Dr. Ninevetch Cruz v.

CA and Lydia Umali

1997 / Francisco / Petition for review on certiorari of a CA decision
Standard of conduct > Experts > Medical professionals

FACTS
Medical malpractice suit – type of claim which a victim has available to him/her to redress a wrong committed by a
medical professional which has caused bodily harm; most often brought as a civil action for damages under NCC
2176 or a criminal case under RPC 365, with which a civil action for damages is impliedly instituted.
Lydia Umali was examined by Dr. Cruz who found a myoma [benign tumor] in her uterus, and scheduled her for
a hysterectomy operation [removal of uterus] on 23 Mar 1991. Rowena Umali de Ocampo accompanied her mother
to the hospital a day before the operation, and they spent the night there. Rowena noticed that the clinic was untidy,
so she tried to persuade her mother not to proceed with the operation. The following day, Rowena asked Dr. Cruz if
the operation could be postponed, but Lydia told her daughter that Dr. Cruz said that the operation must go on as
scheduled.
While Lydia’s relatives were waiting, Dr. Ercillo (anesthesiologist) told them to buy tagamet ampules, and
Rowena’s sister went out to buy some. An hour later, Dr. Ercillo asked them to buy blood for Lydia, so they did. A
few hours later, the operation was finished, but later, Dr. Cruz asked the family to buy additional blood, but there
was no more type A blood available in the blood bank. A person arrived to donate blood 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 shock and her blood pressure dropped. She
was then transferred to another hospital so she could be connected to a respirator and further examined.
However, this transfer was without the consent of the relatives, who only found out about it when an ambulance
came to take Lydia to the other hospital.
In the new hospital, she was re-operated upon by Dr. Cruz and Dr. Ercillo because blood was oozing out
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 was nothing he could
do. Lydia died while Dr. Cruz was closing her abdominal wall. Immediate cause of death is shock; disseminated
intravascular coagulation (DIC) as antecedent cause.
Dr. Cruz and Dr. Ercillo were charged with reckless imprudence and negligence resulting in homicide of
Lydia Umali. The Municipal Trial Court in Cities (MTCC) found Dr. Ercillo not guilty for insufficiency of
evidence against her, but held Dr. Cruz responsible for Umali’s death. RTC and CA affirmed MTCC.
Manifestation of negligence

 untidiness of clinic

 lack of provision of supplies

 the fact that the transfer was needed meant that there was something wrong in the way Dr. Cruz conducted operation

 no showing that pre-surgery procedure (clearance, blood typing/tests) was conducted

ISSUE AND HOLDING
WON the circumstances are sufficient to sustain a judgment of conviction against Dr. Cruz for reckless imprudence
resulting in homicide. NO. DR. CRUZ IS ACQUITTED, BUT SHE IS STILL CIVILLY LIABLE (50K civil
liability; 100k moral damages, 50k exemplary damages).
RATIO
Elements of reckless imprudence
1. Offender does / fails to do an act
2. Doing / failure to do act is voluntary

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3. Without malice
4. Material damage results from reckless imprudence
5. There is inexcusable lack of precaution, taking into consideration offender’s employment, degree of intelligence,
physical condition, other circumstances re: persons, time, place
Standard of care
Standard of care observed by other members of the profession in good standing under similar circumstances, bearing
in mind the advanced state of the profession at the time of treatment or the present state of medical science
When the physician’s qualifications are admitted, there is an inevitable presumption that in proper 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.
Expert testimony
Expert testimony is essential to establish standard of care of the profession, as well as that the physician’s 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 records. NBI doctors presented by the
prosecution only testified as to the possible cause of death.
While it may be true that the circumstances pointed out by the lower courts constitute reckless imprudence,
this conclusion is still best arrived not through the educated surmises nor conjectures of laymen, including
judges, but by the unquestionable knowledge of expert witnesses. The deference of courts to the expert opinion
of qualified physicians stems from the realization that the latter possess unusual technical skills which laymen are
incapable of intelligently evaluating.
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 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 complained of (Chan
Lugay v. St. Luke’s Hospital, Inc.). In this case, no cogent proof exists that the circumstances caused Lydia’s death,
so the 4th element of reckless imprudence is missing.
The testimonies of the doctors presented by the prosecution establish hemorrhage / hemorrhagic 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 doctors do not preclude the
probability that a clotting defect (DIC) caused the hemorrhage and consequently, Lydia’s death.
The Court has no recourse but to rely on the expert testimonies that substantiate Dr. Cruz’ allegation that the cause of
Lydia’s death was DIC, which cannot be attributed to Dr. Cruz’ fault or negligence. This probability was unrebutted
during trial.

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 Cayao-Lasam vs Spouses Ramolete
GR No. 159132 December 18, 2002

Facts: On July 28, 1994, respondent 3 months pregnant Editha Ramolete was brought to Lorma Medical Center
(LMC) in San Fernando, La Union due to vaginal bleeding upon advise of petitioner related via telephone, Editha was
admitted to the LMC on the same day. A pelvic sonogram was then conducted on Editha revealing the fetus weak
cardiac pulsation. The following day, Editha repeat pelvic sonogram showed that aside from the fetus weak cardiac
pulsation, no fetal movement was also appreciated. Due to persistent and profuse vaginal bleeding, petitioner advised
her to undergo a D&C procedure. She was discharged the following day. On September 16, 1994, Editha was once
gain brought at the LMC, as she was suffering from vomiting ans severe abdominal pains. Editha was attended by
Drs. Dela Cruz, Mayo and Komiya. Dr. Mayo allegedly informed Editha that there was a dead fetus in the latter’s
womb, after Editha went laparectomy, she was found to have massive intra abdominal hemorrhage and ruptured uterus.
Thus, she had to go hysterectomy and as a result no more chance to bear a child.

Issue: Whether or not petitioner is liable for medical malpractice.

Held: No. Medical malpractice is a particular form of negligence which consists in the failure of a physician or
surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the profession
generally under similar conditions, and in like surrounding circumstances. In order to successfully pursue such a
claim, a patient must prove that the physician or surgeon either failed to do something which a reasonably prudent
physician or surgeon would not have done, and that the failure or action caused injury to the patient.

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

A physician-patient relationship was created when Editha employed the services of the petitioner. As Editha’s
physician, petitioner was duty-bound to use at least the same level of care that any reasonably competent doctor would
use to treat a condition under the same circumstances. The breach of these professional duties of skill and care, or
their improper performance by a physician surgeon, whereby the patient’s injured in body or in health, constitutes
actionable malpractice, as to this aspect of medical malpractice, the determination of the reasonable level of care and
the breach thereof, expert testimony is essential. Further, in as much as the causes of the injuries involved in
malpractice actions are determinable only in the light of scientific knowledge, it has been recognized that expert
testimony is usually necessary to suspect the conclusion as to causation.

It is undisputed that Editha did not return for follow-up evaluation, in defiance of the petitioners advice. This is as
found out is the proximate cause of the injury she sustained.

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 G.R. 178763 Peter Paul Patrick Lucas et al v. Dr. Prospero Ma. Tuano, April 2009

Facts:

Sometime in 1988, petitioner Peter Paul Patrick Lucas contracted "sore eyes" in his right eye. Upon consultation with
Dr. Tuano, Peter narrated that it has been 9 days since the problem with his right eye began, and that he was already
taking Maxitrol to address the eye problem. According to Dr. Tuano, he performed "ocular routine examination" on
Peter's eyes, wherein: 1. a cross examination Peter's eyes and their surrounding area was made, and 2. Peter's visual
acuity were taken, 3. Peter's eyes were palpated to check the intraocular pressure of each; 4. the mortility of Peter's
eyes were observed, and 5. the ophthalmoscopy on Peter's eyes was used.

On that particular consultation, Dr. Tuano diagnosed that Peter was suffering from conjunctivitis or sore eyes. He then
prescribed Spersacet C-eye drops for Peter and told the latter to return for follow-up after one week.

As instructed, Peter returned and Dr. Tuano discovered that the right eye developed Epidemic Kerato
Conjunctivitis, EKC, a viral infection. To address the problem, Dr. Tuano prescribed Maxitrol, for a dosage of 6 times
a day.

However, the EKC was getting worse yet Dr. Tuano still continued on advising the use of Maxittrol, despite Peter's
discovery of the inscribed warning written in its label.

Upon examination, Dr. Tuano noted the hardness in Peter's right eye and discovered that the tension in Peter's right
eye was 39.0 Hg. Since the tension was way over the normal IOP which only ranged from 10.0 Hg to 21.0 Hg, Dr.
Tuano then ordered him to immediately discontinue the use of Maxitrol and prescribed to the latter Diamox and
Normoglaucon instead. He also required Peter to go for a daily check-up in order for the former to closely monitor the
pressure of the latter' eyes.

During one of Peter's regular follow-ups, Dr. Tuano noted the recurrence of EKC in Peter's right eye. Thus, he referred
Peter to Dr. Manuel Agulto, M.D., another opthalmologist specializing in glaucoma treatment.

Eventually, Peter, in claiming to have "steroid-induced glaucoma" and blaming Dr. Tuano for the same, filed a civil
complaint for damages against Dr. Tuano. In their complaint, petitioners averred that as the direct consequence of
Peter's prolonged use of Maxitrol, he suffered from steroid-induced glaucoma which caused the elevation of his intra-
ocular pressure, which caused the impairment of his vision which may lead to total blindness.

In rebutting petitioner's claim, Dr. Tuano asserted that the treatment made by him more than three years ago has no
causal connection to Peter's glaucoma. He further explained that 'drug-induced glaucoma is temporary and curable,
steroids have the side effect of increasing intraocular pressure. Steroids are prescribed to treat Epidemic Kerato
Conjunctivitis or EKC which is an infiltration of the cornea as a result of conjunctivitis or sore eyes'. Hence, the steroid
treatment of Peter's EKC caused the steroid-induced glaucoma.

RTC Ruling

The RTC dismissed the Civil Case for insufficiency of evidence, opining that petitioners failed to prove by
preponderance of evidence that Dr. Tuano was negligent in his treatment of Peter's condition. The trial court reasoned
hat the recognized standards of the medical community has not been established in thiss case, much less has causation
been established to render Dr. Tuano liable. Further, absence of any medical evidence to the contrary, the RTC ruled
that it cannot accept petitioner's claim that the use of steroid is the proximate cause of the damage sustained by Peter's
eye.

Court of Appeals Ruling

The CA faulted petitioners because they failed to present any medical expert to testify that Dr. Tuano's prescription
of Maxitrol and Blephamide for the treatment of EKC on petiitioner's right eye was not proper and that his palpation
of Peter's right eye was not enough to detect adverse reaction to steroid.

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During the trial in CA, Peter testified that Dr. Manuel Agulto told him that he should not have used steroid for the
treatment of EKC or that he should have used it only for two weeks, as EKC iss only a viral infection which will cure
in tself. However, Dr. Agulto was not presented by petitioners as a witness to confirm what he allegedly told Peter
and therefore, the latter's testimony is hearsay. Under Rule 130, Section 36 of the Rules of Court, a witness can testify
only to those facts which he knows of and his own personal knowledge. Familiar and fundamental is the rule that
hearsay testimony is inadmissible as evidence.

Petitioner's Motion for Reconsideration was denied by resolution, hence, this appeal.

Issue: Did the petitioners failed to prove by preponderance of evidence their claim for damages against Dr. Tuano?

Court Ruling:

Only questions of law may be raised under Rule 45 of the Rules of Court as this court is not a trier of facts.

The said issue constitutes a question of fact, as the Supreme Court is asked to revisit anew the factual findings of the
RTC and the CA. While this general rule admits of certain exceptions, such as the circumstance when the finding of
fact of the Court of Appeals is premised on the supposed absence of evidence, but is contradicted by the evidence on
record.

The fact of want of competence or diligence is evidentiary in nature, the veracity of which can best be passed upon
after a full-blown trial for it is virtually impossible to ascertain the merits of a medical negligence case without
extensive investigation, research, evaluation and consultation with the medical experts.

Petitioner's position in sum is that Peter's glaucoma is the direct result of Dr. Tuano's negligence in his improper
administration of the drug Maxitrol. Clearly, the present controversy is a classic illustration of a medical negligence
case against a physician based on the latter's professional negligence. In this type of suit, the patient or his heirs, in
order to prevail, is required to prove by is required to prove by preponderance of evidence that the physician failed to
exercise that degree of skill, care and learning possessed by other persons in the same profession; and that as a
proximate result of such faiure, the patient or his heirs suffered damages.

For lack of a specific law geared towards the type of negligence committed by members of the medical profession,
such claim for damages is almost always anchored on the alleged violation of Article 2176 of the Civil Code which
states that "whoever by act or omission, causes damage to another, there being no fault or negligence, is obliged to
pay for the damage done. Such fault or negligence, is there is no pre-existing contractual relation between the parties
is called quasi-delict.

In medical negligence cases, the four essential elements are the following: 1. duty 2. breach 3. injury 4. proximate
cause, which must be established by the plaintiffs.

In order that there may be a recovery for an injury, it must be shown that the injury for which the recovery is sought
must be the legitimate consequence of the wrong done, the connection between the negligence and the injury must be
a direct and natural sequence of events, unbroken by intervening efficient causes.

Criminal Law- Proximate cause: It is the cause, which is the natural and continuous sequence, unbroken by any
efficient intervening cause, produces the injury, and without which the result would not have occurred. That is, the
negligence must be the proximate cause of the injury.

Just as with the elements of duty and breach of the same, in order to establish the proximate cause by preponderance
of evidence, the patient must similarly use expert testimony, because the question of whether the alleged professional
negligence caused the patient's injury is generally one for specialized expert knowledge beyond the ken of the average
layperson; using the specialized knowledge and training of his field, the expert's role is to present to the court a realistic
assessment of the likelihood that the physician's alleged negligence caused the patient's injury.

In this case, Dr. Tuano was able to clearly explain what is only required of ophthalmologists, in cases such as Peter's
is the conduct of standard tests/ procedures known as "ocular routine examination" composed of five (5) test

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procedures, specifically: gross examination of the eyes and the surrounding area, taking of the visual acuity of the
patient, checking the intraocular pressure of the patient, checking the motility of the eyes--and he did all those tests
every time Peter went to see him for follow-up consultation and/or check-up.

Even if we are to assume that Dr. Tuano committed negligent acts in his treatment of Peter's condition, the causal
connection between Dr. Tuano's supposed negligence and Peter's injury still needed to be established. The critical
and clinching factor in a medical negligence case is proof of the causal connection between the negligence which
the evidence established and the plaintiff's injuries.

Civil procedure, burden of proof: In civil cases, the party having the burden of proof must establish his case by a
preponderance of evidence, or evidence which is more convincing to the court as worthy of belief than that which
is offered in opposition thereto. The party having the burden of proof must establish his case by a preponderance of
evidence or "evidence which is of greater weight or more convincing that that which is offered in opposition to it; in
the last analysis, it means the probability of truth.

It seems basic that what constitutes proper medical treatment is a medical question that should have been presented to
experts. If no standard is established through expert medical witnesses, then courts have no standard by which to gauge
the basic issue of breach by the physician or surgeon. The RTC, Court of Appeals and even the Supreme Court; could
not be expected to determine on its own what medical technique should have been utilized for a certain disease or
injury. Absent expert medical opinion, the courts would be dangerously engaging in speculations.

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CASUMPANG v. CORTEJO
G.R. No. 171127 | March 11, 2015

FACTS:

 On April 22, 1988, at about 11:30 in the morning, Mrs. Cortejo brought her 11-year old son, Edmer, to the
Emergency Room of the San Juan de Dios Hospital (SJDH) because of difficulty in breathing, chest pain, stomach
pain, and fever. Thereafter, she was referred and assigned to Dr. Casumpang, a pediatrician. At 5:30 in the
afternoon of the same day, Dr. Casumpang, upon examination using only a stethoscope, confirmed the diagnosis
of Bronchopneumonia. Mrs. Cortejo immediately advised Dr. Casumpang that Edmer had a high fever, and had
no colds or cough but Dr. Casumpang merely told her that her son's bloodpressure is just being active and
remarked that that's the usual bronchopneumonia, no colds, no phlegm.

 Dr. Casumpang next visited the following day. Mrs. Cortejo again called Dr. Casumpang's attention and stated
that Edmer had a fever, throat irritation, as well as chest and stomach pain. Mrs. Cortejo also alerted Dr.
Casumpang about the traces of blood in Edmer's sputum. Despite these pieces of information, however, Dr.
Casumpang simply nodded and reassured Mrs. Cortejo that Edmer's illness is bronchopneumonia.

 At around 11:30 in the morning of April 23, 1988, Edmer vomited phlegm with blood streak prompting the
Edmer's father to request for a doctor. Later, Miranda, one of the resident physicians of SJDH, arrived. She
claimed that although aware that Edmer had vomited phlegm with blood streak she failed to examine the blood
specimen. She then advised the respondent to preserve the specimen for examination. Thereafter, Dr. Miranda
conducted a check-up on Edmer and found that Edmer had a low-grade fever and rashes.

 At 3:00 in the afternoon, Edmer once again vomited blood. Dr. Miranda then examined Edmer's sputum with
blood and noted that he was bleeding. Suspecting that he could be afflicted with dengue, Dr. Miranda conducted
a tourniquet test, which turned out to be negative. Dr. Miranda then called up Dr. Casumpang at his clinic and
told him about Edmer's condition. Upon being informed, Dr. Casumpang ordered several procedures done. Dr.
Miranda advised Edmer's parents that the blood test results showed that Edmer was suffering from Dengue
Hemorrhagic Fever. Dr. Casumpang recommended Edmer’s transfer to the ICU, but since the ICU was then full,
the respondent, insisted on transferring his son to Makati Medical Center.

 At 12:00 midnight, Edmer, accompanied by his parents and by Dr. Casumpang, was transferred to Makati Medical
Center. Upon examination, the attending physician diagnosed Dengue Fever Stage IV that was already in its
irreversible stage. Edmer died at 4:00 in the morning of April 24, 1988. His Death Certificate indicated the cause
of death as Hypovolemic Shock/hemorrhagic shock/Dengue Hemorrhagic Fever Stage IV.

 Believing that Edmer's death was caused by the negligent and erroneous diagnosis of his doctors, the respondent
instituted an action for damages against SJDH, and its attending physicians: Dr. Casumpang and Dr. Miranda.

 Dr. Casumpang contends that he gave his patient medical treatment and care to the best of his abilities, and within
the proper standard of care required from physicians under similar circumstances.

 Dr. Miranda argued that the function of making the diagnosis and undertaking the medical treatment devolved
upon Dr. Casumpang, the doctor assigned to Edmer. Dr. Miranda also alleged that she exercised prudence in
performing her duties as a physician, underscoring that it was her professional intervention that led to the correct
diagnosis of Dengue Hemorrhagic Fever.

 SJDH, on the other hand, disclaims liability by asserting that Dr. Casumpang and Dr. Miranda are mere
independent contractors and consultants (not employees) of the hospital; hence, Article 2180 of the Civil Code
does not apply.

ISSUES:

1. W/N Casumpang had committed inexcusable lack of precaution in diagnosing and in treating the patient

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2. W/N Miranda had committed inexcusable lack of precaution in diagnosing and in treating the patient

3. W/N Whether or not the petitioner hospital is solidarity liable with the petitioner doctors

4. W/N or not there is a causal connection between the petitioners' negligent act/omission and the patient's resulting
death

HELD/RATIO:

1. YES, Casumpang was negligent.

 Even assuming that Edmer's symptoms completely coincided with the diagnosis of bronchopneumonia, we still
find Dr. Casumpang guilty of negligence. Wrong diagnosis is not by itself medical malpractice. Physicians are
generally not liable for damages resulting from a bona fide error of judgment and from acting according to
acceptable medical practice standards. Nonetheless, when the physician's erroneous diagnosis was the result of
negligent conduct, it becomes an evidence of medical malpractice.

 In the present case, evidence on record established that in confirming the diagnosis of bronchopneumonia, Dr.
Casumpang selectively appreciated some and not all of the symptoms presented, and failed to promptly conduct
the appropriate tests to confirm his findings. In sum, Dr. Casumpang failed to timely detect dengue fever, which
failure, especially when reasonable prudence would have shown that indications of dengue were evident and/or
foreseeable, constitutes negligence. Apart from failing to promptly detect dengue fever, Dr. Casumpang also
failed to promptly undertake the proper medical management needed for this disease. Dr. Casumpang failed to
measure up to the acceptable medical standards in diagnosing and treating dengue fever.

 Dr. Casumpang's claim that he exercised prudence and due diligence in handling Edmer's case, sside from being
self-serving, is not supported by competent evidence. He failed, as a medical professional, to observe the most
prudent medical procedure under the circumstances in diagnosing and treating Edmer.

2. No, Dr. Miranda is not liable for negligence.

 We find that Dr. Miranda was not independently negligent. Although she was subject to the same standard of care
applicable to attending physicians, as a resident physician, she merely operates as a subordinate who usually refer
to the attending physician on the decision to be made and on the action to be taken. We also believe that a finding
of negligence should also depend on several competing factors. In this case, before Dr. Miranda attended to
Edmer, Dr. Casumpang had diagnosed Edmer with bronchopneumonia. There is also evidence supporting Dr.
Miranda's claim that she extended diligent care to Edmer. In fact, when she suspected, during Edmer's second
episode of bleeding, that Edmer could be suffering from dengue, she wasted no time in conducting the necessary
tests, and promptly notified Dr. Casumpang about the incident. Indubitably, her medical assistance led to the
finding of dengue fever. Dr. Miranda's error was merely an honest mistake of judgment; hence, she should not be
held liable for medical negligence.

3. Yes, causal connection between the petitioners' negligence and the patient's resulting death was established

 Casumpang failed to timely diagnose Edmer with dengue fever despite the presence of its characteristic
symptoms; and as a consequence of the delayed diagnosis, he also failed to promptly manage Edmer's illness.
Had he immediately conducted confirmatory tests, and promptly administered the proper care and management
needed for dengue fever, the risk of complications or even death, could have been substantially reduced. That
Edmer later died of Dengue Hemorrhagic Fever Stage IV, a severe and fatal form of dengue fever, established
the causal link between Dr. Casumpang's negligence and the injury. The element of causation is successfully
proven.

4. YES, SJDH is solidarily liable.

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 As a rule, hospitals are not liable for the negligence of its independent contractors. However, it may be found
liable if the physician or independent contractor acts as an ostensible agent of the hospital. This exception is also
known as the doctrine of apparent authority.

 SJDH impliedly held out and clothed Dr. Casumpang with apparent authority leading the respondent to believe
that he is an employee or agent of the hospital. Based on the records, the respondent relied on SJDH rather than
upon Dr. Casumpang, to care and treat his son Edmer. His testimony during trial showed that he and his wife did
not know any doctors at SJDH; they also did not know that Dr. Casumpang was an independent contractor. They
brought their son to SJDH for diagnosis because of their family doctor's referral. The referral did not specifically
point to Dr. Casumpang or even to Dr. Miranda, but to SJDH.

 Mrs. Cortejo accepted Dr. Casumpang's services on the reasonable belief that such were being provided by SJDH
or its employees, agents, or servants. By referring Dr. Casumpang to care and treat for Edmer, SJDH impliedly
held out Dr. Casumpang as a member of its medical staff. SJDH cannot now disclaim liability since there is no
showing that Mrs. Cortejo or the respondent knew, or should have known, that Dr. Casumpang is only an
independent contractor of the hospital. In this case, estoppel has already set in.

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G.R. No. 118141 September 5, 1997

GARCIA-RUEDA vs. PASCASIO

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 anaesthesiologist. 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, 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 anaesthesia. 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.

During the preliminary investigation, what transpired was a confounding series of events which we shall try
to disentangle. 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, where a volte
face occurred again with the endorsement that the complaint against Dr. Reyes be dismissed and instead, a
corresponding information be filed against Dr. Antonio. Petitioner filed a motion for reconsideration, questioning the
findings of Prosecutor 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,
who recommended that Dr. Reyes be included in the criminal information of Homicide through Reckless Imprudence.
While the recommendation of Prosecutor Gualberto was pending, the case was transferred to Senior State Prosecutor
Gregorio A. Arizala, who resolved to exonerate Dr. Reyes from any wrongdoing, a resolution which was approved by
both City Prosecutor Porfirio G. Macaraeg and City Prosecutor Jesus F. Guerrero.

Aggrieved, petitioner filed graft charges specifically for violation of Section 3(e) of Republic Act No. 3019
3
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.

In fine, petitioner assails the exercise of the discretionary power of the Ombudsman to review the
recommendations of the government prosecutors and to approve and disapprove the same. Petitioner faults the
Ombudsman for, allegedly in grave abuse of discretion, refusing to find that there exists probable cause to hold public
respondent City Prosecutors liable for violation of Section 3(e) of R.A. No. 3019.

ISSUE:

Whether or not expert testimony is necessary to prove the negligent act of the respondent.

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 RULING:

In accepting a case, a doctor in effect represents that, having the needed training and skill possessed by
physicians and surgeons practicing in the same field, he will employ such training, care and skill in the
treatment of his patients. He therefore has a duty to use at least the same level of care that any other reasonably
competent doctor would use to treat a condition under the same circumstances. It is in this aspect of medical
malpractice that expert testimony is essential to establish not only the standard of care of the profession but also that
the physician's conduct in the treatment and care falls below such standard. Further, inasmuch as the causes of the
injuries involved in malpractice actions are determinable only in the light of scientific knowledge, it has been
recognized that expert testimony is usually necessary to support the conclusion as to causation.

Immediately apparent from a review of the records of this case is the absence of any expert testimony on the
matter of the standard of care employed by other physicians of good standing in the conduct of similar operations.
The prosecution's expert witnesses in the persons of Dr. Floresto Arizala and Dr. Nieto Salvador, Jr. of the National
Bureau of Investigation (NBI) only testified as to the possible cause of death but did not venture to illuminate the
court on the matter of the standard of care that petitioner should have exercised.

The better and more logical remedy under the circumstances would have been to appeal the resolution of the
City Prosecutors dismissing the criminal complaint to the Secretary of Justice under the Department of Justice's Order
No. 223, otherwise known as the "1993 Revised Rules on Appeals From Resolutions In Preliminary
Investigations/Reinvestigations," as amended by Department Order No. 359, Section 1 of which provides:

Sec. 1. What May Be Appealed. — Only resolutions of the Chief State Prosecutor/Regional State
Prosecutor/Provincial or City Prosecutor dismissing a criminal complaint may be the subject of an
appeal to the Secretary of Justice except as otherwise provided in Section 4 hereof.

What action may the Secretary of Justice take on the appeal? Section 9 of Order No. 223 states: "The
Secretary of Justice may reverse, affirm or modify the appealed resolution." On the other hand, "He may motu proprio
or on motion of the appellee, dismiss outright the appeal on specified grounds."

In exercising his discretion under the circumstances, the Ombudsman acted within his power and authority
in dismissing the complaint against the Prosecutors and this Court will not interfere with the same.

Petition is dismissed.

TORTS – Medical Malpractice A to D | 11

Reyes Vs. Sisters Of Mercy
Socialize Us

Facts:
 Jorge Reyes has been suffering from recurring fever with chills for around days.
 Home medication afforded him no relief so he went to Mercy Community Clinic. He was then attended by Dr.
Marlyn Rico.
 Since typhoid fever was common at that time, the Widal test was performed and he was found positive for
typhoid.
 Thereafter, Dr. Marlyn Rico indorse Jorge Reyes to Dr. Marvie Blanes.
 Suspecting that that Jorge had typhoid fever, Dr. Marvie Blanes ordered that Jorge be tested for compatibility
with chloromycetin, an antibiotic. Such test was conducted by Nurse Pagente.
 As there was no adverse reaction, Dr. Blanes administered 500 mg of the antibiotic. Another dose was given 3
hours later.
 Subsequently, Jorge Reyes developed high fever and experienced vomiting and convulsions. He then turned
blue due to deficiency in oxygen – cyanosis – and died. The cause of death was stated to be “ventricular
arrhythmia secondary to hyperpyrexia and typhoid fever.”
 The heirs of Reyes filed with the RTC a complaint for damages against Sisters of Mercy, Sister Rose Palacio,
Dr. Blanes, Dr. Rico and Mercy Community Clinic contending that the death of Jorge was due to the wrongful
administration of chloromycetin. (NOTE: Petitioner’s action is for medical malpractice.)
 RTC ruled in favor of the respondents. The CA affirmed in toto the RTC decision. Hence, this appeal.
 Petitioners contend that:
 Dr. Marlyn Rico hastily and erroneously relied upon the Widal test, diagnosed Jorge’s illness as typhoid
fever, and immediately prescribed the administration of the antibiotic chloromycetin
 Dr. Marvie Blanes erred in ordering the administration of the second dose of 500 milligrams of
chloromycetin barely 3 hours after the first was given.
 Testimony presented: That of Dr. Apolinar Vacalares, (Chief Pathologist of the Northern Mindanao Training
Hospital) who performed an autopsy on the body – Dr. Vacalares testified that Reyes did not die of typhoid
fever but of shock undetermined, which could be due to allergic reaction or chloromycetin overdose.

Issue: WON there was medical malpractice. NO

Held:

Dr. Apolinar Vacalares is not a specialist of typhoid fever and he is thus not qualified to prove that Dr. Marlyn
Rico erred in her diagnosis.
While petitioners presented Dr. Apolinar Vacalares as an expert witness, we do not find him to be so as he is not a
specialist on infectious diseases like typhoid fever. Furthermore, although he may have had extensive experience in
performing autopsies, he admitted that he had yet to do one on the body of a typhoid victim at the time he conducted
the postmortem on Jorge Reyes. It is also plain from his testimony that he has treated only about three cases of typhoid
fever.

The two doctors presented by respondents clearly were experts on the subject
They vouched for the correctness of Dr. Marlyn Rico’s diagnosis. Dr. Peter Gotiong, a diplomate whose specialization
is infectious diseases and microbiology and an associate professor at the Southwestern University College of Medicine
and the Gullas College of Medicine, testified that he has already treated over a thousand cases of typhoid fever.

TORTS – Medical Malpractice A to D | 12

According to him, when a case of typhoid fever is suspected, the Widal test is normally used, and if the 1:320 results
of the Widal test on Jorge Reyes had been presented to him along with the patient’s history, his impression would also
be that the patient was suffering from typhoid fever. As to the treatment of the disease, he stated that chloromycetin
was the drug of choice. He also explained that despite the measures taken by respondent doctors and the intravenous
administration of two doses of chloromycetin, complications of the disease could not be discounted.

Respondents also presented the testimony of Dr. Ibarra T. Panopio who is a member of the Philippine and American
Board of Pathology, an examiner of the Philippine Board of Pathology, and chief pathologist at the MetroCebu
Community Hospital, Perpetual Succor Hospital, and the Andres Soriano Jr. Memorial Medical Center.

He stated that, as a clinical pathologist, he recognized that the Widal test is used for typhoid patients, although he did
not encourage its use because a single test would only give a presumption necessitating that the test be repeated,
becoming more conclusive at the second and third weeks of the disease.

He corroborated Dr. Gotiong’s testimony that the danger with typhoid fever is really the possible complications which
could develop like perforation, hemorrhage, as well as liver and cerebral complications.

Dr. Rico was not negligent in administering the 2 doses of 500 g of chloromycetin
The chloromycetin was likewise a proper prescription is best established by medical authority. Even if the deceased
suffered from an anaphylactic shock, this, of itself, would not yet establish the negligence of the appellee-physicians
for all that the law requires of them is that they perform the standard tests and perform standard procedures. The law
cannot require them to predict every possible reaction to all drugs administered.

The practice of medicine requires the highest degree of diligence

The practice of medicine is a profession engaged in only by qualified individuals. It is a right earned through years of
education, training, and by first obtaining a license from the state through professional board examinations. Such
license may, at any time and for cause, be revoked by the government. In addition to state regulation, the conduct of
doctors is also strictly governed by the Hippocratic Oath, an ancient code of discipline and ethical rules which doctors
have imposed upon themselves in recognition and acceptance of their great responsibility to society. Given these
safeguards, there is no need to expressly require of doctors the observance of “extraordinary” diligence.

As it is now, the practice of medicine is already conditioned upon the highest degree of diligence. And, as we have
already noted, the standard contemplated for doctors is simply the reasonable average merit among ordinarily good
physicians. That is reasonable diligence for doctors or, as the Court of Appeals called it, the reasonable “skill and
competence . . . that a physician in the same or similar locality . . . should apply.”

There are thus four elements involved in medical negligence cases, namely: duty, breach, injury, and proximate
causation
Petitioner’s action is for medical malpractice. This is a particular form of negligence which consists in the failure of a
physician or surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed
by the profession generally, under similar conditions, and in like surrounding circumstances.

TORTS – Medical Malpractice A to D | 13

In order to successfully pursue such a claim, a patient must prove that the physician or surgeon either failed to do
something which a reasonably prudent physician or surgeon would have done, or that he or she did something that a
reasonably prudent physician or surgeon would not have done, and that the failure or action caused injury to the
patient.

The doctrine of Res Ipsa Loquitor is not applicable in this case.

Was there a physician-patient relationship between the respondent doctors and Jorge Reyes? Yes.
Respondents were thus duty-bound to use at least the same level of care that any reasonably competent doctor would
use to treat a condition under the same circumstances. It is breach of this duty which constitutes actionable malpractice.
As to this aspect of medical malpractice, the determination of the reasonable level of care and the breach thereof,
expert testimony is essential. Inasmuch as the causes of the injuries involved in malpractice actions are determinable
only in the light of scientific knowledge, it has been recognized that expert testimony is usually necessary to support
the conclusion as to causation.
The doctrine of res ipsa loquitor is not applicable in the case at bar
Though expert testimony is usually needed to prove malpractice, where common knowledge and experience teach that
the injury would not have occurred if due care had been exercised, the doctrine of res ipsa loquitur can be invoked to
establish negligence.
Hence, in cases where the res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon
proper proof of injury to the patient, without the aid of expert testimony, where the court from its fund of common
knowledge can determine the proper standard of care. Where common knowledge and experience teach that a resulting
injury would not have occurred to the patient if due care had been exercised, an inference of negligence may be drawn
giving rise to an application of the doctrine of res ipsa loquitur without medical evidence, which is ordinarily required
to show not only what occurred but how and why it occurred.

When the doctrine is appropriate, all that the patient must do is prove a nexus between the particular act or omission
complained of and the injury sustained while under the custody and management of the defendant without need to
produce expert medical testimony to establish the standard of care.

There is nothing unusual about the death of Jorge Reyes (absence of 1st requisite that the accident was of a
kind which does not ordinarily occur unless someone is negligent)
In this case, while it is true that the patient died just a few hours after professional medical assistance was rendered,
there is really nothing unusual or extraordinary about his death.
Prior to his admission, the patient already had recurring fevers and chills for five days unrelieved by the analgesic,
antipyretic, and antibiotics given him by his wife. This shows that he had been suffering from a serious illness and
professional medical help came too late for him.
It must be conceded that the doctrine of res ipsa loquitur can have no application in a suit against a physician or a
surgeon which involves the merits of a diagnosis or of a scientific treatment. The physician or surgeon is not required
at his peril to explain why any particular diagnosis was not correct, or why any particular scientific treatment did not
produce the desired result.

TORTS – Medical Malpractice A to D | 14

 DR. FERNANDO P. SOLIDUM, Petitioner,
vs.

PEOPLE OF THE PHILIPPINES, Respondent.

Facts:
Gerald Albert Gercayo (Gerald) was born on June 2, 1992 with an imperforate anus. Two days after his birth, Gerald
underwent colostomy, a surgical procedure to bring one end of the large intestine out through the abdominal
wall, enabling him to excrete through a colostomy bag attached to the side of his body.

On May 17, 1995, Gerald, then three years old, was admitted at the Ospital ng Maynila for a pull-through operation.
Dr. Leandro Resurreccion headed the surgical team, and was assisted by Dr. Joselito Luceño, Dr. Donatella Valeña
and Dr. Joseph Tibio. The anesthesiologists included Dr. Marichu Abella, Dr. Arnel Razon and petitioner Dr. Fernando
Solidum (Dr. Solidum). During the operation, Gerald experienced bradycardia, and went into a coma. His coma lasted
for two weeks, but he regained consciousness only after a month. He could no longer see, hear or move.

Agitated by her son’s helpless and unexpected condition, Ma. Luz Gercayo (Luz) lodged a complaint for reckless
imprudence resulting in serious physical injuries with the City Prosecutor’s Office of Manila against the attending
physicians.

On July 19, 2004, the RTC and CA rendered its judgment finding Dr. Solidum guilty beyond reasonable doubt of
reckless imprudence resulting in serious physical injuries and ordering her to indemnify, jointly and severally with the
Ospital ng Maynila, private complainant Luz Gercayo, for damages.

Issue:
Whether Ospital ng Maynila shall be held jointly and severally liable with Dr. Solidum with regard to indemnification
for damages

Ruling:
No. The judgment was flawed in logic and in law.

In criminal prosecutions, the civil action for the recovery of civil liability that is deemed instituted with the criminal
action refers only to that arising from the offense charged. It is puzzling, therefore, how the RTC and the CA could
have adjudged Ospital ng Maynila jointly and severally liable with Dr. Solidum for the damages despite the obvious
fact that Ospital ng Maynila, being an artificial entity, had not been charged along with Dr. Solidum. The judgment
rendered against Ospital ng Maynila void was the product of grave abuse of discretion amounting to lack of
jurisdiction.

The Ospital ng Maynila was not at all a party in the proceedings. Hence, its fundamental right to be heard was not
respected from the outset. The R TC and the CA should have been alert to this fundamental defect. Verily, no person
can be prejudiced by a ruling rendered in an action or proceeding in which he was not made a party. Such a rule would
enforce the constitutional guarantee of due process of law.

Moreover, Ospital ng Maynila could be held civilly liable only when subsidiary liability would be properly enforceable
pursuant to Article 103 of the Revised Penal Code. But the subsidiary liability seems far-fetched here. The conditions
for subsidiary liability to attach to Ospital ng Maynila should first be complied with. Firstly, pursuant to Article 103
of the Revised Penal Code, Ospital ng Maynila must be shown to be a corporation “engaged in any kind of industry.”
The term industry means any department or branch of art, occupation or business, especially one that employs labor
and capital, and is engaged in industry. However, Ospital ng Maynila, being a public hospital, was not engaged in
industry conducted for profit but purely in charitable and humanitarian work. Secondly, assuming that Ospital ng
Maynila was engaged in industry for profit, Dr. Solidum must be shown to be an employee of Ospital ng Maynila
acting in the discharge of his duties during the operation on Gerald. Yet, he definitely was not such employee but a
consultant of the hospital. And, thirdly, assuming that civil liability was adjudged against Dr. Solidum as an employee
(which did not happen here), the execution against him was unsatisfied due to him being insolvent.

TORTS – Medical Malpractice A to D | 15

 Dr. Solidum v. People, G.R. No. 192123, 10 March 2014.

FACTS: Gerald Albert Gercayo (Gerald) was born with an imperforate anus. Two days after his birth, Gerald
underwent colostomy, a surgical procedure to bring one end of the large intestine out through the abdominal
wall, enabling him to excrete through a colostomy bag attached to the side of his body. When Gerald was three years
old, he was admitted at the Ospital ng Maynila for a pull-through operation Dr. Leandro Resurreccion headed the
surgical team, and was assisted by Dr. Joselito Luceño, Dr. Donatella Valeña and Dr. Joseph Tibio. The
anesthesiologists included Dr. Marichu Abella, Dr. Arnel Razon and petitioner Dr. Fernando Solidum (Dr.
Solidum). During the operation, Gerald experienced bradycardia, and went into a coma. His coma lasted for two
weeks, but he regained consciousness only after a month. He could no longer see, hear or move.
A criminal complaint for Reckless Imprudence Resulting in Serious Physical Injuries was filed against Dr. Solidum.
The RTC rendered a judgment of conviction against Dr. Solidum with Ospital ng Maynila jointly and severally liable.
The CA affirmed the RTC judgment. The SC ruled that Dr. Solidum must be acquitted because the prosecution did
not prove beyond reasonable doubt that Dr. Solidum had been recklessly imprudent in administering the anesthetic
agent to Gerald. Indeed, Dr. Vertido’s findings did not preclude the probability that other factors related to Gerald’s
major operation, which could or could not necessarily be attributed to the administration of the anesthesia, had caused
the hypoxia and had then led Gerald to experience bradycardia. Dr. Vertido revealingly concluded in his report,
instead, that “although the anesthesiologist followed the normal routine and precautionary procedures, still hypoxia
and its corresponding side effects did occur.

ISSUE#1: Will the acquittal of Dr. Solidum exempt him from civil liability arising from the crime?
HELD#2: NO, it does not follow.
We have to clarify that the acquittal of Dr. Solidum would not immediately exempt him from civil liability. But we
cannot now find and declare him civilly liable because the circumstances that have been established here do not present
the factual and legal bases for validly doing so. His acquittal did not derive only from reasonable doubt. There was
really no firm and competent showing how the injury to Gerard had been caused. That meant that the manner of
administration of the anesthesia by Dr. Solidum was not necessarily the cause of the hypoxia that caused the
bradycardia experienced by Gerard. Consequently, to adjudge Dr. Solidum civilly liable would be to speculate on the
cause of the hypoxia. We are not allowed to do so, for civil liability must not rest on speculation but on competent
evidence.

ISSUE#2: Is the decree that Ospital ng Maynila is jointly and severally liable with Dr. Solidum correct?
HELD#2: NO, the decree is not correct.
For one, Ospital ng Maynila was not at all a party in the proceedings. Hence, its fundamental right to be heard was
not respected from the outset. The R TC and the CA should have been alert to this fundamental defect. Verily, no
person can be prejudiced by a ruling rendered in an action or proceeding in which he was not made a party. Such a
rule would enforce the constitutional guarantee of due process of law.

Moreover, Ospital ng Maynila could be held civilly liable only when subsidiary liability would be properly enforceable
pursuant to Article 103 of the Revised Penal Code. But the subsidiary liability seems far-fetched here. The conditions
for subsidiary liability to attach to Ospital ng Maynila should first be complied with. Firstly, pursuant to Article 103
of the Revised Penal Code, Ospital ng Maynila must be shown to be a corporation “engaged in any kind of industry.”

TORTS – Medical Malpractice A to D | 16

The term industry means any department or branch of art, occupation or business, especially one that employs labor
and capital, and is engaged in industry.

However, Ospital ng Maynila, being a public hospital, was not engaged in industry conducted for profit but purely in
charitable and humanitarian work. Secondly, assuming that Ospital ng Maynila was engaged in industry for profit, Dr.
Solidum must be shown to be an employee of Ospital ng Maynila acting in the discharge of his duties during the
operation on Gerald. Yet, he definitely was not such employee but a consultant of the hospital. And, thirdly, assuming
that civil liability was adjudged against Dr. Solidum as an employee (which did not happen here), the execution against
him was unsatisfied due to his being insolvent.

N.B.
In criminal prosecutions, the civil action for the recovery of civil liability that is deemed instituted with the criminal
action refers only to that arising from the offense charged. It is puzzling, therefore, how the RTC and the CA could
have adjudged Ospital ng Maynila jointly and severally liable with Dr. Solidum for the damages despite the obvious
fact that Ospital ng Maynila, being an artificial entity, had not been charged along with Dr. Solidum. The lower courts
thereby acted capriciously and whimsically, which rendered their judgment against Ospital ng Maynila void as the
product of grave abuse of discretion amounting to lack of jurisdiction.

TORTS – Medical Malpractice A to D | 17

 Alano vs Magud-Logmao
GR No. 1755540 April 7, 2014

Facts: At around 9:50pm of March 1, 1988, Arnelito Logmao then 18 y/o, was brought to the East Avenue Medical
Center (EAMC) in Quezon City by two sidewalk vendors, who allegedly saw the former fall from the overpass near
the Farmer’s Market in Cubao, Quezon City. The patient’s data sheet identified the patient as Angelito Lugmoso of
Boni Ave., Mandaluyong. However, the clinical abstract prepared by Dr. Paterno F. Cabrera, the surgical resident on-
duty at the emergency room of EAMC, stated the patient is Angelito Logmao. Dr. Cabrera reported that Logmao was
drowsy with alcoholic breath, was conscious and coherent; that the skull x-ray showed no fracture; that at around
4:30am of March 2, 1988, Logmao developed generalized seizures and was managed by the neuro-surgeon resident
on-duty; that the condition of Logmao progressively deteriorated and he was intubated and ambu-bagging support was
provided; that admission to the ICU and mechanical ventilation support became necessary, but there was no vacancy
at the ICU and all the ventilation units were being used by other patients; that a resident physician of NKTI, who was
rotating at EAMC, suggested that Logmao be transferred to NKTI; and that after arrangements were made, Logamo
was transferred to NKTI at 10:10am. At the NKTI, the name Angelito Logmao was recorded as Angelito Lugmoso.
Lugmoso was immediately attended to and given the necessary medical treatment. As Lugmoso had no relatives
around, Jennifer Misa, transplant coordinator was asked to locate his family by enlisting police and media assistance.
Dr. Enrique Ona, chairman of the Department of Surgery, observed that severity of the brain injury of Lugmoso
manifested symptoms of brain death. He requested the laboratory section to conduct tissue typing and tissue cross-
matching examination, so that should Lugmoso expire despite the necessary care and medical management and he
would be found to be a suitable organ donor and his family would consent to organ donation, the organs thus donated
could be detached and transplanted promptly to any compatible beneficiary. The identity of Lugmoso was verified by
Misa from EAMC and she was furnished the patient’s data sheet. She then contacted several radio and television
stations to request for air time for the purpose of locating the family of Angelito Lugmoso of Boni Ave., Mandaluyong
who was confined at NKTI with severe head injury after allegedly falling from the Cubao overpass, as well as police
station no. 5 Eastern Police District. Lugmoso was pronounced brain dead on March 3, 1988 7:00am. Two hours later,
Dr. Ona was informed that EEG recording exhibited a flat tracing thereby confirming his brain death. He was found
to be a suitable donor of the heart, kidneys, pancreas, and liver, and after the extensive search, no relatives were found.
Dr. Ona then requested the removal of the specific organs of Lugmoso from the herein petitioners, Dr. Alano, the
director of NKTI who thereafter issued a memorandum stating that only after the requirements of RA 349 as amended
by PD 856 was complied, they can remove the specified organs of Lugmoso. Lugmoso’s remains was brought at La
Funeraria Oro. A press release made by NKTI announcing a double organ transplant led to the findings of the relatives
of Lugmoso.

Issue: Whether or not the removal of Lugmoso’s organs were valid.

Held: Yes. The internal organs of the deceased were removed only after he had been declared brain dead; thus the
emotional pain suffered by respondent due to the death of her son cannot be in any way be attributed to petitioner.
Neither can the court find evidence or second to show that respondent’s emotional suffering at the sight of the pitful
state in which she found her son’s lifeless body be categorically attributed to petitioner’s conduct.

Thus, there can be no cavil that petitioners employed reasonable means to disseminate notifications intended to reach
the relatives of the deceased. The only question that remains pertains to the sufficiency of time allotted for notices to
reach the relatives of the deceased.

If respondent failed to immediately receive notice of her son’s death because the notices did not properly state the
name or identity of the deceased, fault cannot be laid at petitioner’s door. The trial and appellate courts found that it
was the EAMC, who recorded the wrong information regarding the deceased’s identity to NKTI. The NKTI could not
have obtained the information about his name from the patient, because as found by the lower courts, the deceased
was already unconscious by the time he was brought to NKTI.

TORTS – Medical Malpractice A to D | 18

 Spouses Flores vs Spouses Pineda
GR No. 158996 November 14, 2008

Facts: Teresita Pineda consulted her townmate Dr. Fredelicto Flores regarding her medical condition, complaining
about general body weakness, loss of appetite, frequent urination and thirst, and on-and-off vaginal bleeding. After
interviewing Teresita, Dr. Fredelicto advised her to go to United Doctors Medical Center (UDMC) in Quezon City
for a general check-up the following week but the former did not. As for her other symptoms, he suspected that Teresita
might be suffering from diabetes and told her to continue her medications. When her conditions persisted, she went to
UDMC where Dr. Fredelictor check-up her and ordered her admission and further indicate on call D&C operation to
be performed by his wife, Dra. Felicisima Flores, an Ob-Gyne. Laboratory tests were done on Teresita including
internal vaginal examination, however, only the blood sugar and CBC results came out prior to operation which
indicated of diabetes. D&C operations were still done and thereafter, Dra. Felicisima advised her that she can go home
and continue to rest at home but Teresita opted otherwise. Two days after the operation, her condition worsened
prompting further test to be done which resulted that Teresita have diabetes melitus type II. Insulin was administered
but it might arrived late, she died.

Issue: Whether or not spouses petitioners are liable for medical negligence.

Held: Yes. A medical negligence case is a type of claim to redress a wrong committed by a medical professional, that
caused a bodily harm to or the death of a patient. There are four elements involved in a medical negligence case,
namely: duty, breach, injury, and proximate cause.

Duty refers to the standard of behavior which imposes restrictions on one’s conduct. The standard in turn refers to the
amount of competence associated with the proper discharge of the profession. A physician is expected to use at least
the same level of case that any other reasonably competent doctor would use under the same circumstances. Breach
of duty occurs when the physician fails to comply with those professional standards. If injury results to the patient as
a result of this breach, the physician is answerable for negligence.

If a patient suffers from some disability that increases the magnitude of risk to him, that disability must be taken into
account as long as it is or should have been known to the physician.

Stress, whether physical or emotional, is a factor that can aggravate diabetes; a D&C operation is a form of physical
stress. Dr. Mendoza explained how surgical stress can aggravate the patient’s hyperglycemia: when stress occurs, the
diabetic’s body, especially the autonomic system, reacts by secreting hormones which are counter-regulatory; she can
have prolonged hyperglycemia which, if unchecked, could lead to death. Medical lecture further explains that if the
blood sugar has become very high, the patient becomes comatose (diabetic coma). When this happens over several
days, the body uses its own fats to produce energy, and the result is high level of waste products in the blood and
urine.

These findings leads us to the conclusion that the decision to proceed with the D&C operation notwithstanding
Teresita’s hyperglycemia and without adequately preparing her for the procedure, was contrary to the standards
observed by the medical profession. Deviation from this standard amounted to a breach of duty which resulted in the
patient’s death. Due to this negligent conduct, liability must attach to the petitioner spouses.

TORTS – Medical Malpractice A to D | 19

 Atienza vs Board of Medicine
GR No. 177407 February 9, 2011

Facts: Due to her Lumbar parts, private respondent Editha Sioson went to Rizal Medical Center (RMC) for check-up
on February 4, 1995. Sometime in 1999, due to the same problem, she was referred to Dr. Pedro Lantin III of RMC
who, accordingly, ordered several diagnostic laboratory tests. The tests revealed that her right kidney is normal. It was
ascertained, however, that her left kidney is non-functioning and non-visualizing. This, she underwent kidney
operation in 1999, September. On February 18, 2000, private respondents husband Romeo Sioson, filed a complaint
for gross negligence and/or incompetence before the board of medicine against the doctors who allegedly participated
in the fateful kidney operation. It was alleged in the complaint that the gross negligence and/or incompetence
committed by the said doctors, including petitioner, consists of the removal of private respondents fully functional
right kidney, instead of the left non-functioning and non-visualizing kidney. Among the evidence presented are
certified photocopy of the results of the ultrasound and X-ray conducted to Editha with the interpretation that both of
her kidneys are in their proper anatomical location.

Issue: Whether or not the doctors who conducted the kidney operation are liable for gross negligence despite the
evidence presented were mere photocopies.

Held: Yes. To begin with, it is a well settled rule that the rules of evidence are not strictly applied in proceedings
before administrative bodies such as the Board of Medicine. It is the safest policy to be liberal, not rejecting them on
doubtful or technical grounds, but admitting them unless plainly irrelevant, immaterial or incompetent, for the reason
that their rejection places them beyond the consideration of the court, if they are thereafter found relevant or
competent; on the other hand, their admission, if they turn out later to be irrelevant or incompetent, can easily be
remedied by completely discarding them or ignoring them.

Unquestionably, the rules of evidence are merely the means for ascertaining the truth respecting a matter of fact. This,
they likewise provide for some facts which are established and need not be proved, such as those covered by judicial
notice, both mandatory and discretionary. Laws of nature involving the physical sciences, specifically biology include
the structural make-up and composition of living things such as human beings. In this case, we may take judicial
notice that Editha’s kidneys before, and after the time of her operation, as with most human beings, were in their
proper anatomical locations.

TORTS – Medical Malpractice A to D | 20