1. Carillo v.

People of the Philippines

GR 86890, January 21, 1994
Facts:
Dr. Leandro Carillo, an anesthetist, seeks review of the Decision of
the Court of Appeals dated 28 Novemer !"88, which affirmed his
conviction # the $e%ional &rial Court of the crime of simple
ne%li%ence resultin% in homicide, for the death of his thirteen '!() #ear
old patient, Catherine Acosta. At aout !*:(* o+clock in the mornin% of
,a# (!, !"8! of pains in the lower part of her adomen. Catherine
was then rou%ht to Dr. -lva .e/a. Dra. .e/a called for Dr. -milio
,adrid and the latter e0amined Catherine Acosta. Accordin% to Dr.
,adrid, his findin%s mi%ht e appendicitis. &hen Dr. .e/a told
Catherine+s parents to rin% the child to the hospital in 1aclaran so
that the child will e oserved.
At the 1aclaran 2eneral 3ospital, a nurse took lood sample form the
child. &he findin%s ecame known at around (:** o+clock in the
afternoon and the child was scheduled for operation at 4:** o+clock in
the afternoon. &he operation took place at 4:54 p.m. ecause Dr.
,adrid arrived onl# at that time. 6hen rou%ht inside the operatin%
room, the child was feelin% ver# well and the# did not su7ect the child
to -C2 'electrocardio%ram) and
89ra#.
&he appellant Dr. -milio ,adrid, a sur%eon, operated on Catherine.
3e was assisted # appellant, Dr. Leandro Carillo, an
anesthesiolo%ists. Accordin% to the child:s mother, she ;noticed
somethin% ver# unfamiliar.; &he three nurses who assisted in the
operation were %oin% in and out of the operatin% room, the# were not
carr#in% an#thin%, ut in %oin% out of the operatin% room, the# were
alread# holdin% somethin%.
<t has also een estalished that the deceased was not wei%hed
efore the administration of anesthesia on her.
&he operation was finished at =:** o+clock in the evenin% and when
the child was rou%ht out from the operatin% room, she was oserved
to e shiverin% (nanginginig)> her heart eat was not normal> she was
asleep and did not wake up> she was pale> and as if she had difficult#
in reathin% and Dr. -milio ,adrid su%%ested that she placed under
o0#%en tank> that o0#%en was administered to the child when she was
alread# in the room.
Catherine was transferred to her room . afterwards, her mother
noticed that her hearteat was not normal. Accordin% to the dr ,adrid,
it was due to the lesion of the child. Few mins after the# revived the
hearteat of the child, Dr ,adrid and Dr. Carillo left. At aout !49(*
minutes after, the child developed convulsion and stiffenin% of the
od#. &he nurse called on Dr dela .ena, which in turn called dr.
,adrid and the cardiolo%ist. &he cardiolo%ist informed the mother that
that she suffered from severe infection which went up to her head.
6hen Catherine remained unconscious until noontime the ne0t da#, a
neurolo%ist e0amined her and she was dia%nosed as
comatose.
13
&hree '() da#s later, Catherine died without re%ainin%
consciousness.
A case was filed a%ainst Dr. ,adrid and Dr. Carillo. &he lower court as
well as the appellate court rendered them oth liale for criminal
ne%li%ence .
.etiotioner contends that the Court of Appeals ;completel# rushed
aside; and ;misapprehended; Catherine+s death certificate and iops#
report which alle%edl# showed that the cause of death was a ruptured
appendi0, which led to lood poisonin%, rather than fault# anesthetic
treatment> and '2) there was no direct evidence of record showin% that
Nuain was administered to Catherine either during the
appendectom# procedure or after such operation.
<ssue: 6?N Dr. Carillo failed to e0ercise the dili%ence
re@uired # the standards of his profession.
3eld: Aes. 1oth doctors failed to appreciate the serious condition of
their patient whose adverse ph#sical si%ns were @uite manifest ri%ht
after sur%er#. after revivin% her hearteat, oth doctors failed to
monitor their patient closel# or e0tend further medical care to her>
such conduct was especiall# necessar# in view of the inade@uate,
post9operative facilities of the hospital. the inade@uate nature of those
facilities did impose a somewhat hi%her standard of professional
dili%ence upon the accused sur%eon and anesthetist personall# than
would have een called for in a modern full#9e@uipped hospital. &here
is here a stron% implication that the patient+s post9operative condition
must have een considered # the two '2) doctors as in some wa#
related to the anesthetic treatment she had received from the
petitioner either durin% or after the sur%ical procedure.
?nce summoned, petitioner anesthesiolo%ist could not e readil#
found. 6hen he finall# appeared at !*:(* in the evenin%, he was
evidentl# in a ad temper, commentin% criticall# on the de0trose
ottles efore orderin% their removal. &his circumstance indicated he
was not disposed to attend to this une0pected call, in violation of the
canons of his profession that as a ph#sician, he should serve the
interest of his patient ;with the %reatest of solicitude, %ivin% them
alwa#s his est talent and skill.; &he canons of medical ethics re@uire
a ph#sician to ;attend to his patients faithfull# and conscientiousl#.; 3e
should secure for them all possile enefits that ma# depend upon his
professional skill and care. As the sole triunal to ad7ud%e the
ph#sician+s failure to fulfill his oli%ation to his patient is, in most
cases, his own conscience, violation of this rule on his part is
;discreditale and ine0cusale.
As noted earlier, petitioner relied heavil# in this proceedin% on the
testimon# on cross9e0amination of the e0pert witnesses for the
prosecution to show that lood poisonin% resultin% from a ruptured
appendi0 could also e responsile for the patient+s death.
Also,no su%%estion has een made that the rupture of the patient+s
occurred prior to surgery. After her lood sample was e0amined, the
patient was merel# dia%nosed as a case of appendicitis, without
further elaoration.
40
No intensive preoperative preparations, like the
immediate administration of antiiotics, was thereafter undertaken on
the patient. &his is a standard procedure for patients who are, after
ein% dia%nosed, suspected of sufferin% from a perforated appendi0
and conse@uent peritonitis.
in People v. Vistan,
48
the Court defined simple ne%li%ence, penaliBed
under what is now Article (C4 of the $evised .enal Code, as ;a mere
lack of prevision in a situation where either the threatened harm is
not immediate or the dan%er not openly visible.; .ut in a sli%htl#
different wa#, the %ravamen of the offense of simple ne%li%ence is the
failure to e0ercise the dili%ence necessitated or called for the situation
which was not immediatel#
life9destructive ut which culminated, in the present case, in the death
of a human ein% three '() da#s later. Duch failure to e0ercise the
necessar# de%ree of care and dili%ence is a ne%ative in%redient of the
offense char%ed. &he rule in such cases is that while the prosecution
must prove the ne%ative in%redient of the offense, it needs onl# to
present the est evidence procurale under the circumstances, in
order to shift the urden of disprovin% or counterin% the proof of the
ne%ative in%redient to the accused, provided that such initial evidence
estalishes at least on a prima facie asis the %uilt of the
accused.
49
&his rule is particularl# applicale where the ne%ative
in%redient of the offense is of such a nature or character as, under the
circumstances, to e speciall# within the knowled%e or control of the
accused.
0
<n the instant case, the Court is ound to oserve that the
events which occurred durin% the sur%ical procedure 'includin%
whether or not Nuain had in fact een administered as an anesthesia
immediatel# efore or durin% the sur%er#) were peculiarl# within the
knowled%e and control of Dr. Carillo and Dr. ,adrid.
3ence, the aove mentioned incident presupposes that Dr. ,adrid
failed to e0ercise the appropriate and necessar# de%ree off care and
dili%ence to prevent the sudden decline in the condition of Catherine
Acosta.
2. !ati"uin v. C#
GR 118231, July , 1996
Facts:
.etitioner is a resident ph#sician at the Ne%ros ?ccidental .rovincial
3ospital, Duma%uete Cit#. Dometime in Deptemer 2!, !"88 ,rs
Eille%as sumitted herself to petitioner for prenatal care. .etitioner
performed a simple cesarean operation to respondent in the mornin%
of Deptemer 2!, !"88. ?n the 2=
th
of septemer, petitioner was
dischar%ed . Durin% the period of confinement, dr. 1ati@uin re%ularl#
visit respondent. Doon after leavin% the hospital, respondent e%an to
suffer suffer adominal pains and complained of ein% feverish. Dhe
also %raduall# lost her appetite, so she consulted Dr. 1ati@uin at the
latter+s pol#clinic who prescried for her certain medicines . . . which
she had een takin% up to Decemer, !"88.
<n the meantime, ,rs. Eille%as was %iven a ,edical Certificate # Dr.
1ati@uin on ?ctoer (!, !"88 certif#in% her ph#sical fitness to return
to her work on Novemer =, !"88. Do, on the second week of
Novemer, !"88 ,rs. Eille%as returned to her work at the $ural 1ank
of A#un%on, Ne%ros ?riental.
&he adominal pains and fever kept on recurrin% and othered ,rs.
Eille%as no end and despite the medications administered # Dr.
1ati@uin. &he pains ecame unearale , thus prompted her to
consult Dr. ,a. Dalud Fho at the 3ol# Child+s 3ospital in Duma%uete
Cit# on Ganuar# 2*, !"8".
Hpon e0amination she felt an adominal mass one fin%er elow the
umilicus which she suspected to e either a tumor of the uterus or an
ovarian c#st, either of which could e cancerous. Dhe had an 09ra#
taken of ,rs. Eille%as+ chest, adomen and kidne#. Dhe also took
lood tests of .laintiff. A lood count showed that ,rs. Eille%as had
IanJ infection inside her adominal cavit#. &he result of all those
e0aminations impelled Dr. Fho to su%%est that ,rs. Eille%as sumit to
another sur%er# to which the latter a%reed. 6hen Dr. Fho opened the
adomen of ,rs. Eille%as she found whitish9#ellow dischar%e inside,
an ovarian c#st on each of the left and ri%ht ovaries which %ave out
pus, dirt and pus ehind the uterus, and a piece of ruer materials
on the ri%ht side of the uterus emedded on the ovarian c#st, 2 inches
# (K5 inch in siBe. &his piece of ruer material which Dr. Fho
descried as a ;forei%n od#; looked like a piece of a ;ruer %love;
and also appeared also as ;ruer9drain likeL . <t could have een a
torn section of a sur%eon+s %loves or could have come from other
sources. And this forei%n od# was the cause of the infection of the
ovaries and conse@uentl# of all the discomfort suffered # ,rs.
Eille%as after her deliver# on Deptemer 2!, !"88
Durin% trial, there were two versions of the offendin% MruerL. &he
trial court ruled in favor of the petitioners, however, the court of
appeals reversed its rulin%, holdin% Dr. 1ati@uin liale for ne%li%ence.
.etitioner contends that the appellate court committed error in
appreciatin% the testimon# of Dr. Fho, in favor of the respondents.
&he# further contend that there were falsities and contradictor#
statements of Dr. Fho. 3ence should not e relied upon # the court.
<ssue: 6?N the presence of the ruer inside the cavit# of the
respondents render petitioner liale for ne%li%enceN
3eld. Aes.
Dr. Fho:s positive testimon# prevails over the ne%ative testimon# in
favor of the petitioners. &his doctrine Ires ipsa loquiturJ is stated thus:
;6here the thin% which causes in7ur# is shown to e under the
mana%ement of the defendant, and the accident is such as in the
ordinar# course of thin%s does not happen if those who have the
mana%ement use proper care, it affords reasonale evidence, in the
asence of an e0planation # the defendant, that the accident arose
from want of care.; ?r as Black's Law Dictionary puts it: es ipsa
loquitur. &he thin% speaks for itself. $euttale presumption or
inference that defendant was ne%li%ent, which arises upon proof that
ItheJ instrumentalit# causin% in7ur# was in defendant+s e0clusive
control, and that the accident was one which ordinar# does not
happen in asence of ne%li%ence. es ipsa loquitur is IaJ rule of
evidence where# ne%li%ence of ItheJ alle%ed wron%doer ma# e
inferred from ItheJ mere fact that ItheJ accident happened provided
ItheJ character of ItheJ accident and circumstances attendin% it lead
reasonal# to elief that in ItheJ asence of ne%li%ence it would not
have occurred and that thin% which caused in7ur# is shown to have
een under ItheJ mana%ement and control of ItheJ alle%ed wron%doer .
. . . Hnder IthisJ doctrine . . . the happenin% of an in7ur# permits an
inference of ne%li%ence where plaintiff produces sustantial evidence
that ItheJ in7ur# was caused # an a%enc# or instrumentalit# under
ItheJ e0clusive control and mana%ement of defendant, and that the
occurrence IsicJ was such that in the ordinar# course of thin%s would
not happen if reasonale care had een used. &he doctrine of !r"es
ipsa loquitur as a rule of evidence is peculiar to the law of ne%li%ence
which reco%niBes that prima facie ne%li%ence ma# e estalished
without direct proof and furnishes a sustitute for specific proof of
ne%li%ence. &he doctrine is not a rule of sustantive law, ut merel# a
mode of proof or a mere procedural convenience. &he rule, when
applicale to the facts and circumstances of a particular case, is not
intended to and does not dispense with the re@uirement of proof of
culpale ne%li%ence on the part# char%ed. <t merel# determines and
re%ulates what shall eprima facie evidence thereof and facilitates the
urden of plaintiff of provin% a reach of the dut# of due care. &he
doctrine can e invoked when and onl# when, under the
circumstances involved, direct evidence is asent and not readil#
availale.
I(CJ
<n the instant case, all the re@uisites for recourse to the doctrine are
present. First, the entire proceedin%s of the cesarean section were
under the e0clusive control of Dr. 1ati@uin. <n this li%ht, the private
respondents were ereft of direct evidence as to the actual culprit or
the e0act cause of the forei%n o7ect findin% its wa# into private
respondent Eille%as+ od#, which, needless to sa#, does not occur
unless throu%h the intervention of ne%li%ence. Decond, since aside
from the cesarean section, private respondent Eille%as underwent no
other operation which could have caused the offendin% piece of
ruer to appear in her uterus, it stands to reason that such could onl#
have een a #9product of the cesarean section performed # Dr.
1ati@uin. &he petitioners, in this re%ard, failed to overcome the
presumption of ne%li%ence arisin% from resort to the doctrine of res
ipsa loquitur. Dr. 1ati@uin is therefore liale for ne%li%entl# leavin%
ehind a piece of ruer in private respondent Eille%as+ adomen and
for all the adverse effects thereof.
3. Gar$ia%Rue&a v. Pas$asio
GR 118141, 'epte()er , 199*
Facts: Florencio E. $ueda, husand of petitioner Leonila 2arcia9
$ueda, underwent sur%ical operation at the HD& hospital for the
removal of a stone lockin% his ureter. 3e was attended # Dr.
Domin%o Antonio, Gr. who was the sur%eon, while Dr. -rlinda 1alatat9
$e#es was the anaesthesiolo%ist. Di0 hours after the sur%er#,
however, Florencio died of complications of Munknown cause,L
accordin% to officials of the HD& 3ospital.
Not satisfied with the findin%s of the hospital, petitioner re@uested the
National 1ureau of <nvesti%ation 'N1<) to conduct an autops# on her
husand:s od#. Conse@uentl#, the N1< ruled that Florencio:s death
was due to lack of care # the attendin% ph#sician in administerin%
anaesthesia. .ursuant to its findin%s, the N1< recommended that Dr.
Domin%o Antonio and Dr. -rlinda 1alatat9$e#es e char%ed for
3omicide throu%h $eckless <mprudence efore the ?ffice of the Cit#
.rosecutor. Durin% the preliminar# investi%ation, what transpired was
a confoundin% series of events. &he case was initiall# assi%ned to
.rosecutor Antonio ,. <srael, who had to inhiit himself ecause he
was related to the counsel of one of the doctors. As a result, the case
was re9raffled to .rosecutor Norerto 2. Leono who was, however,
dis@ualified on motion of the petitioner since he disre%arded prevailin%
laws and 7urisprudence re%ardin% preliminar# investi%ation. &he case
was then referred to .rosecutor $amon ?. Carisma, who issued a
resolution recommendin% that onl# Dr. $e#es e held criminall# liale
and that the complaint a%ainst Dr. Antonio e dismissed.
&he case took another perple0in% turn when Assistant Cit# .rosecutor
Gosefina Dantos Dioson, in the Minterest of 7ustice and peace of mind
of the parties,L recommended that the case e re9raffled on the
%round that .rosecutor Carisma was partial to the petitioner. &hus,
the case was transferred to .rosecutor Leoncia $. Dima%ia, where
a volte face occurred a%ain with the endorsement that the complaint
a%ainst Dr. $e#es e dismissed and instead, a correspondin%
information e filed a%ainst Dr. Antonio. .etitioner filed a motion for
reconsideration, @uestionin% the findin%s of .rosecutor Dima%ia.
A%%rieved, petitioner filed %raft char%es specificall# for violation of
Dection ('e) of $epulic Act No. (*!"
I(J
a%ainst .rosecutors
2uerrero, ,acarae%, and AriBala for manifest partialit# in favor of Dr.
$e#es efore the ?ffice of the ?mudsman. 3owever, on Gul# !!,
!""5, the ?mudsman issued the assailed resolution dismissin% the
complaint for lack of evidence.
<ssue: 6?N the dismissal of the complaint # the prosecution a%ainst
the two ph#sician concludes the asence of medical malpractice.
3eld:
No. <n the instant case, no less than the N1< pronounced after
conductin% an autops# that there was indeed ne%li%ence on the part
of the attendin% ph#sicians in administerin% the anaesthesia.
I!!J
&he
fact of want of competence or dili%ence is evidentiar# in nature, the
veracit# of which can est e passed upon after a full9lown trial for it
is virtuall# impossile to ascertain the merits of a medical ne%li%ence
case without e0tensive investi%ation, research, evaluation and
consultations with medical e0perts. Clearl#, the Cit# .rosecutors are
not in a competent position to pass 7ud%ment on such a technical
matter, especiall# when there are conflictin% evidence and
findin%s. &he ases of a part#:s accusation and defenses are etter
ventilated at the trial proper than at the preliminar# investi%ation.
A word on medical malpractice or ne%li%ence cases.
M<n its simplest terms, the t#pe of lawsuit which has een called
medical malpractice or, more appropriatel#, medical ne%li%ence, is
that t#pe of claim which a victim has availale to him or her to redress
a wron% committed # a medical professional which has caused
odil# harm.
<n order to successfull# pursue such a claim, a patient must prove that
a health care provider, in most cases a ph#sician, either failed to do
somethin% which a reasonal# prudent health care provider would
have done, or that he or she did somethin% that a reasonal# prudent
provider would not have done> and that that failure or action caused
in7ur# to the patient.L
I!2J
3ence, there are four elements involved in medical ne%li%ence cases:
dut#, reach, in7ur# and pro0imate causation.
-videntl#, when the victim emplo#ed the services of Dr. Antonio and
Dr. $e#es, a ph#sician9patient relationship was created. <n acceptin%
the case, Dr. Antonio and Dr. $e#es in effect represented that, havin%
the needed trainin% and skill possessed # ph#sicians and sur%eons
practicin% in the same field, the# will emplo# such trainin%, care and
skill in the treatment of their patients.
I!(J
&he# have a dut# to use at
least the same level of care that an# other reasonal# competent
doctor would use to treat a condition under the same
circumstances. &he reach of these professional duties of skill and
care, or their improper performance, # a ph#sician sur%eon where#
the patient is in7ured in od# or in health, constitutes actionale
malpractice.
I!5J
Conse@uentl#, in the event that an# in7ur# results to the
patient from want of due care or skill durin% the operation, the
sur%eons ma# e held answerale in dama%es for ne%li%ence.
I!4J
,oreover, in malpractice or ne%li%ence cases involvin% the
administration of anaesthesia, the necessit# of e0pert testimon# and
the availailit# of the char%e of res ipsa loquitur to the plaintiff, have
een applied in actions a%ainst anaesthesiolo%ists to hold the
defendant liale for the death or in7ur# of a patient under e0cessive or
improper anaesthesia.
I!CJ
-ssentiall#, it re@uires two9pron%ed
evidence: evidence as to the reco%niBed standards of the medical
communit# in the particular kind of case, and a showin% that the
ph#sician in @uestion ne%li%entl# departed from this standard in his
treatment.
I!=J
Another element in medical ne%li%ence cases is causation which is
divided into two in@uiries: whether the doctor:s actions in fact caused
the harm to the patient and whether these were the pro0imate cause
of the patient:s in7ur#.
I!8J
<ndeed here, a causal connection is
discernile from the occurrence of the victim:s death after the
ne%li%ent act of the anaesthesiolo%ist in administerin% the anesthesia,
a fact which, if confirmed, should warrant the filin% of the appropriate
criminal case. &o e sure, the alle%ation of ne%li%ence is not entirel#
aseless. ,oreover, the N1< deduced that the attendin% sur%eons did
not conduct the necessar# interview of the patient prior to the
operation. <t appears that the cause of the death of the victim could
have een averted had the proper dru% een applied to cope with the
s#mptoms of mali%nant h#perthermia. Also, we cannot i%nore the fact
that an antidote was readil# availale to counteract whatever
deleterious effect the anaesthesia mi%ht produce.
I!"J
6h# these
precautionar# measures were disre%arded must e sufficientl#
e0plained.
4. +R. ,-,./.0C1 CR23, petitioner, vs. C42R0 45 #PP.#6'
an& 67+-# 28#6-,respondents.
5a$ts9
?n ,arch 22, !""!, prosecution witness, $owena Hmali De ?campo,
accompanied her mother to the .erpetual 3elp Clinic and 2eneral
3ospital situated in 1ala%tas Dtreet, Dan .alo Cit#, La%una. &he#
arrived at the said hospital at around 5:(* in the afternoon of the
same da#.
I"J
.rior to ,arch 22, !""!, L#dia was e0amined # the
petitioner who found a ;m#oma;
I!*J
in her uterus, and scheduled her
for a h#sterectom# operation on ,arch 2(, !""!.
I!!J
$owena and her
mother slept in the clinic on the evenin% of ,arch 22, !""! as the
latter was to e operated on the ne0t da# at !:** o+clock in the
afternoon.
I!2J
Accordin% to $owena, she noticed that the clinic was
untid# and the window and the floor were ver# dust# promptin% her to
ask the attendant for a ra% to wipe the window and the floor with.
I!(J
1ecause of the untid# state of the clinic, $owena tried to persuade
her mother not to proceed with the operation.
I!5J
&he followin% da#,
efore her mother was wheeled into the operatin% room, $owena
asked the petitioner if the operation could e postponed. &he
petitioner called L#dia into her office and the two had a conversation.
L#dia then informed $owena that the petitioner told her that she must
e operated on as scheduled.
I!4J
$owena and her other relatives, namel# her husand, her sister and
two aunts waited outside the operatin% room while L#dia underwent
operation. 6hile the# were waitin%, Dr. -rcillo went out of the
operatin% room and instructed them to u# ta%amet ampules which
$owena+s sister immediatel# ou%ht. Aout one hour had passed
when Dr. -rcillo came out a%ain this time to ask them to u# lood for
L#dia. &he# ou%ht t#pe ;A; lood from the Dt. 2erald 1lood 1ank and
the same was rou%ht # the attendant into the operatin% room. After
the lapse of a few hours, the petitioner informed them that the
operation was finished. &he operatin% staff then went inside the
petitioner+s clinic to take their snacks. Dome thirt# minutes after, L#dia
was rou%ht out of the operatin% room in a stretcher and the petitioner
asked $owena and the other relatives to u# additional lood for
L#dia. Hnfortunatel#, the# were not ale to compl# with petitioner+s
order as there was no more t#pe ;A; lood availale in the lood
ank. &hereafter, a person arrived to donate lood which was later
transfused to L#dia. $owena then noticed her mother, who was
attached to an o0#%en tank, %aspin% for reath. Apparentl# the o0#%en
suppl# had run out and $owena+s husand to%ether with the driver of
the accused had to %o to the Dan .alo District 3ospital to %et
o0#%en. L#dia was %iven the fresh suppl# of o0#%en as soon as it
arrived.
I!CJ
1ut at around !*:** o+clock ..,. she went into shock and
her lood pressure dropped to C*K4*. L#dia+s unstale condition
necessitated her transfer to the Dan .alo District 3ospital so she
could e connected to a respirator and further e0amined.
I!=J
&he
transfer to the Dan .alo Cit# District 3ospital was without the prior
consent of $owena nor of the other relatives present who found out
aout the intended transfer onl# when an amulance arrived to take
L#dia to the Dan .alo District 3ospital. $owena and her other
relatives then oarded a tric#cle and followed the amulance.
I!8J
Hpon L#dia+s arrival at the Dan .alo District 3ospital, she was
wheeled into the operatin% room and the petitioner and Dr. -rcillo re9
operated on her ecause there was lood ooBin% from the adominal
incision.
I!"J
&he attendin% ph#sicians summoned Dr. 1artolome
An%eles, head of the ?stetrics and 2#necolo%# Department of the
Dan .alo District 3ospital. 3owever, when Dr. An%eles arrived, L#dia
was alread# in shock and possil# dead as her lood pressure was
alread# *K*. Dr. An%eles then informed petitioner and Dr. -rcillo that
there was nothin% he could do to help save the patient.
I2*J
6hile
petitioner was closin% the adominal wall, the patient died.
I2!J
&hus, on
,arch 25, !""!, at (:** o+clock in the mornin%, L#dia Hmali was
pronounced dead. 3er death certificate states ;shock; as the
immediate cause of death and ;Disseminated <ntravascular
Coa%ulation 'D<C); as the antecedent cause.
I22J
<ssue: 6?N petitioner is liale for reckless imprudence resultin% to
homicide.
No. to sustain a 7ud%ment of conviction a%ainst the petitioner for the
crime of reckless imprudence resultin% in homicide. &he elements of
reckless imprudence are: '!) that the offender does or fails to do an
act> '2) that the doin% or the failure to do that act is voluntar#> '() that
it e without malice> '5) that material dama%e results from the reckless
imprudence> and '4) that there is ine0cusale lack of precaution on
the part of the offender, takin% into consideration his emplo#ment or
occupation, de%ree of intelli%ence, ph#sical condition, and other
circumstances re%ardin% persons, time and place.
<mmediatel# apparent from a review of the records of this case is the
asence of an# e0pert testimon# on the matter of the standard of care
emplo#ed # other ph#sicians of %ood standin% in the conduct of
similar operations. &he prosecution+s e0pert witnesses in the persons
of Dr. Floresto AriBala and Dr. Nieto Dalvador, Gr. of the National
1ureau of <nvesti%ation 'N1<) onl# testified as to the possile cause of
death ut did not venture to illuminate the court on the matter of the
standard of care that petitioner should have e0ercised. All three courts
elow ewail the inade@uac# of the facilities of the clinic and its
untidiness> the lack of provisions such as lood, o0#%en, and certain
medicines> the failure to su7ect the patient to a cardio9pulmonar# test
prior to the operation> the omission of an# form of lood t#pin% efore
transfusion> and even the suse@uent transfer of L#dia to the Dan
.alo 3ospital and the reoperation performed on her # the petitioner.
1ut while it ma# e true that the circumstances pointed out # the
courts elow seemed e#ond cavil to constitute reckless imprudence
on the part of the sur%eon, this conclusion is still est arrived at not
throu%h the educated surmises nor con7ectures of la#men, includin%
7ud%es, ut # the un@uestionale knowled%e of e0pert witnesses. For
whether a ph#sician or sur%eon has e0ercised the re@uisite de%ree of
skill and care in the treatment of his patient is, in the %eneralit# of
cases, a matter of e0pert opinion.
I(*J

&he deference of courts to the e0pert opinion of @ualified ph#sicians
stems from its realiBation that the latter possess unusual technical
skills which la#men in most instances are incapale of intelli%entl#
evaluatin%.
I(!J
-0pert testimon# should have een offered to prove that
the circumstances cited # the courts elow are constitutive of
conduct fallin% elow the standard of care emplo#ed # other
ph#sicians in %ood standin% when performin% the same operation. <t
must e rememered that when the @ualifications of a ph#sician are
admitted, as in the instant case, there is an inevitale presumption
that in proper cases he takes the necessar# precaution and emplo#s
the est of his knowled%e and skill in attendin% to his clients, unless
the contrar# is sufficientl# estalished.
I(2J
&his presumption is
reuttale # e0pert opinion which is so sadl# lackin% in the case at
ench
<n liti%ations involvin% medical ne%li%ence, the plaintiff has the urden
of estalishin% appellant+s ne%li%ence and for a reasonale conclusion
of ne%li%ence, there must e proof of reach of dut# on the part of the
sur%eon as well as a casual connection of such reach and the
resultin% death of his patient.
I((J
<n #$an Lugay v% &t Luke's 'ospital(
)nc%,
I(5J
where the attendin% ph#sician was asolved of liailit# for the
death of the complainant+s wife and neworn a#, this court held
that:
;<n order that there ma# e a recover# for an in7ur#, however, it must
e shown that the +in7ur# for which recover# is sou%ht must e the
le%itimate conse@uence of the wron% done> the connection etween
the ne%li%ence and the in7ur# must e a direct and natural se@uence
of events, unroken # intervenin% efficient causes.+ <n other words,
the ne%li%ence must e the pro0imate cause of the in7ur#. For,
+ne%li%ence, no matter in what it consists, cannot create a ri%ht of
action unless it is the pro0imate cause of the in7ur# complained of.+
And +the pro0imate cause of an in7ur# is that cause, which, in natural
and continuous se@uence, unroken # an# efficient intervenin%
cause, produces the in7ur#, and without which the result would not
have occurred.++
Accordin% to oth doctors, the possile causes of hemorrha%e durin%
an operation are: '!) the failure of the sur%eon to tie or suture a cut
lood vessel> '2) allowin% a cut lood vessel to %et out of control> '()
the suse@uent loosenin% of the tie or suture applied to a cut lood
vessel> and '5) and a clottin% defect known as D<C. <t is si%nificant to
state at this 7uncture that the autops# conducted # Dr. AriBala on the
od# of L#dia did not reveal an# untied or unsutured cut lood vessel
nor was there an# indication that the tie or suture of a cut lood vessel
had ecome loose there# causin% the hemorrha%e.
I5*J
?n the other
hand, the findin%s of all three doctors do not preclude the proailit#
that D<C caused the hemorrha%e and conse@uentl#, L#dia+s death.
D<C which is a clottin% defect creates a serious leedin% tendenc# and
when massive D<C occurs as a complication of sur%er# leavin% raw
surface, ma7or hemorrha%e occurs.
I52J
And as testified to # defense
witness, Dr. 1u C. Castro, hemorrha%e due to D<C ;cannot e
prevented, it will happen to an#one, an#time.;
I5(J
&his court has no
recourse ut to rel# on the e0pert testimonies rendered # oth
prosecution and defense witnesses that sustantiate rather than
contradict petitioner+s alle%ation that the cause of L#dia+s death was
D<C which, as attested to # an e0pert witness, cannot e attriuted to
the petitioner+s fault or ne%li%ence. &he proailit# that L#dia+s death
was caused # D<C was unreutted durin% trial and has en%endered
in the mind of this Court a reasonale dout as to the petitioner+s %uilt.
&hus, the ac@uittal of petitioner of the crime reckless imprudence.

. Ra(os vs C#
GR 12434, +e$e()er 28, 1999
5#C0'9
Dometime in !"84, petitioner -rlinda $amos, after seekin%
professional medical help, wasadvised to under%o an operation for the
removal of a stone in her %all ladder 'c$olecystectomy).Dhe was
referred to Dr. 3osaka, a sur%eon, who a%reed to perform the
operation on her. &heoperation was scheduled for Gune !=, !"84 at
":** in the mornin% at private respondent De LosDantos ,edical
Center 'DLD,C). Dince neither petitioner -rlinda nor her husand,
petitioner $o%elio, knew of an# anesthesiolo%ist, Dr. 3osaka
recommended to them the services of Dr.2utierreB..etitioner -rlinda
was admitted to the DLD,C the da# efore the scheduled operation.
1# =:(*in the mornin% of the followin% da#, petitioner -rlinda was
alread# ein% prepared for operation.Hpon the re@uest of petitioner
-rlinda, her sister9in9law, 3erminda CruB, who was then Dean of the
Colle%e of Nursin% at the Capitol ,edical Center, was allowed to
accompan# her inside theoperatin% room.
At around ":(* in the mornin%, Dr. 3osaka had not #et arrived so Dr.
2utierreB tried to %et intouch with him # phone. &hereafter, Dr.
2utierreB informed CruB that the operation mi%ht edela#ed due to the
late arrival of Dr. 3osaka. <n the meantime, the patient, petitioner
-rlinda saidto CruB, ;,ind#, inip na inip na ako(iku$a mo ak o n%
ian% Doctor .;1# !*:** in the mornin%, when Dr. 3osaka was still not
around, petitioner $o%elio alread#wanted to pull out his wife from the
operatin% room. 3e met Dr. 2arcia, who remarked that hewas also
tired of waitin% for Dr. 3osaka. Dr. 3osaka finall# arrived at the
hospital at around!2:!* in the afternoon, or more than three '()hours
after the scheduled operation.
CruB, who was then still inside the operatin% room, heard aout Dr.
3osakaOs arrival. 6hile sheheld the hand of -rlinda, CruB saw Dr.
2utierreB tr#in% to intuate the patient. CruB heard Dr.2utierreB utter:
;an% $ir ap ma9int uate nito(mali yata ang pagkakapasok ko%o
lumalaki ang tiyan.; CruB noticed a luish discoloration of -rlindaOs
naileds on her left hand. Dhe 'CruB)then heard Dr. 3osaka instruct
someone to call Dr. Calderon, another anesthesiolo%ist. 6hen
hearrived, Dr. Calderon attempted to intuate the patient. &he
naileds of the patient remained luish, thus, she was placed in a
trendelenur% position P a position where the head of the patientis
placed in a position lower than her feet.
At this point, CruB went out of the operatin% room toe0press her
concern to petitioner $o%elio that -rlindaOs operation was not %oin%
well.CruB @uickl# rushed ack to the operatin% room and saw that the
patient was still intrendelenur% position.
At almost (:** in the afternoon, she saw -rlinda ein% wheeled to
the<ntensive Care Hnit '<CH). &he doctors e0plained to petitioner
$o%elio that his wife had ronchospasm. -rlinda sta#ed in the <CH for
a month. Dhe was released from the hospital onl# four months later or
on Novemer !4, !"84. Dince the ill9fated operation, -rlinda remained
incomatose condition until she died on Au%ust (, !""".! .etitioners
filed with the $e%ional &rial Court of QueBon Cit# a civil case for
dama%es a%ainst private respondents.After due trial, the courta @uo
rendered 7ud%ment in favor of petitioners.-ssentiall#, the trial court
found that private respondents were ne%li%ent in the performance
of their duties to -rlinda. ?n appeal # private respondents, the Court
of A ppeals reversed the trialcourtOs decision and directed petitioners
to pa# their ;unpaid medical ills; to privaterespondents..etitioners
filed with this Court a petition for review on certiorari. &he private
respondents werethen re@uired to sumit their respective comments
thereon. ?n Decemer 2", !""", this Court promul%ated the decision
which private respondents now seek to e reconsidered.
-''2.'9
!. 63-&3-$ ?$ N?& D$. ?$L<N? 3?DAFA'DH$2-?N)<D
L<A1L- F?$ N-2L<2-NC-
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'A N-D&3-D<?L?2<D&) <D L<A1L- F?$ N-2L<2-NC-N
(. 63-&3-$ ?$ N?& &3- 3?D.<&AL 'D-L?D DA N&?D
,-D<CAL C-N&-$ )<D L<A1L- F?$ A NA AC& ?F N-2L<2-NC-
C?,,<&&-D 1A &3-<$ E<D<&<N2C?NDHL&A N& DH$2-?N A ND
AN-D&3-D<?L?2<D&.
1.6+9
R26-,G9
-n the $ase at )ar, the follo:in; issues :ere resolve& as follo:s9
1< +r. 1osa=a>s irresponsi)le $on&u$t of arrivin; very late for the
s$he&ule& operation of petitioner.rlin&a is violative, not only of
his &uty as a physi$ian ?to serve the interest of his patients :ith
the;reatest soli$itu&e, ;ivin; the( al:ays his )est talent an&
s=ill,)ut also of #rti$le 19 of the Civil Co&e:hi$h re"uires a
person, in the perfor(an$e of his &uties, to a$t :ith @usti$e an&
;ive everyone his &ue.
2< +r. GutierreA $lai( of la$= of ne;li;en$e on her part is )elie&
)y the re$or&s of the $ase. -t has )eensuffi$iently esta)lishe&
that she faile& to eBer$ise the stan&ar&s of $are in the
a&(inistration of anesthesia on a patient. +r. GutierreA o(itte&
to perfor( a thorou;h preoperative evaluation on.rlin&a.
5urther, there is no $o;ent reason for the Court to reverse its
fin&in; that it :as the faultyintu)ation on .rlin&a that $ause& her
$o(atose Con&ition. 0here is no "uestion that .rlin&a
)e$a(e$o(atose after +r. GutierreA perfor(e& a (e&i$al
pro$e&ure on her.
3<#fter a $areful $onsi&eration of the ar;u(ents raise& )y
+6'8C, the Court fin&s thatrespon&ent hospitalCs position on
this issue is (eritorious. 0here is no e(ployer%e(ployee
relationship )et:een +6'8C an& +rs. GutierreA an& 1osa=a
:hi$h :oul& hol& +6'8Csoli&arily lia)le for the in@ury suffere&
)y petitioner .rlin&a un&er #rti$le 2180 of the CivilCo&e. urther,
no evi&en$e :as a&&u$e& to sho: that the in@ury suffere& )y
petitioner .rlin&a:as &ue to a failure on the part of respon&ent
+6'8C to provi&e for hospital fa$ilities an& staff ne$essary for
her treat(ent. 5or these reasons, the 'upre(e Cor& reverse the
fin&in; of lia)ilityon the part of +6'8C for the in@ury suffere& )y
petitioner .rlin&a.
6. R.7.' vs. 'isters of (er$y
5a$ts9
.etitioner Leah Alesna $e#es is the wife of the late Gor%e $e#es. &he
other petitioners,namel#, $ose Nahd7a, Gohnn#, Llo#d, and Fristine, all
surnamed $e#es, were theirchildren. Five da#s efore his death on
Ganuar# 8, !"8=, Gor%e had een sufferin% from arecurrin% fever with
chills. After he failed to %et relief from some home medication he was
takin%, which consisted of anal%esic, antip#retic, and antiiotics, he
decided to seethe doctor.?n Ganuar# 8, !"8=, he was taken to the
,erc# Communit# Clinic # his wife. 3e wasattended to #
respondent Dr. ,arl#n $ico, resident ph#sician and admittin%
ph#sicianon dut#, who %ave Gor%e a ph#sical e0amination and took his
medical histor#. Dhe notedthat at the time of his admission, Gor%e was
conscious, amulator#, oriented, coherent,and with respirator#
distress. &#phoid fever was then prevalent in the localit#, as theclinic
had een %ettin% from !4 to 2* cases of t#phoid per month
Duspectin% that Gor%ecould e sufferin% from this disease, Dr. $ico
ordered a 6idal &est, a standard test fort#phoid fever, to e performed
on Gor%e. 1lood count, routine urinal#sis, stoole0amination, and
malarial smear were also made After aout an hour, the
medicaltechnician sumitted the results of the test from which Dr. $ico
concluded that Gor%e was positive for t#phoid fever. As her shift was
onl# up to 4:** p.m., Dr. $ico indorsed Gor%e to respondent Dr. ,arvie
1lanes.Dr. ,arvie 1lanes attended to Gor%e at around si0 in the
evenin%. Dhe also took Gor%e:shistor# and %ave him a ph#sical
e0amination. Like Dr. $ico, her impression was that Gor%e had t#phoid
fever. Antiiotics ein% the accepted treatment for t#phoid fever,
sheordered that a compatiilit# test with the antiiotic chlorom#cetin
e done on Gor%e. Daidtest was administered # nurse Gosephine
.a%ente who also %ave the patient a dose of tri%loe. As she did not
oserve an# adverse reaction # the patient to chlorom#cetin,Dr.
1lanes ordered the first five hundred milli%rams of said antiiotic to e
administeredon Gor%e at around ":** p.m. A second dose was
administered on Gor%e aout threehours later 7ust efore midni%ht. At
around !:** a.m. of Ganuar# ", !"8=, Dr. 1lanes was called as Gor%e:s
temperature roseto 5!SC. &he patient also e0perienced chills and
e0hiited respirator# distress, nausea, vomitin%, and convulsions. Dr.
1lanes put him under o0#%en, used a suction machine,and
administered h#drocortisone, temporaril# easin% the patient:s
convulsions. 6hen here%ained consciousness, the patient was asked
# Dr. 1lanes whether he had a previousheart ailment or had suffered
from chest pains in the past. Gor%e replied he did not Afteraout !4
minutes, however, Gor%e a%ain started to vomit, showed restlessness,
and hisconvulsions returned. Dr. 1lanes re9applied the emer%enc#
measures taken efore and, inaddition, valium was administered.
Gor%e, however, did not respond to the treatment andslipped into
c#anosis, a luish or purplish discoloration of the skin or mucous
memrane due to deficient o0#%enation of the lood. At around 2:**
a.m., Gor%e died. 3e was fort# #ears old. &he cause of his death was
MEentricular Arr#themia Decondar# to3#perp#re0ia and t#phoid fever.L
<ssue: 6hether or not petitioner is entitled to dama%e appl#in% res
ipsa lo@uiturN
3eld: No.
&here is a case when e0pert testimon# ma# e dispensed with, and
that is under thedoctrine of res ipsa lo@uitur. &hus, courts of other
7urisdictions have applied the doctrinein the followin% situations:
leavin% of a forei%n o7ect in the od# of the patient after anoperation,
in7uries sustained on a health# part of the od# which was not under,
or in thearea, of treatment, removal of the wron% part of the od#
when another part wasintended, knockin% out a tooth while a patient:s
7aw was under anesthetic for the removalof his tonsils, and loss of an
e#e while the patient was under the influence of anesthetic,durin% or
followin% an operation for appendicitis, amon% others..etitioners now
contend that all re@uisites for the application of res ipsalo@uitur were
present, namel#: '!) the accident was of a kind which does not
ordinaril# occur unless someone is ne%li%ent> '2) the instrumentalit# or
a%enc# which caused thein7ur# was under the e0clusive control of the
person in char%e> and '() the in7ur# sufferedmust not have een due
to an# voluntar# action or contriution of the person in7ured. &he
contention is without merit. 6e a%ree with the rulin% of the Court of
Appeals. <nthe $amos case, the @uestion was whether a sur%eon, an
anesthesiolo%ist, and a hospitalshould e made liale for the
comatose condition of a patient scheduled forcholec#stectom#. <n that
case, the patient was %iven anesthesia prior to her operation.Notin%
that the patient was neurolo%icall# sound at the time of her operation,
the Courtapplied the doctrine of res ipsa lo@uitur as mental rain
dama%e does not normall# occurin a %alllader operation in the
asence of ne%li%ence of the anesthesiolo%ist. &akin% 7udicial notice
that anesthesia procedures had ecome so common that even an
ordinar# person could tell if it was administered properl#, we allowed
the testimon# of a witness who was not an e0pert. <n this case, while it
is true that the patient died 7ust a few hoursafter professional medical
assistance was rendered, there is reall# nothin% unusual
ore0traordinar# aout his death. .rior to his admission, the patient
alread# had recurrin% fevers and chills for five da#s unrelieved # the
anal%esic, antip#retic, and antiiotics%iven him # his wife. &his shows
that he had een sufferin% from a serious illness andprofessional
medical help came too late for him.$espondents alle%ed failure to
oserve due care was not immediatel# apparent to ala#man so as to
7ustif# application of res ipsa lo@uitur. &he @uestion re@uired
e0pertopinion on the alle%ed reach # respondents of the standard of
care re@uired # thecircumstances. Furthermore, on the issue of the
correctness of her dia%nosis, nopresumption of ne%li%ence can e
applied to Dr. ,arl#n $ico.
*. R#84' /'. C#
5#C0'9 Dometime in !"84, petitioner -rlinda $amos, after seekin%
professional medical help, was advised to under%o an operation for
the removal of a stone in her %all ladder 'c$olecystectomy). Dhe was
referred to Dr. 3osaka, a sur%eon, who a%reed to perform the
operation on her. &he operation was scheduled for Gune !=, !"84 at
":** in the mornin% at private respondent De Los Dantos ,edical
Center 'DLD,C). Dince neither petitioner -rlinda nor her husand,
petitioner $o%elio, knew of an# anesthesiolo%ist, Dr. 3osaka
recommended to them the services of Dr. 2utierreB.
.etitioner -rlinda was admitted to the DLD,C the da# efore
the scheduled operation. At the da# of the operation Dr. 2utierreB
informed CruB that the operation mi%ht e dela#ed due to the late
arrival of Dr. 3osaka. &he latter finall# arrived at the hospital at around
!2:!* in the afternoon, or more than three '() hours after the
scheduled operation. &hereafter, 3erminda CruB, sister9in9law of
-rlinda $amos saw Dr. 2utierreB tr#in% to intuate the patient and
noticed a luish discoloration of -rlinda:s naileds on her left hand,
thus, she was placed in a trendelenur% position T a position where
the head of the patient is placed in a position lower than her feet.
almost (:** in the afternoon, she saw -rlinda ein% wheeled to the
<ntensive Care Hnit '<CH). &he doctors e0plained to petitioner $o%elio
that his wife had ronchospasm. -rlinda sta#ed in the <CH for a
month. Dhe was released from the hospital onl# four months later or
on Novemer !4, !"84. Dince the ill9fated operation, -rlinda remained
in comatose condition until she died on Au%ust (, !""".
.etitioners filed with the $e%ional &rial Court of QueBon Cit#
a civil case for dama%es a%ainst private respondents. After due trial,
the court a quo rendered 7ud%ment in favor of petitioners. -ssentiall#,
the trial court found that private respondents were ne%li%ent in the
performance of their duties to -rlinda. ?n appeal # private
respondents, the Court of Appeals reversed the trial court:s decision
and directed petitioners to pa# their ;unpaid medical ills; to private
respondents.
-''2.9 63-&3-$ ?$ N?& $-D.?ND-N&D A$- L<A1L- F?$
N-2L<2-NC-.
1.6+9
+R. GutierreAD lia)ility. 7es.
Dr. 2utierreB: claim of lack of ne%li%ence on her part is elied # the
records of the case. <t has een sufficientl# estalished that she failed
to e0ercise the standards of care in the administration of anesthesia
on a patient.
.re9evaluation for anesthesia involves takin% the patient:s medical
histor#, reviewin% his current dru% therap#, conductin% ph#sical
e0amination, interpretin% laorator# data, and determinin% the
appropriate prescription of preoperative medications as necessar# to
the conduct of anesthesia.
Nonetheless, Dr. 2utierreB omitted to perform a thorou%h preoperative
evaluation on -rlinda. As she herself admitted, she saw -rlinda for the
first time on the da# of the operation itself, one hour efore the
scheduled operation. Dhe auscultated the patient:s heart and lun%s
and checked the latter:s lood pressure to determine if -rlinda was
indeed fit for operation. 3owever, she did not proceed to e0amine the
patient:s airwa#. 3ad she een ale to check petitioner -rlinda:s
airwa# prior to the operation, Dr. 2utierreB would most proal# not
have e0perienced difficult# in intuatin% the former, and thus the
resultant in7ur# could have een avoided.
+r. 1osa=a>s lia)ility. 7es.
&here is a trend in American 7urisprudence to do awa# with the
Captain9of9the9Dhip doctrine does not mean that this Court will ipso
facto follow said trend. Due re%ard for the peculiar factual
circumstances otainin% in this case 7ustif# the application of the
Captain9of9the9Dhip doctrine. From the facts on record it can e
lo%icall# inferred that Dr. 3osaka e0ercised a certain de%ree of, at the
ver# least, supervision over the procedure then ein% performed on
-rlinda.
First, it was Dr. 3osaka who recommended to petitioners the services
of Dr. 2utierreB. <n effect, he represented to petitioners that Dr.
2utierreB possessed the necessar# competence and skills. Drs.
3osaka and 2utierreB had worked to%ether since !"==. 6henever Dr.
3osaka performed a sur%er#, he would alwa#s en%a%e the services of
Dr. 2utierreB to administer the anesthesia on his patient.
Decond, Dr. 3osaka himself admitted that he was the attendin%
ph#sician of -rlinda. &hus, when -rlinda showed si%ns of c#anosis, it
was Dr. 3osaka who %ave instructions to call for another
anesthesiolo%ist and cardiolo%ist to help resuscitate -rlinda.
&hird, it is conceded that in performin% their responsiilities to the
patient, Drs. 3osaka and 2utierreB worked as a team. &heir work
cannot e placed in separate waterti%ht compartments ecause their
duties intersect with each other.
6hile the professional services of Dr. 3osaka and Dr. 2utierreB were
secured primaril# for their performance of acts within their respective
fields of e0pertise for the treatment of petitioner -rlinda, and that one
does not e0ercise control over the other, the# were certainl# not
completel# independent of each other so as to asolve one from the
ne%li%ent acts of the other ph#sician.
&hat the# were workin% as a medical team is evident from the fact that
Dr. 3osaka was keepin% an e#e on the intuation of the patient # Dr.
2utierreB, and while doin% so, he oserved that the patient:s nails had
ecome dusk# and had to call Dr. 2utierreB:s attention thereto. &he
Court also notes that the counsel for Dr. 3osaka admitted that in
practice, the anesthesiolo%ist would also have to oserve the
sur%eon:s acts durin% the sur%ical process and calls the attention of
the sur%eon whenever necessar# in the course of the treatment. &he
duties of Dr. 3osaka and those of Dr. 2utierreB in the treatment of
petitioner -rlinda are therefore not as clear9cut as respondents claim
them to e.
<t is e@uall# important to point out that Dr. 3osaka was remiss in his
dut# of attendin% to petitioner -rlinda promptl#, for he arrived more
than three '() hours late for the scheduled operation. &he
unreasonale dela# in petitioner -rlinda:s scheduled operation
su7ected her to continued starvation and conse@uentl#, to the risk of
acidosis, or the condition of decreased alkalinit# of the lood and
tissues, marked # sickl# sweet reath, headache, nausea and
vomitin%, and visual disturances. &he lon% period that Dr. 3osaka
made -rlinda wait for him certainl# a%%ravated the an0iet# that she
must have een feelin% at the time. <t could e safel# said that her
an0iet# adversel# affected the administration of anesthesia on her.
+6'8C>s lia)ility. ,o.
Neither is there an# showin% that it is DLD,C which pa#s an# of its
consultants for medical services rendered # the latter to their
respective patients. ,oreover, the contract etween the consultant in
respondent hospital and his patient is separate and distinct from the
contract etween respondent hospital and said patient.
8. R2E.3, JR. vs. +r. J2R#+4
5#C0'9
?n Ganuar# !2, 2**4, at around 5:2* p.m., $u/eB, Dr.
arrived # himself at this Court:s clinic complainin% of diBBiness.
$u/eB, Gr. alle%ed that despite his father:s medical condition, he was
merel# advised to %o to a hospital and then allowed to walk out of the
clinic on his own. After ein% informed of his father:s condition, he
rushed him to the ,anila Doctors 3ospital. &here, $u/eB, Dr. was
treated in the emer%enc# room for appro0imatel# four hours efore he
was dischar%ed at around 8:(* p.m. and allowed to %o home.
3owever, prior to reachin% their house in 1alintawak, Caloocan Cit#,
$u/eB, Dr. e%an e0periencin% nausea, anormal palpitation and
uneasiness and had to e rou%ht ack to the hospital and arrived at
the emer%enc# room of the ,anila Doctors 3ospital at around !*:**
p.m. after which $u/eB, Dr. underwent a C.&. Dcan. &he C.&. Dcan
revealed a lood clot necessitatin% him to e admitted for treatment
and oservation. Hnfortunatel#, $u/eB Dr. never recovered from his
ailment and, on Deptemer !2, 2**4, he passed awa# due to medical
complications
$u/eB, Gr. filed a letter9complaint with the ?ffice of the Chief
Gustice re%ardin% the alle%ed lack of attention %iven to his father #
Dr. Gurado. Dpecificall#, he claims that Dr. Gurado merel# advised his
father to %o to the hospital and then allowed him to travel to ,anila
Doctors 3ospital despite the availailit# of an amulance at the
disposal of the clinic. $u/eB, Gr. sumits that his father would not have
suffered a stroke if not for the ne%lect of Dr. Gurado.
Att#. Candelaria, Deput# Clerk of Court and Chief of
Administrative Dervices sumitted her report on Gune !=, 2**4. &he
report %ave credence to the account of Dr. Gurado that $u/eB, Dr. was
%iven #apoten, informed that he should e hospitaliBed and that the
amulance was placed on stand# to take him there. &hese factual
findin%s of Att#. Candelaria appear to e supported # the affidavits of
the clinic:s personnel, includin% the amulance driver, who witnessed
the events that happened etween $u/eB, Dr. and Dr. Gurado.
-''2.9 6hether there is cause to hold Dr. Gurado administrativel#
liale.
1.6+9
,4. A doctor:s dut# to his patient is not re@uired to e
e0traordinar#. &he standard contemplated for doctors is simpl# the
reasonale avera%e merit amon% ordinaril# %ood ph#sicians, i%e%
reasonale skill and competence. 6e are persuaded that Dr. Gurado
fulfilled such a standard when she treated $u/eB, Dr. inside the clinic.
1ut what of Dr. Gurado:s conduct after $u/eB, Dr. left the clinic and
failed to returnN
<t has een held that a patient cannot attriute to a ph#sician
dama%es resultin% from his own failure to follow his advice, even
thou%h he was i%norant of the conse@uences which would result from
his failure. <f a patient leaves the hospital contrar# to instructions, the
ph#sician is not liale for suse@uent events. &here is no e0pectation
from doctors that the# track down each patient who apparentl# missed
their appointments or force them to compl# with their directives. After
all, a person is still the master of his own od#.
Dr. Gurado ma# have allowed $u/eB, Dr. to walk out of the clinic
despite her earlier dia%nosis of his condition. 1# that time $u/eB, Dr.:s
condition had temporaril# stailiBed and she did not have the authorit#
to stop him 7ust as other doctors have no power, save in certain
instances 'such as when the law makes treatment compulsor# due to
some communicale disease

or when consent is withheld # a minor
ut non9treatment would e detrimental or when the court of
competent 7urisdiction orders the treatment), to force patients into
sta#in% under their care. Dr. Gurado relied on $u/eB, Dr.:s
representation that he would return in order to e rou%ht to the
hospital ut made no undertakin% to wait for him e#ond the clinic
hours or to look for him if he did not return. &hus, when $u/eB, Dr.
failed to show up as of closin% time, and could not e found # the
male nurse who looked for him at her instructions, Dr. Gurado had
reason to think that he had decided to disre%ard her medical advice,
which he in fact did when he and $u/eB, Gr. decided to %o to the
hospital on their own. $u/eB, Dr., still of sound mind, had the ri%ht to
accept or i%nore his doctor:s recommendation. Dr. Gurado was
oli%ated to care for $u/eB, Dr. when the latter asked for medical
treatment, which she did, ut when he left on his own accord Dr.
Gurado was not e0pected, much less dut#9ound, to seek out her
patient and continue ein% his doctor.
9. ,o;ales vs. Capitol 8e&i$al Center
5#C0'9
CoraBon No%ales ';CoraBon;), (= #ears old pre%nant with
her fourth child, under the e0clusive prenatal care of Dr. ?scar
-strada ';Dr. -strada;). &he Doctor noted an increase in her lood
pressure and development of le% edema indicatin% preeclampsia.
CoraBon started to e0perience mild laor pains Dr. -strada advised
her immediate admission to the Capitol ,edical Center ';C,C;). &he
staff nurse noted the written admission re@uest of Dr. -strada. Due to
the ;Consent on Admission and A%reement; and ;Admission
A%reement; si%ned # CoraBon:s husand she was then rou%ht to
the laor room of the C,C.
CoraBon manifest moderate va%inal leedin% which rapidl# ecame
profusel#, Dr. -spinola ordered immediate h#sterectom#. $o%elio was
made to si%n consent to ?peration. Due to the inclement weather, Dr.
-spinola arrived an hour late. 3e e0amined the patient and ordered
some resuscitative measures to e administered. Despite Dr.
-spinola+s efforts, CoraBon died the cause of death was ;hemorrha%e,
post partum.;
.etitioners filed a complaint for dama%es with the $e%ional &rial Court
of ,anila contendin% that defendant ph#sicians and C,C personnel
were ne%li%ent in the treatment and mana%ement of CoraBon+s
condition also in the selection and supervision of defendant
ph#sicians and hospital staff. &he defendant fail to file their answer to
the complaint the trial court declared Dr. -strada, Dr. -nri@ueB, and
Nurse Dumlao in default. C,C, Dr. Eillaflor, Dr. H#, Dr. -spinola, and
Dr. Lacson filed their respective answers den#in% and opposin% the
alle%ations in the complaint. &he trial court rendered 7ud%ment findin%
Dr. -strada solel# liale for dama%es.
.etitioners appealed the trial court+s decision, &he Court of Appeals
affirmed the decision of the trial court. .etitioners filed a motion for
reconsideration which was denied in its resolution. 3ence, petitioners
filed a ,anifestation that respondents ;need no lon%er e notified of
the petition ecause the# are not involved in the issue raised efore
the ICourtJ, re%ardin% the liailit# of IC,CJ.; &he Court of Appeals
concluded that since $o%elio en%a%ed Dr. -strada as the attendin%
ph#sician of his wife, an# liailit# for malpractice must e Dr. -strada+s
sole responsiilit#. 6hile it found the amount of dama%es fair and
reasonale, the Court of Appeals held that no interest could e
imposed on unli@uidated claims or dama%es. 3ence this petition.
-''2.9 6hether or not C,C is vicariousl# liale for the ne%li%enceN
1.6+9
7.'.&he Court finds no sin%le evidence pointin% to C,C+s
e0ercise of control over Dr. -strada+s treatment and mana%ement of
CoraBon+s condition. <t is undisputed that throu%hout CoraBon+s
pre%nanc#, she was under the e0clusive prenatal care of Dr. -strada.
At the time of CoraBon+s admission at C,C and durin% her deliver#, it
was Dr. -strada, assisted # Dr. Eillaflor, who attended to CoraBon.
&here was no showin% that C,C had a part in dia%nosin% CoraBon+s
condition. 6hile Dr. -strada en7o#ed staff privile%es at C,C, such fact
alone did not make him an emplo#ee of C,C. C,C merel# allowed
Dr. -strada to use its facilities when CoraBon was aout to %ive irth,
which C,C considered an emer%enc#. Considerin% these
circumstances, Dr. -strada is not an emplo#ee of C,C, ut an
independent contractor.
&he @uestion now is whether C,C is automaticall# e0empt from
liailit# considerin% that Dr. -strada is an independent contractor9
ph#sician.
<n %eneral, a hospital is not liale for the ne%li%ence of an independent
contractor9ph#sician. &here is, however, an e0ception to this principle.
&he hospital ma# e liale if the ph#sician is the ;ostensile; a%ent of
the hospital. &his e0ception is also known as the ;doctrine of apparent
authorit#.; <n *ilbert v% &ycamore +unicipal 'ospital, the <llinois
Dupreme Court e0plained the doctrine of apparent authorit# in this
wise:
IHJnder the doctrine of apparent authorit# a hospital can e held
vicariousl# liale for the ne%li%ent acts of a ph#sician providin% care at
the hospital, re%ardless of whether the ph#sician is an independent
contractor, unless the patient knows, or should have known, that the
ph#sician is an independent contractor. &he elements of the action
have een set out as follows:
;For a hospital to e liale under the doctrine of apparent authorit#, a
plaintiff must show that: '!) the hospital, or its a%ent, acted in a
manner that would lead a reasonale person to conclude that the
individual who was alle%ed to e ne%li%ent was an emplo#ee or a%ent
of the hospital> '2) where the acts of the a%ent create the appearance
of authorit#, the plaintiff must also prove that the hospital had
knowled%e of and ac@uiesced in them> and '() the plaintiff acted in
reliance upon the conduct of the hospital or its a%ent, consistent with
ordinar# care and prudence.;
&he element of 7ustifiale reliance on the part of the plaintiff is
satisfied if the plaintiff relies upon the hospital to provide complete
emer%enc# room care, rather than upon a specific ph#sician.
&he doctrine of apparent authorit# essentiall# involves two factors to
determine the liailit# of an independent9contractor ph#sician.
&he first factor focuses on the hospital+s manifestations and is
sometimes descried as an in@uir# whether the hospital acted in a
manner which would lead a reasonale person to conclude that the
individual who was alle%ed to e ne%li%ent was an emplo#ee or a%ent
of the hospital. -n this re;ar&, the hospital nee& not (a=e eBpress
representations to the patient that the treatin; physi$ian is an
e(ployee of the hospitalF rather a representation (ay )e ;eneral
an& i(plie&.
&he doctrine of apparent authorit# is a species of the doctrine of
estoppel. Article !5(! of the Civil Code provides that ;ItJhrou%h
estoppel, an admission or representation is rendered conclusive upon
the person makin% it, and cannot e denied or disproved as a%ainst
the person rel#in% thereon.; -stoppel rests on this rule: ;6henever a
part# has, # his own declaration, act, or omission, intentionall# and
delieratel# led another to elieve a particular thin% true, and to act
upon such elief, he cannot, in an# liti%ation arisin% out of such
declaration, act or omission, e permitted to falsif# it.;
<n the instant case, C,C impliedl# held out Dr. -strada as a memer
of its medical staff. &hrou%h C,C+s acts, C,C clothed Dr. -strada
with apparent authorit# there# leadin% the Dpouses No%ales to
elieve that Dr. -strada was an emplo#ee or a%ent of C,C. C,C
cannot now repudiate such authorit#.
First, C,C %ranted staff privile%es to Dr. -strada. C,C e0tended its
medical staff and facilities to Dr. -strada. Hpon Dr. -strada+s re@uest
for CoraBon+s admission, C,C, throu%h its personnel, readil#
accommodated CoraBon and updated Dr. -strada of her condition.
Decond, C,C made $o%elio si%n consent forms printed on C,C
letterhead. .rior to CoraBon+s admission and supposed h#sterectom#,
C,C asked $o%elio to si%n release forms, the contents of which
reinforced $o%elio+s elief that Dr. -strada was a memer of C,C+s
medical staff.
&hird, Dr. -strada+s referral of CoraBon+s profuse va%inal leedin% to
Dr. -spinola, who was then the 3ead of the ?stetrics and
2#necolo%# Department of C,C, %ave the impression that Dr.
-strada as a memer of C,C+s medical staff was collaoratin% with
other C,C9emplo#ed specialists in treatin% CoraBon.
&he second factor focuses on the patient+s reliance. <t is sometimes
characteriBed as an in@uir# on whether the plaintiff acted in reliance
upon the conduct of the hospital or its a;ent, consistent with ordinar#
care and prudence.
&he records show that the Dpouses No%ales relied upon a perceived
emplo#ment relationship with C,C in acceptin% Dr. -strada+s
services. $o%elio testified that he and his wife specificall# chose Dr.
-strada to handle CoraBon+s deliver# not onl# ecause of their friend+s
recommendation, ut more importantl# ecause of Dr. -strada+s
;connection with a reputale hospital, the IC,CJ.;
10. P'- vs. #G#,#
5#C0'9
?n April 5, !"85, Natividad A%ana was rushed to the ,edical
Cit# 2eneral 3ospital ',edical Cit# 3ospital) ecause of difficult# of
owel movement and lood# anal dischar%e. After a series of medical
e0aminations, Dr. ,i%uel Ampil, dia%nosed her to e sufferin% from
;cancer of the si%moid.; &hen, Dr. Ampil, assisted # the medical staff
of the ,edical Cit# 3ospital, performed an anterior resection sur%er#
on Natividad. 3e found that the mali%nanc# in her si%moid area had
spread on her left ovar#, necessitatin% the removal of certain portions
of it. &hus, Dr. Ampil otained the consent of Natividad:s husand,
-nri@ue A%ana, to permit Dr. Guan Fuentes to perform h#sterectom#
on her.
Natividad was released from the hospital. After a couple of
da#s, Natividad complained of e0cruciatin% pain in her anal re%ion.
Dhe consulted oth Dr. Ampil and Dr. Fuentes aout it. &he# told her
that the pain was the natural conse@uence of the sur%er#. Dr. Ampil
then recommended that she consult an oncolo%ist to e0amine the
cancerous nodes which were not removed durin% the operation. &he#
went to HD for further treatment and came after four months however
two weeks thereafter, her dau%hter found a piece of %auBe protrudin%
from her va%ina. Hpon ein% informed aout it, Dr. Ampil proceeded to
her house where he mana%ed to e0tract # hand a piece of %auBe
measurin% !.4 inches in width. 3e then assured her that the pains
would soon vanish ut never came true promptin% natividad to seek
treatment from .ol#medic 2eneral 3ospital, Dr. $amon 2utierreB
detected the presence of another forei%n o7ect in her va%ina 99 a foul9
smellin% %auBe measurin% !.4 inches in width which adl# infected
her va%inal vault. A recto9va%inal fistula had formed in her
reproductive or%ans which forced stool to e0crete throu%h the va%ina.
Another sur%ical operation underwent # Natividad
?n Novemer !2, !"85, Natividad and her husand filed with
the $&C, 1ranch "C, QueBon Cit# a complaint for dama%es a%ainst
the .rofessional Dervices, <nc. '.D<), owner of the ,edical Cit#
3ospital, Dr. Ampil, and Dr. Fuentes, docketed as Civil Case No. Q9
5((22. &he# alle%ed that the latter are liale for ne%li%ence for leavin%
two pieces of %auBe inside Natividad:s od# and malpractice for
concealin% their acts of ne%li%ence.
-''2.9 6hether .D< is liale for malpractice and ne%li%ence.
1.6+9 7.'.&he rulin% in Dmith v. Rea%ler is e0plicit, thus:
&he removal of all spon%es used is part of a sur%ical operation, and
when a ph#sician or sur%eon fails to remove a spon%e he has placed
in his patient:s od# that should e removed as part of the operation,
he there# leaves his operation uncompleted and creates a new
condition which imposes upon him the le%al dut# of callin% the new
condition to his patient:s attention, and endeavorin% with the means
he has at hand to minimiBe and avoid untoward results likel# to ensue
therefrom.
3ere, Dr. Ampil did not inform Natividad aout the missin% two pieces
of %auBe. 6orse, he even misled her that the pain she was
e0periencin% was the ordinar# conse@uence of her operation. 3ad he
een more candid, Natividad could have taken the immediate and
appropriate medical remed# to remove the %auBes from her od#. &o
our mind, what was initiall# an act of ne%li%ence # Dr. Ampil has
ripened into a delierate wron%ful act of deceivin% his patient.
&his is a clear case of medical malpractice or more appropriatel#,
medical ne%li%ence. &o successfull# pursue this kind of case, a patient
must onl# prove that a health care provider either failed to do
somethin% which a reasonal# prudent health care provider would
have done, or that he did somethin% that a reasonal# prudent
provider would not have done> and that failure or action caused in7ur#
to the patient. Dimpl# put, the elements are dut#, reach, in7ur# and
pro0imate causation. Dr, Ampil, as the lead sur%eon, had the dut# to
remove all forei%n o7ects, such as %auBes, from Natividad:s od#
efore closure of the incision. 6hen he failed to do so, it was his dut#
to inform Natividad aout it. Dr. Ampil reached oth duties. Duch
reach caused in7ur# to Natividad, necessitatin% her further
e0amination # American doctors and another sur%er#. &hat Dr.
Ampil:s ne%li%ence is the pro0imate cause of Natividad:s in7ur# could
e traced from his act of closin% the incision despite the information
%iven # the attendin% nurses that two pieces of %auBe were still
missin%. &hat the# were later on e0tracted from Natividad:s va%ina
estalished the causal link etween Dr. Ampil:s ne%li%ence and the
in7ur#. And what further a%%ravated such in7ur# was his delierate
concealment of the missin% %auBes from the knowled%e of Natividad
and her famil#.
11. +R. C#,0R. vs. 'P'. Go
5#C0'9
.etitioner Dr. ,ila%ros L. Cantre is a specialist in ?stetrics
and 2#necolo%# at the Dr. Gesus Del%ado ,emorial 3ospital. Dhe
was the attendin% ph#sician of respondent Nora D. 2o, who was
admitted at the said hospital on April !", !""2. &he followin% da#,
Nora %ave irth to her fourth child, a a# o#. 3owever, at around
(:(* a.m., Nora suffered profuse leedin% inside her wom due to
some parts of the placenta which were not completel# e0pelled from
her wom after deliver#. 6hile petitioner was massa%in% Nora:s
uterus for it to contract and stop leedin%, she ordered a dropli%ht to
warm Nora and her a#. Nora remained unconscious until she
recovered however respondent Gohn David R. 2o noticed a fresh
%apin% wound two and a half '2 U) # three and a half '( U) inches in
the inner portion of her left arm, close to the armpit.
4
3e asked the
nurses what caused the in7ur#. 3e was informed it was a urn.
?n April 22, !""2, Gohn David filed a re@uest for
investi%ation. <n response, Dr. $ainerio D. Aad, the medical director
of the hospital, called petitioner and the assistin% resident ph#sician to
e0plain what happened. .etitioner said the lood pressure cuff
caused the in7ur#. Gohn David rou%ht Nora to the National 1ureau of
<nvesti%ation for a ph#sical e0amination, which was conducted #
medico9le%al officer Dr. Floresto AriBala, Gr.&he medico9le%al officer
later testified that Nora:s in7ur# appeared to e a urn and that a
dropli%ht when placed near the skin for aout !* minutes could cause
such urn. 3e dismissed the likelihood that the wound was caused #
a lood pressure cuff as the scar was not around the arm, ut 7ust on
one side of the arm. 3er movements now are also restricted. 3er
children cannot pla# with the left side of her od# as the# mi%ht
accidentall# ump the in7ured arm, which aches at the sli%htest touch.
-''2.9
<s petitioner liale for the in7ur# suffered # respondent Nora
2oN

1.6+9
7.'. 6hether the in7ur# was caused # the dropli%ht or #
the lood pressure cuff is of no moment. 1oth instruments are
deemed within the e0clusive control of the ph#sician in char%e under
the ;captain of the ship; doctrine. &his doctrine holds the sur%eon in
char%e of an operation liale for the ne%li%ence of his assistants
durin% the time when those assistants are under the sur%eon:s
control. <n this particular case, it can e lo%icall# inferred that
petitioner, the senior consultant in char%e durin% the deliver# of Nora:s
a#, e0ercised control over the assistants assi%ned to oth the use
of the dropli%ht and the takin% of Nora:s lood pressure. 3ence, the
use of the dropli%ht and the lood pressure cuff is also within
petitioner:s e0clusive control.
&hird, the %apin% wound on Nora:s left arm, # its ver# nature and
considerin% her condition, could onl# e caused # somethin%
e0ternal to her and outside her control as she was unconscious while
in h#povolemic shock. 3ence, Nora could not, # an# stretch of the
ima%ination, have contriuted to her own in7ur#.
12 . -6#4%4R.0# vs. 'P'. R4,G2-664
5#C0'9
Dpouses $on@uillo had not een lessed with a child despite
several #ears of marria%e. &he# thus consulted petitioner, Dr.
Concepcion <lao9?reta 'Dr. <lao9?reta), an ostetrician9%#necolo%ist9
consultant at the Dt. Luke:s ,edical Center where she was, at the
time material to the case, the chief of the $eproductive -ndocrinolo%#
and <nfertilit# Dection.
Hpon Dr. <lao9?reta:s advice, -va ,arie a%reed to under%o a
laparoscopic procedure where# a laparascope would e inserted
throu%h the patient:s adominal wall to %et a direct view of her internal
reproductive or%an in order to determine the real cause of her
infertilit#.
&he procedure was scheduled on April 4, !""" at 2:** p.m., to e
performed # Dr. <lao9?reta. At around =:** a.m. of said date, -va
,arie, accompanied # her husand Noel, checked in at the Dt.
Luke:s ,edical Center and underwent pre9operative procedures
includin% the administration of intravenous fluid and enema. Dr. <lao9
?reta did not arrive at the scheduled time for the procedure, however,
and no prior notice of its cancellation was received. <t turned out that
the doctor was on a return fli%ht from 3awaii to, and arrived at !*:**
p.m. of April 4, !""" in, ,anila.
?n ,a# !8, !""", the $on@uillo spouses filed a complaint a%ainst Dr.
<lao9?reta and the Dt. Luke:s ,edical Center for reach of
professional and service contract and for dama%es efore the
$e%ional &rial Court '$&C) of 1atan%as Cit#.
-''2.9 6hether .etitioner committed 2ross Ne%li%ence in the
performance of her dut#.
1.6+9
,4. &he evidence then shows that Dr. <lao9?reta, who had
traveled more than twice to the Hnited Dtates where she otained a
fellowship in $eproductive -ndocrinolo%# and <nfertilit# was indeed
ne%li%ent when she scheduled to perform professional service at 2:**
p.m. on April 4, !""" without considerin% the time difference etween
the .hilippines and 3awaii.
&he doctor:s act did not, however, reflect gross ne%li%ence as defined
aove. 3er ar%ument that
Althou%h petitioner failed to take into consideration the time difference
etween the .hilippines and 3awaii, the situation then did not present
an# clear and apparent harm or in7ur# that even a careless person
ma# perceive. Hnlike in situations where the Dupreme Court had
found %ross ne%li%ence to e0ist, petitioner could not have een
conscious of an# foreseeale dan%er that ma# occur since she
actuall# elieved that she would make it to the operation that was
elective in nature, the onl# purpose of which was to determine the real
cause of infertilit# and not to treat and cure a life threatenin% disease.
&hus, in merel# fi0in% the date of her appointment with respondent
-va ,arie $on@uillo, petitioner was not in the pursuit or performance
of conduct which an# ordinar# person ma# deem to proal# and
naturall# result in in7ur#,

'Hnderscorin% in ori%inal)
&hus persuades.
<t ears notin% that when she was schedulin% the date of her
performance of the procedure, Dr. <lao9?reta had 7ust %otten married
and was preparin% for her hone#moon, and it is of common human
knowled%e that e0citement attends its preparations. 3er ne%li%ence
could then e partl# attriuted to human frailt# which rules out its
characteriBation as %ross.
&he doctor:s ne%li%ence not ein% %ross, the spouses are not entitled
to recover moral dama%es.
Neither are the spouses entitled to recover e0emplar# dama%es in the
asence of a showin% that Dr. <lao9?reta acted in a wanton,
fraudulent, reckless, oppressive or malevolent manner, nor to award
of attorne#:s fees as, contrar# to the findin% of the Court of Appeals
that the spouses ;were compelled to liti%ate and incur e0penses to
protect their interest,; the records show that the# did not e0ert enou%h
efforts to settle the matter efore %oin% to court.
13. 'ps. 5lores v. 'ps. Pine&a, et. al.
GR 18996, ,ove()er 2008
Facts: &eresita .ineda, 4!, consulted Dr. Flores aout her medical
condition sa#in% she was e0periencin% %eneral od# weakness, loss
of appetite, fre@uent urination and thirst, and on9and9off va%inal
leedin%. &he latter advised her to %o to HD,C for a %eneral check9
up ecause she was suspected to have diaetes.

April 28, !"8=, &eresita went to HD,C 'she was ver# weak). After Dr.
Flores did a routine check9up, he ordered her admission to the
hospital and directed the staff to prepare her for an Von call DWC
operation 'dilatation and curetta%e)to e performed # his wife, Dr.
Felicisima Flores. Damples were taken for la test.
April 2", !"8=, results of lood tests showed that the su%ar in her
urine was ver# hi%h and further results showed she was sufferin% from
Diaetes ,ellitus &#pe <<. <nsulin was %iven ut it mi%ht have een too
late ecause she died on ,a# C, !"8= due to complications induced
# diaetes.

3er famil#, elievin% that ne%li%ence caused her death, filed an action
for dama%es a%ainst Dr. Flores and Felicisima.

FA,<LA: &he# should have waited for la results efore performin%
DWC. Dince she is alread# suspected of diaetes, it should have een
%iven more attention.

D?C&?$D: DWC is the immediate answer to va%inal leedin%. And
that operation on a h#po%l#cemic patient, such as &eresita who is
sufferin% from diaetes, is 7ustified if shown to e life9threatenin%.

1oth $&C and CA ruled in favor of the relatives of &eresita.

<ssue's): 6KN the ne%li%ence of the doctors caused her death thus
renderin% them liale to pa# dama%esN

3eld: A-D, their decision to proceed with the operation,
notwithstandin% her h#po%l#cemia and without preparin% her for the
procedure, was contrar# to the standards oserved # the medical
profession. Deviation from this standard led to a reach of dut#
resultin% to death, thus, the spouses are liale.

$atio:
&he critical and clinchin% factor in a medical ne%li%ence case is proof
of the causal connection etween the ne%li%ence which the evidence
estalished and the plaintiff+s in7uries> the plaintiff must plead and
prove not onl# that he had een in7ured and defendant has een at
fault, ut also that the defendant+s fault caused the in7ur#.

,edical Ne%li%ence is a wron% committed # a medical professional
causin% harm or death to a patient. &he elements of which are: dut#,
reach, in7ur# and pro0imate causation.
Dut#: Dtandard ehavior which imposes restrictions on ones conduct
'the amount of competence associated with the proper dischar%e of a
profession)
1reach: 6hen ph#sician fails to compl# with these professional
standards. <f in7ur# results from this, he is liale for ne%li%ence.
<t must e proven that:
!) .h#sician either failed to do somethin% which a reasonal# prudent
health care provider would have done, or did somethin% a reasonal#
prudent provider would not have done.
2) &his failure or action caused in7ur# to the patient. 'est shown
throu%h e0pert testimon#)

<n this case:
!) Felicisima did not even check on her patient or talk to her efore
the operation '< think the DC is wron% here, ecause the case was an
emer%enc# and usuall# someone else does it for them T ut then
a%ain, thatXs 7ust me G)
2) &he spouses were not ale to prove that the leedin% was life9
threatenin%. Dr. Flores should not have made the decision to operate
on her ecause he was not an e0pert in the field of %#necolo%#.

14. Cayao%6asa( v. Ra(olete
GR 19132, +e$e()er 18, 2008
Facts: $amolete underwent raspa 'DWC procedure ) under Ca#a*9
Lasam and was dischar%ed the followin% da#. Dhe was rou%ht to the
hospital a%ain for severe adominal pains and vomitin%. Dhe was
informed that there is a dead fetus in her womd. Dhe underwent
laparatom# and she was found to have massive intraadominal
hemorrha%e and a ruptured uterus. Dhe had to under%o
h#sterectorm# and as a result she can:t ear a child an#more.
$amolete sa#s that the h#sterectom# is due to the ne%li%ence of
Ca#ao9Lasam in performin% raspa 'not knowin% that what she had
was an ectopic pre%nanc#). Ca#ao9Lasam sa#s that it was ecause of
$amolete:s insistence to e dischar%ed immediatel# and failin% to %o
to her check up.
3eld: $amolete did not present an# e0pert testimon# to support their
claim. Ca#ao9Lasam presented an e0pert on the su7ect who stated
DWC was not the pro0imate cause of the rupture of -ditha:s uterus
resultin% in her h#sterectom#. &he DWC was conducted in accordance
with the standard practice, with the same level of care that an#
reasonal# competent doctor would use to treat a condition under the
same circumstances. Assumin% that there was in fact a misdia%nosis,
the same would have een rectified if $amolete followed the order to
return for a check9up. Dhe omitted the dili%ence re@uired # the
circumstances which could have avoided the in7ur#. &he omission in
not returnin% for a follow9up evaluation pla#ed a sustantial part in
rin%in% aout her in7ur#. 3ad she returned, Ca#ao9Lasam could have
conducted the proper medical tests and procedure necessar# to
determine her health condition and applied the correspondin%
treatment which could have prevented the rupture of her uterus.
D?C&$<N-: ,edical malpractice is a particular form of ne%li%ence
which consists in the failure of a ph#sician or sur%eon to appl# use at
least the same level of care that an# reasonal# competent doctor
would use to treat a condition under the same circumstances. As to
this aspect of medical malpractice, the determination of the
reasonale level of care and the reach thereof, e0pert testimon# is
essential. Further, inasmuch as the causes of the in7uries involved in
malpractice actions are determinale onl# in the li%ht of scientific
knowled%e, it has een reco%niBed that e0pert testimon# is usuall#
necessar# to support the conclusion as to causation.
All told, doctors are protected # a special rule of law. &he# are not
%uarantors of care. &he# are not insurers a%ainst mishaps or unusual
conse@uences speciall# so if the patient herself did not e0ercise the
proper dili%ence re@uired to avoid the in7ur#.
1. 6u$as v. 0uano
GR 1*8*63, #pril 21, 2009
Facts: Lucas had a sore e#e and used ma0itrol 'steroid ased) for it.
3e then consulted Dr. &uano 'opthal) on ?ctoer !"88. 3e was
prescried a different medicine. &he sore e#es was cured ut the e#e
developed -FC 'a viral infection) and he was told to use ma0itrol.
-FC tapered down and Lucas was told %raduall# reduce the dosa%e
of ma0itrol otherwise -FC mi%ht recur. 3is -FC recurred and he was
told to resume the ori% dosa%e of ma0itrol. 1lephamide 'also steroid
ased) was used when ma0itrol is unavailale. Lucas discovered that
prolon%ed used of ma0itrol is dan%erous to the e#es 'ma# develop
%laucoma). 3e told &uano aout it ut the doctor 7ust rushed it aside.
1# Decemer his ri%ht e#e was lind and he was told to stop the use
of ma0itrol and was prescried different medicines. &uano referred
Lucas to another Doctor for the treatment of %laucoma and &uano
treated him accordin% to the advice of that doctor. Lucas consulted Dr.
A@uino on his own initiative and was told that his condition needs
lifetime med and follow ups. Lucas underwent two operations '!""*
and !""!) of laser traeculoplast#. 3e said that what he had is
steroid9induced %laucoma and sued &uano. &uano sa#s that Lucas
%laucoma is not steroid induced for if it were, it would disappear with
the discontinue of the use of ma0itrol.
3eld: No e0pert testimon# was presented. Asent a definitive
standard of care or dili%ence re@uired of the Dr. &uano under the
circumstances, the Court can:t determine whether he was ale to
compl# with the same in his dia%nosis and treatment of Lucas. &here
is no causation etween use of ma0itrol and %laucoma. Lucas failed
to prove # preponderance of evidence that &uani failed to e0ercise
that de%ree of skill, care and learnin% possessed # other persons in
the same profession> and that as a pro0imate result if such failure, the
patient or his heirs suffered dama%es. &he mere fact that the patient
does not %et well or that a ad result is not determinative of the
performance of the ph#sician and he is not re@uired to e infallile.
6hen a patient en%a%es the services of a ph#sician, a ph#sician9
patient relationship is %enerated. And in acceptin% a case, the
ph#sician, for all intents and purposes, represents that he has the
needed trainin% and skill possessed # ph#sicians and sur%eons
practicin% in the same field> and that he will emplo# such trainin%,
care, and skill in the treatment of the patient. &hus, in treatin% his
patient, a ph#sician is under a dut# to Ithe formerJ to e0ercise that
de%ree of care, skill and dili%ence which ph#sicians in the same
%eneral nei%horhood and in the same %eneral line of practice
ordinaril# possess and e0ercise in like cases. Dtated otherwise, the
ph#sician has the dut# to use at least the same level of care that an#
other reasonal# competent ph#sician would use to treat the condition
under similar circumstances.
&his standard level of care, skill and dili%ence is a matter est
addressed # e0pert medical testimon#, ecause the standard of care
in a medical malpractice case is a matter peculiarl# within the
knowled%e of e0perts in the field.
16. P'- v. #;ana HResolution<
GR 12629*, 5e)ruary 2, 2010
Facts: .D<, to%ether with Dr. ,i%uel Ampil 'Dr. Ampil) and Dr. Guan
Fuentes 'Dr. Fuentes), was impleaded # -nri@ue A%ana and
Natividad A%ana 'later sustituted # her heirs), in a complaint for
dama%es filed in the $e%ional &rial Court '$&C) of QueBon Cit#,
1ranch "C, for the in7uries suffered # Natividad when Dr. Ampil and
Dr. Fuentes ne%lected to remove from her od# two %auBes which
were used in the sur%er# the# performed on her on April !!, !"85 at
the ,edical Cit# 2eneral 3ospital. .D< was impleaded as owner,
operator and mana%er of the hospital.
<n a decision dated ,arch !=, !""(, the $&C held .D< solidaril# liale
with Dr. Ampil and Dr. Fuentes for dama%es. ?n appeal, the Court of
Appeals 'CA), asolved Dr. Fuentes ut affirmed the liailit# of Dr.
Ampil and .D<, su7ect to the ri%ht of .D< to claim reimursement from
Dr. Ampil.
?n petition for review, this Court, in its Ganuar# (!, 2**= decision,
affirmed the CA decision. .D< filed a motion for reconsideration ut
the Court denied it in a resolution dated Feruar# !!, 2**8.
<ssue: 6hether the hospital is liale for dama%esN
3eld: A-D, Nonetheless, to alla# the an0iet# of the intervenors, the
Court holds that, in this particular instance, the concurrent findin% of
the $&C and the CA that .D< was not the emplo#er of Dr. Ampil is
correct. Control as a determinative factor in testin% the emplo#er9
emplo#ee relationship etween doctor and hospital under which the
hospital could e held vicariousl# liale to a patient in medical
ne%li%ence cases is a re@uisite fact to e estalished #
preponderance of evidence. 3ere, there was insufficient evidence that
.D< e0ercised the power of control or wielded such power over the
means and the details of the specific process # which Dr. Ampil
applied his skills in the treatment of Natividad. Conse@uentl#, .D<
cannot e held vicariousl# liale for the ne%li%ence of Dr. Ampil under
the principle of respondeat superior.
.D< could not simpl# wave off the prolem and nonchalantl# dele%ate
to Dr. Ampil the dut# to review what transpired durin% the operation.
&he purpose of such review would have een to pinpoint when, how
and # whom two sur%ical %auBes were mislaid so that necessar#
remedial measures could e taken to avert an# 7eopard# to
Natividad:s recover#. Certainl#, .D< could not have e0pected that
purpose to e achieved # merel# hopin% that the person likel# to
have mislaid the %auBes mi%ht e ale to retrace his own steps. 1# its
own standard of corporate conduct, .D<+s dut# to initiate the review
was non9dele%ale.
6hile Dr. Ampil ma# have had the primar# responsiilit# of notif#in%
Natividad aout the missin% %auBes, .D< imposed upon itself the
separate and independent responsiilit# of initiatin% the in@uir# into
the missin% %auBes. &he purpose of the first would have een to
apprise Natividad of what transpired durin% her sur%er#, while the
purpose of the second would have een to pinpoint an# lapse in
procedure that led to the %auBe count discrepanc#, so as to prevent a
recurrence thereof and to determine corrective measures that would
ensure the safet# of Natividad. &hat Dr. Ampil ne%li%entl# failed to
notif# Natividad did not release .D< from its self9imposed separate
responsiilit#.
Corollar# to its non9dele%ale undertakin% to review potential incidents
of ne%li%ence committed within its premises, .D< had the dut# to take
notice of medical records prepared # its own staff and sumitted to
its custod#, especiall# when these ear earmarks of a sur%er# %one
awr#. &hus, the record taken durin% the operation of Natividad which
reported a %auBe count discrepanc# should have %iven .D< sufficient
reason to initiate a review. <t should not have waited for Natividad to
complain.
As it happened, .D< took no heed of the record of operation and
conse@uentl# did not initiate a review of what transpired durin%
Natividad:s operation. $ather, it shirked its responsiilit# and passed it
on to others T to Dr. Ampil whom it e0pected to inform Natividad, and
to Natividad herself to complain efore it took an# meanin%ful step. 1#
its inaction, therefore, .D< failed its own standard of hospital care. -t
$o((itte& $orporate ne;li;en$e.
<t should e orne in mind that the corporate ne%li%ence ascried to
.D< is different from the medical ne%li%ence attriuted to Dr. Ampil.
&he duties of the hospital are distinct from those of the doctor9
consultant practicin% within its premises in relation to the patient>
hence, the failure of .D< to fulfill its duties as a hospital corporation
%ave rise to a direct liailit# to the A%anas distinct from that of Dr.
Ampil.
All this notwithstandin%, we make it clear that .D<:s hospital liailit#
ased on ostensile a%enc# and corporate ne%li%ence applies onl# to
this case, pro hac vice. <t is not intended to set a precedent and
should not serve as a asis to hold hospitals liale for ever# form of
ne%li%ence of their doctors9consultants under an# and all
circumstances. &he rulin% is uni@ue to this case, for the liailit# of .D<
arose from an implied a%enc# with Dr. Ampil and an admitted
corporate dut# to Natividad
1*. 6i v 'oli(an
/illara(a, Jr., J.
June *, 2001
$A&<? D-C<D-ND<: <n a malpractice action ased upon the doctrine
of informed consent, four essential elements must e proven:
&he ph#sician had a dut# to disclose material risks
DKhe failed to disclose or inade@uatel# disclosed those risks
As a direct and pro0imate result of the failure to disclose, the patient
consented to treatment sKhe otherwise would not have consented to
.laintiff was in7ured # the proposed treatment
QH<CF FAC&D: Dpouses Doliman:s dau%hter underwent knee
amputation, which necessitated ad7uvant chemotherap# to minimiBe
the chances of recurrence and prevent the disease from spreadin% to
other parts of the od#. !! da#s after the administration of the first
c#cle of the chemotherap# re%imen, spouses Doliman:s dau%hter
died.
FAC&D:
Name of petitioner9 Dr. $ui Li
Name of respondent9 Dpouses $e#naldo and Lina Doliman
Dpouses Doliman:s dau%hter, An%elica Doliman, was found to e
sufferin% from osteosarcoma, osteolastic t#pe, a hi%h9%rade 'hi%hl#
mali%nant) cancer of the one which usuall# affects teena%e children.
Followin% this dia%nosis, An%elica:s ri%ht le% was amputated # Dr.
Gaime &ama#o in order to remove the tumor. As ad7uvant treatment,
chemotherap# was su%%ested. An%elica was referred to Dr. Li, a
medical oncolo%ist.
Dhe was dischar%ed four da#s after the sur%er# ut was instructed to
return after two or three weeks for the chemotherap#.
?n Au%ust !8, !""(, she was readmitted to Dt. Luke:s ,edical Center
'DL,C). Dhe died !! da#s later.
DL,C refused to release a death certificate without pa#ment of the
hospital ill. 3ence, the spouses rou%ht their dau%hter:s cadaver to
the .N. Crime Laorator# for post9mortem e0amination.
&he ,edico9Le%al $eport indicated the cause of death as
M3#povolemic shock secondar# to multiple or%an hemorrha%es and
Disseminated <ntravascular Coa%ulation.L
?n the other hand, the Certificate of Death issued # DL,C indicated
that the immediate cause of death was osteosarcoma.
&he spouses filed a dama%e suit a%ainst Dr. Li, Dr. ,arella and Dr.
Ledesma 'Dr. Li:s assistants in handlin% An%elica:s case), Dr. Arriete,
and DL,C.
&he# were char%ed with ne%li%ence and disre%ard of An%elica:s
safet#, health, and welfare # their careless administration of the
chemotherap# dru%s, their failure to oserve the essential precautions
in detectin% earl# the s#mptoms of fatal lood platelet decrease and
stoppin% earl# on the chemotherap#, which leedin% led to
h#povolemic shock that caused An%elica:s untimel# demise.
Dr. Li assured the spouses that An%elica would recover in view of "4Y
chance of healin% with chemotherap# and enumerated the side effects
as: '!) sli%ht vomitin%> '2) hair loss> and '() weakness.
Dpouses claim that the# would not have %iven their consent to
chemotherap# had Dr. Li not falsel# assured them of its side effects.
Dr. Li denied havin% een ne%li%ent in administerin% the
chemotherap# dru%s to An%elica and asserted that she had full#
e0plained to the spouses how the chemotherap# will affect not onl#
the cancer cells ut also the patient:s normal od# parts, includin% the
white and red lood cells and platelets.
6hat happened to An%elica can e attriuted to mali%nant tumor cells
possil# left ehind after sur%er#. Few as the# ma# e, these have the
capacit# to compete for nutrients such that the od# ecomes so
weak structurall# 'cache0ia) and functionall# in the form of lower
resistance of the od# to comat infection.
&his infection ecomes uncontrollale and tri%%ers a chain of events
'sepsis or septicemia) that ma# lead to leedin% in the form of
Disseminated <ntravascular Coa%ulation 'D<C), as what the autops#
report showed in the case of An%elica.
6itnesses presented # spouses:
Dr. Eer%ara 'medico9le%al): the D<C can e attriuted to the chemical
a%ents in the dru%s %iven to the victim, which caused platelet
reduction resultin% to leedin% sufficient to cause the victim:s death.
&he time lapse for the production of D<C 'from the time of dia%nosis of
sarcoma) was too short, considerin% the survival rate of aout (
#ears. Dr. Eer%ara admitted that she is not a patholo%ist ut her
statements were ased on the opinion of an oncolo%ist whom she had
interviewed.
Dr. 1almaceda: it is the ph#sician:s dut# to inform and e0plain to the
patient or his relatives ever# known side effect of the procedure or
therapeutic a%ents to e administered, efore securin% the consent of
the patient or his relatives to such procedure or therap#. 3e stressed
that the patient or relatives must e informed of all known side effects
ased on studies and oservations, even if such will a%%ravate the
patient:s condition.
Dr. &ama#o 'who performed the amputation) testified for Dr. Li : Dr. Li
was one of the most proficient in the treatment of cancer and the
patient was afflicted with a ver# a%%ressive t#pe of cancer
necessitatin% chemotherap# as ad7uvant treatment
$&C9 Dr. Li is not liale for dama%es as she oserved the est known
procedures and emplo#ed her hi%hest skill and knowled%e in the
administration of chemotherap# dru%s on An%elica. Citin% .icart v
Dmith, declared that Li has taken the necessar# precaution a%ainst
the adverse effect of chemotherap# on An%elica. A wron% decision is
not # itself ne%li%ence.
CA9 awarded dama%es> while there was no ne%li%ence on her part,
Dr. Li as her attendin% ph#sician failed to full# e0plain to the spouses
all the known side effects of chemotherap# 'doctrine of informed
consent)
<DDH-: 6oN Dr. Li can e liale for failure to full# disclose serious
side effects of chemotherap#, despite the asence of findin% that Dr.
Li was ne%li%ent in administerin% said treatment.
D-C<D<?N: No. !) &here was ade@uate disclosure of material risks
and 2) the spouses failed to present e0pert testimon#.
$A&<?:
&he doctrine of informed consent within the conte0t of ph#sician9
patient relationships %oes far ack into -n%lish common law.
As earl# as !=C=, doctors were char%ed with Matter#L 'unauthoriBed
ph#sical contact with a patient) if the# had not %ained the consent of
their patients prior to performin% a sur%er# or procedure.
Dchoendorff v Dociet# of New Aork 3ospital: -ver# human ein% of
adult #ears and sound mind has a ri%ht to determine what shall e
done with his own od#> and a sur%eon who performs an operation
without his consent, commits and assault, for which he is liale in
dama%es.
Canterur# v Dpence: 'as to scope of disclosure) &he disclosure rule
onl# re@uires of the ph#sician a reasonale e0planation, which means
%enerall# informin% the patient in nontechnical terms as to what is at
stake, the therap# alternatives availale to him, the %oals e0pectal#
to e achieved, and the risks that ma# ensue from particular treatment
or no treatment.
&he patient:s ri%ht of self9decision can onl# e effectivel# e0ercised if
the patient possesses ade@uate information to enale him in makin%
an intelli%ent choice. &he test therefore for determinin% whether a
potential peril must e divul%ed is its materialit# to the patient:s
decision.
Four essential elements to prove in a malpractice action ased upon
the doctrine of informed consent: '!) &he ph#sician had a dut# to
disclose material risks> '2) DKhe failed to disclose or inade@uatel#
disclosed those risks> '() As a direct and pro0imate result of the failure
to disclose, the patient consented to treatment sKhe otherwise would
not have consented to and '5) .laintiff was in7ured # the proposed
treatment
.laintiff is re@uired to point to si%nificant undisclosed information
relatin% to the treatment which would have altered her decision to
under%o it.
?n disclosure of material risks
&here was ade@uate disclosure of material risks inherent in the
chemotherap# procedure performed with the consent of An%elica:s
parents.
6hen Dr. Li informed the spouses eforehand of the side effects
which include lowered counts of 61C and $1C, decrease in lood
platelets, possile kidne# or heart dama%e and skin darkenin%, there
is reasonale e0pectation on the part of the doctor that the
respondents understood ver# well that the severit# of these side
effects will not e the same for all patients under%oin% the procedure.
1# the ver# nature of the disease, the ph#sician cannot precisel#
determine each patient:s reaction to the chemical a%ents.
&hat death can possil# result from complications of the treatment or
the underl#in% cancer itself is a risk that cannot e ruled out, as with
most other ma7or medical procedures, ut conclusion can e
reasonal# drawn from the %eneral side effects of chemotherap#
alread# disclosed.
?n failure to present e0pert testimon#
<n a medical malpractice action ased on lack of informed consent,
the plaintiff must prove oth the dut# and the reach of that dut#
throu%h e0pert testimon#. Duch testimon# must show the customar#
standard of care of ph#sicians in the same practice as that of the
defendant doctor.
&he testimon# of Dr. 1almaceda, who is not an oncolo%ist, does not
@ualif# as e0pert testimon# to estalish the standard of care in
otainin% consent for chemotherap# treatment.
Carpio, dissentin%.
&here are two standards # which courts determine what constitutes
ade@uate disclosure of associated risks and side effects of a
proposed treatment:
.h#sician standard9 a doctor is oli%ated to disclose that information
which a reasonale doctor in the same field of e0pertise would have
disclosed to hisKher patient
.atient standard9 a doctor is oli%ated to disclose that information
which a reasonale patient would deem material in decidin% whether
to proceed with a proposed treatment
3istoricall#, courts used the ph#sician standard. 3owever, modern
prevailin% trend amon% courts is to use the patient standard of
materialit#.
An# definition of scope in terms of a professional standard is at odds
with the patient:s prero%ative to decide on pro7ected therap# himself.
<n order to determine what risks and side effects of a proposed
treatment are material and should e disclosed to the patient,
testimon# # an e0pert witness is unnecessar# 'Canterur#).
Dr. Li admitted that she assured the spouses that there was an 8*Y
chance that An%elica:s cancer would e controlled and that she
disclosed to them onl# some of the associated risks and side effects
of chemotherap#. &hus, Dr. Li impliedl# admits that she failed to
disclose man# of the other associated risks and side effects of
chemotherap#, includin% the most materialZinfection, sepsis, and
death.
Clearl#, infection, sepsis, and death are material risks and side effects
of chemotherap#. &o an# reasonale person, the risk of death is one
of the most important, if not the most important, consideration in
decidin% whether to under%o a proposed treatment.
3ad the spouses full# known the severit# of the risks and side effects
of chemotherap#, the# ma# have opted not to %o throu%h with the
treatment of their dau%hter. <n fact, after some of the side effects of
chemotherap# manifested, the# asked Dr. Li to stop the treatment.
1rion, concurrin% and dissentin%.
Concurs in the result and its conclusion that the respondents failed to
prove # preponderance of evidence the essential elements of a
cause of action ased on the doctrine of informed consent.
Disa%rees with the ponencia:s conclusion that there was ade@uate
disclosure of material risks of the chemotherap# administered in view
of a complete asence of competent e0pert testimon# estalishin% a
medical disclosure standard in the case.
$ather, the conclusion is ased on spouses: failure to prove #
competent e0pert testimon# the first and fourth elements of a prima
facie case for lack of informed consent, specificall#:
&he scope of the dut# to disclose and the violation of this dut# 'i.e.,
failure to define what should e disclosed and to disclose the re@uired
material risks or side effects of chemotherap# that allow the patient
andKor her parents to properl# decide whether to under%o
chemotherap#
&hat the chemotherap# administered # Dr. Li pro0imatel# caused the
death of An%elica Doliman.
18. +r. Jar$ia an& !astan vs People of the Philippines
GR 18*926, 5e)ruary 1, 2012
Facts:
1elinda Dantia%o ',rs. Dantia%o) lod%ed a complaint with the National
1ureau of <nvesti%ation 'N1<) a%ainst the petitioners, Dr. -mmanuel
Garcia, Gr. 'Dr. Garcia) and Dr. ,arilou 1astan 'Dr. 1astan), for their
alle%ed ne%lect of professional dut# which caused her son, $o#
Alfonso Dantia%o '$o# Gr.), to suffer serious ph#sical in7uries. Hpon
investi%ation, the N1< found that $o# Gr. was hit # a ta0ica> that he
was rushed to the ,anila Doctors 3ospital for an emer%enc# medical
treatment> that an 89ra# of the victim:s ankle was ordered> that the 89
ra# result showed no fracture as read # Dr. Garcia> that Dr. 1astan
entered the emer%enc# room '-$) and, after conductin% her own
e0amination of the victim, informed ,rs. Dantia%o that since it was
onl# the ankle that was hit, there was no need to e0amine the upper
le%> that eleven '!!) da#s later, $o# Gr. developed fever, swellin% of
the ri%ht le% and misali%nment of the ri%ht foot> that ,rs. Dantia%o
rou%ht him ack to the hospital> and that the 89ra# revealed a ri%ht
mid9tiial fracture and a linear hairline fracture in the shaft of the one.
&he N1< indorsed the matter to the ?ffice of the Cit# .rosecutor of
,anila for preliminar# investi%ation. .roale cause was found and a
criminal case for reckless imprudence resultin% to serious ph#sical
in7uries, was filed a%ainst Dr. Garcia, Dr. 1astan and Dr. .amittan,4
efore the $&C, docketed as Criminal Case No. *!9!"CC5C.
?n Gune !5, 2**4, the $&C found the petitioners %uilt# e#ond
reasonale dout of the crime of Dimple <mprudence $esultin% to
Derious .h#sical <n7uries. CA affirmed.
<ssues:
I!J whether or not the doctrine of res ipsa lo@uitur is applicale in this
case>
I2J whether or not the petitioners are liale for criminal ne%li%ence.
3eld:
!. N?, &he re@uisites for the application of the doctrine of res ipsa
lo@uitur are: '!) the accident was of a kind which does not ordinaril#
occur unless someone is ne%li%ent> '2) the instrumentalit# or a%enc#
which caused the in7ur# was under the e0clusive control of the person
in char%e> and '() the in7ur# suffered must not have een due to an#
voluntar# action or contriution of the person in7ured.
<n this case, the circumstances that caused patient $o# Gr.:s in7ur#
and the series of tests that were supposed to e under%one # him to
determine the e0tent of the in7ur# suffered were not under the
e0clusive control of Drs. Garcia and 1astan. <t was estalished that
the# are mere residents of the ,anila Doctors 3ospital at that time
who attended to the victim at the emer%enc# room. 6hile it ma# e
true that the circumstances pointed out # the courts elow seem
doutless to constitute reckless imprudence on the part of the
petitioners, this conclusion is still est achieved, not throu%h the
scholarl# assumptions of a la#man like the patient:s mother, ut # the
un@uestionale knowled%e of e0pert witnessKes
2. N?, &he elements of simple ne%li%ence are: '!) that there is lack of
precaution on the part of the offender, and '2) that the dama%e
impendin% to e caused is not immediate or the dan%er is not clearl#
manifest.
<n this case, the Court is not convinced with moral certaint# that the
petitioners are %uilt# of reckless imprudence or simple ne%li%ence.
&he elements thereof were not proved # the prosecution e#ond
reasonale dout.
<nduital#, a ph#sician9patient relationship e0ists etween the
petitioners and patient $o# Gr. Notal#, the latter and his mother went
to the -$ for an immediate medical attention. &he petitioners
alle%edl# passed # and were re@uested to attend to the victim
'contrar# to the testimon# of Dr. &acata that the# were, at that time,
residents on dut# at the -$). &he# oli%ed and e0amined the victim,
and later assured the mother that ever#thin% was fine and that the#
could %o home. Clearl#, a ph#sician9patient relationship was
estalished etween the petitioners and the patient $o# Gr.
&o repeat for clarit# and emphasis, if these doctors knew from the
start that the# were not in the position to attend to $o# Gr., a vehicular
accident victim, with the de%ree of dili%ence and commitment
e0pected of ever# doctor in a case like this, the# should have not
made a aseless assurance that ever#thin% was all ri%ht. 1# doin% so,
the# deprived $o# Gr. of ade@uate medical attention that placed him in
a more dan%erous situation than he was alread# in. 6hat petitioners
should have done, and could have done, was to refer $o# Gr. to
another doctor who could competentl# and thorou%hl# e0amine his
in7uries.
19. 8anila +o$tors 1ospital vs. Chua an& 0y H,ote9 pasensya na
=un; (aha)a, i(portante lahat e, (ahirap )a:asan<
5a$ts: $espondent Chua, mother of &#, was admitted to petitioner
hospital for h#pertension and diaetes. 6hile Chua was confined,
another dau%hter Gudith Chua was admitted for treatment of in7uries
sustained after a vehicular accident. &# shouldered the hospital ills
for the two. After Gudith was dischar%ed, respondent Chua remained
confined. &# was ale to pa# .5(4,8**.**. &he hospital ills
eventuall# totaled .!,*=4,4"2."4. 6hen &# was unale to pa# the
ills, the hospital alle%edl# pressured her, # cuttin% off the telephone
line in her room and removin% the air9conditionin% unit, television set,
and refri%erator, refusin% to render medical attendance and to chan%e
the hospital %own and ed sheets, and arrin% the private nurses or
midwives from assistin% the patient, to settle the same throu%h the
si%nin% of a promissor# note. &# issued postdated checks to pa# the
note. &he checks ounced.
&he petitioner alle%ed that that as earl# as one week after
respondent Chua had een admitted to its hospital, Dr. $od# D#, her
attendin% ph#sician, had alread# %iven instructions for her to e
dischar%ed, ut respondents insisted that Chua remain in
confinement. <t also alle%ed that &# voluntaril# si%ned the a%reement
that she will pa# the ills and that no undue pressure was e0erted #
them> and that the cuttin%9off of the telephone line and removal of the
air9conditionin% unit, television set, and refri%erator cannot constitute
unwarranted actuations, for the same were resorted to as cost9cuttin%
measures and to minimiBe respondents+ char%es that were alread#
pilin% up, especiall# after respondent &# refused to settle the alance
notwithstandin% fre@uent demands. Finall# it alle%ed that this case
was instituted # &# to provide levera%e a%ainst the hospital for filin%
criminal char%es a%ainst the latter for violation of 1. 22.
1oth the trial court and the CA rendered decisions in favor of
the respondents findin% that the removal of the facilities led to the
worsenin% of Chua:s condition.
-ssue: 6hether or not the hospital is liale for dama%es.
Rulin;: No. &he operation of private pa# hospitals and medical clinics
is impressed with pulic interest and imued with a heav# social
responsiilit#. 1ut the hospital is also a usiness, and, as a usiness,
it has a ri%ht to institute all measures of efficienc# commensurate to
the ends for which it is desi%ned, especiall# to ensure its economic
viailit# and survival. And in the le%itimate pursuit of economic
considerations, the e0tent to which the pulic ma# e served and
cured is e0panded, the pulse and life of the medical sector @uickens,
and the re%eneration of the people as a whole ecomes more visil#
attainale. <n the institution of cost9cuttin% measures, the hospital has
a ri%ht to reduce the facilities and services that are deemed to e non9
essential, such that their reduction or removal would not e
detrimental to the medical condition of the patient.
&he lower court:s decisions are results of misappreciation of
the uncorroorated and self9servin% evidence presented # the
respondents. &he evidence in the record firml# estalishes that the
staff of the petitioner took proactive steps to inform the relatives of
respondent Chua of the removal of facilities prior thereto, and to carr#
out the necessar# precautionar# measures to ensure that her health
and well9ein% would not e adversel# affected. Also, the medical
condition of respondent Chua, as consistentl# and indisputal#
confirmed # her attendin% ph#sician, Dr. $od# D#, a cardiolo%ist, who
was called as witness for oth parties, whom even respondent Chua
repeatedl# praised to e ;m# doctor; and ;a ver# %ood doctor; at that,
and whose statements at times had een corroorated # other
competent witnesses, had een ;relativel# well,;
;amulator#,; ;walkin% around in the room,; and that she was ;ale to
leave the hospital on her own without an# assistance>; that althou%h
she complained of s#mptoms such as diBBiness, weakness, and
adominal discomfort, Dr. D# re@uested several medical
e0aminations, such as the laorator# tests, renal tests, ,$<,
ultrasound, and C& scan, all of which were administered after
procurin% the consent of respondent Chua+s famil# as admitted #
respondent &# herself, and even called on other specialists, such as a
neurolo%ist, endocrinolo%ist, and %astroenterolo%ist, to look into her
condition and conduct other tests as well accordin% to their fields of
specialt#, all of which #ielded no serious findin%. Finall#, her illnesses
were ;lifelon% illnesses; at a sta%e where the# cannot e totall#
removed or aolished, makin% it clear to her famil# that ;one hundred
percent recover# is not possile; despite ein% %iven dail# medication
in the hospital. 3er condition, nonetheless, is not serious, as the lood
pressure is more or less controlled and within acceptale limits, ;not
that critical to precipitate an# acute attack,; nor likel# to fall into an#
emer%enc#, nor #et does she re@uire continuous or prolon%ed
hospitaliBation since she was stale enou%h to e treated at home
and on an ;out9patient; asis, so much so that Dr. D# encoura%ed her
to e0ercise and avoid restin% all the time, and recommended that
;an#time she ma# e dischar%ed; even in 7ust ;two weeks after
confinement,; the propriet# of his order of dischar%e concurred upon
# the other specialists as well, had it not een for respondents+
insistence to sta# in the hospital in view of their hope for asolute
recover# despite the admission of respondent Chua herself that she
cannot an#more e totall# cured.
Authorities e0plicitl# declare that a patient cannot e
detained in a hospital for non9pa#ment of the hospital ill. <f the patient
cannot pa# the hospital or ph#sician+s ill, the law provides a remed#
for them to pursue, that is, # filin% the necessar# suit in court for the
recover# of such fee or ill. <f the patient is prevented from leavin% the
hospital for his inailit# to pa# the ill, an# person who can act on his
ehalf can appl# in court for the issuance of the writ of $abeas corpus.
&he form of restraint must e total> movement must e restrained in
all directions. <f restraint is partial, e.%., in a particular direction with
freedom to proceed in another, the restraint on the person+s liert# is
not total. 3owever, the hospital ma# le%all# detain a patient a%ainst
his will when he is a detained or convicted prisoner, or when the
patient is sufferin% from a ver# conta%ious disease where his release
will e pre7udicial to pulic health, or when the patient is mentall# ill
such that his release will endan%er pulic safet#, or in other e0i%ent
cases as ma# e provided # law. ,oreover, under the common law
doctrines on tort, it does not constitute a trespass to the person to
momentaril# prevent him from leavin% the premises or an# part
thereof ecause he refuses to compl# with some reasonale condition
su7ect to which he entered them. <n all cases, the condition of this
kind of restraint must e reasonale in the li%ht of the circumstances.
At an# rate, as stated aove, the patient is free to leave the
premises, even in the ostensile violation of these conditions, after
ein% momentaril# interrupted # the hospital staff for purposes of
informin% him of those reasonale conditions or simpl# for purposes of
makin% a demand to settle the ill. <f the patient chooses to ascond
or leave without the consent of the hospital in violation of an# of the
conditions deemed to e reasonale under the circumstances, the
hospital ma# nonetheless re%ister its protest and ma# choose to
pursue the le%al remedies availale under law, provided that the
hospital ma# not ph#sicall# detain the patient, unless the case falls
under the e0ceptions aovestated.
Authorities are of the view that, ordinaril#, a hospital,
especiall# if it is a private pa# hospital, is entitled to e compensated
for its services, # either an e0press or an implied contract, and if no
e0press contract e0ists, there is %enerall# an implied a%reement that
the patient will pa# the reasonale value of the services
rendered> when a hospital treats a patient+s in7uries, it has an
enforceale claim for full pa#ment for its services, re%ardless of the
patient+s financial status. &he re@uirement to have the relative of
respondent Chua to e0ecute a promissor# note as part of the
arran%ement to settle the unpaid oli%ations is a formalit# that
converts an# implied contract into written form and, moreover,
amounts to a reasonale condition, the non9fulfillment of which, in
itself, however, as discussed, cannot allow the hospital to detain the
patient. Contrar# to the findin%s of the courts a quo, that such an
a%reement emodied in a promissor# note, as well as the Contract for
Admission and Acknowled%ment of $esponsiilit# for .a#ment dated
?ctoer (*, !""*, do not ecome contracts of adhesion simpl#
ecause the person si%nin% it was under stress that was not the result
of the actions of the hospital, especiall# takin% into account that there
is testimon# to the effect that respondent &# si%ned the .romissor#
Note dated Gune 4, !""2 in the presence of counsel and actin% under
his advise.
20. RC#P vs. .Be$utive 'e$retary .r(ita
5a$ts: &here was a report that handwritten copies of two sets of 2**C
Nursin% 1oard e0amination were circulated durin% the e0amination
period amon% e0aminees reviewin% at the $.A. 2apuB $eview Center
and <nress $eview Center. &he e0aminees were provided with a list of
4** @uestions and answers in two of the e0aminations: five su7ects,
particularl# &ests <<< '.s#chiatric Nursin%) and E ',edical9Dur%ical
Nursin%). &he .$C later admitted the leaka%e and traced it to two
1oard of Nursin% memers. -0am results came out ut Court of
Appeals restrained the .$C from proceedin% with the oath9takin% of
the successful e0aminees.
.resident 2,A ordered for a re9e0amination and issued -? 4CC
which authoriBed the C3-D to supervise the estalishment and
operation of all review centers and similar entities in the .hilippines.
C3-D Chairman .uno approved C3-D ,emorandum ?rder No. 5"
series of 2**C '<mplementin% $ules and $e%ulations).
$eview Center Association of the .hilippines 'petitioner), an
or%aniBation of independent review centers, asked the C3-D to
;amend, if not withdraw; the <$$ ar%uin%, amon% other thin%s, that
%ivin% permits to operate a review center to 3i%her -ducation
<nstitutions '3-<s) or consortia of 3-<s and professional or%aniBations
will effectivel# aolish independent review centers. C3-D Chairman
.uno however elieved that suspendin% the implementation of the
<$$ would e inconsistent with the mandate of -? 4CC.
A dialo%ue etween the petitioner and C3-D took place. $evised <$$
was approved. .etitioner filed efore the C3-D a .etition to
Clarif#KAmend $<$$ pra#in% to e0clude independent review center
from the covera%e of the C3-D> to clarif# the meanin% of the
re@uirement for e0istin% review centers to tie9up with 3-<s> to revise
the rules to make it conform with $A ==22 limitin% the C3-D:s
covera%e to pulic and private institutions of hi%her. <n 2**=, then
C3-D Chairman Neri responded to the petitioner that: to e0clude the
operation of independent review centers from the covera%e of C3-D
would clearl# contradict the intention of the said -0ecutive ?rder No.
4CC> As to the re@uest to clarif# what is meant # tie9upKe inte%rated
with an 3-<, tie9upKe inte%rated simpl# means, to e in partner with
an 3-<.
.etitioner filed a petition for .rohiition and ,andamus efore this
Court pra#in% for the annulment of the $<$$, the declaration of -?
4CC as invalid and unconstitutional e0ercise of le%islative power, and
the prohiition a%ainst C3-D from implementin% the $<$$. ,otion to
intervene filed # other or%aniBationsKinstitutions were %ranted # the
Court. ?n 2! ,a# 2**8, C3-D issued C3-D ,emorandum ?rder
No. 2!, Deries of 2**8 'C,? 2!, s. 2**8) e0tendin% the deadline for
si0 months from 2= ,a# 2**8 for all e0istin% independent review
centers to tie9up or e inte%rated with 3-<s in accordance with the
$<$$. ?n 24 Novemer 2**8 $esolution, DC resolved to re@uire the
parties to oserve the status @uo prevailin% efore the issuance of -?
4CC, the $<$$, and C,? 2!, s. 2**8.
-ssues: !. 6hether -? 4CC is an unconstitutional e0ercise # the
-0ecutive of le%islative power as it e0pands the
C3-D:s 7urisdiction IAes, it e0pands C3-D:s 7urisdiction, hence
unconsititutionalJ> and
2. 6hether the $<$$ is an invalid e0ercise of the -0ecutive:s
rule9makin% power. IAes, it is invalid.J
Rulin;: !. &he scopes of -? 4CC and the $<$$ clearl# e0pand the
C3-D:s covera%e under $A ==22. &he C3-D:s covera%e under $A
==22 is limited to pulic and private institutions of hi%her education
and de%ree%rantin% pro%rams in all pulic and private post9secondar#
educational institutions. -? 4CC directed the C3-D to formulate a
framework for the re%ulation of review centers and similar entities.
&he definition of a review center under -? 4CC shows that it refers to
one which offers ;a pro%ram or course of stud# that is intended to
refresh and enhance the knowled%e or competencies and skills of
reviewees otained in the formal school settin% in preparation for the
licensure e0aminations; %iven # the .$C. <t does not offer a de%ree
%rantin% pro%ram that would put it under the 7urisdiction of the C3-D.
A review course is onl# intended to ;refresh and enhance the
knowled%e or competencies and skills of reviewees.; &hus, pro%rams
%iven # review centers could not e considered ;pro%rams 0 0 0 of
hi%her learnin%; that would put them under the 7urisdiction of the
C3-D. ;3i%her education,; is defined as ;education e#ond the
secondar# levelL or ;education provided # a colle%e or universit#.;
Further, the ;similar entities; in -? 4CC cover centers providin%
;review or tutorial services; in areas not covered # licensure
e0aminations %iven # the .$C, which include, althou%h not limited
to, colle%e entrance e0aminations, Civil Dervices e0aminations, and
tutorial services. &hese review and tutorial services hardl# @ualif# as
pro%rams of hi%her learnin%.
2. ) &he e0ercise of the .resident:s residual powers under Dection 2*,
&itle < of 1ook <<< of -? 'invoked # the ?D2 to 7ustif# 2,A:s action)
re@uires le%islation> as the provision clearl# states that the e0ercise of
the .resident:s other powers and functions has to e ;provided for
under the law.; &here is no law %rantin% the .resident the power to
amend the functions of the C3-D. &he .resident has no inherent or
dele%ated le%islative power to amend the functions of the C3-D
under $A ==22.
&he line that delineates Le%islative and -0ecutive power is not
indistinct. Le%islative power is ;the authorit#, under the Constitution, to
make laws, and to alter and repeal them.; &he Constitution, as the will
of the people in their ori%inal, soverei%n and unlimited capacit#, has
vested this power in the Con%ress of the .hilippines. An# power,
deemed to e le%islative # usa%e and tradition, is necessaril#
possessed # Con%ress, unless the Constitution has lod%ed it
elsewhere.
&he .resident has control over the e0ecutive department, ureaus
and offices. ,eanin%, he has the authorit# to assume directl# the
functions of the e0ecutive department, ureau and office, or interfere
with the discretion of its officials. Corollar# to the power of control, he
is %ranted administrative power. Administrative power is concerned
with the work of appl#in% policies and enforcin% orders as determined
# proper %overnmental or%ans. <t enales the .resident to fi0 a
uniform standard of administrative efficienc# and check the official
conduct of his a%ents. &o this end, he can issue administrative orders,
rules and re%ulations. An administrative order is an ordinance issued
# the .resident which relates to specific aspects in the administrative
operation of %overnment. <t must e in harmon# with the law and
should e for the sole purpose of implementin% the law and carr#in%
out the le%islative polic#.
Dince -? 4CC is an invalid e0ercise of le%islative power, the $<$$ is
also an invalid e0ercise of the C3-D:s @uasi9le%islative power.
Administrative a%encies e0ercise their @uasi9le%islative or rule9makin%
power throu%h the promul%ation of rules and re%ulations. &he C3-D
ma# onl# e0ercise its rule9makin% power within the confines of its
7urisdiction under $A ==22. 1ut &he $<$$ covers review centers and
similar entities.
?n the issue of whether $A 8"8! as the appropriate law, the .$C has
the power to adopt measures to preserve the inte%rit# and inviolailit#
of licensure e0aminations. 3owever, this power should properl# e
interpreted to refer to the conduct of the e0aminations. &he power to
preserve the inte%rit# and inviolailit# of licensure e0aminations
should e read to%ether with these functions. &hese powers of the
.$C have nothin% to do at all with the re%ulation of review centers.
21. Phil. 8e&i$al #sso$. vs. !oar& of 8e&i$al .Ba(iners an&
0orres
5a$ts: &he 1oard of ,edical -0aminers %ranted Gose ,a. &orres, a
resident of 1asilan Cit#, a Dpanish su7ect and a memer of the
,issionar# Dons of the <mmaculate 3eart of ,ar#, otherwise known
as the Claretian ,issionaries, a license to practice medicine in the
.hilippines without takin% an# e0amination. &he .hilippine ,edical
Association @uestioned the resolution that %ranted such authorit#.
$espondent was earlier %ranted special authorit# to practice medicine
in Lamitan, 1asilan Cit# pursuant to Dection ==!'e) of the $evised
Administrative Code. &his authorit# has een %ranted and revoked
several times in the past dependin% on the e0istence of the
circumstances referred to in the law.
&he 1oard defends its %rant # invokin% &he &reat# on the
Ealidit# of Academic De%rees and &he -0ercise of the .rofessions
etween the $epulic of the .hilippines and the Dpanish Dtate
specificall# Article < thereof which states:
M&he nationals of oth countries who shall have otained de%rees or
diplomas to practice the lieral professions in either of the Contractin%
Dtates, issued # competent national authorities, shall e deemed
competent to e0ercise said professions in the territor# of the
?ther, sub,ect to t$e laws and regulations of t$e latter. 6hen the
de%ree or diploma of 1achelor, issued # competent national
authorities allows its holder without re@uirin% further evidence of
proficienc# to pursue normall# hi%her courses of stud#, he shall also
e deemed @ualified to continue his studies in the territor# of either
.art# in conformit# with the applicale laws and re%ulations of the
Dtate which reco%niBes the validit# of the title or diploma in @uestion,
and with the rules and re%ulations of the particular educational
institution in which he intends to pursue his studies.L
-ssue: 6hether or not the %rant of authorit# to practice medicine in the
countr# is valid.
Rulin;: No. &he theor# of respondent cannot e accepted without
placin% %raduates from our own educational institutions at a
disadvanta%e vis-a-vis Dpanish %raduates from Dpanish schools,
colle%es or universities. <ndeed, the latter could Z under respondent+s
pretense Z en%a%e in the practice of medicine in the .hilippines
without takin% the e0amination prescried in $epulic Act No. 2882,
whereas the former would have to take and pass said e0amination.
6orse still, since Z as we ruled in the *arcia case Z the enefits of
the aforementioned &reat# cannot e availed of in the .hilippines
e0cept # &panis$ su7ects, the result would e Z should
respondent+s contention e sustained Z that %raduates from Dpanish
schools of medicine would e entitled to practice medicine in the
.hilippines without e0amination, if t$ey were &panis$ sub,ects,
ut not if the# are Filipinos.
Daid &reat# merel# e0tended to diplomas issued or de%rees
conferred # educational institutions of Dpain the same reco%nition
and treatment that we accord to similar diplomas or de%rees from
local institutions of learnin%> that holders of said Dpanish diplomas or
de%rees must take the e0amination prescried # our laws for holders
of similar diplomas or de%rees from educational institutions in the
.hilippines.
22. 0a)larin et al. vs. Ju&;e GutierreA, et al.
5a$ts: &he petitioners herein are @uestionin% the constitutionalit# of
administerin% the National ,edical Admission &est 'N,A&) # the
Center for -ducational ,easurement and as re@uired # the 1oard of
,edical -ducation. &he# claim that the continued implementation of
the law re@uirin% the test violates the followin% provisions of the !"8=
Constitution:
'a) Article <<, Dection !!: ;&he state values the di%nit# of ever# human
person and %uarantees full respect of human ri%hts.;
') Article <<, Dection l(: ;&he Dtate reco%niBes the vital role of the
#outh in nation uildin% and shall promote and protect their ph#sical,
moral, spiritual, intellectual and social well9ein%. <t shall inculcate in
the #outh patriotism and nationalism, and encoura%e their involvement
in pulic and civic affairs.;
'c) Article <<, Dection !=: ;&he Dtate shall %ive priorit# to education,
science and technolo%#, arts, culture and sports to foster patriotism
and nationalism, accelerate social pro%ress and to promote total
human lieration and development.;
'd) Article 8<E, Dection l: ;&he Dtate shall protect and promote the
ri%ht of all citiBens to @ualit# education at all levels and take
appropriate steps to make such education accessile to all. ;
'e) Article 8<E, Dection 4 '(): ;-ver# citiBen has a ri%ht to select a
profession or course of stud#, su7ect to fair, reasonale and e@uitale
admission and academic re@uirements>;
that the implementation is a violation of the constitutional principle
which forids the undue dele%ation of le%islative power> that it is an
;unfair, unreasonale and ine@uitale re@uirement,; which results in a
denial of due process> and that is in conflict with the e@ual protection
clause of the Constitution.
-ssue: 6hether or not the implementation of the N,A& is
unconstitutional.
Rulin;: No. .etitioners have not seriousl# undertaken to demonstrate
to what e0tent or in what manner the statute and the administrative
order the# assail collide with the Dtate policies emodied in Dections
!!, !( and != of Article <<. &he# also failed to demonstrate that the
statute and re%ulation the# assail in fact clash with the Dections
referred to under Article 8<E. &he statute and the re%ulation which
petitioners attack are in fact desi%ned to promote ;@ualit# education;
at the level of professional schools. 6hen one reads Dection ! in
relation to Dection 4 '() of Article 8<E as one must one cannot ut
note that the latter phrase of Dection ! is not to e read with asolute
literalness. &he Dtate is not reall# en7oined to take appropriate steps
to make @ualit# education ;accessile to all who mi%ht for an# numer
of reasons wish to enroll in a professional school ut rather merel# to
make such education accessile to all w$o qualify under .fair(
reasonable and equitable admission and academic requirements%
?nto the ne0t point, the necessar# standards are set forth in
Dection ! of the !"4" ,edical Act: ;the standardiBation and re%ulation
of medical education; and in Dection 4 'a) and = of the same Act, the
od# of the statute itself, and that these considered to%ether are
sufficient compliance with the re@uirements of the non9dele%ation
principle.
[ A%ain, petitioners have failed to specif# 7ust what factors or
features of the N,A& render it ;unfair; and ;unreasonale; or
;ine@uitale.; &he# appear to su%%est that passin% the N,A& is an
unnecessar# re@uirement when added on top of the admission
re@uirements set out in Dection = of the ,edical Act of !"4", and
other admission re@uirements estalished # internal re%ulations of
the various medical schools, pulic or private. .etitioners: ar%uments
thus appear to relate to utilit# and wisdom or desirailit# of the N,A&
re@uirement. 1ut constitutionalit# is essentiall# a @uestion of power or
authorit#: this Court has neither commission nor competence to pass
upon @uestions of the desirailit# or wisdom or utilit# of le%islation or
administrative re%ulation. &hose @uestions must e address to the
political departments of the %overnment not to the courts.
&he regulation of t$e practice of medicine in all its ranches has lon%
een reco%niBed as a reasonale method of protectin% the health and
safet# of the pulic. &hat the power to re%ulate and control the
practice of medicine includes the power to re%ulate admission to the
ranks of those authoriBed to practice medicine, is also well
reco%niBed. &hus, le%islation and administrative re%ulations re@uirin%
those who wish to practice medicine first to take and pass medical
board e/aminations have lon% a%o een reco%niBed as valid
e0ercises of %overnmental power. Dimilarl#, the estalishment of
minimum medical educational re@uirements Z i.e., t$e completion of
prescribed courses in a recogni0ed medical sc$ool 1 for admission to
the medical profession, has also een sustained as a le%itimate
e0ercise of the re%ulator# authorit# of the state. 6hat we have efore
us in the instant case is closel# related: t$e regulation of access to
medical sc$ools.
23. 0he !oar& of 8e&i$al .&u$ation vs. #lfonso
5a$ts: .hilippine ,uslim9Christian Colle%e of ,edicine Foundation,
<nc. failed several inspections re%ardin% the ade@uac# of their school
to operate a medical school. A total of five teams of inspectors ruled
the school to e inade@uate in all aspects of the inspection namel#:
colle%e, curriculum, facilities, teachin% hospital, and studentr#.
Accordin%l#, the 1oard of ,edical -ducation recommended to the
D-CD the closure of the Colle%e. &he Department followed the
recommendation. &he Colle%e went to court. <t filed Civil Case No.
!(84 in the court of respondent Gud%e Daniel .. Alfonso a%ainst
Decretar# Quisumin% in her capacit# as Decretar# of -ducation,
Culture and Dports, @uestionin% the decision as ille%al, oppressive,
aritrar# and discriminator# and applied for a writ of preliminar#
in7unction to restrain its implementation. &he writ was issued. &he
1oard of ,edical -ducation then assailed the writ as ein% issued
with %rave ause of discretion.
-ssue: 6hether or not the issuance was tainted with %rave ause of
discretion.
Rulin;: Aes. &he recorded facts @uite clearl# fail to support the
Colle%e+s claim of %rave ause of discretion containin% the order of
closure, and on the contrar# convincin%l# show the challen%ed
decision to e correct. From !"84, no less than five '4) surve#s were
conducted of respondent institution to determine its compliance with
the minimum standards estalished for a medical colle%e. &he
respondent Colle%e knew that the recommendation for its closure was
made, as earl# as !"8C, that recommendation was reiterated and
reaffirmed four '5) times thereafter until it was finall# approved and
acted upon # the Decretar#, whose action was confirmed # the
?ffice of the .resident. Daid respondent was %iven notice in Gune
!"88, that in conse@uence of all these, the time for its definite closure
had een unalteral# set at ,a#, !"8", a notice which was
accompanied # assurances of assistance in the relocation of its
students efore Gune, !"8" and in its rehailitation as a school for
other courses. After havin% resorted to the whole ran%e of
administrative remedies availale to it, without success, it sou%ht to
otain from the respondent Court the relief it could not otain from
those sources, and what can onl# e descried as a delierate
attempt to frustrate and ostruct implementation of the decision for its
closure as of Gune, !"8" openl# solicited, # newspaper
advertisements or otherwise, enrollment of new and old students.
2iven these facts, and it ein% a matter of law that the
Decretar# of -ducation, Culture and Dports e0ercises the power to
en7oin compliance with the re@uirements laid down for medical
schools and to mete out sanctions where he finds that violations
thereof have een committed, it was a %rave ause of discretion for
the respondent 7ud%e to issue the @uestioned in7unction and there#
thwart official action, in the premises correctl# taken, allowin% the
Colle%e to operate without the re@uisite %overnment permit. A sin%le
ocular inspection, done after the Colle%e had een pre9warned
thereof, did not, in the circumstances, warrant onl# the findin%s of
more @ualified inspectors aout the true state of the Colle%e, its
facult#, facilities, operations, etc. &he, memers of the evaluatin%
team came from the different sectors in the fields of education and
medicine,
14
and their 7ud%ment in this particular area is certainl#
etter than that of the respondent Gud%e whose sole and onl# visit to
the school could hardl# have %iven him much more to %o on than a
rief look at the ph#sical plant and facilities and into the conduct of the
classes and other school activities. $espondent Gud%e %ravel#
aused his discretion in sustitutin% his 7ud%ment for theirs.
24. +.C' vs. 'an +ie;o
5a$ts: Dan Die%o took the N,A& three times and flunked all three
takes. 3e contends that he is constitutionall# entitled to take the test
for the fourth time. 3e invokes his constitutional ri%hts to academic
freedom and @ualit# education. 1# a%reement of the parties, Dan
Die%o was allowed to take the N,A& a%ain, su7ect to the outcome of
his petition. <n an amended petition filed with leave of court, he
s@uarel# challen%ed the constitutionalit# of ,-CD ?rder No. !2,
Deries of !"=2, containin% the rule that an aspirin% med student who
flunks the test ( times in a row is arred from takin% a fourth one. &he
additional %rounds raised were due process and e@ual protection.
After hearin%, the respondent 7ud%e declared the challen%ed order
invalid and %rantin% the petition. &he Decision held that the petitioner
had een deprived of his ri%ht to pursue a medical education throu%h
an aritrar# e0ercise of the police power.
-ssue: 6hether or not the challen%ed order is invalid.
Rulin;: No. 6e see no reason wh# the rationale in the &alarin case
cannot appl# to the case at ar. &he issue raised in oth cases is the
academic preparation of the applicant. &his ma# e %au%ed at least
initiall# # the admission test and, indeed with more reliailit#, # the
three9flunk rule. &he latter cannot e re%arded an# less valid than the
former in the re%ulation of the medical profession. &he su7ect of the
challen%ed re%ulation is certainl# within the amit of the police power.
<t is the ri%ht and indeed the responsiilit# of the Dtate to insure that
the medical profession is not infiltrated # incompetents to whom
patients ma# unwaril# entrust their lives and health. &he method
emplo#ed # the challen%ed re%ulation is not irrelevant to the purpose
of the law nor is it aritrar# or oppressive. &he three9flunk rule is
intended to insulate the medical schools and ultimatel# the medical
profession from the intrusion of those not @ualified to e doctors.
6hile ever# person is entitled to aspire to e a doctor, he does not
have a constitutional ri%ht to e a doctor. &his is true of an# other
callin% in which the pulic interest is involved> and the closer the link,
the lon%er the rid%e to one+s amition.
2. PRC vs. +e GuA(an et al.
5a$ts: &he respondents are all %raduates of the Fatima Colle%e of
,edicine, EalenBuela Cit#, ,etro ,anila. &he# passed the .h#sician
Licensure -0amination conducted in Feruar# !""( # the 1oard of
,edicine '1oard). .etitioner .rofessional $e%ulation Commission
'.$C) then released their names as successful e0aminees in the
medical licensure e0amination. Dhortl# thereafter, the 1oard oserved
that the %rades of the sevent#9nine successful e0aminees from Fatima
Colle%e in the two most difficult su7ects in the medical licensure
e0am, 1iochemistr# '1io9Chem) and ?stetrics and 2#necolo%# '?19
2#ne), were unusuall# and e0ceptionall# hi%h. -leven Fatima
e0aminees scored !**Y in 1io9Chem and ten %ot !**Y in ?192#ne,
another eleven %ot ""Y in 1io9Chem, and twent#9one scored ""Y in
?192#ne.
For its part, the N1< found that Mthe @uestionale passin% rate of
Fatima e0aminees in the I!""(J .h#sician -0amination leads to the
conclusion that the Fatima e0aminees %ained earl# access to the test
@uestions.L &he respondents were constrained from takin% oath as
licensed medical doctors.
-ssue: 6as the act pursuant to $.A. 2(82 a valid e0ercise of police
powerN
Rulin;: Aes, it is true that this Court has upheld the constitutional ri%ht
of ever# citiBen to select a profession or course of stud# su7ect to a
fair, reasonale, and e@uitale admission and academic re@uirements.
1ut like all ri%hts and freedoms %uaranteed # the Charter, their
e0ercise ma# e so re%ulated pursuant to the police power of the
Dtate to safe%uard health, morals, peace, education, order, safet#,
and %eneral welfare of the people. &hus, persons who desire to
en%a%e in the learned professions re@uirin% scientific or technical
knowled%e ma# e re@uired to take an e0amination as a prere@uisite
to en%a%in% in their chosen careers.
<t is a asic rule in statutor# construction that each part of a
statute should e construed in connection with ever# other part to
produce a harmonious whole, not confinin% construction to onl# one
section.
25
&he intent or meanin% of the statute should e ascertained
from the statute taken as a whole, not from an isolated part of the
provision. Accordin%l#, Dection 2*, of $ep. Act No. 2(82, as amended
should e read in con7unction with the other provisions of the Act.
&hus, to determine whether the petitioners had the ministerial
oli%ation to administer the 3ippocratic ?ath to respondents and
re%ister them as ph#sicians, recourse must e had to the entiret# of
the ,edical Act of !"4".
A careful readin% of Dection 2* of the ,edical Act of !"4"
discloses that the law uses the word ;shall; with respect to the
issuance of certificates of re%istration. &hus, the petitioners ;shall si%n
and issue certificates of re%istration to those who have satisfactoril#
complied with the re@uirements of the 1oard.; <n statutor#
construction the term ;shall; is a word of command. <t is %iven
imperative meanin%. &hus, when an e0aminee satisfies the
re@uirements for the %rant of his ph#sician:s license, the 1oard is
oli%ed to administer to him his oath and re%ister him as a ph#sician,
pursuant to Dection 2* and par. '!) of Dection 22
24
of the ,edical Act
of !"4".
3owever, the surroundin% circumstances in this case call for serious
in@uir# concernin% the satisfactor# compliance with the 1oard
re@uirements # the respondents. &he unusuall# hi%h scores in the
two most difficult su7ects was phenomenal, accordin% to Fr. Neres,
the consultant of .$C on the matter, and raised %rave douts aout
the inte%rit#, if not validit#, of the tests. &hese douts have to e
appropriatel# resolved.
Dection 8 of $ep. Act No. 2(82 prescries, amon% others, that a
person who aspires to practice medicine in the .hilippines, must have
;satisfactoril# passed the correspondin% 1oard -0amination.; Dection
22, in turn, provides that the oath ma# onl# e administered ;to
ph#sicians who @ualified in the e0aminations.; &he operative word
here is ;satisfactoril#,; defined as ;sufficient to meet a condition or
oli%ation; or ;capale of dispellin% dout or i%norance.;
(!
2leaned
from 1oard $esolution No. 2C, the licensin% authorit# apparentl# did
not find that the respondents ;satisfactoril# passed; the licensure
e0aminations. &he 1oard instead sou%ht to nullif# the e0amination
results otained # the respondents.
26. !oar& of 8e&i$ine vs. 7asuyu=i 4ta
5a$ts: Aasu#uki ?ta is a Gapanese national, married to a Filipina, who
has continuousl# resided in the .hilippines for more than !* #ears. 3e
%raduated from 1icol Christian Colle%e of ,edicine with a de%ree of
Doctor of ,edicine. After successfull# completin% a one9#ear post
%raduate internship trainin% at the Gose $e#es ,emorial ,edical
Center, he filed an application to take the medical oard e0aminations
in order to otain a medical license. 3e was re@uired # the .$C to
sumit an affidavit of undertakin%, statin% amon% others that should
he successfull# pass the same, he would not practice medicine until
he sumits proof that reciprocit# e0ists etween Gapan and the
.hilippines in admittin% forei%ners into the practice of medicine.
?ta sumitted a dul# notariBed -n%lish translation of the ,edical
.ractitioners Law of Gapan dul# authenticated # the Consul 2eneral
of the .hilippine -mass# to Gapan thus, he was allowed to take the
,edical 1oard -0aminations, which he suse@uentl# passed.
<n spite of all these, the 1oard of ,edicine '1oard) of the .$C, in a
letter dated ,arch 8, !""(, denied respondent+s re@uest for a license
to practice medicine in the .hilippines on the %round that the 1oard
;elieves that no %enuine reciprocit# can e found in the law of Gapan
as there is no Filipino or forei%ner who can possil# practice there.L
?ta filed a .etition for #ertiorari and +andamus a%ainst the 1oard
and .$C alle%in% that the the#, in refusin% to issue in his favor a
Certificate of $e%istration andKor license to practice medicine, had
acted aritraril#, in clear contravention of the provision of Dection 2*
of $epulic Act '$.A.) No. 2(82. .etitioners ar%ue that while the
,edical .ractitioners Law of Gapan allows forei%ners to practice
medicine therein, said document does not show that conditions for the
practice of medicine in said countr# are practical and attainable # a
forei%n applicant> and since the re@uirements are practically
impossible for a Filipino to compl# with, there is no reciprocit#
etween the two countries, hence, respondent ma# not e %ranted
license to practice medicine in the .hilippines. &he $&C ruled in ?ta:s
favor and added that the 1oard had the ministerial dut# to issue the
certificate ?ta seeks. &he CA affirmed the rulin%.
-ssue: 6hether or not the respondent had sufficientl# proven the
e0istence of reciprocit# etween the .hilippines and Gapan.
Rulin;: Aes. $.A. No. 2(82 and ..D. No. 22( allows a forei%ner Mwho
has sumitted competent and conclusive documentar# evidence,
confirmed # the Department of Forei%n Affairs, showin% that his
countr#+s e0istin% laws permit citiBens of the .hilippines to practice
medicine under the same rules and re%ulations %overnin% citiBens
thereof 'Dec. ", $A 2(82)L to e a candidate to take the oard
e0aminations.
$espondent sumitted a cop# of the ,edical .ractitioners Law of
Gapan, dul# authenticated # the Consul 2eneral of the -mass# of
the .hilippines in Gapan, which provides in Articles 2 and !!, thus:
MArticle 2. An#one who wants to e medical practitioner must pass the
national e0amination for medical practitioner and %et license from the
,inister of 3ealth and 6elfare.
0 0 0 0
Article !!. No one can take the National ,edical -0amination e0cept
persons who conform to one of the followin% items:
!. .ersons who finished re%ular medical courses at a universit#
ased on the Dchool -ducation Laws 'Decemer 2C, !"5=) and
%raduated from said universit#.
2. .ersons who passed the preparator# test for the National
,edical -0amination and practiced clinics and pulic sanitation more
than one #ear after passin% the said test.
(. .ersons who %raduated from a forei%n medical school or
ac@uired medical practitioner license in a forei%n countr#, and also are
reco%niBed to have the same or more academic ailit# and techni@ues
as persons stated in item ! and item 2 of this article.L
Nowhere in said statutes is it stated that the forei%n applicant must
show that the conditions for the practice of medicine in said countr#
are practical and attainable # Filipinos. Neither is it stated that it
must first e proven that a Filipino has een %ranted license and
allowed to practice his profession in said countr# efore a forei%n
applicant ma# e %iven license to practice in the .hilippines.
<t is enou%h that the laws in the forei%n countr# permit a Filipino to %et
license and practice therein. $e@uirin% respondent to prove first that a
Filipino has alread# een %ranted license and is actuall# practicin%
therein undul# e0pands the re@uirements provided for under $.A. No.
2(82 and ..D. No. 22(.
&he doctrine enunciated in P# vs% De *u0man cannot
appl# in this case.