PART SIX MEDICAL NEGLIGENCE I.

Definition of Medical Negligence

1 Garcia-Rueda !. Pa!ca!io" G.R. No. 11#1$1" Se%te&'er (" 1))* SEC+ND DI,ISI+N

[G.R. No. 118141. September 5, 1997]

LEONILA GARCIA-RUEDA, petitioner, vs. IL!REDO L. "ASCASIO, RAUL R. ARNAU, A#ELARDO L. A"OR$ADERA %R., &o'or(b)e CONDRADO *. +AS,UE-, ()) o. t/e O..01e o. t/e Omb234m('5 %ESUS !. GUERRERO, "OR!IRIO *ACARAEG, ('3 GREGORIO A. ARI-ALA, ()) o. t/e O..01e o. t/e C0t6 "ro4e12tor, *('0)(, respondents. DECISION RO*ERO, J.7 Ma- t.i! Court re ie/ t.e finding! of t.e +ffice of t.e +&'ud!&an0 T.e general rule .a! 'een enunciated in +ca&%o . +&'ud!&an 112 /.ic. !tate!3 4In t.e e5erci!e of it! in e!tigati e %o/er" t.i! Court .a! con!i!tentl- .eld t.at court! /ill not interfere /it. t.e di!cretion of t.e fi!cal or t.e +&'ud!&an to deter&ine t.e !%ecificitand ade6uac- of t.e a er&ent! of t.e offen!e c.arged. 7e &a- di!&i!! t.e co&%laint fort./it. if .e find! it to 'e in!ufficient in for& and !u'!tance or if .e ot.er/i!e find! no ground to continue /it. t.e in6uir-8 or .e &a- %roceed /it. t.e in e!tigation of t.e co&%laint if" in .i! ie/" it i! in due and %ro%er for&.9 Doe! t.e in!tant ca!e /arrant a de%arture fro& t.e foregoing general rule0 :.en a %atient die! !oon after !urger- under circu&!tance! /.ic. indicate t.at t.e attending !urgeon and anae!t.e!iologi!t &a- .a e 'een guilt- of negligence 'ut u%on t.eir 'eing c.arged" a !erie! of nine %ro!ecutor! to!! t.e re!%on!i'ilit- of conducting a %reli&inarin e!tigation to eac. ot.er /it. contradictor- reco&&endation!" 4%ing-%ong9 !t-le" %er.a%! t.e di!traug.t /ido/ i! not to 'e 'la&ed if !.e finall- decide! to accu!e t.e CitPro!ecutor! at t.e end of t.e line for %artialit- under t.e Anti-Graft and Corru%t Practice! Act. Nor &a- !.e 'e entirel- faulted for finall- filing a %etition 'efore t.i! Court again!t t.e +&'ud!&an for gra e a'u!e of di!cretion in di!&i!!ing .er co&%laint again!t !aid CitPro!ecutor! on t.e ground of lac; of e idence. Muc. a! /e !-&%at.i<e /it. t.e 'erea ed /ido/" .o/e er" t.i! Court i! of t.e o%inion t.at t.e general rule !till find! a%%lication in in!tant ca!e. In ot.er /ord!" t.e re!%ondent +&'ud!&an did not co&&it gra e a'u!e of di!cretion in deciding again!t filing t.e nece!!ar- infor&ation again!t %u'lic re!%ondent! of t.e +ffice of t.e Cit- Pro!ecutor.

T.e follo/ing fact! are 'orne out '- t.e record!. =lorencio ,. Rueda" .u!'and of %etitioner Leonila Garcia-Rueda" under/ent !urgical o%eration at t.e >ST .o!%ital for t.e re&o al of a !tone 'loc;ing .i! ureter. 7e /a! attended '- Dr. Do&ingo Antonio" ?r. /.o /a! t.e !urgeon" /.ile Dr. Erlinda @alat'atRe-e! /a! t.e anae!t.e!iologi!t. Si5 .our! after t.e !urger-" .o/e er" =lorencio died of co&%lication! of 4un;no/n cau!e"9 according to official! of t.e >ST 7o!%ital.1A2 Not !ati!fied /it. t.e finding! of t.e .o!%ital" %etitioner re6ue!ted t.e National @ureau of In e!tigation BN@IC to conduct an auto%!- on .er .u!'andD! 'od-. Con!e6uentl-" t.e N@I ruled t.at =lorencioD! deat. /a! due to lac; of care '- t.e attending %.-!ician in ad&ini!tering anae!t.e!ia. Pur!uant to it! finding!" t.e N@I reco&&ended t.at Dr. Do&ingo Antonio and Dr. Erlinda @alat'at-Re-e! 'e c.arged for 7o&icide t.roug. Rec;le!! I&%rudence 'efore t.e +ffice of t.e Cit- Pro!ecutor. During t.e %reli&inar- in e!tigation" /.at tran!%ired /a! a confounding !erie! of e ent! /.ic. /e !.all tr- to di!entangle. T.e ca!e /a! initiall- a!!igned to Pro!ecutor Antonio M. I!rael" /.o .ad to in.i'it .i&!elf 'ecau!e .e /a! related to t.e coun!el of one of t.e doctor!. A! a re!ult" t.e ca!e /a! re-raffled to Pro!ecutor Nor'erto G. Leono /.o /a!" .o/e er" di!6ualified on &otion of t.e %etitioner !ince .e di!regarded %re ailing la/! and Euri!%rudence regarding %reli&inar- in e!tigation. T.e ca!e /a! t.en referred to Pro!ecutor Ra&on +. Cari!&a" /.o i!!ued a re!olution reco&&ending t.at onl- Dr. Re-e! 'e .eld cri&inall- lia'le and t.at t.e co&%laint again!t Dr. Antonio 'e di!&i!!ed. T.e ca!e too; anot.er %er%le5ing turn /.en A!!i!tant Cit- Pro!ecutor ?o!efina Santo! Sio!on" in t.e 4intere!t of Eu!tice and %eace of &ind of t.e %artie!"9 reco&&ended t.at t.e ca!e 'e re-raffled on t.e ground t.at Pro!ecutor Cari!&a /a! %artial to t.e %etitioner. T.u!" t.e ca!e /a! tran!ferred to Pro!ecutor Leoncia R. Di&agi'a" /.ere a olte face occurred again /it. t.e endor!e&ent t.at t.e co&%laint again!t Dr. Re-e! 'e di!&i!!ed and in!tead" a corre!%onding infor&ation 'e filed again!t Dr. Antonio. Petitioner filed a &otion for recon!ideration" 6ue!tioning t.e finding! of Pro!ecutor Di&agi'a. Pending t.e re!olution of %etitionerD! &otion for recon!ideration regarding Pro!ecutor Di&agi'aD! re!olution" t.e in e!tigati e 4%ing%ong9 continued /.en t.e ca!e /a! again a!!igned to anot.er %ro!ecutor" Eudo5ia T. Gual'erto" /.o reco&&ended t.at Dr. Re-e! 'e included in t.e cri&inal infor&ation of 7o&icide t.roug. Rec;le!! I&%rudence. :.ile t.e reco&&endation of Pro!ecutor Gual'erto /a! %ending" t.e ca!e /a! tran!ferred to Senior State Pro!ecutor Gregorio A. Ari<ala" /.o re!ol ed to e5onerate Dr. Re-e! fro& an- /rongdoing" a re!olution /.ic. /a! a%%ro ed '- 'ot. Cit- Pro!ecutor Porfirio G. Macaraeg and Cit- Pro!ecutor ?e!u! =. Guerrero. Aggrie ed" %etitioner filed graft c.arge! !%ecificall- for iolation of Section FBeC of Re%u'lic Act No. FG1) 1F2 again!t Pro!ecutor! Guerrero" Macaraeg" and Ari<ala for &anife!t %artialit- in fa or of Dr. Re-e! 'efore t.e +ffice of t.e +&'ud!&an. 7o/e er" on ?ul- 11" 1))$" t.e +&'ud!&an i!!ued t.e a!!ailed re!olution di!&i!!ing t.e co&%laint for lac; of e idence. In fine" %etitioner a!!ail! t.e e5erci!e of t.e di!cretionar- %o/er of t.e +&'ud!&an to re ie/ t.e reco&&endation! of t.e go ern&ent %ro!ecutor! and to a%%ro e and di!a%%ro e t.e !a&e. Petitioner fault! t.e +&'ud!&an for" allegedl- in gra e a'u!e of di!cretion" refu!ing to find t.at t.ere e5i!t! %ro'a'le cau!e to .old %u'lic re!%ondent CitPro!ecutor! lia'le for iolation of Section FBeC of R.A. No. FG1).

Preli&inaril-" t.e %o/er! and function! of t.e +&'ud!&an .a e generall- 'een categori<ed into t.e follo/ing3 in e!tigator- %o/er!" %ro!ecutor- %o/er" %u'lic a!!i!tance function" aut.orit- to in6uire and o'tain infor&ation" and function to ado%t" in!titute and i&%le&ent %re enti e &ea!ure!. 1$2 A! %rotector of t.e %eo%le" t.e +ffice of t.e +&'ud!&an .a! t.e %o/er" function and dut- 4to act %ro&%tl- on co&%laint! filed in an- for& or &anner again!t %u'lic official!9 and 4to in e!tigate an- act or o&i!!ion of an- %u'lic official /.en !uc. act or o&i!!ion a%%ear! to 'e illegal" unEu!t" i&%ro%er or inefficient.9 1(2 :.ile t.e +&'ud!&an .a! t.e full di!cretion to deter&ine /.et.er or not a cri&inal ca!e !.ould 'e filed" t.i! Court i! not %recluded fro& re ie/ing t.e +&'ud!&anD! action /.en t.ere i! an a'u!e of di!cretion" in /.ic. ca!e Rule H( of t.e Rule! of Court &ae5ce%tionall- 'e in o;ed %ur!uant to Section I" Article ,III of t.e 1)#* Con!titution. 1H2 In t.i! regard" 4gra e a'u!e of di!cretion9 .a! 'een defined a! 4/.ere a %o/er i! e5erci!ed in an ar'itrar- or de!%otic &anner '- rea!on of %a!!ion or %er!onal .o!tilit- !o %atent and gro!! a! to a&ount to e a!ion of %o!iti e dut- or irtual refu!al to %erfor& a dut- enEoined '-" or in conte&%lation of la/. 1*2 =ro& a %rocedural !tand%oint" it i! certainl- odd /.- t.e !ucce!!i e tran!fer! fro& one %ro!ecutor to anot.er /ere not !ufficientl- e5%lained in t.e Re!olution of t.e +&'ud!&an. @eing t.e %ro%er in e!tigating aut.orit- /it. re!%ect to &i!fea!ance" nonfea!ance and &alfea!ance of %u'lic official!" t.e +&'ud!&an !.ould .a e 'een &ore igilant and a!!iduou! in deter&ining t.e rea!on! 'e.ind t.e 4'uc;%a!!ing9 to en!ure t.at no irregularit- too; %lace. :.et.er !uc. tran!fer! /ere due to an- out!ide %re!!ure or ulterior &oti e i! a &atter of e idence. +ne /ould .a e e5%ected t.e +&'ud!&an" .o/e er" to in6uire into /.at could .ardl- 6ualif- a! 4!tandard o%erating %rocedure"9 gi en t.e !urrounding circu&!tance! of t.e ca!e. :.ile it i! true t.at a %reli&inar- in e!tigation i! e!!entiall- in6ui!itorial" and i! often t.e onl- &ean! to di!co er /.o &a- 'e c.arged /it. a cri&e" it! function i! &erel- to deter&ine t.e e5i!tence of %ro'a'le cau!e. 1#2 Pro'a'le cau!e .a! 'een defined a! 4t.e e5i!tence of !uc. fact and circu&!tance! a! /ould e5cite t.e 'elief" in a rea!ona'le &ind" acting on t.e fact! /it.in t.e ;no/ledge of t.e %ro!ecution" t.at t.e %er!on c.arged /a! guilt- of t.e cri&e for /.ic. .e /a! %ro!ecuted.91)2 4Pro'a'le cau!e i! a rea!ona'le ground of %re!u&%tion t.at a &atter i!" or &a- 'e" /ell founded" !uc. a !tate of fact! in t.e &ind of t.e %ro!ecutor a! /ould lead a %er!on of ordinar- caution and %rudence to 'elie e" or entertain an .one!t or !trong !u!%icion" t.at a t.ing i! !o.9 T.e ter& doe! not &ean actual and %o!iti e cau!e nor doe! it i&%ort a'!olute certaint-. It i! &erel- 'a!ed on o%inion and rea!ona'le 'elief. T.u!" a finding of %ro'a'le cau!e doe! not re6uire an in6uir- into /.et.er t.ere i! !ufficient e idence to %rocure a con iction. It i! enoug. t.at it i! 'elie ed t.at t.e act or o&i!!ion co&%lained of con!titute! t.e offen!e c.arged. Preci!el-" t.ere i! a trial for t.e rece%tion of e idence of t.e %ro!ecution in !u%%ort of t.e c.arge.11G2 In t.e in!tant ca!e" no le!! t.an t.e N@I %ronounced after conducting an auto%!- t.at t.ere /a! indeed negligence on t.e %art of t.e attending %.-!ician! in ad&ini!tering t.e anae!t.e!ia. 1112T.e fact of /ant of co&%etence or diligence i! e identiar- in nature" t.e

eracit- of /.ic. can 'e!t 'e %a!!ed u%on after a full-'lo/n trial for it i! irtualli&%o!!i'le to a!certain t.e &erit! of a &edical negligence ca!e /it.out e5ten!i e in e!tigation" re!earc." e aluation and con!ultation! /it. &edical e5%ert!. Clearl-" t.e Cit- Pro!ecutor! are not in a co&%etent %o!ition to %a!! Eudg&ent on !uc. a tec.nical &atter" e!%eciall- /.en t.ere are conflicting e idence and finding!. T.e 'a!e! of a %art-D! accu!ation and defen!e! are 'etter entilated at t.e trial %ro%er t.an at t.e %reli&inarin e!tigation. A /ord on &edical &al%ractice or negligence ca!e!. 4In it! !i&%le!t ter&!" t.e t-%e of la/!uit /.ic. .a! 'een called &edical &al%ractice or" &ore a%%ro%riatel-" &edical negligence" i! t.at t-%e of clai& /.ic. a icti& .a! a aila'le to .i& or .er to redre!! a /rong co&&itted '- a &edical %rofe!!ional /.ic. .a! cau!ed 'odil- .ar&. In order to !ucce!!full- %ur!ue !uc. a clai&" a %atient &u!t %ro e t.at a .ealt. care %ro ider" in &o!t ca!e! a %.-!ician" eit.er failed to do !o&et.ing /.ic. a rea!ona'l%rudent .ealt. care %ro ider /ould .a e done" or t.at .e or !.e did !o&et.ing t.at a rea!ona'l- %rudent %ro ider /ould not .a e done8 and t.at t.at failure or action cau!ed inEur- to t.e %atient.911A2 7ence" t.ere are four ele&ent! in ol ed in &edical negligence ca!e!3 dut-" 'reac." inEur- and %ro5i&ate cau!ation. E identl-" /.en t.e icti& e&%lo-ed t.e !er ice! of Dr. Antonio and Dr. Re-e!" a %.-!ician-%atient relation!.i% /a! created. In acce%ting t.e ca!e" Dr. Antonio and Dr. Re-e! in effect re%re!ented t.at" .a ing t.e needed training and !;ill %o!!e!!ed '%.-!ician! and !urgeon! %racticing in t.e !a&e field" t.e- /ill e&%lo- !uc. training" care and !;ill in t.e treat&ent of t.eir %atient!.11F2 T.e- .a e a dut- to u!e at lea!t t.e !a&e le el of care t.at an- ot.er rea!ona'l- co&%etent doctor /ould u!e to treat a condition under t.e !a&e circu&!tance!. T.e 'reac. of t.e!e %rofe!!ional dutie! of !;ill and care" or t.eir i&%ro%er %erfor&ance" '- a %.-!ician !urgeon /.ere'- t.e %atient i! inEured in 'od- or in .ealt." con!titute! actiona'le &al%ractice.11$2 Con!e6uentl-" in t.e e ent t.at an- inEur- re!ult! to t.e %atient fro& /ant of due care or !;ill during t.e o%eration" t.e !urgeon! &a- 'e .eld an!/era'le in da&age! for negligence.11(2 Moreo er" in &al%ractice or negligence ca!e! in ol ing t.e ad&ini!tration of anae!t.e!ia" t.e nece!!it- of e5%ert te!ti&on- and t.e a aila'ilit- of t.e c.arge of res ipsa loquitur to t.e %laintiff" .a e 'een a%%lied in action! again!t anae!t.e!iologi!t! to .old t.e defendant lia'le for t.e deat. or inEur- of a %atient under e5ce!!i e or i&%ro%er anae!t.e!ia.11H2 E!!entiall-" it re6uire! t/o-%ronged e idence3 e idence a! to t.e recogni<ed !tandard! of t.e &edical co&&unit- in t.e %articular ;ind of ca!e" and a !.o/ing t.at t.e %.-!ician in 6ue!tion negligentl- de%arted fro& t.i! !tandard in .i! treat&ent.11*2 Anot.er ele&ent in &edical negligence ca!e! i! cau!ation /.ic. i! di ided into t/o in6uirie!3 /.et.er t.e doctorD! action! in fact cau!ed t.e .ar& to t.e %atient and /.et.er t.e!e /ere t.e %ro5i&ate cau!e of t.e %atientD! inEur-.11#2 Indeed .ere" a cau!al connection i! di!cerni'le fro& t.e occurrence of t.e icti&D! deat. after t.e negligent act of t.e anae!t.e!iologi!t in ad&ini!tering t.e ane!t.e!ia" a fact /.ic." if confir&ed" !.ould /arrant t.e filing of t.e a%%ro%riate cri&inal ca!e. To 'e !ure" t.e allegation of negligence i! not entirel- 'a!ele!!. Moreo er" t.e N@I deduced t.at t.e attending !urgeon! did not conduct t.e nece!!ar- inter ie/ of t.e %atient %rior to t.e o%eration. It a%%ear! t.at t.e

cau!e of t.e deat. of t.e icti& could .a e 'een a erted .ad t.e %ro%er drug 'een a%%lied to co%e /it. t.e !-&%to&! of &alignant .-%ert.er&ia. Al!o" /e cannot ignore t.e fact t.at an antidote /a! readil- a aila'le to counteract /.ate er deleteriou! effect t.e anae!t.e!ia &ig.t %roduce. 11)2 :.- t.e!e %recautionar- &ea!ure! /ere di!regarded &u!t 'e !ufficientl- e5%lained. T.e Cit- Pro!ecutor! /ere c.arged /it. iolating Section FBeC of t.e Anti-Graft and Corru%t Practice! Act /.ic. re6uire! t.e follo/ing fact!3 41. T.e accu!ed i! a %u'lic officer di!c.arging ad&ini!trati e or official function! or %ri ate %er!on! c.arged in con!%irac- /it. t.e&8 A. T.e %u'lic officer co&&itted t.e %ro.i'ited act during t.e %erfor&ance of .i! official dut- or in relation to .i! %u'lic %o!ition8 F. T.e %u'lic officer acted /it. &anife!t %artialit-" e ident 'ad fait. or gro!!" ine5cu!a'le negligence8 and $. 7i! action cau!ed undue inEur- to t.e Go ern&ent or an- %ri ate %art-" or ga e an%art- an- un/arranted 'enefit" ad antage or %reference to !uc. %artie!.9 1AG2 :.- did t.e co&%lainant" %etitioner in in!tant ca!e" elect to c.arge re!%ondent! under t.e a'o e la/0 :.ile a %art- /.o feel! .i&!elf aggrie ed i! at li'ert- to c.oo!e t.e a%%ro%riate 4/ea%on fro& t.e ar&or-"9 it i! /it. no little !ur%ri!e t.at t.i! Court ie/! t.e c.oice &ade '- t.e co&%lainant /ido/. To our &ind" t.e 'etter and &ore logical re&ed- under t.e circu&!tance! /ould .a e 'een to a%%eal t.e re!olution of t.e Cit- Pro!ecutor! di!&i!!ing t.e cri&inal co&%laint to t.e Secretar- of ?u!tice under t.e De%art&ent of ?u!ticeD! +rder No. AAF" 1A12 ot.er/i!e ;no/n a! t.e 41))F Re i!ed Rule! on A%%eal! =ro& Re!olution! In Preli&inarIn e!tigation!IRein e!tigation!"9 a! a&ended '- De%art&ent +rder No. F()" Section 1 of /.ic. %ro ide!3 4Section 1. :.at Ma- @e A%%ealed. - +nl- re!olution! of t.e C.ief State Pro!ecutorIRegional State Pro!ecutorIPro incial or Cit- Pro!ecutor di!&i!!ing a cri&inal co&%laint &a- 'e t.e !u'Eect of an a%%eal to t.e Secretar- of ?u!tice e5ce%t a! ot.er/i!e %ro ided in Section $ .ereof.9 :.at action &a- t.e Secretar- of ?u!tice ta;e on t.e a%%eal0 Section ) of +rder No. AAF !tate!3 4T.e Secretar- of ?u!tice &a- re er!e" affir& or &odif- t.e a%%ealed re!olution.9 +n t.e ot.er .and" 47e &a- motu proprio or on &otion of t.e a%%ellee" di!&i!! outrig.t t.e a%%eal on !%ecified ground!.9 1AA2 In e5erci!ing .i! di!cretion under t.e circu&!tance!" t.e +&'ud!&an acted /it.in .i! %o/er and aut.orit- in di!&i!!ing t.e co&%laint again!t t.e Pro!ecutor! and t.i! Court /ill not interfere /it. t.e !a&e. &ERE!ORE" in ie/ of t.e foregoing" t.e in!tant %etition i! DISMISSED , /it.out %reEudice to t.e filing of an a%%eal '- t.e %etitioner /it. t.e Secretar- of ?u!tice a!!ailing t.e di!&i!!al of .er cri&inal co&%laint '- t.e re!%ondent Cit- Pro!ecutor!. No co!t!. SO ORDERED.

Regalado, (Chairman), Puno, Mendoza, and Torres, Jr., JJ., concur.

II. Ele&ent! of &edical negligence3 A PETER PA>L PATRICJ L>CAS" =ATIMA GLADKS L>CAS" A@@EKGAIL L>CAS AND GILLIAN L>CAS !. DR. PR+SPER+ MA. C. T>AL+" 1G.R. No. 1*#*HF. A%ril A1" AGG).2

$&IRD DI+ISION "E$ER "AUL "A$RIC8 LUCAS, !A$I*A GLAD9S LUCAS, A##E9GAIL LUCAS AND GILLIAN LUCAS" Petitioner!" G. R. No. 1787;< Pre!ent3 KNARES-SANTIAG+" J., C.air%er!on" A>STRIA-MARTINEM" C7IC+-NAMARI+" NAC7>RA" and PERALTA" JJ.

- versus -

DR. "ROS"ERO *A. C. $UA:O, Re!%ondent.

Pro&ulgated3

A%ril A1" AGG) 5--------------------------------------------------5

DECISI+N

C&ICO-NA-ARIO, J.7

In t.i! %etition for re ie/ on certiorari112 under Rule $( of t.e Re i!ed Rule! of Court" %etitioner! Peter Paul Patric; Luca!" =ati&a Glad-! Luca!" A''e-gail Luca! and Gillian Luca! !ee; t.e re er!al of t.e A* Se%te&'er AGGH ecision1A2 and F ?ulAGG* Resolution,1F2 'ot. of t.e Court of A%%eal! in CA-G.R. C, No. H#HHH" entitled 4Peter Paul Patric; Luca!" =ati&a Glad-! Luca!" A''e-gail Luca! and Gillian Luca! . Pro!%ero Ma. C. TuaNo.9 In t.e 6ue!tioned deci!ion and re!olution" t.e Court of A%%eal! affir&ed t.e 1$ ?ulAGGG ecision of t.e Regional Trial Court BRTCC" @ranc. 1(G" Ma;ati Cit-" di!&i!!ing t.e

co&%laint filed '- %etitioner! in a ci il ca!e entitled" 4Peter Paul Patric! "ucas, #atima $lad%s "ucas, &''e%gail "ucas and $illian "ucas v. Prospero Ma. C. Tua(o,) doc;eted a! Ci il Ca!e No. )A-A$#A. =ro& t.e record of t.e ca!e" t.e e!ta'li!.ed factual antecedent! of t.e %re!ent %etition are3 So&eti&e in Augu!t 1)##" %etitioner Peter Paul Patric; Luca! BPeterC contracted 4!ore e-e!9 in .i! rig.t e-e. +n A Se%te&'er 1)##" co&%laining of a red rig.t e-e and !/ollen e-elid" Peter &ade u!e of .i! .ealt. care in!urance i!!ued '- P.ila&care 7ealt. S-!te&!" Inc. BP.ila&careC" for a %o!!i'le con!ult. T.e P.ila&care Coordinator" Dr. Ed/in +ca" M.D." referred Peter to re!%ondent" Dr. Pro!%ero Ma. C. TuaNo" M.D. BDr. TuaNoC" an o%.t.al&ologi!t at St. Lu;eD! Medical Center" for an e-e con!ult. >%on con!ultation /it. Dr. TuaNo" Peter narrated t.at it .ad 'een nine B)C da-! !ince t.e %ro'le& /it. .i! rig.t e-e 'egan8 and t.at .e /a! alread- ta;ing Ma*itrol to addre!! t.e %ro'le& in .i! e-e. According to Dr. TuaNo" .e %erfor&ed 4ocular routine e5a&ination9 on PeterD! e-e!" /.erein3 B1C a gro!! e5a&ination of PeterD! e-e! and t.eir !urrounding area /a! &ade8 BAC PeterD! i!ual acuit- /ere ta;en8 BFC PeterD! e-e! /ere %al%ated to c.ec; t.e intraocular %re!!ure of eac.8 B$C t.e &otilit- of PeterD! e-e! /a! o'!er ed8 and B(C t.e o%.t.al&o!co%-1$2 on PeterD! e-e! /a! u!ed. +n t.at %articular con!ultation" Dr. TuaNo diagno!ed t.at Peter /a! !uffering fro& con+unctivitis1(2 or 4!ore e-e!.9 Dr. TuaNo t.en %re!cri'ed ,persacet-C1H2 e-e dro%! for Peter and told t.e latter to return for follo/u% after one /ee;. A! in!tructed" Peter /ent 'ac; to Dr. TuaNo on ) Se%te&'er 1)##. >%on e5a&ination" Dr. TuaNo told Peter t.at t.e 4!ore e-e!9 in t.e latterD! rig.t e-e .ad alread- cleared u% and .e could di!continue t.e ,persacet-C. 7o/e er" t.e !a&e e-e de elo%ed -pidemic .erato Con+unctivitis BEJCC"1*2 a iral infection. To addre!! t.e ne/ %ro'le& /it. PeterD! rig.t e-e" Dr. TuaNo %re!cri'ed to t.e for&er a !teroid-'a!ed e-e dro% called Ma*itrol"1#2 a do!age of !i5 BHC dro%! %er da-.1)2 To recall" Peter .ad alread'een u!ingMa*itrol %rior to .i! con!ult /it. Dr. TuaNo.

+n A1 Se%te&'er 1)##" Peter !a/ Dr. TuaNo for a follo/-u% con!ultation. After e5a&ining 'ot. of PeterD! e-e!" Dr. TuaNo in!tructed t.e for&er to ta%er do/n11G2 t.e do!age of Ma*itrol, 'ecau!e t.e EJC in .i! rig.t e-e .ad alread- re!ol ed. Dr. TuaNo !%ecificallcautioned Peter t.at" 'eing a !teroid" Ma*itrol .ad to 'e /it.dra/n graduall-8 ot.er/i!e" t.e EJC &ig.t recur.1112 Co&%laining of feeling a! if t.ere /a! !o&et.ing in .i! e-e!" Peter returned to Dr. TuaNo for anot.er c.ec;-u% on H +cto'er 1)##. Dr. TuaNo e5a&ined PeterD! e-e! and found t.at t.e rig.t e-e .ad once &ore de elo%ed EJC . So" Dr. TuaNo in!tructed Peter to re!u&e t.e u!e of Ma*itrol at !i5 BHC dro%! %er da-. +n .i! /a- .o&e" Peter /a! una'le to get a .old of Ma*itrol, a! it /a! out of !toc;. Con!e6uentl-" Peter /a! told '- Dr. Tuano to ta;e" in!tead" /lephamide11A2 anot.er !teroid-'a!ed &edication" 'ut /it. a lo/er concentration" a! !u'!titute for t.e una aila'le Ma*itrol" to 'e u!ed t.ree BFC ti&e! a da- for fi e B(C da-!8 t/o BAC ti&e! a dafor fi e B(C da-!8 and t.en Eu!t once a da-.11F2 Se eral da-! later" on 1# +cto'er 1)##" Peter /ent to !ee Dr. TuaNo at .i! clinic" alleging !e ere e-e %ain" feeling a! if .i! e-e! /ere a'out to 4%o%-out"9 a .eadac.e and 'lurred i!ion. Dr. TuaNo e5a&ined PeterD! e-e! and di!co ered t.at t.e EJC /a! again %re!ent in .i! rig.t e-e. A! a re!ult" Dr. TuaNo told Peter to re!u&e t.e &a5i&u& do!age of /lephamide. Dr. TuaNo !a/ Peter once &ore at t.e for&erD! clinic on $ No e&'er 1)##. Dr. TuaNoD! e5a&ination !.o/ed t.at onl- t.e %eri%.er- of PeterD! rig.t e-e /a! %o!iti e for EJC8 .ence" Dr. TuaNo %re!cri'ed a lo/er do!age of /lephamide. It /a! al!o a'out t.i! ti&e t.at =ati&a Glad-! Luca! B=ati&aC" PeterD! !%ou!e" read t.e acco&%an-ing literature of Ma*itrol and found t.erein t.e follo/ing /arning again!t t.e %rolonged u!e of !uc. !teroid!3 :ARNING3 Prolonged u!e &a- re!ult in glauco&a" /it. da&age to t.e o%tic ner e" defect! in i!ual acuit- and field! of i!ion" and %o!terior" !u'ca%!ular cataract for&ation. Prolonged u!e &a- !u%%re!! t.e .o!t re!%on!e and t.u!

increa!e t.e .a<ard of !econdar- ocular infraction!" in t.o!e di!ea!e! cau!ing t.inning of t.e cornea or !clera" %erforation! .a e 'een ;no/n to occur /it. t.e u!e of to%ical !teroid!. In acute %urulent condition! of t.e e-e" !teroid! &a- &a!; infection or en.ance e5i!ting infection. If t.e!e %roduct! are u!ed for 1G da-! or longer" intraocular %re!!ure !.ould 'e routinel&onitored e en t.oug. it &a- 'e difficult in c.ildren and uncoo%erati e %atient!. E&%lo-&ent of !teroid &edication in t.e treat&ent of .er%e! !i&%le5 re6uire! great caution. 5555 AD,ERSE REACTI+NS3 Ad er!e reaction! .a e occurred /it. !teroidIanti-infecti e co&'ination drug! /.ic. can 'e attri'uted to t.e !teroid co&%onent" t.e anti-infecti e co&%onent" or t.e co&'ination. E5act incidence figure! are not a aila'le !ince no deno&inator of treated %atient! i! a aila'le. Reaction! occurring &o!t often fro& t.e %re!ence of t.e anti-infecti e ingredient! are allergic !en!iti<ation!. T.e reaction! due to t.e !teroid co&%onent in decrea!ing order to fre6uenc- are ele ation of intra-ocular %re!!ure BI+PC /it. %o!!i'le de elo%&ent of glauco&a" infre6uent o%tic ner e da&age8 %o!terior !u'ca%!ular cataract for&ation8 and dela-ed /ound .ealing. Secondar- infection3 T.e de elo%&ent of !econdar- .a! occurred after u!e of co&'ination containing !teroid! and anti&icro'ial!. =ungal infection! of t.e correa are %articularl- %rone to de elo% coincidentall- /it. long-ter& a%%lication! of !teroid. T.e %o!!i'ilit- of fungal in a!ion &u!t 'e con!idered in an- %er!i!tent corneal ulceration /.ere !teroid treat&ent .a! 'een u!ed. Secondar- 'acterial ocular infection follo/ing !u%%re!!ion of .o!t re!%on!e! al!o occur!.

+n AH No e&'er 1)##" Peter returned to Dr. TuaNoD! clinic" co&%laining of 4feeling /or!e.911$2 It a%%eared t.at t.e EJC .ad !%read to t.e /.ole of PeterD! rig.t e-e -et again. T.u!" Dr. TuaNo in!tructed Peter to re!u&e t.e u!e of Ma*itrol. Petitioner! a erred t.at Peter alread- &ade &ention to Dr. TuaNo during !aid i!it of t.e a'o e-6uoted /arning again!t t.e %rolonged u!e of !teroid!" 'ut Dr. TuaNo !u%%o!edl- 'ru!.ed a!ide PeterD! concern a! &ere %aranoia" e en a!!uring .i& t.at t.e for&er /a! ta;ing care of .i& BPeterC. Petitioner! furt.er alleged t.at after PeterD! AH No e&'er 1)## i!it to Dr. TuaNo" Peter continued to !uffer %ain in .i! rig.t e-e" /.ic. !ee&ed to 4%rogre!!"9 /it. t.e ac.e inten!if-ing and 'eco&ing &ore fre6uent.

>%on /a;ing in t.e &orning of 1F Dece&'er 1)##" Peter .ad no

i!ion in .i! rig.t

e-e. =ati&a o'!er ed t.at PeterD! rig.t e-e a%%eared to 'e 'lood- and !/ollen.11(2T.u!" !%ou!e! Peter and =ati&a ru!.ed to t.e clinic of Dr. TuaNo. Peter re%orted to Dr. TuaNo t.at .e .ad 'een !uffering fro& con!tant .eadac.e in t.e afternoon and 'lurring of i!ion. >%on e5a&ination" Dr. TuaNo noted t.e .ardne!! of PeterD! rig.t e-e. :it. t.e u!e of a tonometer11H2 to erif- t.e e5act intraocular pressure11*2 BI+PC of PeterD! e-e!" Dr. TuaNo di!co ered t.at t.e ten!ion in PeterD! rig.t e-e /a! <9.= &>" /.ile t.at of .i! left /a! 1*.G 7g.11#2 Since t.e ten!ion in PeterD! rig.t e-e /a! /a- o er t.e 'orm() IO"" /.ic. &erel- ranged fro& 1=.= &> to ?1.= &>"11)2 Dr. TuaNo ordered1AG2 .i& to i&&ediatellatter di!continue t.e u!e of Ma*itrol and %re!cri'ed to t.e iamo*1A12 and0ormoglaucon" in!tead.1AA2 Dr. TuaNo al!o re6uired Peter to go for

dail- c.ec;-u% in order for t.e for&er to clo!el- &onitor t.e %re!!ure of t.e latterD! e-e!. +n 1( Dece&'er 1)##" t.e tono&eter reading of PeterD! rig.t e-e -ielded a /0>/ 'orm() )e@e), i.e., ?1.= u!ing &>. 7ence" Dr. TuaNo told Peter to continue iamo* and0ormoglaucon. @ut u%on PeterD! co&%laint of 4!to&ac. %ain! and iamo*.1A$2

tingling !en!ation in .i! finger!"91AF2 Dr. TuaNo di!continued PeterD! u!e of

Peter /ent to !ee anot.er o%.t.al&ologi!t" Dr. Ra&on T. @atung'acal BDr. @atung'acalC" on A1 Dece&'er 1)##" /.o allegedl- conducted a co&%lete o%.t.al&ological e5a&ination of PeterD! e-e!. Dr. @atung'acalD! diagno!i! /a! $laucoma[25] 1. .1AH2 7e reco&&ended "aser Tra'eculoplast%1A*2 for PeterD! rig.t e-e. :.en Peter returned to Dr. TuaNo on AF Dece&'er 1)##"1A#2 t.e tono&eter &ea!ured t.e I+P of PeterD! rig.t e-e to 'e 41.= &>"1A)2 again" /a- a'o e nor&al. Dr. TuaNo addre!!ed t.e %ro'le& '- ad i!ing Peter to re!u&e ta;ing iamo* along /it. 0ormoglaucon.

During t.e C.ri!t&a! .olida-!" Peter !u%%o!edl- !ta-ed in 'ed &o!t of t.e ti&e and /a! not a'le to cele'rate t.e !ea!on /it. .i! fa&il- 'ecau!e of t.e de'ilitating effect! of iamo*.1FG2 +n A# Dece&'er 1)##" during one of PeterD! regular follo/-u%! /it. Dr. TuaNo" t.e doctor conducted anot.er ocular routine e5a&ination of PeterD! e-e!. Dr. TuaNo noted t.e recurrence of EJC in PeterD! rig.t e-e. Con!idering" .o/e er" t.at t.e I+P of PeterD! rig.t

e-e /a! !till 6uite .ig. at 41.= &>" Dr. TuaNo /a! at a lo!! a! to .o/ to 'alance t.e treat&ent of PeterD! EJC vis-2-vis t.e %re!ence of glaucoma in t.e !a&e e-e. Dr. TuaNo" t.u!" referred Peter to Dr. Manuel @. Agulto" M.D. BDr. AgultoC" anot.er o%.t.al&ologi!t !%eciali<ing in t.e treat&ent of glauco&a.1F12 Dr. TuaNoD! letter of referral to Dr. Agulto !tated t.at3 Referring to -ou Mr. Peter Luca! for e aluation O %o!!i'le &anage&ent. I initiall- !a/ .i& Se%t. A" 1)## 'ecau!e of conEuncti iti!. T.e latter re!ol ed and .e de elo%ed EJC for /.ic. I ga e Ma5itrol. T.e EJC /a! recurrent after !to%%ing !teroid dro%!. Around 1 &ont. of !teroid treat&ent" .e noted 'lurring of i!ion O %ain on t.e R. .o/e er" I continued t.e !teroid! for t.e !a;e of t.e EJC. A &ont. ago" I noted iri! atro%.-" !o I too; t.e I+P and it /a! definitel- ele ated. I !to%%ed t.e !teroid! i&&ediatel- and .a! B!icC 'een treating .i& &edicall-. It !ee&! t.at t.e I+P can 'e controlled onl- /it. oral Dia&o5" and at t.e &o&ent" t.e EJC .a! recurred and ID& in a fi5 /.et.er to re!u&e t.e !teroid or not con!idering t.at t.e I+P i! !till uncontrolled.1FA2

+n A) Dece&'er 1)##" Peter /ent to !ee Dr. Agulto at t.e latterD! clinic. Se eral te!t! /ere conducted t.ereat to e aluate t.e e5tent of PeterD! condition. Dr. Agulto /rote Dr. TuaNo a letter containing t.e follo/ing finding! and reco&&endation!3 T.an;! for !ending Peter Luca!. +n e5a&ination conducted i!ion /a! AGIA( R and AGIAGL. Ten!ion cur e 1) R and 1( L at 1A1G 7 /.ile on Nor&oglaucon @ID +D O Dia&o5 P ta' e er- H. %o. Slit la&% e aluation1FF2 di!clo!ed !u'e%it.elial corneal defect outer +D. T.ere /a! circu&ferential %eri%.eral iri! atro%.-" +D. T.e len!e! /ere clear. =undu!co%-1F$2 !.o/ed ertical cu% di!c of G.#( R and G.H L /it. te&%oral !lo%e RQL. Mei!! gonio!co%-1F(2 re ealed 'a!icall- o%en angle! 'ot. e-e! /it. occa!ional PAS"1FH2 +D. Roll-" I feel t.at Peter Luca! .a! reall- !u!tained !ignificant glauco&a da&age. I !ugge!t t.at /e do a 'a!eline i!ual field! and %u!. &edication to lo/e!t %o!!i'le le el!. If I &a- !ugge!t furt.er" I t.in; /e !.ould %re!cri'e Ti&olol1F*2 @ID1F#2 +D in lieu of Nor&oglaucon. If t.e I+P i! !till inade6uate" /e &a- tr- DDe%ifrin1F)2 @ID +D Bde!%ite lo/ PASC. ID& in fa or of retaining Dia&o5 or !i&ilar CAI.1$G2 If field! !.o/ furt.er lo!! in !a- R F &o!. t.en /e !.ould con!ider tra'eculo%la!t-. I tru!t t.at t.i! a%%roac. /ill %ro e rea!ona'le for -ou and Peter.1$12

Peter /ent to !ee Dr. TuaNo on F1 Dece&'er 1)##" 'earing Dr. AgultoD! afore&entioned letter. T.oug. PeterD! rig.t and left e-e! t.en .ad nor&al I+P of ?1.= &> and 1*.G 7g" re!%ecti el-" Dr. TuaNo !till ga e .i& a %re!cri%tion for Timolol @.I.D. !o Peter could i&&ediatel- !tart u!ing !aid &edication. Regretta'l-" Timolol @.I.D. /a! out of !toc;" !o Dr. TuaNo in!tructed Peter to Eu!t continue u!ing &eanti&e. ?u!t t/o da-! later" on A ?anuar- 1)#)" t.e I+P of PeterD! rig.t e-e re&ained ele ated at ?1.= &>,[4?] a! .e .ad 'een /it.out iamo* for t.e %a!t t.ree BFC da-!. iamo* and 0ormoglaucon in t.e

+n $ ?anuar- 1)#)" Dr. TuaNo conducted a visual 3ield stud%[43] of PeterD! e-e!" /.ic. re ealed t.at t.e latter .ad tu'ular vision1$$2 in .i! rig.t e-e" /.ile t.at of .i! left e-e re&ained t.e and nor&al. Dr. TuaNo directed Peter to religiou!lu!e iamo* and 0ormoglaucon, a! t.e ten!ion of t.e latterD! rig.t e-e /ent u% e en furt.er 4epi3rin /ere !till not a aila'le in t.e &ar;et. Again" Dr. TuaNo ad i!ed Peter to co&e

to 41.= &> in Eu!t a &atter of t/o BAC da-!" in t.e &eanti&e t.at Timolol @.I.D. for regular c.ec;-u% !o .i! I+P could 'e &onitored. +'edientl-" Peter /ent to !ee Dr. TuaNo on t.e * t." 1Ft." 1Ht. and AGt. of ?anuar- 1)#) for c.ec;-u% and I+P &onitoring. In t.e interregnu&" .o/e er" Peter /a! %rodded '- .i! friend! to !ee; a !econd &edical o%inion. +n 1F ?anuar- 1)#)" Peter con!ulted Dr. ?ai&e La%u<" M.D. BDr. La%u<C" an o%.t.al&ologi!t" /.o" in turn" referred Peter to Dr. Mario ,. A6uino" M.D. BDr. A6uinoC" anot.er o%.t.al&ologi!t /.o !%eciali<e! in t.e treat&ent of glauco&a and /.o could underta;e t.e long ter& care of PeterD! e-e!. According to %etitioner!" after Dr. A6uino conducted an e5ten!i e e aluation of PeterD! e-e!" t.e !aid doctor infor&ed Peter t.at .i! e-e! /ere relati el- nor&al" t.oug. t.e rig.t one !o&eti&e! &anife!ted &a5i&u& 'orderline ten!ion. Dr. A6uino al!o confir&ed Dr. TuaNoD! diagno!i! of tu'ular i!ion in PeterD! rig.t e-e. Petitioner! clai&ed t.at Dr. A6uino e!!entiall- told Peter t.at t.e latterD! condition /ould re6uire lifeti&e &edication and follo/-u%!.

In Ma- 1))G and ?une 1))1" Peter under/ent t/o BAC %rocedure! of la!er tra'eculo%la!tto atte&%t to control t.e .ig. I+P of .i! rig.t e-e. Clai&ing to .a e steroid-induced glaucoma1$(2 and 'la&ing Dr. TuaNo for t.e

!a&e" Peter" Eoined '-3 B1C =ati&a" .i! !%ou!e1$H28 BAC A''e-gail" .i! natural c.ild1$*28 and BFC Gillian" .i! legiti&ate c.ild1$#2 /it. =ati&a" in!tituted on 1 Se%te&'er 1))A" a ci il co&%laint for da&age! again!t Dr. TuaNo" 'efore t.e RTC" @ranc. 1(G" Sue<on Cit-. T.e ca!e /a! doc;eted a! Ci il Ca!e No. )A-A$#A. In t.eir Complaint" %etitioner! !%ecificall- a erred t.at a! t.e 4direct con!e6uence of 1PeterD!2 %rolonged u!e of Ma*itrol" 1.e2 !uffered fro& !teroid induced glauco&a /.ic. cau!ed t.e ele ation of .i! intra-ocular %re!!ure. T.e ele ation of t.e intra-ocular %re!!ure of 1PeterD! rig.t e-e2 cau!ed t.e i&%air&ent of .i! i!ion /.ic. i&%air&ent i! not cura'le and &a- e en lead to total 'lindne!!.91$)2 Petitioner! additionall- alleged t.at t.e i!ual i&%air&ent of PeterD! rig.t e-e cau!ed .i& and .i! fa&il- !o &uc. grief. @ecau!e of .i! %re!ent condition" Peter no/ needed clo!e &edical !u%er i!ion fore er8 .e .ad alread- undergone t/o BAC la!er !urgerie!" /it. t.e %o!!i'ilit- t.at &ore !urgerie! /ere !till needed in t.e future8 .i! career in !%ort! ca!ting .ad !uffered and /a! continuing to !uffer81(G2 .i! antici%ated inco&e .ad 'een greatlreduced a! a re!ult of .i! 4li&ited9 ca%acit-8 .e continuall- !uffered fro& 4.eadac.e!" nau!ea" di<<ine!!" .eart %al%itation!" ra!.e!" c.ronic r.initi!" !inu!iti!"91(12 etc.8 PeterD! relation!.i%! /it. .i! !%ou!e and c.ildren continued to 'e !trained" a! .i! condition &ade .i& .ig.l- irrita'le and !en!iti e8 .i! &o'ilit- and !ocial life .ad !uffered8 .i! !%ou!e" =ati&a" 'eca&e t.e 'read/inner in t.e fa&il-81(A2 and .i! t/o c.ildren .ad 'een de%ri ed of t.e o%%ortunit- for a 'etter life and educational %ro!%ect!. Collecti el-" %etitioner! li ed in con!tant fear of Peter 'eco&ing co&%letel- 'lind.1(F2 In t.e end" %etitioner! !oug.t %ecuniar- a/ard for t.eir !u%%o!ed %ain and !uffering" /.ic. /ere ulti&atel- 'roug.t a'out '- Dr. TuaNoD! gro!!l- negligent conduct in %re!cri'ing to Peter t.e &edicine Ma*itrol for a %eriod of t.ree BFC &ont.!" /it.out &onitoring PeterD! I+P" a! re6uired in ca!e! of %rolonged u!e of !aid &edicine" and not/it.!tanding PeterD! con!tant co&%laint of inten!e e-e %ain /.ile u!ing t.e !a&e. Petitioner! %articularl-

%ra-ed t.at Dr. TuaNo 'e adEudged lia'le for t.e follo/ing a&ount!3 1. a! A. 't.at F. &oral $. e5e&%lar(. attorne-D! T.e a&ount of PA"GGG"GGG.GG to %laintiff Peter Luca! and '- /a- of co&%en!ation for .i! i&%aired i!ion.

T.e a&ount of PFGG"GGG.GG to !%ou!e! Luca! a! and /a- of actual da&age! %lu! !uc. additional a&ount! &a- 'e %ro en during trial. T.e T.e a&ount of P1"GGG"GGG.GG da&age!. a&ount of P(GG"GGG.GG da&age!. a! a! and and ''/a/aof of

T.e

a&ount

of PAGG"GGG.GG a! and fee! %lu! co!t! of !uit.1($2

'-

/a-

of

In re'utting %etitioner!D co&%laint" Dr. TuaNo a!!erted t.at t.e 4treat&ent &ade '- 1.i&2 &ore t.an t.ree -ear! ago .a! no cau!al connection to 1PeterD!2 %re!ent glauco&a or condition.91((2 Dr. TuaNo e5%lained t.at 41d2rug-induced glauco&a i! te&%orar- and cura'le" !teroid! .a e t.e !ide effect of increa!ing intraocular %re!!ure. Steroid! are %re!cri'ed to treat E%ide&ic Jerato ConEuncti iti! or EJC /.ic. i! an infiltration of t.e cornea a! a re!ult of conEuncti iti! or !ore e-e!.91(H2 Dr. TuaNo al!o clarified t.at B1C 41c2ontrar- to 1%etitioner!D2 fallaciou! clai&" 1.e2 did N+T continuall- %re!cri'e t.e drug Ma5itrol /.ic. contained !teroid! for an- %rolonged %eriod91(*2 and 41t2.e trut. /a! t.e Ma5itrol /a! di!continued 5 5 5 a! !oon a! EJC di!a%%eared and /a! re!u&ed onl- /.en EJC rea%%eared91(#28 BAC t.e entire ti&e .e /a! treating Peter" .e 4continuall- &onitored t.e intraocular %re!!ure of 1PeterD! e-e!2 '- %al%ating t.e e-e! and '- %utting %re!!ure on t.e e-e'all!"9 and no .ardening of t.e !a&e could 'e detected" /.ic. &eant t.at t.ere /a! no increa!e in t.e ten!ion or I+P" a %o!!i'le !ide reaction to t.e u!e of !teroid &edication!8 and BFC it /a! onl- on 1F Dece&'er 1)## t.at Peter co&%lained of a .eadac.e and 'lurred i!ion in .i! rig.t e-e" and u%on &ea!uring t.e I+P of !aid e-e" it /a! deter&ined for t.e fir!t ti&e t.at t.e I+P of t.e rig.t e-e .ad an ele ated alue. @ut granting for t.e !a;e of argu&ent t.at t.e 4!teroid treat&ent of 1PeterD!2 EJC cau!ed t.e !teroid induced glauco&a"91()2 Dr. TuaNo argued t.at3 1S2uc. condition" i.e." ele ated intraocular %re!!ure" i! te&%orar-. A! !oon

a! t.e inta;e of !teroid! i! di!continued" t.e intraocular %re!!ure auto&aticall- i! reduced. T.u!" 1PeterD!2 glauco&a can onl- 'e due to ot.er cau!e! not attri'uta'le to !teroid!" certainl- not attri'uta'le to 1.i!2 treat&ent of &ore t.an t.ree -ear! ago 5 5 5. =ro& a &edical %oint of ie/" a! re ealed '- &ore current e5a&ination of 1Peter2" t.e latterD! glauco&a can onl- 'e long !tanding glauco&a" o%en angle glauco&a" 'ecau!e of t.e large C3D ratio. T.e !teroid! %ro o;ed t.e late!t glauco&a to 'e re ealed earlier a! 1Peter2 re&ained a!-&%to&atic %rior to !teroid a%%lication. 7ence" t.e !teroid treat&ent /a! in fact 'eneficial to 1Peter2 a! it re ealed t.e inci%ient o%en angle glauco&a of 1Peter2 to allo/ earlier treat&ent of t.e !a&e.1HG2

In a ecision dated 1$ ?ul- AGGG" t.e RTC di!&i!!ed Ci il Ca!e No. )A-A$#A 4for in!ufficienc- of e idence.91H12 T.e decretal %art of !aid ecision read!3

:.erefore" %re&i!e! con!idered" t.e in!tant co&%laint i! di!&i!!ed for in!ufficienc- of e idence. T.e counter clai& B!icC i! li;e/i!e di!&i!!ed in t.e a'!ence of 'ad fait. or &alice on t.e %art of %laintiff in filing t.e !uit.1HA2

T.e RTC o%ined t.at %etitioner! failed to %ro e '- %re%onderance of e idence t.at Dr. TuaNo /a! negligent in .i! treat&ent of PeterD! condition. In %articular" t.e record of t.e ca!e /a! 'ereft of an- e idence to e!ta'li!. t.at t.e !teroid &edication and it! do!age" a! %re!cri'ed '- Dr. TuaNo" cau!ed PeterD! glauco&a. T.e trial court rea!oned t.at t.e 4recogni<ed !tandard! of t.e &edical co&&unit- .a! not 'een e!ta'li!.ed in t.i! ca!e" &uc. le!! .a! cau!ation 'een e!ta'li!.ed to render 1TuaNo2 lia'le.91HF2 According to t.e RTC3 1Petitioner!2 failed to e!ta'li!. t.e dut- re6uired of a &edical %ractitioner again!t /.ic. Peter PaulD! treat&ent '- defendant can 'e co&%ared /it.. T.e- did not %re!ent an- &edical e5%ert or e en a &edical doctor to con ince and e5%ertl- e5%lain to t.e court t.e e!ta'li!.ed nor& or dutre6uired of a %.-!ician treating a %atient" or /.et.er t.e non ta;ing B!icC 'Dr. TuaNo of Peter PaulD! %re!!ure a de iation fro& t.e nor& or .i! nondi!co er- of t.e glauco&a in t.e cour!e of treat&ent con!titute! negligence. It i! i&%ortant and indi!%en!a'le to e!ta'li!. !uc. a !tandard 'ecau!e once it i! e!ta'li!.ed" a &edical %ractitioner /.o de%arted t.ereof 'reac.e! .i! dut- and co&&it! negligence rendering .i& lia'le. :it.out !uc. te!ti&on- or enlig.ten&ent fro& an e5%ert" t.e court i! at a lo!! a! to /.at i! t.en t.e e!ta'li!.ed nor& of dut- of a %.-!ician again!t /.ic. defendantD! conduct can 'e co&%ared /it. to deter&ine negligence.1H$2

T.e RTC added t.at in t.e a'!ence of 4an- &edical e idence to t.e contrar-" t.i!

court cannot acce%t 1%etitioner!D2 clai& t.at t.e u!e of !teroid i! t.e %ro5i&ate cau!e of t.e da&age !u!tained '- 1PeterD!2 e-e.91H(2 Corre!%ondingl-" t.e RTC acce%ted Dr. TuaNoD! &edical o%inion t.at 4Peter Paul &u!t .a e 'een !uffering fro& nor&al ten!ion glauco&a" &eaning" o%tic ner e da&age /a! .a%%ening 'ut no ele ation of t.e e-e %re!!ure i! &anife!ted" t.at t.e !teroid treat&ent actuall- un&a!;ed t.e condition t.at re!ulted in t.e earlier treat&ent of t.e glauco&a. T.ere i! not.ing in t.e record to contradict !uc. te!ti&on-. In fact" %laintiffD! E5.i'it TSD e en tend! to !u%%ort t.e&.9 >ndaunted" %etitioner! a%%ealed t.e foregoing RTC deci!ion to t.e Court of A%%eal!. T.eir a%%eal /a! doc;eted a! CA-G.R. C, No. H#HHH. +n A* Se%te&'er AGGH" t.e Court of A%%eal! rendered a deci!ion in CA-G.R. C, No. H#HHH den-ing %etitioner!D recour!e and affir&ing t.e a%%ealed RTC t.e Eudg&ent of t.e a%%ellate court !tate!3 :7ERE=+RE" t.e Deci!ion a%%ealed fro& i! A==IRMED.1HH2 T.e Court of A%%eal! faulted %etitioner! 'ecau!e t.e- R 1D2id not %re!ent an- &edical e5%ert to te!tif- t.at Dr. TuanoD! %re!cri%tion of Ma5itrol and @le%.a&ide for t.e treat&ent of EJC on PeterD! rig.t e-e /a! not %ro%er and t.at .i! %al%ation of PeterD! rig.t e-e /a! not enoug. to detect ad er!e reaction to !teroid. Peter te!tified t.at Dr. Manuel Agulto told .i& t.at .e !.ould not .a e u!ed !teroid for t.e treat&ent of EJC or t.at .e !.ould .a e u!ed it onl- for t/o BAC /ee;!" a! EJC i! onl- a iral infection /.ic. /ill cure '- it!elf. 7o/e er" Dr. Agulto /a! not %re!ented '1%etitioner!2 a! a /itne!! to confir& /.at .e allegedl- told Peter and" t.erefore" t.e latterD! te!ti&on- i! .ear!a-. >nder Rule 1FG" Section FH of t.e Rule! of Court" a /itne!! can te!tif- onl- to t.o!e fact! /.ic. .e ;no/! of .i! o/n %er!onal ;no/ledge" 5 5 5. =a&iliar and funda&ental i! t.e rule t.at .ear!a- te!ti&on- i! inad&i!!i'le a! e idence.1H*2 ecision. T.e3allo of

Li;e t.e RTC" t.e Court of A%%eal! ga e great /eig.t to Dr. TuaNoD! &edical Eudg&ent" !%ecificall- t.e latterD! e5%lanation t.at3 1:2.en a doctor !ee! a %atient" .e cannot deter&ine /.et.er or not t.e latter /ould react ad er!el- to t.e u!e of !teroid!" t.at it /a! onl- on Dece&'er 1F" 1)#)" /.en Peter co&%lained for t.e fir!t ti&e of .eadac.e and 'lurred

i!ion t.at .e o'!er ed t.at t.e %re!!ure of t.e e-e of Peter /a! ele ated" and it /a! onl- t.en t.at .e !u!%ected t.at Peter 'elong! to t.e (U of t.e %o%ulation /.o react! ad er!el- to !teroid!.1H#2

Petitioner!D Motion 3or Reconsideration /a! denied '- t.e Court of A%%eal! in a Re!olution dated F ?ul- AGG*. 7ence" t.i! Petition for Re ie/ on Certiorari under Rule $( of t.e Re i!ed Rule! of Court %re&i!ed on t.e follo/ing a!!ign&ent of error!3 I. T7E C+>RT += APPEALS C+MMITTED GRA,E RE,ERSI@LE ERR+R IN A==IRMING T7E DECISI+N += T7E TRIAL C+>RT DISMISSING T7E PETITI+NERSD C+MPLAINT =+R DAMAGES AGAINST T7E RESP+NDENT +N T7E GR+>ND += INS>==ICIENCK += E,IDENCE8 II. T7E C+>RT += APPEALS C+MMITTED GRA,E RE,ERSI@LE ERR+R IN DISMISSING T7E PETITI+NERSD C+MPLAINT =+R DAMAGES AGAINST T7E RESP+NDENT +N T7E GR+>ND T7AT N+ MEDICAL EXPERT :AS PRESENTED @K T7E PETITI+NERS T+ PR+,E T7EIR CLAIM =+R MEDICAL NEGLIGENCE AGAINST T7E RESP+NDENT8 AND III. T7E C+>RT += APPEALS C+MMITTED GRA,E RE,ERSI@LE ERR+R IN N+T =INDING T7E RESP+NDENT LIA@LE T+ T7E PETITI+NERSD =+R ACT>AL" M+RAL AND EXEMPLARK DAMAGES" ASIDE =R+M ATT+RNEKDS =EES" C+STS += S>IT" AS A RES>LT += 7IS GR+SS NEGLIGENCE.1H)2

A reading of t.e afore-6uoted re er!i'le error! !u%%o!edl- co&&itted '- t.e Court of A%%eal! in it! ecision and Resolution /ould re eal t.at %etitioner! are funda&entalla!!ailing t.e finding of t.e Court of A%%eal! t.at t.e e idence on record i! in!ufficient to e!ta'li!. %etitioner!D entitle&ent to an- ;ind of da&age. T.erefore" it could 'e !aid t.at t.e !ole i!!ue for our re!olution in t.e Petition at 'ar i! /.et.er t.e Court of A%%eal! co&&itted re er!i'le error in affir&ing t.e Eudg&ent of t.e RTC t.at %etitioner! failed to %ro e" '- %re%onderance of e idence" t.eir clai& for da&age! again!t Dr. TuaNo. E identl-" !aid i!!ue con!titute! a 6ue!tion of fact" a! /e are a!;ed to re i!it ane/ t.e

factual finding! of t.e Court of A%%eal!" a! /ell a! of t.e RTC. In effect" %etitioner! /ould .a e u! !ift t.roug. t.e e idence on record and %a!! u%on /.et.er t.ere i! !ufficient 'a!i! to e!ta'li!. Dr. TuaNoD! negligence in .i! treat&ent of PeterD! e-e condition. T.i! 6ue!tion clearl- in ol e! a factual in6uir-" t.e deter&ination of /.ic. i! not /it.in t.e a&'it of t.i! CourtD! %o/er of re ie/ under Rule $( of t.e 1))* Rule! Ci il Procedure" a! a&ended.1*G2 Ele&entar- i! t.e %rinci%le t.at t.i! Court i! not a trier of fact!8 onl- error! of la/ are generall- re ie/ed in %etition! for re ie/ on certiorari critici<ing deci!ion! of t.e Court of A%%eal!. Sue!tion! of fact are not entertained.1*12 Nonet.ele!!" t.e general rule t.at onl- 6ue!tion! of la/ &a- 'e rai!ed on a%%eal in a %etition for re ie/ under Rule $( of t.e Rule! of Court ad&it! of certain e5ce%tion!" including t.e circu&!tance /.en t.e finding of fact of t.e Court of A%%eal! i! %re&i!ed on t.e !u%%o!ed a'!ence of e idence" 'ut i! contradicted '- t.e e idence on record. Alt.oug. %etitioner! &a- not e5%licitl- in o;e !aid e5ce%tion" it &a- 'e gleaned fro& t.eir allegation! and argu&ent! in t.e in!tant Petition. Petitioner! contend" t.at 41c2ontrar- to t.e finding! of t.e 7onora'le Court of A%%eal!" 1t.e-2 /ere &ore t.an a'le to e!ta'li!. t.at3 Dr. TuaNo ignored t.e !tandard &edical %rocedure for o%.t.al&ologi!t!" ad&ini!tered &edication /it. rec;le!!ne!!" and e5.i'ited an a'!ence of co&%etence and !;ill! e5%ected fro& .i&.91*A2 Petitioner! reEect t.e nece!!it- of %re!enting e5%ert andIor &edical te!ti&on- to e!ta'li!. B1C t.e !tandard of care re!%ecting t.e treat&ent of t.e di!order affecting PeterD! e-e8 and BAC /.et.er or not negligence attended Dr. TuaNoD! treat&ent of Peter" 'ecau!e" in t.eir /ord! R T.at Dr. TuaNo /a! gro!!l- negligent in t.e treat&ent of PeterD! !i&%le e-e ail&ent is a simple case o3 cause and e33ect . :it. &ere docu&entare idence and 'a!ed on t.e fact! %re!ented '- t.e %etitioner!" re!%ondent can readil- 'e .eld lia'le for da&age! e en /it.out an- e5%ert te!ti&on-. In an- ca!e" .o/e er" and contrar- to t.e finding of t.e trial court and t.e Court of A%%eal!" t.ere /a! a &edical e5%ert %re!ented '- t.e %etitioner !.o/ing t.e rec;le!!ne!! co&&itted '- 1Dr. TuaNo2 R Dr. TuaNo .i&!elf. 1E&%.a!i! !u%%lied.2

T.e- in!i!t t.at Dr. TuaNo .i&!elf ga e !ufficient e idence to e!ta'li!. .i! gro!! negligence t.at ulti&atel- cau!ed t.e i&%air&ent of t.e i!ion of PeterD! rig.t e-e" 1*F2 i.e."

t.at 41d2e!%ite 1Dr. TuaNoD!2 ;no/ledge t.at (U of t.e %o%ulation react! ad er!elto Ma*itrol" 1.e2 .ad no 6ual&! /.at!oe er in %re!cri'ing !aid !teroid to Peter /it.out fir!t deter&ining /.et.er or not t.e (sic) Peter 'elong! to t.e (U.91*$2 :e are not con inced. T.e Eudg&ent! of 'ot. t.e Court of A%%eal! and t.e RTC are in accord /it. t.e e idence on record" and /e are accordingl- 'ound '- t.e finding! of fact &ade t.erein. Petitioner!D %o!ition" in !u&" i! t.at PeterD! glauco&a i! t.e direct re!ult of Dr. TuaNoD! negligence in .i! i&%ro%er ad&ini!tration of t.e drug Ma*itrol8 4t.u!" 1t.e latter2 !.ould 'e lia'le for all t.e da&age! !uffered and to 'e !uffered '- 1%etitioner!2.91*(2 Clearl-" t.e %re!ent contro er!- i! a cla!!ic illu!tration of a &edical negligence ca!e again!t a %.-!ician 'a!ed on t.e latterD! %rofe!!ional negligence. In t.i! t-%e of !uit" t.e %atient or .i! .eir!" in order to %re ail" i! re6uired to %ro e '- %re%onderance of e idence t.at t.e %.-!ician failed to e5erci!e t.at degree of !;ill" care" and learning %o!!e!!ed '- ot.er %er!on! in t.e !a&e %rofe!!ion8 and t.at a! a %ro5i&ate re!ult of !uc. failure" t.e %atient or .i! .eir! !uffered da&age!.

=or lac; of a !%ecific la/ geared to/ard! t.e t-%e of negligence co&&itted '- &e&'er! of t.e &edical %rofe!!ion" !uc. clai& for da&age! i! al&o!t al/a-! anc.ored on t.e alleged iolation of Article A1*H of t.e Ci il Code" /.ic. !tate! t.at3 ART. A1*H. :.oe er '- act or o&i!!ion cau!e! da&age to anot.er" t.ere 'eing fault or negligence" i! o'liged to %a- for t.e da&age done. Suc. fault or negligence" if t.ere i! no %re-e5i!ting contractual relation 'et/een t.e %artie!" i! called a quasi-delict and i! go erned '- t.e %ro i!ion! of t.i! C.a%ter.

In &edical negligence ca!e!" al!o called &edical &al%ractice !uit!" t.ere e5i!t a %.-!ician%atient relation!.i% 'et/een t.e doctor and t.e icti&. @ut Eu!t li;e an- ot.er %roceeding for da&age!" four e!!ential B$C ele&ent! i.e." B1C dut-8 BAC 'reac.8 BFC inEur-8 and B$C %ro5i&ate cau!ation"1*H2 &u!t 'e e!ta'li!.ed '- t.e %laintiffI!. All t.e four B$C ele&ent! &u!t co-e5i!t in order to find t.e %.-!ician negligent and" t.u!" lia'le for da&age!.

:.en a %atient engage! t.e !er ice! of a %.-!ician" a %.-!ician-%atient relation!.i% i!

generated. And in acce%ting a ca!e" t.e %.-!ician" for all intent! and %ur%o!e!" re%re!ent! t.at .e .a! t.e needed training and !;ill %o!!e!!ed '- %.-!ician! and !urgeon! %racticing in t.e !a&e field8 and t.at .e /ill e&%lo- !uc. training" care" and !;ill in t.e treat&ent of t.e %atient.1**2 T.u!" in treating .i! %atient" a %.-!ician i! under a duty to 1t.e for&er2 to e5erci!e t.at degree of care" !;ill and diligence /.ic. %.-!ician! in t.e !a&e general neig.'or.ood and in t.e !a&e general line of %ractice ordinaril- %o!!e!! and e5erci!e in li;e ca!e!.1*#2 Stated ot.er/i!e" t.e %.-!ician .a! t.e dut- to u!e at lea!t t.e !a&e le el of care t.at an- ot.er rea!ona'l- co&%etent %.-!ician /ould u!e to treat t.e condition under !i&ilar circu&!tance!. T.i! !tandard le el of care" !;ill and diligence i! a &atter 'e!t addre!!ed '- e5%ert &edical te!ti&on-" 'ecau!e t.e !tandard of care in a &edical &al%ractice ca!e i! a &atter %eculiarl- /it.in t.e ;no/ledge of e5%ert! in t.e field.1*)2 T.ere i! breach of dut- of care" !;ill and diligence" or t.e i&%ro%er %erfor&ance of !uc. dut-" '- t.e attending %.-!ician /.en t.e patient is injured in 'od- or in .ealt. 1and t.i!2 con!titute! t.e actiona'le &al%ractice.1#G2 Proof of !uc. 'reac. &u!t li;e/i!e re!t u%on t.e te!ti&on- of an e5%ert /itne!! t.at t.e treat&ent accorded to t.e %atient failed to &eet t.e !tandard le el of care" !;ill and diligence /.ic. %.-!ician! in t.e !a&e general neig.'or.ood and in t.e !a&e general line of %ractice ordinaril- %o!!e!! and e5erci!e in li;e ca!e!. E en !o" %roof of 'reac. of dut- on t.e %art of t.e attending %.-!ician i! in!ufficient" for t.ere &u!t 'e a cau!al connection 'et/een !aid 'reac. and t.e re!ulting inEur- !u!tained '- t.e %atient. Put in anot.er /a-" in order t.at t.ere &a- 'e a reco er- for an inEur-" it &u!t 'e !.o/n t.at t.e 4inEur- for /.ic. reco er- i! !oug.t &u!t 'e t.e legiti&ate con!e6uence of t.e /rong done8 t.e connection 'et/een t.e negligence and t.e inEur&u!t 'e a direct and natural !e6uence of e ent!" un'ro;en '- inter ening efficient cau!e!981#12 t.at i!" t.e negligence &u!t 'e t.e proximate cause of t.e inEur-. And t.e %ro5i&ate cau!e of an inEur- i! t.at cau!e" /.ic." in t.e natural and continuou! !e6uence" un'ro;en '- an- efficient inter ening cau!e" %roduce! t.e inEur-" and /it.out /.ic. t.e re!ult /ould not .a e occurred.1#A2 ?u!t a! /it. t.e ele&ent! of dut- and 'reac. of t.e !a&e" in order to e!ta'li!. t.e

%ro5i&ate cau!e 1of t.e inEur-2 '- a %re%onderance of t.e e idence in a &edical &al%ractice action" 1t.e %atient2 &u!t !i&ilarl- u!e e5%ert te!ti&on-" 'ecau!e t.e 6ue!tion of /.et.er t.e alleged %rofe!!ional negligence cau!ed 1t.e %atientD!2 inEur- i! generallone for !%eciali<ed e5%ert ;no/ledge 'e-ond t.e ;en of t.e a erage la-%er!on8 u!ing t.e !%eciali<ed ;no/ledge and training of .i! field" t.e e5%ertD! role i! to %re!ent to t.e 1court2 a reali!tic a!!e!!&ent of t.e li;eli.ood t.at 1t.e %.-!icianD!2 alleged negligence cau!ed 1t.e %atientD!2 inEur-.1#F2 =ro& t.e foregoing" it i! a%%arent t.at &edical negligence ca!e! are 'e!t %ro ed 'o%inion! of e5%ert /itne!!e! 'elonging in t.e !a&e general neig.'or.ood and in t.e !a&e general line of %ractice a! defendant %.-!ician or !urgeon. T.e deference of court! to t.e e5%ert o%inion of 6ualified %.-!ician! 1or !urgeon!2 !te&! fro& t.e for&erD! reali<ation t.at t.e latter %o!!e!! unu!ual tec.nical !;ill! /.ic. la-&en in &o!t in!tance! are inca%a'le of intelligentl- e aluating81#$2 .ence" t.e indi!%en!a'ilit- of e5%ert te!ti&onie!. In t.e ca!e at 'ar" t.ere i! no 6ue!tion t.at a %.-!ician-%atient relation!.i% de elo%ed 'et/een Dr. TuaNo and Peter /.en Peter /ent to !ee t.e doctor on A Se%te&'er 1)##" !ee;ing a con!ult for t.e treat&ent of .i! !ore e-e!. Ad&ittedl-" Dr. TuaNo" an o%.t.al&ologi!t" %re!cri'ed Ma*itrol /.en Peter de elo%ed and .ad recurrent EJC. Ma*itrol orneom%cin5pol%m%*in / sul3ates5de*amethasone o%.t.al&ic oint&ent i! a &ulti%le-do!e anti-infecti e !teroid co&'ination in !terile for& for to%ical a%%lication.1#(2 It i! t.e drug /.ic. %etitioner! clai& to .a e cau!ed PeterD! glauco&a. 7o/e er" a! correctl- %ointed out '- t.e Court of A%%eal!" 41t2.e onus pro'andi /a! on t.e %atient to e!ta'li!. 'efore t.e trial court t.at t.e %.-!ician! ignored !tandard &edical %rocedure" %re!cri'ed and ad&ini!tered &edication /it. rec;le!!ne!! and e5.i'ited an a'!ence of t.e co&%etence and !;ill! e5%ected of general %ractitioner! !i&ilarl!ituated.91#H2 >nfortunatel-" in t.i! ca!e" t.ere /a! a'!olute failure on t.e %art of %etitioner! to %re!ent an- e5%ert te!ti&on- to e!ta'li!.3 B1C t.e !tandard of care to 'e i&%le&ented '- co&%etent %.-!ician! in treating t.e !a&e condition a! PeterD! under !i&ilar circu&!tance!8 BAC t.at" in .i! treat&ent of Peter" Dr. TuaNo failed in .i! dut- to e5erci!e !aid !tandard of care t.at an- ot.er co&%etent %.-!ician /ould u!e in treating t.e !a&e condition a! PeterD! under !i&ilar circu&!tance!8 and BFC t.at t.e inEur- or da&age to PeterD! rig.t e-e" i.e." .i! glauco&a" /a! t.e re!ult of .i! u!e of Ma*itrol" a!

%re!cri'ed '- Dr. TuaNo. Petitioner!D failure to %ro e t.e fir!t ele&ent alone i! alread- fatal to t.eir cau!e. Petitioner! &aintain t.at Dr. TuaNo failed to follo/ in PeterD! ca!e t.e re6uired %rocedure for t.e %rolonged u!e of Ma*itrol. @ut /.at i! actuall- t.e re6uired %rocedure in !ituation! !uc. a! in t.e ca!e at 'ar0 To 'e %reci!e" /.at i! t.e !tandard o%erating %rocedure /.en o%.t.al&ologi!t! %re!cri'e !teroid &edication! /.ic." ad&ittedl-" carr- !o&e &odicu& of ri!;0 A'!ent a definiti e !tandard of care or diligence re6uired of Dr. TuaNo under t.e circu&!tance!" /e .a e no &ean! to deter&ine /.et.er .e /a! a'le to co&%l- /it. t.e !a&e in .i! diagno!i! and treat&ent of Peter. T.i! Court .a! no -ard!tic; u%on /.ic. to e aluate or /eig. t.e attendant fact! of t.i! ca!e to 'e a'le to !tate /it. confidence t.at t.e act! co&%lained of" indeed" con!tituted negligence and" t.u!" !.ould 'e t.e !u'Eect of %ecuniar- re%aration. Petitioner! a!!ert t.at %rior to %re!cri'ing Ma*itrol" Dr. TuaNo !.ould .a e deter&ined fir!t /.et.er Peter /a! a 4!teroid re!%onder.91#*2 Ket again" %etitioner! did not %re!ent ancon incing %roof t.at !uc. deter&ination i! actuall- %art of t.e !tandard o%erating %rocedure /.ic. o%.t.al&ologi!t! !.ould unerringl- follo/ %rior to %re!cri'ing !teroid &edication!. In contra!t" Dr. TuaNo /a! a'le to clearl- e5%lain t.at /.at i! onl- re6uired of o%.t.al&ologi!t!" in ca!e! !uc. a! PeterD!" i! t.e conduct of !tandard te!t!I%rocedure! ;no/n a! 4ocular routine e5a&ination"91##2 co&%o!ed of fi e B(C te!t!I%rocedure! R !%ecificall-" gro!! e5a&ination of t.e e-e! and t.e !urrounding area8 ta;ing of t.e i!ual acuit- of t.e %atient8 c.ec;ing t.e intraocular %re!!ure of t.e %atient8 c.ec;ing t.e &otilitof t.e e-e!8 and u!ing o%.t.al&o!co%- on t.e %atientD! e-e R and .e did all t.o!e te!t!I%rocedure! e er- ti&e Peter /ent to !ee .i& for follo/-u% con!ultation andIor c.ec;u%. :e cannot 'ut agree /it. Dr. TuaNoD! a!!ertion t.at /.en a doctor !ee! a %atient" .e cannot deter&ine i&&ediatel- /.et.er t.e latter /ould react ad er!el- to t.e u!e of !teroid!8 all t.e doctor can do i! &a% out a cour!e of treat&ent recogni<ed a! correct '-

t.e !tandard! of t.e &edical %rofe!!ion. It &u!t 'e re&e&'ered t.at a %.-!ician i! not an in!urer of t.e good re!ult of treat&ent. T.e &ere fact t.at t.e %atient doe! not get /ell or t.at a 'ad re!ult occur! doe! not in it!elf indicate failure to e5erci!e due care.1#)2 T.e re!ult i! not deter&inati e of t.e %erfor&ance 1of t.e %.-!ician2 and .e i! not re6uired to 'e infalli'le.1)G2 Moreo er" t.at Dr. TuaNo !a/ it fit to %re!cri'e Ma*itrol to Peter /a! Eu!tified '- t.e fact t.at t.e latter /a! alread- u!ing t.e !a&e &edication /.en .e fir!t ca&e to !ee Dr. TuaNo on A Se%te&'er 1)## and .ad e5.i'ited no %re iou! unto/ard reaction to t.at %articular drug. 1)12 Al!o" Dr. TuaNo categoricall- denied %etitioner!D clai& t.at .e ne er &onitored t.e ten!ion of PeterD! e-e! /.ile t.e latter /a! on Ma*itrol. Dr. TuaNo te!tified t.at .e %al%ated PeterD! e-e! e er- ti&e t.e latter ca&e for a c.ec;-u% a! %art of t.e doctorD! ocular routine e5a&ination" a fact /.ic. %etitioner! failed to re'ut. Dr. TuaNoD! regular conduct of e5a&ination! and te!t! to a!certain t.e !tate of PeterD! e-e! negate t.e er- 'a!i! of %etitioner!D co&%laint for da&age!. A! to /.et.er Dr. TuaNoD! actuation! confor&ed to t.e !tandard of care and diligence re6uired in li;e circu&!tance!" it i! %re!u&ed to .a e !o confor&ed in t.e a'!ence of e idence to t.e contrar-. E en if /e are to a!!u&e t.at Dr. TuaNo co&&itted negligent act! in .i! treat&ent of PeterD! condition" t.e cau!al connection 'et/een Dr. TuaNoD! !u%%o!ed negligence and PeterD! inEur- !till needed to 'e e!ta'li!.ed. T.e critical and clinc.ing factor in a &edical negligence ca!e i! %roof of t.e cau!al connection 'et/een t.e negligence /.ic. t.e e idence e!ta'li!.ed and t.e %laintiffD! inEurie!.1)A2 T.e %laintiff &u!t %lead and %ro e not onl- t.at .e .a! 'een inEured and defendant .a! 'een at fault" 'ut al!o t.at t.e defendantD! fault cau!ed t.e inEur-. A erdict in a &al%ractice action cannot 'e 'a!ed on !%eculation or conEecture. Cau!ation &u!t 'e %ro en /it.in a rea!ona'le &edical %ro'a'ilit- 'a!ed u%on co&%etent e5%ert te!ti&on-.1)F2 T.e cau!ation 'et/een t.e %.-!icianD! negligence and t.e %atientD! inEur- &a- onl- 'e e!ta'li!.ed '- t.e %re!entation of %roof t.at PeterD! glauco&a /ould not .a e occurred 'ut for Dr. TuaNoD! !u%%o!ed negligent conduct. +nce &ore" %etitioner! failed in t.i! regard.

Dr. TuaNo doe! not den- t.at t.e u!e of Ma*itrol in ol e! t.e ri!; of increa!ing a %atientD! I+P. In fact" t.i! /a! t.e rea!on /.- .e &ade it a %oint to %al%ate PeterD! e-e! e er- ti&e t.e latter /ent to !ee .i& -- !o .e could &onitor t.e ten!ion of PeterD! e-e!. @ut to !at.at !aid &edication conclu!i el- cau!ed PeterD! glauco&a i! %urel- !%eculati e. Peter /a! diagno!ed /it. open-angle glauco&a. T.i! ;ind of glauco&a i! c.aracteri<ed '- an al&o!t co&%lete a'!ence of !-&%to&! and a c.ronic" in!idiou! cour!e.1)$2 In o%en-angle glauco&a" .alo! around lig.t! and 'lurring of i!ion do not occur unle!! t.ere .a! 'een a !udden increa!e in t.e intraocular i!ion.1)(2 ,i!ual acuit- re&ain! good until late in t.e cour!e of t.e di!ea!e.1)H2 7ence" Dr. TuaNo clai&! t.at PeterD! glauco&a 4can onl- 'e long !tanding 5 5 5 'ecau!e of t.e large C3D1)*2 ratio"9 and t.at 41t2.e !teroid! %ro o;ed t.e late!t glauco&a to 'e re ealed earlier9 /a! a 'le!!ing in di!gui!e 4a! 1Peter2 re&ained a!-&%to&atic %rior to !teroid a%%lication.9 :.o 'et/een %etitioner! and Dr. TuaNo i! in a 'etter %o!ition to deter&ine and e aluate t.e nece!!it- of u!ing Ma*itrol to cure PeterD! EJC vis-2-vis t.e attendant ri!;! of u!ing t.e !a&e0 T.at Dr. TuaNo .a! t.e nece!!ar- training and !;ill to %ractice .i! c.o!en field i! 'e-ond ca il. Petitioner! do not di!%ute Dr. TuaNoD! 6ualification! R t.at .e .a! 'een a %.-!ician for clo!e to a decade and a .alf at t.e ti&e Peter fir!t ca&e to !ee .i&8 t.at .e .a! .ad ariou! &edical training8 t.at .e .a! aut.ored nu&erou! %a%er! in t.e field of o%.t.al&olog-" .ere and a'road8 t.at .e i! a iplomate of t.e P.ili%%ine @oard of +%.t.al&olog-8 t.at .e occu%ie! ariou! teac.ing %o!t! Bat t.e ti&e of t.e filing of t.e %re!ent co&%laint" .e /a! t.e C.air of t.e De%art&ent of +%.t.al&olog- and an A!!ociate Profe!!or at t.e >ni er!it- of t.e P.ili%%ine!-P.ili%%ine General 7o!%ital and St. Lu;eD! Medical Center" re!%ecti el-C8 and t.at .e .eld an a!!ort&ent of %o!ition! in nu&erou! &edical organi<ation! li;e t.e P.ili%%ine Medical A!!ociation" P.ili%%ine Acade&- of +%.t.al&olog-" P.ili%%ine @oard of +%.t.al&olog-" P.ili%%ine Societ- of +%.t.al&ic Pla!tic and Recon!tructi e Surger-" P.ili%%ine ?ournal of +%.t.al&olog-" A!!ociation of P.ili%%ine +%.t.al&olog- Profe!!or!" et al. It &u!t 'e re&e&'ered t.at /.en t.e 6ualification! of a %.-!ician are ad&itted" a! in t.e in!tant ca!e" t.ere i! an ine ita'le %re!u&%tion t.at in %ro%er ca!e!" .e ta;e! t.e nece!!ar- %recaution and e&%lo-! t.e 'e!t of .i! ;no/ledge and !;ill in attending to .i!

client!" unle!! t.e contrar- i! !ufficientl- e!ta'li!.ed.1)#2 In &a;ing t.e Eudg&ent call of treating PeterD! EJC /it. Ma*itrol" Dr. TuaNo too; t.e nece!!ar- %recaution '- %al%ating PeterD! e-e! to &onitor t.eir I+P e er- ti&e t.e latter /ent for a c.ec;-u%" and .e e&%lo-ed t.e 'e!t of .i! ;no/ledge and !;ill earned fro& -ear! of training and %ractice. In contra!t" /it.out !u%%orting e5%ert &edical o%inion!" %etitioner!D 'are a!!ertion! of negligence on Dr. TuaNoD! %art" /.ic. re!ulted in PeterD! glauco&a" de!er e !cant credit. +ur di!%o!ition of t.e %re!ent contro er!- &ig.t .a e 'een a!tl- different .ad %etitioner! %re!ented a &edical e5%ert to e!ta'li!. t.eir t.eor- re!%ecting Dr. TuaNoD! !o-called negligence. In fact" t.e record of t.e ca!e re eal! t.at %etitioner!D coun!el recogni<ed t.e nece!!it- of %re!enting !uc. e idence. Petitioner! e en ga e an underta;ing to t.e RTC Eudge t.at Dr. Agulto or Dr. A6uino /ould 'e %re!ented. Ala!" no follo/-t.roug. on !aid underta;ing /a! &ade. T.e %laintiff in a ci il ca!e .a! t.e 'urden of %roof a! .e allege! t.e affir&ati e of t.e i!!ue. 7o/e er" in t.e cour!e of trial in a ci il ca!e" once %laintiff &a;e! out a prima3acie ca!e in .i! fa or" t.e dut- or t.e 'urden of e idence !.ift! to defendant to contro ert %laintiffD! prima 3acie ca!e8 ot.er/i!e" a erdict &u!t 'e returned in fa or of %laintiff.1))2 T.e %art- .a ing t.e 'urden of %roof &u!t e!ta'li!. .i! ca!e '- a %re%onderance of e idence.11GG2 T.e conce%t of 4%re%onderance of e idence9 refer! to e idence /.ic. i! of greater /eig.t or &ore con incing t.an t.at /.ic. i! offered in o%%o!ition to it811G12 in t.e la!t anal-!i!" it &ean! %ro'a'ilit- of trut.. It i! e idence /.ic. i! &ore con incing to t.e court a! /ort.- of 'elief t.an t.at /.ic. i! offered in o%%o!ition t.ereto.11GA2 Rule 1FF" Section 1 of t.e Re i!ed Rule! of Court %ro ide! t.e guideline! for deter&ining %re%onderance of e idence" t.u!3 In ci il ca!e!" t.e %art- .a ing t.e 'urden of %roof &u!t e!ta'li!. .i! ca!e 'a %re%onderance of e idence. In deter&ining /.ere t.e %re%onderance or !u%erior /eig.t of e idence on t.e i!!ue! in ol ed lie! t.e court &acon!ider all t.e fact! and circu&!tance! of t.e ca!e" t.e /itne!!e!D &anner of te!tif-ing" t.eir intelligence" t.eir &ean! and o%%ortunit- of ;no/ing t.e fact! to /.ic. t.e- are te!tif-ing" t.e nature of t.e fact! to /.ic. t.e- te!tif-" t.e %ro'a'ilit- or i&%ro'a'ilit- of t.eir te!ti&on-" t.eir intere!t or /ant of intere!t" and al!o t.eir %er!onal credi'ilit- !o far a! t.e !a&e legiti&atela%%ear u%on t.e trial. T.e court &a- al!o con!ider t.e nu&'er of /itne!!e!" t.oug. t.e %re%onderance i! not nece!!aril- /it. t.e greater nu&'er.

7erein" t.e 'urden of %roof /a! clearl- u%on %etitioner!" a! %laintiff! in t.e lo/er court" to e!ta'li!. t.eir ca!e '- a %re%onderance of e idence !.o/ing a rea!ona'le connection 'et/een Dr. TuaNoD! alleged 'reac. of dut- and t.e da&age !u!tained '- PeterD! rig.t e-e. T.i!" t.e- did not do. In realit-" %etitioner!D co&%laint for da&age! i! &erel- anc.ored on a !tate&ent in t.e literature of Ma*itrol identif-ing t.e ri!;! of it! u!e" and t.e %ur%orted co&&ent of Dr. Agulto R anot.er doctor not %re!ented a! /itne!! 'efore t.e RTC R concerning t.e %rolonged u!e of Ma*itrol for t.e treat&ent of EJC. It !ee&! 'a!ic t.at /.at con!titute! %ro%er &edical treat&ent i! a &edical 6ue!tion t.at !.ould .a e 'een %re!ented to e5%ert!. If no !tandard i! e!ta'li!.ed t.roug. e5%ert &edical /itne!!e!" t.en court! .a e no !tandard '- /.ic. to gauge t.e 'a!ic i!!ue of 'reac. t.ereof '- t.e %.-!ician or !urgeon. T.e RTC and Court of A%%eal!" and e en t.i! Court" could not 'e e5%ected to deter&ine on it! o/n /.at &edical tec.ni6ue !.ould .a e 'een utili<ed for a certain di!ea!e or inEur-. A'!ent e5%ert &edical o%inion" t.e court! /ould 'e dangerou!l- engaging in !%eculation!. All told" /e are .ard %re!!ed to find Dr. TuaNo lia'le for an- &edical negligence or &al%ractice /.ere t.ere i! no e idence" in t.e nature of e5%ert te!ti&on-" to e!ta'li!. t.at in treating Peter" Dr. TuaNo failed to e5erci!e rea!ona'le care" diligence and !;ill generallre6uired in &edical %ractice. Dr. TuaNoD! te!ti&on-" t.at .i! treat&ent of Peter confor&ed in all re!%ect! to !tandard &edical %ractice in t.i! localit-" !tand! unrefuted. Con!e6uentl-" t.e RTC and t.e Court of A%%eal! correctl- .eld t.at t.e- .ad no 'a!i! at all to rule t.at %etitioner! /ere de!er ing of t.e ariou! da&age! %ra-ed for in t.eir Complaint. &ERE!ORE" %re&i!e! con!idered" t.e in!tant %etition i! DENIED for lac; of &erit. T.e a!!ailed ecision dated A* Se%te&'er AGGH and Resolution dated F ?ul- AGG*"'ot. of t.e Court of A%%eal! in CA-G.R. C, No. H#HHH" are .ere'- A!!IR*ED. No co!t. SO ORDERED.

III. P.-!ician! &a- 'eco&e %rofe!!ionall- lia'le for &al%ractice in t.e /a-!3 A. @.

follo/ing

T.roug. t.e %.-!icianD! o/n negligence Bfailing to confor& to generallacce%ted &edical %racticeC8 T.roug. t.e negligence of t.e %.-!icianD! e&%lo-ee!3 Re!%ondeat

C. D. E.

Su%eriorC8 T.roug. t.e %.-!icianD! failure to o'tain t.e infor&ed con!ent of t.e %atient %rior to treat&ent8 T.roug. 'reac. of %.-!ician-%atient contractual relation!.i% Bi.e." a'andoning %atient" di!clo!ing confidential infor&ation" or guaranteeing a cure or !o&e ot.er !%ecific re!ultC8 and T.roug. t.e negligence of t.e %.-!icianD! %artner!.

I,. Standard of Care3 T.e !tandard of care for %.-!ician! and .ealt. care %ro ider! re6uire! t.at t.e- e5erci!e t.at degree of !;ill" ;no/ledge and care ordinaril- %o!!e!!ed and e5erci!ed '- ot.er &e&'er! of t.e %rofe!!ion acting under !i&ilar condition! and circu&!tance!. A. @. Garcia-Rueda !. Pa!ca!io" !u%ra. PETER PA>L PATRICJ L>CAS" =ATIMA GLADKS L>CAS" A@@EKGAIL L>CAS AND GILLIAN L>CAS !. DR. PR+SPER+ MA. C. T>AL+" 1G.R. No. 1*#*HF. A%ril A1" AGG).2" !u%ra. So&e doctrine! on !tandard of care3 1. No &atter /.at a .ealt.care %ro ider doe!" .e /ill not 'e found lia'le if t.e !tandard of care i! &aintained. A %ractitioner /.o conduct! .i&!elf in confor&it- /it. t.e !tandard of care /ill not 'e .eld lia'le e en if t.e treat&ent %ro ed un!ucce!!ful. T.e e5i!tence of %oor treat&ent or !urger- re!ult doe! not in an- /arai!e a %re!u&%tion of t.e iolation of t.e !tandard of care. Plaintiff &u!t !till %ro e a !tandard of care iolation. :.ere a .ealt.care %ro ider &a;e! an error in Eudg&ent" if t.ere i! no !tandard of care iolation" t.e %laintiff .a! no ca!e. T.e !tandard of care doe! not call for a %ractitioner to u!e t.e .ig.e!t !;ill ;no/n to &edical !cience. >nder &o!t circu&!tance!" if e idence !ugge!t! t.at t.ere /ere alternati e recogni<ed &et.od! of treat&ent a aila'le" a %ractitioner /ould not 'e found negligent for !electing t.e /rong one a! long a! it i! a 4recogni<ed9 treat&ent c.oice. T.e !tandard of care go erning &edical !%eciali!t! re6uire! t.e e5erci!e of %rofe!!ional conduct nor&all- e5.i'ited '- !%eciali!t! in t.e !a&e or !i&ilar localit- under !i&ilar circu&!tance!.

C.

A. F. $. (.

H.

D.

E5%ert te!ti&on- to e!ta'li!. !tandard of care 1. A. F. to e!ta'li!. t.at t.e defendant %.-!ician .a! de iated fro& t.e a%%lica'le !tandard of care t.at inEur- .a! t.ere'- re!ulted8 +%inion of e5%ert /itne!!" Rule! of Court. E5ce%tion3 Re! i%!a lo6uitur.

E.

Ca!e!3 1. Ra&o! !. CA" G.R. No. 1A$F($" Dece&'er A)" 1)))

=IRST DI,ISI+N

[G.R. No. 1?4<54. De1ember ?9, 1999]

ROGELIO E. RA*OS ('3 ERLINDA RA*OS, 0' t/e0r oA' be/(). ('3 (4 '(t2r() >2(r30('4 o. t/e m0'or4, RO**EL RA*OS, RO9 RODERIC8 RA*OS ('3 RON RA9*OND RA*OS, petitioners, vs. COUR$ O! A""EALS, DELOS SAN$OS *EDICAL CEN$ER, DR. ORLINO &OSA8A ('3 DRA. "ER!EC$A GU$IERRE-, respondents. DECISION 8A"UNAN, J.7 T.e 7i%%ocratic +at. &andate! %.-!ician! to gi e %ri&ordial con!ideration to t.e .ealt. and /elfare of t.eir %atient!. If a doctor fail! to li e u% to t.i! %rece%t" .e i! &ade accounta'le for .i! act!. A &i!ta;e" t.roug. gro!! negligence or inco&%etence or %lain .u&an error" &a- !%ell t.e difference 'et/een life and deat.. In t.i! !en!e" t.e doctor %la-! God on .i! %atientD! fate.112 In t.e ca!e at 'ar" t.e Court i! called u%on to rule /.et.er a !urgeon" an ane!t.e!iologi!t and a .o!%ital !.ould 'e &ade lia'le for t.e unfortunate co&ato!e condition of a %atient !c.eduled for cholec%stectom%.1A2 Petitioner! !ee; t.e re er!al of t.e deci!ion1F2 of t.e Court of A%%eal!" dated A) Ma1))(" /.ic. o erturned t.e deci!ion1$2of t.e Regional Trial Court" dated FG ?anuar- 1))A" finding %ri ate re!%ondent! lia'le for da&age! ari!ing fro& negligence in t.e %erfor&ance of t.eir %rofe!!ional dutie! to/ard! %etitioner Erlinda Ra&o! re!ulting in .er co&ato!e condition. T.e antecedent fact! a! !u&&ari<ed '- t.e trial court are re%roduced .ereunder3 Plaintiff Erlinda Ra&o! /a!" until t.e afternoon of ?une 1*" 1)#(" a $*--ear old BE5.. 4A9C ro'u!t /o&an BTSN" +cto'er 1)" 1)#)" %. 1GC. E5ce%t for occa!ional co&%laint! of di!co&fort due to %ain! allegedl- cau!ed '- t.e %re!ence of a !tone in .er gall 'ladder BTSN" ?anuar- 1F" 1)##" %%. $-(C" !.e /a! a! nor&al a! an- ot.er /o&an. Married to Rogelio E. Ra&o!" an e5ecuti e of P.ili%%ine Long Di!tance Tele%.one Co&%an-" !.e .a! t.ree c.ildren /.o!e na&e! are Ro&&el Ra&o!" Ro- Roderic; Ra&o! and Ron Ra-&ond Ra&o! BTSN" +cto'er 1)" 1)#)" %%. (-HC. @ecau!e t.e di!co&fort! !o&e.o/ interfered /it. .er nor&al /a-!" !.e !oug.t %rofe!!ional ad ice. S.e /a! ad i!ed to undergo an o%eration for t.e re&o al of a !tone in .er gall 'ladder BTSN" ?anuar- 1F" 1)##" %. (C. S.e under/ent a !erie! of e5a&ination! /.ic. included 'lood and urine te!t! BE5.!. 4A9 and 4C9C /.ic. indicated !.e /a! fit for !urger-. T.roug. t.e interce!!ion of a &utual friend" Dr. @uen iaEe BTSN" ?anuar- 1F" 1)##" %. *C" !.e and .er .u!'and Rogelio &et for t.e fir!t ti&e Dr. +rlino 7o<a;a B!.ould 'e 7o!a;a8 !ee TSN" =e'ruar- AG" 1))G" %. FC" one of t.e defendant! in t.i! ca!e" on ?une 1G" 1)#(. T.e- agreed t.at t.eir date at t.e o%erating ta'le at t.e DLSMC Banot.er defendantC" /ould 'e on ?une 1*" 1)#( at )3GG A.M.. Dr. 7o!a;a decided t.at !.e !.ould undergo a 4c.olec-!tecto&-9 o%eration after e5a&ining t.e docu&ent! Bfinding! fro& t.e

Ca%itol Medical Center" =E> 7o!%ital and DLSMCC %re!ented to .i&. Rogelio E. Ra&o!" .o/e er" a!;ed Dr. 7o!a;a to loo; for a good ane!t.e!iologi!t. Dr. 7o!a;a" in turn" a!!ured Rogelio t.at .e /ill get a good ane!t.e!iologi!t. Dr. 7o!a;a c.arged a fee of P1H"GGG.GG" /.ic. /a! to include t.e ane!t.e!iologi!tD! fee and /.ic. /a! to 'e %aid after t.e o%eration BTSN" +cto'er 1)" 1)#)" %%. 1$-1(" AA-AF" F1-FF8 TSN" =e'ruar- A*" 1))G" %. 1F8 and TSN" No e&'er )" 1)#)" %%. F-$" 1G" 1*C. A da- 'efore t.e !c.eduled date of o%eration" !.e /a! ad&itted at one of t.e roo&! of t.e DLSMC" located along E. Rodrigue< A enue" Sue<on Cit- BTSN" +cto'er 1)" 1)#)" %. 11C. At around *3FG A.M. of ?une 1*" 1)#( and /.ile !till in .er roo&" !.e /a! %re%ared for t.e o%eration '- t.e .o!%ital !taff. 7er !i!ter-in-la/" 7er&inda Cru<" /.o /a! t.e Dean of t.e College of Nur!ing at t.e Ca%itol Medical Center" /a! al!o t.ere for &oral !u%%ort. S.e reiterated .er %re iou! re6ue!t for 7er&inda to 'e /it. .er e en during t.e o%eration. After %ra-ing" !.e /a! gi en inEection!. 7er .and! /ere .eld '- 7er&inda a! t.e- /ent do/n fro& .er roo& to t.e o%erating roo& BTSN" ?anuar- 1F" 1)##" %%. )11C. 7er .u!'and" Rogelio" /a! al!o /it. .er BTSN" +cto'er 1)" 1)#)" %. 1#C. At t.e o%erating roo&" 7er&inda !a/ a'out t/o or t.ree nur!e! and Dr. Perfecta Gutierre<" t.e ot.er defendant" /.o /a! to ad&ini!ter ane!t.e!ia. Alt.oug. not a &e&'er of t.e .o!%ital !taff" 7er&inda introduced .er!elf a! Dean of t.e College of Nur!ing at t.e Ca%itol Medical Center /.o /a! to %ro ide &oral !u%%ort to t.e %atient" to t.e&. 7er&inda /a! allo/ed to !ta- in!ide t.e o%erating roo&. At around )3FG A.M." Dr. Gutierre< reac.ed a near'- %.one to loo; for Dr. 7o!a;a /.o /a! not -et in BTSN" ?anuar- 1F" 1)##" %%. 11-1AC. Dr. Gutierre< t.ereafter infor&ed 7er&inda Cru< a'out t.e %ro!%ect of a dela- in t.e arri al of Dr. 7o!a;a. 7er&inda t.en /ent 'ac; to t.e %atient /.o a!;ed" 4Mind-" /ala %a 'a ang Doctor90 T.e for&er re%lied" 47u/ag ;ang &ag-alaala" darating na i-on9 Bi'id.C. T.ereafter" 7er&inda /ent out of t.e o%erating roo& and infor&ed t.e %atientD! .u!'and" Rogelio" t.at t.e doctor /a! not -et around Bid." %. 1FC. :.en !.e returned to t.e o%erating roo&" t.e %atient told .er" 4Mind-" ini% na ini% na a;o" i;u.a &o a;o ng i'ang Doctor.9 So" !.e /ent out again and told Rogelio a'out /.at t.e %atient !aid Bid." %. 1(C. T.ereafter" !.e returned to t.e o%erating roo&. At around 1G3GG A.M." Rogelio E. Ra&o! /a! 4alread- d-ing 1and2 /aiting for t.e arri al of t.e doctor9 e en a! .e did .i! 'e!t to find !o&e'od- /.o /ill allo/ .i& to %ull out .i! /ife fro& t.e o%erating roo& BTSN" +cto'er 1)" 1)#)" %%. 1)-AGC. 7e al!o t.oug.t of t.e feeling of .i! /ife" /.o /a! in!ide t.e o%erating roo& /aiting for t.e doctor to arri e Bi'id.C. At al&o!t 1A3GG noon" .e &et Dr. Garcia /.o re&ar;ed t.at .e BDr. GarciaC /a! al!o tired of /aiting for Dr. 7o!a;a to arri e Bid." %. A1C. :.ile tal;ing to Dr. Garcia at around 1A31G P.M." .e ca&e to ;no/ t.at Dr. 7o!a;a arri ed a! a nur!e re&ar;ed" 4Nandi-an na !i Dr. 7o!a;a" du&ating na ra/.9 >%on .earing t.o!e /ord!" .e /ent do/n to t.e lo''- and /aited for t.e o%eration to 'e co&%leted Bid." %%. 1H" A)-FGC. At a'out 1A31( P.M." 7er&inda Cru<" /.o /a! in!ide t.e o%erating roo& /it. t.e %atient" .eard !o&e'od- !a- t.at 4Dr. 7o!a;a i! alread- .ere.9 S.e t.en !a/ %eo%le in!ide t.e o%erating roo& 4&o ing" doing t.i! and t.at" 1and2 %re%aring t.e %atient for t.e o%eration9 BTSN" ?anuar- 1F" 1)##" %. 1HC. A! !.e .eld t.e .and of Erlinda Ra&o!" !.e t.en !a/ Dr. Gutierre< intu'ating t.e .a%le!! %atient. S.e t.ereafter .eard Dr. Gutierre< !a-" 4ang .ira% &a-intu'ate nito" &ali -ata ang %ag;a;a%a!o;. + lu&ala;i ang ti-an9 Bid." %. 1*C. @ecau!e of t.e re&ar;! of Dra. Gutierre<" !.e focu!ed .er attention on /.at Dr. Gutierre< /a! doing. S.e t.ereafter noticed 'lui!. di!coloration of t.e nail'ed! of t.e left .and of t.e .a%le!! Erlinda e en a! Dr. 7o!a;a a%%roac.ed .er. S.e t.en .eard Dr. 7o!a;a i!!ue an order for !o&eone to call Dr. Calderon" anot.er ane!t.e!iologi!t Bid." %. 1)C. After Dr. Calderon arri ed at t.e o%erating roo&" !.e !a/ t.i! ane!t.e!iologi!t tr-ing

to intu'ate t.e %atient. T.e %atientD! nail'ed 'eca&e 'lui!. and t.e %atient /a! %laced in a trendelen'urg %o!ition - a %o!ition /.ere t.e .ead of t.e %atient i! %laced in a %o!ition lo/er t.an .er feet /.ic. i! an indication t.at t.ere i! a decrea!e of 'lood !u%%l- to t.e %atientD! 'rain BId." %%. 1)-AGC. I&&ediatel- t.ereafter" !.e /ent out of t.e o%erating roo&" and !.e told Rogelio E. Ra&o! 4t.at !o&et.ing /rong /a! 5 5 5 .a%%ening9 BI'id.C. Dr. Calderon /a! t.en a'le to intu'ate t.e %atient BTSN" ?ul- A(" 1))1" %. )C. Mean/.ile" Rogelio" /.o /a! out!ide t.e o%erating roo&" !a/ a re!%irator- &ac.ine 'eing ru!.ed to/ard! t.e door of t.e o%erating roo&. 7e al!o !a/ !e eral doctor! ru!.ing to/ard! t.e o%erating roo&. :.en infor&ed '- 7er&inda Cru< t.at !o&et.ing /rong /a! .a%%ening" .e told .er B7er&indaC to 'e 'ac; /it. t.e %atient in!ide t.e o%erating roo& BTSN" +cto'er 1)" 1)#)" %%. A(-A#C. 7er&inda Cru< i&&ediatel- ru!.ed 'ac;" and !a/ t.at t.e %atient /a! !till in trendelen'urg %o!ition BTSN" ?anuar- 1F" 1)##" %. AGC. At al&o!t F3GG P.M. of t.at fateful da-" !.e !a/ t.e %atient ta;en to t.e Inten!i e Care >nit BIC>C. A'out t/o da-! t.ereafter" Rogelio E. Ra&o! /a! a'le to tal; to Dr. 7o!a;a. T.e latter infor&ed t.e for&er t.at !o&et.ing /ent /rong during t.e intu'ation. Reacting to /.at /a! told to .i&" Rogelio re&inded t.e doctor t.at t.e condition of .i! /ife /ould not .a e .a%%ened" .ad .e BDr. 7o!a;aC loo;ed for a good ane!t.e!iologi!t BTSN" +cto'er 1)" 1)#)" %. F1C. Doctor! Gutierre< and 7o!a;a /ere al!o a!;ed '- t.e .o!%ital to e5%lain /.at .a%%ened to t.e %atient. T.e doctor! e5%lained t.at t.e %atient .ad 'ronc.o!%a!& BTSN" No e&'er 1(" 1))G" %%. AH-A*C. Erlinda Ra&o! !ta-ed at t.e IC> for a &ont.. A'out four &ont.! t.ereafter or on No e&'er 1(" 1)#(" t.e %atient /a! relea!ed fro& t.e .o!%ital. During t.e /.ole %eriod of .er confine&ent" !.e incurred .o!%ital 'ill! a&ounting to P)F"($A.A( /.ic. i! t.e !u'Eect of a %ro&i!!or- note and affida it of underta;ing e5ecuted '- Rogelio E. Ra&o! in fa or of DLSMC. Since t.at fateful afternoon of ?une 1*" 1)#(" !.e .a! 'een in a co&ato!e condition. S.e cannot do an-t.ing. S.e cannot &o e an- %art of .er 'od-. S.e cannot !ee or .ear. S.e i! li ing on &ec.anical &ean!. S.e !uffered 'rain da&age a! a re!ult of t.e a'!ence of o5-gen in .er 'rain for four to fi e &inute! BTSN" No e&'er )" 1)#)" %%. A1-AAC. After 'eing di!c.arged fro& t.e .o!%ital" !.e .a! 'een !ta-ing in t.eir re!idence" !till needing con!tant &edical attention" /it. .er .u!'and Rogelio incurring a &ont.l- e5%en!e ranging fro& P#"GGG.GG to P1G"GGG.GG BTSN" +cto'er 1)" 1)#)" %%. FA-F$C. S.e /a! al!o diagno!ed to 'e !uffering fro& 4diffu!e cere'ral %arenc.-&al da&age9 BE5.. 4G98 !ee al!o TSN" Dece&'er A1" 1)#)" %. HC.1(2 T.u!" on # ?anuar- 1)#H" %etitioner! filed a ci il ca!e1H2 for da&age! /it. t.e Regional Trial Court of Sue<on Cit- again!t .erein %ri ate re!%ondent! alleging negligence in t.e &anage&ent and care of Erlinda Ra&o!. During t.e trial" 'ot. %artie! %re!ented e idence a! to t.e %o!!i'le cau!e of ErlindaD! inEur-. Plaintiff %re!ented t.e te!ti&onie! of Dean 7er&inda Cru< and Dr. Mariano Ga ino to %ro e t.at t.e da&age !u!tained '- Erlinda /a! due to lac; of o5-gen in .er 'rain cau!ed '- t.e fault- &anage&ent of .er air/a- '- %ri ate re!%ondent! during t.e ane!t.e!ia %.a!e. +n t.e ot.er .and" %ri ate re!%ondent! %ri&aril- relied on t.e e5%ert te!ti&on- of Dr. Eduardo ?a&ora" a %ul&onologi!t" to t.e effect t.at t.e cau!e of 'rain da&age /a! ErlindaD! allergic reaction to t.e ane!t.etic agent" T.io%ental Sodiu& BPentot.alC. After con!idering t.e e idence fro& 'ot. !ide!" t.e Regional Trial Court rendered

Eudg&ent in fa or of %etitioner!" to /it3 After e aluating t.e e idence a! !.o/n in t.e finding of fact! !et fort. earlier" and a%%l-ing t.e aforecited %ro i!ion! of la/ and Euri!%rudence to t.e ca!e at 'ar" t.i! Court find! and !o .old! t.at defendant! are lia'le to %laintiff! for da&age!. T.e defendant! /ere guiltof" at t.e er- lea!t" negligence in t.e %erfor&ance of t.eir dut- to %laintiff-%atient Erlinda Ra&o!. +n t.e %art of Dr. Perfecta Gutierre<" t.i! Court find! t.at !.e o&itted to e5erci!e rea!ona'le care in not onl- intu'ating t.e %atient" 'ut al!o in not re%eating t.e ad&ini!tration of atro%ine BTSN" Augu!t AG" 1))1" %%. (-1GC" /it.out due regard to t.e fact t.at t.e %atient /a! in!ide t.e o%erating roo& for al&o!t t.ree BFC .our!. =or after !.e co&&itted a &i!ta;e in intu'ating 1t.e2 %atient" t.e %atientV! nail'ed 'eca&e 'lui!. and t.e %atient" t.ereafter" /a! %laced in trendelen'urg %o!ition" 'ecau!e of t.e decrea!e of 'lood !u%%l- to t.e %atientV! 'rain. T.e e idence furt.er !.o/! t.at t.e .a%le!! %atient !uffered 'rain da&age 'ecau!e of t.e a'!ence of o5-gen in .er B%atientV!C 'rain for a%%ro5i&atelfour to fi e &inute! /.ic." in turn" cau!ed t.e %atient to 'eco&e co&ato!e. +n t.e %art of Dr. +rlino 7o!a;a" t.i! Court find! t.at .e i! lia'le for t.e act! of Dr. Perfecta Gutierre< /.o& .e .ad c.o!en to ad&ini!ter ane!t.e!ia on t.e %atient a! %art of .i! o'ligation to %ro ide t.e %atient a Wgood ane!t.e!iologi!tV" and for arri ing for t.e !c.eduled o%eration al&o!t t.ree BFC .our! late. +n t.e %art of DLSMC Bt.e .o!%italC" t.i! Court find! t.at it i! lia'le for t.e act! of negligence of t.e doctor! in t.eir W%ractice of &edicineV in t.e o%erating roo&. Moreo er" t.e .o!%ital i! lia'le for failing t.roug. it! re!%on!i'le official!" to cancel t.e !c.eduled o%eration after Dr. 7o!a;a ine5cu!a'l- failed to arri e on ti&e. In .a ing .eld t.u!" t.i! Court reEect! t.e defen!e rai!ed '- defendant! t.at t.e- .a e acted /it. due care and %rudence in rendering &edical !er ice! to %laintiff-%atient. =or if t.e %atient /a! %ro%erl- intu'ated a! clai&ed '- t.e&" t.e %atient /ould not .a e 'eco&e co&ato!e. And" t.e fact t.at anot.er ane!t.e!iologi!t /a! called to tr- to intu'ate t.e %atient after .er Bt.e %atientV!C nail'ed turned 'lui!." 'elie t.eir clai&. =urt.er&ore" t.e defendant! !.ould .a e re!c.eduled t.e o%eration to a later date. T.i!" t.e- !.ould .a e done" if defendant! acted /it. due care and %rudence a! t.e %atientV! ca!e /a! an electi e" not an e&ergenc- ca!e. 555 :7ERE=+RE" and in ie/ of t.e foregoing" Eudg&ent i! rendered in fa or of t.e %laintiff! and again!t t.e defendant!. Accordingl-" t.e latter are ordered to %a-" Eointl- and !e erall-" t.e for&er t.e follo/ing !u&! of &one-" to /it3 1C t.e !u& of P#"GGG.GG a! actual &ont.l- e5%en!e! for t.e %laintiff Erlinda Ra&o! rec;oned fro& No e&'er 1(" 1)#( or in t.e total !u& of PHFA"GGG.GG a! of A%ril 1(" 1))A" !u'Eect to it! 'eing u%dated8 AC t.e !u& of P1GG"GGG.GG a! rea!ona'le attorne-V! fee!8 FC t.e !u& of P#GG"GGG.GG '- /a- of &oral da&age! and t.e furt.er !u& of PAGG"GGG.GG '- /a- of e5e&%lar- da&age!8 and" $C t.e co!t! of t.e !uit. S+ +RDERED.1*2 Pri ate re!%ondent! !ea!ona'l- inter%o!ed an a%%eal to t.e Court of A%%eal!. T.e a%%ellate court rendered a Deci!ion" dated A) Ma- 1))(" re er!ing t.e finding! of t.e trial

court. T.e decretal %ortion of t.e deci!ion of t.e a%%ellate court read!3 :7ERE=+RE" for t.e foregoing %re&i!e! t.e a%%ealed deci!ion i! .ere'- RE,ERSED" and t.e co&%laint 'elo/ again!t t.e a%%ellant! i! .ere'- ordered DISMISSED. T.e counterclai& of a%%ellant De Lo! Santo! Medical Center i! GRANTED 'ut onl- in!ofar a! a%%ellee! are .ere'- ordered to %a- t.e un%aid .o!%ital 'ill! a&ounting to P)F"($A.A(" %lu! legal intere!t for Eu!tice &u!t 'e te&%ered /it. &erc-. S+ +RDERED.1#2 T.e deci!ion of t.e Court of A%%eal! /a! recei ed on ) ?une 1))( '- %etitioner Rogelio Ra&o! /.o /a! &i!ta;enl- addre!!ed a! 4Att-. Rogelio Ra&o!.9 No co%- of t.e deci!ion" .o/e er" /a! !ent nor recei ed '- t.e Coronel La/ +ffice" t.en coun!el on record of %etitioner!. Rogelio referred t.e deci!ion of t.e a%%ellate court to a ne/ la/-er" Att-. Lig!a-" onl- on AG ?une 1))(" or four B$C da-! 'efore t.e e5%iration of t.e regle&entar- %eriod for filing a &otion for recon!ideration. +n t.e !a&e da-" Att-. Lig!a-" filed /it. t.e a%%ellate court a &otion for e5ten!ion of ti&e to file a &otion for recon!ideration. T.e &otion for recon!ideration /a! !u'&itted on $ ?ul- 1))(. 7o/e er" t.e a%%ellate court denied t.e &otion for e5ten!ion of ti&e in it! Re!olution dated A( ?ul1))(.1)2 Mean/.ile %etitioner! engaged t.e !er ice! of anot.er coun!el" Att-. Sillano" to re%lace Att-. Lig!a-. Att-. Sillano filed on * Augu!t 1))( a &otion to ad&it t.e &otion for recon!ideration contending t.at t.e %eriod to file t.e a%%ro%riate %leading on t.e a!!ailed deci!ion .ad not -et co&&enced to run a! t.e Di i!ion Cler; of Court of t.e Court of A%%eal! .ad not -et !er ed a co%- t.ereof to t.e coun!el on record. De!%ite t.i! e5%lanation" t.e a%%ellate court !till denied t.e &otion to ad&it t.e &otion for recon!ideration of %etitioner! in it! Re!olution" dated A) Marc. 1))H" %ri&aril- on t.e ground t.at t.e fifteen-da- B1(C %eriod for filing a &otion for recon!ideration .ad alreade5%ired" to /it3 :e !aid in our Re!olution on ?ul- A(" 1))(" t.at t.e filing of a Motion for Recon!ideration cannot 'e e5tended8 %reci!el-" t.e Motion for E5ten!ion BRollo" %. 1AC /a! denied. It i!" on t.e ot.er .and" ad&itted in t.e latter Motion t.at %laintiff!Ia%%ellee! recei ed a co%- of t.e deci!ion a! earl- a! ?une )" 1))(. Co&%utation /i!e" t.e %eriod to file a Motion for Recon!ideration e5%ired on ?une A$. T.e Motion for Recon!ideration" in turn" /a! recei ed '- t.e Court of A%%eal! alread- on ?ul- $" nece!!aril-" t.e 1(-da- %eriod alread%a!!ed. =or t.at alone" t.e latter !.ould 'e denied. E en a!!u&ing ad&i!!i'ilit- of t.e Motion for Recon!ideration" 'ut after con!idering t.e Co&&entI+%%o!ition" t.e for&er" for lac; of &erit" i! .ere'- DENIED. S+ +RDERED.11G2 A co%- of t.e a'o e re!olution /a! recei ed '- Att-. Sillano on 11 A%ril 1))H. T.e ne5t da-" or on 1A A%ril 1))H" Att-. Sillano filed 'efore t.i! Court a &otion for e5ten!ion of ti&e to file t.e %re!ent %etition forcertiorari under Rule $(. T.e Court granted t.e &otion for e5ten!ion of ti&e and ga e %etitioner! additional t.irt- BFGC da-! after t.e e5%iration of t.e fifteen-da- B1(C %eriod counted fro& t.e recei%t of t.e re!olution of t.e Court of A%%eal! /it.in /.ic. to !u'&it t.e %etition. T.e due date fell on A* Ma- 1))H. T.e %etition /a! filed on ) Ma- 1))H" /ell /it.in t.e e5tended %eriod gi en '- t.e Court. Petitioner! a!!ail t.e deci!ion of t.e Court of A%%eal! on t.e follo/ing ground!3 I IN P>TTING M>C7 RELIANCE +N T7E TESTIM+NIES += RESP+NDENTS DRA.

G>TIERREM" DRA. CALDER+N AND DR. ?AM+RA8 II IN =INDING T7AT T7E NEGLIGENCE += T7E RESP+NDENTS DID N+T CA>SE T7E >N=+RT>NATE C+MAT+SE C+NDITI+N += PETITI+NER ERLINDA RAM+S8 III IN N+T APPLKING T7E D+CTRINE += RES IPSA L+S>IT>R.1112 @efore /e di!cu!! t.e &erit! of t.e ca!e" /e !.all fir!t di!%o!e of t.e %rocedural i!!ue on t.e ti&eline!! of t.e %etition in relation to t.e &otion for recon!ideration filed '%etitioner! /it. t.e Court of A%%eal!. In t.eir Co&&ent"11A2 %ri ate re!%ondent! contend t.at t.e %etition !.ould not 'e gi en due cour!e !ince t.e &otion for recon!ideration of t.e %etitioner! on t.e deci!ion of t.e Court of A%%eal! /a! alidl- di!&i!!ed '- t.e a%%ellate court for .a ing 'een filed 'e-ond t.e regle&entar- %eriod. :e do not agree. A careful re ie/ of t.e record! re eal! t.at t.e rea!on 'e.ind t.e dela- in filing t.e &otion for recon!ideration i! attri'uta'le to t.e fact t.at t.e deci!ion of t.e Court of A%%eal! /a! not !ent to t.en coun!el on record of %etitioner!" t.e Coronel La/ +ffice. In fact" a co%- of t.e deci!ion of t.e a%%ellate court /a! in!tead !ent to and recei ed '%etitioner Rogelio Ra&o! on ) ?une 1))( /.erein .e /a! &i!ta;enl- addre!!ed a! Att-. Rogelio Ra&o!. @a!ed on t.e ot.er co&&unication! recei ed '- %etitioner Rogelio Ra&o!" t.e a%%ellate court a%%arentl- &i!too; .i& for t.e coun!el on record. T.u!" no co%- of t.e deci!ion of t.e a%%ellate court /a! furni!.ed to t.e coun!el on record. Petitioner" not 'eing a la/-er and una/are of t.e %re!cri%ti e %eriod for filing a &otion for recon!ideration" referred t.e !a&e to a legal coun!el onl- on AG ?une 1))(. It i! ele&entar- t.at /.en a %art- i! re%re!ented '- coun!el" all notice! !.ould 'e !ent to t.e %art-D! la/-er at .i! gi en addre!!. :it. a fe/ e5ce%tion!" notice to a litigant /it.out notice to .i! coun!el on record i! no notice at all. In t.e %re!ent ca!e" !ince a co%- of t.e deci!ion of t.e a%%ellate court /a! not !ent to t.e coun!el on record of %etitioner" t.ere can 'e no !ufficient notice to !%ea; of. 7ence" t.e dela- in t.e filing of t.e &otion for recon!ideration cannot 'e ta;en again!t %etitioner. Moreo er" !ince t.e Court of A%%eal! alread- i!!ued a !econd Re!olution" dated A) Marc. 1))H" /.ic. !u%er!eded t.e earlier re!olution i!!ued on A( ?ul- 1))(" and denied t.e &otion for recon!ideration of %etitioner" /e 'elie e t.at t.e recei%t of t.e for&er !.ould 'e con!idered in deter&ining t.e ti&eline!! of t.e filing of t.e %re!ent %etition. @a!ed on t.i!" t.e %etition 'efore u! /a! !u'&itted on ti&e. After re!ol ing t.e foregoing %rocedural i!!ue" /e !.all no/ loo; into t.e &erit! of t.e ca!e. =or a &ore logical %re!entation of t.e di!cu!!ion /e !.all fir!t con!ider t.e i!!ue on t.e a%%lica'ilit- of t.e doctrine of res ipsa loquitur to t.e in!tant ca!e. T.ereafter" t.e fir!t t/o a!!igned error! !.all 'e tac;led in relation to t.e res ipsa loquitur doctrine. Res ipsa loquitur i! a Latin %.ra!e /.ic. literall- &ean! 4t.e t.ing or t.e tran!action !%ea;! for it!elf.9 T.e %.ra!e 4 res ipsa loquitur9 i! a &a5i& for t.e rule t.at t.e fact of t.e occurrence of an inEur-" ta;en /it. t.e !urrounding circu&!tance!" &a- %er&it an inference or rai!e a %re!u&%tion of negligence" or &a;e out a %laintiffD! prima 3acie ca!e" and %re!ent a 6ue!tion of fact for defendant to &eet /it. an e5%lanation.11F2 :.ere t.e t.ing /.ic. cau!ed t.e inEur- co&%lained of i! !.o/n to 'e under t.e &anage&ent of t.e defendant or .i! !er ant! and t.e accident i! !uc. a! in ordinar- cour!e of t.ing! doe! not

.a%%en if t.o!e /.o .a e it! &anage&ent or control u!e %ro%er care" it afford! rea!ona'le e idence" in t.e a'!ence of e5%lanation '- t.e defendant" t.at t.e accident aro!e fro& or /a! cau!ed '- t.e defendantD! /ant of care.11$2 T.e doctrine of res ipsa loquitur i! !i&%l- a recognition of t.e %o!tulate t.at" a! a &atter of co&&on ;no/ledge and e5%erience" t.e er- nature of certain t-%e! of occurrence! &a- Eu!tif- an inference of negligence on t.e %art of t.e %er!on /.o control! t.e in!tru&entalit- cau!ing t.e inEur- in t.e a'!ence of !o&e e5%lanation '- t.e defendant /.o i! c.arged /it. negligence.11(2 It i! grounded in t.e !u%erior logic of ordinar- .u&an e5%erience and on t.e 'a!i! of !uc. e5%erience or co&&on ;no/ledge" negligence &a'e deduced fro& t.e &ere occurrence of t.e accident it!elf.11H2 7ence" res ipsa loquitur i! a%%lied in conEunction /it. t.e doctrine of co&&on ;no/ledge. 7o/e er" &uc. .a! 'een !aid t.at res ipsa loquitur i! not a rule of !u'!tanti e la/ and" a! !uc." doe! not create or con!titute an inde%endent or !e%arate ground of lia'ilit-. 11*2 In!tead" it i! con!idered a! &erel- e identiar- or in t.e nature of a %rocedural rule. 11#2 It i! regarded a! a &ode of %roof" or a &ere %rocedural con enience !ince it furni!.e! a !u'!titute for" and relie e! a %laintiff of" t.e 'urden of %roducing !%ecific %roof of negligence.11)2 In ot.er /ord!" &ere in ocation and a%%lication of t.e doctrine doe! not di!%en!e /it. t.e re6uire&ent of %roof of negligence. It i! !i&%l- a !te% in t.e %roce!! of !uc. %roof" %er&itting t.e %laintiff to %re!ent along /it. t.e %roof of t.e accident" enoug. of t.e attending circu&!tance! to in o;e t.e doctrine" creating an inference or %re!u&%tion of negligence" and to t.ere'- %lace on t.e defendant t.e 'urden of going for/ard /it. t.e %roof.1AG2 Still" 'efore re!ort to t.e doctrine &a- 'e allo/ed" t.e follo/ing re6ui!ite! &u!t 'e !ati!factoril- !.o/n3 1. T.e accident i! of a ;ind /.ic. ordinaril- doe! not occur in t.e a'!ence of !o&eoneD! negligence8 A. It i! cau!ed '- an in!tru&entalit- /it.in t.e e5clu!i e control of t.e defendant or defendant!8 and F. T.e %o!!i'ilit- of contri'uting conduct /.ic. /ould &a;e t.e %laintiff re!%on!i'le i! eli&inated.1A12 In t.e a'o e re6ui!ite!" t.e funda&ental ele&ent i! t.e 4control of t.e in!tru&entalit-9 /.ic. cau!ed t.e da&age.1AA2 Suc. ele&ent of control &u!t 'e !.o/n to 'e /it.in t.e do&inion of t.e defendant. In order to .a e t.e 'enefit of t.e rule" a %laintiff" in addition to %ro ing inEur- or da&age" &u!t !.o/ a !ituation /.ere it i! a%%lica'le" and &u!t e!ta'li!. t.at t.e e!!ential ele&ent! of t.e doctrine /ere %re!ent in a %articular incident.1AF2 Medical &al%ractice1A$2ca!e! do not e!ca%e t.e a%%lication of t.i! doctrine. T.u!" res ipsa loquitur .a! 'een a%%lied /.en t.e circu&!tance! attendant u%on t.e .ar& are t.e&!el e! of !uc. a c.aracter a! to Eu!tif- an inference of negligence a! t.e cau!e of t.at .ar&.1A(2 T.e a%%lication of res ipsa loquitur in &edical negligence ca!e! %re!ent! a 6ue!tion of la/ !ince it i! a Eudicial function to deter&ine /.et.er a certain !et of circu&!tance! doe!" a! a &atter of la/" %er&it a gi en inference.1AH2 Alt.oug. generall-" e5%ert &edical te!ti&on- i! relied u%on in &al%ractice !uit! to %ro e t.at a %.-!ician .a! done a negligent act or t.at .e .a! de iated fro& t.e !tandard &edical %rocedure" /.en t.e doctrine of res ipsa loquitur i! a ailed '- t.e %laintiff" t.e need for e5%ert &edical te!ti&on- i! di!%en!ed /it. 'ecau!e t.e inEur- it!elf %ro ide! t.e

%roof of negligence.1A*2 T.e rea!on i! t.at t.e general rule on t.e nece!!it- of e5%ert te!ti&on- a%%lie! onl- to !uc. &atter! clearl- /it.in t.e do&ain of &edical !cience" and not to &atter! t.at are /it.in t.e co&&on ;no/ledge of &an;ind /.ic. &a- 'e te!tified to '- an-one fa&iliar /it. t.e fact!.1A#2+rdinaril-" onl- %.-!ician! and !urgeon! of !;ill and e5%erience are co&%etent to te!tif- a! to /.et.er a %atient .a! 'een treated or o%erated u%on /it. a rea!ona'le degree of !;ill and care. 7o/e er" te!ti&on- a! to t.e !tate&ent! and act! of %.-!ician! and !urgeon!" e5ternal a%%earance!" and &anife!t condition! /.ic. are o'!er a'le '- an- one &a- 'e gi en '- non-e5%ert /itne!!e!.1A)2 7ence" in ca!e! /.ere t.e res ipsa loquitur i! a%%lica'le" t.e court i! %er&itted to find a %.-!ician negligent u%on %ro%er %roof of inEur- to t.e %atient" /it.out t.e aid of e5%ert te!ti&on-" /.ere t.e court fro& it! fund of co&&on ;no/ledge can deter&ine t.e %ro%er !tandard of care.1FG2 :.ere co&&on ;no/ledge and e5%erience teac. t.at a re!ulting inEur- /ould not .a e occurred to t.e %atient if due care .ad 'een e5erci!ed" an inference of negligence &a- 'e dra/n gi ing ri!e to an a%%lication of t.e doctrine of res ipsa loquitur /it.out &edical e idence" /.ic. i! ordinaril- re6uired to !.o/ not onl- /.at occurred 'ut .o/ and /.- it occurred.1F12 :.en t.e doctrine i! a%%ro%riate" all t.at t.e %atient &u!t do i! %ro e a ne5u! 'et/een t.e %articular act or o&i!!ion co&%lained of and t.e inEur- !u!tained /.ile under t.e cu!tod- and &anage&ent of t.e defendant /it.out need to %roduce e5%ert &edical te!ti&on- to e!ta'li!. t.e !tandard of care. Re!ort to res ipsa loquitur i! allo/ed 'ecau!e t.ere i! no ot.er /a-" under u!ual and ordinarcondition!" '- /.ic. t.e %atient can o'tain redre!! for inEur- !uffered '- .i&. T.u!" court! of ot.er Euri!diction! .a e a%%lied t.e doctrine in t.e follo/ing !ituation!3 lea ing of a foreign o'Eect in t.e 'od- of t.e %atient after an o%eration" 1FA2 inEurie! !u!tained on a .ealt.- %art of t.e 'od- /.ic. /a! not under" or in t.e area" of treat&ent"1FF2 re&o al of t.e /rong %art of t.e 'od- /.en anot.er %art /a! intended" 1F$2 ;noc;ing out a toot. /.ile a %atientD! Ea/ /a! under ane!t.etic for t.e re&o al of .i! ton!il!"1F(2 and lo!! of an e-e /.ile t.e %atient %laintiff /a! under t.e influence of ane!t.etic" during or follo/ing an o%eration for a%%endiciti!"1FH2 a&ong ot.er!. Ne ert.ele!!" de!%ite t.e fact t.at t.e !co%e of res ipsa loquitur .a! 'een &ea!ura'lenlarged" it doe! not auto&aticall- a%%l- to all ca!e! of &edical negligence a! to &ec.anicall- !.ift t.e 'urden of %roof to t.e defendant to !.o/ t.at .e i! not guilt- of t.e a!cri'ed negligence. Res ipsa loquitur i! not a rigid or ordinar- doctrine to 'e %erfunctorilu!ed 'ut a rule to 'e cautiou!l- a%%lied" de%ending u%on t.e circu&!tance! of eac. ca!e. It i! generall- re!tricted to !ituation! in &al%ractice ca!e! /.ere a la-&an i! a'le to !a-" a! a &atter of co&&on ;no/ledge and o'!er ation" t.at t.e con!e6uence! of %rofe!!ional care /ere not a! !uc. a! /ould ordinaril- .a e follo/ed if due care .ad 'een e5erci!ed.1F*2 A di!tinction &u!t 'e &ade 'et/een t.e failure to !ecure re!ult!" and t.e occurrence of !o&et.ing &ore unu!ual and not ordinaril- found if t.e !er ice or treat&ent rendered follo/ed t.e u!ual %rocedure of t.o!e !;illed in t.at %articular %ractice. It &u!t 'e conceded t.at t.e doctrine of res ipsa loquitur can .a e no a%%lication in a !uit again!t a %.-!ician or !urgeon /.ic. in ol e! t.e &erit! of a diagno!i! or of a !cientific treat&ent. 1F#2 T.e %.-!ician or !urgeon i! not re6uired at .i! %eril to e5%lain /.- an- %articular diagno!i! /a! not correct" or /.- an- %articular !cientific treat&ent did not %roduce t.e de!ired re!ult.1F)2 T.u!" res ipsa loquitur i! not a aila'le in a &al%ractice !uit if t.e onl!.o/ing i! t.at t.e de!ired re!ult of an o%eration or treat&ent /a! not acco&%li!.ed. 1$G2 T.e real 6ue!tion" t.erefore" i! /.et.er or not in t.e %roce!! of t.e o%eration ane5traordinar- incident or unu!ual e ent out!ide of t.e routine %erfor&ance occurred /.ic. i! 'e-ond t.e regular !co%e of cu!to&ar- %rofe!!ional acti it- in !uc. o%eration!" /.ic." if une5%lained /ould t.e&!el e! rea!ona'l- !%ea; to t.e a erage &an a! t.e negligent cau!e or cau!e! of t.e unto/ard con!e6uence.1$12 If t.ere /a! !uc. e5traneou!

inter ention!" t.e doctrine of res ipsa loquitur &a- 'e utili<ed and t.e defendant i! called u%on to e5%lain t.e &atter" '- e idence of e5cul%ation" if .e could.1$A2 :e find t.e doctrine of res ipsa loquitur a%%ro%riate in t.e ca!e at 'ar. A! /ill .ereinafter 'e e5%lained" t.e da&age !u!tained '- Erlinda in .er 'rain %rior to a !c.eduled gall 'ladder o%eration %re!ent! a ca!e for t.e a%%lication of res ipsa loquitur. A ca!e !tri;ingl- !i&ilar to t.e one 'efore u! i! 6oss vs. /rid7ell"1$F2 /.ere t.e Jan!a! Su%re&e Court in a%%l-ing t.e res ipsa loquitur !tated3 T.e %laintiff .erein !u'&itted .i&!elf for a mastoid operation and deli ered .i! %er!on o er to t.e care" cu!tod- and control of .i! %.-!ician /.o .ad co&%lete and e5clu!i e control o er .i&" 'ut the operation 7as never per3ormed . At t.e ti&e of !u'&i!!ion .e /a! neurologicall- !ound and %.-!icall- fit in &ind and 'od-" 'ut .e !uffered irre%ara'le da&age and inEur- rendering .i& decere'rate and totall- inca%acitated. T.e inEur- /a! one /.ic. doe! not ordinaril- occur in t.e %roce!! of a &a!toid o%eration or in t.e a'!ence of negligence in t.e ad&ini!tration of an ane!t.etic" and in t.e u!e and e&%lo-&ent of an endoctrac.eal tu'e. +rdinaril- a %er!on 'eing %ut under ane!t.e!ia i! not rendered decere'rate a! a con!e6uence of ad&ini!tering !uc. ane!t.e!ia in t.e a'!ence of negligence. >%on t.e!e fact! and under t.e!e circu&!tance! a la-&an /ould 'e a'le to !a-" a! a &atter of co&&on ;no/ledge and o'!er ation" t.at t.e con!e6uence! of %rofe!!ional treat&ent /ere not a! !uc. a! /ould ordinaril- .a e follo/ed if due care .ad 'een e5erci!ed. 7ere t.e %laintiff could not .a e 'een guilt- of contri'utor- negligence 'ecau!e .e /a! under t.e influence of ane!t.etic! and uncon!ciou!" and t.e circu&!tance! are !uc. t.at t.e true e5%lanation of e ent i! &ore acce!!i'le to t.e defendant! t.an to t.e %laintiff for t.e- .ad t.e e5clu!i e control of t.e in!tru&entalitie! of ane!t.e!ia. >%on all t.e fact!" condition! and circu&!tance! alleged in Count II it i! .eld t.at a cau!e of action i! !tated under t.e doctrine of res ipsa loquitur.1$$2 Indeed" t.e %rinci%le! enunciated in t.e afore6uoted ca!e a%%l- /it. e6ual force .ere. In t.e %re!ent ca!e" Erlinda !u'&itted .er!elf for cholec%stectom% and e5%ected a routine general !urger- to 'e %erfor&ed on .er gall 'ladder. +n t.at fateful da- !.e deli ered .er %er!on o er to t.e care" cu!tod- and control of %ri ate re!%ondent! /.o e5erci!ed co&%lete and e5clu!i e control o er .er. At t.e ti&e of !u'&i!!ion" Erlinda /a! neurologicall- !ound and" e5ce%t for a fe/ &inor di!co&fort!" /a! li;e/i!e %.-!icall- fit in &ind and 'od-. 7o/e er" during t.e ad&ini!tration of ane!t.e!ia and %rior to t.e %erfor&ance of cholec%stectom% !.e !uffered irre%ara'le da&age to .er 'rain. T.u!" /it.out undergoing !urger-" !.e /ent out of t.e o%erating roo& alread- decere'rate and totall- inca%acitated. +' iou!l-" 'rain da&age" /.ic. Erlinda !u!tained" i! an inEur- /.ic. doe! not nor&all- occur in t.e %roce!! of a gall 'ladder o%eration. In fact" t.i! ;ind of !ituation doe! not .a%%en in t.e a'!ence of negligence of !o&eone in t.e ad&ini!tration of ane!t.e!ia and in t.e u!e of endotrac.eal tu'e. Nor&all-" a %er!on 'eing %ut under ane!t.e!ia i! not rendered decere'rate a! a con!e6uence of ad&ini!tering !uc. ane!t.e!ia if t.e %ro%er %rocedure /a! follo/ed. =urt.er&ore" t.e in!tru&ent! u!ed in t.e ad&ini!tration of ane!t.e!ia" including t.e endotrac.eal tu'e" /ere all under t.e e5clu!i e control of %ri ate re!%ondent!" /.o are t.e %.-!ician!-in-c.arge. Li;e/i!e" %etitioner Erlinda could not .a e 'een guilt- of contri'utor- negligence 'ecau!e !.e /a! under t.e influence of ane!t.etic! /.ic. rendered .er uncon!ciou!. Con!idering t.at a !ound and unaffected &e&'er of t.e 'od- Bt.e 'rainC i! inEured or de!tro-ed /.ile t.e %atient i! uncon!ciou! and under t.e i&&ediate and e5clu!i e control

of t.e %.-!ician!" /e .old t.at a %ractical ad&ini!tration of Eu!tice dictate! t.e a%%lication of res ipsa loquitur. >%on t.e!e fact! and under t.e!e circu&!tance! t.e Court /ould 'e a'le to !a-" a! a &atter of co&&on ;no/ledge and o'!er ation" if negligence attended t.e &anage&ent and care of t.e %atient. Moreo er" t.e lia'ilit- of t.e %.-!ician! and t.e .o!%ital in t.i! ca!e i! not %redicated u%on an alleged failure to !ecure t.e de!ired re!ult! of an o%eration nor on an alleged lac; of !;ill in t.e diagno!i! or treat&ent a! in fact no o%eration or treat&ent /a! e er %erfor&ed on Erlinda. T.u!" u%on all t.e!e initial deter&ination a ca!e i! &ade out for t.e a%%lication of t.e doctrine of res ipsa loquitur. Nonet.ele!!" in .olding t.at res ipsa loquitur i! a aila'le to t.e %re!ent ca!e /e are not !a-ing t.at t.e doctrine i! a%%lica'le in an- and all ca!e! /.ere inEur- occur! to a %atient /.ile under ane!t.e!ia" or to an- and all ane!t.e!ia ca!e!. Eac. ca!e &u!t 'e ie/ed in it! o/n lig.t and !crutini<ed in order to 'e /it.in t.e res ipsa loquitur co erage. 7a ing in &ind t.e a%%lica'ilit- of t.e res ipsa loquitur doctrine and t.e %re!u&%tion of negligence allo/ed t.erein" t.e Court no/ co&e! to t.e i!!ue of /.et.er t.e Court of A%%eal! erred in finding t.at %ri ate re!%ondent! /ere not negligent in t.e care of Erlinda during t.e ane!t.e!ia %.a!e of t.e o%eration and" if in t.e affir&ati e" /.et.er t.e alleged negligence /a! t.e %ro5i&ate cau!e of ErlindaD! co&ato!e condition. Corollar- t.ereto" /e !.all al!o deter&ine if t.e Court of A%%eal! erred in rel-ing on t.e te!ti&onie! of t.e /itne!!e! for t.e %ri ate re!%ondent!. In !u!taining t.e %o!ition of %ri ate re!%ondent!" t.e Court of A%%eal! relied on t.e te!ti&onie! of Dra. Gutierre<" Dra. Calderon and Dr. ?a&ora. In gi ing /eig.t to t.e te!ti&on- of Dra. Gutierre<" t.e Court of A%%eal! rationali<ed t.at !.e /a! candid enoug. to ad&it t.at !.e e5%erienced !o&e difficult- in t.e endotrac.eal intu'ation1$(2of t.e %atient and t.u!" cannot 'e !aid to 'e co ering .er negligence /it. fal!e.ood. T.e a%%ellate court li;e/i!e o%ined t.at %ri ate re!%ondent! /ere a'le to !.o/ t.at t.e 'rain da&age !u!tained '- Erlinda /a! not cau!ed '- t.e alleged fault- intu'ation 'ut /a! due to t.e allergic reaction of t.e %atient to t.e drug T.io%ental Sodiu& BPentot.alC" a !.ortacting 'ar'iturate" a! te!tified on '- t.eir e5%ert /itne!!" Dr. ?a&ora. +n t.e ot.er .and" t.e a%%ellate court reEected t.e te!ti&on- of Dean 7er&inda Cru< offered in fa or of %etitioner! t.at t.e cau!e of t.e 'rain inEur- /a! tracea'le to t.e /rongful in!ertion of t.e tu'e !ince t.e latter" 'eing a nur!e" /a! allegedl- not ;no/ledgea'le in t.e %roce!! of intu'ation. In !o .olding" t.e a%%ellate court returned a erdict in fa or of re!%ondent! %.-!ician! and .o!%ital and a'!ol ed t.e& of an- lia'ilit- to/ard! Erlinda and .er fa&il-. :e di!agree /it. t.e finding! of t.e Court of A%%eal!. :e .old t.at %ri ate re!%ondent! /ere una'le to di!%ro e t.e %re!u&%tion of negligence on t.eir %art in t.e care of Erlinda and t.eir negligence /a! t.e %ro5i&ate cau!e of .er %iteou! condition. In t.e in!tant ca!e" t.e record! are .el%ful in furni!.ing not onl- t.e logical !cientific e idence of t.e %at.ogene!i! of t.e inEur- 'ut al!o in %ro iding t.e Court t.e legal ne5u! u%on /.ic. lia'ilit- i! 'a!ed. A! /ill 'e !.o/n .ereinafter" %ri ate re!%ondent!D o/n te!ti&onie! /.ic. are reflected in t.e tran!cri%t of !tenogra%.ic note! are re%lete of !ign%o!t! indicati e of t.eir negligence in t.e care and &anage&ent of Erlinda. :it. regard to Dra. Gutierre<" /e find .er negligent in t.e care of Erlinda during t.e ane!t.e!ia %.a!e. A! 'orne '- t.e record!" re!%ondent Dra. Gutierre< failed to %ro%erlintu'ate t.e %atient. T.i! fact /a! atte!ted to '- Prof. 7er&inda Cru<" Dean of t.e Ca%itol Medical Center Sc.ool of Nur!ing and %etitionerV! !i!ter-in-la/" /.o /a! in t.e o%erating roo& rig.t 'e!ide t.e %atient /.en t.e tragic e ent occurred. :itne!! Cru< te!tified to t.i!

effect3 ATTK. PA?ARES3 S3 A3 S3 In %articular" /.at did Dra. Perfecta Gutierre< do" if an- on t.e %atient0 In %articular" I could !ee t.at !.e /a! intu'ating t.e %atient. Do -ou ;no/ /.at .a%%ened to t.at intu'ation %roce!! ad&ini!tered '- Dra. Gutierre<0

ATTK. ALCERA3 S.e /ill 'e inco&%etent Kour 7onor. C+>RT3 :itne!! &a- an!/er if !.e ;no/!. A3 A! I .a e !aid" I /a! /it. t.e %atient" I /a! 'e!ide t.e !tretc.er .olding t.e left .and of t.e %atient and all of a !udden I .eard !o&e re&ar;! co&ing fro& Dra. Perfecta Gutierre< .er!elf. S.e /a! !a-ing 4Ang .ira% &a-intu'ate nito" &ali -ata ang %ag;a;a%a!o;. + lu&ala;i ang ti-an.9

555 ATTK. PA?ARES3 S3 A3 555 After .earing t.e %.ra!e 4lu&ala;i ang ti-an"9 /.at did -ou notice on t.e %er!on of t.e %atient0 A3 S3 A3 S3 A3 S3 A3 I notice B!icC !o&e 'lui!. di!coloration on t.e nail'ed! of t.e left .and /.ere I /a! at. :.ere /a! Dr. +rlino 7o1!2a;a t.en at t.at %articular ti&e0 I !a/ .i& a%%roac.ing t.e %atient during t.at ti&e. :.en .e a%%roac.ed t.e %atient" /.at did .e do" if an-0 7e &ade an order to call on t.e ane!t.e!iologi!t in t.e %er!on of Dr. Calderon. Did Dr. Calderon" u%on 'eing called" arri e in!ide t.e o%erating roo&0 Ke! !ir. =ro& /.o& did -ou .ear t.o!e /ord! 4lu&ala;i ang ti-an90 =ro& Dra. Perfecta Gutierre<.

S3 A3 S3 A3 555 S3 A3 555

:.at did 1!2.e do" if an-0 1S2.e tried to intu'ate t.e %atient. :.at .a%%ened to t.e %atient0 :.en Dr. Calderon tr- B!icC to intu'ate t.e %atient" after a /.ile t.e %atientD! nail'ed 'eca&e 'lui!. and I !a/ t.e %atient /a! %laced in trendelen'urg %o!ition.

Do -ou ;no/ t.e rea!on /.- t.e %atient /a! %laced in t.at trendelen'urg %o!ition0 A! far a! I ;no/" /.en a %atient i! in t.at %o!ition" t.ere i! a decrea!e of 'lood !u%%l- to t.e 'rain.1$H2

T.e a%%ellate court" .o/e er" di!'elie ed Dean Cru<V! te!ti&on- in t.e trial court 'declaring t.at3 A %eru!al of t.e !tandard nur!ing curriculu& in our countr- /ill !.o/ t.at intu'ation i! not taug.t a! %art of nur!ing %rocedure! and tec.ni6ue!. Indeed" /e ta;e Eudicial notice of t.e fact t.at nur!e! do not" and cannot" intu'ate. E en on t.e a!!u&%tion t.at !.e i! fullca%a'le of deter&ining /.et.er or not a %atient i! %ro%erl- intu'ated" /itne!! 7er&inda Cru<" ad&ittedl-" did not %ee% into t.e t.roat of t.e %atient. BTSN" ?ul- A(" 1))1" %. 1FC. More i&%ortantl-" t.ere i! no e idence t.at !.e e er au!cultated t.e %atient or t.at !.e conducted an- t-%e of e5a&ination to c.ec; if t.e endotrac.eal tu'e /a! in it! %ro%er %lace" and to deter&ine t.e condition of t.e .eart" lung!" and ot.er organ!. T.u!" /itne!! Cru<V! categorical !tate&ent! t.at a%%ellant Dra. Gutierre< failed to intu'ate t.e a%%ellee Erlinda Ra&o! and t.at it /a! Dra. Calderon /.o !ucceeded in doing !o clearl- !uffer fro& lac; of !ufficient factual 'a!e!.1$*2 In ot.er /ord!" /.at t.e Court of A%%eal! i! tr-ing to i&%re!! i! t.at 'eing a nur!e" and con!idered a la-&an in t.e %roce!! of intu'ation" /itne!! Cru< i! not co&%etent to te!tif- on /.et.er or not t.e intu'ation /a! a !ucce!!. :e do not agree /it. t.e a'o e rea!oning of t.e a%%ellate court. Alt.oug. /itne!! Cru< i! not an ane!t.e!iologi!t" !.e can er- /ell te!tif- u%on &atter! on /.ic. !.e i! ca%a'le of o'!er ing !uc. a!" t.e !tate&ent! and act! of t.e %.-!ician and !urgeon" e5ternal a%%earance!" and &anife!t condition! /.ic. are o'!er a'le '- an- one.1$#2 T.i! i! %reci!el- allo/ed under t.e doctrine of res ipsa loquitur /.ere t.e te!ti&on- of e5%ert /itne!!e! i! not re6uired. It i! t.e acce%ted rule t.at e5%ert te!ti&on- i! not nece!!ar- for t.e %roof of negligence in non-tec.nical &atter! or t.o!e of /.ic. an ordinar- %er!on &a'e e5%ected to .a e ;no/ledge" or /.ere t.e lac; of !;ill or /ant of care i! !o o' iou! a! to render e5%ert te!ti&on- unnece!!ar-.1$)2 :e ta;e Eudicial notice of t.e fact t.at ane!t.e!ia %rocedure! .a e 'eco&e !o co&&on" t.at e en an ordinar- %er!on can tell if it /a! ad&ini!tered %ro%erl-. A! !uc." it /ould not 'e too difficult to tell if t.e tu'e /a! %ro%erl- in!erted. T.i! ;ind of o'!er ation" /e 'elie e" doe! not re6uire a &edical degree to 'e acce%ta'le.

At an- rate" /it.out dou't" %etitionerV! /itne!!" an e5%erienced clinical nur!e /.o!e long e5%erience and !c.olar!.i% led to .er a%%oint&ent a! Dean of t.e Ca%itol Medical Center Sc.ool of Nur!ing" /a! full- ca%a'le of deter&ining /.et.er or not t.e intu'ation /a! a !ucce!!. S.e .ad e5ten!i e clinical e5%erience !tarting a! a !taff nur!e in C.icago" Illinoi!8 !taff nur!e and clinical in!tructor in a teac.ing .o!%ital" t.e =E>-NRM=8 Dean of t.e Laguna College of Nur!ing in San Pa'lo Cit-8 and t.en Dean of t.e Ca%itol Medical Center Sc.ool of Nur!ing.1(G2Re ie/ing /itne!! Cru<V !tate&ent!" /e find t.at t.e !a&e /ere deli ered in a !traig.tfor/ard &anner" /it. t.e ;ind of detail" clarit-" con!i!tenc- and !%ontaneit- /.ic. /ould .a e 'een difficult to fa'ricate. :it. .er clinical 'ac;ground a! a nur!e" t.e Court i! !ati!fied t.at !.e /a! a'le to de&on!trate t.roug. .er te!ti&on- /.at trul- tran!%ired on t.at fateful da-. Mo!t of all" .er te!ti&on- /a! affir&ed '- no le!! t.an re!%ondent Dra. Gutierre< /.o ad&itted t.at !.e e5%erienced difficult- in in!erting t.e tu'e into ErlindaD! trac.ea" to /it3 ATTK. LIGSAK3 S3 In t.i! %articular ca!e" Doctora" /.ile -ou /ere intu'ating at -our fir!t atte&%t B!icC" -ou did not i&&ediatel- !ee t.e trac.ea0

DRA. G>TIERREM3 A3 S3 A3 S3 A3 S3 A3 S3 A3 Ke! !ir. Did -ou %ull a/a- t.e tu'e i&&ediatel-0 Kou do not %ull t.e ... Did -ou or did -ou not0 I did not %ull t.e tu'e. :.en -ou !aid 4&a.ira% -ata ito"9 /.at /ere -ou referring to0 4Ma.ira% -ata itong i-intu'ate"9 t.at /a! t.e %atient. So" -ou found !o&e difficult- in in!erting t.e tu'e0 Ke!" 'ecau!e of B!icC &- fir!t atte&%t" I did not !ee rig.t a/a-.1(12

Curiou!l- in t.e ca!e at 'ar" re!%ondent Dra. Gutierre< &ade t.e .a%.a<ard defen!e t.at !.e encountered .ard!.i% in t.e in!ertion of t.e tu'e in t.e trac.ea of Erlinda 'ecau!e it /a! %o!itioned &ore anteriorl- B!lig.tl- de iated fro& t.e nor&al anato&- of a %er!onC1(A2 &a;ing it .arder to locate and" !ince Erlinda i! o'e!e and .a! a !.ort nec; and %rotruding teet." it &ade intu'ation e en &ore difficult. T.e argu&ent doe! not con ince u!. If t.i! /a! indeed o'!er ed" %ri ate re!%ondent! adduced no e idence de&on!trating t.at t.e- %roceeded to &a;e a t.oroug. a!!e!!&ent of ErlindaD! air/a-" %rior to t.e induction of ane!t.e!ia" e en if t.i! /ould &ean %o!t%oning t.e %rocedure. =ro& t.eir te!ti&onie!" it a%%ear! t.at t.e o'!er ation /a! &ade onl- a! an aftert.oug.t" a! a &ean! of defen!e.

T.e %re-o%erati e e aluation of a %atient %rior to t.e ad&ini!tration of ane!t.e!ia i! uni er!all- o'!er ed to le!!en t.e %o!!i'ilit- of ane!t.etic accident!. Pre-o%erati e e aluation and %re%aration for ane!t.e!ia 'egin! /.en t.e ane!t.e!iologi!t re ie/! t.e %atientD! &edical record! and i!it! /it. t.e %atient" traditionall-" t.e da- 'efore electi e !urger-.1(F2 It include! ta;ing t.e %atientD! &edical .i!tor-" re ie/ of current drug t.era%-" %.-!ical e5a&ination and inter%retation of la'orator- data.1($2 T.e %.-!ical e5a&ination %erfor&ed '- t.e ane!t.e!iologi!t i! directed %ri&aril- to/ard t.e central ner ou! !-!te&" cardio a!cular !-!te&" lung! and u%%er air/a-.1((2 A t.oroug. anal-!i! of t.e %atientV! air/a- nor&all- in ol e! in e!tigating t.e follo/ing3 cer ical !%ine &o'ilit-" te&%oro&andi'ular &o'ilit-" %ro&inent central inci!or!" di!ea!ed or artificial teet." a'ilitto i!uali<e u ula and t.e t.-ro&ental di!tance.1(H2 T.u!" %.-!ical c.aracteri!tic! of t.e %atientD! u%%er air/a- t.at could &a;e trac.eal intu'ation difficult !.ould 'e !tudied. 1(*2 :.ere t.e need ari!e!" a! /.en initial a!!e!!&ent indicate! %o!!i'le %ro'le&! B!uc. a! t.e alleged !.ort nec; and %rotruding teet. of ErlindaC a t.oroug. e5a&ination of t.e %atientD! air/a- /ould go a long /a- to/ard! decrea!ing %atient &or'idit- and &ortalit-. In t.e ca!e at 'ar" re!%ondent Dra. Gutierre< ad&itted t.at !.e !a/ Erlinda for t.e fir!t ti&e on t.e da- of t.e o%eration it!elf" on 1* ?une 1)#(. @efore t.i! date" no %rior con!ultation! /it." or %re-o%erati e e aluation of Erlinda /a! done '- .er. >ntil t.e da- of t.e o%eration" re!%ondent Dra. Gutierre< /a! una/are of t.e %.-!iological &a;e-u% and need! of Erlinda. S.e /a! li;e/i!e not %ro%erl- infor&ed of t.e %o!!i'le difficultie! !.e /ould face during t.e ad&ini!tration of ane!t.e!ia to Erlinda. Re!%ondent Dra. Gutierre<D act of !eeing .er %atient for t.e fir!t ti&e onl- an .our 'efore t.e !c.eduled o%erati e %rocedure /a!" t.erefore" an act of e5ce%tional negligence and %rofe!!ional irre!%on!i'ilit-. T.e &ea!ure! cautioning %rudence and igilance in dealing /it. .u&an li e! lie at t.e core of t.e %.-!icianD! centurie!-old 7i%%ocratic +at.. 7er failure to follo/ t.i! &edical %rocedure i!" t.erefore" a clear indicia of .er negligence. Re!%ondent Dra. Gutierre<" .o/e er" atte&%t! to glo!! o er t.i! o&i!!ion '- %la-ing around /it. t.e trial courtV! ignorance of clinical %rocedure" .o%ing t.at !.e could get a/a/it. it. Re!%ondent Dra. Gutierre< tried to &uddle t.e difference 'et/een an electi e !urger- and an e&ergenc- !urger- Eu!t !o .er failure to %erfor& t.e re6uired %re-o%erati e e aluation /ould e!ca%e unnoticed. In .er te!ti&on- !.e a!!erted3 ATTK. LIGSAK3 S3 :ould -ou agree" Doctor" t.at it i! good &edical %ractice to !ee t.e %atient a da'efore !o -ou can introduce -our!elf to e!ta'li!. good doctor-%atient relation!.i% and gain t.e tru!t and confidence of t.e %atient0 DRA. G>TIERREM3 A3 A! I !aid in &- %re iou! !tate&ent" it de%end! on t.e o%erati e %rocedure of t.e ane!t.e!iologi!t and in &- ca!e" /it. electi e ca!e! and nor&al cardio-%ul&onarclearance li;e t.at" I u!uall- donVt do it e5ce%t on e&ergenc- and on ca!e! t.at .a e an a'nor&alitie! B!icC.1(#2 7o/e er" t.e e5act o%%o!ite i! true. In an e&ergenc- %rocedure" t.ere i! .ardlenoug. ti&e a aila'le for t.e fa!tidiou! de&and! of %re-o%erati e %rocedure !o t.at an ane!t.e!iologi!t i! a'le to !ee t.e %atient onl- a fe/ &inute! 'efore !urger-" if at all. Electi e %rocedure!" on t.e ot.er .and" are o%erati e %rocedure! t.at can /ait for da-!" /ee;! or e en &ont.!. 7ence" in t.e!e ca!e!" t.e ane!t.e!iologi!t %o!!e!!e! t.e lu5ur- of ti&e to &a;e a %ro%er a!!e!!&ent" including t.e ti&e to 'e at t.e %atientV! 'ed!ide to do a %ro%er inter ie/ and clinical e aluation. T.ere i! a&%le ti&e to e5%lain t.e

&et.od of ane!t.e!ia" t.e drug! to 'e u!ed" and t.eir %o!!i'le .a<ard! for %ur%o!e! of infor&ed con!ent. >!uall-" t.e %re-o%erati e a!!e!!&ent i! conducted at lea!t one da'efore t.e intended !urger-" /.en t.e %atient i! rela5ed and coo%erati e. ErlindaD! ca!e /a! electi e and t.i! /a! ;no/n to re!%ondent Dra. Gutierre<. T.u!" !.e .ad all t.e ti&e to &a;e a t.oroug. e aluation of ErlindaD! ca!e %rior to t.e o%eration and %re%are .er for ane!t.e!ia. 7o/e er" !.e ne er !a/ t.e %atient at t.e 'ed!ide. S.e .er!elf ad&itted t.at !.e .ad !een %etitioner onl- in t.e o%erating roo&" and onl- on t.e actual date of t.e cholec%stectom%. S.e negligentl- failed to ta;e ad antage of t.i! i&%ortant o%%ortunit-. A! !uc." .er atte&%t to e5cul%ate .er!elf &u!t fail. 7a ing e!ta'li!.ed t.at re!%ondent Dra. Gutierre< failed to %erfor& %re-o%erati e e aluation of t.e %atient /.ic." in turn" re!ulted to a /rongful intu'ation" /e no/ deter&ine if t.e fault- intu'ation i! trul- t.e %ro5i&ate cau!e of ErlindaD! co&ato!e condition. Pri ate re!%ondent! re%eatedl- .a&&ered t.e ie/ t.at t.e cere'ral ano5ia /.ic. led to ErlindaD! co&a /a! due to 'ronc.o!%a!&1()2 &ediated '- .er allergic re!%on!e to t.e drug" T.io%ental Sodiu&" introduced into .er !-!te&. To/ard! t.i! end" t.e- %re!ented Dr. ?a&ora" a =ello/ of t.e P.ili%%ine College of P.-!ician! and Di%lo&ate of t.e P.ili%%ine S%ecialt- @oard of Internal Medicine" /.o ad anced %ri ate re!%ondent!V t.eort.at t.e o5-gen de%ri ation /.ic. led to ano5ic ence%.alo%at.-"1HG2 /a! due to an un%redicta'le drug reaction to t.e !.ort-acting 'ar'iturate. :e find t.e t.eor- of %ri ate re!%ondent! unacce%ta'le. =ir!t of all" Dr. ?a&ora cannot 'e con!idered an aut.orit- in t.e field of ane!t.e!iolog!i&%l- 'ecau!e .e i! not an ane!t.e!iologi!t. Since Dr. ?a&ora i! a %ul&onologi!t" .e could not .a e 'een ca%a'le of %ro%erl- enlig.tening t.e court a'out ane!t.e!ia %ractice and %rocedure and t.eir co&%lication!. Dr. ?a&ora i! li;e/i!e not an allergologi!t and could not t.erefore %ro%erl- ad ance e5%ert o%inion on allergic-&ediated %roce!!e!. Moreo er" .e i! not a %.ar&acologi!t and" a! !uc." could not .a e 'een ca%a'le" a! an e5%ert /ould" of e5%laining to t.e court t.e %.ar&acologic and to5ic effect! of t.e !u%%o!ed cul%rit" T.io%ental Sodiu& BPentot.alC. T.e ina%%ro%riatene!! and a'!urdit- of acce%ting Dr. ?a&oraD! te!ti&on- a! an e5%ert /itne!! in t.e ane!t.etic %ractice of Pentot.al ad&ini!tration i! furt.er !u%%orted '- .i! o/n ad&i!!ion t.at .e for&ulated .i! o%inion! on t.e drug not fro& t.e %ractical e5%erience gained '- a !%eciali!t or e5%ert in t.e ad&ini!tration and u!e of Sodiu& Pentot.al on %atient!" 'ut onl- fro& reading certain reference!" to /it3 ATTK. LIGSAK3 S3 In -our line of e5%erti!e on %ul&onolog-" did -ou .a e an- occa!ion to u!e %entot.al a! a &et.od of &anage&ent0

DR. ?AM+RA3 A3 S3 :e do it in conEunction /it. t.e ane!t.e!iologi!t /.en t.e- .a e to intu'ate our %atient. @ut not in %articular /.en -ou %ractice %ul&onolog-0

A3 S3

No. In ot.er /ord!" -our ;no/ledge a'out %entot.al i! 'a!ed onl- on /.at -ou .a e read fro& 'oo;! and not '- -our o/n %er!onal a%%lication of t.e &edicine %entot.al0 @a!ed on &- %er!onal e5%erience al!o on %entot.al. 7o/ &an- ti&e! .a e -ou u!ed %entot.al0 T.e- u!ed it on &e. I /ent into 'ronc.o!%a!& during &- a%%endecto&-. And 'ecau!e t.e- .a e u!ed it on -ou and on account of -our o/n %er!onal e5%erience -ou feel t.at -ou can te!tif- on %entot.al .ere /it. &edical aut.orit-0 No. T.at i! /.- I u!ed reference! to !u%%ort &- clai&!.1H12

A3 S3 A3 S3 A3

An ane!t.etic accident cau!ed '- a rare drug-induced 'ronc.o!%a!& %ro%erl- fall! /it.in t.e field! of ane!t.e!ia" internal &edicine-allerg-" and clinical %.ar&acolog-. T.e re!ulting ano5ic ence%.alo%at.- 'elong! to t.e field of neurolog-. :.ile ad&ittedl-" &an'ronc.o!%a!tic-&ediated %ul&onar- di!ea!e! are /it.in t.e e5%erti!e of %ul&onar&edicine" Dr. ?a&oraV! field" t.e ane!t.etic drug-induced" allergic &ediated 'ronc.o!%a!& alleged in t.i! ca!e i! /it.in t.e di!ci%line! of ane!t.e!iolog-" allergolog- and %.ar&acolog-. +n t.e 'a!i! of t.e foregoing tran!cri%t" in /.ic. t.e %ul&onologi!t .i&!elf ad&itted t.at .e could not te!tif- a'out t.e drug /it. &edical aut.orit-" it i! clear t.at t.e a%%ellate court erred in gi ing /eig.t to Dr. ?a&oraD! te!ti&on- a! an e5%ert in t.e ad&ini!tration of T.io%ental Sodiu&. T.e %ro i!ion in t.e rule! of e idence1HA2regarding e5%ert /itne!!e! !tate!3 Sec. $). 1pinion o3 e*pert 7itness. - T.e o%inion of a /itne!! on a &atter re6uiring !%ecial ;no/ledge" !;ill" e5%erience or training /.ic. .e i! !.o/n to %o!!e!!" &a- 'e recei ed in e idence. Generall-" to 6ualif- a! an e5%ert /itne!!" one &u!t .a e ac6uired !%ecial ;no/ledge of t.e !u'Eect &atter a'out /.ic. .e or !.e i! to te!tif-" eit.er '- t.e !tud- of recogni<ed aut.oritie! on t.e !u'Eect or '- %ractical e5%erience.1HF2 Clearl-" Dr. ?a&ora doe! not 6ualif- a! an e5%ert /itne!! 'a!ed on t.e a'o e !tandard !ince .e lac;! t.e nece!!ar;no/ledge" !;ill" and training in t.e field of ane!t.e!iolog-. +ddl-" a%art fro& !u'&itting te!ti&on- fro& a !%eciali!t in t.e /rong field" %ri ate re!%ondent!D intentionall- a oided %ro iding te!ti&on- '- co&%etent and inde%endent e5%ert! in t.e %ro%er area!. Moreo er" %ri ate re!%ondent!D t.eor-" t.at T.io%ental Sodiu& &a- .a e %roduced ErlindaV! co&a '- triggering an allergic &ediated re!%on!e" .a! no !u%%ort in e idence. No e idence of !tridor" !;in reaction!" or /.ee<ing - !o&e of t.e &ore co&&on acco&%an-ing !ign! of an allergic reaction - a%%ear! on record. No la'orator- data /ere e er %re!ented to t.e court. In an- ca!e" %ri ate re!%ondent! t.e&!el e! ad&it t.at T.io%ental induced" allergic&ediated 'ronc.o!%a!& .a%%en! onl- er- rarel-. If court! /ere to acce%t %ri ate re!%ondent!V .-%ot.e!i! /it.out !u%%orting &edical %roof" and again!t t.e /eig.t of a aila'le e idence" t.en e er- ane!t.etic accident /ould 'e an act of God. E identl-" t.e

T.io%ental-allerg- t.eor- igorou!l- a!!erted '- %ri ate re!%ondent! /a! a &ere aftert.oug.t. Suc. an e5%lanation /a! ad anced in order to a'!ol e t.e& of an- and all re!%on!i'ilit- for t.e %atientD! condition. In ie/ of t.e e idence at .and" /e are inclined to 'elie e %etitioner!D !tand t.at it /a! t.e fault- intu'ation /.ic. /a! t.e %ro5i&ate cau!e of ErlindaD! co&ato!e condition. Pro5i&ate cau!e .a! 'een defined a! t.at /.ic." in natural and continuou! !e6uence" un'ro;en '- an- efficient inter ening cau!e" %roduce! inEur-" and /it.out /.ic. t.e re!ult /ould not .a e occurred.1H$2 An inEur- or da&age i! %ro5i&atel- cau!ed '- an act or a failure to act" /.ene er it a%%ear! fro& t.e e idence in t.e ca!e" t.at t.e act or o&i!!ion %la-ed a !u'!tantial %art in 'ringing a'out or actuall- cau!ing t.e inEur- or da&age8 and t.at t.e inEur- or da&age /a! eit.er a direct re!ult or a rea!ona'l- %ro'a'le con!e6uence of t.e act or o&i!!ion.1H(2 It i! t.e do&inant" &o ing or %roducing cau!e. A%%l-ing t.e a'o e definition in relation to t.e e idence at .and" fault- intu'ation i! undenia'l- t.e %ro5i&ate cau!e /.ic. triggered t.e c.ain of e ent! leading to ErlindaD! 'rain da&age and" ulti&atel-" .er co&ato!ed condition. Pri ate re!%ondent! t.e&!el e! ad&itted in t.eir te!ti&on- t.at t.e fir!t intu'ation /a! a failure. T.i! fact /a! li;e/i!e o'!er ed '- /itne!! Cru< /.en !.e .eard re!%ondent Dra. Gutierre< re&ar;ed" 4Ang .ira% &a-intu'ate nito" &ali -ata ang %ag;a;a%a!o;. + lu&ala;i ang ti-an.9 T.ereafter" /itne!! Cru< noticed a'do&inal di!tention on t.e 'od- of Erlinda. T.e de elo%&ent of a'do&inal di!tention" toget.er /it. re!%irator- e&'arra!!&ent indicate! t.at t.e endotrac.eal tu'e entered t.e e!o%.agu! in!tead of t.e re!%irator- tree. In ot.er /ord!" in!tead of t.e intended endotrac.eal intu'ation /.at actuall- too; %lace /a! an e!o%.ageal intu'ation. During intu'ation" !uc. di!tention indicate! t.at air .a! entered t.e ga!trointe!tinal tract t.roug. t.e e!o%.agu! in!tead of t.e lung! t.roug. t.e trac.ea. Entr- into t.e e!o%.agu! /ould certainl- cau!e !o&e dela- in o5-gen deli er- into t.e lung! a! t.e tu'e /.ic. carrie! o5-gen i! in t.e /rong %lace. T.at a'do&inal di!tention .ad 'een o'!er ed during t.e fir!t intu'ation !ugge!t! t.at t.e lengt. of ti&e utili<ed in in!erting t.e endotrac.eal tu'e Bu% to t.e ti&e t.e tu'e /a! /it.dra/n for t.e !econd atte&%tC /a! fairl- !ignificant. Due to t.e dela- in t.e deli er- of o5-gen in .er lung! Erlinda !.o/ed !ign! of c-ano!i!.1HH2 A! !tated in t.e te!ti&on- of Dr. 7o!a;a" t.e lac; of o5-gen 'eca&e a%%arent onl- after .e noticed t.at t.e nail'ed! of Erlinda /ere alread- 'lue.1H*2 7o/e er" %ri ate re!%ondent! contend t.at a !econd intu'ation /a! e5ecuted on Erlinda and t.i! one /a! !ucce!!full- done. :e do not t.in; !o. No e idence e5i!t! on record" 'e-ond %ri ate re!%ondent!V 'are clai&!" /.ic. !u%%ort! t.e contention t.at t.e !econd intu'ation /a! !ucce!!ful. A!!u&ing t.at t.e endotrac.eal tu'e finall- found it! /a- into t.e %ro%er orifice of t.e trac.ea" t.e !a&e ga e no guarantee of o5-gen deli er-" t.e .all&ar; of a !ucce!!ful intu'ation. In fact" c-ano!i! /a! again o'!er ed i&&ediatel- after t.e !econd intu'ation. Proceeding fro& t.i! e ent Bc-ano!i!C" it could not 'e clai&ed" a! %ri ate re!%ondent! in!i!t" t.at t.e !econd intu'ation /a! acco&%li!.ed. E en granting t.at t.e tu'e /a! !ucce!!fullin!erted during t.e !econd atte&%t" it /a! o' iou!l- too late. A! a%tl- e5%lained '- t.e trial court" Erlinda alread- !uffered 'rain da&age a! a re!ult of t.e inade6uate o5-genation of .er 'rain for a'out four to fi e &inute!.1H#2 T.e a'o e conclu!ion i! not /it.out 'a!i!. Scientific !tudie! %oint out t.at intu'ation %ro'le&! are re!%on!i'le for one-t.ird B1IFC of deat.! and !eriou! inEurie! a!!ociated /it. ane!t.e!ia.1H)2 Ne ert.ele!!" ninet--eig.t %ercent B)#UC or t.e a!t &aEorit- of difficult intu'ation! &a- 'e antici%ated '- %erfor&ing a t.oroug. e aluation of t.e %atientD! air/a-

%rior to t.e o%eration.1*G2 A! !tated 'efore.and" re!%ondent Dra. Gutierre< failed to o'!er e t.e %ro%er %re-o%erati e %rotocol /.ic. could .a e %re ented t.i! unfortunate incident. 7ad a%%ro%riate diligence and rea!ona'le care 'een u!ed in t.e %re-o%erati e e aluation" re!%ondent %.-!ician could .a e 'een &uc. &ore %re%ared to &eet t.e contingenc- 'roug.t a'out '- t.e %ercei ed anato&ic ariation! in t.e %atientD! nec; and oral area" defect! /.ic. /ould .a e 'een ea!il- o erco&e '- a %rior ;no/ledge of t.o!e ariation! toget.er /it. a c.ange in tec.ni6ue.1*12 In ot.er /ord!" an e5%erienced ane!t.e!iologi!t" ade6uatel- alerted '- a t.oroug. %re-o%erati e e aluation" /ould .a e .ad little difficult- going around t.e !.ort nec; and %rotruding teet..1*A2 7a ing failed to o'!er e co&&on &edical !tandard! in %re-o%erati e &anage&ent and intu'ation" re!%ondent Dra. Gutierre<D negligence re!ulted in cere'ral ano5ia and e entual co&a of Erlinda. :e no/ deter&ine t.e re!%on!i'ilit- of re!%ondent Dr. +rlino 7o!a;a a! t.e .ead of t.e !urgical tea&. A! t.e !o-called 4ca%tain of t.e !.i%"91*F2 it i! t.e !urgeonD! re!%on!i'ilit- to !ee to it t.at t.o!e under .i& %erfor& t.eir ta!; in t.e %ro%er &anner. Re!%ondent Dr. 7o!a;aD! negligence can 'e found in .i! failure to e5erci!e t.e %ro%er aut.orit- Ba! t.e 4ca%tain9 of t.e o%erati e tea&C in not deter&ining if .i! ane!t.e!iologi!t o'!er ed %ro%er ane!t.e!ia %rotocol!. In fact" no e idence on record e5i!t! to !.o/ t.at re!%ondent Dr. 7o!a;a erified if re!%ondent Dra. Gutierre< %ro%erlintu'ated t.e %atient. =urt.er&ore" it doe! not e!ca%e u! t.at re!%ondent Dr. 7o!a;a .ad !c.eduled anot.er %rocedure in a different .o!%ital at t.e !a&e ti&e a! ErlindaD! cholec%stectom%" and /a! in fact o er t.ree .our! late for t.e latterD! o%eration. @ecau!e of t.i!" .e .ad little or no ti&e to confer /it. .i! ane!t.e!iologi!t regarding t.e ane!t.e!ia deli er-. T.i! indicate! t.at .e /a! re&i!! in .i! %rofe!!ional dutie! to/ard! .i! %atient. T.u!" .e !.are! e6ual re!%on!i'ilit- for t.e e ent! /.ic. re!ulted in ErlindaD! condition. :e no/ di!cu!! t.e re!%on!i'ilit- of t.e .o!%ital in t.i! %articular incident. T.e uni6ue %ractice Ba&ong %ri ate .o!%ital!C of filling u% !%eciali!t !taff /it. attending and i!iting 4con!ultant!"91*$2 /.o are allegedl- not .o!%ital e&%lo-ee!" %re!ent! %ro'le&! in a%%ortioning re!%on!i'ilit- for negligence in &edical &al%ractice ca!e!. 7o/e er" t.e difficult- i! onl- &ore a%%arent t.an real. In t.e fir!t %lace" .o!%ital! e5erci!e !ignificant control in t.e .iring and firing of con!ultant! and in t.e conduct of t.eir /or; /it.in t.e .o!%ital %re&i!e!. Doctor! /.o a%%l- for 4con!ultant9 !lot!" i!iting or attending" are re6uired to !u'&it %roof of co&%letion of re!idenc-" t.eir educational 6ualification!8 generall-" e idence of accreditation '- t.e a%%ro%riate 'oard Bdi%lo&ateC" e idence of fello/!.i% in &o!t ca!e!" and reference!. T.e!e re6uire&ent! are carefull- !crutini<ed '- &e&'er! of t.e .o!%ital ad&ini!tration or '- a re ie/ co&&ittee !et u% '- t.e .o!%ital /.o eit.er acce%t or reEect t.e a%%lication.1*(2 T.i! i! %articularl- true /it. re!%ondent .o!%ital. After a %.-!ician i! acce%ted" eit.er a! a i!iting or attending con!ultant" .e i! nor&all- re6uired to attend clinico-%at.ological conference!" conduct 'ed!ide round! for cler;!" intern! and re!ident!" &oderate grand round! and %atient audit! and %erfor& ot.er ta!;! and re!%on!i'ilitie!" for t.e %ri ilege of 'eing a'le to &aintain a clinic in t.e .o!%ital" andIor for t.e %ri ilege of ad&itting %atient! into t.e .o!%ital. In addition to t.e!e" t.e %.-!icianD! %erfor&ance a! a !%eciali!t i! generall- e aluated '- a %eer re ie/ co&&ittee on t.e 'a!i! of &ortalit- and &or'idit- !tati!tic!" and feed'ac; fro& %atient!" nur!e!" intern! and re!ident!. A con!ultant re&i!! in .i! dutie!" or a con!ultant /.o regularl- fall! !.ort of t.e &ini&u& !tandard! acce%ta'le to t.e .o!%ital or it! %eer re ie/ co&&ittee" i!

nor&all- %olitel- ter&inated. In ot.er /ord!" %ri ate .o!%ital!" .ire" fire and e5erci!e real control o er t.eir attending and i!iting 4con!ultant9 !taff. :.ile 4con!ultant!9 are not" tec.nicall- e&%lo-ee!" a %oint /.ic. re!%ondent .o!%ital a!!ert! in den-ing all re!%on!i'ilit- for t.e %atientD! condition" t.e control e5erci!ed" t.e .iring" and t.e rig.t to ter&inate con!ultant! all fulfill t.e i&%ortant .all&ar;! of an e&%lo-er-e&%lo-ee relation!.i%" /it. t.e e5ce%tion of t.e %a-&ent of /age!. In a!!e!!ing /.et.er !uc. a relation!.i% in fact e5i!t!" t.e control te!t i! deter&ining. Accordingl-" on t.e 'a!i! of t.e foregoing" /e rule t.at for t.e %ur%o!e of allocating re!%on!i'ilit- in &edical negligence ca!e!" an e&%lo-er-e&%lo-ee relation!.i% in effect e5i!t! 'et/een .o!%ital! and t.eir attending and i!iting %.-!ician!. T.i! 'eing t.e ca!e" t.e 6ue!tion no/ ari!e! a! to /.et.er or not re!%ondent .o!%ital i! !olidarillia'le /it. re!%ondent doctor! for %etitionerD! condition.1*H2 T.e 'a!i! for .olding an e&%lo-er !olidaril- re!%on!i'le for t.e negligence of it! e&%lo-ee i! found in Article A1#G of t.e Ci il Code /.ic. con!ider! a %er!on accounta'le not onl- for .i! o/n act! 'ut al!o for t.o!e of ot.er! 'a!ed on t.e for&erD! re!%on!i'ilitunder a relation!.i% of patria potestas.1**2 Suc. re!%on!i'ilit- cea!e! /.en t.e %er!on! or entit- concerned %ro e t.at t.e- .a e o'!er ed t.e diligence of a good fat.er of t.e fa&ilto %re ent da&age.1*#2 In ot.er /ord!" /.ile t.e 'urden of %ro ing negligence re!t! on t.e %laintiff!" once negligence i! !.o/n" t.e 'urden !.ift! to t.e re!%ondent! B%arent" guardian" teac.er or e&%lo-erC /.o !.ould %ro e t.at t.e- o'!er ed t.e diligence of a good fat.er of a fa&il- to %re ent da&age. In t.e in!tant ca!e" re!%ondent .o!%ital" a%art fro& a general denial of it! re!%on!i'ilit- o er re!%ondent %.-!ician!" failed to adduce e idence !.o/ing t.at it e5erci!ed t.e diligence of a good fat.er of a fa&il- in t.e .iring and !u%er i!ion of t.e latter. It failed to adduce e idence /it. regard to t.e degree of !u%er i!ion /.ic. it e5erci!ed o er it! %.-!ician!. In neglecting to offer !uc. %roof" or %roof of a !i&ilar nature" re!%ondent .o!%ital t.ere'- failed to di!c.arge it! 'urden under t.e la!t %aragra%. of Article A1#G. 7a ing failed to do t.i!" re!%ondent .o!%ital i! con!e6uentl- !olidarilre!%on!i'le /it. it! %.-!ician! for ErlindaD! condition. @a!ed on t.e foregoing" /e .old t.at t.e Court of A%%eal! erred in acce%ting and rel-ing on t.e te!ti&onie! of t.e /itne!!e! for t.e %ri ate re!%ondent!. Indeed" a! !.o/n '- t.e a'o e di!cu!!ion!" %ri ate re!%ondent! /ere una'le to re'ut t.e %re!u&%tion of negligence. >%on t.e!e di!6ui!ition! /e .old t.at %ri ate re!%ondent! are !olidaril- lia'le for da&age! under Article A1*H1*)2 of t.e Ci il Code. :e no/ co&e to t.e a&ount of da&age! due %etitioner!. T.e trial court a/arded a total of PHFA"GGG.GG %e!o! B!.ould 'e PH1H"GGG.GGC in co&%en!ator- da&age! to t.e %laintiff" 4!u'Eect to it! 'eing u%dated9 co ering t.e %eriod fro& 1( No e&'er 1)#( u% to 1( A%ril 1))A" 'a!ed on &ont.l- e5%en!e! for t.e care of t.e %atient e!ti&ated at P#"GGG.GG. At current le el!" t.e P#GGGI&ont.l- a&ount e!ta'li!.ed '- t.e trial court at t.e ti&e of it! deci!ion /ould 'e gro!!l- inade6uate to co er t.e actual co!t! of .o&e-'a!ed care for a co&ato!e indi idual. T.e calculated a&ount /a! not e en arri ed at '- loo;ing at t.e actual co!t of %ro%er .o!%ice care for t.e %atient. :.at it reflected /ere t.e actual e5%en!e! incurred and %ro ed '- t.e %etitioner! after t.e- /ere forced to 'ring .o&e t.e %atient to a oid &ounting .o!%ital 'ill!.

And -et ideall-" a co&ato!e %atient !.ould re&ain in a .o!%ital or 'e tran!ferred to a .o!%ice !%eciali<ing in t.e care of t.e c.ronicall- ill for t.e %ur%o!e of %ro iding a %ro%er &ilieu ade6uate to &eet &ini&u& !tandard! of care. In t.e in!tant ca!e for in!tance" Erlinda .a! to 'e con!tantl- turned fro& !ide to !ide to %re ent 'ed!ore! and .-%o!tatic %neu&onia. =eeding i! done '- na!oga!tric tu'e. =ood %re%aration !.ould 'e nor&all&ade '- a dietitian to %ro ide .er /it. t.e correct dail- caloric re6uire&ent! and ita&in !u%%le&ent!. =urt.er&ore" !.e .a! to 'e !een on a regular 'a!i! '- a %.-!ical t.era%i!t to a oid &u!cle atro%.-" and '- a %ul&onar- t.era%i!t to %re ent t.e accu&ulation of !ecretion! /.ic. can lead to re!%irator- co&%lication!. Gi en t.e!e con!ideration!" t.e a&ount of actual da&age! reco era'le in !uit! ari!ing fro& negligence !.ould at lea!t reflect t.e correct &ini&u& co!t of %ro%er care" not t.e co!t of t.e care t.e fa&il- i! u!uall- co&%elled to underta;e at .o&e to a oid 'an;ru%tc-. 7o/e er" t.e %ro i!ion! of t.e Ci il Code on actual or co&%en!atorda&age! %re!ent u! /it. !o&e difficultie!. :ell-!ettled i! t.e rule t.at actual da&age! /.ic. &a- 'e clai&ed '- t.e %laintiff are t.o!e !uffered '- .i& a! .e .a! dul- %ro ed. T.e Ci il Code %ro ide!3 &rt. 89::. - E5ce%t a! %ro ided '- la/ or '- !ti%ulation" one i! entitled to an ade6uate co&%en!ation onl- for !uc. %ecuniar- lo!! !uffered '- .i& a! .e .a! dul- %ro ed. Suc. co&%en!ation i! referred to a! actual or co&%en!ator- da&age!. +ur rule! on actual or co&%en!ator- da&age! generall- a!!u&e t.at at t.e ti&e of litigation" t.e inEur- !uffered a! a con!e6uence of an act of negligence .a! 'een co&%leted and t.at t.e co!t can 'e li6uidated. 7o/e er" t.e!e %ro i!ion! neglect to ta;e into account t.o!e !ituation!" a! in t.i! ca!e" /.ere t.e re!ulting inEur- &ig.t 'e continuing and %o!!i'le future co&%lication! directl- ari!ing fro& t.e inEur-" /.ile certain to occur" are difficult to %redict. In t.e!e ca!e!" t.e a&ount of da&age! /.ic. !.ould 'e a/arded" if t.e- are to ade6uatel- and correctl- re!%ond to t.e inEur- cau!ed" !.ould 'e one /.ic. co&%en!ate! for %ecuniar- lo!! incurred and %ro ed" u% to t.e ti&e of trial8 and one /.ic. /ould &eet %ecuniar- lo!! certain to 'e !uffered 'ut /.ic. could not" fro& t.e nature of t.e ca!e" 'e &ade /it. certaint-.1#G2 In ot.er /ord!" te&%erate da&age! can and !.ould 'e a/arded on to% of actual or co&%en!ator- da&age! in in!tance! /.ere t.e inEur- i! c.ronic and continuing. And 'ecau!e of t.e uni6ue nature of !uc. ca!e!" no inco&%ati'ilit- ari!e! /.en 'ot. actual and te&%erate da&age! are %ro ided for. T.e rea!on i! t.at t.e!e da&age! co er t/o di!tinct %.a!e!. A! it /ould not 'e e6uita'le - and certainl- not in t.e 'e!t intere!t! of t.e ad&ini!tration of Eu!tice - for t.e icti& in !uc. ca!e! to con!tantl- co&e 'efore t.e court! and in o;e t.eir aid in !ee;ing adEu!t&ent! to t.e co&%en!ator- da&age! %re iou!la/arded - te&%erate da&age! are a%%ro%riate. T.e a&ount gi en a! te&%erate da&age!" t.oug. to a certain e5tent !%eculati e" !.ould ta;e into account t.e co!t of %ro%er care. In t.e in!tant ca!e" %etitioner! /ere a'le to %ro ide onl- .o&e-'a!ed nur!ing care for a co&ato!e %atient /.o .a! re&ained in t.at condition for o er a decade. 7a ing %re&i!ed our a/ard for co&%en!ator- da&age! on t.e a&ount %ro ided '- %etitioner! at t.e on!et of litigation" it /ould 'e no/ &uc. &ore in !te% /it. t.e intere!t! of Eu!tice if t.e alue a/arded for te&%erate da&age! /ould allo/ %etitioner! to %ro ide o%ti&al care for t.eir lo ed one in a facilit- /.ic. generall- !%eciali<e! in !uc. care. T.e- !.ould not 'e

co&%elled '- dire circu&!tance! to %ro ide !u'!tandard care at .o&e /it.out t.e aid of %rofe!!ional!" for an-t.ing le!! /ould 'e gro!!l- inade6uate. >nder t.e circu&!tance!" an a/ard of P1"(GG"GGG.GG in te&%erate da&age! /ould t.erefore 'e rea!ona'le.1#12 In 6alenzuela vs. Court o3 &ppeals"1#A2 t.i! Court /a! confronted /it. a !ituation /.ere t.e inEur- !uffered '- t.e %laintiff /ould .a e led to e5%en!e! /.ic. /ere difficult to e!ti&ate 'ecau!e /.ile t.e- /ould .a e 'een a direct re!ult of t.e inEur- Ba&%utationC" and /ere certain to 'e incurred '- t.e %laintiff" t.e- /ere li;el- to ari!e onl- in t.e future. :e a/arded P1"GGG"GGG.GG in &oral da&age! in t.at ca!e. De!cri'ing t.e nature of t.e inEur-" t.e Court t.erein !tated3 A! a re!ult of t.e accident" Ma. Lourde! ,alen<uela under/ent a trau&atic a&%utation of .er left lo/er e5tre&it- at t.e di!tal left t.ig. Eu!t a'o e t.e ;nee. @ecau!e of t.i!" ,alen<uela /ill fore er 'e de%ri ed of t.e full a&'ulator- function! of .er left e5tre&it-" e en /it. t.e u!e of !tate of t.e art %ro!t.etic tec.nolog-. :ell 'e-ond t.e %eriod of .o!%itali<ation B/.ic. /a! %aid for '- LiC" !.e /ill 'e re6uired to undergo adEu!t&ent! in .er %ro!t.etic de i!e due to t.e !.rin;age of t.e !tu&% fro& t.e %roce!! of .ealing. T.e!e adEu!t&ent! entail co!t!" %ro!t.etic re%lace&ent! and &ont.! of %.-!ical and occu%ational re.a'ilitation and t.era%-. During .er lifeti&e" t.e %ro!t.etic de i!e /ill .a e to 'e re%laced and readEu!ted to c.ange! in t.e !i<e of .er lo/er li&' effected '- t.e 'iological c.ange! of &iddle-age" &eno%au!e and aging. A!!u&ing !.e reac.e! &eno%au!e" for e5a&%le" t.e %ro!t.etic /ill .a e to 'e adEu!ted to re!%ond to t.e c.ange! in 'one re!ulting fro& a %reci%itate decrea!e in calciu& le el! o'!er ed in t.e 'one! of all %o!t-&eno%au!al /o&en. In ot.er /ord!" t.e da&age done to .er /ould not onl- 'e %er&anent and la!ting" it /ould al!o 'e %er&anentl- c.anging and adEu!ting to t.e %.-!iologic c.ange! /.ic. .er 'od- /ould normall% undergo t.roug. t.e -ear!. T.e re%lace&ent!" c.ange!" and adEu!t&ent! /ill re6uire corre!%onding adEu!ti e %.-!ical and occu%ational t.era%-. All of t.e!e adEu!t&ent!" it .a! 'een docu&ented" are %ainful. 5 5 5. A %ro!t.etic de i!e" .o/e er tec.nologicall- ad anced" /ill onl- allo/ a rea!ona'le a&ount of functional re!toration of t.e &otor function! of t.e lo/er li&'. T.e !en!orfunction! are fore er lo!t. T.e re!ultant an5iet-" !lee%le!!ne!!" %!-c.ological inEur-" &ental and %.-!ical %ain are ine!ti&a'le.1#F2 T.e inEur- !uffered '- Erlinda a! a con!e6uence of %ri ate re!%ondent!D negligence i! certainl- &uc. &ore !eriou! t.an t.e a&%utation in t.e 6alenzuela ca!e. Petitioner Erlinda Ra&o! /a! in .er &id-fortie! /.en t.e incident occurred. S.e .a! 'een in a co&ato!e !tate for o er fourteen -ear! no/. T.e 'urden of care .a! !o far 'een .eroicall- !.ouldered '- .er .u!'and and c.ildren" /.o" in t.e inter ening -ear! .a e 'een de%ri ed of t.e lo e of a /ife and a &ot.er. Mean/.ile" t.e actual %.-!ical" e&otional and financial co!t of t.e care of %etitioner /ould 'e irtuall- i&%o!!i'le to 6uantif-. E en t.e te&%erate da&age! .erein a/arded /ould 'e inade6uate if %etitionerD! condition re&ain! unc.anged for t.e ne5t ten -ear!. :e recogni<ed" in 6alenzuela t.at a di!cu!!ion of t.e icti&D! actual inEur- /ould not e en !cratc. t.e !urface of t.e re!ulting &oral da&age 'ecau!e it /ould 'e .ig.l!%eculati e to e!ti&ate t.e a&ount of e&otional and &oral %ain" %!-c.ological da&age and inEur- !uffered '- t.e icti& or t.o!e actuall- affected '- t.e icti&D! condition.

1#$2 T.e .u!'and and t.e c.ildren" all %etitioner! in t.i! ca!e" /ill .a e to li e /it. t.e dato da- uncertaint- of t.e %atientD! illne!!" ;no/ing an- .o%e of reco er- i! clo!e to nil. T.e- .a e fa!.ioned t.eir dail- li e! around t.e nur!ing care of %etitioner" altering t.eir long ter& goal! to ta;e into account t.eir life /it. a co&ato!e %atient. T.e-" not t.e re!%ondent!" are c.arged /it. t.e &oral re!%on!i'ilit- of t.e care of t.e icti&. T.e fa&il-D! &oral inEur- and !uffering in t.i! ca!e i! clearl- a real one. =or t.e foregoing rea!on!" an a/ard of PA"GGG"GGG.GG in &oral da&age! /ould 'e a%%ro%riate. =inall-" '- /a- of e5a&%le" e5e&%lar- da&age! in t.e a&ount of P1GG"GGG.GG are .ere'- a/arded. Con!idering t.e lengt. and nature of t.e in!tant !uit /e are of t.e o%inion t.at attorne-D! fee! alued at P1GG"GGG.GG are li;e/i!e %ro%er. +ur court! face uni6ue difficult- in adEudicating &edical negligence ca!e! 'ecau!e %.-!ician! are not in!urer! of life and" t.e- rarel- !et out to intentionall- cau!e inEur- or deat. to t.eir %atient!. 7o/e er" intent i! i&&aterial in negligence ca!e! 'ecau!e /.ere negligence e5i!t! and i! %ro en" t.e !a&e auto&aticall- gi e! t.e inEured a rig.t to re%aration for t.e da&age cau!ed. E!ta'li!.ed &edical %rocedure! and %ractice!" t.oug. in con!tant flu5 are de i!ed for t.e %ur%o!e of %re enting co&%lication!. A %.-!icianD! e5%erience /it. .i! %atient! /ould !o&eti&e! te&%t .i& to de iate fro& e!ta'li!.ed co&&unit- %ractice!" and .e &a- end a di!tingui!.ed career u!ing unort.odo5 &et.od! /it.out incident. 7o/e er" /.en failure to follo/ e!ta'li!.ed %rocedure re!ult! in t.e e il %reci!el- !oug.t to 'e a erted 'o'!er ance of t.e %rocedure and a ne5u! i! &ade 'et/een t.e de iation and t.e inEur- or da&age" t.e %.-!ician /ould nece!!aril- 'e called to account for it. In t.e ca!e at 'ar" t.e failure to o'!er e %re-o%erati e a!!e!!&ent %rotocol /.ic. /ould .a e influenced t.e intu'ation in a !alutar- /a- /a! fatal to %ri ate re!%ondent!D ca!e. &ERE!ORE" t.e deci!ion and re!olution of t.e a%%ellate court a%%ealed fro& are .ere'- &odified !o a! to a/ard in fa or of %etitioner!" and !olidaril- again!t %ri ate re!%ondent! t.e follo/ing3 1C P1"F(A"GGG.GG a! actual da&age! co&%uted a! of t.e date of %ro&ulgation of t.i! deci!ion %lu! a &ont.l- %a-&ent of P#"GGG.GG u% to t.e ti&e t.at %etitioner Erlinda Ra&o! e5%ire! or &iraculou!l- !ur i e!8 AC PA"GGG"GGG.GG a! &oral da&age!" FC P1"(GG"GGG.GG a! te&%erate da&age!8 $C P1GG"GGG.GG eac. a! e5e&%larda&age! and attorne-D! fee!8 and" (C t.e co!t! of t.e !uit. SO ORDERED. avide, Jr., C.J., (Chairman), Puno, Pardo and ;nares-,antiago, JJ., concur. A. Cru< !. CA" G.R. No. 1AA$$(" No e&'er 1#" 1))*

[G.R. No. 1??445. No@ember 18, 1997] DR. NINE+E$C& CRU-, petitioner, vs. U*ALI, respondents. COUR$ O! A""EALS ('3 L9DIA

DECISION !RANCISCO, J.7 XDoctor! are %rotected '- a !%ecial la/. T.e- are not guarantor! of care. T.e- do not

e en /arrant a good re!ult. T.e- are not in!urer! again!t &i!.a% or unu!ual con!e6uence!. =urt.er&ore t.e- are not lia'le for .one!t &i!ta;e of Eudg&entYX112 T.e %re!ent ca!e again!t %etitioner i! in t.e nature of a &edical &al%ractice !uit" /.ic. in !i&%le!t ter& i! t.e t-%e of clai& /.ic. a icti& .a! a aila'le to .i& or .er to redre!! a /rong co&&itted '- a &edical %rofe!!ional /.ic. .a! cau!e 'odil- .ar&.1A2 In t.i! Euri!diction" .o/e er" !uc. clai&! are &o!t often 'roug.t a! a ci il action for da&age! under Article A1*H of t.e Ci il Code"1F2 and in !o&e in!tance!" a! a cri&inal ca!e under Article FH( of t.e Re i!ed Penal Code1$2 /it. /.ic. t.e ci il action for da&age! i! i&%liedl- in!tituted. It i! via t.e latter t-%e of action t.at t.e .eir! of t.e decea!ed !oug.t redre!! for t.e %etitionerV! alleged i&%rudence and negligence in treating t.e decea!ed t.ere'- cau!ing .er deat.. T.e %etitioner and one Dr. Lina Ercillo /.o /a! t.e attending anae!t.e!iologi!t during t.e o%eration of t.e decea!ed /ere c.arged /it. Xrec;le!! i&%rudence and negligence re!ulting to B!icC .o&icideX in an infor&ation /.ic. read!3 XT.at on or a'out Marc. AF" 1))1" in t.e Cit- of San Pa'lo" Re%u'lic of t.e P.ili%%ine! and /it.in t.e Euri!diction of t.i! 7onora'le Court" t.e accu!ed a'o ena&ed" 'eing t.en t.e attending anae!t.e!iologi!t and !urgeon" re!%ecti el-" did t.en and t.ere" in a negligence B!icC" carele!!" i&%rudent" and inco&%etent &anner" and failing to !u%%l- or !tore !ufficient %ro i!ion! and facilitie! nece!!ar- to &eet an- and all e5igencie! a%t to ari!e 'efore" during andIor after a !urgical o%eration cau!ing '- !uc. negligence" carele!!ne!!" i&%rudence" and inco&%etence" and cau!ing '- !uc. failure" including t.e lac; of %re%aration and fore!ig.t needed to a ert a traged-" t.e unti&el- deat. of !aid L-dia >&ali on t.e da- follo/ing !aid !urgical o%eration.X1(2 Trial en!ued after 'ot. t.e %etitioner and Dr. Lina Ercillo %leaded not guilt- to t.e a'o e-&entioned c.arge. +n Marc. $" 1))$" t.e Munici%al Trial Court in Citie! BMTCCC of San Pa'lo Cit- rendered a deci!ion" t.e di!%o!iti e %ortion of /.ic. i! .ereunder 6uoted a! follo/!3 X:7ERE=+RE" t.e court find! t.e accu!ed Dr. Lina Ercillo not guilt- of t.e offen!e c.arged for in!ufficienc- of e idence /.ile .er co-accu!ed Dra. Nine etc. Cru< i! .ere'.eld re!%on!i'le for t.e deat. of L-dia >&ali on Marc. A$" 1))1" and t.erefore guiltunder Art. FH( of t.e Re i!ed Penal Code" and !.e i! .ere'- !entenced to !uffer t.e %enalt- of A &ont.! and 1 da- i&%ri!on&ent of arre!to &a-or /it. co!t!.X1H2 T.e %etitioner a%%ealed .er con iction to t.e Regional Trial Court BRTCC /.ic. affir&ed in toto t.e deci!ion of t.e MTCC1*2 %ro&%ting t.e %etitioner to file a %etition for re ie/ /it. t.e Court of A%%eal! 'ut to no a ail. 7ence t.i! %etition for re ie/ on certiorari a!!ailing t.e deci!ion %ro&ulgated '- t.e Court of A%%eal! on +cto'er A$" 1))( affir&ing %etitionerV! con iction /it. &odification t.at !.e i! furt.er directed to %a- t.e .eir! of L-dia >&ali P(G"GGG.GG a! inde&nit- for .er deat..1#2 In !u'!tance" t.e %etition 'roug.t 'efore t.i! Court rai!e! t.e i!!ue of /.et.er or not %etitionerV! con iction of t.e cri&e of rec;le!! i&%rudence re!ulting in .o&icide" ari!ing fro& an alleged &edical &al%ractice" i! !u%%orted '- t.e e idence on record. =ir!t t.e antecedent fact!. +n Marc. AA" 1))1" %ro!ecution /itne!!" Ro/ena >&ali De +ca&%o" acco&%anied .er &ot.er to t.e Per%etual 7el% Clinic and General 7o!%ital !ituated in @alagta! Street" San Pa'lo Cit-" Laguna. T.e- arri ed at t.e !aid .o!%ital at around $3FG in t.e afternoon of t.e !a&e da-.1)2 Prior to Marc. AA" 1))1" L-dia /a! e5a&ined '- t.e %etitioner /.o

found a X&-o&aX11G2 in .er uteru!" and !c.eduled .er for a .-!terecto&- o%eration on Marc. AF" 1))1.1112 Ro/ena and .er &ot.er !le%t in t.e clinic on t.e e ening of Marc. AA" 1))1 a! t.e latter /a! to 'e o%erated on t.e ne5t da- at 13GG oVcloc; in t.e afternoon. 11A2 According to Ro/ena" !.e noticed t.at t.e clinic /a! untid- and t.e /indo/ and t.e floor /ere er- du!t- %ro&%ting .er to a!; t.e attendant for a rag to /i%e t.e /indo/ and t.e floor /it..11F2 @ecau!e of t.e untid- !tate of t.e clinic" Ro/ena tried to %er!uade .er &ot.er not to %roceed /it. t.e o%eration.11$2 T.e follo/ing da-" 'efore .er &ot.er /a! /.eeled into t.e o%erating roo&" Ro/ena a!;ed t.e %etitioner if t.e o%eration could 'e %o!t%oned. T.e %etitioner called L-dia into .er office and t.e t/o .ad a con er!ation. L-dia t.en infor&ed Ro/ena t.at t.e %etitioner told .er t.at !.e &u!t 'e o%erated on a! !c.eduled.11(2 Ro/ena and .er ot.er relati e!" na&el- .er .u!'and" .er !i!ter and t/o aunt! /aited out!ide t.e o%erating roo& /.ile L-dia under/ent o%eration. :.ile t.e- /ere /aiting" Dr. Ercillo /ent out of t.e o%erating roo& and in!tructed t.e& to 'u- taga&et a&%ule! /.ic. Ro/enaV! !i!ter i&&ediatel- 'oug.t. A'out one .our .ad %a!!ed /.en Dr. Ercillo ca&e out again t.i! ti&e to a!; t.e& to 'u- 'lood for L-dia. T.e- 'oug.t t-%e XAX 'lood fro& t.e St. Gerald @lood @an; and t.e !a&e /a! 'roug.t '- t.e attendant into t.e o%erating roo&. After t.e la%!e of a fe/ .our!" t.e %etitioner infor&ed t.e& t.at t.e o%eration /a! fini!.ed. T.e o%erating !taff t.en /ent in!ide t.e %etitionerV! clinic to ta;e t.eir !nac;!. So&e t.irt- &inute! after" L-dia /a! 'roug.t out of t.e o%erating roo& in a !tretc.er and t.e %etitioner a!;ed Ro/ena and t.e ot.er relati e! to 'u- additional 'lood for L-dia. >nfortunatel-" t.e- /ere not a'le to co&%l- /it. %etitionerV! order a! t.ere /a! no &ore t-%e XAX 'lood a aila'le in t.e 'lood 'an;. T.ereafter" a %er!on arri ed to donate 'lood /.ic. /a! later tran!fu!ed to L-dia. Ro/ena t.en noticed .er &ot.er" /.o /a! attac.ed to an o5-gen tan;" ga!%ing for 'reat.. A%%arentl- t.e o5-gen !u%%l- .ad run out and Ro/enaV! .u!'and toget.er /it. t.e dri er of t.e accu!ed .ad to go to t.e San Pa'lo Di!trict 7o!%ital to get o5-gen. L-dia /a! gi en t.e fre!. !u%%l- of o5-gen a! !oon a! it arri ed.11H2 @ut at around 1G3GG oVcloc; P.M. !.e /ent into !.oc; and .er 'lood %re!!ure dro%%ed to HGI(G. L-diaV! un!ta'le condition nece!!itated .er tran!fer to t.e San Pa'lo Di!trict 7o!%ital !o !.e could 'e connected to a re!%irator and furt.er e5a&ined.11*2 T.e tran!fer to t.e San Pa'lo Cit- Di!trict 7o!%ital /a! /it.out t.e %rior con!ent of Ro/ena nor of t.e ot.er relati e! %re!ent /.o found out a'out t.e intended tran!fer onl- /.en an a&'ulance arri ed to ta;e L-dia to t.e San Pa'lo Di!trict 7o!%ital. Ro/ena and .er ot.er relati e! t.en 'oarded a tric-cle and follo/ed t.e a&'ulance.11#2 >%on L-diaV! arri al at t.e San Pa'lo Di!trict 7o!%ital" !.e /a! /.eeled into t.e o%erating roo& and t.e %etitioner and Dr. Ercillo re-o%erated on .er 'ecau!e t.ere /a! 'lood oo<ing fro& t.e a'do&inal inci!ion.11)2 T.e attending %.-!ician! !u&&oned Dr. @artolo&e Angele!" .ead of t.e +'!tetric! and G-necolog- De%art&ent of t.e San Pa'lo Di!trict 7o!%ital. 7o/e er" /.en Dr. Angele! arri ed" L-dia /a! alread- in !.oc; and %o!!i'l- dead a! .er 'lood %re!!ure /a! alread- GIG. Dr. Angele! t.en infor&ed %etitioner and Dr. Ercillo t.at t.ere /a! not.ing .e could do to .el% !a e t.e %atient. 1AG2 :.ile %etitioner /a! clo!ing t.e a'do&inal /all" t.e %atient died.1A12 T.u!" on Marc. A$" 1))1" at F3GG oVcloc; in t.e &orning" L-dia >&ali /a! %ronounced dead. 7er deat. certificate !tate! X!.oc;X a! t.e i&&ediate cau!e of deat. and XDi!!e&inated Intra a!cular Coagulation BDICCX a! t.e antecedent cau!e.1AA2 In con icting t.e %etitioner" t.e MTCC found t.e follo/ing circu&!tance! a! !ufficient 'a!i! to conclude t.at !.e /a! indeed negligent in t.e %erfor&ance of t.e o%eration3 X5 5 5" t.e clinic /a! untid-" t.ere /a! lac; of %ro i!ion li;e 'lood and o5-gen to %re%are for an- contingenc- t.at &ig.t .a%%en during t.e o%eration. T.e &anner and t.e fact t.at

t.e %atient /a! 'roug.t to t.e San Pa'lo Di!trict 7o!%ital for reo%eration indicate! t.at t.ere /a! !o&et.ing /rong in t.e &anner in /.ic. Dra. Cru< conducted t.e o%eration. T.ere /a! no !.o/ing t.at 'efore t.e o%eration" accu!ed Dr. Cru< .ad conducted a cardio %ul&onar- clearance or an- t-%ing of t.e 'lood of t.e %atient. It /a! B!icC !aid in &edical %arlance t.at t.e Xa'do&en of t.e %er!on i! a te&%le of !ur%ri!e!X 'ecau!e -ou do not ;no/ t.e /.ole t.ing t.e &o&ent it /a! o%en B!icC and !urgeon &u!t 'e %re%ared for ane entualit- t.ereof. T.e %atient B!icC c.art /.ic. i! a %u'lic docu&ent /a! not %re!ented 'ecau!e it i! onl- t.ere t.at /e could deter&ine t.e condition of t.e %atient 'efore t.e !urger-. T.e court al!o noticed in E5.. X=-1X t.at t.e !i!ter of t.e decea!ed /i!.ed to %o!t%one t.e o%eration 'ut t.e %atient /a! %re ailed u%on '- Dra. Cru< to %roceed /it. t.e !urger-. T.e court find! t.at L-dia >&ali died 'ecau!e of t.e negligence and carele!!ne!! of t.e !urgeon Dra. Nine etc. Cru< 'ecau!e of lo!! of 'lood during t.e o%eration of t.e decea!ed for e ident un%re%aredne!! and for lac; of !;ill" t.e rea!on /.t.e %atient /a! 'roug.t for o%eration at t.e San Pa'lo Cit- Di!trict 7o!%ital. A! !uc." t.e !urgeon !.ould an!/er for !uc. negligence. :it. re!%ect to Dra. Lina Ercillo" t.e anae!t.e!iologi!t" t.ere i! no e idence to indicate t.at !.e !.ould 'e .eld Eointl- lia'le /it. Dra. Cru< /.o actuall- did t.e o%eration.X1AF2 T.e RTC reiterated t.e a'o e&entioned finding! of t.e MTCC and u%.eld t.e latterV! declaration of Xinco&%etenc-" negligence and lac; of fore!ig.t and !;ill of a%%ellant B.erein %etitionerC in .andling t.e !u'Eect %atient 'efore and after t.e o%eration.X1A$2 And li;e/i!e affir&ing t.e %etitionerV! con iction" t.e Court of A%%eal! ec.oed !i&ilar o'!er ation!" t.u!3 X5 5 5. :.ile /e &a- grant t.at t.e untidine!! and filt.ine!! of t.e clinic &a- not '- it!elf indicate negligence" it ne ert.ele!! !.o/! t.e a'!ence of due care and !u%er i!ion o er .er !u'ordinate e&%lo-ee!. Did t.i! un!anitar- condition %er&eate t.e o%erating roo&0 :ere t.e !urgical in!tru&ent! %ro%erl- !terili<ed0 Could t.e condition! in t.e +R .a e contri'uted to t.e infection of t.e %atient0 +nl- t.e %etitioner could an!/er t.e!e" 'ut !.e o%ted not to te!tif-. T.i! could onl- gi e ri!e to t.e %re!u&%tion t.at !.e .a! not.ing good to te!tif- on .er defen!e. An-/a-" t.e alleged Xun erified !tate&ent of t.e %ro!ecution /itne!!X re&ain! unc.allenged and unre'utted. Li;e/i!e undi!%uted i! t.e %ro!ecutionV! er!ion indicating t.e follo/ing fact!3 t.at t.e accu!ed a!;ed t.e %atientV! relati e! to 'u- Taga&et ca%!ule! /.ile t.e o%eration /a! alread- in %rogre!!8 t.at after an .our" t.e- /ere al!o a!;ed to 'u- t-%e XAX 'lood for t.e %atient8 t.at after t.e !urger-" t.e- /ere again a!;ed to %rocure &ore t-%e XAX 'lood" 'ut !uc. /a! not an-&ore a aila'le fro& t.e !ource8 t.at t.e o5-gen gi en to t.e %atient /a! e&%t-8 and t.at t.e !on-in-la/ of t.e %atient" toget.er /it. a dri er of t.e %etitioner" .ad to ru!. to t.e San Pa'lo Cit- Di!trict 7o!%ital to get t.e &uc.-needed o5-gen. All t.e!e conclu!i el- !.o/ t.at t.e %etitioner .ad not %re%ared for an- unfore!een circu&!tance! 'efore going into t.e fir!t !urger-" /.ic. /a! not e&ergenc- in nature" 'ut /a! electi e or %re-!c.eduled8 !.e .ad no read- anti'iotic!" no %re%ared 'lood" %ro%erl- t-%ed and cro!!&atc.ed" and no !ufficient o5-gen !u%%l-. Moreo er" t.ere are a lot of 6ue!tion! t.at ;ee% nagging >!. :a! t.e %atient gi en ancardio-%ul&onar- clearance" or at lea!t a clearance '- an interni!t" /.ic. are !tandard re6uire&ent! 'efore a %atient i! !u'Eected to !urger-. Did t.e %etitioner deter&ine a! %art of t.e %re-o%erati e e aluation" t.e 'leeding %ara&eter! of t.e %atient" !uc. a! 'leeding ti&e and clotting ti&e0 T.ere i! no !.o/ing t.at t.e!e /ere done. T.e %etitioner Eu!t a%%ear! to .a e 'een in a .urr- to %erfor& t.e o%eration" e en a! t.e fa&il- /anted t.e %o!t%one&ent to A%ril H" 1))1. +' iou!l-" !.e did not %re%are t.e %atient8 neit.er did !.e get t.e fa&il-V! con!ent to t.e o%eration. Moreo er" !.e did not %re%are a &edical c.art /it. in!truction! for t.e %atientV! care. If !.e did all t.e!e" %roof t.ereof !.ould .a e 'een

offered. @ut t.ere i! none. Indeed" t.e!e are o er/.el&ing e idence of rec;le!!ne!! and i&%rudence.X1A(2 T.i! court" .o/e er" .old! differentl- and find! t.e foregoing circu&!tance! in!ufficient to !u!tain a Eudg&ent of con iction again!t t.e %etitioner for t.e cri&e of rec;le!! i&%rudence re!ulting in .o&icide. T.e ele&ent! of rec;le!! i&%rudence are3 B1C t.at t.e offender doe! or fail! to do an act8 BAC t.at t.e doing or t.e failure to do t.at act i! oluntar-8 BFC t.at it 'e /it.out &alice8 B$C t.at &aterial da&age re!ult! fro& t.e rec;le!! i&%rudence8 and B(C t.at t.ere i! ine5cu!a'le lac; of %recaution on t.e %art of t.e offender" ta;ing into con!ideration .i! e&%lo-&ent or occu%ation" degree of intelligence" %.-!ical condition" and ot.er circu&!tance! regarding %er!on!" ti&e and %lace. :.et.er or not a %.-!ician .a! co&&itted an Xine5cu!a'le lac; of %recautionX in t.e treat&ent of .i! %atient i! to 'e deter&ined according to t.e !tandard of care o'!er ed 'ot.er &e&'er! of t.e %rofe!!ion in good !tanding under !i&ilar circu&!tance! 'earing in &ind t.e ad anced !tate of t.e %rofe!!ion at t.e ti&e of treat&ent or t.e %re!ent !tate of &edical !cience.1AH2 In t.e recent ca!e of "eonila $arcia-Rueda v. <il3red ". Pacasio, et. al."1A*2 t.i! Court !tated t.at in acce%ting a ca!e" a doctor in effect re%re!ent! t.at" .a ing t.e needed training and !;ill %o!!e!!ed '- %.-!ician! and !urgeon! %racticing in t.e !a&e field" .e /ill e&%lo- !uc. training" care and !;ill in t.e treat&ent of .i! %atient!. 7e t.erefore .a! a dut- to u!e at lea!t t.e !a&e le el of care t.at an- ot.er rea!ona'lco&%etent doctor /ould u!e to treat a condition under t.e !a&e circu&!tance!. It i! in t.i! a!%ect of &edical &al%ractice t.at e5%ert te!ti&on- i! e!!ential to e!ta'li!. not onl- t.e !tandard of care of t.e %rofe!!ion 'ut al!o t.at t.e %.-!icianV! conduct in t.e treat&ent and care fall! 'elo/ !uc. !tandard.1A#2 =urt.er" ina!&uc. a! t.e cau!e! of t.e inEurie! in ol ed in &al%ractice action! are deter&ina'le onl- in t.e lig.t of !cientific ;no/ledge" it .a! 'een recogni<ed t.at e5%ert te!ti&on- i! u!uall- nece!!ar- to !u%%ort t.e conclu!ion a! to cau!ation.1A)2 I&&ediatel- a%%arent fro& a re ie/ of t.e record! of t.i! ca!e i! t.e a'!ence of ane5%ert te!ti&on- on t.e &atter of t.e !tandard of care e&%lo-ed '- ot.er %.-!ician! of good !tanding in t.e conduct of !i&ilar o%eration!. T.e %ro!ecutionV! e5%ert /itne!!e! in t.e %er!on! of Dr. =lore!to Ari<ala and Dr. Nieto Sal ador" ?r. of t.e National @ureau of In e!tigation BN@IC onl- te!tified a! to t.e %o!!i'le cau!e of deat. 'ut did not enture to illu&inate t.e court on t.e &atter of t.e !tandard of care t.at %etitioner !.ould .a e e5erci!ed. All t.ree court! 'elo/ 'e/ail t.e inade6uac- of t.e facilitie! of t.e clinic and it! untidine!!8 t.e lac; of %ro i!ion! !uc. a! 'lood" o5-gen" and certain &edicine!8 t.e failure to !u'Eect t.e %atient to a cardio-%ul&onar- te!t %rior to t.e o%eration8 t.e o&i!!ion of anfor& of 'lood t-%ing 'efore tran!fu!ion8 and e en t.e !u'!e6uent tran!fer of L-dia to t.e San Pa'lo 7o!%ital and t.e reo%eration %erfor&ed on .er '- t.e %etitioner. @ut /.ile it &a- 'e true t.at t.e circu&!tance! %ointed out '- t.e court! 'elo/ !ee&ed 'e-ond ca il to con!titute rec;le!! i&%rudence on t.e %art of t.e !urgeon" t.i! conclu!ion i! !till 'e!t arri ed at not t.roug. t.e educated !ur&i!e! nor conEecture! of la-&en" including Eudge!" 'ut '- t.e un6ue!tiona'le ;no/ledge of e5%ert /itne!!e!. =or /.et.er a %.-!ician or !urgeon .a! e5erci!ed t.e re6ui!ite degree of !;ill and care in t.e treat&ent of .i! %atient i!" in t.e generalit- of ca!e!" a &atter of e5%ert o%inion.1FG2 T.e deference of court! to t.e e5%ert o%inion of 6ualified %.-!ician! !te&! fro& it! reali<ation t.at t.e latter %o!!e!! unu!ual tec.nical !;ill! /.ic. la-&en in &o!t in!tance! are inca%a'le of intelligentle aluating.1F12 E5%ert te!ti&on- !.ould .a e 'een offered to %ro e t.at t.e circu&!tance! cited '- t.e court! 'elo/ are con!tituti e of conduct falling 'elo/ t.e !tandard of care

e&%lo-ed '- ot.er %.-!ician! in good !tanding /.en %erfor&ing t.e !a&e o%eration. It &u!t 'e re&e&'ered t.at /.en t.e 6ualification! of a %.-!ician are ad&itted" a! in t.e in!tant ca!e" t.ere i! an ine ita'le %re!u&%tion t.at in %ro%er ca!e! .e ta;e! t.e nece!!ar- %recaution and e&%lo-! t.e 'e!t of .i! ;no/ledge and !;ill in attending to .i! client!" unle!! t.e contrar- i! !ufficientl- e!ta'li!.ed.1FA2 T.i! %re!u&%tion i! re'utta'le 'e5%ert o%inion /.ic. i! !o !adl- lac;ing in t.e ca!e at 'enc.. E en granting arguendo t.at t.e inade6uac- of t.e facilitie! and untidine!! of t.e clinic8 t.e lac; of %ro i!ion!8 t.e failure to conduct %re-o%eration te!t! on t.e %atient8 and t.e !u'!e6uent tran!fer of L-dia to t.e San Pa'lo 7o!%ital and t.e reo%eration %erfor&ed on .er '- t.e %etitioner do indicate" e en /it.out e5%ert te!ti&on-" t.at %etitioner /a! rec;le!!l- i&%rudent in t.e e5erci!e of .er dutie! a! a !urgeon" no cogent %roof e5i!t! t.at an- of t.e!e circu&!tance! cau!ed %etitionerV! deat.. T.u!" t.e a'!ence of t.e fourt. ele&ent of rec;le!! i&%rudence3 t.at t.e inEur- to t.e %er!on or %ro%ert- /a! a con!e6uence of t.e rec;le!! i&%rudence. In litigation! in ol ing &edical negligence" t.e %laintiff .a! t.e 'urden of e!ta'li!.ing a%%ellantV! negligence and for a rea!ona'le conclu!ion of negligence" t.ere &u!t 'e %roof of 'reac. of dut- on t.e %art of t.e !urgeon a! /ell a! a ca!ual connection of !uc. 'reac. and t.e re!ulting deat. of .i! %atient. 1FF2 In Chan "uga% v. ,t "u!e=s >ospital, ?nc. " 1F$2 /.ere t.e attending %.-!ician /a! a'!ol ed of lia'ilit- for t.e deat. of t.e co&%lainantV! /ife and ne/'orn 'a'-" t.i! court .eld t.at3 XIn order t.at t.ere &a- 'e a reco er- for an inEur-" .o/e er" it &u!t 'e !.o/n t.at t.e VinEur- for /.ic. reco er- i! !oug.t &u!t 'e t.e legiti&ate con!e6uence of t.e /rong done8 t.e connection 'et/een t.e negligence and t.e inEur- &u!t 'e a direct and natural !e6uence of e ent!" un'ro;en '- inter ening efficient cau!e!.V In ot.er /ord!" t.e negligence &u!t 'e t.e %ro5i&ate cau!e of t.e inEur-. =or" Vnegligence" no &atter in /.at it con!i!t!" cannot create a rig.t of action unle!! it i! t.e %ro5i&ate cau!e of t.e inEurco&%lained of.V And Vt.e %ro5i&ate cau!e of an inEur- i! t.at cau!e" /.ic." in natural and continuou! !e6uence" un'ro;en '- an- efficient inter ening cau!e" %roduce! t.e inEur-" and /it.out /.ic. t.e re!ult /ould not .a e occurred.VVV1F(2 B>nder!coring !u%%lied.C Dr. Ari<ala /.o conducted an auto%!- on t.e 'od- of t.e decea!ed !u&&ari<ed .i! finding! a! follo/!3 XAtt-. Cac.ero3 S. Kou &entioned a'out -our Auto%!- Re%ort /.ic. .a! 'een &ar;ed a! E5.. XA-1-'X. T.ere a%%ear! .ere a !ignature a'o e t.e t-%e/ritten na&e =lore!to Ari<ala" ?r." /.o!e !ignature i! t.at0 A. T.at i! &- !ignature" !ir.

S. Do -ou affir& t.e trut. of all t.e content! of E5.. XA-1-'X0 A. +nl- a! to t.e auto%!- re%ort no. )1-G)" t.e ti&e and %lace and e er-t.ing after t.e %o!t &orte& finding!" !ir.

S. Kou &entioned on -our XPo!t Morte& =inding!X a'out !urgical inci!ion" 1$3G c&." infrau&'ilical area" anterior a'do&inal area" &idline" /ill -ou %lea!e e5%lain t.at in -our o/n language0

A.

T.ere /a! inci!ion /ound B!icC t.e area Eu!t 'elo/ t.e na el" !ir.

S. And t.e la!t %aragra%. of t.e %o!t&orte& finding! /.ic. I read3 >teru!" %ear!.a%ed and %ale &ea!uring *.( 5 (.( 5 (.G c&" /it. !o&e !urface nodulation of t.e fundic area %o!teriorl-. Cut-!ection !.o/! diffu!el- %ale &-o&etriu& /it. area! of !trea; induration. T.e o arie! and adne5al !tructure! are &i!!ing /it. t.e ra/ !urface! %atc.ed /it. clotted 'lood. Surgical !uture! /ere noted on t.e o%erati e !ite. Inte!tine! and &e!enterie! are %ale /it. 'lood clot! noted 'et/een t.e &e!entric fold!. 7e&o%eritoniu&3 FGG !.!." rig.t %aracolic gutter" (G c.c." left %aracolic gutter AGG c.c." &e!entric area" 1GG c.c." rig.t %el ic gutter !to&ac. e&%t-. +t.er i!ceral organ!" %ale.V" /ill -ou %lea!e e5%lain ordinar-YYYYY A. t.at on B!icC -our o/n language or in

T.ere /a! a uteru! /.ic. /a! not attac.ed to t.e adne5al !tructure! na&elo arie! /.ic. /ere not %re!ent and al!o !ign of %re iou! !urgical o%eration and t.ere /ere B!icC clotted 'lood" !ir.

S. 7o/ a'out t.e o arie! and adne5al !tructure!0 A. T.e- are &i!!ing" !ir.

S. Kou &ean to !a- t.ere are no o arie!0 A. During t.at ti&e t.ere are no o arie!" !ir.

S. And t.ere /ere li;e/i!e !ign of !urgical !uture!0 A. Ke!" !ir.

S. 7o/ a'out t.e inte!tine! and &e!enterie! are %lace B!icC /it. 'lood clot! noted 'et/een t.e &e!enteric fold!" /ill -ou %lea!e e5%lain on B!icC t.i!0 A. In t.e %eritoneal ca it-" t.e- are &o!tl- %erritonial 'loodYYY.

S. And /.at could .a e cau!ed t.i! 'lood0

A.

:ell" ordinaril- 'lood i! found in!ide t.e 'lood e!!el. @lood /ere B!icC out!ide a! a re!ult of t.e inEurie! /.ic. de!tro-ed t.e integrit- of t.e e!!el allo/ing 'lood to !i% B!icC out" !ir.

S. @- t.e nature of t.e %o!t&orte& finding! indicated in E5.. A-1-@" can -ou tell t.e court t.e cau!e of deat.0 A. Ke!" !ir. T.e cau!e of deat. i!3 Gro!! finding! are co&%ati'le /it. .e&orr.agic !.oc;.

S. Can -ou tell t.e u! /.at could .a e cau!ed t.i! .e&orr.agic !.oc;0 A. :ell .e&orr.agic !.oc; i! t.e re!ult of 'lood lo!!.

S. :.at could .a e t.e effect of t.at lo!! of 'lood0 A. >nattended .e&orr.age" !ir.1FH2 B>nder!coring !u%%lied.C

T.e foregoing /a! corro'orated '- Dr. Nieto Sal ador3 XS. And /ere -ou a'le to deter&ine t.e cau!e of deat. 'e5a&ination of t.e !%eci&en !u'&itted '- Dr. Ari<ala0 A. irtue of t.e

:it.out ;no/ledge of t.e auto%!- finding! it /ould 'e difficult for &e to deter&ine t.e cau!e of deat." !ir.

S. 7a e -ou e5a&ined t.e %o!t &orte& of Dr. Ari<ala0 A. Ke!" !ir" and '- irtue of t.e auto%!- re%ort in connection /it. -our %at.ologre%ort.

S. :.at could .a e cau!ed t.e deat. of t.e icti&0 A. T.i! %at.ologic e5a&ination are B!icC co&%ati'le /it. t.e %er!on /.o died" !ir.

S. :ill -ou e5%lain to u! t.e &eaning of .e&orr.agic co&%ati'le0 A. It &ean! t.at a %er!on died of 'lood lo!!. Meaning a %er!on died of nonre%lace&ent of 'lood and !o t.e icti& 'efore !.e died t.ere /a! !.oc; of di&ini!. of 'lood of t.e circulation. S.e died &o!t %ro'a'l- 'efore t.e actual co&%lete 'lood lo!!" !ir.

Court3 I! it %o!!i'le doctor t.at t.e lo!! of t.e 'lood /a! due on B!icC o%eration0 A. @a!ed on &- %at.olog- finding!" !ir.

S. :.at could .a e cau!ed t.i! lo!! of 'lood0 A. Man-" !ir. A %atient /.o .a e undergone !urger-. Anot.er &a- 'e a 'lood e!!el &a- 'e cut /.ile on o%eration and t.i! cau!e B!icC 'leeding" or &a- 'e

!et in t.e cour!e of t.e o%eration" or &a- 'e B!icC .e died after t.e o%eration. +f cour!e t.ere are ot.er cau!e B!icC. Att-. Cac.ero3 S. A. E!%eciall- !o doctor /.en t.ere /a! no 'lood re%lace&ent0 Ke!" !ir.X1F*2 B>nder!coring !u%%lied.C

T.e te!ti&onie! of 'ot. doctor! e!ta'li!. .e&orr.age or .e&orr.agic !.oc; a! t.e cau!e of deat.. 7o/e er" a! li;e/i!e te!tified to '- t.e e5%ert /itne!!e! in o%en court" .e&orr.age or .e&orr.agic !.oc; during !urger- &a- 'e cau!ed '- !e eral different factor!. T.u!" Dr. Sal adorV! ela'oration on t.e &atter3 XAtt-. Pa!cual3 S. Doctor" a&ong t.e cau!e! of .e&orr.age t.at -ou &entioned -ou !aid t.at it could 'e at t.e &o&ent of o%eration /.en one lo!!e! B!icC control of t.e %re!ence" i! t.at correct0 During t.e o%eration t.ere i! lo!t B!icC of control of t.e cut e!!el0 A. Ke!" !ir.

S. +r t.ere i! a failure to ligate a e!!el of con!idera'le !i<e0 A. Ke!" !ir.

S. +r e en if t.e e!!el /ere ligated t.e ;not &a- .a e !li%%ed later on0 A. Ke!" !ir.

S. And -ou al!o &entioned t.at it &a- 'e %o!!i'le al!o to !o&e clotting defect" i! t.at correct0 A. Ma- 'e B!icC.X1F#2 B>nder!coring !u%%liedC.

Defen!e /itne!!" Dr. @u C. Ca!tro al!o ga e t.e follo/ing e5%ert o%inion3 XS. Doctor e en a %atient after an o%eration! B!icC /ould !uffer .e&orrage /.at /ould 'e t.e %o!!i'le cau!e! of !uc. .e&orrage B!icC0 A. A&ong t.o!e /ould 'e /.at /e call Intra a!cular Coagulation and t.i! i! t.e rea!on for t.e 'leeding" !ir" /.ic. cannot 'e %re ented '- an-one" it /ill .a%%en to an-one" an-ti&e and to an- %er!on! B!icC" !ir.

C+>RT3 :.at do -ou t.in; of t.e cau!e of t.e 'leeding" t.e cutting or t.e o%eration! done in t.e 'od-0 A. Not related to t.i! one" t.e 'leeding .ere i! not related to an- cutting or

o%eration t.at I B!icC .a e done. S. A!ide fro& t.e DIC /.at could anot.er cau!e! B!icC t.at could 'e t.e cau!e for t.e .e&orr.age or 'leeding in a %atient '- an o%eration! B!icC0 A. In general !ir" if t.ere /a! an o%eration! B!icC and it i! %o!!i'le t.at t.e ligature in t.e !uture /a! B!icC 'eco&e B!icC loo!e" it i! B!icC 'eco&e! loo!e if %ro en. 555 555

555

S. If t.e %er!on /.o %erfor&ed an auto%!- doe! not find an- untig.t B!icC clot B!icC 'lood e!!el or an- !uture t.at 'eco&e B!icC loo!e t.e cau!e of t.e 'leeding could not 'e attri'uted to t.e fault of t.e !u'Eect0 A. Definitel-" !ir.X1F)2 B>nder!coring !u%%lied.C

According to 'ot. doctor!" t.e %o!!i'le cau!e! of .e&orr.age during an o%eration are3 B1C t.e failure of t.e !urgeon to tie or !uture a cut 'lood e!!el8 BAC allo/ing a cut 'lood e!!el to get out of control8 BFC t.e !u'!e6uent loo!ening of t.e tie or !uture a%%lied to a cut 'lood e!!el8 and B$C and a clotting defect ;no/n a! DIC. It i! !ignificant to !tate at t.i! Euncture t.at t.e auto%!- conducted '- Dr. Ari<ala on t.e 'od- of L-dia did not re eal an- untied or un!utured cut 'lood e!!el nor /a! t.ere an- indication t.at t.e tie or !uture of a cut 'lood e!!el .ad 'eco&e loo!e t.ere'- cau!ing t.e .e&orr.age.1$G2 7ence t.e follo/ing %ertinent %ortion of Dr. Ari<alaV! te!ti&on-3 XS3 Doctor" in e5a&ining t.e!e !tructure! did -ou ;no/ /.et.er t.e!e /ere !utured ligature or %lain ligature A3 Ligature" !ir.

S3 :e /ill e5%lain t.at later on. Did -ou recall if t.e cut !tructure! /ere tied 'fir!t !uturing it and t.en t-ing a ;not or t.e tie /a! &erel- %laced around t.e cut !tructure and tied0 A3 I cannot recall" !ir.

S3 A! a &atter of fact" -ou cannot recall 'ecau!e -ou did not e en 'ot.ered B!icC to e5a&ine" i! t.at correct0 A3 :ell" I 'ot.ered enoug. to ;no/ t.at t.e- /ere !utured" !ir.

S3 So" t.erefore" Doctor" -ou /ould not ;no/ /.et.er an- of t.e cut !tructure! /ere not !utured or tied neit.er /ere -ou a'le to deter&ine /.et.er an- loo!e !uture /a! found in t.e %eritoneal ca it-0 A3 I could not recall an- loo!e !utured B!icC" !ir.X1$12

+n t.e ot.er .and" t.e finding! of all t.ree doctor! do not %reclude t.e %ro'a'ilit- t.at DIC cau!ed t.e .e&orr.age and con!e6uentl-" L-diaV! deat.. DIC /.ic. i! a clotting defect create! a !eriou! 'leeding tendenc- and /.en &a!!i e DIC occur! a! a co&%lication of !urger- lea ing ra/ !urface" &aEor .e&orr.age occur!.1$A2 And a!

te!tified to '- defen!e /itne!!" Dr. @u C. Ca!tro" .e&orr.age due to DIC Xcannot 'e %re ented" it /ill .a%%en to an-one" an-ti&e.X1$F2 7e te!tified furt.er3 XS. No/" under t.e circu&!tance one of t.e %o!!i'ilit- a! -ou &entioned in B!icC DIC0 A. Ke!" !ir.

S. And -ou &entioned t.at it cannot 'e %re ented0 A. Ke!" !ir.

S. Can -ou e en %redict if it reall- .a%%en B!icC0 A. Po!!i'le" !ir.

S. Are t.ere an- !%ecific finding! of auto%!- t.at /ill tell -ou /.et.er t.i! %atient !uffered a&ong !uc. t.ing! a! DIC0 A. :ell" I did re!er e 'ecau!e of t.e condition of t.e %atient.

S. No/" Doctor -ou !aid t.at -ou /ent t.roug. t.e record of t.e decea!ed L-dia >&ali loo;ing for t.e c.art" t.e o%erated B!icC record!" t.e %o!t &orte& finding! on t.e .i!to%.anic B!icC e5a&ination 'a!ed on -our e5a&ination of record" doctor" can -ou &ore or le!! !a-! B!icC /.at %art are B!icC concerned could .a e 'een t.e cau!ed B!icC of deat. of t.i! L-dia >&ali0 A. A! far a! t.e &edical record i! concern B!icC t.e cau!ed B!icC of deat. i! de!!i&ulated B!icC Intra ,a!cular Coagulation or t.e DIC /.ic. re!ulted to .e&orr.age or 'leeding!" !ir.

S. Doctor 'a!ed on -our finding! t.en t.ere i! ;no/ing B!icC t.e doctor /ould !a/.et.er t.e doctor .er B!icC .a! 'een B!icC fault0 ATTK. MAL,EDA3 :e /ill &o ed B!icC to !tri;e out t.e B!icC 'a!ed on finding t.e- Eu!t read t.e c.art a! /ell a! t.e ot.er record. ATTK. PASC>AL3 Preci!el- 'a!ed on t.i! e5a&ination. ATTK. MAL,EDA3 Not finding" t.ere /a! no finding &ade. C+>RT3 7e i! onl- reading t.e record.

ATTK. PASC>AL3 Ke!" !ir. A. No" !ir" t.ere i! no fault on t.e %art of t.e !urgeon" !ir .X 1$$2

T.i! court .a! no recour!e 'ut to rel- on t.e e5%ert te!ti&onie! rendered '- 'ot. %ro!ecution and defen!e /itne!!e! t.at !u'!tantiate rat.er t.an contradict %etitionerV! allegation t.at t.e cau!e of L-diaV! deat. /a! DIC /.ic." a! atte!ted to '- an e5%ert /itne!!" cannot 'e attri'uted to t.e %etitionerV! fault or negligence. T.e %ro'a'ilit- t.at L-diaV! deat. /a! cau!ed '- DIC /a! unre'utted during trial and .a! engendered in t.e &ind of t.i! Court a rea!ona'le dou't a! to t.e %etitionerV! guilt. T.u!" .er ac6uittal of t.e cri&e of rec;le!! i&%rudence re!ulting in .o&icide. :.ile /e condole /it. t.e fa&il- of L-dia >&ali" our .and! are 'ound '- t.e dictate! of Eu!tice and fair dealing /.ic. .old in iola'le t.e rig.t of an accu!ed to 'e %re!u&ed innocent until %ro en guilt- 'e-ond rea!ona'le dou't. Ne ert.ele!!" t.i! Court find! t.e %etitioner ci ill- lia'le for t.e deat. of L-dia >&ali" for /.ile a con iction of a cri&e re6uire! %roof 'e-ond rea!ona'le dou't" onla %re%onderance of e idence i! re6uired to e!ta'li!. ci il lia'ilit-.1$(2 T.e %etitioner i! a doctor in /.o!e .and! a %atient %ut! .i! life and li&'. =or in!ufficienc- of e idence t.i! Court /a! not a'le to render a !entence of con iction 'ut it i! not 'lind to t.e rec;le!! and i&%rudent &anner in /.ic. t.e %etitioner carried out .er dutie!. A %reciou! life .a! 'een lo!t and t.e circu&!tance! leading t.ereto e5acer'ated t.e grief of t.o!e left 'e.ind. T.e .eir! of t.e decea!ed continue to feel t.e lo!! of t.eir &ot.er u% to t.e %re!ent ti&e1$H2 and t.i! Court i! a/are t.at no a&ount of co&%a!!ion and co&&i!eration nor /ord! of 'erea e&ent can !uffice to a!!uage t.e !orro/ felt for t.e lo!! of a lo ed one. Certainl-" t.e a/ard of &oral and e5e&%lar- da&age! in fa or of t.e .eir! of L-dia >&ali are %ro%er in t.e in!tant ca!e. &ERE!ORE" %re&i!e! con!idered" %etitioner DR. NINE,ETC7 CR>M i! .ere'ACS>ITTED of t.e cri&e of rec;le!! i&%rudence re!ulting in .o&icide 'ut i! ordered to %a- t.e .eir! of t.e decea!ed L-dia >&ali t.e a&ount of =I=TK T7+>SAND PES+S BP(G"GGG.GGC a! ci il lia'ilit-" +NE 7>NDRED T7+>SAND PES+S BP1GG"GGG.GGC a! &oral da&age!" and =I=TK T7+>SAND PES+S BP(G"GGG.GGC a! e5e&%lar- da&age!. Let t.e co%- of t.i! deci!ion 'e furni!.ed to t.e Profe!!ional Regulation Co&&i!!ion BPRCC for a%%ro%riate action. SO ORDERED. Romero, Melo, and Pangani'an, JJ., concur. 0arvasa, C.J., (Chairman), on lea e. F. SEC+ND DI,ISI+N Re-e! !. Si!ter! of Merc- 7o!%ital" G.R. No. 1FG($*" +cto'er F" AGGG

[G.R. No. 1<=547. O1tober <, ?===]

LEA& ALESNA RE9ES, ROSE NA&D%A, %O&NN9, ('3 m0'or4 LLO9D ('3 8RIS$INE, ()) 42r'(me3 RE9ES, repre4e'te3 b6 t/e0r mot/er, LEA& ALESNA RE9ES, petitioners, vs. SIS$ERS O! *ERC9 &OS"I$AL, SIS$ER ROSE "ALACIO, DR. *AR+IE #LANES, ('3 DR. *ARL9N RICO, respondents. DECISION *ENDO-A, J.7 T.i! i! a %etition for re ie/ of t.e deci!ion112 of t.e Court of A%%eal! in CA-G.R. C, No. FH((1 affir&ing t.e deci!ion of t.e Regional Trial Court" @ranc. IX" Ce'u Cit- /.ic. di!&i!!ed a co&%laint for da&age! filed '- %etitioner! again!t re!%ondent!. T.e fact! are a! follo/!3 Petitioner Lea. Ale!na Re-e! i! t.e /ife of t.e late ?orge Re-e!. T.e ot.er %etitioner!" na&el-" Ro!e Na.dEa" ?o.nn-" Llo-d" and Jri!tine" all !urna&ed Re-e!" /ere t.eir c.ildren. =i e da-! 'efore .i! deat. on ?anuar- #" 1)#*" ?orge .ad 'een !uffering fro& a recurring fe er /it. c.ill!. After .e failed to get relief fro& !o&e .o&e &edication .e /a! ta;ing" /.ic. con!i!ted of analge!ic" anti%-retic" and anti'iotic!" .e decided to !ee t.e doctor. +n ?anuar- #" 1)#*" .e /a! ta;en to t.e Merc- Co&&unit- Clinic '- .i! /ife. 7e /a! attended to '- re!%ondent Dr. Marl-n Rico" re!ident %.-!ician and ad&itting %.-!ician on dut-" /.o ga e ?orge a %.-!ical e5a&ination and too; .i! &edical .i!tor-. S.e noted t.at at t.e ti&e of .i! ad&i!!ion" ?orge /a! con!ciou!" a&'ulator-" oriented" co.erent" and /it. re!%irator- di!tre!!.1A2T-%.oid fe er /a! t.en %re alent in t.e localit-" a! t.e clinic .ad 'een getting fro& 1( to AG ca!e! of t-%.oid %er &ont..1F2 Su!%ecting t.at ?orge could 'e !uffering fro& t.i! di!ea!e" Dr. Rico ordered a :idal Te!t" a !tandard te!t for t-%.oid fe er" to 'e %erfor&ed on ?orge. @lood count" routine urinal-!i!" !tool e5a&ination" and &alarial !&ear /ere al!o &ade.1$2 After a'out an .our" t.e &edical tec.nician !u'&itted t.e re!ult! of t.e te!t fro& /.ic. Dr. Rico concluded t.at ?orge /a! %o!iti e for t-%.oid fe er. A! .er !.ift /a! onl- u% to (3GG %.&." Dr. Rico indor!ed ?orge to re!%ondent Dr. Mar ie @lane!. Dr. Mar ie @lane! attended to ?orge at around !i5 in t.e e ening. S.e al!o too; ?orgeD! .i!tor- and ga e .i& a %.-!ical e5a&ination. Li;e Dr. Rico" .er i&%re!!ion /a! t.at ?orge .ad t-%.oid fe er. Anti'iotic! 'eing t.e acce%ted treat&ent for t-%.oid fe er" !.e ordered t.at a co&%ati'ilit- te!t /it. t.e anti'iotic c.loro&-cetin 'e done on ?orge. Said te!t /a! ad&ini!tered '- nur!e ?o!e%.ine Pagente /.o al!o ga e t.e %atient a do!e of triglo'e. A! !.e did not o'!er e an- ad er!e reaction '- t.e %atient to c.loro&-cetin" Dr. @lane! ordered t.e fir!t fi e .undred &illigra&! of !aid anti'iotic to 'e ad&ini!tered on ?orge at around )3GG %.&. A !econd do!e /a! ad&ini!tered on ?orge a'out t.ree .our! later Eu!t 'efore &idnig.t. At around 13GG a.&. of ?anuar- )" 1)#*" Dr. @lane! /a! called a! ?orgeD! te&%erature ro!e to $1ZC. T.e %atient al!o e5%erienced c.ill! and e5.i'ited re!%irator- di!tre!!" nau!ea" o&iting" and con ul!ion!. Dr. @lane! %ut .i& under o5-gen" u!ed a !uction &ac.ine" and ad&ini!tered .-drocorti!one" te&%oraril- ea!ing t.e %atientD! con ul!ion!. :.en .e regained con!ciou!ne!!" t.e %atient /a! a!;ed '- Dr. @lane! /.et.er .e .ad a %re iou! .eart ail&ent or .ad !uffered fro& c.e!t %ain! in t.e

%a!t. ?orge re%lied .e did not.1(2 After a'out 1( &inute!" .o/e er" ?orge again !tarted to o&it" !.o/ed re!tle!!ne!!" and .i! con ul!ion! returned. Dr. @lane! re-a%%lied t.e e&ergenc- &ea!ure! ta;en 'efore and" in addition" aliu& /a! ad&ini!tered. ?orge" .o/e er" did not re!%ond to t.e treat&ent and !li%%ed into c-ano!i!" a 'lui!. or %ur%li!. di!coloration of t.e !;in or &ucou! &e&'rane due to deficient o5-genation of t.e 'lood. At around A3GG a.&." ?orge died. 7e /a! fort- -ear! old. T.e cau!e of .i! deat. /a! 4,entricular Arr-t.e&ia Secondar- to 7-%er%-re5ia and t-%.oid fe er.9 +n ?une F" 1)#*" %etitioner! filed 'efore t.e Regional Trial Court of Ce'u Cit- a co&%laint1H2for da&age! again!t re!%ondent! Si!ter! of Merc-" Si!ter Ro!e Palacio" Dr. Mar ie @lane!" Dr. Marl-n Rico" and nur!e ?o!e%.ine Pagente. +n Se%te&'er A$" 1)#*" %etitioner! a&ended t.eir co&%laint to i&%lead re!%ondent Merc- Co&&unit- Clinic a! additional defendant and to dro% t.e na&e of ?o!e%.ine Pagente a! defendant !ince !.e /a! no longer connected /it. re!%ondent .o!%ital. T.eir %rinci%al contention /a! t.at ?orge did not die of t-%.oid fe er.1*2 In!tead" .i! deat. /a! due to t.e /rongful ad&ini!tration of c.loro&-cetin. T.e- contended t.at .ad re!%ondent doctor! e5erci!ed due care and diligence" t.e- /ould not .a e reco&&ended and ru!.ed t.e %erfor&ance of t.e :idal Te!t" .a!til- concluded t.at ?orge /a! !uffering fro& t-%.oid fe er" and ad&ini!tered c.loro&-cetin /it.out fir!t conducting !ufficient te!t! on t.e %atientD! co&%ati'ilit- /it. !aid drug. T.e- c.arged re!%ondent clinic and it! directre!!" Si!ter Ro!e Palacio" /it. negligence in failing to %ro ide ade6uate facilitie! and in .iring negligent doctor! and nur!e!.1#2 Re!%ondent! denied t.e c.arge!. During t.e %re-trial conference" t.e %artie! agreed to li&it t.e i!!ue! on t.e follo/ing3 B1C /.et.er t.e deat. of ?orge Re-e! /a! due to or cau!ed '- t.e negligence" carele!!ne!!" i&%rudence" and lac; of !;ill or fore!ig.t on t.e %art of defendant!8 BAC /.et.er re!%ondent Merc- Co&&unit- Clinic /a! negligent in t.e .iring of it! e&%lo-ee!8 and BFC /.et.er eit.er %art- /a! entitled to da&age!. T.e ca!e /a! t.en .eard '- t.e trial court during /.ic." in addition to t.e te!ti&onie! of t.e %artie!" t.e te!ti&onie! of doctor! a! e5%ert /itne!!e! /ere %re!ented. Petitioner! offered t.e te!ti&on- of Dr. A%olinar ,acalare!" C.ief Pat.ologi!t at t.e Nort.ern Mindanao Training 7o!%ital" Caga-an de +ro Cit-. +n ?anuar- )" 1)#*" Dr. ,acalare! %erfor&ed an auto%!- on ?orge Re-e! to deter&ine t.e cau!e of .i! deat.. 7o/e er" .e did not o%en t.e !;ull to e5a&ine t.e 'rain. 7i! finding!1)2 !.o/ed t.at t.e ga!tro-inte!tinal tract /a! nor&al and /it.out an- ulceration or enlarge&ent of t.e nodule!. Dr. ,acalare! te!tified t.at ?orge did not die of t-%.oid fe er. 7e al!o !tated t.at .e .ad not !een a %atient die of t-%.oid fe er /it.in fi e da-! fro& t.e on!et of t.e di!ea!e. =or t.eir %art" re!%ondent! offered t.e te!ti&onie! of Dr. Peter Gotiong and Dr. I'arra Pano%io. Dr. Gotiong i! a di%lo&ate in internal &edicine /.o!e e5%erti!e i! &icro'iologand infectiou! di!ea!e!. 7e i! al!o a con!ultant at t.e Ce'u Cit- Medical Center and an a!!ociate %rofe!!or of &edicine at t.e Sout. :e!tern >ni er!it- College of Medicine in Ce'u Cit-. 7e .ad treated o er a t.ou!and ca!e! of t-%.oid %atient!. According to Dr. Gotiong" t.e %atientD! .i!tor- and %o!iti e :idal Te!t re!ult! ratio of 13FAG /ould &a;e .i& !u!%ect t.at t.e %atient .ad t-%.oid fe er. A! to Dr. ,acalare!D o'!er ation regarding t.e a'!ence of ulceration in ?orgeD! ga!tro-inte!tinal tract" Dr. Gotiong !aid t.at !uc. .-%er%la!ia in t.e inte!tine! of a t-%.oid icti& &a- 'e &icro!co%ic. 7e noted t.at !ince t.e to5ic effect of t-%.oid fe er &a- lead to &eningiti!" Dr. ,acalare!D auto%!- !.ould .a e included an e5a&ination of t.e 'rain.11G2

T.e ot.er doctor %re!ented /a! Dr. I'arra Pano%io" a &e&'er of t.e A&erican @oard of Pat.olog-" e5a&iner of t.e P.ili%%ine @oard of Pat.olog- fro& 1)*# to 1))1" fello/ of t.e P.ili%%ine Societ- of Pat.ologi!t" a!!ociate %rofe!!or of t.e Ce'u In!titute of Medicine" and c.ief %at.ologi!t of t.e Andre! Soriano ?r. Me&orial 7o!%ital in Toledo Cit-. Dr. Pano%io !tated t.at alt.oug. .e /a! %artial to t.e u!e of t.e culture te!t for it! greater relia'ilit- in t.e diagno!i! of t-%.oid fe er" t.e :idal Te!t &a- al!o 'e u!ed. Li;e Dr. Gotiong" .e agreed t.at t.e 13FAG ratio in ?orgeD! ca!e /a! alread- t.e &a5i&u& '/.ic. a conclu!ion of t-%.oid fe er &a- 'e &ade. No additional infor&ation &a- 'e deduced fro& a .ig.er dilution.1112 7e !aid t.at Dr. ,acalare!D auto%!- on ?orge /a! inco&%lete and t.u! inconclu!i e. +n Se%te&'er 1A" 1))1" t.e trial court rendered it! deci!ion a'!ol ing re!%ondent! fro& t.e c.arge! of negligence and di!&i!!ing %etitioner!D action for da&age!. T.e trial court li;e/i!e di!&i!!ed re!%ondent!D counterclai&" .olding t.at" in !ee;ing da&age! fro& re!%ondent!" %etitioner! /ere i&%elled '- t.e .one!t 'elief t.at ?orgeD! deat. /a! due to t.e latterD! negligence. Petitioner! 'roug.t t.e &atter to t.e Court of A%%eal!. +n ?ul- F1" 1))*" t.e Court of A%%eal! affir&ed t.e deci!ion of t.e trial court. 7ence t.i! %etition. Petitioner! rai!e t.e follo/ing a!!ign&ent of error!3 I. T7E 7+N+RA@LE C+>RT += APPEALS C+MMITTED A RE,ERSI@LE ERR+R :7EN IT R>LED T7AT T7E D+CTRINE += R-, ?P,& "1@A?TAR IS N+T APPLICA@LE IN T7E INSTANT CASE. II. T7E 7+N+RA@LE C+>RT += APPEALS C+MMITTED RE,ERSI@LE ERR+R :7EN IT MADE AN >N=+>NDED ASS>MPTI+N T7AT T7E LE,EL += MEDICAL PRACTICE IS L+:ER IN ILIGAN CITK. III. T7E 7+N+RA@LE C+>RT += APPEALS GRA,ELK ERRED :7EN IT R>LED =+R A LESSER STANDARD += CARE AND DEGREE += DILIGENCE =+R MEDICAL PRACTICE IN ILIGAN CITK :7EN IT APPRECIATE1D2 N+ D+CT+RDS NEGLIGENCE IN T7E TREATMENT += ?+RGE REKES. PetitionerD! action i! for &edical &al%ractice. T.i! i! a %articular for& of negligence /.ic. con!i!t! in t.e failure of a %.-!ician or !urgeon to a%%l- to .i! %ractice of &edicine t.at degree of care and !;ill /.ic. i! ordinaril- e&%lo-ed '- t.e %rofe!!ion generall-" under !i&ilar condition!" and in li;e !urrounding circu&!tance!.11A2 In order to !ucce!!full- %ur!ue !uc. a clai&" a %atient &u!t %ro e t.at t.e %.-!ician or !urgeon eit.er failed to do !o&et.ing /.ic. a rea!ona'l- %rudent %.-!ician or !urgeon /ould .a e done" or t.at .e or !.e did !o&et.ing t.at a rea!ona'l- %rudent %.-!ician or !urgeon /ould not .a e done" and t.at t.e failure or action cau!ed inEur- to t.e %atient.11F2 T.ere are t.u! four ele&ent! in ol ed in &edical negligence ca!e!" na&el-3 dut-" 'reac." inEur-" and %ro5i&ate cau!ation. In t.e %re!ent ca!e" t.ere i! no dou't t.at a %.-!ician-%atient relation!.i% e5i!ted 'et/een re!%ondent doctor! and ?orge Re-e!. Re!%ondent! /ere t.u! dut--'ound to u!e at lea!t t.e !a&e le el of care t.at an- rea!ona'l- co&%etent doctor /ould u!e to treat a

condition under t.e !a&e circu&!tance!. It i! 'reac. of t.i! dut- /.ic. con!titute! actiona'le &al%ractice.11$2 A! to t.i! a!%ect of &edical &al%ractice" t.e deter&ination of t.e rea!ona'le le el of care and t.e 'reac. t.ereof" e5%ert te!ti&on- i! e!!ential. Ina!&uc. a! t.e cau!e! of t.e inEurie! in ol ed in &al%ractice action! are deter&ina'le onl- in t.e lig.t of !cientific ;no/ledge" it .a! 'een recogni<ed t.at e5%ert te!ti&on- i! u!uall- nece!!ar- to !u%%ort t.e conclu!ion a! to cau!ation.11(2

Res Ipsa o!uitur

T.ere i! a ca!e /.en e5%ert te!ti&on- &a- 'e di!%en!ed /it." and t.at i! under t.e doctrine of res ipsa loquitur. A! .eld in Ramos v. Court o3 &ppeals311H2 Alt.oug. generall-" e5%ert &edical te!ti&on- i! relied u%on in &al%ractice !uit! to %ro e t.at a %.-!ician .a! done a negligent act or t.at .e .a! de iated fro& t.e !tandard &edical %rocedure" /.en t.e doctrine of res ipsa loquitor i! a ailed '- t.e %laintiff" t.e need for e5%ert &edical te!ti&on- i! di!%en!ed /it. 'ecau!e t.e inEur- it!elf %ro ide! t.e %roof of negligence. T.e rea!on i! t.at t.e general rule on t.e nece!!it- of e5%ert te!ti&on- a%%lie! onl- to !uc. &atter! clearl- /it.in t.e do&ain of &edical !cience" and not to &atter! t.at are /it.in t.e co&&on ;no/ledge of &an;ind /.ic. &a- 'e te!tified to '- an-one fa&iliar /it. t.e fact!. +rdinaril-" onl- %.-!ician! and !urgeon! of !;ill and e5%erience are co&%etent to te!tif- a! to /.et.er a %atient .a! 'een treated or o%erated u%on /it. a rea!ona'le degree of !;ill and care. 7o/e er" te!ti&on- a! to t.e !tate&ent! and act! of %.-!ician! and !urgeon!" e5ternal a%%earance!" and &anife!t condition! /.ic. are o'!er a'le '- an- one &a- 'e gi en '- non-e5%ert /itne!!e!. 7ence" in ca!e! /.ere t.e res ipsa loquitur i! a%%lica'le" t.e court i! %er&itted to find a %.-!ician negligent u%on %ro%er %roof of inEur- to t.e %atient" /it.out t.e aid of e5%ert te!ti&on-" /.ere t.e court fro& it! fund of co&&on ;no/ledge can deter&ine t.e %ro%er !tandard of care. :.ere co&&on ;no/ledge and e5%erience teac. t.at a re!ulting inEur- /ould not .a e occurred to t.e %atient if due care .ad 'een e5erci!ed" an inference of negligence &a- 'e dra/n gi ing ri!e to an a%%lication of t.e doctrine of res ipsa loquitur /it.out &edical e idence" /.ic. i! ordinaril- re6uired to !.o/ not onl- /.at occurred 'ut .o/ and /.- it occurred. :.en t.e doctrine i! a%%ro%riate" all t.at t.e %atient &u!t do i! %ro e a ne5u! 'et/een t.e %articular act or o&i!!ion co&%lained of and t.e inEur- !u!tained /.ile under t.e cu!tod- and &anage&ent of t.e defendant /it.out need to %roduce e5%ert &edical te!ti&on- to e!ta'li!. t.e !tandard of care. Re!ort tores ipsa loquitor i! allo/ed 'ecau!e t.ere i! no ot.er /a-" under u!ual and ordinar- condition!" '- /.ic. t.e %atient can o'tain redre!! for inEur- !uffered '- .i&. T.u!" court! of ot.er Euri!diction! .a e a%%lied t.e doctrine in t.e follo/ing !ituation!3 lea ing of a foreign o'Eect in t.e 'od- of t.e %atient after an o%eration" inEurie! !u!tained on a .ealt.- %art of t.e 'od- /.ic. /a! not under" or in t.e area" of treat&ent" re&o al of t.e /rong %art of t.e 'od- /.en anot.er %art /a! intended" ;noc;ing out a toot. /.ile a %atientD! Ea/ /a! under ane!t.etic for t.e re&o al of .i! ton!il!" and lo!! of an e-e /.ile t.e %atient /a! under t.e influence of ane!t.etic" during or follo/ing an o%eration for a%%endiciti!" a&ong ot.er!.11*2 Petitioner! a!!erted in t.e Court of A%%eal! t.at t.e doctrine of res ipsa loquitur a%%lie! to t.e %re!ent ca!e 'ecau!e ?orge Re-e! /a! &erel- e5%eriencing fe er and c.ill! for fi e da-! and /a! full- con!ciou!" co.erent" and a&'ulant /.en .e /ent to t.e .o!%ital. Ket" .e died after onl- ten .our! fro& t.e ti&e of .i! ad&i!!ion.

T.i! contention /a! reEected '- t.e a%%ellate court. Petitioner! no/ contend t.at all re6ui!ite! for t.e a%%lication of res ipsa loquitur /ere %re!ent" na&el-3 B1C t.e accident /a! of a ;ind /.ic. doe! not ordinaril- occur unle!! !o&eone i! negligent8 BAC t.e in!tru&entalit- or agenc- /.ic. cau!ed t.e inEur- /a! under t.e e5clu!i e control of t.e %er!on in c.arge8 and BFC t.e inEur- !uffered &u!t not .a e 'een due to an- oluntar- action or contri'ution of t.e %er!on inEured.11#2 T.e contention i! /it.out &erit. :e agree /it. t.e ruling of t.e Court of A%%eal!. In t.e Ramos ca!e" t.e 6ue!tion /a! /.et.er a !urgeon" an ane!t.e!iologi!t" and a .o!%ital !.ould 'e &ade lia'le for t.e co&ato!e condition of a %atient !c.eduled for c.olec-!tecto&-.11)2 In t.at ca!e" t.e %atient /a! gi en ane!t.e!ia %rior to .er o%eration. Noting t.at t.e %atient /a! neurologicall- !ound at t.e ti&e of .er o%eration" t.e Court a%%lied t.e doctrine of res ipsa loquitur a! &ental 'rain da&age doe! not nor&all- occur in a gall'lader o%eration in t.e a'!ence of negligence of t.e ane!t.e!iologi!t. Ta;ing Eudicial notice t.at ane!t.e!ia %rocedure! .ad 'eco&e !o co&&on t.at e en an ordinar- %er!on could tell if it /a! ad&ini!tered %ro%erl-" /e allo/ed t.e te!ti&on- of a /itne!! /.o /a! not an e5%ert. In t.i! ca!e" /.ile it i! true t.at t.e %atient died Eu!t a fe/ .our! after %rofe!!ional &edical a!!i!tance /a! rendered" t.ere i! reall- not.ing unu!ual or e5traordinar- a'out .i! deat.. Prior to .i! ad&i!!ion" t.e %atient alread- .ad recurring fe er! and c.ill! for fi e da-! unrelie ed '- t.e analge!ic" anti%-retic" and anti'iotic! gi en .i& '- .i! /ife. T.i! !.o/! t.at .e .ad 'een !uffering fro& a !eriou! illne!! and %rofe!!ional &edical .el% ca&e too late for .i&. Re!%ondent! alleged failure to o'!er e due care /a! not i&&ediatel- a%%arent to a la-&an !o a! to Eu!tif- a%%lication of res ipsa loquitur. T.e 6ue!tion re6uired e5%ert o%inion on t.e alleged 'reac. '- re!%ondent! of t.e !tandard of care re6uired '- t.e circu&!tance!. =urt.er&ore" on t.e i!!ue of t.e correctne!! of .er diagno!i!" no %re!u&%tion of negligence can 'e a%%lied to Dr. Marl-n Rico. A! .eld in Ramos3 . . . . Res ipsa loquitur i! not a rigid or ordinar- doctrine to 'e %erfunctoril- u!ed 'ut a rule to 'e cautiou!l- a%%lied" de%ending u%on t.e circu&!tance! of eac. ca!e. It i! generallre!tricted to !ituation! in &al%ractice ca!e! /.ere a la-&an i! a'le to !a-" a! a &atter of co&&on ;no/ledge and o'!er ation" t.at t.e con!e6uence! of %rofe!!ional care /ere not a! !uc. a! /ould ordinaril- .a e follo/ed if due care .ad 'een e5erci!ed. A di!tinction &u!t 'e &ade 'et/een t.e failure to !ecure re!ult!" and t.e occurrence of !o&et.ing &ore unu!ual and not ordinaril- found if t.e !er ice or treat&ent rendered follo/ed t.e u!ual %rocedure of t.o!e !;illed in t.at %articular %ractice. It &u!t 'e conceded t.at t.e doctrine of res ipsa loquitur can .a e no a%%lication in a !uit again!t a %.-!ician or a !urgeon /.ic. in ol e! t.e &erit! of a diagno!i! or of a !cientific treat&ent. T.e %.-!ician or !urgeon i! not re6uired at .i! %eril to e5%lain /.- an- %articular diagno!i! /a! not correct" or /.- an- %articular !cientific treat&ent did not %roduce t.e de!ired re!ult.1AG2

"peci#ic $cts o# %e&'i&ence

:e turn to t.e 6ue!tion /.et.er %etitioner! .a e e!ta'li!.ed !%ecific act! of negligence allegedl- co&&itted '- re!%ondent doctor!. Petitioner! contend t.at3 B1C Dr. Marl-n Rico .a!til- and erroneou!l- relied u%on t.e

:idal te!t" diagno!ed ?orgeD! illne!! a! t-%.oid fe er" and i&&ediatel- %re!cri'ed t.e ad&ini!tration of t.e anti'iotic c.loro&-cetin81A12 and BAC Dr. Mar ie @lane! erred in ordering t.e ad&ini!tration of t.e !econd do!e of (GG &illigra&! of c.loro&-cetin 'arelt.ree .our! after t.e fir!t /a! gi en.1AA2Petitioner! %re!ented t.e te!ti&on- of Dr. A%olinar ,acalare!" C.ief Pat.ologi!t of t.e Nort.ern Mindanao Training 7o!%ital" Caga-an de +ro Cit-" /.o %erfor&ed an auto%!- on t.e 'od- of ?orge Re-e!. Dr. ,acalare! te!tified t.at" 'a!ed on .i! finding! during t.e auto%!-" ?orge Re-e! did not die of t-%.oid fe er 'ut of !.oc; undeter&ined" /.ic. could 'e due to allergic reaction or c.loro&-cetin o erdo!e. :e are not %er!uaded. !0r4t. :.ile %etitioner! %re!ented Dr. A%olinar ,acalare! a! an e5%ert /itne!!" /e do not find .i& to 'e !o a! .e i! not a !%eciali!t on infectiou! di!ea!e! li;e t-%.oid fe er. =urt.er&ore" alt.oug. .e &a- .a e .ad e5ten!i e e5%erience in %erfor&ing auto%!ie!" .e ad&itted t.at .e .ad -et to do one on t.e 'od- of a t-%.oid icti& at t.e ti&e .e conducted t.e %o!t&orte& on ?orge Re-e!. It i! al!o %lain fro& .i! te!ti&on- t.at .e .a! treated onl- a'out t.ree ca!e! of t-%.oid fe er. T.u!" .e te!tified t.at31AF2 ATTK. PASC>AL3 S :.-0 7a e -ou not te!tified earlier t.at -ou .a e ne er !een a %atient /.o died of t-%.oid fe er0 A In auto%!-. @ut" t.at /a! /.en I /a! a re!ident %.-!ician -et. S @ut -ou .a e not %erfor&ed an auto%!- of a %atient /.o died of t-%.oid fe er0 A I .a e not !een one. S And -ou te!tified t.at -ou .a e ne er !een a %atient /.o died of t-%.oid fe er /it.in fi e da-!0 A I .a e not !een one. S 7o/ &an- t-%.oid fe er ca!e! .ad -ou !een /.ile -ou /ere in t.e general %ractice of &edicine0 A In our ca!e /e .ad no /idal te!t t.at ti&e !o /e cannot con!ider t.at t.e t-%.oid fe er i! li;e t.i! and li;e t.at. And t.e /idal te!t doe! not !%ecif- t.e ti&e of t.e t-%.oid fe er. S T.e 6ue!tion i!3 .o/ &an- t-%.oid fe er ca!e! .ad -ou !een in -our general %ractice regardle!! of t.e ca!e! no/ -ou %ractice0 A I .ad onl- !een t.ree ca!e!. S And t.at /a! /a- 'ac; in 1)H$0 A :a- 'ac; after &- training in >P. S Clinicall-0 A :a- 'ac; 'efore &- training.

7e i! t.u! not 6ualified to %ro e t.at Dr. Marl-n Rico erred in .er diagno!i!. @ot. lo/er court! /ere t.erefore correct in di!carding .i! te!ti&on-" /.ic. i! reall- inad&i!!i'le. In Ramos" t.e defendant! %re!ented t.e te!ti&on- of a %ul&onologi!t to %ro e t.at 'rain inEur- /a! due to o5-gen de%ri ation after t.e %atient .ad 'ronc.o!%a!&!1A$2 triggered '- .er allergic re!%on!e to a drug"1A(2 and not due to faultintu'ation '- t.e ane!t.e!iologi!t. A! t.e i!!ue /a! /.et.er t.e intu'ation /a! %ro%erl%erfor&ed '- an ane!t.e!iologi!t" /e reEected t.e o%inion of t.e %ul&onologi!t on t.e ground t.at .e /a! not3 B1C an ane!t.e!iologi!t /.o could enlig.ten t.e court a'out ane!t.e!ia %ractice" %rocedure" and t.eir co&%lication!8 nor BAC an allergologi!t /.o could %ro%erl- ad ance e5%ert o%inion on allergic &ediated %roce!!e!8 nor BFC a %.ar&acologi!t /.o could e5%lain t.e %.ar&acologic and to5ic effect! of t.e drug allegedl- re!%on!i'le for t.e 'ronc.o!%a!&!. Se1o'3. +n t.e ot.er .and" t.e t/o doctor! %re!ented '- re!%ondent! clearl- /ere e5%ert! on t.e !u'Eect. T.e- ouc.ed for t.e correctne!! of Dr. Marl-n RicoD! diagno!i!. Dr. Peter Gotiong" a di%lo&ate /.o!e !%eciali<ation i! infectiou! di!ea!e! and &icro'iolog- and an a!!ociate %rofe!!or at t.e Sout./e!tern >ni er!it- College of Medicine and t.e Gulla! College of Medicine" te!tified t.at .e .a! alread- treated o er a t.ou!and ca!e! of t-%.oid fe er.1AH2 According to .i&" /.en a ca!e of t-%.oid fe er i! !u!%ected" t.e :idal te!t i! nor&all- u!ed"1A*2 and if t.e 13FAG re!ult! of t.e :idal te!t on ?orge Re-e! .ad 'een %re!ented to .i& along /it. t.e %atientD! .i!tor-" .i! i&%re!!ion /ould al!o 'e t.at t.e %atient /a! !uffering fro& t-%.oid fe er.1A#2 A! to t.e treat&ent of t.e di!ea!e" .e !tated t.at c.loro&-cetin /a! t.e drug of c.oice.1A)2 7e al!o e5%lained t.at de!%ite t.e &ea!ure! ta;en '- re!%ondent doctor! and t.e intra enou! ad&ini!tration of t/o do!e! of c.loro&-cetin" co&%lication! of t.e di!ea!e could not 'e di!counted. 7i! te!ti&on- i! a! follo/!31FG2 ATTK. PASC>AL3 S If /it. t.at count /it. t.e te!t of %o!iti e for 1 i! to FAG" /.at treat&ent if an- /ould 'e gi en0 A If t.o!e are t.e finding! t.at /ould 'e %re!ented to &e" t.e fir!t t.ing I /ould con!ider /ould 'e t-%.oid fe er. S And %re!entl- /.at are t.e treat&ent! co&&onl- u!ed0 A Drug of c.oice of c.lora&%.enical. S Doctor" if gi en t.e !a&e %atient and after -ou .a e ad&ini!tered c.lora&%.enical a'out F 1IA .our! later" t.e %atient a!!ociated /it. c.ill!" te&%erature - $1 oC" /.at could %o!!i'l- co&e to -our &ind0 A :ell" /.en it i! c.ange in t.e clinical finding" -ou .a e to t.in; of co&%lication. S And /.at /ill -ou con!ider on t.e co&%lication of t-%.oid0 A +ne &u!t fir!t under!tand t.at t-%.oid fe er i! to5i&ia. T.e %ro'le& i! co&%lication! are cau!ed '- to5in! %roduced '- t.e 'acteria . . . /.et.er -ou .a e !uffered co&%lication! to t.in; of -- .eart to5ic &-ocarditie!8 t.en -ou can con!ider a to5ic

&eningiti! and ot.er co&%lication! and %erforation! and 'leeding in t.e iliu&. S E en t.at $G--ear old &arried %atient /.o recei ed &edication of c.loro&-cetin of (GG &illigra&! intra enou!" after t.e !;in te!t" and recei ed a !econd do!e of c.loro&-cetin of (GG &iligra&!" F .our! later" t.e %atient de elo%ed c.ill! . . . ri!e in te&%erature to $1oC" and t.en a'out $G &inute! later t.e te&%erature ro!e to 1GGo=" cardiac rate of 1(G %er &inute /.o a%%eared to 'e co.erent" re!tle!!" nau!eating" /it. !ei<ure!3 /.at !ignificance could -ou attac. to t.e!e clinical c.ange!0 A I /ould t.en t.in; of to5e&ia" /.ic. /a! to5ic &eningiti! and %ro'a'l- a to5ic &eningiti! 'ecau!e of t.e .ig. cardiac rate. S E en if t.e !a&e %atient /.o" after .a ing gi en intra&u!cular aliu&" 'eca&e con!ciou! and co.erent a'out AG &inute! later" .a e !ei<ure and c-ano!i! and rolling of e-e'all! and o&itting . . . and deat.3 /.at !ignificance /ould -ou attac. to t.i! de elo%&ent0 A :e are %ro'a'l- dealing /it. t-%.oid to &eningiti!. S In !uc. ca!e" Doctor" /.at finding if an- could -ou e5%ect on t.e %o!t-&orte& e5a&ination0 A No" t.e finding /ould 'e &ore on t.e &eninge! or co ering of t.e 'rain. S And in order to !ee t.o!e c.ange! /ould it re6uire o%ening t.e !;ull0 A Ke!. A! regard! Dr. ,acalare!D finding during t.e auto%!- t.at t.e decea!edD! ga!tro-inte!tinal tract /a! nor&al" Dr. Rico e5%lained t.at" /.ile .-%er%la!ia1F12 in t.e %a-erD! %atc.e! or la-er! of t.e !&all inte!tine! i! %re!ent in t-%.oid fe er" t.e !a&e &a- not al/a-! 'e gro!!l- i!i'le and a &icro!co%e /a! needed to !ee t.e te5ture of t.e cell!.1FA2 Re!%ondent! al!o %re!ented t.e te!ti&on- of Dr. I'arra T. Pano%io /.o i! a &e&'er of t.e P.ili%%ine and A&erican @oard of Pat.olog-" an e5a&iner of t.e P.ili%%ine @oard of Pat.olog-" and c.ief %at.ologi!t at t.e MetroCe'u Co&&unit- 7o!%ital" Per%etual Succor 7o!%ital" and t.e Andre! Soriano ?r. Me&orial Medical Center. 7e !tated t.at" a! a clinical %at.ologi!t" .e recogni<ed t.at t.e :idal te!t i! u!ed for t-%.oid %atient!" alt.oug. .e did not encourage it! u!e 'ecau!e a !ingle te!t /ould onl- gi e a %re!u&%tion nece!!itating t.at t.e te!t 'e re%eated" 'eco&ing &ore conclu!i e at t.e !econd and t.ird /ee;! of t.e di!ea!e.1FF2 7e corro'orated Dr. GotiongD! te!ti&on- t.at t.e danger /it. t-%.oid fe er i! reall- t.e %o!!i'le co&%lication! /.ic. could de elo% li;e %erforation" .e&orr.age" a! /ell a! li er and cere'ral co&%lication!.1F$2 A! regard! t.e 13FAG re!ult! of t.e :idal te!t on ?orge Re-e!" Dr. Pano%io !tated t.at no additional infor&ation could 'e o'tained fro& a .ig.er ratio.1F(2 7e al!o agreed /it. Dr. Gotiong t.at .-%er%la!ia in t.e %a-erD! %atc.e! &a- 'e &icro!co%ic.1FH2 Indeed" t.e !tandard conte&%lated i! not /.at i! actuall- t.e a erage &erit a&ong all ;no/n %ractitioner! fro& t.e 'e!t to t.e /or!t and fro& t.e &o!t to t.e lea!t e5%erienced" 'ut t.e rea!ona'le a erage &erit a&ong t.e ordinaril- good %.-!ician!.1F*2 7ere" Dr.

Marl-n Rico did not de%art fro& t.e rea!ona'le !tandard reco&&ended '- t.e e5%ert! a! !.e in fact o'!er ed t.e due care re6uired under t.e circu&!tance!. T.oug. t.e :idal te!t i! not conclu!i e" it re&ain! a !tandard diagno!tic te!t for t-%.oid fe er and" in t.e %re!ent ca!e" greater accurac- t.roug. re%eated te!ting /a! rendered uno'taina'le 't.e earl- deat. of t.e %atient. T.e re!ult! of t.e :idal te!t and t.e %atientD! .i!tor- of fe er /it. c.ill! for fi e da-!" ta;en /it. t.e fact t.at t-%.oid fe er /a! t.en %re alent a! indicated '- t.e fact t.at t.e clinic .ad 'een getting a'out 1( to AG t-%.oid ca!e! a &ont." /ere !ufficient to gi e u%on an- doctor of rea!ona'le !;ill t.e i&%re!!ion t.at ?orge Re-e! .ad t-%.oid fe er. Dr. Rico /a! al!o Eu!tified in reco&&ending t.e ad&ini!tration of t.e drug c.loro&-cetin" t.e drug of c.oice for t-%.oid fe er. T.e 'urden of %ro ing t.at ?orge Re-e! /a! !uffering fro& an- ot.er illne!! re!ted /it. t.e %etitioner!. A! t.e- failed to %re!ent e5%ert o%inion on t.i!" %re%onderant e idence to !u%%ort t.eir contention i! clearla'!ent. $/0r3. Petitioner! contend t.at re!%ondent Dr. Mar ie @lane!" /.o too; o er fro& Dr. Rico" /a! negligent in ordering t.e intra enou! ad&ini!tration of t/o do!e! of (GG &illigra&! of c.loro&-cetin at an inter al of le!! t.an t.ree .our!. Petitioner! clai& t.at ?orge Re-e! died of ana%.-lactic !.oc;1F#2 or %o!!i'l- fro& o erdo!e a! t.e !econd do!e !.ould .a e 'een ad&ini!tered fi e to !i5 .our! after t.e fir!t" %er in!truction of Dr. Marl-n Rico. A! .eld '- t.e Court of A%%eal!" .o/e er3 T.at c.loro&-cetin /a! li;e/i!e a %ro%er %re!cri%tion i! 'e!t e!ta'li!.ed '- &edical aut.orit-. :il!on" et. al." in 7arri!onD! Princi%le of Internal Medicine" 1At. ed. /rite t.at c.lora&%enicol B/.ic. i! t.e generic of c.loro&-cetinC i! t.e drug of c.oice for t-%.oid fe er and t.at no drug .a! -et %ro en 'etter in %ro&oting a fa ora'le clinical re!%on!e. 4C.lora&%enicol BC.loro&-cetinC i! !%ecificall- indicated for 'acterial &eningiti!" t-%.oid fe er" ric;ett!ial infection!" 'acteriode! infection!" etc.9 BPIMS Annual" 1))$" %. A11C The dosage li!e7ise including the 3irst administration o3 3ive hundred milligrams (BCC mg.) at around nine o4cloc! in the evening and the second dose at around 99DEC the same night 7as still 7ithin medicall% accepta'le limits, since the recommended dose o3 chlorom%cetin is one (9) gram ever% si* (F) hours . Bcf. Pediatric Drug 7and'oo;" 1!t Ed." P.ili%%ine Pediatric Societ-" Co&&ittee on T.era%eutic! and To5icolog-" 1))HC. T.e intra enou! route i! li;e/i!e correct. BMan!!er" +DNic;" P.ar&acolog- and T.era%eutic!C E en if t.e te!t /a! not ad&ini!tered '- t.e %.-!ician-on-dut-" t.e e idence introduced t.at it /a! Dra. @lane! /.o inter%reted t.e re!ult! re&ain uncontro erted. BDeci!ion" %%. 1H-1*C +nce &ore" t.i! Court reEect! an- clai& of %rofe!!ional negligence in t.i! regard. .... A! regard! ana%.-lactic !.oc;" t.e u!ual /a- of guarding again!t it %rior to t.e ad&ini!tration of a drug" i! t.e !;in te!t of /.ic." .o/e er" it .a! 'een o'!er ed3 4S;in te!ting /it. .a%tenic drug! i! generall- not relia'le.Certain drug! cau!e non!%ecific .i!ta&ine relea!e" %roducing a /eal-and-flare reaction in nor&al indi idual!. I&&unologic acti ation of &a!t cell! re6uire! a %ol- alent allergen" !o a negati e !;in te!t to a uni alent .a%tenic drug doe! not rule out ana%.-lactic !en!iti it- to t.at drug.9 BTerr" 4Ana%.-la5i! and >rticaria9 in @a!ic and Clinical I&&unolog-" %. F$)C :.at all t.i! &ean! legall- i! t.at e en if t.e decea!ed !uffered fro& an ana%.-lactic !.oc;" t.i!" of it!elf" /ould not -et e!ta'li!. t.e negligence of t.e a%%ellee-%.-!ician! for all t.at t.e la/ re6uire! of t.e& i! t.at t.e- %erfor& t.e !tandard te!t! and %erfor& !tandard %rocedure!. T.e la/ cannot re6uire t.e& to %redict e er- %o!!i'le reaction to all drug! ad&ini!tered. T.e onu! %ro'andi /a! on t.e a%%ellant! to e!ta'li!." 'efore t.e trial court" t.at t.e a%%ellee%.-!ician! ignored !tandard &edical %rocedure" %re!cri'ed and ad&ini!tered &edication

/it. rec;le!!ne!! and e5.i'ited an a'!ence of t.e co&%etence and !;ill! e5%ected of general %ractitioner! !i&ilarl- !ituated.1F)2 !o2rt/. Petitioner! correctl- o'!er e t.at t.e &edical %rofe!!ion i! one /.ic." li;e t.e 'u!ine!! of a co&&on carrier" i! affected /it. %u'lic intere!t. Moreo er" t.e- a!!ert t.at !ince t.e la/ i&%o!e! u%on co&&on carrier! t.e dut- of o'!er ing e5traordinar- diligence in t.e igilance o er t.e good! and for t.e !afet- of t.e %a!!enger!"1$G2 %.-!ician! and !urgeon! !.ould .a e t.e !a&e dut- to/ard t.eir %atient!.1$12 T.e- al!o contend t.at t.e Court of A%%eal! erred /.en it allegedl- a!!u&ed t.at t.e le el of &edical %ractice i! lo/er in Iligan Cit-" t.ere'- reducing t.e !tandard of care and degree of diligence re6uired fro& %.-!ician! and !urgeon! in Iligan Cit-. T.e !tandard of e5traordinar- diligence i! %eculiar to co&&on carrier!. T.e Ci il Code %ro ide!3 &rt. 9GEE. Co&&on carrier!" fro& t.e nature of t.eir 'u!ine!! and for rea!on! of %u'lic %olic-" are 'ound to o'!er e e5traordinar- diligence in t.e igilance o er t.e good! and for t.e !afet- of t.e %a!!enger! tran!%orted '- t.e&" according to t.e circu&!tance! of eac. ca!e. . . . T.e %ractice of &edicine i! a %rofe!!ion engaged in onl- '- 6ualified indi idual!. It i! a rig.t earned t.roug. -ear! of education" training" and '- fir!t o'taining a licen!e fro& t.e !tate t.roug. %rofe!!ional 'oard e5a&ination!. Suc. licen!e &a-" at an- ti&e and for cau!e" 'e re o;ed '- t.e go ern&ent. In addition to !tate regulation" t.e conduct of doctor! i! al!o !trictl- go erned '- t.e 7i%%ocratic +at." an ancient code of di!ci%line and et.ical rule! /.ic. doctor! .a e i&%o!ed u%on t.e&!el e! in recognition and acce%tance of t.eir great re!%on!i'ilit- to !ociet-. Gi en t.e!e !afeguard!" t.ere i! no need to e5%re!!l- re6uire of doctor! t.e o'!er ance of 4e5traordinar-9 diligence. A! it i! no/" t.e %ractice of &edicine i! alread- conditioned u%on t.e .ig.e!t degree of diligence. And" a! /e .a e alread- noted" t.e !tandard conte&%lated for doctor! i! !i&%l- t.e rea!ona'le a erage &erit a&ong ordinaril- good %.-!ician!. T.at i! rea!ona'le diligence for doctor! or" a! t.e Court of A%%eal! called it" t.e rea!ona'le 4!;ill and co&%etence . . . t.at a %.-!ician in t.e !a&e or !i&ilar localit- . . . !.ould a%%l-.9 &ERE!ORE" t.e in!tant %etition i! DENIED and t.e deci!ion of t.e Court of A%%eal! i! A==IRMED. SO ORDERED. /ellosillo, (Chairman), @uisum'ing, /uena, and $. e "eon, Jr., JJ., concur.

DR. PEDR+ DENNIS CEREN+" and DR. SANT+S MA=E !. C+>RT += APPEALS" SP+>SES DI+GENES S. +LA,ERE and =E R. SERRAN+" G.R. No. 1H*FHH. Se%te&'er AH" AG1A.

PD= (. T7IRD DI,ISI+N =E CAKA+-LASAM !. SP+>SES CLAR+ and EDIT7A RAM+LETE" 1G.R. No. 1()1FA. Dece&'er 1#" AGG#.2

G.R. No. 159132

December 18, 2008 CAYAO-LASAM, petitioner,

FE vs. SPO SES CLARO !"# ED$%&A RAMOLE%E, respondents.[ DEC$S$ON A S%R$A-MAR%$NE', J.(

Before the Court is a Petition for Review on Certiorari under Rule 45 of the Rules of Court filed by Dr. Fe Cayao-Lasa !petitioner" see#in$ to annul the De%ision 1 dated &uly 4, '(() of the Court of *ppeals !C*" in C*-+.R. ,P -o. .''(.. /he ante%edent fa%ts0 1n &uly '2, 3444, respondent, three onths pre$nant 5ditha Ra olete !5ditha" was brou$ht to the Lor a 6edi%al Center !L6C" in ,an Fernando, La 7nion due to va$inal bleedin$. 7pon advi%e of petitioner relayed via telephone, 5ditha was ad itted to the L6C on the sa e day. * pelvi% sono$ra A was then %ondu%ted on 5ditha revealin$ the fetus8 wea# %ardia% pulsation. F /he followin$ day, 5ditha8s repeat pelvi% sono$ra $ showed that aside fro the fetus8 wea# %ardia% pulsation, no fetal ove ent was also appre%iated. Due to persistent and profuse va$inal bleedin$, petitioner advised 5ditha to under$o a Dilatation and Curetta$e Pro%edure !D9C" or :raspa.: 1n &uly )(, 3444, petitioner perfor ed the D9C pro%edure. 5ditha was dis%har$ed fro hospital the followin$ day. the

1n ,epte ber 3., 3444, 5ditha was on%e a$ain brou$ht at the L6C, as she was sufferin$ fro vo itin$ and severe abdo inal pains. 5ditha was attended by Dr. Beatri; de la Cru;, Dr. <i%tor B. 6ayo and Dr. &uan <. =o iya. Dr. 6ayo alle$edly infor ed 5ditha that there was a dead fetus in the latter8s wo b. *fter, 5ditha underwent laparoto y, ( she was found to have a assive intraabdo inal he orrha$e and a ruptured uterus. /hus, 5ditha had to under$o a pro%edure for hystere%to yH and as a result, she has no ore %han%e to bear a %hild. 1n -ove ber >, 3444, 5ditha and her husband Claro Ra olete !respondents" filed a Co plaint* for +ross -e$li$en%e and 6alpra%ti%e a$ainst petitioner before the Professional Re$ulations Co ission !PRC". Respondents alle$ed that 5ditha8s hystere%to y was %aused by petitioner8s un iti$ated ne$li$en%e and professional in%o peten%e in %ondu%tin$ the D9C pro%edure and the petitioner8s failure to re ove the fetus inside 5ditha8s wo b.# * on$ the alle$ed a%ts of ne$li$en%e were0 first, petitioner8s failure to %he%# up, visit or ad inister edi%ation on 5ditha durin$ her first day of %onfine ent at the L6C?) second, petitioner re%o ended that a D9C pro%edure be perfor ed on 5ditha without %ondu%tin$ any internal e@a ination prior to the pro%edure? 1G third, petitioner i ediately su$$ested a D9C pro%edure instead of %losely onitorin$ the state of pre$nan%y of 5ditha.11 An her *nswer,1A petitioner denied the alle$ations of ne$li$en%e and in%o peten%e with the followin$ e@planations0 upon 5ditha8s %onfir ation that she would see# ad ission at the L6C, petitioner i ediately %alled the hospital to anti%ipate the arrival of 5ditha and ordered throu$h the telephone the edi%ines 5ditha needed to ta#e, whi%h the nurses %arried out? petitioner visited 5ditha on the ornin$ of &uly '2, 3444 durin$ her rounds? on &uly '4, 3444, she perfor ed an internal e@a ination on 5ditha and she dis%overed that the latter8s %ervi@ was already open, thus, petitioner dis%ussed the possible D9C pro%edure, should the bleedin$ be%o e ore profuse? on &uly )( 3444, she %ondu%ted another internal e@a ination on 5ditha, whi%h revealed that the latter8s %ervi@ was still open? 5ditha persistently %o plained of her va$inal bleedin$ and her passin$ out of so e eaty ass in the pro%ess of urination and bowel ove ent? thus, petitioner advised 5ditha to under$o D9C pro%edure whi%h the respondents %onsented to? petitioner was very vo%al in the

operatin$ roo about not bein$ able to see an abortus? 1F ta#in$ the words of 5ditha to ean that she was passin$ out so e eaty ass and %lotted blood, she assu ed that the abortus ust have been e@pelled in the pro%ess of bleedin$? it was 5ditha who insisted that she wanted to be dis%har$ed? petitioner a$reed, but she advised 5ditha to return for %he%#-up on *u$ust 5, 3444, whi%h the latter failed to do. Petitioner %ontended that it was 5ditha8s $ross ne$li$en%e andBor o ission in insistin$ to be dis%har$ed on &uly )3, 3444 a$ainst do%tor8s advi%e and her unCustified failure to return for %he%#up as dire%ted by petitioner that %ontributed to her life-threatenin$ %ondition on ,epte ber 3., 3444? that 5ditha8s hystere%to y was brou$ht about by her very abnor al pre$nan%y #nown as placenta increta, whi%h was an e@tre ely rare and very unusual %ase of abdo inal pla%ental i plantation. Petitioner ar$ued that whether or not a D9C pro%edure was done by her or any other do%tor, there would be no differen%e at all be%ause at any sta$e of $estation before ter , the uterus would rupture Cust the sa e. 1n 6ar%h 4, 3444, the Board of 6edi%ine !the Board" of the PRC rendered a De%ision,1$ e@oneratin$ petitioner fro the %har$es filed a$ainst her. /he Board held0 Based on the findin$s of the do%tors who %ondu%ted the laparoto y on 5ditha, hers is a %ase of 5%topi% Pre$nan%y Anterstitial. /his type of e%topi% pre$nan%y is one that is bein$ prote%ted by the uterine us%les and anifestations ay ta#e later than four !4" onths and only attributes to two per%ent !'D" of e%topi% pre$nan%y %ases. Ehen %o plainant 5ditha was ad itted at Lor a 6edi%al Center on &uly '2, 3444 due to va$inal bleedin$, an ultra-sound was perfor ed upon her and the result of the ,ono$ra /est reveals a orbid fetus but did not spe%ify where the fetus was lo%ated. 1bstetri%ians will assu e that the pre$nan%y is within the uterus unless so spe%ified by the ,onolo$ist who %ondu%ted the ultra-sound. Respondent !Dr. Lasa " %annot be faulted if she was not able to deter ine that %o plainant 5ditha is havin$ an e%topi% pre$nan%y interstitial. /he D9C %ondu%ted on 5ditha is ne%essary %onsiderin$ that her %ervi@ is already open and so as to stop the profuse bleedin$. ,i ple %uretta$e %annot re ove a fetus if the patient is havin$ an e%topi% pre$nan%y, sin%e e%topi% pre$nan%y is pre$nan%y %on%eived outside the uterus and %uretta$e is done only within the uterus. /herefore, a ore e@tensive operation needed in this %ase of pre$nan%y in order to re ove the fetus.1( Feelin$ a$$rieved, respondents went to the PRC on appeal. 1n -ove ber '', '(((, the PRC rendered a De%ision1H reversin$ the findin$s of the Board and revo#in$ petitioner8s authority or li%ense to pra%ti%e her profession as a physi%ian.1* Petitioner brou$ht the atter to the C* in a Petition for Review under Rule 4) of the Rules of Court. Petitioner also dubbed her petition as one for certiorari1# under Rule .5 of the Rules of Court. An the De%ision dated &uly 4, '((), the C* held that the Petition for Review under Rule 4) of the Rules of Court was an i proper re edy, as the enu eration of the quasi-judicial a$en%ies in Rule 4) is e@%lusive.1) PRC is not a on$ the Fuasi-Cudi%ial bodies whose Cud$ ent or final orders are subCe%t of a petition for review to the C*, thus, the petition for review of the PRC De%ision, filed at the C*, was i proper. /he C* further held that should the petition be treated as a petition for certiorari under Rule .5, the sa e would still be dis issed for bein$ i proper and pre ature. Citin$ ,e%tion '.AG of Republi% *%t !R.*." -o. ')2' or the 6edi%al *%t of 3454, the C* held that the plain, speedy and adeFuate re edy under the ordinary %ourse of law whi%h petitioner should have availed herself of was to appeal to the 1ffi%e of the President.A1 Gen%e, herein petition, assailin$ the de%ision of the C* on the followin$ $rounds0 3. /G5 C17R/ 1F *PP5*L, 5RR5D 1- * H75,/A1- 1F L*E A- G1LDA-+ /G*/ /G5 PR1F5,,A1-*L R5+7L*/A1-I,J C166A,,A1- !PRC" E*, 5KCL7D5D

*61-+ /G5 H7*,A-&7DACA*L *+5-CA5, C1-/56PL*/5D 7-D5R R7L5 4) 1F /G5 R7L5, 1F CA<AL PR1C5D7R5? '. 5<5- *,,76A-+, ARGUENDO, /G*/ PRC E*, 5KCL7D5D FR16 /G5 P7R<A5E 1F R7L5 4) 1F /G5 R7L5, 1F CA<AL PR1C5D7R5, /G5 P5/A/A1-5R E*, -1/ PR5CL7D5D FR16 FALA-+ * P5/A/A1- F1R C5R/A1R*RA EG5R5 /G5 D5CA,A1- E*, *L,1 A,,75D A- 5KC5,, 1F 1R EA/G17/ &7RA,DAC/A1-, 1R EG5R5 /G5 D5CA,A1- E*, * P*/5-/ -7LLA/L? ). G5R5A- R5,P1-D5-/,-,P17,5, *R5 -1/ *LL1E5D BL L*E /1 *PP5*L FR16 /G5 D5CA,A1- 1F /G5 B1*RD 1F 65DACA-5 /1 /G5 PR1F5,,A1-*L R5+7L*/A1-I,J C166A,,A1-? 4. /G5 C17R/ 1F *PP5*L, C166A//5D +R*<5 *B7,5 1F DA,CR5/A1- AD5-LA-+ F1R A6PR1P5R F1R76 /G5 P5/A/A1- F1R R5<A5EBP5/A/A1- F1R C5R/A1R*RA EA/G17/ +1A-+ 1<5R /G5 65RA/, 1F /G5 +R17-D, R5LA5D 7P1- BL /G5 P5/A/A1-5R? 5. PRC8, +R*<5 16A,,A1- /1 *FF1RD G5R5A- P5/A/1-5R * CG*-C5 /1 B5 G5*RD 1- *PP5*L A, * CL5*R <A1L*/A1- 1F G5R C1-,/A/7/A1-*L RA+G/ /1 D75 PR1C5,, *-D G*, /G5 5FF5C/ 1F R5-D5RA-+ /G5 &7D+65-/ -7LL *-D <1AD? .. C1R1LL*RL /1 /G5 F17R/G *,,A+-5D 5RR1R, PRC C166A//5D +R*<5 *B7,5 1F DA,CR5/A1-, *617-/A-+ /1 L*C= 1F &7RA,DAC/A1-, A*CC5P/A-+ *-D C1-,AD5RA-+ /G5 6561R*-D76 1- *PP5*L EA/G17/ PR11F 1F ,5R<AC5 /1 G5R5A- P5/A/A1-5R, *-D A- <A1L*/A1- 1F *R/. A<, ,5C. )5 1F /G5 R7L5, *-D R5+7L*/A1-, +1<5R-A-+ /G5 R5+7L*/A1*-D PR*C/AC5 1F PR1F5,,A1-*L,? >. PRC C166A//5D +R*<5 *B7,5 1F DA,CR5/A1- A- R5<1=A-+ P5/A/A1-5R8, LAC5-,5 /1 PR*C/AC5 65DACA-5 EA/G17/ *- 5KP5R/ /5,/A61-L /1 ,7PP1R/ A/, C1-CL7,A1- *, /1 /G5 C*7,5 1F R5,P1-D5-/ 5DA/G*/ I,ACJ R*61L5/58, A-&7RL? 2. PRC C166A//5D *- 5<5- +R*<5R *B7,5 1F DA,CR5/A1- A- /1/*LLL DA,R5+*RDA-+ /G5 FA-DA-+ 1F /G5 B1*RD 1F 65DACA-5, EGACG G*D /G5 -5C5,,*RL C16P5/5-C5 *-D 5KP5R/A,5 /1 5,/*BLA,G /G5 C*7,5 1F R5,P1-D5-/ 5DA/G*8, A-&7RL, *, E5LL *, /G5 /5,/A61-L 1F /G5 5KP5R/ EA/-5,, *7+7,/1 6*-*L1, 6.D. ?IandJ 4. PRC C166A//5D +R*<5 *B7,5 1F DA,CR5/A1- A- 6*=A-+ C1-CL7,A1-, 1F F*C/, /G*/ E5R5 -1/ 1-LL 7-,7PP1R/5D BL 5<AD5-C5 B7/ E5R5 *C/7*LLL C1-/R*RL /1 5<AD5-C5 1- R5C1RD.AA /he Court will first deal with the pro%edural issues. Petitioner %lai s that the law does not allow %o plainants to appeal to the PRC fro the de%ision of the Board. ,he invo#es *rti%le A<, ,e%tion )5 of the Rules and Re$ulations +overnin$ the Re$ulation and Pra%ti%e of Professionals, whi%h provides0 ,e%. )5. /he respondent ay appeal the de%ision of the Board within thirty days fro re%eipt thereof to the Co ission whose de%ision shall be final. Com)*!+"!",, -.e" !**o-e# b/ *!-, m!/ +",er)o0e !" !))e!* 1rom ,.e Dec+0+o" o1 ,.e 2o!r# -+,.+" ,.e 0!me )er+o#. !5 phasis supplied" Petitioner asserts that a %areful readin$ of the above law indi%ates that while the respondent, as a atter of ri$ht, ay appeal the De%ision of the Board to the Co ission, the %o plainant ay interpose an appeal fro the de%ision of the Board only when so allowed by law. AF Petitioner %ited

,e%tion '. of Republi% *%t -o. ')2' or :/he 6edi%al *%t of 3454,: to wit0 ,e%tion '.. Appeal fro jud! ent. /he de%ision of the Board of 6edi%al 5@a iners !now 6edi%al Board" shall auto ati%ally be%o e final thirty days after the date of its pro ul$ation unless the respondent, durin$ the sa e period, has appealed to the Co issioner of Civil ,ervi%e !now Professional Re$ulations Co ission" and later to the 1ffi%e of the President of the Philippines. Af the final de%ision is not satisfa%tory, the respondent ay as# for a review of the %ase, or ay file in %ourt a petition for %ertiorari. Petitioner posits that the reason why the 6edi%al *%t of 3454 allows only the respondent in an ad inistrative %ase to file an appeal with the Co ission while the %o plainant is not allowed to do so is double Ceopardy. Petitioner is of the belief that the revo%ation of li%ense to pra%ti%e a profession is penal in nature.A$ /he Court does not a$ree. For one, the prin%iple of double Ceopardy finds no appli%ation in ad inistrative %ases. Double Ceopardy atta%hes only0 !3" upon a valid indi%t ent? !'" before a %o petent %ourt? !)" after arrai$n ent? !4" when a valid plea has been entered? and !5" when the defendant was a%Fuitted or %onvi%ted, or the %ase was dis issed or otherwise ter inated without the e@press %onsent of the a%%used.A( /hese ele ents were not present in the pro%eedin$s before the Board of 6edi%ine, as the pro%eedin$s involved in the instant %ase were ad inistrative and not %ri inal in nature. /he Court has already held that double Ceopardy does not lie in ad inistrative %ases.AH 6oreover, ,e%tion )5 of the Rules and Re$ulations +overnin$ the Re$ulation and Pra%ti%e of Professionals %ited by petitioner was subseFuently a ended to read0 ,e%. )5. /he com)*!+"!",3re0)o"#e", ay appeal the order, the resolution or the de%ision of the Board within thirty !)(" days fro re%eipt thereof to the Co ission whose de%ision shall be final and e@e%utory. Anterlo%utory order shall not be appealable to the Co ission. !* ended by Res. 3>4, ,eries of 344(".A*!5 phasis supplied" Ehatever doubt was %reated by the previous provision was settled with said a end ent. At is a@io ati% that the ri$ht to appeal is not a natural ri$ht or a part of due pro%ess, but a ere statutory privile$e that ay be e@er%ised only in the anner pres%ribed by law. A# An this %ase, the %lear intent of the a end ent is to render the ri$ht to appeal fro a de%ision of the Board available to both %o plainants and respondents. ,u%h %on%lusion is bolstered by the fa%t that in '((., the PRC issued Resolution -o. (.-)4'!*", or the -ew Rules of Pro%edure in *d inistrative Anvesti$ations in the Professional Re$ulations Co ission and the Professional Re$ulatory Boards, whi%h provides for the ethod of appeal, to wit0 ,e%. 3. A))e!*4 Per+o# No"-E5,e"#+b*e.- /he de%ision, order or resolution of the Board shall be final and e@e%utory after the lapse of fifteen !35" days fro re%eipt of the de%ision, order or resolution without an appeal bein$ perfe%ted or ta#en by either the respondent or the %o plainant. A )!r,/ !66r+e7e# b/ ,.e #ec+0+o", or#er or re0o*8,+o" m!/ 1+*e ! "o,+ce o1 !))e!* 1rom ,.e #ec+0+o", or#er or re0o*8,+o" o1 ,.e 2o!r# ,o ,.e Comm+00+o" -+,.+" 1+1,ee" 915: #!/0 1rom rece+), ,.ereo1, and servin$ upon the adverse party a noti%e of appeal to$ether with the appellant8s brief or e orandu on appeal, and payin$ the appeal and le$al resear%h fees. @ @ @A) /he above-stated provision does not Fualify whether only the %o plainant or respondent ay file an appeal? rather, the new rules provide that :a party a$$rieved: ay file a noti%e of appeal. /hus, either the %o plainant or the respondent who has been a$$rieved by the de%ision, order or resolution of the Board ay appeal to the Co ission. At is an ele entary rule that when the law spea#s in %lear and %ate$ori%al lan$ua$e, there is no need, in the absen%e of le$islative intent to the %ontrary, for any interpretation.FG Eords and phrases used in the statute should be $iven their plain,

ordinary, and %o

on usa$e or

eanin$.F1

Petitioner also sub its that appeals fro the de%isions of the PRC should be with the C*, as Rule 4)FA of the Rules of Court was pre%isely for ulated and adopted to provide for a unifor rule of appellate pro%edure for Fuasi-Cudi%ial a$en%ies.FF Petitioner further %ontends that a Fuasi-Cudi%ial body is not e@%luded fro the purview of Rule 4) Cust be%ause it is not entioned therein.F$ 1n this point, the Court a$rees with the petitioner. ,e%. 3, Rule 4) of the Rules of Court provides0 ,e%tion 3. "cope. - %.+0 R8*e 0.!** !))*/ ,o !))e!*0 fro Cud$ ents or final orders of the Court of /a@ *ppeals, and 1rom !-!r#0, ;8#6me",0, 1+"!* or#er0 or re0o*8,+o"0 o1 or !8,.or+<e# b/ !"/ =8!0+-;8#+c+!* !6e"c/ +" ,.e e5erc+0e o1 +,0 =8!0+-;8#+c+!* 18"c,+o"0 . * on$ these a$en%ies are the Civil ,ervi%e Co ission, Central Board of *ssess ent *ppeals, ,e%urities and 5@%han$e Co ission, 1ffi%e of the President, Land Re$istration *uthority, ,o%ial ,e%urity Co ission, Civil *eronauti%s Board, Bureau of Patents, /rade ar#s and /e%hnolo$y /ransfer, -ational 5le%trifi%ation *d inistration, 5ner$y Re$ulatory Board, -ational /ele%o uni%ations Co ission, Depart ent of *$rarian Refor under Republi% *%t -o. ..5>, +overn ent ,ervi%e Ansuran%e ,yste , 5 ployees Co pensation Co ission, *$ri%ultural Anventions Board, Ansuran%e Co ission, Philippine *to i% 5ner$y Co ission, Board of Anvest ents, Constru%tion Andustry *rbitration Co ission, and voluntary arbitrators authori;ed by law. !5 phasis supplied" Andeed, the PRC is not e@pressly entioned as one of the a$en%ies whi%h are e@pressly enu erated under ,e%tion 3, Rule 4) of the Rules of Court. Gowever, its absen%e fro the enu eration does not, by this fa%t alone, i ply its e@%lusion fro the %overa$e of said Rule. F( /he Rule e@pressly provides that it should be applied to appeals fro awards, Cud$ ents final orders or resolutions o1 !"/ Fuasi-Cudi%ial a$en%y in the e@er%ise of its Fuasi-Cudi%ial fun%tions. /he phrase :a on$ these a$en%ies: %onfir s that the enu eration ade in the Rule is not e@%lusive to the a$en%ies therein listed.FH ,pe%ifi%ally, the Court, in #an! v. Court of Appeals,F* ruled that $atas %a &ansa !B.P." $l!. 3'4F# %onferred upon the C* e@%lusive appellate Curisdi%tion over appeals fro de%isions of the PRC. /he Court held0 /he law has sin%e been %han$ed, however, at least in the atter of the parti%ular %ourt to whi%h appeals fro the Co ission should be ta#en. 1n *u$ust 34, 3423, Batas Pa bansa Bilan$ 3'4 be%a e effe%tive and in its ,e%tion '4, %onferred on the Court of *ppeals :e@%lusive appellate Curisdi%tion over all final Cud$ ents, de%isions, resolutions, orders or awards of Re$ional /rial Courts and Fuasi-Cudi%ial a$en%ies, instru entalities, boards or %o issions e@%ept those fallin$ under the appellate Curisdi%tion of the ,upre e Court. @ @ @.: $" 7+r,8e o1 2P 129, !))e!*0 1rom ,.e Pro1e00+o"!* Re68*!,+o"0 Comm+00+o" !re "oe5c*80+7e*/ co6"+<!b*e b/ ,.e Co8r, o1 A))e!*0.F) !5 phasis supplied" Clearly, the ena%t ent of $.%. $l!. 3'4, the pre%ursor of the present Rules of Civil Pro%edure,$G lod$ed with the C* su%h Curisdi%tion over the appeals of de%isions ade by the PRC. *nent the substantive erits of the %ase, petitioner Fuestions the PRC de%ision for bein$ without an e@pert testi ony to support its %on%lusion and to establish the %ause of 5ditha8s inCury. Petitioner avers that in %ases of edi%al alpra%ti%e, e@pert testi ony is ne%essary to support the %on%lusion as to the %ause of the inCury.$1 6edi%al alpra%ti%e is a parti%ular for of ne$li$en%e whi%h %onsists in the failure of a physi%ian or sur$eon to apply to his pra%ti%e of edi%ine that de$ree of %are and s#ill whi%h is ordinarily e ployed by the profession $enerally, under si ilar %onditions, and in li#e surroundin$ %ir%u stan%es.$A An order to su%%essfully pursue su%h a %lai , a patient ust prove that the physi%ian or sur$eon either failed to do so ethin$ whi%h a reasonably prudent physi%ian or sur$eon

would not have done, and that the failure or a%tion %aused inCury to the patient.$F /here are four ele ents involved in %ausation.$$ edi%al ne$li$en%e %ases0 duty, brea%h, inCury and pro@i ate

* physi%ian-patient relationship was %reated when 5ditha e ployed the servi%es of the petitioner. *s 5ditha8s physi%ian, petitioner was duty-bound to use at least the sa e level of %are that any reasonably %o petent do%tor would use to treat a %ondition under the sa e %ir%u stan%es. $( /he brea%h of these professional duties of s#ill and %are, or their i proper perfor an%e by a physi%ian sur$eon, whereby the patient is inCured in body or in health, %onstitutes a%tionable alpra%ti%e.$H *s to this aspe%t of edi%al alpra%ti%e, the deter ination of the reasonable level of %are and the brea%h thereof, e@pert testi ony is essential. $* Further, inas u%h as the %auses of the inCuries involved in alpra%ti%e a%tions are deter inable only in the li$ht of s%ientifi% #nowled$e, it has been re%o$ni;ed that e@pert testi ony is usually ne%essary to support the %on%lusion as to %ausation.$# An the present %ase, respondents did not present any e@pert testi ony to support their %lai that petitioner failed to do so ethin$ whi%h a reasonably prudent physi%ian or sur$eon would have done. Petitioner, on the other hand, presented the testi ony of Dr. *u$usto 6. 6analo, who was %learly an e@pert on the subCe%t. +enerally, to Fualify as an e@pert witness, one ust have a%Fuired spe%ial #nowled$e of the subCe%t atter about whi%h he or she is to testify, either by the study of re%o$ni;ed authorities on the subCe%t or by pra%ti%al e@perien%e.$) Dr. 6analo spe%iali;es in $yne%olo$y and obstetri%s, authored and %o-authored various publi%ations on the subCe%t, and is a professor at the 7niversity of the Philippines. (G *%%ordin$ to hi , his dia$nosis of 5ditha8s %ase was :5%topi% Pre$nan%y Anterstitial !also referred to as Cornual", Ruptured.:(1 An statin$ that the D9C pro%edure was not the pro@i ate %ause of the rupture of 5ditha8s uterus resultin$ in her hystere%to y, Dr. 6analo testified as follows0 *tty. Gidal$o0 H0 Do%tor, we want to be %larified on this atter. /he %o plainant had testified here that the D9C was the pro@i ate %ause of the rupture of the uterus. /he %ondition whi%h she found herself in on the se%ond ad ission. Eill you please tell us whether that is true or notM *0 Lah, $ #o "o, ,.+"> 0o 1or ,-o re!0o"0. 1ne, as A have said earlier, the instru ent %annot rea%h the site of the pre$nan%y, for it to further push the pre$nan%y outside the uterus. *nd, -o. ', A was thin#in$ a while a$o about another reason- well, why A don8t thin# so, be%ause it is the tri$$erin$ fa%tor for the rupture, it %ould haveNthe rupture %ould have o%%urred u%h earlier, ri$ht after the D9C or a few days after the D9C. H0 An this parti%ular %ase, do%tor, the rupture o%%urred to have happened inutes prior to the hystere%to y or ri$ht upon ad ission on ,epte ber 35, 3444 whi%h is about 3 O onths after the patient was dis%har$ed, after the D9C was %ondu%ted. Eould you tell us whether there is any relation at all of the D9C and the rupture in this parti%ular instan%eM *0 $ #o"?, ,.+"> 0o 1or ,.e ,-o re!0o"0 ,.!, $ .!7e ;80, me",+o"e#- ,.!, +, -o8*# "o, be )o00+b*e 1or ,.e +"0,r8me", ,o re!c. ,.e 0+,e o1 )re6"!"c/. *nd, -o. ', if it is be%ause of the D9C that rupture %ould have o%%urred earlier.(A !5 phases supplied" Clearly, fro the testi ony of the e@pert witness and the reasons $iven by hi , it is evident that the D9C pro%edure was not the pro@i ate %ause of the rupture of 5ditha8s uterus. Durin$ his %ross-e@a ination, Dr. 6analo testified on how he would have addressed 5ditha8s %ondition should he be pla%ed in a si ilar %ir%u stan%e as the petitioner. Ge stated0

*tty. Ra$onton0 H0 Do%tor, as a pra%ti%in$ 1B-+yne, when do you %onsider that you have done a $ood, %orre%t and ideal dilatation and %uretta$e pro%edureM *0 Eell, if the patient re%overs. Af the patient $ets well. Be%ause even after the pro%edure, even after the pro%edure you ay feel that you have s%raped everythin$, the patient stops bleedin$, she feels well, A thin# you should still have so e reservations, and wait a little ore ti e. H0 Af you were the 1B-+yne who perfor ed the pro%edure on patient 5ditha Ra olete, would it be your standard pra%ti%e to %he%# the fetal parts or fetal tissues that were alle$edly re ovedM *0 Fro what A have re oved, yes. But in this parti%ular %ase, A thin# it was assu ed that it was part of the eaty ass whi%h was e@pelled at the ti e she was urinatin$ and flushed in the toilet. ,o there8s no way. H0 *0 H0 /here was Isi%J so e portions of the fetal parts that were re ovedM -o, it was des%ribed as s%anty s%rapin$ if A re e ber it ri$htNs%anty. *nd you would not ind %he%#in$ those s%ant or those little parts that were re ovedM

*0 Eell, ,.e 1!c, ,.!, +, -!0 #e0cr+be# me!"0, $ !008me ,.!, +, -!0 c.ec>e#, Pno. At was des%ribed as s%anty and the %olor also, A thin# was des%ribed. 2ec!80e +, -o8*# be 7er/ 8"808!*, e7e" +m)rob!b*e ,.!, +, -o8*# "o, be e5!m+"e#, bec!80e -.e" /o8 0cr!)e, ,.e 0)ec+me"0 !re r+6., ,.ere be1ore /o8r e/e0. $,?0 +" 1ro", o1 /o8. Yo8 c!" ,o8c. +,. $" 1!c,, 0ome o1 ,.em -+** 0,+c> ,o ,.e +"0,r8me", !"# ,.ere1ore ,o )ee* +, o11 1rom ,.e +"0,r8me",, /o8 .!7e ,o ,o8c. ,.em. So, !8,om!,+c!**/ ,.e/ !re e5!m+"e# c*o0e*/. H0 *s a telephoneM atter of fa%t, do%tor, you also $ive telephone orders to your patients throu$h

*0 Les, yes, we do that, espe%ially here in 6anila be%ause you #now, so eti es a do%tor %an also be tied-up so ewhere and if you have to wait until he arrive at a %ertain pla%e before you $ive the order, then it would be a lot of ti e wasted. Be%ause if you #now your patient, if you have handled your patient, so e of the sy pto s you %an interpret that %o es with pra%ti%e. *nd, $ 0ee "o re!0o" 1or "o, !**o-+"6 ,e*e).o"e or#er0 8"*e00 +, +0 ,.e 1+r0, ,+me ,.!, /o8 -+** be e"co8",er+"6 ,.e )!,+e",. /hat you have no idea what the proble is. H0 But, do%tor, do you dis%har$e patients without seein$ the M *0 ,o eti es yes, dependin$ on how fa iliar A a with the patient. Ee are on the Fuestion of telephone orders. A a not sayin$ that that is the idle Isi%J thin$ to do, but $ ,.+"> ,.e re!*+,/ o1 )re0e", #!/ )r!c,+ce 0ome.o- ;80,+1+e0 ,e*e).o"e or#er0. A have patients who A have Custified and then all of a sudden, late in the afternoon or late in the evenin$, would suddenly %all they have de%ided that they will $o ho e inas u%h as they anti%ipated that A will dis%har$e the the followin$ day. ,o, A Cust %all and as# our resident on duty or the nurse to allow the to $o be%ause A have seen that patient and A thin# A have full $rasp of her proble s. ,o, that8s when A a#e this telephone orders. *nd, of %ourse before $ivin$ that order A as# about how she feels.(F !5 phases supplied" Fro the fore$oin$ testi ony, it is %lear that the D9C pro%edure was %ondu%ted in a%%ordan%e with the standard pra%ti%e, with the sa e level of %are that any reasonably %o petent do%tor would use to treat a %ondition under the sa e %ir%u stan%es, and that there was nothin$ irre$ular in the way the petitioner dealt with 5ditha. 6edi%al alpra%ti%e, in our Curisdi%tion, is often brou$ht as a %ivil a%tion for da a$es under *rti%le

'3>.($ of the Civil Code. /he defenses in an a%tion for da a$es, provided for under *rti%le '3>4 of the Civil Code are0 *rt. '3>4. @.e" ,.e )*!+",+11?0 o-" "e6*+6e"ce -!0 ,.e +mme#+!,e !"# )ro5+m!,e c!80e o1 .+0 +";8r/, .e c!""o, reco7er #!m!6e0. But if his ne$li$en%e was only %ontributory, the i ediate and pro@i ate %ause of the inCury bein$ the defendant8s la%# of due %are, the plaintiff ay re%over da a$es, but the %ourts shall iti$ate the da a$es to be awarded. Pro@i ate %ause has been defined as that whi%h, in natural and %ontinuous seFuen%e, unbro#en by any effi%ient intervenin$ %ause, produ%es inCury, and without whi%h the result would not have o%%urred.(( *n inCury or da a$e is pro@i ately %aused by an a%t or a failure to a%t, whenever it appears fro the eviden%e in the %ase that the a%t or o ission played a substantial part in brin$in$ about or a%tually %ausin$ the inCury or da a$e? and that the inCury or da a$e was either a dire%t result or a reasonably probable %onseFuen%e of the a%t or o ission.(H An the present %ase, the Court notes the findin$s of the Board of 6edi%ine0 Ehen %o plainant was dis%har$ed on &uly )3, 3444, herein re0)o"#e", !#7+0e# .er ,o re,8r" o" A8680, A, 199A or 1o8r 9A: #!/0 !1,er ,.e DBC. %.+0 !#7+0e -!0 c*e!r +" com)*!+"!",?0 D+0c.!r6e S.ee,. Gowever, com)*!+"!", 1!+*e# ,o #o 0o. /his bein$ the %ase, the %hain of %ontinuity as reFuired in order that the do%trine of pro@i ate %ause %an be validly invo#ed was interrupted. &!# 0.e re,8r"e#, ,.e re0)o"#e", co8*# .!7e e5!m+"e# .er ,.oro86.*/.(* @ @ @ !5 phases supplied" *lso, in the testi ony of Dr. 6analo, he stated further that assu in$ that there was in fa%t a isdia$nosis, the sa e would have been re%tified if 5ditha followed the petitioner8s order to return for a %he%#-up on *u$ust 4, 3444. Dr. 6analo stated0 Gr!",+"6 ,.!, ,.e ob0,e,r+c+!"-6/"eco*o6+0, .!0 bee" m+0*e# 9;80,+1+!b*/: 8) ,o ,.80 )o+", ,.!, ,.ere -o8*# .!7e bee" !m)*e o))or,8"+,/ ,o rec,+1/ ,.e m+0#+!6"o0+0, .!# ,.e )!,+e", re,8r"e#, !0 +"0,r8c,e# 1or .er 1o**o--8) e7!*8!,+o". $, -!0 o"e !"# ! .!*1 mo",.0 *!,er ,.!, ,.e )!,+e", 0o86., co"08*,!,+o" -+,. !"o,.er #oc,or. /he %ontinued $rowth of an e%topi% pre$nan%y, until its eventual rupture, is a dyna i% pro%ess. 6u%h %han$e in physi%al findin$s %ould be e@pe%ted in 3 O onths, in%ludin$ the e er$en%e of su$$estive ones.(# At is undisputed that 5ditha did not return for a follow-up evaluation, in defian%e of the petitioner8s advise. 5ditha o itted the dili$en%e reFuired by the %ir%u stan%es whi%h %ould have avoided the inCury. /he o ission in not returnin$ for a follow-up evaluation played a substantial part in brin$in$ about 5ditha8s own inCury. Gad 5ditha returned, petitioner %ould have %ondu%ted the proper edi%al tests and pro%edure ne%essary to deter ine 5ditha8s health %ondition and applied the %orrespondin$ treat ent whi%h %ould have prevented the rupture of 5ditha8s uterus. /he D9C pro%edure havin$ been %ondu%ted in a%%ordan%e with the standard edi%al pra%ti%e, it is %lear that 5ditha8s o ission was the pro@i ate %ause of her own inCury and not erely a %ontributory ne$li$en%e on her part. Contributory ne$li$en%e is the a%t or o ission a ountin$ to want of ordinary %are on the part of the person inCured, whi%h, %on%urrin$ with the defendant8s ne$li$en%e, is the pro@i ate %ause of the inCury.() Diffi%ulty see s to be apprehended in de%idin$ whi%h a%ts of the inCured party shall be %onsidered i ediate %auses of the a%%ident.HG Ehere the i ediate %ause of an a%%ident resultin$ in an inCury is the plaintiff8s own a%t, whi%h %ontributed to the prin%ipal o%%urren%e as one of its deter inin$ fa%tors, he %annot re%over da a$es for the inCury. H1 A6!+", b!0e# o" ,.e e7+#e"ce )re0e",e# +" ,.e )re0e", c!0e 8"#er re7+e-, +" -.+c. "o "e6*+6e"ce c!" be !,,r+b8,e# ,o ,.e )e,+,+o"er, ,.e +mme#+!,e c!80e o1 ,.e !cc+#e", re08*,+"6 +" E#+,.!?0 +";8r/ -!0 .er o-" om+00+o" -.e" 0.e #+# "o, re,8r" 1or ! 1o**o--8) c.ec> 8), +" #e1+!"ce o1 )e,+,+o"er?0 or#er0. %.e +mme#+!,e c!80e o1 E#+,.!?0 +";8r/ -!0 .er o-" !c,4 ,.80, 0.e c!""o, reco7er #!m!6e0 1rom ,.e +";8r/.

Lastly, petitioner asserts that her ri$ht to due pro%ess was violated be%ause she was never infor ed by either respondents or by the PRC that an appeal was pendin$ before the PRC. HA Petitioner %lai s that a verifi%ation with the re%ords se%tion of the PRC revealed that on *pril 35, 3444, respondents filed a 6e orandu on *ppeal before the PRC, whi%h did not atta%h the a%tual re$istry re%eipt but was erely indi%ated therein.HF Respondents, on the other hand avers that if the ori$inal re$istry re%eipt was not atta%hed to the 6e orandu on *ppeal, PRC would not have entertained the appeal or a%%epted su%h pleadin$ for la%# of noti%e or proof of servi%e on the other party. H$ *lso, the re$istry re%eipt %ould not be appended to the %opy furnished to petitioner8s for er %ounsel, be%ause the re$istry re%eipt was already appended to the ori$inal %opy of the 6e orandu of *ppeal filed with PRC.H( At is a well-settled rule that when servi%e of noti%e is an issue, the rule is that the person alle$in$ that the noti%e was served ust prove the fa%t of servi%e. /he burden of provin$ noti%e rests upon the party assertin$ its e@isten%e.HH An the present %ase, respondents did not present any proof that petitioner was served a %opy of the 6e orandu on *ppeal. /hus, respondents were not able to satisfy the burden of provin$ that they had in fa%t infor ed the petitioner of the appeal pro%eedin$s before the PRC. An ED'-"taff&uilders 'nternational, 'nc. v. National (a&or Relations Co ission ,H* in whi%h the -ational Labor Relations Co ission failed to order the private respondent to furnish the petitioner a %opy of the *ppeal 6e orandu , the Court held that said failure deprived the petitioner of pro%edural due pro%ess $uaranteed by the Constitution, whi%h %ould have served as basis for the nullifi%ation of the pro%eedin$s in the appeal. /he sa e holds true in the %ase at bar. /he Court finds that the failure of the respondents to furnish the petitioner a %opy of the 6e orandu of *ppeal sub itted to the PRC %onstitutes a violation of due pro%ess. /hus, the pro%eedin$s before the PRC were null and void. *ll told, do%tors are prote%ted by a spe%ial rule of law. /hey are not $uarantors of %are. /hey are not insurers a$ainst ishaps or unusual %onseFuen%esH# spe%ially so if the patient herself did not e@er%ise the proper dili$en%e reFuired to avoid the inCury. @&EREFORE, the petition is GRAN%ED. /he assailed De%ision of the Court of *ppeals dated &uly 4, '(() in C*-+R ,P -o. .''(. is hereby RECERSED and SE% AS$DE. /he De%ision of the Board of 6edi%ine dated 6ar%h 4, 3444 e@oneratin$ petitioner is AFF$RMED. -o pronoun%e ent as to %osts. SO ORDERED.

H.

SP+>SES =REDELICT+ =L+RES Bdecea!edC and =ELICISIMA =L+RES !. SP+>SES D+MINAD+R PINEDA and ,IRGINIA SACL+L+" and =L+RENCI+" CANDIDA" MARTA" G+D+=RED+" @ALTAMAR and L>CENA" all !urna&ed PINEDA" a! .eir! of t.e decea!ed TERESITA S. PINEDA" and >NITED D+CT+RS MEDICAL CENTER" INC." 1G.R. No. 1(#))H. No e&'er 1$" AGG#.2

SECOND DI+ISION

S"OUSES !REDELIC$O !LORES B3e1e(4e3C ('3 !ELICISI*A !LORES" Petitioner!" er!u! -

G.R. No. 15899; Pre!ent3 S>IS>M@ING, J., Chairperson, CARPI+ M+RALES" TINGA" ,ELASC+" ?R." and @RI+N" JJ. Pro&ulgated3 No e&'er 1$" AGG#

S"OUSES DO*INADOR "INEDA ('3 +IRGINIA SACLOLO, ('3 !LORENCIO, CANDIDA, *AR$A, GODO!REDO, #AL$A-AR ('3 LUCENA, ()) 42r'(me3 "INEDA, (4 /e0r4 o. t/e 3e1e(4e3 $ERESI$A S. "INEDA, ('3 UNI$ED DOC$ORS *EDICAL CEN$ER, INC., Re!%ondent!.

5 -------------------------------------------------------------------------------------------5 DECISION

#RION, J.3

T.i! %etition in ol e! a &edical negligence ca!e t.at /a! ele ated to t.i! Court t.roug. an a%%eal '- certiorari under Rule $( of t.e Rule! of Court. T.e %etition a!!ail! t.e Deci!ion112 of t.e Court of A%%eal! BC&C in CA G.R. C, No. HFAF$" /.ic. affir&ed /it. &odification t.e Deci!ion1A2 of t.e Regional Trial Court BRTCC of Nue a EciEa" @ranc.F* in Ci il Ca!e No. SD-1AFF. T.e di!%o!iti e %ortion of t.e a!!ailed CA deci!ion !tate!3 :7ERE=+RE" %re&i!e! con!idered" t.e a!!ailed Deci!ion of t.e Regional Trial Court of @aloc" Sto. Do&ingo" Nue a EciEa" @ranc. F* i! .ere'A==IRMED 'ut /it. &odification! a! follo/!3 1C +rdering defendant-a%%ellant! Dr. and Dra. =redelicto A. =lore! and t.e >nited Doctor! Medical Center" Inc. to Eointl- and !e erall- %a- t.e %laintiff-a%%ellee! R .eir! of Tere!ita Pineda" na&el-" S%ou!e! Do&inador Pineda and ,irginia Saclolo and =lorencio" Candida" Marta" Godofredo" @alta<ar and Lucena" all !urna&ed Pineda" t.e !u& of P$GG"GGG.GG '- /a- of &oral da&age!8 AC +rdering t.e a'o e-na&ed defendant-a%%ellant! to Eointland !e erall- %a- t.e a'o e-na&ed %laintiff-a%%ellee! t.e !u&

of P1GG"GGG.GG '- /a- of e5e&%lar- da&age!8 FC +rdering t.e a'o e-na&ed defendant-a%%ellant! to Eointland !e erall- %a- t.e a'o e-na&ed %laintiff-a%%ellee! t.e !u& of PFH"GGG.GG '- /a- of actual and co&%en!ator- da&age!8 and $C Deleting t.e a/ard of attorne-D! fee! and co!t! of !uit.

S+ +RDERED. :.ile t.i! ca!e e!!entiall- in ol e! 6ue!tion! of fact!" /e o%ted for t.e re6ue!ted re ie/ in lig.t of 6ue!tion! /e .a e on t.e finding! of negligence 'elo/" on t.e a/arded da&age! and co!t!" and on t.e i&%ortance of t.i! t-%e of ruling on &edical %ractice.1F2 #AC8GROUND !AC$S Tere!ita Pineda BTeresitaC /a! a (1--ear old un&arried /o&an li ing in Sto. Do&ingo" Nue a EciEa. S.e con!ulted on A%ril 1*" 1)#* .er to/n&ate" Dr. =redelicto =lore!" regarding .er &edical condition. S.e co&%lained of general 'od- /ea;ne!!" lo!! of a%%etite" fre6uent urination and t.ir!t" and on-and-off aginal 'leeding. Dr. =redelicto initiall- inter ie/ed t.e %atient and a!;ed for t.e .i!tor- of .er &ont.l- %eriod to anal-<e t.e %ro'a'le cau!e of t.e aginal 'leeding. 7e ad i!ed .er to return t.e follo/ing /ee; or to go to t.e >nited Doctor! Medical Center B A MCC in Sue<on Cit- for a general c.ec;u%. A! for .er ot.er !-&%to&!" .e !u!%ected t.at Tere!ita &ig.t 'e !uffering fro& dia'ete! and told .er to continue .er &edication!.1$2 Tere!ita did not return t.e ne5t /ee; a! ad i!ed. 7o/e er" /.en .er condition %er!i!ted" !.e /ent to furt.er con!ult Dr. =lore! at .i! >DMC clinic on A%ril A#" 1)#*" tra elling for at lea!t t/o .our! fro& Nue a EciEa to Sue<on Cit- /it. .er !i!ter" Lucena Pineda. T.e- arri ed at >DMC at around 1131( a.&.. Lucena later te!tified t.at .er !i!ter /a! t.en !o /ea; t.at !.e .ad to lie do/n on t.e couc. of t.e clinic /.ile t.e- /aited for t.e doctor. :.en Dr. =redelicto arri ed" .e did a routine c.ec;-u% and ordered Tere!itaD! ad&i!!ion to t.e .o!%ital. In t.e ad&i!!ion !li%" .e directed t.e .o!%ital !taff to %re%are t.e %atient for an 4on call9 DDC[5] o%eration to 'e %erfor&ed '- .i! /ife" Dr. =elici!i&a =lore! B r. #elicisimaC. Tere!ita /a! 'roug.t to .er .o!%ital roo& at around 1A noon8 t.e .o!%ital !taff fort./it. too; .er 'lood and urine !a&%le! for t.e la'orator- te!t!1H2 /.ic. Dr. =redelicto ordered. At A3$G %.&. of t.at !a&e da-" Tere!ita /a! ta;en to t.e o%erating roo&. It /a! onl- t.en t.at !.e &et Dr. =elici!i&a" an o'!tetrician and g-necologi!t. T.e t/o doctor! R Dr. =elici!i&a and Dr. =redelicto" conferred on t.e %atientD! &edical condition" /.ile t.e re!ident %.-!ician and t.e &edical intern ga e Dr. =elici!i&a t.eir o/n 'riefing!. S.e al!o inter ie/ed and conducted an internal aginal e5a&ination of t.e %atient /.ic. la!ted for a'out 1( &inute!. Dr. =elici!i&a t.ereafter called u% t.e la'orator- for t.e re!ult! of t.e te!t!. At t.at ti&e" onl- t.e re!ult! for t.e 'lood !ugar B /,C" uric acid deter&ination" c.ole!terol deter&ination" and co&%lete 'lood count B C/CC /ere a aila'le. Tere!itaD! @S

count /a! 1G.H*&&olIl1*2 and .er C@C /a! 1G)gIl.1#2 @a!ed on t.e!e %re%aration!" Dr. =elici!i&a %roceeded /it. t.e DOC o%eration /it. Dr. =redelicto ad&ini!tering t.e general ane!t.e!ia. T.e DOC o%eration la!ted for a'out 1G to 1( &inute!. @- F3$G %.&." Tere!ita /a! /.eeled 'ac; to .er roo&. A da- after t.e o%eration Bor on A%ril A)" 1)#*C" Tere!ita /a! !u'Eected to an ultra!ound e5a&ination a! a confir&ator- %rocedure. T.e re!ult! !.o/ed t.at !.e .ad an enlarged uteru! and m%oma uteri.1)2 Dr. =elici!i&a" .o/e er" ad i!ed Tere!ita t.at !.e could !%end .er reco er- %eriod at .o&e. Still feeling /ea;" Tere!ita o%ted for .o!%ital confine&ent. Tere!itaD! co&%lete la'orator- e5a&ination re!ult! ca&e onl- on t.at da- BA%ril A)" 1)#*C. Tere!itaD! urinal-!i! !.o/ed a t.ree %lu! !ign B\\\C indicating t.at t.e !ugar in .er urine /a! interni!t. @- A%ril FG" 1)#*" Tere!itaD! condition .ad /or!ened. S.e e5%erienced difficult- in 'reat.ing and /a! ru!.ed to t.e inten!i e care unit. =urt.er te!t! confir&ed t.at !.e /a! !uffering fro& D0(bete4 *e))0t24 $6pe II.11G2 In!ulin /a! ad&ini!tered on t.e %atient" 'ut t.e &edication &ig.t .a e arri ed too late. Due to co&%lication! induced '- dia'ete!" Tere!ita died in t.e &orning of Ma- H" 1)#*.1112 @elie ing t.at Tere!itaD! deat. re!ulted fro& t.e negligent .andling of .er &edical need!" .er fa&il- BrespondentsC in!tituted an action for da&age! again!t Dr. =redelicto =lore! and Dr. =elici!i&a =lore! Bcollecti el- referred to a! t.e petitioner spousesC 'efore t.e RTC of Nue a EciEa. T.e RTC ruled in fa or of Tere!itaD! fa&il- and a/arded actual" &oral" and e5e&%larda&age!" %lu! attorne-D! fee! and co!t!.11A2 T.e CA affir&ed t.e Eudg&ent" 'ut &odified t.e a&ount of da&age! a/arded and deleted t.e a/ard for attorne-D! fee! and co!t! of !uit.11F2 T.roug. t.i! %etition for re ie/ on certiorari" t.e %etitioner !%ou!e! RDr. =redelicto Bno/ decea!edC and Dr. =elici!i&a =lore! R allege t.at t.e RTC and CA co&&itted a re er!i'le error in finding t.e& lia'le t.roug. negligence for t.e deat. of Tere!ita Pineda. ASSIGN*EN$ O! ERRORS er- .ig.. S.e /a! t.en %laced under t.e care of Dr. A&ado ?orge" an

T.e %etitioner !%ou!e! contend t.at t.e- e5erci!ed due care and %rudence in t.e %erfor&ance of t.eir dutie! a! &edical %rofe!!ional!. T.e- .ad attended to t.e %atient to t.e 'e!t of t.eir a'ilitie! and undertoo; t.e &anage&ent of .er ca!e 'a!ed on .er co&%laint of an on-and-off aginal 'leeding. In addition" t.e- clai& t.at not.ing on record !.o/! t.at t.e deat. of Tere!ita could .a e 'een a erted .ad t.e- e&%lo-ed &ean! ot.er t.an /.at t.e- .ad ado%ted in t.e &ini!tration of t.e %atient.

$&E COUR$ES RULING e 3o 'ot .0'3 t/e pet0t0o' mer0tor0o24. T.e re!%ondent!D clai& for da&age! i! %redicated on t.eir allegation t.at t.e deci!ion of t.e %etitioner !%ou!e! to %roceed /it. t.e DOC o%eration" not/it.!tanding Tere!itaD! condition and t.e la'orator- te!t re!ult!" a&ounted to negligence. +n t.e ot.er .and" t.e %etitioner !%ou!e! contend t.at a DOC o%eration i! t.e %ro%er and acce%ted %rocedure to addre!! aginal 'leeding R t.e &edical %ro'le& %re!ented to t.e&. Gi en t.at t.e %atient died after t.e DOC" t.e core i!!ue i! /.et.er t.e deci!ion to %roceed /it. t.e DOC o%eration /a! an .one!t &i!ta;e of Eudg&ent or one a&ounting to negligence. ('ements o# a )edica' %e&'i&ence *ase A me301() 'e>)0>e'1e 1(4e i! a t-%e of clai& to redre!! a /rong co&&itted '- a &edical %rofe!!ional" t.at .a! cau!ed 'odil- .ar& to or t.e deat. of a %atient. T.ere are four ele&ent! in ol ed in a &edical negligence ca!e" na&el-3 dut%, 'reach, in+ur%, and pro*imate causation.11$2 Dut- refer! to t.e !tandard of 'e.a ior /.ic. i&%o!e! re!triction! on oneD! conduct. 11(2 T.e !tandard in turn refer! to t.e a&ount of co&%etence a!!ociated /it. t.e %ro%er di!c.arge of t.e %rofe!!ion. A %.-!ician i! e5%ected to u!e at lea!t t.e !a&e le el of care t.at an- ot.er rea!ona'l- co&%etent doctor /ould u!e under t.e !a&e circu&!tance!. @reac. of dut- occur! /.en t.e %.-!ician fail! to co&%l- /it. t.e!e %rofe!!ional !tandard!. If inEur- re!ult! to t.e %atient a! a re!ult of t.i! 'reac." t.e %.-!ician i! an!/era'le for negligence.11H2 A! in an- ci il action" t.e 'urden to %ro e t.e e5i!tence of t.e nece!!ar- ele&ent!

re!t! /it. t.e %laintiff.11*2 To !ucce!!full- %ur!ue a clai&" t.e %laintiff &u!t %ro e '%re%onderance of e idence t.at" o'e" t.e ph%sician either 3ailed to do something 7hich a reasona'l% prudent health care provider 7ould have done, or that he did something that a reasona'l% prudent provider 7ould not have done 8 and tAo" the 3ailure or action caused in+ur% to the patient.11#2 E5%ert te!ti&on- i! t.erefore e!!ential !ince t.e factual i!!ue of /.et.er a %.-!ician or !urgeon .a! e5erci!ed t.e re6ui!ite degree of !;ill and care in t.e treat&ent of .i! %atient i! generall- a &atter of e5%ert o%inion.11)2 "tandard o# *are and +reach o# ,uty DOC i! t.e cla!!ic g-necologic %rocedure for t.e e aluation and %o!!i'le t.era%eutic treat&ent for a'nor&al aginal 'leeding.1AG2 T.at t.i! i! t.e recogni<ed %rocedure i! confir&ed '- Dr!. Sal ador Nieto B r. 0ietoC and ?o!elito Mercado B r. MercadoC" t.e e5%ert /itne!!e! %re!ented '- t.e re!%ondent!3 DR. NIET+3 1:2.at I ;no/ a&ong o'!tetrician!" if t.ere i! 'leeding" t.e- %erfor& /.at /e call DOC for diagno!tic %ur%o!e!. 555 555 555

S3 So are -ou tr-ing to tell t.e Court t.at DOC can 'e a diagno!tic treat&ent0 A3 Ke!" !ir. An- doctor ;no/! t.i!.1A12

Dr. Mercado" .o/e er" o'Eected /it. re!%ect to t.e ti&e t.e DOC o%eration !.ould .a e 'een conducted in Tere!itaD! ca!e. 7e o%ined t.at gi en t.e 'lood !ugar le el of Tere!ita" .er dia'etic condition !.ould .a e 'een

addre!!ed fir!t3 S3 :.- do -ou con!ider t.e ti&e of %erfor&ance of t.e DOC not a%%ro%riate0 A3 @ecau!e I .a e read t.e record and I .a e !een t.e urinal-!i!" 1t.ere i!2 !%illage in t.e urine" and 'lood !ugar /a! 1G.H* S3 A3 S3 :.at i! t.e !ignificance of t.e !%illage in t.e urine0 It i! a !ign t.at t.e 'lood !ugar i! er- .ig..

Doe! it indicate !ic;ne!!0 A3 #G to )(U it &ean! dia'ete! &ellitu!. T.e 'lood !ugar /a! 1G.H*.

555

555

555

C+>RT3 In ot.er /ord!" t.e o%eration conducted on t.e %atient" -our o%inion" t.at it i! ina%%ro%riate0 A3 T.e ti&ing of 1/.en2 t.e DOC 1/a!2 done" 'a!ed on t.e record" in &- %er!onal o%inion" t.at DOC !.ould 'e %o!t%oned a da- or t/o.1AA2 T.e %etitioner !%ou!e! countered t.at" at t.e ti&e of t.e o%eration" t.ere /a! not.ing to indicate t.at Tere!ita /a! afflicted /it. dia'ete!3 a 'lood !ugar le el of 1G.H*&&olIl did not nece!!aril- &ean t.at !.e /a! a dia'etic con!idering t.at t.i! /a! random b'ood su&ar51AF2 t.ere /ere ot.er factor! t.at &ig.t .a e cau!ed Tere!itaD! 'lood !ugar to ri!e !uc. a! t.e ta;ing of 'lood !a&%le! during lunc.ti&e and /.ile %atient /a! 'eing gi en intra- enou! de5tro!e.1A$2 =urt.er&ore" t.e- clai& t.at t.eir %rinci%al concern /a! to deter&ine t.e cau!e of and to !to% t.e aginal 'leeding. T.e %etitioner !%ou!e!D contention!" in our ie/" &i!! !e eral %oint!. -irst" a! earla! A%ril 1*" 1)#*" Tere!ita /a! alread- !u!%ected to 'e !uffering fro& dia'ete!.1A(2 T.i! !u!%icion again aro!e rig.t 'efore t.e DOC o%eration on A%ril A#" 1)#* /.en t.e la'orator- re!ult re ealed Tere!itaD! increa!ed 'lood !ugar le el.1AH2 >nfortunatel-" t.e %etitioner !%ou!e! did not /ait for t.e full &edical la'orator- re!ult! 'efore %roceeding /it. t.e DOC" a fact t.at /a! ne er con!idered in t.e court! 'elo/. "econd" t.e %etitioner !%ou!e! /ere dul- ad i!ed t.at t.e %atient /a! e5%eriencing general 'od/ea;ne!!" lo!! of a%%etite" fre6uent urination" and t.ir!t R all of /.ic. are cla!!ic !-&%to&! of dia'ete!.1A*2 :.en a %atient e5.i'it! !-&%to&! t-%ical of a %articular di!ea!e" t.e!e !-&%to&! !.ould" at t.e er- lea!t" alert t.e %.-!ician of t.e %o!!i'ilitt.at t.e %atient &a- 'e afflicted /it. t.e !u!%ected di!ea!e3 1E5%ert te!ti&on- for t.e %laintiff !.o/ed t.at2 te!t! !.ould .a e 'een

ordered i&&ediatel- on ad&i!!ion to t.e .o!%ital in ie/ of t.e !-&%to&! %re!ented" and t.at failure to recogni<e t.e e5i!tence of dia'ete! con!titute! negligence.1A#2 .hird, t.e %etitioner !%ou!e! cannot clai& t.at t.eir %rinci%al concern /a! t.e aginal 'leeding and !.ould not t.erefore 'e .eld accounta'le for co&%lication! co&ing fro& ot.er !ource!. T.i! i! a er- narro/ and !elf-!er ing ie/ t.at e en reflect! on t.eir co&%etence. Ta;en toget.er" /e find t.at rea!ona'le %rudence /ould .a e !.o/n t.at dia'ete! and it! co&%lication! /ere fore!eea'le .ar& t.at !.ould .a e 'een ta;en into con!ideration 't.e %etitioner !%ou!e!. I. ( p(t0e't 42..er4 .rom 4ome 304(b0)0t6 t/(t 0'1re(4e4 t/e m(>'0t23e o. r04F to /0m, t/(t 304(b0)0t6 m24t be t(Fe' 0'to (11o2't 4o )o'> (4 0t 04 or 4/o2)3 /(@e bee' F'oA' to t/e p/64010('. 1A)2 And /.en t.e %atient i! e5%o!ed to an increa!ed ri!;" it i! incu&'ent u%on t.e %.-!ician to ta;e co&&en!urate and ade6uate %recaution!. Ta;ing into account Tere!itaD! .ig. 'lood !ugar"1FG2 Dr. Mendo<a o%ined t.at t.e attending %.-!ician !.ould .a e %o!t%oned t.e DOC o%eration in order to conduct a confir&atorte!t to &a;e a conclu!i e diagno!i! of dia'ete! and to refer t.e ca!e to an interni!t or dia'etologi!t. T.i! /a! corro'orated '- Dr. Delfin Tan B r. TanC" an o'!tetrician and g-necologi!t" /.o !tated t.at t.e %atientD! dia'ete! !.ould .a e 'een &anaged '- an interni!t prior to, during, and a3ter t.e o%eration.1F12 A%art fro& 'leeding a! a co&%lication of %regnanc-" aginal 'leeding i! onl- rarel- !o .ea - and life-t.reatening t.at urgent fir!t-aid &ea!ure! are re6uired.1FA2 Indeed" t.e e5%ert /itne!!e! declared t.at a DOC o%eration on a .-%ergl-ce&ic %atient &a- 'e Eu!tified onl- /.en it i! an e&ergenc- ca!e R /.en t.ere i! %rofu!e aginal 'leeding. In t.i! ca!e" /e c.oo!e not to rel- on t.e a!!ertion! of t.e %etitioner !%ou!e! t.at t.ere /a! %rofu!e 'leeding" not onl- 'ecau!e t.e !tate&ent! /ere !elf-!er ing" 'ut al!o 'ecau!e t.e %etitioner !%ou!e! /ere incon!i!tent in t.eir te!ti&onie!. Dr. =redelicto te!tified earlier t.at on A%ril A#" .e %er!onall- !a/ t.e 'leeding"1FF2 'ut later on !aid t.at .e did not !ee it and relied onl- on Tere!itaD! !tate&ent t.at !.e /a! 'leeding.1F$2 7e /ent on to !tate t.at .e !c.eduled t.e DOC o%eration /it.out conducting an- %.-!ical e5a&ination on t.e %atient. T.e li;el- !tor- i! t.at alt.oug. Tere!ita e5%erienced aginal 'leeding on A%ril A#" it /a! not !ufficientl- %rofu!e to nece!!itate an i&&ediate e&ergenc- DOC o%eration. Dr. Tan1F(2 and Dr. Mendo<a1FH2 'ot. te!tified t.at t.e &edical record! of Tere!ita failed to

indicate t.at t.ere /a! %rofu!e aginal 'leeding. T.e clai& t.at t.ere /a! %rofu!e aginal 'leeding alt.oug. t.i! /a! not reflected in t.e &edical record! !tri;e! u! a! odd !ince t.e &ain co&%laint i! aginal 'leeding. A &edical record i! t.e onl- docu&ent t.at &aintain! a long-ter& tran!cri%tion of %atient care and a! !uc." it! &aintenance i! con!idered a %rioritin .o!%ital %ractice. +%ti&al record-;ee%ing include! all %atient inter-action!. T.e record! !.ould al/a-! 'e clear" o'Eecti e" and u%-to-date.1F*2 T.u!" a &edical record t.at doe! not indicate %rofu!e &edical 'leeding !%ea;! loudl- and clearl- of /.at it doe! not contain. T.at t.e DOC o%eration /a! conducted %rinci%all- to diagno!e t.e cau!e of t.e aginal 'leeding furt.er lead! u! to conclude t.at it /a! &erel- an electi e %rocedure" not an e&ergenc- ca!e. In an electi e %rocedure" t.e %.-!ician &u!t conduct a t.oroug. %reo%erati e e aluation of t.e %atient in order to ade6uatel- %re%are .er for t.e o%eration and &ini&i<e %o!!i'le ri!;! and co&%lication!. T.e interni!t i! re!%on!i'le for generating a co&%re.en!i e e aluation of all &edical %ro'le&! during t.e %re-o%erati e e aluation.1F#2 T.e ai& of %re-o%erati e e aluation i! not to !creen 'roadl- for undiagno!ed di!ea!e" 'ut rat.er to identif- and 6uantif- co&or'idit- t.at &a- i&%act on t.e o%erati e outco&e. T.i! e aluation i! dri en '- finding! on .i!tor- and %.-!ical e5a&ination !ugge!ti e of organ !-!te& d-!functionY $/e >o() 04 to 2'1o@er prob)em (re(4 t/(t m(6 reG20re .2rt/er 0'@e4t0>(t0o' or be (me'(b)e to preoper(t0@e opt0m0H(t0o'. If t.e %reo%erati e e aluation unco er! !ignificant co&or'idit- or e idence of %oor control of an underl-ing di!ea!e %roce!!" con!ultation /it. an interni!t or &edical !%eciali!t &a- 'e re6uired to facilitate t.e /or;-u% and direct &anage&ent. In t.i! %roce!!" co&&unication 'et/een t.e !urgeon! and t.e con!ultant! i! e!!ential to define reali!tic goal! for t.i! o%ti&i<ation %roce!! and to e5%edite !urgical &anage&ent.1F)2 1E&%.a!i! !u%%lied.2 Significantl-" t.e e idence !trongl- !ugge!t! t.at t.e %re-o%erati e e aluation /a! le!! t.an co&%lete a! t.e la'orator- re!ult! /ere full- re%orted onl- on t.e da- follo/ing t.e DOC o%eration. Dr. =elici!i&a onl- !ecured a tele%.one re%ort of t.e %reli&inarla'orator- re!ult %rior to t.e DOC. T.i! %reli&inar- re%ort did not include t.e F\ !tatu! of !ugar in t.e %atientD! urine1$G2 R a re!ult .ig.l- confir&ator- of dia'ete!. @ecau!e t.e DOC /a! &erel- an electi e %rocedure" t.e %atientD! uncontrolled .-%ergl-ce&ia %re!ented a far greater ri!; t.an .er on-and-off aginal 'leeding. T.e %re!ence of .-%ergl-ce&ia in a !urgical %atient i! a!!ociated /it. %oor clinical outco&e!" and aggre!!i e gl-ce&ic control %o!iti el- i&%act! on &or'idit- and &ortalit-.1$12 Electi e !urgerin %eo%le /it. uncontrolled dia'ete! !.ould %refera'l'e !c.eduled a3ter acce%ta'le gl-ce&ic control .a! 'een ac.ie ed.1$A2 According to Dr. Mercado" t.i! i! done '- ad&ini!tering in!ulin on t.e %atient.1$F2 T.e &anage&ent a%%roac. in t.i! ;ind of %atient! al/a-! include! in!ulin

t.era%- in co&'ination /it. de5tro!e and %ota!!iu& infu!ion. In!ulin 555 %ro&ote! gluco!e u%ta;e '- t.e &u!cle and fat cell!/.ile decrea!ing gluco!e %roduction '- t.e li er 555. T.e net effect i! to lo/er 'lood gluco!e le el!.1$$2 T.e %rudent &o e i! to addre!! t.e %atientD! .-%ergl-ce&ic !tate i&&ediatel- and %ro&%tl- 'efore an- ot.er %rocedure i! underta;en. In t.i! ca!e" t.ere /a! no e idence t.at in!ulin /a! ad&ini!tered on Tere!ita %rior to or during t.e DOC o%eration. In!ulin /a! onl- ad&ini!tered t/o da-! after t.e o%eration. A! Dr. Tan te!tified" t.e %atientD! .-%ergl-ce&ic condition !.ould .a e 'een &anaged not onl- 'efore and during t.e o%eration" 'ut al!o i&&ediatel- after. De!%ite t.e %o!!i'ilitt.at Tere!ita /a! afflicted /it. dia'ete!" t.e %o!!i'ilit- /a! ca!uall- ignored e en in t.e %o!t-o%erati e e aluation of t.e %atient8 t.e concern" a! t.e %etitioner !%ou!e! e5%re!!lad&itted" /a! li&ited to t.e co&%laint of aginal 'leeding. Intere!tingl-" /.ile t.e ultra!ound te!t confir&ed t.at Tere!ita .ad a &-o&a in .er uteru!" !.e /a! ad i!ed t.at !.e could 'e di!c.arged a da- after t.e o%eration and t.at .er reco er- could ta;e %lace at .o&e. T.i! ad ice i&%lied t.at a da- after t.e o%eration and e en after t.e co&%lete la'orator- re!ult! /ere !u'&itted" t.e %etitioner !%ou!e! !till did not recogni<e an- %o!to%erati e concern t.at /ould re6uire t.e &onitoring of Tere!itaD! condition in t.e .o!%ital. T.e a'o e fact!" %oint onl- to one conclu!ion R t.at t.e %etitioner !%ou!e! failed" a! &edical %rofe!!ional!" to co&%l- /it. t.eir dut- to o'!er e t.e !tandard of care to 'e gi en to .-%ergl-ce&icIdia'etic %atient! undergoing !urger-. :.et.er t.i! 'reac. of dut/a! t.e %ro5i&ate cau!e of Tere!itaD! deat. i! a &atter /e !.all ne5t deter&ine. Injury and *ausation A! %re iou!l- &entioned" t.e critical and clinc.ing factor in a &edical negligence ca!e i! %roof of t.e 1(24() 1o''e1t0o' 'et/een t.e negligence /.ic. t.e e idence e!ta'li!.ed and t.e %laintiffD! inEurie!81$(2 t.e %laintiff &u!t %lead and %ro e not onl- t.at .e .ad 'een inEured and defendant .a! 'een at fault" 'ut al!o t.at t.e defendantD! fault cau!ed t.e inEur-. A erdict in a &al%ractice action cannot 'e 'a!ed on !%eculation or conEecture. Cau!ation &u!t 'e %ro en /it.in a rea!ona'le &edical %ro'a'ilit- 'a!ed u%on co&%etent e5%ert te!ti&on-.1$H2 T.e re!%ondent! contend t.at unnece!!aril- !u'Eecting Tere!ita to a DOC o%eration

/it.out ade6uatel- %re%aring .er" aggra ated .er .-%ergl-ce&ic !tate and cau!ed .er unti&el- de&i!e. T.e deat. certificate of Tere!ita li!t! do/n t.e follo/ing cau!e! of deat.3 I&&ediate cau!e3 Antecedent cau!e3 >nderl-ing cau!e3 +t.er !ignificant condition! contri'uting to deat.3 Cardiore!%irator- arre!t Se%tice&ic !.oc;" Feto(103o104 Dia'ete! Mellitu! II Renal =ailure R Acute1$*2

Stre!!" /.et.er %.-!ical or e&otional" i! a factor t.at can aggra ate dia'ete!8 a DOC o%eration i! a for& of %.-!ical !tre!!. Dr. Mendo<a e5%lained .o/ !urgical !tre!! can aggra ate t.e %atientD! .-%ergl-ce&ia3 /.en !tre!! occur!" t.e dia'eticD! 'od-" e!%eciallt.e autono&ic !-!te&" react! '- !ecreting .or&one! /.ic. are counter-regulator-8 !.e can .a e %rolonged .-%ergl-ce&ia /.ic." if unc.ec;ed" could lead to deat..1$#2 Medical literature furt.er e5%lain! t.at if t.e 'lood !ugar .a! 'eco&e er- .ig." t.e %atient 'eco&e! co&ato!e Bdia'etic co&aC. :.en t.i! .a%%en! o er !e eral da-!" t.e 'od- u!e! it! o/n fat to %roduce energ-" and t.e re!ult i! .ig. le el! of /a!te %roduct! Bcalled ;etone!C in t.e 'lood and urine Bcalled 30(bet01 Feto(1030o404, a &edical e&ergenc- /it. a !ignificant &ortalit-C.1$)2 T.i! /a! a%%arentl- /.at .a%%ened in Tere!itaD! ca!e8 in fact" after !.e .ad 'een referred to t.e interni!t Dr. ?orge" la'orator- te!t !.o/ed t.at .er 'lood !ugar le el !.ot u% to 1$.G&&olIl" /a- a'o e t.e nor&al 'lood !ugar range. T.u!" 'et/een t.e DOC and deat. /a! t.e dia'etic co&%lication t.at could .a e 'een %re ented /it. t.e o'!er ance of !tandard &edical %recaution!. T.e DOC o%eration and Tere!itaD! deat. due to aggra ated dia'etic condition i! t.erefore !ufficientl- e!ta'li!.ed. T.e trial court and t.e a%%ellate court %inned t.e lia'ilit- for Tere!itaD! deat. on 'ot. t.e %etitioner !%ou!e! and t.i! Court find! no rea!on to rule ot.er/i!e. 7o/e er" /e clarift.at Dr. =redelictoD! negligence i! not !olel- t.e act of ordering an 4on call9 DOC o%eration /.en .e /a! &ainl- an ('(e4t/e40o)o>04t /.o .ad &ade a er- cur!or- e5a&ination of t.e %atientD! aginal 'leeding co&%laint. Rat.er" it /a! .i! failure fro& t.e er- !tart to identif- and confir&" de!%ite t.e %atientD! co&%laint! and .i! o/n !u!%icion!" t.at dia'ete! /a! a ri!; factor t.at !.ould 'e guarded again!t" and .i! %artici%ation in t.e i&%rudent deci!ion to %roceed /it. t.e DOC o%eration de!%ite .i! earl- !u!%icion and t.e confir&ator- earl- la'orator- re!ult!. T.e latter %oint co&e! out clearl- fro& t.e follo/ing e5c.ange during t.e trial3 S3 +n /.at a!%ect did -ou and -our /ife con!ult 1/it.2 eac. ot.er0 A3 :e di!cu!!ed on t.e finding of t.e la'orator- 1re!ult!2 'ecau!e t.e .e&oglo'in /a! 'elo/ nor&al" t.e 'lood !ugar /a! ele ated" !o

t.at /e .a e to e aluate t.e!e la'orator- re!ult! R /.at it &ean!. S3 So it /a! -ou and -our /ife /.o &ade t.e e aluation /.en it /a! %.oned in0 A3 Ke!" !ir.

S3 Did -our /ife" 'efore %erfor&ing DOC a!; -our o%inion /.et.er or not !.e can %roceed0 A3 Ke!" an-/a-" !.e a!;ed &e /.et.er /e can do DOC 'a!ed on &- e5%erience. ,7 A'3 6o2r ('4Aer A(4 0' t/e po40t0@e 'otA0t/4t('30'> t/e e)e@(t0o' o. b)oo3 42>(rI A7 9e4, 40r, 0t A(4 bot/ DDC. 1E&%.a!i! !u%%lied.21(G2 o2r 304po40t0o' to 3o t/e

If Dr. =redelicto 'elie ed .i&!elf to 'e inco&%etent to treat t.e dia'ete!" not 'eing an interni!t or a dia'etologi!t Bfor /.ic. rea!on .e referred Tere!ita to Dr. ?orgeC"1(12 .e !.ould .a e li;e/i!e refrained fro& &a;ing a deci!ion to %roceed /it. t.e DOC o%eration !ince .e /a! niet.er an o'!tetrician nor a g-necologi!t. T.e!e finding! lead u! to t.e conclu!ion t.at t.e deci!ion to %roceed /it. t.e DOC o%eration" not/it.!tanding Tere!itaD! .-%ergl-ce&ia and /it.out ade6uatel- %re%aring .er for t.e %rocedure" /a! contrar- to t.e !tandard! o'!er ed '- t.e &edical %rofe!!ion. De iation fro& t.i! !tandard a&ounted to a 'reac. of dut- /.ic. re!ulted in t.e %atientD! deat.. Due to t.i! negligent conduct" lia'ilit- &u!t attac. to t.e %etitioner !%ou!e!. iabi'ity o# the /ospita' In t.e %roceeding! 'elo/" >DMC /a! t.e !%ou!e! =lore!D co-defendant. T.e RTC found t.e .o!%ital Eointl- and !e erall- lia'le /it. t.e %etitioner !%ou!e!" /.ic. deci!ion t.e CA affir&ed. In a Re!olution dated Augu!t A#" AGGH" t.i! Court .o/e er denied >DMCD! %etition for re ie/ on certiorari. Since >DMCD! a%%eal .a! 'een denied and t.e- are not %artie! to t.i! ca!e" /e find it unnece!!ar- to del e on t.e &atter. Con!e6uentl-" t.e RTCD! deci!ion" a! affir&ed '- t.e CA" !tand!.

$0ard o# ,ama&es @ot. t.e trial and t.e a%%ellate court a/arded actual da&age! a! co&%en!ation for t.e %ecuniar- lo!! t.e re!%ondent! !uffered. T.e lo!! /a! %re!ented in ter&! of t.e .o!%ital 'ill! and e5%en!e! t.e re!%ondent! incurred on account of Tere!itaD! confine&ent and deat.. T.e !ettled rule i! t.at a %laintiff i! entitled to 'e co&%en!ated for %ro en %ecuniar- lo!!.1(A2 T.i! %roof t.e re!%ondent! !ucce!!full- %re!ented. T.u!" /e affir& t.e a/ard of (1t2() 3(m(>e4 of PFH"GGG.GG re%re!enting t.e .o!%ital e5%en!e! t.e %atient incurred. In addition to t.e a/ard for actual da&age!" t.e re!%ondent .eir! of Tere!ita are li;e/i!e entitled to P(G"GGG.GG a! 3e(t/ 0'3em'0t6 %ur!uant to Article AAGH of t.e Ci il Code" /.ic. !tate! t.at 4t.e a&ount of da&age! for deat. cau!ed '- a 555 quasi-delict !.all 'e at lea!t t.ree t.ou!and %e!o!"1(F2 e en t.oug. t.ere &a- .a e 'een &itigating circu&!tance! 555.9 This is a question o3 la7 that the C& missed in its decision and 7hich 7e no7 decide in the respondents4 3avor. T.e !a&e article allo/! t.e reco er- of &oral da&age! in ca!e of deat. cau!ed 'a quasi-delict and enu&erate! t.e !%ou!e" legiti&ate or illegiti&ate a!cendant! or de!cendant! a! t.e %er!on! entitled t.ereto. Moral da&age! are de!igned to co&%en!ate t.e clai&ant for t.e inEur- !uffered" t.at i!" for t.e &ental angui!." !eriou! an5iet-" /ounded feeling! /.ic. t.e re!%ondent! .erein &u!t .a e !urel- felt /it. t.e une5%ected of lo!! of t.eir daug.ter. :e affir& t.e a%%ellate courtD! a/ard P$GG"GGG.GG '- /a- of mor() 3(m(>e4 to t.e re!%ondent!.

:e !i&ilarl- affir& t.e grant of e5e&%lar- da&age!. E5e&%lar- da&age! are i&%o!ed '/a- of e5a&%le or correction for t.e %u'lic good.1($2 @ecau!e of t.e %etitioner !%ou!e!D negligence in !u'Eecting Tere!ita to an o%eration /it.out fir!t recogni<ing and addre!!ing .er dia'etic condition" t.e a%%ellate court a/arded eJemp)(r6 3(m(>e4 to t.e re!%ondent! in t.e a&ount of P1GG"GGG.GG. Pu'lic %olic- re6uire! !uc. i&%o!ition to !u%%re!! t.e /anton act! of an offender.1((2 :e t.erefore affir& t.e CAD! a/ard a! an e5a&%le to t.e &edical %rofe!!ion and to !tre!! t.at t.e %u'lic good re6uire! !tricter &ea!ure! to a oid t.e re%etition of t.e t-%e of &edical &al%ractice t.at .a%%ened in t.i! ca!e.

:it. t.e a/ard of e5e&%lar- da&age!" t.e grant of attorne-D! fee! i! legall- in order. 1(H2 :e t.erefore re er!e t.e CA deci!ion deleting t.e!e a/ard!" and grant t.e re!%ondent! t.e a&ount of P1GG"GGG.GG a! (ttor'e6E4 .ee4 ta;ing into con!ideration t.e legal route t.i! ca!e .a! ta;en. &ERE!ORE" /e A!!IR* t.e Deci!ion of t.e CA dated ?une AG" AGGF in CA G.R. C, No. HFAF$ finding %etitioner !%ou!e! lia'le for negligent &edical %ractice. :e li;e/i!e A!!IR* t.e a/ard! of actual and co&%en!ator- da&age! of PFH"GGG.GG8 &oral da&age! of P$GG"GGG.GG8 and e5e&%lar- da&age! of P1GG"GGG.GG. :e *ODI!9 t.e CA Deci!ion '- additionall- granting an a/ard of P(G"GGG.GG a! deat. inde&nit- and '- re er!ing t.e deletion of t.e a/ard of attorne-D! fee! and co!t! and re!toring t.e a/ard of P1GG"GGG.GG a! attorne-D! fee!. Co!t! of litigation are adEudged again!t %etitioner !%ou!e!. To !u&&ari<e" t.e follo/ing a/ard! !.all 'e %aid to t.e fa&il- of t.e late Tere!ita Pineda3 1. A. F. $. (. H. T.e !u& of PFH"GGG.GG '- /a- of actual and co&%en!ator- da&age!8 T.e !u& of P(G"GGG.GG '- /a- of deat. inde&nit-8 T.e !u& of P$GG"GGG.GG '- /a- of &oral da&age!8 T.e !u& of P1GG"GGG.GG '- /a- of e5e&%lar- da&age!8 T.e !u& of P1GG"GGG.GG '- /a- of attorne-D! fee!8 and Co!t!.

SO ORDERED.

,.

La/! go erning &edical negligence A. Ci il Action BArticle!" 1)" AG" A1" A1*H of NCCC

C7APTER A 7>MAN RELATI+NS BnC Art. 19. E@er6 per4o' m24t, 0' t/e eJer104e o. /04 r0>/t4 ('3 0' t/e per.orm('1e o.

/04 32t0e4, (1t A0t/ K24t01e, >0@e e@er6o'e /04 32e, ('3 ob4er@e /o'e4t6 ('3 >oo3 .(0t/. Art. AG. E er- %er!on /.o" contrar- to la/" /ilfull- or negligentl- cau!e! da&age to anot.er" !.all inde&nif- t.e latter for t.e !a&e. Art. A1. An- %er!on /.o /ilfull- cau!e! lo!! or inEur- to anot.er in a &anner t.at i! contrar- to &oral!" good cu!to&! or %u'lic %olic- !.all co&%en!ate t.e latter for t.e da&age. SECTI+N F. - +t.er Sua!i-Contract! Art. A1H*. :.en t.roug. an accident or ot.er cau!e a %er!on i! inEured or 'eco&e! !eriou!l- ill" and .e i! treated or .el%ed /.ile .e i! not in a condition to gi e con!ent to a contract" .e !.all 'e lia'le to %a- for t.e !er ice! of t.e %.-!ician or ot.er %er!on aiding .i&" unle!! t.e !er ice .a! 'een rendered out of %ure genero!it-.

@.

Cri&inal Action BArticle FH(" RPCC

Title =ourteen S>ASI-+==ENSES Sole C.a%ter CRIMINAL NEGLIGENCE Art. FH(. ?mprudence and negligence. ] An- %er!on /.o" '- rec;le!! i&%rudence" !.all co&&it an- act /.ic." .ad it 'een intentional" /ould con!titute a gra e felon-" !.all !uffer t.e %enalt- of arre!to &a-or in it! &a5i&u& %eriod to %ri!ion correccional in it! &ediu& %eriod8 if it /ould .a e con!tituted a le!! gra e felon-" t.e %enalt- of arre!to &a-or in it! &ini&u& and &ediu& %eriod! !.all 'e i&%o!ed8 if it /ould .a e con!tituted a lig.t felon-" t.e %enalt- of arre!to &enor in it! &a5i&u& %eriod !.all 'e i&%o!ed. An- %er!on /.o" '- !i&%le i&%rudence or negligence" !.all co&&it an act /.ic. /ould ot.er/i!e con!titute a gra e felon-" !.all !uffer t.e %enalt- of arre!to &a-or in it! &ediu& and &a5i&u& %eriod!8 if it /ould .a e con!tituted a le!! !eriou! felon-" t.e %enalt- of arre!to &a-or in it! &ini&u& %eriod !.all 'e i&%o!ed. c.anro'le! irtual la/ li'rar:.en t.e e5ecution of t.e act co ered '- t.i! article !.all .a e onl- re!ulted in da&age to t.e %ro%ert- of anot.er" t.e offender !.all 'e %uni!.ed '- a fine ranging fro& an a&ount e6ual to t.e alue of !aid da&age! to t.ree ti&e! !uc. alue" 'ut /.ic. !.all in no ca!e 'e le!! t.an t/ent--fi e %e!o!. c.anro'le! irtual la/ li'rarA fine not e5ceeding t/o .undred %e!o! and cen!ure !.all 'e i&%o!ed u%on an- %er!on /.o" '- !i&%le i&%rudence or negligence" !.all cau!e !o&e /rong /.ic." if done &aliciou!l-" /ould .a e con!tituted a lig.t felon-. c.anro'le! irtual la/ li'rarIn t.e i&%o!ition of t.e!e %enaltie!" t.e court !.all e5erci!e t.eir !ound di!cretion" /it.out regard to t.e rule! %re!cri'ed in Article !i5t--four. c.anro'le! irtual la/ li'rar-

T.e %ro i!ion! contained in t.i! article !.all not 'e a%%lica'le3 1. :.en t.e %enalt- %ro ided for t.e offen!e i! e6ual to or lo/er t.an t.o!e %ro ided in t.e fir!t t/o %aragra%.! of t.i! article" in /.ic. ca!e t.e court !.all i&%o!e t.e %enalt- ne5t lo/er in degree t.an t.at /.ic. !.ould 'e i&%o!ed in t.e %eriod /.ic. t.e- &a- dee& %ro%er to a%%l-. c.anro'le! irtual la/ li'rarA. :.en" '- i&%rudence or negligence and /it. iolation of t.e Auto&o'ile La/" to deat. of a %er!on !.all 'e cau!ed" in /.ic. ca!e t.e defendant !.all 'e %uni!.ed '- %ri!ion correccional in it! &ediu& and &a5i&u& %eriod!. c.anro'le! irtual la/ li'rarRec;le!! i&%rudence con!i!t! in oluntar-" 'ut /it.out &alice" doing or falling to do an act fro& /.ic. &aterial da&age re!ult! '- rea!on of ine5cu!a'le lac; of %recaution on t.e %art of t.e %er!on %erfor&ing of failing to %erfor& !uc. act" ta;ing into con!ideration .i! e&%lo-&ent or occu%ation" degree of intelligence" %.-!ical condition and ot.er circu&!tance! regarding %er!on!" ti&e and %lace. Si&%le i&%rudence con!i!t! in t.e lac; of %recaution di!%la-ed in t.o!e ca!e! in /.ic. t.e da&age i&%ending to 'e cau!ed i! not i&&ediate nor t.e danger clearl&anife!t.c.anro'le! irtual la/ li'rarT.e %enalt- ne5t .ig.er in degree to t.o!e %ro ided for in t.i! article !.all 'e i&%o!ed u%on t.e offender /.o fail! to lend on t.e !%ot to t.e inEured %artie! !uc. .el% a! &a- 'e in t.i! .and to gi e. BA! a&ended '- R.A. 1*)G" a%%ro ed ?une A1" 1)(*C. Carillo !. Peo%le" G.R. No. #H#)G" ?anuar- A1" 1))$ /GARD DA<A,A1G.R. No. 8D890 E!"8!r/ 21, 199A LEANDRO vs. PEOPLE OF %&E P&$L$PP$NES, respondent. $alane, )a ase, Ala pa* (a+ Office for petitioner. )he "olicitor General for the people. FEL$C$ANO, J.: Petitioner Dr. Leandro Carillo, an anesthetist, see#s review of the De%ision of the Court of *ppeals dated '2 -ove ber 3422, whi%h affir ed his %onvi%tion by the Re$ional /rial Court of the %ri e of si ple ne$li$en%e resultin$ in ho i%ide, for the death of his thirteen !3)" year old patient Catherine *%osta. /he trial %ourt had senten%ed hi to suffer the penalty of arresto a*or in its ediu period !four I4J onthsQ i prison ent", as well as to pay the heirs of his patient an inde nity of P)(,(((.(( for her death, P3(,(((.(( as rei burse ent for a%tual e@penses in%urred, P5(,(((.(( as oral da a$es and to pay the %osts of the suit. 1 /he infor ation filed a$ainst petitioner and his %o-a%%used, the sur$eon Dr. 5 ilio 6adrid, alle$ed the followin$0 /hat on or about the )3st of 6ay 3423, in the uni%ipality of ParaRaFue, 6etro 6anila, Philippines and within the Curisdi%tion of this Gonorable Court, the aboveCAR$LLO, petitioner,

na ed a%%used, %onspirin$ and %onfederatin$ to$ether and utually helpin$ and aidin$ with one another, without ta#in$ the ne%essary %are and pre%aution to avoid inCury to person, did then and there willfully, unlawfully and feloniously operate, in a re%#less, %areless and i prudent anner and ne$le%ted to e@er%ise their respe%tive edi%al #nowhow and tas#s andBor departed fro the re%o$ni;ed standard in their treat ent, dia$nosis of the %ondition, and operation of the patient, one Catherine *%osta, 3) years old, whi%h ne$li$en%e %aused the death of the said Catherine *%osta. 2 Petitioner and Dr. 5 ilio 6adrid entered pleas of not $uilty at arrai$n ent and the %ase pro%eeded to trail with &ud$e &ob B. 6adaya$ presidin$. 3 /he prose%ution presented as its prin%ipal eviden%e the testi ony of four !4" witnesses, na ely0 3" Lolanda *%osta, CatherineQs other, who was able to observe the %ondu%t of the a%%used outside the operatin$ theater before, durin$ and after the appende%to y pro%edure %arried out on her dau$hter? A '" Do in$o *%osta, CatherineQs father, who %orroborated so e parts of his wifeQs testi ony? 5 )" Dr. Gora%io Buendia, an e@pert witness who des%ribed before the trial %ourt the relationship between a sur$eon and an anesthetist in the %ourse of a sur$i%al operation, as well as define the li#elihood of %ardia% arrest as a post operative %o pli%ation? D and 4" Dr. -ieto ,alvador, an e@pert witness who analy;ed and e@plained the si$nifi%an%e of the results of the patholo$i%al study and autopsy %ondu%ted on CatherineQs body by one Dr. *lberto Reyes. F *fter the prose%ution had rested its %ase, the defense was $ranted leave to file a de urrer to the eviden%e. 8 *fter failin$ to file the de urrer within the re$le entary period, &ud$e 6anuel Lu;on, who had in the eanti e ta#en over as presidin$ Cud$e of the sala where this %ase was pendin$, denied the defense otion for e@tension of ti e to file de urrer and de%lared the %ase sub itted for de%ision. 9 1n 34 ,epte ber 3425, the trial %ourt pro ul$ated its de%ision %onvi%tin$ both the a%%used of the %ri e %har$ed.10 1n appeal, the Court of *ppeals affir ed the Cud$ ent of %onvi%tion, and spe%ified that the %ivil liability of the two !'" a%%used was solidary in nature. 11 Petitioner Dr. Carillo alone filed the present Petition for Review with the Court, see#in$ reversal of his %onvi%tion, or in the alternative, the $rant of a new trial. Dr. 6adrid did not try to appeal further the Court of *ppeals De%ision. *%%ordin$ly, the Cud$ ent of %onvi%tion be%a e final insofar as the a%%used sur$eon Dr. 6adrid is %on%erned. /he fa%ts of the %ase as established by the Court of *ppeals are as follows0 /he de%eased, Catherine *%osta, a 3) year old $irl, dau$hter of spouses Do in$o and Lolanda *%osta, %o plained to her father at about 3(0)( oQ%lo%# in the ornin$ of 6ay )3, 3423 of pains in the lower part of her abdo en. Catherine was then brou$ht to Dr. 5lva PeRa. Dra. PeRa %alled for Dr. 5 ilio 6adrid and the latter e@a ined Catherine *%osta. *%%ordin$ to Dr. 6adrid, his findin$s i$ht be appendi%itis. /hen Dr. PeRa told CatherineQs parents to brin$ the %hild to the hospital in Ba%laran so that the %hild will be observed. *t the Ba%laran +eneral Gospital, a nurse too# blood sa ple for the %hild. /he findin$s be%a e #nown at around )0(( oQ%lo%# in the afternoon and the %hild was s%heduled for operation at 50(( oQ%lo%# in the afternoon. /he operation too# pla%e at 5045 p. . be%ause Dr. 6adrid arrived only at that ti e. Ehen brou$ht inside the operatin$ roo , the %hild was feelin$ very well and they did not subCe%t the %hild to 5C+ !ele%tro%ardio$ra " and K-ray. /he appellant Dr. 5 ilio 6adrid, a sur$eon, operated on Catherine. Ge was assisted

by appellant, Dr. Leandro Carillo, an anesthesiolo$ists. Durin$ the operation, while Lolanda *%osta, CatherineQs other, was stayin$ outside the operatin$ roo , she :noti%ed so ethin$ very unfa iliar.: /he three nurses who assisted in the operation were $oin$ in and out of the operatin$ roo , they were not %arryin$ anythin$, but in $oin$ out of the operatin$ roo , they were already holdin$ so ethin$. Lolanda as#ed one of the nurses if she %ould enter the operatin$ roo refused. but she was and

*t around .0)( p. ., Dr. 5 ilio 6adrid went outside the operatin$ roo Lolanda *%osta was allowed to enter the first door.

/he appendi%itis !si%" was shown to the by Dr. 6adrid, be%ause, a%%ordin$ to Dr. 6adrid, they i$ht be wonderin$ be%ause he was $oin$ to install draina$e near the operatin$ !si%" portion of the %hild. Ehen as#ed, the do%tor told the operation was not yet finished. the %hild was already out of dan$er but the

At has also been established that the de%eased was not wei$hed before the ad inistration of anesthesia on her. /he operation was finished at >0(( oQ%lo%# in the evenin$ and when the %hild was brou$ht out fro the operatin$ roo , she was observed to be shiverin$ ,nan!in!ini!-? her heart beat was not nor al? she was asleep and did not wa#e up? she was pale? and as if she had diffi%ulty in breathin$ and Dr. 5 ilio 6adrid su$$ested that she pla%ed under o@y$en tan#? that o@y$en was ad inistered to the %hild when she was already in the roo . Eitness Lolanda *%osta further testified that shortly before the %hild was transferred fro the operatin$ roo to her roo , she !witness" was reFuested by the anesthesiolo$ist to $o ho e and $et a blan#et. * portion of Lolanda *%ostaQs testi ony on what happened when she returned to the hospital are reprodu%ed hereunder as follows0 H Ehat happened afterwardM * Ehen A arrived in the hospital, transferred to her bed. H Ehat else happenedM H A noti%ed that the heartbeat of y dau$hter was not nor al. *nd A noti%ed that her hospital $own is risin$ up and down. H Ehat transpired after thatM * A as#ed Dr. 6adrid why it was li#e that, that the heartbeat of y dau$hter is not nor al. H *nd did the do%tor H Ehat else happenedM * After the* have revived the heart&eat of the child, Dr. Carillo and Dr..adrid left. H -ow do you re e ber +hat ti e +as it +hen a#e any replyM * /he do%tor said be%ause of the lesion of the %hild. y %hild was bein$

Dr. Carillo stepped out/ * Onl* a inute after the* have transferred the child to the &ed. H 0hat happened later on after Dr. Carillo and Dr. .adrid stepped out of the hospital/ * After 12 or 34 inutes has lapsed at a&out 5612 or 5634, the child had developed convulsion and stiffenin! of the &od*. H Ehen you observed %onvulsion and stiffenin$ of the body, did you do anythin$M * Ee reFuested the nurse who was attendin$ to her to %all for a do%tor. H *nd the nurse who was attendin$ to the patient %alled for a do%torM * /hey %alled for Dra. PeRa, their fa ily physi%ian. H Ehat transpired afterwardsM * Ehat Dra. PeRa did was %all for Dr. 6adrid and the %ardiolo$ist. H Did this do%tor arrivedM * Les. H Ehat transpired after the do%tor arrivedM * /hey e@a ined the %hild. H *fter they e@a ined the %hild, did they infor the result of the e@a inationM you of

* /he %ardiolo$ist was the one who infor ed us after he stepped out of the roo when we followed hi . /he do%tor told us that she suffered severe infe%tion whi%h went up to her head. H *fter you were infor ed of the result of his e@a ination, what transpired ne@tM * Accordin! to the , the* +ill do their &est for the child and that the* +ill call for Dr. Carillo. H Did Dr. Carillo arrived/ * At around 14634 in the evenin!. H Did Dr. Carillo do anythin$ when he arrived on )3 6ay 3423M * Ehen he arrived, he noti%ed that there were two s all bottles and bi$ bottles of de@trose whi%h were han$in$ above the bed of the %hild. /hen he said, :Ehat is thisM Christ as tree or whatM: Ge told us that one bottle of de@trose be re oved. *nd the bi$ one will re ain. H Ehat happened after thatM

* *fter that +e tal7ed to Dr. Carillo and as7ed hi ho+ did this happen to the child. H Ehat did Dr. Carillo reply !si%" to youM * 8e ans+ered :that is nothin!, the child +ill re!ain consciousness and if the child +ill not re!ain consciousness, ' +ill resi!n ,sic- as a doctor.: 12 !5 phasis supplied" Ehen Catherine re ained un%ons%ious until noonti e the ne@t day, a neurolo$ist e@a ined her and she was dia$nosed as %o atose. 13 /hree !)" days later, Catherine died without re$ainin$ %ons%iousness. 1A /he Court of *ppeals held that Catherine had suffered fro an overdose of, or an adverse rea%tion to, anesthesia, parti%ularly the arbitrary ad inistration of -ubain, a pain #iller, without benefit of prior wei$hin$ of the patientQs body ass, whi%h wei$ht deter ines the dosa$e of -ubain whi%h %an safely be $iven to a patient. 15 /he Court of *ppeals held that this %ondition tri$$ered off a heart atta%# as a post-operative %o pli%ation, deprivin$ CatherineQs brain of o@y$en, leadin$ to the brainQs he orrha$e. 1D /he Court of *ppeals identified su%h %ardia% arrest as the i ediate %ause of CatherineQs death. 1F /he Court of *ppeals found %ri inal ne$li$en%e on the part of petitioner Dr. Carillo and his %oa%%used Dr. 6adrid, holdin$ that both had failed to observe the reFuired standard of dili$en%e in the e@a ination of Catherine prior to the a%tual ad inistration of anesthesia? 18 that it was :a bit rash: on the part of the a%%used Dr. Carillo :to have ad inistered -ubain without first wei$hin$ Catherine:? 19 and that it was an a%t of ne$li$en%e on the part of both do%tors when, !a" they failed to onitor CatherineQs heartbeat after the operation and !b" they left the hospital i ediately after revivin$ CatherineQs heartbeat, deprivin$ the latter of i ediate and e9pert edi%al assistan%e when she suffered a heart atta%# appro@i ately fifteen !35" to thirty !)(" inutes later. 20 ,in%e neither petitioner nor his %o-a%%used presented eviden%e in their own behalf, the present Petition see#s to Fuestion the soundness of the fa%tual %on%lusions drawn by the Court of *ppeals, upon whi%h the affir an%e of petitionerQs %onvi%tion was based. Close e@a ination of the instant Petition for Review shows that petitionerQs ain ar$u ents are two-fold0 !3" the Court of *ppeals :%o pletely brushed aside: and : isapprehended: CatherineQs death %ertifi%ate and biopsy report whi%h alle$edly showed that the %ause of death was a ruptured appendi@, whi%h led to blood poisonin$, 21rather than faulty anestheti% treat ent? and !'" there was no direct eviden%e of re%ord showin$ that -ubain was ad inistered to Catherine either durin! the appende%to y pro%edure or after su%h operation. 22 /wo !'" related issues are thus posed for the CourtQs %onsideration. /he first is whether the Court of *ppeals so drasti%ally : isapprehended: the relevant, operative fa%ts in this %ase as to %o pel this Court to e@a ine and resolve Fuestion!s" of fa%t whi%h would have a de%isive si$nifi%an%e for the disposition of the %ase. /he rule is too fir ly settled to reFuire u%h do%u entation that only Fuestions of law ay be raised before this Court in a petition for review on certiorari, subCe%t to %ertain well-#nown e@%eptions. 23 *fter %areful s%rutiny of petitionerQs %ontentions before us and the re%ord of this %ase, we do not believe that petitioner has shown : isapprehension of fa%ts: on the part of the Court of *ppeals whi%h would reFuire this Court to overturn the Cud$ ent rea%hed by the for er. /he se%ond issue is whether or not the findin$s of fa%t of the Court of *ppeals adeFuately support the %on%lusion that petitioner Dr. Carillo was, alon$ with Dr. 6adrid, $uilty of si ple ne$li$en%e whi%h resulted in ho i%ide. 1ur review of the re%ord leads us to an affir ative answer. Petitioner %ontends that the Court of *ppeals seriously erred in findin$ that an overdose of, or an

aller$i% rea%tion to, the anestheti% dru$ -ubain had led to the death of Catherine *%osta and that the true %ause of CatherineQs death was that set out in the death %ertifi%ate of Catherine0 :,epti%e ia !or blood poisonin$" due to perforated appendi@ with peritonitis.: 2A /he %on%ept of %ausation in $eneral, and the %ause of death in hu an bein$s in parti%ular, are %o ple@ and diffi%ult notions. Ehat is fairly %lear is that death, understood as a physi%al %ondition involvin$ %essation of vital si$ns in the brain and heart, is pre%eded by a series of physiolo$i%al events, any one of whi%h events %an, with eFual %o$en%y, be des%ribed as a :%ause of death:. /he Court of *ppeals found that an overdose of, or an adverse rea%tion to, -ubain, an anestheti% or pain-#illin$ dru$ the appropriate dose of whi%h depends on the body wei$ht or ass of the patient, had $enerated or tri$$ered off %ardia% arrest, whi%h in turn led to la%# of o@y$en in CatherineQs brain, whi%h then brou$ht about he orrha$in$ in the brain. <ital a%tivity in the brain thereupon %eased. /he edi%al eviden%e presented at the trial was Fuite %onsistent with the findin$s of the Court of *ppeals whi%h %on%luded that %ardia% arrest was the %ause of CatherineQs death. 25 For his part, petitioner insists that %ardia% arrest is not the only %ause of o@y$en-starvation of the brain, that septi%e ia with peritonitis or severe infe%tion whi%h had :$one up to the head: of Catherine was an eFually effi%ient %ause of deprivation of the brain of o@y$en and hen%e of brain he orrha$e. /he edi%al testi ony of the e@pert witnesses for the prose%ution on whi%h petitioner relies is also %onsistent with petitionerQs theory that septi%e ia with peritonitis was, or at least %ould have been, the %ause of CatherineQs death. 2D Andeed, it appears to the Court that there was no edi%al proof sub itted to the trial %ourt to show that one or the other :%ause: was necessaril* an e9clusive %ause of death in the %ase of Catherine *%osta? that an overdose or aller$i% rea%tion to -ubain %ould not have %o bined with septi%e ia and peritonitis in brin$in$ about CatherineQs death. Ehat is of %riti%al i portan%e for present purposes is not so u%h the identifi%ation of the :true %ause: or :real %ause: of CatherineQs death but rather the set of %ir%u stan%es whi%h both the trial %ourt and the Court of *ppeals found %onstituted si ple !as distin$uished fro re%#less" ne$li$en%e on the part of the two a%%used Dr. 6adrid and Dr. Carillo leadin$ to the death of Catherine. Ehen the patient was wheeled out of the operatin$ roo after %o pletion of sur$ery, she anifested si$ns of edi%al instability !i.e., shiverin$, paleness, irre$ular breathin$ and wea# heart beat". 2F ,he was not brou$ht to a properly eFuipped re%overy roo , or intensive %are until whi%h the hospital la%#ed. 28 ,u%h fa%ilities and their professional staffs, of whi%h an anesthetist is %o only a part, are essential for providin$ %lose observation and patient %are while a post-sur$ery patient is re%overin$ fro the effe%ts of anesthesia and while the nor al prote%tive e%hanis s are still dull or obtunded. 29 Anstead, the patient was erely brou$ht to her assi$ned hospital bed and was provided o@y$en on the instru%tions of Dr. 6adrid then :revived: her heartbeat. 30 Both do%tors then left their patient and the hospital? appro@i ately fifteen inutes later, she suffered %onvulsions and %ardia% arrest. 31 /he %ondu%t of Dr. 6adrid and of the petitioner %onstituted inadeFuate %are of their patient in view of her vulnerable %ondition. Both do%tors failed to appre%iate the serious %ondition of their patient whose adverse physi%al si$ns were Fuite anifest ri$ht after sur$ery. *nd after revivin$ her heartbeat, both do%tors failed to onitor their patient %losely or e@tend further edi%al %are to her? su%h %ondu%t was espe%ially ne%essary in view of the inadeFuate, post-operative fa%ilities of the hospital. Ee do not, of %ourse, see# to hold petitioner responsible for the inadeFuate fa%ilities of the Ba%laran +eneral Gospital. Ee %onsider, however, that the inadeFuate nature of those fa%ilities did i pose a so ewhat hi$her standard of professional dili$en%e upon the a%%used sur$eon and anesthetist personally than would have been %alled for in a odern fully-eFuipped hospital. Ehile Dr. 6adrid and a %ardiolo$ist were %ontainin$ the patientQs %onvulsions, and after the latter had dia$nosed that infe%tion had rea%hed the patientQs head, these two !'" apparently after

%onsultation, de%ided to %all-in the petitioner. 32 /here is here a stron$ i pli%ation that the patientQs post-operative %ondition ust have been %onsidered by the two !'" do%tors as in so e way related to the anestheti% treat ent she had re%eived fro the petitioner either durin$ or after the sur$i%al pro%edure. 1n%e su oned, petitioner anesthesiolo$ist %ould not be readily found. Ehen he finally appeared at 3(0)( in the evenin$, he was evidently in a bad te per, %o entin$ %riti%ally on the de@trose bottles before orderin$ their re oval. 33 /his %ir%u stan%e indi%ated he was not disposed to attend to this une@pe%ted %all, in violation of the %anons of his profession that as a physi%ian, he should serve the interest of his patient :with the $reatest of soli%itude, $ivin$ the always his best talent and s#ill.: 3A Andeed, when petitioner finally saw his patient, he offered the unprofessional bluster to the parents of Catherine that he would resi$n if the patient will not re$ain %ons%iousness. 35 /he %anons of edi%al ethi%s reFuire a physi%ian to :attend to his patients faithfully and %ons%ientiously.: Ge should se%ure for the all possible benefits that ay depend upon his professional s#ill and %are. *s the sole tribunal to adCud$e the physi%ianQs failure to fulfill his obli$ation to his patient is, in ost %ases, his own %ons%ien%e, violation of this rule on his part is :dis%reditable and ine@%usable:. 3D -ubain was an e9peri ental dru$ for anesthesia and post-operative pain and the edi%al literature reFuired that a patient be wei$hed first before it is ad inistered and warned that there was no !or inadeFuate" e@perien%e relatin$ to the ad inistration thereof to a patient less that ei$hteen !32" ears of a$e. 3F Let, the do%torQs order sheet !5@hibit :C:" did not %ontain this pre%aution but instead dire%ted a reader to apply the dru$ only when warranted by the %ir%u stan%es. 38 Durin$ the offer of 5@hibit :C: by the prose%ution, Dr. 6adrid ad itted that this pres%ription, whi%h was unsi$ned, was ade in his own handwritin$. 39 At ust be observed that the instru%tion was open-ended in that so e other individual still had to deter ine if %ir%u stan%es e@isted warrantin$ ad inistration of the dru$ to the patient. /he do%u ent thus indi%ated the a&dication of edi%al responsibility on an e@tre ely %riti%al atter. ,in%e petitioner anesthesiolo$ist entered su&sequent pres%riptions or orders in the sa e order sheet, whi%h were si$ned by hi , at 5612 p. . on the sa e evenin! of 31 .a* 1:;1, he +as in a position to appreciate the dan!ers inherent in the prior prescription, +hich +as +ithin his ,petitioner<s- area of speciali=ation, and to order easures to %orre%t this ano aly and prote%t his patientQs well-bein$. ,o far as the %ondition of the eviden%e shows, he failed to do so. An su , only a low level of dili$en%e was e@hibited by petitioner and Dr. 6adrid in the pres%ription of edi%ation for their patient. *s noted earlier, petitioner relied heavily in this pro%eedin$ on the testi ony on %ross-e@a ination of the e@pert witnesses for the prose%ution to show that blood poisonin$ resultin$ fro a ruptured appendi@ could also be responsible for the patientQs death. -o su$$estion has been ade that the rupture of the patientQs o%%urred prior to sur!er*. *fter her blood sa ple was e@a ined, the patient was erely dia$nosed as a %ase of appendi%itis, without further elaboration. A0 -ointensive preoperative preparations, li#e the i ediate ad inistration of antibioti%s, was thereafter underta#en on the patient. /his is a standard pro%edure for patients who are, after bein$ dia$nosed, suspe%ted of sufferin$ fro a perforated appendi@ and %onseFuent peritonitis. A1 /he other also testified that petitioner anesthesiolo$ist erely inCe%ted a dru$, :preanesthesia: intended to put the patient to sleep, into the %ontainer of fluids bein$ ad inistered to her dau$hter intravenously at her roo , prior to sur$ery. A2 Ee note further that the sur$eon Dr. 6adrid was forty-five inutes late in arrivin$ at the operatin$ theater. A3 Considerin$ that delay in treat ent of appendi%itis in%reases the orbidity of the patient, AA Dr. 6adridQs %ondu%t %an only be e@plained by a pre-operative dia$nosis on his part that the %ondition of appendi%itis was not yet attended by %o pli%ations !i.e., a ruptured appendi@ and peritonitis". /he above %ir%u stan%es do stron$ly indi%ate that the rupture of the patientQs appendi@ o%%urred durin! the appende%to y pro%edure, that is, at a ti e and pla%e S the operatin$ roo S where the two !'" a%%used were in full %ontrol of the situation and %ould deter ine de%isively what

needed to be done in respe%t of the patient. A5 /his %ir%u stan%e ust be %onsidered in %onCun%tion with other related %ir%u stan%es whi%h the prose%ution had proven0 that the patient was a bulatory when brou$ht to the operatin$ roo ? AD that she left the operatin$ roo two !'" hours later in obviously serious %ondition? and that an appende%to y a%%o panied or followed by sustained antibioti% treat ent is a fairly %o on and $enerally a%%epted edi%al pro%edure for dealin$ with ruptured appendi@ and peritonitis, AF a fa%t of whi%h Cudi%ial note ay be ta#en. *s early as in %eople v. >istan, A8 the Court defined si ple ne$li$en%e, penali;ed under what is now *rti%le ).5 of the Revised Penal Code, as :a ere la%# of prevision in a situation where either the threatened har is not i ediate or the dan$er not openl* visi&le.: Put in a sli$htly different way, the $rava en of the offense of si ple ne$li$en%e is the failure to e@er%ise the dili$en%e ne%essitated or %alled for the situation whi%h was not i ediately life-destru%tive but whi%h %ul inated, in the present %ase, in the death of a hu an bein$ three !)" days later. ,u%h failure to e@er%ise the ne%essary de$ree of %are and dili$en%e is a ne$ative in$redient of the offense %har$ed. /he rule in su%h %ases is that while the prose%ution ust prove the ne$ative in$redient of the offense, it needs only to present the best eviden%e pro%urable under the %ir%u stan%es, in order to shift the burden of disprovin$ or %ounterin$ the proof of the ne$ative in$redient to the a%%used, provided that su%h initial eviden%e establishes at least on a pri a facie basis the $uilt of the a%%used. A9 /his rule is parti%ularly appli%able where the ne$ative in$redient of the offense is of su%h a nature or %hara%ter as, under the %ir%u stan%es, to be spe%ially within the #nowled$e or %ontrol of the a%%used. 50 An the instant %ase, the Court is bound to observe that the events whi%h o%%urred durin$ the sur$i%al pro%edure !in%ludin$ whether or not -ubain had in fa%t been ad inistered as an anesthesia i ediately before or durin$ the sur$ery" were pe%uliarly within the #nowled$e and %ontrol of Dr. Carillo and Dr. 6adrid. At was, therefore, in%u bent upon the two !'" a%%used to overturn the pri a facie%ase whi%h the prose%ution had established, by re%itin$ the easures whi%h they had a%tually ta#en to prevent or to %ounter the obviously serious %ondition of Catherine *%osta whi%h was evident ri$ht after sur$ery. /his they failed or refused to do so. ,till another %ir%u stan%e of whi%h a%%ount ust be ta#en is that both petitioner and Dr. 6adrid failed to infor the parents of their inor patient of the nature of her illness, or to e@plain to the either durin$ the sur$ery !if feasible" or at any ti e after the sur$ery, the events whi%h %o prised the dra ati% deterioration of her %ondition i ediately after sur$ery as %o pared with her pre-sur$ery %ondition. /o $ive a truthful e@planation to the parents was a duty i posed upon the by the %anons of their profession. 51 Petitioner should have e@plained to CatherineQs parents the a%tual %ir%u stan%es surroundin$ CatherineQs death, how, in other words, a si ple appende%to y pro%edure upon an a bulatory patient %ould have led to su%h fatal %onseFuen%es. By way of resu e, in the %ase at bar, we %onsider that the %hain of %ir%u stan%es above noted, na ely0 !3" the failure of petitioner and Dr. 6adrid to appre%iate the serious post-sur$ery %ondition of their patient and to onitor her %ondition and provide %lose patient %are to her? !'" the su ons of petitioner by Dr. 6adrid and the %ardiolo$ist after the patientQs heart atta%# on the very evenin$ that the sur$ery was %o pleted? !)" the low level of %are and dili$en%e e@hibited by petitioner in failin$ to %orre%t Dr. 6adridQs pres%ription of -ubain for post-operative pain? !4" the e@traordinary failure or refusal of petitioner and Dr. 6adrid to infor the parents of Catherine *%osta of her true %ondition after sur$ery, in disre$ard of the reFuire ents of the Code of 6edi%al 5thi%s? and !5" the failure of petitioner and Dr. 6adrid to prove that they had in fa%t e@er%ised the ne%essary and appropriate de$ree of %are and dili$en%e to prevent the sudden de%line in the %ondition of Catherine *%osta and her death three !)" days later, leads the Court to the %on%lusion, with oral %ertainty, that petitioner and Dr. 6adrid were $uilty of si ple ne$li$en%e resultin$ in ho i%ide. An addition to the ain ar$u ents raised by petitioner earlier, he also raised an an%illary, %onstitutional %lai of denial of due pro%ess. Ge %ontends that he was deprived of his ri$ht to have

%o petent representation at trial, and to have his %ause adeFuately heard, be%ause his %ounsel of re%ord, *tty. &ose B. Puerto, was :in%o petent: and e@hibited :$ross ne$li$en%e: by anifestin$ an intent to file a de urrer to the eviden%e, in failin$ to present eviden%e in his behalf and in o ittin$ to file a defense e orandu for the benefit of &ud$e Lu;on, after the latter too# over the %ase at the end of trial and before the &ud$e rendered his de%ision. 52Petitioner sub its he is entitled to a new trial. 53 /hese %ontentions do not persuade. *n e@a ination of the re%ord indi%ates that *tty. Puerto represented petitioner durin$ trial with reasonable %o peten%e. 5@%ept for the two hearin$ sessions when witnesses Do in$o *%osta was %ross-e@a ined and re%ross-e@a ined by *tty. Puerto, petitioner was present durin$ all the sessions when the other prose%ution witnesses were presented and durin$ whi%h *tty. Puerto e@tensively %ross-e@a ined the in behalf of petitioner and Dr. 6adrid. /his %ounsel eli%ited fro the two !'" e@pert witnesses for the prose%ution testi ony favorable to petitioner and whi%h was relied upon by the latter in this pro%eedin$. 5A /he re%ord further indi%ates that if petitioner indeed entertained substantial doubts about the %apability of *tty. Puerto, he %ould have easily ter inated the servi%es of that %ounsel and retained a new one, or sou$ht fro the trial %ourt the appoint ent of %ounsel de oficio, durin$ the a ple opportunity $iven fro the ti e *tty. Puerto anifested his intent to file a de urrer on 3. 1%tober 3425, to the sub ission of the %ase for de%ision on '5 &une 342. and before the pro ul$ation of Cud$ ent on 34 ,epte ber 342.. 55 Durin$ all this ti e, petitioner %ould have obtained leave of %ourt to present eviden%e in his behalf in lieu of a de urrer, or to sub it a e orandu for the defense. *fter pro ul$ation of the Cud$ ent of %onvi%tion, petitioner did not see# a new trial, but per itted *tty. Puerto to obtain leave fro the trial %ourt to %ontinue on bail durin$ the penden%y of the pro%eedin$s before the Court of *ppeals. 5D Andeed, petitioner repla%ed *tty. Puerto as %ounsel only upon institution of the present petition. 5F PetitionerQs %onstitutional obCe%tion is plainly an afterthou$ht. EG5R5F1R5, the De%ision of the Court of *ppeals dated '2 -ove ber 3422 is hereby *FFAR65D, subCe%t only to the odifi%ation that the inde nity for the death of Catherine *%osta is hereby in%reased to P5(,(((.((, in line with %urrent Curispruden%e. 58 ,1 1RD5R5D. $idin, Ro ero, .elo and >itu!, ??., concur.

Cru< !. CA" G.R. No. 1AA$$(" No e&'er 1#" 1))* T7IRD DI,ISI+N

[G.R. No. 1??445. No@ember 18, 1997]

DR.

NINE+E$C& CRU-, petitioner, vs. U*ALI, respondents.

COUR$

O!

A""EALS

('3

L9DIA

DECISION

!RANCISCO, J.7 XDoctor! are %rotected '- a !%ecial la/. T.e- are not guarantor! of care. T.e- do not e en /arrant a good re!ult. T.e- are not in!urer! again!t &i!.a% or unu!ual con!e6uence!. =urt.er&ore t.e- are not lia'le for .one!t &i!ta;e of Eudg&entYX112 T.e %re!ent ca!e again!t %etitioner i! in t.e nature of a &edical &al%ractice !uit" /.ic. in !i&%le!t ter& i! t.e t-%e of clai& /.ic. a icti& .a! a aila'le to .i& or .er to redre!! a /rong co&&itted '- a &edical %rofe!!ional /.ic. .a! cau!e 'odil- .ar&.1A2 In t.i! Euri!diction" .o/e er" !uc. clai&! are &o!t often 'roug.t a! a ci il action for da&age! under Article A1*H of t.e Ci il Code"1F2 and in !o&e in!tance!" a! a cri&inal ca!e under Article FH( of t.e Re i!ed Penal Code1$2 /it. /.ic. t.e ci il action for da&age! i! i&%liedl- in!tituted. It i! via t.e latter t-%e of action t.at t.e .eir! of t.e decea!ed !oug.t redre!! for t.e %etitionerV! alleged i&%rudence and negligence in treating t.e decea!ed t.ere'- cau!ing .er deat.. T.e %etitioner and one Dr. Lina Ercillo /.o /a! t.e attending anae!t.e!iologi!t during t.e o%eration of t.e decea!ed /ere c.arged /it. Xrec;le!! i&%rudence and negligence re!ulting to B!icC .o&icideX in an infor&ation /.ic. read!3 XT.at on or a'out Marc. AF" 1))1" in t.e Cit- of San Pa'lo" Re%u'lic of t.e P.ili%%ine! and /it.in t.e Euri!diction of t.i! 7onora'le Court" t.e accu!ed a'o ena&ed" 'eing t.en t.e attending anae!t.e!iologi!t and !urgeon" re!%ecti el-" did t.en and t.ere" in a negligence B!icC" carele!!" i&%rudent" and inco&%etent &anner" and failing to !u%%l- or !tore !ufficient %ro i!ion! and facilitie! nece!!ar- to &eet an- and all e5igencie! a%t to ari!e 'efore" during andIor after a !urgical o%eration cau!ing '- !uc. negligence" carele!!ne!!" i&%rudence" and inco&%etence" and cau!ing '- !uc. failure" including t.e lac; of %re%aration and fore!ig.t needed to a ert a traged-" t.e unti&el- deat. of !aid L-dia >&ali on t.e da- follo/ing !aid !urgical o%eration.X1(2 Trial en!ued after 'ot. t.e %etitioner and Dr. Lina Ercillo %leaded not guilt- to t.e a'o e-&entioned c.arge. +n Marc. $" 1))$" t.e Munici%al Trial Court in Citie! BMTCCC of San Pa'lo Cit- rendered a deci!ion" t.e di!%o!iti e %ortion of /.ic. i! .ereunder 6uoted a! follo/!3 X:7ERE=+RE" t.e court find! t.e accu!ed Dr. Lina Ercillo not guilt- of t.e offen!e c.arged for in!ufficienc- of e idence /.ile .er co-accu!ed Dra. Nine etc. Cru< i! .ere'.eld re!%on!i'le for t.e deat. of L-dia >&ali on Marc. A$" 1))1" and t.erefore guiltunder Art. FH( of t.e Re i!ed Penal Code" and !.e i! .ere'- !entenced to !uffer t.e %enalt- of A &ont.! and 1 da- i&%ri!on&ent of arre!to &a-or /it. co!t!.X1H2 T.e %etitioner a%%ealed .er con iction to t.e Regional Trial Court BRTCC /.ic. affir&ed in toto t.e deci!ion of t.e MTCC1*2 %ro&%ting t.e %etitioner to file a %etition for re ie/ /it. t.e Court of A%%eal! 'ut to no a ail. 7ence t.i! %etition for re ie/ on certiorari a!!ailing t.e deci!ion %ro&ulgated '- t.e Court of A%%eal! on +cto'er A$" 1))( affir&ing %etitionerV! con iction /it. &odification t.at !.e i! furt.er directed to %a- t.e .eir! of L-dia >&ali P(G"GGG.GG a! inde&nit- for .er deat..1#2 In !u'!tance" t.e %etition 'roug.t 'efore t.i! Court rai!e! t.e i!!ue of /.et.er or not %etitionerV! con iction of t.e cri&e of rec;le!! i&%rudence re!ulting in .o&icide" ari!ing fro& an alleged &edical &al%ractice" i! !u%%orted '- t.e e idence on record. =ir!t t.e antecedent fact!. +n Marc. AA" 1))1" %ro!ecution /itne!!" Ro/ena >&ali De +ca&%o" acco&%anied

.er &ot.er to t.e Per%etual 7el% Clinic and General 7o!%ital !ituated in @alagta! Street" San Pa'lo Cit-" Laguna. T.e- arri ed at t.e !aid .o!%ital at around $3FG in t.e afternoon of t.e !a&e da-.1)2 Prior to Marc. AA" 1))1" L-dia /a! e5a&ined '- t.e %etitioner /.o found a X&-o&aX11G2 in .er uteru!" and !c.eduled .er for a .-!terecto&- o%eration on Marc. AF" 1))1.1112 Ro/ena and .er &ot.er !le%t in t.e clinic on t.e e ening of Marc. AA" 1))1 a! t.e latter /a! to 'e o%erated on t.e ne5t da- at 13GG oVcloc; in t.e afternoon. 11A2 According to Ro/ena" !.e noticed t.at t.e clinic /a! untid- and t.e /indo/ and t.e floor /ere er- du!t- %ro&%ting .er to a!; t.e attendant for a rag to /i%e t.e /indo/ and t.e floor /it..11F2 @ecau!e of t.e untid- !tate of t.e clinic" Ro/ena tried to %er!uade .er &ot.er not to %roceed /it. t.e o%eration.11$2 T.e follo/ing da-" 'efore .er &ot.er /a! /.eeled into t.e o%erating roo&" Ro/ena a!;ed t.e %etitioner if t.e o%eration could 'e %o!t%oned. T.e %etitioner called L-dia into .er office and t.e t/o .ad a con er!ation. L-dia t.en infor&ed Ro/ena t.at t.e %etitioner told .er t.at !.e &u!t 'e o%erated on a! !c.eduled.11(2 Ro/ena and .er ot.er relati e!" na&el- .er .u!'and" .er !i!ter and t/o aunt! /aited out!ide t.e o%erating roo& /.ile L-dia under/ent o%eration. :.ile t.e- /ere /aiting" Dr. Ercillo /ent out of t.e o%erating roo& and in!tructed t.e& to 'u- taga&et a&%ule! /.ic. Ro/enaV! !i!ter i&&ediatel- 'oug.t. A'out one .our .ad %a!!ed /.en Dr. Ercillo ca&e out again t.i! ti&e to a!; t.e& to 'u- 'lood for L-dia. T.e- 'oug.t t-%e XAX 'lood fro& t.e St. Gerald @lood @an; and t.e !a&e /a! 'roug.t '- t.e attendant into t.e o%erating roo&. After t.e la%!e of a fe/ .our!" t.e %etitioner infor&ed t.e& t.at t.e o%eration /a! fini!.ed. T.e o%erating !taff t.en /ent in!ide t.e %etitionerV! clinic to ta;e t.eir !nac;!. So&e t.irt- &inute! after" L-dia /a! 'roug.t out of t.e o%erating roo& in a !tretc.er and t.e %etitioner a!;ed Ro/ena and t.e ot.er relati e! to 'u- additional 'lood for L-dia. >nfortunatel-" t.e- /ere not a'le to co&%l- /it. %etitionerV! order a! t.ere /a! no &ore t-%e XAX 'lood a aila'le in t.e 'lood 'an;. T.ereafter" a %er!on arri ed to donate 'lood /.ic. /a! later tran!fu!ed to L-dia. Ro/ena t.en noticed .er &ot.er" /.o /a! attac.ed to an o5-gen tan;" ga!%ing for 'reat.. A%%arentl- t.e o5-gen !u%%l- .ad run out and Ro/enaV! .u!'and toget.er /it. t.e dri er of t.e accu!ed .ad to go to t.e San Pa'lo Di!trict 7o!%ital to get o5-gen. L-dia /a! gi en t.e fre!. !u%%l- of o5-gen a! !oon a! it arri ed.11H2 @ut at around 1G3GG oVcloc; P.M. !.e /ent into !.oc; and .er 'lood %re!!ure dro%%ed to HGI(G. L-diaV! un!ta'le condition nece!!itated .er tran!fer to t.e San Pa'lo Di!trict 7o!%ital !o !.e could 'e connected to a re!%irator and furt.er e5a&ined.11*2 T.e tran!fer to t.e San Pa'lo Cit- Di!trict 7o!%ital /a! /it.out t.e %rior con!ent of Ro/ena nor of t.e ot.er relati e! %re!ent /.o found out a'out t.e intended tran!fer onl- /.en an a&'ulance arri ed to ta;e L-dia to t.e San Pa'lo Di!trict 7o!%ital. Ro/ena and .er ot.er relati e! t.en 'oarded a tric-cle and follo/ed t.e a&'ulance.11#2 >%on L-diaV! arri al at t.e San Pa'lo Di!trict 7o!%ital" !.e /a! /.eeled into t.e o%erating roo& and t.e %etitioner and Dr. Ercillo re-o%erated on .er 'ecau!e t.ere /a! 'lood oo<ing fro& t.e a'do&inal inci!ion.11)2 T.e attending %.-!ician! !u&&oned Dr. @artolo&e Angele!" .ead of t.e +'!tetric! and G-necolog- De%art&ent of t.e San Pa'lo Di!trict 7o!%ital. 7o/e er" /.en Dr. Angele! arri ed" L-dia /a! alread- in !.oc; and %o!!i'l- dead a! .er 'lood %re!!ure /a! alread- GIG. Dr. Angele! t.en infor&ed %etitioner and Dr. Ercillo t.at t.ere /a! not.ing .e could do to .el% !a e t.e %atient. 1AG2 :.ile %etitioner /a! clo!ing t.e a'do&inal /all" t.e %atient died.1A12 T.u!" on Marc. A$" 1))1" at F3GG oVcloc; in t.e &orning" L-dia >&ali /a! %ronounced dead. 7er deat. certificate !tate! X!.oc;X a! t.e i&&ediate cau!e of deat. and XDi!!e&inated Intra a!cular Coagulation BDICCX a! t.e antecedent cau!e.1AA2 In con icting t.e %etitioner" t.e MTCC found t.e follo/ing circu&!tance! a! !ufficient

'a!i! to conclude t.at !.e /a! indeed negligent in t.e %erfor&ance of t.e o%eration3 X5 5 5" t.e clinic /a! untid-" t.ere /a! lac; of %ro i!ion li;e 'lood and o5-gen to %re%are for an- contingenc- t.at &ig.t .a%%en during t.e o%eration. T.e &anner and t.e fact t.at t.e %atient /a! 'roug.t to t.e San Pa'lo Di!trict 7o!%ital for reo%eration indicate! t.at t.ere /a! !o&et.ing /rong in t.e &anner in /.ic. Dra. Cru< conducted t.e o%eration. T.ere /a! no !.o/ing t.at 'efore t.e o%eration" accu!ed Dr. Cru< .ad conducted a cardio %ul&onar- clearance or an- t-%ing of t.e 'lood of t.e %atient. It /a! B!icC !aid in &edical %arlance t.at t.e Xa'do&en of t.e %er!on i! a te&%le of !ur%ri!e!X 'ecau!e -ou do not ;no/ t.e /.ole t.ing t.e &o&ent it /a! o%en B!icC and !urgeon &u!t 'e %re%ared for ane entualit- t.ereof. T.e %atient B!icC c.art /.ic. i! a %u'lic docu&ent /a! not %re!ented 'ecau!e it i! onl- t.ere t.at /e could deter&ine t.e condition of t.e %atient 'efore t.e !urger-. T.e court al!o noticed in E5.. X=-1X t.at t.e !i!ter of t.e decea!ed /i!.ed to %o!t%one t.e o%eration 'ut t.e %atient /a! %re ailed u%on '- Dra. Cru< to %roceed /it. t.e !urger-. T.e court find! t.at L-dia >&ali died 'ecau!e of t.e negligence and carele!!ne!! of t.e !urgeon Dra. Nine etc. Cru< 'ecau!e of lo!! of 'lood during t.e o%eration of t.e decea!ed for e ident un%re%aredne!! and for lac; of !;ill" t.e rea!on /.t.e %atient /a! 'roug.t for o%eration at t.e San Pa'lo Cit- Di!trict 7o!%ital. A! !uc." t.e !urgeon !.ould an!/er for !uc. negligence. :it. re!%ect to Dra. Lina Ercillo" t.e anae!t.e!iologi!t" t.ere i! no e idence to indicate t.at !.e !.ould 'e .eld Eointl- lia'le /it. Dra. Cru< /.o actuall- did t.e o%eration.X1AF2 T.e RTC reiterated t.e a'o e&entioned finding! of t.e MTCC and u%.eld t.e latterV! declaration of Xinco&%etenc-" negligence and lac; of fore!ig.t and !;ill of a%%ellant B.erein %etitionerC in .andling t.e !u'Eect %atient 'efore and after t.e o%eration.X1A$2 And li;e/i!e affir&ing t.e %etitionerV! con iction" t.e Court of A%%eal! ec.oed !i&ilar o'!er ation!" t.u!3 X5 5 5. :.ile /e &a- grant t.at t.e untidine!! and filt.ine!! of t.e clinic &a- not '- it!elf indicate negligence" it ne ert.ele!! !.o/! t.e a'!ence of due care and !u%er i!ion o er .er !u'ordinate e&%lo-ee!. Did t.i! un!anitar- condition %er&eate t.e o%erating roo&0 :ere t.e !urgical in!tru&ent! %ro%erl- !terili<ed0 Could t.e condition! in t.e +R .a e contri'uted to t.e infection of t.e %atient0 +nl- t.e %etitioner could an!/er t.e!e" 'ut !.e o%ted not to te!tif-. T.i! could onl- gi e ri!e to t.e %re!u&%tion t.at !.e .a! not.ing good to te!tif- on .er defen!e. An-/a-" t.e alleged Xun erified !tate&ent of t.e %ro!ecution /itne!!X re&ain! unc.allenged and unre'utted. Li;e/i!e undi!%uted i! t.e %ro!ecutionV! er!ion indicating t.e follo/ing fact!3 t.at t.e accu!ed a!;ed t.e %atientV! relati e! to 'u- Taga&et ca%!ule! /.ile t.e o%eration /a! alread- in %rogre!!8 t.at after an .our" t.e- /ere al!o a!;ed to 'u- t-%e XAX 'lood for t.e %atient8 t.at after t.e !urger-" t.e- /ere again a!;ed to %rocure &ore t-%e XAX 'lood" 'ut !uc. /a! not an-&ore a aila'le fro& t.e !ource8 t.at t.e o5-gen gi en to t.e %atient /a! e&%t-8 and t.at t.e !on-in-la/ of t.e %atient" toget.er /it. a dri er of t.e %etitioner" .ad to ru!. to t.e San Pa'lo Cit- Di!trict 7o!%ital to get t.e &uc.-needed o5-gen. All t.e!e conclu!i el- !.o/ t.at t.e %etitioner .ad not %re%ared for an- unfore!een circu&!tance! 'efore going into t.e fir!t !urger-" /.ic. /a! not e&ergenc- in nature" 'ut /a! electi e or %re-!c.eduled8 !.e .ad no read- anti'iotic!" no %re%ared 'lood" %ro%erl- t-%ed and cro!!&atc.ed" and no !ufficient o5-gen !u%%l-. Moreo er" t.ere are a lot of 6ue!tion! t.at ;ee% nagging >!. :a! t.e %atient gi en ancardio-%ul&onar- clearance" or at lea!t a clearance '- an interni!t" /.ic. are !tandard re6uire&ent! 'efore a %atient i! !u'Eected to !urger-. Did t.e %etitioner deter&ine a! %art of t.e %re-o%erati e e aluation" t.e 'leeding %ara&eter! of t.e %atient" !uc. a! 'leeding ti&e and clotting ti&e0 T.ere i! no !.o/ing t.at t.e!e /ere done. T.e %etitioner Eu!t

a%%ear! to .a e 'een in a .urr- to %erfor& t.e o%eration" e en a! t.e fa&il- /anted t.e %o!t%one&ent to A%ril H" 1))1. +' iou!l-" !.e did not %re%are t.e %atient8 neit.er did !.e get t.e fa&il-V! con!ent to t.e o%eration. Moreo er" !.e did not %re%are a &edical c.art /it. in!truction! for t.e %atientV! care. If !.e did all t.e!e" %roof t.ereof !.ould .a e 'een offered. @ut t.ere i! none. Indeed" t.e!e are o er/.el&ing e idence of rec;le!!ne!! and i&%rudence.X1A(2 T.i! court" .o/e er" .old! differentl- and find! t.e foregoing circu&!tance! in!ufficient to !u!tain a Eudg&ent of con iction again!t t.e %etitioner for t.e cri&e of rec;le!! i&%rudence re!ulting in .o&icide. T.e ele&ent! of rec;le!! i&%rudence are3 B1C t.at t.e offender doe! or fail! to do an act8 BAC t.at t.e doing or t.e failure to do t.at act i! oluntar-8 BFC t.at it 'e /it.out &alice8 B$C t.at &aterial da&age re!ult! fro& t.e rec;le!! i&%rudence8 and B(C t.at t.ere i! ine5cu!a'le lac; of %recaution on t.e %art of t.e offender" ta;ing into con!ideration .i! e&%lo-&ent or occu%ation" degree of intelligence" %.-!ical condition" and ot.er circu&!tance! regarding %er!on!" ti&e and %lace. :.et.er or not a %.-!ician .a! co&&itted an Xine5cu!a'le lac; of %recautionX in t.e treat&ent of .i! %atient i! to 'e deter&ined according to t.e !tandard of care o'!er ed 'ot.er &e&'er! of t.e %rofe!!ion in good !tanding under !i&ilar circu&!tance! 'earing in &ind t.e ad anced !tate of t.e %rofe!!ion at t.e ti&e of treat&ent or t.e %re!ent !tate of &edical !cience.1AH2 In t.e recent ca!e of "eonila $arcia-Rueda v. <il3red ". Pacasio, et. al."1A*2 t.i! Court !tated t.at in acce%ting a ca!e" a doctor in effect re%re!ent! t.at" .a ing t.e needed training and !;ill %o!!e!!ed '- %.-!ician! and !urgeon! %racticing in t.e !a&e field" .e /ill e&%lo- !uc. training" care and !;ill in t.e treat&ent of .i! %atient!. 7e t.erefore .a! a dut- to u!e at lea!t t.e !a&e le el of care t.at an- ot.er rea!ona'lco&%etent doctor /ould u!e to treat a condition under t.e !a&e circu&!tance!. It i! in t.i! a!%ect of &edical &al%ractice t.at e5%ert te!ti&on- i! e!!ential to e!ta'li!. not onl- t.e !tandard of care of t.e %rofe!!ion 'ut al!o t.at t.e %.-!icianV! conduct in t.e treat&ent and care fall! 'elo/ !uc. !tandard.1A#2 =urt.er" ina!&uc. a! t.e cau!e! of t.e inEurie! in ol ed in &al%ractice action! are deter&ina'le onl- in t.e lig.t of !cientific ;no/ledge" it .a! 'een recogni<ed t.at e5%ert te!ti&on- i! u!uall- nece!!ar- to !u%%ort t.e conclu!ion a! to cau!ation.1A)2 I&&ediatel- a%%arent fro& a re ie/ of t.e record! of t.i! ca!e i! t.e a'!ence of ane5%ert te!ti&on- on t.e &atter of t.e !tandard of care e&%lo-ed '- ot.er %.-!ician! of good !tanding in t.e conduct of !i&ilar o%eration!. T.e %ro!ecutionV! e5%ert /itne!!e! in t.e %er!on! of Dr. =lore!to Ari<ala and Dr. Nieto Sal ador" ?r. of t.e National @ureau of In e!tigation BN@IC onl- te!tified a! to t.e %o!!i'le cau!e of deat. 'ut did not enture to illu&inate t.e court on t.e &atter of t.e !tandard of care t.at %etitioner !.ould .a e e5erci!ed. All t.ree court! 'elo/ 'e/ail t.e inade6uac- of t.e facilitie! of t.e clinic and it! untidine!!8 t.e lac; of %ro i!ion! !uc. a! 'lood" o5-gen" and certain &edicine!8 t.e failure to !u'Eect t.e %atient to a cardio-%ul&onar- te!t %rior to t.e o%eration8 t.e o&i!!ion of anfor& of 'lood t-%ing 'efore tran!fu!ion8 and e en t.e !u'!e6uent tran!fer of L-dia to t.e San Pa'lo 7o!%ital and t.e reo%eration %erfor&ed on .er '- t.e %etitioner. @ut /.ile it &a- 'e true t.at t.e circu&!tance! %ointed out '- t.e court! 'elo/ !ee&ed 'e-ond ca il to con!titute rec;le!! i&%rudence on t.e %art of t.e !urgeon" t.i! conclu!ion i! !till 'e!t arri ed at not t.roug. t.e educated !ur&i!e! nor conEecture! of la-&en" including Eudge!" 'ut '- t.e un6ue!tiona'le ;no/ledge of e5%ert /itne!!e!. =or /.et.er a %.-!ician or !urgeon .a! e5erci!ed t.e re6ui!ite degree of !;ill and care in t.e treat&ent of .i! %atient i!" in t.e generalit- of ca!e!" a &atter of e5%ert o%inion.1FG2 T.e deference of court! to t.e

e5%ert o%inion of 6ualified %.-!ician! !te&! fro& it! reali<ation t.at t.e latter %o!!e!! unu!ual tec.nical !;ill! /.ic. la-&en in &o!t in!tance! are inca%a'le of intelligentle aluating.1F12 E5%ert te!ti&on- !.ould .a e 'een offered to %ro e t.at t.e circu&!tance! cited '- t.e court! 'elo/ are con!tituti e of conduct falling 'elo/ t.e !tandard of care e&%lo-ed '- ot.er %.-!ician! in good !tanding /.en %erfor&ing t.e !a&e o%eration. It &u!t 'e re&e&'ered t.at /.en t.e 6ualification! of a %.-!ician are ad&itted" a! in t.e in!tant ca!e" t.ere i! an ine ita'le %re!u&%tion t.at in %ro%er ca!e! .e ta;e! t.e nece!!ar- %recaution and e&%lo-! t.e 'e!t of .i! ;no/ledge and !;ill in attending to .i! client!" unle!! t.e contrar- i! !ufficientl- e!ta'li!.ed.1FA2 T.i! %re!u&%tion i! re'utta'le 'e5%ert o%inion /.ic. i! !o !adl- lac;ing in t.e ca!e at 'enc.. E en granting arguendo t.at t.e inade6uac- of t.e facilitie! and untidine!! of t.e clinic8 t.e lac; of %ro i!ion!8 t.e failure to conduct %re-o%eration te!t! on t.e %atient8 and t.e !u'!e6uent tran!fer of L-dia to t.e San Pa'lo 7o!%ital and t.e reo%eration %erfor&ed on .er '- t.e %etitioner do indicate" e en /it.out e5%ert te!ti&on-" t.at %etitioner /a! rec;le!!l- i&%rudent in t.e e5erci!e of .er dutie! a! a !urgeon" no cogent %roof e5i!t! t.at an- of t.e!e circu&!tance! cau!ed %etitionerV! deat.. T.u!" t.e a'!ence of t.e fourt. ele&ent of rec;le!! i&%rudence3 t.at t.e inEur- to t.e %er!on or %ro%ert- /a! a con!e6uence of t.e rec;le!! i&%rudence. In litigation! in ol ing &edical negligence" t.e %laintiff .a! t.e 'urden of e!ta'li!.ing a%%ellantV! negligence and for a rea!ona'le conclu!ion of negligence" t.ere &u!t 'e %roof of 'reac. of dut- on t.e %art of t.e !urgeon a! /ell a! a ca!ual connection of !uc. 'reac. and t.e re!ulting deat. of .i! %atient. 1FF2 In Chan "uga% v. ,t "u!e=s >ospital, ?nc. " 1F$2 /.ere t.e attending %.-!ician /a! a'!ol ed of lia'ilit- for t.e deat. of t.e co&%lainantV! /ife and ne/'orn 'a'-" t.i! court .eld t.at3 XIn order t.at t.ere &a- 'e a reco er- for an inEur-" .o/e er" it &u!t 'e !.o/n t.at t.e VinEur- for /.ic. reco er- i! !oug.t &u!t 'e t.e legiti&ate con!e6uence of t.e /rong done8 t.e connection 'et/een t.e negligence and t.e inEur- &u!t 'e a direct and natural !e6uence of e ent!" un'ro;en '- inter ening efficient cau!e!.V In ot.er /ord!" t.e negligence &u!t 'e t.e %ro5i&ate cau!e of t.e inEur-. =or" Vnegligence" no &atter in /.at it con!i!t!" cannot create a rig.t of action unle!! it i! t.e %ro5i&ate cau!e of t.e inEurco&%lained of.V And Vt.e %ro5i&ate cau!e of an inEur- i! t.at cau!e" /.ic." in natural and continuou! !e6uence" un'ro;en '- an- efficient inter ening cau!e" %roduce! t.e inEur-" and /it.out /.ic. t.e re!ult /ould not .a e occurred.VVV1F(2 B>nder!coring !u%%lied.C Dr. Ari<ala /.o conducted an auto%!- on t.e 'od- of t.e decea!ed !u&&ari<ed .i! finding! a! follo/!3 XAtt-. Cac.ero3 S. Kou &entioned a'out -our Auto%!- Re%ort /.ic. .a! 'een &ar;ed a! E5.. XA-1-'X. T.ere a%%ear! .ere a !ignature a'o e t.e t-%e/ritten na&e =lore!to Ari<ala" ?r." /.o!e !ignature i! t.at0 A. T.at i! &- !ignature" !ir.

S. Do -ou affir& t.e trut. of all t.e content! of E5.. XA-1-'X0 A. +nl- a! to t.e auto%!- re%ort no. )1-G)" t.e ti&e and %lace and e er-t.ing after t.e %o!t &orte& finding!" !ir.

S. Kou &entioned on -our XPo!t Morte& =inding!X a'out !urgical inci!ion" 1$3G c&." infrau&'ilical area" anterior a'do&inal area" &idline" /ill -ou %lea!e e5%lain t.at in -our o/n language0 A. T.ere /a! inci!ion /ound B!icC t.e area Eu!t 'elo/ t.e na el" !ir.

S. And t.e la!t %aragra%. of t.e %o!t&orte& finding! /.ic. I read3 >teru!" %ear!.a%ed and %ale &ea!uring *.( 5 (.( 5 (.G c&" /it. !o&e !urface nodulation of t.e fundic area %o!teriorl-. Cut-!ection !.o/! diffu!el- %ale &-o&etriu& /it. area! of !trea; induration. T.e o arie! and adne5al !tructure! are &i!!ing /it. t.e ra/ !urface! %atc.ed /it. clotted 'lood. Surgical !uture! /ere noted on t.e o%erati e !ite. Inte!tine! and &e!enterie! are %ale /it. 'lood clot! noted 'et/een t.e &e!entric fold!. 7e&o%eritoniu&3 FGG !.!." rig.t %aracolic gutter" (G c.c." left %aracolic gutter AGG c.c." &e!entric area" 1GG c.c." rig.t %el ic gutter !to&ac. e&%t-. +t.er i!ceral organ!" %ale.V" /ill -ou %lea!e e5%lain ordinar-YYYYY A. t.at on B!icC -our o/n language or in

T.ere /a! a uteru! /.ic. /a! not attac.ed to t.e adne5al !tructure! na&elo arie! /.ic. /ere not %re!ent and al!o !ign of %re iou! !urgical o%eration and t.ere /ere B!icC clotted 'lood" !ir.

S. 7o/ a'out t.e o arie! and adne5al !tructure!0 A. T.e- are &i!!ing" !ir.

S. Kou &ean to !a- t.ere are no o arie!0 A. During t.at ti&e t.ere are no o arie!" !ir.

S. And t.ere /ere li;e/i!e !ign of !urgical !uture!0 A. Ke!" !ir.

S. 7o/ a'out t.e inte!tine! and &e!enterie! are %lace B!icC /it. 'lood clot! noted 'et/een t.e &e!enteric fold!" /ill -ou %lea!e e5%lain on B!icC t.i!0

A.

In t.e %eritoneal ca it-" t.e- are &o!tl- %erritonial 'loodYYY.

S. And /.at could .a e cau!ed t.i! 'lood0 A. :ell" ordinaril- 'lood i! found in!ide t.e 'lood e!!el. @lood /ere B!icC out!ide a! a re!ult of t.e inEurie! /.ic. de!tro-ed t.e integrit- of t.e e!!el allo/ing 'lood to !i% B!icC out" !ir.

S. @- t.e nature of t.e %o!t&orte& finding! indicated in E5.. A-1-@" can -ou tell t.e court t.e cau!e of deat.0 A. Ke!" !ir. T.e cau!e of deat. i!3 Gro!! finding! are co&%ati'le /it. .e&orr.agic !.oc;.

S. Can -ou tell t.e u! /.at could .a e cau!ed t.i! .e&orr.agic !.oc;0 A. :ell .e&orr.agic !.oc; i! t.e re!ult of 'lood lo!!.

S. :.at could .a e t.e effect of t.at lo!! of 'lood0 A. >nattended .e&orr.age" !ir.1FH2 B>nder!coring !u%%lied.C

T.e foregoing /a! corro'orated '- Dr. Nieto Sal ador3 XS. And /ere -ou a'le to deter&ine t.e cau!e of deat. 'e5a&ination of t.e !%eci&en !u'&itted '- Dr. Ari<ala0 A. irtue of t.e

:it.out ;no/ledge of t.e auto%!- finding! it /ould 'e difficult for &e to deter&ine t.e cau!e of deat." !ir.

S. 7a e -ou e5a&ined t.e %o!t &orte& of Dr. Ari<ala0 A. Ke!" !ir" and '- irtue of t.e auto%!- re%ort in connection /it. -our %at.ologre%ort.

S. :.at could .a e cau!ed t.e deat. of t.e icti&0 A. T.i! %at.ologic e5a&ination are B!icC co&%ati'le /it. t.e %er!on /.o died" !ir.

S. :ill -ou e5%lain to u! t.e &eaning of .e&orr.agic co&%ati'le0 A. It &ean! t.at a %er!on died of 'lood lo!!. Meaning a %er!on died of nonre%lace&ent of 'lood and !o t.e icti& 'efore !.e died t.ere /a! !.oc; of di&ini!. of 'lood of t.e circulation. S.e died &o!t %ro'a'l- 'efore t.e actual co&%lete 'lood lo!!" !ir.

Court3 I! it %o!!i'le doctor t.at t.e lo!! of t.e 'lood /a! due on B!icC o%eration0 A. @a!ed on &- %at.olog- finding!" !ir.

S. :.at could .a e cau!ed t.i! lo!! of 'lood0 A. Man-" !ir. A %atient /.o .a e undergone !urger-. Anot.er &a- 'e a 'lood e!!el &a- 'e cut /.ile on o%eration and t.i! cau!e B!icC 'leeding" or &a- 'e !et in t.e cour!e of t.e o%eration" or &a- 'e B!icC .e died after t.e o%eration. +f cour!e t.ere are ot.er cau!e B!icC.

Att-. Cac.ero3 S. A. E!%eciall- !o doctor /.en t.ere /a! no 'lood re%lace&ent0 Ke!" !ir.X1F*2 B>nder!coring !u%%lied.C

T.e te!ti&onie! of 'ot. doctor! e!ta'li!. .e&orr.age or .e&orr.agic !.oc; a! t.e cau!e of deat.. 7o/e er" a! li;e/i!e te!tified to '- t.e e5%ert /itne!!e! in o%en court" .e&orr.age or .e&orr.agic !.oc; during !urger- &a- 'e cau!ed '- !e eral different factor!. T.u!" Dr. Sal adorV! ela'oration on t.e &atter3 XAtt-. Pa!cual3 S. Doctor" a&ong t.e cau!e! of .e&orr.age t.at -ou &entioned -ou !aid t.at it could 'e at t.e &o&ent of o%eration /.en one lo!!e! B!icC control of t.e %re!ence" i! t.at correct0 During t.e o%eration t.ere i! lo!t B!icC of control of t.e cut e!!el0 A. Ke!" !ir.

S. +r t.ere i! a failure to ligate a e!!el of con!idera'le !i<e0 A. Ke!" !ir.

S. +r e en if t.e e!!el /ere ligated t.e ;not &a- .a e !li%%ed later on0 A. Ke!" !ir.

S. And -ou al!o &entioned t.at it &a- 'e %o!!i'le al!o to !o&e clotting defect" i! t.at correct0 A. Ma- 'e B!icC.X1F#2 B>nder!coring !u%%liedC.

Defen!e /itne!!" Dr. @u C. Ca!tro al!o ga e t.e follo/ing e5%ert o%inion3 XS. Doctor e en a %atient after an o%eration! B!icC /ould !uffer .e&orrage /.at /ould 'e t.e %o!!i'le cau!e! of !uc. .e&orrage B!icC0 A. A&ong t.o!e /ould 'e /.at /e call Intra a!cular Coagulation and t.i! i! t.e rea!on for t.e 'leeding" !ir" /.ic. cannot 'e %re ented '- an-one" it /ill .a%%en to an-one" an-ti&e and to an- %er!on! B!icC" !ir.

C+>RT3

:.at do -ou t.in; of t.e cau!e of t.e 'leeding" t.e cutting or t.e o%eration! done in t.e 'od-0 A. Not related to t.i! one" t.e 'leeding .ere i! not related to an- cutting or o%eration t.at I B!icC .a e done.

S. A!ide fro& t.e DIC /.at could anot.er cau!e! B!icC t.at could 'e t.e cau!e for t.e .e&orr.age or 'leeding in a %atient '- an o%eration! B!icC0 A. In general !ir" if t.ere /a! an o%eration! B!icC and it i! %o!!i'le t.at t.e ligature in t.e !uture /a! B!icC 'eco&e B!icC loo!e" it i! B!icC 'eco&e! loo!e if %ro en. 555 555

555

S. If t.e %er!on /.o %erfor&ed an auto%!- doe! not find an- untig.t B!icC clot B!icC 'lood e!!el or an- !uture t.at 'eco&e B!icC loo!e t.e cau!e of t.e 'leeding could not 'e attri'uted to t.e fault of t.e !u'Eect0 A. Definitel-" !ir.X1F)2 B>nder!coring !u%%lied.C

According to 'ot. doctor!" t.e %o!!i'le cau!e! of .e&orr.age during an o%eration are3 B1C t.e failure of t.e !urgeon to tie or !uture a cut 'lood e!!el8 BAC allo/ing a cut 'lood e!!el to get out of control8 BFC t.e !u'!e6uent loo!ening of t.e tie or !uture a%%lied to a cut 'lood e!!el8 and B$C and a clotting defect ;no/n a! DIC. It i! !ignificant to !tate at t.i! Euncture t.at t.e auto%!- conducted '- Dr. Ari<ala on t.e 'od- of L-dia did not re eal an- untied or un!utured cut 'lood e!!el nor /a! t.ere an- indication t.at t.e tie or !uture of a cut 'lood e!!el .ad 'eco&e loo!e t.ere'- cau!ing t.e .e&orr.age.1$G2 7ence t.e follo/ing %ertinent %ortion of Dr. Ari<alaV! te!ti&on-3 XS3 Doctor" in e5a&ining t.e!e !tructure! did -ou ;no/ /.et.er t.e!e /ere !utured ligature or %lain ligature A3 Ligature" !ir.

S3 :e /ill e5%lain t.at later on. Did -ou recall if t.e cut !tructure! /ere tied 'fir!t !uturing it and t.en t-ing a ;not or t.e tie /a! &erel- %laced around t.e cut !tructure and tied0 A3 I cannot recall" !ir.

S3 A! a &atter of fact" -ou cannot recall 'ecau!e -ou did not e en 'ot.ered B!icC to e5a&ine" i! t.at correct0 A3 :ell" I 'ot.ered enoug. to ;no/ t.at t.e- /ere !utured" !ir.

S3 So" t.erefore" Doctor" -ou /ould not ;no/ /.et.er an- of t.e cut !tructure! /ere not !utured or tied neit.er /ere -ou a'le to deter&ine /.et.er an- loo!e !uture /a! found in t.e %eritoneal ca it-0 A3 I could not recall an- loo!e !utured B!icC" !ir.X1$12

+n t.e ot.er .and" t.e finding! of all t.ree doctor! do not %reclude t.e %ro'a'ilit- t.at DIC cau!ed t.e .e&orr.age and con!e6uentl-" L-diaV! deat.. DIC /.ic. i! a clotting defect create! a !eriou! 'leeding tendenc- and /.en &a!!i e DIC occur! a! a co&%lication of !urger- lea ing ra/ !urface" &aEor .e&orr.age occur!.1$A2 And a! te!tified to '- defen!e /itne!!" Dr. @u C. Ca!tro" .e&orr.age due to DIC Xcannot 'e %re ented" it /ill .a%%en to an-one" an-ti&e.X1$F2 7e te!tified furt.er3 XS. No/" under t.e circu&!tance one of t.e %o!!i'ilit- a! -ou &entioned in B!icC DIC0 A. Ke!" !ir.

S. And -ou &entioned t.at it cannot 'e %re ented0 A. Ke!" !ir.

S. Can -ou e en %redict if it reall- .a%%en B!icC0 A. Po!!i'le" !ir.

S. Are t.ere an- !%ecific finding! of auto%!- t.at /ill tell -ou /.et.er t.i! %atient !uffered a&ong !uc. t.ing! a! DIC0 A. :ell" I did re!er e 'ecau!e of t.e condition of t.e %atient.

S. No/" Doctor -ou !aid t.at -ou /ent t.roug. t.e record of t.e decea!ed L-dia >&ali loo;ing for t.e c.art" t.e o%erated B!icC record!" t.e %o!t &orte& finding! on t.e .i!to%.anic B!icC e5a&ination 'a!ed on -our e5a&ination of record" doctor" can -ou &ore or le!! !a-! B!icC /.at %art are B!icC concerned could .a e 'een t.e cau!ed B!icC of deat. of t.i! L-dia >&ali0 A. A! far a! t.e &edical record i! concern B!icC t.e cau!ed B!icC of deat. i! de!!i&ulated B!icC Intra ,a!cular Coagulation or t.e DIC /.ic. re!ulted to .e&orr.age or 'leeding!" !ir.

S. Doctor 'a!ed on -our finding! t.en t.ere i! ;no/ing B!icC t.e doctor /ould !a/.et.er t.e doctor .er B!icC .a! 'een B!icC fault0 ATTK. MAL,EDA3 :e /ill &o ed B!icC to !tri;e out t.e B!icC 'a!ed on finding t.e- Eu!t read t.e c.art a! /ell a! t.e ot.er record. ATTK. PASC>AL3 Preci!el- 'a!ed on t.i! e5a&ination. ATTK. MAL,EDA3 Not finding" t.ere /a! no finding &ade. C+>RT3

7e i! onl- reading t.e record. ATTK. PASC>AL3 Ke!" !ir. A. No" !ir" t.ere i! no fault on t.e %art of t.e !urgeon" !ir .X 1$$2

T.i! court .a! no recour!e 'ut to rel- on t.e e5%ert te!ti&onie! rendered '- 'ot. %ro!ecution and defen!e /itne!!e! t.at !u'!tantiate rat.er t.an contradict %etitionerV! allegation t.at t.e cau!e of L-diaV! deat. /a! DIC /.ic." a! atte!ted to '- an e5%ert /itne!!" cannot 'e attri'uted to t.e %etitionerV! fault or negligence. T.e %ro'a'ilit- t.at L-diaV! deat. /a! cau!ed '- DIC /a! unre'utted during trial and .a! engendered in t.e &ind of t.i! Court a rea!ona'le dou't a! to t.e %etitionerV! guilt. T.u!" .er ac6uittal of t.e cri&e of rec;le!! i&%rudence re!ulting in .o&icide. :.ile /e condole /it. t.e fa&il- of L-dia >&ali" our .and! are 'ound '- t.e dictate! of Eu!tice and fair dealing /.ic. .old in iola'le t.e rig.t of an accu!ed to 'e %re!u&ed innocent until %ro en guilt- 'e-ond rea!ona'le dou't. Ne ert.ele!!" t.i! Court find! t.e %etitioner ci ill- lia'le for t.e deat. of L-dia >&ali" for /.ile a con iction of a cri&e re6uire! %roof 'e-ond rea!ona'le dou't" onla %re%onderance of e idence i! re6uired to e!ta'li!. ci il lia'ilit-.1$(2 T.e %etitioner i! a doctor in /.o!e .and! a %atient %ut! .i! life and li&'. =or in!ufficienc- of e idence t.i! Court /a! not a'le to render a !entence of con iction 'ut it i! not 'lind to t.e rec;le!! and i&%rudent &anner in /.ic. t.e %etitioner carried out .er dutie!. A %reciou! life .a! 'een lo!t and t.e circu&!tance! leading t.ereto e5acer'ated t.e grief of t.o!e left 'e.ind. T.e .eir! of t.e decea!ed continue to feel t.e lo!! of t.eir &ot.er u% to t.e %re!ent ti&e1$H2 and t.i! Court i! a/are t.at no a&ount of co&%a!!ion and co&&i!eration nor /ord! of 'erea e&ent can !uffice to a!!uage t.e !orro/ felt for t.e lo!! of a lo ed one. Certainl-" t.e a/ard of &oral and e5e&%lar- da&age! in fa or of t.e .eir! of L-dia >&ali are %ro%er in t.e in!tant ca!e. &ERE!ORE" %re&i!e! con!idered" %etitioner DR. NINE,ETC7 CR>M i! .ere'ACS>ITTED of t.e cri&e of rec;le!! i&%rudence re!ulting in .o&icide 'ut i! ordered to %a- t.e .eir! of t.e decea!ed L-dia >&ali t.e a&ount of =I=TK T7+>SAND PES+S BP(G"GGG.GGC a! ci il lia'ilit-" +NE 7>NDRED T7+>SAND PES+S BP1GG"GGG.GGC a! &oral da&age!" and =I=TK T7+>SAND PES+S BP(G"GGG.GGC a! e5e&%lar- da&age!. Let t.e co%- of t.i! deci!ion 'e furni!.ed to t.e Profe!!ional Regulation Co&&i!!ion BPRCC for a%%ro%riate action. SO ORDERED. Romero, Melo, and Pangani'an, JJ., concur. 0arvasa, C.J., (Chairman), on lea e.

,I.

+t.er a%%lica'le doctrine! A. @. Contri'utor- negligence A!!u&%tion of ri!;

C. D. E. =.

La!t clear c.ance Inde%endent Contractor3 e&%lo-er-e&%lo-ee relation!.i% Re! i%!a lo6uitur3 re6ui!ite! @ati6uin !. CA" G.R. No. 11#AF1" 1))H

T7IRD DI,ISI+N

[G.R. No. 118?<1. %2)6 5, 199;]

DR. +IC$ORIA L. #A$I,UIN ('3 ALLAN #A$I,UIN, petitioners, vs. COUR$ O! A""EALS, S"OUSES ,UEDO D. ACOGIDO ('3 !LO$ILDE G. +ILLEGAS, respondents. DECISION DA+IDE, %R., J.7 T.roug.out .i!tor-" %atient! .a e con!igned t.eir fate! and li e! to t.e !;ill of t.eir doctor!. =or a 'reac. of t.i! tru!t" &en .a e 'een 6uic; to de&and retri'ution. So&e $"GGG -ear! ago" t.e Code of 7a&&ura'i112 t.en alread- %ro ided3 XIf a %.-!ician &a;e a dee% inci!ion u%on a &an /it. .i! 'ron<e lancet and cau!e t.e &anV! deat." or o%erate on t.e e-e !oc;et of a &an /it. .i! 'ron<e lancet and de!tro- t.e &anV! e-e!" t.e- !.all cut off .i! .and.X1A2 Su'!e6uentl-" 7i%%ocrate!1F2 /rote /.at /a! to 'eco&e %art of t.e .ealerV! oat.3 XI /ill follo/ t.at &et.od of treat&ent /.ic. according to &- a'ilit- and Eudg&ent" I con!ider for t.e 'enefit of &- %atient!" and a'!tain fro& /.ate er i! deleteriou! and &i!c.ie ou! . . . . :.ile I continue to ;ee% t.i! oat. un iolated &a- it 'e granted &e to enEo- life and %ractice t.e art" re!%ected '- all &en at all ti&e! 'ut !.ould I tre!%a!! and iolate t.i! oat." &a- t.e re er!e 'e &- lot.X At %re!ent" t.e %ri&aro'Eecti e of t.e &edical %rofe!!ion i! t.e %re!er ation of life and &aintenance of t.e .ealt. of t.e %eo%le.1$2 Needle!! to !a- t.en" /.en a %.-!ician !tra-! fro& .i! !acred dut- and endanger! in!tead t.e life of .i! %atient" .e &u!t 'e &ade to an!/er t.erefor. Alt.oug. !ociet- todacannot and /ill not tolerate t.e %uni!.&ent &eted out '- t.e ancient!" neit.er /ill it and t.i! Court" a! t.i! ca!e /ould !.o/" let t.e act go unconde&ned. T.e %etitioner! a%%eal fro& t.e deci!ion1(2 of t.e Court of A%%eal! of 11 Ma- 1))$ in CA-G.R. C, No. FG#(1" /.ic. re er!ed t.e deci!ion1H2 of A1 Dece&'er 1))G of @ranc. FG of t.e Regional Trial Court BRTCC of Negro! +riental in Ci il Ca!e No. )$)A. T.e fact!" a! found '- t.e trial court" are a! follo/!3 Dr. @ati6uin /a! a Re!ident P.-!ician at t.e Negro! +riental Pro incial 7o!%ital" Du&aguete Cit- fro& ?anuar- )" 1)*# to Se%te&'er 1)#). @et/een 1)#* and Se%te&'er" 1)#) !.e /a! al!o t.e Actg. 7ead of t.e De%art&ent of +'!tetric! and

G-necolog- at t.e !aid 7o!%ital. Mr!. ,illega! i! a &arried /o&an /.o !u'&itted to Dr. @ati6uin for %renatal care a! t.e latterV! %ri ate %atient !o&eti&e 'efore Se%te&'er A1" 1)##. In t.e &orning of Se%te&'er A1" 1)## Dr. @ati6uin" /it. t.e a!!i!tance of Dr. Dori! Tere!ita S- /.o /a! al!o a Re!ident P.-!ician at t.e !a&e 7o!%ital" C.I. and +.R. Nur!e Arlene Dione! and !o&e !tudent nur!e! %erfor&ed a !i&%le ce!arean !ection on Mr!. ,illega! at t.e Negro! +riental Pro incial 7o!%ital and after $( &inute! Mr!. ,illega! deli ered .er fir!t c.ild" Rac.el Acogido" at a'out 113$( t.at &orning. T.ereafter" Plaintiff re&ained confined at t.e 7o!%ital until Se%te&'er A*" 1)## during /.ic. %eriod of confine&ent !.e /a! regularl- i!ited '- Dr. @ati6uin. +n Se%te&'er A#" 1)##" Mr!. ,illega! c.ec;ed out of t.e 7o!%ital . . . and on t.e !a&e da- !.e %aid Dr. @ati6uin" t.ru t.e latterV! !ecretar-" t.e a&ount of P1"(GG.GG a! X%rofe!!ional feeX . . . . Soon after lea ing t.e 7o!%ital Mr!. ,illega! 'egan to !uffer a'do&inal %ain! and co&%lained of 'eing fe eri!.. S.e al!o graduall- lo!t .er a%%etite" !o !.e con!ulted Dr. @ati6uin at t.e latterV! %ol-clinic /.o %re!cri'ed for .er certain &edicine! . . . /.ic. !.e .ad 'een ta;ing u% to Dece&'er" 1)##. In t.e &eanti&e" Mr!. ,illega! /a! gi en a Medical Certificate '- Dr. @ati6uin on +cto'er F1" 1)## . . . certif-ing to .er %.-!ical fitne!! to return to .er /or; on No e&'er *" 1)##. So" on t.e !econd /ee; of No e&'er" 1)## Mr!. ,illega! returned to .er /or; at t.e Rural @an; of A-ungon" Negro! +riental. T.e a'do&inal %ain! and fe er ;e%t on recurring and 'ot.ered Mr!. ,illega! no end and de!%ite t.e &edication! ad&ini!tered '- Dr. @ati6uin. :.en t.e %ain! 'eco&e un'eara'le and !.e /a! ra%idl- lo!ing /eig.t !.e con!ulted Dr. Ma. Salud J.o at t.e 7olC.ildV! 7o!%ital in Du&aguete Cit- on ?anuar- AG" 1)#). T.e e idence of Plaintiff! !.o/ t.at /.en Dr. Ma. Salud J.o e5a&ined Mr!. ,illega! at t.e 7ol- C.ildV! 7o!%ital on ?anuar- AG" 1)#) !.e found Mr!. ,illega! to 'e fe eri!." %ale and /a! 'reat.ing fa!t. >%on e5a&ination !.e felt an a'do&inal &a!! one finger 'elo/ t.e u&'ilicu! /.ic. !.e !u!%ected to 'e eit.er a tu&or of t.e uteru! or an o arian c-!t" eit.er of /.ic. could 'e cancerou!. S.e .ad an 5-ra- ta;en of Mr!. ,illega!V c.e!t" a'do&en and ;idne-. S.e al!o too; 'lood te!t! of Plaintiff. A 'lood count !.o/ed t.at Mr!. ,illega! .ad 1an2 infection in!ide .er a'do&inal ca it-. T.e re!ult of all t.o!e e5a&ination! i&%elled Dr. J.o to !ugge!t t.at Mr!. ,illega! !u'&it to anot.er !urger- to /.ic. t.e latter agreed. :.en Dr. J.o o%ened t.e a'do&en of Mr!. ,illega! !.e found /.iti!.--ello/ di!c.arge in!ide" an o arian c-!t on eac. of t.e left and rig.t o arie! /.ic. ga e out %u!" dirt and %u! 'e.ind t.e uteru!" and a %iece of ru''er &aterial! on t.e rig.t !ide of t.e uteru! e&'edded on 1!ic2 t.e o arian c-!t" A inc.e! '- FI$ inc. in !i<e. T.i! %iece of ru''er &aterial /.ic. Dr. J.o de!cri'ed a! a Xforeign 'od-X loo;ed li;e a %iece of a Xru''er glo eX . . . and /.ic. i! 1!ic2 al!o Xru''er-drain li;e9 . . . . It could .a e 'een a torn !ection of a !urgeonV! glo e! or could .a e co&e fro& ot.er !ource!. And t.i! foreign 'od- /a! t.e cau!e of t.e infection of t.e o arie! and con!e6uentl- of all t.e di!co&fort !uffered '- Mr!. ,illega! after .er deli er- on Se%te&'er A1" 1)##.1*2 T.e %iece of ru''er allegedl- found near %ri ate re!%ondent =lotilde ,illega!V uteru! /a! not %re!ented in court" and alt.oug. Dr. Ma. Salud J.o te!tified t.at !.e !ent it to a

%at.ologi!t in Ce'u Cit- for e5a&ination"1#2 it /a! not &entioned in t.e %at.ologi!tV! Surgical Pat.olog- Re%ort.1)2 A!ide fro& Dr. J.oV! te!ti&on-" t.e e idence /.ic. &entioned t.e %iece of ru''er are a Medical Certificate"11G2 a Progre!! Record"1112 an Ane!t.e!ia Record"11A2 a Nur!eV! Record"11F2and a P.-!icianV! Di!c.arge Su&&ar-.11$2 T.e trial court" .o/e er" regarded t.e!e docu&entar- e idence a! &ere .ear!a-" Xt.ere 'eing no !.o/ing t.at t.e %er!on or %er!on! /.o %re%ared t.e& are decea!ed or una'le to te!tif- on t.e fact! t.erein !tated . . . . E5ce%t for t.e Medical Certificate BE5.i'it X=XC" all t.e a'o e docu&ent! /ere allegedl%re%ared '- %er!on! ot.er t.an Dr. J.o" and !.e &erel- affi5ed .er !ignature on !o&e of t.e& to e5%re!! .er agree&ent t.ereto . . . .X11(2 T.e trial court al!o refu!ed to gi e /eig.t to Dr. J.oV! te!ti&on- regarding t.e !u'Eect %iece of ru''er a! Dr. J.o X&a- not .a e .ad fir!t-.and ;no/ledgeX t.ereof"11H2 a! could 'e gleaned fro& .er !tate&ent" t.u!3 A . . . I .a e .eard !o&e'od- t.at 1!ic2 !a-! 1!ic2 t.ere i! 1!ic2 a foreign 'od- t.at goe! /it. t.e ti!!ue! 'ut unluc;il- I donVt ;no/ /.ere t.e ru''er /a!.11*2

T.e trial court dee&ed ital Dr. ,ictoria @ati6uinV! te!ti&on- t.at /.en !.e confronted Dr. J.o regarding t.e %iece of ru''er" XDr. J.o an!/ered t.at t.ere /a! ru''er indeed 'ut t.at !.e t.re/ it a/a-.X11#2 T.i! !tate&ent" t.e trial court noted" /a! ne er denied nor di!%uted '- Dr. J.o" leading it to conclude3 T.ere are no/ t/o different er!ion! on t.e /.erea'out! of t.at offending Xru''erX ] B1C t.at it /a! !ent to t.e Pat.ologi!t in Ce'u a! te!tified to in Court '- Dr. J.o and BAC t.at Dr. J.o t.re/ it a/a- a! told '- .er to Defendant. T.e failure of t.e Plaintiff! to reconcile t.e!e t/o different er!ion! !er e onl- to /ea;en t.eir clai& again!t Defendant @ati6uin. 11)2 All told" t.e trial court .eld in fa or of t.e %etitioner! .erein. T.e Court of A%%eal! re ie/ed t.e entiret- of Dr. J.oV! te!ti&on- and" e en /it.out ad&itting t.e %ri ate re!%ondent!V docu&entar- e idence" dee&ed Dr. J.oV! %o!iti e te!ti&on- to definitel- e!ta'li!. t.at a %iece of ru''er /a! found near %ri ate re!%ondent ,illega!V uteru!. T.u!" t.e Court of A%%eal! re er!ed t.e deci!ion of t.e trial court" .olding3 $. T.e fault or negligence of a%%ellee Dr. @ati6uin i! e!ta'li!.ed '- %re%onderance of e idence. T.e trial court it!elf .ad narrated /.at .a%%ened to a%%ellant =lotilde after t.e ce!arean o%eration &ade '- a%%ellee doctor . . . . After t.e !econd o%eration" a%%ellant =lotilde 'eca&e /ell and .ealt.-. A%%ellant =lotildeV! trou'le! /ere cau!ed '- t.e infection due to t.e Xru''erX t.at /a! left in!ide .er a'do&en. @ot. a%%ellant! te!tified t.at after t.e o%eration &ade '- a%%ellee doctor" t.e- did not go to an- ot.er doctor until t.e- finall- decided to !ee anot.er doctor in ?anuar-" 1)#) /.en !.e /a! not getting an'etter under t.e care of a%%ellee Dr. @ati6uin . . . . A%%ellee Dr. @ati6uin ad&itted on t.e /itne!! !tand t.at !.e alone decided /.en to clo!e t.e o%erating area8 t.at !.e e5a&ined t.e %ortion !.e o%erated on 'efore clo!ing t.e !a&e . . . . 7ad !.e e5erci!ed due diligence" a%%ellee Dr. @ati6uin /ould .a e found t.e ru''er and re&o ed it 'efore clo!ing t.e o%erating area.1AG2 T.e a%%ellate court t.en ruled3 A%%ellant!V e idence !.o/1!2 t.at t.e- %aid a total of P1*"GGG.GG 1de%o!it of P*"1GG.GG BE5.. G-1-AC %lu! .o!%ital and &edical e5%en!e! toget.er /it. doctorV! fee! in t.e total a&ount P)")GG.GG BE5.!. G and G-AC2 for t.e !econd o%eration t.at !a ed .er life.

=or t.e &i!erie! a%%ellant! endured for &ore t.an t.ree BFC &ont.!" due to t.e negligence of a%%ellee Dr. @ati6uin" t.e- are entitled to &oral da&age! in t.e a&ount of P1GG"GGG.GG8 e5e&%lar- da&age! in t.e a&ount of PAG"GGG.GG and attorne-V! fee! in t.e a&ount of PA("GGG.GG. T.e fact t.at a%%ellant =lotilde can no longer 'ear c.ildren 'ecau!e .er uteru! and o arie! /ere re&o ed '- Dr. J.o i! not ta;en into con!ideration a! it i! not !.o/n t.at t.e re&o al of !aid organ! /ere t.e direct re!ult of t.e ru''er left '- a%%ellee Dr. @ati6uin near t.e uteru!. :.at i! e!ta'li!.ed i! t.at t.e ru''er left '- a%%ellee cau!e infection" %laced t.e life of a%%ellant =lotilde in Eeo%ard- and cau!ed a%%ellant! fear" /orr- and an5iet- . . . . :7ERE=+RE" t.e a%%ealed Eudg&ent" di!&i!!ing t.e co&%laint for da&age! i! RE,ERSED and SET ASIDE. Anot.er Eudg&ent i! .ere'- entered ordering defendant!a%%ellee! to %a- %laintiff!-a%%ellant! t.e a&ount! of P1*"GGG.GG a! and for actual da&age!8 P1GG"GGG.GG a! and for &oral da&age!8 PAG"GGG.GG a! and for e5e&%larda&age!8 and PA("GGG.GG a! and for attorne-V! fee! %lu! t.e co!t of litigation. S+ +RDERED.1A12 =ro& t.e a'o e Eudg&ent" t.e %etitioner! a%%ealed to t.i! Court clai&ing t.at t.e a%%ellate court8 B1C co&&itted gra e a'u!e of di!cretion '- re!orting to finding! of fact not !u%%orted '- t.e e idence on record" and BAC e5ceeded it! di!cretion" a&ounting to lac; or e5ce!! of Euri!diction" /.en it ga e credence to te!ti&onie! %unctured /it. contradiction! and fal!itie!. T.e %ri ate re!%ondent! co&&ented t.at t.e %etition rai!ed onl- 6ue!tion! of fact" /.ic. /ere not %ro%er for re ie/ '- t.i! Court. :.ile t.e rule i! t.at onl- 6ue!tion! of la/ &a- 'e rai!ed in a %etition for re ie/ on certiorari" t.ere are e5ce%tion!" a&ong /.ic. are /.en t.e factual finding! of t.e trial court and t.e a%%ellate court conflict" /.en t.e a%%ealed deci!ion i! clearl- contradicted '- t.e e idence on record" or /.en t.e a%%ellate court &i!a%%re.ended t.e fact!.1AA2 After deci%.ering t.e cr-%tic %etition" /e find t.at t.e focal %oint of t.e in!tant a%%eal i! t.e a%%reciation of Dr. J.oV! te!ti&on-. T.e %etitioner! contend t.at t.e Court of A%%eal! &i!a%%reciated t.e follo/ing %ortion of Dr. J.oV! te!ti&on-3 S A :.at i! t.e %ur%o!e of t.e e5a&ination0 ?u!t in ca!e" I /a! Eu!t t.in;ing at t.e 'ac; of &- &ind" Eu!t in ca!e t.i! /ould turn out to 'e a &edico-legal ca!e , ? have heard some'od% that HsicI sa%s HsicI there is HsicI a 3oreign 'od% that goes 7ith the tissues 'ut unluc!il% ? don=t !no7 7here the ru''er 7as. It /a! not in t.e La'" it /a! not in Ce'u.1AF2 BItalic! !u%%liedC

T.e %etitioner! %refer t.e trial courtV! inter%retation of t.e a'o e te!ti&on-" i.e." t.at Dr. J.oV! ;no/ledge of t.e %iece of ru''er /a! 'a!ed on .ear!a-. T.e Court of A%%eal!" on t.e ot.er .and" concluded t.at t.e under!cored %.ra!e /a! ta;en out of conte5t '- t.e trial court. According to t.e Court of A%%eal!" t.e trial court !.ould .a e li;e/i!e con!idered t.e ot.er %ortion! of Dr. J.oV! te!ti&on-" e!%eciall- t.e follo/ing3 S So -ou did actuall- conduct t.e o%eration on .er0

A S A

Ke!" I did. And /.at /a! t.e re!ult0 +%ening u% .er a'do&en" t.ere /a! /.iti!.--ello/ di!c.arge in!ide t.e a'do&en" t.ere /a! an o arian c-!t on t.e left and !ide and t.ere /a! al!o an o arian c-!t on t.e rig.t /.ic." on o%ening u% or freeing it u% fro& t.e uteru!" turned out to 'e %u!. @ot. o arie! turned out . . . to .a e %u!. And t.en" cleaning u% t.e uteru!" at t.e 'ac; of t.e uteru! it /a! er- dirt-" it /a! full of %u!. And t.ere /a! a 1%iece of2 ru''er" /e found a 1%iece of2 ru''er on t.e rig.t !ide.1A$2

:e agree /it. t.e Court of A%%eal!. T.e %.ra!e relied u%on '- t.e trial court doe! not negate t.e fact t.at Dr. J.o !a/ a %iece of ru''er in %ri ate re!%ondent ,illega!V a'do&en" and t.at !.e !ent it to a la'orator- and t.en to Ce'u Cit- for e5a&ination '- a %at.ologi!t.1A(2 Not e en t.e Pat.ologi!tV! Re%ort" alt.oug. de oid of an- &ention of a %iece of ru''er" could alter /.at Dr. J.o !a/. =urt.er&ore" Dr. J.oV! ;no/ledge of t.e %iece of ru''er could not 'e 'a!ed on ot.er t.an fir!t .and ;no/ledge for" a! !.e a!!erted 'efore t.e trial court3 S A @ut -ou are !ure -ou .a e !een 1t.e %iece of ru''er20 +. -e!. I /a! not t.e onl- one /.o !a/ it.1AH2

T.e %etitioner! e&%.a!i<e t.at t.e %ri ate re!%ondent! ne er reconciled Dr. J.oV! te!ti&on- /it. Dr. @ati6uinV! clai& on t.e /itne!! !tand t.at /.en Dr. @ati6uin confronted Dr. J.o a'out t.e foreign 'od-" t.e latter !aid t.at t.ere /a! a %iece of ru''er 'ut t.at !.e t.re/ it a/a-. Alt.oug. .ear!a-" Dr. @ati6uinV! clai& /a! not o'Eected to" and .ence" t.e !a&e i! ad&i!!i'le1A*2 'ut it carrie! no %ro'ati e alue.1A#2 Ne ert.ele!!" a!!u&ing ot.er/i!e" Dr. @ati6uinV! !tate&ent cannot 'elie t.e fact t.at Dr. J.o found a %iece of ru''er near %ri ate re!%ondent ,illega!V uteru!. And e en if /e /ere to dou't Dr. J.o a! to /.at !.e did to t.e %iece of ru''er" i.e., /.et.er !.e t.re/ it a/a- or !ent it to Ce'u Cit-" /e are not Eu!tified in di!tru!ting .er a! to .er reco er- of a %iece of ru''er fro& %ri ate re!%ondent ,illega!V a'do&en. +n t.i! !core" it i! %erfectl- rea!ona'le to 'elie e t.e te!ti&on- of a /itne!! /it. re!%ect to !o&e fact! and di!'elie e .i! te!ti&on- /it. re!%ect to ot.er fact!. And it .a! 'een a%tl- !aid t.at e en /.en a /itne!! i! found to .a e deli'eratel- fal!ified in !o&e &aterial %articular!" it i! not re6uired t.at t.e /.ole of .i! uncorro'orated te!ti&on- 'e reEected" 'ut !uc. %ortion! t.ereof dee&ed /ort.- of 'elief &a- 'e credited.1A)2 It i! .ere /ort. not.ing t.at t.e trial court %aid .eed to t.e follo/ing %ortion! of Dr. @ati6uinV! te!ti&on-3 t.at no ru''er drain /a! u!ed in t.e o%eration"1FG2 and t.at t.ere /a! neit.er an- tear on Dr. @ati6uinV! glo e! after t.e o%eration nor 'lood !&ear! on .er .and! u%on re&o ing .er glo e!.1F12 Moreo er" t.e trial court %ointed out t.at t.e a'!ence of a ru''er drain /a! corro'orated '- Dr. Dori! S-" Dr. @ati6uinV! a!!i!tant during t.e o%eration on %ri ate re!%ondent ,illega!.1FA2 @ut t.e trial court failed to recogni<e t.at t.e a!!ertion! of Dr!. @ati6uin and S- /ere denial! or negati e te!ti&onie!. :ell-!ettled i! t.e rule t.at %o!iti e te!ti&on- i! !tronger t.an negati e te!ti&on-.1FF2 +f cour!e" a! t.e %etitioner! ad ocate" !uc. %o!iti e te!ti&on- &u!t co&e fro& a credi'le !ource" /.ic. lead! u! to t.e !econd a!!igned error. :.ile t.e %etitioner! clai& t.at contradiction! and fal!itie! %unctured Dr. J.oV! te!ti&on-" a reading of t.e !aid te!ti&on- re eal! no !uc. infir&it- and e!ta'li!.e! Dr.

J.o a! a credi'le /itne!!. Dr. J.o /a! fran; t.roug.out .er turn on t.e /itne!! !tand. =urt.er&ore" no &oti e to !tate an- untrut. /a! e er i&%uted again!t Dr. J.o" lea ing .er tru!t/ort.ine!! uni&%aired.1F$2T.e trial courtV! follo/ing declaration !.o/! t.at /.ile it /a! critical of t.e lac; of care /it. /.ic. Dr. J.o .andled t.e %iece of ru''er" it /a! not %re%ared to dou't Dr. J.oV! credi'ilit-" t.u! onl- !u%%orting out a%%rai!al of Dr. J.oV! tru!t/ort.ine!!3 T.i! i! not to !a- t.at !.e /a! le!! t.an .one!t /.en !.e te!tified a'out .er finding!" 'ut it can al!o 'e !aid t.at !.e did not ta;e t.e &o!t a%%ro%riate %recaution to %re!er e t.at X%iece of ru''erX a! an elo6uent e idence of /.at !.e /ould re eal !.ould t.ere 'e a Xlegal %ro'le&X /.ic. !.e clai&1!2 to .a e antici%ated.1F(2 Con!idering t.at /e .a e a!!e!!ed Dr. J.o to 'e a credi'le /itne!!" .er %o!iti e te!ti&on- 1t.at a %iece of ru''er /a! indeed found in %ri ate re!%ondent ,illega!V a'do&en2 %re ail! o er t.e negati e te!ti&on- in fa or of t.e %etitioner!. A! !uc." t.e rule of res ipsa loquitur co&e! to fore. T.i! Court .a! .ad occa!ion to del e into t.e nature and o%eration of t.i! doctrine3 T.i! doctrine 1res ipsa loquitur2 i! !tated t.u!3 X:.ere t.e t.ing /.ic. cau!e! inEur- i! !.o/n to 'e under t.e &anage&ent of t.e defendant" and t.e accident i! !uc. a! in t.e ordinar- cour!e of t.ing! doe! not .a%%en if t.o!e /.o .a e t.e &anage&ent u!e %ro%er care" it afford! rea!ona'le e idence" in t.e a'!ence of an e5%lanation '- t.e defendant" t.at t.e accident aro!e fro& /ant of care.X +r a! /lac!=s "a7 ictionar% %ut! it3 Res ipsa loquitur. T.e t.ing !%ea;! for it!elf. Re'utta'le %re!u&%tion or inference t.at defendant /a! negligent" /.ic. ari!e! u%on %roof t.at 1t.e2 in!tru&entalit- cau!ing inEur/a! in defendantV! e5clu!i e control" and t.at t.e accident /a! one /.ic. ordinar- doe! not .a%%en in a'!ence of negligence. Res ipsa loquitur i! 1a2 rule of e idence /.ere'negligence of 1t.e2 alleged /rongdoer &a- 'e inferred fro& 1t.e2 &ere fact t.at 1t.e2 accident .a%%ened %ro ided 1t.e2 c.aracter of 1t.e2 accident and circu&!tance! attending it lead rea!ona'l- to 'elief t.at in 1t.e2 a'!ence of negligence it /ould not .a e occurred and t.at t.ing /.ic. cau!ed inEur- i! !.o/n to .a e 'een under 1t.e2 &anage&ent and control of 1t.e2 alleged /rongdoer . . . . >nder 1t.i!2 doctrine . . . t.e .a%%ening of an inEur%er&it! an inference of negligence /.ere %laintiff %roduce! !u'!tantial e idence t.at 1t.e2 inEur- /a! cau!ed '- an agenc- or in!tru&entalit- under 1t.e2 e5clu!i e control and &anage&ent of defendant" and t.at t.e occurrence 1!ic2 /a! !uc. t.at in t.e ordinarcour!e of t.ing! /ould not .a%%en if rea!ona'le care .ad 'een u!ed. 555 555 555

T.e doctrine of HrIes ipsa loquitur a! a rule of e idence i! %eculiar to t.e la/ of negligence /.ic. recogni<e! t.at prima 3acie negligence &a- 'e e!ta'li!.ed /it.out direct %roof and furni!.e! a !u'!titute for !%ecific %roof of negligence. T.e doctrine i! not a rule of !u'!tanti e la/" 'ut &erel- a &ode of %roof or a &ere %rocedural con enience. T.e rule" /.en a%%lica'le to t.e fact! and circu&!tance! of a %articular ca!e" i! not intended to and doe! not di!%en!e /it. t.e re6uire&ent of %roof of cul%a'le negligence on t.e %artc.arged. It &erel- deter&ine! and regulate! /.at !.all 'e prima 3acie e idence t.ereof and facilitate! t.e 'urden of %laintiff of %ro ing a 'reac. of t.e dut- of due care. T.e doctrine can 'e in o;ed /.en and onl- /.en" under t.e circu&!tance! in ol ed" direct e idence i! a'!ent and not readil- a aila'le.1FH2 In t.e in!tant ca!e" all t.e re6ui!ite! for recour!e to t.e doctrine are %re!ent. =ir!t" t.e

entire %roceeding! of t.e ce!arean !ection /ere under t.e e5clu!i e control of Dr. @ati6uin. In t.i! lig.t" t.e %ri ate re!%ondent! /ere 'ereft of direct e idence a! to t.e actual cul%rit or t.e e5act cau!e of t.e foreign o'Eect finding it! /a- into %ri ate re!%ondent ,illega!V 'od-" /.ic." needle!! to !a-" doe! not occur unle!! t.roug. t.e inter ention of negligence. Second" !ince a!ide fro& t.e ce!arean !ection" %ri ate re!%ondent ,illega! under/ent no ot.er o%eration /.ic. could .a e cau!ed t.e offending %iece of ru''er to a%%ear in .er uteru!" it !tand! to rea!on t.at !uc. could onl- .a e 'een a '--%roduct of t.e ce!arean !ection %erfor&ed '- Dr. @ati6uin. T.e %etitioner!" in t.i! regard" failed to o erco&e t.e %re!u&%tion of negligence ari!ing fro& re!ort to t.e doctrine of res ipsa loquitur. Dr. @ati6uin i! t.erefore lia'le for negligentl- lea ing 'e.ind a %iece of ru''er in %ri ate re!%ondent ,illega!V a'do&en and for all t.e ad er!e effect! t.ereof. A! a final /ord" t.i! Court reiterate! it! recognition of t.e ital role t.e &edical %rofe!!ion %la-! in t.e li e! of t.e %eo%le"1F*2 and StateV! co&%elling intere!t to enact &ea!ure! to %rotect t.e %u'lic fro& Xt.e %otentiall- deadl- effect! of inco&%etence and ignorance in t.o!e /.o /ould underta;e to treat our 'odie! and &ind! for di!ea!e or trau&a.X1F#2 Indeed" a %.-!ician i! 'ound to !er e t.e intere!t of .i! %atient! X/it. t.e greate!t of !olicitude" gi ing t.e& al/a-! .i! 'e!t talent and !;ill.X1F)2 T.roug. .er tortiou! conduct" t.e %etitioner endangered t.e life of =lotilde ,illega!" in iolation of .er %rofe!!ionV! rigid et.ical code and in contra ention of t.e legal !tandard! !et fort. for %rofe!!ional!" in t.e general"1$G2 and &e&'er! of t.e &edical %rofe!!ion"1$12 in %articular. &ERE!ORE" t.e c.allenged deci!ion of 11 Ma- 1))$ of t.e Court of A%%eal! in CAG.R. C, No. FG#(1 i! .ere'- A==IRMED in toto. Co!t! again!t t.e %etitioner!. SO ORDERED. 0arvasa, C.J., (Chairman), Melo, #rancisco, and Pangani'an, JJ., concur.

Ra&o! !. CA" G.R. No. 1A$F($" !u%ra. Re-e! !. Si!ter! of Merc- 7o!%ital" !u%ra. DR. MILAGR+S L. CANTRE !. SPS. ?+7N DA,ID M. G+ and N+RA S. G+" G.R. No. 1HG##)" A%ril A*" AGG*. ,5C1-D DA<A,A1G.R. No. 1D0889 A)r+* 2F, 200F CAN%RE, Petitioner, DR. M$LAGROS L. vs. SPS. EO&N DAC$D '. GO !"# NORA S. GO, Respondents. D5CA,A1G $S M2$NG, J.: For review on %ertiorari are the De%ision1 dated 1%tober ), '((' and ResolutionA dated -ove ber 34, '(() of the Court of *ppeals in C*-+.R. C< -o. 52324, whi%h affir ed with odifi%ation the De%isionF dated 6ar%h ), 344> of the Re$ional /rial Court of Hue;on City, Bran%h 42, in Civil

Case -o. H-4)-3.5.'. /he fa%ts, %ulled fro the re%ords, are as follows0 Petitioner Dr. 6ila$ros L. Cantre is a spe%ialist in 1bstetri%s and +yne%olo$y at the Dr. &esus Del$ado 6e orial Gospital. ,he was the attendin$ physi%ian of respondent -ora ,. +o, who was ad itted at the said hospital on *pril 34, 344'. *t 30)( a. . of *pril '(, 344', -ora $ave birth to her fourth %hild, a baby boy. Gowever, at around )0)( a. ., -ora suffered profuse bleedin$ inside her wo b due to so e parts of the pla%enta whi%h were not %o pletely e@pelled fro her wo b after delivery. ConseFuently, -ora suffered hypovole i% sho%#, resultin$ in a drop in her blood pressure to :4(: over :(.: Petitioner and the assistin$ resident physi%ian perfor ed various edi%al pro%edures to stop the bleedin$ and to restore -ora8s blood pressure. Ger blood pressure was freFuently onitored with the use of a sphy$ o ano eter. Ehile petitioner was assa$in$ -ora8s uterus for it to %ontra%t and stop bleedin$, she ordered a dropli$ht to war -ora and her baby. $ -ora re ained un%ons%ious until she re%overed. Ehile in the re%overy roo , her husband, respondent &ohn David T. +o noti%ed a fresh $apin$ wound two and a half !' O" by three and a half !) O" in%hes in the inner portion of her left ar , %lose to the ar pit.( Ge as#ed the nurses what %aused the inCury. Ge was infor ed it was a burn. Forthwith, on *pril '', 344', &ohn David filed a reFuest for investi$ation. H An response, Dr. Rainerio ,. *bad, the edi%al dire%tor of the hospital, %alled petitioner and the assistin$ resident physi%ian to e@plain what happened. Petitioner said the blood pressure %uff %aused the inCury. 1n 6ay >, 344', &ohn David brou$ht -ora to the -ational Bureau of Anvesti$ation for a physi%al e@a ination, whi%h was %ondu%ted by edi%o-le$al offi%er Dr. Floresto *ri;ala, &r. * /he edi%ole$al offi%er later testified that -ora8s inCury appeared to be a burn and that a dropli$ht when pla%ed near the s#in for about 3( inutes %ould %ause su%h burn. # Ge dis issed the li#elihood that the wound was %aused by a blood pressure %uff as the s%ar was not around the ar , but Cust on one side of the ar .) 1n 6ay '', 344', -ora8s inCury was referred to a plasti% sur$eon at the Dr. &esus Del$ado 6e orial Gospital for s#in $raftin$.1G Ger wound was %overed with s#in sour%ed fro her abdo en, whi%h %onseFuently bore a s%ar as well. *bout a year after, on *pril )(, 344), s%ar revision had to be perfor ed at the sa e hospital. 11 /he sur$i%al operation left a healed linear s%ar in -ora8s left ar about three in%hes in len$th, the thi%#est portion risin$ about one-fourth !3B4" of an in%h fro the surfa%e of the s#in. /he %osts of the s#in $raftin$ and the s%ar revision were shouldered by the hospital.1A 7nfortunately, -ora8s ar would never be the sa e.1a@ABphi1.net *side fro the unsi$htly ar#, the pain in her left ar re ains. Ehen sleepin$, she has to %radle her wounded ar . Ger ove ents now are also restri%ted. Ger %hildren %annot play with the left side of her body as they i$ht a%%identally bu p the inCured ar , whi%h a%hes at the sli$htest tou%h. /hus, on &une '3, 344), respondent spouses filed a %o plaint 1F for da a$es a$ainst petitioner, Dr. *bad, and the hospital. Findin$ in favor of respondent spouses, the trial %ourt de%reed0 An view of the fore$oin$ %onsideration, Cud$ ent is hereby rendered in favor of the plaintiffs and a$ainst the defendants, dire%tin$ the latters, !sic" Cointly and severally N !a" to pay the su of Five Gundred /housand Pesos !P5((,(((.((" in oral da a$es? !b" to pay the su da a$es? !%" to pay the su of 1ne Gundred Fifty /housand Pesos !P35(,(((.((" e@e plary

of 5i$hty /housand Pesos !P2(,(((.((" no inal da a$es?

!d" to pay Fifty /housand Pesos !P5(,(((.((" for and as attorney8s fees? and

!e" to pay ,i@ /housand Pesos !P.,(((.((" liti$ation e@penses. ,1 1RD5R5D.1$ Petitioner, Dr. *bad, and the hospital all appealed to the Court of *ppeals, whi%h affir ed with odifi%ation the trial %ourt de%ision, thus0 EG5R5F1R5, in view of all the fore$oin$, and findin$ no reversible error in the appealed De%ision dated 6ar%h ), 344> of Bran%h 42 of the Re$ional /rial Court of Hue;on City in Civil Case -o. H-4)-3.5.', the sa e is hereby *FFAR65D, with the followin$ 61DAFAC*/A1-,0 3. 1rderin$ defendant-appellant Dra. 6ila$ros IL.J Cantre only to pay plaintiffs-appellees &ohn David +o and -ora ,. +o the su of P'((,(((.(( as oral da a$es? '. Deletin$ the award IofJ e@e plary da a$es, attorney8s fees and e@penses of liti$ation?1a+phi1.nCt ). Dis issin$ the %o plaint with respe%t to defendants-appellants Dr. Rainerio ,. *bad and Del$ado Clini%, An%.? 4. Dis issin$ the %ounter%lai s of defendants-appellants for la%# of ,1 1RD5R5D.1( Petitioner8s otion for re%onsideration was denied by the Court of *ppeals. Gen%e, the instant petition assi$nin$ the followin$ as errors and issues0 A. EG5/G5R 1R -1/, /G5 L1E5R C17R/, *-D /G5 C17R/ 1F *PP5*L, C166A//5D +R*<5 *B7,5 1F /G5AR DA,CR5/A1EG5-, -1/EA/G,/*-DA-+ /G*/ B1/G P*R/A5, G*<5 R5,/5D /G5AR R5,P5C/A<5 C*,5,, /G5 L1E5R C17R/ *D6A//5D /G5 *DDA/A1-*L 5KGABA/, F7R/G5R 1FF5R5D BL R5,P1-D5-/, -1/ /5,/AFA5D /1 BL *-L EA/-5,, *-D /GA, D5CA,A1- 1F /G5 L1E5R C17R/ E*, 7PG5LD BL /G5 C17R/ 1F *PP5*L, LA=5EA,5 C166A//A-+ +R*<5 *B7,5 1F DA,CR5/A1-? AA. EG5/G5R 1R -1/ /G5 L1E5R C17R/ C166A//5D +R*<5 *B7,5 1F A/, DA,CR5/A1- EG5-, C1-/R*RL /1 PR5P1-D5R*-C5 1F 5<AD5-C5 PR5,5-/5D BL /G5 P5/A/A1-5R, A/ R7L5D /G*/ /G5 P5/A/A1-5R G*, -1/ *6PLL ,G1E5D /G*/ /G5 DR1PLA+G/ DAD -1/ /17CG /G5 B1DL 1F 6R,. -1R* +1, *-D /GA, D5CA,A1- 1F /G5 L1E5R C17R/ E*, 7PG5LD BL /G5 C17R/ 1F *PP5*L, LA=5EA,5 C166A//A-+ +R*<5 *B7,5 1F DA,CR5/A1-? AAA. EG5/G5R 1R -1/ /G5 L1E5R C17R/ C166A//5D +R*<5 *B7,5 1F A/, DA,CR5/A1- EG5-, C1-/R*RL /1 PR5P1-D5R*-C5 1F 5<AD5-C5 PR5,5-/5D BL /G5 P5/A/A1-5R, A/ R7L5D /G*/ P5/A/A1-5R DR*. C*-/R5 E*, -1/ *BL5 /1 *6PLL 5KPL*A- G1E /G5 A-&7RL !BLA,/5R," A- /G5 L5F/ A--5R *R6 1F R5,P1-D5-/ 6R,. +1 C*65 *B17/? erit? and 5. 1rderin$ defendant-appellant Dra. 6ila$ros IL.J Cantre only to pay the %osts.

A<. EG5/G5R 1R -1/ /G5 C17R/ 1F *PP5*L, C166A//5D +R*<5 *B7,5 1F A/, DA,CR5/A1- EG5- A/ 6*D5 * R7LA-+ 1- /G5 R5,P1-D5-/8, A-&7RL H71/A-+ /G5 /5,/A61-L 1F ,1651-5 EG1 E*, -1/ PR5,5-/ *-D G*, -1/ ,55- /G5 1RA+A-*L, FR5,G A-&7RL 1F R5,P1-D5-/ 6R,. -1R* +1? <. EG5/G5R 1R -1/ /G5 C17R/ 1F *PP5*L, +R*<5LL *B7,A-+ A/, DA,CR5/A1- R7L5D /G*/ P5/A/A1-5R DR*. C*-/R5 ,G17LD G*<5 A-/5-D5D /1 A-FLAC/ /G5 A-&7RL /1 ,*<5 /G5 LAF5 1F R5,P1-D5-/ 6R,. +1? <A. EG5/G5R 1R -1/ /G5 L1E5R C17R/ *-D /G5 C17R/ I1FJ *PP5*L, C166A//5D +R*<5 *B7,5 1F DA,CR5/A1- EG5-, C1-/R*RL /1 /G5 D5/*AL5D PR1C5D7R5, D1-5 BL P5/A/A1-5R, B1/G R7L5D /G*/ /G5 R5,P1-D5-/ E*, L5F/ /1 /G5 C*R5 1F /G5 -7R,A-+ ,/*FF? <AA. EG5/G5R 1R -1/ /G5 L1E5R C17R/ C166A//5D +R*<5 *B7,5 1F DA,CR5/A1- EG5-, C1-/R*RL /1 /G5 65DAC*L P7RP1,5, 1F C1,65/AC ,7R+5RL, A/ R7L5D /G*/ /G5 C1,65/AC ,7R+5RL 6*D5 /G5 ,C*R, 5<5- 61R5 7+LL *-D D5CL*R5D /G5 C1,65/AC ,7R+5RL * F*AL7R5? <AAA. EG5/G5R 1R -1/ /G5 L1E5R C17R/ +R*<5LL *B7,5 1F ! "'C" DA,CR5/A1- EG5-, C1-/R*RL /1 R5,P1-D5-/,8 C1-/R*RL /5,/A61-A5, *-D /G5 *B,5-C5 1F *-L /5,/A61-L, A/ R7L5D /G*/ /G5L *R5 5-/A/L5D /1 D*6*+5, *-D EGACG E*, 7PG5LD, *L/G17+G 61DAFA5D, BL /G5 C17R/ 1F *PP5*L, LA=5EA,5 *B7,A-+ A/, DA,CR5/A1-.1H Petitioner %ontends that additional do%u entary e@hibits not testified to by any witness are inad issible in eviden%e be%ause they deprived her of her %onstitutional ri$ht to %onfront the witnesses a$ainst her. Petitioner insists the dropli$ht %ould not have tou%hed -ora8s body. ,he aintains the inCury was due to the %onstant ta#in$ of -ora8s blood pressure. Petitioner also insinuates the Court of *ppeals was isled by the testi ony of the edi%o-le$al offi%er who never saw the ori$inal inCury before plasti% sur$ery was perfor ed. Finally, petitioner stresses that plasti% sur$ery was not intended to restore respondent8s inCury to its ori$inal state but rather to prevent further %o pli%ation. Respondents, however, %ounter that the $enuineness and due e@e%ution of the additional do%u entary e@hibits were duly ad itted by petitioner8s %ounsel. Respondents point out that petitioner8s blood pressure %uff theory is hi$hly i probable, bein$ unpre%edented in edi%al history and that the inCury was definitely %aused by the dropli$ht. *t any rate, they ar$ue, even if the inCury was brou$ht about by the blood pressure %uff, petitioner was still ne$li$ent in her duties as -ora8s

attendin$ physi%ian. ,i ply put, the threshold issues for resolution are0 !3" *re the Fuestioned additional e@hibits ad issible in eviden%eM !'" As petitioner liable for the inCury suffered by respondent -ora +oM /hereafter, the inFuiry is whether the appellate %ourt %o itted $rave abuse of dis%retion in its assailed issuan%es. *s to the first issue, we a$ree with the Court of *ppeals that said e@hibits are ad issible in eviden%e. Ee note that the Fuestioned e@hibits %onsist ostly of -ora8s edi%al re%ords, whi%h were produ%ed by the hospital durin$ trial pursuant to a subpoena duces tecu . Petitioner8s %ounsel ad itted the e@isten%e of the sa e when they were for ally offered for ad ission by the trial %ourt. An any %ase, $iven the parti%ular %ir%u stan%es of this %ase, a rulin$ on the ne$li$en%e of petitioner ay be ade based on the res ipsa loquitur do%trine even in the absen%e of su%h additional e@hibits. Petitioner8s %ontention that the edi%o-le$al offi%er who %ondu%ted -ora8s physi%al e@a ination never saw her ori$inal inCury before plasti% sur$ery was perfor ed is without basis and %ontradi%ted by the re%ords. Re%ords show that the edi%o-le$al offi%er %ondu%ted the physi%al e@a ination on 6ay >, 344', while the s#in $raftin$ and the s%ar revision were perfor ed on -ora on 6ay '', 344' and *pril )(, 344), respe%tively. Co in$ now to the substantive +oM atter, is petitioner liable for the inCury suffered by respondent -ora

/he Gippo%rati% 1ath andates physi%ians to $ive pri ordial %onsideration to the well-bein$ of their patients. Af a do%tor fails to live up to this pre%ept, he is a%%ountable for his a%ts. /his notwithstandin$, %ourts fa%e a uniFue restraint in adCudi%atin$ edi%al ne$li$en%e %ases be%ause physi%ians are not $uarantors of %are and, they never set out to intentionally %ause inCury to their patients. Gowever, intent is i aterial in ne$li$en%e %ases be%ause where ne$li$en%e e@ists and is proven, it auto ati%ally $ives the inCured a ri$ht to reparation for the da a$e %aused.1* An %ases involvin$ edi%al ne$li$en%e, the do%trine of res ipsa loquitur allows the ere e@isten%e of an inCury to Custify a presu ption of ne$li$en%e on the part of the person who %ontrols the instru ent %ausin$ the inCury, provided that the followin$ reFuisites %on%ur0 3. /he a%%ident is of a #ind whi%h ordinarily does not o%%ur in the absen%e of so eone8s ne$li$en%e? '. At is %aused by an instru entality within the e@%lusive %ontrol of the defendant or defendants? and ). /he possibility of %ontributin$ %ondu%t whi%h would eli inated.1# a#e the plaintiff responsible is

*s to the first reFuire ent, the $apin$ wound on -ora8s ar is %ertainly not an ordinary o%%urren%e in the a%t of deliverin$ a baby, far re oved as the ar is fro the or$ans involved in the pro%ess of $ivin$ birth. ,u%h inCury %ould not have happened unless ne$li$en%e had set in so ewhere. ,e%ond, whether the inCury was %aused by the dropli$ht or by the blood pressure %uff is of no o ent. Both instru ents are dee ed within the e@%lusive %ontrol of the physi%ian in %har$e under the :%aptain of the ship: do%trine. /his do%trine holds the sur$eon in %har$e of an operation liable for the ne$li$en%e of his assistants durin$ the ti e when those assistants are under the sur$eon8s %ontrol.1) An this parti%ular %ase, it %an be lo$i%ally inferred that petitioner, the senior %onsultant in %har$e durin$ the delivery of -ora8s baby, e@er%ised %ontrol over the assistants assi$ned to both the use of the dropli$ht and the ta#in$ of -ora8s blood pressure. Gen%e, the use of the dropli$ht and the blood pressure %uff is also within petitioner8s e@%lusive %ontrol. /hird, the $apin$ wound on -ora8s left ar , by its very nature and %onsiderin$ her %ondition, %ould only be %aused by so ethin$ e@ternal to her and outside her %ontrol as she was un%ons%ious while in hypovole i% sho%#. Gen%e, -ora %ould not, by any stret%h of the i a$ination, have %ontributed

to her own inCury. Petitioner8s defense that -ora8s wound was %aused not by the dropli$ht but by the %onstant ta#in$ of her blood pressure, even if the latter was ne%essary $iven her %ondition, does not absolve her fro liability. *s testified to by the edi%o-le$al offi%er, Dr. *ri;ala, &r., the edi%al pra%ti%e is to deflate the blood pressure %uff i ediately after ea%h use. 1therwise, the inflated band %an %ause inCury to the patient si ilar to what %ould have happened in this %ase. /hus, if -ora8s wound was %aused by the blood pressure %uff, then the ta#in$ of -ora8s blood pressure ust have been done so ne$li$ently as to have infli%ted a $apin$ wound on her ar ,AG for whi%h petitioner %annot es%ape liability under the :%aptain of the ship: do%trine. Further, petitioner8s ar$u ent that the failed plasti% sur$ery was not intended as a %os eti% pro%edure, but rather as a easure to prevent %o pli%ation does not help her %ase. At does not ne$ate ne$li$en%e on her part. Based on the fore$oin$, the presu ption that petitioner was ne$li$ent in the e@er%ise of her profession stands unrebutted. An this %onne%tion, the Civil Code provides0 *R/. '3>.. Ehoever by a%t or o ission %auses da a$e to another, there bein$ fault or ne$li$en%e, is obli$ed to pay for the da a$e done.U *R/. ''3>. 6oral da a$es in%lude physi%al sufferin$, ental an$uish, fri$ht, serious an@iety, bes ir%hed reputation, wounded feelin$s, oral sho%#, so%ial hu iliation, and si ilar inCury. /hou$h in%apable of pe%uniary %o putation, oral da a$es ay be re%overed if they are the pro@i ate result of the defendant8s wron$ful a%t or o ission. Clearly, under the law, petitioner is obli$ed to pay -ora for a pro@i ate result of petitioner8s ne$li$en%e. oral da a$es suffered by the latter as

Ee note, however, that petitioner has served well as -ora8s obstetri%ian for her past three su%%essful deliveries. /his is the first ti e petitioner is bein$ held liable for da a$es due to ne$li$en%e in the pra%ti%e of her profession. /he fa%t that petitioner pro ptly too# %are of -ora8s wound before infe%tion and other %o pli%ations set in is also indi%ative of petitioner8s $ood intentions. Ee also ta#e note of the fa%t that -ora was sufferin$ fro a %riti%al %ondition when the inCury happened, su%h that savin$ her life be%a e petitioner8s ele ental %on%ern. -onetheless, it should be stressed that all these %ould not Custify ne$li$en%e on the part of petitioner. Gen%e, %onsiderin$ the spe%ifi% %ir%u stan%es in the instant %ase, we find no $rave abuse of dis%retion in the assailed de%ision and resolution of the Court of *ppeals. Further, we rule that the Court of *ppeals8 award of /wo Gundred /housand Pesos !P'((,(((" as oral da a$es in favor of respondents and a$ainst petitioner is Cust and eFuitable.A1 @&EREFORE, the petition is DEN$ED. /he De%ision dated 1%tober ), '((' and Resolution dated -ove ber 34, '(() of the Court of *ppeals in C*-+.R. C< -o. 52324 are AFF$RMED. -o pronoun%e ent as to %osts.

Profe!!ional Ser ice!" Inc. . Agana8 G.R. No. 1AH$H*" ?an. F1" AGG*. FAR,/ DA<A,A1G.R. No. 12D29F E!"8!r/ 31, 200F $NC., Petitioner, PROFESS$ONAL SERC$CES, vs. NA%$C$DAD !"# ENR$G E AGANA, Respondents.

@-----------------------@ G.R. No. 12DADF E!"8!r/ 31, 200F NA%$C$DAD 9S8b0,+,8,e# b/ .er c.+*#re" MARCEL$NO AGANA $$$, ENR$G E AGANA, ER., EMMA AGANA ANDAYA, EES S AGANA, !"# RAYM ND AGANA: !"# ENR$G E AGANA, Petitioners, vs. E AN F EN%ES, Respondent. @- - - - - - - - - - - - - - - - - - - -- - - - @ G.R. No. 12F590 E!"8!r/ 31, 200F AMP$L, Petitioner, M$G EL vs. NA%$C$DAD AGANA !"# ENR$G E AGANA, Respondents. D5CA,A1SANDOCAL-G %$ERRE', J.: Gospitals, havin$ underta#en one of an#ind8s ost i portant and deli%ate endeavors, ust assu e the $rave responsibility of pursuin$ it with appropriate %are. /he %are and servi%e dispensed throu$h this hi$h trust, however te%hni%al, %o ple@ and esoteri% its %hara%ter ay be, ust eet standards of responsibility %o ensurate with the underta#in$ to preserve and prote%t the health, and indeed, the very lives of those pla%ed in the hospital8s #eepin$.1 *ssailed in these three %onsolidated petitions for review on %ertiorari is the Court of *ppeals8 De%isionA dated ,epte ber ., 344. in C*-+.R. C< -o. 4'(.' and C*-+.R. ,P -o. )'342 affir in$ with odifi%ation the De%isionFdated 6ar%h 3>, 344) of the Re$ional /rial Court !R/C", Bran%h 4., Hue;on City in Civil Case -o. H-4))'' and nullifyin$ its 1rder dated ,epte ber '3, 344). /he fa%ts, as %ulled fro the re%ords, are0 1n *pril 4, 3424, -atividad *$ana was rushed to the 6edi%al City +eneral Gospital !6edi%al City Gospital" be%ause of diffi%ulty of bowel ove ent and bloody anal dis%har$e. *fter a series of edi%al e@a inations, Dr. 6i$uel * pil, petitioner in +.R. -o. 3'>54(, dia$nosed her to be sufferin$ fro :%an%er of the si$ oid.: 1n *pril 33, 3424, Dr. * pil, assisted by the edi%al staff $ of the 6edi%al City Gospital, perfor ed an anterior rese%tion sur$ery on -atividad. Ge found that the ali$nan%y in her si$ oid area had spread on her left ovary, ne%essitatin$ the re oval of %ertain portions of it. /hus, Dr. * pil obtained the %onsent of -atividad8s husband, 5nriFue *$ana, to per it Dr. &uan Fuentes, respondent in +.R. -o. 3'.4.>, to perfor hystere%to y on her. *fter Dr. Fuentes had %o pleted the hystere%to y, Dr. * pil too# over, %o pleted the operation and %losed the in%ision. Gowever, the operation appeared to be flawed. An the %orrespondin$ Re%ord of 1peration dated *pril 33, 3424, the attendin$ nurses entered these re ar#s0 :spon$e %ount la%#in$ ' :announ%ed to sur$eon sear%hed !si%" done but to no avail %ontinue for %losure.: 1n *pril '4, 3424, -atividad was released fro the hospital. Ger hospital and in%ludin$ the do%tors8 fees, a ounted to P.(,(((.((. edi%al bills,

*fter a %ouple of days, -atividad %o plained of e@%ru%iatin$ pain in her anal re$ion. ,he %onsulted both Dr. * pil and Dr. Fuentes about it. /hey told her that the pain was the natural %onseFuen%e of

the sur$ery. Dr. * pil then re%o ended that she %onsult an on%olo$ist to e@a ine the %an%erous nodes whi%h were not re oved durin$ the operation. 1n 6ay 4, 3424, -atividad, a%%o panied by her husband, went to the 7nited ,tates to see# further treat ent. *fter four onths of %onsultations and laboratory e@a inations, -atividad was told she was free of %an%er. Gen%e, she was advised to return to the Philippines. 1n *u$ust )3, 3424, -atividad flew ba%# to the Philippines, still sufferin$ fro pains. /wo wee#s thereafter, her dau$hter found a pie%e of $au;e protrudin$ fro her va$ina. 7pon bein$ infor ed about it, Dr. * pil pro%eeded to her house where he ana$ed to e@tra%t by hand a pie%e of $au;e easurin$ 3.5 in%hes in width. Ge then assured her that the pains would soon vanish. Dr. * pil8s assuran%e did not %o e true. Anstead, the pains intensified, pro ptin$ -atividad to see# treat ent at the Poly edi% +eneral Gospital. Ehile %onfined there, Dr. Ra on +utierre; dete%ted the presen%e of another forei$n obCe%t in her va$ina -- a foul-s ellin$ $au;e easurin$ 3.5 in%hes in width whi%h badly infe%ted her va$inal vault. * re%to-va$inal fistula had for ed in her reprodu%tive or$ans whi%h for%ed stool to e@%rete throu$h the va$ina. *nother sur$i%al operation was needed to re edy the da a$e. /hus, in 1%tober 3424, -atividad underwent another sur$ery. 1n -ove ber 3', 3424, -atividad and her husband filed with the R/C, Bran%h 4., Hue;on City a %o plaint for da a$es a$ainst the Professional ,ervi%es, An%. !P,A", owner of the 6edi%al City Gospital, Dr. * pil, and Dr. Fuentes, do%#eted as Civil Case -o. H-4))''. /hey alle$ed that the latter are liable for ne$li$en%e for leavin$ two pie%es of $au;e inside -atividad8s body and alpra%ti%e for %on%ealin$ their a%ts of ne$li$en%e. 6eanwhile, 5nriFue *$ana also filed with the Professional Re$ulation Co ission !PRC" an ad inistrative %o plaint for $ross ne$li$en%e and alpra%ti%e a$ainst Dr. * pil and Dr. Fuentes, do%#eted as *d inistrative Case -o. 3.4(. /he PRC Board of 6edi%ine heard the %ase only with respe%t to Dr. Fuentes be%ause it failed to a%Fuire Curisdi%tion over Dr. * pil who was then in the 7nited ,tates. 1n February 3., 342., pendin$ the out%o e of the above %ases, -atividad died and was duly substituted by her above-na ed %hildren !the *$anas". 1n 6ar%h 3>, 344), the R/C rendered its De%ision in favor of the *$anas, findin$ P,A, Dr. * pil and Dr. Fuentes liable for ne$li$en%e and alpra%ti%e, the de%retal part of whi%h reads0 EG5R5F1R5, Cud$ ent is hereby rendered for the plaintiffs orderin$ the defendants PR1F5,,A1-*L ,5R<AC5,, A-C., DR. 6A+75L *6PAL and DR. &7*- F75-/5, to pay to the plaintiffs, Cointly and severally, e@%ept in respe%t of the award for e@e plary da a$es and the interest thereon whi%h are the liabilities of defendants Dr. * pil and Dr. Fuentes only, as follows0 3. *s a%tual da a$es, the followin$ a ounts0 a. /he eFuivalent in Philippine Curren%y of the total of 7,V34,4((.(( at the rate of P'3..(-7,V3.((, as rei burse ent of a%tual e@penses in%urred in the 7nited ,tates of * eri%a? b. /he su of P4,2((.(( as travel ta@es of plaintiffs and their physi%ian dau$hter? %. /he total su of P45,2('.5(, representin$ the %ost of hospitali;ation at Poly edi% Gospital, edi%al fees, and %ost of the saline solution? '. *s oral da a$es, the su of P',(((,(((.((? of P)((,(((.((? date of filin$ of the of P'5(,(((.((? ). *s e@e plary da a$es, the su 4. *s attorney8s fees, the su

5. Le$al interest on ite s 3 !a", !b", and !%"? '? and ) hereinabove, fro %o plaint until full pay ent? and

.. Costs of suit. ,1 1RD5R5D. *$$rieved, P,A, Dr. Fuentes and Dr. * pil interposed an appeal to the Court of *ppeals, do%#eted as C*-+.R. C< -o. 4'(.'. An%identally, on *pril ), 344), the *$anas filed with the R/C a otion for a partial e@e%ution of its De%ision, whi%h was $ranted in an 1rder dated 6ay 33, 344). /hereafter, the sheriff levied upon %ertain properties of Dr. * pil and sold the for P453,'>5.(( and delivered the a ount to the *$anas. Followin$ their re%eipt of the oney, the *$anas entered into an a$ree ent with P,A and Dr. Fuentes to indefinitely suspend any further e@e%ution of the R/C De%ision. Gowever, not lon$ thereafter, the *$anas a$ain filed a otion for an alias writ of e@e%ution a$ainst the properties of P,A and Dr. Fuentes. 1n ,epte ber '3, 344), the R/C $ranted the otion and issued the %orrespondin$ writ, pro ptin$ Dr. Fuentes to file with the Court of *ppeals a petition for %ertiorari and prohibition, with prayer for preli inary inCun%tion, do%#eted as C*-+.R. ,P -o. )'342. Durin$ its penden%y, the Court of *ppeals issued a Resolution( dated 1%tober '4, 344) $rantin$ Dr. Fuentes8 prayer for inCun%tive relief. 1n &anuary '4, 3444, C*-+.R. ,P -o. )'342 was %onsolidated with C*-+.R. C< -o. 4'(.'. 6eanwhile, on &anuary '), 3445, the PRC Board of 6edi%ine rendered its De%ision H in *d inistrative Case -o. 3.4( dis issin$ the %ase a$ainst Dr. Fuentes. /he Board held that the prose%ution failed to show that Dr. Fuentes was the one who left the two pie%es of $au;e inside -atividad8s body? and that he %on%ealed su%h fa%t fro -atividad. 1n ,epte ber ., 344., the Court of *ppeals rendered its De%ision Cointly disposin$ of C*-+.R. C< -o. 4'(.' and C*-+.R. ,P -o. )'342, thus0 EG5R5F1R5, e@%ept for the odifi%ation that the %ase a$ainst defendant-appellant Dr. &uan Fuentes is hereby DA,6A,,5D, and with the pronoun%e ent that defendant-appellant Dr. 6i$uel * pil is liable to rei burse defendant-appellant Professional ,ervi%es, An%., whatever a ount the latter will pay or had paid to the plaintiffs-appellees, the de%ision appealed fro is hereby *FFAR65D and the instant appeal DA,6A,,5D. Con%o itant with the above, the petition for %ertiorari and prohibition filed by herein defendantappellant Dr. &uan Fuentes in C*-+.R. ,P -o. )'342 is hereby +R*-/5D and the %hallen$ed order of the respondent Cud$e dated ,epte ber '3, 344), as well as the alias writ of e@e%ution issued pursuant thereto are hereby -7LLAFA5D and ,5/ *,AD5. /he bond posted by the petitioner in %onne%tion with the writ of preli inary inCun%tion issued by this Court on -ove ber '4, 344) is hereby %an%elled. Costs a$ainst defendants-appellants Dr. 6i$uel * pil and Professional ,ervi%es, An%. ,1 1RD5R5D. 1nly Dr. * pil filed a De%e ber 34, 344.. otion for re%onsideration, but it was denied in a Resolution * dated

Gen%e, the instant %onsolidated petitions. An +.R. -o. 3'.'4>, P,A alle$ed in its petition that the Court of *ppeals erred in holdin$ that0 !3" it is estopped fro raisin$ the defense that Dr. * pil is not its e ployee? !'" it is solidarily liable with Dr. * pil? and !)" it is not entitled to its %ounter%lai a$ainst the *$anas. P,A %ontends that Dr. * pil is not its e ployee, but a ere %onsultant or independent %ontra%tor. *s su%h, he alone should answer for his ne$li$en%e. An +.R. -o. 3'.4.>, the *$anas aintain that the Court of *ppeals erred in findin$ that Dr. Fuentes is not $uilty of ne$li$en%e or edi%al alpra%ti%e, invo#in$ the do%trine of res ipsa loFuitur. /hey

%ontend that the pie%es of $au;e are pri a fa%ie proofs that the operatin$ sur$eons have been ne$li$ent. Finally, in +.R. -o. 3'>54(, Dr. * pil asserts that the Court of *ppeals erred in findin$ hi liable for ne$li$en%e and alpra%ti%e sans eviden%e that he left the two pie%es of $au;e in -atividad8s va$ina. Ge pointed to other probable %auses, su%h as0 !3" it was Dr. Fuentes who used $au;es in perfor in$ the hystere%to y? !'" the attendin$ nurses8 failure to properly %ount the $au;es used durin$ sur$ery? and !)" the edi%al intervention of the * eri%an do%tors who e@a ined -atividad in the 7nited ,tates of * eri%a. For our resolution are these three vital issues0 first, whether the Court of *ppeals erred in holdin$ Dr. * pil liable for ne$li$en%e and alpra%ti%e? se%ond, whether the Court of *ppeals erred in absolvin$ Dr. Fuentes of any liability? and third, whether P,A ay be held solidarily liable for the ne$li$en%e of Dr. * pil. A - +.R. -o. 3'>54( Ehether the Court of *ppeals 5rred in Goldin$ Dr. * pil Liable for -e$li$en%e and 6alpra%ti%e. Dr. * pil, in an atte pt to absolve hi self, $ears the Court8s attention to other possible %auses of -atividad8s detri ent. Ge ar$ues that the Court should not dis%ount either of the followin$ possibilities0 first, Dr. Fuentes left the $au;es in -atividad8s body after perfor in$ hystere%to y? se%ond, the attendin$ nurses erred in %ountin$ the $au;es? and third, the * eri%an do%tors were the ones who pla%ed the $au;es in -atividad8s body. Dr. * pil8s ar$u ents are purely %onCe%tural and without basis. Re%ords show that he did not present any eviden%e to prove that the * eri%an do%tors were the ones who put or left the $au;es in -atividad8s body. -either did he sub it eviden%e to rebut the %orre%tness of the re%ord of operation, parti%ularly the nu ber of $au;es used. *s to the alle$ed ne$li$en%e of Dr. Fuentes, we are indful that Dr. * pil e@a ined his !Dr. Fuentes8" wor# and found it in order. /he $larin$ truth is that all the aCor %ir%u stan%es, ta#en to$ether, as spe%ified by the Court of *ppeals, dire%tly point to Dr. * pil as the ne$li$ent party, thus0 First, it is not disputed that the sur$eons used $au;es as spon$es to %ontrol the bleedin$ of the patient durin$ the sur$i%al operation. ,e%ond, i ediately after the operation, the nurses who assisted in the sur$ery noted in their report that the Pspon$e %ount !was" la%#in$ '8? that su%h ano aly was Pannoun%ed to sur$eon8 and that a Psear%h was done but to no avail8 pro ptin$ Dr. * pil to P%ontinue for %losure8 @ @ @. /hird, after the operation, two !'" $au;es were e@tra%ted fro 6rs. *$ana where the sur$ery was perfor ed. the sa e spot of the body of

*n operation reFuirin$ the pla%in$ of spon$es in the in%ision is not %o plete until the spon$es are properly re oved, and it is settled that the leavin$ of spon$es or other forei$n substan%es in the wound after the in%ision has been %losed is at least pri a fa%ie ne$li$en%e by the operatin$ sur$eon.# /o put it si ply, su%h a%t is %onsidered so in%onsistent with due %are as to raise an inferen%e of ne$li$en%e. /here are even le$ions of authorities to the effe%t that su%h a%t is ne$li$en%e per se.) 1f %ourse, the Court is not blind to the reality that there are ti es when dan$er to a patient8s life pre%ludes a sur$eon fro further sear%hin$ issin$ spon$es or forei$n obCe%ts left in the body. But this does not leave hi free fro any obli$ation. 5ven if it has been shown that a sur$eon was reFuired by the ur$ent ne%essities of the %ase to leave a spon$e in his patient8s abdo en, be%ause of the dan$ers attendant upon delay, still, it is his le$al duty to so infor his patient within a reasonable ti e thereafter by advisin$ her of what he had been %o pelled to do. /his is in order that

she i$ht see# relief fro the effe%ts of the forei$n obCe%t left in her body as her %ondition per it. /he rulin$ in , ith v. Tea$ler1G is e@pli%it, thus0

i$ht

/he re oval of all spon$es used is part of a sur$i%al operation, and when a physi%ian or sur$eon fails to re ove a spon$e he has pla%ed in his patient8s body that should be re oved as part of the operation, he thereby leaves his operation un%o pleted and %reates a new %ondition whi%h i poses upon hi the le$al duty of %allin$ the new %ondition to his patient8s attention, and endeavorin$ with the eans he has at hand to ini i;e and avoid untoward results li#ely to ensue therefro . Gere, Dr. * pil did not infor -atividad about the issin$ two pie%es of $au;e. Eorse, he even isled her that the pain she was e@perien%in$ was the ordinary %onseFuen%e of her operation. Gad he been ore %andid, -atividad %ould have ta#en the i ediate and appropriate edi%al re edy to re ove the $au;es fro her body. /o our ind, what was initially an a%t of ne$li$en%e by Dr. * pil has ripened into a deliberate wron$ful a%t of de%eivin$ his patient. /his is a %lear %ase of edi%al alpra%ti%e or ore appropriately, edi%al ne$li$en%e. /o su%%essfully pursue this #ind of %ase, a patient ust only prove that a health %are provider either failed to do so ethin$ whi%h a reasonably prudent health %are provider would have done, or that he did so ethin$ that a reasonably prudent provider would not have done? and that failure or a%tion %aused inCury to the patient.11 ,i ply put, the ele ents are duty, brea%h, inCury and pro@i ate %ausation. Dr, * pil, as the lead sur$eon, had the duty to re ove all forei$n obCe%ts, su%h as $au;es, fro -atividad8s body before %losure of the in%ision. Ehen he failed to do so, it was his duty to infor -atividad about it. Dr. * pil brea%hed both duties. ,u%h brea%h %aused inCury to -atividad, ne%essitatin$ her further e@a ination by * eri%an do%tors and another sur$ery. /hat Dr. * pil8s ne$li$en%e is the pro@i ate %ause 1A of -atividad8s inCury %ould be tra%ed fro his a%t of %losin$ the in%ision despite the infor ation $iven by the attendin$ nurses that two pie%es of $au;e were still issin$. /hat they were later on e@tra%ted fro -atividad8s va$ina established the %ausal lin# between Dr. * pil8s ne$li$en%e and the inCury. *nd what further a$$ravated su%h inCury was his deliberate %on%eal ent of the issin$ $au;es fro the #nowled$e of -atividad and her fa ily. AA - +.R. -o. 3'.4.> Ehether the Court of *ppeals 5rred in *bsolvin$ Dr. Fuentes of any Liability /he *$anas assailed the dis issal by the trial %ourt of the %ase a$ainst Dr. Fuentes on the $round that it is %ontrary to the do%trine of res ipsa loFuitur. *%%ordin$ to the , the fa%t that the two pie%es of $au;e were left inside -atividad8s body is a pri a fa%ie eviden%e of Dr. Fuentes8 ne$li$en%e. Ee are not %onvin%ed. Literally, res ipsa loFuitur eans :the thin$ spea#s for itself.: At is the rule that the fa%t of the o%%urren%e of an inCury, ta#en with the surroundin$ %ir%u stan%es, ay per it an inferen%e or raise a presu ption of ne$li$en%e, or a#e out a plaintiff8s pri a fa%ie %ase, and present a Fuestion of fa%t for defendant to eet with an e@planation. 1F,tated differently, where the thin$ whi%h %aused the inCury, without the fault of the inCured, is under the e@%lusive %ontrol of the defendant and the inCury is su%h that it should not have o%%urred if he, havin$ su%h %ontrol used proper %are, it affords reasonable eviden%e, in the absen%e of e@planation that the inCury arose fro the defendant8s want of %are, and the burden of proof is shifted to hi to establish that he has observed due %are and dili$en%e.1$ Fro the fore$oin$ state ents of the rule, the reFuisites for the appli%ability of the do%trine of res ipsa loFuitur are0 !3" the o%%urren%e of an inCury? !'" the thin$ whi%h %aused the inCury was under the %ontrol and ana$e ent of the defendant? !)" the o%%urren%e was su%h that in the ordinary %ourse of thin$s, would not have happened if those who had %ontrol or ana$e ent used proper %are? and !4" the absen%e of e@planation by the defendant. 1f the fore$oin$ reFuisites, the ost instru ental is the :%ontrol and ana$e ent of the thin$ whi%h %aused the inCury.:1(

Ee find the ele ent of :%ontrol and ana$e ent of the thin$ whi%h %aused the inCury: to be wantin$. Gen%e, the do%trine of res ipsa loFuitur will not lie. At was duly established that Dr. * pil was the lead sur$eon durin$ the operation of -atividad. Ge reFuested the assistan%e of Dr. Fuentes only to perfor hystere%to y when he !Dr. * pil" found that the ali$nan%y in her si$ oid area had spread to her left ovary. Dr. Fuentes perfor ed the sur$ery and thereafter reported and showed his wor# to Dr. * pil. /he latter e@a ined it and findin$ everythin$ to be in order, allowed Dr. Fuentes to leave the operatin$ roo . Dr. * pil then resu ed operatin$ on -atividad. Ge was about to finish the pro%edure when the attendin$ nurses infor ed hi that two pie%es of $au;e were issin$. * :dili$ent sear%h: was %ondu%ted, but the ispla%ed $au;es were not found. Dr. * pil then dire%ted that the in%ision be %losed. Durin$ this entire period, Dr. Fuentes was no lon$er in the operatin$ roo and had, in fa%t, left the hospital. 7nder the :Captain of the ,hip: rule, the operatin$ sur$eon is the person in %o plete %har$e of the sur$ery roo and all personnel %onne%ted with the operation. /heir duty is to obey his orders. 1H *s stated before, Dr. * pil was the lead sur$eon. An other words, he was the :Captain of the ,hip.: /hat he dis%har$ed su%h role is evident fro his followin$ %ondu%t0 !3" %allin$ Dr. Fuentes to perfor a hystere%to y? !'" e@a inin$ the wor# of Dr. Fuentes and findin$ it in order? !)" $rantin$ Dr. Fuentes8 per ission to leave? and !4" orderin$ the %losure of the in%ision. /o our ind, it was this a%t of orderin$ the %losure of the in%ision notwithstandin$ that two pie%es of $au;e re ained una%%ounted for, that %aused inCury to -atividad8s body. Clearly, the %ontrol and ana$e ent of the thin$ whi%h %aused the inCury was in the hands of Dr. * pil, not Dr. Fuentes. An this Curisdi%tion, res ipsa loFuitur is not a rule of substantive law, hen%e, does not per se %reate or %onstitute an independent or separate $round of liability, bein$ a ere evidentiary rule. 1* An other words, ere invo%ation and appli%ation of the do%trine does not dispense with the reFuire ent of proof of ne$li$en%e. Gere, the ne$li$en%e was proven to have been %o itted by Dr. * pil and not by Dr. Fuentes. AAA - +.R. -o. 3'.'4> Ehether P,A As Liable for the -e$li$en%e of Dr. * pil /he third issue ne%essitates a $li pse at the histori%al develop ent of hospitals and the resultin$ theories %on%ernin$ their liability for the ne$li$en%e of physi%ians. 7ntil the id-nineteenth %entury, hospitals were $enerally %haritable institutions, providin$ edi%al servi%es to the lowest %lasses of so%iety, without re$ard for a patient8s ability to pay. 1# /hose who %ould afford edi%al treat ent were usually treated at ho e by their do%tors. 1) Gowever, the days of house %alls and philanthropi% health %are are over. /he odern health %are industry %ontinues to distan%e itself fro its %haritable past and has e@perien%ed a si$nifi%ant %onversion fro a not-forprofit health %are to for-profit hospital businesses. ConseFuently, si$nifi%ant %han$es in health law have a%%o panied the business-related %han$es in the hospital industry. 1ne i portant le$al %han$e is an in%rease in hospital liability for edi%al alpra%ti%e. 6any %ourts now allow %lai s for hospital vi%arious liability under the theories of respondeat superior, apparent authority, ostensible authority, or a$en%y by estoppel. AG An this Curisdi%tion, the statute $overnin$ liability for ne$li$ent a%ts is *rti%le '3>. of the Civil Code, whi%h reads0 *rt. '3>.. Ehoever by a%t or o ission %auses da a$e to another, there bein$ fault or ne$li$en%e, is obli$ed to pay for the da a$e done. ,u%h fault or ne$li$en%e, if there is no pre-e@istin$ %ontra%tual relation between the parties, is %alled a Fuasi-deli%t and is $overned by the provisions of this Chapter. * derivative of this provision is *rti%le '32(, the rule $overnin$ vi%arious liability under the do%trine of respondeat superior, thus0

*R/. '32(. /he obli$ation i posed by *rti%le '3>. is de andable not only for one8s own a%ts or o issions, but also for those of persons for who one is responsible. 5 5 5 5 5 5

/he owners and ana$ers of an establish ent or enterprise are li#ewise responsible for da a$es %aused by their e ployees in the servi%e of the bran%hes in whi%h the latter are e ployed or on the o%%asion of their fun%tions. 5 ployers shall be liable for the da a$es %aused by their e ployees and household helpers a%tin$ within the s%ope of their assi$ned tas#s even thou$h the for er are not en$a$ed in any business or industry. 5 5 5 5 5 5 entioned prove that

/he responsibility treated of in this arti%le shall %ease when the persons herein they observed all the dili$en%e of a $ood father of a fa ily to prevent da a$e.

* pro inent %ivilist %o ented that professionals en$a$ed by an e ployer, su%h as physi%ians, dentists, and phar a%ists, are not :e ployees: under this arti%le be%ause the anner in whi%h they perfor their wor# is not within the %ontrol of the latter !e ployer". An other words, professionals are %onsidered personally liable for the fault or ne$li$en%e they %o it in the dis%har$e of their duties, and their e ployer %annot be held liable for su%h fault or ne$li$en%e. An the %onte@t of the present %ase, :a hospital %annot be held liable for the fault or ne$li$en%e of a physi%ian or sur$eon in the treat ent or operation of patients.:A1 /he fore$oin$ view is $rounded on the traditional notion that the professional status and the very nature of the physi%ian8s %allin$ pre%lude hi fro bein$ %lassed as an a$ent or e ployee of a hospital, whenever he a%ts in a professional %apa%ity. AA At has been said that edi%al pra%ti%e stri%tly involves hi$hly developed and spe%iali;ed #nowled$e, AF su%h that physi%ians are $enerally free to e@er%ise their own s#ill and Cud$ ent in renderin$ edi%al servi%es sans interferen%e.A$ Gen%e, when a do%tor pra%ti%es edi%ine in a hospital settin$, the hospital and its e ployees are dee ed to subserve hi in his inistrations to the patient and his a%tions are of his own responsibility.A( /he %ase of ,%hloendorff v. ,o%iety of -ew Lor# Gospital AH was then %onsidered an authority for this view. /he :,%hloendorff do%trine: re$ards a physi%ian, even if e ployed by a hospital, as an independent %ontra%tor be%ause of the s#ill he e@er%ises and the la%# of %ontrol e@erted over his wor#. 7nder this do%trine, hospitals are e@e pt fro the appli%ation of the respondeat superior prin%iple for fault or ne$li$en%e %o itted by physi%ians in the dis%har$e of their profession. Gowever, the effi%a%y of the fore$oin$ do%trine has wea#ened with the si$nifi%ant develop ents in edi%al %are. Courts %a e to reali;e that odern hospitals are in%reasin$ly ta#in$ a%tive role in supplyin$ and re$ulatin$ edi%al %are to patients. -o lon$er were a hospital8s fun%tions li ited to furnishin$ roo , food, fa%ilities for treat ent and operation, and attendants for its patients. /hus, in Bin$ v. /huni$,A* the -ew Lor# Court of *ppeals deviated fro the ,%hloendorff do%trine, notin$ that odern hospitals a%tually do far ore than provide fa%ilities for treat ent. Rather, they re$ularly e ploy, on a salaried basis, a lar$e staff of physi%ians, interns, nurses, ad inistrative and anual wor#ers. /hey %har$e patients for edi%al %are and treat ent, even %olle%tin$ for su%h servi%es throu$h le$al a%tion, if ne%essary. /he %ourt then %on%luded that there is no reason to e@e pt hospitals fro the universal rule of respondeat superior. An our shores, the nature of the relationship between the hospital and the physi%ians is rendered in%onseFuential in view of our %ate$ori%al pronoun%e ent in Ra os v. Court of *ppealsA# that for purposes of apportionin$ responsibility in edi%al ne$li$en%e %ases, an e ployer-e ployee relationship in effe%t e@ists between hospitals and their attendin$ and visitin$ physi%ians. /his Court held0

:Ee now dis%uss the responsibility of the hospital in this parti%ular in%ident. /he uniFue pra%ti%e !a on$ private hospitals" of fillin$ up spe%ialist staff with attendin$ and visitin$ :%onsultants,: who are alle$edly not hospital e ployees, presents proble s in apportionin$ responsibility for ne$li$en%e in edi%al alpra%ti%e %ases. Gowever, the diffi%ulty is ore apparent than real. An the first pla%e, hospitals e@er%ise si$nifi%ant %ontrol in the hirin$ and firin$ of %onsultants and in the %ondu%t of their wor# within the hospital pre ises. Do%tors who apply for P%onsultant8 slots, visitin$ or attendin$, are reFuired to sub it proof of %o pletion of residen%y, their edu%ational Fualifi%ations, $enerally, eviden%e of a%%reditation by the appropriate board !diplo ate", eviden%e of fellowship in ost %ases, and referen%es. /hese reFuire ents are %arefully s%rutini;ed by e bers of the hospital ad inistration or by a review %o ittee set up by the hospital who either a%%ept or reCe%t the appli%ation. @ @ @. *fter a physi%ian is a%%epted, either as a visitin$ or attendin$ %onsultant, he is nor ally reFuired to attend %lini%o-patholo$i%al %onferen%es, %ondu%t bedside rounds for %ler#s, interns and residents, oderate $rand rounds and patient audits and perfor other tas#s and responsibilities, for the privile$e of bein$ able to aintain a %lini% in the hospital, andBor for the privile$e of ad ittin$ patients into the hospital. An addition to these, the physi%ian8s perfor an%e as a spe%ialist is $enerally evaluated by a peer review %o ittee on the basis of ortality and orbidity statisti%s, and feedba%# fro patients, nurses, interns and residents. * %onsultant re iss in his duties, or a %onsultant who re$ularly falls short of the ini u standards a%%eptable to the hospital or its peer review %o ittee, is nor ally politely ter inated. An other words, private hospitals, hire, fire and e@er%ise real %ontrol over their attendin$ and visitin$ P%onsultant8 staff. Ehile P%onsultants8 are not, te%hni%ally e ployees, @ @ @, the %ontrol e@er%ised, the hirin$, and the ri$ht to ter inate %onsultants all fulfill the i portant hall ar#s of an e ployere ployee relationship, with the e@%eption of the pay ent of wa$es. An assessin$ whether su%h a relationship in fa%t e@ists, the %ontrol test is deter inin$. *%%ordin$ly, on the basis of the fore$oin$, we rule that for the purpose of allo%atin$ responsibility in edi%al ne$li$en%e %ases, an e ployere ployee relationship in effe%t e@ists between hospitals and their attendin$ and visitin$ physi%ians. : But the Ra os pronoun%e ent is not our only basis in sustainin$ P,A8s liability. Ats liability is also an%hored upon the a$en%y prin%iple of apparent authority or a$en%y by estoppel and the do%trine of %orporate ne$li$en%e whi%h have $ained a%%eptan%e in the deter ination of a hospital8s liability for ne$li$ent a%ts of health professionals. /he present %ase serves as a perfe%t platfor to test the appli%ability of these do%trines, thus, enri%hin$ our Curispruden%e. *pparent authority, or what is so eti es referred to as the :holdin$ out: theory, or do%trine of ostensible a$en%y or a$en%y by estoppel, A) has its ori$in fro the law of a$en%y. At i poses liability, not as the result of the reality of a %ontra%tual relationship, but rather be%ause of the a%tions of a prin%ipal or an e ployer in so ehow isleadin$ the publi% into believin$ that the relationship or the authority e@ists.FG /he %on%ept is essentially one of estoppel and has been e@plained in this anner0 :/he prin%ipal is bound by the a%ts of his a$ent with the apparent authority whi%h he #nowin$ly per its the a$ent to assu e, or whi%h he holds the a$ent out to the publi% as possessin$. /he Fuestion in every %ase is whether the prin%ipal has by his voluntary a%t pla%ed the a$ent in su%h a situation that a person of ordinary pruden%e, %onversant with business usa$es and the nature of the parti%ular business, is Custified in presu in$ that su%h a$ent has authority to perfor the parti%ular a%t in Fuestion.F1 /he appli%ability of apparent authority in the field of hospital liability was upheld lon$ ti e a$o in Arvin$ v. Do%tor Gospital of La#e Eorth, An%.FA /here, it was e@pli%itly stated that :there does not appear to be any rational basis for e@%ludin$ the %on%ept of apparent authority fro the field of hospital liability.: /hus, in %ases where it %an be shown that a hospital, by its a%tions, has held out a

parti%ular physi%ian as its a$ent andBor e ployee and that a patient has a%%epted treat ent fro that physi%ian in the reasonable belief that it is bein$ rendered in behalf of the hospital, then the hospital will be liable for the physi%ian8s ne$li$en%e. 1ur Curisdi%tion re%o$ni;es the %on%ept of an a$en%y by i pli%ation or estoppel. *rti%le 32.4 of the Civil Code reads0 *R/. 32.4. *$en%y ay be e@press, or i plied fro the a%ts of the prin%ipal, fro his silen%e or la%# of a%tion, or his failure to repudiate the a$en%y, #nowin$ that another person is a%tin$ on his behalf without authority. An this %ase, P,A publi%ly displays in the lobby of the 6edi%al City Gospital the na es and spe%iali;ations of the physi%ians asso%iated or a%%redited by it, in%ludin$ those of Dr. * pil and Dr. Fuentes. Ee %on%ur with the Court of *ppeals8 %on%lusion that it :is now estopped fro passin$ all the bla e to the physi%ians whose na es it proudly paraded in the publi% dire%tory leadin$ the publi% to believe that it vou%hed for their s#ill and %o peten%e.: Andeed, P,A8s a%t is tanta ount to holdin$ out to the publi% that 6edi%al City Gospital, throu$h its a%%redited physi%ians, offers Fuality health %are servi%es. By a%%reditin$ Dr. * pil and Dr. Fuentes and publi%ly advertisin$ their Fualifi%ations, the hospital %reated the i pression that they were its a$ents, authori;ed to perfor edi%al or sur$i%al servi%es for its patients. *s e@pe%ted, these patients, -atividad bein$ one of the , a%%epted the servi%es on the reasonable belief that su%h were bein$ rendered by the hospital or its e ployees, a$ents, or servants. /he trial %ourt %orre%tly pointed out0 @ @ @ re$ardless of the edu%ation and status in life of the patient, he ou$ht not be burdened with the defense of absen%e of e ployer-e ployee relationship between the hospital and the independent physi%ian whose na e and %o peten%e are %ertainly %ertified to the $eneral publi% by the hospital8s a%t of listin$ hi and his spe%ialty in its lobby dire%tory, as in the %ase herein. /he hi$h %osts of today8s edi%al and health %are should at least e@a%t on the hospital $reater, if not broader, le$al responsibility for the %ondu%t of treat ent and sur$ery within its fa%ility by its a%%redited physi%ian or sur$eon, re$ardless of whether he is independent or e ployed.:FF /he wisdo of the fore$oin$ ratio%ination is easy to dis%ern. Corporate entities, li#e P,A, are %apable of a%tin$ only throu$h other individuals, su%h as physi%ians. Af these a%%redited physi%ians do their Cob well, the hospital su%%eeds in its ission of offerin$ Fuality edi%al servi%es and thus profits finan%ially. Lo$i%ally, where ne$li$en%e ars the Fuality of its servi%es, the hospital should not be allowed to es%ape liability for the a%ts of its ostensible a$ents. Ee now pro%eed to the do%trine of %orporate ne$li$en%e or %orporate responsibility. 1ne alle$ation in the %o plaint in Civil Case -o. H-4)))' for ne$li$en%e and alpra%ti%e is that P,A as owner, operator and ana$er of 6edi%al City Gospital, :did not perfor the ne%essary supervision nor e@er%ise dili$ent efforts in the supervision of Drs. * pil and Fuentes and its nursin$ staff, resident do%tors, and edi%al interns who assisted Drs. * pil and Fuentes in the perfor an%e of their duties as sur$eons.:F$ Pre ised on the do%trine of %orporate ne$li$en%e, the trial %ourt held that P,A is dire%tly liable for su%h brea%h of duty. Ee a$ree with the trial %ourt. Re%ent years have seen the do%trine of %orporate ne$li$en%e as the Cudi%ial answer to the proble of allo%atin$ hospital8s liability for the ne$li$ent a%ts of health pra%titioners, absent fa%ts to support the appli%ation of respondeat superior or apparent authority. Ats for ulation pro%eeds fro the Cudi%iary8s a%#nowled$ ent that in these odern ti es, the duty of providin$ Fuality edi%al servi%e is no lon$er the sole prero$ative and responsibility of the physi%ian. /he odern hospitals have %han$ed stru%ture. Gospitals now tend to or$ani;e a hi$hly professional edi%al staff whose %o peten%e and perfor an%e need to be onitored by the hospitals %o ensurate with their inherent responsibility to provide Fuality edi%al %are.F( /he do%trine has its $enesis in Darlin$ v. Charleston Co unity Gospital. FH /here, the ,upre e

Court of Allinois held that :the Cury %ould have found a hospital ne$li$ent, inter alia, in failin$ to have a suffi%ient nu ber of trained nurses attendin$ the patient? failin$ to reFuire a %onsultation with or e@a ination by e bers of the hospital staff? and failin$ to review the treat ent rendered to the patient.: 1n the basis of Darlin$, other Curisdi%tions held that a hospital8s %orporate ne$li$en%e e@tends to per ittin$ a physi%ian #nown to be in%o petent to pra%ti%e at the hospital.F* Eith the passa$e of ti e, ore duties were e@pe%ted fro hospitals, a on$ the 0 !3" the use of reasonable %are in the aintenan%e of safe and adeFuate fa%ilities and eFuip ent? !'" the sele%tion and retention of %o petent physi%ians? !)" the overseein$ or supervision of all persons who pra%ti%e edi%ine within its walls? and !4" the for ulation, adoption and enfor%e ent of adeFuate rules and poli%ies that ensure Fuality %are for its patients. F# /hus, in /u%son 6edi%al Center, An%. v. 6isevi%h,F) it was held that a hospital, followin$ the do%trine of %orporate responsibility, has the duty to see that it eets the standards of responsibilities for the %are of patients. ,u%h duty in%ludes the proper supervision of the e bers of its edi%al staff. *nd in Bost v. Riley,$G the %ourt %on%luded that a patient who enters a hospital does so with the reasonable e@pe%tation that it will atte pt to %ure hi . /he hospital a%%ordin$ly has the duty to a#e a reasonable effort to onitor and oversee the treat ent pres%ribed and ad inistered by the physi%ians pra%ti%in$ in its pre ises. An the present %ase, it was duly established that P,A operates the 6edi%al City Gospital for the purpose and under the %on%ept of providin$ %o prehensive edi%al servi%es to the publi%. *%%ordin$ly, it has the duty to e@er%ise reasonable %are to prote%t fro har all patients ad itted into its fa%ility for edi%al treat ent. 7nfortunately, P,A failed to perfor su%h duty. /he findin$s of the trial %ourt are %onvin%in$, thus0 @ @ @ P,A8s liability is tra%eable to its failure to %ondu%t an investi$ation of the atter reported in the nota bene of the %ount nurse. ,u%h failure established P,A8s part in the dar# %onspira%y of silen%e and %on%eal ent about the $au;es. 5thi%al %onsiderations, if not also le$al, di%tated the holdin$ of an i ediate inFuiry into the events, if not for the benefit of the patient to who the duty is pri arily owed, then in the interest of arrivin$ at the truth. /he Court %annot a%%ept that the edi%al and the healin$ professions, throu$h their e bers li#e defendant sur$eons, and their institutions li#e P,A8s hospital fa%ility, %an %allously turn their ba%#s on and disre$ard even a ere probability of ista#e or ne$li$en%e by refusin$ or failin$ to investi$ate a report of su%h seriousness as the one in -atividad8s %ase. At is worthy to note that Dr. * pil and Dr. Fuentes operated on -atividad with the assistan%e of the 6edi%al City Gospital8s staff, %o posed of resident do%tors, nurses, and interns. *s su%h, it is reasonable to %on%lude that P,A, as the operator of the hospital, has a%tual or %onstru%tive #nowled$e of the pro%edures %arried out, parti%ularly the report of the attendin$ nurses that the two pie%es of $au;e were issin$. An Fridena v. 5vans, $1 it was held that a %orporation is bound by the #nowled$e a%Fuired by or noti%e $iven to its a$ents or offi%ers within the s%ope of their authority and in referen%e to a atter to whi%h their authority e@tends. /his eans that the #nowled$e of any of the staff of 6edi%al City Gospital %onstitutes #nowled$e of P,A. -ow, the failure of P,A, despite the attendin$ nurses8 report, to investi$ate and infor -atividad re$ardin$ the issin$ $au;es a ounts to %allous ne$li$en%e. -ot only did P,A brea%h its duties to oversee or supervise all persons who pra%ti%e edi%ine within its walls, it also failed to ta#e an a%tive step in fi@in$ the ne$li$en%e %o itted. /his renders P,A, not only vi%ariously liable for the ne$li$en%e of Dr. * pil under *rti%le '32( of the Civil Code, but also dire%tly liable for its own ne$li$en%e under *rti%le '3>.. An Fridena, the ,upre e Court of *ri;ona held0 @ @ @ An re%ent years, however, the duty of %are owed to the patient by the hospital has e@panded. /he e er$in$ trend is to hold the hospital responsible where the hospital has failed to onitor and review edi%al servi%es bein$ provided within its walls. ,ee =ahn Gospital 6alpra%ti%e Prevention, '> De Paul . Rev. ') !34>>". * on$ the %ases indi%ative of the Pe er$in$ trend8 is Pur%ell v. Ti bel an, 32 *ri;. *pp. >5,5(( P.

'd ))5 !34>'". An Pur%ell, the hospital ar$ued that it %ould not be held liable for the alpra%ti%e of a edi%al pra%titioner be%ause he was an independent %ontra%tor within the hospital. /he Court of *ppeals pointed out that the hospital had %reated a professional staff whose %o peten%e and perfor an%e was to be onitored and reviewed by the $overnin$ body of the hospital, and the %ourt held that a hospital would be ne$li$ent where it had #nowled$e or reason to believe that a do%tor usin$ the fa%ilities was e ployin$ a ethod of treat ent or %are whi%h fell below the re%o$ni;ed standard of %are. ,ubseFuent to the Pur%ell de%ision, the *ri;ona Court of *ppeals held that a hospital has %ertain inherent responsibilities re$ardin$ the Fuality of edi%al %are furnished to patients within its walls and it ust eet the standards of responsibility %o ensurate with this underta#in$. Bee%# v. /u%son +eneral Gospital, 32 *ri;. *pp. 3.5, 5(( P. 'd 335) !34>'". /his %ourt has %onfir ed the rulin$s of the Court of *ppeals that a hospital has the duty of supervisin$ the %o peten%e of the do%tors on its staff. @ @ @. 5 5 5 5 5 5

An the a ended %o plaint, the plaintiffs did plead that the operation was perfor ed at the hospital with its #nowled$e, aid, and assistan%e, and that the ne$li$en%e of the defendants was the pro@i ate %ause of the patient8s inCuries. Ee find that su%h $eneral alle$ations of ne$li$en%e, alon$ with the eviden%e produ%ed at the trial of this %ase, are suffi%ient to support the hospital8s liability based on the theory of ne$li$ent supervision.: *nent the %orollary issue of whether P,A is solidarily liable with Dr. * pil for da a$es, let it be e phasi;ed that P,A, apart fro a $eneral denial of its responsibility, failed to addu%e eviden%e showin$ that it e@er%ised the dili$en%e of a $ood father of a fa ily in the a%%reditation and supervision of the latter. An ne$le%tin$ to offer su%h proof, P,A failed to dis%har$e its burden under the last para$raph of *rti%le '32( %ited earlier, and, therefore, ust be adCud$ed solidarily liable with Dr. * pil. 6oreover, as we have dis%ussed, P,A is also dire%tly liable to the *$anas. 1ne final word. 1n%e a physi%ian underta#es the treat ent and %are of a patient, the law i poses on hi %ertain obli$ations. An order to es%ape liability, he ust possess that reasonable de$ree of learnin$, s#ill and e@perien%e reFuired by his profession. *t the sa e ti e, he ust apply reasonable %are and dili$en%e in the e@er%ise of his s#ill and the appli%ation of his #nowled$e, and e@ert his best Cud$ ent. EG5R5F1R5, we D5-L all the petitions and *FFAR6 the %hallen$ed De%ision of the Court of *ppeals in C*-+.R. C< -o. 4'(.' and C*-+.R. ,P -o. )'342. Costs a$ainst petitioners P,A and Dr. 6i$uel * pil. ,1 1RD5R5D.

G. 7. ,II.

,icariou! Lia'ilitCa%tain of t.e S.i%3 Ra&o! !. CA" !u%ra.

7+SPITAL LIA@ILITK A. Ra&o! . CA" !u%ra.8 See al!o G.R. No. 1A$F($" A%ril 11" AGGA @. PSI . Agana" !u%ra.8 G.R. No. 1AHA)*. =e'ruar- 11" AGG#" G.R. No. 1AHA)*" =e'ruar- A" AG1G C. DR. PEDR+ DENNIS CEREN+" and DR. SANT+S MA=E !. C+>RT += APPEALS" SP+>SES DI+GENES S. +LA,ERE and =E R. SERRAN+" !u%ra.

D. DR. ED>ARD+ AS>IN+ !. 7EIRS += RAKM>NDA CALAKAG" na&el-3 Rodrigo" :il&a" :illie" :illia&" :il!on" :end-" :.itne- and :arren" all !urna&ed CALAKAG" Re%re!ented '- R+DRIG+ CALAKAG" 1G.R. No. 1(#$H1. Augu!t AA" AG1A.2 %df

E. R+GELI+ P. N+GALES" for .i&!elf and on 'e.alf of t.e &inor!" R+GER ANT7+NK" ANGELICA" NANCK" and MIC7AEL C7RIST+P7ER" all !urna&ed N+GALES !. CAPIT+L MEDICAL CENTER" DR. +SCAR ESTRADA" DR. ELK ,ILLA=L+R" DR. R+SA >K" DR. ?+EL ENRIS>EM" DR. PERPET>A LACS+N" DR. N+E ESPIN+LA" and N>RSE ?. D>MLA+" 1G.R. No. 1$AHA(. Dece&'er 1)" AGGH.2

$&IRD DI+ISION

ROGELIO ". NOGALES, .or /0m4e). ('3 o' be/(). o. t/e m0'or4, ROGER AN$&ON9, ANGELICA, NANC9, ('3 *IC&AEL C&RIS$O"&ER, ()) 42r'(me3 NOGALES, Petitioner!" - er!u! -

G.R. No. 14?;?5 Pre!ent3 S>IS>M@ING" J., Chairperson" CARPI+" CARPI+ M+RALES" TINGA" and ,ELASC+" ?R." JJ.

CA"I$OL *EDICAL CEN$ER" DR. OSCAR ES$RADA" DR. EL9 +ILLA!LOR" DR. ROSA U9" DR. %OEL ENRI,UE-" DR. "ER"E$UA LACSON" DR. NOE ES"INOLA, ('3 Pro&ulgated3 NURSE %. DU*LAO, Re!%ondent!. Dece&'er 1)" AGGH 5-----------------------------------------------------------------------------------------5 DECISION CAR"IO, J.7 $/e C(4e

T.i! %etition for re ie/112 a!!ail! t.e H =e'ruar- 1))# Deci!ion1A2 and A1 Marc. AGGG Re!olution1F2 of t.e Court of A%%eal! in CA-G.R. C, No. $(H$1. T.e Court of A%%eal! affir&ed in toto t.e AA No e&'er 1))F Deci!ion1$2 of t.e Regional Trial Court of Manila" @ranc. FF" finding Dr. +!car E!trada !olel- lia'le for da&age! for t.e deat. of .i! %atient" Cora<on Nogale!" /.ile a'!ol ing t.e re&aining re!%ondent! of an- lia'ilit-. T.e Court of A%%eal! denied %etitioner!D &otion for recon!ideration.

$/e !(1t4 Pregnant /it. .er fourt. c.ild" Cora<on Nogale! B4Cora<on9C" /.o /a! t.en F* -ear! old" /a! under t.e e5clu!i e %renatal care of Dr. +!car E!trada B4Dr. E!trada9C 'eginning on .er fourt. &ont. of %regnanc- or a! earl- a! Dece&'er 1)*(. :.ile Cora<on /a! on .er la!t tri&e!ter of %regnanc-" Dr. E!trada noted an increa!e in .er 'lood %re!!ure and de elo%&ent of leg ede&a1(2 indicating %reecla&%!ia"1H2 /.ic. i! a dangerou! co&%lication of %regnanc-.1*2 Around &idnig.t of A( Ma- 1)*H" Cora<on !tarted to e5%erience &ild la'or %ain! %ro&%ting Cora<on and Rogelio Nogale! B4S%ou!e! Nogale!9C to !ee Dr. E!trada at .i! .o&e. After e5a&ining Cora<on" Dr. E!trada ad i!ed .er i&&ediate ad&i!!ion to t.e Ca%itol Medical Center B4CMC9C. +n AH Ma- 1)*H" Cora<on /a! ad&itted at A3FG a.&. at t.e CMC after t.e !taff nur!e noted t.e /ritten ad&i!!ion re6ue!t1#2 of Dr. E!trada. >%on Cora<onD! ad&i!!ion at t.e CMC" Rogelio Nogale! B4Rogelio9C e5ecuted and !igned t.e 4Con!ent on Ad&i!!ion and Agree&ent91)2 and 4Ad&i!!ion Agree&ent.911G2 Cora<on /a! t.en 'roug.t to t.e la'or roo& of t.e CMC. Dr. Ro!a >- B4Dr. >-9C" /.o /a! t.en a re!ident %.-!ician of CMC" conducted an internal e5a&ination of Cora<on. Dr. >- t.en called u% Dr. E!trada to notif- .i& of .er finding!. @a!ed on t.e DoctorD! +rder S.eet"1112 around F3GG a.&." Dr. E!trada ordered for 1G

&g. of aliu& to 'e ad&ini!tered i&&ediatel- '- intra&u!cular inEection. Dr. E!trada later ordered t.e !tart of intra enou! ad&ini!tration of !-ntocinon ad&i5ed /it. de5tro!e" (U" in lactated Ringer!D !olution" at t.e rate of eig.t to ten &icro-dro%! %er &inute. According to t.e Nur!eD! +'!er ation Note!"11A2 Dr. ?oel Enri6ue< B4Dr. Enri6ue<9C" an ane!t.e!iologi!t at CMC" /a! notified at $31( a.&. of Cora<onD! ad&i!!ion. Su'!e6uentl-" /.en a!;ed if .e needed t.e !er ice! of an ane!t.e!iologi!t" Dr. E!trada refu!ed. De!%ite Dr. E!tradaD! refu!al" Dr. Enri6ue< !ta-ed to o'!er e Cora<onD! condition. At H3GG a.&." Cora<on /a! tran!ferred to Deli er- Roo& No. 1 of t.e CMC. At H31G a.&." Cora<onD! 'ag of /ater ru%tured !%ontaneou!l-. At H31A a.&." Cora<onD! cer i5 /a! full- dilated. At H31F a.&." Cora<on !tarted to e5%erience con ul!ion!. At H31( a.&." Dr. E!trada ordered t.e inEection of ten gra&! of &agne!iu& !ulfate. 7o/e er" Dr. El- ,illaflor B4Dr. ,illaflor9C" /.o /a! a!!i!ting Dr. E!trada" ad&ini!tered onl- A.( gra&! of &agne!iu& !ulfate. At H3AA a.&." Dr. E!trada" a!!i!ted '- Dr. ,illaflor" a%%lied lo/ force%! to e5tract Cora<onD! 'a'-. In t.e %roce!!" a 1.G 5 A.( c&. %iece of cer ical ti!!ue /a! allegedltorn. T.e 'a'- ca&e out in an a%nic" c-anotic" /ea; and inEured condition. Con!e6uentl-" t.e 'a'- .ad to 'e intu'ated and re!u!citated '- Dr. Enri6ue< and Dr. Pa-u&o. At H3A* a.&." Cora<on 'egan to &anife!t &oderate aginal 'leeding /.ic. ra%idl'eca&e %rofu!e. Cora<onD! 'lood %re!!ure dro%%ed fro& 1FGI#G to HGI$G /it.in fi e &inute!. T.ere /a! continuou! %rofu!e aginal 'leeding. T.e a!!i!ting nur!e ad&ini!tered .e&acel t.roug. a gauge 1) needle a! a !ide dri% to t.e ongoing intra enou! inEection of de5tro!e. At *3$( a.&." Dr. E!trada ordered 'lood t-%ing and cro!! &atc.ing /it. 'ottled 'lood. It too; a%%ro5i&atel- FG &inute! for t.e CMC la'orator-" .eaded '- Dr. Per%etua Lac!on B4Dr. Lac!on9C" to co&%l- /it. Dr. E!tradaD! order and deli er t.e 'lood. At #3GG a.&." Dr. Noe E!%inola B4Dr. E!%inola9C" .ead of t.e +'!tetric!-G-necolog-

De%art&ent of t.e CMC" /a! a%%ri!ed of Cora<onD! condition '- tele%.one. >%on 'eing infor&ed t.at Cora<on /a! 'leeding %rofu!el-" Dr. E!%inola ordered i&&ediate .-!terecto&-. Rogelio /a! &ade to !ign a 4Con!ent to +%eration.911F2 Due to t.e incle&ent /eat.er t.en" Dr. E!%inola" /.o /a! fetc.ed fro& .i! re!idence '- an a&'ulance" arri ed at t.e CMC a'out an .our later or at )3GG a.&. 7e e5a&ined t.e %atient and ordered !o&e re!u!citati e &ea!ure! to 'e ad&ini!tered. De!%ite Dr. E!%inolaD! effort!" Cora<on died at )31( a.&. T.e cau!e of deat. /a! 4.e&orr.age" %o!t %artu&.911$2 +n 1$ Ma- 1)#G" %etitioner! filed a co&%laint for da&age!11(2 /it. t.e Regional Trial Court11H2 of Manila again!t CMC" Dr. E!trada" Dr. ,illaflor" Dr. >-" Dr. Enri6ue<" Dr. Lac!on" Dr. E!%inola" and a certain Nur!e ?. Du&lao for t.e deat. of Cora<on. Petitioner! &ainl- contended t.at defendant %.-!ician! and CMC %er!onnel /ere negligent in t.e treat&ent and &anage&ent of Cora<onD! condition. Petitioner! c.arged CMC /it. negligence in t.e !election and !u%er i!ion of defendant %.-!ician! and .o!%ital !taff. =or failing to file t.eir an!/er to t.e co&%laint de!%ite !er ice of !u&&on!" t.e trial court declared Dr. E!trada" Dr. Enri6ue<" and Nur!e Du&lao in default.11*2 CMC" Dr. ,illaflor" Dr. >-" Dr. E!%inola" and Dr. Lac!on filed t.eir re!%ecti e an!/er! den-ing and o%%o!ing t.e allegation! in t.e co&%laint. Su'!e6uentl-" trial en!ued. After &ore t.an 11 -ear! of trial" t.e trial court rendered Eudg&ent on AA No e&'er 1))F finding Dr. E!trada !olel- lia'le for da&age!. T.e trial court ruled a! follo/!3 T.e icti& /a! under .i! %re-natal care" a%%arentl-" .i! fault 'egan fro& .i! incorrect and inade6uate &anage&ent and lac; of treat&ent of t.e %reecla&%tic condition of .i! %atient. It i! not di!%uted t.at .e &i!a%%lied t.e force%! in cau!ing t.e deli er- 'ecau!e it re!ulted in a large cer ical tear /.ic. .ad cau!ed t.e %rofu!e 'leeding /.ic. .e al!o failed to control /it. t.e a%%lication of inade6uate inEection of &agne!iu& !ulfate '- .i! a!!i!tant Dra. El- ,illaflor. Dr. E!trada e en failed to notice t.e erroneou! ad&ini!tration '- nur!e Du&lao of .e&acel '- /a- of !ide dri%" in!tead of direct intra enou! inEection" and .i! failure to con!ult a !enior o'!tetrician at an earl- !tage of t.e %ro'le&. +n t.e %art .o/e er of Dra. El- ,illaflor" Dra. Ro!a >-" Dr. ?oel Enri6ue<" Dr. Lac!on" Dr. E!%inola" nur!e ?. Du&lao and CMC" t.e Court find! no legal Eu!tification to find t.e& ci ill- lia'le.

+n t.e %art of Dra. El- ,illaflor" !.e /a! onl- ta;ing order! fro& Dr. E!trada" t.e %rinci%al %.-!ician of Cora<on Nogale!. S.e can onl- &a;e !ugge!tion! in t.e &anner t.e %atient &a-'e treated 'ut !.e cannot i&%o!e .er /ill a! to do !o /ould 'e to !u'!titute .er good Eudg&ent to t.at of Dr. E!trada. If !.e failed to correctl- diagno!e t.e true cau!e of t.e 'leeding /.ic. in t.i! ca!e a%%ear! to 'e a cer ical laceration" it cannot 'e !afelconcluded '- t.e Court t.at Dra. ,illaflor .ad t.e correct diagno!i! and !.e failed to infor& Dr. E!trada. No e idence /a! introduced to !.o/ t.at indeed Dra. ,illaflor .ad di!co ered t.at t.ere /a! laceration at t.e cer ical area of t.e %atientD! internal organ. +n t.e %art of nur!e Du&lao" t.ere i! no !.o/ing t.at /.en !.e ad&ini!tered t.e .e&acel a! a !ide dri%" !.e did it on .er o/n. If t.e correct %rocedure /a! directl- t.ru t.e ein!" it could onl- 'e 'ecau!e t.i! /a! /.at /a! %ro'a'l- t.e order! of Dr. E!trada. :.ile t.e e idence of t.e %laintiff! !.o/! t.at Dr. Noe E!%inola" /.o /a! t.e C.ief of t.e De%art&ent of +'!tetric! and G-necolog- /.o attended to t.e %atient Mr!. Nogale!" it /a! onl- at )3GG a.&. T.at .e /a! a'le to reac. t.e .o!%ital 'ecau!e of t-%.oon Didang BE5.i'it AC. :.ile .e /a! a'le to gi e %re!cri%tion in t.e &anner Cora<on Nogale! &a- 'e treated" t.e %re!cri%tion /a! 'a!ed on t.e infor&ation gi en to .i& '- %.one and .e acted on t.e 'a!i! of fact! a! %re!ented to .i&" 'elie ing in good fait. t.at !uc. i! t.e correct re&ed-. 7e /a! not /it. Dr. E!trada /.en t.e %atient /a! 'roug.t to t.e .o!%ital at A3FG oDcloc; a.&. So" /.ate er error! t.at Dr. E!trada co&&itted on t.e %atient 'efore )3GG oDcloc; a.&. are certainl- t.e error! of Dr. E!trada and cannot 'e t.e &i!ta;e of Dr. Noe E!%inola. 7i! failure to co&e to t.e .o!%ital on ti&e /a! due to fortuitou! e ent. +n t.e %art of Dr. ?oel Enri6ue<" /.ile .e /a! %re!ent in t.e deli erroo&" it i! not incu&'ent u%on .i& to call t.e attention of Dr. E!trada" Dra. ,illaflor and al!o of Nur!e Du&lao on t.e alleged error! co&&itted 't.e&. @e!ide!" a! ane!t.e!iologi!t" .e .a! no aut.orit- to control t.e actuation! of Dr. E!trada and Dra. ,illaflor. =or t.e Court to a!!u&e t.at t.ere /ere error! 'eing co&&itted in t.e %re!ence of Dr. Enri6ue< /ould 'e to d/ell on conEecture! and !%eculation!. +n t.e ci il lia'ilit- of Dr. Per%etua Lac!on" 1!2.e i! a .e&atologi!t and in-c.arge of t.e 'lood 'an; of t.e CMC. T.e Court cannot acce%t t.e t.eor- of t.e %laintiff! t.at t.ere /a! dela- in deli ering t.e 'lood needed 't.e %atient. It /a! te!tified" t.at in order t.at t.i! 'lood /ill 'e &ade a aila'le" a la'orator- te!t .a! to 'e conducted to deter&ine t.e t-%e of 'lood" cro!! &atc.ing and ot.er &atter! con!i!tent /it. &edical !cience !o" t.e la%!e of FG &inute! &a-'e con!idered a rea!ona'le ti&e to do all of t.e!e t.ing!" and not a dela- a! t.e %laintiff! /ould /ant t.e Court to 'elie e. Ad&ittedl-" Dra. Ro!a >- i! a re!ident %.-!ician of t.e Ca%itol Medical Center. S.e /a! !ued 'ecau!e of .er alleged failure to notice t.e inco&%etence and negligence of Dr. E!trada. 7o/e er" t.ere i! no e idence to !u%%ort !uc. t.eor-. No e idence /a! adduced to !.o/ t.at Dra. Ro!a >- a! a re!ident %.-!ician of Ca%itol Medical Center" .ad

;no/ledge of t.e &i!&anage&ent of t.e %atient Cora<on Nogale!" and t.at not/it.!tanding !uc. ;no/ledge" !.e tolerated t.e !a&e to .a%%en. In t.e %re-trial order" %laintiff! and CMC agreed t.at defendant CMC did not .a e an- .and or %artici%ation in t.e !election or .iring of Dr. E!trada or .i! a!!i!tant Dra. El- ,illaflor a! attending %.-!ician1!2 of t.e decea!ed. In ot.er /ord!" t.e t/o BAC doctor! /ere not e&%lo-ee! of t.e .o!%ital and t.erefore t.e .o!%ital did not .a e control o er t.eir %rofe!!ional conduct. :.en Mr!. Nogale! /a! 'roug.t to t.e .o!%ital" it /a! an e&ergenc- ca!e and defendant CMC .ad no c.oice 'ut to ad&it .er. Suc. 'eing t.e ca!e" t.ere i! t.erefore no legal ground to a%%l- t.e %ro i!ion! of Article A1*H and A1#G of t.e Ne/ Ci il Code referring to t.e icariou! lia'ilit- of an e&%lo-er for t.e negligence of it! e&%lo-ee!. If e er in t.i! ca!e t.ere i! fault or negligence in t.e treat&ent of t.e decea!ed on t.e %art of t.e attending %.-!ician! /.o /ere e&%lo-ed '- t.e fa&il- of t.e decea!ed" !uc. ci il lia'ilit- !.ould 'e 'orne '- t.e attending %.-!ician! under t.e %rinci%le of 4re!%ondeat !u%erior9. :7ERE=+RE" %re&i!e! con!idered" Eudg&ent i! .ere'- rendered finding defendant Dr. E!trada of Nu&'er 1F Piti&ini St. San =ranci!co del Monte" Sue<on Cit- ci ill- lia'le to %a- %laintiff!3 1C @- /a- of actual da&age! in t.e a&ount of P1G("GGG.GG8 AC @- /a- of &oral da&age! in t.e a&ount of P*GG"GGG.GG8 FC Attorne-D! fee! in t.e a&ount of P1GG"GGG.GG and to %a- t.e co!t! of !uit. =or failure of t.e %laintiff! to adduce e idence to !u%%ort it! 1!ic2 allegation! again!t t.e ot.er defendant!" t.e co&%laint i! .ere'- ordered di!&i!!ed. :.ile t.e Court loo;! /it. di!fa or t.e filing of t.e %re!ent co&%laint again!t t.e ot.er defendant! '- t.e .erein %laintiff!" a! in a /a- it .a! cau!ed t.e& %er!onal incon enience and !lig.t da&age on t.eir na&e and re%utation" t.e Court cannot acce%t! 1!ic2 .o/e er" t.e t.eor- of t.e re&aining defendant! t.at %laintiff! /ere &oti ated in 'ad fait. in t.e filing of t.i! co&%laint. =or t.i! rea!on defendant!D counterclai&! are .ere'ordered di!&i!!ed. S+ +RDERED.11#2

Petitioner! a%%ealed t.e trial courtD! deci!ion. Petitioner! clai&ed t.at a!ide fro& Dr. E!trada" t.e re&aining re!%ondent! !.ould 'e .eld e6ualllia'le for negligence. Petitioner! %ointed out t.e e5tent of eac. re!%ondentD! alleged lia'ilit-. +n H =e'ruar- 1))#" t.e Court of A%%eal! affir&ed t.e deci!ion of t.e trial court. 11)2 Petitioner! filed a &otion for recon!ideration /.ic. t.e Court of A%%eal! denied in it! Re!olution of A1 Marc. AGGG.1AG2 7ence" t.i! %etition.

Mean/.ile" %etitioner! filed a Manife!tation dated 1A A%ril AGGA1A12 !tating t.at re!%ondent! Dr. E!trada" Dr. Enri6ue<" Dr. ,illaflor" and Nur!e Du&lao 4need no longer 'e notified of t.e %etition 'ecau!e t.e- are a'!olutel- not in ol ed in t.e i!!ue rai!ed 'efore t.e 1Court2" regarding t.e lia'ilit- of 1CMC2.91AA2 Petitioner! !tre!!ed t.at t.e !u'Eect &atter of t.i! %etition i! t.e lia'ilit- of CMC for t.e negligence of Dr. E!trada.1AF2 T.e Court i!!ued a Re!olution dated ) Se%te&'er AGGA1A$2 di!%en!ing /it. t.e re6uire&ent to !u'&it t.e correct and %re!ent addre!!e! of re!%ondent! Dr. E!trada" Dr. Enri6ue<" Dr. ,illaflor" and Nur!e Du&lao. T.e Court !tated t.at /it. t.e filing of %etitioner!D Manife!tation" it !.ould 'e under!tood t.at t.e- are clai&ing onl- again!t re!%ondent! CMC" Dr. E!%inola" Dr. Lac!on" and Dr. >- /.o .a e filed t.eir re!%ecti e co&&ent!. Petitioner! are foregoing furt.er clai&! again!t re!%ondent! Dr. E!trada" Dr. Enri6ue<" Dr. ,illaflor" and Nur!e Du&lao. T.e Court noted t.at Dr. E!trada did not a%%eal t.e deci!ion of t.e Court of A%%eal! affir&ing t.e deci!ion of t.e Regional Trial Court. Accordingl-" t.e deci!ion of t.e Court of A%%eal!" affir&ing t.e trial courtD! Eudg&ent" i! alread- final a! again!t Dr. +!car E!trada. Petitioner! filed a &otion for recon!ideration1A(2 of t.e CourtD! ) Se%te&'er AGGA Re!olution clai&ing t.at Dr. Enri6ue<" Dr. ,illaflor and Nur!e Du&lao /ere notified of t.e %etition at t.eir coun!el!D la!t ;no/n addre!!e!. Petitioner! reiterated t.eir i&%utation of negligence on t.e!e re!%ondent!. T.e Court denied %etitioner!D Motion for Recon!ideration in it! 1# =e'ruar- AGG$ Re!olution.1AH2

$/e Co2rt o. Appe()4E R2)0'> In it! Deci!ion of H =e'ruar- 1))#" t.e Court of A%%eal! u%.eld t.e trial courtD! ruling. T.e Court of A%%eal! reEected %etitioner!D of A%%eal!" t.e %re!ent ca!e differ! fro& t.e inde%endent contractor-%.-!ician /.erea! t.e nur!e /.o /ere e&%lo-ee! of t.e .o!%ital. ie/ t.at t.e doctrine in arling v. Charleston Communit% Memorial >ospital 1A*2 a%%lie! to t.i! ca!e. According to t.e Court arling ca!e !ince Dr. E!trada i! an arling ca!e in ol ed a %.-!ician and a

Citing ot.er A&erican ca!e!" t.e Court of A%%eal! furt.er .eld t.at t.e &ere fact t.at a .o!%ital %er&itted a %.-!ician to %ractice &edicine and u!e it! facilitie! i! not !ufficient to render t.e .o!%ital lia'le for t.e %.-!icianD! negligence.1A#2 A .o!%ital i! not re!%on!i'le for t.e negligence of a %.-!ician /.o i! an inde%endent contractor.1A)2 T.e Court of A%%eal! found t.e ca!e! of avidson v. Conole1FG2 and Camp'ell v.

-mma "aing ,tevens >ospital1F12 a%%lica'le to t.i! ca!e. Suoting Camp'ell" t.e Court of A%%eal! !tated t.at /.ere t.ere i! no %roof t.at defendant %.-!ician /a! an e&%lo-ee of defendant .o!%ital or t.at defendant .o!%ital .ad rea!on to ;no/ t.at an- act! of &al%ractice /ould ta;e %lace" defendant .o!%ital could not 'e .eld lia'le for it! failure to inter ene in t.e relation!.i% of %.-!ician-%atient 'et/een defendant %.-!ician and %laintiff. +n t.e lia'ilit- of t.e ot.er re!%ondent!" t.e Court of A%%eal! a%%lied t.e 4'orro/ed !er ant9 doctrine con!idering t.at Dr. E!trada /a! an inde%endent contractor /.o /a! &erel- e5erci!ing .o!%ital %ri ilege!. T.i! doctrine %ro ide! t.at once t.e !urgeon enter! t.e o%erating roo& and ta;e! c.arge of t.e %roceeding!" t.e act! or o&i!!ion! of o%erating roo& %er!onnel" and an- negligence a!!ociated /it. !uc. act! or o&i!!ion!" are i&%uta'le to t.e !urgeon.1FA2 :.ile t.e a!!i!ting %.-!ician! and nur!e! &a- 'e e&%lo-ed '- t.e .o!%ital" or engaged '- t.e %atient" t.e- nor&all- 'eco&e t.e te&%orar!er ant! or agent! of t.e !urgeon in c.arge /.ile t.e o%eration i! in %rogre!!" and lia'ilit&a- 'e i&%o!ed u%on t.e !urgeon for t.eir negligent act! under t.e doctrine of respondeat superior.1FF2 T.e Court of A%%eal! concluded t.at !ince Rogelio engaged Dr. E!trada a! t.e attending %.-!ician of .i! /ife" an- lia'ilit- for &al%ractice &u!t 'e Dr. E!tradaD! !ole re!%on!i'ilit-. :.ile it found t.e a&ount of da&age! fair and rea!ona'le" t.e Court of A%%eal! .eld t.at no intere!t could 'e i&%o!ed on unli6uidated clai&! or da&age!. $/e I442e @a!icall-" t.e i!!ue in t.i! ca!e i! /.et.er CMC i! icariou!l- lia'le for t.e

negligence of Dr. E!trada. T.e re!olution of t.i! i!!ue re!t!" on t.e ot.er .and" on t.e

a!certain&ent of t.e relation!.i% 'et/een Dr. E!trada and CMC. T.e Court al!o 'elie e! t.at a deter&ination of t.e e5tent of lia'ilit- of t.e ot.er re!%ondent! i! ine ita'le to finalland co&%letel- di!%o!e of t.e %re!ent contro er!-.

$/e R2)0'> o. t/e Co2rt T.e %etition i! %artl- &eritoriou!.

1n the iabi'ity o# *)*

Dr. E!tradaD! negligence in .andling t.e treat&ent and &anage&ent of Cora<onD! condition /.ic. ulti&atel- re!ulted in Cora<onD! deat. i! no longer in i!!ue. Dr. E!trada did not a%%eal t.e deci!ion of t.e Court of A%%eal! /.ic. affir&ed t.e ruling of t.e trial court finding Dr. E!trada !olel- lia'le for da&age!. Accordingl-" t.e finding of t.e trial court on Dr. E!tradaD! negligence i! alread- final. Petitioner! &aintain t.at CMC i! icariou!l- lia'le for Dr. E!tradaD! negligence 'a!ed on Article A1#G in relation to Article A1*H of t.e Ci il Code. T.e!e %ro i!ion! %ertinentl!tate3 Art. A1#G. T.e o'ligation i&%o!ed '- article A1*H i! de&anda'le not onl- for oneD! o/n act! or o&i!!ion!" 'ut al!o for t.o!e of %er!on! for /.o& one i! re!%on!i'le. 5555 E&%lo-er! !.all 'e lia'le for t.e da&age! cau!ed '- t.eir e&%lo-ee! and .ou!e.old .el%er! acting /it.in t.e !co%e of t.eir a!!igned ta!;!" e en t.oug. t.e for&er are not engaged in an- 'u!ine!! or indu!tr-. 5555

T.e re!%on!i'ilit- treated of in t.i! article !.all cea!e /.en t.e %er!on! .erein &entioned %ro e t.at t.e- o'!er ed all t.e diligence of a good fat.er of a fa&il- to %re ent da&age. Art. A1*H. :.oe er '- act or o&i!!ion cau!e! da&age to anot.er" t.ere 'eing fault or negligence" i! o'liged to %a- for t.e da&age done. Suc. fault

or negligence" if t.ere i! no %re-e5i!ting contractual relation 'et/een t.e %artie!" i! called a 6ua!i-delict and i! go erned '- t.e %ro i!ion! of t.i! C.a%ter.

Si&ilarl-" in t.e >nited State!" a .o!%ital /.ic. i! t.e e&%lo-er" &a!ter" or %rinci%al of a %.-!ician e&%lo-ee" !er ant" or agent" &a- 'e .eld lia'le for t.e %.-!icianD! negligence under t.e doctrine of respondeat superior.1F$2 In t.e %re!ent ca!e" %etitioner! &aintain t.at CMC" in allo/ing Dr. E!trada to %ractice and ad&it %atient! at CMC" !.ould 'e lia'le for Dr. E!tradaD! &al%ractice. Rogelio clai&! t.at .e ;ne/ Dr. E!trada a! an accredited %.-!ician of CMC" t.oug. .e di!co ered later t.at Dr. E!trada /a! not a !alaried e&%lo-ee of t.e CMC.1F(2 Rogelio furt.er clai&! t.at .e /a! dealing /it. CMC" /.o!e %ri&ar- concern /a! t.e treat&ent and &anage&ent of .i! /ifeD! condition. Dr. E!trada Eu!t .a%%ened to 'e t.e !%ecific %er!on .e tal;ed to re%re!enting CMC.1FH2 Moreo er" t.e fact t.at CMC &ade Rogelio !ign a Con!ent on Ad&i!!ion and Ad&i!!ion Agree&ent1F*2 and a Con!ent to +%eration %rinted on t.e letter.ead of CMC indicate! t.at CMC con!idered Dr. E!trada a! a &e&'er of it! &edical !taff. +n t.e ot.er .and" CMC di!clai&! lia'ilit- '- a!!erting t.at Dr. E!trada /a! a &ere i!iting %.-!ician and t.at it ad&itted Cora<on 'ecau!e .er %.-!ical condition t.en /a! cla!!ified an e&ergenc- o'!tetric! ca!e.1F#2 CMC allege! t.at Dr. E!trada i! an inde%endent contractor 4for /.o!e actuation! CMC /ould 'e a total !tranger.9 CMC &aintain! t.at it .ad no control or !u%er i!ion o er Dr. E!trada in t.e e5erci!e of .i! &edical %rofe!!ion. T.e Court .ad t.e occa!ion to deter&ine t.e relation!.i% 'et/een a .o!%ital and a con!ultant or i!iting %.-!ician and t.e lia'ilit- of !uc. .o!%ital for t.at %.-!icianD! negligence in Ramos v. Court o3 &ppeals"1F)2 to /it3 In t.e fir!t %lace" .o!%ital! e5erci!e !ignificant control in t.e .iring and firing of con!ultant! and in t.e conduct of t.eir /or; /it.in t.e .o!%ital %re&i!e!. Doctor! /.o a%%l- for 4con!ultant9 !lot!" i!iting or attending" are re6uired to !u'&it %roof of co&%letion of re!idenc-" t.eir educational 6ualification!8 generall-" e idence of accreditation '- t.e a%%ro%riate 'oard

Bdi%lo&ateC" e idence of fello/!.i% in &o!t ca!e!" and reference!. T.e!e re6uire&ent! are carefull- !crutini<ed '- &e&'er! of t.e .o!%ital ad&ini!tration or '- a re ie/ co&&ittee !et u% '- t.e .o!%ital /.o eit.er acce%t or reEect t.e a%%lication. T.i! i! %articularl- true /it. re!%ondent .o!%ital. After a %.-!ician i! acce%ted" eit.er a! a i!iting or attending con!ultant" .e i! nor&all- re6uired to attend clinico-%at.ological conference!" conduct 'ed!ide round! for cler;!" intern! and re!ident!" &oderate grand round! and %atient audit! and %erfor& ot.er ta!;! and re!%on!i'ilitie!" for t.e %ri ilege of 'eing a'le to &aintain a clinic in t.e .o!%ital" andIor for t.e %ri ilege of ad&itting %atient! into t.e .o!%ital. In addition to t.e!e" t.e %.-!icianD! %erfor&ance a! a !%eciali!t i! generall- e aluated '- a %eer re ie/ co&&ittee on t.e 'a!i! of &ortalit- and &or'idit- !tati!tic!" and feed'ac; fro& %atient!" nur!e!" intern! and re!ident!. A con!ultant re&i!! in .i! dutie!" or a con!ultant /.o regularl- fall! !.ort of t.e &ini&u& !tandard! acce%ta'le to t.e .o!%ital or it! %eer re ie/ co&&ittee" i! nor&all- %olitelter&inated. In ot.er /ord!" %ri ate .o!%ital!" .ire" fire and e5erci!e real control o er t.eir attending and i!iting 4con!ultant9 !taff. /0)e L1o'42)t('t4M (re 'ot, te1/'01())6 emp)o6ee4, ( po0't A/01/ re4po'3e't /o4p0t() (44ert4 0' 3e'60'> ()) re4po'40b0)0t6 .or t/e p(t0e'tE4 1o'30t0o', t/e 1o'tro) eJer104e3, t/e /0r0'>, ('3 t/e r0>/t to term0'(te 1o'42)t('t4 ()) .2).0)) t/e 0mport('t /())m(rF4 o. (' emp)o6er-emp)o6ee re)(t0o'4/0p, A0t/ t/e eJ1ept0o' o. t/e p(6me't o. A(>e4. I' (44e440'> A/et/er 421/ ( re)(t0o'4/0p 0' .(1t eJ04t4, t/e 1o'tro) te4t 04 3eterm0'0'>. A11or30'>)6, o' t/e b(404 o. t/e .ore>o0'>, Ae r2)e t/(t .or t/e p2rpo4e o. ())o1(t0'> re4po'40b0)0t6 0' me301() 'e>)0>e'1e 1(4e4, (' emp)o6er-emp)o6ee re)(t0o'4/0p 0' e..e1t eJ04t4 betAee' /o4p0t()4 ('3 t/e0r (tte'30'> ('3 @040t0'> p/64010('4. T.i! 'eing t.e ca!e" t.e 6ue!tion no/ ari!e! a! to /.et.er or not re!%ondent .o!%ital i! !olidaril- lia'le /it. re!%ondent doctor! for %etitionerD! condition. T.e 'a!i! for .olding an e&%lo-er !olidaril- re!%on!i'le for t.e negligence of it! e&%lo-ee i! found in Article A1#G of t.e Ci il Code /.ic. con!ider! a %er!on accounta'le not onl- for .i! o/n act! 'ut al!o for t.o!e of ot.er! 'a!ed on t.e for&erD! re!%on!i'ilit- under a relation!.i% of patria potestas. 5 5 51$G2 BE&%.a!i! !u%%liedC

:.ile t.e Court in Ramos did not e5%ound on t.e control te!t" !uc. te!t e!!entialldeter&ine! /.et.er an e&%lo-&ent relation!.i% e5i!t! 'et/een a %.-!ician and a .o!%ital 'a!ed on t.e e5erci!e of control o er t.e %.-!ician a! to detail!. S%ecificall-" t.e e&%lo-er Bor t.e .o!%italC &u!t .a e t.e rig.t to control 'ot. t.e &ean! and t.e detail! of t.e %roce!! '- /.ic. t.e e&%lo-ee Bor t.e %.-!icianC i! to acco&%li!. .i! ta!;.1$12 After a t.oroug. e5a&ination of t.e olu&inou! record! of t.i! ca!e" t.e Court find! no !ingle e idence %ointing to CMCD! e5erci!e of control o er Dr. E!tradaD! treat&ent and

&anage&ent of Cora<onD! condition. It i! undi!%uted t.at t.roug.out Cora<onD! %regnanc-" !.e /a! under t.e e5clu!i e %renatal care of Dr. E!trada. At t.e ti&e of Cora<onD! ad&i!!ion at CMC and during .er deli er-" it /a! Dr. E!trada" a!!i!ted '- Dr. ,illaflor" /.o attended to Cora<on. T.ere /a! no !.o/ing t.at CMC .ad a %art in diagno!ing Cora<onD! condition. :.ile Dr. E!trada enEo-ed !taff %ri ilege! at CMC" !uc. fact alone did not &a;e .i& an e&%lo-ee of CMC.1$A2 CMC &erel- allo/ed Dr. E!trada to u!e it! facilitie!1$F2 /.en Cora<on /a! a'out to gi e 'irt." /.ic. CMC con!idered an e&ergenc-. Con!idering t.e!e circu&!tance!" Dr. E!trada i! not an e&%lo-ee of CMC" 'ut an inde%endent contractor. T.e 6ue!tion no/ i! /.et.er CMC i! auto&aticall- e5e&%t fro& lia'ilit- con!idering t.at Dr. E!trada i! an inde%endent contractor-%.-!ician. In general" a .o!%ital i! not lia'le for t.e negligence of an inde%endent contractor%.-!ician. T.ere i!" .o/e er" an e5ce%tion to t.i! %rinci%le. T.e .o!%ital &a- 'e lia'le if t.e %.-!ician i! t.e 4o!ten!i'le9 agent of t.e .o!%ital.1$$2 T.i! e5ce%tion i! al!o ;no/n a! t.e 4doctrine of a%%arent aut.orit-.91$(2 In $il'ert v. ,%camore Municipal >ospital"1$H2t.e Illinoi! Su%re&e Court e5%lained t.e doctrine of a%%arent aut.orit- in t.i! /i!e3 1>2nder t.e doctrine of a%%arent aut.orit- a .o!%ital can 'e .eld icariou!llia'le for t.e negligent act! of a %.-!ician %ro iding care at t.e .o!%ital" regardle!! of /.et.er t.e %.-!ician i! an inde%endent contractor" unle!! t.e %atient ;no/!" or !.ould .a e ;no/n" t.at t.e %.-!ician i! an inde%endent contractor. T.e ele&ent! of t.e action .a e 'een !et out a! follo/!3 4=or a .o!%ital to 'e lia'le under t.e doctrine of a%%arent aut.orit-" a %laintiff &u!t !.o/ t.at3 B1C t.e .o!%ital" or it! agent" acted in a &anner t.at /ould lead a rea!ona'le %er!on to conclude t.at t.e indi idual /.o /a! alleged to 'e negligent /a! an e&%lo-ee or agent of t.e .o!%ital8 BAC /.ere t.e act! of t.e agent create t.e a%%earance of aut.orit-" t.e %laintiff &u!t al!o %ro e t.at t.e .o!%ital .ad ;no/ledge of and ac6uie!ced in t.e&8 and BFC t.e %laintiff acted in reliance u%on t.e conduct of t.e .o!%ital or it! agent" con!i!tent /it. ordinar- care and %rudence.9 T.e ele&ent of 4.olding out9 on t.e %art of t.e .o!%ital doe! not re6uire an e5%re!! re%re!entation '- t.e .o!%ital t.at t.e %er!on alleged to 'e negligent i! an e&%lo-ee. Rat.er" t.e ele&ent i! !ati!fied if t.e .o!%ital .old! it!elf out a! a %ro ider of e&ergenc- roo& care /it.out infor&ing t.e %atient t.at t.e care i! %ro ided '- inde%endent contractor!. T.e ele&ent of Eu!tifia'le reliance on t.e %art of t.e %laintiff i! !ati!fied if t.e %laintiff relie! u%on t.e .o!%ital to %ro ide co&%lete e&ergenc- roo& care" rat.er t.an u%on a !%ecific %.-!ician.

T.e doctrine of a%%arent aut.orit- e!!entiall- in ol e! t/o factor! to deter&ine t.e lia'ilit- of an inde%endent-contractor %.-!ician. T.e fir!t factor focu!e! on t.e .o!%italD! &anife!tation! and i! !o&eti&e! de!cri'ed a! an in6uir- /.et.er t.e .o!%ital acted in a &anner /.ic. /ould lead a rea!ona'le %er!on to conclude t.at t.e indi idual /.o /a! alleged to 'e negligent /a! an e&%lo-ee or agent of t.e .o!%ital.1$*2 I' t/04 re>(r3, t/e /o4p0t() 'ee3 'ot m(Fe eJpre44 repre4e't(t0o'4 to t/e p(t0e't t/(t t/e tre(t0'> p/64010(' 04 (' emp)o6ee o. t/e /o4p0t()5 r(t/er ( repre4e't(t0o' m(6 be >e'er() ('3 0mp)0e3. 1$#2 T.e doctrine of a%%arent aut.orit- i! a !%ecie! of t.e doctrine of e!to%%el. Article 1$F1 of t.e Ci il Code %ro ide! t.at 41t2.roug. e!to%%el" an ad&i!!ion or re%re!entation i! rendered conclu!i e u%on t.e %er!on &a;ing it" and cannot 'e denied or di!%ro ed a! again!t t.e %er!on rel-ing t.ereon.9 E!to%%el re!t! on t.i! rule3 4:.ene er a %art- .a!" '.i! o/n declaration" act" or o&i!!ion" intentionall- and deli'eratel- led anot.er to 'elie e a %articular t.ing true" and to act u%on !uc. 'elief" .e cannot" in an- litigation ari!ing out of !uc. declaration" act or o&i!!ion" 'e %er&itted to fal!if- it.91$)2 In t.e in!tant ca!e" CMC i&%liedl- .eld out Dr. E!trada a! a &e&'er of it! &edical !taff. T.roug. CMCD! act!" CMC clot.ed Dr. E!trada /it. a%%arent aut.orit- t.ere'leading t.e S%ou!e! Nogale! to 'elie e t.at Dr. E!trada /a! an e&%lo-ee or agent of CMC. CMC cannot no/ re%udiate !uc. aut.orit-. =ir!t" CMC granted !taff %ri ilege! to Dr. E!trada. CMC e5tended it! &edical !taff and facilitie! to Dr. E!trada. >%on Dr. E!tradaD! re6ue!t for Cora<onD! ad&i!!ion" CMC" t.roug. it! %er!onnel" readil- acco&&odated Cora<on and u%dated Dr. E!trada of .er condition. Second" CMC &ade Rogelio !ign con!ent for&! %rinted on CMC letter.ead. Prior to Cora<onD! ad&i!!ion and !u%%o!ed .-!terecto&-" CMC a!;ed Rogelio to !ign relea!e for&!" t.e content! of /.ic. reinforced RogelioD! 'elief t.at Dr. E!trada /a! a &e&'er of CMCD! &edical !taff.1(G2 T.e Con!ent on Ad&i!!ion and Agree&ent e5%licitl- %ro ide!3 JN+: ALL MEN @K T7ESE PRESENTS3

I" Rogelio Nogale!" of legal age" a re!ident of 1)*$ M. 7. Del Pilar St." Malate Mla." 'eing t.e fat.erI&ot.erI'rot.erI!i!terI!%ou!eIrelati eI guardianIor %er!on in cu!tod- of Ma. Cora<on" and re%re!enting .i!I.er fa&il-" of &- o/n olition and free /ill" do con!ent and !u'&it !aid Ma. Cora<on to Dr. +!car E!trada B.ereinafter referred to a! P.-!icianC for cure" treat&ent" retreat&ent" or e&ergenc- &ea!ure!" t/(t t/e "/64010(', per4o'())6 or b6 ('3 t/ro2>/ t/e C(p0to) *e301() Ce'ter ('3Nor 0t4 4t(.., m(6 24e, (3(pt, or emp)o6 421/ me('4, .orm4 or met/o34 o. 12re, tre(tme't, retre(tme't, or emer>e'16 me(42re4 (4 /e m(6 4ee be4t ('3 mo4t eJpe30e't5 t/(t *(. Cor(Ho' ('3 I A0)) 1omp)6 A0t/ ('6 ('3 ()) r2)e4, re>2)(t0o'4, 30re1t0o'4, ('3 0'4tr21t0o'4 o. t/e "/64010(', t/e C(p0to) *e301() Ce'ter ('3Nor 0t4 4t(.. 8 and" t.at I /ill not .old lia'le or re!%on!i'le and .ere'- /ai e and fore er di!c.arge and .old free t.e P.-!ician" t.e Ca%itol Medical Center andIor it! !taff" fro& an- and all clai&! of /.ate er ;ind of nature" ari!ing fro& directl- or indirectl-" or '- rea!on of !aid cure" treat&ent" or retreat&ent" or e&ergenc- &ea!ure! or inter ention of !aid %.-!ician" t.e Ca%itol Medical Center andIor it! !taff. 5 5 5 51(12 BE&%.a!i! !u%%liedC :.ile t.e Con!ent to +%eration %ertinentl- read!" t.u!3 I" R+GELI+ N+GALES" 5 5 5" of &- o/n olition and free /ill" do con!ent and !u'&it !aid C+RAM+N N+GALES to 7-!terecto&-" 't.e S2r>01() St(.. ('3 A'e4t/e40o)o>04t4 o. C(p0to) *e301() Ce'ter andIor /.ate er !ucceeding o%eration!" treat&ent" or e&ergenc&ea!ure! a! &a- 'e nece!!ar- and &o!t e5%edient8 and" t.at I /ill not .old lia'le or re!%on!i'le and .ere'- /ai e and fore er di!c.arge and .old free t.e Surgeon" .i! a!!i!tant!" ane!t.e!iologi!t!" t.e Ca%itol Medical Center andIor it! !taff" fro& an- and all clai&! of /.ate er ;ind of nature" ari!ing fro& directl- or indirectl-" or '- rea!on of !aid o%eration or o%eration!" treat&ent" or e&ergenc- &ea!ure!" or inter ention of t.e Surgeon" .i! a!!i!tant!" ane!t.e!iologi!t!" t.e Ca%itol Medical Center andIor it! !taff. 1(A2 BE&%.a!i! !u%%liedC

:it.out an- indication in t.e!e con!ent for&! t.at Dr. E!trada /a! an inde%endent contractor-%.-!ician" t.e S%ou!e! Nogale! could not .a e ;no/n t.at Dr. E!trada /a! an inde%endent contractor. Significantl-" no one fro& CMC infor&ed t.e S%ou!e! Nogale! t.at Dr. E!trada /a! an inde%endent contractor. +n t.e contrar-" Dr. Atencio" /.o /a! t.en a &e&'er of CMC @oard of Director!" te!tified t.at Dr. E!trada /a! %art of CMCD! !urgical !taff.1(F2 T.ird" Dr. E!tradaD! referral of Cora<onD! %rofu!e aginal 'leeding to Dr. E!%inola" /.o /a! t.en t.e 7ead of t.e +'!tetric! and G-necolog- De%art&ent of CMC" ga e t.e i&%re!!ion t.at Dr. E!trada a! a &e&'er of CMCD! &edical !taff /a! colla'orating /it.

ot.er CMC-e&%lo-ed !%eciali!t! in treating Cora<on. T.e !econd factor focu!e! on t.e %atientD! reliance. It i! !o&eti&e! c.aracteri<ed a! an in6uir- on /.et.er t.e %laintiff acted in reliance u%on t.e conduct of t.e .o!%ital or it! (>e't" con!i!tent /it. ordinar- care and %rudence.1($2 T.e record! !.o/ t.at t.e S%ou!e! Nogale! relied u%on a %ercei ed e&%lo-&ent relation!.i% /it. CMC in acce%ting Dr. E!tradaD! !er ice!. Rogelio te!tified t.at .e and .i! /ife !%ecificall- c.o!e Dr. E!trada to .andle Cora<onD! deli er- not onl- 'ecau!e of t.eir friendD! reco&&endation" 'ut &ore i&%ortantl- 'ecau!e of Dr. E!tradaD! 4connection /it. a re%uta'le .o!%ital" t.e 1CMC2.91((2 In ot.er /ord!" Dr. E!tradaD! relation!.i% /it. CMC %la-ed a !ignificant role in t.e S%ou!e! Nogale!D deci!ion in acce%ting Dr. E!tradaD! !er ice! a! t.e o'!tetrician-g-necologi!t for Cora<onD! deli er-. Moreo er" a! earlier !tated" t.ere i! no !.o/ing t.at 'efore and during Cora<onD! confine&ent at CMC" t.e S%ou!e! Nogale! ;ne/ or !.ould .a e ;no/n t.at Dr. E!trada /a! not an e&%lo-ee of CMC. =urt.er" t.e S%ou!e! Nogale! loo;ed to CMC to %ro ide t.e 'e!t &edical care and !u%%ort !er ice! for Cora<onD! deli er-. T.e Court note! t.at %rior to Cora<onD! fourt. %regnanc-" !.e u!ed to gi e 'irt. in!ide a clinic. Con!idering Cora<onD! age t.en" t.e S%ou!e! Nogale! decided to .a e t.eir fourt. c.ild deli ered at CMC" /.ic. Rogelio regarded one of t.e 'e!t .o!%ital! at t.e ti&e.1(H2 T.i! i! %reci!el- 'ecau!e t.e S%ou!e! Nogale! feared t.at Cora<on &ig.t e5%erience co&%lication! during .er deli er- /.ic. /ould 'e 'etter addre!!ed and treated in a &odern and 'ig .o!%ital !uc. a! CMC. Moreo er" RogelioD! con!ent in Cora<onD! .-!terecto&- to 'e %erfor&ed '- a different %.-!ician" na&el- Dr. E!%inola" i! a clear indication of RogelioD! confidence in CMCD! !urgical !taff. CMCD! defen!e t.at all it did /a! 4to e5tend to 1Cora<on2 it! facilitie!9 i! untena'le. T.e Court cannot clo!e it! e-e! to t.e realit- t.at .o!%ital!" !uc. a! CMC" are in t.e 'u!ine!! of treat&ent. In t.i! regard" t.e Court agree! /it. t.e o'!er ation &ade '- t.e Court of A%%eal! of Nort. Carolina in iggs v. 0ovant >ealth, ?nc."1(*2 to /it3

4T.e conce%tion t.at t.e .o!%ital doe! not underta;e to treat t.e %atient" doe! not underta;e to act t.roug. it! doctor! and nur!e!" 'ut underta;e! in!tead !i&%l- to %rocure t.e& to act u%on t.eir o/n re!%on!i'ilit-" no longer

reflect! t.e fact. "re4e't 3(6 /o4p0t()4, (4 t/e0r m(''er o. oper(t0o' p)(0')6 3emo'4tr(te4, 3o .(r more t/(' .2r'04/ .(10)0t0e4 .or tre(tme't. $/e6 re>2)(r)6 emp)o6 o' ( 4()(r6 b(404 ( )(r>e 4t(.. o. p/64010('4, '2r4e4 ('3 0'ter'e4 [401], (4 Ae)) (4 (3m0'04tr(t0@e ('3 m('2() AorFer4, ('3 t/e6 1/(r>e p(t0e't4 .or me301() 1(re ('3 tre(tme't, 1o))e1t0'> .or 421/ 4er@01e4, 0. 'e1e44(r6, b6 )e>() (1t0o'. Cert(0')6, t/e per4o' A/o (@(0)4 /0m4e). o. O/o4p0t() .(10)0t0e4E eJpe1t4 t/(t t/e /o4p0t() A0)) (ttempt to 12re /0m, 'ot t/(t 0t4 '2r4e4 or ot/er emp)o6ee4 A0)) (1t o' t/e0r oA' re4po'40b0)0t6.M 5 5 5 BE&%.a!i! !u%%liedC

Li;e/i!e uncon incing i! CMCD! argu&ent t.at %etitioner! are e!to%%ed fro& clai&ing da&age! 'a!ed on t.e Con!ent on Ad&i!!ion and Con!ent to +%eration. @ot. relea!e for&! con!i!t of t/o %art!. T.e fir!t %art ga e CMC %er&i!!ion to ad&ini!ter to Cora<on an- for& of recogni<ed &edical treat&ent /.ic. t.e CMC &edical !taff dee&ed ad i!a'le. T.e !econd %art of t.e docu&ent!" /.ic. &a- %ro%erl- 'e de!cri'ed a! t.e relea!ing %art" relea!e! CMC and it! e&%lo-ee! 4fro& an- and all clai&!9 ari!ing fro& or '- rea!on of t.e treat&ent and o%eration. T.e docu&ent! do not e5%re!!l- relea!e CMC fro& lia'ilit- for inEur- to Cora<on due to negligence during .er treat&ent or o%eration. Neit.er do t.e con!ent for&! e5%re!!le5e&%t CMC fro& lia'ilit- for Cora<onD! deat. due to negligence during !uc. treat&ent or o%eration. Suc. relea!e for&!" 'eing in t.e nature of contract! of ad.e!ion" are con!trued !trictl- again!t .o!%ital!. @e!ide!" a 'lan;et relea!e in fa or of .o!%ital! 4fro& an- and all clai&!"9 /.ic. include! clai&! due to 'ad fait. or gro!! negligence" /ould 'e contrar- to %u'lic %olic- and t.u! oid. E en !i&%le negligence i! not !u'Eect to 'lan;et relea!e in fa or of e!ta'li!.&ent! li;e .o!%ital! 'ut &a- onl- &itigate lia'ilit- de%ending on t.e circu&!tance!.1(#2 :.en a %er!on needing urgent &edical attention ru!.e! to a .o!%ital" .e cannot 'argain on e6ual footing /it. t.e .o!%ital on t.e ter&! of ad&i!!ion and o%eration. Suc. a %er!on i! literall- at t.e &erc- of t.e .o!%ital. T.ere can 'e no clearer e5a&%le of a contract of ad.e!ion t.an one ari!ing fro& !uc. a dire !ituation. T.u!" t.e relea!e for&! of CMC cannot relie e CMC fro& lia'ilit- for t.e negligent &edical treat&ent of Cora<on.

1n the iabi'ity o# the 1ther Respondents De!%ite t.i! CourtD! %ronounce&ent in it! ) Se%te&'er AGGA1()2 Re!olution t.at t.e

filing of %etitioner!D Manife!tation confined %etitioner!D clai& onl- again!t CMC" Dr. E!%inola" Dr. Lac!on" and Dr. >-" /.o .a e filed t.eir co&&ent!" t.e Court dee&! it %ro%er to re!ol e t.e indi idual lia'ilit- of t.e re&aining re!%ondent! to %ut an end finallto t.i! &ore t.an t/o-decade old contro er!-. (C Dr. E)6 +0))(.)or Petitioner! 'la&e Dr. El- ,illaflor for failing to diagno!e t.e cau!e of Cora<onD! 'leeding and to !ugge!t t.e correct re&ed- to Dr. E!trada.1HG2 Petitioner! a!!ert t.at it /a! Dr. ,illaflorD! dut- to correct t.e error of Nur!e Du&lao in t.e ad&ini!tration of .e&acel.

T.e Court i! not %er!uaded. Dr. ,illaflor ad&itted ad&ini!tering a lo/er do!age of &agne!iu& !ulfate. 7o/e er" t.i! /a! after infor&ing Dr. E!trada t.at Cora<on /a! no longer in con ul!ion and t.at .er 'lood %re!!ure /ent do/n to a dangerou! le el. 1H12 At t.at &o&ent" Dr. E!trada in!tructed Dr. ,illaflor to reduce t.e do!age of &agne!iu& !ulfate fro& 1G to A.( gra&!. Since %etitioner! did not di!%ute Dr. ,illaflorD! allegation" Dr. ,illaflorD! defen!e re&ain! uncontro erted. Dr. ,illaflorD! act of ad&ini!tering a lo/er do!age of &agne!iu& !ulfate /a! not out of .er o/n olition or /a! in contra ention of Dr. E!tradaD! order. bC Dr. Ro4( U6 Dr. Ro!a >-D! alleged negligence con!i!ted of .er failure B1C to call t.e attention of Dr. E!trada on t.e incorrect do!age of &agne!iu& !ulfate ad&ini!tered '- Dr. ,illaflor8 BAC to ta;e correcti e &ea!ure!8 and BFC to correct Nur!e Du&laoD! /rong &et.od of .e&acel ad&ini!tration. T.e Court 'elie e! Dr. >-D! clai& t.at a! a !econd -ear re!ident %.-!ician t.en at CMC" !.e /a! &erel- aut.ori<ed to ta;e t.e clinical .i!tor- and %.-!ical e5a&ination of Cora<on.1HA2 7o/e er" t.at routine internal e5a&ination did not ipso 3acto &a;e Dr. >lia'le for t.e error! co&&itted '- Dr. E!trada. =urt.er" %etitioner!D i&%utation of negligence re!t! on t.eir 'a!ele!! a!!u&%tion t.at Dr. >- /a! %re!ent at t.e deli er-

roo&. Not.ing !.o/! t.at Dr. >- %artici%ated in deli ering Cora<onD! 'a'-. =urt.er" it i! une5%ected fro& Dr. >-" a &ere re!ident %.-!ician at t.at ti&e" to call t.e attention of a &ore e5%erienced !%eciali!t" if e er !.e /a! %re!ent at t.e deli er- roo&.

1C Dr. %oe) E'r0G2eH Petitioner! fault Dr. ?oel Enri6ue< al!o for not calling t.e attention of Dr. E!trada" Dr. ,illaflor" and Nur!e Du&lao a'out t.eir error!.1HF2 Petitioner! in!i!t t.at Dr. Enri6ue< !.ould .a e ta;en" or at lea!t !ugge!ted" correcti e &ea!ure! to rectif- !uc. error!. T.e Court i! not con inced. Dr. Enri6ue< i! an ane!t.e!iologi!t /.o!e field of e5%erti!e i! definitel- not o'!tetric! and g-necolog-. A! !uc." Dr. Enri6ue< /a! not e5%ected to correct Dr. E!tradaD! error!. @e!ide!" t.ere /a! no e idence of Dr. Enri6ue<D! ;no/ledge of an- error co&&itted '- Dr. E!trada and .i! failure to act u%on !uc. o'!er ation. 3C Dr. "erpet2( L(14o' Petitioner! fault Dr. Per%etua Lac!on for .er %ur%orted dela- in t.e deli er- of 'lood Cora<on needed.1H$2 Petitioner! clai& t.at Dr. Lac!on /a! re&i!! in .er dut- of !u%er i!ing t.e 'lood 'an; !taff. A! found '- t.e trial court" t.ere /a! no unrea!ona'le dela- in t.e deli er- of 'lood fro& t.e ti&e of t.e re6ue!t until t.e tran!fu!ion to Cora<on. Dr. Lac!on co&%etentle5%lained t.e %rocedure 'efore 'lood could 'e gi en to t.e %atient.1H(2 Ta;ing into account t.e 'leeding ti&e" clotting ti&e and cro!!-&atc.ing" Dr. Lac!on !tated t.at it /ould ta;e a%%ro5i&atel- $(-HG &inute! 'efore 'lood could 'e read- for tran!fu!ion. 1HH2 =urt.er" no e idence e5i!t! t.at Dr. Lac!on neglected .er dutie! a! .ead of t.e 'lood 'an;. eC Dr. Noe E4p0'o)( Petitioner! argue t.at Dr. E!%inola !.ould not .a e ordered i&&ediate .-!terecto&-

/it.out deter&ining t.e underl-ing cau!e of Cora<onD! 'leeding. Dr. E!%inola !.ould .a e fir!t con!idered t.e %o!!i'ilit- of cer ical inEur-" and ad i!ed a t.oroug. e5a&ination of t.e cer i5" in!tead of 'elie ing outrig.t Dr. E!tradaD! diagno!i! t.at t.e cau!e of 'leeding /a! uterine aton-. Dr. E!%inolaD! order to do .-!terecto&- /.ic. /a! 'a!ed on t.e infor&ation .e recei ed '- %.one i! not negligence. T.e Court agree! /it. t.e trial courtD! o'!er ation t.at Dr. E!%inola" u%on .earing !uc. infor&ation a'out Cora<onD! condition" 'elie ed in good fait. t.at .-!terecto&- /a! t.e correct re&ed-. At an- rate" t.e .-!terecto&- did not %u!. t.roug. 'ecau!e u%on Dr. E!%inolaD! arri al" it /a! alread- too late. At t.e ti&e" Cora<on /a! %racticall- dead. .C N2r4e %. D2m)(o In Moore v. $uthrie >ospital ?nc."1H*2 t.e >S Court of A%%eal!" =ourt. Circuit" .eld t.at to reco er" a %atient co&%laining of inEurie! allegedl- re!ulting /.en t.e nur!e negligentl- inEected &edicine to .i& intra enou!l- in!tead of intra&u!cularl- .ad to !.o/ t.at B1C an intra enou! inEection con!tituted a lac; of rea!ona'le and ordinar- care8 BAC t.e nur!e inEected &edicine intra enou!l-8 and BFC !uc. inEection /a! t.e %ro5i&ate cau!e of .i! inEur-. In t.e %re!ent ca!e" t.ere i! no e idence of Nur!e Du&laoD! alleged failure to follo/ Dr. E!tradaD! !%ecific in!truction!. E en a!!u&ing Nur!e Du&lao defied Dr. E!tradaD! order" t.ere i! no !.o/ing t.at !ide-dri% ad&ini!tration of .e&acel %ro5i&atel- cau!ed Cora<onD! deat.. No e idence lin;ing Cora<onD! deat. and t.e alleged /rongful .e&acel ad&ini!tration /a! introduced. T.erefore" t.ere i! no 'a!i! to .old Nur!e Du&lao lia'le for negligence.

1n the $0ard o# Interest on ,ama&es T.e a/ard of intere!t on da&age! i! %ro%er and allo/ed under Article AA11 of t.e Ci il Code" /.ic. !tate! t.at in cri&e! and 6ua!i-delict!" intere!t a! a %art of t.e da&age! &a-" in a %ro%er ca!e" 'e adEudicated in t.e di!cretion of t.e court.1H#2

&ERE!ORE" t.e Court "AR$L9 GRAN$S t.e %etition. T.e Court find! re!%ondent Ca%itol Medical Center icariou!l- lia'le for t.e negligence of Dr. +!car E!trada. T.e a&ount! of P1G("GGG a! actual da&age! and P*GG"GGG a! &oral da&age! !.ould eac. earn legal intere!t at t.e rate of !i5 %ercent BHUC %er annu& co&%uted fro& t.e date of t.e Eudg&ent of t.e trial court. T.e Court affir&! t.e re!t of t.e Deci!ion dated H =e'ruar1))# and Re!olution dated A1 Marc. AGGG of t.e Court of A%%eal! in CA-G.R. C, No. $(H$1. SO ORDERED.