Dr.

Ninevetch Cruz vs Court of Appeals and Lydia Umali

Facts
This is a medical malpractice suit in which Dr Cruz and Dr Ercillo were sentenced under RPC Article
365 with civil action for damages. They were charged with Reckless Imprudence and Negligence resulting
to Homicide.
Lydia Umali was examined by Dr. Cruz, who later found out that the former had a myoma in her uterus
hence, she needs to undergo hysterectomy operation on March 23, 1991. Rowena Umali de Ocampo
objected to the said operation because she noticed that the clinic was untidy and dusty. She even asked
Dr. Cruz if they could postpone the operation but the doctor is convinced that it should go as scheduled.
While the operation is ongoing, Dr. Ercillo [anesthesiologist] asked them [the relatives] to buy tagamet
ampules to which they obeyed. And then, again Dr. Ercillo asked to buy a type A blood and they did.
After the operation, they were again told to buy a type A blood but to no avail they were not able to find
one. A person arrived to donate blood which was later transfused to Lydia. However, they noticed that
Lydia was gasping for breath. Apparently, the oxygen supply went out hence they needed to buy such.
During the evening, Lydia went in shock and her blood pressure dropped hence, she was then transferred
to a hospital without the consent of the relative who only found out about it when a ambulance came. She
was then re-operated by Dr. Cruz and Dr. Ercillo because blood was oozing out from her incision. They
called Dr. Angeles but when he arrived, Lydia was already in shock and possibly dead so there is nothing
he can do.
Lydia dies while Dr. Cruz was operating on her abdominal wall. The immediate cause of death was
shock, disseminated intravascular coagulation as antecedent cause. MTCC found Dr Ercillo not guilty of the
said crime due to insufficiency of evidence but held that Dr Cruz is guilty of the said charge. RTC and CA
affirmed the MTCC decision.
Issue Whether or not the circumstances are sufficient to sustain a judgment of conviction against
Dr Cruz for reckless imprudence and negligence resulting to homicide.
Held NO. Dr Cruz is not to be held liable under RPC Article 365 but she is still civilly liable 50k
civil liability, 100k moral damages and 50k exemplary damages.
The foregoing circumstances are insufficient to sustain a judgment of conviction against Dr Cruz for
the said crime. The elements of reckless imprudence are 1. That offender does or fails to do an act, 2.
That the doing or the failure to do the act is voluntary, 3. That it be without malice, 4. That material damage
results from reckless imprudence and 5. That there is inexcusable lack of precaution on the part of the
offender, taking into consideration his employment, degree of intelligence, physical condition etc.
If the physician had committed an inexcusable lack of precaution, it should be determined
according to the standard of care observed by other member of the profession. However, apparent from the
case is the absence of any expert testimony on the matter of standard of care by other physicians of good
standing in the conduct of similar operations. All three courts bewail the untidiness, lack of certain medical
equipments and needs and the re-operation of the patient in the hospital. The court reiterated that the
unquestionable knowledge of expert witnesses are indispensable in this case. Expert testimony should
have been offered to prove that the circumstances cited by the courts are constitutive of conduct falling
below the standard of care needed.
Based from the testimonies of the expert witnesses presented by the prosecution and the defense,
there is no cogent proof that any of these circumstances caused the petitioners death thus, the absence of
the fourth requisite in the reckless imprudence elements. The testimonies of the doctors presented
establish hemorrhage as the cause of death which may be caused by different factors. The findings of the
doctors do not preclude the probability that a clotting defect caused the hemorrhage and consequently,
Lydias death. There was no fault or negligence on Dr Cruzs part according to the expert testimonies.
 Nilo Rosit vs Davao Doctors Hospital and Dr Rolando Gestuvo

Facts
Rosit figured in a motorcycle accident. The X-ray taken at Davao Doctors Hospital showed that he
fractured his jaw hence, he was referred to Dr Gestuvo, who specializes in mandibular injuries and later on
operated on Rosit.
During the operation, Dr Gestuvo used a metal plate fastened to the jaw with metal screws to
immobilize the mandible. As the operation needed the smallest screws, Dr Gestuvo just cut the screws on
hand to make it smaller. He knew that the needed screws are available in Manila but he did not say so for
the reason that he might not afford it.
After the procedure, Rosit could not properly open and close his mouth and was in pain. The X-ray
shows that the fracture in his jaw was aligned but the screws used on him touched his molar. Dr Gestuvo
then referred him to a dentist, Dr Pangan. Dr Pangan opined that another operation is needed and it would
be performed in Cebu. Rosit went to Dr Gestuvo to inform him of the improper operation he did and
demanded a loan to cover his expenses and operation needs in Cebu. He was given P4500.
In Cebu, Dr Pangan operated on Rosit and was able to successfully placed the correct screws and
extracted the molar that was hit by the incorrect screw. On his return to Davao, Rosit demanded that Dr
Gestuvo should reimburse him for the cost of operation and his expenses in Cebu for a total of P140k and
the P50k that was paid to Dr Pangan however, Dr Gestuvo refused hence, this civil case for damages
against Dr Gestuvo and DDH.
RTC freed DDH on the ground that it exercised proper diligence but adjudged Dr Gestuvo
negligent thus, awarded damages. The trial court applied the res ipsa loquitur principle that the need for
an expert witness may be dispensed with because the injury itself provides the proof of negligence. CA
opined that res ipsa loquitur is not applicable and that expert witness is still needed. It also gave credence
to Dr Pangans letter that Dr Gestuvo did not commit gross negligence.
Issue Whether or not the appellate correctly absolved Dr Gestuvo from liability
Held NO. Dr. Gestuvos actions are clearly negligent. Dr Gestuvo acted in bad faith towards not
informing Rosit about the proper screws and Rosit was able to prove that Dr Gestuvo negligently
placed the incorrect screws in the operation.
A medical negligence case is a type of claim to redress a wrong committed by a medical
professional that has caused bodily harm or even death of a patient. The four elements in medical
negligence are duty, breach, injury and proximate causation.
An expert witness is not necessary as the res ipsa loquitur doctrine is applicable in this case. The
general rule in most cases is that an expert opinion or testimony is needed to define the standard behavior
by which the physician may have done. This case is one of the exceptions wherein the need for expert
testimony is dispensed with because the injury itself provides for the proof of negligence.
The resort to the doctrine of res ipsa loquitur as an exception to the requirement of expert
testimony in medical negligence cases may be availed by if the essential requisites concur 1. Accident
was of a kind that does not ordinarily occur unless someone is negligent, 2. Instrumentality or agency that
caused the injury was under the exclusive control of the person charged, 3. Injury suffered must not have
been due to any voluntary action or contribution to the person injured. These are all evident in the instant
case.
As regards to the informed consent doctrine where it requires the plaintiff to pint the significant
undisclosed information relating to the treatment which would have altered his decision to undergo it.
Without a doubt, Dr Gestuvo is guilty of withholding material information which would have been vital in the
decision of Rosit in going through the operation with the materials at hand. Dr Gestuvos negligence is
clearly demonstrable by the doctrines of res ipsa loquitur and informed consent.