Rogelio & Erlinda Ramos, (Minors- Rommel, Roy, & Ron Ramos) v.
CA, Delos Santos Medical ISSUE: an employment relationship exists DSNC Solidarily liable
Center (DSMC), Dr. Orlino Hosaka & Dra. Perfecta Gutierrez.
● Erlinda 47, was, until afternoon of 6/17/85 was a robust normal woman, except for
occasional discomfort due to pains caused by presence of stone in her gall bladder.
○ Married to Rogelio, a PLDT executive with 3 children.
● She sought professional advice, & was advised to undergo operation for stone removal
○ Underwent examinations which included blood & urine tests = fit for surgery.
● Thru mutual friend, Dr. Buenviaje, spouses met for the first time Dr. Hozaka
○ Agreed operating table date at DLSMC 6/17/85 at 9AM.
○ Dr. Hosaka: undergo a "cholecystectomy" operation after examining docs presented
● Rogelio asked Dr. Hosaka to look for a good anesthesiologist.
○ Dr. Hosaka assured he will get a good anesthesiologist, & charged P16,000.00, which
was to include the anesthesiologist's fee & which was to be paid after operation.
● Day before operation, she was admitted at one of DLSMC room, lE. Rod, Quezon City.
○ OD 7:30AM while still in her room, she was prepared for the operation by hospital staff.
○ Husband & Sis-in-law, Nursing Dean Herminda Cruz, was also there for moral support.
● Operating room, Herminda saw 2/3 nurses & Dr. Gutierrez, who was to administer
anesthesia
○ Although not hospital staff, Herminda introduced herself & allowed in OR
● 9:30AM, Dr. Gutierrez reached nearby phone to look for Dr. Hosaka who was not yet in
○ Dr. Gutierrez informed Herminda about prospect of a delay in Dr. Hosaka’s arrival.
● Herminda went out of OR & informed Rogelio, that the doctor was not yet around
○ 10AM Rogelio was waiting for doc’s arrival
● 12:00NN, he met Dr. Garcia who remarked that he was also tired of waiting for Dr. Hosaka.
○ Dr. Hosaka arrived, & he waited for the operation to be completed.
● 12:15PM Herminda held Erlinda’s hand, saw Dr. Gutierrez intubating the hapless patient.
○ Dr. Gutierrez: hirap ma-intubate nito, mali yata ang pagkakapasok. lumalaki ang tiyan
○ Noticed bluish discoloration left hand nailbeds even as Dr. Hosaka approached.
○ Heard Dr. Hosaka issue an order for someone to call Dr. Calderon, anesthesiologist.
● After Dr. Calderon arrived, she saw this anesthesiologist trying to intubate the patient.
○ nailbed became bluish & the patient was placed in a trendelenburg position
■ a position where the head of the patient is placed in a position lower than her feet
which is an indication that there is a decrease of blood supply to the patient's brain
● Immediately thereafter, she went out of OR, Dr. Calderon was able to intubate the patient.
● Rogelio outside the operating room, saw a respiratory machine being rushed towards OR
○ saw several doctors rushing towards OR. Herminda informed him something wrong was
happening, he told her to be back with the patient inside the operating room
● Herminda immediately rushed back, & saw patient was still in trendelenburg position.
● 3:00 P.M. of that fateful day, she saw the patient taken to the Intensive Care Unit (ICU).
○ 2 days after, Rogelio talked to Dr. Hosaka: something went wrong during intubation.
● Rogelio: wife’s condition wouldn’t happened, had he looked for good anesthesiologist
○ Doctors, when asked, explained that the patient had bronchospasm.
● Erlinda stayed at ICU for a month, & 4 months thereafter was released from the hospital.
○ During whole confinement, she incurred hospital bills P93,542.25
○ Since then = comatose condition, can’t do anything/move any body part/see or hear.
○ Suffered brain damage as a result of absence of oxygen in her brain for 4-5 minutes.
● After being discharged, she has been staying in their residence, still needing constant
medical attention, with her husband Rogelio incurring monthly expense P8-P10,000.00
● RTC: Granted, CA: Reversed, SC Modified
● Hospitals exercise significant control in the hiring & firing of consultants & work
conduct within the hospital premises.
○ Doctors who apply for "consultant" slots, visiting or attending, are required to submit
proof of completion of residency, educational qualifications, evidence of accreditation by
appropriate board (diplomate), evidence of fellowship in most cases, & references.
○ Requirements carefully scrutinized by hospital members or hospital review
committee set up by the hospital who either accept or reject the application.
■ This is particularly true with DSMC.
● After a physician is accepted, (visiting or attending consultant) he is normally required to
attend clinico-pathological conferences, conduct bedside rounds for clerks, interns &
residents, moderate grand rounds & patient audits & perform other tasks & responsibilities,
for the privilege of being able to maintain a clinic in the hospital, and/or for the privilege of
admitting patients into the hospital.
○ In addition to these, physician's performance as a specialist is generally evaluated by a
peer review committee on the basis of mortality & morbidity statistics, & feedback from
patients, nurses, interns & residents.
○ Consultant remiss in his duties, or a consultant who regularly falls short of the minimum
standards acceptable to the hospital or its peer review committee, is normally politely
terminated.
● Private hospitals, hire, fire & exercise real control over attending & visiting
"consultant" staff.
○ While "consultants" aren’t, technically employees, a point which DSMC asserts in
denying all responsibility for the patient's condition, the control exercised, the hiring,
& the right to terminate consultants all fulfill the important hallmarks of an
employer-employee relationship, with the exception of the payment of wages.
○ Control test - for the purpose of allocating responsibility in medical
negligence cases, an employer-employee relationship in effect exists
between hospitals & their attending & visiting physicians.
● Basis for holding employer solidarily responsible for employee negligence Article 2180
○ Person accountable not only for his own acts but also for those of others based on the
former's responsibility under a relationship of patria potestas.
○ Responsibility ceases when persons or entity concerned prove that they have observed
the diligence of a good father of the family to prevent damage.
○ While the burden of proving negligence rests on plaintiffs, once negligence is shown,
burden shifts to respondents (parent, guardian, teacher or employer) who should prove
that they observed the diligence of a good father of a family to prevent damage.
● DSMC, apart from general denial of responsibility over physicians, failed to adduce evidence
showing exercised diligence of a good father of a family in hiring & supervision of the latter.
○ failed to adduce evidence with regard to degree of supervision it exercised over Rs.
○ failed to discharge its burden under the last paragraph of Article 2180.
○ Having failed to do this, DSMC is consequently solidarily responsible with its physicians
for Erlinda's condition.
● Res ipsa loquitur -“the thing or the transaction speaks for itself."
● Erlinda submitted herself for cholecystectomy & expected a routine general surgery to be
performed on her gall bladder.
○ On that fateful day she delivered her person over to the care, custody & control of Rs
who exercised complete & exclusive control over her.
● during submission, Erlinda was neurologically sound & except for a few minor discomforts,
was likewise physically fit in mind & body.
○ During anesthesia administration & prior cholecystectomy she suffered irreparable
damage to her brain.
○ w/o surgery, she went out of operating room decerebrate & totally incapacitated.
○ Brain damage injury doesn’t normally occur in gall bladder operation, & doesn’t in
absence of negligence in anesthesia administration & endotracheal tube use.
● Normally, a person being put under anesthesia is not rendered decerebrate as a
consequence of administering such anesthesia if the proper procedure was followed.
○ Instruments used in administration, including endotracheal tube, were all under the
exclusive control of Rs, who are the physicians-in-charge.
○ Erlinda couldn’t have been guilty of contributory negligence because she was under the
influence of anesthetics which rendered her unconscious.
● Practical administration of justice dictates application of res ipsa loquitur.
○ Sound & unaffected member of body (the brain) is injured or destroyed while patient is
unconscious & under immediate & exclusive control of physicians,
○ Common knowledge & observation, if negligence attended patient management & care
○ liability of physicians & hospital not predicated upon an alleged failure to
secure desired results of an operation/alleged lack of skill in diagnosis or treatment as
in fact no operation or treatment was ever performed on Erlinda.
■ Upon all these initial determination a case is made out for the application of the
doctrine of res ipsa loquitur.
● Doctrine res ipsa loquitur is not applicable in any & all cases where injury occurs to a
patient while under anesthesia, or to any & all anesthesia cases.
○ Each case must be viewed in its own light & scrutinized in order to be within coverage.