Ramos v.

CA Facts: Erlinda Ramos, a 47-year old robust woman, was normal except for her experiencing occasional pain due to the presence of stone in her gall bladder. She was advised to undergo an operation for its removal. The results in the examinations she underwent indicate that she was fit for the operation. She and her husband Rogelio met Dr. Hosaka, one of the defendants, who advised that she should undergo cholecystectomy. Dr. Hosaka assured them that he will get a good anaesthesiologist. At 7:30 a.m. on the day of the operation at Delos Santos Medical Center, Herminda Cruz, Erlindas sister-in-law and the dean of the College of Nursing in Capitol Medical Center, was there to provide moral support. Dr. Perfecta Gutierrez was to administer the anaesthesia. Dr. Hosaka arrived only at 12:15 p. m. Herminda saw Dr. Gutierrez intubating the patient, and heard the latter say Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O, lumalaki ang tiyan. Herminda saw bluish discoloration of the nailbeds of the patient. She heard Dr. Hosaka issue an order for someone to call Dr. Calderon. The doctor arrived and placed the patient in trendelenburg position, wherein the head of the patient is positioned lower than the feet, which indicates a decrease of blood supply in the brain. Herminda knew and told Rogelio that something wrong was happening. Dr. Calderon was able to intubate the patient. Erlinda was taken to the ICU and became comatose. Rogelio filed a civil case for damages. The trial court ruled in his favor, finding Dr. Gutierrez, Dr. Hosaka, and the hospital, guilty of negligence, but the Court of Appeals reversed the decision. Hence, petitioner filed a Motion for Reconsideration, which the Court of Appeals denied for having been filed beyond the reglementary period. However, it was found that the notice of the decision was never sent to the petitioners counsel. Rather, it was sent to the petitioner, addressing him as Atty. Rogelio Ramos, as if he was the legal counsel. The petitioner filed the instant petition for certiorari. On the procedural issue, the Supreme Court rules that since the notice did not reach the petitioners then legal counsel, the motion was filed on time. Issue: Whether a surgeon, an anaesthesiologist, and a hospital, should be made liable for the unfortunate comatose condition of a patient scheduled for cholecystectomy Held: Res Ipsa Loquitor Res ipsa loquitur is a Latin phrase which literally means "the thing or the transaction speaks for itself." The phrase " res ipsa loquitur'' is a maxim for the rule that the fact of the occurrence of an injury, taken with the surrounding circumstances, may permit an inference or raise a presumption of negligence, or make out a plaintiff's prima facie case, and present a question of fact for defendant to meet with an explanation. Where the thing which caused the injury complained of is shown to be under the management of the defendant or his servants and the accident is such as in ordinary course of things does not happen if those who have its management or control use proper care, it affords reasonable evidence, in the absence of explanation by the defendant, that the accident arose from or was caused by the defendant's want of care. It is grounded in the superior logic of ordinary human experience and on the basis of such experience or common knowledge, negligence may be deduced from the mere occurrence of the accident itself. However, much has been said that res ipsa loquitur is not a rule of substantive law and, as such, does not create or constitute an independent or separate ground of liability. Mere invocation and application of the doctrine does not dispense with the requirement of proof of negligence. It is simply a step in the process of such proof, permitting the plaintiff to present along with the proof of the accident, enough of the attending circumstances to invoke the doctrine, creating an inference or presumption of negligence, and to thereby place on the defendant the burden of going forward with the proof. Still, before resort to the doctrine may be allowed, the following requisites must be satisfactorily shown. (1) The accident is of a kind which ordinarily does not occur in the absence of someone's negligence; (2) It is caused by an instrumentality within the exclusive control of the defendant or defendants; and (3) The possibility of contributing conduct which would make the plaintiff responsible is eliminated. Medical malpractice cases do not escape the application of this doctrine. Thus, res ipsa loquitur has been applied when the circumstances attendant upon the harm are themselves of such a character as to justify an inference of negligence as the cause of that harm. Although generally, expert medical testimony is relied upon in malpractice suits to prove that a physician has done a negligent act or that he has deviated from the standard medical procedure, when the doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert medical testimony is dispensed with because the injury itself

provides the proof of negligence. Hence, in cases where the res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon proper proof of injury to the patient, without the aid of expert testimony, where the court from its fund of common knowledge can determine the proper standard of care. When the doctrine is appropriate, all that the patient must do is prove a nexus between the particular act or omission complained of and the injury sustained while under the custody and management of the defendant without need to produce expert medical testimony to establish the standard of care. Resort to res ipsa loquitur is allowed because there is no other way, under usual and ordinary conditions, by which the patient can obtain redress for injury suffered by him. Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously applied, depending upon the circumstances of each case. A distinction must be made between the failure to secure results, and the occurrence of something more unusual and not ordinarily found if the service or treatment rendered followed the usual procedure of those skilled in that particular practice. The real question, therefore, is whether or not in the process of the operation any extraordinary incident or unusual event outside of the routine performance occurred which is beyond the regular scope of customary professional activity in such operations, which, if unexplained would themselves reasonably speak to the average man as the negligent cause or causes of the untoward consequence. We find the doctrine of res ipsa loquitur appropriate in the case at bar. Erlinda submitted herself for cholecystectomy and expected a routine general surgery to be performed on her gall bladder. On that fateful day she delivered her person over to the care, custody and control of private respondents who exercised complete and exclusive control over her. At the time of submission, Erlinda was neurologically sound and, except for a few minor discomforts, was likewise physically fit in mind and body. However, during the administration of anesthesia and prior to the performance of cholecystectomy she suffered irreparable damage to her brain. Thus, without undergoing surgery, she went out of the operating room already decerebrate and totally incapacitated. Obviously, brain damage, which Erlinda sustained, is an injury which does not normally occur in the process of a gall bladder operation. In fact, this kind of situation does not in the absence of negligence of someone in the administration of anesthesia and in the use of endotracheal tube. Furthermore, the instruments used in the administration of anesthesia, including the endotracheal tube, were all under the exclusive control of private respondents, who are the physicians-in-charge. Likewise, petitioner Erlinda could not have been guilty of contributory negligence because she was under the influence of anesthetics which rendered her unconscious. Negligence of the Anaesthesiologist The pre-operative evaluation of a patient prior to the administration of anesthesia is universally observed to lessen the possibility of anesthetic accidents. Respondent Dra. Gutierrez' act of seeing her patient for the first time only an hour before the scheduled operative procedure was, therefore, an act of exceptional negligence and professional irresponsibility. Her failure to follow this medical procedure is, therefore, a clear indicia of her negligence. Erlinda's case was elective and this was known to respondent Dra. Gutierrez. Thus, she had all the time to make a thorough evaluation of Erlinda's case prior to the operation and prepare her for anesthesia. However, she never saw the patient at the bedside. She herself admitted that she had seen petitioner only in the operating room, and only on the actual date of the cholecystectomy. She negligently failed to take advantage of this important opportunity. As such, her attempt to exculpate herself must fail. Opinion of Expert Witness An anesthetic accident caused by a rare drug-induced bronchospasm properly falls within the fields of anesthesia, internal medicine-allergy, and clinical pharmacology. The resulting anoxic encephalopathy belongs to the field of neurology. While admittedly, many bronchospastic-mediated pulmonary diseases are within the expertise of pulmonary medicine, Dr. Jamora's field, the anesthetic drug-induced, allergic mediated bronchospasm alleged in this case is within the disciplines of anesthesiology, allergology and pharmacology. On the basis of the foregoing transcript, in which the pulmonologist himself admitted that he could not testify about the drug with medical authority, it is clear that the appellate court erred in giving weight to Dr. Jamora's testimony as an expert in the administration of Thiopental Sodium. Generally, to qualify as an expert witness, one must have acquired special knowledge of the subject matter about which he or she is to testify, either by the study of recognized authorities on the subject or by practical experience. Clearly, Dr. Jamora does not qualify as an expert witness based on the above standard since he lacks the necessary knowledge, skill, and training in the field of anesthesiology. Oddly, apart from submitting testimony from a specialist in the wrong field, private respondents' intentionally avoided providing testimony by competent and independent experts in the proper areas.

Proximate Cause Proximate cause has been defined as that which, in natural and continuous sequence, unbroken by any efficient intervening cause, produces injury, and without which the result would not have occurred. An injury or damage is proximately caused by an act or a failure to act, whenever it appears from the evidence in the case, that the act or omission played a substantial part in bringing about or actually causing the injury or damage; and that the injury or damage was either a direct result or a reasonably probable consequence of the act or omission. Instead of the intended endotracheal intubation what actually took place was an esophageal intubation. During intubation, such distention indicates that air has entered the gastrointestinal tract through the esophagus instead of the lungs through the trachea. Entry into the esophagus would certainly cause some delay in oxygen delivery into the lungs as the tube which carries oxygen is in the wrong place. That abdominal distention had been observed during the first intubation suggests that the length of time utilized in inserting the endotracheal tube (up to the time the tube was withdrawn for the second attempt) was fairly significant. Due to the delay in the delivery of oxygen in her lungs Erlinda showed signs of cyanosis. Responsibility of the Surgeon As the so-called "captain of the ship," it is the surgeon's responsibility to see to it that those under him perform their task in the proper manner. Respondent Dr. Hosaka's negligence can be found in his failure to exercise the proper authority in not determining if his anesthesiologist observed proper anesthesia protocols. In fact, no evidence on record exists to show that respondent Dr. Hosaka verified if respondent Dra. Gutierrez properly intubated the patient. Furthermore, it does not escape us that respondent Dr. Hosaka had scheduled another procedure in a different hospital at the same time as Erlinda's cholecystectomy, and was in fact over three hours late for the latter's operation. Because of this, he had little or no time to confer with his anesthesiologist regarding the anesthesia delivery. This indicates that he was remiss in his professional duties towards his patient. Thus, he shares equal responsibility for the events which resulted in Erlinda's condition. Responsibility of the Hospital Hospitals hire, fire and exercise real control over their attending and visiting "consultant" staff. While "consultants" are not, technically employees, a point which respondent hospital asserts in denying all responsibility for the patient's condition, the control exercised, the hiring, and the right to terminate consultants all fulfill the important hallmarks of an employer-employee relationship, with the exception of the payment of wages. In assessing whether such a relationship in fact exists, the control test is determining. Accordingly, on the basis of the foregoing, we rule that for the purpose of allocating responsibility in medical negligence cases, an employer-employee relationship in effect exists between hospitals and their attending and visiting physicians. The basis for holding an employer solidarily responsible for the negligence of its employee is found in Article 2180 of the Civil Code which considers a person accountable not only for his own acts but also for those of others based on the former's responsibility under a relationship of patria potestas. Such responsibility ceases when the persons or entity concerned prove that they have observed the diligence of a good father of the family to prevent damage. In the instant case, respondent hospital, apart from a general denial of its responsibility over respondent physicians, failed to adduce evidence showing that it exercised the diligence of a good father of a family in the hiring and supervision of the latter. It failed to adduce evidence with regard to the degree of supervision which it exercised over its physicians. In neglecting to offer such proof, or proof of a similar nature, respondent hospital thereby failed to discharge its burden under the last paragraph of Article 2180. Having failed to do this, respondent hospital is consequently solidarily responsible with its physicians for Erlinda's condition. Finally, by way of example, exemplary damages in the amount of P100,000.00 are hereby awarded. Considering the length and nature of the instant suit we are of the opinion that attorney's fees valued at P100,000.00 are likewise proper. WHEREFORE, the decision and resolution of the appellate court appealed from are hereby modified so as to award in favor of petitioners, and solidarily against private respondents the following: 1) P1,352,000.00 as actual damages computed as of the date of promulgation of this decision plus a monthly payment of P8,000.00 up to the time that petitioner Erlinda Ramos expires or miraculously survives; 2) P2,000,000.00 as moral damages, 3) P1,500,000.00 as temperate damages; 4) P100,000.00 each as exemplary damages and attorney's fees; and, 5) the costs of the suit.

G.R. No. 194259

March 16, 2011

PEOPLE OF THE PHILIPPINES, vs. JIMMY ALVERIO, Accused-Appellant. In the afternoon of June 2, 2002, AAA, along with her friends Belen Sabanag (Sabanag) and Aileen Sinangote (Sinangote), went to the house of her grandmother to attend a dance event.5 At around 8:30 in the evening, they proceeded to the dance hall because the dance would start at around 9 oclock.6 During the dance, Sabanag and Sinangote danced with Alverio but AAA did not.7 At 2 oclock in the morning of June 3, 2002, AAA noticed that her friends were no longer at the dance so she decided to go home to her grandmothers house.8 As she was nearing the barangay hall, Alverio suddenly appeared and took hold of AAA. She tried to resist him but he was too strong and he managed to pull her away. AAA started to cry while she was being dragged towards the back of the barangay hall.9 There, Alverio held her hair, undressed her, and started to kiss her.10 AAA kept on resisting and even punched Alverio after he kissed her, at which point, Alverio told her that it was painful and that he might retaliate if she continued.11 This caused AAA to stop resisting and Alverio then proceeded to insert his penis in her vagina repeatedly.12 After having carnal knowledge with her, Alverio stood up and put on his clothes. He warned AAA that if she told anyone about what happened, he will kill her.13 After threatening her, he left. During this entire incident, Alverio was armed with a knife which he used to poke AAAs side. Dazed, AAA could not muster enough strength to go home. She just sat on the road beside the barangay hall until 5 oclock in the morning when her Uncle Intoy passed by. He brought her home to her parents but she did not tell him anything. Upon reaching home, AAA told her parents about what happened.14 Version of the Defense: Alibi accused was at home corroborated by his mother and sister After trial, the RTC convicted Alverio. The dispositive portion of its August 26, 2004 Decision reads: On March 25, 2010, the CA affirmed the judgment of the RTC. The dispositive portion of the CA . His penalty of reclusion perpetua and the award of civil indemnity of Php50,000.00 stands. WON the medical certificate is admissible as evidence Ruling: Same; Same; Medical evidence is dispensable and merely corroborative in proving the crime of rape.Although the medical certificate was presented as evidence, its contents were never testified to by the signatory himself and, as such, cannot be considered as corroborative of the claim of the victim that she was raped. Such argument, however, cannot prosper. Medical evidence is dispensable and merely corroborative in proving the crime of rape. Besides, a medical certificate is not even necessary to prove the crime of rape. The gravamen of rape is carnal knowledge of a woman through force and intimidation.

PEOPLE OF THE PHILIPPINES, plaintiff-appellee, vs. BERNARDINO DOMANTAY, @ "JUNIOR OTOT," accusedappellant. FACTS: Appellant, 29 years old, was charged with rape with homicide for the death of Jennifer Domantay, a 6-year old girl whose body was found in a bamboo grove with 38 stab wounds at the back and whose hymen was completely lacerated on the right side, though found fully clothed in blue shorts and white shirt. The trial court found appellant guilty as charged and was sentenced to death.

Conviction was based primarily on the testimonies of SPO1 Espinoza and Celso Manuel, a radio reporter. SPO1 Espinoza testified that appellant confessed to the killing of Jennifer and disclosed to him the location of the bayonet used which was submitted as evidence for the prosecution. According to him, appellant waived assistance of counsel but the waiver was not put in writing nor made in the presence of counsel. On the other hand, Manuel declared that appellant, in an interview, admitted the brutal killing of Jennifer; that he was just outside the cell when he interviewed appellant accompanied by his uncle inside the jail, that the nearest policemen were about 2-3 meters from him and that no lawyer assisted appellant during the interview. Also presented as a witness was Dr. Bandonill, medico-legal expert of the NBI, who testified that it was possible that the lacerations on the victim could have been caused by something blunt other than the male organ.

ISSUE: WON the laceration of the hymen proves that the accused committed rape HELD: Same; Same; Words and Phrases; Carnal knowledge is defined as the act of a man having sexual intercourse or sexual bodily connections with a woman.As the victim here was six years old, only carnal knowledge had to be proved to establish rape. Carnal knowledge is defined as the act of a man having sexual intercourse or sexual bodily connections with a woman. For this purpose, it is enough if there was even the slightest contact of the male sex organ with the labia of the victims genitalia. However, there must be proof, by direct or indirect evidence, of such contact. Same; Same; Standing alone, a physicians finding that the hymen of the alleged victim was lacerated does not prove rape.Hymenal laceration is not necessary to prove rape; neither does its presence prove its commission. As held in People v. Ulili, a medical certificate or the testimony of the physician is presented not to prove that the victim was raped but to show that the latter had lost her virginity. Consequently, standing alone, a physicians finding that the hymen of the alleged victim was lacerated does not prove rape. It is only when this is corroborated by other evidence proving carnal knowledge that rape may be deemed to have been established. This Court has sustained a number of convictions for rape with homicide based on purely circumstantial evidence. In those instances, however, the prosecution was able to present other tell-tale signs of rape such as the location and description of the victims clothings, especially her undergarments, the position of the body when found and the like. In People v. Macalino, for instance, the Court affirmed a conviction for the rape of a two year-old child on the basis of circumstantial evidence: The Court notes that the testimony or medical opinion of Dr. Gajardo that the fresh laceration had been produced by sexual intercourse is corroborated by the testimony given by complainant Elizabeth that when she rushed upstairs upon hearing her daughter suddenly cry out, she found appellant Macalino beside the child buttoning his own pants and that she found some sticky fluid on the childs buttocks and some blood on her private part. Considering the relative physical positions of the accused and the victim in crimes of rape, the usual location of the external bodily injuries of the victim is on the face, neck, and anterior portion of her body. Although it is not unnatural to find contusions on the posterior side, these are usually caused by the downward pressure on the victims body during the sexual assault.It is unquestionably different when, as in this case, allthe stab wounds (except for a minor cut in the lower left leg) had their entry points at the back running from the upper left shoulder to the lower right buttocks.

G.R. No. 159738

December 9, 2004

UNION MOTOR CORPORATION, vs. NATIONAL LABOR RELATIONS COMMISSION and ALEJANDRO A. ETIS (ETITS pre) On October 23, 1993, the respondent was hired by the petitioner as an automotive mechanic at the service department in the latters Paco Branch. In 1994, he was transferred to the Caloocan City Branch, where his latest monthly salary was P6,330.00. During his employment, he was awarded the "Top Technician" for the month of May in 1995 and Technician of the Year (1995). He also became a member of the Exclusive P40,000.00 Club and received the Model Employee Award in the same year. On September 22, 1997, the respondent made a phone call to Rosita dela Cruz, the company nurse, and informed her that he had to take a sick leave as he had a painful and unbearable toothache. The next day, he again phoned Dela Cruz and told her that he could not report for work because he still had to consult a doctor. Finding that the respondents ailment was due to a tooth inflammation, the doctor referred him to a dentist for further management.2 Dr. Rodolfo Pamor, a dentist, then scheduled the respondents tooth extraction on September 27, 1997, hoping that, by that time, the inflammation would have subsided. Upon instructions from the management, Mr. Dumagan, a company security guard, visited the respondent in his house on September 24, 1997 and confirmed that the latter was ill. On September 27, 1997, Dr. Pamor rescheduled the respondents tooth extraction on October 4, 1997 because the inflammation had not yet subsided and recommended that he rest. Thus, the respondent was not able to report for work due to the painful and unbearable toothache. On October 2, 1997, the petitioner issued an Inter Office Memorandum3 through Angelo B. Nicolas, the manager of its Human Resources Department, terminating the services of the respondent for having incurred more than five (5) consecutive absences without proper notification. The petitioner considered the consecutive absences of the respondent as abandonment of office under Section 6.1.1, Article III of the Company Rules. On October 4, 1997, Dr. Pamor successfully extracted the respondents tooth. As soon as he had recovered, the respondent reported for work, but was denied entry into the companys premises. He was also informed that his employment had already been terminated. The respondent sought help from the union which, in turn, included his grievance in the arbitration before the National Conciliation and Mediation Board (NCMB). Pending the resolution thereof, the respondent wrote to the petitioner asking for the reconsideration of his dismissal,4 which was denied. Sometime thereafter, the unions complaints were dismissed by the NCMB. Left with no other recourse, the respondent filed, on May 18, 1999, a complaint for illegal dismissal before the arbitration branch of the NLRC against the petitioner and/or Benito Cua which was ruled in favor of Alejandro. A motion for reconsideration by Union was denied hence this petition. In both cases petitioner contends that the medical certificates adduced in evidence by the respondent to prove (a) his illness, the nature and the duration of the procedures performed by the dentist on him; and (b) the period during which he was incapacitated to work are inadmissible in evidence and barren of probative weight simply because they were not notarized, and the medical certificate dated September 23, 1997 was not written on paper bearing the dentists letterhead. Even assuming that the respondent was ill and had been advised by his dentist to rest, the same does not appear on the medical certificate dated September 23, 1997as ruled in Maligsa v. Atty. Cabanting Issue: WON the medical certificates are admissible as evidence even though they were not notarized Ruling: Yes. After full scrutiny and judicious evaluation of the records of this case, We find the appeal to be meritorious. Regrettably, the Labor Arbiter a quo clearly failed to appreciate complainants pieces of evidence. Nowhere in our jurisprudence requires that all medical certificates be notarized to be accepted as a valid evidence. In this case, there is [neither] difficulty nor an obstacle to claim that the medical certificates presented by complainant are genuine and authentic. Indeed, the physician and the dentist who examined the complainant, aside from their respective letterheads, had written their respective license numbers below their names and signatures. These facts have not been impugned nor rebutted by respondent-appellee throughout the proceedings of his case. Common sense dictates that an ordinary worker does not need to have these medical certificates to be notarized for proper presentation to his company to prove his ailment; hence, the Labor Arbiter a quo, in cognizance with the liberality and the appreciation on the rules on evidence, must not negate the acceptance of these medical certificates as valid pieces of evidence.

We believe, as we ought to hold, that the medical certificates can prove clearly and convincingly the complainants allegation that he consulted a physician because of tooth inflammation on September 23, 1997 and a dentist who later advised him to rest and, thus, clinically extended his tooth extraction due to severe pain and inflammation. Admittingly, it was only on October 4, 1997 While it is true that the petitioner had objected to the veracity of the medical certificates because of lack of notarization, it has been said that verification of documents is not necessary in order that the said documents could be considered as substantial evidence.20 The medical certificates were properly signed by the physicians; hence, they bear all the earmarks of regularity in their issuance and are entitled to full probative weight. IN LIGHT OF ALL THE FOREGOING, the petition is DENIED DUE COURSE. The Decision of the Court of Appeals in CA-G.R. SP No. 73602 is AFFIRMED.