RAMOS vs.

COURT OF APPEALS
G.R. No. 124354. December 29, 1999.

Ponente: Kapunan

FACTS:
Erlinda Ramos underwent a surgical procedure to remove stone from her gall bladder
(cholecystectomy). They hired Dr. Hosaka, a surgeon, to conduct the surgery at the De Los
Santos Medical Center (DLSMC). Hosaka assured them that he would find a good
anesthesiologist. But the operation did not go as planned, Dr. Hosaka arrived 3 hours late
for the operation, Dra. Gutierrez, the anesthesiologist “botched” the administration of the
anesthesia causing Erlinda to go into a coma and suffer brain damage. The botched
operation was witnessed by Herminda Cruz, sister in law of Erlinda and Dean of College of
Nursing of Capitol Medical Center.

The family of Ramos (petitioners) sued the hospital, the surgeon and the anesthesiologist
for damages. The petitioners showed expert testimony showing that Erlinda's condition was
caused by the anesthesiologist in not exercising reasonable care in “intubating” Erlinda.
Eyewitnesses heard the anesthesiologist saying “Ang hirap ma-intubate nito, mali yata ang
pagkakapasok. O lumalaki ang tiyan.”

Diagnostic tests prior to surgery showed that Erlinda was robust and fit to undergo surgery.

The RTC held that the anesthesiologist ommitted to exercise due care in intubating the
patient, the surgeon was remiss in his obligation to provide a “good anesthesiologist” and
for arriving 3 hours late and the hospital is liable for the negligence of the doctors and for
not cancelling the operation after the surgeon failed to arrive on time. The surgeon,
anesthesiologist and the DLSMC were all held jointly and severally liable for damages to
petitioners. The CA reversed the decision of the Trial Court.

ISSUES: Whether or not the private respondents were negligent and thereby caused the
comatose condition of Ramos.

HELD:
Yes, private respondents were all negligent and are solidarily liable for the damages.

RATIO:

Res ipsa loquitur – a procedural or evidentiary rule which means “the thing or the
transaction speaks for itself.” It is a maxim for the rule that the fact of the occurrence of an
injury, taken with the surrounding circumstances, may permit an inference or raise a
presumption of negligence, or make out a plaintiff’s prima facie case, and present a
question of fact for defendant to meet with an explanation, where ordinarily in a medical
malpractice case, the complaining party must present expert testimony to prove that the
attending physician was negligent.

This doctrine finds application in this case. On the day of the operation, Erlinda Ramos
already surrendered her person to the private respondents who had complete and exclusive
control over her. Apart from the gallstone problem, she was neurologically sound and fit.
Then, after the procedure, she was comatose and brain damaged—res ipsa loquitur!—the
thing speaks for itself!
Negligence – Private respondents were not able to disprove the presumption of negligence
on their part in the care of Erlinda and their negligence was the proximate cause of her
condition. One need not be an anesthesiologist in order to tell whether or not the intubation
was a success. [res ipsa loquitur applies here]. The Supreme Court also found that the
anesthesiologist only saw Erlinda for the first time on the day of the operation which
indicates unfamiliarity with the patient and which is an act of negligence and irresponsibility.

The head surgeon, Dr. Hosaka was also negligent. He failed to exercise the proper authority
as the “captain of the ship” in determining if the anesthesiologist observed the proper
protocols. Also, because he was late, he did not have time to confer with the
anesthesiologist regarding the anesthesia delivery.

The hospital failed to adduce evidence showing that it exercised the diligence of a good
father of the family in hiring and supervision of its doctors (Art. 2180). The hospital was
negligent since they are the one in control of the hiring and firing of their “consultants”.
While these consultants are not employees, hospitals still exert significant controls on the
selection and termination of doctors who work there which is one of the hallmarks of an
employer-employee reationship. Thus, the hospital was allocated a share in the liability.

Damages – temperate damages can and should be awarded on top of actual or

compensatory damages in instances where the injury is chronic and continuing.
.R. No. 124354 December 29, 1999

Lessons Applicable: Personal Injury and Death (Torts and Damages)

Laws Applicable:

FACTS:

 June 17, 1985 afternoon: Erlinda Ramos, 47-year old robust woman underwent on an
operation to the stone at her gall bladder removed after being tested that she was fit
for "cholecystectomy" operation performed by Dr. Orlino Hozaka. Dr. Hosaka
charged a fee of P16,000.00, which was to include the anesthesiologist's
fee and which was to be paid after the operation. He assured Rogelio E.
Ramos, husband that he will get a good anesthesiologist who was Dra.
Perfecta Gutierrez. Erlinda's hand was held by Herminda Cruz, her sister -in-
law who was the Dean of the College of Nursing at the Capitol Medical
Center together with her husband went down with her to the operating
room.
 Instead of 9:30 am, Dr. Hosaka arrived at about 12:15 P.M.
 Herminda noticing what Dra. Perfecta Gutierrez was doing, saw the
nailbed of Erlinda becoming bluish and Dr. Hosaka called for
another anesthesiologist Dr. Calderon.
 She went out of the operating room to tell Rogelio that something is
wrong.
 When she went back she saw Erlinda in a trendelenburg position and at 3
p.m. she was taken to the Intensive Care Unit (ICU) where she stayed for
 a month due to bronchospasm incurring P93,542.25 and she was since
then comatosed.
 She suffered brain damage as a result of the absence of oxygen in her
brain for four to five minutes.
 She was also diagnosed to be suffering from "diffuse cerebral parenchymal damage"
 Monthly expenses ranged from P8,000 to P10,000
 Spouses Ramos and their minors filed against Dr. Hosaka and Dra.
Perfecta Gutierrez
 RTC: favored the Ramos' awarding P8,000 as actual monthly expenses
totalling to P632,000 as of April 15, 1992, P100,000 atty. fees, P800,000 moral
damages,P200,000 exemplary damages and cost of suit
 CA: reversed ordering the Ramos' to pay their unpaid bills of P93,542.25
plus interest
ISSUE: W/N the Ramos' are entitled to damages

HELD: YES. CA modified in favor of petitioners, and solidarily against private

respondents the following: 1) P1,352,000 actual damages computed as of
the date of promulgation plus a monthly payment of P8,000.00 up to the
time that petitioner Erlinda Ramos expires or miraculously survives; 2)
P2,000,000 moral damages, 3) P1,500,000 temperate damages; 4)
P100,000 exemplary damages and P100,000 attorney's fees; and, 5) the
costs of the suit.

 The application of res ipsa loquitur in medical negligence cases presents a question of law
since it is a judicial function to determine whether a certain set of circumstances does, as a
matter of law, permit a given inference.
 doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert medical testimony
is dispensed with because the injury itself provides the proof of negligence - applicable in
this case
 doctrine of res ipsa loquitur can have no application in a suit against a physician or surgeon
which involves the merits of a diagnosis or of a scientific treatment
 As borne by the records, respondent Dra. Gutierrez failed to properly intubate the patient
according to witness Herminda
 With her clinical background as a nurse, the Court is satisfied with her testimony
 Dra. Gutierrez' act of seeing her patient for the first time only an hour before the scheduled
operative procedure was, therefore, an act of exceptional negligence and professional
irresponsibility
 Generally, to qualify as an expert witness, one must have acquired special knowledge of the
subject matter about which he or she is to testify, either by the study of recognized
authorities on the subject or by practical experience.
 Dr. Jamora, not an anesthesiologist, stated that oxygen deprivation which led to anoxic
encephalopathy was due to an unpredictable drug reaction to the short-
acting barbiturate was not accepted as expert opinion
 Dr. Hosaka's negligence can be found in his failure to exercise the proper authority in not
determining if his anesthesiologist observed proper anesthesia protocols
 Dr. Hosaka had scheduled another procedure in a different hospital at the same time as
Erlinda's cholecystectomy, and was in fact over three hours late for the latter's operation.
Because of this, he had little or no time to confer with his anesthesiologist regarding the
anesthesia delivery. This indicates that he was remiss in his professional duties towards his
patient
 private hospitals, hire, fire and exercise real control over their attending and visiting
"consultant" staff. While "consultants" are not, technically employees, a point which
respondent hospital asserts in denying all responsibility for the patient's condition, the control
exercised, the hiring, and the right to terminate consultants all fulfill the important hallmarks
of an employer-employee relationship, with the exception of the payment of wages.
 Art. 2199. — Except as provided by law or by stipulation, one is entitled to an adequate
compensation only for such pecuniary loss suffered by him as he has duly proved. Such
compensation is referred to as actual or compensatory damages.
 temperate damages can and should be awarded on top of actual or compensatory damages in
instances where the injury is chronic and continuing. And because of the unique nature of
such cases, no incompatibility arises when both actual and temperate damages are provided
for. The reason is that these damages cover two distinct phases.
 They should not be compelled by dire circumstances to provide substandard care at home
without the aid of professionals, for anything less would be grossly inadequate. Under the
circumstances, an award of P1,500,000.00 in temperate damages would therefore be
reasonable.
 the damage done to her would not only be permanent and lasting, it would also be
permanently changing and adjusting to the physiologic changes which her body would
normally undergo through the years.
 Erlinda Ramos was in her mid-forties when the incident occurred. She has been in a
comatose state for over fourteen years now
 Ramos' are charged with the moral responsibility of the care of the victim. The family's
moral injury and suffering in this case is clearly a real one. Award of P2,000,000 in moral
damages would be appropriate.
 Finally, by way of example, exemplary damages in the amount of
P100,000.00 are hereby awarded. Considering the length and nature of
the instant suit we are of the opinion that attorney's fees valued at
P100,000 are likewise proper.