Batiquin v.

Court of Appeals
FACTS: On Sept 1988, Petitioner Dr. Batiquin performed a simple caesarean section
on Respondent Mrs. Villegas when the latter gave birth. Soon after leaving the
hospital, respondent began to suffer abdominal pains and complained of being
feverish.
The abdominal pains and fever kept on recurring and this prompted respondent to
consult with another doctor, Dr. Kho (not Hayden). When Dr. Kho opened the
abdomen of respondent to check her out respondents infection, she discovered that
a piece of rubber material, which looked like a piece of rubber glove and was
deemed a foreign body, was the cause of the respondents infection.
Respondent then sued petitioner for damages. RTC held in favor of petitioner. CA
reversed, ruling for the respondent.
ISSUE: W/N Batiqtuin may be held liable under the doctrine of Res ipsa loquitur.
RULING: Res ipsa loquitur. The thing speaks for itself. Rebuttable presumption or
inference that defendant was negligent, which arises upon proof that the
instrumentality causing injury was in defendant's exclusive control, and that the
accident was one which ordinary does not happen in absence of negligence. Res
ipsa loquitur is a rule of evidence whereby negligence of the alleged wrongdoer may
be inferred from the mere fact that the accident happened provided the character of
the accident and circumstances attending it lead reasonably to belief that in the
absence of negligence it would not have occurred and that thing which caused
injury is shown to have been under the management and control of the alleged
wrongdoer. Under this doctrine the happening of an injury permits an inference of
negligence where plaintiff produces substantial evidence that the injury was caused
by an agency or instrumentality under the exclusive control and management of
defendant, and that the occurrence was such that in the ordinary course of things
would not happen if reasonable care had been used.
The doctrine of res ipsa loquitur as a rule of evidence is peculiar to the law of
negligence which recognizes that prima facie negligence may be established without
direct proof and furnishes a substitute for specific proof of negligence. The doctrine
is not a rule of substantive law, but merely a mode of proof or a mere procedural
convenience.
The rule, when applicable to the facts and circumstances of a particular case, is not
intended to and does not dispense with the requirement of proof of culpable
negligence on the party charged. It merely determines and regulates what shall be
prima facie evidence thereof and facilitates the burden of plaintiff of proving a
breach of the duty of due care.
The doctrine can be invoked when and only when, under the circumstances
involved, direct evidence is absent and not readily available.

In the instant case, all the requisites for recourse to the doctrine are present. First,
the entire proceedings of the caesarean section were under the exclusive control of
Dr. Batiquin. In this light, the private respondents were bereft of direct evidence as
to the actual culprit or the exact cause of the foreign object finding its way into
private respondent Villegas's body, which, needless to say, does not occur unless
through the intersection of negligence.
Second, since aside from the caesarean section, private respondent Villegas
underwent no other operation which could have caused the offending piece of
rubber to appear in her uterus, it stands to reason that such could only have been a
by-product of the caesarean section performed by Dr. Batiquin.
The petitioners, in this regard, failed to overcome the presumption of negligence
arising from resort to the doctrine of res ipsa loquitur. Dr. Batiquin is therefore liable
for negligently leaving behind a piece of rubber in private respondent Villegas's
abdomen and for all the adverse effects thereof.
* Medical practitioners play a vital role in the lives of the people, and the State has
compelling interest to enact measures to protect the public from "the potentially
deadly effects of incompetence and ignorance in those who would undertake to
treat our bodies and minds for disease or trauma." Indeed, a physician is bound to
serve the interest of his patients "with the greatest of solicitude, giving them
always his best talent and skill." Through her tortious conduct, the petitioner
endangered the life of Flotilde Villegas, in violation of her profession's rigid ethical
code and in contravention of the legal standards set forth for professionals, in
general, and members of the medical profession, in particular.

GARCIA-RUEDA VS PASCASIO
FACTS: Florencio V. Rueda, husband
of petitioner Leonila Garcia-Rueda,
underwent surgical operation at the
UST hospital for the removal of a
stone blocking his ureter. He was
attended by Dr. Domingo Antonio, Jr.
who was the surgeon, while Dr. Erlinda
Balatbat-Reyes
was
the
anaesthesiologist. Six hours after the
surgery, however, Florencio died of
complications of unknown cause,
according to officials of the UST
Hospital. Florencios wife sought the
assistance of NBI for autopsy. NBI
ruled that Florencios death was due to
lack of care by the attending physician
in administering anaesthesia. Pursuant
to its findings, the NBI recommended
that Dr. Domingo Antonio and Dr.
Erlinda Balatbat-Reyes be charged for
Homicide
through
Reckless
Imprudence before the Office of the
City Prosecutor. During the preliminary
investigation, what transpired was a
confounding series of events. a series
of
nine
prosecutors
toss
the
responsibility
of
conducting
a
preliminary investigation to each other
with contradictory recommendations,
ping-pong
style,
perhaps
the
distraught widow is not to be blamed
if she finally decides to accuse the City
Prosecutors at the end of the line for
partiality under the Anti-Graft and
Corrupt Practices Act.
ISSUE: WON the City Prosecutors
should be held liable under Anti-Graft
and Corrupt Practices Act?
SC says the matter on medical
malpractice is best resolved in a fullblown trial than at a preliminary
investigation. In the instant case, no
less than the NBI pronounced after
conducting an autopsy that there was

indeed negligence on the part of the

attending physicians in administering
the anaesthesia.
The fact of want of competence or
diligence is evidentiary in nature, the
veracity of which can best be passed
upon after a full-blown trial for it is
virtually impossible to ascertain the
merits of a medical negligence case
without
extensive
investigation,
research, evaluation and consultations
with medical experts. Clearly, the City
Prosecutors are not in a competent
position to pass judgment on such a
technical matter, especially when
there are conflicting evidence and
findings. The bases of a partys
accusation and defenses are better
ventilated at the trial proper than at
the preliminary investigation.
Medical Malpractice A word on medical
malpractice or negligence cases.In its
simplest terms, the type of lawsuit
which has been called medical
malpractice or, more appropriately,
medical negligence, is that type of
claim which a victim has available to
him or her to redress a wrong
committed by a medical professional
which has caused bodily harm.
In order to successfully pursue such a
claim, a patient must prove that a
health care provider, in most cases a
physician,
either
failed
to
do
something which a reasonably prudent
health care provider would have done,
or that he or she did something that a
reasonably prudent provider would not
have done; and that that failure or
action caused injury to the patient.

Hence, there are four elements

involved in medical negligence
cases:
1. duty; 2. Breach; 3. Injury; 4.
proximate causation
Evidently, when the victim employed
the services of Dr. Antonio and Dr.
Reyes, a physician-patient relationship
was created. In accepting the case,
Dr. Antonio and Dr. Reyes in effect
represented that, having the needed
training and skill possessed by
physicians and surgeons practicing in
the same field, they will employ such
training, care and skill in the
treatment of their patients. They have
a duty to useat least the same level of
care that any other reasonably
competent doctor would use to treat a
condition
under
the
same
circumstances. The breach of these
professional duties of skill and care, or
their improper performance, by a
physician surgeon whereby the patient
is injured in body or in health,
constitutes actionable malpractice.
Consequently, in the event that any
injury results to the patient from want
of due care or skill during the
operation, the surgeons may be held
answerable
in
damages
for
negligence. Moreover, in malpractice
or negligence cases involving the
administration of anaesthesia, the
necessity of expert testimony and the
availability of the charge of res ipsa
loquitur to the plaintiff, have been
applied
in
actions
against
anaesthesiologists
to
hold
the
defendant liable for the death or injury
of a patient under excessive or
improper anaesthesia.
Essentially, it requires two-pronged
evidence:
evidence
as
to
the
recognized standards of the medical

community in the particular kind of

case, and a showing that the physician
in question negligently departed from
this standard in his treatment.
Another element in medical negligence
cases is causation which is divided
into two inquiries: whether the
doctors actions in fact caused the
harm to the patient and whether
these were the proximate cause of the
patients injury.
Indeed
here,
a
causal
connection is discernible from the
occurrence of the victims death after
the
negligent
act
of
the
anaesthesiologist in administering the
anesthesia, a fact which, if confirmed,
should warrant the filing of the
appropriate criminal case. To be sure,
the allegation of negligence is not
entirely baseless. Moreover, the NBI
deduced that the attending surgeons
did not conduct the necessary
interview of the patient prior to the
operation. It appears that the cause of
the death of the victim could have
been averted had the proper drug
been applied to cope with the
symptoms of malignant hyperthermia.
Also, we cannot ignore the fact
that an antidote was readily available
to counteract whatever deleterious
effect the anaesthesia might produce.
Why these precautionary measures
were disregarded must be sufficiently
explained.
In the end, SC said in this case
that the wife of Florencio did not avail
of the proper remedy (i.e. filing a
complaint
under
Anti-graft
and
Corruption Act). The better and more
logical
remedy
under
the
circumstances would have been to
appeal the resolution of the City
Prosecutors dismissing the criminal
complaint to the Secretary of Justice

Dr. Rubi Li vs. Spouses Reynaldo and

Lina Soliman, as parents/heirs of
deceased Angelica Soliman
Legal
Issue:
How
malpractice proven?

is

medical

Legal Facts:
Respondents 11-year old daughter,
Angelica Soliman, underwent a biopsy
of the mass located in her lower
extremity at the St. Lukes Medical
Center (SLMC) on July 7, 1993 and
results showed that Angelica was
suffering
from
osteosarcoma,
osteoblastic type, (highly malignant)
cancer of the bone because of that a
necessity
of
amputation
was
conducted by Dr, Tamayo on Angelicas
right leg in order to remove the tumor
and to prevent the metastasis that
chemotherapy was suggested by Dr.
Tamayo,
which
he
referred
to
petitioner Dr. Rubi Li, a medical
oncologist.
The
respondent
was
admitted to SLMC on August 18,
1993; however, she died eleven (11)
days
after
the
(intravenous)
administration of chemotherapy first
cycle. Respondents brought their
daughters body to the Philippine
National Police (PNP) Crime Laboratory
at Camp Crame for post-mortem
examination after the refusal of the
hospital
to
release
the
death
certificate without full payment of
bills.
The Medico-Legal Report showed that
the cause of death as "Hypovolemic
shock secondary to multiple organ
hemorrhages
and
Disseminated
Intravascular Coagulation.
The respondents filed charges against
the SLMC and physicians involve for
negligence and failure to observe the

essential precautions in to prevent

Angelicas untimely death.
Petitioner denied the allegation for
damages as she observed best known
procedures,
highest
skill
and
knowledge in the administration of
chemotherapy drugs despite all efforts
the patient died.
The trial court was in favor of the
petitioner and ordered to pay their
unpaid hospital bill in the amount
of P139, 064.43, but the Court of
Appeals
reversed
the
decision
supporting the respondents pray.
Holding:
In
this
case
medical
malpractice is proven because the four
essential elements of such action are
present based upon the doctrine of
informed consent.
Reasoning:
There are four essential elements
a plaintiff must prove in a
malpractice action based upon the
doctrine of informed consent: "(1)
the physician had a duty to disclose
material risks; (2) he failed to
disclose or inadequately disclosed
those risks; (3) as a direct and
proximate result of the failure to
disclose, the patient consented to
treatment she otherwise would not
have consented to; and (4) plaintiff
was
injured
by
the
proposed
treatment."
Informed consent case requires the
plaintiff to "point to significant
undisclosed information relating to the
treatment that would alter her
decision to undergo. The physician is
not expected to give the patient a
short
medical
education,
the

disclosure rule only requires of him a

reasonable general explanation in
nontechnical terms.
Policy Formation:
In all sorts of medical procedures
either invasive or not, medical
institution must have a certificate of
competency in rendering standards of
care to delicate medical procedures
before initiating a general protocol
that would establish a guideline
principle in a form of proper disclosure
of such procedure and presenting a
consent or waiver to their patients so
that possible future medico-legal suits
will
be
prevented.
Synthesis:
In Dr. Rubi Li, vs. Spouses Reynaldo
and Lina Soliman, as parents/heirs of
deceased
Angelica
Soliman, Respondents,
G.R.
No.
165279, promulgated on June 7,
2011, the Court ruled that medical
malpractice
is
proved
base
on
lack/impaired informed consent, and
reasonable expert testimony subject a
breach of duty causing gross injury to
its patient.

PEDRITO DELA TORRE vs.DR.

ARTURO IMBUIDO, DRA. NORMA
IMBUIDO

failed to exercise the degree of

diligence required of them by their
profession as doctors.

FACTS:
Carmen
underwent
a
caesarian operation in the hospital
owned by the respondents. The next
day, Carmen experienced abdominal
pain and difficulty in urinating. She
was diagnosed to be suffering from
urinary tract infection (UTI), and was
prescribed medications by Dr. Norma.
A second operation was performed on
Carmen but her condition did not
improve and she died on February 14,
1992.

ISSUE: W/N the respondents may be

held liable

In an autopsy report prepared by Dr.

Patilano, provided that the Case of
Carmens death was shock due to
pretonitis and concluded that This
peritonitis in the abdominal cavity may
be caused by several conditions which
are supposed to be infections,
entrance of foreign bodies in the
intestines in connection with ruptured
peptic ulcer or [may be] somewhere in
the spleen. In cases of surgical
operation, it [may be] due to the
conditions of the instruments used,
the materials used in the operating
room being not aseptic and the ladies
assisting the operation were not in
uniform, and added further
that
peritonitis could have been prevented
through proper medical procedures
and medicines.
RTC ruled in favor of plaintiff; CA
reversed and set aside the decision of
the trial court and ruled that it was
not established that the respondents

RULING: Medical malpractice or,

more
appropriately,
medical
negligence, is that type of claim which
a victim has available to him or her to
redress a wrong committed by a
medical professional which has caused
bodily harm."
In order to successfully pursue such a
claim, a patient, or his or her family
as in this case, " must prove that a
health care provider, in most cases a
physician,
either
failed
to
do
something which a reasonably prudent
health care provider would have done,
or that he or she did something that a
reasonably prudent provider would not
have done; and that failure or action
caused injury to the patient."
As there is a physician-patient
relationship between the doctor and
the victim, four essential elements
must be established by the plaintiff,
namely: (1) duty; (2) breach; (3)
injury; and (4) proximate causation.
All four elements must be present in
order to find the physician negligent
and, thus, liable for damages.
There is breach of this duty when the
patient is injured in body or in health.
Proof of this breach rests upon the
testimony of an expert witness that
the treatment accorded to the patient
failed to meet the standard level of

care, skill and diligence. To justify an

award of damages, the negligence of
the doctor must be established to be
the proximate cause of the injury.
Upon review, however, the Court
agrees with the CA that the report and
testimony of Dr. Patilano failed to
justify Pedritos entitlement to the
damages awarded by the RTC.
However, it was not duly established
that Dr. Patilano practiced and was an
expert inthe fields that involved
Carmens condition, he could not have
accurately identified the said degree of
care, skill, diligence and the medical
procedures that should have been
applied by her attending physicians.
Similarly, such duty, degree of care,
skill and diligence were not sufficiently
established in this case because the
testimony of Dr. Patilano was based
solely on the results of his autopsy on
the cadaver of Carmen. His study and
assessment
were
restricted
by
limitations
that
denied
his
full
evaluation
of
Carmens
case.
Furthermore, For lack of sufficient
information
on
Carmens
health
condition while still alive, Dr. Patilano
could not have fully evaluated the
suitability
of
the
respondents
decisions
in
handling
Carmens
medical condition as it turned critical.
Moreover, while Dr. Patilano opined
that Carmen died of peritonitis which
could be due to the poor state of the
hospital
equipment
and
medical
supplies used during her operation,
there was no sufficient proof that any

such fault actually attended the

surgery of Carmen, caused her illness
and resulted in her death. Dr. Patilano,
did not comply with the basic autopsy
procedure when he examined the
cadaver of Carmen, as he did not
appear to have thoroughly examined
Carmens vital organs during the
autopsy. His findings were then
inconclusive on the issue of the actual
cause of Carmen's death, and the
claim
of
negligence
allegedly
committed by the respondents.
As the Court held in Spouses Flores v.
Spouses Pineda, et al., the critical
and clinching factor in a medical
negligence case is proof of the
causal connection between the
negligence and the injuries. The
claimant must prove not only the
injury but also the defendant's fault,
and that such fault caused the injury.
A verdict in a malpractice action
cannot be based on speculation or
conjecture. Causation must be proven
within
a
reasonable
medical
probability based upon competent
expert testimony, which the Court
finds absent in the case at bar.

DR. IDOL L. BONDOC, v. MARILOU

R. MANTALA
FACTS: Mantala was admitted at the
Oriental Mindoro Provincial Hospital
(OMPH) with referral5 from the Bansud
Municipal Health Office (BMHO). She
was due to deliver her fifth child and
was advised by the BMHO for a
cesarean section because her baby
was big and there was excessive
amniotic fluid in her womb. She
started to labor at 7:00 in the morning
and was initially brought to the
Bongabon Health Center. However,
said health center also told her to
proceed directly to the hospital.
Respondent alleged that inside the
delivery room of OMPH, she was
attended
to
by
petitioner
who
instructed the midwife and two
younger assistants to press down on
respondent's abdomen and even
demonstrated to them how to insert
their
fingers
into
her
vagina.
Thereafter, petitioner went out of the
delivery room and later, his assistants
also left. As she labored in pain, she
felt the movement of her baby inside
her womb and the intermittent
stiffening of her abdomen.
At about 4:00 in the afternoon,
petitioner returned to the delivery
room and asked her, "Hindi ka pa
nanganganak?" Since she could no
longer bear the pain, she requested
petitioner to perform a cesarean
section but this was not done
The
midwife
and
the
younger
assistants again pressed down on her

abdomen causing excruciating pain on

her ribs and made her very weak.
They repeatedly did this pressing until
the baby and placenta came out.
When she regained consciousness, she
was already at the recovery room. She
learned that an operation was
performed on her by petitioner to
remove her ruptured uterus but what
depressed her most was her stillborn
baby and the loss of her reproductive
capacity.
Deputy Ombudsman:

The Petitioner administratively liable.

That by fully entrusting to his
subordinates the task of handling
respondent's complicated delivery,
petitioner exhibited an improper or
wrongful conduct and dereliction of
duty as medical practitioner. Being the
most competent person who should
have rendered the appropriate medical
service to respondent, petitioner
should have personally attended to
the latter. Such action or inaction of
his part amounts to intentional or
willful neglect in discharging his sworn
duty as a government physician which
is also equivalent to misconduct in
office. The administrative case filed
against the respondent is also not
rendered moot by his subsequent
resignation in office.
CA: concurred that petitioner should
have chosen to stay in the delivery
room and personally attend to the
patient as he is the most competent
person to render medical service in
view of respondent's critical condition.

It likewise faulted the petitioner for

deliberately leaving the laboring and
unstable respondent to the care of his
inexperienced subordinates at the
time she was about to give birth. As to
petitioner's excuse that he had to
attend to an equally important
cesarean operation, the CA said there
was no sufficient showing of the
latter's urgency and assuming it to be
true, still, petitioner should have
exerted efforts to refer respondent's
case to another competent doctor or
one of his consultants.
ISSUE: W/N Petitioner is Liable
RULING: Yes.
Misconduct
is
defined
as
a
transgression of some established and
definite
rule
of
action,
more
particularly, unlawful behavior or gross
negligence by a public officer,13 a
forbidden act, a dereliction of duty,
willful in character, and implies
wrongful intent and not mere error in
judgment.14 It
generally
means
wrongful,
improper
or
unlawful
conduct motivated by a premeditated,
obstinate or intentional purpose. The
term, however, does not necessarily
imply corruption or criminal intent. To
constitute an administrative offense,
misconduct should relate to or be
connected with the performance of the
official functions and duties of a public
officer. On the other hand, when the
elements of corruption, clear intent to
violate the law or flagrant disregard of
established rule are manifest, the
public officer shall be liable for grave
misconduct.15

In this case, both the Ombudsman

and CA found the petitioner guilty of
grave misconduct in failing to attend
to respondent when she was having
prolonged difficult labor and vaginal
delivery
after
being
diagnosed
with macrosamia and polyhydramnios.
In deliberately leaving the respondent
to a midwife and two inexperienced
assistants despite knowing that she
was under prolonged painful labor and
about to give birth to a macrosomic
baby by vaginal delivery, petitioner
clearly committed a dereliction of duty
and a breach of his professional
obligations.
The
gravity
of
respondent's condition is highlighted
by the expected complications she
suffered - her stillborn baby, a
ruptured uterus that necessitated
immediate
surgery
and
blood
transfusion, and vulvar hematomas.
Article II, Section 1 of the Code of
Medical
Ethics
of
the
Medical
Profession in the Philippines states:
A physician should attend to his
patients faithfully and conscientiously.
He should secure for them all possible
benefits that may depend upon his
professional skill and care. As the sole
tribunal to adjudge the physician's
failure to fulfill his obligation to his
patients is, in most cases, his own
conscience, violation of this rule on his
part is discreditable and inexcusable.26
We therefore hold that the CA
correctly affirmed the Ombudsman in
finding the petitioner guilty of grave
misconduct. His violation of the sworn
duty to attend to his patients faithfully
and conscientiously is inexcusable.

Such flagrant disregard of established

rule and improper conduct were
proven
by
substantial
evidence.
Not only did petitioner routinely
delegate his responsibility to his
subordinates, he casually instructed
them to press down repeatedly on
respondent's abdomen, unmindful of
her critical condition as borne out by
his
very
own
findings.
Worse,
petitioner haughtily and callously
spoke of respondent's case to the
other doctors and medical staff while
performing a CS after he had briefly
attended to her at the delivery room
"...paanakin na long 'yon, abnormal
din naman ang bata kahit mabuhay,
kawawa lang siya." Such insensitive
and derisive language was again heard
from the petitioner when he referred
for the second time to respondent's
traumatic delivery, saying that: "Pinilit
no 'ng tatlong ungas, ayon lumusot

pero patay ang bata, tapos ito,

mukhang pumutok" As a government
physician, petitioner's demeanor is
unbecoming and bespeaks of his
indifference to the well-being of his
patients.
Petitioner thus not only committed a
dereliction
of
duty,
but
also
transgressed the ethical norms of his
profession when he failed to render
competent
medical
care
with
compassion and respect for his
patient's
dignity.
A physician should be dedicated to
provide competent medical care with
full professional skill in accordance
with the current standards of care,
compassion,
independence
and
respect for human dignity.28