LEGAL MEDICINE

1. Krohn vs. CA GR No. 108854 June 14, 1994

Facts:
The subject of the private psychiatric evaluation report being presented as evidence in a petition for
annulment of marriage grounded on psychological incapacity, Ma. Paz Fernandez Krohn, invoked the
rule on privileged communication between physician and patient, and sought to enjoin her husband
from disclosing the contents of the report. Edgar was able to secure a copy of the confidential
psychiatric report on Ma. Paz prepared and signed by Drs. Cornelio Banaag, Jr., and Baltazar Reyes.
Edgar took the witness stand and tried to testify on the contents of the Confidential Psychiatric
Evaluation Report. This was objected to on the ground that it violated the rule on privileged
communication between physician and patient.

Procedural History:

Ma. Paz filed a Manifestation expressing her "continuing objection" to any evidence, oral or
documentary, "that would thwart the physician-patient privileged communication rule." Edgar opposed
Ma. Paz' motion to disallow the introduction of the confidential psychiatric report as evidence, 7 and
afterwards moved to strike out Ma. Paz' Statement for the Record. The trial court issued an Order
admitting the Confidential Psychiatric Evaluation Report in evidence. The appellate court dismissed the
petition for certiorari. She argues that to allow her husband to testify on the contents of the psychiatric
evaluation report "will set a very bad and dangerous precedent because it abets circumvention of the
rule's intent in preserving the sanctity, security and confidence to the relation of physician and his
patient." Her thesis is that what cannot be done directly should not be allowed to be done indirectly.

Judgment:

The instant petition for review is DENIED for lack of merit. In the instant case, the person against whom
the privilege is claimed is not one duly authorized to practice medicine, surgery or obstetrics. He is
simply the patient's husband who wishes to testify on a document executed by medical practitioners.
Plainly and clearly, this does not fall within the claimed prohibition. Neither can his testimony be
considered a circumvention of the prohibition because his testimony cannot have the force and effect
of the testimony of the physician who examined the patient and executed the report.

2. Casumpang, et. Al. vs Cortejo - GR No. 171127 March 11, 2015

Facts:

Mrs. Jesusa Cortejo brought her 11-year old son, Edmer Cortejo (Edmer), to the Emergency Room
of the San Juan de Dios Hospital (SJDH) because of difficulty in breathing, chest pain, stomach
pain, and fever. Based on these initial examinations and the chest x-ray test that followed, Dr. Livelo
diagnosed Edmer with "bronchopneumonia.7 She was thereafter assigned to Dr. Noel Casumpang
(Dr. Casumpang), a pediatrician also accredited with Fortune Care, who, for the first time, examined
Edmer in his room. Using only a stethoscope, he confirmed the initial diagnosis of
"Bronchopneumonia." Despite the pieces of information given by the mother, Dr. Casumpang
reassured Mrs. Cortejo that Edmers illness is bronchopneumonia. However, further findings
showed a different result. Another physician, Dr. Sanga, advised Edmers parents that the blood
test results showed that Edmer was suffering from "Dengue Hemorrhagic Fever." Edmer died and
the indicated cause of death was "Hypovolemic Shock/hemorrhagic shock;" "Dengue Hemorrhagic
Fever Stage IV.

Procedural History:

The RTC ruled in favor of the respondent, and awarded actual and moral damages, plus attorney's
fees and costs. In ruling that the petitioning doctors were negligent, the RTC found untenable the
petitioning doctors contention that Edmers initial symptoms did not indicate dengue fever. The
court held that in diagnosing and treating an illness, the physicians conduct should be judged not
only by what he/she saw and knew, but also by what he/she could have reasonably seen and known.
The CA affirmed en toto the RTCs ruling, finding that SJDH and its attending physicians failed to
exercise the minimum medical care, attention, and treatment expected of an ordinary doctor under
like circumstances. The CA found the petitioning doctors failure to read even the most basic signs
of "dengue fever" expected of an ordinary doctor as medical negligence.

Judgment:

The SC found the petition partly meritorious.

It is a medical malpractice suit, an action available to victims to redress a wrong committed by

medical professionals who caused bodily harm to, or the death of, a patient. The elements of
medical negligence are: (1) duty; (2) breach; (3) injury; and (4) proximate causation. If the patient,
as a result of the breach of duty, is injured in body or in health, actionable malpractice is committed,
entitling the patient to damages. To successfully claim damages, the patient must lastly prove the
causal relation between the negligence and the injury. This connection must be direct, natural, and
should be unbroken by any intervening efficient causes. In other words, the negligence must be the
proximate cause of the injury.

While he noted some of these symptoms in confirming bronchopneumonia, he did not seem to have
considered the patients other manifestations in ruling out dengue fever or dengue hemorrhagic
fever.58 To our mind, Dr. Casumpang selectively appreciated some, and not all of the symptoms;
worse, he casually ignored the pieces of information that could have been material in detecting
dengue fever. When a patient exhibits symptoms typical of a particular disease, these symptoms
should, at the very least, alert the physician of the possibility that the patient may be afflicted with
the suspected disease.

The Court clarified that a wrong diagnosis is not by itself medical malpractice.65 Physicians are
generally not liable for damages resulting from a bona fide error of judgment. Nonetheless, when
the physicians erroneous diagnosis was the result of negligent conduct (e.g., neglect of medical
history, failure to order the appropriate tests, failure to recognize symptoms), it becomes an
evidence of medical malpractice.

Apart from failing to promptly detect dengue fever, Dr. Casumpang also failed to promptly undertake
the proper medical management needed for this disease.
 3. Coca-cola vs Dr. Climaco GR No. 146881 Feb. 5, 2007

Facts:

Respondent Dr. Dean N. Climaco is a medical doctor who was hired by petitioner Coca-Cola Bottlers
Phils., Inc. by virtue of a Retainer Agreement. The Retainer Agreement, which began on January 1,
1988, was renewed annually. The last one expired on December 31, 1993. Despite the non-renewal of
the Retainer Agreement, respondent continued to perform his functions as company doctor to Coca-
Cola until he received a letter4 dated March 9, 1995 from petitioner company concluding their
retainership agreement effective 30 days from receipt thereof. Respondent inquired from the
management of petitioner company whether it was agreeable to recognizing him as a regular employee.
The management refused to do so.

Procedural History:

Respondent filed a Complaint9 before the NLRC, Bacolod City, seeking recognition as a regular
employee of petitioner company and prayed for the payment of all benefits of a regular employee.
Subsequently. He respondent filed a complaint for illegal dismissal against petitioner company with the
NLRC. The Labor Arbiter found that petitioner company lacked the power of control over respondent's
performance of his duties, and recognized as valid the Retainer Agreement between the parties. The
case for illegal dismissal was also dismissed in view of the previous finding that complainant therein,
Dr. Dean Climaco, is not an employee of Coca-Cola Bottlers Phils., Inc.

The Court of Appeals ruled that an employer-employee relationship existed between petitioner
company and respondent after applying the four-fold test: (1) the power to hire the employee; (2) the
payment of wages; (3) the power of dismissal; and (4) the employer's power to control the employee
with respect to the means and methods by which the work is to be accomplished.

Judgment:

The Court agrees with the finding of the Labor Arbiter and the NLRC that the circumstances of this case
show that no employer-employee relationship exists between the parties. The Labor Arbiter reasoned
that the Comprehensive Medical Plan, which contains the respondent's objectives, duties and
obligations, does not tell respondent "how to conduct his physical examination, how to immunize, or
how to diagnose and treat his patients, employees of [petitioner] company, in each case. In effect, the
Labor Arbiter held that petitioner company, through the Comprehensive Medical Plan, provided
guidelines merely to ensure that the end result was achieved, but did not control the means and
methods by which respondent performed his assigned tasks. The Labor Arbiter also correctly found
that the provision in the Retainer Agreement that respondent was on call during emergency cases did
not make him a regular employee.

Considering that there is no employer-employee relationship between the parties, the termination of
the Retainership Agreement, which is in accordance with the provisions of the Agreement, does not
constitute illegal dismissal of respondent. Consequently, there is no basis for the moral and exemplary
damages granted by the Court of Appeals to respondent due to his alleged illegal dismissal.
 4. MANILA DOCTORS HOSPITAL vs. SO UN CHUA and VICKY TY GR no. 150355 July 31,
2006

Facts:

The complaint is premised on the alleged unwarranted actuations of the petitioner towards its patient,
respondent So Un Chua, who was confined for hypertension, diabetes, and related illnesses. Because
one of the children of Chua was also confined during that period, there was an accumulated hospital
bill. Respondent Chua was pressured by the petitioner, through its Credit and Collection Department,
to settle the unpaid bills. Petitioner made good its threat and employed unethical, unpleasant and
unlawful methods which allegedly worsened the condition of respondent Chua, particularly, by (i) cutting
off the telephone line in her room and removing the air-conditioning unit, television set, and refrigerator,
(ii) refusing to render medical attendance and to change the hospital gown and bed sheets, and (iii)
barring the private nurses or midwives from assisting the patient. Respondents thus prayed for the
award of moral damages, exemplary damages, and attorney's fees.

Procedural History:

The RTC rendered its Decision in favor of the respondents. The RTC held that the removal of the
facilities of the room triggered the hypertension of respondent Chua; that the petitioner acted in bad
faith in removing the facilities without prior notice; that her condition was aggravated by the pressure
employed by the administration upon her to pay the hospital bills; that the food always came late as
compared to the other patients; that the beddings and clothes of respondent Chua were no longer
changed and, as a result, bed sores emerged on her body; that there was an utter lack of medical
attendance; that, because of these, respondent Chua suffered from self-pity and depression; that
petitioner clearly discriminated against the respondents; that respondent Ty had no choice but to sign
the promissory notes in order to secure the release of her mother, respondent Chua; that the foregoing
actuations constitute an abuse of rights.

The CA affirmed all salient portions of the RTC Decision and declined to disturb the findings of fact.

Judgment:

The Court granted the petition.

The evidence in the record overwhelmingly demonstrates that respondent Chua had been adequately
attended to, and this Court cannot understand why the courts a quo had declared that there was an
"utter lack of medical attendance," or that her health suffered during the period after the removal of the
facilities. The Court finds that the facilities in question are non-essential for the care of respondent Chua
and, hence, they may be lessened or removed by the petitioner for the sake of economic necessity and
survival.

Haha ang haba ng ruling masadot nakon.

5. Awan nkwa online copy na detoy 1911 case

 6. PROFESSIONAL SERVICES, INC. vs. NATIVIDAD and ENRIQUE AGANA GR No. 126297
January 31, 2007

Facts:

Natividad Agana was rushed to the Medical City General Hospital (Medical City Hospital) because of
difficulty of bowel movement and bloody anal discharge. After a series of medical examinations, Dr.
Miguel Ampil diagnosed her to be suffering from "cancer of the sigmoid." A series of surgeries were
performed. However, the operation appeared to be flawed. Pain was still persistent. Thereafter, her
daughter found a piece of gauze protruding from her vagina. Upon being informed about it, Dr. Ampil
proceeded to her house where he managed to extract by hand a piece of gauze measuring 1.5 inches
in width.

Following that occurrence, another doctor detected the presence of another foreign object in her vagina
-- a foul-smelling gauze measuring 1.5 inches in width which badly infected her vaginal vault. A recto-
vaginal fistula had formed in her reproductive organs which forced stool to excrete through the vagina.
Another surgical operation was needed to remedy the damage. Thus, in October 1984, Natividad
underwent another surgery.

Procedural History:

Natividad and her husband filed with the RTC, Branch 96, Quezon City a complaint for damages against
the Professional Services, Inc. (PSI), owner of the Medical City Hospital, Dr. Ampil, and Dr. Fuentes.
They alleged that the latter are liable for negligence for leaving two pieces of gauze inside Natividads
body and malpractice for concealing their acts of negligence. The RTC rendered its Decision in favor
of the Aganas. The CA ordered affirming the decision appealed from and dismissing the instant petition.

Judgment:

The Court denied all the petitions and affirmed the challenged Decision of the Court of Appeals.

Once a physician undertakes the treatment and care of a patient, the law imposes on him certain
obligations. In order to escape liability, he must possess that reasonable degree of learning, skill and
experience required by his profession. At the same time, he must apply reasonable care and diligence
in the exercise of his skill and the application of his knowledge, and exert his best judgment.

Recent years have seen the doctrine of corporate negligence as the judicial answer to the problem of
allocating hospitals liability for the negligent acts of health practitioners, absent facts to support the
application of respondeat superior or apparent authority. Its formulation proceeds from the judiciarys
acknowledgment that in these modern times, the duty of providing quality medical service is no longer
the sole prerogative and responsibility of the physician. The modern hospitals have changed structure.
Hospitals now tend to organize a highly professional medical staff whose competence and performance
need to be monitored by the hospitals commensurate with their inherent responsibility to provide quality
medical care. In the present case, it was duly established that PSI operates the Medical City Hospital
for the purpose and under the concept of providing comprehensive medical services to the public.
Accordingly, it has the duty to exercise reasonable care to protect from harm all patients admitted into
its facility for medical treatment. Unfortunately, PSI failed to perform such duty.
 7. DR. NINEVETCH CRUZ vs. COURT OF APPEALS and LYDIA UMALI GR No. 122445
November 18 1997

Facts:

The petitioner and one Dr. Lina Ercillo who was the attending anaesthesiologist during the operation of
the deceased were charged with "reckless imprudence and negligence resulting to (sic) homicide" in
an information. Rowena Umali De Ocampo, accompanied her mother to the Perpetual Help Clinic and
General Hospital. Lydia was examined by the petitioner who found a "myoma" 10 in her uterus, and
scheduled her for a hysterectomy operation. According to Rowena, she noticed that the clinic was
untidy and the window and the floor were very dusty prompting her to ask the attendant for a rag to
wipe the window and the floor with. Rowena and her other relatives, namely her husband, her sister
and two aunts waited outside the operating room while Lydia underwent operation. While they were
waiting, Dr. Ercillo went out of the operating room and instructed them to buy tagamet ampules which
Rowena's sister immediately bought. About one hour had passed when Dr. Ercillo came out again this
time to ask them to buy blood for Lydia. After the lapse of a few hours, the petitioner informed them
that the operation was finished. But at around 10:00 o'clock P.M. she went into shock and her blood
pressure dropped to 60/50. After being transferred to another hospital, she was re-operated because
there was blood oozing from the abdominal incision. Lydia unfortunately died. Her death certificate
states "shock" as the immediate cause of death and "Disseminated Intravascular Coagulation (DIC)"
as the antecedent cause.

Procedural History:

In convicting the petitioner, the MTCC found the following circumstances as sufficient basis to conclude
that she was indeed negligent in the performance of the operation. The RTC reiterated the findings of
the MTCC and upheld the latter's declaration of "incompetency, negligence and lack of foresight and
skill of appellant (herein petitioner) in handling the subject patient before and after the operation." And
likewise affirming the petitioner's conviction, the Court of Appeals echoed similar observations.

Judgment:

The Court acquitted petitioner DR. NINEVETCH CRUZ of the crime of reckless imprudence resulting
in homicide but is ordered to pay the heirs of the deceased civil liability, moral damages, and exemplary
damages.

All three courts below bewail the inadequacy of the facilities of the clinic and its untidiness; the lack of
provisions such as blood, oxygen, and certain medicines; the failure to subject the patient to a cardio-
pulmonary test prior to the operation; the omission of any form of blood typing before transfusion; and
even the subsequent transfer of Lydia to the San Pablo Hospital and the reoperation performed on her
by the petitioner. But while it may be true that the circumstances pointed out by the courts below
seemed beyond cavil to constitute reckless imprudence on the part of the surgeon, this conclusion is
still best arrived at not through the educated surmises nor conjectures of laymen, including judges, but
by the unquestionable knowledge of expert witnesses. For whether a physician or surgeon has
exercised the requisite degree of skill and care in the treatment of his patient is, in the generality of
cases, a matter of expert opinion.
Even granting arguendo that the inadequacy of the facilities and untidiness of the clinic; the lack of
provisions; the failure to conduct pre-operation tests on the patient; and the subsequent transfer of
Lydia to the San Pablo Hospital and the reoperation performed on her by the petitioner do indicate,
even without expert testimony, that petitioner was recklessly imprudent in the exercise of her duties as
a surgeon, no cogent proof exists that any of these circumstances caused petitioner's death. Thus, the
absence of the fourth element of reckless imprudence: that the injury to the person or property was a
consequence of the reckless imprudence.

The elements of reckless imprudence are: (1) that the offender does or fails to do an act; (2) that the
doing or the failure to do that act is voluntary; (3) that it be without malice; (4) that material damage
results from the reckless imprudence; and (5) that there is inexcusable lack of precaution on the part
of the offender, taking into consideration his employment or occupation, degree of intelligence, physical
condition, and other circumstances regarding persons, time and place.

The petitioner is a doctor in whose hands a patient puts his life and limb. For insufficiency of evidence
this Court was not able to render a sentence of conviction but it is not blind to the reckless and imprudent
manner in which the petitioner carried out her duties

8. Dr. Solidum vs People GR No. 192123 March 10 2014

Facts:

Gerald Albert Gercayo was born on June 2, 1992 with an imperforate anus. Two days after his birth,
Gerald under went colostomy, a surgical procedure to bring one end of the large intestine out through
the abdominal walls, enabling him to excrete through a colostomy bag attached to the side of his body.
On May 17, 1995, Gerald was admitted at the Ospital ng Maynila for a pull-through operation. Dr.
Leandro Resurreccionheaded the surgical team, and was assisted by Dr. Joselito Lucerio, Dr.Donatella
Valeria and Dr. Joseph Tibio. The anesthesiologist included Drs. Abella, Razon and Solidum. During
the operation, Gerald experienced bradycardia and went into a coma. His coma lasted for two weeks ,
but he regained consciousness only after a month. He could no longer see, hear, or move. A complaint
for reckless imprudence resulting in serious physical injuries were filed by Geralds parents against the
team of doctors alleging that there was failure in monitoring the anesthesia administered to Gerald.

Procedural History:

The RTC rendered its judgment finding Dr. Solidum guilty beyond reasonable doubt of reckless
imprudence resulting to serious physical injuries. The CA affirmed the conviction of Dr. Solidum
pertinently stating and ruling that the case appears to be a textbook example of res ipsa loquitur.

Except for his imperforate anus, the child was healthy. Hence, the lower court has been left with no
reasonable hypothesis except to attribute the accident to a failure in the proper administration of
anesthesia, the gravamen of the charge in this case.

Judgment:
The Court granted the petition and reversed and set aside the decision. Dr Solidum is acquitted of the
crime of reckless imprudence resulting to serious physical injuries.

Res ipsa liquitor is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously
applied, depending upon the circumstances of each case. It is generally restricted to situations in
malpractice cases where a layman is able to say, as a matter of common knowledge and observation,
that the consequences of professional care were not as such as would ordinarily have followed if due
care had been exercised. A distinction must be made between the failure to secure results, and the
occurrence of something more unusual and not ordinarily found if the service or treatment rendered
followed the usual procedure of those skilled in that particular practice. It must be conceded that the
doctrine of res ipsa liquitor can have no application in a suit against a physician or surgeon which
involves the merits of a diagnosis or of a scientific treatment. The physician or surgeon is not required
at his peril to explain why any particular diagnosis was not correct, or why any particular scientific
treatment did not produce the desired results. Thus, res ipsa liquitor is not available in a malpractice
suit if the only showing is that the desired result of an operation or treatment was not accomplished.
The real question, therefore, is whether or not in the process of the operation any extraordinary incident
or unusual event outside the routine performance occurred which is beyond the regular scope of
customary professional activity in such operations, which if unexplained would themselves reasonably
speak to the average man as the negligent case or causes of the untoward consequence. If there was
such extraneous intervention, the doctrine of res ipsa liquitor may be utilized and the dependent is
called upon to explain the matter, by evidence of exculpation, if he could.

9. Sps. Flores vs. Sps. Pineda GR No. 158996 November 14 2008

Facts:

Teresita Pineda (Teresita) was a 51-year old unmarried woman. She complained of general body
weakness, loss of appetite, frequent urination and thirst, and on-and-off vaginal bleeding. Dr. Fredelicto
initially interviewed the patient and asked for the history of her monthly period to analyze the probable
cause of the vaginal bleeding. When her condition persisted, she went to further consult Dr. Flores at
his UDMC clinic. Teresita was taken to the operating room. It was only then that she met Dr. Felicisima,
an obstetrician and gynecologist. Dr. Felicisima proceeded with the D&C operation with Dr. Fredelicto
administering the general anesthesia. The results showed that she had an enlarged uterus and myoma
uteri. Teresita's condition had worsened. She experienced difficulty in breathing and was rushed to the
intensive care unit. Further tests confirmed that she was suffering from Diabetes Mellitus Type II.10
Insulin was administered on the patient, but the medication might have arrived too late. Due to
complications induced by diabetes, Teresita died.

Procedural History:

The RTC ruled in favor of Teresita's family and awarded actual, moral, and exemplary damages, plus
attorney's fees and costs.12 The CA affirmed the judgment, but modified the amount of damages
awarded and deleted the award for attorney's fees and costs of suit.

Judgment:

The SC affirmed the lower and the appellate courts decision.

A medical negligence case is a type of claim to redress a wrong committed by a medical professional,
that has caused bodily harm to or the death of a patient. There are four elements involved in a medical
negligence case, namely: duty, breach, injury, and proximate causation. The Court finds that
reasonable prudence would have shown that diabetes and its complications were foreseeable harm
that should have been taken into consideration by the petitioner spouses. 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. And when the patient is exposed to an increased
risk, it is incumbent upon the physician to take commensurate and adequate precautions. The prudent
move is to address the patient's hyperglycemic state immediately and promptly before any other
procedure is undertaken. In this case, there was no evidence that insulin was administered on Teresita
prior to or during the D&C operation. Insulin was only administered two days after the operation which
was done to address the bleeding organ of deceased.

10. Nogales vs Capitol Medical Center GR No. 1426245 Dec 19 2006

Facts:

Pregnant with her fourth child, Corazon, who was then 37 years old, was under the exclusive prenatal
care of "Dr. Estrada" beginning on her fourth month of pregnancy or as early as December 1975. While
Corazon was on her last trimester of pregnancy, Dr. Estrada noted an increase in her blood pressure
and development of leg edema5 indicating preeclampsia, which is a dangerous complication of
pregnancy. . After examining Corazon, Dr. Estrada advised her immediate admission to the Capitol
Medical Center. Dr. Estrada ordered for 10 mg. of valium to be administered immediately by
intramuscular injection.

Dr. Estrada, assisted by Dr. Villaflor, applied low forceps to extract Corazon's baby. In the process, a
1.0 x 2.5 cm. piece of cervical tissue was allegedly torn. The baby came out in an apnic, cyanotic, weak
and injured condition. Corazon began to manifest moderate vaginal bleeding which rapidly became
profuse. Despite Dr. Espinola's efforts, Corazon died at 9:15 a.m. The cause of death was "hemorrhage,
post partum."

Procedural History:

Petitioners filed a complaint for damages with the Regional Trial Court. The trial court rendered
judgment on 22 November 1993 finding Dr. Estrada solely liable for damages. Petitioners appealed the
trial court's decision. Petitioners claimed that aside from Dr. Estrada, the remaining respondents should
be held equally liable for negligence. Petitioners pointed out the extent of each respondent's alleged
liability. On 6 February 1998, the Court of Appeals affirmed the decision of the trial court.

Judgment:

The SC finds the petition partly meritorious. The Court finds respondent Capitol Medical Center
vicariously liable for the negligence of Dr. Oscar Estrada.

The question now is whether CMC is automatically exempt from liability considering that Dr. Estrada is
an independent contractor-physician. In general, a hospital is not liable for the negligence of an
independent contractor-physician. There is, however, an exception to this principle. The hospital may
be liable if the physician is the "ostensible" agent of the hospital. This exception is also known as the
"doctrine of apparent authority." In the instant case, CMC impliedly held out Dr. Estrada as a member
of its medical staff. Through CMC's acts, CMC clothed Dr. Estrada with apparent authority thereby
leading the Spouses Nogales to believe that Dr. Estrada was an employee or agent of CMC. CMC
cannot now repudiate such authority.

11. Dr. Cantre vs Sps. Go GR No. 160889 April 27 2007

Facts:

Petitioner Dr. Milagros L. Cantre is a specialist in obstetrics and gynecology at the Dr. Jesus Delgado
memorial Hospital. She was the attending physician of respondent Nora Go, who was admitted at the
said hospital on April 19, 1992. At 1:30am of April 20, 1992, Nora gave birth to her fourth child, a baby
boy. However, at around 3:30am Nora suffered profuse bleeding insider her womb due to some parts
of the placenta were not completely expelled from her womb after delivery consequently, Nora suffered
hypovolemic shock, resulting in a drop in her blood pressure to 40/0. Petitioner said the assisting
resident physician performed various medical procedures to stop the bleeding and to restore Noras
blood pressure. Her blood pressure was frequently monitored with the use of a sphygmamometer.
While petitioner was massaging Noras uterus for it to contract and stop bleeding, she ordered a drop
light to warm Nora and her baby. Nora remained unconscious until she recovered. While in the recovery
room, her husband, respondent John David Z. Go noticed a fresh gasping wound 2 1/2 x 3 1/2 in the
inner portion of her left arm, close to the armpit. He asked the nurses what caused the injury. He was
informed, it was a burn. An investigation was filed by Noras husband and found out from the petitioner
that it was caused by the blood pressure cuff, however, this was contrary to the findings from a medico-
legal report which stated that it was indeed a burn and that a drop light when placed near a skin for
about 10mins could cause such burn. Nora was referred to a plastic surgeon from the hospital and skin
grafting was done on her and scar revision but both still left a mark on Noras arm compelling the
respondent spouse to file a complaint for damages against petitioner.

Procedural History:

Respondent spouses filed a complaint13 for damages against petitioner, Dr. Abad, and the hospital.
The trial court decided in favor of respondent spouses. Petitioner, Dr. Abad, and the hospital all
appealed to the Court of Appeals, which affirmed with modification the trial court decision.

Judgment:

The petition is DENIED and the assailed decision is hereby affirmed.

The Hippocratic oath mandates physicians to give primordial consideration to the well-being of their
patients. If a doctor fails to live up to his precept, he is accountable for his acts. This is notwithstanding,
courts face a unique restraint in adjudicating medical negligence cases because physicians are not
guardians of care and they never set out to intentionally cause injury to their patients. However, intent
is immaterial in negligence cases because where negligence exist and is proven, it automatically gives
the injured a right to reparation for the damage caused.
In cases, involving medical negligence, the doctrine of res ipsa liquitor allows the mere existence of an
injury to justify a presumption of negligence on the part of the person who controls the instrument
causing the injury, provided that the following requisites concur:

The accident is of a kind which ordinarily does not occur in the absence of someones negligence;
It is caused by an instrumentality within the exclusive control of the defendant or defendants;
The possibility of contributing conduct which would make the plaintiff responsible is eliminated.
All of these three requisites were present in the case at bar.

Under the the captain of the ship doctrine, the surgeon in charge of the operation is liable for the
negligence of his assistants during the time when those are under the surgeons control.

12. Ramos vs CA GR No. 124354 Dec 29 1999

Facts:

Plaintiff Erlinda Ramos was, until the afternoon of June 17, 1985 a 47-year old robust woman. Except
for occasional complaints of discomfort due to pains allegedly caused by presence of a stone in her
gall bladder, she was as normal as any other woman. Married to Rogelio Ramos, an executive of
Philippine Long Distance Telephone Company (PLDT), she has three children whose names are
Rommel, Roy Roderick, and Ron Raymond. Because of the discomforts somehow interfered with her
normal ways, she sough professional advice. She was told to undergo an operation for the removal of
a stone in her gall bladder. She underwent series of examination which revealed that she was fit for the
said surgery. Through the intercession of a mutual friend, she and her husband met Dr. Osaka for the
first time and she was advised by Dr. Osaka to go under the operation called cholecystectomy and the
same was agreed to be scheduled on June 17,1985 at 9:00am at the Delos Santos Medical Center.
Rogelio asked Dr. Osaka to look for a good anesthesiologist to which the latter agreed to. A day before
the scheduled operation, she was admitted at the hospital and on the day of the operation, Erlindas
sister was with her insider the operating room. Dr. Osaka arrived at the hospital late, Dr. Guttierez, the
anesthesiologist, started to intubate Erlina when Herminda heard her say that intubating Erlinda is quite
difficult and there were complications. This prompt Dr. Osaka to order a call to another anesthesiologist,
Dr. Caldron who successfully intubated Erlina. The patients nails became bluish and the patient was
placed in a trendelenburg position. After the operation, Erlina was diagnosed to be suffering from diffuse
cerebral parenchymal damage and that the petitioner alleged that this was due to lack of oxygen supply
to Erlindas brain which resulted from the intubation.

Procedural History:

Petitioners filed a civil case 6 for damages with the Regional Trial Court of Quezon City against herein
private respondents alleging negligence in the management and care of Erlinda Ramos. The Regional
Trial Court rendered judgment in favor of petitioners. Private respondents seasonably interposed an
appeal to the Court of Appeals. The appellate court rendered a Decision reversing the findings of the
trial court.
Judgment:

The private respondents were unable to disprove the presumption of negligence on their part in the
care of Erlinda and their negligence was the proximate case of her piteous condition.

Nevertheless, despite the fact that the scope of res ipsa liquitor has been measurably enlarged, it does
not automatically follow that it apply to all cases of medical negligence as to mechanically shift the
burden of proof to the defendant to show that he is not guilty of the ascribed negligence. Res ipsa
liquitor is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously applied,
depending upon the circumstances of each case. It is generally restricted to situations in malpractice
cases where a layman is able to say, as a matter of common knowledge and observation, that the
consequences of professional care were not as such as would ordinarily have followed if due care had
been exercised. A distinction must be made between the failure to secure results, and the occurrence
of something more unusual and not ordinarily found if the service or treatment rendered followed the
usual procedure of those skilled in that particular practice. It must be conceded that the doctrine of res
ipsa liquitor can have no application in a suit against a physician or surgeon which involves the merits
of a diagnosis or of a scientific treatment.

Scientific studies point out that intubation problems are responsible for 1/3 of deaths and serious injuries
associated with anesthesia. Nevertheless, 98% or the vast majority of difficult intubation may be
anticipated by performing a thorough evaluation of the patients airway prior to the operation. As stated
beforehand, respondent, Dra. Guttierez failed to observe the proper pre-operative protocol which could
have prevented this unfortunate incident. Had appropriate diligence and reasonable care been used in
the pre-operative evaluation, respondent physician could have been more prepared to meet the
contingency brought about by the perceived atomic variations in the patients neck and oral area;
defects which could have been easily overcome by a prior knowledge of those variations together with
a change in technique. In other words, an experienced anesthesiologist, adequately alerted by a
thorough pre-operative evaluation, would have had little difficulty going around the short neck and
potruding teeth. Having failed to observe common medical standards in pre-operative management
and intubation, respondent Dra. Guttierez negligence resulted in cerebral anoxia and eventual coma of
Erlinda.

13. Borromeo vs Family Care Hospital January 25, 2016

14. Dr. Huang vs Phil. Hoteliers Inc. GR No. 180440 Dec 5 2012
15. Achevarra vs Ramos GR No. 175172 Sept. 29 2009