1. DR. EMMANUEL JARCIA, Jr. and Dr. MARILOU BASTAN omission alone constitutes simple imprudence on their part.
imprudence on their part. xxx Where
vs. PEOPLE OF THE PHILIPPINES
FACTS:
Belinda Santiago (Mrs. Santiago) lodged a complaint with the NBI against
the petitioners, Dr. Emmanuel Jarcia, Jr. (Dr. Jarcia) and Dr. Marilou Bastan
(Dr. Bastan), for their alleged neglect of professional duty which caused her
son, Roy Alfonso Santiago (Roy Jr.), to suffer serious physical injuries.
In an NBI report:
1. Roy Jr. was hit by a taxicab and was rushed to the Manila Doctors
Hospital for an emergency medical treatment. An X-ray of the
victim’s ankle showed no fracture as read by Dr. Jarcia. Dr. Bastan
entered the emergency room (ER) and, after conducting her own
examination of the victim, informed Mrs. Santiago that since it was
only the ankle that was hit, there was no need to examine the upper
leg.
2. Eleven (11) days later, Roy Jr. developed fever, swelling of the right
leg and misalignment of the right foot; that Mrs. Santiago brought
him back to the hospital; and that the X-ray revealed a right mid-
tibial fracture and a linear hairline fracture in the shaft of the bone.
The NBI indorsed the matter to the Office of the City Prosecutor of Manila
for preliminary investigation. Probable cause was found and a criminal case
for reckless imprudence resulting to serious physical injuries, was filed
against Dr. Jarcia, Dr. Bastan and Dr. Pamittan before the RTC
RTC: Petitioners guilty of Simple Imprudence Resulting to Serious Physical
Injuries. Not having voluntarily surrendered, an warrant of arrest was issued
against Dr. Pamitan. Accused are negligent when both failed to exercise the
necessary and reasonable prudence in ascertaining the extent of injury of
Alfonso Santiago, Jr. However, the negligence exhibited by the two doctors
does not approximate negligence of a reckless nature but merely amounts to
simple imprudence. Simple imprudence consists in the lack of precaution
displayed in those cases in which the damage impending to be caused is not
the immediate nor the danger clearly manifest.
CA: Affirmed the RTC decision in toto. As junior residents who only
practice general surgery and without specialization with the case consulted
before them, they should have referred the matter to a specialist. This
LEGAL MEDICINE 3C 2016-2017
common knowledge and experience teach that a resulting injury would not
have occurred to the patient if due care had been exercised, an inference of
negligence may be drawn giving rise to an application of the doctrine of res
ipsa loquitur without medical evidence, which is ordinarily required to show
not only what occurred but how and why it occurred. In the case at bench, we
give credence to the testimony of Mrs. Santiago by applying the doctrine of
res ipsa loquitur.
ISSUES:
1. Whether or not the doctrine of res ipsa loquitur is applicable in this
case
2. Whether or not the petitioners are liable for criminal negligence.
HELD:
1. Doctrine not applicable.
This doctrine of res ipsa loquitur means "Where the thing which causes
injury is shown to be under the management of the defendant, and the
accident is such as in the ordinary course of things does not happen if those
who have the management use proper care, it affords reasonable evidence, in
the absence of an explanation by the defendant, that the accident arose from
want of care." xxx The doctrine can be invoked when and only when, under
the circumstances involved, direct evidence is absent and not readily
available.
The requisites for the application of the doctrine of res ipsa loquitur are: (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.
In this case, the circumstances that caused patient Roy Jr.’s injury and the
series of tests that were supposed to be undergone by him to determine the
extent of the injury suffered were not under the exclusive control of Drs.
Jarcia and Bastan. It was established that they are mere residents of the
Manila Doctors Hospital at that time who attended to the victim at the
emergency room. While it may be true that the circumstances pointed out by
the courts below seem doubtless to constitute reckless imprudence on the part
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of the petitioners, this conclusion is still best achieved, not through the
scholarly assumptions of a layman like the patient’s mother, but by the
unquestionable knowledge of expert witness/es. As to whether the petitioners
have exercised the requisite degree of skill and care in treating patient Roy,
Jr. is generally a matter of expert opinion.
1. Negligent but liable only civilly; not criminal. Elements of simple
negligence not proven.
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. The elements of simple negligence are: (1) that there is
lack of precaution on the part of the offender, and (2) that the damage
impending to be caused is not immediate or the danger is not clearly
manifest.
As residents on duty at the emergency room, Dr. Jarcia and Dr. Bastan were
expected to know the medical protocol in treating leg fractures and in
attending to victims of car accidents. There was, however, no precise
evidence and scientific explanation pointing to the fact that the delay in the
application of the cast to the patient’s fractured leg because of failure to
immediately diagnose the specific injury of the patient, prolonged the pain of
the child or aggravated his condition or even caused further complications.
If these doctors knew from the start that they were not in the position to
attend to Roy Jr., a vehicular accident victim, with the degree of diligence
and commitment expected of every doctor in a case like this, they should
have not made a baseless assurance that everything was all right. By doing
so, they deprived Roy Jr. of adequate medical attention that placed him in a
more dangerous situation than he was already in. What petitioners should
have done, and could have done, was to refer Roy Jr. to another doctor
who could competently and thoroughly examine his injuries.
However, Dr. Jarcia and Dr. Bastan cannot pass on the liability to the taxi
driver who hit the victim. If this would be so, doctors would have a ready
defense should they fail to do their job in attending to victims of hit-and-run,
LEGAL MEDICINE 3C 2016-2017
maltreatment, and other crimes of violence in which the actual, direct,
immediate, and proximate cause of the injury is indubitably the act of the
perpetrator/s.
Indubitably, a physician-patient relationship exists between the petitioners
and patient Roy Jr. Notably, the latter and his mother went to the ER for an
immediate medical attention. The petitioners allegedly passed by and were
requested to attend to the victim (contrary to the testimony of Dr. Tacata that
they were, at that time, residents on duty at the ER). They obliged and
examined the victim, and later assured the mother that everything was fine
and that they could go home. Clearly, a physician-patient relationship was
established between the petitioners and the patient Roy Jr.
All told, the petitioners were, indeed, negligent but only civilly, and not
criminally, liable as the facts show.
WHEREFORE, the petition is PARTLY GRANTED. The Decision of the
Court of Appeals dated August 29, 2008 is REVERSED and SET ASIDE.
A new judgment is entered ACQUITTING Dr. Emmanuel Jarcia, Jr. and Dr.
Marilou Bastan of the crime of reckless imprudence resulting to serious
physical injuries but declaring them civilly liable.
2. DR. RUBI LI v. SPOUSES REYNALDO and LINA SOLIMAN, as
parents/heirs of deceased ANGELICA SOLIMAN
Facts:
Respondents’ 11-year old daughter, Angelica Soliman, underwent a
biopsy of the mass located in her lower extremity at the St. Luke’s Medical
Center (SLMC) on July 7, 1993 and results showed that Angelica was
suffering from osteosarcoma, osteoblastic type, (highly malignant) cancer of
the bone because of that a necessity of amputation was conducted by Dr,
Tamayo on Angelica’s right leg in order to remove the tumor and to prevent
the metastasis that chemotherapy was suggested by Dr. Tamayo, which he
referred to petitioner Dr. Rubi Li, a medical oncologist. The respondent was
admitted to SLMC on August 18, 1993; however, she died eleven (11) days
after the (intravenous) administration of chemotherapy first cycle.
Respondents brought their daughter’s body to the Philippine National Police
Page 2
(PNP) Crime Laboratory at Camp Crame for post-mortem examination after
the refusal of the hospital to release the death certificate without full payment
of bills. The Medico-Legal Report showed that the cause of death as
"Hypovolemic shock secondary to multiple organ hemorrhages and
Disseminated Intravascular Coagulation. The respondents filed charges
against the SLMC and physicians involve for negligence and failure to
observe the essential precautions in to prevent Angelica’s untimely death.
Petitioner denied the allegation for damages as she observed best known
procedures, highest skill and knowledge in the administration of
chemotherapy drugs despite all efforts the patient died. The trial court was in
favor of the petitioner and ordered to pay their unpaid hospital bill in the
amount of P139, 064.43, but the Court of Appeals reversed the decision
supporting the respondents pray.
procedure and presenting a consent or waiver to their patients so that possible
future medico-legal suits will be prevented.
Synthesis:
In Dr. Rubi Li, vs. Spouses Reynaldo and Lina Soliman, as
parents/heirs of deceased Angelica Soliman, Respondents, G.R. No. 165279,
promulgated on June 7, 2011, the Court ruled that medical malpractice is
proved base on lack/impaired informed consent, and reasonable expert
testimony subject a breach of duty causing gross injury to its patient.
3. ROSIT vs. DAVAO DOCTORS

Issue: Whether or not there is a Medical Malpractice? FACTS:

Rosit figured in a motorcycle accident. The X-ray taken at the Davao Doctors
Hospital (DDH) showed that he fractured his jaw. Rosit was then referred to
Held:
Dr. Gestuvo, a specialist in mandibular injuries, said doctor operated on
Yes. In this case medical malpractice is proven because the four
Rosit. During the operation, Dr. Gestuvo used a metal plate fastened to the
essential elements of such action are present based upon the doctrine of
jaw with metal screws to immobilize the mandible. As the operation required
informed consent.
the smallest screws available, Dr. Gestuvo cut the screws on hand to make
Reasoning:
them smaller. Dr. Gestuvo knew that there were smaller titanium screws
There are four essential elements a plaintiff must prove in a
available in Manila, but did not so inform Rosit supposing that the latter
malpractice action based upon the doctrine of informed consent: "(1) the
would not be able to afford the same. Following the procedure, Rosit could
physician had a duty to disclose material risks; (2) he failed to disclose or
not properly open and close his mouth and was in pain. X-rays done on Rosit
inadequately disclosed those risks; (3) as a direct and proximate result of the
two after the operation showed that the fracture in his jaw was aligned but the
failure to disclose, the patient consented to treatment she otherwise would not
screws used on him touched his molar. Given the X-ray results, Dr. Gestuvo
have consented to; and (4) plaintiff was injured by the proposed treatment."
referred Rosit to a dentist. The dentist who checked Rosit, Dr. Pangan,
Informed consent case requires the plaintiff to "point to significant
opined that another operation is necessary and that it is to be performed in
undisclosed information relating to the treatment that would alter her
Cebu. Alleging that the dentist told him that the operation conducted on his
decision to undergo. The physician is not expected to give the patient a short
mandible was improperly done, Rosit went back to Dr. Gestuvo to demand a
medical education, the disclosure rule only requires of him a reasonable
loan to defray the cost of the additional operation as well as the expenses of
general explanation in nontechnical terms.
the trip to Cebu. Dr. Gestuvo gave Rosit ₱4,500. Rosit went to Cebu still
suffering from pain and could hardly open his mouth. In Cebu, Dr. Pangan
Policy Formation:
removed the plate and screws thus installed by Dr. Gestuvo and replaced
In all sorts of medical procedures either invasive or not, medical
them with smaller titanium plate and screws. Dr. Pangan also extracted
institution must have a certificate of competency in rendering standards of
Rosit’s molar that was hit with a screw and some bone fragments. After the
care to delicate medical procedures before initiating a general protocol that
operation, Rosit was able to eat and speak well and could open and close his
would establish a guideline principle in a form of proper disclosure of such
mouth normally. Rosit demanded that Dr. Gestuvo reimburse him for the cost

LEGAL MEDICINE 3C 2016-2017 Page 3

of the operation and the expenses he incurred in Cebu amounting to
₱140,000, as well as for the ₱50,000 that Rosit would have to spend for the
removal of the plate and screws that Dr. Pangan installed. Dr. Gestuvo
refused to pay. Thus, Rosit filed a civil case for damages and attorney’s fees
with the RTC against Dr. Gestuvo and DDH.
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. 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.”
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.
ISSUE: Whether the appellate court correctly absolved Dr. Gestuvo from
liability.
HELD:
NO. In Flores v. Pineda, 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.
An expert witness is not necessary as the res ipsa loquitur doctrine is
applicable to establish medical negligence, the SC 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. The SC 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
LEGAL MEDICINE 3C 2016-2017
suffered must not have been due to any voluntary action or contribution of
the person injured.
The SC 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. 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. 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. 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
Page 4
expert testimony is required to establish the negligence of defendant Dr.
Gestuvo.
Petitioner was deprived of the opportunity to make an “informed
consent”
Li v. Soliman 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. x x x x 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.
4. FLORES v. PINEDA
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
LEGAL MEDICINE 3C 2016-2017
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 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 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 patient’s hyperglycemia: when stress occurs,
the diabetic’s body, especially the autonomic system, reacts by secreting
hormones which are counter-regulatory; she can have prolonged
Page 5
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 Teresita’s 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 patient’s death. Due to this negligent
conduct, liability must attach to the petitioner spouses.
5. SOLIDUM v. PEOPLE OF THE PHILIPPINES
Facts:
Gerald Albert Gercayo was born on June 2, 1992 with an imperforate anus.
Two days after his birth, Gerald underwent 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 Resurreccion headed 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 was filed by Gerald’s
parents against the team of doctors alleging that there was failure in
monitoring the anesthesia administered to
Issues:
1. Whether or not petitioner is liable for medical negligence.
2. Whether or not res ipsa liquitor can be resorted to in medical negligence
cases.
Held:
1. 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
LEGAL MEDICINE 3C 2016-2017
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 physician’s 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
individual’s physician’s 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.
2. 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
Page 6
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.
LEGAL MEDICINE 3C 2016-2017
6. ROMMEL ATIENZA V. BOARD OF MEDICINE AND
EDITHA SIOSON
Facts:
Due to her lumbar pains, private respondent Editha Sioson went to Rizal
Medical Center (RMC) for check-up on February 4, 1995. Sometime in 1999,
due to the same problem, she was referred to Dr. Pedro Lantin III of RMC
who, accordingly, ordered several diagnostic laboratory tests. The tests
revealed that her right kidney is normal. It was ascertained, however, that her
left kidney is non-functioning and non-visualizing. Thus, she underwent
kidney operation in September, 1999.
On February 18, 2000, private respondents husband, Romeo Sioson (as
complainant), filed a complaint for gross negligence and/or incompetence
before the [BOM] against the doctors who allegedly participated in the
fateful kidney operation, namely: Dr. Judd dela Vega, Dr. Pedro Lantin, III,
Dr. Gerardo Antonio Florendo and petitioner Rico Rommel Atienza.
It was alleged in the complaint that the gross negligence and/or incompetence
committed by the said doctors, including petitioner, consists of the removal
of private respondents fully functional right kidney, instead of the left non-
functioning and non-visualizing kidney.
Editha Sioson Attached to the formal offer of documentary evidence are her
Exhibits A to D, which she offered for the purpose of proving that her
kidneys were both in their proper anatomical locations at the time she was
operated.
The following are the pieces of evidence presented by Sioson:
EXHIBIT A the certified photocopy of the X-ray Request form dated
December 12, 1996 (handwritten entries which are the interpretation of the
results of the ultrasound examination)
EXHIBIT B the certified photo copy of the X-ray request form dated January
30, 1997 (handwritten entries which are the interpretation of the results of the
examination)
EXHIBIT C the certified photocopy of the X-ray request form dated March
16, 1996 (EXHIBIT C the certified photocopy of the X-ray request form
dated March 16, 1996)
EXHIBIT D the certified photocopy of the X-ray request form dated May 20,
1999 (handwritten entries which are the interpretation of the results of the
examination)
Page 7
Petitioner alleged that said exhibits are inadmissible because the same are
mere photocopies, not properly identified and authenticated, and intended to
establish matters which are hearsay. He added that the exhibits are
incompetent to prove the purpose for which they are offered.
The Board of Medicine admitted Editha Sioson’s formal offer of Evidence. A
subsequent Motion for Reconsideration was denied by the Board.
Petitioner appealed to the CA. CA dismissed the appeal.
ISSUES:
1. WON Petition for certiorari to the CA a proper remedy
2. WON CA committed grave abuse of discretion when it upheld the
admission of incompetent and inadmissible evidence by respondent
board
HELD:
I. YES. Petitioner is correct when he asserts that a petition for certiorari is the
proper remedy to assail the Orders of the BOM, admitting in evidence the
exhibits of Editha. As the assailed Orders were interlocutory, these cannot be
the subject of an appeal separate from the judgment that completely or finally
disposes of the case. At that stage, where there is no appeal, or any plain,
speedy, and adequate remedy in the ordinary course of law, the only and
remaining remedy left to petitioner is a petition for certiorari under Rule 65
of the Rules of Court on the ground of grave abuse of discretion amounting
to lack or excess of jurisdiction.
However, the writ of certiorari will not issue absent a showing that the BOM
has acted without or in excess of jurisdiction or with grave abuse of
discretion.
2. NO. To begin with, it is well-settled that the rules of evidence are not
strictly applied in proceedings before administrative bodies such as the
BOM. Although trial courts are enjoined to observe strict enforcement of the
rules of evidence, in connection with evidence which may appear to be of
doubtful relevancy, incompetency, or admissibility, we have held that:
[I]t is the safest policy to be liberal, not rejecting them on doubtful or
technical grounds, but admitting them unless plainly irrelevant,
immaterial or incompetent, for the reason that their rejection places
them beyond the consideration of the court, if they are thereafter
LEGAL MEDICINE 3C 2016-2017
found relevant or competent; on the other hand, their admission, if
they turn out later to be irrelevant or incompetent, can easily be
remedied by completely discarding them or ignoring them.
From the foregoing, we emphasize the distinction between the
admissibility of evidence and the probative weight to be accorded the
same pieces of evidence.
Admissibility of evidence refers to the question of whether or not the
circumstance (or evidence) is to be considered at all. On the other hand, the
probative value of evidence refers to the question of whether or not it
proves an issue.
Second, petitioners insistence that the admission of Edithas exhibits violated
his substantive rights leading to the loss of his medical license is misplaced.
As pointed out by the appellate court, the admission of the exhibits did not
prejudice the substantive rights of petitioner because, at any rate, the fact
sought to be proved thereby, that the two kidneys of Editha were in their
proper anatomical locations at the time she was operated on, is presumed
under Section 3, Rule 131 of the Rules of Court:
Sec. 3. Disputable presumptions. The following presumptions are
satisfactory if uncontradicted, but may be contradicted and overcome
by other evidence:
xxxx
(y) That things have happened according to the ordinary course of
nature and the ordinary habits of life.
To lay the predicate for her case, Editha offered the exhibits in evidence to
prove that her kidneys were both in their proper anatomical locations at the
time of her operation.
The fact sought to be established by the admission of Edithas exhibits, that
her kidneys were both in their proper anatomical locations at the time of her
operation, need not be proved as it is covered by mandatory judicial notice.
Unquestionably, the rules of evidence are merely the means for ascertaining
the truth respecting a matter of fact. Thus, they likewise provide for some
facts which are established and need not be proved, such as those covered by
judicial notice, both mandatory and discretionary. Laws of nature involving
Page 8
the physical sciences, specifically biology, include the structural make-up
and composition of living things such as human beings. In this case, we may
take judicial notice that Edithas kidneys before, and at the time of, her
operation, as with most human beings, were in their proper anatomical
locations.
Third, contrary to the assertion of petitioner, the best evidence rule is
inapplicable. Section 3 of Rule 130 provides:
1. Best Evidence Rule
Sec. 3. Original document must be produced; exceptions. When the
subject of inquiry is the contents of a document, no evidence shall be
admissible other than the original document itself, except in the
following cases:
(a) When the original has been lost or destroyed, or cannot be
produced in court, without bad faith on the part of the offeror; (b)
When the original is in the custody or under the control of the party
against whom the evidence is offered, and the latter fails to produce
it after reasonable notice;
(c) When the original consists of numerous accounts or other
documents which cannot be examined in court without great loss of
time and the fact sought to be established from them is only the
general result of the whole; and
(d) When the original is a public record in the custody of a public
officer or is recorded in a public office.
The subject of inquiry in this case is whether respondent doctors before the
BOM are liable for gross negligence in removing the right functioning
kidney of Editha instead of the left non-functioning kidney, not the proper
anatomical locations of Edithas kidneys. As previously discussed, the proper
anatomical locations of Edithas kidneys at the time of her operation at the
RMC may be established not only through the exhibits offered in evidence.
Finally, these exhibits do not constitute hearsay evidence of the anatomical
locations of Edithas kidneys. To further drive home the point, the anatomical
positions, whether left or right, of Edithas kidneys, and the removal of one or
both, may still be established through a belated ultrasound or x-ray of her
abdominal area.
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In fact, the introduction of secondary evidence, such as copies of the exhibits,
is allowed. Witness Dr. Nancy Aquino testified that the Records Office of
RMC no longer had the originals of the exhibits because [it] transferred from
the previous building, x x x to the new building. Ultimately, since the
originals cannot be produced, the BOM properly admitted Edithas formal
offer of evidence and, thereafter, the BOM shall determine the probative
value thereof when it decides the case.
7. CERENO v. CA
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
emergency room of the Bicol Regional Medical Center (BRMC).
There, Raymond was attended to by Nurse Balares and Dr. Realuyo
the emergency room resident physician.
Subsequently, the parents of Raymond the spouses Deogenes Olavere
(Deogenes) and Fe R. Serrano arrived at the BRMC. They were
accompanied by one Andrew Olavere, the uncle of Raymond. After
extending initial medical treatment to Raymond, Dr. Realuyo
recommended that the patient undergo "emergency exploratory
laparotomy." Dr. Realuyo then requested the parents of Raymond to
procure 500 cc of type "O" blood needed for the operation. Complying
with the request, Deogenes and Andrew Olavere went to the Philippine
National Red Cross to secure the required blood.
At 10:30 P.M., Raymond was wheeled inside the operating room.
During that time, the hospital 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. Dr. Tatad
also happened to be the head of Anesthesiology Department of the
BRMC. Just before the operation on Maluluy-on was finished, another
emergency case involving Lilia Aguila, a woman who was giving birth
to triplets, was brought to the operating room. At 10:59 P.M., the
Page 9
operation on Charles Maluluy-on was finished. By that time, however,
Dr. Tatad was already working with the obstetricians who will perform
surgery on Lilia Aguila. There being no other available
anesthesiologist to assist them, Drs. Zafe and Cereno decided to defer
the operation on Raymond. Drs. Zafe and Cereno, in the meantime,
proceeded to examine Raymond and they found that the latter’s blood
pressure was normal and "nothing in him was significant." Dr.
Cereno reported that based on the xray result he interpreted, the fluid
inside the thoracic cavity of Raymond was minimal at around 200-300
cc.
At 11:15 P.M., Deogenes and Andrew Olavere returned to the BRMC
with a bag containing the requested 500 cc type "O" blood. They
handed over the bag of blood to Dr. Realuyo. After Dr. Tatad finished
her work with the Lilia Aguila operation, petitioners immediately
started their operation on Raymond at around 12:15 A.M. of 17
September 1995. Upon opening of Raymond’s thoracic cavity, they
found that 3,200 cc of blood was stocked therein. The blood was
evacuated and petitioners found a puncture at the inferior pole of the
left lung. In his testimony, Dr. Cereno stated that considering the loss
of blood suffered by Raymond, he did not immediately transfuse blood
because he had to control the bleeders first.
Blood was finally transfused on Raymond at 1:40 A.M. At 1:45 A.M.,
while the operation was on-going, Raymond suffered a cardiac arrest.
The operation ended at 1:50 A.M. and Raymond was pronounced dead
at 2:30 A.M. Raymond’s death certificate indicated that the immediate
cause of death was "hypovolemic shock" or the cessation of the
functions of the organs of the body due to loss of blood.
Claiming that there was negligence on the part of those who attended
to their son, the parents of Raymond, on 25 October 1995, filed before
the RTC, Branch 22, Naga City a complaint for damages7 against
Nurse Balares, Dr. Realuyo and attending surgeons Dr. Cereno and Dr.
Zafe. the case against dr realuyo and balares was dismissed. Dr. cereno
and dr zafe found guilty and ordered to pay for damages.
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The trial court found petitioners negligent in not immediately
conducting surgery on Raymond. It noted that petitioners have already
finished operating on Charles Maluluy-on as early as 10:30 in the
evening, and yet they only started the operation on Raymond at around
12:15 early morning of the following day. The trial court held that had
the surgery been performed promptly, Raymond would not have lost
so much blood and, therefore, could have been saved.10 The trial court
also held that the non-availability of Dr. Tatad after the operation on
Maluluy-on was not a sufficient excuse for the petitioners to not
immediately operate on Raymond. It called attention to the testimony
of Dr. Tatad herself, which disclosed the possibility of calling a
standby anesthesiologist in that situation. The trial court opined that
the petitioners could have just requested for the standby
anesthesiologist from Dr. Tatad, but they did not. Lastly, the trial court
faulted petitioners for the delay in the transfusion of blood on
Raymond. On appeal, the CA in a decision dated 21 February 2005
affirmed in toto the judgment rendered by the RTC finding herein
petitioners guilty of gross negligence in the performance of their duties
and awarding damages to private respondents.
Issue: Whether or not Dr. Cereno and Dr. Zafe are guilty of gross
negligence in the performance of their duties.
Held:
No. Causation Not Proven 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.
A verdict in malpractice action cannot be based on speculation or
conjecture. Causation must be proven within a reasonable medical
probability based upon competent expert testimony. The parents of
Raymond failed in this respect. Aside from their failure to prove
negligence on the part of the petitioners, they also failed to prove that
it was petitioners’ fault that caused the injury. Their cause stands on
Page 10
the mere assumption that Raymond’s life would have been saved had
petitioner surgeons immediately operated on him; had the blood been
cross-matched immediately and had the blood been transfused
immediately.
There was, however, no proof presented that Raymond’s life would
have been saved had those things been done. Those are mere
assumptions and cannot guarantee their desired result. Such cannot be
made basis of a decision in this case, especially considering that the
name, reputation and career of petitioners are at stake. The Court
understands the parents’ grief over their son’s death.1âwphi1 That
notwithstanding, it cannot hold petitioners liable.
It was noted that Raymond, who was a victim of a stabbing incident,
had multiple wounds when brought to the hospital. Upon opening of
his thoracic cavity, it was discovered that there was gross bleeding
inside the body. Thus, the need for petitioners to control first what was
causing the bleeding. Despite the situation that evening i.e. numerous
patients being brought to the hospital for emergency treatment
considering that it was the height of the Peñafrancia Fiesta, it was
evident that petitioners exerted earnest efforts to save the life of
Raymond.
It was just unfortunate that the loss of his life was not prevented. In
the case of Dr. Cruz v. CA, it was held that doctors are protected by a
special law. They are not guarantors of care. They do not even warrant
a good result. They are not insurers against mishaps or unusual
consequences. Furthermore, they are not liable for honest mistake of
judgment…"
This Court affirms the ruling of the CA that the BRMC is not an
indispensible party. The core issue as agreed upon by the parties and
stated in the pre-trial order is whether petitioners were negligent in the
performance of their duties. It pertains to acts/omissions of petitioners
for which they could be held liable. The cause of action against
petitioners may be prosecuted fully and the determination of their
LEGAL MEDICINE 3C 2016-2017
liability may be arrived at without impleading the hospital where they
are employed. As such, the BRMC cannot be considered an
indispensible party without whom no final determination can be had of
an action.
8. CASUMPANG v. CORTEJO
FACTS:
Mrs. Jesusa Cortejo brought her 11-year old son, Edmer
Cortejo (Edmer), to the Emergency Room of the San Juan de Dios
Hospital (SJDH) because of difficulty in breathing, chest pain,
stomach pain, and fever. Dr. Livelo initially attended to and examined
Edmer. He took his vital signs, body temperature, and blood pressure.
Based on these initial examinations and the chest x-ray test that
followed, Dr. Livelo diagnosed Edmer with "bronchopneumonia."
Edmer's blood was also taken for testing, typing, and for purposes of
administering antibiotics. Afterwards, Dr. Livelo gave Edmer an
antibiotic medication to lessen his fever and to loosen his phlegm.
Mrs. Cortejo did not know any doctor at SJDH. She used her
Fortune Care card and was referred to an accredited Fortune Care
coordinator, who was then out of town. She was thereafter assigned to
Dr. Noel Casumpang (Dr. Casumpang), a pediatrician also accredited
with Fortune Care. Dr. Casumpang confirmed the initial diagnosis of
bronchopneumonia. Mrs. Cortejo had doubts on the doctor's diagnosis.
She immediately advised Dr. Casumpang that Edmer had a high fever,
and had no colds or cough, but Dr. Casumpang merely told her that her
son's "bloodpressure is just being active”, and remarked that "that's the
usual bronchopneumonia, no colds, no phlegm”.
The following day, Edmer vomited "phlegm with blood streak"
prompting the respondent (Edmer's father) to request for a doctor at
the nurses' station. Forty-five minutes later, Dr. Ruby Sanga-Miranda
(Dr. Miranda), one of the resident physicians of SJDH, arrived. She
Page 11
claimed that although aware that Edmer had vomited "phlegm with
blood streak," she failed to examine the blood specimen because the
respondent washed it away. She then advised the respondent to
preserve the specimen for examination.
Thereafter, Dr. Miranda conducted a physical check-up
covering Edmer's head, eyes, nose, throat, lungs, skin and abdomen;
and found that Edmer had a low-grade non-continuing fever, and
rashes that were not typical of dengue fever. Her medical findings
state: “the patient's rapid breathing and then the lung showed sibilant
and the patient's nose is flaring which is a sign that the patient is in
respiratory distress; the abdomen has negative finding; the patient has
low grade fever and not continuing; and the rashes in the patient's skin
were not "Herman's Rash" and not typical of dengue fever”.
At 3:00 in the afternoon, Edmer once again vomited blood.
Upon seeing Dr. Miranda, the respondent showed her Edmer's blood
specimen, and reported that Edmer had complained of severe stomach
pain and difficulty in moving his right leg. Dr. Miranda then examined
Edmer's "sputum with blood" and noted that he was bleeding.
Suspecting that he could be afflicted with dengue, she inserted a
plastic tube in his nose, drained the liquid from his stomach with ice
cold normal saline solution, and gave an instruction not to pull out the
tube, or give the patient any oral medication.
Dr. Miranda thereafter conducted a tourniquet test, which
turned out to be negative. She likewise ordered the monitoring of the
patient's blood pressure and some blood tests. Edmer's blood pressure
was later found to be normal. At 4:40 in the afternoon, Dr. Miranda
called up Dr. Casumpang at his clinic and told him about Edmer's
condition. Upon being informed, Dr. Casumpang ordered several
procedures done including: hematocrit, hemoglobin, blood typing,
blood transfusion and tourniquet tests.
The blood test results came at about 6:00 in the evening. Dr.
Miranda advised Edmer's parents that the blood test results showed
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that Edmer was suffering from "Dengue Hemorrhagic Fever." One
hour later, Dr. Casumpang arrived at Edmer's room and he
recommended his transfer to the Intensive Care Unit (ICU), to which
the respondent consented. Since the ICU was then full, Dr. Casumpang
suggested to the respondent that they hire a private nurse. The
respondent, however, insisted on transferring his son to Makati
Medical Center.
After the respondent had signed the waiver, Dr. Casumpang,
for the last time, checked Edmer's condition, found that his blood
pressure was stable, and noted that he was "comfortable." The
respondent requested for an ambulance but he was informed that the
driver was nowhere to be found. This prompted him to hire a private
ambulance that cost him P600.00.23
At 12:00 midnight, Edmer, accompanied by his parents and by
Dr. Casumpang, was transferred to Makati Medical Center. Dr.
Casumpang immediately gave the attending physician the patient's
clinical history and laboratory exam results. Upon examination, the
attending physician diagnosed "Dengue Fever Stage IV" that was
already in its irreversible stage.
Edmer died at 4:00 in the morning of April 24, 1988. His Death
Certificate indicated the cause of death as "Hypovolemic
Shock/hemorrhagic shock;" "Dengue Hemorrhagic Fever Stage IV."
Believing that Edmer's death was caused by the negligent and
erroneous diagnosis of his doctors, the respondent instituted an action
for damages against SJDH, and its attending physicians: Dr.
Casumpang and Dr. Miranda (collectively referred to as the
"petitioners") before the RTC.
The RTC ruled in favor of the respondent, and awarded actual and
moral damages. The CA affirmed the RTC ruling in toto. The rulings
of both courts gave credence to the expert testimony of Dr. Jaudian.
ISSUE:
Page 12
1. Whether or not there was a physician-patient relationship between
the petitioning doctors and Edmer.
2. Whether or not the petitioning doctors are guilty of negligence.
3. Whether or not the lower courts erred in considering Dr. Rodolfo
Tabangcora Jaudian as an expert witness.
4. Whether or not there is a causal connection between the petitioners'
negligent act/omission and the patient's resulting death.
5. Whether or not the petitioner hospital is solidarity liable with the
petitioning doctors.
RULING:
1. Yes. In the discussion below, the elements of medical
malpractice should first be discussed before the determination of
the physician-patient relationship.
The claim for damages is based on the petitioning doctors'
negligence in diagnosing and treating the deceased Edmer, the child of
the respondent. It is a medical malpractice suit, an action available to
victims to redress a wrong committed by medical professionals who
caused bodily harm to, or the death of, a patient. As the term is used,
the suit is brought whenever a medical practitioner or health care
provider fails to meet the standards demanded by his profession, or
deviates from this standard, and causes injury to the patient. To
successfully pursue a medical malpractice suit, the plaintiff (in this
case, the deceased patient's heir) must prove that the doctor either
failed to do what a reasonably prudent doctor would have done, or did
what a reasonably prudent doctor would not have done; and the act or
omission had caused injury to the patient. The patient's heir/s bears the
burden of proving his/her cause of action.
The elements of medical negligence are: (1) duty; (2) breach;
(3) injury; and (4) proximate causation. Duty refers to the standard of
behavior that imposes restrictions on one's conduct. It requires proof of
professional relationship between the physician and the patient.
Without the professional relationship, a physician owes no duty to the
patient, and cannot therefore incur any liability. A physician-patient
LEGAL MEDICINE 3C 2016-2017
relationship is created when a patient engages the services of a
physician, and the latter accepts or agrees to provide care to the
patient. The establishment of this relationship is consensual, and the
acceptance by the physician essential. The mere fact that an individual
approaches a physician and seeks diagnosis, advice or treatment does
not create the duty of care unless the physician agrees. The consent
needed to create the relationship does not always need to be express. In
the absence of an express agreement, a physician-patient relationship
may be implied from the physician's affirmative action to diagnose
and/or treat a patient, or in his participation in such diagnosis and/or
treatment. The usual illustration would be the case of a patient who
goes to a hospital or a clinic, and is examined and treated by the
doctor. In this case, we can infer, based on the established and
customary practice in the medical community that a patient-physician
relationship exists. Once a physician-patient relationship is established,
the legal duty of care follows. The doctor accordingly becomes duty-
bound to use at least the same standard of care that a reasonably
competent doctor would use to treat a medical condition under similar
circumstances.
Breach of duty occurs when the doctor fails to comply with, or
improperly performs his duties under professional standards. This
determination is both factual and legal, and is specific to each
individual case. If the patient, as a result of the breach of duty, is
injured in body or in health, actionable malpractice is committed,
entitling the patient to damages.
To successfully claim damages, the patient must lastly prove
the causal relation between the negligence and the injury. This
connection must be direct, natural, and should be unbroken by any
intervening efficient causes. In other words, the negligence must be the
proximate cause of the injury. The injury or damage is proximately
caused by the physician's negligence when it appears, based on the
evidence and the expert testimony, that the negligence played an
integral part in causing the injury or damage, and that the injury or
Page 13
damage was either a direct result, or a reasonably probable
consequence of the physician's negligence.
In the present case, the physician-patient relationship between
Dr. Casumpang and Edmer was created when the latter's parents
sought the medical services of Dr. Casumpang, and the latter
knowingly accepted Edmer as a patient. Dr. Casumpang's acceptance
is implied from his affirmative examination, diagnosis and treatment
of Edmer. On the other hand, Edmer's parents, on their son's behalf,
manifested their consent by availing of the benefits of their health care
plan, and by accepting the hospital's assigned doctor without
objections.
With respect to Dr. Miranda, her professional relationship with
Edmer arose when she assumed the obligation to provide resident
supervision over the latter. As second year resident doctor tasked to do
rounds and assist other physicians, Dr. Miranda is deemed to have
agreed to the creation of physician-patient relationship with the
hospital's patients when she participated in the diagnosis and
prescribed a course of treatment for Edmer. The undisputed evidence
shows that Dr. Miranda examined Edmer twice (at around 12:00 and
3:30 in the afternoon of April 23, 1988), and in both instances, she
prescribed treatment and participated in the diagnosis of Edmer's
medical condition. Her affirmative acts amounted to her acceptance of
the physician-patient relationship, and incidentally, the legal duty of
care that went with it.
2. Only Dr. Casumpang is guilty of negligence.
Whether or not Dr. Casumpang and Dr. Miranda committed a
breach of duty is to be measured by the yardstick of professional
standards observed by the other members of the medical profession in
good standing under similar circumstances. It is in this aspect of
medical malpractice that expert testimony is essential to establish not
only the professional standards observed in the medical community,
but also that the physician's conduct in the treatment of care falls
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below such standard. In the present case, expert testimony is crucial in
determining first, the standard medical examinations, tests, and
procedures that the attending physicians should have undertaken in the
diagnosis and treatment of dengue fever; and second, the dengue fever
signs and symptoms that the attending physicians should have noticed
and considered.
Dr. Jaudian testified that Edmer's rapid breathing, chest and
stomach pain, fever, and the presence of blood in his saliva are classic
symptoms of dengue fever. According to him, if the patient was
admitted for chest pain, abdominal pain, and difficulty in breathing
coupled with fever, dengue fever should definitely be considered; if
the patient spits coffee ground with the presence of blood, and the
patient's platelet count drops to 47,000, it becomes a clear case of
dengue fever, and bronchopneumonia can be reasonably ruled out.
Furthermore, the standard of care according to Dr. Jaudian is to
administer oxygen inhalation, analgesic, and fluid infusion or dextrose.
If the patient had twice vomited fresh blood and thrombocytopenia has
already occurred, the doctor should order blood transfusion,
monitoring of the patient every 30 minutes, hemostatic to stop
bleeding, and oxygen if there is difficulty in breathing.
Dr. Casumpang failed to promptly detect dengue fever
It will be recalled that during Dr. Casumpang's first and second
visits to Edmer, he already had knowledge of Edmer's laboratory test
result, medical history, and symptoms (i.e., fever, rashes, rapid
breathing, chest and stomach pain, throat irritation, difficulty in
breathing, and traces of blood in the sputum). However, these
information did not lead Dr. Casumpang to the possibility that Edmer
could be suffering from either dengue fever, or dengue hemorrhagic
fever, as he clung to his diagnosis of broncho pneumonia. This means
that given the symptoms exhibited, Dr. Casumpang already ruled out
the possibility of other diseases like dengue.
In other words, it was lost on Dr. Casumpang that the
characteristic symptoms of dengue (as Dr. Jaudian testified) are:
Page 14
patient's rapid breathing; chest and stomach pain; fever; and the
presence of blood in his saliva. All these manifestations were present
and known to Dr. Casumpang at the time of his first and second visits
to Edmer. While he noted some of these symptoms in confirming
bronchopneumonia, he did not seem to have considered the patient's
other manifestations in ruling out dengue fever or dengue hemorrhagic
fever.
The Court also find it strange why Dr. Casumpang did not even
bother to check Edmer's throat despite knowing that as early as 9:00 in
the morning of April 23, 1988, Edmer had blood streaks in his sputum.
Neither did Dr. Casumpang order confirmatory tests to confirm the
source of bleeding. The Physician's Progress Notes stated: "Blood
streaks on phlegm can be due to bronchial irritation or congestion"
which clearly showed that Dr. Casumpang merely assumed, without
confirmatory physical examination, that bronchopneumonia caused the
bleeding. Dr. Jaudian likewise opined that Dr. Casumpang's medical
examination was not comprehensive enough to reasonably lead to a
correct diagnosis.60 Dr. Casumpang only used a stethoscope in
coming up with the diagnosis that Edmer was suffering from
bronchopneumonia; he never confirmed this finding with the use of a
bronchoscope. Furthermore, Dr. Casumpang based his diagnosis
largely on the chest x-ray result that is generally inconclusive.
Significantly, it was only at around 5:00 in the afternoon of
April 23, 1988 (after Edmer's third episode of bleeding) that Dr.
Casumpang ordered the conduct of hematocrit, hemoglobin, blood
typing, blood transfusion and tourniquet tests. These tests came too
late, as proven by: (1) the blood test results that came at about 6:00 in
the evening, confirming that Edmer's illness had developed to "Dengue
Hemorrhagic Fever" and (2) Dr. Jaudian's testimony that "dengue
fever could have been detected earlier than 7:30 in the evening of
April 23, 1988 because the symptoms were already evident.
Dr. Casumpang’s negligence in the Treatment and Management of
Dengue
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As Dr. Jaudian opined, the standard medical procedure once
the patient had exhibited the classic symptoms of dengue fever should
have been: oxygen inhalation, use of analgesic, and infusion of fluids
or dextrose; and once the patient had twice vomited fresh blood, the
doctor should have ordered: blood transfusion, monitoring of the
patient every 30 minutes, hemostatic to stop bleeding, and oxygen if
there is difficulty in breathing.
Dr. Casumpang failed to measure up to these standards. The
evidence strongly suggests that he ordered a transfusion of platelet
concentrate instead of blood transfusion. The tourniquet test was only
conducted after Edmer's second episode of bleeding, and the medical
management (as reflected in the records) did not include antibiotic
therapy and complete physical examination.
Dr. Miranda is Not Liable for Negligence
In considering the case of Dr. Miranda, the junior resident
physician who was on-duty at the time of Edmer's confinement, we see
the need to draw distinctions between the responsibilities and
corresponding liability of Dr. Casumpang, as the attending physician,
and that of Dr. Miranda.
The resident applicants are generally doctors of medicine
licensed to practice in the Philippines and who would like to pursue a
particular specialty. They are usually the front line doctors responsible
for the first contact with the patient. During the scope of the residency
program, resident physicians (or "residents") function under the
supervision of attending physicians or of the hospital's teaching staff.
Under this arrangement, residents operate merely as subordinates who
usually defer to the attending physician on the decision to be made and
on the action to be taken.
The attending physician, on the other hand, is primarily
responsible for managing the resident's exercise of duties. While
attending and resident physicians share the collective responsibility to
deliver safe and appropriate care to the patients, it is the attending
physician who assumes the principal responsibility of patient care.
Page 15
Because he/she exercises a supervisory role over the resident, and is
ultimately responsible for the diagnosis and treatment of the patient,
the standards applicable to and the liability of the resident for medical
malpractice is theoretically less than that of the attending physician.
These relative burdens and distinctions, however, do not translate to
immunity from the legal duty of care for residents, or from the
responsibility arising from their own negligent act.
In the US Case of Centman v. Cobb, it was held that interns
and first-year residents are "practitioners of medicine required to
exercise the same standard of care applicable to physicians with
unlimited licenses to practice." The Indiana Court held that although a
first-year resident practices under a temporary medical permit, he/she
impliedly contracts that he/she has the reasonable and ordinary
qualifications of her profession and that he/she will exercise
reasonable skill, diligence, and care in treating the patient.
We find that Dr. Miranda was not independently negligent.
Although she had greater patient exposure, and was' subject to the
same standard of care applicable to attending physicians, we believe
that a finding of negligence should also depend on several competing
factors, among them, her authority to make her own diagnosis, the
degree of supervision of the attending physician over her, and the
shared responsibility between her and the attending physicians.
In this case, before Dr. Miranda attended to Edmer, both Dr.
Livelo and Dr. Casumpang had diagnosed Edmer with
bronchopneumonia. In her testimony, Dr. Miranda admitted that she
had been briefed about Edmer's condition, his medical history, and
initial diagnosis; and based on these pieces of information, she
confirmed the, finding of bronchopneumonia. Dr. Miranda likewise
duly reported to Dr. Casumpang, who admitted receiving updates
regarding Edmer's condition. There is also evidence supporting Dr.
Miranda's claim that she extended diligent care to Edmer. In fact,
when she suspected - during Edmer's second episode of bleeding - that
Edmer could be suffering from dengue fever, she wasted no time in
LEGAL MEDICINE 3C 2016-2017
conducting the necessary tests, and promptly notified Dr. Casumpang
about the incident. Indubitably, her medical assistance led to the
finding of dengue fever.
We note however, that during Edmer's second episode of
bleeding, Dr. Miranda failed to immediately examine and note the
cause of the blood specimen. Like Dr. Casumpang, she merely
assumed that the blood in Edmer's phlegm was caused by
bronchopneumonia. Based on her statements we find that Dr. Miranda
was not entirely faultless. Nevertheless, her failure to discern the
import of Edmer's second bleeding does not necessarily amount to
negligence as the respondent himself admitted that Dr. Miranda failed
to examine the blood specimen because he washed it away. In
addition, considering the diagnosis previously made by two doctors,
and the uncontroverted fact that the burden of final diagnosis pertains
to the attending physician (in this case, Dr. Casumpang), we believe
that Dr. Miranda's error was merely an honest mistake of judgment
influenced in no small measure by her status in the hospital hierarchy;
hence, she should not be held liable for medical negligence.
3. No. The RTC and CA correctly ruled for the competency of Dr.
Jaudian as an expert witness in the case.
The competence of an expert witness is a matter for the trial
court to decide upon in the exercise of its discretion. The test of
qualification is necessarily a relative one, depending upon the subject
matter of the investigation, and the fitness of the expert witness. In our
jurisdiction, the criterion remains to be the expert witness' special
knowledge experience and practical training that qualify him/her
to explain highly technical medical matters to the Court.
In this case, the court find that Dr. Jaudian is competent to
testify on the standard of care in dengue fever cases. Although he
specializes in pathology, it was established during trial that he had
attended not less than 30 seminars held by the Pediatric Society, had
Page 16
exposure in pediatrics, had been practicing medicine for 16 years, and
had handled not less than 50 dengue related cases.
As a licensed medical practitioner specializing in pathology,
who had practical and relevant exposure in pediatrics and dengue
related cases, we are convinced that Dr. Jaudian demonstrated
sufficient familiarity with the standard of care to be applied in dengue
fever cases. Furthermore, we agree that he possesses knowledge and
experience sufficient to qualify him to speak with authority on the
subject.
4. Yes. The causation between the negligence and the injury was
proven.
Dr. Casumpang failed to timely diagnose Edmer with dengue
fever despite the presence of its characteristic symptoms; and as a
consequence of the delayed diagnosis, he also failed to promptly
manage Edmer's illness. Had he immediately conducted confirmatory
tests, (i.e., tourniquet tests and series of blood tests) and promptly
administered the proper care and management needed for dengue
fever, the risk of complications or even death, could have been
substantially reduced.
Furthermore, medical literature on dengue shows that early
diagnosis and management of dengue is critical in reducing the risk of
complications and avoiding further spread of the virus. That Edmer
later died of "Hypovolemic Shock/hemorrhagic shock," "Dengue
Hemorrhagic Fever Stage IV," a severe and fatal form of dengue fever,
established the causal link between Dr. Casumpang's negligence and
the injury.
5. Yes. SJDH is solidarily liable with Dr. Casumpang. The Court
affirms the hospital's liability not on the basis of Article 2180 of the
Civil Code, but on the basis of the doctrine of apparent authority or
agency by estoppel.
LEGAL MEDICINE 3C 2016-2017
There is No Employer-Employee Relationship Between SJDH and
the Petitioning Doctors
In determining whether an employer-employee relationship
exists between the parties, the following elements must be present: (1)
selection and engagement of services; (2) payment of wages; (3) the
power to hire and fire; and (4) the power to control not only the end to
be achieved, but the means to be used in reaching such an end.
Control, which is the most crucial among the elements, is not
present in this case.
Based on the records, no evidence exists showing that SJDH
exercised any degree of control over the means, methods of procedure
and manner by which the petitioning doctors conducted and performed
their medical profession. SJDH did not control their diagnosis and
treatment. Likewise, no evidence was presented to show that SJDH
monitored, supervised, or directed the petitioning doctors in the
treatment and management of Edmer's case. In these lights, the
petitioning doctors were not employees of SJDH, but were mere
independent contractors.
SJDH is Solidarity Liable Based on The Principle of Agency or
Doctrine of Apparent Authority
Despite the absence of employer-employee relationship
between SJDH and the petitioning doctors, SJDH is not free from
liability. As a rule, hospitals are not liable for the negligence of its
independent contractors. However, it may be found liable if the
physician or independent contractor acts as an ostensible agent of the
hospital. This exception is also known as the "doctrine of apparent
authority." In sum, a hospital can be held vicariously liable for the
negligent acts of a physician (or an independent contractor) providing
care at the hospital if the plaintiff can prove these two factors: first, the
hospital's manifestations; and second, the patient's reliance.
Hospital’s Manifestations
Page 17
 It involves an inquiry on whether the hospital acted in a manner
that would lead a reasonable person to conclude that the individual
alleged to be negligent was an employee or agent of the hospital. As
pointed out in the Nogales Case, the hospital need not make express
representations to the patient that the physician or independent
contractor is an employee of the hospital; representation may be
general and implied.
In Pamperin v. Trinity Memorial Hospital, questions were
raised on "what acts by the hospital or its agent are sufficient to lead a
reasonable person to conclude that the individual was an agent of the
hospital." In this case, the court considered the act of the hospital of
holding itself out as provider of complete medical care, and considered
the hospital to have impliedly created the appearance of authority.
Patient’s Reliance
It involves an inquiry on whether the plaintiff acted in reliance on the
conduct of the hospital or its agent, consistent with ordinary care and
prudence. In Pamperin, the court held that the important consideration
in determining the patient's reliance is: whether the plaintiff is seeking
care from the hospital itself or whether the plaintiff is looking to the
hospital merely as a place for his/her personal physician to provide
medical care.
Thus, this requirement is deemed satisfied if the plaintiff can
prove that he/she relied upon the hospital to provide care and
treatment, rather than upon a specific physician. In this case, we shall
limit the determination of the hospital's apparent authority to Dr.
Casumpang, in view of our finding that Dr. Miranda is not liable for
negligence.
SJDH Clothed Dr. Casumpang With Apparent Authority
SJDH impliedly held out and clothed Dr. Casumpang with
apparent authority leading the respondent to believe that he is an
employee or agent of the hospital.
LEGAL MEDICINE 3C 2016-2017
Based on the records, the respondent relied on SJDH rather
than upon Dr. Casumpang, to care and treat his son Edmer. His
testimony during trial showed that he and his wife did not know any
doctors at SJDH; they also did not know that Dr. Casumpang was an
independent contractor. They brought their son to SJDH for diagnosis
because of their family doctor's referral. The referral did not
specifically point to Dr. Casumpang or even to Dr. Miranda, but to
SJDH.
Significantly, the respondent had relied on SJDH's
representation of Dr. Casumpang's authority. To recall, when Mrs.
Cortejo presented her Fortune Care card, she was initially referred to
the Fortune Care coordinator, who was then out of town. She was
thereafter referred to Dr. Casumpang, who is also accredited with
Fortune Care. In both instances, SJDH through its agent failed to
advise Mrs. Cortejo that Dr. Casumpang is an independent contractor.
Mrs. Cortejo accepted Dr. Casumpang's services on the
reasonable belief that such were being provided by SJDH or its
employees, agents, or servants. By referring Dr. Casumpang to care
and treat for Edmer, SJDH impliedly held out Dr. Casumpang, not
only as an accredited member of Fortune Care, but also as a member
of its medical staff. SJDH cannot now disclaim liability since there is
no showing that Mrs. Cortejo or the respondent knew, or should have
known, that Dr. Casumpang is only an independent contractor of the
hospital. In this case, estoppel has already set in.
We also stress that Mrs. Cortejo's use of health care plan
(Fortune Care) did not affect SJDH's liability. The only effect of the
availment of her Fortune Care card benefits is that her choice of
physician is limited only to physicians who are accredited with
Fortune Care. Thus, her use of health care plan in this case only
limited the choice of doctors (or coverage of services, amount etc.) and
not the liability of doctors or the hospital.
Page 18

9. THE PEOPLE OF THE PHILIPPINES vs. FILOMENO
CAMANO
FACTS:
The two victims Godofredo Pascua and Mariano Buenaflor, together with the
accused are neighbors, residing at the same street. Three years prior to the
incident, the victims had a misunderstading with the accused while fishing in
the Sagnay river. The accused requested Pascua to tow his fishing boat with
the motor boat owned by Buenaflor but the request was refused by both
which greatly offended and embittered the accused. Attempts were made by
the neighbors for the reconciliation of the three but to no avail.
On February 17, 1970 in Nato, Sagnay, Camarines Sur, between the hours of
4 and 5 pm, the accused after drinking liquor stabbed twice the vicitim
Godofredo Pascua with a bolo while the latter was walking alone along the
barrio street almost infornt of the store of one Socorro Buates. The victim
sustained two mortal wounds for which he died instantaneously.
After hacking and stabbing Godofredo Pascua, the accused proceeded to the
seashore of the barrio, and on finding Mariano Buenaflor leaning at the gate
of the fence of his house, hacked the latter with the same bolo, first on the
head and continued hacking him until he lay on the ground, face up, the
accused then gave him a final trust of the bolo at the left side of the chest
above the nipple running and penetrating the right side a little posteriorly and
superiorly with an exit at the back. Mariano Buenaflor sustained eight
wounds. The bloody incident was not preceded or precipitated by any
altercation between the victims and the accused.
After killing the two victims, he returned to his house, where he subsequently
surrendered to Policemen Adolfo Avila, Juan Chavez, Erasmo Valencia,
upon demand by laid peace officers for him to surrender. When brought to
the Police headquarters of the town for investigation he revealed that the bolo
he used in the killing was hidden by him under the table of his house.
As a defense, Camano stated that he was merely acting on self-defense upon
the aggression of the two. The defense was rejected by the Court and the
LEGAL MEDICINE 3C 2016-2017
latter held that Camano is guilty of Murder attended by evident premeditation
and treachery.
Issue: WON treachery is present in the commission of the crime.
Held:
YES. Filomeno Camano attacked Godofredo Pascua from behind, a method
which has ensured the accomplishment of the criminal act without any risk to
the perpetrator arising from the defense that his victim may put up.
The autopsy report, showed that the point of entry of the stab wound inflicted
upon Pascua was three (3) inches long and three (3) inches below the left
armpit, a little bit posteriorly or toward the hinder end of the body; and the
point of exit was the right chest, one (1) inch Iateral to the right nipple with a
one (1) inch opening. If the deceased was stabbed while he was facing his
assailant, as claimed by counsel for the accused, the entrance wound would
have been in the front part of the body, and its exit wound, if any, would be
at the back. The trial court, therefore, did not commit an error in finding that
the deceased Godofredo Pascua was assaulted from behind.
With respect to Mariano Buenaflor, the evidence shows that he was attacked
while in a kneeling position, with his arms on top of the gate of the fence
surrounding his hut and his head was "stooping down." He was hacked on
the head, causing him to fall to the ground, and then successively hacked and
stabbed without respite, as he lay on the ground, until he died. The attack was
also sudden, unexpected, and lethal, such as to disable and incapacitate the
victim from putting up any defense.
10. PEOPLE OF THE PHILIPPINES vs. BERNARDINO
DOMANTAY
FACTS:
On October 17, 1996, the body of six-year old Jennifer Domantay was found
sprawled amidst a bamboo grove in Guilig, Malasiqui, Pangasinan.
The medical examination conducted the following day by Dr. Ma. Fe Leticia
Macaranas, the rural health physician of Malasiqui, showed that Jennifer died
Page 19
of multiple organ failure and hypovolemic shock secondary to 38 stab
wounds at the back. Dr. Macaranas found no lacerations or signs of
inflammation of the outer and inner labia and the vaginal walls of the victims
genitalia, although the vaginal canal easily admitted the little finger with
minimal resistance. Noting possible commission of acts of lasciviousness,
Dr. Macaranas recommended an autopsy by a medico-legal expert of the
NBI.
The lone suspect of the crime was Bernardino Domantay, a cousin of the
victims grandfather, who was later picked up by the police and up
questioning he confessed to the crime and even disclosed where the weapon
he has used was located.
On the basis of the post-mortem findings of Dr. Macaranas, SPO4 Juan
Carpizo, the Philippine National Police chief investigator at Malasiqui, filed,
on October 21, 1996, a criminal complaint for murder against accused-
appellant before the Municipal Trial Court (MTC) of Malasiqui. On October
25, 1996, Dr. Ronald Bandonill, medico-legal expert of the NBI, performed
an autopsy on the embalmed body of Jennifer. The result of his examination
of the victims genitalia indicated that the childs hymen had been completely
lacerated on the right side. Based on this finding, SPO4 Carpizo amended the
criminal complaint against accused-appellant to rape with homicide.
At the trial, the prosecution presented seven witnesses, namely, Edward,
Jiezl, Lorenzo, all surnamed Domantay, Joselito Mejia, Antonio Espinoza,
Celso Manuel, and Dr. Ronald Bandonill, to establish its charge that accused-
appellant had raped and killed Jennifer Domantay.
Dr. Bandonill, the NBI medico-legal who conducted an autopsy of the victim
on October 25, 1996, testified that Jennifer Domantay died as a result of the
numerous stab wounds she sustained on her back, the average depth of which
was six inches. He opined that the wounds were probably caused by a
pointed sharp-edged instrument. He also noted contusions on the forehead,
neck, and breast bone of the victim. As for the results of the genital
examination of the victim, Dr. Bandonill said he found that the laceration on
the right side of the hymen was caused within 24 hours of her death. He
added that the genital area showed signs of inflammation.
The defense then presented accused-appellant as its lone witness. Accused-
appellant denied the allegations against him.
LEGAL MEDICINE 3C 2016-2017
The accused was found guilty of the crime charged. Hence, this appeal.
ISSUE: Whether or not the court a quo erred in convicting the accused of the
crime of rape with homicide.
HELD:
YES. There is, no sufficient evidence to hold accused-appellant guilty of
raping Jennifer Domantay. Art. 335 of the Revised Penal Code, as amended,
in part provides:
ART. 335. When and how rape is committed. Rape is committed by having
carnal knowledge of a woman under any of the following circumstances.
1. By using force or intimidation;
2. When the woman is deprived of reason or otherwise unconscious; and
3. When the woman is under twelve years of age or is demented.
As the victim here was six years old, only carnal knowledge had to be proved
to establish rape. Carnal knowledge is defined as the act of a man having
sexual intercourse or sexual bodily connections with a woman. For this
purpose, it is enough if there was even the slightest contact of the male sex
organ with the labia of the victims genitalia. However, there must be proof,
by direct or indirect evidence, of such contact.
Dr. Ronald Bandonills report on the genital examination he had performed on
the deceased reads:
GENITAL EXAMINATION; showed a complete laceration of the right side
of the hymen. The surrounding genital area shows signs of inflamation.
REMARKS: 1) Findings at the genital area indicate the probability of
penetration of that area by a hard, rigid instrument.
Hymenal laceration is not necessary to prove rape;neither does its presence
prove its commission. As held in People v. Ulili, a medical certificate or the
testimony of the physician is presented not to prove that the victim was raped
but to show that the latter had lost her virginity. Consequently, standing
Page 20
alone, a physicians finding that the hymen of the alleged victim was lacerated
does not prove rape. It is only when this is corroborated by other evidence
proving carnal knowledge that rape may be deemed to have been established.
This conclusion is based on the medically accepted fact that a hymenal tear
may be caused by objects other than the male sex organ or may arise from
other causes. Dr. Bandonill himself admitted this. He testified that the right
side of the victims hymen had been completely lacerated while the
surrounding genital area showed signs of inflammation. He opined that the
laceration had been inflicted within 24 hours of the victims death and that the
inflammation was due to a trauma in that area. When asked by the private
prosecutor whether the lacerations of the hymen could have been caused by
the insertion of a male organ he said this was possible. But he also said when
questioned by the defense that the lacerations could have been caused by
something blunt other than the male organ.
To be sure, this Court has sustained a number of convictions for rape with
homicide based on purely circumstantial evidence. In those instances,
however, the prosecution was able to present other tell-tale signs of rape such
as the location and description of the victims clothings, especially her
undergarments, the position of the body when found and the like.
In contrast, in the case at bar, there is no circumstantial evidence from which
to infer that accused-appellant sexually abused the victim. The only
circumstance from which such inference might be made is that accused-
appellant was seen with the victim walking toward the place where the girls
body was found. Maybe he raped the girl. Maybe he did not. Maybe he
simply inserted a blunt object into her organ, thus causing the lacerations in
the hymen. Otherwise, there is no circumstance from which it might
reasonably be inferred that he abused her, e.g., that he was zipping up his
pants, that there was spermatozoa in the girls vaginal canal.
Indeed, the very autopsy report of Dr. Bandonill militates against the finding
of rape. In describing the stab wounds on the body of the victim, he testified:
[A]fter examining the body I took note that there were several stab wounds . .
. these were all found at the back area sir . . . extending from the back
shoulder down to the lower back area from the left to the right.
LEGAL MEDICINE 3C 2016-2017
Considering the relative physical positions of the accused and the victim in
crimes of rape, the usual location of the external bodily injuries of the victim
is on the face, neck, and anterior portion of her body. Although it is not
unnatural to find contusions on the posterior side, these are usually caused by
the downward pressure on the victims body during the sexual assault. It is
unquestionably different when, as in this case, all the stab wounds (except for
a minor cut in the lower left leg) had their entry points at the back running
from the upper left shoulder to the lower right buttocks.
It is noteworthy that the deceased was fully clothed in blue shorts and white
shirt when her body was brought to her parents house immediately after it
was found. Furthermore, there is a huge bloodstain in the back portion of her
shorts. This must be because she was wearing this piece of clothing when the
stab wounds were inflicted or immediately thereafter, thus allowing the blood
to seep into her shorts to such an extent. As accused-appellant would
naturally have to pull down the girls lower garments in order to consummate
the rape, then, he must have, regardless of when the stab wounds were
inflicted, pulled up the victims shorts and undergarments after the alleged
rape, otherwise, the victims shorts would not have been stained so
extensively. Again, this is contrary to ordinary human experience.
Even assuming that Jennifer had been raped, there is no sufficient proof that
it was accused-appellant who had raped her. He did not confess to having
raped the victim.
From the foregoing, we cannot find that accused-appellant also committed
rape. In the special complex crime of rape with homicide, both the rape and
the homicide must be established beyond reasonable doubt.
WHEREFORE, the judgment of the trial court is SET ASIDE and another
one is rendered FINDING accused-appellant guilty of homicide with the
aggravating circumstance of abuse of superior strength and sentencing him to
a prison term of 12 years of prision mayor, as minimum, to 20 years of
reclusion temporal, as maximum, and ORDERING him to pay the heirs of
Jennifer Domantay the amounts of P50,000.00, as indemnity, P50,000.00, as
moral damages, P25,000.00, as exemplary damages, and P12,000.00, as
actual damages, and the costs.
Page 21

11. UNION MOTOR CORP. v. NLRC and ALEJANDRO ETIS
FACTS:
Respondent (Alejandro) was hired by the petitioner as an automotive
mechanic. During his employment he was given several awards such as the
Top Technician of the Month of May in 1996 and Technician of the Year
also in 1996
In 1997 Alejandro made a phone call to the company nurse and informed her
that he had to take a sick leave because of a painful and unbearable
toothache. The next day, he again phoned the company nurse and told her
that he could not report for work because he still had to consult a doctor.
Finding that the respondent’s ailment was due to a tooth inflammation, the
doctor referred him to a dentist for further management
Alejandro went to Dr. Pamor, a dentist, and scheduled Alejandro's tooth
extraction. However, it was rescheduled causing Alejandro to miss more days
of work.
Upon instructions from the management, a company security guard, visited
the respondent in his house on and confirmed that the latter was ill.
Union Motor, through its HR department, a memorandum terminating the
services of Alejandro for having incurred more than 5 consecutive absences
without proper notification.
Two days after the memorandum was issued, Dr. Pamor extracted
Alejandro's tooth. When Alejandro tried to return to work he was informed
that his employment was already terminated. Alejandro wrote to the
petitioner asking for the reconsideration of his dismissal, which was denied.
Alejandro filed with the arbitration branch of the NLRC, a complaint for
illegal dismissal against Union Motor. The complaint, however, was
dismissed by the LA.
When Alejandro appealed to the NLRC, the latter reversed the decision of
the LA. Later the CA affirmed the decision of the NLRC.
LEGAL MEDICINE 3C 2016-2017
Both the NLRC and CA decided that that medical certificates need not be
notarized in order to be admitted in evidence and accorded full probative
weight. Both held that the medical certificates which bore the names and
licenses of the doctor and the dentist who attended to the respondent
adequately substantiated the latter’s illness, as well as the tooth extraction
procedure performed on him by the dentist.
Union Motor contends that the un-notarized medical certificates submitted
should be inadmissible in evidence. Union Motor also contends that
Alejandro's dismissal was justified under Article 282(b) of the Labor Code,
which provides that an employer may dismiss an employee due to gross and
habitual neglect of his duties.
ISSUE:
1. WON the medical certificates submitted should be given evidentiary
weight.
2. WON Alejandro's dismissal is justified under the Labor Code.
HELD:
1. The contention of Union Motor has no merit. The Decision of the CA was
affirmed.
Nowhere in our jurisprudence requires that all medical certificates be
notarized to be accepted as a valid evidence
In this case, there is neither difficulty nor an obstacle to claim that the
medical certificates presented by complainant are genuine and authentic.
Indeed, the physician and the dentist who examined the complainant, aside
from their respective letterheads, had written their respective license numbers
below their names and signatures.
It has been said that verification of documents is not necessary in order that
the said documents could be considered as substantial evidence. The medical
certificates were properly signed by the physicians; hence, they bear all the
earmarks of regularity in their issuance and are entitled to full probative
weight
2. Union Motor has not sufficiently shown that the respondent had willfully
disobeyed the company rules and regulation. The petitioner also failed to
prove that the respondent abandoned his job. The bare fact that the
respondent incurred excusable and unavoidable absences does not amount to
Page 22
an abandonment of his employment. Union Motor’s claim of gross and
habitual neglect of duty pales in comparison to the respondent’s unblemished
record. The respondent did not incur any intermittent absences.
12. PEOPLE v. BASITE
FACTS:
On 1 September 1996 at around 10:30 in the morning, Sonia was in Natuel,
Buguias, Benguet, on her way to her parents home in Tinoc, Ifugao, to get
her allowance. As she was walking, she met Eddie Basite who was headed
towards the opposite direction. They passed by each other. A few seconds
later, Sonia heard footsteps behind her. When she looked back she saw Eddie
Basite following her. He reached her, held her by both hands and told her to
go down with him. Sonia resisted. But the accused Eddie Basite pulled out a
knife from his waistband, thrust it at her neck and threatened to stab her if
she continued to resist. He ordered her to lie down on the ground and out of
fear she obeyed.
The accused raped Sonia. Sonia felt pain in her vagina. She resisted but the
accused threatened to stab her. When he was through with the sexual assault,
he warned her not to relate the incident to anyone or else he would stab her.
Sonia pleaded with the accused to allow her to go home. Upon seeing that the
accused had laid down his knife beside her head while he was putting on his
clothes, Sonia grabbed the knife and stabbed him on the left shoulder.
Wounded, the accused ran away.
Sonia tried to put on her clothes, but losing her balance she rolled down the
cliff and lost consciousness. After which, Sonia made her way up the
mountain. Sonia proceeded to Monsoyohoy to wait for her uncle Nazario
Habungan who, she learned earlier, was going home and would pass by
Monsoyohoy.
As she was walking towards Monsoyohoy she met her uncle Nazario and
other relatives on the way and she narrated her ordeal to them. Together with
some companions they proceeded to the Abatan Police Station to report the
incident and to file a complaint.
LEGAL MEDICINE 3C 2016-2017
Passing through Bo-toan on their way to Abatan, Nazatrio saw Eddie Basite.
Nazario and his companions gave chase and caught up with the accused.
At the police station, Sonia was advised to undergo medical examination.
She went to the Abatan Emergency Hospital for the physical examination,
and to the Lutheran Hospital for the laboratory tests. She was issued a
medical certificate. The following day, 3 September 1996, Sonia filed her
Sworn Statement and a criminal complaint was formally lodged with the
Fiscals Office against Eddie Basite.
The prosecution presented Dr. Relante Raper of the Abatan Emergency
Hospital who testified on the medical findings he made upon examination of
Sonia Pa-ay. There were multiple healing scratches and contusions on her
arms, legs and inner thighs which could have been caused by the application
of an external force or the impact of a fall. Internal examination revealed that
there were no lacerations, scratches or bleeding on the perineal area and her
hymen was intact. The vagina admitted one (1) finger with difficulty. A
whitish mucoid discharge found over the labia minora was sent to the
Lutheran Hospital for microscopy. Examination of the discharge yielded
negative for sperm. Dr. Raper clarified that it was possible, even for a
married woman, to have an intact hymen since there are some hymen that are
very elastic.
The accused presented Dr. Ronald Bandonill of the NBI-CAR, Baguio City,
as an expert witness to dispute the findings of prosecution witness Dr.
Relante Raper. Based on Dr. Rapers findings that there was no bleeding or
scratches inside the genitalia and that the injuries were only outside the
genital area and on the upper and lower extremities of Sonia, Dr. Bandonill
opined that there was no insertion into the vagina and there was no physical
contact or sexual intercourse.
The trial court agreed with Dr. Bandonill that the Medico-Legal Certificate
issued by Dr. Raper was insufficient to conclude that sexual intercourse
actually took place. However, it still found the accused guilty beyond
reasonable doubt of the crime charged based on Sonias spontaneous,
forthright and positive testimony identifying the accused as the person who
raped her
Page 23
Accused-appellant assails the decision of the trial court.
ISSUE:
1. WON the trial court erred in not taking these testimonies into
consideration and relying solely on the declarations of Sonia
2. WON the trial court erred in disregarding Dr. Bandonills expert
testimony, especially in view of its ruling that the Medico-Legal Certificate
was inadequate to prove the alleged sexual intercourse.
RULING:
1. The accused fails to persuade us. In rape offenses, the lone
testimony of the complainant, if credible, straightforward, convincing and
otherwise consistent with human nature and the ordinary course of things,
may stand to convict the accused.
Sonia Pa-ay testified in a categorical, straightforward and consistent manner.
As observed by the trial court, she tearfully narrated the details of the sexual
abuse she suffered at the hands of accused-appellant and the circumstances
leading and subsequent thereto. She unwaveringly and positively identified
Eddie Basite as her defiler without any purpose other than to seek justice for
the crime committed against her.
jurisprudence holds that even without a medical examination, the accused
may still be convicted of rape as long as the testimony of the complainant
meets the test of credibility and resolutely points to the accused as the author
of the crime. A medical certificate is not indispensable to prove rape.
absence of fresh lacerations in the vagina does not prove that private
complainant was not sexually abused. For rape to be consummated, rupture
of the hymen is not necessary, nor is it essential that the vagina sustains a
laceration. Research in medicine even points out that negative findings are of
no significance, since the hymen may not be torn despite repeated coitus.
2. As to the opinions of defense expert witness Dr. Bandonill, it is
important to note that the testimony of expert witnesses must be construed to
have been presented not to sway the court in favor of any of the parties, but
LEGAL MEDICINE 3C 2016-2017
to assist the court in the determination of the issue before it.
The trial court merely used Dr. Bandonills testimony to determine for itself if
that Medico-Legal Certificate would satisfactorily show the results of a
complete and thorough physical examination of Sonia Pa-ay, consistent with
the physical examinations being conducted by the NBI and Dr. Bandonill.
WHEREFORE, the assailed Decision of the court a quo finding accused-
appellant EDDIE BASITE guilty of simple rape and sentencing him to
reclusion perpetua and to pay complaining witness Sonia Pa-ay the amount
of P50,000.00 as civil indemnity and P50,000.00 as moral damages is
AFFIRMED. Costs against accused-appellant.
SO ORDERED.
13. PEOPLE OF THE PHILIPPINES VS. JIMMY ALVERIO
FACTS:
Accused Jimmy Silverio was charged with the crime of Rape for
wilfully, unlawfully and feloniously having carnal knowledge with AAA
(Identity concealed). He was convicted by the lower court which was later
affirmed by the Court of Appeals.
According to the prosecution, on the night of June 2, 2002, AAA,
cousin of accused Alverio attended a dance event along with her friends.
Later that night, she decided to go home as she noticed that her friends were
no longer at the dance hall. And as she was on her way, Alverio, armed with
a knife, suddenly appeared and took hold of AAA. She tried to resist and
punch Alverio but she didn’t manage to pull away because of the fear that the
accused might retaliate. As she stopped resisting, the accused then proceeded
to insert his penis in her vagina repeatedly. Afterwards, the accused allegedly
warned her, that if she told anyone about what happened, he will kill her.
Dazed, AAA was not able to go home until his uncle passed by and brought
her to her parents where she told what happened.
Accused Alverio denied the accusation and posted the defense of
alibi saying that on the midnight of June 2, he was in the house of one Henry
Toledo, sleeping. His defense was corroborated by Toledo and the latter’s
mother, Lily Toledo.
Page 24

As he was convicted both by the RTC and CA, Alverio appealed
before the Supreme Court. He assailed the trial court’s act of giving credence
to the sole testimony of the victim, and claimed that the prosecution should
have presented other witnesses to corroborate the victim’s testimony. He also
contended that the medical certificate presented as evidence was not testified
to by the signatory and should therefore not be considered as corroborative
evidence.
ISSUE: Whether or not Alverio is guilty for the crime charged
HELD:
YES. The Court sustained the conviction of the accused
Citing the case of People v. Malate, the Court reiterated the principles in
determining the guilt of the accused in rape cases, to wit: (1) an accusation of
rape can be made with facility and while the accusation is difficult to prove,
it is even more difficult for the person accused, though innocent, to disprove
the charge; (2) considering that, in the nature of things, only two persons are
usually involved in the crime of rape, the testimony of the complainant
should be scrutinized with great caution; and (3) the evidence of the
prosecution must stand or fall on its own merit, and cannot be allowed to
draw strength from the weakness of the evidence for the defense.
Furthermore, in cases involving the prosecution for forcible rape,
corroboration of the victim’s testimony is not a necessary condition to a
conviction for rape where the victim’s testimony is credible, or clear and
convincing or sufficient to prove the elements of the offense beyond a
reasonable doubt. The exceptions to this rule are when the trial court’s
findings of facts and conclusions are not supported by the evidence on
record, or when certain facts of substance and value likely to change the
outcome of the case have been overlooked by the lower court, or when the
assailed decision is based on a misapprehension of facts.
As to the issue regarding the admission of the medical certificate, the
Court ruled that medical evidence is dispensable and merely corroborative in
proving the crime of rape. Besides, a medical certificate is not even necessary
to prove the crime of rape. The gravamen of rape is carnal knowledge of a
woman through force and intimidation. Moreover, Furthermore, Alverio’s
defense of alibi cannot stand versus the positive identification of AAA.
LEGAL MEDICINE 3C 2016-2017
Nothing is more settled in criminal law jurisprudence than the rule that alibi
and denial cannot prevail over the positive and categorical testimony and
identification of the accused by the complainant.
Supreme Court AFFIRMED the rulings of RTC and CA.
14. PEOPLE vs ENOLVA
FACTS:
At around seven o'clock in the evening of July 25, 1995, Rogelio Abunda and
his three-year old daughter Julie were shot while they were sleeping on the
floor of their house at Barangay Bagombong, Municipality of Minalabac,
Camarines Sur. Brought to the hospital, Rogelio Abunda was dead on arrival
from hemorrhagic shock, secondary to two gunshot wounds. Julie died the
following day at the Bicol Regional Hospital due to the gunshot wound that
she sustained which caused a raptured spleen and lacerated lung parenchyma.
Cresenciano "Sonny" Enolva y Alegre was charged in Criminal Case No. 95-
6021 and Criminal Case No 95-6047, filed respectively on November 15,
1995 and December 12, 1995
Dr. Antonio Borja Estanislao was the Municipal Health Officer who issued
the post mortem certificate for the autopsy conducted by him on the cadaver
of Rogelio Abunda on July 26, 1995. He testified that the cadaver at the time
of the examination, was already in the state of rigor mortis. There were two
gunshot wounds found on the body. The first, was found on the armpit, 2 cm.
In diameter, with its edges inverted, (edges were directed inwards) with
contusion collar (there was a contusion right around the wound) and with
gunpowder tattoing (blackened area around the wound). This was allegedly
the entry wound.
The second wound, also 2 cm. In diameter, its edges everted anterolateral
aspect, was found on the front left shoulder. This is allegedly the exit wound
because the edges are directed outwards. When asked on the possible
position of the victim at the time he was shot, Dr. Estanislao said that either
the victim's position was higher than the assailant or the victim was lying
down with the assailant in equal level as the victim so that the direction of
the slug was horizontal. The cause of death was hemorrhagic shock due to
assault by firearms and explosives.
Page 25

Major Lorlie Arroyo is a PNP member assigned as Forensic Chemist of the
Crime Laboratory at Region V, Camp Simeon Ola, Legaspi City. She was the
one who prepared Chemistry Report No. C-27-95 on the suspect Cresenciano
Enolva. She testified that she received the paraffin cast of Cresenciano
Enolva on July 28, 1995 upon request of the Chief of Police of Minalabac,
Camarines Sur. The specimen submitted to her was a pair of paraffin cast
taken from both hands of Cresenciano Enolva. The purpose of the laboratory
examination was to determine the presence of gunpowder residue (nitrates) in
the specimen submitted her laboratory examination consisted of adding
diphenylamine reagent to the dorsal portion of the paraffin cast and
thereafter, dark blue specks appeared on the cast which is an indication of the
presence of nitrates or gunpowder residue. These findings were stated in her
report in this manner: "Qualitative examination conducted on the specimen
mentioned above gave POSITIVE result to the tests for the presence of
gunpowder residue (nitrates)". She further testified that the presence of
gunpowder residue would still be very clear on the hands of the suspect
because the crime laboratory personnel at the Provincial Command of
Camarines Sur had taken the paraffin cast a day after the incident. Then it
was turned over to Camp Ola for examination on the 28th of July, 1995.
On cross-examination, she testified that plain washing of the hands with
water before the paraffin cast is done will not remove the nitrates or
gunpowder from the hand. As a matter of fact, the technician, prior to the
examination even washes the hands of the suspect with plain water
to eliminate contaminants adhering to the hands of the suspect. She further
explained that if someone handled fertilizer, like complete fertilizer which
contains nitrates, it is possible to have a blue speck of nitrates but its
appearance would be different from the nitrates residue coming from
gunpowder. Even if firecrackers have been exploded by the suspect, again
there would be a difference from the nitrates of gunpowder residue which is a
distinct blue speck.
Upon examination by the Court, Major Lorlie Arroyo said that a paraffin test
is conducted on the dorsal side of the hand because it is the portion which is
directly exposed to the firearm. In exploding firecrackers, the most
contaminated is the palm side of the hand not the dorsal side.
On redirect examination by the prosecutor, Major Lorlie Arroyo also
explained that contaminants from fertilizers or firecrackers can just be taken
off by washing the hands because they are soluble in water. Nitrates from
LEGAL MEDICINE 3C 2016-2017
gunpowder, however, are embedded in the pores of the skin, so ordinary
washing would not remove them. If they are examined, nitrates from that
embedded portion of the skin would appear very neatly as dark blue specks.
She was very positive that the nitrates she found in her examination of the
paraffin cast were gunpowder residue.
The accused Cresenciano denied that he shot Rogelio Abunda and Julie
Abunda. He claimed that he was sleeping in his house and was drank at the
time of the incident. The trial court upheld the version of the prosecution,
relying on the testimonies of the two persons who claim to be eyewitnesses
to the shooting, and the fact that gunpowder residue (nitrates) was found on
the paraffin cast taken from the hands of the accused. Finding that there was
treachery in the attack as the victims were asleep when they were shot, the
court found the accused guilty of murder.
ISSUE: WON THE COURT A QUO ERRED IN HOLDING THAT THE
GUNPOWDER (NITRATES) FOUND ON THE ACCUSED-APPELLANT
CONFIRM THE SUSPICION THAT IT WAS THE LATTER WHO
PERPETRATED THE CRIMES CHARGED.
HELD:
No. Accused-appellant's insistence that although he was found positive for
gunpowder residue (nitrates), there was no conclusive evidence as to the
exact source of the same. Thus, although Major Lorlie Arroyo testified on
cross-examination that the same "blue reaction" can "possibly" be caused by
exploding firecrackers and handling fertilizers, the same witness
categorically testified that both hands of the accused-appellant were found
positive of nitratesEsmmis
Major Arroyo on cross-examination explained that if someone handled
fertilizer, like complete fertilizer which contains nitrates, or exploded
firecrackers, the distinct blue speck of gunpowder residue would be different
"Q:......Is it possible also that nitrates can be found not only in
gunpowder but also in other elements?
A:......It can also be found, sir.
Q:......Like fertilizers use by farmers?
A:......Yes, sir.
Q:......So, it is correct to say that the fertilizer like urea and this
similar fertilizer used by farmers contain nitrates?
A:......Urea has no nitrates except for those what we call complete. It
has nitrates.
Page 26
 Q:......If a farmer has just handled fertilizer known as complete since
he has fertilized his farm if his hands are examined for nitrate
contents, is it possible that nitrate compound can be found on his
hands?
A:......It is possible to have a blue speck also for nitrates but the
appearance of the nitrates is different from that nitrate residue
coming from gunpowder.
Q:......And firecrackers contain also nitrates?
A:......Yes, sir, potassium nitrate.
Q:......If a person has just been recently exploding firecrackers
because there is a barangay fiesta and a paraffin test is conducted on
his hands, is it also possible to find nitrates on the paraffin cast on his
hands?
A:......It is also possible, sir, but it is also different since the nitrates
would be very abundant unlike that of the nitrates from gunpowder
residue, distinct blue speck there is an "abundance of blue color" on
the hands resulting from the firing of a gun. The crime committed is
murder qualified by treachery. When the victims were shot, they
were lying down completely unaware and had no way of defending
themselves. Thus, appellant employed means or methods to insure
the execution of the crime, without risk to himself. Evident
premeditation as alleged in the informations was not proven. There is
no evidence presented to show that the accused-appellant meditated
and reflected upon his decision to kill the victims and the intervening
time that elapsed before his plan was carried out. Settled in the rule
that when it is not shown as to how and when the plan to kill was
hatched or what time had elapsed before it was carried out, evident
premeditation cannot be considered.
Murder is punishable by reclusion perpetua to death which are two
indivisible penalties. In the absence of mitigating or aggravating
circumstances in the commission of the offense, the lower penalty shall be
applied. Hence, the imposable penalty is reclusion perpetua in both cases.
LEGAL MEDICINE 3C 2016-2017
15. ARTEMIO YADAO v. PEOPLE OF THE PHILIPPINES
FACTS:
It was petitioner Yadao's birthday, he had a few guests over at his
house to help him celebrate it. At around 9:00 a.m., petitioner Yadao noticed
the victim, Gundran, albeit not invited, to be milling around with the guests
and was already drinking gin. The afternoon of the said day, while Yadao
was sitting on one end of a bench, the victim, who happened to be lying
down on the other end of the same bench, suddenly stood up. Said bench
tilted due to the weight of Yadao, thus, causing him to fall to the ground.
Upon seeing him fall to the ground, the victim went over to Yadao and began
boxing him on the stomach. Yadao's wife tried to pacify her nephew but this
merely enraged the Gundran who then got a can opener and tried to stab
Yadao with it. Yadao deflected said attempt and delivered a slap on the face
of the victim in order to "knock some sense" into him. But because he was
already intoxicated, as he had been drinking since early that morning, the
victim lost his balance, hit his head on the edge of a table and fell to the
ground landing on his behind. The other guest helped the victim to stand up
and proceeded to show him to the door.
The victim, Gundran, left the house of petitioner Yadao, and
proceeded to the house of Carmelita Limon who was the sister of one of his
friends. The victim told her that Yadao "mauled" him. While she treated the
wound, the victim complained of pain on his breast/stomach area, the area
where he claimed to have been hit by petitioner Yadao.
Two days later, Teofilo Gundran, the father of the victim was
informed by his granddaughter that his son, the victim, was having difficulty
breathing. Teofilo Gundran saw the victim sitting on an "arinola" gasping for
breath. He then held the victim's two hands until the latter expired.
On the same day that he died, the body of the victim was autopsied
by Dr. Magdalena Alambra, Medical Specialist. An Autopsy Report was
made.
During the trial of the case, Dr. Alambra testified for the defense that
immediately after the death of the victim, she conducted the autopsy of the
body of said victim; that during the procedure, she made an internal, as well
as external, examination of the body of the victim; that half of the victim's
right lung was already gone; that although a hematoma was present on the
Page 27
victim's forehead, she did not consider it as the cause of death as hematoma
alone will not cause the death of a person especially seven to eight days later;
and, that when she opened the skull of the victim to study the latter's brain,
she did not see anything unusual. Dr. Alambra then confirmed that the cause
of death of the victim was cardio-respiratory arrest due to pulmonary
tuberculosis that was already so far advanced with massive pleural adhesions.
On cross, however, she stated that a person with only one lung left, with
proper medication, would still be able to live normally.
Disbelieving the autopsy report, Teofilo Gundran had the victim's
body re-autopsied, this time by the NBI. Dr. Llavore's autopsy report stated
that the cause of death was CEREBRAL EDEMA, SEVERE, SECONDARY
TO TRAUMATIC INJURIES; HEAD/
During the trial, prosecution witness Dr. Llavore testified that the
cause of death of the victim was the collective effect of all the injuries
sustained by the latter on the head. He explained that the forces that could
have caused the injuries to the victim's head were also the same forces that
could have caused the edema or swelling of the victim's brain. He illustrated
further that a human fist applied with "sufficient" force on the fronto-
temporo-parietalregion of the head could cause an injury the same as that
sustained by the victim on his forehead. On cross examination, Dr. Llavore
admitted that he did the re-autopsy seven (7) days after the victim died but
that his Autopsy Report failed to indicate that the cadaver had previously
been autopsied by another physician.
RTC rendered judgment finding petitioner Yadao guilty of the crime
of homicide. Aggrieved, petitioner Yadao appealed the aforequoted decision
to the Court of Appeals. The appellate court affirmed in toto the judgment of
conviction rendered by the RTC.
Yadao maintains that the existence of two autopsy reports entirely
differing as to the cause of death of the victim is tantamount to reasonable
doubt respecting his legal culpability thereto.
The Office of the Solicitor General, for its part, asserts that it is clear
from the record that Dr. Alambra failed to notice the brain injury sustained
by the victim because she merely relied on "gross findings" of said organ
during her autopsy.
LEGAL MEDICINE 3C 2016-2017
ISSUE: Whether or not the prosecution was able to prove the guilt of
petitioner Yadao beyond reasonable doubt on the basis of the testimonies of
the prosecution witnesses, especially Dr. Llavore's, and documentary
evidence presented, i.e., the Dr. Llavore's Autopsy Report.
RULING:
NO. The guilt of petitioner Yadao has not been proved beyond
reasonable doubt.
Though it was established that petitioner Yadao slapped the victim, and
as a result of which the latter fell down and struck his head on the edge of a
table, the prosecution nonetheless failed to show the nexus between the
injury sustained by the victim and his death. It failed to discharge the burden
to show beyond a reasonable doubt that the death of the victim resulted from
the use of violent and criminal means by Yadao.
In convicting Petitioner Yadao, the RTC and the CA principally
relied upon the testimony of Dr. Llavore in addition to the latter's autopsy
report, both essentially stating that the injury sustained by the victim in the
head caused massive hematoma and/or cerebral edema. However, we find
said testimonial and documentary evidence utterly insufficient on which to
anchor a judgment of conviction for homicide. To our mind, the conduct of
two autopsies done on said cadaver, do not engender a moral certainty, much
less a belief, that the injury sustained was the cause of his death.
This Court's doubt is brought about by Dr. Llavore's failure to
account the effects of the following facts: 1) that the cadaver had previously
been autopsied; 2) that during the first autopsy, Dr. Alambra opened up the
skull of the victim to physically examine his brain and did not see anything
out of the ordinary, neither blood clot and/or pooling nor any swelling; 3)
that the cadaver of the victim had already been embalmed; 4) that the re-
autopsy was conducted eight 8 days after the death of the victim and 5) that
the only hematoma noted inside of the cadaver's head was that on the scalp,
just below the skin, of the frontal right side of the head – nowhere near the
brain as the area was still outside of the skull.
Consequently, the post mortem report and testimony of Dr. Alambra
should not be easily discounted. The same is significant in that the testimony
and the report on the autopsy, which was done immediately after the death,
establishes the nature and extent of the "injury," sustained as a result of the
Page 28
assault, as well as the state of the brain and the surrounding area at the time
of death. The significance of said evidence will lead to the precise nature of
the injury sustained by the victim. From a legal perspective, therefore, the
examination of a wound should lead to the determination as to the degree of
danger of the wound and the danger it poses to the life or bodily function of
the victim when the wound was inflicted
.
Additionally, to delay the onset of decomposition, cadavers are
embalmed. The embalming fluid may render the tissue and blood unfit for
toxicological analyses. The embalming may alter the gross appearance of the
tissues or may result to a wide variety of artifacts that tend to destroy or
obscure evidence. Thus, the fact that such had already been embalmed, any
examination will likely lead to findings or conclusion not at all accurate as to
the true status of the tissues of the body of the victim.
From the above, absent further clarifications, Dr. Llavore's conclusion that
the victim's cause of death is cerebral edema is nothing but conjecture, being
tenuous and flawed.
Indeed, the evidence of the defense might not, by itself, suffice to
emphatically negate the causal relationship between the actions of petitioner
Yadao causing injury to the victim and the cause of his death, but the same
must be considered in conjunction with the weakness of the evidence given
by the prosecution's witness discussed above. Conviction must rest on the
strength of the prosecution's evidence, not merely on conjectures or
suppositions, and certainly not on the weakness of the accused's defense;
otherwise, the phrase "constitutional presumption of innocence" will be
reduced to nothing but an innocuous grouping of words; worse, to a
conspicuous exercise in futulity.
If the evidence is susceptible of two interpretations, one consistent
with the innocence of the accused and the other consistent with his guilt, the
accused must be acquitted. The overriding consideration is not whether the
court doubts the innocence of the accused but whether it entertains a
reasonable doubt as to his guilt. If there exist even one iota of doubt, this
Court is "under a long standing legal injunction to resolve the doubt in favor
of herein accused-petitioner.”
LEGAL MEDICINE 3C 2016-2017
From the foregoing, the inevitable conclusion is that the guilt of
petitioner Yadao has not been proved beyond reasonable doubt. The facts of
the case, the autopsy reports, as well as the testimony of Dr. Llavore do not
definitely establish that the assault was the proximate cause of the death of
the victim.
16. PEOPLE OF THE PHILIPPINES vs. EMETERIO ORZAME,
ET AL., EMETERIO ORZAME
FACTS:
In the evening of February 17, 1958, Dominador Magno, a barriomate of the
accused Emeterio Orzame, was called by Arturo Gallarde, his nephew, and
son-in-law of Orzame, to the house of the latter, where together they hatched
up the plan of killing the deceased Juan Dulay who was then insured for
P3,000.00, with Orzame as the sole beneficiary, with the purpose of sharing
the proceeds thereof among themselves. After setting all the wicked plan,
they agreed to meet again on February 23, 1958, on the occasion of the town
fiesta. On their way, Orzame picked up a bag from the nearby field and when
asked what the content was, he deliberately lied by saying that it contained
bread. After walking for some time, they hit upon a railroad track at barrio
Balingog, Guimba, Nueva Ecija, where they sat supposedly to get some rest.
Thereupon, Orzame, taking advantage of the situation, pulled out a
Thompson sub-machine gun from the bag and with its handle he immediately
began hitting Juan Dulay several times on the right ear, face and back of the
head while the said Juan Dulay was still sitting down, causing his instant
death.
Upon instruction of Orzame, the body of the deceased was carried to barrio
Calibungan Victoria, Tarlac, where, although already dead, it was still
subjected to further beatings with the Thompson sub-machine gun causing
the brain to scatter, and was also stabbed on the face with a knife several
times by Orzame. Then the deceased was lain across the railroad track to
simulate a train accident as the cause of death.
The following day, February 24, 1958, the body of the deceased Juan Dulay
was found lying near the railroad tracks and among those who saw it was
Jeremias Damo who identified the deceased as Juan Dulay.
Page 29

The important defense of the accused is alibi. According to him he fell sick
and was kept in a bed a week before February 23, 1958. On the said date, his
son Lorenzo went to the poblacion of Guimba to call for a physician, Dr.
Felipe Batangan, the municipal health officer. But due to the town fiesta, Dr.
Batangan was unable to go so Lorenzo went to Dr. Benjamin Castañeda who
consented to treat Orzame.
Dr. Castañeda, in corroborating the alibi of Orzame, alleged that he arrived in
Orzame's house at 4:00 o'clock p.m. on February 23, 1958; that after
examining Orzame he diagnosed the illness as lobar pneumonia with high
fever, headache, and in a state of delirium; that he gave some antibiotics, plus
supportive medicines as caffein, sodium benzoate to support the heart, and
other drugs.
Orzame alleged further that Juan Dulay lived with his family during the
Japanese occupation and was like a brother to him and, therefore, cannot kill
him and that Dominador Magno testified against him because they quarreled
and almost boloed each other.
The version of the appellant was doubted by the lower court on the following
reasons: (1) According to Dr. Castañeda when he was called to treat Orzame
on February 23, 1958 the sickness of Orzame was lobar pneumonia with high
fever, headache. shivering or trembling, and the patient was in a state of
delirium and that, in his opinion, his said patient would be cured in two or
three weeks. However, the next time he visited Orzame on February 25,
1958, two days after the first visit of said Castañeda, his patient was already
cured, although weak and that was the last time he visited his patient.
The lower court, in doubting this defense, said that it is easy for anybody to
pretend to be sick and that headache cannot be seen or felt except by one who
claims to have it. (2) It was proven that Orzame was the one who paid the
premiums of the life insurance of Juan Dulay up to May 15, 1958. And there
is no doubt that the motive of the accused in killing Juan Dulay was to collect
the P3,000.00 value of the victim's insurance policy. (3) The alleged quarrel
between Orzame and Magno was not sufficient or strong enough for Magno
to impute falsely a very grave crime against Orzame. Besides, nothing
happened in the alleged quarrel between them. (4) The lower court
considered the fact that the Thompson sub-machine gun, Exhibit 1, used by
Emeterio Orzame in killing Juan Dulay on the night of February 23, 1958
LEGAL MEDICINE 3C 2016-2017
was confiscated from him, for which reason he was charged and convicted
with illegal possession of firearm.
Issue:
1. WON the testimony of Dominador Magno is uncorroborated and
comes from a polluted source, the witness being a former co-accused
who was discharged from the complaint to become a state witness?
2. WON the lower court erred in stating that the cause of death was due
to severe traumatic shock as a result of the blows inflicted upon the
victim.
Held:
1. Solicitor General observes in his brief "that although Magno was
discharged from the information and used as a state witness, said
circumstances should not be considered against his credibility. This is so
because his testimony at the trial incriminating the herein appellant was but a
reiteration of his affidavit and his testimony during the preliminary
investigation both of which were subscribed by him long prior to his
discharged. Besides, "an uncorroborated testimony of a witness is sufficient
to convict a co-accused, if and when the court gives it full faith. In the
determination of the values and credibility of evidence, witnesses are to be
weighed and not numbered. The testimony of only one witness, if credible
and positive ... if it satisfies the court beyond reasonable doubt, is sufficient
to convict".
2. The post mortem examinations on the body of the victim made on
February 24, 1959, at 12:30 p.m., to wit:
xxxxxxxxx
4. Plenty of clotted blood in front, neck and back of his polo shirt and
few spotted blood in front of his trousers corresponding to the thighs.
5. The skull of his head at the vertex was badly battered and opened
crosswise and most of the brain substance was missing and the
remaining brain substance appeared like mash potatoes with small
amount of blood mixed with it.
6. Punctured wound of the middle of his chin in front, punctured
wound just below the left nostril, punctured wound 1 cm. lateral to
Page 30
 the left bridge of his nose, punctured wound between the eyebrows
and clotted blood at the surface of each wound.
7. The face was greatly deformed and swollen with clotted blood all
around, with depression of the lower forehead the bridge of his nose
and the upper jaw at the front including the skull sockets of the eyes.
8. No findings of external violence at the other parts of his body.
9. The cadaver was already at the state of rigor mortis so that he
might have been killed 10 hours before autopsy and probably the
assailants only dumped him in one of the rails of the railroad to
disguise that he had been run over by the train.
AUTOPSY FINDINGS: 1. Head and Neck
(a) The skull of his head at the vertex was badly battered and opened
crosswise as a result of the bumper of the train striking it, part of the skull
missing so that most of the brain substance appeared like mash potatoes with
small amount of blood mixed with it.
(b) The skull of the lower portion of the forehead was fractured crosswise
including the skull sockets of both eyes injuring both optic nerves including
the upper jaw in front was fractured causing the removal of the first two
incisors teeth.
xxxxxxxxx
Impression of the case is that the cause of death was due to severe traumatic
shock as a result of the blows inflicted upon him causing the fracture of the
skull of the lower portion of the forehead at the middle including the skull
sockets of both eyes injuring both optic nerves, fracture of the bridge of his
nose, crosswise, fracture of the upper jaw in front resulting in the removal of
the first two incisors teeth. confirm Magno's testimony that the victim was
struck with the handle of the sub-machine gun and stabbed with a knife by
the accused several times. Premises considered, the decision appealed from
being in conformity with the law and the evidence, the same is hereby
affirmed in all respects.
LEGAL MEDICINE 3C 2016-2017
17. PEOPLE V. MARIANO
Facts:
Michelle Priol, then only sixteen (16), left home for Manila in
January 1996 to work as a domestic helper. Soon enough Michelle found
herself hired at the household of the sisters Ruth Mariano and Ruby Mariano
in Bambang, Pasig City. Jenny Priol, Michelle's older sister, testified that she
often visited Michelle at the Mariano.residence. Jenny said that they are
being constantly watched by the Mariano sisters and denied their privacy.
Ruth and Ruby brought Michelle to her sister Jenny to complain to her that
their rice cooker no longer functioned and heaped the blame on Michelle. On
that occasion Jenny noticed that Michelle's hair was unevenly cut to the
scalp. Michelle told her that it was Ruby who gave her the ugly haircut.
Jenny then told Ruby that she was going to take her sister back from them
but the furious Ruby hurriedly left with Ruth, taking Michelle with them.
That was the last time Jenny saw her younger sister alive.
On 17 August 1997 at around 6:00 o'clock in the evening, SPO2
Edgardo Hernandez of the Pasig Police Station received an anonymous call
reporting that a woman was seen in Bambang, Pasig City, carrying a
rectangular box with a human leg protruding. They conducted a "stake-out
and surveillance operation". After a couple of minutes, the police officers
spotted two (2) women boarding a car with the reported plate number UPR-
561. They turned out to be accused-appellants Ruth Mariano y Lara and
Ruby Mariano y Lara. Upon opening the compartment, SPO2 Hernandez was
greeted by a putrid odor emanating from a decomposing body inside the box.
Ruth and Ruby identified the body as that of their maid Michelle Priol.
The result of autopsy stated that the body was found to be poorly
nourished and already in a state of decomposition. The skin and underlying
soft tissues on the chest appeared to have been gnawed by rats apparently
attracted to the exposed scalded flesh resulting from the repeated splashing of
boiling water, and that the victim had died two (2) to three (3) days prior to
the autopsy.
Ruth claimed that they caught Michelle stealing money and jewelry
from their bedroom several times. Because of that, fights between Ruth and
Michelle often occur. On 22 June 1998 Ruth arid Ruby were convicted of
Page 31
murder by the trial court. Accordingly, Ruth was sentenced to death while
Ruby was found guilty as an accomplice and sentenced to reclusion temporal.
Issue:
(1)Whether or not Ruth Mariano is guilty of crime of murder?
(2) Whether or not Ruby Mariano should be acquitted?
Held:
(1)Yes.
Accused-appellant's brutality was confirmed by Dr. Emmanuel L.
Aranas who concluded in his autopsy report that the cause of death of the
victim was "multiple traumatic wounds, and first and second degree scalding
burns covering 72% of the body surface," which were the very same injuries
accused-appellant admitted she had inflicted on the victim. Dr. Aranas
testified –
Q: And after conducting the examination, what was the cause of death that
you found?
A: Well, the cause of death Ma'am, is the multiple traumatic injuries, as well
as the scalding burns, first to second degree recovering 72% of the surface
area.
Q: Combined together?
A: Yes, your honor. All these are contributory to the death of the deceased.
These medical findings when combined with accused-appellant's
judicial admission, certainly wove a tight web of evidence as to accused-
appellant's culpability. They clearly established her guilt to a moral
certainty, for which she could not escape punishment.
(2) Yes.
As to the liability of accused-appellant Ruby Mariano, there is no
solid evidence on record effectively linking her to the gruesome killing of
Michelle Priol. Accused-appellant Ruby Mariano is the sister of accused-
appellant Ruth Mariano. As such, their relationship exempts appellant Ruby
Mariano from criminal liability under Art. 20 of RPC. It is based on ties of
blood and the preservation of the cleanliness of one's name, which compels
one to conceal crimes committed by relatives so near as those mentioned in
the above-quoted article. This Court is thus mandated by law to acquit
accused-appellant Ruby Mariano.
LEGAL MEDICINE 3C 2016-2017
19. BAYQUEN VS CA
FACTS:
The victim Teofilo Estepa arrived home in his house( Baguio City). His older
sister, 22 year-old Bernadette Estepa was already home. To celebrate his
birthday, Bernadette and Teofilo dined together. Teofilo then told his sister
that is anyone asked for him to say that he was asleep, adding that he had
nothing to do with what happened. Bernadette inquired but Teofilo merely
said "Pinasubodac", meaning "I was led into trouble". However, nobody
came to see Teofilo Estepa.
The following day, Bernadette was asked by Virgie Corpuz, who was their
boarder at the basement and who came up with her mother-in-law to use the
phone, if Teofilo was already home. When she replied that he was still in
school, Virgie Corpuz told Bernadette that earlier that afternoon Barangay
Captain Albert Della and Dr. Bayquen, father of Mark Bayquen, came to the
house looking for Teofilo and leaving word that if Teofilo did not show up
that same night they will pick him up on the first hour the following morning.
At that juncture, Teofilo arrived. Immediately, Virgie Corpuz told him what
she had just told Bernadette. Teofilo said that he had nothing to do with the
destruction of the motorcycle and he will tell what really happened if he had
to. Teofilo asked permission from his sister to go out to look for appellant
Wilfredo Boco whom he said was his companion in the motorcycle incident.
He came back at about 10:00 p.m., telling that her was not able to find Boco
and instructed her to wake him up at 4:00 a.m. the next day, July 25, 1984, so
he could review for his examinations.
Before 4:00 a.m. of July 25, 1984, Bernadette Estepa was awakened by a
commotion outside her room as if a door was being closed. She notice from
the space under the door that the light on the sala was turned on so she got up
and tried to open the door but could not. It was as if somebody was pulling
the door knob outside. Thinking that it was only her brother, she returned to
her bed and went back to sleep. After about 5 minutes, she was awakened by
the alarm clock which she previously set at 4:00. She called out Bong several
times but nobody answered so she got up to wake him up per his request. She
opened the door, this time without any difficulty. Since the lights in the sala
and kitchen were on, showed immediately noticed Bong's room which is
about 13 meters from her's opened. She walked to the room but was surprised
Page 32
to see it in complete disarray. Bongs books and beddings were scattered on
the floor. As she was calling his name she heard two gunshots coming from
downstairs. Immediately she went down and there she saw at the stair
landing her brother, Bong, lying face down. She lifted him up and noticed
that he was bleeding. She asked him "why". Bong answered in Ilocos,
"Pinaltogandak ken sinasakdak" (They shot and stabbed me.) Bernadette
asked him who did it and he answered clearly, "Mark Bayquen and Boco".
She leaned him on the sofa and tried to call Baguio Police Station but failed
to connect. She also called Camp Allen to report the incident. Thereafter, she
went to the kitchen door and called Virgie Corpuz for some help. Virgie
called and was able to contact the police station. Bernadette then requested
Bongbong to bring the victim to the hospital. She and Bongbong helped
Teofilo, who was already weak, to go downstairs, When a police jeep
arrived. Immediately they assisted Teofilo to bound (sic) the jeep and they
proceeded to Notre Dame Hospital. On their way, Bernadette did not tell
anything to the police. It was about 20 minutes from the time Bernadette
discovered her brother bleeding up to the time they reached the emergency
room of the Norte Dame Hospital. An hour after, Teofilo was pronounced
dead on arrival. Again Bernadette kept mum about the death of her brother
but upon advise of Dra. Cabato, consented to the autopsy of the cadaver of
her brother.
Wilfredo Boco and Mark Bayquen were charge before the Regional Trial
Court of Baguio City for the crime of Homicide Code.
That on or about the 25th of day of July, 1984, in the city of Baguio,
Philippines, the above-named accused, conspiring, confederating and
mutually helping one another, with evident premeditation, being then armed
with gun and a bladed weapon, did then and there wilfully, unlawfully, and
feloniously attack, assault, shot and hack or would TEOFILO ESTEPA,
thereby inflicting upon him cardio respiratory failure secondary to massive
hemorrhage and gunshot wound injuring the heart, liver and lung, and as a
result thereof the said Teofilo Estepa died thereafter.
After trial, the court rendered its decision finding accused Mark Bayquen and
Wilfredo Boco guilty beyond reasonable doubt of the offense of Homicide
(CA decision pp. 32-22, Rollo)
From the judgment of conviction, Boco first appealed the decision
LEGAL MEDICINE 3C 2016-2017
On the other hand, Bayquen (Petitioner) separately appealed, raising the
following errors:
Two separate appellee's briefs were filed by counsel for the people.
The Court of Appeals, rendered its decision affirming in toto the findings of
the trial court, with costs against the accused-appellants.
Boco filed a motion for reconsideration which was denied for insufficiency
of form and substance.
Petitioner on the other hand, filed the instant petition premised on the Court
of Appeals alleged failure to consider/apply specific provisions of law, or
applicable jurisprudence, as follows:
(a) the application of the res-gestae rule;
(b) the unwarranted and unreasonable delay in reporting the
alleged "dying declaration" which defies credulity;
(c) the fact that there was object or real evidence of a
robbery;
(d) the lack of motive on the part of your petitioner and his
co-accused and the failure to prove conspiracy;
(e) the fact that the judge who rendered the decision was not
the one who heard the testimony of witness Bernadette
Estepa;
(f) the credible, convincing and satisfactory defense of the
accused.
Petitioner faults the appellate court for upholding the trial court's reliance on
the sole testimony of Bernadette Estepa, the deceased's sister, who had
pointed to Wilfredo Boco and Mark Bayquen ads the persons who "shot and
stabbed" her brother Bong Estepa, based on Bong's dying declaration. The
petitioner believes that the ante-mortem statements should have been
disregarded considering that they were revealed 14 days after Bong Estepa's
death on July 24, 1984 or on August 8, 1984.
ISSUE: WON the petitioner is guilty of the crime charged.
Held:
Page 33
The judgment of conviction against petitioner was reversed and set aside, and
petitioner is acquitted of the crime charged
In the same manner, Bernadette's excuse in the present case for not divulging
the dying declaration of her brother, Bong Estepa, was that she was afraid
because she was all alone since her parents, brothers and sisters were all
abroad. Strangely, however, this was not her attitude, when, in the morning
of the incident, she ventured out into the dark alone at 4:00 in the morning,
walked down the stairs despite the sound of two gunshots.
Nonetheless, granting her fears, the Court cannot understand why she still
failed to go to the police authorities upon arrival from Germany of her father
and her mother, brothers and sister, from the States. The physical presence of
these persons would have provided her the necessary moral support and
would have shielded her from feared reprisals.
Moreover, the autopsy findings (Exh. "B") states:
xxx xxx xxx
4. Presence of a gunshot wound 1/8" in diameter; edges very black
located below and medial to the left nipple;
a). penetrating the chest wall between the 6th and 7th ribs, 2
inches from the misternal line,
b) perforating the tip of the right ventricle
c) penetrating the left side of the diaphragm
d) perforating the liver
e) penetrating the right side of the diaphragm
f) perforating the lower lobe of the right lung
g) bullet lodged at the level of the right floating rib 4 inches
from the right posterior axillary line, Bullet is colored lead
and copper, with a diameter at its base of .38 in. and a length
of 6/8 in. (Bullet given to BCPD).
xxx xxx xxx
Dra. Florita Ferrer-Garcia, a physician of the Baguio General Hospital, who
conducted the autopsy, testified as follows:
LEGAL MEDICINE 3C 2016-2017
Q In No. 4 of your post-mortem report, it is stated "presence
of a gunshot wound 1/8" in diameter." [I]s this the wound that caused
the ultimate death of the victim in this case Teofilo Estepa?
A Yes, sir.
Q You also mentioned . . .
COURT:
Q Will you please explain why that wound according to you
was the cause of the death of the victim?
A Because the wound has perforated vital organs which
when injured is fatal.
xxx xxx xxx
Q In letter "h" of this report Doctora which is marked a
Exhibit "B" there is mentioned of 2 slits 3/8" in length on the skin
over where the bullet is lodged. Would you please describe these slits
and will you give us an opinion what caused these slits?
A This slits is just a linear opening measuring 3/8 inch. in
length, over the skin. And underneath it is the bullet. The probable
reason of the slit is the foreign object underneath the skin which has
caused pressure on the skin but was not able to get out.
Q So, could we assume that these slits were caused by the
impact of the bullet going in?
A Yes, sir. (T.S.N., February 28, 1985, pp. 9-10)
Contrary, therefore to Bong Estepa's dying declaration that he was "shot and
stabbed", Bong Estepa died of a single gunshot wound. He was not stabbed.
In sum, the prosecution's case rest entirely upon the identification of
petitioner and Wilfredo Boco made to Bernadette Estepa by the deceased
Bong Estepa. As We have pointed out earlier, however, considering the
belated disclosure, We are not inclined to give weight to the alleged dying
declarations of Bong Estepa. As the Chief Justice in the Hernandez case
(supra), pointed out: "The ante mortem statements being thus relegated to
limbo, . . . very little remains by way of evidence upon which to rest a verdict
of conviction" against petitioner.
Page 34
 20. CUSTODIO v. SANDIGANBAYAN
FACTS:
On December 2, 1985, the Sandiganbayan rendered a Decision acquitting all
the accused, which include the petitioners. However, the proceedings before
the Sandiganbayan were later found by this Court to be a sham trial (Galman
vs Sandiganbayan). The Court thus nullified said proceedings, as well as the
judgment of acquittal, and ordered a re-trial of the cases. A re-trial ensued
before the Sandiganbayan. the Sandiganbayan, while acquitting the other
accused, found the petitioners guilty as principals of the crime of murder.
The judgment became final after the Supreme Court denied petitioners’
petition for review of the Sandiganbayan decision for failure to show
reversible error in the questioned decision, as well as their subsequent motion
for reconsideration. In August 2004, petitioners sought legal assistance from
the Chief Public Attorney who, in turn, requested the Independent Forensic
Group of the University of the Philippines to make a thorough review of the
forensic evidence in the double murder case. The petitioners, assisted by the
Public Attorney’s Office, now want to present the findings of the forensic
group to this Court and ask the Court to allow the re-opening of the cases and
the holding of a third trial to determine the circumstances surrounding the
death of Senator Benigno Aquino, Jr. and Rolando Galman. Petitioners
invoke the following grounds for the re-opening of the case: (1) Existence of
newly discovered pieces of evidence that were not available during the
second trial of the above-entitled cases which could have altered the
judgment of the Sandiganbayan, specifically the abovementioned
independent forensic evidence uncovering the false forensic claims that led to
the unjust conviction of the petitioners-movants and a key defense
eyewitness to the actual killing of Senator Benigno Aquino, Jr; (2) There was
a grave violation of due process by reason of insufficient legal assistance of
counsel, deprivation of right to counsel of choice and that testimonies of
defense witnesses were under duress.
This is a Motion To Re-Open Case With Leave Of Court filed by petitioners
who were convicted and sentenced to reclusion perpetua by the
Sandiganbayan in Criminal Cases Nos. 10010 and 10011 for the double
murder of Senator Benigno Aquino, Jr. and Rolando Galman on August 21,
1983.
ISSUE: WON Petitioners are entitled to a re-trial.
LEGAL MEDICINE 3C 2016-2017
RULING:
NO. Petitioners anchor their motion on the ground of newly discovered
evidence. Courts are generally reluctant in granting motions for new trial on
the ground of newly discovered evidence for it is presumed that the moving
party has had ample opportunity to prepare his case carefully and to secure
all the necessary evidence before the trial. If the alleged newly discovered
evidence could have been very well presented during the trial with the
exercise of reasonable diligence, the same cannot be considered newly
discovered.
During the trial, the Sandiganbayan held that the trajectory of the fatal bullet
which killed Sen. Benigno Aquino, Jr. was, indeed, "forward, downward and
medially." For the reason that the wound of entrance was at a higher
elevation than the wound of exit, there can be no other conclusion but that
the trajectory was downward. The bullet when traveling at a fast rate of speed
takes a straight path from the wound of entrance to the wound of exit. It is
unthinkable that the bullet, while projected upwards, would, instead of
exiting to the roof of the head, go down to the mandible because it was
allegedly deflected by a petrous bone which though hard is in fact a mere
spongy protuberance, akin to a cartilage.
The finding that the fatal bullet which killed Sen. Benigno Aquino, Jr. was
directed downwards sustains the allegation of prosecution eyewitnesses to
the effect that Sen. Benigno Aquino, Jr. was shot by a military soldier at the
bridge stairs while he was being brought down from the plane. Rebecca
Quijano saw that the senator was shot by the military man who was directly
behind the Senator while the Senator and he were descending the stairs.
Rebecca Quijano’s (prosec witness) testimony in this regard is echoed by
Jessie Barcelona, Ramon Balang, Olivia Antimano, and Mario Laher, whose
testimonies the Court found likewise as credible. The report of the forensic
group may not be considered as newly discovered evidence as petitioners
failed to show that it was impossible for them to secure an independent
forensic study of the physical evidence during the trial of the double murder
case. It appears from their report that the forensic group used the same
physical and testimonial evidence proferred during the trial, but made their
own analysis and interpretation of said evidence. The materials used by the
forensic group were available to the parties during the trial and there was
nothing that prevented the petitioners from using them at the time to support
Page 35
their theory that it was not the military, but Rolando Galman, who killed
Senator Aquino. Petitioners, in their present motion, failed to present any
new forensic evidence that could not have been obtained by the defense at
the time of the trial even with the exercise of due diligence. If they really
wanted to seek and offer the opinion of other forensic experts at the time
regarding the physical evidence gathered at the scene of the crime, there was
ample opportunity for them to do so before the case was finally submitted
and decided.
The same is true with the statement of the alleged eyewitness, SPO4
Cantimbuhan. His narration merely corroborates the testimonies of other
defense witnesses during the trial that they saw Senator Aquino already
walking on the airport tarmac toward the AVSECOM van when a man in
blue-gray uniform darted from behind and fired at the back of the Senator’s
head. A new trial will not be granted if the new evidence is merely
cumulative, corroborative or impeaching. As to the petitioners claim that they
were denied due process, . The records will bear out that petitioners were
ably represented by Atty. Rodolfo U. Jimenez during the trial and when the
case was elevated to this Court. An experienced lawyer in criminal cases,
Atty. Jimenez vigorously defended the petitioners’ cause throughout the
entire proceedings. Finally, the Court was not moved by petitioners’ assertion
that the forensic evidence may have been manipulated and misinterpreted
during the trial of the case. Again, petitioners did not allege concrete facts to
support their crass claim. Hence, we find the same to be unfounded and
purely speculative.
IN VIEW WHEREOF, the motion is DENIED.
22. PEOPLE OF THE PHILIPPINES vs. DANILO VIZCARRA,
LEOBINO SALAMATIN, JOSE DELOS REYES and LIBERATO
FERNANDO
Facts:
In the evening of June 25, 1969, herein accused-appellants together
with Patricio Verdote, Rogelio Vismanos and Rodolfo Bagtasos (hereinafter
referred to as conspirators) conspired together in the commission of the crime
of rape against the person of Erlinda Manzano (Erlinda), which was executed
LEGAL MEDICINE 3C 2016-2017
by taking turns while the others held the victim. During this incident, Erlinda
died, because, as found by the medico-legal officers, she was strangled by a
piece of cloth tied around her neck. Thus, the cause of death is the
strangulation and not the gang rape.
The conspirators, except Vizcarra (since he was then at large), were
apprehended by the police officers, and upon investigation, narrated on how
they committed the aforesaid crime of rape upon the person of Erlinda. A
complaint was then filed against the conspirators, while Rodolfo Bagtasos
was discharged and utilized as a witness. Vizcarra was still at large at the
commencement of the trial, but was subsequently apprehended. After trial,
the Court of First Instance (CFI) acquitted Patricio Verdote and Rogelio
Vizmanos, and convicted the others (accused-appellants) with the crime of
rape with homicide and sentencing them to suffer the capital penalty of
death. In view of the penalty imposed, the case was automatically elevated to
the Supreme Court (SC/Court) for automatic review.
Issue: Whether or not herein accused-appellants are guilty beyond
reasonable doubt of the crime of rape with homicide.
Ruling:
Yes. The Court agreed with the CFI when the latter court ruled that
the alibis presented by the accused-appellants cannot overcome the evidence
against them as well as the clear and positive identification made by their co-
conspirator Bagtasos, considering that alibis can be easily manufactured, and
is thus, a very weak defense.
Moreover, the challenge of the accused-appellants against the
admissibility of their respective extrajudicial statements on the ground of
force and intimidation by the investigators during the investigation conducted
with them cannot be sustained for the reason that their responses to the
investigators were so candid and informative as to indicate the lack of any
extraneous pressure on their mind. Also, when the medico-legal officer
examined the accused-appellants, at the request of the City Mayor of Quezon
City, the medico-legal officer found no sign of maltreatment or torture.
However, the Court said that the accused-appellants, with the
exception of Vizcarra, cannot be said to be equally responsible for the death
of Erlinda, since it is undisputed that it was Vizcarra alone who strangled the
Page 36
victim. Moreover, while they conspired to rape the victim, it was found that it
was not part of their plan to kill her. But the Court still affirmed the
imposition of death penalty in view of the presence of aggravating
circumstances – night time and abuse of superior strength.
23. PEOPLE OF THE PHILIPPINES vs. SIEGFRED FAJARDO
FACTS:
At around 7:00 p.m., while complainant, Ma. Charity Lazaro was
walking alone, the accused held her arm saying he loves her, whereupon she
retorted "Are you crazy". She tried to extricate from his hold but the accused
boxed her in the stomach where, she fell to the ground unconscious. When
she regained consciousness, she was already naked while the accused was
standing zippering his shorts, after which he ran away. Her whole body was
painful and blood was oozing from her private part which was likewise very
painful. She dressed and walked to the house of her aunt and reported that
she was raped. The father arrived and after investigating complainant
immediately reported the matter to the barangay captain, then with
complainant, reported the same to the police in.
That same night, they proceeded to Dr. Renato V. Cruz in Angat but
she was medically examined only the following day. According to Dr.Cruz's
findings, the hymenal part admits one (1) to two (2) fingers with slight
difficulty. Presence of old lacerations (more than 30 days old) was found at
3:00, 7:00 and 10:00 o'clock of the hymen. Also found was a 1/4 inch
diameter abrasion, at upper outer quadrant of the left breast, Dr. Cruz advised
complainant to have a vaginal smear to determine the presence of semen. He
did not discount the possibility of rape since according to him the hymen is
elastic but is sure that there were no new lacerations.
The father later asked for a copy of the doctor’s examination but was
not given and doubting the doctor's findings alleging the latter's relationship
with the accused, he brought his daughter to the NBI and was examined. Dr.
Nieto Salvador found the hymen superficially lacerated 7:00 o'clock but
healing, edges are slightly edematous and with fibrin formation; deep
laceration at 3:00 o'clock and 9:00 o'clock, edges edematous. No evident sign
LEGAL MEDICINE 3C 2016-2017
of extragenital physical injuries on the body and the hymenal lacerations
were healing. Dr. Salvador said that the injuries were inflicted two or three
days before examination as fibrin formation which indicate healing was
present.
Fajardo states that complainant Ma. Charity Lazaro was his girlfriend
and that he never raped her. He alleged that Lazaro was walking towards
home at about 5:00 in the afternoon. She was met by the accused who was
then a boyfriend of said private complainant. The accused accompanied her
to the house of the private complainant. They were talking about their
relationship while walking along the street and before they parted they kissed
each other at a place near the gate.
Later in the evening Marcelino Agustin, uncle of the private
complainant went to the house of the accused and told the accused's father
that Fajardo embraced the private complainant. He, however, advised the
father of the accused not to see the barangay captain as he might meet there
the father of the complainant.
ISSUES:
A. Whether or not the inconsistencies by the private doctor and the NBI was
sufficient to disprove the crime of rape.
B. Whether or not the complainant sufficiently established the crime of rape.
RULING:
1. The court is thus confronted with two sets of conflicting medical
certificates, one issued by Dr. Cruz and the other issued by Dr. Salvador,
medico-legal of the NBI. The medical certificate issued by the former dated
August 15, 1982 found old healed lacerations (more than 30 days old) while
the latter's medical certificate dated August 12, 1982 concluded that the 3
lacerations two of them deep were fresh and healing (around two or three
days old) exactly coincided with the alleged rape of August 9, 1982.
Despite his findings however, Dr. Cruz did not discount the
possibility of rape and suggested a vaginal smear. On the other hand NBI
medico-legal was emphatic that complainant had sexual intercourse and the
lacerations were the result of such intercourse.
The court ruled that greater weight should be given to the medical
examination conducted by the NBI which is a police agency under the
Department of Justice tasked by the government to conduct or perform
Page 37
medico-legal work should be afforded full faith and credit because not only
could Dr. Salvador be categorized as a disinterested witness, he also enjoys
the presumption of regularity in the performance of official duty. On the
other hand, Dr. Cruz being a private medical practitioner in Angat, Bulacan,
can not avail of this presumption. His private clinic is well known there and
serves the general public, his relatives, friends, and acquaintances.
The testimony of complainant's foster father that Dr. Cruz is related
to the accused cannot just be dismissed casually and it becomes credible
when it remained unrebutted. He is therefore not a disinterested witness.
The court affirmed the findings of the trial court to give greater
weight to the medical findings of the NBI physician. Not only is he a
medico-legal expert whose duty is to look into medico-legal cases but he is a
completely disinterested witness.
Appellant's testimony that complainant's uncle, Marcelino Agustin,
followed him home after having seen appellant embrace complainant near the
gate of the house, and reported the matter to appellant's father who suggested
that they see the barangay captain about the incident but later decided not to,
is utterly incredible. If complainant and appellant were really sweethearts and
were getting along very well, she would not accuse him of such a serious and
heinous crime. All these cast doubts on appellant's version. There was
absolutely no reason for her to falsely accuse appellant. Moreover, her
alleged inconsistency, that she was raped at 7:00 p.m., and her statement on
cross-examination that she reached the place of incident about 7:00 p.m., are
trivial and minor so that they do not impair the complainant's credibility.
Complainant's torn and bloody pants, soiled shirt, abrasion in her
breast and three fresh lacerations on her hymen are mute but eloquent proof
of her dishonor.
24. PEOPLE OF THE PHILIPPINE V. NOEL DION
DOCTRINE: The medical examination of the victim as well as the
medical certificate is merely corroborative in character.
FACTS:
LEGAL MEDICINE 3C 2016-2017
Accused-appellant Noel Dion y Duque (Dion) was charged
with two counts of rape in two separate criminal complaints filed
directly before the RTC. The arraignment for both cases was held on
September 12, 2001, after the Office of the Assistant Provincial
Prosecutor, which conducted the preliminary investigation requested
by Dion, found probable cause to hold him for trial.
The prosecution introduced in evidence the Medico-Legal
Certificate prepared by Dr. Mary Ann Valdez Romero-Fernandez, who
conducted the physical examination on AAA. Noticeable in the
Medico-Legal Certificate were the findings that the hymenal
lacerations on AAA were not only healed but also only superficial.
Moreover, the cervicovaginal smear done on AAA to test for presence
of spermatozoa yielded a negative result. Asked to restate her findings
in non-technical language, Dr. Romero-Fernandez explained that the
lacerations were superficial as they had not gone through beyond more
than half of the width of the hymen.
The RTC rendered its Decision, finding Dion guilty beyond
reasonable doubt of two counts of statutory rape. The Court of Appeals
affirmed in toto the RTC decision.
ISSUE: WHETHER OR NOT THE TRIAL COURT ERRED IN NOT
FINDING THAT THE RESULT OF THE MEDICAL
EXAMINATION FAILED TO CONFORM TO THE ATTRIBUTED
RAPE INCIDENT.
HELD:
NO, The trial court did not err in not finding that the result of the
medical examination failed to conform to the attributed Rape.
Thus, Accused is guilty as charged.
In People v. Ferrer, the Court held:
Page 38
 [I]t must be pointed out that the absence of
spermatozoa in the vagina of the victim does not
negate the commission of rape for the simple reason
that the mere touching of the labia of the female
organ by the penis is already considered as
consummated rape. The presence of sperm is not a
requisite for rape. For in rape, it is not ejaculation but
penetration that consummates the sexual act.
We accordingly reject accused-appellants
arguments which hinge on alleged inconsistencies
between the statements made by the private
complainant vis-a-vis the medical examination and
report. The medical report is by no means
controlling. This Court has repeatedly held that a
medical examination of the victim is not indispensable
in the prosecution for rape, and no law requires a
medical examination for the successful prosecution
thereof. The medical examination of the victim or the
presentation of the medical certificate is not essential to
prove the commission of rape as the testimony of the
victim alone, if credible, is sufficient to convict the
accused of the crime. The medical examination of the
victim as well as the medical certificate is merely
corroborative in character.
Dion had failed to impeach the credible and straightforward
testimony of AAA. Well-settled is the doctrine that testimonies
of child-victims are given full weight and credit.
25. ROÑO SEGURITAN y JARA vs. PEOPLE OF THE PHILIPPINES
LEGAL MEDICINE 3C 2016-2017
FACTS: Afternoon of Nov 25, 1995, Seguritan was in a drinking session
with his uncles Lucrecio Seguritan, Melchor Panis, Baltazar Panis in the
house of Manuel Dela Cruz in Bgy Paradise, Gonzaga, Cagayan. Rono
claimed that Lucrecio’s carabao entered his farm and destroyed his crops,
and this was followed by a heated discussion and then Rono punched
Lucrecio twice (right and left temple) which caused Lucrecio to fall as he
was standing up, and his head hit a hollow block which was an improvised
stove. Lucrecio lost consciousness but later revived, and he was able to go
home. His wife noticed blood on his forehead but he said he was stoned and
then went to sleep.
At about 9pm, his wife and daughter noticed that his complexion darkened
and foam coming out of his mouth. He was not revived and he died the same
night. After his burial on December 4, his wife learned of Rono’s
involvement and sought the help of NBI. NBI Medico-Legal officer Dr.
Antonio Vertido exhumed the body and performed an autopsy which found
hematomas in the right parietal and left occipital areas, a linear fracture in the
right middle fossa, and subdural hemorrhage. The conclusion was that the
cause of death was traumatic head injury.
Rono denied hitting Lucrecio and alleged that the latter died of heart attack.
He said that since Lucrecio was sitting on the opposite end of the bench, that
when Rono stood up Lucrecio fell before he could be hit, and Lucrecio’s
head hit the hollow block.
Rono presented Joel Cabebe, Asst. Registration Officer of Gonzaga, and Dr.
Corazon Flor to prove that Lucrecio died of heart attack. The witnesses
identified the Certificate of Death and the entry there that says that cause of
death was cardiovascular disease.
ISSUES: WON accused should be convicted, and whether it should be
homicide or reckless imprudence resulting to homicide.
RULING: Accused is guilty of homicide
Melchor categorically testified that Rono punched Lucrecio twice, who fell
to the ground and hit his head on the hollow block. He even hesitated to
testify, as shown by the fact that he executed the sworn statement only after
the autopsy report. Melchor’s testimony was consistent with the autopsy
findings. The court also declared that the punches could really cause the
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fracture on deceased’s head. The testimony of Dr. Vertido also says that the
cause of death is not heart attack but internal hemorrhage. His testimony said
that the gross examination of the heart showed no signs of heart attack which
caused him not to further examine. The notation in the Death Certificate has
no weight since Dr. Flor said she did not examine the cadaver of Lucrecio
since Renato Sidantes, brother-in-law of the deceased had no knowledge of
the real cause of death.
Rono contended that the delay in autopsy of Lucrecio’s body and its
embalming compromised the results thereof. He quotes the book Legal
Medicine by Dr. Pedro Solis: (lifted from the case)
(1) "a dead body must not be embalmed before the autopsy. The
embalming fluid may render the tissue and blood unfit for toxilogical
analyses. The embalming may alter the gross appearance of the tissues or
may result to a wide variety of artifacts that tend to destroy or obscure
evidence."
(2) "the body must be autopsied in the same condition when found at the
crime scene. A delay in the performance may fail or modify the possible
findings thereby not serving the interest of justice."
However, Rono failed to adduce evidence that the one month delay in
autopsy modified the findings. He failed to substantiate the claim that
embalming fluid rendered the tissue and blood sample unfit for toxilogical
analysis.
Further, it is settled that courts will only consider as evidence that which has
been formally offered. The allegation that the results of the autopsy are
unworthy of credence was based on a book that was neither marked for
identification nor formally offered in evidence during the hearing of the case.
Thus, the trial court as well as the appellate court correctly disregarded them.
The prosecution was not even given the opportunity to object as the book or a
portion thereof was never offered in evidence
A formal offer is necessary since judges are required to base their findings of
fact and judgment only – and strictly – upon the evidence offered by the
parties at the trial. To rule otherwise would deprive the opposing party of his
chance to examine the document and object to its admissibility. The appellate
court will have difficulty reviewing documents not previously scrutinized by
the court below. Any evidence which a party desires to submit to the courts
LEGAL MEDICINE 3C 2016-2017
must be offered formally because a judge must base his findings strictly on
the evidence offered by the parties at the trial.
Hence, the Decision of the Court of Appeals finding petitioner Roño
Seguritan y Jara guilty of homicide and sentencing him to suffer the penalty
of six years and one day of prision mayor as minimum, to 12 years and one
day of reclusion temporal as maximum, and to pay the heirs of Lucrecio
Seguritan the amounts of P50,000.00 as moral damages and P135,331.00 as
loss of earning capacity is AFFIRMED with MODIFICATION that
petitioner is further ordered to pay P25,000.00 as temperate damages in lieu
of actual damages, and P50,000.00 as civil indemnity.
26. ROLITO RABANAL v. PEOPLE OF THE PHILIPPINES
FACTS:
Dionisio Javier was watching a card game of pusoy inside the chapel
in Seminary Road, Sitio Maligaya, Quezon City when Ador and Eloy
arrived. Ador uttered, “Kung sino ang matapang ditto, ako lang anag
harapin, kung sino ang manggulo, ako lang ang harapin.” Ador
suddenly boxed Javier on the right side of his head, causing the latter
to move backward. Eloy collared him and dragged him to a corner of
the chapels room. Javier then saw the victim Felipe Sales. Suddenly,
Javier saw petitioner Rabanal appear from the back of the chapel.
Petitioner pulled out a knife measuring seven (7) inches in length
stabbed the victim at his right armpit. Javier also saw Ador stab the
victim near the chest. Eloy entered the scene and also stabbed the
victim until he fell down and he continuous stabbed several times at
the back while he was lying on the floor.
Dr. Florante Mendoza was on duty at the Quezon City General
Hospital when he examined Felipe Sales who was declared dead on
arrival. He testified that the victim suffered several stab wounds on the
left upper arm, in the forearm, and at the back, which possibly caused
his death. Dr. Desiderio Moraleda, on the other hand, testified that as
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per autopsy result, the cause of the victims death was cardio arrest due
to respiratory shock and hemorrhage secondary to multiple stab
wounds. The wounds totaled twenty-six (26), twenty-three (23) of
which were located in the dorsal side, chest, forearm and back. He said
that there was no wound at the right armpit. Based on his examination
of the wounds, he opined that the assailants had been in motion,
although he also said that it was possible that there could have been
only one assailant.
The case against Ador was dismissed on demurrer to
evidence. However, petitioner was eventually convicted of homicide in
a Decision. CA dismissed petitioners contention by holding that the
location of the stab wounds at the cadaver is inconsequential in a
homicidal attack. CA affirmed the trial courts judgment of conviction.
the instant case, the autopsy report negates the lone witnesss account
of the participation of petitioner in the stabbing of the victim.
The inconsistency between the positive testimony of Javier and the
physical evidence, particularly the autopsy report, further diminishes
the credibility of the lone eyewitness. The medico-legal officer
conceded that it was possible that only one person inflicted all the stab
wounds on the victim, thus it is also possible that any one of the
several people mentioned by Javier could have, on his own,
perpetrated the crime.
The prosecution failed to establish the identity of the assailant beyond
reasonable doubt. Hence, the Court cannot sustain petitioners
conviction. CA decision reversed and set aside.

ISSUE: Whether or not petitioner shall be held guilty for the death of
Felipe Sales

RULING:
No. The testimonies given by Javier were inconsistent. The Court is
well aware of the rule that minor inconsistencies and contradictions do
not destroy the credibility of the witness. However, these
inconsistencies and contradictions in Javiers testimony cannot be
characterized as minor. He was categorical in describing Adors
participation in stabbing the victim during the direct examination and
even earlier in his sworn statement, only to retract during the cross-
examination and deny having seen Ador stab the victim. This
turnaround bears relevance to the identification of the assailants so as
to create a reasonable doubt as to their culpability.

Javier had unequivocally testified that petitioner stabbed victim on the

right armpit. This does not correspond with the autopsy report. Of the
twenty-six (26) stab wounds, not a single wound was found at the right
armpit. Physical evidence is a mute but eloquent manifestation of truth
and rates highly in the hierarchy of trustworthy evidence. It enjoys a
far more superior probative weight than corroborative testimonies. In

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