10/7/2016 G.R.No.

187926

RepublicofthePhilippines
SupremeCourt
Manila

THIRD DIVISION

DR. EMMANUEL JARCIA, JR. G.R. No. 187926

and DR. MARILOU BASTAN,

Petitioners,
Present:

CARPIO,* J.,

PERALTA,** Acting Chairperson,

versus ABAD,

PEREZ,*** and
MENDOZA, JJ.


Promulgated:
PEOPLE OF THE
PHILIPPINES, February15,2012
Respondent.

x x

DECISION

MENDOZA, J.:
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Evenearlyon,patientshaveconsignedtheirlivestotheskilloftheirdoctors.Timeand
again,itcanbesaidthatthemostimportantgoalofthemedicalprofessionisthepreservation
oflifeandhealthofthepeople.Corollarily,whenaphysiciandepartsfromhissacreddutyand
endangersinsteadthelifeofhispatient,hemustbemadeliablefortheresultinginjury.This
[1]
Court,asthiscasewouldshow,cannotandwillnotlettheactgounpunished.
This is a petition for review under Rule 45 of the Rules of Court challenging the August 29, 2008
[2] [3]
Decision oftheCourtofAppeals(CA),anditsMay19,2009Resolution inCAG.R.CRNo.29559,
[4]
dismissing the appeal and affirming in toto the June 14, 2005 Decision of the Regional Trial Court,
Branch 43, Manila (RTC), finding the accused guilty beyond reasonable doubt of simple imprudence
resultingtoseriousphysicalinjuries.


THEFACTS

BelindaSantiago(Mrs.Santiago)lodgedacomplaintwiththeNationalBureauofInvestigation(NBI)
againstthepetitioners,Dr.EmmanuelJarcia,Jr.(Dr.Jarcia)andDr.MarilouBastan(Dr.Bastan),fortheir
allegedneglectofprofessionaldutywhichcausedherson,RoyAlfonsoSantiago(RoyJr.),tosufferserious
physicalinjuries.Uponinvestigation,theNBIfoundthatRoyJr.washitbyataxicabthathewasrushedto
the Manila Doctors Hospital for an emergency medical treatment that an Xray of the victims ankle was
ordered that the Xray result showed no fracture as read by Dr. Jarcia that Dr. Bastan entered the
emergencyroom(ER)and,afterconductingherownexaminationofthevictim,informedMrs.Santiagothat
sinceitwasonlytheanklethatwashit,therewasnoneedtoexaminetheupperlegthateleven(11)days
later, Roy Jr. developed fever, swelling of the right leg and misalignment of the right foot that Mrs.
SantiagobroughthimbacktothehospitalandthattheXrayrevealedarightmidtibialfractureandalinear
hairlinefractureintheshaftofthebone.

The NBI indorsed the matter to the Office of the City Prosecutor of Manila for preliminary
investigation. Probable cause was found and a criminal case for reckless imprudence resulting to serious
[5]
physicalinjuries,wasfiledagainstDr.Jarcia,Dr.BastanandDr.Pamittan, beforetheRTC,docketedas
CriminalCaseNo.01196646.

On June 14, 2005, the RTC found the petitioners guilty beyond reasonable doubt of the crime of
SimpleImprudenceResultingtoSeriousPhysicalInjuries.ThedecretalportionoftheRTCdecisionreads:

WHEREFORE,premisesconsidered,theCourtfindsaccusedDR.EMMANUELJARCIA,JR.
and DR. MARILOU BASTAN GUILTY beyond reasonable doubt of the crime of SIMPLE
IMPRUDENCERESULTINGTOSERIOUSPHYSICALINJURIESandareherebysentencedtosuffer
the penalty of ONE (1) MONTH and ONE (1) DAY to TWO (2) MONTHS and to indemnify MRS.
BELINDA SANTIAGO the amount of 3,850.00 representing medical expenses without subsidiary
imprisonmentincaseofinsolvencyandtopaythecosts.
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ItappearingthatDr.Pamittanhasnotbeenapprehendednorvoluntarilysurrendereddespite
warrant issued for her arrest, let warrant be issued for her arrest and the case against her be
ARCHIVED,tobereinstateduponherapprehension.

[6]
SOORDERED.

TheRTCexplained:

Afterathoroughandindepthevaluationoftheevidenceadducedbytheprosecutionandthe
defense, this court finds that the evidence of the prosecution is the more credible, concrete and
sufficienttocreatethatmoralcertaintyinthemindoftheCourtthataccusedherein[are]criminally
responsible.TheCourtbelievesthataccusedarenegligentwhenbothfailedtoexercisethenecessary
andreasonableprudenceinascertainingtheextentofinjuryofAlfonsoSantiago,Jr.


However,thenegligenceexhibitedbythetwodoctorsdoesnotapproximatenegligenceofareckless
nature but merely amounts to simple imprudence. Simple imprudence consists in the lack of
precaution displayed in those cases in which the damage impending to be caused is not the
immediatenorthedangerclearlymanifest.Theelementsofsimpleimprudenceareasfollows.

1.thatthereislackofprecautiononthepartoftheoffenderand

2. that the damage impending to be caused is not immediate of the danger is not
clearlymanifest.

Considering all the evidence on record, The Court finds the accused guilty for simple
imprudenceresultingtophysicalinjuries.UnderArticle365oftheRevisedPenalCode,thepenalty
[7]
providedforisarrestomayorinitsminimumperiod.


Dissatisfied,thepetitionersappealedtotheCA.

Asearlierstated,theCAaffirmedtheRTCdecisionintoto.TheAugust29,2008DecisionoftheCA
pertinentlyreads:

This Court holds concurrently and finds the foregoing circumstances sufficient to sustain a
judgmentofconvictionagainsttheaccusedappellantsforthecrimeofsimpleimprudenceresulting
inseriousphysicalinjuries.Theelementsofimprudenceare:(1)thattheoffenderdoesorfailstodo
anact(2)thatthedoingorthefailuretodothatactisvoluntary(3)thatitbewithoutmalice(4)
that material damage results from the imprudence and (5) that there is inexcusable lack of
precaution on the part of the offender, taking into consideration his employment or occupation,
degree of intelligence, physical condition, and other circumstances regarding persons, time and
place.

Whether or not Dr. Jarcia and Dr. Bastan had committed an inexcusable lack of precaution in the
treatment of their patient is to be determined according to the standard of care observed by other
members of the profession in good standing under similar circumstances, bearing in mind the
advancedstateoftheprofessionatthetimeoftreatmentorthepresentstateofmedicalscience. In
thecaseofLeonilaGarciaRuedav.Pascasio,theSupremeCourtstatedthat,inacceptingacase,a
doctor in effect represents that, having the needed training and skill possessed by physicians and
surgeonspracticinginthesamefield,hewillemploysuchtraining,careandskillinthetreatmentof

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hispatients.Hethereforehasadutytouseatleastthesamelevelofcarethatanyotherreasonably
competentdoctorwouldusetotreataconditionunderthesamecircumstances.

In litigations involving medical negligence, the plaintiff has the burden of establishing accused
appellantsnegligence,andforareasonableconclusionofnegligence,theremustbeproofofbreachof
duty on the part of the physician as well as a causal connection of such breach and the resulting
injury of his patient. The connection between the negligence and the injury must be a direct and
naturalsequenceofevents,unbrokenbyinterveningefficientcauses.Inotherwords,thenegligence
mustbetheproximatecauseoftheinjury.Negligence,nomatterinwhatitconsists,cannotcreatea
rightofactionunlessitistheproximatecauseoftheinjurycomplainedof.Theproximatecauseofan
injuryisthatcausewhich,innaturalandcontinuoussequence,unbrokenbyanyefficientintervening
cause,producestheinjuryandwithoutwhichtheresultwouldnothaveoccurred.

Inthecaseatbench,theaccusedappellantsquestionedtheimputationagainstthemandarguedthat
thereisnocausalconnectionbetweentheirfailuretodiagnosethefractureandtheinjurysustained
byRoy.

Wearenotconvinced.

TheprosecutionishoweverafterthecausewhichprolongedthepainandsufferingofRoyandnoton
thefailureoftheaccusedappellantstocorrectlydiagnosetheextentoftheinjurysustainedbyRoy.

For a more logical presentation of the discussion, we shall first consider the applicability of the
doctrineofres ipsa loquitur to the instant case.Res ipsa loquitur is a Latin phrase which literally
means the thing or the transaction speaks for itself. The doctrine of res ipsa loquitur is simply a
recognitionofthepostulatethat,asamatterofcommonknowledgeandexperience,theverynature
ofcertaintypesofoccurrencesmayjustifyaninferenceofnegligenceonthepartofthepersonwho
controls the instrumentality causing the injury in the absence of some explanation by the accused
appellant who is charged with negligence. It is grounded in the superior logic of ordinary human
experienceand,onthebasisofsuchexperienceorcommonknowledge,negligencemaybededuced
from the mere occurrence of the accident itself. Hence, res ipsa loquitur is applied in conjunction
withthedoctrineofcommonknowledge.

ThespecificactsofnegligencewasnarratedbyMrs.Santiagowhoaccompaniedher son during the
lattersordealatthehospital.Shetestifiedasfollows:

FiscalFormoso:

Q:Now,heisaninterndidyounotconsultthedoctors,Dr.JarciaorDra.Pamittanto
confirmwhetheryoushouldgohomeornot?
A: Dra. Pamittan was inside the cubicle of the nurses and I asked her, you let us go
homeandyoudontevencleanthewoundsofmyson.

Q:Andwhatdidshe[tell]you?
A:Theytoldmetheywillcallaresidentdoctor,sir.

xxxxxxxxx

Q:Wastherearesidentdoctor[who]came?
A:Yes,Sir.Dra.Bastanarrived.
Q:Didyoutellherwhatyouwantonyoutobedone?
A:Yes,sir.

Q:Whatdidyou[tell]her?
A:Itoldher,sir,whileshewascleaningthewoundsofmyson,areyounotgoingtox
rayuptothekneebecausemysonwascomplainingpainfromhisankleuptothe
middlepartoftherightleg.

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Q:Andwhatdidshetellyou?
A:AccordingtoDra.Bastan,thereisnoneedtoxraybecauseitwastheanklepartthat
wasrunover.

Q:Whatdidyoudoortellher?
A:Itoldher,sir,whyisitthattheydidnotexamine[x]thewholeleg.Theyjustlifted
thepantsofmyson.

Q:Soyoumeantosaytherewasnotreatmentmadeatall?
A:None,sir.

xxxxxxxxx

A:Ijustlistenedtothem,sir.AndIjustaskedifIwillstillreturnmyson.

xxxxxxxxx

Q:Andyouwerepresentwhentheywerecalled?
A:Yes,sir.

Q:AndwhatwasdiscussedthenbySis.Retoria?
A:Whentheyweretheretheyadmittedthattheyhavemistakes,sir.

Still, before resort to the doctrine may be allowed, the following requisites must be satisfactorily
shown:

1.Theaccidentisofakindwhichordinarilydoesnotoccurintheabsenceofsomeones
negligence

2. Itiscausedbyaninstrumentalitywithintheexclusivecontrolofthedefendantor
defendantsand

3.Thepossibilityofcontributingconductwhichwouldmaketheplaintiffresponsibleis
eliminated.

Intheaboverequisites,thefundamentalelementisthecontroloftheinstrumentalitywhichcaused
the damage. Such element of control must be shown to be within the dominion of the accused
appellants. In order to have the benefit of the rule, a plaintiff, in addition to proving injury or
damage,mustshowasituationwhereitisapplicableandmustestablishthattheessentialelements
ofthedoctrinewerepresentinaparticularincident.TheearlytreatmentofthelegofRoywouldhave
lessenhissufferingifnotentirelyrelievehimfromthefracture.Aboyoftenderagewhoselegwashit
by a vehicle would engender a wellfounded belief that his condition may worsen without proper
medicalattention.As junior residents who only practice general surgery and without specialization
with the case consulted before them, they should have referred the matter to a specialist. This
omissionaloneconstitutessimpleimprudenceontheirpart.WhenMrs.Santiagoinsistedonhaving
anotherxrayofherchildontheupperpartofhisleg,theyrefusedtodoso.Themotherwouldnot
haveaskedthemiftheyhadnoexclusivecontrolorprerogativetorequestanxraytest.Suchisafact
becausearadiologistwouldonlyconductthexraytestuponrequestofaphysician.

ThetestimonyofMrs.SantiagowascorroboratedbyabonespecialistDr.Tacata.Hefurthertestified
based on his personal knowledge, and not as an expert, as he examined himself the child Roy. He
testifiedasfollows:

FiscalMacapagal:

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Q:And was that the correct respon[se] to the medical problem that was presented to
Dr.JarciaandDra.Bastan?
A: I would say at that stage, yes. Because they have presented the patient and the
history.At sabi nila, nadaanan lang po ito.And then, considering their year of
residency they are still junior residents, and they are not also orthopedic
residents but general surgery residents, its entirely different thing. Because if
youareanorthopedicresident,IamnottryingtosaybutifIwereanorthopedic
resident, there would be more precise and accurate decision compare to a
generalsurgeryresidentinsofarasinvolved.

Q:Youmeantosaythereisnosupervisorattendingtheemergencyroom?
A: At the emergency room, at the Manila Doctors Hospital, the supervisor there is a
consultantthatusuallycomesfromafamilymedicine.Theyseewhereacertain
patient have to go and then if they cannot manage it, they refer it to the
consultant on duty. Now at that time, I dont [know] why they dont.Because at
thattime,Ithink,itisthedecision.Sincethexrays.

Ordinarily,onlyphysiciansandsurgeonsofskillandexperiencearecompetenttotestifyasto
whether a patient has been treated or operated upon with a reasonable degree of skill and care.
However,testimonyastothestatementsandactsofphysicians,externalappearances,andmanifest
conditionswhichareobservablebyanyonemaybegivenbynonexpertwitnesses.Hence,incases
wheretheres 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
fundofcommonknowledgecandeterminetheproperstandardofcare.Wherecommonknowledge
andexperienceteachthataresultinginjurywouldnothaveoccurredtothepatientifduecarehad
beenexercised,aninferenceofnegligencemaybedrawngivingrisetoanapplicationofthedoctrine
of res ipsa loquitur without medical evidence, which is ordinarily required to show not only what
occurred but how and why it occurred. In the case at bench, we give credence to the testimony of
Mrs.Santiagobyapplyingthedoctrineofresipsaloquitur.

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
situationsinmalpracticecaseswherealaymanisabletosay,asamatterofcommonknowledgeand
observation, that the consequences of professional care were not as such as would ordinarily have
followed if due care had been exercised. 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. The
lattercircumstanceistheprimordialissuethatconfrontedthisCourtandwefindapplicationofthe
doctrineofresipsaloquiturtobeinorder.

WHEREFORE, in view of the foregoing, the appeal in this case is hereby DISMISSED and the
assailed decision of the trial court finding accusedappellants guilty beyond reasonable doubt of
simpleimprudenceresultinginseriousphysicalinjuriesisherebyAFFIRMEDintoto.

[8]
SOORDERED.


Thepetitionersfiledamotionforreconsideration,butitwasdeniedbytheCAinitsMay19,2009
Resolution.

Hence,thispetition.

The petitioners pray for the reversal of the decision of both the RTC and the CA anchored on the
following
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GROUNDS

1. IN AFFIRMING ACCUSEDPETITIONERS CONVICTION, THE COURT OF APPEALS
ERRED IN NOT HOLDING THAT THE ACTUAL, DIRECT, IMMEDIATE, AND PROXIMATE
CAUSE OF THE PHYSICAL INJURY OF THE PATIENT (FRACTURE OF THE LEG BONE OR
TIBIA), WHICH REQUIRED MEDICAL ATTENDANCE FOR MORE THAN THIRTY (30) DAYS
AND INCAPACITATED HIM FROM PERFORMING HIS CUSTOMARY DUTY DURING THE
SAMEPERIODOFTIME,WASTHEVEHICULARACCIDENTWHERETHEPATIENTSRIGHT
LEGWASHITBYATAXI,NOTTHEFAILUREOFTHEACCUSEDPETITIONERSTOSUBJECT
THEPATIENTSWHOLELEGTOANXRAYEXAMINATION.

2. THE COURT OF APPEALS ERRED IN DISREGARDING ESTABLISHED FACTS
CLEARLY NEGATING PETITIONERS ALLEGED NEGLIGENCE OR IMPRUDENCE.
SIGNIFICANTLY, THE COURT OF APPEALS UNJUSTIFIABLY DISREGARDED THE OPINION
OF THE PROSECUTIONS EXPERT WITNESS, DR. CIRILO TACATA, THAT PETITIONERS
WERENOTGUILTYOFNEGLIGENCEORIMPRUDENCECOMPLAINEDOF.

3. THE COURT OF APPEALS ERRED IN HOLDING THAT THE FAILURE OF
PETITIONERS TO SUBJECT THE PATIENTS WHOLE LEG TO AN XRAY EXAMINATION
PROLONGED THE PAIN AND SUFFERING OF THE PATIENT, SUCH CONCLUSION BEING
UNSUPPORTEDBY,ANDEVENCONTRARYTO,THEEVIDENCEONRECORD.

4.ASSUMINGARGUENDOTHATTHEPATIENTEXPERIENCEDPROLONGEDPAINAND
SUFFERING,THECOURTOFAPPEALSERREDINNOTHOLDINGTHATTHEALLEGEDPAIN
ANDSUFFERINGWEREDUETOTHEUNJUSTIFIEDFAILUREOFTHEPATIENTSMOTHER,A
NURSE HERSELF, TO IMMEDIATELY BRING THE PATIENT BACK TO THE HOSPITAL, AS
ADVISEDBYTHEPETITIONERS,AFTERHECOMPLAINEDOFSEVEREPAININHISRIGHT
LEG WHEN HE REACHED HOME AFTER HE WAS SEEN BY PETITIONERS AT THE
HOSPITAL. THUS,THE PATIENTS ALLEGED INJURY (PROLONGED PAIN AND SUFFERING)
WASDUETOHISOWNMOTHERSACTOROMISSION.

5.THECOURTOFAPPEALSERREDINNOTHOLDINGTHATNOPHYSICIANPATIENT
RELATIONSHIPEXISTEDBETWEENPETITIONERSANDPATIENTALFONSOSANTIAGO,JR.,
PETITIONERSNOTBEINGTHELATTERSATTENDINGPHYSICIANASTHEYWEREMERELY
REQUESTEDBYTHEEMERGENCYROOM(ER)NURSETOSEETHEPATIENTWHILETHEY
WEREPASSINGBYTHEERFORTHEIRLUNCH.

6. THE COURT OF APPEALS GRAVELY ERRED IN NOT ACQUITTING ACCUSED
[9]
PETITIONERSOFTHECRIMECHARGED.
The foregoing can be synthesized into two basic issues: [1] whether or not the doctrine ofres ipsa
loquiturisapplicableinthiscaseand[2]whetherornotthepetitionersareliableforcriminalnegligence.

THECOURTSRULING
TheCAiscorrectinfindingthattherewasnegligenceonthepartofthepetitioners.Afteraperusalof
the records, however, the Court is not convinced that the petitioners are guilty of criminal negligence
complainedof.TheCourtisalsooftheviewthattheCAerredinapplyingthedoctrineofresipsaloquitur
inthisparticularcase.

AstotheApplicationof
TheDoctrineofResIpsaLoquitur

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Thisdoctrineofresipsaloquiturmeans"Wherethethingwhichcausesinjuryisshowntobeunder
the management of the defendant, and the accident is such as in the ordinary course of things does not
happenifthosewhohavethemanagementusepropercare,itaffordsreasonableevidence,intheabsenceof
an explanation by the defendant, that the accident arose from want of care." The Black's Law Dictionary
definesthesaiddoctrine.Thus:

Thethingspeaksforitself.Rebuttablepresumptionorinferencethatdefendantwasnegligent,
whicharisesuponproofthattheinstrumentalitycausinginjurywasindefendant'sexclusivecontrol,
andthattheaccidentwasonewhichordinarilydoesnothappeninabsenceofnegligence.Resipsa
loquiturisaruleofevidencewherebynegligenceoftheallegedwrongdoermaybeinferredfromthe
merefactthattheaccidenthappenedprovidedthecharacteroftheaccidentandcircumstances
attendingitleadreasonablytobeliefthatintheabsenceofnegligenceitwouldnothaveoccurredand
thatthingwhichcausedinjuryisshowntohavebeenunderthemanagementandcontrolofthe
allegedwrongdoer.Underthisdoctrine,thehappeningofaninjurypermitsaninferenceof
negligencewhereplaintiffproducessubstantialevidencethattheinjurywascausedbyanagencyor
instrumentalityundertheexclusivecontrolandmanagementofdefendant,andthattheoccurrence
wassuchthatintheordinarycourseofthingswouldnothappenifreasonablecarehadbeenused.
[10]


The doctrine of res ipsa loquitur as a rule of evidence is unusual to the law of negligence which
recognizesthatprimafacienegligencemaybeestablishedwithoutdirectproofandfurnishesasubstitutefor
specificproofofnegligence.Thedoctrine,however,isnotaruleofsubstantivelaw,butmerelyamodeof
prooforamereproceduralconvenience.Therule,whenapplicabletothefactsandcircumstancesofagiven
case, is not meant to and does not dispense with the requirement of proof of culpable negligence on the
partycharged.Itmerelydeterminesandregulateswhatshallbeprimafacieevidencethereofandhelpsthe
plaintiff in proving a breach of the duty. The doctrine can be invoked when and only when, under the
[11]
circumstancesinvolved,directevidenceisabsentandnotreadilyavailable.

The requisites for the application of the doctrine of res ipsa loquitur are: (1) the accident was of a
kindwhichdoesnotordinarilyoccurunlesssomeoneisnegligent(2)theinstrumentalityoragencywhich
causedtheinjurywasundertheexclusivecontrolofthepersoninchargeand(3)theinjurysufferedmust
[12]
nothavebeenduetoanyvoluntaryactionorcontributionofthepersoninjured.

In this case, the circumstances that caused patient Roy Jr.s injury and the series of tests that were
supposedtobeundergonebyhimtodeterminetheextentoftheinjurysufferedwerenotundertheexclusive
control of Drs. Jarcia and Bastan. It was established that they are mere residents of the Manila Doctors
[13]
Hospitalatthattimewhoattendedtothevictimattheemergencyroom. Whileitmaybetruethatthe
circumstancespointedoutbythecourtsbelowseemdoubtlesstoconstituterecklessimprudenceonthepart
ofthepetitioners,thisconclusionisstillbestachieved,notthroughthescholarlyassumptionsofalayman
like the patients mother, but by the unquestionable knowledge of expert witness/es. As to whether the

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petitioners have exercised the requisite degree of skill and care in treating patient Roy, Jr. is generally a
matterofexpertopinion.

AstoDr.Jarciaand
Dr.Bastansnegligence

Thetotalityoftheevidenceonrecordclearlypointstothenegligenceofthepetitioners.Attheriskof
beingrepetitious,theCourt,however,isnotsatisfiedthatDr.JarciaandDr.Bastanarecriminallynegligent
inthiscase.

Negligenceisdefinedasthefailuretoobservefortheprotectionoftheinterestsofanotherpersonthat
degreeofcare,precaution,andvigilancewhichthecircumstancesjustlydemand,wherebysuchotherperson
[14]
suffersinjury.

Recklessimprudenceconsistsofvoluntarilydoingorfailingtodo,withoutmalice,anactfromwhich
materialdamageresultsbyreasonofaninexcusablelackofprecautiononthepartofthepersonperforming
[15]
orfailingtoperformsuchact.

Theelementsofsimplenegligenceare:(1)thatthereislackofprecautiononthepartoftheoffender,
[16]
and(2)thatthedamageimpendingtobecausedisnotimmediateorthedangerisnotclearlymanifest.

Inthiscase,theCourtisnotconvincedwithmoralcertaintythatthepetitionersareguiltyofreckless
imprudence or simple negligence. The elements thereof were not proved by the prosecution beyond
reasonabledoubt.

The testimony of Dr. Cirilo R. Tacata (Dr. Tacata), a specialist in pediatric orthopedic, although
pointingtosomemedicalproceduresthatcouldhavebeendonebyDr.JarciaandDr.Bastan,asphysicians
onduty,wasnotclearastowhethertheinjuriessufferedbypatientRoyJr.wereindeedaggravatedbythe
petitionersjudgmentcallandtheirdiagnosisorappreciationoftheconditionofthevictimatthetimethey
assessedhim.Thus:

Q:Willyoupleasetellus,fortherecord,doctor,whatisyourspecialization?
A:AtpresentIamthechairmandepartmentoforthopedicinUPPGHandIhadspecialtrainingin
pediatricorthopedicfortwo(2)years.

Q:InJune1998,doctor,whatwasyourpositionandwhatwasyourspecializationatthattime?
A:Since1980,Ihavebeenspecialistinpediatricorthopedic.

Q: When Alfonso Santiago, Jr. was brought to you by his mother, what did you do by way of
physiciansasfirststep?
A:Asusual,Iexaminedthepatientphysicallyand,atthattimeasIhavesaid,thepatientcouldnot
walk so I [began] to suspect that probably he sustained a fracture as a result of a vehicular

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accident.SoIexaminedthepatientatthattime,theinvolvedleg,Idontknowifthatisleftor
right,theinvolvedlegthenwasswollenandthepatientcouldnotwalk,soIrequestedforthex
rayof[the]lowerleg.

Q:Whatpartoftheleg,doctor,didyourequesttobeexamined?
A: If we refer for an xray, usually, we suspect a fracture whether in approximal, middle or lebistal
tinial,weusuallyxraytheentireextremity.

Q:Andwhatwastheresult?
A:Well,Icansaythatitwasaspiralfractureofthemidtibial,itisthebiggerboneoftheleg.

Q:Andwhenyousayspiral,doctor,howlongwasthisfracture?
A:Whenwesayspiral,itisasortofletterS,thelengthwasaboutsix(6)toeight(8)centimeters.

Q:Midtibial,willyoupleasepointtous,doctor,wherethetibialis?
(Witnesspointingtohislowerleg)
A:Thetibialishere,therearetwoboneshere,thebiggeroneisthetibialandthesmalleroneisthe
fibula.Thebiggeroneistheonethatgetfractured.

Q:AndinthecourseofyourexaminationofAlfonsoSantiago,Jr.didyouaskforthehistoryofsuch
injury?
A:Yes,actually,thatwasaroutinepartofourexaminationthatonceapatientcomesin,beforewe
actually examine the patient, we request for a detailed history. If it is an accident, then, we
requestfortheexactmechanismofinjuries.

Q:Andasfarasyoucanrecall,Doctor,whatwasthehistoryofthatinjurythatwastoldtoyou?
A:Thepatientwassideswiped,Idontknowifitisacar,butitisavehicularaccident.

Q:Whodidyouinterview?
A:Themother.

Q:Howaboutthechildhimself,AlfonsoSantiago,Jr.?
A:Normally,wedonotinterviewthechildbecause,usually,athisage,theanswersarenotaccurate.
So,itwasthemotherthatIinterviewed.

Q:AndwereyouinformedalsoofhisearlymedicationthatwasadministeredonAlfonsoSantiago,
Jr.?
A:No,notactuallymedication.Iwasinformedthatthispatientwasseeninitiallyattheemergency
roombythetwo(2)physiciansthatyoujustmentioned,Dr.JarciaandDra.Bastan,thattime
whohappenedtobemyresidentswhowere[on]dutyattheemergencyroom.

xxxx

A:Attheemergencyroom,attheManilaDoctorsHospital,thesupervisorthereisaconsultantthat
usuallycomesfromafamilymedicine.Theyseewhereacertainpatienthavetogoandthenif
theycannotmanageit,theyreferittotheconsultantonduty.Nowatthattime,Idontwhythey
dontBecauseatthattime,Ithink,itisthedecision.Sincethexrays

xxx

Q:Youalsosaid,Doctor,thatDr.JarciaandDra.Bastanarenotevenanorthopedicspecialist.
A:They are general surgeon residents. You have to man[x] the emergency room, including neurology,
orthopedic,generalsurgery,theyseeeverythingattheemergencyroom.

xxxx

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Q:Butifinitially,AlfonsoSantiago,Jr.andhiscasewaspresentedtoyouattheemergencyroom,you
wouldhavesubjectedtheentirefoottoxrayevenifthehistorythatwasgiventoDr.Jarciaand
Dra.Bastanisthesame?
A:Icouldnotdirectlysayyes,becauseitwouldstilldependonmyexamination,wecannotsubjectthe
wholebodyforxrayifwethinkthatthedamagedwasonlytheleg.

Q:Nottheentirebodybuttheentireleg?
A:Ithink,ifmyexaminationrequiresit,Iwould.

Q:So,youwouldconductfirstanexamination?
A:Yes,sir.

Q:Anddoyouthinkthatwiththatexaminationthatyouwouldhaveconductedyouwoulddiscoverthe
necessitysubjectingtheentirefootforxray?
A:Itisalsopossiblebutaccordingtothem,thefootandtheanklewereswollenandnottheleg,which
sometimesnormallyhappensthattheactualfracturedbonedonotgetswollen.

xxxx

Q:Doctor,ifyouknowthatthepatientsustainedafractureontheankleandonthefootandthehistory
thatwastoldtoyouistheregionthatwashitistheregionofthefoot,willthedoctorsubjectthe
entirelegforxray?
A:Iamanorthopedicsurgeon,youhavetosubjectanxrayoftheleg.Becauseyouhavetoconsiderthe
kind of fracture that the patient sustained would you say the exact mechanism of injury. For
examplespiral,paikotyungbalenya,soitwaspossiblethatthelegwasrunover,thepatientfell,
[17]
anditgottwisted.Thatswhythelegseemstobefractured. [Emphasessupplied]

ItcanbegleanedfromthetestimonyofDr.Tacatathatathoroughexaminationwasnotperformedon
RoyJr.Asresidentsondutyattheemergencyroom,Dr.JarciaandDr.Bastanwereexpectedtoknowthe
medicalprotocolintreatinglegfracturesandinattendingtovictimsofcaraccidents.Therewas,however,
nopreciseevidenceandscientificexplanationpointingtothefactthatthedelayintheapplicationofthecast
to the patients fractured leg because of failure to immediately diagnose the specific injury of the patient,
prolonged the pain of the child or aggravated his condition or even caused further complications. Any
personmayopinethathadpatientRoyJr.beentreatedproperlyandgiventheextensiveXrayexamination,
theextentandseverityoftheinjury,spiralfractureofthemidtibialpartorthebiggerboneoftheleg,could
havebeendetectedearlyonandtheprolongedpainandsufferingofRoyJr.couldhavebeenprevented.But
still, that opinion, even how logical it may seem would not, and could not, be enough basis to hold one
criminallyliablethus,areasonabledoubtastothepetitionersguilt.

AlthoughtheCourtsympathizeswiththeplightofthemotherandthechildinthiscase,theCourtis
boundbythedictatesofjusticewhichholdinviolabletherightoftheaccusedtobepresumedinnocentuntil
provenguiltybeyondreasonabledoubt.TheCourt,nevertheless,findsthepetitionerscivillyliablefortheir
failure to sufficiently attend to Roy Jr.s medical needs when the latter was rushed to the ER, for while a
criminalconvictionrequiresproofbeyondreasonabledoubt,onlyapreponderanceofevidenceisrequiredto
establishcivilliability.Takenintoaccountalsowasthefactthattherewasnobadfaithontheirpart.

Dr.JarciaandDr.Bastancannotpassontheliabilitytothetaxidriverwhohitthevictim.Itmaybe
truethattheactual,direct,immediate,andproximatecauseoftheinjury(fractureofthelegboneortibia)of
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Roy Jr. was the vehicular accident when he was hit by a taxi. The petitioners, however, cannot simply
invokesuchfactalonetoexcusethemselvesfromanyliability.Ifthiswouldbeso,doctorswouldhavea
readydefenseshouldtheyfailtodotheirjobinattendingtovictimsofhitandrun,maltreatment,andother
crimesofviolenceinwhichtheactual,direct,immediate,andproximatecauseoftheinjuryisindubitably
theactoftheperpetrator/s.

InfailingtoperformanextensivemedicalexaminationtodeterminetheextentofRoyJr.sinjuries,
Dr.JarciaandDr.Bastanwereremissoftheirdutiesasmembersofthemedicalprofession.Assumingfor
thesakeofargumentthattheydidnothavethecapacitytomakesuchthoroughevaluationatthatstage,they
shouldhavereferredthepatienttoanotherdoctorwithsufficienttrainingandexperienceinsteadofassuring
himandhismotherthateverythingwasallright.
This Court cannot also stamp its imprimatur on the petitioners contention that no physicianpatient
relationshipexistedbetweenthemandpatientRoyJr.,sincetheywerenothisattendingphysiciansatthat
time.TheyclaimthattheyweremerelyrequestedbytheERnursetoseethepatientwhiletheywerepassing
bytheERfortheirlunch.Firstly,thisissuewasneverraisedduringthetrialattheRTCorevenbeforethe
CA.Thepetitioners,therefore,raisethewantofdoctorpatientrelationshipforthefirsttimeonappealwith
thisCourt.Ithasbeensettledthatissuesraisedforthefirsttimeonappealcannotbeconsideredbecausea
partyisnotpermittedtochangehistheoryonappeal.Toallowhimtodosoisunfairtotheotherpartyand
[18]
offensivetotherulesoffairplay,justiceanddueprocess. Stateddifferently,basicconsiderationsofdue
processdictatethattheories,issuesandargumentsnotbroughttotheattentionofthetrialcourtneednotbe,
[19]
andordinarilywillnotbe,consideredbyareviewingcourt.

Assuming again for the sake of argument that the petitioners may still raise this issue of no
physicianpatientrelationship,theCourtfindsandsoholdsthattherewasaphysicianpatientrelationshipin
thiscase.

[20]
In the case of Lucas v. Tuao, the Court wrote that [w]hen a patient engages the services of a
physician, a physicianpatient relationship is generated. And in accepting a case, the physician, for all
intents and purposes, represents that he has the needed training and skill possessed by physicians and
surgeonspracticinginthesamefieldandthathewillemploysuchtraining,care,andskillinthetreatment
ofthepatient.Thus,intreatinghispatient,aphysicianisunderadutytoexercisethatdegreeofcare,skill
anddiligencewhichphysiciansinthesamegeneralneighborhoodandinthesamegenerallineofpractice
ordinarily possess and exercise in like cases. Stated otherwise, the physician has the obligation to use at
leastthesamelevelofcarethatanyotherreasonablycompetentphysicianwouldusetotreatthecondition
undersimilarcircumstances.

Indubitably, a physicianpatient relationship exists between the petitioners and patient Roy Jr.
Notably, the latter and his mother went to the ER for an immediate medical attention. The petitioners
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allegedlypassedbyandwererequestedtoattendtothevictim(contrarytothetestimonyofDr.Tacatathat
[21]
theywere,atthattime,residentsondutyattheER). Theyobligedandexaminedthevictim,andlater
assured the mother that everything was fine and that they could go home. Clearly, a physicianpatient
relationshipwasestablishedbetweenthepetitionersandthepatientRoyJr.

To repeat for clarity and emphasis, if these doctors knew from the start that they were not in the
position to attend to Roy Jr., a vehicular accident victim, with the degree of diligence and commitment
expectedofeverydoctorinacaselikethis,theyshouldhavenotmadeabaselessassurancethateverything
wasallright.Bydoingso,theydeprivedRoyJr.ofadequatemedicalattentionthatplacedhiminamore
dangeroussituationthanhewasalreadyin.Whatpetitionersshouldhavedone,andcouldhavedone,wasto
referRoyJr.toanotherdoctorwhocouldcompetentlyandthoroughlyexaminehisinjuries.

Alltold,thepetitionerswere,indeed,negligentbutonlycivilly,andnotcriminally,liableasthefacts
show.

ArticleII,Section1oftheCodeofMedicalEthicsoftheMedicalProfessioninthePhilippinesstates:

Aphysicianshouldattendtohispatientsfaithfullyandconscientiously.Heshouldsecurefor
themallpossiblebenefitsthatmaydependuponhisprofessionalskillandcare.Asthesoletribunal
to adjudge the physicians failure to fulfill his obligation to his patients is, in most cases, his own
[22]
conscience,violationofthisruleonhispartisdiscreditableandinexcusable.
Established medical procedures and practices, though in constant instability, are devised for the
purposeofpreventingcomplications.Inthiscase,thepetitionersfailedtoobservethemostprudentmedical
procedureunderthecircumstancestopreventthecomplicationssufferedbyachildoftenderage.

AstotheAwardof
Damages

Whilenocriminalnegligencewasfoundinthepetitionersfailuretoadministerthenecessarymedical
attentiontoRoyJr.,theCourtholdsthemcivillyliablefortheresultingdamagestotheirpatient.Whileit
wasthetaxidriverwhoranoverthefootorlegofRoyJr.,theirnegligencewasdoubtlesscontributory.

It appears undisputed that the amount of 3,850.00, as expenses incurred by patient Roy Jr., was
adequately supported by receipts. The Court, therefore, finds the petitioners liable to pay this amount by
wayofactualdamages.

TheCourtisawarethatnoamountofcompassioncansufficetoeasethesorrowfeltbythefamilyof
the child at that time. Certainly, the award of moral and exemplary damages in favor of Roy Jr. in the
amountof100,000.00and50,000.00,respectively,isproperinthiscase.

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It is settled that moral damages are not punitive in nature, but are designed to compensate and
alleviateinsomewaythephysicalsuffering,mentalanguish,fright,seriousanxiety,besmirchedreputation,
wounded feelings, moral shock, social humiliation, and similar injury unjustly inflicted on a
person.Intendedfortherestorationofthepsychologicaloremotionalstatusquoante,theawardofmoral
damages is designed to compensate emotional injury suffered, not to impose a penalty on the wrongdoer.
[23]

The Court, likewise, finds the petitioners also liable for exemplary damages in the said amount.
Article 2229 of the Civil Code provides that exemplary damages may be imposed by way of example or
correctionforthepublicgood.

WHEREFORE,thepetitionisPARTLYGRANTED.TheDecisionoftheCourtofAppealsdated
August 29, 2008 is REVERSED and SET ASIDE. A new judgment is entered ACQUITTING Dr.
Emmanuel Jarcia, Jr. and Dr. Marilou Bastan of the crime of reckless imprudence resulting to serious
physicalinjuriesbutdeclaringthemcivillyliableintheamountsof:

(1)3,850.00asactualdamages
(2)100,000.00asmoraldamages
(3)50,000.00asexemplarydamagesand
(4)Costsofthesuit.

withinterestattherateof6%perannumfromthedateofthefilingoftheInformation.Therateshallbe
12%interestperannumfromthefinalityofjudgmentuntilfullypaid.

SOORDERED.


JOSECATRALMENDOZA
AssociateJustice

WE CONCUR:

ANTONIOT.CARPIO
AssociateJustice

DIOSDADO M. PERALTA ROBERTO A. ABAD

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Associate Justice Associate Justice

Acting Chairperson

JOSE PORTUGAL PEREZ

Associate Justice

ATTESTATION

IattestthattheconclusionsintheaboveDecisionhadbeenreachedinconsultationbeforethecase
wasassignedtothewriteroftheopinionoftheCourtsDivision.



DIOSDADOM.PERALTA
AssociateJustice
ActingChairperson,ThirdDivision


CERTIFICATION

Pursuant to Section 13, Article VIII of the Constitution and the Division Acting Chairpersons
Attestation,IcertifythattheconclusionsintheaboveDecisionhadbeenreachedinconsultationbeforethe
casewasassignedtothewriteroftheopinionoftheCourtsDivision.




RENATOC.CORONA
ChiefJustice

*DesignatedasadditionalmemberinlieuofAssociateJusticePresbiteroJ.Velasco,Jr.,perSpecialOrderNo.1185datedFebruary10,2012.
**DesignatedasActingChairperson,perSpecialOrderNo.1184datedFebruary10,2012.
***DesignatedasadditionalmemberinlieuofAssociateJusticeEstelaM.PerlasBernabe,perSpecialOrderNo.1192datedFebruary10,2012.
[1]
SeethecaseofDr.Batiquinv.CourtofAppeals,327Phil.965(1996).
[2]
Rollo, pp. 5065. Penned by Associate Justice Isaias Dicdican, with Associate Justice Juan Q. Enriquez, Jr. and Associate Justice Marlene
GonzalesSison,concurring.
[3]
Id.at6768.
[4]
Id.at7079.

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[5]
Nofirstnameonrecord.
[6]
Rollo,p.79.
[7]
Id.at78.
[8]
Id.at5865.
[9]
Id.at2022.
[10]
AlsoquotedinthecaseofLayuganv.IntermediateAppellateCourt,249Phil.363,377(1988).
[11]
Dr.Batiquinv.CA,supranote1,at979980.
[12]
Reyesv.SistersofMercyHospital,396Phil.87,98(2000).
[13]
TSN,September20,2004,p.13.
[14]
Gaidv.People,G.R.No.171636,April7,2009,584SCRA489,497.
[15]
Id.at495.
[16]
Id.at497.

[17]
TSN,September20,2004,pp.924.
[18]
Balitaosanv.TheSecretaryofEducation,457Phil.300,304(2003).
[19]
DelRosariov.Bonga,402Phil.949,957958(2001).
[20]
G.R.No.178763,April21,2009,586SCRA173,200.
[21]
TSN,September20,2004,p.13.
[22]
AsquotedinthecaseofRuez,Jr.v.Jurado,513Phil.101,106(2005).
[23]
QuezonCityGovt.v.Dacara,499Phil.228,243(2005).

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