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G.R. No. 124354 Rogelio and Erlinda Ramos v.

Court of Appeals
Kapunan, J.

FACTS: Erlinda Ramos was a 47-year old robust woman. Except for occasional complaints of discomfort due to
pains allegedly caused by the presence of a stone in her gall bladder, she was as normal as any other woman.
Married to Rogelio Ramos, she has three children. Because the discomforts somehow interfered with her normal
ways, she sought professional advice. She was advised to undergo an operation for the removal of a stone in her gall
bladder. She underwent a series of examinations which included blood and urine tests which indicated she was fit
for surgery.
Dr. Buenviaje, she and her husband Rogelio met for the first time Dr. Orlino Hosaka. They agreed their date at the
operating table at the Delos Santos Medical Center (DLSMC). Dr. Hosaka decided that she should undergo a
"cholecystectomy" operation after examining the documents presented to him. Rogelio Ramos, however, asked Dr.
Hosaka to look for a good anesthesiologist. Dr. Hosaka, in turn, assured Rogelio that he will get a good
anesthesiologist.
During the day of the operation, while still in her room, she was prepared for the medical procedure by the hospital
staff. Her sister-in-law, Herminda Cruz, who was the Dean of the College of Nursing at the Capitol Medical Center,
was also there for moral support. Her husband, Rogelio, was also with her. At the operating room, Herminda saw
about two or three nurses and Dra. Perfecta Gutierrez, who was to administer anesthesia. Herminda was allowed to
stay inside the operating room.
At around 9:30 A.M., Dra. Gutierrez reached a nearby phone to look for Dr. Hosaka who was not yet in. Dra.
Gutierrez thereafter informed Herminda Cruz about the prospect of a delay in the arrival of Dr. Hosaka. Thereafter,
Herminda went out of the operating room and informed the patient's husband, Rogelio, that the doctor was not yet
around. At around 10:00 A.M., Rogelio E. Ramos was "already dying and waiting for the arrival of the doctor" even
as he did his best to find somebody who will allow him to pull out his wife from the operating room.
At almost 12:00 noon, he met Dr. Garcia who remarked that he (Dr. Garcia) was also tired of waiting for Dr. Hosaka
to arrive. After few minutes, Dr. Hosaka finally arrived. People inside the operating room started to prepare the
patient for the operation. As she held the hand of Erlinda Ramos, she then saw Dra. Gutierrez intubating the hapless
patient.
She thereafter heard Dra. Gutierrez say, "ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang
tiyan." Because of the remarks of Dra. Gutierrez, she focused her attention on what Dra. Gutierrez was doing. She
thereafter noticed bluish discoloration of the nailbeds of the left hand of the hapless Erlinda even as Dr. Hosaka
approached her. She then heard Dr. Hosaka issue an order for someone to call Dr. Calderon, another
anesthesiologist.
After Dr. Calderon arrived at the operating room, she saw this anesthesiologist trying to intubate the patient. The
patient's nailbed became bluish and the patient was placed in a trendelenburg position — a position where the head
of the patient is placed in a position lower than her feet which is an indication that there is a decrease of blood
supply to the patient's brain. Immediately thereafter, she went out of the operating room, and she told Rogelio E.
Ramos about the situation. Dr. Calderon was then able to intubate the patient. When informed by Herminda Cruz
that something wrong was happening, he told her (Herminda) to be back with the patient inside the operating room.
Herminda Cruz immediately rushed back, and saw that the patient was still in trendelenburg position.
At almost 3:00 P.M., she saw the patient taken to the Intensive Care Unit (ICU). About two days thereafter, Rogelio
E. Ramos was able to talk to Dr. Hosaka. The latter informed the former that something went wrong during the
intubation. Reacting to what was told to him, Rogelio reminded the doctor that the condition of his wife would not
have happened, had he (Dr. Hosaka) looked for a good anesthesiologist. Doctors Gutierrez and Hosaka were also
asked by the hospital to explain what happened to the patient. The doctors explained that the patient had
bronchospasm. Erlinda Ramos stayed at the ICU for a month. After four months, the patient was released from the
hospital. During the whole period of her confinement, she incurred hospital bills amounting to P93,542.25 which is
the subject of a promissory note and affidavit of undertaking executed by Rogelio Ramos in favor of DLSMC. The
patient has been in a comatose condition since then. She suffered brain damage as a result of the absence of oxygen
in her brain for four to five minutes. After being discharged from the hospital, she has been staying in their
residence, still needing constant medical attention, with her husband Rogelio incurring a monthly expense ranging
from P8,000.00 to P10,000.00. She was also diagnosed to be suffering from "diffuse cerebral parenchymal damage.”
ISSUES: ​(1) Whether or not ​the Court of Appeals (CA) erred in finding that private respondents (including
DLSMC) were not negligent in the care of Erlinda during the anesthesia phase of the operation, and (2) whether or
not the alleged negligence was the proximate cause of Erlinda's comatose condition.
HOLDING: (1) YES. The private respondents were unable to disprove the presumption of negligence on their part
in the care of Erlinda. (2) The respondents’ negligence was the proximate cause of the piteous condition of the
patient. In the case at bar, Erlinda submitted herself for cholecystectomy and expected a routine general surgery to
be performed on her gallbladder. She delivered her person over to the care and control of private respondents who
exercised 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 administration of anesthesia and prior to the performance of
cholecystectomy, she suffered irreparable damage to her brain. Thus, without undergoing surgery, she went out of
the operating room already decerebrate and totally incapacitated. Brain damage, which Erlinda sustained, is an
injury which does not normally occur in the process of a gallbladder operation. In fact, this kind of situation does not
happen in the absence of negligence of someone in the administration of anesthesia and in the use of endotracheal
tube.
Normally, a person being put under anesthesia is not rendered decerebrate as a consequence of administering such
anesthesia if the proper procedure was followed. The instruments used in the administration of anesthesia, including
the endotracheal tube, were all under the exclusive control of private respondents, who are the physicians-in-charge.
Likewise, petitioner Erlinda could not have been guilty of contributory negligence because she was under the
influence of anesthetics which rendered her unconscious.
Considering that a sound and unaffected member of the body (the brain) is injured or destroyed while the patient is
unconscious and under the immediate and exclusive control of the physicians, the Court holds that a practical
administration of justice dictates the application of ​res ipsa loquitur​. Upon these facts and under these circumstances
the Court would be able to say, as a matter of common knowledge and observation, if negligence attended the
management and care of the patient. Moreover, the liability of the physicians and the hospital in this case is not
predicated upon an alleged failure to secure the desired results of an operation nor on an alleged lack of skill in the
diagnosis or treatment as in fact no operation or treatment was ever performed on Erlinda.
Furthermore, w​hat the CA is trying to impress is that being a nurse, and considered a layman in the process of
intubation, witness Cruz is not competent to testify on whether or not the intubation was a success. The Court does
not agree with the reasoning of the appellate court. Although witness Cruz is not an anesthesiologist, she can very
well testify upon matters on which she is capable of observing such as, the statements and acts of the physician and
surgeon, external appearances, and manifest conditions which are observable by any one. ​This is precisely allowed
under the doctrine of ​res ipsa loquitur where the testimony of expert witnesses is not required. It is the accepted rule
that expert testimony is not necessary for the proof of negligence in non-technical matters or those of which an
ordinary person may be expected to have knowledge, or where the lack of skill or want of care is so obvious as to
render expert testimony unnecessary. Moreover, respondent Dra. Gutierrez' act of seeing her patient for the first time
only an hour before the scheduled operative procedure was an act of exceptional negligence and professional
irresponsibility.
Private respondents themselves admitted in their testimony that the first intubation was a failure. Instead of the
intended endotracheal intubation what actually took place was an esophageal intubation. Entry into the esophagus
would certainly cause some delay in oxygen delivery into the lungs as the tube which carries oxygen is in the wrong
place. Due to the delay in the delivery of oxygen in her lungs, Erlinda showed signs of cyanosis. ​However, private
respondents contend that a second intubation was executed on Erlinda and this one was successfully done. No
evidence exists on record which supports the contention that the second intubation was successful. Assuming that
the endotracheal tube finally found its way into the proper orifice of the trachea, the same gave no guarantee of
oxygen delivery, the hallmark of a successful intubation. Even granting that the tube was successfully inserted
during the second attempt, it, was obviously too late. As aptly explained by the trial court, Erlinda already suffered
brain damage as a result of the inadequate oxygenation of her brain for about four to five minutes.
Meanwhile, the basis for holding an employer (DLSMC in this case) solidarily responsible for the negligence of its
employee is found in ​Article 2180 of the Civil Code which considers a person accountable not only for his own
acts but also for those of 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 family to prevent damage. In the instant case, respondent hospital, apart from a general denial of its
responsibility over respondent physicians, failed to adduce evidence showing that it exercised the diligence of a
good father of a family in the hiring and supervision of the latter. It failed to adduce evidence with regard to the
degree of supervision which it exercised over its physicians. In neglecting to offer such proof, or proof of a similar
nature, respondent hospital thereby failed to discharge its burden under the last paragraph of Article 2180. Also,
where negligence exists and is proven, the same automatically gives the injured a right to reparation for the damage
caused.
DISPOSITIVE PORTION: ​WHEREFORE​, ​the decision and resolution of the appellate court appealed from are
hereby modified so as to award in favor of petitioners, and solidarily against private respondents the following: 1)
P1,352,000.00 as actual damages computed as of the date of promulgation of this decision plus a monthly payment
of P8,000.00 up to the time that petitioner Erlinda Ramos expires or miraculously survives; 2) P2,000,000.00 as
moral damages, 3) P1,500,000.00 as temperate damages; 4) P100,000.00 each as exemplary damages and attorney's
fees; and, 5) the costs of the suit.