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G.R. No. J4468J.

June 2J, 2004


PROILSSIONAL RLGULA1ION COMMISSION (PRC), CHAIRMAN HLRMOGLNLS P. POBRL, ASSOCIA1L COMMISSIONLR
ARMANDO PASCUAL, BOARD OI MLDICINL, CHAIRMAN RODOLIO P. DL GUZMAN, JOSL S. RAMIRLZ, JUANI1O B.
BILLO1L, RUBLN R. POLICARPIO, LDGARDO 1. ILRNANDO and RICARDO D. IULGLNCIO II, petitioners, vs.
ARLLNL V. DL GUZMAN, VIOLL1A V. MLNLSLS, CLLLRINA S. NAVARRO, JOSL RAMONCI1O P. NAVARRO, ARNLL
V. HLRRLRA and GLRALDINL LLIZABL1H M. PAGILAGAN, LLNORA R. RAQULNO, MARISSA A. RLGODON, LAURA
M. SAN1OS, KARANGALAN D. SLRRANO, DANILO A. VILLAVLR, MARIA ROSARIO L. LLONOR, ALICIA S. LIZANO,
MARI1LL M. LCHIVLRRI, BLRNADL11L 1. MLNDOZA, ILRNANDO I. MANDAPA1, ALLLI A. GOLLAYAN, LLCIN C.
ARRIOLA, HLRMINIGILDA L. CONLJOS, SALLY B. BUNAGAN, ROGLLIO B. ANCHL1A, OSCAR H. PADUA, JR.,
LVLLYN D. GRAJO, LVLLYN S. ACOS1A, MARGARI1A BLLINDA L. VICLNCIO, VALLN1INO P. ARBOLLDA, LVLLYN
O. RAMOS, ACHILLLS J. PLRAL1A, CORAZON M. CRUZ, LLUVINA P. CHICO, JOSLPH A. JAO, MA. LUISA S.
GU1ILRRLZ, LYDIA C. CHAN, OPHLLIA C. HIDALGO, ILRNANDO 1. CRUZ, MLLVIN M. USI1A, RAIALL I.
1OLLN1INO, GRACL L. UY, CHLRYL R. 1RIGULRO, MICHALL L. SLRRANO, ILDLRICO L. CAS1ILLO, MLLI1A J.
CALDO, SAMULL B. BANGOY, BLRNARDI1A B. SY, GLORIA 1. JULARBAL, IRLDLRICK D. IRANCISCO, CARLOS M.
BLRNARDO, JR., HUBLR1 S. NAZARLNO, CLARISSA B. BACLIG, DAYMINDA G. BON1UYAN, BLRNADL11L H.
CABUHA1, NANCY J. CHAVLZ, MARIO D. CUARLSMA, LRNLS1O L. CUL, LVLLYN C. CUNDANGAN, RHONLIL R.
DLVLRA1URDA, DLRILLLN D. DORADO, SAIBZUR N. LDDING, VIOLL1A C. ILLIPL, HLRMINIO V. ILRNANDLZ,
JR., MARIA VIC1ORIA M. LACSAMANA, NORMA G. LAIAVILLA, RUBY B. LAN1IN, MA. LLOISA Q. MALLARI, CLARISA
SJ. NICOLAS, PLRCIVAL H. PANGILINAN, ARNULIO A. SALVADOR, ROBLR1 B. SANCHLZ, MLRLY D. S1A. ANA and
YOLANDA P. UNICA, respondents.
D L C I S I O N
1INGA, J.:
1his petition or reiew under Rule 45 o the 199 Rules o Ciil Procedure seeks to nulliy the Deci.iov,
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dated May 16, 2000, o the Court o
Appeals in CA-G.R. SP No. 3283. 1he appellate court airmed the judgment
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dated December 19, 1994, o the Regional 1rial Court ,R1C, o Manila,
Branch 52, in Ciil Case No. 93-66530. The trial court allowed the respondents to take their physicians oath and to register as duly licensed physicians.
Lqually challenged is the Re.otvtiov
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promulgated on August 25, 2000 of the Court of Appeals, denying petitioners Motion for Reconsideration.
1he acts o this case are as ollows:
1he respondents are all graduates o the latima College o Medicine, Valenzuela City, Metro Manila. 1hey passed the Physician Licensure
Lxamination conducted in lebruary 1993 by the Board o Medicine ,Board,. Petitioner Proessional Regulation Commission ,PRC, then released their
names as successul examinees in the medical licensure examination.
Shortly thereater, the Board obsered that the grades o the seenty-nine successul examinees rom latima College in the two most diicult
subjects in the medical licensure exam, Biochemistry ,Bio-Chem, and Obstetrics and Gynecology ,OB-Gyne,, were unusually and exceptionally high.
Lleen latima examinees scored 100 in Bio-Chem and ten got 100 in OB-Gyne, another eleen got 99 in Bio-Chem, and twenty-one scored 99 in
OB-Gyne. 1he Board also obsered that many o those who passed rom latima got marks o 95 or better in both subjects, and no one got a mark
lower than 90. A comparison o the perormances o the candidates rom other schools was made. 1he Board obsered that strangely, the unusually
high ratings were true only or latima College examinees. It was a record-breaking phenomenon in the history o the Physician Licensure Lxamination.
On June , 1993, the Board issued Resolution No. 19, withholding the registration as physicians o all the examinees rom the latima College o
Medicine.
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1he PRC asked the National Bureau o Inestigation ,NBI, to inestigate whether any anomaly or irregularity marred the lebruary 1993
Physician Licensure Lxamination.
Prior to the NBI inestigation, the Board requested lr. Bienenido l. Nebres, S.J., an expert mathematician and authority in statistics, and later
president o the Ateneo de Manila Uniersity, to conduct a statistical analysis o the results in Bio-Chem and Ob-Gyne o the said examination.
On June 10, 1993, lr. Nebres submitted his report. le reported that a comparison o the scores in Bio-Chem and Ob-Gyne, o
the latima College examinees with those o examinees rom De La Salle Uniersity and Perpetual lelp College o Medicine showed that the scores
o latima College examinees were not only incredibly high but unusually clustered close to each other. le concluded that there must be some unusual
reason creating the clustering o scores in the two subjects. It must be a cause strong enough to eliminate the normal variations that one should expect
rom the examinees |o latima College] in terms of talent, effort, energy, etc.
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For its part, the NBI found that the questionable passing rate of latima examinees in the |1993| Physician Lxamination leads to the conclusion that
the latima examinees gained early access to the test questions.
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On July 5, 1993, respondents Arlene V. De Guzman, Violeta V. Meneses, Celerina S. Naarro, Jose Ramoncito P. Naarro, Arnel V. lerrera, and
Geraldine Llizabeth M. Pagilagan ,Arlene V. De Guzman et at., or breity, iled a special ciil action or mandamus, with prayer or preliminary
mandatory injunction docketed as Ciil Case No. 93-66530 with the Regional 1rial Court ,R1C, o Manila, Branch 52. 1heir petition was adopted by the
other respondents as interenors.
Meanwhile, the Board issued Resolution No. 26, dated July 21, 1993, charging respondents with immorality, dishonest conduct, fraud, and deceit
in connection with the Bio-Chem and Ob-Gyne examinations. It recommended that the test results o the latima examinees be nulliied. 1he case was
docketed as Adm. Case No. 168 by the PRC.
On July 28, 1993, the R1C issued an Oraer in Ciil Case No. 93-66530 granting the preliminary mandatory injunction sought by the respondents. It
ordered the petitioners to administer the physicians oath to Arlene V. De Guzman et at., and enter their names in the rolls o the PRC.
1he petitioners then iled a special ciil action or certiorari with the Court o Appeals to set aside the mandatory injunctie writ, docketed as CA-
G.R. SP No. 3101.
On October 21, 1993, the appellate court decided CA-G.R. SP No. 3101, with the dispositie portion o the Deci.iov ordaining as ollows:
\lLRLlORL, this petition is GRAN1LD. Accordingly, the writ o preliminary mandatory injunction issued by the lower court against petitioners is
hereby nulliied and set aside.
SO ORDLRLD.
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Arlene V. de Guzman, et at., then eleated the oregoing Deci.iov to this Court in G.R. No. 112315. In our Re.otvtiov dated May 23, 1994, we denied
the petition or ailure to show reersible error on the part o the appellate court.
Meanwhile, on Noember 22, 1993, during the pendency o the instant petition, the pre-trial conerence in Ciil Case No. 93-66530 was held. 1hen,
the parties, agreed to reduce the testimonies o their respectie witnesses to sworn questions-and-answers. 1his was without prejudice to cross-
examination by the opposing counsel.
On December 13, 1993, petitioners counsel failed to appear at the trial in the mistaken belief that the trial was set for December 15. 1he trial court
then ruled that petitioners waied their right to cross-examine the witnesses.
On January 2, 1994, counsel or petitioners iled a Mavife.tatiov ava Motiov stating the reasons or her non-appearance and praying that the cross-
examination o the witnesses or the opposing parties be reset. 1he trial court denied the motion or lack o notice to aderse counsel. It also denied
the Motiov for Recov.iaeratiov that ollowed on the ground that aderse counsel was notiied less than three ,3, days prior to the hearing.
Meanwhile, to preent the PRC and the Board rom proceeding with Adm. Case No. 168, the respondents herein moed or the issuance o a
restraining order, which the lower court granted in its Oraer dated April 4, 1994.
1he petitioners then iled with this Court a petition or certiorari docketed as G.R. No. 11504, to annul the Oraer. o the trial court
dated Noember 13, 1993, lebruary 28, 1994, and April 4, 1994. \e reerred the petition to the Court o Appeals where it was docketed as CA-G.R. SP
No. 34506.
On August 31, 1994, the appellate court decided CA-G.R. SP No. 34506 as ollows:
\lLRLlORL, the present petition or certiorari with prayer or temporary restraining order,preliminary injunction is GRAN1LD and the Orders o
December 13, 1993, lebruary , 1994, lebruary 28, 1994, and April 4, 1994 o the R1C-Manila, Branch 52, and all urther proceedings taken by it in
Special Ciil Action No. 93-66530 are hereby DLCLARLD NULL and VOID. 1he said R1C-Manila is ordered to allow petitioners counsel to cross-
examine the respondents witnesses, to allow petitioners to present their eidence in due course o trial, and thereater to decide the case on the merits on
the basis o the eidence o the parties. Costs against respondents.
I1 IS SO ORDLRLD.
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1he trial was then set and notices were sent to the parties.
A day beore the irst hearing, on September 22, 1994, the petitioners iled an |rgevt Parte Mavife.tatiov ava Motiov praying or the partial
reconsideration of the appellate courts decision in CA-G.R. SP No. 34506, and or the outright dismissal o Ciil Case No. 93-66530. 1he petitioners
asked or the suspension o the proceedings.
In its Oraer dated September 23, 1994, the trial court granted the aoresaid motion, cancelled the scheduled hearing dates, and reset the proceedings
to October 21 and 28, 1994.
Meanwhile, on October 25, 1994, the Court o Appeals denied the partial motion or reconsideration in CA-G.R. SP No. 34506. 1hus, petitioners
iled with the Supreme Court a petition or reiew docketed as G.R. No. 1181, entitled Profe..iovat Regvtatiov Covvi..iov, et at. r. Covrt of .eat., et at.
On Noember 11, 1994, counsel or the petitioners ailed to appear at the trial o Ciil Case No. 93-66530. Upon motion o the respondents herein,
the trial court ruled that herein petitioners waied their right to cross-examine the herein respondents. 1rial was reset to Noember 28, 1994.
On November 25, 1994, petitioners counsel moved for the inhibition o the trial court judge or alleged partiality. On Noember 28, 1994, the day
the Motiov to vbibit was to be heard, petitioners ailed to appear. 1hus, the trial court denied the Motiov to vbibit and declared Ciil Case No. 93-66530
deemed submitted or decision.
On December 19, 1994, the trial court handed down its judgment in Ciil Case No. 93-66530, the fatto o which reads:
\lLRLlORL, judgment is rendered ordering the respondents to allow the petitioners and interenors ,except those with asterisks and ootnotes in
pages 1 & 2 o this decision, |sic|,
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to take the physicians oath and to register them as physicians.
It should be made clear that this decision is without prejudice to any administratie disciplinary action which may be taken against any o the petitioners
or such causes and in the manner proided by law and consistent with the requirements o the Constitution as any other proessionals.
No costs.
SO ORDLRLD.
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As a result o these deelopments, petitioners iled with this Court a petition or reiew on certiorari docketed as G.R. No. 11843,
entitled Profe..iovat Regvtatiov Covvi..iov r. ov. Daria C. ^itafav, praying ivter atia, that ,1, G.R. No. 11843 be consolidated with G.R. No. 1181, ,2, the
decision o the Court o Appeals dated August 31, 1994 in CA-G.R. SP No. 34506 be nulliied or its ailure to decree the dismissal o Ciil Case No. 93-
66530, and in the alternatie, to set aside the decision o the trial court in Ciil Case No. 93-66530, order the trial court judge to inhibit himsel, and Ciil
Case No. 93-66530 be re-raled to another branch.
On December 26, 1994, the petitioners herein iled their ^otice of .eat
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in Ciil Case No. 93-66530, thereby eleating the case to the Court o
Appeals, where it was docketed as CA-G.R. SP No. 3283.
In our Re.otvtiov o June , 1995, G.R. No. 11843 was consolidated with G.R. No. 1181.
On July 9, 1998, we disposed o G.R. Nos. 1181 and 11843 in this wise:
\lLRLlORL, the petition in G.R. No. 1181 is DISMISSLD or being moot. 1he petition in G.R. No. 11843 is likewise DISMISSLD on the ground
that there is a pending appeal beore the Court o Appeals. Assistant Solicitor General Amparo M. Cabotaje-1ang is adised to be more circumspect in her
dealings with the courts as a repetition o the same or similar acts will be dealt with accordingly.
SO ORDLRLD.
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\hile CA-G.R. SP No. 3283 was awaiting disposition by the appellate court, Arnel V. lerrera, one o the original petitioners in Ciil Case No. 93-
66530, joined by twenty-seen interenors, to wit: lernando l. Mandapat, Ophelia C. lidalgo, Bernadette 1. Mendoza, Ruby B. Lantin-1an, lernando 1.
Cruz, Marissa A. Regodon, Ma. Lloisa Q. Mallari-Largoza, Cheryl R. 1riguero, Joseph A. Jao, Bernadette l. Cabuhat, Lelyn S. Acosta-Cabanes, Laura M.
Santos, Maritel M. Lchierri, Bernadette C. Lscusa, Carlosito C. Domingo, Alicia S. Lizano, Llnora R. Raqueno-Rabaino, Saibzur N. Ldding, Derileen D.
Dorado-Ldding, Robert B. Sanchez, Maria Rosario L. Leonor-Lacandula, Geraldine Llizabeth M. Pagilagan-Palma, Margarita Belinda L. Vicencio-Gamilla,
lerminigilda L. Conejos, Leuina P. Chico-Paguio, Llcin C. Arriola-Ocampo, and Jose Ramoncito P. Naarro, maniested that they were no longer
interested in proceeding with the case and moed or its dismissal. A similar maniestation and motion was later iled by interenors Mary Jean I. \eban-
Merlan, Michael L. Serrano, Norma G. Laailla, Arnulo A. Salador, Belinda C. Rabara, \olanda P. Unica, Dayminda G. Bontuyan, Clarissa B. Baclig,
Ma. Luisa S. Gutierrez, Rhoneil R. Deeraturda, Aleli A. Gollayan, Lelyn C. Cundangan, lrederick D. lrancisco, Viol eta V. Meneses, Melita J. Canedo,
Clarisa SJ. Nicolas, lederico L. Castillo, Karangalan D. Serrano, Danilo A. Villaer, Grace L. Uy, Lydia C. Chan, and Melin M. Usita. 1he Court o
Appeals ruled that its decision in CA-G.R. SP No. 3283 would not apply to them.
On May 16, 2000, the Court o Appeals decided CA-G.R. SP No. 3283, with the ollowing fatto, to wit:
\lLRLlORL, inding no reersible error in the decision appealed rom, \e hereby AllIRM the same and DISMISS the instant appeal.
No pronouncement as to costs.
SO ORDLRLD.
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In sustaining the trial courts decision, the appellate court ratiocinated that the respondents complied with all the statutory requirements or
admission into the licensure examination or physicians in lebruary 1993. 1hey all passed the said examination. laing ulil led the requirements o
Republic Act No. 2382,
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they should be allowed to take their oaths as physicians and be registered in the rolls o the PRC.
lence, this petition raising the ollowing issues:
I
\lL1lLR OR NO1 RLSPONDLN1S lAVL A VALID CAUSL Ol AC1ION lOR MANDAMUS AGAINS1 PL1I1IONLRS IN 1lL LIGl1
OF THE RESOLUTION OF THIS HONORABLE COURT IN G.R. NO. 112315 AFFIRMING THE COURT OF APPEALS DECISION
DLCLARING 1lA1 Il LVLR 1lLRL IS SOML DOUB1 AS 1O 1lL MORAL lI1NLSS Ol LXAMINLLS, 1lL ISSUANCL Ol LICLNSL
1O PRAC1ICL MLDICINL IS NO1 AU1OMA1ICALL\ GRAN1LD 1O 1lL SUCCLSSlUL LXAMINLLS.
II
\lL1lLR OR NO1 1lL PL1I1ION lOR MANDAMUS COULD PROCLLD DLSPI1L 1lL PLNDLNC\ Ol ADMINIS1RA1IVL CASL
NO. 168, \lICl \AS PRLCISLL\ LODGLD 1O DL1LRMINL 1lL MORAL lI1NLSS Ol RLSPONDLN1S 1O BLCOML DOC1ORS.
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1o our mind, the only issue is: Did the Court o Appeals commit a reersible error o law in sustaining the judgment o the trial court that
respondents are entitled to a writ o mandamus
1he petitioners submit that a writ o mandamus will not lie in this case. 1hey point out that or a writ o mandamus to issue, the applicant must hae
a well-deined, clear and certain legal right to the thing demanded and it is the duty o the respondent to perorm the act required. 1hus, mandamus may
be aailed o only when the duty sought to be perormed is a ministerial and not a discretionary one. 1he petitioners argue that the appellate courts
decision in CA-G.R. SP No. 3283 upholding the decision o the trial court in Ciil Case No. 93-66530 oerlooked its own pronouncement in CA-G.R. SP
No. 3101. 1he Court o Appeals held in CA-G.R. SP No. 3101 that the issuance o a license to engage in the practice o medicine becomes discretionary
on the PRC i there exists some doubt that the successul examinee has not ully met the requirements o the law. 1he petitioners stress that this Courts
Resolution dated May 24, 1994 in G.R. No. 112315 held that there was no showing that the Court of Appeals had committed any reversible error in
rendering the questioned judgment in CA-G.R. SP No. 3101. 1he petitioners point out that our Re.otvtiov in G.R. No. 112315 has long become inal and
executory.
Respondents counter that haing passed the 1993 licensure examinations or physicians, the petitioners hae the obligation to administer to them
the oath as physicians and to issue their certiicates o registration as physicians pursuant to Section 20
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o Rep. Act No. 2382. 1he Court o Appeals in
CA-G.R. SP No. 3283, ound that respondents complied with all the requirements o Rep. Act No. 2382. lurthermore, respondents were admitted by
the Medical Board to the licensure examinations and had passed the same. lence, pursuant to Section 20 o Rep. Act No. 2382, the petitioners had the
obligation to administer their oaths as physicians and register them.
Mavaavv. is a command issuing rom a court o competent jurisdiction, in the name o the state or the soereign, directed to some inerior court,
tribunal, or board, or to some corporation or person requiring the perormance o a particular duty therein speciied, which duty results rom the oicial
station o the party to whom the writ is directed, or rom operation o law.
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Section 3 o Rule 65
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o the 199 Rules o Ciil Procedure outlines two
situations when a writ o mandamus may issue, when any tribunal, corporation, board, oicer or person unlawully ,1, neglects the perormance o an act
which the law speciically enjoins as a duty resulting rom an oice, trust, or station, or ,2, excludes another rom the use and enjoyment o a right or
oice to which the other is entitled.
\e shall discuss the issues successiely.
1. Ov 1be i.tevce of a Dvt, of tbe oara of Meaicive 1o ..ve Certificate. of Regi.tratiov a. Pb,.iciav. vvaer Re. .ct ^o. 22.
lor vavaavv. to prosper, there must be a showing that the oicer, board, or oicial concerned, has a clear legal duty, not inoling
discretion.
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Moreoer, there must be statutory authority or the perormance o the act,
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and the perormance o the duty has been reused.
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1hus, it
must be pertinently asked now: Did petitioners hae the duty to administer the lippocratic Oath and register respondents as physicians under the Medical
Act o 1959
As ound by the Court o Appeals, on which we agree on the basis o the records:
It bears emphasizing herein that petitioner-appellees and interenor-appellees hae ully complied with all the statutory requirements or admission into
the licensure examinations or physicians conducted and administered by the respondent-appellants on lebruary 12, 14, 20 and 21, 1993. Stress, too, must
be made o the act that all o them successully passed the same examinations.
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1he crucial query now is whether the Court o Appeals erred in concluding that petitioners should allow the respondents to take their oaths as physicians
and register them, steps which would enable respondents to practice the medical proession
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pursuant to Section 20 o the Medical Act o 1959
1he appellate court relied on a single proision, Section 20 o Rep. Act No. 2382, in concluding that the petitioners had the ministerial obligation to
administer the lippocratic Oath to respondents and register them as physicians. But it is a basic rule in statutory construction that each part o a statute
should be construed in connection with eery other part to produce a harmonious whole, not conining construction to only one section.
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1he intent or
meaning o the statute should be ascertained rom the statute taken as a whole, not rom an isolated part o the proision. Accordingly, Section 20 o Rep.
Act No. 2382, as amended should be read in conjunction with the other proisions o the Act. 1hus, to determine whether the petitioners had the
ministerial obligation to administer the lippocratic Oath to respondents and register them as physicians, recourse must be had to the entirety o the
Medical Act o 1959.
A careful reading of Section 20 of the Medical Act of 1959 discloses that the law uses the word shall with respect to the i ssuance o certiicates o
registration. 1hus, the petitioners shall sign and issue certiicates o registration to those who hae satisactorily complied with the requirements o the
Board. In statutory construction the term shall is a word of command. It is gien imperatie meaning. 1hus, when an examinee satisies the
requirements for the grant of his physicians license, the Board is obliged to administer to him his oath and register him as a physician, pursuant to Section
20 and par. ,1, o Section 22
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o the Medical Act o 1959.
loweer, the surrounding circumstances in this case call or serious inquiry concerning the satisactory compliance with the Board requirements by
the respondents. 1he unusually high scores in the two most diicult subjects was phenomenal, according to lr. Nebres, the consultant o PRC on the
matter, and raised grae doubts about the integrity, i not alidity, o the tests. 1hese doubts hae to be appropriately resoled.
Under the second paragraph of Section 22, the Board is vested with the power to conduct administrative investigations and di sapproe applications
for examination or registration, pursuant to the objectives of Rep. Act No. 2382 as outlined in Section 1
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thereo. In this case, ater the inestigation,
the Board iled beore the PRC, Adm. Case No. 168 against the respondents to ascertain their moral and mental itness to practice medicine, as required
by Section 9
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o Rep. Act No. 2382. In its Deci.iov dated July 1, 199, the Board ruled:
\lLRLlORL, the BOARD hereby CANCELS the respondents[] examination papers in the Physician Licensure Examinations given in February 1993
and urther DLBARS them rom taking any licensure examination or a period o ONL ,1, \LAR rom the date o the promulgation o this DLCISION.
1hey may, i they so desire, apply or the scheduled examinations or physicians ater the lapse o the period imposed by the BOARD.
SO ORDLRLD.
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Until the moral and mental itness o the respondents could be ascertained, according to petitioners, the Board has discretion to hold in abeyance
the administration o the lippocratic Oath and the issuance o the certiicates to them. 1he writ o mandamus does not lie to compel perormance o an
act which is not duly authorized.
1he respondents neertheless argue that under Section 20, the Board shall not issue a certiicate o registration only in the ollowing instances: ,1, to
any candidate who has been conicted by a court o competent jurisdiction o any criminal oense inoling moral turpitude, ,2, or has been ound guilty
o immoral or dishonorable conduct ater the inestigation by the Board, or ,3, has been declared to be o unsound mind. 1hey aer that none o these
circumstances are present in their case.
Petitioners reject respondents argument. \e are inormed that in Board Resolution No. 26,
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dated July 21, 1993, the Board resoled to ile
charges against the examinees from Fatima College of Medicine for immorality, dishonesty, fraud, and deceit in the Obstetrics-Gynecology and
Biochemistry examinations. It likewise sought to cancel the examination results obtained by the examinees rom the latima College.
Section 8
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o Rep. Act No. 2382 prescribes, among others, that a person who aspires to practice medicine in the Philippines, must hae
satisfactorily passed the corresponding Board Examination. Section 22, in turn, provides that the oath may only be administered to physicians who
qualified in the examinations. The operative word here is satisfactorily, defined as sufficient to meet a condition or obligation or capable of
dispelling doubt or ignorance.
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Gleaned rom Board Resolution No. 26, the licensing authority apparently did not ind that the respondents
satisfactorily passed the licensure examinations. The Board instead sought to nullify the examination results obtained by the respondents.
2. Ov tbe Rigbt Of 1be Re.ovaevt. 1o e Regi.terea .. Pb,.iciav.
1he unction o mandamus is not to establish a right but to enorce one that has been established by law. I no legal right has been iolated, there
can be no application o a legal remedy, and the writ o mandamus is a legal remedy or a legal right.
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1here must be a well-deined, clear and certain legal
right to the thing demanded.
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It is long established rule that a license to practice medicine is a priilege or ranchise granted by the goernment.
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It is true that this Court has upheld the constitutional right
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o eery citizen to select a proession or course o study subject to a air, reasonable,
and equitable admission and academic requirements.
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But like all rights and reedoms guaranteed by the Charter, their exercise may be so regulated
pursuant to the police power o the State to saeguard health, morals, peace, education, order, saety, and general welare o the people.
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1hus, persons
who desire to engage in the learned proessions requiring scientiic or technical knowledge may be required to take an examination as a prerequisite to
engaging in their chosen careers. 1his regulation takes particular pertinence in the ield o medicine, to protect the public rom the potentially deadly
eects o incompetence and ignorance among those who would practice medicine. In a preious case, it may be recalled, this Court has ordered the Board
o Medical Lxaminers to annul both its resolution and certiicate authorizing a Spanish subject, with the degree o Licentiate in Medicine and Surgery rom
the Uniersity o Barcelona, Spain, to practice medicine in the Philippines, without irst passing the examination required by the Philippine Medical
Act.
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In another case worth noting, we upheld the power o the State to upgrade the selection o applicants into medical schools through admission
tests.
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It must be stressed, neertheless, that the power to regulate the exercise o a proession or pursuit o an occupation cannot be exercised by the State
or its agents in an arbitrary, despotic, or oppressie manner. A political body that regulates the exercise o a particular priilege has the authority to both
orbid and grant such priilege in accordance with certain conditions. Such conditions may not, howeer, require giing up ones constitutional rights as a
condition to acquiring the license.
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Under the iew that the legislature cannot alidly bestow an arbitrary power to grant or reuse a license on a public
agency or oicer, courts will generally strike down license legislation that ests in public oicials discretion to grant or reuse a license to carry on some
ordinarily lawul business, proession, or actiity without prescribing deinite rules and conditions or the guidance o said oicials in the exercise o their
power.
|41|

In the present case, the aorementioned guidelines are proided or in Rep. Act No. 2382, as amended, which prescribes the requi rements or
admission to the practice o medicine, the qualiications o candidates or the board examinations, the scope and conduct o the examinations, the grounds
for denying the issuance of a physicians license, or revoking a license that has been issued. Verily, to be granted the privilege to practice medicine, the
applicant must show that he possesses all the qualiications and none o the disqualiications. lurthermore, it must appear that he has ully complied with
all the conditions and requirements imposed by the law and the licensing authority. Should doubt taint or mar the compliance as being less than
satisactory, then the priilege will not issue. lor said priilege is distinguishable rom a matter o right, which may be demanded i denied. 1hus, without a
deinite showing that the aoresaid requirements and conditions hae been satisactorily met, the courts may not grant the writ o mandamus to secure said
priilege without thwarting the legislatie will.
. Ov tbe Rieve.. of tbe Petitiov for Mavaavv.
Lastly, the petitioners herein contend that the Court o Appeals should hae dismissed the petition or mandamus bel ow or being premature. 1hey
argue that the administratie remedies had not been exhausted. 1he records show that this is not the irst time that petitioners hae sought the dismissal o
Ciil Case No. 93-66530. 1his issue was raised in G.R. No. 11504, which petition we reerred to the Court o Appeals, where it was docketed as CA-G.R.
SP No. 34506. On motion or reconsideration in CA-G.R. SP No. 34506, the appellate court denied the motion to dismiss on the ground that the prayers
or the nulliication o the order o the trial court and the dismissal o Ciil Case No. 93-66530 were inconsistent relies. In G.R. No. 11843, the
petitioners sought to nulliy the decision o the Court o Appeals in CA-G.R. SP No. 34506 insoar as it did not order the dismissal o Ciil Case No. 93-
66530. In our consolidated decision, dated July 9, 1998, in G.R. Nos. 1181 & 11843, this Court speaking through Justice Bellosillo opined that:
Indeed, the issue as to whether the Court o Appeals erred in not ordering the dismissal o Ciil Case No. 93-66530 sought to be resoled in the instant
petition has been rendered meaningless by an eent taking place prior to the iling o this petition and denial thereo should ollow as a logical
consequence.
|42|
1here is no longer any justiciable controersy so that any declaration thereon would be o no practical use or alue.
|43|
It should be
recalled that in its decision o 19 December 1994 the trial court granted the writ o mandamus prayed or by priate respondents, which decision was
receied by petitioners on 20 December 1994. 1hree ,3, days ater, or on 23 December 1994, petitioners iled the instant petition. By then, the remedy
aailable to them was to appeal the decision to the Court o Appeals, which they in act did, by iling a notice o appeal on 26 December 1994.
|44|

1he petitioners hae shown no cogent reason or us to reerse the aorecited ruling. Nor will their reliance upon the doctrine o the exhaustion o
administratie remedies in the instant case adance their cause any.
Section 26
|45|
o the Medical Act o 1959 proides or the administratie and judicial remedies that respondents herein can aail to question
Resolution No. 26 o the Board o Medicine, namely: ,a, appeal the unaorable judgment to the PRC, ,b, should the PRC ruling still be unaorable, to
eleate the matter on appeal to the Oice o the President, and ,c, should they still be unsatisied, to ask or a reiew o the case or to bring the case to
court ria a special ciil action o certiorari. 1hus, as a rule, mandamus will not lie when administratie remedies are still aailable.
|46|
loweer, the doctrine
o exhaustion o administratie remedies does not apply where, as in this case, a pure question o law is raised.
|4|
On this issue, no reersible error may,
thus, be laid at the door o the appellate court in CA-G.R. SP No. 3283, when it reused to dismiss Ciil Case No. 93-66530.
As we earlier pointed out, herein respondents Arnel V. lerrera, lernando l. Mandapat, Ophelia C. lidalgo, Bernadette 1. Mendoza, Ruby B.
Lantin-1an, lernando 1. Cruz, Marissa A. Regodon, Ma. Lloisa Q. Mallari-Largoza, Cheryl R. 1riguero, Joseph A. Jao, Bernadette l. Cabuhat, Lelyn S.
Acosta-Cabanes, Laura M. Santos, Maritel M. Lchierri, Bernadette C. Lscusa, Carlosito C. Domingo, Alicia S. Lizano, Llnora R. Raqueno-Rabaino,
Saibzur N. Ldding, Derileen D. Dorado-Ldding, Robert B. Sanchez, Maria Rosario Leonor-Lacandula, Geraldine Llizabeth M. Pagilagan-Palma, Margarita
Belinda L. Vicencio-Gamilla, lerminigilda L. Conejos, Leuina P. Chico-Paguio, Llcin C. Arriola-Ocampo, and Jose Ramoncito P. Naarro maniested to
the Court o Appeals during the pendency o CA-G.R. SP No. 3283, that they were no longer interested in proceeding with the case and moed or its
dismissal insoar as they were concerned. A similar maniestation and motion were later iled by interenors Mary Jean I. \eban-Merlan, Michael L.
Serrano, Norma G. Laailla, Arnulo A. Salador, Belinda C. Rabarra, \olanda P. Unica, Dayminda G. Bontuyan, Clarissa B. Baclig, Ma. Luisa S.
Gutierrez, Rhoneil R. Deeraturda, Aleli A. Gollayan, Lelyn C. Cundangan, lrederick D. lrancisco, Violeta V. Meneses, Melita J. Canedo, Clarisa SJ.
Nicolas, lederico L. Castillo, Karangalan D. Serrano, Danilo A. Villaer, Grace L. Uy, Lydia C. Chan, and Melin M. Usita. lol lowing these
maniestations and motions, the appellate court in CA-G.R. SP No. 3283 decreed that its ruling would not apply to them. 1hus, inasmuch as the instant
case is a petition for review of the appellate courts ruling in CA-G.R. SP No. 3283, a decision which is inapplicable to the aorementioned respondents
will similarly not apply to them.
As to Achilles J. Peralta, Lelyn O. Ramos, Sally B. Bunagan, Rogelio B. Ancheta, Oscar l. Padua, Jr., Lelyn D. Grajo, Valentino P. Arboleda,
Carlos M. Bernardo, Jr., Mario D. Cuaresma, Violeta C. lelipe, Percial l. Pangilinan, Corazon M. Cruz and Samuel B. Bangoy, herein decision shall not
apply pursuant to the Orders o the trial court in Ciil Case No. 93-66530, dropping their names rom the suit.
Consequently, this Deci.iov is binding only on the remaining respondents, namely: Arlene V. de Guzman, Celerina S. Naarro, Raael I. 1olentino,
Bernardita B. Sy, Gloria 1. Jularbal, lubert S. Nazareno, Nancy J. Chaez, Lrnesto L. Cue, lerminio V. lernandez, Jr., Maria Victoria M. Lacsamana and
Merly D. Sta. Ana, as well as the petitioners.
WHLRLIORL, the instant petition is GRAN1LD. Accordingly, ,1, the assailed decision dated May 16, 2000, o the Court o Appeals, in CA-
G.R. SP No. 3283, which airmed the judgment dated December 19, 1994, o the Regional 1rial Court o Manila, Branch 52, in Ciil Case No. 93-66530,
ordering petitioners to administer the physicians oath to herein respondents as well as the resolution dated August 25, 2000, of the appellate court,
denying the petitioners motion for reconsideration, are REVERSED and SET ASIDE; and ,2, the writ o mandamus, issued in Ciil Case No. 93-66530,
and airmed by the appellate court in CA-G.R. SP No. 3283 is NULLIlILD AND SL1 ASIDL.
SO ORDLRLD.
Pvvo, ;Cbairvav), and Catte;o, r., ]]., concur.
Qvi.vvbivg, ]., no part.
.v.triaMartive, ]., no part - on leae.
G.R. No. JJ823J. July S, J996
DR. VIC1ORIA L. BA1IQUIN and ALLAN BA1IQUIN, petitioners, vs. COUR1 OI APPLALS, SPOUSLS QULDO D. ACOGIDO and
ILO1ILDL G. VILLLGAS, respondents.
D L C I S I O N
DAVIDL, JR., J.:
1hroughout history, patients hae consigned their ates and lies to the skill o their doctors. lor a breach o this trust, men hae been quick to
demand retribution. Some 4,000 years ago, the Code o lammurabi
|1|
then already proided: "I a physician make a deep incision upon a man with his
bronze lancet and cause the man's death, or operate on the eye socket o a man with his bronze lancet and destroy the man's eyes, they shall cut o his
hand."
|2|
Subsequently, lippocrates
|3|
wrote what was to become part o the healer's oath: "I will ollow that method o treatment which according to my
ability and judgment, I consider or the beneit o my patients, and abstain rom whateer is deleterious and mischieous . . . . \hile I continue to keep
this oath uniolated may it be granted me to enjoy lie and practice the art, respected by all men at all times but should I trespass and iolate this oath, may
the reerse be my lot." At present, the primary objectie o the medical proession is the preseration o lie and mai ntenance o the health o the people.
|4|

Needless to say then, when a physician strays rom his sacred duty and endangers instead the lie o his patient, he must be made to answer
thereor. Although society today cannot and will not tolerate the punishment meted out by the ancients, neither will it and this Court, as this case would
show, let the act go uncondemned.
1he petitioners appeal rom the decision
|5|
o the Court o Appeals o 11 May 1994 in CA-G.R. CV No. 30851, which reersed the decision
|6|
o 21
December 1990 o Branch 30 o the Regional 1rial Court ,R1C, o Negros Oriental in Ciil Case No. 9492.
1he acts, as ound by the trial court, are as ollows:
Dr. Batiquin was a Resident Physician at the Negros Oriental Proincial lospital, Dumaguete City rom January 9, 198 to September 1989. Between
198 and September, 1989 she was also the Actg. lead o the Department o Obstetrics and Gynecology at the said lospital.
Mrs. Villegas is a married woman who submitted to Dr. Batiquin or prenatal care as the latter's priate patient sometime beore September 21,
1988.
In the morning o September 21, 1988 Dr. Batiquin, with the assistance o Dr. Doris 1eresita Sy who was also a Resident Physi cian at the same
lospital, C.I. and O.R. Nurse Arlene Diones and some student nurses perormed a simple cesarean section on Mrs. Villegas at the Negros Oriental
Proincial lospital and ater 45 minutes Mrs. Villegas deliered her irst child, Rachel Acogido, at about 11:45 that morning. 1hereater, Plainti
remained conined at the lospital until September 2, 1988 during which period o coninement she was regularly isited by Dr. Batiquin. On September
28, 1988, Mrs. Villegas checked out o the lospital . . . and on the same day she paid Dr. Batiquin, thru the latter's secretary, the amount o P1,500.00 as
"proessional ee" . . . .
Soon ater leaing the lospital Mrs. Villegas began to suer abdominal pains and complained o being eerish. She also gradually lost her appetite,
so she consulted Dr. Batiquin at the latter's polyclinic who prescribed or her certain medicines . . . which she had been taking up to December, 1988.
In the meantime, Mrs. Villegas was gien a Medical Certiicate by Dr. Batiquin on October 31, 1988 . . . certiying to her physical itness to return to
her work on Noember , 1988. So, on the second week o Noember, 1988 Mrs. Villegas returned to her work at the Rural Bank o Ayungon, Negros
Oriental.
1he abdominal pains and eer kept on recurring and bothered Mrs. Villegas no end and despite the medications administered by Dr.
Batiquin. \hen the pains become unbearable and she was rapidly losing weight she consulted Dr. Ma. Salud Kho at the loly Child's lospital in
Dumaguete City on January 20, 1989.
1he eidence o Plaintis show that when Dr. Ma. Salud Kho examined Mrs. Villegas at the loly Child's lospital on January 20, 1989 she ound
Mrs. Villegas to be eerish, pale and was breathing ast. Upon examination she elt an abdominal mass one inger below the umbilicus which she
suspected to be either a tumor o the uterus or an oarian cyst, either o which could be cancerous. She had an x-ray taken o Mrs. Villegas' chest,
abdomen and kidney. She also took blood tests o Plainti. A blood count showed that Mrs. Villegas had |an| inection inside her abdominal caity. 1he
result o all those examinations impelled Dr. Kho to suggest that Mrs. Villegas submit to another surgery to which the latter agreed.
\hen Dr. Kho opened the abdomen o Mrs. Villegas she ound whitish-yellow discharge inside, an oarian cyst on each o the let and right oaries
which gae out pus, dirt and pus behind the uterus, and a piece o rubber materials on the right side o the uterus embedded on |sic| the oarian cyst, 2
inches by 3,4 inch in size. 1his piece o rubber material which Dr. Kho described as a "oreign body" looked like a piece o a "rubber gloe" . . . and
which is |sic| also "rubber-drain like . . . . It could hae been a torn section o a surgeon's gloes or could hae come rom other sources. And this
oreign body was the cause o the inection o the oaries and consequently o all the discomort suered by Mrs. Villegas ater her deliery on September
21, 1988.
||

1he piece o rubber allegedly ound near priate respondent llotilde Villegas' uterus was not presented in court, and although Dr. Ma. Salud Kho
testiied that she sent it to a pathologist in Cebu City or examination,
|8|
it was not mentioned in the pathologist's Surgical Pathology Report.
|9|

Aside rom Dr. Kho's testimony, the eidence which mentioned the piece o rubber are a Medical Certiicate,
|10|
a Progress Record,
|11|
an Anesthesia
Record,
|12|
a Nurse's Record,
|13|
and a Physician's Discharge Summary.
|14|
1he trial court, howeer, regarded these documentary eidence as mere hearsay,
"there being no showing that the person or persons who prepared them are deceased or unable to testiy on the acts therein stated . . . . Lxcept or the
Medical Certiicate ,Lxhibit "l",, all the aboe documents were allegedly prepared by persons other than Dr. Kho, and she merely aixed her signature on
some o them to express her agreement thereto . . . ."
|15|
1he trial court also reused to gie weight to Dr. Kho's testimony regarding the subject piece o
rubber as Dr. Kho "may not hae had irst-hand knowledge" thereo,
|16|
as could be gleaned rom her statement, thus:
A . . . I hae heard somebody that |sic| says |sic| there is |sic| a oreign body that goes with the tissues but unluckily I don't know where the
rubber was.
|1|

1he trial court deemed ital Dr. Victoria Batiquin's testimony that when she conronted Dr. Kho regarding the piece o rubber, "Dr. Kho answered
that there was rubber indeed but that she threw it away."
|18|
1his statement, the trial court noted, was neer denied nor disputed by Dr. Kho, leading it to
conclude:
1here are now two dierent ersions on the whereabouts o that oending "rubber" ,1, that it was sent to the Pathologist in Cebu as testiied to in
Court by Dr. Kho and ,2, that Dr. Kho threw it away as told by her to Deendant. 1he ailure o the Plaintis to reconcile these two dierent ersions
sere only to weaken their claim against Deendant Batiquin.
|19|

All told, the trial court held in aor o the petitioners herein.
1he Court o Appeals reiewed the entirety o Dr. Kho's testimony and, een without admitting the priate respondents' documentary eidence,
deemed Dr. Kho's positie testimony to deinitely establish that a piece o rubber was ound near priate respondent Villegas' uterus. 1hus, the Court o
Appeals reersed the decision o the trial court, holding:
4. 1he ault or negligence o appellee Dr. Batiquin is established by preponderance o eidence. 1he trial court itsel had narrated what happened to
appellant llotilde ater the cesarean operation made by appellee doctor . . . . Ater the second operation, appellant llotilde became well and
healthy. Appellant llotilde's troubles were caused by the inection due to the "rubber" that was let inside her abdomen. Both appellants testiied that ater
the operation made by appellee doctor, they did not go to any other doctor until they inally decided to see another doctor i n January, 1989 when she was
not getting any better under the care o appellee Dr. Batiquin . . . . Appellee Dr. Batiquin admitted on the witness stand that she alone decided when to
close the operating area, that she examined the portion she operated on beore closing the same . . . . lad she exercised due diligence, appellee Dr.
Batiquin would hae ound the rubber and remoed it beore closing the operating area.
|20|

1he appellate court then ruled:
Appellants' eidence show|s| that they paid a total o P1,000.00 |deposit o P,100.00 ,Lxh. G-1-A, plus hospital and medical expenses together with
doctor's ees in the total amount P9,900.00 ,Lxhs. G and G-2,| or the second operation that saed her lie.
lor the miseries appellants endured or more than three ,3, months, due to the negligence o appellee Dr. Batiquin, they are entitled to moral damages in
the amount o P100,000.00, exemplary damages in the amount o P20,000.00 and attorney's ees in the amount o P25,000.00.
1he act that appellant llotilde can no longer bear children because her uterus and oaries were remoed by Dr. Kho is not taken into consideration as it
is not shown that the remoal o said organs were the direct result o the rubber let by appellee Dr. Batiquin near the uterus. \hat is established is that
the rubber let by appellee cause inection, placed the lie o appellant llotilde in jeopardy and caused appellants ear, worry and anxiety . . . .
\lLRLlORL, the appealed judgment, dismissing the complaint or damages is RLVLRSLD and SL1 ASIDL. Another judgment is hereby entered
ordering deendants-appellees to pay plaintis-appellants the amounts o P1,000.00 as and or actual damages, P100,000.00 as and or moral damages,
P20,000.00 as and or exemplary damages, and P25,000.00 as and or attorney's ees plus the cost o litigation.
SO ORDLRLD.
|21|

lrom the aboe judgment, the petitioners appealed to this Court claiming that the appellate court, ,1, committed grae abuse o discretion by
resorting to indings o act not supported by the eidence on record, and ,2, exceeded its discretion, amounting to lack or excess o jurisdiction, when it
gae credence to testimonies punctured with contradictions and alsities.
1he priate respondents commented that the petition raised only questions o act, which were not proper or reiew by this Court.
\hile the rule is that only questions o law may be raised in a petition or reiew on certiorari, there are exceptions, among which are when the actual
indings o the trial court and the appellate court conlict, when the appealed decision is clearly contradicted by the eidence on record, or when the
appellate court misapprehended the acts.
|22|

Ater deciphering the cryptic petition, we ind that the ocal point o the instant appeal is the appreciation o Dr. Kho's testimony. 1he petitioners
contend that the Court o Appeals misappreciated the ollowing portion o Dr. Kho's testimony:
Q \hat is the purpose o the examination
A Just in case, I was just thinking at the back o my mind, just in case this would turn out to be a medico-legal case, bare beara .oveboa, tbat .ic
.a,. .ic tbere i. .ic a foreigv boa, tbat goe. ritb tbe ti..ve. bvt vvtvc/it, aovt /vor rbere tbe rvbber ra.. It was not in the Lab, it was not in
Cebu.
|23|
,Italics supplied,
1he petitioners preer the trial court's interpretation o the aboe testimony, i.e., that Dr. Kho's knowledge o the piece o rubber was based on
hearsay. 1he Court o Appeals, on the other hand, concluded that the underscored phrase was taken out o context by the trial court. According to the
Court o Appeals, the trial court should hae likewise considered the other portions o Dr. Kho's testimony, especially the ollowing:
Q So you did actually conduct the operation on her
A \es, I did.
Q And what was the result
A Opening up her abdomen, there was whitish-yellow discharge inside the abdomen, there was an oarian cyst on the let and side and there was
also an oarian cyst on the right which, on opening up or reeing it up rom the uterus, turned out to be pus. Both oaries turned out . . . to
hae pus. And then, cleaning up the uterus, at the back o the uterus it was ery dirty, it was ull o pus. And there was a |piece o| rubber, we
ound a |piece o| rubber on the right side.
|24|

\e agree with the Court o Appeals. 1he phrase relied upon by the trial court does not negate the act that Dr. Kho saw a piece o rubber in priate
respondent Villegas' abdomen, and that she sent it to a laboratory and then to Cebu City or examination by a pathologist.
|25|
Not een the Pathologist's
Report, although deoid o any mention o a piece o rubber, could alter what Dr. Kho saw. lurthermore, Dr. Kho's knowledge o the piece o rubber
could not be based on other than irst hand knowledge or, as she asserted beore the trial court:
Q But you are sure you hae seen |the piece o rubber|
A Oh yes. I was not the only one who saw it.
|26|

1he petitioners emphasize that the priate respondents neer reconciled Dr. Kho's testimony with Dr. Batiquin's claim on the witness stand that
when Dr. Batiquin conronted Dr. Kho about the oreign body, the latter said that there was a piece o rubber but that she threw it away. Although
hearsay, Dr. Batiquin's claim was not objected to, and hence, the same is admissible
|2|
but it carries no probatie alue.
|28|
Neertheless, assuming
otherwise, Dr. Batiquin's statement cannot belie the act that Dr. Kho ound a piece o rubber near priate respondent Villegas' uterus. And een i we
were to doubt Dr. Kho as to what she did to the piece o rubber, i.e., whether she threw it away or sent it to Cebu City, we are not justiied in distrusting
her as to her recoery o a piece o rubber rom priate respondent Villegas' abdomen. On this score, it is perectly reasonable to beliee the testimony o
a witness with respect to some acts and disbeliee his testimony with respect to other acts. And it has been aptly said that een when a witness is ound
to hae deliberately alsiied in some material particulars, it is not required that the whole o his uncorroborated testimony be rejected, but such portions
thereo deemed worthy o belie may be credited.
|29|

It is here worth nothing that the trial court paid heed to the ollowing portions o Dr. Batiquin's testimony: that no rubber drain was used in the
operation,
|30|
and that there was neither any tear on Dr. Batiquin's gloes ater the operation nor blood smears on her hands upon remoing her
gloes.
|31|
Moreoer, the trial court pointed out that the absence o a rubber drain was corroborated by Dr. Doris Sy, Dr. Batiquin's assistant during the
operation on priate respondent Villegas.
|32|
But the trial court ailed to recognize that the assertions o Drs. Batiquin and Sy were denials or negatie
testimonies. \ell-settled is the rule that positie testimony is stronger than negatie testimony.
|33|
O course, as the petitioners adocate, such positie
testimony must come rom a credible source, which leads us to the second assigned error.
\hile the petitioners claim that contradictions and alsities punctured Dr. Kho's testimony, a reading o the said testimony reeals no such inirmity
and establishes Dr. Kho as a credible witness. Dr. Kho was rank throughout her turn on the witness stand. lurthermore, no motie to state any untruth
was eer imputed against Dr. Kho, leaing her trustworthiness unimpaired.
|34|
1he trial court's ollowing declaration shows that while it was critical o the
lack o care with which Dr. Kho handled the piece o rubber, it was not prepared to doubt Dr. Kho's credibility, thus only supporting out appraisal o Dr.
Kho's trustworthiness:
1his is not to say that she was less than honest when she testiied about her indings, but it can also be said that she did not take the most appropriate
precaution to presere that "piece o rubber" as an eloquent eidence o what she would reeal should there be a "legal problem" which she claim|s| to
hae anticipated.
|35|

Considering that we hae assessed Dr. Kho to be a credible witness, her positie testimony |that a piece o rubber was indeed ound in priate
respondent Villegas' abdomen| preails oer the negatie testimony in aor o the petitioners.
As such, the rule o re. i.a toqvitvr comes to ore. 1his Court has had occasion to dele into the nature and operation o this doctrine:
1his doctrine |re. i.a toqvitvr| is stated thus: "\here the thing which causes injury is shown to be under the management o the deendant, and the
accident is such as in the ordinary course o things does not happen i those who hae the management use proper care, it aords reasonable eidence, in
the absence o an explanation by the deendant, that the accident arose rom want o care." Or as tac/. ar Dictiovar, puts it:
Re. i.a toqvitvr. 1he thing speaks or itsel. Rebuttable presumption or inerence that deendant was negligent, which arises upon proo that |the|
instrumentality causing injury was in deendant's exclusie control, and that the accident was one which ordinary does not happen in absence o
negligence. Re. i.a toqvitvr is |a| rule o eidence whereby negligence o |the| alleged wrongdoer may be inerred rom |the| mere act that |the| accident
happened proided |the| character o |the| accident and circumstances attending it lead reasonably to belie that in |the| absence o negligence it would not
hae occurred and that thing which caused injury is shown to hae been under |the| management and control o |the| alleged wrongdoer . . . . Under |this|
doctrine . . . the happening o an injury permits an inerence o negligence where plainti produces substantial eidence that |the| injury was caused by an
agency or instrumentality under |the| exclusie control and management o deendant, and that the occurrence |sic| was such that in the ordinary course o
things would not happen i reasonable care had been used.
xxx xxx xxx
1he doctrine o re. i.a toqvitvr as a rule o eidence is peculiar to the law o negligence which recognizes that riva facie negligence may be established
without direct proo and urnishes a substitute or speciic proo o negligence. 1he doctrine is not a rule o substantie law, but merely a mode o proo
or a mere procedural conenience. 1he rule, when applicable to the acts and circumstances o a particular case, is not intended to and does not dispense
with the requirement o proo o culpable negligence on the party charged. It merely determines and regulates what shall be riva facie eidence thereo
and acilitates the burden o plainti o proing a breach o the duty o due care. 1he doctrine can be inoked when and only when, under the
circumstances inoled, direct eidence is absent and not readily aailable.
|36|

In the instant case, all the requisites or recourse to the doctrine are present. lirst, the entire proceedings o the cesarean section were under the
exclusie control o Dr. Batiquin. In this light, the priate respondents were beret o direct eidence as to the actual culprit or the exact cause o the
oreign object inding its way into priate respondent Villegas' body, which, needless to say, does not occur unless through the interention o
negligence. Second, since aside rom the cesarean section, priate respondent Villegas underwent no other operation which could hae caused the
oending piece o rubber to appear in her uterus, it stands to reason that such could only hae been a by-product o the cesarean section perormed by
Dr. Batiquin. 1he petitioners, in this regard, ailed to oercome the presumption o negligence arising rom resort to the doctrine o re. i.a toqvitvr. Dr.
Batiquin is thereore liable or negligently leaing behind a piece o rubber in priate respondent Villegas' abdomen and or all the aderse eects thereo.
As a inal word, this Court reiterates its recognition o the ital role the medical proession plays in the lies o the people,
|3|
and State's compelling
interest to enact measures to protect the public rom "the potentially deadly eects o incompetence and ignorance in those who would undertake to treat
our bodies and minds or disease or trauma."
|38|
Indeed, a physician is bound to sere the interest o his patients "with the greatest o solicitude, giing
them always his best talent and skill."
|39|
1hrough her tortious conduct, the petitioner endangered the lie o llotilde Villegas, in iolation o her
proession's rigid ethical code and in contraention o the legal standards set orth or proessionals, in the general,
|40|
and members o the medical
proession,
|41|
in particular.
WHLRLIORL, the challenged decision o 11 May 1994 o the Court o Appeals in CA-G.R. CV No. 30851 is hereby AllIRMLD iv toto.
Costs against the petitioners.
SO ORDLRLD.
^arra.a, C.]., ;Cbairvav), Meto, ravci.co, and Pavgavibav, ]]., concur.
G.R. No. 89S72 December 2J, J989
DLPAR1MLN1 OI LDUCA1ION, CUL1URL AND SPOR1S (DLCS) and DIRLC1OR OI CLN1LR IOR LDUCA1IONAL
MLASURLMLN1, petitioners,
s.
ROBLR1O RLY C. SAN DILGO and JUDGL 1LRLSI1A DIZON-CAPULONG, in her capacity as Presiding Judge of the Regional 1rial
Court of Valenzuela, Metro Manila, Branch J72, respondents.
Ravov M. Cverara for rirate re.ovaevt.

CRUZ, J.:
1he issue beore us is mediocrity. 1he question is whether a person who has thrice ailed the National Medical Admission 1est ,NMA1, is entitled to take
it again.
1he petitioner contends he may not, under its rule that-
h, A student shall be allowed only three ,3, chances to take the NMA1. Ater three ,3, successie ailures, a student shall not be
allowed to take the NMA1 or the ourth time.
1he priate respondent insists he can, on constitutional grounds.
But irst the acts.
1he priate respondent is a graduate o the Uniersity o the Last with a degree o Bachelor o Science in Zoology. 1he petitioner claims that he took the
NMA1 three times and lunked it as many times.
J
\hen he applied to take it again, the petitioner rejected his application on the basis o the aoresaid
rule. le then went to the Regional 1rial Court o Valenzuela, Metro Manila, to compel his admission to the test.
In his original petition or mandamus, he irst inoked his constitutional rights to academic reedom and quality education. By agreement o the parties,
the priate respondent was allowed to take the NMA1 scheduled on April 16, 1989, subject to the outcome o his petition.
2
In an amended petition iled
with leae o court, he squarely challenged the constitutionality o MLCS Order No. 12, Series o 192, containing the aboe-cited rule. 1he additional
grounds raised were due process and equal protection.
Ater hearing, the respondent judge rendered a decision on July 4, 1989, declaring the challenged order inalid and granting the petition. Judge 1eresita
Dizon-Capulong held that the petitioner had been depried o his right to pursue a medical education through an arbitrary exercise o the police power.
3

\e cannot sustain the respondent judge. ler decision must be reersed.
In 1ablarin . Gutierrez,
4
this Court upheld the constitutionality o the NMA1 as a measure intended to limit the admission to medical schools only to
those who hae initially proed their competence and preparation or a medical education. Justice llorentino P. leliciano declared or a unanimous Court:
Perhaps the only issue that needs some consideration is whether there is some reasonable relation between the prescribing o passing
the NMA1 as a condition or admission to medical school on the one hand, and the securing o the health and saety o the general
community, on the other hand. 1his question is perhaps most useully approached by recalling that the regulation o the prati ce o
medicine in all its branches has long been recognized as a reasonable method o protecting the health and saety o the public. 1hat
the power to regulate and control the practice o medicine includes the power to regulate admission to the ranks o those authorized
to practice medicine, is also well recognized. 1hus, legislation and administratie regulations requiring those who wish to practice
medicine irst to take and pass medical board examinations hae long ago been recognized as alid exercises o goernmental power.
Similarly, the establishment o minimum medical educational requirements-i.e., the completion o prescribed courses in a recognized
medical school-or admission to the medical proession, has also been sustained as a legitimate exercise o the regulatory authority o
the state. \hat we hae beore us in the instant case is closely related: the regulation o access to medical schools. MLCS Order No.
52, s. 1985, as noted earlier, articulates the rationale o regulation o this type: the improement o the proessional and technical
quality o the graduates o medical schools, by upgrading the quality o those admitted to the student body o the medical schools.
1hat upgrading is sought by selectiity in the process o admission, selectiity consisting, among other things, o limiting admission to
those who exhibit in the required degree the aptitude or medical studies and eentually or medical practice. 1he need to maintain,
and the diiculties o maintaining, high standards in our proessional schools in general, and medical schools in particular, in the
current state o our social and economic deelopment, are widely known.
\e beliee that the goernment is entitled to prescribe an admission test like the NMA1 as a means o achieing its stated objectie
o "upgrading the selection o applicants into |our| medical schools" and o "impro|ing| the quality o medical education in the
country." Gien the widespread use today o such admission tests in, or instance, medical schools in the United States o America
,the Medical College Admission 1est |MCA1| and quite probably, in other countries with ar more deeloped educational resources
than our own, and taking into account the ailure or inability o the petitioners to een attempt to proe otherwise, we are entitled to
hold that the NMA1 is reasonably related to the securing o the ultimate end o legislation and regulation in this area. 1hat end, it is
useul to recall, is the protection o the public rom the potentially deadly eects o incompetence and ignorance in those who would
undertake to treat our bodies and minds or disease or trauma.
loweer, the respondent judge agreed with the petitioner that the said case was not applicable. ler reason was that it upheld only the requirement or the
admission test and said nothing about the so-called "three-lunk rule."
\e see no reason why the rationale in the 1ablarin case cannot apply to the case at bar. 1he issue raised in both cases is the academic preparation o the
applicant. 1his may be gauged at least initially by the admission test and, indeed with more reliability, by the three-lunk rule. 1he latter cannot be regarded
any less alid than the ormer in the regulation o the medical proession.
1here is no need to redeine here the police power o the State. Suice it to repeat that the power is alidly exercised i ,a, the interests o the public
generally, as distinguished rom those o a particular class, require the intererence o the State, and ,b, the means employed are reasonably necessary to the
attainment o the object sought to be accomplished and not unduly oppressie upon indiiduals.
S

In other words, the proper exercise o the police power requires the concurrence o a lawul subject and a lawul method.
1he subject o the challenged regulation is certainly within the ambit o the police power. It is the right and indeed the responsibility o the State to insure
that the medical proession is not iniltrated by incompetents to whom patients may unwarily entrust their lies and health.
1he method employed by the challenged regulation is not irreleant to the purpose o the law nor is it arbitrary or oppressie. 1he three-lunk rule is
intended to insulate the medical schools and ultimately the medical proession rom the intrusion o those not qualiied to be doctors.
\hile eery person is entitled to aspire to be a doctor, he does not hae a constitutional right to be a doctor. 1his is true o any other calling in which the
public interest is inoled, and the closer the link, the longer the bridge to one's ambition. 1he State has the responsibility to harness its human resources
and to see to it that they are not dissipated or, no less worse, not used at all. 1hese resources must be applied in a manner that will best promote the
common good while also giing the indiidual a sense o satisaction.
A person cannot insist on being a physician i he will be a menace to his patients. I one who wants to be a lawyer may proe better as a plumber, he
should be so adised and adiced. O course, he may not be orced to be a plumber, but on the other hand he may not orce his entry into the bar. By the
same token, a student who has demonstrated promise as a pianist cannot be shunted aside to take a course in nursing, howeer appropriate this career may
be or others.
1he right to quality education inoked by the priate respondent is not absolute. 1he Constitution also proides that "eery citizen has the right to choose
a proession or course o study, subject to air, reasonable and equitable admission and academic requirements.
6

1he priate respondent must yield to the challenged rule and gie way to those better prepared. \here een those who hae qualiied may still not be
accommodated in our already crowded medical schools, there is all the more reason to bar those who, like him, hae been tested and ound wanting.
1he contention that the challenged rule iolates the equal protection clause is not well-taken. A law does not hae to operate with equal orce on all
persons or things to be conormable to Article III, Section 1 o the Constitution.
1here can be no question that a substantial distinction exists between medical students and other students who are not subjected to the NMA1 and the
three-lunk rule. 1he medical proession directly aects the ery lies o the people, unlike other careers which, or this reason, do not require more
igilant regulation. 1he accountant, or example, while belonging to an equally respectable proession, does not hold the same delicate responsibility as that
o the physician and so need not be similarly treated.
1here would be unequal protection i some applicants who hae passed the tests are admitted and others who hae also qualiied are denied entrance. In
other words, what the equal protection requires is equality among equals.
1he Court eels that it is not enough to simply inoke the right to quality education as a guarantee o the Constitution: one must show that he is entitled to
it because o his preparation and promise. 1he priate respondent has ailed the NMA1 ie times.
7
\hile his persistence is noteworthy, to say the least, it
is certainly misplaced, like a hopeless loe.
No depreciation is intended or made against the priate respondent. It is stressed that a person who does not qualiy in the NMA1 is not an absolute
incompetent unit or any work or occupation. 1he only inerence is that he is a probably better, not or the medical proession, but or another calling
that has not excited his interest.
In the ormer, he may be a bungler or at least lackluster, in the latter, he is more likely to succeed and may een be outstanding. It is or the appropriate
calling that he is entitled to quality education or the ull harnessing o his potentials and the sharpening o his latent talents toward what may een be a
brilliant uture.
\e cannot hae a society o square pegs in round holes, o dentists who should neer hae let the arm and engineers who should hae studied banking
and teachers who could be better as merchants.
It is time indeed that the State took decisie steps to regulate and enrich our system o education by directing the student to the course or which he is best
suited as determined by initial tests and ealuations. Otherwise, we may be "swamped with mediocrity," in the words o Justice lolmes, not because we
are lacking in intelligence but because we are a nation o misits.
\lLRLlORL, the petition is GRAN1LD. 1he decision o the respondent court dated January 13, 1989, is RLVLRSLD, with costs agai nst the priate
respondent. It is so ordered.
ervav, C.]., ^arra.a Metevcioerrera, Cvtierre, ]r., Para., eticiavo, Cavca,co, Paaitta, iaiv, arvievto, Corte., Crivo.qvivo, Meaiataea ava Regataao, ]]., covcvr.
IL CAYAO-LASAM, G.R. No. JS9J32
Petitioner,
Present:

\NARLS-SAN1IAGO, ].,
Cbairer.ov,
- ersus - AUS1RIA-MAR1INLZ,
ClICO-NAZARIO,
NAClURA, ava
RL\LS, ]].
SPOUSLS CLARO and
LDI1HA RAMOLL1L, Promulgated:
Respondents.

December 18, 2008


x - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - x
D L C I S I O N
AUS1RIA-MAR1INLZ, J.:

Beore the Court is a Petition or Reiew on Certiorari under Rule 45 o the Rules o Court iled by Dr. le Cayao-Lasam ,petitioner, seeking to annul the
Decision
|1|
dated July 4, 2003 o the Court o Appeals ,CA, in CA-G.R. SP No. 62206.
1he antecedent acts:
On July 28, 1994, respondent, three months pregnant Lditha Ramolete ,Lditha, was brought to the Lorma Medical Center ,LMC, in San lernando, La Union due to
aginal bleeding. Upon adice o petitioner relayed ria telephone, Lditha was admitted to the LMC on the same day. A pelic sonogram
|2|
was then conducted on Lditha reealing
the fetus weak cardiac pulsation.
|3|
1he ollowing day, Edithas repeat pelic sonogram
|4|
showed that aside from the fetus weak cardiac pulsation, no etal moement was also
appreciated. Due to persistent and prouse aginal bleeding, petitioner adised Lditha to undergo a Dilatation and Curettage Procedure (D&C) or ra.a.
On July 30, 1994, petitioner perormed the D&C procedure. Lditha was discharged rom the hospital the ollowing day.
On September 16, 1994, Lditha was once again brought at the LMC, as she was suering rom omiting and seere abdominal pains. Lditha was attended by Dr. Beatriz de
la Cruz, Dr. Victor B. Mayo and Dr. Juan V. Komiya. Dr. Mayo allegedly inormed Lditha that there was a dead fetus in the latters
womb. Ater, Lditha underwent laparotomy,
|5|
she was ound to hae a massie intra-abdominal hemorrhage and a ruptured uterus. 1hus, Lditha had to undergo a procedure or
hysterectomy
|6|
and as a result, she has no more chance to bear a child.
On Noember , 1994, Lditha and her husband Claro Ramolete ,respondents, iled a Complaint
||
or Gross Negligence and Malpractice against petitioner beore the
Proessional Regulations Commission ,PRC,.
Respondents alleged that Edithas hysterectomy was caused by petitioners unmitigated negligence and professional incompetence in conducting the D&C procedure
and the petitioners failure to remove the fetus inside Edithas womb.
|8|
Among the alleged acts o negligence were: fir.t, petitioners failure to check up, isit or administer medication
onLditha during her irst day o coninement at the LMC,
|9|
.ecova, petitioner recommended that a D&C procedure be perormed on Lditha without conducting any internal
examination prior to the procedure,
|10|
tbira, petitioner immediately suggested a D&C procedure instead o closely monitoring the state o pregnancy o Lditha.
|11|

In her Answer,
|12|
petitioner denied the allegations o negligence and incompetence with the ollowing explanations: upon Edithas conirmation that she would seek
admission at the LMC, petitioner immediately called the hospital to anticipate the arrial o Lditha and ordered through the telephone the medicines Lditha needed to take, which
the nurses carried out, petitioner isited Lditha on the morning o July 28, 1994 during her rounds, on July 29, 1994, she perormed an internal examination on Lditha and she
discovered that the latters cervix was already open, thus, petitioner discussed the possible D&C procedure, should the bleeding become more prouse, on July 30 1994, she
conducted another internal examination on Lditha, which revealed that the latters cervix was still open; Lditha persistently complained o her aginal bleeding and her passing out
o some meaty mass in the process o urination and bowel moement, thus, petitioner adised Lditha to undergo D&C procedure which the respondents consented to, petitioner
was ery ocal in the operating room about not being able to see an abortus,
|13|
taking the words o Lditha to mean that she was passing out some meaty mass and clotted blood,
she assumed that the abortus must hae been expelled in the process o bleeding, it was Lditha who insisted that she wanted to be discharged, petitioner agreed, but she
adised Lditha to return or check-up on August 5, 1994, which the latter ailed to do.
Petitioner contended that it was Edithas gross negligence and/or omission in insisting to be discharged on July 31, 1994 against doctors advice and her unjustiied ailure to
return or check-up as directed by petitioner that contributed to her lie-threatening condition on September 16, 1994, that Edithas hysterectomy was brought about by her ery
abnormal pregnancy known as tacevta ivcreta, which was an extremely rare and ery unusual case o abdominal placental implantation. Petitioner argued that whether or not a D&C
procedure was done by her or any other doctor, there would be no dierence at all because at any stage o gestation beore term, the uterus would rupture just the same.
On March 4, 1999, the Board o Medicine ,the Board, o the PRC rendered a Decision,
|14|
exonerating petitioner rom the charges iled against her. 1he Board held:
Based on the indings o the doctors who conducted the laparotomy on Lditha, hers is a case o Lctopic Pregnancy Interstitial. 1his type
o ectopic pregnancy is one that is being protected by the uterine muscles and maniestations may take later than our ,4, months and only attributes to two
percent ,2, o ectopic pregnancy cases.
\hen complainant Lditha was admitted at Lorma Medical Center on July 28, 1994 due to aginal bleeding, an ultra-sound was perormed upon
her and the result o the Sonogram 1est reeals a morbid etus but did not speciy where the etus was located. Obstetricians will assume that the pregnancy
is within the uterus unless so speciied by the Sonologist who conducted the ultra-sound. Respondent ,Dr. Lasam, cannot be aulted i she was not able to
determine that complainant Lditha is haing an ectopic pregnancy interstitial. 1he D&C conducted on Lditha is necessary considering that her cerix is
already open and so as to stop the prouse bleeding. Simple curettage cannot remoe a etus i the patient is haing an ectopic pregnancy,
since ectopic pregnancy is pregnancy conceied outside the uterus and curettage is done only within the uterus. 1hereore, a more extensie operation
needed in this case o pregnancy in order to remoe the etus.
|15|

leeling aggrieed, respondents went to the PRC on appeal. On Noember 22, 2000, the PRC rendered a Decision
|16|
reersing the indings o the Board and reoking
petitioners authority or license to practice her proession as a physician.
|1|

Petitioner brought the matter to the CA in a Petition or Reiew under Rule 43 o the Rules o Court. Petitioner also dubbed her petition as one or certiorari
|18|
under
Rule 65 o the Rules o Court.
In the Decision dated July 4, 2003, the CA held that the Petition or Reiew under Rule 43 o the Rules o Court was an improper remedy, as the enumeration o
the qva.i;vaiciat agencies in Rule 43 is exclusie.
|19|
PRC is not among the quasi-judicial bodies whose judgment or inal orders are subject o a petition or reiew to the CA, thus, the
petition or reiew o the PRC Decision, iled at the CA, was improper. 1he CA urther held that should the petition be treated as a petition or certiorari under Rule 65, the same
would still be dismissed or being improper and premature. Citing Section 26
|20|
o Republic Act ,R.A., No. 2382 or the Medical Act o 1959, the CA held that the plain, speedy and
adequate remedy under the ordinary course o law which petitioner should hae aailed hersel o was to appeal to the Oice o the President.
|21|


lence, herein petition, assailing the decision o the CA on the ollowing grounds:

1. 1lL COUR1 Ol APPLALS LRRLD ON A QULS1ION Ol LA\ IN lOLDING 1lA1 1lL PROlLSSIONAL
RLGULA1ION|S| COMMISSION ,PRC, \AS LXCLUDLD AMONG 1lL QUASI-JUDICIAL AGLNCILS CON1LMPLA1LD
UNDLR RULL 43 Ol 1lL RULLS Ol CIVIL PROCLDURL,

2. LVLN ASSUMING, .RC|^DO, 1lA1 PRC \AS LXCLUDLD lROM 1lL PURVIL\ Ol RULL 43 Ol 1lL
RULLS Ol CIVIL PROCLDURL, 1lL PL1I1IONLR \AS NO1 PRLCLUDLD lROM lILING A PL1I1ION lOR
CLR1IORARI \lLRL 1lL DLCISION \AS ALSO ISSULD IN LXCLSS Ol OR \I1lOU1 JURISDIC1ION, OR \lLRL
1lL DLCISION \AS A PA1LN1 NULLI1\,

3. lLRLIN RLSPONDLN1S-SPOUSLS ARL NO1 ALLO\LD B\ LA\ 1O APPLAL lROM 1lL DLCISION Ol
1lL BOARD Ol MLDICINL 1O 1lL PROlLSSIONAL RLGULA1ION|S| COMMISSION,

4. 1lL COUR1 Ol APPLALS COMMI11LD GRAVL ABUSL Ol DISCRL1ION IN DLN\ING lOR IMPROPLR
lORUM 1lL PL1I1ION lOR RLVIL\,PL1I1ION lOR CLR1IORARI \I1lOU1 GOING OVLR 1lL MLRI1S Ol 1lL
GROUNDS RLLILD UPON B\ 1lL PL1I1IONLR,

5. PRCS GRAVL OMISSION 1O AllORD lLRLIN PL1I1ONLR A ClANCL 1O BL lLARD ON APPLAL IS A
CLLAR VIOLA1ION Ol lLR CONS1I1U1IONAL RIGl1 1O DUL PROCLSS AND lAS 1lL LllLC1 Ol RLNDLRING
1lL JUDGMLN1 NULL AND VOID,

6. COROLLAR\ 1O 1lL lOUR1l ASSIGNLD LRROR, PRC COMMI11LD GRAVL ABUSL Ol DISCRL1ION,
AMOUN1ING 1O LACK Ol JURISDIC1ION, IN ACCLP1ING AND CONSIDLRING 1lL MLMORANDUM ON APPLAL
\I1lOU1 PROOl Ol SLRVICL 1O lLRLIN PL1I1IONLR, AND IN VIOLA1ION Ol AR1. IV, SLC. 35 Ol 1lL RULLS
AND RLGULA1IONS GOVLRNING 1lL RLGULA1ION AND PRAC1ICL Ol PROlLSSIONALS,

. PRC COMMITTED GRAVE ABUSE OF DISCRETION IN REVOKING PETITIONERS LICENSE TO PRACTICE
MLDICINL \I1lOU1 AN LXPLR1 1LS1IMON\ 1O SUPPOR1 I1S CONCLUSION AS 1O 1lL CAUSL Ol
RESPONDENT EDITHAT [SIC] RAMOLETES INJURY;

8. PRC COMMI11LD AN LVLN GRAVLR ABUSL Ol DISCRL1ION IN 1O1ALL\ DISRLGARDING 1lL
lINDING Ol 1lL BOARD Ol MLDICINL, \lICl lAD 1lL NLCLSSAR\ COMPL1LNCL AND LXPLR1ISL 1O
ESTABLISH THE CAUSE OF RESPONDENT EDITHAS INJURY, AS WELL AS THE TESTIMONY OF THE EXPERT
\I1NLSS AUGUS1O MANALO, M.D. ,|AND|

9. PRC COMMI11LD GRAVL ABUSL Ol DISCRL1ION IN MAKING CONCLUSIONS Ol lAC1S 1lA1 \LRL NO1 ONL\
UNSUPPOR1LD B\ LVIDLNCL BU1 \LRL AC1UALL\ CON1RAR\ 1O LVIDLNCL ON RLCORD.
|22|


1he Court will irst deal with the procedural issues.

Petitioner claims that the law does not allow complainants to appeal to the PRC rom the decision o the Board. She inokes Article IV, Section 35 o the Rules and
Regulations Goerning the Regulation and Practice o Proessionals, which proides:

Sec. 35. 1he respondent may appeal the decision o the Board within thirty days rom receipt thereo to the Commission whose decision shall
be inal. Complainant, when allowed by law, may interpose an appeal from the Decision of the Board within the same period. ,Lmphasis
supplied,

Petitioner asserts that a careul reading o the aboe law indicates that while the respondent, as a matter o right, may appeal the Decision o the Board to the
Commission, the complainant may interpose an appeal rom the decision o the Board only when so allowed by law.
|23|
Petitioner cited Section 26 o Republic Act No. 2382 or
The Medical Act of 1959, to wit:

Section 26. .eat frov ;vagvevt. 1he decision o the Board o Medical Lxaminers ,now Medical Board, shall automatically become inal thirty days
ater the date o its promulgation unless the respondent, during the same period, has appealed to the Commissioner o Ciil Serice ,now Proessional
Regulations Commission, and later to the Oice o the President o the Philippines. I the inal decision is not satisactory, the respondent may ask or a
reiew o the case, or may ile in court a petition or certiorari.

Petitioner posits that the reason why the Medical Act o 1959 allows only the respondent in an administratie case to ile an appeal with the Commission while the
complainant is not allowed to do so is double jeopardy. Petitioner is o the belie that the reocation o license to practice a proession is penal in nature.
|24|


1he Court does not agree.

lor one, the principle o double jeopardy inds no application in administratie cases. Double jeopardy attaches only: ,1, upon a alid indictment, ,2, beore a competent
court, ,3, ater arraignment, ,4, when a alid plea has been entered, and ,5, when the deendant was acquitted or conicted, or the case was dismissed or otherwise terminated
without the express consent o the accused.
|25|
1hese elements were not present in the proceedings beore the Board o Medicine, as the proceedings inoled in the instant case
were administratie and not criminal in nature. 1he Court has already held that double jeopardy does not lie in administratie cases.
|26|


Moreoer, Section 35 o the Rules and Regulations Goerning the Regulation and Practice o Proessionals cited by petitioner was subsequently amended to read:

Sec. 35. 1he complainant/respondent may appeal the order, the resolution or the decision o the Board within thirty ,30, days rom receipt
thereo to the Commission whose decision shall be inal andexecutory. Interlocutory order shall not be appealable to the Commission. ,Amended by Res.
14, Series o 1990,.
|2|
,Lmphasis supplied,

\hateer doubt was created by the preious proision was settled with said amendment. It is axiomatic that the right to appeal is not a natural
right or a part o due process, but a mere statutory priilege that may be exercised only in the manner prescribed by law.
|28|
In this case, the clear intent o
the amendment is to render the right to appeal rom a decision o the Board aailable to both complainants and respondents.

Such conclusion is bolstered by the act that in 2006, the PRC issued Resolution No. 06-342,A,, or the New Rules o Procedure in Administratie Inestigations
in the Proessional Regulations Commission and the Proessional Regulatory Boards, which proides or the method o appeal, to wit:

Sec. 1. Appeal, Period Non-Lxtendible.- 1he decision, order or resolution o the Board shall be inal and executory ater the lapse o iteen ,15,
days rom receipt o the decision, order or resolution without an appeal being perected or taken by either the respondent or the complainant. A party
aggrieved by the decision, order or resolution may file a notice of appeal from the decision, order or resolution of the Board to the
Commission within fifteen (JS) days from receipt thereof, and serving upon the adverse party a notice of appeal together with the appellants brief or
memorandum on appeal, and paying the appeal and legal research ees. x x x
|29|


1he aboe-stated proision does not qualiy whether only the complainant or respondent may ile an appeal, rather, the new rules proide that a party aggrieved may
ile a notice o appeal. 1hus, either the complainant or the respondent who has been aggrieed by the decision, order or resolution o the Board may appeal to the Commission. It
is an elementary rule that when the law speaks in clear and categorical language, there is no need, in the absence o legislatie intent to the contrary, or any interpretation.
|30|
\ords
and phrases used in the statute should be gien their plain, ordinary, and common usage or meaning.
|31|


Petitioner also submits that appeals rom the decisions o the PRC should be with the CA, as Rule 43
|32|
o the Rules o Court was precisely ormulated and adopted to
proide or a uniorm rule o appellate procedure or quasi-judicial agencies.
|33|
Petitioner urther contends that a quasi-judicial body is not excluded rom the puriew o Rule 43 just
because it is not mentioned therein.
|34|


On this point, the Court agrees with the petitioner.

Sec. 1, Rule 43 o the Rules o Court proides:

Section 1. coe. 1his Rule shall apply to appeals rom judgments or inal orders o the Court o 1ax Appeals, and from awards,
judgments, final orders or resolutions of or authorized by any quasi-judicial agency in the exercise of its quasi-judicial functions. Among these
agencies are the Ciil Serice Commission, Central Board o Assessment Appeals, Securities and Lxchange Commission, Oice o the President, Land
Registration Authority, Social Security Commission, Ciil Aeronautics Board, Bureau o Patents, 1rademarks and 1echnology 1ranser, National
Llectriication Administration, Lnergy Regulatory Board, National 1elecommunications Commission, Department o Agrarian Reorm under Republic
Act No. 665, Goernment Serice Insurance System, Lmployees Compensation Commission, Agricultural Inentions Board, Insurance Commission,
Philippine Atomic Lnergy Commission, Board o Inestments, Construction Industry Arbitration Commission, and oluntary arbitrators authorized by
law. ,Lmphasis supplied,

Indeed, the PRC is not expressly mentioned as one o the agencies which are expressly enumerated under Section 1, Rule 43 o the Rules o Court. loweer, its
absence rom the enumeration does not, by this act alone, imply its exclusion rom the coerage o said Rule.
|35|
1he Rule expressly proides that it should be applied to appeals
rom awards, judgments inal orders or resolutions of any quasi-judicial agency in the exercise o its quasi-judicial unctions. The phrase among these agencies confirms that the
enumeration made in the Rule is not exclusie to the agencies therein listed.
|36|


Speciically, the Court, in Yavg r. Covrt of .eat.,
|3|
ruled that ata. Pavbav.a ,B.P., tg. 129
|38|
conerred upon the CA exclusie appellate jurisdiction oer appeals rom
decisions o the PRC. 1he Court held:

1he law has since been changed, howeer, at least in the matter o the particular court to which appeals rom the Commission should be
taken. On August 14, 1981, Batas Pambansa Bilang 129 became effective and in its Section 29, conferred on the Court of Appeals exclusive appellate
jurisdiction oer all inal judgments, decisions, resolutions, orders or awards o Regional 1rial Courts and quasi-judicial agencies, instrumentalities, boards or
commissions except those alling under the appellate jurisdiction o the Supreme Court. x x x. In virtue of BP J29, appeals from the Professional
Regulations Commission are now exclusively cognizable by the Court of Appeals.
39
,Lmphasis supplied,

Clearly, the enactment o .P. tg. 129, the precursor o the present Rules o Ciil Procedure,
|40|
lodged with the CA such jurisdiction oer the appeals o decisions made
by the PRC.

Anent the substantie merits o the case, petitioner questions the PRC decision or being without an expert testimony to support its conclusion and to establish the cause
oEdithas injury. Petitioner aers that in cases o medical malpractice, expert testimony is necessary to support the conclusion as to the cause o the injury.
|41|


Medical malpractice is a particular orm o negligence which consists in the ailure o a physician or surgeon to apply to his practice o medicine that degree o care and skill
which is ordinarily employed by the proession generally, under similar conditions, and in like surrounding circumstances.
|42|
In order to successully pursue such a claim, a patient
must proe that the physician or surgeon either ailed to do something which a reasonably prudent physician or surgeon would not hae done, and that the ailure or action caused
injury to the patient.
|43|


1here are our elements inoled in medical negligence cases: duty, breach, injury and proximate causation.
|44|


A physician-patient relationship was created when Lditha employed the serices o the petitioner. As Edithas physician, petitioner was duty-bound to use at least the same
leel o care that any reasonably competent doctor would use to treat a condition under the same circumstances.
|45|
1he breach o these proessional duties o skill and care, or their
improper perormance by a physician surgeon, whereby the patient is injured in body or in health, constitutes actionable malpractice.
|46|
As to this aspect o medical malpractice, the
determination o the reasonable leel o care and the breach thereo, expert testimony is essential.
|4|
lurther, inasmuch as the causes o the injuries inoled in malpractice actions
are determinable only in the light o scientiic knowledge, it has been recognized that expert testimony is usually necessary to support the conclusion as to causation.
|48|


In the present case, respondents did not present any expert testimony to support their claim that petitioner ailed to do something which a reasonably prudent physician or
surgeon would hae done.

Petitioner, on the other hand, presented the testimony o Dr. Augusto M. Manalo, who was clearly an expert on the subject.

Generally, to qualiy as an expert witness, one must hae acquired special knowledge o the subject matter about which he or she is to testiy, either by the study o
recognized authorities on the subject or by practical experience.
|49|


Dr. Manalo specializes in gynecology and obstetrics, authored and co-authored arious publications on the subject, and is a proessor at the Uniersity o
the Philippines.
|50|
According to him, his diagnosis o Edithas case was Lctopic Pregnancy Interstitial ,also reerred to as Cornual), Ruptured.
|51|
In stating that the D&C
procedure was not the proximate cause o the rupture o Ldithas uterus resulting in her hysterectomy, Dr. Manalo testiied as ollows:

Atty. lidalgo:
Q: Doctor, we want to be clariied on this matter. 1he complainant had testiied here that the D&C was the proximate cause o the rupture o the
uterus. 1he condition which she ound hersel in on the second admission. \ill you please tell us whether that is true or not
A: \ah, I do not think so for two reasons. One, as I hae said earlier, the instrument cannot reach the site o the pregnancy, or it to urther push
the pregnancy outside the uterus. And, No. 2, I was thinking a while ago about another reason- well, why I dont think so, because it is the
triggering actor or the rupture, it could haethe rupture could hae occurred much earlier, right ater the D&C or a ew days ater the D&C.

Q: In this particular case, doctor, the rupture occurred to hae happened minutes prior to the hysterectomy or right upon admission on September
15, 1994 which is about 1 ' months ater the patient was discharged, ater the D&C was conducted. \ould you tell us whether there is any
relation at all o the D&C and the rupture in this particular instance
A: I dont think so for the two reasons that I have just mentioned- that it would not be possible for the instrument to reach the site of
pregnancy. And, No. 2, i it is because o the D&C that rupture could hae occurred earlier.
|52|
,Lmphases supplied,

Clearly, rom the testimony o the expert witness and the reasons gien by him, it is eident that the D&C procedure was not the proximate cause o the rupture
o Edithasuterus.

During his cross-examination, Dr. Manalo testiied on how he would hae addressed Edithas condition should he be placed in a similar circumstance as the
petitioner. le stated:

Atty. Ragonton:
Q: Doctor, as a practicing OB-Gyne, when do you consider that you hae done a good, correct and ideal dilatation and curettage procedure
A: \ell, i the patient recoers. I the patient gets well. Because een ater the procedure, een ater the procedure you may eel that you hae scraped
eerything, the patient stops bleeding, she eels well, I think you should still hae some reserations, and wait a little more time.

Q: I you were the OB-Gyne who perormed the procedure on patient Lditha Ramolete, would it be your standard practice to check the etal parts or
etal tissues that were allegedly remoed
A: lrom what I hae remoed, yes. But in this particular case, I think it was assumed that it was part o the meaty mass which was expelled at the
time she was urinating and lushed in the toilet. So theres no way.

Q: 1here was |sic| some portions o the etal parts that were remoed
A: No, it was described as scanty scraping i I remember it rightscanty.

Q: And you would not mind checking those scant or those little parts that were remoed
A: \ell, the fact that it was described means, I assume that it was checked, no. It was described as scanty and the color also, I think was
described. Because it would be very unusual, even improbable that it would not be examined, because when you scrape, the
specimens are right there before your eyes. Its in front of you. You can touch it. In fact, some of them will stick to the instrument
and therefore to peel it off from the instrument, you have to touch them. So, automatically they are examined closely.
Q: As a matter o act, doctor, you also gie telephone orders to your patients through telephone
A: \es, yes, we do that, especially here in Manila because you know, sometimes a doctor can also be tied-up somewhere and i you hae to wait until
he arrie at a certain place beore you gie the order, then it would be a lot o time wasted. Because i you know your patient, i you hae
handled your patient, some o the symptoms you can interpret that comes with practice. And, I see no reason for not allowing telephone
orders unless it is the first time that you will be encountering the patient. 1hat you hae no idea what the problem is.

Q: But, doctor, do you discharge patients without seeing them
A: Sometimes yes, depending on how amiliar I am with the patient. \e are on the question o telephone orders. I am not saying that that is the idle
|sic| thing to do, but I think the reality of present day practice somehow justifies telephone orders. I hae patients whom I hae justiied
and then all o a sudden, late in the aternoon or late in the eening, would suddenly call they hae decided that they will go home inasmuch as
they anticipated that I will discharge them the ollowing day. So, I just call and ask our resident on duty or the nurse to allow them to go because
I hae seen that patient and I think I hae ull grasp o her problems. So, thats when I make this telephone orders. And, of course before giing
that order I ask about how she eels.
|53|
,Lmphases supplied,

lrom the oregoing testimony, it is clear that the D&C procedure was conducted in accordance with the standard practice, with the same leel o care that any
reasonably competent doctor would use to treat a condition under the same circumstances, and that there was nothing irregular in the way the petitioner dealt with Lditha.

Medical malpractice, in our jurisdiction, is oten brought as a ciil action or damages under Article 216
|54|
o the Ciil Code. 1he deenses in an action or damages,
proided or under Article 219 o the Ciil Code are:

Art. 219. When the plaintiffs own negligence was the immediate and proximate cause of his injury, he cannot recover
damages. But i his negligence was only contributory, the immediate and proximate cause of the injury being the defendants lack of due care, the plaintiff
may recoer damages, but the courts shall mitigate the damages to be awarded.

Proximate cause has been deined as that which, in natural and continuous sequence, unbroken by any eicient interening cause, produces injury, and without which
the result would not hae occurred.
|55|
An injury or damage is proximately caused by an act or a ailure to act, wheneer it appears rom the eidence in the case that the act or
omission played a substantial part in bringing about or actually causing the injury or damage, and that the injury or damage was either a direct result or a reasonably probable
consequence o the act or omission.
|56|


In the present case, the Court notes the indings o the Board o Medicine:

\hen complainant was discharged on July 31, 1994, herein respondent advised her to return on August 4, J994 or four (4) days after the
D&C. This advise was clear in complainants Discharge Sheet. loweer, complainant failed to do so. 1his being the case, the chain o
continuity as required in order that the doctrine o proximate cause can be alidly inoked was interrupted. Had she returned, the respondent could
have examined her thoroughly.
S7
x x x ,Lmphases supplied,

Also, in the testimony o Dr. Manalo, he stated urther that assuming that there was in act a misdiagnosis, the same would hae been rectiied i Lditha ollowed the
petitioners order to return for a check-up on August 4, 1994. Dr. Manalo stated:

Granting that the obstetrician-gynecologist has been misled (justifiably) up to thus point that there would have been ample
opportunity to rectify the misdiagnosis, had the patient returned, as instructed for her follow-up evaluation. It was one and a half months later
that the patient sought consultation with another doctor. 1he continued growth o an ectopic pregnancy, until its eentual rupture, is a dynamic
process. Much change in physical indings could be expected in 1 ' months, including the emergence o suggestie ones.
|58|


It is undisputed that Lditha did not return or a ollow-up evaluation, in defiance of the petitioners advise. Lditha omitted the diligence required by the circumstances
which could hae aoided the injury. 1he omission in not returning or a ollow-up ealuation played a substantial part in bringing about Edithas own injury. lad Lditha returned,
petitioner could hae conducted the proper medical tests and procedure necessary to determine Edithas health condition and applied the corresponding treatment which could
hae preented the rupture o Edithas uterus. 1he D&C procedure haing been conducted in accordance with the standard medical practice, it is clear that Edithas omission was
the proximate cause o her own injury and not merely a contributory negligence on her part.

Contributory negligence is the act or omission amounting to want o ordinary care on the part o the person injured, which, concurring with the defendants negligence,
is the proximate cause o the injury.
|59|
Diiculty seems to be apprehended in deciding which acts o the injured party shall be considered immediate causes o the accident.
|60|
\here
the immediate cause of an accident resulting in an injury is the plaintiffs own act, which contributed to the principal occurrence as one o its determining actors, he cannot recoer
damages or the injury.
|61|
Again, based on the evidence presented in the present case under review, in which no negligence can be attributed to the petitioner, the
immediate cause of the accident resulting in Edithas injury was her own omission when she did not return for a follow-up check up, in defiance of petitioners
orders. 1he immediate cause of Edithas injury was her own act, thus, she cannot recover damages from the injury.

Lastly, petitioner asserts that her right to due process was iolated because she was neer inormed by either respondents or by the PRC that an appeal was pending beore
the PRC.
|62|
Petitioner claims that a eriication with the records section o the PRC reealed that on April 15, 1999, respondents iled a Memorandum on Appeal beore the PRC,
which did not attach the actual registry receipt but was merely indicated therein.
|63|

Respondents, on the other hand aers that i the original registry receipt was not attached to the Memorandum on Appeal, PRC would not hae entertained the appeal or
accepted such pleading or lack o notice or proo o serice on the other party.
|64|
Also, the registry receipt could not be appended to the copy furnished to petitioners former
counsel, because the registry receipt was already appended to the original copy o the Memorandum o Appeal iled with PRC.
|65|


It is a well-settled rule that when serice o notice is an issue, the rule is that the person alleging that the notice was sered must proe the act o serice. 1he burden o
proing notice rests upon the party asserting its existence.
|66|
In the present case, respondents did not present any proo that petitioner was sered a copy o the Memorandum on
Appeal. 1hus, respondents were not able to satisy the burden o proing that they had in act inormed the petitioner o the appeal proceedings beore the PRC.

In Dtaffbvitaer. vtervatiovat, vc. r. ^atiovat abor Retatiov. Covvi..iov,
|6|
in which the National Labor Relations Commission ailed to order the priate respondent to
urnish the petitioner a copy o the Appeal Memorandum, the Court held that said ailure depried the petitioner o procedural due process guaranteed by the Constitution, which
could hae sered as basis or the nulliication o the proceedings in the appeal. 1he same holds true in the case at bar. 1he Court inds that the ailure o the respondents to urnish
the petitioner a copy o the Memorandum o Appeal submitted to the PRC constitutes a iolation o due process. 1hus, the proceedings beore the PRC were null and oid.

All told, doctors are protected by a special rule o law. 1hey are not guarantors o care. 1hey are not insurers against mishaps or unusual consequences
|68|
specially so i
the patient hersel did not exercise the proper diligence required to aoid the injury.

WHLRLIORL, the petition is GRAN1LD. 1he assailed Decision o the Court o Appeals dated July 4, 2003 in CA-GR SP No. 62206 is
hereby RLVLRSLD and SL1 ASIDL. 1he Decision o the Board o Medicine dated March 4, 1999 exonerating petitioner is AIIIRMLD. No pronouncement as to costs.

SO ORDLRLD.

G.R. No. J4262S December J9, 2006
ROGLLIO P. NOGALLS, for himself and on behalf of the minors, ROGLR AN1HONY, ANGLLICA, NANCY, and MICHALL
CHRIS1OPHLR, all surnamed NOGALLS, petitioners,
s.
CAPI1OL MLDICAL CLN1LR, DR. OSCAR LS1RADA, DR. LLY VILLAILOR, DR. ROSA UY, DR. JOLL LNRIQULZ, DR.
PLRPL1UA LACSON, DR. NOL LSPINOLA, and NURSL J. DUMLAO, respondents.


D L C I S I O N
CARPIO, J.:
1he Case
1his petition or reiew
1
assails the 6 lebruary 1998 Decision
2
and 21 March 2000 Resolution
3
o the Court o Appeals in CA-G.R. CV No. 45641. 1he
Court o Appeals airmed iv toto the 22 Noember 1993 Decision
4
o the Regional 1rial Court o Manila, Branch 33, inding Dr. Oscar Lstrada solely
liable or damages or the death o his patient, Corazon Nogales, while absoling the remaining respondents o any liability. 1he Court o Appeals denied
petitioners' motion or reconsideration.
1he Iacts
Pregnant with her ourth child, Corazon Nogales ,"Corazon",, who was then 3 years old, was under the exclusie prenatal care o Dr. Oscar Lstrada
,"Dr. Lstrada", beginning on her ourth month o pregnancy or as early as December 195. \hile Corazon was on her last trimester o pregnancy, Dr.
Lstrada noted an increase in her blood pressure and deelopment o leg edema
5
indicating preeclampsia,
6
which is a dangerous complication o
pregnancy.


Around midnight o 25 May 196, Corazon started to experience mild labor pains prompting Corazon and Rogelio Nogales ,"Spouses Nogales", to see
Dr. Lstrada at his home. Ater examining Corazon, Dr. Lstrada adised her immediate admission to the Capitol Medical Center ,"CMC",.
On 26 May 196, Corazon was admitted at 2:30 a.m. at the CMC ater the sta nurse noted the written admission request
8
o Dr. Lstrada. Upon
Corazon's admission at the CMC, Rogelio Nogales ,"Rogelio", executed and signed the "Consent on Admission and Agreement"
9
and "Admission
Agreement."
10
Corazon was then brought to the labor room o the CMC.
Dr. Rosa Uy ,"Dr. Uy",, who was then a resident physician o CMC, conducted an internal examination o Corazon. Dr. Uy then called up Dr. Lstrada to
notiy him o her indings.
Based on the Doctor's Order Sheet,
11
around 3:00 a.m., Dr. Lstrada ordered or 10 mg. o alium to be administered immediately by intramuscular
injection. Dr. Lstrada later ordered the start o intraenous administration o syntocinon admixed with dextrose, 5, in lactated Ringers' solution, at the
rate o eight to ten micro-drops per minute.
According to the Nurse's Obseration Notes,
12
Dr. Joel Lnriquez ,"Dr. Lnriquez",, an anesthesiologist at CMC, was notiied at 4:15 a.m. o Corazon's
admission. Subsequently, when asked i he needed the serices o an anesthesiologist, Dr. Lstrada reused. Despite Dr. Lstrada's reusal, Dr. Lnriquez
stayed to obsere Corazon's condition.
At 6:00 a.m., Corazon was transerred to Deliery Room No. 1 o the CMC. At 6:10 a.m., Corazon's bag o water ruptured spontaneously. At 6:12 a.m.,
Corazon's cerix was ully dilated. At 6:13 a.m., Corazon started to experience conulsions.
At 6:15 a.m., Dr. Lstrada ordered the injection o ten grams o magnesium sulate. loweer, Dr. Lly Villalor ,"Dr. Villalor",, who was assisting Dr.
Lstrada, administered only 2.5 grams o magnesium sulate.
At 6:22 a.m., Dr. Lstrada, assisted by Dr. Villalor, applied low orceps to extract Corazon's baby. In the process, a 1.0 x 2.5 cm. piece o cerical tissue
was allegedly torn. 1he baby came out in an apnic, cyanotic, weak and injured condition. Consequently, the baby had to be intubated and resuscitated by
Dr. Lnriquez and Dr. Payumo.
At 6:2 a.m., Corazon began to maniest moderate aginal bleeding which rapidly became prouse. Corazon's blood pressure dropped rom 130,80 to
60,40 within ie minutes. 1here was continuous prouse aginal bleeding. 1he assisting nurse administered hemacel through a gauge 19 needle as a side
drip to the ongoing intraenous injection o dextrose.
At :45 a.m., Dr. Lstrada ordered blood typing and cross matching with bottled blood. It took approximately 30 minutes or the CMC laboratory, headed
by Dr. Perpetua Lacson ,"Dr. Lacson",, to comply with Dr. Lstrada's order and delier the blood.
At 8:00 a.m., Dr. Noe Lspinola ,"Dr. Lspinola",, head o the Obstetrics-Gynecology Department o the CMC, was apprised o Corazon's condition by
telephone. Upon being inormed that Corazon was bleeding prousely, Dr. Lspinola ordered immediate hysterectomy. Rogelio was made to sign a
"Consent to Operation."
13

Due to the inclement weather then, Dr. Lspinola, who was etched rom his residence by an ambulance, arried at the CMC about an hour later or at 9:00
a.m. le examined the patient and ordered some resuscitatie measures to be administered. Despite Dr. Lspinola's eorts, Corazon died at 9:15 a.m. 1he
cause o death was "hemorrhage, post partum."
14

On 14 May 1980, petitioners iled a complaint or damages
15
with the Regional 1rial Court
16
o Manila against CMC, Dr. Lstrada, Dr. Villalor, Dr. Uy,
Dr. Lnriquez, Dr. Lacson, Dr. Lspinola, and a certain Nurse J. Dumlao or the death o Corazon. Petitioners mainly contended that deendant physicians
and CMC personnel were negligent in the treatment and management o Corazon's condition. Petitioners charged CMC with negligence in the selection
and superision o deendant physicians and hospital sta.
lor ailing to ile their answer to the complaint despite serice o summons, the trial court declared Dr. Lstrada, Dr. Lnriquez, and Nurse Dumlao in
deault.
1
CMC, Dr. Villalor, Dr. Uy, Dr. Lspinola, and Dr. Lacson iled their respectie answers denying and opposing the allegations in the complaint.
Subsequently, trial ensued.
Ater more than 11 years o trial, the trial court rendered judgment on 22 Noember 1993 inding Dr. Lstrada solely liable or damages. 1he trial court
ruled as ollows:
1he ictim was under his pre-natal care, apparently, his ault began rom his incorrect and inadequate management and lack o treatment o the
pre-eclamptic condition o his patient. It is not disputed that he misapplied the orceps in causing the deliery because it resulted in a large
cerical tear which had caused the prouse bleeding which he also ailed to control with the application o inadequate injection o magnesium
sulate by his assistant Dra. Lly Villalor. Dr. Lstrada een ailed to notice the erroneous administration by nurse Dumlao o hemacel by way o
side drip, instead o direct intraenous injection, and his ailure to consult a senior obstetrician at an early stage o the problem.
On the part howeer o Dra. Lly Villalor, Dra. Rosa Uy, Dr. Joel Lnriquez, Dr. Lacson, Dr. Lspinola, nurse J. Dumlao and CMC, the Court
inds no legal justiication to ind them ciilly liable.
On the part o Dra. Lly Villalor, she was only taking orders rom Dr. Lstrada, the principal physician o Corazon Nogales. She can only make
suggestions in the manner the patient maybe treated but she cannot impose her will as to do so would be to substitute her good judgment to
that o Dr. Lstrada. I she ailed to correctly diagnose the true cause o the bleeding which in this case appears to be a cerical laceration, it
cannot be saely concluded by the Court that Dra. Villalor had the correct diagnosis and she ailed to inorm Dr. Lstrada. No eidence was
introduced to show that indeed Dra. Villalor had discoered that there was laceration at the cerical area o the patient's internal organ.
On the part o nurse Dumlao, there is no showing that when she administered the hemacel as a side drip, she did it on her own. I the correct
procedure was directly thru the eins, it could only be because this was what was probably the orders o Dr. Lstrada.
\hile the eidence o the plaintis shows that Dr. Noe Lspinola, who was the Chie o the Department o Obstetrics and Gynecology who
attended to the patient Mrs. Nogales, it was only at 9:00 a.m. 1hat he was able to reach the hospital because o typhoon Didang ,Lxhibit 2,.
\hile he was able to gie prescription in the manner Corazon Nogales may be treated, the prescription was based on the inormation gien to
him by phone and he acted on the basis o acts as presented to him, belieing in good aith that such is the correct remedy. le was not with
Dr. Lstrada when the patient was brought to the hospital at 2:30 o'clock a.m. So, whateer errors that Dr. Lstrada committed on the patient
beore 9:00 o'clock a.m. are certainly the errors o Dr. Lstrada and cannot be the mistake o Dr. Noe Lspinola. lis ailure to come to the
hospital on time was due to ortuitous eent.
On the part o Dr. Joel Lnriquez, while he was present in the deliery room, it is not incumbent upon him to call the attenti on o Dr. Lstrada,
Dra. Villalor and also o Nurse Dumlao on the alleged errors committed by them. Besides, as anesthesiologist, he has no authority to control
the actuations o Dr. Lstrada and Dra. Villalor. lor the Court to assume that there were errors being committed in the presence o Dr.
Lnriquez would be to dwell on conjectures and speculations.
On the ciil liability o Dr. Perpetua Lacson, |s|he is a hematologist and in-charge o the blood bank o the CMC. 1he Court cannot accept the
theory o the plaintis that there was delay in deliering the blood needed by the patient. It was testiied, that in order that this blood will be
made aailable, a laboratory test has to be conducted to determine the type o blood, cross matching and other matters consistent with medical
science so, the lapse o 30 minutes maybe considered a reasonable time to do all o these things, and not a delay as the plaintis would want the
Court to beliee.
Admittedly, Dra. Rosa Uy is a resident physician o the Capitol Medical Center. She was sued because o her alleged ailure to notice the
incompetence and negligence o Dr. Lstrada. loweer, there is no eidence to support such theory. No eidence was adduced to show that
Dra. Rosa Uy as a resident physician o Capitol Medical Center, had knowledge o the mismanagement o the patient Corazon Nogales, and that
notwithstanding such knowledge, she tolerated the same to happen.
In the pre-trial order, plaintis and CMC agreed that deendant CMC did not hae any hand or participation in the selection or hiring o Dr.
Lstrada or his assistant Dra. Lly Villalor as attending physician|s| o the deceased. In other words, the two ,2, doctors were not employees o
the hospital and thereore the hospital did not hae control oer their proessional conduct. \hen Mrs. Nogales was brought to the hospital, it
was an emergency case and deendant CMC had no choice but to admit her. Such being the case, there is thereore no legal ground to apply the
proisions o Article 216 and 2180 o the New Ciil Code reerring to the icarious liability o an employer or the negligence o its employees.
I eer in this case there is ault or negligence in the treatment o the deceased on the part o the attending physicians who were employed by the
amily o the deceased, such ciil liability should be borne by the attending physicians under the principle o "respondeat superior".
\lLRLlORL, premises considered, judgment is hereby rendered inding deendant Dr. Lstrada o Number 13 Pitimini St. San lrancisco del
Monte, Quezon City ciilly liable to pay plaintis: 1, By way o actual damages in the amount o P105,000.00, 2, By way o moral damages in
the amount o P00,000.00, 3, Attorney's ees in the amount o P100,000.00 and to pay the costs o suit.
lor ailure o the plaintis to adduce eidence to support its |sic| allegations against the other deendants, the complaint is hereby ordered
dismissed. \hile the Court looks with disaor the iling o the present complaint against the other deendants by the herein plaintis, as in a
way it has caused them personal inconenience and slight damage on their name and reputation, the Court cannot accepts |sic| howeer, the
theory o the remaining deendants that plaintis were motiated in bad aith in the iling o this complaint. lor this reason deendants'
counterclaims are hereby ordered dismissed.
SO ORDLRLD.
18

Petitioners appealed the trial court's decision. Petitioners claimed that aside rom Dr. Lstrada, the remaining respondents should be held equally liable or
negligence. Petitioners pointed out the extent o each respondent's alleged liability.
On 6 lebruary 1998, the Court o Appeals airmed the decision o the trial court.
19
Petitioners iled a motion or reconsideration which the Court o
Appeals denied in its Resolution o 21 March 2000.
20

lence, this petition.
Meanwhile, petitioners iled a Maniestation dated 12 April 2002
21
stating that respondents Dr. Lstrada, Dr. Lnriquez, Dr. Villalor, and Nurse Dumlao
"need no longer be notiied o the petition because they are absolutely not inoled in the issue raised beore the |Court|, regarding the liability o
|CMC|."
22
Petitioners stressed that the subject matter o this petition is the liability o CMC or the negligence o Dr. Lstrada.
23

1he Court issued a Resolution dated 9 September 2002
24
dispensing with the requirement to submit the correct and present addresses o respondents Dr.
Lstrada, Dr. Lnriquez, Dr. Villalor, and Nurse Dumlao. 1he Court stated that with the iling o petitioners' Maniestation, it should be understood that
they are claiming only against respondents CMC, Dr. Lspinola, Dr. Lacson, and Dr. Uy who hae iled their respectie comments. Petitioners are
oregoing urther claims against respondents Dr. Lstrada, Dr. Lnriquez, Dr. Villalor, and Nurse Dumlao.
1he Court noted that Dr. Lstrada did not appeal the decision o the Court o Appeals airming the decision o the Regional 1rial Court. Accordingly, the
decision o the Court o Appeals, airming the trial court's judgment, is already inal as against Dr. Oscar Lstrada.
Petitioners iled a motion or reconsideration
25
o the Court's 9 September 2002 Resolution claiming that Dr. Lnriquez, Dr. Villalor and Nurse Dumlao
were notiied o the petition at their counsels' last known addresses. Petitioners reiterated their imputation o negligence on these respondents. 1he Court
denied petitioners' Motion or Reconsideration in its 18 lebruary 2004 Resolution.
26

1he Court of Appeals' Ruling
In its Decision o 6 lebruary 1998, the Court o Appeals upheld the trial court's ruling. 1he Court o Appeals rejected petitioners' iew that the doctrine
in Dartivg r. Cbarte.tov Covvvvit, Mevoriat o.itat
2
applies to this case. According to the Court o Appeals, the present case diers rom the Dartivg case
since Dr. Lstrada is an independent contractor-physician whereas the Dartivg case inoled a physician and a nurse who were employees o the hospital.
Citing other American cases, the Court o Appeals urther held that the mere act that a hospital permitted a physician to practice medicine and use its
acilities is not suicient to render the hospital liable or the physician's negligence.
28
A hospital is not responsible or the negligence o a physician who is
an independent contractor.
29

1he Court o Appeals ound the cases o Daria.ov r. Covote
30
and Cavbett r. vva aivg terev. o.itat
31
applicable to this case. Quoting Cavbett, the
Court o Appeals stated that where there is no proo that deendant physician was an employee o deendant hospital or that deendant hospital had
reason to know that any acts o malpractice would take place, deendant hospital could not be held liable or its ailure to interene in the relationship o
physician-patient between deendant physician and plainti.
On the liability o the other respondents, the Court o Appeals applied the "borrowed serant" doctrine considering that Dr. Lstrada was an independent
contractor who was merely exercising hospital priileges. 1his doctrine proides that once the surgeon enters the operating room and takes charge o the
proceedings, the acts or omissions o operating room personnel, and any negligence associated with such acts or omissions, are imputable to the
surgeon.
32
\hile the assisting physicians and nurses may be employed by the hospital, or engaged by the patient, they normally become the temporary
serants or agents o the surgeon in charge while the operation is in progress, and liability may be imposed upon the surgeon or their negligent acts under
the doctrine o re.ovaeat .verior.
33

1he Court o Appeals concluded that since Rogelio engaged Dr. Lstrada as the attending physician o his wie, any liability or malpractice must be Dr.
Lstrada's sole responsibility.
\hile it ound the amount o damages air and reasonable, the Court o Appeals held that no interest could be imposed on unliquidated claims or
damages.
1he Issue
Basically, the issue in this case is whether CMC is icariously liable or the negligence o Dr. Lstrada. 1he resolution o this issue rests, on the other hand,
on the ascertainment o the relationship between Dr. Lstrada and CMC. 1he Court also beliees that a determination o the extent o liability o the other
respondents is ineitable to inally and completely dispose o the present controersy.
1he Ruling of the Court
1he petition is partly meritorious.
On the Liability of CMC
Dr. Lstrada's negligence in handling the treatment and management o Corazon's condition which ultimately resulted in Corazon's death is no longer in
issue. Dr. Lstrada did not appeal the decision o the Court o Appeals which airmed the ruling o the trial court inding Dr. Lstrada solely liable or
damages. Accordingly, the inding o the trial court on Dr. Lstrada's negligence is already inal.
Petitioners maintain that CMC is icariously liable or Dr. Lstrada's negligence based on Article 2180 in relation to Article 216 o the Ciil Code. 1hese
proisions pertinently state:
Art. 2180. 1he obligation imposed by article 216 is demandable not only or one's own acts or omissions, but also or those o persons or
whom one is responsible.
x x x x
Lmployers shall be liable or the damages caused by their employees and household helpers acting within the scope o their assigned tasks, een
though the ormer are not engaged in any business or industry.
x x x x
1he responsibility treated o in this article shall cease when the persons herein mentioned proe that they obsered all the diligence o a good
ather o a amily to preent damage.
Art. 216. \hoeer by act or omission causes damage to another, there being ault or negligence, is obliged to pay or the damage done. Such
ault or negligence, i there is no pre-existing contractual relation between the parties, is called a quasi-delict and is goerned by the proisions o
this Chapter.
Similarly, in the United States, a hospital which is the employer, master, or principal o a physician employee, serant, or agent, may be held liable or the
physician's negligence under the doctrine o re.ovaeat .verior.
34

In the present case, petitioners maintain that CMC, in allowing Dr. Lstrada to practice and admit patients at CMC, should be liable or Dr. Lstrada's
malpractice. Rogelio claims that he knew Dr. Lstrada as an accredited physician o CMC, though he discoered later that Dr. Lstrada was not a salaried
employee o the CMC.
35
Rogelio urther claims that he was dealing with CMC, whose primary concern was the treatment and management o his wie's
condition. Dr. Lstrada just happened to be the speciic person he talked to representing CMC.
36
Moreoer, the act that CMC made Rogelio sign a
Consent on Admission and Admission Agreement
3
and a Consent to Operation printed on the letterhead o CMC indicates that CMC considered Dr.
Lstrada as a member o its medical sta.
On the other hand, CMC disclaims liability by asserting that Dr. Lstrada was a mere isiting physician and that it admitted Corazon because her physical
condition then was classiied an emergency obstetrics case.
38

CMC alleges that Dr. Lstrada is an independent contractor "or whose actuations CMC would be a total stranger." CMC maintains that it had no control
or superision oer Dr. Lstrada in the exercise o his medical proession.
1he Court had the occasion to determine the relationship between a hospital and a consultant or isiting physician and the li ability o such hospital or that
physician's negligence in Ravo. r. Covrt of .eat.,
39
to wit:
In the irst place, hospitals exercise signiicant control in the hiring and iring o consultants and in the conduct o their work within the hospital
premises. Doctors who apply or "consultant" slots, isiting or attending, are required to submit proo o completion o resi dency, their
educational qualiications, generally, eidence o accreditation by the appropriate board ,diplomate,, eidence o ellowship in most cases, and
reerences. 1hese requirements are careully scrutinized by members o the hospital administration or by a reiew committee set up by the
hospital who either accept or reject the application. 1his is particularly true with respondent hospital.
Ater a physician is accepted, either as a isiting or attending consultant, he is normally required to attend clinico-pathological conerences,
conduct bedside rounds or clerks, interns and residents, moderate grand rounds and patient audits and perorm other tasks and responsibilities,
or the priilege o being able to maintain a clinic in the hospital, and,or or the priilege o admitting patients into the hospital. In addition to
these, the physician's perormance as a specialist is generally ealuated by a peer reiew committee on the basis o mortality and morbidity
statistics, and eedback rom patients, nurses, interns and residents. A consultant remiss in his duties, or a consultant who regularly alls short o
the minimum standards acceptable to the hospital or its peer reiew committee, is normally politely terminated.
In other words, priate hospitals, hire, ire and exercise real control oer their attending and isiting "consultant" sta. 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. In assessing whether such a relationship in fact exists, the control test is
determining. Accordingly, on the basis of the foregoing, we rule that for the purpose of allocating responsibility in medical
negligence cases, an employer-employee relationship in effect exists between hospitals and their attending and visiting
physicians. 1his being the case, the question now arises as to whether or not respondent hospital is solidarily liable wi th respondent doctors or
petitioner's condition.
1he basis or holding an employer solidarily responsible or the negligence o its employee is ound in Article 2180 o the Ciil Code which
considers a person accountable not only or his own acts but also or those o others based on the ormer's responsibility under a relationship o
patria potestas. x x x
40
,Lmphasis supplied,
\hile the Court in Ravo. did not expound on the control test, such test essentially determines whether an employment relationship exists between a
physician and a hospital based on the exercise o control oer the physician as to details. Speciically, the employer ,or the hospital, must hae the right to
control both the means and the details o the process by which the employee ,or the physician, is to accomplish his task.
41

Ater a thorough examination o the oluminous records o this case, the Court inds no single eidence pointing to CMC's exercise o control oer Dr.
Lstrada's treatment and management o Corazon's condition. It is undisputed that throughout Corazon's pregnancy, she was under the exclusie prenatal
care o Dr. Lstrada. At the time o Corazon's admission at CMC and during her deliery, it was Dr. Lstrada, assisted by Dr. Villalor, who attended to
Corazon. 1here was no showing that CMC had a part in diagnosing Corazon's condition. \hile Dr. Lstrada enjoyed sta priileges at CMC, such act
alone did not make him an employee o CMC.
42
CMC merely allowed Dr. Lstrada to use its acilities
43
when Corazon was about to gie birth, which CMC
considered an emergency. Considering these circumstances, Dr. Lstrada is not an employee o CMC, but an independent contractor.
1he question now is whether CMC is automatically exempt rom liability considering that Dr. Lstrada is an independent contractor-physician.
In general, a hospital is not liable or the negligence o an independent contractor-physician. 1here is, howeer, an exception to this principle. 1he hospital
may be liable i the physician is the "ostensible" agent o the hospital.
44
1his exception is also known as the "doctrine o apparent authority."
45
In Citbert r.
,cavore Mvviciat o.itat,
46
the Illinois Supreme Court explained the doctrine o apparent authority in this wise:
|U|nder the doctrine o apparent authority a hospital can be held icariously liable or the negligent acts o a physician proiding care at the
hospital, regardless o whether the physician is an independent contractor, unless the patient knows, or should hae known, that the physician is
an independent contractor. 1he elements o the action hae been set out as ollows:
"lor a hospital to be liable under the doctrine o apparent authority, a plainti must show that: ,1, the hospital, or its agent, acted in a manner
that would lead a reasonable person to conclude that the indiidual who was alleged to be negligent was an employee or agent o the hospital, ,2,
where the acts o the agent create the appearance o authority, the plainti must also proe that the hospital had knowledge o and acquiesced in
them, and ,3, the plainti acted in reliance upon the conduct o the hospital or its agent, consistent with ordinary care and prudence."
1he element o "holding out" on the part o the hospital does not require an express representation by the hospital that the person alleged to be
negligent is an employee. Rather, the element is satisied i the hospital holds itsel out as a proider o emergency room care without inorming
the patient that the care is proided by independent contractors.
1he element o justiiable reliance on the part o the plainti is satisied i the plainti relies upon the hospital to proide complete emergency
room care, rather than upon a speciic physician.
1he doctrine o apparent authority essentially inoles two actors to determine the liability o an independent-contractor physician.
1he irst actor ocuses on the hospital's maniestations and is sometimes described as an inquiry whether the hospital acted in a manner which would lead
a reasonable person to conclude that the indiidual who was alleged to be negligent was an employee or agent o the hospital.
4
In this regard, the
hospital need not make express representations to the patient that the treating physician is an employee of the hospital, rather a
representation may be general and implied.
48

1he doctrine o apparent authority is a species o the doctrine o estoppel. Article 1431 o the Ciil Code proides that "|t|hrough estoppel, an admission
or representation is rendered conclusie upon the person making it, and cannot be denied or disproed as against the person relying thereon." Lstoppel
rests on this rule: "\heneer a party has, by his own declaration, act, or omission, intentionally and deliberately led another to beliee a particular thing
true, and to act upon such belie, he cannot, in any litigation arising out o such declaration, act or omission, be permitted to alsiy it."
49

In the instant case, CMC impliedly held out Dr. Lstrada as a member o its medical sta. 1hrough CMC's acts, CMC clothed Dr. Lstrada with apparent
authority thereby leading the Spouses Nogales to beliee that Dr. Lstrada was an employee or agent o CMC. CMC cannot now repudiate such authority.
lirst, CMC granted sta priileges to Dr. Lstrada. CMC extended its medical sta and acilities to Dr. Lstrada. Upon Dr. Lstrada's request or Corazon's
admission, CMC, through its personnel, readily accommodated Corazon and updated Dr. Lstrada o her condition.
Second, CMC made Rogelio sign consent orms printed on CMC letterhead. Prior to Corazon's admission and supposed hysterectomy, CMC asked
Rogelio to sign release orms, the contents o which reinorced Rogelio's belie that Dr. Lstrada was a member o CMC's medical sta.
50
1he Consent on
Admission and Agreement explicitly proides:
KNO\ ALL MLN B\ 1lLSL PRLSLN1S:
I, Rogelio Nogales, o legal age, a resident o 194 M. l. Del Pilar St., Malate Mla., being the ather,mother,brother,sister,spouse,relatie,
guardian,or person in custody o Ma. Corazon, and representing his,her amily, o my own olition and ree will, do consent and submit said
Ma. Corazon to Dr. Oscar Lstrada ,hereinater reerred to as Physician, or cure, treatment, retreatment, or emergency measures, that the
Physician, personally or by and through the Capitol Medical Center and/or its staff, may use, adapt, or employ such means, forms or
methods of cure, treatment, retreatment, or emergency measures as he may see best and most expedient, that Ma. Corazon and I
will comply with any and all rules, regulations, directions, and instructions of the Physician, the Capitol Medical Center and/or its
staff, and, that I will not hold liable or responsible and hereby waie and oreer discharge and hold ree the Physician, the Capitol Medical
Center and,or its sta, rom any and all claims o whateer kind o nature, arising rom directly or indirectly, or by reason o said cure,
treatment, or retreatment, or emergency measures or interention o said physician, the Capitol Medical Center and,or its sta.
x x x x
51
,Lmphasis supplied,
\hile the Consent to Operation pertinently reads, thus:
I, ROGLLIO NOGALLS, x x x, o my own olition and ree will, do consent and submit said CORAZON NOGALLS to lysterectomy, by
the Surgical Staff and Anesthesiologists of Capitol Medical Centerand,or whateer succeeding operations, treatment, or emergency
measures as may be necessary and most expedient, and, that I will not hold liable or responsible and hereby waie and oreer discharge and
hold ree the Surgeon, his assistants, anesthesiologists, the Capitol Medical Center and,or its sta, rom any and all claims o whateer kind o
nature, arising rom directly or indirectly, or by reason o said operation or operations, treatment, or emergency measures, or interention o the
Surgeon, his assistants, anesthesiologists, the Capitol Medical Center and,or its sta.
52
,Lmphasis supplied,
\ithout any indication in these consent orms that Dr. Lstrada was an independent contractor-physician, the Spouses Nogales could not hae known that
Dr. Lstrada was an independent contractor. Signiicantly, no one rom CMC inormed the Spouses Nogales that Dr. Lstrada was an independent
contractor. On the contrary, Dr. Atencio, who was then a member o CMC Board o Directors, testiied that Dr. Lstrada was part o CMC's surgical
sta.
53

1hird, Dr. Lstrada's reerral o Corazon's prouse aginal bleeding to Dr. Lspinola, who was then the lead o the Obstetrics and Gynecology Department
o CMC, gae the impression that Dr. Lstrada as a member o CMC's medical sta was collaborating with other CMC-employed specialists in treating
Corazon.
1he second actor ocuses on the patient's reliance. It is sometimes characterized as an inquiry on whether the plainti acted in reliance upon the conduct
o the hospital or its agent, consistent with ordinary care and prudence.
54

1he records show that the Spouses Nogales relied upon a perceied employment relationship with CMC in accepting Dr. Lstrada's serices. Rogelio
testiied that he and his wie speciically chose Dr. Lstrada to handle Corazon's deliery not only because o their riend's recommendation, but more
importantly because o Dr. Lstrada's "connection with a reputable hospital, the |CMC|."
55
In other words, Dr. Lstrada's relationship with CMC played a
signiicant role in the Spouses Nogales' decision in accepting Dr. Lstrada's serices as the obstetrician-gynecologist or Corazon's deliery. Moreoer, as
earlier stated, there is no showing that beore and during Corazon's coninement at CMC, the Spouses Nogales knew or should hae known that Dr.
Lstrada was not an employee o CMC.
lurther, the Spouses Nogales looked to CMC to proide the best medical care and support serices or Corazon's deliery. 1he Court notes that prior to
Corazon's ourth pregnancy, she used to gie birth inside a clinic. Considering Corazon's age then, the Spouses Nogales decided to hae their ourth child
deliered at CMC, which Rogelio regarded one o the best hospitals at the time.
56
1his is precisely because the Spouses Nogales eared that Corazon might
experience complications during her deliery which would be better addressed and treated in a modern and big hospital such as CMC. Moreoer, Rogelio's
consent in Corazon's hysterectomy to be perormed by a dierent physician, namely Dr. Lspinola, is a clear indication o Rogelio's conidence in CMC's
surgical sta.
CMC's deense that all it did was "to extend to |Corazon| its acilities" is untenable. 1he Court cannot close its eyes to the reality that hospitals, such as
CMC, are in the business o treatment. In this regard, the Court agrees with the obseration made by the Court o Appeals o North Carolina in Diggs .
Noant lealth, Inc.,
5
to wit:
"1he conception that the hospital does not undertake to treat the patient, does not undertake to act through its doctors and nurses, but
undertakes instead simply to procure them to act upon their own responsibility, no longer relects the act. Present day hospitals, as their
manner of operation plainly demonstrates, do far more than furnish facilities for treatment. 1hey regularly employ on a salary basis a
large staff of physicians, nurses and internes sic, as well as administrative and manual workers, and they charge patients for
medical care and treatment, collecting for such services, if necessary, by legal action. Certainly, the person who avails himself of
'hospital facilities' expects that the hospital will attempt to cure him, not that its nurses or other employees will act on their own
responsibility." x x x ,Lmphasis supplied,
Likewise unconincing is CMC's argument that petitioners are estopped rom claiming damages based on the Consent on Admission and Consent to
Operation. Both release orms consist o two parts. 1he irst part gae CMC permission to administer to Corazon any orm o recognized medical
treatment which the CMC medical sta deemed adisable. 1he second part o the documents, which may properly be described as the releasing part,
releases CMC and its employees "rom any and all claims" arising rom or by reason o the treatment and operation.
1he documents do not expressly release CMC rom liability or injury to Corazon due to negligence during her treatment or operation. Neither do the
consent orms expressly exempt CMC rom liability or Corazon's death due to negligence during such treatment or operation. Such release orms, being
in the nature o contracts o adhesion, are construed strictly against hospitals. Besides, a blanket release in aor o hospitals "rom any and all claims,"
which includes claims due to bad aith or gross negligence, would be contrary to public policy and thus oid.
Len simple negligence is not subject to blanket release in aor o establishments like hospitals but may only mitigate liability depending on the
circumstances.
58
\hen a person needing urgent medical attention rushes to a hospital, he cannot bargain on equal ooting with the hospital on the terms
o admission and operation. Such a person is literally at the mercy o the hospital. 1here can be no clearer example o a contract o adhesion than one
arising rom such a dire situation. 1hus, the release orms o CMC cannot reliee CMC rom liability or the negligent medical treatment o Corazon.
On the Liability of the Other Respondents
Despite this Court's pronouncement in its 9 September 2002
59
Resolution that the iling o petitioners' Maniestation conined petitioners' claim only
against CMC, Dr. Lspinola, Dr. Lacson, and Dr. Uy, who hae iled their comments, the Court deems it proper to resole the indiidual liabi lity o the
remaining respondents to put an end inally to this more than two-decade old controersy.
a) Dr. Lly Villaflor
Petitioners blame Dr. Lly Villalor or ailing to diagnose the cause o Corazon's bleeding and to suggest the correct remedy to Dr. Lstrada.
60
Petitioners
assert that it was Dr. Villalor's duty to correct the error o Nurse Dumlao in the administration o hemacel.
1he Court is not persuaded. Dr. Villalor admitted administering a lower dosage o magnesium sulate. loweer, this was ater inorming Dr. Lstrada that
Corazon was no longer in conulsion and that her blood pressure went down to a dangerous leel.
61
At that moment, Dr. Lstrada instructed Dr. Villalor
to reduce the dosage o magnesium sulate rom 10 to 2.5 grams. Since petitioners did not dispute Dr. Villalor's allegation, Dr. Villalor's deense remains
uncontroerted. Dr. Villalor's act o administering a lower dosage o magnesium sulate was not out o her own olition or was in contraention o Dr.
Lstrada's order.
b) Dr. Rosa Uy
Dr. Rosa Uy's alleged negligence consisted o her ailure ,1, to call the attention o Dr. Lstrada on the incorrect dosage o magnesium sulate administered
by Dr. Villalor, ,2, to take correctie measures, and ,3, to correct Nurse Dumlao's wrong method o hemacel administration.
1he Court beliees Dr. Uy's claim that as a second year resident physician then at CMC, she was merely authorized to take the clinical history and physical
examination o Corazon.
62
loweer, that routine internal examination did not i.o facto make Dr. Uy liable or the errors committed by Dr. Lstrada.
lurther, petitioners' imputation o negligence rests on their baseless assumption that Dr. Uy was present at the deliery room. Nothing shows that Dr. Uy
participated in deliering Corazon's baby. lurther, it is unexpected rom Dr. Uy, a mere resident physician at that time, to call the attention o a more
experienced specialist, i eer she was present at the deliery room.
c) Dr. Joel Lnriquez
Petitioners ault Dr. Joel Lnriquez also or not calling the attention o Dr. Lstrada, Dr. Villalor, and Nurse Dumlao about their errors.
63
Petitioners insist
that Dr. Lnriquez should hae taken, or at least suggested, correctie measures to rectiy such errors.
1he Court is not coninced. Dr. Lnriquez is an anesthesiologist whose ield o expertise is deinitely not obstetrics and gynecology. As such, Dr. Lnriquez
was not expected to correct Dr. Lstrada's errors. Besides, there was no eidence o Dr. Lnriquez's knowledge o any error committed by Dr. Lstrada and
his ailure to act upon such obseration.
d) Dr. Perpetua Lacson
Petitioners ault Dr. Perpetua Lacson or her purported delay in the deliery o blood Corazon needed.
64
Petitioners claim that Dr. Lacson was remiss in
her duty o superising the blood bank sta.
As ound by the trial court, there was no unreasonable delay in the deliery o blood rom the time o the request until the transusion to Corazon. Dr.
Lacson competently explained the procedure beore blood could be gien to the patient.
65
1aking into account the bleeding time, clotting time and cross-
matching, Dr. Lacson stated that it would take approximately 45-60 minutes beore blood could be ready or transusion.
66
lurther, no eidence exists that
Dr. Lacson neglected her duties as head o the blood bank.
e) Dr. Noe Lspinola
Petitioners argue that Dr. Lspinola should not hae ordered immediate hysterectomy without determining the underlying cause o Corazon's bleeding. Dr.
Lspinola should hae irst considered the possibility o cerical injury, and adised a thorough examination o the cerix, instead o belieing outright Dr.
Lstrada's diagnosis that the cause o bleeding was uterine atony.
Dr. Lspinola's order to do hysterectomy which was based on the inormation he receied by phone is not negligence. 1he Court agrees with the trial
court's obseration that Dr. Lspinola, upon hearing such inormation about Corazon's condition, belieed in good aith that hysterectomy was the correct
remedy. At any rate, the hysterectomy did not push through because upon Dr. Lspinola's arrial, it was already too late. At the time, Corazon was
practically dead.
f) Nurse J. Dumlao
In Moore r. Cvtbrie o.itat vc.,
6
the US Court o Appeals, lourth Circuit, held that to recoer, a patient complaining o injuries allegedly resulting when
the nurse negligently injected medicine to him intraenously instead o intramuscularly had to show that ,1, an intraenous injection constituted a lack o
reasonable and ordinary care, ,2, the nurse injected medicine intraenously, and ,3, such injection was the proximate cause o his injury.
In the present case, there is no eidence o Nurse Dumlao's alleged ailure to ollow Dr. Lstrada's speciic instructions. Len assuming Nurse Dumlao
deied Dr. Lstrada's order, there is no showing that side-drip administration o hemacel proximately caused Corazon's death. No eidence linking
Corazon's death and the alleged wrongul hemacel administration was introduced. 1hereore, there is no basis to hold Nurse Dumlao liable or negligence.
On the Award of Interest on Damages
1he award o interest on damages is proper and allowed under Article 2211 o the Ciil Code, which states that in crimes and quasi-delicts, interest as a
part o the damages may, in a proper case, be adjudicated in the discretion o the court.
68

WHLRLIORL, the Court PAR1LY GRAN1S the petition. 1he Court inds respondent Capitol Medical Center icariously liable or the negligence o
Dr. Oscar Lstrada. 1he amounts o P105,000 as actual damages andP00,000 as moral damages should each earn legal interest at the rate o six percent
,6, per annum computed rom the date o the judgment o the trial court. 1he Court airms the rest o the Decision dated 6 lebruary 1998 and
Resolution dated 21 March 2000 o the Court o Appeals in CA-G.R. CV No. 45641.
SO ORDLRLD.
Qvi.vvbivg, ]., Cbairer.ov, Cario Morate., 1ivga, ava 1eta.co, ]r., ]]., concur.
G.R. No. J26297 January 3J, 2007
PROILSSIONAL SLRVICLS, INC., Petitioner,
s.
NA1IVIDAD and LNRIQUL AGANA, Respondents.
x - - - - - - - - - - - - - - - - - - - - - - - x
G.R. No. J26467 January 3J, 2007
NA1IVIDAD (Substituted by her children MARCLLINO AGANA III, LNRIQUL AGANA, JR., LMMA AGANA ANDAYA, JLSUS
AGANA, and RAYMUND AGANA) and LNRIQUL AGANA, Petitioners,
s.
JUAN IULN1LS, Respondent.
x- - - - - - - - - - - - - - - - - - - -- - - - x
G.R. No. J27S90 January 3J, 2007
MIGULL AMPIL, Petitioner,
s.
NA1IVIDAD AGANA and LNRIQUL AGANA, Respondents.
D L C I S I O N
SANDOVAL-GU1ILRRLZ, J.:
Hospitals, having undertaken one of mankinds most important and delicate endeavors, must assume the grave responsibility of pursuing it with
appropriate care. 1he care and serice dispensed through this high trust, howeer technical, complex and esoteric its character may be, must meet
standards o responsibility commensurate with the undertaking to presere and protect the health, and indeed, the ery lies o those placed in the
hospitals keeping.
1

Assailed in these three consolidated petitions for review on certiorari is the Court of Appeals Decision
2
dated September 6, 1996 in CA-G.R. CV No.
42062 and CA-G.R. SP No. 32198 airming with modiication the Decision
3
dated March 1, 1993 o the Regional 1rial Court ,R1C,, Branch 96, Quezon
City in Ciil Case No. Q-43322 and nulliying its Order dated September 21, 1993.
1he acts, as culled rom the records, are:
On April 4, 1984, Natiidad Agana was rushed to the Medical City General lospital ,Medical City lospital, because o diiculty o bowel moement and
bloody anal discharge. Ater a series o medical examinations, Dr. Miguel Ampil, petitioner in G.R. No. 12590, diagnosed her to be suering rom
"cancer o the sigmoid."
On April 11, 1984, Dr. Ampil, assisted by the medical sta
4
o the Medical City lospital, perormed an anterior resection surgery on Natiidad. le ound
that the malignancy in her sigmoid area had spread on her let oary, necessitating the remoal o certain portions o it. 1hus, Dr. Ampil obtained the
consent of Natividads husband, Enrique Agana, to permit Dr. Juan Fuentes, respondent in G.R. No. 126467, to perorm hysterectomy on her.
Ater Dr. luentes had completed the hysterectomy, Dr. Ampil took oer, completed the operation and closed the incision.
loweer, the operation appeared to be lawed. In the corresponding Record o Operation dated April 11, 1984, the attending nurses entered these
remarks:
"sponge count lacking 2
"announced to surgeon searched ,sic, done but to no aail continue or closure."
On April 24, 1984, Natiidad was released rom the hospital. ler hospital and medical bills, including the doctors fees, amounted to P60,000.00.
Ater a couple o days, Natiidad complained o excruciating pain in her anal region. She consulted both Dr. Ampil and Dr. luentes about it. 1hey told
her that the pain was the natural consequence o the surgery. Dr. Ampil then recommended that she consult an oncologist to examine the cancerous nodes
which were not remoed during the operation.
On May 9, 1984, Natiidad, accompanied by her husband, went to the United States to seek urther treatment. Ater our months o consultations and
laboratory examinations, Natiidad was told she was ree o cancer. lence, she was adised to return to the Philippines.
On August 31, 1984, Natiidad lew back to the Philippines, still suering rom pains. 1wo weeks thereater, her daughter ound a piece o gauze
protruding rom her agina. Upon being inormed about it, Dr. Ampil proceeded to her house where he managed to extract by hand a piece o gauze
measuring 1.5 inches in width. le then assured her that the pains would soon anish.
Dr. Ampils assurance did not come true. Instead, the pains intensified, prompting Natividad to seek treatment at the Polymedic General lospital. \hile
conined there, Dr. Ramon Gutierrez detected the presence o another oreign object in her agina -- a oul-smelling gauze measuring 1.5 inches in width
which badly inected her aginal ault. A recto-aginal istula had ormed in her reproductie organs which orced stool to excrete through the agina.
Another surgical operation was needed to remedy the damage. 1hus, in October 1984, Natiidad underwent another surgery.
On Noember 12, 1984, Natiidad and her husband iled with the R1C, Branch 96, Quezon City a complaint or damages against the Proessional
Serices, Inc. ,PSI,, owner o the Medical City lospital, Dr. Ampil, and Dr. luentes, docketed as Ciil Case No. Q-43322. 1hey alleged that the latter are
liable for negligence for leaving two pieces of gauze inside Natividads body and malpractice for concealing their acts of negligence.
Meanwhile, Lnrique Agana also iled with the Proessional Regulation Commission ,PRC, an administratie complaint or gross negligence and
malpractice against Dr. Ampil and Dr. luentes, docketed as Administratie Case No. 1690. 1he PRC Board o Medicine heard the case only with respect
to Dr. luentes because it ailed to acquire jurisdiction oer Dr. Ampil who was then in the United States.
On lebruary 16, 1986, pending the outcome o the aboe cases, Natiidad died and was duly substituted by her aboe-named children ,the Aganas,.
On March 1, 1993, the R1C rendered its Decision in aor o the Aganas, inding PSI, Dr. Ampil and Dr. luentes liable or negligence and malpractice,
the decretal part o which reads:
\lLRLlORL, judgment is hereby rendered or the plaintis ordering the deendants PROlLSSIONAL SLRVICLS, INC., DR. MIGULL AMPIL and
DR. JUAN lULN1LS to pay to the plaintis, jointly and seerally, except in respect o the award or exemplary damages and the interest thereon which
are the liabilities o deendants Dr. Ampil and Dr. luentes only, as ollows:
1. As actual damages, the ollowing amounts:
a. 1he equialent in Philippine Currency o the total o US>19,900.00 at the rate o P21.60-US>1.00, as reimbursement o actual
expenses incurred in the United States o America,
b. 1he sum o P4,800.00 as trael taxes o plaintis and their physician daughter,
c. 1he total sum o P45,802.50, representing the cost o hospitalization at Polymedic lospital, medical ees, and cost o the saline
solution,
2. As moral damages, the sum o P2,000,000.00,
3. As exemplary damages, the sum o P300,000.00,
4. As attorneys fees, the sum of P250,000.00;
5. Legal interest on items 1 ,a,, ,b,, and ,c,, 2, and 3 hereinaboe, rom date o iling o the complaint until ull payment, and
6. Costs o suit.
SO ORDLRLD.
Aggrieed, PSI, Dr. luentes and Dr. Ampil interposed an appeal to the Court o Appeals, docketed as CA-G.R. CV No. 42062.
Incidentally, on April 3, 1993, the Aganas iled with the R1C a motion or a partial execution o its Decision, which was granted in an Order dated May 11,
1993. 1hereater, the sheri leied upon certain properties o Dr. Ampil and sold them or P451,25.00 and deliered the amount to the Aganas.
lollowing their receipt o the money, the Aganas entered into an agreement with PSI and Dr. luentes to indeinitely suspend any urther execution o the
R1C Decision. loweer, not long thereater, the Aganas again iled a motion or an alias writ o execution against the properties o PSI and Dr. luentes.
On September 21, 1993, the R1C granted the motion and issued the corresponding writ, prompting Dr. luentes to ile with the Court o Appeals a
petition or certiorari and prohibition, with prayer or preliminary injunction, docketed as CA-G.R. SP No. 32198. During its pendency, the Court o
Appeals issued a Resolution
5
dated October 29, 1993 granting Dr. Fuentes prayer for injunctive relief.
On January 24, 1994, CA-G.R. SP No. 32198 was consolidated with CA-G.R. CV No. 42062.
Meanwhile, on January 23, 1995, the PRC Board o Medicine rendered its Decision
6
in Administratie Case No. 1690 dismissing the case against Dr.
luentes. 1he Board held that the prosecution ailed to show that Dr. luentes was the one who let the two pieces o gauze inside Natividads body; and
that he concealed such act rom Natiidad.
On September 6, 1996, the Court o Appeals rendered its Decision jointly disposing o CA-G.R. CV No. 42062 and CA-G.R. SP No. 32198, thus:
\lLRLlORL, except or the modiication that the case against deendant-appellant Dr. Juan luentes is hereby DISMISSLD, and with the
pronouncement that deendant-appellant Dr. Miguel Ampil is liable to reimburse deendant-appellant Proessional Serices, Inc., whateer amount the
latter will pay or had paid to the plaintis-appellees, the decision appealed rom is hereby AllIRMLD and the instant appeal DISMISSLD.
Concomitant with the aboe, the petition or certiorari and prohibition iled by herein deendant-appellant Dr. Juan luentes in CA-G.R. SP No. 32198 is
hereby GRAN1LD and the challenged order o the respondent judge dated September 21, 1993, as well as the alias writ o execution issued pursuant
thereto are hereby NULLIlILD and SL1 ASIDL. 1he bond posted by the petitioner in connection with the writ o preliminary injunction issued by this
Court on Noember 29, 1993 is hereby cancelled.
Costs against deendants-appellants Dr. Miguel Ampil and Proessional Serices, Inc.
SO ORDLRLD.
Only Dr. Ampil iled a motion or reconsideration, but it was denied in a Resolution

dated December 19, 1996.


lence, the instant consolidated petitions.
In G.R. No. 12629, PSI alleged in its petition that the Court o Appeals erred in holding that: ,1, it is estopped rom raising the deense that Dr. Ampil is
not its employee, ,2, it is solidarily liable with Dr. Ampil, and ,3, it is not entitled to its counterclaim against the Aganas. PSI contends that Dr. Ampil is
not its employee, but a mere consultant or independent contractor. As such, he alone should answer or his negligence.
In G.R. No. 12646, the Aganas maintain that the Court o Appeals erred in inding that Dr. luentes is not guilty o negligence or medical malpractice,
inoking the doctrine o res ipsa loquitur. 1hey contend that the pieces o gauze are prima acie proos that the operating surgeons hae been negligent.
linally, in G.R. No. 12590, Dr. Ampil asserts that the Court o Appeals erred in inding him liable or negligence and malpractice sans eidence that he
let the two pieces o gauze in Natividads vagina. He pointed to other probable causes, such as: (1) it was Dr. Fuentes who used gauzes in performing the
hysterectomy; (2) the attending nurses failure to properly count the gauzes used during surgery; and (3) the medical intervention o the American doctors
who examined Natiidad in the United States o America.
lor our resolution are these three ital issues: irst, whether the Court o Appeals erred in holding Dr. Ampil liable or negligence and malpractice, second,
whether the Court o Appeals erred in absoling Dr. luentes o any liability, and third, whether PSI may be held solidarily liable or the negligence o Dr.
Ampil.
I - G.R. No. 12590
\hether the Court o Appeals Lrred in lolding Dr. Ampil
Liable or Negligence and Malpractice.
Dr. Ampil, in an attempt to absolve himself, gears the Courts attention to other possible causes of Natividads detriment. He argues that the Court should
not discount either o the ollowing possibilities: irst, Dr. luentes let the gauzes in Natividads body after performing hysterectomy; second, the attending
nurses erred in counting the gauzes; and third, the American doctors were the ones who placed the gauzes in Natividads body.
Dr. Ampils arguments are purely conjectural and without basis. Records show that he did not present any eidence to proe that the American doctors
were the ones who put or left the gauzes in Natividads body. Neither did he submit evidence to rebut the correctness of the record o operation,
particularly the number of gauzes used. As to the alleged negligence of Dr. Fuentes, we are mindful that Dr. Ampil examined his (Dr. Fuentes) work and
ound it in order.
1he glaring truth is that all the major circumstances, taken together, as speciied by the Court o Appeals, directly point to Dr. Ampil as the negligent party,
thus:
lirst, it is not disputed that the surgeons used gauzes as sponges to control the bleeding o the patient during the surgical operation.
Second, immediately ater the operation, the nurses who assisted in the surgery noted in their report that the sponge count (was) lacking 2; that
such anomaly was announced to surgeon and that a search was done but to no avail prompting Dr. Ampil to continue for closure x x x.
1hird, ater the operation, two ,2, gauzes were extracted rom the same spot o the body o Mrs. Agana where the surgery was perormed.
An operation requiring the placing o sponges in the incision is not complete until the sponges are properly remoed, and it is settled that the leaing o
sponges or other oreign substances in the wound ater the incision has been closed is at least prima acie negligence by the operating surgeon.
8
1o put it
simply, such act is considered so inconsistent with due care as to raise an inerence o negligence. 1here are een legions o authorities to the eect that
such act is negligence per se.
9

Of course, the Court is not blind to the reality that there are times when danger to a patients life precludes a surgeon from urther searching missing
sponges or oreign objects let in the body. But this does not leae him ree rom any obligation. Len i it has been shown that a surgeon was required by
the urgent necessities of the case to leave a sponge in his patients abdomen, because of the dangers attendant upon delay, still, it is his legal duty to so
inorm his patient within a reasonable time thereater by adising her o what he had been compelled to do. 1his is in order that she might seek relie rom
the eects o the oreign object let in her body as her condition might permit. 1he ruling in Smith . Zeagler
10
is explicit, thus:
1he remoal o all sponges used is part o a surgical operation, and when a physician or surgeon ails to remoe a sponge he has placed in his patients
body that should be remoed as part o the operation, he thereby leaes his operation uncompleted and creates a new condition which imposes upon him
the legal duty of calling the new condition to his patients attention, and endeavoring with the means he has at hand to minimize and aoid untoward
results likely to ensue thererom.
lere, Dr. Ampil did not inorm Natiidad about the missing two pieces o gauze. \orse, he een misled her that the pain she was experiencing was the
ordinary consequence o her operation. lad he been more candid, Natiidad could hae taken the immediate and appropriate medical remedy to remoe
the gauzes rom her body. 1o our mind, what was initially an act o negligence by Dr. Ampil has ripened into a deliberate wrongul act o deceiing his
patient.
1his is a clear case o medical malpractice or more appropriately, medical negligence. 1o successully pursue this kind o case, a patient must only proe
that a health care proider either ailed to do something which a reasonably prudent health care proider would hae done, or that he did something that a
reasonably prudent proider would not hae done, and that ailure or action caused injury to the patient.
11
Simply put, the elements are duty, breach, injury
and proximate causation. Dr, Ampil, as the lead surgeon, had the duty to remoe all oreign objects, such as gauzes, rom Natividads body before closure
o the incision. \hen he ailed to do so, it was his duty to inorm Natiidad about it. Dr. Ampil breached both duties. Such breach caused injury to
Natividad, necessitating her further examination by American doctors and another surgery. That Dr. Ampils negligence is the proximate cause
12
o
Natividads injury could be traced from his act of closing the incision despite the information given by the attending nurses that two pieces o gauze were
still missing. That they were later on extracted from Natividads vagina established the causal link between Dr. Ampils negl igence and the injury. And what
urther aggraated such injury was his deliberate concealment o the missing gauzes rom the knowledge o Natiidad and her amily.
II - G.R. No. 12646
\hether the Court o Appeals Lrred in Absoling
Dr. luentes o any Liability
1he Aganas assailed the dismissal by the trial court o the case against Dr. luentes on the ground that it is contrary to the doctrine o res ipsa loquitur.
According to them, the fact that the two pieces of gauze were left inside Natividads body is a prima facie evidence of Dr. Fuentes negligence.
\e are not coninced.
Literally, res ipsa loquitur means "the thing speaks or itsel." It is the rule that the act o the occurrence o an injury, taken with the surrounding
circumstances, may permit an inference or raise a presumption of negligence, or make out a plaintiffs prima facie case, and present a question o act or
deendant to meet with an explanation.
13
Stated dierently, where the thing which caused the injury, without the ault o the injured, is under the exclusie
control o the deendant and the injury is such that it should not hae occurred i he, haing such control used proper care, it aords reasonable eidence,
in the absence of explanation that the injury arose from the defendants want of care, and the burden o proo is shited to him to establish that he has
obsered due care and diligence.
14

lrom the oregoing statements o the rule, the requisites or the applicability o the doctrine o res ipsa loquitur are: ,1, the occurrence o an injury, ,2, the
thing which caused the injury was under the control and management o the deendant, ,3, the occurrence was such that in the ordinary course o things,
would not hae happened i those who had control or management used proper care, and ,4, the absence o explanation by the deendant. O the
oregoing requisites, the most instrumental is the "control and management o the thing which caused the injury."
15

\e ind the element o "control and management o the thing which caused the injury" to be wanting. lence, the doctrine o res ipsa loquitur will not lie.
It was duly established that Dr. Ampil was the lead surgeon during the operation o Natiidad. le requested the assistance o Dr. luentes only to perorm
hysterectomy when he ,Dr. Ampil, ound that the malignancy in her sigmoid area had spread to her let oary. Dr. luentes perormed the surgery and
thereater reported and showed his work to Dr. Ampil. 1he latter examined it and inding eerything to be in order, allowed Dr. luentes to leae the
operating room. Dr. Ampil then resumed operating on Natiidad. le was about to inish the procedure when the attending nurses inormed him that two
pieces o gauze were missing. A "diligent search" was conducted, but the misplaced gauzes were not ound. Dr. Ampil then directed that the incision be
closed. During this entire period, Dr. luentes was no longer in the operating room and had, in act, let the hospital.
Under the "Captain o the Ship" rule, the operating surgeon is the person in complete charge o the surgery room and all personnel connected with the
operation. 1heir duty is to obey his orders.
16
As stated beore, Dr. Ampil was the lead surgeon. In other words, he was the "Captain o the Ship." 1hat he
discharged such role is eident rom his ollowing conduct: ,1, calling Dr. luentes to perorm a hysterectomy, ,2, examining the work o Dr. luentes and
finding it in order; (3) granting Dr. Fuentes permission to leave; and (4) ordering the closure of the incision. To our mind, it was this act o ordering the
closure of the incision notwithstanding that two pieces of gauze remained unaccounted for, that caused injury to Natividads body. Clearly, the control and
management o the thing which caused the injury was in the hands o Dr. Ampil, not Dr. luentes.
In this jurisdiction, res ipsa loquitur is not a rule o substantie law, hence, does not per se create or constitute an independent or separate ground o
liability, being a mere eidentiary rule.
1
In other words, mere inocation and application o the doctrine does not dispense with the requirement o proo
o negligence. lere, the negligence was proen to hae been committed by Dr. Ampil and not by Dr. luentes.
III - G.R. No. 12629
\hether PSI Is Liable or the Negligence o Dr. Ampil
1he third issue necessitates a glimpse at the historical deelopment o hospitals and the resulting theories concerning their liability or the negligence o
physicians.
Until the mid-nineteenth century, hospitals were generally charitable institutions, proiding medical serices to the lowest classes o society, without regard
for a patients ability to pay.
18
1hose who could aord medical treatment were usually treated at home by their doctors.
19
loweer, the days o house calls
and philanthropic health care are oer. 1he modern health care industry continues to distance itsel rom its charitable past and has experienced a
signiicant conersion rom a not-or-proit health care to or-proit hospital businesses. Consequently, signiicant changes in health law hae accompanied
the business-related changes in the hospital industry. One important legal change is an increase in hospital liability or medical malpractice. Many courts
now allow claims or hospital icarious liability under the theories o respondeat superior, apparent authority, ostensible authority, or agency by estoppel.
20

In this jurisdiction, the statute goerning liability or negligent acts is Article 216 o the Ciil Code, which reads:
Art. 216. \hoeer by act or omission causes damage to another, there being ault or negligence, is obliged to pay or the damage done. Such ault or
negligence, i there is no pre-existing contractual relation between the parties, is called a quasi-delict and is goerned by the proisions o this Chapter.
A deriatie o this proision is Article 2180, the rule goerning icarious liability under the doctrine o respondeat superior, thus:
ART. 2180. The obligation imposed by Article 2176 is demandable not only for ones own acts or omissions, but also for those o persons or whom one
is responsible.
x x x x x x
1he owners and managers o an establishment or enterprise are likewise responsible or damages caused by their employees in the serice o the branches
in which the latter are employed or on the occasion o their unctions.
Lmployers shall be liable or the damages caused by their employees and household helpers acting within the scope o their assigned tasks een though the
ormer are not engaged in any business or industry.
x x x x x x
1he responsibility treated o in this article shall cease when the persons herein mentioned proe that they obsered all the diligence o a good ather o a
amily to preent damage.
A prominent ciilist commented that proessionals engaged by an employer, such as physicians, dentists, and pharmacists, are not "employees" under this
article because the manner in which they perorm their work is not within the control o the latter ,employer,. In other words, proessionals are considered
personally liable or the ault or negligence they commit in the discharge o their duties, and their employer cannot be held liable or such ault or
negligence. In the context o the present case, "a hospital cannot be held liable or the ault or negligence o a physician or surgeon in the treatment or
operation o patients."
21

1he oregoing iew is grounded on the traditional notion that the professional status and the very nature of the physicians calling preclude him from
being classed as an agent or employee o a hospital, wheneer he acts in a proessional capacity.
22
It has been said that medical practice strictly inoles
highly deeloped and specialized knowledge,
23
such that physicians are generally ree to exercise their own skill and judgment in rendering medical serices
sans intererence.
24
lence, when a doctor practices medicine in a hospital setting, the hospital and its employees are deemed to subsere him in his
ministrations to the patient and his actions are o his own responsibility.
25

1he case o Schloendor . Society o New \ork lospital
26
was then considered an authority or this iew. 1he "Schloendor doctrine" regards a
physician, een i employed by a hospital, as an independent contractor because o the skill he exercises and the lack o control exerted oer his work.
Under this doctrine, hospitals are exempt rom the application o the respondeat superior principle or ault or negligence committed by physicians in the
discharge o their proession.
loweer, the eicacy o the oregoing doctrine has weakened with the signiicant deelopments in medical care. Courts came to realize that modern
hospitals are increasingly taking actie role in supplying and regulating medical care to patients. No longer were a hospitals functions limited to furnishing
room, ood, acilities or treatment and operation, and attendants or its patients. 1hus, in Bing . 1hunig,
2
the New \ork Court o Appeals deiated rom
the Schloendor doctrine, noting that modern hospitals actually do ar more than proide acilities or treatment. Rather, they regularly employ, on a
salaried basis, a large sta o physicians, interns, nurses, administratie and manual workers. 1hey charge patients or medical care and treatment, een
collecting or such serices through legal action, i necessary. 1he court then concluded that there is no reason to exempt hospitals rom the uniersal rule
o respondeat superior.
In our shores, the nature o the relationship between the hospital and the physicians is rendered inconsequential in iew o our categorical pronouncement
in Ramos . Court o Appeals
28
that or purposes o apportioning responsibility in medical negligence cases, an employer-employee relationship in eect
exists between hospitals and their attending and isiting physicians. 1his Court held:
"\e now discuss the responsibility o the hospital in this particular incident. 1he unique practice ,among priate hospitals, o illing up specialist sta with
attending and isiting "consultants," who are allegedly not hospital employees, presents problems in apportioning responsibility or negligence in medical
malpractice cases. loweer, the diiculty is more apparent than real.
In the irst place, hospitals exercise signiicant control in the hiring and iring o consultants and in the conduct o their work within the hospital premises.
Doctors who apply for consultant slots, visiting or attending, are required to submit proof of completion of residency, their educational qualiications,
generally, eidence o accreditation by the appropriate board ,diplomate,, eidence o ellowship in most cases, and reerences. 1hese requirements are
careully scrutinized by members o the hospital administration or by a reiew committee set up by the hospital who either accept or reject the application.
x x x.
Ater a physician is accepted, either as a isiting or attending consultant, he is normally required to attend clinico-pathological conerences, conduct
bedside rounds or clerks, interns and residents, moderate grand rounds and patient audits and perorm other tasks and responsibilities, or the priilege o
being able to maintain a clinic in the hospital, and,or or the priilege o admitting patients into the hospital. In addition to these, the physicians
perormance as a specialist is generally ealuated by a peer reiew committee on the basis o mortality and morbidity statistics, and eedback rom patients,
nurses, interns and residents. A consultant remiss in his duties, or a consultant who regularly alls short o the minimum standards acceptable to the
hospital or its peer reiew committee, is normally politely terminated.
In other words, private hospitals, hire, fire and exercise real control over their attending and visiting consultant staff. While consultants are not,
technically employees, x x x, the control exercised, the hiring, and the right to terminate consultants all ulill the important hallmarks o an employer-
employee relationship, with the exception o the payment o wages. In assessing whether such a relationship in act exists, the control test is determining.
Accordingly, on the basis o the oregoing, we rule that or the purpose o allocating responsibility in medical negligence cases, an employer-employee
relationship in eect exists between hospitals and their attending and isiting physicians. "
But the Ramos pronouncement is not our only basis in sustaining PSIs liability. Its liability is also anchored upon the agency principle o apparent
authority or agency by estoppel and the doctrine of corporate negligence which have gained acceptance in the determination of a hospitals liability or
negligent acts o health proessionals. 1he present case seres as a perect platorm to test the applicability o these doctrines, thus, enriching our
jurisprudence.
Apparent authority, or what is sometimes reerred to as the "holding
out" theory, or doctrine o ostensible agency or agency by estoppel,
29
has its origin rom the law o agency. It imposes liability, not as the result o the
reality o a contractual relationship, but rather because o the actions o a principal or an employer in somehow misleading the public into belieing that
the relationship or the authority exists.
30
1he concept is essentially one o estoppel and has been explained in this manner:
"1he principal is bound by the acts o his agent with the apparent authority which he knowingly permits the agent to assume, or which he holds the agent
out to the public as possessing. 1he question in eery case is whether the principal has by his oluntary act placed the agent in such a situation that a
person o ordinary prudence, conersant with business usages and the nature o the particular business, is justiied in presuming that such agent has
authority to perorm the particular act in question.
31

1he applicability o apparent authority in the ield o hospital liability was upheld long time ago in Iring . Doctor lospi tal o Lake \orth, Inc.
32
1here,
it was explicitly stated that "there does not appear to be any rational basis or excluding the concept o apparent authority rom the ield o hospital
liability." 1hus, in cases where it can be shown that a hospital, by its actions, has held out a particular physician as its agent and,or employee and that a
patient has accepted treatment rom that physician in the reasonable belie that it is being rendered in behal o the hospital, then the hospital will be liable
for the physicians negligence.
Our jurisdiction recognizes the concept o an agency by implication or estoppel. Article 1869 o the Ciil Code reads:
AR1. 1869. Agency may be express, or implied rom the acts o the principal, rom his silence or lack o action, or his ailure to repudiate the agency,
knowing that another person is acting on his behal without authority.
In this case, PSI publicly displays in the lobby o the Medical City lospital the names and specializations o the physicians associated or accredited by it,
including those of Dr. Ampil and Dr. Fuentes. We concur with the Court of Appeals conclusion that it "is now estopped from passing all the blame to the
physicians whose names it proudly paraded in the public directory leading the public to beliee that it ouched or their skill and competence." Indeed,
PSIs act is tantamount to holding out to the public that Medical City Hospital, through its accredited physicians, offers quality health care serices. By
accrediting Dr. Ampil and Dr. luentes and publicly adertising their qualiications, the hospital created the impression that they were its agents, authorized
to perorm medical or surgical serices or its patients. As expected, these patients, Natiidad being one o them, accepted the serices on the reasonable
belie that such were being rendered by the hospital or its employees, agents, or serants. 1he trial court correctly pointed out:
x x x regardless o the education and status in lie o the patient, he ought not be burdened with the deense o absence o employer-employee relationship
between the hospital and the independent physician whose name and competence are certainly certiied to the general public by the hospitals act of listing
him and his specialty in its lobby directory, as in the case herein. The high costs of todays medical and health care should at least exact on the hospital
greater, i not broader, legal responsibility or the conduct o treatment and surgery within its acility by its accredited physician or surgeon, regardless o
whether he is independent or employed."
33

1he wisdom o the oregoing ratiocination is easy to discern. Corporate entities, like PSI, are capable o acting only through other indiiduals, such as
physicians. I these accredited physicians do their job well, the hospital succeeds in its mission o oering quality medical serices and thus proits
inancially. Logically, where negligence mars the quality o its serices, the hospital should not be allowed to escape liability or the acts o its ostensible
agents.
\e now proceed to the doctrine o corporate negligence or corporate responsibility.
One allegation in the complaint in Ciil Case No. Q-43332 or negligence and malpractice is that PSI as owner, operator and manager o Medical City
lospital, "did not perorm the necessary superision nor exercise diligent eorts in the superision o Drs. Ampil and luentes and its nursing sta,
resident doctors, and medical interns who assisted Drs. Ampil and luentes in the perormance o their duties as surgeons."
34
Premised on the doctrine o
corporate negligence, the trial court held that PSI is directly liable or such breach o duty.
\e agree with the trial court.
Recent years hae seen the doctrine o corporate negligence as the judicial answer to the problem o allocating hospitals liability for the negligent acts of
health practitioners, absent acts to support the application o respondeat superior or apparent authority. Its ormulation proceeds from the judiciarys
acknowledgment that in these modern times, the duty o proiding quality medical serice is no longer the sole prerogatie and responsibility o the
physician. 1he modern hospitals hae changed structure. lospitals now tend to organize a highly proessional medical sta whose competence and
perormance need to be monitored by the hospitals commensurate with their inherent responsibility to proide quality medical care.
35

1he doctrine has its genesis in Darling . Charleston Community lospital.
36
1here, the Supreme Court o Illinois held that "the jury could hae ound a
hospital negligent, inter alia, in ailing to hae a suicient number o trained nurses attending the patient, ailing to require a consultation with or
examination by members o the hospital sta, and ailing to reiew the treatment rendered to the patient." On the basis o Darling, other jurisdictions held
that a hospitals corporate negligence extends to permitting a physician known to be incompetent to practice at the hospital.
3
\ith the passage o time,
more duties were expected rom hospitals, among them: ,1, the use o reasonable care in the maintenance o sae and adequate acilities and equipment,
,2, the selection and retention o competent physicians, ,3, the oerseeing or superision o all persons who practice medicine within its walls, and ,4, the
ormulation, adoption and enorcement o adequate rules and policies that ensure quality care or its patients.
38
1hus, in 1ucson Medical Center, Inc. .
Miseich,
39
it was held that a hospital, ollowing the doctrine o corporate responsibility, has the duty to see that it meets the standards o responsibilities
or the care o patients. Such duty includes the proper superision o the members o its medical sta. And in Bost . Riley,
40
the court concluded that a
patient who enters a hospital does so with the reasonable expectation that it will attempt to cure him. 1he hospital accordingly has the duty to make a
reasonable eort to monitor and oersee the treatment prescribed and administered by the physicians practicing in its premises.
In the present case, it was duly established that PSI operates the Medical City lospital or the purpose and under the concept o proiding comprehensie
medical serices to the public. Accordingly, it has the duty to exercise reasonable care to protect rom harm all patients admitted into its acility or medical
treatment. Unortunately, PSI ailed to perorm such duty. 1he indings o the trial court are conincing, thus:
x x x PSIs liability is traceable to its ailure to conduct an inestigation o the matter reported in the nota bene o the count nurse. Such ailure established
PSIs part in the dark conspiracy of silence and concealment about the gauzes. Ethical considerations, if not also legal, dictated the holding o an
immediate inquiry into the eents, i not or the beneit o the patient to whom the duty is primarily owed, then in the interest o arriing at the truth. 1he
Court cannot accept that the medical and the healing professions, through their members like defendant surgeons, and their institutions like PSIs hospital
acility, can callously turn their backs on and disregard een a mere probability o mistake or negligence by reusing or ailing to inestigate a report o such
seriousness as the one in Natividads case.
It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance of the Medical City Hospitals sta, composed o resident
doctors, nurses, and interns. As such, it is reasonable to conclude that PSI, as the operator o the hospital, has actual or constructie knowledge o the
procedures carried out, particularly the report o the attending nurses that the two pieces o gauze were missing. In lridena . Lans,
41
it was held that a
corporation is bound by the knowledge acquired by or notice gien to its agents or oicers within the scope o their authori ty and in reerence to a matter
to which their authority extends. 1his means that the knowledge o any o the sta o Medical City lospital constitutes knowledge o PSI. Now, the
failure of PSI, despite the attending nurses report, to investigate and inform Natividad regarding the missing gauzes amounts to callous negligence. Not
only did PSI breach its duties to oersee or superise all persons who practice medicine within its walls, it also ailed to take an actie step in ixing the
negligence committed. 1his renders PSI, not only icariously liable or the negligence o Dr. Ampil under Article 2180 o the Ciil Code, but also directly
liable or its own negligence under Article 216. In lridena, the Supreme Court o Arizona held:
x x x In recent years, howeer, the duty o care owed to the patient by the hospital has expanded. 1he emerging trend is to hold the hospital responsible
where the hospital has ailed to monitor and reiew medical serices being proided within its walls. See Kahn lospital Malpractice Preention, 2 De
Paul . Re. 23 ,19,.
Among the cases indicative of the emerging trend is Purcell v. Zimbelman, 18 Ariz. App. 75,500 P. 2d 335 (1972). In Purcell , the hospital argued that it
could not be held liable or the malpractice o a medical practitioner because he was an independent contractor within the hospital. 1he Court o Appeals
pointed out that the hospital had created a proessional sta whose competence and perormance was to be monitored and reiewed by the goerning
body o the hospital, and the court held that a hospital would be negligent where it had knowledge or reason to beliee that a doctor using the acilities was
employing a method o treatment or care which ell below the recognized standard o care.
Subsequent to the Purcell decision, the Arizona Court o Appeals held that a hospital has certain inherent responsibilities regarding the quality o medical
care urnished to patients within its walls and it must meet the standards o responsibility commensurate with this undertaki ng. Beeck . 1ucson General
lospital, 18 Ariz. App. 165, 500 P. 2d 1153 ,192,. 1his court has conirmed the rulings o the Court o Appeals that a hospi tal has the duty o
superising the competence o the doctors on its sta. x x x.
x x x x x x
In the amended complaint, the plaintis did plead that the operation was perormed at the hospital with its knowledge, aid, and assistance, and that the
negligence o the deendants was the proximate cause o the patients injuries. We find that such general allegations of negligence, along with the evidence
produced at the trial of this case, are sufficient to support the hospitals liability based on the theory of negligent superision."
Anent the corollary issue o whether PSI is solidarily liable with Dr. Ampil or damages, let it be emphasized that PSI, apart rom a general denial o its
responsibility, ailed to adduce eidence showing that it exercised the diligence o a good ather o a amily in the accredi tation and superision o the
latter. In neglecting to oer such proo, PSI ailed to discharge its burden under the last paragraph o Article 2180 cited earlier, and, thereore, must be
adjudged solidarily liable with Dr. Ampil. Moreoer, as we hae discussed, PSI is also directly liable to the Aganas.
One inal word. Once a physician undertakes the treatment and care o a patient, the law imposes on him certain obligations. In order to escape liability, he
must possess that reasonable degree o learning, skill and experience required by his proession. At the same time, he must apply reasonable care and
diligence in the exercise o his skill and the application o his knowledge, and exert his best judgment.
\lLRLlORL, we DLN\ all the petitions and AllIRM the challenged Decision o the Court o Appeals in CA-G.R. CV No. 42062 and CA-G.R. SP
No. 32198.
Costs against petitioners PSI and Dr. Miguel Ampil.
SO ORDLRLD.
G.R. No. J243S4 December 29, J999
ROGLLIO L. RAMOS and LRLINDA RAMOS, in their own behalf and as natural guardians of the minors, ROMMLL RAMOS, ROY
RODLRICK RAMOS and RON RAYMOND RAMOS, petitioners,
s.
COUR1 OI APPLALS, DLLOS SAN1OS MLDICAL CLN1LR, DR. ORLINO HOSAKA and DRA. PLRILC1A
GU1ILRRLZ, respondents.
KAPUNAN, J.:
1he lippocratic Oath mandates physicians to gie primordial consideration to the health and welare o their patients. I a doctor ails to lie up to this
precept, he is made accountable or his acts. A mistake, through gross negligence or incompetence or plain human error, may spell the dierence between
lie and death. In this sense, the doctor plays God on his patient's ate.
J

In the case at bar, the Court is called upon to rule whether a surgeon, an anesthesiologist and a hospital should be made liable or the unortunate
comatose condition o a patient scheduled or cholecystectomy.
2

Petitioners seek the reersal o the decision
3
o the Court o Appeals, dated 29 May 1995, which oerturned the decision
4
o the Regional 1rial Court,
dated 30 January 1992, inding priate respondents liable or damages arising rom negligence in the perormance o their proessional duties towards
petitioner Lrlinda Ramos resulting in her comatose condition.
1he antecedent acts as summarized by the trial court are reproduced hereunder:
Plainti Lrlinda Ramos was, until the aternoon o June 1, 1985, a 4-year old ,Lxh. "A", robust woman ,1SN, October 19, 1989, p.
10,. Lxcept or occasional complaints o discomort due to pains allegedly caused by the presence o a stone in her gall bladder ,1SN,
January 13, 1988, pp. 4-5,, she was as normal as any other woman. Married to Rogelio L. Ramos, an executie o Philippine Long
Distance 1elephone Company, she has three children whose names are Rommel Ramos, Roy Roderick Ramos and Ron Raymond
Ramos ,1SN, October 19, 1989, pp. 5-6,.
Because the discomorts somehow interered with her normal ways, she sought proessional adice. She was adised to undergo an
operation or the remoal o a stone in her gall bladder ,1SN, January 13, 1988, p. 5,. She underwent a series o examinations which
included blood and urine tests ,Lxhs. "A" and "C", which indicated she was it or surgery.
1hrough the intercession o a mutual riend, Dr. Bueniaje ,1SN, January 13, 1988, p. ,, she and her husband Rogelio met or
the fir.t tive Dr. Orlino lozaka ,should be losaka, .ee 1SN, lebruary 20, 1990, p. 3,, one o the deendants in this case, on June 10,
1985. 1hey agreed that their date at the operating table at the DLSMC ,another deendant,, would be on June 1, 1985 at 9:00 A.M..
Dr. losaka decided that she should undergo a "cholecystectomy" operation ater examining the documents ,indings rom the
Capitol Medical Center, lLU lospital and DLSMC, presented to him. Rogelio L. Ramos, howeer, asked Dr. losaka to look or a
good anesthesiologist. Dr. losaka, in turn, assured Rogelio that he will get a good anesthesiologist. Dr. losaka charged a ee o
P16,000.00, which was to include the anesthesiologist's ee and which was to be paid ater the operation ,1SN, October 19, 1989, pp.
14-15, 22-23, 31-33, 1SN, lebruary 2, 1990, p. 13, and 1SN, Noember 9, 1989, pp. 3-4, 10, 1,.
A day beore the scheduled date o operation, she was admitted at one o the rooms o the DLSMC, located along L. Rodriguez
Aenue, Quezon City ,1SN, October 19,1989, p. 11,.
At around :30 A.M. o June 1, 1985 and while still in her room, she was prepared or the operation by the hospital sta. ler sister-
in-law, lerminda Cruz, who was the Dean o the College o Nursing at the Capitol Medical Center, was also there or moral support.
She reiterated her preious request or lerminda to be with her een during the operation. Ater praying, she was gien injections.
ler hands were held by lerminda as they went down rom her room to the operating room ,1SN, January 13, 1988, pp. 9-11,. ler
husband, Rogelio, was also with her ,1SN, October 19, 1989, p. 18,. At the operating room, lerminda saw about two or three nurses
and Dr. Perecta Gutierrez, the other deendant, who was to administer anesthesia. Although not a member o the hospital sta,
lerminda introduced hersel as Dean o the College o Nursing at the Capitol Medical Center who was to proide moral support to
the patient, to them. lerminda was allowed to stay inside the operating room.
At around 9:30 A.M., Dr. Gutierrez reached a nearby phone to look or Dr. losaka who was not yet in ,1SN, January 13, 1988, pp.
11-12,. Dr. Gutierrez thereater inormed lerminda Cruz about the prospect o a delay in the arrial o Dr. losaka. lerminda then
went back to the patient who asked, "Mindy, wala pa ba ang Doctor" 1he ormer replied, "luwag kang mag-alaala, darating na iyon"
,bia.,.
1hereater, lerminda went out o the operating room and inormed the patient's husband, Rogelio, that the doctor was not yet
around ,ia., p. 13,. \hen she returned to the operating room, the patient told her, "Mindy, inip na inip na ako, ikuha mo ako ng ibang
Doctor." So, she went out again and told Rogelio about what the patient said ,ia., p. 15,. 1hereater, she returned to the operating
room.
At around 10:00 A.M., Rogelio L. Ramos was "already dying |and| waiting or the arrial o the doctor" een as he did his best to ind
somebody who will allow him to pull out his wie rom the operating room ,1SN, October 19, 1989, pp. 19-20,. le also thought o
the eeling o his wie, who was inside the operating room waiting or the doctor to arrie ,ibia.,. At almost 12:00 noon, he met Dr.
Garcia who remarked that he ,Dr. Garcia, was also tired o waiting or Dr. losaka to arrie ,ia., p. 21,. \hile talking to Dr. Garcia at
around 12:10 P.M., he came to know that Dr. losaka arried as a nurse remarked, "Nandiyan na si Dr. losaka, dumating na raw."
Upon hearing those words, he went down to the lobby and waited or the operation to be completed ,ia., pp. 16, 29-30,.
At about 12:15 P.M., lerminda Cruz, who was inside the operating room with the patient, heard somebody say that "Dr. losaka is
already here." She then saw people inside the operating room "moing, doing this and that, |and| preparing the patient or the
operation" ,1SN, January 13, 1988, p. 16,. As she held the hand o Lrlinda Ramos, she then saw Dr. Gutierrez intubating the hapless
patient. She thereater heard Dr. Gutierrez say, "ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan" ,ia., p.
1,. Because o the remarks o Dra. Gutierrez, she ocused her attention on what Dr. Gutierrez was doing. She thereater noticed
bluish discoloration o the nailbeds o the let hand o the hapless Lrlinda een as Dr. losaka approached her. She then heard Dr.
losaka issue an order or someone to call Dr. Calderon, another anesthesiologist ,ia., p. 19,. Ater Dr. Calderon arried at the
operating room, she saw this anesthesiologist trying to intubate the patient. 1he patient's nailbed became bluish and the patient was
placed in a trendelenburg position a position where the head o the patient is placed in a position lower than her eet which is an
indication that there is a decrease o blood supply to the patient's brain ,a., pp. 19-20,. Immediately thereater, she went out o the
operating room, and she told Rogelio L. Ramos "that something wrong was . . . happening" ,bia.,. Dr. Calderon was then able to
intubate the patient ,1SN, July 25, 1991, p. 9,.
Meanwhile, Rogelio, who was outside the operating room, saw a respiratory machine being rushed towards the door o the operating
room. le also saw seeral doctors rushing towards the operating room. \hen inormed by lerminda Cruz that something wrong
was happening, he told her ,lerminda, to be back with the patient inside the operating room ,1SN, October 19, 1989, pp. 25-28,.
lerminda Cruz immediately rushed back, and saw that the patient was still in trendelenburg position ,1SN, January 13, 1988, p. 20,.
At almost 3:00 P.M. o that ateul day, she saw the patient taken to the Intensie Care Unit ,ICU,.
About two days thereater, Rogelio L. Ramos was able to talk to Dr. losaka. 1he latter inormed the ormer that something went
wrong during the intubation. Reacting to what was told to him, Rogelio reminded the doctor that the condition o his wie would not
hae happened, had he ,Dr. losaka, looked or a good anesthesiologist ,1SN, October 19, 1989, p. 31,.
Doctors Gutierrez and losaka were also asked by the hospital to explain what happened to the patient. 1he doctors explained that
the patient had bronchospasm ,1SN, Noember 15, 1990, pp. 26-2,.
Lrlinda Ramos stayed at the ICU or a month. About our months thereater or on Noember 15, 1985, the patient was released rom
the hospital.
During the whole period o her coninement, she incurred hospital bills amounting to P93,542.25 which is the subject o a promissory
note and aidait o undertaking executed by Rogelio L. Ramos in aor o DLSMC. Since that ateul aternoon o June 1, 1985,
she has been in a comatose condition. She cannot do anything. She cannot moe any part o her body. She cannot see or hear. She is
liing on mechanical means. She suered brain damage as a result o the absence o oxygen in her brain or our to ie minutes
,1SN, Noember 9, 1989, pp. 21-22,. Ater being discharged rom the hospital, she has been staying in their residence, still needing
constant medical attention, with her husband Rogelio incurring a monthly expense ranging rom P8,000.00 to P10,000.00 ,1SN,
October 19, 1989, pp. 32-34,. She was also diagnosed to be suering rom "diuse cerebral parenchymal damage" ,Lxh. "G", .ee
at.o 1SN, December 21, 1989,
p. 6,.
S

1hus, on 8 January 1986, petitioners iled a ciil case
6
or damages with the Regional 1rial Court o Quezon City against herein priate respondents
alleging negligence in the management and care o Lrlinda Ramos.
During the trial, both parties presented eidence as to the possible cause o Lrlinda's injury. Plainti presented the testimonies o Dean lerminda Cruz
and Dr. Mariano Gaino to proe that the sustained by Lrlinda was due to lack o oxygen in her brain caused by the aulty management o her airway by
priate respondents during the anesthesia phase. On the other hand, priate respondents primarily relied on the expert testimony o Dr. Lduardo Jamora,
a pulmonologist, to the eect that the cause o brain damage was Lrlinda's allergic reaction to the anesthetic agent, 1hiopental Sodium ,Pentothal,.
Ater considering the eidence rom both sides, the Regional 1rial Court rendered judgment in aor o petitioners, to wit:
Ater ealuating the eidence as shown in the inding o acts set orth earlier, and applying the aorecited proisions o law and
jurisprudence to the case at bar, this Court inds and so holds that deendants are liable to plaintis or damages. 1he deendants were
guilty o, at the ery least, negligence in the perormance o their duty to plainti-patient Lrlinda Ramos.
On the part o Dr. Perecta Gutierrez, this Court inds that she omitted to exercise reasonable care in not only intubating the patient,
but also in not repeating the administration o atropine ,1SN, August 20, 1991, pp. 5-10,, without due regard to the act that the
patient was inside the operating room or almost three ,3, hours. lor ater she committed a mistake in intubating |the| patient, the
patient's nailbed became bluish and the patient, thereater, was placed in trendelenburg position, because o the decrease o blood
supply to the patient's brain. 1he eidence urther shows that the hapless patient suered brain damage because o the absence o
oxygen in her ,patient's, brain or approximately our to ie minutes which, in turn, caused the patient to become comatose.
On the part o Dr. Orlino losaka, this Court inds that he is liable or the acts o Dr. Perecta Gutierrez whom he had chosen to
administer anesthesia on the patient as part o his obligation to proide the patient a good anesthesiologist', and or arriing or the
scheduled operation almost three ,3, hours late.
On the part o DLSMC ,the hospital,, this Court inds that it is liable or the acts o negligence o the doctors in their "practice o
medicine" in the operating room. Moreoer, the hospital is liable or ailing through its responsible oicials, to cancel the scheduled
operation ater Dr. losaka inexcusably ailed to arrie on time.
In haing held thus, this Court rejects the deense raised by deendants that they hae acted with due care and prudence in rendering
medical serices to plainti-patient. lor i the patient was properly intubated as claimed by them, the patient would not hae become
comatose. And, the act that another anesthesiologist was called to try to intubate the patient ater her ,the patient's, nailbed turned
bluish, belie their claim. lurthermore, the deendants should hae rescheduled the operation to a later date. 1his, they should hae
done, i deendants acted with due care and prudence as the patient's case was an electie, not an emergency case.
xxx xxx xxx
\lLRLlORL, and in iew o the oregoing, judgment is rendered in aor o the plaintis and against the deendants. Accordingly,
the latter are ordered to pay, jointly and seerally, the ormer the ollowing sums o money, to wit:
1, the sum o P8,000.00 as actual monthly expenses or the plainti Lrlinda Ramos reckoned rom Noember
15, 1985 or in the total sum o P632,000.00 as o April 15, 1992, subject to its being updated,
2, the sum o P100,000.00 as reasonable attorney's ees,
3, the sum o P800,000.00 by way o moral damages and the urther sum o P200,000,00 by way o exemplary
damages, and,
4, the costs o the suit.
SO ORDLRLD.
7

Priate respondents seasonably interposed an appeal to the Court o Appeals. 1he appellate court rendered a Decision, dated 29 May 1995, reersing the
indings o the trial court. 1he decretal portion o the decision o the appellate court reads:
\lLRLlORL, or the oregoing premises the appealed decision is hereby RLVLRSLD, and the complaint below against the
appellants is hereby ordered DISMISSLD. 1he counterclaim o appellant De Los Santos Medical Center is GRAN1LD but only
insoar as appellees are hereby ordered to pay the unpaid hospital bills amounting to P93,542.25, plus legal interest or justice must be
tempered with mercy.
SO ORDLRLD.
8

1he decision o the Court o Appeals was receied on 9 June 1995 by petitioner Rogelio Ramos who was mistakenly addressed as "Atty. Rogelio Ramos."
No copy o the decision, howeer, was sent nor receied by the Coronel Law Oice, then counsel on record o petitioners. Rogelio reerred the decision
o the appellate court to a new lawyer, Atty. Ligsay, only on 20 June 1995, or our ,4, days beore the expiration o the reglementary period or iling a
motion or reconsideration. On the same day, Atty. Ligsay, iled with the appellate court a motion or extension o time to ile a motion or
reconsideration. 1he motion or reconsideration was submitted on 4 July 1995. loweer, the appellate court denied the motion or extension o time in its
Resolution dated 25 July 1995.
9
Meanwhile, petitioners engaged the serices o another counsel, Atty. Sillano, to replace Atty. Ligsay. Atty. Sillano iled on
August 1995 a motion to admit the motion or reconsideration contending that the period to ile the appropriate pleading on the assailed decision had
not yet commenced to run as the Diision Clerk o Court o the Court o Appeals had not yet sered a copy thereo to the counsel on record. Despite this
explanation, the appellate court still denied the motion to admit the motion or reconsideration o petitioners in its Resolution, dated 29 March 1996,
primarily on the ground that the iteen-day ,15, period or iling a motion or reconsideration had already expired, to wit:
\e said in our Resolution on July 25, 1995, that the iling o a Motion or Reconsideration cannot be extended, precisely, the Motion
or Lxtension ,Rotto, p. 12, was denied. It is, on the other hand, admitted in the latter Motion that plaintis,appellees receied a copy
o the decision as early as June 9, 1995. Computation wise, the period to ile a Motion or Reconsideration expired on June 24. 1he
Motion or Reconsideration, in turn, was receied by the Court o Appeals already on July 4, necessarily, the 15-day period already
passed. lor that alone, the latter should be denied.
Len assuming admissibility o the Motion or the Reconsideration, but ater considering the Comment,Opposition, the ormer, or
lack o merit, is hereby DLNILD.
SO ORDLRLD.
J0

A copy o the aboe resolution was receied by Atty. Sillano on 11 April 1996. 1he next day, or on 12 April 1996, Atty. Sillano iled beore this Court a
motion or extension o time to ile the present petition or certiorari under Rule 45. 1he Court granted the motion or extension o time and gae
petitioners additional thirty ,30, days ater the expiration o the iteen-day ,15, period counted rom the receipt o the resolution o the Court o Appeals
within which to submit the petition. 1he due date ell on 2 May 1996. 1he petition was iled on 9 May 1996, well within the extended period gien by the
Court.
Petitioners assail the decision o the Court o Appeals on the ollowing grounds:
I
IN PU11ING MUCl RLLIANCL ON 1lL 1LS1IMONILS Ol RLSPONDLN1S DRA. GU1ILRRLZ, DRA. CALDLRON
AND DR. JAMORA,
II
IN lINDING 1lA1 1lL NLGLIGLNCL Ol 1lL RLSPONDLN1S DID NO1 CAUSL 1lL UNlOR1UNA1L
COMA1OSL CONDI1ION Ol PL1I1IONLR LRLINDA RAMOS,
III
IN NO1 APPL\ING 1lL DOC1RINL Ol R P. OQ|1|R.
JJ

Beore we discuss the merits o the case, we shall irst dispose o the procedural issue on the timeliness o the petition in relation to the motion or
reconsideration iled by petitioners with the Court o Appeals. In their
Comment,
J2
priate respondents contend that the petition should not be gien due course since the motion or reconsideration o the petitioners on the
decision o the Court o Appeals was alidly dismissed by the appellate court or haing been iled beyond the reglementary period. \e do not agree.
A careul reiew o the records reeals that the reason behind the delay in iling the motion or reconsideration is attributable to the act that the decision
o the Court o Appeals was not sent to then counsel on record o petitioners, the Coronel Law Oice. In act, a copy o the decision o the appellate
court was instead sent to and receied by petitioner Rogelio Ramos on 9 June 1995 wherein he was mistakenly addressed as Atty. Rogelio Ramos. Based
on the other communications receied by petitioner Rogelio Ramos, the appellate court apparently mistook him or the counsel on record. 1hus, no copy
o the decision o the counsel on record. Petitioner, not being a lawyer and unaware o the prescriptie period or iling a motion or reconsideration,
reerred the same to a legal counsel only on 20 June 1995.
It is elementary that when a party is represented by counsel, all notices should be sent to the party's lawyer at his gien address. \ith a ew exceptions,
notice to a litigant without notice to his counsel on record is no notice at all. In the present case, since a copy o the decision o the appellate court was not
sent to the counsel on record o petitioner, there can be no suicient notice to speak o. lence, the delay in the iling o the motion or reconsideration
cannot be taken against petitioner. Moreoer, since the Court o Appeals already issued a second Resolution, dated 29 March 1996, which superseded the
earlier resolution issued on 25 July 1995, and denied the motion or reconsideration o petitioner, we belieed that the receipt o the ormer should be
considered in determining the timeliness o the iling o the present petition. Based on this, the petition beore us was submitted on time.
Ater resoling the oregoing procedural issue, we shall now look into the merits o the case. lor a more logical presentation o the discussion we shall irst
consider the issue on the applicability o the doctrine o re. i.a toqvitvr to the instant case. 1hereater, the irst two assigned errors shall be tackled in
relation to the re. i.a toqvitvr doctrine.
Re. i.a toqvitvr is a Latin phrase which literally means "the thing or the transaction speaks or itsel." 1he phrase "re. i.a toqvitvr'' is a maxim or the rule
that the act o the occurrence o an injury, taken with the surrounding circumstances, may permit an inerence or raise a presumption o negligence, or
make out a plainti's riva faciecase, and present a question o act or deendant to meet with an explanation.
J3
\here the thing which caused the injury
complained o is shown to be under the management o the deendant or his serants and the accident is such as in ordinary course o things does not
happen i those who hae its management or control use proper care, it aords reasonable eidence, in the absence o explanation by the deendant, that
the accident arose rom or was caused by the deendant's want o care.
J4

1he doctrine o re. i.a toqvitvr is simply a recognition o the postulate that, as a matter o common knowledge and experience, the ery nature o certain
types o occurrences may justiy an inerence o negligence on the part o the person who controls the instrumentality causing the injury in the absence o
some explanation by the deendant who is charged with negligence.
JS
It is grounded in the superior logic o ordinary human experience and on the basis
o such experience or common knowledge, negligence may be deduced rom the mere occurrence o the accident itsel.
J6
lence, re. i.a toqvitvr is applied
in conjunction with the doctrine o common knowledge.
loweer, much has been said that re. i.a toqvitvr is not a rule o substantie law and, as such, does not create or constitute an independent or separate
ground o liability.
J7
Instead, it is considered as merely eidentiary or in the nature o a procedural rule.
J8
It is regarded as a mode o proo, or a mere
procedural o conenience since it urnishes a substitute or, and reliees a plainti o, the burden o producing speciic proo o negligence.
J9
In other
words, mere inocation and application o the doctrine does not dispense with the requirement o proo o negligence. It is simply a step in the process o
such proo, permitting the plainti to present along with the proo o the accident, enough o the attending circumstances to inoke the doctrine, creating
an inerence or presumption o negligence, and to thereby place on the deendant the burden o going orward with the proo.
20
Still, beore resort to the
doctrine may be allowed, the ollowing requisites must be satisactorily shown:
1. 1he accident is o a kind which ordinarily does not occur in the absence o someone's negligence,
2. It is caused by an instrumentality within the exclusie control o the deendant or deendants, and
3. 1he possibility o contributing conduct which would make the plainti responsible is eliminated.
2J

In the aboe requisites, the undamental element is the "control o instrumentality" which caused the damage.
22
Such element o control must be shown to
be within the dominion o the deendant. In order to hae the beneit o the rule, a plainti, in addition to proing injury or damage, must show a
situation where it is applicable, and must establish that the essential elements o the doctrine were present in a particular incident.
23

Medical malpractice
24
cases do not escape the application o this doctrine. 1hus, re. i.a toqvitvr has been applied when the circumstances attendant upon
the harm are themseles o such a character as to justiy an inerence o negligence as the cause o that harm.
2S
1he application o re. i.a toqvitvr in
medical negligence cases presents a question o law since it is a judicial unction to determine whether a certain set o circumstances does, as a matter o
law, permit a gien inerence.
26

Although generally, expert medical testimony is relied upon in malpractice suits to proe that a physician has done a negligent act or that he has deiated
rom the standard medical procedure, when the doctrine o re. i.a toqvitvr is aailed by the plainti, the need or expert medical testimony is dispensed
with because the injury itsel proides the proo o negligence.
27
1he reason is that the general rule on the necessity o expert testimony applies only to
such matters clearly within the domain o medical science, and not to matters that are within the common knowledge o mankind which may be testiied
to by anyone amiliar with the acts.
28
Ordinarily, only physicians and surgeons o skill and experience are competent to testiy as to whether a patient has
been treated or operated upon with a reasonable degree o skill and care. loweer, testimony as to the statements and acts o physicians and surgeons,
external appearances, and maniest conditions which are obserable by any one may be gien by non-expert witnesses.
29
lence, in cases where the re. i.a
toqvitvr is applicable, the court is permitted to ind a physician negligent upon proper proo o injury to the patient, without the aid o expert testimony,
where the court rom its und o common knowledge can determine the proper standard o care.
30
\here common knowledge and experience teach that a
resulting injury would not hae occurred to the patient i due care had been exercised, an inerence o negligence may be drawn giing rise to an
application o the doctrine o re. i.a toqvitvr without medical eidence, which is ordinarily required to show not only what occurred but how and why it
occurred.
3J
\hen the doctrine is appropriate, all that the patient must do is proe a nexus between the particular act or omission complained o and the
injury sustained while under the custody and management o the deendant without need to produce expert medical testimony to establish the standard o
care. Resort to re. i.a toqvitvr is allowed because there is no other way, under usual and ordinary conditions, by which the patient can obtain redress or
injury suered by him.
1hus, courts o other jurisdictions hae applied the doctrine in the ollowing situations: leaing o a oreign object in the body o the patient ater an
operation,
32
injuries sustained on a healthy part o the body which was not under, or in the area, o treatment,
33
remoal o the wrong part o the body
when another part was intended,
34
knocking out a tooth while a patient's jaw was under anesthetic or the remoal o his tonsils,
3S
and loss o an eye while
the patient plainti was under the inluence o anesthetic, during or ollowing an operation or appendicitis,
36
among others.
Neertheless, despite the act that the scope o re. i.a toqvitvr has been measurably enlarged, it does not automatically apply to all cases o medical
negligence as to mechanically shit the burden o proo to the deendant to show that he is not guilty o the ascribed negligence. Re. i.a toqvitvr is not a
rigid or ordinary doctrine to be perunctorily used but a rule to be cautiously applied, depending upon the circumstances o each case. It is generally
restricted to situations in malpractice cases where a layman is able to say, as a matter o common knowledge and obseration, that the consequences o
proessional care were not as such as would ordinarily hae ollowed i due care had been
exercised.
37
A distinction must be made between the ailure to secure results, and the occurrence o something more unusual and not ordinarily ound i
the serice or treatment rendered ollowed the usual procedure o those skilled in that particular practice. It must be conceded that the doctrine o re. i.a
toqvitvr can hae no application in a suit against a physician or surgeon which inoles the merits o a diagnosis or o a scientiic treatment.
38
1he
physician or surgeon is not required at his peril to explain why any particular diagnosis was not correct, or why any particular scientiic treatment did not
produce the desired result.
39
1hus, re. i.a toqvitvr is not aailable in a malpractice suit i the only showing is that the desired result o an operation or
treatment was not accomplished.
40
1he real question, thereore, is whether or not in the process o the operation any extraordinary incident or unusual
eent outside o the routine perormance occurred which is beyond the regular scope o customary proessional actiity in such operations, which, i
unexplained would themseles reasonably speak to the aerage man as the negligent cause or causes o the untoward consequence.
4J
I there was such
extraneous interentions, the doctrine o re. i.a toqvitvr may be utilized and the deendant is called upon to explain the matter, by eidence o exculpation,
i he could.
42

\e ind the doctrine o re. i.a toqvitvr appropriate in the case at bar. As will hereinater be explained, the damage sustained by Lrlinda in her brain prior to
a scheduled gall bladder operation presents a case or the application o re. i.a toqvitvr.
A case strikingly similar to the one beore us is 1o.. r.. riarett,
43
where the Kansas Supreme Court in applying the re. i.a toqvitvr stated:
1he plainti herein submitted himsel or a mastoid operation and deliered his person oer to the care, custody and control o hi s
physician who had complete and exclusie control oer him, but the operation was neer perormed. At the time o submission he
was neurologically sound and physically it in mind and body, but he suered irreparable damage and injury rendering him decerebrate
and totally incapacitated. 1he injury was one which does not ordinarily occur in the process o a mastoid operation or in the absence
o negligence in the administration o an anesthetic, and in the use and employment o an endoctracheal tube. Ordinarily a person
being put under anesthesia is not rendered decerebrate as a consequence o administering such anesthesia in the absence o
negligence. Upon these acts and under these circumstances a layman would be able to say, as a matter o common knowledge and
obseration, that the consequences o proessional treatment were not as such as would ordinarily hae ollowed i due care had been
exercised.
lere the plainti could not hae been guilty o contributory negligence because he was under the inluence o anesthetics and
unconscious, and the circumstances are such that the true explanation o eent is more accessible to the deendants than to the
plainti or they had the exclusie control o the instrumentalities o anesthesia.
Upon all the acts, conditions and circumstances alleged in Count II it is held that a cause o action is stated under the doctrine o re.
i.a toqvitvr.
44

Indeed, the principles enunciated in the aorequoted case apply with equal orce here. In the present case, Lrlinda submitted hersel or cholecystectomy
and expected a routine general surgery to be perormed on her gall bladder. On that ateul day she deliered her person oer to the care, custody and
control o priate respondents who exercised complete and exclusie control oer her. At the time o submission, Lrlinda was neurologically sound and,
except or a ew minor discomorts, was likewise physically it in mind and body. loweer, during the administration o anesthesia and prior to the
perormance o cholecystectomy she suered irreparable damage to her brain. 1hus, without undergoing surgery, she went out o the operating room
already decerebrate and totally incapacitated. Obiously, brain damage, which Lrlinda sustained, is an injury which does not normally occur in the process
o a gall bladder operation. In act, this kind o situation does not in the absence o negligence o someone in the administration o anesthesia and in the
use o endotracheal tube. Normally, a person being put under anesthesia is not rendered decerebrate as a consequence o administering such anesthesia i
the proper procedure was ollowed. lurthermore, the instruments used in the administration o anesthesia, including the endotracheal tube, were all under
the exclusie control o priate respondents, who are the physicians-in-charge. Likewise, petitioner Lrlinda could not hae been guilty o contributory
negligence because she was under the inluence o anesthetics which rendered her unconscious.
Considering that a sound and unaected member o the body ,the brain, is injured or destroyed while the patient is unconscious and under the immediate
and exclusie control o the physicians, we hold that a practical administration o justice dictates the application o re. i.a toqvitvr. Upon these acts and
under these circumstances the Court would be able to say, as a matter o common knowledge and obseration, i negligence attended the management and
care o the patient. Moreoer, the liability o the physicians and the hospital in this case is not predicated upon an alleged ailure to secure the desired
results o an operation nor on an alleged lack o skill in the diagnosis or treatment as in act no operation or treatment was eer perormed on Lrlinda.
1hus, upon all these initial determination a case is made out or the application o the doctrine o re. i.a toqvitvr.
Nonetheless, in holding that re. i.a toqvitvr is aailable to the present case we are not saying that the doctrine is applicable in any and all cases where injury
occurs to a patient while under anesthesia, or to any and all anesthesia cases. Lach case must be iewed in its own light and scrutinized in order to be
within the re. i.a toqvitvr coerage.
laing in mind the applicability o the re. i.a toqvitvr doctrine and the presumption o negligence allowed therein, the Court now comes to the issue o
whether the Court o Appeals erred in inding that priate respondents were not negligent in the care o Lrlinda during the anesthesia phase o the
operation and, i in the airmatie, whether the alleged negligence was the proximate cause o Lrlinda's comatose condition. Corollary thereto, we shall
also determine i the Court o Appeals erred in relying on the testimonies o the witnesses or the priate respondents.
In sustaining the position o priate respondents, the Court o Appeals relied on the testimonies o Dra. Gutierrez, Dra. Cal deron and Dr. Jamora. In
giing weight to the testimony o Dra. Gutierrez, the Court o Appeals rationalized that she was candid enough to admit that she experienced some
diiculty in the endotracheal intubation
4S
o the patient and thus, cannot be said to be coering her negligence with alsehood. 1he appellate court
likewise opined that priate respondents were able to show that the brain damage sustained by Lrlinda was not caused by the alleged aulty intubation but
was due to the allergic reaction o the patient to the drug 1hiopental Sodium ,Pentothal,, a short-acting barbiturate, as testiied on by their expert witness,
Dr. Jamora. On the other hand, the appellate court rejected the testimony o Dean lerminda Cruz oered in aor o petitioners that the cause o the
brain injury was traceable to the wrongul insertion o the tube since the latter, being a nurse, was allegedly not knowledgeable in the process o intubation.
In so holding, the appellate court returned a erdict in aor o respondents physicians and hospital and absoled them o any liability towards Lrlinda and
her amily.
\e disagree with the indings o the Court o Appeals. \e hold that priate respondents were unable to disproe the presumpti on o negligence on their
part in the care o Lrlinda and their negligence was the proximate cause o her piteous condition.
In the instant case, the records are helpul in urnishing not only the logical scientiic eidence o the pathogenesis o the injury but also in proiding the
Court the legal nexus upon which liability is based. As will be shown hereinater, priate respondents' own testimonies which are relected in the transcript
o stenographic notes are replete o signposts indicatie o their negligence in the care and management o Lrlinda.
\ith regard to Dra. Gutierrez, we ind her negligent in the care o Lrlinda during the anesthesia phase. As borne by the records, respondent Dra.
Gutierrez ailed to properly intubate the patient. 1his act was attested to by Pro. lerminda Cruz, Dean o the Capitol Medical Center School o Nursing
and petitioner's sister-in-law, who was in the operating room right beside the patient when the tragic eent occurred. \itness Cruz testiied to this eect:
A11\. PAJARLS:
Q: In particular, what did Dra. Perecta Gutierrez do, i any on the patient
A: In particular, I could see that she was intubating the patient.
Q: Do you know what happened to that intubation process administered by Dra. Gutierrez
A11\. ALCLRA:
She will be incompetent \our lonor.
COUR1:
\itness may answer i she knows.
A: As hae said, I was with the patient, I was beside the stretcher holding the let hand o the patient and all o a
sudden heard some remarks coming rom Dra. Perecta Gutierrez hersel. She was saying "Ang hirap ma-intubate
nito, mali yata ang pagkakapasok. O lumalaki ang tiyan.
xxx xxx xxx
A11\. PAJARLS:
Q: lrom whom did you hear those words "lumalaki ang tiyan"
A: lrom Dra. Perecta Gutierrez.
xxx xxx xxx
Q: Ater hearing the phrase "lumalaki ang tiyan," what did you notice on the person o the patient
A: I notice ,.ic, some bluish discoloration on the nailbeds o the let hand where I was at.
Q: \here was Dr. Orlino lo|s|aka then at that particular time
A: I saw him approaching the patient during that time.
Q: \hen he approached the patient, what did he do, i any
A: le made an order to call on the anesthesiologist in the person o Dr. Calderon.
Q: Did Dr. Calderon, upon being called, arrie inside the operating room
A: \es sir.
Q: \hat did |s|he do, i any
A: |S|he tried to intubate the patient.
Q: \hat happened to the patient
A: \hen Dr. Calderon try ,.ic, to intubate the patient, ater a while the patient's nailbed became bluish and I saw
the patient was placed in trendelenburg position.
xxx xxx xxx
Q: Do you know the reason why the patient was placed in that trendelenburg position
A: As ar as I know, when a patient is in that position, there is a decrease o blood supply to the brain.
46

xxx xxx xxx
1he appellate court, howeer, disbelieed Dean Cruz's testimony in the trial court by declaring that:
A perusal o the standard nursing curriculum in our country will show that intubation is not taught as part o nursing procedures and
techniques. Indeed, we take judicial notice o the act that nurses do not, and cannot, intubate. Len on the assumption that she is
ully capable o determining whether or not a patient is properly intubated, witness lerminda Cruz, admittedly, did not peep into the
throat o the patient. ,1SN, July 25, 1991, p. 13,. More importantly, there is no eidence that she eer auscultated the patient or that
she conducted any type o examination to check i the endotracheal tube was in its proper place, and to determine the condition o
the heart, lungs, and other organs. 1hus, witness Cruz's categorical statements that appellant Dra. Gutierrez ailed to intubate the
appellee Lrlinda Ramos and that it was Dra. Calderon who succeeded in doing so clearly suer rom lack o suicient actual bases.
47

In other words, what the Court o Appeals is trying to impress is that being a nurse, and considered a layman in the process o intubation, witness Cruz is
not competent to testiy on whether or not the intubation was a success.
\e do not agree with the aboe reasoning o the appellate court. Although witness Cruz is not an anesthesiologist, she can ery well testiy upon matters
on which she is capable o obsering such as, the statements and acts o the physician and surgeon, external appearances, and maniest conditions which
are obserable by any one.
48
1his is precisely allowed under the doctrine o re. i.a toqvitvr where the testimony o expert witnesses is not required. It is the
accepted rule that expert testimony is not necessary or the proo o negligence in non-technical matters or those o which an ordinary person may be
expected to hae knowledge, or where the lack o skill or want o care is so obious as to render expert testimony unnecessary.
49
\e take judicial notice o
the act that anesthesia procedures hae become so common, that een an ordinary person can tell i it was administered properly. As such, it would not
be too diicult to tell i the tube was properly inserted. 1his kind o obseration, we beliee, does not require a medical degree to be acceptable.
At any rate, without doubt, petitioner's witness, an experienced clinical nurse whose long experience and scholarship led to her appointment as Dean o
the Capitol Medical Center School at Nursing, was ully capable o determining whether or not the intubation was a success. She had extensie clinical
experience starting as a sta nurse in Chicago, Illinois, sta nurse and clinical instructor in a teaching hospital, the lLU-NRMl, Dean o the Laguna
College o Nursing in San Pablo City, and then Dean o the Capitol Medical Center School o Nursing.
S0
Reiewing witness Cruz' statements, we ind that
the same were deliered in a straightorward manner, with the kind o detail, clarity, consistency and spontaneity which woul d hae been diicult to
abricate. \ith her clinical background as a nurse, the Court is satisied that she was able to demonstrate through her testimony what truly transpired on
that ateul day.
Most o all, her testimony was airmed by no less than respondent Dra. Gutierrez who admitted that she experienced dii culty in inserting the tube into
Lrlinda's trachea, to wit:
A11\. LIGSA\:
Q: In this particular case, Doctora, while you were intubating at your irst attempt ,.ic,, you did not immediately
see the trachea
DRA. GU1ILRRLZ:
A: \es sir.
Q: Did you pull away the tube immediately
A: \ou do not pull the . . .
Q: Did you or did you not
A: I did not pull the tube.
Q: \hen you said "mahirap yata ito," what were you reerring to
A: "Mahirap yata itong i-intubate," that was the patient.
Q: So, you ound some diiculty in inserting the tube
A: \es, because o ,.ic, my irst attempt, I did not see right away.
SJ

Curiously in the case at bar, respondent Dra. Gutierrez made the haphazard deense that she encountered hardship in the insertion o the tube in the
trachea o Lrlinda because it was positioned more anteriorly ,slightly deiated rom the normal anatomy o a person,
S2
making it harder to locate and,
since Lrlinda is obese and has a short neck and protruding teeth, it made intubation een more diicult.
1he argument does not conince us. I this was indeed obsered, priate respondents adduced no eidence demonstrating that they proceeded to make a
thorough assessment o Lrlinda's airway, prior to the induction o anesthesia, een i this would mean postponing the procedure. lrom their testimonies, it
appears that the obseration was made only as an aterthought, as a means o deense.
1he pre-operatie ealuation o a patient prior to the administration o anesthesia is uniersally obsered to lessen the possibility o anesthetic accidents.
Pre-operatie ealuation and preparation or anesthesia begins when the anesthesiologist reiews the patient's medical records and isits with the patient,
traditionally, the day beore electie surgery.
S3
It includes taking the patient's medical history, reiew o current drug therapy, physical examination and
interpretation o laboratory data.
S4
1he physical examination perormed by the anesthesiologist is directed primarily toward the central nerous system,
cardioascular system, lungs and ver airra,.
SS
A thorough analysis o the patient's airway normally inoles inestigating the ollowing: cerical spine
mobility, temporomandibular mobility, prominent central incisors, diseased or artiicial teeth, ability to isualize uula and the thyromental
distance.
S6
1hus, physical characteristics o the patient's upper airway that could make tracheal intubation diicult should be studied.
S7
\here the need
arises, as when initial assessment indicates possible problems ,such as the alleged short neck and protruding teeth o Lrlinda, a thorough examination o
the patient's airway would go a long way towards decreasing patient morbidity and mortality.
In the case at bar, respondent Dra. Gutierrez admitted that she saw Lrlinda or the irst time on the day o the operation itsel, on 1 June 1985. Beore
this date, no prior consultations with, or pre-operatie ealuation o Lrlinda was done by her. Until the day o the operation, respondent Dra. Gutierrez
was unaware o the physiological make-up and needs o Lrlinda. She was likewise not properly inormed o the possible diiculties she would ace during
the administration o anesthesia to Lrlinda. Respondent Dra. Gutierrez' act o seeing her patient or the irst time only an hour beore the scheduled
operatie procedure was, thereore, an act o exceptional negligence and proessional irresponsibility. 1he measures cautioni ng prudence and igilance in
dealing with human lies lie at the core o the physician's centuries-old lippocratic Oath. ler ailure to ollow this medical procedure is, thereore, a
clear ivaicia o her negligence.
Respondent Dra. Gutierrez, howeer, attempts to gloss oer this omission by playing around with the trial court's ignorance o clinical procedure, hoping
that she could get away with it. Respondent Dra. Gutierrez tried to muddle the dierence between an electie surgery and an emergency surgery just so her
ailure to perorm the required pre-operatie ealuation would escape unnoticed. In her testimony she asserted:
A11\. LIGSA\:
Q: \ould you agree, Doctor, that it is good medical practice to see the patient a day beore so you can introduce
yoursel to establish good doctor-patient relationship and gain the trust and conidence o the patient
DRA. GU1ILRRLZ:
A: As I said in my preious statement, it depends on the operatie procedure o the anesthesiologist and in my
case, with electie cases and normal cardio-pulmonary clearance like that, I usually don't do it except on
emergency and on cases that hae an abnormalities ,.ic,. S8
loweer, the exact opposite is true. In an emergency procedure, there is hardly enough time aailable or the astidious demands o pre-operatie
procedure so that an anesthesiologist is able to see the patient only a ew minutes beore surgery, i at all. Llectie procedures, on the other hand, are
operatie procedures that can wait or days, weeks or een months. lence, in these cases, the anesthesiologist possesses the luxury o time to be at the
patient's beside to do a proper interiew and clinical ealuation. 1here is ample time to explain the method o anesthesia, the drugs to be used, and their
possible hazards or purposes o inormed consent. Usually, the pre-operatie assessment is conducted at least one day beore the intended surgery, when
the patient is relaxed and cooperatie.
Lrlinda's case was electie and this was known to respondent Dra. Gutierrez. 1hus, she had all the time to make a thorough ealuation o Lrlinda's case
prior to the operation and prepare her or anesthesia. loweer, she neer saw the patient at the bedside. She hersel admitted that she had seen petitioner
only in the operating room, and only on the actual date o the cholecystectomy. She negligently ailed to take adantage o this important opportunity. As
such, her attempt to exculpate hersel must ail.
laing established that respondent Dra. Gutierrez ailed to perorm pre-operatie ealuation o the patient which, in turn, resulted to a wrongul
intubation, we now determine i the aulty intubation is truly the proximate cause o Lrlinda's comatose condition.
Priate respondents repeatedly hammered the iew that the cerebral anoxia which led to Lrlinda's coma was due to bronchospasm
S9
mediated by her
allergic response to the drug, 1hiopental Sodium, introduced into her system. 1owards this end, they presented Dr. Jamora, a lellow o the Philippine
College o Physicians and Diplomate o the Philippine Specialty Board o Internal Medicine, who adanced priate respondents' theory that the oxygen
depriation which led to anoxic encephalopathy,
60
was due to an unpredictable drug reaction to the short-acting barbiturate. \e ind the theory o priate
respondents unacceptable.
lirst o all, Dr. Jamora cannot be considered an authority in the ield o anesthesiology simply because he is not an anesthesiologist. Since Dr. Jamora is a
pulmonologist, he could not hae been capable o properly enlightening the court about anesthesia practice and procedure and their complications. Dr.
Jamora is likewise not an allergologist and could not thereore properly adance expert opinion on allergic-mediated processes. Moreoer, he is not a
pharmacologist and, as such, could not hae been capable, as an expert would, o explaining to the court the pharmacologic and toxic eects o the
supposed culprit, 1hiopental Sodium ,Pentothal,.
1he inappropriateness and absurdity o accepting Dr. Jamora's testimony as an expert witness in the anesthetic practice o Pentothal administration is
urther supported by his own admission that he ormulated his opinions on the drug not rom the practical experience gained by a specialist or expert in
the administration and use o Sodium Pentothal on patients, but only rom reading certain reerences, to wit:
A11\. LIGSA\:
Q: In your line o expertise on pulmonology, did you hae any occasion to use pentothal as a method o
management
DR. JAMORA:
A: \e do it in conjunction with the anesthesiologist when they hae to intubate our patient.
Q: But not in particular when you practice pulmonology
A: No.
Q: In other words, your knowledge about pentothal is based only on what you hae read rom books and not by
your own personal application o the medicine pentothal
A: Based on my personal experience also on pentothal.
Q: low many times hae you used pentothal
A: 1hey used it on me. I went into bronchospasm during my appendectomy.
Q: And because they hae used it on you and on account o your own personal experience you eel that you can
testiy on pentothal here with medical authority
A: No. 1hat is why I used reerences to support my claims. 6J
An anesthetic accident caused by a rare drug-induced bronchospasm properly alls within the ields o anesthesia, internal medicine-allergy, and clinical
pharmacology. 1he resulting anoxic encephalopathy belongs to the ield o neurology. \hile admittedly, many bronchospastic-mediated pulmonary
diseases are within the expertise o pulmonary medicine, Dr. Jamora's ield, the anesthetic drug-induced, allergic mediated bronchospasm alleged in this
case is within the disciplines o anesthesiology, allergology and pharmacology. On the basis o the oregoing transcript, in which the pulmonologist himsel
admitted that he could not testiy about the drug with medical authority, it is clear that the appellate court erred in giing weight to Dr. Jamora's testimony
as an expert in the administration o 1hiopental Sodium.
1he proision in the rules o eidence
62
regarding expert witnesses states:
Sec. 49. Oiviov of eert ritve... 1he opinion o a witness on a matter requiring special knowledge, skill, experience or training
which he is shown to possess, may be receied in eidence.
Generally, to qualiy as an expert witness, one must hae acquired special knowledge o the subject matter about which he or she is to testiy, either by the
study o recognized authorities on the subject or by practical experience.
63
Clearly, Dr. Jamora does not qualiy as an expert witness based on the aboe
standard since he lacks the necessary knowledge, skill, and training in the ield o anesthesiology. Oddly, apart rom submitting testimony rom a specialist
in the wrong ield, priate respondents' intentionally aoided proiding testimony by competent and independent experts in the proper areas.
Moreoer, priate respondents' theory, that 1hiopental Sodium may hae produced Lrlinda's coma by triggering an allergic mediated response, has no
support in eidence. No eidence o stridor, skin reactions, or wheezing some o the more common accompanying signs o an allergic reaction
appears on record. No laboratory data were eer presented to the court.
In any case, priate respondents themseles admit that 1hiopental induced, allergic-mediated bronchospasm happens only ery rarely. I courts were to
accept priate respondents' hypothesis without supporting medical proo, and against the weight o aailable eidence, then eery anesthetic accident
would be an act o God. Lidently, the 1hiopental-allergy theory igorously asserted by priate respondents was a mere aterthought. Such an explanation
was adanced in order to adanced in order to absole them o any and all responsibility or the patient's condition.
In iew o the eidence at hand, we are inclined to beliee petitioners' stand that it was the aulty intubation which was the proximate cause o Lrlinda's
comatose condition.
Proximate cause has been deined as that which, in natural and continuous sequence, unbroken by any eicient interening cause, produces injury, and
without which the result would not hae occurred.
64
An injury or damage is proximately caused by an act or a ailure to act, wheneer it appears rom the
eidence in the case, that the act or omission played a substantial part in bringing about or actually causing the injury or damage, and that the injury or
damage was either a direct result or a reasonably probable consequence o the act or omission.
6S
It is the dominant, moing or producing cause.
Applying the aboe deinition in relation to the eidence at hand, aulty intubation is undeniably the proximate cause which triggered the chain o eents
leading to Lrlinda's brain damage and, ultimately, her comatosed condition.
Priate respondents themseles admitted in their testimony that the irst intubation was a ailure. 1his act was likewise obsered by witness Cruz when
she heard respondent Dra. Gutierrez remarked, "Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan." 1hereater, witness Cruz
noticed abdominal distention on the body o Lrlinda. 1he deelopment o abdominal distention, together with respiratory embarrassment indicates that
the endotracheal tube entered the esophagus instead o the respiratory tree. In other words, instead o the intended endotracheal intubation what actually
took place was an esophageal intubation. During intubation, such distention indicates that air has entered the gastrointestinal tract through the esophagus
instead o the lungs through the trachea. Lntry into the esophagus would certainly cause some delay in oxygen deliery into the lungs as the tube which
carries oxygen is in the wrong place. 1hat abdominal distention had been obsered during the irst intubation suggests that the length o time utilized in
inserting the endotracheal tube ,up to the time the tube was withdrawn or the second attempt, was airly signiicant. Due to the delay in the deliery o
oxygen in her lungs Lrlinda showed signs o cyanosis.
66
As stated in the testimony o Dr. losaka, the lack o oxygen became apparent only ater he
noticed that the nailbeds o Lrlinda were already blue.
67
loweer, priate respondents contend that a second intubation was executed on Lrlinda and this
one was successully done. \e do not think so. No eidence exists on record, beyond priate respondents' bare claims, which supports the contention that
the second intubation was successul. Assuming that the endotracheal tube inally ound its way into the proper oriice o the trachea, the same gae no
guarantee o oxygen deliery, the hallmark o a successul intubation. In act, cyanosis was again obsered immediately ater the second intubation.
Proceeding rom this eent ,cyanosis,, it could not be claimed, as priate respondents insist, that the second intubation was accomplished. Len granting
that the tube was successully inserted during the second attempt, it was obiously too late. As aptly explained by the trial court, Lrlinda already suered
brain damage as a result o the inadequate oxygenation o her brain or about our to ie minutes.
68

1he aboe conclusion is not without basis. Scientiic studies point out that intubation problems are responsible or one-third ,1,3, o deaths and serious
injuries associated with anesthesia.
69
Neertheless, ninety-eight percent ,98, or the ast majority o diicult intubations may be anticipated by
perorming a thorough ealuation o the patient's airway prior to the operation.
70
As stated beorehand, respondent Dra. Gutierrez ailed to obsere the
proper pre-operatie protocol which could hae preented this unortunate incident. lad appropriate diligence and reasonable care been used in the pre-
operatie ealuation, respondent physician could hae been much more prepared to meet the contingency brought about by the perceied anatomic
ariations in the patient's neck and oral area, deects which would hae been easily oercome by a prior knowledge o those ariations together with a
change in technique.
7J
In other words, an experienced anesthesiologist, adequately alerted by a thorough pre-operatie ealuation, would hae had little
diiculty going around the short neck and protruding teeth.
72
laing ailed to obsere common medical standards in pre-operatie management and
intubation, respondent Dra. Gutierrez' negligence resulted in cerebral anoxia and eentual coma o Lrlinda.
\e now determine the responsibility o respondent Dr. Orlino losaka as the head o the surgical team. As the so-called "captain o the ship,"
73
it is the
surgeon's responsibility to see to it that those under him perorm their task in the proper manner. Respondent Dr. losaka's negligence can be ound in his
ailure to exercise the proper authority ,as the "captain" o the operatie team, in not determining i his anesthesiologist obsered proper anesthesia
protocols. In act, no eidence on record exists to show that respondent Dr. losaka eriied i respondent Dra. Gutierrez properly intubated the patient.
lurthermore, it does not escape us that respondent Dr. losaka had scheduled another procedure in a dierent hospital at the same time as Lrlinda's
cholecystectomy, and was in act oer three hours late or the latter's operation. Because o this, he had little or no time to coner with his anesthesiologist
regarding the anesthesia deliery. 1his indicates that he was remiss in his proessional duties towards his patient. 1hus, he shares equal responsibility or
the eents which resulted in Lrlinda's condition.
\e now discuss the responsibility o the hospital in this particular incident. 1he unique practice ,among priate hospitals, o illing up specialist sta with
attending and isiting "consultants,"
74
who are allegedly not hospital employees, presents problems in apportioning responsibility or negligence in medical
malpractice cases. loweer, the diiculty is only more apparent than real.
In the irst place, hospitals exercise signiicant control in the hiring and iring o consultants and in the conduct o their work wi thin the hospital premises.
Doctors who apply or "consultant" slots, isiting or attending, are required to submit proo o completion o residency, their educational qualiications,
generally, eidence o accreditation by the appropriate board ,diplomate,, eidence o ellowship in most cases, and reerences. 1hese requirements are
careully scrutinized by members o the hospital administration or by a reiew committee set up by the hospital who either accept or reject the
application.
7S
1his is particularly true with respondent hospital.
Ater a physician is accepted, either as a isiting or attending consultant, he is normally required to attend clinico-pathological conerences, conduct
bedside rounds or clerks, interns and residents, moderate grand rounds and patient audits and perorm other tasks and responsibilities, or the priilege o
being able to maintain a clinic in the hospital, and,or or the priilege o admitting patients into the hospital. In addition to these, the physician's
perormance as a specialist is generally ealuated by a peer reiew committee on the basis o mortality and morbidity statistics, and eedback rom patients,
nurses, interns and residents. A consultant remiss in his duties, or a consultant who regularly alls short o the minimum standards acceptable to the
hospital or its peer reiew committee, is normally politely terminated.
In other words, priate hospitals, hire, ire and exercise real control oer their attending and isiting "consultant" sta. \hile "consultants" are not,
technically employees, a point which respondent hospital asserts in denying all responsibility or the patient's condition, the control exercised, the hiring,
and the right to terminate consultants all ulill the important hallmarks o an employer-employee relationship, with the exception o the payment o
wages. In assessing whether such a relationship in act exists, the control test is determining. Accordingly, on the basis o the oregoing, we rule that or
the purpose o allocating responsibility in medical negligence cases, an employer-employee relationship in eect exists between hospitals and their
attending and isiting physicians. 1his being the case, the question now arises as to whether or not respondent hospital is solidarily liable with respondent
doctors or petitioner's condition.
76

1he basis or holding an employer solidarily responsible or the negligence o its employee is ound in Article 2180 o the Ciil Code which considers a
person accountable not only or his own acts but also or those o others based on the ormer's responsibility under a relati onship o atria ote.ta..
77
Such
responsibility ceases when the persons or entity concerned proe that they hae obsered the diligence o a good ather o the amily to preent
damage.
78
In other words, while the burden o proing negligence rests on the plaintis, once negligence is shown, the burden shits to the respondents
,parent, guardian, teacher or employer, who should proe that they obsered the diligence o a good ather o a amily to preent damage.
In the instant case, respondent hospital, apart rom a general denial o its responsibility oer respondent physicians, ailed to adduce eidence showing that
it exercised the diligence o a good ather o a amily in the hiring and superision o the latter. It ailed to adduce eidence with regard to the degree o
superision which it exercised oer its physicians. In neglecting to oer such proo, or proo o a similar nature, respondent hospital thereby ailed to
discharge its burden under the last paragraph o Article 2180. laing ailed to do this, respondent hospital is consequently solidarily responsible with its
physicians or Lrlinda's condition.
Based on the oregoing, we hold that the Court o Appeals erred in accepting and relying on the testimonies o the witnesses or the priate respondents.
Indeed, as shown by the aboe discussions, priate respondents were unable to rebut the presumption o negligence. Upon these disquisitions we hold
that priate respondents are solidarily liable or damages under Article 216
79
o the Ciil Code.
\e now come to the amount o damages due petitioners. 1he trial court awarded a total o P632,000.00 pesos ,should be P616,000.00, in compensatory
damages to the plainti, "subject to its being updated" coering the period rom 15 Noember 1985 up to 15 April 1992, based on monthly expenses or
the care o the patient estimated at P8,000.00.
At current leels, the P8000,monthly amount established by the trial court at the time o its decision would be grossly inadequate to coer the actual costs
o home-based care or a comatose indiidual. 1he calculated amount was not een arried at by looking at the actual cost o proper hospice care or the
patient. \hat it relected were the actual expenses incurred and proed by the petitioners ater they were orced to bring home the patient to aoid
mounting hospital bills.
And yet ideally, a comatose patient should remain in a hospital or be transerred to a hospice specializing in the care o the chronically ill or the purpose
o proiding a proper milieu adequate to meet minimum standards o care. In the instant case or instance, Lrlinda has to be constantly turned rom side
to side to preent bedsores and hypostatic pneumonia. leeding is done by nasogastric tube. lood preparation should be normally made by a dietitian to
proide her with the correct daily caloric requirements and itamin supplements. lurthermore, she has to be seen on a regular basis by a physical therapist
to aoid muscle atrophy, and by a pulmonary therapist to preent the accumulation o secretions which can lead to respiratory complications.
Gien these considerations, the amount o actual damages recoerable in suits arising rom negligence should at least relect the correct minimum cost o
proper care, not the cost o the care the amily is usually compelled to undertake at home to aoid bankruptcy. loweer, the proisions o the Ciil Code
on actual or compensatory damages present us with some diiculties.
\ell-settled is the rule that actual damages which may be claimed by the plainti are those suered by him as he has duly proed. 1he Ciil Code
proides:
Art. 2199. Lxcept as proided by law or by stipulation, one is entitled to an adequate compensation only or such pecuniary loss
suered by him as he has duly proed. Such compensation is reerred to as actual or compensatory damages.
Our rules on actual or compensatory damages generally assume that at the time o litigation, the injury suered as a consequence o an act o negligence
has been completed and that the cost can be liquidated. loweer, these proisions neglect to take into account those situations, as in this case, where the
resulting injury might be continuing and possible uture complications directly arising rom the injury, while certain to occur, are diicult to predict.
In these cases, the amount o damages which should be awarded, i they are to adequately and correctly respond to the injury caused, should be one which
compensates or pecuniary loss incurred and proed, up to the time o trial, ava one which would meet pecuniary loss certain to be suered but which
could not, rom the nature o the case, be made with certainty.
80
In other words, temperate damages can and should be awarded on top o actual or
compensatory damages in instances where the injury is chronic and continuing. And because o the unique nature o such cases, no incompatibility arises
when both actual and temperate damages are proided or. 1he reason is that these damages coer two distinct phases.
As it would not be equitable and certainly not in the best interests o the administration o justice or the ictim in such cases to constantly come
beore the courts and inoke their aid in seeking adjustments to the compensatory damages preiously awarded temperate damages are appropriate.
1he amount gien as temperate damages, though to a certain extent speculatie, should take into account the cost o proper care.
In the instant case, petitioners were able to proide only home-based nursing care or a comatose patient who has remained in that condition or oer a
decade. laing premised our award or compensatory damages on the amount proided by petitioners at the onset o litigation, it would be now much
more in step with the interests o justice i the alue awarded or temperate damages would allow petitioners to proide optimal care or their loed one in
a acility which generally specializes in such care. 1hey should not be compelled by dire circumstances to proide substandard care at home without the aid
o proessionals, or anything less would be grossly inadequate. Under the circumstances, an award o P1,500,000.00 in temperate damages would
thereore be reasonable.
8J

In 1atevveta r.. Covrt of .eat.,
82
this Court was conronted with a situation where the injury suered by the plainti would hae led to expenses which
were diicult to estimate because while they would hae been a direct result o the injury ,amputation,, and were certain to be incurred by the plainti,
they were likely to arise only in the uture. \e awarded P1,000,000.00 in moral damages in that case.
Describing the nature o the injury, the Court therein stated:
As a result o the accident, Ma. Lourdes Valenzuela underwent a traumatic amputation o her let lower extremity at the distal let
thigh just aboe the knee. Because o this, Valenzuela will oreer be depried o the ull ambulatory unctions o her let extremity,
een with the use o state o the art prosthetic technology. \ell beyond the period o hospitalization ,which was paid or by Li,, she
will be required to undergo adjustments in her prosthetic deise due to the shrinkage o the stump rom the process o healing.
1hese adjustments entail costs, prosthetic replacements and months o physical and occupational rehabilitation and therapy. During
the lietime, the prosthetic deise will hae to be replaced and readjusted to changes in the size o her lower limb eected by the
biological changes o middle-age, menopause and aging. Assuming she reaches menopause, or example, the prosthetic will hae to be
adjusted to respond to the changes in bone resulting rom a precipitate decrease in calcium leels obsered in the bones o all post-
menopausal women. In other words, 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. 1he replacements,
changes, and adjustments will require corresponding adjustie physical and occupational therapy. All o these adjustments, it has been
documented, are painul.
xxx xxx xxx
A prosthetic deise, howeer technologically adanced, will only allow a reasonable amount o unctional restoration o the motor
unctions o the lower limb. 1he sensory unctions are oreer lost. 1he resultant anxiety, sleeplessness, psychological injury, mental
and physical pain are inestimable.
83

1he injury suered by Lrlinda as a consequence o priate respondents' negligence is certainly much more serious than the amputation in the Valenzuela
case.
Petitioner Lrlinda Ramos was in her mid-orties when the incident occurred. She has been in a comatose state or oer ourteen years now. 1he burden o
care has so ar been heroically shouldered by her husband and children, who, in the interening years hae been depried o the loe o a wie and a
mother.
Meanwhile, the actual physical, emotional and inancial cost o the care o petitioner would be irtually impossible to quantiy. Len the temperate
damages herein awarded would be inadequate i petitioner's condition remains unchanged or the next ten years.
\e recognized, in Valenzuela that a discussion o the ictim's actual injury would not een scratch the surace o the resulting moral damage because it
would be highly speculatie to estimate the amount o emotional and moral pain, psychological damage and injury suered by the ictim or those actually
aected by the ictim's condition.
84
1he husband and the children, all petitioners in this case, will hae to lie with the day to day uncertainty o the
patient's illness, knowing any hope o recoery is close to nil. 1hey hae ashioned their daily lies around the nursing care o petitioner, altering their long
term goals to take into account their lie with a comatose patient. 1hey, not the respondents, are charged with the moral responsibility o the care o the
ictim. 1he amily's moral injury and suering in this case is clearly a real one. lor the oregoing reasons, an award o P2,000,000.00 in moral damages
would be appropriate.
linally, by way o example, exemplary damages in the amount o P100,000.00 are hereby awarded. Considering the length and nature o the instant suit we
are o the opinion that attorney's ees alued at P100,000.00 are likewise proper.
Our courts ace unique diiculty in adjudicating medical negligence cases because physicians are not insurers o lie and, they rarely set out to intentionally
cause injury or death to their patients. loweer, intent is immaterial in negligence cases because where negligence exists and is proen, the same
automatically gies the injured a right to reparation or the damage caused.
Lstablished medical procedures and practices, though in constant lux are deised or the purpose o preenting complications. A physician's experience
with his patients would sometimes tempt him to deiate rom established community practices, and he may end a distinguished career using unorthodox
methods without incident. loweer, when ailure to ollow established procedure results in the eil precisely sought to be aerted by obserance o the
procedure and a nexus is made between the deiation and the injury or damage, the physician would necessarily be called to account or it. In the case at
bar, the ailure to obsere pre-operatie assessment protocol which would hae inluenced the intubation in a salutary way was atal to priate respondents'
case.
\lLRLlORL, the decision and resolution o the appellate court appealed rom are hereby modiied so as to award in aor o petitioners, and solidarily
against priate respondents the ollowing: 1, P1,352,000.00 as actual damages computed as o the date o promulgation o this decision plus a monthly
payment o P8,000.00 up to the time that petitioner Lrlinda Ramos expires or miraculously suries, 2, P2,000,000.00 as moral damages, 3, P1,500,000.00
as temperate damages, 4, P100,000.00 each as exemplary damages and attorney's ees, and, 5, the costs o the suit.
SO ORDLRLD.
DR. LMMANULL JARCIA, JR.and DR. MARILOU
BAS1AN,
Petitioners,




- ersus -





PLOPLL OI 1HLPHILIPPINLS,
Respondent.
G.R. No. J87926

Present:

CARPIO,

].,
PLRAL1A,

.ctivg Cbairer.ov,
ABAD,
PLRLZ,

and
MLNDOZA, ]].


Promulgated:

lebruary 15, 2012

x --------------------------------------------------------------------------------------- x

D L C I S I O N

MLNDOZA, J.:


rev eart, ov, atievt. bare cov.igvea tbeir tire. to tbe ./itt of tbeir aoctor.. 1ive ava agaiv, it cav be .aia tbat tbe vo.t ivortavt goat of tbe
veaicat rofe..iov i. tbe re.erratiov of tife ava beattb of tbe eote. Corottarit,, rbev a b,.iciav aeart. frov bi. .acrea avt, ava evaavger. iv.teaa tbe tife
of bi. atievt, be vv.t be vaae tiabte for tbe re.vttivg iv;vr,. 1bi. Covrt, a. tbi. ca.e rovta .bor, cavvot ava ritt vot tet tbe act go vvvvi.bea.
J


1his is a petition or reiew under Rule 45 o the Rules o Court challenging the August 29, 2008 Decision
|2|
o the Court o Appeals ;C.), and
its May 19, 2009 Resolution
|3|
in CA-G.R. CR No. 29559, dismissing the appeal and airming iv toto the June 14, 2005 Decision
|4|
o the Regional 1rial
Court, Branch 43, Manila;R1C), inding the accused guilty beyond reasonable doubt o simple imprudence resulting to serious physical injuries.


1HL IAC1S


Belinda Santiago ;Mr.. avtiago) lodged a complaint with the National Bureau o Inestigation ;^) against the petitioners, Dr. Lmmanuel
Jarcia, Jr. ;Dr. ]arcia) and Dr. Marilou Bastan ;Dr. a.tav), or their alleged neglect o proessional duty which caused her son, Roy Alonso Santiago ;Ro,
]r.), to suer serious physical injuries. Upon inestigation, the NBI ound that Roy Jr. was hit by a taxicab, that he was rushed to the Manila Doctors
lospital or an emergency medical treatment, that an X-ray of the victims ankle was ordered; that the X-ray result showed no racture as read by Dr.
Jarcia; that Dr. Bastan entered the emergency room;R) and, ater conducting her own examination o the ictim, inormed Mrs. Santiago that since it was
only the ankle that was hit, there was no need to examine the upper leg, that eleen ,11, days later, Roy Jr. deeloped eer, swelling o the right leg and
misalignment o the right oot, that Mrs. Santiago brought him back to the hospital, and that the X-ray reealed a right mid-tibial racture and a linear
hairline racture in the shat o the bone.

1he NBI indorsed the matter to the Oice o the City Prosecutor o Manila or preliminary inestigation. Probable cause was ound and a
criminal case or reckless imprudence resulting to serious physical injuries, was iled against Dr. Jarcia, Dr. Bastan and Dr. Pamittan,
|5|
beore the R1C,
docketed as Criminal Case No. 01-196646.

On June 14, 2005, the R1C ound the petitioners guilty beyond reasonable doubt o the crime o ivte vrvaevce Re.vttivg to eriov. Pb,.icat
v;vrie.. 1he decretal portion o the R1C decision reads:

\lLRLlORL, premises considered, the Court inds accused DR. LMMANULL JARCIA, JR. and DR. MARILOU
BAS1AN GUIL1\ beyond reasonable doubt o the crime o SIMPLL IMPRUDLNCL RLSUL1ING 1O SLRIOUS Pl\SICAL
INJURILS and are hereby sentenced to suer the penalty o ONL (J) MON1H and ONL (J) DAY to 1WO (2)
MON1HS and to indemniy MRS. BLLINDA SAN1IAGO the amount o 3,850.00 representing medical expenses without
subsidiary imprisonment in case o insolency and to pay the costs.

It appearing that Dr. Pamittan has not been apprehended nor oluntarily surrendered despite warrant issued or her arrest,
let warrant be issued or her arrest and the case against her be ARClIVLD, to be reinstated upon her apprehension.

SO ORDLRLD.
|6|


1he R1C explained:

Ater a thorough and in depth ealuation o the eidence adduced by the prosecution and the deense, this court inds that
the eidence o the prosecution is the more credible, concrete and suicient to create that moral certainty in the mind o the Court
that accused herein |are| criminally responsible. 1he Court beliees that accused are negligent when both ailed to exercise the
necessary and reasonable prudence in ascertaining the extent o injury o Alonso Santiago, Jr.


loweer, the negligence exhibited by the two doctors does not approximate negligence o a reckless nature but merely
amounts to simple imprudence. Simple imprudence consists in the lack o precaution displayed in those cases in which the damage
impending to be caused is not the immediate nor the danger clearly maniest. 1he elements o simple imprudence are as ollows.

1. that there is lack o precaution on the part o the oender, and

2. that the damage impending to be caused is not immediate o the danger is not clearly maniest.

Considering all the eidence on record, 1he Court inds the accused guilty or simple imprudence resulting to physical
injuries. Under Article 365 o the Reised Penal Code, the penalty proided or is arresto mayor in its minimum period.
||



Dissatisied, the petitioners appealed to the CA.

As earlier stated, the CA airmed the R1C decision iv toto. 1he August 29, 2008 Decision o the CA pertinently reads:

1his Court holds concurrently and inds the oregoing circumstances suicient to sustain a judgment o coniction against
the accused-appellants or the crime o simple imprudence resulting in serious physical injuries. 1he elements o imprudence are: ,1,
that the oender does or ails to do an act, ,2, that the doing or the ailure to do that act is oluntary, ,3, that it be without malice, ,4,
that material damage results rom the imprudence, and ,5, that there is inexcusable lack o precaution on the part o the oender,
taking into consideration his employment or occupation, degree o intelligence, physical condition, and other circumstances regarding
persons, time and place.

Whether or not Dr. Jarcia and Dr. Bastan had committed an inexcusable lack of precaution in the treatment of their patient
is to be determined according to the standard o care obsered by other members o the proession in good standing under
similar circumstances, bearing in mind the adanced state o the proession at the time o treatment or the present state o medical
science. In the case o eovita CarciaRveaa r. Pa.ca.io, the Supreme Court stated that, in accepting a case, a doctor in eect represents
that, haing the needed training and skill possessed by physicians and surgeons practicing in the same ield, he will employ such
training, care and skill in the treatment o his patients. le thereore has a duty to use at least the same leel o care that any other
reasonably competent doctor would use to treat a condition under the same circumstances.

In litigations inoling medical negligence, the plainti has the burden o establishing accused-appellants negligence, and for a
reasonable conclusion o negligence, there must be proo o breach o duty on the part o the physician as well as a causal connection
o such breach and the resulting injury o his patient. 1he connection between the negligence and the injury must be a direct and
natural sequence o eents, unbroken by interening eicient causes. In other words, the negligence must be the proximate cause o
the injury. Negligence, no matter in what it consists, cannot create a right o action unless it is the proximate cause o the injury
complained o. 1he proximate cause o an injury is that cause which, in natural and continuous sequence, unbroken by any ei cient
interening cause, produces the injury and without which the result would not hae occurred.

In the case at bench, the accused-appellants questioned the imputation against them and argued that there is no causal
connection between their ailure to diagnose the racture and the injury sustained by Roy.

\e are not coninced.

1he prosecution is howeer ater the cause which prolonged the pain and suering o Roy and not on the ailure o the
accused-appellants to correctly diagnose the extent o the injury sustained by Roy.

lor a more logical presentation o the discussion, we shall irst consider the applicability o the doctrine o re. i.a toqvitvr to
the instant case. Re. i.a toqvitvr is a Latin phrase which literally means the thing or the transaction speaks for itself. The doctrine
o re. i.a toqvitvr is simply a recognition o the postulate that, as a matter o common knowledge and experience, the ery nature o
certain types o occurrences may justiy an inerence o negligence on the part o the person who controls the instrumentality causing
the injury in the absence o some explanation by the accused-appellant who is charged with negligence. It is grounded in the superior
logic o ordinary human experience and, on the basis o such experience or common knowledge, negligence may be deduced rom the
mere occurrence o the accident itsel. lence, re. i.a toqvitvr is applied in conjunction with the doctrine o common knowledge.

1he speciic acts o negligence was narrated by Mrs. Santiago who accompanied her son during the latters ordeal at the
hospital. She testiied as ollows:

liscal lormoso:

Q: Now, he is an intern did you not consult the doctors, Dr. Jarcia or Dra. Pamittan to conirm whether you
should go home or not
A: Dra. Pamittan was inside the cubicle of the nurses and I asked her, you let us go home and you dont even
clean the wounds o my son.

Q: And what did she |tell| you
A: 1hey told me they will call a resident doctor, sir.

x x x x x x x x x

Q: \as there a resident doctor |who| came
A: \es, Sir. Dra. Bastan arried.
Q: Did you tell her what you want on you to be done
A: \es, sir.

Q: \hat did you |tell| her
A: I told her, sir, while she was cleaning the wounds o my son, are you not going to x-ray up to the knee
because my son was complaining pain rom his ankle up to the middle part o the right leg.

Q: And what did she tell you
A: According to Dra. Bastan, there is no need to x-ray because it was the ankle part that was run oer.

Q: \hat did you do or tell her
A: I told her, sir, why is it that they did not examine|x| the whole leg. 1hey just lited the pants o my son.

Q: So you mean to say there was no treatment made at all
A: None, sir.

x x x x x x x x x

A: I just listened to them, sir. And I just asked i I will still return my son.

x x x x x x x x x

Q: And you were present when they were called
A: \es, sir.

Q: And what was discussed then by Sis. Retoria
A: \hen they were there they admitted that they hae mistakes, sir.

Still, beore resort to the doctrine may be allowed, the ollowing requisites must be satisactorily shown:

1. 1he accident is o a kind which ordinarily does not occur in the absence o someones negligence;

2. It is caused by an instrumentality within the exclusie control o the deendant or deendants, and

3. 1he possibility o contributing conduct which would make the plainti responsible is eliminated.

In the above requisites, the fundamental element is the control of the instrumentality which caused the damage. Such
element o control must be shown to be within the dominion o the accused-appellants. In order to hae the beneit o the rule, a
plainti, in addition to proing injury or damage, must show a situation where it is applicable and must establish that the essential
elements o the doctrine were present in a particular incident. 1he early treatment o the leg o Roywould hae lessen his suering i
not entirely reliee him rom the racture. A boy o tender age whose leg was hit by a ehicle would engender a well-ounded belie
that his condition may worsen without proper medical attention. As junior residents who only practice general surgery and without
specialization with the case consulted beore them, they should hae reerred the matter to a specialist. 1his omission alone
constitutes simple imprudence on their part. \hen Mrs. Santiago insisted on haing another x-ray o her child on the upper part o
his leg, they reused to do so. 1he mother would not hae asked them i they had no exclusie control or prerogatie to request an x-
ray test. Such is a act because a radiologist would only conduct the x-ray test upon request o a physician.

1he testimony o Mrs. Santiago was corroborated by a bone specialist Dr. 1acata. le urther testiied based on his personal
knowledge, and not as an expert, as he examined himsel the child Roy. le testiied as ollows:

liscal Macapagal:

Q: And was that the correct respon|se| to the medical problem that was presented to Dr. Jarcia and Dra.
Bastan
A: I would say at that stage, yes. Because they hae presented the patient and the history. At sabi nila,
nadaanan lang po ito. And then, considering their year o residency they are still junior residents, and
they are not also orthopedic residents but general surgery residents, its entirely different
thing. Because if you are an orthopedic resident, I am not trying to saybut i I were an orthopedic
resident, there would be more precise and accurate decision compare to a general surgery resident in so
ar as inoled.

Q: \ou mean to say there is no superisor attending the emergency room
A: At the emergency room, at the Manila Doctors Hospital, the supervisor there is a consultant that usually
comes rom a amily medicine. 1hey see where a certain patient hae to go and then i they cannot
manage it, they reer it to the consultant on duty. Now at that time, I dont [know] why they
dont.Because at that time, I think, it is the decision. Since the x-rays.


Ordinarily, only physicians and surgeons o skill and experience are competent to testiy as to whether a patient has been
treated or operated upon with a reasonable degree o skill and care. loweer, testimony as to the statements and acts o physicians,
external appearances, and maniest conditions which are obserable by any one may be gien by non-expert witnesses. lence, in
cases where the re. i.a toqvitvr is applicable, the court is permitted to ind a physician negligent upon proper proo o injury to the
patient, without the aid o expert testimony, where the court rom its und o common knowledge can determine the proper standard
o care. \here common knowledge and experience teach that a resulting injury would not hae occurred to the patient i due care had
been exercised, an inerence o negligence may be drawn giing rise to an application o the doctrine o re. i.a toqvitvr without medical
eidence, which is ordinarily required to show not only what occurred but how and why it occurred. In the case at bench, we gie
credence to the testimony o Mrs. Santiago by applying the doctrine o re. i.a toqvitvr.

Re. i.a toqvitvr is not a rigid or ordinary doctrine to be perunctorily used but a rule to be cautiously applied, depending upon
the circumstances o each case. It is generally restricted to situations in malpractice cases where a layman is able to say, as a matter o
common knowledge and obseration, that the consequences o proessional care were not as such as would ordinarily hae ollowed
i due care had been exercised. A distinction must be made between the ailure to secure results and the occurrence o something
more unusual and not ordinarily ound i the serice or treatment rendered ollowed the usual procedure o those skilled in that
particular practice. 1he latter circumstance is the primordial issue that conronted this Court and we ind application o the doctrine
o re. i.a toqvitvr to be in order.

WHLRLIORL, in iew o the oregoing, the appeal in this case is hereby DISMISSLD and the assailed decision o the trial
court inding accused-appellants guilty beyond reasonable doubt o simple imprudence resulting in serious physical injuries is
hereby AIIIRMLD iv toto.

SO ORDLRLD.
|8|



1he petitioners iled a motion or reconsideration, but it was denied by the CA in its May 19, 2009 Resolution.

lence, this petition.

1he petitioners pray or the reersal o the decision o both the R1C and the CA anchored on the ollowing
GROUNDS-

J. IN AIIIRMING ACCUSLD-PETITIONERS CONVICTION, THE COURT OF APPEALS ERRED
IN NO1 HOLDING 1HA1 1HL AC1UAL, DIRLC1, IMMLDIA1L, AND PROXIMA1L CAUSL OI 1HL
PHYSICAL INJURY OI 1HL PA1ILN1 (IRAC1URL OI 1HL LLG BONL OR 1IBIA), WHICH RLQUIRLD
MLDICAL A11LNDANCL IOR MORL 1HAN 1HIR1Y (30) DAYS AND INCAPACI1A1LD HIM IROM
PLRIORMING HIS CUS1OMARY DU1Y DURING 1HL SAML PLRIOD OI 1IML, WAS 1HL VLHICULAR
ACCIDENT WHERE THE PATIENTS RIGHT LEG WAS HIT BY A TAXI, NOT THE FAILURE OF THE
ACCUSLD-PETITIONERS TO SUBJECT THE PATIENTS WHOLL LLG 1O AN X-RAY LXAMINA1ION.

2. 1HL COUR1 OI APPLALS LRRLD IN DISRLGARDING LS1ABLISHLD IAC1S CLLARLY
NEGATING PETITIONERS ALLEGED NEGLIGENCE OR IMPRUDENCE. SIGNIFICANTLY, THE COURT OF
APPLALS UNJUS1IIIABLY DISRLGARDLD 1HL OPINION OI 1HL PROSECUTIONS EXPERT WITNESS, DR.
CIRILO 1ACA1A, 1HA1 PL1I1IONLRS WLRL NO1 GUIL1Y OI NLGLIGLNCL OR IMPRUDLNCL
COMPLAINLD OI.

3. 1HL COUR1 OI APPLALS LRRLD IN HOLDING 1HA1 1HL IAILURL OI PL1I1IONLRS 1O
SUBJECT THE PATIENTS WHOLE LEG TO AN X-RAY LXAMINA1ION PROLONGLD 1HL PAIN AND
SUIILRING OI 1HL PA1ILN1, SUCH CONCLUSION BLING UNSUPPOR1LD BY, AND LVLN CON1RARY
1O, 1HL LVIDLNCL ON RLCORD.

4. ASSUMING ARGULNDO 1HA1 1HL PA1ILN1 LXPLRILNCLD PROLONGLD PAIN AND
SUIILRING, 1HL COUR1 OI APPLALS LRRLD IN NO1 HOLDING 1HA1 1HL ALLLGLD PAIN AND
SUFFERING WERE DUE TO THE UNJUSTIFIED FAILURE OF THE PATIENTS MOTHER, A NURSE
HLRSLLI, 1O IMMLDIA1LLY BRING 1HL PA1ILN1 BACK 1O 1HL HOSPI1AL, AS ADVISLD BY 1HL
PL1I1IONLRS, AI1LR HL COMPLAINLD OI SLVLRL PAIN IN HIS RIGH1 LLG WHLN HL RLACHLD
HOME AFTER HE WAS SEEN BY PETITIONERS AT THE HOSPITAL. THUS, THE PATIENTS ALLEGED
INJURY (PROLONGED PAIN AND SUFFERING) WAS DUE TO HIS OWN MOTHERS ACT OR OMISSION.

S. 1HL COUR1 OI APPLALS LRRLD IN NO1 HOLDING 1HA1 NO PHYSICIAN-PA1ILN1
RLLA1IONSHIP LXIS1LD BL1WLLN PL1I1IONLRS AND PA1ILN1 ALIONSO SAN1IAGO, JR.,
PETITIONERS NOT BEING THE LATTERS ATTENDING PHYSICIAN AS THEY WERE MERELY
RLQULS1LD BY 1HL LMLRGLNCY ROOM (LR) NURSL 1O SLL 1HL PA1ILN1 WHILL 1HLY WLRL
PASSING BY 1HL LR IOR 1HLIR LUNCH.

6. 1HL COUR1 OI APPLALS GRAVLLY LRRLD IN NO1 ACQUI11ING ACCUSLD-PL1I1IONLRS
OF THE CRIME CHARGED.
|9|



1he oregoing can be synthesized into two basic issues: |1| whether or not the doctrine o re. i.a toqvitvr is applicable in this case, and |2|
whether or not the petitioners are liable or criminal negligence.

THE COURTS RULING

1he CA is correct in inding that there was negligence on the part o the petitioners. Ater a perusal o the records, howeer, the Court is not
coninced that the petitioners are guilty o criminal negligence complained o. 1he Court is also o the iew that the CA erred in applying the doctrine
o re. i.a toqvitvr in this particular case.

As to the Application of
1he Doctrine of Res Ipsa Loquitur

1his doctrine o re. i.a toqvitvr means "\here the thing which causes injury is shown to be under the management o the deendant, and the
accident is such as in the ordinary course o things does not happen i those who hae the management use proper care, it aords reasonable eidence, in
the absence o an explanation by the deendant, that the accident arose rom want o care." 1he tac/. ar Dictiovar, deines the said doctrine. 1hus:

1he thing speaks or itsel. Rebuttable presumption or inerence that deendant was negligent, which arises upon proo that
the instrumentality causing injury was in deendant's exclusie control, and that the accident was one which ordinarily does not
happen in absence o negligence. Re. i.a toqvitvr is a rule o eidence whereby negligence o the alleged wrongdoer may be inerred
rom the mere act that the accident happened proided the character o the accident and circumstances attending it lead reasonably
to belie that in the absence o negligence it would not hae occurred and that thing which caused injury is shown to hae been under
the management and control o the alleged wrongdoer. Under this doctrine, the happening o an injury permits an inerence o
negligence where plainti produces substantial eidence that the injury was caused by an agency or instrumentality under the exclusie
control and management o deendant, and that the occurrence was such that in the ordinary course o things would not happen i
reasonable care had been used.
|10|



1he doctrine o re. i.a toqvitvr as a rule o eidence is unusual to the law o negligence which recognizes that riva facie negligence may be
established without direct proo and urnishes a substitute or speciic proo o negligence. 1he doctrine, howeer, is not a rule o substantie law, but
merely a mode o proo or a mere procedural conenience. 1he rule, when applicable to the acts and circumstances o a gien case, is not meant to and
does not dispense with the requirement o proo o culpable negligence on the party charged. It merely determines and regulates what shall
be riva facie eidence thereo and helps the plainti in proing a breach o the duty. 1he doctrine can be inoked when and only when, under the
circumstances inoled, direct eidence is absent and not readily aailable.
|11|


1he requisites or the application o the doctrine o re. i.a toqvitvr are: (J) the accident was o a kind which does not ordinarily occur unless
someone is negligent, (2) the instrumentality or agency which caused the injury was under the exclusie control o the person in charge, and (3) the injury
suered must not hae been due to any oluntary action or contribution o the person injured.
|12|


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 o the injury suered were not under the exclusie control o Drs. Jarcia and Bastan. It was established that they are mere residents
o the Manila Doctors lospital at that time who attended to the ictim at the emergency room.
|13|
\hile it may be true that the circumstances pointed out
by the courts below seem doubtless to constitute reckless imprudence on the part o the petitioners, this conclusion is still best achieed, not through the
scholarly assumptions of a layman like the patients mother, but by the unquestionable knowledge of expert witness/es. As to whether the petitioners hae
exercised the requisite degree o skill and care in treating patient Roy, Jr. is generally a matter o expert opinion.

As to Dr. Jarcia and
Dr. Bastans negligence

1he totality o the eidence on record clearly points to the negligence o the petitioners. At the risk o being repetitious, the Court, howeer, is
not satisied that Dr. Jarcia and Dr. Bastan are criminally negligent in this case.

Negligence is deined as the ailure to obsere or the protection o the interests o another person that degree o care, precaution, and igilance
which the circumstances justly demand, whereby such other person suers injury.
|14|


Reckless imprudence consists o oluntarily doing or ailing to do, without malice, an act rom which material damage results by reason o
an ivecv.abte tac/ of recavtiov on the part o the person perorming or ailing to perorm such act.
|15|


1he elements o simple negligence are: ,1, that there is lack o precaution on the part o the oender, and ,2, that the damage impending to be
caused is not immediate or the danger is not clearly maniest.
|16|


In this case, the Court is not coninced with moral certainty that the petitioners are guilty o reckless imprudence or simple negligence. 1he
elements thereo were not proed by the prosecution beyond reasonable doubt.

1he testimony o Dr. Cirilo R. 1acata ;Dr. 1acata), a specialist in pediatric orthopedic, although pointing to some medical procedures that could
hae been done by Dr. Jarcia and Dr. Bastan, as physicians on duty, was not clear as to whether the injuries suered by pati ent Roy Jr. were indeed
aggravated by the petitioners judgment call and their diagnosis or appreciation o the condition o the ictim at the time they assessed him. 1hus:

Q: \ill you please tell us, or the record, doctor, what is your specialization
A: At present I am the chairman department o orthopedic in UP-PGl and I had special training in pediatric orthopedic or two
,2, years.

Q: In June 1998, doctor, what was your position and what was your specialization at that time
A: Since 1980, I hae been specialist in pediatric orthopedic.

Q: \hen Alonso Santiago, Jr. was brought to you by his mother, what did you do by way o physicians as irst step
A: As usual, I examined the patient physically and, at that time as I hae said, the patient could not walk so I |began| to suspect that
probably he sustained a racture as a result o a ehicular accident. So I examined the patient at that time, the inoled leg, I
dont know if that is left or right, the involved leg then was swollen and the patient could not walk, so I requested for the x-ray
o |the| lower leg.

Q: \hat part o the leg, doctor, did you request to be examined
A: If we refer for an x-ray, usually, we suspect a fracture whether in approximal, middle or lebistal tinial, we usually x-ray
the entire extremity.

Q: And what was the result
A: \ell, I can say that it was a spiral racture o the mid-tibial, it is the bigger bone o the leg.

Q: And when you say spiral, doctor, how long was this racture
A: \hen we say spiral, it is a sort o letter S, the length was about six ,6, to eight ,8, centimeters.

Q: Mid-tibial, will you please point to us, doctor, where the tibial is
;!itve.. oivtivg to bi. torer teg)
A: 1he tibial is here, there are two bones here, the bigger one is the tibial and the smaller one is the ibula. 1he bigger one is the
one that get ractured.

Q: And in the course o your examination o Alonso Santiago, Jr. did you ask or the history o such injury
A: \es, actually, that was a routine part o our examination that once a patient comes in, beore we actually examine the patient, we
request or a detailed history. I it is an accident, then, we request or the exact mechanism o injuries.

Q: And as ar as you can recall, Doctor, what was the history o that injury that was told to you
A: The patient was sideswiped, I dont know if it is a car, but it is a vehicular accident.

Q: \ho did you interiew
A: 1he mother.

Q: low about the child himsel, Alonso Santiago, Jr.
A: Normally, we do not interiew the child because, usually, at his age, the answers are not accurate. So, it was the mother that I
interiewed.

Q: And were you inormed also o his early medication that was administered on Alonso Santiago, Jr.
A: No, not actually medication. I was inormed that this patient was seen initially at the emergency room by the two ,2, physicians
that you just mentioned, Dr. Jarcia and Dra. Bastan, that time who happened to be my residents who were |on| duty at the
emergency room.

x x x x

A: At the emergency room, at the Manila Doctors Hospital, the supervisor there is a consultant that usually comes from a family
medicine. 1hey see where a certain patient hae to go and then i they cannot manage it, they reer it to the consultant on
duty. Now at that time, I dont why they dont Because at that time, I think, it is the decision. Since the x-rays

x x x

Q: \ou also said, Doctor, that Dr. Jarcia and Dra. Bastan are not een an orthopedic specialist.
A: 1hey are general surgeon residents. You have to manx the emergency room, including neurology, orthopedic,
general surgery, they see everything at the emergency room.

x x x x

Q: But if initially, Alfonso Santiago, Jr. and his case was presented to you at the emergency room, you would have
subjected the entire foot to x-ray even if the history that was given to Dr. Jarcia and Dra. Bastan is the same?
A: I could not directly say yes, because it would still depend on my examination, we cannot subject the whole body for x-
ray if we think that the damaged was only the leg.

Q: Not the entire body but the entire leg?
A: I think, if my examination requires it, I would.

Q: So, you would conduct first an examination?
A: Yes, sir.

Q: And do you think that with that examination that you would have conducted you would discover the necessity
subjecting the entire foot for x-ray?
A: It is also possible but according to them, the foot and the ankle were swollen and not the leg, which sometimes
normally happens that the actual fractured bone do not get swollen.

x x x x

Q: Doctor, if you know that the patient sustained a fracture on the ankle and on the foot and the history that was told to
you is the region that was hit is the region of the foot, will the doctor subject the entire leg for x-ray?
A: I am an orthopedic surgeon, you have to subject an x-ray of the leg. Because you have to consider the kind of fracture
that the patient sustained would you say the exact mechanism of injury. For example spiral, paikot yung bale nya,
so it was possible that the leg was run over, the patient fell, and it got twisted. Thats why the leg seems to be
fractured.
|1|
|Lmphases supplied|

It can be gleaned rom the testimony o Dr. 1acata that a thorough examination was not perormed on Roy Jr. As residents on duty at the
emergency room, Dr. Jarcia and Dr. Bastan were expected to know the medical protocol in treating leg ractures and in attending to ictims o car
accidents. 1here was, howeer, no precise eidence and scientiic explanation pointing to the act that the delay in the appl ication o the cast to the
patients fractured leg because of failure to immediately diagnose the specific injury of the patient, prolonged the pain of the child or aggraated his
condition or een caused urther complications. Any person may opine that had patient Roy Jr. been treated properly and gien the extensie X-ray
examination, the extent and seerity o the injury, spiral racture o the mid-tibial part or the bigger bone o the leg, could hae been detected early on and
the prolonged pain and suering o Roy Jr. could hae been preented. But still, that opinion, een how logical it may seem would not, and could not, be
enough basis to hold one criminally liable; thus, a reasonable doubt as to the petitioners guilt.

Although the Court sympathizes with the plight o the mother and the child in this case, the Court is bound by the dictates o justice which hold
iniolable the right o the accused to be presumed innocent until proen guilty beyond reasonable doubt. 1he Court, neertheless, inds the
petitioners ciritt, liable for their failure to sufficiently attend to Roy Jr.s medical needs when the latter was rushed to the ER, for while a criminal coniction
requires proo beyond reasonable doubt, only a preponderance o eidence is required to establish ciil liability. 1aken into account also was the act that
there was no bad aith on their part.

Dr. Jarcia and Dr. Bastan cannot pass on the liability to the taxi drier who hit the ictim. It may be true that the actual, direct, immediate, and
proximate cause o the injury ,racture o the leg bone or tibia, o Roy Jr. was the ehicular accident when he was hit by a taxi. 1he petitioners, howeer,
cannot simply inoke such act alone to excuse themseles rom any liability. I this would be so, doctors would hae a ready deense should they ail to do
their job in attending to ictims o hit-and-run, maltreatment, and other crimes o iolence in which the actual, direct, immediate, and proximate cause o
the injury is indubitably the act o the perpetrator,s.

In failing to perform an extensive medical examination to determine the extent of Roy Jr.s injuries, Dr. Jarcia and Dr. Bastan were remiss o
their duties as members o the medical proession. Assuming or the sake o argument that they did not hae the capacity to make such thorough
ealuation at that stage, they should hae reerred the patient to another doctor with suicient training and experience instead o assuring him and his
mother that eerything was all right.

1his Court cannot also stamp its imprimatur on the petitioners contention that no physician-patient relationship existed between them and
patient Roy Jr., since they were not his attending physicians at that time. 1hey claim that they were merely requested by the LR nurse to see the patient
while they were passing by the LR or their lunch. ir.tt,, this issue was neer raised during the trial at the R1C or een beore the CA. 1he petitioners,
thereore, raise the want o doctor-patient relationship or the irst time on appeal with this Court. It has been settled that issues raised for the first time
on appeal cannot be considered because a party is not permitted to change his theory on appeal. 1o allow him to do so is unair to the other party and
oensie to the rules o air play, justice and due process.
|18|
Stated dierently, basic considerations o due process dictate that theories, issues and
arguments not brought to the attention o the trial court need not be, and ordinarily will not be, considered by a reiewing court.
|19|


Assuming again or the sake o argument that the petitioners may still raise this issue of no physicianpatient relationship, the Court finds and
so holds that there was a physicianpatient relationship in this case.

In the case o vca. r. 1vavo,
|20|
the Court wrote that [w]hen a patient engages the services of a physician, a physician-patient relationship is
generated. And in accepting a case, the physician, or all intents and purposes, represents that he has the needed training and skill possessed by physicians
and surgeons practicing in the same ield, and that he will employ such training, care, and skill in the treatment o the patient. 1hus, in treating his patient,
a physician is under a duty to exercise that degree o care, skill and diligence which physicians in the same general neighborhood and in the same general
line o practice ordinarily possess and exercise in like cases. Stated otherwise, the physician has the obligation to use at least the same leel o care that any
other reasonably competent physician would use to treat the condition under similar circumstances.

Indubitably, a physician-patient relationship exists between the petitioners and patient Roy Jr. Notably, the latter and his mother went to the LR
or an immediate medical attention. 1he petitioners allegedly passed by and were requested to attend to the ictim ;covtrar, to tbe te.tivov, of Dr. 1acata tbat
tbe, rere, at tbat tive, re.iaevt. ov avt, at tbe R).
|21|
1hey obliged and examined the ictim, and later assured the mother that eerything was ine and that they
could go home. Clearly, a physician-patient relationship was established between the petitioners and the patient Roy Jr.

1o repeat or clarity and emphasis, i these doctors knew rom the start that they were not in the position to attend to Roy Jr., a ehicular
accident ictim, with the degree o diligence and commitment expected o eery doctor in a case like this, they should hae not made a baseless assurance
that eerything was all right. By doing so, they depried Roy Jr. o adequate medical attention that placed him in a more dangerous situation than he was
already in. \hat petitioners should hae done, and could hae done, was to reer Roy Jr. to another doctor who could competently and thoroughly
examine his injuries.

All told, the petitioners were, indeed, negligent but only ciilly, and not criminally, liable as the acts show.

Article II, Section 1 o the Code o Medical Lthics o the Medical Proession in the Philippines states:

A physician should attend to his patients aithully and conscientiously. le should secure or them all possible beneits that
may depend upon his professional skill and care. As the sole tribunal to adjudge the physicians failure to fulfill his obligation to his
patients is, in most cases, his own conscience, iolation o this rule on his part is discreditable and inexcusable.
|22|



Lstablished medical procedures and practices, though in constant instability, are deised or the purpose o preenting complications. In
this case, the petitioners ailed to obsere the most prudent medical procedure under the circumstances to preent the compli cations suered by a
child o tender age.

As to the Award of
Damages

While no criminal negligence was found in the petitioners failure to administer the necessary medical attention to Roy Jr., the Court holds them
ciilly liable or the resulting damages to their patient. \hile it was the taxi drier who ran oer the oot or leg o Roy Jr., their negligence was doubtless
contributory.

It appears undisputed that the amount o 3,850.00, as expenses incurred by patient Roy Jr., was adequately supported by receipts. 1he Court,
thereore, inds the petitioners liable to pay this amount by way o actual damages.

1he Court is aware that no amount o compassion can suice to ease the sorrow elt by the amily o the child at that time. Certainly, the award
o moral and exemplary damages in aor o Roy Jr. in the amount o 100,000.00 and 50,000.00, respectiely, is proper in this case.

It is settled that moral damages are not punitie in nature, but are designed to compensate and alleiate in some way the physical suering,
mental anguish, right, serious anxiety, besmirched reputation, wounded eelings, moral shock, social humiliation, and similar injury unjustly inlicted on a
person. Intended or the restoration o the psychological or emotional .tatv. qvo avte, the award o moral damages is designed to compensate emotional
injury suered, not to impose a penalty on the wrongdoer.
|23|


1he Court, likewise, inds the petitioners also liable or exemplary damages in the said amount. Article 2229 o the Ciil Code proides that
exemplary damages may be imposed by way o example or correction or the public good.

WHLRLIORL, the petition is PAR1LY GRAN1LD. 1he Decision o the Court o Appeals dated August 29, 2008 is RLVLRSLD and
SL1 ASIDL. A new judgment is entered ACQUI11ING Dr. Lmmanuel Jarcia, Jr. and Dr. Marilou Bastan o the crime o reckless imprudence resulting
to serious physical injuries but declaring them ciilly liable in the amounts o:


(J) 3,850.00 as actual damages,
(2) 100,000.00 as moral damages,
(3) 50,000.00 as exemplary damages, and
(4) Costs o the suit.

with interest at the rate o 6 er avvvv rom the date o the iling o the Inormation. 1he rate shall be 12 interest er avvvv rom the inality o
judgment until ully paid.

SO ORDLRLD.


LN BANC

DR. RUBI LI,
Petitioner,










- ersus -
G.R. No. J6S279

Present:

CORONA, C.].,
CARPIO,
CARPIO MORALLS,
VLLASCO, JR.,
NAClURA,
LLONARDO-DL CAS1RO,
BRION,
PLRAL1A,
BLRSAMIN,
DLL CAS1ILLO,
*

ABAD,
VILLARAMA, JR.,
PLRLZ,
MLNDOZA, and
SLRLNO, ]].

SPOUSLS RLYNALDO and LINA SOLIMAN, as
parents/heirs of deceased Angelica Soliman,
Respondents.

Promulgated:

June , 2011
x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x

DLCISION

VILLARAMA, JR., J.:

Challenged in this petition or reiew on certiorari is the Decision
J
dated June 15, 2004 as well as the Resolution
2
dated September 1, 2004 o the
Court o Appeals ,CA, in CA-G.R. CV No. 58013 which modiied the Decision
3
dated September 5, 199 o the Regional 1rial Court o Legazpi City,
Branch 8 in Ciil Case No. 8904.
1he actual antecedents:
On July 7, 1993, respondents 11-year old daughter, Angelica Soliman, underwent a biopsy o the mass located in her lower extremity at the St.
Lukes Medical Center (SLMC). Results showed that Angelica was suering rom o.teo.arcova, osteoblastic type,
4
a high-grade ,highly malignant, cancer
o the bone which usually alicts teenage children. Following this diagnosis and as primary intervention, Angelicas right leg was amputated by Dr. Jaime
1amayo in order to remoe the tumor. As adjuant treatment to eliminate any remaining cancer cells, and hence minimize the chances o recurrence and
prevent the disease from spreading to other parts of the patients body (veta.ta.i.,, chemotherapy was suggested by Dr. 1amayo. Dr. 1amayo reerred
Angelica to another doctor at SLMC, herein petitioner Dr. Rubi Li, a medical oncologist.
On August 18, 1993, Angelica was admitted to SLMC. loweer, she died on September 1, 1993, just eleen ,11, days ater the ,intraenous,
administration o the irst cycle o the chemotherapy regimen. Because SLMC reused to release a death certiicate without ull payment o their hospital
bill, respondents brought the cadaer o Angelica to the Philippine National Police ,PNP, Crime Laboratory at Camp Crame or post-mortem
examination. 1he Medico-Legal Report issued by said institution indicated the cause of death as Hypovolemic shock secondary to multiple organ
hemorrhages and Disseminated Intravascular Coagulation.
S

On the other hand, the Certiicate o Death
6
issued by SLMC stated the cause o death as ollows:
Immediate cause : a. Osteosarcoma, Status Post AKA
Antecedent cause : b. ,aboe knee amputation,
Underlying cause : c. Status Post Chemotherapy
On lebruary 21, 1994, respondents iled a damage suit
7
against petitioner, Dr. Leo Marbella, Mr. Jose Ledesma, a certain Dr. Arriete and SLMC.
Respondents charged them with negligence and disregard of Angelicas safety, health and welfare by their careless administration of the chemotherapy
drugs, their ailure to obsere the essential precautions in detecting early the symptoms o atal blood platelet decrease and stopping early on the
chemotherapy, which bleeding led to hypovolemic shock that caused Angelicas untimely demise. Further, it was specifically averred that petitioner assured
the respondents that Angelica would recover in view of 95% chance of healing with chemotherapy (Magigivg vorvat va avg ava/ v,o ba.ta vacbevo. : avg
healing) and when asked regarding the side effects, petitioner mentioned only slight vomiting, hair loss and weakness (Mag.v.v/a vg /avvti. Matvtvga. avg
buhok. Manghihina,. Respondents thus claimed that they would not hae gien their consent to chemotherapy had petitioner not alsely assured them o
its side eects.
In her answer,
8
petitioner denied haing been negligent in administering the chemotherapy drugs to Angelica and asserted that she had ully
explained to respondents how the chemotherapy will affect not only the cancer cells but also the patients normal body parts, including the lowering o
white and red blood cells and platelets. She claimed that what happened to Angelica can be attributed to malignant tumor cells possibly let behind ater
surgery. lew as they may be, these hae the capacity to compete or nutrients such that the body becomes so weak structurally ,cachexia, and unctionally
in the orm o lower resistance o the body to combat inection. Such inection becomes uncontrollable and triggers a chain o eents ,.e.i. or .eticevia,
that may lead to bleeding in the orm o Disseminated Intraascular Coagulation ,DIC,, as what the autopsy report showed in the case o Angelica.
Since the medical records o Angelica were not produced in court, the trial and appellate courts had to rely on testimonial eidence, principally the
declarations o petitioner and respondents themseles. 1he ollowing chronology o eents was gathered:
On July 23, 1993, petitioner saw the respondents at the hospital after Angelicas surgery and discussed with them Angelicas condition. Petitioner
told respondents that Angelica should be gien two to three weeks to recoer rom the operation beore starting chemotherapy. Respondents were
apprehensie due to inancial constraints as Reynaldo earns only rom P0,000.00 to P150,000.00 a year rom his jewelry and watch repairing
business.
9
Petitioner, howeer, assured them not to worry about her proessional ee and told them to just sae up or the medicines to be used.
Petitioner claimed that she explained to respondents that een when a tumor is remoed, there are still small lesions undetectable to the naked
eye, and that adjuant chemotherapy is needed to clean out the small lesions in order to lessen the chance o the cancer to recur. She did not gie the
respondents any assurance that chemotherapy will cure Angelicas cancer. During these consultations with respondents, she explained the ollowing side
eects o chemotherapy treatment to respondents: ,1, alling hair, ,2, nausea and omiting, ,3, loss o appetite, ,4, low count o white blood cells |\BC|,
red blood cells [RBC] and platelets; (5) possible sterility due to the effects on Angelicas ovary; (6) damage to the heart and kidneys, and ,, darkening o
the skin especially when exposed to sunlight. She actually talked with respondents our times, once at the hospital ater the surgery, twice at her clinic and
the fourth time when Angelicas mother called her through long distance.
J0
1his was disputed by respondents who countered that petitioner gae them
assurance that there is 95 chance o healing or Angelica i she undergoes chemotherapy and that the only side eects were nausea, omiting and hair
loss.
JJ
1hose were the only side-eects o chemotherapy treatment mentioned by petitioner.
J2

On July 2, 1993, SLMC discharged Angelica, with instruction rom petitioner that she be readmitted ater two or three weeks or the
chemotherapy.
On August 18, 1993, respondents brought Angelica to SLMC or chemotherapy, bringing with them the results o the laboratory tests requested
by petitioner: Angelicas chest x-ray, ultrasound o the lier, creatinine and complete lier unction tests.
J3
Petitioner proceeded with the chemotherapy
by irst administering hydration luids to Angelica.
J4

1he ollowing day, August 19, petitioner began administering three chemotherapy drugs Cisplatin,
JS
Doxorubicin
J6
and Cosmegen
J7

intraenously. Petitioner was supposedly assisted by her trainees Dr. Leo Marbella
J8
and Dr. Grace Arriete.
J9
In his testimony, Dr. Marbella denied
haing any participation in administering the said chemotherapy drugs.
20

On the second day of chemotherapy, August 20, respondents noticed reddish discoloration on Angelicas face.
2J
1hey asked petitioner about
it, but she merely quipped, !ata ,av. e/to vg gavot.
22
Petitioner recalled noticing the skin rashes on the nose and cheek area o Angelica. At that
moment, she entertained the possibility that Angelica also had systemic lupus and consulted Dr. Victoria Abesamis on the matter.
23

On the third day o chemotherapy, August 21, Angelica had diiculty breathing and was thus proided with oxygen inhalation apparatus. 1his
time, the reddish discoloration on Angelicas face had extended to her neck, but petitioner dismissed it again as merely the eect o
medicines.
24
Petitioner testified that she did not see any discoloration on Angelicas face, nor did she notice any difficulty in the childs breathing. She
claimed that Angelica merely complained o nausea and was gien ice chips.
2S

On August 22, 1993, at around ten oclock in the morning, upon seeing that their child could not anymore bear the pain, respondents pleaded
with petitioner to stop the chemotherapy. Petitioner supposedly replied: Dapat 15 Cosmegen pa iyan. Okay, lets observe. If pwede na, bigyan uli ng chemo. At this
point, respondents asked petitioners permission to bring their child home. Later in the eening, Angelica passed black stool and reddish
urine.
26
Petitioner countered that there was no record o blackening o stools but only an episode o loose bowel moement ,LBM,. Petitioner also
testiied that what Angelica complained o was carpo-pedal spasm, not conulsion or epileptic attack, as respondents call it ,petitioner described it in the
ernacular as naninigas ang kamay at paa,. She then requested or a serum calcium determination and stopped the chemotherapy. \hen Angelica was
gien calcium gluconate, the spasm and numbness subsided.
27

The following day, August 23, petitioner yielded to respondents request to take Angelica home. But prior to discharging Angelica, petitioner
requested or a repeat serum calcium determination and explained to respondents that the chemotherapy will be temporarily stopped while she obseres
Angelicas muscle twitching and serum calcium level. 1ake-home medicines were also prescribed or Angelica, with instructions to respondents that the
serum calcium test will hae to be repeated ater seen days. Petitioner told respondents that she will see Angelica again ater two weeks, but respondents
can see her anytime i any immediate problem arises.
28

However, Angelica remained in confinement because while still in the premises of SLMC, her convulsions returned and she also had
LBM. Angelica was gien oxygen and administration o calcium continued.
29

1he next day, August 24, respondents claimed that Angelica still suered rom conulsions. 1hey also noticed that she had a eer and had
diiculty breathing.
30
Petitioner insisted it was carpo-pedal spasm, not conulsions. She eriied that at around 4:50 that aternoon, Angelica deeloped
diiculty in breathing and had eer. She then requested or an electrocardiogram analysis, and inused calcium gluconate on the patient at a stat dose. She
urther ordered that Angelica be gien Bactrim,
3J
a synthetic antibacterial combination drug,
32
to combat any infection on the childs body.
33

By August 26, Angelica was bleeding through the mouth. Respondents also saw blood on her anus and urine. \hen Lina asked peti tioner what
was happening to her daughter, petitioner replied, ag.a/ avg tatetet. vg ava/ vo. lour units o platelet concentrates were then transused to
Angelica. Petitioner prescribed Solucortef. Considering that Angelicas fever was high and her white blood cell count was low, petitioner prescribed
Leucomax. About our to eight bags o blood, consisting o packed red blood cells, resh whole blood, or platelet concentrate, were transused to
Angelica. lor two days ,August 2 to 28,, Angelica continued bleeding, but petitioner claimed it was lesser in amount and in requency. Petitioner also
denied that there were gadgets attached to Angelica at that time.
34

On August 29, Angelica deeloped ulcers in her mouth, which petitioner said were blood clots that should not be remoed. Respondents
claimed that Angelica passed about hal a liter o blood through her anus at around seven oclock that eening, which petitioner likewise denied.
On August 30, Angelica continued bleeding. She was restless as endotracheal and nasogastric tubes were inserted into her weakened body. An
aspiration o the nasogastric tube inserted to Angelica also reealed a bloody content. Angelica was gien more platelet concentrate and resh whole blood,
which petitioner claimed improed her condition. Petitioner told Angelica not to remoe the endotracheal tube because this may induce urther
bleeding.
3S
She was also transerred to the intensie care unit to aoid inection.
The next day, respondents claimed that Angelica became hysterical, vomited blood and her body turned black. Part of Angelica s skin was also
noted to be shredding by just rubbing cotton on it. Angelica was so restless she remoed those gadgets attached to her, saying .,ar /o va; there were
tears in her eyes and she kept turning her head. Obsering her daughter to be at the point o death, Lina asked or a doctor but the latter could not answer
her anymore.
36
At this time, the attending physician was Dr. Marbella who was shaking his head saying that Angelicas platelets were down and
respondents should pray or their daughter. Reynaldo claimed that he was introduced to a pediatrician who took over his daughters case, Dr. Abesamis
who also told him to pray or his daughter. Angelica continued to hae diiculty in her breathing and blood was being suctioned rom her stomach. A
nurse was posted inside Angelicas room to assist her breathing and at one point they had to revive Angelica by pumping her chest. 1hereater, Reynaldo
claimed that Angelica already experienced diiculty in urinating and her bowel consisted o blood-like luid. Angelica requested or an electric an as she
was in pain. lospital sta attempted to take blood samples rom Angelica but were unsuccessul because they could not een locate her ein. Angelica
asked or a ruit but when it was gien to her, she only smelled it. At this time, Reynaldo claimed he could not ind either petitioner or Dr. Marbella. 1hat
night, Angelica became hysterical and started remoing those gadgets attached to her. At three oclock in the morning o September 1, a priest came and
they prayed beore Angelica expired. Petitioner finally came back and supposedly told respondents that there was malfunction or bogged-down
machine.
37

By petitioners own account, Angelica was merely irritable that day (August 31). Petitioner noted though that Angelicas skin was indeed
sloughing o.
38
She stressed that at 9:30 in the eening, Angelica pulled out her endotracheal tube.
39
On September 1, exactly two weeks ater being
admitted at SLMC or chemotherapy, Angelica died.
40
1he cause o death, according to petitioner, was septicemia, or oerwhelming inection, which
caused Angelicas other organs to fail.
4J
Petitioner attributed this to the patients poor deense mechanism brought about by the cancer itsel.
42

While he was seeking the release of Angelicas cadaver from SLMC, Reynaldo claimed that petitioner acted arrogantly and called him names. le
was asked to sign a promissory note as he did not hae cash to pay the hospital bill.
43

Respondents also presented as witnesses Dr. Jesusa Niees-Vergara, Medico-Legal Oicer o the PNP-Crime Laboratory who conducted the
autopsy on Angelicas cadaver, and Dr. Melinda Vergara Balmaceda who is a Medical Specialist employed at the Department of Health ,DOl, Operations
and Management Serices.
1estiying on the indings stated in her medico-legal report, Dr. Vergara noted the ollowing: ,1, there were luids recoered rom the abdominal
caity, which is not normal, and was due to hemorrhagic shock secondary to bleeding, ,2, there was hemorrhage at the let side o the heart, ,3, bleeding at
the upper portion o and areas adjacent to, the esophagus, ,4, lungs were heay with bleeding at the back and lower portion, due to accumulation o luids,
,4, yellowish discoloration o the lier, ,5, kidneys showed appearance o acial shock on account o hemorrhages, and ,6, reddishness on external surace
of the spleen. All these were the end result of hypovolemic shock secondary to multiple organ hemorrhages and disseminated intraascular
coagulation. Dr. Vergara opined that this can be attributed to the chemical agents in the drugs gien to the ictim, which caused platelet reduction
resulting to bleeding sufficient to cause the victims death. 1he time lapse or the production o DIC in the case o Angelica ,rom the time o diagnosis o
sarcoma, was too short, considering the surial rate o about 3 years. 1he witness conceded that the ictim will also die o osteosarcoma een with
amputation or chemotherapy, but in this case Angelicas death was not caused by osteosarcoma. Dr. Vergara admitted that she is not a pathologist but her
statements were based on the opinion o an oncologist whom she had interiewed. 1his oncologist supposedly said that i the ictim already had DIC
prior to the chemotherapy, the hospital sta could hae detected it.
44

On her part, Dr. Balmaceda declared that it is the physicians duty to inorm and explain to the patient or his relaties eery known side eect o
the procedure or therapeutic agents to be administered, beore securing the consent o the patient or his relaties to such procedure or therapy. 1he
physician thus bases his assurance to the patient on his personal assessment of the patients condition and his knowledge of the general effects of the
agents or procedure that will be allowed on the patient. Dr. Balmaceda stressed that the patient or relaties must be inormed o all known side eects
based on studies and observations, even if such will aggravate the patients condition.
4S

Dr. Jaime 1amayo, the orthopaedic surgeon who operated on Angelicas lower extremity, testified for the defendants. le explained that in case
o malignant tumors, there is no guarantee that the ablation or remoal o the amputated part will completely cure the cancer. 1hus, surgery is not
enough. 1he mortality rate o osteosarcoma at the time o modern chemotherapy and early diagnosis still remains at 80 to 90. Usually, deaths occur
rom metastasis, or spread o the cancer to other ital organs like the lier, causing systemic complications. 1he modes o therapy aailable are the
remoal o the primary source o the cancerous growth and then the residual cancer cells or metastasis should be treated with chemotherapy. Dr. 1amayo
urther explained that patients with osteosarcoma hae poor deense mechanism due to the cancer cells in the blood stream. In the case o Angelica, he
had preiously explained to her parents that ater the surgical procedure, chemotherapy is imperatie so that metastasis o these cancer cells will hopeully
be addressed. le reerred the patient to petitioner because he elt that petitioner is a competent oncologist. Considering that this type o cancer is ery
aggressie and will metastasize early, it will cause the demise o the patient should there be no early interention (in this case, the patient developed
sepsis which caused her death). Cancer cells in the blood cannot be seen by the naked eye nor detected through bone scan. On cross-examination, Dr.
1amayo stated that o the more than 50 child patients who had osteogenic sarcoma he had handled, he thought that probably all o them died within six
months rom amputation because he did not see them anymore ater ollow-up, it is either they died or had seen another doctor.
46

In dismissing the complaint, the trial court held that petitioner was not liable or damages as she obsered the best known procedures and employed
her highest skill and knowledge in the administration o chemotherapy drugs on Angelica but despite all eorts said patient died. It cited the testimony o
Dr. 1amayo who testiied that he considered petitioner one o the most proicient in the treatment o cancer and that the patient in this case was alicted
with a ery aggressie type o cancer necessitating chemotherapy as adjuant treatment. Using the standard o negligence laid down in Picart r.
vitb,
47
the trial court declared that petitioner has taken the necessary precaution against the aderse eect o chemotherapy on the patient, adding that a
wrong decision is not by itsel negligence. Respondents were ordered to pay their unpaid hospital bill in the amount o P139,064.43.
48

Respondents appealed to the CA which, while concurring with the trial courts finding that there was no negligence committed by the petitioner in
the administration o chemotherapy treatment to Angelica, ound that petitioner as her attending physician ailed to ully explain to the respondents all the
known side eects o chemotherapy. 1he appellate court stressed that since the respondents hae been told o only three side eects o chemotherapy,
they readily consented thereto. lad petitioner made known to respondents those other side eects which graely aected their child -- such as carpo-
pedal spasm, sepsis, decrease in the blood platelet count, bleeding, inections and eentual death -- respondents could hae decided dierently or adopted
a dierent course o action which could hae delayed or preented the early death o their child.
1he CA thus declared:
Plaintis-appellants child was suffering from a malignant disease. 1he attending physician recommended that she undergo
chemotherapy treatment ater surgery in order to increase her chances o surial. Appellants consented to the chemotherapy
treatment because they believed in Dr. Rubi Lis representation that the deceased would have a strong chance of survival after
chemotherapy and also because o the representation o appellee Dr. Rubi Li that there were only three possible side-eects o the
treatment. loweer, all sorts o painul side-eects resulted rom the treatment including the premature death o Angelica. 1he
appellants were clearly and totally unaware of these other side-effects which manifested only during the chemotherapy
treatment. This was shown by the fact that every time a problem would take place regarding Angelicas condition (like an
unexpected side-effect manifesting itself), they would immediately seek explanation from Dr. Rubi Li. Surely, those
unexpected side-eects culminating in the loss o a loe|d| one caused the appellants so much trouble, pain and suering.
On this point thereore, |w|e ind deendant-appellee Dr. Rubi Li negligent which would entitle plaintis-appellants to their
claim or damages.
x x x x
\lLRLlORL, the instant appeal is hereby GRAN1LD. Accordingly, the assailed decision is hereby modiied to the
extent that deendant-appellee Dr. Rubi Li is ordered to pay the plaintis-appellants the ollowing amounts:
1. Actual damages o P139,064.43, plus P9,828.00 or uneral expenses,
2. Moral damages o P200,000.00,
3. Lxemplary damages o P50,000.00,
4. Attorneys fee of P30,000.00.
SO ORDLRLD.
49
,Lmphasis supplied.,
Petitioner iled a motion or partial reconsideration which the appellate court denied.
lence, this petition.
Petitioner assails the CA in inding her guilty o negligence in not explaining to the respondents all the possible side eects o the chemotherapy
on their child, and in holding her liable for actual, moral and exemplary damages and attorneys fees. Petitioner emphasized that she was not negligent in
the pre-chemotherapy procedures and in the administration o chemotherapy treatment to Angelica.
On her supposed non-disclosure o all possible side eects o chemotherapy, including death, petitioner argues that it was oolhardy to imagine her
to be all-knowing,omnipotent. \hile the theoretical side eects o chemotherapy were explained by her to the respondents, as these should be known to
a competent doctor, petitioner cannot possibly predict how a particular patients genetic make-up, state o mind, general health and body constitution
would respond to the treatment. 1hese are obiously dependent on too many known, unknown and immeasurable ariables, thus requiring that Angelica
be, as she was, constantly and closely monitored during the treatment. Petitioner asserts that she did eerything within her proessional competence to
attend to the medical needs o Angelica.
Citing numerous trainings, distinctions and achieements in her ield and her current position as co-director or clinical aairs o the Medical
Oncology, Department o Medicine o SLMC, petitioner contends that in the absence o any clear showing or proo, she cannot be charged with
negligence in not inorming the respondents all the side eects o chemotherapy or in the pre-treatment procedures done on Angelica.
As to the cause o death, petitioner insists that Angelica did not die o platelet depletion but o sepsis which is a complication o the cancer
itsel. Sepsis itsel leads to bleeding and death. She explains that the response rate to chemotherapy o patients with osteosarcoma is high, so much so
that surial rate is aorable to the patient. Petitioner then points to some probable consequences i Angelica had not undergone chemotherapy. 1hus,
without chemotherapy, other medicines and supportie treatment, the patient might hae died the next day because o massie inection, or the cancer
cells might hae spread to the brain and brought the patient into a coma, or into the lungs that the patient could hae been hooked to a respirator, or into
her kidneys that she would hae to undergo dialysis. Indeed, respondents could hae spent as much because o these complications. 1he patient would
have been deprived of the chance to survive the ailment, of any hope for life and her quality of life surely compromised. Since she had not been shown
to be at ault, petitioner maintains that the CA erred in holding her liable or the damages suered by the respondents.
S0

1he issue to be resoled is whether the petitioner can be held liable or ailure to ully disclose serious side eects to the parents o the child patient
who died while undergoing chemotherapy, despite the absence o inding that petitioner was negligent in administering the said treatment.
1he petition is meritorious.
1he type o lawsuit which has been called medical malpractice or, more appropriately, medical negligence, is that type o claim which a ictim
has aailable to him or her to redress a wrong committed by a medical proessional which has caused bodily harm. In order to successully pursue such a
claim, a patient must proe that a health care proider, in most cases a physician, either ailed to do something which a reasonably prudent health care
proider would hae done, or that he or she did something that a reasonably prudent proider would not hae done, and that that ailure or action caused
injury to the patient.
SJ

1his Court has recognized that medical negligence cases are best proed by opinions o expert witnesses belonging in the same general
neighborhood and in the same general line o practice as deendant physician or surgeon. 1he deerence o courts to the expert opinion o qualiied
physicians stems from the formers realization that the latter possess unusual technical skills which laymen in most instances are incapable o intelligently
ealuating, hence the indispensability o expert testimonies.
S2

In this case, both the trial and appellate courts concurred in inding that the alleged negligence o petitioner in the administration o chemotherapy
drugs to respondents child was not proven considering that Drs. Vergara and Balmaceda, not being oncologists or cancer specialists, were not qualiied to
gie expert opinion as to whether petitioners lack of skill, knowledge and professional competence in failing to observe the standard o care in her line o
practice was the proximate cause of the patients death. Furthermore, respondents case was not at all helped by the non-production o medical records
by the hospital ,only the biopsy result and medical bills were submitted to the court,. Neertheless, the CA ound petitioner liable or her ailure to inorm
the respondents on all possible side eects o chemotherapy beore securing their consent to the said treatment.
1he doctrine o ivforvea cov.evt within the context o physician-patient relationships goes ar back into Lnglish common law. As early as 16,
doctors were charged with the tort of battery (i.e., an unauthorized physical contact with a patient) if they had not gained the consent of their patients
prior to perorming a surgery or procedure. In the United States, the seminal case was cboevaorff r. ociet, of ^er Yor/ o.itat
S3
which inoled unwanted
treatment performed by a doctor. Justice Benjamin Cardozos oft-quoted opinion upheld the basic right o a patient to gie consent to any medical
procedure or treatment: Every human being o adult years and sound mind has a right to determine what shall be done with his own body, and a surgeon
who performs an operation without his patients consent, commits an assault, for which he is liable in damages.
S4
lrom a purely ethical norm, inormed
consent eoled into a general principle o law that a physician has a duty to disclose what a reasonably prudent physician in the medical community in the
exercise o reasonable care would disclose to his patient as to whateer grae risks o injury might be incurred rom a proposed course o treatment, so
that a patient, exercising ordinary care or his own welare, and aced with a choice o undergoing the proposed treatment, or alternatie treatment, or
none at all, may intelligently exercise his judgment by reasonably balancing the probable risks against the probable beneits.
SS

Subsequently, in Cavterbvr, r. evce
S6
the court obsered that the duty to disclose should not be limited to medical usage as to arrogate the decision
on revelation to the physician alone. Thus, respect for the patients right of self-determination on particular therapy demands a standard set by law or
physicians rather than one which physicians may or may not impose upon themseles.
S7
1he scope o disclosure is premised on the act that patients
ordinarily are persons unlearned in the medical sciences. Proficiency in diagnosis and therapy is not the full measure of a physicians responsibility. It is
also his duty to warn o the dangers lurking in the proposed treatment and to impart inormation which the patient has eery right to expect. Indeed, the
patients reliance upon the physician is a trust of the kind which traditionally has exacted obligations beyond those associated with armslength
transactions.
S8
1he physician is not expected to gie the patient a short medical education, the disclosure rule only requires o him a reasonable
explanation, which means generally inorming the patient in nontechnical terms as to what is at stake, the therapy alternaties open to him, the goals
expectably to be achieed, and the risks that may ensue rom particular treatment or no treatment.
S9
As to the issue o demonstrating what risks are
considered material necessitating disclosure, it was held that experts are unnecessary to a showing o the materiality o a risk to a patients decision on
treatment, or to the reasonably, expectable eect o risk disclosure on the decision. Such unreealed risk that should hae been made known must urther
materialize, or otherwise the omission, howeer unpardonable, is without legal consequence. And, as in malpractice actions generally, there must be a
causal relationship between the physicians failure to divulge and damage to the patient.
60

Reiterating the oregoing considerations, Cobb. r. Cravt
6J
deemed it as integral part of physicians overall obligation to patient, the duty of
reasonable disclosure o aailable choices with respect to proposed therapy and o dangers inherently and potentially inoled in each. loweer, the
physician is not obliged to discuss relatiely minor risks inherent in common procedures when it is common knowledge that such risks inherent in
procedure o ery low incidence. Cited as exceptions to the rule that the patient should not be denied the opportunity to wei gh the risks o surgery or
treatment are emergency cases where it is eident he cannot ealuate data, and where the patient is a child or incompetent.
62
1he court thus concluded
that the patients right of self-decision can only be eectiely exercised i the patient possesses adequate inormation to enable him in making an intelligent
choice. The scope of the physicians communications to the patient, then must be measured by the patients need, and that need is whateer inormation
is material to the decision. 1he test therefore for determining whether a potential peril must be divulged is its materiality to the patients decision.
63

Cobb. r. Cravt urther reiterated the pronouncement in Cavterbvr, r. evce that or liability o the physician or ailure to inorm patient, there must
be causal relationship between physicians failure to inform and the injury to patient and such connection arises only if it is established that, had reelation
been made, consent to treatment would not hae been gien.
1here are our essential elements a plainti must proe in a malpractice action based upon the doctrine o inormed consent: (1) the physician had
a duty to disclose material risks, ,2, he ailed to disclose or inadequately disclosed those risks, ,3, as a direct and proximate result o the ailure to disclose,
the patient consented to treatment she otherwise would not hae consented to, and ,4, plainti 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 hae altered her
decision to undergo it.
64

Lxamining the eidence on record, we hold that there was adequate disclosure o material risks inherent in the chemotherapy procedure
performed with the consent of Angelicas parents. Respondents could not hae been unaware in the course o initial treatment and amputation o
Angelicas lower extremity, that her immune system was already weak on account of the malignant tumor in her knee. When petitioner inormed the
respondents beorehand o the side eects o chemotherapy which includes lowered counts o white and red blood cells, decrease in blood platelets,
possible kidney or heart damage and skin darkening, there is reasonable expectation on the part o the doctor that the respondents understood ery well
that the seerity o these side eects will not be the same or all patients undergoing the procedure. In other words, by the nature o the disease itsel,
each patients reaction to the chemical agents even with pre-treatment laboratory tests cannot be precisely determined by the physician. 1hat
death cav possibly result rom complications o the treatment or the underlying cancer itsel, immediately or sometime ater the admini stration o
chemotherapy drugs, is a risk that cannot be ruled out, as with most other major medical procedures, bvt such conclusion can be reasonably drawn rom
the general side eects o chemotherapy already disclosed.
As a physician, petitioner can reasonably expect the respondents to hae considered the ariables in the recommended treatment or their
daughter alicted with a lie-threatening illness. On the other hand, it is difficult to give credence to respondents claim that petitioner told them of 95%
chance o recoery or their daughter, as it was unlikely or doctors like petitioner who were dealing with grae conditions such as cancer to hae alsely
assured patients of chemotherapys success rate. Besides, inormed consent laws in other countries generally require only a reasonable explanation o
potential harms, so speciic disclosures such as statistical data, may not be legally necessary.
6S

1he element o ethical duty to disclose material risks in the proposed medical treatment cannot thus be reduced to one simplistic ormula applicable
in all instances. Further, in a medical malpractice action based on lack of informed consent, the plaintiff must prove both the duty and the breach o that
duty through expert testimony.
66
Such expert testimony must show the customary standard o care o physicians in the same practice as that o the
deendant doctor.
67

In this case, the testimony of Dr. Balmaceda who is not an oncologist but a Medical Specialist of the DOHs Operational and Management Serices
charged with receiing complaints against hospitals, does not qualiy as expert testimony to establish the standard o care i n obtaining consent or
chemotherapy treatment. In the absence o expert testimony in this regard, the Court eels hesitant in deining the scope o mandatory disclosure in cases
o malpractice based on lack o inormed consent, much less set a standard o disclosure that, een in oreign jurisdictions, has been noted to be an
eoling one.
As society has grappled with the juxtaposition between personal autonomy and the medical proession's intrinsic impetus to
cure, the law defining adequate disclosure has undergone a dynamic evolution. A standard once guided solely by the ruminati ons o
physicians is now dependent on what a reasonable person in the patients position regards as significant. 1his change in perspectie is
especially important as medical breakthroughs moe practitioners to the cutting edge o technology, eer encountering new and
heretoore unimagined treatments or currently incurable diseases or ailments. An adaptable standard is needed to account or this
constant progression. Reasonableness analyses permeate our legal system or the ery reason that they are determined by social norms,
expanding and contracting with the ebb and low o societal eolution.

As we progress toward the twenty-irst century, we now realize that the legal standard of disclosure is not subject to
construction as a categorical imperative. \hateer ormulae or processes we adopt are only useul as a oundational starting
point, the particular quality or quantity of disclosure will remain inextricably bound by the facts of each case. Neertheless,
juries that ultimately determine whether a physician properly inormed a patient are ineitably guided by what they perceie as the
common expectation o the medical consumera reasonable person in the patients position when deciding to accept or reject a
recommended medical procedure.
68
,Lmphasis supplied.,

WHLRLIORL, the petition or reiew on certiorari is GRAN1LD. 1he Decision dated June 15, 2004 and the Resolution dated September 1,
2004 o the Court o Appeals in CA-G.R. CV No. 58013 are SL1 ASIDL.
1he Decision dated September 5, 199 o the Regional 1rial Court o Legazpi City, Branch 8, in Ciil Case No. 8904 is RLINS1A1LD and
UPHLLD.
No costs.
SO ORDLRLD.
G.R. No. J60889 April 27, 2007
DR. MILAGROS L. CAN1RL, Petitioner,
s.
SPS. JOHN DAVID Z. GO and NORA S. GO, Respondents.
D L C I S I O N
QUISUMBING, J.:
lor reiew on certiorari are the Decision
1
dated October 3, 2002 and Resolution
2
dated Noember 19, 2003 o the Court o Appeals in CA-G.R. CV No.
58184, which airmed with modiication the Decision
3
dated March 3, 199 o the Regional 1rial Court o Quezon City, Branch 98, in Ciil Case No. Q-
93-16562.
1he acts, culled rom the records, are as ollows:
Petitioner Dr. Milagros L. Cantre is a specialist in Obstetrics and Gynecology at the Dr. Jesus Delgado Memorial lospital. She was the attending physician
o respondent Nora S. Go, who was admitted at the said hospital on April 19, 1992.
At 1:30 a.m. o April 20, 1992, Nora gae birth to her ourth child, a baby boy. loweer, at around 3:30 a.m., Nora suered prouse bleeding inside her
womb due to some parts o the placenta which were not completely expelled rom her womb ater deliery. Consequently, Nora suered hypoolemic
shock, resulting in a drop in her blood pressure to "40" oer "0." Petitioner and the assisting resident physician perormed arious medical procedures to
stop the bleeding and to restore Noras blood pressure. ler blood pressure was requently monitored with the use o a sphygmomanometer. \hile
petitioner was massaging Noras uterus for it to contract and stop bleeding, she ordered a droplight to warm Nora and her baby.
4
Nora remained
unconscious until she recoered.
\hile in the recoery room, her husband, respondent John Daid Z. Go noticed a resh gaping wound two and a hal ,2 ', by three and a hal ,3 ',
inches in the inner portion o her let arm, close to the armpit.
5
le asked the nurses what caused the injury. le was inormed it was a burn. lorthwith, on
April 22, 1992, John Daid iled a request or inestigation.
6
In response, Dr. Rainerio S. Abad, the medical director o the hospital, called petitioner and
the assisting resident physician to explain what happened. Petitioner said the blood pressure cu caused the injury.
On May , 1992, John Daid brought Nora to the National Bureau o Inestigation or a physical examination, which was conducted by medico-legal
oicer Dr. lloresto Arizala, Jr.

1he medico-legal officer later testified that Noras injury appeared to be a burn and that a droplight when placed near the
skin or about 10 minutes could cause such burn.
8
le dismissed the likelihood that the wound was caused by a blood pressure cu as the scar was not
around the arm, but just on one side o the arm.
9

On May 22, 1992, Noras injury was referred to a plastic surgeon at the Dr. Jesus Delgado Memorial Hospital for skin grafting.
10
ler wound was coered
with skin sourced rom her abdomen, which consequently bore a scar as well. About a year ater, on April 30, 1993, scar reision had to be perormed at
the same hospital.
11
The surgical operation left a healed linear scar in Noras left arm about three inches in length, the thickest portion rising about one-
ourth ,1,4, o an inch rom the surace o the skin. 1he costs o the skin grating and the scar reision were shouldered by the hospital.
12

Unortunately, Noras arm would never be the same.1a``,bi1.vet Aside rom the unsightly mark, the pain in her let arm remains. \hen sleeping, she has
to cradle her wounded arm. ler moements now are also restricted. ler children cannot play with the let side o her body as they might accidentally
bump the injured arm, which aches at the slightest touch.
1hus, on June 21, 1993, respondent spouses iled a complaint
13
or damages against petitioner, Dr. Abad, and the hospital. linding in aor o respondent
spouses, the trial court decreed:
In iew o the oregoing consideration, judgment is hereby rendered in aor o the plaintis and against the deendants, directing the latters, ,.ic, jointly
and seerally
,a, to pay the sum o lie lundred 1housand Pesos ,P500,000.00, in moral damages,
,b, to pay the sum o One lundred lity 1housand Pesos ,P150,000.00, exemplary damages,
,c, to pay the sum o Lighty 1housand Pesos ,P80,000.00, nominal damages,
(d) to pay Fifty Thousand Pesos (P50,000.00) for and as attorneys fees; and
,e, to pay Six 1housand Pesos ,P6,000.00, litigation expenses.
SO ORDLRLD.
14

Petitioner, Dr. Abad, and the hospital all appealed to the Court o Appeals, which airmed with modiication the trial court decision, thus:
\lLRLlORL, in iew o all the oregoing, and inding no reersible error in the appealed Decision dated March 3, 199 o Branch 98 o the Regional
1rial Court o Quezon City in Ciil Case No. Q-93-16562, the same is hereby AllIRMLD, with the ollowing MODIlICA1IONS:
1. Ordering deendant-appellant Dra. Milagros |L.| Cantre only to pay plaintis-appellees John Daid Go and Nora S. Go the sum o
P200,000.00 as moral damages,
2. Deleting the award [of] exemplary damages, attorneys fees and expenses of litigation;1arbi1.vet
3. Dismissing the complaint with respect to deendants-appellants Dr. Rainerio S. Abad and Delgado Clinic, Inc.,
4. Dismissing the counterclaims o deendants-appellants or lack o merit, and
5. Ordering deendant-appellant Dra. Milagros |L.| Cantre only to pay the costs.
SO ORDLRLD.
15

Petitioners motion for reconsideration was denied by the Court of Appeals. Hence, the instant petition assigning the followi ng as errors and issues:
I.
\lL1lLR OR NO1, 1lL LO\LR COUR1, AND 1lL COUR1 Ol APPLALS COMMI11LD GRAVL ABUSL Ol 1lLIR DISCRL1ION
\lLN, NO1\I1lS1ANDING 1lA1 BO1l PAR1ILS lAVL RLS1LD 1lLIR RLSPLC1IVL CASLS, 1lL LO\LR COUR1 ADMI11LD
1lL ADDI1IONAL LXlIBI1S lUR1lLR OllLRLD B\ RLSPONDLN1S NO1 1LS1IlILD 1O B\ AN\ \I1NLSS AND 1lIS DLCISION
Ol 1lL LO\LR COUR1 \AS UPlLLD B\ 1lL COUR1 Ol APPLALS LIKL\ISL COMMI11ING GRAVL ABUSL Ol DISCRL1ION,
II.
\lL1lLR OR NO1 1lL LO\LR COUR1 COMMI11LD GRAVL ABUSL Ol I1S DISCRL1ION \lLN, CON1RAR\ 1O
PRLPONDLRANCL Ol LVIDLNCL PRLSLN1LD B\ 1lL PL1I1IONLR, I1 RULLD 1lA1 1lL PL1I1IONLR lAS NO1 AMPL\
SlO\LD 1lA1 1lL DROPLIGl1 DID NO1 1OUCl 1lL BOD\ Ol MRS. NORA GO, AND 1lIS DLCISION Ol 1lL LO\LR COUR1
\AS UPlLLD B\ 1lL COUR1 Ol APPLALS LIKL\ISL COMMI11ING GRAVL ABUSL Ol DISCRL1ION,
III.
\lL1lLR OR NO1 1lL LO\LR COUR1 COMMI11LD GRAVL ABUSL Ol I1S DISCRL1ION \lLN, CON1RAR\ 1O
PRLPONDLRANCL Ol LVIDLNCL PRLSLN1LD B\ 1lL PL1I1IONLR, I1 RULLD 1lA1 PL1I1IONLR DRA. CAN1RL \AS NO1
ABLL 1O AMPL\ LXPLAIN lO\ 1lL INJUR\ ,BLIS1LRS, IN 1lL LLl1 INNLR ARM Ol RLSPONDLN1 MRS. GO CAML ABOU1,
IV.
\lL1lLR OR NO1 1lL COUR1 Ol APPLALS COMMI11LD GRAVL ABUSL Ol I1S DISCRL1ION \lLN I1 MADL A RULING ON
THE RESPONDENTS INJURY QUOTING THE TESTIMONY OF SOMEONE WHO WAS NOT PRESENT AND HAS NOT SEEN THE
ORIGINAL, lRLSl INJUR\ Ol RLSPONDLN1 MRS. NORA GO,
V.
\lL1lLR OR NO1 1lL COUR1 Ol APPLALS GRAVLL\ ABUSING I1S DISCRL1ION RULLD 1lA1 PL1I1IONLR DRA. CAN1RL
SlOULD lAVL IN1LNDLD 1O INlLIC1 1lL INJUR\ 1O SAVL 1lL LIlL Ol RLSPONDLN1 MRS. GO,
VI.
\lL1lLR OR NO1 1lL LO\LR COUR1 AND 1lL COUR1 |Ol| APPLALS COMMI11LD GRAVL ABUSL Ol DISCRL1ION \lLN,
CON1RAR\ 1O 1lL DL1AILLD PROCLDURLS DONL B\ PL1I1IONLR, BO1l RULLD 1lA1 1lL RLSPONDLN1 \AS LLl1 1O
1lL CARL Ol 1lL NURSING S1All,
VII.
\lL1lLR OR NO1 1lL LO\LR COUR1 COMMI11LD GRAVL ABUSL Ol DISCRL1ION \lLN, CON1RAR\ 1O 1lL MLDICAL
PURPOSLS Ol COSML1IC SURGLR\, I1 RULLD 1lA1 1lL COSML1IC SURGLR\ MADL 1lL SCARS LVLN MORL UGL\ AND
DLCLARLD 1lL COSML1IC SURGLR\ A lAILURL,
VIII.
\lL1lLR OR NO1 1lL LO\LR COUR1 GRAVLL\ ABUSL Ol ,C) DISCRETION WHEN, CONTRARY TO RESPONDENTS
CON1RAR\ 1LS1IMONILS AND 1lL ABSLNCL Ol AN\ 1LS1IMON\, I1 RULLD 1lA1 1lL\ ARL LN1I1LLD 1O DAMAGLS AND
\lICl \AS UPlLLD, AL1lOUGl MODIlILD, B\ 1lL COUR1 Ol APPLALS LIKL\ISL ABUSING I1S DISCRL1ION.
16

Petitioner contends that additional documentary exhibits not testiied to by any witness are inadmissible in eidence because they depried her o her
constitutional right to conront the witnesses against her. Petitioner insists the droplight could not have touched Noras body. She maintains the injury was
due to the constant taking of Noras blood pressure. Petitioner also insinuates the Court of Appeals was misled by the testimony o the medico-legal
oicer who neer saw the original injury beore plastic surgery was perormed. linally, petitioner stresses that plastic surgery was not intended to restore
respondents injury to its original state but rather to prevent further complication.
Respondents, howeer, counter that the genuineness and due execution of the additional documentary exhibits were duly admitted by petitioners counsel.
Respondents point out that petitioners blood pressure cuff theory is highly improbable, being unprecedented in medical history and that the injury was
deinitely caused by the droplight. At any rate, they argue, een i the injury was brought about by the blood pressure cu, petitioner was still negligent in
her duties as Noras attending physician.
Simply put, the threshold issues or resolution are: ,1, Are the questioned additional exhibits admissible in eidence ,2, Is petitioner liable or the injury
suered by respondent Nora Go 1hereater, the inquiry is whether the appellate court committed grae abuse o discretion in its assailed issuances.
As to the fir.t issue, we agree with the Court o Appeals that said exhibits are admissible in eidence. \e note that the questioned exhibits consist mostly
of Noras medical records, which were produced by the hospital during trial pursuant to a subpoena avce. tecvv. Petitioners counsel admitted the existence
o the same when they were ormally oered or admission by the trial court. In any case, gien the particular circumstances o this case, a ruling on the
negligence o petitioner may be made based on the re. i.a toqvitvr doctrine een in the absence o such additional exhibits.
Petitioners contention that the medico-legal officer who conducted Noras physical examination never saw her original injury before plastic surgery was
perormed is without basis and contradicted by the records. Records show that the medico-legal oicer conducted the physical examination on May ,
1992, while the skin grating and the scar reision were perormed on Nora on May 22, 1992 and April 30, 1993, respectiely.
Coming now to the substantie matter, is petitioner liable or the injury suered by respondent Nora Go
1he lippocratic Oath mandates physicians to gie primordial consideration to the well-being o their patients. I a doctor ails to lie up to this precept,
he is accountable or his acts. 1his notwithstanding, courts ace a unique restraint in adjudicating medical negligence cases because physicians are not
guarantors o care and, they neer set out to intentionally cause injury to their patients. loweer, intent is immaterial in negligence cases because where
negligence exists and is proen, it automatically gies the injured a right to reparation or the damage caused.
1

In cases inoling medical negligence, the doctrine o re. i.a toqvitvr allows the mere existence o an injury to justiy a presumption o negligence on the
part o the person who controls the instrument causing the injury, proided that the ollowing requisites concur:
1. The accident is of a kind which ordinarily does not occur in the absence of someones negligence;
2. It is caused by an instrumentality within the exclusie control o the deendant or deendants, and
3. 1he possibility o contributing conduct which would make the plainti responsible is eliminated.
18

As to the first requirement, the gaping wound on Noras arm is certainly not an ordinary occurrence in the act o deliering a baby, ar remoed as the arm
is rom the organs inoled in the process o giing birth. Such injury could not hae happened unless negligence had set in somewhere.
Second, whether the injury was caused by the droplight or by the blood pressure cu is o no moment. Both instruments are deemed within the exclusie
control o the physician in charge under the "captain o the ship" doctrine. 1his doctrine holds the surgeon in charge o an operation liable or the
negligence of his assistants during the time when those assistants are under the surgeons control.
19
In this particular case, it can be logically inerred that
petitioner, the senior consultant in charge during the delivery of Noras baby, exercised control over the assistants assigned to both the use o the droplight
and the taking of Noras blood pressure. Hence, the use of the droplight and the blood pressure cuff is also within petitioners exclusive control.
Third, the gaping wound on Noras left arm, by its very nature and considering her condition, could only be caused by somethi ng external to her and
outside her control as she was unconscious while in hypoolemic shock. lence, Nora could not, by any stretch o the imagination, hae contributed to her
own injury.
Petitioners defense that Noras wound was caused not by the droplight but by the constant taking of her blood pressure, even i the latter was necessary
gien her condition, does not absole her rom liability. As testiied to by the medico-legal oicer, Dr. Arizala, Jr., the medical practice is to delate the
blood pressure cu immediately ater each use. Otherwise, the inlated band can cause injury to the patient similar to what could hae happened in this
case. Thus, if Noras wound was caused by the blood pressure cuff, then the taking of Noras blood pressure must have been done so negligently as to
hae inlicted a gaping wound on her arm,
20
or which petitioner cannot escape liability under the "captain o the ship" doctrine.
Further, petitioners argument that the failed plastic surgery was not intended as a cosmetic procedure, but rather as a measure to preent complication
does not help her case. It does not negate negligence on her part.
Based on the oregoing, the presumption that petitioner was negligent in the exercise o her proession stands unrebutted. In this connection, the Ciil
Code proides:
AR1. 216. \hoeer by act or omission causes damage to another, there being ault or negligence, is obliged to pay or the damage done.
AR1. 221. Moral damages include physical suering, mental anguish, right, serious anxiety, besmirched reputation, wounded eelings, moral shock,
social humiliation, and similar injury. 1hough incapable o pecuniary computation, moral damages may be recoered i they are the proximate result o the
defendants wrongful act or omission.
Clearly, under the law, petitioner is obliged to pay Nora or moral damages suered by the latter as a proximate result o petitioners negligence.
We note, however, that petitioner has served well as Noras obstetrician or her past three successul delieries. 1his is the irst time petitioner is being
held liable or damages due to negligence in the practice o her proession. 1he act that petitioner promptly took care o Noras wound before infection
and other complications set in is also indicative of petitioners good intentions. We also take note of the fact that Nora was suffering rom a critical
condition when the injury happened, such that saving her life became petitioners elemental concern. Nonetheless, it should be stressed that all these could
not justiy negligence on the part o petitioner.
lence, considering the speciic circumstances in the instant case, we ind no grae abuse o discretion in the assailed decision and resolution o the Court
o Appeals. Further, we rule that the Court of Appeals award of Two Hundred Thousand Pesos (P200,000, as moral damages in aor o respondents and
against petitioner is just and equitable.
21

WHLRLIORL, the petition is DLNILD. 1he Decision dated October 3, 2002 and Resolution dated Noember 19, 2003 o the Court o Appeals in
CA-G.R. CV No. 58184 are AIIIRMLD.
No pronouncement as to costs.
SO ORDLRLD.
G.R. No. J942S9 March J6, 20JJ
PLOPLL OI 1HL PHILIPPINLS, Plainti-Appellee,
s.
JIMMY ALVLRIO, Accused-Appellant.
D L C I S I O N
VLLASCO, JR., J.:
1he Case
1his is an appeal rom the March 25, 2010 Decision
1
o the Court o Appeals ,CA, in CA-G.R. CR-l.C. No. 00020, which airmed the August 26, 2004
Decision in Criminal Case No. CB-02-195 o the Regional 1rial Court ,R1C,, Branch 3 in Caibiran, Naal, Biliran.
2
1he R1C conicted accused Jimmy
Alerio ,Alerio, o rape.
1he Iacts
1he charge against Alerio stemmed rom the ollowing Inormation:
That on or about the 3rd day of June, 2002, at about 2:00 oclock early dawn, more or less, at [PPP],
3
Philippines, and within the jurisdiction o this
Honorable Court, while [AAA] was on her way to her grandmothers house from the benefit dance, herein accused, a cousin of herein complainant, with
lewd designs, and by means o orce and intimidation, get hold o her arm and did then and there drag her to the back o the barangay hall, by holding her
hair and forcibly laid her to the ground, willfully, unlawfully and feloniously poked her a short bladed weapon known as pisao forcibly took off her pants
and panty and succeeded in haing carnal knowledge with her against her will to her damage and prejudice.
Contrary to law.
4

On July 3, 2003, Alerio, with the assistance o his counsel de oicio, was arraigned, and he pleaded "not guilty" to the charge against him. Ater the pre-
trial, trial on the merits ensued.
During the trial, the prosecution oered the sole testimony o the priate complainant. On the other hand, the deense presented accused Alerio, lenry
1oledo ,1oledo,, and Lily 1oledo as its witnesses.
The Prosecutions Version of Facts
In the aternoon o June 2, 2002, AAA, along with her riends Belen Sabanag ,Sabanag, and Aileen Sinangote ,Sinangote,, went to the house o her
grandmother to attend a dance eent.
5
At around 8:30 in the eening, they proceeded to the dance hall because the dance would start at around 9
oclock.
6
During the dance, Sabanag and Sinangote danced with Alerio but AAA did not.

At 2 oclock in the morning of June 3, 2002, AAA noticed that


her friends were no longer at the dance so she decided to go home to her grandmothers house.
8

As she was nearing the barangay hall, Alerio suddenly appeared and took hold o AAA. She tried to resist him but he was too strong and he managed to
pull her away. AAA started to cry while she was being dragged towards the back o the barangay hall.
9
1here, Alerio held her hair, undressed her, and
started to kiss her.
10
AAA kept on resisting and een punched Alerio ater he kissed her, at which point, Alerio told her that it was painul and that he
might retaliate i she continued.
11
1his caused AAA to stop resisting and Alerio then proceeded to insert his penis in her agina repeatedly.
12

Ater haing carnal knowledge with her, Alerio stood up and put on his clothes. le warned AAA that i she told anyone about what happened, he will
kill her.
13
Ater threatening her, he let.
During this entire incident, Alverio was armed with a knife which he used to poke AAAs side.
Dazed, AAA could not muster enough strength to go home. She just sat on the road beside the barangay hall until 5 oclock in the morning when her
Uncle Intoy passed by. le brought her home to her parents but she did not tell him anything. Upon reaching home, AAA told her parents about what
happened.
14

Version o the Deense
Alverios defense, on the other hand, was confined to his denial of the accusation and an alibi, to wit:
Sometime around :30 in the eening o June 2, 2002, Alerio recalled that he was in the barangay chapel with his riend, 1ol edo, waiting or the dance to
begin.
15
1he dance hall was just adjacent to the barangay chapel. At 8:30 in the eening, the dance started. le danced with some persons whose names he
could no longer recall.
16
But he categorically remembered that he did not see AAA in the dance area.
1

At 12:00 midnight, Alverio and Toledo walked home to Toledos house, where Alverio was staying.
18
On their way home, they passed by the barangay
hall.
19
Upon reaching home, they slept and woke up at 5:30 in the morning o June 3, 2002.
20

In his testimony, Alerio admitted that he and AAA are cousins, their mothers being sisters.
21

lis testimony was corroborated by 1oledo
22
and Toledos mother, Lily Toledo.
23

Ruling o the 1rial Court
Ater trial, the R1C conicted Alerio. 1he dispositie portion o its August 26, 2004 Decision reads:
\lLRLlORL, premises considered, judgment is hereby rendered inding the accused JIMM\ ALVLRIO guilty beyond reasonable doubt o the crime
o rape. \ith no aggraating or mitigating circumstance, he is sentenced to the lesser penalty o reclusion perpetua, to indemniy |AAA| lity 1housand
,P50,000.00, Pesos, and to pay the costs.
SO ORDLRLD.
24

On appeal to the CA, Alverio disputed the trial courts finding of his guilt beyond reasonable doubt of the crime charged. He argued that the presumption
o innocence should preail especially considering that the prosecution only had a single testimony to support the charge o rape.
Ruling o the Appellate Court
On March 25, 2010, the CA airmed the judgment o the R1C. 1he dispositie portion o the CA Decision reads:
IN LIGl1 Ol ALL 1lL lORLGOING, the Decision o the Regional 1rial Court, Branch 3, Caibiran, Naal, Biliran in Criminal Case No. CB-02-195
conicting the accused-appellant is AllIRMLD with MODIlICA1ION in that he is also hereby adjudged liable to pay the ictim the amount o
Php50,000.00 as moral damages.
lis penalty o reclusion perpetua and the award o ciil indemnity o Php50,000.00 stands.
Costs against the accused-appellant.
SO ORDLRLD.
25

1he Issue
Alerio now comes beore this Court with the lone assignment o error contending that "|t|he trial court graely erred in inding the accused-appellant
guilty beyond reasonable doubt o rape."
26

The Courts Ruling
We sustain Alverios conviction.
In his Brie, Alerio argues that the trial court should hae taken the lone testimony o the complainant with caution and that the testimony should hae
been weighed careully, taking into consideration the constitutional precept that in all criminal prosecutions, the accused must be presumed innocent
unless the contrary is proed.
Alerio raises three ,3, grounds in support o his argument. lirst, he assails the trial court or giing credence to the sole testimony o the ictim. le
claims that the prosecution should hae presented other witnesses to corroborate the testimony o the ictim. Second, he contends that the medical
certiicate presented as eidence was not testiied to by the signatory himsel and should thereore not be considered as corroboratie eidence. Lastly, he
claims that the trial court graely erred in conicting him o the crime o rape or ailure o the prosecution to proe his guilt beyond reasonable doubt.
After a careful perusal of the records of this case, however, the Court is satisfied that the prosecutions evidence sufficiently established Alverios guilt with
moral certainty.
In People . Malate,
2
\e reiterated the principles with which courts are guided in determining the guilt or innocence o the accused in rape cases, iz:
x x x ,1, an accusation o rape can be made with acility and while the accusation is diicult to proe, it is een more diicult or the person accused,
though innocent, to disproe the charge, ,2, considering that, in the nature o things, only two persons are usually inoled in the crime o rape, the
testimony o the complainant should be scrutinized with great caution, and ,3, the eidence o the prosecution must stand or all on its own merit, and
cannot be allowed to draw strength rom the weakness o the eidence or the deense.
Moreoer, in that same case, this Court held that "in cases involving the prosecution for forcible rape x x x corroboration of the victims testimony is not a
necessary condition to a conviction for rape where the victims testimony is credible, or clear and convincing or suicient to proe the elements o the
oense beyond a reasonable doubt."
28
As such, appellate courts generally do not disturb the indings o the trial court with regard to the assessment o the
credibility o witnesses,
29
the reason being that the trial court has the "unique opportunity to obsere the witnesses irst hand and note their demeanor,
conduct and attitude under grilling examination."
30
More importantly, courts generally gie ull credence to the testimony o a complainant or rape,
especially one who is only a minor.
31

The exceptions to this rule are when the trial courts findings of facts and conclusions are not supported by the eidence on record, or when certain acts
o substance and alue likely to change the outcome o the case hae been oerlooked by the lower court, or when the assailed decision is based on a
misapprehension o acts.
32
loweer, this Court inds none o these exceptions present in the instant case.
1he ictim testiied in a steadast and straightorward manner, to wit:
PROS. JOCOBO:
Q Now can you tell now |since| there are no more persons around except you and the accused can tell to the Court, or were you able to reach in
the house o your lola
A \hen I was walking I was suddenly held by Jimmy Alerio.
Q \here were you already walking did Jimmy Alerio suddenly held you
A Near Brgy. lall o Brgy. Maurang.
Q \hat happened next ater you were held by Jimmy Alerio near the brgy. hall o Maurang
A le tried to pull me but then I resisted, and Jimmy insisted by pulling me until I cried.
Q 1hen een i you were already crying what next happened
A le drag me towards the back o the Brgy hall.
Q Did you in act drag to the brgy. hall
A \es sir.
Q \hile you were at the back o the brgy. hall can you tell this lonorable Court what happened
A |le| held my hair and he tried to undressed me but I resisted.
Q Since he tried to undressed |sic| you and you were resisted |sic| was he able or was he successul in undressing you
A \es sir.
Q Despite o your resistance
A \es sir.
Q \hen you were already undressed what happened, can you tell this to the lonorable Court
A le tried kissed |sic| me seeral times and I resisted and I boxed him.
Q Ater you hae boxed him ater kissing you what next happened
A le said that is painul I might retaliate with you.
Q Ater hearing on that what did Jimmy had done to you
A I just cried I did not mind him anymore.
Q low about Jimmy what was he doing
A le continued kissing me.
Q Ater kissing you what next ollow
A11\. SABANDAL:
I would like to request \our lonor that the prosecution would discontinue and encouraging ery much because its up to the witness to answer
\our lonor the question. Since preiously it would |seem| that the witness could be able to answer only ater so much question
PROS. JOBOCO:
\our lonor please according to the circular on examining minors we will to gie ull support and we to understand the minors especially i
ictims o minor cases.
A11\. SABANDAL:
It was not established that she is a minor, \our lonor.
COUR1:
She is 14 years old.
lROM 1lL COUR1:
Q Now you said that you were undressed by Jimmy Alerio, do you mean to say that you were already naked when you said undressed
A \es sir.
Q And when Jimmy Alerio kissing you seeral times were you already naked
A \es sir.
x x x x
Q \hat did Jimmy do more while he was kissing seeral times and you were naked
COUR1 IN1LRPRL1LR:
At this juncture \our lonor the witness is crying.
COUR1:
Q And when you were naked was Jimmy also naked
A \es sir.
x x x x
Q \ou were naked and Jimmy Alerio was also naked and Jimmy Alerio was kissing you so many times, what more did Jimmy Alerio do to
you
A le inserted his penis.
Q \hat were your position, were you standing, or you were lying down
A Lying position.
Q Or something was placed on the ground
A On the ground.
COUR1:
Alright Pros. Joboco you can proceed the continuation o your direct examination.
PROS. JOBOCO:
Q \hen you said when Jimmy Alerio was inserted his penis where was inserted
A to my agina.
Q And when Jimmy inserted his penis to your agina what did you eel
A I elt pain.
Q And when you elt pain what did you do
A I kept on crying.
PROS. JOBOCO:
I think that would be all \our lonor I think the witness already crying.
COUR1:
low many times did Jimmy insert his penis to your agina
A three ,3, times.
Q Ater the three ,3, times intercourse with you what did Jimmy do to you
A le stood up and he dressed himsel and he let me.
Q Did he not leae words to you
A le told me that i you will told anybody in your amily, your mother and your ather I will kill you.
Q \as she hae arm |sic| at that time o the incident
A \es sir.
Q \hat arm or irearm or what
A a knie.
Q Did he use that in orcing you to do the sexual acts
A \es sir.
Q By what means did he threatened you
A le poke it at my side.
Q Now what would you mean, he poke it at my side, what did you do
A I remain there crying.
33

It is strikingly clear from the above transcript that AAAs testimony was ery coherent and candid. 1hus, \e ind no reason to oerturn the indings o the
trial court.
In addition, Alerio submits that although the medical certiicate was presented as eidence, its contents were neer testii ed to by the signatory himsel
and, as such, cannot be considered as corroboratie o the claim o the ictim that she was raped.
Such argument, howeer, cannot prosper. Medical eidence is dispensable and merely corroboratie in proing the crime o rape. Besides, a medical
certiicate is not een necessary to proe the crime o rape.
34
1he graamen o rape is carnal knowledge o a woman through orce and intimidation.
35

1he elements needed to proe the crime o rape under paragraph 1,a, o Article 266-A o the Reised Penal Code are: ,1, the oender is a man, ,2, the
oender had carnal knowledge o a woman, and ,3, the act is accomplished by using orce or intimidation. All these elements were suiciently proed by
the prosecution. 1he testimony o AAA oerwhelmingly proes that Alerio raped her with the use o orce and intimidation.
lurthermore, Alverios defense of alibi cannot stand versus the positive identification of AAA. Nothing is more settled in criminal l aw jurisprudence than
the rule that alibi and denial cannot preail oer the positie and categorical testimony and identiication o the accused by the complainant.
36

Accordingly, \e ind that the prosecution has discharged its burden o proing the guilt o Alerio beyond reasonable doubt.
As to the award o damages, the CA was correct in awarding PhP 50,000 as moral damages without need o proo. loweer, in line with current
jurisprudence,
3
an additional award o PhP 30,000 as exemplary damages should likewise be gien, as well as interest o six percent ,6, per annum on all
damages awarded rom the inality o judgment until ully paid.
\lLRLlORL, the appeal is DLNILD. 1he CA Decision in CA-G.R. CR-l.C. No. 00020 inding accused-appellant Jimmy Alerio guilty o the crime
charged is AllIRMLD with MODIlICA1ION. As modiied, the ruling o the trial court should read as ollows:
\lLRLlORL, premises considered, judgment is hereby rendered inding the accused JIMM\ ALVLRIO guilty beyond reasonable doubt o the crime
o rape. \ith no aggraating or mitigating circumstance, he is sentenced to the lesser penalty o reclusion perpetua, to pay |AAA| lity 1housand
,P50,000.00, Pesos as ciil indemnity, lity 1housand ,P50,000.00, as moral damages and 1hirty 1housand ,P30,000.00, as exemplary damages with
interest o six percent ,6, per annum on all awards o damages rom the inality o judgment until ully paid, and to pay the costs.
SO ORDLRLD.
G.R. No. J306J2 May JJ, J999
PLOPLL OI 1HL PHILIPPINLS, plainti-appellee,
s.
BLRNARDINO DOMAN1AY, "JUNIOR O1O1," accused-appellant.
MLNDOZA, J.:
1his case is here on appeal rom the decision
J
o the Regional 1rial Court o Dagupan City ,Branch 5,, inding accused-appellant guilty o rape with
homicide and sentencing him to death, and to indemniy the heirs o the ictim in the amount o P480,000.00, and to pay the costs.
1he acts hark back to the aternoon o October 1, 1996, at around 4 o'clock, when the body o six-year old Jennier Domantay was ound sprawled
amidst a bamboo groe in Guilig, Malasiqui, Pangasinan. 1he child's body bore seeral stab wounds. Jennier had been missing since lunch time.
1he medical examination conducted the ollowing day by Dr. Ma. le Leticia Macaranas, the rural health physician o Malasiqui, showed that Jennier died
o multiple organ ailure and hypoolemic shock secondary to 38 stab wounds at the back. Dr. Macaranas ound no lacerations or signs o inlammation o
the outer and inner labia and the aginal walls o the ictim's genitalia, although the aginal canal easily admitted the little inger with minimal resistance.
Noting possible commission o acts o lasciiousness, Dr. Macaranas recommended an autopsy by a medico-legal expert o the NBI.
2

1he inestigation by the Malasiqui police pointed to accused-appellant Bernardino Domantay, a cousin o the ictim's grandather, as the lone suspect in
the gruesome crime. At around 6:30 in the eening o that day, police oicers Montemayor, de la Cruz, and de Guzman o the Malasiqui Philippine
National Police ,PNP, picked up accused-appellant at the Malasiqui public market and took him to the police station where accused-appellant, upon
questioning by SPO1 Antonio Lspinoza, conessed to killing Jennier Domantay. le likewise disclosed that at around 3:30 that aternoon, he had gien
the atal weapon used, a bayonet, to Llsa and Jorge Casingal, his aunt and uncle respectiely, in Poblacion Sur, Bayambang, Pangasinan. 1he next day,
October 18, 1996, SPO1 Lspinoza and another policeman took accused-appellant to Bayambang and recoered the bayonet rom a tricycle belonging to
the Casingal spouses. 1he police oicers executed a receipt to eidence the coniscation o the weapon.
3

On the basis o the post-mortem indings o Dr. Macaranas, SPO4 Juan Carpizo, the Philippine National Police chie inestigator at Malasiqui, iled, on
October 21, 1996, a criminal complaint or murder against accused-appellant beore the Municipal 1rial Court ,M1C, o Malasiqui. On October 25, 1996,
Dr. Ronald Bandonill, medico-legal expert o the NBI, perormed an autopsy on the embalmed body o Jennier. 1he result o his examination o the
ictim's genitalia indicated that the child's hymen had been completely lacerated on the right side. Based on this inding, SPO4 Carpizo amended the
criminal complaint against accused-appellant to rape with homicide. Subsequently, the ollowing inormation was iled:
4

1hat on or about the 1th day o October, 1996, in the aternoon, in barangay Guilig, Municipality o Malasiqui, proince o
Pangasinan, Philippines and within the jurisdiction o this lonorable Court, the aboe-named accused, with lewd design and armed
with a bayonnete, did then and there, wilully, unlawully and eloniously hae sexual intercourse with Jennier Domantay, a minor o
6 years old against her will and consent, and on the same occasion, the said accused with intent to kill, then and there, wilully,
unlawully and eloniously stab with the use o a bayonnete, the said Jennier Domantay, inlicting upon her multiple stab wounds,
which resulted to her death, to the damage and prejudice o her heirs.
At the trial, the prosecution presented seen witnesses, namely, Ldward, Jiezl, Lorenzo, all surnamed Domantay, Joselito Mejia, Antonio Lspinoza, Celso
Manuel, and Dr. Ronald Bandonill, to establish its charge that accused-appellant had raped and killed Jennier Domantay.
Ldward Domantay testiied that in the morning o October 1, 1996, accused-appellant and his two brothers-in-law, Jaime Caballero and Daudencio
Macasaeb, had a round o drinks in ront o the latter's house in Guilig, Malasiqui, Pangasinan. Ldward Domantay said that he was in ront o Macasaeb's
house, tending to some pigeons in his yard.
S
Ater the group had consumed seeral bottles o San Miguel gin, accused-appellant gae money to Ldward
Domantay and asked him to buy two bottles o gin and a bottle o Sprite.
6
Ldward said he joined the group and sat between Daudencio Macasaeb and
accused-appellant.
7
Ldward said that accused-appellant, who, apparently had one too many then, rolled up his shirt and said: "No diad Antipolo tan L|i|pa
et walay massacre, diad Guilig wala, walay massacren kod dia, walay onakis-akis" ,"In Antipolo and Lipa, there were massacres, here in Guilig, there will
also be a massacre. I will massacre somebody here, and they will cry and cry",. Ldward Domantay saw that tucked in the let side o accused-appellant's
waistline was a bayonet without a coer handle.
8
It was not the irst time that Ldward had seen accused-appellant with the knie as the latter usually carried
it with him.
9

Jiezl Domantay, 10, likewise testiied. She said that, at about 2 o'clock in the aternoon on October 1, 1996, she and our other children were playing in
ront o their house in Guilig, Malasiqui, Pangasinan. Jiezl saw accused-appellant and Jennier Domantay walking towards the bamboo groe o Amparo
Domantay where Jennier's body was later ound. Accused-appellant was about two meters ahead o Jennier. 1he bamboo groe was about 8 to 10 meters
rom the house o Jiezl Domantay.
J0

Lorenzo Domantay, a relatie o the ictim, corroborated Jiezl's testimony that accused-appellant had gone to Amparo Domantay's bamboo groe in the
aternoon o October 1, 1996. Lorenzo said that aternoon, on his way to his arm, he saw accused-appellant about 30 meters away, standing at the spot
in the bamboo groe where Jennier's body was later ound. Accused-appellant appeared restless and worried as he kept looking around. loweer, as
Lorenzo was in a hurry, he did not try to ind out why accused-appellant appeared to be nerous.
JJ

Prosecution witness Joselito Mejia, a tricycle drier, said that, in the aternoon o October 1, 1996, he was about to take his lunch at home in Alacan, a
neighboring barangay about hal a kilometer rom Guilig, when accused-appellant implored Mejia to take him to Malasiqui at once. Mejia told accused-
appellant that he was going to take his lunch irst, but the latter pleaded with him, saying they will not be gone or long. Mejia, thereore, agreed. Mejia
noticed that accused-appellant was nerous and araid. Accused-appellant later changed his mind. Instead o going to the town proper, he alighted near the
Mormon's church, outside Malasiqui.
J2

In addition, the prosecution presented SPO1 Antonio Lspinoza and Celso Manuel who testiied that, on separate occasions, accused-appellant had
conessed to the brutal killing o Jennier Domantay.
SPO1 Lspinoza testiied that he inestigated accused-appellant ater the latter had been brought to the Malasiqui police station in the eening o October
1, 1996. Beore he commenced his questioning, he apprised accused-appellant o his constitutional right to remain silent and to hae competent and
independent counsel, in Lnglish, which was later translated into Pangasinense.
J3
According to SPO1 Lspinoza, accused-appellant agreed to answer the
questions o the inestigator een in the absence o counsel and admitted killing the ictim. Accused-appellant also disclosed the location o the bayonet
he used in killing the ictim.
J4
On cross-examination, Lspinoza admitted that at no time during the course o his questioning was accused-appellant
assisted by counsel. Neither was accused-appellant's conession reduced in writing.
JS
Lspinoza's testimony was admitted by the trial court oer the
objection o the deense.
Celso Manuel, or his part, testiied that he is a radio reporter o station D\PR, an AM station based in Dagupan City. le coers the third district o
Pangasinan, including Malasiqui. Sometime in October 1996, an uncle o the ictim came to Dagupan City and inormed the station about Jennier
Domantay's case.
J6
On October 23, 1996, Manuel went to Malasiqui to interiew accused-appellant who was then detained in the municipal jail. le
described what transpired during the interiew thus:
J7

PROS. QUINI1:
Q Did you introduce yoursel as a media practitioner
A \es, sir.
Q low did you introduce yoursel to the accused
A I showed to Bernardino Domantay atia. "Junior Otot" my I.D. card and I presented mysel as a media
practitioner with my tape recorder |in| my hand, sir.
Q \hat was his reaction to your request or an interiew
A le was willing to state what had happened, sir.
Q \hat are those matters which you brought out in that interiew with the accused Bernardino
Domantay atia. "Junior Otot"
A I asked him what was his purpose or human interest's sake as a reporter, why did he commit that alleged
crime. And I asked also i he committed the crime and he answered "yes." 1hat's it.
xxx xxx xxx
PROS. QUINI1:
Q \ou mentioned about accused admitting to you on the commi|ssion| o the crime, how did you ask him that
A I asked him ery politely.
Q More or less what hae you asked him on that particular matter
A I asked "Junior Otot," Bernardino Domantay, "Kung pinagsisisihan mo ba ang iyong ginawa" "Opo" sabi
niya, "Ibig mo bang sabihin Jun, ikaw ang pumatay kay Jennier", "Ako nga po" 1he |l|ast part o my interiew,
"Kung nakikinig ang mga magulang ni Jennier, ano ang gusto mong iparating", "kung gusto nilang makamtan
ang hustisya ay tatanggapin ko". 1hat is what he said, and I also asked Junior Otot, what was his purpose, and he
said, it was about the boundary dispute, and he used that little girl in his reenge.
On cross-examination, Manuel explained that the interiew was conducted in the jail, about two to three meters away rom the police station. An uncle o
the ictim was with him and the nearest policemen present were about two to three meters rom him, including those who were in the radio
room.
J8
1here was no lawyer present. Beore interiewing accused-appellant, Manuel said he talked to the chie o police and asked permission to
interiew accused-appellant.
J9
On questioning by the court, Manuel said that it was the irst time he had been called to testiy regarding an interiew he
had conducted.
20
As in the case o the testimony o SPO1 Lspinoza, the deense objected to the admission o Manuel's testimony, but the lower court
allowed it.
Dr. Bandonill, the NBI medico-legal who conducted an autopsy o the ictim on October 25, 1996, testiied that Jennier Domantay died as a result o the
numerous stab wounds she sustained on her back,
2J
the aerage depth o which was six inches.
22
le opined that the wounds were probably caused by a
"pointed sharp-edged instrument."
23
le also noted on the aorehead, neck, and breast bone o the ictim.
24
As or the results o the genital examination
o the ictim, Dr. Bandonill said he ound that the laceration on the right side o the hymen was caused within 24 hours o her death. le added that the
genital area showed signs o inlammation.
2S

Paciico Bulatao, the photographer who took the pictures o the scene o the crime and o the ictim ater the latter's body was brought to her parents'
house, identiied and authenticated the ie pictures ,Lxhibits A, B, C, D, and L, oered by the prosecution.
1he deense then presented accused-appellant as its lone witness. Accused-appellant denied the allegation against him. le testiied he is an uncle o
Jennier Domantay ,he and her grandather are cousins, and that he worked as a janitor at the Malasiqui Municipal lall. le said that at around 1 o'clock in
the aternoon o October 1, 1996, he was bathing his pigs outside in the house o his brother-in-law Daudencio Macasaeb in Guilig, Malasiqui,
Pangasinan. le conirmed that Daudencio was then haing drinks in ront o his ,Macasaeb's, house. Accused-appellant claimed, howeer, that he did not
join in the drinking and that it was Ldward Domantay, whom the prosecution had presented as witness, and a certain Jaime Caballero who joined the
party. le also claimed that it was he whom Macasaeb had requested to buy some more liquor, or which reason he gae money to Ldward Domantay so
that the latter could get two bottles o gin, a bottle o Sprite, and a pack o cigarettes.
26
le denied Ldward Domantay's claim that he ,accused-appellant,
had raised his shirt to show a bayonet tucked in his waistline and that he had said he would massacre someone in Guilig.
27

Accused-appellant also conirmed that, at about 2 o'clock in the aternoon, he went to Alacan passing on the trail beside the bamboo groe o Amparo
Domantay. But he said he did not know that Jennier Domantay was ollowing him. le urther conirmed that in Alacan, he took a tricycle to Malasiqui.
1he tricycle was drien by Joselito Mejia. le said he alighted near the Mormon church, just outside o the town proper o Malasiqui to meet his brother.
As his brother did not come, accused-appellant proceeded to town and reported or work. 1hat night, while he was in the Malasiqui public market, he was
picked up by three policemen and brought to the Malasiqui police station where he was interrogated by SPO1 Lspinoza regarding the killing o Jennier
Domantay. le denied haing owned to the killing o Jennier Domantay to SPO1 Lspinoza. le denied he had a grudge against the ictim's parents
because o a boundary dispute.
28
\ith respect to his extrajudicial conession to Celso Manuel, he admitted that he had been interiewed by the latter, but
he denied that he eer admitted anything to the ormer.
29

As already stated, the trial court ound accused-appellant guilty as charged. 1he dispositie portion o its decision reads:
30

\lLRLlORL, in light o all the oregoing, the Court hereby inds the accused, Bernardino Domantay "Junior Otot" guilty
beyond reasonable doubt with the crime o Rape with lomicide deined and penalized under Article 335 o the Reised Penal Code
in relation and as amended by Republic Act No. 659 and accordingly, the Court hereby sentences him to suer the penalty o death
by lethal injection, and to indemniy the heirs o the ictim in the total amount o lour lundred Lighty 1housand Pesos
,P480,000.00,,
3J
and to pay the costs.
SO ORDLRLD.
In this appeal, accused-appellant alleges that:
32

I
1lL COUR1 . Q|O LRRLD IN APPRLCIA1ING 1lL LX1RAJUDICIAL CONlLSSION|S| MADL B\ 1lL ACCUSLD-
APPLLLAN1.
II
1lL COUR1 . Q|O LRRLD IN CONVIC1ING 1lL ACCUSLD DLSPI1L lAILURL Ol 1lL PROSLCU1ION 1O
PROVL lIS GUIL1 BL\OND RLASONABLL DOUB1.
ir.t. Accused-appellant contends that his alleged conessions to SPO1 Antonio Lspinoza and Celso Manuel are inadmissible in eidence because they had
been obtained in iolation o Art. III, 12,1, o the Constitution and that, with these ital pieces o eidence excluded, the remaining proo o his alleged
guilt, consisting o circumstantial eidence, is inadequate to establish his guilt beyond reasonable doubt.
33

Art. III, 12 o the Constitution in part proides:
,1, Any person under inestigation or the commission o an oense shall hae the right to be inormed o his right to remai n silent
and to hae competent and independent counsel preerably o his own choice. I the person cannot aord the serices o counsel, he
must be proided with one. 1hese rights cannot be waied except in writing and in the presence o counsel.
xxx xxx xxx
,3, Any conession or admission obtained in iolation o this section or section 1 hereo shall be inadmissible in eidence.
1his proision applies to the stage o custodial inestigation, that is, "when the inestigation is no longer a general inqui ry into an unsoled crime but starts
to ocus on a particular person as a suspect."
34
R.A. No. 438 has extended the constitutional guarantee to situations in which an indiidual has not been
ormally arrested but has merely been "inited" or questioning.
3S

Decisions
36
o this Court hold that or an extrajudicial conession to be admissible, it must satisy the ollowing requirements: ,1, it must be oluntary, ,2,
it must be made with the assistance o competent and independent counsel, ,3, it must be express, and ,4, it must be in writing.
In the case at bar, when accused-appellant was brought to the Malasiqui police station in the eening o October 1, 1996,
37
he was already a suspect, in
act the only one, in the brutal slaying o Jennier Domantay. le was, thereore, already under custodial inestigation and the rights guaranteed in Art. III,
12,1, o the Constitution applied to him. SPO1 Lspinoza narrated what transpired during accused-appellant's interrogation:
38

|I| interrogated Bernardino Domantay, prior to the interrogation conducted to him, I inormed him o his constitutional right as
ollows, that he has the right to remain silent, that he has the right to a competent lawyer o his own choice and i he can not aord |a
counsel| then he will be proided with one, and urther inormed |him| that all he will say will be reduced into writing and will be used
the same in the proceedings o the case, but he told me that he will cooperate een in the absence o his counsel, that he admitted to
me that he killed Jennier Domantay, and he reealed also the weapon used |and| where he gae |it| to.
But though he waied the assistance o counsel, the waier was neither put in writing nor made in the presence o counsel. lor this reason, the waier is
inalid and his conession is inadmissible. SPO1 Lspinoza's testimony on the alleged conession o accused-appellant should hae been excluded by the
trial court. So is the bayonet inadmissible in eidence, being, as it were, the "ruit o the poisonous tree." As explained i n Peote r. .ticavao:
39

. . . According to this rule, once the primary source ,the "tree", is shown to hae been unlawully obtained, any secondary or
deriatie eidence ,the "ruit", deried rom it is also inadmissible. Stated otherwise, illegally seized eidence is obtained as a direct
result o the illegal act, whereas the "ruit o the poisonous tree" is at least once remoed rom the illegally seized eidence, but it is
equally inadmissible. 1he rule is based the principle that eidence illegally obtained by the State should not be used to gain other
eidence because the originally illegal obtained eidence taints all eidence subsequently obtained.
\e agree with the Solicitor General, howeer, that accused-appellant's conession to the radio reporter, Celso Manuel, is admissible. In Peote r.
.vaav,
40
the accused in a rape with homicide case conessed to the crime during interiews with the media. In holding the conession admissible, despite
the act that the accused gae his answers without the assistance o counsel, this Court said:
4J

|A|ppellant's |oral| conessions to the newsmen are not coered by Section 12,1, and ,3, o Article III o the Constitution. 1he Bill o
Rights does not concern itsel with the relation between a priate indiidual and another indiidual. It goerns the relationship
between the indiidual and the State. 1he prohibitions therein are primarily addressed to the State and its agents.
Accused-appellant claims, howeer, that the atmosphere in the jail when he was interiewed was "tense and intimidating" and was similar to that which
preails in a custodial inestigation.
42
\e are not persuaded. Accused-appellant was interiewed while he was inside his cell. 1he interiewer stayed
outside the cell and the only person besides him was an uncle o the ictim. Accused-appellant could hae reused to be interiewed, but instead, he
agreed. le answered questions reely and spontaneously. According to Celso Manuel, he said he was willing to accept the consequences o his act.
Celso Manuel admitted that there were indeed some police oicers around because about two to three meters rom the jail were the police station and the
radio room.
43
\e do not think the presence o the police oicers exerted any undue pressure or inluence on accused-appellant and coerced him into
giing his conession.
Accused-appellant contends that "it is . . . not altogether improbable or the police inestigators to ask the police reporter ,Manuel, to try to elicit some
incriminating inormation rom the accused."
44
1his is pure conjecture. Although he testiied that he had interiewed inmates beore, there is no eidence
to show that Celso was a police beat reporter. Len assuming that he was, it has not been shown that, in conducting the interiew in question, his purpose
was to elicit incriminating inormation rom accused-appellant. 1o the contrary, the media are known to take an opposite stance against the goernment by
exposing oicial wrongdoings.
Indeed, there is no showing that the radio reporter was acting or the police or that the interiew was conducted under circumstances where it is apparent
that accused-appellant conessed to the killing our o ear. As already stated, the interiew was conducted on October 23, 1996, 6 days ater accused-
appellant had already conessed to the killing to the police.
Accused-appellant's extrajudicial conession is corroborated by eidence o corv. aeticti, namely, the act o death o Jennier Domantay. In addition, the
circumstantial eidence urnished by the other prosecution witnesses doetails in material points with his conession. le was seen walking toward the
bamboo groe, ollowed by the ictim. Later, he was seen standing near the bamboo groe where the child's body was ound. Rule 133 o the Reised
Rules on Lidence proides:
3. tra;vaiciat covfe..iov, vot .vfficievt grovva for covrictiov. An extrajudicial conession made by an accused, shall not be suicient
ground or coniction, unless corroborated by eidence ocorv. aeticti.
4. riaevce vece..ar, iv trea.ov ca.e.. No person charged with treason shall be conicted unless on the testimony o two witnesses to
the same oert act, or on conession in open court.
Accused-appellant argues that it was improbable or a brutal killing to hae been committed without the children who were playing about eight to ten
meters rom Amparo Domantay's groe, where the crime took place, haing heard any commotion.
4S
1he contention has no merit. Accused-appellant
could hae coered the young child's mouth to preent her rom making any sound. In act, Dr. Bandonill noted a ie by two inch ,5" x 2", contusion on
the let side o the ictim's orehead, which he said could hae been caused by a hard blunt instrument or by impact as her head hit the ground.
46
1he
blow could hae rendered her unconscious, thus precluding her rom shouting or crying.
Accused-appellant also contends that the testimony o Jiezl Domantay contradicts that o Lorenzo Domantay because while Jiezl said she had seen
accused-appellant walking towards the bamboo groe, ollowed by the ictim, at around 2 o'clock in the aternoon on October 1, 1996. Lorenzo said he
saw accused-appellant standing near the bamboo groe at about the same time.
1hese witnesses, howeer, did not testiy concerning what they saw exactly the same time. \hat they told the court was what they had seen "at around" 2
o'clock in the aternoon. 1here could hae been a between dierence in time, howeer little it was, between the time Jiezl saw accused-appellant and the
ictim walking and the time Lorenzo saw accused-appellant near the place where the ictim's body was later ound. lar rom contradicting each other,
these witnesses conirmed what each had said each one saw. \hat is striking about their testimonies is that while Jiezl said she saw accused-appellant going
toward the bamboo groe ollowed by the ictim "at around" 2 o'clock in the aternoon on October 1, 1996, Lorenzo said he had seen accused-appellant
near the bamboo groe "at around" that time. le described accused-appellant as nerous and worried. 1here is no reason to doubt the claim o these
witnesses. Lorenzo is a relatie o accused-appellant. 1here is no reason he would testiied alsely against the latter. Jiezl, on the other hand, is also
surnamed Domantay and could also be related to accused-appellant and has not been shown to hae any reason to testiy alsely against accused-appellant.
At the time o the incident, she was only 10 years old.
lor the oregoing reasons, the Court is coninced o accused-appellant's guilt with respect to the killing o the child. It is clear that the prosecution has
proen beyond reasonable doubt that accused-appellant is guilty o homicide. Art. 249 o the Reised Penal Code proides:
Any person who, not alling within the proisions o Article 246 |parricide| shall kill another without the attendance o any o the
circumstances enumerated in the next preceding article |murder|, shall be deemed guilty o homicide and be punished by rectv.iov
tevorat.
1he killing was committed with the generic aggraating circumstance o abuse o superior strength. 1he record shows that the ictim, Jennier Domantay,
was six years old at the time o the killing. She was a child o small build, 46" in height.
47
It is clear then that she could not hae put up much o a deense
against accused-appellant's assault, the latter being a ully grown man o 29 years. Indeed, the physical eidence supports a inding o abuse o superior
strength: accused-appellant had a weapon, while the ictim was not shown to hae had any, there were 38 stab wounds, and all the knie wounds are
located at the back o Jennier's body.
But we think the lower court erred in inding that the killing was committed with cruelty.
48
1he trial court appears to hae been led to this conclusion by
the number o wounds inlicted on the ictim. But the number o wounds is not a test or determining whether there was circumstance.
49
"1he rest . . . is
whether the accused deliberately and sadistically augmented the ictim's suering thus . . . there must be proo that the ictim was made to agonize beore
the |the accused| rendered the blow which snued out |her| lie."
S0
In this case, there is no such proo o cruelty. Dr. Bandonill testiied that any o the
major wounds on the ictim's back could hae caused her death as they penetrated her heart, lungs and lier, kidney and intestines.
SJ

ecova. 1here is, howeer, no suicient eidence to hold accused-appellant guilty o raping Jennier Domantay. Art. 335. o the Reised Penal Code, as
amended, in part proides:
Art. 335. !bev ava bor rae i. covvittea. Rape is committed by haing carnal knowledge o a woman under any o the ollowing
circumstances.
1. By using orce or intimidation,
2. \hen the woman is deprie o reason or otherwise unconscious, and
3. \hen the woman is under twele years o age or is demented.
As the ictim here was six years old, only carnal knowledge had to be proed to establish rape. Carnal knowledge is deined as the act o a man
haing sexual intercourse or sexual bodily connections with a woman.
S2
lor this purpose, it is enough i there was een the slightest contact o
the male sex organ with the labia o the ictim's genitalia.
S3
loweer, there must be proo, by direct or indirect eidence, o such contact.
Dr. Ronald Bandonill's report on the genital examination he had perormed on the deceased reads:
S4

GLNI1AL LXAMINA1ION, showed a complete laceration o the right side o the hymen. 1he surrounding genital area shows signs
o inlammation.
xxx xxx xxx
RLMARKS: 1, lindings at the genital area indicate the probability o penetration o that area by a hard, rigid instrument.
lymenal laceration is not necessary to proe rape,
SS
neither does its presence proe its commission. As held inPeote r. |titi,
S6
a medical certiicate or the
testimony o the physician is presented not to proe that the ictim was raped but to show that the latter had lost her irgi nity. Consequently, standing
alone, a physician's inding that the hymen o the alleged ictim was lacerated does not proe rape. It is only when this is corroborated by other eidence
proing carnal knowledge that rape may be deemed to hae been established.
S7

1his conclusion is based on the medically accepted act that a hymenal tear may be caused by objects other than the male sex organ
S8
or may arise rom
other causes.
S9
Dr. Bandonill himsel admitted this. le testiied that the right side o the ictim's hymen had been completely lacerated whi le the
surrounding genital area showed signs o inlammation.
60
le opined that the laceration had been inlicted within 24 hours o the ictim's death and that
the inlammation was due to a trauma in that area.
6J
\hen asked by the priate prosecutor whether the lacerations o the hymen could hae been caused
by the insertion o a male organ he said this was possible. But he also said when questioned by the deense that the lacerati ons could hae been caused by
something blunt other than the male organ. 1hus, he testiied:
62

PROS. l. QUINI1:
Q ^or, rbat vigbt bare cav.ea tbe covtete taceratiov of tbe rigbt .iae of tbe b,vev,aoctor
A \ell, sir, i you look at my report there is a remark and it says there, fivaivg. at tbe gevitat area ivaicatea tbe
robabitit, of evetratiov of tbat area b, a bara rigia iv.trvvevt.
Q Could it hae been caused by a human organ
A f tbe bvvav vate orgav i. erect, fvtt, erect ava bara tbev it i. o..ibte, .ir.
xxx xxx xxx
A11\. VALDLZ:
Q In your remarks, inding at the genital area indicates the probability o penetration o that area by a hard rigid
instrument, tbi. va, bare at.o beev cav.ea b, a aagger v.ea iv tbe /ittivg of ]evvifer Dovavta, i. tbat correct
A !ett, .ir rbev .a, bara rigia iv.trvvevt it .bovta vot be .bar oivtea ava .bare rigia, it .bovta be a bara btvvt iv.trvvevt.
Q Do you consider a bolo a bl|u| instrument, or a dagger
A 1he dagger is a sharp rigid but it is not a bl|u|nt instrument, sir.
Q 1bi. Cevitat avivatiov .borea a covtete taceratiov of tbe rigbt .iae of tbe b,vev, tbi. va, bare beev o..ibt, cav.ea b, a
aagger, i. it vot
A ^o, .ir. I won't say that this would hae been caused by a dagger, because a dagger would hae made at its
incision . . . not a laceration, sir.
Q vt tbi. taceratiov va, at.o bare beev cav.ea b, otber factor. otber tbe bvvav vate orgav, i. tbat correct
A A hard bl|u|nt instrument, sir could show.
Q My question is other than the human male organ
A Po..ibte, .ir.
xxx xxx xxx
COUR1:
Q \ou mentioned that the hymen was lacerated on the right side
A \es, your lonor.
Q .va if tbere i. a covtete erectiov b, a bvvav orgav i. tbi. o..ibte tbat tbe taceratiov cav ovt, be ov tbe rigbt .iae of tbe b,vev
A \es, your lonor, its possible.
Q low about i the penetration was done by a inger, was it the same as the human organ
A \ell, it deends on the size o the inger that penetrat|es| that organ, i the inger is small it could the
supericial laceration, and i the inger is large then it is possible your honor.
Q low about two ingers
A Possible, sir.
1o be sure, this Court has sustained a number o conictions or rape with homicide based on purely circumstantial eidence. In those instances, howeer,
the prosecution was able to present other tell-tale signs o rape such as the location and description o the ictim's clothings, especially her undergarments,
the position o the body when ound and the like.
63
In Peote r. Macativo,
64
or instance, the Court airmed a coniction or the rape o a two-year old
child on the basis o circumstantial eidence.
6S

1he Court notes that the testimony or medical opinion o Dr. Gajardo that the resh laceration had been produced by sexual
intercourse is corroborated by the testimony gien by complainant. Llizabeth that when she rushed upstairs upon hearing her
daughter suddenly cry out, she ound appellant Macalino beside the child buttoning his own pants and that she ound some sticky
luid on the child's buttocks and some blood on her priate part.,Lmphasis in the original,
In contrast, in the case at bar, there is no circumstantial eidence rom which to iner that accused-appellant sexually abused the ictim. 1he only
circumstance rom which such inerence might be made is that accused-appellant was seen with the ictim walking toward the place where the girl's body
was ound. 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 rom which it might reasonably be inerred that he abused her, e.g., that he was zipping up his pants, that there was
spermatozoa in the girl's aginal canal.
Indeed, the ery autopsy report o Dr. Bandonill militates against the inding o rape. In describing the stab wounds on the body o the ictim, he
testiied:
66

|A|ter examining the body I took note that were seeral stab wounds . . . these were all ound at the back area sir . . . extending rom
the back shoulder down to the lower back area rom the let to the right.
Considering the relatie physical positions o the accused and the ictim in crimes o rape, the usual location o the external bodily injuries o
the ictim is on the ace,
67
neck,
68
and anterior portion
69
o her body. Although it is not unnatural to ind contusions on the posterior side,
these are usually caused by the downward pressure on the ictim's body during the sexual assault.
70
It is unquestionably dierent when, as in
this case, all the stab wounds ,except or a minor cut in the lower let leg, had their entry points at the back running rom the upper let shoulder
to the lower right buttocks.
It is noteworthy that the deceased was ully clothed in blue shorts and white shirt when her body was immediately ater it was ound.
7J
lurthermore, there
is a huge bloodstain in the back portion o her shorts.
72
1his must be because she wearing this piece o clothing when the stab wounds were inlicated or
immediately thereater, thus allowing the blood to seep into her shorts to such an extent. As accused-appellant would naturally hae to pull down the girl's
lower garments in order to consummate the rape, then, he must hae, regardless o when the stab wounds were inlicted, pulled up the ictim's shorts and
undergarments ater the alleged rape, otherwise, the ictim's shorts would not hae been stained so extensiely. Again, this is contrary to ordinary human
experience.
Len assuming that Jennier had been raped, there is no suicient proo that it was accused-appellant who had raped her. le did not coness to haing
raped the ictim.
lrom the oregoing, we cannot ind that accused-appellant also committed rape. In the special complex crime o rape with homicide, both the rape and
the homicide must be established beyond reasonable doubt.
73

1bira. 1he trial court ordered accused-appellant to pay the heirs o Jennier Domantay the amount o P30,000.00 as actual damages. loweer, the list o
expenses produced by the ictim's ather, Jaime Domantay, only totaled P28,430.00. O this amount, only P12,000.00 was supported by a receipt. Art.
2199 o the Ciil Code proides that a party may recoer actual or compensatory damages only or such loss as he has duly proed. 1hereore, the award
o actual damages should be reduced to P12,000.00.
In addition, the heirs o Jennier Domantay are entitled to recoer exemplary damages in iew o the presence o the aggraating circumstance o abuse o
superior strength. Art. 2230 o the Ciil Code proides or the payment o exemplary damages when the crime is committed with one or more aggraating
circumstance. An amount o P25,000.00 is deemed appropriate.
74

In accordance with our rulings in Peote r. Robte.
7S
and Peote r. Mevgote,
76
the indemnity should be ixed at P50,000.00 and the moral damages at
P50,000.00.
77

\lLRLlORL, the judgment o the trial court is SL1 ASIDL and another one is rendered lINDING accused-appellant guilty o homicide with the
aggraating circumstance o abuse o superior strength and sentencing him to a prison term o 12 years o ri.iov va,or, as minimum, to 20 years o rectv.iov
tevorat, as maximum, and ORDLRING him to pay the heirs o Jennier Domantay the amounts o 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.1rbi1.vt
SO ORDLRLD.
G.R. No. JS9738 December 9, 2004
UNION MO1OR CORPORA1ION, petitioner,
s.
NA1IONAL LABOR RLLA1IONS COMMISSION and ALLJANDRO A. L1IS, respondents.
D L C I S I O N
CALLLJO, SR., J.:
1his is a petition or reiew on certiorari iled by petitioner Union Motor Corporation o the April 10, 2003 Decision
1
o the Court o Appeals ,CA, in CA-
G.R. SP No. 3602 which airmed the decision o the National Labor Relations Commission ,NLRC, holding that respondent Alejandro A. Ltis was
illegally dismissed rom his employment.
On October 23, 1993, the respondent was hired by the petitioner as an automotie mechanic at the serice department in the latters Paco Branch. In
1994, he was transerred to the Caloocan City Branch, where his latest monthly salary was P6,330.00. During his employment, he was awarded the "1op
1echnician" or the month o May in 1995 and 1echnician o the \ear ,1995,. le also became a member o the Lxclusie P40,000.00 Club and receied
the Model Lmployee Award in the same year.
On September 22, 199, the respondent made a phone call to Rosita dela Cruz, the company nurse, and inormed her that he had to take a sick leae as he
had a painul and unbearable toothache. 1he next day, he again phoned Dela Cruz and told her that he could not report or work because he still had to
consult a doctor. Finding that the respondents ailment was due to a tooth inflammation, the doctor referred him to a dentist or urther management.
2
Dr.
Rodolfo Pamor, a dentist, then scheduled the respondents tooth extraction on September 27, 1997, hoping that, by that time, the inlammation would
hae subsided. Upon instructions rom the management, Mr. Dumagan, a company security guard, isited the respondent in his house on September 24,
199 and conirmed that the latter was ill.
On September 27, 1997, Dr. Pamor rescheduled the respondents tooth extraction on October 4, 199 because the inlammation had not yet subsided and
recommended that he rest. 1hus, the respondent was not able to report or work due to the painul and unbearable toothache.
On October 2, 199, the petitioner issued an Inter Oice Memorandum
3
through Angelo B. Nicolas, the manager o its luman Resources Department,
terminating the serices o the respondent or haing incurred more than ie ,5, consecutie absences without proper notiication. 1he petitioner
considered the consecutie absences o the respondent as abandonment o oice under Section 6.1.1, Article III o the Company Rules.
On October 4, 199, Dr. Pamor successfully extracted the respondents tooth. As soon as he had recovered, the respondent reported for work, but was
denied entry into the companys premises. He was also informed that his employment had already been terminated. The respondent sought help rom the
union which, in turn, included his grieance in the arbitration beore the National Conciliation and Mediation Board ,NCMB,. Pending the resolution
thereo, the respondent wrote to the petitioner asking or the reconsideration o his dismissal,
4
which was denied. Sometime thereafter, the unions
complaints were dismissed by the NCMB.
Let with no other recourse, the respondent iled, on May 18, 1999, a complaint or illegal dismissal beore the arbitration branch o the NLRC against the
petitioner and,or Benito Cua, docketed as NLRC-NCR Case No. 00-05-05691-99.
5

1he respondent alleged that he was dismissed rom his employment without just and legal basis. lor its part, the petitioner aerred that his dismissal was
justiied by his ten ,10, unauthorized absences. It posited that, under Article 282 o the Labor Code, an employees gross and habitual neglect of his duties
is a just cause for termination. It further alleged that the respondents repetitive and habitual acts of being absent without notiication constituted nothing
less than abandonment, which is a orm o neglect o duties.
6

On October 19, 2000, the Labor Arbiter rendered a Decision dismissing the complaint. 1he Labor Arbiter ruled that the respondents failure to report or
work or ten ,10, days without an approed leae o absence was equialent to gross neglect o duty, and that his claim that he had been absent due to
seere toothache leading to a tooth extraction was unsubstantiated. 1he Labor Arbiter stressed that "unnotarized medical certiicates were sel-sering and
had no probatie weight."
Aggrieed, the respondent appealed the decision to the NLRC, docketed as NLRC NCR CA No. 02002-01. le alleged therein that
I
1lL lONORABLL LABOR ARBI1LR COMMI11LD GRAVL ABUSL Ol DISCRL1ION IN DISMISSING 1lL COMPLAIN1.
II
1lLRL ARL SLRIOUS LRRORS IN 1lL lINDINGS Ol lAC1S \lICl \OULD CAUSL GRAVL OR IRRLPARABLL DAMAGL
OR INJUR\ 1O lLRLIN COMPLAINAN1.


On Noember 29, 2001, the NLRC issued a Resolution reersing the decision o the Labor Arbiter. 1he dispositie portion o the resolution reads:
\lLRLlORL, the assailed decision dated October 19, 2000 is SL1 ASIDL and RLVLRSLD. Accordingly, the respondent-appellee is hereby
ordered to immediately reinstate complainant to his ormer position without loss o seniority rights and other beneits and payment o his ull
backwages rom the time o his actual dismissal up to the time o his reinstatement.
All other claims are dismissed or lack o merit.
8

1he NLRC upheld the claim o the respondent that his successie absences due to seere toothache was known to management. It ruled that the medical
certificates issued by the doctor and dentist who attended to the respondent substantiated the latters medical problem. It also declared that the lack o
notarization o the said certiicates was not a valid justification for their rejection as evidence. The NLRC declared that the respondents absence for ten
,10, consecutie days could not be classiied as gross and habitual neglect o duty under Article 282 o the Labor Code.
1he NLRC resoled to deny the motion or reconsideration o the petitioner, per its Resolution
9
dated August 26, 2002.
1he petitioner, thereater, iled a petition or certiorari under Rule 65 o the Rules o Court beore the CA, docketed as CA-G.R. SP No. 3602. It raised
the ollowing issues:
\hether or not the public respondent graely abused it|s| discretion, amounting to lack or excess o jurisdiction in reersing the decision o the
labor arbiter a quo and inding that priate respondent Alejandro A. Ltis was illegally dismissed.
\hether or not public respondent graely abused its discretion in reinstating priate respondent Alejandro A. Ltis to his ormer position
without loss o seniority rights and awarding him ull backwages.
10

In its Decision
11
dated April 10, 2003, the CA airmed in toto the Noember 29, 2001 Resolution o the NLRC.
1he CA agreed with the ruling o the NLRC that medical certiicates need not be notarized in order to be admitted in eidence and accorded ull probatie
weight. It held that the medical certiicates which bore the names and licenses o the doctor and the dentist who attended to the respondent adequately
substantiated the latters illness, as well as the tooth extraction procedure performed on him by the dentist. The CA concluded that since the respondents
absences were substantiated, the petitioners termination of his employment was without legal and factual basis.
1he CA similarly pointed out that een i the ten-day absence o the respondent was unauthorized, the same was not equialent to gross and habitual
neglect of duty. The CA took into consideration the respondents unblemished service, from 1993 up to the time of his dismissal, and the latters proven
dedication to his job eidenced by no less than the ollowing awards: 1op 1echnician o the \ear ,1995,, Member o the Lxclusie P40,000.00 Club, and
Model Lmployee o the \ear ,1995,.
1he motion or reconsideration o the petitioner was denied by the appellate court. lence, the petition at bar.
1he petitioner raises the following issues for the Courts resolution:
I
\lL1lLR OR NO1 1lL lONORABLL COUR1 Ol APPLALS COMMI11LD RLVLRSIBLL LRROR IN GIVING MUCl
LVIDLN1IAR\ \LIGl1 1O 1lL MLDICAL CLR1IlICA1LS SUBMI11LD B\ 1lL PRIVA1L RLSPONDLN1.
II
\lL1lLR OR NO1 1lL lONORABLL LABOR ARBI1LR COMMI11LD A RLVLRSIBLL LRROR IN RULING 1lA1 PRIVA1L
RLSPONDLN1 \AS ILLLGALL\ DISMISSLD.
12

As had been enunciated in numerous cases, the issues that can be deled with in a petition or reiew under Rule 45 are limited to questions o law. 1he
Court is not tasked to calibrate and assess the probatie weight o eidence adduced by the parties during trial all oer again.
13
\ell-established is the
principle that indings o act o quasi-judicial bodies, like the NLRC, are accorded with respect, een inality, i supported by substantial
eidence.
14
loweer, i, as in this case, the indings o the Labor Arbiter clash with those o the NLRC and CA, this Court is compelled to go oer the
records o the case, as well as the submissions o the parties, and resole the actual issues.
The petitioner avers that the respondents absences were unauthorized, and that the latter failed to notify the petitioner in writing o such absences, the
reasons thereor, and his (respondents) whereabouts as prescribed by the company rules. The petitioner avers that its security guard caught the respondent
at home, it to work. 1he petitioner urther asserts that it was justiied in dismissing the respondent under Section 6.1.1, Article III o the Company Rules
which reads:
An employee who commits unauthorized absences continuously or ie ,5, consecutie working days without notice shall be considered as
haing abandoned his job and shall be terminated or cause with applicable laws.
The petitioner contends that the respondents dismissal was also justified under Article 282(b) of the Labor Code, which provides that an employer may
dismiss an employee due to gross and habitual neglect o his duties.
1he contention o the petitioner has no merit.
1he NLRC ruled that the respondent notiied the petitioner o his illness through the company nurse, and that the petitioner een dispatched a security
guard to the respondents house to ascertain the reason of his absences, thus:
1he termination by respondent-appellee of complainants service despite knowledge of complainants ailment, as shown by the telephone calls
made by the latter to the company nurse and the actual confirmation made by respondents company guard, who personally visi ted
complainants residence, clearly establishes the illegality of complainants dismissal. The documentary testimonies of the nurse, Miss Rosita dela
Cruz, regarding complainants telephone calls and the confirmation made by respondents security guard, Mr. Dumagan, are eidentiary matters
which are releant and material and must be considered to the ullest by the Labor Arbiter a quo. 1hese circumstantial acts were miserably set
aside by the Labor Arbiter a quo wherein he concluded that complainant committed gross neglect o duty on alleged continued absences is to
our mind, not ully substantiated and ought not be gien credence by this Commission. 1ime and again, this 1ribunal impresses that, in labor
proceedings, in case o doubt, the doubt must be reasonably in aor o labor. Maybe doubts hang in this case but these doubts must be
resoled in aor o labor as mandated by law and our jurisprudence. lrom the acts o this case, it is only but reasonable to conclude that
complainants service was, indeed, terminated without legal or alid cause. \here the law protects the right o employer to alidly exercise
management prerogatie such as to terminate the serices o an employee, such exercise must be with legal cause as enumerated in Article 282
o the Labor Code or by authorized cause as deined in Article 283 o the Labor Code.
15

1he CA airmed the indings o acts o the NLRC.
\e agree with the rulings of the NLRC and the CA. We note that the company rules do not require that the notice of an employees absence and the
reasons thereor be in writing and or such notice to be gien to any speciic oice and,or employee o the petitioner. lence, the notice may be erbal, it
is enough then that an oicer or employee o the petitioner, competent and responsible enough to receie such notice or and in behal o the petitioner,
was inormed o such absence and the corresponding reason.
1he eidence on record shows that the respondent inormed the petitioner o his illness through the company nurse. 1he security guard who was
dispatched by the petitioner to verify the information received by the company nurse, confirmed the respondents illness. We ind and so hold that the
respondent complied with the requisite o giing notice o his illness and the reason or his absences to the petitioner.
We reject the petitioners contention that the medical certificates adduced in evidence by the respondent to prove (a) his illness, the nature and the
duration o the procedures perormed by the dentist on him, and ,b, the period during which he was incapacitated to work are inadmissible in eidence
and barren o probatie weight simply because they were not notarized, and the medical certiicate dated September 23, 199 was not written on paper
bearing the dentists letterhead. Neither do we agree with the petitioners argument that even assuming that the respondent was ill and had been adised by
his dentist to rest, the same does not appear on the medical certiicate dated September 23, 199, hence, it behooed the respondent to report or work on
September 23, 199. 1he ruling o the Court in Maligsa . Atty. Cabanting
16
is not applicable in this case.
It bears stressing that the petitioner made the same arguments in the NLRC and the CA, and both tribunals ruled as ollows:
lirst, \e concur with the ratiocination o respondent NLRC when it ruled that a medical certiicate need not be notarized, to quote:
xxx. le was dismissed by reason o the act that the Medical Certiicate submitted by the complainant should not be gien credence
or not being notarized and that no aidait was submitted by the nurse to proe that the complainant, indeed, called the
respondents office by telephone.
Ater ull scrutiny and judicious ealuation o the records o this case, \e ind the appeal to be meritorious. Regrettably, the Labor
Arbiter a quo clearly failed to appreciate complainants pieces of evidence. Nowhere in our jurisprudence requires that all medical
certiicates be notarized to be accepted as a alid eidence. In this case, there is |neither| diiculty nor an obstacle to claim that the
medical certiicates presented by complainant are genuine and authentic. Indeed, the physician and the dentist who examined the
complainant, aside rom their respectie letterheads, had written their respectie license numbers below their names and signatures.
1hese acts hae not been impugned nor rebutted by respondent-appellee throughout the proceedings o his case. Common sense
dictates that an ordinary worker does not need to hae these medical certiicates to be notarized or proper presentation to his
company to proe his ailment, hence, the Labor Arbiter a quo, in cognizance with the liberality and the appreciation on the rules on
eidence, must not negate the acceptance o these medical certiicates as alid pieces o eidence.
We believe, as we ought to hold, that the medical certificates can prove clearly and convincingly the complainants allegation that he
consulted a physician because o tooth inlammation on September 23, 199 and a dentist who later adised him to rest and, thus,
clinically extended his tooth extraction due to seere pain and inlammation. Admittingly, it was only on October 4, 199 that
complainants tooth was finally extracted.

lrom these disquisitions, it is clear that the absences o priate respondent are justiiable.
1

\e agree with the NLRC and the appellate court. In light o the indings o acts o the NLRC and the CA, the petitioner cannot ind solace in the ruling
o this Court in Maligsa . Atty. Cabantnig.
18

\hile the records do not reeal that the respondent iled the required leae o absence or the period during which he suered rom a toothache, he
immediately reported or work upon recoery, armed with medical certiicates to attest to the cause o his absence. 1he respondent could not hae
anticipated the cause o his illness, thus, to require prior approal would be unreasonable.
19
\hile it is true that the petitioner had objected to the eracity
o the medical certiicates because o lack o notarization, it has been said that eriication o documents is not necessary in order that the said documents
could be considered as substantial eidence.
20
1he medical certiicates were properly signed by the physicians, hence, they bear all the earmarks o
regularity in their issuance and are entitled to ull probatie weight.
21

1he petitioner, likewise, ailed to proe the actual basis or its dismissal o the respondent on the ground o gross and habitual negligence under Article
282,b, o the Labor Code o the Philippines, or een under Section 6.1.1, Rule III o the Company Rules.
Dismissal is the ultimate penalty that can be meted to an employee. 1hus, it must be based on just cause and must be supported by clear and conincing
eidence.
22
1o eect a alid dismissal, the law requires not only that there be just and alid cause or termination, it, likewise, enjoins the employer to
aord the employee the opportunity to be heard and to deend himsel.
23
Article 282 o the Labor Code enumerates the just causes or the termination o
employment by the employer:
AR1. 282. 1LRMINA1ION B\ LMPLO\LR
An employer may terminate an employment or any o the ollowing causes:
,a, Serious misconduct or willul disobedience by the employee o the lawul orders o his employer or representatie in connection with his
work,
,b, Gross and habitual neglect by the employee o his duties.
1o warrant remoal rom serice, the negligence should not merely be gross but also habitual. Gross negligence implies a want or absence o or ailure to
exercise slight care or diligence, or the entire absence o care. It einces a thoughtless disregard o consequences without exerting any eort to aoid
them.
24
1he petitioner has not suiciently shown that the respondent had willully disobeyed the company rules and regulation. 1he petitioner also ailed
to proe that the respondent abandoned his job. 1he bare act that the respondent incurred excusable and unaoidable absences does not amount to an
abandonment o his employment.
The petitioners claim of gross and habitual neglect of duty pales in comparison to the respondents unblemished record. The respondent did not incur any
intermittent absences. lis only recorded absence was the consecutie ten-day unauthorized absence, albeit due to painul and unbearable toothache. 1he
petitioners claim that the respondent had manifested poor work attitude was belied by its own recognition of the respondents dedication to his job as
evidenced by the latters awards: Top 1echnician o the \ear ,1995,, Member o the LxclusieP40,000.00 Club, and Model Lmployee o the \ear ,1995,.
IN LIGH1 OI ALL 1HL IORLGOING, the petition is DLNILD DUL COURSL. 1he Decision o the Court o Appeals in CA-G.R. SP No. 3602
is AllIRMLD.
SO ORDLRLD.


SLCOND DIVISION

RICO ROMMLL A1ILNZA,
Petitioner,




- ersus -




BOARD OI MLDICINL and LDI1HA SIOSON,
Respondents.
G.R. No. J77407

Present:

NAClURA,
.ctivg Cbairer.ov,
PLRAL1A,
DLL CAS1ILLO,


VILLARAMA, JR.,

and
MLNDOZA, ]].

Promulgated:

lebruary 9, 2011

x------------------------------------------------------------------------------------x


DLCISION

NACHURA, J.:


Beore us is a petition or reiew on certiorari under Rule 45 o the Rules o Court, assailing the Decision
|1|
dated September 22, 2006 o the Court o
Appeals ,CA, in CA-G.R. SP No. 855. 1he CA dismissed the petition or certiorari iled by petitioner Rico Rommel Atienza ,Atienza,, which, in turn,
assailed the Orders
|2|
issued by public respondent Board o Medicine ,BOM, in Administratie Case No. 1882.

1he acts, airly summarized by the appellate court, ollow.




Due to her lumbar pains, priate respondent Lditha Sioson went to Rizal Medical Center ,RMC, or check-up on lebruary 4,
1995. Sometime in 1999, due to the same problem, she was reerred to Dr. Pedro Lantin III o RMC who, accordingly, ordered
seeral diagnostic laboratory tests. 1he tests reealed that her right kidney is normal. It was ascertained, howeer, that her let kidney
is non-unctioning and non-isualizing. 1hus, 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 beore the |BOM| against the doctors who allegedly participated in the ateul kidney operation, namely: Dr.
Judd dela Vega, Dr. Pedro Lantin, III, Dr. Gerardo Antonio llorendo 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-unctioning and non-
isualizing kidney.

1he complaint was heard by the |BOM|. Ater complainant Romeo Sioson presented his eidence, priate respondent Lditha
Sioson, also named as complainant there, iled her ormal oer o documentary eidence. Attached to the ormal oer o
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. She described her exhibits, as ollows:

EXHIBIT A the certiied photocopy o the X-ray Request orm dated December 12, 1996, which is
also marked as Annex 2 as it was actually originally the Annex to x x x Dr. Pedro Lantin, IIIs counter affidavit
iled with the City Prosecutor o Pasig City in connection with the criminal complaint iled by |Romeo Sioson|
with the said oice, on which are handwritten entries which are the interpretation o the results o the ultrasound
examination. Incidentally, this exhibit happens to be the same as or identical to the certiied photocopy o the
document marked as Annex 2 to the Counter-Aidait dated March 15, 2000, iled by x x x Dr. Pedro Lantin,
III, on May 4, 2000, with this lonorable Board in answer to this complaint,

EXHIBIT B the certiied photo copy o the X-ray request orm dated January 30, 199, which is also
marked as Annex 3 as it was actually likewise originally an Annex to x x x Dr. Pedro Lantin, IIIs counter-
aidait iled with the Oice o the City Prosecutor o Pasig City in connection with the criminal complaint iled
by the herein complainant with the said oice, on which are handwritten entries which are the interpretation o
the results o the examination. Incidentally, this exhibit happens to be also the same as or identical to the certiied
photo copy of the document marked as Annex 3 which is likewise dated January 30, 1997, which is appended as
such Annex 3 to the counter-aidait dated March 15, 2000, iled by x x x Dr. Pedro Lantin, III on May 4,
2000, with this lonorable Board in answer to this complaint.

EXHIBIT C the certiied photocopy o the X-ray request orm dated March 16, 1996, which is also
marked as Annex 4, on which are handwritten entries which are the interpretation of the results o the
examination.

EXHIBIT D the certiied photocopy o the X-ray request orm dated May 20, 1999, which is also
marked as Annex 16, on which are handwritten entries which are the interpretation of the results of the
examination. Incidentally, this exhibit appears to be the drat o the typewritten inal report o the same
examination which is the document appended as Annexes 4 and 1 respectively to the counter-aidaits iled by
x x x Dr. Judd dela Vega and Dr. Pedro Lantin, III in answer to the complaint. In the case o Dr. dela Vega
however, the document which is marked as Annex 4 is not a certified photocopy, while in the case of Dr.
Lantin, the document marked as Annex 1 is a certified photocopy. Both documents are of the same date and
typewritten contents are the same as that which are written on Exhibit D.

Petitioner filed his comments/objections to private respondents [Editha Siosons] formal offer of exhibits. He alleged that
said exhibits are inadmissible because the same are mere photocopies, not properly identiied and authenticated, and intended to
establish matters which are hearsay. le added that the exhibits are incompetent to proe the purpose or which they are oered.

Dispositions of the Board of Medicine

1he ormal oer o documentary exhibits o priate respondent |Lditha Sioson| was admitted by the |BOM| per its Order
dated May 26, 2004. It reads:

The Formal Offer of Documentary Evidence of [Romeo Sioson], the Comments,Objections o |herein
petitioner| Atienza, |therein respondents| De la Vega and Lantin, and the Maniestation o |therein| respondent
llorendo are hereby ADMI11LD by the |BOM| or whateer purpose they may sere in the resolution o this
case.

Let the hearing be set on July 19, 2004 all at 1:30 p.m. for the reception of the evidence of the
respondents.

SO ORDERED.

Petitioner moed or reconsideration o the aboementioned Order basically on the same reasons stated in his
comment,objections to the ormal oer o exhibits.

1he |BOM| denied the motion or reconsideration o petitioner in its Order dated October 8, 2004. It concluded that it
should irst admit the eidence being oered so that it can determine its probatie alue when it decides the case. According to the
Board, it can determine whether the eidence is releant or not i it will take a look at it through the process o admission. x x x.
|3|



Disagreeing with the BOM, and as preiously aderted to, Atienza iled a petition or certiorari with the CA, assailing the BOMs Orders which
admitted Editha Siosons (Edithas) Formal Offer of Documentary Evidence. The CA dismissed the petition for certiorari or lack o merit.

lence, this recourse positing the ollowing issues:

I. PROCLDURAL ISSUL:

\lL1lLR PL1I1IONLR A1ILNZA AVAILLD Ol 1lL PROPLR RLMLD\ \lLN lL lILLD 1lL PL1I1ION
lOR CR1OR.R DA1LD 06 DLCLMBLR 2004 \I1l 1lL COUR1 Ol APPLALS UNDLR RULL 65 Ol 1lL
RULLS Ol COUR1 1O ASSAIL 1lL ORDLRS DA1LD 26 MA\ 2004 AND 08 OC1OBLR 2004 Ol
RLSPONDLN1 BOARD.

II. SUBS1AN1IVL ISSUL:

\lL1lLR 1lL COUR1 Ol APPLALS COMMI11LD GRAVL RLVLRSIBLL LRROR AND DLCIDLD A
QULS1ION Ol SUBS1ANCL IN A \A\ NO1 IN ACCORDANCL \I1l LA\ AND 1lL APPLICABLL
DLCISIONS Ol 1lL lONORABLL COUR1 \lLN I1 UPlLLD 1lL ADMISSION Ol INCOMPL1LN1 AND
INADMISSIBLL LVIDLNCL B\ RLSPONDLN1 BOARD, \lICl CAN RLSUL1 IN 1lL DLPRIVA1ION Ol
PROlLSSIONAL LICLNSL A PROPERTY RIGHT OR ONES LIVELIHOOD.
|4|



\e ind no reason to depart rom the ruling o the CA.

Petitioner is correct when he asserts that a petition or certiorari is the proper remedy to assail the Orders o the BOM, admitting in eidence the
exhibits o Lditha. As the assailed Orders were interlocutory, these cannot be the subject o an appeal separate rom the judgment that completely or
inally disposes o the case.
|5|
At that stage, where there is no appeal, or any plain, speedy, and adequate remedy in the ordinary course o law, the only and
remaining remedy let to petitioner is a petition or certiorari under Rule 65 o the Rules o Court on the ground o grae abuse o discretion amounting to
lack or excess o jurisdiction.

loweer, the writ o certiorari will not issue absent a showing that the BOM has acted without or in excess o jurisdiction or with grae abuse o
discretion. Embedded in the CAs finding that the BOM did not exceed its jurisdiction or act in grae abuse o discretion is the issue o whether the
exhibits o Lditha contained in her lormal Oer o Documentary Lidence are inadmissible.

Petitioner argues that the exhibits ormally oered in eidence by Lditha: ,1, iolate the best eidence rule, ,2, hae not been properly identiied
and authenticated, ,3, are completely hearsay, and ,4, are incompetent to proe their purpose. 1hus, petitioner contends that the exhibits are inadmissible
eidence.

\e disagree.

1o begin with, it is well-settled that the rules o eidence are not strictly applied in proceedings beore administratie bodies such as the
BOM.
|6|
Although trial courts are enjoined to obsere strict enorcement o the rules o eidence,
||
in connection with eidence which may appear to be
o doubtul releancy, incompetency, or admissibility, we hae held that:

|I|t is the saest policy to be liberal, not rejecting them on doubtul or technical grounds, but admitting them unless plainly irreleant,
immaterial or incompetent, or the reason that their rejection places them beyond the consideration o the court, i they are thereater
ound releant or competent, on the other hand, their admission, i they turn out later to be irreleant or incompetent, can easily be
remedied by completely discarding them or ignoring them.
|8|


lrom the oregoing, we emphasize the distinction between the admissibility o eidence and the probatie weight to be accorded the same pieces o
eidence.P^OC biivg ava 1rav.ort Cororatiov r. Covrt of .eat.
|9|
teaches:

Admissibility o eidence reers to the question o whether or not the circumstance ,or eidence, is to be considered at all. On the
other hand, the probatie alue o eidence reers to the question o whether or not it proes 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. Petitioner mistakenly relies on Section 20, Article I o the Proessional Regulation Commission Rules o Procedure, which reads:

Section 20. Administratie inestigation shall be conducted in accordance with these Rules. 1he Rules o Court shall only
apply in these proceedings by analogy or on a suppletory character and wheneer practicable and conenient. 1echnical errors in the
admission o eidence which do not prejudice the substantie rights o either party shall not itiate the proceedings.
|10|


As pointed out by the appellate court, the admission o the exhibits did not prejudice the substantie rights o petitioner because, at any rate, the
act sought to be proed thereby, that the two kidneys o Lditha were in their proper anatomical locations at the time she was operated on, is presumed
under Section 3, Rule 131 o the Rules o Court:

Sec. 3. Di.vtabte re.vvtiov.. 1he ollowing presumptions are satisactory i uncontradicted, but may be contradicted and
oercome by other eidence:

x x x x

,y, 1hat things hae happened according to the ordinary course o nature and the ordinary habits o lie.


1he exhibits are certiied photocopies o X-ray Request lorms dated December 12, 1996, January 30, 199, March 16, 1996, and May 20, 1999,
iled in connection with Edithas medical case. The documents contain handwritten entries interpreting the results of the examination. 1hese exhibits were
actually attached as annexes to Dr. Pedro Lantin IIIs counter affidavit filed with the Office of the City Prosecutor o Pasig City, which was inestigating
the criminal complaint or negligence iled by Lditha against the doctors o Rizal Medical Center ,RMC, who handled her surgical procedure. 1o lay the
predicate or her case, Lditha oered 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.
|11|


Unquestionably, the rules o eidence are merely the means or ascertaining the truth respecting a matter o act.
|12|
1hus, they likewise proide
or some acts which are established and need not be proed, such as those coered by judicial notice, both mandatory and discretionary.
|13|
Laws o
nature inoling the physical sciences, speciically biology,
|14|
include the structural make-up and composition o liing things such as human beings. In this
case, we may take judicial notice that Edithas kidneys beore, and at the time o, her operation, as with most human beings, were in their proper
anatomical locations.

1hird, contrary to the assertion o petitioner, the best eidence rule is inapplicable. Section 3 o Rule 130 proides:

J. Best Lvidence Rule

Sec. 3. Origivat aocvvevt vv.t be roavcea; ecetiov.. \hen the subject o inquiry is the contents o a document, no eidence
shall be admissible other than the original document itsel, except in the ollowing cases:

,a, \hen the original has been lost or destroyed, or cannot be produced in court, without bad aith on the part o the
oeror,

,b, \hen the original is in the custody or under the control o the party against whom the eidence is oered, and the
latter ails to produce it ater reasonable notice,

,c, \hen the original consists o numerous accounts or other documents which cannot be examined in court without
great loss o time and the act sought to be established rom them is only the general result o the whole, and

,d, \hen the original is a public record in the custody o a public oicer or is recorded in a public oice.


1he subject o inquiry in this case is whether respondent doctors beore the BOM are liable or gross negligence in remoing the right unctioning
kidney o Lditha instead o the let 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 exhi bits oered in eidence.

linally, these exhibits do not constitute hearsay eidence o 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 o her abdominal area.

In act, the introduction o secondary eidence, such as copies o the exhibits, is allowed.
|15|
\itness Dr. Nancy Aquino testiied that the Records
Ofice of RMC no longer had the originals of the exhibits because [it] transferred from the previous building, x x x to the new building.
|16|
Ultimately,
since the originals cannot be produced, the BOM properly admitted Edithas formal offer of evidence and, thereafter, the BOM shall determine the
probatie alue thereo when it decides the case.

WHLRLIORL, the petition is DLNILD. 1he Decision o the Court o Appeals in CA-G.R. SP No. 855 is AIIIRMLD. Costs against
petitioner.


SO ORDLRLD.
LN BANC
G.R. Nos. 96027-28. March 08, 200S
BRIG. GLN. LU1HLR A. CUS1ODIO
*
, CAP1. ROMLO M. BAU1IS1A, 2
nd
L1. JLSUS D. CAS1RO, SG1. CLARO L. LA1, SG1.
ARNULIO B. DL MLSA, CJC ROGLLIO B. MORLNO, CJC MARIO L. LAZAGA, SG1. IILOMLNO D. MIRANDA, SG1.
ROLANDO C. DL GUZMAN, SG1. LRNLS1O M. MA1LO, SG1. RODOLIO M. DLSOLONG, AJC CORDOVA G. LS1LLO,
MSG1. PABLO S. MAR1INLZ, SG1. RUBLN AQUINO, SG1. ARNULIO AR1A1LS, AJC ILLIZARDO 1ARAN, petitioners,
vs. SANDIGANBAYAN and PLOPLL OI 1HL PHILIPPINLS, respondents.
R L S O L U 1 I O N
PUNO, J.:
Beore us is a Motion 1o Re-Open Case \ith Leae O Court iled by petitioners who were conicted and sentenced to rectv.iov eretva by the
Sandiganbayan in Criminal Cases Nos. 10010 and 10011 or the double murder o Senator Benigno Aquino, Jr. and Rolando Galman on August 21,
1983.
|1|

Petitioners were members of the military who acted as Senator Aquinos security detail upon his arrival in Manila from his three-year sojourn in the
United States. 1hey were charged, together with seeral other members o the military, beore the Sandiganbayan or the killing o Senator Aquino who
was atally shot as he was coming down rom the aircrat o China Airlines at the Manila International Airport. Petitioners were also indicted or the
killing o Rolando Galman who was also gunned down at the airport tarmac.
On December 2, 1985, the Sandiganbayan rendered a Decision in Criminal Cases Nos. 10010-10011 acquitting all the accused, which include the
petitioners. loweer, the proceedings beore the Sandiganbayan were later ound by this Court to be a sham trial. 1he Court thus nulliied said
proceedings, as well as the judgment o acquittal, and ordered a re-trial o the cases.
|2|

A re-trial ensued beore the Sandiganbayan.
In its decision dated September 28, 1990, the Sandiganbayan, while acquitting the other accused, ound the petitioners guilty as principals o the
crime o murder in both Criminal Cases Nos. 10010 and 10011. It sentenced them to rectv.iov eretva in each case.
|3|
1he judgment became inal ater this
Court denied petitioners petition for review of the Sandiganbayan decision for failure to show reversible error in the questioned decision,
|4|
as well as their
subsequent motion or reconsideration.
|5|

In August 2004, petitioners sought legal assistance rom the Chie Public Attorney who, in turn, requested the Independent lorensic Group o the
Uniersity o the Philippines to make a thorough reiew o the orensic eidence in the double murder case. 1he petitioners, assisted by the Public
Attorneys Office, now want to present the findings of the orensic group to this Court and ask the Court to allow the re-opening o the cases and the
holding o a third trial to determine the circumstances surrounding the death o Senator Benigno Aquino, Jr. and Rolando Galman.
Petitioners inoke the ollowing grounds or the re-opening o the case:
I
Lxistence o newly discoered pieces o eidence that were not aailable during the second trial o the aboe-entitled cases which could hae altered the
judgment o the Sandiganbayan, speciically:
A, Independent orensic eidence uncoering the alse orensic claims that led to the unjust coniction o the petitioners-moants.
B, A key deense eyewitness to the actual killing o Senator Benigno Aquino, Jr.
II
1here was a grae iolation o due process by reason o:
A, Insuicient legal assistance o counsel,
B, Depriation o right to counsel o choice,
C, 1estimonies o deense witnesses were under duress,
D, \illul suppression o eidence,
L, Use o alse orensic eidence that led to the unjust coniction o the petitioners-moants.
III
1here was serious misapprehension o acts on the part o the Sandiganbayan based on alse orensic eidence, which entitles petitioners-moants to a re-
trial.
|6|

Petitioners seek to present as new eidence the indings o the orensic group composed o Pro. Jerome B. Bailen, a orensic anthropologist rom
the Uniersity o the Philippines, Atty. Lrwin P. Lre, M.D., a medico-legal practitioner, Benito L. Molino, M.D., a orensic consultant and luman Rights
and Peace Adocate, and Anastacio N. Rosete, Jr., D.M.D., a orensic dentistry consultant. 1heir report essentially concludes that it was not possible,
based on the orensic study o the eidence in the double murder case, that C1C Rogelio Moreno ired at Senator Aquino as they descended the serice
stairway rom the aircrat. 1hey posit that Senator Aquino was shot while he was walking on the airport tarmac toward the waiting AVSLCOM an which
was supposed to transport him rom the airport to lort Boniacio. 1his is contrary to the inding o the Sandiganbayan in the second trial that it was C1C
Moreno, the security escort positioned behind Senator Aquino, who shot the latter. 1he report also suggests that the physical eidence in these cases may
hae been misinterpreted and manipulated to mislead the court. 1hus, petitioners assert that the September 28, 1990 decision o the Sandiganbayan
should be oided as it was based on alse orensic eidence. Petitioners submit that the reiew by the orensic group o the physical eidence in the
double murder case constitutes newly discovered evidence which would entitle them to a new trial under Rule 121 o the 2000 Rules o Criminal
Procedure. In addition to the report o the orensic group, petitioners seek to present the testimony o an alleged eyewitness, the drier o the waiting
AVSLCOM an, SPO4 Ruben M. Cantimbuhan. In his aidait submitted to this Court, SPO4 Cantimbuhan states that he saw a man in blue uniorm
similar to that o the Philippine Airlines maintenance crew, suddenly ire at Senator Aquino as the latter was about to board the an. 1he man in blue was
later identiied as Rolando Galman.
Petitioners pray that the Court issue a resolution:
1. [a]nnulling and setting aside this Honorable Courts Resolutions dated July 23, 1991 and September 10, 1991;
2. |a|nnulling and setting aside the Decision o the Sandiganbayan ,3
rd
Diision, dated September 28, 1990 in People s. Custodio, et al., Case
No. 10010-10011|,|
3. |o|rdering the re-opening o this case, |and|
4. |o|rdering the Sandiganbayan to allow the reception o additional deense eidence,re-trial in the aboe entitled cases.
||

1he issue now is whether petitioners are entitled to a third trial under Rule 121 o the 2000 Rules o Criminal Procedure.
1he pertinent sections o Rule 121 o the 2000 Rules o Criminal Procedure proide:
Section J. New 1rial or reconsideration. At any time beore a judgment o coniction becomes inal, the court may, on motion o the accused or at
its own instance but with the consent o the accused, grant a new trial or reconsideration.
Sec. 2. Grounds for a new trial. 1he court shall grant a new trial on any o the ollowing grounds:
,a, 1hat errors o law or irregularities prejudicial to the substantial rights o the accused hae been committed during the trial,
(b) 1hat new and material evidence has been discovered which the accused could not with reasonable diligence have discovered and
produced at the trial and which if introduced and admitted would probably change the judgment.
xxx
Sec. 6. Lffects of granting a new trial or reconsideration. 1he eects o granting a new trial or reconsideration are the ollowing:
,a, \hen a new trial is granted on the ground o errors o law or irregularities committed during the trial, all the proceedings and eidence aected
thereby shall be set aside and taken anew. 1he court may, in the interest o justice, allow the introduction o additional eidence.
,b, \hen a new trial is granted on the ground o newly discoered eidence, the eidence already adduced shall stand and the newly-discoered and
such other eidence as the court may, in the interest o justice, allow to be introduced shall be taken and considered together with the eidence already in
the record.
,c, In all cases, when the court grants new trial or reconsideration, the original judgment shall be set aside or acated and a new judgment rendered
accordingly. ;evba.i. .vtiea)
In line with the objectie o the Rules o Court to set guidelines in the dispensation o justice, but without shackling the hands that dispense it, the
remedy of new trial has been described as a new invention to temper the severity of a judgment or prevent the failure of justice.
|8|
1hus, the Rules allow
the courts to grant a new trial when there are errors o law or irregularities prejudicial to the substantial rights o the accused committed during the trial, or
when there exists newly discoered eidence. In the proceedings or new trial, the errors o law or irregularities are expunged rom the record or new
eidence is introduced. 1hereater, the original judgment is acated and a new one is rendered.
|9|

Under the Rules, a person conicted o a crime may aail o the remedy o new trial beore the judgment o coniction becomes inal. Petitioners
admit that the decision o the Sandiganbayan in Criminal Cases Nos. 10010 and 10011 became inal and executory upon denial o their petition or reiew
iled beore this Court and their motion or reconsideration. Lntry o judgment has in act been made on September 30, 1991.
|10|
Nonetheless, they
maintain that equitable considerations exist in this case to justiy the relaxation o the Rules and re-open the case to accord petitioners the opportunity to
present eidence that will exonerate them rom the charges against them. \e do not ind merit in their submission.
Petitioners anchor their motion on the ground o newly discoered eidence. Courts are generally reluctant in granting motions or new trial on the
ground o newly discoered eidence or it is presumed that the moing party has had ample opportunity to prepare his case careully and to secure all
the necessary eidence beore the trial. Such motions aretreated with great caution due to the danger o perjury and the maniest injustice o allowing a
party to allege that which may be the consequence o his own neglect to deeat an aderse judgment. lence, the moing party is oten required to rebut a
presumption that the judgment is correct and that there has been a lack o due diligence, and to establish other acts essential to warrant the granting o a
new trial on the ground o newly discoered eidence.
|11|
1his Court has repeatedly held that beore a new trial may be granted on the ground o newly
discoered eidence, it must be shown ,1, that the eidence was discoered ater trial, ,2, that such eidence could not hae been discoered and
produced at the trial een with the exercise o reasonable diligence, ,3, that it is material, not merely cumulatie, corroboratie, or impeaching, and ,4, the
eidence is o such weight that it would probably change the judgment i admitted. I the alleged newly discoered eidence could hae been ery well
presented during the trial with the exercise o reasonable diligence, the same cannot be considered newly discoered.
|12|

1hese standards, also known as the Berry rule, trace their origin to the 1851 case o Berry vs. State of Georgia
|13|
where the Supreme Court o
Georgia held:
Applications or new trial on account o newly discoered eidence, are not aored by the Courts. x x x Upon the ollowing points there seems to be a
pretty general concurrence o authority, iz, that it is incumbent on a party who asks or a new trial, on the ground o newly discoered eidence, to satisy
the Court, 1
st
. 1hat the eidence has come to his knowledge since the trial. 2d. 1hat it was not owing to the want o due diligence that it did not come
sooner. 3d. 1hat it is so material that it would produce a dierent erdict, i the new trial were granted. 4
th
. 1hat it is not cumulatie only iz, speaking
to acts, in relation to which there was eidence on the trial. 5
th
. 1hat the aidait o the witness himsel should be produced, or its absence accounted or.
And 6
th
, a new trial will not be granted, i the only object o the testimony is to impeach the character or credit o a witness. ;citatiov. ovittea)
1hese guidelines hae since been ollowed by our courts in determining the propriety o motions or new trial based on newly discoered eidence.
It should be emphasized that the applicant or new trial has the burden o showing that the new eidence he seeks to present has complied with the
requisites to justiy the holding o a new trial.
1he threshold question in resoling a motion or new trial based on newly discoered eidence is whether the proerred eidence is in act a
newly discovered evidence which could not have been discovered by due diligence. 1he question of whether evidence is newly discovered has two
aspects: a temporal one, i.e., when was the eidence discoered, and a predictive one, i.e., when should or could it hae been discoered. It is to the
latter that the requirement o due diligence has releance.
|14|
\e hae held that in order that a particular piece o eidence may be properly regarded as
newly discoered to justiy new trial, what is essential is not so much the time when the eidence oered irst sprang into existence nor the time when it
irst came to the knowledge o the party now submitting it, what is essential is that the oering party had exercised reasonable diligence in seeking to
locate such eidence beore or during trial but had nonetheless ailed to secure it.
|15|

1he Rules do not gie an exact deinition o due diligence, and whether the moant has exercised due diligence depends upon the particular
circumstances o each case.
|16|
Nonetheless, it has been obsered that the phrase is often equated with reasonable promptness to avoid prejudice to the
defendant. In other words, the concept of due diligence has both a time component and a good faith component. 1he moant or a new trial must
not only act in a timely ashion in gathering eidence in support o the motion, he must act reasonably and in good aith as well. Due diligence
contemplates that the deendant acts reasonably and in good aith to obtain the eidence, in light o the totality o the circumstances and the acts known
to him.
|1|

Applying the foregoing tests, we find that petitioners purported evidence does not qualify as newly discovered evidence that would justiy the re-
opening o the case and the holding o a third trial.
1he report o the orensic group may not be considered as newly discoered eidence as petitioners ailed to show that it was impossible or them to
secure an independent orensic study o the physical eidence during the trial o 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. 1hey cited the materials and methods that they used or their study, ri:
MA1LRIALS AND ML1lODS
MA1LRIALS:
a. Court records o the case, especially photographs o: a, the stairway where the late Sen. Aquino and his escorts descended, b, the part o the
tarmac where the lieless bodies o the late Sen. Aquino and Galman ell, and c, the autopsy conducted by the NBI Medico-legal team
headed by Dr. Mu|n|oz, and the autopsy report o the late Sen. Benigno Aquino|,| Jr. signed by Dr. Mu|n|oz and Dr. Solis,
b. 1he gun and lie ammunitions collected at the crime scene,
c. A reerence human skull photos and X-rays o the same to demonstrate wound location and bullet trajectory,
d. 1he reports o interiews and statements by the conicted military escorts, and other witnesses,
e. Re-enactment of the killing of Aquino based on the military escorts[] version, by the military escorts themselves in the Bilibid Prison and by
olunteers at the NAIA 1armac,
. Various books and articles on orensic and the medico-legal ield|,|
g. Results o lorensic experiments conducted in relation to the case.
ML1lODS:
a. Reiew o the orensic exhibits presented in the court,
b. Reiew o 1SNs releant to the orensic reiew,
c. Study o and research on the guns, slugs and ammunitions allegedly inoled in the crime,
d. Interiews,re-enactment of the crime based on the militarys accounts, both in the Bilibid Prison where the convicts are confined and the MIA
,now NAIA, stairway and tarmac,
e. Conduct o ocular inspection and measurements on the actual crime scene ,stairway and tarmac, at the old Manila International Airport ,now
NAIA,,
. Retracing the slugs trajectory based on the autopsy reports and experts testimonies using an actual human skull,
g. X-rays of the skull with the retraced trajectory based on the autopsy report and experts testimonies;
h. Laluation o the presented acts and opinions o local experts in relation to accepted orensic indings in international publications on
orensic science, particularly on guns and |gunshot| wound injuries,
i. lorensic experiments and simulations o eents in relation to this case.
|18|

1hese materials were aailable to the parties during the trial and there was nothing that preented the petitioners rom using them at the time to
support their theory that it was not the military, but Rolando Galman, who killed Senator Aquino. Petitioners, in their present motion, ailed to present any
new orensic eidence that could not hae been obtained by the deense at the time o the trial een with the exercise o due diligence. I they really
wanted to seek and oer the opinion o other orensic experts at the time regarding the physical eidence gathered at the scene o the crime, there was
ample opportunity or them to do so beore the case was inally submitted and decided.
|19|

A reading o the Sandiganbayan decision dated September 28, 1990 shows a thorough study by the court o the orensic eidence presented during
the trial, ri:
COUR1 lINDINGS
As to the physical
eidence
Great signiicance has to be accorded the trajectory o the single bullet that penetrated the head and caused the death o Sen. Benigno Aquino, Jr. Basic to
the question as to trajectory ought to be the indings during the autopsy. 1he prosector in the autopsy, Dr. Bienenido Munoz, NBI Medico-Legal Oicer,
reported in his Autopsy Report No. N-83-22-36, that the trajectory o the gunshot, the wound o entrance haing been located at the mastoid region, let,
below the external auditory meatus, and the exit wound having been at the anterior portion of the mandible, was forward, downward and medially.
,Autopsy Report No. N-83-22-36, Exhibit NNNN-2-t-2)
A controersy as to this trajectory came about when, upon being cross-examined by counsel or the deense, Dr. Bienenido Munoz made a signiicant
turn-about by stating that the correct trajectory of the fatal bullet was upward, downward, and medially. 1he present position o Dr. Munoz is
premised upon the alleged act that he ound the petrous bone ractured, obiously hit by the atal bullet. le concluded, in iew o this inding, that the
atal bullet must hae gone upward rom the wound o entrance. Since the atal bullet exited at the mandible, it is his belie that the petrous bone delected
the trajectory o the bullet and, thus, the bullet proceeded downwards rom the petrous bone to the mandible.
1his opinion o Dr. Bienenido Munoz in this regard notwithstanding, \e hold that the trajectory o the atal bullet which ki lled Sen. Benigno Aquino, Jr.
was, indeed, forward, downward and medially. lor the reason that the wound o entrance was at a higher eleation than the wound o exit, there can be
no other conclusion but that the trajectory was downward. 1he bullet when traeling at a ast rate o speed takes a straight path rom the wound o
entrance to the wound o exit. It is unthinkable that the bullet, while projected upwards, would, instead o exiting to the roo o the head, go down to the
mandible because it was allegedly delected by a petrous bone which though hard is in act a mere spongy protuberance, akin to a cartilage.
Clear is proo o the downward trajectory o the atal bullet, lirst, as Dr. Pedro Solis and Dr. Ceerino Cunanan, the immediate superiors o Dr.
Bienenido Munoz, maniested beore the Court, that, since the wound o entrance appeared oaloid and there is what is known as a contusion collar
which was widest at the superior portion, indicating an acute angle o approach, a downward trajectory o the bullet is indicated. 1his phenomenon
indicates that the muzzle o the atal gun was at a leel higher than that o the point o entry o the atal bullet.
1here was no showing as to whether a probe could hae been made rom the wound o entrance to the petrous bone. Out o curiosity, Dr. Juanito Billote
tried to insert a probe rom the wound o exit into the petrous bone. le was unsuccessul notwithstanding our or ie attempts. I at all, this disproes
the theory o Dr. Munoz that the trajectory was upward, downward and medially. On the other hand, Dr. Juanito Billote and photographer Alexander
Loinaz witnessed the fact that Dr. Muoz[s] understudy, Alejandrino Javier, had successfully made a probe from the wound of entrance directly towards
the wound o exit. Alejandrino Jaier shouted with excitement upon his success and Alexander Loinaz promptly photographed this eent with
Alejandrino Jaier holding the protruding end o the probe at the mandible. (Exhibit XXXXX-39-A)
1o be sure, had the main bullet hit the petrous bone, this spongy mash o cartilage would hae been decimated or obliterated. 1he act that the main bullet
was o such orce, power and speed that it was able to bore a hole into the mandible and crack it, is an indication that it could not hae been stopped or
delected by a mere petrous bone. By its power and orce, it must hae been propelled by a powerul gun. It would hae been i mpossible or the main
bullet to hae been delected orm an upward course by a mere spongy protuberance. Granting that it was so delected, howeer, it could not hae
maintained the same power and orce as when it entered the skull at the mastoid region so as to crack the mandible and make i ts exit there.
But what caused the racture o the petrous bone \as there a cause o the racture, other than that the bullet had hit it Dr. Pedro Solis, maintaining the
conclusion that the trajectory o the bullet was downward, gae the ollowing alternatie explanations or the racture o the petrous bone:
lirst, the petrous bone could hae been hit by a splinter o the main bullet, particularly, that which was ound at the temporal region, and,
Second, the racture must hae been caused by the kinetic orce applied to the point o entrance at the mastoid region which had the tendency o being
radiated towards the petrous bone.
1hus, the racture in the occipital bone, o the temporal bone, and o the parietal bone, Dr. Pedro Solis pointed out, had been caused by the aoresaid
kinetic orce. \hen a orce is applied to the mastoid region o the head, Dr. Pedro Solis emphasized, a radiation o orces is distributed all oer the cranial
back, including, although not limited to, the parietal bone. 1he skull, Dr. Solis explains, is a box-like structure. 1he moment you apply pressure on the
portion, a distortion, tension or some other mechanical deect is caused. This radiation of forces produces what is known as the spider web linear
fracture which goes to different parts of the body. The so-called racturing o the petrous portion o the let temporal bone is one o the consequences o
the kinetic orce orceully applied to the mastoid region.
1he act that there was ound a racture o the petrous bone is not necessarily indicatie o the theory that the main bullet passed through the petrous
bone.
Doubt was expressed by Dr. Pedro Solis as to whether the metal ragments alleged by Dr. Bienenido Munoz to hae been ound by him inside the skull
or at the wound o exit were really parts o the main bullet which killed the Senator. \hen Dr. Pedro Solis examined these ragments, he ound that two
,2, o the ragments were larger in size, and were o such shapes, that they could not hae gone out o the wound o exit considering the size and shape o
the exit wound.
linding o a downward
trajectory o the
atal bullet atal
to the credibility
o deense witnesses.
1he inding that the atal bullet which killed Sen. Benigno Aquino, Jr. was directed downwards sustains the allegation o prosecution eyewitnesses to the
eect that Sen. Benigno Aquino, Jr. was shot by a military soldier at the bridge stairs while he was being brought down rom 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
Quijanos testimony in this regard is echoed by Jessie Barcelona, Ramon Balang, Olivia Antimano, and Mario Laher, whose testi monies this Court inds
likewise as credible.
1he downward trajectory o the bullet haing been established, it stands to reason that the gun used in shooting the Senator was ired rom an eleation
higher than that o the wound o entrance at the back o the head o the Senator. 1his is consistent with the testimony o prosecution witnesses to the
eect that the actual killer o the Senator shot as he stood at the upper step o the stairs, the second or third behind Senator Aqui no, while Senator Aquino
and the military soldiers bringing him were at the bridge stairs. 1his is likewise consistent with the statement o Sandra Jean Burton that the shooting o
Senator Aquino occurred while the Senator was still on the bridge stairs, a conclusion deried rom the act that the atal shot was ired ten ,10, seconds
ater Senator Aquino crossed the serice door and was led down the bridge stairs.
It was the expert inding o Dr. Matsumi Suzuki that, as was gauged rom the sounds o the ootsteps o Senator Aquino, as the Senator went down the
bridge stairs, the shooting o the Senator occurred while the Senator had stepped on the 11
th
step rom the top.
At the ocular inspection conducted by this Court, with the prosecution and the deense in attendance, it should be noted that the ollowing acts were
established as regards the bridge stairs:
Observations:
1he length o one block coering the tarmac 196;
1he width o one block coering the tarmac 10;
1he distance rom the base o the staircase leading to the emergency tube to the Ninoy marker at the tarmac 126;
1here are 20 steps in the staircase including the landing,
1he distance rom the irst rung o the stairway up to the 20
th
rung which is the landing o stairs 208;
Distance rom the irst rung o the stairway up to the 20
th
rung until the edge o the exit door 2311;
Distance rom the 4
th
rung up to the exit door 21;
Distance rom the 5
th
rung up to the exit door 1911;
Length o one rung including railpost 34;
Space between two rungs o stairway 9;
\idth o each rung 11-1/2;
Length o each rung ,end to end, 29:
leight o railpost rom edge o rung to railing 25.
,underlining supplied,
|20|

1he Sandiganbayan again exhaustiely analyzed and discussed the orensic eidence in its resolution dated Noember 15, 1990 denying the motion
or reconsideration iled by the conicted accused. 1he court held:
1he Autopsy Report No. N-83-2236, Exhibit NNNN-2-t-2 indicated a downward trajectory of the fatal bullet when it stated that the atal bullet was
forward, downward, and medially . . .
xxx
II
1he wound o entrance haing been at a higher eleation than the wound o exit, there can be no other conclusion but that the trajectory was downward.
1he atal bullet, whether it be a Smith and \esson Caliber .35 magnum reoler or a .45 caliber, must hae traeled at a ast rate o speed and it stands to
reason that it took a straight path rom the wound o entrance to the wound o exit. A hole indicating this straight path was proen to hae existed. I, as
contended on cross-examination by Dr. Bienenido Munoz, that the bullet was projected upwards, it ought to hae exited at the roo o the head. 1he
theory that the atal bullet was delected by a mere petrous bone is inconceiable.
III
Since the wound o entrance appeared oaloid and there is what is known as a contusion collar which was widest at the superior portion, indicating an
acute angle o approach, a downward trajectory o the atal bullet is conclusiely indicated. 1his phenomenon indicates that the muzzle o the atal gun
was at a leel higher than that o the point o entry o the atal bullet.
IV
1here was no hole rom the petrous bone to the mandible where the atal bullet had exited and, thus, there is no support to the theory o Dr. Bienenido
Munoz that the atal bullet had hit the petrous bone on an upward trajectory and had been delected by the petrous bone towards the mandible. Dr.
Juanito Billotes testimony in this regard had amplified the matter with clarity.
xxx
1hese physical acts, notwithstanding the arguments and protestations o counsel or the deense as now and heretoore aowed, compel the Court to
maintain the holding: ,1, that the trajectory o the atal bullet which hit and killed Senator Benigno Aquino, Jr. was forward, downward and medially;
,2, that the Senator was shot by a person who stood at a higher eleation than he, and ,3, that the Senator was shot and killed by CIC Rogelio Moreno on
the bridge stairs and not on the tarmac, in conspiracy with the rest o the accused conicted herein.
|21|

1his Court airmed said indings o the Sandiganbayan when it denied the petition or reiew in its resolution o July 25, 1991. 1he Court ruled:
1he Court has careully considered and deliberated upon all the contentions o the petitioners but inds no basis or the all egation that the respondent
Sandiganbayan has graely erred in resoling the actual issues.
1he attempt to place a constitutional dimension in the petition is a labor in ain. Basically, only questions o act are raised. Not only is it axiomatic that
the actual indings o the Sandiganbayan are inal unless they all within speciically recognized exceptions to the rule but rom the petition and its annexes
alone, it is readily apparent that the respondent Court correctly resoled the actual issues.
xxx
1he trajectory o the atal bullet, whether or not the ictim was descending the stairway or was on the tarmac when shot, the circumstances showing
conspiracy, the participants in the conspiracy, the indiidual roles o the accused and their respectie parts in the conspiracy, the absence o eidence
against thirteen accused and their co-accused Col. Vicente B. 1igas, Jr., the lack o credibility o the witnesses against ormer Minister Jose D. Aspiras,
Director Jesus Z. Singson, Col. Arturo A. Custodio, lermilo Gosuico, Major General Prospero Olias, and the shooting o Rolando Galman are all actual
matters w|h|ich the respondent court discussed with airness and at length. The petitioners insistence that a few witnesses in their favor should be
belieed while that o some witnesses against them should be discredited goes into the question o credibility o witnesses, a matter which under the
records o this petition is best let to the judgment o the Sandiganbayan.
|22|

1he report of the forensic group essentially reiterates the theory presented by the defense during the trial of the double murder case.
Clearly, the report is not newly discoered, but rather recently sought, which is not allowed by the Rules.
|23|
I at all, it only seres to discredit the ersion
o the prosecution which had already been weighed and assessed, and thereater upheld by the Sandiganbayan.
1he same is true with the statement o the alleged eyewitness, SPO4 Cantimbuhan. lis narration merely corroborates the testimonies o other
deense witnesses during the trial that they saw Senator Aquino already walking on the airport tarmac toward the AVSLCOM an when a man in blue-gray
uniform darted from behind and fired at the back of the Senators head.
|24|
1he Sandiganbayan, howeer, did not gie weight to their account as it ound
the testimonies o prosecution eyewitnesses Rebecca Quijano and Jessie Barcelona more credible. Quijano and Barcelona testiied that they saw the
soldier behind Senator Aquino on the stairway aim and ire a gun on the latters nape. As earlier quoted, the Sandiganbayan ound their testimonies to be
more consistent with the physical eidence. SPO4 Cantimbuhans testimony will not in any way alter the courts decision in view of the eyewitness
account o Quijano and Barcelona, taken together with the physical eidence presented during the trial. Certainly, a new trial will only be allowed if the
new evidence is of such weight that it would probably change the judgment if admitted.
|25|
Also, new trial will not be granted if the new
evidence is merely cumulative, corroborative or impeaching.
As additional support to their motion or new trial, petitioners also claim that they were denied due process because they were depried o adequate
legal assistance by counsel. \e are not persuaded. 1he records will bear out that petitioners were ably represented by Atty. Rodolo U. Jimenez during
the trial and when the case was eleated to this Court. An experienced lawyer in criminal cases, Atty. Jimenez vigorously defended the petitioners cause
throughout the entire proceedings. 1he records show that the deense presented a substantial number o witnesses and exhibits during the trial. Ater the
Sandiganbayan rendered its decision, Atty. Jimenez iled a petition or reiew with this Court, inoking all conceiable grounds to acquit the petitioners.
\hen the Court denied the petition or reiew, he again iled a motion or reconsideration exhausting his deep reseroir o legal talent. \e thereore ind
petitioners claim to be unblushingly unsubstantiated. \e note that they did not allege any speciic acts in their present motion to show that Atty.
Jimenez had been remiss in his duties as counsel. Petitioners are thereore bound by the acts and decisions o their counsel as regards the conduct o the
case. 1he general rule is that the client is bound by the action o his counsel in the conduct o his case and cannot be heard to complain that the result o
the litigation might hae been dierent had his counsel proceeded dierently.
|26|
\e held in People vs. Umali:
|2|

In criminal as well as ciil cases, it has requently been held that the act that blunders and mistakes may hae been made i n the conduct o the proceedings
in the trial court, as a result o the ignorance, inexperience, or incompetence o counsel, does not urnish a ground or a new trial.
I such grounds were to be admitted as reasons or reopening cases, there would neer be an end to a suit so long as new counsel could be employed who
could allege and show that prior counsel had not been suiciently diligent, or experienced, or learned.
So it has been held that mistakes o attorneys as to the competency o a witness, the suiciency, releancy, materiality, or immateriality o a certain
eidence, the proper deense, or the burden o proo are not proper grounds or a new trial, and in general the client is bound by the action o his counsel
in the conduct o his case, and can not be heard to complain that the result o the litigation might hae been dierent had counsel proceeded
dierently. ;citatiov. ovittea)
Finally, we are not moved by petitioners assertion that the forensic evidence may hae been manipulated and misinterpreted during the trial o the
case. Again, petitioners did not allege concrete acts to support their crass claim. lence, we ind the same to be unounded and purely speculatie.
IN VILW WHLRLOI, the motion is DLNILD.
SO ORDLRLD.

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