Legal Medicine First 26 Cases

1. Carillo vs. People of the Philippines

G.R. No. 86890, January 21, 1994
Facts: Petitioner filed a petition for review on certiorari on the decision of the Court of Appeals affirming
his conviction by the RTC of the crime of simple negligence resulting in homicide, for the death of his 13
year old patient Catherine Acosta after an appendectomy procedure conducted on the patient.
Catherine Acosta, a 13 year old girl, daughter of spouses Domingo and Yolanda Acosta, complained to
her father at about 10:30 o'clock in the morning of May 31, 1981 of pains in the lower part of her
abdomen. Catherine was then brought to Dr. Elva Pea. Dra. Pea called for Dr. Emilio Madrid and the
latter examined Catherine Acosta. According to Dr. Madrid, his findings might be appendicitis. The
appellant Dr. Emilio Madrid, a surgeon, operated on Catherine. He was assisted by appellant, Dr.
Leandro Carillo, anesthesiologists. After operation, Catherine remained unconscious until noontime the
next day, a neurologist examined her and she was diagnosed as comatose. Three (3) days later,
Catherine died without regaining consciousness.
The Court of Appeals held that Catherine had suffered from an overdose of, or an adverse reaction to,
anesthesia, particularly the arbitrary administration of Nubain, a pain killer, without benefit of prior
weighing of the patient's body mass, which weight determines the dosage of Nubain which can safely be
given to a patient. The Court of Appeals held that this condition triggered off a heart attack as a postoperative complication, depriving Catherine's brain of oxygen, leading to the brain's hemorrhage. The
Court of Appeals identified such cardiac arrest as the immediate cause of Catherine's death.
The Court of Appeals found criminal negligence on the part of petitioner Dr. Carillo and his co-accused
Dr. Madrid, holding that both had failed to observe the required standard of diligence in the
examination of Catherine prior to the actual administration of anesthesia; that it was "a bit rash" on the
part of the accused Dr. Carillo "to have administered Nubain without first weighing Catherine"; and that
it was an act of negligence on the part of both doctors when, (a) they failed to monitor Catherine's
heartbeat after the operation and (b) they left the hospital immediately after reviving Catherine's
heartbeat, depriving the latter of immediate and expert medical assistance when she suffered a heart
attack approximately fifteen (15) to thirty (30) minutes later.
Issue:
Whether or not Dr. Carillo is guilty of the crime of simple negligence resulting in homicide.
Held:
Simple negligence, penalized under what is now Article 365 of the Revised Penal Code, is defined as "a
mere lack of prevision in a situation where either the threatened harm is not immediate or the danger
not openly visible." Put in a slightly different way, the gravamen of the offense of simple negligence is
the failure to exercise the diligence necessitated or called for the situation which was not immediately
life-destructive but which culminated in the present case, in the death of a human being three (3) days
later.

In the case at bar, we consider that the chain of circumstances above noted, namely: (1)the failure of
petitioner and Dr. Madrid to appreciate the serious post-surgery condition of their patient and to
monitor her condition and provide close patient care to her; (2) the summons of petitioner by Dr.
Madrid and the cardiologist after the patient's heart attack on the very evening that the surgery was
completed; (3) the low level of care and diligence exhibited by petitioner in failing to correct Dr.
Madrid's prescription of Nubain for post-operative pain; (4) the extraordinary failure or refusal of
petitioner and Dr. Madrid to inform the parents of Catherine Acosta of her true condition after surgery,
in disregard of the requirements of the Code of Medical Ethics; and (5) the failure of petitioner and Dr.
Madrid to prove that they had in fact exercised the necessary and appropriate degree of care and
diligence to prevent the sudden decline in the condition of Catherine Acosta and her death three (3)
days later, leads the Court to the conclusion, with moral certainty, that petitioner and Dr. Madrid were
guilty of simple negligence resulting in homicide.

2. DR. VICTORIA L. BATIQUIN and ALLAN BATIQUIN, petitioners, vs. COURT OF APPEALS, SPOUSES
QUEDO D. ACOGIDO and FLOTILDE G. VILLEGAS, respondents.
G.R. No. 118231. July 5, 1996
Facts:
The petitioner Dr. Batiquin was a Resident Physician at the Negros Oriental Provincial Hospital,
Dumaguete City from January 9, 1978 to September 1989. And Mrs. Villegas is a married woman who
submitted to Dr. Batiquin for prenatal care as the latter's private patient sometime before September
21, 1988. The latter was submitted to a simple cesarean operation by herein petitioner to deliver her
first child. Soon after leaving the Hospital Mrs. Villegas began to suffer abdominal pains and complained
of being feverish. She also gradually lost her appetite, so she consulted Dr. Batiquin at the latter's
polyclinic who prescribed for her certain medicines.
In the meantime, Mrs. Villegas was given a Medical Certificate by Dr. Batiquin certifying to her physical
fitness to return to her work and indeed soon after she returned back to her work. But still the
abdominal pains and fever kept on recurring and bothered Mrs. Villegas no end and despite the
medications administered by Dr. Batiquin. When the pains become unbearable and she was rapidly
losing weight she consulted Dr. Ma. Salud Kho at the Holy Child's Hospital in Dumaguete City on January
20, 1989. Dr. Kho found whitish-yellow discharge inside, an ovarian cyst on each of the left and right
ovaries which gave out pus, dirt and pus behind the uterus, and a piece of rubber materials on the right
side of the uterus embedded on the ovarian cyst, 2 inches by 3/4 inch in size. This piece of rubber
material which Dr. Kho described as a "foreign body" looked like a piece of a "rubber glove" . . . and
which is also "rubber-drain like . . . . It could have been a torn section of a surgeon's gloves or could
have come from other sources. And this foreign body was the cause of the infection of the ovaries and
consequently of all the discomfort suffered by Mrs. Villegas after her delivery. And this prompted Mrs.
Villegas to file this present case against Dr. Batiquin. The CA ruled against the petitioner, hence, this
petition.
Issue:
Whether or not petitioner, Dr. Batiquin should be held liable for her negligence in leaving behind the
piece of rubber from Mrs. Villegas abdomen.

Held:
Yes.
Dr. Batiquin is liable for negligently leaving behind a piece of rubber in private respondent Villegas'
abdomen and for all the adverse effects thereof.
As such, the rule of res ipsa loquitur comes to fore. This Court has had occasion to delve into the nature
and operation of this doctrine:
This doctrine [res ipsa loquitur] is stated thus: "Where the thing which causes injury is shown to be
under the management of the defendant, and the accident is such as in the ordinary course of things
does not happen if those who have the management use proper care, it affords reasonable evidence, in
the absence of an explanation by the defendant, that the accident arose from want of care." Or as
Black's Law Dictionary puts it:
Res ipsa loquitur. The thing speaks for itself. Rebuttable presumption or inference that defendant was
negligent, which arises upon proof that [the] instrumentality causing injury was in defendant's exclusive
control, and that the accident was one which ordinary does not happen in absence of negligence. Res
ipsa loquitur is [a] rule of evidence whereby negligence of [the] alleged wrongdoer may be inferred from
[the] mere fact that [the] accident happened provided [the] character of [the] accident and
circumstances attending it lead reasonably to belief that in [the] absence of negligence it would not
have occurred and that thing which caused injury is shown to have been under [the] management and
control of [the] alleged wrongdoer . . . . Under [this] doctrine . . . the happening of an injury permits an
inference of negligence where plaintiff produces substantial evidence that [the] injury was caused by an
agency or instrumentality under [the] exclusive control and management of defendant, and that the
occurrence [sic] was such that in the ordinary course of things would not happen if reasonable care had
been used.
xxx

xxx

xxx

The doctrine of [r]es ipsa loquitur as a rule of evidence is peculiar to the law of negligence which
recognizes that prima facie negligence may be established without direct proof and furnishes a
substitute for specific proof of negligence. The doctrine is not a rule of substantive law, but merely a
mode of proof or a mere procedural convenience. The rule, when applicable to the facts and
circumstances of a particular case, is not intended to and does not dispense with the requirement of
proof of culpable negligence on the party charged. It merely determines and regulates what shall be
prima facie evidence thereof and facilitates the burden of plaintiff of proving a breach of the duty of due
care. The doctrine can be invoked when and only when, under the circumstances involved, direct
evidence is absent and not readily available.
In the instant case, all the requisites for recourse to the doctrine are present. First, the entire
proceedings of the cesarean section were under the exclusive control of Dr. Batiquin. In this light, the
private respondents were bereft of direct evidence as to the actual culprit or the exact cause of the
foreign object finding its way into private respondent Villegas' body, which, needless to say, does not
occur unless through the intervention of negligence. Second, since aside from the cesarean section,
private respondent Villegas underwent no other operation which could have caused the offending

piece of rubber to appear in her uterus, it stands to reason that such could only have been a byproduct of the cesarean section performed by Dr. Batiquin. The petitioners, in this regard, failed to
overcome the presumption of negligence arising from resort to the doctrine of res ipsa loquitur.
As a final word, this Court reiterates its recognition of the vital role the medical profession plays in the
lives of the people, and State's compelling interest to enact measures to protect the public from "the
potentially deadly effects of incompetence and ignorance in those who would undertake to treat our
bodies and minds for disease or trauma." Indeed, a physician is bound to serve the interest of his
patients "with the greatest of solicitude, giving them always his best talent and skill." Through her
tortious conduct, the petitioner endangered the life of Flotilde Villegas, in violation of her profession's
rigid ethical code and in contravention of the legal standards set forth for professionals, in the general,
and members of the medical profession, in particular.
3. LEONILA GARCIA-RUEDA, petitioner, vs. WILFREDO L. PASCASIO, RAUL R. ARNAU, ABELARDO L.
APORTADERA JR., Honorable CONDRADO M. VASQUEZ, all of the Office of the Ombudsman; JESUS F.
GUERRERO, PORFIRIO MACARAEG, and GREGORIO A. ARIZALA, all of the Office of the City Prosecutor,
Manila, respondents.
G.R. No. 118141. September 5, 1997
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 husbands body. Consequently, the NBI ruled that Florencios 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.
Issue:
(1) Whether or not Dr. Domingo Antonio and Dr. Erlinda Balatbat-Reyes should be charged for
Homicide through Reckless Imprudence before the Office of the City Prosecutor.
(2) Whether or not a medical malpractice committed by Dr. Domingo Antonio and Dr. Erlinda
Balatbat-Reyes indeed transpired.
Held:
(1) No. In this instant case, no less than the NBI pronounced after conducting an autopsy that there was
indeed negligence on the part of the attending physicians in administering the anaesthesia. 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 consultations with medical experts. Clearly,

the City Prosecutors are not in a competent position to pass judgment on such a technical matter,
especially when there are conflicting evidence and findings. The bases of a partys accusation and
defenses are better ventilated at the trial proper than at the preliminary investigation.
(2) Yes. In its simplest terms, the type of lawsuit which has been called medical malpractice or, more
appropriately, medical negligence, is that type of claim which a victim has available to him or her to
redress a wrong committed by a medical professional which has caused bodily harm. In order to
successfully pursue such a claim, a patient must prove that a health care provider, in most cases a
physician, either failed to do something which a reasonably prudent health care provider would have
done, or that he or she did something that a reasonably prudent provider would not have done; and
that that failure or action caused injury to the patient.
Hence, there are four elements involved in medical negligence cases: duty, breach, injury and
proximate causation.
Evidently, when the victim employed the services of Dr. Antonio and Dr. Reyes, a physician-patient
relationship was created. In accepting the case, Dr. Antonio and Dr. Reyes in effect represented that,
having the needed training and skill possessed by physicians and surgeons practicing in the same field,
they will employ such training, care and skill in the treatment of their patients. They have 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. The breach of these professional duties of skill and care, or
their improper performance, by a physician surgeon whereby the patient is injured in body or in
health, constitutes actionable malpractice. Consequently, in the event that any injury results to the
patient from want of due care or skill during the operation, the surgeons may be held answerable in
damages for negligence.
Moreover, in malpractice or negligence cases involving the administration of anaesthesia, the necessity
of expert testimony and the availability of the charge of res ipsa loquitur to the plaintiff, have been
applied in actions against anaesthesiologists to hold the defendant liable for the death or injury of a
patient under excessive or improper anaesthesia. Essentially, it requires two-pronged evidence:
evidence as to the recognized standards of the medical community in the particular kind of case, and a
showing that the physician in question negligently departed from this standard in his treatment.
Another element in medical negligence cases is causation which is divided into two inquiries: whether
the doctors actions in fact caused the harm to the patient and whether these were the proximate cause
of the patients injury. Indeed here, a causal connection is discernible from the occurrence of the
victims death after the negligent act of the anaesthesiologist in administering the anesthesia, a fact
which, if confirmed, should warrant the filing of the appropriate criminal case. To be sure, the allegation
of negligence is not entirely baseless. Moreover, the NBI deduced that the attending surgeons did not
conduct the necessary interview of the patient prior to the operation. It appears that the cause of the
death of the victim could have been averted had the proper drug been applied to cope with the
symptoms of malignant hyperthermia. Also, we cannot ignore the fact that an antidote was readily
available to counteract whatever deleterious effect the anaesthesia might produce. Why these
precautionary measures were disregarded must be sufficiently explained. Absent otherwise, the
attending medical expert should have been held liable therein.

4. DR. NINEVETCH CRUZ, petitioner, vs. COURT OF APPEALS and LYDIA UMALI, respondents.
G.R. No. 122445. November 18, 1997
Facts:
On March 22, 1991, prosecution witness, Rowena Umali De Ocampo, accompanied her mother to the
Perpetual Help Clinic and General Hospital situated in Balagtas Street, San Pablo City, Laguna. They
arrived at the said hospital at around 4:30 in the afternoon of the same day. Prior to March 22, 1991,
Lydia was examined by the petitioner who found a "myoma" in her uterus, and scheduled her for a
hysterectomy operation on March 23, 1991.
According to Rowena, she noticed that the clinic was untidy and the window and the floor were very
dusty prompting her to ask the attendant for a rag to wipe the window and the floor with. Because of
the untidy state of the clinic, Rowena tried to persuade her mother not to proceed with the operation.
The following day, before her mother was wheeled into the operating room, Rowena asked the
petitioner if the operation could be postponed. The petitioner called Lydia into her office and the two
had a conversation. Lydia then informed Rowena that the petitioner told her that she must be operated
on as scheduled. The operation nevertheless happened with these circumstances attending:
a.
b.
c.
d.

The relatives of Umali were asked to buy tagamet ampules by Dr. Ercillo.
They were asked to buy blood for Umali, Type A.
When asked again to buy blood, nowhere blodd available at the Blood Bank of the Hospital.
The condition of Umali became worse that she has to be transferred to another Hospital, San
Pablo District hospital.

Upon Lydia's arrival at the San Pablo District Hospital, she was wheeled into the operating room and the
petitioner and Dr. Ercillo re-operated on her because there was blood oozing from the abdominal
incision. While petitioner was closing the abdominal wall, the patient died. Thus, on March 24, 1991,
Lydia Umali was pronounced dead. Her death certificate states "shock" as the immediate cause of death
and "Disseminated Intravascular Coagulation (DIC)" as the antecedent cause.
In convicting the petitioner, the MTCC found her to be negligent in the performance of the operation.
The RTC reiterated the abovementioned findings of the MTCC and upheld the latter's declaration of
"incompetency, negligence and lack of foresight and skill of appellant (herein petitioner) in handling the
subject patient before and after the operation." And likewise affirming the petitioner's conviction, the
Court of Appeals echoed similar observations, thus:
"x x x. While we may grant that the untidiness and filthiness of the clinic may not by itself indicate
negligence, it nevertheless shows the absence of due care and supervision over her subordinate
employees. Did this unsanitary condition permeate the operating room? Were the surgical instruments
properly sterilized? Could the conditions in the OR have contributed to the infection of the patient? Only
the petitioner could answer these, but she opted not to testify. This could only give rise to the
presumption that she has nothing good to testify on her defense. Anyway, the alleged "unverified
statement of the prosecution witness" remains unchallenged and unrebutted.

Issue:
Whether or not a physician has committed an "inexcusable lack of precaution" in the treatment of his
patient is to be determined according to the 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.

Held:
The attending physician may have committed the lack of precaution if duly proven with concrete
evidence supporting such claim. But absence of the same will lead such allegations as mere hearsay.
In the recent case of Leonila Garcia-Rueda v. Wilfred L. Pacasio, et. al., this Court stated that 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.
All three courts below bewail the inadequacy of the facilities of the clinic and its untidiness; the lack of
provisions such as blood, oxygen, and certain medicines; the failure to subject the patient to a cardiopulmonary test prior to the operation; the omission of any form of blood typing before transfusion; and
even the subsequent transfer of Lydia to the San Pablo Hospital and the reoperation performed on her
by the petitioner. But while it may be true that the circumstances pointed out by the courts below
seemed beyond cavil to constitute reckless imprudence on the part of the surgeon, this conclusion is still
best arrived at not through the educated surmises nor conjectures of laymen, including judges, but by
the unquestionable knowledge of expert witnesses. For whether a physician or surgeon has exercised
the requisite degree of skill and care in the treatment of his patient is, in the generality of cases, a
matter of expert opinion. The deference of courts to the expert opinion of qualified physicians stems
from its realization that the latter possess unusual technical skills which laymen in most instances are
incapable of intelligently evaluating. Expert testimony should have been offered to prove that the
circumstances cited by the courts below are constitutive of conduct falling below the standard of care
employed by other physicians in good standing when performing the same operation. It must be
remembered that when the qualifications of a physician are admitted, as in the instant case, 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. This presumption is rebuttable by expert opinion which is so sadly lacking in the case at
bench.
Even granting arguendo that the inadequacy of the facilities and untidiness of the clinic; the lack of
provisions; the failure to conduct pre-operation tests on the patient; and the subsequent transfer of
Lydia to the San Pablo Hospital and the reoperation performed on her by the petitioner do indicate,
even without expert testimony, that petitioner was recklessly imprudent in the exercise of her duties as
a surgeon, no cogent proof exists that any of these circumstances caused petitioner's death. Thus, the
absence of the fourth element of reckless imprudence: that the injury to the person or property was a
consequence of the reckless imprudence.
In litigations involving medical negligence, the plaintiff has the burden of establishing appellant's
negligence 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 casual connection of such breach and the resulting death of his patient.
In Chan Lugay v. St Luke's Hospital, Inc., where the attending physician was absolved of liability for the
death of the complainant's wife and newborn baby, this court held that:
"In order that there may be a recovery for an injury, however, it must be shown that the 'injury for
which 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.' In other words, the negligence must be the proximate cause of the injury.
For, 'negligence, no matter in what it consists, cannot create a right of action unless it is the proximate
cause of the injury complained of.' And 'the proximate cause of an injury is that cause, which, in natural
and continuous sequence, unbroken by any efficient intervening cause, produces the injury, and without
which the result would not have occurred.''' (Underscoring supplied.)
The petitioner is a doctor in whose hands a patient puts his life and limb. For insufficiency of evidence
this Court was not able to render a sentence of conviction but it is not blind to the reckless and
imprudent manner in which the petitioner carried out her duties. A precious life has been lost and the
circumstances leading thereto exacerbated the grief of those left behind. The heirs of the deceased
continue to feel the loss of their mother up to the present time and this Court is aware that no amount
of compassion and commiseration nor words of bereavement can suffice to assuage the sorrow felt for
the loss of a loved one. Certainly, the award of moral and exemplary damages in favor of the heirs of
Lydia Umali are proper in the instant case.
Hence, petitioner DR. NINEVETCH CRUZ is hereby ACQUITTED of the crime of reckless imprudence
resulting in homicide but is ordered to pay the heirs of the deceased Lydia Umali the amount of FIFTY
THOUSAND PESOS (P50,000.00) as civil liability, ONE HUNDRED THOUSAND PESOS (P100,000.00) as
moral damages, and FIFTY THOUSAND PESOS (P50,000.00) as exemplary damages.

5. ROGELIO E. RAMOS and ERLINDA RAMOS, in their own behalf and as natural guardians of the
minors, ROMMEL RAMOS, ROY RODERICK RAMOS and RON RAYMOND RAMOS, petitioners,
vs. COURT OF APPEALS, DELOS SANTOS MEDICAL CENTER, DR. ORLINO HOSAKA and DRA. PERFECTA
GUTIERREZ, respondents.
G.R. No. 124354 December 29, 1999
Facts:
Plaintiff Erlinda Ramos was, until the afternoon of June 17, 1985, a 47-year old was a 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 E. Ramos, an executive of
Philippine Long Distance Telephone Company, she has three children whose names are Rommel Ramos,
Roy Roderick Ramos and Ron Raymond Ramos.
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 indicated she was fit for surgery.
Through the intercession of a mutual friend, Dr. Buenviaje, she and her husband Rogelio met for the first
time Dr. Orlino Hozaka, one of the defendants in this case, on June 10, 1985. They agreed that their date
at the operating table at the DLSMC (another defendant), would be on June 17, 1985 at 9:00 A.M.. Dr.
Hosaka decided that she should undergo a "cholecystectomy" operation after examining the documents
presented to him. Rogelio E. Ramos, however, asked Dr. Hosaka to look for a good anesthesiologist.
After the operation, unfortunately, 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".
Thus, on 8 January 1986, petitioners filed a civil case for damages with the Regional Trial Court of
Quezon City against herein private respondents alleging negligence in the management and care of
Erlinda Ramos.
After considering the evidence from both sides, the Regional Trial Court rendered judgment in favor of
petitioners. Private respondents seasonably interposed an appeal to the Court of Appeals. The appellate
court rendered a Decision, dated 29 May 1995, reversing the findings of the trial court.
Issue:
Whether a surgeon, an anesthesiologist and a hospital should be made liable for the unfortunate
comatose condition of a patient scheduled for cholecystectomy.
Held:
Yes. We hold that private respondents were unable to disprove the presumption of negligence on their
part in the care of Erlinda and their negligence was the proximate cause of her piteous condition.

We do 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. We take judicial notice of the fact that anesthesia
procedures have become so common, that even an ordinary person can tell if it was administered
properly. As such, it would not be too difficult to tell if the tube was properly inserted. This kind of
observation, we believe, does not require a medical degree to be acceptable.
The doctrine of res ipsa loquitur is simply a recognition of the postulate that, as a matter of common
knowledge and experience, the very nature of certain types of occurrences may justify an inference of
negligence on the part of the person who controls the instrumentality causing the injury in the absence
of some explanation by the defendant who is charged with negligence. It is grounded in the superior
logic of ordinary human experience and on the basis of such experience or common knowledge,
negligence may be deduced from the mere occurrence of the accident itself. Hence, res ipsa loquitur is
applied in conjunction with the doctrine of common knowledge.
Established medical procedures and practices, though in constant flux are devised for the purpose of
preventing complications. A physician's experience with his patients would sometimes tempt him to
deviate from established community practices, and he may end a distinguished career using unorthodox
methods without incident. However, when failure to follow established procedure results in the evil
precisely sought to be averted by observance of the procedure and a nexus is made between the
deviation and the injury or damage, the physician would necessarily be called to account for it. In the
case at bar, the failure to observe pre-operative assessment protocol which would have influenced the
intubation in a salutary way was fatal to private respondents' case.
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.
6. Reyes v Sisters of Mercy Hospital
G.R. 130547 October 3, 2000
Facts:
Petitioner Leah Alesna Reyes is the wife of the late Jorge Reyes. The other petitioners, namely, Rose
Nahdja, Johnny, Lloyd, and Kristine, all surnamed Reyes, were their children. Five days before his death
on January 8, 1987, Jorge had been suffering from are curring fever with chills. After he failed to get
relief from some home medication he was taking, which consisted of analgesic, antipyretic, and
antibiotics, he decided to see the doctor. On January 8, 1987, he was taken to the Mercy Community
Clinic by his wife. He was attended to by respondent Dr. Marlyn Rico, resident physician and admitting
physician on duty, who gave Jorge a physical examination and took his medical history. She noted that at

the time of his admission, Jorge was conscious, ambulatory, oriented, coherent, and with respiratory
distress. Typhoid fever was then prevalent in the locality, as the clinic had been getting from 15 to 20
cases of typhoid per month Suspecting that Jorge could be suffering from this disease, Dr. Rico ordered a
Widal Test, a standard test for typhoid fever, to be performed on Jorge. Blood count, routine urinalysis,
stool examination, and malarial smear were also made after about an hour, the medical technician
submitted the results of the test from which Dr. Rico concluded that Jorge was positive for typhoid
fever. As her shift was only up to 5:00 p.m., Dr. Rico indorsed Jorge to respondent Dr. Marvie Blanes.Dr.
Marvie Blanes attended to Jorge at around six in the evening. She also took Jorges history and gave him
a physical examination. Like Dr. Rico, her impression was that Jorge had typhoid fever. Antibiotics being
the accepted treatment for typhoid fever, she ordered that a compatibility test with the antibiotic
chloromycetin be done on Jorge. Said test was administered by nurse Josephine Pagente who also gave
the patient a dose of triglobe.
As she did not observe any adverse reaction by the patient to chloromycetin,Dr. Blanes ordered the first
five hundred milligrams of said antibiotic to be administered on Jorge at around 9:00 p.m. A second
dose was administered on Jorge about three hours later just before midnight. At around 1:00 a.m. of
January 9, 1987, Dr. Blanes was called as Jorges temperature roseto 41C. The patient also experienced
chills and exhibited respiratory distress, nausea, vomiting, and convulsions. Dr. Blanes put him under
oxygen, used a suction machine, and administered hydrocortisone, temporarily easing the patients
convulsions. When here gained consciousness, the patient was asked by Dr. Blanes whether he had a
previous heart ailment or had suffered from chest pains in the past. Jorge replied he did not After about
15 minutes, however, Jorge again started to vomit, showed restlessness, and his convulsions returned.
Dr. Blanes re-applied the emergency measures taken before and, in addition, valium was administered.
Jorge, however, did not respond to the treatment and slipped into cyanosis, a bluish or purplish
discoloration of the skin or mucous membrane due to deficient oxygenation of the blood. At around
2:00 a.m., Jorge died. He was forty years old. The cause of his death was Ventricular Arrythemia
Secondary to Hyperpyrexia and typhoid fever.
Issue:
Whether or not petitioner is entitled to damage applying res ipsa loquitur?
Held:
There is a case when expert testimony may be dispensed with, and that is under the doctrine of res ipsa
loquitur. Thus, courts of other jurisdictions have applied the doctrine in the following situations: leaving
of a foreign object in the body of the patient after an operation, injuries sustained on a healthy part of
the body which was not under, or in the area, of treatment, removal of the wrong part of the body when
another part was intended, knocking out a tooth while a patients jaw was under anesthetic for the
removal of his tonsils, and loss of an eye while the patient was under the influence of anesthetic, during
or following an operation for appendicitis, among others. Petitioners now contend that all requisites for
the application of res ipsa loquitur were present, namely: (1) the accident was of a kind which does not
ordinarily occur unless someone is negligent; (2) the instrumentality or agency which caused the injury
was under the exclusive control of the person in charge; and (3) the injury suffered must not have been
due to any voluntary action or contribution of the person injured. The contention is without merit. We
agree with the ruling of the Court of Appeals. In the Ramos case, the question was whether a surgeon,
an anesthesiologist, and a hospital should be made liable for the comatose condition of a patient
scheduled for cholecystectomy. In that case, the patient was given anesthesia prior to her operation.

Noting that the patient was neurologically sound at the time of her operation, the Courtapplied the
doctrine of res ipsa loquitur as mental brain damage does not normally occurin a gall blader operation in
the absence of negligence of the anesthesiologist.
Taking judicial notice that anesthesia procedures had become so common that even an ordinary person
could tell if it was administered properly, we allowed the testimony of a witness who was not an expert.
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. Respondents alleged failure to observe due care was
not immediately apparent to a layman so as to justify application of res ipsa loquitur. The question
required expert opinion on the alleged breach by respondents of the standard of care required by th
circumstances. Furthermore, on the issue of the correctness of her diagnosis, no presumption of
negligence can be applied to Dr. Marlyn Rico.
7. Ramos vs. CA;
GR No. 124354 ; April 11, 2001
Facts:
After seeking professional help, Erlinda Ramos was advised to undergo an operation for the removal of a
stone in her gallbladder. She was referred to Dr. Hosaka who agreed to do the operation and was
further recommended to an anaesthesiologist, Dr. Gutierrez.
On the day of the scheduled operation at De Los Santos Medical Center, around 9:30 in the morning Dr.
Hosaka had not yet arrived so Dr. Gutierres tried to get in touch with him by phone and informed
Hermina Cruz, sister-in-law of Erlina who accompanied Erlinda to the operating room, that the operation
might be delayed. Dr. Hosaka arrived around 12:20 in the afternoon, or more than three hours after the
scheduled operation.
Cruz, who was then still inside the operation room while still holding the hand of Erlinda saw Dr.
Gutierrez trying to intubate the patient and heard Dr. Gutierrez utter and hirap ma-intubate nito, mali
yata ang pagkakapasok. O lumalaki ang tiyan. Cruz then noticed bluish discoloration of Erlindas
nailbeds on her left hand. She then hear Osaka instructed someone to call another anestheologist in the
name of Dr. Calderon. Dr. Calderon then attempted to intubate the patient but still the nailbeds of the
patient remained bluish thus she was placed in a trendelenburg position.
At almost 3:00 in the afternoon, Cruz saw Erlinda being wheeled to the ICU and the doctors explained to
Rogelio that Erlinda his wife had bronchospasm. Erlinda stayed in the ICU for a month. She was then
released from the hospital after four months and since then she remained in a comatose condition and
died on August 1999.
Petitioner then filed with the RTC a civil case for damages against private respondents. After due trial,
RTC rendered judgment in favor of petitioners and found the respondent negiligent in the performance
of their duties to Erlinda. On appeal, the CA reversed the RTCs decision and directed the petitioners to
pay their unpaid medical bills.

Issue:
Whether Dr. Hosaka and Gutierrez were liable for negligence.
Held:
Dr. Hosaka's irresponsible conduct of arriving very late for the scheduled operation of petitioner Erlinda
is violative, not only of his duty as a physician "to serve the interest of his patients with the greatest
solicitude, giving them always his best talent and skill," but also of Article 19 of the Civil Code which
requires a person, in the performance of his duties, to act with justice and give everyone his due. Dr.
Gutierrez claim of lack of negligence on her part is belied by the records of the case. It has been
sufficiently established that she failed to exercise the standards of care in the administration
of anesthesia on a patient. Dr. Gutierrez omitted to perform a thorough preoperative evaluation on
Erlinda. Further, there is no cogent reason for the Court to reverse its finding that it was the faulty
intubation on Erlinda that caused her comatose condition. There is no question that Erlinda became
comatose after Dr. Gutierrez performed a medical procedure on her.
8. Ruez Jr. vs. Dr. Jurado
A.M. No. 2005-08-SC, December 9, 2005
(To follow by Gladys Chua)
9. ROGELIO P. NOGALES, for himself and on behalf of the minors, ROGER ANTHONY,
ANGELICA,NANCY, and MICHAEL CHRISTOPHER, all surnamed NOGALES, petitioners, vs. CAPITOL
MEDICAL CENTER, DR. OSCAR ESTRADA, DR. ELY VILLAFLOR, DR. ROSA UY, DR. JOELENRIQUEZ, DR.
PERPETUA LACSON, DR. NOE ESPINOLA, and NURSE J. DUMLAO, respondents.
G.R. No. 142625 December 19, 2006
Facts:
Corazon Nogales ("Corazon"), 37 years old pregnant with her fourth child, under the exclusive prenatal
care of Dr. Oscar Estrada ("Dr. Estrada"). The Doctor noted an increase in her blood pressure and
development of leg edema indicating preeclampsia. Corazon started to experience mild labor pains
Dr. Estrada advised her immediate admission to the Capitol Medical Center ("CMC"). The staff nurse
noted the written admission request of Dr. Estrada. Due to the "Consent on Admission and Agreement"
and "Admission Agreement" signed by Corazons husband she was then brought to the labor room of
the CMC. Corazon manifest moderate vaginal bleeding which rapidly became profusely, Dr. Espinola
ordered immediate hysterectomy. Rogelio was made to sign. Consent to Operation."Due to the
inclement weather, Dr. Espinola arrived an hour late. He examined the patient and ordered some
resuscitative measures to be administered. Despite Dr. Espinola's efforts, Corazon died the cause
of death was "hemorrhage, post partum."Petitioners filed a complaint for damages with the Regional
Trial Court of Manila contending that defendant physicians and CMC personnel were negligent in the
treatment and management of Corazon's condition also in the selection and supervision of defendant
physicians and hospital staff. The defendant fail to file their answer to the complaint the trial court
declared Dr. Estrada, Dr. Enriquez, and Nurse Dumlao in default. CMC, Dr. Villaflor, Dr. Uy, Dr. Espinola,
and Dr. Lacson filed their respective answers denying and opposing the allegations in the complaint. The
trial court rendered judgment finding Dr. Estrada solely liable for damages.

Petitioners appealed the trial court's decision, The Court of Appeals affirmed the decision of the trial
court. Petitioners filed a motion for reconsideration which was denied in its Resolution. Hence,
petitioners filed a Manifestation that respondents "need no longer be notified of the petition because
they are not involved in the issue raised before the [Court], regarding the liability of [CMC]." The Court
of Appeals concluded that since Rogelio engaged Dr.Estrada as the attending physician of his wife, any
liability for malpractice must be Dr. Estrada's sole responsibility. While it found the amount of damages
fair and reasonable, the Court of Appeals held that no interest could be imposed on unliquidated claims
or damages. Hence this petition.
Issue:
Whether or not CMC is vicariously liable for the negligence?
Held:
On the Liability of CMC
CMC is vicariously liable for Dr. Estrada's negligence based on Article 2180 in relation to Article2176 of
the Civil Code. Art. 2180. The obligation imposed by article 2176 is demandable not only for one's own
acts or omissions, but also for those of persons for whom one is responsible. Employers shall be liable
for the damages caused by their employees. The records show that Rogelio testified that he and his wife
specifically chose Dr. Estrada to handle Corazon's delivery not only because of their friend's
recommendation, but more importantly because of Dr.Estrada's "connection with a reputable hospital,
to provide the best medical care and support services for Corazon's delivery.
On the Liability of the other Respondents
There was no evidence showing that the other respondents are liable for negligent act. The records
show that all are acting with good faith.
On the Award of interest on Damages
The award of interest on damages is proper and allowed under Article 2211 of the Civil Code, which
states that in crimes and quasi-delicts, interest as a part of the damages may, in a proper case, be
adjudicated in the discretion of the court. The Court partly grants the petition finds respondent Capitol
Medical Center vicariously liable for the negligence of Dr. Oscar Estrada. The actual damages and moral
damages should each earn legal interest at the rate of six percent (6%) per annum computed from the
date of the judgment of the trial court.

10. PROFESSIONAL SERVICES, INC. VS. NATIVIDAD and ENRIQUE AGANA

G.R. no. 126297 January 31, 2007
NATIVIDAD and ENRIQUE AGANAVS JUAN FUENTES
G.R. no. 127590 January 31, 2007

Facts:
Natividad Agana was rushed to the Medical City Hospital Dr. Miguel Ampil diagnosed her to be suffering
from cancer of the sigmoid . Dr. Ampil performed the surgery and found the malignancy in her
sigmoid necessitating the removal. Dr. Juan Fuentes performs hysterectomy Dr. Ampil took over,
completed the operation and closed the incision. The attending nurse entered the remarks that the
sponge count lacking 2. Since nowhere to be found the surgeon avail to continue closure. After a couple
of days, Natividad complained of excruciating pain she consulted both the doctors about it but they told
that it was natural consequence of the surgery. Dr. Ampil. Natividad, went to the United States after
four months of consultation and laboratory examinations, she was free of cancer. Natividad flew back
to the Philippines, still suffering from pains, her daughter found gauze protruding from her Vagina. Then
after the pain intensified, prompting Natividad to seek treatment. Dr. Ramon Gutierez detected the
presence of another foreign object in her vagina a foul-smelling gauze which badly infected her vaginal
vault. Natividad underwent another surgery to remedy the damage.
Natividad and her husband filed with the RTC, Quezon City a complaint for damages against the
Professional Services, Inc. (PSI), owner of the Medical City Hospital, Dr. Ampil, and Dr. Fuentes. Enrique
Agana also filed with the Professional Regulation Commission (PRC) an administrative complaint
for gross negligence and malpractice against Dr. Ampil and Dr. Fuentes. The PRC Board of Medicine
heard the case but it failed to acquire jurisdiction over Dr. Ampil who was then in the United States. The
case was pending; Natividad died and was duly substituted by her above-named children (the Aganas).
RTC rendered its Decision in favor of the Aganas, finding PSI, Dr. Ampil and Dr. Fuentes liable for
negligence and malpractice, ordering the defendants PROFESSIONAL SERVICES, INC., Dr Miguel Ampil
and Dr. Juan Fuentes to pay to the plaintiffs, jointly and severally, except in respect of the award for
exemplary damages and the interest thereon which are the liabilities of defendants Dr. Ampil and Dr.
Fuentes. Aggrieved, PSI, Dr. Fuentes and Dr. Ampil interposed an appeal to the Court of Appeals, Aganas
filed with the RTC a motion for a partial execution of its Decision. Aganas again filed a motion for an alias
writ of execution against the properties of PSI and Dr. Fuentes. RTC granted the motion and issued the
corresponding writ, prompting Dr. Fuentes to file with the Court of Appeals a petition for certiorari and
prohibition, with prayer for preliminary injunction. During its pendency, the Court of Appeals issued a
Resolution granting Dr. Fuentes prayer for injunctive relief. PRC Board of Medicine rendered its
Decision in Administrative Case dismissing the case against Dr. Fuentes. The prosecution failed to show
that Dr. Fuentes was the one who left the two pieces of gauze inside Natividads body. The Court of
Appeals rendered its Decision Dr.Miguel Ampil is liable to reimburse defendant-appellant Professional
Services, Inc., whatever amount the latter will pay or had paid to the plaintiffs-appellees. Dr. Ampil filed
a motion for reconsideration, but it was denied in a Resolution Aganas maintain that the Court of
Appeals erred in finding that Dr. Fuentes is not guilty of negligence or medical malpractice, invoking the
doctrine of res ipsa loquitur. Dr. Ampilasserts that the Court of Appeals erred in finding him liable
for negligence and malpractice.

Issues:
(1) Whether the Court of Appeals erred in holding Dr. Ampil liable for negligence and malpractice
(2) Whether the Court of Appeals erred in absolving Dr. Fuentes of any liability
(3) Whether PSI may be held solidarily liable for the negligence of Dr. Ampil.
Held:
(1) Dr. Ampil is liable for Negligence and Malpractice, an attempt to absolve himself, gears the Courts
attention to other possible causes of Natividads detriment. His arguments are purely conjectural and
without basis. He did not present any evidence to prove that the American doctors were the ones who
put or left the gauzes in Natividads body. Neither submit evidence to rebut the correctness of the
record of operation, particularly the number of gauzes used. As to the alleged negligence of Dr. Fuentes,
we are mindful that Dr. Ampil examined his (Dr.Fuentes) work and found it in order.
(2) The court is not convinced, that the Court of Appeals Erred in Absolving Dr. Fuentes of any Liability. It
was duly established that Dr. Ampil was the lead surgeon during the operation of Natividad. He
requested the assistance of Dr. Fuentes only to perform hysterectomy when he(Dr. Ampil) found that
the malignancy in her sigmoid area had spread to her left ovary. Dr. Fuentes performed the surgery and
thereafter reported and showed his work to Dr. Ampil. The latter examined it and finding everything to
be in order, allowed Dr. Fuentes to leave the operating room. Dr. Ampil then resumed operating on
Natividad. He was about to finish the procedure when the attending nurses informed him that two
pieces of gauze were missing. A"diligent search" was conducted, but the misplaced gauzes were not
found. Dr. Ampil then directed that the incision be closed. During this entire period, Dr. Fuentes was no
longer in the operating room and had, in fact, left the hospital.
(3) The issue of whether PSI is solidarily liable with Dr. Ampil for damages, that PSI, failed to adduce
evidence showing that it exercised the diligence of a good father of a family in the accreditation and
supervision of the latter. Moreover PSI is also directly liable to the Aganas. When a doctor practices
medicine in a hospital setting, the hospital and its employees are deemed to sub serve him in his
ministrations to the patient and his actions are of his own responsibility. The nature of the relationship
between the hospital and the physicians is an employer-employee relationship the hospitals exercise
significant control in the hiring and firing of consultants and in the conduct of their work within the
hospital premises. Doctors who apply for consultant slots, are required to submit proof of completion of
residency, their educational qualifications, evidence of accreditation by the appropriate board
(diplomate), evidence of fellowship in most cases, and references. These requirements in other words,
private hospitals, hire, fire and exercise real control over their attending and visiting consultant staff.
The hiring, and the right to terminate consultants all fulfill the important hallmarks of an employeremployee relationship, with the exception of the payment of wages. PSI publicly displays in the lobby of
the Medical City Hospital the names and specializations of the physicians associated or accredited by it,
including those of Dr. Ampil and Dr. Fuentes. PSI failed to discharge its burden under the last paragraph
of Article 2180 cited must be adjudged solidarily liable with Dr. Ampil.

11. DR. MILAGROS L. CANTRE, Petitioner, vs. SPS. JOHN DAVID Z. GO and NORA S. GO, Respondents.

Facts:
At 1:30 a.m. of April 20, 1992, Nora gave birth to her fourth child, a baby boy. However, at around 3:30
a.m., Nora suffered profuse bleeding inside her womb due to some parts of the placenta which were not
completely expelled from her womb after delivery. Consequently, Nora suffered hypovolemic shock,
resulting in a drop in her blood pressure to "40" over "0." Petitioner and the assisting resident physician
performed various medical procedures to stop the bleeding and to restore Noras blood pressure. Her
blood pressure was frequently monitored with the use of a sphygmomanometer. While petitioner was
massaging Noras uterus for it to contract and stop bleeding, she ordered a droplight to warm Nora and
her baby.4 Nora remained unconscious until she recovered.
While in the recovery room, her husband, respondent John David Z. Go noticed a fresh gaping wound
two and a half (2 ) by three and a half (3 ) inches in the inner portion of her left arm, close to the
armpit.5 He asked the nurses what caused the injury. He was informed it was a burn. Respondent
spouses filed a complaint13 for damages against petitioner, Dr. Abad, and the hospital.
Issue:
Is petitioner liable for the injury suffered by respondent Nora Go??
Held:
The Court ruled In cases involving medical negligence, the doctrine of res ipsa loquitur allows the mere
existence of an injury to justify a presumption of negligence on the part of the person who controls the
instrument causing the injury, provided that the following requisites concur:
1. The accident is of a kind which ordinarily does not occur in the absence of someones
negligence;
2. It is caused by an instrumentality within the exclusive control of the defendant or defendants;
and
3. The possibility of contributing conduct which would make the plaintiff responsible is
eliminated.18
As to the first requirement, the gaping wound on Noras arm is certainly not an ordinary occurrence in
the act of delivering a baby, far removed as the arm is from the organs involved in the process of giving
birth. Such injury could not have happened unless negligence had set in somewhere.
Second, whether the injury was caused by the droplight or by the blood pressure cuff is of no moment.
Both instruments are deemed within the exclusive control of the physician in charge under the "captain
of the ship" doctrine. This doctrine holds the surgeon in charge of an operation liable for the negligence
of his assistants during the time when those assistants are under the surgeons control.

Use of the droplight and the blood pressure cuff is also within petitioners exclusive control.
Third, the gaping wound on Noras left arm, by its very nature and considering her condition, could only
be caused by something external to her and outside her control as she was unconscious while in
hypovolemic shock. Hence, Nora could not, by any stretch of the imagination, have contributed to her
own injury.

12. ILAO-ORETA vs. RONQUILLOGR

G.R. No. 172406 October 17, 2007
Facts:
Despite several years of marriage, Spouses Ronquillo is still childless. They consulted Dr. Concepcion
Ilao-Oreta, an obstetrician gynecologist-consultant at St. Lukes and Chief of the
Reproductive Endocrinology and Infertility Section. Eva Marie agreed to undergo alaparoscopic
procedure where a laparoscope would be inserted through her abdominal
wall to get a direct view of her internal reproductive organ in order to determine the real cause of her
infertility.
The procedure was scheduled on April 5, 1999 at 2 pm. Dr. Ilao-Oreta did not arrive at the
schedules time and no prior notice of its cancellation was received by the Ronquillos. Dr. IlaoOreta was on her honeymoon in Hawaii.
She estimated that she would arrive in Manila in the early morning of April5. However, she failed to
consider the time difference between Hawaii and Philippines. Ronquillos filed a complaint against Dr.
Ilao-Oreta and St. Lukes for breach of professional and service contract and for damages.
RTC: awarded Eva Marie only actual damages upon finding that the
doctors failure to arrive on time was not intentional
CA: found Dr. Ilao-Oreta grossly negligent
Issue:
WON Dr. Ilao-Oreta was grossly negligent in not arriving on time for the scheduled laparoscopy
Held:
Records show that Dr- Ilao-Oreta left an admitting order with her secretary for one of the spouses to
pick up, apprised Eva Marie of the necessary preparations for the procedure and instructed the hospital
staff to perform pre-operative treatments before leaving for Hawaii. These acts reflect an
earnest intention to perform the procedure on the day and time scheduled.
On realizing that she missed the scheduled procedure, Dr. Ilao Oreta, upon
arrival in Manila, immediately called the hospital and asked the nurses about Eva Marie. She also
wanted to call the Ronquillos but she didnt have their number at that time. So the next morning, she

went to her office to get the Ronquillos contact number, which is written on Eva Maries chart, and
called them right away.
Noel admitted that indeed Dr. Ilao-Oreta called him up after she arrived in Manila. Although Dr. IlaoOretas act is not grossly negligent, she was negligent when she scheduled to perform professional
service at 2 pm without considering the time difference between Philippines and Hawaii. Having
travelled to the US, where she obtained a fellowship in Reproductive
Endocrinology and Infertility, more than twice, she should have been mindful of said difference.
The procedure to be conducted on Eva Marie was only elective in nature thus the situation did not
present any clear and apparent harm or injury that even a careless person may perceive.
According to the SC, it bears noting that when Dr. Ilao-Oreta was scheduling the date of her
performance of the procedure, she had just gotten married and was preparing for her honeymoon. It is
common knowledge that excitement attends its preparations. Her negligence could then be
partly attributed to human frailty which rules out its characterization as gross.

13. SPOUSES FREDELICTO FLORES (deceased) and FELICISIMA FLORES, petitioners,

vs. SPOUSES DOMINADOR PINEDA and VIRGINIA SACLOLO, and FLORENCIO, CANDIDA, MARTA,
GODOFREDO, BALTAZAR and LUCENA, all surnamed PINEDA, as heirs of the deceased TERESITA S.
PINEDA, and UNITED DOCTORS MEDICAL CENTER, INC., respondents.
Facts:
Teresita was a 51-year old unmarried woman living in Sto. Domingo, Nueva Ecija. She consulted on April
17, 1987 her townmate, Dr. Fredelicto Flores, regarding her medical condition. She complained of
general body weakness, loss of appetite, frequent urination and thirst, and on-and-off vaginal bleeding.
He advised her to return the following week or to go to the United Doctors Medical Center (UDMC) in
Quezon City for a general check-up. As for her other symptoms, he suspected that Teresita might be
suffering from diabetes and told her to continue her medications.
They went to United Doctors Medical Center (UDMC) in Quezon City. Teresita was taken to the
operating room. It was only then that she met Dr. Felicisima, an obstetrician and gynecologist.
Upon Teresita's complete laboratory examination results came only on that day . Teresita's urinalysis
showed a three plus sign (+++) indicating that the sugar in her urine was very high. She was then placed
under the care of Dr. Amado Jorge, an internist.
Teresita's condition had worsened. She experienced difficulty in breathing and was rushed to the
intensive care unit. Further tests confirmed that she was suffering from Diabetes Mellitus Type
II. Insulin was administered on the patient, but the medication might have arrived too late. Due to
complications induced by diabetes, Teresita died.

Believing that Teresita's death resulted from the negligent handling of her medical needs, her family
(respondents) instituted an action for damages against Dr. Fredelicto Flores and Dr. Felicisima Flores
(collectively referred to as the petitioner spouses) before the RTC of Nueva Ecija.
Issue:
Whether the said doctors can be held liable for negligence?
Held:
A medical negligence case is a type of claim to redress a wrong committed by a medical professional,
that has caused 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 causation.
We clarify that Dr. Fredelicto's negligence is not solely the act of ordering an "on call" D&C operation
when he was mainly ananaesthesiologist who had made a very cursory examination of the patient's
vaginal bleeding complaint. Rather, it was his failure from the very start to identify and confirm, despite
the patient's complaints and his own suspicions, that diabetes was a risk factor that should be guarded
against, and his participation in the imprudent decision to proceed with the D&C operation despite his
early suspicion and the confirmatory early laboratory results.
If Dr. Fredelicto believed himself to be incompetent to treat the diabetes, not being an internist or a
diabetologist (for which reason he referred Teresita to Dr. Jorge), he should have likewise refrained from
making a decision to proceed with the D&C operation since he was niether an obstetrician nor a
gynecologist.
These findings lead 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

14. FE CAYAO-LASAM, PETITIONER, VS. SPOUSES CLARO AND EDITHA RAMOLETE, RESPONDENTS.
Facts:
On July 28, 1994, respondent, three months pregnant Editha Ramolete (Editha) was brought to the
Lorma Medical Center (LMC) in San Fernando, La Union due to vaginal bleeding. Upon advice of
petitioner relayed 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's 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 Editha to undergo a Dilatation and Curettage Procedure (D&C) or "raspa."
Petitioner performed the D&C procedure. Editha was discharged from the hospital the following day.

Editha was once again brought at the LMC, as she was suffering from vomiting and severe abdominal
pains. Editha was attended by Dr. Beatriz de la Cruz, Dr. Victor B. Mayo and Dr. Juan V. Komiya. Dr.
Mayo allegedly informed Editha that there was a dead fetus in the latter's womb. After, Editha
underwent laparotomy, she was found to have a massive intra-abdominal hemorrhage and a ruptured
uterus. Thus, Editha had to undergo a procedure for hysterectomy and as a result, she has no more
chance to bear a child. Editha and her husband Claro Ramolete (respondents) filed a Complaint for Gross
Negligence and Malpractice against petitioner before the Professional Regulations Commission (PRC).
Petitioner contended that it was Editha's gross negligence and/or omission in insisting to be discharged
on such day against doctor's advice and her unjustified failure to return for check-up as directed by
petitioner that contributed to her life-threatening condition on September 16, 1994; that Editha's
hysterectomy was brought about by her very abnormal pregnancy known as placenta increta, which was
an extremely rare and very unusual case of abdominal placental implantation.
On March 4, 1999, the Board of Medicine (the Board) of the PRC rendered a Decision, exonerating
petitioner from the charges filed against her. On appeal, the PRC rendered a Decision reversing the
findings of the Board and revoking petitioner's authority or license to practice her profession as a
physician. Hence, this petition.
Issue:
Whether the petitioner is liable for malpractice?
Held:
When complainant was discharged on July 31, 1994, herein respondent advised her to return on August
4, 1994 or four (4) days after the D&C. This advise was clear in complainant's Discharge
Sheet. However, complainant failed to do so. This being the case, the chain of continuity as required in
order that the doctrine of proximate cause can be validly invoked was interrupted. Had she returned,
the respondent could have examined her thoroughly.
No negligence can be attributed to the petitioner, the immediate cause of the accident resulting in
Editha's injury was her own omission when she did not return for a follow-up check up, in defiance of
petitioner's orders. The immediate cause of Editha's injury was her own act; thus, she cannot recover
damages from the injury.
The Decision of the Board of Medicine dated March 4, 1999 exonerating petitioner is AFFIRMED.

15. PETER PAUL PATRICK LUCAS, FATIMA GLADYS LUCAS, ABBEYGAIL LUCAS AND GILLIAN LUCAS,
Petitioners, vs. DR. PROSPERO MA. C. TUAO,
Facts:
Petitioner Peter Paul Patrick Lucas (Peter) contracted "sore eyes" in his right eye. Upon consultation
with Dr. Tuao, Peter narrated that it had been nine (9) days since the problem with his right eye began;
and that he was already taking Maxitrol to address the problem in his eye. Dr. Tuao diagnosed that

Peter was suffering from conjunctivitis 5 or "sore eyes." Dr. Tuao then prescribed Spersacet-C6 eye
drops for Peter and told the latter to return for follow-up after one week.
As instructed, Peter went back to Dr. Tua. Upon examination, Dr. Tuao told Peter that the "sore eyes"
in the latters right eye had already cleared up and he could discontinue the Spersacet-C. However, the
same eye developed Epidemic Kerato Conjunctivitis (EKC), 7 a viral infection. To address the new problem
with Peters right eye, Dr. Tuao prescribed to the former a steroid-based eye drop called Maxitrol, a
dosage of six (6) drops per day. To recall, Peter had already been using Maxitrol prior to his consult with
Dr. Tuao.
Peter saw Dr. Tuao for a follow-up consultation. After examining both of Peters eyes, Dr. Tuao
instructed the former to taper down the dosage of Maxitrol, because the EKC in his right eye had already
resolved. Dr. Tuao specifically cautioned Peter that, being a steroid, Maxitrol had to be withdrawn
gradually; otherwise, the EKC might recur.
Complaining of feeling as if there was something in his eyes, Peter returned to Dr. Tuao for another
check-up on . Dr. Tuao examined Peters eyes and found that the right eye had once more developed
EKC. So, Dr. Tuao instructed Peter to resume the use of Maxitrol at six (6) drops per day.
Several days later, Peter went to see Dr. Tuao at his clinic, alleging severe eye pain, feeling as if his eyes
were about to "pop-out," a headache and blurred vision. Dr. Tuao examined Peters eyes and
discovered that the EKC was again present in his right eye. As a result, Dr. Tuao told Peter to resume
the maximum dosage of Blephamide.
Dr. Tuao saw Peter once more at the formers clinic. Dr. Tuaos examination showed that only the
periphery of Peters right eye was positive for EKC; hence, Dr. Tuao prescribed a lower dosage of
Blephamide.
Upon waking in the morning of 13 December 1988, Peter had no vision in his right eye. Fatima observed
that Peters right eye appeared to be bloody and swollen. 15 Thus, spouses Peter and Fatima rushed to
the clinic of Dr. Tuao. Peter reported to Dr. Tuao that he had been suffering from constant headache
in the afternoon and blurring of vision.
A civil complaint for damages against Dr. Tuao on the ground of Dr. Tuaos grossly negligent conduct
in prescribing to Peter the medicine Maxitrol for a period of three (3) months, without monitoring
Peters IOP, as required in cases of prolonged use of said medicine, and notwithstanding Peters
constant complaint of intense eye pain while using the same.
Issue:
Whether Dr. Tuano was negligent?
Held:
Absent a definitive standard of care or diligence required of Dr. Tuao under the circumstances, we
have no means to determine whether he was able to comply with the same in his diagnosis and
treatment of Peter. This Court has no yardstick upon which to evaluate or weigh the attendant facts of

this case to be able to state with confidence that the acts complained of, indeed, constituted negligence
and, thus, should be the subject of pecuniary reparation.
Herein, the burden of proof was clearly upon petitioners, as plaintiffs in the lower court, to establish
their case by a preponderance of evidence showing a reasonable connection between Dr. Tuaos
alleged breach of duty and the damage sustained by Peters right eye. This, they did not do. In reality,
petitioners complaint for damages is merely anchored on a statement in the literature of Maxitrol
identifying the risks of its use, and the purported comment of Dr. Agulto another doctor not presented
as witness before the RTC concerning the prolonged use of Maxitrol for the treatment of EKC.
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 thereof by the physician or surgeon. The
RTC and Court of Appeals, and even this 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.

16. PSI vs AGANA

Facts:
Natividad Agana was rushed to the Medical City Hospital Dr. Miguel Ampil diagnosed her to be suffering
from cancer of the sigmoid. Dr. Ampil performed the surgery and found the malignancy in her sigmoid
necessitating the removal. Dr. Juan Fuentes performs hysterectomyDr. Ampil took over, completed the
operation and closed the incision. The attending nurse entered the remarks that the sponge count
lacking 2. Since nowhere to be found the surge on avail to continue closure. After a couple of days,
Natividad complained of excruciating pain she consulted both the doctors about it but they told that
it was natural consequence of the surgery. Dr. Ampil Natividad, went to the United States after four
months of consultation and laboratory examinations, she was free of cancer. Natividad flew back to the
Philippines, still suffering from pains, her daughter found gauze protruding from her Vagina. Then after
the pain intensified, prompting Natividad to seek treatment. Dr. Ramon Gutierez detected the presence
of another foreign object in her vagina a foul-smelling gauze which badly infected her vaginal vault.
Natividad underwent another surgery to remedy the damage. Natividad and her husband filed with the
RTC, Quezon City a complaint for damages against the Professional Services, Inc. (PSI), owner of
the Medical City Hospital, Dr. Ampil, andDr. Fuentes. Enrique Agana also filed with the Professional
Regulation Commission (PRC) an administrative complaint for gross negligence and malpractice against
Dr. Ampil and Dr.Fuentes. The PRC Board of Medicine heard the case but it failed to acquire jurisdiction
over Dr.Ampil who was then in the United States. The case was pending; Natividad died and was
dulysubstituted by her above-named children (the Aganas).
RTC rendered its Decision in favor of the Aganas, finding PSI, Dr. Ampil and Dr. Fuentes liable
for negligence and malpractice,ordering the defendants PROFESSIONAL SERVICES, INC., Dr Miguel Ampil
and
Dr.
JuanFuentes to pay to the
plaintiffs, jointly and severally, except in respect of the
award for exemplary damages and the interest thereon which are the liabilities of defendants Dr.
Ampiland Dr. Fuentes.Aggrieved, PSI, Dr. Fuentes and Dr. Ampil interposed an appeal to the Court of
Appeals,Aganas filed with the RTC a motion for a partial execution of its Decision. Aganas again filed
amotion for an alias writ of execution against the properties of PSI and Dr. Fuentes. RTC grantedthe

motion and issued the corresponding writ, prompting Dr. Fuentes to file with the Court of Appeals a
petition for certiorari and prohibition, with prayer for preliminary injunction. During itspendency,
the Court of Appeals issued a Resolution granting Dr. Fuentes prayer for injunctiverelief.
PRC Board of Medicine rendered its Decision in Administrative Case dismissing thecase against Dr.
Fuentes. The prosecution failed to show that Dr. Fuentes was the one who leftthe two pieces of gauze
inside Natividads body. The Court of Appeals rendered its Decision Dr.Miguel Ampil is liable to
reimburse defendant-appellant Professional Services, Inc., whatever amount the latter will pay or had
paid to the plaintiffs-appellees. Dr. Ampil filed a motion for reconsideration, but it was denied in a
ResolutionAganas maintain that the Court of Appeals erred in finding that Dr. Fuentes is not
guiltyof negligence or medical malpractice, invoking the doctrine of res ipsa loquitur. Dr. Ampilasserts
that the Court of Appeals erred in finding him liable for negligence and malpractice.
Issues:
(1) Whether the Court of Appeals erred in holding Dr. Ampil liable for negligence andmalpractice
(2) Whether the Court of Appeals erred in absolving Dr. Fuentes of any liability
Held:
Dr. Ampil is liable for Negligence and Malpractice, an attempt to absolve himself, gears theCourts
attention to other possible causes of Natividads detriment. His arguments are purelyconjectural and
without basis. He did not present any evidence to prove that the Americandoctors were the ones who
put or left the gauzes in Natividads body. Neither submit evidenceto rebut the correctness of the record
of operation, particularly the number of gauzes used. Asto the alleged negligence of Dr. Fuentes, we are
mindful that Dr. Ampil examined his (Dr.Fuentes) work and found it in order. The court is not convinced,
that the Court of Appeals Erred in Absolving Dr. Fuentes of anyLiability. It was duly established that Dr.
Ampil was the lead surgeon during the operation of Natividad. He requested the assistance of Dr.
Fuentes only to perform hysterectomy when he(Dr. Ampil) found that the malignancy in her sigmoid
area had spread to her left ovary. Dr.Fuentes performed the surgery and thereafter reported and
showed his work to Dr. Ampil. Thelatter examined it and finding everything to be in order, allowed Dr.
Fuentes to leave theoperating room. Dr. Ampil then resumed operating on Natividad. He was about to
finish theprocedure when the attending nurses informed him that two pieces of gauze were missing.
A"diligent search" was conducted, but the misplaced gauzes were not found. Dr. Ampil thendirected
that the incision be closed. During this entire period, Dr. Fuentes was no longer in theoperating room
and had, in fact, left the hospital.

17. Dr Li vs Sps Soliman

Facts:
This case involved the death of Angelica Soliman, respondents 11-year old daughter. Previously,
Angelica was diagnosed withosteosarcoma, osteoblastic type, a highly malignant cancer of the [thigh]
bone. To remove the tumor, her right leg was amputated. And to eliminate any remaining cancer cells
and minimize the chances of recurrence and prevent the disease from spreading to other parts of her

body (metastasis), she subsequently underwent chemotherapy. The chemotherapy was administered by
petitioner Dr. Rubi Li, an oncologist at St. Lukes Medical Center (SLMC) upon consent by her parents,
herein respondents. Angelica died just eleven days after the administration of the first cycle of the
chemotherapy regimen.
The parents of the child thereafter sued the doctor for damages before the RTC, charging the latter
(along with other doctors and the SLMC itself) with negligence in causing Angelicas untimely demise. It
was specifically averred in the complaint that the doctor assured the parents that Angelica would
recover in view of 95% chance of healing with chemotherapy (Magiging normal na ang anak nyo basta
ma-chemo. 95% ang healing), and when asked regarding the side effects, petitioner mentioned only
slight vomiting, hair loss and weakness (Magsusuka ng kaunti. Malulugas ang buhok.
Manghihina). The parents thus claimed that they would not have given their consent to chemotherapy
had the doctor not falsely assured them of its side effects.
The trial court however dismissed the case. It found that the doctor was not liable for damages as she
observed the best known procedures and employed her highest skill and knowledge in the
administration of chemotherapy drugs on Angelica [though] despite all efforts said patient died.
The parents appealed to the Court of Appeals (CA). While concurring with the trial courts finding that
there was no negligence committed by the petitioner in the administration of chemotherapy treatment
to Angelica, the CA found that the doctor failed to fully explain to the parents of the patient all the
known side effects of chemotherapy. The CA thus adjudged the doctor liable for damages.
The doctor then appealed to the Supreme Court (SC), raising the following issue: Under the facts, can
she be held liable [of failing] to fully disclose serious side effects of chemotherapy to the parents of her
patient despite the absence of finding that she was negligent in administering the said treatment.
Issue:
Whether or not there is malpractice
Held:
As indicated above, Justice Villarama ruled that there are four essential elements a plaintiff must prove
in a malpractice action based upon the doctrine of informed consent: (1) the physician had a duty to
disclose material risks; (2) he failed to disclose or inadequately disclosed those risks; (3) as a direct and
proximate result of the failure to disclose, the patient consented to treatment she otherwise would not
have consented to; and (4) plaintiff was injured by the proposed treatment. The gravamen in an
informed consent case requires the plaintiff to point to significant undisclosed information relating to
the treatment which would have altered her decision to undergo it.
There was adequate disclosure of material risk inherent in the chemotherapy procedure performed with
the consent of Angelicas parents. [The parents] could not have been unaware in the course of initial

treatment and amputation of Angelicas lower extremity, that her immune system was already weak on
account of the malignant tumor in her knee. When [the doctor] informed the [parents] beforehand of
the side effects of chemotherapy[,] which includes lowered counts of white and red blood cells,
decrease in blood platelets, possible kidney or heart damage and skin darkening, there is reasonable
expectation on the part of the doctor that the parents understood very well that the severity of these
side effects will not be the same for all patients undergoing the procedure.
As a physician, petitioner can reasonably expect the parents to have considered the variables in the
recommended treatment for their daughter afflicted with a life-threatening illness. On the other hand,
it is difficult to give credence to respondents claim that petitioner told them of 95% chance of recovery
for their daughter, as it was unlikely for doctors like petitioner who were dealing with grave conditions
such as cancer to have falsely assured patients of chemotherapys success rate. Besides, informed
consent laws in other countries generally require only a reasonable explanation of potential harms, so
specific disclosures such as statistical data, may not be legally necessary.
The element of ethical duty to disclose material risks in the proposed medical treatment cannot thus be
reduced to one simplistic formula applicable in all instances. Further, in a medical malpractice action
based on lack of informed consent, the plaintiff must prove both the duty and the breach of that duty
through expert testimony. Such expert testimony must show the customary standard of care of
physicians in the same practice as that of the defendant doctor.
In this case, the testimony of Dr. Balmaceda [witness for the girls parents] who is not an oncologist but
a Medical Specialist of the DOHs Operational and Management Services charged with receiving
complaints against hospitals, does not qualify as expert testimony to establish thestandard of care in
obtaining consent for chemotherapy treatment. In the absence of expert testimony in this regard, the
Court felt hesitant defining the scope of mandatory disclosure in cases of malpractice based on lack of
informed consent, much less set a standard of disclosure that, even in foreign jurisdictions, has been
noted to be an evolving one.

18. Dr Jarcia vs Bastan

Facts:
Belinda Santiago (Mrs. Santiago) lodged a complaint with the National Bureau of
Investigation (NBI) against the petitioners, Dr. Emmanuel Jarcia, Jr. (Dr. Jarcia) and Dr. Marilou
Bastan (Dr. Bastan), for their alleged neglect of professional duty which caused her son, Roy Alfonso
Santiago (Roy Jr.), to suffer serious physical injuries. Upon investigation, the NBI found that Roy Jr. was
hit by a taxicab; that he was rushed to the Manila Doctors Hospital for an emergency medical treatment;
that an X-ray of the victims ankle was ordered; that the X-ray result showed no fracture as read by Dr.
Jarcia; that Dr. Bastan entered the emergency room (ER) and, after conducting her own examination of
the victim, informed Mrs. Santiago that since it was only the ankle that was hit, there was no need to

examine the upper leg; that eleven (11) days later, Roy Jr. developed fever, swelling of the right leg and
misalignment of the right foot; that Mrs. Santiago brought him back to the hospital; and that the X-ray
revealed a right mid-tibial fracture and a linear hairline fracture in the shaft of the bone.
On June 14, 2005, the RTC found the petitioners guilty beyond reasonable doubt of the crime of Simple
Imprudence Resulting to Serious Physical Injuries. The Court believes that accused are negligent when
both failed to exercise the necessary and reasonable prudence in ascertaining the extent of injury of
Alfonso Santiago, Jr. However, the negligence exhibited by the two doctors does not approximate
negligence of a reckless nature but merely amounts to simple imprudence. Simple imprudence consists
in the lack of precaution displayed in those cases in which the damage impending to be caused is not the
immediate nor the danger clearly manifest. The elements of simple imprudence are as follows.
1. that there is lack of precaution on the part of the offender; and
2. that the damage impending to be caused is not immediate of the danger is not clearly
manifest.
Issue:
Whether or not the Petitioners are guilty of negligence
Held:
The Supreme Court reversed the decision of the lower court and the CA. The totality of the evidence on
record clearly points to the negligence of the petitioners. At the risk of being repetitious, the Court,
however, is not satisfied that Dr. Jarcia and Dr. Bastan are criminally negligent in this case. Negligence is
defined as the failure to observe for the protection of the interests of another person that degree of
care, precaution, and vigilance which the circumstances justly demand, whereby such other person
suffers injury. Reckless imprudence consists of voluntarily doing or failing to do, without malice, an act
from which material damage results by reason of an inexcusable lack of precaution on the part of the
person performing or failing to perform such act.The elements of simple negligence are: (1) that there is
lack of precaution on the part of the offender, and (2) that the damage impending to be caused is not
immediate or the danger is not clearly manifest. In this case, the Court is not convinced with moral
certainty that the petitioners are guilty of reckless imprudence or simple negligence. The elements
thereof were not proved by the prosecution beyond reasonable doubt
It can be gleaned from the testimony of Dr. Tacata that a thorough examination was not performed on
Roy Jr. As residents on duty at the emergency room, Dr. Jarcia and Dr. Bastan were expected to know
the medical protocol in treating leg fractures and in attending to victims of car accidents. There was,
however, no precise evidence and scientific explanation pointing to the fact that the delay in the
application of the cast to the patients fractured leg because of failure to immediately diagnose the
specific injury of the patient, prolonged the pain of the child or aggravated his condition or even caused
further complications. Any person may opine that had patient Roy Jr. been treated properly and given
the extensive X-ray examination, the extent and severity of the injury, spiral fracture of the mid-tibial
part or the bigger bone of the leg, could have been detected early on and the prolonged pain and
suffering of Roy Jr. could have been prevented. But still, that opinion, even how logical it may seem
would not, and could not, be enough basis to hold one criminally liable; thus, a reasonable doubt as to
the petitioners guilt.

The Court, nevertheless, finds the petitioners civilly liable for their failure to sufficiently attend to Roy
Jr.s medical needs when the latter was rushed to the ER, for while a criminal conviction requires proof
beyond reasonable doubt, only a preponderance of evidence is required to establish civil liability. Taken
into account also was the fact that there was no bad faith on their part.Dr. Jarcia and Dr. Bastan cannot
pass on the liability to the taxi driver who hit the victim. It may be true that the actual, direct,
immediate, and proximate cause of the injury (fracture of the leg bone or tibia) of Roy Jr. was the
vehicular accident when he was hit by a taxi. The petitioners, however, cannot simply invoke such fact
alone to excuse themselves from any liability. If this would be so, doctors would have a ready defense
should they fail to do their job in attending to victims of hit-and-run, maltreatment, and other crimes of
violence in which the actual, direct, immediate, and proximate cause of the injury is indubitably the act
of the perpetrator/s. In failing to perform an extensive medical examination to determine the extent of
Roy Jr.s injuries, Dr. Jarcia and Dr. Bastan were remiss of their duties as members of the medical
profession. Assuming for the sake of argument that they did not have the capacity to make such
thorough evaluation at that stage, they should have referred the patient to another doctor with
sufficient training and experience instead of assuring him and his mother that everything was all right. If
these doctors knew from the start that they were not in the position to attend to Roy Jr., a vehicular
accident victim, with the degree of diligence and commitment expected of every doctor in a case like
this, they should have not made a baseless assurance that everything was all right. By doing so, they
deprived Roy Jr. of adequate medical attention that placed him in a more dangerous situation than he
was already in. What petitioners should have done, and could have done, was to refer Roy Jr. to another
doctor who could competently and thoroughly examine his injuries.

19. Manila Doctors Hospital vs Chua and Ty

Facts:
On December 13, 1993, respondents filed a Complaint averring that on October 30, 1990, respondent
Chua, the mother of respondent Vicky Ty, was admitted in petitioner's hospital for hypertension and
diabetes; that while respondent Chua was confined, Judith Chua, the sister of respondent Ty, had been
likewise confined for injuries suffered in a vehicular accident; that partial payments of the hospital bills
were made, totaling P435,800.00; that after the discharge of Judith Chua, respondent Chua remained in
confinement and the hospital bills for both patients accumulated; that respondent Chua was pressured
by the petitioner, through its Credit and Collection Department, to settle the unpaid bills; that
respondent Ty represented that she will settle the bills as soon as the funds become available; that
respondent Ty pleaded to the management that in view of the physical condition of her mother,
respondent Chua, the correspondences relating to the settlement of the unpaid hospital bills should be
relayed to the former; that these pleas were unheeded by the petitioner; that petitioner threatened to
implement unpleasant measures unless respondent Ty undertakes her mother's obligation as well as the
obligation of her sister, Judith Chua, to pay the hospitalization expenses; that petitioner made good its
threat and employed unethical, unpleasant and unlawful methods which allegedly worsened the
condition of respondent Chua, particularly, by (i) cutting off the telephone line in her room and
removing the air-conditioning unit, television set, and refrigerator, (ii) refusing to render medical
attendance and to change the hospital gown and bed sheets, and (iii) barring the private nurses or
midwives from assisting the patient. Respondents thus prayed for the award of moral damages,
exemplary damages, and attorney's fees.

RTC held that the removal of the facilities of the room triggered the hypertension of respondent Chua;
that the petitioner acted in bad faith in removing the facilities without prior notice; that her condition
was aggravated by the pressure employed by the administration upon her to pay the hospital bills; that
the food always came late as compared to the other patients; that the beddings and clothes of
respondent Chua were no longer changed and, as a result, bed sores emerged on her body; that there
was an utter lack of medical attendance; that, because of these, respondent Chua suffered from self-pity
and depression; that petitioner clearly discriminated against the respondents; that respondent Ty had
no choice but to sign the promissory notes in order to secure the release of her mother, respondent
Chua; that the foregoing actuations constitute an abuse of rights; that petitioner failed to establish the
pecuniary loss it suffered and, hence, it is not entitled to compensatory damages; and that, since the
promissory note is a contract of adhesion, the petitioner is not entitled to the award of attorney's fees
as stipulated thereon.
Issue:
Whether or not the petitioner is liable
Held:
The Supreme Court ruled that the petitioner is not liable. Indeed the operation of private pay hospitals
and medical clinics is impressed with public interest and imbued with a heavy social responsibility. But
the hospital is also a business, and, as a business, it has a right to institute all measures of efficiency
commensurate to the ends for which it is designed, especially to ensure its economic viability and
survival. And in the legitimate pursuit of economic considerations, the extent to which the public may be
served and cured is expanded, the pulse and life of the medical sector quickens, and the regeneration of
the people as a whole becomes more visibly attainable. In the institution of cost-cutting measures, the
hospital has a right to reduce the facilities and services that are deemed to be non-essential, such that
their reduction or removal would not be detrimental to the medical condition of the patient. For the
moment, the question to be considered is whether the subject facilities are indeed non-essential the
air-conditioner, telephone, television, and refrigerator the removal of which would cause the adverse
health effects and emotional trauma the respondents so claimed. Corollary to this question is whether
the petitioner observed the diligence of a good father of the family in the course of ascertaining the
possible repercussions of the removal of the facilities prior to the removal itself and for a reasonable
time thereafter, with a view to prevent damage.
The evidence in the record overwhelmingly demonstrates that respondent Chua had been adequately
attended to, and this Court cannot understand why the courts a quo had declared that there was an
"utter lack of medical attendance," or that her health suffered during the period after the removal of
the facilities. The Court finds that the facilities in question are non-essential for the care of respondent
Chua and, hence, they may be lessened or removed by the petitioner for the sake of economic necessity
and survival.
Authorities are of the view that, ordinarily, a hospital, especially if it is a private pay hospital, is entitled
to be compensated for its services, by either an express or an implied contract, and if no express
contract exists, there is generally an implied agreement that the patient will pay the reasonable value of
the services rendered; when a hospital treats a patient's injuries, it has an enforceable claim for full
payment for its services, regardless of the patient's financial status. At this juncture, it must be noted
that there is testimony, though to a degree disputable, to the effect that the execution of the

promissory note and the issuance of postdated checks were conditions imposed not by the petitioner
but voluntarily offered by the counsel for respondents. At any rate, however, this Court holds, in view of
the foregoing authorities, that the requirement to have the relative of respondent Chua to execute a
promissory note as part of the arrangement to settle the unpaid obligations is a formality that converts
any implied contract into written form and, moreover, amounts to a reasonable condition, the nonfulfillment of which, in itself, however, as discussed, cannot allow the hospital to detain the patient. It
must also be stressed, contrary to the findings of the courts a quo, that such an agreement embodied in
a promissory note, as well as the Contract for Admission and Acknowledgment of Responsibility for
Payment dated October 30, 1990, do not become contracts of adhesion simply because the person
signing it was under stress that was not the result of the actions of the hospital, 117 especially taking into
account that there is testimony to the effect that respondent Ty signed the Promissory Note dated June
5, 1992 in the presence of counsel and acting under his advise.

20. RCAP vs Executive Secretary

Facts:
On 11 and 12 June 2006, the Professional Regulation Commission (PRC) conducted the Nursing Board
Examinations nationwide. In June 2006, licensure applicants wrote the PRC to report that handwritten
copies of two sets of examinations were circulated during the examination period among the examinees
reviewing at the R.A. Gapuz Review Center and Inress Review Center. George Cordero, Inress Review
Centers President, was then the incumbent President of the Philippine Nurses Association. The
examinees were provided with a list of 500 questions and answers in two of the examinations five
subjects, particularly Tests III (Psychiatric Nursing) and V (Medical-Surgical Nursing). The PRC later
admitted the leakage and traced it to two Board of Nursing members.On 19 June 2006, the PRC released
the results of the Nursing Board Examinations. On 18 August 2006, the Court of Appeals restrained the
PRC from proceeding with the oath-taking of the successful examinees set on 22 August 2006.
Consequently, President Gloria Macapagal-Arroyo (President Arroyo) replaced all the members of the
PRCs Board of Nursing. President Arroyo also ordered the examinees to re-take the Nursing Board
Examinations. On 8 September 2006, President Arroyo issued EO 566 which authorized the CHED to
supervise the establishment and operation of all review centers and similar entities in the Philippines.
In a letter dated 24 November 2006, the Review Center Association of the Philippines (petitioner), an
organization of independent review centers, asked the CHED to "amend, if not withdraw" the IRR
arguing, among other things, that giving permits to operate a review center to Higher Education
Institutions (HEIs) or consortia of HEIs and professional organizations will effectively abolish
independent review centers. In a letter dated 3 January 2007, Chairman Puno wrote petitioner, through
its President Jose Antonio Fudolig (Fudolig), that to suspend the implementation of the IRR would be
inconsistent with the mandate of EO 566. Chairman Puno wrote that the IRR was presented to the
stakeholders during a consultation process prior to its finalization and publication on 13 November
2006. Chairman Puno also wrote that petitioners comments and suggestions would be considered in
the event of revisions to the IRR.

Issue:
Whether or not EO 566 is an unconstitutional exercise by the Executive of legislative power as it expands
the CHEDs jurisdiction
Held:
The President has no inherent or delegated legislative power to amend the functions of the CHED under
RA 7722. Legislative power is the authority to make laws and to alter or repeal them, and this power is
vested with the Congress. The line that delineates Legislative and Executive power is not
indistinct. Legislative power is "the authority, under the Constitution, to make laws, and to alter and
repeal them." The Constitution, as the will of the people in their original, sovereign and unlimited
capacity, has vested this power in the Congress of the Philippines. The grant of legislative power to
Congress is broad, general and comprehensive. The legislative body possesses plenary power for all
purposes of civil government. Any power, deemed to be legislative by usage and tradition, is necessarily
possessed by Congress, unless the Constitution has lodged it elsewhere. In fine, except as limited by the
Constitution, either expressly or impliedly, legislative power embraces all subjects and extends to
matters of general concern or common interest. While Congress is vested with the power to enact
laws, the President executes the laws. The executive power is vested in the President. It is generally
defined as the power to enforce and administer laws. It is the power of carrying the laws into practical
operation and enforcing their due observance. As head of the Executive Department, the President is
the Chief Executive. He represents the government as a whole and sees to it that all laws are enforced
by the officials and employees of his department. He has control over the executive department,
bureaus and offices. This means that he has the authority to assume directly the functions of the
executive department, bureau and office, or interfere with the discretion of its officials. Corollary to the
power of control, the President also has the duty of supervising the enforcement of laws for the
maintenance of general peace and public order. Thus, he is granted administrative power over bureaus
and offices under his control to enable him to discharge his duties effectively. Administrative power is
concerned with the work of applying policies and enforcing orders as determined by proper
governmental organs. It enables the President to fix a uniform standard of administrative efficiency and
check the official conduct of his agents. To this end, he can issue administrative orders, rules and
regulations.

21. PMA v. Board of Medical Examiners

G.R. L-25135 September 21, 1968
Facts:
Respondent Jose Ma. Torres was granted a certificate to practice medicine in the Philippines without the
examination required in Republic Act No. 2882, otherwise known as the Medical Act of 1959. Thereafter
petitioner Philippine Medical Association filed an action contending that the grant of the respondents
certificate for the general practice of medicine in the Philippines without the examination prescribed by
law is violative of the law and that the respondent Board of Medical Examiners had exceeded its
authority in passing the resolution that granted respondent Torres said certificate. Respondent
contends that under the Treaty on the Validity of Academic Degrees and the Exercise of the Professions
between the Republic of the Philippines and the Spanish State, she can be allowed to perform general
practice of medicine in the country without taking the required examination.

Issue:
Whether or not respondent should be allowed to perform the general practice of medicine in the
Philippines even without taking the examination required by law.
Ruling:
The SC held that the benefits of the aforementioned Treaty merely extended to diplomas issued or
degrees conferred by educational institutions of Spain the same recognition and treatment that the
Philippines accord to similar diplomas or degrees from local institutions of learning. Thus, holders of said
Spanish diplomas or degrees must take the examination prescribed by the Philippines laws for holders
of similar diplomas or degrees from educational institutions in the Philippines. The resolution No. 25,
series of 1965, of respondent Board is violative of Republic Act No. 2882 and hence, null and void; and
that, respondent Board of Medical Examiners should be, as it is hereby ordered to cancel the certificate
of registration, for the practice of medicine in the Philippines, issued in favor of respondent Jose Ma.
Torres.

22. TABLARIN VS. GUTIERREZ

152 SCRA 730; G.R. No. 78164; 31 July 1987
Facts:
The petitioners sought to enjoin the Secretary of Education, Culture and Sports, the Board of Medical
Education and the Center for Educational Measurement from enforcing Section 5 (a) and (f) of Republic
Act No. 2382, as amended, and MECS Order No. 52, series of 1985, dated 23 August 1985 and from
requiring the taking and passing of the NMAT as a condition for securing certificates of eligibility for
admission, from proceeding with accepting applications for taking the NMAT and from administering the
NMAT as scheduled on 26 April 1987 and in the future. The trial court denied said petition on 20 April
1987. The NMAT was conducted and administered as previously scheduled.
Republic Act 2382, as amended by Republic Acts Nos. 4224 and 5946, known as the "Medical Act of
1959" defines its basic objectives in the following manner:
"SECTION 1. Objectives. This Act provides for and shall govern (a) the standardization and regulation
of medical education; (b) the examination for registration of physicians; and (c) the supervision, control
and regulation of the practice of medicine in the Philippines."
The statute, among other things, created a Board of Medical Education. Its functions as specified in
Section 5 of the statute include the following:
"(a) To determine and prescribe requirements for admission into a recognized college of medicine;
xxx
(f) To accept applications for certification for admission to a medical school and keep a register of those

issued said certificate; and to collect from said applicants the amount of twenty-five pesos each which
shall accrue to the operating fund of the Board of Medical Education;
Section 7 prescribes certain minimum requirements for applicants to medical schools:
"Admission requirements. The medical college may admit any student who has not been convicted by
any court of competent jurisdiction of any offense involving moral turpitude and who presents (a) a
record of completion of a bachelor's degree in science or arts; (b) a certificate of eligibility for entrance
to a medical school from the Board of Medical Education; (c) a certificate of good moral character issued
by two former professors in the college of liberal arts; and (d) birth certificate. Nothing in this act shall
be construed to inhibit any college of medicine from establishing, in addition to the preceding, other
entrance requirements that may be deemed admissible.
MECS Order No. 52, s. 1985, issued by the then Minister of Education, Culture and Sports and dated 23
August 1985, established a uniform admission test called the National Medical Admission Test (NMAT)
as an additional requirement for issuance of a certificate of eligibility for admission into medical schools
of the Philippines, beginning with the school year 1986-1987. This Order goes on to state that: "2. The
NMAT, an aptitude test, is considered as an instrument toward upgrading the selection of applicants for
admission into the medical schools and its calculated to improve the quality of medical education in the
country. The cutoff score for the successful applicants, based on the scores on the NMAT, shall be
determined every year by the Board of Medical Education after consultation with the Association of
Philippine Medical Colleges. The NMAT rating of each applicant, together with the other admission
requirements as presently called for under existing rules, shall serve as a basis for the issuance of the
prescribed certificate of eligibility for admission into the medical colleges.

Issue:
Whether or not Section 5 (a) and (f) of Republic Act No. 2382, as amended, and MECS Order No. 52, s.
1985 are constitutional.

Held:
Yes. We conclude that prescribing the NMAT and requiring certain minimum scores therein as a
condition for admission to medical schools in the Philippines, do not constitute an unconstitutional
imposition.
The police power, it is commonplace learning, is the pervasive and non-waivable power and authority of
the sovereign to secure and promote all the important interests and needs in a word, the public order
of the general community. An important component of that public order is the health and physical
safety and well being of the population, the securing of which no one can deny is a legitimate objective
of governmental effort and regulation. Perhaps the only issue that needs some consideration is whether
there is some reasonable relation between the prescribing of passing the NMAT as a condition for
admission to medical school on the one hand, and the securing of the health and safety of the general
community, on the other hand. This question is perhaps most usefully approached by recalling that the
regulation of the practice of medicine in all its branches has long been recognized as a reasonable
method
of
protecting
the
health
and
safety
of
the
public.

MECS Order No. 52, s. 1985 articulates the rationale of regulation of this type: the improvement of the
professional and technical quality of the graduates of medical schools, by upgrading the quality of those
admitted to the student body of the medical schools. That upgrading is sought by selectivity in the
process of admission, selectivity consisting, among other things, of limiting admission to those who
exhibit in the required degree the aptitude for medical studies and eventually for medical practice. The
need to maintain, and the difficulties of maintaining, high standards in our professional schools in
general, and medical schools in particular, in the current stage of our social and economic development,
are widely known. We believe that the government is entitled to prescribe an admission test like the
NMAT as a means for achieving its stated objective of "upgrading the selection of applicants into [our]
medical schools" and of "improv[ing] the quality of medical education in the country. We are entitled to
hold that the NMAT is reasonably related to the securing of the ultimate end of legislation and
regulation in this area. That end, it is useful to recall, is the protection of the public from the potentially
deadly effects of incompetence and ignorance in those who would undertake to treat our bodies and
minds for disease or trauma. WHEREFORE, the Petition for Certiorari is DISMISSED.

23. Board of Medical Education v. Alfonso

G.R. 88259 August 10, 1989
Facts:
Upon finding, after conducting several inspections and evaluations, that the respondent Philippine
Muslim-Christian College of Medicine Foundation, Inc. fell very much short of the minimum standards
set for medical schools, the petitioner Board of Medical Education recommended to the DECS the
closure of the said College. Secretary Lourdes Quisumbing of DECS ordered the closure of the said
College. The College appealed to the Office of the President, however, the contested decision was
affirmed. Thereafter, the College filed a case against Secretary Quisumbing in her capacity as Secretary
of Education, Culture and Sports, questioning the decision as illegal, oppressive, arbitrary and
discriminatory. The trial court ruled that there was no basis in ordering the closure of the College, as
there was no evidence supporting such findings. It ordered a writ of injunction for the closure order
made by Secretary Quisumbing. Hence, the petition.
Issue:
Whether or not the Philippine Muslim-Christian College of Medicine Foundation, Inc. should be closed.
Held:
There have been several evaluations conducted on the College and all yielded to the findings that it have
failed to fully comply with the prescribed requirements by law. The discovered deficiencies as a medical
college (i.e., the inadequate faculty with no prospects for satisfactory growth and development, and the
total lack of serious development efforts in academic medicine) are so serious a character as to be
irremediable. Under the law, the Secretary of Education, Culture and Sports have the power to enjoin
compliance with the requirements laid down for medical schools and to mete out sanctions where he
finds that violations thereof have been committed. In the case at bar, Secretary Quisumbing correctly
ordered the closure of the College after it had been given several opportunities to comply with certain

requirements yet it failed to do so. It was grave abuse of discretion for respondent judge to issue the
questioned injunction and there by thwart official action.

24. DEPARTMENT OF EDUCATION, CULTURE AND SPORTS (DECS) and DIRECTOR OF CENTER FOR
EDUCATIONAL MEASUREMENT vs. ROBERTO REY C. SAN DIEGO
G.R. No. 89572 December 21, 1989
Facts:
The private respondent Roberto Rey San Diego, is a graduate of the University of the East with a degree
of Bachelor of Science in Zoology. The petitioner claims that he took the NMAT three times and flunked
it as many times. When he applied to take it again, the petitioner rejected his application on the basis of
the aforesaid rule. He then went to the Regional Trial Court of Valenzuela, Metro Manila, to compel his
admission to the test. After hearing, the respondent judge rendered a decision on July 4, 1989, declaring
the challenged order invalid and granting the petition. Judge Teresita Dizon-Capulong held that the
petitioner had been deprived of his right to pursue a medical education through an arbitrary exercise of
the police power.
Issue:
Whether or not San Diego is entitled to take NMAT as requirement for admission to any medical school?

Held:
The private respondent cannot take the NMAT again and pursue his medical profession because of the
following grounds:
1. For the purpose of gauging at least initially by the admission test and by the three-flunk rule, a
student shall not be allowed to take the NMAT again after three successive failures.
2. The State ensures that medical profession is not permeated by incompetents to whom patients may
unwarily hand over their lives and health.
3.It is not enough to simply invoke the right to quality education as a guarantee of the Constitution,
while one has the right to aspire to be a doctor, he does not have the constitutional right to be a doctor;
one must show that he is entitled to it because of his preparation and promise.
4. The conflict that the challenged rule violates the equal protection clause is not well taken.
Conformable to Article III, Section 1 of the Constitution, a law does not have to operate with equal force
on all person or things.

25. PRC vs. De Guzman et al.

GR 144681 June 21, 2004
Facts:

The respondents are all graduates of the Fatima College of Medicine, Valenzuela City, Metro Manila.
They passed the Physician Licensure Examination conducted in February 1993 by the Board of Medicine
(Board). Petitioner Professional Regulation Commission (PRC) then released their names as successful
examinees in the medical licensure examination. Shortly thereafter, the Board observed that the grades
of the seventy-nine successful examinees from Fatima College in the two most difficult subjects in the
medical licensure exam, Biochemistry (Bio-Chem) and Obstetrics and Gynecology (OB-Gyne), were
unusually and exceptionally high. Eleven Fatima examinees scored 100% in Bio-Chem and ten got 100%
in OB-Gyne, another eleven got 99% in Bio-Chem, and twenty-one scored 99% in OB-Gyne. The Board
also observed that many of those who passed from Fatima got marks of 95% or better in both subjects,
and no one got a mark lower than 90%. A comparison of the performances of the candidates from other
schools was made. The Board observed that strangely, the unusually high ratings were true only for
Fatima College examinees. It was a record-breaking phenomenon in the history of the Physician
Licensure Examination. On June 7, 1993, the Board issued Resolution No. 19, withholding the
registration as physicians of all the examinees from the Fatima College of Medicine. The PRC asked the
National Bureau of Investigation (NBI) to investigate whether any anomaly or irregularity marred the
February 1993 Physician Licensure Examination. For its part, the NBI found that the questionable
passing rate of Fatima examinees in the [1993] Physician Examination leads to the conclusion that the
Fatima
examinees
gained
early
access
to
the
test
questions.

Issue:
Was

the

act

pursuant

to

R.A.

2382

valid

exercise

of

police

power

Held:
Yes, it is true that this Court has upheld the constitutional right of every citizen to select a profession or
course of study subject to a fair, reasonable, and equitable admission and academic requirements. But
like all rights and freedoms guaranteed by the Charter, their exercise may be so regulated pursuant to
the police power of the State to safeguard health, morals, peace, education, order, safety, and general
welfare of the people. Thus, persons who desire to engage in the learned professions requiring scientific
or technical knowledge may be required to take an examination as a prerequisite to engaging in their
chosen careers. This regulation takes particular pertinence in the field of medicine, to protect the public
from the potentially deadly effects of incompetence and ignorance among those who would practice
medicine.
It must be stressed, nevertheless, that the power to regulate the exercise of a profession or pursuit of an
occupation cannot be exercised by the State or its agents in an arbitrary, despotic, or oppressive
manner. A political body that regulates the exercise of a particular privilege has the authority to both
forbid and grant such privilege in accordance with certain conditions. Such conditions may not,
however, require giving up ones constitutional rights as a condition to acquiring the license. Under the
view that the legislature cannot validly bestow an arbitrary power to grant or refuse a license on a public
agency or officer, courts will generally strike down license legislation that vests in public officials
discretion to grant or refuse a license to carry on some ordinarily lawful business, profession, or activity
without prescribing definite rules and conditions for the guidance of said officials in the exercise of their
power.

26. BOARD OF MEDICINE, DR. RAUL FLORES (NOW DR. JOSE S. RAMIREZ), IN HIS CAPACITY AS
CHAIRMAN OF THE BOARD, PROFESSIONAL REGULATION COMMISSION, THROUGH ITS CHAIRMAN,
HERMOGENES POBRE (NOW DR. ALCESTIS M. GUIANG), PETITIONERS, VS. YASUYUKI OTA,
RESPONDENT.
G.R. No. 166097, July 14, 2008
Facts:
Yasuyuki Ota (respondent) is a Japanese national, married to a Filipina, who has continuously resided in
the Philippines for more than 10 years. He graduated from Bicol Christian College of Medicine on April
21, 1991 with a degree of Doctor of Medicine. After successfully completing a one-year post graduate
internship training at the Jose Reyes Memorial Medical Center, he filed an application to take the
medical board examinations in order to obtain a medical license. He was required by the Professional
Regulation Commission (PRC) to submit an affidavit of undertaking, stating among others that should he
successfully pass the same, he would not practice medicine until he submits proof that reciprocity
exists between Japan and the Philippines in admitting foreigners into the practice of medicine.
Respondent submitted a duly notarized English translation of the Medical Practitioners Law of Japan
duly authenticated by the Consul General of the Philippine Embassy to Japan, Jesus I. Yabes; thus, he
was allowed to take the Medical Board Examinations in August 1992, which he subsequently passed.
In spite of all these, the Board of Medicine (Board) of the PRC, in a letter dated March 8, 1993, denied
respondent's request for a license to practice medicine in the Philippines on the ground that the
Board "believes that no genuine reciprocity can be found in the law of Japan as there is no Filipino or
foreigner who can possibly practice there." Respondent then filed a Petition for Certiorari and
Mandamus against the Board before the RTC of Manila on June 24, 1993. In his petition before the RTC,
respondent alleged that the Board and the PRC, in refusing to issue in his favor a Certificate of
Registration and/or license to practice medicine, had acted arbitrarily, in clear contravention of the
provision of Section 20 of Republic Act (R.A.) No. 2382 (The Medical Act of 1959), depriving him of his
legitimate right to practice his profession in the Philippines to his great damage and prejudice.
The RTC decided in favor of the respondent and thereby ordering the Board to issue in favor of
respondent the corresponding Certificate of Registration and/or license to practice medicine in the
Philippines. However, the Board and the PRC (petitioners) appealed the case to the CA, stating that
while respondent submitted documents showing that foreigners are allowed to practice medicine in
Japan, it was not shown that the conditions for the practice of medicine there are practical and
attainable by a foreign applicant, hence, reciprocity was not established; also, the power of the PRC and
the Board to regulate and control the practice of medicine is discretionary and not ministerial, hence,
not compellable by a writ of mandamus. The CA denied the appeal and affirmed the ruling of the RTC.
Issue:
Whether or not reciprocity in the practice of medicine exists between the Philippines and Japan
Held:

Yes.
R.A. No. 2382 otherwise known as the Medical Act of 1959 states in Section 9 thereof that:
Section 9. Candidates for Board Examinations. Candidates for Board examinations shall have the
following qualifications:
1. He shall be a citizen of the Philippines or a citizen of any foreign country who has submitted
competent and conclusive documentary evidence, confirmed by the Department of Foreign
Affairs, showing that his country's existing laws permit citizens of the Philippines to practice
medicine under the same rules and regulations governing citizens thereof;
xxxx
Presidential Decree (P.D.) No. 223 also provides in Section (j) thereof that:
j) The [Professional Regulation] Commission may, upon the recommendation of the Board concerned,
approve the registration of and authorize the issuance of a certificate of registration with or without
examination to a foreigner who is registered under the laws of his country: Provided, That the
requirement for the registration or licensing in said foreign state or country are substantially the same
as those required and contemplated by the laws of the Philippines and that the laws of such foreign
state or country allow the citizens of the Philippines to practice the profession on the same basis and
grant the same privileges as the subject or citizens of such foreign state or country: Provided, finally,
That the applicant shall submit competent and conclusive documentary evidence, confirmed by the
Department of Foreign Affairs, showing that his country's existing laws permit citizens of the Philippines
to practice the profession under the rules and regulations governing citizens thereof. The Commission is
also hereby authorized to prescribe additional requirements or grant certain privileges to foreigners
seeking registration in the Philippines if the same privileges are granted to or some additional
requirements are required of citizens of the Philippines in acquiring the same certificates in his country;
xxxx
As required by the said laws, respondent submitted a copy of the Medical Practitioners Law of Japan,
duly authenticated by the Consul General of the Embassy of the Philippines in Japan, which provides in
Articles 2 and 11, thus:
Article 2. Anyone who wants to be medical practitioner must pass the national examination for medical
practitioner
and
get
license
from
the
Minister
of
Health
and
Welfare.
xxxx
Article 11. No one can take the National Medical Examination except persons who conform to one of
the following items:
1. Persons who finished regular medical courses at a university based on the School Education
Laws (December 26, 1947) and graduated from said university.
2. Persons who passed the preparatory test for the National Medical Examination and practiced
clinics and public sanitation more than one year after passing the said test.

3. Persons who graduated from a foreign medical school or acquired medical practitioner license
in a foreign country, and also are recognized to have the same or more academic ability and
techniques as persons stated in item 1 and item 2 of this article.
Petitioners argue that while the Medical Practitioners Law of Japan allows foreigners to practice
medicine therein, said document does not show that conditions for the practice of medicine in said
country are practical and attainable by a foreign applicant; and since the requirements are practically
impossible for a Filipino to comply with, there is no reciprocity between the two countries, hence,
respondent may not be granted license to practice medicine in the Philippines. The Court does not
agree.
R.A. No. 2382, which provides who may be candidates for the medical board examinations, merely
requires a foreign citizen to submit competent and conclusive documentary evidence, confirmed by the
Department of Foreign Affairs (DFA), showing that his country's existing laws permit citizens of the
Philippines to practice medicine under the same rules and regulations governing citizens thereof.
Section (j) of P.D. No. 223 also defines the extent of PRC's power to grant licenses, i.e., it may, upon
recommendation of the board, approve the registration and authorize the issuance of a certificate of
registration with or without examination to a foreigner who is registered under the laws of his country,
provided the following conditions are met: (1) that the requirement for the registration or licensing in
said foreign state or country are substantially the same as those required and contemplated by the laws
of the Philippines; (2) that the laws of such foreign state or country allow the citizens of the Philippines to
practice the profession on the same basis and grant the same privileges as the subject or citizens of such
foreign state or country; and (3) that the applicant shall submit competent and conclusive documentary
evidence, confirmed by the DFA, showing that his country's existing laws permit citizens of the
Philippines to practice the profession under the rules and regulations governing citizens thereof.
The said provision further states that the PRC is authorized to prescribe additional requirements or grant
certain privileges to foreigners seeking registration in the Philippines if the same privileges are granted
to or some additional requirements are required of citizens of the Philippines in acquiring the same
certificates in his country. Nowhere in said statutes is it stated that the foreign applicant must show
that the conditions for the practice of medicine in said country are practical and attainable by
Filipinos. Neither is it stated that it must first be proven that a Filipino has been granted license and
allowed to practice his profession in said country before a foreign applicant may be given license to
practice in the Philippines.
Indeed, the phrase used in both R.A. No. 2382 and P.D. No. 223 is that: [T]he applicant shall submit]
competent and conclusive documentary evidence, confirmed by the Department of Foreign Affairs,
showing that his country's existing laws permit citizens of the Philippines to practice the profession [of
medicine] under the [same] rules and regulations governing citizens thereof. x x x (Emphasis supplied) It
is enough that the laws in the foreign country permit a Filipino to get license and practice therein.
Requiring respondent to prove first that a Filipino has already been granted license and is actually
practicing therein unduly expands the requirements provided for under R.A. No. 2382 and P.D. No. 223.
While it is true that respondent failed to give details as to the conditions stated in the Medical
Practitioners Law of Japan -- i.e., the provisions of the School Educations Laws, the criteria of the
Minister of Health and Welfare of Japan in determining whether the academic and technical capability
of foreign medical graduates are the same as or better than that of graduates of medical schools in
Japan, and who can actually qualify to take the preparatory test for the National Medical Examination

respondent, however, presented proof that foreigners are actually practicing in Japan and that Filipinos
are
not
precluded
from
getting
a
license
to
practice
there.

In fine, the only matter being questioned by petitioners is the alleged failure of respondent to prove that
there is reciprocity between the laws of Japan and the Philippines in admitting foreigners into the
practice of medicine. Respondent has satisfactorily complied with the said requirement and the CA has
not committed any reversible error in rendering its Decision dated November 16, 2004 and Resolution
dated October 19, 2003.