RAMOS VS COURT OF APPEALS

GR No. 124354, 29 December 1999

FACTS:

June 17, 1985 afternoon: Erlinda Ramos, 47-year old robust woman underwent
on an operation to the stone at her gall bladder removed after being tested that she
was fit for "cholecystectomy" operation performed by Dr. Orlino Hozaka. Dr. Hosaka
charged a fee of P16,000.00, which was to include the anesthesiologist's fee and which
was to be paid after the operation. He assured Rogelio E. Ramos, husband that he will
get a good anesthesiologist who was Dra. Perfecta Gutierrez. Erlinda's hand was held
by Herminda Cruz, her sister -in-law who was the Dean of the College of Nursing at
the Capitol Medical Center together with her husband went down with her to the
operating room. Instead of 9:30 am, Dr. Hosaka arrived at about 12:15 P.M.Herminda
noticing what Dra. Perfecta Gutierrez was doing, saw the nailbed of Erlinda becoming
bluish and Dr. Hosaka called for another anesthesiologist Dr. Calderon. She went out
of the operating room to tell Rogelio that something is wrong. When she went back
she saw Erlinda in a trendelenburg position and at 3 p.m. she was taken to the
Intensive Care Unit (ICU) where she stayed for a month due to bronchospasm
incurring P93,542.25 and she was since then comatosed. She suffered brain damage
as a result of the absence of oxygen in her brain for four to five minutes. She was also
diagnosed to be suffering from "diffuse cerebral parenchymal damage". Monthly
expenses ranged from P8,000 to P10,000. Spouses Ramos and their minors filed
against Dr. Hosaka and Dra. Perfecta Gutierrez. RTC: favored the Ramos'
awarding P8,000 as actual monthly expenses totalling to P632,000 as of April 15,
1992, P100,000 atty. fees, P800,000 moral damages,P200,000 exemplary damages
and cost of suit. Respondents appealed. CA: reversed ordering the Ramos' to pay their
unpaid bills of P93,542.25 plus interest

ISSUE: W/N the Ramos' are entitled to damages

HELD: YES. CA modified in favor of petitioners, and solidarily against private

respondents the following: 1) P1,352,000 actual damages computed as of the date of
promulgation plus a monthly payment of P8,000.00 up to the time that petitioner
Erlinda Ramos expires or miraculously survives; 2) P2,000,000 moral damages, 3)
P1,500,000 temperate damages; 4) P100,000 exemplary damages
and P100,000 attorney's fees; and, 5) the costs of the suit.

The application of res ipsa loquitur in medical negligence cases presents a

question of law since it is a judicial function to determine whether a certain set of
circumstances does, as a matter of law, permit a given inference.
doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert
medical testimony is dispensed with because the injury itself provides the proof of
negligence - applicable in this case
doctrine of res ipsa loquitur can have no application in a suit against a physician
or surgeon which involves the merits of a diagnosis or of a scientific treatment
As borne by the records, respondent Dra. Gutierrez failed to properly intubate
the patient according to witness Herminda
o With her clinical background as a nurse, the Court is satisfied with her
testimony
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
Generally, to qualify as an expert witness, one must have acquired special
knowledge of the subject matter about which he or she is to testify, either by the study
of recognized authorities on the subject or by practical experience.
o Dr. Jamora, not an anesthesiologist, stated that oxygen deprivation
which led to anoxic encephalopathy was due to an unpredictable drug reaction
to the short-acting barbiturate was not accepted as expert opinion
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
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
private 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.
Art. 2199. — Except as provided by law or by stipulation, one is entitled to an
adequate compensation only for such pecuniary loss suffered by him as he has duly
proved. Such compensation is referred to as actual or compensatory damages.
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.
They should not be compelled by dire circumstances to provide substandard
care at home without the aid of professionals, for anything less would be grossly
inadequate. Under the circumstances, an award of P1,500,000.00 in temperate
damages would therefore be reasonable.
the damage done to her would not only be permanent and lasting, it would also
be permanently changing and adjusting to the physiologic changes which her body
would normally undergo through the years.
Erlinda Ramos was in her mid-forties when the incident occurred. She has been
in a comatose state for over fourteen years now
Ramos' are charged with the moral responsibility of the care of the victim. The
family's moral injury and suffering in this case is clearly a real one. Award of
P2,000,000 in moral damages would be appropriate.
 Finally, by way of example, exemplary damages in the amount of
P100,000.00 are hereby awarded. Considering the length and nature of
the instant suit we are of the opinion that attorney's fees valued at
P100,000 are likewise proper

FACTS:
Erlinda Ramos underwent a surgical procedure to remove stone from her gall bladder
(cholecystectomy). They hired Dr. Hosaka, a surgeon, to conduct the surgery at the
De Los Santos Medical Center (DLSMC). Hosaka assured them that he would find a
good anesthesiologist. But the operation did not go as planned, Dr. Hosaka arrived 3
hours late for the operation, Dra. Gutierrez, the anesthesiologist “botched” the
administration of the anesthesia causing Erlinda to go into a coma and suffer brain
damage. The botched operation was witnessed by Herminda Cruz, sister in law of
Erlinda and Dean of College of Nursing of Capitol Medical Center.

The family of Ramos (petitioners) sued the hospital, the surgeon and the
anesthesiologist for damages. The petitioners showed expert testimony showing that
Erlinda's condition was caused by the anesthesiologist in not exercising reasonable
care in “intubating” Erlinda. Eyewitnesses heard the anesthesiologist saying “Ang
hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan.”

Diagnostic tests prior to surgery showed that Erlinda was robust and fit to undergo
surgery.

The RTC held that the anesthesiologist ommitted to exercise due care in intubating
the patient, the surgeon was remiss in his obligation to provide a “good
anesthesiologist” and for arriving 3 hours late and the hospital is liable for the
negligence of the doctors and for not cancelling the operation after the surgeon failed
to arrive on time. The surgeon, anesthesiologist and the DLSMC were all held jointly
and severally liable for damages to petitioners. The CA reversed the decision of the
Trial Court.

ISSUES: Whether or not the private respondents were negligent and thereby caused
the comatose condition of Ramos.

HELD:
Yes, private respondents were all negligent and are solidarily liable for the damages.

RATIO:

Res ipsa loquitur – a procedural or evidentiary rule which means “the thing or the
transaction speaks for itself.” It is a maxim for the rule that the fact of the
occurrence of an injury, taken with the surrounding circumstances, may permit an
inference or raise a presumption of negligence, or make out a plaintiff’s prima facie
case, and present a question of fact for defendant to meet with an explanation,
where ordinarily in a medical malpractice case, the complaining party must present
expert testimony to prove that the attending physician was negligent.

This doctrine finds application in this case. On the day of the operation, Erlinda
Ramos already surrendered her person to the private respondents who had complete
and exclusive control over her. Apart from the gallstone problem, she was
neurologically sound and fit. Then, after the procedure, she was comatose and brain
damaged—res ipsa loquitur!—the thing speaks for itself!

Negligence – Private respondents were not able to disprove the presumption of

negligence on their part in the care of Erlinda and their negligence was the proximate
cause of her condition. One need not be an anesthesiologist in order to tell whether
or not the intubation was a success. [res ipsa loquitur applies here]. The Supreme
Court also found that the anesthesiologist only saw Erlinda for the first time on the
day of the operation which indicates unfamiliarity with the patient and which is an
act of negligence and irresponsibility.

The head surgeon, Dr. Hosaka was also negligent. He failed to exercise the proper
authority as the “captain of the ship” in determining if the anesthesiologist observed
the proper protocols. Also, because he was late, he did not have time to confer with
the anesthesiologist regarding the anesthesia delivery.

The hospital failed to adduce evidence showing that it exercised the diligence of a
good father of the family in hiring and supervision of its doctors (Art. 2180). The
hospital was negligent since they are the one in control of the hiring and firing of
their “consultants”. While these consultants are not employees, hospitals still exert
significant controls on the selection and termination of doctors who work there which
is one of the hallmarks of an employer-employee reationship. Thus, the hospital was
allocated a share in the liability.