (rain in.ur) was due to o9)#en
deprivation after the patient had (ronchospas"s
[;>]
tri##ered () her aller#ic response to a dru#$
[;!]
and not due to
fault) intu(ation () the anesthesiolo#ist. As the issue was whether the intu(ation was properl) perfor"ed () an
anesthesiolo#ist$ we re.ected the opinion of the pul"onolo#ist on the #round that he was not* D1E an anesthesiolo#ist
who could enli#hten the court a(out anesthesia practice$ procedure$ and their co"plicationsF nor D;E an aller#olo#ist
who could properl) advance e9pert opinion on aller#ic "ediated processesF nor D3E a phar"acolo#ist who could
e9plain the phar"acolo#ic and to9ic effects of the dru# alle#edl) responsi(le for the (ronchospas"s.
Seco!. 5n the other hand$ the two doctors presented () respondents clearl) were e9perts on the su(.ect. The)
vouched for the correctness of 8r. 6arl)n Rico?s dia#nosis. 8r. +eter Gotion#$ a diplo"ate whose specialiJation is
infectious diseases and "icro(iolo#) and an associate professor at the :outhwestern Gniversit) Colle#e of 6edicine
and the Gullas Colle#e of 6edicine$ testified that he has alread) treated over a thousand cases of t)phoid fever.
[;]
Accordin# to hi"$ when a case of t)phoid fever is suspected$ the =idal test is nor"all) used$
[;3]
and if the 1*3;<
results of the =idal test on -or#e Re)es had (een presented to hi" alon# with the patient?s histor)$ his i"pression
would also (e that the patient was sufferin# fro" t)phoid fever.
[;1]
As to the treat"ent of the disease$ he stated that
chloro")cetin was the dru# of choice.
[;2]
7e also e9plained that despite the "easures ta4en () respondent doctors
and the intravenous ad"inistration of two doses of chloro")cetin$ co"plications of the disease could not (e
discounted. 7is testi"on) is as follows*
[3<]
ATTI. +A:CGA,*
K &f with that count with the test of positive for 1 is to 3;<$ what treat"ent if an) would (e #ivenL
A &f those are the findin#s that would (e presented to "e$ the first thin# & would consider would (e t)phoid fever.
K And presentl) what are the treat"ents co""onl) usedL
A 8ru# of choice of chlora"phenical.
K 8octor$ if #iven the sa"e patient and after )ou have ad"inistered chlora"phenical a(out 3 1M; hours later$ the
patient associated with chills$ te"perature - >1
o
C$ what could possi(l) co"e to )our "indL
A =ell$ when it is chan#e in the clinical findin#$ )ou have to thin4 of co"plication.
K And what will )ou consider on the co"plication of t)phoidL
A 5ne "ust first understand that t)phoid fever is to9i"ia. The pro(le" is co"plications are caused () to9ins
produced () the (acteria . . . whether )ou have suffered co"plications to thin4 of -- heart to9ic ")ocarditiesF then
)ou can consider a to9ic "enin#itis and other co"plications and perforations and (leedin# in the iliu".
K Hven that ><-)ear old "arried patient who received "edication of chloro")cetin of !<< "illi#ra"s intravenous$
after the s4in test$ and received a second dose of chloro")cetin of !<< "ili#ra"s$ 3 hours later$ the patient
developed chills . . . rise in te"perature to >1
o
C$ and then a(out >< "inutes later the te"perature rose to 1<<
o
0$
cardiac rate of 1!< per "inute who appeared to (e coherent$ restless$ nauseatin#$ with seiJures* what si#nificance
could )ou attach to these clinical chan#esL
A & would then thin4 of to9e"ia$ which was to9ic "enin#itis and pro(a(l) a to9ic "enin#itis (ecause of the hi#h
cardiac rate.
K Hven if the sa"e patient who$ after havin# #iven intra"uscular valiu"$ (eca"e conscious and coherent a(out ;<
"inutes later$ have seiJure and c)anosis and rollin# of e)e(alls and vo"ittin# . . . and death* what si#nificance would
)ou attach to this develop"entL
A =e are pro(a(l) dealin# with t)phoid to "enin#itis.
K &n such case$ 8octor$ what findin# if an) could )ou e9pect on the post-"orte" e9a"inationL
A No$ the findin# would (e "ore on the "enin#es or coverin# of the (rain.
K And in order to see those chan#es would it reCuire openin# the s4ullL
A Ies.
As re#ards 8r. Vacalares? findin# durin# the autops) that the deceased?s #astro-intestinal tract was nor"al$ 8r. Rico
e9plained that$ while h)perplasia
[31]
in the pa)er?s patches or la)ers of the s"all intestines is present in t)phoid fever$
the sa"e "a) not alwa)s (e #rossl) visi(le and a "icroscope was needed to see the te9ture of the cells.
[3;]
Respondents also presented the testi"on) of 8r. &(arra T. +anopio who is a "e"(er of the +hilippine and A"erican
%oard of +atholo#)$ an e9a"iner of the +hilippine %oard of +atholo#)$ and chief patholo#ist at the 6etroCe(u
Co""unit) 7ospital$ +erpetual :uccor 7ospital$ and the Andres :oriano -r. 6e"orial 6edical Center. 7e stated
that$ as a clinical patholo#ist$ he reco#niJed that the =idal test is used for t)phoid patients$ althou#h he did not
encoura#e its use (ecause a sin#le test would onl) #ive a presu"ption necessitatin# that the test (e repeated$
(eco"in# "ore conclusive at the second and third wee4s of the disease.
[33]
7e corro(orated 8r. Gotion#?s testi"on)
that the dan#er with t)phoid fever is reall) the possi(le co"plications which could develop li4e perforation$
he"orrha#e$ as well as liver and cere(ral co"plications.
[3>]
As re#ards the 1*3;< results of the =idal test on -or#e
Re)es$ 8r. +anopio stated that no additional infor"ation could (e o(tained fro" a hi#her ratio.
[3!]
7e also a#reed with
8r. Gotion# that h)perplasia in the pa)er?s patches "a) (e "icroscopic.
[3]
&ndeed$ the standard conte"plated is not what is actuall) the avera#e "erit a"on# all 4nown practitioners fro" the
(est to the worst and fro" the "ost to the least e9perienced$ (ut the reasona(le avera#e "erit a"on# the ordinaril)
#ood ph)sicians.
[33]
7ere$ 8r. 6arl)n Rico did not depart fro" the reasona(le standard reco""ended () the e9perts
as she in fact o(served the due care reCuired under the circu"stances. Thou#h the =idal test is not conclusive$ it
re"ains a standard dia#nostic test for t)phoid fever and$ in the present case$ #reater accurac) throu#h repeated
testin# was rendered uno(taina(le () the earl) death of the patient. The results of the =idal test and the patient?s
histor) of fever with chills for five da)s$ ta4en with the fact that t)phoid fever was then prevalent as indicated () the
fact that the clinic had (een #ettin# a(out 1! to ;< t)phoid cases a "onth$ were sufficient to #ive upon an) doctor of
reasona(le s4ill the i"pression that -or#e Re)es had t)phoid fever.
8r. Rico was also .ustified in reco""endin# the ad"inistration of the dru# chloro")cetin$ the dru# of choice for
t)phoid fever. The (urden of provin# that -or#e Re)es was sufferin# fro" an) other illness rested with the
petitioners. As the) failed to present e9pert opinion on this$ preponderant evidence to support their contention is
clearl) a(sent.
',#r!. +etitioners contend that respondent 8r. 6arvie %lanes$ who too4 over fro" 8r. Rico$ was ne#li#ent in orderin#
the intravenous ad"inistration of two doses of !<< "illi#ra"s of chloro")cetin at an interval of less than three hours.
+etitioners clai" that -or#e Re)es died of anaph)lactic shoc4
[31]
or possi(l) fro" overdose as the second dose
should have (een ad"inistered five to si9 hours after the first$ per instruction of 8r. 6arl)n Rico. As held () the Court
of Appeals$ however*
That chloro")cetin was li4ewise a proper prescription is (est esta(lished () "edical authorit). =ilson$ et. al.$
in 7arrison?s +rinciple of &nternal 6edicine$ 1;th ed. write that chlora"penicol Dwhich is the #eneric of chloro")cetinE
is the dru# of choice for t)phoid fever and that no dru# has )et proven (etter in pro"otin# a favora(le clinical
response. AChlora"penicol DChloro")cetinE is specificall) indicated for (acterial "enin#itis$ t)phoid fever$ ric4ettsial
infections$ (acteriodes infections$ etc.B D+&6: Annual$ 122>$ p. ;11E The dosage lie!ise i"#ludi"g the first
admi"istratio" of five hu"dred milligrams $%&& mg.' at arou"d "i"e o(#lo# i" the eve"i"g a"d the se#o"d dose at
arou"d ))*+& the same "ight !as still !ithi" medi#all, a##epta-le limits. si"#e the re#omme"ded dose of
#hlorom,#eti" is o"e $)' gram ever, si/ $0' hours. Dcf. +ediatric 8ru# 7and(oo4$ 1st Hd.$ +hilippine +ediatric :ociet)$
Co""ittee on Therapeutics and To9icolo#)$ 122E. The intravenous route is li4ewise correct. D6ansser$ 5?Nic4$
+har"acolo#) and TherapeuticsE Hven if the test was not ad"inistered () the ph)sician-on-dut)$ the evidence
introduced that it was 8ra. %lanes who interpreted the results re"ain uncontroverted. D8ecision$ pp. 1-13E 5nce
"ore$ this Court re.ects an) clai" of professional ne#li#ence in this re#ard.
. . . .
As re#ards anaph)lactic shoc4$ the usual wa) of #uardin# a#ainst it prior to the ad"inistration of a dru#$ is the s4in
test of which$ however$ it has (een o(served* A:4in testin# with haptenic dru#s is #enerall) not relia(le.Certain dru#s
cause nonspecific hista"ine release$ producin# a weal-and-flare reaction in nor"al individuals. &""unolo#ic
activation of "ast cells reCuires a pol)valent aller#en$ so a ne#ative s4in test to a univalent haptenic dru# does not
rule out anaph)lactic sensitivit) to that dru#.B DTerr$ AAnaph)la9is and GrticariaB in %asic and Clinical &""unolo#)$ p.
3>2E =hat all this "eans le#all) is that even if the deceased suffered fro" an anaph)lactic shoc4$ this$ of itself$
would not )et esta(lish the ne#li#ence of the appellee-ph)sicians for all that the law reCuires of the" is that the)
perfor" the standard tests and perfor" standard procedures. The law cannot reCuire the" to predict ever) possi(le
reaction to all dru#s ad"inistered. The onus pro(andi was on the appellants to esta(lish$ (efore the trial court$ that
the appellee-ph)sicians i#nored standard "edical procedure$ prescri(ed and ad"inistered "edication with
rec4lessness and e9hi(ited an a(sence of the co"petence and s4ills e9pected of #eneral practitioners si"ilarl)
situated.
[32]
-o)rt,. +etitioners correctl) o(serve that the "edical profession is one which$ li4e the (usiness of a co""on
carrier$ is affected with pu(lic interest. 6oreover$ the) assert that since the law i"poses upon co""on carriers the
dut) of o(servin# e9traordinar) dili#ence in the vi#ilance over the #oods and for the safet) of the passen#ers$
[><]
ph)sicians and sur#eons should have the sa"e dut) toward their patients.
[>1]
The) also contend that the Court of
Appeals erred when it alle#edl) assu"ed that the level of "edical practice is lower in &li#an Cit)$ there() reducin#
the standard of care and de#ree of dili#ence reCuired fro" ph)sicians and sur#eons in &li#an Cit).
The standard of e9traordinar) dili#ence is peculiar to co""on carriers. The Civil Code provides*
Art. )1++. Co""on carriers$ fro" the nature of their (usiness and for reasons of pu(lic polic)$ are (ound to o(serve
e9traordinar) dili#ence in the vi#ilance over the #oods and for the safet) of the passen#ers transported () the"$
accordin# to the circu"stances of each case. . . .
The practice of "edicine is a profession en#a#ed in onl) () Cualified individuals. &t is a ri#ht earned throu#h )ears of
education$ trainin#$ and () first o(tainin# a license fro" the state throu#h professional (oard e9a"inations. :uch
license "a)$ at an) ti"e and for cause$ (e revo4ed () the #overn"ent. &n addition to state re#ulation$ the conduct of
doctors is also strictl) #overned () the 7ippocratic 5ath$ an ancient code of discipline and ethical rules which
doctors have i"posed upon the"selves in reco#nition and acceptance of their #reat responsi(ilit) to societ). Given
these safe#uards$ there is no need to e9pressl) reCuire of doctors the o(servance of Ae9traordinar)B dili#ence. As it
is now$ the practice of "edicine is alread) conditioned upon the hi#hest de#ree of dili#ence. And$ as we have
alread) noted$ the standard conte"plated for doctors is si"pl) the reasona(le avera#e "erit a"on# ordinaril) #ood
ph)sicians. That is reasona(le dili#ence for doctors or$ as the Court of Appeals called it$ the reasona(le As4ill and
co"petence . . . that a ph)sician in the sa"e or si"ilar localit) . . . should appl).B
5HERE-ORE$ the instant petition is 8HN&H8 and the decision of the Court of Appeals is A00&R6H8.
SO ORDERED.
[G.R. No. 124354. Dece"ber 26, 1666]
ROGEL&O E. RA.OS a! ERL&NDA RA.OS, # t,e#r o7 be,a(8 a! a$ at)ra( 9)ar!#a$ o8 t,e "#or$,
RO..EL RA.OS, ROY RODER&/% RA.OS a! RON RAY.OND RA.OS, petitioners, vs. /O:R' O-
A00EALS, DELOS SAN'OS .ED&/AL /EN'ER, DR. ORL&NO HOSA%A a! DRA. 0ER-E/'A
G:'&ERRE3, respondents.
D E / & S & O N
%A0:NAN, J.4
The 7ippocratic 5ath "andates ph)sicians to #ive pri"ordial consideration to the health and welfare of their
patients. &f a doctor fails to live up to this precept$ he is "ade accounta(le for his acts. A "ista4e$ throu#h #ross
ne#li#ence or inco"petence or plain hu"an error$ "a) spell the difference (etween life and death. &n this sense$ the
doctor pla)s God on his patient?s fate.
[1]
&n the case at (ar$ the Court is called upon to rule whether a sur#eon$ an anesthesiolo#ist and a hospital should (e
"ade lia(le for the unfortunate co"atose condition of a patient scheduled for#hole#,ste#tom,.
[;]
+etitioners see4 the reversal of the decision
[3]
of the Court of Appeals$ dated ;2 6a) 122!$ which overturned the
decision
[>]
of the Re#ional Trial Court$ dated 3< -anuar) 122;$ findin# private respondents lia(le for da"a#es arisin#
fro" ne#li#ence in the perfor"ance of their professional duties towards petitioner Hrlinda Ra"os resultin# in her
co"atose condition.
The antecedent facts as su""ariJed () the trial court are reproduced hereunder*
+laintiff Hrlinda Ra"os was$ until the afternoon of -une 13$ 121!$ a >3-)ear old DH9h. AABE ro(ust wo"an DT:N$
5cto(er 12$ 1212$ p. 1<E. H9cept for occasional co"plaints of disco"fort due to pains alle#edl) caused () the
presence of a stone in her #all (ladder DT:N$ -anuar) 13$ 1211$ pp. >-!E$ she was as nor"al as an) other
wo"an. 6arried to Ro#elio H. Ra"os$ an e9ecutive of +hilippine ,on# 8istance Telephone Co"pan)$ she has three
children whose na"es are Ro""el Ra"os$ Ro) Roderic4 Ra"os and Ron Ra)"ond Ra"os DT:N$ 5cto(er 12$
1212$ pp. !-E.
%ecause the disco"forts so"ehow interfered with her nor"al wa)s$ she sou#ht professional advice. :he was
advised to under#o an operation for the re"oval of a stone in her #all (ladder DT:N$ -anuar) 13$ 1211$ p. !E. :he
underwent a series of e9a"inations which included (lood and urine tests DH9hs. AAB and ACBE which indicated she
was fit for sur#er).
Throu#h the intercession of a "utual friend$ 8r. %uenvia.e DT:N$ -anuar) 13$ 1211$ p. 3E$ she and her hus(and
Ro#elio "et for the first ti"e 8r. 5rlino 7oJa4a Dshould (e 7osa4aF see T:N$ 0e(ruar) ;<$ 122<$ p. 3E$ one of the
defendants in this case$ on -une 1<$ 121!. The) a#reed that their date at the operatin# ta(le at the 8,:6C Danother
defendantE$ would (e on -une 13$ 121! at 2*<< A.6.. 8r. 7osa4a decided that she should under#o a
Acholec)stecto")B operation after e9a"inin# the docu"ents Dfindin#s fro" the Capitol 6edical Center$ 0HG 7ospital
and 8,:6CE presented to hi". Ro#elio H. Ra"os$ however$ as4ed 8r. 7osa4a to loo4 for a #ood
anesthesiolo#ist. 8r. 7osa4a$ in turn$ assured Ro#elio that he will #et a #ood anesthesiolo#ist. 8r. 7osa4a char#ed
a fee of +1$<<<.<<$ which was to include the anesthesiolo#ist?s fee and which was to (e paid after the operation
DT:N$ 5cto(er 12$ 1212$ pp. 1>-1!$ ;;-;3$ 31-33F T:N$ 0e(ruar) ;3$ 122<$ p. 13F and T:N$ Nove"(er 2$ 1212$ pp.
3->$ 1<$ 13E.
A da) (efore the scheduled date of operation$ she was ad"itted at one of the roo"s of the 8,:6C$ located alon# H.
Rodri#ueJ Avenue$ KueJon Cit) DT:N$ 5cto(er 12$ 1212$ p. 11E.
At around 3*3< A.6. of -une 13$ 121! and while still in her roo"$ she was prepared for the operation () the hospital
staff. 7er sister-in-law$ 7er"inda CruJ$ who was the 8ean of the Colle#e of Nursin# at the Capitol 6edical Center$
was also there for "oral support. :he reiterated her previous reCuest for 7er"inda to (e with her even durin# the
operation. After pra)in#$ she was #iven in.ections. 7er hands were held () 7er"inda as the) went down fro" her
roo" to the operatin# roo" DT:N$ -anuar) 13$ 1211$ pp. 2-11E. 7er hus(and$ Ro#elio$ was also with her DT:N$
5cto(er 12$ 1212$ p. 11E. At the operatin# roo"$ 7er"inda saw a(out two or three nurses and 8r. +erfecta
GutierreJ$ the other defendant$ who was to ad"inister anesthesia. Althou#h not a "e"(er of the hospital staff$
7er"inda introduced herself as 8ean of the Colle#e of Nursin# at the Capitol 6edical Center who was to provide
"oral support to the patient$ to the". 7er"inda was allowed to sta) inside the operatin# roo".
At around 2*3< A.6.$ 8r. GutierreJ reached a near() phone to loo4 for 8r. 7osa4a who was not )et in DT:N$ -anuar)
13$ 1211$ pp. 11-1;E. 8r. GutierreJ thereafter infor"ed 7er"inda CruJ a(out the prospect of a dela) in the arrival of
8r. 7osa4a. 7er"inda then went (ac4 to the patient who as4ed$ A6ind)$ wala pa (a an# 8octorBL The for"er
replied$ A7uwa# 4an# "a#-alaala$ daratin# na i)onB Di(id.E.
Thereafter$ 7er"inda went out of the operatin# roo" and infor"ed the patient?s hus(and$ Ro#elio$ that the doctor
was not )et around Did.$ p. 13E. =hen she returned to the operatin# roo"$ the patient told her$ A6ind)$ inip na inip na
a4o$ i4uha "o a4o n# i(an# 8octor.B :o$ she went out a#ain and told Ro#elio a(out what the patient said Did.$ p.
1!E. Thereafter$ she returned to the operatin# roo".
At around 1<*<< A.6.$ Ro#elio H. Ra"os was Aalread) d)in# [and] waitin# for the arrival of the doctorB even as he did
his (est to find so"e(od) who will allow hi" to pull out his wife fro" the operatin# roo" DT:N$ 5cto(er 12$ 1212$ pp.
12-;<E. 7e also thou#ht of the feelin# of his wife$ who was inside the operatin# roo" waitin# for the doctor to arrive
Di(id.E. At al"ost 1;*<< noon$ he "et 8r. Garcia who re"ar4ed that he D8r. GarciaE was also tired of waitin# for 8r.
7osa4a to arrive Did.$ p. ;1E. =hile tal4in# to 8r. Garcia at around 1;*1< +.6.$ he ca"e to 4now that 8r. 7osa4a
arrived as a nurse re"ar4ed$ ANandi)an na si 8r. 7osa4a$ du"atin# na raw.B Gpon hearin# those words$ he went
down to the lo(() and waited for the operation to (e co"pleted Did.$ pp. 1$ ;2-3<E.
At a(out 1;*1! +.6.$ 7er"inda CruJ$ who was inside the operatin# roo" with the patient$ heard so"e(od) sa) that
A8r. 7osa4a is alread) here.B :he then saw people inside the operatin# roo" A"ovin#$ doin# this and that$ [and]
preparin# the patient for the operationB DT:N$ -anuar) 13$ 1211$ p. 1E. As she held the hand of Hrlinda Ra"os$ she
then saw 8r. GutierreJ intu(atin# the hapless patient. :he thereafter heard 8r. GutierreJ sa)$ Aan# hirap "a-
intu(ate nito$ "ali )ata an# pa#4a4apaso4. 5 lu"ala4i an# ti)anB Did.$ p. 13E. %ecause of the re"ar4s of 8ra.
GutierreJ$ she focused her attention on what 8r. GutierreJ was doin#. :he thereafter noticed (luish discoloration of
the nail(eds of the left hand of the hapless Hrlinda even as 8r. 7osa4a approached her. :he then heard 8r. 7osa4a
issue an order for so"eone to call 8r. Calderon$ another anesthesiolo#ist Did.$ p. 12E. After 8r. Calderon arrived at
the operatin# roo"$ she saw this anesthesiolo#ist tr)in# to intu(ate the patient. The patient?s nail(ed (eca"e (luish
and the patient was placed in a trendelen(ur# position - a position where the head of the patient is placed in a
position lower than her feet which is an indication that there is a decrease of (lood suppl) to the patient?s (rain D&d.$
pp. 12-;<E. &""ediatel) thereafter$ she went out of the operatin# roo"$ and she told Ro#elio H. Ra"os Athat
so"ethin# wron# was 9 9 9 happenin#B D&(id.E. 8r. Calderon was then a(le to intu(ate the patient DT:N$ -ul) ;!$
1221$ p. 2E.
6eanwhile$ Ro#elio$ who was outside the operatin# roo"$ saw a respirator) "achine (ein# rushed towards the door
of the operatin# roo". 7e also saw several doctors rushin# towards the operatin# roo". =hen infor"ed ()
7er"inda CruJ that so"ethin# wron# was happenin#$ he told her D7er"indaE to (e (ac4 with the patient inside the
operatin# roo" DT:N$ 5cto(er 12$ 1212$ pp. ;!-;1E.
7er"inda CruJ i""ediatel) rushed (ac4$ and saw that the patient was still in trendelen(ur# position DT:N$ -anuar)
13$ 1211$ p. ;<E. At al"ost 3*<< +.6. of that fateful da)$ she saw the patient ta4en to the &ntensive Care Gnit D&CGE.
A(out two da)s thereafter$ Ro#elio H. Ra"os was a(le to tal4 to 8r. 7osa4a. The latter infor"ed the for"er that
so"ethin# went wron# durin# the intu(ation. Reactin# to what was told to hi"$ Ro#elio re"inded the doctor that the
condition of his wife would not have happened$ had he D8r. 7osa4aE loo4ed for a #ood anesthesiolo#ist DT:N$
5cto(er 12$ 1212$ p. 31E.
8octors GutierreJ and 7osa4a were also as4ed () the hospital to e9plain what happened to the patient. The doctors
e9plained that the patient had (ronchospas" DT:N$ Nove"(er 1!$ 122<$ pp. ;-;3E.
Hrlinda Ra"os sta)ed at the &CG for a "onth. A(out four "onths thereafter or on Nove"(er 1!$ 121!$ the patient
was released fro" the hospital.
8urin# the whole period of her confine"ent$ she incurred hospital (ills a"ountin# to +23$!>;.;! which is the su(.ect
of a pro"issor) note and affidavit of underta4in# e9ecuted () Ro#elio H. Ra"os in favor of 8,:6C. :ince that
fateful afternoon of -une 13$ 121!$ she has (een in a co"atose condition. :he cannot do an)thin#. :he cannot
"ove an) part of her (od). :he cannot see or hear. :he is livin# on "echanical "eans. :he suffered (rain
da"a#e as a result of the a(sence of o9)#en in her (rain for four to five "inutes DT:N$ Nove"(er 2$ 1212$ pp. ;1-
;;E. After (ein# dischar#ed fro" the hospital$ she has (een sta)in# in their residence$ still needin# constant "edical
attention$ with her hus(and Ro#elio incurrin# a "onthl) e9pense ran#in# fro" +1$<<<.<< to+1<$<<<.<< DT:N$
5cto(er 12$ 1212$ pp. 3;-3>E. :he was also dia#nosed to (e sufferin# fro" Adiffuse cere(ral parench)"al da"a#eB
DH9h. AGBF see also T:N$ 8ece"(er ;1$ 1212$ p. E.
[!]
Thus$ on 1 -anuar) 121$ petitioners filed a civil case
[]
for da"a#es with the Re#ional Trial Court of KueJon Cit)
a#ainst herein private respondents alle#in# ne#li#ence in the "ana#e"ent and care of Hrlinda Ra"os.
8urin# the trial$ (oth parties presented evidence as to the possi(le cause of Hrlinda?s in.ur). +laintiff presented the
testi"onies of 8ean 7er"inda CruJ and 8r. 6ariano Gavino to prove that the da"a#e sustained () Hrlinda was due
to lac4 of o9)#en in her (rain caused () the fault) "ana#e"ent of her airwa) () private respondents durin# the
anesthesia phase. 5n the other hand$ private respondents pri"aril) relied on the e9pert testi"on) of 8r. Hduardo
-a"ora$ a pul"onolo#ist$ to the effect that the cause of (rain da"a#e was Hrlinda?s aller#ic reaction to the
anesthetic a#ent$ Thiopental :odiu" D+entothalE.
After considerin# the evidence fro" (oth sides$ the Re#ional Trial Court rendered .ud#"ent in favor of petitioners$ to
wit*
After evaluatin# the evidence as shown in the findin# of facts set forth earlier$ and appl)in# the aforecited provisions
of law and .urisprudence to the case at (ar$ this Court finds and so holds that defendants are lia(le to plaintiffs for
da"a#es. The defendants were #uilt) of$ at the ver) least$ ne#li#ence in the perfor"ance of their dut) to plaintiff-
patient Hrlinda Ra"os.
5n the part of 8r. +erfecta GutierreJ$ this Court finds that she o"itted to e9ercise reasona(le care in not onl)
intu(atin# the patient$ (ut also in not repeatin# the ad"inistration of atropine DT:N$ Au#ust ;<$ 1221$ pp. !-1<E$
without due re#ard to the fact that the patient was inside the operatin# roo" for al"ost three D3E hours. 0or after she
co""itted a "ista4e in intu(atin# [the] patient$ the patientNs nail(ed (eca"e (luish and the patient$ thereafter$ was
placed in trendelen(ur# position$ (ecause of the decrease of (lood suppl) to the patientNs (rain. The evidence
further shows that the hapless patient suffered (rain da"a#e (ecause of the a(sence of o9)#en in her DpatientNsE
(rain for appro9i"atel) four to five "inutes which$ in turn$ caused the patient to (eco"e co"atose.
5n the part of 8r. 5rlino 7osa4a$ this Court finds that he is lia(le for the acts of 8r. +erfecta GutierreJ who" he had
chosen to ad"inister anesthesia on the patient as part of his o(li#ation to provide the patient a O#ood
anesthesiolo#istN$ and for arrivin# for the scheduled operation al"ost three D3E hours late.
5n the part of 8,:6C Dthe hospitalE$ this Court finds that it is lia(le for the acts of ne#li#ence of the doctors in their
Opractice of "edicineN in the operatin# roo". 6oreover$ the hospital is lia(le for failin# throu#h its responsi(le
officials$ to cancel the scheduled operation after 8r. 7osa4a ine9cusa(l) failed to arrive on ti"e.
&n havin# held thus$ this Court re.ects the defense raised () defendants that the) have acted with due care and
prudence in renderin# "edical services to plaintiff-patient. 0or if the patient was properl) intu(ated as clai"ed ()
the"$ the patient would not have (eco"e co"atose. And$ the fact that another anesthesiolo#ist was called to tr) to
intu(ate the patient after her Dthe patientNsE nail(ed turned (luish$ (elie their clai". 0urther"ore$ the defendants
should have rescheduled the operation to a later date. This$ the) should have done$ if defendants acted with due
care and prudence as the patientNs case was an elective$ not an e"er#enc) case.
9 9 9
=7HRH05RH$ and in view of the fore#oin#$ .ud#"ent is rendered in favor of the plaintiffs and a#ainst the
defendants. Accordin#l)$ the latter are ordered to pa)$ .ointl) and severall)$ the for"er the followin# su"s of "one)$
to wit*
1E the su" of +1$<<<.<< as actual "onthl) e9penses for the plaintiff Hrlinda Ra"os rec4oned fro" Nove"(er 1!$
121! or in the total su" of +3;$<<<.<< as of April 1!$ 122;$ su(.ect to its (ein# updatedF
;E the su" of +1<<$<<<.<< as reasona(le attorne)Ns feesF
3E the su" of +1<<$<<<.<< () wa) of "oral da"a#es and the further su" of +;<<$<<<.<< () wa) of e9e"plar)
da"a#esF and$
>E the costs of the suit.
:5 5R8HRH8.
[3]
+rivate respondents seasona(l) interposed an appeal to the Court of Appeals. The appellate court rendered a
8ecision$ dated ;2 6a) 122!$ reversin# the findin#s of the trial court. The decretal portion of the decision of the
appellate court reads*
=7HRH05RH$ for the fore#oin# pre"ises the appealed decision is here() RHVHR:H8$ and the co"plaint (elow
a#ainst the appellants is here() ordered 8&:6&::H8. The counterclai" of appellant 8e ,os :antos 6edical Center
is GRANTH8 (ut onl) insofar as appellees are here() ordered to pa) the unpaid hospital (ills a"ountin#
to +23$!>;.;!$ plus le#al interest for .ustice "ust (e te"pered with "erc).
:5 5R8HRH8.
[1]
The decision of the Court of Appeals was received on 2 -une 122! () petitioner Ro#elio Ra"os who was "ista4enl)
addressed as AAtt). Ro#elio Ra"os.B No cop) of the decision$ however$ was sent nor received () the Coronel ,aw
5ffice$ then counsel on record of petitioners. Ro#elio referred the decision of the appellate court to a new law)er$
Att). ,i#sa)$ onl) on ;< -une 122!$ or four D>E da)s (efore the e9piration of the re#le"entar) period for filin# a
"otion for reconsideration. 5n the sa"e da)$ Att). ,i#sa)$ filed with the appellate court a "otion for e9tension of
ti"e to file a "otion for reconsideration. The "otion for reconsideration was su("itted on > -ul) 122!. 7owever$
the appellate court denied the "otion for e9tension of ti"e in its Resolution dated ;! -ul) 122!.
[2]
6eanwhile
petitioners en#a#ed the services of another counsel$ Att). :illano$ to replace Att). ,i#sa). Att). :illano filed on 3
Au#ust 122! a "otion to ad"it the "otion for reconsideration contendin# that the period to file the appropriate
pleadin# on the assailed decision had not )et co""enced to run as the 8ivision Cler4 of Court of the Court of
Appeals had not )et served a cop) thereof to the counsel on record. 8espite this e9planation$ the appellate court still
denied the "otion to ad"it the "otion for reconsideration of petitioners in its Resolution$ dated ;2 6arch 122$
pri"aril) on the #round that the fifteen-da) D1!E period for filin# a "otion for reconsideration had alread) e9pired$ to
wit*
=e said in our Resolution on -ul) ;!$ 122!$ that the filin# of a 6otion for Reconsideration cannot (e e9tendedF
precisel)$ the 6otion for H9tension DRollo$ p. 1;E was denied. &t is$ on the other hand$ ad"itted in the latter 6otion
that plaintiffsMappellees received a cop) of the decision as earl) as -une 2$ 122!. Co"putation wise$ the period to
file a 6otion for Reconsideration e9pired on -une ;>. The 6otion for Reconsideration$ in turn$ was received () the
Court of Appeals alread) on -ul) >$ necessaril)$ the 1!-da) period alread) passed. 0or that alone$ the latter should
(e denied.
Hven assu"in# ad"issi(ilit) of the 6otion for Reconsideration$ (ut after considerin# the Co""entM5pposition$ the
for"er$ for lac4 of "erit$ is here() 8HN&H8.
:5 5R8HRH8.
[1<]
A cop) of the a(ove resolution was received () Att). :illano on 11 April 122. The ne9t da)$ or on 1; April 122$
Att). :illano filed (efore this Court a "otion for e9tension of ti"e to file the present petition for #ertiorari under Rule
>!. The Court #ranted the "otion for e9tension of ti"e and #ave petitioners additional thirt) D3<E da)s after the
e9piration of the fifteen-da) D1!E period counted fro" the receipt of the resolution of the Court of Appeals within
which to su("it the petition. The due date fell on ;3 6a) 122. The petition was filed on 2 6a) 122$ well within the
e9tended period #iven () the Court.
+etitioners assail the decision of the Court of Appeals on the followin# #rounds*
&
&N +GTT&NG 6GC7 RH,&ANCH 5N T7H TH:T&65N&H: 50 RH:+5N8HNT: 8RA. GGT&HRRHP$ 8RA.
CA,8HR5N AN8 8R. -A65RAF
&&
&N 0&N8&NG T7AT T7H NHG,&GHNCH 50 T7H RH:+5N8HNT: 8&8 N5T CAG:H T7H GN05RTGNATH
C56AT5:H C5N8&T&5N 50 +HT&T&5NHR HR,&N8A RA65:F
&&&
&N N5T A++,I&NG T7H 85CTR&NH 50 RH: &+:A ,5KG&TGR.
[11]
%efore we discuss the "erits of the case$ we shall first dispose of the procedural issue on the ti"eliness of the
petition in relation to the "otion for reconsideration filed () petitioners with the Court of Appeals. &n their Co""ent$
[1;]
private respondents contend that the petition should not (e #iven due course since the "otion for reconsideration
of the petitioners on the decision of the Court of Appeals was validl) dis"issed () the appellate court for havin#
(een filed (e)ond the re#le"entar) period. =e do not a#ree.
A careful review of the records reveals that the reason (ehind the dela) in filin# the "otion for reconsideration is
attri(uta(le to the fact that the decision of the Court of Appeals was not sent to then counsel on record of petitioners$
the Coronel ,aw 5ffice. &n fact$ a cop) of the decision of the appellate court was instead sent to and received ()
petitioner Ro#elio Ra"os on 2 -une 122! wherein he was "ista4enl) addressed as Att). Ro#elio Ra"os. %ased on
the other co""unications received () petitioner Ro#elio Ra"os$ the appellate court apparentl) "istoo4 hi" for the
counsel on record. Thus$ no cop) of the decision of the appellate court was furnished to the counsel on
record. +etitioner$ not (ein# a law)er and unaware of the prescriptive period for filin# a "otion for reconsideration$
referred the sa"e to a le#al counsel onl) on ;< -une 122!.
&t is ele"entar) that when a part) is represented () counsel$ all notices should (e sent to the part)?s law)er at his
#iven address. =ith a few e9ceptions$ notice to a liti#ant without notice to his counsel on record is no notice at
all. &n the present case$ since a cop) of the decision of the appellate court was not sent to the counsel on record of
petitioner$ there can (e no sufficient notice to spea4 of. 7ence$ the dela) in the filin# of the "otion for
reconsideration cannot (e ta4en a#ainst petitioner. 6oreover$ since the Court of Appeals alread) issued a second
Resolution$ dated ;2 6arch 122$ which superseded the earlier resolution issued on ;! -ul) 122!$ and denied the
"otion for reconsideration of petitioner$ we (elieve that the receipt of the for"er should (e considered in deter"inin#
the ti"eliness of the filin# of the present petition. %ased on this$ the petition (efore us was su("itted on ti"e.
After resolvin# the fore#oin# procedural issue$ we shall now loo4 into the "erits of the case. 0or a "ore lo#ical
presentation of the discussion we shall first consider the issue on the applica(ilit) of the doctrine of res ipsa
loquitur to the instant case. Thereafter$ the first two assi#ned errors shall (e tac4led in relation to the res ipsa
loquitur doctrine.
Res ipsa loquitur is a ,atin phrase which literall) "eans Athe thin# or the transaction spea4s for itself.B The phrase
Ares ipsa loquiturB is a "a9i" for the rule that the fact of the occurrence of an in.ur)$ ta4en with the surroundin#
circu"stances$ "a) per"it an inference or raise a presu"ption of ne#li#ence$ or "a4e out a plaintiff?s prima
fa#ie case$ and present a Cuestion of fact for defendant to "eet with an e9planation.
[13]
=here the thin# which
caused the in.ur) co"plained of is shown to (e under the "ana#e"ent of the defendant or his servants and the
accident is such as in ordinar) course of thin#s does not happen if those who have its "ana#e"ent or control use
proper care$ it affords reasona(le evidence$ in the a(sence of e9planation () the defendant$ that the accident arose
fro" or was caused () the defendant?s want of care.
[1>]
The doctrine of res ipsa loquitur is si"pl) a reco#nition of the postulate that$ as a "atter of co""on 4nowled#e and
e9perience$ the ver) nature of certain t)pes of occurrences "a) .ustif) an inference of ne#li#ence on the part of the
person who controls the instru"entalit) causin# the in.ur) in the a(sence of so"e e9planation () the defendant who
is char#ed with ne#li#ence.
[1!]
&t is #rounded in the superior lo#ic of ordinar) hu"an e9perience and on the (asis of
such e9perience or co""on 4nowled#e$ ne#li#ence "a) (e deduced fro" the "ere occurrence of the accident
itself.
[1]
7ence$res ipsa loquitur is applied in con.unction with the doctrine of co""on 4nowled#e.
7owever$ "uch has (een said that res ipsa loquitur is not a rule of su(stantive law and$ as such$ does not create or
constitute an independent or separate #round of lia(ilit).
[13]
&nstead$ it is considered as "erel) evidentiar) or in the
nature of a procedural rule.
[11]
&t is re#arded as a "ode of proof$ or a "ere procedural convenience since it furnishes
a su(stitute for$ and relieves a plaintiff of$ the (urden of producin# specific proof of ne#li#ence.
[12]
&n other words$
"ere invocation and application of the doctrine does not dispense with the reCuire"ent of proof of ne#li#ence. &t is
si"pl) a step in the process of such proof$ per"ittin# the plaintiff to present alon# with the proof of the accident$
enou#h of the attendin# circu"stances to invo4e the doctrine$ creatin# an inference or presu"ption of ne#li#ence$
and to there() place on the defendant the (urden of #oin# forward with the proof.
[;<]
:till$ (efore resort to the doctrine
"a) (e allowed$ the followin# reCuisites "ust (e satisfactoril) shown*
1. The accident is of a 4ind which ordinaril) does not occur in the a(sence of so"eone?s ne#li#enceF
;. &t is caused () an instru"entalit) within the e9clusive control of the defendant or defendantsF and
3. The possi(ilit) of contri(utin# conduct which would "a4e the plaintiff responsi(le is eli"inated.
[;1]
&n the a(ove reCuisites$ the funda"ental ele"ent is the Acontrol of the instru"entalit)B which caused the da"a#e.
[;;]
:uch ele"ent of control "ust (e shown to (e within the do"inion of the defendant. &n order to have the (enefit of
the rule$ a plaintiff$ in addition to provin# in.ur) or da"a#e$ "ust show a situation where it is applica(le$ and "ust
esta(lish that the essential ele"ents of the doctrine were present in a particular incident.
[;3]
6edical "alpractice
[;>]
cases do not escape the application of this doctrine. Thus$ res ipsa loquitur has (een applied
when the circu"stances attendant upon the har" are the"selves of such a character as to .ustif) an inference of
ne#li#ence as the cause of that har".
[;!]
The application of res ipsa loquitur in "edical ne#li#ence cases presents a
Cuestion of law since it is a .udicial function to deter"ine whether a certain set of circu"stances does$ as a "atter of
law$ per"it a #iven inference.
[;]
Althou#h #enerall)$ e9pert "edical testi"on) is relied upon in "alpractice suits to prove that a ph)sician has done a
ne#li#ent act or that he has deviated fro" the standard "edical procedure$ when the doctrine of res ipsa loquitur is
availed () the plaintiff$ the need for e9pert "edical testi"on) is dispensed with (ecause the in.ur) itself provides the
proof of ne#li#ence.
[;3]
The reason is that the #eneral rule on the necessit) of e9pert testi"on) applies onl) to such
"atters clearl) within the do"ain of "edical science$ and not to "atters that are within the co""on 4nowled#e of
"an4ind which "a) (e testified to () an)one fa"iliar with the facts.
[;1]
5rdinaril)$ onl) ph)sicians and sur#eons of
s4ill and e9perience are co"petent to testif) as to whether a patient has (een treated or operated upon with a
reasona(le de#ree of s4ill and care. 7owever$ testi"on) as to the state"ents and acts of ph)sicians and sur#eons$
e9ternal appearances$ and "anifest conditions which are o(serva(le () an) one "a) (e #iven () non-e9pert
witnesses.
[;2]
7ence$ in cases where the res ipsa loquitur is applica(le$ the court is per"itted to find a ph)sician
ne#li#ent upon proper proof of in.ur) to the patient$ without the aid of e9pert testi"on)$ where the court fro" its fund
of co""on 4nowled#e can deter"ine the proper standard of care.
[3<]
=here co""on 4nowled#e and e9perience
teach that a resultin# in.ur) would not have occurred to the patient if due care had (een e9ercised$ an inference of
ne#li#ence "a) (e drawn #ivin# rise to an application of the doctrine of res ipsa loquitur without "edical evidence$
which is ordinaril) reCuired to show not onl) what occurred (ut how and wh) it occurred.
[31]
=hen the doctrine is
appropriate$ all that the patient "ust do is prove a ne9us (etween the particular act or o"ission co"plained of and
the in.ur) sustained while under the custod) and "ana#e"ent of the defendant without need to produce e9pert
"edical testi"on) to esta(lish the standard of care. Resort to res ipsa loquitur is allowed (ecause there is no other
wa)$ under usual and ordinar) conditions$ () which the patient can o(tain redress for in.ur) suffered () hi".
Thus$ courts of other .urisdictions have applied the doctrine in the followin# situations* leavin# of a forei#n o(.ect in
the (od) of the patient after an operation$
[3;]
in.uries sustained on a health) part of the (od) which was not under$ or
in the area$ of treat"ent$
[33]
re"oval of the wron# part of the (od) when another part was intended$
[3>]
4noc4in# out a
tooth while a patient?s .aw was under anesthetic for the re"oval of his tonsils$
[3!]
and loss of an e)e while the patient
plaintiff was under the influence of anesthetic$ durin# or followin# an operation for appendicitis$
[3]
a"on# others.
Nevertheless$ despite the fact that the scope of res ipsa loquitur has (een "easura(l) enlar#ed$ it does not
auto"aticall) appl) to all cases of "edical ne#li#ence as to "echanicall) shift the (urden of proof to the defendant to
show that he is not #uilt) of the ascri(ed ne#li#ence. Res ipsa loquituris not a ri#id or ordinar) doctrine to (e
perfunctoril) used (ut a rule to (e cautiousl) applied$ dependin# upon the circu"stances of each case. &t is
#enerall) restricted to situations in "alpractice cases where a la)"an is a(le to sa)$ as a "atter of co""on
4nowled#e and o(servation$ that the conseCuences of professional care were not as such as would ordinaril) have
followed if due care had (een e9ercised.
[33]
A distinction "ust (e "ade (etween the failure to secure results$ and the
occurrence of so"ethin# "ore unusual and not ordinaril) found if the service or treat"ent rendered followed the
usual procedure of those s4illed in that particular practice. &t "ust (e conceded that the doctrine of res ipsa
loquitur can have no application in a suit a#ainst a ph)sician or sur#eon which involves the "erits of a dia#nosis or
of a scientific treat"ent.
[31]
The ph)sician or sur#eon is not reCuired at his peril to e9plain wh) an) particular
dia#nosis was not correct$ or wh) an) particular scientific treat"ent did not produce the desired result.
[32]
Thus$ res
ipsa loquitur is not availa(le in a "alpractice suit if the onl) showin# is that the desired result of an operation or
treat"ent was not acco"plished.
[><]
The real Cuestion$ therefore$ is whether or not in the process of the operation an)
e9traordinar) incident or unusual event outside of the routine perfor"ance occurred which is (e)ond the re#ular
scope of custo"ar) professional activit) in such operations$ which$ if une9plained would the"selves reasona(l)
spea4 to the avera#e "an as the ne#li#ent cause or causes of the untoward conseCuence.
[>1]
&f there was such
e9traneous interventions$ the doctrine of res ipsa loquitur "a) (e utiliJed and the defendant is called upon to e9plain
the "atter$ () evidence of e9culpation$ if he could.
[>;]
=e find the doctrine of res ipsa loquitur appropriate in the case at (ar. As will hereinafter (e e9plained$ the da"a#e
sustained () Hrlinda in her (rain prior to a scheduled #all (ladder operation presents a case for the application of res
ipsa loquitur.
A case stri4in#l) si"ilar to the one (efore us is 2oss vs. 3rid!ell$
[>3]
where the /ansas :upre"e Court in appl)in#
the res ipsa loquitur stated*
The plaintiff herein su("itted hi"self for a mastoid operatio" and delivered his person over to the care$ custod) and
control of his ph)sician who had co"plete and e9clusive control over hi"$ -ut the operatio" !as "ever
performed. At the ti"e of su("ission he was neurolo#icall) sound and ph)sicall) fit in "ind and (od)$ (ut he
suffered irrepara(le da"a#e and in.ur) renderin# hi" decere(rate and totall) incapacitated. The in.ur) was one
which does not ordinaril) occur in the process of a "astoid operation or in the a(sence of ne#li#ence in the
ad"inistration of an anesthetic$ and in the use and e"plo)"ent of an endoctracheal tu(e. 5rdinaril) a person (ein#
put under anesthesia is not rendered decere(rate as a conseCuence of ad"inisterin# such anesthesia in the
a(sence of ne#li#ence. Gpon these facts and under these circu"stances a la)"an would (e a(le to sa)$ as a
"atter of co""on 4nowled#e and o(servation$ that the conseCuences of professional treat"ent were not as such as
would ordinaril) have followed if due care had (een e9ercised.
7ere the plaintiff could not have (een #uilt) of contri(utor) ne#li#ence (ecause he was under the influence of
anesthetics and unconscious$ and the circu"stances are such that the true e9planation of event is "ore accessi(le
to the defendants than to the plaintiff for the) had the e9clusive control of the instru"entalities of anesthesia.
Gpon all the facts$ conditions and circu"stances alle#ed in Count && it is held that a cause of action is stated under
the doctrine of res ipsa loquitur.
[>>]
&ndeed$ the principles enunciated in the aforeCuoted case appl) with eCual force here. &n the present case$ Hrlinda
su("itted herself for #hole#,ste#tom, and e9pected a routine #eneral sur#er) to (e perfor"ed on her #all
(ladder. 5n that fateful da) she delivered her person over to the care$ custod) and control of private respondents
who e9ercised co"plete and e9clusive control over her. At the ti"e of su("ission$ Hrlinda was neurolo#icall) sound
and$ e9cept for a few "inor disco"forts$ was li4ewise ph)sicall) fit in "ind and (od). 7owever$ durin# the
ad"inistration of anesthesia and prior to the perfor"ance of #hole#,ste#tom, she suffered irrepara(le da"a#e to her
(rain. Thus$ without under#oin# sur#er)$ she went out of the operatin# roo" alread) decere(rate and totall)
incapacitated. 5(viousl)$ (rain da"a#e$ which Hrlinda sustained$ is an in.ur) which does not nor"all) occur in the
process of a #all (ladder operation. &n fact$ this 4ind of situation does not happen in the a(sence of ne#li#ence of
so"eone in the ad"inistration of anesthesia and in the use of endotracheal tu(e. Nor"all)$ a person (ein# put
under anesthesia is not rendered decere(rate as a conseCuence of ad"inisterin# such anesthesia if the proper
procedure was followed. 0urther"ore$ the instru"ents used in the ad"inistration of anesthesia$ includin# the
endotracheal tu(e$ were all under the e9clusive control of private respondents$ who are the ph)sicians-in-
char#e. ,i4ewise$ petitioner Hrlinda could not have (een #uilt) of contri(utor) ne#li#ence (ecause she was under
the influence of anesthetics which rendered her unconscious.
Considerin# that a sound and unaffected "e"(er of the (od) Dthe (rainE is in.ured or destro)ed while the patient is
unconscious and under the i""ediate and e9clusive control of the ph)sicians$ we hold that a practical ad"inistration
of .ustice dictates the application of res ipsa loquitur. Gpon these facts and under these circu"stances the Court
would (e a(le to sa)$ as a "atter of co""on 4nowled#e and o(servation$ if ne#li#ence attended the "ana#e"ent
and care of the patient. 6oreover$ the lia(ilit) of the ph)sicians and the hospital in this case is not predicated upon
an alle#ed failure to secure the desired results of an operation nor on an alle#ed lac4 of s4ill in the dia#nosis or
treat"ent as in fact no operation or treat"ent was ever perfor"ed on Hrlinda. Thus$ upon all these initial
deter"ination a case is "ade out for the application of the doctrine of res ipsa loquitur.
Nonetheless$ in holdin# that res ipsa loquitur is availa(le to the present case we are not sa)in# that the doctrine is
applica(le in an) and all cases where in.ur) occurs to a patient while under anesthesia$ or to an) and all anesthesia
cases. Hach case "ust (e viewed in its own li#ht and scrutiniJed in order to (e within the res ipsa loquitur covera#e.
7avin# in "ind the applica(ilit) of the res ipsa loquitur doctrine and the presu"ption of ne#li#ence allowed therein$
the Court now co"es to the issue of whether the Court of Appeals erred in findin# that private respondents were not
ne#li#ent in the care of Hrlinda durin# the anesthesia phase of the operation and$ if in the affir"ative$ whether the
alle#ed ne#li#ence was the pro9i"ate cause of Hrlinda?s co"atose condition. Corollar) thereto$ we shall also
deter"ine if the Court of Appeals erred in rel)in# on the testi"onies of the witnesses for the private respondents.
&n sustainin# the position of private respondents$ the Court of Appeals relied on the testi"onies of 8ra. GutierreJ$
8ra. Calderon and 8r. -a"ora. &n #ivin# wei#ht to the testi"on) of 8ra. GutierreJ$ the Court of Appeals rationaliJed
that she was candid enou#h to ad"it that she e9perienced so"e difficult) in the endotracheal intu(ation
[>!]
of the
patient and thus$ cannot (e said to (e coverin# her ne#li#ence with falsehood. The appellate court li4ewise opined
that private respondents were a(le to show that the (rain da"a#e sustained () Hrlinda was not caused () the
alle#ed fault) intu(ation (ut was due to the aller#ic reaction of the patient to the dru# Thiopental :odiu" D+entothalE$
a short-actin# (ar(iturate$ as testified on () their e9pert witness$ 8r. -a"ora. 5n the other hand$ the appellate court
re.ected the testi"on) of 8ean 7er"inda CruJ offered in favor of petitioners that the cause of the (rain in.ur) was
tracea(le to the wron#ful insertion of the tu(e since the latter$ (ein# a nurse$ was alle#edl) not 4nowled#ea(le in the
process of intu(ation. &n so holdin#$ the appellate court returned a verdict in favor of respondents ph)sicians and
hospital and a(solved the" of an) lia(ilit) towards Hrlinda and her fa"il).
=e disa#ree with the findin#s of the Court of Appeals. =e hold that private respondents were una(le to disprove the
presu"ption of ne#li#ence on their part in the care of Hrlinda and their ne#li#ence was the pro9i"ate cause of her
piteous condition.
&n the instant case$ the records are helpful in furnishin# not onl) the lo#ical scientific evidence of the patho#enesis of
the in.ur) (ut also in providin# the Court the le#al ne9us upon which lia(ilit) is (ased. As will (e shown hereinafter$
private respondents? own testi"onies which are reflected in the transcript of steno#raphic notes are replete of
si#nposts indicative of their ne#li#ence in the care and "ana#e"ent of Hrlinda.
=ith re#ard to 8ra. GutierreJ$ we find her ne#li#ent in the care of Hrlinda durin# the anesthesia phase. As (orne ()
the records$ respondent 8ra. GutierreJ failed to properl) intu(ate the patient. This fact was attested to () +rof.
7er"inda CruJ$ 8ean of the Capitol 6edical Center :chool of Nursin# and petitionerNs sister-in-law$ who was in the
operatin# roo" ri#ht (eside the patient when the tra#ic event occurred. =itness CruJ testified to this effect*
ATTI. +A-ARH:*
K* &n particular$ what did 8ra. +erfecta GutierreJ do$ if an) on the patientL
A* &n particular$ & could see that she was intu(atin# the patient.
K* 8o )ou 4now what happened to that intu(ation process ad"inistered () 8ra. GutierreJL
ATTI. A,CHRA*
:he will (e inco"petent Iour 7onor.
C5GRT*
=itness "a) answer if she 4nows.
A* As & have said$ & was with the patient$ & was (eside the stretcher holdin# the left hand of the patient and all of a
sudden & heard so"e re"ar4s co"in# fro" 8ra. +erfecta GutierreJ herself. :he was sa)in# AAn# hirap "a-intu(ate
nito$ "ali )ata an# pa#4a4apaso4. 5 lu"ala4i an# ti)an.B
9 9 9
ATTI. +A-ARH:*
K* 0ro" who" did )ou hear those words Alu"ala4i an# ti)anBL
A* 0ro" 8ra. +erfecta GutierreJ.
9 9 9
After hearin# the phrase Alu"ala4i an# ti)an$B what did )ou notice on the person of the patientL
A* & notice DsicE so"e (luish discoloration on the nail(eds of the left hand where & was at.
K* =here was 8r. 5rlino 7o[s]a4a then at that particular ti"eL
A* & saw hi" approachin# the patient durin# that ti"e.
K* =hen he approached the patient$ what did he do$ if an)L
A* 7e "ade an order to call on the anesthesiolo#ist in the person of 8r. Calderon.
K* 8id 8r. Calderon$ upon (ein# called$ arrive inside the operatin# roo"L
A* Ies sir.
K* =hat did [s]he do$ if an)L
A* [:]he tried to intu(ate the patient.
K* =hat happened to the patientL
A* =hen 8r. Calderon tr) DsicE to intu(ate the patient$ after a while the patient?s nail(ed (eca"e (luish and & saw
the patient was placed in trendelen(ur# position.
9 9 9
K* 8o )ou 4now the reason wh) the patient was placed in that trendelen(ur# positionL
A* As far as & 4now$ when a patient is in that position$ there is a decrease of (lood suppl) to the (rain.
[>]
9 9 9
The appellate court$ however$ dis(elieved 8ean CruJNs testi"on) in the trial court () declarin# that*
A perusal of the standard nursin# curriculu" in our countr) will show that intu(ation is not tau#ht as part of nursin#
procedures and techniCues. &ndeed$ we ta4e .udicial notice of the fact that nurses do not$ and cannot$
intu(ate. Hven on the assu"ption that she is full) capa(le of deter"inin# whether or not a patient is properl)
intu(ated$ witness 7er"inda CruJ$ ad"ittedl)$ did not peep into the throat of the patient. DT:N$ -ul) ;!$ 1221$ p.
13E. 6ore i"portantl)$ there is no evidence that she ever auscultated the patient or that she conducted an) t)pe of
e9a"ination to chec4 if the endotracheal tu(e was in its proper place$ and to deter"ine the condition of the heart$
lun#s$ and other or#ans. Thus$ witness CruJNs cate#orical state"ents that appellant 8ra. GutierreJ failed to intu(ate
the appellee Hrlinda Ra"os and that it was 8ra. Calderon who succeeded in doin# so clearl) suffer fro" lac4 of
sufficient factual (ases.
[>3]
&n other words$ what the Court of Appeals is tr)in# to i"press is that (ein# a nurse$ and considered a la)"an in the
process of intu(ation$ witness CruJ is not co"petent to testif) on whether or not the intu(ation was a success.
=e do not a#ree with the a(ove reasonin# of the appellate court. Althou#h witness CruJ is not an anesthesiolo#ist$
she can ver) well testif) upon "atters on which she is capa(le of o(servin# such as$ the state"ents and acts of the
ph)sician and sur#eon$ e9ternal appearances$ and "anifest conditions which are o(serva(le () an) one.
[>1]
This is
precisel) allowed under the doctrine of res ipsa loquitur where the testi"on) of e9pert witnesses is not reCuired. &t is
the accepted rule that e9pert testi"on) is not necessar) for the proof of ne#li#ence in non-technical "atters or those
of which an ordinar) person "a) (e e9pected to have 4nowled#e$ or where the lac4 of s4ill or want of care is so
o(vious as to render e9pert testi"on) unnecessar).
[>2]
=e ta4e .udicial notice of the fact that anesthesia procedures
have (eco"e so co""on$ that even an ordinar) person can tell if it was ad"inistered properl). As such$ it would not
(e too difficult to tell if the tu(e was properl) inserted. This 4ind of o(servation$ we (elieve$ does not reCuire a
"edical de#ree to (e accepta(le.
At an) rate$ without dou(t$ petitionerNs witness$ an e9perienced clinical nurse whose lon# e9perience and scholarship
led to her appoint"ent as 8ean of the Capitol 6edical Center :chool of Nursin#$ was full) capa(le of deter"inin#
whether or not the intu(ation was a success. :he had e9tensive clinical e9perience startin# as a staff nurse in
Chica#o$ &llinoisF staff nurse and clinical instructor in a teachin# hospital$ the 0HG-NR60F 8ean of the ,a#una
Colle#e of Nursin# in :an +a(lo Cit)F and then 8ean of the Capitol 6edical Center :chool of Nursin#.
[!<]
Reviewin#
witness CruJN state"ents$ we find that the sa"e were delivered in a strai#htforward "anner$ with the 4ind of detail$
clarit)$ consistenc) and spontaneit) which would have (een difficult to fa(ricate. =ith her clinical (ac4#round as a
nurse$ the Court is satisfied that she was a(le to de"onstrate throu#h her testi"on) what trul) transpired on that
fateful da).
6ost of all$ her testi"on) was affir"ed () no less than respondent 8ra. GutierreJ who ad"itted that she e9perienced
difficult) in insertin# the tu(e into Hrlinda?s trachea$ to wit*
ATTI. ,&G:AI*
K* &n this particular case$ 8octora$ while )ou were intu(atin# at )our first atte"pt DsicE$ )ou did not i""ediatel) see
the tracheaL
8RA. GGT&HRRHP*
A* Ies sir.
K* 8id )ou pull awa) the tu(e i""ediatel)L
A* Iou do not pull the ...
K* 8id )ou or did )ou notL
A* & did not pull the tu(e.
K* =hen )ou said A"ahirap )ata ito$B what were )ou referrin# toL
A* A6ahirap )ata iton# i-intu(ate$B that was the patient.
K* :o$ )ou found so"e difficult) in insertin# the tu(eL
A* Ies$ (ecause of DsicE ") first atte"pt$ & did not see ri#ht awa).
[!1]
Curiousl) in the case at (ar$ respondent 8ra. GutierreJ "ade the haphaJard defense that she encountered hardship
in the insertion of the tu(e in the trachea of Hrlinda (ecause it was positioned "ore anteriorl) Dsli#htl) deviated fro"
the nor"al anato") of a personE
[!;]
"a4in# it harder to locate and$ since Hrlinda is o(ese and has a short nec4 and
protrudin# teeth$ it "ade intu(ation even "ore difficult.
The ar#u"ent does not convince us. &f this was indeed o(served$ private respondents adduced no evidence
de"onstratin# that the) proceeded to "a4e a thorou#h assess"ent of Hrlinda?s airwa)$ prior to the induction of
anesthesia$ even if this would "ean postponin# the procedure. 0ro" their testi"onies$ it appears that the
o(servation was "ade onl) as an afterthou#ht$ as a "eans of defense.
The pre-operative evaluation of a patient prior to the ad"inistration of anesthesia is universall) o(served to lessen
the possi(ilit) of anesthetic accidents. +re-operative evaluation and preparation for anesthesia (e#ins when the
anesthesiolo#ist reviews the patient?s "edical records and visits with the patient$ traditionall)$ the da) (efore elective
sur#er).
[!3]
&t includes ta4in# the patient?s "edical histor)$ review of current dru# therap)$ ph)sical e9a"ination and
interpretation of la(orator) data.
[!>]
The ph)sical e9a"ination perfor"ed () the anesthesiolo#ist is directed pri"aril)
toward the central nervous s)ste"$ cardiovascular s)ste"$ lun#s and upper airwa).
[!!]
A thorou#h anal)sis of the
patientNs airwa) nor"all) involves investi#atin# the followin#* cervical spine "o(ilit)$ te"poro"andi(ular "o(ilit)$
pro"inent central incisors$ diseased or artificial teeth$ a(ilit) to visualiJe uvula and the th)ro"ental distance.
[!]
Thus$
ph)sical characteristics of the patient?s upper airwa) that could "a4e tracheal intu(ation difficult should (e studied.
[!3]
=here the need arises$ as when initial assess"ent indicates possi(le pro(le"s Dsuch as the alle#ed short nec4
and protrudin# teeth of HrlindaE a thorou#h e9a"ination of the patient?s airwa) would #o a lon# wa) towards
decreasin# patient "or(idit) and "ortalit).
&n the case at (ar$ respondent 8ra. GutierreJ ad"itted that she saw Hrlinda for the first ti"e on the da) of the
operation itself$ on 13 -une 121!. %efore this date$ no prior consultations with$ or pre-operative evaluation of Hrlinda
was done () her. Gntil the da) of the operation$ respondent 8ra. GutierreJ was unaware of the ph)siolo#ical "a4e-
up and needs of Hrlinda. :he was li4ewise not properl) infor"ed of the possi(le difficulties she would face durin#
the ad"inistration of anesthesia to Hrlinda. Respondent 8ra. GutierreJ? act of seein# her patient for the first ti"e
onl) an hour (efore the scheduled operative procedure was$ therefore$ an act of e9ceptional ne#li#ence and
professional irresponsi(ilit). The "easures cautionin# prudence and vi#ilance in dealin# with hu"an lives lie at the
core of the ph)sician?s centuries-old 7ippocratic 5ath. 7er failure to follow this "edical procedure is$ therefore$ a
clear i"di#ia of her ne#li#ence.
Respondent 8ra. GutierreJ$ however$ atte"pts to #loss over this o"ission () pla)in# around with the trial courtNs
i#norance of clinical procedure$ hopin# that she could #et awa) with it. Respondent 8ra. GutierreJ tried to "uddle
the difference (etween an elective sur#er) and an e"er#enc) sur#er) .ust so her failure to perfor" the reCuired pre-
operative evaluation would escape unnoticed. &n her testi"on) she asserted*
ATTI. ,&G:AI*
K* =ould )ou a#ree$ 8octor$ that it is #ood "edical practice to see the patient a da) (efore so )ou can introduce
)ourself to esta(lish #ood doctor-patient relationship and #ain the trust and confidence of the patientL
8RA. GGT&HRRHP*
A* As & said in ") previous state"ent$ it depends on the operative procedure of the anesthesiolo#ist and in ") case$
with elective cases and nor"al cardio-pul"onar) clearance li4e that$ & usuall) donNt do it e9cept on e"er#enc) and
on cases that have an a(nor"alities DsicE.
[!1]
7owever$ the e9act opposite is true. &n an e"er#enc) procedure$ there is hardl) enou#h ti"e availa(le for the
fastidious de"ands of pre-operative procedure so that an anesthesiolo#ist is a(le to see the patient onl) a few
"inutes (efore sur#er)$ if at all. Hlective procedures$ on the other hand$ are operative procedures that can wait for
da)s$ wee4s or even "onths. 7ence$ in these cases$ the anesthesiolo#ist possesses the lu9ur) of ti"e to "a4e a
proper assess"ent$ includin# the ti"e to (e at the patientNs (edside to do a proper interview and clinical
evaluation. There is a"ple ti"e to e9plain the "ethod of anesthesia$ the dru#s to (e used$ and their possi(le
haJards for purposes of infor"ed consent. Gsuall)$ the pre-operative assess"ent is conducted at least one da)
(efore the intended sur#er)$ when the patient is rela9ed and cooperative.
Hrlinda?s case was elective and this was 4nown to respondent 8ra. GutierreJ. Thus$ she had all the ti"e to "a4e a
thorou#h evaluation of Hrlinda?s case prior to the operation and prepare her for anesthesia. 7owever$ she never saw
the patient at the (edside. :he herself ad"itted that she had seen petitioner onl) in the operatin# roo"$ and onl) on
the actual date of the #hole#,ste#tom,. :he ne#li#entl) failed to ta4e advanta#e of this i"portant opportunit). As
such$ her atte"pt to e9culpate herself "ust fail.
7avin# esta(lished that respondent 8ra. GutierreJ failed to perfor" pre-operative evaluation of the patient which$ in
turn$ resulted to a wron#ful intu(ation$ we now deter"ine if the fault) intu(ation is trul) the pro9i"ate cause of
Hrlinda?s co"atose condition.
+rivate respondents repeatedl) ha""ered the view that the cere(ral ano9ia which led to Hrlinda?s co"a was due to
(ronchospas"
[!2]
"ediated () her aller#ic response to the dru#$ Thiopental :odiu"$ introduced into her
s)ste". Towards this end$ the) presented 8r. -a"ora$ a 0ellow of the +hilippine Colle#e of +h)sicians and
8iplo"ate of the +hilippine :pecialt) %oard of &nternal 6edicine$ who advanced private respondentsN theor) that the
o9)#en deprivation which led to ano9ic encephalopath)$
[<]
was due to an unpredicta(le dru# reaction to the short-
actin# (ar(iturate. =e find the theor) of private respondents unaccepta(le.
0irst of all$ 8r. -a"ora cannot (e considered an authorit) in the field of anesthesiolo#) si"pl) (ecause he is not an
anesthesiolo#ist. :ince 8r. -a"ora is a pul"onolo#ist$ he could not have (een capa(le of properl) enli#htenin# the
court a(out anesthesia practice and procedure and their co"plications. 8r. -a"ora is li4ewise not an aller#olo#ist
and could not therefore properl) advance e9pert opinion on aller#ic-"ediated processes. 6oreover$ he is not a
phar"acolo#ist and$ as such$ could not have (een capa(le$ as an e9pert would$ of e9plainin# to the court the
phar"acolo#ic and to9ic effects of the supposed culprit$ Thiopental :odiu" D+entothalE.
The inappropriateness and a(surdit) of acceptin# 8r. -a"ora?s testi"on) as an e9pert witness in the anesthetic
practice of +entothal ad"inistration is further supported () his own ad"ission that he for"ulated his opinions on the
dru# not fro" the practical e9perience #ained () a specialist or e9pert in the ad"inistration and use of :odiu"
+entothal on patients$ (ut onl) fro" readin# certain references$ to wit*
ATTI. ,&G:AI*
K* &n )our line of e9pertise on pul"onolo#)$ did )ou have an) occasion to use pentothal as a "ethod of
"ana#e"entL
8R. -A65RA*
A* =e do it in con.unction with the anesthesiolo#ist when the) have to intu(ate our patient.
K* %ut not in particular when )ou practice pul"onolo#)L
A* No.
K* &n other words$ )our 4nowled#e a(out pentothal is (ased onl) on what )ou have read fro" (oo4s and not ()
)our own personal application of the "edicine pentothalL
A* %ased on ") personal e9perience also on pentothal.
K* 7ow "an) ti"es have )ou used pentothalL
A* The) used it on "e. & went into (ronchospas" durin# ") appendecto").
K* And (ecause the) have used it on )ou and on account of )our own personal e9perience )ou feel that )ou can
testif) on pentothal here with "edical authorit)L
A* No. That is wh) & used references to support ") clai"s.
[1]
An anesthetic accident caused () a rare dru#-induced (ronchospas" properl) falls within the fields of anesthesia$
internal "edicine-aller#)$ and clinical phar"acolo#). The resultin# ano9ic encephalopath) (elon#s to the field of
neurolo#). =hile ad"ittedl)$ "an) (ronchospastic-"ediated pul"onar) diseases are within the e9pertise of
pul"onar) "edicine$ 8r. -a"oraNs field$ the anesthetic dru#-induced$ aller#ic "ediated (ronchospas" alle#ed in this
case is within the disciplines of anesthesiolo#)$ aller#olo#) and phar"acolo#). 5n the (asis of the fore#oin#
transcript$ in which the pul"onolo#ist hi"self ad"itted that he could not testif) a(out the dru# with "edical authorit)$
it is clear that the appellate court erred in #ivin# wei#ht to 8r. -a"ora?s testi"on) as an e9pert in the ad"inistration
of Thiopental :odiu".
The provision in the rules of evidence
[;]
re#ardin# e9pert witnesses states*
:ec. >2. Opi"io" of e/pert !it"ess. - The opinion of a witness on a "atter reCuirin# special 4nowled#e$ s4ill$
e9perience or trainin# which he is shown to possess$ "a) (e received in evidence.
Generall)$ to Cualif) as an e9pert witness$ one "ust have acCuired special 4nowled#e of the su(.ect "atter a(out
which he or she is to testif)$ either () the stud) of reco#niJed authorities on the su(.ect or () practical e9perience.
[3]
Clearl)$ 8r. -a"ora does not Cualif) as an e9pert witness (ased on the a(ove standard since he lac4s the
necessar) 4nowled#e$ s4ill$ and trainin# in the field of anesthesiolo#). 5ddl)$ apart fro" su("ittin# testi"on) fro" a
specialist in the wron# field$ private respondents? intentionall) avoided providin# testi"on) () co"petent and
independent e9perts in the proper areas.
6oreover$ private respondents? theor)$ that Thiopental :odiu" "a) have produced HrlindaNs co"a () tri##erin# an
aller#ic "ediated response$ has no support in evidence. No evidence of stridor$ s4in reactions$ or wheeJin# - so"e
of the "ore co""on acco"pan)in# si#ns of an aller#ic reaction - appears on record. No la(orator) data were ever
presented to the court.
&n an) case$ private respondents the"selves ad"it that Thiopental induced$ aller#ic-"ediated (ronchospas"
happens onl) ver) rarel). &f courts were to accept private respondentsN h)pothesis without supportin# "edical proof$
and a#ainst the wei#ht of availa(le evidence$ then ever) anesthetic accident would (e an act of God. Hvidentl)$ the
Thiopental-aller#) theor) vi#orousl) asserted () private respondents was a "ere afterthou#ht. :uch an e9planation
was advanced in order to a(solve the" of an) and all responsi(ilit) for the patient?s condition.
&n view of the evidence at hand$ we are inclined to (elieve petitioners? stand that it was the fault) intu(ation which
was the pro9i"ate cause of Hrlinda?s co"atose condition.
+ro9i"ate cause has (een defined as that which$ in natural and continuous seCuence$ un(ro4en () an) efficient
intervenin# cause$ produces in.ur)$ and without which the result would not have occurred.
[>]
An in.ur) or da"a#e is
pro9i"atel) caused () an act or a failure to act$ whenever it appears fro" the evidence in the case$ that the act or
o"ission pla)ed a su(stantial part in (rin#in# a(out or actuall) causin# the in.ur) or da"a#eF and that the in.ur) or
da"a#e was either a direct result or a reasona(l) pro(a(le conseCuence of the act or o"ission.
[!]
&t is the do"inant$
"ovin# or producin# cause.
Appl)in# the a(ove definition in relation to the evidence at hand$ fault) intu(ation is undenia(l) the pro9i"ate cause
which tri##ered the chain of events leadin# to Hrlinda?s (rain da"a#e and$ ulti"atel)$ her co"atosed condition.
+rivate respondents the"selves ad"itted in their testi"on) that the first intu(ation was a failure. This fact was
li4ewise o(served () witness CruJ when she heard respondent 8ra. GutierreJ re"ar4ed$ AAn# hirap "a-intu(ate
nito$ "ali )ata an# pa#4a4apaso4. 5 lu"ala4i an# ti)an.B Thereafter$ witness CruJ noticed a(do"inal distention on
the (od) of Hrlinda. The develop"ent of a(do"inal distention$ to#ether with respirator) e"(arrass"ent indicates
that the endotracheal tu(e entered the esopha#us instead of the respirator) tree. &n other words$ instead of the
intended endotracheal intu(ation what actuall) too4 place was an esopha#eal intu(ation. 8urin# intu(ation$ such
distention indicates that air has entered the #astrointestinal tract throu#h the esopha#us instead of the lun#s throu#h
the trachea. Hntr) into the esopha#us would certainl) cause so"e dela) in o9)#en deliver) into the lun#s as the
tu(e which carries o9)#en is in the wron# place. That a(do"inal distention had (een o(served durin# the first
intu(ation su##ests that the len#th of ti"e utiliJed in insertin# the endotracheal tu(e Dup to the ti"e the tu(e was
withdrawn for the second atte"ptE was fairl) si#nificant. 8ue to the dela) in the deliver) of o9)#en in her lun#s
Hrlinda showed si#ns of c)anosis.
[]
As stated in the testi"on) of 8r. 7osa4a$ the lac4 of o9)#en (eca"e apparent
onl) after he noticed that the nail(eds of Hrlinda were alread) (lue.
[3]
7owever$ private respondents contend that a
second intu(ation was e9ecuted on Hrlinda and this one was successfull) done. =e do not thin4 so. No evidence
e9ists on record$ (e)ond private respondentsN (are clai"s$ which supports the contention that the second intu(ation
was successful. Assu"in# that the endotracheal tu(e finall) found its wa) into the proper orifice of the trachea$ the
sa"e #ave no #uarantee of o9)#en deliver)$ the hall"ar4 of a successful intu(ation. &n fact$ c)anosis was a#ain
o(served i""ediatel) after the second intu(ation. +roceedin# fro" this event Dc)anosisE$ it could not (e clai"ed$ as
private respondents insist$ that the second intu(ation was acco"plished. Hven #rantin# that the tu(e was
successfull) inserted durin# the second atte"pt$ it was o(viousl) too late. As aptl) e9plained () the trial court$
Hrlinda alread) suffered (rain da"a#e as a result of the inadeCuate o9)#enation of her (rain for a(out four to five
"inutes.
[1]
The a(ove conclusion is not without (asis. :cientific studies point out that intu(ation pro(le"s are responsi(le for
one-third D1M3E of deaths and serious in.uries associated with anesthesia.
[2]
Nevertheless$ ninet)-ei#ht percent D21QE
or the vast "a.orit) of difficult intu(ations "a) (e anticipated () perfor"in# a thorou#h evaluation of the patient?s
airwa) prior to the operation.
[3<]
As stated (eforehand$ respondent 8ra. GutierreJ failed to o(serve the proper pre-
operative protocol which could have prevented this unfortunate incident. 7ad appropriate dili#ence and reasona(le
care (een used in the pre-operative evaluation$ respondent ph)sician could have (een "uch "ore prepared to "eet
the contin#enc) (rou#ht a(out () the perceived anato"ic variations in the patient?s nec4 and oral area$ defects
which would have (een easil) overco"e () a prior 4nowled#e of those variations to#ether with a chan#e in
techniCue.
[31]
&n other words$ an e9perienced anesthesiolo#ist$ adeCuatel) alerted () a thorou#h pre-operative
evaluation$ would have had little difficult) #oin# around the short nec4 and protrudin# teeth.
[3;]
7avin# failed to
o(serve co""on "edical standards in pre-operative "ana#e"ent and intu(ation$ respondent 8ra. GutierreJ?
ne#li#ence resulted in cere(ral ano9ia and eventual co"a of Hrlinda.
=e now deter"ine the responsi(ilit) of respondent 8r. 5rlino 7osa4a as the head of the sur#ical tea". As the so-
called Acaptain of the ship$B
[33]
it is the sur#eon?s responsi(ilit) to see to it that those under hi" perfor" their tas4 in
the proper "anner. Respondent 8r. 7osa4a?s ne#li#ence can (e found in his failure to e9ercise the proper authorit)
Das the AcaptainB of the operative tea"E in not deter"inin# if his anesthesiolo#ist o(served proper anesthesia
protocols. &n fact$ no evidence on record e9ists to show that respondent 8r. 7osa4a verified if respondent 8ra.
GutierreJ properl) intu(ated the patient. 0urther"ore$ it does not escape us that respondent 8r. 7osa4a had
scheduled another procedure in a different hospital at the sa"e ti"e as Hrlinda?s #hole#,ste#tom,$ and was in fact
over three hours late for the latter?s operation. %ecause of this$ he had little or no ti"e to confer with his
anesthesiolo#ist re#ardin# the anesthesia deliver). This indicates that he was re"iss in his professional duties
towards his patient. Thus$ he shares eCual responsi(ilit) for the events which resulted in Hrlinda?s condition.
=e now discuss the responsi(ilit) of the hospital in this particular incident. The uniCue practice Da"on# private
hospitalsE of fillin# up specialist staff with attendin# and visitin# Aconsultants$B
[3>]
who are alle#edl) not hospital
e"plo)ees$ presents pro(le"s in apportionin# responsi(ilit) for ne#li#ence in "edical "alpractice cases. 7owever$
the difficult) is onl) "ore apparent than real.
&n the first place$ hospitals e9ercise si#nificant control in the hirin# and firin# of consultants and in the conduct of their
wor4 within the hospital pre"ises. 8octors who appl) for AconsultantB slots$ visitin# or attendin#$ are reCuired to
su("it proof of co"pletion of residenc)$ their educational CualificationsF #enerall)$ evidence of accreditation () the
appropriate (oard Ddiplo"ateE$ evidence of fellowship in "ost cases$ and references. These reCuire"ents are
carefull) scrutiniJed () "e"(ers of the hospital ad"inistration or () a review co""ittee set up () the hospital who
either accept or re.ect the application.
[3!]
This is particularl) true with respondent hospital.
After a ph)sician is accepted$ either as a visitin# or attendin# consultant$ he is nor"all) reCuired to attend clinico-
patholo#ical conferences$ conduct (edside rounds for cler4s$ interns and residents$ "oderate #rand rounds and
patient audits and perfor" other tas4s and responsi(ilities$ for the privile#e of (ein# a(le to "aintain a clinic in the
hospital$ andMor for the privile#e of ad"ittin# patients into the hospital. &n addition to these$ the ph)sician?s
perfor"ance as a specialist is #enerall) evaluated () a peer review co""ittee on the (asis of "ortalit) and
"or(idit) statistics$ and feed(ac4 fro" patients$ nurses$ interns and residents. A consultant re"iss in his duties$ or a
consultant who re#ularl) falls short of the "ini"u" standards accepta(le to the hospital or its peer review
co""ittee$ is nor"all) politel) ter"inated.
&n other words$ private hospitals$ hire$ fire and e9ercise real control over their attendin# and visitin# AconsultantB
staff. =hile AconsultantsB are not$ technicall) e"plo)ees$ a point which respondent hospital asserts in den)in# all
responsi(ilit) for the patient?s condition$ the control e9ercised$ the hirin#$ and the ri#ht to ter"inate consultants all
fulfill the i"portant hall"ar4s of an e"plo)er-e"plo)ee relationship$ with the e9ception of the pa)"ent of wa#es. &n
assessin# whether such a relationship in fact e9ists$ the control test is deter"inin#. Accordin#l)$ on the (asis of the
fore#oin#$ we rule that for the purpose of allocatin# responsi(ilit) in "edical ne#li#ence cases$ an e"plo)er-
e"plo)ee relationship in effect e9ists (etween hospitals and their attendin# and visitin# ph)sicians. This (ein# the
case$ the Cuestion now arises as to whether or not respondent hospital is solidaril) lia(le with respondent doctors for
petitioner?s condition.
[3]
The (asis for holdin# an e"plo)er solidaril) responsi(le for the ne#li#ence of its e"plo)ee is found in Article ;11< of
the Civil Code which considers a person accounta(le not onl) for his own acts (ut also for those of others (ased on
the for"er?s responsi(ilit) under a relationship of patria potestas.
[33]
:uch responsi(ilit) ceases when the persons or
entit) concerned prove that the) have o(served the dili#ence of a #ood father of the fa"il) to prevent da"a#e.
[31]
&n
other words$ while the (urden of provin# ne#li#ence rests on the plaintiffs$ once ne#li#ence is shown$ the (urden
shifts to the respondents Dparent$ #uardian$ teacher or e"plo)erE who should prove that the) o(served the dili#ence
of a #ood father of a fa"il) to prevent da"a#e.
&n the instant case$ respondent hospital$ apart fro" a #eneral denial of its responsi(ilit) over respondent ph)sicians$
failed to adduce evidence showin# that it e9ercised the dili#ence of a #ood father of a fa"il) in the hirin# and
supervision of the latter. &t failed to adduce evidence with re#ard to the de#ree of supervision which it e9ercised over
its ph)sicians. &n ne#lectin# to offer such proof$ or proof of a si"ilar nature$ respondent hospital there() failed to
dischar#e its (urden under the last para#raph of Article ;11<. 7avin# failed to do this$ respondent hospital is
conseCuentl) solidaril) responsi(le with its ph)sicians for Hrlinda?s condition.
%ased on the fore#oin#$ we hold that the Court of Appeals erred in acceptin# and rel)in# on the testi"onies of the
witnesses for the private respondents. &ndeed$ as shown () the a(ove discussions$ private respondents were
una(le to re(ut the presu"ption of ne#li#ence. Gpon these disCuisitions we hold that private respondents are
solidaril) lia(le for da"a#es under Article ;13
[32]
of the Civil Code.
=e now co"e to the a"ount of da"a#es due petitioners. The trial court awarded a total of+3;$<<<.<< pesos
Dshould (e +1$<<<.<<E in co"pensator) da"a#es to the plaintiff$ Asu(.ect to its (ein# updatedB coverin# the period
fro" 1! Nove"(er 121! up to 1! April 122;$ (ased on "onthl) e9penses for the care of the patient esti"ated
at +1$<<<.<<.
At current levels$ the +1<<<M"onthl) a"ount esta(lished () the trial court at the ti"e of its decision would (e #rossl)
inadeCuate to cover the actual costs of ho"e-(ased care for a co"atose individual. The calculated a"ount was not
even arrived at () loo4in# at the actual cost of proper hospice care for the patient. =hat it reflected were the actual
e9penses incurred and proved () the petitioners after the) were forced to (rin# ho"e the patient to avoid "ountin#
hospital (ills.
And )et ideall)$ a co"atose patient should re"ain in a hospital or (e transferred to a hospice specialiJin# in the care
of the chronicall) ill for the purpose of providin# a proper "ilieu adeCuate to "eet "ini"u" standards of care. &n the
instant case for instance$ Hrlinda has to (e constantl) turned fro" side to side to prevent (edsores and h)postatic
pneu"onia. 0eedin# is done () naso#astric tu(e. 0ood preparation should (e nor"all) "ade () a dietitian to
provide her with the correct dail) caloric reCuire"ents and vita"in supple"ents. 0urther"ore$ she has to (e seen
on a re#ular (asis () a ph)sical therapist to avoid "uscle atroph)$ and () a pul"onar) therapist to prevent the
accu"ulation of secretions which can lead to respirator) co"plications.
Given these considerations$ the a"ount of actual da"a#es recovera(le in suits arisin# fro" ne#li#ence should at
least reflect the correct "ini"u" cost of proper care$ not the cost of the care the fa"il) is usuall) co"pelled to
underta4e at ho"e to avoid (an4ruptc). 7owever$ the provisions of the Civil Code on actual or co"pensator)
da"a#es present us with so"e difficulties.
=ell-settled is the rule that actual da"a#es which "a) (e clai"ed () the plaintiff are those suffered () hi" as he
has dul) proved. The Civil Code provides*
Art. 4)55. - H9cept as provided () law or () stipulation$ one is entitled to an adeCuate co"pensation onl) for such
pecuniar) loss suffered () hi" as he has dul) proved. :uch co"pensation is referred to as actual or co"pensator)
da"a#es.
5ur rules on actual or co"pensator) da"a#es #enerall) assu"e that at the ti"e of liti#ation$ the in.ur) suffered as a
conseCuence of an act of ne#li#ence has (een co"pleted and that the cost can (e liCuidated. 7owever$ these
provisions ne#lect to ta4e into account those situations$ as in this case$ where the resultin# in.ur) "i#ht (e continuin#
and possi(le future co"plications directl) arisin# fro" the in.ur)$ while certain to occur$ are difficult to predict.
&n these cases$ the a"ount of da"a#es which should (e awarded$ if the) are to adeCuatel) and correctl) respond to
the in.ur) caused$ should (e one which co"pensates for pecuniar) loss incurred and proved$ up to the ti"e of
trialF and one which would "eet pecuniar) loss certain to (e suffered (ut which could not$ fro" the nature of the
case$ (e "ade with certaint).
[1<]
&n other words$ te"perate da"a#es can and should (e awarded on top of actual or
co"pensator) da"a#es in instances where the in.ur) is chronic and continuin#. And (ecause of the uniCue nature
of such cases$ no inco"pati(ilit) arises when (oth actual and te"perate da"a#es are provided for. The reason is
that these da"a#es cover two distinct phases.
As it would not (e eCuita(le - and certainl) not in the (est interests of the ad"inistration of .ustice - for the victi" in
such cases to constantl) co"e (efore the courts and invo4e their aid in see4in# ad.ust"ents to the co"pensator)
da"a#es previousl) awarded - te"perate da"a#es are appropriate. The a"ount #iven as te"perate da"a#es$
thou#h to a certain e9tent speculative$ should ta4e into account the cost of proper care.
&n the instant case$ petitioners were a(le to provide onl) ho"e-(ased nursin# care for a co"atose patient who has
re"ained in that condition for over a decade. 7avin# pre"ised our award for co"pensator) da"a#es on the a"ount
provided () petitioners at the onset of liti#ation$ it would (e now "uch "ore in step with the interests of .ustice if the
value awarded for te"perate da"a#es would allow petitioners to provide opti"al care for their loved one in a facilit)
which #enerall) specialiJes in such care. The) should not (e co"pelled () dire circu"stances to provide
su(standard care at ho"e without the aid of professionals$ for an)thin# less would (e #rossl) inadeCuate. Gnder the
circu"stances$ an award of +1$!<<$<<<.<< in te"perate da"a#es would therefore (e reasona(le.
[11]
&n 2ale"6uela vs. Court of Appeals$
[1;]
this Court was confronted with a situation where the in.ur) suffered () the
plaintiff would have led to e9penses which were difficult to esti"ate (ecause while the) would have (een a direct
result of the in.ur) Da"putationE$ and were certain to (e incurred () the plaintiff$ the) were li4el) to arise onl) in the
future. =e awarded +1$<<<$<<<.<< in "oral da"a#es in that case.
8escri(in# the nature of the in.ur)$ the Court therein stated*
As a result of the accident$ 6a. ,ourdes ValenJuela underwent a trau"atic a"putation of her left lower e9tre"it) at
the distal left thi#h .ust a(ove the 4nee. %ecause of this$ ValenJuela will forever (e deprived of the full a"(ulator)
functions of her left e9tre"it)$ even with the use of state of the art prosthetic technolo#). =ell (e)ond the period of
hospitaliJation Dwhich was paid for () ,iE$ she will (e reCuired to under#o ad.ust"ents in her prosthetic devise due to
the shrin4a#e of the stu"p fro" the process of healin#.
These ad.ust"ents entail costs$ prosthetic replace"ents and "onths of ph)sical and occupational reha(ilitation and
therap). 8urin# her lifeti"e$ the prosthetic devise will have to (e replaced and read.usted to chan#es in the siJe of
her lower li"( effected () the (iolo#ical chan#es of "iddle-a#e$ "enopause and a#in#. Assu"in# she reaches
"enopause$ for e9a"ple$ the prosthetic will have to (e ad.usted to respond to the chan#es in (one resultin# fro" a
precipitate decrease in calciu" levels o(served in the (ones of all post-"enopausal wo"en. &n other words$ the
da"a#e done to her would not onl) (e per"anent and lastin#$ it would also (e per"anentl) chan#in# and ad.ustin#
to the ph)siolo#ic chan#es which her (od) would "ormall, under#o throu#h the )ears. The replace"ents$ chan#es$
and ad.ust"ents will reCuire correspondin# ad.ustive ph)sical and occupational therap). All of these ad.ust"ents$ it
has (een docu"ented$ are painful.
9 9 9.
A prosthetic devise$ however technolo#icall) advanced$ will onl) allow a reasona(le a"ount of functional restoration
of the "otor functions of the lower li"(. The sensor) functions are forever lost. The resultant an9iet)$
sleeplessness$ ps)cholo#ical in.ur)$ "ental and ph)sical pain are inesti"a(le.
[13]
The in.ur) suffered () Hrlinda as a conseCuence of private respondents? ne#li#ence is certainl) "uch "ore serious
than the a"putation in the 2ale"6uela case.
+etitioner Hrlinda Ra"os was in her "id-forties when the incident occurred. :he has (een in a co"atose state for
over fourteen )ears now. The (urden of care has so far (een heroicall) shouldered () her hus(and and children$
who$ in the intervenin# )ears have (een deprived of the love of a wife and a "other.
6eanwhile$ the actual ph)sical$ e"otional and financial cost of the care of petitioner would (e virtuall) i"possi(le to
Cuantif). Hven the te"perate da"a#es herein awarded would (e inadeCuate if petitioner?s condition re"ains
unchan#ed for the ne9t ten )ears.
=e reco#niJed$ in 2ale"6uela that a discussion of the victi"?s actual in.ur) would not even scratch the surface of the
resultin# "oral da"a#e (ecause it would (e hi#hl) speculative to esti"ate the a"ount of e"otional and "oral pain$
ps)cholo#ical da"a#e and in.ur) suffered () the victi" or those actuall) affected () the victi"?s condition.
[1>]
The
hus(and and the children$ all petitioners in this case$ will have to live with the da) to da) uncertaint) of the patient?s
illness$ 4nowin# an) hope of recover) is close to nil. The) have fashioned their dail) lives around the nursin# care of
petitioner$ alterin# their lon# ter" #oals to ta4e into account their life with a co"atose patient. The)$ not the
respondents$ are char#ed with the "oral responsi(ilit) of the care of the victi". The fa"il)?s "oral in.ur) and
sufferin# in this case is clearl) a real one. 0or the fore#oin# reasons$ an award of+;$<<<$<<<.<< in "oral da"a#es
would (e appropriate.
0inall)$ () wa) of e9a"ple$ e9e"plar) da"a#es in the a"ount of +1<<$<<<.<< are here() awarded. Considerin# the
len#th and nature of the instant suit we are of the opinion that attorne)?s fees valued at +1<<$<<<.<< are li4ewise
proper.
5ur courts face uniCue difficult) in ad.udicatin# "edical ne#li#ence cases (ecause ph)sicians are not insurers of life
and$ the) rarel) set out to intentionall) cause in.ur) or death to their patients. 7owever$ intent is i""aterial in
ne#li#ence cases (ecause where ne#li#ence e9ists and is proven$ the sa"e auto"aticall) #ives the in.ured a ri#ht to
reparation for the da"a#e caused.
Hsta(lished "edical procedures and practices$ thou#h in constant flu9 are devised for the purpose of preventin#
co"plications. A ph)sician?s e9perience with his patients would so"eti"es te"pt hi" to deviate fro" esta(lished
co""unit) practices$ and he "a) end a distin#uished career usin# unorthodo9 "ethods without incident. 7owever$
when failure to follow esta(lished procedure results in the evil precisel) sou#ht to (e averted () o(servance of the
procedure and a ne9us is "ade (etween the deviation and the in.ur) or da"a#e$ the ph)sician would necessaril) (e
called to account for it. &n the case at (ar$ the failure to o(serve pre-operative assess"ent protocol which would
have influenced the intu(ation in a salutar) wa) was fatal to private respondents? case.
5HERE-ORE$ the decision and resolution of the appellate court appealed fro" are here() "odified so as to award
in favor of petitioners$ and solidaril) a#ainst private respondents the followin#* 1E +1$3!;$<<<.<< as actual da"a#es
co"puted as of the date of pro"ul#ation of this decision plus a "onthl) pa)"ent of +1$<<<.<< up to the ti"e that
petitioner Hrlinda Ra"os e9pires or "iraculousl) survivesF ;E +;$<<<$<<<.<< as "oral da"a#es$ 3E +1$!<<$<<<.<< as
te"perate da"a#esF >E +1<<$<<<.<< each as e9e"plar) da"a#es and attorne)?s feesF and$ !E the costs of the suit.
SO ORDERED.
7avide. 8r.. C.8.. $

-&RS' D&1&S&ON

0RO-ESS&ONAL SER1&/ES, &N/.$
+etitioner$

- versus -


NA'&1&DAD a! ENR&;:E AGANA$
Respondents.
9 - - - - - - - - - - - - - - - - - - - - - - - 9
NA'&1&DAD <S)b$t#t)te! b+ ,er c,#(!re .AR/EL&NO
AGANA &&&, ENR&;:E AGANA, JR., E..A AGANA
ANDAYA, JES:S AGANA, a! RAY.:ND AGANA= a!
ENR&;:E AGANA$
+etitioners$

- versus -


J:AN -:EN'ES$
Respondent.
9- - - - - - - - - - - - - - - - - - - -- - - - 9
.&G:EL A.0&L$
+etitioner$


- versus -




NA'&1&DAD AGANA a! ENR&;:E AGANA$
Respondents.
G.R. No. 12>267










G.R. No. 12>4>7















G.R. No. 127560

+resent*

+GN5$ C.8.$ Chairperso"
:AN85VA,-GGT&HRRHP$
C5R5NA$
APCGNA$ and

R
GARC&A$ 88.

+ro"ul#ated*

January 31, 2!
?@ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ @ ?


8HC&:&5N

:AN85VA,-GGT&HRRHP$ 8.*


7ospitals$ havin# underta4en one of "an4ind?s "ost i"portant and delicate endeavors$ "ust assu"e the
#rave responsi(ilit) of pursuin# it with appropriate care. The care and service dispensed throu#h this hi#h trust$
however technical$ co"ple9 and esoteric its character "a) (e$ "ust "eet standards of responsi(ilit) co""ensurate
with the underta4in# to preserve and protect the health$ and indeed$ the ver) lives of those placed in the hospital?s
4eepin#.
[1]
Assailed in these three consolidated petitions for review on certiorari is the Court of Appeals?
8ecision
[;]
dated :epte"(er $ 122 in CA-G.R. CV No. >;<; and CA-G.R. :+ No. 3;121 affir"in# with
"odification the 8ecision
[3]
dated 6arch 13$ 1223 of the Re#ional Trial Court DRTCE$ %ranch 2$ KueJon Cit) in Civil
Case No. K->33;; and nullif)in# its 5rder dated :epte"(er ;1$ 1223.
The facts$ as culled fro" the records$ are*
5n April >$ 121>$ Natividad A#ana was rushed to the 6edical Cit) General7ospital D6edical Cit) 7ospitalE
(ecause of difficult) of (owel "ove"ent and (lood) anal dischar#e. After a series of "edical e9a"inations$ 8r.
6i#uel A"pil$ petitioner in G.R. No. 1;3!2<$ dia#nosed her to (e sufferin# fro" Acancer of the si#"oid.B
5n April 11$ 121>$ 8r. A"pil$ assisted () the "edical staff
[>]
of the6edical Cit) 7ospital$ perfor"ed an anterior
resection sur#er) on Natividad. 7e found that the "ali#nanc) in her si#"oid area had spread on her left ovar)$
necessitatin# the re"oval of certain portions of it. Thus$ 8r. A"pil o(tained the consent of Natividad?s hus(and$
HnriCue A#ana$ to per"it 8r. -uan 0uentes$ respondent in G.R. No. 1;>3$ to perfor" h)sterecto") on her.
After 8r. 0uentes had co"pleted the h)sterecto")$ 8r. A"pil too4 over$ co"pleted the operation and closed
the incision.
7owever$ the operation appeared to (e flawed. &n the correspondin# Record of 5peration dated April 11$
121>$ the attendin# nurses entered these re"ar4s*
A$*o9e co)t (acB#9 2
Aao)ce! to $)r9eo $earc,e! <$#c= !oe b)t to o aCa#( cot#)e 8or c(o$)re.D

5n April ;>$ 121>$ Natividad was released fro" the hospital. 7er hospital and "edical (ills$ includin# the
doctors? fees$ a"ounted to +<$<<<.<<.
After a couple of da)s$ Natividad co"plained of e9cruciatin# pain in her anal re#ion. :he consulted (oth 8r.
A"pil and 8r. 0uentes a(out it. The) told her that the pain was the natural conseCuence of the sur#er). 8r.
A"pil then reco""ended that she consult an oncolo#ist to e9a"ine the cancerous nodes which were not re"oved
durin# the operation.
5n 6a) 2$ 121>$ Natividad$ acco"panied () her hus(and$ went to theGnited :tates to see4 further treat"ent.
After four "onths of consultations and la(orator) e9a"inations$ Natividad was told she was free of cancer. 7ence$
she was advised to return to the +hilippines.
5n Au#ust 31$ 121>$ Natividad flew (ac4 to the +hilippines$ still sufferin# fro" pains. Two wee4s thereafter$
her dau#hter found a piece of #auJe protrudin# fro" her va#ina. Gpon (ein# infor"ed a(out it$ 8r. A"pil proceeded
to her house where he "ana#ed to e9tract () hand a piece of #auJe "easurin# 1.! inches in width. 7e then
assured her that the pains would soon vanish.
8r. A"pil?s assurance did not co"e true. &nstead$ the pains intensified$ pro"ptin# Natividad to see4 treat"ent
at the +ol)"edic General 7ospital. =hile confined there$ 8r. Ra"on GutierreJ detected the presence of another
forei#n o(.ect in her va#ina -- a foul-s"ellin# #auJe "easurin# 1.! inches in width which (adl) infected her va#inal
vault. A recto-va#inal fistula had for"ed in her reproductive or#ans which forced stool to e9crete throu#h the
va#ina. Another sur#ical operation was needed to re"ed) the da"a#e. Thus$ in 5cto(er 121>$ Natividad underwent
another sur#er).
5n Nove"(er 1;$ 121>$ Natividad and her hus(and filed with the RTC$ %ranch 2$ KueJon Cit) a co"plaint
for da"a#es a#ainst the +rofessional :ervices$ &nc. D+:&E$ owner of the 6edical Cit) 7ospital$ 8r. A"pil$ and
8r. 0uentes$ doc4eted as Civil Case No. K->33;;. The) alle#ed that the latter are lia(le for e9(#9ece for leavin#
two pieces of #auJe inside Natividad?s (od) and"a(*ract#ce for concealin# their acts of ne#li#ence.
6eanwhile$ HnriCue A#ana also filed with the +rofessional Re#ulation Co""ission D+RCE an ad"inistrative
co"plaint for #ross ne#li#ence and "alpractice a#ainst 8r. A"pil and 8r. 0uentes$ doc4eted as Ad"inistrative Case
No. 12<. The +RC %oard of 6edicine heard the case onl) with respect to 8r. 0uentes (ecause it failed to acCuire
.urisdiction over 8r. A"pil who was then in the Gnited :tates.
5n 0e(ruar) 1$ 121$ pendin# the outco"e of the a(ove cases$ Natividad died and was dul) su(stituted ()
her a(ove-na"ed children Dthe A#anasE.
5n 6arch 13$ 1223$ the RTC rendered its 8ecision in favor of the A#anas$ findin# +:&$ 8r. A"pil and 8r.
0uentes lia(le for ne#li#ence and "alpractice$ the decretal part of which reads*
5HERE-ORE$ .ud#"ent is here() rendered for the plaintiffs orderin# the defendants 0RO-ESS&ONAL
SER1&/ES, &N/., DR. .&G:EL A.0&L andDR. J:AN -:EN'ES to pa) to the plaintiffs$ .ointl) and severall)$ e9cept
in respect of the award for e9e"plar) da"a#es and the interest thereon which are the lia(ilities of defendants 8r.
A"pil and 8r. 0uentes onl)$ as follows*

1. As actual da"a#es$ the followin# a"ounts*

a. The eCuivalent in +hilippine Currenc) of the total of G:S12$2<<.<< at the rate of +;1.<-G:S1.<<$ as
rei"(urse"ent of actual e9penses incurred in the Gnited :tates of A"ericaF

(. The su" of +>$1<<.<< as travel ta9es of plaintiffs and their ph)sician dau#hterF

c. The total su" of +>!$1<;.!<$ representin# the cost of hospitaliJation at +ol)"edic 7ospital$ "edical fees$ and
cost of the saline solutionF

;. As "oral da"a#es$ the su" of +;$<<<$<<<.<<F

3. As e9e"plar) da"a#es$ the su" of +3<<$<<<.<<F

>. As attorne)?s fees$ the su" of +;!<$<<<.<<F

!. ,e#al interest on ite"s 1 DaE$ D(E$ and DcEF ;F and 3 hereina(ove$ fro" date of filin# of the co"plaint until full
pa)"entF and

. Costs of suit.

SO ORDERED.


A##rieved$ +:&$ 8r. 0uentes and 8r. A"pil interposed an appeal to the Court of Appeals$ doc4eted as CA-G.R. CV
No. >;<;.
&ncidentall)$ on April 3$ 1223$ the A#anas filed with the RTC a "otion for a partial e9ecution of its 8ecision$
which was #ranted in an 5rder dated 6a) 11$ 1223. Thereafter$ the sheriff levied upon certain properties of 8r.
A"pil and sold the" for +>!1$;3!.<< and delivered the a"ount to the A#anas.
0ollowin# their receipt of the "one)$ the A#anas entered into an a#ree"ent with +:& and 8r. 0uentes to
indefinitel) suspend an) further e9ecution of the RTC 8ecision. 7owever$ not lon# thereafter$ the A#anas a#ain filed
a "otion for an alias writ of e9ecution a#ainst the properties of +:& and 8r. 0uentes. 5nSe*te"ber 21, 1663$ the
RTC #ranted the "otion and issued the correspondin# writ$ pro"ptin# 8r. 0uentes to file with the Court of Appeals a
petition for certiorari and prohi(ition$ with pra)er for preli"inar) in.unction$ doc4eted as CA-G.R. :+ No.
3;121. 8urin# its pendenc)$ the Court of Appeals issued a Resolution
[!]
dated 5cto(er ;2$ 1223 #rantin# 8r.
0uentes? pra)er for in.unctive relief.
5n -anuar) ;>$ 122>$ CA-G.R. :+ No. 3;121 was consolidated with CA-G.R. CV No. >;<;.
6eanwhile$ on -anuar) ;3$ 122!$ the +RC %oard of 6edicine rendered its 8ecision
[]
in Ad"inistrative Case
No. 12< dis"issin# the case a#ainst 8r. 0uentes. The %oard held that the prosecution failed to show that 8r.
0uentes was the one who left the two pieces of #auJe inside Natividad?s (od)F and that he concealed such fact fro"
Natividad.
5n :epte"(er $ 122$ the Court of Appeals rendered its 8ecision .ointl) disposin# of CA-G.R. CV No. >;<;
and CA-G.R. :+ No. 3;121$ thus*
5HERE-ORE, e9cept for the "odification that the case a#ainst defendant-appellant 8r. -uan 0uentes is
here() "IS#ISS$"$ and with the pronounce"ent that defendant-appellant 8r. 6i#uel A"pil is lia(le to rei"(urse
defendant-appellant 0ro8e$$#oa( SerC#ce$, &c.$ whatever a"ount the latter will pa) or had paid to the plaintiffs-
appellees$ the decision appealed fro" is here()A--&R.ED and the instant appeal D&S.&SSED.

Conco"itant with the a(ove$ the petition for certiorari and prohi(ition filed () herein defendant-appellant 8r.
-uan 0uentes in CA-G.R. :+ No. 3;121 is here() GRAN'ED and the challen#ed order of the respondent .ud#e
dated:epte"(er ;1$ 1223$ as well as the alias writ of e9ecution issued pursuant thereto are
here() N:LL&-&ED and SE' AS&DE. The (ond posted () the petitioner in connection with the writ of preli"inar)
in.unction issued () this Court on Nove"(er ;2$ 1223 is here() cancelled.

Costs a#ainst defendants-appellants Dr. .#9)e( A"*#( and 0ro8e$$#oa( SerC#ce$, &c.

SO ORDERED.

5nl) 8r. A"pil filed a "otion for reconsideration$ (ut it was denied in a Resolution
[3]
dated 8ece"(er 12$ 122.
7ence$ the instant consolidated petitions.
&n 9.R. :o. )40451$ +:& alle#ed in its petition that the Court of Appeals erred in holdin# that* <1= it is estopped
fro" raisin# the defense that 8r. A"pil is not its e"plo)eeF <2= it is solidaril) lia(le with 8r. A"pilF and <3= it is not
entitled to its counterclai" a#ainst the A#anas. +:& contends that 8r. A"pil is not its e"plo)ee$ (ut a "ere
consultant or independent contractor. As such$ he alone should answer for his ne#li#ence.
&n 9.R. :o. )40;01$ the A#anas "aintain that the Court of Appeals erred in findin# that 8r. 0uentes is not
#uilt) of ne#li#ence or "edical "alpractice$ invo4in# the doctrine of res ipsa loquitur. The) contend that the pieces
of #auJe are prima fa#ie proofs that the operatin# sur#eons have (een ne#li#ent.
0inall)$ in 9.R. :o. )41%5&$ 8r. A"pil asserts that the Court of Appeals erred in findin# hi" lia(le for
ne#li#ence and "alpractice sa"s evidence that he left the two pieces of #auJe in Natividad?s va#ina. 7e pointed to
other pro(a(le causes$ such as* <1= it was 8r. 0uentes who used #auJes in perfor"in# the h)sterecto")F <2= the
attendin# nurses? failure to properl) count the #auJes used durin# sur#er)F and <3= the "edical intervention of the
A"erican doctors who e9a"ined Natividad in the Gnited :tates of A"erica.
0or our resolution are these three vital issues* first. whether the Court of Appeals erred in holdin# 8r. A"pil lia(le for
ne#li#ence and "alpracticeF se#o"d.whether the Court of Appeals erred in a(solvin# 8r. 0uentes of an) lia(ilit)F
andthird. whether +:& "a) (e held solidaril) lia(le for the ne#li#ence of 8r. A"pil.
& @ G.R. No. 127560
%&et&er t&e 'ourt of Appeals $rred in (olding "r. A)pil
Lia*le for Negligence and #alpractice.

8r. A"pil$ in an atte"pt to a(solve hi"self$ #ears the Court?s attention to other possi(le causes of Natividad?s
detri"ent. 7e ar#ues that the Court should not discount either of the followin# possi(ilities* first$ 8r. 0uentes
left the #auJes in Natividad?s (od) after perfor"in# h)sterecto")F se#o"d. the attendin# nurses erred in countin# the
#auJesF and third. the A"erican doctors were the ones who placed the #auJes in Natividad?s (od).
8r. A"pil?s ar#u"ents are purel) con.ectural and without (asis. Records show that he did not present an) evidence
to prove that the A"erican doctors were the ones who put or left the #auJes in Natividad?s (od). Neither did he
su("it evidence to re(ut the correctness of the record of operation$ particularl) the nu"(er of #auJes used. As to
the alle#ed ne#li#ence of 8r. 0uentes$ we are "indful that 8r. A"pil e9a"ined his D8r. 0uentes?E wor4 and found it
in order.
The #larin# truth is that all the "a.or circu"stances$ ta4en to#ether$ as specified () the Court of Appeals$
directl) point to 8r. A"pil as the ne#li#ent part)$ thus*
<irst$ it is not disputed that the sur#eons used #auJes as spon#es to control the (leedin# of the patient durin# the
sur#ical operation.
Se#o"d. i""ediatel) after the operation$ the nurses who assisted in the sur#er) noted in their report that the Tspon#e
count DwasE lac4in# ;?F t,at $)c, ao"a(+ 7a$ Eao)ce! to $)r9eoF a! t,at a E$earc, 7a$ !oe b)t to o
aCa#(F *ro"*t#9 Dr. A"*#( to Ecot#)e 8or c(o$)reF 9 9 9.
Third. after the operation$ two D;E #auJes were e9tracted fro" the sa"e spot of the (od) of 6rs. A#ana where the
sur#er) was perfor"ed.

An operation reCuirin# the placin# of spon#es in the incision is not co"plete until the spon#es are properl) re"oved$
and it is settled that the leavin# of spon#es or other forei#n su(stances in the wound after the incision has (een
closed is at least prima fa#ie ne#li#ence () the operatin# sur#eon.
[1]
To put it si"pl)$ such act is considered so
inconsistent with due care as to raise an inference of ne#li#ence. There are even le#ions of authorities to the effect
that such act is e9(#9ece per se.
[2]

5f course$ the Court is not (lind to the realit) that there are ti"es when dan#er to a patient?s life precludes a sur#eon
fro" further searchin# "issin# spon#es or forei#n o(.ects left in the (od). 2)t t,#$ !oe$ ot (eaCe ,#" 8ree 8ro"
a+ ob(#9at#o. Hven if it has (een shown that a sur#eon was reCuired () the ur#ent necessities of the case to
leave a spon#e in his patient?s a(do"en$ (ecause of the dan#ers attendant upon dela)$ $t#((, #t #$ ,#$ (e9a( !)t+ to
$o #8or" ,#$ *at#et 7#t,# a rea$oab(e t#"e t,erea8ter b+ a!C#$#9 ,er o8 7,at ,e ,a! bee co"*e((e! to
!o. This is in order that she "i#ht see4 relief fro" the effects of the forei#n o(.ect left in her (od) as her condition
"i#ht per"it. The rulin# in Smith v. =eagler
+1,
is e9plicit$ thus*

The re"oval of all spon#es used is part of a sur#ical operation$ and when a ph)sician or sur#eon fails to re"ove a
spon#e he has placed in his patient?s (od) that should (e re"oved as part of the operation$ he there() leaves his
operation unco"pleted and create$ a e7 co!#t#o 7,#c, #"*o$e$ )*o ,#" t,e (e9a( !)t+ o8 ca((#9 t,e e7
co!#t#o to ,#$ *at#etF$ attet#o, a! e!eaCor#9 7#t, t,e "ea$ ,e ,a$ at ,a! to "##"#Ge a! aCo#!
)to7ar! re$)(t$ (#Be(+ to e$)e t,ere8ro".

7ere$ 8r. A"pil did not infor" Natividad a(out the "issin# two pieces of #auJe. 5or$e, ,e eCe "#$(e! ,er t,at
t,e *a# $,e 7a$ e?*er#ec#9 7a$ t,e or!#ar+ co$eH)ece o8 ,er o*erat#o. 7ad he (een "ore candid$
Natividad could have ta4en the i""ediate and appropriate "edical re"ed) to re"ove the #auJes fro" her
(od). To our "ind$ what was initiall) an act of ne#li#ence () 8r. A"pil has ripened into a deli(erate wron#ful act of
deceivin# his patient.
This is a clear case of "edical "alpractice or "ore appropriatel)$ "edical ne#li#ence. To successfull) pursue this
4ind of case$ a patient "ust onl) prove that a health care provider either failed to do so"ethin# which a reasona(l)
prudent health care provider would have done$ or that he did so"ethin# that a reasona(l) prudent provider would not
have doneF and that failure or action caused in.ur) to the patient.
[11]
:i"pl) put$ the ele"ents
are !)t+$ breac,$#I)r+ and *ro?#"ate ca)$at#o. 8r$ A"pil$ as the lead sur#eon$ had the dut) to re"ove all
forei#n o(.ects$ such as #auJes$ fro" Natividad?s (od) (efore closure of the incision. =hen he failed to do so$ it
was his dut) to infor" Natividad a(out it. 8r. A"pil (reached (oth duties. :uch (reach caused in.ur) to Natividad$
necessitatin# her further e9a"ination () A"erican doctors and another sur#er). That 8r. A"pil?s ne#li#ence is the
pro9i"ate cause
[1;]
of Natividad?s in.ur) could (e traced fro" his act o8 c(o$#9 t,e #c#$#o !e$*#te t,e
#8or"at#o 9#Ce b+ t,e atte!#9 )r$e$ t,at t7o *#ece$ o8 9a)Ge 7ere $t#(( "#$$#9. That the) were later on
e9tracted fro" Natividad?s va#ina esta(lished the causal lin4 (etween 8r. A"pil?s ne#li#ence and the in.ur). And
what further a##ravated such in.ur) was his deli(erate conceal"ent of the "issin# #auJes fro" the 4nowled#e of
Natividad and her fa"il).
&& @ G.R. No. 12>4>7
%&et&er t&e 'ourt of Appeals $rred in A*solving
"r. -uentes of any Lia*ility


The A#anas assailed the dis"issal () the trial court of the case a#ainst 8r. 0uentes on the #round that it is
contrar) to the doctrine of res ipsa loquitur. Accordin# to the"$ the fact that the two pieces of #auJe were left inside
Natividad?s (od) is a prima fa#ie evidence of 8r. 0uentes? ne#li#ence.
=e are not convinced.
,iterall)$ res ipsa loquitur "eans Athe thin# spea4s for itself.B &t is the rule that the fact of the occurrence of an
in.ur)$ ta4en with the surroundin# circu"stances$ "a) per"it an inference or raise a presu"ption of ne#li#ence$ or
"a4e out a plaintiff?s prima fa#ie case$ and present a Cuestion of fact for defendant to "eet with an e9planation.
[13]
:tated differentl)$ where the thin# which caused the in.ur)$ without the fault of the in.ured$ is under the e9clusive
control of the defendant and the in.ur) is such that it should not have occurred if he$ havin# such control used proper
care$ #t a88or!$ rea$oab(e eC#!ece$ in the a(sence of e9planation that the in.ur) arose fro" the defendant?s want
of care$ and the (urden of proof is shifted to hi" to esta(lish that he has o(served due care and dili#ence.
[1>]
0ro" the fore#oin# state"ents of the rule$ the reCuisites for the applica(ilit) of the doctrine of res ipsa
loquitur are* <1= the occurrence of an in.ur)F <2= the thin# which caused the in.ur) was under the control and
"ana#e"ent of the defendantF <3= the occurrence was such that in the ordinar) course of thin#s$ would not have
happened if those who had control or "ana#e"ent used proper careF and <4= the a(sence of e9planation () the
defendant. 5f the fore#oin# reCuisites$ the "ost instru"ental is the Acotro( a! "aa9e"et o8 t,e t,#9 7,#c,
ca)$e! t,e #I)r+.B
[1!]
=e find the ele"ent of Acontrol and "ana#e"ent of the thin# which caused the in.ur)B to (e wantin#. 7ence$
the doctrine of res ipsa loquitur will not lie.
&t was dul) esta(lished that 8r. A"pil was the (ea! $)r9eo durin# the operation of Natividad. 7e reCuested
the assistance of 8r. 0uentes onl) to perfor" h)sterecto") when he D8r. A"pilE found that the "ali#nanc) in her
si#"oid area had spread to her left ovar). 8r. 0uentes perfor"ed the sur#er) and thereafter reported and showed
his wor4 to 8r. A"pil. ',e (atter e?a"#e! #t a! 8#!#9 eCer+t,#9 to be # or!er, a((o7e! Dr. -)ete$ to
(eaCe t,e o*erat#9 roo". 8r. A"pil then resu"ed operatin# on Natividad. 7e was a(out to finish the procedure
when the attendin# nurses infor"ed hi" that two pieces of #auJe were "issin#. A Adili#ent searchB was conducted$
(ut the "isplaced #auJes were not found. Dr. A"*#( t,e !#recte! t,at t,e #c#$#o be c(o$e!. 8urin# this entire
period$ 8r. 0uentes was no lon#er in the operatin# roo" and had$ in fact$ left the hospital.
Gnder the A/a*ta# o8 t,e S,#*B rule$ the operatin# sur#eon is the person in co"plete char#e of the sur#er)
roo" and all personnel connected with the operation. Their dut) is to o(e) his orders.
[1]
As stated (efore, Dr.
A"*#( 7a$ t,e (ea! $)r9eo. &n other words$ he was the ACaptain of the :hip.B That he dischar#ed such role is
evident fro" his followin# conduct* <1= callin# 8r. 0uentes to perfor" a h)sterecto")F <2= e9a"inin# the wor4 of 8r.
0uentes and findin# it in orderF <3= #rantin# 8r. 0uentes? per"ission to leaveF and <4= orderin# the closure of the
incision. 'o o)r "#!, it 7a$ t,#$ act o8 or!er#9 t,e c(o$)re o8 t,e #c#$#o ot7#t,$ta!#9 t,at t7o *#ece$ o8
9a)Ge re"a#e! )acco)te! 8or, t,at ca)$e! #I)r+ to Nat#C#!a!F$ bo!+. Clearl)$ the control and "ana#e"ent
of the thin# which caused the in.ur) was in the hands of 8r. A"pil$ not 8r. 0uentes.
&n this .urisdiction$ res ipsa loquitur is not a rule of su(stantive law$ hence$ does not per se create or constitute
an independent or separate #round of lia(ilit)$ (ein# a "ere evidentiar) rule.
[13]
&n other words$ "ere invocation and
application of the doctrine does not dispense with the reCuire"ent of proof of ne#li#ence. 7ere$ the ne#li#ence was
proven to have (een co""itted () 8r. A"pil and not () 8r. 0uentes.


&&& @ G.R. No. 12>267
%&et&er .SI Is Lia*le for t&e Negligence of "r. A)pil

The third issue necessitates a #li"pse at the historical develop"ent of hospitals and the resultin# theories
concernin# their lia(ilit) for the ne#li#ence of ph)sicians.
Gntil the "id-nineteenth centur)$ hospitals were #enerall) charita(le institutions$ providin# "edical services to
the lowest classes of societ)$ without re#ard for a patient?s a(ilit) to pa).
[11]
Those who could afford "edical
treat"ent were usuall) treated at ho"e () their doctors.
[12]
7owever$ the da)s of house calls and philanthropic
health care are over. The "odern health care industr) continues to distance itself fro" its charita(le past and has
e9perienced a si#nificant conversion fro" a not-for-profit health care to for-profit hospital (usinesses. ConseCuentl)$
si#nificant chan#es in health law have acco"panied the (usiness-related chan#es in the hospital industr). 5ne
i"portant le#al chan#e is an increase in hospital lia(ilit) for "edical "alpractice. 6an) courts now allow clai"s for
hospital vicarious lia(ilit) under the theories of respo"deat superior$ apparent authorit)$ ostensi(le authorit)$ or
a#enc) () estoppel.
[;<]

&n this .urisdiction$ the statute #overnin# lia(ilit) for ne#li#ent acts is Article ;13 of the Civil Code$ which reads*
Art. 217>. =hoever () act or o"ission causes da"a#e to another$ there (ein# fault or ne#li#ence$ is o(li#ed to
pa) for the da"a#e done. :uch fault or ne#li#ence$ if there is no pre-e9istin# contractual relation (etween the
parties$ is called a Cuasi-delict and is #overned () the provisions of this Chapter.

A derivative of this provision is Article ;11<$ the rule #overnin# vicarious lia(ilit) under the doctrine of respo"deat
superior. thus*
ART. ;11<. The o(li#ation i"posed () Article ;13 is de"anda(le not onl) for one?s own acts or o"issions$
(ut also for those of persons for who" one is responsi(le.
9 9 9 9 9 9
The owners and "ana#ers of an esta(lish"ent or enterprise are li4ewise responsi(le for da"a#es caused ()
their e"plo)ees in the service of the (ranches in which the latter are e"plo)ed or on the occasion of their functions.

H"plo)ers shall (e lia(le for the da"a#es caused () their e"plo)ees and household helpers actin# within
the scope of their assi#ned tas4s even thou#h the for"er are not en#a#ed in an) (usiness or industr).
9 9 9 9 9 9
The responsi(ilit) treated of in this article shall cease when the persons herein "entioned prove that the)
o(served all the dili#ence of a #ood father of a fa"il) to prevent da"a#e.


A pro"inent civilist co""ented that professionals en#a#ed () an e"plo)er$ such as ph)sicians$ dentists$ and
phar"acists$ are not Ae"plo)eesB under this article (ecause the "anner in which the) perfor" their wor4 is not
within the control of the latter De"plo)erE. & ot,er 7or!$, *ro8e$$#oa($ are co$#!ere! *er$oa((+ (#ab(e 8or t,e
8a)(t or e9(#9ece t,e+ co""#t # t,e !#$c,ar9e o8 t,e#r !)t#e$, a! t,e#r e"*(o+er caot be ,e(! (#ab(e 8or
$)c, 8a)(t or e9(#9ece. &n the conte9t of the present case$ Aa hospital cannot (e held lia(le for the fault or
ne#li#ence of a ph)sician or sur#eon in the treat"ent or operation of patients.B
[;1]

The fore#oin# view is #rounded on the tra!#t#oa( notion that the professional status and the ver) nature of
the ph)sician?s callin# preclude hi" fro" (ein# classed as an a#ent or e"plo)ee of a hospital$ whenever he acts in
a professional capacit).
[;;]
&t has (een said that "edical practice strictl) involves hi#hl) developed and specialiJed
4nowled#e$
[;3]
such that ph)sicians are #enerall) 8ree to e9ercise their own s4ill and .ud#"ent in renderin# "edical
services sa"s #ter8erece.
[;>]
7ence$ when a doctor practices "edicine in a hospital settin#$ the hospital and its
e"plo)ees are dee"ed to su(serve hi" in his "inistrations to the patient and his actions are of his own
responsi(ilit).
[;!]
The case of S#hloe"dorff v. So#iet, of :e! >or ?ospital
[;]
was then considered an authorit) for this view.
The AS#hloe"dorff doctrineB re#ards a ph)sician$ even if e"plo)ed () a hospital$ as an #!e*e!et
cotractor(ecause of the s4ill he e9ercises and the lac4 of control e9erted over his wor4. Gnder this doctrine$
hospitals are e9e"pt fro" the application of the respo"deatsuperior principle for fault or ne#li#ence co""itted ()
ph)sicians in the dischar#e of their profession.
7owever$ the efficac) of the fore#oin# doctrine has wea4ened with the si#nificant develop"ents in "edical
care. Courts ca"e to realiJe that "odern hospitals are increasin#l) ta4in# active role in suppl)in# and re#ulatin#
"edical care to patients. No lon#er were a hospital?s functions li"ited to furnishin# roo"$ food$ facilities for treat"ent
and operation$ and attendants for its patients. Thus$ in 3i"g v. Thu"ig.
[;3]
the New Ior4 Court of Appeals deviated
fro" theS#hloe"dorff doctrine$ notin# that "odern hospitals actuall) do far "ore than provide facilities for
treat"ent. Rather$ the) re#ularl) e"plo)$ on a salaried (asis$ a lar#e staff of ph)sicians$ interns$ nurses$
ad"inistrative and "anual wor4ers. The) char#e patients for "edical care and treat"ent$ even collectin# for such
services throu#h le#al action$ if necessar). The court then concluded that there is no reason to e9e"pt hospitals
fro" the universal rule of respo"deat superior.
&n our shores$ the nature of the relationship (etween the hospital and the ph)sicians is rendered
inconseCuential in view of our cate#orical pronounce"ent in Ramos v. Court of Appeals
[;1]
that for purposes of
apportionin# responsi(ilit) in "edical ne#li#ence cases$ a e"*(o+er@e"*(o+ee re(at#o$,#* # e88ect e?#$t$
bet7ee ,o$*#ta($ a! t,e#r atte!#9 a! C#$#t#9 *,+$#c#a$. This Court held*
A=e now discuss the responsi(ilit) of the hospital in this particular incident. The uniCue practice Da"on# private
hospitalsE of fillin# up specialist staff with attendin# and visitin# Aconsultants$B who are alle#edl) not hospital
e"plo)ees$ presents pro(le"s in apportionin# responsi(ilit) for ne#li#ence in "edical "alpractice cases. 7owever$
the difficult) is "ore apparent than real.
& t,e 8#r$t *(ace, ,o$*#ta($ e?erc#$e $#9#8#cat cotro( # t,e ,#r#9 a! 8#r#9 o8 co$)(tat$ a! # t,e
co!)ct o8 t,e#r 7orB 7#t,# t,e ,o$*#ta( *re"#$e$. Doctor$ 7,o a**(+ 8or Eco$)(tatF $(ot$, C#$#t#9 or
atte!#9, are reH)#re! to $)b"#t *roo8 o8 co"*(et#o o8 re$#!ec+, t,e#r e!)cat#oa( H)a(#8#cat#o$,
9eera((+, eC#!ece o8 accre!#tat#o b+ t,e a**ro*r#ate boar! <!#*(o"ate=, eC#!ece o8 8e((o7$,#* # "o$t
ca$e$, a! re8erece$. ',e$e reH)#re"et$ are care8)((+ $cr)t##Ge! b+ "e"ber$ o8 t,e ,o$*#ta(
a!"##$trat#o or b+ a reC#e7 co""#ttee $et )* b+ t,e ,o$*#ta( 7,o e#t,er acce*t or reIect t,e
a**(#cat#o. 9 9 9.
A8ter a *,+$#c#a #$ acce*te!, e#t,er a$ a C#$#t#9 or atte!#9 co$)(tat, ,e #$ or"a((+ reH)#re! to atte!
c(##co@*at,o(o9#ca( co8erece$, co!)ct be!$#!e ro)!$ 8or c(erB$, #ter$ a! re$#!et$, "o!erate 9ra!
ro)!$ a! *at#et a)!#t$ a! *er8or" ot,er ta$B$ a! re$*o$#b#(#t#e$, 8or t,e *r#C#(e9e o8 be#9 ab(e to
"a#ta# a c(##c # t,e ,o$*#ta(, a!Jor 8or t,e *r#C#(e9e o8 a!"#tt#9 *at#et$ #to t,e ,o$*#ta(. &n addition to
these$ the ph)sician?s perfor"ance as a specialist is #enerall) evaluated () a peer review co""ittee on the (asis of
"ortalit) and "or(idit) statistics$ and feed(ac4 fro" patients$ nurses$ interns and residents. A co$)(tat re"#$$ #
,#$ !)t#e$, or a co$)(tat 7,o re9)(ar(+ 8a(($ $,ort o8 t,e "##")" $ta!ar!$ acce*tab(e to t,e ,o$*#ta( or
#t$ *eer reC#e7 co""#ttee, #$ or"a((+ *o(#te(+ ter"#ate!.
& ot,er 7or!$, *r#Cate ,o$*#ta($, ,#re, 8#re a! e?erc#$e rea( cotro( oCer t,e#r atte!#9 a! C#$#t#9
Eco$)(tatF $ta88. 5,#(e Eco$)(tat$F are ot, tec,#ca((+ e"*(o+ee$, ? ? ?, t,e cotro( e?erc#$e!, t,e
,#r#9, a! t,e r#9,t to ter"#ate co$)(tat$ a(( 8)(8#(( t,e #"*ortat ,a(("arB$ o8 a e"*(o+er@e"*(o+ee
re(at#o$,#*, 7#t, t,e e?ce*t#o o8 t,e *a+"et o8 7a9e$. &n assessin# whether such a relationship in fact
e9ists$ the control test is deter"inin#. Accordin#l)$ on the (asis of the fore#oin#$ 7e r)(e t,at 8or t,e *)r*o$e o8
a((ocat#9 re$*o$#b#(#t+ # "e!#ca( e9(#9ece ca$e$, a e"*(o+er@e"*(o+ee re(at#o$,#* # e88ect e?#$t$
bet7ee ,o$*#ta($ a! t,e#r atte!#9 a! C#$#t#9 *,+$#c#a$. D


%ut the Ramos pronounce"ent is not our onl) (asis in sustainin# +:&?s lia(ilit). &ts lia(ilit) is also anchored upon the
a#enc) principle of a**aret a)t,or#t+ or a9ec+ b+ e$to**e( and the doctrine of cor*orate
e9(#9ecewhich have #ained acceptance in the deter"ination of a hospital?s lia(ilit) for ne#li#ent acts of health
professionals. The present case serves as a perfect platfor" to test the applica(ilit) of these doctrines$ thus$
enrichin# our .urisprudence.
Apparent authorit)$ or what is so"eti"es referred to as the A,o(!#9 o)tD theor)$ or doctrine of o$te$#b(e
a9ec+ or a9ec+ b+ e$to**e($
[;2]
has its ori#in fro" the law of a#enc). &t i"poses lia(ilit)$ not as the result of the
realit) of a contractual relationship$ (ut rather (ecause of the actions of a principal or an e"plo)er in so"ehow
"isleadin# the pu(lic into (elievin# that the relationship or the authorit) e9ists.
[3<]
The concept is essentiall) one of
estoppel and has (een e9plained in this "anner*
AThe principal is (ound () the acts of his a#ent with the apparent authorit) which he 4nowin#l) per"its the
a#ent to assu"e$ or which he holds the a#ent out to the pu(lic as possessin#. The Cuestion in ever) case is whether
the principal has () his voluntar) act placed the a#ent in such a situation that a person of ordinar) prudence$
conversant with (usiness usa#es and the nature of the particular (usiness$ is .ustified in presu"in# that such a#ent
has authorit) to perfor" the particular act in Cuestion.
[31]

The applica(ilit) of apparent authorit) in the field of hospital lia(ilit) was upheld lon# ti"e a#o in Irvi"g v. 7o#tor
?ospital of Lae @orth. I"#.
[3;]
There$ it was e9plicitl) stated that At,ere !oe$ ot a**ear to be a+ rat#oa( ba$#$
8or e?c()!#9 t,e coce*t o8 a**aret a)t,or#t+ 8ro" t,e 8#e(! o8 ,o$*#ta( (#ab#(#t+.D Thus$ in cases where it can
(e shown that a hospital$ () its actions$ has held out a particular ph)sician as its a#ent andMor e"plo)ee and that a
patient has accepted treat"ent fro" that ph)sician in the reasona(le (elief that it is (ein# rendered in (ehalf of the
hospital$ then the hospital will (e lia(le for the ph)sician?s ne#li#ence.
5ur .urisdiction reco#niJes the concept of an a#enc) () i"plication or estoppel. Article 112 of the Civil Code reads*
AR'. 1K>6. A#enc) "a) (e e9press$ or i"plied fro" the acts of the principal$ fro" his silence or lac4 of action$
or his failure to repudiate the a#enc)$ 4nowin# that another person is actin# on his (ehalf without authorit).


&n this case$ +:& pu(licl) displa)s in the lo(() of the 6edical Cit)7ospital the na"es and specialiJations of the
ph)sicians associated or accredited () it$ includin# those of 8r. A"pil and 8r. 0uentes. =e concur with the Court of
Appeals? conclusion that it A#$ o7 e$to**e! 8ro" *a$$#9 a(( t,e b(a"e to t,e *,+$#c#a$ 7,o$e a"e$ #t
*ro)!(+ *ara!e! # t,e *)b(#c !#rector+ (ea!#9 t,e *)b(#c to be(#eCe t,at #t Co)c,e! 8or t,e#r $B#(( a!
co"*etece.B &ndeed$ +:&?s act is tanta"ount to holdin# out to the pu(lic that6edical Cit) 7ospital$ t,ro)9, #t$
accre!#te! *,+$#c#a$$ offers Cualit) health care services. %) accreditin# 8r. A"pil and 8r. 0uentes and pu(licl)
advertisin# their Cualifications$ the hospital created the i"pression that the) were its a#ents$ authoriJed to perfor"
"edical or sur#ical services for its patients. As e9pected$ these patients$ Natividad (ein# one of the"$ accepted the
services on the reasona(le (elief that such were (ein# rendered () the hospital or its e"plo)ees$ a#ents$ or
servants. The trial court correctl) pointed out*
9 9 9 re9ar!(e$$ o8 t,e e!)cat#o a! $tat)$ # (#8e o8 t,e *at#et, ,e o)9,t ot be b)r!ee! 7#t, t,e !e8e$e
o8 ab$ece o8 e"*(o+er@e"*(o+ee re(at#o$,#* bet7ee t,e ,o$*#ta( a! t,e #!e*e!et *,+$#c#a 7,o$e
a"e a! co"*etece are certa#(+ cert#8#e! to t,e 9eera( *)b(#c b+ t,e ,o$*#ta(F$ act o8 (#$t#9 ,#" a! ,#$
$*ec#a(t+ # #t$ (obb+ !#rector+, a$ # t,e ca$e ,ere#. ',e ,#9, co$t$ o8 to!a+F$ "e!#ca( a! ,ea(t, care
$,o)(! at (ea$t e?act o t,e ,o$*#ta( 9reater, #8 ot broa!er, (e9a( re$*o$#b#(#t+ 8or t,e co!)ct o8 treat"et
a! $)r9er+ 7#t,# #t$ 8ac#(#t+ b+ #t$ accre!#te! *,+$#c#a or $)r9eo, re9ar!(e$$ o8 7,et,er ,e #$
#!e*e!et or e"*(o+e!.D
[33]


The wisdo" of the fore#oin# ratiocination is eas) to discern. Corporate entities$ li4e +:&$ are capa(le of actin# onl)
throu#h other individuals$ such as ph)sicians. &f these accredited ph)sicians do their .o( well$ the hospital succeeds
in its "ission of offerin# Cualit) "edical services and thus *ro8#t$ 8#ac#a((+. ,o#icall)$ where ne#li#ence "ars the
Cualit) of its services$ the hospital should not (e allowed to escape lia(ilit) for the acts of its ostensi(le a#ents.
=e now proceed to the doctrine of cor*orate e9(#9ece or cor*orate re$*o$#b#(#t+.
5ne alle#ation in the co"plaint in Civil Case No. K->333; for ne#li#ence and "alpractice is that +:& as owner$
operator and "ana#er of 6edical Cit)7ospital$ A!#! ot *er8or" t,e ece$$ar+ $)*erC#$#o or e?erc#$e !#(#9et
e88ort$ # t,e $)*erC#$#o o8 Dr$. A"*#( a! -)ete$ a! #t$ )r$#9 $ta88, re$#!et !octor$, a! "e!#ca(
#ter$ 7,o a$$#$te! Dr$. A"*#( a! -)ete$ # t,e *er8or"ace o8 t,e#r !)t#e$ a$ $)r9eo$.B
[3>]
+re"ised on
the doctrine of corporate ne#li#ence$ the trial court held that +:& is !#rect(+ (#ab(efor such (reach of dut).
=e a#ree with the trial court.
Recent )ears have seen the doctrine of corporate ne#li#ence as the .udicial answer to the pro(le" of
allocatin# hospital?s lia(ilit) for the ne#li#ent acts of health practitioners$ a(sent facts to support the application
of respo"deat superior or apparent authorit). &ts for"ulation proceeds fro" the .udiciar)?s ac4nowled#"ent that in
these "odern ti"es$ the dut) of providin# Cualit) "edical service is no lon#er the sole prero#ative and responsi(ilit)
of the ph)sician. The "odern hospitals have chan#ed structure. 7ospitals now tend to or#aniJe a hi#hl) professional
"edical staff whose co"petence and perfor"ance need to (e "onitored () the hospitals co""ensurate with their
inherent responsi(ilit) to provide Cualit) "edical care.
[3!]

The doctrine has its #enesis in 7arli"g v. Charlesto" Commu"it, ?ospital.
[3]
There$ the :upre"e Court of &llinois
held that At,e I)r+ co)(! ,aCe 8o)! a ,o$*#ta( e9(#9et, inter alia, # 8a#(#9 to ,aCe a $)88#c#et )"ber o8
tra#e! )r$e$ atte!#9 t,e *at#etL 8a#(#9 to reH)#re a co$)(tat#o 7#t, or e?a"#at#o b+ "e"ber$ o8 t,e
,o$*#ta( $ta88L a! 8a#(#9 to reC#e7 t,e treat"et re!ere! to t,e *at#et.D 5n the (asis of7arli"g$ other
.urisdictions held that a ,o$*#ta(F$ cor*orate e9(#9ece e?te!$ to *er"#tt#9 a *,+$#c#a Bo7 to be
#co"*etet to *ract#ce at t,e ,o$*#ta(.
[33]
=ith the passa#e of ti"e$ "ore duties were e9pected fro" hospitals$
a"on# the"* <1= the use of reasona(le care in the "aintenance of safe and adeCuate facilities and
eCuip"entF <2= t,e $e(ect#o a! retet#o o8 co"*etet *,+$#c#a$L <3= t,e oCer$ee#9 or $)*erC#$#o o8 a((
*er$o$ 7,o *ract#ce "e!#c#e 7#t,# #t$ 7a(($F and <4= the for"ulation$ adoption and enforce"ent of adeCuate
rules and policies that ensure Cualit) care for its patients.
[31]
Thus$ in Tu#so" Aedi#al Ce"ter. I"#. v. Aisevi#h$
[32]
it
was held that a hospital$ followin# the doctrine of corporate responsi(ilit)$ has the dut) to see that it "eets the
standards of responsi(ilities for the care of patients. S)c, !)t+ #c()!e$ t,e *ro*er $)*erC#$#o o8 t,e "e"ber$
o8 #t$ "e!#ca( $ta88. And in 3ost v. Rile,$
[><]
the court concluded that a patient who enters a hospital does so with the
reasona(le e9pectation that it will atte"pt to cure hi". ',e ,o$*#ta( accor!#9(+ ,a$ t,e !)t+ to "aBe a
rea$oab(e e88ort to "o#tor a! oCer$ee t,e treat"et *re$cr#be! a! a!"##$tere! b+ t,e *,+$#c#a$
*ract#c#9 # #t$ *re"#$e$.
&n the present case$ it was dul) esta(lished that +:& operates the 6edicalCit) 7ospital for the purpose and
under the concept of providin# co"prehensive "edical services to the pu(lic. Accordin#l)$ it has the dut) to
e9erciserea$oab(e care to *rotect 8ro" ,ar" a(( *at#et$ a!"#tte! #to #t$ 8ac#(#t+ 8or "e!#ca(
treat"et. Gnfortunatel)$ +:& failed to perfor" such dut). The findin#s of the trial court are convincin#$ thus*
9 9 9 0S&F$ (#ab#(#t+ #$ traceab(e to #t$ 8a#()re to co!)ct a #Ce$t#9at#o o8 t,e "atter re*orte! # t,e nota
*ene o8 t,e co)t )r$e. S)c, 8a#()re e$tab(#$,e! 0S&F$ *art # t,e !arB co$*#rac+ o8 $#(ece a!
cocea("et abo)t t,e 9a)Ge$. Hthical considerations$ if not also le#al$ dictated the holdin# of an i""ediate
inCuir) into the events$ if not for the (enefit of the patient to who" the dut) is pri"aril) owed$ then in the interest of
arrivin# at the truth. The Court cannot accept that the "edical and the healin# professions$ throu#h their "e"(ers
li4e defendant sur#eons$ and their institutions li4e +:&?s hospital facilit)$ can callousl) turn their (ac4s on and
disre#ard even a "ere pro(a(ilit) of "ista4e or ne#li#ence () refusin# or failin# to investi#ate a report of such
seriousness as the one in Natividad?s case.

&t is worth) to note that 8r. A"pil and 8r. 0uentes operated on Natividad with the assistance of
the 6edical Cit) 7ospital?s staff$ co"posed of resident doctors$ nurses$ and interns. As such$ it is reasona(le to
conclude that +:&$ as the operator of the hospital$ has act)a( or co$tr)ct#Ce 4nowled#e of the procedures carried
out$ *art#c)(ar(+ t,e re*ort o8 t,e atte!#9 )r$e$ t,at t,e t7o *#ece$ o8 9a)Ge 7ere "#$$#9. &n <ride"a v.
Eva"s.
[>1]
it was held that a corporation is bo)! () the 4nowled#e acCuired () or notice #iven to its a#ents or
officers within the scope of their authorit) and in reference to a "atter to which their authorit) e9tends. This "eans
that the 4nowled#e of an) of the staff of 6edical Cit) 7ospital constitutes 4nowled#e of +:&. Now$ the failure of +:&$
despite the attendin# nurses? report$ to investi#ate and infor" Natividad re#ardin# the "issin# #auJes a"ounts to
callous ne#li#ence. Not o(+ !#! 0S& breac, #t$ !)t#e$ to oCer$ee or $)*erC#$e a(( *er$o$ 7,o *ract#ce
"e!#c#e 7#t,# #t$ 7a(($, #t a($o 8a#(e! to taBe a act#Ce $te* # 8#?#9 t,e e9(#9ece co""#tte!. This
renders +:&$ not onl) vicariousl) lia(le for the ne#li#ence of 8r. A"pil under Article ;11< of the Civil Code$ (ut
also !#rect(+ (#ab(e for its own ne#li#ence under Article ;13. &n <ride"a. the :upre"e Court of AriJona held*
9 9 9 &n recent )ears$ however$ the dut) of care owed to the patient () the hospital has e9panded. ',e e"er9#9
tre! #$ to ,o(! t,e ,o$*#ta( re$*o$#b(e 7,ere t,e ,o$*#ta( ,a$ 8a#(e! to "o#tor a! reC#e7 "e!#ca(
$erC#ce$ be#9 *roC#!e! 7#t,# #t$ 7a(($. :ee Bah" ?ospital Aalpra#ti#e Preve"tio". ;3 8e +aul . Rev. ;3 D1233E.
A"on# the cases indicative of the Te"er#in# trend? is Pur#ell v. =im-elma"$ 11 AriJ. App. 3!$!<< +. ;d 33! D123;E.
&n Pur#ell. the hospital ar#ued that it could not (e held lia(le for the "alpractice of a "edical practitioner (ecause he
was an independent contractor within the hospital. ',e /o)rt o8 A**ea($ *o#te! o)t t,at t,e ,o$*#ta( ,a!
create! a *ro8e$$#oa( $ta88 7,o$e co"*etece a! *er8or"ace 7a$ to be "o#tore! a! reC#e7e! b+ t,e
9oCer#9 bo!+ o8 t,e ,o$*#ta(, a! t,e co)rt ,e(! t,at a ,o$*#ta( 7o)(! be e9(#9et 7,ere #t ,a!
Bo7(e!9e or rea$o to be(#eCe t,at a !octor )$#9 t,e 8ac#(#t#e$ 7a$ e"*(o+#9 a "et,o! o8 treat"et or
care 7,#c, 8e(( be(o7 t,e reco9#Ge! $ta!ar! o8 care.
S)b$eH)et to t,e .urcell !ec#$#o, t,e Ar#Goa /o)rt o8 A**ea($ ,e(! t,at a ,o$*#ta( ,a$ certa# #,eret
re$*o$#b#(#t#e$ re9ar!#9 t,e H)a(#t+ o8 "e!#ca( care 8)r#$,e! to *at#et$ 7#t,# #t$ 7a(($ a! #t ")$t "eet
t,e $ta!ar!$ o8 re$*o$#b#(#t+ co""e$)rate 7#t, t,#$ )!ertaB#9. 3ee# v. Tu#so" 9e"eral ?ospital$
11 AriJ. App. 1!$ !<< +. ;d 11!3 D123;E. This court has confir"ed the rulin#s of the Court of Appeals that a
hospital has the dut) of supervisin# the co"petence of the doctors on its staff. 9 9 9.
? ? ? ? ? ?
&n the a"ended co"plaint$ the plaintiffs did plead that the operation was perfor"ed at the hospital with its
4nowled#e$ aid$ and assistance$ and that the ne#li#ence of the defendants was the pro9i"ate cause of the patient?s
in.uries. 5e 8#! t,at $)c, 9eera( a((e9at#o$ o8 e9(#9ece, a(o9 7#t, t,e eC#!ece *ro!)ce! at t,e tr#a( o8
t,#$ ca$e, are $)88#c#et to $)**ort t,e ,o$*#ta(F$ (#ab#(#t+ ba$e! o t,e t,eor+ o8 e9(#9et $)*erC#$#o.D

Anent the corollar) issue of whether +:& is solidaril) lia(le with 8r. A"pil for da"a#es$ let it (e
e"phasiJed that +:&$ apart fro" a #eneral denial of its responsi(ilit)$ failed to adduce evidence showin# that it
e9ercised the dili#ence of a #ood father of a fa"il) in the accreditation and supervision of the latter. &n ne#lectin# to
offer such proof$ +:& failed to dischar#e its (urden under the last para#raph of Article ;11< cited earlier$ and$
therefore$ "ust (e ad.ud#ed solidaril) lia(le with 8r. A"pil. 6oreover$ as we have discussed$ +:& is also !#rect(+
(#ab(e to the A#anas.
5ne final word. 5nce a ph)sician underta4es the treat"ent and care of a patient$ the law i"poses on hi"
certain o(li#ations. &n order to escape lia(ilit)$ he "ust possess that reasona(le de#ree of learnin#$ s4ill and
e9perience reCuired () his profession. At the sa"e ti"e$ he "ust appl) reasona(le care and dili#ence in the
e9ercise of his s4ill and the application of his 4nowled#e$ and e9ert his (est .ud#"ent.
5HERE-ORE, we DENY all the petitions and A--&R. the challen#ed 8ecision of the Court of Appeals in CA-
G.R. CV No. >;<; and CA-G.R. :+ No. 3;121.
Costs a#ainst petitioners +:& and 8r. 6i#uel A"pil.
SO ORDERED.


[G.R. No. 122445. NoCe"ber 1K, 1667]
DR. N&NE1E'/H /R:3, petitioner, vs. /O:R' O- A00EALS a! LYD&A :.AL&, respondents.
D E / & S & O N
-RAN/&S/O, J.4
U8octors are protected () a special law. The) are not #uarantors of care. The) do not even warrant a #ood
result. The) are not insurers a#ainst "ishap or unusual conseCuences. 0urther"ore the) are not lia(le for honest
"ista4e of .ud#"entVU
[1]
The present case a#ainst petitioner is in the nature of a "edical "alpractice suit$ which in si"plest ter" is the t)pe of
clai" which a victi" has availa(le to hi" or her to redress a wron# co""itted () a "edical professional which has
cause (odil) har".
[;]
&n this .urisdiction$ however$ such clai"s are "ost often (rou#ht as a civil action for da"a#es
under Article ;13 of the Civil Code$
[3]
and in so"e instances$ as a cri"inal case under Article 3! of the Revised
+enal Code
[>]
with which the civil action for da"a#es is i"pliedl) instituted. &t is via the latter t)pe of action that the
heirs of the deceased sou#ht redress for the petitionerNs alle#ed i"prudence and ne#li#ence in treatin# the deceased
there() causin# her death. The petitioner and one 8r. ,ina Hrcillo who was the attendin# anaesthesiolo#ist durin#
the operation of the deceased were char#ed with Urec4less i"prudence and ne#li#ence resultin# to DsicE ho"icideU in
an infor"ation which reads*
UThat on or a(out 6arch ;3$ 1221$ in the Cit) of :an +a(lo$ Repu(lic of the +hilippines and within the .urisdiction of
this 7onora(le Court$ the accused a(ovena"ed$ (ein# then the attendin# anaesthesiolo#ist and sur#eon$
respectivel)$ did then and there$ in a ne#li#ence DsicE$ careless$ i"prudent$ and inco"petent "anner$ and failin# to
suppl) or store sufficient provisions and facilities necessar) to "eet an) and all e9i#encies apt to arise (efore$ durin#
andMor after a sur#ical operation causin# () such ne#li#ence$ carelessness$ i"prudence$ and inco"petence$ and
causin# () such failure$ includin# the lac4 of preparation and foresi#ht needed to avert a tra#ed)$ the unti"el) death
of said ,)dia G"ali on the da) followin# said sur#ical operation.U
[!]
Trial ensued after (oth the petitioner and 8r. ,ina Hrcillo pleaded not #uilt) to the a(ove-"entioned char#e. 5n
6arch >$ 122>$ the 6unicipal Trial Court in Cities D6TCCE of :an +a(lo Cit) rendered a decision$ the dispositive
portion of which is hereunder Cuoted as follows*
U=7HRH05RH$ the court finds the accused 8r. ,ina Hrcillo not #uilt) of the offense char#ed for insufficienc) of
evidence while her co-accused 8ra. Ninevetch CruJ is here() held responsi(le for the death of ,)dia G"ali on
6arch ;>$ 1221$ and therefore #uilt) under Art. 3! of the Revised +enal Code$ and she is here() sentenced to
suffer the penalt) of ; "onths and 1 da) i"prison"ent of arresto "a)or with costs.U
[]
The petitioner appealed her conviction to the Re#ional Trial Court DRTCE which affir"edi" toto the decision of the
6TCC
[3]
pro"ptin# the petitioner to file a petition for review with the Court of Appeals (ut to no avail. 7ence this
petition for review on #ertiorariassailin# the decision pro"ul#ated () the Court of Appeals on 5cto(er ;>$ 122!
affir"in# petitionerNs conviction with "odification that she is further directed to pa) the heirs of ,)dia
G"ali +!<$<<<.<< as inde"nit) for her death.
[1]
&n su(stance$ the petition (rou#ht (efore this Court raises the issue of whether or not petitionerNs conviction of the
cri"e of rec4less i"prudence resultin# in ho"icide$ arisin# fro" an alle#ed "edical "alpractice$ is supported () the
evidence on record.
0irst the antecedent facts.
5n 6arch ;;$ 1221$ prosecution witness$ Rowena G"ali 8e 5ca"po$ acco"panied her "other to the +erpetual
7elp Clinic and General 7ospital situated in %ala#tas :treet$ :an +a(lo Cit)$ ,a#una. The) arrived at the said
hospital at around >*3< in the afternoon of the sa"e da).
[2]
+rior to 6arch ;;$ 1221$ ,)dia was e9a"ined () the
petitioner who found a U")o"aU
[1<]
in her uterus$ and scheduled her for a h)sterecto") operation on 6arch ;3$ 1221.
[11]
Rowena and her "other slept in the clinic on the evenin# of 6arch ;;$ 1221 as the latter was to (e operated on
the ne9t da) at 1*<< oNcloc4 in the afternoon.
[1;]
Accordin# to Rowena$ she noticed that the clinic was untid) and the
window and the floor were ver) dust) pro"ptin# her to as4 the attendant for a ra# to wipe the window and the floor
with.
[13]
%ecause of the untid) state of the clinic$ Rowena tried to persuade her "other not to proceed with the
operation.
[1>]
The followin# da)$ (efore her "other was wheeled into the operatin# roo"$ Rowena as4ed the
petitioner if the operation could (e postponed. The petitioner called ,)dia into her office and the two had a
conversation. ,)dia then infor"ed Rowena that the petitioner told her that she "ust (e operated on as scheduled.
[1!]
Rowena and her other relatives$ na"el) her hus(and$ her sister and two aunts waited outside the operatin# roo"
while ,)dia underwent operation. =hile the) were waitin#$ 8r. Hrcillo went out of the operatin# roo" and instructed
the" to (u) ta#a"et a"pules which RowenaNs sister i""ediatel) (ou#ht. A(out one hour had passed when 8r.
Hrcillo ca"e out a#ain this ti"e to as4 the" to (u) (lood for ,)dia. The) (ou#ht t)pe UAU (lood fro" the :t. Gerald
%lood %an4 and the sa"e was (rou#ht () the attendant into the operatin# roo". After the lapse of a few hours$ the
petitioner infor"ed the" that the operation was finished. The operatin# staff then went inside the petitionerNs clinic to
ta4e their snac4s. :o"e thirt) "inutes after$ ,)dia was (rou#ht out of the operatin# roo" in a stretcher and the
petitioner as4ed Rowena and the other relatives to (u) additional (lood for ,)dia. Gnfortunatel)$ the) were not a(le
to co"pl) with petitionerNs order as there was no "ore t)pe UAU (lood availa(le in the (lood (an4. Thereafter$ a
person arrived to donate (lood which was later transfused to ,)dia. Rowena then noticed her "other$ who was
attached to an o9)#en tan4$ #aspin# for (reath. Apparentl) the o9)#en suppl) had run out and RowenaNs hus(and
to#ether with the driver of the accused had to #o to the :an +a(lo 8istrict 7ospital to #et o9)#en. ,)dia was #iven
the fresh suppl) of o9)#en as soon as it arrived.
[1]
%ut at around 1<*<< oNcloc4 +.6. she went into shoc4 and her
(lood pressure dropped to <M!<. ,)diaNs unsta(le condition necessitated her transfer to the :an +a(lo 8istrict
7ospital so she could (e connected to a respirator and further e9a"ined.
[13]
The transfer to the :an +a(lo Cit)
8istrict 7ospital was without the prior consent of Rowena nor of the other relatives present who found out a(out the
intended transfer onl) when an a"(ulance arrived to ta4e ,)dia to the :an +a(lo 8istrict 7ospital. Rowena and her
other relatives then (oarded a tric)cle and followed the a"(ulance.
[11]
Gpon ,)diaNs arrival at the :an +a(lo 8istrict 7ospital$ she was wheeled into the operatin# roo" and the petitioner
and 8r. Hrcillo re-operated on her (ecause there was (lood ooJin# fro" the a(do"inal incision.
[12]
The attendin#
ph)sicians su""oned 8r. %artolo"e An#eles$ head of the 5(stetrics and G)necolo#) 8epart"ent of the :an +a(lo
8istrict 7ospital. 7owever$ when 8r. An#eles arrived$ ,)dia was alread) in shoc4 and possi(l) dead as her (lood
pressure was alread) <M<. 8r. An#eles then infor"ed petitioner and 8r. Hrcillo that there was nothin# he could do to
help save the patient.
[;<]
=hile petitioner was closin# the a(do"inal wall$ the patient died.
[;1]
Thus$ on 6arch ;>$ 1221$
at 3*<< oNcloc4 in the "ornin#$ ,)dia G"ali was pronounced dead. 7er death certificate states Ushoc4U as the
i""ediate cause of death and U8isse"inated &ntravascular Coa#ulation D8&CEU as the antecedent cause.
[;;]
&n convictin# the petitioner$ the 6TCC found the followin# circu"stances as sufficient (asis to conclude that she was
indeed ne#li#ent in the perfor"ance of the operation*
U9 9 9$ the clinic was untid)$ there was lac4 of provision li4e (lood and o9)#en to prepare for an) contin#enc) that
"i#ht happen durin# the operation. The "anner and the fact that the patient was (rou#ht to the :an +a(lo 8istrict
7ospital for reoperation indicates that there was so"ethin# wron# in the "anner in which 8ra. CruJ conducted the
operation. There was no showin# that (efore the operation$ accused 8r. CruJ had conducted a cardio pul"onar)
clearance or an) t)pin# of the (lood of the patient. &t was DsicE said in "edical parlance that the Ua(do"en of the
person is a te"ple of surprisesU (ecause )ou do not 4now the whole thin# the "o"ent it was open DsicE and sur#eon
"ust (e prepared for an) eventualit) thereof. The patient DsicE chart which is a pu(lic docu"ent was not presented
(ecause it is onl) there that we could deter"ine the condition of the patient (efore the sur#er). The court also
noticed in H9h. U0-1U that the sister of the deceased wished to postpone the operation (ut the patient was prevailed
upon () 8ra. CruJ to proceed with the sur#er). The court finds that ,)dia G"ali died (ecause of the ne#li#ence and
carelessness of the sur#eon 8ra. Ninevetch CruJ (ecause of loss of (lood durin# the operation of the deceased for
evident unpreparedness and for lac4 of s4ill$ the reason wh) the patient was (rou#ht for operation at the :an +a(lo
Cit) 8istrict 7ospital. As such$ the sur#eon should answer for such ne#li#ence. =ith respect to 8ra. ,ina Hrcillo$ the
anaesthesiolo#ist$ there is no evidence to indicate that she should (e held .ointl) lia(le with 8ra. CruJ who actuall)
did the operation.U
[;3]
The RTC reiterated the a(ove"entioned findin#s of the 6TCC and upheld the latterNs declaration of Uinco"petenc)$
ne#li#ence and lac4 of foresi#ht and s4ill of appellant Dherein petitionerE in handlin# the su(.ect patient (efore and
after the operation.U
[;>]
And li4ewise affir"in# the petitionerNs conviction$ the Court of Appeals echoed si"ilar
o(servations$ thus*
U9 9 9. =hile we "a) #rant that the untidiness and filthiness of the clinic "a) not () itself indicate ne#li#ence$ it
nevertheless shows the a(sence of due care and supervision over her su(ordinate e"plo)ees. 8id this unsanitar)
condition per"eate the operatin# roo"L =ere the sur#ical instru"ents properl) steriliJedL Could the conditions in
the 5R have contri(uted to the infection of the patientL 5nl) the petitioner could answer these$ (ut she opted not to
testif). This could onl) #ive rise to the presu"ption that she has nothin# #ood to testif) on her defense. An)wa)$ the
alle#ed Uunverified state"ent of the prosecution witnessU re"ains unchallen#ed and unre(utted.
,i4ewise undisputed is the prosecutionNs version indicatin# the followin# facts* that the accused as4ed the patientNs
relatives to (u) Ta#a"et capsules while the operation was alread) in pro#ressF that after an hour$ the) were also
as4ed to (u) t)pe UAU (lood for the patientF that after the sur#er)$ the) were a#ain as4ed to procure "ore t)pe UAU
(lood$ (ut such was not an)"ore availa(le fro" the sourceF that the o9)#en #iven to the patient was e"pt)F and that
the son-in-law of the patient$ to#ether with a driver of the petitioner$ had to rush to the :an +a(lo Cit) 8istrict
7ospital to #et the "uch-needed o9)#en. All these conclusivel) show that the petitioner had not prepared for an)
unforeseen circu"stances (efore #oin# into the first sur#er)$ which was not e"er#enc) in nature$ (ut was elective or
pre-scheduledF she had no read) anti(iotics$ no prepared (lood$ properl) t)ped and cross-"atched$ and no sufficient
o9)#en suppl).
6oreover$ there are a lot of Cuestions that 4eep na##in# Gs. =as the patient #iven an) cardio-pul"onar) clearance$
or at least a clearance () an internist$ which are standard reCuire"ents (efore a patient is su(.ected to sur#er). 8id
the petitioner deter"ine as part of the pre-operative evaluation$ the (leedin# para"eters of the patient$ such as
(leedin# ti"e and clottin# ti"eL There is no showin# that these were done. The petitioner .ust appears to have (een
in a hurr) to perfor" the operation$ even as the fa"il) wanted the postpone"ent to April $ 1221. 5(viousl)$ she did
not prepare the patientF neither did she #et the fa"il)Ns consent to the operation. 6oreover$ she did not prepare a
"edical chart with instructions for the patientNs care. &f she did all these$ proof thereof should have (een offered. %ut
there is none. &ndeed$ these are overwhel"in# evidence of rec4lessness and i"prudence.U
[;!]
This court$ however$ holds differentl) and finds the fore#oin# circu"stances insufficient to sustain a .ud#"ent of
conviction a#ainst the petitioner for the cri"e of rec4less i"prudence resultin# in ho"icide. The ele"ents of rec4less
i"prudence are* D1E that the offender does or fails to do an actF D;E that the doin# or the failure to do that act is
voluntar)F D3E that it (e without "aliceF D>E that "aterial da"a#e results fro" the rec4less i"prudenceF and D!E that
there is ine9cusa(le lac4 of precaution on the part of the offender$ ta4in# into consideration his e"plo)"ent or
occupation$ de#ree of intelli#ence$ ph)sical condition$ and other circu"stances re#ardin# persons$ ti"e and place.
=hether or not a ph)sician has co""itted an Uine9cusa(le lac4 of precautionU in the treat"ent of his patient is to (e
deter"ined accordin# to the standard of care o(served () other "e"(ers of the profession in #ood standin# under
si"ilar circu"stances (earin# in "ind the advanced state of the profession at the ti"e of treat"ent or the present
state of "edical science.
[;]
&n the recent case of Leo"ila 9ar#iaCRueda v. @ilfred L. Pa#asio. et. al.$
[;3]
this Court
stated that in acceptin# a case$ a doctor in effect represents that$ havin# the needed trainin# and s4ill possessed ()
ph)sicians and sur#eons practicin# in the sa"e field$ he will e"plo) such trainin#$ care and s4ill in the treat"ent of
his patients. 7e therefore has a dut) to use at least the sa"e level of care that an) other reasona(l) co"petent
doctor would use to treat a condition under the sa"e circu"stances. &t is in this aspect of "edical "alpractice that
e9pert testi"on) is essential to esta(lish not onl) the standard of care of the profession (ut also that the ph)sicianNs
conduct in the treat"ent and care falls (elow such standard.
[;1]
0urther$ inas"uch as the causes of the in.uries
involved in "alpractice actions are deter"ina(le onl) in the li#ht of scientific 4nowled#e$ it has (een reco#niJed that
e9pert testi"on) is usuall) necessar) to support the conclusion as to causation.
[;2]
&""ediatel) apparent fro" a review of the records of this case is the a(sence of an) e9pert testi"on) on the "atter
of the standard of care e"plo)ed () other ph)sicians of #ood standin# in the conduct of si"ilar operations. The
prosecutionNs e9pert witnesses in the persons of 8r. 0loresto AriJala and 8r. Nieto :alvador$ -r. of the National
%ureau of &nvesti#ation DN%&E onl) testified as to the possi(le cause of death (ut did not venture to illu"inate the
court on the "atter of the standard of care that petitioner should have e9ercised.
All three courts (elow (ewail the inadeCuac) of the facilities of the clinic and its untidinessF the lac4 of provisions
such as (lood$ o9)#en$ and certain "edicinesF the failure to su(.ect the patient to a cardio-pul"onar) test prior to the
operationF the o"ission of an) for" of (lood t)pin# (efore transfusionF and even the su(seCuent transfer of ,)dia to
the :an +a(lo 7ospital and the reoperation perfor"ed on her () the petitioner. %ut while it "a) (e true that the
circu"stances pointed out () the courts (elow see"ed (e)ond cavil to constitute rec4less i"prudence on the part of
the sur#eon$ this conclusion is still (est arrived at not throu#h the educated sur"ises nor con.ectures of la)"en$
includin# .ud#es$ (ut () the unCuestiona(le 4nowled#e of e9pert witnesses. 0or whether a ph)sician or sur#eon has
e9ercised the reCuisite de#ree of s4ill and care in the treat"ent of his patient is$ in the #eneralit) of cases$ a "atter
of e9pert opinion.
[3<]
The deference of courts to the e9pert opinion of Cualified ph)sicians ste"s fro" its realiJation
that the latter possess unusual technical s4ills which la)"en in "ost instances are incapa(le of intelli#entl)
evaluatin#.
[31]
H9pert testi"on) should have (een offered to prove that the circu"stances cited () the courts (elow
are constitutive of conduct fallin# (elow the standard of care e"plo)ed () other ph)sicians in #ood standin# when
perfor"in# the sa"e operation. &t "ust (e re"e"(ered that when the Cualifications of a ph)sician are ad"itted$ as
in the instant case$ there is an inevita(le presu"ption that in proper cases he ta4es the necessar) precaution and
e"plo)s the (est of his 4nowled#e and s4ill in attendin# to his clients$ unless the contrar) is sufficientl) esta(lished.
[3;]
This presu"ption is re(utta(le () e9pert opinion which is so sadl) lac4in# in the case at (ench.
Hven #rantin# argue"do that the inadeCuac) of the facilities and untidiness of the clinicF the lac4 of provisionsF the
failure to conduct pre-operation tests on the patientF and the su(seCuent transfer of ,)dia to the :an +a(lo 7ospital
and the reoperation perfor"ed on her () the petitioner do indicate$ even without e9pert testi"on)$ that petitioner was
rec4lessl) i"prudent in the e9ercise of her duties as a sur#eon$ no co#ent proof e9ists that an) of these
circu"stances caused petitionerNs death. Thus$ the a(sence of the fourth ele"ent of rec4less i"prudence* that the
in.ur) to the person or propert) was a conseCuence of the rec4less i"prudence.
&n liti#ations involvin# "edical ne#li#ence$ the plaintiff has the (urden of esta(lishin# appellantNs ne#li#ence and for a
reasona(le conclusion of ne#li#ence$ there "ust (e proof of (reach of dut) on the part of the sur#eon as well as a
casual connection of such (reach and the resultin# death of his patient.
[33]
&n Cha" Luga, v. St LueDs ?ospital. I"#.$
[3>]
where the attendin# ph)sician was a(solved of lia(ilit) for the death of the co"plainantNs wife and new(orn (a()$
this court held that*
U&n order that there "a) (e a recover) for an in.ur)$ however$ it "ust (e shown that the Nin.ur) for which recover) is
sou#ht "ust (e the le#iti"ate conseCuence of the wron# doneF the connection (etween the ne#li#ence and the
in.ur) "ust (e a direct and natural seCuence of events$ un(ro4en () intervenin# efficient causes.N &n other words$ the
ne#li#ence "ust (e the pro9i"ate cause of the in.ur). 0or$ Nne#li#ence$ no "atter in what it consists$ cannot create a
ri#ht of action unless it is the pro9i"ate cause of the in.ur) co"plained of.N And Nthe pro9i"ate cause of an in.ur) is
that cause$ which$ in natural and continuous seCuence$ un(ro4en () an) efficient intervenin# cause$ produces the
in.ur)$ and without which the result would not have occurred.NNN
[3!]
DGnderscorin# supplied.E
8r. AriJala who conducted an autops) on the (od) of the deceased su""ariJed his findin#s as follows*
UAtt). Cachero*
K. Iou "entioned a(out )our Autops) Report which has (een "ar4ed as H9h. UA-1-(U. There appears here a
si#nature a(ove the t)pewritten na"e 0loresto AriJala$ -r.$ whose si#nature is thatL
A. That is ") si#nature$ sir.
K. 8o )ou affir" the truth of all the contents of H9h. UA-1-(UL
A. 5nl) as to the autops) report no. 21-<2$ the ti"e and place and ever)thin# after the post "orte" findin#s$ sir.
K. Iou "entioned on )our U+ost 6orte" 0indin#sU a(out sur#ical incision$ 1>*< c".$ infrau"(ilical area$ anterior
a(do"inal area$ "idline$ will )ou please e9plain that in )our own lan#ua#eL
A. There was incision wound DsicE the area .ust (elow the navel$ sir.
K. And the last para#raph of the post"orte" findin#s which & read* Gterus$ pear-shaped and pale "easurin# 3.! 9
!.! 9 !.< c"$ with so"e surface nodulation of the fundic area posteriorl). Cut-section shows diffusel) pale
")o"etriu" with areas of strea4 induration. The ovaries and adne9al structures are "issin# with the raw surfaces
patched with clotted (lood. :ur#ical sutures were noted on the operative site.
&ntestines and "esenteries are pale with (lood clots noted (etween the "esentric folds.
7e"operitoniu"* 3<< s.s.$
ri#ht paracolic #utter$
!< c.c.$ left paracolic #utter
;<< c.c.$ "esentric area$
1<< c.c.$ ri#ht pelvic #utter
sto"ach e"pt).
5ther visceral or#ans$ pale.N$
will )ou please e9plain that on DsicE )our own lan#ua#e or in ordinar)VVVVV
A. There was a uterus which was not attached to the adne9al structures na"el) ovaries which were not present
and also si#n of previous sur#ical operation and there were DsicE clotted (lood$ sir.
K. 7ow a(out the ovaries and adne9al structuresL
A. The) are "issin#$ sir.
K. Iou "ean to sa) there are no ovariesL
A. 8urin# that ti"e there are no ovaries$ sir.
K. And there were li4ewise si#n of sur#ical suturesL
A. Ies$ sir.
K. 7ow a(out the intestines and "esenteries are place DsicE with (lood clots noted (etween the "esenteric folds$
will )ou please e9plain on DsicE thisL
A. &n the peritoneal cavit)$ the) are "ostl) perritonial (loodVVV.
K. And what could have caused this (loodL
A. =ell$ ordinaril) (lood is found inside the (lood vessel. %lood were DsicE outside as a result of the in.uries which
destro)ed the inte#rit) of the vessel allowin# (lood to sip DsicE out$ sir.
K. %) the nature of the post"orte" findin#s indicated in H9h. A-1-%$ can )ou tell the court the cause of deathL
A. Ies$ sir. The cause of death is* Gross findin#s are co"pati(le with he"orrha#ic shoc4.
K. Can )ou tell the us what could have caused this he"orrha#ic shoc4L
A. =ell he"orrha#ic shoc4 is the result of (lood loss.
K. =hat could have the effect of that loss of (loodL
A. Gnattended he"orrha#e$ sir.
[3]
DGnderscorin# supplied.E
The fore#oin# was corro(orated () 8r. Nieto :alvador*
UK. And were )ou a(le to deter"ine the cause of death () virtue of the e9a"ination of the speci"en su("itted ()
8r. AriJalaL
A. =ithout 4nowled#e of the autops) findin#s it would (e difficult for "e to deter"ine the cause of death$ sir.
K. 7ave )ou e9a"ined the post "orte" of 8r. AriJalaL
A. Ies$ sir$ and () virtue of the autops) report in connection with )our patholo#) report.
K. =hat could have caused the death of the victi"L
A. This patholo#ic e9a"ination are DsicE co"pati(le with the person who died$ sir.
K. =ill )ou e9plain to us the "eanin# of he"orrha#ic co"pati(leL
A. &t "eans that a person died of (lood loss. 6eanin# a person died of non-replace"ent of (lood and so the victi"
(efore she died there was shoc4 of di"inish of (lood of the circulation. :he died "ost pro(a(l) (efore the actual
co"plete (lood loss$ sir.
Court* &s it possi(le doctor that the loss of the (lood was due on DsicE operationL
A. %ased on ") patholo#) findin#s$ sir.
K. =hat could have caused this loss of (loodL
A. 6an)$ sir. A patient who have under#one sur#er). Another "a) (e a (lood vessel "a) (e cut while on operation
and this cause DsicE (leedin#$ or "a) (e set in the course of the operation$ or "a) (e DsicE he died after the
operation. 5f course there are other cause DsicE.
Att). Cachero*
K. Hspeciall) so doctor when there was no (lood replace"entL
A. Ies$ sir.U
[33]
DGnderscorin# supplied.E
The testi"onies of (oth doctors esta(lish he"orrha#e or he"orrha#ic shoc4 as the cause of death. 7owever$ as
li4ewise testified to () the e9pert witnesses in open court$ he"orrha#e or he"orrha#ic shoc4 durin# sur#er) "a) (e
caused () several different factors. Thus$ 8r. :alvadorNs ela(oration on the "atter*
UAtt). +ascual*
K. 8octor$ a"on# the causes of he"orrha#e that )ou "entioned )ou said that it could (e at the "o"ent of
operation when one losses DsicE control of the presence$ is that correctL 8urin# the operation there is lost DsicE of
control of the cut vesselL
A. Ies$ sir.
K. 5r there is a failure to li#ate a vessel of considera(le siJeL
A. Ies$ sir.
K. 5r even if the vessel were li#ated the 4not "a) have slipped later onL
A. Ies$ sir.
K. And )ou also "entioned that it "a) (e possi(le also to so"e clottin# defect$ is that correctL
A. 6a) (e DsicE.U
[31]
DGnderscorin# suppliedE.
8efense witness$ 8r. %u C. Castro also #ave the followin# e9pert opinion*
UK. 8octor even a patient after an operations DsicE would suffer he"orra#e what would (e the possi(le causes of
such he"orra#e DsicEL
A. A"on# those would (e what we call &ntravascular Coa#ulation and this is the reason for the (leedin#$ sir$ which
cannot (e prevented () an)one$ it will happen to an)one$ an)ti"e and to an) persons DsicE$ sir.
C5GRT*
=hat do )ou thin4 of the cause of the (leedin#$ the cuttin# or the operations done in the (od)L
A. Not related to this one$ the (leedin# here is not related to an) cuttin# or operation that & DsicE have done.
K. Aside fro" the 8&C what could another causes DsicE that could (e the cause for the he"orrha#e or (leedin# in a
patient () an operations DsicEL
A. &n #eneral sir$ if there was an operations DsicE and it is possi(le that the li#ature in the suture was DsicE (eco"e
DsicE loose$ it is DsicE (eco"es loose if proven.
9 9 9 9 9 9 9 9 9
K. &f the person who perfor"ed an autops) does not find an) unti#ht DsicE clot DsicE (lood vessel or an) suture that
(eco"e DsicE loose the cause of the (leedin# could not (e attri(uted to the fault of the su(.ectL
A. 8efinitel)$ sir.U
[32]
DGnderscorin# supplied.E
Accordin# to (oth doctors$ the possi(le causes of he"orrha#e durin# an operation are* D1E the failure of the sur#eon
to tie or suture a cut (lood vesselF D;E allowin# a cut (lood vessel to #et out of controlF D3E the su(seCuent loosenin#
of the tie or suture applied to a cut (lood vesselF and D>E and a clottin# defect 4nown as 8&C. &t is si#nificant to state
at this .uncture that the autops) conducted () 8r. AriJala on the (od) of ,)dia did not reveal an) untied or unsutured
cut (lood vessel nor was there an) indication that the tie or suture of a cut (lood vessel had (eco"e loose there()
causin# the he"orrha#e.
[><]
7ence the followin# pertinent portion of 8r. AriJalaNs testi"on)*
UK* 8octor$ in e9a"inin# these structures did )ou 4now whether these were sutured li#ature or plain li#ature
A* ,i#ature$ sir.
K* =e will e9plain that later on. 8id )ou recall if the cut structures were tied () first suturin# it and then t)in# a 4not
or the tie was "erel) placed around the cut structure and tiedL
A* & cannot recall$ sir.
K* As a "atter of fact$ )ou cannot recall (ecause )ou did not even (othered DsicE to e9a"ine$ is that correctL
A* =ell$ & (othered enou#h to 4now that the) were sutured$ sir.
K* :o$ therefore$ 8octor$ )ou would not 4now whether an) of the cut structures were not sutured or tied neither
were )ou a(le to deter"ine whether an) loose suture was found in the peritoneal cavit)L
A* & could not recall an) loose sutured DsicE$ sir.U
[>1]
5n the other hand$ the findin#s of all three doctors do not preclude the pro(a(ilit) that 8&C caused the he"orrha#e
and conseCuentl)$ ,)diaNs death. 8&C which is a clottin# defect creates a serious (leedin# tendenc) and when
"assive 8&C occurs as a co"plication of sur#er) leavin# raw surface$ "a.or he"orrha#e occurs.
[>;]
And as testified
to () defense witness$ 8r. %u C. Castro$ he"orrha#e due to 8&C Ucannot (e prevented$ it will happen to an)one$
an)ti"e.U
[>3]
7e testified further*
UK. Now$ under the circu"stance one of the possi(ilit) as )ou "entioned in DsicE 8&CL
A. Ies$ sir.
K. And )ou "entioned that it cannot (e preventedL
A. Ies$ sir.
K. Can )ou even predict if it reall) happen DsicEL
A. +ossi(le$ sir.
K. Are there an) specific findin#s of autops) that will tell )ou whether this patient suffered a"on# such thin#s as
8&CL
A. =ell$ & did reserve (ecause of the condition of the patient.
K. Now$ 8octor )ou said that )ou went throu#h the record of the deceased ,)dia G"ali loo4in# for the chart$ the
operated DsicE records$ the post "orte" findin#s on the histophanic DsicE e9a"ination (ased on )our e9a"ination of
record$ doctor$ can )ou "ore or less sa)s DsicE what part are DsicE concerned could have (een the caused DsicE of
death of this ,)dia G"aliL
A. As far as the "edical record is concern DsicE the caused DsicE of death is dessi"ulated DsicE &ntra Vascular
Coa#ulation or the 8&C which resulted to he"orrha#e or (leedin#s$ sir.
K. 8octor (ased on )our findin#s then there is 4nowin# DsicE the doctor would sa) whether the doctor her DsicE has
(een DsicE faultL
ATTI. 6A,VH8A*
=e will "oved DsicE to stri4e out the DsicE (ased on findin# the) .ust read the chart as well as the other record.
ATTI. +A:CGA,*
+recisel) (ased on this e9a"ination.
ATTI. 6A,VH8A*
Not findin#$ there was no findin# "ade.
C5GRT*
7e is onl) readin# the record.
ATTI. +A:CGA,*
Ies$ sir.
A. No$ sir$ there is no fault on the part of the sur#eon$ sir .U
[>>]
This court has no recourse (ut to rel) on the e9pert testi"onies rendered () (oth prosecution and defense witnesses
that su(stantiate rather than contradict petitionerNs alle#ation that the cause of ,)diaNs death was 8&C which$ as
attested to () an e9pert witness$ cannot (e attri(uted to the petitionerNs fault or ne#li#ence. The pro(a(ilit) that
,)diaNs death was caused () 8&C was unre(utted durin# trial and has en#endered in the "ind of this Court a
reasona(le dou(t as to the petitionerNs #uilt. Thus$ her acCuittal of the cri"e of rec4less i"prudence resultin# in
ho"icide. =hile we condole with the fa"il) of ,)dia G"ali$ our hands are (ound () the dictates of .ustice and fair
dealin# which hold inviola(le the ri#ht of an accused to (e presu"ed innocent until proven #uilt) (e)ond reasona(le
dou(t. Nevertheless$ this Court finds the petitioner civill) lia(le for the death of ,)dia G"ali$ for while a conviction of
a cri"e reCuires proof (e)ond reasona(le dou(t$ onl) a preponderance of evidence is reCuired to esta(lish civil
lia(ilit).
[>!]
The petitioner is a doctor in whose hands a patient puts his life and li"(. 0or insufficienc) of evidence this Court was
not a(le to render a sentence of conviction (ut it is not (lind to the rec4less and i"prudent "anner in which the
petitioner carried out her duties. A precious life has (een lost and the circu"stances leadin# thereto e9acer(ated the
#rief of those left (ehind. The heirs of the deceased continue to feel the loss of their "other up to the present
ti"e
[>]
and this Court is aware that no a"ount of co"passion and co""iseration nor words of (ereave"ent can
suffice to assua#e the sorrow felt for the loss of a loved one. Certainl)$ the award of "oral and e9e"plar) da"a#es
in favor of the heirs of ,)dia G"ali are proper in the instant case.
5HERE-ORE$ pre"ises considered$ petitioner 8R. N&NHVHTC7 CRGP is here() ACKG&TTH8 of the cri"e of
rec4less i"prudence resultin# in ho"icide (ut is ordered to pa) the heirs of the deceased ,)dia G"ali the a"ount of
0&0TI T75G:AN8 +H:5: D+!<$<<<.<<E as civil lia(ilit)$ 5NH 7GN8RH8 T75G:AN8 +H:5: D+1<<$<<<.<<E as
"oral da"a#es$ and 0&0TI T75G:AN8 +H:5: D+!<$<<<.<<E as e9e"plar) da"a#es.
,et the cop) of this decision (e furnished to the +rofessional Re#ulation Co""ission D+RCE for appropriate action.
SO ORDERED.
[G.R. No. 11K141. Se*te"ber 5, 1667]
LEON&LA GAR/&A@R:EDA, petitioner, vs. 5&L-REDO L. 0AS/AS&O, RA:L R. ARNA:, A2ELARDO L.
A0OR'ADERA JR., Hoorab(e /ONDRADO .. 1AS;:E3, a(( o8 t,e O88#ce o8 t,e O"b)!$"aL JES:S -.
G:ERRERO, 0OR-&R&O .A/ARAEG, a! GREGOR&O A. AR&3ALA, a(( o8 t,e O88#ce o8 t,e /#t+ 0ro$ec)tor,
.a#(a, respondents.
D E / & S & O N
RO.ERO, J.4
6a) this Court review the findin#s of the 5ffice of the 5"(uds"anL The #eneral rule has (een enunciated
in 5ca"po v. 5"(uds"an
[1]
which states*
A&n the e9ercise of its investi#ative power$ this Court has consistentl) held that courts will not interfere with the
discretion of the fiscal or the 5"(uds"an to deter"ine the specificit) and adeCuac) of the aver"ents of the offense
char#ed. 7e "a) dis"iss the co"plaint forthwith if he finds it to (e insufficient in for" and su(stance or if he
otherwise finds no #round to continue with the inCuir)F or he "a) proceed with the investi#ation of the co"plaint if$ in
his view$ it is in due and proper for".B
8oes the instant case warrant a departure fro" the fore#oin# #eneral ruleL =hen a patient dies soon after sur#er)
under circu"stances which indicate that the attendin# sur#eon and anaesthesiolo#ist "a) have (een #uilt) of
ne#li#ence (ut upon their (ein# char#ed$ a series of nine prosecutors toss the responsi(ilit) of conductin# a
preli"inar) investi#ation to each other with contradictor) reco""endations$ Apin#-pon#B st)le$ perhaps the distrau#ht
widow is not to (e (la"ed if she finall) decides to accuse the Cit) +rosecutors at the end of the line for partialit)
under the Anti-Graft and Corrupt +ractices Act. Nor "a) she (e entirel) faulted for finall) filin# a petition (efore this
Court a#ainst the 5"(uds"an for #rave a(use of discretion in dis"issin# her co"plaint a#ainst said Cit)
+rosecutors on the #round of lac4 of evidence. 6uch as we s)"pathiJe with the (ereaved widow$ however$ this
Court is of the opinion that the #eneral rule still finds application in instant case. &n other words$ the respondent
5"(uds"an did not co""it #rave a(use of discretion in decidin# a#ainst filin# the necessar) infor"ation a#ainst
pu(lic respondents of the 5ffice of the Cit) +rosecutor.
The followin# facts are (orne out () the records.
0lorencio V. Rueda$ hus(and of petitioner ,eonila Garcia-Rueda$ underwent sur#ical operation at the G:T hospital
for the re"oval of a stone (loc4in# his ureter. 7e was attended () 8r. 8o"in#o Antonio$ -r. who was the sur#eon$
while 8r. Hrlinda %alat(at-Re)es was the anaesthesiolo#ist. :i9 hours after the sur#er)$ however$ 0lorencio died of
co"plications of Aun4nown cause$B accordin# to officials of the G:T 7ospital.
[;]
Not satisfied with the findin#s of the hospital$ petitioner reCuested the National %ureau of &nvesti#ation DN%&E to
conduct an autops) on her hus(and?s (od). ConseCuentl)$ the N%& ruled that 0lorencio?s death was due to lac4 of
care () the attendin# ph)sician in ad"inisterin# anaesthesia. +ursuant to its findin#s$ the N%& reco""ended that
8r. 8o"in#o Antonio and 8r. Hrlinda %alat(at-Re)es (e char#ed for 7o"icide throu#h Rec4less &"prudence (efore
the 5ffice of the Cit) +rosecutor.
8urin# the preli"inar) investi#ation$ what transpired was a confoundin# series of events which we shall tr) to
disentan#le. The case was initiall) assi#ned to +rosecutor Antonio 6. &srael$ who had to inhi(it hi"self (ecause he
was related to the counsel of one of the doctors. As a result$ the case was re-raffled to +rosecutor Nor(erto G.
,eono who was$ however$ disCualified on "otion of the petitioner since he disre#arded prevailin# laws and
.urisprudence re#ardin# preli"inar) investi#ation. The case was then referred to +rosecutor Ra"on 5. Caris"a$
who issued a resolution reco""endin# that onl) 8r. Re)es (e held cri"inall) lia(le and that the co"plaint a#ainst
8r. Antonio (e dis"issed.
The case too4 another perple9in# turn when Assistant Cit) +rosecutor -osefina :antos :ioson$ in the Ainterest of
.ustice and peace of "ind of the parties$B reco""ended that the case (e re-raffled on the #round that +rosecutor
Caris"a was partial to the petitioner. Thus$ the case was transferred to +rosecutor ,eoncia R. 8i"a#i(a$ where
a volte face occurred a#ain with the endorse"ent that the co"plaint a#ainst 8r. Re)es (e dis"issed and instead$ a
correspondin# infor"ation (e filed a#ainst 8r. Antonio. +etitioner filed a "otion for reconsideration$ Cuestionin# the
findin#s of +rosecutor 8i"a#i(a.
+endin# the resolution of petitioner?s "otion for reconsideration re#ardin# +rosecutor 8i"a#i(a?s resolution$ the
investi#ative Apin#pon#B continued when the case was a#ain assi#ned to another prosecutor$ Hudo9ia T. Gual(erto$
who reco""ended that 8r. Re)es (e included in the cri"inal infor"ation of 7o"icide throu#h Rec4less
&"prudence. =hile the reco""endation of +rosecutor Gual(erto was pendin#$ the case was transferred to :enior
:tate +rosecutor Gre#orio A. AriJala$ who resolved to e9onerate 8r. Re)es fro" an) wron#doin#$ a resolution which
was approved () (oth Cit) +rosecutor +orfirio G. 6acarae# and Cit) +rosecutor -esus 0. Guerrero.
A##rieved$ petitioner filed #raft char#es specificall) for violation of :ection 3DeE of Repu(lic Act No. 3<12
[3]
a#ainst
+rosecutors Guerrero$ 6acarae#$ and AriJala for "anifest partialit) in favor of 8r. Re)es (efore the 5ffice of the
5"(uds"an. 7owever$ on -ul) 11$ 122>$ the 5"(uds"an issued the assailed resolution dis"issin# the co"plaint
for lac4 of evidence.
&n fine$ petitioner assails the e9ercise of the discretionar) power of the 5"(uds"an to review the reco""endations
of the #overn"ent prosecutors and to approve and disapprove the sa"e. +etitioner faults the 5"(uds"an for$
alle#edl) in #rave a(use of discretion$ refusin# to find that there e9ists pro(a(le cause to hold pu(lic respondent Cit)
+rosecutors lia(le for violation of :ection 3DeE of R.A. No. 3<12.
+reli"inaril)$ the powers and functions of the 5"(uds"an have #enerall) (een cate#oriJed into the followin#*
investi#ator) powers$ prosecutor) power$ pu(lic assistance function$ authorit) to inCuire and o(tain infor"ation$ and
function to adopt$ institute and i"ple"ent preventive "easures.
[>]
As protector of the people$ the 5ffice of the 5"(uds"an has the power$ function and dut) Ato act pro"ptl) on
co"plaints filed in an) for" or "anner a#ainst pu(lic officialsB and Ato investi#ate an) act or o"ission of an) pu(lic
official when such act or o"ission appears to (e ille#al$ un.ust$ i"proper or inefficient.B
[!]
=hile the 5"(uds"an has the full discretion to deter"ine whether or not a cri"inal case should (e filed$ this Court
is not precluded fro" reviewin# the 5"(uds"an?s action when there is an a(use of discretion$ in which case Rule
! of the Rules of Court "a) e9ceptionall) (e invo4ed pursuant to :ection &$ Article V&&& of the 1213 Constitution.
[]
&n this re#ard$ A#rave a(use of discretionB has (een defined as Awhere a power is e9ercised in an ar(itrar) or
despotic "anner () reason of passion or personal hostilit) so patent and #ross as to a"ount to evasion of positive
dut) or virtual refusal to perfor" a dut) en.oined ()$ or in conte"plation of law.
[3]
0ro" a procedural standpoint$ it is certainl) odd wh) the successive transfers fro" one prosecutor to another were
not sufficientl) e9plained in the Resolution of the 5"(uds"an. %ein# the proper investi#atin# authorit) with respect
to "isfeasance$ non-feasance and "alfeasance of pu(lic officials$ the 5"(uds"an should have (een "ore vi#ilant
and assiduous in deter"inin# the reasons (ehind the A(uc4passin#B to ensure that no irre#ularit) too4 place.
=hether such transfers were due to an) outside pressure or ulterior "otive is a "atter of evidence. 5ne would have
e9pected the 5"(uds"an$ however$ to inCuire into what could hardl) Cualif) as Astandard operatin# procedure$B
#iven the surroundin# circu"stances of the case.
=hile it is true that a preli"inar) investi#ation is essentiall) inCuisitorial$ and is often the onl) "eans to discover who
"a) (e char#ed with a cri"e$ its function is "erel) to deter"ine the e9istence of pro(a(le cause.
[1]
+ro(a(le cause
has (een defined as Athe e9istence of such fact and circu"stances as would e9cite the (elief$ in a reasona(le "ind$
actin# on the facts within the 4nowled#e of the prosecution$ that the person char#ed was #uilt) of the cri"e for which
he was prosecuted.B
[2]
A+ro(a(le cause is a reasona(le #round of presu"ption that a "atter is$ or "a) (e$ well founded$ such a state of
facts in the "ind of the prosecutor as would lead a person of ordinar) caution and prudence to (elieve$ or entertain
an honest or stron# suspicion$ that a thin# is so.B The ter" does not "ean actual and positive cause nor does it
i"port a(solute certaint). &t is "erel) (ased on opinion and reasona(le (elief. Thus$ a findin# of pro(a(le cause
does not reCuire an inCuir) into whether there is sufficient evidence to procure a conviction. &t is enou#h that it is
(elieved that the act or o"ission co"plained of constitutes the offense char#ed. +recisel)$ there is a trial for the
reception of evidence of the prosecution in support of the char#e.
[1<]
&n the instant case$ no less than the N%& pronounced after conductin# an autops) that there was indeed ne#li#ence
on the part of the attendin# ph)sicians in ad"inisterin# the anaesthesia.
[11]
The fact of want of co"petence or
dili#ence is evidentiar) in nature$ the veracit) of which can (est (e passed upon after a full-(lown trial for it is virtuall)
i"possi(le to ascertain the "erits of a "edical ne#li#ence case without e9tensive investi#ation$ research$ evaluation
and consultations with "edical e9perts. Clearl)$ the Cit) +rosecutors are not in a co"petent position to pass
.ud#"ent on such a technical "atter$ especiall) when there are conflictin# evidence and findin#s. The (ases of a
part)?s accusation and defenses are (etter ventilated at the trial proper than at the preli"inar) investi#ation.
A word on "edical "alpractice or ne#li#ence cases.
A&n its si"plest ter"s$ the t)pe of lawsuit which has (een called "edical "alpractice or$ "ore appropriatel)$ "edical
ne#li#ence$ is that t)pe of clai" which a victi" has availa(le to hi" or her to redress a wron# co""itted () a
"edical professional which has caused (odil) har".
&n order to successfull) pursue such a clai"$ a patient "ust prove that a health care provider$ in "ost cases a
ph)sician$ either failed to do so"ethin# which a reasona(l) prudent health care provider would have done$ or that he
or she did so"ethin# that a reasona(l) prudent provider would not have doneF and that that failure or action caused
in.ur) to the patient.B
[1;]
7ence$ there are four ele"ents involved in "edical ne#li#ence cases* dut)$ (reach$ in.ur) and pro9i"ate causation.
Hvidentl)$ when the victi" e"plo)ed the services of 8r. Antonio and 8r. Re)es$ a ph)sician-patient relationship was
created. &n acceptin# the case$ 8r. Antonio and 8r. Re)es in effect represented that$ havin# the needed trainin# and
s4ill possessed () ph)sicians and sur#eons practicin# in the sa"e field$ the) will e"plo) such trainin#$ care and s4ill
in the treat"ent of their patients.
[13]
The) have a dut) to use at least the sa"e level of care that an) other reasona(l)
co"petent doctor would use to treat a condition under the sa"e circu"stances. The (reach of these professional
duties of s4ill and care$ or their i"proper perfor"ance$ () a ph)sician sur#eon where() the patient is in.ured in (od)
or in health$ constitutes actiona(le "alpractice.
[1>]
ConseCuentl)$ in the event that an) in.ur) results to the patient
fro" want of due care or s4ill durin# the operation$ the sur#eons "a) (e held answera(le in da"a#es for ne#li#ence.
[1!]
6oreover$ in "alpractice or ne#li#ence cases involvin# the ad"inistration of anaesthesia$ the necessit) of e9pert
testi"on) and the availa(ilit) of the char#e of res ipsa loquitur to the plaintiff$ have (een applied in actions a#ainst
anaesthesiolo#ists to hold the defendant lia(le for the death or in.ur) of a patient under e9cessive or i"proper
anaesthesia.
[1]
Hssentiall)$ it reCuires two-pron#ed evidence* evidence as to the reco#niJed standards of the
"edical co""unit) in the particular 4ind of case$ and a showin# that the ph)sician in Cuestion ne#li#entl) departed
fro" this standard in his treat"ent.
[13]
Another ele"ent in "edical ne#li#ence cases is causation which is divided into two inCuiries* whether the doctor?s
actions in fact caused the har" to the patient and whether these were the pro9i"ate cause of the patient?s in.ur).
[11]
&ndeed here$ a causal connection is discerni(le fro" the occurrence of the victi"?s death after the ne#li#ent act of
the anaesthesiolo#ist in ad"inisterin# the anesthesia$ a fact which$ if confir"ed$ should warrant the filin# of the
appropriate cri"inal case. To (e sure$ the alle#ation of ne#li#ence is not entirel) (aseless. 6oreover$ the N%&
deduced that the attendin# sur#eons did not conduct the necessar) interview of the patient prior to the operation. &t
appears that the cause of the death of the victi" could have (een averted had the proper dru# (een applied to cope
with the s)"pto"s of "ali#nant h)perther"ia. Also$ we cannot i#nore the fact that an antidote was readil) availa(le
to counteract whatever deleterious effect the anaesthesia "i#ht produce.
[12]
=h) these precautionar) "easures
were disre#arded "ust (e sufficientl) e9plained.
The Cit) +rosecutors were char#ed with violatin# :ection 3DeE of the Anti-Graft and Corrupt +ractices Act which
reCuires the followin# facts*
A1. The accused is a pu(lic officer dischar#in# ad"inistrative or official functions or private persons char#ed in
conspirac) with the"F
;. The pu(lic officer co""itted the prohi(ited act durin# the perfor"ance of his official dut) or in relation to his
pu(lic positionF
3. The pu(lic officer acted with "anifest partialit)$ evident (ad faith or #ross$ ine9cusa(le ne#li#enceF and
>. 7is action caused undue in.ur) to the Govern"ent or an) private part)$ or #ave an) part) an) unwarranted
(enefit$ advanta#e or preference to such parties.B
[;<]
=h) did the co"plainant$ petitioner in instant case$ elect to char#e respondents under the a(ove lawL
=hile a part) who feels hi"self a##rieved is at li(ert) to choose the appropriate Aweapon fro" the ar"or)$B it is with
no little surprise that this Court views the choice "ade () the co"plainant widow.
To our "ind$ the (etter and "ore lo#ical re"ed) under the circu"stances would have (een to appeal the resolution
of the Cit) +rosecutors dis"issin# the cri"inal co"plaint to the :ecretar) of -ustice under the 8epart"ent of
-ustice?s 5rder No. ;;3$
[;1]
otherwise 4nown as the A1223 Revised Rules on Appeals 0ro" Resolutions &n
+reli"inar) &nvesti#ationsMReinvesti#ations$B as a"ended () 8epart"ent 5rder No. 3!2$ :ection 1 of which
provides*
A:ection 1. =hat 6a) %e Appealed. - 5nl) resolutions of the Chief :tate +rosecutorMRe#ional :tate
+rosecutorM+rovincial or Cit) +rosecutor dis"issin# a cri"inal co"plaint "a) (e the su(.ect of an appeal to the
:ecretar) of -ustice e9cept as otherwise provided in :ection > hereof.B
=hat action "a) the :ecretar) of -ustice ta4e on the appealL :ection 2 of 5rder No. ;;3 states* AThe :ecretar) of
-ustice "a) reverse$ affir" or "odif) the appealed resolution.B 5n the other hand$ A7e "a) motu proprio or on
"otion of the appellee$ dis"iss outri#ht the appeal on specified #rounds.B
[;;]
&n e9ercisin# his discretion under the circu"stances$ the 5"(uds"an acted within his power and authorit) in
dis"issin# the co"plaint a#ainst the +rosecutors and this Court will not interfere with the sa"e.
5HERE-ORE$ in view of the fore#oin#$ the instant petition is 8&:6&::H8, without pre.udice to the filin# of an
appeal () the petitioner with the :ecretar) of -ustice assailin# the dis"issal of her cri"inal co"plaint () the
respondent Cit) +rosecutors. No costs.
SO ORDERED.
Regalado. $Chairma"'. Pu"o. Ae"do6a. and Torres. 8r.. 88.. concur.

SE/OND D&1&S&ON


S0O:SES -REDEL&/'O -LORES <!ecea$e!= a!
-EL&/&S&.A -LORES$
+etitioners$


- versus -


S0O:SES DO.&NADOR 0&NEDA a! 1&RG&N&A
SA/LOLO, a! -LOREN/&O, /AND&DA, .AR'A,
GODO-REDO, 2AL'A3AR a! L:/ENA, a(( $)ra"e!
0&NEDA, a$ ,e#r$ o8 t,e !ecea$e! 'ERES&'A S.
0&NEDA, a! :N&'ED DO/'ORS .ED&/AL /EN'ER,
&N/.,
Respondents.
G.R. No. 15K66>

+resent*

KG&:G6%&NG. 8.. Chairperso".
CAR+&5 65RA,H:$
T&NGA$
VH,A:C5$ -R.$ and
%R&5N$ 88.


+ro"ul#ated*


Nove"(er 1>$ ;<<1

9 -------------------------------------------------------------------------------------------9

D E / & S & O N

2R&ON, J.*

This petition involves a "edical ne#li#ence case that was elevated to this Court throu#h an appeal
() #ertiorari under Rule >! of the Rules of Court. The petition assails the 8ecision
[1]
of the Court of Appeals DCAE in
CA G.R. CV No. 3;3>$ which affir"ed with "odification the 8ecision
[;]
of the Re#ional Trial Court DRTCE of Nueva
Hci.a$ %ranch 33 in Civil Case No. :8-1;33. The dispositive portion of the assailed CA decision states*

=7HRH05RH$ pre"ises considered$ the assailed 8ecision of the Re#ional Trial Court of %aloc$ :to. 8o"in#o$
Nueva Hci.a$ %ranch 33 is here() A00&R6H8 (ut with "odifications as follows*

1E 5rderin# defendant-appellants 8r. and 8ra. 0redelicto A. 0lores and the Gnited 8octors 6edical Center$ &nc. to
.ointl) and severall) pa) the plaintiff-appellees W heirs of Teresita +ineda$ na"el)$ :pouses 8o"inador +ineda and
Vir#inia :aclolo and 0lorencio$ Candida$ 6arta$ Godofredo$ %altaJar and ,ucena$ all surna"ed +ineda$ the su"
of+><<$<<<.<< () wa) of "oral da"a#esF

;E 5rderin# the a(ove-na"ed defendant-appellants to .ointl) and severall) pa) the a(ove-na"ed plaintiff-
appellees the su" of +1<<$<<<.<< () wa) of e9e"plar) da"a#esF

3E 5rderin# the a(ove-na"ed defendant-appellants to .ointl) and severall) pa) the a(ove-na"ed plaintiff-
appellees the su" of +3$<<<.<< () wa) of actual and co"pensator) da"a#esF and

>E 8eletin# the award of attorne)?s fees and costs of suit.

:5 5R8HRH8.

=hile this case essentiall) involves Cuestions of facts$ we opted for the reCuested review in li#ht of Cuestions we
have on the findin#s of ne#li#ence (elow$ on the awarded da"a#es and costs$ and on the i"portance of this t)pe of
rulin# on "edical practice.
[3]

2A/%GRO:ND -A/'S

Teresita +ineda DTeresitaE was a !1-)ear old un"arried wo"an livin# in :to. 8o"in#o$ Nueva Hci.a. :he
consulted on April 13$ 1213 her town"ate$ 8r. 0redelicto 0lores$ re#ardin# her "edical condition. :he co"plained of
#eneral (od) wea4ness$ loss of appetite$ freCuent urination and thirst$ and on-and-off va#inal (leedin#. 8r.
0redelicto initiall) interviewed the patient and as4ed for the histor) of her "onthl) period to anal)Je the pro(a(le
cause of the va#inal (leedin#. 7e advised her to return the followin# wee4 or to #o to the Gnited 8octors 6edical
Center DU7ACE in KueJon Cit) for a #eneral chec4-up. As for her other s)"pto"s$ he suspected that Teresita "i#ht
(e sufferin# fro" dia(etes and told her to continue her "edications.
[>]

Teresita did not return the ne9t wee4 as advised. 7owever$ when her condition persisted$ she went to further
consult 8r. 0lores at his G86C clinic onApril ;1$ 1213$ travellin# for at least two hours fro" Nueva Hci.a to KueJon
Cit)with her sister$ ,ucena +ineda. The) arrived at G86C at around 11*1! a.".. ,ucena later testified that her sister
was then so wea4 that she had to lie down on the couch of the clinic while the) waited for the doctor. =hen 8r.
0redelicto arrived$ he did a routine chec4-up and ordered Teresita?s ad"ission to the hospital. &n the ad"ission slip$
he directed the hospital staff to prepare the patient for an Aon callB DM/
[5]
operation to (e perfor"ed () his wife$ 8r.
0elicisi"a 0lores D7r. <eli#isimaE. Teresita was (rou#ht to her hospital roo" at around 1; noonF the hospital staff
forthwith too4 her (lood and urine sa"ples for the la(orator) tests
[]
which 8r. 0redelicto ordered.

At ;*>< p.". of that sa"e da)$ Teresita was ta4en to the operatin# roo". &t was onl) then that she "et 8r. 0elicisi"a$
an o(stetrician and #)necolo#ist. The two doctors W 8r. 0elicisi"a and 8r. 0redelicto$ conferred on the patient?s
"edical condition$ while the resident ph)sician and the "edical intern #ave 8r. 0elicisi"a their own (riefin#s. :he
also interviewed and conducted an internal va#inal e9a"ination of the patient which lasted for a(out 1! "inutes. 8r.
0elicisi"a thereafter called up the la(orator) for the results of the tests. At that ti"e$ onl) the results for the (lood
su#ar D3SE$ uric acid deter"ination$ cholesterol deter"ination$ and co"plete (lood count DC3CE were
availa(le. Teresita?s %: count was 1<.3""olMl
[3]
and her C%C was 1<2#Ml.
[1]

%ased on these preparations$ 8r. 0elicisi"a proceeded with the 8XC operation with 8r. 0redelicto ad"inisterin# the
#eneral anesthesia. The 8XC operation lasted for a(out 1< to 1! "inutes. %) 3*>< p.".$ Teresita was wheeled (ac4
to her roo".

A da) after the operation Dor on April ;2$ 1213E$ Teresita was su(.ected to an ultrasound e9a"ination as a
confir"ator) procedure. The results showed that she had an enlar#ed uterus and m,oma uteri.
[2]
8r. 0elicisi"a$
however$ advised Teresita that she could spend her recover) period at ho"e. :till feelin# wea4$ Teresita opted for
hospital confine"ent.

Teresita?s co"plete la(orator) e9a"ination results ca"e onl) on that da) DApril ;2$ 1213E. Teresita?s urinal)sis
showed a three plus si#n DYYYE indicatin# that the su#ar in her urine was ver) hi#h. :he was then placed under the
care of 8r. A"ado -or#e$ an internist.

%) April 3<$ 1213$ Teresita?s condition had worsened. :he e9perienced difficult) in (reathin# and was rushed to the
intensive care unit. 0urther tests confir"ed that she was sufferin# fro" D#abete$ .e((#t)$ '+*e &&.
[1<]
&nsulin was
ad"inistered on the patient$ (ut the "edication "i#ht have arrived too late. 8ue to co"plications induced ()
dia(etes$ Teresita died in the "ornin# of 6a) $ 1213.
[11]

%elievin# that Teresita?s death resulted fro" the ne#li#ent handlin# of her "edical needs$ her fa"il) Drespo"de"tsE
instituted an action for da"a#es a#ainst 8r. 0redelicto 0lores and 8r. 0elicisi"a 0lores Dcollectivel) referred to as
thepetitio"er spousesE (efore the RTC of Nueva Hci.a.

The RTC ruled in favor of Teresita?s fa"il) and awarded actual$ "oral$ and e9e"plar) da"a#es$ plus attorne)?s fees
and costs.
[1;]
The CA affir"ed the .ud#"ent$ (ut "odified the a"ount of da"a#es awarded and deleted the award
for attorne)?s fees and costs of suit.
[13]

Throu#h this petition for review on #ertiorari$ the petitioner spouses W8r. 0redelicto Dnow deceasedE and 8r.
0elicisi"a 0lores W alle#e that the RTC and CA co""itted a reversi(le error in findin# the" lia(le throu#h
ne#li#ence for the death of Teresita +ineda.

ASS&GN.EN' O- ERRORS

The petitioner spouses contend that the) e9ercised due care and prudence in the perfor"ance of their duties
as "edical professionals. The) had attended to the patient to the (est of their a(ilities and undertoo4 the
"ana#e"ent of her case (ased on her co"plaint of an on-and-off va#inal (leedin#. &n addition$ the) clai" that
nothin# on record shows that the death of Teresita could have (een averted had the) e"plo)ed "eans other than
what the) had adopted in the "inistration of the patient.


'HE /O:R'FS R:L&NG

5e !o ot 8#! t,e *et#t#o "er#tor#o)$.

The respondents? clai" for da"a#es is predicated on their alle#ation that the decision of the petitioner
spouses to proceed with the 8XC operation$ notwithstandin# Teresita?s condition and the la(orator) test results$
a"ounted to ne#li#ence. 5n the other hand$ the petitioner spouses contend that a 8XC operation is the proper and
accepted procedure to address va#inal (leedin# W the "edical pro(le" presented to the". Given that the patient
died after the 8XC$ the core issue is whether the decision to proceed with the 8XC operation was an honest "ista4e
of .ud#"ent or one a"ountin# to ne#li#ence.

$le)ents of a #edical Negligence 'ase

A "e!#ca( e9(#9ece ca$e is a t)pe of clai" to redress a wron# co""itted () a "edical professional$ that
has caused (odil) har" to or the death of a patient. There are four ele"ents involved in a "edical ne#li#ence case$
na"el)* dut,. -rea#h. i"Eur,. a"d pro/imate #ausatio".
[1>]

8ut) refers to the standard of (ehavior which i"poses restrictions on one?s conduct.
[1!]
The standard in turn
refers to the a"ount of co"petence associated with the proper dischar#e of the profession. A ph)sician is e9pected
to use at least the sa"e level of care that an) other reasona(l) co"petent doctor would use under the sa"e
circu"stances. %reach of dut) occurs when the ph)sician fails to co"pl) with these professional standards. &f in.ur)
results to the patient as a result of this (reach$ the ph)sician is answera(le for ne#li#ence.
[1]

As in an) civil action$ the (urden to prove the e9istence of the necessar) ele"ents rests with the plaintiff.
[13]
To successfull) pursue a clai"$ the plaintiff "ust prove () preponderance of evidence that$ oe$ the ph,si#ia"
either failed to do somethi"g !hi#h a reaso"a-l, prude"t health #are provider !ould have do"e. or that he did
somethi"g that a reaso"a-l, prude"t provider !ould "ot have do"eF and t7o$ the failure or a#tio" #aused i"Eur, to
the patie"t.
[11]
H9pert testi"on) is therefore essential since the factual issue of whether a ph)sician or sur#eon has
e9ercised the reCuisite de#ree of s4ill and care in the treat"ent of his patient is #enerall) a "atter of e9pert opinion.
[12]

Standard of 'are and /reac& of "uty

8XC is the classic #)necolo#ic procedure for the evaluation and possi(le therapeutic treat"ent for a(nor"al
va#inal (leedin#.
[;<]
That this is the reco#niJed procedure is confir"ed () 8rs. :alvador Nieto D7r. :ietoE and
-oselito 6ercado D7r. Aer#adoE$ the e9pert witnesses presented () the respondents*

8R. N&HT5* [=]hat & 4now a"on# o(stetricians$ if there is (leedin#$ the) perfor" what we call 8XC for dia#nostic
purposes.

999 999 999

K* :o are )ou tr)in# to tell the Court that 8XC can (e a dia#nostic treat"entL

A* Ies$ sir. An) doctor 4nows this.
[;1]

8r. 6ercado$ however$ o(.ected with respect to the ti"e the 8XC operation should have (een conducted in
Teresita?s case. 7e opined that #iven the (lood su#ar level of Teresita$ her dia(etic condition should have (een
addressed first*

K* =h) do )ou consider the ti"e of perfor"ance of the 8XC not appropriateL

A* %ecause & have read the record and & have seen the urinal)sis$ [there is] spilla#e in the urine$ and (lood
su#ar was 1<.3

K* =hat is the si#nificance of the spilla#e in the urineL

A* &t is a si#n that the (lood su#ar is ver) hi#h.

K* 8oes it indicate sic4nessL

A* 1< to 2!Q it "eans dia(etes "ellitus. The (lood su#ar was 1<.3.

999 999 999

C5GRT* &n other words$ the operation conducted on the patient$ )our opinion$ that it is inappropriateL

A* The ti"in# of [when] the 8XC [was] done$ (ased on the record$ in ") personal opinion$ that 8XC should (e
postponed a da) or two.
[;;]

The petitioner spouses countered that$ at the ti"e of the operation$ there was nothin# to indicate that Teresita was
afflicted with dia(etes* a (lood su#ar level of 1<.3""olMl did not necessaril) "ean that she was a dia(etic
considerin# that this was rando) *lood sugarL
[;3]
there were other factors that "i#ht have caused Teresita?s (lood
su#ar to rise such as the ta4in# of (lood sa"ples durin# lunchti"e and while patient was (ein# #iven intra-venous
de9trose.
[;>]
0urther"ore$ the) clai" that their principal concern was to deter"ine the cause of and to stop the
va#inal (leedin#.

The petitioner spouses? contentions$ in our view$ "iss several points. -irst$ as earl) as April 13$ 1213 $ Teresita was
alread) suspected to (e sufferin# fro" dia(etes.
[;!]
This suspicion a#ain arose ri#ht (efore the 8XC operation
on April ;1$ 1213 when the la(orator) result revealed Teresita?s increased (lood su#ar level.
[;]
Gnfortunatel)$ the
petitioner spouses did not wait for the full "edical la(orator) results (efore proceedin# with the 8XC$ a fact that was
never considered in the courts (elow. Second$ the petitioner spouses were dul) advised that the patient was
e9periencin# #eneral (od) wea4ness$ loss of appetite$ freCuent urination$ and thirst W all of which are classic
s)"pto"s of dia(etes.
[;3]
=hen a patient e9hi(its s)"pto"s t)pical of a particular disease$ these s)"pto"s should$
at the ver) least$ alert the ph)sician of the possi(ilit) that the patient "a) (e afflicted with the suspected disease*

[H9pert testi"on) for the plaintiff showed that] tests should have (een ordered i""ediatel) on ad"ission to the
hospital in view of the s)"pto"s presented$ and that failure to reco#niJe the e9istence of dia(etes constitutes
ne#li#ence.
[;1]

0&ird, the petitioner spouses cannot clai" that their principal concern was the va#inal (leedin# and should not
therefore (e held accounta(le for co"plications co"in# fro" other sources. This is a ver) narrow and self-servin#
view that even reflects on their co"petence.

Ta4en to#ether$ we find that reasona(le prudence would have shown that dia(etes and its co"plications were
foreseea(le har" that should have (een ta4en into consideration () the petitioner spouses. &8 a *at#et $)88er$
8ro" $o"e !#$ab#(#t+ t,at #crea$e$ t,e "a9#t)!e o8 r#$B to ,#", t,at !#$ab#(#t+ ")$t be taBe #to acco)t
$o (o9 a$ #t #$ or $,o)(! ,aCe bee Bo7 to t,e *,+$#c#a.
[;2]
And when the patient is e9posed to an increased
ris4$ it is incu"(ent upon the ph)sician to ta4e co""ensurate and adeCuate precautions.

Ta4in# into account Teresita?s hi#h (lood su#ar$
[3<]
8r. 6endoJa opined that the attendin# ph)sician should have
postponed the 8XC operation in order to conduct a confir"ator) test to "a4e a conclusive dia#nosis of dia(etes and
to refer the case to an internist or dia(etolo#ist. This was corro(orated () 8r. 8elfin Tan D7r. Ta"E$ an o(stetrician
and #)necolo#ist$ who stated that the patient?s dia(etes should have (een "ana#ed () an internist prior to. duri"g.
a"d after the operation.
[31]

Apart fro" (leedin# as a co"plication of pre#nanc)$ va#inal (leedin# is onl) rarel) so heav) and life-threatenin# that
ur#ent first-aid "easures are reCuired.
[3;]
&ndeed$ the e9pert witnesses declared that a 8XC operation on a
h)per#l)ce"ic patient "a) (e .ustified onl) when it is an e"er#enc) case W when there is profuse va#inal
(leedin#. &n this case$ we choose not to rel) on the assertions of the petitioner spouses that there was profuse
(leedin#$ not onl) (ecause the state"ents were self-servin#$ (ut also (ecause the petitioner spouses were
inconsistent in their testi"onies. 8r. 0redelicto testified earlier that on April ;1$ he personall) saw the (leedin#$
[33]
(ut
later on said that he did not see it and relied onl) on Teresita?s state"ent that she was (leedin#.
[3>]
7e went on to
state that he scheduled the 8XC operation without conductin# an) ph)sical e9a"ination on the patient.

The li4el) stor) is that althou#h Teresita e9perienced va#inal (leedin# on April ;1$ it was not sufficientl) profuse to
necessitate an i""ediate e"er#enc) 8XC operation. 8r. Tan
[3!]
and 8r. 6endoJa
[3]
(oth testified that the "edical
records of Teresita failed to indicate that there was profuse va#inal (leedin#. The clai" that there was profuse
va#inal (leedin# althou#h this was not reflected in the "edical records stri4es us as odd since the "ain co"plaint is
va#inal (leedin#. A "edical record is the onl) docu"ent that "aintains a lon#-ter" transcription of patient care and
as such$ its "aintenance is considered a priorit) in hospital practice. 5pti"al record-4eepin# includes all patient
inter-actions. The records should alwa)s (e clear$ o(.ective$ and up-to-date.
[33]
Thus$ a "edical record that does not
indicate profuse "edical (leedin# spea4s loudl) and clearl) of what it does not contain.

That the 8XC operation was conducted principall) to dia#nose the cause of the va#inal (leedin# further leads us to
conclude that it was "erel) an elective procedure$ not an e"er#enc) case. &n an elective procedure$ the ph)sician
"ust conduct a thorou#h pre-operative evaluation of the patient in order to adeCuatel) prepare her for the operation
and "ini"iJe possi(le ris4s and co"plications. The internist is responsi(le for #eneratin# a co"prehensive
evaluation of all "edical pro(le"s durin# the pre-operative evaluation.
[31]

The ai" of pre-operative evaluation is not to screen (roadl) for undia#nosed disease$ (ut rather to identif) and
Cuantif) co"or(idit) that "a) i"pact on the operative outco"e. This evaluation is driven () findin#s on histor) and
ph)sical e9a"ination su##estive of or#an s)ste" d)sfunctionV',e 9oa( #$ to )coCer *rob(e" area$ t,at "a+
reH)#re 8)rt,er #Ce$t#9at#o or be a"eab(e to *reo*erat#Ce o*t#"#Gat#o.

&f the preoperative evaluation uncovers si#nificant co"or(idit) or evidence of poor control of an underl)in# disease
process$ consultation with an internist or "edical specialist "a) (e reCuired to facilitate the wor4-up and direct
"ana#e"ent. &n this process$ co""unication (etween the sur#eons and the consultants is essential to define
realistic #oals for this opti"iJation process and to e9pedite sur#ical "ana#e"ent.
[32]
[H"phasis supplied.]

:i#nificantl)$ the evidence stron#l) su##ests that the pre-operative evaluation was less than co"plete as the
la(orator) results were full) reported onl) on the da) followin# the 8XC operation. 8r. 0elicisi"a onl) secured a
telephone report of the preli"inar) la(orator) result prior to the 8XC. This preli"inar) report did not include the 3Y
status of su#ar in the patient?s urine
[><]
W a result hi#hl) confir"ator) of dia(etes.

%ecause the 8XC was "erel) an elective procedure$ the patient?s uncontrolled h)per#l)ce"ia presented a far
#reater ris4 than her on-and-off va#inal (leedin#. The presence of h)per#l)ce"ia in a sur#ical patient is associated
with poor clinical outco"es$ and a##ressive #l)ce"ic control positivel) i"pacts on "or(idit) and "ortalit).
[>1]
Hlective sur#er) in people with uncontrolled dia(etes

should prefera(l) (e scheduled after accepta(le #l)ce"ic
control

has (een achieved.
[>;]
Accordin# to 8r. 6ercado$ this is done () ad"inisterin# insulin on the patient.
[>3]

The "ana#e"ent approach in

this 4ind of patients alwa)s includes insulin therap)

in co"(ination with de9trose and
potassiu" infusion. &nsulin 999 pro"otes #lucose upta4e () the "uscle and fat cells

while decreasin# #lucose
production () the liver 999. The net effect is to lower (lood #lucose levels.
[>>]

The prudent "ove is to address the patient?s h)per#l)ce"ic state i""ediatel) and pro"ptl) (efore an) other
procedure is underta4en. &n this case$ there was no evidence that insulin was ad"inistered on Teresita prior to or
durin# the 8XC operation. &nsulin was onl) ad"inistered two da)s after the operation.

As 8r. Tan testified$ the patient?s h)per#l)ce"ic condition should have (een "ana#ed not onl) (efore and durin# the
operation$ (ut also i""ediatel) after. 8espite the possi(ilit) that Teresita was afflicted with dia(etes$ the possi(ilit)
was casuall) i#nored even in the post-operative evaluation of the patientF the concern$ as the petitioner spouses
e9pressl) ad"itted$ was li"ited to the co"plaint of va#inal (leedin#. &nterestin#l)$ while the ultrasound test
confir"ed that Teresita had a ")o"a in her uterus$ she was advised that she could (e dischar#ed a da) after the
operation and that her recover) could ta4e place at ho"e. This advice i"plied that a da) after the operation and
even after the co"plete la(orator) results were su("itted$ the petitioner spouses still did not reco#niJe an) post-
operative concern that would reCuire the "onitorin# of Teresita?s condition in the hospital.

The a(ove facts$ point onl) to one conclusion W that the petitioner spouses failed$ as "edical professionals$ to
co"pl) with their dut) to o(serve the standard of care to (e #iven to h)per#l)ce"icMdia(etic patients under#oin#
sur#er). =hether this (reach of dut) was the pro9i"ate cause of Teresita?s death is a "atter we shall ne9t
deter"ine.

In1ury and 'ausation

As previousl) "entioned$ the critical and clinchin# factor in a "edical ne#li#ence case is proof of the ca)$a(
coect#o (etween the ne#li#ence which the evidence esta(lished and the plaintiff?s in.uriesF
[>!]
the plaintiff "ust
plead and prove not onl) that he had (een in.ured and defendant has (een at fault$ (ut also that the defendant?s fault
caused the in.ur). A verdict in a "alpractice action cannot (e (ased on speculation or con.ecture. Causation "ust
(e proven within a reasona(le "edical pro(a(ilit) (ased upon co"petent e9pert testi"on).
[>]

The respondents contend that unnecessaril) su(.ectin# Teresita to a 8XC operation without adeCuatel)
preparin# her$ a##ravated her h)per#l)ce"ic state and caused her unti"el) de"ise. The death certificate of
Teresita lists down the followin# causes of death*

&""ediate cause* Cardiorespirator) arrest
Antecedent cause* :eptice"ic shoc4$ Betoac#!oc#$
Gnderl)in# cause* 8ia(etes 6ellitus &&
5ther si#nificant conditions
contri(utin# to death* Renal 0ailure W Acute
[>3]


:tress$ whether ph)sical or e"otional$ is a factor that can a##ravate dia(etesF a 8XC operation is a for" of ph)sical
stress. 8r. 6endoJa e9plained how sur#ical stress can a##ravate the patient?s h)per#l)ce"ia* when stress occurs$
the dia(etic?s (od)$ especiall) the autono"ic s)ste"$ reacts () secretin# hor"ones which are counter-re#ulator)F
she can have prolon#ed h)per#l)ce"ia which$ if unchec4ed$ could lead to death.
[>1]
6edical literature further
e9plains that if the (lood su#ar has (eco"e ver) hi#h$ the patient (eco"es co"atose Ddia(etic co"aE. =hen this
happens over several da)s$ the (od) uses its own fat to produce ener#)$ and the result is hi#h levels of waste
products Dcalled 4etonesE in the (lood and urine Dcalled !#abet#c Betoac#!#o$#$, a "edical e"er#enc) with a
si#nificant "ortalit)E.
[>2]
This was apparentl) what happened in Teresita?s caseF in fact$ after she had (een referred to
the internist 8r. -or#e$ la(orator) test showed that her (lood su#ar level shot up to 1>.<""olMl$ wa) a(ove the
nor"al (lood su#ar ran#e. Thus$ (etween the 8XC and death was the dia(etic co"plication that could have (een
prevented with the o(servance of standard "edical precautions. The 8XC operation and Teresita?s death due to
a##ravated dia(etic condition is therefore sufficientl) esta(lished.

The trial court and the appellate court pinned the lia(ilit) for Teresita?s death on (oth the petitioner spouses and this
Court finds no reason to rule otherwise. 7owever$ we clarif) that 8r. 0redelicto?s ne#li#ence is not solel) the act of
orderin# an Aon callB 8XC operation when he was "ainl) anaae$t,e$#o(o9#$t who had "ade a ver) cursor)
e9a"ination of the patient?s va#inal (leedin# co"plaint. Rather$ it was his failure fro" the ver) start to identif) and
confir"$ despite the patient?s co"plaints and his own suspicions$ that dia(etes was a ris4 factor that should (e
#uarded a#ainst$ and his participation in the i"prudent decision to proceed with the 8XC operation despite his earl)
suspicion and the confir"ator) earl) la(orator) results. The latter point co"es out clearl) fro" the followin#
e9chan#e durin# the trial*

K* 5n what aspect did )ou and )our wife consult [with] each otherL

A* =e discussed on the findin# of the la(orator) [results] (ecause the he"o#lo(in was (elow nor"al$ the (lood
su#ar was elevated$ so that we have to evaluate these la(orator) results W what it "eans.

K* :o it was )ou and )our wife who "ade the evaluation when it was phoned inL

A* Ies$ sir.

K* 8id )our wife$ (efore perfor"in# 8XC as4 )our opinion whether or not she can proceedL

A* Ies$ an)wa)$ she as4ed "e whether we can do 8XC (ased on ") e9perience.

;4 A! +o)r a$7er 7a$ # t,e *o$#t#Ce ot7#t,$ta!#9 t,e e(eCat#o o8 b(oo! $)9arN

A4 Ye$, $#r, #t 7a$ bot, o)r !#$*o$#t#o to !o t,e DM/. [H"phasis supplied.]
[!<]

&f 8r. 0redelicto (elieved hi"self to (e inco"petent to treat the dia(etes$ not (ein# an internist or a dia(etolo#ist Dfor
which reason he referred Teresita to 8r. -or#eE$
[!1]
he should have li4ewise refrained fro" "a4in# a decision to
proceed with the 8XC operation since he was niether an o(stetrician nor a #)necolo#ist.

These findin#s lead us to the conclusion that the decision to proceed with the 8XC operation$ notwithstandin#
Teresita?s h)per#l)ce"ia and without adeCuatel) preparin# her for the procedure$ was contrar) to the standards
o(served () the "edical profession. 8eviation fro" this standard a"ounted to a (reach of dut) which resulted in the
patient?s death. 8ue to this ne#li#ent conduct$ lia(ilit) "ust attach to the petitioner spouses.

Lia*ility of t&e (ospital

&n the proceedin#s (elow$ G86C was the spouses 0lores? co-defendant. The RTC found the hospital .ointl) and
severall) lia(le with the petitioner spouses$ which decision the CA affir"ed. &n a Resolution dated Au#ust ;1$ ;<<$
this Court however denied G86C?s petition for review on #ertiorari. :ince G86C?s appeal has (een denied and the)
are not parties to this case$ we find it unnecessar) to delve on the "atter. ConseCuentl)$ the RTC?s decision$ as
affir"ed () the CA$ stands.

A2ard of "a)ages

%oth the trial and the appellate court awarded actual da"a#es as co"pensation for the pecuniar) loss the
respondents suffered. The loss was presented in ter"s of the hospital (ills and e9penses the respondents incurred
on account of Teresita?s confine"ent and death. The settled rule is that a plaintiff is entitled to (e co"pensated for
proven pecuniar) loss.
[!;]
This proof the respondents successfull) presented. Thus$ we affir" the award of act)a(
!a"a9e$ of +3$<<<.<< representin# the hospital e9penses the patient incurred.

&n addition to the award for actual da"a#es$ the respondent heirs of Teresita are li4ewise entitled to +!<$<<<.<<
as !eat, #!e"#t+ pursuant to Article ;;< of the Civil Code$ which states that Athe a"ount of da"a#es for death
caused () a 999 quasiCdeli#t shall (e at least three thousand pesos$
[!3]
even thou#h there "a) have (een "iti#atin#
circu"stances 999.B This is a questio" of la! that the CA missed i" its de#isio" a"d !hi#h !e "o! de#ide i" the
respo"de"ts( favor.

The sa"e article allows the recover) of "oral da"a#es in case of death caused () a quasiCdeli#t and enu"erates
the spouse$ le#iti"ate or ille#iti"ate ascendants or descendants as the persons entitled thereto. 6oral da"a#es
are desi#ned to co"pensate the clai"ant for the in.ur) suffered$ that is$ for the "ental an#uish$ serious an9iet)$
wounded feelin#s which the respondents herein "ust have surel) felt with the une9pected loss of their dau#hter. =e
affir" the appellate court?s award of +><<$<<<.<< () wa) of "ora( !a"a9e$ to the respondents.

=e si"ilarl) affir" the #rant of e9e"plar) da"a#es. H9e"plar) da"a#es are i"posed () wa) of e9a"ple or
correction for the pu(lic #ood.
[!>]
%ecause of the petitioner spouses? ne#li#ence in su(.ectin# Teresita to an
operation without first reco#niJin# and addressin# her dia(etic condition$ the appellate court awarded e?e"*(ar+
!a"a9e$ to the respondents in the a"ount of +1<<$<<<.<<. +u(lic polic) reCuires such i"position to suppress the
wanton acts of an offender.
[!!]
=e therefore affir" the CA?s award as an e9a"ple to the "edical profession and to
stress that the pu(lic #ood reCuires stricter "easures to avoid the repetition of the t)pe of "edical "alpractice that
happened in this case.

=ith the award of e9e"plar) da"a#es$ the #rant of attorne)?s fees is le#all) in order.
[!]
=e therefore reverse the CA
decision deletin# these awards$ and #rant the respondents the a"ount of +1<<$<<<.<< as attore+F$ 8ee$ ta4in#
into consideration the le#al route this case has ta4en.

5HERE-ORE$ we A--&R. the 8ecision of the CA dated -une ;<$ ;<<3 in CA G.R. CV No. 3;3> findin# petitioner
spouses lia(le for ne#li#ent "edical practice. =e li4ewise A--&R. the awards of actual and co"pensator)
da"a#es of +3$<<<.<<F "oral da"a#es of +><<$<<<.<<F and e9e"plar) da"a#es of +1<<$<<<.<<.

=e .OD&-Y the CA 8ecision () additionall) #rantin# an award of+!<$<<<.<< as death inde"nit) and () reversin#
the deletion of the award of attorne)?s fees and costs and restorin# the award of +1<<$<<<.<< as attorne)?s
fees. Costs of liti#ation are ad.ud#ed a#ainst petitioner spouses.

To su""ariJe$ the followin# awards shall (e paid to the fa"il) of the late Teresita +ineda*

1. The su" of +3$<<<.<< () wa) of actual and co"pensator) da"a#esF
;. The su" of +!<$<<<.<< () wa) of death inde"nit)F
3. The su" of +><<$<<<.<< () wa) of "oral da"a#esF
>. The su" of +1<<$<<<.<< () wa) of e9e"plar) da"a#esF
!. The su" of +1<<$<<<.<< () wa) of attorne)?s feesF and
. Costs.

SO ORDERED.


'H&RD D&1&S&ON

0E'ER 0A:L 0A'R&/% L:/AS, -A'&.A GLADYS
L:/AS, A22EYGA&L L:/AS AND G&LL&AN L:/AS$
+etitioners$




C versus C




DR. 0ROS0ERO .A. /. ':AOO,
Respondent.
G. R. No. 17K7>3


+resent*

INARH:-:ANT&AG5$ 8..
Chairperson$
AG:TR&A-6ART&NHP$
C7&C5-NAPAR&5$
NAC7GRA$ and
+HRA,TA$ 88.



+ro"ul#ated*

April ;1$ ;<<2
9 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9

8 H C & : & 5 N


/H&/O@NA3AR&O, J.4


&n this petition for review on #ertiorari
[1]
under Rule >! of the Revised Rules of Court$ petitioners +eter +aul +atric4
,ucas$ 0ati"a Glad)s ,ucas$ A((e)#ail ,ucas and Gillian ,ucas see4 the reversal of the ;3 :epte"(er
;<<7e#isio"
[;]
and 3 -ul) ;<<3 Resolutio".
[3]
(oth of the Court of Appeals in CA-G.R. CV No. 1$ entitled A+eter
+aul +atric4 ,ucas$ 0ati"a Glad)s ,ucas$ A((e)#ail ,ucas and Gillian ,ucas v. +rospero 6a. C. TuaZo.B
&n the Cuestioned decision and resolution$ the Court of Appeals affir"ed the 1> -ul) ;<<< 7e#isio" of the Re#ional
Trial Court DRTCE$ %ranch 1!<$ 6a4atiCit)$ dis"issin# the co"plaint filed () petitioners in a civil case entitled$ FPeter
Paul Patri# Lu#as. <atima 9lad,s Lu#as. A--e,gail Lu#as a"d 9illia" Lu#as v. Prospero Aa. C. TuaGo.H doc4eted
as Civil Case No. 2;-;>1;.

0ro" the record of the case$ the esta(lished factual antecedents of the present petition are*

:o"eti"e in Au#ust 1211$ petitioner +eter +aul +atric4 ,ucas D+eterE contracted Asore e)esB in his ri#ht e)e.

5n ; :epte"(er 1211$ co"plainin# of a red ri#ht e)e and swollen e)elid$ +eter "ade use of his health care
insurance issued () +hila"care 7ealth :)ste"s$ &nc. D+hila"careE$ for a possi(le consult. The +hila"care
Coordinator$ 8r. Hdwin 5ca$ 6.8.$ referred +eter to respondent$ 8r. +rospero 6a. C. TuaZo$ 6.8. D8r. TuaZoE$ an
ophthal"olo#ist at :t. ,u4e?s 6edical Center$ for an e)e consult.

Gpon consultation with 8r. TuaZo$ +eter narrated that it had (een nine D2E da)s since the pro(le" with his ri#ht e)e
(e#anF and that he was alread) ta4in#Aa/itrol to address the pro(le" in his e)e. Accordin# to 8r. TuaZo$ he
perfor"ed Aocular routine e9a"inationB on +eter?s e)es$ wherein* D1E a #ross e9a"ination of +eter?s e)es and their
surroundin# area was "adeF D;E +eter?s visual acuit) were ta4enF D3E +eter?s e)es were palpated to chec4 the
intraocular pressure of eachF D>E the "otilit) of +eter?s e)es was o(servedF and D!E the ophthal"oscop)
[>]
on +eter?s
e)es was used. 5n that particular consultation$ 8r. TuaZo dia#nosed that +eter was sufferin# fro" #o"Eu"#tivitis
[!]
or
Asore e)es.B 8r. TuaZo then prescri(ed Spersa#etCC
[]
e)e drops for +eter and told the latter to return for follow-up
after one wee4.

As instructed$ +eter went (ac4 to 8r. TuaZo on 2 :epte"(er 1211. Gpon e9a"ination$ 8r. TuaZo told +eter that the
Asore e)esB in the latter?s ri#ht e)e had alread) cleared up and he could discontinue the Spersa#etCC. 7owever$ the
sa"e e)e developed Epidemi# Berato Co"Eu"#tivitis DH/CE$
[3]
a viral infection. To address the new pro(le" with
+eter?s ri#ht e)e$ 8r. TuaZo prescri(ed to the for"er a steroid-(ased e)e drop called Aa/itrol$
[1]
a dosa#e of si9 DE
drops per da).
[2]
To recall$ +eter had alread) (een usin# Aa/itrol prior to his consult with 8r. TuaZo.

5n ;1 :epte"(er 1211$ +eter saw 8r. TuaZo for a follow-up consultation. After e9a"inin# (oth of +eter?s e)es$ 8r.
TuaZo instructed the for"er to taper down
[1<]
the dosa#e of Aa/itrol. (ecause the H/C in his ri#ht e)e had alread)
resolved. 8r. TuaZo specificall) cautioned +eter that$ (ein# a steroid$ Aa/itrolhad to (e withdrawn #raduall)F
otherwise$ the H/C "i#ht recur.
[11]

Co"plainin# of feelin# as if there was so"ethin# in his e)es$ +eter returned to 8r. TuaZo for another chec4-up on
5cto(er 1211. 8r. TuaZo e9a"ined +eter?s e)es and found that the ri#ht e)e had once "ore developed H/C. :o$
8r. TuaZo instructed +eter to resu"e the use of Aa/itrol at si9 DE drops per da).

5n his wa) ho"e$ +eter was una(le to #et a hold of Aa/itrol. as it was out of stoc4. ConseCuentl)$ +eter was told ()
8r. Tuano to ta4e$ instead$3lephamide
[1;]
another steroid-(ased "edication$ (ut with a lower concentration$ as
su(stitute for the unavaila(le Aa/itrol$ to (e used three D3E ti"es a da) for five D!E da)sF two D;E ti"es a da) for five
D!E da)sF and then .ust once a da).
[13]

:everal da)s later$ on 11 5cto(er 1211$ +eter went to see 8r. TuaZo at his clinic$ alle#in# severe e)e pain$ feelin#
as if his e)es were a(out to Apop-out$B a headache and (lurred vision. 8r. TuaZo e9a"ined +eter?s e)es and
discovered that the H/C was a#ain present in his ri#ht e)e. As a result$ 8r. TuaZo told +eter to resu"e the
"a9i"u" dosa#e of 3lephamide.

8r. TuaZo saw +eter once "ore at the for"er?s clinic on > Nove"(er 1211. 8r. TuaZo?s e9a"ination showed that
onl) the peripher) of +eter?s ri#ht e)e was positive for H/CF hence$ 8r. TuaZo prescri(ed a lower dosa#e
of3lephamide.

&t was also a(out this ti"e that 0ati"a Glad)s ,ucas D0ati"aE$ +eter?s spouse$ read the acco"pan)in# literature
of Aa/itrol and found therein the followin# warnin# a#ainst the prolon#ed use of such steroids*
=ARN&NG*

+rolon#ed use "a) result in #lauco"a$ with da"a#e to the optic nerve$ defects in visual acuit) and fields of vision$
and posterior$ su(capsular cataract for"ation. +rolon#ed use "a) suppress the host response and thus increase
the haJard of secondar) ocular infractions$ in those diseases causin# thinnin# of the cornea or sclera$ perforations
have (een 4nown to occur with the use of topical steroids. &n acute purulent conditions of the e)e$ steroids "a)
"as4 infection or enhance e9istin# infection. &f these products are used for 1< da)s or lon#er$ intraocular pressure
should (e routinel) "onitored even thou#h it "a) (e difficult in children and uncooperative patients.

H"plo)"ent of steroid "edication in the treat"ent of herpes si"ple9 reCuires #reat caution.

9 9 9 9

A8VHR:H RHACT&5N:*

Adverse reactions have occurred with steroidManti-infective co"(ination dru#s which can (e attri(uted to the steroid
co"ponent$ the anti-infective co"ponent$ or the co"(ination. H9act incidence fi#ures are not availa(le since no
deno"inator of treated patients is availa(le.
Reactions occurrin# "ost often fro" the presence of the anti-infective in#redients are aller#ic sensitiJations. The
reactions due to the steroid co"ponent in decreasin# order to freCuenc) are elevation of intra-ocular pressure D&5+E
with possi(le develop"ent of #lauco"a$ infreCuent optic nerve da"a#eF posterior su(capsular cataract for"ationF
and dela)ed wound healin#.
:econdar) infection* The develop"ent of secondar) has occurred after use of co"(ination containin# steroids and
anti"icro(ials. 0un#al infections of the correa are particularl) prone to develop coincidentall) with lon#-ter"
applications of steroid. The possi(ilit) of fun#al invasion "ust (e considered in an) persistent corneal ulceration
where steroid treat"ent has (een used.
:econdar) (acterial ocular infection followin# suppression of host responses also occurs.

5n ; Nove"(er 1211$ +eter returned to 8r. TuaZo?s clinic$ co"plainin# of Afeelin# worse.B
[1>]
&t appeared that the
H/C had spread to the whole of +eter?s ri#ht e)e )et a#ain. Thus$ 8r. TuaZo instructed +eter to resu"e the use
ofAa/itrol. +etitioners averred that +eter alread) "ade "ention to 8r. TuaZo durin# said visit of the a(ove-Cuoted
warnin# a#ainst the prolon#ed use of steroids$ (ut 8r. TuaZo supposedl) (rushed aside +eter?s concern as "ere
paranoia$ even assurin# hi" that the for"er was ta4in# care of hi" D+eterE.

+etitioners further alle#ed that after +eter?s ; Nove"(er 1211 visit to 8r. TuaZo$ +eter continued to suffer pain in
his ri#ht e)e$ which see"ed to Apro#ress$B with the ache intensif)in# and (eco"in# "ore freCuent.

Gpon wa4in# in the "ornin# of 13 8ece"(er 1211$ +eter had no vision in his ri#ht e)e. 0ati"a o(served that
+eter?s ri#ht e)e appeared to (e (lood) and swollen.
[1!]
Thus$ spouses +eter and 0ati"a rushed to the clinic of 8r.
TuaZo. +eter reported to 8r. TuaZo that he had (een sufferin# fro" constant headache in the afternoon and (lurrin#
of vision.

Gpon e9a"ination$ 8r. TuaZo noted the hardness of +eter?s ri#ht e)e. =ith the use of a to"ometer
[1]
to verif) the
e9act i"trao#ular pressure
[13]
D&5+E of +eter?s e)es$ 8r. TuaZo discovered that the tension in +eter?s ri#ht e)e
was 36.0 H9$ while that of his left was 13.< 7#.
[11]
:ince the tension in +eter?s ri#ht e)e was wa) over the or"a(
&O0$ which "erel) ran#ed fro" 10.0 H9 to 21.0 H9$
[12]
8r. TuaZo ordered
[;<]
hi" to i""ediatel) discontinue the use
ofAa/itrol and prescri(ed to the latter 7iamo/
[;1]
and :ormoglau#o"$ instead.
[;;]
8r. TuaZo also reCuired +eter to #o
for dail) chec4-up in order for the for"er to closel) "onitor the pressure of the latter?s e)es.
5n 1! 8ece"(er 1211$ the tono"eter readin# of +eter?s ri#ht e)e )ielded a,#9, or"a( (eCe(, i.e., 21.0 H9. 7ence$
8r. TuaZo told +eter to continue usin#7iamo/ and :ormoglau#o". %ut upon +eter?s co"plaint of Asto"ach pains and
tin#lin# sensation in his fin#ers$B
[;3]
8r. TuaZo discontinued +eter?s use of7iamo/.
[;>]


+eter went to see another ophthal"olo#ist$ 8r. Ra"on T. %atun#(acal D8r. %atun#(acalE$ on ;1 8ece"(er 1211$
who alle#edl) conducted a co"plete ophthal"olo#ical e9a"ination of +eter?s e)es. 8r. %atun#(acal?s dia#nosis
was9lau#oma
+23,
O.7.
[;]
7e reco""ended Laser Tra-e#uloplast,
[;3]
for +eter?s ri#ht e)e.

=hen +eter returned to 8r. TuaZo on ;3 8ece"(er 1211$
[;1]
the tono"eter "easured the &5+ of +eter?s ri#ht e)e to
(e 41.0 H9$
[;2]
a#ain$ wa) a(ove nor"al. 8r. TuaZo addressed the pro(le" () advisin# +eter to resu"e
ta4in# 7iamo/ alon# with :ormoglau#o".

8urin# the Christ"as holida)s$ +eter supposedl) sta)ed in (ed "ost of the ti"e and was not a(le to cele(rate the
season with his fa"il) (ecause of the de(ilitatin# effects of 7iamo/.
[3<]

5n ;1 8ece"(er 1211$ durin# one of +eter?s re#ular follow-ups with 8r. TuaZo$ the doctor conducted another ocular
routine e9a"ination of +eter?s e)es. 8r. TuaZo noted the recurrence of H/C in +eter?s ri#ht e)e. Considerin#$
however$ that the &5+ of +eter?s ri#ht e)e was still Cuite hi#h at 41.0 H9$ 8r. TuaZo was at a loss as to how to
(alance the treat"ent of +eter?s H/C visCICvisthe presence of glau#oma in the sa"e e)e. 8r. TuaZo$ thus$ referred
+eter to 8r. 6anuel %. A#ulto$ 6.8. D8r. A#ultoE$ another ophthal"olo#ist specialiJin# in the treat"ent of #lauco"a.
[31]
8r. TuaZo?s letter of referral to 8r. A#ulto stated that*

Referrin# to )ou 6r. +eter ,ucas for evaluation X possi(le "ana#e"ent. & initiall) saw hi" :ept. ;$ 1211 (ecause of
con.unctivitis. The latter resolved and he developed H/C for which & #ave 6a9itrol. The H/C was recurrent after
stoppin# steroid drops. Around 1 "onth of steroid treat"ent$ he noted (lurrin# of vision X pain on the R. however$ &
continued the steroids for the sa4e of the H/C. A "onth a#o$ & noted iris atroph)$ so & too4 the &5+ and it was
definitel) elevated. & stopped the steroids i""ediatel) and has DsicE (een treatin# hi" "edicall).

&t see"s that the &5+ can (e controlled onl) with oral 8ia"o9$ and at the "o"ent$ the H/C has recurred and &?" in a
fi9 whether to resu"e the steroid or not considerin# that the &5+ is still uncontrolled.
[3;]



5n ;2 8ece"(er 1211$ +eter went to see 8r. A#ulto at the latter?s clinic. :everal tests were conducted thereat to
evaluate the e9tent of +eter?s condition. 8r. A#ulto wrote 8r. TuaZo a letter containin# the followin# findin#s and
reco""endations*

Than4s for sendin# +eter ,ucas. 5n e9a"ination conducted vision was ;<M;! R and ;<M;<,. Tension curve 12 R and
1! , at 1;1< 7 while on Nor"o#laucon %&8 58 X 8ia"o9 [ ta( ever) h po.

:lit la"p evaluation
[33]
disclosed su(epithelial corneal defect outer 58. There was circu"ferential peripheral iris
atroph)$ 58. The lenses were clear.
0unduscop)
[3>]
showed vertical cup disc of <.1! R and <. , with te"poral slope R\,.

Peiss #onioscop)
[3!]
revealed (asicall) open an#les (oth e)es with occasional +A:$
[3]
58.

Roll)$ & feel that +eter ,ucas has reall) sustained si#nificant #lauco"a da"a#e. & su##est that we do a (aseline
visual fields and push "edication to lowest possi(le levels. &f & "a) su##est further$ & thin4 we should prescri(e
Ti"olol
[33]
%&8
[31]
58 in lieu of Nor"o#laucon. &f the &5+ is still inadeCuate$ we "a) tr) 8?epifrin
[32]
%&8 58 Ddespite low
+A:E. &?" in favor of retainin# 8ia"o9 or si"ilar CA&.
[><]

&f fields show further loss in sa) W 3 "os. then we should consider tra(eculoplast).

& trust that this approach will prove reasona(le for )ou and +eter.
[>1]


+eter went to see 8r. TuaZo on 31 8ece"(er 1211$ (earin# 8r. A#ulto?s afore"entioned letter. Thou#h +eter?s ri#ht
and left e)es then had nor"al &5+ of21.0 H9 and 13.< 7#$ respectivel)$ 8r. TuaZo still #ave hi" a prescription
forTimolol %.&.8. so +eter could i""ediatel) start usin# said "edication. Re#retta(l)$ Timolol %.&.8. was out of stoc4$
so 8r. TuaZo instructed +eter to .ust continue usin# 7iamo/ and :ormoglau#o" in the "eanti"e.

-ust two da)s later$ on ; -anuar) 1212$ the &5+ of +eter?s ri#ht e)e re"ained elevated at 21.0 H9,
[42]
as he had (een
without 7iamo/ for the past three D3E da)s.

5n > -anuar) 1212$ 8r. TuaZo conducted a visual field stud,
+43,
of +eter?s e)es$ which revealed that the latter
had tu-ular visio"
[>>]
in his ri#ht e)e$ while that of his left e)e re"ained nor"al. 8r. TuaZo directed +eter to reli#iousl)
use the 7iamo/ and :ormoglau#o". as the tension of the latter?s ri#ht e)e went up even further to 41.0 H9 in .ust a
"atter of two D;E da)s$ in the "eanti"e thatTimolol %.&.8. and 7(epifri" were still not availa(le in the "ar4et. A#ain$
8r. TuaZo advised +eter to co"e for re#ular chec4-up so his &5+ could (e "onitored.

5(edientl)$ +eter went to see 8r. TuaZo on the 3
th
$

13
th
$ 1
th
and ;<
th
of -anuar) 1212 for chec4-up and &5+
"onitorin#.

&n the interre#nu"$ however$ +eter was prodded () his friends to see4 a second "edical opinion. 5n 13 -anuar)
1212$ +eter consulted 8r. -ai"e ,apuJ$ 6.8. D8r. ,apuJE$ an ophthal"olo#ist$ who$ in turn$ referred +eter to 8r.
6ario V. ACuino$ 6.8. D8r. ACuinoE$ another ophthal"olo#ist who specialiJes in the treat"ent of #lauco"a and who
could underta4e the lon# ter" care of +eter?s e)es.

Accordin# to petitioners$ after 8r. ACuino conducted an e9tensive evaluation of +eter?s e)es$ the said doctor
infor"ed +eter that his e)es were relativel) nor"al$ thou#h the ri#ht one so"eti"es "anifested "a9i"u" (orderline
tension. 8r. ACuino also confir"ed 8r. TuaZo?s dia#nosis of tu(ular vision in +eter?s ri#ht e)e. +etitioners clai"ed
that 8r. ACuino essentiall) told +eter that the latter?s condition would reCuire lifeti"e "edication and follow-ups.

&n 6a) 122< and -une 1221$ +eter underwent two D;E procedures of laser tra(eculoplast) to atte"pt to control the
hi#h &5+ of his ri#ht e)e.

Clai"in# to have steroidCi"du#ed glau#oma
[>!]
and (la"in# 8r. TuaZo for the sa"e$ +eter$ .oined ()* D1E 0ati"a$ his
spouse
[>]
F D;E A((e)#ail$ his natural child
[>3]
F and D3E Gillian$ his le#iti"ate child
[>1]
with 0ati"a$ instituted on 1
:epte"(er 122;$ a civil co"plaint for da"a#es a#ainst 8r. TuaZo$ (efore the RTC$ %ranch 1!<$ KueJon Cit). The
case was doc4eted as Civil Case No. 2;-;>1;.

&n their Complai"t$ petitioners specificall) averred that as the Adirect conseCuence of [+eter?s] prolon#ed use
of Aa/itrol$ [he] suffered fro" steroid induced #lauco"a which caused the elevation of his intra-ocular pressure. The
elevation of the intra-ocular pressure of [+eter?s ri#ht e)e] caused the i"pair"ent of his vision which i"pair"ent is
not cura(le and "a) even lead to total (lindness.B
[>2]


+etitioners additionall) alle#ed that the visual i"pair"ent of +eter?s ri#ht e)e caused hi" and his fa"il) so "uch
#rief. %ecause of his present condition$ +eter now needed close "edical supervision foreverF he had alread)
under#one two D;E laser sur#eries$ with the possi(ilit) that "ore sur#eries were still needed in the futureF his career
in sports castin# had suffered and was continuin# to sufferF
[!<]
his anticipated inco"e had (een #reatl) reduced as a
result of his Ali"itedB capacit)F he continuall) suffered fro" Aheadaches$ nausea$ diJJiness$ heart palpitations$
rashes$ chronic rhinitis$ sinusitis$B
[!1]
et#.F +eter?s relationships with his spouse and children continued to (e strained$
as his condition "ade hi" hi#hl) irrita(le and sensitiveF his "o(ilit) and social life had sufferedF his spouse$ 0ati"a$
(eca"e the (readwinner in the fa"il)F
[!;]
and his two children had (een deprived of the opportunit) for a (etter life
and educational prospects. Collectivel)$ petitioners lived in constant fear of +eter (eco"in# co"pletel) (lind.
[!3]

&n the end$ petitioners sou#ht pecuniar) award for their supposed pain and sufferin#$ which were ulti"atel) (rou#ht
a(out () 8r. TuaZo?s #rossl) ne#li#ent conduct in prescri(in# to +eter the "edicine Aa/itrol for a period of three D3E
"onths$ without "onitorin# +eter?s &5+$ as reCuired in cases of prolon#ed use of said "edicine$ and notwithstandin#
+eter?s constant co"plaint of intense e)e pain while usin# the sa"e. +etitioners particularl) pra)ed that 8r. TuaZo
(e ad.ud#ed lia(le for the followin# a"ounts*

1. The a"ount of +;$<<<$<<<.<< to plaintiff +eter ,ucas as and () wa) of co"pensation
for his i"paired vision.

;. The a"ount of +3<<$<<<.<< to spouses ,ucas as and () wa) of actual da"a#es
plus such additional a"ounts that "a) (e proven durin# trial.

3. The a"ount of +1$<<<$<<<.<< as and () wa) of "oral da"a#es.

>. The a"ount of +!<<$<<<.<< as and () wa) of e9e"plar) da"a#es.


!. The a"ount of +;<<$<<<.<< as and () wa) of attorne)?s fees plus costs of suit.
[!>]


&n re(uttin# petitioners? co"plaint$ 8r. TuaZo asserted that the Atreat"ent "ade () [hi"] "ore than three )ears a#o
has no causal connection to [+eter?s] present #lauco"a or condition.B
[!!]
8r. TuaZo e9plained that A[d]ru#-induced
#lauco"a is te"porar) and cura(le$ steroids have the side effect of increasin# intraocular pressure. :teroids are
prescri(ed to treat Hpide"ic /erato Con.unctivitis or H/C which is an infiltration of the cornea as a result of
con.unctivitis or sore e)es.B
[!]
8r. TuaZo also clarified that D1E A[c]ontrar) to [petitioners?] fallacious clai"$ [he] did
N5T continuall) prescri(e the dru# 6a9itrol which contained steroids for an) prolon#ed periodB
[!3]
and A[t]he truth was
the 6a9itrol was discontinued 9 9 9 as soon as H/C disappeared and was resu"ed onl) when H/C reappearedB
[!1]
F
D;E the entire ti"e he was treatin# +eter$ he Acontinuall) "onitored the intraocular pressure of [+eter?s e)es] ()
palpatin# the e)es and () puttin# pressure on the e)e(alls$B and no hardenin# of the sa"e could (e detected$ which
"eant that there was no increase in the tension or &5+$ a possi(le side reaction to the use of steroid "edicationsF
and D3E it was onl) on 13 8ece"(er 1211 that +eter co"plained of a headache and (lurred vision in his ri#ht e)e$
and upon "easurin# the &5+ of said e)e$ it was deter"ined for the first ti"e that the &5+ of the ri#ht e)e had an
elevated value.

%ut #rantin# for the sa4e of ar#u"ent that the Asteroid treat"ent of [+eter?s] H/C caused the steroid induced
#lauco"a$B
[!2]
8r. TuaZo ar#ued that*

[:]uch condition$ i.e.$ elevated intraocular pressure$ is te"porar). As soon as the inta4e of steroids is discontinued$
the intraocular pressure auto"aticall) is reduced. Thus$ [+eter?s] #lauco"a can onl) (e due to other causes not
attri(uta(le to steroids$ certainl) not attri(uta(le to [his] treat"ent of "ore than three )ears a#o 9 9 9.

0ro" a "edical point of view$ as revealed () "ore current e9a"ination of [+eter]$ the latter?s #lauco"a can onl) (e
lon# standin# #lauco"a$ open an#le #lauco"a$ (ecause of the lar#e C*8 ratio. The steroids provo4ed the latest
#lauco"a to (e revealed earlier as [+eter] re"ained as)"pto"atic prior to steroid application. 7ence$ the steroid
treat"ent was in fact (eneficial to [+eter] as it revealed the incipient open an#le #lauco"a of [+eter] to allow earlier
treat"ent of the sa"e.
[<]


&n a 7e#isio" dated 1> -ul) ;<<<$ the RTC dis"issed Civil Case No. 2;-;>1; Afor insufficienc) of evidence.B
[1]
The
decretal part of said 7e#isio"reads*

=herefore$ pre"ises considered$ the instant co"plaint is dis"issed for insufficienc) of evidence. The counter clai"
DsicE is li4ewise dis"issed in the a(sence of (ad faith or "alice on the part of plaintiff in filin# the suit.
[;]

The RTC opined that petitioners failed to prove () preponderance of evidence that 8r. TuaZo was ne#li#ent in his
treat"ent of +eter?s condition. &n particular$ the record of the case was (ereft of an) evidence to esta(lish that the
steroid "edication and its dosa#e$ as prescri(ed () 8r. TuaZo$ caused +eter?s #lauco"a. The trial court reasoned
that the Areco#niJed standards of the "edical co""unit) has not (een esta(lished in this case$ "uch less has
causation (een esta(lished to render [TuaZo] lia(le.B
[3]
Accordin# to the RTC*

[+etitioners] failed to esta(lish the dut) reCuired of a "edical practitioner a#ainst which +eter +aul?s treat"ent ()
defendant can (e co"pared with. The) did not present an) "edical e9pert or even a "edical doctor to convince and
e9pertl) e9plain to the court the esta(lished nor" or dut) reCuired of a ph)sician treatin# a patient$ or whether the
non ta4in# DsicE () 8r. TuaZo of +eter +aul?s pressure a deviation fro" the nor" or his non-discover) of the
#lauco"a in the course of treat"ent constitutes ne#li#ence. &t is i"portant and indispensa(le to esta(lish such a
standard (ecause once it is esta(lished$ a "edical practitioner who departed thereof (reaches his dut) and co""its
ne#li#ence renderin# hi" lia(le. =ithout such testi"on) or enli#hten"ent fro" an e9pert$ the court is at a loss as to
what is then the esta(lished nor" of dut) of a ph)sician a#ainst which defendant?s conduct can (e co"pared with to
deter"ine ne#li#ence.
[>]

The RTC added that in the a(sence of Aan) "edical evidence to the contrar)$ this court cannot accept
[petitioners?] clai" that the use of steroid is the pro9i"ate cause of the da"a#e sustained () [+eter?s] e)e.B
[!]


Correspondin#l)$ the RTC accepted 8r. TuaZo?s "edical opinion that A+eter +aul "ust have (een sufferin# fro"
nor"al tension #lauco"a$ "eanin#$ optic nerve da"a#e was happenin# (ut no elevation of the e)e pressure is
"anifested$ that the steroid treat"ent actuall) un"as4ed the condition that resulted in the earlier treat"ent of the
#lauco"a. There is nothin# in the record to contradict such testi"on). &n fact$ plaintiff?s H9hi(it T:? even tends to
support the".B

Gndaunted$ petitioners appealed the fore#oin# RTC decision to the Court of Appeals. Their appeal was doc4eted as
CA-G.R. CV No. 1.

5n ;3 :epte"(er ;<<$ the Court of Appeals rendered a decision in CA-G.R. CV No. 1 den)in# petitioners?
recourse and affir"in# the appealed RTC 7e#isio". The fallo of the .ud#"ent of the appellate court states*

=7HRH05RH$ the 8ecision appealed fro" is A00&R6H8.
[]

The Court of Appeals faulted petitioners (ecause the) W

[8]id not present an) "edical e9pert to testif) that 8r. Tuano?s prescription of 6a9itrol and %lepha"ide for the
treat"ent of H/C on +eter?s ri#ht e)e was not proper and that his palpation of +eter?s ri#ht e)e was not enou#h to
detect adverse reaction to steroid. +eter testified that 8r. 6anuel A#ulto told hi" that he should not have used
steroid for the treat"ent of H/C or that he should have used it onl) for two D;E wee4s$ as H/C is onl) a viral infection
which will cure () itself. 7owever$ 8r. A#ulto was not presented () [petitioners] as a witness to confir" what he
alle#edl) told +eter and$ therefore$ the latter?s testi"on) is hearsa). Gnder Rule 13<$ :ection 3 of the Rules of
Court$ a witness can testif) onl) to those facts which he 4nows of his own personal 4nowled#e$ 9 9 9. 0a"iliar and
funda"ental is the rule that hearsa) testi"on) is inad"issi(le as evidence.
[3]

,i4e the RTC$ the Court of Appeals #ave #reat wei#ht to 8r. TuaZo?s "edical .ud#"ent$ specificall) the latter?s
e9planation that*

[=]hen a doctor sees a patient$ he cannot deter"ine whether or not the latter would react adversel) to the use of
steroids$ that it was onl) on 8ece"(er 13$ 1212$ when +eter co"plained for the first ti"e of headache and (lurred
vision that he o(served that the pressure of the e)e of +eter was elevated$ and it was onl) then that he suspected
that +eter (elon#s to the !Q of the population who reacts adversel) to steroids.
[1]


+etitioners? Aotio" for Re#o"sideratio" was denied () the Court of Appeals in a Resolution dated 3 -ul) ;<<3.

7ence$ this +etition for Review on Certiorari under Rule >! of the Revised Rules of Court pre"ised on the followin#
assi#n"ent of errors*

&.

T7H C5GRT 50 A++HA,: C566&TTH8 GRAVH RHVHR:&%,H HRR5R &N A00&R6&NG T7H 8HC&:&5N 50 T7H
TR&A, C5GRT 8&:6&::&NG T7H +HT&T&5NHR:? C56+,A&NT 05R 8A6AGH: AGA&N:T T7H RH:+5N8HNT
5N T7H GR5GN8 50 &N:G00&C&HNCI 50 HV&8HNCHF

&&.

T7H C5GRT 50 A++HA,: C566&TTH8 GRAVH RHVHR:&%,H HRR5R &N 8&:6&::&NG T7H +HT&T&5NHR:?
C56+,A&NT 05R 8A6AGH: AGA&N:T T7H RH:+5N8HNT 5N T7H GR5GN8 T7AT N5 6H8&CA, H'+HRT
=A: +RH:HNTH8 %I T7H +HT&T&5NHR: T5 +R5VH T7H&R C,A&6 05R 6H8&CA, NHG,&GHNCH AGA&N:T
T7H RH:+5N8HNTF AN8

&&&.

T7H C5GRT 50 A++HA,: C566&TTH8 GRAVH RHVHR:&%,H HRR5R &N N5T 0&N8&NG T7H RH:+5N8HNT
,&A%,H T5 T7H +HT&T&5NHR:? 05R ACTGA,$ 65RA, AN8 H'H6+,ARI 8A6AGH:$ A:&8H 0R56
ATT5RNHI?: 0HH:$ C5:T: 50 :G&T$ A: A RH:G,T 50 7&: GR5:: NHG,&GHNCH.
[2]


A readin# of the afore-Cuoted reversi(le errors supposedl) co""itted () the Court of Appeals in
its 7e#isio" and Resolutio" would reveal that petitioners are funda"entall) assailin# the findin# of the Court of
Appeals that the evidence on record is insufficient to esta(lish petitioners? entitle"ent to an) 4ind of da"a#e.
Therefore$ it could (e said that the sole issue for our resolution in the +etition at (ar is whether the Court of Appeals
co""itted reversi(le error in affir"in# the .ud#"ent of the RTC that petitioners failed to prove$ () preponderance of
evidence$ their clai" for da"a#es a#ainst 8r. TuaZo.

Hvidentl)$ said issue constitutes a Cuestion of fact$ as we are as4ed to revisit anew the factual findin#s of the Court
of Appeals$ as well as of the RTC.&n effect$ petitioners would have us sift throu#h the evidence on record and pass
upon whether there is sufficient (asis to esta(lish 8r. TuaZo?s ne#li#ence in his treat"ent of +eter?s e)e condition.
This Cuestion clearl) involves a factual inCuir)$ the deter"ination of which is not within the a"(it of this Court?s
power of review under Rule >! of the 1223 Rules Civil +rocedure$ as a"ended.
[3<]


Hle"entar) is the principle that this Court is not a trier of factsF onl) errors of law are #enerall) reviewed in petitions
for review on #ertiorari criticiJin# decisions of the Court of Appeals. Kuestions of fact are not entertained.
[31]

Nonetheless$ the #eneral rule that onl) Cuestions of law "a) (e raised on appeal in a petition for review under Rule
>! of the Rules of Court ad"its of certain e9ceptions$ includin# the circu"stance when the findin# of fact of the Court
of Appeals is pre"ised on the supposed a(sence of evidence$ (ut is contradicted () the evidence on record.
Althou#h petitioners "a) not e9plicitl) invo4e said e9ception$ it "a) (e #leaned fro" their alle#ations and ar#u"ents
in the instant +etition.

+etitioners contend$ that A[c]ontrar) to the findin#s of the 7onora(le Court of Appeals$ [the)] were "ore than a(le to
esta(lish that* 8r. TuaZo i#nored the standard "edical procedure for ophthal"olo#ists$ ad"inistered "edication with
rec4lessness$ and e9hi(ited an a(sence of co"petence and s4ills e9pected fro" hi".B
[3;]
+etitioners re.ect the
necessit) of presentin# e9pert andMor "edical testi"on) to esta(lish D1E the standard of care respectin# the
treat"ent of the disorder affectin# +eter?s e)eF and D;E whether or not ne#li#ence attended 8r. TuaZo?s treat"ent of
+eter$ (ecause$ in their words W

That 8r. TuaZo was #rossl) ne#li#ent in the treat"ent of +eter?s si"ple e)e ail"ent is a simple #ase of #ause a"d
effe#t. =ith "ere docu"entar) evidence and (ased on the facts presented () the petitioners$ respondent can readil)
(e held lia(le for da"a#es even without an) e9pert testi"on). &n an) case$ however$ and contrar) to the findin# of
the trial court and the Court of Appeals$ there was a "edical e9pert presented () the petitioner showin# the
rec4lessness co""itted () [8r. TuaZo] W 8r. TuaZo hi"self. [H"phasis supplied.]

The) insist that 8r. TuaZo hi"self #ave sufficient evidence to esta(lish his #ross ne#li#ence that ulti"atel) caused
the i"pair"ent of the vision of +eter?s ri#ht e)e$
[33]
i.e.$ that A[d]espite [8r. TuaZo?s] 4nowled#e that !Q of the
population reacts adversel) to Aa/itrol$ [he] had no Cual"s whatsoever in prescri(in# said steroid to +eter without
first deter"inin# whether or not the $si#'+eter (elon#s to the !Q.B
[3>]

=e are not convinced. The .ud#"ents of (oth the Court of Appeals and the RTC are in accord with the evidence on
record$ and we are accordin#l) (ound () the findin#s of fact "ade therein.

+etitioners? position$ in su"$ is that +eter?s #lauco"a is the direct result of 8r. TuaZo?s ne#li#ence in his i"proper
ad"inistration of the dru# Aa/itrolF Athus$ [the latter] should (e lia(le for all the da"a#es suffered and to (e suffered
() [petitioners].B
[3!]
Clearl)$ the present controvers) is a classic illustration of a "edical ne#li#ence case a#ainst a
ph)sician (ased on the latter?s professional ne#li#ence. &n this t)pe of suit$ the patient or his heirs$ in order to prevail$
is reCuired to prove () preponderance of evidence that the ph)sician failed to e9ercise that de#ree of s4ill$ care$ and
learnin# possessed () other persons in the sa"e professionF and that as a pro9i"ate result of such failure$ the
patient or his heirs suffered da"a#es.

0or lac4 of a specific law #eared towards the t)pe of ne#li#ence co""itted () "e"(ers of the "edical profession$
such clai" for da"a#es is al"ost alwa)s anchored on the alle#ed violation of Article ;13 of the Civil Code$ which
states that*

ART. ;13. =hoever () act or o"ission causes da"a#e to another$ there (ein# fault or ne#li#ence$ is o(li#ed to pa)
for the da"a#e done. :uch fault or ne#li#ence$ if there is no pre-e9istin# contractual relation (etween the parties$ is
called a quasi-deli#t and is #overned () the provisions of this Chapter.


&n "edical ne#li#ence cases$ also called "edical "alpractice suits$ there e9ist a ph)sician-patient relationship
(etween the doctor and the victi". %ut .ust li4e an) other proceedin# for da"a#es$ four essential D>E ele"ents i.e.$
D1E dut)F D;E (reachF D3E in.ur)F and D>E pro9i"ate causation$
[3]
"ust (e esta(lished () the plaintiffMs. All the four D>E
ele"ents "ust co-e9ist in order to find the ph)sician ne#li#ent and$ thus$ lia(le for da"a#es.

=hen a patient en#a#es the services of a ph)sician$ a ph)sician-patient relationship is #enerated. And in acceptin# a
case$ the ph)sician$ for all intents and purposes$ represents that he has the needed trainin# and s4ill possessed ()
ph)sicians and sur#eons practicin# in the sa"e fieldF and that he will e"plo) such trainin#$ care$ and s4ill in the
treat"ent of the patient.
[33]
Thus$ in treatin# his patient$ a ph)sician is under a duty to [the for"er] to e9ercise that
de#ree of care$ s4ill and dili#ence which ph)sicians in the sa"e #eneral nei#h(orhood and in the sa"e #eneral line
of practice ordinaril) possess and e9ercise in li4e cases.
[31]
:tated otherwise$ the ph)sician has the dut) to use at
least the sa"e level of care that an) other reasona(l) co"petent ph)sician would use to treat the condition under
si"ilar circu"stances.

This standard level of care$ s4ill and dili#ence is a "atter (est addressed () e9pert "edical testi"on)$ (ecause the
standard of care in a "edical "alpractice case is a "atter peculiarl) within the 4nowled#e of e9perts in the field.
[32]

There is *reac& of dut) of care$ s4ill and dili#ence$ or the i"proper perfor"ance of such dut)$ () the attendin#
ph)sician when the patient isin1ured in (od) or in health [and this] constitutes the actiona(le "alpractice.
[1<]
+roof of
such (reach "ust li4ewise rest upon the testi"on) of an e9pert witness that the treat"ent accorded to the patient
failed to "eet the standard level of care$ s4ill and dili#ence which ph)sicians in the sa"e #eneral nei#h(orhood and
in the sa"e #eneral line of practice ordinaril) possess and e9ercise in li4e cases.

Hven so$ proof of (reach of dut) on the part of the attendin# ph)sician is insufficient$ for there "ust (e a causal
connection (etween said (reach and the resultin# in.ur) sustained () the patient. +ut in another wa)$ in order that
there "a) (e a recover) for an in.ur)$ it "ust (e shown that the Ain.ur) for which recover) is sou#ht "ust (e the
le#iti"ate conseCuence of the wron# doneF the connection (etween the ne#li#ence and the in.ur) "ust (e a direct
and natural seCuence of events$ un(ro4en () intervenin# efficient causesBF
[11]
that is$ the ne#li#ence "ust (e
the pro5i)ate cause of the in.ur). And the pro9i"ate cause of an in.ur) is that cause$ which$ in the natural and
continuous seCuence$ un(ro4en () an) efficient intervenin# cause$ produces the in.ur)$ and without which the result
would not have occurred.
[1;]


-ust as with the ele"ents of dut) and (reach of the sa"e$ in order to esta(lish the pro9i"ate cause [of the in.ur)] ()
a preponderance of the evidence in a "edical "alpractice action$ [the patient] "ust si"ilarl) use e9pert testi"on)$
(ecause the Cuestion of whether the alle#ed professional ne#li#ence caused [the patient?s] in.ur) is #enerall) one for
specialiJed e9pert 4nowled#e (e)ond the 4en of the avera#e la)personF usin# the specialiJed 4nowled#e and
trainin# of his field$ the e9pert?s role is to present to the [court] a realistic assess"ent of the li4elihood that [the
ph)sician?s] alle#ed ne#li#ence caused [the patient?s] in.ur).
[13]

0ro" the fore#oin#$ it is apparent that "edical ne#li#ence cases are (est proved () opinions of e9pert witnesses
(elon#in# in the sa"e #eneral nei#h(orhood and in the sa"e #eneral line of practice as defendant ph)sician or
sur#eon. The deference of courts to the e9pert opinion of Cualified ph)sicians [or sur#eons] ste"s fro" the for"er?s
realiJation that the latter possess unusual technical s4ills which la)"en in "ost instances are incapa(le of
intelli#entl) evaluatin#F
[1>]
hence$ the indispensa(ilit) of e9pert testi"onies.

&n the case at (ar$ there is no Cuestion that a ph)sician-patient relationship developed (etween 8r. TuaZo and +eter
when +eter went to see the doctor on ; :epte"(er 1211$ see4in# a consult for the treat"ent of his sore e)es.
Ad"ittedl)$ 8r. TuaZo$ an ophthal"olo#ist$ prescri(ed Aa/itrol when +eter developed and had recurrent
H/C. Aa/itrol or "eom,#i"Jpol,m,/i" 3 sulfatesJde/amethaso"eophthal"ic oint"ent is a "ultiple-dose anti-infective
steroid co"(ination in sterile for" for topical application.
[1!]
&t is the dru# which petitioners clai" to have caused
+eter?s #lauco"a.

7owever$ as correctl) pointed out () the Court of Appeals$ A[t]he o"us pro-a"di was on the patient to esta(lish
(efore the trial court that the ph)sicians i#nored standard "edical procedure$ prescri(ed and ad"inistered
"edication with rec4lessness and e9hi(ited an a(sence of the co"petence and s4ills e9pected of #eneral
practitioners si"ilarl) situated.B
[1]
Gnfortunatel)$ in this case$ there was a(solute failure on the part of petitioners to
present an) e9pert testi"on) to esta(lish* D1E the standard of care to (e i"ple"ented () co"petent ph)sicians in
treatin# the sa"e condition as +eter?s under si"ilar circu"stancesF D;E that$ in his treat"ent of +eter$ 8r. TuaZo
failed in his dut) to e9ercise said standard of care that an) other co"petent ph)sician would use in treatin# the sa"e
condition as +eter?s under si"ilar circu"stancesF and D3E that the in.ur) or da"a#e to +eter?s ri#ht e)e$ i.e.$ his
#lauco"a$ was the result of his use ofAa/itrol$ as prescri(ed () 8r. TuaZo. +etitioners? failure to prove the first
ele"ent alone is alread) fatal to their cause.

+etitioners "aintain that 8r. TuaZo failed to follow in +eter?s case the reCuired procedure for the prolon#ed use
of Aa/itrol. %ut what is actuall) the reCuired procedure in situations such as in the case at (arL To (e precise$ what
is the standard operatin# procedure when ophthal"olo#ists prescri(e steroid "edications which$ ad"ittedl)$ carr)
so"e "odicu" of ris4L

A(sent a definitive standard of care or dili#ence reCuired of 8r. TuaZo under the circu"stances$ we have no "eans
to deter"ine whether he was a(le to co"pl) with the sa"e in his dia#nosis and treat"ent of +eter. This Court has
no )ardstic4 upon which to evaluate or wei#h the attendant facts of this case to (e a(le to state with confidence that
the acts co"plained of$ indeed$ constituted ne#li#ence and$ thus$ should (e the su(.ect of pecuniar) reparation.

+etitioners assert that prior to prescri(in# Aa/itrol$ 8r. TuaZo should have deter"ined first whether +eter was a
Asteroid responder.B
[13]
Iet a#ain$ petitioners did not present an) convincin# proof that such deter"ination is actuall)
part of the standard operatin# procedure which ophthal"olo#ists should unerrin#l) follow prior to prescri(in# steroid
"edications.

&n contrast$ 8r. TuaZo was a(le to clearl) e9plain that what is onl) reCuired of ophthal"olo#ists$ in cases such as
+eter?s$ is the conduct of standard testsMprocedures 4nown as Aocular routine e9a"ination$B
[11]
co"posed of five D!E
testsMprocedures W specificall)$ #ross e9a"ination of the e)es and the surroundin# areaF ta4in# of the visual acuit) of
the patientF chec4in# the intraocular pressure of the patientF chec4in# the "otilit) of the e)esF and usin#
ophthal"oscop) on the patient?s e)e W and he did all those testsMprocedures ever) ti"e +eter went to see hi" for
follow-up consultation andMor chec4-up.

=e cannot (ut a#ree with 8r. TuaZo?s assertion that when a doctor sees a patient$ he cannot deter"ine i""ediatel)
whether the latter would react adversel) to the use of steroidsF all the doctor can do is "ap out a course of treat"ent
reco#niJed as correct () the standards of the "edical profession. &t "ust (e re"e"(ered that a ph)sician is not an
insurer of the #ood result of treat"ent. The "ere fact that the patient does not #et well or that a (ad result occurs
does not in itself indicate failure to e9ercise due care.
[12]
The result is not deter"inative of the perfor"ance [of the
ph)sician] and he is not reCuired to (e infalli(le.
[2<]


6oreover$ that 8r. TuaZo saw it fit to prescri(e Aa/itrol to +eter was .ustified () the fact that the latter was alread)
usin# the sa"e "edication when he first ca"e to see 8r. TuaZo on ; :epte"(er 1211 and had e9hi(ited no
previous untoward reaction to that particular dru#.
[21]

Also$ 8r. TuaZo cate#oricall) denied petitioners? clai" that he never "onitored the tension of +eter?s e)es while the
latter was on Aa/itrol. 8r. TuaZo testified that he palpated +eter?s e)es ever) ti"e the latter ca"e for a chec4-up as
part of the doctor?s ocular routine e9a"ination$ a fact which petitioners failed to re(ut. 8r. TuaZo?s re#ular conduct of
e9a"inations and tests to ascertain the state of +eter?s e)es ne#ate the ver) (asis of petitioners? co"plaint for
da"a#es. As to whether 8r. TuaZo?s actuations confor"ed to the standard of care and dili#ence reCuired in li4e
circu"stances$ it is presu"ed to have so confor"ed in the a(sence of evidence to the contrar).

Hven if we are to assu"e that 8r. TuaZo co""itted ne#li#ent acts in his treat"ent of +eter?s condition$ the causal
connection (etween 8r. TuaZo?s supposed ne#li#ence and +eter?s in.ur) still needed to (e esta(lished. The critical
and clinchin# factor in a "edical ne#li#ence case is proof of the causal connection (etween the ne#li#ence which the
evidence esta(lished and the plaintiff?s in.uries.
[2;]
The plaintiff "ust plead and prove not onl) that he has (een
in.ured and defendant has (een at fault$ (ut also that the defendant?s fault caused the in.ur). A verdict in a
"alpractice action cannot (e (ased on speculation or con.ecture. Causation "ust (e proven within a reasona(le
"edical pro(a(ilit) (ased upon co"petent e9pert testi"on).
[23]

The causation (etween the ph)sician?s ne#li#ence and the patient?s in.ur) "a) onl) (e esta(lished () the
presentation of proof that +eter?s #lauco"a would not have occurred (ut for 8r. TuaZo?s supposed ne#li#ent
conduct. 5nce "ore$ petitioners failed in this re#ard.

8r. TuaZo does not den) that the use of Aa/itrol involves the ris4 of increasin# a patient?s &5+. &n fact$ this was the
reason wh) he "ade it a point to palpate +eter?s e)es ever) ti"e the latter went to see hi" -- so he could "onitor
the tension of +eter?s e)es. %ut to sa) that said "edication conclusivel) caused +eter?s #lauco"a is purel)
speculative. +eter was dia#nosed with ope"Ca"gle#lauco"a. This 4ind of #lauco"a is characteriJed () an al"ost
co"plete a(sence of s)"pto"s and a chronic$ insidious course.
[2>]
&n open-an#le #lauco"a$ halos around li#hts and
(lurrin# of vision do not occur unless there has (een a sudden increase in the intraocular vision.
[2!]
Visual acuit)
re"ains #ood until late in the course of the disease.
[2]
7ence$ 8r. TuaZo clai"s that +eter?s #lauco"a Acan onl) (e
lon# standin# 9 9 9 (ecause of the lar#e C*8
[23]
ratio$B and that A[t]he steroids provo4ed the latest #lauco"a to (e
revealed earlierB was a (lessin# in dis#uise Aas [+eter] re"ained as)"pto"atic prior to steroid application.B

=ho (etween petitioners and 8r. TuaZo is in a (etter position to deter"ine and evaluate the necessit) of
usin# Aa/itrol to cure +eter?s H/C visCICvis the attendant ris4s of usin# the sa"eL

That 8r. TuaZo has the necessar) trainin# and s4ill to practice his chosen field is (e)ond cavil. +etitioners do not
dispute 8r. TuaZo?s Cualifications W that he has (een a ph)sician for close to a decade and a half at the ti"e +eter
first ca"e to see hi"F that he has had various "edical trainin#F that he has authored nu"erous papers in the field of
ophthal"olo#)$ here and a(roadF that he is a7iplomate of the +hilippine %oard of 5phthal"olo#)F that he occupies
various teachin# posts Dat the ti"e of the filin# of the present co"plaint$ he was the Chair of the 8epart"ent of
5phthal"olo#) and an Associate +rofessor at the Gniversit) of the +hilippines-+hilippine General 7ospital and :t.
,u4e?s 6edical Center$ respectivel)EF and that he held an assort"ent of positions in nu"erous "edical or#aniJations
li4e the +hilippine 6edical Association$ +hilippine Acade") of 5phthal"olo#)$ +hilippine %oard of 5phthal"olo#)$
+hilippine :ociet) of 5phthal"ic +lastic and Reconstructive :ur#er)$ +hilippine -ournal of 5phthal"olo#)$
Association of +hilippine 5phthal"olo#) +rofessors$ et al.

&t "ust (e re"e"(ered that when the Cualifications of a ph)sician are ad"itted$ as in the instant case$ there is an
inevita(le presu"ption that in proper cases$ he ta4es the necessar) precaution and e"plo)s the (est of his
4nowled#e and s4ill in attendin# to his clients$ unless the contrar) is sufficientl) esta(lished.
[21]
&n "a4in# the
.ud#"ent call of treatin# +eter?s H/C with Aa/itrol$ 8r. TuaZo too4 the necessar) precaution () palpatin# +eter?s
e)es to "onitor their &5+ ever) ti"e the latter went for a chec4-up$ and he e"plo)ed the (est of his 4nowled#e and
s4ill earned fro" )ears of trainin# and practice.

&n contrast$ without supportin# e9pert "edical opinions$ petitioners? (are assertions of ne#li#ence on 8r. TuaZo?s
part$ which resulted in +eter?s #lauco"a$ deserve scant credit.

5ur disposition of the present controvers) "i#ht have (een vastl) different had petitioners presented a "edical
e9pert to esta(lish their theor) respectin# 8r. TuaZo?s so-called ne#li#ence. &n fact$ the record of the case reveals
that petitioners? counsel reco#niJed the necessit) of presentin# such evidence. +etitioners even #ave an underta4in#
to the RTC .ud#e that 8r. A#ulto or 8r. ACuino would (e presented. Alas$ no follow-throu#h on said underta4in# was
"ade.

The plaintiff in a civil case has the (urden of proof as he alle#es the affir"ative of the issue. 7owever$ in the course
of trial in a civil case$ once plaintiff "a4es out a prima fa#ie case in his favor$ the dut) or the (urden of evidence
shifts to defendant to controvert plaintiff?s prima fa#ie caseF otherwise$ a verdict "ust (e returned in favor of plaintiff.
[22]
The part) havin# the (urden of proof "ust esta(lish his case () a preponderance of evidence.
[1<<]
The concept of
Apreponderance of evidenceB refers to evidence which is of #reater wei#ht or "ore convincin# than that which is
offered in opposition to itF
[1<1]
in the last anal)sis$ it "eans pro(a(ilit) of truth. &t is evidence which is "ore convincin#
to the court as worth) of (elief than that which is offered in opposition thereto.
[1<;]
Rule 133$ :ection 1 of the Revised
Rules of Court provides the #uidelines for deter"inin# preponderance of evidence$ thus*

&n civil cases$ the part) havin# the (urden of proof "ust esta(lish his case () a preponderance of evidence. &n
deter"inin# where the preponderance or superior wei#ht of evidence on the issues involved lies the court "a)
consider all the facts and circu"stances of the case$ the witnesses? "anner of testif)in#$ their intelli#ence$ their
"eans and opportunit) of 4nowin# the facts to which the) are testif)in#$ the nature of the facts to which the) testif)$
the pro(a(ilit) or i"pro(a(ilit) of their testi"on)$ their interest or want of interest$ and also their personal credi(ilit)
so far as the sa"e le#iti"atel) appear upon the trial. The court "a) also consider the nu"(er of witnesses$ thou#h
the preponderance is not necessaril) with the #reater nu"(er.

7erein$ the (urden of proof was clearl) upon petitioners$ as plaintiffs in the lower court$ to esta(lish their case () a
preponderance of evidence showin# a reasona(le connection (etween 8r. TuaZo?s alle#ed (reach of dut) and the
da"a#e sustained () +eter?s ri#ht e)e. This$ the) did not do. &n realit)$ petitioners? co"plaint for da"a#es is "erel)
anchored on a state"ent in the literature of Aa/itrol identif)in# the ris4s of its use$ and the purported co""ent of 8r.
A#ulto W another doctor not presented as witness (efore the RTC W concernin# the prolon#ed use of Aa/itrol for the
treat"ent of H/C.

&t see"s (asic that what constitutes proper "edical treat"ent is a "edical Cuestion that should have (een presented
to e9perts. &f no standard is esta(lished throu#h e9pert "edical witnesses$ then courts have no standard () which to
#au#e the (asic issue of (reach thereof () the ph)sician or sur#eon. The RTC and Court of Appeals$ and even this
Court$ could not (e e9pected to deter"ine on its own what "edical techniCue should have (een utiliJed for a certain
disease or in.ur). A(sent e9pert "edical opinion$ the courts would (e dan#erousl) en#a#in# in speculations.

All told$ we are hard pressed to find 8r. TuaZo lia(le for an) "edical ne#li#ence or "alpractice where there is no
evidence$ in the nature of e9pert testi"on)$ to esta(lish that in treatin# +eter$ 8r. TuaZo failed to e9ercise
reasona(le care$ dili#ence and s4ill #enerall) reCuired in "edical practice. 8r. TuaZo?s testi"on)$ that his treat"ent
of +eter confor"ed in all respects to standard "edical practice in this localit)$ stands unrefuted. ConseCuentl)$ the
RTC and the Court of Appeals correctl) held that the) had no (asis at all to rule that petitioners were deservin# of
the various da"a#es pra)ed for in theirComplai"t.

5HERE-ORE$ pre"ises considered$ the instant petition is DEN&ED for lac4 of "erit. The assailed 7e#isio" dated ;3
:epte"(er ;<< and Resolutio"dated 3 -ul) ;<<3$ (oth of the Court of Appeals in CA-G.R. CV No. 1$ are
here() A--&R.ED. No cost.

SO ORDERED.




'H&RD D&1&S&ON


ROGEL&O 0. NOGALES, G.R. No. 142>25
8or ,#"$e(8 a! o be,a(8 o8 t,e "#or$,
ROGER AN'HONY, +resent*
ANGEL&/A, NAN/Y, a!
.&/HAEL /HR&S'O0HER, KG&:G6%&NG$ 8..
a(( $)ra"e! NOGALES, Chairperso"$
+etitioners$ CAR+&5$
CAR+&5 65RA,H:$
- versus - T&NGA$ and
VH,A:C5$ -R.$ 88.

/A0&'OL .ED&/AL /EN'ER$
DR. OS/AR ES'RADA$
DR. ELY 1&LLA-LOR$
DR. ROSA :Y$
DR. JOEL ENR&;:E3$
DR. 0ER0E':A LA/SON$
DR. NOE ES0&NOLA, a! +ro"ul#ated*
N:RSE J. D:.LAO,
Respondents. 8ece"(er 12$ ;<<
9-----------------------------------------------------------------------------------------9


D E / & S & O N

/AR0&O, J.4


',e /a$e


This petition for review
[1]
assails the 0e(ruar) 1221 8ecision
[;]
and ;1 6arch ;<<< Resolution
[3]
of the Court
of Appeals in CA-G.R. CV No. >!>1. The Court of Appeals affir"ed i" toto the ;; Nove"(er 1223 8ecision
[>]
of the
Re#ional Trial Court of 6anila$ %ranch 33$ findin# 8r. 5scar Hstrada solel) lia(le for da"a#es for the death of his
patient$ CoraJon No#ales$ while a(solvin# the re"ainin# respondents of an) lia(ilit). The Court of Appeals denied
petitioners? "otion for reconsideration.


',e -act$

+re#nant with her fourth child$ CoraJon No#ales DACoraJonBE$ who was then 33 )ears old$ was under the
e9clusive prenatal care of 8r. 5scar Hstrada DA8r. HstradaBE (e#innin# on her fourth "onth of pre#nanc) or as earl)
as 8ece"(er 123!. =hile CoraJon was on her last tri"ester of pre#nanc)$ 8r. Hstrada noted an increase in her
(lood pressure and develop"ent of le# ede"a
[!]
indicatin# preecla"psia$
[]
which is a dan#erous co"plication of
pre#nanc).
[3]

Around "idni#ht of ;! 6a) 123$ CoraJon started to e9perience "ild la(or pains pro"ptin# CoraJon and
Ro#elio No#ales DA:pouses No#alesBE to see 8r. Hstrada at his ho"e. After e9a"inin# CoraJon$ 8r. Hstrada
advised her i""ediate ad"ission to the Capitol 6edical Center DAC6CBE.

5n ; 6a) 123$ CoraJon was ad"itted at ;*3< a.". at the C6C after the staff nurse noted the written
ad"ission reCuest
[1]
of 8r. Hstrada. Gpon CoraJon?s ad"ission at the C6C$ Ro#elio No#ales DARo#elioBE e9ecuted
and si#ned the AConsent on Ad"ission and A#ree"entB
[2]
and AAd"ission A#ree"ent.B
[1<]
CoraJon was then (rou#ht
to the la(or roo" of the C6C.

8r. Rosa G) DA8r. G)BE$ who was then a resident ph)sician of C6C$ conducted an internal e9a"ination of
CoraJon. 8r. G) then called up 8r. Hstrada to notif) hi" of her findin#s.

%ased on the 8octor?s 5rder :heet$
[11]
around 3*<< a.".$ 8r. Hstrada ordered for 1< "#. of valiu" to (e
ad"inistered i""ediatel) () intra"uscular in.ection. 8r. Hstrada later ordered the start of intravenous ad"inistration
of s)ntocinon ad"i9ed with de9trose$ !Q$ in lactated Rin#ers? solution$ at the rate of ei#ht to ten "icro-drops per
"inute.

Accordin# to the Nurse?s 5(servation Notes$
[1;]
8r. -oel HnriCueJ DA8r. HnriCueJBE$ an anesthesiolo#ist at C6C$
was notified at >*1! a.". of CoraJon?s ad"ission. :u(seCuentl)$ when as4ed if he needed the services of an
anesthesiolo#ist$ 8r. Hstrada refused. 8espite 8r. Hstrada?s refusal$ 8r. HnriCueJ sta)ed to o(serve CoraJon?s
condition.

At *<< a.".$ CoraJon was transferred to 8eliver) Roo" No. 1 of the C6C. At *1< a.".$ CoraJon?s (a# of
water ruptured spontaneousl). At *1; a.".$ CoraJon?s cervi9 was full) dilated. At *13 a.".$ CoraJon started to
e9perience convulsions.

At *1! a.".$ 8r. Hstrada ordered the in.ection of ten #ra"s of "a#nesiu" sulfate. 7owever$ 8r. Hl) Villaflor
DA8r. VillaflorBE$ who was assistin# 8r. Hstrada$ ad"inistered onl) ;.! #ra"s of "a#nesiu" sulfate.

At *;; a.".$ 8r. Hstrada$ assisted () 8r. Villaflor$ applied low forceps to e9tract CoraJon?s (a(). &n the
process$ a 1.< 9 ;.! c". piece of cervical tissue was alle#edl) torn. The (a() ca"e out in an apnic$ c)anotic$ wea4
and in.ured condition. ConseCuentl)$ the (a() had to (e intu(ated and resuscitated () 8r. HnriCueJ and 8r.
+a)u"o.

At *;3 a.".$ CoraJon (e#an to "anifest "oderate va#inal (leedin# which rapidl) (eca"e profuse. CoraJon?s
(lood pressure dropped fro" 13<M1< to <M>< within five "inutes. There was continuous profuse va#inal
(leedin#. The assistin# nurse ad"inistered he"acel throu#h a #au#e 12 needle as a side drip to the on#oin#
intravenous in.ection of de9trose.

At 3*>! a.".$ 8r. Hstrada ordered (lood t)pin# and cross "atchin# with (ottled (lood. &t too4 appro9i"atel) 3<
"inutes for the C6C la(orator)$ headed () 8r. +erpetua ,acson DA8r. ,acsonBE$ to co"pl) with 8r. Hstrada?s order
and deliver the (lood.

At 1*<< a.".$ 8r. Noe Hspinola DA8r. HspinolaBE$ head of the 5(stetrics-G)necolo#) 8epart"ent of the C6C$
was apprised of CoraJon?s condition () telephone. Gpon (ein# infor"ed that CoraJon was (leedin# profusel)$ 8r.
Hspinola ordered i""ediate h)sterecto"). Ro#elio was "ade to si#n a AConsent to 5peration.B
[13]


8ue to the incle"ent weather then$ 8r. Hspinola$ who was fetched fro" his residence () an a"(ulance$ arrived
at the C6C a(out an hour later or at 2*<< a.". 7e e9a"ined the patient and ordered so"e resuscitative "easures
to (e ad"inistered. 8espite 8r. Hspinola?s efforts$ CoraJon died at 2*1! a.". The cause of death was Ahe"orrha#e$
post partu".B
[1>]

5n 1> 6a) 121<$ petitioners filed a co"plaint for da"a#es
[1!]
with the Re#ional Trial Court
[1]
of 6anila a#ainst
C6C$ 8r. Hstrada$ 8r. Villaflor$ 8r. G)$ 8r. HnriCueJ$ 8r. ,acson$ 8r. Hspinola$ and a certain Nurse -. 8u"lao for the
death of CoraJon. +etitioners "ainl) contended that defendant ph)sicians and C6C personnel were ne#li#ent in the
treat"ent and "ana#e"ent of CoraJon?s condition. +etitioners char#ed C6C with ne#li#ence in the selection and
supervision of defendant ph)sicians and hospital staff.

0or failin# to file their answer to the co"plaint despite service of su""ons$ the trial court declared 8r. Hstrada$
8r. HnriCueJ$ and Nurse 8u"lao in default.
[13]
C6C$ 8r. Villaflor$ 8r. G)$ 8r. Hspinola$ and 8r. ,acson filed their
respective answers den)in# and opposin# the alle#ations in the co"plaint. :u(seCuentl)$ trial ensued.

After "ore than 11 )ears of trial$ the trial court rendered .ud#"ent on ;; Nove"(er 1223 findin# 8r. Hstrada
solel) lia(le for da"a#es. The trial court ruled as follows*

The victi" was under his pre-natal care$ apparentl)$ his fault (e#an fro" his incorrect and inadeCuate "ana#e"ent
and lac4 of treat"ent of the pre-ecla"ptic condition of his patient. &t is not disputed that he "isapplied the forceps in
causin# the deliver) (ecause it resulted in a lar#e cervical tear which had caused the profuse (leedin# which he also
failed to control with the application of inadeCuate in.ection of "a#nesiu" sulfate () his assistant 8ra. Hl)
Villaflor. 8r. Hstrada even failed to notice the erroneous ad"inistration () nurse 8u"lao of he"acel () wa) of side
drip$ instead of direct intravenous in.ection$ and his failure to consult a senior o(stetrician at an earl) sta#e of the
pro(le".

5n the part however of 8ra. Hl) Villaflor$ 8ra. Rosa G)$ 8r. -oel HnriCueJ$ 8r. ,acson$ 8r. Hspinola$ nurse -.
8u"lao and C6C$ the Court finds no le#al .ustification to find the" civill) lia(le.

5n the part of 8ra. Hl) Villaflor$ she was onl) ta4in# orders fro" 8r. Hstrada$ the principal ph)sician of
CoraJon No#ales. :he can onl) "a4e su##estions in the "anner the patient "a)(e treated (ut she cannot i"pose
her will as to do so would (e to su(stitute her #ood .ud#"ent to that of 8r. Hstrada. &f she failed to correctl)
dia#nose the true cause of the (leedin# which in this case appears to (e a cervical laceration$ it cannot (e safel)
concluded () the Court that 8ra. Villaflor had the correct dia#nosis and she failed to infor" 8r. Hstrada. No
evidence was introduced to show that indeed 8ra. Villaflor had discovered that there was laceration at the cervical
area of the patient?s internal or#an.

5n the part of nurse 8u"lao$ there is no showin# that when she ad"inistered the he"acel as a side drip$ she
did it on her own. &f the correct procedure was directl) thru the veins$ it could onl) (e (ecause this was what was
pro(a(l) the orders of 8r. Hstrada.

=hile the evidence of the plaintiffs shows that 8r. Noe Hspinola$ who was the Chief of the 8epart"ent of
5(stetrics and G)necolo#) who attended to the patient 6rs. No#ales$ it was onl) at 2*<< a.". That he was a(le to
reach the hospital (ecause of t)phoon 8idan# DH9hi(it ;E. =hile he was a(le to #ive prescription in the "anner
CoraJon No#ales "a) (e treated$ the prescription was (ased on the infor"ation #iven to hi" () phone and he acted
on the (asis of facts as presented to hi"$ (elievin# in #ood faith that such is the correct re"ed). 7e was not with 8r.
Hstrada when the patient was (rou#ht to the hospital at ;*3< o?cloc4 a.". :o$ whatever errors that 8r. Hstrada
co""itted on the patient (efore 2*<< o?cloc4 a.".are certainl) the errors of 8r. Hstrada and cannot (e the "ista4e of
8r. Noe Hspinola. 7is failure to co"e to the hospital on ti"e was due to fortuitous event.

5n the part of 8r. -oel HnriCueJ$ while he was present in the deliver) roo"$ it is not incu"(ent upon hi" to
call the attention of 8r. Hstrada$ 8ra. Villaflor and also of Nurse 8u"lao on the alle#ed errors co""itted ()
the". %esides$ as anesthesiolo#ist$ he has no authorit) to control the actuations of 8r. Hstrada and 8ra.
Villaflor. 0or the Court to assu"e that there were errors (ein# co""itted in the presence of 8r. HnriCueJ would (e
to dwell on con.ectures and speculations.

5n the civil lia(ilit) of 8r. +erpetua ,acson$ [s]he is a he"atolo#ist and in-char#e of the (lood (an4 of the
C6C. The Court cannot accept the theor) of the plaintiffs that there was dela) in deliverin# the (lood needed () the
patient. &t was testified$ that in order that this (lood will (e "ade availa(le$ a la(orator) test has to (e conducted to
deter"ine the t)pe of (lood$ cross "atchin# and other "atters consistent with "edical science so$ the lapse of 3<
"inutes "a)(e considered a reasona(le ti"e to do all of these thin#s$ and not a dela) as the plaintiffs would want
the Court to (elieve.

Ad"ittedl)$ 8ra. Rosa G) is a resident ph)sician of the Capitol 6edicalCenter. :he was sued (ecause of her
alle#ed failure to notice the inco"petence and ne#li#ence of 8r. Hstrada. 7owever$ there is no evidence to support
such theor). No evidence was adduced to show that 8ra. Rosa G) as a resident ph)sician ofCapitol 6edical Center$
had 4nowled#e of the "is"ana#e"ent of the patient CoraJon No#ales$ and that notwithstandin# such 4nowled#e$
she tolerated the sa"e to happen.


&n the pre-trial order$ plaintiffs and C6C a#reed that defendant C6C did not have an) hand or participation in
the selection or hirin# of 8r. Hstrada or his assistant 8ra. Hl) Villaflor as attendin# ph)sician[s] of the deceased. &n
other words$ the two D;E doctors were not e"plo)ees of the hospital and therefore the hospital did not have control
over their professional conduct. =hen 6rs. No#ales was (rou#ht to the hospital$ it was an e"er#enc) case and
defendant C6C had no choice (ut to ad"it her. :uch (ein# the case$ there is therefore no le#al #round to appl) the
provisions of Article ;13 and ;11< of the New Civil Code referrin# to the vicarious lia(ilit) of an e"plo)er for the
ne#li#ence of its e"plo)ees. &f ever in this case there is fault or ne#li#ence in the treat"ent of the deceased on the
part of the attendin# ph)sicians who were e"plo)ed () the fa"il) of the deceased$ such civil lia(ilit) should (e (orne
() the attendin# ph)sicians under the principle of Arespondeat superiorB.

=7HRH05RH$ pre"ises considered$ .ud#"ent is here() rendered findin# defendant 8r. Hstrada of Nu"(er 13
+iti"ini :t. :an 0rancisco del 6onte$ KueJon Cit) civill) lia(le to pa) plaintiffs* 1E %) wa) of actual da"a#es in the
a"ount of+1<!$<<<.<<F ;E %) wa) of "oral da"a#es in the a"ount of +3<<$<<<.<<F 3E Attorne)?s fees in the a"ount
of +1<<$<<<.<< and to pa) the costs of suit.

0or failure of the plaintiffs to adduce evidence to support its [sic] alle#ations a#ainst the other defendants$ the
co"plaint is here() ordered dis"issed. =hile the Court loo4s with disfavor the filin# of the present co"plaint a#ainst
the other defendants () the herein plaintiffs$ as in a wa) it has caused the" personal inconvenience and sli#ht
da"a#e on their na"e and reputation$ the Court cannot accepts [sic] however$ the theor) of the re"ainin#
defendants that plaintiffs were "otivated in (ad faith in the filin# of this co"plaint. 0or this reason defendants?
counterclai"s are here() ordered dis"issed.

:5 5R8HRH8.
[11]



+etitioners appealed the trial court?s decision. +etitioners clai"ed that aside fro" 8r. Hstrada$ the re"ainin#
respondents should (e held eCuall) lia(le for ne#li#ence. +etitioners pointed out the e9tent of each respondent?s
alle#ed lia(ilit).

5n 0e(ruar) 1221$ the Court of Appeals affir"ed the decision of the trial court.
[12]
+etitioners filed a "otion
for reconsideration which the Court of Appeals denied in its Resolution of ;1 6arch ;<<<.
[;<]
7ence$ this petition.

6eanwhile$ petitioners filed a 6anifestation dated 1; April ;<<;
[;1]
statin# that respondents 8r. Hstrada$ 8r.
HnriCueJ$ 8r. Villaflor$ and Nurse 8u"lao Aneed no lon#er (e notified of the petition (ecause the) are a(solutel) not
involved in the issue raised (efore the [Court]$ re#ardin# the lia(ilit) of [C6C].B
[;;]
+etitioners stressed that the
su(.ect "atter of this petition is the lia(ilit) of C6C for the ne#li#ence of 8r. Hstrada.
[;3]

The Court issued a Resolution dated 2 :epte"(er ;<<;
[;>]
dispensin# with the reCuire"ent to su("it the
correct and present addresses of respondents 8r. Hstrada$ 8r. HnriCueJ$ 8r. Villaflor$ and Nurse 8u"lao. The Court
stated that with the filin# of petitioners? 6anifestation$ it should (e understood that the) are clai"in# onl) a#ainst
respondents C6C$ 8r. Hspinola$ 8r. ,acson$ and 8r. G) who have filed their respective co""ents. +etitioners are
fore#oin# further clai"s a#ainst respondents 8r. Hstrada$ 8r. HnriCueJ$ 8r. Villaflor$ and Nurse 8u"lao.

The Court noted that 8r. Hstrada did not appeal the decision of the Court of Appeals affir"in# the decision of
the Re#ional Trial Court. Accordin#l)$ the decision of the Court of Appeals$ affir"in# the trial court?s .ud#"ent$ is
alread) final as a#ainst 8r. 5scar Hstrada.

+etitioners filed a "otion for reconsideration
[;!]
of the Court?s 2 :epte"(er ;<<; Resolution clai"in# that 8r.
HnriCueJ$ 8r. Villaflor and Nurse 8u"lao were notified of the petition at their counsels? last 4nown
addresses. +etitioners reiterated their i"putation of ne#li#ence on these respondents. The Court denied petitioners?
6otion for Reconsideration in its 11 0e(ruar) ;<<>Resolution.
[;]


',e /o)rt o8 A**ea($F R)(#9

&n its 8ecision of 0e(ruar) 1221$ the Court of Appeals upheld the trial court?s rulin#. The Court of Appeals
re.ected petitioners? view that the doctrine in 7arli"g v. Charlesto" Commu"it, Aemorial ?ospital
[;3]
applies to this
case. Accordin# to the Court of Appeals$ the present case differs fro" the7arli"g case since 8r. Hstrada is an
independent contractor-ph)sician whereas the 7arli"g case involved a ph)sician and a nurse who were e"plo)ees
of the hospital.

Citin# other A"erican cases$ the Court of Appeals further held that the "ere fact that a hospital per"itted a
ph)sician to practice "edicine and use its facilities is not sufficient to render the hospital lia(le for the ph)sician?s
ne#li#ence.
[;1]
A hospital is not responsi(le for the ne#li#ence of a ph)sician who is an independent contractor.
[;2]

The Court of Appeals found the cases of 7avidso" v. Co"ole
[3<]
andCamp-ell v. Emma Lai"g Steve"s
?ospital
[31]
applica(le to this case. Kuotin# Camp-ell$ the Court of Appeals stated that where there is no proof that
defendant ph)sician was an e"plo)ee of defendant hospital or that defendant hospital had reason to 4now that an)
acts of "alpractice would ta4e place$ defendant hospital could not (e held lia(le for its failure to intervene in the
relationship of ph)sician-patient (etween defendant ph)sician and plaintiff.

5n the lia(ilit) of the other respondents$ the Court of Appeals applied the A(orrowed servantB doctrine
considerin# that 8r. Hstrada was an independent contractor who was "erel) e9ercisin# hospital privile#es. This
doctrine provides that once the sur#eon enters the operatin# roo" and ta4es char#e of the proceedin#s$ the acts or
o"issions of operatin# roo" personnel$ and an) ne#li#ence associated with such acts or o"issions$ are i"puta(le to
the sur#eon.
[3;]
=hile the assistin# ph)sicians and nurses "a) (e e"plo)ed () the hospital$ or en#a#ed () the
patient$ the) nor"all) (eco"e the te"porar) servants or a#ents of the sur#eon in char#e while the operation is in
pro#ress$ and lia(ilit) "a) (e i"posed upon the sur#eon for their ne#li#ent acts under the doctrine ofrespo"deat
superior.
[33]

The Court of Appeals concluded that since Ro#elio en#a#ed 8r. Hstrada as the attendin# ph)sician of his wife$ an)
lia(ilit) for "alpractice "ust (e 8r. Hstrada?s sole responsi(ilit).

=hile it found the a"ount of da"a#es fair and reasona(le$ the Court of Appeals held that no interest could (e
i"posed on unliCuidated clai"s or da"a#es.

',e &$$)e

%asicall)$ the issue in this case is whether C6C is vicariousl) lia(le for the ne#li#ence of 8r. Hstrada. The
resolution of this issue rests$ on the other hand$ on the ascertain"ent of the relationship (etween 8r. Hstrada and
C6C. The Court also (elieves that a deter"ination of the e9tent of lia(ilit) of the other respondents is inevita(le to
finall) and co"pletel) dispose of the present controvers).


',e R)(#9 o8 t,e /o)rt

The petition is partl) "eritorious.

6n t&e Lia*ility of '#'


8r. Hstrada?s ne#li#ence in handlin# the treat"ent and "ana#e"ent of CoraJon?s condition which ulti"atel)
resulted in CoraJon?s death is no lon#er in issue. 8r. Hstrada did not appeal the decision of the Court of Appeals
which affir"ed the rulin# of the trial court findin# 8r. Hstrada solel) lia(le for da"a#es. Accordin#l)$ the findin# of the
trial court on 8r. Hstrada?s ne#li#ence is alread) final.

+etitioners "aintain that C6C is vicariousl) lia(le for 8r. Hstrada?s ne#li#ence (ased on Article ;11< in relation
to Article ;13 of the Civil Code. These provisions pertinentl) state*

Art. ;11<. The o(li#ation i"posed () article ;13 is de"anda(le not onl) for one?s own acts or o"issions$ (ut also
for those of persons for who" one is responsi(le.

9 9 9 9

H"plo)ers shall (e lia(le for the da"a#es caused () their e"plo)ees and household helpers actin# within
the scope of their assi#ned tas4s$ even thou#h the for"er are not en#a#ed in an) (usiness or industr).

9 9 9 9



The responsi(ilit) treated of in this article shall cease when the persons herein "entioned prove that the)
o(served all the dili#ence of a #ood father of a fa"il) to prevent da"a#e.

Art. ;13. =hoever () act or o"ission causes da"a#e to another$ there (ein# fault or ne#li#ence$ is o(li#ed to pa)
for the da"a#e done. :uch fault or ne#li#ence$ if there is no pre-e9istin# contractual relation (etween the parties$ is
called a Cuasi-delict and is #overned () the provisions of this Chapter.



:i"ilarl)$ in the Gnited :tates$ a hospital which is the e"plo)er$ "aster$ or principal of a ph)sician e"plo)ee$
servant$ or a#ent$ "a) (e held lia(le for the ph)sician?s ne#li#ence under the doctrine of respo"deat superior.
[3>]


&n the present case$ petitioners "aintain that C6C$ in allowin# 8r. Hstrada to practice and ad"it patients at
C6C$ should (e lia(le for 8r. Hstrada?s "alpractice. Ro#elio clai"s that he 4new 8r. Hstrada as an accredited
ph)sician of C6C$ thou#h he discovered later that 8r. Hstrada was not a salaried e"plo)ee of the C6C.
[3!]
Ro#elio
further clai"s that he was dealin# with C6C$ whose pri"ar) concern was the treat"ent and "ana#e"ent of his
wife?s condition. 8r. Hstrada .ust happened to (e the specific person he tal4ed to representin# C6C.
[3]
6oreover$
the fact that C6C "ade Ro#elio si#n a Consent on Ad"ission and Ad"ission A#ree"ent
[33]
and a Consent to
5peration printed on the letterhead of C6C indicates that C6C considered 8r. Hstrada as a "e"(er of its "edical
staff.

5n the other hand$ C6C disclai"s lia(ilit) () assertin# that 8r. Hstrada was a "ere visitin# ph)sician and that
it ad"itted CoraJon (ecause her ph)sical condition then was classified an e"er#enc) o(stetrics case.
[31]

C6C alle#es that 8r. Hstrada is an independent contractor Afor whose actuations C6C would (e a total
stran#er.B C6C "aintains that it had no control or supervision over 8r. Hstrada in the e9ercise of his "edical
profession.

The Court had the occasion to deter"ine the relationship (etween a hospital and a consultant or visitin#
ph)sician and the lia(ilit) of such hospital for that ph)sician?s ne#li#ence in Ramos v. Court of Appeals$
[32]
to wit*

&n the first place$ hospitals e9ercise si#nificant control in the hirin# and firin# of consultants and in the conduct
of their wor4 within the hospital pre"ises. 8octors who appl) for AconsultantB slots$ visitin# or attendin#$ are reCuired
to su("it proof of co"pletion of residenc)$ their educational CualificationsF #enerall)$ evidence of accreditation () the
appropriate (oard Ddiplo"ateE$ evidence of fellowship in "ost cases$ and references. These reCuire"ents are
carefull) scrutiniJed () "e"(ers of the hospital ad"inistration or () a review co""ittee set up () the hospital who
either accept or re.ect the application. This is particularl) true with respondent hospital.
After a ph)sician is accepted$ either as a visitin# or attendin# consultant$ he is nor"all) reCuired to attend
clinico-patholo#ical conferences$ conduct (edside rounds for cler4s$ interns and residents$ "oderate #rand rounds
and patient audits and perfor" other tas4s and responsi(ilities$ for the privile#e of (ein# a(le to "aintain a clinic in
the hospital$ andMor for the privile#e of ad"ittin# patients into the hospital. &n addition to these$ the ph)sician?s
perfor"ance as a specialist is #enerall) evaluated () a peer review co""ittee on the (asis of "ortalit) and
"or(idit) statistics$ and feed(ac4 fro" patients$ nurses$ interns and residents. A consultant re"iss in his duties$ or a
consultant who re#ularl) falls short of the "ini"u" standards accepta(le to the hospital or its peer review
co""ittee$ is nor"all) politel) ter"inated.
&n other words$ private hospitals$ hire$ fire and e9ercise real control over their attendin# and visitin#
AconsultantB staff. 5,#(e Aco$)(tat$D are ot, tec,#ca((+ e"*(o+ee$, a *o#t 7,#c, re$*o!et ,o$*#ta(
a$$ert$ # !e+#9 a(( re$*o$#b#(#t+ 8or t,e *at#etF$ co!#t#o, t,e cotro( e?erc#$e!, t,e ,#r#9, a! t,e
r#9,t to ter"#ate co$)(tat$ a(( 8)(8#(( t,e #"*ortat ,a(("arB$ o8 a e"*(o+er@e"*(o+ee re(at#o$,#*, 7#t,
t,e e?ce*t#o o8 t,e *a+"et o8 7a9e$. & a$$e$$#9 7,et,er $)c, a re(at#o$,#* # 8act e?#$t$, t,e cotro(
te$t #$ !eter"##9. Accor!#9(+, o t,e ba$#$ o8 t,e 8ore9o#9, 7e r)(e t,at 8or t,e *)r*o$e o8 a((ocat#9
re$*o$#b#(#t+ # "e!#ca( e9(#9ece ca$e$, a e"*(o+er@e"*(o+ee re(at#o$,#* # e88ect e?#$t$ bet7ee
,o$*#ta($ a! t,e#r atte!#9 a! C#$#t#9 *,+$#c#a$. This (ein# the case$ the Cuestion now arises as to whether
or not respondent hospital is solidaril) lia(le with respondent doctors for petitioner?s condition.
The (asis for holdin# an e"plo)er solidaril) responsi(le for the ne#li#ence of its e"plo)ee is found in Article
;11< of the Civil Code which considers a person accounta(le not onl) for his own acts (ut also for those of others
(ased on the for"er?s responsi(ilit) under a relationship of patria potestas. 9 9 9
[><]
DH"phasis suppliedE

=hile the Court in Ramos did not e9pound on the control test$ such test essentiall) deter"ines whether an
e"plo)"ent relationship e9ists (etween a ph)sician and a hospital (ased on the e9ercise of control over the
ph)sician as to details. :pecificall)$ the e"plo)er Dor the hospitalE "ust have the ri#ht to control (oth the "eans and
the details of the process () which the e"plo)ee Dor the ph)sicianE is to acco"plish his tas4.
[>1]

After a thorou#h e9a"ination of the volu"inous records of this case$ the Court finds no sin#le evidence
pointin# to C6C?s e9ercise of control over 8r. Hstrada?s treat"ent and "ana#e"ent of CoraJon?s condition. &t is
undisputed that throu#hout CoraJon?s pre#nanc)$ she was under the e9clusive prenatal care of 8r. Hstrada. At the
ti"e of CoraJon?s ad"ission at C6C and durin# her deliver)$ it was 8r. Hstrada$ assisted () 8r. Villaflor$ who
attended to CoraJon. There was no showin# that C6C had a part in dia#nosin# CoraJon?s condition. =hile 8r.
Hstrada en.o)ed staff privile#es at C6C$ such fact alone did not "a4e hi" an e"plo)ee of C6C.[>;] C6C "erel)
allowed 8r. Hstrada to use its facilities[>3] when CoraJon was a(out to #ive (irth$ which C6C considered an
e"er#enc). Considerin# these circu"stances$ 8r. Hstrada is not an e"plo)ee of C6C$ (ut an independent
contractor.
The Cuestion now is whether C6C is auto"aticall) e9e"pt fro" lia(ilit) considerin# that 8r. Hstrada is an
independent contractor-ph)sician.

&n #eneral$ a hospital is not lia(le for the ne#li#ence of an independent contractor-ph)sician. There is$ however$
an e9ception to this principle. The hospital "a) (e lia(le if the ph)sician is the Aostensi(leB a#ent of the hospital.
[>>] This e9ception is also 4nown as the Adoctrine of apparent authorit).B[>!] &n9il-ert v. S,#amore Au"i#ipal
?ospital$[>] the &llinois :upre"e Court e9plained the doctrine of apparent authorit) in this wise*

[G]nder the doctrine of apparent authorit) a hospital can (e held vicariousl) lia(le for the ne#li#ent acts of a
ph)sician providin# care at the hospital$ re#ardless of whether the ph)sician is an independent contractor$ unless the
patient 4nows$ or should have 4nown$ that the ph)sician is an independent contractor. The ele"ents of the action
have (een set out as follows*
A0or a hospital to (e lia(le under the doctrine of apparent authorit)$ a plaintiff "ust show that* D1E the hospital$ or its
a#ent$ acted in a "anner that would lead a reasona(le person to conclude that the individual who was alle#ed to (e
ne#li#ent was an e"plo)ee or a#ent of the hospitalF D;E where the acts of the a#ent create the appearance of
authorit)$ the plaintiff "ust also prove that the hospital had 4nowled#e of and acCuiesced in the"F and D3E the plaintiff
acted in reliance upon the conduct of the hospital or its a#ent$ consistent with ordinar) care and prudence.B

The ele"ent of Aholdin# outB on the part of the hospital does not reCuire an e9press representation () the
hospital that the person alle#ed to (e ne#li#ent is an e"plo)ee. Rather$ the ele"ent is satisfied if the hospital holds
itself out as a provider of e"er#enc) roo" care without infor"in# the patient that the care is provided ()
independent contractors.

The ele"ent of .ustifia(le reliance on the part of the plaintiff is satisfied if the plaintiff relies upon the hospital
to provide co"plete e"er#enc) roo" care$ rather than upon a specific ph)sician.


The doctrine of apparent authorit) essentiall) involves two factors to deter"ine the lia(ilit) of an independent-
contractor ph)sician.

The first factor focuses on the hospital?s "anifestations and is so"eti"es descri(ed as an inCuir) whether the
hospital acted in a "anner which would lead a reasona(le person to conclude that the individual who was alle#ed to
(e ne#li#ent was an e"plo)ee or a#ent of the hospital.[>3] & t,#$ re9ar!, t,e ,o$*#ta( ee! ot "aBe e?*re$$
re*re$etat#o$ to t,e *at#et t,at t,e treat#9 *,+$#c#a #$ a e"*(o+ee o8 t,e ,o$*#ta(L rat,er a
re*re$etat#o "a+ be 9eera( a! #"*(#e!.[>1]

The doctrine of apparent authorit) is a species of the doctrine of estoppel. Article 1>31 of the Civil Code
provides that A[t]hrou#h estoppel$ an ad"ission or representation is rendered conclusive upon the person "a4in# it$
and cannot (e denied or disproved as a#ainst the person rel)in# thereon.B Hstoppel rests on this rule* A=henever a
part) has$ () his own declaration$ act$ or o"ission$ intentionall) and deli(eratel) led another to (elieve a particular
thin# true$ and to act upon such (elief$ he cannot$ in an) liti#ation arisin# out of such declaration$ act or o"ission$ (e
per"itted to falsif) it.B
[>2]

&n the instant case$ C6C i"pliedl) held out 8r. Hstrada as a "e"(er of its "edical staff. Throu#h C6C?s acts$
C6C clothed 8r. Hstrada with apparent authorit) there() leadin# the :pouses No#ales to (elieve that 8r. Hstrada
was an e"plo)ee or a#ent of C6C. C6C cannot now repudiate such authorit).

0irst$ C6C #ranted staff privile#es to 8r. Hstrada. C6C e9tended its "edical staff and facilities to 8r. Hstrada.
Gpon 8r. Hstrada?s reCuest for CoraJon?s ad"ission$ C6C$ throu#h its personnel$ readil) acco""odated CoraJon
and updated 8r. Hstrada of her condition.

:econd$ C6C "ade Ro#elio si#n consent for"s printed on C6C letterhead. +rior to CoraJon?s ad"ission and
supposed h)sterecto")$ C6C as4ed Ro#elio to si#n release for"s$ the contents of which reinforced Ro#elio?s (elief
that 8r. Hstrada was a "e"(er of C6C?s "edical staff.[!<] The Consent on Ad"ission and A#ree"ent e9plicitl)
provides*

/N5= A,, 6HN %I T7H:H +RH:HNT:*

&$ Ro#elio No#ales$ of le#al a#e$ a resident of 123> 6. 7. 8el +ilar :t.$ 6alate 6la.$ (ein# the
fatherM"otherM(rotherMsisterMspouseMrelativeM #uardianMor person in custod) of 6a. CoraJon$ and representin# hisMher
fa"il)$ of ") own volition and free will$ do consent and su("it said 6a. CoraJon to 8r. 5scar Hstrada Dhereinafter
referred to as +h)sicianE for cure$ treat"ent$ retreat"ent$ or e"er#enc) "easures$ t,at t,e 0,+$#c#a, *er$oa((+
or b+ a! t,ro)9, t,e /a*#to( .e!#ca( /eter a!Jor #t$ $ta88, "a+ )$e, a!a*t, or e"*(o+ $)c, "ea$, 8or"$
or "et,o!$ o8 c)re, treat"et, retreat"et, or e"er9ec+ "ea$)re$ a$ ,e "a+ $ee be$t a! "o$t e?*e!#etL
t,at .a. /oraGo a! & 7#(( co"*(+ 7#t, a+ a! a(( r)(e$, re9)(at#o$, !#rect#o$, a! #$tr)ct#o$ o8 t,e
0,+$#c#a, t,e /a*#to( .e!#ca( /eter a!Jor #t$ $ta88F and$ that & will not hold lia(le or responsi(le and here()
waive and forever dischar#e and hold free the +h)sician$ the Capitol 6edical Center andMor its staff$ fro" an) and all
clai"s of whatever 4ind of nature$ arisin# fro" directl) or indirectl)$ or () reason of said cure$ treat"ent$ or
retreat"ent$ or e"er#enc) "easures or intervention of said ph)sician$ the Capitol 6edical Center andMor its staff.

9 9 9 9[!1] DH"phasis suppliedE


=hile the Consent to 5peration pertinentl) reads$ thus*

&$ R5GH,&5 N5GA,H:$ 9 9 9$ of ") own volition and free will$ do consent and su("it said C5RAP5N
N5GA,H: to 7)sterecto")$ () the S)r9#ca( Sta88 a! Ae$t,e$#o(o9#$t$ o8 /a*#to( .e!#ca( /eter andMor
whatever succeedin# operations$ treat"ent$ or e"er#enc) "easures as "a) (e necessar) and "ost e9pedientF and$
that & will not hold lia(le or responsi(le and here() waive and forever dischar#e and hold free the :ur#eon$ his
assistants$ anesthesiolo#ists$ the Capitol 6edical Center andMor its staff$ fro" an) and all clai"s of whatever 4ind of
nature$ arisin# fro" directl) or indirectl)$ or () reason of said operation or operations$ treat"ent$ or e"er#enc)
"easures$ or intervention of the :ur#eon$ his assistants$ anesthesiolo#ists$ the Capitol 6edical Center andMor its
staff.[!;] DH"phasis suppliedE

=ithout an) indication in these consent for"s that 8r. Hstrada was an independent contractor-ph)sician$ the
:pouses No#ales could not have 4nown that 8r. Hstrada was an independent contractor. :i#nificantl)$ no one fro"
C6C infor"ed the :pouses No#ales that 8r. Hstrada was an independent contractor. 5n the contrar)$ 8r. Atencio$
who was then a "e"(er of C6C %oard of 8irectors$ testified that 8r. Hstrada was part of C6C?s sur#ical staff.[!3]

Third$ 8r. Hstrada?s referral of CoraJon?s profuse va#inal (leedin# to 8r. Hspinola$ who was then the 7ead of
the 5(stetrics and G)necolo#) 8epart"ent of C6C$ #ave the i"pression that 8r. Hstrada as a "e"(er of C6C?s
"edical staff was colla(oratin# with other C6C-e"plo)ed specialists in treatin# CoraJon.

The second factor focuses on the patient?s reliance. &t is so"eti"es characteriJed as an inCuir) on whether the
plaintiff acted in reliance upon the conduct of the hospital or its a9et$ consistent with ordinar) care and prudence.
[!>]

The records show that the :pouses No#ales relied upon a perceived e"plo)"ent relationship with C6C in
acceptin# 8r. Hstrada?s services. Ro#elio testified that he and his wife specificall) chose 8r. Hstrada to handle
CoraJon?s deliver) not onl) (ecause of their friend?s reco""endation$ (ut "ore i"portantl) (ecause of 8r. Hstrada?s
Aconnection with a reputa(le hospital$ the [C6C].B[!!]&n other words$ 8r. Hstrada?s relationship with C6C pla)ed a
si#nificant role in the :pouses No#ales? decision in acceptin# 8r. Hstrada?s services as the o(stetrician-
#)necolo#ist for CoraJon?s deliver). 6oreover$ as earlier stated$ there is no showin# that (efore and durin#
CoraJon?s confine"ent at C6C$ the :pouses No#ales 4new or should have 4nown that 8r. Hstrada was not an
e"plo)ee of C6C.

0urther$ the :pouses No#ales loo4ed to C6C to provide the (est "edical care and support services for
CoraJon?s deliver). The Court notes that prior to CoraJon?s fourth pre#nanc)$ she used to #ive (irth inside a clinic.
Considerin# CoraJon?s a#e then$ the :pouses No#ales decided to have their fourth child delivered at C6C$ which
Ro#elio re#arded one of the (est hospitals at the ti"e.[!] This is precisel) (ecause the :pouses No#ales feared
that CoraJon "i#ht e9perience co"plications durin# her deliver) which would (e (etter addressed and treated in a
"odern and (i# hospital such as C6C. 6oreover$ Ro#elio?s consent in CoraJon?s h)sterecto") to (e perfor"ed ()
a different ph)sician$ na"el) 8r. Hspinola$ is a clear indication of Ro#elio?s confidence in C6C?s sur#ical staff.

C6C?s defense that all it did was Ato e9tend to [CoraJon] its facilitiesB is untena(le. The Court cannot close its
e)es to the realit) that hospitals$ such as C6C$ are in the (usiness of treat"ent. &n this re#ard$ the Court a#rees with
the o(servation "ade () the Court of Appeals of North Carolina in 7iggs v. :ova"t ?ealth. I"#.$[!3] to wit*

AThe conception that the hospital does not underta4e to treat the patient$ does not underta4e to act throu#h its
doctors and nurses$ (ut underta4es instead si"pl) to procure the" to act upon their own responsi(ilit)$ no lon#er
reflects the fact. 0re$et !a+ ,o$*#ta($, a$ t,e#r "aer o8 o*erat#o *(a#(+ !e"o$trate$, !o 8ar "ore t,a
8)r#$, 8ac#(#t#e$ 8or treat"et. ',e+ re9)(ar(+ e"*(o+ o a $a(ar+ ba$#$ a (ar9e $ta88 o8 *,+$#c#a$, )r$e$
a! #tere$ [$#c], a$ 7e(( a$ a!"##$trat#Ce a! "a)a( 7orBer$, a! t,e+ c,ar9e *at#et$ 8or "e!#ca( care
a! treat"et, co((ect#9 8or $)c, $erC#ce$, #8 ece$$ar+, b+ (e9a( act#o. /erta#(+, t,e *er$o 7,o aCa#($
,#"$e(8 o8 E,o$*#ta( 8ac#(#t#e$F e?*ect$ t,at t,e ,o$*#ta( 7#(( atte"*t to c)re ,#", ot t,at #t$ )r$e$ or ot,er
e"*(o+ee$ 7#(( act o t,e#r o7 re$*o$#b#(#t+.D 9 9 9 DH"phasis suppliedE


,i4ewise unconvincin# is C6C?s ar#u"ent that petitioners are estopped fro" clai"in# da"a#es (ased on the
Consent on Ad"ission and Consent to 5peration. %oth release for"s consist of two parts. The first part #ave C6C
per"ission to ad"inister to CoraJon an) for" of reco#niJed "edical treat"ent which the C6C "edical staff dee"ed
advisa(le. The second part of the docu"ents$ which "a) properl) (e descri(ed as the releasin# part$ releases C6C
and its e"plo)ees Afro" an) and all clai"sB arisin# fro" or () reason of the treat"ent and operation.

The docu"ents do not e9pressl) release C6C fro" lia(ilit) for in.ur) to CoraJon due to "eglige"#e durin# her
treat"ent or operation. Neither do the consent for"s e9pressl) e9e"pt C6C fro" lia(ilit) for CoraJon?s death due to
"eglige"#e durin# such treat"ent or operation. :uch release for"s$ (ein# in the nature of contracts of adhesion$ are
construed strictl) a#ainst hospitals. %esides$ a (lan4et release in favor of hospitals Afro" an) and all clai"s$B which
includes clai"s due to (ad faith or #ross ne#li#ence$ would (e contrar) to pu(lic polic) and thus void.

Hven si"ple ne#li#ence is not su(.ect to (lan4et release in favor of esta(lish"ents li4e hospitals (ut "a) onl)
"iti#ate lia(ilit) dependin# on the circu"stances.
[!1]
=hen a person needin# ur#ent "edical attention rushes to a
hospital$ he cannot (ar#ain on eCual footin# with the hospital on the ter"s of ad"ission and operation. :uch a
person is literall) at the "erc) of the hospital. There can (e no clearer e9a"ple of a contract of adhesion than one
arisin# fro" such a dire situation. Thus$ the release for"s of C6C cannot relieve C6C fro" lia(ilit) for the
ne#li#ent "edical treat"ent of CoraJon.

6n t&e Lia*ility of t&e 6t&er Respondents

8espite this Court?s pronounce"ent in its 2 :epte"(er ;<<;
[!2]
Resolution that the filin# of petitioners?
6anifestation confined petitioners? clai" onl) a#ainst C6C$ 8r. Hspinola$ 8r. ,acson$ and 8r. G)$ who have filed
their co""ents$ the Court dee"s it proper to resolve the individual lia(ilit) of the re"ainin# respondents to put an
end finall) to this "ore than two-decade old controvers).

a= Dr. E(+ 1#((a8(or

+etitioners (la"e 8r. Hl) Villaflor for failin# to dia#nose the cause of CoraJon?s (leedin# and to su##est the
correct re"ed) to 8r. Hstrada.
[<]
+etitioners assert that it was 8r. Villaflor?s dut) to correct the error of Nurse 8u"lao
in the ad"inistration of he"acel.


The Court is not persuaded. 8r. Villaflor ad"itted ad"inisterin# a lower dosa#e of "a#nesiu"
sulfate. 7owever$ this was after infor"in# 8r. Hstrada that CoraJon was no lon#er in convulsion and that her (lood
pressure went down to a dan#erous level.
[1]
At that "o"ent$ 8r. Hstrada instructed 8r. Villaflor to reduce the
dosa#e of "a#nesiu" sulfate fro" 1< to ;.! #ra"s. :ince petitioners did not dispute 8r. Villaflor?s alle#ation$ 8r.
Villaflor?s defense re"ains uncontroverted. 8r. Villaflor?s act of ad"inisterin# a lower dosa#e of "a#nesiu" sulfate
was not out of her own volition or was in contravention of 8r. Hstrada?s order.

b= Dr. Ro$a :+

8r. Rosa G)?s alle#ed ne#li#ence consisted of her failure D1E to call the attention of 8r. Hstrada on the incorrect
dosa#e of "a#nesiu" sulfate ad"inistered () 8r. VillaflorF D;E to ta4e corrective "easuresF and D3E to correct Nurse
8u"lao?s wron# "ethod of he"acel ad"inistration.

The Court (elieves 8r. G)?s clai" that as a second )ear resident ph)sician then at C6C$ she was "erel)
authoriJed to ta4e the clinical histor) and ph)sical e9a"ination of CoraJon.
[;]
7owever$ that routine internal
e9a"ination did notipso fa#to "a4e 8r. G) lia(le for the errors co""itted () 8r. Hstrada. 0urther$ petitioners?
i"putation of ne#li#ence rests on their (aseless assu"ption that 8r. G) was present at the deliver) roo". Nothin#
shows that 8r. G) participated in deliverin# CoraJon?s (a(). 0urther$ it is une9pected fro" 8r. G)$ a "ere resident
ph)sician at that ti"e$ to call the attention of a "ore e9perienced specialist$ if ever she was present at the deliver)
roo".


c= Dr. Joe( Er#H)eG

+etitioners fault 8r. -oel HnriCueJ also for not callin# the attention of 8r. Hstrada$ 8r. Villaflor$ and Nurse
8u"lao a(out their errors.
[3]
+etitioners insist that 8r. HnriCueJ should have ta4en$ or at least su##ested$ corrective
"easures to rectif) such errors.

The Court is not convinced. 8r. HnriCueJ is an anesthesiolo#ist whose field of e9pertise is definitel) not
o(stetrics and #)necolo#). As such$ 8r. HnriCueJ was not e9pected to correct 8r. Hstrada?s errors. %esides$ there
was no evidence of 8r. HnriCueJ?s 4nowled#e of an) error co""itted () 8r. Hstrada and his failure to act upon such
o(servation.

!= Dr. 0er*et)a Lac$o

+etitioners fault 8r. +erpetua ,acson for her purported dela) in the deliver) of (lood CoraJon needed.
[>]
+etitioners clai" that 8r. ,acson was re"iss in her dut) of supervisin# the (lood (an4 staff.

As found () the trial court$ there was no unreasona(le dela) in the deliver) of (lood fro" the ti"e of the
reCuest until the transfusion to CoraJon. 8r. ,acson co"petentl) e9plained the procedure (efore (lood could (e
#iven to the patient.
[!]
Ta4in# into account the (leedin# ti"e$ clottin# ti"e and cross-"atchin#$ 8r. ,acson stated
that it would ta4e appro9i"atel) >!-< "inutes (efore (lood could (e read) for transfusion.
[]
0urther$ no evidence
e9ists that 8r. ,acson ne#lected her duties as head of the (lood (an4.

e= Dr. Noe E$*#o(a

+etitioners ar#ue that 8r. Hspinola should not have ordered i""ediate h)sterecto") without deter"inin# the
underl)in# cause of CoraJon?s (leedin#. 8r. Hspinola should have first considered the possi(ilit) of cervical in.ur)$
and advised a thorou#h e9a"ination of the cervi9$ instead of (elievin# outri#ht 8r. Hstrada?s dia#nosis that the
cause of (leedin# was uterine aton).

8r. Hspinola?s order to do h)sterecto") which was (ased on the infor"ation he received () phone is not
ne#li#ence. The Court a#rees with the trial court?s o(servation that 8r. Hspinola$ upon hearin# such infor"ation
a(out CoraJon?s condition$ (elieved in #ood faith that h)sterecto") was the correct re"ed). At an) rate$ the
h)sterecto") did not push throu#h (ecause upon 8r. Hspinola?s arrival$ it was alread) too late. At the ti"e$ CoraJon
was practicall) dead.

8= N)r$e J. D)"(ao

&n Aoore v. 9uthrie ?ospital I"#.$
[3]
the G: Court of Appeals$ 0ourth Circuit$ held that to recover$ a patient
co"plainin# of in.uries alle#edl) resultin# when the nurse ne#li#entl) in.ected "edicine to hi" intravenousl) instead
of intra"uscularl) had to show that D1E an intravenous in.ection constituted a lac4 of reasona(le and ordinar) careF
D;E the nurse in.ected "edicine intravenousl)F and D3E such in.ection was the pro9i"ate cause of his in.ur).

&n the present case$ there is no evidence of Nurse 8u"lao?s alle#ed failure to follow 8r. Hstrada?s specific
instructions. Hven assu"in# Nurse 8u"lao defied 8r. Hstrada?s order$ there is no showin# that side-drip
ad"inistration of he"acel pro9i"atel) caused CoraJon?s death. No evidence lin4in# CoraJon?s death and the
alle#ed wron#ful he"acel ad"inistration was introduced. Therefore$ there is no (asis to hold Nurse 8u"lao lia(le for
ne#li#ence.

6n t&e A2ard of Interest on "a)ages

The award of interest on da"a#es is proper and allowed under Article ;;11 of the Civil Code$ which states that
in cri"es and Cuasi-delicts$ interest as a part of the da"a#es "a)$ in a proper case$ (e ad.udicated in the discretion
of the court.
[1]

5HERE-ORE$ the Court 0AR'LY GRAN'S the petition. The Court finds respondent Capitol 6edical Center
vicariousl) lia(le for the ne#li#ence of 8r. 5scar Hstrada. The a"ounts of +1<!$<<< as actual da"a#es
and +3<<$<<< as "oral da"a#es should each earn le#al interest at the rate of si9 percent DQE per annu"
co"puted fro" the date of the .ud#"ent of the trial court. The Court affir"s the rest of the 8ecision dated
0e(ruar) 1221 and Resolution dated ;1 6arch ;<<< of the Court of Appeals in CA-G.R. CV No. >!>1.

SO ORDERED.



AN'ON&O '. /AR0&O
Associate -ustice


5E /ON/:R*


LEONARDO A. ;:&S:.2&NG
Associate -ustice
Chairperson


/ON/H&'A /AR0&O .ORALES DAN'E O. '&NGA
Associate -ustice Associate -ustice


0RES2&'ERO J. 1ELAS/O, JR.
Associate -ustice

A''ES'A'&ON
& attest that the conclusions in the a(ove 8ecision had (een reached in consultation (efore the case was
assi#ned to the writer of the opinion of the Court?s 8ivision.


LEONARDO A. ;:&S:.2&NG
Associate -ustice
Chairperson




/ER'&-&/A'&ON
+ursuant to :ection 13$ Article V&&& of the Constitution$ and the 8ivision Chairperson?s Attestation$ & certif) that
the conclusions in the a(ove 8ecision had (een reached in consultation (efore the case was assi#ned to the writer
of the opinion of the Court?s 8ivision.



REYNA'O S. 0:NO
Chief -ustice

Re*)b(#c o8 t,e 0,#(#**#e$
S)*re"e /o)rt
.a#(a


'H&RD D&1&S&ON


-E /AYAO@LASA., G.R. No. 156132
+etitioner$
+resent*

INARH:-:ANT&AG5$ 8..
Chairperso".
- versus - AG:TR&A-6ART&NHP$
C7&C5-NAPAR&5$
NAC7GRA$ a"d
RHIH:$ 88.
S0O:SES /LARO a!
ED&'HA RA.OLE'E, +ro"ul#ated*
Respondents.
R
8ece"(er 11$ ;<<1
9 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9


D E / & S & O N


A:S'R&A@.AR'&NE3, J.*

%efore the Court is a +etition for Review on Certiorari under Rule >! of the Rules of Court filed () 8r. 0e Ca)ao-
,asa" DpetitionerE see4in# to annul the 8ecision
[1]
dated-ul) >$ ;<<3 of the Court of Appeals DCAE in CA-G.R. :+ No.
;;<.

The antecedent facts*

5n -ul) ;1$ 122>$ respondent$ three "onths pre#nant Hditha Ra"olete DHdithaE was (rou#ht to the ,or"a 6edical
Center D,6CE in :an 0ernando$ ,a Gnion due to va#inal (leedin#. Gpon advice of petitioner
rela)ed via telephone$ Hditha was ad"itted to the ,6C on the sa"e da). A pelvic sono#ra"
[;]
was then conducted
on Hditharevealin# the fetus? wea4 cardiac pulsation.
[3]
The followin# da)$ Hditha?s repeat pelvic sono#ra"
[>]
showed
that aside fro" the fetus? wea4 cardiac pulsation$ no fetal "ove"ent was also appreciated. 8ue to persistent and
profuse va#inal (leedin#$ petitioner advised Hditha to under#o a 8ilatation and Curetta#e +rocedure D8XCE or
Araspa.B

5n -ul) 3<$ 122>$ petitioner perfor"ed the 8XC procedure. Hditha was dischar#ed fro" the hospital the followin#
da).

5n :epte"(er 1$ 122>$ Hditha was once a#ain (rou#ht at the ,6C$ as she was sufferin# fro" vo"itin# and
severe a(do"inal pains. Hditha was attended () 8r. %eatriJ de la CruJ$ 8r. Victor %. 6a)o and 8r. -uan V.
/o"i)a. 8r. 6a)o alle#edl) infor"edHditha that there was a dead fetus in the latter?s
wo"(. After$ Hditha underwentlaparoto")$
[!]
she was found to have a "assive intra-a(do"inal he"orrha#e and a
ruptured uterus. Thus$ Hditha had to under#o a procedure for h)sterecto")
[]
and as a result$ she has no "ore
chance to (ear a child.

5n Nove"(er 3$ 122>$ Hditha and her hus(and Claro Ra"olete DrespondentsE filed a Co"plaint
[3]
for Gross
Ne#li#ence and 6alpractice a#ainst petitioner (efore the +rofessional Re#ulations Co""ission D+RCE.

Respondents alle#ed that Hditha?s h)sterecto") was caused () petitioner?s un"iti#ated ne#li#ence and
professional inco"petence in conductin# the 8XC procedure and the petitioner?s failure to re"ove the fetus
inside Hditha?s wo"(.
[1]
A"on# the alle#ed acts of ne#li#ence were* first$ petitioner?s failure to chec4 up$ visit or
ad"inister "edication on Hditha durin# her first da) of confine"ent at the ,6CF
[2]
se#o"d$ petitioner reco""ended
that a 8XC procedure (e perfor"ed on Hditha without conductin# an) internal e9a"ination prior to the procedureF
[1<]
third$ petitioner i""ediatel) su##ested a 8XC procedure instead of closel) "onitorin# the state of pre#nanc)
of Hditha.
[11]


&n her Answer$
[1;]
petitioner denied the alle#ations of ne#li#ence and inco"petence with the followin#
e9planations* upon Hditha?s confir"ation that she would see4 ad"ission at the ,6C$ petitioner i""ediatel) called
the hospital to anticipate the arrival of Hditha and ordered throu#h the telephone the "edicines Hditha needed to
ta4e$ which the nurses carried outF petitioner visited Hditha on the "ornin# of -ul) ;1$ 122> durin# her roundsF on
-ul) ;2$ 122>$ she perfor"ed an internal e9a"ination on Hditha and she discovered that the latter?s cervi9 was
alread) open$ thus$ petitioner discussed the possi(le 8XC procedure$ should the (leedin# (eco"e "ore profuseF on
-ul) 3< 122>$ she conducted another internal e9a"ination on Hditha$ which revealed that the latter?s cervi9 was still
openF Hditha persistentl) co"plained of her va#inal (leedin# and her passin# out of so"e "eat) "ass in the
process of urination and (owel "ove"entF thus$ petitioner advised Hditha to under#o 8XC procedure which the
respondents consented toF petitioner was ver) vocal in the operatin# roo" a(out not (ein# a(le to see an a(ortusF
[13]
ta4in# the words of Hditha to "ean that she was passin# out so"e "eat) "ass and clotted (lood$ she assu"ed
that the a(ortus "ust have (een e9pelled in the process of (leedin#F it was Hditha who insisted that she wanted to
(e dischar#edF petitioner a#reed$ (ut she advised Hditha to return for chec4-up on Au#ust !$ 122>$ which the latter
failed to do.
+etitioner contended that it was Hditha?s #ross ne#li#ence andMor o"ission in insistin# to (e dischar#ed on
-ul) 31$ 122> a#ainst doctor?s advice and her un.ustified failure to return for chec4-up as directed () petitioner that
contri(uted to her life-threatenin# condition on :epte"(er 1$ 122>F that Hditha?s h)sterecto") was (rou#ht a(out
() her ver) a(nor"al pre#nanc) 4nown as pla#e"ta i"#reta. which was an e9tre"el) rare and ver) unusual case of
a(do"inal placental i"plantation. +etitioner ar#ued that whether or not a 8XC procedure was done () her or an)
other doctor$ there would (e no difference at all (ecause at an) sta#e of #estation (efore ter"$ the uterus would
rupture .ust the sa"e.

5n 6arch >$ 1222$ the %oard of 6edicine Dthe %oardE of the +RC rendered a 8ecision$
[1>]
e9oneratin#
petitioner fro" the char#es filed a#ainst her. The %oard held*

%ased on the findin#s of the doctors who conducted the laparoto") on Hditha$ hers is a case
of Hctopic +re#nanc) &nterstitial. This t)pe of ectopic pre#nanc) is one that is (ein# protected () the uterine
"uscles and "anifestations "a) ta4e later than four D>E "onths and onl) attri(utes to two percent D;QE
of ectopic pre#nanc) cases.

=hen co"plainant Hditha was ad"itted at ,or"a 6edical Center on -ul) ;1$ 122>due to va#inal (leedin#$
an ultra-sound was perfor"ed upon her and the result of the :ono#ra" Test reveals a "or(id fetus (ut did not
specif) where the fetus was located. 5(stetricians will assu"e that the pre#nanc) is within the uterus unless so
specified () the :onolo#ist who conducted the ultra-sound. Respondent D8r. ,asa"E cannot (e faulted if she was
not a(le to deter"ine that co"plainant Hditha is havin# an ectopic pre#nanc) interstitial. The 8XC conducted
on Hditha is necessar) considerin# that her cervi9 is alread) open and so as to stop the profuse (leedin#. :i"ple
curetta#e cannot re"ove a fetus if the patient is havin# an ectopicpre#nanc)$ since ectopic pre#nanc) is pre#nanc)
conceived outside the uterus and curetta#e is done onl) within the uterus. Therefore$ a "ore e9tensive operation
needed in this case of pre#nanc) in order to re"ove the fetus.
[1!]

0eelin# a##rieved$ respondents went to the +RC on appeal. 5n Nove"(er ;;$ ;<<<$ the +RC rendered a
8ecision
[1]
reversin# the findin#s of the %oard and revo4in# petitioner?s authorit) or license to practice her profession
as a ph)sician.
[13]
+etitioner (rou#ht the "atter to the CA in a +etition for Review under Rule >3 of the Rules of Court. +etitioner also
du((ed her petition as one for #ertiorari
[11]
under Rule ! of the Rules of Court.

&n the 8ecision dated -ul) >$ ;<<3$ the CA held that the +etition for Review under Rule >3 of the Rules of Court was
an i"proper re"ed)$ as the enu"eration of the quasiCEudi#ial a#encies in Rule >3 is e9clusive.
[12]
+RC is not a"on#
the Cuasi-.udicial (odies whose .ud#"ent or final orders are su(.ect of a petition for review to the CA$ thus$ the
petition for review of the +RC 8ecision$ filed at the CA$ was i"proper. The CA further held that should the petition
(e treated as a petition for #ertiorari under Rule !$ the sa"e would still (e dis"issed for (ein# i"proper and
pre"ature. Citin# :ection ;
[;<]
of Repu(lic Act DR.A.E No. ;31; or the 6edical Act of 12!2$ the CA held that the
plain$ speed) and adeCuate re"ed) under the ordinar) course of law which petitioner should have availed herself of
was to appeal to the 5ffice of the +resident.
[;1]


7ence$ herein petition$ assailin# the decision of the CA on the followin# #rounds*

1. T7H C5GRT 50 A++HA,: HRRH8 5N A KGH:T&5N 50 ,A= &N 75,8&NG T7AT T7H
+R50H::&5NA, RHGG,AT&5N[:] C566&::&5N D+RCE =A: H'C,G8H8 A65NG T7H KGA:&--G8&C&A,
AGHNC&H: C5NTH6+,ATH8 GN8HR RG,H >3 50 T7H RG,H: 50 C&V&, +R5CH8GRHF

;. HVHN A::G6&NG$ AR9UE:7O. T7AT +RC =A: H'C,G8H8 0R56 T7H +GRV&H=
50 RG,H >3 50 T7H RG,H: 50 C&V&, +R5CH8GRH$ T7H +HT&T&5NHR =A: N5T +RHC,G8H8 0R56 0&,&NG
A +HT&T&5N 05R CHRT&5RAR& =7HRH T7H 8HC&:&5N =A: A,:5 &::GH8 &N H'CH:: 50 5R
=&T75GT -GR&:8&CT&5N$ 5R =7HRH T7H 8HC&:&5N =A: A +ATHNT NG,,&TIF

3. 7HRH&N RH:+5N8HNT:-:+5G:H: ARH N5T A,,5=H8 %I ,A= T5 A++HA, 0R56
T7H 8HC&:&5N 50 T7H %5AR8 50 6H8&C&NH T5 T7H +R50H::&5NA, RHGG,AT&5N[:] C566&::&5NF

>. T7H C5GRT 50 A++HA,: C566&TTH8 GRAVH A%G:H 50 8&:CRHT&5N &N
8HNI&NG 05R &6+R5+HR 05RG6 T7H +HT&T&5N 05R RHV&H=M+HT&T&5N 05R CHRT&5RAR& =&T75GT
G5&NG 5VHR T7H 6HR&T: 50 T7H GR5GN8: RH,&H8 G+5N %I T7H +HT&T&5NHRF

!. +RC?: GRAVH 56&::&5N T5 A005R8 7HRH&N +HT&T5NHR A C7ANCH T5 %H
7HAR8 5N A++HA, &: A C,HAR V&5,AT&5N 50 7HR C5N:T&TGT&5NA, R&G7T T5 8GH +R5CH:: AN8 7A:
T7H H00HCT 50 RHN8HR&NG T7H -G8G6HNT NG,, AN8 V5&8F

. C5R5,,ARI T5 T7H 05GRT7 A::&GNH8 HRR5R$ +RC C566&TTH8 GRAVH
A%G:H 50 8&:CRHT&5N$ A65GNT&NG T5 ,AC/ 50 -GR&:8&CT&5N$ &N ACCH+T&NG AN8 C5N:&8HR&NG T7H
6H65RAN8G6 5N A++HA, =&T75GT +R550 50 :HRV&CH T5 7HRH&N +HT&T&5NHR$ AN8 &N V&5,AT&5N
50 ART. &V$ :HC. 3! 50 T7H RG,H: AN8 RHGG,AT&5N: G5VHRN&NG T7H RHGG,AT&5N AN8 +RACT&CH 50
+R50H::&5NA,:F

3. +RC C566&TTH8 GRAVH A%G:H 50 8&:CRHT&5N &N RHV5/&NG +HT&T&5NHR?:
,&CHN:H T5 +RACT&CH 6H8&C&NH =&T75GT AN H'+HRT TH:T&65NI T5 :G++5RT &T: C5NC,G:&5N A:
T5 T7H CAG:H 50 RH:+5N8HNT H8&T7AT [:&C] RA65,HTH?: &N-GRIF

1. +RC C566&TTH8 AN HVHN GRAVHR A%G:H 50 8&:CRHT&5N &N T5TA,,I
8&:RHGAR8&NG T7H 0&N8&NG 50 T7H %5AR8 50 6H8&C&NH$ =7&C7 7A8 T7H NHCH::ARI C56+HTHNCH
AN8 H'+HRT&:H T5 H:TA%,&:7 T7H CAG:H 50 RH:+5N8HNT H8&T7A?: &N-GRI$ A: =H,, A: T7H
TH:T&65NI 50 T7H H'+HRT =&TNH:: AGGG:T5 6ANA,5$ 6.8. F[AN8]

2. +RC C566&TTH8 GRAVH A%G:H 50 8&:CRHT&5N &N 6A/&NG C5NC,G:&5N: 50 0ACT: T7AT
=HRH N5T 5N,I GN:G++5RTH8 %I HV&8HNCH %GT =HRH ACTGA,,I C5NTRARI T5 HV&8HNCH 5N
RHC5R8.
[;;]

The Court will first deal with the procedural issues.

+etitioner clai"s that the law does not allow co"plainants to appeal to the +RC fro" the decision of the
%oard. :he invo4es Article &V$ :ection 3! of the Rules and Re#ulations Governin# the Re#ulation and +ractice of
+rofessionals$ which provides*

:ec. 3!. The respondent "a) appeal the decision of the %oard within thirt) da)s fro" receipt thereof to the
Co""ission whose decision shall (e final. /o"*(a#at, 7,e a((o7e! b+ (a7, "a+ #ter*o$e a a**ea( 8ro"
t,e Dec#$#o o8 t,e 2oar! 7#t,# t,e $a"e *er#o!. DH"phasis suppliedE

+etitioner asserts that a careful readin# of the a(ove law indicates that while the respondent$ as a "atter of ri#ht$
"a) appeal the 8ecision of the %oard to the Co""ission$ the co"plainant "a) interpose an appeal fro" the
decision of the %oard onl) when so allowed () law.
[;3]
+etitioner cited :ection ; of Repu(lic Act No. ;31; or AThe
6edical Act of 12!2$B to wit*

:ection ;. Appeal from Eudgme"t. The decision of the %oard of 6edical H9a"iners Dnow 6edical %oardE
shall auto"aticall) (eco"e final thirt) da)s after the date of its pro"ul#ation unless the respondent$ durin# the sa"e
period$ has appealed to the Co""issioner of Civil :ervice Dnow +rofessional Re#ulations Co""issionE and later to
the 5ffice of the +resident of the +hilippines. &f the final decision is not satisfactor)$ the respondent "a) as4 for a
review of the case$ or "a) file in court a petition for #ertiorari.

+etitioner posits that the reason wh) the 6edical Act of 12!2 allows onl) the respondent in an ad"inistrative case to
file an appeal with the Co""ission while the co"plainant is not allowed to do so is dou(le .eopard). +etitioner is of
the (elief that the revocation of license to practice a profession is penal in nature.
[;>]

The Court does not a#ree.

0or one$ the principle of dou(le .eopard) finds no application in ad"inistrative cases. 8ou(le .eopard)
attaches onl)* D1E upon a valid indict"entF D;E (efore a co"petent courtF D3E after arrai#n"entF D>E when a valid plea
has (een enteredF and D!E when the defendant was acCuitted or convicted$ or the case was dis"issed or otherwise
ter"inated without the e9press consent of the accused.
[;!]
These ele"ents were not present in the proceedin#s
(efore the %oard of 6edicine$ as the proceedin#s involved in the instant case were ad"inistrative and not cri"inal in
nature. The Court has alread) held that dou(le .eopard) does not lie in ad"inistrative cases.
[;]

6oreover$ :ection 3! of the Rules and Re#ulations Governin# the Re#ulation and +ractice of +rofessionals
cited () petitioner was su(seCuentl) a"ended to read*

:ec. 3!. The co"*(a#atJre$*o!et "a) appeal the order$ the resolution or the decision of the %oard
within thirt) D3<E da)s fro" receipt thereof to the Co""ission whose decision shall (e final
and e9ecutor). &nterlocutor) order shall not (e appeala(le to the Co""ission. DA"ended () Res. 13>$ :eries of
122<E.
[;3]
DH"phasis suppliedE

=hatever dou(t was created () the previous provision was settled with said a"end"ent. &t is a9io"atic that the
ri#ht to appeal is not a natural ri#ht or a part of due process$ (ut a "ere statutor) privile#e that "a) (e e9ercised
onl) in the "anner prescri(ed () law.
[;1]
&n this case$ the clear intent of the a"end"ent is to render the ri#ht to
appeal fro" a decision of the %oard availa(le to (oth co"plainants and respondents.

:uch conclusion is (olstered () the fact that in ;<<$ the +RC issued Resolution No. <-3>;DAE$ or the New Rules of
+rocedure in Ad"inistrative &nvesti#ations in the +rofessional Re#ulations Co""ission and the +rofessional
Re#ulator) %oards$ which provides for the "ethod of appeal$ to wit*

:ec. 1. A**ea(L 0er#o! No@E?te!#b(e.@ The decision$ order or resolution of the %oard shall (e final
and e9ecutor) after the lapse of fifteen D1!E da)s fro" receipt of the decision$ order or resolution without an appeal
(ein# perfected or ta4en () either the respondent or the co"plainant. A *art+ a99r#eCe! b+ t,e !ec#$#o, or!er or
re$o()t#o "a+ 8#(e a ot#ce o8 a**ea( 8ro" t,e !ec#$#o, or!er or re$o()t#o o8 t,e 2oar! to t,e /o""#$$#o
7#t,# 8#8tee <15= !a+$ 8ro" rece#*t t,ereo8, and servin# upon the adverse part) a notice of appeal to#ether with
the appellant?s (rief or "e"orandu" on appeal$ and pa)in# the appeal and le#al research fees. 9 9 9
[;2]

The a(ove-stated provision does not Cualif) whether onl) the co"plainant or respondent "a) file an appealF rather$
the new rules provide that Aa part) a##rievedB "a) file a notice of appeal. Thus$ either the co"plainant or the
respondent who has (een a##rieved () the decision$ order or resolution of the %oard "a) appeal to the
Co""ission. &t is an ele"entar) rule that when the law spea4s in clear and cate#orical lan#ua#e$ there is no need$
in the a(sence of le#islative intent to the contrar)$ for an) interpretation.
[3<]
=ords and phrases used in the statute
should (e #iven their plain$ ordinar)$ and co""on usa#e or "eanin#.
[31]


+etitioner also su("its that appeals fro" the decisions of the +RC should (e with the CA$ as Rule >3
[3;]
of the Rules
of Court was precisel) for"ulated and adopted to provide for a unifor" rule of appellate procedure for Cuasi-.udicial
a#encies.
[33]
+etitioner further contends that a Cuasi-.udicial (od) is not e9cluded fro" the purview of Rule >3 .ust
(ecause it is not "entioned therein.
[3>]

5n this point$ the Court a#rees with the petitioner.

:ec. 1$ Rule >3 of the Rules of Court provides*

:ection 1. S#ope. C ',#$ R)(e $,a(( a**(+ to a**ea($ fro" .ud#"ents or final orders of the Court of Ta9 Appeals$
and 8ro" a7ar!$, I)!9"et$, 8#a( or!er$ or re$o()t#o$ o8 or a)t,or#Ge! b+ a+ H)a$#@I)!#c#a( a9ec+ # t,e
e?erc#$e o8 #t$ H)a$#@I)!#c#a( 8)ct#o$. A"on# these a#encies are the Civil :ervice Co""ission$ Central %oard of
Assess"ent Appeals$ :ecurities and H9chan#e Co""ission$ 5ffice of the +resident$ ,and Re#istration Authorit)$
:ocial :ecurit) Co""ission$ Civil Aeronautics %oard$ %ureau of +atents$ Trade"ar4s and Technolo#) Transfer$
National Hlectrification Ad"inistration$ Hner#) Re#ulator) %oard$ National Teleco""unications Co""ission$
8epart"ent of A#rarian Refor" under Repu(lic Act No. !3$ Govern"ent :ervice &nsurance :)ste"$ H"plo)ees
Co"pensation Co""ission$ A#ricultural &nventions %oard$ &nsurance Co""ission$ +hilippine Ato"ic Hner#)
Co""ission$ %oard of &nvest"ents$ Construction &ndustr) Ar(itration Co""ission$ and voluntar) ar(itrators
authoriJed () law. DH"phasis suppliedE

&ndeed$ the +RC is not e9pressl) "entioned as one of the a#encies which are e9pressl) enu"erated under :ection
1$ Rule >3 of the Rules of Court. 7owever$ its a(sence fro" the enu"eration does not$ () this fact alone$ i"pl) its
e9clusion fro" the covera#e of said Rule.
[3!]
The Rule e9pressl) provides that it should (e applied to appeals fro"
awards$ .ud#"ents final orders or resolutions o8 a+ Cuasi-.udicial a#enc) in the e9ercise of its Cuasi-.udicial
functions. The phrase Aa"on# these a#enciesB confir"s that the enu"eration "ade in the Rule is not e9clusive to
the a#encies therein listed.
[3]


:pecificall)$ the Court$ in >a"g v. Court of Appeals.
[33]
ruled that 3atasPam-a"sa D%.+.E 3lg. 1;2
[31]
conferred
upon the CA e9clusive appellate .urisdiction over appeals fro" decisions of the +RC. The Court held*

The law has since (een chan#ed$ however$ at least in the "atter of the particular court to which appeals fro" the
Co""ission should (e ta4en. 5n Au#ust 1>$ 1211$ %atas+a"(ansa %ilan# 1;2 (eca"e effective and in its :ection
;2$ conferred on the Court of Appeals Ae9clusive appellate .urisdiction over all final .ud#"ents$ decisions$ resolutions$
orders or awards of Re#ional Trial Courts and Cuasi-.udicial a#encies$ instru"entalities$ (oards or co""issions
e9cept those fallin# under the appellate .urisdiction of the :upre"e Court. 9 9 9.B & C#rt)e o8 20 126, a**ea($ 8ro"
t,e 0ro8e$$#oa( Re9)(at#o$ /o""#$$#o are o7 e?c()$#Ce(+ co9#Gab(e b+ t,e /o)rt o8 A**ea($.
[36]
DH"phasis suppliedE

Clearl)$ the enact"ent of 3.P. 3lg. 1;2$ the precursor of the present Rules of Civil +rocedure$
[><]
lod#ed with the CA
such .urisdiction over the appeals of decisions "ade () the +RC.

Anent the su(stantive "erits of the case$ petitioner Cuestions the +RC decision for (ein# without an e9pert
testi"on) to support its conclusion and to esta(lish the cause of Hditha?s in.ur). +etitioner avers that in cases of
"edical "alpractice$ e9pert testi"on) is necessar) to support the conclusion as to the cause of the in.ur).
[>1]

6edical "alpractice is a particular for" of ne#li#ence which consists in the failure of a ph)sician or sur#eon
to appl) to his practice of "edicine that de#ree of care and s4ill which is ordinaril) e"plo)ed () the profession
#enerall)$ under si"ilar conditions$ and in li4e surroundin# circu"stances.
[>;]
&n order to successfull) pursue such a
clai"$ a patient "ust prove that the ph)sician or sur#eon either failed to do so"ethin# which a reasona(l) prudent
ph)sician or sur#eon would not have done$ and that the failure or action caused in.ur) to the patient.
[>3]

There are four ele"ents involved in "edical ne#li#ence cases* dut)$ (reach$ in.ur) and pro9i"ate causation.
[>>]

A ph)sician-patient relationship was created when Hditha e"plo)ed the services of the
petitioner. As Hditha?s ph)sician$ petitioner was dut)-(ound to use at least the sa"e level of care that an)
reasona(l) co"petent doctor would use to treat a condition under the sa"e circu"stances.
[>!]
The (reach of these
professional duties of s4ill and care$ or their i"proper perfor"ance () a ph)sician sur#eon$ where() the patient is
in.ured in (od) or in health$ constitutes actiona(le "alpractice.
[>]
As to this aspect of "edical "alpractice$ the
deter"ination of the reasona(le level of care and the (reach thereof$ e9pert testi"on) is essential.
[>3]
0urther$
inas"uch as the causes of the in.uries involved in "alpractice actions are deter"ina(le onl) in the li#ht of scientific
4nowled#e$ it has (een reco#niJed that e9pert testi"on) is usuall) necessar) to support the conclusion as to
causation.
[>1]

&n the present case$ respondents did not present an) e9pert testi"on) to support their clai" that petitioner
failed to do so"ethin# which a reasona(l) prudent ph)sician or sur#eon would have done.

+etitioner$ on the other hand$ presented the testi"on) of 8r. Au#usto 6. 6analo$ who was clearl) an e9pert on the
su(.ect.

Generall)$ to Cualif) as an e9pert witness$ one "ust have acCuired special 4nowled#e of the su(.ect "atter a(out
which he or she is to testif)$ either () the stud) of reco#niJed authorities on the su(.ect or () practical e9perience.
[>2]

8r. 6analo specialiJes in #)necolo#) and o(stetrics$ authored and co-authored various pu(lications on the su(.ect$
and is a professor at the Gniversit) of the +hilippines.
[!<]
Accordin# to hi"$ his dia#nosis of Hditha?s case was
AHctopic +re#nanc) &nterstitial Dalso referred to as CornualE$ Ruptured.B
[!1]
&n statin# that the 8XC procedure was not
the pro9i"ate cause of the rupture of Hditha?s uterus resultin# in her h)sterecto")$ 8r. 6analo testified as follows*

Att). 7idal#o*
K* 8octor$ we want to (e clarified on this "atter. The co"plainant had testified here that the 8XC was the
pro9i"ate cause of the rupture of the uterus. The condition which she found herself in on the second
ad"ission. =ill )ou please tell us whether that is true or notL
A* Iah$ & !o ot t,#B $o 8or t7o rea$o$. 5ne$ as & have said earlier$ the instru"ent cannot reach the site
of the pre#nanc)$ for it to further push the pre#nanc) outside the uterus. And$ No. ;$ & was thin4in# a while a#o
a(out another reason- well$ wh) & don?t thin4 so$ (ecause it is the tri##erin# factor for the rupture$ it could have]the
rupture could have occurred "uch earlier$ ri#ht after the 8XC or a few da)s after the 8XC.

K* &n this particular case$ doctor$ the rupture occurred to have happened "inutes prior to the h)sterecto") or
ri#ht upon ad"ission on :epte"(er 1!$ 122> which is a(out 1 [ "onths after the patient was dischar#ed$ after the
8XC was conducted. =ould )ou tell us whether there is an) relation at all of the 8XC and the rupture in this
particular instanceL
A* & !oFt t,#B $o 8or t,e t7o rea$o$ t,at & ,aCe I)$t "et#oe!@ t,at #t 7o)(! ot be *o$$#b(e 8or t,e
#$tr)"et to reac, t,e $#te o8 *re9ac+. And$ No. ;$ if it is (ecause of the 8XC that rupture could have occurred
earlier.
[!;]
DH"phases suppliedE

Clearl)$ fro" the testi"on) of the e9pert witness and the reasons #iven () hi"$ it is evident that the 8XC procedure
was not the pro9i"ate cause of the rupture ofHditha?s uterus.

8urin# his cross-e9a"ination$ 8r. 6analo testified on how he would have addressed Hditha?s condition should he (e
placed in a si"ilar circu"stance as the petitioner. 7e stated*

Att). Ra#onton*
K* 8octor$ as a practicin# 5%-G)ne$ when do )ou consider that )ou have done a #ood$ correct and ideal
dilatation and curetta#e procedureL
A* =ell$ if the patient recovers. &f the patient #ets well. %ecause even after the procedure$ even after the
procedure )ou "a) feel that )ou have scraped ever)thin#$ the patient stops (leedin#$ she feels well$ & thin4 )ou
should still have so"e reservations$ and wait a little "ore ti"e.

K* &f )ou were the 5%-G)ne who perfor"ed the procedure on patient Hditha Ra"olete$ would it (e )our
standard practice to chec4 the fetal parts or fetal tissues that were alle#edl) re"ovedL
A* 0ro" what & have re"oved$ )es. %ut in this particular case$ & thin4 it was assu"ed that it was part of the
"eat) "ass which was e9pelled at the ti"e she was urinatin# and flushed in the toilet. :o there?s no wa).

K* There was [sic] so"e portions of the fetal parts that were re"ovedL
A* No$ it was descri(ed as scant) scrapin# if & re"e"(er it ri#ht]scant).

K* And )ou would not "ind chec4in# those scant or those little parts that were re"ovedL
A* =ell$ t,e 8act t,at #t 7a$ !e$cr#be! "ea$, & a$$)"e t,at #t 7a$ c,ecBe!, Tno. &t was descri(ed as
scant) and the color also$ & thin4 was descri(ed. 2eca)$e #t 7o)(! be Cer+ ))$)a(, eCe #"*robab(e t,at #t
7o)(! ot be e?a"#e!, beca)$e 7,e +o) $cra*e, t,e $*ec#"e$ are r#9,t t,ere be8ore +o)r e+e$. &tF$ #
8rot o8 +o). Yo) ca to)c, #t. & 8act, $o"e o8 t,e" 7#(( $t#cB to t,e #$tr)"et a! t,ere8ore to *ee( #t o88
8ro" t,e #$tr)"et, +o) ,aCe to to)c, t,e". So, a)to"at#ca((+ t,e+ are e?a"#e! c(o$e(+.
K* As a "atter of fact$ doctor$ )ou also #ive telephone orders to )our patients throu#h telephoneL
A* Ies$ )es$ we do that$ especiall) here in 6anila (ecause )ou 4now$ so"eti"es a doctor can also (e tied-up
so"ewhere and if )ou have to wait until he arrive at a certain place (efore )ou #ive the order$ then it would (e a lot
of ti"e wasted. %ecause if )ou 4now )our patient$ if )ou have handled )our patient$ so"e of the s)"pto"s )ou can
interpret that co"es with practice. And$ & $ee o rea$o 8or ot a((o7#9 te(e*,oe or!er$ )(e$$ #t #$ t,e 8#r$t
t#"e t,at +o) 7#(( be eco)ter#9 t,e *at#et. That )ou have no idea what the pro(le" is.

K* %ut$ doctor$ do )ou dischar#e patients without seein# the"L
A* :o"eti"es )es$ dependin# on how fa"iliar & a" with the patient. =e are on the Cuestion of telephone
orders. & a" not sa)in# that that is the idle [sic] thin# to do$ (ut & t,#B t,e rea(#t+ o8 *re$et !a+ *ract#ce
$o"e,o7 I)$t#8#e$ te(e*,oe or!er$. & have patients who" & have .ustified and then all of a sudden$ late in the
afternoon or late in the evenin#$ would suddenl) call the) have decided that the) will #o ho"e inas"uch as the)
anticipated that & will dischar#e the" the followin# da). :o$ & .ust call and as4 our resident on dut) or the nurse to
allow the" to #o (ecause & have seen that patient and & thin4 & have full #rasp of her pro(le"s. :o$ that?s when &
"a4e this telephone orders. And$ of course (efore #ivin# that order & as4 a(out how she feels.
[!3]
DH"phases
suppliedE

0ro" the fore#oin# testi"on)$ it is clear that the 8XC procedure was conducted in accordance with the standard
practice$ with the sa"e level of care that an) reasona(l) co"petent doctor would use to treat a condition under the
sa"e circu"stances$ and that there was nothin# irre#ular in the wa) the petitioner dealt with Hditha.

6edical "alpractice$ in our .urisdiction$ is often (rou#ht as a civil action for da"a#es under Article ;13
[!>]
of the Civil
Code. The defenses in an action for da"a#es$ provided for under Article ;132 of the Civil Code are*

Art. ;132. 5,e t,e *(a#t#88F$ o7 e9(#9ece 7a$ t,e #""e!#ate a! *ro?#"ate ca)$e o8 ,#$ #I)r+, ,e
caot recoCer !a"a9e$. %ut if his ne#li#ence was onl) contri(utor)$ the i""ediate and pro9i"ate cause of the
in.ur) (ein# the defendant?s lac4 of due care$ the plaintiff "a) recover da"a#es$ (ut the courts shall "iti#ate the
da"a#es to (e awarded.

+ro9i"ate cause has (een defined as that which$ in natural and continuous seCuence$ un(ro4en () an) efficient
intervenin# cause$ produces in.ur)$ and without which the result would not have occurred.
[!!]
An in.ur) or da"a#e is
pro9i"atel) caused () an act or a failure to act$ whenever it appears fro" the evidence in the case that the act or
o"ission pla)ed a su(stantial part in (rin#in# a(out or actuall) causin# the in.ur) or da"a#eF and that the in.ur) or
da"a#e was either a direct result or a reasona(l) pro(a(le conseCuence of the act or o"ission.
[!]

&n the present case$ the Court notes the findin#s of the %oard of 6edicine*

=hen co"plainant was dischar#ed on -ul) 31$ 122>$ herein re$*o!et a!C#$e! ,er to ret)r
o A)9)$t 4, 1664 or 8o)r <4= !a+$ a8ter t,e DM/. ',#$ a!C#$e 7a$ c(ear # co"*(a#atF$ D#$c,ar9e
S,eet. 7owever$ co"*(a#at 8a#(e! to !o $o. This (ein# the case$ the chain of continuit) as reCuired in order that
the doctrine of pro9i"ate cause can (e validl) invo4ed was interrupted. Ha! $,e ret)re!, t,e re$*o!et co)(!
,aCe e?a"#e! ,er t,oro)9,(+.
[57]
9 9 9 DH"phases suppliedE

Also$ in the testi"on) of 8r. 6analo$ he stated further that assu"in# that there was in fact a "isdia#nosis$ the sa"e
would have (een rectified if Hditha followed the petitioner?s order to return for a chec4-up on Au#ust >$ 122>.
8r. 6analo stated*

Grat#9 t,at t,e ob$tetr#c#a@9+eco(o9#$t ,a$ bee "#$(e! <I)$t#8#ab(+= )* to t,)$ *o#t t,at
t,ere 7o)(! ,aCe bee a"*(e o**ort)#t+ to rect#8+ t,e "#$!#a9o$#$, ,a! t,e *at#et ret)re!, a$ #$tr)cte!
8or ,er 8o((o7@)* eCa()at#o. &t 7a$ oe a! a ,a(8 "ot,$ (ater t,at t,e *at#et $o)9,t co$)(tat#o 7#t,
aot,er !octor. The continued #rowth of an ectopic pre#nanc)$ until its eventual rupture$ is a d)na"ic
process. 6uch chan#e in ph)sical findin#s could (e e9pected in 1 [ "onths$ includin# the e"er#ence of su##estive
ones.
[!1]

&t is undisputed that Hditha did not return for a follow-up evaluation$ in defiance of the petitioner?s
advise. Hditha o"itted the dili#ence reCuired () the circu"stances which could have avoided the in.ur). The
o"ission in not returnin# for a follow-up evaluation pla)ed a su(stantial part in (rin#in# a(out Hditha?s own
in.ur). 7ad Hditha returned$ petitioner could have conducted the proper "edical tests and procedure necessar) to
deter"ine Hditha?s health condition and applied the correspondin# treat"ent which could have prevented the rupture
of Hditha?s uterus. The 8XC procedure havin# (een conducted in accordance with the standard "edical practice$ it
is clear that Hditha?so"ission was the pro9i"ate cause of her own in.ur) and not "erel) a contri(utor) ne#li#ence on
her part.

Contri(utor) ne#li#ence is the act or o"ission a"ountin# to want of ordinar) care on the part of the person in.ured$
which$ concurrin# with the defendant?s ne#li#ence$ is the pro9i"ate cause of the in.ur).
[!2]
8ifficult) see"s to (e
apprehended in decidin# which acts of the in.ured part) shall (e considered i""ediate causes of the accident.
[<]
=here the i""ediate cause of an accident resultin# in an in.ur) is the plaintiff?s own act$ which contri(uted to the
principal occurrence as one of its deter"inin# factors$ he cannot recover da"a#es for the in.ur).
[1]
A9a#, ba$e! o
t,e eC#!ece *re$ete! # t,e *re$et ca$e )!er reC#e7, # 7,#c, o e9(#9ece ca be attr#b)te! to t,e
*et#t#oer, t,e #""e!#ate ca)$e o8 t,e acc#!et re$)(t#9 # E!#t,aF$ #I)r+ 7a$ ,er o7 o"#$$#o 7,e $,e
!#! ot ret)r 8or a 8o((o7@)* c,ecB )*, # !e8#ace o8 *et#t#oerF$ or!er$. ',e #""e!#ate ca)$e
o8 E!#t,aF$ #I)r+ 7a$ ,er o7 actL t,)$, $,e caot recoCer !a"a9e$ 8ro" t,e #I)r+.

,astl)$ petitioner asserts that her ri#ht to due process was violated (ecause she was never infor"ed () either
respondents or () the +RC that an appeal was pendin# (efore the +RC.
[;]
+etitioner clai"s that a verification with
the records section of the +RC revealed that on April 1!$ 1222$ respondents filed a 6e"orandu" on Appeal (efore
the +RC$ which did not attach the actual re#istr) receipt (ut was "erel) indicated therein.
[3]
Respondents$ on the other hand avers that if the ori#inal re#istr) receipt was not attached to the
6e"orandu" on Appeal$ +RC would not have entertained the appeal or accepted such pleadin# for lac4 of notice or
proof of service on the other part).
[>]
Also$ the re#istr) receipt could not (e appended to the cop) furnished to
petitioner?s for"er counsel$ (ecause the re#istr) receipt was alread) appended to the ori#inal cop) of the
6e"orandu" of Appeal filed with +RC.
[!]

&t is a well-settled rule that when service of notice is an issue$ the rule is that the person alle#in# that the
notice was served "ust prove the fact of service. The (urden of provin# notice rests upon the part) assertin# its
e9istence.
[]
&n the present case$ respondents did not present an) proof that petitioner was served a cop) of the
6e"orandu" on Appeal. Thus$ respondents were not a(le to satisf) the (urden of provin# that the) had in fact
infor"ed the petitioner of the appeal proceedin#s (efore the +RC.

&n E7ICStaff-uilders I"ter"atio"al. I"#. v. :atio"al La-or Relatio"s Commissio".
[3]
in which the National ,a(or
Relations Co""ission failed to order the private respondent to furnish the petitioner a cop) of the Appeal
6e"orandu"$ the Court held that said failure deprived the petitioner of procedural due process #uaranteed () the
Constitution$ which could have served as (asis for the nullification of the proceedin#s in the appeal. The sa"e holds
true in the case at (ar. The Court finds that the failure of the respondents to furnish the petitioner a cop) of the
6e"orandu" of Appeal su("itted to the +RC constitutes a violation of due process. Thus$ the proceedin#s (efore
the +RC were null and void.

All told$ doctors are protected () a special rule of law. The) are not #uarantors of care. The) are not insurers a#ainst
"ishaps or unusual conseCuences
[1]
speciall) so if the patient herself did not e9ercise the proper dili#ence reCuired
to avoid the in.ur).

5HERE-ORE$ the petition is GRAN'ED. The assailed 8ecision of the Court of Appeals dated -ul) >$ ;<<3 in CA-
GR :+ No. ;;< is here() RE1ERSEDand SE' AS&DE. The 8ecision of the %oard of 6edicine dated 6arch >$
1222e9oneratin# petitioner is A--&R.ED. No pronounce"ent as to costs.

SO ORDERED.


'H&RD D&1&S&ON


RAD&O /O..:N&/A'&ONS O- 'HE 0H&L&00&NES,
&N/. <R/0&=,
+etitioner.


@ Cer$)$ @
G.R. No. 1>4346

0re$et4

KG&:G6%&NG 8.. Chairperso".
CAR+&5$
CAR+&5 65RA,H:$ and

AL-ONSO 1ER/HE3, GRA/E 1ER/HE3@&N-AN'E,
.ARDON&O &N-AN'E, 3ENA&DA 1ER/HE3@/A'&2OG, AND
-OR':NA'O /A'&2OG,
Respondents.
T&NGA$ 88.


0ro")(9ate!4

Ja)ar+ 31, 200>

9-----------------------------------------------------------------------------------------9


D E / & S & O N

/AR0&O .ORALES, J.4
5n -anuar) ;1$ 1221$ Hditha 7e(ron VercheJ DHdithaE was confined at the:orso#on +rovincial 7ospital due to an
ail"ent. 5n even date$ her dau#hter Grace VercheJ-&nfante DGraceE i""ediatel) hied to the :orso#on %ranch of the
Radio Co""unications of the +hilippines$ &nc. DRC+&E whose services she en#a#ed to send a tele#ra" to her
sister Penaida VercheJ-Cati(o# DPenaidaE who was residin# at 11 ,e#al :t.$ G:&:
Villa#e$ KueJon Cit)
[1]
readin#* A:end chec4 "one) 6o"") hospital.B 0or RC+&?s services$ Grace paid +1<.!<
[;]
for
which she was issued a receipt.
[3]
As three da)s after RC+& was en#a#ed to send the tele#ra" to Penaida no response was received fro" her$ Grace
sent a letter to Penaida$ this ti"e thru -R: 8eliver) :ervice$ repri"andin# her for not sendin# an) financial aid.
&""ediatel) after she received Grace?s letter$ Penaida$ alon# with her hus(and 0ortunato Cati(o#$ left on -anuar)
;$ 1221 for :orso#on. 5n her arrival at :orso#on$ she disclai"ed havin# received an) tele#ra".
&n the "eanti"e$ Penaida and her hus(and$ to#ether with her "other Hdithaleft for KueJon Cit) on -anuar) ;1$ 1221
and (rou#ht Hditha to the Veterans 6e"orial 7ospital in KueJon Cit) where she was confined fro" -anuar) 3<$
1221 to 6arch ;1$ 1221.
The tele#ra" was finall) delivered to Penaida ;! da)s later or on 0e(ruar) 1!$ 1221.
[>]
5n inCuir) fro" RC+& wh) it
too4 that lon# to deliver it$ a "essen#er of RC+& replied that he had nothin# to do with the deliver) thereof as it was
another "essen#er who previousl) was assi#ned to deliver the sa"e (ut the address could not (e located$ hence$
the tele#ra" was resent on 0e(ruar) ;$ 1221$ and the second "essen#er finall) found the address on 0e(ruar) 1!$
1221.
Hditha?s hus(and Alfonso VercheJ DVercheJE$ () letter of 6arch !$ 1221$
[!]
de"anded an e9planation fro" the
"ana#er of the :ervice Kualit) Control 8epart"ent of the RC+&$ 6rs. ,orna 8. 0a(ian$ who replied$ () letter of
6arch 13$ 1221$
[]
as follows*
5ur investi#ation on this "atter disclosed that su(.ect tele#ra" was dul) processed in accordance with our standard
operatin# procedure. 7owever$ deliver) was not i""ediatel) effected due to the occurrence of circu"stances which
were (e)ond the control and foresi#ht of RC+&. A"on# others$ durin# the trans"ission process$ the radio lin4
connectin# the points of co""unication involved encountered radio noise and interferences such that su(.ect
tele#ra" did not initiall) re#istered Dsi#E in the receivin#teleprinter "achine .
5ur internal "essa#e "onitorin# led to the discover) of the a(ove. Thus$ a repeat trans"ission was "ade and
su(seCuent deliver) was effected . DGnderscorin# suppliedE
VercheJ?s law)er thereupon wrote RC+&?s "ana#er 0a(ian$ () letter of -ul) ;3$ 1221$
[3]
reCuestin# for a conference
on a specified date and ti"e$ (ut no representative of RC+& showed up at said date and ti"e.
5n April 13$ 122;$ Hditha died.
5n :epte"(er 1$ 1223$ VercheJ$ alon# with his dau#hters Grace andPenaida and their respective spouses$ filed a
co"plaint a#ainst RC+& (efore the Re#ional Trial Court DRTCE of :orso#on for da"a#es. &n their co"plaint$ the
plaintiffs alle#ed that$ i"ter alia$ the dela) in deliverin# the tele#ra" contri(uted to the earl) de"ise of the
late Hditha to their da"a#e and pre.udice$
[1]
for which the) pra)ed for the award of "oral and e9e"plar)
da"a#es
[2]
and attorne)?s fees.
[1<]

After its "otion to dis"iss the co"plaint for i"proper venue
[11]
was denied
[1;]
() %ranch ! of the RTC of :orso#on$
RC+& filed its answer$ alle#in# that e9cept with respect to Grace$
[13]
the other plaintiffs had no privit) of contract with
itF an) dela) in the sendin# of the tele#ra" was due to for#emaEeure$ Aspecificall)$ (ut not li"ited to$ radio noise and
interferences which adversel) affected the trans"ission andMor reception of the tele#raphic "essa#eBF
[1>]
the clause
in the Tele#ra" Trans"ission 0or" si#ned () Grace a(solved it fro" lia(ilit) for an) da"a#e arisin# fro" the
trans"ission other than the refund of tele#ra" tollsF
[1!]
it o(served due dili#ence in the selection and supervision of its
e"plo)eesF and at all events$ an) cause of action had (een (arred () laches.
[1]
The trial court$ o(servin# that Aalthou#h the dela)ed deliver) of the Cuestioned tele#ra" was not apparentl) the
pro9i"ate cause of the death ofHditha$B ruled out the presence of for#e maEeure. Respectin# the clause in the
tele#ra" relied upon () RC+&$ the trial court held that it parta4es of the nature of a contract of adhesion.
0indin# that the nature of RC+&?s (usiness o(li#ated it to dispatch the tele#ra" to the addressee at the earliest
possi(le ti"e (ut that it did not in view of the ne#li#ence of its e"plo)ees to repair its radio trans"itter and the
conco"itant dela) in deliverin# the tele#ra" on ti"e$ the trial court$ upon the followin# provisions of the Civil Code$
to wit*
Article ;13 W =hoever () act or o"ission causes da"a#e to another$ there (ein# at fault or ne#li#ence$ is o(li#ed
to pa) for the da"a#e done. :uch fault or ne#li#ence if there is no pre-e9istin# contractual relation (etween
the parties$ is called Cuasi-delict and is #overned () the provisions of this Chapter.
Article 1133 defines the fault of Dsi#E ne#li#ence of the o(li#or as the Ao"ission of the dili#ence which is reCuired ()
the nature of the o(li#ation and corresponds with the circu"stances of the person$ of the ti"e$ or the place.B
&n the instant case$ the o(li#ation of the defendant to deliver the tele#ra" to the addressee is of an ur#ent nature. &ts
essence is the earl) deliver) of the tele#ra" to the concerned person. Iet$ due to the ne#li#ence of its e"plo)ees$
the defendant failed to dischar#e of its o(li#ation on ti"e "a4in# it lia(le for da"a#es under Article ;13.
The ne#li#ence on the part of the e"plo)ees #ives rise to the presu"ption of ne#li#ence on the part of the e"plo)er.
[13]
DGnderscorin# suppliedE$
rendered .ud#"ent a#ainst RC+&. Accordin#l)$ it disposed*
=7HRH05RH$ in the li#ht of the fore#oin# pre"ises$ .ud#"ent is here() rendered in favor of the plaintiffs and
a#ainst the defendant$ to wit*
5rderin# the defendant to pa) the plaintiffs the followin# a"ount*
1. The a"ount of 5ne 7undred Thousand D+1<<$<<<.<<E +esos as "oral da"a#esF
;. The a"ount of Twent) Thousand D+;<$<<<.<<E +esos as attorne)?s feesF and
3. To pa) the costs.
:5 5R8HRH8.
[11]
5n appeal$ the Court of Appeals$ () 8ecision of 0e(ruar) ;3$ ;<<>$
[12]
affir"ed the trial court?s decision.
7ence$ RC+&?s present petition for review on certiorari$ it raisin# the followin# Cuestions* D1E A&s the award of "oral
da"a#es proper even if the trial court found that there was no direct connection (etween the in.ur) and the alle#ed
ne#li#ent actsLB
[;<]
and D;E AAre the stipulations in the TTele#ra" Trans"ission 0or"$? in the nature Acontracts of
adhesionB Dsi#EL
[;1]
RC+& insists that respondents failed to prove an) causal connection (etween its dela) in trans"ittin# the tele#ra"
and Hditha?s death.
[;;]

RC+&?s stand fails. &t (ears notin# that its lia(ilit) is anchored on #ulpa #o"tra#tual or (reach of contract with re#ard
to Grace$ and on tort with re#ard to her co-plaintiffs-herein-co-respondents.
Article 113< of the Civil Code provides*
Those who in the perfor"ance of their o(li#ations are #uilt) of fraud$ ne#li#ence$ or dela)$ and those who in an)
"anner contravene the tenor thereof$ are lia(le for da"a#es. DGnderscorin# suppliedE
+assin# on this codal provision$ this Court e9plained*
&n #ulpa #o"tra#tual 9 9 9 the "ere proof of the e9istence of the contract and the failure of its co"pliance
.ustif)$ prima fa#ie $ a correspondin# ri#ht of relief . The law$ reco#niJin# the o(li#ator) force of contracts$ will not
per"it a part) to (e set free fro" lia(ilit) for an) 4ind of "isperfor"ance of the contractual underta4in# or a
contravention of the tenor thereof. A (reach upon the contract confers upon the in.ured part) a valid cause for
recoverin# that which "a) have (een lost or suffered. The re"ed) serves to preserve the interests of
the pro"issee that "a) include his Ae?*ectat#o #tere$t,D which is his interest in havin# the (enefit of his (ar#ain
() (ein# put in as #ood a position as he would have (een in had the contract (een perfor"ed$ or his Are(#ace
#tere$t,D which is his interest in (ein# rei"(ursed for loss caused () reliance on the contract () (ein# put in as
#ood a position as he would have (een in had the contract not (een "adeF or his Are$t#t)t#o #tere$t,Dwhich is his
interest in havin# restored to hi" an) (enefit that he has conferred on the other part). &ndeed$ a#ree"ents can
acco"plish little$ either for their "a4ers or for societ)$ unless the) are "ade the (asis for action. The effect of ever)
infraction is to create a new dut)$ that is$ to "a4e reco"pense to the one who has (een in.ured () the failure of
another to o(serve his contractual o(li#ation unless he can show e9tenuatin# circu"stances$ li4e *roo8 o8 ,#$
e?erc#$e o8 !)e !#(#9ece 9 9 9 or of the atte!ace o8 8ort)#to)$ eCet, to e9cuse hi" fro" his ensuin# lia(ilit).
[;3]
DH"phasis and underscorin# suppliedE
&n the case at (ar$ RC+& (ound itself to deliver the tele#ra" within the shortest possi(le ti"e. &t too4 ;! da)s$
however$ for RC+& to deliver it.
RC+& invo4es for#e maEeure$ specificall)$ the alle#ed radio noise and interferences which adversel) affected the
trans"ission andMor reception of the tele#raphic "essa#e. Additionall)$ its "essen#er clai"ed he could not locate
the address of Penaida and it was onl) on the third atte"pt that he was a(le to deliver the tele#ra".
0or the defense of for#e maEeure to prosper$
9 9 9 it is necessar) that one has co""itted o ne#li#ence or "isconduct that "a) have occasioned the loss . An
act of God cannot (e invo4ed to protect a person who has failed to ta4e steps to forestall the possi(le adverse
conseCuences of such a loss. 5ne?s ne#li#ence "a) have concurred with an act of God in producin# da"a#e and
in.ur) to anotherF nonetheless$ showin# that the i""ediate or pro9i"ate cause of the da"a#e or in.ur) was a
fortuitous event would not e9e"pt one fro" lia(ilit). 5,e t,e e88ect #$ 8o)! to be *art(+ t,e re$)(t o8 a
*er$oF$ *art#c#*at#o P 7,et,er b+ act#Ce #terCet#o, e9(ect or 8a#()re to act P t,e 7,o(e occ)rrece #$
,)"a#Ge! a! re"oCe! 8ro" t,e r)(e$ a**(#cab(e to act$ o8 Go!.
9 9 9 9


Article 113> of the Civil Code states that no person shall (e responsi(le for a fortuitous event that could not (e
foreseen or$ thou#h foreseen$ was inevita(le. & ot,er 7or!$, t,ere ")$t be a e?c()$#o o8 ,)"a #terCet#o
8ro" t,e ca)$e o8 #I)r+ or (o$$.
[;>]
DH"phasis and underscorin# suppliedE
Assu"in# argue"do that fortuitous circu"stances prevented RC+& fro" deliverin# the tele#ra" at the soonest
possi(le ti"e$ it should have at least infor"ed Grace of the non-trans"ission and the non-deliver) so that she could
have ta4en steps to re"ed) the situation. %ut it did not. There lies the fault or ne#li#ence.
&n an earlier case also involvin# RC+&$ this Court held*
Considerin# the pu(lic utilit) of RC+&?s (usiness and its contractual o(li#ation to trans"it "essa#es$ it should
e9ercise due dili#ence to ascertain that "essa#es are delivered to the persons at the #iven address and
should provide a s)ste" where() in cases of undelivered "essa#es the sender is #iven notice of non-
deliver). 6essa#es sent () cab(e or 7#re(e$$ "ea$ are usuall) "ore #"*ortat and )r9et than those which can
wait for the "ail.
[;!]

9 9 9 9
+eople !e*e! o te(eco"")#cat#o$ co"*a#e$ # t#"e$ o8 !ee* e"ot#oa( $tre$$ or *re$$#9 8#ac#a(
ee!$. /nowin# that "essa#es a(out the illnesses or deaths of loved ones$ (irths or "arria#es in a fa"il)$
i"portant (usiness transactions$ and notices of conferences or "eetin#s as in this case$ are coursed throu#h the
petitioner and si"ilar corporations$ it is incu"(ent upon the" to e9ercise a #reater a"ount of care and concern than
that shown in this case. Hver) reasona(le effort to infor" senders of the non-deliver) of "essa#es should (e
underta4en.
[;]

DH"phasis and underscorin# suppliedE
RC+& ar#ues$ however$ a#ainst the presence of ur#enc) in the deliver) of the tele#ra"$ as well as the (asis for the
award of "oral da"a#es$ thus*
[;3]
The reCuest to send c,ecB as written in the tele#raphic te9t ne#ates the e9istence of ur#enc) that private
respondents? alle#ations that Tti"e was of the essence? i"ports. A chec4 drawn a#ainst a 6anila %an4 and
trans"itted to :orso#on$ :orso#on will have to (e deposited in a (an4 in :orso#on and pass thru a "ini"u"
clearin# period of ! da)s (efore it "a) (e encashed or withdrawn. &f the trans"ittal of the reCuested chec4
to :orso#on too4 1 da) W private respondents could therefore still wait for da)s (efore the sa"e "a) (e
withdrawn. ReCuestin# a chec4 that would ta4e da)s (efore it could (e withdrawn therefore contradicts plaintiff?s
clai" of ur#enc) or need.
[;1]

At an) rate$ an) sense of ur#enc) of the situation was "et when Grace VercheJ was a(le to co""unicate to 6anila
via a letter that she sent to the sa"e addressee in 6anila thru -R:.
[;2]
9 9 9 9
As far as the respondent court?s award for "oral da"a#es is concerned$ the sa"e has no (asis whatsoever since
private respondent Alfonso VercheJ did not acco"pan) his late wife when the latter went to 6anila () (us . 7e
sta)ed (ehind in:orso#on for al"ost 1 wee4 (efore he proceeded to 6anila.
[3<]
=hen pressed on cross-e9a"ination$ private respondent Alfonso VercheJ could not #ive an) plausi(le reason as to
the reason wh) he did not acco"pan) his ailin# wife to 6anila.
[31]
9 9 9 9
&t is also i"portant to consider in resolvin# private respondents? clai" for "oral da"a#es that private respondent
Grace VercheJ did not acco"pan) her ailin# "other to 6anila .
[3;]


9 9 9 9
&t is the co""on reaction of a hus(and to (e at his ailin# wife?s side as "uch as possi(le. The fact that private
respondent Alfonso VercheJ sta)ed (ehind in:orso#on for al"ost 1 wee4 convincin#l) de"onstrates that he hi"self
4new that his wife was not in critical condition.
[33]

DH"phasis and underscorin# suppliedE
RC+&?s ar#u"ents fail. 0or it is its (reach of contract upon which its lia(ilit) is$ it (ears repeatin#$ anchored. :ince
RC+& (reached its contract$ the presu"ption is that it was at fault or ne#li#ent. &t$ however$ failed to re(ut this
presu"ption.
0or (reach of contract then$ RC+& is lia(le to Grace for da"a#es.
And for quasiCdeli#t. RC+& is lia(le to Grace?s co-respondents followin# Article ;13 of the Civil Code which provides*
=hoever () act or o"ission causes da"a#e to another$ there (ein# fault or ne#li#ence$ is o(li#ed to pa) for the
da"a#e done. :uch fault or ne#li#ence$ if there is no pre-e9istin# contractual relation (etween the parties$ is called
a Cuasi-delict and is #overned () the provisions of this Chapter. DGnderscorin# suppliedE
RC+&?s lia(ilit) as an e"plo)er could of course (e avoided if it could prove that it o(served the dili#ence of a #ood
father of a fa"il) to prevent da"a#e. Article ;11< of the Civil Code so provides*
The o(li#ation i"posed () Article ;13 is de"anda(le not onl) for one?s own acts or o"issions$ (ut also for those of
persons for who" one is responsi(le.
9 9 9 9
The owners and "ana#ers of an esta(lish"ent or enterprise are li4ewise responsi(le for da"a#es caused () their
e"plo)ees in the service of the (ranches in which the latter are e"plo)ed or on the occasion of their functions.
H"plo)ers shall (e lia(le for the da"a#es caused () their e"plo)ees and household helpers actin# within the scope
of their assi#ned tas4s$ even thou#h the for"er are not en#a#ed in an) (usiness or industr).
9 9 9 9
The responsi(ilit) treated of in this article shall cease when the persons herein "entioned prove that the) o(served
all the dili#ence of a #ood father of a fa"il) to prevent da"a#e. DGnderscorin# suppliedE
RC+& failed$ however$ to prove that it o(served all the dili#ence of a #ood father of a fa"il) to prevent da"a#e.
Respectin# the assailed award of "oral da"a#es$ a deter"ination of the presence of the followin# reCuisites to
.ustif) the award is in order*
9 9 9 firstl,$ evidence of (es"irched reputation or ph)sical$ "ental or ps)cholo#ical sufferin# sustained () the
clai"antF se#o"dl,$ a culpa(le act or o"ission factuall) esta(lishedF thirdl,$ proof that the wron#ful act or o"ission of
the defendant is the pro9i"ate cause of da"a#es sustained () the clai"antF and fourthl,$ that the case is predicated
on an) of the instances e9pressed or envisioned () Article ;;12 and Article ;;;< of the Civil Code.
[3>]
Respectin# the first reCuisite$ evidence of sufferin# () the plaintiffs-hereinrespondents was correctl) appreciated ()
the CA in this wise*
The failure of RC+& to deliver the tele#ra" containin# the "essa#e of appellees onti"e$ distur(ed their
filial tranCuillit). 0a"il) "e"(ers (la"ed each other for failin# to respond swiftl) to an e"er#enc) that involved the
life of the late 6rs. VercheJ$ who suffered fro" dia(etes.
[3!]
As reflected in the fore#oin# discussions$ the second and third reCuisites are present.
5n the fourth reCuisite$ Article ;;;< of the Civil Code provides*
=illful in.ur) to propert) "a) (e a le#al #round for awardin# "oral da"a#es if the court should find that$ under the
circu"stances$ such da"a#es are .ustl) due. ',e $a"e r)(e a**(#e$ to breac,e$ o8 cotract 7,ere t,e
!e8e!at acte! 8ra)!)(et(+ or # ba! 8a#t,. DH"phasis and underscorin# suppliedE
After RC+&?s first atte"pt to deliver the tele#ra" failed$ it did not infor" Grace of the non-deliver) thereof and waited
for 1; da)s (efore tr)in# to deliver it a#ain$ 4nowin# W as it should 4now W that ti"e is of the essence in the deliver)
of tele#ra"s. =hen its second lon#-dela)ed atte"pt to deliver the tele#ra" a#ain failed$ it$ a#ain$ waited for another
1; da)s (efore "a4in# a third atte"pt. :uch nonchalance in perfor"in# its ur#ent o(li#ation indicates #ross
ne#li#ence a"ountin# to (ad faith. The fourth reCuisite is thus also present.
&n appl)in# the a(ove-Cuoted Article ;;;<$ this Court has awarded "oral da"a#es in cases of (reach of contract
where the defendant was #uilt) of #ross ne#li#ence a"ountin# to (ad faith$ or in wanton disre#ard of his contractual
o(li#ation.
[3]

As for RC+&?s tort-(ased lia(ilit)$ Article ;;12 of the Civil Code provides*
6oral da"a#es "a) (e recovered in the followin# and aa(o9o)$ ca$e$*
9 9 9 9
D1<E Acts and actions referred to in Articles ;1$ 2>$ ;3$ ;1$ ;2$ 3<$ 3;$ 3>$ and 3!. DH"phasis suppliedE
Article ; of the Civil Code$ in turn$ provides*Hver) person shall respect the di#nit)$ personalit)$ privac) and *eace
o8 "#! of his nei#h(ors and other persons. The followin# and si"ilar acts$ thou#h the) "a) not constitute a
cri"inal offense$ shall produce a cause of action for da"a#es$ prevention$ and other relief*
9 9 9 9
D;E 6eddlin# with or !#$t)rb#9 the private life or 8a"#(+ re(at#o$ of another. DH"phasis suppliedE
RC+&?s ne#li#ence in not pro"ptl) perfor"in# its o(li#ation undou(tedl) distur(ed the peace of "ind not onl) of
Grace (ut also her co-respondents. As o(served () the appellate court$ it disrupted the Afilial tranCuillit)B a"on#
the" as the) (la"ed each other Afor failin# to respond swiftl) to an e"er#enc).B The tortious acts andMor o"issions
co"plained of in this case are$ therefore$ analo#ous to acts "entioned under Article ; of the Civil Code$ which are
a"on# the instances of Cuasi-delict when courts "a) award "oral da"a#es under Article ;;12 of the Civil Code.
&n fine$ the award to the plaintiffs-herein respondents of "oral da"a#es is in order$ as is the award of attorne)?s
fees$ respondents havin# (een co"pelled to liti#ate to protect their ri#hts.
Clutchin# at straws$ RC+& insists that the li"ited lia(ilit) clause in the ATele#ra" Trans"ission 0or"B is not a contract
of adhesion. Thus it ar#ues*
Neither can the Tele#ra" Trans"ission 0or" (e considered a contract of adhesion as held () the respondent
court. The said stipulations were all written in (old letters ri#ht in front of the Tele#ra" Trans"ission 0or". As a
"atter of fact the) were (eside the space where the tele#ra" senders write their tele#raphic "essa#es. &t would
have (een different if the stipulations were written at the (ac4 for surel) there is no wa) the sender will easil) notice
the". The fact that the stipulations were located in a particular space where the) can easil) (e seen$ is sufficient
notice to an) sender Dli4e Grace VercheJ-&nfanteE where she could "anifest her disapproval$ leave the RC+& station
and avail of the services of the other tele#ra" operators.
[33]
DGnderscorin# suppliedE
RC+& "isunderstands the nature of a contract of adhesion. Neither the reada(ilit) of the stipulations nor their
ph)sical location in the contract deter"ines whether it is one of adhesion.
A contract of adhesion is defined as one in which one of the parties i"poses a read)-"ade for" of contract$ which
the other part) "a) accept or re.ect$ (ut which the latter cannot "odif). 5ne part) prepares the stipulation in the
contract$ while the other part) "erel) affi9es his si#nature or his AadhesionB thereto$ 9#C#9 o roo" 8or e9ot#at#o
a! !e*r#C#9 t,e (atter o8 t,e o**ort)#t+ to bar9a# o eH)a( 8oot#9.
[31]
DH"phasis and underscorin#
suppliedE
=hile a contract of adhesion is not necessaril) void and unenforcea(le$ since it is construed strictl) a#ainst the part)
who drafted it or #ave rise to an) a"(i#uit) therein$ it is stric4en down as void and unenforcea(le or su(versive of
pu(lic polic) when the wea4er part) is i"posed upon in dealin# with the do"inant (ar#ainin# part) and is reduced to
the alternative of ta4in# it or leavin# it$ co"pletel) deprived of the opportunit) to (ar#ain on eCual footin#.
[32]

This Court holds that the Court of Appeals? findin# that the parties? contract is one of adhesion which is void is$ #iven
the facts and circu"stances of the case$ thus well-ta4en.
5HERE-ORE$ the petition is DEN&ED$ and the challen#ed decision of the Court of Appeals is A--&R.ED.
Costs a#ainst petitioner.
SO ORDERED.