RAMOS VS CA
Facts:
Erlinda Ramos, a 47-year old robust woman, was normal except for her
experiencing occasional pain due to the presence of stone in her gall
bladder. She was advised to undergo an operation for its removal. The
results in the examinations she underwent indicate that she was fit for the
operation. She and her husband Rogelio met Dr. Hosaka, one of the
defendants, who advised that she should undergo cholecystectomy. Dr.
Hosaka assured them that he will get a good anaesthesiologist. At 7:30
a.m. on the day of the operation at Delos Santos Medical Center, Herminda
Cruz, Erlinda’s sister-in-law and the dean of the College of Nursing in
Capitol Medical Center, was there to provide moral support. Dr. Perfecta
Gutierrez was to administer the anaesthesia. Dr. Hosaka arrived only at
12:15 p. m. Herminda saw Dr. Gutierrez intubating the patient, and 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 someone to call Dr.
Calderon. The doctor arrived and placed the patient in trendelenburg
position, wherein the head of the patient is positioned lower than the feet,
which indicates a decrease of blood supply in the brain. Herminda knew
and told Rogelio that something wrong was happening. Dr. Calderon was
able to intubate the patient. Erlinda was taken to the ICU and became
comatose.
Rogelio filed a civil case for damages. The trial court ruled in his favor,
finding Dr. Gutierrez, Dr. Hosaka, and the hospital, guilty of negligence,
but the Court of Appeals reversed the decision. Hence, petitioner filed a
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 counsel.
Rather, it was sent to the petitioner, addressing him as Atty. Rogelio
Ramos, as if he was the legal counsel. The petitioner filed the instant
petition for certiorari. On the procedural issue, the Supreme Court rules
that since the notice did not reach the petitioner’s then legal counsel, the
motion was filed on time.
Issue:
Whether a surgeon, an anaesthesiologist, and a hospital, should be made
liable for the unfortunate comatose condition of a patient scheduled for
cholecystectomy
Held:
Negligence of the Anaesthesiologist
The pre-operative evaluation of a patient prior to the administration of
anesthesia is universally observed to lessen the possibility of anesthetic
accidents. Respondent Dra. Gutierrez' act of seeing her patient for the first
time only an hour before the scheduled operative procedure was,
therefore, an act of exceptional negligence and professional
irresponsibility. Her failure to follow this medical procedure is, therefore,
a clear indicia of her negligence. Erlinda's case was elective and this was
known to respondent Dra. Gutierrez. Thus, she had all the time to make a
thorough evaluation of Erlinda's case prior to the operation and prepare
her for anesthesia. However, she never saw the patient at the bedside. She
herself admitted that she had seen petitioner only in the operating room,
and only on the actual date of the cholecystectomy. She negligently failed
to take advantage of this important opportunity. As such, her attempt to
exculpate herself must fail.
Proximate Cause
Proximate cause has been defined as that which, in natural and
continuous sequence, unbroken by any 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 case, that the act or
omission played a substantial part in bringing about or actually causing
the injury or damage; and that the injury or damage was either a direct
result or a reasonably probable consequence of the act or omission.
Instead of the intended endotracheal intubation what actually took place
was an esophageal intubation. During intubation, such distention
indicates that air has entered the gastrointestinal tract through the
esophagus instead of the lungs through the trachea. 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. That
abdominal distention had been observed during the first intubation
suggests that the length of time utilized in inserting the endotracheal tube
(up to the time the tube was withdrawn for the second attempt) was fairly
significant. Due to the delay in the delivery of oxygen in her lungs Erlinda
showed signs of cyanosis.
Responsibility of the Surgeon
As the so-called "captain of the ship," it is the surgeon's responsibility to
see to it that those under him perform their task in the proper manner.
Respondent Dr. Hosaka's negligence can be found in his failure to exercise
the proper authority in not determining if his anesthesiologist observed
proper anesthesia protocols. In fact, no evidence on record exists to show
that respondent Dr. Hosaka verified if respondent Dra. Gutierrez properly
intubated the patient. Furthermore, it does not escape us that respondent
Dr. Hosaka had scheduled another procedure in a different hospital at the
same time as Erlinda's cholecystectomy, and was 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 duties towards his
patient. Thus, he shares equal responsibility for the events which resulted
in Erlinda's condition.
Responsibility of the Hospital
Hospitals hire, fire and exercise real control over their attending and
visiting "consultant" staff. While "consultants" are not, technically
employees, a point which respondent hospital asserts in denying all
responsibility for the patient's condition, the control exercised, the hiring,
and the right to terminate consultants all fulfill the important hallmarks
of an employer-employee relationship, with the exception of the payment
of wages. In assessing whether such a relationship in fact exists, the
control test is determining. Accordingly, on the basis of the foregoing, we
rule that for the purpose of allocating responsibility in medical negligence
cases, an employer-employee relationship in effect exists between
hospitals and their attending and visiting physicians.
The basis for holding an employer 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.
Having failed to do this, respondent hospital is consequently solidarily
responsible with its physicians for Erlinda's condition.
Damages
At current levels, the P8000/monthly amount established by the trial
court at the time of its decision would be grossly inadequate to cover the
actual costs of home-based care for a comatose individual. The calculated
amount was not even arrived at by looking at the actual cost of proper
hospice care for the patient. What it reflected were the actual expenses
incurred and proved by the petitioners after they were forced to bring
home the patient to avoid mounting hospital bills. And yet ideally, a
comatose patient should remain in a hospital or be transferred to a
hospice specializing in the care of the chronically ill for the purpose of
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 minimum
cost of proper care, not the cost of the care the family is usually compelled
to undertake at home to avoid bankruptcy.
 inadequate if petitioner's condition remains unchanged for the next ten
years. The husband and the children, all petitioners in this case, will have
Our rules on actual or compensatory damages generally assume that at
to live with the day to day uncertainty of the patient's illness, knowing any
the time of litigation, the injury suffered as a consequence of an act of
hope of recovery is close to nil. They have fashioned their daily lives
negligence has been completed and that the cost can be liquidated.
around the nursing care of petitioner, altering their long term goals to
However, these provisions neglect to take into account those situations,
take into account their life with a comatose patient. They, not the
as in this case, where the resulting injury might be continuing and
respondents, are charged with the moral responsibility of the care of the
possible future complications directly arising from the injury, while
victim. The family's moral injury and suffering in this case is clearly a real
certain to occur, are difficult to predict. Temperate damages can and
one. For the foregoing reasons, an award of P2,000,000.00 in moral
should be awarded on top of actual or compensatory damages in
damages would be appropriate.
instances where the injury is chronic and continuing. And because of the
unique nature of such cases, no incompatibility arises when both actual
and temperate damages are provided for. The reason is that these
Hospitals; Damages; Proximate Cause Defined.—Proximate cause has
damages cover two distinct phases. As it would not be equitable - and
been defined as that which, in natural and continuous sequence,
certainly not in the best interests of the administration of justice - for the
unbroken by any efficient intervening cause, produces injury, and without
victim in such cases to constantly come before the courts and invoke their
which the result would not have occurred. An injury or damage is
aid in seeking adjustments to the compensatory damages previously
proximately caused by an act or a failure to act, whenever it appears from
awarded - temperate damages are appropriate. The amount given as
the evidence in the case, that the act or omission played a substantial part
temperate damages, though to a certain extent speculative, should take
in bringing about or actually causing the injury or damage; and that the
into account the cost of proper care. In the instant case, petitioners were
injury or damage was either a direct result or a reasonably probable
able to provide only home-based nursing care for a comatose patient who
consequence of the act or omission. It is the dominant, moving or
has remained in that condition for over a decade. Having premised our
producing cause.
award for compensatory damages on the amount provided by petitioners
at the onset of litigation, it would be now much more in step with the Same; Same; For the purpose of allocating responsibility in medical
interests of justice if the value awarded for temperate damages would negligence cases, an employer-employee relationship in effect exists
allow petitioners to provide optimal care for their loved one in a facility between hospitals and their attending and visiting physicians.—
which generally specializes in such care. They should not be compelled by Private hospitals, hire, fire and exercise real control over their attending
dire circumstances to provide substandard care at home without the aid and visiting “consultant” staff. While “consultants” are not, technically
of professionals, for anything less would be grossly inadequate. Under the employees, a point which respondent hospital asserts in denying all
circumstances, an award of P1,500,000.00 in temperate damages would responsibility for the patient’s condition, the control exercised, the hiring,
therefore be reasonable. and the right to terminate consultants all fulfill the important hallmarks
of an employer-employee relationship, with the exception of the payment
Petitioner Erlinda Ramos was in her mid-forties when the incident
of wages. In assessing whether such a relationship in fact exists, the
occurred. She has been in a comatose state for over fourteen years now.
control test is determining. Accordingly, on the basis of the foregoing, we
The burden of care has so far been heroically shouldered by her husband
rule that for the purpose of allocating responsibility in medical negligence
and children, who, in the intervening years have been deprived of the love
cases, an employer-employee relationship in effect exists between
of a wife and a mother. Meanwhile, the actual physical, emotional and
hospitals and their attending and visiting physicians. This being the case,
financial cost of the care of petitioner would be virtually impossible to
the question now arises as to whether or not respondent hospital is
quantify. Even the temperate damages herein awarded would be
solidarily liable with respondent doctors for petitioner’s condition.

Same; Same; The basis for holding an employer solidarily
responsible for the negligence of its employee is found in Article
2180 of the Civil Code.—The basis for holding an employer 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 other words,
while the burden of proving negligence rests on the plaintiffs, once
negligence is shown, the burden shifts to the respondents (parent,
guardian, teacher or employer) who should prove that they observed the
diligence of a good father of a family to prevent damage.
Same; Same; Amount of damages awarded may be a continuing one
where the injury is chronic and continuing, as when the patient is
comatose.—In these cases, the amount of damages which should be
awarded, if they are to adequately and correctly respond to the injury
caused, should be one which compensates for pecuniary loss incurred and
proved, up to the time of trial; and one which would meet pecuniary loss
certain to be suffered but which could not, from the nature of the case, be
made with certainty. In other words, temperate damages can and should
be awarded on top of actual or compensatory damages in instances where
the injury is chronic and continuing. And because of the unique nature of
such cases, no incompatibility arises when both actual and temperate
damages are provided for. The reason is that these damages cover two
distinct phases.
Jose Mel Bernante v. PBA et al
Facts: Complainants (Jose Mel Bernarte and Renato Guevarra) aver that
they were invited to join the PBA as referees and were made to sign
contracts on a year-to-year basis. Bernarte was not made to sign a
contract during the 1st conference of the All-Filipino Cup. It was only
during the 2nd conference when he was made to sign a one and a half
month contract.
On January 15, 2004, Bernarte received a letter from the Office of
the Commissioner advising him that his contract would not be renewed
citing his unsatisfactory performance on and off the court. It was a total
shock for him who was awarded Referee of the year in 2003. He felt that
the dismissal was caused by his refusal to fix a game upon order of Ernie
De Leon.
On the other hand, complainant Guevarra alleges that he was
invited to join the PBA pool of referees. On March 1, 2001, he signed a
contract as trainee. Beginning 2002, he signed a yearly contract as
Regular Class C referee.
On May 6, 2003, respondent Martinez issued a memorandum to
Guevarra expressing dissatisfaction over his questioning on the
assignment of referees officiating out-of-town games. Beginning February
2004, he was no longer made to sign a contract.
Respondents aver that complainants were not illegally dismissed because
they were not employees of the PBA. Their respective contracts of
retainer were simply not renewed. PBA had the prerogative of whether
or not to renew their contracts, which they knew were fixed.
Issue: Whether petitioner is an employee of respondents, which in turn
determines whether petitioner was illegally dismissed.
Ruling: Petitioners are not employees of the respondent, for the latter
doesn’t exercise control over the former.
Once in the playing court, the referees exercise their own independent
judgment, based on the rules of the game, as to when and how a call or
decision is to be made. The referees decide whether an infraction was
committed, and the PBA cannot overrule them once the decision is made
on the playing court. The referees are the only, absolute, and final
authority on the playing court. Respondents or any of the PBA officers
cannot and do not determine which calls to make or not to make and
cannot control the referee when he blows the whistle because such
authority exclusively belongs to the referees.
Moreover, the following circumstances indicate that petitioner is an
independent contractor: (1) the referees are required to report for work
only when PBA games are scheduled, which is three times a week spread
over an average of only 105 playing days a year, and they officiate games
at an average of two hours per game; and (2) the only deductions from
the fees received by the referees are withholding taxes.
In other words, unlike regular employees who ordinarily report for work
eight hours per day for five days a week, petitioner is required to report
for work only when PBA games are scheduled or three times a week at
two hours per game. In addition, there are no deductions for
contributions to the SSS, Philhealth or Pag-Ibig, which are the usual
deductions from employees’ salaries. These undisputed circumstances
buttress the fact that petitioner is an independent contractor, and not an
employee of respondents