THIRD DIVISION

[G.R. No. 118231. July 5, 1996]

DR. VICTORIA L. BATIQUIN and ALLAN BATIQUIN,
petitioners, vs. COURT OF APPEALS, SPOUSES QUEDO D.
ACOGIDO and FLOTILDE G. VILLEGAS, respondents.

FACTS:
Dr. Batiquin with the assistance of other doctors performed a
simple cesarian section on Mrs. Villegas, the respondent.
After delivering her first child, she remained confined in the
hospital for about seven days. After leaving the hospital, Mrs.
Villegas began to suffer abdominal pains and complained of
being feverish. She also suffered loss of appetite. She
consulted Dr. Batiquin about it and the doctor prescribed her
medicines which Mrs. Villegas took for about three months.
The pains and fever however kept up and became even
worse. She also lost weight rapidly. She consulted with
another doctor, Dr. Kho who examined her. Dr. Kho took an
x-ray of Mrs. Villegas chest, abdomen and kidney and found
a mass inside her abdominal cavity. She suggested another
surgery to which Mrs. Villegas agreed. When Dr. Kho opened
the abdomen of Mrs. Villegas, she found whitish-yellow
discharge inside, an ovarian cyst on both the left and right
ovaries which gave out pus, dirt and pus behind the uterus
and a rubber material on the right side of the uterus. This
rubber material found could have been a torn section of a
surgeons gloves, causing infection to the ovaries, a reason
why Mrs. Villegas has been suffering the symptoms. Upon
learning that she was being charged, Dr. Batiquin confronted
Dr. Kho about the rubber material and the latter doctor
replied that there was indeed rubber but she threw it away.

The trial court ruled in favour of Dr. Batiquin seeing that
there were inconsistencies between Dr. Kho and Mrs.
Villegas statement wherein Dr. Kho stated that she sent this
rubber material to a phatologist and Dr. Batiquin stated
that Dr. Kho threw it away. On appeal, the CA reversed the
decision of the trial court, finding that the fault or negligence
of Dr. Batiquin needs only preponderance of evidence. And
the testimony of Dr. Kho has made it credible that there was
indeed a rubber material that was found inside the abdomen
of Mrs. Villegas.

ISSUE: Whether or not Dr. Batiquin was negligent for leaving
the piece of rubber inside her patients abdomen.

RULING: YES.

The rule of res ipsa loquitur comes to force. This doctrine [res
ipsa loquitur] is stated thus: "Where the thing which causes
injury is shown to be under the management of the
defendant, and the accident is such as in the ordinary course
of things does not happen if those who have the
management use proper care, it affords reasonable evidence,
in the absence of an explanation by the defendant, that the
accident arose from want of care."

In the instant case, all the requisites for recourse to the
doctrine are present. First, the entire proceedings of the
cesarean section were under the exclusive control of Dr.
Batiquin. In this light, the private respondents were bereft of
direct evidence as to the actual culprit or the exact cause of
the foreign object finding its way into private respondent
Villegas' body, which, needless to say, does not occur unless
through the intervention of negligence. Second, since aside
from the cesarean section, private respondent Villegas
underwent no other operation which could have caused the
offending piece of rubber to appear in her uterus, it stands to
reason that such could only have been a by-product of the
cesarean section performed by Dr. Batiquin. The petitioners,
in this regard, failed to overcome the presumption of
negligence arising from resort to the doctrine of res ipsa
loquitur. Dr. Batiquin is therefore liable for negligently leaving
behind a piece of rubber in private respondent Villegas'
abdomen and for all the adverse effects thereof.
ROGELIO E. RAMOS and ERLINDA RAMOS, in their own
behalf and as natural guardians of the minors,
ROMMEL RAMOS, ROY RODERICK RAMOS and RON
RAYMOND RAMOS, petitioners, vs. COURT OF
APPEALS, DELOS SANTOS MEDICAL CENTER, DR.
ORLINO HOSAKA and DRA. PERFECTA GUTIERREZ,
respondents.
FACTS:
When Erlinda Ramos suffered discomfort, she sought for
professional advice and was advised to undergo an operation
for the removal of a stone in her gall bladder. She and her
husband met up with Dr. Orlino Hozoka who decided that
Ramos should undergo a cholecystectomy. He agreed to
choose the anaesthesiologist and charged a fee of Php 16,000
which shall cover the anesthesiologists fee, payable after the
operation. During the operation, Herminda Cruz, Erlindas
sister-in-law stayed in the operating room as the patients
moral support. The plan was to operate Elinda on June 13,
1988 at 9:00 in the morning. However, that day of the
operation, the operation started past 1200 in the noon
because Dr. Hosaka came very late about three hours after
the scheduled operation. They prepared the patient for
operation. Dr. Gutierrez, the assigned anesthesiologist
started intubating the patient, however she remarked that
ang hirap ma-intubate nito, mali yata ang pagkakapasok. O
lumalaki ang tiyan. Herminda noticed bluish discoloration of
the nailbeds of the left hand of Erlinda. Dr. Hosaka called for
another anesthesiologist, Dr. Calderon. The patient was
placed in a trendelenburg position - a position where the
head of the patient is placed in a position lower than her feet
which is an indication that there is a decrease of blood supply
to the patients brain. By 3:00 in the afternoon, Erlinda was
taken to the ICU. The hospital asked Drs Guttierez and Hosaka
to explain what happened, they said that the patient had
bronchospasm (constriction in the muscles of the
bronchioles). Erlinda, on the other hand, has been in a
comatose condition. She suffered brain damage as a result of
the absence of oxygen in her brain for four to five minutes.
She also stayed in the hospital for four months with one
month in the ICU. Even after release, she still needs constant
medical attention. She was diagnose to be suffering from
diffuse cerebral parenchymal damage.
The petitioners filed a civil case for damages against the
doctors and the hospital. RTC of Q.C. ruled against the
respondents for negligence. On appeal, the CA reversed the
decision of the RTC, finding that the negligence of the
respondents did not cause the comatose condition of
petitioner.
ISSUE: Whether or not Dr. Guttierez, Dr. Hosaka and the
hospital were negligent.
RULING: YES. The Court of Appeals erred for not applying the
DOCTRINE OF RES IPSA LOQUITUR.
Before resort to the doctrine may be allowed, the following
requisites must be satisfactorily shown:
1. The accident is of a kind which ordinarily does
not occur in the absence of someones
negligence;
2. It is caused by an instrumentality within the
exclusive control of the defendant or
defendants; and
3. The possibility of contributing conduct which
would make the plaintiff responsible is
eliminated.
In the above requisites, the fundamental element is the
control of the instrumentality. The Supreme Court finds
that the damage sustained by Erlinda in her brain prior to a
scheduled gall bladder operation presents a case for the
application of res ipsa loquitur.
Before the operation, Erlina's brain was sound and
unaffected. However, after the procedure, this part - the
brain - was affected and was injured or destroyed. Erlinda
was unconscious when the damage took place and during
that time, it was under the immediate and exclusive control
of the doctors. Dra. Guiterrez was negligent when she failed
to properly intubate the patient. Her defense that she had a
hard time inserting the tube in Erlinda's treachea since the
latter was obese and has a short neck and has protuding
teeth were not convincing. She did not make a prior
assessment before starting the procedure, thus, her
averment was a mere afterthought, as a means of defense.
Pre-operative evaluation of a patient prior to the
administration of anesthesia is universally observed to lessen
the possibility of anesthetic accidents. This was not properly
observed by Dr. Guttierez. And for that, she should be
charged for their negligence.
Is Dr. Orlino Hosaka liable?
YES. It was his responsibility to see to it that those under him
perform their task in the proper manner. His negligence can
be found in his failure to to determine if his anesthesiologist
observed proper anesthesia protocols. No records could state
that he verified if Dra Guttierez indeed porperly intubated the
patient. He was even three hours late because he was
scheduled with another procedure in another hospital. This
gave him no time to confer with his anesthesiologist
regarding the anesthesia delivery.
G.R. No. 150355 July 31, 2006
MANILA DOCTORS HOSPITAL, petitioner, vs. SO UN CHUA
and VICKY TY, respondents.
FACTS:
So Un Chua was admitted in the Manila Doctors Hospital for
hypertension and diabetes. Her sister, Judith, was likewise
confined for injuries suffered in a vehicular accident. Judith
eas later discharged but So Un remained in the hospital. Their
balance when Judith left was P435,800. This was later
accumulated and Chua was pressured by the hospitla through
its Credit and Collection Department to settle her unpaid bills.
Chua's daughter, Vicky, promised that she will settle the bills
as soon as funds were available. When the balance remain
unpaid, the hospital threatened that it will implement
"unpleasant measures" if the bill is unsettled. It later made
good of its threat by (1) cutting the telephone line and
removing the air-con unit of the patient's room; (2) refusing
to render medical attendance and to chang the beds and
sheets; (3) barring the private nurses or midwives from
assisting the patients. Vicky claimed that this has worsened
Chua's condition. In addition to the cutting of facilities and
"neglect",
Vicky and So Un Chua then filed a complaint against the
hospital for damages. In its answer, the hospital denied their
allegations, claiming that the patient's doctor has advised
Chua to be discharged after being confined for one week. The
hospital said that Chua insisted on staying. The cutting off of
the telephone line and the removal of the aircon unit was
also the hospital's way of cost-cutting the patient's bills,
which were piling up.
The RTC ruled inf favor of Chua and Vicky, saying that the
hospital was in bad faith where the actions of the hospital has
worsened Chua's condition. On appeal, the CA affirmed the
trial court's decision.
ISSUE: Whether or not the hospital was guilty of medical
negligence.
RULING: NO.
Evidence shows that there was no harassment on the
hospital's part. It sent notices to Vicky who refused to
acknowledge the notices and who has avoided the staff. After
sending its final notice, the hospital said that if there were no
actions to settle the bill, it will be compelled to transfer the
patient to a room with a lower rate and to file a legal action
against Vicky and her mother. When Vicky won't still
acknowledge the bill, the facilities were removed as per
hospital policy - "if the patient occupies a private room all to
herself; had the room been semi-private shared by other
patients, or had it been the ward, the hospital cannot
disconnect the facilities since this would unduly prejudice the
other patients".
Also, there were no medical neglect that occurred as the
hospital was diligent in giving the patient the proper care she
really needed.
As for the facilities, it should be noted that hospital is also a
business, and, as a business, it has a right to institute all
measures of efficiency commensurate to the ends for which it
is designed, especially to ensure its economic viability and
survival. In the institution of cost-cutting measures, the
hospital has a right to reduce the facilities and services that
are deemed to be non-essential, such that their reduction or
removal would not be detrimental to the medical condition of
the patient.
The aircon unit and telephone were non-essential for the care
of Chua. They were removed for the sake of the economic
necessity and survival. There was also no evidence showing
that the hospital neglected the patient. The underlying basis
for the award of tort damages is the premise that an
individual was injured in contemplation of law. Thus, there
must first be the breach of some duty and the imposition of
liability for that breach before damages may be awarded; it
is not sufficient to state that there should be tort liability
merely because the plaintiff suffered some pain and
suffering.
Spouses Flores vs Spouses Pineda, et.al. (GR 158996)
After consultation with Dr. Flores, Teresita was suspected of
having diabetes. Her symptoms persisted so she went to
UDMC for further consultation with Dr. Flores. Teresita
arrived at the hospital, feeling weak. Dr. Flores arrived and
did a routine check-up on her. He then ordered the admission
of Teresita and to prepare her for an on-call D&C operation
to be performed by his wife, Dr. Felicima Flores. Samples of
urine and blood from Teresita were taken for laboratory
examination. The results of the lab exam were later sent to
the spouse doctors, however they were incomplete since
they consisted only of the results on the blood sugar and
blood count. The doctors, after interviewing the patient and
conducting a vaginal exam, performed the D&C operation
which lasted only for 10 to 15 minutes.
The next day, Teresita was subjected to an ultrasound exam
showing that she has an enlarged uterus and myoma uteri.
The complete lab test results came in stating that the sugar in
her urine was very high. Her conditioned worsened and she
was taken to the ICU. It was later found that she has Diabetes
Mellitus Type II. Insulin was administered on her but it was
too late. She died the next day.
Teresitas family instituted a complaint for damages against
the two doctors and UDMC, claiming that the death of
Teresita was caused by their negligence. The doctors
contended that their main concern was to stop the vaginal
bleeding. Medical expert witnesses said that the operation
should have been suspended, given that the blood test shows
that the patient might have diabetes.
The RTC and on appeal, the CA, ruled in favour of the Pinedas.
Issue: Whether or not Doctros Pineda were negligent in the
performance of their duties as medical professionals.
Ruling: YES.
As in any civil action, the burden to prove the existence of the
necessary elements rests with the plaintiff. To successfully
pursue a claim, the plaintiff must prove by preponderance of
evidence that, one, the physician either failed to do
something which a reasonably prudent health care provider
would have done, or that he did something that a reasonably
prudent provider would not have done; and two, the failure or
action caused injury to the patient.
Dr. Fredelicto knew before hand that Teresita might be
suffering from diabetes, given the symptoms she has
complained to him the day she consulted with him. And that
day of the operation, the lab results werent complete. The
couple doctors should have waited for the full results before
subjecting the patient with D&C. Their contention that their
main concern was to stop the vaginal bleeding cannot also
save them from what they have done. They should have
taken into account the increased risk to the patient caused by
diabetes. The S.C. states that, If a patient suffers from some
disability that increases the magnitude of risk to him, that
disability must be taken into account so long as it is or
should have been known to the physician. Further, the
D&C operation is merely an elective procedure and not an
emergency case. The physician must conduct a thorough pre-
operative evaluation of the patient first to adequately
prepare the patient for the operation and minimize possible
risks and complications. They should have also injected
insulin in her before they start the operation. In this case, the
insulin was administered two days after the operation.
Professional Services, Inc vs Natividad and Enrique Agana
(G.R. No. 126297 )
Natividad Agana was diagnosed from cancer of the
sigmoind. The malignancy of her sigmoind area had spread
on her left ovary, necessating the removal of certain portions
of it. He obtained the consent from the patients husband,
Enrique, to permit Dr. Juan Fuentes to perform hysterectomy
on Natividad. Dr. Fuentes completed the hysterectomy while
Dr. Ampil completed the operation and closed the incision.
However, the operation appeared to be flawed. The
attending nurses entered the remarks sponge count lacking
2 and announced to surgeon searched done but to no avail
continue for closure in the Record of Operation.
Natividad was released a few days later. After two days,
Natividad complained of excruciating pain in her anal region.
She consulted the doctors who operated on her but was told
that the pain was a natural consequence of the operation.
She was also recommended to consult an oncologist to
examine the cancerous nodes which were not removed
during the operation.
Natividad went to the US with her husband to seek further
treatment. She was told that she was free of cancer. She
returned to the Philippines, still suffering from pains. Later, a
piece of gauze was found protruding from her vagina. She
informed Dr. Ampil about it and the gauze was removed by
hand. He informed her that the pain will disappear. However,
the pains instensified and Natividad sought treatment at the
Polymedic General Hospital. Dr. Ramon Gutierrez detected
another gauze, which has now badly infected her vaginal
vault. Another surgery was needed to remedy the damage.
So, Natividad underwent another surgery.
Natividad and her husband filed a complaint against the
Professional Services, Inc. (PSI) (owner of the Medical City
Hospital), Dr. Ampil and Dr. Fuentes, for negligence, having
left two pieces of gauze inside Natividads body.
The trial court ruled in favour of Natividad. On appeal, the
Court of Appeals found that Dr. Fuentes was not guilty of
negligence, invoking the doctrine of res ipsa loquitur. Dr.
Ampil, on the other hand, together with the hospital are
solidary liable for damages.
ISSUE: (1) Whether or not Dr. Ampil was negligent
RULING: YES.
The elements of medical negligence are: duty, breach, injury
and proximate causation.
The removal of all sponges is part of a surgical operation. It
was Dr. Ampils duty. And if he fails to do so, he leaves the
operation incomplete and creates a new condition wherein
he has to tell his patient of the new condition and to perform
acts that would minimize and avoid untoward results likely to
ensue therefrom. In this case, Dr. Ampil was about to close
the wound when one of the attending nurses informed him
that there were two pieces of gauze missing. They diligently
searched the area but found none of the misplaced gauzes
so Dr. Ampil directed the closing of the wound. After this, he
did not inform Natividad about the two missing pieces of
gauze. He even misled her that the pain was a natural
consequence to her operation. If he told her earlier about
the gauzes, they might have done something about it
immediately.
Here, the proximate cause is Dr. Ampils negligence. He knew
that there were two gauzes missing after the operation, yet
he did not inform his patient about them. Worse, he even
misled Natividad that everything was normal.
(2) Is Dr. Fuentes Negligent?
No. The cause of the injury was the fact that there were two
pieces of gauze missing and that Dr. Ampil did not act on this
problem immediately, further worsening the situation by
concealing it to the patient.
From the foregoing statements of the rule, the requisites for
the applicability of the doctrine of res ipsa loquitur are: (1)
the occurrence of an injury; (2) the thing which caused the
injury was under the control and management of the
defendant; (3) the occurrence was such that in the ordinary
course of things, would not have happened if those who had
control or management used proper care; and (4) the
absence of explanation by the defendant. Of the foregoing
requisites, the most instrumental is the "control and
management of the thing which caused the injury."
We find the element of "control and management of the
thing which caused the injury" to be wanting. After Dr.
Feuntes completed hysterectomy, he was allowed to leave
the operating room. It was then when Dr. Ampil took over
and completed the operation. When he was closing the
wound and when the nurses discovered the lost gauzes, Dr.
Fuentes was out of the hospital.