DR. RUBI LI, Petitioner, v.

SPOUSES REYNALDO and LINA SOLIMAN

FACTS:
OnJuly 7, 1993, respondents 11-year old daughter, Angelica Soliman, underwent a biopsy
of the mass located in her lower extremity at the St. Lukes Medical Center
(SLMC).Results showed that Angelica was suffering fromosteosarcoma,osteoblastic
type,a high-grade (highly malignant) cancer of the bone which usually afflicts teenage
children.Following this diagnosis and as primary intervention, Angelicas right leg was
amputated by Dr. Jaime Tamayo in order to remove the tumor.As adjuvant treatment to
eliminate any remaining cancer cells, and hence minimize the chances of recurrence and
prevent the disease from spreading to other parts of the patients body (metastasis),
chemotherapy was suggested by Dr. Tamayo.Dr. Tamayo referred Angelica to another
doctor at SLMC, herein petitioner Dr. Rubi Li, a medical oncologist.
OnAugust 18, 1993, Angelica was admitted to SLMC.However, she died onSeptember 1,
1993, just eleven (11) days after the (intravenous) administration of the first cycle of the
chemotherapy regimen.Because SLMC refused to release a death certificate without full
payment of their hospital bill, respondents brought the cadaver of Angelica to the
Philippine National Police (PNP) Crime Laboratory atCampCramefor post-mortem
examination.The Medico-Legal Report issued by said institution indicated the cause of
death as "Hypovolemic shock secondary to multiple organ hemorrhages and
Disseminated Intravascular Coagulation."
OnFebruary 21, 1994, respondents filed a damage suitagainst petitioner, Dr. Leo
Marbella, Mr. Jose Ledesma, a certain Dr. Arriete and SLMC. Respondents charged them
with negligence and disregard of Angelicas safety, health and welfare by their careless
administration of the chemotherapy drugs, their failure to observe the essential
precautions in detecting early the symptoms of fatal blood platelet decrease and
stopping early on the chemotherapy, which bleeding led to hypovolemic shock that
caused Angelicas untimely demise.
On her part, Dr. Balmaceda declared that it is the physicians duty to inform and explain
to the patient or his relatives every known side effect of the procedure or therapeutic
agents to be administered, before securing the consent of the patient or his relatives to
such procedure or therapy.The physician thus bases his assurance to the patient on his
personal assessment of the patients condition and his knowledge of the general effects
of the agents or procedure that will be allowed on the patient.Dr. Balmaceda stressed
that the patient or relatives must be informed of all known side effects based on studies
and observations, even if such will aggravate the patients condition.
In dismissing the complaint, the trial court held that petitioner was not liable for
damages as she observed the best known procedures and employed her highest skill and
knowledge in the administration of chemotherapy drugs on Angelica but despite all
efforts said patient died.
ISSUE: Whether the petitioner can be held liable for failure to fully disclose serious side
effects to the parents of the child patient who died while undergoing chemotherapy,
despite the absence of finding that petitioner was negligent in administering the said
treatment
HELD. No
Medical Malpractice; Medical malpractice, or more appropriately, medical negligence, is
that type of claim which a victim has available to him or her to redress a wrong
committed by a medical professional which has caused bodily harm.The type of lawsuit
which has been called medical malpractice or, more appropriately, medical negligence, is
that type of claim which a victim has available to him or her to redress a wrong
committed by a medical professional which has caused bodily harm. In order to
successfully pursue such a claim, a patient must prove that a health care provider, in

most cases a physician, either failed to do something which a reasonably prudent health
care provider would have done, or that he or she did something that a reasonably
prudent provider would not have done; and that that failure or action caused injury to
the patient.
SAME; Court has recognized that medical negligence cases are best proved by opinions
of expert witnesses belonging in the SAME general neighborhood and in the SAME
general line of practice as defendant physician or surgeon.This Court has recognized
that medical negligence cases are best proved by opinions of expert witnesses belonging
in the SAME general neighborhood and in the SAME general line of practice as defendant
physician or surgeon. The deference of courts to the expert opinion of qualified
physicians stems from the formers realization that the latter possess unusual technical
skills which laymen in most instances are incapable of intelligently evaluating, hence the
indispensability of expert testimonies.
SAME; Doctrine of Informed Consent; Informed consent evolved into a general principle
of law that a physician has a duty to disclose what a reasonably prudent physician in the
medical community in the exercise of reasonable care would disclose to his patient as to
whatever grave risks of injury might be incurred from a proposed course of treatment, so
that a patient, exercising ordinary care for his own welfare, and faced with a choice of
undergoing the proposed treatment, or alternative treatment, or none at all, may
intelligently exercise his judgment by reasonably balancing the probable risks against
the probable benefits.The doctrine of informed consent within the context of physicianpatient relationships goes far back into English common law. As early as 1767, doctors
were charged with the tort of battery (i.e., an unauthorized physical contact with a
patient) if they had not gained the consent of their patients prior to performing a surgery
or procedure. In the United States, the seminal case was Schoendorff v. Society of New
York Hospital which involved unwanted treatment performed by a doctor. Justice
Benjamin Cardozos oft-quoted opinion upheld the basic right of a patient to give consent
to any medical procedure or treatment: Every human being of adult years and sound
mind has a right to determine what shall be done with his own body; and a surgeon who
performs an operation without his patients consent, commits an assault, for which he is
liable in damages. From a purely ethical norm, informed consent evolved into a general
principle of law that a physician has a duty to disclose what a reasonably prudent
physician in the medical community in the exercise of reasonable care would disclose to
his patient as to whatever grave risks of injury might be incurred from a proposed course
of treatment, so that a patient, exercising ordinary care for his own welfare, and faced
with a choice of undergoing the proposed treatment, or alternative treatment, or none at
all, may intelligently exercise his judgment by reasonably balancing the probable risks
against the probable benefits.
SAME; SAME; Proficiency in diagnosis and therapy is not the full measure of a physicians
responsibility; The physician is not expected to give the patient a short medical
education, the disclosure rule only requires of him a reasonable explanation, which
means generally informing the patient in nontechnical terms as to what is at stake, the
therapy alternatives open to him, the goals expectably to be achieved, and the risks that
may ensure from particular treatment or no treatment.The scope of disclosure is
premised on the fact that patients ordinarily are persons unlearned in the medical
sciences. Proficiency in diagnosis and therapy is not the full measure of a physicians
responsibility. It is also his duty to warn of the dangers lurking in the proposed treatment
and to impart information which the patient has every right to expect. Indeed, the
patients reliance upon the physician is a trust of the kind which traditionally has exacted
obligations beyond those associated with armslength transactions. The physician is not
expected to give the patient a short medical education, the disclosure rule only requires

of him a reasonable explanation, which means generally informing the patient in

nontechnical terms as to what is at stake; the therapy alternatives open to him, the goals
expectably to be achieved, and the risks that may ensue from particular treatment or no
treatment. As to the issue of demonstrating what risks are considered material
necessitating disclosure, it was held that experts are unnecessary to a showing of the
materiality of a risk to a patients decision on treatment, or to the reasonably, expectable
effect of risk disclosure on the decision. Such unrevealed risk that should have been
made known must further materialize, for otherwise the omission, however
unpardonable, is without legal consequence. And, as in malpractice actions generally,
there must be a causal relationship between the physicians failure to divulge and
damage to the patient.
SAME; SAME; Four essential elements a plaintiff must prove in a malpractice action
based upon the doctrine of informed consent.There are four essential elements a
plaintiff must prove in a malpractice action based upon the doctrine of informed consent:
(1) the physician had a duty to disclose material risks; (2) he failed to disclose or
inadequately disclosed those risks; (3) as a direct and proximate result of the failure to
disclose, the patient consented to treatment she otherwise would not have consented to;
and (4) plaintiff was injured by the proposed treatment. The gravamen in an informed
consent case requires the plaintiff to point to significant undisclosed information
relating to the treatment which would have altered her decision to undergo it.
CARPIO, J., Dissenting Opinion:
Medical Malpractice; Doctrine of Informed Consent; The doctrine of informed consent
requires doctors, before administering treatment to their patients, to disclose adequately
the material risks and side effects of the proposed treatment; it is distinct from the
doctors duty to skillfully diagnose and treat the patient.The doctrine of informed
consent requires doctors, before administering treatment to their patients, to disclose
adequately the material risks and side effects of the proposed treatment. The duty to
obtain the patients informed consent is distinct from the doctors duty to skillfully
diagnose and treat the patient.
SAME; SAME; Two standards by which courts determine what constitutes adequate
disclosure of associated risks and side effects of a proposed treatment: the physician
standard, and the patient standard of materiality.There are two standards by which
courts determine what constitutes adequate disclosure of associated risks and side
effects of a proposed treatment: the physician standard, and the patient standard of
materiality. Under the physician standard, a doctor is obligated to disclose that
information which a reasonable doctor in the SAME field of expertise would have
disclosed to his or her patient. x x x Under the patient standard of materiality, a doctor is
obligated to disclose that information which a reasonable patient would deem material in
deciding whether to proceed with a proposed treatment.
SAME; SAME; In order to determine what the associated risks and side effects of
proposed treatment are, testimony by an expert witness is necessary because these are
beyond the common knowledge of ordinary people.In order to determine what the
associated risks and side effects of a proposed treatment are, testimony by an expert
witness is necessary because these are beyond the common knowledge of ordinary
people. In Canterbury, the Court held that, There are obviously important roles for
medical testimony in [nondisclosure] cases, and some roles which only medical evidence
can fill. Experts are ordinarily indispensable to identify and elucidate for the fact-finder
the risks of therapy. The Court also held that, medical facts are for medical experts.
SAME; SAME; Under the patient standard of materiality, a doctor obligated to disclose
that information which a reasonable patient would deem material in deciding whether to
proceed with a proposed treatment.Again, under the patient standard of materiality, a

doctor is obligated to disclose that information which a reasonable patient would deem
material in deciding whether to proceed with a proposed treatment. Stated differently,
what should be disclosed depends on what a reasonable person, in the SAME or similar
situation as the patient, would deem material in deciding whether to proceed with the
proposed treatment.
SAME; SAME; Dr. Li impliedly admits that she failed to disclose to Reynaldo and Lina
many of the other associated risks and side effects of chemotherapy, including the most
materialinfection, sepsis and death.Dr. Li impliedly admits that she failed to disclose
to Reynaldo and Lina many of the other associated risks and side effects of
chemotherapy, including the most materialinfection, sepsis and death. She impliedly
admits that she failed to disclose as risks and side effects (1) rashes; (2) difficulty in
breathing; (3) fever; (4) excretion of blood in the mouth; (5) excretion of blood in the
anus; (6) development of ulcers in the mouth; (7) sloughing off of skin; (8) systemic
lupus erythematosus; (9) carpo-pedal spasm; (10) loose bowel movement; (11) infection;
(12) gum bleeding; (13) hypovolemic shock; (14) sepsis; and (15) death in 13 days.
SAME; SAME; Infection, sepsis and death are material risks and side effects of
chemotherapy.Clearly, infection, sepsis and death are material risks and side effects of
chemotherapy. To any reasonable person, the risk of death is one of the most important,
if not the most important, consideration in deciding whether to undergo a proposed
treatment. Thus, Dr. Li should have disclosed to Reynaldo and Lina that there was a
chance that their 11-year old daughter could die as a result of chemotherapy as, in fact,
she did after only 13 days of treatment.
BRION,J., Separate Opinion:
Medical Malpractice; Philippine jurisprudence tells us that expert testimony is crucial, if
not determinative of a physicians liability in a medical negligence case; Expert
testimony is, therefore, essential since the factual issue of whether a physician or
surgeon exercised the requisite degree of skill and care in the treatment of his patient is
generally a matter of expert opinion.Philippine jurisprudence tells us that expert
testimony is crucial, if not determinative of a physicians liability in a medical negligence
case. In litigations involving medical negligence as in any civil action, we have
consistently ruled that the burden to prove by preponderance of evidence the essential
elementsi.e., duty, breach, injury and proximate causationrests with the plaintiff.
Expert testimony is, therefore, essential since the factual issue of whether a physician or
surgeon exercised the requisite degree of skill and care in the treatment of his patient is
generally a matter of expert opinion.
SAME; In the present case, expert testimony is required in determining the risks and or
side effects of chemotherapy that the attending physician should have considered and
disclosed as these are clearly beyond the knowledge of a layperson to testify on.In the
present case, expert testimony is required in determining the risks and or side effects of
chemotherapy that the attending physician should have considered and disclosed as
these are clearly beyond the knowledge of a layperson to testify on. In other words, to
prevail in their claim of lack of informed consent, the respondents must present expert
supporting testimony to establish the scope of what should be disclosed and the
significant risks attendant to chemotherapy that the petitioner should have considered
and disclosed; the determination of the scope of disclosure, and the risks and their
probability are matters a medical expert must determine and testify on since these are
beyond the knowledge of laypersons.
SAME; Dr. Balmacedas testimony failed to establish the existence of the risks or sideeffects the petitioner should have disclosed to them in the use of chemotherapy in the
treatment of osteosarcoma.Unfortunately for the respondents, Dr. Balmacedas
testimony failed to establish the existence of the risks or side-effects the petitioner

should have disclosed to them in the use of chemotherapy in the treatment of

osteosarcoma; the witness, although a medical doctor, could not have testified as an
expert on these points for the simple reason that she is not an oncologist nor a qualified
expert on the diagnosis and treatment of cancers. Neither is she a pharmacologist who
can properly advance an opinion on the toxic side effects of chemotherapy, particularly
the effects of Cisplatin, Doxorubicin and Cosmegenthe drugs administered to Angelica.
As a doctor whose specialty encompasses hospital management and administration, she
is no different from a layperson for purposes of testifying on the risks and probabilities
that arise from chemotherapy.
SAME; Sufficiency of disclosure can be made only after determination and assessment of
risks have been made.The ponencia concludes that there was adequate disclosure of
material risks of the [chemotherapy administered] with the consent of Angelicas
parents in view of the fact that the petitioner informed the respondents of the side
effects of chemotherapy, such as low white and red blood cell and platelet count, kidney
or heart damage and skin darkening. I cannot agree with this conclusion because it was
made without the requisite premises. As heretofore discussed, sufficiency of disclosure
can be made only after a determination and assessment of risks have been made. As
discussed above, no evidence exists showing that these premises have been properly
laid and proven. Hence, for lack of basis, no conclusion can be made on whether
sufficient disclosure followed. In other words, the disclosure cannot be said to be
sufficient in the absence of evidence of what, in the first place, should be disclosed.
SAME; Specific disclosures such as life expectancy probabilities are not legally necessary
or required to be disclosed in informed consent situations.A third consideration is that
specific disclosures such as life expectancy probabilities are not legally necessary or
required to be disclosed in informed consent situations, thus the respondent Lina
Solimans testimony on this point cannot be given any probative value. Thus, in the
landmark case of Arato v. Avedon, where family members of a patient who died of
pancreatic cancer brought an informed consent action against defendant physicians who
failed to provide the patient material information (statistical life expectancy) necessary
for his informed consent to undergo chemotherapy and radiation treatmentthe
Supreme Court of California rejected the mandatory disclosure of life expectancy
probabilities on account of the variations among doctor-patient interactions and the
intimacy of the relationship itself.
ABAD,J., Concurring Opinion:
Medical Malpractice; Doctrine of Informed Consent; The claim that Dr. Li gave assurance
that Angelica had 95% chance of recovery after chemotherapy cannot be believedit
would be most unlikely for someone of Dr. Lis expertise to make such a grossly reckless
claim to a patient who actually had only a 20% chance of surviving the first year. She
would literally be inviting a malpractice suit.The claim that Dr. Li gave assurance that
Angelica had a 95% chance of recovery after chemotherapy cannot be believed. The
Solimans knew that their daughter had bone cancer. Having consulted with other doctors
from four medical institutions, the Ago Medical and Educational Center in Bicol, the
UERM Medical Center in Manila, the National Childrens Hospital in Quezon City, and
finally the St. Lukes hospital, all of whom gave the SAME dire opinion, it would be quite
unlikely for the Solimans to accept Dr. Lis supposed assurance that their daughter had
95% chance of returning to normal health after chemotherapy. In fact, it would be most
unlikely for someone of Dr. Lis expertise to make such a grossly reckless claim to a
patient who actually had only a 20% chance of surviving the first year. She would literary
be inviting a malpractice suit.
SAME; SAME; Respondents are arguing from hindsight. The fact is that they were willing
to assume huge risks on the chance that their daughter could cheat death.The

Solimans are arguing from hindsight. The fact is that they were willing to assume huge
risks on the chance that their daughter could cheat death. They did not mind that their
young daughters left leg would be amputated from above the knee for a 50% chance of
preventing the spread of the cancer. There is probably no person on this planet whose
family members, relatives, or close friends have not been touched by cancer. Every one
knows of the travails and agonies of chemotherapy, yet it is rare indeed for a cancer
patient or his relatives not to take a chance with this treatment, which had proved
successful in extending the lives of some. Unfortunately for the Solimans, their daughter
did not number among the successful cases.
SAME; SAME; Respondents accepted the risks that chemotherapy offered with full
knowledge of its effects on their daughter.The Solimans accepted the risks that
chemotherapy offered with full knowledge of its effects on their daughter. It is not fair
that they should blame Dr. Li for Angelicas suffering and death brought about by a
decease that she did not wish upon her. Indeed, it was not Dr. Li, according to Reynaldo,
who convinced him to agree to submit his daughter to chemotherapy but Dr. Tamayo.
The latter explained to him the need for her daughter to undergo chemotherapy to
increase the chance of containing her cancer. This consultation took place even before
the Solimans met Dr. Li. [Li vs. Soliman, 651 SCRA 32(2011)]
Professional Services Inc. (PSI) v. Natividad and Enrique Agana
FACTS
Natividad Agana was rushed to Medical City because of difficulty of bowel movement and
bloody anal discharge. Dr. Ampil diagnosed her to be suffering from cancer of the
sigmoid. Dr. Ampil performed an anterior resection surgery on her, and finding that the
malignancy spread on her left ovary, he obtained the consent of her husband, Enrique, to
permit Dr. Fuentes to perform hysterectomy on her. After the hysterectomy, Dr. Fuentes
showed his work to Dr. Ampil, who examined it and found it in order, so he allowed Dr.
Fuentes to leave the operating room. Dr. Ampil was about to complete the procedure
when the attending nurses made some remarks on the Record of Operation: sponge
count lacking 2; announced to surgeon search done but to no avail continue for closure
(two pieces of gauze were missing). A diligent search was conducted but they could
not be found. Dr. Ampil then directed that the incision be closed.
A couple of days after, she complained of pain in her anal region, but the doctors told her
that it was just a natural consequence of the surgery. Dr. Ampil recommended that she
consult an oncologist to examine the cancerous nodes which were not removed during
the operation. After months of consultations and examinations in the US, she was told
that she was free of cancer. Weeks after coming back, her daughter found a piece of
gauze (1.5 in) protruding from her vagina, so Dr. Ampil manually extracted this, assuring
Natividad that the pains will go away. However, the pain worsened, so she sought
treatment at a hospital, where another 1.5 in piece of gauze was found in her vagina.
She underwent another surgery.
Sps. Agana filed a complaint for damages against PSI (owner of Medical City), Dr. Ampil,
and Dr. Fuentes, alleging that the latter are liable for negligence for leaving 2 pieces of
gauze in Natividads body, and malpractice for concealing their acts of negligence.
Enrique Agana also filed an administrative complaint for gross negligence and
malpractice against the two doctors with the PRC (although only the case against Dr.
Fuentes was heard since Dr. Ampil was abroad). Pending the outcome of the cases,
Natividad died (now substituted by her children). RTC found PSI and the two doctors

liable for negligence and malpractice. PRC dismissed the case against Dr. Fuentes. CA
dismissed only the case against Fuentes.
ISSUE AND HOLDING
WON CA erred in holding Dr. Ampil liable for negligence and malpractice. NO; DR. AMPIL
IS GUILTY
WON CA erred in absolving Dr. Fuentes of any liability. NO
WON PSI may be held solidarily liable for Dr. Ampils negligence. YES
Civil Law; Damages; Negligence; The leaving of sponges or other foreign substances in
the wound after the incision has been closed is at least prima facie negligence by the
operating surgeon. An operation requiring the placing of sponges in the incision is not
complete until the sponges are properly removed, and it is settled that the leaving of
sponges or other foreign substances in the wound after the incision has been closed is at
least prima facie negligence by the operating surgeon. To put it simply, such act is
considered so inconsistent with due care as to raise an inference of negligence. There
are even legions of authorities to the effect that such act is negligence per se.
SAME; SAME; SAME; To the mind of the Court, what was initially an act of negligence by
Dr. Ampil has ripened into a deliberate wrongful act of deceiving his patient.Here, Dr.
Ampil did not inform Natividad about the missing two pieces of gauze. Worse, he even
misled her that the pain she was experiencing was the ordinary consequence of her
operation. Had he been more candid, Natividad could have taken the immediate and
appropriate medical remedy to remove the gauzes from her body. To our mind, what was
initially an act of negligence by Dr. Ampil has ripened into a deliberate wrongful act of
deceiving his patient.
SAME; SAME; SAME; Doctrine of Res Ipsa Loquitur; Requisites for the Applicability of the
Doctrine.Literally, res ipsa loquitur means the thing speaks for itself. It is 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 plaintiffs
prima facie case, and present a question of fact for defendant to meet with an
explanation. Stated differently, where the thing which caused the injury, without the fault
of the injured, is under the exclusive control of the defendant and the injury is such that
it should not have occurred if he, having such control used proper care, it affords
reasonable evidence, in the absence of explanation that the injury arose from the
defendants want of care, and the burden of proof is shifted to him to establish that he
has observed due care and diligence. From the foregoing statements of the rule, the
requisites for the applicability of the doctrine of res ipsa loquitur are: (1) the occurrence
of an injury; (2) the thing which caused the injury was under the control and
management of the defendant; (3) the occurrence was such that in the ordinary course
of things, would not have happened if those who had control or management used
proper care; and (4) the absence of explanation by the defendant. Of the foregoing
requisites, the most instrumental is the control and management of the thing which
caused the injury.
SAME; SAME; SAME; SAME; Res ipsa loquitur is not a rule of substantive law, hence, does
not per se create or constitute an independent or separate ground of liability, being a
mere evidentiary rule.In this jurisdiction, res ipsa loquitur is not a rule of substantive
law, hence, does not per se create or constitute an independent or separate ground of
liability, being a mere evidentiary rule. In other words, mere invocation and application
of the doctrine does not dispense with the requirement of proof of negligence. Here, the
negligence was proven to have been committed by Dr. Ampil and not by Dr. Fuentes.
SAME; SAME; SAME; Professionals are considered personally liable for the fault or
negligence they commit in the discharge of their duties and their employer cannot be

held liable for such fault or negligence.A prominent civilist commented that
professionals engaged by an employer, such as physicians, dentists, and pharmacists,
are not employees under this article because the manner in which they perform their
work is not within the control of the latter (employer). In other words, professionals are
considered personally liable for the fault or negligence they commit in the discharge of
their duties, and their employer cannot be held liable for such fault or negligence. In the
context of the present case, a hospital cannot be held liable for the fault or negligence
of a physician or surgeon in the treatment or operation of patients.
SAME; SAME; SAME; In this jurisdiction, the nature of the relationship between the
hospital and the physicians is rendered inconsequential in view of the pronouncement in
Ramos vs. Court of Appeals, 321 SCRA 584 (1999), that for purposes of apportioning
responsibility in medical negligence cases, an employer-employee relationship in effect
exists between hospitals and their attending and visiting physicians.In our shores, the
nature of the relationship between the hospital and the physicians is rendered
inconsequential in view of our categorical pronouncement in Ramos v. Court of Appeals,
321 SCRA 584 (1999), that for purposes of apportioning responsibility in medical
negligence cases, an employer-employee relationship in effect exists between hospitals
and their attending and visiting physicians.
SAME;SAME; SAME; PSIs liability is also anchored upon the agency principle of apparent
authority or agency by estoppel and the doctrine of corporate negligence.But the
Ramos pronouncement is not our only basis in sustaining PSIs liability. Its liability is also
anchored upon the agency principle of apparent authority or agency by estoppel and the
doctrine of corporate negligence which have gained acceptance in the determination of a
hospitals liability for negligent acts of health professionals. The present case serves as a
perfect platform to test the applicability of these doctrines, thus, enriching our
jurisprudence. Apparent authority, or what is sometimes referred to as the holding out
theory, or doctrine of ostensible agency or agency by estoppel, has its origin from the
law of agency. It imposes liability, not as the result of the reality of a contractual
relationship, but rather because of the actions of a principal or an employer in somehow
misleading the public into believing that the relationship or the authority exists. The
concept is essentially one of estoppel and has been explained in this manner: The
principal is bound by the acts of his agent with the apparent authority which he
knowingly permits the agent to assume, or which he holds the agent out to the public as
possessing. The question in every case is whether the principal has by his voluntary act
placed the agent in such a situation that a person of ordinary prudence, conversant with
business usages and the nature of the particular business, is justified in presuming that
such agent has authority to perform the particular act in question.
SAME; SAME; SAME; In cases where it can be shown that a hospital, by its actions, has
held out a particular physician as its agent and/or employee and that a patient has
accepted treatment from that physician in the reasonable belief that it is being rendered
in behalf of the hospital, then the hospital will be liable for the physicians negligence.
The applicability of apparent authority in the field of hospital liability was upheld long
time ago in Irving v. Doctor Hospital of Lake Worth, Inc., 415 So. 2d 55 (1982). There, it
was explicitly stated that there does not appear to be any rational basis for excluding
the concept of apparent authority from the field of hospital liability. Thus, in cases
where it can be shown that a hospital, by its actions, has held out a particular physician
as its agent and/or employee and that a patient has accepted treatment from that
physician in the reasonable belief that it is being rendered in behalf of the hospital, then
the hospital will be liable for the physicians negligence.
SAME; SAME; SAME; By accrediting Dr. Ampil and Dr. Fuentes and publicly advertising
their qualifications, the hospital created the impression that they were its agents,

authorized to perform medical or surgical services for its patients.In this case, PSI
publicly displays in the lobby of the Medical City Hospital the names and specializations
of the physicians associated or accredited by it, including those of Dr. Ampil and Dr.
Fuentes. We concur with the Court of Appeals conclusion that it is now estopped from
passing all the blame to the physicians whose names it proudly paraded in the public
directory leading the public to believe that it vouched for their skill and competence.
Indeed, PSIs act is tantamount to holding out to the public that Medical City Hospital,
through its accredited physicians, offers quality health care services. By accrediting Dr.
Ampil and Dr. Fuentes and publicly advertising their qualifications, the hospital created
the impression that they were its agents, authorized to perform medical or surgical
services for its patients. As expected, these patients, Natividad being one of them,
accepted the services on the reasonable belief that such were being rendered by the
hospital or its employees, agents, or servants. [Professional Services, Inc. vs. Agana, 513
SCRA 478(2007)]
Dr. Ninevetch Cruz v. CA and Lydia Umali
FACTS
Lydia Umali was examined by Dr. Cruz who found a myoma [benign tumor] in her uterus,
and scheduled her for a hysterectomy operation [removal of uterus] on 23 Mar 1991.
Rowena Umali de Ocampo accompanied her mother to the hospital a day before the
operation, and they spent the night there. Rowena noticed that the clinic was untidy, so
she tried to persuade her mother not to proceed with the operation. The following day,
Rowena asked Dr. Cruz if the operation could be postponed, but Lydia told her daughter
that Dr. Cruz said that the operation must go on as scheduled.
While Lydias relatives were waiting, Dr. Ercillo (anesthesiologist) told them to buy
tagamet ampules, and Rowenas sister went out to buy some. An hour later, Dr. Ercillo
asked them to buy blood for Lydia, so they did. A few hours later, the operation was
finished, but later, Dr. Cruz asked the family to buy additional blood, but there was no
more type A blood available in the blood bank. A person arrived to donate blood which
was later transfused to Lydia. Rowena noticed that her mother was gasping for breath
apparently, the oxygen supply had run out, so the family went out to buy oxygen. Later
in the evening, she went into shock and her blood pressure dropped. She was then
transferred to another hospital so she could be connected to a respirator and further
examined. However, this transfer was without the consent of the relatives, who only
found out about it when an ambulance came to take Lydia to the other hospital.
In the new hospital, she was re-operated upon by Dr. Cruz and Dr. Ercillo because blood
was oozing out from her incision. They summoned Dr. Angeles, Ob-Gyne head of the new
hospital, but when he arrived, Lydia was already in shock and possibly dead (BP: 0/0). Dr.
Angeles told Drs. Cruz and Ercillo that there was nothing he could do. Lydia died while Dr.
Cruz was closing her abdominal wall. Immediate cause of death is shock; disseminated
intravascular coagulation (DIC) as antecedent cause.
Dr. Cruz and Dr. Ercillo were charged with reckless imprudence and negligence resulting
in homicide of Lydia Umali. The Municipal Trial Court in Cities (MTCC) found Dr. Ercillo not
guilty for insufficiency of evidence against her, but held Dr. Cruz responsible for Umalis
death. RTC and CA affirmed MTCC.
Manifestation of negligence
untidiness of clinic
lack of provision of supplies
the fact that the transfer was needed meant that there was something wrong in the way
Dr. Cruz conducted operation
no showing that pre-surgery procedure (clearance, blood typing/tests) was conducted

ISSUE AND HOLDING

WON the circumstances are sufficient to sustain a judgment of conviction against Dr.
Cruz for reckless imprudence resulting in homicide. NO. DR. CRUZ IS ACQUITTED, BUT
SHE IS STILL CIVILLY LIABLE (50K civil liability; 100k moral damages, 50k exemplary
damages).
Held
Physicians; Medical Malpractice; Criminal Law; Reckless Imprudence; Elements.This
Court, however, holds differently and finds the foregoing circumstances insufficient to
sustain a judgment of conviction against the petitioner for the crime of reckless
imprudence resulting in homicide. The elements of reckless imprudence are: (1) that the
offender does or fails to do an act; (2) that the doing or the failure to do that act is
voluntary; (3) that it be without malice; (4) that material damage results from the
reckless imprudence; and (5) that there is inexcusable lack of precaution on the part of
the offender, taking into consideration his employment or occupation, degree of
intelligence, physical condition, and other circumstances regarding persons, time and
place.
SAME; SAME; SAME; Evidence; Witnesses; Expert Testimony; Whether or not a physician
has committed an inexcusable lack of precaution in the treatment of his patient is to
be determined according to the standard of care observed by other members of the
profession in good standing under similar circumstances bearing in mind the advanced
state of the profession at the time of treatment or the present state of medical science;
Inasmuch as the causes of the injuries involved in malpractice actions are determinable
only in the light of scientific knowledge, it has been recognized that exp ert testimony is
usually necessary to support the conclusion as to causation.Whether or not a physician
has committed an inexcusable lack of precaution in the treatment of his patient is to
be determined according to the standard of care observed by other members of the
profession in good standing under similar circumstances bearing in mind the advanced
state of the profession at the time of treatment or the present state of medical science.
In the recent case of Leonila Garcia-Rueda v. Wilfred L. Pascasio, et al., this Court stated
that in accepting a case, a doctor in effect represents that, having the needed training
and skill possessed by physicians and surgeons practicing in the SAME field, he will
employ such training, care and skill in the treatment of his patients. He therefore has a
duty to use at least the SAME level of care that any other reasonably competent doctor
would use to treat a condition under the SAME circumstances. It is in this aspect of
medical malpractice that expert testimony is essential to establish not only the standard
of care of the profession but also that the physicians conduct in the treatment and care
falls below such standard. Further, inasmuch as the causes of the injuries involved in
malpractice actions are determinable only in the light of scientific knowledge, it has been
recognized that expert testimony is usually necessary to support the conclusion as to
causation.
SAME; SAME; SAME; SAME; SAME; SAME; While it may be true that certain circumstances
pointed out by the courts below seemed beyond cavil to constitute reckless imprudence
on the part of the surgeon, such conclusion is still best arrived at not through the
educated surmises nor conjectures of laymen, including judges, but by the
unquestionable knowledge of expert witnesses. For whether a physician or surgeon has
exercised the requisite degree of skill and care in the treatment of his patient is, in the
generality of cases, a matter of expert opinion.All three courts below bewail the
inadequacy of the facilities of the clinic and its untidiness; the lack of provisions such as
blood, oxygen, and certain medicines; the failure to subject the patient to a cardio-

pulmonary test prior to the operation; the omission of any form of blood typing before
transfusion; and even the subsequent transfer of Lydia to the San Pablo Hospital and the
reoperation performed on her by the petitioner. But while it may be true that the
circumstances pointed about by the courts below seemed beyond cavil to constitute
reckless imprudence on the part of the surgeon, this conclusion is still best arrived at not
through the educated surmises nor conjectures of laymen, including judges, but by the
unquestionable knowledge of expert witnesses. For whether a physician or surgeon has
exercised the requisite degree of skill and care in the treatment of his patient is, in the
generality of cases, a matter of expert opinion. The deference of courts to the expert
opinion of qualified physicians stems from its realization that the latter possess unusual
technical skills which laymen in most instances are incapable of intelligently evaluating.
Expert testimony should have been offered to prove that the circumstances cited by the
courts below are constitutive of conduct falling below the standard of care employed by
other physicians in good standing when performing the SAME operation. It must be
remembered that when the qualifications of a physician are admitted, as in the instant
case, there is an inevitable presumption that in proper cases he takes the necessary
precaution and employs the best of his knowledge and skill in attending to his clients,
unless the contrary is sufficiently established. This presumption is rebuttable by expert
opinion which is so sadly lacking in the case at bench.
SAME; SAME; SAME; SAME; Burden of Proof; In litigations involving medical negligence,
the plaintiff has the burden of establishing the defendants negligence and for a
reasonable conclusion of negligence, there must be proof of breach of duty on the part of
the surgeon as well as a causal connection of such breach and the resulting death of his
patient.In litigations involving medical negligence, the plaintiff has the burden of
establishing appellants negligence and for a reasonable conclusion of negligence, there
must be proof of breach of duty on the part of the surgeon as well as a causal connection
of such breach and the resulting death of his patient. In Chan Lugay v. St. Lukes
Hospital, Inc., where the attending physician was absolved of liability for the death of the
complainants wife and newborn baby, this Court held that: In order that there may be a
recovery for an injury, however, it must be shown that the injury for which recovery is
sought must be the legitimate consequence of the wrong done; the connection between
the negligence and the injury must be a direct and natural sequence of events, unbroken
by intervening efficient causes. In other words, the negligence must be the proximate
cause of the injury. For, negligence, no matter in what it consists, cannot create a right
of action unless it is the proximate cause of the injury complained of. And the proximate
cause of an injury is that cause, which, in natural and continuous sequence, unbroken by
any efficient intervening cause, produces the injury, and without which the result would
not have occurred. (Italics supplied.)
SAME; SAME; SAME; Evidence; Damages; While a conviction of a crime requires proof
beyond reasonable doubt, only a preponderance of evidence is required to establish civil
liability, thus, even as the Court was not able to render a sentence of conviction for
insufficiency of evidence, the Court is not blind to the reckless and imprudent manner in
which the surgeon carried out her duties.Nevertheless, this Court finds the petitioner
civilly liable for the death of Lydia Umali, for while a conviction of a crime requires proof
beyond reasonable doubt, only a preponderance of evidence is required to establish civil
liability. The petitioner is a doctor in whose hands a patient puts his life and limb. For
insufficiency of evidence this Court was not able to render a sentence of conviction but it
is not blind to the reckless and imprudent manner in which the petitioner carried out her
duties. A precious life has been lost and the circumstances leading thereto exacerbated
the grief of those left behind. The heirs of the deceased continue to feel the loss of their
mother up to the present time and this Court is aware that no amount of compassion and

commiseration nor words of bereavement can suffice to assuage the sorrow felt for the
loss of a loved one. Certainly, the award of moral and exemplary damages in favor of the
heirs of Lydia Umali are proper in the instant case. [Cruz vs. Court of Appeals, 282 SCRA
188(1997)]
Flores vs. Pineda, 571 SCRA 83(2008)
Teresita Pineda consulted Dr. Fredelicto Flores for her medical condition, where the latter
ordered the former to undergo an on call D&C operation to be performed by Dr.
Felicisima Flores, Fredelictos wife. After the operation, Teresitas condition worsened and
she died eventually. Believing that it was the negligence of Dr. Felicisima and Dr.
Fredelicto, Teresitas family filed a medical negligence case against the doctors.
The trial court and the Court of Appeals ruled in favour of Teresitas family. The spouses
appealed. UMDC, the spouses co-defendant, filed a petition for a review on certiorari.
The factual settings of the case presented that Teresita Pineda consulted Dr. Fredelicto
Flores, where she complained of general body weakness, loss of appetite, frequent
urination and thirst, and on-and-off vaginal bleeding. Dr. Fredelicto interviewed Teresita
and subsequently advised her to return the next week for a general check-up. She failed
to return the next week as advised, but when her condition persisted, she further
consulted Dr. Fredelicto at his UMDC clinic. The latter did a routine check-up and ordered
her to undergo an on-call D&C operation to be performed by his wife, Dr. Felisima
Flores. Teresita was taken to the operating room and had undergone a series of medical
examinations. The preliminary laboratory results indicated that her blood sugar was high.
After the operation, Teresitas condition worsened. She had difficulty in breathing and
was rushed to the intensive care unit. Tests confirmed that she was suffering from
Diabetes Mellitus Type H. Insulin was administered on her but the medications were
already too late and Teresita died eventually.
Issue
Whether or not spouses Dr. Fredelicto Flores and Dr. Felisima Flores are guilty of medical
negligence.
Ruling Yes. Dr. Fredelicto Flores and Dr. Felisima Flores are guilty of medical negligence
Civil Law; Negligence; Medical Negligence; A medical negligence is a type of claim to
redress a wrong committed by a medical professional, that has caused bodily harm to or
the death of a patient; Elements Involved in a Medical Negligence Case; A physician is
expected to use at least the SAME level of care that any other reasonably competent
doctor would use under the SAME circumstances; Breach of duty occurs when the
physician fails to comply with these professional standards.A medical negligence case
is a type of claim to redress a wrong committed by a medical professional, that has
caused bodily harm to or the death of a patient. There are four elements involved in a
medical negligence case, namely: duty, breach, injury, and proximate causation. Duty
refers to the standard of behavior which imposes restrictions on ones conduct. The
standard in turn refers to the amount of competence associated with the proper
discharge of the profession. A physician is expected to use at least the SAME level of
care that any other reasonably competent doctor would use under the SAME
circumstances. Breach of duty occurs when the physician fails to comply with these
professional standards. If injury results to the patient as a result of this breach, the
physician is answerable for negligence.
SAME; SAME; SAME; To successfully pursue a claim, the plaintiff must prove by
preponderance of evidence that, one, the physician either failed to do something which a
reasonable prudent health care provider would have done, or that he did something that
a reasonably prudent provider would not have done and two, the failure or action caused
injury to the patient; Expert testimony is therefore essential.As in any civil action, the

burden to prove the existence of the necessary elements rests with the plaintiff. To
successfully pursue a claim, the plaintiff must prove by preponderance of evidence that,
one, the physician either failed to do something which a reasonably prudent health care
provider would have done, or that he did something that a reasonably prudent provider
would not have done; and two, the failure or action caused injury to the patient. Expert
testimony is therefore essential since the factual issue of whether a physician or surgeon
has exercised the requisite degree of skill and care in the treatment of his patient is
generally a matter of expert opinion.
SAME; SAME; SAME; If a patient suffers from some disability that increases the
magnitude of risk to him, that disability must be taken into account so long as it is or
should have been known to the physician.Taken together, we find that reasonable
prudence would have shown that diabetes and its complications were foreseeable harm
that should have been taken into consideration by the petitioner spouses. If a patient
suffers from some disability that increases the magnitude of risk to him, that disability
must be taken into account so long as it is or should have been known to the physician.
And when the patient is exposed to an increased risk, it is incumbent upon the physician
to take commensurate and adequate precautions.
SAME; SAME; SAME; The critical and clinching factor in a medical negligence case is
proof of the causal connection between the negligence which the evidence established
and the plaintiffs injuries; Causation must be proven within a reasonable medical
probability based upon competent expert testimony.The critical and clinching factor in
a medical negligence case is proof of the causal connection between the negligence
which the evidence established and the plaintiffs injuries; the plaintiff must plead and
prove not only that he had been injured and defendant has been at fault, but also that
the defendants fault caused the injury. A verdict in a malpractice action cannot be based
on speculation or conjecture. Causation must be proven within a reasonable medical
probability based upon competent expert testimony.
SAME; SAME; Damages; The settled rule is that a plaintiff is entitled to be compensated
for proven pecuniary loss.Both the trial and the appellate court awarded actual
damages as compensation for the pecuniary loss the respondents suffered. The loss was
presented in terms of the hospital bills and expenses the respondents incurred on
account of Teresitas confinement and death. The settled rule is that a plaintiff is entitled
to be compensated for proven pecuniary loss. This proof the respondents successfully
presented. Thus, we affirm the award of actual damages of P36,000.00 representing the
hospital expenses the patient incurred.
SAME; SAME; SAME; Article 2206 of the Civil Code allows the recovery of moral damages
in case of death caused by a quasi-delict and enumerates the spouse, legitimate or
illegitimate ascendants or descendants as the persons entitled thereto.The SAME
article allows the recovery of moral damages in case of death caused by a quasi-delict
and enumerates the spouse, legitimate or illegitimate ascendants or descendants as the
persons entitled thereto. Moral damages are designed to compensate the claimant for
the injury suffered, that is, for the mental anguish, serious anxiety, wounded feelings
which the respondents herein must have surely felt with the unexpected loss of their
daughter. We affirm the appellate courts award of P400,000.00 by way of moral
damages to the respondents.
SAME; SAME; SAME; Damages; Exemplary Damages.The Supreme Court similarly
affirms the grant of exemplary damages. Exemplary damages are imposed by way of
example or correction for the public good. Because of the petitioner spouses negligence
in subjecting Teresita to an operation without first recognizing and addressing her
diabetic condition, the appellate court awarded exemplary damages to the respondents
in the amount of P100,000.00. Public policy requires such imposition to suppress the

wanton acts of an offender. We therefore affirm the CAs award as an example to the
medical profession and to stress that the public good requires stricter measures to avoid
the repetition of the type of medical malpractice that happened in this case. [Flores vs.
Pineda, 571 SCRA 83(2008)]
Solidum vs. People, 718 SCRA 263(2014)
On May 17, 1995, Gerald, then three years old, was admitted at the Ospital ng Maynila
for a pull-through operation.[5] Dr. Leandro Resurreccion headed the surgical team, and
was assisted by Dr. Joselito Luceo, Dr. Donatella Valea and Dr. Joseph Tibio. The
anesthesiologists included Dr. Marichu Abella, Dr. Arnel Razon and petitioner Dr.
Fernando Solidum (Dr. Solidum).[6] During the operation, Gerald experienced
bradycardia,[7] and went into a coma.[8] His coma lasted for two weeks,[9] but he
regained consciousness only after a month.[10] He could no longer see, hear or move.
[11]
Agitated by her sons helpless and unexpected condition, Ma. Luz Gercayo (Luz) lodged a
complaint for reckless imprudence resulting in serious physical injuries with the City
Prosecutors Office of Manila against the attending physicians.[12]
Upon a finding of probable cause, the City Prosecutors Office filed an information solely
against Dr. Solidum,[13] alleging:
That on or about May 17, 1995, in the City of Manila, Philippines, the said accused, being
then an anesthesiologist at the Ospital ng Maynila, Malate, this City, and as such was
tasked to administer the anesthesia on three-year old baby boy GERALD ALBERT
GERCAYO, represented by his mother, MA. LUZ GERCAYO, the former having been born
with an imperforate anus [no anal opening] and was to undergo an operation for anal
opening [pull through operation], did then and there willfully, unlawfully and feloniously
fail and neglect to use the care and diligence as the best of his judgment would dictate
under said circumstance, by failing to monitor and regulate properly the levels of
anesthesia administered to said GERALD ALBERT GERCAYO and using 100% halothane
and other anesthetic medications, causing as a consequence of his said carelessness and
negligence, said GERALD ALBERT GERCAYO suffered a cardiac arrest and consequently a
defect called hypoxic encephalopathy meaning insufficient oxygen supply in the brain,
thereby rendering said GERALD ALBERT GERCAYO incapable of moving his body, seeing,
speaking or hearing, to his damage and prejudice.
ISSUE:(a) whether or not the doctrine of res ipsa loquitur was applicable herein; and (b)
whether or not Dr. Solidum was liable for criminal negligence.
Ruling
The appeal is meritorious. [Solidum vs. People, 718 SCRA 263(2014)]
Held
Civil Law; Quasi-Delicts; Res Ipsa Loquitur; The doctrine res ipsa loquitur means that
where the thing which causes injury is shown to be under the management of the
defendant, and the accident is such as in the ordinary course of things does not happen
if those who have the management use proper care, it affords reasonable evidence, in
the absence of an explanation by the defendant, that the accident arose from want of
care.Res ipsa loquitur is literally translated as the thing or the transaction speaks for
itself. The doctrine res ipsa loquitur means that where the thing which causes injury is
shown to be under the management of the defendant, and the accident is such as in the
ordinary course of things does not happen if those who have the management use
proper care, it affords reasonable evidence, in the absence of an explanation by the
defendant, that the accident arose from want of care. It is simply a recognition of the
postulate that, as a matter of common knowledge and experience, the very nature of
certain types of occurrences may justify an inference of negligence on the part of the

person who controls the instrumentality causing the injury in the absence of some
explanation by the defendant who is charged with negligence. It is grounded in the
superior logic of ordinary human experience and on the basis of such experience or
common knowledge, negligence may be deduced from the mere occurrence of the
accident itself. Hence, res ipsa loquitur is applied in conjunction with the doctrine of
common knowledge.
SAME; SAME; SAME; Essential Requisites Before Resorting to the Doctrine of Res Ipsa
Loquitur.In order to allow resort to the doctrine, therefore, the following essential
requisites must first be satisfied, to wit: (1) the accident was of a kind that does not
ordinarily occur unless someone is negligent; (2) the instrumentality or agency that
caused the injury was under the exclusive control of the person charged; and (3) the
injury suffered must not have been due to any voluntary action or contribution of the
person injured.
SAME; SAME; Negligence; Words and Phrases; Negligence is defined as the failure to
observe for the protection of the interests of another person that degree of care,
precaution, and vigilance that the circumstances justly demand, whereby such other
person suffers injury.Negligence is defined as the failure to observe for the protection
of the interests of another person that degree of care, precaution, and vigilance that the
circumstances justly demand, whereby such other person suffers injury. Reckless
imprudence, on the other hand, consists of voluntarily doing or failing to do, without
malice, an act from which material damage results by reason of an inexcusable lack of
precaution on the part of the person performing or failing to perform such act. Dr.
Solidums conviction by the RTC was primarily based on his failure to monitor and
properly regulate the level of anesthetic agent administered on Gerald by overdosing at
100% halothane.
SAME; SAME; SAME; Medical Negligence; An action upon medical negligence whether
criminal, civil or administrative calls for the plaintiff to prove by competent evidence
each of the four elements.An action upon medical negligence whether criminal, civil
or administrative calls for the plaintiff to prove by competent evidence each of the
following four elements, namely: (a) the duty owed by the physician to the patient, as
created by the physician-patient relationship, to act in accordance with the specific
norms or standards established by his profession; (b) the breach of the duty by the
physicians failing to act in accordance with the applicable standard of care; (3) the
causation, i.e., there must be a reasonably close and causal connection between the
negligent act or omission and the resulting injury; and (4) the damages suffered by the
patient.
SAME; SAME; SAME; SAME; In the medical profession, specific norms or standards to
protect the patient against unreasonable risk, commonly referred to as standards of care,
set the duty of the physician to act in respect of the patient.In the medical profession,
specific norms or standards to protect the patient against unreasonable risk, commonly
referred to as standards of care, set the duty of the physician to act in respect of the
patient. Unfortunately, no clear definition of the duty of a particular physician in a
particular case exists. Because most medical malpractice cases are highly technical,
witnesses with special medical qualifications must provide guidance by giving the
knowledge necessary to render a fair and just verdict. As a result, the standard of
medical care of a prudent physician must be determined from expert testimony in most
cases; and in the case of a specialist (like an anesthesiologist), the standard of care by
which the specialist is judged is the care and skill commonly possessed and exercised by
similar specialists under similar circumstances. The specialty standard of care may be
higher than that required of the general practitioner.

SAME; SAME; SAME; SAME; In attempting to fix a standard by which a court may
determine whether the physician has properly performed the requisite duty toward the
patient, expert medical testimony from both plaintiff and defense experts is required.
The standard of care is an objective standard by which the conduct of a physician sued
for negligence or malpractice may be measured, and it does not depend, therefore, on
any individual physicians own knowledge either. In attempting to fix a standard by which
a court may determine whether the physician has properly performed the requisite duty
toward the patient, expert medical testimony from both plaintiff and defense experts is
required. The judge, as the trier of fact, ultimately determines the standard of care, after
listening to the testimony of all medical experts.
Remedial Law; Criminal Procedure; Prosecution of Offenses; Civil Liability; In criminal
prosecutions, the civil action for the recovery of civil liability that is deemed instituted
with the criminal action refers only to that arising from the offense charged.In criminal
prosecutions, the civil action for the recovery of civil liability that is deemed instituted
with the criminal action refers only to that arising from the offense charged. It is
puzzling, therefore, how the RTC and the CA could have adjudged Ospital ng Maynila
jointly and severally liable with Dr. Solidum for the damages despite the obvious fact that
Ospital ng Maynila, being an artificial entity, had not been charged along with Dr.
Solidum. The lower courts thereby acted capriciously and whimsically, which rendered
their judgment against Ospital ng Maynila void as the product of grave abuse of
discretion amounting to lack of jurisdiction.
SAME; SAME; SAME; SAME; Ospital ng Maynila could be held civilly liable only when
subsidiary liability would be properly enforceable pursuant to Article 103 of the Revised
Penal Code.Ospital ng Maynila could be held civilly liable only when subsidiary liability
would be properly enforceable pursuant to Article 103 of the Revised Penal Code. But the
subsidiary liability seems far-fetched here. The conditions for subsidiary liability to attach
to Ospital ng Maynila should first be complied with. Firstly, pursuant to Article 103 of the
Revised Penal Code, Ospital ng Maynila must be shown to be a corporation engaged in
any kind of industry. The term industry means any department or branch of art,
occupation or business, especially one that employs labor and capital, and is engaged in
industry. However, Ospital ng Maynila, being a public hospital, was not engaged in
industry conducted for profit but purely in charitable and humanitarian work. Secondly,
assuming that Ospital ng Maynila was engaged in industry for profit, Dr. Solidum must be
shown to be an employee of Ospital ng Maynila acting in the discharge of his duties
during the operation on Gerald. Yet, he definitely was not such employee but a
consultant of the hospital. And, thirdly, assuming that civil liability was adjudged against
Dr. Solidum as an em- ployee (which did not happen here), the execution against him
was unsatisfied due to his being insolvent. [Solidum vs. People, 718 SCRA 263(2014)]
Cayao-Lasam vs. Ramolete, 574 SCRA 439(2008)
On July 28, 1994, respondent, three months pregnant Editha Ramolete (Editha) was
brought to the Lorma Medical Center (LMC) in San Fernando, La Union due to vaginal
bleeding. Upon advice of petitioner relayed via telephone, Editha was admitted to the
LMC on the SAME day. A pelvic sonogram2 was then conducted on Editha revealing the
fetus weak cardiac pulsation.3The following day, Edithas repeat pelvic sonogram4
showed that aside from the fetus weak cardiac pulsation, no fetal movement was also
appreciated. Due to persistent and profuse vaginal bleeding, petitioner advised Editha to
undergo a Dilatation and Curettage Procedure (D&C) or raspa.

On July 30, 1994, petitioner performed the D&C procedure. Editha was discharged from
the hospital the following day.
On September 16, 1994, Editha was once again brought at the LMC, as she was suffering
from vomiting and severe abdominal pains. Editha was attended by Dr. Beatriz de la
Cruz, Dr. Victor B. Mayo and Dr. Juan V. Komiya. Dr. Mayo allegedly informed Editha that
there was a dead fetus in the latters womb. After, Editha underwent laparotomy,5 she
was found to have a massive intra-abdominal hemorrhage and a ruptured uterus. Thus,
Editha had to undergo a procedure for hysterectomy6 and as a result, she has no more
chance to bear a child.
On November 7, 1994, Editha and her husband Claro Ramolete (respondents) filed a
Complaint7 for Gross Negligence and Malpractice against petitioner before the
Professional Regulation Commission (PRC).
Respondents alleged that Edithas hysterectomy was caused by petitioners unmitigated
negligence and professional incompetence in conducting the D&C procedure and the
petitioners failure to remove the fetus inside Edithas womb.8 Among the alleged acts of
negligence were: first, petitioners failure to check up, visit or administer medication on
Editha during her first day of confinement at the LMC;9 second, petitioner recommended
that a D&C procedure be performed on Editha without conducting any internal
examination prior to the procedure;10 third, petitioner immediately suggested a D&C
procedure instead of closely monitoring the state of pregnancy of Editha.11
In her Answer,12 petitioner denied the allegations of negligence and incompetence with
the following explanations: upon Edithas confirmation that she would seek admission at
the LMC, petitioner immediately called the hospital to anticipate the arrival of Editha and
ordered through the telephone the medicines Editha needed to take, which the nurses
carried out; petitioner visited Editha on the morning of July 28, 1994 during her rounds;
on July 29, 1994, she performed an internal examination on Editha and she discovered
that the latters cervix was already open, thus, petitioner discussed the possible D&C
procedure, should the bleeding become more profuse; on July 30 1994, she conducted
another internal examination on Editha, which revealed that the latters cervix was still
open; Editha persistently complained of her vaginal bleeding and her passing out of
some meaty mass in the process of urination and bowel movement; thus, petitioner
advised Editha to undergo D&C procedure which the respondents consented to;
petitioner was very vocal in the operating room about not being able to see an
abortus;13 taking the words of Editha to mean that she was passing out some meaty
mass and clotted blood, she assumed that the abortus must have been expelled in the
process of bleeding; it was Editha who insisted that she wanted to be discharged;
petitioner agreed, but she advised Editha to return for check-up on August 5, 1994,
which the latter failed to do.
Petitioner contended that it was Edithas gross negligence and/or omission in insisting to
be discharged on July 31, 1994 against doctors advice and her unjustified failure to
return for check-up as directed by petitioner that contributed to her life-threatening
condition on September 16, 1994; that Edithas hysterectomy was brought about by her
very abnormal pregnancy known as placenta increta, which was an extremely rare and
very unusual case of abdominal placental implantation. Petitioner argued that whether or
not a D&C procedure was done by her or any other doctor, there would be no difference
at all because at any stage of gestation before term, the uterus would rupture just the
SAME. [Cayao-Lasam vs. Ramolete, 574 SCRA 439(2008)]
Issue: BOM not guilty- PRC Revoke license- CA improper venue
HELD:
Administrative Law; Double Jeopardy; Requisites; The principle of double jeopardy finds
no application in administrative cases.The principle of double jeopardy finds no

application in administrative cases. Double jeopardy attaches only: (1) upon a valid
indictment; (2) before a competent court; (3) after arraignment; (4) when a valid plea
has been entered; and (5) when the defendant was acquitted or convicted, or the case
was dismissed or otherwise terminated without the express consent of the accused.
These elements were not present in the proceedings before the Board of Medicine, as the
proceedings involved in the instant case were administrative and not criminal in nature.
The Court has already held that double jeopardy does not lie in administrative cases.
SAME; Physicians; Board of Medicine; Appeals; The right to appeal from a decision of the
Board of Medicine to the Professional Regulation Commission is available to both
complainants and respondents.Section 35 of the Rules and Regulations Governing the
Regulation and Practice of Professionals cited by petitioner was subsequently amended
to read: Sec. 35. The complainant/respondent may appeal the order, the resolution or the
decision of the Board within thirty (30) days from receipt thereof to the Commission
whose decision shall be final and executory. Interlocutory order shall not be appealable
to the Commission. (Amended by Res. 174, Series of 1990). Whatever doubt was created
by the previous provision was settled with said amendment. It is axiomatic that the right
to appeal is not a natural right or a part of due process, but a mere statutory privilege
that may be exercised only in the manner prescribed by law. In this case, the clear intent
of the amendment is to render the right to appeal from a decision of the Board available
to both complainants and respondents.
SAME; Statutory Construction; It is an elementary rule that when the law speaks in clear
and categorical language, there is no need, in the absence of legislative intent to the
contrary, for any interpretation.Such conclusion is bolstered by the fact that in 2006,
the PRC issued Resolution No. 06-342(A), or the New Rules of Procedure in Administrative
Investigations in the Professional Regulation Commission and the Professional Regulatory
Boards, which provides for the method of appeal, to wit: Sec. 1. Appeal; Period NonExtendible.The decision, order or resolution of the Board shall be final and executory
after the lapse of fifteen (15) days from receipt of the decision, order or resolution
without an appeal being perfected or taken by either the respondent or the complainant.
A party aggrieved by the decision, order or resolution may file a notice of appeal from
the decision, order or resolution of the Board to the Commission within fifteen (15) days
from receipt thereof, and serving upon the adverse party a notice of appeal together
with the appellants brief or memorandum on appeal, and paying the appeal and legal
research fees. x x x The above-stated provision does not qualify whether only the
complainant or respondent may file an appeal; rather, the new rules provide that a
party aggrieved may file a notice of appeal. Thus, either the complainant or the
respondent who has been aggrieved by the decision, order or resolution of the Board
may appeal to the Commission. It is an elementary rule that when the law speaks in
clear and categorical language, there is no need, in the absence of legislative intent to
the contrary, for any interpretation. Words and phrases used in the statute should be
given their plain, ordinary, and common usage or meaning.
SAME; SAME; Jurisdiction; Batas Pambansa (B.P.) Blg. 129 conferred upon the Court of
Appeals (CA) exclusive appellate jurisdiction over appeals from decisions of the
Professional Regulation Commission (PRC).The PRC is not expressly mentioned as one
of the agencies which are expressly enumerated under Section 1, Rule 43 of the Rules of
Court. However, its absence from the enumeration does not, by this fact alone, imply its
exclusion from the coverage of said Rule. The Rule expressly provides that it should be
applied to appeals from awards, judgments final orders or resolutions of any quasijudicial agency in the exercise of its quasi-judicial functions. The phrase among these
agencies confirms that the enumeration made in the Rule is not exclusive to the
agencies therein listed. Specifically, the Court, in Yang v. Court of Appeals, 186 SCRA 287

(1990), ruled that Batas Pambansa (B.P.) Blg. 129 conferred upon the CA exclusive
appellate jurisdiction over appeals from decisions of the PRC.
Physicians; Medical Malpractice; Words and Phrases; Medical malpractice is a particular
form of negligence which consists in the failure of a physician or surgeon to apply to his
practice of medicine that degree of care and skill which is ordinarily employed by the
profession generally, under similar conditions, and in like surrounding circumstances;
There are four elements involved in medical negligence casesduty, breach, injury and
proximate causation.Anent the substantive merits of the case, petitioner questions the
PRC decision for being without an expert testimony to support its conclusion and to
establish the cause of Edithas injury. Petitioner avers that in cases of medical
malpractice, expert testimony is necessary to support the conclusion as to the cause of
the injury. Medical malpractice is a particular form of negligence which consists in the
failure of a physician or surgeon to apply to his practice of medicine that degree of care
and skill which is ordinarily employed by the profession generally, under similar
conditions, and in like surrounding circumstances. In order to successfully pursue such a
claim, a patient must prove that the physician or surgeon either failed to do something
which a reasonably prudent physician or surgeon would not have done, and that the
failure or action caused injury to the patient. There are four elements involved in medical
negligence cases: duty, breach, injury and proximate causation.
SAME; SAME; Witnesses; Expert Witnesses; The breach of professional duties of skill and
care, or their improper performance by a physician surgeon, whereby the patient is
injured in body or in health, constitutes actionable malpractice, and as to this aspect of
medical malpractice, the determination of the reasonable level of care and the breach
thereof, expert testimony is essential.A physician-patient relationship was created
when Editha employed the services of the petitioner. As Edithas physician, petitioner
was duty-bound to use at least the SAME level of care that any reasonably competent
doctor would use to treat a condition under the SAME circumstances. The breach of
these professional duties of skill and care, or their improper performance by a physician
surgeon, whereby the patient is injured in body or in health, constitutes actionable
malpractice. As to this aspect of medical malpractice, the determination of the
reasonable level of care and the breach thereof, expert testimony is essential. Further,
inasmuch as the causes of the injuries involved in malpractice actions are determinable
only in the light of scientific knowledge, it has been recognized that expert testimony is
usually necessary to support the conclusion as to causation.
SAME; SAME; SAME; SAME; 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.
In the present case, respondents did not present any expert testimony to support their
claim that petitioner failed to do something which a reasonably prudent physician or
surgeon would have done. Petitioner, on the other hand, presented the testimony of Dr.
Augusto M. Manalo, who was clearly an expert on the subject. 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. Dr. Manalo specializes in gynecology and obstetrics, authored
and co-authored various publications on the subject, and is a professor at the University
of the Philippines.
SAME; SAME; Negligence; Proximate Cause; Words and Phrases; Medical malpractice, in
our jurisdiction, is often brought as a civil action for damages under Article 2176 of the
Civil Code, and the defenses in an action for damages are provided for under Article
2179; Proximate cause is that which, in natural and continuous sequence, unbroken by
any efficient intervening cause, produces injury, and without which the result would not

have occurred.Medical malpractice, in our jurisdiction, is often brought as a civil action

for damages under Article 2176 of the Civil Code. The defenses in an action for damages,
provided for under Article 2179 of the Civil Code are: Art. 2179. When the plaintiffs own
negligence was the immediate and proximate cause of his injury, he cannot recover
damages. But if his negligence was only contributory, the immediate and proximate
cause of the injury being the defendants lack of due care, the plaintiff may recover
damages, but the courts shall mitigate the damages to be awarded. 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.
SAME; SAME; SAME; SAME; SAME; Where the immediate cause of an accident resulting in
an injury is the plaintiffs own act, which contributed to the principal occurrence as one
of its determining factors, he cannot recover damages for the injury; Contributory
negligence is the act or omission amounting to want of ordinary care on the part of the
person injured, which, concurring with the defendants negligence, is the proximate
cause of the injury.Contributory negligence is the act or omission amounting to want of
ordinary care on the part of the person injured, which, concurring with the defendants
negligence, is the proximate cause of the injury. Difficulty seems to be apprehended in
deciding which acts of the injured party shall be considered immediate causes of the
accident. Where the immediate cause of an accident resulting in an injury is the
plaintiffs own act, which contributed to the principal occurrence as one of its
determining factors, he cannot recover damages for the injury. Again, based on the
evidence presented in the present case under review, in which no negligence can be
attributed to the petitioner, the immediate cause of the accident resulting in Edithas
injury was her own omission when she did not return for a follow-up check up, in
defiance of petitioners orders. The immediate cause of Edithas injury was her own act;
thus, she cannot recover damages from the injury.
Actions; Pleadings and Practice; Service of Notice; Burden of Proof; It is a well-settled rule
that when service of notice is an issue, the rule is that the person alleging that the notice
was served must prove the fact of servicethe burden of proving notice rests upon the
party asserting its existence.It is a well-settled rule that when service of notice is an
issue, the rule is that the person alleging that the notice was served must prove the fact
of service. The burden of proving notice rests upon the party asserting its existence. In
the present case, respondents did not present any proof that petitioner was served a
copy of the Memorandum on Appeal. Thus, respondents were not able to satisfy the
burden of proving that they had in fact informed the petitioner of the appeal proceedings
before the PRC.
SAME; SAME; SAME; Due Process; Failure of the appellant to furnish the appellee a copy
of the Memorandum of Appeal submitted to the Professional Regulation Commission
(PRC) constitutes a violation of due process.In EDI-Staffbuilders International, Inc. v.
National Labor Relations Commission, 537 SCRA 409 (2007), in which the National Labor
Relations Commission failed to order the private respondent to furnish the petitioner a
copy of the Appeal Memorandum, the Court held that said failure deprived the petitioner
of procedural due process guaranteed by the Constitution, which could have served as
basis for the nullification of the proceedings in the appeal. The SAME holds true in the
case at bar. The Court finds that the failure of the respondents to furnish the petitioner a

copy of the Memorandum of Appeal submitted to the PRC constitutes a violation of due
process. Thus, the proceedings before the PRC were null and void.
Physicians; Doctors are protected by a special rule of lawthey are not guarantors of
care and they are not insurers against mishaps or unusual consequences.Doctors are
protected by a special rule of law. They are not guarantors of care. They are not insurers
against mishaps or unusual consequences specially so if the patient herself did not
exercise the proper diligence required to avoid the injury. [Cayao-Lasam vs. Ramolete,
574 SCRA 439(2008)]
Nogales vs. Capitol Medical Center
Carpio, J.:G.R. No. 142625, Dec. 19, 2006 | 511 SCRA 204
FACTS:
Pregnant with her fourth child, Corazon Nogales ("Corazon"), who was then 37 years old,
was under the exclusive prenatal care of Dr. Oscar Estrada ("Dr. Estrada") beginning on
her fourth month of pregnancy or as early as December 1975. While Corazon was on her
last trimester of pregnancy, Dr. Estrada noted an increase in her blood pressure and
development of leg edema5 indicating preeclampsia, which is a dangerous complication
of pregnancy. Around midnight of 25 May 1976, Corazon started to experience mild labor
painsprompting Corazon and Rogelio Nogales ("Spouses Nogales") to see Dr. Estrada at
his home. After examining Corazon, Dr. Estrada advised her immediate admission to the
Capitol Medical Center ("CMC"). On 26 May 1976, Corazon was admitted at 2:30 a.m. at
the CMC after the staff nurse noted the written admission request8 of Dr. Estrada. Upon
Corazon's admission at the CMC, Rogelio Nogales ("Rogelio") executed and signed the
"Consent on Admission Agreement and Admission Agreement. Corazon was then
bought to the labor room of the CMC. Dr. Rosa Uy ("Dr. Uy"), who was then a resident
physician of CMC, conducted an internal examination of Corazon. Dr. Uy then called up
Dr. Estrada to notify him of her findings. Based on the Doctor's Order Sheet, around 3:00
a.m., Dr. Estrada ordered for 10 mg.of valium to be administered immediately by
intramuscular injection. Dr. Estrada later ordered the start of intravenous administration
of syntocinon admixed with dextrose,5%, in lactated Ringers' solution, at the rate of
eight to ten micro-drops per minute. According to the Nurse's Observation Notes, Dr. Joel
Enriquez ("Dr. Enriquez"), an anesthesiologist at CMC, was notified at 4:15 a.m. of
Corazon's admission. Subsequently, when asked if he needed the services of an
anesthesiologist, Dr. Estrada refused. Despite Dr. Estrada's refusal, Dr. Enriquez stayed to
observeCorazons condition. At 6:00 a.m., Corazon was transferred to Delivery Room No.
1 of the CMC. At 6:10a.m., Corazon's bag of water ruptured spontaneously. At 6:12 a.m.,
Corazon's cervix was fully dilated. At 6:13 a.m., Corazon started to experience
convulsions. At 6:15 a.m., Dr. Estrada ordered the injection of ten grams of magnesium
sulfate. However, Dr. Ely Villaflor ("Dr. Villaflor"), who was assisting Dr. Estrada,
administered only 2.5 grams of magnesium sulphate. At 6:22 a.m. Dr. Estrada, assisted
by Dr. Villaflor, applied low forceps to extract Corazon's baby. In the process, a 1.0 x 2.5
cm. piece of cervical tissue was allegedly torn. The baby came out in an apnic, cyanotic,
weak and injured condition. Consequently, the baby had to be intubated and
resuscitated by Dr. Enriquez and Dr. Payumo. At 6:27 a.m., Corazon began to manifest
moderate vaginal bleeding which rapidly became profuse. Corazon's blood pressure
dropped from 130/80 to 60/40 within five minutes. There was continuous profuse vaginal
bleeding. The assisting nurse administered hemacel through a gauge 19 needle as a side
drip to the ongoing intravenous injection of dextrose. At 7:45 a.m., Dr. Estrada ordered
blood typing and cross matching with bottled blood. Ittook approximately 30 minutes for
the CMC laboratory, headed by Dr. Perpetua Lacson("Dr. Lacson"), to comply with Dr.
Estrada's order and deliver the blood. At 8:00 a.m., Dr. Noe Espinola ("Dr. Espinola"),
head of the Obstetrics-Gynecology Department of the CMC, was apprised of Corazon's

condition by telephone. Upon being informed that Corazon was bleeding profusely, Dr.
Espinola ordered immediate hysterectomy. Rogelio was made to sign a "Consent to
Operation."13 Due to the inclement weather then, Dr. Espinola, who was fetched from his
residence by an ambulance, arrived at the CMC about an hour later or at 9:00 a.m. He
examined the patient and ordered some resuscitative measures to be administered.
Despite Dr.Espinola's efforts, Corazon died at 9:15 a.m. The cause of death was
"hemorrhage, postpartum."14 On 14 May 1980, petitioners filed a complaint for
damages15 with the Regional TrialCourt16 of Manila against CMC, Dr. Estrada, Dr.
Villaflor, Dr. Uy, Dr. Enriquez, Dr.Lacson, Dr. Espinola, and a certain Nurse J. Dumlao for
the death of Corazon. Petitioners mainly contended that defendant physicians and CMC
personnel were negligent in the treatment and management of Corazon's condition.
Petitioners charged CMC with negligence in the selection and supervision of defendant
physicians and hospital staff.
ISSUES & ARGUMENTS W/N CMC should be held liable
Hospitals; Medical Malpractice; Employer-Employee Relationship; The control test
essentially determines whether an employment relationship exists between a physician
and a hospital based on the exercise of control over the physician as to details.While
the Court in Ramos did not expound on the control test, such test essentially determines
whether an employment relationship exists between a physician and a hospital based on
the exercise of control over the physician as to details. Specifically, the employer (or the
hospital) must have the right to control both the means and the details of the process by
which the employee (or the physician) is to accomplish his task.
SAME; SAME; SAME; Doctrine of Apparent Authority; Words and Phrases; An exception to
the general rule that a hospital is not liable for the negligence of an independent
contractor-physician is when the physician is the ostensible agent of the hospital,
which exception is also known as the doctrine of apparent authority.In general, a
hospital is not liable for the negligence of an independent contractor-physician. There is,
however, an exception to this principle. The hospital may be liable if the physician is the
ostensible agent of the hospital. This exception is also known as the doctrine of
apparent authority. In Gilbert v. Sycamore Municipal Hospital, the Illinois Supreme Court
explained the doctrine of apparent authority in this wise: [U]nder the doctrine of
apparent authority a hospital can be held vicariously liable for the negligent acts of a
physician providing care at the hospital, regardless of whether the physician is an
independent contractor, unless the patient knows, or should have known, that the
physician is an independent contractor. The elements of the action have been set out as
follows: For a hospital to be liable under the doctrine of apparent authority, a plaintiff
must show that: (1) the hospital, or its agent, acted in a manner that would lead a
reasonable person to conclude that the individual who was alleged to be negligent was
an employee or agent of the hospital; (2) where the acts of the agent create the
appearance of authority, the plaintiff must also prove that the hospital had knowledge of
and acquiesced in them; and (3) the plaintiff acted in reliance upon the conduct of the
hospital or its agent, consistent with ordinary care and prudence. The element of
holding out on the part of the hospital does not require an express representation by
the hospital that the person alleged to be negligent is an employee. Rather, the element
is satisfied if the hospital holds itself out as a provider of emergency room care without
informing the patient that the care is provided by independent contractors. The element
of justifiable reliance on the part of the plaintiff is satisfied if the plaintiff relies upon the
hospital to provide complete emergency room care, rather than upon a specific
physician.
SAME; SAME; SAME; SAME; Estoppel; The doctrine of apparent authority is a species of
the doctrine of estoppel.The doctrine of apparent authority is a species of the doctrine

of estoppel. Article 1431 of the Civil Code provides that [t]hrough estoppel, an
admission or representation is rendered conclusive upon the person making it, and
cannot be denied or disproved as against the person relying thereon. Estoppel rests on
this rule: Whenever a party has, by his own declaration, act, or omission, intentionally
and deliberately led another to believe a particular thing true, and to act upon such
belief, he cannot, in any litigation arising out of such declaration, act or omission, be
permitted to falsify it.
SAME; SAME; SAME; SAME; The Court cannot close its eyes to the reality that hospitals
are in the business of treatment.CMCs defense that all it did was to extend to
[Corazon] its facilities is untenable. The Court cannot close its eyes to the reality that
hospitals, such as CMC, are in the business of treatment. In this regard, the Court agrees
with the observation made by the Court of Appeals of North Carolina in Diggs v. Novant
Health, Inc., to wit: The conception that the hospital does not undertake to treat the
patient, does not undertake to act through its doctors and nurses, but undertakes
instead simply to procure them to act upon their own responsibility, no longer reflects
the fact. Present day hospitals, as their manner of operation plainly demonstrates, do far
more than furnish facilities for treatment. They regularly employ on a salary basis a large
staff of physicians, nurses and internes [sic], as well as administrative and manual
workers, and they charge patients for medical care and treatment, collecting for such
services, if necessary, by legal action. Certainly, the person who avails himself of
hospital facilities expects that the hospital will attempt to cure him, not that its nurses
or other employees will act on their own responsibility. x x x
SAME; SAME; SAME; SAME; Contracts of Adhesion; Consent and Release Forms; A blanket
release in favor of hospitals from any and all claims, which includes claims due to bad
faith or gross negligence, would be contrary to public policy and thus void.Likewise
unconvincing is CMCs argument that petitioners are estopped from claiming damages
based on the Consent on Admission and Consent to Operation. Both release forms
consist of two parts. The first part gave CMC permission to administer to Corazon any
form of recognized medical treatment which the CMC medical staff deemed advisable.
The second part of the documents, which may properly be described as the releasing
part, releases CMC and its employees from any and all claims arising from or by reason
of the treatment and operation. The documents do not expressly release CMC from
liability for injury to Corazon due to negligence during her treatment or operation.
Neither do the consent forms expressly exempt CMC from liability for Corazons death
due to negligence during such treatment or operation. Such release forms, being in the
nature of contracts of adhesion, are construed strictly against hospitals. Besides, a
blanket release in favor of hospitals from any and all claims, which includes claims due
to bad faith or gross negligence, would be contrary to public policy and thus void.
SAME; SAME; SAME; SAME; SAME; SAME; Even simple negligence is not subject to
blanket release in favor of establishments like hospitals but may only mitigate liability
depending on the circumstances.Even simple negligence is not subject to blanket
release in favor of establishments like hospitals but may only mitigate liability depending
on the circumstances. When a person needing urgent medical attention rushes to a
hospital, he cannot bargain on equal footing with the hospital on the terms of admission
and operation. Such a person is literally at the mercy of the hospital. There can be no
clearer example of a contract of adhesion than one arising from such a dire situation.
Thus, the release forms of CMC cannot relieve CMC from liability for the negligent
medical treatment of Corazon.
Cantre vs. Go, 522 SCRA 547(2007)

Petitioner Dr. Milagros L. Cantre is a specialist in Obstetrics and Gynecology at the Dr.
Jesus Delgado Memorial Hospital. She was the attending physician of respondent Nora S.
Go, who was admitted at the said hospital on April 19, 1992.
At 1:30 a.m. of April 20, 1992, Nora gave birth to her fourth child, a baby boy. However,
at around 3:30 a.m., Nora suffered profuse bleeding inside her womb due to some parts
of the placenta which were not completely expelled from her womb after delivery.
Consequently, Nora suffered hypovolemic shock, resulting in a drop in her blood pressure
to 40 over 0. Petitioner and the assisting resident physician performed various
medical procedures to stop the bleeding and to restore Noras blood pressure. Her blood
pressure was frequently monitored with the use of a sphygmomanometer. While
petitioner was massaging Noras uterus for it to contract and stop bleeding, she ordered
a droplight to warm Nora and her baby.4 Nora remained unconscious until she recovered.
While in the recovery room, her husband, respondent John David Z. Go noticed a fresh
gaping wound two and a half (2 1/2) by three and a half (3 1/2) inches in the inner
portion of her left arm, close to the armpit.5 He asked the nurses what caused the injury.
He was informed it was a burn. Forthwith, on April 22, 1992, John David filed a request
for investigation.6 In response, Dr. Rainerio S. Abad, the medical director of the hospital,
called petitioner and the assisting resident physician to explain what happened.
Petitioner said the blood pressure cuff caused the injury.
On May 7, 1992, John David brought Nora to the National Bureau of Investigation for a
physical examination, which was conducted by medico-legal officer Dr. Floresto Arizala,
Jr.7 The medico-legal officer later testified that Noras injury appeared to be a burn and
that a droplight when placed near the skin for about 10 minutes could cause such burn.8
He dismissed the likelihood that the wound was caused by a blood pressure cuff as the
scar was not around the arm, but just on one side of the arm.9
On May 22, 1992, Noras injury was referred to a plastic surgeon at the Dr. Jesus Delgado
Memorial Hospital for skingrafting.10 Her wound was covered with skin sourced from her
abdomen, which consequently bore a scar as well. About a year after, on April 30, 1993,
scar revision had to be performed at the SAME hospital.11 The surgical operation left a
healed linear scar in Noras left arm about three inches in length, the thickest portion
rising about one-fourth (1/4) of an inch from the surface of the skin. The costs of the skin
grafting and the scar revision were shouldered by the hospital.12
Unfortunately, Noras arm would never be the SAME. Aside from the unsightly mark, the
pain in her left arm remains. When sleeping, she has to cradle her wounded arm. Her
movements now are also restricted. Her children cannot play with the left side of her
body as they might accidentally bump the injured arm, which aches at the slightest
touch. Thus, on June 21, 1993, respondent spouses filed a complaint13 for damages
against petitioner, Dr. Abad, and the hospital. Finding in favor of respondent spouses, the
trial court decreed: Petitioner contends that additional documentary exhibits not testified
to by any witness are inadmissible in evidence because they deprived her of her
constitutional right to confront the witnesses against her. Petitioner insists the droplight
could not have touched Noras body. She maintains the injury was due to the constant
taking of Noras blood pressure. Petitioner also insinuates the Court of Appeals was
misled by the testimony of the medico-legal officer who never saw the original injury
before plastic surgery was performed. Finally, petitioner stresses that plastic surgery was
not intended to restore respondents injury to its original state but rather to prevent
further complication.
Respondents, however, counter that the genuineness and due execution of the additional
documentary exhibits were duly admitted by petitioners counsel. Respondents point out
that petitioners blood pressure cuff theory is highly improbable, being unprecedented in
medical history and that the injury was definitely caused by the droplight. At any rate,

they argue, even if the injury was brought about by the blood pressure cuff, petitioner
was still negligent in her duties as Noras attending physician.
Simply put, the threshold issues for resolution are: (1) Are the questioned additional
exhibits admissible in evidence? (2) Is petitioner liable for the injury suffered by
respondent Nora Go? Thereafter, the inquiry is whether the appellate court committed
grave abuse of discretion in its assailed issuances. [Cantre vs. Go, 522 SCRA 547(2007)]
Civil Law; Negligence; Damages; Intent is immaterial in negligence cases because where
negligence exists and is proven, it automatically gives the injured a right to reparation
for the damages caused.The Hippocratic Oath mandates physicians to give primordial
consideration to the well-being of their patients. If a doctor fails to live up to this precept,
he is accountable for his acts. This notwithstanding, courts face a unique restraint in
adjudicating medical negligence cases because physicians are not guarantors of care
and, they never set out to intentionally cause injury to their patients.
However, intent is immaterial in negligence cases because where negligence exists and
is proven, it automatically gives the injured a right to reparation for the damage caused.
SAME; SAME; SAME; Requisites in Order for the Doctrine of Res Ipsa Loquitur to Apply in
Cases Involving Medical Negligence.In cases involving medical negligence, the doctrine
of res ipsa loquitur allows the mere existence of an injury to justify a presumption of
negligence on the part of the person who controls the instrument causing the injury,
provided that the following requisites concur: 1. The accident is of a kind which ordinarily
does not occur in the absence of someones 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.
SAME; SAME; SAME; Captain of the Ship Doctrine; The doctrine holds the surgeon in
charge of an operation liable for the negligence of his assistants during the time when
those assistants are under the surgeons control.Whether the injury was caused by the
droplight or by the blood pressure cuff is of no moment. Both instruments are deemed
within the exclusive control of the physician in charge under the captain of the ship
doctrine. This doctrine holds the surgeon in charge of an operation liable for the
negligence of his assistants during the time when those assistants are under the
surgeons control. In this particular case, it can be logically inferred that petitioner, the
senior consultant in charge during the delivery of Noras baby, exercised control over the
assistants assigned to both the use of the droplight and the taking of Noras blood
pressure. Hence, the use of the droplight and the blood pressure cuff is also within
petitioners exclusive control.
SAME; SAME; SAME; Petitioner is obliged to pay Nora for moral damages suffered by the
latter as a proximate result of petitioners negligence.Based on the foregoing, the
presumption that petitioner was negligent in the exercise of her profession stands
unrebutted. In this connection, the Civil Code provides: ART. 2176. Whoever by act or
omission causes damage to another, there being fault or negligence, is obliged to pay for
the damage done. . . . ART. 2217. Moral damages include physical suffering, mental
anguish, fright, serious anxiety, besmirched reputation, wounded feelings, moral shock,
social humiliation, and similar injury. Though incapable of pecuni-ary computation, moral
damages may be recovered if they are the proximate result of the defendants wrongful
act or omission. Clearly, under the law, petitioner is obliged to pay Nora for moral
damages suffered by the latter as a proximate result of petitioners negligence.
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:
Remedial Law; Pleadings and Practice; When a party is represented by counsel, all
notices should be sent to the partys lawyer at his given address.It is elementary that
when a party is represented by counsel, all notices should be sent to the partys lawyer
at his given address. With a few exceptions, notice to a litigant without notice to his
counsel on record is no notice at all. In the present case, since a copy of the decision of
the appellate court was not sent to the counsel on record of petitioner, there can be no
sufficient notice to speak of. Hence, the delay in the filing of the motion for
reconsideration cannot be taken against petitioner.
SAME; Evidence; Res Ipsa Loquitur; Doctrine of Res Ipsa Loquitur.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 plaintiffs 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 defen-dant
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 defendants want of care.
SAME; SAME; SAME; SAME; Res Ipsa Loquitur is applied in conjunction with the doctrine
of common knowledge.The doctrine of res ipsa loquitur is simply a recognition of the

postulate that, as a matter of common knowledge and experience, the very nature of
certain types of occurrences may justify an inference of negligence on the part of the
person who controls the instrumentality causing the injury in the absence of some
explanation by the defendant who is charged with negligence. It is grounded in the
superior logic of ordinary human experience and on the basis of such experience or
common knowledge, negligence may be deduced from the mere occurrence of the
accident itself. Hence, res ipsa loquitur is applied in conjunction with the doctrine of
common knowledge.
SAME; SAME; SAME; SAME; Mere invocation and application of the doctrine does not
dispense with the requirement of proof of negligence; Requisites before resort to the
doctrine may be allowed.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. Instead, it is considered as merely evidentiary or in the nature of a
procedural rule. It is regarded as a mode of proof, or a mere procedural convenience
since it furnishes a substitute for, and relieves a plaintiff of, the burden of producing
specific proof of negligence. In other words, 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 someones 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.
SAME; SAME; SAME; SAME; When the doctrine of res ipsa loqui-tur is availed by the
plaintiff, the need for expert medical testimony is dispensed with because the injury
itself provides the proof of negligence.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. The reason is that the
general rule on the necessity of expert testimony applies only to such matters clearly
within the domain of medical science, and not to matters that are within the common
knowledge of mankind which may be testified to by anyone familiar with the facts.
Ordinarily, only physicians and surgeons of skill and experience are competent to testify
as to whether a patient has been treated or operated upon with a reasonable degree of
skill and care. However, testimony as to the statements and acts of physicians and
surgeons, external appearances, and manifest conditions which are observable by any
one may be given by non-expert witnesses.
SAME; SAME; SAME; SAME; 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.Despite the fact that the scope of res ipsa loquitur has been measurably
enlarged, it does not automatically apply to all cases of medical negligence as to
mechanically shift the burden of proof to the defendant to show that he is not guilty of
the ascribed negligence. Res ipsa loquitur is not a rigid or ordinary doctrine to be
perfunctorily used but a rule to be cautiously applied, depending upon the circumstances
of each case. It is generally restricted to situations in malpractice cases where a layman
is able to say, as a matter of common knowledge and observation, that the

consequences of professional care were not as such as would ordinarily have followed if
due care had been exercised.
SAME; SAME; SAME; SAME; Res ipsa loquitur is not available in a malpractice suit if the
only showing is that the desired result of an operation or treatment was not
accomplished.It must be conceded that the doctrine of res ipsa loquitur can have no
application in a suit against a physician or surgeon which involves the merits of a
diagnosis or of a scientific treatment. The physician or surgeon is not required at his peril
to explain why any particular diagnosis was not correct, or why any particular scientific
treatment did not producethe desired result. Thus, res ipsa loquitur is not available in a
malpractice suit if the only showing is that the desired result of an operation or
treatment was not accomplished.
Hospitals; Damages; Proximate Cause Defined.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. It is the
dominant, moving or producing cause.
SAME; SAME; 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.Private 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
patients 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. This being the case, the question now arises as to whether or not
respondent hospital is solidarily liable with respondent doctors for petitioners condition.
SAME; SAME; The basis for holding an employer solidarily responsible for the negligence
of its employee is found in Article 2180 of the Civil Code.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 formers 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 other words, while the burden of proving negligence restson the plaintiffs, once
negligence is shown, the burden shifts to the respondents (parent, guardian, teacher or
employer) who should prove that they observed the diligence of a good father of a family
to prevent damage.
SAME; SAME; Amount of damages awarded may be a continuing one where the injury is
chronic and continuing, as when the patient is comatose.In these cases, the amount of
damages which should be awarded, if they are to adequately and correctly respond to
the injury caused, should be one which compensates for pecuniary loss incurred and
proved, up to the time of trial; and one which would meet pecuniary loss certain to be
suffered but which could not, from the nature of the case, be made with certainty. In
other words, temperate damages can and should be awarded on top of actual or
compensatory damages in instances where the injury is chronic and continuing. And

because of the unique nature of such cases, no incompatibility arises when both actual
and temperate damages are provided for. The reason is that these damages cover two
distinct phases. [Ramos vs. Court of Appeals, 321 SCRA 584(1999)]
Jarcia, Jr. vs. People, 666 SCRA 336(2012)
Belinda Santiago (Mrs. Santiago) lodged a complaint with the National Bureau of
Investigation (NBI) against the petitioners, Dr. Emmanuel Jarcia, Jr. (Dr. Jarcia) and Dr.
Marilou Bastan (Dr. Bastan), for their alleged neglect of professional duty which caused
her son, Roy Alfonso Santiago (Roy Jr.), to suffer serious physical injuries. Upon
investigation, the NBI found that Roy Jr. was hit by a taxicab; that he was rushed to the
Manila Doctors Hospital for an emergency medical treatment; that an X-ray of the
victims ankle was ordered; that the X-ray result showed no fracture as read by Dr. Jarcia;
that Dr. Bastan entered the emergency room (ER) and, after conducting her own
examination of the victim, informed Mrs. Santiago that since it was only the ankle that
was hit, there was no need to examine the upper leg; that eleven (11) days later, Roy Jr.
developed fever, swelling of the right leg and misalignment of the right foot; that Mrs.
Santiago brought him back to the hospital; and that the X-ray revealed a right mid-tibial
fracture and a linear hairline fracture in the shaft of the bone.
The NBI indorsed the matter to the Office of the City Prosecutor of Manila for preliminary
investigation. Probable cause was found and a criminal case for reckless imprudence
resulting to serious physical injuries, was filed against Dr. Jarcia, Dr. Bastan and Dr.
Pamittan,5 before the RTC, docketed as Criminal Case No. 01-196646.
On June 14, 2005, the RTC found the petitioners guilty beyond reasonable doubt of the
crime of Simple Imprudence Resulting to Serious Physical Injuries. The decretal portion of
the RTC decision reads:
WHEREFORE, premises considered, the Court finds accused DR. EMMANUEL JARCIA, JR.
and DR. MARILOU BASTAN GUILTY beyond reasonable doubt of the crime of SIMPLE
IMPRU-DENCE RESULTING TO SERIOUS PHYSICAL INJURIES and are hereby sentenced to
suffer the penalty of ONE (1) MONTH and ONE (1) DAY to TWO (2) MONTHS and to
indemnify MRS. BELINDA SANTIAGO the amount of P3,850.00 representing medical
expenses without subsidiary imprisonment in case of insolvency and to pay the costs.
It appearing that Dr. Pamittan has not been apprehended nor voluntarily surrendered
despite warrant issued for her arrest, let warrant be issued for her arrest and the case
against her be ARCHIVED, to be reinstated upon her apprehension.
SO ORDERED.6
The RTC explained:
After a thorough and in depth evaluation of the evidence adduced by the prosecution
and the defense, this court finds that the evidence of the prosecution is the more
credible, concrete and sufficient to create that moral certainty in the mind of the Court
that accused herein [are] criminally responsible. The Court believes that accused are
negligent when both failed to exercise the necessary and reasonable prudence in
ascertaining the extent of injury of Alfonso Santiago, Jr.
However, the negligence exhibited by the two doctors does not approximate negligence
of a reckless nature but merely amounts to simple imprudence. Simple imprudence
consists in the lack of precaution displayed in those cases in which the damage
impending to be caused is not the immediate nor the danger clearly manifest. The
elements of simple imprudence are as follows.
1.that there is lack of precaution on the part of the offender; and
2.that the damage impending to be caused is not immediate of the danger is not
clearly manifest.

Considering all the evidence on record, The Court finds the accused guilty for simple
imprudence resulting to physical injuries. Under Article 365 of the Revised Penal Code,
the penalty provided for is arresto mayor in its minimum period.7
As earlier stated, the CA affirmed the RTC decision
HELD:
Civil Law; Quasi-Delicts; Res Ipsa Loquitor; The doctrine of res ipsa loquitur means
Where the thing which causes injury is shown to be under the management of the
defendant, and the accident is such as in the ordinary course of things does not happen
if those who have the management use proper care, it affords reasonable evidence, in
the absence of an explanation by the defendant, that the accident arose from want of
care.This doctrine of res ipsa loquitur means Where the thing which causes injury is
shown to be under the management of the defendant, and the accident is such as in the
ordinary course of things does not happen if those who have the management use
proper care, it affords reasonable evidence, in the absence of an explanation by the
defendant, that the accident arose from want of care. The Blacks Law Dictionary
defines the said doctrine. Thus: The thing speaks for itself. Rebuttable presumption or
inference that defendant was negligent, which arises upon proof that the instrumentality
causing injury was in defendants exclusive control, and that the accident was one which
ordinarily does not happen in absence of negligence. Res ipsa loquitur is a rule of
evidence whereby negligence of the alleged wrongdoer may be inferred from the mere
fact that the accident happened provided the character of the accident and
circumstances attending it lead reasonably to belief that in the absence of negligence it
would not have occurred and that thing which caused injury is shown to have been under
the management and control of the alleged wrongdoer. Under this doctrine, the
happening of an injury permits an inference of negligence where plaintiff produces
substantial evidence that the injury was caused by an agency or instrumentality under
the exclusive control and management of defendant, and that the occurrence was such
that in the ordinary course of things would not happen if reasonable care had been used.
SAME; SAME; SAME; The doctrine of res ipsa loquitur as a rule of evidence is unusual to
the law of negligence which recognizes that prima facie negligence may be established
without direct proof and furnishes a substitute for specific proof of negligence.The
doctrine of res ipsa loquitur as a rule of evidence is unusual to the law of negligence
which recognizes that prima facie negligence may be established without direct proof
and furnishes a substitute for specific proof of negligence. The doctrine, however, is not
a rule of substantive law, but merely a mode of proof or a mere procedural convenience.
The rule, when applicable to the facts and circumstances of a given case, is not meant to
and does not dispense with the requirement of proof of culpable negligence on the party
charged. It merely determines and regulates what shall be prima facie evidence thereof
and helps the plaintiff in proving a breach of the duty. The doctrine can be invoked when
and only when, under the circumstances involved, direct evidence is absent and not
readily available.
SAME; SAME; SAME; Requisites for the Application of the Doctrine of Res Ipsa Loquitur.
The requisites for the application of the doctrine of res ipsa loquitur are: (1) the accident
was of a kind which does not ordinarily occur unless someone is negligent; (2) the
instrumentality or agency which caused the injury was under the exclusive control of the
person in charge; and (3) the injury suffered must not have been due to any voluntary
action or contribution of the person injured.
SAME; SAME; Negligence, Defined; Words and Phrases.Negligence is defined as the
failure to observe for the protection of the interests of another person that degree of
care, precaution, and vigilance which the circumstances justly demand, whereby such
other person suffers injury.

SAME; SAME; Reckless Imprudence, Defined; Words and Phrases.Reckless

imprudence consists of voluntarily doing or failing to do, without malice, an act from
which material damage results by reason of an inexcusable lack of precaution on the part
of the person performing or failing to perform such act.
SAME; SAME; Simple Negligence; Elements of Simple Negligence.The elements of
simple negligence are: (1) that there is lack of precaution on the part of the offender,
and (2) that the damage impending to be caused is not immediate or the danger is not
clearly manifest.
SAME; Reckless Imprudence; The Court finds the petitioners civilly liable for their failure
to sufficiently attend to Roy Jr.s medical needs when the latter was rushed to the ER, for
while a criminal conviction requires proof beyond reasonable doubt, only a
preponderance of evidence is required to establish civil liability.Although the Court
sympathizes with the plight of the mother and the child in this case, the Court is bound
by the dictates of justice which hold inviolable the right of the accused to be presumed
innocent until proven guilty beyond reasonable doubt. The Court, nevertheless, finds the
petitioners civilly liable for their failure to sufficiently attend to Roy Jr.s medical needs
when the latter was rushed to the ER, for while a criminal conviction requires proof
beyond reasonable doubt, only a preponderance of evidence is required to establish civil
liability. Taken into account also was the fact that there was no bad faith on their part.
Remedial Law; Civil Procedure; Appeals; Issues raised for the first time on appeal cannot
be considered because a party is not permitted to change his theory on appeal.This
Court cannot also stamp its imprimatur on the petitioners contention that no physicianpatient relationship existed between them and patient Roy Jr., since they were not his
attending physicians at that time. They claim that they were merely requested by the ER
nurse to see the patient while they were passing by the ER for their lunch. Firstly, this
issue was never raised during the trial at the RTC or even before the CA. The petitioners,
therefore, raise the want of doctor-patient relationship for the first time on appeal with
this Court. It has been settled that issues raised for the first time on appeal cannot be
considered because a party is not permitted to change his theory on appeal. To allow him
to do so is unfair to the other party and offensive to the rules of fair play, justice and due
process. Stated differently, basic considerations of due process dictate that theories,
issues and arguments not brought to the attention of the trial court need not be, and
ordinarily will not be, considered by a reviewing court.
Civil Law; Physician-Patient Relationship; When a patient engages the services of a
physician, a physician-patient relationship is generated; Thus, in treating his patient, a
physician is under a duty to exercise that degree of care, skill and diligence which
physicians in the SAME general neighborhood and in the SAME general line of practice
ordinarily possess and exercise in like cases.In the case of Lucas v. Tuao, 586 SCRA
173 (2009), the Court wrote that [w]hen a patient engages the services of a physician, a
physician-patient relationship is generated. And in accepting a case, the physician, for all
intents and purposes, represents that he has the needed training and skill possessed by
physicians and surgeons practicing in the SAME field; and that he will employ such
training, care, and skill in the treatment of the patient. Thus, in treating his patient, a
physician is under a duty to exercise that degree of care, skill and diligence which
physicians in the SAME general neighborhood and in the SAME general line of practice
ordinarily possess and exercise in like cases. Stated otherwise, the physician has the
obligation to use at least the SAME level of care that any other reasonably competent
physician would use to treat the condition under similar circumstances.
SAME; SAME; Medical Ethics; Established medical procedures and practices, though in
constant instability, are devised for the purpose of preventing complications.Article II,
Section 1 of the Code of Medical Ethics of the Medical Profession in the Philippines states:

A physician should attend to his patients faithfully and conscientiously. He should secure
for them all possible benefits that may depend upon his professional skill and care. As
the sole tribunal to adjudge the physicians failure to fulfill his obligation to his patients
is, in most cases, his own conscience, violation of this rule on his part is discreditable and
inexcusable. Established medical procedures and practices, though in constant
instability, are devised for the purpose of preventing complications. In this case, the
petitioners failed to observe the most prudent medical procedure under the
circumstances to prevent the complications suffered by a child of tender age.
SAME; Negligence; While no criminal negligence was found in the petitioners failure to
administer the necessary medical attention to Roy Jr., the Court holds them civilly liable
for the resulting damages to their patient.While no criminal negligence was found in
the petitioners failure to administer the necessary medical attention to Roy Jr., the Court
holds them civilly liable for the resulting damages to their patient. While it was the taxi
driver who ran over the foot or leg of Roy Jr., their negligence was doubtless contributory.
SAME; Damages; Actual Damages; Claims for actual damages must be adequately
supported by receipts.It appears undisputed that the amount of P3,850.00, as
expenses incurred by patient Roy Jr., was adequately supported by receipts. The Court,
therefore, finds the petitioners liable to pay this amount by way of actual damages.
SAME; SAME; Moral Damages; It is settled that moral damages are not punitive in nature,
but are designed to compensate and alleviate in some way the physical suffering, mental
anguish, fright, serious anxiety, besmirched reputation, wounded feelings, moral shock,
social humiliation, and similar injury unjustly inflicted on a person.The Court is aware
that no amount of compassion can suffice to ease the sorrow felt by the family of the
child at that time. Certainly, the award of moral and exemplary damages in favor of Roy
Jr. in the amount of P100,000.00 and P50,000.00, respectively, is proper in this case. It is
settled that moral damages are not punitive in nature, but are designed to compensate
and alleviate in some way the physical suffering, mental anguish, fright, serious anxiety,
besmirched reputation, wounded feelings, moral shock, social humiliation, and similar
injury unjustly inflicted on a person. Intended for the restoration of the psychological or
emotional status quo ante, the award of moral damages is designed to compensate
emotional injury suffered, not to impose a penalty on the wrongdoer.
SAME; SAME; Exemplary Damages; Exemplary damages may be imposed by way of
example or correction for the public good.The Court, likewise, finds the petitioners also
liable for exemplary dam-ages in the said amount. Article 2229 of the Civil Code provides
that exemplary damages may be imposed by way of example or correction for the public
good. [Jarcia, Jr. vs. People, 666 SCRA 336(2012)]