[PRACTICE OF MEDICINE]

LEONILA GARCIA-RUEDA, petitioner, vs. WILFRED L. PASCASIO, RAUL R.

ARNAU, ABELARDO L. APORTADERA JR., Honorable CONRADO M. VASQUEZ, all
of the Office of the Ombudsman; JESUS F. GUERRERO, PORFIRIO MACARAEG,
and GREGORIO A. ARIZALA, all of the Office of the City Prosecutor, Manila,
respondents.

G.R. No. z. September 5, 1997.

Ponente
DOCTRINE
In its simplest terms, the type of lawsuit which has been called medical malpractice
or, more appropriately, medical negligence, is that type of claim which a victim has
available to him or her to redress a wrong committed by a medical professional
which has caused bodily harm.

In order to successfully pursue such a claim, a patient must prove that a health care
provider, in most cases a physician, either failed to do something which a reasonably
prudent health care provider would have done, or that he or she did something that
a reasonably prudent provider would not have done; and that that failure or action
caused injury to the patient.
FACTS
Florencio V. Rueda, husband of petitioner Leonila Garcia-Rueda, underwent surgical
operation at the UST hospital for the removal of a stone blocking his ureter. He was
attended by Dr. Domingo Antonio, Jr. who was the surgeon, while Dr. Erlinda
Balatbat-Reyes was the anesthesiologist.

Six hours after the surgery, however, Florencio died of complications of "unknown
cause," according to officials of the UST Hospital.

Not satisfied with the findings of the hospital, the petitioner requested the National
Bureau of Investigation (NBI) to conduct an autopsy on her husband's body.
Consequently, the NBI ruled that Florencio's death was due to lack of care by the
attending physician in administering anesthesia. Pursuant to its findings, the NBI
recommended that Dr. Domingo Antonio and Dr. Erlinda Balatbat-Reyes be
charged for Homicide through Reckless Imprudence before the Office of the City
Prosecutor.

Related to the procedural aspects, the case was initially assigned to Prosecutor
Antonio M. Israel, who had to inhibit himself because he was related to the counsel
of one of the doctors. As a result, the case was re-raffled to Prosecutor Norberto G.
Leono who was, however, disqualified on motion of the petitioner since he
disregarded prevailing laws and jurisprudence regarding preliminary investigation.
The case was then referred to Prosecutor Ramon O. Carisma, who issued a resolution
recommending that only Dr. Reyes be held criminally liable and that the complaint
against Dr. Antonio be dismissed.
The case took another perplexing turn when Assistant City Prosecutor Josefina
Santos Sioson, in the "interest of justice and peace of mind of the parties,"
recommended that the case be re-raffled on the ground that Prosecutor Carisma
was partial to the petitioner. Thus, the case was transferred to Prosecutor Leoncia R.
Dimagiba.

Pending the resolution of petitioner's motion for reconsideration regarding

Prosecutor Dimagiba's resolution, the investigative "pingpong" continued when the
case was again assigned to another prosecutor, Eudoxia T. Gualberto.

The petitioner filed graft charges specifically for violation of Section 3(e) of Republic
Act No. 30193 against Prosecutors Guerrero, Macaraeg, and Arizala for manifest
partiality in favor of Dr. Reyes before the Office of the Ombudsman. However, on July
11, 1994, the Ombudsman issued the assailed resolution dismissing the complaint for
lack of evidence.
ISSUE/S
W/N Medical Negligence was present? - YES.
RULING
RE: POWER OF THE OMBUDSMAN (PROCEDURAL ISSUE)
Preliminarily, the powers and functions of the Ombudsman have generally been
categorized into the following: investigatory powers, prosecutory power, public
assistance function, authority to inquire and obtain information, and function to
adopt, institute and implement preventive measures.

While the Ombudsman has the full discretion to determine whether or not a
criminal case should be filed, this Court is not precluded from reviewing the
Ombudsman's action when there is an abuse of discretion. "Grave abuse of
discretion" has been defined as "where a power is exercised in an arbitrary or
despotic manner by reason of passion or personal hostility so patent and gross as to
amount to evasion of positive duty or virtual refusal to perform a duty enjoined by,
or in contemplation of law.

HERE, from a procedural standpoint, it is certainly odd why the successive transfers
from one prosecutor to another were not sufficiently explained in the Resolution of
the Ombudsman. Being the proper investigating authority with respect to
misfeasance, non-feasance and malfeasance of public officials, the Ombudsman's
should have been more vigilant and assiduous in determining the reasons behind
the "buckpassing" to ensure that no irregularity took place.

RE: MEDICAL NEGLIGENCE (SUBSTANTIVE ISSUE)

The type of lawsuit which has been called medical malpractice or, more
appropriately, medical negligence, is that type of claim which a victim has available
to him or her to redress a wrong committed by a medical professional which has
caused bodily harm.

There are four elements involved in medical negligence cases: duty, breach,
injury and proximate causation.

Another element in medical negligence cases is causation which is divided into two
inquiries: whether the doctor's actions in fact caused the harm to the patient and
whether these were the proximate cause of the patient's
Injury.

In malpractice or negligence cases involving the administration of anesthesia,

the necessity of expert testimony and the availability of the charge of res ipsa
loquitur to the plaintiff; have been applied in actions against anesthesiologists to
hold the defendant liable for the death or injury of a patient under excessive or
improper anesthesia.

Essentially, it requires two-pronged evidence: evidence as to the recognized

standards of the medical community in the particular kind of case, and a showing
that the physician in question negligently departed from this standard in his
treatment.

HERE, regarding the medical negligence in relation to the probable cause, the NBI
pronounced after conducting an autopsy that there was indeed negligence on
the part of the attending physicians in administering the anesthesia.

A causal connection is discernible from the occurrence of the victim's death after
the negligent act of the anesthesiologist in administering the anesthesia, a fact
which, if confirmed, should warrant the filing of the appropriate criminal case. To be
sure, the allegation of negligence is not entirely baseless.

Moreover, the NBI deduced that the attending surgeons did not conduct the
necessary interview of the patient prior to the operation. It appears that the cause of
the death of the victim could have been averted had the proper drug been applied
to cope with the symptoms of malignant hyperthermia. Also, we cannot ignore the
fact that an antidote was readily available to counteract whatever deleterious effect
the anesthesia might produce.
DISPOSITIVE
WHEREFORE, in view of the foregoing, the instant petition is DISMISSED.