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G.R. Nos.

78813-14 November 8, 1993


PEOPLE OF THE PHILIPPINES, plaintiff-appellee,
vs.
FARHAD HATANI y ABOLHASSAN, accused-appellant.
QUIASON, J.:
This is an appeal from the decisions of the Regional Trial Court, Branch 105, Quezon City, convicting
appellant in Criminal Cases No. Q-11867 and No. Q-11868.
The dispositive portion of the decision in Criminal Case No. Q-11867 reads as follows:
WHEREFORE, premises considered, the Court finds the accused Farhad Hatani y
Abolhassan, GUILTY beyond reasonable doubt of illegal practice of medicine in
violation of R.A. 2382 otherwise known as the Medical Act of 1959 (Secs. 8, 10)
penalized by Section 28 thereof with "a fine of not less than one thousand pesos nor
more than ten thousand pesos with subsidiary imprisonment in case of insolvency, or
by imprisonment of not less than one year nor more than five years, or by both such
fine and imprisonment, in the discretion of the court; and considering the
circumstances of the case and the ignominy caused by him to his two teen-aged,
female, then unmarried victims, this Court exercising its discretion granted under said
Section 28 of the law, hereby SENTENCES said accused FARHAD HATANI Y
ABOLHASSAN to pay a fine of ten thousand pesos (P10,000.00) with subsidiary
imprisonment in case of insolvency AND to suffer imprisonment of five (5) years; and
to pay the costs.
This Court further recommends that after service of his sentence the accused be
deported as undesirable alien (Rollo, p. 35).
The dispositive portion of the decision in Criminal Case No. Q-11868 reads as follows:
WHEREFORE, premises considered, the Court finds the accused, FARHAD HATANI
y ABOLHASSAN, GUILTY beyond reasonable doubt of the crime of rape punishable
under Article 335 of the Revised Penal Code and hereby SENTENCES said accused
to suffer life imprisonment orreclusion perpetua; and to indemnify the complainant,
Precila Borja, in the sum of fifty thousand pesos (P50,000.00) and to pay costs (Rollo,
p. 41).
The information in Criminal Case No. Q-11867 charged appellant with illegal practice of medicine, in
violation of R.A. No. 2382, otherwise known as the Medical Act of 1959, committed as follows:
That on or about the 6th day of July, 1979, in Quezon City, Philippines the above
named accused, knowing fully well that he has not satisfactorily passed the
corresponding Board Examination, neither is he a holder of a valid Certificate of
Registration duly issued by the Board of Medical Examiners, as in fact he does not
even appear to have taken or completed the course leading to a medical degree, did,
then and there, willfully, unlawfully and feloniously for compensation, fee and salary,
paid to him directly, physically examined Priscila (sic) Borja Y Loquero and Wilma
Borja Y Loquero, diagnosed, treated and administer injections on the persons of
Prescila (sic) Borja Y Loquero and Wilma Borja Y Loquero, in Violation of Section 10,
in relation to Section 28, Republic Act No. 2382 (Records, Vol. I, p. 1).

The information in Criminal Case No. Q-11868, charged appellant with Rape, committed as follows:
That on or about the 6th day of July, 1979, in Quezon City, Philippines, the abovenamed accused, with lewd designs, and while she was deprived of reason or
unconscious after having been drugged or administered medicine, did, then and there,
willfully, unlawfully and feloniously have sexual intercourse with the undersigned
PRECILA BORJA Y LOQUERO without her consent and against her will, to her
damage and prejudice in such amount as may be awarded under the provisions of the
Civil Code (Records, Vol. II, p. 1).
It appears that in the morning of July 6, 1979, Agustina Borja visited her comadre, Maura Fontreras,
and requested malunggay leaves as medication for her 16-year old daughter, Precila, who had high
fever and loose bowel movement. Upon learning that Precila was sick, Marita, Maura's daughter,
introduced Agustina to her husband, appellant herein, whom she said was a medical doctor. Marita
suggested that her husband treat Precila and Agustina agreed.
Appellant and Marita went to the Borja residence, where he examined Precila. He gave her tablets to
take and administered two injections (to her), one in the morning and the second at noon. After each
injection, Precila would feel dizzy and fall asleep.
It was appellant's diagnosis that Precila was a drug addict and required further observation and
treatment. Appellant offered to attend to Precila at his house and again, Agustina agreed in the belief
that her daughter was a drug addict.
In the evening of the same day, Precila was fetched by appellant and Marita and was brought to
appellant's house. Again, Precila was given an injection which caused her to sleep. When she awoke,
she realized that she was naked and her entire body was in pain. Appellant was seated on the bed
and was fondling her private parts. Shocked, Precila called for her mother and tried to get up.
Appellant, however, punched her on the chest and forced her to lie down. He pressed a pillow on her
face and injected her again, causing her to fall asleep.
When Precila awoke the second time, she found appellant in bed with her. He was naked and fondling
her private parts. The pain all over her body lingered. When Precila touched her private parts, she saw
blood stains on her hand. She tried to stand up but she was too weak. Appellant gave her another
injection rendering her unconscious.
The following morning, Agustina went to fetch Precila. Upon reaching the Fontreras' residence, she
went straight to the bedroom, where, to her great dismay, she found Precila and appellant both asleep
and naked. She hurriedly dressed up Precila and brought her home.
When Precila woke up, she noticed she was already home and her mother was crying. Precila
remained dizzy, with throbbing pains all over her body. When talked to, she was incoherent.
That evening, Precila's oldest sister, Josefina, a nurse by profession, came home and saw Precila
looking very weak. Her mother, who was crying narrated what she had witnessed that morning. She
also told Josefina that appellant was in the other bedroom, treating another sister, Wilma whom he
also diagnosed as a drug addict. Josefina immediately proceeded to the bedroom and saw appellant
about to inject Wilma.
Josefina saw the open bag of appellant, which contained empty capsules of dalmane and empty vials
of valium. She inquired on the need of the injection and appellant replied that a second shot of plain
distilled water was required to cure Wilma of her drug addiction. Josefina told appellant to stop but he

persisted. Only upon threat that she would call the police did appellant stop. Appellant and his wife
then left the Borja residence.
The following day, Agustina and Josefina brought Precila and Wilma to the Philippine Constabulary
Headquarters at Camp Crame, Quezon City, where Josefina and Wilma gave their statements (Exhs.
"D" and "F"). Precila was physically examined by a doctor, whose medical report stated that Precila's
hymen and "deep, healing lacerations" and that "subject is in non-virgin state physically" (Exh. A).
Several needle puncture marks were also found on Precila's arms and buttocks.
A physical examination was likewise done on Wilma, which showed that she too had a needle
puncture, as shown in the Medico-Legal Report (Exh. "L").
Acting on the complaint filed before the Constabulary Anti-Narcotics Unit (CANU), a surveillance of
appellant's residence was conducted. Subsequently, a search warrant was secured from Judge Jose
P. Castro of the Court of First Instance of Quezon City. Armed with the warrant, CANU agents raided
appellant's residence on July 15, 1979.
Assorted drugs, such as dalmane, valium and mogadon, as well as prescription pads in the name of
Dr. Jesus Yap (Exhs. "H" "H-4") and other medical instruments, such as a "thermometer, a
"hygomonometer (sic), stethoscope, syringes and needles, were seized.
The Handwriting Identification Report (Exh. "I") on the prescription slips showed that these were written
by the appellant himself. The report on the chemistry examination of the seized tablets and capsules
(Exhs. "J" "J-1") confirmed the presence of mogadon, dalmane and valium.
After the preliminary investigation, separate informations for rape and violation of R.A. No. 2382 were
filed. Appellant pleaded not guilty to both crimes.
The defense's version is that in the evening of July 6, 1976, Agustina and Precila Borja visited the
mother-in-law of the appellant, Maura Fontreras. In the course of the conversation, Agustina asked
Marita if she could help Precila. Marita obliged and agreed to take care of Precila for the night and
allow her to sleep in her bedroom.
Precila and Marita chatted the whole night. Accordingly, Precila confessed that she was not really sick.
She merely related her personal problems, involving her parents. She also admitted her vice, such as
drinking, smoking and taking drugs.
Their talk lasted until the wee hours of the morning and during their conversation, appellant would
occasionally enter the room but he never joined their discussion.
Precila and Marita shared the same bed. Appellant; who was wearing only his pajama pants, slept on
the floor at the opposite end of the room.
The following morning Agustina arrived and Marita related some of Precila's problems. Nothing
untoward happened that day and Agustina headed for home while Precila and Marita followed later.
At past midnight of July 15, 1979, a raid was conducted by CANU agents in the house of the appellant
under the supervision of C1C Agustin Timbol, Jr. The raid was made upon Josefina's complaint for
illegal possession of drugs.

Appellant and his wife were driven out of their bedroom, while three-men remained. Later, appellant
was called to join them in the bedroom and he was shocked to see assorted drugs scattered around.
Appellant denied owning them. Photographs were taken of him with the drugs. A barangay official was
called to attest to the list of the confiscated drugs. Appellant, however, refused to sign the said list.
C1C Timbol offered to fur the case in exchange of money. Instead of acceding, appellant demanded
to see the search warrant. C1C Timbol failed to show a warrant on the pretext that they were military
men without need of any identification or search warrant. Appellant, his wife and brother-in-law were
forced to join C1C Timbol for questioning in Camp Crame. Upon boarding the van, appellant saw
Josefina aboard kissing C1C Timbol and both exchanged victory signs.
The trial court rendered two separate decisions and convicted the appellant of both crimes. In finding
appellant guilty of illegal purchase of medicine, considerable weight was given to the prosecution's
exhibits.
The Professional Regulation Commission certified that appellant is not among the list of registered
physicians nor among those with special permit to practice medicine in a limited scope (Exh. "K").
Appellant failed to refute the Handwriting Identification Report (Exh. "I") released by the PC Crime
Laboratory showing that the signature of Dr. Jesus D. Yap (Exhs. "H" "H-4") prescribing medicine
belonged to him. The pictures also taken during the raid (Exhs. "G" - "G-8'" undeniably reveal several
medical equipment used by practicing physicians.
Notwithstanding the trial court's finding that there was no direct evidence of rape, it concluded that
circumstantial evidence indicate that rape was consummated by appellant considering the following:
1. The medico-legal examination of victim Precila, taken on July 8, 1979 at 10:25 in
the morning or less than 48 hours from the evening of July 6, 1979 found "hymen with
deep, healing lacerations at 4, 6 and 9 o'clock position"; thus indicating that the
lacerations were recent as they are in the process of healing; (Exh. "A-1")
2. The above undeniable findings of the expert confirms the statement of the victim, a
young girl of 16 or 17 years of age, that when she held private parts which were painful
then, she noticed blood. (tsn. Alma, Feb. 9, 1984, pp. 4-5).
The fresh laceration of the hymen further confirms the carnal assault. (People vs. Ocampo, L-47335,
Aug. 13, 1986)
3. In the two short waking moments of the victim she noticed she was naked and
beside her on the same bed was the accused, also naked. (tsn. Alma, Feb. 9, 1984,
pp. 3-5)
4. The accused, then 21 years of age was in the prime of youth, and the unconscious
girl beside him was just 16 or 17 years of age, thus in the full bloom of womanhood.
The sexual excitement on the part of the accused was therefore exceedingly great.
5. When the mother, Agustina, came into the room of the accused that early morning
of July 7, 1979 she saw her daughter and the accused on the same bed and both
naked. (tsn., Rogato, Jan. 27, 1981, p. 9)

6. The medico-legal found several needle puncture marks on the arms and buttocks
of Precila (Exh. "A"); thus confirming Precila's testimony that she had been injected by
the accused, rendering her unconscious (tsn. Alma, Feb. 9, 1984, pp. 4-5; tsn., Nenita,
May 21, 1984, pp. 3-6; also pp. 29-30).
7. The medico-legal found the victim "in non-virgin state physically." (Exh; "A-i")
8. At the time of the medico-legal examination, i.e. morning of July 8, 1979, the victim
was found to be "incoherent." (Exh. A) after effect of the injections or drugs.
9. At the time of the incident (July 6, 1979) the Borjas and Frontreras (sic) were
"comadres" and neighbors. There is no enmity between and among them.
10. Between accused and Marita on one hand, and the victim, her mother, and sisters,
on the other hand, there was no misunderstanding before the incident. There is
absolutely absence of any ulterior motive for the teen-aged victim or her family to file
the serious charge of rape which would expose her to embarrassment of examination
of her private parts and public trial (Rollo, pp. 38-39).
In his first assignment of error, appellant questions the credibility of the prosecution witnesses.
Appellant faults complainant for recounting her ordeal only after four years when she took the witness
stand. This argument is misleading. The record shows that the day after the rape, Josefina and Wilma
Borja, accompanied by their mother, Agustina, issued their statements at Camp Crame. Agustina gave
her statement twice on separate days. Precila did not give any statement due to her weak condition
but it cannot be denied that she was instead physically examined. Suffice it to say, the Medico Legal
Report (Exh. "A") indicates swellings and lacerations and concludes that Precila was no longer a virgin.
Although the records fail to show any sworn statement by Precila, such is not fatal where the sworn
affidavits of her mother, her two sisters and the medico-legal report are sufficient to show probable
cause of rape (People v. Yambao, 193 SGRA 571 [1991]).
Precila was either dizzy or unconscious at the time she was sexually abused. We find her testimony
consistent and credible. While her testimony is limited to the times when she would gain her
consciousness, it is not unlikely that such traumatic incidents would still be engraved on her mind even
four years after.
Appellant's assertion that Precila failed to inform her family of his misdeeds is explainable. As correctly
pointed out by the Solicitor General, Precila was still dizzy and incoherent as a consequence of the
injections administered by appellant. In fact, when Precila was physically examined by the doctor the
day after, she was still sleepy and groggy (TSN, March 31, 1980, pp. 7-8).
Appellant also finds it strange that considering the acts allegedly committed by him against Precila,
the medico-legal report fails to specify any injuries on the body of Precila. Appellant need not inflict
heavy blows on Precila for the simple reason that she was under sedation. The absence of the injuries
does not negate the commission of rape (People v. Torrevillas, 203 SCRA 576 [1991]; People v.
Arenas, 198 172 [1991]) for rape may be committed after rendering a woman unconscious (Art. 335,
Revised Penal Code; People v. Gerones, 193 SCRA 263 [1991]).
Appellant alleges that Precila was no longer a virgin on that fateful day and that her bleeding was
actually the start of her menstrual cycle. It is settled jurisprudence that virginity is not an essential
element of rape (People v. Corro, 197 SCRA 121 [1991]; People v. Banayo, 195 SCRA 543 [1991]).
To claim that Precila's menstrual cycle began on that day is highly speculative.

Appellant claims that the sworn statements of the Borjas (Exhs. "D", "E" and "F") were antedated and
were prepared after the illegal search was conducted in his residence. He also cites some
inconsistencies in said statements. We find the claim to be devoid of merit. It is only now on appeal
that appellant disputes the execution of these affidavits. When they were presented and offered as
evidence, appellant failed to raise such objections and to refute them.
The alleged inconsistencies in the testimony of the prosecution witnesses merely refer to minor details,
which cannot destroy their credibility (People v. Doctolero, 193 SCRA 632 [1991]). This is also true
where statements made while on the witness stand are claimed to be inconsistent with the affidavit,
which are generally incomplete (People v. Lagota, 194 SCRA 92 [1991]; People v. Avanzado, 158
SCRA 427 [1988]).
With regard to the second assignment of error, appellant insists that his conviction arose from
insufficient evidence and his failure to prove his innocence.
Indeed, the circumstantial evidence established at the trial are more than sufficient to prove the guilt
of appellant. The Medico-Legal Report on Precila, taken within 48 hours from the commission of rape
confirmed that her hymen had "deep, healing lacerations at 4, 6 and 9 o'clock position" and Precila
was "in non-virgin state physically" (Exh. "A"). Furthermore, the report confirms that Precila had at
least six needle puncture marks and swellings, which confirm that appellant had injected her several
times.
On the two occasions that Precila woke up, she positively stated that appellant was with her on the
bed and that they were both naked. She also tried to free herself on both attempts from accused, but,
he made her unconscious through injections (TSN, February 9, 1984, pp. 3-5). This is corroborated
by the testimony of Agustina, who saw her daughter and accused together naked on bed (TSN,
January 27, 1981, p. 9). These unbroken chain of events leads one to a fair and reasonable conclusion
that accused actually raped Precila.
As held in People v. Yambao, supra, credence is given to the findings of the trial court where the rape
victim's testimony is buttressed by the corroborative testimony of the mother and the medico-legal
report, as well as the report of the police investigator.
It must also be borne in mind that at the time of the commission of the crime, Precila was just sixteen
years old. No young lady at the prime of her youth would concoct a story of defloration, allow an
examination of her intimate parts and later bare herself to the disgrace brought to her honor in a public
trial unless she was motivated solely by a desire to have the culprit apprehended and brought to justice
(People v. Patilan, 197 SCRA 354 [1991]; People v. Yambao, 193 SCRA 571 [1991]).
Appellant claims that his right to be presumed innocent was violated. He cites the trial court's decision
holding that it.
. . . finds that with these circumstantial evidences (sic) pieced together the prosecution
has proved the crime of rape, and the burden shifted on the defense to show the
contrary (Rollo, p. 40).
Appellant was afforded a fair trial and in fact he availed of surrebuttal evidence. The statement of the
trial court, as correctly argued by the Solicitor General, implies that the circumstantial evidence is
sufficient to support appellant's conviction unless the defense is able to provide evidence to the
contrary.

With respect to his conviction of illegal practice of medicine, appellant presented inconsistent claims.
On one hand, he claims that the drugs and other paraphernalia were planted by the raiding team;
while on the other hand, he claims that these were seized without any warrant.
If indeed the evidence were all planted, how can appellant explain his handwriting on the prescription
pads in the name of Dr. Jesus Yap? A perusal of the photographs showing accused during the raid,
fails to indicate any protestation by him. In fact, the other photographs (Exhs. "G-l", "G-2", "G-4" "G8") do not bear any sign of disorder, in contrast to appellant's testimony that his room was made into
a mess during the raid.
The records fail to disclose a copy of a search warrant. However, the prosecution was able to present
its return (Exh. "ZZ") and we are satisfied that indeed a lawful search warrant was obtained. Besides,
the judge who granted the search warrant was the same judge who initially heard both criminal cases.
It can therefore be presumed, that the search was made with a search warrant and absent of any
showing that it was procured maliciously, the items seized are admissible in evidence (People v. Umali,
193 SCRA 493 [1991]).
The evidence is overwhelming that appellant actually treated and diagnosed Precila and Wilma Borja.
The positive testimony of Agustina, Precila, Wilma and Josefina Borja; the medico-legal reports (Exhs.
"A", "A-7", "C", "L" and "L-1") which attest to the needle marks; the Handwriting Identification Report
(Exh. I); the photographs (Exhs. "G-l "G-8") showing assorted drugs and medical equipment in
appellant's room; and the chemistry reports (Exhs. "J" "J-1") prove that appellant was engaged in
the practice of medicine. And as to his allegation that there was no proof of payment, the law
specifically punishes said act whether or not done for a fee.
Appellant claims that Precila admitted in her cross-examination that she was in school the whole day
of July 6, 1979 and it was therefore impossible for him to have treated and diagnosed her on that date.
An accurate reading of the transcript, however, will show that Precila's testimony was in response to
a question regarding her school schedule for that day.
Finally, appellant claims that the ponente of both decisions was not the trial judge, ergo said judge
was thus deprived of the opportunity to assess the credibility of the prosecution witnesses.
Admittedly, the ponente's participation was limited to the resolution of the cases. The fact that the
judge who heard the evidence is not the one who rendered the judgment, and for that reason the latter
did not have the opportunity to observe the demeanor of the witnesses during the trial but merely relied
on the records of the case, does not render the judgment erroneous (People v. Ramos, Jr., 203 SCRA
237 [1991]; People v. Villamayor, 199 SCRA 472 [1991]), especially where the evidence on record is
sufficient to support its conclusion.
WHEREFORE, the judgments appealed from are AFFIRMED in toto. Costs de oficio.
SO ORDERED.

G.R. No. 72964 January 7, 1988


FILOMENO URBANO, petitioner,
vs.
HON. INTERMEDIATE APPELLATE COURT AND PEOPLE OF THE PHILIPPINES, respondents.
GUTIERREZ, JR., J.:
This is a petition to review the decision of the then Intermediate Appellate Court which affirmed the
decision of the then Circuit Criminal Court of Dagupan City finding petitioner Filomeno Urban guilty
beyond reasonable doubt of the crime of homicide.
The records disclose the following facts of the case.
At about 8:00 o'clock in the morning of October 23, 1980, petitioner Filomeno Urbano went to his
ricefield at Barangay Anonang, San Fabian, Pangasinan located at about 100 meters from the tobacco
seedbed of Marcelo Javier. He found the place where he stored his palay flooded with water coming
from the irrigation canal nearby which had overflowed. Urbano went to the elevated portion of the
canal to see what happened and there he saw Marcelo Javier and Emilio Erfe cutting grass. He asked
them who was responsible for the opening of the irrigation canal and Javier admitted that he was the
one. Urbano then got angry and demanded that Javier pay for his soaked palay. A quarrel between
them ensued. Urbano unsheathed his bolo (about 2 feet long, including the handle, by 2 inches wide)
and hacked Javier hitting him on the right palm of his hand, which was used in parrying the bolo hack.
Javier who was then unarmed ran away from Urbano but was overtaken by Urbano who hacked him
again hitting Javier on the left leg with the back portion of said bolo, causing a swelling on said leg.
When Urbano tried to hack and inflict further injury, his daughter embraced and prevented him from
hacking Javier.
Immediately thereafter, Antonio Erfe, Emilio Erfe, and Felipe Erfe brought Javier to his house about
50 meters away from where the incident happened. Emilio then went to the house of Barangay Captain
Menardo Soliven but not finding him there, Emilio looked for barrio councilman Felipe Solis instead.
Upon the advice of Solis, the Erfes together with Javier went to the police station of San Fabian to
report the incident. As suggested by Corporal Torio, Javier was brought to a physician. The group
went to Dr. Guillermo Padilla, rural health physician of San Fabian, who did not attend to Javier but
instead suggested that they go to Dr. Mario Meneses because Padilla had no available medicine.
After Javier was treated by Dr. Meneses, he and his companions returned to Dr. Guillermo Padilla who
conducted a medico-legal examination. Dr. Padilla issued a medico-legal certificate (Exhibit "C" dated
September 28, 1981) which reads:
TO WHOM IT MAY CONCERN:
This is to certify that I have examined the wound of Marcelo Javier, 20 years of age,
married, residing at Barangay Anonang, San Fabian, Pangasinan on October 23, 1980
and found the following:
1 -Incised wound 2 inches in length at the upper portion of the lesser palmar
prominence, right.

As to my observation the incapacitation is from (7-9) days period. This wound was
presented to me only for medico-legal examination, as it was already treated by the
other doctor. (p. 88, Original Records)
Upon the intercession of Councilman Solis, Urbano and Javier agreed to settle their differences.
Urbano promised to pay P700.00 for the medical expenses of Javier. Hence, on October 27, 1980,
the two accompanied by Solis appeared before the San Fabian Police to formalize their amicable
settlement. Patrolman Torio recorded the event in the police blotter (Exhibit A), to wit:
xxx xxx xxx
Entry Nr 599/27 Oct '80/103OH/ Re entry Nr 592 on page 257 both parties appeared
before this Station accompanied by brgy. councilman Felipe Solis and settled their
case amicably, for they are neighbors and close relatives to each other. Marcelo Javier
accepted and granted forgiveness to Filomeno Urbano who shoulder (sic) all the
expenses in his medical treatment, and promising to him and to this Office that this will
never be repeated anymore and not to harbour any grudge against each other. (p. 87,
Original Records.)
Urbano advanced P400.00 to Javier at the police station. On November 3, 1980, the additional
P300.00 was given to Javier at Urbano's house in the presence of barangay captain Soliven.
At about 1:30 a.m. on November 14, 1980, Javier was rushed to the Nazareth General Hospital in a
very serious condition. When admitted to the hospital, Javier had lockjaw and was having convulsions.
Dr. Edmundo Exconde who personally attended to Javier found that the latter's serious condition was
caused by tetanus toxin. He noticed the presence of a healing wound in Javier's palm which could
have been infected by tetanus.
On November 15, 1980 at exactly 4:18 p.m., Javier died in the hospital. The medical findings of Dr.
Exconde are as follows:
Date Diagnosis
11-14-80 ADMITTED due to trismus
adm. at DX TETANUS
1:30 AM Still having frequent muscle spasm. With diffi#35, 421 culty opening his mouth. Restless at times. Febrile
11-15-80 Referred. Novaldin 1 amp. inj. IM. Sudden cessation of respiration and HR after
muscular spasm.
02 inhalation administered. Ambo bag
resuscitation and cardiac massage done but to
no avail.

Pronounced dead by Dra. Cabugao at


4:18 P.M.
PMC done and cadaver brought home
by relatives. (p. 100, Original Records)
In an information dated April 10, 1981, Filomeno Urbano was charged with the crime of homicide
before the then Circuit Criminal Court of Dagupan City, Third Judicial District.
Upon arraignment, Urbano pleaded "not guilty." After trial, the trial court found Urbano guilty as
charged. He was sentenced to suffer an indeterminate prison term of from TWELVE (12) YEARS
of prision mayor, as minimum to SEVENTEEN (17) years, FOUR (4) MONTHS and ONE (1) DAY
of reclusion temporal, as maximum, together with the accessories of the law, to indemnify the heirs of
the victim, Marcelo Javier, in the amount of P12,000.00 without subsidiary imprisonment in case of
insolvency, and to pay the costs. He was ordered confined at the New Bilibid Prison, in Muntinlupa,
Rizal upon finality of the decision, in view of the nature of his penalty.
The then Intermediate Appellate Court affirmed the conviction of Urbano on appeal but raised the
award of indemnity to the heirs of the deceased to P30,000.00 with costs against the appellant.
The appellant filed a motion for reconsideration and/or new trial. The motion for new trial was based
on an affidavit of Barangay Captain Menardo Soliven (Annex "A") which states:
That in 1980, I was the barrio captain of Barrio Anonang, San Fabian, Pangasinan,
and up to the present having been re-elected to such position in the last barangay
elections on May 17, 1982;
That sometime in the first week of November, 1980, there was a typhoon that swept
Pangasinan and other places of Central Luzon including San Fabian, a town of said
province;
That during the typhoon, the sluice or control gates of the Bued irrigation dam which
irrigates the ricefields of San Fabian were closed and/or controlled so much so that
water and its flow to the canals and ditches were regulated and reduced;
That due to the locking of the sluice or control gates of the dam leading to the canals
and ditches which will bring water to the ricefields, the water in said canals and ditches
became shallow which was suitable for catching mudfishes;
That after the storm, I conducted a personal survey in the area affected, with my
secretary Perfecto Jaravata;
That on November 5, 1980, while I was conducting survey, I saw the late Marcelo
Javier catching fish in the shallow irrigation canals with some companions;
That few days there after,or on November l5, l980, I came to know that said Marcelo
Javier died of tetanus. (p. 33, Rollo)
The motion was denied. Hence, this petition.

In a resolution dated July 16, 1986, we gave due course to the petition.
The case involves the application of Article 4 of the Revised Penal Code which provides that "Criminal
liability shall be incurred: (1) By any person committing a felony (delito) although the wrongful act done
be different from that which he intended ..." Pursuant to this provision "an accused is criminally
responsible for acts committed by him in violation of law and for all the natural and logical
consequences resulting therefrom." (People v. Cardenas, 56 SCRA 631).
The record is clear that Marcelo Javier was hacked by the petitioner who used a bolo as a result of
which Javier suffered a 2-inch incised wound on his right palm; that on November 14, 1981 which was
the 22nd day after the incident, Javier was rushed to the hospital in a very serious condition and that
on the following day, November 15, 1981, he died from tetanus.
Under these circumstances, the lower courts ruled that Javier's death was the natural and logical
consequence of Urbano's unlawful act. Hence, he was declared responsible for Javier's death. Thus,
the appellate court said:
The claim of appellant that there was an efficient cause which supervened from the
time the deceased was wounded to the time of his death, which covers a period of 23
days does not deserve serious consideration. True, that the deceased did not die right
away from his wound, but the cause of his death was due to said wound which was
inflicted by the appellant. Said wound which was in the process of healing got infected
with tetanus which ultimately caused his death.
Dr. Edmundo Exconde of the Nazareth General Hospital testified that the victim
suffered lockjaw because of the infection of the wound with tetanus. And there is no
other way by which he could be infected with tetanus except through the wound in his
palm (tsn., p. 78, Oct. 5, 1981). Consequently, the proximate cause of the victim's
death was the wound which got infected with tetanus. And the settled rule in this
jurisdiction is that an accused is liable for all the consequences of his unlawful act.
(Article 4, par. 1, R.P.C. People v. Red, CA 43 O.G. 5072; People v. Cornel 78 Phil.
418).
Appellant's allegation that the proximate cause of the victim's death was due to his
own negligence in going back to work without his wound being properly healed, and
lately, that he went to catch fish in dirty irrigation canals in the first week of November,
1980, is an afterthought, and a desperate attempt by appellant to wiggle out of the
predicament he found himself in. If the wound had not yet healed, it is impossible to
conceive that the deceased would be reckless enough to work with a disabled hand.
(pp. 20-21, Rollo)
The petitioner reiterates his position that the proximate cause of the death of Marcelo Javier was due
to his own negligence, that Dr. Mario Meneses found no tetanus in the injury, and that Javier got
infected with tetanus when after two weeks he returned to his farm and tended his tobacco plants with
his bare hands exposing the wound to harmful elements like tetanus germs.
The evidence on record does not clearly show that the wound inflicted by Urbano was infected with
tetanus at the time of the infliction of the wound. The evidence merely confirms that the wound, which
was already healing at the time Javier suffered the symptoms of the fatal ailment, somehow got
infected with tetanus However, as to when the wound was infected is not clear from the record.

In Vda. de Bataclan, et al. v. Medina (102 Phil. 1181), we adopted the following definition of proximate
cause:
xxx xxx xxx
... A satisfactory definition of proximate cause is found in Volume 38, pages 695-696
of American Jurisprudence, cited by plaintiffs-appellants in their brief. It is as follows:
... "that cause, which, in natural and continuous sequence, unbroken by any efficient
intervening cause, produces the injury, and without which the result would not have
occurred."And more comprehensively, "the proximate legal cause is that acting first
and producing the injury, either immediately or by setting other events in motion, all
constituting a natural and continuous chain of events, each having a close causal
connection with its immediate predecessor, the final event in the chain immediately
effecting the injury as a natural and probable result of the cause which first acted,
under such circumstances that the person responsible for the first event should, as an
ordinarily prudent and intelligent person, have reasonable ground to expect at the
moment of his act or default that an injury to some person might probably result
therefrom." (at pp. 185-186)
The issue, therefore, hinges on whether or not there was an efficient intervening cause from the time
Javier was wounded until his death which would exculpate Urbano from any liability for Javier's death.
We look into the nature of tetanusThe incubation period of tetanus, i.e., the time between injury and the appearance of
unmistakable symptoms, ranges from 2 to 56 days. However, over 80 percent of
patients become symptomatic within 14 days. A short incubation period indicates
severe disease, and when symptoms occur within 2 or 3 days of injury the mortality
rate approaches 100 percent.
Non-specific premonitory symptoms such as restlessness, irritability, and headache
are encountered occasionally, but the commonest presenting complaints are pain and
stiffness in the jaw, abdomen, or back and difficulty swallowing. As the progresses,
stiffness gives way to rigidity, and patients often complain of difficulty opening their
mouths. In fact, trismus in the commonest manifestation of tetanus and is responsible
for the familiar descriptive name of lockjaw. As more muscles are involved, rigidity
becomes generalized, and sustained contractions called risus sardonicus. The
intensity and sequence of muscle involvement is quite variable. In a small proportion
of patients, only local signs and symptoms develop in the region of the injury. In the
vast majority, however, most muscles are involved to some degree, and the signs and
symptoms encountered depend upon the major muscle groups affected.
Reflex spasm usually occur within 24 to 72 hours of the first symptom, an interval
referred to as the onset time. As in the case of the incubation period, a short onset
time is associated with a poor prognosis. Spasms are caused by sudden intensification
of afferent stimuli arising in the periphery, which increases rigidity and causes
simultaneous and excessive contraction of muscles and their antagonists. Spasms
may be both painful and dangerous. As the disease progresses, minimal or inapparent
stimuli produce more intense and longer lasting spasms with increasing frequency.
Respiration may be impaired by laryngospasm or tonic contraction of respiratory

muscles which prevent adequate ventilation. Hypoxia may then lead to irreversible
central nervous system damage and death.
Mild tetanus is characterized by an incubation period of at least 14 days and an onset
time of more than 6 days. Trismus is usually present, but dysphagia is absent and
generalized spasms are brief and mild. Moderately severe tetanus has a somewhat
shorter incubation period and onset time; trismus is marked, dysphagia and
generalized rigidity are present, but ventilation remains adequate even during spasms.
The criteria for severe tetanus include a short incubation time, and an onset time of 72
hrs., or less, severe trismus, dysphagia and rigidity and frequent prolonged,
generalized convulsive spasms. (Harrison's Principle of Internal Medicine, 1983
Edition, pp. 1004-1005; Emphasis supplied)
Therefore, medically speaking, the reaction to tetanus found inside a man's body depends on the
incubation period of the disease.
In the case at bar, Javier suffered a 2-inch incised wound on his right palm when he parried the bolo
which Urbano used in hacking him. This incident took place on October 23, 1980. After 22 days, or on
November 14, 1980, he suffered the symptoms of tetanus, like lockjaw and muscle spasms. The
following day, November 15, 1980, he died.
If, therefore, the wound of Javier inflicted by the appellant was already infected by tetanus germs at
the time, it is more medically probable that Javier should have been infected with only a mild cause of
tetanus because the symptoms of tetanus appeared on the 22nd day after the hacking incident or more
than 14 days after the infliction of the wound. Therefore, the onset time should have been more than
six days. Javier, however, died on the second day from the onset time. The more credible conclusion
is that at the time Javier's wound was inflicted by the appellant, the severe form of tetanus that killed
him was not yet present. Consequently, Javier's wound could have been infected with tetanus after
the hacking incident. Considering the circumstance surrounding Javier's death, his wound could have
been infected by tetanus 2 or 3 or a few but not 20 to 22 days before he died.
The rule is that the death of the victim must be the direct, natural, and logical consequence of the
wounds inflicted upon him by the accused. (People v. Cardenas, supra) And since we are dealing with
a criminal conviction, the proof that the accused caused the victim's death must convince a rational
mind beyond reasonable doubt. The medical findings, however, lead us to a distinct possibility that the
infection of the wound by tetanus was an efficient intervening cause later or between the time Javier
was wounded to the time of his death. The infection was, therefore, distinct and foreign to the crime.
(People v. Rellin, 77 Phil. 1038).
Doubts are present. There is a likelihood that the wound was but the remote cause and its subsequent
infection, for failure to take necessary precautions, with tetanus may have been the proximate cause
of Javier's death with which the petitioner had nothing to do. As we ruled in Manila Electric Co. v.
Remoquillo, et al. (99 Phil. 118).
"A prior and remote cause cannot be made the be of an action if such remote cause
did nothing more than furnish the condition or give rise to the occasion by which the
injury was made possible, if there intervened between such prior or remote cause and
the injury a distinct, successive, unrelated, and efficient cause of the injury, even
though such injury would not have happened but for such condition or occasion. If no
danger existed in the condition except because of the independent cause, such
condition was not the proximate cause. And if an independent negligent act or
defective condition sets into operation the instances which result in injury because of

the prior defective condition, such subsequent act or condition is the proximate cause."
(45 C.J. pp. 931-932). (at p. 125)
It strains the judicial mind to allow a clear aggressor to go scot free of criminal liability. At the very
least, the records show he is guilty of inflicting slight physical injuries. However, the petitioner's criminal
liability in this respect was wiped out by the victim's own act. After the hacking incident, Urbano and
Javier used the facilities of barangay mediators to effect a compromise agreement where Javier
forgave Urbano while Urbano defrayed the medical expenses of Javier. This settlement of minor
offenses is allowed under the express provisions of Presidential Decree G.R. No. 1508, Section 2(3).
(See also People v. Caruncho, 127 SCRA 16).
We must stress, however, that our discussion of proximate cause and remote cause is limited to the
criminal aspects of this rather unusual case. It does not necessarily follow that the petitioner is also
free of civil liability. The well-settled doctrine is that a person, while not criminally liable, may still be
civilly liable. Thus, in the recent case of People v. Rogelio Ligon y Tria, et al. (G.R. No. 74041, July
29, 1987), we said:
xxx xxx xxx
... While the guilt of the accused in a criminal prosecution must be established beyond
reasonable doubt, only a preponderance of evidence is required in a civil action for
damages. (Article 29, Civil Code). The judgment of acquittal extinguishes the civil
liability of the accused only when it includes a declaration that the facts from which the
civil liability might arise did not exist. (Padilla v. Court of Appeals, 129 SCRA 559).
The reason for the provisions of article 29 of the Civil Code, which provides that the
acquittal of the accused on the ground that his guilt has not been proved beyond
reasonable doubt does not necessarily exempt him from civil liability for the same act
or omission, has been explained by the Code Commission as follows:
The old rule that the acquittal of the accused in a criminal case also
releases him from civil liability is one of the most serious flaws in the
Philippine legal system. It has given use to numberless instances of
miscarriage of justice, where the acquittal was due to a reasonable
doubt in the mind of the court as to the guilt of the accused. The
reasoning followed is that inasmuch as the civil responsibility is derived
from the criminal offense, when the latter is not proved, civil liability
cannot be demanded.
This is one of those causes where confused thinking leads to
unfortunate and deplorable consequences. Such reasoning fails to
draw a clear line of demarcation between criminal liability and civil
responsibility, and to determine the logical result of the distinction. The
two liabilities are separate and distinct from each other. One affects
the social order and the other, private rights. One is for the punishment
or correction of the offender while the other is for reparation of
damages suffered by the aggrieved party. The two responsibilities are
so different from each other that article 1813 of the present (Spanish)
Civil Code reads thus: "There may be a compromise upon the civil
action arising from a crime; but the public action for the imposition of
the legal penalty shall not thereby be extinguished." It is just and proper
that, for the purposes of the imprisonment of or fine upon the accused,

the offense should be proved beyond reasonable doubt. But for the
purpose of indemnity the complaining party, why should the offense
also be proved beyond reasonable doubt? Is not the invasion or
violation of every private right to be proved only by a preponderance of
evidence? Is the right of the aggrieved person any less private because
the wrongful act is also punishable by the criminal law?
"For these reasons, the Commission recommends the adoption of the
reform under discussion. It will correct a serious defect in our law. It
will close up an inexhaustible source of injustice-a cause for
disillusionment on the part of the innumerable persons injured or
wronged."
The respondent court increased the P12,000.00 indemnification imposed by the trial court to
P30,000.00. However, since the indemnification was based solely on the finding of guilt beyond
reasonable doubt in the homicide case, the civil liability of the petitioner was not thoroughly examined.
This aspect of the case calls for fuller development if the heirs of the victim are so minded.
WHEREFORE, the instant petition is hereby GRANTED. The questioned decision of the then
Intermediate Appellate Court, now Court of Appeals, is REVERSED and SET ASIDE. The petitioner
is ACQUITTED of the crime of homicide. Costs de oficio.
SO ORDERED.

G.R. No. L-65295 March 10, 1987


PHOENIX CONSTRUCTION, INC. and ARMANDO U. CARBONEL, petitioners,
vs.
THE INTERMEDIATE APPELLATE COURT and LEONARDO DIONISIO, respondents.
FELICIANO, J:
In the early morning of 15 November 1975 at about 1:30 a.m. private respondent Leonardo
Dionisio was on his way home he lived in 1214-B Zamora Street, Bangkal, Makati from a
cocktails-and-dinner meeting with his boss, the general manager of a marketing corporation. During
the cocktails phase of the evening, Dionisio had taken "a shot or two" of liquor. Dionisio was driving
his Volkswagen car and had just crossed the intersection of General Lacuna and General Santos
Streets at Bangkal, Makati, not far from his home, and was proceeding down General Lacuna Street,
when his car headlights (in his allegation) suddenly failed. He switched his headlights on "bright" and
thereupon he saw a Ford dump truck looming some 2-1/2 meters away from his car. The dump truck,
owned by and registered in the name of petitioner Phoenix Construction Inc. ("Phoenix"), was parked
on the right hand side of General Lacuna Street (i.e., on the right hand side of a person facing in the
same direction toward which Dionisio's car was proceeding), facing the oncoming traffic. The dump
truck was parked askew (not parallel to the street curb) in such a manner as to stick out onto the street,
partly blocking the way of oncoming traffic. There were no lights nor any so-called "early warning"
reflector devices set anywhere near the dump truck, front or rear. The dump truck had earlier that
evening been driven home by petitioner Armando U. Carbonel, its regular driver, with the permission
of his employer Phoenix, in view of work scheduled to be carried out early the following morning,
Dionisio claimed that he tried to avoid a collision by swerving his car to the left but it was too late and
his car smashed into the dump truck. As a result of the collision, Dionisio suffered some physical
injuries including some permanent facial scars, a "nervous breakdown" and loss of two gold bridge
dentures.
Dionisio commenced an action for damages in the Court of First Instance of Pampanga basically
claiming that the legal and proximate cause of his injuries was the negligent manner in which Carbonel
had parked the dump truck entrusted to him by his employer Phoenix. Phoenix and Carbonel, on the
other hand, countered that the proximate cause of Dionisio's injuries was his own recklessness in
driving fast at the time of the accident, while under the influence of liquor, without his headlights on
and without a curfew pass. Phoenix also sought to establish that it had exercised due rare in the
selection and supervision of the dump truck driver.
The trial court rendered judgment in favor of Dionisio and against Phoenix and Carbonel and ordered
the latter:
(1) To pay plaintiff jointly and severally the sum of P 15,000.00 for hospital bills and
the replacement of the lost dentures of plaintiff;
(2) To pay plaintiff jointly and severally the sum of P 1,50,000.-00 as loss of expected
income for plaintiff brought about the accident in controversy and which is the result of
the negligence of the defendants;
(3) To pay the plaintiff jointly and severally the sum of P 10,000. as moral damages for
the unexpected and sudden withdrawal of plaintiff from his lifetime career as a
marketing man; mental anguish, wounded feeling, serious anxiety, social humiliation,
besmirched reputation, feeling of economic insecurity, and the untold sorrows and

frustration in life experienced by plaintiff and his family since the accident in
controversy up to the present time;
(4) To pay plaintiff jointly and severally the sum of P 10,000.00 as damages for the
wanton disregard of defendants to settle amicably this case with the plaintiff before the
filing of this case in court for a smaller amount.
(5) To pay the plaintiff jointly and severally the sum of P 4,500.00 due as and for
attorney's fees; and
(6) The cost of suit. (Emphasis supplied)
Phoenix and Carbonel appealed to the Intermediate Appellate Court. That court in CA-G.R. No. 65476
affirmed the decision of the trial court but modified the award of damages to the following extent:
1. The award of P15,000.00 as compensatory damages was reduced
to P6,460.71, the latter being the only amount that the appellate court
found the plaintiff to have proved as actually sustained by him;
2. The award of P150,000.00 as loss of expected income was reduced
to P100,000.00,basically because Dionisio had voluntarily resigned his
job such that, in the opinion of the appellate court, his loss of income
"was not solely attributable to the accident in question;" and
3. The award of P100,000.00 as moral damages was held by the
appellate court as excessive and unconscionable and hence reduced
to P50,000.00.
The award of P10,000.00 as exemplary damages and P4,500.00 as
attorney's fees and costs remained untouched.
This decision of the Intermediate Appellate Court is now before us on a petition for review.
Both the trial court and the appellate court had made fairly explicit findings of fact relating to the manner
in which the dump truck was parked along General Lacuna Street on the basis of which both courts
drew the inference that there was negligence on the part of Carbonel, the dump truck driver, and that
this negligence was the proximate cause of the accident and Dionisio's injuries. We note, however,
that both courts failed to pass upon the defense raised by Carbonel and Phoenix that the true legal
and proximate cause of the accident was not the way in which the dump truck had been parked but
rather the reckless way in which Dionisio had driven his car that night when he smashed into the dump
truck. The Intermediate Appellate Court in its questioned decision casually conceded that Dionisio was
"in some way, negligent" but apparently failed to see the relevance of Dionisio's negligence and made
no further mention of it. We have examined the record both before the trial court and the Intermediate
Appellate Court and we find that both parties had placed into the record sufficient evidence on the
basis of which the trial court and the appellate court could have and should have made findings of fact
relating to the alleged reckless manner in which Dionisio drove his car that night. The petitioners
Phoenix and Carbonel contend that if there was negligence in the manner in which the dump truck
was parked, that negligence was merely a "passive and static condition" and that private respondent
Dionisio's recklessness constituted an intervening, efficient cause determinative of the accident and
the injuries he sustained. The need to administer substantial justice as between the parties in this
case, without having to remand it back to the trial court after eleven years, compels us to address
directly the contention put forward by the petitioners and to examine for ourselves the record pertaining

to Dionisio's alleged negligence which must bear upon the liability, or extent of liability, of Phoenix and
Carbonel.
There are four factual issues that need to be looked into: (a) whether or not private respondent Dionisio
had a curfew pass valid and effective for that eventful night; (b) whether Dionisio was driving fast or
speeding just before the collision with the dump truck; (c) whether Dionisio had purposely turned off
his car's headlights before contact with the dump truck or whether those headlights accidentally
malfunctioned moments before the collision; and (d) whether Dionisio was intoxicated at the time of
the accident.
As to the first issue relating to the curfew pass, it is clear that no curfew pass was found on the person
of Dionisio immediately after the accident nor was any found in his car. Phoenix's evidence here
consisted of the testimony of Patrolman Cuyno who had taken Dionisio, unconscious, to the Makati
Medical Center for emergency treatment immediately after the accident. At the Makati Medical Center,
a nurse took off Dionisio's clothes and examined them along with the contents of pockets together with
Patrolman Cuyno. 1 Private respondent Dionisio was not able to produce any curfew pass during the trial. Instead, he offered the
explanation that his family may have misplaced his curfew pass. He also offered a certification (dated two years after the accident) issued by
one Major Benjamin N. Libarnes of the Zone Integrated Police Intelligence Unit of Camp Olivas, San Fernando, Pampanga, which was said to
have authority to issue curfew passes for Pampanga and Metro Manila. This certification was to the effect that private respondent Dionisio had
a valid curfew pass. This certification did not, however, specify any pass serial number or date or period of effectivity of the supposed curfew
pass. We find that private respondent Dionisio was unable to prove possession of a valid curfew pass during the night of the accident and that
the preponderance of evidence shows that he did not have such a pass during that night. The relevance of possession or non-possession of
a curfew pass that night lies in the light it tends to shed on the other related issues: whether Dionisio was speeding home and whether he had
indeed purposely put out his headlights before the accident, in order to avoid detection and possibly arrest by the police in the nearby police
station for travelling after the onset of curfew without a valid curfew pass.

On the second issue whether or not Dionisio was speeding home that night both the trial court
and the appellate court were completely silent.
The defendants in the trial court introduced the testimony of Patrolman Cuyno who was at the scene
of the accident almost immediately after it occurred, the police station where he was based being
barely 200 meters away. Patrolman Cuyno testified that people who had gathered at the scene of the
accident told him that Dionisio's car was "moving fast" and did not have its headlights on. 2 Dionisio,
on the other hand, claimed that he was travelling at a moderate speed at 30 kilometers per hour and had
just crossed the intersection of General Santos and General Lacuna Streets and had started to accelerate
when his headlights failed just before the collision took place. 3

Private respondent Dionisio asserts that Patrolman Cuyno's testimony was hearsay and did not fag
within any of the recognized exceptions to the hearsay rule since the facts he testified to were not
acquired by him through official information and had not been given by the informants pursuant to any
duty to do so. Private respondent's objection fails to take account of the fact that the testimony of
Patrolman Cuyno is admissible not under the official records exception to the hearsay rule 4 but rather
as part of the res gestae. 5 Testimonial evidence under this exception to the hearsay rule consists of excited
utterances made on the occasion of an occurrence or event sufficiently startling in nature so as to render
inoperative the normal reflective thought processes of the observer and hence made as a spontaneous
reaction to the occurrence or event, and not the result of reflective thought. 6

We think that an automobile speeding down a street and suddenly smashing into a stationary object
in the dead of night is a sufficiently startling event as to evoke spontaneous, rather than reflective,
reactions from observers who happened to be around at that time. The testimony of Patrolman Cuyno
was therefore admissible as part of the res gestae and should have been considered by the trial court.
Clearly, substantial weight should have been ascribed to such testimony, even though it did not, as it
could not, have purported to describe quantitatively the precise velocity at winch Dionisio was travelling
just before impact with the Phoenix dump truck.

A third related issue is whether Dionisio purposely turned off his headlights, or whether his headlights
accidentally malfunctioned, just moments before the accident. The Intermediate Appellate Court
expressly found that the headlights of Dionisio's car went off as he crossed the intersection but was
non-committal as to why they did so. It is the petitioners' contention that Dionisio purposely shut off
his headlights even before he reached the intersection so as not to be detected by the police in the
police precinct which he (being a resident in the area) knew was not far away from the intersection.
We believe that the petitioners' theory is a more credible explanation than that offered by private
respondent Dionisio i.e., that he had his headlights on but that, at the crucial moment, these had in
some mysterious if convenient way malfunctioned and gone off, although he succeeded in switching
his lights on again at "bright" split seconds before contact with the dump truck.
A fourth and final issue relates to whether Dionisio was intoxicated at the time of the accident. The
evidence here consisted of the testimony of Patrolman Cuyno to the effect that private respondent
Dionisio smelled of liquor at the time he was taken from his smashed car and brought to the Makati
Medical Center in an unconscious condition. 7 This testimony has to be taken in conjunction with the
admission of Dionisio that he had taken "a shot or two" of liquor before dinner with his boss that night. We
do not believe that this evidence is sufficient to show that Dionisio was so heavily under the influence of
liquor as to constitute his driving a motor vehicle per se an act of reckless imprudence. 8There simply is not
enough evidence to show how much liquor he had in fact taken and the effects of that upon his physical
faculties or upon his judgment or mental alertness. We are also aware that "one shot or two" of hard liquor
may affect different people differently.

The conclusion we draw from the factual circumstances outlined above is that private respondent
Dionisio was negligent the night of the accident. He was hurrying home that night and driving faster
than he should have been. Worse, he extinguished his headlights at or near the intersection of General
Lacuna and General Santos Streets and thus did not see the dump truck that was parked askew and
sticking out onto the road lane.
Nonetheless, we agree with the Court of First Instance and the Intermediate Appellate Court that the
legal and proximate cause of the accident and of Dionisio's injuries was the wrongful or negligent
manner in which the dump truck was parked in other words, the negligence of petitioner Carbonel.
That there was a reasonable relationship between petitioner Carbonel's negligence on the one hand
and the accident and respondent's injuries on the other hand, is quite clear. Put in a slightly different
manner, the collision of Dionisio's car with the dump truck was a natural and foreseeable consequence
of the truck driver's negligence.
The petitioners, however, urge that the truck driver's negligence was merely a "passive and static
condition" and that private respondent Dionisio's negligence was an "efficient intervening cause and
that consequently Dionisio's negligence must be regarded as the legal and proximate cause of the
accident rather than the earlier negligence of Carbonel. We note that the petitioners' arguments are
drawn from a reading of some of the older cases in various jurisdictions in the United States but we
are unable to persuade ourselves that these arguments have any validity for our jurisdiction. We note,
firstly, that even in the United States, the distinctions between "cause" and "condition" which the
'petitioners would have us adopt have already been "almost entirely discredited." Professors and
Keeton make this quite clear:
Cause and condition. Many courts have sought to distinguish between the active
"cause" of the harm and the existing "conditions" upon which that cause operated. If
the defendant has created only a passive static condition which made the damage
possible, the defendant is said not to be liable. But so far as the fact of causation is
concerned, in the sense of necessary antecedents which have played an important
part in producing the result it is quite impossible to distinguish between active forces
and passive situations, particularly since, as is invariably the case, the latter are the

result of other active forces which have gone before. The defendant who spills gasoline
about the premises creates a "condition," but the act may be culpable because of the
danger of fire. When a spark ignites the gasoline, the condition has done quite as much
to bring about the fire as the spark; and since that is the very risk which the defendant
has created, the defendant will not escape responsibility. Even the lapse of a
considerable time during which the "condition" remains static will not necessarily affect
liability; one who digs a trench in the highway may still be liable to another who fans
into it a month afterward. "Cause" and "condition" still find occasional mention in the
decisions; but the distinction is now almost entirely discredited. So far as it has any
validity at all, it must refer to the type of case where the forces set in operation by the
defendant have come to rest in a position of apparent safety, and some new force
intervenes. But even in such cases, it is not the distinction between "cause" and
"condition" which is important but the nature of the risk and the character of the
intervening cause. 9
We believe, secondly, that the truck driver's negligence far from being a "passive and static condition"
was rather an indispensable and efficient cause. The collision between the dump truck and the private
respondent's car would in an probability not have occurred had the dump truck not been parked askew
without any warning lights or reflector devices. The improper parking of the dump truck created an
unreasonable risk of injury for anyone driving down General Lacuna Street and for having so created
this risk, the truck driver must be held responsible. In our view, Dionisio's negligence, although later in
point of time than the truck driver's negligence and therefore closer to the accident, was not an efficient
intervening or independent cause. What the Petitioners describe as an "intervening cause" was no
more than a foreseeable consequent manner which the truck driver had parked the dump truck. In
other words, the petitioner truck driver owed a duty to private respondent Dionisio and others similarly
situated not to impose upon them the very risk the truck driver had created. Dionisio's negligence was
not of an independent and overpowering nature as to cut, as it were, the chain of causation in fact
between the improper parking of the dump truck and the accident, nor to sever the juris vinculum of
liability. It is helpful to quote once more from Professor and Keeton:
Foreseeable Intervening Causes. If the intervening cause is one which in ordinary
human experience is reasonably to be anticipated or one which the defendant has
reason to anticipate under the particular circumstances, the defendant may be
negligence among other reasons, because of failure to guard against it; or the
defendant may be negligent only for that reason. Thus one who sets a fire may be
required to foresee that an ordinary, usual and customary wind arising later wig spread
it beyond the defendant's own property, and therefore to take precautions to prevent
that event. The person who leaves the combustible or explosive material exposed in a
public place may foresee the risk of fire from some independent source. ... In all of
these cases there is an intervening cause combining with the defendant's conduct to
produce the result and in each case the defendant's negligence consists in failure to
protect the plaintiff against that very risk.
Obviously the defendant cannot be relieved from liability by the fact that the risk or a
substantial and important part of the risk, to which the defendant has subjected the
plaintiff has indeed come to pass. Foreseeable intervening forces are within the scope
original risk, and hence of the defendant's negligence. The courts are quite generally
agreed that intervening causes which fall fairly in this category will not supersede the
defendant's responsibility.
Thus it has been held that a defendant will be required to anticipate the usual weather
of the vicinity, including all ordinary forces of nature such as usual wind or rain, or snow

or frost or fog or even lightning; that one who leaves an obstruction on the road or a
railroad track should foresee that a vehicle or a train will run into it; ...
The risk created by the defendant may include the intervention of the foreseeable
negligence of others. ... [The standard of reasonable conduct may require the
defendant to protect the plaintiff against 'that occasional negligence which is one of
the ordinary incidents of human life, and therefore to be anticipated.' Thus, a defendant
who blocks the sidewalk and forces the plaintiff to walk in a street where the plaintiff
will be exposed to the risks of heavy traffic becomes liable when the plaintiff is run
down by a car, even though the car is negligently driven; and one who parks an
automobile on the highway without lights at night is not relieved of responsibility when
another negligently drives into it. --- 10
We hold that private respondent Dionisio's negligence was "only contributory," that the "immediate
and proximate cause" of the injury remained the truck driver's "lack of due care" and that consequently
respondent Dionisio may recover damages though such damages are subject to mitigation by the
courts (Article 2179, Civil Code of the Philippines).
Petitioners also ask us to apply what they refer to as the "last clear chance" doctrine. The theory here
of petitioners is that while the petitioner truck driver was negligent, private respondent Dionisio had
the "last clear chance" of avoiding the accident and hence his injuries, and that Dionisio having failed
to take that "last clear chance" must bear his own injuries alone. The last clear chance doctrine of the
common law was imported into our jurisdiction by Picart vs. Smith 11 but it is a matter for debate whether, or to what
extent, it has found its way into the Civil Code of the Philippines. The historical function of that doctrine in the common law was to mitigate the
harshness of another common law doctrine or rule that of contributory negligence. 12 The common law rule of contributory negligence
prevented any recovery at all by a plaintiff who was also negligent, even if the plaintiff's negligence was relatively minor as compared with the
wrongful act or omission of the defendant. 13 The common law notion of last clear chance permitted courts to grant recovery to a plaintiff who
had also been negligent provided that the defendant had the last clear chance to avoid the casualty and failed to do so. 14 Accordingly, it is
difficult to see what role, if any, the common law last clear chance doctrine has to play in a jurisdiction where the common law concept of
contributory negligence as an absolute bar to recovery by the plaintiff, has itself been rejected, as it has been in Article 2179 of the Civil Code
of the Philippines. 15

Is there perhaps a general concept of "last clear chance" that may be extracted from its common law
matrix and utilized as a general rule in negligence cases in a civil law jurisdiction like ours? We do not
believe so. Under Article 2179, the task of a court, in technical terms, is to determine whose negligence
the plaintiff's or the defendant's was the legal or proximate cause of the injury. That task is not
simply or even primarily an exercise in chronology or physics, as the petitioners seem to imply by the
use of terms like "last" or "intervening" or "immediate." The relative location in the continuum of time
of the plaintiff's and the defendant's negligent acts or omissions, is only one of the relevant factors that
may be taken into account. Of more fundamental importance are the nature of the negligent act or
omission of each party and the character and gravity of the risks created by such act or omission for
the rest of the community. The petitioners urge that the truck driver (and therefore his employer) should
be absolved from responsibility for his own prior negligence because the unfortunate plaintiff failed to
act with that increased diligence which had become necessary to avoid the peril precisely created by
the truck driver's own wrongful act or omission. To accept this proposition is to come too close to
wiping out the fundamental principle of law that a man must respond for the forseeable consequences
of his own negligent act or omission. Our law on quasi-delicts seeks to reduce the risks and burdens
of living in society and to allocate them among the members of society. To accept the petitioners' proposition must tend to weaken the very bonds of society.
Petitioner Carbonel's proven negligence creates a presumption of negligence on the part of his
employer Phoenix16 in supervising its employees properly and adequately. The respondent appellate court in effect found, correctly in
our opinion, that Phoenix was not able to overcome this presumption of negligence. The circumstance that Phoenix had allowed its truck driver
to bring the dump truck to his home whenever there was work to be done early the following morning, when coupled with the failure to show
any effort on the part of Phoenix to supervise the manner in which the dump truck is parked when away from company premises, is an
affirmative showing of culpa in vigilando on the part of Phoenix.

Turning to the award of damages and taking into account the comparative negligence of private
respondent Dionisio on one hand and petitioners Carbonel and Phoenix upon the other hand, 17 we
believe that the demands of substantial justice are satisfied by allocating most of the damages on a 20-80 ratio. Thus, 20% of the damages
awarded by the respondent appellate court, except the award of P10,000.00 as exemplary damages and P4,500.00 as attorney's fees and
costs, shall be borne by private respondent Dionisio; only the balance of 80% needs to be paid by petitioners Carbonel and Phoenix who shall
be solidarity liable therefor to the former. The award of exemplary damages and attorney's fees and costs shall be borne exclusively by the
petitioners. Phoenix is of course entitled to reimbursement from Carbonel. 18 We see no sufficient reason for disturbing the reduced award of
damages made by the respondent appellate court.

WHEREFORE, the decision of the respondent appellate court is modified by reducing the aggregate
amount of compensatory damages, loss of expected income and moral damages private respondent
Dionisio is entitled to by 20% of such amount. Costs against the petitioners.
SO ORDERED.

G.R. No. 151452. July 29, 2005


SPS. ANTONIO C. SANTOS and ESPERANZA C. SANTOS, NORA BARNALO, BELINDA
LUMACTAD, MARIENELA DY, NIKKA SANTOS and LEONARDO FERRER, Petitioners,
vs.
HON. NORMANDIE B. PIZARDO, as Presiding Judge, RTC of Quezon City, Branch 101,
DIONISIO M SIBAYAN, and VIRON TRANSPORTATION COMPANY, INC., represented by
VIRGILIO Q. RONDARIS, President/Chairman, Respondent.
TINGA, J.:
In this Petition for Review on Certiorari1 dated March 1, 2002, petitioners assail the Resolutions of the
Court of Appeals dated September 10, 2001 and January 9, 2002, respectively dismissing their petition
for certiorari and denying their motion for reconsideration, arising from the dismissal of their complaint
to recover civil indemnity for the death and physical injuries of their kin.
The following facts are matters of record.
In an Information dated April 25, 1994, Dionisio M. Sibayan (Sibayan) was charged with Reckless
Imprudence Resulting to Multiple Homicide and Multiple Physical Injuries in connection with a vehicle
collision between a southbound Viron Transit bus driven by Sibayan and a northbound Lite Ace Van,
which claimed the lives of the vans driver and three (3) of its passengers, including a two-month old
baby, and caused physical injuries to five (5) of the vans passengers. After trial, Sibayan was
convicted and sentenced to suffer the penalty of imprisonment for two (2) years, four (4) months and
one (1) day to four (4) years and two (2) months. However, as there was a reservation to file a separate
civil action, no pronouncement of civil liability was made by the municipal circuit trial court in its decision
promulgated on December 17, 1998.2
On October 20, 2000, petitioners filed a complaint for damages against Sibayan, Viron Transit and its
President/Chairman, Virgilio Q. Rondaris, with the Regional Trial Court of Quezon City, pursuant to
their reservation to file a separate civil action.3 They cited therein the judgment convicting Sibayan.
Viron Transit moved to dismiss the complaint on the grounds of improper service of summons,
prescription and laches, and defective certification of non-forum shopping. It also sought the dropping
of Virgilio Q. Rondaris as defendant in view of the separate personality of Viron Transit from its
officers.4
Petitioners opposed the motion to dismiss contending, among others, that the right to file a separate
action in this case prescribes in ten (10) years reckoned from the finality of the judgment in the criminal
action. As there was no appeal of the decision convicting Sibayan, the complaint which was filed barely
two (2) years thence was clearly filed within the prescriptive period.
The trial court dismissed the complaint on the principal ground that the cause of action had already
prescribed. According to the trial court, actions based on quasi delict, as it construed petitioners cause
of action to be, prescribe four (4) years from the accrual of the cause of action. Hence, notwithstanding
the fact that petitioners reserved the right to file a separate civil action, the complaint ought to be
dismissed on the ground of prescription.5
Improper service of summons was likewise cited as a ground for dismissal of the complaint as
summons was served through a certain Jessica Ubalde of the legal department without mentioning
her designation or position.

Petitioners filed a motion for reconsideration pointing out yet again that the complaint is not based
on quasi delictbut on the final judgment of conviction in the criminal case which prescribes ten (10)
years from the finality of the judgment.6 The trial court denied petitioners motion for reconsideration
reiterating that petitioners cause of action was based on quasi delict and had prescribed under Article
1146 of the Civil Code because the complaint was filed more than four (4) years after the vehicular
accident.7 As regards the improper service of summons, the trial court reconsidered its ruling that the
complaint ought to be dismissed on this ground.
Petitioners filed a petition for certiorari with the Court of Appeals which dismissed the same for error
in the choice or mode of appeal.8 The appellate court also denied petitioners motion for
reconsideration reasoning that even if the respondent trial court judge committed grave abuse of
discretion in issuing the order of dismissal, certiorari is still not the permissible remedy as appeal was
available to petitioners and they failed to allege that the petition was brought within the recognized
exceptions for the allowance of certiorari in lieu of appeal.9
In this petition, petitioners argue that a rigid application of the rule that certiorari cannot be a substitute
for appeal will result in a judicial rejection of an existing obligation arising from the criminal liability of
private respondents. Petitioners insist that the liability sought to be enforced in the complaint arose ex
delicto and is not based on quasi delict. The trial court allegedly committed grave abuse of discretion
when it insisted that the cause of action invoked by petitioners is based on quasi delict and concluded
that the action had prescribed. Since the action is based on the criminal liability of private respondents,
the cause of action accrued from the finality of the judgment of conviction.
Assuming that their petition with the appellate court was procedurally flawed, petitioners implore the
Court to exempt this case from the rigid operation of the rules as they allegedly have a legitimate
grievance to vindicate,i.e., damages for the deaths and physical injuries caused by private
respondents for which no civil liability had been adjudged by reason of their reservation of the right to
file a separate civil action.
In their Comment10 dated June 13, 2002, private respondents insist that the dismissal of the complaint
on the ground of prescription was in order. They point out that the averments in the complaint make
out a cause of action for quasi delict under Articles 2176 and 2180 of the Civil Code. As such, the
prescriptive period of four (4) years should be reckoned from the time the accident took place.
Viron Transit also alleges that its subsidiary liability cannot be enforced since Sibayan was not ordered
to pay damages in the criminal case. It is Viron Transits contention that the subsidiary liability of the
employer contemplated in Article 103 of the Revised Penal Code presupposes a situation where the
civil aspect of the case was instituted in the criminal case and no reservation to file a separate civil
case was made.
Private respondents likewise allege that the recourse to the Court of Appeals via certiorari was
improper as petitioners should have appealed the adverse order of the trial court. Moreover, they point
out several other procedural lapses allegedly committed by petitioners, such as lack of certification
against forum-shopping; lack of duplicate original or certified true copy of the assailed order of the trial
court; and non-indication of the full names and addresses of petitioners in the petition.
Petitioners filed a Reply11 dated September 14, 2002, while private respondents filed
a Rejoinder12 dated October 14, 2002, both in reiteration of their arguments.
We grant the petition.

Our Revised Penal Code provides that every person criminally liable for a felony is also civilly
liable.13 Such civil liability may consist of restitution, reparation of the damage caused and
indemnification of consequential damages.14 When a criminal action is instituted, the civil liability
arising from the offense is impliedly instituted with the criminal action, subject to three notable
exceptions: first, when the injured party expressly waives the right to recover damages from the
accused; second, when the offended party reserves his right to have the civil damages determined in
a separate action in order to take full control and direction of the prosecution of his cause; andthird,
when the injured party actually exercises the right to maintain a private suit against the offender by
instituting a civil action prior to the filing of the criminal case.
Notably, it was the 1985 Rules on Criminal Procedure, as amended in 1988, which governed the
institution of the criminal action, as well as the reservation of the right to file a separate civil action.
Section 1, Rule 111 thereof states:
Section 1. Institution of criminal and civil actions.When a criminal action is instituted, the civil action
for the recovery of civil liability is impliedly instituted with the criminal action, unless the offended party
waives the civil action, reserves his right to institute it separately, or institutes the civil action prior to
the criminal action.
Such civil action includes recovery of indemnity under the Revised Penal Code, and damages under
Articles 32, 33, 34 and 2176 of the Civil Code of the Philippines arising from the same act or omission
of the accused.
A waiver of any of the civil actions extinguishes the others. The institution of, or the reservation of the
right to file, any of said civil actions separately waives the others.
The reservation of the right to institute the separate civil actions shall be made before the prosecution
starts to present its evidence and under circumstances affording the offended party a reasonable
opportunity to make such reservation.
In no case may the offended party recover damages twice for the same act or omission of the accused.
When the offended party seeks to enforce civil liability against the accused by way of moral, nominal,
temperate or exemplary damages, the filing fees for such action as provided in these Rules shall
constitute a first lien on the judgment except in an award for actual damages.
In cases wherein the amount of damages, other than actual, is alleged in the complaint or information,
the corresponding filing fees shall be paid by the offended party upon filing thereof in court for trial.
Petitioners expressly made a reservation of their right to file a separate civil action as a result of the
crime committed by Sibayan. On account of this reservation, the municipal circuit trial court, in its
decision convicting Sibayan, did not make any pronouncement as to the latters civil liability.
Predicating their claim on the judgment of conviction and their reservation to file a separate civil action
made in the criminal case, petitioners filed a complaint for damages against Sibayan, Viron Transit
and its President/Chairman. Petitioners assert that by the institution of the complaint, they seek to
recover private respondents civil liability arising from crime. Unfortunately, based on its misreading of
the allegations in the complaint, the trial court dismissed the same, declaring that petitioners cause of
action was based on quasi delictand should have been brought within four (4) years from the time the
cause of action accrued, i.e., from the time of the accident.

A reading of the complaint reveals that the allegations therein are consistent with petitioners claim
that the action was brought to recover civil liability arising from crime. Although there are allegations
of negligence on the part of Sibayan and Viron Transit, such does not necessarily mean that petitioners
were pursuing a cause of action based on quasi delict, considering that at the time of the filing of the
complaint, the cause of action ex quasi delicto had already prescribed. Besides, in cases of
negligence, the offended party has the choice between an action to enforce civil liability arising from
crime under the Revised Penal Code and an action for quasi delictunder the Civil Code.
An act or omission causing damage to another may give rise to two separate civil liabilities on the part
of the offender, i.e., (1) civil liability ex delicto, under Article 100 of the Revised Penal Code; and (2)
independent civil liabilities, such as those (a) not arising from an act or omission complained of as a
felony, e.g., culpa contractualor obligations arising from law under Article 31 of the Civil Code,
intentional torts under Articles 32 and 34, andculpa aquiliana under Article 2176 of the Civil Code; or
(b) where the injured party is granted a right to file an action independent and distinct from the criminal
action under Article 33 of the Civil Code.15 Either of these liabilities may be enforced against the
offender subject to the caveat under Article 2177 of the Civil Code that the plaintiff cannot recover
damages twice for the same act or omission of the defendant and the similar proscription against
double recovery under the Rules above-quoted.
At the time of the filing of the complaint for damages in this case, the cause of action ex quasi
delicto had already prescribed. Nonetheless, petitioners can pursue the remaining avenue opened for
them by their reservation, i.e.,the surviving cause of action ex delicto. This is so because the
prescription of the action ex quasi delicto does not operate as a bar to an action to enforce the civil
liability arising from crime especially as the latter action had been expressly reserved.
The case of Mendoza v. La Mallorca Bus Company16 was decided upon a similar set of facts. Therein,
the driver of La Mallorca Bus Company was charged with reckless imprudence resulting to damage to
property. The plaintiff made an express reservation for the filing of a separate civil action. The driver
was convicted which conviction was affirmed by this Court. Later, plaintiff filed a separate civil action
for damages based on quasi delict which was ordered dismissed by the trial court upon finding that
the action was instituted more than six (6) years from the date of the accident and thus, had already
prescribed. Subsequently, plaintiff instituted another action, this time based on the subsidiary liability
of the bus company. The trial court dismissed the action holding that the dismissal of the earlier civil
case operated as a bar to the filing of the action to enforce the bus companys subsidiary liability.
We held that the dismissal of the action based on culpa aquiliana is not a bar to the enforcement of
the subsidiary liability of the employer. Once there is a conviction for a felony, final in character, the
employer becomes subsidiarily liable if the commission of the crime was in the discharge of the duties
of the employees. This is so because Article 103 of the Revised Penal Code operates with controlling
force to obviate the possibility of the aggrieved party being deprived of indemnity even after the
rendition of a final judgment convicting the employee.
Seen in this light, the trial court should not have dismissed the complaint on the ground of prescription,
but instead allowed the complaint for damages ex delicto to be prosecuted on the merits, considering
petitioners allegations in their complaint, opposition to the motion to dismiss17 and motion for
reconsideration18 of the order of dismissal, insisting that the action was to recover civil liability arising
from crime.
This does not offend the policy that the reservation or institution of a separate civil action waives the
other civil actions. The rationale behind this rule is the avoidance of multiple suits between the same
litigants arising out of the same act or omission of the offender.19 However, since the stale action for
damages based on quasi delictshould be considered waived, there is no more occasion for petitioners

to file multiple suits against private respondents as the only recourse available to them is to pursue
damages ex delicto. This interpretation is also consistent with the bar against double recovery for
obvious reasons.
Now the procedural issue. Admittedly, petitioners should have appealed the order of dismissal of the
trial court instead of filing a petition for certiorari with the Court of Appeals. Such procedural misstep,
however, should be exempted from the strict application of the rules in order to promote their
fundamental objective of securing substantial justice.20 We are loathe to deprive petitioners of the
indemnity to which they are entitled by law and by a final judgment of conviction based solely on a
technicality. It is our duty to prevent such an injustice.21
WHEREFORE, judgment is hereby rendered SETTING ASIDE the resolutions of the Court of Appeals
dated September 10, 2001 and January 9, 2002, respectively dismissing the present action and
denying petitioners motion for reconsideration, as well as the orders of the lower court dated February
26, 2001 and July 16, 2001. Let the case be REMANDED to the trial court for further proceedings.
SO ORDERED.

G.R. No. 145391

August 26, 2002

AVELINO CASUPANAN and ROBERTO CAPITULO, petitioners,


vs.
MARIO LLAVORE LAROYA, respondent.
CARPIO, J.:
The Case
This is a petition for review on certiorari to set aside the Resolution1 dated December 28, 1999
dismissing the petition for certiorari and the Resolution2 dated August 24, 2000 denying the motion for
reconsideration, both issued by the Regional Trial Court of Capas, Tarlac, Branch 66, in Special Civil
Action No. 17-C (99).
The Facts
Two vehicles, one driven by respondent Mario Llavore Laroya ("Laroya" for brevity) and the other
owned by petitioner Roberto Capitulo ("Capitulo" for brevity) and driven by petitioner Avelino
Casupanan ("Casupanan" for brevity), figured in an accident. As a result, two cases were filed with
the Municipal Circuit Trial Court ("MCTC" for brevity) of Capas, Tarlac. Laroya filed a criminal case
against Casupanan for reckless imprudence resulting in damage to property, docketed as Criminal
Case No. 002-99. On the other hand, Casupanan and Capitulo filed a civil case against Laroya for
quasi-delict, docketed as Civil Case No. 2089.
When the civil case was filed, the criminal case was then at its preliminary investigation stage. Laroya,
defendant in the civil case, filed a motion to dismiss the civil case on the ground of forum-shopping
considering the pendency of the criminal case. The MCTC granted the motion in the Order of March
26, 1999 and dismissed the civil case.
On Motion for Reconsideration, Casupanan and Capitulo insisted that the civil case is a separate civil
action which can proceed independently of the criminal case. The MCTC denied the motion for
reconsideration in the Order of May 7, 1999. Casupanan and Capitulo filed a petition for certiorari
under Rule 65 before the Regional Trial Court ("Capas RTC" for brevity) of Capas, Tarlac, Branch
66,3 assailing the MCTCs Order of dismissal.
The Trial Courts Ruling
The Capas RTC rendered judgment on December 28, 1999 dismissing the petition for certiorari for
lack of merit. The Capas RTC ruled that the order of dismissal issued by the MCTC is a final order
which disposes of the case and therefore the proper remedy should have been an appeal. The Capas
RTC further held that a special civil action for certiorari is not a substitute for a lost appeal. Finally, the
Capas RTC declared that even on the premise that the MCTC erred in dismissing the civil case, such
error is a pure error of judgment and not an abuse of discretion.
Casupanan and Capitulo filed a Motion for Reconsideration but the Capas RTC denied the same in
the Resolution of August 24, 2000.
Hence, this petition.
The Issue

The petition premises the legal issue in this wise:


"In a certain vehicular accident involving two parties, each one of them may think and believe
that the accident was caused by the fault of the other. x x x [T]he first party, believing himself
to be the aggrieved party, opted to file a criminal case for reckless imprudence against the
second party. On the other hand, the second party, together with his operator, believing
themselves to be the real aggrieved parties, opted in turn to file a civil case for quasi-delict
against the first party who is the very private complainant in the criminal case."4
Thus, the issue raised is whether an accused in a pending criminal case for reckless imprudence can
validly file, simultaneously and independently, a separate civil action for quasi-delict against the private
complainant in the criminal case.
The Courts Ruling
Casupanan and Capitulo assert that Civil Case No. 2089, which the MCTC dismissed on the ground
of forum-shopping, constitutes a counterclaim in the criminal case. Casupanan and Capitulo argue
that if the accused in a criminal case has a counterclaim against the private complainant, he may file
the counterclaim in a separate civil action at the proper time. They contend that an action on quasidelict is different from an action resulting from the crime of reckless imprudence, and an accused in a
criminal case can be an aggrieved party in a civil case arising from the same incident. They maintain
that under Articles 31 and 2176 of the Civil Code, the civil case can proceed independently of the
criminal action. Finally, they point out that Casupanan was not the only one who filed the independent
civil action based on quasi-delict but also Capitulo, the owner-operator of the vehicle, who was not a
party in the criminal case.
In his Comment, Laroya claims that the petition is fatally defective as it does not state the real
antecedents. Laroya further alleges that Casupanan and Capitulo forfeited their right to question the
order of dismissal when they failed to avail of the proper remedy of appeal. Laroya argues that there
is no question of law to be resolved as the order of dismissal is already final and a petition for certiorari
is not a substitute for a lapsed appeal.
In their Reply, Casupanan and Capitulo contend that the petition raises the legal question of whether
there is forum-shopping since they filed only one action - the independent civil action for quasidelict against Laroya.
Nature of the Order of Dismissal
The MCTC dismissed the civil action for quasi-delict on the ground of forum-shopping under Supreme
Court Administrative Circular No. 04-94. The MCTC did not state in its order of dismissal5 that the
dismissal was with prejudice. Under the Administrative Circular, the order of dismissal is without
prejudice to refiling the complaint, unless the order of dismissal expressly states it is with
prejudice.6 Absent a declaration that the dismissal is with prejudice, the same is deemed without
prejudice. Thus, the MCTCs dismissal, being silent on the matter, is a dismissal without prejudice.
Section 1 of Rule 417 provides that an order dismissing an action without prejudice is not appealable.
The remedy of the aggrieved party is to file a special civil action under Rule 65. Section 1 of Rule 41
expressly states that "where the judgment or final order is not appealable, the aggrieved party may file
an appropriate special civil action under Rule 65." Clearly, the Capas RTCs order dismissing the
petition for certiorari, on the ground that the proper remedy is an ordinary appeal, is erroneous.
Forum-Shopping

The essence of forum-shopping is the filing of multiple suits involving the same parties for the same
cause of action, either simultaneously or successively, to secure a favorable judgment.8 Forumshopping is present when in the two or more cases pending, there is identity of parties, rights of action
and reliefs sought.9 However, there is no forum-shopping in the instant case because the law and the
rules expressly allow the filing of a separate civil action which can proceed independently of the
criminal action.
Laroya filed the criminal case for reckless imprudence resulting in damage to property based on the
Revised Penal Code while Casupanan and Capitulo filed the civil action for damages based on Article
2176 of the Civil Code. Although these two actions arose from the same act or omission, they have
different causes of action. The criminal case is based on culpa criminal punishable under the Revised
Penal Code while the civil case is based on culpa aquiliana actionable under Articles 2176 and 2177
of the Civil Code. These articles on culpa aquiliana read:
"Art. 2176. Whoever by act or omission causes damage to another, there being fault or
negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no preexisting contractual relation between the parties, is called a quasi-delict and is governed by
the provisions of this Chapter.
Art. 2177. Responsibility for fault or negligence under the preceding article is entirely separate
and distinct from the civil liability arising from negligence under the Penal Code. But the plaintiff
cannot recover damages twice for the same act or omission of the defendant."
Any aggrieved person can invoke these articles provided he proves, by preponderance of evidence,
that he has suffered damage because of the fault or negligence of another. Either the private
complainant or the accused can file a separate civil action under these articles. There is nothing in the
law or rules that state only the private complainant in a criminal case may invoke these articles.
Moreover, paragraph 6, Section 1, Rule 111 of the 2000 Rules on Criminal Procedure ("2000 Rules"
for brevity) expressly requires the accused to litigate his counterclaim in a separate civil action, to wit:
"SECTION 1. Institution of criminal and civil actions. (a) x x x.
No counterclaim, cross-claim or third-party complaint may be filed by the accused in the
criminal case, but any cause of action which could have been the subject thereof may be
litigated in a separate civil action." (Emphasis supplied)
Since the present Rules require the accused in a criminal action to file his counterclaim in a separate
civil action, there can be no forum-shopping if the accused files such separate civil action.
Filing of a separate civil action
Section 1, Rule 111 of the 1985 Rules on Criminal Procedure ("1985 Rules" for brevity), as amended
in 1988, allowed the filing of a separate civil action independently of the criminal action provided the
offended party reserved the right to file such civil action. Unless the offended party reserved the civil
action before the presentation of the evidence for the prosecution, all civil actions arising from the
same act or omission were deemed "impliedly instituted" in the criminal case. These civil actions
referred to the recovery of civil liability ex-delicto, the recovery of damages for quasi-delict, and the
recovery of damages for violation of Articles 32, 33 and 34 of the Civil Code on Human Relations.

Thus, to file a separate and independent civil action for quasi-delict under the 1985 Rules, the offended
party had to reserve in the criminal action the right to bring such action. Otherwise, such civil action
was deemed "impliedly instituted" in the criminal action. Section 1, Rule 111 of the 1985 Rules
provided as follows:
"Section 1. Institution of criminal and civil actions. When a criminal action is instituted, the
civil action for the recovery of civil liability is impliedly instituted with the criminal action, unless
the offended party waives the action, reserves his right to institute it separately, or institutes
the civil action prior to the criminal action.
Such civil action includes recovery of indemnity under the Revised Penal Code, and
damages under Articles 32, 33, 34 and 2176 of the Civil Code of the Philippines arising
from the same act or omission of the accused.
A waiver of any of the civil actions extinguishes the others. The institution of, or the reservation
of the right to file, any of said civil actions separately waives the others.
The reservation of the right to institute the separate civil actions shall be made before the
prosecution starts to present its evidence and under circumstances affording the offended
party a reasonable opportunity to make such reservation.
In no case may the offended party recover damages twice for the same act or omission of the
accused.
x x x." (Emphasis supplied)
Section 1, Rule 111 of the 1985 Rules was amended on December 1, 2000 and now provides as
follows:
"SECTION 1. Institution of criminal and civil actions. (a) When a criminal action is
instituted, the civil action for the recovery of civil liability arising from the offense
charged shall be deemed instituted with the criminal action unless the offended party
waives the civil action, reserves the right to institute it separately or institutes the civil action
prior to the criminal action.
The reservation of the right to institute separately the civil action shall be made before the
prosecution starts presenting its evidence and under circumstances affording the offended
party a reasonable opportunity to make such reservation.
xxx
(b) x x x
Where the civil action has been filed separately and trial thereof has not yet commenced, it
may be consolidated with the criminal action upon application with the court trying the latter
case. If the application is granted, the trial of both actions shall proceed in accordance with
section 2 of this rule governing consolidation of the civil and criminal actions." (Emphasis
supplied)
Under Section 1 of the present Rule 111, what is "deemed instituted" with the criminal action is only
the action to recover civil liability arising from the crime or ex-delicto. All the other civil actions under

Articles 32, 33, 34 and 2176 of the Civil Code are no longer "deemed instituted," and may be filed
separately and prosecuted independently even without any reservation in the criminal action. The
failure to make a reservation in the criminal action is not a waiver of the right to file a separate and
independent civil action based on these articles of the Civil Code. The prescriptive period on the civil
actions based on these articles of the Civil Code continues to run even with the filing of the criminal
action. Verily, the civil actions based on these articles of the Civil Code are separate, distinct and
independent of the civil action "deemed instituted" in the criminal action.10
Under the present Rule 111, the offended party is still given the option to file a separate civil action to
recover civil liability ex-delicto by reserving such right in the criminal action before the prosecution
presents its evidence. Also, the offended party is deemed to make such reservation if he files a
separate civil action before filing the criminal action. If the civil action to recover civil liability ex-delicto is
filed separately but its trial has not yet commenced, the civil action may be consolidated with the
criminal action. The consolidation under this Rule does not apply to separate civil actions arising from
the same act or omission filed under Articles 32, 33, 34 and 2176 of the Civil Code.11
Suspension of the Separate Civil Action
Under Section 2, Rule 111 of the amended 1985 Rules, a separate civil action, if reserved in the
criminal action, could not be filed until after final judgment was rendered in the criminal action. If the
separate civil action was filed before the commencement of the criminal action, the civil action, if still
pending, was suspended upon the filing of the criminal action until final judgment was rendered in the
criminal action. This rule applied only to the separate civil action filed to recover liability ex-delicto. The
rule did not apply to independent civil actions based on Articles 32, 33, 34 and 2176 of the Civil Code,
which could proceed independently regardless of the filing of the criminal action.
The amended provision of Section 2, Rule 111 of the 2000 Rules continues this procedure, to wit:
"SEC. 2. When separate civil action is suspended. After the criminal action has been
commenced, the separate civil action arising therefrom cannot be instituted until final judgment
has been entered in the criminal action.
If the criminal action is filed after the said civil action has already been instituted, the
latter shall be suspended in whatever stage it may be found before judgment on the
merits. The suspension shall last until final judgment is rendered in the criminal
action. Nevertheless, before judgment on the merits is rendered in the civil action, the same
may, upon motion of the offended party, be consolidated with the criminal action in the court
trying the criminal action. In case of consolidation, the evidence already adduced in the civil
action shall be deemed automatically reproduced in the criminal action without prejudice to the
right of the prosecution to cross-examine the witnesses presented by the offended party in the
criminal case and of the parties to present additional evidence. The consolidated criminal and
civil actions shall be tried and decided jointly.
During the pendency of the criminal action, the running of the period of prescription of the civil
action which cannot be instituted separately or whose proceeding has been suspended shall
be tolled.
x x x." (Emphasis supplied)
Thus, Section 2, Rule 111 of the present Rules did not change the rule that the separate civil action,
filed to recover damages ex-delicto, is suspended upon the filing of the criminal action. Section 2 of

the present Rule 111 also prohibits the filing, after commencement of the criminal action, of a separate
civil action to recover damagesex-delicto.
When civil action may proceed independently
The crucial question now is whether Casupanan and Capitulo, who are not the offended parties in the
criminal case, can file a separate civil action against the offended party in the criminal case. Section
3, Rule 111 of the 2000 Rules provides as follows:
"SEC 3. When civil action may proceed independently. - In the cases provided in Articles 32,
33, 34 and 2176 of the Civil Code of the Philippines, the independent civil action may be
brought by the offendedparty. It shall proceed independently of the criminal action and shall
require only a preponderance of evidence. In no case, however, may the offended party
recover damages twice for the same act or omission charged in the criminal action." (Emphasis
supplied)
Section 3 of the present Rule 111, like its counterpart in the amended 1985 Rules, expressly allows
the "offended party" to bring an independent civil action under Articles 32, 33, 34 and 2176 of the Civil
Code. As stated in Section 3 of the present Rule 111, this civil action shall proceed independently of
the criminal action and shall require only a preponderance of evidence. In no case, however, may the
"offended party recover damages twice for the same act or omission charged in the criminal action."
There is no question that the offended party in the criminal action can file an independent civil action
for quasi-delict against the accused. Section 3 of the present Rule 111 expressly states that the
"offended party" may bring such an action but the "offended party" may not recover damages twice for
the same act or omission charged in the criminal action. Clearly, Section 3 of Rule 111 refers to the
offended party in the criminal action, not to the accused.
Casupanan and Capitulo, however, invoke the ruling in Cabaero vs. Cantos12 where the Court held
that the accused therein could validly institute a separate civil action for quasi-delict against the private
complainant in the criminal case. In Cabaero, the accused in the criminal case filed his Answer with
Counterclaim for malicious prosecution. At that time the Court noted the "absence of clear-cut rules
governing the prosecution on impliedly instituted civil actions and the necessary consequences and
implications thereof." Thus, the Court ruled that the trial court should confine itself to the criminal
aspect of the case and disregard any counterclaim for civil liability. The Court further ruled that the
accused may file a separate civil case against the offended party "after the criminal case is terminated
and/or in accordance with the new Rules which may be promulgated." The Court explained that a
cross-claim, counterclaim or third-party complaint on the civil aspect will only unnecessarily complicate
the proceedings and delay the resolution of the criminal case.
Paragraph 6, Section 1 of the present Rule 111 was incorporated in the 2000 Rules precisely to
address thelacuna mentioned in Cabaero. Under this provision, the accused is barred from filing a
counterclaim, cross-claim or third-party complaint in the criminal case. However, the same provision
states that "any cause of action which could have been the subject (of the counterclaim, cross-claim
or third-party complaint) may be litigated in a separate civil action." The present Rule 111 mandates
the accused to file his counterclaim in a separate civil actiosn which shall proceed independently of
the criminal action, even as the civil action of the offended party is litigated in the criminal action.
Conclusion
Under Section 1 of the present Rule 111, the independent civil action in Articles 32, 33, 34 and 2176
of the Civil Code is not deemed instituted with the criminal action but may be filed separately by the

offended party even without reservation. The commencement of the criminal action does not suspend
the prosecution of the independent civil action under these articles of the Civil Code. The suspension
in Section 2 of the present Rule 111 refers only to the civil action arising from the crime, if such civil
action is reserved or filed before the commencement of the criminal action.
Thus, the offended party can file two separate suits for the same act or omission. The first a criminal
case where the civil action to recover civil liability ex-delicto is deemed instituted, and the other a civil
case for quasi-delict - without violating the rule on non-forum shopping. The two cases can proceed
simultaneously and independently of each other. The commencement or prosecution of the criminal
action will not suspend the civil action for quasi-delict. The only limitation is that the offended party
cannot recover damages twice for the same act or omission of the defendant. In most cases, the
offended party will have no reason to file a second civil action since he cannot recover damages twice
for the same act or omission of the accused. In some instances, the accused may be insolvent,
necessitating the filing of another case against his employer or guardians.
Similarly, the accused can file a civil action for quasi-delict for the same act or omission he is accused
of in the criminal case. This is expressly allowed in paragraph 6, Section 1 of the present Rule 111
which states that the counterclaim of the accused "may be litigated in a separate civil action." This
is only fair for two reasons. First, the accused is prohibited from setting up any counterclaim in the civil
aspect that is deemed instituted in the criminal case. The accused is therefore forced to litigate
separately his counterclaim against the offended party. If the accused does not file a separate civil
action for quasi-delict, the prescriptive period may set in since the period continues to run until the civil
action for quasi-delict is filed.
Second, the accused, who is presumed innocent, has a right to invoke Article 2177 of the Civil Code,
in the same way that the offended party can avail of this remedy which is independent of the criminal
action. To disallow the accused from filing a separate civil action for quasi-delict, while refusing to
recognize his counterclaim in the criminal case, is to deny him due process of law, access to the
courts, and equal protection of the law.
Thus, the civil action based on quasi-delict filed separately by Casupanan and Capitulo is proper. The
order of dismissal by the MCTC of Civil Case No. 2089 on the ground of forum-shopping is erroneous.
We make this ruling aware of the possibility that the decision of the trial court in the criminal case may
vary with the decision of the trial court in the independent civil action. This possibility has always been
recognized ever since the Civil Code introduced in 1950 the concept of an independent civil action
under Articles 32, 33, 34 and 2176 of the Code. But the law itself, in Article 31 of the Code, expressly
provides that the independent civil action "may proceed independently of the criminal proceedings and
regardless of the result of the latter." In Azucena vs. Potenciano,13 the Court declared:
"x x x. There can indeed be no other logical conclusion than this, for to subordinate the civil
action contemplated in the said articles to the result of the criminal prosecution whether it
be conviction or acquittal would render meaningless the independent character of the civil
action and the clear injunction in Article 31 that this action 'may proceed independently of the
criminal proceedings and regardless of the result of the latter."
More than half a century has passed since the Civil Code introduced the concept of a civil action
separate and independent from the criminal action although arising from the same act or omission.
The Court, however, has yet to encounter a case of conflicting and irreconcilable decisions of trial
courts, one hearing the criminal case and the other the civil action for quasi-delict. The fear of
conflicting and irreconcilable decisions may be more apparent than real. In any event, there are
sufficient remedies under the Rules of Court to deal with such remote possibilities.

One final point. The Revised Rules on Criminal Procedure took effect on December 1, 2000 while the
MCTC issued the order of dismissal on December 28, 1999 or before the amendment of the rules.
The Revised Rules on Criminal Procedure must be given retroactive effect considering the well-settled
rule that "x x x statutes regulating the procedure of the court will be construed as applicable to actions
pending and undetermined at the time of their passage. Procedural laws are retroactive in that
sense and to that extent."14
WHEREFORE, the petition for review on certiorari is hereby GRANTED. The Resolutions dated
December 28, 1999 and August 24, 2000 in Special Civil Action No. 17-C (99) are ANNULLED and
Civil Case No. 2089 is REINSTATED.
SO ORDERED.

G.R. No. 133978

November 12, 2002

JOSE S. CANCIO, JR., represented by ROBERTO L. CANCIO, petitioner,


vs.
EMERENCIANA ISIP, respondent.
YNARES-SANTIAGO, J.:
The instant petition for review under Rule 45 of the Rules of Court raises pure questions of law
involving the March 20, 19981 and June 1, 19982 Orders3 rendered by the Regional Trial Court of
Pampanga, Branch 49, in Civil Case No. G-3272.
The undisputed facts are as follows:
Petitioner, assisted by a private prosecutor, filed three cases of Violation of B.P. No. 22 and three
cases of Estafa, against respondent for allegedly issuing the following checks without sufficient funds,
to wit: 1) Interbank Check No. 25001151 in the amount of P80,000.00; 2) Interbank Check No.
25001152 in the amount of P 80,000.00; and 3) Interbank Check No. 25001157 in the amount of
P30,000.00.4
The Office of the Provincial Prosecutor dismissed Criminal Case No. 13356, for Violation of B.P. No.
22 covering check no. 25001151 on the ground that the check was deposited with the drawee bank
after 90 days from the date of the check. The two other cases for Violation of B.P. No. 22 (Criminal
Case No. 13359 and 13360) were filed with and subsequently dismissed by the Municipal Trial Court
of Guagua, Pampanga, Branch 1, on the ground of "failure to prosecute."5
Meanwhile, the three cases for Estafa were filed with the Regional Trial Court of Pampanga, Branch
49, and docketed as Criminal Case Nos. G-3611 to G-3613. On October 21, 1997, after failing to
present its second witness, the prosecution moved to dismiss the estafa cases against respondent.
The prosecution likewise reserved its right to file a separate civil action arising from the said criminal
cases. On the same date, the trial court granted the motions of the prosecution. ThusUpon motion of the prosecution for the dismissal of these cases without prejudice to the refiling of the
civil aspect thereof and there being no comment from the defense, let these cases be dismissed
without prejudice to the refiling of the civil aspect of the cases.
SO ORDER[ED].6
On December 15, 1997, petitioner filed the instant case for collection of sum of money, seeking to
recover the amount of the checks subject of the estafa cases. On February 18, 1998, respondent filed
a motion to dismiss the complaint contending that petitioners action is barred by the doctrine of res
judicata. Respondent further prayed that petitioner should be held in contempt of court for forumshopping.7
On March 20, 1998, the trial court found in favor of respondent and dismissed the complaint. The court
held that the dismissal of the criminal cases against respondent on the ground of lack of interest or
failure to prosecute is an adjudication on the merits which amounted to res judicata on the civil case
for collection. It further held that the filing of said civil case amounted to forum-shopping.
On June 1, 1998, the trial court denied petitioners motion for reconsideration.8 Hence, the instant
petition.

The legal issues for resolution in the case at bar are: 1) whether the dismissal of the estafa cases
against respondent bars the institution of a civil action for collection of the value of the checks subject
of the estafa cases; and 2) whether the filing of said civil action violated the anti-forum-shopping rule.
An act or omission causing damage to another may give rise to two separate civil liabilities on the part
of the offender, i.e., (1) civil liability ex delicto, under Article 100 of the Revised Penal Code; 9 and (2)
independent civil liabilities, such as those (a) not arising from an act or omission complained of as
felony [e.g. culpa contractual or obligations arising from law under Article 31 10 of the Civil
Code,11 intentional torts under Articles 3212 and 34,13and culpa aquiliana under Article 217614 of the
Civil Code]; or (b) where the injured party is granted a right to file an action independent and distinct
from the criminal action [Article 33,15 Civil Code].16 Either of these two possible liabilities may be
enforced against the offender subject, however, to the caveat under Article 2177 of the Civil Code that
the offended party "cannot recover damages twice for the same act or omission" or under both
causes.17
The modes of enforcement of the foregoing civil liabilities are provided for in the Revised Rules of
Criminal Procedure. Though the assailed order of the trial court was issued on March 20, 1998, the
said Rules, which took effect on December 1, 2000, must be given retroactive effect in the instant case
considering that statutes regulating the procedure of the court are construed as applicable to actions
pending and undetermined at the time of their passage.18
Section 1, Rule 111, of the Revised Rules of Criminal Procedure provides:
SECTION 1. Institution of criminal and civil actions. (a) When a criminal action is instituted, the civil
action for the recovery of civil liability arising from the offense charged shall be deemed instituted with
the criminal action unless the offended party waives the civil action, reserves the right to institute it
separately or institutes the civil action prior to the criminal action.
The reservation of the right to institute separately the civil action shall be made before the prosecution
starts presenting its evidence and under circumstances affording the offended party a reasonable
opportunity to make such reservation.
xxxxxxxxx
Where the civil action has been filed separately and trial thereof has not yet commenced, it may be
consolidated with the criminal action upon application with the court trying the latter case. If the
application is granted, the trial of both actions shall proceed in accordance with section 2 of this Rule
governing consolidation of the civil and criminal actions.
Under the 1985 Rules on Criminal Procedure, as amended in 1988 and under the present Rules, the
civil liability ex-delicto is deemed instituted with the criminal action, but the offended party is given the
option to file a separate civil action before the prosecution starts to present evidence.19
Anent the independent civil actions under Articles 31, 32, 33, 34 and 2176 of the Civil Code, the old
rules considered them impliedly instituted with the civil liability ex-delicto in the criminal action, unless
the offended party waives the civil action, reserves his right to institute it separately, or institutes the
civil action prior to the criminal action. Under the present Rules, however, the independent civil actions
may be filed separately and prosecuted independently even without any reservation in the criminal
action. The failure to make a reservation in the criminal action is not a waiver of the right to file a
separate and independent civil action based on these articles of the Civil Code.20

In the case at bar, a reading of the complaint filed by petitioner show that his cause of action is based
on culpa contractual, an independent civil action. Pertinent portion of the complaint reads:
xxxxxxxxx
2. That plaintiff is the owner/proprietor to CANCIOS MONEY EXCHANGE with office address
at Guagua, Pampanga;
3. That on several occasions, particularly on February 27, 1993 to April 17 1993, inclusive,
defendant drew, issued and made in favor of the plaintiff the following checks:
CHECK NO. DATE AMOUNT
1. Interbank Check No. 25001151 March 10, 1993 P80,000.00
2. Interbank Check No. 25001152 March 27, 1993 P80,000.00
3. Interbank Check No. 25001157 May 17, 1993 P30,000.00
in exchange of cash with the assurance that the said checks will be honored for
payment on their maturity dates, copy of the aforementioned checks are hereto
attached and marked.
4. That when the said checks were presented to the drawee bank for encashment, the same
were all dishonored for reason of DRAWN AGAINST INSUFFICIENT FUNDS (DAIF);
5. That several demands were made upon the defendant to make good the checks but she
failed and refused and still fails and refuses without justifiable reason to pay plaintiff;
6. That for failure of the defendant without any justifiable reason to pay plaintiff the value of
the checks, the latter was forced to hire the services of undersigned counsel and agreed to
pay the amount of P30,000.00 as attorneys fees and P1,000.00 per appearance in court;
7. That for failure of the defendant without any justifiable reason to pay plaintiff and forcing the
plaintiff to litigate, the latter will incur litigation expenses in the amount of P20,000.00.
IN VIEW OF THE FOREGOING, it is prayed of this Court that after due notice and hearing a judgment
be rendered ordering defendant to pay plaintiff as follows:
a. the principal sum of P190,000.00 plus the legal interest;
b. attorneys fees of P30,000.00 plus P1,000.00 per court appearance;
c. litigation expenses in the amount of P20,000.00
PLAINTIFF prays for other reliefs just and equitable under the premises.
x x x x x x x x x.21

Evidently, petitioner sought to enforce respondents obligation to make good the value of the checks
in exchange for the cash he delivered to respondent. In other words, petitioners cause of action is the
respondents breach of the contractual obligation. It matters not that petitioner claims his cause of
action to be one based on delict.22 The nature of a cause of action is determined by the facts alleged
in the complaint as constituting the cause of action. The purpose of an action or suit and the law to
govern it is to be determined not by the claim of the party filing the action, made in his argument or
brief, but rather by the complaint itself, its allegations and prayer for relief.23
Neither does it matter that the civil action reserved in the October 21, 1997 order of the trial court was
the civil action ex delicto. To reiterate, an independent civil action arising from contracts, as in the
instant case, may be filed separately and prosecuted independently even without any reservation in
the criminal action. Under Article 31 of the Civil Code "[w]hen the civil action is based on an obligation
not arising from the act or omission complained of as a felony, [e.g. culpa contractual] such civil action
may proceed independently of the criminal proceedings and regardless of the result of the latter."
Thus, in Vitola, et al. v. Insular Bank of Asia and America,24the Court, applying Article 31 of the Civil
Code, held that a civil case seeking to recover the value of the goods subject of a Letter of CreditTrust Receipt is a civil action ex contractu and not ex delicto. As such, it is distinct and independent
from the estafa case filed against the offender and may proceed regardless of the result of the criminal
proceedings.
One of the elements of res judicata is identity of causes of action.25 In the instant case, it must be
stressed that the action filed by petitioner is an independent civil action, which remains separate and
distinct from any criminal prosecution based on the same act.26 Not being deemed instituted in the
criminal action based on culpa criminal, a ruling on the culpability of the offender will have no bearing
on said independent civil action based on an entirely different cause of action, i.e., culpa contractual.
In the same vein, the filing of the collection case after the dismissal of the estafa cases against
respondent did not amount to forum-shopping. The essence of forum-shopping is the filing of multiple
suits involving the same parties for the same cause of action, either simultaneously or successively,
to secure a favorable judgment. Although the cases filed by petitioner arose from the same act or
omission of respondent, they are, however, based on different causes of action. The criminal cases
for estafa are based on culpa criminal while the civil action for collection is anchored on culpa
contractual. Moreover, there can be no forum-shopping in the instant case because the law expressly
allows the filing of a separate civil action which can proceed independently of the criminal action.27
Clearly, therefore, the trial court erred in dismissing petitioners complaint for collection of the value of
the checks issued by respondent. Being an independent civil action which is separate and distinct from
any criminal prosecution and which require no prior reservation for its institution, the doctrine of res
judicata and forum-shopping will not operate to bar the same.
WHEREFORE, in view of all the foregoing, the instant petition is GRANTED. The March 20, 1998 and
June 1, 1998 Orders of the Regional Trial Court of Pampanga, Branch 49, in Civil Case No. G-3272
are REVERSED and SET ASIDE. The instant case is REMANDED to the trial court for further
proceedings.
SO ORDERED.

G.R. No. 124354 December 29, 1999


ROGELIO E. RAMOS and ERLINDA RAMOS, in their own behalf and as natural guardians of
the minors, ROMMEL RAMOS, ROY RODERICK RAMOS and RON RAYMOND
RAMOS, petitioners,
vs.
COURT OF APPEALS, DELOS SANTOS MEDICAL CENTER, DR. ORLINO HOSAKA and DRA.
PERFECTA GUTIERREZ, respondents.
KAPUNAN, J.:
The Hippocratic Oath mandates physicians to give primordial consideration to the health and welfare
of their patients. If a doctor fails to live up to this precept, he is made accountable for his acts. A
mistake, through gross negligence or incompetence or plain human error, may spell the difference
between life and death. In this sense, the doctor plays God on his patient's fate. 1
In the case at bar, the Court is called upon to rule whether a surgeon, an anesthesiologist and a
hospital should be made liable for the unfortunate comatose condition of a patient scheduled for
cholecystectomy. 2
Petitioners seek the reversal of the decision

of the Court of Appeals, dated 29 May 1995, which


overturned the decision of the Regional Trial Court, dated 30 January 1992, finding private respondents
liable for damages arising from negligence in the performance of their professional duties towards petitioner
Erlinda Ramos resulting in her comatose condition.
4

The antecedent facts as summarized by the trial court are reproduced hereunder:
Plaintiff Erlinda Ramos was, until the afternoon of June 17, 1985, a 47-year old (Exh.
"A") robust woman (TSN, October 19, 1989, p. 10). Except for occasional complaints
of discomfort due to pains allegedly caused by the presence of a stone in her gall
bladder (TSN, January 13, 1988, pp. 4-5), she was as normal as any other woman.
Married to Rogelio E. Ramos, an executive of Philippine Long Distance Telephone
Company, she has three children whose names are Rommel Ramos, Roy Roderick
Ramos and Ron Raymond Ramos (TSN, October 19, 1989, pp. 5-6).
Because the discomforts somehow interfered with her normal ways, she sought
professional advice. She was advised to undergo an operation for the removal of a
stone in her gall bladder (TSN, January 13, 1988, p. 5). She underwent a series of
examinations which included blood and urine tests (Exhs. "A" and "C") which indicated
she was fit for surgery.
Through the intercession of a mutual friend, Dr. Buenviaje (TSN, January 13, 1988, p.
7), she and her husband Rogelio met for the first time Dr. Orlino Hozaka (should be
Hosaka; see TSN, February 20, 1990, p. 3), one of the defendants in this case, on
June 10, 1985. They agreed that their date at the operating table at the DLSMC
(another defendant), would be on June 17, 1985 at 9:00 A.M.. Dr. Hosaka decided that
she should undergo a "cholecystectomy" operation after examining the documents
(findings from the Capitol Medical Center, FEU Hospital and DLSMC) presented to
him. Rogelio E. Ramos, however, asked Dr. Hosaka to look for a good
anesthesiologist. Dr. Hosaka, in turn, assured Rogelio that he will get a good
anesthesiologist. Dr. Hosaka charged a fee of P16,000.00, which was to include the
anesthesiologist's fee and which was to be paid after the operation (TSN, October 19,

1989, pp. 14-15, 22-23, 31-33; TSN, February 27, 1990, p. 13; and TSN, November 9,
1989, pp. 3-4, 10, 17).
A day before the scheduled date of operation, she was admitted at one of the rooms
of the DLSMC, located along E. Rodriguez Avenue, Quezon City (TSN, October
19,1989, p. 11).
At around 7:30 A.M. of June 17, 1985 and while still in her room, she was prepared for
the operation by the hospital staff. Her sister-in-law, Herminda Cruz, who was the Dean
of the College of Nursing at the Capitol Medical Center, was also there for moral
support. She reiterated her previous request for Herminda to be with her even during
the operation. After praying, she was given injections. Her hands were held by
Herminda as they went down from her room to the operating room (TSN, January 13,
1988, pp. 9-11). Her husband, Rogelio, was also with her (TSN, October 19, 1989, p.
18). At the operating room, Herminda saw about two or three nurses and Dr. Perfecta
Gutierrez, the other defendant, who was to administer anesthesia. Although not a
member of the hospital staff, Herminda introduced herself as Dean of the College of
Nursing at the Capitol Medical Center who was to provide moral support to the patient,
to them. Herminda was allowed to stay inside the operating room.
At around 9:30 A.M., Dr. Gutierrez reached a nearby phone to look for Dr. Hosaka who
was not yet in (TSN, January 13, 1988, pp. 11-12). Dr. Gutierrez thereafter informed
Herminda Cruz about the prospect of a delay in the arrival of Dr. Hosaka. Herminda
then went back to the patient who asked, "Mindy, wala pa ba ang Doctor"? The former
replied, "Huwag kang mag-alaala, darating na iyon" (Ibid.).
Thereafter, Herminda went out of the operating room and informed the patient's
husband, Rogelio, that the doctor was not yet around (id., p. 13). When she returned
to the operating room, the patient told her, "Mindy, inip na inip na ako, ikuha mo ako
ng ibang Doctor." So, she went out again and told Rogelio about what the patient said
(id., p. 15). Thereafter, she returned to the operating room.
At around 10:00 A.M., Rogelio E. Ramos was "already dying [and] waiting for the
arrival of the doctor" even as he did his best to find somebody who will allow him to
pull out his wife from the operating room (TSN, October 19, 1989, pp. 19-20). He also
thought of the feeling of his wife, who was inside the operating room waiting for the
doctor to arrive (ibid.). At almost 12:00 noon, he met Dr. Garcia who remarked that he
(Dr. Garcia) was also tired of waiting for Dr. Hosaka to arrive (id., p. 21). While talking
to Dr. Garcia at around 12:10 P.M., he came to know that Dr. Hosaka arrived as a
nurse remarked, "Nandiyan na si Dr. Hosaka, dumating na raw." Upon hearing those
words, he went down to the lobby and waited for the operation to be completed (id.,
pp. 16, 29-30).
At about 12:15 P.M., Herminda Cruz, who was inside the operating room with the
patient, heard somebody say that "Dr. Hosaka is already here." She then saw people
inside the operating room "moving, doing this and that, [and] preparing the patient for
the operation" (TSN, January 13, 1988, p. 16). As she held the hand of Erlinda Ramos,
she then saw Dr. Gutierrez intubating the hapless patient. She thereafter heard Dr.
Gutierrez say, "ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki
ang tiyan" (id., p. 17). Because of the remarks of Dra. Gutierrez, she focused her
attention on what Dr. Gutierrez was doing. She thereafter noticed bluish discoloration
of the nailbeds of the left hand of the hapless Erlinda even as Dr. Hosaka approached

her. She then heard Dr. Hosaka issue an order for someone to call Dr. Calderon,
another anesthesiologist (id., p. 19). After Dr. Calderon arrived at the operating room,
she saw this anesthesiologist trying to intubate the patient. The patient's nailbed
became bluish and the patient was placed in a trendelenburg 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 blood supply to the patient's brain (Id., pp. 1920). Immediately thereafter, she went out of the operating room, and she told Rogelio
E. Ramos "that something wrong was . . . happening" (Ibid.). Dr. Calderon was then
able to intubate the patient (TSN, July 25, 1991, p. 9).
Meanwhile, Rogelio, who was outside the operating room, saw a respiratory machine
being rushed towards the door of the operating room. He also saw several doctors
rushing towards the operating room. When informed by Herminda Cruz that something
wrong was happening, he told her (Herminda) to be back with the patient inside the
operating room (TSN, October 19, 1989, pp. 25-28).
Herminda Cruz immediately rushed back, and saw that the patient was still in
trendelenburg position (TSN, January 13, 1988, p. 20). At almost 3:00 P.M. of that
fateful day, she saw the patient taken to the Intensive Care Unit (ICU).
About two days thereafter, Rogelio E. Ramos was able to talk to Dr. Hosaka. The latter
informed the former that something went wrong during the intubation. Reacting to what
was told to him, Rogelio reminded the doctor that the condition of his wife would not
have happened, had he (Dr. Hosaka) looked for a good anesthesiologist (TSN,
October 19, 1989, p. 31).
Doctors Gutierrez and Hosaka were also asked by the hospital to explain what
happened to the patient. The doctors explained that the patient had bronchospasm
(TSN, November 15, 1990, pp. 26-27).
Erlinda Ramos stayed at the ICU for a month. About four months thereafter or on
November 15, 1985, the patient was released from the hospital.
During the whole period of her confinement, she incurred hospital bills amounting to
P93,542.25 which is the subject of a promissory note and affidavit of undertaking
executed by Rogelio E. Ramos in favor of DLSMC. Since that fateful afternoon of June
17, 1985, she has been in a comatose condition. She cannot do anything. She cannot
move any part of her body. She cannot see or hear. She is living on mechanical means.
She suffered brain damage as a result of the absence of oxygen in her brain for four
to five minutes (TSN, November 9, 1989, pp. 21-22). After being discharged from the
hospital, she has been staying in their residence, still needing constant medical
attention, with her husband Rogelio incurring a monthly expense ranging from
P8,000.00 to P10,000.00 (TSN, October 19, 1989, pp. 32-34). She was also diagnosed
to be suffering from "diffuse cerebral parenchymal damage" (Exh. "G"; see also TSN,
December
21,
1989,
p. 6). 5
Thus, on 8 January 1986, petitioners filed a civil case

for damages with the Regional Trial Court of


Quezon City against herein private respondents alleging negligence in the management and care of Erlinda
Ramos.

During the trial, both parties presented evidence as to the possible cause of Erlinda's injury. Plaintiff
presented the testimonies of Dean Herminda Cruz and Dr. Mariano Gavino to prove that the sustained
by Erlinda was due to lack of oxygen in her brain caused by the faulty management of her airway by
private respondents during the anesthesia phase. On the other hand, private respondents primarily
relied on the expert testimony of Dr. Eduardo Jamora, a pulmonologist, to the effect that the cause of
brain damage was Erlinda's allergic reaction to the anesthetic agent, Thiopental Sodium (Pentothal).
After considering the evidence from both sides, the Regional Trial Court rendered judgment in favor
of petitioners, to wit:
After evaluating the evidence as shown in the finding of facts set forth earlier, and
applying the aforecited provisions of law and jurisprudence to the case at bar, this
Court finds and so holds that defendants are liable to plaintiffs for damages. The
defendants were guilty of, at the very least, negligence in the performance of their duty
to plaintiff-patient Erlinda Ramos.
On the part of Dr. Perfecta Gutierrez, this Court finds that she omitted to exercise
reasonable care in not only intubating the patient, but also in not repeating the
administration of atropine (TSN, August 20, 1991, pp. 5-10), without due regard to the
fact that the patient was inside the operating room for almost three (3) hours. For after
she committed a mistake in intubating [the] patient, the patient's nailbed became bluish
and the patient, thereafter, was placed in trendelenburg position, because of the
decrease of blood supply to the patient's brain. The evidence further shows that the
hapless patient suffered brain damage because of the absence of oxygen in her
(patient's) brain for approximately four to five minutes which, in turn, caused the patient
to become comatose.
On the part of Dr. Orlino Hosaka, this Court finds that he is liable for the acts of Dr.
Perfecta Gutierrez whom he had chosen to administer anesthesia on the patient as
part of his obligation to provide the patient a good anesthesiologist', and for arriving for
the scheduled operation almost three (3) hours late.
On the part of DLSMC (the hospital), this Court finds that it is liable for the acts of
negligence of the doctors in their "practice of medicine" in the operating room.
Moreover, the hospital is liable for failing through its responsible officials, to cancel the
scheduled operation after Dr. Hosaka inexcusably failed to arrive on time.
In having held thus, this Court rejects the defense raised by defendants that they have
acted with due care and prudence in rendering medical services to plaintiff-patient. For
if the patient was properly intubated as claimed by them, the patient would not have
become comatose. And, the fact that another anesthesiologist was called to try to
intubate the patient after her (the patient's) nailbed turned bluish, belie their claim.
Furthermore, the defendants should have rescheduled the operation to a later date.
This, they should have done, if defendants acted with due care and prudence as the
patient's case was an elective, not an emergency case.
xxx xxx xxx
WHEREFORE, and in view of the foregoing, judgment is rendered in favor of the
plaintiffs and against the defendants. Accordingly, the latter are ordered to pay, jointly
and severally, the former the following sums of money, to wit:

1) the sum of P8,000.00 as actual monthly expenses for the plaintiff


Erlinda Ramos reckoned from November 15, 1985 or in the total sum
of P632,000.00 as of April 15, 1992, subject to its being updated;
2) the sum of P100,000.00 as reasonable attorney's fees;
3) the sum of P800,000.00 by way of moral damages and the further
sum of P200,000,00 by way of exemplary damages; and,
4) the costs of the suit.
SO ORDERED. 7
Private respondents seasonably interposed an appeal to the Court of Appeals. The appellate court
rendered a Decision, dated 29 May 1995, reversing the findings of the trial court. The decretal portion
of the decision of the appellate court reads:
WHEREFORE, for the foregoing premises the appealed decision is hereby
REVERSED, and the complaint below against the appellants is hereby ordered
DISMISSED. The counterclaim of appellant De Los Santos Medical Center is
GRANTED but only insofar as appellees are hereby ordered to pay the unpaid hospital
bills amounting to P93,542.25, plus legal interest for justice must be tempered with
mercy.
SO ORDERED. 8
The decision of the Court of Appeals was received on 9 June 1995 by petitioner Rogelio Ramos who
was mistakenly addressed as "Atty. Rogelio Ramos." No copy of the decision, however, was sent nor
received by the Coronel Law Office, then counsel on record of petitioners. Rogelio referred the
decision of the appellate court to a new lawyer, Atty. Ligsay, only on 20 June 1995, or four (4) days
before the expiration of the reglementary period for filing a motion for reconsideration. On the same
day, Atty. Ligsay, filed with the appellate court a motion for extension of time to file a motion for
reconsideration. The motion for reconsideration was submitted on 4 July 1995. However, the appellate
court denied the motion for extension of time in its Resolution dated 25 July 1995. 9Meanwhile,
petitioners engaged the services of another counsel, Atty. Sillano, to replace Atty. Ligsay. Atty. Sillano filed
on 7 August 1995 a motion to admit the motion for reconsideration contending that the period to file the
appropriate pleading on the assailed decision had not yet commenced to run as the Division Clerk of Court
of the Court of Appeals had not yet served a copy thereof to the counsel on record. Despite this explanation,
the appellate court still denied the motion to admit the motion for reconsideration of petitioners in its
Resolution, dated 29 March 1996, primarily on the ground that the fifteen-day (15) period for filing a motion
for reconsideration had already expired, to wit:

We said in our Resolution on July 25, 1995, that the filing of a Motion for
Reconsideration cannot be extended; precisely, the Motion for Extension (Rollo, p. 12)
was denied. It is, on the other hand, admitted in the latter Motion that
plaintiffs/appellees received a copy of the decision as early as June 9, 1995.
Computation wise, the period to file a Motion for Reconsideration expired on June 24.
The Motion for Reconsideration, in turn, was received by the Court of Appeals already
on July 4, necessarily, the 15-day period already passed. For that alone, the latter
should be denied.

Even assuming admissibility of the Motion for the Reconsideration, but after
considering the Comment/Opposition, the former, for lack of merit, is hereby DENIED.
SO ORDERED. 10
A copy of the above resolution was received by Atty. Sillano on 11 April 1996. The next day, or on 12
April 1996, Atty. Sillano filed before this Court a motion for extension of time to file the present petition
for certiorari under Rule 45. The Court granted the motion for extension of time and gave petitioners
additional thirty (30) days after the expiration of the fifteen-day (15) period counted from the receipt of
the resolution of the Court of Appeals within which to submit the petition. The due date fell on 27 May
1996. The petition was filed on 9 May 1996, well within the extended period given by the Court.
Petitioners assail the decision of the Court of Appeals on the following grounds:
I
IN PUTTING MUCH RELIANCE ON THE TESTIMONIES OF RESPONDENTS DRA.
GUTIERREZ, DRA. CALDERON AND DR. JAMORA;
II
IN FINDING THAT THE NEGLIGENCE OF THE RESPONDENTS DID NOT CAUSE
THE UNFORTUNATE COMATOSE CONDITION OF PETITIONER ERLINDA
RAMOS;
III
IN NOT APPLYING THE DOCTRINE OF RES IPSA LOQUITUR. 11
Before we discuss the merits of the case, we shall first dispose of the procedural issue on the
timeliness of the petition in relation to the motion for reconsideration filed by petitioners with the Court
of
Appeals.
In
their
Comment, 12 private respondents contend that the petition should not be given due course since the motion
for reconsideration of the petitioners on the decision of the Court of Appeals was validly dismissed by the
appellate court for having been filed beyond the reglementary period. We do not agree.

A careful review of the records reveals that the reason behind the delay in filing the motion for
reconsideration is attributable to the fact that the decision of the Court of Appeals was not sent to then
counsel on record of petitioners, the Coronel Law Office. In fact, a copy of the decision of the appellate
court was instead sent to and received by petitioner Rogelio Ramos on 9 June 1995 wherein he was
mistakenly addressed as Atty. Rogelio Ramos. Based on the other communications received by
petitioner Rogelio Ramos, the appellate court apparently mistook him for the counsel on record. Thus,
no copy of the decision of the counsel on record. Petitioner, not being a lawyer and unaware of the
prescriptive period for filing a motion for reconsideration, referred the same to a legal counsel only on
20 June 1995.
It is elementary that when a party is represented by counsel, all notices should be sent to the party's
lawyer at his given address. With a few exceptions, notice to a litigant without notice to his counsel on
record is no notice at all. In the present case, since a copy of the decision of the appellate court was
not sent to the counsel on record of petitioner, there can be no sufficient notice to speak of. Hence,
the delay in the filing of the motion for reconsideration cannot be taken against petitioner. Moreover,

since the Court of Appeals already issued a second Resolution, dated 29 March 1996, which
superseded the earlier resolution issued on 25 July 1995, and denied the motion for reconsideration
of petitioner, we believed that the receipt of the former should be considered in determining the
timeliness of the filing of the present petition. Based on this, the petition before us was submitted on
time.
After resolving the foregoing procedural issue, we shall now look into the merits of the case. For a
more logical presentation of the discussion we shall first consider the issue on the applicability of the
doctrine of res ipsa loquitur to the instant case. Thereafter, the first two assigned errors shall be tackled
in relation to the res ipsa loquitur doctrine.
Res ipsa loquitur is a Latin phrase which literally means "the thing or the transaction speaks for itself."
The phrase "res ipsa loquitur'' is a maxim for the rule that the fact of the occurrence of an injury, taken
with the surrounding circumstances, may permit an inference or raise a presumption of negligence, or
make out a plaintiff's prima faciecase, and present a question of fact for defendant to meet with an
explanation. 13 Where the thing which caused the injury complained of is shown to be under the
management of the defendant or his servants and the accident is such as in ordinary course of things does
not happen if those who have its management or control use proper care, it affords reasonable evidence,
in the absence of explanation by the defendant, that the accident arose from or was caused by the
defendant's want of care. 14

The doctrine of res ipsa loquitur is simply a recognition of the postulate that, as a matter of common
knowledge and experience, the very nature of certain types of occurrences may justify an inference of
negligence on the part of the person who controls the instrumentality causing the injury in the absence
of some explanation by the defendant who is charged with negligence. 15 It is grounded in the superior
logic of ordinary human experience and on the basis of such experience or common knowledge, negligence
may be deduced from the mere occurrence of the accident itself. 16 Hence, res ipsa loquitur is applied in
conjunction with the doctrine of common knowledge.

However, much has been said that res ipsa loquitur is not a rule of substantive law and, as such, does
not create or constitute an independent or separate ground of liability. 17 Instead, it is considered as
merely evidentiary or in the nature of a procedural rule. 18 It is regarded as a mode of proof, or a mere
procedural of convenience since it furnishes a substitute for, and relieves a plaintiff of, the burden of
producing specific proof of negligence. 19 In other words, mere invocation and application of the doctrine
does not dispense with the requirement of proof of negligence. It is simply a step in the process of such
proof, permitting the plaintiff to present along with the proof of the accident, enough of the attending
circumstances to invoke the doctrine, creating an inference or presumption of negligence, and to thereby
place on the defendant the burden of going forward with the proof. 20 Still, before resort to the doctrine may
be allowed, the following requisites must be satisfactorily shown:

1. The accident is of a kind which ordinarily does not occur in the


absence of someone's negligence;
2. It is caused by an instrumentality within the exclusive control of the
defendant or defendants; and
3. The possibility of contributing conduct which would make the plaintiff
responsible is eliminated. 21
In the above requisites, the fundamental element is the "control of instrumentality" which caused the
damage. 22Such element of control must be shown to be within the dominion of the defendant. In order to
have the benefit of the rule, a plaintiff, in addition to proving injury or damage, must show a situation where

it is applicable, and must establish that the essential elements of the doctrine were present in a particular
incident. 23

Medical malpractice

24

cases do not escape the application of this doctrine. Thus, res ipsa loquitur has
been applied when the circumstances attendant upon the harm are themselves of such a character as to
justify an inference of negligence as the cause of that harm. 25 The application of res ipsa loquitur in medical
negligence cases presents a question of law since it is a judicial function to determine whether a certain
set of circumstances does, as a matter of law, permit a given inference. 26

Although generally, expert medical testimony is relied upon in malpractice suits to prove that a
physician has done a negligent act or that he has deviated from the standard medical procedure, when
the doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert medical testimony is
dispensed with because the injury itself provides the proof of negligence. 27 The reason is that the
general rule on the necessity of expert testimony applies only to such matters clearly within the domain of
medical science, and not to matters that are within the common knowledge of mankind which may be
testified to by anyone familiar with the facts. 28 Ordinarily, only physicians and surgeons of skill and
experience are competent to testify as to whether a patient has been treated or operated upon with a
reasonable degree of skill and care. However, testimony as to the statements and acts of physicians and
surgeons, external appearances, and manifest conditions which are observable by any one may be given
by non-expert witnesses. 29 Hence, in cases where theres ipsa loquitur is applicable, the court is permitted
to find a physician negligent upon proper proof of injury to the patient, without the aid of expert testimony,
where the court from its fund of common knowledge can determine the proper standard of care. 30 Where
common knowledge and experience teach that a resulting injury would not have occurred to the patient if
due care had been exercised, an inference of negligence may be drawn giving rise to an application of the
doctrine of res ipsa loquitur without medical evidence, which is ordinarily required to show not only what
occurred but how and why it occurred. 31 When the doctrine is appropriate, all that the patient must do is
prove a nexus between the particular act or omission complained of and the injury sustained while under
the custody and management of the defendant without need to produce expert medical testimony to
establish the standard of care. Resort to res ipsa loquitur is allowed because there is no other way, under
usual and ordinary conditions, by which the patient can obtain redress for injury suffered by him.

Thus, courts of other jurisdictions have applied the doctrine in the following situations: leaving of a
foreign object in the body of the patient after an operation, 32 injuries sustained on a healthy part of the
body which was not under, or in the area, of treatment, 33 removal of the wrong part of the body when
another part was intended, 34 knocking out a tooth while a patient's jaw was under anesthetic for the removal
of his tonsils, 35 and loss of an eye while the patient plaintiff was under the influence of anesthetic, during
or following an operation for appendicitis, 36 among others.

Nevertheless, despite the fact that the scope of res ipsa loquitur has been measurably enlarged, it
does not automatically apply to all cases of medical negligence as to mechanically shift the burden of
proof to the defendant to show that he is not guilty of the ascribed negligence. Res ipsa loquitur is not
a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously applied, depending upon
the circumstances of each case. It is generally restricted to situations in malpractice cases where a
layman is able to say, as a matter of common knowledge and observation, that the consequences of
professional care were not as such as would ordinarily have followed if due care had been
exercised. 37 A distinction must be made between the failure to secure results, and the occurrence of
something more unusual and not ordinarily found if the service or treatment rendered followed the usual
procedure of those skilled in that particular practice. It must be conceded that the doctrine of res ipsa
loquitur can have no application in a suit against a physician or surgeon which involves the merits of a
diagnosis or of a scientific treatment. 38 The physician or surgeon is not required at his peril to explain why
any particular diagnosis was not correct, or why any particular scientific treatment did not produce the
desired result. 39 Thus, res ipsa loquitur is not available in a malpractice suit if the only showing is that the
desired result of an operation or treatment was not accomplished. 40 The real question, therefore, is whether
or not in the process of the operation any extraordinary incident or unusual event outside of the routine

performance occurred which is beyond the regular scope of customary professional activity in such
operations, which, if unexplained would themselves reasonably speak to the average man as the negligent
cause or causes of the untoward consequence. 41 If there was such extraneous interventions, the doctrine
of res ipsa loquitur may be utilized and the defendant is called upon to explain the matter, by evidence of
exculpation, if he could. 42

We find the doctrine of res ipsa loquitur appropriate in the case at bar. As will hereinafter be explained,
the damage sustained by Erlinda in her brain prior to a scheduled gall bladder operation presents a
case for the application of res ipsa loquitur.
A case strikingly similar to the one before us is Voss vs. Bridwell, 43 where the Kansas Supreme Court
in applying theres ipsa loquitur stated:

The plaintiff herein submitted himself for a mastoid operation and delivered his person
over to the care, custody and control of his physician who had complete and exclusive
control over him, but the operation was never performed. At the time of submission he
was neurologically sound and physically fit in mind and body, but he suffered
irreparable damage and injury rendering him decerebrate and totally incapacitated.
The injury was one which does not ordinarily occur in the process of a mastoid
operation or in the absence of negligence in the administration of an anesthetic, and
in the use and employment of an endoctracheal tube. Ordinarily a person being put
under anesthesia is not rendered decerebrate as a consequence of administering such
anesthesia in the absence of negligence. Upon these facts and under these
circumstances a layman would be able to say, as a matter of common knowledge and
observation, that the consequences of professional treatment were not as such as
would ordinarily have followed if due care had been exercised.
Here the plaintiff could not have been guilty of contributory negligence because he was
under the influence of anesthetics and unconscious, and the circumstances are such
that the true explanation of event is more accessible to the defendants than to the
plaintiff for they had the exclusive control of the instrumentalities of anesthesia.
Upon all the facts, conditions and circumstances alleged in Count II it is held that a
cause of action is stated under the doctrine of res ipsa loquitur. 44
Indeed, the principles enunciated in the aforequoted case apply with equal force here. In the present
case, Erlinda submitted herself for cholecystectomy and expected a routine general surgery to be
performed on her gall bladder. On that fateful day she delivered her person over to the care, custody
and control of private respondents who exercised complete and exclusive control over her. At the time
of submission, Erlinda was neurologically sound and, except for a few minor discomforts, was likewise
physically fit in mind and body. However, during the administration of anesthesia and prior to the
performance of cholecystectomy she suffered irreparable damage to her brain. Thus, without
undergoing surgery, she went out of the operating room already decerebrate and totally incapacitated.
Obviously, brain damage, which Erlinda sustained, is an injury which does not normally occur in the
process of a gall bladder operation. In fact, this kind of situation does not in the absence of negligence
of someone in the administration of anesthesia and in the use of endotracheal tube. Normally, a person
being put under anesthesia is not rendered decerebrate as a consequence of administering such
anesthesia if the proper procedure was followed. Furthermore, the instruments used in the
administration of anesthesia, including the endotracheal tube, were all under the exclusive control of
private respondents, who are the physicians-in-charge. Likewise, petitioner Erlinda could not have
been guilty of contributory negligence because she was under the influence of anesthetics which
rendered her unconscious.

Considering that a sound and unaffected member of the body (the brain) is injured or destroyed while
the patient is unconscious and under the immediate and exclusive control of the physicians, we hold
that a practical administration of justice dictates the application of res ipsa loquitur. Upon these facts
and under these circumstances the Court would be able to say, as a matter of common knowledge
and observation, if negligence attended the management and care of the patient. Moreover, the liability
of the physicians and the hospital in this case is not predicated upon an alleged failure to secure the
desired results of an operation nor on an alleged lack of skill in the diagnosis or treatment as in fact
no operation or treatment was ever performed on Erlinda. Thus, upon all these initial determination a
case is made out for the application of the doctrine of res ipsa loquitur.
Nonetheless, in holding that res ipsa loquitur is available to the present case we are not saying that
the doctrine is applicable in any and all cases where injury occurs to a patient while under anesthesia,
or to any and all anesthesia cases. Each case must be viewed in its own light and scrutinized in order
to be within the res ipsa loquitur coverage.
Having in mind the applicability of the res ipsa loquitur doctrine and the presumption of negligence
allowed therein, the Court now comes to the issue of whether the Court of Appeals erred in finding
that private respondents were not negligent in the care of Erlinda during the anesthesia phase of the
operation and, if in the affirmative, whether the alleged negligence was the proximate cause of
Erlinda's comatose condition. Corollary thereto, we shall also determine if the Court of Appeals erred
in relying on the testimonies of the witnesses for the private respondents.
In sustaining the position of private respondents, the Court of Appeals relied on the testimonies of Dra.
Gutierrez, Dra. Calderon and Dr. Jamora. In giving weight to the testimony of Dra. Gutierrez, the Court
of Appeals rationalized that she was candid enough to admit that she experienced some difficulty in
the endotracheal intubation 45 of the patient and thus, cannot be said to be covering her negligence with
falsehood. The appellate court likewise opined that private respondents were able to show that the brain
damage sustained by Erlinda was not caused by the alleged faulty intubation but was due to the allergic
reaction of the patient to the drug Thiopental Sodium (Pentothal), a short-acting barbiturate, as testified on
by their expert witness, Dr. Jamora. On the other hand, the appellate court rejected the testimony of Dean
Herminda Cruz offered in favor of petitioners that the cause of the brain injury was traceable to the wrongful
insertion of the tube since the latter, being a nurse, was allegedly not knowledgeable in the process of
intubation. In so holding, the appellate court returned a verdict in favor of respondents physicians and
hospital and absolved them of any liability towards Erlinda and her family.

We disagree with the findings of the Court of Appeals. We hold that private respondents were unable
to disprove the presumption of negligence on their part in the care of Erlinda and their negligence was
the proximate cause of her piteous condition.
In the instant case, the records are helpful in furnishing not only the logical scientific evidence of the
pathogenesis of the injury but also in providing the Court the legal nexus upon which liability is based.
As will be shown hereinafter, private respondents' own testimonies which are reflected in the transcript
of stenographic notes are replete of signposts indicative of their negligence in the care and
management of Erlinda.
With regard to Dra. Gutierrez, we find her negligent in the care of Erlinda during the anesthesia phase.
As borne by the records, respondent Dra. Gutierrez failed to properly intubate the patient. This fact
was attested to by Prof. Herminda Cruz, Dean of the Capitol Medical Center School of Nursing and
petitioner's sister-in-law, who was in the operating room right beside the patient when the tragic event
occurred. Witness Cruz testified to this effect:
ATTY. PAJARES:

Q: In particular, what did Dra. Perfecta Gutierrez do, if any on the


patient?
A: In particular, I could see that she was intubating the patient.
Q: Do you know what happened to that intubation process
administered by Dra. Gutierrez?
ATTY. ALCERA:
She will be incompetent Your Honor.
COURT:
Witness may answer if she knows.
A: As have said, I was with the patient, I was beside the stretcher
holding the left hand of the patient and all of a sudden heard some
remarks coming from Dra. Perfecta Gutierrez herself. She was saying
"Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki
ang tiyan.
xxx xxx xxx
ATTY. PAJARES:
Q: From whom did you hear those words "lumalaki ang tiyan"?
A: From Dra. Perfecta Gutierrez.
xxx xxx xxx
Q: After hearing the phrase "lumalaki ang tiyan," what did you notice
on the person of the patient?
A: I notice (sic) some bluish discoloration on the nailbeds of the left
hand where I was at.
Q: Where was Dr. Orlino Ho[s]aka then at that particular time?
A: I saw him approaching the patient during that time.
Q: When he approached the patient, what did he do, if any?
A: He made an order to call on the anesthesiologist in the person of
Dr. Calderon.
Q: Did Dr. Calderon, upon being called, arrive inside the operating
room?

A: Yes sir.
Q: What did [s]he do, if any?
A: [S]he tried to intubate the patient.
Q: What happened to the patient?
A: When Dr. Calderon try (sic) to intubate the patient, after a while the
patient's nailbed became bluish and I saw the patient was placed in
trendelenburg position.
xxx xxx xxx
Q: Do you know the reason why the patient was placed in that
trendelenburg position?
A: As far as I know, when a patient is in that position, there is a
decrease of blood supply to the brain. 46
xxx xxx xxx

The appellate court, however, disbelieved Dean Cruz's testimony in the trial court by declaring that:
A perusal of the standard nursing curriculum in our country will show that intubation is
not taught as part of nursing procedures and techniques. Indeed, we take judicial
notice of the fact that nurses do not, and cannot, intubate. Even on the assumption
that she is fully capable of determining whether or not a patient is properly intubated,
witness Herminda Cruz, admittedly, did not peep into the throat of the patient. (TSN,
July 25, 1991, p. 13). More importantly, there is no evidence that she ever auscultated
the patient or that she conducted any type of examination to check if the endotracheal
tube was in its proper place, and to determine the condition of the heart, lungs, and
other organs. Thus, witness Cruz's categorical statements that appellant Dra.
Gutierrez failed to intubate the appellee Erlinda Ramos and that it was Dra. Calderon
who succeeded in doing so clearly suffer from lack of sufficient factual bases. 47
In other words, what the Court of Appeals is trying to impress is that being a nurse, and considered a
layman in the process of intubation, witness Cruz is not competent to testify on whether or not the
intubation was a success.
We do not agree with the above reasoning of the appellate court. Although witness Cruz is not an
anesthesiologist, she can very well testify upon matters on which she is capable of observing such as,
the statements and acts of the physician and surgeon, external appearances, and manifest conditions
which are observable by any one. 48 This is precisely allowed under the doctrine of res ipsa loquitur where
the testimony of expert witnesses is not required. It is the accepted rule that expert testimony is not
necessary for the proof of negligence in non-technical matters or those of which an ordinary person may
be expected to have knowledge, or where the lack of skill or want of care is so obvious as to render expert
testimony unnecessary. 49 We take judicial notice of the fact that anesthesia procedures have become so
common, that even an ordinary person can tell if it was administered properly. As such, it would not be too
difficult to tell if the tube was properly inserted. This kind of observation, we believe, does not require a
medical degree to be acceptable.

At any rate, without doubt, petitioner's witness, an experienced clinical nurse whose long experience
and scholarship led to her appointment as Dean of the Capitol Medical Center School at Nursing, was
fully capable of determining whether or not the intubation was a success. She had extensive clinical
experience starting as a staff nurse in Chicago, Illinois; staff nurse and clinical instructor in a teaching
hospital, the FEU-NRMF; Dean of the Laguna College of Nursing in San Pablo City; and then Dean of
the Capitol Medical Center School of Nursing. 50Reviewing witness Cruz' statements, we find that the
same were delivered in a straightforward manner, with the kind of detail, clarity, consistency and
spontaneity which would have been difficult to fabricate. With her clinical background as a nurse, the Court
is satisfied that she was able to demonstrate through her testimony what truly transpired on that fateful day.

Most of all, her testimony was affirmed by no less than respondent Dra. Gutierrez who admitted that
she experienced difficulty in inserting the tube into Erlinda's trachea, to wit:
ATTY. LIGSAY:
Q: In this particular case, Doctora, while you were intubating at your
first attempt (sic), you did not immediately see the trachea?
DRA. GUTIERREZ:
A: Yes sir.
Q: Did you pull away the tube immediately?
A: You do not pull the . . .
Q: Did you or did you not?
A: I did not pull the tube.
Q: When you said "mahirap yata ito," what were you referring to?
A: "Mahirap yata itong i-intubate," that was the patient.
Q: So, you found some difficulty in inserting the tube?
A: Yes, because of (sic) my first attempt, I did not see right away. 51
Curiously in the case at bar, respondent Dra. Gutierrez made the haphazard defense that she
encountered hardship in the insertion of the tube in the trachea of Erlinda because it was positioned
more anteriorly (slightly deviated from the normal anatomy of a person) 52 making it harder to locate
and, since Erlinda is obese and has a short neck and protruding teeth, it made intubation even more difficult.

The argument does not convince us. If this was indeed observed, private respondents adduced no
evidence demonstrating that they proceeded to make a thorough assessment of Erlinda's airway, prior
to the induction of anesthesia, even if this would mean postponing the procedure. From their
testimonies, it appears that the observation was made only as an afterthought, as a means of defense.
The pre-operative evaluation of a patient prior to the administration of anesthesia is universally
observed to lessen the possibility of anesthetic accidents. Pre-operative evaluation and preparation
for anesthesia begins when the anesthesiologist reviews the patient's medical records and visits with

the patient, traditionally, the day before elective surgery. 53 It includes taking the patient's medical history,
review of current drug therapy, physical examination and interpretation of laboratory data. 54 The physical
examination performed by the anesthesiologist is directed primarily toward the central nervous system,
cardiovascular system, lungs and upper airway. 55 A thorough analysis of the patient's airway normally
involves investigating the following: cervical spine mobility, temporomandibular mobility, prominent central
incisors, diseased or artificial teeth, ability to visualize uvula and the thyromental distance. 56 Thus, physical
characteristics of the patient's upper airway that could make tracheal intubation difficult should be
studied. 57 Where the need arises, as when initial assessment indicates possible problems (such as the
alleged short neck and protruding teeth of Erlinda) a thorough examination of the patient's airway would go
a long way towards decreasing patient morbidity and mortality.

In the case at bar, respondent Dra. Gutierrez admitted that she saw Erlinda for the first time on the
day of the operation itself, on 17 June 1985. Before this date, no prior consultations with, or preoperative evaluation of Erlinda was done by her. Until the day of the operation, respondent Dra.
Gutierrez was unaware of the physiological make-up and needs of Erlinda. She was likewise not
properly informed of the possible difficulties she would face during the administration of anesthesia to
Erlinda. Respondent Dra. Gutierrez' act of seeing her patient for the first time only an hour before the
scheduled operative procedure was, therefore, an act of exceptional negligence and professional
irresponsibility. The measures cautioning prudence and vigilance in dealing with human lives lie at the
core of the physician's centuries-old Hippocratic Oath. Her failure to follow this medical procedure is,
therefore, a clear indicia of her negligence.
Respondent Dra. Gutierrez, however, attempts to gloss over this omission by playing around with the
trial court's ignorance of clinical procedure, hoping that she could get away with it. Respondent Dra.
Gutierrez tried to muddle the difference between an elective surgery and an emergency surgery just
so her failure to perform the required pre-operative evaluation would escape unnoticed. In her
testimony she asserted:
ATTY. LIGSAY:
Q: Would you agree, Doctor, that it is good medical practice to see the
patient a day before so you can introduce yourself to establish good
doctor-patient relationship and gain the trust and confidence of the
patient?
DRA. GUTIERREZ:
A: As I said in my previous statement, it depends on the operative
procedure of the anesthesiologist and in my case, with elective cases
and normal cardio-pulmonary clearance like that, I usually don't do it
except on emergency and on cases that have an abnormalities (sic). 58
However, the exact opposite is true. In an emergency procedure, there is hardly enough time available
for the fastidious demands of pre-operative procedure so that an anesthesiologist is able to see the
patient only a few minutes before surgery, if at all. Elective procedures, on the other hand, are
operative procedures that can wait for days, weeks or even months. Hence, in these cases, the
anesthesiologist possesses the luxury of time to be at the patient's beside to do a proper interview and
clinical evaluation. There is ample time to explain the method of anesthesia, the drugs to be used, and
their possible hazards for purposes of informed consent. Usually, the pre-operative assessment is
conducted at least one day before the intended surgery, when the patient is relaxed and cooperative.

Erlinda's case was elective and this was known to respondent Dra. Gutierrez. Thus, she had all the
time to make a thorough evaluation of Erlinda's case prior to the operation and prepare her for
anesthesia. However, she never saw the patient at the bedside. She herself admitted that she had
seen petitioner only in the operating room, and only on the actual date of the cholecystectomy. She
negligently failed to take advantage of this important opportunity. As such, her attempt to exculpate
herself must fail.
Having established that respondent Dra. Gutierrez failed to perform pre-operative evaluation of the
patient which, in turn, resulted to a wrongful intubation, we now determine if the faulty intubation is
truly the proximate cause of Erlinda's comatose condition.
Private respondents repeatedly hammered the view that the cerebral anoxia which led to Erlinda's
coma was due to bronchospasm 59 mediated by her allergic response to the drug, Thiopental Sodium,
introduced into her system. Towards this end, they presented Dr. Jamora, a Fellow of the Philippine College
of Physicians and Diplomate of the Philippine Specialty Board of Internal Medicine, who advanced private
respondents' theory that the oxygen deprivation which led to anoxic encephalopathy, 60 was due to an
unpredictable drug reaction to the short-acting barbiturate. We find the theory of private respondents
unacceptable.

First of all, Dr. Jamora cannot be considered an authority in the field of anesthesiology simply because
he is not an anesthesiologist. Since Dr. Jamora is a pulmonologist, he could not have been capable
of properly enlightening the court about anesthesia practice and procedure and their complications.
Dr. Jamora is likewise not an allergologist and could not therefore properly advance expert opinion on
allergic-mediated processes. Moreover, he is not a pharmacologist and, as such, could not have been
capable, as an expert would, of explaining to the court the pharmacologic and toxic effects of the
supposed culprit, Thiopental Sodium (Pentothal).
The inappropriateness and absurdity of accepting Dr. Jamora's testimony as an expert witness in the
anesthetic practice of Pentothal administration is further supported by his own admission that he
formulated his opinions on the drug not from the practical experience gained by a specialist or expert
in the administration and use of Sodium Pentothal on patients, but only from reading certain
references, to wit:
ATTY. LIGSAY:
Q: In your line of expertise on pulmonology, did you have any occasion
to use pentothal as a method of management?
DR. JAMORA:
A: We do it in conjunction with the anesthesiologist when they have to
intubate our patient.
Q: But not in particular when you practice pulmonology?
A: No.
Q: In other words, your knowledge about pentothal is based only on
what you have read from books and not by your own personal
application of the medicine pentothal?

A: Based on my personal experience also on pentothal.


Q: How many times have you used pentothal?
A: They used it on me. I went into bronchospasm during my
appendectomy.
Q: And because they have used it on you and on account of your own
personal experience you feel that you can testify on pentothal here with
medical authority?
A: No. That is why I used references to support my claims. 61
An anesthetic accident caused by a rare drug-induced bronchospasm properly falls within the fields of
anesthesia, internal medicine-allergy, and clinical pharmacology. The resulting anoxic encephalopathy
belongs to the field of neurology. While admittedly, many bronchospastic-mediated pulmonary
diseases are within the expertise of pulmonary medicine, Dr. Jamora's field, the anesthetic druginduced, allergic mediated bronchospasm alleged in this case is within the disciplines of
anesthesiology, allergology and pharmacology. On the basis of the foregoing transcript, in which the
pulmonologist himself admitted that he could not testify about the drug with medical authority, it is clear
that the appellate court erred in giving weight to Dr. Jamora's testimony as an expert in the
administration of Thiopental Sodium.
The provision in the rules of evidence 62 regarding expert witnesses states:
Sec. 49. Opinion of expert witness. The opinion of a witness on a matter requiring
special knowledge, skill, experience or training which he is shown to possess, may be
received in evidence.
Generally, to qualify as an expert witness, one must have acquired special knowledge of the subject
matter about which he or she is to testify, either by the study of recognized authorities on the subject
or by practical experience.63 Clearly, Dr. Jamora does not qualify as an expert witness based on the above
standard since he lacks the necessary knowledge, skill, and training in the field of anesthesiology. Oddly,
apart from submitting testimony from a specialist in the wrong field, private respondents' intentionally
avoided providing testimony by competent and independent experts in the proper areas.

Moreover, private respondents' theory, that Thiopental Sodium may have produced Erlinda's coma by
triggering an allergic mediated response, has no support in evidence. No evidence of stridor, skin
reactions, or wheezing some of the more common accompanying signs of an allergic reaction
appears on record. No laboratory data were ever presented to the court.
In any case, private respondents themselves admit that Thiopental induced, allergic-mediated
bronchospasm happens only very rarely. If courts were to accept private respondents' hypothesis
without supporting medical proof, and against the weight of available evidence, then every anesthetic
accident would be an act of God. Evidently, the Thiopental-allergy theory vigorously asserted by
private respondents was a mere afterthought. Such an explanation was advanced in order to advanced
in order to absolve them of any and all responsibility for the patient's condition.
In view of the evidence at hand, we are inclined to believe petitioners' stand that it was the faulty
intubation which was the proximate cause of Erlinda's comatose condition.

Proximate cause has been defined as that which, in natural and continuous sequence, unbroken by
any efficient intervening cause, produces injury, and without which the result would not have
occurred. 64 An injury or damage is proximately caused by an act or a failure to act, whenever it appears
from the evidence in the case, that the act or omission played a substantial part in bringing about or actually
causing the injury or damage; and that the injury or damage was either a direct result or a reasonably
probable consequence of the act or omission. 65 It is the dominant, moving or producing cause.

Applying the above definition in relation to the evidence at hand, faulty intubation is undeniably the
proximate cause which triggered the chain of events leading to Erlinda's brain damage and, ultimately,
her comatosed condition.
Private respondents themselves admitted in their testimony that the first intubation was a failure. This
fact was likewise observed by witness Cruz when she heard respondent Dra. Gutierrez remarked,
"Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan." Thereafter, witness
Cruz noticed abdominal distention on the body of Erlinda. The development of abdominal distention,
together with respiratory embarrassment indicates that the endotracheal tube entered the esophagus
instead of the respiratory tree. In other words, instead of the intended endotracheal intubation what
actually took place was an esophageal intubation. During intubation, such distention indicates that air
has entered the gastrointestinal tract through the esophagus instead of the lungs through the trachea.
Entry into the esophagus would certainly cause some delay in oxygen delivery into the lungs as the
tube which carries oxygen is in the wrong place. That abdominal distention had been observed during
the first intubation suggests that the length of time utilized in inserting the endotracheal tube (up to the
time the tube was withdrawn for the second attempt) was fairly significant. Due to the delay in the
delivery of oxygen in her lungs Erlinda showed signs of cyanosis. 66 As stated in the testimony of Dr.
Hosaka, the lack of oxygen became apparent only after he noticed that the nailbeds of Erlinda were already
blue. 67 However, private respondents contend that a second intubation was executed on Erlinda and this
one was successfully done. We do not think so. No evidence exists on record, beyond private respondents'
bare claims, which supports the contention that the second intubation was successful. Assuming that the
endotracheal tube finally found its way into the proper orifice of the trachea, the same gave no guarantee
of oxygen delivery, the hallmark of a successful intubation. In fact, cyanosis was again observed
immediately after the second intubation. Proceeding from this event (cyanosis), it could not be claimed, as
private respondents insist, that the second intubation was accomplished. Even granting that the tube was
successfully inserted during the second attempt, it was obviously too late. As aptly explained by the trial
court, Erlinda already suffered brain damage as a result of the inadequate oxygenation of her brain for
about four to five minutes. 68

The above conclusion is not without basis. Scientific studies point out that intubation problems are
responsible for one-third (1/3) of deaths and serious injuries associated with
anesthesia. 69 Nevertheless, ninety-eight percent (98%) or the vast majority of difficult intubations may be
anticipated by performing a thorough evaluation of the patient's airway prior to the operation. 70 As stated
beforehand, respondent Dra. Gutierrez failed to observe the proper pre-operative protocol which could have
prevented this unfortunate incident. Had appropriate diligence and reasonable care been used in the preoperative evaluation, respondent physician could have been much more prepared to meet the contingency
brought about by the perceived anatomic variations in the patient's neck and oral area, defects which would
have been easily overcome by a prior knowledge of those variations together with a change in
technique. 71 In other words, an experienced anesthesiologist, adequately alerted by a thorough preoperative evaluation, would have had little difficulty going around the short neck and protruding
teeth. 72 Having failed to observe common medical standards in pre-operative management and intubation,
respondent Dra. Gutierrez' negligence resulted in cerebral anoxia and eventual coma of Erlinda.

We now determine the responsibility of respondent Dr. Orlino Hosaka as the head of the surgical team.
As the so-called "captain of the ship," 73 it is the surgeon's responsibility to see to it that those under him
perform their task in the proper manner. Respondent Dr. Hosaka's negligence can be found in his failure to
exercise the proper authority (as the "captain" of the operative team) in not determining if his

anesthesiologist observed proper anesthesia protocols. In fact, no evidence on record exists to show that
respondent Dr. Hosaka verified if respondent Dra. Gutierrez properly intubated the patient. Furthermore, it
does not escape us that respondent Dr. Hosaka had scheduled another procedure in a different hospital at
the same time as Erlinda's cholecystectomy, and was in fact over three hours late for the latter's operation.
Because of this, he had little or no time to confer with his anesthesiologist regarding the anesthesia delivery.
This indicates that he was remiss in his professional duties towards his patient. Thus, he shares equal
responsibility for the events which resulted in Erlinda's condition.

We now discuss the responsibility of the hospital in this particular incident. The unique practice (among
private hospitals) of filling up specialist staff with attending and visiting "consultants," 74 who are
allegedly not hospital employees, presents problems in apportioning responsibility for negligence in medical
malpractice cases. However, the difficulty is only more apparent than real.

In the first place, hospitals exercise significant control in the hiring and firing of consultants and in the
conduct of their work within the hospital premises. Doctors who apply for "consultant" slots, visiting or
attending, are required to submit proof of completion of residency, their educational qualifications;
generally, evidence of accreditation by the appropriate board (diplomate), evidence of fellowship in
most cases, and references. These requirements are carefully scrutinized by members of the hospital
administration or by a review committee set up by the hospital who either accept or reject the
application. 75 This is particularly true with respondent hospital.
After a physician is accepted, either as a visiting or attending consultant, he is normally required to
attend clinico-pathological conferences, conduct bedside rounds for clerks, interns and residents,
moderate grand rounds and patient audits and perform other tasks and responsibilities, for the
privilege of being able to maintain a clinic in the hospital, and/or for the privilege of admitting patients
into the hospital. In addition to these, the physician's performance as a specialist is generally evaluated
by a peer review committee on the basis of mortality and morbidity statistics, and feedback from
patients, nurses, interns and residents. A consultant remiss in his duties, or a consultant who regularly
falls short of the minimum standards acceptable to the hospital or its peer review committee, is
normally politely terminated.
In other words, private hospitals, hire, fire and exercise real control over their attending and visiting
"consultant" staff. While "consultants" are not, technically employees, a point which respondent
hospital asserts in denying all responsibility for the patient's condition, the control exercised, the hiring,
and the right to terminate consultants all fulfill the important hallmarks of an employer-employee
relationship, with the exception of the payment of wages. In assessing whether such a relationship in
fact exists, the control test is determining. Accordingly, on the basis of the foregoing, we rule that for
the purpose of allocating responsibility in medical negligence cases, an employer-employee
relationship in effect exists between hospitals and their attending and visiting physicians. This being
the case, the question now arises as to whether or not respondent hospital is solidarily liable with
respondent doctors for petitioner's condition. 76
The basis for holding an employer solidarily responsible for the negligence of its employee is found in
Article 2180 of the Civil Code which considers a person accountable not only for his own acts but also
for those of others based on the former's responsibility under a relationship of patria potestas. 77 Such
responsibility ceases when the persons or entity concerned prove that they have observed the diligence of
a good father of the family to prevent damage.78 In other words, while the burden of proving negligence
rests on the plaintiffs, once negligence is shown, the burden shifts to the respondents (parent, guardian,
teacher or employer) who should prove that they observed the diligence of a good father of a family to
prevent damage.

In the instant case, respondent hospital, apart from a general denial of its responsibility over
respondent physicians, failed to adduce evidence showing that it exercised the diligence of a good

father of a family in the hiring and supervision of the latter. It failed to adduce evidence with regard to
the degree of supervision which it exercised over its physicians. In neglecting to offer such proof, or
proof of a similar nature, respondent hospital thereby failed to discharge its burden under the last
paragraph of Article 2180. Having failed to do this, respondent hospital is consequently solidarily
responsible with its physicians for Erlinda's condition.
Based on the foregoing, we hold that the Court of Appeals erred in accepting and relying on the
testimonies of the witnesses for the private respondents. Indeed, as shown by the above discussions,
private respondents were unable to rebut the presumption of negligence. Upon these disquisitions we
hold that private respondents are solidarily liable for damages under Article 2176 79 of the Civil Code.
We now come to the amount of damages due petitioners. The trial court awarded a total of
P632,000.00 pesos (should be P616,000.00) in compensatory damages to the plaintiff, "subject to its
being updated" covering the period from 15 November 1985 up to 15 April 1992, based on monthly
expenses for the care of the patient estimated at P8,000.00.
At current levels, the P8000/monthly amount established by the trial court at the time of its decision
would be grossly inadequate to cover the actual costs of home-based care for a comatose individual.
The calculated amount was not even arrived at by looking at the actual cost of proper hospice care for
the patient. What it reflected were the actual expenses incurred and proved by the petitioners after
they were forced to bring home the patient to avoid mounting hospital bills.
And yet ideally, a comatose patient should remain in a hospital or be transferred to a hospice
specializing in the care of the chronically ill for the purpose of providing a proper milieu adequate to
meet minimum standards of care. In the instant case for instance, Erlinda has to be constantly turned
from side to side to prevent bedsores and hypostatic pneumonia. Feeding is done by nasogastric tube.
Food preparation should be normally made by a dietitian to provide her with the correct daily caloric
requirements and vitamin supplements. Furthermore, she has to be seen on a regular basis by a
physical therapist to avoid muscle atrophy, and by a pulmonary therapist to prevent the accumulation
of secretions which can lead to respiratory complications.
Given these considerations, the amount of actual damages recoverable in suits arising from
negligence should at least reflect the correct minimum cost of proper care, not the cost of the care the
family is usually compelled to undertake at home to avoid bankruptcy. However, the provisions of the
Civil Code on actual or compensatory damages present us with some difficulties.
Well-settled is the rule that actual damages which may be claimed by the plaintiff are those suffered
by him as he has duly proved. The Civil Code provides:
Art. 2199. Except as provided by law or by stipulation, one is entitled to an adequate
compensation only for such pecuniary loss suffered by him as he has duly proved.
Such compensation is referred to as actual or compensatory damages.
Our rules on actual or compensatory damages generally assume that at the time of litigation, the injury
suffered as a consequence of an act of negligence has been completed and that the cost can be
liquidated. However, these provisions neglect to take into account those situations, as in this case,
where the resulting injury might be continuing and possible future complications directly arising from
the injury, while certain to occur, are difficult to predict.
In these cases, the amount of damages which should be awarded, if they are to adequately and
correctly respond to the injury caused, should be one which compensates for pecuniary loss incurred
and proved, up to the time of trial; and one which would meet pecuniary loss certain to be suffered but

which could not, from the nature of the case, be made with certainty.

80

In other words, temperate


damages can and should be awarded on top of actual or compensatory damages in instances where the
injury is chronic and continuing. And because of the unique nature of such cases, no incompatibility arises
when both actual and temperate damages are provided for. The reason is that these damages cover two
distinct phases.

As it would not be equitable and certainly not in the best interests of the administration of justice
for the victim in such cases to constantly come before the courts and invoke their aid in seeking
adjustments to the compensatory damages previously awarded temperate damages are
appropriate. The amount given as temperate damages, though to a certain extent speculative, should
take into account the cost of proper care.
In the instant case, petitioners were able to provide only home-based nursing care for a comatose
patient who has remained in that condition for over a decade. Having premised our award for
compensatory damages on the amount provided by petitioners at the onset of litigation, it would be
now much more in step with the interests of justice if the value awarded for temperate damages would
allow petitioners to provide optimal care for their loved one in a facility which generally specializes in
such care. They should not be compelled by dire circumstances to provide substandard care at home
without the aid of professionals, for anything less would be grossly inadequate. Under the
circumstances, an award of P1,500,000.00 in temperate damages would therefore be reasonable. 81
In Valenzuela vs. Court of Appeals, 82 this Court was confronted with a situation where the injury suffered
by the plaintiff would have led to expenses which were difficult to estimate because while they would have
been a direct result of the injury (amputation), and were certain to be incurred by the plaintiff, they were
likely to arise only in the future. We awarded P1,000,000.00 in moral damages in that case.

Describing the nature of the injury, the Court therein stated:


As a result of the accident, Ma. Lourdes Valenzuela underwent a traumatic amputation
of her left lower extremity at the distal left thigh just above the knee. Because of this,
Valenzuela will forever be deprived of the full ambulatory functions of her left extremity,
even with the use of state of the art prosthetic technology. Well beyond the period of
hospitalization (which was paid for by Li), she will be required to undergo adjustments
in her prosthetic devise due to the shrinkage of the stump from the process of healing.
These adjustments entail costs, prosthetic replacements and months of physical and
occupational rehabilitation and therapy. During the lifetime, the prosthetic devise will
have to be replaced and readjusted to changes in the size of her lower limb effected
by the biological changes of middle-age, menopause and aging. Assuming she
reaches menopause, for example, the prosthetic will have to be adjusted to respond
to the changes in bone resulting from a precipitate decrease in calcium levels observed
in the bones of all post-menopausal women. In other words, the damage done to her
would not only be permanent and lasting, it would also be permanently changing and
adjusting to the physiologic changes which her body would normally undergo through
the years. The replacements, changes, and adjustments will require corresponding
adjustive physical and occupational therapy. All of these adjustments, it has been
documented, are painful.
xxx xxx xxx
A prosthetic devise, however technologically advanced, will only allow a reasonable
amount of functional restoration of the motor functions of the lower limb. The sensory

functions are forever lost. The resultant anxiety, sleeplessness, psychological injury,
mental and physical pain are inestimable.83
The injury suffered by Erlinda as a consequence of private respondents' negligence is certainly much
more serious than the amputation in the Valenzuela case.
Petitioner Erlinda Ramos was in her mid-forties when the incident occurred. She has been in a
comatose state for over fourteen years now. The burden of care has so far been heroically shouldered
by her husband and children, who, in the intervening years have been deprived of the love of a wife
and a mother.
Meanwhile, the actual physical, emotional and financial cost of the care of petitioner would be virtually
impossible to quantify. Even the temperate damages herein awarded would be inadequate if
petitioner's condition remains unchanged for the next ten years.
We recognized, in Valenzuela that a discussion of the victim's actual injury would not even scratch the
surface of the resulting moral damage because it would be highly speculative to estimate the amount
of emotional and moral pain, psychological damage and injury suffered by the victim or those actually
affected by the victim's condition. 84The husband and the children, all petitioners in this case, will have to
live with the day to day uncertainty of the patient's illness, knowing any hope of recovery is close to nil.
They have fashioned their daily lives around the nursing care of petitioner, altering their long term goals to
take into account their life with a comatose patient. They, not the respondents, are charged with the moral
responsibility of the care of the victim. The family's moral injury and suffering in this case is clearly a real
one. For the foregoing reasons, an award of P2,000,000.00 in moral damages would be appropriate.

Finally, by way of example, exemplary damages in the amount of P100,000.00 are hereby awarded.
Considering the length and nature of the instant suit we are of the opinion that attorney's fees valued
at P100,000.00 are likewise proper.
Our courts face unique difficulty in adjudicating medical negligence cases because physicians are not
insurers of life and, they rarely set out to intentionally cause injury or death to their patients. However,
intent is immaterial in negligence cases because where negligence exists and is proven, the same
automatically gives the injured a right to reparation for the damage caused.
Established medical procedures and practices, though in constant flux are devised for the purpose of
preventing complications. A physician's experience with his patients would sometimes tempt him to
deviate from established community practices, and he may end a distinguished career using
unorthodox methods without incident. However, when failure to follow established procedure results
in the evil precisely sought to be averted by observance of the procedure and a nexus is made between
the deviation and the injury or damage, the physician would necessarily be called to account for it. In
the case at bar, the failure to observe pre-operative assessment protocol which would have influenced
the intubation in a salutary way was fatal to private respondents' case.
WHEREFORE, the decision and resolution of the appellate court appealed from are hereby modified
so as to award in favor of petitioners, and solidarily against private respondents the following: 1)
P1,352,000.00 as actual damages computed as of the date of promulgation of this decision plus a
monthly payment of P8,000.00 up to the time that petitioner Erlinda Ramos expires or miraculously
survives; 2) P2,000,000.00 as moral damages, 3) P1,500,000.00 as temperate damages; 4)
P100,000.00 each as exemplary damages and attorney's fees; and, 5) the costs of the suit.
SO ORDERED

G.R. No. 124354

April 11, 2002

ROGELIO E. RAMOS and ERLINDA RAMOS, in their own behalf and as natural guardians of
the minors, ROMMEL RAMOS, ROY RODERICK RAMOS, and RON RAYMOND
RAMOS, petitioners,
vs.
COURT OF APPEALS, DE LOS SANTOS MEDICAL CENTER, DR. ORLINO HOSAKA and DR.
PERFECTA GUTIERREZ, respondents.
RESOLUTION
KAPUNAN, J.:
Private respondents De Los Santos Medical Center, Dr. Orlino Hosaka and Dr. Perfecta Gutierrez
move for a reconsideration of the Decision, dated December 29, 1999, of this Court holding them civilly
liable for petitioner Erlinda Ramos comatose condition after she delivered herself to them for their
professional care and management.
For better understanding of the issues raised in private respondents respective motions, we will briefly
restate the facts of the case as follows:
Sometime in 1985, petitioner Erlinda Ramos, after seeking professional medical help, was advised to
undergo an operation for the removal of a stone in her gall bladder (cholecystectomy). She was
referred to Dr. Hosaka, a surgeon, who agreed to perform the operation on her. The operation was
scheduled for June 17, 1985 at 9:00 in the morning at private respondent De Los Santos Medical
Center (DLSMC). Since neither petitioner Erlinda nor her husband, petitioner Rogelio, knew of any
anesthesiologist, Dr. Hosaka recommended to them the services of Dr. Gutierrez.
Petitioner Erlinda was admitted to the DLSMC the day before the scheduled operation. By 7:30 in the
morning of the following day, petitioner Erlinda was already being prepared for operation. Upon the
request of petitioner Erlinda, her sister-in-law, Herminda Cruz, who was then Dean of the College of
Nursing at the Capitol Medical Center, was allowed to accompany her inside the operating room.
At around 9:30 in the morning, Dr. Hosaka had not yet arrived so Dr. Gutierrez tried to get in touch
with him by phone. Thereafter, Dr. Gutierrez informed Cruz that the operation might be delayed due
to the late arrival of Dr. Hosaka. In the meantime, the patient, petitioner Erlinda said to Cruz,
"Mindy, inip na inip na ako, ikuha mo ako ng ibang Doctor."
By 10:00 in the morning, when Dr. Hosaka was still not around, petitioner Rogelio already wanted to
pull out his wife from the operating room. He met Dr. Garcia, who remarked that he was also tired of
waiting for Dr. Hosaka. Dr. Hosaka finally arrived at the hospital at around 12:10 in the afternoon, or
more than three (3) hours after the scheduled operation.
Cruz, who was then still inside the operating room, heard about Dr. Hosakas arrival. While she held
the hand of Erlinda, Cruz saw Dr. Gutierrez trying to intubate the patient. Cruz heard Dr. Gutierrez
utter: "ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan." Cruz noticed a
bluish discoloration of Erlindas nailbeds on her left hand. She (Cruz) then heard Dr. Hosaka instruct
someone to call Dr. Calderon, another anesthesiologist. When he arrived, Dr. Calderon attempted to
intubate the patient. The nailbeds of the patient remained bluish, thus, she was placed in a
trendelenburg position a position where the head of the patient is placed in a position lower than her
feet. At this point, Cruz went out of the operating room to express her concern to petitioner Rogelio
that Erlindas operation was not going well.

Cruz quickly rushed back to the operating room and saw that the patient was still in trendelenburg
position. At almost 3:00 in the afternoon, she saw Erlinda being wheeled to the Intensive Care Unit
(ICU). The doctors explained to petitioner Rogelio that his wife had bronchospasm. Erlinda stayed in
the ICU for a month. She was released from the hospital only four months later or on November 15,
1985. Since the ill-fated operation, Erlinda remained in comatose condition until she died on August
3, 1999.1
Petitioners filed with the Regional Trial Court of Quezon City a civil case for damages against private
respondents. After due trial, the court a quo rendered judgment in favor of petitioners. Essentially, the
trial court found that private respondents were negligent in the performance of their duties to Erlinda.
On appeal by private respondents, the Court of Appeals reversed the trial courts decision and directed
petitioners to pay their "unpaid medical bills" to private respondents.
Petitioners filed with this Court a petition for review on certiorari. The private respondents were then
required to submit their respective comments thereon. On December 29, 1999, this Court promulgated
the decision which private respondents now seek to be reconsidered. The dispositive portion of said
Decision states:
WHEREFORE, the decision and resolution of the appellate court appealed from are hereby
modified so as to award in favor of petitioners, and solidarily against private respondents the
following: 1) P1,352,000.00 as actual damages computed as of the date of promulgation of
this decision plus a monthly payment of P8,000.00 up to the time that petitioner Erlinda Ramos
expires or miraculously survives; 2) P2,000,000.00 as moral damages, 3) P1,500,000.00 as
temperate damages; 4) P100,000.00 each exemplary damages and attorneys fees; and 5)
the costs of the suit.2
In his Motion for Reconsideration, private respondent Dr. Hosaka submits the following as grounds
therefor:
I
THE HONORABLE SUPREME COURT COMMITTED REVERSIBLE ERROR WHEN IT HELD
RESPONDENT DR. HOSAKA LIABLE ON THE BASIS OF THE "CAPTAIN-OF-THE-SHIP"
DOCTRINE.
II
THE HONORABLE SUPREME COURT ERRED IN HOLDING RESPONDENT DR. HOSAKA LIABLE
DESPITE THE FACT THAT NO NEGLIGENCE CAN BE ATTRIBUTABLE TO HIM.
III
ASSUMING WITHOUT ADMITTING THAT RESPONDENT DR. HOSAKA IS LIABLE, THE
HONORABLE SUPREME COURT ERRED IN AWARDING DAMAGES THAT WERE CLEARLY
EXCESSIVE AND WITHOUT LEGAL BASIS.3
Private respondent Dr. Gutierrez, for her part, avers that:
A. THE HONORABLE SUPREME COURT MAY HAVE INADVERTENTLY OVERLOOKED
THE FACT THAT THE COURT OF APPEALS DECISION DATED 29 MAY 1995 HAD
ALREADY BECOME FINAL AND EXECUTORY AS OF 25 JUNE 1995, THEREBY

DEPRIVING THIS HONORABLE COURT OF JURISDICTION OVER THE INSTANT


PETITION;
B. THE HONORABLE SUPREME COURT MAY HAVE INADVERTENTLY OVERLOOKED
SEVERAL MATERIAL FACTUAL CIRCUMSTANCES WHICH, IF PROPERLY
CONSIDERED, WOULD INDUBITABLY LEAD TO NO OTHER CONCLUSION BUT THAT
PRIVATE RESPONDENT DOCTORS WERE NOT GUILTY OF ANY NEGLIGENCE IN
RESPECT OF THE INSTANT CASE;
B.1 RESPONDENT DOCTOR PERFECTA GUTIERREZ HAS SUFFICIENTLY
DISCHARGED THE BURDEN OF EVIDENCE BY SUBSTANTIAL PROOF OF HER
COMPLIANCE WITH THE STANDARDS OF DUE CARE EXPECTED IN HER
RESPECTIVE FIELD OF MEDICAL SPECIALIZATION.
B.2 RESPONDENT DOCTOR PERFECTA GUTIERREZ HAS SUFFICIENTLY
DISCHARGED THE BURDEN OF EVIDENCE BY SUBSTANTIAL PROOF OF HER
HAVING SUCCESSFULLY INTUBATED PATIENT ERLINDA RAMOS
C. THE SUPREME COURT MAY HAVE INADVERTENTLY PLACED TOO MUCH RELIANCE
ON THE TESTIMONY OF PETITIONERS WITNESS HERMINDA CRUZ, DESPITE THE
EXISTENCE OF SEVERAL FACTUAL CIRCUMSTANCES WHICH RENDERS DOUBT ON
HER CREDIBILITY
D. THE SUPREME COURT MAY HAVE INADVERTENTLY DISREGARDED THE EXPERT
TESTIMONY OF DR. JAMORA AND DRA. CALDERON
E. THE HONORABLE SUPREME COURT MAY HAVE INADVERTENTLY AWARDED
DAMAGES TO PETITIONERS DESPITE THE FACT THAT THERE WAS NO NEGLIGENCE
ON THE PART OF RESPONDENT DOCTOR.4
Private respondent De Los Santos Medical Center likewise moves for reconsideration on the following
grounds:
I
THE HONORABLE COURT ERRED IN GIVING DUE COURSE TO THE INSTANT PETITION AS
THE DECISION OF THE HONORABLE COURT OF APPEALS HAD ALREADY BECOME FINAL AND
EXECUTORY
II
THE HONORABLE SUPREME COURT ERRED IN FINDING THAT AN EMPLOYER-EMPLOYEE
[RELATIONSHIP] EXISTS BETWEEN RESPONDENT DE LOS SANTOS MEDICAL CENTER AND
DRS. ORLINO HOSAKA AND PERFECTA GUTIERREZ
III
THE HONORABLE SUPREME COURT ERRED IN FINDING THAT RESPONDENT DE LOS
SANTOS MEDICAL CENTER IS SOLIDARILY LIABLE WITH RESPONDENT DOCTORS
IV

THE HONORABLE SUPREME COURT ERRED IN INCREASING THE AWARD OF DAMAGES IN


FAVOR OF PETITIONERS.5
In the Resolution of February 21, 2000, this Court denied the motions for reconsideration of private
respondents Drs. Hosaka and Gutierrez. They then filed their respective second motions for
reconsideration. The Philippine College of Surgeons filed its Petition-in-Intervention contending in the
main that this Court erred in holding private respondent Dr. Hosaka liable under the captain of the ship
doctrine. According to the intervenor, said doctrine had long been abandoned in the United States in
recognition of the developments in modern medical and hospital practice.6 The Court noted these
pleadings in the Resolution of July 17, 2000.7
On March 19, 2001, the Court heard the oral arguments of the parties, including the intervenor. Also
present during the hearing were the amicii curiae: Dr. Felipe A. Estrella, Jr., Consultant of the
Philippine Charity Sweepstakes, former Director of the Philippine General Hospital and former
Secretary of Health; Dr. Iluminada T. Camagay, President of the Philippine Society of
Anesthesiologists, Inc. and Professor and Vice-Chair for Research, Department of Anesthesiology,
College of Medicine-Philippine General Hospital, University of the Philippines; and Dr. Lydia M. Egay,
Professor and Vice-Chair for Academics, Department of Anesthesiology, College of MedicinePhilippine General Hospital, University of the Philippines.
The Court enumerated the issues to be resolved in this case as follows:
1. WHETHER OR NOT DR. ORLINO HOSAKA (SURGEON) IS LIABLE FOR NEGLIGENCE;
2. WHETHER OR NOT DR. PERFECTA GUTIERREZ (ANESTHESIOLOGIST) IS LIABLE
FOR NEGLIGENCE; AND
3. WHETHER OR NOT THE HOSPITAL (DELOS SANTOS MEDICAL CENTER) IS LIABLE
FOR ANY ACT OF NEGLIGENCE COMMITTED BY THEIR VISITING CONSULTANT
SURGEON AND ANESTHESIOLOGIST.8
We shall first resolve the issue pertaining to private respondent Dr. Gutierrez. She maintains that the
Court erred in finding her negligent and in holding that it was the faulty intubation which was the
proximate cause of Erlindas comatose condition. The following objective facts allegedly negate a
finding of negligence on her part: 1) That the outcome of the procedure was a comatose patient and
not a dead one; 2) That the patient had a cardiac arrest; and 3) That the patient was revived from that
cardiac arrest.9 In effect, Dr. Gutierrez insists that, contrary to the finding of this Court, the intubation
she performed on Erlinda was successful.
Unfortunately, Dr. Gutierrez claim of lack of negligence on her part is belied by the records of the
case. It has been sufficiently established that she failed to exercise the standards of care in the
administration of anesthesia on a patient. Dr. Egay enlightened the Court on what these standards
are:
x x x What are the standards of care that an anesthesiologist should do before we administer
anesthesia? The initial step is the preparation of the patient for surgery and this is a preoperative evaluation because the anesthesiologist is responsible for determining the medical
status of the patient, developing the anesthesia plan and acquainting the patient or the
responsible adult particularly if we are referring with the patient or to adult patient who may not
have, who may have some mental handicaps of the proposed plans. We do pre-operative
evaluation because this provides for an opportunity for us to establish identification and
personal acquaintance with the patient. It also makes us have an opportunity to alleviate

anxiety, explain techniques and risks to the patient, given the patient the choice and
establishing consent to proceed with the plan. And lastly, once this has been agreed upon by
all parties concerned the ordering of pre-operative medications. And following this line at the
end of the evaluation we usually come up on writing, documentation is very important as far
as when we train an anesthesiologist we always emphasize this because we need records for
our protection, well, records. And it entails having brief summary of patient history and physical
findings pertinent to anesthesia, plan, organize as a problem list, the plan anesthesia
technique, the plan post operative, pain management if appropriate, special issues for this
particular patient. There are needs for special care after surgery and if it so it must be written
down there and a request must be made known to proper authorities that such and such care
is necessary. And the request for medical evaluation if there is an indication. When we ask for
a cardio-pulmonary clearance it is not in fact to tell them if this patient is going to be fit for
anesthesia, the decision to give anesthesia rests on the anesthesiologist. What we ask them
is actually to give us the functional capacity of certain systems which maybe affected by the
anesthetic agent or the technique that we are going to use. But the burden of responsibility in
terms of selection of agent and how to administer it rest on the anesthesiologist.10
The conduct of a preanesthetic/preoperative evaluation prior to an operation, whether elective or
emergency, cannot be dispensed with.11 Such evaluation is necessary for the formulation of a plan of
anesthesia care suited to the needs of the patient concerned.
Pre-evaluation for anesthesia involves taking the patients medical history, reviewing his current drug
therapy, conducting physical examination, interpreting laboratory data, and determining the
appropriate prescription of preoperative medications as necessary to the conduct of anesthesia.12
Physical examination of the patient entails not only evaluating the patients central nervous system,
cardiovascular system and lungs but also the upper airway. Examination of the upper airway would in
turn include an analysis of the patients cervical spine mobility, temporomandibular mobility, prominent
central incisors, deceased or artificial teeth, ability to visualize uvula and the thyromental distance.13
Nonetheless, Dr. Gutierrez omitted to perform a thorough preoperative evaluation on Erlinda. As she
herself admitted, she saw Erlinda for the first time on the day of the operation itself, one hour before
the scheduled operation. She auscultated14 the patients heart and lungs and checked the latters blood
pressure to determine if Erlinda was indeed fit for operation.15 However, she did not proceed to
examine the patients airway. Had she been able to check petitioner Erlindas airway prior to the
operation, Dr. Gutierrez would most probably not have experienced difficulty in intubating the former,
and thus the resultant injury could have been avoided. As we have stated in our Decision:
In the case at bar, respondent Dra. Gutierrez admitted that she saw Erlinda for the first time
on the day of the operation itself, on 17 June 1985. Before this date, no prior consultations
with, or pre-operative evaluation of Erlinda was done by her. Until the day of the operation,
respondent Dra. Gutierrez was unaware of the physiological make-up and needs of Erlinda.
She was likewise not properly informed of the possible difficulties she would face during the
administration of anesthesia to Erlinda. Respondent Dra. Gutierrez act of seeing her patient
for the first time only an hour before the scheduled operative procedure was, therefore, an act
of exceptional negligence and professional irresponsibility. The measures cautioning prudence
and vigilance in dealing with human lives lie at the core of the physicians centuries-old
Hippocratic Oath. Her failure to follow this medical procedure is, therefore, a clear indicia of
her negligence.16
Further, there is no cogent reason for the Court to reverse its finding that it was the faulty intubation
on Erlinda that caused her comatose condition. There is no question that Erlinda became comatose

after Dr. Gutierrez performed a medical procedure on her. Even the counsel of Dr. Gutierrez admitted
to this fact during the oral arguments:
CHIEF JUSTICE:
Mr. Counsel, you started your argument saying that this involves a comatose patient?
ATTY. GANA:
Yes, Your Honor.
CHIEF JUSTICE:
How do you mean by that, a comatose, a comatose after any other acts were done by
Dr. Gutierrez or comatose before any act was done by her?
ATTY. GANA:
No, we meant comatose as a final outcome of the procedure.
CHIEF JUSTICE:
Meaning to say, the patient became comatose after some intervention, professional
acts have been done by Dr. Gutierrez?
ATTY. GANA:
Yes, Your Honor.
CHIEF JUSTICE:
In other words, the comatose status was a consequence of some acts performed by
D. Gutierrez?
ATTY. GANA:
It was a consequence of the well, (interrupted)
CHIEF JUSTICE:
An acts performed by her, is that not correct?
ATTY. GANA:
Yes, Your Honor.
CHIEF JUSTICE:
Thank you.17

What is left to be determined therefore is whether Erlindas hapless condition was due to any fault or
negligence on the part of Dr. Gutierrez while she (Erlinda) was under the latters care. Dr. Gutierrez
maintains that the bronchospasm and cardiac arrest resulting in the patients comatose condition was
brought about by the anaphylactic reaction of the patient to Thiopental Sodium (pentothal). 18 In the
Decision, we explained why we found Dr. Gutierrez theory unacceptable. In the first place, Dr.
Eduardo Jamora, the witness who was presented to support her (Dr. Gutierrez) theory, was a
pulmonologist. Thus, he could not be considered an authority on anesthesia practice and procedure
and their complications.19
Secondly, there was no evidence on record to support the theory that Erlinda developed an allergic
reaction to pentothal. Dr. Camagay enlightened the Court as to the manifestations of an allergic
reaction in this wise:
DR. CAMAGAY:
All right, let us qualify an allergic reaction. In medical terminology an allergic reaction
is something which is not usual response and it is further qualified by the release of a
hormone called histamine and histamine has an effect on all the organs of the body
generally release because the substance that entered the body reacts with the
particular cell, the mass cell, and the mass cell secretes this histamine. In a way it is
some form of response to take away that which is not mine, which is not part of the
body. So, histamine has multiple effects on the body. So, one of the effects as you will
see you will have redness, if you have an allergy you will have tearing of the eyes, you
will have swelling, very crucial swelling sometimes of the larynges which is your voice
box main airway, that swelling may be enough to obstruct the entry of air to the trachea
and you could also have contraction, constriction of the smaller airways beyond the
trachea, you see you have the trachea this way, we brought some visual aids but
unfortunately we do not have a projector. And then you have the smaller airways, the
bronchi and then eventually into the mass of the lungs you have the bronchus. The
difference is that these tubes have also in their walls muscles and this particular kind
of muscles is smooth muscle so, when histamine is released they close up like this
and that phenomenon is known as bronco spasm. However, the effects of histamine
also on blood vessels are different. They dilate blood vessel open up and the patient
or whoever has this histamine release has hypertension or low blood pressure to a
point that the patient may have decrease blood supply to the brain and may collapse
so, you may have people who have this.20
These symptoms of an allergic reaction were not shown to have been extant in Erlindas case. As we
held in our Decision, "no evidence of stridor, skin reactions, or wheezing some of the more common
accompanying signs of an allergic reaction appears on record. No laboratory data were ever
presented to the court."21
Dr. Gutierrez, however, insists that she successfully intubated Erlinda as evidenced by the fact that
she was revived after suffering from cardiac arrest. Dr. Gutierrez faults the Court for giving credence
to the testimony of Cruz on the matter of the administration of anesthesia when she (Cruz), being a
nurse, was allegedly not qualified to testify thereon. Rather, Dr. Gutierrez invites the Courts attention
to her synopsis on what transpired during Erlindas intubation:
12:15 p.m. Patient was inducted with sodium pentothal 2.5% (250 mg) given by slow IV. 02
was started by mask. After pentothal injection this was followed by IV injection of Norcuron
4mg. After 2 minutes 02 was given by positive pressure for about one minute. Intubation with
endotracheal tube 7.5 m in diameter was done with slight difficulty (short neck & slightly

prominent upper teeth) chest was examined for breath sounds & checked if equal on both
sides. The tube was then anchored to the mouth by plaster & cuff inflated. Ethrane 2% with 02
4 liters was given. Blood pressure was checked 120/80 & heart rate regular and normal 90/min.
12:25 p.m. After 10 minutes patient was cyanotic. Ethrane was discontinued & 02 given alone.
Cyanosis disappeared. Blood pressure and heart beats stable.
12:30 p.m. Cyanosis again reappeared this time with sibilant and sonorous rales all over the
chest. D_5%_H20 & 1 ampule of aminophyline by fast drip was started. Still the cyanosis was
persistent. Patient was connected to a cardiac monitor. Another ampule of of [sic]
aminophyline was given and solu cortef was given.
12:40 p.m. There was cardiac arrest. Extra cardiac massage and intercardiac injection of
adrenalin was given & heart beat reappeared in less than one minute. Sodium bicarbonate &
another dose of solu cortef was given by IV. Cyanosis slowly disappeared & 02 continuously
given & assisted positive pressure. Laboratory exams done (see results in chart).
Patient was transferred to ICU for further management.22
From the foregoing, it can be allegedly seen that there was no withdrawal (extubation) of the tube.
And the fact that the cyanosis allegedly disappeared after pure oxygen was supplied through the tube
proved that it was properly placed.
The Court has reservations on giving evidentiary weight to the entries purportedly contained in Dr.
Gutierrez synopsis. It is significant to note that the said record prepared by Dr. Gutierrez was made
only after Erlinda was taken out of the operating room. The standard practice in anesthesia is that
every single act that the anesthesiologist performs must be recorded. In Dr. Gutierrez case, she could
not account for at least ten (10) minutes of what happened during the administration of anesthesia on
Erlinda. The following exchange between Dr. Estrella, one of the amicii curiae, and Dr. Gutierrez is
instructive:
DR. ESTRELLA
Q

You mentioned that there were two (2) attempts in the intubation period?

DR. GUTIERREZ
Yes.
Q
There were two attempts. In the first attempt was the tube inserted or was the
laryngoscope only inserted, which was inserted?
A

All the laryngoscope.

Q
All the laryngoscope. But if I remember right somewhere in the re-direct, a certain
lawyer, you were asked that you did a first attempt and the question was did you withdraw
the tube? And you said you never withdrew the tube, is that right?
A

Yes.

Q
Yes. And so if you never withdrew the tube then there was no, there was no insertion
of the tube during that first attempt. Now, the other thing that we have to settle here is when
cyanosis occurred, is it recorded in the anesthesia record when the cyanosis, in your recording
when did the cyanosis occur?
A

(sic)

Q
Is it a standard practice of anesthesia that whatever you do during that period or from
the time of induction to the time that you probably get the patient out of the operating room
that every single action that you do is so recorded in your anesthesia record?
A
I was not able to record everything I did not have time anymore because I did that after
the, when the patient was about to leave the operating room. When there was second cyanosis
already that was the (interrupted)
Q

When was the first cyanosis?

The first cyanosis when I was (interrupted)

What time, more or less?

I think it was 12:15 or 12:16.

Well, if the record will show you started induction at 12:15?

Yes, Your Honor.

And the first medication you gave was what?

A
Q

The first medication, no, first the patient was oxygenated for around one to two minutes.
Yes, so, that is about 12:13?

A
Yes, and then, I asked the resident physician to start giving the pentothal very slowly
and that was around one minute.
Q

So, that is about 12:13 no, 12:15, 12:17?

Yes, and then, after one minute another oxygenation was given and after (interrupted)

12:18?

A
Yes, and then after giving the oxygen we start the menorcure which is a relaxant. After
that relaxant (interrupted)
Q

After that relaxant, how long do you wait before you do any manipulation?

Usually you wait for two minutes or three minutes.

So, if our estimate of the time is accurate we are now more or less 12:19, is that right?

Maybe.

12:19. And at that time, what would have been done to this patient?

A
After that time you examine the, if there is relaxation of the jaw which you push it
downwards and when I saw that the patient was relax because that monorcure is a relaxant,
you cannot intubate the patient or insert the laryngoscope if it is not keeping him relax. So, my
first attempt when I put the laryngoscope on I saw the trachea was deeply interiorly. So, what
I did ask "mahirap ata ito ah." So, I removed the laryngoscope and oxygenated again the
patient.
Q
So, more or less you attempted to do an intubation after the first attempt as you claimed
that it was only the laryngoscope that was inserted.
A

Yes.

And in the second attempt you inserted the laryngoscope and now possible intubation?

Yes.

And at that point, you made a remark, what remark did you make?

A
I said "mahirap ata ito" when the first attempt I did not see the trachea right away. That
was when I (interrupted)
Q

That was the first attempt?

Yes.

What about the second attempt?

On the second attempt I was able to intubate right away within two to three seconds.

Q
At what point, for purposes of discussion without accepting it, at what point did you
make the comment "na mahirap ata to intubate, mali ata ang pinasukan"
A

I did not say "mali ata ang pinasukan" I never said that.

Q
Well, just for the information of the group here the remarks I am making is based on
the documents that were forwarded to me by the Supreme Court. That is why for purposes of
discussion I am trying to clarify this for the sake of enlightenment. So, at what point did you
ever make that comment?
A

Which one, sir?

The "mahirap intubate ito" assuming that you (interrupted)

Iyon lang, that is what I only said "mahirap intubate (interrupted)

At what point?

When the first attempt when I inserted the laryngoscope for the first time.

So, when you claim that at the first attempt you inserted the laryngoscope, right?

Yes.

Q
But in one of the recordings somewhere at the, somewhere in the transcript of records
that when the lawyer of the other party try to inquire from you during the first attempt that was
the time when "mayroon ba kayong hinugot sa tube, I do not remember the page now, but it
seems to me it is there. So, that it was on the second attempt that (interrupted)
A

I was able to intubate.

And this is more or less about what time 12:21?

Maybe, I cannot remember the time, Sir.

Q
Okay, assuming that this was done at 12:21 and looking at the anesthesia records from
12:20 to 12:30 there was no recording of the vital signs. And can we presume that at this stage
there was already some problems in handling the patient?
A

Not yet.

But why are there no recordings in the anesthesia record?

I did not have time.

Ah, you did not have time, why did you not have time?

Because it was so fast, I really (at this juncture the witness is laughing)

Q
No, I am just asking. Remember I am not here not to pin point on anybody I am here
just to more or less clarify certainty more ore less on the record.
A

Yes, Sir.

Q
And so it seems that there were no recording during that span of ten (10) minutes.
From 12:20 to 12:30, and going over your narration, it seems to me that the cyanosis appeared
ten (10) minutes after induction, is that right?
A

Yes.

And that is after induction 12:15 that is 12:25 that was the first cyanosis?

Yes.

And that the 12:25 is after the 12:20?

We cannot (interrupted)

Q
Huwag ho kayong makuwan, we are just trying to enlighten, I am just going over the
record ano,kung mali ito kuwan eh di ano. So, ganoon po ano, that it seems to me that there
is no recording from 12:20 to 12:30, so, I am just wondering why there were no recordings
during the period and then of course the second cyanosis, after the first cyanosis. I think that
was the time Dr. Hosaka came in?
A

No, the first cyanosis (interrupted).23

We cannot thus give full credence to Dr. Gutierrez synopsis in light of her admission that it does not
fully reflect the events that transpired during the administration of anesthesia on Erlinda. As pointed
out by Dr. Estrella, there was a ten-minute gap in Dr. Gutierrez synopsis, i.e., the vital signs of Erlinda
were not recorded during that time. The absence of these data is particularly significant because, as
found by the trial court, it was the absence of oxygen supply for four (4) to five (5) minutes that caused
Erlindas comatose condition.
On the other hand, the Court has no reason to disbelieve the testimony of Cruz. As we stated in the
Decision, she is competent to testify on matters which she is capable of observing such as, the
statements and acts of the physician and surgeon, external appearances and manifest conditions
which are observable by any one.24 Cruz, Erlindas sister-in-law, was with her inside the operating
room. Moreover, being a nurse and Dean of the Capitol Medical Center School of Nursing at that, she
is not entirely ignorant of anesthetic procedure. Cruz narrated that she heard Dr. Gutierrez remark,
"Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan." She observed that
the nailbeds of Erlinda became bluish and thereafter Erlinda was placed in trendelenburg
position.25 Cruz further averred that she noticed that the abdomen of Erlinda became distended.26
The cyanosis (bluish discoloration of the skin or mucous membranes caused by lack of oxygen or
abnormal hemoglobin in the blood) and enlargement of the stomach of Erlinda indicate that the
endotracheal tube was improperly inserted into the esophagus instead of the trachea. Consequently,
oxygen was delivered not to the lungs but to the gastrointestinal tract. This conclusion is supported by
the fact that Erlinda was placed in trendelenburg position. This indicates that there was a decrease of
blood supply to the patients brain. The brain was thus temporarily deprived of oxygen supply causing
Erlinda to go into coma.
The injury incurred by petitioner Erlinda does not normally happen absent any negligence in the
administration of anesthesia and in the use of an endotracheal tube. As was noted in our Decision,
the instruments used in the administration of anesthesia, including the endotracheal tube, were all
under the exclusive control of private respondents Dr. Gutierrez and Dr. Hosaka.27 In Voss vs.
Bridwell,28 which involved a patient who suffered brain damage due to the wrongful administration of
anesthesia, and even before the scheduled mastoid operation could be performed, the Kansas
Supreme Court applied the doctrine of res ipsa loquitur, reasoning that the injury to the patient therein
was one which does not ordinarily take place in the absence of negligence in the administration of an
anesthetic, and in the use and employment of an endotracheal tube. The court went on to say that
"[o]rdinarily a person being put under anesthesia is not rendered decerebrate as a consequence of
administering such anesthesia in the absence of negligence. Upon these facts and under these
circumstances, a layman would be able to say, as a matter of common knowledge and observation,
that the consequences of professional treatment were not as such as would ordinarily have followed
if due care had been exercised."29Considering the application of the doctrine of res ipsa loquitur, the
testimony of Cruz was properly given credence in the case at bar.
For his part, Dr. Hosaka mainly contends that the Court erred in finding him negligent as a surgeon by
applying the Captain-of-the-Ship doctrine.30 Dr. Hosaka argues that the trend in United States
jurisprudence has been to reject said doctrine in light of the developments in medical practice. He

points out that anesthesiology and surgery are two distinct and specialized fields in medicine and as
a surgeon, he is not deemed to have control over the acts of Dr. Gutierrez. As anesthesiologist, Dr.
Gutierrez is a specialist in her field and has acquired skills and knowledge in the course of her training
which Dr. Hosaka, as a surgeon, does not possess.31 He states further that current American
jurisprudence on the matter recognizes that the trend towards specialization in medicine has created
situations where surgeons do not always have the right to control all personnel within the operating
room,32 especially a fellow specialist.33
Dr. Hosaka cites the case of Thomas v. Raleigh General Hospital,34 which involved a suit filed by a
patient who lost his voice due to the wrongful insertion of the endotracheal tube preparatory to the
administration of anesthesia in connection with the laparotomy to be conducted on him. The patient
sued both the anesthesiologist and the surgeon for the injury suffered by him. The Supreme Court of
Appeals of West Virginia held that the surgeon could not be held liable for the loss of the patients
voice, considering that the surgeon did not have a hand in the intubation of the patient. The court
rejected the application of the "Captain-of-the-Ship Doctrine," citing the fact that the field of medicine
has become specialized such that surgeons can no longer be deemed as having control over the other
personnel in the operating room. It held that "[a]n assignment of liability based on actual control more
realistically reflects the actual relationship which exists in a modern operating room."35 Hence, only the
anesthesiologist who inserted the endotracheal tube into the patients throat was held liable for the
injury suffered by the latter.
This contention fails to persuade.
That there is a trend in American jurisprudence to do away with the Captain-of-the-Ship doctrine does
not mean that this Court will ipso facto follow said trend. Due regard for the peculiar factual
circumstances obtaining in this case justify the application of the Captain-of-the-Ship doctrine. From
the facts on record it can be logically inferred that Dr. Hosaka exercised a certain degree of, at the
very least, supervision over the procedure then being performed on Erlinda.
First, it was Dr. Hosaka who recommended to petitioners the services of Dr. Gutierrez. In effect, he
represented to petitioners that Dr. Gutierrez possessed the necessary competence and skills. Drs.
Hosaka and Gutierrez had worked together since 1977. Whenever Dr. Hosaka performed a surgery,
he would always engage the services of Dr. Gutierrez to administer the anesthesia on his patient.36
Second, Dr. Hosaka himself admitted that he was the attending physician of Erlinda. Thus, when
Erlinda showed signs of cyanosis, it was Dr. Hosaka who gave instructions to call for another
anesthesiologist and cardiologist to help resuscitate Erlinda.37
Third, it is conceded that in performing their responsibilities to the patient, Drs. Hosaka and Gutierrez
worked as a team. Their work cannot be placed in separate watertight compartments because their
duties intersect with each other.38
While the professional services of Dr. Hosaka and Dr. Gutierrez were secured primarily for their
performance of acts within their respective fields of expertise for the treatment of petitioner Erlinda,
and that one does not exercise control over the other, they were certainly not completely independent
of each other so as to absolve one from the negligent acts of the other physician.
That they were working as a medical team is evident from the fact that Dr. Hosaka was keeping an
eye on the intubation of the patient by Dr. Gutierrez, and while doing so, he observed that the patients
nails had become dusky and had to call Dr. Gutierrezs attention thereto. The Court also notes that
the counsel for Dr. Hosaka admitted that in practice, the anesthesiologist would also have to observe
the surgeons acts during the surgical process and calls the attention of the surgeon whenever

necessary39 in the course of the treatment. The duties of Dr. Hosaka and those of Dr. Gutierrez in the
treatment of petitioner Erlinda are therefore not as clear-cut as respondents claim them to be. On the
contrary, it is quite apparent that they have a common responsibility to treat the patient, which
responsibility necessitates that they call each others attention to the condition of the patient while the
other physician is performing the necessary medical procedures.
It is equally important to point out that Dr. Hosaka was remiss in his duty of attending to petitioner
Erlinda promptly, for he arrived more than three (3) hours late for the scheduled operation.
The cholecystectomy was set for June 17, 1985 at 9:00 a.m., but he arrived at DLSMC only at around
12:10 p.m. In reckless disregard for his patients well being, Dr. Hosaka scheduled two procedures on
the same day, just thirty minutes apart from each other, at different hospitals. Thus, when the first
procedure (protoscopy) at the Sta. Teresita Hospital did not proceed on time, Erlinda was kept in a
state of uncertainty at the DLSMC.
The unreasonable delay in petitioner Erlindas scheduled operation subjected her to continued
starvation and consequently, to the risk of acidosis,40 or the condition of decreased alkalinity of the
blood and tissues, marked by sickly sweet breath, headache, nausea and vomiting, and visual
disturbances.41 The long period that Dr. Hosaka made Erlinda wait for him certainly aggravated the
anxiety that she must have been feeling at the time. It could be safely said that her anxiety adversely
affected the administration of anesthesia on her. As explained by Dr. Camagay, the patients anxiety
usually causes the outpouring of adrenaline which in turn results in high blood pressure or
disturbances in the heart rhythm:
DR. CAMAGAY:
x x x Pre-operative medication has three main functions: One is to alleviate anxiety.
Second is to dry up the secretions and Third is to relieve pain. Now, it is very important
to alleviate anxiety because anxiety is associated with the outpouring of certain
substances formed in the body called adrenalin. When a patient is anxious there is an
outpouring of adrenalin which would have adverse effect on the patient. One of it is
high blood pressure, the other is that he opens himself to disturbances in the heart
rhythm, which would have adverse implications. So, we would like to alleviate patients
anxiety mainly because he will not be in control of his body there could be adverse
results to surgery and he will be opened up; a knife is going to open up his body. x x
x42
Dr. Hosaka cannot now claim that he was entirely blameless of what happened to Erlinda. His conduct
clearly constituted a breach of his professional duties to Erlinda:
CHIEF JUSTICE:
Two other points. The first, Doctor, you were talking about anxiety, would you consider
a patient's stay on the operating table for three hours sufficient enough to aggravate
or magnify his or her anxiety?
DR. CAMAGAY:
Yes.
CHIEF JUSTICE:

In other words, I understand that in this particular case that was the case, three hours
waiting and the patient was already on the operating table (interrupted)
DR. CAMAGAY:
Yes.
CHIEF JUSTICE:
Would you therefore conclude that the surgeon contributed to the aggravation of the
anxiety of the patient?
DR. CAMAGAY:
That this operation did not take place as scheduled is already a source of anxiety and
most operating tables are very narrow and that patients are usually at risk of falling on
the floor so there are restraints that are placed on them and they are never, never left
alone in the operating room by themselves specially if they are already pre-medicated
because they may not be aware of some of their movement that they make which
would contribute to their injury.
CHIEF JUSTICE:
In other words due diligence would require a surgeon to come on time?
DR. CAMAGAY:
I think it is not even due diligence it is courtesy.
CHIEF JUSTICE:
Courtesy.
DR. CAMAGAY:
And care.
CHIEF JUSTICE:
Duty as a matter of fact?
DR. CAMAGAY:
Yes, Your Honor.43
Dr. Hosaka's irresponsible conduct of arriving very late for the scheduled operation of petitioner Erlinda
is violative, not only of his duty as a physician "to serve the interest of his patients with the greatest
solicitude, giving them always his best talent and skill,"44 but also of Article 19 of the Civil Code which
requires a person, in the performance of his duties, to act with justice and give everyone his due.

Anent private respondent DLSMCs liability for the resulting injury to petitioner Erlinda, we held that
respondent hospital is solidarily liable with respondent doctors therefor under Article 2180 of the Civil
Code45 since there exists an employer-employee relationship between private respondent DLSMC and
Drs. Gutierrez and Hosaka:
In other words, private hospitals, hire, fire and exercise real control over their attending and
visiting "consultant" staff. While "consultants" are not, technically employees, x x x the control
exercised, the hiring and the right to terminate consultants all fulfill the important hallmarks of
an employer-employee relationship, with the exception of the payment of wages. In assessing
whether such a relationship in fact exists, the control test is determining. x x x46
DLSMC however contends that applying the four-fold test in determining whether such a relationship
exists between it and the respondent doctors, the inescapable conclusion is that DLSMC cannot be
considered an employer of the respondent doctors.
It has been consistently held that in determining whether an employer-employee relationship exists
between the parties, the following elements must be present: (1) selection and engagement of
services; (2) payment of wages; (3) the power to hire and fire; and (4) the power to control not only
the end to be achieved, but the means to be used in reaching such an end.47
DLSMC maintains that first, a hospital does not hire or engage the services of a consultant, but rather,
accredits the latter and grants him or her the privilege of maintaining a clinic and/or admitting patients
in the hospital upon a showing by the consultant that he or she possesses the necessary qualifications,
such as accreditation by the appropriate board (diplomate), evidence of fellowship and
references.48 Second, it is not the hospital but the patient who pays the consultants fee for services
rendered by the latter.49 Third, a hospital does not dismiss a consultant; instead, the latter may lose
his or her accreditation or privileges granted by the hospital.50 Lastly, DLSMC argues that when a
doctor refers a patient for admission in a hospital, it is the doctor who prescribes the treatment to be
given to said patient. The hospitals obligation is limited to providing the patient with the preferred room
accommodation, the nutritional diet and medications prescribed by the doctor, the equipment and
facilities necessary for the treatment of the patient, as well as the services of the hospital staff who
perform the ministerial tasks of ensuring that the doctors orders are carried out strictly.51
After a careful consideration of the arguments raised by DLSMC, the Court finds that respondent
hospitals position on this issue is meritorious. There is no employer-employee relationship between
DLSMC and Drs. Gutierrez and Hosaka which would hold DLSMC solidarily liable for the injury
suffered by petitioner Erlinda under Article 2180 of the Civil Code.
As explained by respondent hospital, that the admission of a physician to membership in DLSMCs
medical staff as active or visiting consultant is first decided upon by the Credentials Committee thereof,
which is composed of the heads of the various specialty departments such as the Department of
Obstetrics and Gynecology, Pediatrics, Surgery with the department head of the particular specialty
applied for as chairman. The Credentials Committee then recommends to DLSMC's Medical Director
or Hospital Administrator the acceptance or rejection of the applicant physician, and said director or
administrator validates the committee's recommendation.52 Similarly, in cases where a disciplinary
action is lodged against a consultant, the same is initiated by the department to whom the consultant
concerned belongs and filed with the Ethics Committee consisting of the department specialty heads.
The medical director/hospital administrator merely acts as ex-officio member of said committee.
Neither is there any showing that it is DLSMC which pays any of its consultants for medical services
rendered by the latter to their respective patients. Moreover, the contract between the consultant in
respondent hospital and his patient is separate and distinct from the contract between respondent

hospital and said patient. The first has for its object the rendition of medical services by the consultant
to the patient, while the second concerns the provision by the hospital of facilities and services by its
staff such as nurses and laboratory personnel necessary for the proper treatment of the patient.
Further, no evidence was adduced to show that the injury suffered by petitioner Erlinda was due to a
failure on the part of respondent DLSMC to provide for hospital facilities and staff necessary for her
treatment.
For these reasons, we reverse the finding of liability on the part of DLSMC for the injury suffered by
petitioner Erlinda.
Finally, the Court also deems it necessary to modify the award of damages to petitioners in view of
the supervening event of petitioner Erlindas death. In the assailed Decision, the Court awarded actual
damages of One Million Three Hundred Fifty Two Thousand Pesos (P1,352,000.00) to cover the
expenses for petitioner Erlindas treatment and care from the date of promulgation of the Decision up
to the time the patient expires or survives.53 In addition thereto, the Court awarded temperate damages
of One Million Five Hundred Thousand Pesos (P1,500,000.00) in view of the chronic and continuing
nature of petitioner Erlindas injury and the certainty of further pecuniary loss by petitioners as a result
of said injury, the amount of which, however, could not be made with certainty at the time of the
promulgation of the decision. The Court justified such award in this manner:
Our rules on actual or compensatory damages generally assume that at the time of litigation,
the injury suffered as a consequence of an act of negligence has been completed and that the
cost can be liquidated. However, these provisions neglect to take into account those situations,
as in this case, where the resulting injury might be continuing and possible future complications
directly arising from the injury, while certain to occur, are difficult to predict.
In these cases, the amount of damages which should be awarded, if they are to adequately
and correctly respond to the injury caused, should be one which compensates for pecuniary
loss incurred and proved, up to the time of trial; and one which would meet pecuniary loss
certain to be suffered but which could not, from the nature of the case, be made with certainty.
In other words, temperate damages can and should be awarded on top of actual or
compensatory damages in instances where the injury is chronic and continuing. And because
of the unique nature of such cases, no incompatibility arises when both actual and temperate
damages are provided for. The reason is that these damages cover two distinct phases.
As it would not be equitableand certainly not in the best interests of the administration of
justicefor the victim in such cases to constantly come before the courts and invoke their aid
in seeking adjustments to the compensatory damages previously awardedtemperate
damages are appropriate. The amount given as temperate damages, though to a certain
extent speculative, should take into account the cost of proper care.
In the instant case, petitioners were able to provide only home-based nursing care for a
comatose patient who has remained in that condition for over a decade. Having premised our
award for compensatory damages on the amount provided by petitioners at the onset of
litigation, it would be now much more in step with the interests of justice if the value awarded
for temperate damages would allow petitioners to provide optimal care for their loved one in a
facility which generally specializes in such care. They should not be compelled by dire
circumstances to provide substandard care at home without the aid of professionals, for
anything less would be grossly inadequate. Under the circumstances, an award of
P1,500,000.00 in temperate damages would therefore be reasonable.54

However, subsequent to the promulgation of the Decision, the Court was informed by petitioner
Rogelio that petitioner Erlinda died on August 3, 1999.55 In view of this supervening event, the award
of temperate damages in addition to the actual or compensatory damages would no longer be justified
since the actual damages awarded in the Decision are sufficient to cover the medical expenses
incurred by petitioners for the patient. Hence, only the amounts representing actual, moral and
exemplary damages, attorneys fees and costs of suit should be awarded to petitioners.
WHEREFORE, the assailed Decision is hereby modified as follows:
(1) Private respondent De Los Santos Medical Center is hereby absolved from liability arising from the
injury suffered by petitioner Erlinda Ramos on June 17, 1985;
(2) Private respondents Dr. Orlino Hosaka and Dr. Perfecta Gutierrez are hereby declared to be
solidarily liable for the injury suffered by petitioner Erlinda on June 17, 1985 and are ordered to pay
petitioners
(a) P1,352,000.00 as actual damages;
(b) P2,000,000.00 as moral damages;
(c) P100,000.00 as exemplary damages;
(d) P100,000.00 as attorneys fees; and
(e) the costs of the suit.
SO ORDERED.

G.R. No. 142625

December 19, 2006

ROGELIO P. NOGALES, for himself and on behalf of the minors, ROGER ANTHONY,
ANGELICA, NANCY, and MICHAEL CHRISTOPHER, all surnamed NOGALES, petitioners,
vs.
CAPITOL MEDICAL CENTER, DR. OSCAR ESTRADA, DR. ELY VILLAFLOR, DR. ROSA UY,
DR. JOEL ENRIQUEZ, DR. PERPETUA LACSON, DR. NOE ESPINOLA, and NURSE J.
DUMLAO, respondents.
CARPIO, J.:
The Case
This petition for review1 assails the 6 February 1998 Decision2 and 21 March 2000 Resolution3 of the
Court of Appeals in CA-G.R. CV No. 45641. The Court of Appeals affirmed in toto the 22 November
1993 Decision4 of the Regional Trial Court of Manila, Branch 33, finding Dr. Oscar Estrada solely liable
for damages for the death of his patient, Corazon Nogales, while absolving the remaining respondents
of any liability. The Court of Appeals denied petitioners' motion for reconsideration.
The Facts
Pregnant with her fourth child, Corazon Nogales ("Corazon"), who was then 37 years old, was under
the exclusive prenatal care of Dr. Oscar Estrada ("Dr. Estrada") beginning on her fourth month of
pregnancy or as early as December 1975. While Corazon was on her last trimester of pregnancy, Dr.
Estrada noted an increase in her blood pressure and development of leg edema5 indicating
preeclampsia,6 which is a dangerous complication of pregnancy.7
Around midnight of 25 May 1976, Corazon started to experience mild labor pains prompting Corazon
and Rogelio Nogales ("Spouses Nogales") to see Dr. Estrada at his home. After examining Corazon,
Dr. Estrada advised her immediate admission to the Capitol Medical Center ("CMC").
On 26 May 1976, Corazon was admitted at 2:30 a.m. at the CMC after the staff nurse noted the written
admission request8 of Dr. Estrada. Upon Corazon's admission at the CMC, Rogelio Nogales
("Rogelio") executed and signed the "Consent on Admission and Agreement"9 and "Admission
Agreement."10 Corazon was then brought to the labor room of the CMC.
Dr. Rosa Uy ("Dr. Uy"), who was then a resident physician of CMC, conducted an internal examination
of Corazon. Dr. Uy then called up Dr. Estrada to notify him of her findings.
Based on the Doctor's Order Sheet,11 around 3:00 a.m., Dr. Estrada ordered for 10 mg. of valium to
be administered immediately by intramuscular injection. Dr. Estrada later ordered the start of
intravenous administration of syntocinon admixed with dextrose, 5%, in lactated Ringers' solution, at
the rate of eight to ten micro-drops per minute.
According to the Nurse's Observation Notes,12 Dr. Joel Enriquez ("Dr. Enriquez"), an anesthesiologist
at CMC, was notified at 4:15 a.m. of Corazon's admission. Subsequently, when asked if he needed
the services of an anesthesiologist, Dr. Estrada refused. Despite Dr. Estrada's refusal, Dr. Enriquez
stayed to observe Corazon's condition.

At 6:00 a.m., Corazon was transferred to Delivery Room No. 1 of the CMC. At 6:10 a.m., Corazon's
bag of water ruptured spontaneously. At 6:12 a.m., Corazon's cervix was fully dilated. At 6:13 a.m.,
Corazon started to experience convulsions.
At 6:15 a.m., Dr. Estrada ordered the injection of ten grams of magnesium sulfate. However, Dr. Ely
Villaflor ("Dr. Villaflor"), who was assisting Dr. Estrada, administered only 2.5 grams of magnesium
sulfate.
At 6:22 a.m., Dr. Estrada, assisted by Dr. Villaflor, applied low forceps to extract Corazon's baby. In
the process, a 1.0 x 2.5 cm. piece of cervical tissue was allegedly torn. The baby came out in an apnic,
cyanotic, weak and injured condition. Consequently, the baby had to be intubated and resuscitated by
Dr. Enriquez and Dr. Payumo.
At 6:27 a.m., Corazon began to manifest moderate vaginal bleeding which rapidly became profuse.
Corazon's blood pressure dropped from 130/80 to 60/40 within five minutes. There was continuous
profuse vaginal bleeding. The assisting nurse administered hemacel through a gauge 19 needle as a
side drip to the ongoing intravenous injection of dextrose.
At 7:45 a.m., Dr. Estrada ordered blood typing and cross matching with bottled blood. It took
approximately 30 minutes for the CMC laboratory, headed by Dr. Perpetua Lacson ("Dr. Lacson"), to
comply with Dr. Estrada's order and deliver the blood.
At 8:00 a.m., Dr. Noe Espinola ("Dr. Espinola"), head of the Obstetrics-Gynecology Department of the
CMC, was apprised of Corazon's condition by telephone. Upon being informed that Corazon was
bleeding profusely, Dr. Espinola ordered immediate hysterectomy. Rogelio was made to sign a
"Consent to Operation."13
Due to the inclement weather then, Dr. Espinola, who was fetched from his residence by an
ambulance, arrived at the CMC about an hour later or at 9:00 a.m. He examined the patient and
ordered some resuscitative measures to be administered. Despite Dr. Espinola's efforts, Corazon died
at 9:15 a.m. The cause of death was "hemorrhage, post partum."14
On 14 May 1980, petitioners filed a complaint for damages15 with the Regional Trial Court16 of Manila
against CMC, Dr. Estrada, Dr. Villaflor, Dr. Uy, Dr. Enriquez, Dr. Lacson, Dr. Espinola, and a certain
Nurse J. Dumlao for the death of Corazon. Petitioners mainly contended that defendant physicians
and CMC personnel were negligent in the treatment and management of Corazon's condition.
Petitioners charged CMC with negligence in the selection and supervision of defendant physicians
and hospital staff.
For failing to file their answer to the complaint despite service of summons, the trial court declared Dr.
Estrada, Dr. Enriquez, and Nurse Dumlao in default.17 CMC, Dr. Villaflor, Dr. Uy, Dr. Espinola, and Dr.
Lacson filed their respective answers denying and opposing the allegations in the complaint.
Subsequently, trial ensued.
After more than 11 years of trial, the trial court rendered judgment on 22 November 1993 finding Dr.
Estrada solely liable for damages. The trial court ruled as follows:
The victim was under his pre-natal care, apparently, his fault began from his incorrect and
inadequate management and lack of treatment of the pre-eclamptic condition of his patient. It
is not disputed that he misapplied the forceps in causing the delivery because it resulted in a
large cervical tear which had caused the profuse bleeding which he also failed to control with
the application of inadequate injection of magnesium sulfate by his assistant Dra. Ely Villaflor.

Dr. Estrada even failed to notice the erroneous administration by nurse Dumlao of hemacel by
way of side drip, instead of direct intravenous injection, and his failure to consult a senior
obstetrician at an early stage of the problem.
On the part however of Dra. Ely Villaflor, Dra. Rosa Uy, Dr. Joel Enriquez, Dr. Lacson, Dr.
Espinola, nurse J. Dumlao and CMC, the Court finds no legal justification to find them civilly
liable.
On the part of Dra. Ely Villaflor, she was only taking orders from Dr. Estrada, the principal
physician of Corazon Nogales. She can only make suggestions in the manner the patient
maybe treated but she cannot impose her will as to do so would be to substitute her good
judgment to that of Dr. Estrada. If she failed to correctly diagnose the true cause of the bleeding
which in this case appears to be a cervical laceration, it cannot be safely concluded by the
Court that Dra. Villaflor had the correct diagnosis and she failed to inform Dr. Estrada. No
evidence was introduced to show that indeed Dra. Villaflor had discovered that there was
laceration at the cervical area of the patient's internal organ.
On the part of nurse Dumlao, there is no showing that when she administered the hemacel as
a side drip, she did it on her own. If the correct procedure was directly thru the veins, it could
only be because this was what was probably the orders of Dr. Estrada.
While the evidence of the plaintiffs shows that Dr. Noe Espinola, who was the Chief of the
Department of Obstetrics and Gynecology who attended to the patient Mrs. Nogales, it was
only at 9:00 a.m. That he was able to reach the hospital because of typhoon Didang (Exhibit
2). While he was able to give prescription in the manner Corazon Nogales may be treated, the
prescription was based on the information given to him by phone and he acted on the basis of
facts as presented to him, believing in good faith that such is the correct remedy. He was not
with Dr. Estrada when the patient was brought to the hospital at 2:30 o'clock a.m. So, whatever
errors that Dr. Estrada committed on the patient before 9:00 o'clock a.m. are certainly the
errors of Dr. Estrada and cannot be the mistake of Dr. Noe Espinola. His failure to come to the
hospital on time was due to fortuitous event.
On the part of Dr. Joel Enriquez, while he was present in the delivery room, it is not incumbent
upon him to call the attention of Dr. Estrada, Dra. Villaflor and also of Nurse Dumlao on the
alleged errors committed by them. Besides, as anesthesiologist, he has no authority to control
the actuations of Dr. Estrada and Dra. Villaflor. For the Court to assume that there were errors
being committed in the presence of Dr. Enriquez would be to dwell on conjectures and
speculations.
On the civil liability of Dr. Perpetua Lacson, [s]he is a hematologist and in-charge of the blood
bank of the CMC. The Court cannot accept the theory of the plaintiffs that there was delay in
delivering the blood needed by the patient. It was testified, that in order that this blood will be
made available, a laboratory test has to be conducted to determine the type of blood, cross
matching and other matters consistent with medical science so, the lapse of 30 minutes maybe
considered a reasonable time to do all of these things, and not a delay as the plaintiffs would
want the Court to believe.
Admittedly, Dra. Rosa Uy is a resident physician of the Capitol Medical Center. She was sued
because of her alleged failure to notice the incompetence and negligence of Dr. Estrada.
However, there is no evidence to support such theory. No evidence was adduced to show that
Dra. Rosa Uy as a resident physician of Capitol Medical Center, had knowledge of the

mismanagement of the patient Corazon Nogales, and that notwithstanding such knowledge,
she tolerated the same to happen.
In the pre-trial order, plaintiffs and CMC agreed that defendant CMC did not have any hand or
participation in the selection or hiring of Dr. Estrada or his assistant Dra. Ely Villaflor as
attending physician[s] of the deceased. In other words, the two (2) doctors were not employees
of the hospital and therefore the hospital did not have control over their professional conduct.
When Mrs. Nogales was brought to the hospital, it was an emergency case and defendant
CMC had no choice but to admit her. Such being the case, there is therefore no legal ground
to apply the provisions of Article 2176 and 2180 of the New Civil Code referring to the vicarious
liability of an employer for the negligence of its employees. If ever in this case there is fault or
negligence in the treatment of the deceased on the part of the attending physicians who were
employed by the family of the deceased, such civil liability should be borne by the attending
physicians under the principle of "respondeat superior".
WHEREFORE, premises considered, judgment is hereby rendered finding defendant Dr.
Estrada of Number 13 Pitimini St. San Francisco del Monte, Quezon City civilly liable to pay
plaintiffs: 1) By way of actual damages in the amount of P105,000.00; 2) By way of moral
damages in the amount of P700,000.00; 3) Attorney's fees in the amount of P100,000.00 and
to pay the costs of suit.
For failure of the plaintiffs to adduce evidence to support its [sic] allegations against the other
defendants, the complaint is hereby ordered dismissed. While the Court looks with disfavor
the filing of the present complaint against the other defendants by the herein plaintiffs, as in a
way it has caused them personal inconvenience and slight damage on their name and
reputation, the Court cannot accepts [sic] however, the theory of the remaining defendants
that plaintiffs were motivated in bad faith in the filing of this complaint. For this reason
defendants' counterclaims are hereby ordered dismissed.
SO ORDERED.18
Petitioners appealed the trial court's decision. Petitioners claimed that aside from Dr. Estrada, the
remaining respondents should be held equally liable for negligence. Petitioners pointed out the extent
of each respondent's alleged liability.
On 6 February 1998, the Court of Appeals affirmed the decision of the trial court. 19 Petitioners filed a
motion for reconsideration which the Court of Appeals denied in its Resolution of 21 March 2000.20
Hence, this petition.
Meanwhile, petitioners filed a Manifestation dated 12 April 200221 stating that respondents Dr. Estrada,
Dr. Enriquez, Dr. Villaflor, and Nurse Dumlao "need no longer be notified of the petition because they
are absolutely not involved in the issue raised before the [Court], regarding the liability of
[CMC]."22 Petitioners stressed that the subject matter of this petition is the liability of CMC for the
negligence of Dr. Estrada.23
The Court issued a Resolution dated 9 September 200224 dispensing with the requirement to submit
the correct and present addresses of respondents Dr. Estrada, Dr. Enriquez, Dr. Villaflor, and Nurse
Dumlao. The Court stated that with the filing of petitioners' Manifestation, it should be understood that
they are claiming only against respondents CMC, Dr. Espinola, Dr. Lacson, and Dr. Uy who have filed
their respective comments. Petitioners are foregoing further claims against respondents Dr. Estrada,
Dr. Enriquez, Dr. Villaflor, and Nurse Dumlao.

The Court noted that Dr. Estrada did not appeal the decision of the Court of Appeals affirming the
decision of the Regional Trial Court. Accordingly, the decision of the Court of Appeals, affirming the
trial court's judgment, is already final as against Dr. Oscar Estrada.
Petitioners filed a motion for reconsideration25 of the Court's 9 September 2002 Resolution claiming
that Dr. Enriquez, Dr. Villaflor and Nurse Dumlao were notified of the petition at their counsels' last
known addresses. Petitioners reiterated their imputation of negligence on these respondents. The
Court denied petitioners' Motion for Reconsideration in its 18 February 2004 Resolution.26
The Court of Appeals' Ruling
In its Decision of 6 February 1998, the Court of Appeals upheld the trial court's ruling. The Court of
Appeals rejected petitioners' view that the doctrine in Darling v. Charleston Community Memorial
Hospital27 applies to this case. According to the Court of Appeals, the present case differs from
the Darling case since Dr. Estrada is an independent contractor-physician whereas the Darling case
involved a physician and a nurse who were employees of the hospital.
Citing other American cases, the Court of Appeals further held that the mere fact that a hospital
permitted a physician to practice medicine and use its facilities is not sufficient to render the hospital
liable for the physician's negligence.28 A hospital is not responsible for the negligence of a physician
who is an independent contractor.29
The Court of Appeals found the cases of Davidson v. Conole30 and Campbell v. Emma Laing Stevens
Hospital31applicable to this case. Quoting Campbell, the Court of Appeals stated that where there is
no proof that defendant physician was an employee of defendant hospital or that defendant hospital
had reason to know that any acts of malpractice would take place, defendant hospital could not be
held liable for its failure to intervene in the relationship of physician-patient between defendant
physician and plaintiff.
On the liability of the other respondents, the Court of Appeals applied the "borrowed servant" doctrine
considering that Dr. Estrada was an independent contractor who was merely exercising hospital
privileges. This doctrine provides that once the surgeon enters the operating room and takes charge
of the proceedings, the acts or omissions of operating room personnel, and any negligence associated
with such acts or omissions, are imputable to the surgeon.32 While the assisting physicians and nurses
may be employed by the hospital, or engaged by the patient, they normally become the temporary
servants or agents of the surgeon in charge while the operation is in progress, and liability may be
imposed upon the surgeon for their negligent acts under the doctrine of respondeat superior.33
The Court of Appeals concluded that since Rogelio engaged Dr. Estrada as the attending physician
of his wife, any liability for malpractice must be Dr. Estrada's sole responsibility.
While it found the amount of damages fair and reasonable, the Court of Appeals held that no interest
could be imposed on unliquidated claims or damages.
The Issue
Basically, the issue in this case is whether CMC is vicariously liable for the negligence of Dr. Estrada.
The resolution of this issue rests, on the other hand, on the ascertainment of the relationship between
Dr. Estrada and CMC. The Court also believes that a determination of the extent of liability of the other
respondents is inevitable to finally and completely dispose of the present controversy.

The Ruling of the Court


The petition is partly meritorious.
On the Liability of CMC
Dr. Estrada's negligence in handling the treatment and management of Corazon's condition which
ultimately resulted in Corazon's death is no longer in issue. Dr. Estrada did not appeal the decision of
the Court of Appeals which affirmed the ruling of the trial court finding Dr. Estrada solely liable for
damages. Accordingly, the finding of the trial court on Dr. Estrada's negligence is already final.
Petitioners maintain that CMC is vicariously liable for Dr. Estrada's negligence based on Article 2180
in relation to Article 2176 of the Civil Code. These provisions pertinently state:
Art. 2180. The obligation imposed by article 2176 is demandable not only for one's own acts
or omissions, but also for those of persons for whom one is responsible.
xxxx
Employers shall be liable for the damages caused by their employees and household helpers
acting within the scope of their assigned tasks, even though the former are not engaged in any
business or industry.
xxxx
The responsibility treated of in this article shall cease when the persons herein mentioned
prove that they observed all the diligence of a good father of a family to prevent damage.
Art. 2176. Whoever by act or omission causes damage to another, there being fault or
negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no preexisting contractual relation between the parties, is called a quasi-delict and is governed by
the provisions of this Chapter.
Similarly, in the United States, a hospital which is the employer, master, or principal of a physician
employee, servant, or agent, may be held liable for the physician's negligence under the doctrine
of respondeat superior.34
In the present case, petitioners maintain that CMC, in allowing Dr. Estrada to practice and admit
patients at CMC, should be liable for Dr. Estrada's malpractice. Rogelio claims that he knew Dr.
Estrada as an accredited physician of CMC, though he discovered later that Dr. Estrada was not a
salaried employee of the CMC.35 Rogelio further claims that he was dealing with CMC, whose primary
concern was the treatment and management of his wife's condition. Dr. Estrada just happened to be
the specific person he talked to representing CMC.36 Moreover, the fact that CMC made Rogelio sign
a Consent on Admission and Admission Agreement37 and a Consent to Operation printed on the
letterhead of CMC indicates that CMC considered Dr. Estrada as a member of its medical staff.
On the other hand, CMC disclaims liability by asserting that Dr. Estrada was a mere visiting physician
and that it admitted Corazon because her physical condition then was classified an emergency
obstetrics case.38

CMC alleges that Dr. Estrada is an independent contractor "for whose actuations CMC would be a
total stranger." CMC maintains that it had no control or supervision over Dr. Estrada in the exercise of
his medical profession.
The Court had the occasion to determine the relationship between a hospital and a consultant or
visiting physician and the liability of such hospital for that physician's negligence in Ramos v. Court of
Appeals,39 to wit:
In the first place, hospitals exercise significant control in the hiring and firing of consultants and
in the conduct of their work within the hospital premises. Doctors who apply for "consultant"
slots, visiting or attending, are required to submit proof of completion of residency, their
educational qualifications; generally, evidence of accreditation by the appropriate board
(diplomate), evidence of fellowship in most cases, and references. These requirements are
carefully scrutinized by members of the hospital administration or by a review committee set
up by the hospital who either accept or reject the application. This is particularly true with
respondent hospital.
After a physician is accepted, either as a visiting or attending consultant, he is normally
required to attend clinico-pathological conferences, conduct bedside rounds for clerks, interns
and residents, moderate grand rounds and patient audits and perform other tasks and
responsibilities, for the privilege of being able to maintain a clinic in the hospital, and/or for the
privilege of admitting patients into the hospital. In addition to these, the physician's
performance as a specialist is generally evaluated by a peer review committee on the basis of
mortality and morbidity statistics, and feedback from patients, nurses, interns and residents. A
consultant remiss in his duties, or a consultant who regularly falls short of the minimum
standards acceptable to the hospital or its peer review committee, is normally politely
terminated.
In other words, private hospitals, hire, fire and exercise real control over their attending and
visiting "consultant" staff. While "consultants" are not, technically employees, a point
which respondent hospital asserts in denying all responsibility for the patient's
condition, the control exercised, the hiring, and the right to terminate consultants all
fulfill the important hallmarks of an employer-employee relationship, with the exception
of the payment of wages. In assessing whether such a relationship in fact exists, the
control test is determining. Accordingly, on the basis of the foregoing, we rule that for
the purpose of allocating responsibility in medical negligence cases, an employeremployee relationship in effect exists between hospitals and their attending and visiting
physicians. This being the case, the question now arises as to whether or not respondent
hospital is solidarily liable with respondent doctors for petitioner's condition.
The basis for holding an employer solidarily responsible for the negligence of its employee is
found in Article 2180 of the Civil Code which considers a person accountable not only for his
own acts but also for those of others based on the former's responsibility under a relationship
of patria potestas. x x x40(Emphasis supplied)
While the Court in Ramos did not expound on the control test, such test essentially determines whether
an employment relationship exists between a physician and a hospital based on the exercise of control
over the physician as to details. Specifically, the employer (or the hospital) must have the right to
control both the means and the details of the process by which the employee (or the physician) is to
accomplish his task.41

After a thorough examination of the voluminous records of this case, the Court finds no single evidence
pointing to CMC's exercise of control over Dr. Estrada's treatment and management of Corazon's
condition. It is undisputed that throughout Corazon's pregnancy, she was under the exclusive prenatal
care of Dr. Estrada. At the time of Corazon's admission at CMC and during her delivery, it was Dr.
Estrada, assisted by Dr. Villaflor, who attended to Corazon. There was no showing that CMC had a
part in diagnosing Corazon's condition. While Dr. Estrada enjoyed staff privileges at CMC, such fact
alone did not make him an employee of CMC.42 CMC merely allowed Dr. Estrada to use its
facilities43 when Corazon was about to give birth, which CMC considered an emergency. Considering
these circumstances, Dr. Estrada is not an employee of CMC, but an independent contractor.
The question now is whether CMC is automatically exempt from liability considering that Dr. Estrada
is an independent contractor-physician.
In general, a hospital is not liable for the negligence of an independent contractor-physician. There is,
however, an exception to this principle. The hospital may be liable if the physician is the "ostensible"
agent of the hospital.44This exception is also known as the "doctrine of apparent authority."45 In Gilbert
v. Sycamore Municipal Hospital,46 the Illinois Supreme Court explained the doctrine of apparent
authority in this wise:
[U]nder the doctrine of apparent authority a hospital can be held vicariously liable for the
negligent acts of a physician providing care at the hospital, regardless of whether the physician
is an independent contractor, unless the patient knows, or should have known, that the
physician is an independent contractor. The elements of the action have been set out as
follows:
"For a hospital to be liable under the doctrine of apparent authority, a plaintiff must show that:
(1) the hospital, or its agent, acted in a manner that would lead a reasonable person to
conclude that the individual who was alleged to be negligent was an employee or agent of the
hospital; (2) where the acts of the agent create the appearance of authority, the plaintiff must
also prove that the hospital had knowledge of and acquiesced in them; and (3) the plaintiff
acted in reliance upon the conduct of the hospital or its agent, consistent with ordinary care
and prudence."
The element of "holding out" on the part of the hospital does not require an express
representation by the hospital that the person alleged to be negligent is an employee. Rather,
the element is satisfied if the hospital holds itself out as a provider of emergency room care
without informing the patient that the care is provided by independent contractors.
The element of justifiable reliance on the part of the plaintiff is satisfied if the plaintiff relies
upon the hospital to provide complete emergency room care, rather than upon a specific
physician.
The doctrine of apparent authority essentially involves two factors to determine the liability of an
independent-contractor physician.
The first factor focuses on the hospital's manifestations and is sometimes described as an inquiry
whether the hospital acted in a manner which would lead a reasonable person to conclude that the
individual who was alleged to be negligent was an employee or agent of the hospital.47 In this regard,
the hospital need not make express representations to the patient that the treating physician
is an employee of the hospital; rather a representation may be general and implied.48

The doctrine of apparent authority is a species of the doctrine of estoppel. Article 1431 of the Civil
Code provides that "[t]hrough estoppel, an admission or representation is rendered conclusive upon
the person making it, and cannot be denied or disproved as against the person relying thereon."
Estoppel rests on this rule: "Whenever a party has, by his own declaration, act, or omission,
intentionally and deliberately led another to believe a particular thing true, and to act upon such belief,
he cannot, in any litigation arising out of such declaration, act or omission, be permitted to falsify it."49
In the instant case, CMC impliedly held out Dr. Estrada as a member of its medical staff. Through
CMC's acts, CMC clothed Dr. Estrada with apparent authority thereby leading the Spouses Nogales
to believe that Dr. Estrada was an employee or agent of CMC. CMC cannot now repudiate such
authority.
First, CMC granted staff privileges to Dr. Estrada. CMC extended its medical staff and facilities to Dr.
Estrada. Upon Dr. Estrada's request for Corazon's admission, CMC, through its personnel, readily
accommodated Corazon and updated Dr. Estrada of her condition.
Second, CMC made Rogelio sign consent forms printed on CMC letterhead. Prior to Corazon's
admission and supposed hysterectomy, CMC asked Rogelio to sign release forms, the contents of
which reinforced Rogelio's belief that Dr. Estrada was a member of CMC's medical staff.50 The Consent
on Admission and Agreement explicitly provides:
KNOW ALL MEN BY THESE PRESENTS:
I, Rogelio Nogales, of legal age, a resident of 1974 M. H. Del Pilar St., Malate Mla., being the
father/mother/brother/sister/spouse/relative/ guardian/or person in custody of Ma. Corazon,
and representing his/her family, of my own volition and free will, do consent and submit said
Ma. Corazon to Dr. Oscar Estrada (hereinafter referred to as Physician) for cure, treatment,
retreatment, or emergency measures, that the Physician, personally or by and through the
Capitol Medical Center and/or its staff, may use, adapt, or employ such means, forms
or methods of cure, treatment, retreatment, or emergency measures as he may see best
and most expedient; that Ma. Corazon and I will comply with any and all rules,
regulations, directions, and instructions of the Physician, the Capitol Medical Center
and/or its staff; and, that I will not hold liable or responsible and hereby waive and forever
discharge and hold free the Physician, the Capitol Medical Center and/or its staff, from any
and all claims of whatever kind of nature, arising from directly or indirectly, or by reason of said
cure, treatment, or retreatment, or emergency measures or intervention of said physician, the
Capitol Medical Center and/or its staff.
x x x x51 (Emphasis supplied)
While the Consent to Operation pertinently reads, thus:
I, ROGELIO NOGALES, x x x, of my own volition and free will, do consent and submit said
CORAZON NOGALES to Hysterectomy, by the Surgical Staff and Anesthesiologists of
Capitol Medical Centerand/or whatever succeeding operations, treatment, or emergency
measures as may be necessary and most expedient; and, that I will not hold liable or
responsible and hereby waive and forever discharge and hold free the Surgeon, his assistants,
anesthesiologists, the Capitol Medical Center and/or its staff, from any and all claims of
whatever kind of nature, arising from directly or indirectly, or by reason of said operation or
operations, treatment, or emergency measures, or intervention of the Surgeon, his assistants,
anesthesiologists, the Capitol Medical Center and/or its staff.52 (Emphasis supplied)

Without any indication in these consent forms that Dr. Estrada was an independent contractorphysician, the Spouses Nogales could not have known that Dr. Estrada was an independent
contractor. Significantly, no one from CMC informed the Spouses Nogales that Dr. Estrada was an
independent contractor. On the contrary, Dr. Atencio, who was then a member of CMC Board of
Directors, testified that Dr. Estrada was part of CMC's surgical staff.53
Third, Dr. Estrada's referral of Corazon's profuse vaginal bleeding to Dr. Espinola, who was then the
Head of the Obstetrics and Gynecology Department of CMC, gave the impression that Dr. Estrada as
a member of CMC's medical staff was collaborating with other CMC-employed specialists in treating
Corazon.
The second factor focuses on the patient's reliance. It is sometimes characterized as an inquiry on
whether the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with
ordinary care and prudence.54
The records show that the Spouses Nogales relied upon a perceived employment relationship with
CMC in accepting Dr. Estrada's services. Rogelio testified that he and his wife specifically chose Dr.
Estrada to handle Corazon's delivery not only because of their friend's recommendation, but more
importantly because of Dr. Estrada's "connection with a reputable hospital, the [CMC]."55 In other
words, Dr. Estrada's relationship with CMC played a significant role in the Spouses Nogales' decision
in accepting Dr. Estrada's services as the obstetrician-gynecologist for Corazon's delivery. Moreover,
as earlier stated, there is no showing that before and during Corazon's confinement at CMC, the
Spouses Nogales knew or should have known that Dr. Estrada was not an employee of CMC.
Further, the Spouses Nogales looked to CMC to provide the best medical care and support services
for Corazon's delivery. The Court notes that prior to Corazon's fourth pregnancy, she used to give birth
inside a clinic. Considering Corazon's age then, the Spouses Nogales decided to have their fourth
child delivered at CMC, which Rogelio regarded one of the best hospitals at the time.56 This is precisely
because the Spouses Nogales feared that Corazon might experience complications during her
delivery which would be better addressed and treated in a modern and big hospital such as CMC.
Moreover, Rogelio's consent in Corazon's hysterectomy to be performed by a different physician,
namely Dr. Espinola, is a clear indication of Rogelio's confidence in CMC's surgical staff.
CMC's defense that all it did was "to extend to [Corazon] its facilities" is untenable. The Court cannot
close its eyes to the reality that hospitals, such as CMC, are in the business of treatment. In this regard,
the Court agrees with the observation made by the Court of Appeals of North Carolina in Diggs v.
Novant Health, Inc.,57 to wit:
"The conception that the hospital does not undertake to treat the patient, does not undertake
to act through its doctors and nurses, but undertakes instead simply to procure them to act
upon their own responsibility, no longer reflects the fact. Present day hospitals, as their
manner of operation plainly demonstrates, do far more than furnish facilities for
treatment. They regularly employ on a salary basis a large staff of physicians, nurses
and internes [sic], as well as administrative and manual workers, and they charge
patients for medical care and treatment, collecting for such services, if necessary, by
legal action. Certainly, the person who avails himself of 'hospital facilities' expects that
the hospital will attempt to cure him, not that its nurses or other employees will act on
their own responsibility." x x x (Emphasis supplied)
Likewise unconvincing is CMC's argument that petitioners are estopped from claiming damages based
on the Consent on Admission and Consent to Operation. Both release forms consist of two parts. The
first part gave CMC permission to administer to Corazon any form of recognized medical treatment

which the CMC medical staff deemed advisable. The second part of the documents, which may
properly be described as the releasing part, releases CMC and its employees "from any and all claims"
arising from or by reason of the treatment and operation.
The documents do not expressly release CMC from liability for injury to Corazon due to negligence
during her treatment or operation. Neither do the consent forms expressly exempt CMC from liability
for Corazon's death due to negligence during such treatment or operation. Such release forms, being
in the nature of contracts of adhesion, are construed strictly against hospitals. Besides, a blanket
release in favor of hospitals "from any and all claims," which includes claims due to bad faith or gross
negligence, would be contrary to public policy and thus void.
Even simple negligence is not subject to blanket release in favor of establishments like hospitals but
may only mitigate liability depending on the circumstances.58 When a person needing urgent medical
attention rushes to a hospital, he cannot bargain on equal footing with the hospital on the terms of
admission and operation. Such a person is literally at the mercy of the hospital. There can be no
clearer example of a contract of adhesion than one arising from such a dire situation. Thus, the release
forms of CMC cannot relieve CMC from liability for the negligent medical treatment of Corazon.
On the Liability of the Other Respondents
Despite this Court's pronouncement in its 9 September 200259 Resolution that the filing of petitioners'
Manifestation confined petitioners' claim only against CMC, Dr. Espinola, Dr. Lacson, and Dr. Uy, who
have filed their comments, the Court deems it proper to resolve the individual liability of the remaining
respondents to put an end finally to this more than two-decade old controversy.
a) Dr. Ely Villaflor
Petitioners blame Dr. Ely Villaflor for failing to diagnose the cause of Corazon's bleeding and to
suggest the correct remedy to Dr. Estrada.60 Petitioners assert that it was Dr. Villaflor's duty to correct
the error of Nurse Dumlao in the administration of hemacel.
The Court is not persuaded. Dr. Villaflor admitted administering a lower dosage of magnesium sulfate.
However, this was after informing Dr. Estrada that Corazon was no longer in convulsion and that her
blood pressure went down to a dangerous level.61 At that moment, Dr. Estrada instructed Dr. Villaflor
to reduce the dosage of magnesium sulfate from 10 to 2.5 grams. Since petitioners did not dispute Dr.
Villaflor's allegation, Dr. Villaflor's defense remains uncontroverted. Dr. Villaflor's act of administering
a lower dosage of magnesium sulfate was not out of her own volition or was in contravention of Dr.
Estrada's order.
b) Dr. Rosa Uy
Dr. Rosa Uy's alleged negligence consisted of her failure (1) to call the attention of Dr. Estrada on the
incorrect dosage of magnesium sulfate administered by Dr. Villaflor; (2) to take corrective measures;
and (3) to correct Nurse Dumlao's wrong method of hemacel administration.
The Court believes Dr. Uy's claim that as a second year resident physician then at CMC, she was
merely authorized to take the clinical history and physical examination of Corazon. 62 However, that
routine internal examination did not ipso facto make Dr. Uy liable for the errors committed by Dr.
Estrada. Further, petitioners' imputation of negligence rests on their baseless assumption that Dr. Uy
was present at the delivery room. Nothing shows that Dr. Uy participated in delivering Corazon's baby.
Further, it is unexpected from Dr. Uy, a mere resident physician at that time, to call the attention of a
more experienced specialist, if ever she was present at the delivery room.

c) Dr. Joel Enriquez


Petitioners fault Dr. Joel Enriquez also for not calling the attention of Dr. Estrada, Dr. Villaflor, and
Nurse Dumlao about their errors.63 Petitioners insist that Dr. Enriquez should have taken, or at least
suggested, corrective measures to rectify such errors.
The Court is not convinced. Dr. Enriquez is an anesthesiologist whose field of expertise is definitely
not obstetrics and gynecology. As such, Dr. Enriquez was not expected to correct Dr. Estrada's errors.
Besides, there was no evidence of Dr. Enriquez's knowledge of any error committed by Dr. Estrada
and his failure to act upon such observation.
d) Dr. Perpetua Lacson
Petitioners fault Dr. Perpetua Lacson for her purported delay in the delivery of blood Corazon
needed.64Petitioners claim that Dr. Lacson was remiss in her duty of supervising the blood bank staff.
As found by the trial court, there was no unreasonable delay in the delivery of blood from the time of
the request until the transfusion to Corazon. Dr. Lacson competently explained the procedure before
blood could be given to the patient.65 Taking into account the bleeding time, clotting time and crossmatching, Dr. Lacson stated that it would take approximately 45-60 minutes before blood could be
ready for transfusion.66 Further, no evidence exists that Dr. Lacson neglected her duties as head of
the blood bank.
e) Dr. Noe Espinola
Petitioners argue that Dr. Espinola should not have ordered immediate hysterectomy without
determining the underlying cause of Corazon's bleeding. Dr. Espinola should have first considered the
possibility of cervical injury, and advised a thorough examination of the cervix, instead of believing
outright Dr. Estrada's diagnosis that the cause of bleeding was uterine atony.
Dr. Espinola's order to do hysterectomy which was based on the information he received by phone is
not negligence. The Court agrees with the trial court's observation that Dr. Espinola, upon hearing
such information about Corazon's condition, believed in good faith that hysterectomy was the correct
remedy. At any rate, the hysterectomy did not push through because upon Dr. Espinola's arrival, it
was already too late. At the time, Corazon was practically dead.
f) Nurse J. Dumlao
In Moore v. Guthrie Hospital Inc.,67 the US Court of Appeals, Fourth Circuit, held that to recover, a
patient complaining of injuries allegedly resulting when the nurse negligently injected medicine to him
intravenously instead of intramuscularly had to show that (1) an intravenous injection constituted a
lack of reasonable and ordinary care; (2) the nurse injected medicine intravenously; and (3) such
injection was the proximate cause of his injury.
In the present case, there is no evidence of Nurse Dumlao's alleged failure to follow Dr. Estrada's
specific instructions. Even assuming Nurse Dumlao defied Dr. Estrada's order, there is no showing
that side-drip administration of hemacel proximately caused Corazon's death. No evidence linking
Corazon's death and the alleged wrongful hemacel administration was introduced. Therefore, there is
no basis to hold Nurse Dumlao liable for negligence.
On the Award of Interest on Damages

The award of interest on damages is proper and allowed under Article 2211 of the Civil Code, which
states that in crimes and quasi-delicts, interest as a part of the damages may, in a proper case, be
adjudicated in the discretion of the court.68
WHEREFORE, the Court PARTLY GRANTS the petition. The Court finds respondent Capitol Medical
Center vicariously liable for the negligence of Dr. Oscar Estrada. The amounts of P105,000 as actual
damages andP700,000 as moral damages should each earn legal interest at the rate of six percent
(6%) per annum computed from the date of the judgment of the trial court. The Court affirms the rest
of the Decision dated 6 February 1998 and Resolution dated 21 March 2000 of the Court of Appeals
in CA-G.R. CV No. 45641.
SO ORDERED.

G.R. No. 126297

January 31, 2007

PROFESSIONAL SERVICES, INC., Petitioner,


vs.
NATIVIDAD and ENRIQUE AGANA, Respondents.
x-----------------------x
G.R. No. 126467

January 31, 2007

NATIVIDAD (Substituted by her children MARCELINO AGANA III, ENRIQUE AGANA, JR.,
EMMA AGANA ANDAYA, JESUS AGANA, and RAYMUND AGANA) and ENRIQUE
AGANA, Petitioners,
vs.
JUAN FUENTES, Respondent.
x- - - - - - - - - - - - - - - - - - - -- - - - x
G.R. No. 127590

January 31, 2007

MIGUEL AMPIL, Petitioner,


vs.
NATIVIDAD AGANA and ENRIQUE AGANA, Respondents.
DECISION
SANDOVAL-GUTIERREZ, J.:
Hospitals, having undertaken one of mankinds most important and delicate endeavors, must assume
the grave responsibility of pursuing it with appropriate care. The care and service dispensed through
this high trust, however technical, complex and esoteric its character may be, must meet standards of
responsibility commensurate with the undertaking to preserve and protect the health, and indeed, the
very lives of those placed in the hospitals keeping.1
Assailed in these three consolidated petitions for review on certiorari is the Court of Appeals
Decision2 dated September 6, 1996 in CA-G.R. CV No. 42062 and CA-G.R. SP No. 32198 affirming
with modification the Decision3 dated March 17, 1993 of the Regional Trial Court (RTC), Branch 96,
Quezon City in Civil Case No. Q-43322 and nullifying its Order dated September 21, 1993.
The facts, as culled from the records, are:
On April 4, 1984, Natividad Agana was rushed to the Medical City General Hospital (Medical City
Hospital) because of difficulty of bowel movement and bloody anal discharge. After a series of medical
examinations, Dr. Miguel Ampil, petitioner in G.R. No. 127590, diagnosed her to be suffering from
"cancer of the sigmoid."
On April 11, 1984, Dr. Ampil, assisted by the medical staff4 of the Medical City Hospital, performed an
anterior resection surgery on Natividad. He found that the malignancy in her sigmoid area had spread
on her left ovary, necessitating the removal of certain portions of it. Thus, Dr. Ampil obtained the
consent of Natividads husband, Enrique Agana, to permit Dr. Juan Fuentes, respondent in G.R. No.
126467, to perform hysterectomy on her.

After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the operation and
closed the incision.
However, the operation appeared to be flawed. In the corresponding Record of Operation dated April
11, 1984, the attending nurses entered these remarks:
"sponge count lacking 2
"announced to surgeon searched (sic) done but to no avail continue for closure."
On April 24, 1984, Natividad was released from the hospital. Her hospital and medical bills, including
the doctors fees, amounted to P60,000.00.
After a couple of days, Natividad complained of excruciating pain in her anal region. She consulted
both Dr. Ampil and Dr. Fuentes about it. They told her that the pain was the natural consequence of
the surgery. Dr. Ampil then recommended that she consult an oncologist to examine the cancerous
nodes which were not removed during the operation.
On May 9, 1984, Natividad, accompanied by her husband, went to the United States to seek further
treatment. After four months of consultations and laboratory examinations, Natividad was told she was
free of cancer. Hence, she was advised to return to the Philippines.
On August 31, 1984, Natividad flew back to the Philippines, still suffering from pains. Two weeks
thereafter, her daughter found a piece of gauze protruding from her vagina. Upon being informed about
it, Dr. Ampil proceeded to her house where he managed to extract by hand a piece of gauze measuring
1.5 inches in width. He then assured her that the pains would soon vanish.
Dr. Ampils assurance did not come true. Instead, the pains intensified, prompting Natividad to seek
treatment at the Polymedic General Hospital. While confined there, Dr. Ramon Gutierrez detected the
presence of another foreign object in her vagina -- a foul-smelling gauze measuring 1.5 inches in width
which badly infected her vaginal vault. A recto-vaginal fistula had formed in her reproductive organs
which forced stool to excrete through the vagina. Another surgical operation was needed to remedy
the damage. Thus, in October 1984, Natividad underwent another surgery.
On November 12, 1984, Natividad and her husband filed with the RTC, Branch 96, Quezon City a
complaint for damages against the Professional Services, Inc. (PSI), owner of the Medical City
Hospital, Dr. Ampil, and Dr. Fuentes, docketed as Civil Case No. Q-43322. They alleged that the latter
are liable for negligence for leaving two pieces of gauze inside Natividads body and malpractice for
concealing their acts of negligence.
Meanwhile, Enrique Agana also filed with the Professional Regulation Commission (PRC) an
administrative complaint for gross negligence and malpractice against Dr. Ampil and Dr. Fuentes,
docketed as Administrative Case No. 1690. The PRC Board of Medicine heard the case only with
respect to Dr. Fuentes because it failed to acquire jurisdiction over Dr. Ampil who was then in the
United States.
On February 16, 1986, pending the outcome of the above cases, Natividad died and was duly
substituted by her above-named children (the Aganas).
On March 17, 1993, the RTC rendered its Decision in favor of the Aganas, finding PSI, Dr. Ampil and
Dr. Fuentes liable for negligence and malpractice, the decretal part of which reads:

WHEREFORE, judgment is hereby rendered for the plaintiffs ordering the defendants
PROFESSIONAL SERVICES, INC., DR. MIGUEL AMPIL and DR. JUAN FUENTES to pay to the
plaintiffs, jointly and severally, except in respect of the award for exemplary damages and the interest
thereon which are the liabilities of defendants Dr. Ampil and Dr. Fuentes only, as follows:
1. As actual damages, the following amounts:
a. The equivalent in Philippine Currency of the total of US$19,900.00 at the rate of
P21.60-US$1.00, as reimbursement of actual expenses incurred in the United States
of America;
b. The sum of P4,800.00 as travel taxes of plaintiffs and their physician daughter;
c. The total sum of P45,802.50, representing the cost of hospitalization at Polymedic
Hospital, medical fees, and cost of the saline solution;
2. As moral damages, the sum of P2,000,000.00;
3. As exemplary damages, the sum of P300,000.00;
4. As attorneys fees, the sum of P250,000.00;
5. Legal interest on items 1 (a), (b), and (c); 2; and 3 hereinabove, from date of filing of the
complaint until full payment; and
6. Costs of suit.
SO ORDERED.
Aggrieved, PSI, Dr. Fuentes and Dr. Ampil interposed an appeal to the Court of Appeals, docketed as
CA-G.R. CV No. 42062.
Incidentally, on April 3, 1993, the Aganas filed with the RTC a motion for a partial execution of its
Decision, which was granted in an Order dated May 11, 1993. Thereafter, the sheriff levied upon
certain properties of Dr. Ampil and sold them for P451,275.00 and delivered the amount to the Aganas.
Following their receipt of the money, the Aganas entered into an agreement with PSI and Dr. Fuentes
to indefinitely suspend any further execution of the RTC Decision. However, not long thereafter, the
Aganas again filed a motion for an alias writ of execution against the properties of PSI and Dr. Fuentes.
On September 21, 1993, the RTC granted the motion and issued the corresponding writ, prompting
Dr. Fuentes to file with the Court of Appeals a petition for certiorari and prohibition, with prayer for
preliminary injunction, docketed as CA-G.R. SP No. 32198. During its pendency, the Court of Appeals
issued a Resolution5 dated October 29, 1993 granting Dr. Fuentes prayer for injunctive relief.
On January 24, 1994, CA-G.R. SP No. 32198 was consolidated with CA-G.R. CV No. 42062.
Meanwhile, on January 23, 1995, the PRC Board of Medicine rendered its Decision6 in Administrative
Case No. 1690 dismissing the case against Dr. Fuentes. The Board held that the prosecution failed to
show that Dr. Fuentes was the one who left the two pieces of gauze inside Natividads body; and that
he concealed such fact from Natividad.

On September 6, 1996, the Court of Appeals rendered its Decision jointly disposing of CA-G.R. CV
No. 42062 and CA-G.R. SP No. 32198, thus:
WHEREFORE, except for the modification that the case against defendant-appellant Dr. Juan Fuentes
is hereby DISMISSED, and with the pronouncement that defendant-appellant Dr. Miguel Ampil is liable
to reimburse defendant-appellant Professional Services, Inc., whatever amount the latter will pay or
had paid to the plaintiffs-appellees, the decision appealed from is hereby AFFIRMED and the instant
appeal DISMISSED.
Concomitant with the above, the petition for certiorari and prohibition filed by herein defendantappellant Dr. Juan Fuentes in CA-G.R. SP No. 32198 is hereby GRANTED and the challenged order
of the respondent judge dated September 21, 1993, as well as the alias writ of execution issued
pursuant thereto are hereby NULLIFIED and SET ASIDE. The bond posted by the petitioner in
connection with the writ of preliminary injunction issued by this Court on November 29, 1993 is hereby
cancelled.
Costs against defendants-appellants Dr. Miguel Ampil and Professional Services, Inc.
SO ORDERED.
Only Dr. Ampil filed a motion for reconsideration, but it was denied in a Resolution 7 dated December
19, 1996.
Hence, the instant consolidated petitions.
In G.R. No. 126297, PSI alleged in its petition that the Court of Appeals erred in holding that: (1) it is
estopped from raising the defense that Dr. Ampil is not its employee; (2) it is solidarily liable with Dr.
Ampil; and (3) it is not entitled to its counterclaim against the Aganas. PSI contends that Dr. Ampil is
not its employee, but a mere consultant or independent contractor. As such, he alone should answer
for his negligence.
In G.R. No. 126467, the Aganas maintain that the Court of Appeals erred in finding that Dr. Fuentes
is not guilty of negligence or medical malpractice, invoking the doctrine of res ipsa loquitur. They
contend that the pieces of gauze are prima facie proofs that the operating surgeons have been
negligent.
Finally, in G.R. No. 127590, Dr. Ampil asserts that the Court of Appeals erred in finding him liable for
negligence and malpractice sans evidence that he left the two pieces of gauze in Natividads vagina.
He pointed to other probable causes, such as: (1) it was Dr. Fuentes who used gauzes in performing
the hysterectomy; (2) the attending nurses failure to properly count the gauzes used during surgery;
and (3) the medical intervention of the American doctors who examined Natividad in the United States
of America.
For our resolution are these three vital issues: first, whether the Court of Appeals erred in holding Dr.
Ampil liable for negligence and malpractice; second, whether the Court of Appeals erred in absolving
Dr. Fuentes of any liability; and third, whether PSI may be held solidarily liable for the negligence of
Dr. Ampil.
I - G.R. No. 127590
Whether the Court of Appeals Erred in Holding Dr. Ampil

Liable for Negligence and Malpractice.


Dr. Ampil, in an attempt to absolve himself, gears the Courts attention to other possible causes of
Natividads detriment. He argues that the Court should not discount either of the following possibilities:
first, Dr. Fuentes left the gauzes in Natividads body after performing hysterectomy; second, the
attending nurses erred in counting the gauzes; and third, the American doctors were the ones who
placed the gauzes in Natividads body.
Dr. Ampils arguments are purely conjectural and without basis. Records show that he did not present
any evidence to prove that the American doctors were the ones who put or left the gauzes in
Natividads body. Neither did he submit evidence to rebut the correctness of the record of operation,
particularly the number of gauzes used. As to the alleged negligence of Dr. Fuentes, we are mindful
that Dr. Ampil examined his (Dr. Fuentes) work and found it in order.
The glaring truth is that all the major circumstances, taken together, as specified by the Court of
Appeals, directly point to Dr. Ampil as the negligent party, thus:
First, it is not disputed that the surgeons used gauzes as sponges to control the bleeding of
the patient during the surgical operation.
Second, immediately after the operation, the nurses who assisted in the surgery noted in their
report that the sponge count (was) lacking 2; that such anomaly was announced to surgeon
and that a search was done but to no avail prompting Dr. Ampil to continue for closure x x
x.
Third, after the operation, two (2) gauzes were extracted from the same spot of the body of
Mrs. Agana where the surgery was performed.
An operation requiring the placing of sponges in the incision is not complete until the sponges are
properly removed, and it is settled that the leaving of sponges or other foreign substances in the wound
after the incision has been closed is at least prima facie negligence by the operating surgeon.8 To put
it simply, such act is considered so inconsistent with due care as to raise an inference of negligence.
There are even legions of authorities to the effect that such act is negligence per se.9
Of course, the Court is not blind to the reality that there are times when danger to a patients life
precludes a surgeon from further searching missing sponges or foreign objects left in the body. But
this does not leave him free from any obligation. Even if it has been shown that a surgeon was required
by the urgent necessities of the case to leave a sponge in his patients abdomen, because of the
dangers attendant upon delay, still, it is his legal duty to so inform his patient within a reasonable time
thereafter by advising her of what he had been compelled to do. This is in order that she might seek
relief from the effects of the foreign object left in her body as her condition might permit. The ruling in
Smith v. Zeagler10 is explicit, thus:
The removal of all sponges used is part of a surgical operation, and when a physician or surgeon fails
to remove a sponge he has placed in his patients body that should be removed as part of the
operation, he thereby leaves his operation uncompleted and creates a new condition which imposes
upon him the legal duty of calling the new condition to his patients attention, and endeavoring with the
means he has at hand to minimize and avoid untoward results likely to ensue therefrom.
Here, Dr. Ampil did not inform Natividad about the missing two pieces of gauze. Worse, he even misled
her that the pain she was experiencing was the ordinary consequence of her operation. Had he been
more candid, Natividad could have taken the immediate and appropriate medical remedy to remove

the gauzes from her body. To our mind, what was initially an act of negligence by Dr. Ampil has ripened
into a deliberate wrongful act of deceiving his patient.
This is a clear case of medical malpractice or more appropriately, medical negligence. To successfully
pursue this kind of case, a patient must only prove that a health care provider either failed to do
something which a reasonably prudent health care provider would have done, or that he did something
that a reasonably prudent provider would not have done; and that failure or action caused injury to the
patient.11 Simply put, the elements are duty, breach, injury and proximate causation. Dr, Ampil, as the
lead surgeon, had the duty to remove all foreign objects, such as gauzes, from Natividads body before
closure of the incision. When he failed to do so, it was his duty to inform Natividad about it. Dr. Ampil
breached both duties. Such breach caused injury to Natividad, necessitating her further examination
by American doctors and another surgery. That Dr. Ampils negligence is the proximate cause 12 of
Natividads injury could be traced from his act of closing the incision despite the information given by
the attending nurses that two pieces of gauze were still missing. That they were later on extracted
from Natividads vagina established the causal link between Dr. Ampils negligence and the injury. And
what further aggravated such injury was his deliberate concealment of the missing gauzes from the
knowledge of Natividad and her family.
II - G.R. No. 126467
Whether the Court of Appeals Erred in Absolving
Dr. Fuentes of any Liability
The Aganas assailed the dismissal by the trial court of the case against Dr. Fuentes on the ground
that it is contrary to the doctrine of res ipsa loquitur. According to them, the fact that the two pieces of
gauze were left inside Natividads body is a prima facie evidence of Dr. Fuentes negligence.
We are not convinced.
Literally, res ipsa loquitur means "the thing speaks for itself." It is the rule that the fact of the occurrence
of an injury, taken with the surrounding circumstances, may permit an inference or raise a presumption
of negligence, or make out a plaintiffs prima facie case, and present a question of fact for defendant
to meet with an explanation.13 Stated differently, where the thing which caused the injury, without the
fault of the injured, is under the exclusive control of the defendant and the injury is such that it should
not have occurred if he, having such control used proper care, it affords reasonable evidence, in the
absence of explanation that the injury arose from the defendants want of care, and the burden of proof
is shifted to him to establish that he has observed due care and diligence.14
From the foregoing statements of the rule, the requisites for the applicability of the doctrine of res ipsa
loquitur are: (1) the occurrence of an injury; (2) the thing which caused the injury was under the control
and management of the defendant; (3) the occurrence was such that in the ordinary course of things,
would not have happened if those who had control or management used proper care; and (4) the
absence of explanation by the defendant. Of the foregoing requisites, the most instrumental is the
"control and management of the thing which caused the injury."15
We find the element of "control and management of the thing which caused the injury" to be wanting.
Hence, the doctrine of res ipsa loquitur will not lie.
It was duly established that Dr. Ampil was the lead surgeon during the operation of Natividad. He
requested the assistance of Dr. Fuentes only to perform hysterectomy when he (Dr. Ampil) found that
the malignancy in her sigmoid area had spread to her left ovary. Dr. Fuentes performed the surgery

and thereafter reported and showed his work to Dr. Ampil. The latter examined it and finding everything
to be in order, allowed Dr. Fuentes to leave the operating room. Dr. Ampil then resumed operating on
Natividad. He was about to finish the procedure when the attending nurses informed him that two
pieces of gauze were missing. A "diligent search" was conducted, but the misplaced gauzes were not
found. Dr. Ampil then directed that the incision be closed. During this entire period, Dr. Fuentes was
no longer in the operating room and had, in fact, left the hospital.
Under the "Captain of the Ship" rule, the operating surgeon is the person in complete charge of the
surgery room and all personnel connected with the operation. Their duty is to obey his orders.16 As
stated before, Dr. Ampil was the lead surgeon. In other words, he was the "Captain of the Ship." That
he discharged such role is evident from his following conduct: (1) calling Dr. Fuentes to perform a
hysterectomy; (2) examining the work of Dr. Fuentes and finding it in order; (3) granting Dr. Fuentes
permission to leave; and (4) ordering the closure of the incision. To our mind, it was this act of ordering
the closure of the incision notwithstanding that two pieces of gauze remained unaccounted for, that
caused injury to Natividads body. Clearly, the control and management of the thing which caused the
injury was in the hands of Dr. Ampil, not Dr. Fuentes.
In this jurisdiction, res ipsa loquitur is not a rule of substantive law, hence, does not per se create or
constitute an independent or separate ground of liability, being a mere evidentiary rule.17 In other
words, mere invocation and application of the doctrine does not dispense with the requirement of proof
of negligence. Here, the negligence was proven to have been committed by Dr. Ampil and not by Dr.
Fuentes.
III - G.R. No. 126297
Whether PSI Is Liable for the Negligence of Dr. Ampil
The third issue necessitates a glimpse at the historical development of hospitals and the resulting
theories concerning their liability for the negligence of physicians.
Until the mid-nineteenth century, hospitals were generally charitable institutions, providing medical
services to the lowest classes of society, without regard for a patients ability to pay.18 Those who could
afford medical treatment were usually treated at home by their doctors.19 However, the days of house
calls and philanthropic health care are over. The modern health care industry continues to distance
itself from its charitable past and has experienced a significant conversion from a not-for-profit health
care to for-profit hospital businesses. Consequently, significant changes in health law have
accompanied the business-related changes in the hospital industry. One important legal change is an
increase in hospital liability for medical malpractice. Many courts now allow claims for hospital
vicarious liability under the theories of respondeat superior, apparent authority, ostensible authority,
or agency by estoppel. 20
In this jurisdiction, the statute governing liability for negligent acts is Article 2176 of the Civil Code,
which reads:
Art. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is
obliged to pay for the damage done. Such fault or negligence, if there is no pre-existing contractual
relation between the parties, is called a quasi-delict and is governed by the provisions of this Chapter.
A derivative of this provision is Article 2180, the rule governing vicarious liability under the doctrine of
respondeat superior, thus:

ART. 2180. The obligation imposed by Article 2176 is demandable not only for ones own acts or
omissions, but also for those of persons for whom one is responsible.
x x x

x x x

The owners and managers of an establishment or enterprise are likewise responsible for damages
caused by their employees in the service of the branches in which the latter are employed or on the
occasion of their functions.
Employers shall be liable for the damages caused by their employees and household helpers acting
within the scope of their assigned tasks even though the former are not engaged in any business or
industry.
x x x

The responsibility treated of in this article shall cease when the persons herein mentioned prove that
they observed all the diligence of a good father of a family to prevent damage.
A prominent civilist commented that professionals engaged by an employer, such as physicians,
dentists, and pharmacists, are not "employees" under this article because the manner in which they
perform their work is not within the control of the latter (employer). In other words, professionals are
considered personally liable for the fault or negligence they commit in the discharge of their duties,
and their employer cannot be held liable for such fault or negligence. In the context of the present
case, "a hospital cannot be held liable for the fault or negligence of a physician or surgeon in the
treatment or operation of patients."21
The foregoing view is grounded on the traditional notion that the professional status and the very
nature of the physicians calling preclude him from being classed as an agent or employee of a
hospital, whenever he acts in a professional capacity.22 It has been said that medical practice strictly
involves highly developed and specialized knowledge,23 such that physicians are generally free to
exercise their own skill and judgment in rendering medical services sans interference.24 Hence, when
a doctor practices medicine in a hospital setting, the hospital and its employees are deemed to
subserve him in his ministrations to the patient and his actions are of his own responsibility.25
The case of Schloendorff v. Society of New York Hospital 26 was then considered an authority for this
view. The "Schloendorff doctrine" regards a physician, even if employed by a hospital, as an
independent contractor because of the skill he exercises and the lack of control exerted over his work.
Under this doctrine, hospitals are exempt from the application of the respondeat superior principle for
fault or negligence committed by physicians in the discharge of their profession.
However, the efficacy of the foregoing doctrine has weakened with the significant developments in
medical care. Courts came to realize that modern hospitals are increasingly taking active role in
supplying and regulating medical care to patients. No longer were a hospitals functions limited to
furnishing room, food, facilities for treatment and operation, and attendants for its patients. Thus, in
Bing v. Thunig,27 the New York Court of Appeals deviated from the Schloendorff doctrine, noting that
modern hospitals actually do far more than provide facilities for treatment. Rather, they regularly
employ, on a salaried basis, a large staff of physicians, interns, nurses, administrative and manual
workers. They charge patients for medical care and treatment, even collecting for such services
through legal action, if necessary. The court then concluded that there is no reason to exempt hospitals
from the universal rule of respondeat superior.

In our shores, the nature of the relationship between the hospital and the physicians is rendered
inconsequential in view of our categorical pronouncement in Ramos v. Court of Appeals28 that for
purposes of apportioning responsibility in medical negligence cases, an employer-employee
relationship in effect exists between hospitals and their attending and visiting physicians. This Court
held:
"We now discuss the responsibility of the hospital in this particular incident. The unique practice
(among private hospitals) of filling up specialist staff with attending and visiting "consultants," who are
allegedly not hospital employees, presents problems in apportioning responsibility for negligence in
medical malpractice cases. However, the difficulty is more apparent than real.
In the first place, hospitals exercise significant control in the hiring and firing of consultants and in the
conduct of their work within the hospital premises. Doctors who apply for consultant slots, visiting or
attending, are required to submit proof of completion of residency, their educational qualifications,
generally, evidence of accreditation by the appropriate board (diplomate), evidence of fellowship in
most cases, and references. These requirements are carefully scrutinized by members of the hospital
administration or by a review committee set up by the hospital who either accept or reject the
application. x x x.
After a physician is accepted, either as a visiting or attending consultant, he is normally required to
attend clinico-pathological conferences, conduct bedside rounds for clerks, interns and residents,
moderate grand rounds and patient audits and perform other tasks and responsibilities, for the
privilege of being able to maintain a clinic in the hospital, and/or for the privilege of admitting patients
into the hospital. In addition to these, the physicians performance as a specialist is generally evaluated
by a peer review committee on the basis of mortality and morbidity statistics, and feedback from
patients, nurses, interns and residents. A consultant remiss in his duties, or a consultant who regularly
falls short of the minimum standards acceptable to the hospital or its peer review committee, is
normally politely terminated.
In other words, private hospitals, hire, fire and exercise real control over their attending and visiting
consultant staff. While consultants are not, technically employees, x x x, the control exercised, the
hiring, and the right to terminate consultants all fulfill the important hallmarks of an employer-employee
relationship, with the exception of the payment of wages. In assessing whether such a relationship in
fact exists, the control test is determining. Accordingly, on the basis of the foregoing, we rule that for
the purpose of allocating responsibility in medical negligence cases, an employer-employee
relationship in effect exists between hospitals and their attending and visiting physicians. "
But the Ramos pronouncement is not our only basis in sustaining PSIs liability. Its liability is also
anchored upon the agency principle of apparent authority or agency by estoppel and the doctrine of
corporate negligence which have gained acceptance in the determination of a hospitals liability for
negligent acts of health professionals. The present case serves as a perfect platform to test the
applicability of these doctrines, thus, enriching our jurisprudence.
Apparent authority, or what is sometimes referred to as the "holding
out" theory, or doctrine of ostensible agency or agency by estoppel,29 has its origin from the law of
agency. It imposes liability, not as the result of the reality of a contractual relationship, but rather
because of the actions of a principal or an employer in somehow misleading the public into believing
that the relationship or the authority exists.30 The concept is essentially one of estoppel and has been
explained in this manner:

"The principal is bound by the acts of his agent with the apparent authority which he knowingly permits
the agent to assume, or which he holds the agent out to the public as possessing. The question in
every case is whether the principal has by his voluntary act placed the agent in such a situation that a
person of ordinary prudence, conversant with business usages and the nature of the particular
business, is justified in presuming that such agent has authority to perform the particular act in
question.31
The applicability of apparent authority in the field of hospital liability was upheld long time ago in Irving
v. Doctor Hospital of Lake Worth, Inc.32 There, it was explicitly stated that "there does not appear to
be any rational basis for excluding the concept of apparent authority from the field of hospital liability."
Thus, in cases where it can be shown that a hospital, by its actions, has held out a particular physician
as its agent and/or employee and that a patient has accepted treatment from that physician in the
reasonable belief that it is being rendered in behalf of the hospital, then the hospital will be liable for
the physicians negligence.
Our jurisdiction recognizes the concept of an agency by implication or estoppel. Article 1869 of the
Civil Code reads:
ART. 1869. Agency may be express, or implied from the acts of the principal, from his silence or lack
of action, or his failure to repudiate the agency, knowing that another person is acting on his behalf
without authority.
In this case, PSI publicly displays in the lobby of the Medical City Hospital the names and
specializations of the physicians associated or accredited by it, including those of Dr. Ampil and Dr.
Fuentes. We concur with the Court of Appeals conclusion that it "is now estopped from passing all
the blame to the physicians whose names it proudly paraded in the public directory leading the public
to believe that it vouched for their skill and competence." Indeed, PSIs act is tantamount to holding
out to the public that Medical City Hospital, through its accredited physicians, offers quality health care
services. By accrediting Dr. Ampil and Dr. Fuentes and publicly advertising their qualifications, the
hospital created the impression that they were its agents, authorized to perform medical or surgical
services for its patients. As expected, these patients, Natividad being one of them, accepted the
services on the reasonable belief that such were being rendered by the hospital or its employees,
agents, or servants. The trial court correctly pointed out:
x x x regardless of the education and status in life of the patient, he ought not be burdened with the
defense of absence of employer-employee relationship between the hospital and the independent
physician whose name and competence are certainly certified to the general public by the hospitals
act of listing him and his specialty in its lobby directory, as in the case herein. The high costs of todays
medical and health care should at least exact on the hospital greater, if not broader, legal responsibility
for the conduct of treatment and surgery within its facility by its accredited physician or surgeon,
regardless of whether he is independent or employed."33
The wisdom of the foregoing ratiocination is easy to discern. Corporate entities, like PSI, are capable
of acting only through other individuals, such as physicians. If these accredited physicians do their job
well, the hospital succeeds in its mission of offering quality medical services and thus profits financially.
Logically, where negligence mars the quality of its services, the hospital should not be allowed to
escape liability for the acts of its ostensible agents.
We now proceed to the doctrine of corporate negligence or corporate responsibility.
One allegation in the complaint in Civil Case No. Q-43332 for negligence and malpractice is that PSI
as owner, operator and manager of Medical City Hospital, "did not perform the necessary supervision

nor exercise diligent efforts in the supervision of Drs. Ampil and Fuentes and its nursing staff, resident
doctors, and medical interns who assisted Drs. Ampil and Fuentes in the performance of their duties
as surgeons."34 Premised on the doctrine of corporate negligence, the trial court held that PSI is directly
liable for such breach of duty.
We agree with the trial court.
Recent years have seen the doctrine of corporate negligence as the judicial answer to the problem of
allocating hospitals liability for the negligent acts of health practitioners, absent facts to support the
application of respondeat superior or apparent authority. Its formulation proceeds from the judiciarys
acknowledgment that in these modern times, the duty of providing quality medical service is no longer
the sole prerogative and responsibility of the physician. The modern hospitals have changed structure.
Hospitals now tend to organize a highly professional medical staff whose competence and
performance need to be monitored by the hospitals commensurate with their inherent responsibility to
provide quality medical care.35
The doctrine has its genesis in Darling v. Charleston Community Hospital.36 There, the Supreme Court
of Illinois held that "the jury could have found a hospital negligent, inter alia, in failing to have a sufficient
number of trained nurses attending the patient; failing to require a consultation with or examination by
members of the hospital staff; and failing to review the treatment rendered to the patient." On the basis
of Darling, other jurisdictions held that a hospitals corporate negligence extends to permitting a
physician known to be incompetent to practice at the hospital.37 With the passage of time, more duties
were expected from hospitals, among them: (1) the use of reasonable care in the maintenance of safe
and adequate facilities and equipment; (2) the selection and retention of competent physicians; (3) the
overseeing or supervision of all persons who practice medicine within its walls; and (4) the formulation,
adoption and enforcement of adequate rules and policies that ensure quality care for its
patients.38 Thus, in Tucson Medical Center, Inc. v. Misevich,39 it was held that a hospital, following the
doctrine of corporate responsibility, has the duty to see that it meets the standards of responsibilities
for the care of patients. Such duty includes the proper supervision of the members of its medical staff.
And in Bost v. Riley,40 the court concluded that a patient who enters a hospital does so with the
reasonable expectation that it will attempt to cure him. The hospital accordingly has the duty to make
a reasonable effort to monitor and oversee the treatment prescribed and administered by the
physicians practicing in its premises.
In the present case, it was duly established that PSI operates the Medical City Hospital for the purpose
and under the concept of providing comprehensive medical services to the public. Accordingly, it has
the duty to exercise reasonable care to protect from harm all patients admitted into its facility for
medical treatment. Unfortunately, PSI failed to perform such duty. The findings of the trial court are
convincing, thus:
x x x PSIs liability is traceable to its failure to conduct an investigation of the matter reported in the
nota bene of the count nurse. Such failure established PSIs part in the dark conspiracy of silence and
concealment about the gauzes. Ethical considerations, if not also legal, dictated the holding of an
immediate inquiry into the events, if not for the benefit of the patient to whom the duty is primarily
owed, then in the interest of arriving at the truth. The Court cannot accept that the medical and the
healing professions, through their members like defendant surgeons, and their institutions like PSIs
hospital facility, can callously turn their backs on and disregard even a mere probability of mistake or
negligence by refusing or failing to investigate a report of such seriousness as the one in Natividads
case.
It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance of the
Medical City Hospitals staff, composed of resident doctors, nurses, and interns. As such, it is

reasonable to conclude that PSI, as the operator of the hospital, has actual or constructive knowledge
of the procedures carried out, particularly the report of the attending nurses that the two pieces of
gauze were missing. In Fridena v. Evans,41 it was held that a corporation is bound by the knowledge
acquired by or notice given to its agents or officers within the scope of their authority and in reference
to a matter to which their authority extends. This means that the knowledge of any of the staff of
Medical City Hospital constitutes knowledge of PSI. Now, the failure of PSI, despite the attending
nurses report, to investigate and inform Natividad regarding the missing gauzes amounts to callous
negligence. Not only did PSI breach its duties to oversee or supervise all persons who practice
medicine within its walls, it also failed to take an active step in fixing the negligence committed. This
renders PSI, not only vicariously liable for the negligence of Dr. Ampil under Article 2180 of the Civil
Code, but also directly liable for its own negligence under Article 2176. In Fridena, the Supreme Court
of Arizona held:
x x x In recent years, however, the duty of care owed to the patient by the hospital has expanded. The
emerging trend is to hold the hospital responsible where the hospital has failed to monitor and review
medical services being provided within its walls. See Kahn Hospital Malpractice Prevention, 27 De
Paul . Rev. 23 (1977).
Among the cases indicative of the emerging trend is Purcell v. Zimbelman, 18 Ariz. App. 75,500 P.
2d 335 (1972). In Purcell, the hospital argued that it could not be held liable for the malpractice of a
medical practitioner because he was an independent contractor within the hospital. The Court of
Appeals pointed out that the hospital had created a professional staff whose competence and
performance was to be monitored and reviewed by the governing body of the hospital, and the court
held that a hospital would be negligent where it had knowledge or reason to believe that a doctor using
the facilities was employing a method of treatment or care which fell below the recognized standard
of care.
Subsequent to the Purcell decision, the Arizona Court of Appeals held that a hospital has certain
inherent responsibilities regarding the quality of medical care furnished to patients within its walls and
it must meet the standards of responsibility commensurate with this undertaking. Beeck v. Tucson
General Hospital, 18 Ariz. App. 165, 500 P. 2d 1153 (1972). This court has confirmed the rulings of
the Court of Appeals that a hospital has the duty of supervising the competence of the doctors on its
staff. x x x.
x

In the amended complaint, the plaintiffs did plead that the operation was performed at the hospital with
its knowledge, aid, and assistance, and that the negligence of the defendants was the proximate cause
of the patients injuries. We find that such general allegations of negligence, along with the evidence
produced at the trial of this case, are sufficient to support the hospitals liability based on the theory of
negligent supervision."
Anent the corollary issue of whether PSI is solidarily liable with Dr. Ampil for damages, let it be
emphasized that PSI, apart from a general denial of its responsibility, failed to adduce evidence
showing that it exercised the diligence of a good father of a family in the accreditation and supervision
of the latter. In neglecting to offer such proof, PSI failed to discharge its burden under the last
paragraph of Article 2180 cited earlier, and, therefore, must be adjudged solidarily liable with Dr. Ampil.
Moreover, as we have discussed, PSI is also directly liable to the Aganas.
One final word. Once a physician undertakes the treatment and care of a patient, the law imposes on
him certain obligations. In order to escape liability, he must possess that reasonable degree of
learning, skill and experience required by his profession. At the same time, he must apply reasonable

care and diligence in the exercise of his skill and the application of his knowledge, and exert his best
judgment.
WHEREFORE, we DENY all the petitions and AFFIRM the challenged Decision of the Court of
Appeals in CA-G.R. CV No. 42062 and CA-G.R. SP No. 32198.
Costs against petitioners PSI and Dr. Miguel Ampil.
SO ORDERED.

G.R. No. 126297

February 2, 2010

PROFESSIONAL SERVICES, INC., Petitioner,


vs.
THE COURT OF APPEALS and NATIVIDAD and ENRIQUE AGANA, Respondents.
x - - - - - - - - - - - - - - - - - - - - - - -x
G.R. No. 126467
NATIVIDAD [substituted by her children Marcelino Agana III, Enrique Agana, Jr., Emma
Agana-Andaya, Jesus Agana and Raymund Agana] and ENRIQUE AGANA, Petitioners,
vs.
THE COURT OF APPEALS and JUAN FUENTES, Respondents.
x - - - - - - - - - - - - - - - - - - - - - - -x
G.R. No. 127590
MIGUEL AMPIL, Petitioner,
vs.
NATIVIDAD and ENRIQUE AGANA, Respondents.
RESOLUTION
CORONA, J.:
With prior leave of court,1 petitioner Professional Services, Inc. (PSI) filed a second motion for
reconsideration2urging referral thereof to the Court en banc and seeking modification of the decision
dated January 31, 2007 and resolution dated February 11, 2008 which affirmed its vicarious and direct
liability for damages to respondents Enrique Agana and the heirs of Natividad Agana (Aganas).
Manila Medical Services, Inc. (MMSI),3 Asian Hospital, Inc. (AHI),4 and Private Hospital Association of
the Philippines (PHAP)5 all sought to intervene in these cases invoking the common ground that,
unless modified, the assailed decision and resolution will jeopardize the financial viability of private
hospitals and jack up the cost of health care.
The Special First Division of the Court granted the motions for intervention of MMSI, AHI and PHAP
(hereafter intervenors),6 and referred en consulta to the Court en banc the motion for prior leave of
court and the second motion for reconsideration of PSI.7
Due to paramount public interest, the Court en banc accepted the referral8 and heard the parties on
oral arguments on one particular issue: whether a hospital may be held liable for the negligence of
physicians-consultants allowed to practice in its premises.9
To recall the salient facts, PSI, together with Dr. Miguel Ampil (Dr. Ampil) and Dr. Juan Fuentes (Dr.
Fuentes), was impleaded by Enrique Agana and Natividad Agana (later substituted by her heirs), in a
complaint10 for damages filed in the Regional Trial Court (RTC) of Quezon City, Branch 96, for the
injuries suffered by Natividad when Dr. Ampil and Dr. Fuentes neglected to remove from her body two
gauzes11 which were used in the surgery they performed on her on April 11, 1984 at the Medical City
General Hospital. PSI was impleaded as owner, operator and manager of the hospital.

In a decision12 dated March 17, 1993, the RTC held PSI solidarily liable with Dr. Ampil and Dr. Fuentes
for damages.13 On appeal, the Court of Appeals (CA), absolved Dr. Fuentes but affirmed the liability
of Dr. Ampil and PSI, subject to the right of PSI to claim reimbursement from Dr. Ampil.14
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On petition for review, this Court, in its January 31, 2007 decision, affirmed the CA decision.15 PSI filed
a motion for reconsideration16 but the Court denied it in a resolution dated February 11, 2008.17
The Court premised the direct liability of PSI to the Aganas on the following facts and law:
First, there existed between PSI and Dr. Ampil an employer-employee relationship as contemplated
in the December 29, 1999 decision in Ramos v. Court of Appeals18 that "for purposes of allocating
responsibility in medical negligence cases, an employer-employee relationship exists between
hospitals and their consultants."19Although the Court in Ramos later issued a Resolution dated April
11, 200220 reversing its earlier finding on the existence of an employment relationship between hospital
and doctor, a similar reversal was not warranted in the present case because the defense raised by
PSI consisted of a mere general denial of control or responsibility over the actions of Dr. Ampil.21
Second, by accrediting Dr. Ampil and advertising his qualifications, PSI created the public impression
that he was its agent.22 Enrique testified that it was on account of Dr. Ampil's accreditation with PSI
that he conferred with said doctor about his wife's (Natividad's) condition.23 After his meeting with Dr.
Ampil, Enrique asked Natividad to personally consult Dr. Ampil.24 In effect, when Enrigue and Natividad
engaged the services of Dr. Ampil, at the back of their minds was that the latter was a staff member
of a prestigious hospital. Thus, under the doctrine of apparent authority applied in Nogales, et al. v.
Capitol Medical Center, et al.,25 PSI was liable for the negligence of Dr. Ampil.
Finally, as owner and operator of Medical City General Hospital, PSI was bound by its duty to provide
comprehensive medical services to Natividad Agana, to exercise reasonable care to protect her from
harm,26 to oversee or supervise all persons who practiced medicine within its walls, and to take active
steps in fixing any form of negligence committed within its premises.27 PSI committed a serious breach
of its corporate duty when it failed to conduct an immediate investigation into the reported missing
gauzes.28
PSI is now asking this Court to reconsider the foregoing rulings for these reasons:
I
The declaration in the 31 January 2007 Decision vis-a-vis the 11 February 2009 Resolution that the
ruling in Ramos vs. Court of Appeals (G.R. No. 134354, December 29, 1999) that "an employeremployee relations exists between hospital and their consultants" stays should be set aside for being
inconsistent with or contrary to the import of the resolution granting the hospital's motion for
reconsideration in Ramos vs. Court of Appeals (G.R. No. 134354, April 11, 2002), which is applicable
to PSI since the Aganas failed to prove an employer-employee relationship between PSI and Dr. Ampil
and PSI proved that it has no control over Dr. Ampil. In fact, the trial court has found that there is no
employer-employee relationship in this case and that the doctor's are independent contractors.
II
Respondents Aganas engaged Dr. Miguel Ampil as their doctor and did not primarily and specifically
look to the Medical City Hospital (PSI) for medical care and support; otherwise stated, respondents
Aganas did not select Medical City Hospital (PSI) to provide medical care because of any apparent
authority of Dr. Miguel Ampil as its agent since the latter was chosen primarily and specifically based
on his qualifications and being friend and neighbor.

III
PSI cannot be liable under doctrine of corporate negligence since the proximate cause of Mrs. Agana's
injury was the negligence of Dr. Ampil, which is an element of the principle of corporate negligence.29
In their respective memoranda, intervenors raise parallel arguments that the Court's ruling on the
existence of an employer-employee relationship between private hospitals and consultants will force
a drastic and complex alteration in the long-established and currently prevailing relationships among
patient, physician and hospital, with burdensome operational and financial consequences and adverse
effects on all three parties.30
The Aganas comment that the arguments of PSI need no longer be entertained for they have all been
traversed in the assailed decision and resolution.31
After gathering its thoughts on the issues, this Court holds that PSI is liable to the Aganas, not under
the principle of respondeat superior for lack of evidence of an employment relationship with Dr. Ampil
but under the principle of ostensible agency for the negligence of Dr. Ampil and, pro hac vice, under
the principle of corporate negligence for its failure to perform its duties as a hospital.
While in theory a hospital as a juridical entity cannot practice medicine,32 in reality it utilizes doctors,
surgeons and medical practitioners in the conduct of its business of facilitating medical and surgical
treatment.33 Within that reality, three legal relationships crisscross: (1) between the hospital and the
doctor practicing within its premises; (2) between the hospital and the patient being treated or
examined within its premises and (3) between the patient and the doctor. The exact nature of each
relationship determines the basis and extent of the liability of the hospital for the negligence of the
doctor.
Where an employment relationship exists, the hospital may be held vicariously liable under Article
217634 in relation to Article 218035 of the Civil Code or the principle of respondeat superior. Even when
no employment relationship exists but it is shown that the hospital holds out to the patient that the
doctor is its agent, the hospital may still be vicariously liable under Article 2176 in relation to Article
143136 and Article 186937 of the Civil Code or the principle of apparent authority.38 Moreover, regardless
of its relationship with the doctor, the hospital may be held directly liable to the patient for its own
negligence or failure to follow established standard of conduct to which it should conform as a
corporation.39
This Court still employs the "control test" to determine the existence of an employer-employee
relationship between hospital and doctor. In Calamba Medical Center, Inc. v. National Labor Relations
Commission, et al.40 it held:
Under the "control test", an employment relationship exists between a physician and a hospital if the
hospital controls both the means and the details of the process by which the physician is to accomplish
his task.
xxx

xxx

xxx

As priorly stated, private respondents maintained specific work-schedules, as determined by petitioner


through its medical director, which consisted of 24-hour shifts totaling forty-eight hours each week and
which were strictly to be observed under pain of administrative sanctions.

That petitioner exercised control over respondents gains light from the undisputed fact that in
the emergency room, the operating room, or any department or ward for that matter,
respondents' work is monitored through its nursing supervisors, charge nurses and orderlies.
Without the approval or consent of petitioner or its medical director, no operations can be
undertaken in those areas. For control test to apply, it is not essential for the employer to
actually supervise the performance of duties of the employee, it being enough that it has the
right to wield the power. (emphasis supplied)
Even in its December 29, 1999 decision41 and April 11, 2002 resolution42 in Ramos, the Court found
the control test decisive.
In the present case, it appears to have escaped the Court's attention that both the RTC and the CA
found no employment relationship between PSI and Dr. Ampil, and that the Aganas did not question
such finding. In its March 17, 1993 decision, the RTC found "that defendant doctors were not
employees of PSI in its hospital, they being merely consultants without any employer-employee
relationship and in the capacity of independent contractors."43 The Aganas never questioned such
finding.
PSI, Dr. Ampil and Dr. Fuentes appealed44 from the RTC decision but only on the issues of negligence,
agency and corporate liability. In its September 6, 1996 decision, the CA mistakenly referred to PSI
and Dr. Ampil as employer-employee, but it was clear in its discussion on the matter that it viewed
their relationship as one of mere apparent agency.45
The Aganas appealed from the CA decision, but only to question the exoneration of Dr. Fuentes.46 PSI
also appealed from the CA decision, and it was then that the issue of employment, though long settled,
was unwittingly resurrected.
In fine, as there was no dispute over the RTC finding that PSI and Dr. Ampil had no employeremployee relationship, such finding became final and conclusive even to this Court.47 There was no
reason for PSI to have raised it as an issue in its petition. Thus, whatever discussion on the matter
that may have ensued was purely academic.
Nonetheless, to allay the anxiety of the intervenors, the Court holds that, in this particular instance,
the concurrent finding of the RTC and the CA that PSI was not the employer of Dr. Ampil is correct.
Control as a determinative factor in testing the employer-employee relationship between doctor and
hospital under which the hospital could be held vicariously liable to a patient in medical negligence
cases is a requisite fact to be established by preponderance of evidence. Here, there was insufficient
evidence that PSI exercised the power of control or wielded such power over the means and the details
of the specific process by which Dr. Ampil applied his skills in the treatment of Natividad.
Consequently, PSI cannot be held vicariously liable for the negligence of Dr. Ampil under the principle
of respondeat superior.
There is, however, ample evidence that the hospital (PSI) held out to the patient (Natividad)48 that the
doctor (Dr. Ampil) was its agent. Present are the two factors that determine apparent authority: first,
the hospital's implied manifestation to the patient which led the latter to conclude that the doctor was
the hospital's agent; and second, the patients reliance upon the conduct of the hospital and the doctor,
consistent with ordinary care and prudence.49
Enrique testified that on April 2, 1984, he consulted Dr. Ampil regarding the condition of his wife; that
after the meeting and as advised by Dr. Ampil, he "asked [his] wife to go to Medical City to be
examined by [Dr. Ampil]"; and that the next day, April 3, he told his daughter to take her mother to Dr.
Ampil.50 This timeline indicates that it was Enrique who actually made the decision on whom Natividad

should consult and where, and that the latter merely acceded to it. It explains the testimony of Natividad
that she consulted Dr. Ampil at the instigation of her daughter.51
Moreover, when asked what impelled him to choose Dr. Ampil, Enrique testified:
Atty. Agcaoili
On that particular occasion, April 2, 1984, what was your reason for choosing Dr. Ampil to contact with
in connection with your wife's illness?
A. First, before that, I have known him to be a specialist on that part of the body as a surgeon, second,
I have known him to be a staff member of the Medical City which is a prominent and known hospital.
And third, because he is a neighbor, I expect more than the usual medical service to be given to us,
than his ordinary patients.52 (emphasis supplied)
Clearly, the decision made by Enrique for Natividad to consult Dr. Ampil was significantly influenced
by the impression that Dr. Ampil was a staff member of Medical City General Hospital, and that said
hospital was well known and prominent. Enrique looked upon Dr. Ampil not as independent of but as
integrally related to Medical City.
PSI's acts tended to confirm and reinforce, rather than negate, Enrique's view. It is of record that PSI
required a "consent for hospital care"53 to be signed preparatory to the surgery of Natividad. The form
reads:
Permission is hereby given to the medical, nursing and laboratory staff of the Medical City General
Hospital to perform such diagnostic procedures and to administer such medications and treatments as
may be deemed necessary or advisable by the physicians of this hospital for and during the
confinement of xxx. (emphasis supplied)
By such statement, PSI virtually reinforced the public impression that Dr. Ampil was a physician of its
hospital, rather than one independently practicing in it; that the medications and treatments he
prescribed were necessary and desirable; and that the hospital staff was prepared to carry them out.
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PSI pointed out in its memorandum that Dr. Ampil's hospital affiliation was not the exclusive basis of
the Aganas decision to have Natividad treated in Medical City General Hospital, meaning that, had
Dr. Ampil been affiliated with another hospital, he would still have been chosen by the Aganas as
Natividad's surgeon.54
The Court cannot speculate on what could have been behind the Aganas decision but would rather
adhere strictly to the fact that, under the circumstances at that time, Enrique decided to consult Dr.
Ampil for he believed him to be a staff member of a prominent and known hospital. After his meeting
with Dr. Ampil, Enrique advised his wife Natividad to go to the Medical City General Hospital to be
examined by said doctor, and the hospital acted in a way that fortified Enrique's belief.
This Court must therefore maintain the ruling that PSI is vicariously liable for the negligence of Dr.
Ampil as its ostensible agent.
Moving on to the next issue, the Court notes that PSI made the following admission in its Motion for
Reconsideration:

51. Clearly, not being an agent or employee of petitioner PSI, PSI [sic] is not liable for Dr. Ampil's acts
during the operation. Considering further that Dr. Ampil was personally engaged as a doctor by Mrs.
Agana, it is incumbent upon Dr. Ampil, as "Captain of the Ship", and as the Agana's doctor to advise
her on what to do with her situation vis-a-vis the two missing gauzes. In addition to noting the
missing gauzes, regular check-ups were made and no signs of complications were exhibited
during her stay at the hospital, which could have alerted petitioner PSI's hospital to render and
provide post-operation services to and tread on Dr. Ampil's role as the doctor of Mrs. Agana.
The absence of negligence of PSI from the patient's admission up to her discharge is borne by
the finding of facts in this case. Likewise evident therefrom is the absence of any complaint
from Mrs. Agana after her discharge from the hospital which had she brought to the hospital's
attention, could have alerted petitioner PSI to act accordingly and bring the matter to Dr.
Ampil's attention. But this was not the case. Ms. Agana complained ONLY to Drs. Ampil and
Fuentes, not the hospital. How then could PSI possibly do something to fix the negligence
committed by Dr. Ampil when it was not informed about it at all.55 (emphasis supplied)
PSI reiterated its admission when it stated that had Natividad Agana "informed the hospital of her
discomfort and pain, the hospital would have been obliged to act on it."56
The significance of the foregoing statements is critical.
First, they constitute judicial admission by PSI that while it had no power to control the means or
method by which Dr. Ampil conducted the surgery on Natividad Agana, it had the power to review or
cause the review of what may have irregularly transpired within its walls strictly for the purpose of
determining whether some form of negligence may have attended any procedure done inside its
premises, with the ultimate end of protecting its patients.
Second, it is a judicial admission that, by virtue of the nature of its business as well as its
prominence57 in the hospital industry, it assumed a duty to "tread on" the "captain of the ship" role of
any doctor rendering services within its premises for the purpose of ensuring the safety of the patients
availing themselves of its services and facilities.
Third, by such admission, PSI defined the standards of its corporate conduct under the circumstances
of this case, specifically: (a) that it had a corporate duty to Natividad even after her operation to ensure
her safety as a patient; (b) that its corporate duty was not limited to having its nursing staff note or
record the two missing gauzes and (c) that its corporate duty extended to determining Dr. Ampil's role
in it, bringing the matter to his attention, and correcting his negligence.
And finally, by such admission, PSI barred itself from arguing in its second motion for reconsideration
that the concept of corporate responsibility was not yet in existence at the time Natividad underwent
treatment;58 and that if it had any corporate responsibility, the same was limited to reporting the missing
gauzes and did not include "taking an active step in fixing the negligence committed."59 An admission
made in the pleading cannot be controverted by the party making such admission and is conclusive
as to him, and all proofs submitted by him contrary thereto or inconsistent therewith should be ignored,
whether or not objection is interposed by a party.60
Given the standard of conduct that PSI defined for itself, the next relevant inquiry is whether the
hospital measured up to it.
PSI excuses itself from fulfilling its corporate duty on the ground that Dr. Ampil assumed the personal
responsibility of informing Natividad about the two missing gauzes.61 Dr. Ricardo Jocson, who was
part of the group of doctors that attended to Natividad, testified that toward the end of the surgery,
their group talked about the missing gauzes but Dr. Ampil assured them that he would personally notify

the patient about it.62Furthermore, PSI claimed that there was no reason for it to act on the report on
the two missing gauzes because Natividad Agana showed no signs of complications. She did not even
inform the hospital about her discomfort.63
The excuses proffered by PSI are totally unacceptable.
To begin with, PSI could not simply wave off the problem and nonchalantly delegate to Dr. Ampil the
duty to review what transpired during the operation. The purpose of such review would have been to
pinpoint when, how and by whom two surgical gauzes were mislaid so that necessary remedial
measures could be taken to avert any jeopardy to Natividads recovery. Certainly, PSI could not have
expected that purpose to be achieved by merely hoping that the person likely to have mislaid the
gauzes might be able to retrace his own steps. By its own standard of corporate conduct, PSI's duty
to initiate the review was non-delegable.
While Dr. Ampil may have had the primary responsibility of notifying Natividad about the missing
gauzes, PSI imposed upon itself the separate and independent responsibility of initiating the inquiry
into the missing gauzes. The purpose of the first would have been to apprise Natividad of what
transpired during her surgery, while the purpose of the second would have been to pinpoint any lapse
in procedure that led to the gauze count discrepancy, so as to prevent a recurrence thereof and to
determine corrective measures that would ensure the safety of Natividad. That Dr. Ampil negligently
failed to notify Natividad did not release PSI from its self-imposed separate responsibility.
Corollary to its non-delegable undertaking to review potential incidents of negligence committed within
its premises, PSI had the duty to take notice of medical records prepared by its own staff and submitted
to its custody, especially when these bear earmarks of a surgery gone awry. Thus, the record taken
during the operation of Natividad which reported a gauze count discrepancy should have given PSI
sufficient reason to initiate a review. It should not have waited for Natividad to complain.
As it happened, PSI took no heed of the record of operation and consequently did not initiate a review
of what transpired during Natividads operation. Rather, it shirked its responsibility and passed it on to
others to Dr. Ampil whom it expected to inform Natividad, and to Natividad herself to complain before
it took any meaningful step. By its inaction, therefore, PSI failed its own standard of hospital care. It
committed corporate negligence.
It should be borne in mind that the corporate negligence ascribed to PSI is different from the medical
negligence attributed to Dr. Ampil. The duties of the hospital are distinct from those of the doctorconsultant practicing within its premises in relation to the patient; hence, the failure of PSI to fulfill its
duties as a hospital corporation gave rise to a direct liability to the Aganas distinct from that of Dr.
Ampil.
All this notwithstanding, we make it clear that PSIs hospital liability based on ostensible agency and
corporate negligence applies only to this case, pro hac vice. It is not intended to set a precedent and
should not serve as a basis to hold hospitals liable for every form of negligence of their doctorsconsultants under any and all circumstances. The ruling is unique to this case, for the liability of PSI
arose from an implied agency with Dr. Ampil and an admitted corporate duty to Natividad.64
Other circumstances peculiar to this case warrant this ruling,65 not the least of which being that the
agony wrought upon the Aganas has gone on for 26 long years, with Natividad coming to the end of
her days racked in pain and agony. Such wretchedness could have been avoided had PSI simply done
what was logical: heed the report of a guaze count discrepancy, initiate a review of what went wrong
and take corrective measures to ensure the safety of Nativad. Rather, for 26 years, PSI hemmed and

hawed at every turn, disowning any such responsibility to its patient. Meanwhile, the options left to the
Aganas have all but dwindled, for the status of Dr. Ampil can no longer be ascertained.66
Therefore, taking all the equities of this case into consideration, this Court believes P15 million would
be a fair and reasonable liability of PSI, subject to 12% p.a. interest from the finality of this resolution
to full satisfaction.
WHEREFORE, the second motion for reconsideration is DENIED and the motions for intervention
are NOTED.
Professional Services, Inc. is ORDERED pro hac vice to pay Natividad (substituted by her children
Marcelino Agana III, Enrique Agana, Jr., Emma Agana-Andaya, Jesus Agana and Raymund Agana)
and Enrique Agana the total amount of P15 million, subject to 12% p.a. interest from the finality of this
resolution to full satisfaction.
No further pleadings by any party shall be entertained in this case.
Let the long-delayed entry of judgment be made in this case upon receipt by all concerned parties of
this resolution.
SO ORDERED.