Digested by MEEEEE!!!

LEANDRO CARILLO, petitioner, vs. PEOPLE OF THE PHILIPPINES Facts: The deceased, Catherine Acosta, a 13 year old girl, daughter of spouses Domingo and Yolanda Acosta, complained to her father at about 10:30 o'clock in the morning of May 31, 1981 of pains in the lower part of her abdomen. Catherine was then brought to Dr. Elva Pea. Dra. Pea called for Dr. Emilio Madrid and the latter examined Catherine Acosta. According to Dr. Madrid, his findings might be appendicitis. Then Dr. Pea told Catherine's parents to bring the child to the hospital in Baclaran so that the child will be observed. The appellant Dr. Emilio Madrid, a surgeon, operated on Catherine. He was assisted by appellant, Dr. Leandro Carillo, an anesthesiologists. Catherine after the operation suffered combulsion, trembling and later on had been under comatose as diagnosed by a Neurologist. Then she died. The parents sued Dr. Emilio Madrid and Leandro Carillo. The Court of Appeals held that Catherine had suffered from an overdose of, or an adverse reaction to, anesthesia, particularly the arbitrary administration of Nubain, a pain killer, without benefit of prior weighing of the patient's body mass, which weight determines the dosage of Nubain which can safely be given to a patient. Issue: whether or not the accused were guilty of simple negligence or reckless imprudence Ruling: the Court defined simple negligence, penalized under what is now Article 365 of the Revised Penal Code, as "a mere lack of prevision in a situation where either the threatened harm is not immediate or the danger not openly visible." Put in a slightly different way, the gravamen of the offense of simple negligence is the failure to exercise the diligence necessitated or called for the situation which was not immediately lifedestructive but which culminated, in the present case, in the death of a human being three (3) days later. By way of resume, in the case at bar, we consider that the chain of circumstances above noted, namely: (1) the failure of petitioner and Dr. Madrid to appreciate the serious post-surgery condition of their patient and to monitor her condition and provide close patient care to her; (2) the summons of petitioner by Dr. Madrid and the cardiologist after the patient's heart attack on the very evening that the surgery was completed; (3) the low level of care and diligence exhibited by petitioner in failing to correct Dr. Madrid's prescription of Nubain for post-operative pain; (4) the extraordinary failure or refusal of petitioner and Dr. Madrid to inform the parents of Catherine Acosta of her true condition after surgery, in disregard of the requirements of the Code of Medical Ethics; and (5) the failure of petitioner and Dr. Madrid to prove that they had in fact exercised the necessary and appropriate degree of care and diligence to prevent

the sudden decline in the condition of Catherine Acosta and her death three (3) days later, leads the Court to the conclusion, with moral certainty, that petitioner and Dr. Madrid were guilty of simple negligence resulting in homicide.

DR. VICTORIA L. BATIQUIN and ALLAN BATIQUIN, petitioners, vs. COURT OF APPEALS, SPOUSES QUEDO D. ACOGIDO and FLOTILDE G. VILLEGAS, respondents. Facts: In the morning of September 21, 1988 Dr. Batiquin, with the assistance of Dr. Doris Teresita Sy who was also a Resident Physician at the same Hospital, C.I. and O.R. Nurse Arlene Diones and some student nurses performed a simple caesarean section on Mrs. Villegas at the Negros Oriental Provincial Hospital and after 45 minutes Mrs. Villegas delivered her first child, Rachel Acogido, at about 11:45 that morning. Thereafter, Plaintiff remained confined at the Hospital until September 27, 1988 during which period of confinement she was regularly visited by Dr. Batiquin. On September 28, 1988 Mrs. Villegas checked out of the Hospital. . . and on that same day she paid Dr. Batiquin, thru the latter's secretary, the amount of P1,500.00 as "professional fee". After the operations, Mrs. Villegas suffered pains in her abdomen. She then came back to Dr. Batuiquin, and the latter gave her medicines but to no avail. She then consulted Dr. Salud Kho whom found out that there is a piece of rubber in her ovary probably left by the doctor during her last operation. Mrs. Villegas then turned well the following months. Mrs. Villegas sued Dr. Batuiqin. The trial court ruled in favor of the accused due to the inconsistency of the Testimony of Dr. Salud kho stating that she (1) that it was sent to the Pathologist in Cebu as testified to in Court by Dr. Kho and (2) that Dr. Kho threw it away as told by her to Defendant. CA reversed the said decision. Issue: Whether or not Dr. Salud Khos testimony is sufficient to prove the malpractice of Dr. Batuiqin et al. Ruling: Yes. It is because even when a witness is found to have deliberately falsified in some material particulars, it is not required that the whole of his uncorroborated testimony be rejected, but such portions thereof deemed worthy of belief may be credited. The trial court's following declaration shows that while it was critical of the lack of care with which Dr. Kho handled the piece of rubber, it was not prepared to doubt Dr. Kho's credibility, thus only supporting our appraisal of Dr. Kho's trustworthiness: Considering that we have assessed Dr. Kho to be a credible witness, her positive testimony [that a piece of rubber was indeed found in private respondent Villega's abdomen] prevails over the negative testimony in favor of the petitioners.

LEONILA GARCIA-RUEDA, petitioner, vs. WILFRED L. PASCASIO Facts: Florencio V. Rueda, husband of petitioner Leonila Garcia-Rueda, underwent surgical operation at the UST hospital for the removal of a stone blocking his ureter. He was attended by Dr. Domingo Antonio, Jr. who was the surgeon, while Dr. Erlinda Balatbat-Reyes was the anaesthesiologist. Six hours after the surgery, however, Florencio died of complications of "unknown cause," according to officials of the UST Hospital. The case was initially assigned to Prosecutor Antonio M. Israel, who had to inhibit himself because he was related to the counsel of one of the doctors. As a result, the case was re-raffled to Prosecutor Norberto G. Leono who was, however, disqualified on motion of the petitioner since he disregarded prevailing laws and jurisprudence regarding preliminary investigation. The case was then referred to Prosecutor Ramon O. Carisma, who issued a resolution recommending that only Dr. Reyes be held criminally liable and that the complaint against Dr. Antonio be dismissed. A series of nine prosecutors toss the responsibility of conducting a preliminary investigation to each other with contradictory recommendations, "ping-pong" style, perhaps the distraught widow is not to be blamed if she finally decides to accuse the City Prosecutors at the end of the line for partiality under the Anti-Graft and Corrupt Practices Act. She filed a petition before this Court against the Ombudsman for grave abuse of discretion in dismissing her complaint against said City Prosecutors on the ground of lack of evidence. Petitioner filed graft charges against Prosecutors Guerrero, Macaraeg, and Arizala for manifest partiality before the Office of the Ombudsman. However was dismissed for lack of evidence. Petitioner appealed to the SC. Issue: Whether or not there is probable cause, and whether or not the SC may review the decision of the Ombudsman

Ruling: there are four elements involved in medical negligence cases: duty, breach, injury and proximate causation. Evidently, when the victim employed the services of Dr. Antonio and Dr. Reyes, a physician-patient relationship was created. In accepting the case, Dr. Antonio and Dr. Reyes in effect represented that, having the needed training and skill possessed by physicians and surgeons practicing in the same field, they will employ such training, care and skill in the treatment of their patients. 13 They have a duty to use at least the same level of care that any other reasonably competent doctor would use to treat a condition under the same circumstances. The breach of these professional duties of skill and care, or their improper performance, by a physician surgeon whereby the

patient is injured in body or in health, constitutes actionable malpractice. 14 Consequently, in the event that any injury results to the patient from want of due care or skill during the operation, the surgeons may be held answerable in damages for negligence. 15 Moreover, in malpractice or negligence cases involving the administration of anaesthesia, the necessity of expert testimony and the availability of the charge of res ipsa loquitur to the plaintiff; have been applied in actions against anaesthesiologists to hold the defendant liable for the death or injury of a patient under excessive or improper anaesthesia. 16 Essentially, it requires two-pronged evidence: evidence as to the recognized standards of the medical community in the particular kind of case, and a showing that the physician in question negligently departed from this standard in his treatment. 17 Another element in medical negligence cases is causation which is divided into two inquiries: whether the doctor's actions in fact caused the harm to the patient and whether these were the proximate cause of the patient's injury. 18 Indeed here, a causal connection is discernible from the occurrence of the victim's death after the negligent act of the anaesthesiologist in administering the anesthesia, a fact which, if confirmed, should warrant the filing of the appropriate criminal case. The petitioner must appeal to the Secretary of Justice whom have the power to review and reverse the findings of probable cause of the Prosecutors.

DR. NINEVETCH CRUZ, petitioner, vs. COURT OF APPEALS and LYDIA UMALI, respondents. Facts: Dra. Ninevetch Cruz was the attending anaesthesiologist and surgeon of Lydia Umali in the Perpetual Help Clinic and General Hospital. Lydia Umali was then scheduled for Operation due to myoma. However, Rowena, her daughter, hesitant because the clinic was untidy. The operations pursued but Lydia was then rushed to San Pablo District Hospital due to Shock and sudden fall of her blood pressure caused by the loss of blood oozing from the incision. Lydia died. Dra. Ninevetch Cruz was sued butwas rendered not guilty by the MTC. RTC reversed the decision and convicted Dra. Ninevetch Cruz. Issue: Whether or not Dr Cruz is guilty of Negligence and incompetence

Ruling: No. It is because the prosecution failed to establish the elements of reckless imprudence that there is inexcusable lack of precaution on the part of the offender, taking into consideration his employment or occupation, degree of intelligence, physical condition, and other circumstances regarding persons, time and place Likewise undisputed is the prosecution's version indicating the following facts: that the accused asked the patient's relatives to buy Tagamet capsules while the operation was already in progress; that after an hour, they were also asked to buy type "A" blood for the patient; that after the surgery, they were again asked to procure more type "A" blood, but such was not anymore available from the source; that the oxygen given to the patient was empty; and that the son-in-law of the patient, together with a driver of the petitioner, had to rush to the San Pablo City District Hospital to get the much-needed oxygen. All these conclusively show that the petitioner had not prepared for any unforeseen circumstances before going into the first surgery, which was not emergency in nature, but was elective or pre-scheduled; she had no ready antibiotics, no prepared blood, properly typed and cross-matched, and no sufficient oxygen supply. This Court, however, holds differently and finds the foregoing circumstances insufficient to sustain a judgment of conviction against the petitioner for the crime of reckless imprudence resulting in homicide. The elements of reckless imprudence are: (1) that the offender does or fails to do an act; (2) that the doing or the failure to do that act is voluntary; (3) that it be without malice; (4) that material damage results from the reckless imprudence; and (5) that there is inexcusable lack of precaution on the part of the offender, taking into consideration his employment or occupation, degree of intelligence, physical condition, and other circumstances regarding persons, time and place. It is because the prosecution failed to rebut through expert witness the presumption that in proper cases she takes the necessary precaution and employs the best of his knowledge and skill in attending to his clients. According to the expert witnesses, the cause of the Death is DIC Disseminated Intravascular Coagulation which could happen to anyone and cannot be prevented. It is a clotting problem wherein the blood do not easily dry up which causes the continuous flow of blood. RAMOS v. CA Facts: the Ramos case, the question was whether a surgeon, an anesthesiologist, and a hospital should be made liable for the comatose condition of a patient scheduled for cholecystectomy.[19] In that case, the patient was given anesthesia prior to her operation. Noting that the patient was neurologically sound at the time of her operation, the Court applied the doctrine of res ipsa loquitur as mental brain damage does not normally occur in a gallblader operation in the absence of negligence of the anesthesiologist. Taking judicial notice that anesthesia procedures had become so common that even an ordinary person could tell if it was administered properly, we allowed the testimony of a witness who was not an expert. In this case, while it is true that the patient died just a few hours after professional medical assistance was

rendered, there is really nothing unusual or extraordinary about his death. Prior to his admission, the patient already had recurring fevers and chills for five days unrelieved by the analgesic, antipyretic, and antibiotics given him by his wife. This shows that he had been suffering from a serious illness and professional medical help came too late for him.

Sisters of Mary Facts: Jorge Reyes suffered from a fever with chills. After examination, Dr. Marlyn Rico diagnosed him to have typhoid fever. Dr. Rico ordered a Widal Test, a standard test for typhoid fever, to be performed on Jorge. Blood count, routine urinalysis, stool examination, and malarial smear were also made. Dr Blanes, the night shift doctor, ordered that Jorge be given chloromycetin. Just around midnight, Jorge suffered from a Fever reaching 41 degrees. He was under distress, nausea, vomiting, and convulsions. Dr. Blanes put him under oxygen, used a suction machine, and administered hydrocortisone, temporarily easing the patients convulsions. However, he still had the same effect and later on died. The cause of his death was Ventricular Arrythemia Secondary to Hyperpyrexia and typhoid fever. The heirs of Jorge Reyes filed a complaint for Medical Malpractice. They impleaded Sisters of Mercy Hospital for negligence in failing to provide adequate facilities and in hiring negligent doctors and nurses. Issue: Whether or not there is Medical Malpractice Ruling:No. The existence of the Four requisites is clear, there is duty, breach, injury and causation. In the present case, there is no doubt that a physician-patient relationship existed between respondent doctors and Jorge Reyes. Respondents were thus dutybound to use at least the same level of care that any reasonably competent doctor would use to treat a condition under the same circumstances. It is breach of this duty which constitutes actionable malpractice. Respondents alleged failure to observe due care was not immediately apparent to a layman so as to justify application of res ipsa loquitur. However, the Petitioners invoking Res Ipsa loquitur was rejected by the SC. The question required expert opinion on the alleged breach by respondents of the standard of care required by the circumstances due to the seriousness of the illness. It is not easily determinable and apparent to the laymans sight. Dr. Apolinar Vacalares testimony was not admitted due to the fact that he was not a specialist in typhoid fever. However, Dr. Ricos expert witness were qualified and vouched on the correctness of the respondents diagnosis and procedure. Dr. Rico was also justified in recommending the administration of the drug chloromycetin, the drug of choice for typhoid fever. The burden of proving that Jorge Reyes was suffering from any other illness rested with the petitioners. As they failed to present expert opinion on this, preponderant evidence to support their contention is clearly absent. Petitioners allegation of extraordinary diligence was rejected due to the fact that it is only peculiar on common carriers. And, as we have already noted, the standard contemplated for doctors is simply the

reasonable average merit among ordinarily good physicians. That is reasonable diligence for doctors or, as the Court of Appeals called it, the reasonable skill and competence . . . that a physician in the same or similar locality . . . should apply.

Runez jr. v. Dr. Jurado Facts: