Cases and Doctrines On Legal Medicine

LEGAL Doctrines and Principles
[LEGAL MEDICINE] with Jurisprudence
MEDICINE
Doctrines and Principles with Jurisprudence
Prepared by:
ELIZA M. MONTEMAYOR
0
Doctrines and Principles
Illegal
Practice of
Medicine
- practice of medicine by any
person not qualified and not
duly-admitted to perform
medical acts in compliance with
law.
1
ORLANDO D. GARCIA, JR., G.R. No. 168512

doing business under the name and
style COMMUNITY DIAGNOSTIC
CENTER and BU CASTRO,
Petitioners
- versus -
RANIDA D. SALVADOR and
RAMON SALVADOR,
Respondents. Promulgated:
March 20, 2007
x ---------------------------------------------------------------------------------------- x
This is a petition for review under Rule 45 of the Rules of Court assailing the February 27,
2004 Decision of the Court of Appeals in CA-G.R. CV No. 58668 finding petitioner Orlando D. Garcia
liable for gross negligence; and its June 16, 2005 Resolution denying petitioner’s motion for
reconsideration.
On October 1, 1993, respondent Ranida D. Salvador started working as a trainee in the

Accounting Department of Limay Bulk Handling Terminal, Inc. (the Company). As a prerequisite for
regular employment, she underwent a medical examination at the Community Diagnostic Center
(CDC). Garcia who is a medical technologist, conducted the HBs Ag (Hepatitis B Surface Antigen)
test and on October 22, 1993, CDC issued the test result indicating that Ranida was “HBs Ag:
Reactive.” The result bore the name and signature of Garcia as examiner and the rubber stamp
signature of Castro as pathologist.
When Ranida submitted the test result to Dr. Sto. Domingo, the Company physician, the
latter apprised her that the findings indicated that she is suffering from Hepatitis B, a liver
disease. Thus, based on the medical report submitted by Sto. Domingo, the Company terminated
Ranida’s employment for failing the physical examination.
When Ranida informed her father, Ramon, about her ailment, the latter suffered a heart attack
and was confined at the Bataan Doctors Hospital. During Ramon’s confinement, Ranida underwent
another HBs Ag test at the said hospital and the result indicated that she is non-reactive. She
informed Sto. Domingo of this development but was told that the test conducted by CDC was more
reliable because it used the Micro-Elisa Method.
Thus, Ranida went back to CDC for confirmatory testing, and this time, the Anti-HBs test
conducted on her indicated a “Negative” result.
Ranida also underwent another HBs Ag test at the Bataan Doctors Hospital using the Micro-
Elisa Method. The result indicated that she was non-reactive.
2
Ranida submitted the test results from Bataan Doctors Hospital and CDC to the Executive
Officer of the Company who requested her to undergo another similar test before her re-employment
would be considered. Thus, CDC conducted another HBs Ag test on Ranida which indicated a
“Negative” result. Ma. Ruby G. Calderon, Med-Tech Officer-in-Charge of CDC, issued a Certification
correcting the initial result and explaining that the examining medical technologist (Garcia)
interpreted the delayed reaction as positive or reactive.
Thereafter, the Company rehired Ranida.
On July 25, 1994, Ranida and Ramon filed a complaint for damages against petitioner Garcia
and a purportedly unknown pathologist of CDC, claiming that, by reason of the erroneous
interpretation of the results of Ranida’s examination, she lost her job and suffered serious mental
anxiety, trauma and sleepless nights, while Ramon was hospitalized and lost business opportunities.
On September 26, 1994, respondents amended their complaint by naming Castro as the
“unknown pathologist.”
Garcia denied the allegations of gross negligence and incompetence and reiterated the
scientific explanation for the “false positive” result of the first HBs Ag test in his December 7,
1993 letter to the respondents.
For his part, Castro claimed that as pathologist, he rarely went to CDC and only when a
case was referred to him; that he did not examine Ranida; and that the test results bore only his
rubber-stamp signature.
On September 1, 1997, the trial court dismissed the complaint for failure of the respondents to
present sufficient evidence to prove the liability of Garcia and Castro. It held that respondents
should have presented Sto. Domingo because he was the one who interpreted the test result issued
by CDC. Likewise, respondents should have presented a medical expert to refute the testimonies of
Garcia and Castro regarding the medical explanation behind the conflicting test results on Ranida.
Respondents appealed to the Court of Appeals which reversed the trial court’s findings, the
dispositive portion of which states:
WHEREFORE, the decision appealed from is REVERSED and SET ASIDE

and another one entered ORDERING defendant-appellee Orlando D. Garcia, Jr. to
pay plaintiff-appellant Ranida D. Salvador moral damages in the amount of
P50,000.00, exemplary damages in the amount of P50,000.00 and attorney’s fees in
the amount of P25,000.00.
SO ORDERED.
The appellate court found Garcia liable for damages for negligently issuing an erroneous HBs
Ag result. On the other hand, it exonerated Castro for lack of participation in the issuance of the
results.
After the denial of his motion for reconsideration, Garcia filed the instant petition.
3
The main issue for resolution is whether the Court of Appeals, in reversing the decision of
the trial court, correctly found petitioner liable for damages to the respondents for issuing an
incorrect HBsAG test result.
Garcia maintains he is not negligent, thus not liable for damages, because he followed the
appropriate laboratory measures and procedures as dictated by his training and experience; and that
he did everything within his professional competence to arrive at an objective, impartial and
impersonal result.
At the outset, we note that the issues raised are factual in nature. Whether a person is
negligent or not is a question of fact which we cannot pass upon in a petition for review
on certiorari which is limited to reviewing errors of law.
Negligence is the failure to observe for the protection of the interest of another person that
degree of care, precaution and vigilance which the circumstances justly demand, whereby such
other person suffers injury. For health care providers, the test of the existence of negligence is: did
the health care provider either fail to do something which a reasonably prudent health care provider
would have done, or that he or she did something that a reasonably prudent health care provider
would not have done; and that failure or action caused injury to the patient; if yes, then he is guilty of
negligence.
Thus, the elements of an actionable conduct are: 1) duty, 2) breach, 3) injury, and 4)
proximate causation.
All the elements are present in the case at bar.
Owners and operators of clinical laboratories have the duty to comply with statutes, as well
as rules and regulations, purposely promulgated to protect and promote the health of the people by
preventing the operation of substandard, improperly managed and inadequately supported clinical
laboratories and by improving the quality of performance of clinical laboratory examinations. Their
business is impressed with public interest, as such, high standards of performance are expected
from them.
In F.F. Cruz and Co., Inc. v. Court of Appeals, we found the owner of a furniture shop liable
for the destruction of the plaintiff’s house in a fire which started in his establishment in view of his
failure to comply with an ordinance which required the construction of a firewall. In Teague v.
Fernandez, we stated that where the very injury which was intended to be prevented by the
ordinance has happened, non-compliance with the ordinance was not only an act of negligence, but
also the proximate cause of the death.
In fine, violation of a statutory duty is negligence. Where the law imposes upon a person the
duty to do something, his omission or non-performance will render him liable to whoever may be
injured thereby.
Section 2 of Republic Act (R.A.) No. 4688, otherwise known as The Clinical Laboratory Law,
provides:
4
Sec. 2. It shall be unlawful for any person to be professionally in-charge of a

registered clinical laboratory unless he is a licensed physician duly qualified in
laboratory medicine and authorized by the Secretary of Health, such authorization to
be renewed annually.
No license shall be granted or renewed by the Secretary of Health for the

operation and maintenance of a clinical laboratory unless such laboratory is under
the administration, direction and supervision of an authorized physician, as provided
for in the preceding paragraph.
Corollarily, Sections 9(9.1)(1), 11 and 25(25.1)(1) of the DOH Administrative Order No. 49-B
Series of 1988, otherwise known as the Revised Rules and Regulations Governing the Registration,
Operation and Maintenance of Clinical Laboratories in the Philippines, read:
Sec. 9. Management of the Clinical Laboratory:
9.1 Head of the Clinical Laboratory: The head is that

person who assumes technical and administrative
supervision and control of the activities in the laboratory.
For all categories of clinical laboratories, the head

shall be a licensed physician certified by the Philippine
Board of Pathology in either Anatomic or Clinical Pathology
or both provided that:
(1) This shall be mandatory for all categories of

free-standing clinical laboratories; all tertiary category
hospital laboratories and for all secondary category hospital
laboratories located in areas with sufficient available
pathologist.
xxxx
Sec. 11. Reporting: All laboratory requests shall be considered as

consultations between the requesting physician and pathologist of the
laboratory. As such all laboratory reports on various examinations of human
specimens shall be construed as consultation report and shall bear the name of the
pathologist or his associate. No person in clinical laboratory shall issue a report,
orally or in writing, whole portions thereof without a directive from the pathologist or
his authorized associate and only to the requesting physician or his authorized
representative except in emergencies when the results may be released as
authorized by the pathologist.
xxxx
Sec. 25. Violations:
5
25.1 The license to operate a clinical laboratory may be suspended or

revoked by the Undersecretary of Health for Standards and Regulation upon
violation of R.A. 4688 or the rules and regulations issued in pursuance thereto or the
commission of the following acts by the persons owning or operating a clinical
laboratory and the persons under their authority.
(1) Operation of a Clinical Laboratory without a certified

pathologist or qualified licensed physician authorized by the
Undersecretary of Health or without employing a registered
medical technologist or a person not registered as a
medical technologist in such a position.
And Section 29(b) of R.A. No. 5527, otherwise known as The Philippine Medical Technology
Act of 1969, reads:
Section 29. Penal Provisions.- Without prejudice to the provision of the Medical Act
of 1959, as amended relating to illegal practice of Medicine, the following shall be
punished by a fine of not less than two thousand pesos nor more than five thousand
pesos, or imprisonment for not less than six months nor more than two years, or
both, in the discretion of the court:
xxxx
(b) Any medical technologist, even if duly registered, who shall practice
medical technology in the Philippines without the necessary supervision of a
qualified pathologist or physician authorized by the Department of Health;
From the foregoing laws and rules, it is clear that a clinical laboratory must be administered,
directed and supervised by a licensed physician authorized by the Secretary of Health, like a
pathologist who is specially trained in methods of laboratory medicine; that the medical technologist
must be under the supervision of the pathologist or a licensed physician; and that the results of any
examination may be released only to the requesting physician or his authorized representative upon
the direction of the laboratory pathologist.
These rules are intended for the protection of the public by preventing performance of
substandard clinical examinations by laboratories whose personnel are not properly
supervised. The public demands no less than an effective and efficient performance of clinical
laboratory examinations through compliance with the quality standards set by laws and regulations.
We find that petitioner Garcia failed to comply with these standards.
First, CDC is not administered, directed and supervised by a licensed physician as required
by law, but by Ma. Ruby C. Calderon, a licensed Medical Technologist. In the License to Open and
Operate a Clinical Laboratory for the years 1993 and 1996 issued by Dr. Juan R. Nañagas, M.D.,
Undersecretary for Health Facilities, Standards and Regulation, defendant-appellee Castro was
named as the head of CDC. However, in his Answer with Counterclaim, he stated:
6
3. By way of affirmative and special defenses, defendant pathologist further

avers and plead as follows:
Defendant pathologist is not the owner of

the Community Diagnostic Center nor an employee of the same nor the employer of
its employees. Defendant pathologist comes to
theCommunity Diagnostic Center when and where a problem is referred to him. Its
employees are licensed under the Medical Technology Law (Republic Act No. 5527)
and are certified by, and registered with, the Professional Regulation Commission
after having passed their Board Examinations. They are competent within the
sphere of their own profession in so far as conducting laboratory examinations and
are allowed to sign for and in behalf of the clinical laboratory. The defendant
pathologist, and all pathologists in general, are hired by laboratories for purposes of
complying with the rules and regulations and orders issued by the Department of
Health through the Bureau of Research and Laboratories. Defendant pathologist
does not stay that long period of time at the Community Diagnostic Center but only
periodically or whenever a case is referred to him by the laboratory. Defendant
pathologist does not appoint or select the employees of the laboratory nor does he
arrange or approve their schedules of duty.
Castro’s infrequent visit to the clinical laboratory barely qualifies as an effective

administrative supervision and control over the activities in the laboratory. “Supervision and control”
means the authority to act directly whenever a specific function is entrusted by law or regulation to a
subordinate; direct the performance of duty; restrain the commission of acts; review, approve, revise
or modify acts and decisions of subordinate officials or units.
Second, Garcia conducted the HBsAG test of respondent Ranida without the supervision of
defendant-appellee Castro, who admitted that:
[He] does not know, and has never known or met, the plaintiff-patient even
up to this time nor has he personally examined any specimen, blood, urine or any
other tissue, from the plaintiff-patient otherwise his own handwritten signature would
have appeared in the result and not merely stamped as shown in Annex “B” of the
Amended Complaint.
Last, the disputed HBsAG test result was released to respondent Ranida without the
authorization of defendant-appellee Castro.
Garcia may not have intended to cause the consequences which followed after the release
of the HBsAG test result. However, his failure to comply with the laws and rules promulgated and
issued for the protection of public safety and interest is failure to observe that care which a
reasonably prudent health care provider would observe. Thus, his act or omission constitutes a
breach of duty.
Indubitably, Ranida suffered injury as a direct consequence of Garcia’s failure to comply with
the mandate of the laws and rules aforequoted. She was terminated from the service for failing the
physical examination; suffered anxiety because of the diagnosis; and was compelled to undergo
7
several more tests. All these could have been avoided had the proper safeguards been scrupulously
followed in conducting the clinical examination and releasing the clinical report.
Article 20 of the New Civil Code provides:
Art. 20. Every person who, contrary to law, willfully or negligently causes
damage to another, shall indemnify the latter for the same.
The foregoing provision provides the legal basis for the award of damages to a party who
suffers damage whenever one commits an act in violation of some legal provision. This was
incorporated by the Code Commission to provide relief to a person who suffers damage because
another has violated some legal provision.
We find the Court of Appeals’ award of moral damages reasonable under the circumstances
bearing in mind the mental trauma suffered by respondent Ranida who thought she was afflicted by
Hepatitis B, making her “unfit or unsafe for any type of employment.” Having established her right to
moral damages, we see no reason to disturb the award of exemplary damages and attorney’s
fees. Exemplary damages are imposed, by way of example or correction for the public good, in
addition to moral, temperate, liquidated or compensatory damages, and attorney’s fees may be
recovered when, as in the instant case, exemplary damages are awarded.
WHEREFORE, the Decision of the Court of Appeals in CA-G.R. CV No. 58668

dated February 27, 2004 finding petitioner Orlando D. Garcia, Jr. guilty of gross negligence and
liable to pay to respondents P50,000.00 as moral damages, P50,000.00 as exemplary damages,
and P25,000.00 as attorney’s fees, is AFFIRMED.
SO ORDERED.
8
Doctrine of
Res Ipsa
Loquitor
- “The thing speaks for itself”;

nature of the wrongful act or injury is
suggestive of negligence.
- General rule: expert testimony is
necessary to prove that a physician
has done a negligent act or that has
9
deviated from the standard of medical

practice.
DR. MILAGROS L. CANTRE, G.R. No. 160889

Petitioner,
- versus - .
SPS. JOHN DAVID Z. GO and Promulgated:

NORA S. GO,
Respondents. April 27, 2007
x ------------------------------------------------x
For review on certiorari are the Decision dated October 3, 2002 and Resolution dated
November 19, 2003 of the Court of Appeals in CA-G.R. CV No. 58184, which affirmed with
modification the Decision dated March 3, 1997 of the Regional Trial Court of Quezon City, Branch
98, in Civil Case No. Q-93-16562.
The facts, culled from the records, are as follows:
Petitioner Dr. Milagros L. Cantre is a specialist in Obstetrics and Gynecology at the Dr.
Jesus Delgado Memorial Hospital. She was the attending physician of respondent Nora S. Go, who
was admitted at the said hospital on April 19, 1992.
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 Nora’s blood pressure. Her blood pressure was frequently monitored with the use of a
sphygmomanometer. While petitioner was massaging Nora’s uterus for it to contract and stop
bleeding, she ordered a droplight to warm Nora and her baby. 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 ½) by three and a half (3 ½) inches in the inner portion of her left
arm, close to the armpit. He asked the nurses what caused the injury. He was informed it was a
burn. Forthwith, on April 22, 1992, John David filed a request for investigation. In response,
10
Dr. Rainerio S. Abad, the medical director of the hospital, called petitioner and the assisting resident
physician to explain what happened. Petitioner said the blood pressure cuff caused the injury.
On May 7, 1992, John David brought Nora to the National Bureau of Investigation for a
physical examination, which was conducted by medico-legal officer Dr.Floresto Arizala, Jr. The
medico-legal officer later testified that Nora’s injury appeared to be a burn and that a droplight when
placed near the skin for about 10 minutes could cause such burn. He dismissed the likelihood that
the wound was caused by a blood pressure cuff as the scar was not around the arm, but just on one
side of the arm.
On May 22, 1992, Nora’s injury was referred to a plastic surgeon at the Dr. Jesus Delgado
Memorial Hospital for skin grafting. Her wound was covered with skin sourced from her abdomen,
which consequently bore a scar as well. About a year after, on April 30, 1993, scar revision had to be
performed at the same hospital. The surgical operation left a healed linear scar in Nora’s left arm
about three inches in length, the thickest portion rising about one-fourth (1/4) of an inch from the
surface of the skin. The costs of the skin grafting and the scar revision were shouldered by the
hospital.
Unfortunately, Nora’s arm would never be the same. Aside from the unsightly mark, the pain
in her left arm remains. When sleeping, she has to cradle her wounded arm. Her movements now
are also restricted. Her children cannot play with the left side of her body as they might accidentally
bump the injured arm, which aches at the slightest touch.
Thus, on June 21, 1993, respondent spouses filed a complaintfor damages against
petitioner, Dr. Abad, and the hospital. Finding in favor of respondent spouses, the trial court decreed:
In view of the foregoing consideration, judgment is hereby rendered in favor

of the plaintiffs and against the defendants, directing the latters, (sic) jointly and
severally –
(a) to pay the sum of Five Hundred Thousand Pesos (P500,000.00) in

moral damages;
(b) to pay the sum of One Hundred Fifty Thousand Pesos
(P150,000.00) exemplary damages;
(c) to pay the sum of Eighty Thousand Pesos (P80,000.00) nominal
damages;
(d) to pay Fifty Thousand Pesos (P50,000.00) for and as attorney’s
fees; and
(e) to pay Six Thousand Pesos (P6,000.00) litigation expenses.
SO ORDERED.
Petitioner, Dr. Abad, and the hospital all appealed to the Court of Appeals, which affirmed
with modification the trial court decision, thus:
11
WHEREFORE, in view of all the foregoing, and finding no reversible error in

the appealed Decision dated March 3, 1997 of Branch 98 of the Regional Trial Court
of Quezon City in Civil Case No. Q-93-16562, the same is hereby AFFIRMED, with
the following MODIFICATIONS:
1. Ordering defendant-appellant Dra. Milagros [L.] Cantre only to pay

plaintiffs-appellees John David Go and Nora S. Go the sum of
P200,000.00 as moral damages;
2. Deleting the award [of] exemplary damages, attorney’s fees and

expenses of litigation;
3. Dismissing the complaint with respect to defendants-appellants

Dr. Rainerio S. Abad and Delgado Clinic, Inc.;
4. Dismissing the counterclaims of defendants-appellants for lack of

merit; and
5. Ordering defendant-appellant Dra. Milagros [L.] Cantre only to pay

the costs.
SO ORDERED.
Petitioner’s motion for reconsideration was denied by the Court of Appeals. Hence, the
instant petition assigning the following as errors and issues:
I.
WHETHER OR NOT, THE LOWER COURT, AND THE COURT OF APPEALS

COMMITTED GRAVE ABUSE OF THEIR DISCRETION WHEN,
NOTWITHSTANDING THAT BOTH PARTIES HAVE RESTED THEIR RESPECTIVE
CASES, THE LOWER COURT ADMITTED THE ADDITIONAL EXHIBITS FURTHER
OFFERED BY RESPONDENTS NOT TESTIFIED TO BY ANY WITNESS AND THIS
DECISION OF THE LOWER COURT WAS UPHELD BY THE COURT OF
APPEALS LIKEWISE COMMITTING GRAVE ABUSE OF DISCRETION;
II.
WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS

DISCRETION WHEN, CONTRARY TO PREPONDERANCE OF EVIDENCE
PRESENTED BY THE PETITIONER, IT RULED THAT THE PETITIONER HAS NOT
AMPLY SHOWED THAT THE DROPLIGHT DID NOT TOUCH THE BODY OF MRS.
NORA GO, AND THIS DECISION OF THE LOWER COURT WAS UPHELD BY THE
COURT OF APPEALS LIKEWISE COMMITTING GRAVE ABUSE OF
DISCRETION;
III.
12
WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS

DISCRETION WHEN, CONTRARY TO PREPONDERANCE OF EVIDENCE
PRESENTED BY THE PETITIONER, IT RULED THAT PETITIONER DRA.
CANTRE WAS NOT ABLE TO AMPLY EXPLAIN HOW THE INJURY (BLISTERS) IN
THE LEFT INNER ARM OF RESPONDENT MRS. GO CAME ABOUT;
IV.
WHETHER OR NOT THE COURT OF APPEALS COMMITTED GRAVE ABUSE OF

ITS DISCRETION WHEN IT MADE A RULING ON THE RESPONDENT’S INJURY
QUOTING THE TESTIMONY OF SOMEONE WHO WAS NOT PRESENT AND HAS
NOT SEEN THE ORIGINAL, FRESH INJURY OF RESPONDENT MRS. NORA GO;
V.
WHETHER OR NOT THE COURT OF APPEALS GRAVELY ABUSING ITS

DISCRETION RULED THAT PETITIONER DRA. CANTRE SHOULD HAVE
INTENDED TO INFLICT THE INJURY TO SAVE THE LIFE OF RESPONDENT
MRS. GO;
VI.
WHETHER OR NOT THE LOWER COURT AND THE COURT [OF] APPEALS
COMMITTED GRAVE ABUSE OF DISCRETION WHEN, CONTRARY TO THE
DETAILED PROCEDURES DONE BY PETITIONER, BOTH RULED THAT THE
RESPONDENT WAS LEFT TO THE CARE OF THE NURSING STAFF;
VII.
WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF

DISCRETION WHEN, CONTRARY TO THE MEDICAL PURPOSES OF COSMETIC
SURGERY, IT RULED THAT THE COSMETIC SURGERY MADE THE SCARS
EVEN MORE UGLY AND DECLARED THE COSMETIC SURGERY A FAILURE;
VIII.
WHETHER OR NOT THE LOWER COURT GRAVELY ABUSE OF (SIC)

DISCRETION WHEN, CONTRARY TO RESPONDENTS’ CONTRARY
TESTIMONIES AND THE ABSENCE OF ANY TESTIMONY, IT RULED THAT THEY
ARE ENTITLED TO DAMAGES AND WHICH WAS UPHELD, ALTHOUGH
MODIFIED, BY THE COURT OF APPEALS LIKEWISE ABUSING ITS
DISCRETION.
Petitioner contends that additional documentary exhibits not testified to by any witness are
inadmissible in evidence because they deprived her of her constitutional right to confront the
witnesses against her. Petitioner insists the droplight could not have touched Nora’s body. She
maintains the injury was due to the constant taking of Nora’s blood pressure. Petitioner also
insinuates the Court of Appeals was misled by the testimony of the medico-legal officer who never
saw the original injury before plastic surgery was performed. Finally, petitioner stresses that plastic
13
surgery was not intended to restore respondent’s injury to its original state but rather to prevent
further complication.
Respondents, however, counter that the genuineness and due execution of the additional
documentary exhibits were duly admitted by petitioner’s counsel. Respondents point out that
petitioner’s blood pressure cuff theory is highly improbable, being unprecedented in medical history
and that the injury was definitely caused by the droplight. At any rate, they argue, even if the injury
was brought about by the blood pressure cuff, petitioner was still negligent in her duties as Nora’s
attending physician.
Simply put, the threshold issues for resolution are: (1) Are the questioned additional exhibits
admissible in evidence? (2) Is petitioner liable for the injury suffered by respondent Nora
Go? Thereafter, the inquiry is whether the appellate court committed grave abuse of discretion in its
assailed issuances.
As to the first issue, we agree with the Court of Appeals that said exhibits are admissible in
evidence. We note that the questioned exhibits consist mostly of Nora’s medical records, which were
produced by the hospital during trial pursuant to a subpoena duces tecum. Petitioner’s counsel
admitted the existence of the same when they were formally offered for admission by the trial court.
In any case, given the particular circumstances of this case, a ruling on the negligence of petitioner
may be made based on the res ipsa loquitur doctrine even in the absence of such additional exhibits.
Petitioner’s contention that the medico-legal officer who conducted Nora’s physical
examination never saw her original injury before plastic surgery was performed is without basis and
contradicted by the records. Records show that the medico-legal officer conducted the physical
examination on May 7, 1992, while the skin grafting and the scar revision were performed on Nora
on May 22, 1992 and April 30, 1993, respectively.
Coming now to the substantive matter, is petitioner liable for the injury suffered by
respondent Nora Go?
The Hippocratic Oath mandates physicians to give primordial consideration to the well-being
of their patients. If a doctor fails to live up to this precept, he is accountable for his acts. This
notwithstanding, courts face a unique restraint in adjudicating medical negligence cases because
physicians are not guarantors of care and, they never set out to intentionally cause injury to their
patients. However, intent is immaterial in negligence cases because where negligence exists and is
proven, it automatically gives the injured a right to reparation for the damage caused.
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
someone’s negligence;
2. It is caused by an instrumentality within the exclusive control of the defendant or

defendants; and
14
3. The possibility of contributing conduct which would make the plaintiff responsible is
eliminated.
As to the first requirement, the gaping wound on Nora’s 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 surgeon’s
control. In this particular case, it can be logically inferred that petitioner, the senior consultant in
charge during the delivery of Nora’s baby, exercised control over the assistants assigned to both the
use of the droplight and the taking of Nora’s blood pressure. Hence, the use of the droplight and the
blood pressure cuff is also within petitioner’s exclusive control.
Third, the gaping wound on Nora’s 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.
Petitioner’s defense that Nora’s wound was caused not by the droplight but by the constant
taking of her blood pressure, even if the latter was necessary given her condition, does not absolve
her from liability. As testified to by the medico-legal officer, Dr. Arizala, Jr., the medical practice is to
deflate the blood pressure cuff immediately after each use. Otherwise, the inflated band can cause
injury to the patient similar to what could have happened in this case. Thus, if Nora’s wound was
caused by the blood pressure cuff, then the taking of Nora’s blood pressure must have been done so
negligently as to have inflicted a gaping wound on her arm, for which petitioner cannot escape
liability under the “captain of the ship” doctrine.
Further, petitioner’s argument that the failed plastic surgery was not intended as a cosmetic
procedure, but rather as a measure to prevent complication does not help her case. It does not
negate negligence on her part.
Based on the foregoing, the presumption that petitioner was negligent in the exercise of her
profession stands unrebutted. In this connection, the Civil Code provides:
ART. 2176. Whoever by act or omission causes damage to another, there

being fault or negligence, is obliged to pay for the damage done.…
ART. 2217. Moral damages include physical suffering, mental anguish,

fright, serious anxiety, besmirched reputation, wounded feelings, moral shock, social
humiliation, and similar injury. Though incapable of pecuniary computation, moral
damages may be recovered if they are the proximate result of the defendant’s
wrongful act or omission.
15
Clearly, under the law, petitioner is obliged to pay Nora for moral damages suffered by the
latter as a proximate result of petitioner’s negligence.
We note, however, that petitioner has served well as Nora’s obstetrician for her past three
successful deliveries. This is the first time petitioner is being held liable for damages due to
negligence in the practice of her profession. The fact that petitioner promptly took care of Nora’s
wound before infection and other complications set in is also indicative of petitioner’s good
intentions. We also take note of the fact that Nora was suffering from a critical condition when the
injury happened, such that saving her life became petitioner’s elemental concern. Nonetheless, it
should be stressed that all these could not justify negligence on the part of petitioner.
Hence, considering the specific circumstances in the instant case, we find no grave abuse of
discretion in the assailed decision and resolution of the Court of Appeals. Further, we rule that the
Court of Appeals’ award of Two Hundred Thousand Pesos (P200,000) as moral damages in favor of
respondents and against petitioner is just and equitable.
WHEREFORE, the petition is DENIED. The Decision dated October 3, 2002 and Resolution
dated November 19, 2003 of the Court of Appeals in CA-G.R. CV No. 58184 are AFFIRMED.
No pronouncement as to costs.
SO ORDERED.
16
Doctrine Of
Ostensible
Agent
- In cases wherein the employees
are at the same time are
independent contractors of the
hospital;
- Because of this peculiar situation,

they are considered ostensible
17
agents and therefore, the hospital

must be held liable for their
negligent acts. (pathologist,
radiologist, anesthesiologist).
PROFESSIONAL SERVICES, G.R. No. 126297

INC.,
Petitioner,
- versus -
THE COURT OF APPEALS and NATIVIDAD and

ENRIQUE
AGANA,
Respondents.
x-------------------x
NATIVIDAD [substituted by her G.R. No. 126467

children Marcelino Agana III,
Enrique Agana, Jr.,
Emma Agana-Andaya,
Jesus Agana and Raymund
Agana] and ENRIQUE AGANA,
Petitioners,
- versus -
THE COURT OF APPEALS and JUAN FUENTES,

Respondents.
x-------------------x
MIGUEL AMPIL, G.R. No. 127590
Petitioner,
- versus -
18
NATIVIDAD and ENRIQUE

AGANA,
Respondents.
Promulgated:
February 2, 2010
x - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x
CORONA, J.:
With prior leave of court, petitioner Professional Services, Inc. (PSI) filed a second motion
for reconsideration urging referral thereof to the Court en bancand seeking modification of the
decision dated January 31, 2007 and resolution dated February 11, 2008 which affirmed its vicarious
and direct liability for damages to respondents Enrique Agana and the heirs of Natividad Agana
(Aganas).
Manila Medical Services, Inc. (MMSI), Asian Hospital, Inc. (AHI), and Private Hospital
Association of the Philippines (PHAP) all sought to intervene in these cases invoking the common
ground that, unless modified, the assailed decision and resolution will jeopardize the financial
viability of private hospitals and jack up the cost of health care.
The Special First Division of the Court granted the motions for intervention of MMSI, AHI and
PHAP (hereafter intervenors), and referred en consulta to the Court en banc the motion for prior
leave of court and the second motion for reconsideration of PSI.
Due to paramount public interest, the Court en banc accepted the referral and heard the
parties on oral arguments on one particular issue: whether a hospital may be held liable for the
negligence of physicians-consultants allowed to practice in its premises.
To recall the salient facts, PSI, together with Dr. Miguel Ampil (Dr. Ampil) and Dr. Juan
Fuentes (Dr. Fuentes), was impleaded by Enrique Agana and Natividad Agana (later substituted by
her heirs), in a complaint for damages filed in the Regional Trial Court (RTC) of Quezon City, Branch
96, for the injuries suffered by Natividad when Dr. Ampil and Dr. Fuentes neglected to remove
from her body two gauzes which were used in the surgery they performed on her on April 11, 1984 at
the Medical City General Hospital. PSI was impleaded as owner, operator and manager of the
hospital.
In a decision dated March 17, 1993, the RTC held PSI solidarily liable with Dr. Ampil and Dr.
Fuentes for damages. On appeal, the Court of Appeals (CA), absolved Dr. Fuentes but affirmed the
liability of Dr. Ampil and PSI, subject to the right of PSI to claim reimbursement from Dr. Ampil.
On petition for review, this Court, in its January 31, 2007 decision, affirmed the CA decision.
PSI filed a motion for reconsideration but the Court denied it in a resolution dated February 11, 2008.
The Court premised the direct liability of PSI to the Aganas on the following facts and law:
First, there existed between PSI and Dr. Ampil an employer-employee relationship as
contemplated in the December 29, 1999 decision in Ramos v. Court of Appeals that “for purposes of
allocating responsibility in medical negligence cases, an employer-employee relationship exists
19
between hospitals and their consultants.” Although the Court in Ramos later issued a Resolution
dated April 11, 2002 reversing its earlier finding on the existence of an employment relationship
between hospital and doctor, a similar reversal was not warranted in the present case because the
defense raised by PSI consisted of a mere general denial of control or responsibility over the actions
of Dr. Ampil.
Second, by accrediting Dr. Ampil and advertising his qualifications, PSI created the public
impression that he was its agent. Enrique testified that it was on account of Dr. Ampil's accreditation
with PSI that he conferred with said doctor about his wife's (Natividad's) condition. After his meeting
with Dr. Ampil, Enrique asked Natividad to personally consult Dr. Ampil. In effect, when Enrigue and
Natividad engaged the services of Dr. Ampil, at the back of their minds was that the latter was a staff
member of a prestigious hospital. Thus, under the doctrine of apparent authority applied in Nogales,
et al. v. Capitol Medical Center, et al., PSI was liable for the negligence of Dr. Ampil.
Finally, as owner and operator of Medical City General Hospital, PSI was bound by its duty
to provide comprehensive medical services to Natividad Agana, to exercise reasonable care to
protect her from harm, to oversee or supervise all persons who practiced medicine within its walls,
and to take active steps in fixing any form of negligence committed within its premises. PSI
committed a serious breach of its corporate duty when it failed to conduct an immediate investigation
into the reported missing gauzes.
PSI is now asking this Court to reconsider the foregoing rulings for these reasons:
I
The declaration in the 31 January 2007 Decision vis-a-vis the 11 February

2009 Resolution that the ruling in Ramos vs. Court of Appeals (G.R. No. 134354,
December 29, 1999) that “an employer-employee relations exists between hospital
and their consultants” stays should be set aside for being inconsistent with or contrary
to the import of the resolution granting the hospital's motion for reconsideration in
Ramos vs. Court of Appeals (G.R. No. 134354, April 11, 2002), which is applicable to
PSI since the Aganas failed to prove an employer-employee relationship between PSI
and Dr. Ampil and PSI proved that it has no control over Dr. Ampil. In fact, the trial
court has found that there is no employer-employee relationship in this case and that
the doctor's are independent contractors.
II
Respondents Aganas engaged Dr. Miguel Ampil as their doctor and did not
primarily and specifically look to the Medical City Hospital (PSI) for medical care and
support; otherwise stated, respondents Aganas did not select Medical City Hospital
(PSI) to provide medical care because of any apparent authority of Dr. Miguel Ampil
as its agent since the latter was chosen primarily and specifically based on his
qualifications and being friend and neighbor.
III
20
PSI cannot be liable under doctrine of corporate negligence since the

proximate cause of Mrs. Agana's injury was the negligence of Dr. Ampil, which is an
element of the principle of corporate negligence.
In their respective memoranda, intervenors raise parallel arguments that the Court's ruling
on the existence of an employer-employee relationship between private hospitals and consultants
will force a drastic and complex alteration in the long-established and currently prevailing
relationships among patient, physician and hospital, with burdensome operational and financial
consequences and adverse effects on all three parties.
The Aganas comment that the arguments of PSI need no longer be entertained for they
have all been traversed in the assailed decision and resolution.
After gathering its thoughts on the issues, this Court holds that PSI is liable to the Aganas, not
under the principle of respondeat superior for lack of evidence of an employment relationship with
Dr. Ampil but under the principle of ostensible agency for the negligence of Dr. Ampil and, pro hac
vice, under the principle of corporate negligence for its failure to perform its duties as a hospital.
While in theory a hospital as a juridical entity cannot practice medicine, in reality it utilizes
doctors, surgeons and medical practitioners in the conduct of its business of facilitating medical and
surgical treatment. Within that reality, three legal relationships crisscross: (1) between the hospital
and the doctor practicing within its premises; (2) between the hospital and the patient being treated
or examined within its premises and (3) between the patient and the doctor. The exact nature of
each relationship determines the basis and extent of the liability of the hospital for the negligence of
the doctor.
Where an employment relationship exists, the hospital may be held vicariously liable under
Article 2176 in relation to Article 2180 of the Civil Code or the principle of respondeat superior. Even
when no employment relationship exists but it is shown that the hospital holds out to the patient that
the doctor is its agent, the hospital may still be vicariously liable under Article 2176 in relation to
Article 1431 and Article 1869 of the Civil Code or the principle of apparent authority. Moreover,
regardless of its relationship with the doctor, the hospital may be held directly liable to the patient
for its own negligence or failure to follow established standard of conduct to which it should conform
as a corporation.
This Court still employs the “control test” to determine the existence of an employer-
employee relationship between hospital and doctor. In Calamba Medical Center, Inc. v. National
Labor Relations Commission, et al. it held:
Under the "control test", an employment relationship exists between a physician and
a hospital if the hospital controls both the means and the details of the process by
which the physician is to accomplish his task.
xx xx xx
As priorly stated, private respondents maintained specific work-schedules, as

determined by petitioner through its medical director, which consisted of 24-hour
shifts totaling forty-eight hours each week and which were strictly to be observed
under pain of administrative sanctions.
21
That petitioner exercised control over respondents gains light from the
undisputed fact that in the emergency room, the operating room, or any
department or ward for that matter, respondents' work is monitored through its
nursing supervisors, charge nurses and orderlies. Without the approval or
consent of petitioner or its medical director, no operations can be undertaken
in those areas. For control test to apply, it is not essential for the employer to
actually supervise the performance of duties of the employee, it being enough
that it has the right to wield the power. (emphasis supplied)
Even in its December 29, 1999 decision and April 11, 2002 resolution in Ramos, the Court
found the control test decisive.
In the present case, it appears to have escaped the Court's attention that both the RTC and
the CA found no employment relationship between PSI and Dr. Ampil, and that the Aganas did not
question such finding. In its March 17, 1993 decision, the RTC found “that defendant doctors were
not employees of PSI in its hospital, they being merely consultants without any employer-employee
relationship and in the capacity of independent contractors.” The Aganas never questioned such
finding.
PSI, Dr. Ampil and Dr. Fuentes appealed from the RTC decision but only on the issues of
negligence, agency and corporate liability. In its September 6, 1996 decision, the CA mistakenly
referred to PSI and Dr. Ampil as employer-employee, but it was clear in its discussion on the matter
that it viewed their relationship as one of mere apparent agency.
The Aganas appealed from the CA decision, but only to question the exoneration of Dr.
Fuentes. PSI also appealed from the CA decision, and it was then that the issue of employment,
though long settled, was unwittingly resurrected.
In fine, as there was no dispute over the RTC finding that PSI and Dr. Ampil had no
employer-employee relationship, such finding became final and conclusive even to this Court. There
was no reason for PSI to have raised it as an issue in its petition. Thus, whatever discussion on the
matter that may have ensued was purely academic.
Nonetheless, to allay the anxiety of the intervenors, the Court holds that, in this
particular instance, the concurrent finding of the RTC and the CA that PSI was not the employer of
Dr. Ampil is correct. Control as a determinative factor in testing the employer-employee relationship
between doctor and hospital under which the hospital could be held vicariously liable to a patient in
medical negligence cases is a requisite fact to be established by preponderance of evidence. Here,
there was insufficient evidence that PSI exercised the power of control or wielded such power over
the means and the details of the specific process by which Dr. Ampil applied his skills in the
treatment of Natividad. Consequently, PSI cannot be held vicariously liable for the negligence of Dr.
Ampil under the principle of respondeat superior.
There is, however, ample evidence that the hospital (PSI) held out to the patient (Natividad)
that the doctor (Dr. Ampil) was its agent. Present are the two factors that determine apparent
authority: first, the hospital's implied manifestation to the patient which led the latter to conclude that
22
the doctor was the hospital's agent; and second, the patient’s reliance upon the conduct of the
hospital and the doctor, consistent with ordinary care and prudence.
Enrique testified that on April 2, 1984, he consulted Dr. Ampil regarding the condition of his
wife; that after the meeting and as advised by Dr. Ampil, he “asked[his] wife to go to Medical City to
be examined by [Dr. Ampil]”; and that the next day, April 3, he told his daughter to take her mother to
Dr. Ampil. This timeline indicates that it was Enrique who actually made the decision on whom
Natividad should consult and where, and that the latter merely acceded to it. It explains the
testimony of Natividad that she consulted Dr. Ampil at the instigation of her daughter.
Moreover, when asked what impelled him to choose Dr. Ampil, Enrique testified:
Atty. Agcaoili
On that particular occasion, April 2, 1984, what was your reason for choosing
Dr. Ampil to contact with in connection with your wife's illness?
A. First, before that, I have known him to be a specialist on that part of the body
as a surgeon, second, I have known him to be a staff member of
the Medical City which is a prominent and known hospital. And third, because he is
a neighbor, I expect more than the usual medical service to be given to us, than his
ordinary patients. (emphasis supplied)
Clearly, the decision made by Enrique for Natividad to consult Dr. Ampil was significantly
influenced by the impression that Dr. Ampil was a staff member ofMedical City General Hospital, and
that said hospital was well known and prominent. Enrique looked upon Dr. Ampil not as independent
of but as integrally related toMedical City.
PSI's acts tended to confirm and reinforce, rather than negate, Enrique's view. It is of
record that PSI required a “consent for hospital care” to be signed preparatory to the surgery of
Natividad. The form reads:
Permission is hereby given to the medical, nursing and laboratory staff of

the Medical City General Hospital to perform such diagnostic procedures and to
administer such medications and treatments as may be deemed necessary or
advisable by the physicians of this hospital for and during the confinement of xxx.
(emphasis supplied)
By such statement, PSI virtually reinforced the public impression that Dr. Ampil was a
physician of its hospital, rather than one independently practicing in it; that the medications and
treatments he prescribed were necessary and desirable; and that the hospital staff was prepared to
carry them out.
PSI pointed out in its memorandum that Dr. Ampil's hospital affiliation was not the exclusive
basis of the Aganas’ decision to have Natividad treated in MedicalCity General Hospital, meaning
that, had Dr. Ampil been affiliated with another hospital, he would still have been chosen by the
Aganas as Natividad's surgeon.
23
The Court cannot speculate on what could have been behind the Aganas’ decision but
would rather adhere strictly to the fact that, under the circumstances at that time, Enrique decided to
consult Dr. Ampil for he believed him to be a staff member of a prominent and known hospital. After
his meeting with Dr. Ampil, Enrique advised his wife Natividad to go to
the Medical City General Hospital to be examined by said doctor, and the hospital acted in a way
that fortified Enrique's belief.
This Court must therefore maintain the ruling that PSI is vicariously liable for the negligence
of Dr. Ampil as its ostensible agent.
Moving on to the next issue, the Court notes that PSI made the following admission in
its Motion for Reconsideration:
51. Clearly, not being an agent or employee of petitioner PSI, PSI [sic] is not liable
for Dr. Ampil's acts during the operation. Considering further that Dr. Ampil was
personally engaged as a doctor by Mrs. Agana, it is incumbent upon Dr. Ampil, as
“Captain of the Ship”, and as the Agana's doctor to advise her on what to do with her
situation vis-a-vis the two missing gauzes. In addition to noting the missing
gauzes, regular check-ups were made and no signs of complications were
exhibited during her stay at the hospital, which could have alerted petitioner
PSI's hospital to render and provide post-operation services to and tread on Dr.
Ampil's role as the doctor of Mrs. Agana. The absence of negligence of PSI
from the patient's admission up to her discharge is borne by the finding of
facts in this case. Likewise evident therefrom is the absence of any complaint
from Mrs. Agana after her discharge from the hospital which had she brought
to the hospital's attention, could have alerted petitioner PSI to act accordingly
and bring the matter to Dr. Ampil's attention. But this was not the case. Ms.
Agana complained ONLY to Drs. Ampil and Fuentes, not the hospital. How then
could PSI possibly do something to fix the negligence committed by Dr. Ampil
when it was not informed about it at all. (emphasis supplied)
PSI reiterated its admission when it stated that had Natividad Agana “informed the hospital
of her discomfort and pain, the hospital would have been obliged to act on it.”
The significance of the foregoing statements is critical.
First, they constitute judicial admission by PSI that while it had no power to control the
means or method by which Dr. Ampil conducted the surgery on Natividad Agana, it had the power to
review or cause the review of what may have irregularly transpired within its walls strictly for the
purpose of determining whether some form of negligence may have attended any procedure done
inside its premises, with the ultimate end of protecting its patients.
Second, it is a judicial admission that, by virtue of the nature of its business as well as its
prominence in the hospital industry, it assumed a duty to “tread on” the “captain of the ship” role of
any doctor rendering services within its premises for the purpose of ensuring the safety of the
patients availing themselves of its services and facilities.
24
Third, by such admission, PSI defined the standards of its corporate conduct under the
circumstances of this case, specifically: (a) that it had a corporate duty to Natividad even after her
operation to ensure her safety as a patient; (b) that its corporate duty was not limited to having its
nursing staff note or record the two missing gauzes and (c) that its corporate duty extended to
determining Dr. Ampil's role in it, bringing the matter to his attention, and correcting his negligence.
And finally, by such admission, PSI barred itself from arguing in its second motion for
reconsideration that the concept of corporate responsibility was not yet in existence at the time
Natividad underwent treatment; and that if it had any corporate responsibility, the same was limited
to reporting the missing gauzes and did not include “taking an active step in fixing the negligence
committed.” An admission made in the pleading cannot be controverted by the party making such
admission and is conclusive as to him, and all proofs submitted by him contrary thereto or
inconsistent therewith should be ignored, whether or not objection is interposed by a party.
Given the standard of conduct that PSI defined for itself, the next relevant inquiry is
whether the hospital measured up to it.
PSI excuses itself from fulfilling its corporate duty on the ground that Dr. Ampil assumed the
personal responsibility of informing Natividad about the two missing gauzes. Dr. Ricardo Jocson,
who was part of the group of doctors that attended to Natividad, testified that toward the end of the
surgery, their group talked about the missing gauzes but Dr. Ampil assured them that he would
personally notify the patient about it. Furthermore, PSI claimed that there was no reason for it to act
on the report on the two missing gauzes because Natividad Agana showed no signs of
complications. She did not even inform the hospital about her discomfort.
The excuses proffered by PSI are totally unacceptable.
To begin with, PSI could not simply wave off the problem and nonchalantly delegate to Dr.
Ampil the duty to review what transpired during the operation. The purpose of such review would
have been to pinpoint when, how and by whom two surgical gauzes were mislaid so that necessary
remedial measures could be taken to avert any jeopardy to Natividad’s recovery. Certainly, PSI could
not have expected that purpose to be achieved by merely hoping that the person likely to have
mislaid the gauzes might be able to retrace his own steps. By its own standard of corporate conduct,
PSI's duty to initiate the review was non-delegable.
While Dr. Ampil may have had the primary responsibility of notifying Natividad about the
missing gauzes, PSI imposed upon itself the separate and independent responsibility of initiating the
inquiry into the missing gauzes. The purpose of the first would have been to apprise Natividad of
what transpired during her surgery, while the purpose of the second would have been to pinpoint any
lapse in procedure that led to the gauze count discrepancy, so as to prevent a recurrence thereof
and to determine corrective measures that would ensure the safety of Natividad. That Dr. Ampil
negligently failed to notify Natividad did not release PSI from its self-imposed separate responsibility.
Corollary to its non-delegable undertaking to review potential incidents of negligence

committed within its premises, PSI had the duty to take notice of medical records prepared by its
own staff and submitted to its custody, especially when these bear earmarks of a surgery gone awry.
Thus, the record taken during the operation of Natividad which reported a gauze count discrepancy
25
should have given PSI sufficient reason to initiate a review. It should not have waited for Natividad to
complain.
As it happened, PSI took no heed of the record of operation and consequently did not
initiate a review of what transpired during Natividad’s operation. Rather, it shirked its responsibility
and passed it on to others – to Dr. Ampil whom it expected to inform Natividad, and to Natividad
herself to complain before it took any meaningful step. By its inaction, therefore, PSI failed its own
standard of hospital care. It committed corporate negligence.
It should be borne in mind that the corporate negligence ascribed to PSI is different from the
medical negligence attributed to Dr. Ampil. The duties of the hospital are distinct from those of the
doctor-consultant practicing within its premises in relation to the patient; hence, the failure of PSI to
fulfill its duties as a hospital corporation gave rise to a direct liability to the Aganas distinct from that
of Dr. Ampil.
All this notwithstanding, we make it clear that PSI’s hospital liability based on ostensible
agency and corporate negligence applies only to this case, pro hac vice. It is not intended to set a
precedent and should not serve as a basis to hold hospitals liable for every form of negligence of
their doctors-consultants under any and all circumstances. The ruling is unique to this case, for the
liability of PSI arose from an implied agency with Dr. Ampil and an admitted corporate duty to
Natividad.
Other circumstances peculiar to this case warrant this ruling, not the least of which being
that the agony wrought upon the Aganas has gone on for 26 long years, with Natividad coming to the
end of her days racked in pain and agony. Such wretchedness could have been avoided had PSI
simply done what was logical: heed the report of a guaze count discrepancy, initiate a review of what
went wrong and take corrective measures to ensure the safety of Nativad. Rather, for 26 years, PSI
hemmed and hawed at every turn, disowning any such responsibility to its patient. Meanwhile, the
options left to the Aganas have all but dwindled, for the status of Dr. Ampil can no longer be
ascertained.
Therefore, taking all the equities of this case into consideration, this Court believes P15
million would be a fair and reasonable liability of PSI, subject to 12% p.a. interest from the finality of
this resolution to full satisfaction.
WHEREFORE, the second motion for reconsideration is DENIED and the motions for
intervention are NOTED.
Professional Services, Inc. is ORDERED pro hac vice to pay Natividad (substituted by
her children Marcelino Agana III, Enrique Agana, Jr., Emma Agana-Andaya, Jesus Agana and
Raymund Agana) and Enrique Agana the total amount of P15 million, subject to 12% p.a. interest
from the finality of this resolution to full satisfaction.
No further pleadings by any party shall be entertained in this case.
SO ORDERED.
26
Criminal
Negligence
- indicates a deficiency of perception
or when the wrongful act maybe
avoided by paying proper attention
and using due diligence in foreseeing
them.
27
Physician –
Patient
Contractual
Relationship
- The physician-patient relationship is
fiduciary in nature.
- Contract - is the meeting of minds
between two persons whereby one
binds himself with respect to the
other, to give something or to render
some service(Art.1305, NCC)
28
Dr. EMMANUEL JARCIA, Jr. and Dr. MARILOU G.R. No. 187926
BASTAN,
Petitioner,
- versus - .
PEOPLE OF THE PHILIPPINES, Promulgated:

Respondents.
February 15, 2012
x - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x
MENDOZA, J.:
Even early on, patients have consigned their lives to the skill of their doctors. Time and again, it can
be said that the most important goal of the medical profession is the preservation of life and health of
the people. Corollarily, when a physician departs from his sacred duty and endangers instead the life
of his patient, he must be made liable for the resulting injury. This Court, as this case would show,
cannot and will not let the act go unpunished.
This is a petition for review under Rule 45 of the Rules of Court challenging the August 29, 2008
Decision of the Court of Appeals (CA), and its May 19, 2009 Resolution in CA-G.R. CR No. 29559,
dismissing the appeal and affirming in toto the June 14, 2005 Decision of the Regional Trial Court,
Branch 43, Manila (RTC), finding the accused guilty beyond reasonable doubt of simple imprudence
resulting to serious physical injuries.
THE 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 victim’s 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.
The NBI indorsed the matter to the Office of the City Prosecutor of Manila for preliminary
investigation. Probable cause was found and a criminal case for reckless imprudence resulting to
serious physical injuries, was filed against Dr. Jarcia, Dr. Bastan and Dr. Pamittan, before the RTC,
docketed as Criminal Case No. 01-196646.
29
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 decretal portion of the RTC
decision reads:
WHEREFORE, premises considered, the Court finds accused DR. EMMANUEL JARCIA, JR. and
DR. MARILOU BASTAN GUILTY beyond reasonable doubt of the crime of SIMPLE IMPRUDENCE
RESULTING TO SERIOUS PHYSICAL INJURIES and are hereby sentenced to suffer the penalty of
ONE (1) MONTH and ONE (1) DAY to TWO (2) MONTHS and to indemnify MRS. BELINDA
SANTIAGO the amount of P 3,850.00 representing medical expenses without subsidiary
imprisonment in case of insolvency and to pay the costs.
It appearing that Dr. Pamittan has not been apprehended nor voluntarily surrendered despite warrant
issued for her arrest, let warrant be issued for her arrest and the case against her be ARCHIVED, to
be reinstated upon her apprehension.
SO ORDERED.
The RTC explained:
After a thorough and in depth evaluation of the evidence adduced by the prosecution and the
defense, this court finds that the evidence of the prosecution is the more credible, concrete and
sufficient to create that moral certainty in the mind of the Court that accused herein [are] criminally
responsible. 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.
Considering all the evidence on record, The Court finds the accused guilty for simple imprudence
resulting to physical injuries. Under Article 365 of the Revised Penal Code, the penalty provided for
is arresto mayor in its minimum period.
Dissatisfied, the petitioners appealed to the CA.
As earlier stated, the CA affirmed the RTC decision in toto. The August 29, 2008 Decision of the CA
pertinently reads:
This Court holds concurrently and finds the foregoing circumstances sufficient to sustain a judgment
of conviction against the accused-appellants for the crime of simple imprudence resulting in serious
physical injuries. The elements of imprudence are: (1) that the offender does or fails to do an act; (2)
30
that the doing or the failure to do that act is voluntary; (3) that it be without malice; (4) that material
damage results from the imprudence; and (5) that there is inexcusable lack of precaution on the part
of the offender, taking into consideration his employment or occupation, degree of intelligence,
physical condition, and other circumstances regarding persons, time and place.
Whether or not Dr. Jarcia and Dr. Bastan had committed an "inexcusable lack of precaution" in the
treatment of their 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. In
the case of Leonila Garcia-Rueda v. Pascasio, the Supreme 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.
In litigations involving medical negligence, the plaintiff has the burden of establishing accused-
appellants’ negligence, and for a reasonable conclusion of negligence, there must be proof of breach
of duty on the part of the physician as well as a causal connection of such breach and the resulting
injury of his patient. 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. Negligence, no matter in what it consists, cannot create a
right of action unless it is the proximate cause of the injury complained of. 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.
In the case at bench, the accused-appellants questioned the imputation against them and argued
that there is no causal connection between their failure to diagnose the fracture and the injury
sustained by Roy.
We are not convinced.
The prosecution is however after the cause which prolonged the pain and suffering of Roy and not
on the failure of the accused-appellants to correctly diagnose the extent of the injury sustained by
Roy.
For a more logical presentation of the discussion, we shall first consider the applicability of the
doctrine of res ipsa loquitur to the instant case. Res ipsa loquitur is a Latin phrase which literally
means "the thing or the transaction speaks for itself. 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 accused-
appellant 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.
31
The specific acts of negligence was narrated by Mrs. Santiago who accompanied her son during the
latter’s ordeal at the hospital. She testified as follows:
Fiscal Formoso:
Q: Now, he is an intern did you not consult the doctors, Dr. Jarcia or Dra. Pamittan to confirm
whether you should go home or not?
A: Dra. Pamittan was inside the cubicle of the nurses and I asked her, you let us go home and you
don’t even clean the wounds of my son.
Q: And what did she [tell] you?
A: They told me they will call a resident doctor, sir.
xxx xxx xxx
Q: Was there a resident doctor [who] came?
A: Yes, Sir. Dra. Bastan arrived.
Q: Did you tell her what you want on you to be done?
A: Yes, sir.
Q: What did you [tell] her?
A: I told her, sir, while she was cleaning the wounds of my son, are you not going to x-ray up to the
knee because my son was complaining pain from his ankle up to the middle part of the right leg.
Q: And what did she tell you?
A: According to Dra. Bastan, there is no need to x-ray because it was the ankle part that was run
over.
Q: What did you do or tell her?
A: I told her, sir, why is it that they did not examine[x] the whole leg. They just lifted the pants of my
son.
Q: So you mean to say there was no treatment made at all?
A: None, sir.
xxx xxx xxx
xxx xxx xxx
32
A: I just listened to them, sir. And I just asked if I will still return my son.
xxx xxx xxx
xxx xxx xxx
Q: And you were present when they were called?
A: Yes, sir.
Q: And what was discussed then by Sis. Retoria?
A: When they were there they admitted that they have mistakes, sir.
Still, before resort to the doctrine may be allowed, the following requisites must be satisfactorily
shown:
1. The accident is of a kind which ordinarily does not occur in the absence of someone’s
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.
In the above requisites, the fundamental element is the "control of the instrumentality" which caused
the damage. Such element of control must be shown to be within the dominion of the accused-
appellants. In order to have the benefit of the rule, a plaintiff, in addition to proving injury or damage,
must show a situation where it is applicable and must establish that the essential elements of the
doctrine were present in a particular incident. The early treatment of the leg of Roy would have
lessen his suffering if not entirely relieve him from the fracture. A boy of tender age whose leg was hit
by a vehicle would engender a well-founded belief that his condition may worsen without proper
medical attention. As junior residents who only practice general surgery and without specialization
with the case consulted before them, they should have referred the matter to a specialist. This
omission alone constitutes simple imprudence on their part. When Mrs. Santiago insisted on having
another x-ray of her child on the upper part of his leg, they refused to do so. The mother would not
have asked them if they had no exclusive control or prerogative to request an x-ray test. Such is a
fact because a radiologist would only conduct the x-ray test upon request of a physician.
The testimony of Mrs. Santiago was corroborated by a bone specialist Dr. Tacata. He further testified
based on his personal knowledge, and not as an expert, as he examined himself the child Roy. He
testified as follows:
Fiscal Macapagal:
33
Q: And was that the correct respon[se] to the medical problem that was presented to Dr. Jarcia and
Dra. Bastan?
A: I would say at that stage, yes. Because they have presented the patient and the history. "At sabi
nila, nadaanan lang po ito." And then, considering their year of residency they are still junior
residents, and they are not also orthopedic residents but general surgery residents, it’s entirely
different thing. Because if you are an orthopedic resident, I am not trying to say…but if I were an
orthopedic resident, there would be more precise and accurate decision compare to a general
surgery resident in so far as involved.
Q: You mean to say there is no supervisor attending the emergency room?
A: At the emergency room, at the Manila Doctor’s Hospital, the supervisor there is a consultant that
usually comes from a family medicine. They see where a certain patient have to go and then if they
cannot manage it, they refer it to the consultant on duty. Now at that time, I don’t [know] why they
don’t….Because at that time, I think, it is the decision. Since the x-rays….
Ordinarily, only physicians and surgeons of skill and experience are competent to testify as to
whether a patient has been treated or operated upon with a reasonable degree of skill and care.
However, testimony as to the statements and acts of physicians, external appearances, and manifest
conditions which are observable by any one may be given by non-expert witnesses. Hence, in cases
where the res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon
proper proof of injury to the patient, without the aid of expert testimony, where the court from its fund
of common knowledge can determine the proper standard of care. Where common knowledge and
experience teach that a resulting injury would not have occurred to the patient if due care had been
exercised, an inference of negligence may be drawn giving rise to an application of the doctrine
of res ipsa loquitur without medical evidence, which is ordinarily required to show not only what
occurred but how and why it occurred. In the case at bench, we give credence to the testimony of
Mrs. Santiago by applying the doctrine of res ipsa loquitur.
Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously
applied, depending upon the circumstances of each case. It is generally restricted to situations in
malpractice cases where a layman is able to say, as a matter of common knowledge and
observation, that the consequences of professional care were not as such as would ordinarily have
followed if due care had been exercised. A distinction must be made between the failure to secure
results and the occurrence of something more unusual and not ordinarily found if the service or
treatment rendered followed the usual procedure of those skilled in that particular practice. The latter
circumstance is the primordial issue that confronted this Court and we find application of the doctrine
of res ipsa loquitur to be in order.
WHEREFORE, in view of the foregoing, the appeal in this case is hereby DISMISSED and the
assailed decision of the trial court finding accused-appellants guilty beyond reasonable doubt of
simple imprudence resulting in serious physical injuries is hereby AFFIRMED in toto.
SO ORDERED.
34
The petitioners filed a motion for reconsideration, but it was denied by the CA in its May 19, 2009
Resolution.
Hence, this petition.
The petitioners pray for the reversal of the decision of both the RTC and the CA anchored on the
following
GROUNDS-
1. IN AFFIRMING ACCUSED-PETITIONERS’ CONVICTION, THE COURT OF APPEALS

ERRED IN NOT HOLDING THAT THE ACTUAL, DIRECT, IMMEDIATE, AND PROXIMATE
CAUSE OF THE PHYSICAL INJURY OF THE PATIENT (FRACTURE OF THE LEG BONE
OR TIBIA), WHICH REQUIRED MEDICAL ATTENDANCE FOR MORE THAN THIRTY (30)
DAYS AND INCAPACITATED HIM FROM PERFORMING HIS CUSTOMARY DUTY
DURING THE SAME PERIOD OF TIME, WAS THE VEHICULAR ACCIDENT WHERE THE
PATIENT’S RIGHT LEG WAS HIT BY A TAXI, NOT THE FAILURE OF THE ACCUSED-
PETITIONERS TO SUBJECT THE PATIENT’S WHOLE LEG TO AN X-RAY
EXAMINATION.
2. THE COURT OF APPEALS ERRED IN DISREGARDING ESTABLISHED FACTS

CLEARLY NEGATING PETITIONERS’ ALLEGED NEGLIGENCE OR IMPRUDENCE.
SIGNIFICANTLY, THE COURT OF APPEALS UNJUSTIFIABLY DISREGARDED THE
OPINION OF THE PROSECUTION’S EXPERT WITNESS, DR. CIRILO TACATA, THAT
PETITIONERS WERE NOT GUILTY OF NEGLIGENCE OR IMPRUDENCE COMPLAINED
OF.
3. THE COURT OF APPEALS ERRED IN HOLDING THAT THE FAILURE OF

PETITIONERS TO SUBJECT THE PATIENT’S WHOLE LEG TO AN X-RAY
EXAMINATION PROLONGED THE PAIN AND SUFFERING OF THE PATIENT, SUCH
CONCLUSION BEING UNSUPPORTED BY, AND EVEN CONTRARY TO, THE EVIDENCE
ON RECORD.
4. ASSUMING ARGUENDO THAT THE PATIENT EXPERIENCED PROLONGED PAIN

AND SUFFERING, THE COURT OF APPEALS ERRED IN NOT HOLDING THAT THE
ALLEGED PAIN AND SUFFERING WERE DUE TO THE UNJUSTIFIED FAILURE OF THE
PATIENT’S MOTHER, A NURSE HERSELF, TO IMMEDIATELY BRING THE PATIENT
BACK TO THE HOSPITAL, AS ADVISED BY THE PETITIONERS, AFTER HE
COMPLAINED OF SEVERE PAIN IN HIS RIGHT LEG WHEN HE REACHED HOME
AFTER HE WAS SEEN BY PETITIONERS AT THE HOSPITAL. THUS, THE PATIENT’S
ALLEGED INJURY (PROLONGED PAIN AND SUFFERING) WAS DUE TO HIS OWN
MOTHER’S ACT OR OMISSION.
5. THE COURT OF APPEALS ERRED IN NOT HOLDING THAT NO PHYSICIAN-PATIENT

RELATIONSHIP EXISTED BETWEEN PETITIONERS AND PATIENT ALFONSO
SANTIAGO, JR., PETITIONERS NOT BEING THE LATTER’S ATTENDING PHYSICIAN
35
AS THEY WERE MERELY REQUESTED BY THE EMERGENCY ROOM (ER) NURSE TO

SEE THE PATIENT WHILE THEY WERE PASSING BY THE ER FOR THEIR LUNCH.
6. THE COURT OF APPEALS GRAVELY ERRED IN NOT ACQUITTING ACCUSED-

PETITIONERS OF THE CRIME CHARGED."
The foregoing can be synthesized into two basic issues: [1] whether or not the doctrine of res ipsa
loquitur is applicable in this case; and [2] whether or not the petitioners are liable for criminal
negligence.
THE COURT’S RULING
The CA is correct in finding that there was negligence on the part of the petitioners. After a perusal of
the records, however, the Court is not convinced that the petitioners are guilty of criminal negligence
complained of. The Court is also of the view that the CA erred in applying the doctrine of res ipsa
loquitur in this particular case.
As to the Application of The Doctrine of Res Ipsa Loquitur
This doctrine of res ipsa loquitur means "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."
The Black's Law Dictionary defines the said doctrine. Thus:
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 ordinarily 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
was such that in the ordinary course of things would not happen if reasonable care had been used.
The doctrine of res ipsa loquitur as a rule of evidence is unusual to the law of negligence which
recognizes thatprima facie negligence may be established without direct proof and furnishes a
substitute for specific proof of negligence. The doctrine, however, 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 given case, is not meant 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 helps the plaintiff in proving a breach of the duty. The doctrine
can be invoked when and only when, under the circumstances involved, direct evidence is absent
and not readily available.
36
The requisites for the application of the doctrine of res ipsa loquitur are: (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.
In this case, the circumstances that caused patient Roy Jr.’s injury and the series of tests that were
supposed to be undergone by him to determine the extent of the injury suffered were not under the
exclusive control of Drs. Jarcia and Bastan. It was established that they are mere residents of the
Manila Doctors Hospital at that time who attended to the victim at the emergency room. While it may
be true that the circumstances pointed out by the courts below seem doubtless to constitute reckless
imprudence on the part of the petitioners, this conclusion is still best achieved, not through the
scholarly assumptions of a layman like the patient’s mother, but by the unquestionable knowledge of
expert witness/es. As to whether the petitioners have exercised the requisite degree of skill and care
in treating patient Roy, Jr. is generally a matter of expert opinion.
As to Dr. Jarcia and Dr. Bastan’s negligence
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.
The testimony of Dr. Cirilo R. Tacata (Dr. Tacata), a specialist in pediatric orthopedic, although
pointing to some medical procedures that could have been done by Dr. Jarcia and Dr. Bastan, as
physicians on duty, was not clear as to whether the injuries suffered by patient Roy Jr. were indeed
aggravated by the petitioners’ judgment call and their diagnosis or appreciation of the condition of
the victim at the time they assessed him. Thus:
Q: Will you please tell us, for the record, doctor, what is your specialization?
A: At present I am the chairman department of orthopedic in UP-PGH and I had special training in
pediatric orthopedic for two (2) years.
37
Q: In June 1998, doctor, what was your position and what was your specialization at that time?
A: Since 1980, I have been specialist in pediatric orthopedic.
Q: When Alfonso Santiago, Jr. was brought to you by his mother, what did you do by way of
physicians as first step?
A: As usual, I examined the patient physically and, at that time as I have said, the patient could not
walk so I [began] to suspect that probably he sustained a fracture as a result of a vehicular accident.
So I examined the patient at that time, the involved leg, I don’t know if that is left or right, the involved
leg then was swollen and the patient could not walk, so I requested for the x-ray of [the] lower leg.
Q: What part of the leg, doctor, did you request to be examined?
A: If we refer for an x-ray, usually, we suspect a fracture whether in approximal, middle or lebistal
tinial, we usually x-ray the entire extremity.
Q: And what was the result?
A: Well, I can say that it was a spiral fracture of the mid-tibial, it is the bigger bone of the leg.
Q: And when you say spiral, doctor, how long was this fracture?
A: When we say spiral, it is a sort of letter S, the length was about six (6) to eight (8) centimeters.
Q: Mid-tibial, will you please point to us, doctor, where the tibial is?
(Witness pointing to his lower leg)
A: The tibial is here, there are two bones here, the bigger one is the tibial and the smaller one is the
fibula. The bigger one is the one that get fractured.
Q: And in the course of your examination of Alfonso Santiago, Jr. did you ask for the history of such
injury?
A: Yes, actually, that was a routine part of our examination that once a patient comes in, before we
actually examine the patient, we request for a detailed history. If it is an accident, then, we request
for the exact mechanism of injuries.
Q: And as far as you can recall, Doctor, what was the history of that injury that was told to you?
A: The patient was sideswiped, I don’t know if it is a car, but it is a vehicular accident.
Q: Who did you interview?
A: The mother.
38
Q: How about the child himself, Alfonso Santiago, Jr.?
A: Normally, we do not interview the child because, usually, at his age, the answers are not accurate.
So, it was the mother that I interviewed.
Q: And were you informed also of his early medication that was administered on Alfonso Santiago,
Jr.?
A: No, not actually medication. I was informed that this patient was seen initially at the emergency
room by the two (2) physicians that you just mentioned, Dr. Jarcia and Dra. Bastan, that time who
happened to be my residents who were [on] duty at the emergency room.
xxxx
A: At the emergency room, at the Manila Doctor’s Hospital, the supervisor there is a consultant that
usually comes from a family medicine. They see where a certain patient have to go and then if they
cannot manage it, they refer it to the consultant on duty. Now at that time, I don’t why they don’t …
Because at that time, I think, it is the decision. Since the x-rays…
xxx
Q: You also said, Doctor, that Dr. Jarcia and Dra. Bastan are not even an orthopedic specialist.
A: They are general surgeon residents. You have to man[x] the emergency room, including
neurology, orthopedic, general surgery, they see everything at the emergency room.
xxxx
Q: But if initially, Alfonso Santiago, Jr. and his case was presented to you at the emergency room,
you would have subjected the entire foot to x-ray even if the history that was given to Dr. Jarcia and
Dra. Bastan is the same?
A: I could not directly say yes, because it would still depend on my examination, we cannot subject
the whole body for x-ray if we think that the damaged was only the leg.
Q: Not the entire body but the entire leg?
A: I think, if my examination requires it, I would.
Q: So, you would conduct first an examination?
A: Yes, sir.
Q: And do you think that with that examination that you would have conducted you would discover
the necessity subjecting the entire foot for x-ray?
39
A: It is also possible but according to them, the foot and the ankle were swollen and not the leg,
which sometimes normally happens that the actual fractured bone do not get swollen.
xxxx
Q: Doctor, if you know that the patient sustained a fracture on the ankle and on the foot and
the history that was told to you is the region that was hit is the region of the foot, will the
doctor subject the entire leg for x-ray?
A: I am an orthopedic surgeon, you have to subject an x-ray of the leg. Because you have to
consider the kind of fracture that the patient sustained would you say the exact mechanism
of injury. For example spiral, "paikot yung bale nya," so it was possible that the leg was run
over, the patient fell, and it got twisted. That’s why the leg seems to be fractured. [Emphases
supplied]
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 patient’s 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.
Although the Court sympathizes with the plight of the mother and the child in this case, the Court is
bound by the dictates of justice which hold inviolable the right of the accused to be presumed
innocent until proven guilty beyond reasonable doubt. 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
40
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.
This Court cannot also stamp its imprimatur on the petitioners’ contention that no physician-patient
relationship existed between them and patient Roy Jr., since they were not his attending physicians
at that time. They claim that they were merely requested by the ER nurse to see the patient while
they were passing by the ER for their lunch. Firstly, this issue was never raised during the trial at the
RTC or even before the CA. The petitioners, therefore, raise the want of doctor-patient relationship
for the first time on appeal with this Court. It has been settled that "issues raised for the first time on
appeal cannot be considered because a party is not permitted to change his theory on appeal. To
allow him to do so is unfair to the other party and offensive to the rules of fair play, justice and due
process." Stated differently, basic considerations of due process dictate that theories, issues and
arguments not brought to the attention of the trial court need not be, and ordinarily will not be,
considered by a reviewing court.
Assuming again for the sake of argument that the petitioners may still raise this issue of "no
physician–patient relationship," the Court finds and so holds that there was a "physician–patient"
relationship in this case.
In the case of Lucas v. Tuaño, the Court wrote that "[w]hen a patient engages the services of a
physician, a physician-patient relationship is generated. And in accepting a case, the physician, for
all intents and purposes, represents that he has the needed training and skill possessed by
physicians and surgeons practicing in the same field; and that he will employ such training, care, and
skill in the treatment of the patient. Thus, in treating his patient, a physician is under a duty to
exercise that degree of care, skill and diligence which physicians in the same general neighborhood
and in the same general line of practice ordinarily possess and exercise in like cases. Stated
otherwise, the physician has the obligation to use at least the same level of care that any other
reasonably competent physician would use to treat the condition under similar circumstances."
Indubitably, a physician-patient relationship exists between the petitioners and patient Roy Jr.
Notably, the latter and his mother went to the ER for an immediate medical attention. The petitioners
allegedly passed by and were requested to attend to the victim (contrary to the testimony of Dr.
Tacata that they were, at that time, residents on duty at the ER). They obliged and examined the
victim, and later assured the mother that everything was fine and that they could go home. Clearly, a
physician-patient relationship was established between the petitioners and the patient Roy Jr.
To repeat for clarity and emphasis, 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.
All told, the petitioners were, indeed, negligent but only civilly, and not criminally, liable as the facts
show.
41
Article II, Section 1 of the Code of Medical Ethics of the Medical Profession in the Philippines states:
A physician should attend to his patients faithfully and conscientiously. He should secure for them all
possible benefits that may depend upon his professional skill and care. As the sole tribunal to
adjudge the physician’s failure to fulfill his obligation to his patients is, in most cases, his own
conscience, violation of this rule on his part is discreditable and inexcusable.
Established medical procedures and practices, though in constant instability, are devised for the
purpose of preventing complications. In this case, the petitioners failed to observe the most prudent
medical procedure under the circumstances to prevent the complications suffered by a child of
tender age.
As to the Award of Damages
While no criminal negligence was found in the petitioners’ failure to administer the necessary
medical attention to Roy Jr., the Court holds them civilly liable for the resulting damages to their
patient. While it was the taxi driver who ran over the foot or leg of Roy Jr., their negligence was
doubtless contributory.
It appears undisputed that the amount of P 3,850.00, as expenses incurred by patient Roy Jr., was
adequately supported by receipts. The Court, therefore, finds the petitioners liable to pay this amount
by way of actual damages.
The Court is aware that no amount of compassion can suffice to ease the sorrow felt by the family of
the child at that time. Certainly, the award of moral and exemplary damages in favor of Roy Jr. in the
amount of P 100,000.00 and P 50,000.00, respectively, is proper in this case.
It is settled that moral damages are not punitive in nature, but are designed to compensate and
alleviate in some way the physical suffering, mental anguish, fright, serious anxiety, besmirched
reputation, wounded feelings, moral shock, social humiliation, and similar injury unjustly inflicted on a
person. Intended for the restoration of the psychological or emotional status quo ante, the award of
moral damages is designed to compensate emotional injury suffered, not to impose a penalty on the
wrongdoer.
The Court, likewise, finds the petitioners also liable for exemplary damages in the said
amount.1âwphi1 Article 2229 of the Civil Code provides that exemplary damages may be imposed
by way of example or correction for the public good.
WHEREFORE, the petition is PARTLY GRANTED. The Decision of the Court of Appeals dated
August 29, 2008 is REVERSED and SET ASIDE. A new judgment is entered ACQUITTING Dr.
Emmanuel Jarcia, Jr. and Dr. Marilou Bastan of the crime of reckless imprudence resulting to serious
physical injuries but declaring them civilly liable in the amounts of:
(1) P 3,850.00 as actual damages;
(2) P 100,000.00 as moral damages;
42
(3) P 50,000.00 as exemplary damages; and
(4) Costs of the suit.
with interest at the rate of 6% per annum from the date of the filing of the Information. The rate shall
be 12% interest per annum from the finality of judgment until fully paid.
SO ORDERED.
43

Cases and Doctrines On Legal Medicine

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cases and Doctrines On Legal Medicine

Uploaded by

Copyright:

Available Formats

LEGAL Doctrines and Principles

[LEGAL MEDICINE] with Jurisprudence

Doctrines and Principles with Jurisprudence

ORLANDO D. GARCIA, JR., G.R. No. 168512

On October 1, 1993, respondent Ranida D. Salvador started working as a trainee in the

Thereafter, the Company rehired Ranida.

WHEREFORE, the decision appealed from is REVERSED and SET ASIDE

All the elements are present in the case at bar.

Sec. 2. It shall be unlawful for any person to be professionally in-charge of a

No license shall be granted or renewed by the Secretary of Health for the

Sec. 9. Management of the Clinical Laboratory:

9.1 Head of the Clinical Laboratory: The head is that

For all categories of clinical laboratories, the head

(1) This shall be mandatory for all categories of

Sec. 11. Reporting: All laboratory requests shall be considered as

Sec. 25. Violations:

25.1 The license to operate a clinical laboratory may be suspended or

(1) Operation of a Clinical Laboratory without a certified

We find that petitioner Garcia failed to comply with these standards.

3. By way of affirmative and special defenses, defendant pathologist further

Defendant pathologist is not the owner of

Castro’s infrequent visit to the clinical laboratory barely qualifies as an effective

Article 20 of the New Civil Code provides:

WHEREFORE, the Decision of the Court of Appeals in CA-G.R. CV No. 58668

- “The thing speaks for itself”;

deviated from the standard of medical

DR. MILAGROS L. CANTRE, G.R. No. 160889

SPS. JOHN DAVID Z. GO and Promulgated:

The facts, culled from the records, are as follows:

In view of the foregoing consideration, judgment is hereby rendered in favor

(a) to pay the sum of Five Hundred Thousand Pesos (P500,000.00) in

WHEREFORE, in view of all the foregoing, and finding no reversible error in

1. Ordering defendant-appellant Dra. Milagros [L.] Cantre only to pay

2. Deleting the award [of] exemplary damages, attorney’s fees and

3. Dismissing the complaint with respect to defendants-appellants

4. Dismissing the counterclaims of defendants-appellants for lack of

5. Ordering defendant-appellant Dra. Milagros [L.] Cantre only to pay

WHETHER OR NOT, THE LOWER COURT, AND THE COURT OF APPEALS

WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS

WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS

WHETHER OR NOT THE COURT OF APPEALS COMMITTED GRAVE ABUSE OF

WHETHER OR NOT THE COURT OF APPEALS GRAVELY ABUSING ITS

WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF

WHETHER OR NOT THE LOWER COURT GRAVELY ABUSE OF (SIC)

2. It is caused by an instrumentality within the exclusive control of the defendant or

ART. 2176. Whoever by act or omission causes damage to another, there

ART. 2217. Moral damages include physical suffering, mental anguish,

- Because of this peculiar situation,

agents and therefore, the hospital

PROFESSIONAL SERVICES, G.R. No. 126297

THE COURT OF APPEALS and NATIVIDAD and

NATIVIDAD [substituted by her G.R. No. 126467

THE COURT OF APPEALS and JUAN FUENTES,

NATIVIDAD and ENRIQUE

The declaration in the 31 January 2007 Decision vis-a-vis the 11 February

PSI cannot be liable under doctrine of corporate negligence since the

As priorly stated, private respondents maintained specific work-schedules, as

Permission is hereby given to the medical, nursing and laboratory staff of

The significance of the foregoing statements is critical.

The excuses proffered by PSI are totally unacceptable.

Corollary to its non-delegable undertaking to review potential incidents of negligence

No further pleadings by any party shall be entertained in this case.