Carillo vs.

People of the Philippines

G.R. No. 86890, January 21, 1994

In the case at bar, we consider that the chain of circumstances

above noted, namely: (1) the failure of petitioner and Dr. Madrid to

FACTS:
appreciate the serious post-surgery condition of their patient and to monitor
Petitioner filed a petition for review on certiorari on the decision of
her condition and provide close patient care to her; (2) the summons of
the Court of Appeals affirming his conviction by the RTC of the crime of
petitioner by Dr. Madrid and the cardiologist after the patient's heart attack
simple negligence resulting in homicide, for the death of his 13 year old
on the very evening that the surgery was completed; (3) the low level of care
patient Catherine Acosta after an appendectomy procedure conducted on
and diligence exhibited by petitioner in failing to correct Dr. Madrid's
the patient.
prescription of Nubain for post-operative pain; (4) the extraordinary failure or
ISSUE:

refusal of petitioner and Dr. Madrid to inform the parents of Catherine Acosta
Whether or not Dr. Carillo is guilty of the crime of simple negligence

resulting in homicide.

of her true condition after surgery, in disregard of the requirements of the

Code of Medical Ethics; and (5) the failure of petitioner and Dr. Madrid to
prove that they had in fact exercised the necessary and appropriate degree

RULING:

of care and diligence to prevent the sudden decline in the condition of

Simple negligence, penalized under what is now Article 365 of the

Catherine Acosta and her death three (3) days later, leads the Court to the

Revised Penal Code, is defined as "a mere lack of prevision in a situation

conclusion, with moral certainty, that petitioner and Dr. Madrid were guilty of

where either the threatened harm is not immediate or the danger not openly

simple negligence resulting in homicide.

visible." Put in a slightly different way, the gravamen of the offense of simple
negligence is the failure to exercise the diligence necessitated or called for
the situation which was not immediately life-destructive but which
culminated, in the present case, in the death of a human being three (3)
days later.

BATIQUIN V CA July 5, 1996

FACTSMrs. Villegas submitted to Dr. Batiquin for prenatal care as the
latter's private patientsometime before September 21,1988. In
the morning of September 21, 1988 Dr. Batiquin, alongwith
other physicians and nurses, performed a caesarean operation
on Mrs. Villegas andsuccessfully delivered the latters baby.
After leaving the hospital, Mrs. Villegas began tosuffer
abdominal pains and complained of being feverish. She also
gradually lost her appetite, soshe consulted Dr. Batiquin at the
latter's polyclinic who prescribed for her certain
medicines.However, the pains still kept recurring. She then
consulted Dr.Ma. Salud Kho. After examiningher, Dr Kho
suggested that Mrs.Villegas submit to another surgery.- When
Dr. Kho opened theabdomen 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 material 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 ovariesand consequently of all the
discomfort suffered by Mrs. Villegas. The piece of rubber
allegedlyfound was not presented in court, and Dr. Kho
testified that she sent it to a pathologist in CebuCity for
examination. Aside from Dr. Kho's testimony, the evidence
which mentioned the pieceof rubber are a Medical Certificate,
a Progress Record, an Anaesthesia Record, a Nurse's
Record,and a Physician's Discharge Summary. The trial court,
however, regarded these documentaryevidence as mere
hearsay, "there being no showing that the person or persons
who prepared themare deceased or unable to testify on the facts
therein stated- There was also doubts as to thewhereabouts of

the piece of rubber, as 2 versions arose from Dr. Khos

testimony: 1) that it wassent to the Pathologist in Cebu as
testified to in Court by Dr. Kho and (2) that Dr. Kho threw
itaway as told by her to Defendant. The failure of the Plaintiffs
to reconcile these two differentversions served only to weaken
their claim against Defendant Batiquin. The trial court ruled
infavor of the defendants. The CA reversed the decision.
ISSUES
Procedural:WON the court can review questions of fact
Substantive:WON Dr. Batiquin is liable
HELDProcedural:
YES - While the rule is that only questions of law may be
raised in a petition for review oncertiorari , there are
exceptions, among which are when the factual findings of the
trial court andthe appellate court conflict, when the appealed
decision is clearly contradicted by the evidenceon record, or
when the appellate court misapprehended the factsSubstantiveThe focal point of the appeal is Dr. Khos testimony. There
were inconsistencies within her own testimony, which led to
the different decision of the RTC and CA. The CA was correct
insaying that the trial court erred when it isolated the disputed
portion of Dr. Khos testimony anddid not consider it with
other portions of Dr. Khos testimony. Also, the phrase relied
upon bythe trial court does not negate the fact that Dr. Kho saw
a piece of rubber in private respondentVillegas' abdomen, and
that she sent it to a laboratory and then to Cebu City for
examination bya pathologist. Furthermore, Dr. Kho's
knowledge of the piece of rubber could not be based onother
than first hand knowledge for, as she asserted before the trial
court.

Garcia-Rueda vs. Pascasio

G.R. No. 118141. September 5, 1997
Facts:

Florencio, husband of petitioner, Leonila Garcia-Rueda, underwent

a surgical operation at University of Sto. Tomas Hospital for the
removal of a stone blocking his uterer.
However, due to an unknown cause and complications, Florencio
died.
Leonila seek the help of NBI, then later on NBI concluded that his
death was caused by lack of care by attending physician in
administering anesthesia.
NBI recommended that Dr. Antonio and Dr. Balatbat-Reyes be
charged of Reckless Imprudence Resulting to Homicide

Issue:
Whether or not an expert testimony is needed to prove the negligence of Dr.
Antonio and Dr. Balatbat-Reyes?
Held: Yes
Ratio:
In malpractice or negligence cases involving the administration of
anaesthesia, the necessity of expert testimony and the availability of the
charge of res ipsa loquitur to the plaintiff, have been applied in actions
against anaesthesiologists to hold the defendant liable for the death or injury
of a patient under excessive or improper anaesthesia. Essentially, it requires
two-pronged evidence: evidence as to the recognized standards of the
medical community in the particular kind of case, and a showing that the
physician in question negligently departed from this standard in his treatment
Evidently, when the victim employed the services of Dr. Antonio and Dr.
Reyes, a physician-patient relationship was created. In accepting the case,
Dr. Antonio and Dr. Reyes in effect represented that, having the needed
training and skill possessed by physicians and surgeons practicing in the
same field, they will employ such training, care and skill in the treatment of
their patients. They have 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. The breach of these professional duties of skill and
care, or their improper performance, by a physician surgeon whereby the
patient is injured in body or in health, constitutes actionable malpractice.
Consequently, in the event that any injury results to the patient from want of
due care or skill during the operation, the surgeons may be held answerable
in damages for negligence.

Another element in medical negligence cases is causation which is divided

into two inquiries: whether the doctors actions in fact caused the harm to the
patient and whether these were the proximate cause of the patients
injury. Indeed here, a causal connection is discernible from the occurrence of
the victims death after the negligent act of the anaesthesiologist in
administering the anesthesia, a fact which, if confirmed, should warrant the
filing of the appropriate criminal case. To be sure, the allegation of
negligence is not entirely baseless. Moreover, the NBI deduced that the
attending surgeons did not conduct the necessary interview of the patient
prior to the operation. It appears that the cause of the death of the victim
could have been averted had the proper drug been applied to cope with the
symptoms of malignant hyperthermia. Also, we cannot ignore the fact that an
antidote was readily available to counteract whatever deleterious effect the
anaesthesia might produce. Why these precautionary measures were
disregarded must be sufficiently explained.
Doctrine: To hold hospitals liable for medical malpractice, a patient must
only prove that a health care provider either failed to do something which a
reasonably prudent health care provider would have done, or that he did
something that a reasonably prudent provider would not have done; and that
failure or action caused injury to the patient.

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 maintubate 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 thatres 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, without
undergoing surgery, she went out of the operating
room
already
decerebrate
and
totally
incapacitated. 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 in
the absence of negligence of someone in the
administration of anesthesia and in the use of

endotracheal tube. Furthermore, the instruments

used in the administration of anesthesia, including
the endotracheal tube, were all under the exclusive
control of private respondents, who are the
physicians-in-charge. Likewise, petitioner Erlinda
could not have been guilty of contributory
negligence because she was under the influence of
anesthetics which rendered her unconscious.
Negligence of the Anaesthesiologist
The pre-operative evaluation of a patient prior to
the administration of anesthesia is universally
observed to lessen the possibility of anesthetic
accidents. 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. Her failure to follow this medical
procedure is, therefore, a clear indicia of her
negligence. Erlinda's case was elective and this was
known to respondent Dra. Gutierrez. Thus, she had
all the time to make a thorough evaluation of
Erlinda's case prior to the operation and prepare
her for anesthesia. However, she never saw the
patient at the bedside. She herself admitted that
she had seen petitioner only in the operating room,
and only on the actual date of the cholecystectomy.
She negligently failed to take advantage of this

important opportunity. As such, her attempt to

exculpate herself must fail.
Opinion of Expert Witness
An anesthetic accident caused by a rare druginduced bronchospasm properly falls within the
fields of anesthesia, internal medicine-allergy, and
clinical pharmacology. The resulting anoxic
encephalopathy belongs to the field of neurology.
While admittedly, many bronchospastic-mediated
pulmonary diseases are within the expertise of
pulmonary medicine, Dr. Jamora's field, the
anesthetic
drug-induced,
allergic
mediated
bronchospasm alleged in this case is within the
disciplines of anesthesiology, allergology and
pharmacology. On the basis of the foregoing
transcript, in which the pulmonologist himself
admitted that he could not testify about the drug
with medical authority, it is clear that the appellate
court erred in giving weight to Dr. Jamora's
testimony as an expert in the administration of
Thiopental Sodium. Generally, to qualify as an
expert witness, one must have acquired special
knowledge of the subject matter about which he or
she is to testify, either by the study of recognized
authorities on the subject or by practical
experience. Clearly, Dr. Jamora does not qualify as
an expert witness based on the above standard
since he lacks the necessary knowledge, skill, and

training in the field of anesthesiology. Oddly, apart

from submitting testimony from a specialist in the
wrong field, private respondents' intentionally
avoided providing testimony by competent and
independent experts in the proper areas.

utilized in inserting the endotracheal tube (up to

the time the tube was withdrawn for the second
attempt) was fairly significant. Due to the delay in
the delivery of oxygen in her lungs Erlinda showed
signs of cyanosis.

Proximate Cause

Responsibility of the Surgeon

Proximate cause has been defined as that which, in

natural and continuous sequence, unbroken by any
efficient intervening cause, produces injury, and
without which the result would not have occurred.
An injury or damage is proximately caused by an
act or a failure to act, whenever it appears from the
evidence in the case, that the act or omission
played a substantial part in bringing about or
actually causing the injury or damage; and that the
injury or damage was either a direct result or a
reasonably probable consequence of the act or
omission. Instead of the intended endotracheal
intubation what actually took place was an
esophageal intubation. During intubation, such
distention indicates that air has entered the
gastrointestinal tract through the esophagus
instead of the lungs through the trachea. Entry into
the esophagus would certainly cause some delay in
oxygen delivery into the lungs as the tube which
carries oxygen is in the wrong place. That
abdominal distention had been observed during
the first intubation suggests that the length of time

As the so-called "captain of the ship," it is the

surgeon's responsibility to see to it that those
under him perform their task in the proper
manner. Respondent Dr. Hosaka's negligence can
be found in his failure to exercise the proper
authority in not determining if his anesthesiologist
observed proper anesthesia protocols. In fact, no
evidence on record exists to show that respondent
Dr. Hosaka verified if respondent Dra. Gutierrez
properly intubated the patient. Furthermore, it
does not escape us that respondent Dr. Hosaka had
scheduled another procedure in a different hospital
at the same time as Erlinda's cholecystectomy, and
was in fact over three hours late for the latter's
operation. Because of this, he had little or no time
to confer with his anesthesiologist regarding the
anesthesia delivery. This indicates that he was
remiss in his professional duties towards his
patient. Thus, he shares equal responsibility for the
events which resulted in Erlinda's condition.
Responsibility of the Hospital

Hospitals hire, fire and exercise real control over

their attending and visiting "consultant" staff.
While "consultants" are not, technically employees,
a point which respondent hospital asserts in
denying all responsibility for the patient's
condition, the control exercised, the hiring, and the
right to terminate consultants all fulfill the
important hallmarks of an employer-employee
relationship, with the exception of the payment of
wages. In assessing whether such a relationship in
fact exists, the control test is determining.
Accordingly, on the basis of the foregoing, we rule
that for the purpose of allocating responsibility in
medical negligence cases, an employer-employee
relationship in effect exists between hospitals and
their attending and visiting physicians.
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. Such responsibility ceases when
the persons or entity concerned prove that they
have observed the diligence of a good father of the
family to prevent damage. In the instant case,
respondent hospital, apart from a general denial of
its responsibility over respondent physicians, failed
to adduce evidence showing that it exercised the

diligence of a good father of a family in the hiring

and supervision of the latter. It failed to adduce
evidence with regard to the degree of supervision
which it exercised over its physicians. In neglecting
to offer such proof, or proof of a similar nature,
respondent hospital thereby failed to discharge its
burden under the last paragraph of Article 2180.
Having failed to do this, respondent hospital is
consequently solidarily responsible with its
physicians for Erlinda's condition.
Damages
At current levels, the P8000/monthly amount
established by the trial court at the time of its
decision would be grossly inadequate to cover the
actual costs of home-based care for a comatose
individual. The calculated amount was not even
arrived at by looking at the actual cost of proper
hospice care for the patient. What it reflected were
the actual expenses incurred and proved by the
petitioners after they were forced to bring home
the patient to avoid mounting hospital bills. And
yet ideally, a comatose patient should remain in a
hospital or be transferred to a hospice specializing
in the care of the chronically ill for the purpose of
providing a proper milieu adequate to meet
minimum standards of care. Given these
considerations, the amount of actual damages
recoverable in suits arising from negligence should

at least reflect the correct minimum cost of proper

care, not the cost of the care the family is usually
compelled to undertake at home to avoid
bankruptcy.
Our rules on actual or compensatory damages
generally assume that at the time of litigation, the
injury suffered as a consequence of an act of
negligence has been completed and that the cost
can be liquidated. However, these provisions
neglect to take into account those situations, as in
this case, where the resulting injury might be
continuing and possible future complications
directly arising from the injury, while certain to
occur, are difficult to predict. Temperate damages
can and should be awarded on top of actual or
compensatory damages in instances where the
injury is chronic and continuing. And because of
the unique nature of such cases, no incompatibility
arises when both actual and temperate damages
are provided for. The reason is that these damages
cover two distinct phases. As it would not be
equitable - and certainly not in the best interests of
the administration of justice - for the victim in such
cases to constantly come before the courts and
invoke their aid in seeking adjustments to the
compensatory
damages
previously
awarded - temperate damages are appropriate. The
amount given as temperate damages, though to a
certain extent speculative, should take into account

the cost of proper care. In the instant case,

petitioners were able to provide only home-based
nursing care for a comatose patient who has
remained in that condition for over a decade.
Having premised our award for compensatory
damages on the amount provided by petitioners at
the onset of litigation, it would be now much more
in step with the interests of justice if the value
awarded for temperate damages would allow
petitioners to provide optimal care for their loved
one in a facility which generally specializes in such
care. They should not be compelled by dire
circumstances to provide substandard care at
home without the aid of professionals, for anything
less would be grossly inadequate. Under the
circumstances, an award of P1,500,000.00 in
temperate damages would therefore be reasonable.
Petitioner Erlinda Ramos was in her mid-forties
when the incident occurred. She has been in a
comatose state for over fourteen years now. The
burden of care has so far been heroically
shouldered by her husband and children, who, in
the intervening years have been deprived of the
love of a wife and a mother. Meanwhile, the actual
physical, emotional and financial cost of the care of
petitioner would be virtually impossible to
quantify. Even the temperate damages herein
awarded would be inadequate if petitioner's
condition remains unchanged for the next ten

years. The husband and the children, all petitioners

in this case, will have to live with the day to day
uncertainty of the patient's illness, knowing any
hope of recovery is close to nil. They have
fashioned their daily lives around the nursing care
of petitioner, altering their long term goals to take
into account their life with a comatose patient.
They, not the respondents, are charged with the
moral responsibility of the care of the victim. The
family's moral injury and suffering in this case is
clearly a real one. For the foregoing reasons, an
award of P2,000,000.00 in moral damages would
be appropriate.
Finally, by way of example, exemplary damages in
the amount of P100,000.00 are hereby awarded.
Considering the length and nature of the instant
suit we are of the opinion that attorney's fees
valued at P100,000.00 are likewise proper.
WHEREFORE, the decision and resolution of the
appellate court appealed from are hereby modified
so as to award in favor of petitioners, and solidarily
against private respondents the following: 1)
P1,352,000.00 as actual damages computed as of
the date of promulgation of this decision plus a
monthly payment of P8,000.00 up to the time that
petitioner Erlinda Ramos expires or miraculously
survives; 2) P2,000,000.00 as moral damages, 3)
P1,500,000.00 as temperate damages; 4)

P100,000.00 each as exemplary damages and

attorney's fees; and, 5) the costs of the suit.

Reyes vs. Sisters of Mercy Hospital

G.R No. 130547 (October 3, 2000)
A.

Legal Issue

Whether or not Sisters of Mercy Hospital is liable for

the death of Jorge Reyes.
B.
Facts
Petitioner, Leah Alesna Reyes, is the wife of the
deceased patient, Jorge Reyes. Five days before the latters
death, Jorge has been suffering from recurring fever with chills.
The doctors confirmed through the Widal test that Jorge has
typhoid fever. However, he did not respond to the treatment
and died. The cause of his death was Ventricular Arrythemia
Secondary to Hyperpyrexia and typhoid fever. Consequently,
petitioner filed the instant case for damages before the
Regional Trial Court of Cebu City, which dismissed the case
and was affirmed by the Court of Appeals.
The contention was that Jorge did not die of typhoid
fever. Instead, his death was due to the wrongful administration
of chloromycetin. They contended that had respondent doctors
exercised due care and diligence, they would not have
recommended and rushed the performance of the Widal Test,
hastily concluded that Jorge was suffering from typhoid fever,
and administered chloromycetin without first conducting
sufficient tests on the patients compatibility with said drug.
C.
Ruling
Sisters of Mercy Hospital is not liable for the death of
Jorge Reyes.
D.
Reasoning of the Court

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.
E.
Policy
In Medical Negligence cases, it is incumbent upon the
plaintiff to establish that the usual procedure in treating the
illness is not followed by the doctor. Failure to prove this, the
doctor is not liable. Physicians are not insurers of the success
of every procedure undertaken and if the procedure was shown
to be properly done but did not work, they cannot be faulted for
such result.

G.R. NO. 124354

APRIL 11, 2002

ROGELIO E. RAMOS vs. CA

FACTS:
Sometime in 1985, petitioner Erlinda Ramos, after seeking
professional medical help, was advised to undergo an operation
for the removal of a stone in her gall bladder
(cholecystectomy). She was referred to Dr. Hosaka, a surgeon,
who agreed to perform the operation on her. The operation was
scheduled for June 17, 1985 at 9:00 in the morning at private
respondent De Los Santos Medical Center (DLSMC). Since
neither petitioner Erlinda nor her husband, petitioner Rogelio,
knew of any anesthesiologist, Dr. Hosaka recommended to
them the services of Dr. Gutierrez.
Petitioner Erlinda was admitted to the DLSMC the day before
the scheduled operation. By 7:30 in the morning of the
following day, petitioner Erlinda was already being prepared
for operation. Upon the request of petitioner Erlinda, her sisterin-law, Herminda Cruz, who was then Dean of the College of
Nursing at the Capitol Medical Center, was allowed to
accompany her inside the operating room.
At around 9:30 in the morning, Dr. Hosaka had not yet arrived
so Dr. Gutierrez tried to get in touch with him by phone.
Thereafter, Dr. Gutierrez informed Cruz that the operation
might be delayed due to the late arrival of Dr. Hosaka. In the
meantime, the patient, petitioner Erlinda said to Cruz, "Mindy,
inip na inip na ako, ikuha mo ako ng ibang Doctor."
By 10:00 in the morning, when Dr. Hosaka was still not
around, petitioner Rogelio already wanted to pull out his wife
from the operating room. He met Dr. Garcia, who remarked
that he was also tired of waiting for Dr. Hosaka. Dr. Hosaka

finally arrived at the hospital at around 12:10 in the afternoon,

or more than three (3) hours after the scheduled operation.
Cruz, who was then still inside the operating room, heard about
Dr. Hosakas arrival. While she held the hand of Erlinda, Cruz
saw Dr. Gutierrez trying to intubate the patient. Cruz heard Dr.
Gutierrez utter: "ang hirap ma-intubate nito, mali yata ang
pagkakapasok. O lumalaki ang tiyan." Cruz noticed a bluish
discoloration of Erlindas nailbeds on her left hand. She (Cruz)
then heard Dr. Hosaka instruct someone to call Dr. Calderon,
another anesthesiologist. When he arrived, Dr. Calderon
attempted to intubate the patient. The nailbeds of the patient
remained bluish, thus, she was placed in a trendelenburg
position a position where the head of the patient is placed in a
position lower than her feet. At this point, Cruz went out of the
operating room to express her concern to petitioner Rogelio
that Erlindas operation was not going well.
Cruz quickly rushed back to the operating room and saw that
the patient was still in trendelenburg position. At almost 3:00 in
the afternoon, she saw Erlinda being wheeled to the Intensive
Care Unit (ICU). The doctors explained to petitioner Rogelio
that his wife had bronchospasm. Erlinda stayed in the ICU for a
month. She was released from the hospital only four months
later or on November 15, 1985. Since the ill-fated operation,
Erlinda remained in comatose condition until she died on
August 3, 1999.1
Petitioners filed with the Regional Trial Court of Quezon City a
civil case for damages against private respondents. After due
trial, the court a quo rendered judgment in favor of petitioners.
Essentially, the trial court found that private respondents were
negligent in the performance of their duties to Erlinda. On
appeal by private respondents, the Court of Appeals reversed
the trial courts decision and directed petitioners to pay their
"unpaid medical bills" to private respondents.

Petitioners filed with this Court a petition for review on

certiorari. The private respondents were then required to submit
their respective comments thereon. On December 29, 1999,
this Court promulgated the decision which private respondents
now seek to be reconsidered.
ISSUES:
1. WHETHER OR NOT DR. ORLINO HOSAKA
(SURGEON) IS LIABLE FOR NEGLIGENCE;
2. WHETHER OR NOT DR. PERFECTA GUTIERREZ
(ANESTHESIOLOGIST) IS LIABLE FOR NEGLIGENCE;
AND
3. WHETHER OR NOT THE HOSPITAL (DELOS SANTOS
MEDICAL CENTER) IS LIABLE FOR ANY ACT OF
NEGLIGENCE COMMITTED BY THEIR VISITING
CONSULTANT SURGEON AND ANESTHESIOLOGIST.8

Erlinda. 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.
3) After a careful consideration of the arguments raised by
DLSMC, the Court finds that respondent hospitals position on
this issue is meritorious. There is no employer-employee
relationship between DLSMC and Drs. Gutierrez and Hosaka
which would hold DLSMC solidarily liable for the injury
suffered by petitioner Erlinda under Article 2180 of the Civil
Code. urther, no evidence was adduced to show that the injury
suffered by petitioner Erlinda was due to a failure on the part of
respondent DLSMC to provide for hospital facilities and staff
necessary for her treatment. For these reasons, the Supreme
Cord reverse the finding of liability on the part of DLSMC for
the injury suffered by petitioner Erlinda.

RULING:
In the case at bar, the following issues were resolved as
follows:
1) 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.
2) Dr. Gutierrez claim of lack of negligence on her part is
belied by the records of the case. It has been sufficiently
established that she failed to exercise the standards of care in
the administration of anesthesia on a patient. Dr. Gutierrez
omitted to perform a thorough preoperative evaluation on

. WHEREFORE, the assailed Decision is hereby modified as

follows:
(1) Private respondent De Los Santos Medical Center is hereby
absolved from liability arising from the injury suffered by
petitioner Erlinda Ramos on June 17, 1985;
(2) Private respondents Dr. Orlino Hosaka and Dr. Perfecta
Gutierrez are hereby declared to be solidarily liable for the
injury suffered by petitioner Erlinda on June 17, 1985 and are
ordered to pay petitioners
(a) P1,352,000.00 as actual damages;
(b) P2,000,000.00 as moral damages;
(c) P100,000.00 as exemplary damages;
(d) P100,000.00 as attorneys fees; and
(e) the costs of the suit.
SO ORDERED.