Professional Services Inc. v.
Agana To successfully pursue this case of medical negligence, a patient must only prove that a health care
Professional Services Inc. (PSI) v. Natividad and Enrique Agana
Natividad and Enrique Agana v. Juan Fuentes
Miguel Ampil v. Natividad and Enrique Agana
2007 / Sandoval-Gutierrez / Petition for review on certiorari of CA decisions
Standard of conduct > Experts > Medical professionals
FACTS
Natividad Agana was rushed to Medical City because of difficulty of bowel movement and bloody anal
discharge. Dr. Ampil diagnosed her to be suffering from cancer of the sigmoid. Dr. Ampil performed
an anterior resection surgery on her, and finding that the malignancy spread on her left ovary, he
obtained the consent of her husband, Enrique, to permit Dr. Fuentes to perform hysterectomy on her.
After the hysterectomy, Dr. Fuentes showed his work to Dr. Ampil, who examined it and found it in order,
so he allowed Dr. Fuentes to leave the operating room. Dr. Ampil was about to complete the procedure
when the attending nurses made some remarks on the Record of Operation: sponge count lacking 2;
announced to surgeon search done but to no avail continue for closure (two pieces of gauze were
missing). A diligent search was conducted but they could not be found. Dr. Ampil then directed that the
incision be closed.
A couple of days after, she complained of pain in her anal region, but the doctors told her that it was
just a natural consequence of the surgery. Dr. Ampil recommended that she consult an oncologist to
examine the cancerous nodes which were not removed during the operation. After months of consultations
and examinations in the US, she was told that she was free of cancer. Weeks after coming back, her
daughter found a piece of gauze (1.5 in) protruding from her vagina, so Dr. Ampil manually extracted this,
assuring Natividad that the pains will go away. However, the pain worsened, so she sought treatment at a
hospital, where another 1.5 in piece of gauze was found in her vagina. She underwent another surgery.
Sps. Agana filed a complaint for damages against PSI (owner of Medical City), Dr. Ampil, and Dr.
Fuentes, alleging that the latter are liable for negligence for leaving 2 pieces of gauze in Natividads body,
and malpractice for concealing their acts of negligence. Enrique Agana also filed an administrative
complaint for gross negligence and malpractice against the two doctors with the PRC (although only the
case against Dr. Fuentes was heard since Dr. Ampil was abroad). Pending the outcome of the
cases, Natividad died (now substituted by her children). RTC found PSI and the two doctors liable for
negligence and malpractice. PRC dismissed the case against Dr. Fuentes. CA dismissed only the case
against Fuentes.
ISSUE AND HOLDING
1. WON CA erred in holding Dr. Ampil liable for negligence and malpractice. NO; DR. AMPIL IS
GUILTY
2. WON CA erred in absolving Dr. Fuentes of any liability. NO
3. WON PSI may be held solidarily liable for Dr. Ampils negligence. YES
RATIO
DR. AMPIL IS LIABLE FOR NEGLIGENCE AND MALPRACTICE
His arguments are without basis [did not prove that the American doctors were the ones who put / left the
gauzes; did not submit evidence to rebut the correctness of the operation record (re: number of gauzes
used); re: Dr. Fuentes alleged negligence, Dr. Ampil examined his work and found it in order].
Leaving foreign substances in the wound after incision has been closed is at least prima
facie negligence by the operating surgeon. Even if it has been shown that a surgeon was required to
leave a sponge in his patients abdomen because of the dangers attendant upon delay, still, it is his legal
duty to inform his patient within a reasonable time by advising her of what he had been compelled to do,
so she can seek relief from the effects of the foreign object left in her body as her condition might permit.
Whats worse in this case is that he misled her by saying that the pain was an ordinary consequence of her
operation.
Medical negligence; standard of diligence
provider either failed to do something [or did something] which a reasonably prudent health care provider
would have done [or wouldnt have done], and that the failure or action caused injury to the patient.
Duty to remove all foreign objects from the body before closure of the incision; if he fails to do so, it
was his duty to inform the patient about it
Breach failed to remove foreign objects; failed to inform patient
Injury suffered pain that necessitated examination and another surgery
Proximate Causation breach caused this injury; could be traced from his act of closing the incision
despite information given by the attendant nurses that 2 pieces of gauze were still missing; what
established causal link: gauze pieces later extracted from patients vagina
DR. FUENTES NOT LIABLE
The res ipsa loquitur [thing speaks for itself] argument of the Aganas does not convince the court. Mere
invocation and application of this doctrine does not dispense with the requirement of proof of negligence.
Requisites for the applicability of res ipsa loquitur
1. Occurrence of injury
2. Thing which caused injury was under the control and management of the defendant [DR.
FUENTES] LACKING SINCE CTRL+MGT WAS WITH DR. AMPIL
3. Occurrence was such that in the ordinary course of things, would not have happened if those who
had control or management used proper care
4. Absence of explanation by defendant
Under the Captain of the Ship rule, the operating surgeon is the person in complete charge of the surgery
room and all personnel connected with the operation. That Dr. Ampil discharged such role is evident from
the following:
He called Dr. Fuentes to perform a hysterectomy
He examined Dr. Fuentes work and found it in order
He granted Dr. Fuentes permission to leave
He ordered the closure of the incision
HOSPITAL OWNER PSI SOLIDARILY LIABLE WITH DR. AMPIL [NCC 2180], AND DIRECTLY
LIABLE TO SPS. AGANAS [NCC 2176]
Previously, employers cannot be held liable for the fault or negligence of its professionals. However, this
doctrine has weakened since courts came to realize that modern hospitals are taking a more active role in
supplying and regulating medical care to its patients, by employing staff of physicians, among others.
Hence, there is no reason to exempt hospitals from the universal rule of respondeat superior. Here are the
Courts bases for sustaining PSIs liability:
Ramos v. CA doctrine on E-E relationship
o For purposes of apportioning responsibility in medical negligence cases, an employer-employee
relationship in effect exists between hospitals and their attending and visiting physicians. [LABOR
LESSON: power to hire, fire, power of control]
Agency principle of apparent authority / agency by estoppel
o Imposes liability because of the actions of a principal or employer in somehow misleading the
public into believing that the relationship or the authority exists [see NCC 1869]
o PSI publicly displays in the Medical City lobby the names and specializations of their physicians.
Hence, PSI is now estopped from passing all the blame to the physicians whose names it proudly
paraded in the public directory, leading the public to believe that it vouched for their skill and
competence.
o
If doctors do well, hospital profits financially, so when negligence mars the quality of its
services, the hospital should not be allowed to escape liability for its agents acts.
 Doctrine of corporate negligence / corporate responsibility
o This is the judicial answer to the problem of allocating hospitals liability for the negligent acts of
health practitioners, absent facts to support the application of respondeat superior.
o This provides for the duties expected [from hospitals]. In this case, PSI failed to perform the duty
of exercising reasonable care to protect from harm all patients admitted into its facility for medical
treatment. PSI failed to conduct an investigation of the matter reported in the note of the
count nurse, and this established PSIs part in the dark conspiracy of silence and
concealment about the gauzes.
o
PSI has actual / constructive knowledge of the matter, through the report of the attending
nurses + the fact that the operation was carried on with the assistance of various hospital staff
o It also breached its duties to oversee or supervise all persons who practice medicine within its
walls and take an active step in fixing the negligence committed
PSI also liable under NCC 2180
o It failed to adduce evidence to show that it exercised the diligence of a good father of the family in
the accreditation and supervision of Dr. Ampil
Cantre vs Go
GR No. 160889 April 27, 2007
Facts: Petitioner Dr. Milagros L. Cantre is a specialist in obstetrics and gynecology at the Dr. Jesus
Delgado memorial Hospital. She was the attending physician of respondent Nora Go, who was admitted at
the said hospital on April 19, 1992. At 1:30am of April 20, 1992, Nora gave birth to her fourth child, a
baby boy. However, at around 3:30am Nora suffered profuse bleeding insider her womb due to some parts
of the placenta were not completely expelled from her womb after delivery consequently, Nora suffered
hypovolemic shock, resulting in a drop in her blood pressure to 40/0. Petitioner said the assisting resident
physician performed various medical procedures to stop the bleeding and to restore Noras blood pressure.
Her blood pressure was frequently monitored with the use of a sphygmamometer. While petitioner was
massaging Noras uterus for it to contract and stop bleeding, she ordered a drop light to warm Nora and
her baby. Nora remained unconscious until she recovered. While in the recovery room, her husband,
respondent John David Z. Go noticed a fresh gasping wound 2 1/2 x 3 1/2 in the inner portion of her left
arm, close to the armpit. He asked the nurses what caused the injury. He was informed, it was a burn. An
investigation was filed by Noras husband and found out from the petitioner that it was caused by the
blood pressure cuff, however, this was contrary to the findings from a medico-legal report which stated
that it was indeed a burn and that a drop light when placed near a skin for about 10mins could cause such
burn. Nora was referred to a plastic surgeon from the hospital and skin grafting was done on her and scar
revision but both still left a mark on Noras arm compelling the respondent spouse to file a complaint for
damages against petitioner.
Issue: Whether or not petitioner is liable for the injury referred by Nora.
Held: Yes. The Hippocratic oath mandates physicians to give primordial consideration to the well-being
of their patients. If a doctor fails to live up to his precept, he is accountable for his acts. This is
notwithstanding, courts face a unique restraint in adjudicating medical negligence cases because
physicians are not guardians of care and they never set out to intentionally cause injury to their patients.
However, intent is immaterial in negligence cases because where negligence exist and is proven, it
automatically gives the injured a right to reparation for the damage caused.
In cases, involving medical negligence, the doctrine of res ipsa liquitor 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, provided that the following requisites concur:
1. The accident is of a kind which ordinarily does not occur in the absence of someones
negligence;
2. It is caused by an instrumentality within the exclusive control of the defendant or defendants;
3. The possibility of contributing conduct which would make the plaintiff responsible is
eliminated.
All of these three requisites were present in the case at bar.
Under the the captain of the ship doctrine, the surgeon in charge of the operation is liable for the
negligence of his assistants during the time when those are under the surgeons control.
CONCEPCION ILAO-ORETA v. SPOUSES EVA MARIE and BENEDICTO NOEL
RONQUILLO, et al.
Respondent spouses Eva Marie Ronquillo and Noel Benedicto Ronquillo had not been
blessed with a child despite several years of marriage. They thus consulted petitioner Dr.
Concepcion Ilao-Oreta, an obstetrician-gynecologist-consultant and chief of the Reproductive
Endocrinology and Infertility Section at the St. Lukes Medical Center. Dr. Ilao-Oreta advised
Eva Marie to undergo a laparoscopic procedure whereby a laparascope would be inserted
through the patients abdominal wall to get a direct view of her internal reproductive organ in
order to determine the real cause of her infertility.
The procedure was scheduled on April 5, 1999 at 2:00 p.m. to be performed by Dr.
Ilao-Oreta. Eva Marie, accompanied by Noel, checked in at the St. Lukes Medical Center and
underwent pre-operative procedures including the administration of intravenous fluid and
enema. However, Dr. Ilao-Oreta did not arrive at the scheduled time for the procedure and no
prior notice of its cancellation was received. It turned out that the doctor was on a return flight
from Hawaii to, and arrived at 10:00 p.m. of April 5, 1999 in, Manila.
The Ronquillo spouses filed a complaint against Dr. Ilao-Oreta and the St. Lukes
Medical Center for breach of professional and service contract and for damages before the
Regional Trial Court of Batangas City. They prayed for the award of actual damages including
alleged loss of income of Noel while accompanying his wife to the hospital, moral damages,
exemplary damages, costs of litigation, attorneys fees, and other available reliefs and remedies.
The RTC decided in favor of Ronquillo spouses and awarded Eva Marie actual damages but ruled
that the failure of the doctor to arrive on time was not intentional. It found no adequate proof
that Noel had been deprived of any job contract while attending to his wife in the hospital. The
spouses appealed to the Court of Appeals and found that Dr. Ilao-Oreta grossly negligent.
ISSUE:
Whether or not Dr. Ilao-Oreta is guilty of gross negligence for her failure to arrive at the
scheduled time for the procedure
HELD:
It bears noting that when she was scheduling the date of her performance of the procedure, Dr.
Ilao-Oreta had just gotten married and was preparing for her honeymoon, and it is
of common human knowledge that excitement attends its preparations. Her negligence could
then be partly attributed to human frailty which rules out its characterization as gross.
Dr. Ilao-Oretas negligence not being gross, Ronquillo spouses are not entitled to recover moral
damages. Neither are the spouses entitled to recover exemplary damages in the absence of a
showing that Dr. Ilao-Oreta acted in a wanton, fraudulent, reckless, oppressive or malevolent
manner, nor to award of attorneys fees as, contrary to the finding of the CA that the spouses
were compelled to litigate and incur expenses to protect their interest, the records show that
they did not exert enough efforts to settle the matter before going to court.
Spouses Flores vs Spouses Pineda
GR No. 158996 November 14, 2008
Facts: Teresita Pineda consulted her townmate Dr. Fredelicto Flores regarding her medical condition,
complaining about general body weakness, loss of appetite, frequent urination and thirst, and on-and-off
vaginal bleeding. After interviewing Teresita, Dr. Fredelicto advised her to go to United Doctors Medical
Center (UDMC) in Quezon City for a general check-up the following week but the former did not. As for
her other symptoms, he suspected that Teresita might be suffering from diabetes and told her to continue
her medications. When her conditions persisted, she went to UDMC where Dr. Fredelictor check-up her
and ordered her admission and further indicate on call D&C operation to be performed by his wife, Dra.
Felicisima Flores, an Ob-Gyne. Laboratory tests were done on Teresita including internal vaginal
examination, however, only the blood sugar and CBC results came out prior to operation which indicated
of diabetes. D&C operations were still done and thereafter, Dra. Felicisima advised her that she can go
home and continue to rest at home but Teresita opted otherwise. Two days after the operation, her
condition worsened prompting further test to be done which resulted that Teresita have diabetes melitus
type II. Insulin was administered but it might arrived late, she died.
Issue: Whether or not spouses petitioners are liable for medical negligence.
Held: Yes. A medical negligence case is a type of claim to redress a wrong committed by a medical
professional, that caused a bodily harm to or the death of a patient. There are four elements involved in a
medical negligence case, namely: duty, breach, injury, and proximate cause.
Duty refers to the standard of behavior which imposes restrictions on ones conduct. The standard in turn
refers to the amount of competence associated with the proper discharge of the profession. A physician is
expected to use at least the same level of case that any other reasonably competent doctor would use under
the same circumstances. Breach of duty occurs when the physician fails to comply with those professional
standards. If injury results to the patient as a result of this breach, the physician is answerable for
negligence.
If a patient suffers from some disability that increases the magnitude of risk to him, that disability must be
taken into account as long as it is or should have been known to the physician.
Stress, whether physical or emotional, is a factor that can aggravate diabetes; a D&C operation is a form
of physical stress. Dr. Mendoza explained how surgical stress can aggravate the patients hyperglycemia:
when stress occurs, the diabetics body, especially the autonomic system, reacts by secreting hormones
which are counter-regulatory; she can have prolonged hyperglycemia which, if unchecked, could lead to
death. Medical lecture further explains that if the blood sugar has become very high, the patient becomes
comatose (diabetic coma). When this happens over several days, the body uses its own fats to produce
energy, and the result is high level of waste products in the blood and urine.
These findings leads us to the conclusion that the decision to proceed with the D&C operation
notwithstanding Teresitas hyperglycemia and without adequately preparing her for the procedure, was
contrary to the standards observed by the medical profession. Deviation from this standard amounted to a
breach of duty which resulted in the patients death. Due to this negligent conduct, liability must attach to
the petitioner spouses.
Cayao-Lasam vs Spouses Ramolete
GR No. 159132 December 18, 2002
Facts: On July 28, 1994, respondent 3 months pregnant Editha Ramolete was brought to Lorma Medical
Center (LMC) in San Fernando, La Union due to vaginal bleeding upon advise of petitioner related via
telephone, Editha was admitted to the LMC on the same day. A pelvic sonogram was then conducted on
Editha revealing the fetus weak cardiac pulsation. The following day, Editha repeat pelvic sonogram
showed that aside from the fetus weak cardiac pulsation, no fetal movement was also appreciated. Due to
persistent and profuse vaginal bleeding, petitioner advised her to undergo a D&C procedure. She was
discharged the following day. On September 16, 1994, Editha was once gain brought at the LMC, as she
was suffering from vomiting ans severe abdominal pains. Editha was attended by Drs. Dela Cruz, Mayo
and Komiya. Dr. Mayo allegedly informed Editha that there was a dead fetus in the latters womb, after
Editha went laparectomy, she was found to have massive intra abdominal hemorrhage and ruptured uterus.
Thus, she had to go hysterectomy and as a result no more chance to bear a child.
Issue: Whether or not petitioner is liable for medical malpractice.
Held: No. Medical malpractice is a particular form of negligence which consists in the failure of a
physician or surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily
employed by the profession generally under similar conditions, and in like surrounding circumstances. In
order to successfully pursue such a claim, a patient must prove that the physician or surgeon either failed
to do something which a reasonably prudent physician or surgeon would not have done, and that the
failure or action caused injury to the patient.
There are four elements involved in medical negligence cases: duty, breach, injury, and proximate cause..
A physician-patient relationship was created when Editha employed the services of the petitioner. As
Edithas physician, petitioner was duty-bound to use at least the same level of care that any 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
patients injured in body or in health, constitutes actionable malpractice, as to this aspect of medical
malpractice, the determination of the reasonable level of care and the breach thereof, expert testimony is
essential. Further, in as much 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 suspect the conclusion as to causation.
It is undisputed that Editha did not return for follow-up evaluation, in defiance of the petitioners advice.
This is as found out is the proximate cause of the injury she sustained.
Li vs Spouses Soliman
GR No. 165279 June 7, 2011
Facts: On July 7, 1993, respondents 11 year old daughter, Angelica Soliman underwent a biopsy of the
mass located in her lower extremity at the St. Lukes Medical Center (SLMC). Results showed that
Angelica was suffering from osteosaucoma, ostiobiostic type, a high-grade (highly malignant) cancer of
the bone which usually affects teenage children. Following this diagnosis, Angelicas right leg was
amputated by Dr. Tamayo in order to remove the tumor. As a adjuvant treatment to eliminate any
remaining cancer cells, and hence minimizing the chances of recurrence and prevent the decease from
spreading to other parts of the patients body, chemotherapy was suggested by Dr. Tamayo and referred
Angelica to another doctor at SLMC, herein petitioner Dr. Rubi Li, a medical oncologist.
On July 23, 1993, petitioner saw the respondents at the hospital after Angelicas surgery and discussed
with them Angelicas condition. Petitioner told respondents that Angelica should be given 2-3 weeks to
recover from the operation before starting the chemotherapy. Respondents were apprehensive due to
financial constraints as Reynaldo earns only from P70,000-150,000 a year from his jewelry and watching
repair business. Petitioner, however, assured them not to worry about her professional fee and told them to
just save up for medicines to be used.
There are four essential elements a plaintiff must proved in a malpractice action based upon the doctrine
of informed consent: 1.) the physician had a duty to disclose material risks; 2.) he failed to disclose or
inadequately disclosed those risks; 3.) as a direct and proximate result of the failure to disclose, the patient
consented to treatment she otherwise would not have consented to; and 4.) plaintiff was injured by the
proposed treatment. The gravamen in an informed consent requires the plaintiff to point to significant
undisclosed information relating to the treatment which could have altered her decision to undergo it.

As the chemotherapy session started, day by day, Angelica experience worsening condition and other Examining the evidence, we hold that there was adequate disclosure of material risks inherent in
physical effect on the body such as discoloration, nausea, and vomiting. chemotherapy procedure performed with the consent of Angelicas parents. Respondents could not have
been unaware in the course of initial treatment and amputation of Angelicas lower extremity that her
immune system was already weak on account of the malignant tumor in her knee. When petitioner
Petitioner claimed, that she explained to respondents that even when a tumor is removed, there are still
informed the respondents beforehand of the side effects of chemotherapy which includes lowered counts
small lesions undetectable to the naked eye and that adjuvant chemotherapy is needed to clean out the
of white and red blood cells, decrease in blood platelets, possible kidney or heart damage and skin
small lesions in order to lessen the chance of cancer to recur. She did not give the respondents any
darkening, there is reasonable expectation on the part of the doctor that the respondents understood very
assurance that chemotherapy will cure Angelicas cancer. During these consultations with respondents,
well that the severity of these side effects will not be the same for all patients undergoing the procedure. In
she explained the following side effects of chemotherapy treatment to respondents: 1.) Falling hair; 2.)
other words, by the nature of the disease itself, each patients reaction to the chemical agents even with
nausea and vomiting; 3.) loss of appetite; 4.) low count of WBC, RBC, and platelets; 5.) possible sterility
pre-treatment laboratory tests cannot be precisely determined by the physician. That death can possibly
due to the effects on Angelicas ovary; 6.) Damage to kidney and heart; 7.) darkening of the skin
result from complications of the treatment or the underlying cancer itself, immediately or sometime after
especially when exposed to sunlight. She actually talked to the respondents four times, once at the hospital
the administration of chemotherapy drugs, is a risk that cannot be ruled out, as with most other major
after the surgery, twice at her clinic and fourth when Angelicas mother called her through long distance.
medical procedures, but such conclusion can be reasonably drawn from the general side effects of
This was disputed by respondents who countered that petitioner gave them assurance that there is 95%
chemotherapy already disclosed.
chance of healing for Angelica if she undergoes chemotherapy and that the only side effects were nausea,
vomiting and hair loss. Those were the only side effects of chemotherapy mentioned by petitioner.
Jarcia vs People of the Philippines
GR No. 187926 February 15, 2012
Issue: Whether or not petitioner committed medical malpractice.

Facts: Belinda Santiago lodged a complaint with the National Bureau of Investigation (NBI) against the
Held: No. The type of lawsuit which has been called medical malpractice or more appropriately, medical
petitioners, Dr. Emanuel Jarcia and Dr. Marilou Bastan, for their alleged neglect of professional duty
negligence, is that type of claim which a victim has available to him or her to redress a wrong committed
which caused her son, Roy Alfonso Santiago, to suffer physical injuries. Upon investigation, the NBI
by a medical professional which has caused bodily harm. In order to successfully pursue such claim, a
found that Roy Jr. was hit by a taxicab; that he was rushed to the Manila Doctors Hospital for an
patient must prove that a health care provider in most cases a physician, either failed to do something
emergency medical treatment; that an X-ray of the victims ankle was ordered; that the X-ray result
which a reasonably prudent health care provider would have done or that he or she did something that a
showed no fracture as read by Dr. Jarcia; that Dr. Bastan entered the emergency room and, after
reasonably health care provider would not have done; and that failure or action caused injury to the
conducting her own examination of the victim, informed Mrs. Santiago that since it was only the ankle
patient.
that was hit there was no need to examine the upper leg; that 11 days later, Roy developed fever, swelling
of the right leg and misalignment of the right foot; that Mrs. Santiago brought him back to the hospital;
Medical negligence cases are best proved by opinions of expert witnesses belonging in the same general and that the x-ray revealed a right mid-tibial fracture and a linear hairline fracture in the shaft of the bone.
neighborhood and in the same general line of practice as defendant physician or surgeon. The deference of A complaint for reckless imprudence resulting physical injuries was filed against the petitioners for the
courts to the expert opinion of qualified physicians stems from the formers realization that the latter alleged misconduct in the handling of the illness of Roy.
possess unusual technical skills which layman in most instances are incapable of intelligently evaluating,
hence the indispensability of expert testimonies.
Issue: Whether or not the petitioners failed to exercise the degree of care expected of them as doctors and
are liable for negligence to the private respondent.
The doctrine of informed consent within the context of physician-patient relationships goes as far back
into english common law. As early as 1767, doctors were charged with the tort of battery if they have not
Held: Yes. The doctrine of res ipsa liquitor as a rule of evidence is unusual to the law of negligence
gained the consent of their patients prior to performing a surgery or procedure. In the United States, the
which recognizes that prima facie negligencce may be established without direct proof and furnishes a
seminal case was Schoendorff vs Society of New York Hospital which involved unwanted treatment
substitute for specific proof of negligence. The doctrine however, is not a rule of substantive law, but
performed by a doctor. Justice Bejamin Cardozo oft-quoted opinion upheld the basic right of a patient to
merely a mode of proof or a mere procedural convenience the rule when applicable to the facts and
give consent to any medical procedure or treatment; every human being of adult year and sound mind has
circumstances of a given case, is not meant to and does not dispense with the requirement of proof of
a right to determine what shall be done with his own body; and a surgeon who performs an operation
culpable negligence on the party charged. It merely determines and regulates what shall be prima
without his patients consent commits an assault, for which he is liable in damages. From a purely ethical
facie evidence thereof and helps the plaintiff in proving a breach of duty. The doctrine can be invoked
norm, informed consent evolved into a general principle of law that a physician has a duty to disclose
when and only when, under the circumstances involved, direct evidence is absolute and not readily
what a reasonably prudent physician in the medical community in the exercise of reasonable care would
available.
disclose to his patient as to whatever grave risk of injury might be incurred from a proposed course of
treatment, so that a patient, exercising ordinary care for her own welfare and faced with a choice of
undergoing the proposed treatment, as alternative treatment, or none at all, may intelligently exercise his The requisites for the application of the doctrine of res ipsa liquitor are:
judgement by reasonably balancing the probable risk against the probable benefits.
1. The accident was of a kind which does not ordinarily occur unless someone is negligent;
 2. The instrumentality or agency which caused the injury was under the exclusive control of the
person in charge; and
3. The injury suffered must not have been due to any voluntary action or contribution of the
person injured.
Negligence is defined as the failure to observe for the protection of the interests of another person that
degree of care, precaution and vigilance which the circumstances justly demand whereby such other
person suffers injury.
Reckless imprudence consists of voluntarily doing or failing to do, without malice, an act from which
material damage results by reason of an inexcusable lack of precaution on the part of the person
performing or failing to perform such act.
In failing to perform an extensive medical examination to determine the extent of Roys injuries, Dr.
Jarcia and Dr. Bastan were remiss of their duties as members of the medical profession. Assuming for the
sake of argument that they did not have the capacity to make such thorough evaluation at that stage they
should have referred the patient to another doctor with sufficient training and experience instead of
assuring him and his mother that everything was all right.
LUMANTAS VS. CALAPIZ
[BERSAMIN, J.]
FACTS:
In 1995, Spouses Hilario Calapiz, Jr. and Herlita Calapiz brought their 8-year-old son, Hanz
Calapiz (Hanz), to the Misamis Occidental Provincial Hospital, Oroquieta City, for an emergency
appendectomy. Hanz was attended to by the petitioner, who suggested to the parents that Hanz
also undergo circumcision at no added cost to spare him the pain. With the parents consent, the
petitioner performed the coronal type of circumcision on Hanz after his appendectomy. On the
following day, Hanz complained of pain in his penis, which exhibited blisters. His testicles were
swollen. The parents noticed that the child urinated abnormally after the petitioner forcibly
removed the catheter, but the petitioner dismissed the abnormality as normal. Hanz was
discharged from the hospital over his parents protestations, and was directed to continue taking
antibiotics. After a few days, Hanz was confined in a hospital because of the abscess formation
between the base and the shaft of his penis. Presuming that the ulceration was brought about by
Hanzs appendicitis, the petitioner referred him to Dr. Henry Go, an urologist, who diagnosed the
boy to have a damaged urethra. Thus, Hanz underwent cystostomy, and thereafter was
operated on three times to repair his damaged urethra.
When his damaged urethra could not be fully repaired and reconstructed, Hanzs parents
brought a criminal charge against the petitioner for reckless imprudence resulting to serious
physical injuries. In his defense, the petitioner denied the charge. He contended that at the time
of his examination of Hanz, he had found an accumulation of pus at the vicinity of the appendix
two to three inches from the penis that had required immediate surgical operation; that after
performing the appendectomy, he had circumcised Hanz with his parents consent by using a
congo instrument, thereby debunking the parents claim that their child had been cauterized; that
he had then cleared Hanz once his fever had subsided; that he had found no complications
when Hanz returned for his follow up check-up; and that the abscess formation between the
base and the shaft of the penis had been brought about by Hanzs burst appendicitis.
The RTC acquitted the petitioner of the crime charged for insufficiency of the evidence. It held
that the Prosecutions evidence did not show the required standard of care to be observed by
other members of the medical profession under similar circumstances. Nonetheless, the RTC
ruled that the petitioner was liable for moral damages because there was a preponderance of
evidence showing that Hanz had received the injurious trauma from his circumcision by the
petitioner. The Petitioner appealed his case to the CA contending that he could not be held civilly
liable because there was no proof of his negligence. The CA affirmed the RTC, sustaining the
award of moral damages.
ISSUE:
Whether the CA erred in affirming the petitioners civil liability despite his acquittal of the crime of
reckless imprudence resulting in serious physical injuries.
HELD:
NO.
It is axiomatic that every person criminally liable for a felony is also civilly liable. xxx Our law
recognizes two kinds of acquittal, with different effects on the civil liability of the accused. First is
an acquittal on the ground that the accused is not the author of the act or omission complained
of. This instance closes the door to civil liability, for a person who has been found to be not the
perpetrator of any act or omission cannot and can never be held liable for such act or omission.
There being no delict, civil liability ex delicto is out of the question, and the civil action, if any,
which may be instituted must be based on grounds other than the delict complained of. This is
the situation contemplated in Rule 111 of the Rules of Court. The second instance is an acquittal
based on reasonable doubt on the guilt of the accused. In this case, even if the guilt of the
accused has not been satisfactorily established, he is not exempt from civil liability which may be
proved by preponderance of evidence only.
The petitioners contention that he could not be held civilly liable because there was no proof of
his negligence deserves scant consideration. The failure of the Prosecution to prove his criminal
negligence with moral certainty did not forbid a finding against him that there was preponderant
evidence of his negligence to hold him civilly liable. With the RTC and the CA both finding that
Hanz had sustained the injurious trauma from the hands of the petitioner on the occasion of or
incidental to the circumcision, and that the trauma could have been avoided, the Court must
concur with their uniform findings. In that regard, the Court need not analyze and weigh again
the evidence considered in the proceedings a quo. The Court, by virtue of its not being a trier of
facts, should now accord the highest respect to the factual findings of the trial court as affirmed
by the CA in the absence of a clear showing by the petitioner that such findings were tainted with
arbitrariness, capriciousness or palpable error.
Every person is entitled to the physical integrity of his body. Although we have long advocated
the view that any physical injury, like the loss or diminution of the use of any part of ones body,
is not equatable to a pecuniary loss, and is not susceptible of exact monetary estimation, civil
damages should be assessed once that integrity has been violated. The assessment is but an
imperfect estimation of the true value of ones body. The usual practice is to award moral
damages for the physical injuries sustained. In Hanzs case, the undesirable outcome of the
circumcision performed by the petitioner forced the young child to endure several other
procedures on his penis in order to repair his damaged urethra. Surely, his physical and moral
sufferings properly warranted the amount of P50,000.00 awarded as moral damages.
Many years have gone by since Hanz suffered the injury. Interest of 6% per annum should then
be imposed on the award as a sincere means of adjusting the value of the award to a level that
is not only reasonable but just and commensurate. Unless we make the adjustment in the
permissible manner by prescribing legal interest on the award, his sufferings would be unduly
compounded. For that purpose, the reckoning of interest should be from the filing of the criminal
information on April 17, 1997, the making of the judicial demand for the liability of the petitioner.
DR. JAIME T. CRUZ, PETITIONER, VS. FELICISIMO V. AGAS, JR., RESPONDENT.
DECISION
MENDOZA, J.:
This petition for review on certiorari under Rule 45 of the Rules of Court assails the May 22,
2012 Decision[1] and October 18, 2012 Resolution[2] of the Court of Appeals (CA), in CA-G.R. SP
No. 111910, which affirmed the March 2, 2007[3] and September 23, 2009[4]Resolutions of the
Secretary of Justice. The said resolutions let stand the February 16, 2004 Resolution of the Office
of the Prosecutor of Quezon City, dismissing the complaint of petitioner Dr. Jaime T. Cruz (Dr.
Cruz) for Serious Physical Injuries through Reckless Imprudence and Medical Malpractice
against respondent, Dr. Felicisimo V. Agas, Jr. (Dr. Agas).
The Antecedents
In his Complaint-Affidavit[5] for Serious Physical Injuries through Reckless Imprudence and
Medical Malpractice against Dr. Agas, Dr. Cruz alleged, among others, that sometime in May
2003, he engaged the services of St. Luke's Medical Center (SLMC) for a medical check-up; that
after being admitted in SLMC on May 28, 2003, he underwent stool, urine, blood, and other
body fluid tests conducted by the employees and doctors of the said hospital; that on May 29,
2003, he was sent to the Gastro-Enterology Department for a scheduled gastroscopy and
colonoscopy; that because the specialist assigned to perform the procedure was nowhere to be
found, he gave the colonoscopy results to the attending female anesthesiologist for the
information and consideration of the assigned specialist; that, thereafter, he was sedated and the
endoscopic examination was carried out; that when he regained consciousness, he felt that
something went wrong during the procedure because he felt dizzy, had cold clammy perspiration
and experienced breathing difficulty; that he could not stand or sit upright because he felt so
exhausted and so much pain in his abdomen; that when he was about to urinate in the comfort
room, he collapsed; that he tried to consult the specialist who performed the colonoscopy but he
was nowhere to be found; and that his cardiologist, Dra. Agnes Del Rosario, was able to observe
his critical condition and immediately referred him to the surgical department which suspected
that he had hemorrhage in his abdomen and advised him to undergo an emergency surgical
operation.
Dr. Cruz further averred that he agreed to the operation and upon waking up at the ICU on May
30, 2003, he found out that the doctors did an exploratory laparatomy because of the internal
bleeding; that he learned that the doctors cut a portion of the left side of his colon measuring 6-8
inches because it had a partial tear of the colonic wall which caused the internal bleeding; that
despite the painkillers, he was under tremendous pain in the incision area during his recovery
period in the ICU and had fever; and that he had intravenous tubes attached to his arms,
subclavian artery on the left part of his chest and a nasogastric tube through his nose.
Dr. Cruz claimed that Dr. Agas admitted that he was the one who performed the colonoscopy
procedure but the latter insisted that nothing went wrong. On June 7, 2003, he was discharged
from SLMC. Nevertheless, he complained that he had a hard time digesting his food; that he was
frequently fed every two hours because he easily got full; that he had fresh blood stools every
time he moved his bowel; that he had lost his appetite and had gastric acidity; that he slept most
of the day; and that he was in good physical condition before the colonoscopy procedure. He
asserted that at the time of the filing of the complaint, he was still weak, tired and in pain.
Defense of Dr. Agas
Dr. Agas, on the other hand, countered that Dr. Cruz failed to prove the basic elements of
reckless imprudence or negligence. He averred that Dr. Cruz unfairly made it appear that he did
not know that he would perform the procedure. He explained that before the start of the
colonoscopy procedure, he was able to confer with Dr. Cruz and review his medical history which
was taken earlier by a fellow gastrointestinal physician. He claimed that the gastroscopy and
colonoscopy procedures conducted on Dr. Cruz were completely successful considering that the
latter did not manifest any significant adverse reaction or body resistance during the procedures
and that his vital signs were normal throughout the procedure.[6]
Dr. Agas added that certifications and sworn statements were submitted by the Assistant
Medical Director for Professional Services, the Director of the Institute of Digestive Diseases, the
anesthesiologist, and the hospital nurse attesting to the fact that the intraperitonial bleeding
which developed after the colonoscopy procedure, was immediately recognized, evaluated,
carefully managed, and corrected; that he provided an adequate and reasonable standard of care
to Dr. Cruz; that the endoscopist followed all precautionary measures; that the colonoscopy
procedure was done properly; that he was not negligent or reckless in conducting the
colonoscopy procedure; that he did not deviate from any standard medical norm, practice or
procedure; and that he exercised competence and diligence in rendering medical services to Dr.
Cruz.[7]
Antecedents at the Prosecution Level
On February 16, 2004, the Office of the City Prosecutor (OCP) issued a resolution dismissing the
complaint for Serious Physical Injuries through Reckless Imprudence and Medical Malpractice.
Aggrieved, Dr. Cruz filed a petition for review with the Department of Justice (DOJ) but the
same was dismissed in its March 2, 2007 Resolution. Dr. Cruz filed a motion for reconsideration
but it was denied by the DOJ in its September 23, 2009 Resolution.[8]
At the Court of Appeals
Not satisfied, Dr. Cruz filed a petition for certiorari before the CA questioning the unfavorable
DOJ resolutions. On May 22, 2012, the CA rendered a decision affirming the said DOJ
resolutions. The CA explained that, as a matter of sound judicial policy, courts would not
interfere with the public prosecutor's wide discretion of determining probable cause in a
preliminary investigation unless such executive determination was tainted with manifest error or
grave abuse of discretion. It stated that the public prosecutor's finding of lack of probable cause
against Dr. Agas was in accordance with law and that his alleged negligence was not adequately
established by Dr. Cruz.
The CA also declared that Dr. Cruz failed to state in his Complaint-Affidavit the specific
procedures that Dr. Agas failed to do which a reasonable prudent doctor would have done, or
specific norms he failed to observe which a reasonably prudent doctor would have complied
with. The CA pointed out that Dr. Agas was able to satisfactorily explain in his Counter-Affidavit
that the complications suffered by Dr. Cruz was not caused by his negligence or was the result of
medical malpractice. Dr. Agas explained as follows:
That the complication was due to the abnormal condition and configuration of the digestive
system, colon in particular, of the complainant and not from any negligent act in connection with
the conduct of colonoscopy. The surgical findings (xxx) revealed marked adhesions in the
sigmoid colon which is not and never within my control. That the tear in the serosa (the
outermost layer of the colonic wall which has 4 layers) happened likely because of the marked
interloop adhesions and tortuousity of the sigmoid segment of the colon. These adhesions that
connect the serosa to the peritoneal lining of each loop detached from the serosa during the
procedure. It is not possible to detect the presence of marked adhesions prior to the endoscopic
procedure because no clinical findings, laboratory tests or diagnostic imaging such as x-ray,
ultrasound or computed tomography (CT scan) of the abdomen can diagnose these conditions.
This can only be detected by surgically opening up the abdomen. Moreover, marked adhesions
and serosal tear, in particular, cannot likewise be detected by colonoscopy because they are in
the outer wall of the colon and only the inner lining of the colon is within the view of the
colonoscope (camera).[9]
The CA further wrote that the counter-affidavit of Dr. Agas was supported by the sworn affidavit
of Dr. Jennifel S. Bustos, an anesthesiologist at the SLMC and the affidavit of Evelyn E. Daulat, a
nurse at SLMC, both swearing under oath that Dr. Agas was not negligent in conducting a
gastroscopy and colonoscopy procedure on Dr. Cruz and the certification issued by the Hospital
Ethics Committee which stated that Dr. Cruz was given an adequate and reasonable standard of
care; that Dr. Agas followed all precautionary measures in safeguarding Dr. Cruz from any
possible complications; and that the colonoscopy was done properly.
Hence, this petition.
ISSUE
WHETHER OR NOT THE CA WAS CORRECT IN AFFIRMING THE DECISION OF
THE DOJ THAT NO PROBABLE CAUSE EXISTS FOR FILING AN INFORMATION
AGAINST THE RESPONDENT, THAT THE RESPONDENT WAS NOT NEGLIGENT
AND THAT THERE WAS NO DENIAL OF DUE PROCESS.
Non-interference with Executive Determination of Probable Cause in Preliminary
Investigations
Under the doctrine of separation of powers, courts have no right to directly decide on matters
over which full discretionary authority has been delegated to the Executive Branch of the
Government, or to substitute their own judgment for that of the Executive Branch, represented
in this case by the Department of Justice. The settled policy is that the courts will not interfere
with the executive determination of probable cause for the purpose of filing an Information, in
the absence of grave abuse of discretion. That abuse of discretion must be so patent and gross as
to amount to an evasion of a positive duty or a virtual refusal to perform a duty enjoined by law
or to act at all in contemplation of law, such as where the power is exercised in an arbitrary and
despotic manner by reason of passion or hostility.
Medical Negligence and Malpractice Not Established
In the case at bench, Dr. Cruz failed to show that the DOJ gravely abused its discretion in finding
that there was lack of probable cause and dismissing the complaint against Dr. Agas for Serious
Physical Injuries through Reckless Imprudence and Medical Malpractice.
A medical negligence case can prosper if the patient can present solid proof that the doctor, like
in this case, either failed to do something which a reasonably prudent doctor would have done,
or that he did something that a reasonably prudent doctor would not have done, and such failure
or action caused injury to the patient.
To successfully pursue this kind of case, 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. Simply put, the elements are duty, breach, injury
and proximate causation.[10]
In this case, Dr. Cruz has the burden of showing the negligence or recklessness of Dr. Agas.
Although there is no dispute that Dr. Cruz sustained internal hemorrhage due to a tear in the
serosa of his sigmoid colon, he failed to show that it was caused by Dr. Agas's negligent and
reckless conduct of the colonoscopy procedure. In other words, Dr. Cruz failed to show and
explain that particular negligent or reckless act or omission committed by Dr. Agas. Stated
differently, Dr. Cruz did not demonstrate that there was "inexcusable lack of precaution" on the
part of Dr. Agas.
Res Ipsa Loquitur Doctrine
Not Applicable Against Respondent
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 plaintiff's prima facie case, and present a
question of fact for defendant to meet with an explanation.[11]
The requisites for the applicability of the doctrine of res ipsa loquitur are: (1) the occurrence of
an injury; (2) the thing which caused the injury was under the control and management of the
defendant; (3) the occurrence was such that in the ordinary course of things, would not have
happened if those who had control or management used proper care; and (4) the absence of
explanation by the defendant. Of the foregoing requisites, the most instrumental is the control
and management of the thing which caused the injury.[12]
In this case, the Court agrees with Dr. Agas that his purported negligence in performing the
colonoscopy on Dr. Cruz was not immediately apparent to a layman to justify the application
of res ipsa loquitur doctrine.
Dr. Agas was able to establish that the internal bleeding sustained by Dr. Cruz was due to the
abnormal condition and configuration of his sigmoid colon which was beyond his control
considering that the said condition could not be detected before a colonoscopic procedure. Dr.
Agas adequately explained that no clinical findings, laboratory tests, or diagnostic imaging, such
as x-rays, ultrasound or computed tomography (CT) scan of the abdomen, could have detected
this condition prior to an endoscopic procedure. Specifically, Dr. Agas wrote:
On the other hand, in the present case, the correlation between petitioner's injury, i.e., tear in the
serosa of sigmoid colon, and the colonoscopy conducted by respondent to the petitioner clearly
requires the presentation of an expert opinion considering that no perforation of the sigmoid
colon was ever noted during the laparotomy. It cannot be overemphasized that the colonoscope
inserted by the respondent only passed through the inside of petitioner's sigmoid colon while the
damaged tissue, i.e., serosa, which caused the bleeding, is located in the outermost layer of the
colon. It is therefore impossible for the colonoscope to touch, scratch, or even tear the serosa
since the said membrane is beyond reach of the colonoscope in the absence of perforation on the
colon.[13]
Dr. Cruz failed to rebut this.
WHEREFORE, the petition is DENIED.
DELA TORRE VS IMBUIDO (GR NO. 192973 SEPTEMBER 29, 2014)
Dela Torre vs Imbuido
GR No. 192973 September 29, 2014
Facts: At around 3:00pm of February 3, 1992, Carmen was brought to Divine Spirit General Hospitals
operating room for her caesarian section operation, which was to be performed by Dr. Nestor. By 5:30pm,
of the same day, Pedrito was informed by his wifes delivery of a baby boy. In the early morning of
February 4, 1992, Carmen experienced abdominal pains and difficulty in urinating. She was diagnosed to
be suffering from urinary tract infection (UTI), and was prescribed medication by Dr. Norma. On
February 10, 1992, Pedrito noticed that Carmens stomach was getting bigger, but Dr. Norma dismissed
the patients condition as mere fratulence. When Carmens stomach still grow bigger despite medications,
Dr. Norma advised Pedrito of the possibility of a second operation on Carmen. Dr. Norma, however,
provided no details on its purpose and the doctor who would perform it. At around 3:00pm on February
12, 1992 Carmen had her second operation. Later in the evening, Dr. Norma informed Pedrito that
everything was going on fine with his wife. The condition of Carmen, however, did not improve. It
instead worsened that on February 13, 1992, she vomited dark red blood. At 9:30pm of the same day,
Carmen died. Per her death certificate upon information provided by the hospital, the immediate cause of
Carmens death was cardio-respiratory arrest secondary to cerebro vascular accident, hypertension and
chronic nephritis induced by pregnancy. An autopsy report prepared by Dr. Partilano, medico-legal officer
designate of Olongapo City, however, provided that the cause of Carmens death was shock due to
peritonitis severe with multiple intestinal adhesions; status post caesarian section and exploratory
laparotomy. Pedrito claimed in his complaint that the respondents failed to exercise the degree of
diligence required of them as members of the medical profession, and were negligent for practicing
surgery on Carmen in the most unskilled, ignorant, and cruel manner.
Issue: Whether or not respondents were liable for medical malpractice that resulted to Carmens death.
Held: No. Medical malpractice or, more appropriately, medical negligence, is that type of claim which a
victim has available to him or her to redress a wrong committed by a medical professional which has
caused bodily harm. In order to successfully pursue such a claim, a patient, or his or her family as in this
case, must prove that healthcare provider, in most cases, a physician, either failed to do something which a
reasonably prudent health care provider would have done, or that he or she did something that a
reasonably prudent provider would not have done; and that failure or action caused injury to the patient.
Four essential elements must be established namely: 1.) duty; 2.) breach; 3.) injury and 4.) proximate
causation. All four elements must be present in order to find the physician negligent and thus, liable for
damages.
For the trial court to give weight to Dr. Partilanos report, it was necessary to show first Dr. Partilanos
specialization and competence to testify on the degree of care, skill and diligence needed for the treatment
of Carmens case. Considering that it was not duly established that Dr. Partilano practiced and was an
expert on the fields that involved Carmens condition, he could not have accurately identified the said
degree of care, skill and diligence and the medical procedure, that should have been applied.
ROSIT VS. DDH
The Case
This is a petition filed under Rule 45 of the Rules of Court assailing the Decision and Resolution
dated January 22, 2013[1] and November 7, 2013,[2] respectively, of the Court of Appeals, Cagayan
De Oro City (CA), in CA-G.R. CV No. 00911-MIN. The CA Decision reversed the Decision dated
September 14, 2004[3] of the Regional Trial Court, Branch 33 in Davao City-(RTC) in Civil Case
No. 27,354-99, a suit for damages thereat which Nilo B. Rosit (Rosit) commenced against Dr.
Rolando Gestuvo (Dr. Gestuvo).
Factual Antecedents
On January 15, 1999, Rosit figured in a motorcycle accident. The X-ray soon taken the next day
at the Davao Doctors Hospital (DDH) showed that he fractured his jaw. Rosit was then referred
to Dr. Gestuvo, a specialist in mandibular injuries,[4] who, on January 19, 1999, operated on
Rosit.
During the operation, Dr. Gestuvo used a metal plate fastened to the jaw with metal screws to
immobilize the mandible. As the operation required the smallest screws available, Dr. Gestuvo
cut the screws on hand to make them smaller. Dr. Gestuvo knew that there were smaller
titanium screws available in Manila, but did not so inform Rosit supposing that the latter would
not be able to afford the same.[5]
Following the procedure, Rosit could not properly open and close his mouth and was in pain. X-
rays done on Rosit two (2) days after the operation showed that the fracture in his jaw was
aligned but the screws used on him touched his molar. Given the X-ray results, Dr. Gestuvo
referred Rosit to a dentist. The dentist who checked Rosit, Dr. Pangan, opined that another
operation is necessary and that it is to be performed in Cebu.[6]
Alleging that the dentist told him that the operation conducted on his mandible was improperly
done, Rosit went back to Dr. Gestuvo to demand a loan to defray the cost of the additional
operation as well as the expenses of the trip to Cebu. Dr. Gestuvo gave Rosit P4,500.
Rosit went to Cebu on February 19, 1999, still suffering from pain and could hardly open his
mouth.
In Cebu, Dr. Pangan removed the plate and screws thus installed by Dr. Gestuvo and replaced
them with smaller titanium plate and screws. Dr. Pangan also extracted Rosit's molar that was
hit with a screw and some bone fragments. Three days after the operation, Rosit was able to eat
and speak well and could open and close his mouth normally.[7]
On his return to Davao, Rosit demanded that Dr. Gestuvo reimburse him for the cost of the
operation and the expenses he incurred in Cebu amounting to P140,000, as well as for the
P50,000 that Rosit would have to spend for the removal of the plate and screws that Dr. Pangan
installed. Dr. Gestuvo refused to pay.[8]
Thus, Rosit filed a civil case for damages and attorney's fees with the RTC against Dr. Gestuvo
and DDH, the suit docketed as Civil Case No. 27,354-99.
The Ruling of the Regional Trial Court
The RTC freed DDH from liability on the ground that it exercised the proper diligence in the
selection and supervision of Dr. Gestuvo, but adjudged Dr. Gestuvo negligent and ruled, thus:
FOR ALL THE FOREGOING, finding the plaintiff Nilo B. Rosit to have preponderantly
established his cause of action in the complaint against defendant Dr. Rolando G. Gestuvo only,
judgment is hereby rendered for the plaintiff and against said defendant, ordering the defendant
DR. ROLANDO G. GESTUVO to pay unto plaintiff NILO B. ROSIT the following:
the sum of ONE HUNDRED FORTY THOUSAND ONE HUNDRED NINETY NINE PESOS
a) and 13/100 (P140,199.13) representing reimbursement of actual expenses incurred by
plaintiff in the operation and re-operation of his mandible;
the sum of TWENTY NINE THOUSAND AND SIXTY EIGHT PESOS (P29,068.00)
b)
representing reimbursement of the filing fees and appearance fees;
the sum of ONE HUNDRED FIFTY THOUSAND PESOS (P150,000.00) as and for
c)
attorney's fees;
d) the amount of FIFTY THOUSAND PESOS (P50,000.00) as moral damages;
e) the amount of TEN THOUSAND PESOS (P10,000.00) as exemplary damages; and
f) the costs of the suit.
For lack of merit, the complaint against defendant DAVAO DOCTORS HOSPITAL and the
defendants' counterclaims are hereby ordered DISMISSED.
Cost against Dr. Rolando G. Gestuvo.
SO ORDERED.
In so ruling, the trial court applied the res ipsa loquitur principle holding that "the need for
expert, medical testimony may be dispensed with because the injury itself provides the proof of
negligence."
Therefrom, both parties appealed to the CA.
The Ruling of the Court of Appeals
In its January 22, 2013 Decision, the CA modified the appealed judgment by deleting the awards
made by the trial court, disposing as follows:
WHEREFORE, the appeal filed by Gestuvo is GRANTED. The Decision dated September 14,
2004 of the Regional Trial Court, Branch 33, Davao City, rendered in Civil Case No. 27,354-99 is
hereby MODIFIED. The monetary awards adjudged in favor of Nilo B. Rosit are hereby
DELETED for lack of basis.
SO ORDERED.
Unlike the RTC, the CA ruled that the res ipsa loquitur principle is not applicable and that the
testimony of an expert witness is necessary for a finding of negligence. The appellate court also
gave credence to Dr. Pangan's letter stating the opinion that Dr. Gestuvo did not commit gross
negligence in his emergency management of Rosit's fractured mandible.
Rosit's motion for reconsideration was denied in the CA's November 7, 2013 Resolution.
Hence, the instant appeal.
The Issue
The ultimate issue for our resolution is whether the appellate court correctly absolved Dr.
Gestuvo from liability.
The Court's Ruling
The petition is impressed with merit.
In Flores v. Pineda,[9] the Court explained the concept of a medical negligence case and the
elements required for its prosecution, viz:
A medical negligence case is a type of claim to redress a wrong committed by a medical
professional, that has caused bodily harm to or the death of a patient. There are four
elements involved in a medical negligence case, namely: duty, breach, injury, and
proximate causation.
Duty refers to the standard of behavior which imposes restrictions on one's conduct. The
standard in turn refers to the amount of competence associated with the proper discharge of the
profession. A physician is expected to use at least the same level of care that any other
reasonably competent doctor would use under the same circumstances. Breach of duty occurs
when the physician fails to comply with these professional standards. If injury results to the
patient as a result of this breach, the physician is answerable for negligence. (emphasis supplied)
An expert witness is not necessary as the res ipsa loquitur doctrine is applicable
To establish medical negligence, this Court has held that an expert testimony is generally
required to define the standard of behavior by which the court may determine whether the
physician has properly performed the requisite duty toward the patient. This is so considering
that the requisite degree of skill and care in the treatment of a patient is usually a matter of
expert opinion.[10]
Solidum v. People of the Philippines[11] provides an exception. There, the Court explained that
where the application of the principle of res ipsa loquitur is warranted, an expert testimony may
be dispensed with in medical negligence cases:
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. The reason is that the general rule on the
necessity of expert testimony applies only to such matters clearly within the domain of medical
science, and not to matters that are within the common knowledge of mankind which may be
testified to by anyone familiar with the facts. x x x
Thus, courts of other jurisdictions have applied the doctrine in the following situations: leaving
of a foreign object in the body of the patient after an operation, injuries sustained on a healthy
part of the body which was not under, or in the area, of treatment, removal of the wrong part of
the body when another part was intended, knocking out a tooth while a patient's jaw was under
anesthetic for the removal of his tonsils, and loss of an eye while the patient plaintiff was under
the influence of anesthetic, during or following an operation for appendicitis, among others.
We have further held that resort to the doctrine of res ipsa loquitur as an exception to the
requirement of an expert testimony in medical negligence cases may be availed of if the following
essential requisites are satisfied: (1) the accident was of a kind that does not ordinarily occur
unless someone is negligent; (2) the instrumentality or agency that caused the injury was under
the exclusive control of the person charged; and (3) the injury suffered must not have been due
to any voluntary action or contribution of the person injured.[12]
In its assailed Decision, the CA refused to acknowledge the application of the res ipsa
loquitur doctrine on the ground that the foregoing elements are absent. In particular, the
appellate court is of the position that post-operative pain is not unusual after surgery and that
there is no proof that the molar Dr. Pangan removed is the same molar that was hit by the screw
installed by Dr. Gestuvo in Rosit's mandible. Further, a second operation was conducted within
the 5-week usual healing period of the mandibular fracture so that the second element cannot be
considered present. Lastly, the CA pointed out that the X-ray examination conducted on Rosit
prior to his first surgery suggests that he had "chronic inflammatory lung disease compatible,"
implying that the injury may have been due to Rosit's peculiar condition, thus effectively
negating the presence of the third element.[13]
After careful consideration, this Court cannot accede to the CA's findings as it is at once apparent
from the records that the essential requisites for the application of the doctrine of res ipsa
loquitur are present.
The first element was sufficiently established when Rosit proved that one of the screws installed
by Dr. Gestuvo struck his molar. It was for this issue that Dr. Gestuvo himself referred Rosit to
Dr. Pangan. In fact, the affidavit of Dr. Pangan presented by Dr. Gestuvo himself before the trial
court narrated that the same molar struck with the screw installed by Dr. Gestuvo was examined
and eventually operated on by Dr. Pangan. Dr. Gestuvo cannot now go back and say that Dr.
Pangan treated a molar different from that which was affected by the first operation.
Clearly, had Dr. Gestuvo used the proper size and length of screws and placed the same in the
proper locations, these would not have struck Rosit's teeth causing him pain and requiring him
to undergo a corrective surgery.
Dr. Gestuvo knew that the screws he used on Rosit were too large as, in fact, he cut the same with
a saw.[14] He also stated during trial that common sense dictated that the smallest screws
available should be used. More importantly, he also knew that these screws were available locally
at the time of the operation.[15] Yet, he did not avail of such items and went ahead with the larger
screws and merely sawed them off. Even assuming that the screws were already at the proper
length after Dr. Gestuvo cut the same, it is apparent that he negligently placed one of the screws
in the wrong area thereby striking one of Rosit's teeth.
In any event, whether the screw hit Rosit's molar because it was too long or improperly placed,
both facts are the product of Dr. Gestuvo's negligence. An average man of common intelligence
would know that striking a tooth with any foreign object much less a screw would cause severe
pain. Thus, the first essential requisite is present in this case.
Anent the second element for the res ipsa loquitur doctrine application, it is sufficient that the
operation which resulted in the screw hitting Rosit's molar was, indeed, performed by Dr.
Gestuvo. No other doctor caused such fact.
The CA finds that Rosit is guilty of contributory negligence in having Dr. Pangan operate on him
during the healing period of his fractured mandible. What the CA overlooked is that it was Dr.
Gestuvo himself who referred Rosit to Dr. Pangan. Nevertheless, Dr. Pangan's participation
could not have contributed to the reality that the screw that Dr. Gestuvo installed hit Rosit's
molar.
Lastly, the third element that the injury suffered must not have been due to any voluntary action
or contribution of the person injured was satisfied in this case. It was not shown that Rosit's lung
disease could have contributed to the pain. What is clear is that he suffered because one of the
screws that Dr. Gestuvo installed hit Rosit's molar.
Clearly then, the res ipsa loquitur doctrine finds application in the instant case and
no expert testimony is required to establish the negligence of defendant Dr.
Gestuvo.
Petitioner was deprived of the opportunity to make an "informed consent"
What is more damning for Dr. Gestuvo is his failure to inform Rosit that such smaller screws
were available in Manila, albeit at a higher price.[16] As testified to by Dr. Gestuvo himself:
Court This titanium materials according to you were already available in the Philippines since
Alright. the time of Rosit's accident?
Witness Yes, your Honor.
xxxx
Did you inform Rosit about the existence of titanium screws and plates which
Court
according to you is the screws and plates of choice?
Witness No, your Honor.
xxxx
The reason I did not inform him anymore Judge because what I thought he was already
Witness hard up with the down payment. And if I will further introduce him this screws, the
more he will not be able to afford the operation.
xxxx
This titanium screws and plates were available then it is up to Rosit to decide whether
Court to use it or not because after all the material you are using is paid by the patient
himscll, is it not?
Witness Yes, that is true.
Li v. Soliman[17] made the following disquisition on the relevant Doctrine of Informed Consent in
relation to medical negligence cases, to wit:
The doctrine of informed consent within the context of physician-patient relationships goes
far back into English common law. x x x From a purely ethical norm, informed consent
evolved into a general principle of law that a physician has a duty to disclose what a
reasonably prudent physician in the medical community in the exercise of
reasonable care would disclose to his patient as to whatever grave risks of injury
might be incurred from a proposed course of treatment, so that a patient,
exercising ordinary care for his own welfare, and faced with a choice of undergoing
the proposed treatment, or alternative treatment, or none at all, may intelligently
exercise his judgment by reasonably balancing the probable risks against the
probable benefits.
xxxx
There are four essential elements a plaintiff must prove in a malpractice action
based upon the doctrine of informed consent: "(1) the physician had a duty to
disclose material risks; (2) he failed to disclose or inadequately disclosed those
risks; (3) as a direct and proximate result of the failure to disclose, the patient
consented to treatment she otherwise would not have consented to; and (4)
plaintiff was injured by the proposed treatment."The gravamen in an informed consent
case requires the plaintiff to "point to significant undisclosed information relating to the
treatment which would have altered her decision to undergo it." (emphasis supplied)
The four adverted essential elements above are present here.
First, Dr. Gestuvo clearly had the duty of disclosing to Rosit the risks of using the larger screws
for the operation. This was his obligation as the physician undertaking the operation.
Second, Dr. Gestuvo failed to disclose these risks to Rosit, deciding by himself that Rosit could
not afford to get the more expensive titanium screws.
Third, had Rosit been informed that there was a risk that the larger screws are not appropriate
for the operation and that an additional operation replacing the screws might be required to
replace the same, as what happened in this case, Rosit would not have agreed to the operation. It
bears pointing out that Rosit was, in fact, able to afford the use of the smaller titanium screws
that were later used by Dr. Pangan to replace the screws that were used by Dr. Gestuvo.
Fourth, as a result of using the larger screws, Rosit experienced pain and could not heal properly
because one of the screws hit his molar. This was evident from the fact that just three (3) days
after Dr. Pangan repeated the operation conducted by Dr. Gestuvo, Rosit was pain-free and
could already speak. This is compared to the one (1) month that Rosit suffered pain and could
not use his mouth after the operation conducted by Dr. Gestuvo until the operation of Dr.
Pangan.
Without a doubt, Dr. Gestuvo is guilty of withholding material information which would have
been vital in the decision of Rosit in going through with the operation with the materials at hand.
Thus, Dr. Gestuvo is also guilty of negligence on this ground.
Dr. Pangan's Affidavit is not admissible
The appellate court's Decision absolving Dr. Gestuvo of negligence was also anchored on a letter
signed by Dr. Pangan who stated the opinion that Dr. Gestuvo did not commit gross negligence
in his emergency management of Mr. Rosit's fractured mandible.[18] Clearly, the appellate court
overlooked the elementary principle against hearsay evidence.
In Dantis v. Maghinang, Jr.,[19] the Court reiterated the oft-repeated rule that "an affidavit is
merely hearsay evidence where its affiant/maker did not take the witness stand." Here, Dr.
Pangan never took the witness stand to affirm the contents of his affidavit. Thus, the affidavit is
inadmissible and cannot be given any weight. The CA, therefore, erred when it considered the
affidavit of Dr. Pangan, mpreso for considering the same as expert testimony.
Moreover, even if such affidavit is considered as admissible and the testimony of an expert
witness, the Court is not bound by such testimony. As ruled in Ilao-Quianay v. Mapile:[20]
Indeed, courts are not bound by expert testimonies. They may place whatever weight they choose
upon such testimonies in accordance with the facts of the case. The relative weight and
sufficiency of expert testimony is peculiarly within the province of the trial court to decide,
considering the ability and character of the witness, his actions upon the witness stand, the
weight and process of the reasoning by which he has supported his opinion, his possible bias in
favor of the side for whom he testifies, and any other matters which serve to illuminate his
statements. The opinion of an expert should be considered by the court in view of all the facts
and circumstances of the case. The problem of the evaluation of expert testimony is left to the
discretion of the trial court whose ruling thereupon is not revicwable in the absence of an abuse
of that discretion.
Thus, the belief of Dr. Pangan whether Dr. Gestuvo is guilty of negligence or not will not bind the
Court. The Court must weigh and examine such testimony and decide for itself the merits
thereof.
As discussed above, Dr. Gestuvo's negligence is clearly demonstrable by the doctrines of res ipsa
loquitur and informed consent.
SOLIDUM VS PEOPLE (GR NO. 192123 MARCH 10, 2014)
Solidum vs People of the Philippines
GR No. 192123 March 10, 2014
Facts: Gerald Albert Gercayo was born on June 2, 1992 with an imperforate anus. Two days after his
birth, Gerald under went colostomy, a surgical procedure to bring one end of the large intestine out
through the abdominal walls, enabling him to excrete through a colostomy bag attached to the side of his
body. On May 17, 1995, Gerald was admitted at the Ospital ng Maynila for a pull-through operation. Dr.
Leandro Resurreccionheaded the surgical team, and was assisted by Dr. Joselito Lucerio, Dr.Donatella
Valeria and Dr. Joseph Tibio. The anesthesiologist included Drs. Abella, Razon and Solidum. During the
operation, Gerald experienced bradycardia and went into a coma. His coma lasted for two weeks , but he
regained consciousness only after a month. He could no longer see, hear, or move. A complaint for
reckless imprudence resulting in serious physical injuries were filed by Geralds parents against the team
of doctors alleging that there was failure in monitoring the anesthesia administered to Gerald.
Issues: Whether or not petitioner is liable for medical negligence.
Whether or not res ipsa liquitor can be resorted to in medical negligence cases.
Held: No. Negligence is defined as the failure to observe for the protection of the interests of another
person that degree of care, precaution, and vigilance that the circumstances justly demand, whereby such
other person suffers injury. Reckless imprudence, on the other hand, consists of voluntarily doing or
failing to do, without malice, an act from which material damage results by reason of an inexcusable lack
of precaution on the part of the person to perform or failing to perform such act.
The negligence must be the proximate cause of the injury. For, negligence no matter in what it consists,
cannot create a right of action unless it is the proximate cause of the injury complained of. And the
proximate cause of an injury is that cause, which, in natural and continuous sequence and unbroken by any
efficient intervening cause, produces the injury, and without which the result would not have occurred.
An action upon medical negligence whether criminal, civil or administrative calls for the plaintiff to
prove by competent evidence each of the following four elements namely: 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.
In the medical profession, specific norms on standard of care to protect the patient against unreasonable
risk, commonly referred to as standards of care, set the duty of the physician in respect of the patient. The
standard of care is an objective standard which conduct of a physician sued for negligence or malpractice
may be measured, and it does not depend therefore, on any individuals physicians own knowledge
either. In attempting to fix a standard by which a court may determine whether the physician has properly
performed the requisite duty toward the patient, expert medical testimony from both plaintiff and defense
experts is required.
The doctrine of res ipsa liquitor means that where the thing which causes injury is shown to be under the
management of the defendant, and the accident is such as in ordinary course of things does not happen if
those who have management use proper care, it affords reasonable evidence, in the absence of an
explanation by defendant that the accident arose from want of care.
Nevertheless, despite the fact that the scope of res ipsa liquitor has been measurably enlarged, it does not
automatically apply to all cases of medical negligence as to mechanically shift the burden of proof to the
defendant to show that he is not guilty of the ascribed negligence. Res ipsa liquitor 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. It is generally restricted to situations in malpractice cases where a layman is
able to say, as a matter of common knowledge and observation, that the consequences of professional care
were not as such as would ordinarily have followed if due care had been exercised. 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. It must be conceded that the doctrine of res ipsa liquitor can have no application in a
suit against a physician or surgeon which involves the merits of a diagnosis or of a scientific treatment.
The physician or surgeon is not required at his peril to explain why any particular diagnosis was not
correct, or why any particular scientific treatment did not produce the desired results. Thus, res ipsa
liquitor is not available in a malpractice suit if the only showing is that the desired result of an operation
or treatment was not accomplished. The real question, therefore, is whether or not in the process of the
operation any extraordinary incident or unusual event outside 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 case or causes of the untoward
consequence. If there was such extraneous intervention, the doctrine of res ipsa liquitor may be utilized
and the dependent is called upon to explain the matter, by evidence of exculpation, if he could.
thoracic cavity, they found that 3,200 cc of blood was stocked therein. Dr. Cereno did not immediately
transfuse the blood since the bleeders had to be controlled rst. Blood was nally transfused on
Raymond at 1:40 A.M. However, during the operation, Raymond died due to massive loss of
blood.Claiming that there was negligence on the part of those who attended to their son, the parents of
Raymond (herein respondents) led a complaint for damages against Drs. Zafe and Cereno. The RTC
found Drs. Zafe and Cereno negligent for not
immediately conducting surgery on Raymond. On appeal, the CA armed RTCs ndings.
ISSUE: Whether or not Drs. Zafe and Cereno are guilty of gross negligence in the performance of their
duties?
HELD: The petition is granted.CIVIL LAW: medical negligenceThe type of lawsuit which has been called
medical malpractice or, more appropriately, medical negligence, is that type of claim which a victim has
available tohim or her to redress a wrong committed by a medical professional which has caused bodily
harm. In order to successfully pursue such a claim, a patient must prove that a health care provider, in
most cases a physician, either failed to do something which a reasonably prudent health care provider
would have done, or thathe or she did something that a reasonably prudent provider would not have
done; and that the failure or action caused injury to the patient.Given that Dr. Tatad was already
engaged in another urgent operation and that Raymond was not showing any symptom of suering from
major blood loss requiring an immediate operation, We nd it reasonable that petitioners decided to
wait for Dr. Tatad to nish her surgery and not to call the standby anesthesiologist anymore. There is,
after all, no evidence that shows that a prudent surgeon faced with similar circumstances would decide
otherwise.In medical negligence cases, it is settled that the complainant has the burden of establishing
breach of duty on the part of the doctors or surgeons. It must be proven that such breach of duty has a
causal connection to the resulting death of the patient.Upon opening of his thoracic cavity, it was
discovered that there was gross bleeding inside the body. Thus, the need for petitioners to control rst
what was causing the bleeding.Petition is GRANTED. The CA is REVERSED and SET ASIDE.

G.R. No. 167366 : September 26, 2012DR. PEDRO DENNIS CERENO, and DR. SANTOS ZAFE, Petitioners,
v. COURT OFAPPEALS, SPOUSES DIOGENES S. OLAVERE and FE R. SERRANO, Respondents.PEREZ, J.:

FACTS:At about 9:15 in the evening of 16 September 1995, Raymond S. Olavere (Raymond), a victim of a
stabbing incident, was rushed to the Bicol Regional MedicalCenter (BRMC). Dr. Realuyo, the emergency
room resident physician, recommendedthat Raymond should undergo blood transfusion.At 10:30 P.M.,
Raymond was brought inside the operating room. During that time, thehospital surgeons, Drs. Zafe and
Cereno, were busy operating on gunshot victim Charles Maluluy-on. Assisting them in the said operation
was Dr. Rosalina Tatad (Dr. Tatad), who was the only senior anesthesiologist on duty at BRMC that night.
Just before the operation on Maluluy-on was nished, another emergency case involving Lilia Aguila, a
woman who was giving birth to triplets, was brought to the operating room.Drs. Zafe and Cereno, in the
meantime, proceeded to examine Raymond and they found that the latters blood pressure was normal
and "nothing in him was signicant."There being no other available anesthesiologist to assist them, Drs.
Zafe and Cerenodecided to defer the operation on Raymond.At 11:15 P.M., the relatives of Raymond
brought the bag of blood to be used for blood transfusion. Drs. Cereno and Zafe immediately started
their operation on Raymond at around 12:15 A.M. of 17 September 1995. Upon opening of Raymonds