Professional Documents
Culture Documents
FIRST DIVISION
PROFESSIONAL SERVICES, INC.,
Petitioner,
Present:
PUNO, C.J., Chairperson
SANDOVAL-GUTIERREZ,
CORONA,
AZCUNA, and
*
GARCIA, JJ.
Promulgated:
4,
1984,
Natividad
Agana
was
rushed
to
because
of
11,
1984,
Dr.
Ampil,
assisted
by
the
medical
staff [4] of
On April 24, 1984, Natividad was released from the hospital. Her hospital
and medical bills, including the doctors fees, amounted to P60,000.00.
After a couple of days, Natividad complained of excruciating pain in her
anal region. She consulted both Dr. Ampil and Dr. Fuentes about it. They
told her that the pain was the natural consequence of the surgery. Dr.
Ampil then recommended that she consult an oncologist to examine the
cancerous nodes which were not removed during the operation.
On May 9, 1984, Natividad, accompanied by her husband, went to
the United
States to
seek
further
treatment.
After
four
months
of
Natividad
to
seek
treatment
at
the Polymedic
General Hospital. While confined there, Dr. Ramon Gutierrez detected the
presence of another foreign object in her vagina -- a foul-smelling gauze
measuring 1.5 inches in width which badly infected her vaginal vault. A
recto-vaginal fistula had formed in her reproductive organs which forced
stool to excrete through the vagina. Another surgical operation was
needed to remedy the damage.
Thus,
PSI,
Dr.
Ampil
and
Dr.
Fuentes
liable
for
negligence
b.
c.
2.
3.
4.
5.
6.
and
Miguel
SO ORDERED.
Only Dr. Ampil filed a motion for reconsideration, but it was denied
in a Resolution[7] dated December 19, 1996.
Hence, the instant consolidated petitions.
In G.R. No. 126297, PSI alleged in its petition that the Court of Appeals
erred in holding that: (1) it is estopped from raising the defense that Dr.
Ampil is not its employee; (2) it is solidarily liable with Dr. Ampil; and (3) it
is not entitled to its counterclaim against the Aganas. PSI contends that
Dr. Ampil is not its employee, but a mere consultant or independent
contractor. As such, he alone should answer for his negligence.
In G.R. No. 126467, the Aganas maintain that the Court of Appeals erred in
finding that Dr. Fuentes is not guilty of negligence or medical malpractice,
invoking the doctrine ofres ipsa loquitur. They contend that the pieces of
gauze are prima facie proofs that the operating surgeons have been
negligent.
Finally, in G.R. No. 127590, Dr. Ampil asserts that the Court of Appeals
erred in finding him liable for negligence and malpractice sans evidence
that he left the two pieces of gauze in Natividads vagina. He pointed to
other probable causes, such as: (1) it was Dr. Fuentes who used gauzes in
performing the hysterectomy; (2) the attending nurses failure to properly
count the gauzes used during surgery; and (3) the medical intervention of
the American doctors who examined Natividad in the United States of
America.
For our resolution are these three vital issues: first, whether the
Court of Appeals erred in holding Dr. Ampil liable for negligence and
malpractice; second, whether the Court of Appeals erred in absolving Dr.
Malpractice.
the
gauzes
in
Natividads
body
after
performing
has
operating
been
surgeon.
closed
[8]
To
is
put
at
it
such
act
is
by
considered
the
so
even
legions
of
authorities
to
the
effect
that
such
act
both
duties.
Such
breach
caused
injury
to
Natividad,
The Aganas assailed the dismissal by the trial court of the case against Dr.
Fuentes on the ground that it is contrary to the doctrine of res ipsa
loquitur. According to them, the fact that the two pieces of gauze were left
inside Natividads body is a prima facie evidence of Dr. Fuentes negligence.
We are not convinced.
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. [13] 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
or
management
used
proper
care;
absence
of
However, the days of house calls and philanthropic health care are
over.The modern health care industry continues to distance itself from its
charitable past and has experienced a significant conversion from a notfor-profit health care to for-profit hospital businesses. Consequently,
significant changes in health law have accompanied the business-related
changes in the hospital industry. One important legal change is an
increase in hospital liability for medical malpractice. Many courts now
allow
claims
of respondeat
for
hospital
superior,
vicarious
apparent
liability
authority,
under
ostensible
the
theories
authority,
or
prominent
employer,
civilist
such
as
commented
physicians,
that
professionals
dentists,
and
engaged
pharmacists,
by
are
an
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
foregoing
view
is
grounded
on
that
the
professional status and the very nature of the physicians calling preclude
him from being classed as an agent or employee of a hospital, whenever
he acts in a professional capacity. [22] It has been said that medical practice
strictly involves highly developed and specialized knowledge, [23]such that
physicians are generally free to exercise their own skill and judgment in
rendering medical services sans interference.[24] Hence, when a doctor
practices medicine in a hospital setting, the hospital and its employees
are deemed to subserve him in his ministrations to the patient and his
actions are of his own responsibility.[25]
The case of Schloendorff v. Society of New York Hospital[26] was then
considered an authority for this view. The Schloendorff doctrine regards a
physician,
even
if
employed
by
hospital,
as
an independent
contractor because of the skill he exercises and the lack of control exerted
over his work. Under this doctrine, hospitals are exempt from the
application of the respondeat superior principle for fault or negligence
committed by physicians in the discharge of their profession.
However, the efficacy of the foregoing doctrine has weakened with
the significant developments in medical care. Courts came to realize that
modern hospitals are increasingly taking active role in supplying and
regulating medical care to patients. No longer were a hospitals functions
limited to furnishing room, food, facilities for treatment and operation,
and attendants for its patients. Thus, in Bing v. Thunig,[27] the New York
Court of Appeals deviated from the Schloendorff doctrine, noting that
modern
hospitals
actually
do
far
more
than
provide
facilities
for
is
no
reason
to
exempt
hospitals
from
the
universal
rule
of respondeat superior.
In our shores, the nature of the relationship between the hospital and the
physicians
is
rendered
inconsequential
in
view
of
our
categorical
acceptance
in
the
determination
of
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.
malpractice
is
that
PSI
as
owner,
operator
and
manager
of Medical City Hospital, did not perform the necessary supervision nor
the
present
case,
it
was
the
duly
established
purpose
and
that
under
PSI
the
operates
concept
of
with
the
assistance
composed
of
resident
doctors,
of
nurses,
and
interns. As
staff,
such,
it
is
of
the
procedures
carried
out, particularly the report of the attending nurses that the two pieces of
gauze were missing. In Fridena v. Evans,[41] it was held that a corporation
is bound by the knowledge acquired by or notice given to its agents or
officers within the scope of their authority and in reference to a matter to
which their authority extends. This means that the knowledge of any of
the staff ofMedical City Hospital constitutes knowledge of PSI. Now, the
Natividad
regarding
the
missing
gauzes amounts
to
callous
negligence. Not only did PSI breach its duties to oversee or supervise all
persons who practice medicine within its walls, it also failed to take an
active step in fixing the negligence committed. This renders PSI, not only
vicariously liable for the negligence of Dr. Ampil under Article 2180 of the
Civil Code, but alsodirectly liable for its own negligence under Article
2176. In Fridena, the Supreme Court of Arizona held:
x x x In recent years, however, the duty of care owed to
the patient by the hospital has expanded. The emerging trend
is to hold the hospital responsible where the hospital has
failed to monitor and review medical services being provided
within its walls. See Kahn Hospital Malpractice Prevention, 27
De Paul . Rev. 23 (1977).
Among the cases indicative of the emerging trend
is Purcell v. Zimbelman, 18 Ariz. App. 75,500 P. 2d 335 (1972).
In Purcell, the hospital argued that it could not be held liable
for the malpractice of a medical practitioner because he was
an independent contractor within the hospital. The Court of
Appeals pointed out that the hospital had created a
professional staff whose competence and performance was to
be monitored and reviewed by the governing body of the
hospital, and the court held that a hospital would be negligent
where it had knowledge or reason to believe that a doctor
using the facilities was employing a method of treatment or
care which fell below the recognized standard of care.
Subsequent to the Purcell decision, the Arizona Court of
Appeals held that a hospital has certain inherent
responsibilities regarding the quality of medical care
furnished to patients within its walls and it must meet the
standards
of
responsibility
commensurate
with
this
undertaking. Beeck v. Tucson General Hospital, 18 Ariz. App.
165, 500 P. 2d 1153 (1972). This court has confirmed the
rulings of the Court of Appeals that a hospital has the duty of
supervising the competence of the doctors on its staff. x x x.
xxxxxx
In the amended complaint, the plaintiffs did plead that
the operation was performed at the hospital with its
knowledge, aid, and assistance, and that the negligence of
the defendants was the proximate cause of the patients
injuries. We find that such general allegations of negligence,
along with the evidence produced at the trial of this case, are
Anent the corollary issue of whether PSI is solidarily liable with Dr. Ampil
for damages, let it be emphasized that PSI, apart from a general denial of
its responsibility, failed to adduce evidence showing that it exercised the
diligence of a good father of a family in the accreditation and supervision
of the latter. In neglecting to offer such proof, PSI failed to discharge its
burden under the last paragraph of Article 2180 cited earlier, and,
therefore, must be adjudged solidarily liable with Dr. Ampil. Moreover, as
we have discussed, PSI is also directly liable to the Aganas.
One final word. Once a physician undertakes the treatment and care of a
patient, the law imposes on him certain obligations. In order to escape
liability, he must possess that reasonable degree of learning, skill and
experience required by his profession. At the same time, he must apply
reasonable care and diligence in the exercise of his skill and the
application of his knowledge, and exert his best judgment.
WHEREFORE, we DENY all
the
petitions
challenged
Republic
SUPREME
Manila
of
the
Philippines
COURT
THIRD DIVISION
G.R. No. 142625
ROGELIO P. NOGALES, for himself and on behalf of the minors, ROGER ANTHONY, ANGELICA, NANCY, and
MICHAEL
CHRISTOPHER,
all
surnamed
NOGALES, petitioners,
vs.
CAPITOL MEDICAL CENTER, DR. OSCAR ESTRADA, DR. ELY VILLAFLOR, DR. ROSA UY, DR. JOEL ENRIQUEZ, DR.
PERPETUA LACSON, DR. NOE ESPINOLA, and NURSE J. DUMLAO, respondents.
DECISION
CARPIO, J.:
The Case
This petition for review 1 assails the 6 February 1998 Decision 2 and 21 March 2000 Resolution 3 of the Court of Appeals in CAG.R. CV No. 45641. The Court of Appeals affirmed in toto the 22 November 1993 Decision4 of the Regional Trial Court of
Manila, Branch 33, finding Dr. Oscar Estrada solely liable for damages for the death of his patient, Corazon Nogales, while
absolving the remaining respondents of any liability. The Court of Appeals denied petitioners' motion for reconsideration.
The 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,6 which is a dangerous complication of pregnancy. 7
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").
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 and Agreement" 9 and "Admission Agreement." 10 Corazon was then brought 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, 11 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, 12 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 observe Corazon's condition.
At 6:00 a.m., Corazon was transferred to Delivery Room No. 1 of the CMC. At 6:10 a.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 sulfate.
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. It took 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, post partum." 14
FIRST DIVISION
A.
THE
HONORABLE
SUPREME
COURT
MAY
HAVE
INADVERTENTLY OVERLOOKED THE FACT THAT THE COURT OF
APPEALS DECISION DATED 29 MAY 1995 HAD ALREADY
BECOME FINAL AND EXECUTORY AS OF 25 JUNE 1995,
THEREBY
DEPRIVING
THIS
HONORABLE
COURT
OF
JURISDICTION OVER THE INSTANT PETITION;
B.
THE
HONORABLE
SUPREME
COURT
MAY
HAVE
INADVERTENTLY OVERLOOKED SEVERAL MATERIAL FACTUAL
CIRCUMSTANCES WHICH, IF PROPERLY CONSIDERED, WOULD
INDUBITABLY LEAD TO NO OTHER CONCLUSION BUT THAT
PRIVATE RESPONDENT DOCTORS WERE NOT GUILTY OF ANY
NEGLIGENCE IN RESPECT OF THE INSTANT CASE;
B.1 RESPONDENT
DOCTOR
PERFECTA
GUTIERREZ
HAS
SUFFICIENTLY DISCHARGED THE BURDEN OF EVIDENCE BY
SUBSTANTIAL PROOF OF HER COMPLIANCE WITH THE
STANDARDS OF DUE CARE EXPECTED IN HER RESPECTIVE FIELD
OF MEDICAL SPECIALIZATION.
B.2 RESPONDENT
DOCTOR
PERFECTA
GUTIERREZ
HAS
SUFFICIENTLY DISCHARGED THE BURDEN OF EVIDENCE BY
SUBSTANTIAL PROOF OF HER HAVING SUCCESSFULLY
INTUBATED PATIENT ERLINDA RAMOS
In the case at bar, respondent Dra. Gutierrez admitted that she saw
Erlinda for the first time on the day of the operation itself, on 17
June 1985. Before this date, no prior consultations with, or preoperative evaluation of Erlinda was done by her. Until the day of the
operation, respondent Dra. Gutierrez was unaware of the
physiological make-up and needs of Erlinda. She was likewise not
properly informed of the possible difficulties she would face during
the administration of anesthesia to Erlinda. Respondent Dra.
Gutierrez act of seeing her patient for the first time only an hour
before the scheduled operative procedure was, therefore, an act of
exceptional negligence and professional irresponsibility. The
measures cautioning prudence and vigilance in dealing with human
lives lie at the core of the physicians centuries-old Hippocratic Oath.
Her failure to follow this medical procedure is, therefore, a
clear indicia of her negligence.[16]
Further, there is no cogent reason for the Court to reverse its finding that
it was the faulty intubation on Erlinda that caused her comatose
condition. There is no question that Erlinda became comatose after Dr.
Gutierrez performed a medical procedure on her. Even the counsel of Dr.
Gutierrez admitted to this fact during the oral arguments:
CHIEF JUSTICE:
Mr. Counsel, you started your argument saying that this involves a comatose
patient?
ATTY. GANA:
Yes, Your Honor.
CHIEF JUSTICE:
We cannot thus give full credence to Dr. Gutierrez synopsis in light of her
admission that it does not fully reflect the events that transpired during the
administration of anesthesia on Erlinda. As pointed out by Dr. Estrella, there
was a ten-minute gap in Dr. Gutierrez synopsis, i.e., the vital signs of Erlinda
were not recorded during that time. The absence of these data is particularly
significant because, as found by the trial court, it was the absence of oxygen
supply for four (4) to five (5) minutes that caused Erlindas comatose
condition.
Dr. Hosaka cannot now claim that he was entirely blameless of what
happened to Erlinda. His conduct clearly constituted a breach of his
professional duties to Erlinda:
CHIEF JUSTICE:
Two other points. The first, Doctor, you were talking about anxiety, would you
consider a patient's stay on the operating table for three hours sufficient
enough to aggravate or magnify his or her anxiety?
DR. CAMAGAY:
Yes.
CHIEF JUSTICE:
In other words, I understand that in this particular case that was the case,
three hours waiting and the patient was already on the operating table
(interrupted)
DR. CAMAGAY:
Yes.
CHIEF JUSTICE:
Would you therefore conclude that the
aggravation of the anxiety of the patient?
surgeon
contributed
to
the
DR. CAMAGAY:
That this operation did not take place as scheduled is already a source of
anxiety and most operating tables are very narrow and that patients are
usually at risk of falling on the floor so there are restraints that are placed on
them and they are never, never left alone in the operating room by
themselves specially if they are already pre-medicated because they may not
be aware of some of their movement that they make which would contribute
to their injury.
Dr. Hosaka's irresponsible conduct of arriving very late for the scheduled
operation of petitioner Erlinda is violative, not only of his duty as a physician
to serve the interest of his patients with the greatest solicitude, giving them
always his best talent and skill,[44] but also of Article 19 of the Civil Code
which requires a person, in the performance of his duties, to act with justice
and give everyone his due.
Anent private respondent DLSMCs liability for the resulting injury to
petitioner Erlinda, we held that respondent hospital is solidarily liable with
respondent doctors therefor under Article 2180 of the Civil Code[45] since
there exists an employer-employee relationship between private respondent
DLSMC and Drs. Gutierrez and Hosaka:
In other words, private hospitals, hire, fire and exercise real control
over their attending and visiting consultant staff. While consultants
are not, technically employees, x x x 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. x x x[46]
DLSMC however contends that applying the four-fold test in determining
whether such a relationship exists between it and the respondent doctors,
the inescapable conclusion is that DLSMC cannot be considered an employer
of the respondent doctors.
It has been consistently held that in determining whether an employeremployee relationship exists between the parties, the following elements
Republic
SUPREME
Manila
of
the
Philippines
COURT
THIRD DIVISION
a physician make a deep incision upon a man with his bronze lancet and cause the man's
death, or operate on the eye socket of a man with his bronze lancet and destroy the man's
eyes, they shall cut off his hand." Subsequently, Hippocrates wrote what was to become
part of the healer's oath: "I will follow that method of treatment which according to my
ability and judgment, I consider for the benefit of my patients, and abstain from whatever is
deleterious and mischievous. . . . While I continue to keep this oath unviolated may it be
granted me to enjoy life and practice the art, respected by all men at all times but should I
trespass and violate this oath, may the reverse be my lot." At present, the primary objective
of the medical profession if the preservation of life and maintenance of the health of the
people.
2
Needless to say then, when a physician strays from his sacred duty and endangers instead the life of his patient, he must
be made to answer therefor. Although society today cannot and will not tolerate the punishment meted out by the ancients,
neither will it and this Court, as this case would show, let the act go uncondemned.
a
Progress Record, an Anesthesia Record, a Nurse's Record, and a Physician's Discharge
Summary. The trial court, however, regarded these documentary evidence as mere
hearsay, "there being no showing that the person or persons who prepared them are
deceased or unable to testify on the facts therein stated. . . . Except for the Medical
Aside from Dr. Kho's testimony, the evidence which mentioned the piece of rubber are a Medical Certificate,
11
14
12
13
10
16
A . . . I have heard somebody that [sic] says [sic] there is [sic] a foreign body that
goes with the tissues but unluckily I don't know where the rubber was. 17
The trial court deemed vital Dr. Victoria Batiquin's testimony that when she confronted Dr. Kho regarding the piece of
rubber, "Dr. Kho answered that there was rubber indeed but that she threw it away." 18 This statement, the trial
court noted, was never denied nor disputed by Dr. Kho, leading it to conclude:
There are now two different versions on the whereabouts of that offending "rubber" (1) that it was
sent to the Pathologist in Cebu as testified to in Court by Dr. Kho and (2) that Dr. Kho threw it away as
told by her to Defendant. The failure of the Plaintiffs to reconcile these two different versions serve only
to weaken their claim against Defendant Batiquin. 19
All told, the trial court held in favor of the petitioners herein.
The Court of Appeals reviewed the entirety of Dr. Kho's testimony and, even without admitting the private respondents'
documentary evidence, deemed Dr. Kho's positive testimony to definitely establish that a piece of rubber was found near
private respondent Villegas's uterus. Thus, the Court of Appeals reversed the decision of the trial court, holding:
4. The fault or negligence of appellee Dr. Batiquin is established by preponderance of evidence. The trial
court itself had narrated what happened to appellant Flotilde after the caesarean operation made by
appellee doctor. . . . After the second operation, appellant Flotilde became well and healthy. Appellant
Flotilde's troubles were caused by the infection due to the "rubber" that was left inside her abdomen.
Both appellant; testified that after the operation made by appellee doctor, they did not go to any other
doctor until they finally decided to see another doctor in January, 1989 when she was not getting any
better under the care of appellee Dr. Batiquin. . . . Appellee Dr. Batiquin admitted on the witness stand
that she alone decided when to close the operating area; that she examined the portion she operated on
before closing the same. . . Had she exercised due diligence, appellee Dr. Batiquin would have found the
rubber and removed it before closing the operating area. 20
The appellate court then ruled:
Appellants' evidence show[s] that they paid a total of P17,000.00 [deposit of P7,100.00 (Exh. G-1-A) plus
hospital and medical expenses together with doctor's fees in the total amount P9,900.00 (Exhs. G and G2)] for the second operation that saved her life.
For the miseries appellants endured for more than three (3) months, due to the negligence of appellee
Dr. Batiquin they are entitled to moral damages in the amount of P100,000.00; exemplary damages in
the amount of P20,000.00 and attorney's fees in the amount of P25,000.00.
The fact that appellant Flotilde can no longer bear children because her uterus and ovaries were
removed by Dr. Kho is not taken into consideration as it is not shown that the removal of said organs
were the direct result of the rubber left by appellee Dr. Batiquin near the uterus. What is established is
that the rubber left by appellee caused infection, placed the life of appellant Flotilde in jeopardy and
caused appellant fear, worry and anxiety. . . .
WHEREFORE, the appealed judgment, dismissing the complaint for damages is REVERSED and SET
ASIDE. Another judgment is hereby entered ordering defendants-appellees to pay plaintiffs-appellants
the amounts of P17,000.00 as and for actual damages; P100,000.00 as and for moral damages;
P20,000.00 as and for exemplary damages; and P25,000.00 as and for attorney's fees plus the costs of
litigation.
SO ORDERED. 21
From the above judgment, the petitioners appealed to this Court claiming that the appellate court: (1) committed grave
abuse of discretion by resorting to findings of fact not supported by the evidence on record, and (2) exceeded its discretion,
of a piece of rubber, could alter what Dr. Kho saw. Furthermore, Dr. Kho's knowledge of the
piece of rubber could not be based on other than first-hand knowledge for, as she asserted
before the trial court:
Q But you are sure you have seen [the piece of rubber]?
A Oh yes. I was not the only one who saw it.
26
The petitioners emphasize that the private respondents never reconciled Dr. Kho's testimony with Dr. Batiquin's claim on
the witness stand that when Dr. Batiquin confronted Dr. Kho about the foreign body, the latter said that there was a piece of
rubber but that she threw it away. Although hearsay, Dr. Batiquin's claim was not objected to, and hence, the same is
admissible 27 but it carries no probative value. 28 Nevertheless, assuming otherwise, Dr.
Batiquin's statement cannot belie the fact that Dr. Kho found a piece of rubber near private
respondent Villegas's uterus. And even if we were to doubt Dr. Kho as to what she did to the
piece of rubber, i.e., whether she threw it away or sent it to Cebu City, we are not justified in
distrusting her as to her recovery of a piece of rubber from private respondent Villegas's
abdomen. On this score, it is perfectly reasonable to believe the testimony of a witness with
It is here worth noting that the trial court paid heed to the following portions of Dr. Batiquin's testimony: that no rubber
drain was used in the operation, 30 and that there was neither any tear on Dr. Batiquin's gloves after
the operation nor blood smears on her hands upon removing her gloves. Moreover, the trial
court pointed out that the absence of a rubber drain was corroborated by Dr. Doris Sy, Dr.
Batiquin's assistant during the operation on private respondent Villegas. But the trial court
failed to recognize that the assertions of Drs. Batiquin and Sy were denials or negative
testimonies. Well-settled is the rule that positive testimony is stronger than negative
testimony. Of course, as the petitioners advocate, such positive testimony must come from
a credible source, which leads us to the second assigned error.
31
32
33
While the petitioners claim that contradictions and falsities punctured Dr. Kho's testimony, a regarding of the said
testimony reveals no such infirmity and establishes Dr. Kho as a credible witness. Dr. Kho was frank throughout her turn on
the witness stand. Furthermore, no motive to state any untruth was ever imputed against Dr. Kho, leaving her
trustworthiness unimpaired. 34 The trial court's following declaration shows that while it was critical
of the lack of care with which Dr. Kho handled the piece of rubber, it was not prepared to
doubt Dr. Kho's credibility, thus only supporting our appraisal of Dr. Kho's trustworthiness:
This is not to say that she was less than honest when she testified about her findings, but it can also be
said that she did not take the most appropriate precaution to preserve that "piece of rubber" as an
eloquent evidence of what she would reveal should there be a "legal problem" which she claim[s] to
have anticipated. 35
Considering that we have assessed Dr. Kho to be a credible witness, her positive testimony [that a piece of rubber was
indeed found in private respondent Villega's abdomen] prevails over the negative testimony in favor of the petitioners.
As such, the rule of res ipsa loquitur comes to fore. This Court has had occasion to delve into the nature and operation of
this doctrine:
This doctrine [res ipsa loquitur] is stated thus: "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 in 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." Or
as Black's Law Dictionary puts it:
Res ipsa loquitur. The thing speaks for itself. Rebuctable presumption or inference
that defendant was negligent, which arises upon proof that [the] instrumentality
causing injury was in defendant's exclusive control, and that the accident was one
which ordinary 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 [sic] was such that in the ordinary course of things would not happen
if reasonable care had been used.
xxx xxx xxx
The doctrine of [r]es ipsa loquitur as a rule of evidence is peculiar 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 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 particular
"the potentially deadly effects of incompetence and ignorance in those who would undertake
to treat our bodies and minds for disease or trauma." Indeed, a physician is bound to serve
the interest of his patients "with the greatest of solicitude, giving them always his best
talent and skill." Through her tortious conduct, the petitioner endangered the life of Flotilde
Villegas, in violation of her profession's rigid ethical code and in contravention of the legal
standards set forth for professionals, in general, and members of the medical
profession, in particular.
38
39
40
41
WHEREFORE, the challenged decision of 11 May 1994 of the Court of Appeals in CA-G.R. CV No. 30851 is hereby AFFIRMED
in toto.
Costs against the petitioners.
SO ORDERED.
Republic
SUPREME
Manila
of
the
Philippines
COURT
SECOND DIVISION
G.R. No. 130547
October 3, 2000
LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, and minors LLOYD and KRISTINE, all surnamed REYES,
represented
by
their
mother,
LEAH
ALESNA
REYES, petitioners,
vs.
SISTERS OF MERCY HOSPITAL, SISTER ROSE PALACIO, DR. MARVIE BLANES, and DR. MARLYN RICO,respondents.
DECISION
MENDOZA, J.:
This is a petition for review of the decision 1 of the Court of Appeals in CA-G.R. CV No. 36551 affirming the decision of the
Regional Trial Court, Branch IX, Cebu City which dismissed a complaint for damages filed by petitioners against
respondents.
The facts are as follows:
Petitioner Leah Alesna Reyes is the wife of the late Jorge Reyes. The other petitioners, namely, Rose Nahdja, Johnny, Lloyd,
and Kristine, all surnamed Reyes, were their children. Five days before his death on January 8, 1987, Jorge had been
suffering from a recurring fever with chills. After he failed to get relief from some home medication he was taking, which
consisted of analgesic, antipyretic, and antibiotics, he decided to see the doctor.
WHEREFORE, the instant petition is DENIED and the decision of the Court of Appeals is AFFIRMED.
SO ORDERED.