Dr. Lis v.

Spouses Soliman
Medical malpractice. An integral part of physicians overall obligation to patient is the duty of
reasonable disclosure of available choices with respect to proposed therapy and of dangers
inherently and potentially involved in each. However, the physician is not obliged to discuss
relatively minor risks inherent in common procedures when it is common knowledge that such
risks inherent in procedure of very low incidence. Cited as exceptions to the rule that the patient
should not be denied the opportunity to weigh the risks of surgery or treatment are emergency
cases where it is evident he cannot evaluate data, and where the patient is a child or incompetent.
The court thus concluded that the patients right of self-decision can only be effectively exercised
if the patient possesses adequate information to enable him in making an intelligent choice. The
scope of the physicians communications to the patient, then must be measured by the patients
need, and that need is whatever information is material to the decision. The test therefore for
determining whether a potential peril must be divulged is its materiality to the patients decision.
Cobbs v. Grant reiterated the pronouncement in Canterbury v. Spence that for liability of the
physician for failure to inform patient, there must be causal relationship between physicians
failure to inform and the injury to patient and such connection arises only if it is established that,
had revelation been made, consent to treatment would not have been given.
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.
The element of ethical duty to disclose material risks in the proposed medical treatment cannot
thus be reduced to one simplistic formula applicable in all instances. Further, in a medical
malpractice action based on lack of informed consent, the plaintiff must prove both the duty and
the breach of that duty through expert testimony. Dr. Rubi Li vs. Spouses Reynaldo and Lina
Soliman as parents/heirs of deceased Angelica Soliman, G.R. No. 165279. June 7, 2011

Urbano v. IAC
Facts:
On October 23, 1980, petitioner Filomeno Urbano was on his way to his ricefield. He found the
place where he stored palay flooded with water coming from the irrigation canal. Urbano went
to the elevated portion to see what happened, and there he saw Marcelino Javier and Emilio
Efre cutting grass. Javier admitted that he was the one who opened the canal. A quarrel ensued,
and Urbano hit Javier on the right palm with his bolo, and again on the leg with the back of the
bolo. On October 27, 1980, Urbano and Javier had an amicable settlement. Urbano paid P700
for the medical expenses of Javier. On November 14, 1980, Urbano was rushed to the hospital
where he had lockjaw and convulsions. The doctor found the condition to be caused by tetanus
toxin which infected the healing wound in his palm. He died the following day. Urbano was
charged with homicide and was found guilty both by the trial court and on appeal by the Court
of Appeals. Urbano filed a motion for new trial based on the affidavit of the Barangay Captain
who stated that he saw the deceased catching fish in the shallow irrigation canals on November
5. The motion was denied; hence, this petition.
Issue:
Whether the wound inflicted by Urbano to Javier was the proximate cause of the latters death
Held:
A satisfactory definition of proximate cause 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."And more comprehensively, "the proximate legal cause is
that acting first and producing the injury, either immediately or by setting other events in
motion, all constituting a natural and continuous chain of events, each having a close causal
connection with its immediate predecessor, the final event in the chain immediately effecting
the injury as a natural and probable result of the cause which first acted, under such
circumstances that the person responsible for the first event should, as an ordinarily prudent
and intelligent person, have reasonable ground to expect at the moment of his act or default that
an injury to some person might probably result therefrom."
If the wound of Javier inflicted by the appellant was already infected by tetanus germs at the
time, it is more medically probable that Javier should have been infected with only a mild cause
of tetanus because the symptoms of tetanus appeared on the 22nd day after the hacking
incident or more than 14 days after the infliction of the wound. Therefore, the onset time should
have been more than six days. Javier, however, died on the second day from the onset time. The
more credible conclusion is that at the time Javier's wound was inflicted by the appellant, the
severe form of tetanus that killed him was not yet present. Consequently, Javier's wound could
have been infected with tetanus after the hacking incident. Considering the circumstance
surrounding Javier's death, his wound could have been infected by tetanus 2 or 3 or a few but
not 20 to 22 days before he died.
The rule is that the death of the victim must be the direct, natural, and logical consequence of
the wounds inflicted upon him by the accused. And since we are dealing with a criminal

conviction, the proof that the accused caused the victim's death must convince a rational mind
beyond reasonable doubt. The medical findings, however, lead us to a distinct possibility that
the infection of the wound by tetanus was an efficient intervening cause later or between the
time Javier was wounded to the time of his death. The infection was, therefore, distinct and
foreign to the crime.
There is a likelihood that the wound was but the remote cause and its subsequent infection, for
failure to take necessary precautions, with tetanus may have been the proximate cause of
Javier's death with which the petitioner had nothing to do. "A prior and remote cause cannot be
made the be of an action if such remote cause did nothing more than furnish the condition or
give rise to the occasion by which the injury was made possible, if there intervened between such
prior or remote cause and the injury a distinct, successive, unrelated, and efficient cause of the
injury, even though such injury would not have happened but for such condition or occasion. If
no danger existed in the condition except because of the independent cause, such condition was
not the proximate cause. And if an independent negligent act or defective condition sets into
operation the instances which result in injury because of the prior defective condition, such
subsequent act or condition is the proximate cause."

Phoenix Construction v. IAC

Facts:
At about 1:30 a.m. on November 15, 1975, private respondent Leonardo Dionisio was on his way home
from cocktails and dinner meeting with his boss. He was proceeding down General Lacuna Street when
he saw a Ford dump truck parked askew, partly blocking the way of oncoming traffic, with no lights or
early warning reflector devices. The truck was driven earlier by Armando Carbonel, a regular driver of the
petitioner company. Dionisio tried to swerve his car to the left, but it was too late. He suffered some
physical injuries and nervous breakdown. Dionision filed an action for damages against Carbonel and
Phoenix Insurance. Petitioners countered the claim by imputing the accident to respondents own
negligence in driving at high speed without curfew pass and headlights, and while intoxicated. The trial
court and the Court of Appeals ruled in favor of private respondent.
Issue:
Whether the collision was brought about by the way the truck was parked, or by respondents own
negligence
Held:
We find that private respondent Dionisio was unable to prove possession of a valid curfew pass during the
night of the accident and that the preponderance of evidence shows that he did not have such a pass
during that night. It is the petitioners' contention that Dionisio purposely shut off his headlights even
before he reached the intersection so as not to be detected by the police in the police precinct which he
(being a resident in the area) knew was not far away from the intersection. We believe that the petitioners'
theory is a more credible explanation than that offered by private respondent Dionisio, i.e., that he had his
headlights on but that, at the crucial moment, these had in some mysterious if convenient way
malfunctioned and gone off, although he succeeded in switching his lights on again at "bright" split
seconds before contact with the dump truck. We do not believe that this evidence is sufficient to show that
Dionisio was so heavily under the influence of liquor as to constitute his driving a motor vehicle per se an
act of reckless imprudence. The conclusion we draw from the factual circumstances outlined above is that
private respondent Dionisio was negligent the night of the accident. He was hurrying home that night and
driving faster than he should have been. Worse, he extinguished his headlights at or near the intersection
of General Lacuna and General Santos Streets and thus did not see the dump truck that was parked askew
and sticking out onto the road lane.
Nonetheless, we agree with the Court of First Instance and the Intermediate Appellate Court that the legal
and proximate cause of the accident and of Dionisio's injuries was the wrongful or negligent manner in
which the dump truck was parked in other words, the negligence of petitioner Carbonel. The collision of
Dionisio's car with the dump truck was a natural and foreseeable consequence of the truck driver's
negligence.
The distinctions between "cause" and "condition" which the 'petitioners would have us adopt have already
been "almost entirely discredited. If the defendant has created only a passive static condition which made
the damage possible, the defendant is said not to be liable. But so far as the fact of causation is concerned,
in the sense of necessary antecedents which have played an important part in producing the result it is
quite impossible to distinguish between active forces and passive situations, particularly since, as is

invariably the case, the latter are the result of other active forces which have gone before. Even the lapse
of a considerable time during which the "condition" remains static will not necessarily affect liability.
"Cause" and "condition" still find occasional mention in the decisions; but the distinction is now almost
entirely discredited. So far as it has any validity at all, it must refer to the type of case where the forces set
in operation by the defendant have come to rest in a position of apparent safety, and some new force
intervenes. But even in such cases, it is not the distinction between "cause" and "condition" which is
important but the nature of the risk and the character of the intervening cause.
We believe, secondly, that the truck driver's negligence far from being a "passive and static condition"
was rather an indispensable and efficient cause. The improper parking of the dump truck created an
unreasonable risk of injury for anyone driving down General Lacuna Street and for having so created this
risk, the truck driver must be held responsible. In our view, Dionisio's negligence, although later in point
of time than the truck driver's negligence and therefore closer to the accident, was not an efficient
intervening or independent cause.
The defendant cannot be relieved from liability by the fact that the risk or a substantial and important part
of the risk, to which the defendant has subjected the plaintiff has indeed come to pass. Foreseeable
intervening forces are within the scope original risk, and hence of the defendant's negligence. The courts
are quite generally agreed that intervening causes which fall fairly in this category will not supersede the
defendant's responsibility. Thus, a defendant who blocks the sidewalk and forces the plaintiff to walk in a
street where the plaintiff will be exposed to the risks of heavy traffic becomes liable when the plaintiff is
run down by a car, even though the car is negligently driven; and one who parks an automobile on the
highway without lights at night is not relieved of responsibility when another negligently drives into it.
We hold that private respondent Dionisio's negligence was "only contributory," that the "immediate and
proximate cause" of the injury remained the truck driver's "lack of due care" and that consequently
respondent Dionisio may recover damages though such damages are subject to mitigation by the courts.
Petitioners also ask us to apply what they refer to as the "last clear chance" doctrine. The common law
notion of last clear chance permitted courts to grant recovery to a plaintiff who had also been negligent
provided that the defendant had the last clear chance to avoid the casualty and failed to do so.
Accordingly, it is difficult to see what role, if any, the common law last clear chance doctrine has to play
in a jurisdiction where the common law concept of contributory negligence as an absolute bar to recovery
by the plaintiff, has itself been rejected, as it has been in Article 2179 of the Civil Code of the Philippines.
Under Article 2179, the task of a court, in technical terms, is to determine whose negligence - the
plaintiff's or the defendant's - was the legal or proximate cause of the injury. The relative location in the
continuum of time of the plaintiff's and the defendant's negligent acts or omissions, is only one of the
relevant factors that may be taken into account. Of more fundamental importance are the nature of the
negligent act or omission of each party and the character and gravity of the risks created by such act or
omission for the rest of the community. Our law on quasi-delicts seeks to reduce the risks and burdens of
living in society and to allocate them among the members of society. To accept the petitioners' proposition must tend to weaken the very bonds of society.
We believe that the demands of substantial justice are satisfied by allocating most of the damages on a 2080 ratio. Thus, 20% of the damages awarded by the respondent appellate court, except the award of
P10,000.00 as exemplary damages and P4,500.00 as attorney's fees and costs, shall be borne by private
respondent Dionisio; only the balance of 80% needs to be paid by petitioners Carbonel and Phoenix who
shall be solidarity liable therefor to the former. The award of exemplary damages and attorney's fees and
costs shall be borne exclusively by the petitioners. Phoenix is of course entitled to reimbursement from
Carbonel. 18 We see no sufficient reason for disturbing the reduced award of damages made by the
respondent appellate court.

Brief Fact Summary. Esther Hunter-Lyons (Hunter-Lyons) was killed in a collision with a truck
owned by Midnight Sun Transportation Services Incorporated (Defendant). The jury was given
instructions concerning the sudden emergency doctrine and found that while the driver of the
truck was negligent. His negligence was not the legal cause of the accident. Hunter-Lyons
appealed, asserting that the instruction was improper.
Synopsis of Rule of Law. The sudden emergency doctrine is a rule of law which states that a
person confronted with a sudden and unexpected peril, not resulting from that persons own
negligence, is not expected to exercise the same judgment and prudence the law requires of a
person in calmer and more deliberate moments. The person confronted with the imminent peril
must, however, act as a reasonable person would under the same conditions.
Facts. Hunter-Lyons was killed when her Volkswagen van was struck broadside by a truck driven
by David Jette (Jette) and owned by Defendant. When the accident occurred, Jette was driving
south in the right-hand lane of a thoroughfare in Anchorage, Alaska. Hunter-Lyons pulled out of
a parking lot in front of him. Jette braked and steered to the left, but Hunter-Lyons continued to
pull out further into the traffic lane. Jettes truck collided with Hunter-Lyonss vehicle. David
Lyons, the deceaseds husband, (Plaintiff) filed suit, asserting that Jette had been speeding and
driving
negligently.
Issue. Was the jury instruction concerning the sudden emergency doctrine improper?
Held. The court affirmed the trial courts decision that Jette was not at fault in the accident, but
that the primary cause was the decedent pulling out in front of Jette. The use of the sudden
emergency instruction was harmless error.
Discussion. The sudden emergency doctrine, which arises in Lyons, has at times caused
confusion with respect to the degree of care a party may owe another. The idea is, if a person,
through no fault of his or her own, is faced with a sudden emergency, they are not to be held to
the same correctness of judgment and action as if he had time and opportunity to fully consider
the
situation.
* The individual is, however, expected to exercise that care which a reasonably prudent person
would have exercised under the same or similar circumstances. As the court explains, The
sudden emergency doctrine arose as a method of ameliorating the, sometimes harsh, all or
nothing
rule
in
contributory
negligence
systems.
* Or, as The American Law Institute articulates the doctrine: In determining whether conduct is
negligent toward another, the fact that the actor is confronted with a sudden emergency which
requires rapid decision is a factor in determining the reasonable character of his choice of
action.
* The modern trend, as is reflected in Lyons, is to move away from instructing juries on the
sudden emergency doctrine because, rather than explaining to the jury that emergency
circumstances are a factor in determining the reasonableness of the defendants actions, the

instruction has a tendency to elevate its principles above what is required to be proven in a
negligence action.
Brief Fact Summary. The husband of the Plaintiff, Ms. Perkins (Plaintiff), was a passenger in a
car when a train at a railway crossing struck the car. The Plaintiffs husband was killed.
Synopsis of Rule of Law. The defendants negligence must be a substantial factor in the cause of
the harm for liability to attach.

Facts. The Plaintiffs husband was killed in a collision between the car he was a passenger in and
a freight train operated by the Defendant, New Orleans Railroad Co. At the intersection of the
road and rail crossing where the accident occurred, a large warehouse obstructed the view of
both the cars driver and the trains engineer and brakeman. The trains engineer and brakeman
were aware of the obstruction and while approaching the intersection rang the trains bell and
whistle and put its headlights on. The intersection also had warning signals to warn drivers of
approaching trains. These signals were operating at the time of the accident. Of the three railway
employees in the forward engine of the train only two, the brakeman and a fireman saw the car
emerge from the intersection. The third, the engineer did not see the car due to the obstructed
view, but applied the emergency brakes when his companions alerted him to the presence of the
car. At the time of the accident the train
was between 30 to 60 feet from the car. Both parties have conceded that the driver of the car,
who was also killed, was negligent in driving upon the train track with the signal lights on. The
parties have also conceded that the train was traveling at 37 miles per hour when the selfimposed speed limit for the intersection was 25 miles per hour.
Issue. Whether the negligence of the Defendant was a substantial factor in causing the accident.
Held. The trains speed was not a substantial factor in the cause of the accident.

Discussion. By traveling twelve miles over the self-imposed speed limit, the engineer was
negligent. The engineer testified that even at a rate of 25 mph, the train could not have avoided
the car. Based on this testimony, the court finds that the speed of the train was not a substantial
factor in the crash. Because the accident would have occurred even if the train had been traveling
within the speed limit, the negligence of the trains operator is not a substantial factor in the
collision.

Villareal vs People (Lenny Villa Case)

Facts:
February 1991- 7 freshmen law students of ADMU signified their intention to join the Aquila
Legis fraternity. They were met by members of AL at the lobby of Ateneo Law. They were
informed that there will be physical beatings and that they can quit anytime. The rites were
scheduled to last 3 days. They were subjected to traditional Aquilan initiation rites such as the
Indian Run, Bicol Express, Rounds, Auxies Privilege Round, rough basketball, comic
plays, and other forms of paddling. Lenny received several blows, one of which was so strong
that it sent him sprawling to the ground. When they were already sleeping, the neophytes were
roused by Lennys shivering and mumblings. He was brought to the hospital but was pronounced
dead on arrival.
Held:

No crime without a law punishing it

Thus, having in mind the potential conflict between the proposed law and the
core principle of mala in seadhered to under the Revised Penal Code,
Congress did not simply enact an amendment thereto. Instead, it created a
special law on hazing, founded upon the principle of mala prohibita. This
dilemma faced by Congress is further proof of how the nature of hazing
unique as against typical crimes cast a cloud of doubt on whether society
considered the act as an inherently wrong conduct or mala in seat the time.

Consequently, the collective acts of the fraternity members were tantamount

to recklessness, which made the resulting death of Lenny a culpable felony. It
must be remembered that organizations owe to their initiates a duty of care
not to cause them injury in the process. With the foregoing facts, we rule that
the accused are guilty of reckless imprudence resulting in homicide. Since the
NBI medico-legal officer found that the victims death was the cumulative
effect of the injuries suffered, criminal responsibility redounds to all those
who directly participated in and contributed to the infliction of physical
injuries

Our finding of criminal liability for the felony of reckless imprudence resulting
in homicide shall cover only accused Tecson, Ama, Almeda, Bantug, and
Dizon. Had the Anti-Hazing Law been in effect then, these five accused
fraternity members would have all been convicted of the crime of hazing
punishable by reclusion perpetua(life imprisonment). Since there was no law
prohibiting the act of hazing when Lenny died, we are constrained to rule
according to existing laws at the time of his death.

Ramos v. CA
Facts:
Erlinda Ramos, a 47-year old robust woman, was normal except for her experiencing occasional
pain due to the presence of stone in her gall bladder. She was advised to undergo an operation
for its removal. The results in the examinations she underwent indicate that she was fit for the
operation. She and her husband Rogelio met Dr. Hosaka, one of the defendants, who advised
that she should undergo cholecystectomy. Dr. Hosaka assured them that he will get a good
anaesthesiologist. At 7:30 a.m. on the day of the operation at Delos Santos Medical Center,
Herminda Cruz, Erlindas sister-in-law and the dean of the College of Nursing in Capitol
Medical Center, was there to provide moral support. Dr. Perfecta Gutierrez was to administer
the anaesthesia. Dr. Hosaka arrived only at 12:15 p. m. Herminda saw Dr. Gutierrez intubating
the patient, and heard the latter say Ang hirap ma-intubate nito, mali yata ang pagkakapasok.
O, lumalaki ang tiyan. Herminda saw bluish discoloration of the nailbeds of the patient. She
heard Dr. Hosaka issue an order for someone to call Dr. Calderon. The doctor arrived and placed
the patient in trendelenburg position, wherein the head of the patient is positioned lower than
the feet, which indicates a decrease of blood supply in the brain. Herminda knew and told
Rogelio that something wrong was happening. Dr. Calderon was able to intubate the patient.
Erlinda was taken to the ICU and became comatose.
Rogelio filed a civil case for damages. The trial court ruled in his favor, finding Dr. Gutierrez, Dr.
Hosaka, and the hospital, guilty of negligence, but the Court of Appeals reversed the decision.
Hence, petitioner filed a Motion for Reconsideration, which the Court of Appeals denied for
having been filed beyond the reglementary period. However, it was found that the notice of the
decision was never sent to the petitioners counsel. Rather, it was sent to the petitioner,
addressing him as Atty. Rogelio Ramos, as if he was the legal counsel. The petitioner filed the
instant petition for certiorari. On the procedural issue, the Supreme Court rules that since the
notice did not reach the petitioners then legal counsel, the motion was filed on time.
Issue:
Whether a surgeon, an anaesthesiologist, and a hospital, should be made liable for the
unfortunate comatose condition of a patient scheduled for cholecystectomy
Held:
Res Ipsa Loquitor
Res ipsa loquitur is a Latin phrase which literally means "the thing or the transaction speaks for
itself." The phrase "res ipsa loquitur'' is a maxim for the rule that the fact of the occurrence of an
injury, taken with the surrounding circumstances, may permit an inference or raise a
presumption of negligence, or make out a plaintiff's prima facie case, and present a question of
fact for defendant to meet with an explanation. Where the thing which caused the injury
complained of is shown to be under the management of the defendant or his servants and the
accident is such as in ordinary course of things does not happen if those who have its
management or control use proper care, it affords reasonable evidence, in the absence of
explanation by the defendant, that the accident arose from or was caused by the defendant's

want of care. It is grounded in the superior logic of ordinary human experience and on the basis
of such experience or common knowledge, negligence may be deduced from the mere
occurrence of the accident itself. However, much has been said that res ipsa loquitur is not a
rule of substantive law and, as such, does not create or constitute an independent or separate
ground of liability. Mere invocation and application of the doctrine does not dispense with the
requirement of proof of negligence. It is simply a step in the process of such proof, permitting
the plaintiff to present along with the proof of the accident, enough of the attending
circumstances to invoke the doctrine, creating an inference or presumption of negligence, and to
thereby place on the defendant the burden of going forward with the proof. Still, before resort to
the doctrine may be allowed, the following requisites must be satisfactorily shown.
(1) The accident is of a kind which ordinarily does not occur in the absence of someone's
negligence;
(2) It is caused by an instrumentality within the exclusive control of the defendant or
defendants; and
(3) The possibility of contributing conduct which would make the plaintiff responsible is
eliminated.
Medical malpractice cases do not escape the application of this doctrine. Thus, res ipsa loquitur
has been applied when the circumstances attendant upon the harm are themselves of such a
character as to justify an inference of negligence as the cause of that harm. Although generally,
expert medical testimony is relied upon in malpractice suits to prove that a physician has done a
negligent act or that he has deviated from the standard medical procedure, when the doctrine of
res ipsa loquitur is availed by the plaintiff, the need for expert medical testimony is dispensed
with because the injury itself provides the proof of negligence. Hence, in cases where the res
ipsa loquitur is applicable, the court is permitted to find a physician negligent upon proper
proof of injury to the patient, without the aid of expert testimony, where the court from its fund
of common knowledge can determine the proper standard of care. When the doctrine is
appropriate, all that the patient must do is prove a nexus between the particular act or omission
complained of and the injury sustained while under the custody and management of the
defendant without need to produce expert medical testimony to establish the standard of care.
Resort to res ipsa loquitur is allowed because there is no other way, under usual and ordinary
conditions, by which the patient can obtain redress for injury suffered by him.
Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be
cautiously applied, depending upon the circumstances of each case. A distinction must be made
between the failure to secure results, and the occurrence of something more unusual and not
ordinarily found if the service or treatment rendered followed the usual procedure of those
skilled in that particular practice. The real question, therefore, is whether or not in the process
of the operation any extraordinary incident or unusual event outside of the routine performance
occurred which is beyond the regular scope of customary professional activity in such
operations, which, if unexplained would themselves reasonably speak to the average man as the
negligent cause or causes of the untoward consequence.
We find the doctrine of res ipsa loquitur appropriate in the case at bar. Erlinda submitted
herself for cholecystectomy and expected a routine general surgery to be performed on her gall
bladder. On that fateful day she delivered her person over to the care, custody and control of
private respondents who exercised complete and exclusive control over her. At the time of
submission, Erlinda was neurologically sound and, except for a few minor discomforts, was

likewise physically fit in mind and body. However, during the administration of anesthesia and
prior to the performance of cholecystectomy she suffered irreparable damage to her brain. Thus,

NOGALES vs CAPITOL MEDICAL CENTER Case Digest

ROGELIO NOGALES vs. CAPITOL MEDICAL CENTER et al.
G.R. No. 142625
December 19, 2006
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. Around
midnight of 25 May 1976, Corazon started to experience mild labor pains prompting
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"). t 6:13 a.m., Corazon started to experience convulsionsAt 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.At 6:27
a.m., Corazon began to manifest moderate vaginal bleeding which rapidly became
profuse. Corazon died at 9:15 a.m. The cause of death was "hemorrhage, post partum.
Issue: Whether or not CMC is vicariously liable for the negligence of Dr. Estrada.
Ruling: Private hospitals, hire, fire and exercise real control over their attending and
visiting "consultant" staff. The basis for holding an employer solidarily responsible for
the negligence of its employee is found in Article 2180 of the Civil Code which considers
a person accountable not only for his own acts but also for those of others based on the
former's responsibility under a relationship of patria potestas.
In general, a hospital is not liable for the negligence of an independent contractorphysician. 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.
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. In the instant case,
CMC impliedly held out Dr. Estrada as a member of its medical staff. Through CMC's
acts, CMC clothed Dr. Estrada with apparent authority thereby leading the Spouses
Nogales to believe that Dr. Estrada was an employee or agent of CMC.