Ramos v.

Court of Appeals
GR No. 124354 December 29, 1999

Kapunan, J.:

Facts:

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 sought 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, Erlinda’s 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 patient’s 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 Erlinda’s brain which
resulted from the intubation.

Issue: Were the Doctors and the Hospital liable for the damages suffered by Erlinda?

Ruling:

Yes. 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 ipsaliquitor 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 ipsaliquitor 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 ipsaliquitor 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 patient’s 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 patient’s 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.