BOARD OF MEDICINE vs.

YASUYUKI OTA
G.R. No. 166097, July 14, 2008

Law and Practice of Medicine

Facts: Yasuyuki Ota is a Japanese national who continuously resided in the Philippines
for more than ten (10) years. He graduated Medicine in Bicol Christian College. After
completing internship at Jose Reyes Medical Center, he filed an application to take the
medical board examinations to obtain a license. He was further required by Professional
Regulation Commission (PRC) to submit a documentary proof that reciprocity exists
between Japan and Philippines in admitting foreigners to practice of medicine. In spite of
passing the licensure examination and submitting proof that reciprocity exists, the Board
of Medicine of the PRC still denied Ota’s request on the ground that no reciprocity can be
found, and even if there is, it is impractical and impossible.

Issue: Can Ota Practice Medicine in the Philippines?

Ruling: Ota can practice Medicine in the Philippines. Under RA 2382 or the Medical Act
of 1959, it merely requires a foreign citizen to submit competent and conclusive
documentary evidence, confirmed by the Department of Foreign Affairs, showing that his
country’s existing laws permit citizens of the Philippines to practice medicine under the
same rules and regulations governing citizens. Nowhere in said statute is it stated that
the foreign applicant must show that the conditions of practice of Medicine in said country
are practical and attainable by Filipinos. It is enough that the laws in a foreign country
permit a Filipino to get license and practice therein. Thus, since Oto has all the
qualification and does not possess any of the disqualifications, he can practice medicine
in the Philippines.
MEDICAL MALPRACTICE
GARCIA-RUEDA vs PASCASIO
G.R. No. 118141, September 5, 1997

FACTS: Florencio Rueda underwent surgery, and was attended by Dr. Antonio Jr (as
surgeon) and Br. Balatbat-Reyes (anesthesiologist). Six hours after surgery, Florencio
died of complications. Thus, his wife filed a case against the doctors. The case was
bolstered when the NBI pronounced that after conducting an autopsy, there was indeed
negligence on the part of the physicians.

ISSUE: Is Medical Malpractice committed by the doctors?

RULING: Yes, medical malpractice was committed. Medical malpractice is committed

when the following elements are present:
1. Duty
2. Breach of Duty
3. Proximate Causation
4. Injury or Death

Here, the doctors are duty-bound to take care of Florencio in accordance with
standards established by its profession. However, they breached such duty when they
wrongfully administered the anesthesia. Indeed here, a causal connection is discernible
from the occurrence of Florencio’s death after the negligent act. Therefore, the doctors
are liable for Medical Malpractice.
CASUMPANG v. CORTEJO
G.R. No. 171127 | March 11, 2015

FACTS:

 On April 22, 1988, at about 11:30 in the morning, Mrs. Cortejo brought her 11-year old
son, Edmer, to the Emergency Room of the San Juan de Dios Hospital (SJDH)
because of difficulty in breathing, chest pain, stomach pain, and fever. Thereafter, she
was referred and assigned to Dr. Casumpang, a pediatrician. At 5:30 in the afternoon
of the same day, Dr. Casumpang, upon examination using only a stethoscope,
confirmed the diagnosis of Bronchopneumonia. Mrs. Cortejo immediately advised Dr.
Casumpang that Edmer had a high fever, and had no colds or cough but Dr.
Casumpang merely told her that her son's bloodpressure is just being active and
remarked that that's the usual bronchopneumonia, no colds, no phlegm.

 Dr. Casumpang next visited the following day. Mrs. Cortejo again called Dr.
Casumpang's attention and stated that Edmer had a fever, throat irritation, as well as
chest and stomach pain. Mrs. Cortejo also alerted Dr. Casumpang about the traces of
blood in Edmer's sputum. Despite these pieces of information, however, Dr.
Casumpang simply nodded and reassured Mrs. Cortejo that Edmer's illness is
bronchopneumonia.

 At around 11:30 in the morning of April 23, 1988, Edmer vomited phlegm with blood
streak prompting the Edmer's father to request for a doctor. Later, Miranda, one of the
resident physicians of SJDH, arrived. She claimed that although aware that Edmer
had vomited phlegm with blood streak she failed to examine the blood specimen. She
then advised the respondent to preserve the specimen for examination. Thereafter,
Dr. Miranda conducted a check-up on Edmer and found that Edmer had a low-grade
fever and rashes.

 At 3:00 in the afternoon, Edmer once again vomited blood. Dr. Miranda then examined
Edmer's sputum with blood and noted that he was bleeding. Suspecting that he could
be afflicted with dengue, Dr. Miranda conducted a tourniquet test, which turned out to
be negative. Dr. Miranda then called up Dr. Casumpang at his clinic and told him about
Edmer's condition. Upon being informed, Dr. Casumpang ordered several procedures
done. Dr. Miranda advised Edmer's parents that the blood test results showed that
Edmer was suffering from Dengue Hemorrhagic Fever. Dr. Casumpang
recommended Edmer’s transfer to the ICU, but since the ICU was then full, the
respondent, insisted on transferring his son to Makati Medical Center.

 At 12:00 midnight, Edmer, accompanied by his parents and by Dr. Casumpang, was
transferred to Makati Medical Center. Upon examination, the attending physician
diagnosed Dengue Fever Stage IV that was already in its irreversible stage. Edmer
died at 4:00 in the morning of April 24, 1988. His Death Certificate indicated the cause
of death as Hypovolemic Shock/hemorrhagic shock/Dengue Hemorrhagic Fever
Stage IV.
 Believing that Edmer's death was caused by the negligent and erroneous diagnosis
of his doctors, the respondent instituted an action for damages against SJDH, and its
attending physicians: Dr. Casumpang and Dr. Miranda.

 Dr. Casumpang contends that he gave his patient medical treatment and care to the
best of his abilities, and within the proper standard of care required from physicians
under similar circumstances.

 Dr. Miranda argued that the function of making the diagnosis and undertaking the
medical treatment devolved upon Dr. Casumpang, the doctor assigned to Edmer. Dr.
Miranda also alleged that she exercised prudence in performing her duties as a
physician, underscoring that it was her professional intervention that led to the correct
diagnosis of Dengue Hemorrhagic Fever.

 SJDH, on the other hand, disclaims liability by asserting that Dr. Casumpang and Dr.
Miranda are mere independent contractors and consultants (not employees) of the
hospital; hence, Article 2180 of the Civil Code does not apply.

ISSUES:

1. W/N Casumpang had committed inexcusable lack of precaution in diagnosing and in

treating the patient

2. W/N Miranda had committed inexcusable lack of precaution in diagnosing and in

treating the patient

3. W/N Whether or not the petitioner hospital is solidarity liable with the petitioner doctors

4. W/N or not there is a causal connection between the petitioners' negligent

act/omission and the patient's resulting death

HELD/RATIO:

1. YES, Casumpang was negligent.

 Even assuming that Edmer's symptoms completely coincided with the diagnosis of
bronchopneumonia, we still find Dr. Casumpang guilty of negligence. Wrong diagnosis
is not by itself medical malpractice. Physicians are generally not liable for damages
resulting from a bona fide error of judgment and from acting according to acceptable
medical practice standards. Nonetheless, when the physician's erroneous diagnosis
was the result of negligent conduct, it becomes an evidence of medical malpractice.

 In the present case, evidence on record established that in confirming the diagnosis
of bronchopneumonia, Dr. Casumpang selectively appreciated some and not all of the
symptoms presented, and failed to promptly conduct the appropriate tests to confirm
 his findings. In sum, Dr. Casumpang failed to timely detect dengue fever, which failure,
especially when reasonable prudence would have shown that indications of dengue
were evident and/or foreseeable, constitutes negligence. Apart from failing to promptly
detect dengue fever, Dr. Casumpang also failed to promptly undertake the proper
medical management needed for this disease. Dr. Casumpang failed to measure up
to the acceptable medical standards in diagnosing and treating dengue fever.

 Dr. Casumpang's claim that he exercised prudence and due diligence in handling
Edmer's case, sside from being self-serving, is not supported by competent evidence.
He failed, as a medical professional, to observe the most prudent medical procedure
under the circumstances in diagnosing and treating Edmer.

2. No, Dr. Miranda is not liable for negligence.

 We find that Dr. Miranda was not independently negligent. Although she was subject
to the same standard of care applicable to attending physicians, as a resident
physician, she merely operates as a subordinate who usually refer to the attending
physician on the decision to be made and on the action to be taken. We also believe
that a finding of negligence should also depend on several competing factors. In this
case, before Dr. Miranda attended to Edmer, Dr. Casumpang had diagnosed Edmer
with bronchopneumonia. There is also evidence supporting Dr. Miranda's claim that
she extended diligent care to Edmer. In fact, when she suspected, during Edmer's
second episode of bleeding, that Edmer could be suffering from dengue, she wasted
no time in conducting the necessary tests, and promptly notified Dr. Casumpang about
the incident. Indubitably, her medical assistance led to the finding of dengue fever. Dr.
Miranda's error was merely an honest mistake of judgment; hence, she should not be
held liable for medical negligence.

3. Yes, causal connection between the petitioners' negligence and the patient's
resulting death was established

 Casumpang failed to timely diagnose Edmer with dengue fever despite the presence
of its characteristic symptoms; and as a consequence of the delayed diagnosis, he
also failed to promptly manage Edmer's illness. Had he immediately conducted
confirmatory tests, and promptly administered the proper care and management
needed for dengue fever, the risk of complications or even death, could have been
substantially reduced. That Edmer later died of Dengue Hemorrhagic Fever Stage IV,
a severe and fatal form of dengue fever, established the causal link between Dr.
Casumpang's negligence and the injury. The element of causation is successfully
proven.

4. YES, SJDH is solidarily liable.

 As a rule, hospitals are not liable for the negligence of its independent contractors.
However, it may be found liable if the physician or independent contractor acts as an
 ostensible agent of the hospital. This exception is also known as the doctrine of
apparent authority.

 SJDH impliedly held out and clothed Dr. Casumpang with apparent authority leading
the respondent to believe that he is an employee or agent of the hospital. Based on
the records, the respondent relied on SJDH rather than upon Dr. Casumpang, to care
and treat his son Edmer. His testimony during trial showed that he and his wife did not
know any doctors at SJDH; they also did not know that Dr. Casumpang was an
independent contractor. They brought their son to SJDH for diagnosis because of their
family doctor's referral. The referral did not specifically point to Dr. Casumpang or
even to Dr. Miranda, but to SJDH.

 Mrs. Cortejo accepted Dr. Casumpang's services on the reasonable belief that such
were being provided by SJDH or its employees, agents, or servants. By referring Dr.
Casumpang to care and treat for Edmer, SJDH impliedly held out Dr. Casumpang as
a member of its medical staff. SJDH cannot now disclaim liability since there is no
showing that Mrs. Cortejo or the respondent knew, or should have known, that Dr.
Casumpang is only an independent contractor of the hospital. In this case, estoppel
has already set in.
Rubi Li vs. SPS Soliman

Facts:

On july 1993, respondents 11 year old daughter, Angelica Soliman underwent a

biopsy of the mass located in her lower extremity Result shows that Angelica was
suffering from osteosarcoma, a high grade cancer of the bone which usually affect
children and teenager. Angelica’s right leg was amputated in order to remove the tumor
by Dr. Tomayo and further refer Angelica to Dr. Rubi Li for Adjuvant treatment to
eliminate remaining cancer cells. Dr. Rubi Li has seen Angelica after surgery and
discussed with her parents her present condition. She assured then not to worry about
the professional fee but has to save up for medicines to be used. Petitioner claimed that
she explained to respondents the side effects of chemotherapy and that it is needed to
clean out the small lessions in order to lessen the chance of cancer to recur but did not
give an assurance that chemotherapy will cure cancer. Respondents on the other hand
avers that Dr. Rubi Li assured then that 95% chance of healing Angelica.

ISSUE: Did Dr. Rubi Li committed malpractice?

HELD:

No. In order to pursue such claim, a patient must prove that a health care
provider would have done or that he or she did something that a reasonably healthcare
provider would not have done, and that failure or action caused injury to the patient. In
the case at bar, there was adequate disclosure of material risk inherent in
chemotherapy procedure performed with the consent of Angelica’s parents. The parents
already was aware that the immune system of Angelica is already weak on account of
tumor in her knee. Therefore, there was no Medical Malpractice.
RAMOS vs. COURT OF APPEALS
G.R. No. 124354. December 29, 1999.

FACTS:

Erlinda Ramos underwent a surgical procedure to remove stone from her gall
bladder (cholecystectomy). They hired Dr. Hosaka, a surgeon, to conduct the surgery at
the De Los Santos Medical Center (DLSMC). Hosaka assured them that he would find a
good anesthesiologist. But the operation did not go as planned, Dr. Hosaka arrived 3
hours late for the operation, Dra. Gutierrez, the anesthesiologist “botched” the
administration of the anesthesia causing Erlinda to go into a coma and suffer brain
damage. The botched operation was witnessed by Herminda Cruz, sister in law of Erlinda
and Dean of College of Nursing of Capitol Medical Center.

The family of Ramos (petitioners) sued the hospital, the surgeon and the
anesthesiologist for damages. The petitioners showed expert testimony showing that
Erlinda's condition was caused by the anesthesiologist in not exercising reasonable care
in “intubating” Erlinda. Eyewitnesses heard the anesthesiologist saying “Ang hirap ma-
intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan.”

Diagnostic tests prior to surgery showed that Erlinda was robust and fit to undergo
surgery.

The RTC held that the anesthesiologist ommitted to exercise due care in intubating
the patient, the surgeon was remiss in his obligation to provide a “good anesthesiologist”
and for arriving 3 hours late and the hospital is liable for the negligence of the doctors and
for not cancelling the operation after the surgeon failed to arrive on time. The surgeon,
anesthesiologist and the DLSMC were all held jointly and severally liable for damages to
petitioners. The CA reversed the decision of the Trial Court.

ISSUE: Whether or not the private respondents were negligent and thereby caused the
comatose condition of Ramos.

HELD:

Yes, private respondents were all negligent and are solidarily liable for the
damages.

Res ipsa loquitur – a procedural or evidentiary rule which means “the thing or the
transaction speaks for itself.” It 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 facie case, and present a
question of fact for defendant to meet with an explanation, where ordinarily in a medical
malpractice case, the complaining party must present expert testimony to prove that the
attending physician was negligent.
This doctrine finds application in this case. On the day of the operation, Erlinda Ramos
already surrendered her person to the private respondents who had complete and
exclusive control over her. Apart from the gallstone problem, she was neurologically
sound and fit. Then, after the procedure, she was comatose and brain damaged—res
ipsa loquitur!—the thing speaks for itself!

Negligence – Private respondents were not able to disprove the presumption of

negligence on their part in the care of Erlinda and their negligence was the proximate
cause of her condition. One need not be an anesthesiologist in order to tell whether or
not the intubation was a success. [res ipsa loquitur applies here]. The Supreme Court
also found that the anesthesiologist only saw Erlinda for the first time on the day of the
operation which indicates unfamiliarity with the patient and which is an act of negligence
and irresponsibility.

The head surgeon, Dr. Hosaka was also negligent. He failed to exercise the proper
authority as the “captain of the ship” in determining if the anesthesiologist observed the
proper protocols. Also, because he was late, he did not have time to confer with the
anesthesiologist regarding the anesthesia delivery.

The hospital failed to adduce evidence showing that it exercised the diligence of a good
father of the family in hiring and supervision of its doctors (Art. 2180). The hospital was
negligent since they are the one in control of the hiring and firing of their “consultants”.
While these consultants are not employees, hospitals still exert significant controls on the
selection and termination of doctors who work there which is one of the hallmarks of an
employer-employee reationship. Thus, the hospital was allocated a share in the liability.
 Professional Services Inc. vs Agana
GR No. 126297 January 31, 2007

Facts: On April 4, 1984, Natividad Agana was rushed to the Medical City General
Hospital because of difficulty of bowel movement and bloody anal discharge. After a
series of medical examinations, Dr. Miguel Ampil diagnosed her to be suffering from
Cancer of the sigmoid. On April 11, 1984, Dr. Ampil assisted by the medical staff of the
Medical City Hospital performed an Anterior resection surgery on Natividad. He found that
the malignancy on her sigmoid area had spread on her left ovary, necessitating the
removal of certain portions of it. Thus, Dr. Ampil obtained the consent of Natividad’s
husband, Enrique Agana, to permit Dr. Juan Fuentes to perform hysterectomy on her.
After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the
operation and closed the incision after searching for the missing 2 gauzes as indicated
by the assisting nurses but failed to locate it. After a couple of days, Natividad complained
of excruciating pains in her anal region but Dr. Ampil said it is a natural consequence of
the operation/surgery and recommended that she consult an oncologist to examine the
cancerous nodes which were not removed during the operation. Natividad and her
husband went to the US to seek further treatment and she was declared free from cancer.
A piece of gauze portruding from Natividad’s vagina was found by her daughter which
was then removed by hand by Dr. Ampil and assured that the pains will vanished.
However, it didn’t. The pains intensified prompting Natividad to seek treatment at the
Polymedic General Hospital. While confined there, Dr. Ramon Guttierez detected the
presence of another foreign object in her vagina – a foul smelling gauze measuring 1.5
inches in width which badly infected her vagina. A recto-vaginal fistula had forced stool
to excrete through her vagina. Another surgical operation was needed to remedy the
damage.

Issue: Whether or not Dr. Ampil and Fuentes are liable for medical malpractice and the
PSI for damages due to the negligence of the said doctors.

Held: Yes. No. Yes. 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. To put it simply, such act is
considered so inconsistent with due care as to raise inference of negligence. There are
even legions of authorities to the effect that such act is negligence per se.

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. Simply puts 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 Natividad’s 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. Ampil’s negligence is the
proximate cause of Natividad’s injury could be traced from his act of closing the incision
despite the information given by the attending nurses that 2 pieces of gauze were still
missing. That they were later on extracted from Natividad’s vagina established the causal
link between Dr. Ampil’s negligence and the injury. And what further aggravated such
injury was his deliberate concealment of this missing gauzes from the knowledge of
Natividad and her family.

The requisites for the applicability of the doctrine of res ipsa liquitor are:

1. 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, the most instrumental is the “Control and management of the thing which
caused the injury.”

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.

The knowledge of any of the staff of Medical City constitutes knowledge of PSI.

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. The hospital accordingly has the duty to make a
reasonable effort to monitor and over see the treatment prescribed and administered by
the physician practicing in its premises.
 Reyes vs. Sisters of Mercy Hospital

FACTS:

Petitioner, Leah Alesna Reyes, is the wife of the deceased patient, Jorge Reyes.
Five days before the latter’s death, Jorge has been suffering from recurring fever with
chills. The doctors confirmed through the Widal test that Jorge has typhoid fever.
However, he did not respond to the treatment and died. The cause of his death was
“Ventricular Arrythemia Secondary to Hyperpyrexia and typhoid fever.” Consequently,
petitioner filed the instant case for damages before the Regional Trial Court of Cebu City,
which dismissed the case and was affirmed by the Court of Appeals.

The contention was that Jorge did not die of typhoid fever. Instead, his death was
due to the wrongful administration of chloromycetin. They contended that had respondent
doctors exercised due care and diligence, they would not have recommended and rushed
the performance of the Widal Test, hastily concluded that Jorge was suffering from
typhoid fever, and administered chloromycetin without first conducting sufficient tests on
the patient’s compatibility with said drug.

ISSUE: Whether the death of Jorge Reyes was due to or caused by the negligence,
carelessness, imprudence, and lack of skill or foresight on the part of defendant

RULING:

No, the death of Jorge Reyes was due to or caused by the negligence,
carelessness, imprudence, and lack of skill or foresight on the part of defendant

There is no showing that the attending physician in this case deviated from the
usual course of treatment with respect to typhoid fever. Jorge was given antibiotic
choloromycetin and some dose of triglobe after compatibility test was made by the doctor
and found that no adverse reactions manifested which would necessitate replacement of
the medicines. Indeed, the standard contemplated is not what is actually the average
merit among all known practitioners from the best to the worst and from the most to the
least experienced, but the reasonable average merit among the ordinarily good
physicians. Here, the doctors did not depart from the reasonable standard recommended
by the experts as they in fact observed the due care required under the circumstances.

In Medical Negligence cases, it is incumbent upon the plaintiff to establish that the
usual procedure in treating the illness is not followed by the doctor. Failure to prove this,
the doctor is not liable. Physicians are not insurers of the success of every procedure
undertaken and if the procedure was shown to be properly done but did not work, they
cannot be faulted for such result.
 Dr. Victoria L. Batiquin, et al. vs. Court of Appeals, G.R. No. 118231, July 5, 1996

Petitioner: Dr. Batiquin was a Resident Physician at the Negros Oriental

Provincial Hospital, Dumaguete City.

Respondents: Mrs. Villegas is a married woman who submitted to Dr.

Batiquin for prenatal care as the latter's private patient.

Witness: Dr. Ma. Salud Kho

Facts:

In the morning of September 21, 1988 Dr. Batiquin, with the assistance of Dr. Doris
Teresita Sy who was also a Resident Physician at the same Hospital, C.I. and O.R.
Nurse Arlene Diones and some student nurses performed a simple cesarean section on
Mrs. Villegas.

Mrs. Villegas delivered her first child and on September 28, 1988, Mrs. Villegas checked
out of the Hospital. Soon after leaving the Hospital Mrs. Villegas began to suffer
abdominal pains and complained of being feverish.

She consulted Dr. Batiquin at the latter's polyclinic who prescribed for her certain
medicines and issued her a Medical Certificate certifying to her physical fitness to return
to her work.

The abdominal pains and fever kept on recurring and bothered Mrs. Villegas. When the
pains become unbearable and she was rapidly losing weight she consulted Dr. Ma. Salud
Kho. . Upon examination she felt an abdominal mass one finger below the umbilicus
which she suspected to be either a tumor of the uterus or an ovarian cyst, Dr. Kho
suggested to Mrs. Villegas that she submits to another surgery to which the latter agreed.
When Dr. Kho opened the abdomen of Mrs. Villegas she found whitish-yellow discharge
inside, an ovarian cyst on each of the left and right ovaries which gave out pus, dirt and
pus behind the uterus, and a piece of rubber materials This piece of rubber material which
Dr. Kho described as a "foreign body" looked like a piece of a "rubber glove”. And this
foreign body was the cause of the infection of the ovaries and consequently of all the
discomfort suffered by Mrs. Villegas.
The trial court, after hearing the case, considered respondent’s witness’ testimony as a
matter of hearsay and rendered a decision in favor of the petitioners.
The Court of Appeals reversed the decision which they deemed Dr. Kho's positive
testimony to definitely establish that a piece of rubber was found near private respondent
Villegas' uterus.
Hence, petitioners appealed to this Court claiming that the appellate court; (1) committed
grave abuse of discretion by resorting to findings of fact not supported by the evidence
on record, and (2) exceeded its discretion, amounting to lack or excess of jurisdiction,
when it gave credence to testimonies punctured with contradictions and falsities.

Issue:
1. W/N the Dr. Kho is a credible witness which would allow the court to admit her
positive testimony over petitioner’s negative testimony on the case?
2. W/N petitioner is liable to the defendant?

Held:
1. Yes. Dr. Kho was frank throughout her turn on the witness stand. Furthermore,
no motive to state any untruth was ever imputed against Dr. Kho, leaving her
trustworthiness unimpaired. She positively testified that a piece of rubber was
indeed found in private respondent Villegas' abdomen. While petitioner testified
that no rubber drain was used in the operation, and that there was neither any tear
on the gloves after the operation nor blood smears on her hands upon removing
her gloves are all denials or negative testimonies. Well-settled is the rule that
positive testimony is stronger than negative testimony.

Moreover, it has been aptly said that even when a witness is found to have
deliberately falsified in some material particulars, it is not required that the whole
of his uncorroborated testimony be rejected, but such portions thereof deemed
worthy of belief may be credited.
2. Yes. Considering that we have assessed Dr. Kho to be a credible witness, her
positive testimony prevails over the negative testimony in favor of the petitioners.
As such, the rule of res ipsa loquitur (the thing speaks for itself) comes to
fore. Under [this] doctrine . . . the happening of an injury permits an inference
of negligence where plaintiff produces substantial evidence that [the] injury
was caused by an agency or instrumentality under [the] exclusive control
and management of defendant, and that the occurrence [sic] was such that
in the ordinary course of things would not happen if reasonable care had
been used.
The doctrine of res ipsa loquitur as a rule of evidence is peculiar to the law of
negligence which recognizes that prima facie negligence may be established
without direct proof and furnishes a substitute for specific proof of
negligence.
In the instant case, all the requisites for recourse to the doctrine are present. First,
the entire proceedings of the cesarean section were under the exclusive control of
Dr. Batiquin. Second, since aside from the cesarean section, private respondent
Villegas underwent no other operation which could have caused the offending
piece of rubber to appear in her uterus, it stands to reason that such could only
have been a by-product of the cesarean section performed by Dr. Batiquin. The
petitioners, in this regard, failed to overcome the presumption of negligence arising
from resort to the doctrine of res ipsa loquitur. Dr. Batiquin is therefore liable for
negligently leaving behind a piece of rubber in private respondent Villegas'
abdomen and for all the adverse effects thereof.
 Bondoc vs Mantala
GR No. 203080 November 12, 2014

Facts: Respondent was admitted at the Oriental Mindoro Provincial Hospital (OMPH) on April 3, 2009, at
around 11:00am, with referral from the Bansud Municipal Health Office. She was due to deliver her 5th
child and was advised for a caesarian section because her baby was big and there was excessive amniotic
fluid in her womb. She started to labor at 7:00am and was initially brought to the Bongabon Health Center.
However, said health center also told her to proceed directly to the hospital. In her complaint-affidavit,
respondent alleged that inside the delivery room of OMPH, she was attended to by petitioner who
instructed the midwife and two younger assistants to press down on respondent’s abdomen and even
demonstrated to them how to insert their fingers into her vagina. Thereafter, petitioner went out of the
delivery room and later, his assistants also left. After hours of being in labor, respondent pleaded for a
caesarian section. The midwife and the younger assistants pressed down on her abdomen causing
excruciating pains on her ribs and made her very weak. They repeatedly did this pressing until the bay and
placenta came out. When she regained consciousness, she was already at the recovery room, she learned
that an operation was performed on her by petitioner to removed her ruptured uterus but what
depressed her most was her stillborn baby and the loss of her reproductive capacity. The respondent
noticed that her vulva swollen and there is an open wound which widened later on and was re-stitched
by petitioner. Petitioner was heard uttering words unbecoming of his profession pertaining to the
respondent’s states while in labor. Respondent filed then a complaint for grave misconduct against the
petitioner before the ombudsman. The petitioner resigned as medical officer of OMPH, alleging that the
complaint against him is now moot and academic.

Issue: Whether or not petitioner’s conduct during the delivery of respondent’s baby constitute grave
misconduct.

Held: Yes. Misconduct is defined as a transgression of some established and definite rule of action, more
particularly unlawful behavior or gross negligence by a public officer, a forbidden act, a dereliction of duty,
willful in character, and implies wrongful intent and not mere error in judgement. It generally means
wrongful, improper or unlawful conduct motivated by a premeditated, obstinate or intentional purpose.
The term, however does not necessarily imply corruption or criminal intent. To constitute an
administrative offense, misconduct should relate to or be connected with the performance of the official
functions and duties of a public officer. On the other hand, when the elements of corruption, clear intent
to violate the law or flagrant disregard of established rule are manifest, the public officer shall be liable
for grave misconduct.

In deliberately leaving the respondent to a midwife and two inexperienced assistants despite knowing
that she was under prolonged painful labor and about to give birth to a macrosomic baby by vaginal
delivery, petitioner clearly committed a dereliction of duty and a breach of his professional obligations.
The gravity of respondent’s conditions is highlighted by the expected complications she suffered – her
stillborn baby, a ruptured uterus that necessitated the immediate surgery and blood transfusion and
vulvar hematomas.
Article II section 1 of the code of medical ethics of the medical profession in the Philippines states: A
physician, should attend to his patients faithfully and conscientiously. He should secure fore them all
possible benefits that may depend upon his professional skill and care. As the sole tribunal to adjudge the
physician’s failure to fulfill his obligation to his patient is, in most cases, his own conscience, violation of
this rule on his part is discreditable and inexcusable.

A doctor’s duty to his patient is not required to be extraordinary. The standard contemplated for doctors
is simply the reasonable coverage merit among ordinarily good physicians i.e. reasonable skill and
competence. Even by this standard, petitioner fill short when he routinely delegated an important task
that requires his professional skill and competence to his subordinates who have no requisite training and
capability to make crucial decisions in difficult child births.

A physician should be dedicated to provide competent medical care with full professional skill and
accordance with the current standards of care, compassion, independence, and respect for human
dignity.
 Jarcia vs People of the Philippines
GR No. 187926 February 15, 2012

Facts:

Belinda Santiago lodged a complaint with the National Bureau of Investigation (NBI)
against the petitioners, Dr. Emanuel Jarcia and Dr. Marilou Bastan, for their alleged
neglect of professional duty which caused her son, Roy Alfonso Santiago, to suffer
physical injuries. Upon investigation, the NBI found that Roy Jr. was hit by a taxicab; that
he was rushed to the Manila Doctors Hospital for an emergency medical treatment; that
an X-ray of the victim’s ankle was ordered; that the X-ray result showed no fracture as
read by Dr. Jarcia; that Dr. Bastan entered the emergency room and, after conducting her
own examination of the victim, informed Mrs. Santiago that since it was only the ankle
that was hit there was no need to examine the upper leg; that 11 days later, Roy
developed fever, swelling of the right leg and misalignment of the right foot; that Mrs.
Santiago brought him back to the hospital; and that the x-ray revealed a right mid-tibial
fracture and a linear hairline fracture in the shaft of the bone. A complaint for reckless
imprudence resulting physical injuries was filed against the petitioners for the alleged
misconduct in the handling of the illness of Roy.

Issue: Whether the petitioners failed to exercise the degree of care expected of them as
doctors and are liable for negligence to the private respondent.

Held:

Yes. The Supreme Court considered the applicability of the doctrine of res 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
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 accused-appellant who is charged with negligence. 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.

The doctrine of res ipsa liquitor as a rule of evidence is unusual to the law of
negligence which recognizes that prima facie negligencce may be established without
direct proof and furnishes a substitute for specific proof of negligence. Hence, res ipsa
loquitur is applied in conjunction with the doctrine of common knowledge. The doctrine
however, is not a rule of substantive law, but merely a mode of proof or a mere procedural
convenience the rule when applicable to the facts and circumstances of a given case, is
not meant to and does not dispense with the requirement of proof of culpable negligence
on the party charged. It merely determines and regulates what shall be prima
facie evidence thereof and helps the plaintiff in proving a breach of duty. The doctrine can
be invoked when and only when, under the circumstances involved, direct evidence is
absolute and not readily available.

The requisites for the application of the doctrine of res ipsa liquitor are:

1. The accident was of a kind which does not ordinarily occur unless someone is
negligent;
2. The instrumentality or agency which caused the injury was under the exclusive
control of the person in charge; and
3. The injury suffered must not have been due to any voluntary action or contribution
of the person injured.

Negligence is defined as the failure to observe for the protection of the interests of
another person that degree of care, precaution and vigilance which the circumstances
justly demand whereby such other person suffers injury.

Reckless imprudence consists of voluntarily doing or failing to do, without malice, an

act from which material damage results by reason of an inexcusable lack of precaution
on the part of the person performing or failing to perform such act.

In failing to perform an extensive medical examination to determine the extent of

Roy’s injuries, Dr. Jarcia and Dr. Bastan were remiss of their duties as members of the
medical profession. Assuming for the sake of argument that they did not have the capacity
to make such thorough evaluation at that stage they should have referred the patient to
another doctor with sufficient training and experience instead of assuring him and his
mother that everything was all right.

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. 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 latter circumstance is the
primordial issue that confronted this Court and we find application of the doctrine of res
ipsa loquitur to be in order.
WHAT MAY BE RECOVERED V. B. 3.

RAMOS vs. COURT OF APPEALS

G.R. No. 124354. December 29, 1999.

FACTS:
Erlinda Ramos underwent a surgical procedure to remove stone from her gall bladder
(cholecystectomy). They hired Dr. Hosaka, a surgeon, to conduct the surgery at the De
Los Santos Medical Center (DLSMC). Hosaka assured them that he would find a good
anesthesiologist. But the operation did not go as planned, Dr. Hosaka arrived 3 hours late
for the operation, Dra. Gutierrez, the anesthesiologist “botched” the administration of the
anesthesia causing Erlinda to go into a coma and suffer brain damage. The botched
operation was witnessed by Herminda Cruz, sister in law of Erlinda and Dean of College
of Nursing of Capitol Medical Center.

The family of Ramos (petitioners) sued the hospital, the surgeon and the anesthesiologist
for damages. The petitioners showed expert testimony showing that Erlinda's condition
was caused by the anesthesiologist in not exercising reasonable care in “intubating”
Erlinda. Eyewitnesses heard the anesthesiologist saying “Ang hirap ma-intubate nito, mali
yata ang pagkakapasok. O lumalaki ang tiyan.”

Diagnostic tests prior to surgery showed that Erlinda was robust and fit to undergo
surgery.

The RTC held that the anesthesiologist ommitted to exercise due care in intubating the
patient, the surgeon was remiss in his obligation to provide a “good anesthesiologist” and
for arriving 3 hours late and the hospital is liable for the negligence of the doctors and for
not cancelling the operation after the surgeon failed to arrive on time. The surgeon,
anesthesiologist and the DLSMC were all held jointly and severally liable for damages to
petitioners. The CA reversed the decision of the Trial Court.

ISSUES: Whether or not the private respondents were negligent and thereby caused the
comatose condition of Ramos.

HELD:
Yes, private respondents were all negligent and are solidarily liable for the damages.

RATIO:

Res ipsa loquitur – a procedural or evidentiary rule which means “the thing or the
transaction speaks for itself.” It 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 facie case, and present a
question of fact for defendant to meet with an explanation, where ordinarily in a medical
malpractice case, the complaining party must present expert testimony to prove that the
attending physician was negligent.
This doctrine finds application in this case. On the day of the operation, Erlinda Ramos
already surrendered her person to the private respondents who had complete and
exclusive control over her. Apart from the gallstone problem, she was neurologically
sound and fit. Then, after the procedure, she was comatose and brain damaged—res
ipsa loquitur!—the thing speaks for itself!

Negligence – Private respondents were not able to disprove the presumption of

negligence on their part in the care of Erlinda and their negligence was the proximate
cause of her condition. One need not be an anesthesiologist in order to tell whether or
not the intubation was a success. [res ipsa loquitur applies here]. The Supreme Court
also found that the anesthesiologist only saw Erlinda for the first time on the day of the
operation which indicates unfamiliarity with the patient and which is an act of negligence
and irresponsibility.

The head surgeon, Dr. Hosaka was also negligent. He failed to exercise the proper
authority as the “captain of the ship” in determining if the anesthesiologist observed the
proper protocols. Also, because he was late, he did not have time to confer with the
anesthesiologist regarding the anesthesia delivery.

The hospital failed to adduce evidence showing that it exercised the diligence of a good
father of the family in hiring and supervision of its doctors (Art. 2180). The hospital was
negligent since they are the one in control of the hiring and firing of their “consultants”.
While these consultants are not employees, hospitals still exert significant controls on the
selection and termination of doctors who work there which is one of the hallmarks of an
employer-employee reationship. Thus, the hospital was allocated a share in the liability.

Damages – temperate damages can and should be awarded on top of actual or

compensatory damages in instances where the injury is chronic and continuing.
DR NINEVETCH CRUZ vs CA

FACTS: Lydia Umali was examined by Dr Cruz who found myoma in her uterus and
scheduled her for a hysterectomy operation(removal of uterus). Rowena Umali
accompanied her mother to the hospital for the operation. While waiting, Dr Ercillo
(anaesthesiologist) told them to buy Tagamet ampules. An hour later, Dr Ercillo asked
them to buy blood. After the operation, Dr Cruz asked them to buy additional blood but
there was no more type A blood available. A person arrived to donate blood w/c was later
transfused to Lydia. Rowena noticed that her mother was gasping for breath apparently,
the oxygen supply had run out, so the family went out to buy oxygen. Later in the evening,
she was transferred to another hospital because she went into shock & her blood pressure
dropped.
In the new hospital, she was re-operated again by Dr Cruz & Dr Ercillo because blood
was oozing out from her incision. Later, Lydia died. Her immediate cause of death is
shock; disseminated intravascular coagulation (DIC) as antecedent cause.
Dr Cruz & Dr Ercillo were charged w/reckless imprudence & negligence resulting in
homicide. The trial crt found Dr Ercillo not guilty for insufficiency of evidence byt held Dr
Cruz responsible for Lydia’s death. The RTC and CA affirmed.

ISSUE: WON THE CIRCUMSTANCES( inadequacy of the facilities of the clinic & its
untidiness; the lack of
provisions such as blood, oxygen & certain medicines, the failure to subject the
patient to a cardio-pulmonary test prior to the operation, the omission of any form
of blood typing before transfusion & even the subsequent transfer of Lydia to San
Pablo Hospital & the reoperation performed on her by the petitioner) ARE
SUFFICIENT TO SUSTAIN A JUDGMENT OF CONVICTION AGAINST DR CRUZ FOR
RECKLESS IMPRUDENCE RESULTING IN HOMICIDE.

HELD: NO. Dr Cruz is acquitted but she is still civilly liable. The court relied on the expert
testimonies rendered by both prosecution & defense witnesses that substantiate rather
contradict the petitioner’s allegation that the cause of Lydia’s death was DIC & cannot be
attributed to the petitioner’s fault or negligence. The probability that Lydia’s death was
caused by DIC was unrebutted during trial & has engendered in the mind of this crt a
reasonable doubt as to the petitioner’s guilt. Thus, her acquittal of the crime of reckless
imprudence resulting to homicide.
Neverthless, the crt finds the petitioner civilly liable for the death of Lydia Umali, for
while a conviction of a crime requires proof beyond reasonable doubt, only a
preponderance of evidence is required to establish civil liability.
VI. HOSPITAL AND ITS LIABILITIES

A. Vicarious Liabilities

PROFESSIONAL SERVICES INC., vs CA and AGANA

FACTS:
Natividad Agana suffered injuries due to non-removal of 2 gauzes inside her body which was used during
her surgery conducted by Dr. Miguel Ampil and Dr. Juan Fuentes on April 11, 1984 at the Medical City
General Hospital. Thus, Enrique and Natividad Agana filed a complaint for damages before the RTC of
Quezon City against the said doctors and Professional Services Inc., being the owner, operator and manager
of the hospital.
RTC held PSI solidarily liable with Dr. Ampil and Dr. Fuentes for damages. However, the 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 deciding that PSI committed a serious breach of its corporate duty when it failed to conduct an
immediate investigation into the reported missing gauzes.

ISSUE: May a hospital may be held liable for the negligence of physicians-consultants allowed to practice in
its premises?

HELD: Yes. While in theory a hospital as a juridical entity cannot practice medicine, in reality it utilizes
doctors, surgeons and medical practitioners in the conduct of its business of facilitating medical and surgical
treatment. 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.
In the instant case, PSI took no heed of the record of operation and consequently did not initiate a
review of what transpired during Natividad’s operation. By its inaction, PSI failed its own standard of hospital
care. It committed corporate negligence which is different from the medical negligence attributed to Dr. Ampil.
The duties of the hospital are distinct from those of the doctor-consultant 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.
The liability of PSI arose from an implied agency with Dr. Ampil and an admitted corporate duty to
Natividad.
ROGELIO NOGALES vs. CAPITOL MED CENTER

FACTS: Corazon Nogales was under the exclusive prenatal care of Dr Oscar Estrada
beginning on her 4th month of pregnancy (Dec 1975. While on her last trimester of
pregnancy, Dr Estrada noted an increase in her blood pressure & development of leg
edema indicating preeclampsia, w/c is a dangerous complication of pregnancy. Around
midnight of May 25, 1976, Corazon started to experience mild labor pains prompting the
spouses to see Dr Estrada advised her immediate admission to the Capitol Medical
Center. The ff day, Corazon was admitted at the CMC at 2:30 AM and was brought to the
labor room. She died at 9:15 AM due to “hemorrhage post partum”. Petitioners file a
complaint for damages against Dr Estrada & the CMC medical staff. In their defense,
CMC pointed out that Dr Estrada was a consultant to be considered as an independent-
contractor, & that no employer-emploee relationship existed between the former & the
latter.

ISSUE: WON CMC IS VICARIOUSLY LIABLE FOR THE NEGLIGENCE OF DR

ESTRADA AS ITS ATTENDING INDEPENDENT-CONTRACTOR PHYSICIAN.

HELD: YES. In general, a hospital is not liable for the negligence of an indpt contractor-
physician. However, there is an exception to this principle. The hospital may be liable if
the physician is the “ostensible” agent of the hospital. This exception is is known as
“doctrine of apparent authority”. It essentially involves 2 factors to determine the liability
of an indpt-contractor physician. First factor: focuses on the hospital’s manifestations & is
sometimes described as an inquiry whether the hospital acted in a manner w/c wld lead
a reasonable person to conclude that the individual who was alleged to be negligent was
an employee or agent of the hospital. 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& implied. Second factor:
focuses on the patient’s reliance. It is sometimes characterized as an inquiry on whether
the pltf acted in reliance upon the conduct of the hospital or its agent, consistent
w/ordinary care & prudence.
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 w/apparent authority leading the
spouses to believe that she was an employee or agent of CMC. CMC cannot now
repudiate such authority. The records show that the spouses relied upon a perceived
relationship w/CMC in accepting Corazon’s delivery not only because of their friend’s
recommendation, but more importantly bec of Dr Estrada’s “connection w/a reputable
hospital”. The spouses did not knew that Dr Estrada was not an employee of CMC.
Thus, CMC is vicariously liable for the negligence of Dr Oscar Estrada.
VII. C. Physician Patient Privilege

MA. PAZ FERNANDEZ KROHN, petitioner,

vs.
COURT OF APPEALS and EDGAR KROHN, JR., respondents.

Cruz, Durian, Agabin, Atienza, Alday and Tuason for petitioner.

Oscar F. Martinez for private respondent.

Facts:

The subject of the evaluation report, Ma. Paz Fernandez Krohn, invoking the rule on
privileged communication between physician and patient, seeks to enjoin her husband
from disclosing the contents of the report.

Edgar Krohn, Jr., and Ma. Paz Fernandez were, the union produced three children,
their blessings notwithstanding, the relationship between the couple developed into a
stormy one. Ma. Paz underwent psychological testing purportedly in an effort to ease the
marital strain. The effort however proved futile. In 1973, they finally separated in fact.

Edgar was able to secure a copy of the confidential psychiatric report on Ma. Paz
prepared and signed by Drs. Cornelio Banaag, Jr., and Baltazar Reyes. Edgar filed a
petition for the annulment of his marriage with Ma. Paz before the trial court. 3 In his
petition, he cited the Confidential Psychiatric Evaluation Report which Ma. Paz merely
denied in her Answer as "either unfounded or irrelevant." 4

Edgar took the witness stand and tried to testify on the contents of the Confidential
Psychiatric Evaluation Report. This was objected to on the ground that it violated the rule
on privileged communication between physician and patient.

Private respondent Edgar Krohn, Jr., however contends that "the rules are very
explicit: the prohibition applies only to a physician. Thus . . . the legal prohibition to testify
is not applicable to the case at bar where the person sought to be barred from testifying
on the privileged communication is the husband and not the physician of the petitioner

The trial court issued an Order admitting the Confidential Psychiatric Evaluation Report
in evidence

Petitioner now seeks to enjoin the presentation and disclosure of the contents of the
psychiatric report and prays for the admission of her Statement for the Record to form
part of the records of the case.
Issue : Whether the admission of the psychiatric report is a violation of Sec. 24, par. (c),
Rule 130, of the Rules of Court which is physician-client privileged rule

Held: NO. Unde Sec. 24, par. (c), Rule 130, of the Rules of Court 11 prohibits a physician
from testifying on matters which he may have acquired in attending to a patient in a
professional capacity,

In the instant case, the person against whom the privilege is claimed is not one duly
authorized to practice medicine, surgery or obstetrics. He is simply the patient's husband
who wishes to testify on a document executed by medical practitioners. Plainly and
clearly, this does not fall within the claimed prohibition. Neither can his testimony be
considered a circumvention of the prohibition because his testimony cannot have the
force and effect of the testimony of the physician who examined the patient and executed
the report.

Petitioner's discourse while exhaustive is however misplaced. Lim v. Court of

Appeals 22 clearly lays down the requisites in order that the privilege may be successfully
invoked: (a) the privilege is claimed in a civil case; (b) the person against whom the
privilege is claimed is one duly authorized to practice medicine, surgery or obstetrics; (c)
such person acquired the information while he was attending to the patient in his
professional capacity; (d) the information was necessary to enable him to act in that
capacity; and, (e) the information was confidential and, if disclosed, would blacken the
reputation (formerly character) of the patient.

Counsel for petitioner indulged heavily in objecting to the testimony of private respondent
on the ground that it was privileged. In his Manifestation before the trial court dated 10
May 1991, he invoked the rule on privileged communications but never questioned the
testimony as hearsay. It was a fatal mistake. For, in failing to object to the testimony on
the ground that it was hearsay, counsel waived his right to make such objection and,
consequently, the evidence offered may be admitted.
. NELLY LIM vs COURT OF APPEALS

REQUISITES IN ORDER THAT THE PRVILEGE MAY BE SUCCESSFULLY INVOKED:

1) The privilege is claimed in a civil case;
2) The person against whom the privilege is claimed is one duly authorized to practice medicine,
surgery or obstetrics;
3) Such person acquired the information while he was attending to the patient in his professional
capacity;
4) The information was necessary to enable him to act in that capacity;
5) The information was confidential & if disclosed would blacken the reputation of the patient.

FACTS: Juan filed a petition for annulment of his marriage with Nelly on the ground that she has been
suffering from a mental illness called schizophrenia “before, during & after the marriage & until the
present.” During the trial, Juan’s counsel announced that he wld present Dr Lydia Acampanado, a Doctor
of Medicine who specializes in Psychiatry. Nelly’s counsel opposed on the ground that the testimony
sought to be elicited from the witness is privileged since the doctor examined Nelly in a professional
capacity & diagnosed her to be suffering from schizophrenia.
Juan’s counsel contended that Dr Acampanado would be presented as an expert witness & wld not
testify on any information acquired while attending to Nelly in a professional capacity. She took the
witness stand and was asked hypothetical questions related to her field of expertise. She neither revealed
the illness she examined & treated Nelly nor disclosed the results of her examination & the medicines she
had prescribed.
ISSUE: WON THE INFORMATION GIVEN BY THE PHYSICIAN IN HER TESTIMONY IN OPEN CRT, A
PRIVILEGED COMMUNICATION.
HELD: NO. The physician may be considered to be acting in his professional capacity when he attends to
the patient for curative, preventive or palliative treatment. Thus, only disclosures w/c wld have been
made to the physician to enable him “safely & efficaciously to treat his patient” are covered by the
privilege. It is to be emphasized that “it is the tenor only of the communication that is privileged. The mere
fact of making a communication, as well as the date of consultation & the number of consultations are
therefore not privileged from disclosure, so long as the subject communicated is not stated.” One who
claims this privilege must prove the presence of these aforementioned requisites.
JOSIELENE LARA CHAN vs JOHNNY T. CHAN

FACTS: Josielene Chan filed a petition for the declaration of nullity of marriage claiming that Johnny Chan,
her husband failed to care & support his family & that a psychiatrist diagnosed him as mentally deficient
due to incessant drinking & excessive use of prohibited drugs. Johnny claims that it was the wife who
failed in her duties. And that he initially agrees to marriage counselling to save their marriage but upon
arriving at the hospital, 2 men forcibly held him by both arms while another gave him an injection. He
attached a Philhealth claim form to his answer as proof that he was forcibly confined at the rehabilitation
unit of a hospital. However, that same form carried a physician’s handwritten note that the husband
suffered from methamphetamine & alcohol abuse.
Based on the physician’s handwritten statement, the wife requested for the issuance of a subpoena
duces tecum for the production of the husband’s medical records. The husband opposed that the medical
records were covered by physician-patient privilege. The request of the wife was denied by the trial crt.
CA affirmed.

ISSUE: WON THE ISSUANCE OF SUBPOENA DUCES TECUM OF THE HUSBAND’S RECORDS COVERED BY
THE PRIVILEGED CHARACTER OF THE PHYSICIAN-PATIENT COMMUNICATION.

HELD: It is possible to treat Josielene’s motion for the issuance of a subpoena duces tecum covering the
hospital records as a motion for production of documents, a discovery procedure available to a litigant
prior to trial. Sec 1, Rule 27 of the Rules of Civil Procedure provides xxx But the above right to compel the
production of documents has a limitation: the documents to be disclosed are “not privileged.” Josielene’s
claim that the hospital records subject of this case are not privileged since it is the testimonial evidence
of the physician that may be regarded as privileged. Sec 24, Rule 130 of the RC states that the “physician
“cannot in a civil case, w/out the consent of the patient, be examined” regarding heir professional
conversation. The privilege, accdg to her does not cover the hospital records, but only the examination of
the physician at the trial.
However, to allow the disclosure during the discovery procedure of the hospital records—the results
of tests that the physician ordered, the diagnosis of the patient’s illness & the advise or treatment he gave
him—he would be to allow to evidence that it inadmissible w/out the patient’s consent. Physician
memorializes all these information in the patient’s records. Disclosing them wld be the equivalent of
compelling the physician to testify on privileged matters he gained while dealing w/the patient, w/out the
latter’s prior consent.