Republic of the Philippines REGIONAL TRIAL COURT 11th Judicial Region Branch ___ Davao City

Jane Ramos, Plaintiff, - versus Susan Tan, and Davao City Medical Center

CIVIL CASE No.___ FOR: Damages and Attorneys Fees.

Defendants.

x- - - - - - - - - - -- - - - - x JUDICIAL AFFIDAVIT of ROMULO ONG ABRANTES

I, ROMULO ONG ABRANTES, Filipino, of legal age, single, a resident of # 257 Halcon Rd., Central Park, Bangkal, Davao City, , after having been sworn to in accordance with law, do hereby depose and state that: 1. Atty. Julie Meriam Buca conducted and supervised my examination at her law office at Room 8 2nd Floor, LandCo Building, Bajada, Davao City. 2. I answered the questions the examining lawyer asked fully conscious and I do so under oath knowing fully that I may face criminal liability for false testimony or perjury. The questions she asked and my corresponding answers were the following: 1. QUESTION (Q): Do you swear to tell the truth, the whole truth and nothing but the truth in this proceeding?

ANSWER (A): Yes.

Q: Please state your name, age, address and occupation? A: I am Romulo Ong Abrantes, 31 years old, single, and residing at 257 Halcon Rd Central Park Bangkal Davao City.

Q: What is your occupation Mr. Romulo? A: I am a Medical Doctor Maam.

Q: I have here a photocopy of a PRC physicians license card (Exhibit I) with a license number of 03131982, having your name in it as a registered Physician. Are you familiar with this? A: Yes.

Q: Why do you say so? A: I have my signature in it, Maam.

Q: Where do you practice your profession, Doctor Romulo? A: At the Davao Doctors Hospital, Maam.

Q: What is your position there? A: I am recently promoted as chief resident of that Hospital, Maam.

Q: What does a chief resident of Davao Doctors Hospital do? A: Chief residents have been described as middle managers with four directions of responsibility: upward to the consultant body, downward to the trainee body, laterally to other middle managers, and internally to other chief residents. We practically manage other residents in the hospital. Most of the time, in difficult cases or in cases of unavailable residents, we do the job of the residents.
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If there is an emergency, we will be called and we immediately attend to such emergency.

Q: Do you know the Plaintiff in this case, Ms. Jane Ramos? A: Yes.

Q: How did you know Ms. Jane Ramos? A; She was my patient.

Q: Can you please elaborate on the circumstances which made Ms. Jane Ramos your patient? A: On June 13, 2013, I was still a senior resident at the surgery department of Davao Doctors Hospital when I got a call from the Emergency Room about a patient transferred from Davao City Medical Center suffering from severe abdominal pain postoperative. When I arrived at the emergency room, I took some history and physical examination and issued an admitting order.

Q: I have here a copy of the admitting order dated June 13, 2013. Are you familiar with this? ( Exhibit J) Yes. Maam

Q: How can you say so? A: I was the one who issued it. Maam.

Q: What happened after that? A: As our standard operating procedure, we conducted physical examination and laboratory examination.

Q: I have here a record of the Physical Examination conducted and the Laboratory Resuts. Are you familiar with these (Exhibit K 1-3) A: Yes.

Q: How can you say so? A: I have my signature in it. Maam.

Q: Are there other test? A: Yes. Maam. We did the CT Scan

I have here an image from the CT Scan. Are you familiar with Vthis? (Exhibit L ) Yes. Maam.

Q: How do you say so? A: There is my initial Maam.

Q: What was the impression for the said tests There was latrogenic bile duct injury with multiple colonic injury secondary to Endoscopic retrograde Cholangiopancreatography (ERCP).

Q: What happened after that? A: I reported the same to one of the Consultant Physician Dr. Lobo the situation. After assessing the same, he recommended emergency Exlap, Enterolysis/Adhesiolysis, Partial Colectomy with end Colostomy and Mucus Drain, Placement of drain.

Q: Why did you think these procedures were necessary?

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A: These procedures were necessary since there were already multiple bowel perforation, accumulation of pus, infected tissue, and bile juices, which caused a massive infection and necrosis of the various parts of his digestive tract. Without these procedures, the patient could die.

Q:What did you do after that? A: We conducted the exploratory laparotomy and performed an enterolysis.

Q:Can you please elaborate on the said procedure? A: It is actually surgical division or removal of intestinal adhesions, specifically the abscess and accumulation of pus in the area.

Q: I have here a copy of the Operative Record dated June 16, 2013. (Exhibit M) Are you familiar with this? Yes, Maam.

Q: How can you say so. I have my signature in it, Maam.

Q: Now, what happened to the patient after the surgery? A: We performed Colostomy to the patient, Maam.

Q: Why did you perform such procedure? A: Because due to series of operations made, a portion of the intestine needs to be 'rested' until it is healed. This was later reversed on November 30, 2013.

Q: I have here a copy of the Operative Record dated June 19, 2013. (Marked as Exhibit N)Are you familiar with this? A: Yes, Maam.

Q: How can you say so. A: I have my signature in it, Maam.

Q: Now, what is the proximate cause or reason why you have to make 2 successive operations on the patient? A: We had the make the said operations because the same is a matter of life and death. There is much damage to the patients abdominal and intestinal areas which warranted the said surgical procedure.

Q: What do you think is the cause of the said damage? A: The damage is due to the perforations in the common bile duct which causes infection and eventually led to the damage of the intestines.

Q: What is this perforation? A: Perforation occurs within the bowel wall by the endoscope, through extension of a sphincterotomy incision beyond the intramural portion of the bile or pancreatic duct with retroperitoneal leakage, or at any location due to extramural passage or migration of guidewires or stents.

Q:In this particular case, what is the cause of this perforation? A: This perforation is considered to be one of the complications of ERCP

Q: Is this complication common? A: No. It depends upon how the procedure was made.

Q:Can you please describe the proper procedure? A: ERCP is performed in a room that contains X-ray equipment. You will lie on a special table during the examination, generally on your left side or stomach. Although many people worry about discomfort from the endoscopy, most people tolerate it well and feel fine afterwards. Medications will be given through the IV line during the procedure. A plastic mouth guard is placed between the teeth to prevent damage to the teeth and endoscope. Many patients sleep during the test; others are very relaxed and not aware of the examination. The ERCP endoscope is a special flexible tube, approximately the size of a finger. It contains a lens and a light source that allows the endoscopist to view the inside of the patient's body; images are magnified on a monitor so that even very small details and changes can be seen. The endoscope also contains channels that allow the endoscopist to take biopsies (painless tissue samples) and introduce or withdraw fluid, air, or other instruments. You will be asked to swallow the tube. Once the scope is inserted through the mouth, air is gently introduced to open up the esophagus, stomach, and intestine so the scope can be passed through those structures and to allow the endoscopist to see. A small plastic tube (cannula) is passed through the endoscope into the opening of the bile duct through a structure called the papilla , dye is injected, and X-ray pictures are taken after the injection and displayed on a TV monitor so the endoscopist can examine the bile ducts and pancreatic duct. Depending on what the endoscopist sees during the ERCP, he or she may perform a variety of procedures or treatments. If bile duct stones are present in the common bile duct, the opening of the papilla can be widened, and the stones are removed by a basket. If the X-ray pictures show a narrowing of the bile duct, a stent (a small wire-mesh or plastic tube) can be inserted to allow the bile to bypass the blockage and pass into the duodenum. The length of the examination varies, between 30 and 90 minutes (usually about an hour).

Q: In the case of Jane Ramos, what is the relation of the perforation to the ERCP conducted? A: In this particular case, what the previous Doctor did was to conduct an ERCP based on an abdominal pain. We believe that the Doctor was not qualified or yet incompetent to conduct the procedure and the ERCP was not called for in that situation. ERCP has evolved into an almost exclusively therapeutic procedure. The main reason for this evolution is that diagnostic modalities have been developed that are less invasive than ERCP but possess similar sensitivity and specificity for disease processes of the hepatobiliary system. Imaging techniques currently used in the diagnosis of hepatobiliary processes include computed tomography (CT), ultrasonography, endoscopic ultrasonography (EUS), and magnetic resonance cholangiopancreatography (MRCP). The use of these modalities, in conjunction with pertinent clinical information (eg, the clinical history, physical examination findings, and laboratory data), can help select those patients for whom ERCP is most appropriate. Because ERCP has a higher rate of severe complications than most other endoscopic procedures do, having an appropriate indication for its use is extremely important When conducting the ERCP, as a general rule, the duodenoscope should never be forced against significant resistance during insertion. The forceps elevator should be in the closed position during passage of the endoscope down the lumen because it may lacerate the adjacent tissue if left in the open position. We believe that the previous doctor forced the duodenoscope which casued perforations in various parts of the digestive tract in this particular case. I also believed that the abdominal pain as complained by the patient does not warrant the immediate conduct of ERCP Q: Given that the ERCP was necessary, what would have happened to the Patient if the same was properly conducted? A: She may not have proceeded to the 2 successive remedial surgeries and 1 reversal surgery.

IN WITNESS WHEREOF, I hereby affix my signature this __________ 2013 at Davao City, Philippines. ROMULO ONG ABRANTES Affiant SUBSCRIBED AND SWORN to before me this ________ at Davao City Philippines. Affiant exhibited to me her Non-Professional Drivers License with no. L234-587-886, issue by the Land Transportation Office which expires on June 13, 2015 as proof of her identity. Witness my hand and seal. Atty Jade P. Go Notary Public for Davao City Until December 31, 2014 Notarial Commission No. 485-2011 Roll of Attorney No. 82,287 PTR No. 88772; 1/3/14;Davao City IBP No. 8722; 1/3/14;Davao City Tin No. 654-852-321 Second Floor, JAC Building J.P. Laurel Ave. Bajada, Davao City

Doc. No. 001 Page No. 001 Book No. 002 Series of 2014.

ATTESTATION I, ATTY. JULIE MERIAM BUCA of BUCA, ONG ABRANTES and TAY Law Firm with office address at Room 8 2nd Floor LandCo Building Bajada, Davao City, conducted and supervised my examination at said office, under oath hereby states that: 1. I conducted and supervised the examined of ROMULO ONG ABRANTES as witness of the above-mentioned case; 2. I faithfully caused to be recorded the questions I asked and corresponding answers that the said witness gave; and

3. Neither I nor any other person then present or assisting me coached the witness regarding the answers. IN WITNESS WHEREOF. I hereby affix my signature this _____ at Davao City, Philippines

JULIE MERIAM BUCA SUBSCRIBED AND SWORN TO before me this ___________ at Davao City, Philippines. Affiant exhibited to me his TIN 598-426327 above indicated as proof of his identity. Witness my hand and seal. Atty Jade P. Go Notary Public for Davao City Until December 31, 2014 Notarial Commission No. 485-2011 Roll of Attorney No. 82,287 PTR No. 88772; 1/3/14;Davao City IBP No. 8722; 1/3/14;Davao City Tin No. 654-852-321 Second Floor, JAC Building J.P. Laurel Ave. Bajada, Davao City

Doc. No. 001 Page No. 001 Book No. 002 Series of 2014.

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