1) OUR LADY OF LOURDES HOSPITAL vs SPOUSES ROMEO AND REGINA CAPANZANA ● Mrs.

● Mrs. Cortejo did not know any doctor at SJDH. She used her Fortune card and was referred to an
G.R. No. 189218, March 22, 2017, Sereno, CJ. accredited Fortune Care coordinator, Dr. Casumpang.
○ Dr. Casumpang: Confirmed “bronchopneumonia”.
In an action for damages against a hospital, the negligence of its nurses can be imputed to the employer ○ Mrs. Cortejo was doubtful of the diagnosis. She advised the doctor that Edmer had high fever and no colds
where there is no proof that the employer exercised actual supervision and monitoring of consistent or cough. Dr. Casumpang reassured her that that’s usual for bronchopneumonia.
compliance with hospital rules by its staff. ● Eventually, Edmer started vomiting “phlegm with blood streak”
○ Dr. Miranda: Initially ruled out dengue but ordered several tests after seeing his “sputum with blood”
FACTS: Diagnosed dengue and recommended transfer to ICU.
Regina Capanzana was brought to petitioner hospital for an emergency C-section. She successfully gave ○ Since the ICU was full, Dr. Casumpang suggested they hire a private nurse. Nelson Cortejo (respondent)
birth to a baby boy. 13 hours after her operation, she asked for oxygen, and complained of a headache, a insisted that they transfer to Makati Med.
chilly sensation, restlessness, and shortness of breath. It took around 10 minutes for nurses to respond to ○ Dr. Casumpang checked Edmer for the last time. BP was stable, noting that he was “comfortable”.
the call and administer oxygen. She was eventually transferred to the Intensive Care Unit, where she was ● Edmer was transferred to Makati Med.
hooked to a mechanical ventilator. When her condition still showed no improvement, Regina was transferred ○ Attending physician diagnosed “Dengue Fever Stage IV” that was already in its irreversible stage.
to the Cardinal Santos Hospital. The doctors thereat found that she was suffering from rheumatic heart ○ Edmer died. Cause: "Hypovolemic Shock/hemorrhagic shock;" "Dengue Hemorrhagic Fever Stage IV."
disease mitral stenosis with mild pulmonary hypertension. This development resulted in cardiopulmonary ● Cortejo instituted an action for damages against SJDH, Dr. Casumpang and Dr. Miranda before the RTC.
arrest and, subsequently, brain damage. Regina lost the use of her speech, eyesight, hearing and limbs. She ● RTC: Ruled in favor of Cortejo. Awarded actual and moral damages, atty’s fees.
was discharged in a vegetative state and eventually died. ○ Doctors were negligent because they ignored other manifestations that Edmer’s parents relayed.
○ In diagnosing and treating an illness, the physician's conduct should be judged not only by what he/she
Respondent spouses Capanzana filed a complaint for damages against petitioner hospital, along with saw and knew, but also by what he/she could have reasonably seen and known.
co-defendants: the nurses on duty. They allege that the nurses were negligent for not having promptly given ■ Based on Edmer's signs and symptoms, his medical history and physical examination, and also the
oxygen, and that the hospital was equally negligent for not making available and accessible the oxygen unit information that the petitioning doctors gathered from his family members, dengue fever was a reasonably
on that same hospital floor. foreseeable illness.
○ Did not present other evidence to prove that they exercised the proper medical attention in diagnosing and
ISSUE: treating the patient.
W/N petitioner hospital is negligent ○ SJDH is solidarily liable for damages.
■ Dr. Casumpang, as consultant, is an ostensible agent of SJDH because before the hospital engaged his
RULING: medical services, it scrutinized and determined his fitness, qualifications, and competence as a medical
YES. Proximate cause has been defined as that which, in natural and continuous sequence, unbroken by practitioner; a
any efficient intervening cause, produces injury, and without which the result would not have occurred.The ■ Dr. Miranda, as resident physician, is an employee of SJDH because like Dr. Casumpang, the hospital,
omission of the nurses - their failure to promptly check on Regina and to refer her to the resident doctor and, through its screening committee, scrutinized and determined her qualifications, fitness, and competence
thereafter, to immediately provide oxygen - was clearly the proximate cause that led to the brain damage before engaging her services; the hospital also exercised control over her work.
suffered by the patient. ● CA: Affirmed RTC. Failure to read even the most basic signs of dengue fever expected of an ordinary
doctor was medical negligence. SJDH liable under Art 2180. Failed to adduce evidence that it exercised the
As to the nurses: ​the RTC and CA found that there was a delay in the administration of oxygen to the diligence of a good father of a family in the hiring and supervision of its physicians.
patient. When she was gasping for breath and turning cyanotic (bluish), it was the duty of the nurses to ● Present petition under Rule 45.
intervene immediately by informing the resident doctor. Such high degree of care and responsiveness was
needed cannot be overemphasized because it takes only five minutes of oxygen deprivation for irreversible DISCUSSION ON MEDICAL MALPRACTICE SUITS
brain damage to set in. Regina herself had asked for oxygen but even if the patient had not asked for
oxygen, the mere fact that her breathing was labored to an abnormal degree should have impelled the Medical Malpractice Suit as a Specialized Area of Tort Law
nurses to immediately call the doctor and to administer oxygen. They committed a breach of their duty to ● This is a medical malpractice suit, an action available to victims to redress a wrong committed by medical
respond immediately to the needs of Regina. Regina suffered from brain damage and the proximate cause professionals who caused bodily harm to, or the death of, a patient.
of the brain damage was the delay in responding to Regina's call for help and for oxygen. ○ Brought whenever a medical practitioner or health care provider fails to meet the standards demanded by
his profession, or deviates from this standard, and causes injury to the patient.
As to the hospital: ​For the negligence of its nurses, petitioner is thus liable under Article 2180 (NCC). An ● To successfully pursue a medical malpractice suit, the plaintiff must prove that the doctor either failed to do
employer like petitioner hospital may be held liable for the negligence of its employees based on its what a reasonably prudent doctor would have done, or did what a reasonably prudent doctor would not have
responsibility under a relationship of patria potestas. Once negligence of the employee is shown, the burden done; and the act or omission had caused injury to the patient.
is on the employer to overcome the presumption of negligence on the latter's part by proving observance of ○ The patient's heir/s bears the burden of proving his/her cause of action.
the required diligence. The hospital failed to discharge its burden of proving due diligence in the supervision ● Elements of a medical malpractice suit:
of its nurses and is therefore liable for their negligence. While the hospital offered proof of diligence in hiring, 1. Duty: Refers to the standard of behavior that imposes restrictions on one's conduct.
there is no proof of actual supervision of the employees' work or actual implementation and monitoring of ○ It requires proof of professional relationship between the physician and the patient. Without this, a
consistent compliance with hospital rules. The hospital is directly liable for the negligence of its nurses. physician owes no duty to the patient, and cannot therefore incur any liability.
○ A physician-patient relationship is created when a patient engages the services of a physician, and the
2) CASUMPANG v. CORTEJO latter accepts or agrees to provide care to the patient. The establishment of this relationship is consensual,
and the acceptance by the physician essential
● Mrs. Jesusa Cortejo brought her 11-year old son, Edmer Cortejo to the Emergency Room of the San Juan ■ Consent does not have to be express. May be implied from the physician’s affirmative action to diagnose
de Dios Hospital (SJDH) because of difficulty in breathing, chest pain, stomach pain, and fever. and/or treat a patient.
○ Dr. Livelo: Diagnosed “bronchopneumonia”. Prescribed antibiotics.
■ Once relationship is established, the legal duty of care follows. Doctor becomes duty-bound to use at least ○ It was only after Edmer’s 3rd episode of bleeding that Casumpang ordered the conduct of hematocrit,
the same standard of care that a reasonably competent doctor would use to treat a medical condition under hemoglobin, blood typing, blood transfusion and tourniquet tests. These tests came too late.
similar circumstances. ● BREACH: He was negligent in the treatment and management of Dengue.
2. Breach: Occurs when the doctor fails to comply with, or improperly performs his duties under professional ○ Dr. Jaudian: Standard procedure is oxygen inhalation, use of analgesic, and infusion of fluids or
standards. Determination is both factual and legal, and is specific to each individual case. dextrose;67 and once the patient had twice vomited fresh blood, the doctor should have ordered: blood
3. Injury: If as a result of breach, patient is injured in body or health, actionable malpractice is committed. transfusion, monitoring of the patient every 30 minutes, hemostatic to stop bleeding, and oxygen if there is
4. Proximate Causation: This connection must be direct, natural, and should be unbroken by any intervening difficulty in breathing.
efficient causes. The injury or damage must be either a direct result, or a reasonably probable consequence ■ Dr. Casumpang failed to measure up to these standards (ex. Ordered the tourniquet test only after 2nd
of the physician's negligence. episode of bleeding)
● INJURY: Death
Standard of Care and Breach of Duty ● PROXIMATE CAUSATION: Dengue, if left untreated, is a life threatening disease. It requires immediate
● Determination of fact and law. medical attention. Survival is directly related to early and proper management of the illness.
○ Factual: Medical negligence cases are highly technical in nature, requiring the presentation of expert
witnesses to provide guidance to the court on matters clearly falling within the domain of medical science W/N Dr. Miranda was negligent - YES but cannot be held liable for medical negligence
○ Legal: The Court ultimately determines whether breach of duty took place. ● DUTY: Professional relationship arose when she assumed the obligation to provide resident supervision
● WN Dr. Casumpang and Miranda committed a breach of duty is to be measured by the yardstick of over the latter. She participated in the diagnosis and prescribed a course of treatment for Edmer.
professional standards observed by the other members of the medical profession in good standing under ○ BUT standard of care is different. Miranda was the junior resident physician on-duty at the time of Edmer’s
similar circumstances. confinement. Casumpang was the attending physician.
○ Expert testimony is essential to establish (1) the standard medical examinations, tests, and procedures ■ The attending physician exercises a supervisory role over the resident, and is ultimately responsible for the
that the attending physicians should have undertaken in the diagnosis and treatment of dengue fever; and diagnosis and treatment of the patient. The standards applicable to and the liability of the resident for
(2) the dengue fever signs and symptoms that the attending physicians should have noticed and considered. medical malpractice is theoretically less than that of the attending physician. This, however, do not translate
● Dr. Jaudian testified as the expert witness. to immunity from the legal duty of care.
● NO BREACH: Miranda was not independently negligent.
Competence of Dr. Jaudian as expert witness ○ She was briefed about Edmer’s condition, medical history and initial diagnosis. Based on these pieces of
● Criteria: Competence of an expert witness is a matter for the trial court to decide upon in the exercise of its information, she confirmed the finding of bronchopneumonia.
discretion. ○ In fact, when she suspected that Edmer could be suffering from dengue, she wasted no time in conducting
○ In our jurisdiction, the criterion remains to be the expert witness' special knowledge experience and the necessary tests, and promptly notified Dr. Casumpang about the incident.
practical training that qualify him/her to explain highly technical medical matters to the Court. ○ She was not entirely faultless. However, considering the diagnosis previously made by two doctors, and
○ To qualify a witness as a medical expert, it must be shown that the witness (1) has the required the uncontroverted fact that the burden of final diagnosis pertains to the attending physician (in this case, Dr.
professional knowledge, learning and skill of the subject under inquiry sufficient to qualify him to speak with Casumpang), we believe that Dr. Miranda's error was merely an honest mistake of judgment influenced in no
authority on the subject; and (2) is familiar with the standard required of a physician under similar small measure by her status in the hospital hierarchy; hence, she should not be held liable for medical
circumstances. negligence.
■ Not critical whether general practitioner or specialist as long as he exhibits knowledge of the subject.
Where a duly licensed and practicing physician has gained knowledge of the standard of care applicable to a W/N SJDH is liable? YES on the basis of the doctrine of apparent authority or agency by estoppel.
specialty in which he is not directly engaged but as to which he has an opinion based on education,
experience, observation, or association wit that specialty, his opinion is competent. No employer-employee relationship
● In this case, although Dr. Jaudian specializes in pathology, he had attended not less than 30 seminars ● In determining whether an employer-employee relationship exists between the parties, the following
held by the Pediatric Society, had exposure in pediatrics, had been practicing medicine for 16 years, and had elements must be present: (1) selection and engagement of services; (2) payment of wages; (3) the power to
handled not less than 50 dengue related cases. hire and fire; and (4) the power to control not only the end to be achieved, but the means to be used in
○ He demonstrated sufficient familiarity with the standard of care to be applied in dengue fever cases. reaching such an end.
○ Control, which is the most crucial among the elements, is not present in this case. No evidence exists
ISSUES: showing that SJDH exercised any degree of control over the means, methods of procedure and manner by
W/N Dr. Casumpang was negligent - YES which the petitioning doctors conducted and performed their medical profession.
● DUTY: Relationship was created when Casumpang accepted Edmer as a patient. Implied from his ■ The petitioning doctors were not employees of SJDH, but were mere independent contractors.
affirmative examination, diagnosis and treatment. Parents manifested consent by availing of the benefits of
their health care plan. Still liable based on the Principle of Agency or Doctrine of Apparent Authority
● BREACH: He was negligent in detecting dengue. He failed to timely detect dengue fever, which failure, ● As a rule, hospitals are not liable for the negligence of its independent contractors.
especially when reasonable prudence would have shown that indications of dengue were evident and/or ○ Exception: Liable if the physician or independent contractor acts as an ostensible agent of the hospital.
foreseeable, constitutes negligence. Known as the "doctrine of apparent authority."
○ During his first and second visits to Edmer, he already had knowledge of Edmer's CBC, medical history, ● Under this doctrine, a hospital can be held vicariously liable for the negligent acts of a physician providing
and symptoms. However, these information did not lead him to the possibility that Edmer could be suffering care at the hospital, regardless of whether the physician is an independent contractor, unless the patient
from either dengue fever, or dengue hemorrhagic fever, as he clung to his diagnosis of bronchopneumonia. knows, or should have known, that the physician is an independent contractor. The elements of the action
○ He selectively appreciated some symptoms. He ignored pieces of information that could have been have been set out as follows:
material in detecting dengue fever. (1) the hospital, or its agent, acted in a manner that would lead a reasonable person to conclude that the
○ His medical examination was not comprehensive enough to reasonably lead to a correct diagnosis. He individual who was alleged to be negligent was an employee or agent of the hospital;
only used a stethoscope in coming up with the diagnosis that Edmer was suffering from bronchopneumonia; ● In this case, hospital manifested itself out as provider of complete medical care.
he never confirmed this finding.
(2) where the acts of the agent create the appearance of authority, the plaintiff must also prove that the RULING:
hospital had knowledge of and acquiesced in them; and
● SJDH did not advise Mrs. Cortejo that Dr. Casumpang is an independent contractor. By referring Dr. 1) NO. In the case at hand, Dr. Cruz failed to show that the DOJ gravely abused its discretion in finding
Casumpang to care and treat for Edmer, SJDH impliedly held out Dr. Casumpang, not only as an accredited that there was a lack of probable cause and dismissing the complaint against Dr. Agas for Serious Physical
member of Fortune Care, but also as a member of its medical staff. Injuries through Reckless Imprudence and Medical Malpractice.
(3) the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with ordinary care
and prudence. A medical negligence case can prosper if the patient can present solid proof that the doctor,
● Satisfied if plaintiff can prove that he/she relied upon the hospital to provide care and treatment, rather like in this case, either failed to do something which a reasonably prudent doctor would have done, or that he
than upon a specific physician. In this case, Cortejo relied on SJDH, not on Dr. Casumpang to treat is son. did something that a reasonably prudent doctor would not have done, and such failure or action caused
They did not know that Dr. Casumpang was an independent contractor. injury to the patient.

DISPOSITIVE: To successfully pursue this kind of case, a patient must only prove that a health care provider either
PARTLY GRANTED The Court finds Dr. Noel Casumpang and San Juan de Dios Hospital solidarity liable for failed to do something which a reasonably prudent health care provider would have done, or that he did
negligent medical practice. We SET ASIDE the finding of liability as to Dr. Ruby Sanga-Miranda. The something that a reasonably prudent provider would not have done; and that failure or action caused injury
amounts of P45,000.00 as actual damages and P500,000.00 as moral damages should each earn legal to the patient. Simply put, the elements are duty, breach, injury and proximate causation.
interest at the rate of six percent (6%) per annum computed from the date of the judgment of the trial court.
The Court AFFIRMS the rest of the Decision dated October 29, 2004 and the Resolution dated January 12, In this case, Dr. Cruz has the burden of showing the negligence or recklessness of Dr. Agas.
2006 in CA-G.R. CV No. 56400. Although there is no dispute that Dr. Cruz sustained internal hemorrhage due to a tear in the serosa of his
sigmoid colon, he failed to show that it was caused by Dr. Agas’s negligent and reckless conduct of the
colonoscopy procedure. In other words, Dr. Cruz failed to show and explain that particular negligent or
3) Dr. Cruz v. Agas, Jr. (G.R. No. 204095 June 15, 2015) reckless act or omission committed by Dr. Agas. Stated differently, Dr. Cruz did not demonstrate that there
was "inexcusable lack of precaution" on the part of Dr. Agas.
STATEMENT OF FACTS:
Dr. Jaime Cruz (Cruz) engaged the services of St. Luke’s Medical Center (SLMC) for a medical check-up. 2) NO. The requisites for the applicability of the doctrine of res ipsa loquitur are:
He underwent stool, urine, bloody and other body fluid tests. He was then sent to the Gastro-Enterology
Department for a scheduled gastroscopy and colonoscopy. The specialist assigned to him was absent, so he (1) the occurrence of an injury;
gave the colonoscopy results to the attending female anesthesiologist. Thereafter he underwent the (2) the thing which caused the injury was under the control and management of the
procedure, but when he woke up he felt something was wrong. He felt dizzy, cold clammy perspiration and defendant;
pain in his abdomen, and when he tried to urinate he collapsed. He tried to consult the specialist who treated (3) the occurrence was such that in the ordinary course of things, would not have happened
him, but was nowhere to be found. He then found his cardiologist if those who had control or management used proper care; and
Dra. Agnes Del Rosario (Rosario) (4) the absence of explanation by the defendant. Of the foregoing requisites, the most
who observed his condition and referred him to the surgical department which suspected that he had a instrumental is the control and management of the thing which caused the injury.
hemorrhage. Dr. Cruz agreed, and upon waking up in the ICU, he found that 6-8 inches of his colon was
missing. It was found out that there was a tear in the colonic wall which caused the bleeding. During his In this case, the Court agrees with Dr. Agas that his purported negligence in performing the
recuperation, despite the painkillers, he was in under so much pain. Dr. Cruz claimed that colonoscopy on Dr. Cruz was not immediately apparent to a layman to justify the application of res ipsa
Dr. Felicismo Agas (Agas) loquitur doctrine.
admitted that he was the one who conducted the colonoscopy procedure, but insisted that nothing was
wrong. Dr. Cruz was discharged from SLMC, nevertheless he complained of having a hard time digesting his Dr. Agas was able to establish that the internal bleeding sustained by Dr. Cruz was due to the
food, he had to be fed every 2 hours because he easily got full, and had fresh blood stools every time he abnormal condition and configuration of his sigmoid colon which was beyond his control considering that the
moved his bowel, and had lost his appetite and had gastric acidity. He claimed that he was in good condition said condition could not be detected before a colonoscopic procedure. Dr. Agas adequately explained that
prior to the surgery. no clinical findings, laboratory tests, or diagnostic imaging, such as x-rays, ultrasound or computed
tomography (CT) scan of the abdomen, could have detected this condition prior to an endoscopic procedure.
STATEMENT OF THE CASE:
Dr. Cruz filed a complaint for serious physical injuries, through reckless imprudence and medical malpractice On the other hand, in the present case, the correlation between petitioner’s injury, i.e., tear
against Dr. Agas before office of the prosecutor. Dr. Agas had countered that Dr. Cruz failed to prove the in the serosa of sigmoid colon, and the colonoscopy conducted by respondent to the petitioner
basic elements of reckless impudence or medical negligence. Furthermore, the procedure was conducted clearly requires the presentation of an expert opinion considering that no perforation of the sigmoid colon
properly considering there did not manifest any significant adverse reaction or body resistance during the was ever noted during the laparotomy. It cannot be overemphasized that the colonoscope inserted by the
procedures. Finally he had added certifications and sworn statements by the: Assistant Medical Directior for respondent only passed through the inside of petitioner’s sigmoid colon while the damaged tissue, i.e.,
Professional Services, the Director of the Institute of Digestive Diseases, the anesthesiologist, and the serosa, which caused the bleeding, is located in the outermost layer of the colon. It is therefore impossible
gospital nurse that testitfied that the intraperonial bleeding was immediately managed and cure. The office of for the colonoscope to touch, scratch, or even tear the serosa since the said membrane is beyond the reach
the prosecutor however dismissed the case, Dr. Cruz appealed of the DOJ which likewise dismissed the of the colonoscope in the absence of perforation on the colon.
case. The case was then elevated to the CA which also dismissed the case, hence this petition.

ISSUES: 4) Ramos v. CA
1) Whether Dr. Agas is guilty of reckless imprudence and medical negligence
2) Whether the doctrine of Res Ipsa Loquitur is applicable in the case at hand Facts:
Erlinda Ramos, a 47-year old robust woman, was normal except for her experiencing occasional pain due to in cases where the ​res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon
the presence of stone in her gall bladder. She was advised to undergo an operation for its removal. The proper proof of injury to the patient, without the aid of expert testimony, where the court from its fund of
results in the examinations she underwent indicate that she was fit for the operation. She and her husband common knowledge can determine the proper standard of care. When the doctrine is appropriate, all that the
Rogelio met Dr. Hosaka, one of the defendants, who advised that she should undergo cholecystectomy. Dr. patient must do is prove a nexus between the particular act or omission complained of and the injury
Hosaka assured them that he will get a good anaesthesiologist. At 7:30 a.m. on the day of the operation at sustained while under the custody and management of the defendant without need to produce expert
Delos Santos Medical Center, Herminda Cruz, Erlinda’s sister-in-law and the dean of the College of Nursing medical testimony to establish the standard of care. Resort to ​res ipsa loquitur ​is allowed because there is no
in Capitol Medical Center, was there to provide moral support. Dr. Perfecta Gutierrez was to administer the other way, under usual and ordinary conditions, by which the patient can obtain redress for injury suffered by
anaesthesia. Dr. Hosaka arrived only at 12:15 p. m. Herminda saw Dr. Gutierrez intubating the patient, and him.
heard the latter say “Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O, lumalaki ang tiyan.”
Herminda saw bluish discoloration of the nailbeds of the patient. She heard Dr. Hosaka issue an order for Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously applied,
someone to call Dr. Calderon. The doctor arrived and placed the patient in trendelenburg position, wherein depending upon the circumstances of each case. A distinction must be made between the failure to secure
the head of the patient is positioned lower than the feet, which indicates a decrease of blood supply in the results, and the occurrence of something more unusual and not ordinarily found if the service or treatment
brain. Herminda knew and told Rogelio that something wrong was happening. Dr. Calderon was able to rendered followed the usual procedure of those skilled in that particular practice. The real question,
intubate the patient. Erlinda was taken to the ICU and became comatose. therefore, is whether or not in the process of the operation any extraordinary incident or unusual event
outside of the routine performance occurred which is beyond the regular scope of customary professional
Rogelio filed a civil case for damages. The trial court ruled in his favor, finding Dr. Gutierrez, Dr. Hosaka, and activity in such operations, which, if unexplained would themselves reasonably speak to the average man as
the hospital, guilty of negligence, but the Court of Appeals reversed the decision. Hence, petitioner filed a the negligent cause or causes of the untoward consequence.
Motion for Reconsideration, which the Court of Appeals denied for having been filed beyond the
reglementary period. However, it was found that the notice of the decision was never sent to the petitioner’s We find the doctrine of ​res ipsa loquitur appropriate in the case at bar. Erlinda submitted herself for
counsel. Rather, it was sent to the petitioner, addressing him as Atty. Rogelio Ramos, as if he was the legal cholecystectomy and expected a routine general surgery to be performed on her gall bladder. On that fateful
counsel. The petitioner filed the instant petition for certiorari. On the procedural issue, the Supreme Court day she delivered her person over to the care, custody and control of private respondents who exercised
ruled that since the notice did not reach the petitioner’s then legal counsel, the motion was filed on time. complete and exclusive control over her. At the time of submission, Erlinda was neurologically sound and,
except for a few minor discomforts, was likewise physically fit in mind and body. However, during the
Issue: administration of anesthesia and prior to the performance of cholecystectomy she suffered irreparable
Whether a surgeon, an anaesthesiologist, and a hospital, should be made liable for the unfortunate damage to her brain. Thus, without undergoing surgery, she went out of the operating room already
comatose condition of a patient scheduled for cholecystectomy decerebrate and totally incapacitated. Obviously, brain damage, which Erlinda sustained, is an injury which
does not normally occur in the process of a gall bladder operation. In fact, this kind of situation does not in
Held: the absence of negligence of someone in the administration of anesthesia and in the use of endotracheal
Res Ipsa Loquitor tube. Furthermore, the instruments used in the administration of anesthesia, including the endotracheal tube,
Res ipsa loquitur is a Latin phrase which literally means "the thing or the transaction speaks for itself." The were all under the exclusive control of private respondents, who are the physicians-in-charge. Likewise,
phrase "​res ipsa loquitur'​ ' is a maxim for the rule that the fact of the occurrence of an injury, taken with the petitioner Erlinda could not have been guilty of contributory negligence because she was under the influence
surrounding circumstances, may permit an inference or raise a presumption of negligence, or make out a of anesthetics which rendered her unconscious.
plaintiff's prima facie c​ ase, and present a question of fact for defendant to meet with an explanation. Where
the thing which caused the injury complained of is shown to be under the management of the defendant or Negligence of the Anaesthesiologist
his servants and the accident is such as in ordinary course of things does not happen if those who have its The pre-operative evaluation of a patient prior to the administration of anesthesia is universally observed to
management or control use proper care, it affords reasonable evidence, in the absence of explanation by the lessen the possibility of anesthetic accidents. Respondent Dra. Gutierrez' act of seeing her patient for the
defendant, that the accident arose from or was caused by the defendant's want of care. It is grounded in the first time only an hour before the scheduled operative procedure was, therefore, an act of exceptional
superior logic of ordinary human experience and on the basis of such experience or common knowledge, negligence and professional irresponsibility. Her failure to follow this medical procedure is, therefore, a clear
negligence may be deduced from the mere occurrence of the accident itself. However, much has been said indicia of her negligence. Erlinda's case was elective and this was known to respondent Dra. Gutierrez.
that ​res ipsa loquitur is not a rule of substantive law and, as such, does not create or constitute an Thus, she had all the time to make a thorough evaluation of Erlinda's case prior to the operation and prepare
independent or separate ground of liability. Mere invocation and application of the doctrine does not her for anesthesia. However, she never saw the patient at the bedside. She herself admitted that she had
dispense with the requirement of proof of negligence. It is simply a step in the process of such proof, seen petitioner only in the operating room, and only on the actual date of the cholecystectomy. She
permitting the plaintiff to present along with the proof of the accident, enough of the attending circumstances negligently failed to take advantage of this important opportunity. As such, her attempt to exculpate herself
to invoke the doctrine, creating an inference or presumption of negligence, and to thereby place on the must fail.
defendant the burden of going forward with the proof. Still, before resort to the doctrine may be allowed, the
following requisites must be satisfactorily shown. Opinion of Expert Witness
An anesthetic accident caused by a rare drug-induced bronchospasm properly falls within the fields of
(1) The accident is of a kind which ordinarily does not occur in the absence of someone's negligence; anesthesia, internal medicine-allergy, and clinical pharmacology. The resulting anoxic encephalopathy
(2) It is caused by an instrumentality within the exclusive control of the defendant or defendants; and belongs to the field of neurology. While admittedly, many bronchospastic-mediated pulmonary diseases are
(3) The possibility of contributing conduct which would make the plaintiff responsible is eliminated. within the expertise of pulmonary medicine, Dr. Jamora's field, the anesthetic drug-induced, allergic
mediated bronchospasm alleged in this case is within the disciplines of anesthesiology, allergology and
Medical malpractice cases do not escape the application of this doctrine. Thus, ​res ipsa loquitur has been pharmacology. On the basis of the foregoing transcript, in which the pulmonologist himself admitted that he
applied when the circumstances attendant upon the harm are themselves of such a character as to justify an could not testify about the drug with medical authority, it is clear that the appellate court erred in giving
inference of negligence as the cause of that harm. Although generally, expert medical testimony is relied weight to Dr. Jamora's testimony as an expert in the administration of Thiopental Sodium. Generally, to
upon in malpractice suits to prove that a physician has done a negligent act or that he has deviated from the qualify as an expert witness, one must have acquired special knowledge of the subject matter about which
standard medical procedure, when the doctrine of ​res ipsa loquitur is availed by the plaintiff, the need for he or she is to testify, either by the study of recognized authorities on the subject or by practical experience.
expert medical testimony is dispensed with because the injury itself provides the proof of negligence. Hence, Clearly, Dr. Jamora does not qualify as an expert witness based on the above standard since he lacks the
necessary knowledge, skill, and training in the field of anesthesiology. Oddly, apart from submitting home the patient to avoid mounting hospital bills. And yet ideally, a comatose patient should remain in a
testimony from a specialist in the wrong field, private respondents' intentionally avoided providing testimony hospital or be transferred to a hospice specializing in the care of the chronically ill for the purpose of
by competent and independent experts in the proper areas. providing a proper milieu adequate to meet minimum standards of care. Given these considerations, the
amount of actual damages recoverable in suits arising from negligence should at least reflect the correct
Proximate Cause minimum cost of proper care, not the cost of the care the family is usually compelled to undertake at home to
Proximate cause has been defined as that which, in natural and continuous sequence, unbroken by any avoid bankruptcy.
efficient intervening cause, produces injury, and without which the result would not have occurred. An injury
or damage is proximately caused by an act or a failure to act, whenever it appears from the evidence in the Our rules on actual or compensatory damages generally assume that at the time of litigation, the injury
case, that the act or omission played a substantial part in bringing about or actually causing the injury or suffered as a consequence of an act of negligence has been completed and that the cost can be liquidated.
damage; and that the injury or damage was either a direct result or a reasonably probable consequence of However, these provisions neglect to take into account those situations, as in this case, where the resulting
the act or omission. Instead of the intended endotracheal intubation what actually took place was an injury might be continuing and possible future complications directly arising from the injury, while certain to
esophageal intubation. During intubation, such distention indicates that air has entered the gastrointestinal occur, are difficult to predict. Temperate damages can and should be awarded on top of actual or
tract through the esophagus instead of the lungs through the trachea. Entry into the esophagus would compensatory damages in instances where the injury is chronic and continuing. And because of the unique
certainly cause some delay in oxygen delivery into the lungs as the tube which carries oxygen is in the wrong nature of such cases, no incompatibility arises when both actual and temperate damages are provided for.
place. That abdominal distention had been observed during the first intubation suggests that the length of The reason is that these damages cover two distinct phases. As it would not be equitable - and certainly not
time utilized in inserting the endotracheal tube (up to the time the tube was withdrawn for the second in the best interests of the administration of justice - for the victim in such cases to constantly come before
attempt) was fairly significant. Due to the delay in the delivery of oxygen in her lungs Erlinda showed signs of the courts and invoke their aid in seeking adjustments to the compensatory damages previously awarded -
cyanosis. temperate damages are appropriate. The amount given as temperate damages, though to a certain extent
speculative, should take into account the cost of proper care. In the instant case, petitioners were able to
Responsibility of the Surgeon provide only home-based nursing care for a comatose patient who has remained in that condition for over a
As the so-called "captain of the ship," it is the surgeon's responsibility to see to it that those under him decade. Having premised our award for compensatory damages on the amount provided by petitioners at
perform their task in the proper manner. Respondent Dr. Hosaka's negligence can be found in his failure to the onset of litigation, it would be now much more in step with the interests of justice if the value awarded for
exercise the proper authority in not determining if his anesthesiologist observed proper anesthesia protocols. temperate damages would allow petitioners to provide optimal care for their loved one in a facility which
In fact, no evidence on record exists to show that respondent Dr. Hosaka verified if respondent Dra. generally specializes in such care. They should not be compelled by dire circumstances to provide
Gutierrez properly intubated the patient. Furthermore, it does not escape us that respondent Dr. Hosaka had substandard care at home without the aid of professionals, for anything less would be grossly inadequate.
scheduled another procedure in a different hospital at the same time as Erlinda's cholecystectomy, and was Under the circumstances, an award of P1,500,000.00 in temperate damages would therefore be reasonable.
in fact over three hours late for the latter's operation. Because of this, he had little or no time to confer with
his anesthesiologist regarding the anesthesia delivery. This indicates that he was remiss in his professional Petitioner Erlinda Ramos was in her mid-forties when the incident occurred. She has been in a comatose
duties towards his patient. Thus, he shares equal responsibility for the events which resulted in Erlinda's state for over fourteen years now. The burden of care has so far been heroically shouldered by her husband
condition. and children, who, in the intervening years have been deprived of the love of a wife and a mother.
Meanwhile, the actual physical, emotional and financial cost of the care of petitioner would be virtually
Responsibility of the Hospital impossible to quantify. Even the temperate damages herein awarded would be inadequate if petitioner's
Hospitals hire, fire and exercise real control over their attending and visiting "consultant" staff. While condition remains unchanged for the next ten years. ​The husband and the children, all petitioners in this
"consultants" are not, technically employees, a point which respondent hospital asserts in denying all case, will have to live with the day to day uncertainty of the patient's illness, knowing any hope of recovery is
responsibility for the patient's condition, the control exercised, the hiring, and the right to terminate close to nil. They have fashioned their daily lives around the nursing care of petitioner, altering their long
consultants all fulfill the important hallmarks of an employer-employee relationship, with the exception of the term goals to take into account their life with a comatose patient. They, not the respondents, are charged
payment of wages. In assessing whether such a relationship in fact exists, the control test is determining. with the moral responsibility of the care of the victim. The family's moral injury and suffering in this case is
Accordingly, on the basis of the foregoing, we rule that for the purpose of allocating responsibility in medical clearly a real one. For the foregoing reasons, an award of P2,000,000.00 in moral damages would be
negligence cases, an employer-employee relationship in effect exists between hospitals and their attending appropriate.
and visiting physicians. Finally, by way of example, exemplary damages in the amount of P100,000.00 are hereby awarded.
The basis for holding an employer solidarily responsible for the negligence of its employee is found in Article Considering the length and nature of the instant suit we are of the opinion that attorney's fees valued at
2180 of the Civil Code which considers a person accountable not only for his own acts but also for those of P100,000.00 are likewise proper.
others based on the former's responsibility under a relationship of patria potestas​. Such responsibility ceases
when the persons or entity concerned prove that they have observed the diligence of a good father of the WHEREFORE, the decision and resolution of the appellate court appealed from are hereby modified so as to
family to prevent damage. In the instant case, respondent hospital, apart from a general denial of its award in favor of petitioners, and solidarily against private respondents the following: 1) P1,352,000.00 as
responsibility over respondent physicians, failed to adduce evidence showing that it exercised the diligence actual damages computed as of the date of promulgation of this decision plus a monthly payment of
of a good father of a family in the hiring and supervision of the latter. It failed to adduce evidence with regard P8,000.00 up to the time that petitioner Erlinda Ramos expires or miraculously survives; 2) P2,000,000.00 as
to the degree of supervision which it exercised over its physicians. In neglecting to offer such proof, or proof moral damages, 3) P1,500,000.00 as temperate damages; 4) P100,000.00 each as exemplary damages and
of a similar nature, respondent hospital thereby failed to discharge its burden under the last paragraph of attorney's fees; and, 5) the costs of the suit.
Article 2180. Having failed to do this, respondent hospital is consequently solidarily responsible with its
physicians for Erlinda's condition. 5) SPS. ALFREDO BONTILAO AND SHERLINA BONTILAO, VS. DR. CARLOS GERONA

Damages FACTS:
At current levels, the P8000/monthly amount established by the trial court at the time of its decision would be Respondent Dr. Carlos Gerona, an orthopedic surgeon at the Vicente Gullas Memorial Hospital, treated
grossly inadequate to cover the actual costs of home-based care for a comatose individual. The calculated petitioners' son, 8-year-old Allen Key Bontilao (Allen), for a fractured right wrist. Respondent administered a
amount was not even arrived at by looking at the actual cost of proper hospice care for the patient. What it "U-splint" and immobilized Allen's wrist with a cast, then sent Allen home.
reflected were the actual expenses incurred and proved by the petitioners after they were forced to bring
Allen re-fractured the same wrist and was brought back to the hospital. The x-ray examination showed a contend that respondent, being the lead surgeon, should be held liable for the negligence of the physicians
complete fracture and displacement of the bone, with the fragments overlapping each other. Respondent and nurses working with him during the operation.
performed a closed reduction procedure, with Dr. Vicente Jabagat (Dr. Jabagat) as the anesthesiologist.
Then he placed Allen's arm in a plaster cast to immobilize it. He allowed Allen to go home after the post On the other hand, respondent posited that he should not be held solidarity liable with Dr. Jabagat as they
reduction x-ray showed that the bones were properly aligned, but advised Allen's mother, petitioner Sherlina were employed independently from each other and their services were divided as their best judgment
Bontilao (Sherlina), to bring Allen back for re-tightening of the cast not later than June 15, 1992. dictated. He insisted that the captain-of-the-ship doctrine had long been abandoned especially in this age of
specialization. An anesthesiologist and a surgeon are specialists in their own field and neither one (1) could
Allen, however, was brought back to the hospital late. By then, because the cast had not been re-tightened, dictate upon the other.
a rotational deformity had developed in Allen's arm. The x-ray examination showed that the deformity was
caused by a re-displacement of the bone fragments, so it was agreed that an open reduction surgery will be The trial court erred in applying the doctrine of res ipsa loquitur to pin liability on respondent for Allen's death.
conducted by respondent, again with Dr. Jabagat as the anesthesiologist. Res ipsa loquitur is a rebuttable presumption or inference that the defendant was negligent. The presumption
only arises upon proof that the instrumentality causing injury was in the defendant's exclusive control, and
On the said date, Sherlina was allowed to observe the operation behind a glass panel. Dr. Jabagat failed to that the accident was one (1) which ordinarily does not happen in the absence of negligence.
intubate the patient after five (5) attempts, so anesthesia was administered through a gas mask. Respondent
asked Dr. Jabagat if the operation should be postponed given the failure to intubate, but Dr. Jabagat said In malpractice cases, the doctrine is generally restricted to situations where a layman is able to say, as a
that it was alright to proceed. Respondent verified that Allen was breathing properly before proceeding with matter of common knowledge and observation, that the consequences of professional care were not as such
the surgery. As respondent was about to finish the suturing, Sherlina decided to go out of the operating room as would ordinarily have followed if due care had been exercised.
to make a telephone call and wait for her son. Later, she was informed that her son had died on the
operating table. The cause of death was "asphyxia due to congestion and edema of the epiglottis." Here, we find that the CA correctly found that petitioners failed to present substantial evidence of any
specific act of negligence on respondent's part or of the surrounding facts and circumstances which would
Aside from criminal and administrative cases, petitioners filed a complaint for damages against both lead to the reasonable inference that the untoward consequence was caused by respondent's negligence. In
respondent and Dr. Jabagat in the RTC of Cebu City alleging negligence and incompetence on the part of fact, having seen that Dr. Jabagat failed in the intubation, respondent inquired from the latter, who was the
the doctors. The documentary evidence and testimonies of several witnesses presented in the criminal expert on the matter of administering anesthesia, whether the surgery should be postponed considering the
proceedings were offered and admitted in evidence at the RTC. failure to intubate.

The RTC decided in favor of the petitioners. It held that the doctrine of res ipsa loquitur was applicable in Respondent further verified that Allen was still breathing by looking at his chest to check that there was
establishing respondent's liability. According to the RTC, asphyxia or cardiac arrest does not normally occur excursion before proceeding with the surgery. That respondent decided to continue with the surgery even
in an operation on a fractured bone in the absence of negligence in the administration of anesthesia and the though there was a failure to intubate also does not tend to establish liability, contrary to the trial court's
use of an endotracheal tube. Also, the instruments used in the administration of anesthesia were all under ruling. Petitioners failed to present substantial proof that intubation was an indispensable prerequisite for the
the exclusive control of respondent and Dr. Jabagat, and neither Allen nor his mother could be said to be operation and that it would be grave error for any surgeon to continue with the operation under such
guilty of contributory negligence. Thus, the trial court held that respondent and Dr. Jabagat were solidarity circumstances. In fact, the testimony of the expert witness presented by the prosecution in the criminal
liable for they failed to prove that they were not negligent. proceedings and admitted into evidence at the RTC, was even to the effect that the anesthesia could be
administered by alternative means such as a mask and that the operation could proceed even without
CA reversed the RTC's ruling. It held that the doctrine of res ipsa loquitur does not apply for it must be intubation.
satisfactorily shown that (1) the accident is of a kind which ordinarily does not occur in the absence of
someone's negligence; (2) the plaintiff was not guilty of contributory conduct; and (3) the instrumentality Here, the respondent could only supervise Dr. Jabagat to make sure that he was performing his duties. But
which caused the accident was within the control of the defendant. respondent could not dictate upon Dr. Jabagat the particular anesthesia to administer, the dosage thereof, or
that it be administered in any particular way not deemed appropriate by Dr. Jabagat. Respondent's
The CA held that while it may be true that an Open Reduction and Internal Fixation or ORIF could not specialization not being in the field of anesthesiology, it would be dangerous for him to substitute his
possibly lead to a patient's death unless somebody was negligent, still what was involved in this case was a judgment for Dr. Jabagat's decisions in matters that fall appropriately within the scope of Dr. Jabagat's
surgical procedure with all risks attendant, including death. As explained by the expert testimony, expertise.
unexplained death and mal-occurrence is a possibility in surgical procedures especially those involving the
administration of general anesthesia. It had also been established in both the criminal and administrative 6) ROGELIO NOGALES vs. CAPITOL MEDICAL CENTER et al.
cases against respondent that Allen's death was the result of the anesthesiologist's negligence and not his. G.R. No. 142625; December 19, 2006

ISSUE: Whether or not respondent is liable for damages for Allen’s death Facts: Pregnant with her fourth child, Corazon Nogales ("Corazon"), who was then 37 years old, was under
the exclusive prenatal care of Dr. Oscar Estrada ("Dr. Estrada") beginning on her fourth month of pregnancy
CIVIL LAW: Res ipsa loquitur is a rebuttable presumption or inference that the defendant was or as early as December 1975. Around midnight of 25 May 1976, Corazon started to experience mild labor
negligent. The presumption only arises upon proof that the instrumentality causing injury was in the pains prompting Corazon and Rogelio Nogales ("Spouses Nogales") to see Dr. Estrada at his home. After
defendant's exclusive control, and that the accident was one (1) which ordinarily does not happen in examining Corazon, Dr. Estrada advised her immediate admission to the Capitol Medical Center ("CMC"). t
the absence of negligence 6:13 a.m., Corazon started to experience convulsionsAt 6:22 a.m., 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
HELD: allegedly torn.At 6:27 a.m., Corazon began to manifest moderate vaginal bleeding which rapidly became
Petitioners argued that the doctrine of res ipsa loquitur applies to the present case because Allen was profuse. Corazon died at 9:15 a.m. The cause of death was "hemorrhage, post partum.
healthy, fully conscious, coherent, and ambulant when he went to the hospital to correct a deformed arm.
Yet, he did not survive the operation, which was not even an emergency surgery but a corrective one. They Issue: ​Whether or not CMC is vicariously liable for the negligence of Dr. Estrada.
Ruling: Private hospitals, hire, fire and exercise real control over their attending and visiting "consultant"
staff. The basis for holding an employer solidarily responsible for the negligence of its employee is found in RATIO:
Article 2180 of the Civil Code which considers a person accountable not only for his own acts but also for DR. AMPIL IS LIABLE FOR NEGLIGENCE AND MALPRACTICE
those of others based on the former's responsibility under a relationship of patria potestas. His arguments are without basis [did not prove that the American doctors were the ones who put / left the
gauzes; did not submit evidence to rebut the correctness of the operation record (re: number of gauzes
In general, a hospital is not liable for the negligence of an independent contractor-physician. There is, used); re: Dr. Fuentes’ alleged negligence, Dr. Ampil examined his work and found it in order].
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”. Leaving foreign substances in the wound after incision has been closed is at least ​prima facie
negligence by the operating surgeon. ​Even if it has been shown that a surgeon was required to leave a
For a hospital to be liable under the doctrine of apparent authority, a plaintiff must show that: (1) the hospital, sponge in his patient’s abdomen because of the dangers attendant upon delay, still, it is his ​legal duty to
or its agent, acted in a manner that would lead a reasonable person to conclude that the individual who was inform his patient within a reasonable time by advising her of what he had been compelled to do​, so she can
alleged to be negligent was an employee or agent of the hospital; (2) where the acts of the agent create the seek relief from the effects of the foreign object left in her body as her condition might permit. What’s worse
appearance of authority, the plaintiff must also prove that the hospital had knowledge of and acquiesced in in this case is that he misled her by saying that the pain was an ordinary consequence of her operation.
them; and (3) the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with
ordinary care and prudence. In the instant case, CMC impliedly held out Dr. Estrada as a member of its Medical negligence; standard of diligence
medical staff. Through CMC's acts, CMC clothed Dr. Estrada with apparent authority thereby leading the To successfully pursue this case of medical negligence, a patient must only prove that a health care provider
Spouses Nogales to believe that Dr. Estrada was an employee or agent of CMC. either failed to do something [or did something] which a reasonably prudent health care provider would have
done [or wouldn’t have done], and that the failure or action caused injury to the patient.
● Duty ​– to remove all foreign objects from the body before closure of the incision; if he fails to do
7) Professional Services Inc. (PSI) v. Natividad and Enrique Agana so, it was his duty to inform the patient about it
Natividad and Enrique Agana v. Juan Fuentes ● Breach – f​ ailed to remove foreign objects; failed to inform patient
Miguel Ampil v. Natividad and Enrique Agana ● ​ suffered pain that necessitated examination and another surgery
Injury –
● Proximate Causation – ​ breach caused this injury; ​could be traced from his act of closing the
FACTS: incision despite information given by the attendant nurses that 2 pieces of gauze were still
Natividad Agana was rushed to Medical City because of difficulty of bowel movement and bloody anal missing​; what established c​ ausal link​: ​gauze pieces later extracted from patient’s vagina
discharge. Dr. Ampil diagnosed her to be suffering from ​cancer of the sigmoid​. Dr. Ampil performed an
anterior resection surgery on her, and finding that the malignancy spread on her left ovary, he obtained the DR. FUENTES NOT LIABLE
consent of her husband, Enrique, to permit Dr. Fuentes to perform ​hysterectomy on her. After the The ​res ipsa loquitur ​[thing speaks for itself] argument of the Aganas’ does not convince the court. Mere
hysterectomy, Dr. Fuentes showed his work to Dr. Ampil, who examined it and found it in order, so he invocation and application of this doctrine does not dispense with the requirement of proof of negligence.
allowed Dr. Fuentes to leave the operating room. Dr. Ampil was about to complete the procedure when the
attending nurses made some remarks on the Record of Operation: “​sponge count lacking 2; announced Requisites for the applicability of ​res ipsa loquitur
to surgeon search done but to no avail continue for closure”​ (two pieces of gauze were missing). A 1. Occurrence of injury
“diligent search” was conducted but they could not be found. Dr. Ampil then directed that the incision be 2. Thing which caused injury was under the ​control and management of the defendant [DR.
closed. FUENTES] ​— ​LACKING SINCE ​CTRL+MGT WAS WITH DR. AMPIL
3. Occurrence was such that in the ordinary course of things, would not have happened if
A couple of days after, she complained of ​pain in her anal region​, but the doctors told her that it was those who had control or management used proper care
just a natural consequence of the surgery. Dr. Ampil recommended that she consult an oncologist to 4. Absence of explanation by defendant
examine the cancerous nodes which were not removed during the operation. After months of consultations
and examinations in the US, she was told that she was free of cancer. Weeks after coming back, her Under the ​Captain of the Ship ​rule, the ​operating surgeon is the person ​in complete charge of the surgery
daughter found a ​piece of gauze (1.5 in) protruding from her vagina​, so Dr. Ampil manually extracted this, room and all personnel connected with the operation​. That Dr. Ampil discharged such role is evident from the
assuring Natividad that the pains will go away. However, the pain worsened, so she sought treatment at a following:
hospital, where another 1.5 in piece of gauze was found in her vagina. She underwent another surgery. ● He called Dr. Fuentes to perform a hysterectomy
● He examined Dr. Fuentes’ work and found it in order
Sps. Agana filed a ​complaint for damages ​against PSI (owner of Medical City), Dr. Ampil, and Dr. ● He granted Dr. Fuentes permission to leave
Fuentes, alleging that the latter are liable for ​negligence for leaving 2 pieces of gauze in Natividad’s body, ● He ordered the closure of the incision
and ​malpractice for concealing their acts of negligence. Enrique Agana also filed an ​administrative
complaint for gross negligence and malpractice against the two doctors with the PRC (although only the HOSPITAL OWNER PSI SOLIDARILY LIABLE WITH DR. AMPIL [NCC 2180], AND DIRECTLY LIABLE
case against Dr. Fuentes was heard since Dr. Ampil was abroad). Pending the outcome of the cases, TO SPS. AGANAS [NCC 2176]
Natividad died (now substituted by her children). ​RTC found PSI and the two doctors liable for Previously, employers cannot be held liable for the fault or negligence of its professionals. However, this
negligence and malpractice. PRC dismissed the case against Dr. Fuentes. CA dismissed only the doctrine has weakened since courts came to realize that modern hospitals are taking a more active role in
case against Fuentes. supplying and regulating medical care to its patients, by employing staff of physicians, among others. Hence,
there is no reason to exempt hospitals from the universal rule of ​respondeat superior.​ Here are the Court’s
ISSUE AND HOLDING: bases for sustaining PSI’s liability:
1. WON CA erred in holding Dr. Ampil liable for negligence and malpractice. ​NO; DR. AMPIL ● Ramos v. CA d ​ octrine on E-E relationship
IS GUILTY ○ For purposes of apportioning responsibility in medical negligence cases, an
2. WON CA erred in absolving Dr. Fuentes of any liability. ​NO employer-employee relationship in effect exists between hospitals and their
3. WON PSI may be held solidarily liable for Dr. Ampil’s negligence. ​YES
 attending and visiting physicians. [LABOR LESSON: power to hire, fire, power of Sps. Go filed a complaint for damages against Dr. Cantre, the medical director, and the hospital. In the
control] RTC, parties have rested their respective cases, but the court admitted additional exhibits [consist mostly of
● Agency principle of ​apparent authority / agency by estoppel medical records produced by the hospital during trial pursuant to a subpoena ​duces tecum​] offered by Sps.
○ Imposes liability because of the actions of a principal or employer in somehow Go, which were not testified to by any witness. RTC ruled in favor of the spouses. CA affirmed RTC with
misleading the public into believing that the relationship or the authority exists modification (complaint dismissed with respect to the medical director and the hospital; only moral damages
[see NCC 1869] awarded).
○ PSI publicly displays in the Medical City lobby the names and specializations of
their physicians. Hence, PSI is now estopped from passing all the blame to the ISSUES AND HOLDING:
physicians whose names it proudly paraded in the public directory, leading the 1. WON the questioned additional exhibits are admissible in evidence. ​YES
public to believe that it vouched for their skill and competence. 2. WON Dr. Cantre is liable for the injury suffered by Nora Go. ​YES
■ If doctors do well, hospital profits financially, so when negligence
mars the quality of its services, the hospital should not be allowed RATIO:
to escape liability for its agents’ acts. Preliminary discussion
● Doctrine of ​corporate negligence / corporate responsibility Dr. Cantre's counsel admitted the existence of the additional exhibits when they were formally offered for
○ This is the judicial answer to the problem of allocating hospital’s liability for the admission by the RTC. In any case, given the circumstances of this case, a ruling on Dr. Cantre's negligence
negligent acts of health practitioners, absent facts to support the application of may be made based on the ​res ipsa loquitur ​doctrine even in the absence of the additional exhibits.
respondeat superior.
○ This provides for the duties expected [from hospitals]. In this case, PSI failed to Backgrounder
perform the duty of exercising ​reasonable care to protect from harm all patients The Hippocratic Oath mandates physicians to give primordial consideration to their patients' well-being, and
admitted into its facility for medical treatment​. ​PSI failed to conduct an if a doctor fails to live up to this precept, he is accountable for his acts. This notwithstanding, ​courts face a
investigation of the matter reported in the note of the count nurse, and this unique restraint in adjudicating medical negligence cases because ​physicians are not guarantors of
established PSI’s part in the dark conspiracy of silence and concealment care​, and ​they never set out to intentionally cause injury to their patients​. ​HOWEVER​, ​intent is
about the gauzes. immaterial ​in these cases because ​where negligence exists and is proven, it automatically gives the
■ PSI has actual / constructive knowledge of the matter, through the injured a right to reparation for the damage caused​.
report of the attending nurses + the fact that the operation was
carried on with the assistance of various hospital staff Res ipsa loquitur x Medical negligence cases
○ It also breached its duties to ​oversee or supervise all persons who practice In ​medical negligence cases​, the doctrine of ​res ipsa loquitur allows the ​mere existence of an injury to
medicine within its walls and ​take an active step in fixing the negligence justify a presumption of negligence on the part of the person who controls the instrument causing
committed the injury, ​provided that the following ​requisites​ concur:
● PSI also liable under ​NCC 2180 1. Accident is of a kind which ​ordinarily does not occur absent someone's negligence
○ It failed to adduce evidence to show that it exercised the ​diligence of a good ○ Wound not an ordinary occurrence in the act of delivering a baby; could not have
father of the family​ in the accreditation and supervision of Dr. Ampil happened unless negligence set in somewhere
2. Caused by an ​instrumentality within​ ​defendant's exclusive control
○ It doesn't matter WON the injury was caused by the droplight or by the blood pressure
8) Dr. Milagros Cantre v. Sps. John David and Nora Go cuff, since both are within the exclusive control of the physician in charge [Dr. Cantre]
under the ​captain of the ship d​ octrine [surgeon in charge of an operation is held liable
FACTS: for his assistants' negligence during the time when they are under the surgeon's control].
Nora Go gave birth to her 4th child. Two hours later, she suffered profuse bleeding inside her womb due to 3. Possibility of contributing conduct​ which would make plaintiff responsible is ​eliminated
some placenta parts which were not completely expelled after delivery. She then suffered hypovolemic ○ Wound could only be caused by something external to and outside the control of Nora
shock, so her BP dropped to 40/0. Dr. Milagros Cantre, an Ob-Gyne specialist and Nora's attending since she was unconscious while in hypervolemic shock.
physician, together with an assisting resident physician, performed various medical procedures to stop the
bleeding and to restore Nora's BP. While Dr. Cantre was massaging Nora's uterus for it to contract and stop On Dr. Cantre's other arguments + what would have been her saving grace
bleeding, she ordered a droplight to warm Nora and her baby. At that time, she was unconscious.
● BP cuff defense does not afford her an escape. ​The medical practice is to deflate the cuff
While in the recovery room, Nora's husband John David noticed a fresh gaping wound (2 1/2 x 3 1/2 in) in immediately after use, or else, it could cause an injury similar to what happened to Nora. If the
the inner portion of her left arm near the armpit. When he asked the nurses about the cause of the injury, he wound was caused by the constant taking of BP, it must have been done so negligently as to inflict
was informed that it was due to a burn. John David filed a request for investigation. Dr. Cantre said that what a gaping wound.
caused the injury was the blood pressure cuff. John David brought Nora to the NBI for a physical ● The argument that the failed plastic surgery was a measure to prevent complication (and not
examination. The medico-legal said that the injury appeared to be a burn and that a droplight when placed intended as a cosmetic procedure) does not negate negligence on Dr. Cantre's part.
near the skin for about 10 minutes could cause such burn. He dismissed the likelihood that the wound was
● Dr. Cantre has been Nora's ob-gyne for her past 3 deliveries, and this is the first time that Dr.
caused by a blood pressure cuff since the scar was not around the arm, but just on one side of the arm.
Cantre is being held liable for damages due to negligence in the practice of her profession. She
Nora's injury was referred to a plastic surgeon for skin grafting. However, her arm would never be the
promptly took care of the wound before infection set in. Since Nora was in a critical condition at
same--the surgery left an unsightly scar, her movements are restricted, and the injured arm aches at the
that time, saving her life became Dr. Cantre's elemental concern. ​Still, ​her good intentions
slightest touch.
characteristics do not justify negligence.
NCC provisions applied 4. Injuries suffered by Ranida could have been avoided had proper safeguards been
● NCC 2176. ​Whoever by act or omission causes damage to another, there being fault or followed
negligence, is obliged to pay for the damage done. [...] 5. NCC 20 is the legal basis for award of damages to one who suffers whenever another
commits an act in violation of some legal provision
● NCC 2217. ​Moral damages include physical suffering, mental anguish, fright, serious anxiety,
besmirched reputation, wounded feelings, moral shock, social humiliation, and similar injury.
Though incapable of pecuniary computation, moral damages may be recovered if they are the Damages, fees upheld. Garcia guilty of gross negligence.
proximate result of the defendant's wrongful act or omission. [​200k moral damages awarded​]

10) Dr. Ninevetch Cruz v. CA and Lydia Umali

9) Garcia, Jr. v. Salvador
FACTS:
Facts: Medical malpractice suit - type of claim which a victim has available to him/her to redress a wrong
Ranida Salvador started working as a trainee in LBHT. She underwent a medical exam @ CDC with Garcia committed by a medical professional which has caused bodily harm; most often brought as a civil action for
(medtech) conducting the HBs Ag test. Her result was REACTIVE. The company physician (Sto. Domingo) damages under NCC 2176 or a ​criminal case under RPC 365, with which a civil action for damages is
told her she is suffering from HepaB, and based on the medical report SD submitted, LBHT terminated her impliedly instituted​.
employment. Ranida told her father Ramon about her condition, then the latter suffered a heart attack and
was confined at Bataan Doctors Hospital. Ranida took another HBs Ag test in BDH, and the result was Lydia Umali was examined by Dr. Cruz who found a ​myoma ​[benign tumor] in her uterus, and scheduled her
NON-REACTIVE. She told Dr. SD about it but the latter said the CDC test was more reliable, so she took for a ​hysterectomy operation [removal of uterus] on 23 Mar 1991. Rowena Umali de Ocampo
another test at CDC again, and the result this time was NON-REACTIVE. She took the same test used in accompanied her mother to the hospital a day before the operation, and they spent the night there. Rowena
CDC @ BDH and the result was NON-REACTIVE (four tests!). She submitted the results to the LBHT noticed that the ​clinic was untidy​, so she tried to persuade her mother not to proceed with the operation.
ExecOff who requested her to undergo under test (WTF!) - result is NEGATIVE (5th test, haha), so LBHT The following day, Rowena asked Dr. Cruz if the operation could be postponed, but Lydia told her daughter
rehired her. that Dr. Cruz said that the operation must go on as scheduled.

Ranida and Ramon filed a complaint for damages against medtech Garcia + pathologist Castro, claiming While Lydia's relatives were waiting, Dr. Ercillo (anesthesiologist) told them to buy ​tagamet ampules​, and
that the erroneous interpretation led her to lose her job, suffer mental anxiety, while Ramon was hospitalized Rowena's sister went out to buy some. An hour later, Dr. Ercillo asked them to buy ​blood for Lydia, so they
+ lost business opportunities. Garcia denied the allegations of gross negligence and incompetence; did. A few hours later, the operation was finished, but later, Dr. Cruz asked the family to buy ​additional
explained "false positive." Castro said he did not examine Ranida, and that the results bore only his stamped blood​, but there was no more type A blood available in the blood bank. ​A person arrived to donate blood
signature. which was later transfused to Lydia. Rowena noticed that her mother was ​gasping for breath​--apparently,
the ​oxygen supply had run out​, so the family went out to buy oxygen. Later in the evening, she went into
RTC dismissed the Salvadors' complaint for failure to present sufficient evidence. CA reversed this shock ​and her ​blood pressure dropped​. She was then ​transferred to another hospital so she could be
and ordered Garcia to pay moral damages (50k), exemplary damages (50k), and atty's fees (25k). Castro connected to a respirator and further examined. However, ​this transfer was without the consent of the
was exonerated. relatives, who only found out about it when an ambulance came to take Lydia to the other hospital​.

Issue and Holding: In the new hospital, ​she was re-operated upon by Dr. Cruz and Dr. Ercillo because blood was oozing out
WON CA correctly found Garcia liable for damages. ​YES from her incision. They summoned Dr. Angeles, Ob-Gyne head of the new hospital, but when he arrived,
Lydia was already in ​shock ​and ​possibly dead (BP: 0/0). Dr. Angeles told Drs. Cruz and Ercillo that there
1. WON a person is negligent is a question of fact -- petition for review on certiorari limited to was nothing he could do. ​Lydia died ​while Dr. Cruz was closing her abdominal wall. ​Immediate cause of
reviewing errors of law death is shock; disseminated intravascular coagulation (DIC) as antecedent cause.
1. Negligence - failure to observe for the protection of another's interest that degree of Dr. Cruz and Dr. Ercillo were charged with ​reckless imprudence and negligence resulting in homicide ​of
care, precaution and vigilance which circ demand, whereby the other suffers injury Lydia Umali. The ​Municipal Trial Court in Cities (​MTCC​) found Dr. Ercillo not guilty for insufficiency of
1. ALL ELEMENTS OF AN ACTIONABLE CONDUCT ARE PRESENT IN THIS evidence against her, but ​held Dr. Cruz responsible​ for Umali's death. ​RTC and CA affirmed MTCC.
CASE
1. Duty Manifestation of negligence
2. Breach ● untidiness of clinic
3. Injury ● lack of provision of supplies
4. Proximate causation
2. Negligence is a violation of statutory duty -- so many laws were broken! ● the fact that the transfer was needed meant that there was something wrong in the way Dr. Cruz
1. CDC is not administered, directed, supervised by licensed physician but by a conducted operation
licensed medtech ● no showing that pre-surgery procedure (clearance, blood typing/tests) was conducted
1. Castro's infrequent visit barely qualifies as an admin supervision
and control
ISSUE AND HOLDING:
2. Garcia conducted HBs Ag test of Ranida without Castro's supervision
WON the circumstances are sufficient to sustain a judgment of conviction against Dr. Cruz for reckless
3. HBs Ag test result released to Ranida without Castro's authorization
imprudence resulting in homicide. ​NO. DR. CRUZ IS ACQUITTED, BUT SHE IS STILL CIVILLY LIABLE
3. Garcia's failure to comply with laws, rules promulgated for the protection of public safety
(50K civil liability; 100k moral damages, 50k exemplary damages).
and interest is failure to observe the care which a reasonably prudent health care
provider would observe --> BREACH OF DUTY!
RATIO: Cayao-Lasam advised Editha to undergo a Dilatation and Curettage Procedure (D&C) or raspa which the
Elements of reckless imprudence petitioner performed.
1. Offender does / fails to do an act
2. Doing / failure to do act is voluntary On September 1994, Editha was brought again to LMC due to vomiting and severe abdominal pains. One of
3. Without malice the attending physician, Dr. Mayo allegedly informed Editha that there was a dead fetus in her womb. Editha
4. Material damage results from reckless imprudence underwent laparotomy where she was found to have a massive intra-abdominal hemorrhage and a ruptured
5. There is inexcusable lack of precaution, taking into consideration offender's employment, degree uterus. Editha had to undergo a procedure for hysterectomy and as a result, she has no more chance to
of intelligence, physical condition, other circumstances re: persons, time, place bear a child.

Standard of care On November 1994, Editha and her husband Claro Ramolete filed a Complaint for Gross Negligence and
Standard of care observed by other members of the profession in good standing under similar Malpractice against petitioner before the PRC.
circumstances, bearing in mind the advanced state of the profession at the time of treatment or the present
state of medical science. Respondents alleged that Editha’s hysterectomy was caused by petitioners unmitigated negligence and
professional incompetence in conducting the D&C procedure and the petitioners failure to remove the fetus
When the physician's qualifications are admitted, there is an inevitable ​presumption that in proper inside Editha’s womb. Petitioner denied the allegations of negligence and incompetence.
cases, he takes the necessary precaution and employs the best of his knowledge and skill in attending to his
clients, unless the contrary is sufficiently established by ​expert testimony​. On March 1999, Board of Medicine of the PRC exonerated petitioner from the charges filed against her.
Feeling aggrieved, respondents went to the PRC on appeal. On November 2000, the PRC reversed the
Expert testimony findings of the Board and revoked petitioners authority or license to practice her profession as a physician.
Expert testimony is essential to ​establish standard of care of the profession, as well as that the ​physician's Petitioner brought the matter to the CA but was dismissed on the ground of being improper and premature.
conduct in the treatment and care ​falls below such standard​. It is also usually necessary to ​support the
conclusion as to causation​. There is an ​absence of any expert testimony re: standard of care ​in the case Issue​: WON there was medical malpractice in the case?
records. NBI doctors presented by the prosecution only testified as to the possible cause of death.
Held​: There was no medical malpractice in the case.
While it may be true that the circumstances pointed out by the lower courts constitute reckless Medical malpractice is a particular form of negligence which consists in the failure of a physician or surgeon
imprudence, this conclusion is still best arrived not through the educated surmises nor conjectures to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the
of laymen, including judges, but by the unquestionable knowledge of expert witnesses. The profession generally, under similar conditions, and in like surrounding circumstances. In order to successfully
deference of courts to the ​expert opinion of qualified physicians stems from the realization that the latter pursue such a claim, a patient must prove that the physician or surgeon either failed to do something which a
possess ​unusual technical skills​ which laymen are incapable of intelligently evaluating. reasonably prudent physician or surgeon would not have done, and that the failure or action caused injury to
the patient.
Burden of establishing medical negligence on plaintiff
Plaintiff has the burden to establish this, and for a reasonable conclusion of negligence, there must be proof There are four elements involved in medical negligence cases: duty, breach, injury and proximate causation.
of ​breach of duty on the part of the surgeon, as well as a ​causal connection of such breach and the resulting
death of patient. ​Negligence cannot create a right of action unless it is the proximate cause of the injury From the testimony of the expert witness and the reasons given by him, it is evident that the D&C procedure
complained of (Chan Lugay v. St. Luke's Hospital, Inc.). I​ n this case, no cogent proof exists that the was not the proximate cause of the rupture of Editha’s uterus. Further in the testimony, it is clear that the
circumstances caused Lydia's death, so ​the 4th element of reckless imprudence is missing​. D&C procedure was conducted in accordance with the standard practice, with the same level of care that
any reasonably competent doctor would use to treat a condition under the same circumstances, and that
The testimonies of the doctors presented by the prosecution establish ​hemorrhage / hemorrhagic there was nothing irregular in the way the petitioner dealt with Editha.
shock as the cause of death, which may be caused by several different factors. ​Autopsy did not reveal any
untied cut blood vessel, nor was there a tie of a cut blood vessel that became loose. ​The findings of the Medical malpractice is often brought as a civil action for damages under Article 2176 of the Civil Code. The
doctors do not preclude the probability that a clotting defect (DIC) caused the hemorrhage and defenses in an action for damages, provided for under Article 2179 of the Civil Code are:
consequently, Lydia's death​.
Art. 2179. When the plaintiffs own negligence was the immediate and proximate cause of his injury, he
The Court has no recourse but to rely on the expert testimonies that substantiate Dr. Cruz' allegation that the cannot recover damages. But if his negligence was only contributory, the immediate and proximate cause of
cause of Lydia's death was DIC, which cannot be attributed to Dr. Cruz' fault or negligence. This probability the injury being the defendants lack of due care, the plaintiff may recover damages, but the courts shall
was unrebutted during trial. mitigate the damages to be awarded.

It is also undisputed that Editha did not return for a follow-up evaluation, in defiance of the petitioners advise.
11) Cayao-Lasam vs. Sps. Ramolete G.R. No. 159132 December 8, 2008 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 Editha’s own
Facts​: injury. Had Editha returned, petitioner could have conducted the proper medical tests and procedure
On July 1994, respondent three months pregnant Editha Ramolete was brought to the Lorma Medical Center necessary to determine Editha’s health condition and applied the corresponding treatment which could have
(LMC) to vaginal bleeding. A pelvic sonogram was then conducted on Editha revealing the fetus weak prevented the rupture of Editha’s uterus. The D&C procedure having been conducted in accordance with the
cardiac pulsation. Editha’s repeat pelvic sonogram showed that aside from the fetus weak cardiac pulsation, standard medical practice, it is clear that Editha’s omission was the proximate cause of her own injury and
no fetal movement was also appreciated. Due to persistent and profuse vaginal bleeding, petitioner Dr. Fe not merely a contributory negligence on her part.
12) PETER PAUL PATRICK LUCAS, et al. vs. DR. PROSPERO MA. C. TUAÑO
13) DR. FERNANDO P. SOLIDUM v. PEOPLE OF THE PHILIPPINES
DOCTRINES:
In a medical negligence suit, the patient or his heirs, in order to prevail, is required to prove by FACTS:
preponderance of evidence that the physician failed to exercise that degree of skill, care, and learning On June 2, 1992, Gerald Albert Gercayo (Gerald) was born with an imperforate anus. Hence, two days after
possessed by other persons in the same profession; and that as a proximate result of such failure, the his birth, he underwent colostomy which enabled him to excrete through a colostomy bag attached to the
patient or his heirs suffered damages. side of his body.

There is a breach of duty of care, skill and diligence, or the improper performance of such duty, by the Three years later or on May 17, 1995, he was admitted at the Ospital ng Maynila for a pull-through operation.
attending physician when the patient is injured in body or in health constitutes the actionable malpractice. The surgical team consisted of Dr. Resurreccion, Dr. Luceo, Dr. Valea, and Dr. Tibio. The anesthesiologists
included Dr. Abella, Dr. Razon and herein Petitioner Dr. Solidum. It was during the said operation that Gerald
FACTS: experienced bradycardia or an abnormally slow heart rate of less than 60 beats per minute. He subsequently
Herein petitioner, Peter Lucas, first consulted respondent, Dr. Tuaño, on a complaint of soreness and went into a coma which lasted for two weeks. When he regained consciousness after a month, he could no
redness on his right eye. The respondent, after a series of examinations, found that the former was suffering longer see, hear, or move. Ma. Luz Gercayo (Luz) lodged a complaint for reckless imprudence resulting in
from conjunctivitis or “sore eyes” and prescribed the use of the Spersacet-C. However, after the petitioner’s serious physical injuries against the attending physicians.
condition seemed to have worsened, he sought for the respondent’s second finding wherein the latter said
that his condition had progressed to Epidemic Kerato Conjunctivitis (EKC), a viral infection. The respondent The RTC found Dr. Solidum guilty beyond reasonable doubt of reckless imprudence resulting to serious
then prescribed the use of Maxitrol, a steroid-based eye drop. The petitioner’s condition worsened overtime, physical injuries. The CA affirmed the conviction of Dr. Solidum.
yet he obediently complied with all the prescriptions and orders of the respondent.
ISSUES: Whether or not the doctrine of res ipsa loquitur applies in this case?
Four months later and after the petitioner suffered from significant swelling of his right eyeball, headaches,
nausea and blindness on this right eye, he sought for the opinion of another doctor, Dr. Aquino. Dr. Aquino HELD: The Court of Appeals decision is overruled.
found that the petitioner had been suffering from glaucoma and needed to undergo laser surgery, lest he
might suffer from total blindness. TORTS: applicability of the Doctrine of Res Ipsa Loquitur

After reading the literature on the use of the medicine Maxitrol, Fatima, one of the petitioners herein and The Court held that the application of the doctrine of res ipsa loquitur in the case at bar is inappropriate. Res
Peter Lucas’ wife, read that one of the adverse effects of prolonged use of steroid-based eye drops could ipsa loquitur is literally translated as the thing or the transaction speaks for itself.Jarcia, Jr. v. People, G.R.
possibly be glaucoma. Peter, Fatima, and their two children instituted a civil case for damages against No. 187926 laid down that, here the thing which causes injury is shown to be under the management of the
herein respondent for medical malpractice. 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
ISSUE: defendant, that the accident arose from want of care.Hence, the requisites for the doctrine to apply are as
Whether or not the petitioners amply proved that Dr. Tuaño failed to exercise diligence in the performance of follows: (1) the accident was of the kind that does not ordinarily occur unless someone is negligent; (2) the
his duty as petitioner Peter Lucas’ physician. instrumentality or agency that caused the injury was under the exclusive control of the person charged; and
(3) the injury suffered must not have been due to any voluntary action or contribution of the person injured.
RULING:
No. Absent a definitive standard of care or diligence required of Dr. Tuaño under the circumstances, the Elements 2 and 3 were present in the case at bar. However, the first element was undeniably wanting.
Court has no yardstick upon which to evaluate the attendant facts of the case at hand to be able to state with
confidence that the acts complained of, indeed, constituted negligence and, thus, should be the subject of TORTS: elements of medical negligence
pecuniary reparation.
The Prosecution failed to prove the existence of the elements of reckless imprudence beyond reasonable
In medical negligence cases, also called medical malpractice suits, there exist a physician-patient doubt. Gaid v. People, G.R. No. 171636 defined negligence as the failure to observe for the protection of the
relationship between the doctor and the victim. But just like any other proceeding for damages, four interests of another person that degree of care, precaution, and vigilance that the circumstances justly
essential (4) elements i.e., (1) duty; (2) breach; (3) injury; and (4) proximate causation, must be established demand, whereby such other person suffers injury.
by the plaintiff/s. All the four (4) elements must co-exist in order to find the physician negligent and, thus,
liable for damages. The following are the elements of medical negligence: (1) the duty owed by the physician to the patient, as
created by the physician-patient relationship, to act in accordance with the specific norms or standards
As the physician has the duty to use at least the same level of care as that of any other reasonably established by his profession; (2) the breach of the duty by the physician failing to act in accordance with the
competent physician would use in the treatment of his patient, said standard level of care, skill and diligence applicable standard of care; (3) the causation, i.e., there must be a reasonably close and causal connection
must likewise be proven by expert medical testimony, because the standard of care in a medical malpractice between the negligent act or omission and the resulting injury; and (4) the damages suffered by the patient.
case is a matter peculiarly within the knowledge of experts in the field. The same is outside the ken of the
average layperson. Most medical malpractice cases are highly technical, therefore, witnesses with special medical qualifications
must impart the knowledge necessary to render a fair and just verdict. In the case at bar, there were no
There is a breach of duty of care, skill and diligence, or the improper performance of such duty, by the witnesses with special medical qualifications in anesthesia presented. Hence, it is difficult to assess whether
attending physician when the patient is injured in body or in health [and this] constitutes the actionable the first three elements of medical negligence were present.
malpractice. Hence, proof of breach of duty on the part of the attending physician is insufficient. Rather, the
negligence of the physician must be the proximate cause of the injury.
14) Rosit vs. Davao Doctors Hospital
 Facts:
STATEMENT OF FACTS: Mrs. Villegas submitted to Dr. Batiquin for prenatal care as the latter's private patient sometime before
Nilo Rosit (Rosit) fractured his Jaw in a motorcycle accident. He was operated in Davao Doctors September 21, 1988. In the morning of September 21, 1988 Dr. Batiquin, along with other physicians and
Hospital (DDH) by Dr. Rolando Gestuvo (Gestuvo). During the operation there was an absence of small nurses, performed a caesarean operation on Mrs. Villegas and successfully delivered the latter’s baby. After
titanium screws, hence Dr. Gestuvo just cut the available ones despite the fact that there were some leaving the hospital, Mrs. Villegas began to suffer abdominal pains and complained of being feverish. She
available in Manila. Dr. Gestuvo did not inform Rosit of such fact considering that he could not afford the also gradually lost her appetite, so she consulted Dr. Batiquin at the latter's polyclinic who prescribed for her
same. certain medicines. However, the pains still kept recurring. She then consulted Dr.Ma. Salud Kho. After
examining her, Dr Kho suggested that Mrs.Villegas submit to another surgery. When Dr. Kho opened the
After the operation he Rosit couldn’t open his jaws properly and was in pain. An x-ray was conducted abdomen of Mrs. Villegas she found whitish-yellow discharge inside, an ovarian cyst on each of the left and
on him and saw that one of the screws hit his molar. Dr. Gestuvo referred him to a dentist, Dr. Pangan, that a right ovaries which gave out pus, dirt and pus behind the uterus, and a piece of rubber material on the right
2nd operation would be necessary due to the fact that the 1st operation was improperly done. 2nd operation side of the uterus, embedded on the ovarian cyst. The piece of rubber appeared to be a part of a rubber
was said to be performed in Cebu. glove. This was the cause of all of the infection of the ovaries and consequently of all the discomfort suffered
by Mrs. Villegas. The piece of rubber allegedly found was not presented in court, and Dr. Kho testified that
Rosit went back to Dr. Gestuvo to demand a loan to defray the cost of the additional she sent it to a pathologist in Cebu City for examination. Aside from Dr. Kho's testimony, the evidence which
operation as well as transpo fees. Dr. Pangan removed the plate and screws and installed a smaller one with mentioned the piece of rubber is a Medical Certificate, a Progress Record, an Anaesthesia Record, a
the proper titanium screws. His molar that was hit and some bone fragments were also extracted. Going Nurse's Record, and a Physician's Discharge Summary.
back to Davao, Rosit demanded 190k in total for all the expenses from Dr. Gestuvo. Dr. Gestuvo refused
to pay. Issue:
Whether or not Dr. Batiquin is liable
STATEMENT OF THE CASE:
Rosit filed a case for civil damages and atty’s fees with the RTC of Davao and DDH. The RTC ruled in Held:
favor of Rosit under the doctrine of res ipsa loquitur. Dr. Gestuvo appealed before the CA, who granted the Yes. The doctrine of res ipsa loquitur as a rule of evidence is peculiar to the law of negligence which
same. The CA removed the awards and stated that said principle was not applicable hence an expert recognizes that ​prima facie negligence may be established without direct proof and furnishes a substitute for
testimony was necessary. Rosit filed an MR, buy was denied, hence this petition. specific proof of negligence. The rule, when applicable to the facts and circumstances of a particular case, is
not intended to and does not dispense with the requirement of proof of culpable negligence on the party
ISSUES: charged. It merely determines and regulates what shall be ​prima ​facie evidence thereof and facilitates the
Whether the appellate court correctly absolved Dr. Gestuvo’s liability. burden of plaintiff of proving a breach of the duty of due care. The doctrine can be invoked when and only
when, under the circumstances involved, direct evidence is absent and not readily available.
RULING:
In the instant case, all the requisites for recourse to the doctrine are present. First, the entire proceedings of
YES, due to the principle of res ipsa loquitur.
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
The doctrine of res ipsa loquitur as an exception to the requirement of an expert testimony in medical
into private respondent Villegas' body, which, needless to say, does not occur unless through the
negligence cases may be availed of if the following essential requisites are satisfied:
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
(1) the accident was of a kind that does not ordinarily occur unless someone is negligent; (2) the
uterus, it stands to reason that such could only have been a by-product of the cesarean section performed
instrumentality or agency that caused the injury was under the exclusive control of the person charged; and
by Dr. Batiquin. The petitioners, in this regard, failed to overcome the presumption of negligence arising from
(3) the injury suffered must not have been due to any voluntary action or contribution of the person injured.
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.
The first element was sufficiently established when Rosit proved that one of the screws installed by Dr.
Gestuvo struck his molar. It was for this issue that Dr. Gestuvo himself referred Rosit to Dr. Pangan. In fact, The court reiterates its recognition of the vital role the medical profession plays in the lives of the people and
the affidavit of Dr. Pangan presented by Dr. Gestuvo himself before the trial court narrated that the same State's compelling interest to enact measures to protect the public from "the potentially deadly effects of
molar struck with the screw installed by Dr. Gestuvo was examined and eventually operated on by Dr. incompetence and ignorance in those who would undertake to treat our bodies and minds for disease or
Pangan. Dr. Gestuvo cannot now go back and say that Dr. Pangan treated a molar different from that which trauma. Indeed, a physician is bound to serve the interest of his patients "with the greatest of solicitude,
was affected by the first operation. giving them always his best talent and skill." Through her tortious conduct, the petitioner endangered the life
of Flotilde Villegas, in violation of her profession's rigid ethical code and in contravention of the legal
Anent the second element for the res ipsa loquitur doctrine application, it is sufficient that the operation standards set forth for professionals, in the general and members of the medical profession, in particular.
which resulted in the screw hitting Rosit's molar was, indeed, performed by Dr. Gestuvo. No other doctor
caused such fact.

Lastly, the third element that the injury suffered must not have been due to any voluntary action or
contribution of the person injured was satisfied in this case. It was not shown that Rosit's lung disease could
have contributed to the pain. What is clear is that he suffered because one of the screws that Dr.
Gestuvo installed hit Rosit's molar.

15) Dr. Victoria Batiquin, et. al vs Court of Appeals, et. Al