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Cayao-Lasam v Sps Ramolete

G.R. No. 159132 | December 18, 2008  Respondents alleged

Austria-Martinez, J. | Group 2 Gueco that Editha’s hysterectomy was caused by
petitioner’s unmitigated negligence and
Topic: Res ipsa loquitur versus expert testimony professional incompetence in conducting the
in medical negligence cases D&C procedure and the petitioners failure to
remove the fetus inside Edithas womb.
Petitioner: Fe Cayao-Lasam  Among the alleged acts of negligence were:
Respondents: Spouses Claro and Editha o petitioners failure to check up, visit or
Ramolete administer medication
on Editha during her first day of
Facts confinement at the LMC
o petitioner recommended that a D&C
 July 28, 1994  Editha Ramolete (3 procedure be performed
months pregnant) was brought to the on Editha without conducting any
Lorma Medical Center (LMC) in San internal examination prior to the
Fernando, La Union due to vaginal procedure
bleeding. Upon advice of Dr. Cayao- o petitioner immediately suggested a
Lasam relayed via telephone, Editha was D&C procedure instead of closely
admitted to LMC on the same day. monitoring the state of pregnancy
 A pelvic sonogram was conducted, of Editha.
revealing the fetus’ weak cardiac
pulsation. The next day, Editha’s repeat  In her Answer, petitioner denied the
pelvic sonogram also showed that no allegations of negligence and incompetence
fetal movement was appreciated. and contended that it was Editha’s gross
o Due to persistent and profuse negligence and/or omission in insisting to
vaginal bleeding, petitioner be discharged on July 31, 1994 against
advised Editha to undergo a doctor’s advice and her unjustified failure
Dilatation and Currettage to return for check-up as directed by
Procedure (D&C) or raspa petitioner that contributed to her life-
 July 30, 1994  petitioner performed the threatening condition on September 16,
D&C procedure. Editha was discharged 1994; that Edithas hysterectomy was brought
from the hospital the following day. about by her very abnormal pregnancy known
 September 16, 1994  Editha was as placenta increta, which was an extremely
brought to LMC again, as she was rare and very unusual case of abdominal
suffering from vomiting and severe placental implantation. Petitioner argued that
abdominal pains. whether or not a D&C procedure was done by
o She was attended by Dr. Beatriz her or any other doctor, there would be no
de la Cruz, Dr. Victor B. Mayo, difference at all because at any stage of
and Dr. Juan V. Komiya gestation before term, the uterus would
o Dr. Mayo allegedly informed rupture just the same.
Editha that there was a dead
fetus in her womb.  March 4, 1999  the Board of Medicine (the
 Editha underwent laparotomy, where she Board) of the PRC rendered a Decision,
was found to have a massive intra- exonerating petitioner from the charges filed
abdominal hemorrhage and a ruptured against her.
uterus.  Respondents went to the PRC on appeal.
o Had to undergo a procedure for  November 22, 2000  the PRC rendered a
hysterectomy – as a result, she Decision reversing the findings of the Board
can no longer bear a child and revoking petitioners authority or license to
 November 7, 1994  Editha and her practice her profession as a physician.
husband Claro filed a Complaint for  Petitioner brought the matter to the CA in a
Gross Negligence and Malpractice Petition for Review under Rule 43 of the Rules
against petitioner before the Professional of Court and for certiorari under Rule 65
Regulations Commission (PRC).
o CA held that these were improper determinable only in the light of scientific
remedies knowledge, it has been recognized that expert
o Citing Section 26 of RA 2382 testimony is usually necessary to support the
(Medical Act of 1959), the CA held conclusion as to causation.
that the plain, speedy and adequate
remedy under the ordinary course of
law which petitioner should have  In the present case, respondents did not
availed herself of was to appeal to present any expert testimony to support their
the Office of the President. claim that petitioner failed to do something
which a reasonably prudent physician or
Relevant issue: surgeon would have done. Petitioner, on the
W/N PRC committed grave abuse of other hand, presented the testimony of
discretion in revoking petitioner’s license Dr. Augusto M. Manalo, who was clearly an
to practice medicine without an expert expert on the subject.
testimony to supports its conclusion as to  Generally, to qualify as an expert witness, one
the cause of respondent’s injury NO. must have acquired special knowledge of the
subject matter about which he or she is to
Held: testify, either by the study of recognized
 Petitioner avers that in cases of medical authorities on the subject or by practical
malpractice, expert testimony is necessary to experience.
support the conclusion as to the cause of the  Dr. Manalo specializes in gynecology and
injury. obstetrics, authored and co-authored various
 Medical malpractice is a particular form of publications on the subject, and is a professor
negligence which consists in the failure of a at UP. According to him, his diagnosis
physician or surgeon to apply to his practice of of Edithas case was Ectopic Pregnancy
medicine that degree of care and skill which is Interstitial (also referred to as Cornual),
ordinarily employed by the profession Ruptured.
generally, under similar conditions, and in like o Dr. Manalo testified that he did not
surrounding circumstances. think the D&C was the proximate
 In order to successfully pursue such a claim, a cause of the rupture of the uterus
patient must prove that the physician or because (1) the instrument cannot
surgeon either failed to do something which a reach the site of the pregnancy, 92) if
reasonably prudent physician or surgeon it is because of D&C the rupture
would not have done, and that the failure or could have occurred much earlier
action caused injury to the patient.  From the testimony of the expert witness and
 There are four elements involved in medical the reasons given by him, it is evident that the
negligence cases: duty, breach, injury and D&C procedure was not the proximate cause
proximate causation. of the rupture of Edithas uterus.
 A physician-patient relationship was created  During his cross-examination,
when Editha employed the services of the Dr. Manalo testified on how he would have
petitioner. As Editha’s physician, petitioner addressed Edithas condition should he be
was duty-bound to use at least the same level placed in a similar circumstance as the
of care that any reasonably competent doctor petitioner. It was made clear that the D&C
would use to treat a condition under the same procedure was conducted in accordance with
circumstances. the standard practice, with the same level of
 The breach of these professional duties of skill care that any reasonably competent doctor
and care, or their improper performance by a would use to treat a condition under the same
physician surgeon, whereby the patient is circumstances;
injured in body or in health, constitutes  Medical malpractice, in our jurisdiction, is often
actionable malpractice. brought as a civil action for damages under
 As to this aspect of medical malpractice, the Article 2176 of the Civil Code. The defenses in
determination of the reasonable level of care an action for damages, provided for under
and the breach thereof, expert testimony is Article 2179 of the Civil Code are:
essential. Further, inasmuch as the causes of
the injuries involved in malpractice actions are Art. 2179. When the
plaintiffs own negligence was the
immediate and proximate cause  Had Editha returned, petitioner could have
of his injury, he cannot recover conducted the proper medical tests and
damages. But if his negligence was procedure necessary to
only contributory, the immediate and determine Edithas health condition and
proximate cause of the injury being applied the corresponding treatment which
the defendants lack of due care, the could have prevented the rupture
plaintiff may recover damages, but of Edithas uterus. The D&C procedure having
the courts shall mitigate the been conducted in accordance with the
damages to be awarded. standard medical practice, it is clear
that Edithas omission was the proximate
 Proximate cause has been defined as that cause of her own injury and not merely a
which, in natural and continuous sequence, contributory negligence on her part.
unbroken by any efficient intervening cause,
produces injury, and without which the result  Contributory negligence is the act or omission
would not have occurred. An injury or damage amounting to want of ordinary care on the part
is proximately caused by an act or a failure to of the person injured, which, concurring with
act, whenever it appears from the evidence in the defendants negligence, is the proximate
the case that the act or omission played a cause of the injury. Difficulty seems to be
substantial part in bringing about or actually apprehended in deciding which acts of the
causing the injury or damage; and that the injured party shall be considered immediate
injury or damage was either a direct result or a causes of the accident.
reasonably probable consequence of the act
or omission.  Where the immediate cause of an accident
 In the present case, the Court notes the resulting in an injury is the plaintiffs own act,
findings of the Board of Medicine: which contributed to the principal occurrence
as one of its determining factors, he cannot
When complainant was discharged recover damages for the injury.
on July 31, 1994,
herein respondent advised her to  ]Based on the evidence presented in the
return on August 4, 1994 or four present case under review, in which no
(4) days after the D&C. This negligence can be attributed to the
advise was clear in complainants petitioner, the immediate cause of the
Discharge accident resulting in Edithas injury was
Sheet. However, complainant her own omission when she did not return
failed to do so. This being the case, for a follow-up check up, in defiance of
the chain of continuity as required in petitioners orders. The immediate cause
order that the doctrine of proximate of Edithas injury was her own act; thus,
cause can be validly invoked was she cannot recover damages from the
interrupted. Had she returned, the injury.
respondent could have examined
her thoroughly. x x x
All told, doctors are protected by a special rule of law.
 Also, in the testimony of Dr. Manalo, he stated They are not guarantors of care. They are not insurers
further that assuming that there was in fact a against mishaps or unusual consequences specially so
misdiagnosis, the same would have been if the patient herself did not exercise the proper diligence
rectified if Editha followed the petitioners order required to avoid the injury.
to return for a check-up on August 4, 1994.
 It is undisputed that Editha did not return for a
follow-up evaluation, in defiance of the
petitioners advise. Editha omitted the
diligence required by the circumstances which
could have avoided the injury. The omission in
not returning for a follow-up evaluation played
a substantial part in bringing
about Edithas own injury.