Ruby U. Santillana | I.D. No.

11593466 | G07
Legal Medicine
DR. VICTORIA BATIQUIN v. COURT OF APPEALS | G.R. No. 118231 | July 5, 1996
FACTS: Mrs. Villegas is a married woman who submitted to Dr. Batiquin for parental care as
the latters private patient. Dr. Batiquin with the assistance of Dr. Doris Teresita Sy, C.I. and O.R.
Nurse Arlene Diones and some student nurses, performed a simple cesarean section on Mrs.
Villegas. After 45 minutes, Mrs. Villegas delivered her first child.
After leaving the Hospital, Mrs. Villegas began to suffer abdominal pains and complained
of being feverish. She gradually lost her appetite, so she consulted Dr. Batiquin who prescribed
for her certain medicines.
The abdominal pains and fever kept on recurring and bothered Mrs. Villegas. The pains
became unbearable and she rapidly lost weight so she consulted Dr. Ma. Salud Kho.
Dr. Kho opened the abdomen of Mrs. Villegas. She found whitish-yellow discharge
inside, an ovarian cyst on each of the left and right ovaries which gave out pus, dirt and pus
behind the uterus, and a piece of rubber materials on the right side of the uterus embedded on the
ovarian cyst. The piece of rubber appeared to be a part of a rubber glove. This was the cause of
all of the infection of the ovaries and consequently of all of the discomfort suffered by Mrs.
Villegas.
Mrs. Villegas with her husband sued Dr. Batiquin for damages.
The RTC found for Dr. Batiquin. The CA reversed in favor of the Spouses.
ISSUE: W/N Dr. Batiquin should be held liable.
HELD: YES. CA affirmed in toto.
Under the rule of res ipsa loquitour, the thing speaks for itself, rebuttable 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 was such that in the ordinary course of things would not happen if reasonable care
had been used.
In the instant case, all the requisites for recourse to the doctrine are present. First, the
entire proceedings of the caesarean section were under the exclusive control of Dr. Batiquin. In
this light, the private respondents were bereft of direct evidence as to the actual culprit or the
exact cause of the foreign object finding its way into private respondent Villegas's body, which,
needless to say, does not occur unless through the intersection of negligence. Second, since
aside from the caesarean section, private respondent Villegas underwent no other operation
which could have caused the offending piece of rubber to appear in her uterus, it stands to
reason that such could only have been a by-product of the caesarean section performed by Dr.
Batiquin. The petitioners, in this regard, failed to overcome the presumption of negligence
arising from resort to the doctrine of res ipsa loquitur. Dr. Batiquin is therefore liable for

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negligently leaving behind a piece of rubber in private respondent Villegas's abdomen and for
all the adverse effects thereof.
LEONILA GARCIA-RUEDA v. WILFREDO PASCASIO | G.R. No. 118141 | Sept. 5 1997
FACTS: Florencio Rueda, husband of petitioner, underwent surgical operation for the removal
of a stone blocking his ureter. His surgeon was Dr. Domingo Antonio Jr. while his
anesthesiologist was Dr. Erlinda Balatbat-Reyes. Six hours after surgery, Florencio died of
complications of unknown cause.
Petitioner requested the National Bureau of Investigation (NBI) to conduct an autopsy
on her husbands body. The NBI ruled that Florencios death was due to lack of care by the
attending physician in administering anesthesia. The NBI then recommended that Dr. Antonio
and Dr Balatbat-Reyes be charged for Homicide through Reckless Imprudence.
A series of nine prosecutors toss the responsibility of conducting a preliminary
investigation to each other with contradictory recommendations, ping-pong style.
Petitioner filed graft charges specifically against Prosecutors Guerrero, Macaraeg, and
Arizala for manifest partiality in favor of Dr. Reyes before the Office of the
Ombudsman.However, the Ombudsman issued the assailed resolution dismissing the complaint
for lack of evidence.
Petitioner assails the exercise of the discretionary power of the Ombudsman to review the
recommendations of the government prosecutors and to approve and disapprove the same.
Petitioner faults the Ombudsman for, allegedly in grave abuse of discretion, refusing to find that
there exists probable cause to hold public respondent City Prosecutors liable under the Anti-Graft
and Corrupt Practices Act.
ISSUE: W/N expert testimony is necessary to prove the negligent act of Dr. Balatbat-Reyes.
HELD: NO. Petition dismissed.
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 physician's 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.
Immediately apparent from a review of the records of this case is the absence of any
expert testimony on the matter of the standard of care employed by other physicians of good
standing in the conduct of similar operations. The prosecution's expert witnesses in the persons
of Dr. Floresto Arizala and Dr. Nieto Salvador, Jr. of the National Bureau of Investigation (NBI)
only testified as to the possible cause of death but did not venture to illuminate the court on the
matter of the standard of care that petitioner should have exercised.

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In exercising his discretion under the circumstances, the Ombudsman acted within his
power and authority in dismissing the complaint against the Prosecutors and this Court will not
interfere with the same.

DR. NINEVETCH CRUZ v. COURT OF APPEALS | G.R. No. 122445 | Nov. 18, 1997
FACTS: Lydia Umali was examined by Dr. Ninevetch Cruz, who found a myoma in her
uterus, and scheduled her for hysterectomy operation. Rowena Umali de Ocampo accompanied
her mother to the hospital a day before the operation. Rowena noticed that the clinic was untidy.
Because of this, she tried to persuade her mother not to proceed with the operation. The
following day, Rowena asked Dr. Cruz to postpone the operation, but Lydia was told by Dr. Cruz
that the operation must go on as scheduled.
While Lydias relatives were waiting outside the operating room, Dr. Lina Ercillo, the
anesthesiologist, told them to buy tagamet ampules. Rowenas sister went out to buy one. An
hour later, Dr. Ercillo asked them to buy blood for Lydia, so they did. Rowena noticed her
mother was gasping for breath. Apparently, the oxygen supply had run out, so the family went
out to buy oxygen. Later, Lydia 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.
Upon arrival, she was re-operated by Dr. Cruz and Dr. Ercillo because blood was oozing
from the abdominal incision. When Dr. Bartolome Angeles, Ob-Gyne head, arrived, Lydia was
already in shock and possibly dead as her blood pressure was already 0/0. Dr. Angeles informed
petitioner and Dr. Ercillo that there was nothing he could do. Lydia died. The immediate cause of
death is shock and 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 MTCC found Dr. Ercillo not guilty, but held Dr. Cruz liable for Umalis death. The
RTC and CA affirmed the MTCCs Decision.
ISSUE: W/N the circumstances are sufficient to convict Dr. Cruz.
HELD: NO. Dr. Cruz is acquitted, but she is held civilly liable.
While it may be true that the circumstances pointed out by the lower courts constitute
reckless imprudence, this conclusion is still best arrived not through the educated surmises nor
conjectures of laymen, including judges, but by the unquestionable knowledge of expert
witnesses. The deference of courts to the expert opinion of qualified physicians stems from the
realization that the latter possess unusual technical skills which laymen are incapable of
intelligently evaluating.
Plaintiff has the burden to establish medical 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 patient. Negligence cannot create a
right of action unless it is the proximate cause of the injury complained of. In this case, no cogent
proof exists that the circumstances caused Lydias death.
The testimonies of the doctors presented by the prosecution establish hemorrhage or
hemorrhagic shock as the cause of death, which may be caused by several different factors.

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Autopsy did not reveal any untied cut blood vessel, nor was there a tie of a cut blood vessel that
became loose. The findings of the doctors do not preclude the probability that a clotting defect
(DIC) caused the hemorrhage and consequently, Lydias death.
The Court has no recourse but to rely on the expert testimonies that substantiate Dr.
Cruzs allegation that the cause of Lydias death was DIC, which cannot be attributed to Dr.
Cruzs fault or negligence. This probability was unrebutted during trial.
ROGELIO RAMOS v. COURT OF APPEALS | G.R. No. 124354 | Dec. 29, 1999
FACTS: Erlinda Ramos, 47-year old robust woman underwent an operation for the stone in her
gall bladder to be removed after being tested that she was fit for "cholecystectomy" operation
performed by Dr. Orlino Hozaka.
Dr. Hosaka charged a fee of P16,000.00, which was to include the anesthesiologist's fee
and which was to be paid after the operation. He assured Rogelio E. Ramos, husband that he
will get a good anesthesiologist who was Dra. Perfecta Gutierrez.
Herminda Cruz, Erlindas sister -in-law, and her husband, went down with her to the
operating room. Herminda introduced herself as the Dean of the college of Nursing at the Capitol
Medical Center who was to provide moral support to the patient. She was allowed to stay inside
th operating room.
Instead of 9:30 am, Dr. Hosaka arrived at about 12:15 P.M.
Herminda focused her attention on what Dra. Perfecta Gutierrez was doing; she saw the
nailbed of Erlinda becoming bluish. Dr. Hosaka called for another anesthesiologist, Dr. Calderon.
She went out of the operating room to tell Rogelio that something wrong was
happening. When she went back she saw Erlinda in a trendelenburg position and at 3 p.m. she
was taken to the Intensive Care Unit (ICU) where she stayed for a month due to bronchospasm
incurring P93,542.25 and she was since then comatosed.
She suffered brain damage as a result of the absence of oxygen in her brain for four to
five minutes. She was also diagnosed to be suffering from "diffuse cerebral parenchymal
damage".
The RTC favored Spouses Ramos. The CA reversed the RTC Decision, ordering the
Ramos' to pay their unpaid bills.
ISSUE: W/N the doctrine of res ipsa loquitur shall apply.
HELD: YES. All respondents are held liable for damages.
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
the anesthesia and prior to the performance of cholecystectomy she suffered irreparable damage
in her brain.
Obviously, brain damage, which Erlinda sustained, is an injury which does not normally
occur in the process of a gall bladder operation. In fact, this kind of situation does not happen in
the absence of negligence of someone in the administration of anesthesia and in the use of
endotracheal.
Considering the sound and unaffected member of the body, the brain, is injured or
destroyed while the patient is unconscious and under the immediate and exclusive control of the

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physicians, the Court held that a practical administration of justice dictates the application of res
ipsa loquitur.

REYES v. SISTERS OF MERCY HOSPITAL | G.R. NO. 130547 | Oct. 3, 2000

FACTS: Leah Alesna Reyes is the wife of late Jorge Reyes. Five days before his death Jorge has
been suffering from a recurring fever with chills. After he failed to get relief from home
medication, he decided to see the doctor.
He was taken to Mercy Community Clinic by his wife. Dr. Rico, resident physician and
admitting physician on duty gave Jorge a physical examination and took his medical history.
Typhoid fever was then prevalent in the locality and Jorge was diagnosed with the same
disease.
As his shift was only up to 5 pm, Dr. Rice indorsed Jorge to respondent Dr. Blanes.
Dr. Blanes ordered that a compatibility test with antibiotic chloromycetin be done to
Jorge.
At around 1 am, Dr. Blanes was called as Jorges temperature rose to 41 degrees Celsius.
The patient also experienced chills and exhibited respiratory distress, nausea, vomiting, and
convulsions. Dr. Blanes put him under oxygen, used suction machine, and administered
hydrocortisone, temporarily easing the patients convulsions.
After 15 minutes, Jorge exhibited the same symptoms and Dr. Blanes did the same thing
but this time Jorge died.
The heirs of Jorge filed a case for damages stating that the real reason of Jorges death is
not typhoid fever but the wrongful administration of chloromycetin.
The RTC absolved the respondents.
The CA affirmed the RTC.
ISSUE: WON the respondents are liable for damages.
HELD: NO. Petition denied and the CA is affirmed.
There is no showing that the attending physician in this case deviated from the usual
course of treatment with respect to typhoid fever. Jorge was given antibiotic choloromycetin and
some dose of triglobe after compatibility test was made by the doctor and found that no adverse
reactions manifested which would necessitate replacement of the medicines. Indeed, the standard
contemplated is not what is actually the average merit among all known practitioners from
the best to the worst and from the most to the least experienced, but the reasonable average merit
among the ordinarily good physicians.
Here, the doctors did not depart from the reasonable standard recommended by the
experts as they in fact observed the due care required under the circumstances.

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PROFESSIONAL SERVICES, INC. v. AGANA | G.R. No. 126297 | Jan. 31, 2007
FACTS: Natividad Agana was rushed to The Medical City General Hospital due to bowel
movement difficulty and bloody anal discharge. Dr. Ampils diagnosis is Cancer of the sigmoid.
Upon performing anterior resection surgery on Natividad, Dr. Ampil found that cancer had
spread on her left ovary.
Dr. Ampil sought the consent of Enrique Agana, Natividads husband, to permit Dr. Juan
Fuentes to perform hysterectomy. After Dr. Fuentes completed hysterectomy, Dr. Ampil took
over to complete the operation and to close the incision.
A couple of days after her release, Natividad complained of excruciating pain in her anal
region. Her doctors told her that said pain was the consequence of her operation. Dr. Ampil
recommended that she consult an oncologist to examine the cancerous node they were not able to
remove. Natividad then went to the US for further treatment and was later found free from
cancer. She then returned to the Philippines.
Two weeks after Natividads arrival, her daughter found a piece of gauze protruding from
her vagina. Dr. Ampil removed said piece, and assured her that the pains would vanish soon.
Still suffering from pain, Natividad sought help from Polymedic General Hospital where
it was found that another piece of gauze badly infected her vaginal vault. She took another
surgery to remove the same.
The spouses Agana then filed a complaint for damages against Professional Services,
Inc., owner of The Medical City, Dr. Ampil and Dr. Fuentes. Enrique likewise
filed administrative cases against Dr. Ampil, who was unfortunately abroad at that time, so the
case did not proceed, and Dr. Fuentes. Pending said cases, Natividad died and was substituted by
her children.
The RTC favored the spouses, but the administrative complaint against Dr. Fuentes was
dismissed.
The CA affirmed that Dr. Ampil was liable for damages but exonerated Dr. Fuentes from
liability.
Hence, these three consolidated petitions for review on certiorari.
ISSUE: W/N Dr. Ampil is liable for negligence and malpractice.
HELD: YES. All petitions, denied. The CA is affirmed.
All the major circumstances, taken together, directly point to Dr. Ampil as the negligent
party. Because after the operation the nurses informed Dr. Ampil that 2 gauzes were lacking but

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still Dr. Ampil continued the closure. And the 2 gauzes were extracted from the same spot of the
body of Mrs. Agana where the surgery was performed.
Dr. Ampil also 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.

DR. RUBI LI v. SPS. REYNALDO and LINA SOLIMAN | G.R. No. 165279 | June 7, 2011
FACTS: Angelica Soliman, the daughter of the respondents, underwent a biopsy of the mass
located in her lower extremity at St. Lukes Medical Center (SLMC). She was diagnosed with a
highly malignant cancer of bone. Her right leg was amputated to remove the tumor. To eliminate
the remaining cancer cells and to further prevent recurrence and spreading of the disease, she
underwent chemotherapy which was administered by petitioner Dr. Rubi Li, an oncologist at
SLMC. However, eleven days after the (intravenous) administration of the first cycle of
chemotherapy, Angelica died. The respondents, thereafter, brought their daughters body to the
Philippine National Police Crime Laboratory for post-mortem examination. The Medico-Legal
Report showed that Hypovolemic shock secondary to multiple organ hemorrhages and
Disseminated Intravascular Coagulation was the cause of death.
Subsequently, the respondents filed a damage suit against SLMC and certain physicians
for negligence and for disregard of the deceaseds welfare. They further averred that Dr. Rubi Li
assured them of 95% chance of healing by undergoing chemotherapy. They claimed that if they
were only informed by the petitioner of the other side effects, they would have not given their
consent to undergo chemotherapy. However, petitioner denied the allegations. She argued that
she had given the proper information to the respondents and observed best known procedures,
highest skill and knowledge in the administration of chemotherapy.
The trial court dismissed the case. It held that Dr. Rubi Li was not liable since she
observed the best known procedures and employed her highest skill and knowledge in
administering the chemotherapy drugs.
The Court of Appeals affirmed the trial courts finding. However, it ruled that Dr. Rubi Li
is liable for damages since she failed to fully explain to respondents all the known side effects of
chemotherapy.
ISSUE: W/N petitioner should held liable for failure to disclose the serious side effects of
chemotherapy to the respondents.
HELD: NO. The CA is reversed and the case is reinstated the RTC Decision dismissing the
case.
The Court ruled that to constitute a medical malpractice based upon the doctrine of
informed consent, four elements must be present: "(1) the physician had a duty to disclose

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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."
Here, petitioner adequately informed the respondents of the material risks in the
chemotherapy.
As regards to the respondents claim, the Court further ruled that it was highly unlikely
for a doctor to give a patient an assurance of 95% chance of recovery from cancer, given its
grave conditions.

DR. EMMANUEL JARCIA, JR. and DR. MARILOU BASTAN v. PEOPLE |

G.R. No. 187926 | February 15, 2012
FACTS: A complaint was filed by Berlinda Santiago against the petitioners Dr. Emmanuel
Jarcia, Jr and Dr. Marilou Bastan for their alleged neglect of professional duty which caused her
son, Roy Alfronso Santiago, Jr. (Roy Jr.) to suffer serious physical injuries.
The National Bureau of Investigation (NBI) found that the victim, Roy Jr, was rushed to
the Manila Doctors Hospital when he was hit by a taxicab. An X-ray of the ankle of the victim
was conducted; the result showed no fracture as read by Dr. Jarcia. Meanwhile, Dr. Bastan, after
conducting her own medical examination of the victim, she informed Mrs. Santiago that there
was no need for upper leg examination since it was only the ankle that was hit. However, after
eleven days, Roy Jr was brought back to the hospital and was ordered as X-ray examination. The
X-ray revealed a right mid-tibial fracture and a linear hairline fracture in the shaft of the bone.
The RTC found the petitioners guilty beyond reasonable doubt of Simple Imprudence
Resulting to Serious Physical Injuries.
This was affirmed by the CA.
ISSUES:
1. W/N the doctrine of res ipsa loquitur is applicable in this case
2. W/N the petitioners are liable for criminal negligence
HELD:
1. NO, because in order to ascertain the degree of skill and care in treating Roy Jr, expert opinion is
generally needed.
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." Here, it was established that series of test given to the patient were not under the exclusive
control of the respondents, who were mere residents of the hospital.
2. NO, but they are civilly liable since only preponderance of evidence was established. The Court
found that the petitioners failed to sufficiently attend to the patients medial needs. From the

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start, if they already knew that they were not in the position to attend to the medical needs of the
patient, they should have not assured the patient and his mother that everything was all right. By
this, they had already deprived the patient of adequate medical attention.
Petition is Partly granted. The CA decision is reversed and set aside. Petitioners are
acquitted but civilly liable.

DR. FERNANDO SOLIDUM v. PEOPLE | G.R. No. 192123 | March 10, 2014
FACTS: Gerald Albert Gercayo was born on June 2, 1992 with an imperforate anus. He
underwent colostomy, two days after his birth. He was admitted at the Ospital ng Maynila on
May 17, 1995 for a pull-through operation.
Dr. Leandro Resurreccion headed the surgical team. Petitioner Dr. Solidum was one of
the anesthesiologists included in the team. However, Gerald experience bradycardia during the
operation and went into a coma which lasted for two weeks.
A month later, he regained consciousness but could no longer see, hear, or move.
Hence, a complaint for reckless imprudence resulting in serious physical injuries was
filed by his mother, Ma. Luz Gercayo, against the team of doctors. She alleged that there was
failure in monitoring the anesthesia administered to Gerald.
The RTC found Dr. Solidum guilty beyond reasonable doubt of reckless imprudence
resulting to serious physical injuries.
The CA affirmed the RTC decision.
ISSUE: W/N petitioner is liable for medical negligence.
RULE: NO. Petition is granted. Dr. Solidum is acquitted of reckless imprudence resulting
to serious physical injuries.
In an action against medical negligence, the plaintiff must prove using competent
evidence the following four elements:
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;
c) the causation, is, there must be a reasonably close and casual connection between the
negligent act or omission and the resulting injury; and
d) the damages suffered by the patient.
The standard of care is an objective standard used to measure the conduct of a physician
sued for negligence or malpractice. This standard does not depend on any individual physicians

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own knowledge. Given that most medical malpractice cases are highly technical, expert witness
is necessary to render a fair and just verdict. However, in this case, there were no witnesses with
special medical qualification in anesthesia presented.
The Prosecution failed to prove the existence of the elements of reckless imprudence
beyond reasonable doubt. However, the Court held that, it cannot find and declare Dr. Solidum
civilly liable because there was no mere preponderance of evidence. There was no clear and
competent proof how the injury to the patient had been caused.