9/8/2016

G.R. No. 160889

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RepublicofthePhilippines
SUPREMECOURT
Manila
SECONDDIVISION

G.R.No.160889April27,2007
DR.MILAGROSL.CANTRE,Petitioner,
vs.
SPS.JOHNDAVIDZ.GOandNORAS.GO,Respondents.
DECISION
QUISUMBING,J.:
ForreviewoncertiorariaretheDecision1datedOctober3,2002andResolution2datedNovember19,2003ofthe
CourtofAppealsinCAG.R.CVNo.58184,whichaffirmedwithmodificationtheDecision3datedMarch3,1997of
theRegionalTrialCourtofQuezonCity,Branch98,inCivilCaseNo.Q9316562.
Thefacts,culledfromtherecords,areasfollows:
Petitioner Dr. Milagros L. Cantre is a specialist in Obstetrics and Gynecology at the Dr. Jesus Delgado Memorial
Hospital.ShewastheattendingphysicianofrespondentNoraS.Go,whowasadmittedatthesaidhospitalonApril
19,1992.
At1:30a.m.ofApril20,1992,Noragavebirthtoherfourthchild,ababyboy.However,ataround3:30a.m.,Nora
sufferedprofusebleedinginsideherwombduetosomepartsoftheplacentawhichwerenotcompletelyexpelled
from her womb after delivery. Consequently, Nora suffered hypovolemic shock, resulting in a drop in her blood
pressureto"40"over"0."Petitionerandtheassistingresidentphysicianperformedvariousmedicalproceduresto
stopthebleedingandtorestoreNorasbloodpressure.Herbloodpressurewasfrequentlymonitoredwiththeuseof
a sphygmomanometer. While petitioner was massaging Noras uterus for it to contract and stop bleeding, she
orderedadroplighttowarmNoraandherbaby.4Noraremainedunconsciousuntilsherecovered.
Whileintherecoveryroom,herhusband,respondentJohnDavidZ.Gonoticedafreshgapingwoundtwoanda
half(2)bythreeandahalf(3)inchesintheinnerportionofherleftarm,closetothearmpit.5Heaskedthe
nurses what caused the injury. He was informed it was a burn. Forthwith, on April 22, 1992, John David filed a
requestforinvestigation.6Inresponse,Dr.RainerioS.Abad,themedicaldirectorofthehospital,calledpetitioner
andtheassistingresidentphysiciantoexplainwhathappened.Petitionersaidthebloodpressurecuffcausedthe
injury.
OnMay7,1992,JohnDavidbroughtNoratotheNationalBureauofInvestigationforaphysicalexamination,which
was conducted by medicolegal officer Dr. Floresto Arizala, Jr.7 The medicolegal officer later testified that Noras
injuryappearedtobeaburnandthatadroplightwhenplacedneartheskinforabout10minutescouldcausesuch
burn.8Hedismissedthelikelihoodthatthewoundwascausedbyabloodpressurecuffasthescarwasnotaround
thearm,butjustononesideofthearm.9
OnMay22,1992,NorasinjurywasreferredtoaplasticsurgeonattheDr.JesusDelgadoMemorialHospitalfor
skingrafting.10Herwoundwascoveredwithskinsourcedfromherabdomen,whichconsequentlyboreascaras
well.Aboutayearafter,onApril30,1993,scarrevisionhadtobeperformedatthesamehospital.11Thesurgical
operationleftahealedlinearscarinNorasleftarmaboutthreeinchesinlength,thethickestportionrisingabout
onefourth (1/4) of an inch from the surface of the skin. The costs of the skin grafting and the scar revision were
shoulderedbythehospital.12
Unfortunately, Noras arm would never be the same. Aside from the unsightly mark, the pain in her left arm
remains.Whensleeping,shehastocradleherwoundedarm.Hermovementsnowarealsorestricted.Herchildren
1a\^/phi1.net

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cannot play with the left side of her body as they might accidentally bump the injured arm, which aches at the
slightesttouch.
Thus,onJune21,1993,respondentspousesfiledacomplaint13fordamagesagainstpetitioner,Dr.Abad,andthe
hospital.Findinginfavorofrespondentspouses,thetrialcourtdecreed:
In view of the foregoing consideration, judgment is hereby rendered in favor of the plaintiffs and against the
defendants,directingthelatters,(sic)jointlyandseverally
(a)topaythesumofFiveHundredThousandPesos(P500,000.00)inmoraldamages
(b)topaythesumofOneHundredFiftyThousandPesos(P150,000.00)exemplarydamages
(c)topaythesumofEightyThousandPesos(P80,000.00)nominaldamages
(d)topayFiftyThousandPesos(P50,000.00)forandasattorneysfeesand
(e)topaySixThousandPesos(P6,000.00)litigationexpenses.
SOORDERED.14
Petitioner,Dr.Abad,andthehospitalallappealedtotheCourtofAppeals,whichaffirmedwithmodificationthetrial
courtdecision,thus:
WHEREFORE,inviewofalltheforegoing,andfindingnoreversibleerrorintheappealedDecisiondatedMarch3,
1997 of Branch 98 of the Regional Trial Court of Quezon City in Civil Case No. Q9316562, the same is hereby
AFFIRMED,withthefollowingMODIFICATIONS:
1.OrderingdefendantappellantDra.Milagros[L.]CantreonlytopayplaintiffsappelleesJohnDavidGoand
NoraS.GothesumofP200,000.00asmoraldamages
2.Deletingtheaward[of]exemplarydamages,attorneysfeesandexpensesoflitigation

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3.DismissingthecomplaintwithrespecttodefendantsappellantsDr.RainerioS.AbadandDelgadoClinic,
Inc.
4.Dismissingthecounterclaimsofdefendantsappellantsforlackofmeritand
5.OrderingdefendantappellantDra.Milagros[L.]Cantreonlytopaythecosts.
SOORDERED.15
PetitionersmotionforreconsiderationwasdeniedbytheCourtofAppeals.Hence,theinstantpetitionassigningthe
followingaserrorsandissues:
I.
WHETHERORNOT,THELOWERCOURT,ANDTHECOURTOFAPPEALSCOMMITTEDGRAVE
ABUSE OF THEIR DISCRETION WHEN, NOTWITHSTANDING THAT BOTH PARTIES HAVE
RESTED THEIR RESPECTIVE CASES, THE LOWER COURT ADMITTED THE ADDITIONAL
EXHIBITSFURTHEROFFEREDBYRESPONDENTSNOTTESTIFIEDTOBYANYWITNESSAND
THISDECISIONOFTHELOWERCOURTWASUPHELDBYTHECOURTOFAPPEALSLIKEWISE
COMMITTINGGRAVEABUSEOFDISCRETION
II.
WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS DISCRETION
WHEN,CONTRARYTOPREPONDERANCEOFEVIDENCEPRESENTEDBYTHEPETITIONER,IT
RULED THAT THE PETITIONER HAS NOT AMPLY SHOWED THAT THE DROPLIGHT DID NOT
TOUCH THE BODY OF MRS. NORA GO, AND THIS DECISION OF THE LOWER COURT WAS
UPHELD BY THE COURT OF APPEALS LIKEWISE COMMITTING GRAVE ABUSE OF
DISCRETION
III.
WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS DISCRETION
WHEN,CONTRARYTOPREPONDERANCEOFEVIDENCEPRESENTEDBYTHEPETITIONER,IT
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RULED THAT PETITIONER DRA. CANTRE WAS NOT ABLE TO AMPLY EXPLAIN HOW THE
INJURY(BLISTERS)INTHELEFTINNERARMOFRESPONDENTMRS.GOCAMEABOUT
IV.
WHETHERORNOTTHECOURTOFAPPEALSCOMMITTEDGRAVEABUSEOFITSDISCRETION
WHEN IT MADE A RULING ON THE RESPONDENTS INJURY QUOTING THE TESTIMONY OF
SOMEONEWHOWASNOTPRESENTANDHASNOTSEENTHEORIGINAL,FRESHINJURYOF
RESPONDENTMRS.NORAGO
V.
WHETHER OR NOT THE COURT OF APPEALS GRAVELY ABUSING ITS DISCRETION RULED
THATPETITIONERDRA.CANTRESHOULDHAVEINTENDEDTOINFLICTTHEINJURYTOSAVE
THELIFEOFRESPONDENTMRS.GO
VI.
WHETHERORNOTTHELOWERCOURTANDTHECOURT[OF]APPEALSCOMMITTEDGRAVE
ABUSE OF DISCRETION WHEN, CONTRARY TO THE DETAILED PROCEDURES DONE BY
PETITIONER, BOTH RULED THAT THE RESPONDENT WAS LEFT TO THE CARE OF THE
NURSINGSTAFF
VII.
WHETHERORNOTTHELOWERCOURTCOMMITTEDGRAVEABUSEOFDISCRETIONWHEN,
CONTRARY TO THE MEDICAL PURPOSES OF COSMETIC SURGERY, IT RULED THAT THE
COSMETICSURGERYMADETHESCARSEVENMOREUGLYANDDECLAREDTHECOSMETIC
SURGERYAFAILURE
VIII.
WHETHER OR NOT THE LOWER COURT GRAVELY ABUSE OF (SIC) DISCRETION WHEN,
CONTRARY TO RESPONDENTS CONTRARY TESTIMONIES AND THE ABSENCE OF ANY
TESTIMONY, IT RULED THAT THEY ARE ENTITLED TO DAMAGES AND WHICH WAS UPHELD,
ALTHOUGHMODIFIED,BYTHECOURTOFAPPEALSLIKEWISEABUSINGITSDISCRETION.16
Petitionercontendsthatadditionaldocumentaryexhibitsnottestifiedtobyanywitnessareinadmissibleinevidence
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 medicolegal
officerwhoneversawtheoriginalinjurybeforeplasticsurgerywasperformed.Finally,petitionerstressesthatplastic
surgerywasnotintendedtorestorerespondentsinjurytoitsoriginalstatebutrathertopreventfurthercomplication.
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
highlyimprobable,beingunprecedentedinmedicalhistoryandthattheinjurywasdefinitelycausedbythedroplight.
Atanyrate,theyargue,eveniftheinjurywasbroughtaboutbythebloodpressurecuff,petitionerwasstillnegligent
inherdutiesasNorasattendingphysician.
Simply put, the threshold issues for resolution are: (1) Are the questioned additional exhibits admissible in
evidence?(2)IspetitionerliablefortheinjurysufferedbyrespondentNoraGo?Thereafter,theinquiryiswhether
theappellatecourtcommittedgraveabuseofdiscretioninitsassailedissuances.
Astothefirstissue,weagreewiththeCourtofAppealsthatsaidexhibitsareadmissibleinevidence.Wenotethat
thequestionedexhibitsconsistmostlyofNorasmedicalrecords,whichwereproducedbythehospitalduringtrial
pursuant to a subpoena duces tecum. Petitioners counsel admitted the existence of the same when they were
formallyofferedforadmissionbythetrialcourt.Inanycase,giventheparticularcircumstancesofthiscase,aruling
onthenegligenceofpetitionermaybemadebasedontheresipsaloquiturdoctrineevenintheabsenceofsuch
additionalexhibits.
Petitioners contention that the medicolegal officer who conducted Noras physical examination never saw her
originalinjurybeforeplasticsurgerywasperformediswithoutbasisandcontradictedbytherecords.Recordsshow
that the medicolegal officer conducted the physical examination on May 7, 1992, while the skin grafting and the
scarrevisionwereperformedonNoraonMay22,1992andApril30,1993,respectively.
Comingnowtothesubstantivematter,ispetitionerliablefortheinjurysufferedbyrespondentNoraGo?
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TheHippocraticOathmandatesphysicianstogiveprimordialconsiderationtothewellbeingoftheirpatients.Ifa
doctor fails to live up to this precept, he is accountable for his acts. This notwithstanding, courts face a unique
restraintinadjudicatingmedicalnegligencecasesbecausephysiciansarenotguarantorsofcareand,theynever
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.17
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,
providedthatthefollowingrequisitesconcur:
1.Theaccidentisofakindwhichordinarilydoesnotoccurintheabsenceofsomeonesnegligence
2.Itiscausedbyaninstrumentalitywithintheexclusivecontrolofthedefendantordefendantsand
3.Thepossibilityofcontributingconductwhichwouldmaketheplaintiffresponsibleiseliminated.18
As to the first requirement, the gaping wound on Noras arm is certainly not an ordinary occurrence in the act of
delivering a baby, far removed as the arm is from the organs involved in the process of giving birth. Such injury
couldnothavehappenedunlessnegligencehadsetinsomewhere.
Second, 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.Thisdoctrineholdsthesurgeoninchargeofanoperationliableforthenegligenceofhisassistantsduring
thetimewhenthoseassistantsareunderthesurgeonscontrol.19Inthisparticularcase,itcanbelogicallyinferred
that petitioner, the senior consultant in charge during the delivery of Noras baby, exercised control over the
assistantsassignedtoboththeuseofthedroplightandthetakingofNorasbloodpressure.Hence,theuseofthe
droplightandthebloodpressurecuffisalsowithinpetitionersexclusivecontrol.
Third,thegapingwoundonNorasleftarm,byitsverynatureandconsideringhercondition,couldonlybecaused
bysomethingexternaltoherandoutsidehercontrolasshewasunconsciouswhileinhypovolemicshock.Hence,
Noracouldnot,byanystretchoftheimagination,havecontributedtoherowninjury.
Petitioners defense that Noras wound was caused not by the droplight but by the constant taking of her blood
pressure,evenifthelatterwasnecessarygivenhercondition,doesnotabsolveherfromliability.Astestifiedtoby
themedicolegalofficer,Dr.Arizala,Jr.,themedicalpracticeistodeflatethebloodpressurecuffimmediatelyafter
eachuse.Otherwise,theinflatedbandcancauseinjurytothepatientsimilartowhatcouldhavehappenedinthis
case.Thus,ifNoraswoundwascausedbythebloodpressurecuff,thenthetakingofNorasbloodpressuremust
havebeendonesonegligentlyastohaveinflictedagapingwoundonherarm,20forwhichpetitionercannotescape
liabilityunderthe"captainoftheship"doctrine.
Further,petitionersargumentthatthefailedplasticsurgerywasnotintendedasacosmeticprocedure,butratheras
ameasuretopreventcomplicationdoesnothelphercase.Itdoesnotnegatenegligenceonherpart.
Based on the foregoing, the presumption that petitioner was negligent in the exercise of her profession stands
unrebutted.Inthisconnection,theCivilCodeprovides:
ART.2176.Whoeverbyactoromissioncausesdamagetoanother,therebeingfaultornegligence,isobligedtopay
forthedamagedone.
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 pecuniary
computation,moraldamagesmayberecoverediftheyaretheproximateresultofthedefendantswrongfulactor
omission.
Clearly, under the law, petitioner is obliged to pay Nora for moral damages suffered by the latter as a proximate
resultofpetitionersnegligence.
We note, however, that petitioner has served well as Noras obstetrician for her past three successful deliveries.
Thisisthefirsttimepetitionerisbeingheldliablefordamagesduetonegligenceinthepracticeofherprofession.
ThefactthatpetitionerpromptlytookcareofNoraswoundbeforeinfectionandothercomplicationssetinisalso
indicative of petitioners good intentions. We also take note of the fact that Nora was suffering from a critical
conditionwhentheinjuryhappened,suchthatsavingherlifebecamepetitionerselementalconcern.Nonetheless,it
shouldbestressedthatallthesecouldnotjustifynegligenceonthepartofpetitioner.
Hence, considering the specific circumstances in the instant case, we find no grave abuse of discretion in the
assaileddecisionandresolutionoftheCourtofAppeals.Further,werulethattheCourtofAppealsawardofTwo
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HundredThousandPesos(P200,000)asmoraldamagesinfavorofrespondentsandagainstpetitionerisjustand
equitable.21
WHEREFORE,thepetitionisDENIED. The Decision dated October 3, 2002 and Resolution dated November 19,
2003oftheCourtofAppealsinCAG.R.CVNo.58184areAFFIRMED.
Nopronouncementastocosts.
SOORDERED.
LEONARDOA.QUISUMBING
AssociateJustice
WECONCUR:
ANTONIOT.CARPIO
AssociateJustice
CONCHITACARPIOMORALES
AssociateJustice

DANTEO.TINGA
AsscociateJustice

PRESBITEROJ.VELASCO,JR.
AssociateJustice
ATTESTATION
IattestthattheconclusionsintheaboveDecisionhadbeenreachedinconsultationbeforethecasewasassigned
tothewriteroftheopinionoftheCourtsDivision.
LEONARDOA.QUISUMBING
AssociateJustice
Chairperson
CERTIFICATION
PursuanttoSection13,ArticleVIIIoftheConstitution,andtheDivisionChairpersonsAttestation,Icertifythatthe
conclusionsintheaboveDecisionhadbeenreachedinconsultationbeforethecasewasassignedtothewriterof
theopinionoftheCourtsDivision.
REYNATOS.PUNO
ChiefJustice

Footnotes
1Rollo,pp.4368.
2Id.at4041.
3Records,pp.218227.
4TSN,December5,1995,pp.5455.
5TSN,June25,1996,p.9.
6Exhibit"A,"folderofexhibits,p.1.
7TSN,September16,1994,p.6Exhibit"D,"folderofexhibits,p.7.
8TSN,September12,1995,pp.1316.
9Id.at23.
10Exhibit"L,"folderofexhibits,p.42.

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11TSN,January31,1994,pp.3536.
12TSN,April29,1994,p.16TSN,June25,1996,p.23.
13Records,pp.16.
14Id.at227.
15Rollo,p.67.
16Id.at169171.
17Ramosv.CourtofAppeals,G.R.No.124354,December29,1999,321SCRA584,628.
18Id.at600.
19BlacksLawDictionary192,(5thed.,1979).
20TSN,September16,1994,pp.2728.
21SeeChildLearningCenter,Inc.v.Tagorio,G.R.No.150920,November25,2005,476SCRA236,240.
TheLawphilProjectArellanoLawFoundation

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