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11. Atienza v. Board (CASE the removal of private respondents Editha.

As the assailed Orders were


REGARDING KIDNEY) fully functional right kidney, instead interlocutory, these cannot be the subject
of the left nonfunctioning and of an appeal separate from
NOTES: Admissibility of evidence refers to nonvisualizing kidney. the judgment that completely or finally
the question of whether or not the disposes of the case. At that stage, where
circumstance (or evidence) is to be Submitted evidence by the complainant there is no appeal, or any plain, speedy,
considered at all. were certified photocopy of the x-ray and adequate remedy in the ordinary
requests. course of law, the only and remaining
Probative value of evidence refers to the Petitioner filed his comments/objections to remedy left to petitioner is a petition for
question of whether or not it proves an private respondents [Editha Siosons] certiorari under Rule 65 of
issue. formal offer of exhibits. He alleged that the Rules of Court on the ground of grave
said exhibits are inadmissible because the abuse of discretion amounting to lack or
The rules of evidence are merely the same are mere photocopies, not excess of jurisdiction. However, the writ of
means for ascertaining the truth properly identified and certiorari will not issue absent a showing
respecting a matter of fact. Thus, they authenticated, and intended to that the BOM has acted without or in
likewise provide for some facts which are establish matters which are hearsay. excess of jurisdiction or with grave abuse
established and need not be proved, such He added that the exhibits are of discretion. Embedded in the CAs
as those covered by judicial notice, both incompetent to prove the purpose for finding that the BOM did not exceed its
mandatory and discretionary. which they are offered. jurisdiction or act in grave abuse of
discretion is the issue of whether the
Facts of the case: Disposition of the BOM: The formal offer of exhibits of Editha contained in
Due to her lumbar pains, private documentary exhibits of private her Formal Offer of Documentary Evidence
respondent Editha Sioson went to Rizal respondent [Editha Sioson] was admitted. are inadmissible.
Medical Center (RMC) for checkup, was The petitioners moved for motion for
referred to Dr. Pedro Lantin III of RMC who, reconsideration, but was denied. It 2. Whether CA committed grave
accordingly, ordered several diagnostic concluded that it should first admit reversible error and decided a question
laboratory tests wherein it was noticed the evidence being offered so that it of substance in a way not in
that right kidney was normal but her left can determine its probative value accordance with law and the
kidney is nonfunctioning and when it decides the case. According applicable decisions when it upheld
nonvisualizing. Thus, she underwent to the Board, it can determine the admission of incompetent and
kidney operation in September, 1999. whether the evidence is relevant or inadmissible evidence by the
not if it will take a look at it through respondent board, which can result to
Private respondents husband, Romeo the process of admission. Thus, a deprivation of Professional License.
Sioson (as complainant), filed a complaint petition for certiorari was filed with the CA
for gross negligence and/or incompetence which the court dismissed due to lack of SC: No. It is well-settled that the rules of
before the [BOM] against the doctors who merit. Hence, this petition. evidence are not strictly applied in
allegedly participated in the fateful kidney proceedings before administrative bodies
operation, namely: Dr. Judd dela Vega, Dr. ISSUES: such as the BOM. [I]t is the safest
Pedro Lantin, III, Dr. Gerardo Antonio 1. Whether the petitioner availed proper policy to be liberal, not rejecting
Florendo and petitioner Rico Rommel remedy when he filed a petition for them on doubtful or technical
Atienza. It was alleged in the certiorari with the CA under RULE 65 grounds, but admitting them unless
complaint that the gross negligence plainly irrelevant, immaterial or
and/or incompetence committed by SC: Petitioner is correct when he asserts incompetent, for the reason that
the said doctors, including petitioner, that a petition for certiorari is the proper their rejection places them beyond
consists of remedy to assail the Orders of the BOM, the consideration of the court, if they
admitting in evidence the exhibits of are thereafter found relevant or
competent on the other hand, their transferred from the previous building, x x had not delivered her baby at the
admission, if they turn out later to be x to the new building. Ultimately, since expected time, Dr. Norma discussed
irrelevant or incompetent, can easily the originals cannot be produced, the BOM with Pedrito the possibility of a
be remedied by completely properly admitted Edithas formal offer of
caesarean section operation.5
discarding them or ignoring them. evidence and, thereafter, the BOM shall
determine the probative value thereof
At around 3:00 p.m. on February 3, 1992,
when it decides the case.
Petitioners insistence that the admission Carmen was brought to the hospitals
of Edithas exhibits violated his WHEREFORE, the petition is DENIED. The operating room for her caesarian section
substantive rights leading to the loss of his Decision of the Court of Appeals in CAG. R. operation, which was to be performed by
SP No. 87755 is AFFIRMED. Dr. Nestor. By 5:30 p.m. of the same day,
medical license is misplaced.
Pedrito was informed of his wifes delivery
Best evidence rule is inapplicable. of a baby boy. In the early morning of
Sec. 3. Original document must be 12. G.R. No. 192973 (CASE February 4, 1992, Carmen experienced
produced exceptions.When the subject REGARDING SPECIALIZATION OF THE abdominal pain and difficulty in
of inquiry is the contents of a document, EXPERT)
urinating. She was diagnosed to be
no evidence shall be admissible other than PEDRITO DELA TORRE, Petitioner,
suffering from urinary tract infection
the original document itself, except in the DR. ARTURO IMBUIDO, DRA. NORMA
following (UTI), and was prescribed
IMBUIDO in their capacity as owners
cases: medications by Dr. Norma. On February
and operators of DIVINE SPIRIT
(a) When the original has been lost or 10, 1992, Pedrito noticed that
GENERAL HOSPITAL and/or DR.
destroyed, or cannot be produced in court, Carmens stomach was getting
NESTOR PASAMBA, Respondents.
without bad faith on the part of the bigger, but Dr. Norma dismissed the
offeror patients condition as mere flatulence
Facts of the case:
(b) When the original is in the custody or
(kabag).6
under the control of the party against
The case stemmed from a complaint 4 for
whom the evidence is offered, and the
damages filed by Pedrito against herein When Carmens stomach still grew bigger
latter fails to produce it after reasonable
notice respondents Dr. Arturo Imbuido and Dr. despite medications, Dr. Norma advised
(c) When the original consists of numerous Norma Imbuido (Dr. Norma), in their Pedrito of the possibility of a second
accounts or other documents which capacity as the owners and operators of operation on Carmen. Dr. Norma, however,
cannot be examined in court without great the Divine Spirit General Hospital in provided no details on its purpose and the
loss of time and the fact sought to be Olongapo City, and Dr. Nestor Pasamba doctor who would perform it. At around
established from them is only the general 3:00 p.m. on February 12, 1992, Carmen
(Dr. Nestor) (respondents).
result of the whole and
had her second operation. Later in the
(d) When the original is a public record in
Pedrito alleged in his complaint that he evening, Dr. Norma informed Pedrito that
the custody of a public officer or is
recorded in a public office. was married to one Carmen Castillo Dela "everything was going on fine with [his]
Torre(Carmen), who died while wife."7
admitted at the Divine Spirit General
The introduction of secondary evidence, Hospital on February 13, 1992. Carmen The condition of Carmen, however, did not
such as copies of the exhibits, is allowed. was due to give birth on February 2,1992 improve. It instead worsened that on
Witness Dr. Nancy Aquino testified that the and was brought at around 11:30 p.m. on February 13, 1992, she vomited dark red
Records Office of RMC no longer had the blood. At 9:30 p.m. on the same day,
that day by Pedrito to the Divine Spirit
originals of the exhibits because [it]
General Hospital. When Carmen still Carmen died.8 Per her certificate of death
upon information provided by the was fully explained to Carmen and Pedrito [may be] somewhere in the spleen. The
hospital,the immediate cause of Carmens prior to its conduct. During the second entrance of foreign object in the
death was "cardio-respiratory arrest operation, the diagnosis of intestinal abdominal cavities may cause severe
secondary to cerebro vascular obstruction and adhesion was confirmed infections of the intra-abdominal cavities
accident, hypertension and chronic but resolved by her doctors. Despite the resulting [in] multiple adhesions of the
nephritis induced by pregnancy."9 An observance of due care by the doctors, intestines. In cases of surgical operation, it
autopsy Report10prepared by Dr. Richard however, Carmen died on February 13, [may be] due to the conditions of the
Patilano(Dr. Patilano), Medico-Legal 1992.15 instruments used, the materials used in
Officer-Designate of Olongapo City, the operating room being not aseptic and
however, provided that the cause of After the pre-trial conference, trial proper the ladies assisting the operation were not
Carmens death was "shock due to ensued. To support his claim, Pedrito in uniform. x x x.17
peritonitis, severe, with multiple intestinal presented the testimony of Dr. Patilano,
adhesions; Status post C[a]esarian Section the medicolegal officer who conducted an Dr. Patilano claimed that peritonitis could
and Exploratory Laparotomy." autopsy on the body of Carmen upon a have been prevented through proper
telephone request made by the City medical procedures and medicines. He
Pedrito claimed in his complaint that the Health Officer of Olongapo City, Dr. also stated that if the cause of Carmens
respondents "failed to exercise the degree Generoso Espinosa. Among Dr. Patilanos death was actually cerebro-vascular
of diligence required of them" as observations, as narrated in the lower accident, there would have been ruptured
members of the medical profession, and courts decision, were as follows: blood vessels and blood clot in her head;
were "negligent for practicing surgery on but there were none in Carmens case.18
[Carmen] in the most unskilled, ignorant In the intestines, [Dr. Patilano] found out
and cruel manner, x x x[.]"11 that it was more reddish than the normal Among those who testified to
condition which is supposed to be pinkish. refutePedritos claim was Dr. Nestor. He
In their answer12 to the complaint, the There was presence of adhesions, claimed that when Carmen was referred to
respondents argued that they "observed meaning, it sticks to each other and these him on February 3, 1992, she was in full
the required standard of medical care in areas were dilated. There were constricted term uterine pregnancy, with pre-
attending to the needs of Carmen." 13 The areas. He concluded that there might have eclampsia, fetal distress and active labor
respondents explained that Carmen was been foreign organic matters in the pains. A caesarian section operation
admitted in Divine Spirit General Hospital intestines. He did not see any swelling but became necessary to terminate the
for "pregnancy in labor and pre- assuming that there was, it would be pregnancy for her safety. Carmen was
eclampsia." Her condition was closely concomitant to the enlargement. x x x He ready to go home four days after giving
monitored during her confinement. A came to the conclusion that the cause of birth, but was advised by the doctors to
caesarian section operation became death was peritonitis, with the multiple stay more because of her persistent
necessary, as she manifested no adhesions status in the post caesarian hypertension.19
significant progress for the spontaneous section. In connection with peritonitis, this
delivery of her baby. 14 No unusual events is the inflammation of the abdomen. This The second surgery performed on Carmen
were observed during the course of peritonitis in the abdominal cavity may be was necessary after she showed
Carmens caesarian section operation. The caused by several conditions which are symptoms of intestinal obstruction, which
second surgery, however, became supposed to be infections, entrance of happens as the intestines get twisted due
necessary due to suspected intestinal foreign bodies in the intestines in to adhesions and the normal flow of
obstruction and adhesions. This procedure connection with ruptured peptic ulcer or intestinal contents are obstructed. For Dr.
Nestor, this occurrence was not most cases a physician, either failed to do medical negligence depended mainly on
preventable since any interference of the something which a reasonably prudent the testimony of Dr. Patilano. Upon
abdominal cavity would irritate the serosa health care provider would have done, or review, however, the Court agrees
of the intestines, inviting adhesions that that he or she did something that a with the CA that the report and
could cause obstruction. Surgery could reasonably prudent provider would not testimony of Dr. Patilano failed to
remedy the adhesions and have done; and that failure or action justify Pedritos entitlement to the
obstruction.20 Both Carmen and Pedrito caused injury to the patient."27 damages awarded by the RTC.
gave their written consent to this second
procedure.21 The Court emphasized in Lucas, et al. v. For the trial court to give weightto
Tuao28 that in medical negligence cases, Dr. Patilanos report, it was necessary
RTC: RTC rendered its Decision24 in favor there is a physician-patient relationship to show first Dr. Patilanos
of Pedrito. The trial court gave greater between the doctor and the victim, but specialization and competence to
weight to the testimony of Dr. just like in any other proceeding for testify on the degree of care, skill
Patilano damages, four essential elements must be and diligence needed for the
established by the plaintiff, namely: (1) treatment of Carmens case.
Dissatisfied with the RTC ruling, the duty; (2) breach; (3) injury; and (4) Considering that it was not duly
respondents appealed to the CA. proximate causation. All four elements established that Dr. Patilano
must be present in order to find the practiced and was an expert inthe
CA: The CA rendered its Decision
physician negligent and, thus, liable for fields that involved Carmens
reversing and setting aside the
damages.29 condition, he could not have
decision of the RTC. For the appellate
accurately identified the said degree
court, it was not established that the It is settled that a physicians duty to his of care, skill, diligence and the
respondents failed to exercise the degree patient relates to his exercise of the medical procedures that should have
of diligence required of them by their degree of care, skill and diligence which been applied by her attending
profession as doctors. physicians in the same general physicians.
neighborhood, and in the same general
Hence, this petition for review on
line of practice, ordinarily possess and Similarly, such duty, degree of care, skill
certiorariin which Pedrito insists that the
exercise in like cases. There is breach of and diligence were not sufficiently
respondents should be held liable for the
this duty when the patient is injured in established in this case because the
death of Carmen.
body or in health. Proof of this breach testimony of Dr. Patilano was based solely
SC: The petition is denied. rests upon the testimony of an expert on the results of his autopsy on the
witness that the treatment accorded to cadaver of Carmen. His study and
"[M]edical malpractice or, more the patient failed to meet the standard assessment were restrictedby limitations
appropriately, medical negligence, is that level of care, skill and diligence. To justify that denied his full evaluation of Carmens
type of claim which a victim has available an award of damages, the negligence of case. He could have only deduced from
to him or her to redress a wrong the doctor must be established to be the the injuries apparent in Carmens body,
committed by a medical professionalwhich proximate cause of the injury.30 and in the condition when the body was
has caused bodily harm." In order to examined. Judging from his testimony, Dr.
successfully pursue such a claim, a Through the instant petition, Pedritoseeks Patilano did not even take full
patient, or his or her family as in this case, the reinstatement of the decision of the consideration of the medical history of
"must prove that a health care provider, in RTC whose finding of the respondents Carmen, her actual health condition at the
time of hospital admission, and her Laboratory Service, Dr. Torres, testified
condition as it progressed while she was before the trial court that based on the
being monitored and treated by the autopsy report issued by Dr. Patilano, the
respondents. There was also no reference latter did not comply with the basic
to the respondents defense that the autopsy procedure when he examined the
emergency caesarian section operation cadaver of Carmen. Dr. Patilano did not
had to be performed in order to protect appear to have thoroughly examined
the lives and safety of Carmen and her Carmens vital organs such as her heart,
then unborn child. For lack of sufficient lungs, uterus and brain during the
information on Carmens health condition autopsy. His findings were then
while still alive, Dr. Patilano could not have inconclusive on the issue of the actual
fully evaluated the suitability of the cause of Carmen's death, and the claim of
respondents decisions in handling negligence allegedly committed by the
Carmens medical condition as it turned respondents.
critical.
As the Court held in Spouses Flores v.
On the other hand, the CA pointed out that Spouses Pineda, et al.,31 the critical and
Dr. Nestor, a surgeon, possessed the clinching factor in a medical negligence
reasonable degree of learning, skill and case is proof of the causal connection
experience required by his profession for between the negligence and the injuries.
the treatment ofCarmen. The respondents The claimant must prove not only the
also emphasized in their pleadings injury but also the defendant's fault, and
beforethe RTC that Dr. Nestor had his that such fault caused the injury. A verdict
training and experience in surgery and in a malpractice action cannot be based
obstetrics since 1970. Without sufficient on speculation or conjecture. Causation
proof from the claimant on a different must be proven within a reasonable
degree of care, skill and diligence that medical probability based upon competent
should be expected from the respondents, expert testimony,32 which the Court finds
it could not be said with certainty that a absent in the case at bar.
breachwas actually committed.
WHEREFORE, the petition is DENIED. The
Moreover, while Dr. Patilano opined that Decision dated December 15, 2009 and
Carmen died of peritonitis which could be Resolution dated July 27, 2010 of the
due to the poor state of the hospital Court of Appeals in CA-G.R. CV No. 78534
equipment and medical supplies used are AFFIRMED.
during her operation, there was no
sufficient proof that any such fault actually
attended the surgery of Carmen, caused
her illness and resulted in her death. It is
also significant that the Chief of the
Medico-Legal Division of the PNP Crime
13. G.R. No. 175540 (Case deteriorated and he was intubated and furnished by EAMC a copy of the patients
regarding lack of consent for ambu-bagging support was provided; that date sheet which bears the name Angelito
transplant) admission to the Intensive Care Unit (ICU) Lugmoso, with address at Boni Avenue,
and mechanical ventilator support became Mandaluyong. She then contacted several
DR. FILOTEO A. ALANO, Petitioner, necessary, but there was no vacancy at radio and television stations to request for
ZENAIDA MAGUD- the ICU and all the ventilator units were air time for the purpose of locating the
LOGMAO, Respondent. being used by other patients; that a family of Angelito Lugmoso of Boni
resident physician of NKI, who was Avenue, Mandaluyong, who was confined
FACTS OF THE CASE:
rotating at EAMC, suggested that at NKI for severe head injury after
Plaintiff-appellee Zenaida Magud-Logmao [Logmao] be transferred to NKI; and that allegedly falling from the Cubao overpass,
is the mother of deceased Arnelito after arrangements were made, [Logmao] as well as Police Station No. 5, Eastern
Logmao. Defendant-appellant Dr. Filoteo was transferred to NKI at 10:10 in the Police District, whose area of jurisdiction
Alano is the Executive Director of the morning. includes Boni Avenue, Mandaluyong, for
National Kidney Institute (NKI). assistance in locating the relatives of
At the NKI, the name Angelito [Logmao] Angelito Lugmoso. Certifications were
At around 9:50 in the evening of March 1, was recorded as Angelito Lugmoso. issued by Channel 4, ABS-CBN and GMA
1988, Arnelito Logmao, then eighteen (18) Lugmoso was immediately attended to attesting that the request made by the NKI
years old, was brought to the East Avenue and given the necessary medical on March 2, 1988 to air its appeal to locate
Medical Center (EAMC) in Quezon City by treatment. As Lugmoso had no the family and relatives of Angelito
two sidewalk vendors, who allegedly saw relatives around, Jennifer B. Misa, Lugmoso of Boni Avenue, Mandaluyong
the former fall from the overpass Transplant Coordinator, was asked to was accommodated. A Certification was
near the Farmers Market in Cubao, locate his family by enlisting police likewise issued by Police Station No. 5,
Quezon City. The patients data sheet and media assistance. Dr. Enrique T. Eastern Police District, Mandaluyong
identified the patient as Angelito Lugmoso Ona, Chairman of the Department of attesting to the fact that on March 2,
of Boni Avenue, Mandaluyong. Surgery, observed that the severity of 1988, at about 6:00 p.m., Jennifer Misa
the brain injury of Lugmoso requested for assistance to immediately
However, the clinical abstract prepared by manifested symptoms of brain death. locate the family and relatives of Angelito
Dr. Paterno F. Cabrera, the surgical He requested the Laboratory Section to Lugmoso and that she followed up her
resident on-duty at the Emergency Room conduct a tissue typing and tissue cross- request until March 9, 1988.
of EAMC, stated that the patient is matching examination, so that should
Angelito [Logmao]. Lugmoso expire despite the necessary On March 3, 1988, at about 7:00
medical care and management and he oclock in the morning, Dr. Ona was
Dr. Cabrera reported that [Logmao] was would be found to be a suitable organ informed that Lugmoso had been
drowsy with alcoholic breath, was donor and his family would consent to pronounced brain dead by Dr. Abdias V.
conscious and coherent; that the skull organ donation, the organs thus donated Aquino, a neurologist, and by Dr. Antonio
x-ray showed no fracture; that at around could be detached and transplanted Rafael, a neurosurgeon and attending
4:00 oclock in the morning of March 2, promptly to any compatible beneficiary. physician of Lugmoso, and that a repeat
1988, [Logmao] developed generalized electroencephalogram (EEG) was in
seizures and was managed by the neuro- Jennifer Misa verified on the same day, progress to confirm the diagnosis of brain
surgery resident on-duty; that the March 2, 1988, from EAMC the identity of death. Two hours later, Dr. Ona was
condition of [Logmao] progressively Lugmoso and, upon her request, she was
informed that the EEG recording exhibited the morning due to craniocerebral injury. Ricardo Fernando, and Myrna Mendoza,
a flat tracing, thereby confirming that The memo requires to make certain that removed the heart, kidneys, pancreas,
Lugmoso was brain dead. Upon learning the Department has exerted all reasonable liver and spleen of Lugmoso. The medical
that Lugmoso was a suitable organ donor efforts to locate the relatives or next of kin team then transplanted a kidney and the
and that some NKI patients awaiting organ of the said deceased patient such as pancreas of Lugmoso to Lee Tan Hoc and
donation had blood and tissue types appeal through the radios and television the other kidney of Lugmoso to Alexis
compatible with Lugmoso, Dr. Ona as well as through police and other Ambustan. The transplant operation was
inquired from Jennifer Misa whether the government agencies and that the NBI completed at around 11:00 oclock in the
relatives of Lugmoso had been located so [Medico-Legal] Section has been notified evening of March 3, 1988.
that the necessary consent for organ and is aware of the case.
donation could be obtained. As the On March 4, 1988, Dr. Antonio R. Paraiso,
extensive search for the relatives of In accordance with the provisions of Head of the Cadaver Organ Retrieval Effort
Lugmoso yielded no positive result and Republic Act No. 349 as amended and P.D. (CORE) program of NKI, made
time being of the essence in the success 856, the department was given permission arrangements with La Funeraria Oro for
of organ transplantation, Dr. Ona and/or authority to retrieve and remove the embalmment of the cadaver of
requested Dr. Filoteo A. Alano, Executive the kidneys, pancreas, liver and heart of Lugmoso good for a period of fifteen (15)
Director of NKI, to authorize the removal the said deceased patient and to days to afford NKI more time to continue
of specific organs from the body of transplant the said organs to any searching for the relatives of the latter. On
Lugmoso for transplantation purposes. Dr. compatible patient who maybe in need of the same day, Roberto Ortega, Funeral
Ona likewise instructed Dr. Rose Marie said organs to live and survive. Consultant of La Funeraria Oro, sent a
Rosete-Liquete to secure permission for request for autopsy to the NBI. The
A Certification dated March 10, 1988 was Autopsy Report and Certification of Post-
the planned organ retrieval and
issued by Dr. Maximo Reyes, Medico-Legal Mortem Examination issued by the NBI
transplantation from the Medico-Legal
Officer of the NBI, stating that he received stated that the cause of death of Lugmoso
Office of the National Bureau of
a telephone call from Dr. Liquete on March was intracranial hemorrhage secondary to
Investigation (NBI), on the assumption
3, 1988 at 9:15 a.m. regarding the case of skull fracture.
that the incident which lead to the brain
Lugmoso, who was declared brain dead;
injury and death of Lugmoso was a medico
that despite efforts to locate the latters On March 11, 1988, the NKI issued a press
legal case.
relatives, no one responded; that Dr. release announcing its successful double
On March 3, 1988, Dr. Alano issued to Dr. Liquete sought from him a second opinion organ transplantation. Aida Doromal, a
Ona a Memorandum, in connection with for organ retrieval for donation purposes cousin of plaintiff, heard the news aired on
the use of the human organs or any even in the absence of consent from the television that the donor was an eighteen
portion or portions of the human body of family of the deceased; and that he (18) year old boy whose remains were at
the deceased patient, identified as a verbally agreed to organ retrieval. La Funeraria Oro in Quezon City. As the
certain Mr. Angelito Lugmoso who was name of the donor sounded like Arnelito
At 3:45 in the afternoon of March 3, 1988, Logmao, Aida informed plaintiff of the
brought to the National Kidney Institute on
a medical team, composed of Dr. Enrique news report.
March 2, 1988 from the East Avenue
Ona, as principal surgeon, Drs. Manuel
Medical Center.
Chua-Chiaco, Jr., Rose Marie Rosete- It appears that on March 3, 1988, Arlen
As shown by the medical records, the said Liquete, Aurea Ambrosio, Ludivino de Logmao, a brother of Arnelito, who was
patient died on March 3, 1988 at 9:10 in Guzman, Mary Litonjua, Jaime Velasquez, then a resident of 17-C San Pedro Street,
Mandaluyong, reported to Police Station THAT THE ACT OF THE PETITIONER IS NOT other patients, he did so in accordance
No. 5, Eastern Police District, Mandaluyong THE PROXIMATE CAUSE NOR IS THERE ANY with the letter of the law, Republic Act
that the latter did not return home after FINDING THAT THE ACT OF THE (R.A.) No. 349, as amended by Presidential
seeing a movie in Cubao, Quezon City, as PETITIONER WAS THE PROXIMATE CAUSE Decree (P.D.) 856, i.e., giving his
evidenced by a Certification issued by said OF THE INJURY OR DAMAGE ALLEGEDLY subordinates instructions to exert all
Station; and that the relatives of Arnelito SUSTAINED BY RESPONDENT ZENAIDA reasonable efforts to locate the
were likewise informed that the latter was MAGUD-LOGMAO. relatives or next of kin of
missing. Upon receiving the news from respondent's son. In fact,
Aida, plaintiff and her other children went B. WHETHER THE COURT OF APPEALS announcements were made through radio
to La Funeraria Oro, where they saw GRAVELY ERRED IN REFUSING AND/OR and television, the assistance of police
Arnelito inside a cheap casket. FAILING TO DECLARE THAT PETITIONER authorities was sought, and the NBI
DR. ALANO ACTED IN GOOD FAITH AND Medico-Legal Section was notified. Thus,
On April 29, 1988, plaintiff filed with the PURSUANT TO LAW WHEN HE ISSUED THE petitioner insists that he should not be
court a quo a complaint for damages. AUTHORIZATION TO REMOVE AND held responsible for any damage allegedly
Plaintiff alleged that defendants conspired RETRIEVE THE ORGANS OF ANGELITO suffered by respondent due to the death
to remove the organs of Arnelito while the LUGMOSO (LATER IDENTIFIED TO BE IN of her son and the removal of her sons
latter was still alive and that they FACT ARNELITO LOGMAO) CONSIDERING internal organs for transplant purposes.
concealed his true identity. THAT NO NEGLIGENCE CAN BE
ATTRIBUTED OR IMPUTED ON HIM IN HIS The appellate court affirmed the trial
RTC: On January 17, 2000, the court a quo PERFORMANCE OF AN ACT MANDATED BY court's finding that there was negligence
rendered judgment finding only Dr. Filoteo LAW. on petitioner's part when he failed to
Alano liable for damages to plaintiff and ensure that reasonable time had elapsed
dismissing the complaint against the other C. WHETHER THE COURT OF APPEALS to locate the relatives of the deceased
defendants for lack of legal basis.3 GRAVELY ERRED IN AWARDING before giving the authorization to remove
RESPONDENT ZENAIDA MAGUD-LOGMAO said deceased's internal organs for
Petitioner appealed to the CA. MORAL AND EXEMPLARY DAMAGES AND transplant purposes.
ATTORNEY'S FEES THAT ARE NOT IN
CA: Affirmed the decision with
ACCORDANCE WITH AND ARE CONTRARY However, a close examination of the
modification on the reward for damages.
TO ESTABLISHED JURISPRUDENCE.5 records of this case would reveal that this
Petitioner then elevated the matter to this case falls under one of the exceptions to
The first two issues boil down to the the general rule that factual findings of
Court via a petition for review on
question of whether respondent's the trial court, when affirmed by the
certiorari, where the following issues are
sufferings were brought about by appellate court, are binding on this Court.
presented for resolution:
petitioner's alleged negligence in granting There are some important circumstances
ISSUES: WHETHER THE COURT OF authorization for the removal or retrieval that the lower courts failed to consider in
APPEALS DISREGARDED EXISTING of the internal organs of respondent's son ascertaining whether it was the actions of
JURISPRUDENCE PRONOUNCED BY THIS who had been declared brain dead. petitioner that brought about the
HONORABLE SUPREME COURT IN HOLDING sufferings of respondent. 6
Petitioner maintains that when he gave
PETITIONER DR. FILOTEO ALANO LIABLE
authorization for the removal of some of A careful reading shows that petitioner
FOR MORAL AND EXEMPLARY DAMAGES
the internal organs to be transplanted to instructed his subordinates to "make
AND ATTORNEY'S FEES DESPITE THE FACT
certain" that "all reasonable efforts" are opinion and approval of the Medico-Legal reasonable under the circumstances. They
exerted to locate the patient's next of kin, Officer of the NBI. failed to present any expert witness to
even enumerating ways in which to ensure prove that given the medical technology
that notices of the death of the patient Thus, there can be no cavil that petitioner and knowledge at that time in the 1980's,
would reach said relatives. It also clearly employed reasonable means to the doctors could or should have waited
stated that permission or disseminate notifications intended to longer before harvesting the internal
authorization to retrieve and remove reach the relatives of the deceased. The organs for transplantation.
the internal organs of the deceased only question that remains pertains
was being given ONLY IF the to the sufficiency of time allowed for Verily, the Court cannot, in conscience,
provisions of the applicable law had notices to reach the relatives of the agree with the lower court. Finding
been complied with. Such instructions deceased. petitioner liable for damages is improper.
reveal that petitioner acted prudently It should be emphasized that the
If respondent failed to immediately receive internal organs of the deceased were
by directing his subordinates to
notice of her son's death because the removed only after he had been
exhaust all reasonable means of
notices did not properly state the name or declared brain dead; thus, the
locating the relatives of the
identity of the deceased, fault cannot be emotional pain suffered by
deceased. He could not have made
laid at petitioner's door. The trial and respondent due to the death of her
his directives any clearer. He even
appellate courts found that it was the son cannot in any way be attributed
specifically mentioned that
EAMC, who had the opportunity to to petitioner. Neither can the Court find
permission is only being granted IF
ascertain the name of the deceased, who evidence on record to show that
the Department of Surgery has
recorded the wrong information regarding respondent's emotional suffering at the
complied with all the requirements of
the deceased's identity to NKI. The NKI sight of the pitiful state in which she found
the law. Verily, petitioner could not have
could not have obtained the information her son's lifeless body be categorically
been faulted for having full confidence in
about his name from the patient, because attributed to petitioner's conduct.
the ability of the doctors in the
as found by the lower courts, the
Department of Surgery to comprehend the
deceased was already unconscious by the WHEREFORE, the petition is GRANTED.
instructions, obeying all his directives, and
time he was brought to the NKI. The Decision of the Court of Appeals,
acting only in accordance with the
dated March 31, 2006, is REVERSED and
requirements of the law. Ultimately, it is respondent's failure to SET ASIDE. The complaint against
adduce adequate evidence that doomed petitioner is hereby DISMISSED.
Furthermore, as found by the lower courts
this case. As stated in Otero v. Tan, 8 "[i]n
from the records of the case, the doctors
civil cases, it is a basic rule that the party
and personnel of NKI disseminated notices
making allegations has the burden of
of the death of respondent's son to the
proving them by a preponderance of 14. G.R. No. 203080
media and sought the assistance of the
evidence. The parties must rely on the
appropriate police authorities as early as DR. IDOL L.
strength of their own evidence and not
March 2, 1988, even before petitioner BONDOC, Petitioner, v. MARILOU R.
upon the weakness of the defense offered
issued the Memorandum. Prior to MANTALA, Respondent.
by their opponent."9 Here, there is to proof
performing the procedure for retrieval of
that, indeed, the period of around 24
the deceased's internal organs, the Facts of the case:
hours from the time notices were
doctors concerned also the sought the On November 6, 2009, Marilou R. Mantala
disseminated, cannot be considered as
(respondent) filed a complaint for grave The midwife arrived and berated her for who regularly checked on her condition.
misconduct against Dr. Idol L. Bondoc not yet sleeping and holding on to the
(petitioner), Medical Officer III at the steel bar. The midwife and the younger On April 27, 2009, petitioner removed the
Oriental Mindoro Provincial Hospital assistants again pressed down on her sutures but still left open three of them.
(OMPH). abdomen causing excruciating pain on her She wondered then why petitioner
ribs and made her very weak. They suddenly showed kindness towards her. In
Respondent was admitted at the OMPH on repeatedly did this pressing until the baby the evening of April 28, 2009, petitioner
April 3, 2009, at around 11:00 in the and placenta came out. When she talked to her and said in a threatening
morning, with referral5 from the Bansud regained consciousness, she was already tone "Ikaw ang sadyang ayaw magpa-cs"
Municipal Health Office (BMHO). She was at the recovery room. She learned that and also told her that he just came from
due to deliver her fifth child and was an operation was performed on her Pinamalayan and Bansud and already
advised by the BMHO for a cesarean by petitioner to remove her ruptured talked to Dr. Atienza and Dr. Sales.
section because her baby was big and uterus but what depressed her most Petitioner then told the nurse on
there was excessive amniotic fluid in was her stillborn baby and the loss of duty, "Papirmahin mo si Mantala,
her womb. She started to labor at 7:00 in her reproductive capacity. The next pauuwiin ko na 'yan bukas. Tanggalin mo
the morning and was initially brought to day, she was transferred to a ward. She na rin ang tahi." He further said, "huwag
the Bongabon Health Center. However, noticed her very swollen vulva and her sana akong idemanda ni Mantala kasi
said health center also told her to proceed surgical wound open with liquid squirting kaya ko siyang baligtarin" The following
directly to the hospital. from it. Her wound was regularly cleaned day, she was discharged after the nurse
by a nurse. On April 9, 2009, she was had removed the remaining sutures. At
In her complaint-affidavit,6 respondent discharged notwithstanding that the home, it was her sister who cleaned the
alleged that inside the delivery room of suture on her wound needs to be fixed and still open wound.
OMPH, she was attended to by petitioner she still has a cough. At home, she took
who instructed the midwife and two the antibiotics, cough medicine and Joel F. Mantala, respondent's husband, and
younger assistants to press down on multivitamins prescribed by petitioner. her sisters Mylen R. Amistad and Lucia
respondent's abdomen and even Rala, executed their respective
demonstrated to them how to insert their After two days, the opening in her wound 7
affidavits to corroborate her story. In
fingers into her vagina. Thereafter, widened. Her husband brought her to the addition, respondent submitted the
petitioner went out of the delivery room Bongabon Community Hospital but they affidavit of Dr. Rosinico F. Fabon, the
and later, his assistants also left. As she were advised to have her wound re- anesthesiologist on duty during the
labored in pain, she felt the movement of stitched by the same surgeon (petitioner) operation performed by petitioner on April
her baby inside her womb and the who operated on her. Thus, on April 14, 3, 2009.
intermittent stiffening of her abdomen. 2009, they went back to OMPH. She was
attended to by a certain Dr. Gonzales who Joel Mantala claimed that at the OMPH at
At about 4:00 in the afternoon, petitioner cleaned her wound which now has a lot of around 2:30 in the afternoon when her
returned to the delivery room and asked pus, and the said doctor commented wife was still laboring, petitioner talked to
her, "Hindi ka pa nanganganak?" Since that "problema ito ni Bondoc." On April 18, him and told her that the baby is too big
she could no longer bear the pain, she 2009, after she was given blood and if it comes out alive it will probably be
requested petitioner to perform a transfusion, petitioner re-stitched her abnormal so that it would be better if the
cesarean section but this was not done. wound. Thereafter, it was Dr. Gonzales baby is stillborn. He further averred that
despite the pleas of her wife for a while surgery began at 8:45 p.m. He That Dr. Bondoc operated on the patient
cesarean operation, petitioner insisted on continued to narrate what transpired next all by himself without the help of a
a normal delivery during which she almost and his observations, as consultant or an assistant surgeon.
died.8 Nowhere in the patient chart will show
That right after induction - when patient that he referred this case to his
On the other hand, Dr. Fabon narrated that was asleep already and don't feel any pain consultant; one thing that I was wondering
in the afternoon of April 3, 2009, he was at all - her blood pressure suddenly why he was doing the surgery alone. He
attending to a patient being operated on dropped to 70/40 utilized the scrub nurse to assist him
by petitioner when he heard the latter making a delicate and bloody surgery
saying that "meron pa nga kami sa DR That after opening the abdomen, I saw more bloody and difficult.
macrosomia, polyhydramnios pa, pero massive hemoperitonium and the
paanakin na lang 'yon, abnormal din ruptured uterus with bleeding from That after Dr. Bondoc had removed the
naman ang bata kahit mabuhay, kawawa various directions. I immediately ruptured uterus and the bleeding was
lang siya" After the operation, petitioner requested for additional blood to be used controlled, he made intra-operative
went out of the Operating Room (OR) and intra-operatively while at the same time I referral to Dr. Ariel Tria, a resident
proceeded towards the direction of the OB established another intravenous line so as surgeon, to check on the urinary bladder
ward. At 5:35 in the afternoon, a Request to cope with on-going surgical blood loss. I and the ureters.
for Surgery[9was forwarded to the OR for had now three big-bore fast-dripping IV
Emergency Pelvic Laparotomy of lines. That the operation performed was
respondent with a diagnosis of T/C Subtotal Hysterectomy with Unilateral
Ruptured Uterus. That in spite of this measure, blood Salpingooophorectomy. I noticed that the
pressure dropped to 50/30 mmHg. There operation technique was different from
When respondent was brought to the OR was an instance wherein I cannot even that which Dr. Bondoc had written in the
at 8:15 p.m., Dr. Fabon found her appreciate the blood pressure of the Surgical Memo and that the patient did not
conscious but very weak and pale, with patient, her pulse hardly noticeable on tolerate the procedure well.
abdominal pain and tenderness on very palpation and she was very pale that
slight palpation. He then heard from necessitates turning the anesthetic gas off That the patient was very pale after the
petitioner himself that it was the same so as to keep her alive. She was given a procedure with low blood pressure due to
patient he was referring to earlier with a dose of Atropine after patient did not massive blood loss. That her blood
diagnosis of macrosomia, polyhydramnios. respond to two l0mg doses of Ephedrine. I pressure started to improve at the
Petitioner volunteered that respondent prescribed Dobutamine and Dopamine Recovery Room but the pulse rate
had just delivered her baby but that her drips to help improve her blood pressure remained considerably high for several
uterus probably ruptured in the process of and maintain adequate urine output. hours. Her urine output was inadequate
childbirth. "Pinilit no 'ng tatlong ungas, Unfortunately, only Dopamine was and that it had to be maintained using
ayon lumusot pero patay ang bata, tapos available. I had to use 100% Oxygen at Dopamine.
Ho, mukhang pumutok" petitioner said. 3L/minute without mixture of volatile gas
for several minutes. She was maintained That when Leo Reyes, the Recovery Room
Dr. Fabon immediately prepared using muscle relaxants alone on controlled nurse, referred the patient to me and I
respondent for General Anesthesia; ventilation. checked the urinary catheter, I noticed her
respondent was inducted at 8:35 p.m. vagina to be massively swollen with
hematomas all over. respondent to his assistants, petitioner Petitioner blamed respondent for risking
claimed that between 12 noon and 2:00 her own life in not seeking immediately a
That the patient had to be referred to o'clock in the afternoon, he was busy higher level of medical care and instead
Internal Medicine for co-management[.] checking on pregnant patients at the out- preferring a TBA who is prohibited under a
patient department (OPD) of OMPH until 2006 provincial circular to handle
That Marilou Mantala stayed in the he was called for his first cesarean section deliveries at home. He emphasized that
Recovery Room for almost eleven (11) (CS). Later at 4:00 o'clock, without resting upon admission the fetal heart tone is no
hours. She was transferred to Gyne Ward and having lunch, he visited respondent longer appreciated and maintained that
at 9:20 AM the following day.10 and other admitted patients at the diligent care was extended to respondent
delivery room. Together with the nurse on during her stay at OMPH. As to the
duty, Mrs. Evelyn D. Morales, petitioner complications like cough and wound
In his counter-affidavit,11 petitioner said he explained to respondent her and dehiscence, he explained that these were
averred that when respondent was her baby's condition based on the referral the effects of anesthesia and surgery (loss
brought to OMPH with referral form from from BMHO (polyhydramnios) and initial of blood, massive blood transfusion and
BMHO, she had been in labor for more findings that her abdomen and baby were intravenous fluid infusion), and also poor
than twelve (12) hours at home. He big and the baby's heartbeat is not compliance with prescribed medication.
submitted his admitting diagnosis of the appreciated. He presented the respondent He further asserted that he had referred
patient, "Gravida 5 Parity 4 (4004) with two options: have a normal delivery the patient to other co-doctors on duty like
Pregnancy Uterine 38 to 39 Weeks Age of or undergo cesarean section, and the Dr. Romy Lomio (Internal Medicine) for co-
Gestation by Last Menstrual Period consequences of each choice. Respondent management.
Cephalic in Labor; Macrosomia; Fetal chose the former believing that she can
Death in Utero." handle this childbirth at home, and On April 23, 2010, petitioner submitted
petitioner respected her decision. a manifestation that he had resigned
Petitioner alleged that during his interview as Medical Officer of OMPH effective
with respondent, the latter admitted to After seeing other patients at the delivery March 5, 2010. He thus posited that
him that she doesn't want to be confined room, petitioner was called for his second the administrative case is now
at any hospital because she was afraid to CS that day. Thus, he was obliged to rendered moot and academic.
be handled by medical doctors. Instead, proceed to the OR and left the respondent
she went to a traditional birth attendant under the care of three assistants, one of On August 12, 2010, the Office of the
(TBA) or "hilot which she voluntarily whom is an experienced midwife. That he Deputy Ombudsman for Luzon
named as Apolonia Salcedo, residing at was not the one who attended to the, rendered a Decision finding the
Dalapian, Labasan, Bongabon, Oriental respondent during her delivery is petitioner administratively liable. It
Mindoro. Respondent clearly defied the confirmed by the statements of held that by fully entrusting to his
advice of Drs. Theresa Atienza and Mario respondent herself, Dr. Fabon and Mrs. subordinates the task of handling
Sales not to give birth at home. As to her Morales. Further, petitioner claimed it has respondent's complicated delivery,
swollen vulvar hematoma which was been a long-time practice at OMPH that petitioner exhibited an improper or
noticed by Dr. Fabon, it was the result of whenever the doctor is at the OR, the wrongful conduct and dereliction of duty
prolonged labor. experienced midwives will take over the as medical practitioner. Being the most
delivery of laboring patients. competent person who should have
As to the charge that he abandoned the rendered the appropriate medical service
to respondent, petitioner should have view of respondent's critical condition. It duties of a public officer. On the other
personally attended to the latter. Such likewise faulted the petitioner for hand, when the elements of corruption,
action or inaction of his part amounts to deliberately leaving the laboring and clear intent to violate the law or flagrant
intentional or willful neglect in discharging unstable respondent to the care of his disregard of established rule are manifest,
his sworn duty as a government physician inexperienced subordinates at the time the public officer shall be liable for grave
which is also equivalent to misconduct in she was about to give birth. As to misconduct.15
office. The administrative case filed petitioner's excuse that he had to attend
against the respondent is also not to an equally important cesarean
rendered moot by his subsequent operation, the CA said there was no In this case, both the Ombudsman and
resignation in office. sufficient showing of the latter's urgency CA found the petitioner guilty of grave
and assuming it to be true, still, petitioner misconduct in failing to attend to
The Decision of the OMB: should have exerted efforts to refer respondent when she was having
respondent's case to another competent prolonged difficult labor and vaginal
Medical Officer Idol L. Bondoc of Oriental doctor or one of his consultants. delivery after being diagnosed
Mindoro Provincial Hospital (OMPH) - guilty
with macrosamia and polyhydramnios.
of Grave Misconduct with penalty Petitioner is now before this Court arguing
of DISMISSAL in the Government Service that the CA erred in affirming the Polyhydramnios is an abnormal condition
pursuant to Section 10, Rule III, Ombudsman's ruling that he is guilty of occurring in pregnancy, characterized by
Administrative Order No. 07, as amended grave misconduct and imposing on him excessive amniotic fluid (the fluid
by Administrative Order No. 17, in relation the penalty of dismissal from the service. surrounding the baby in the uterus). Apart
to Section 25 of Republic Act No. 6770. from protecting the baby from any
The penalty of dismissal shall carry with it external impact by providing a cushioning
that of cancellation of eligibility, forfeiture SC: The petition has no merit. effect, the clear or slightly yellowish fluid
of the retirement benefits, and the plays a vital role in proper fetal
perpetual disqualification for development as well. However, increased
reemployment in the government service Misconduct is defined as a transgression
levels of the fluid can cause various
pursuant to Section 58, Rule IV of the of some established and definite rule of
complications during different stages of
Uniform Rules on Administrative Cases in action, more particularly, unlawful
pregnancy and childbirth.16 Intra-amniotic
the Civil Service. behavior or gross negligence by a public
pressure is markedly elevated in most
officer,13 a forbidden act, a dereliction of
patients with severe hydramnios. The
duty, willful in character, and implies
incidence of cesarean section is also
The foregoing ruling was affirmed by wrongful intent and not mere error in
increased as a result of unstable lie and
the CA and petitioner's motion for judgment.14 It generally means wrongful,
placental abruption, which may occur with
reconsideration was denied. improper or unlawful conduct motivated
the rapid decrease in intrauterine pressure
by a premeditated, obstinate or
that accompanies membrane rupture.17
intentional purpose. The term, however,
The CA concurred that petitioner should does not necessarily imply corruption
have chosen to stay in the delivery One of the known causes and risk factors
or criminal intent. To constitute an
room and personally attend to the of polyhydramnios is
administrative offense, misconduct should
patient as he is the most competent fetal macrosomia (having a baby too large
relate to or be connected with the
person to render medical service in for the gestational age).18
performance of the official functions and
delivery. However, this claim is belied by delivery, petitioner clearly committed
According to medical authorities, a the sworn statements of respondent, her a dereliction of duty and a breach of
macrosomic infant poses a different set of husband and her sisters, all of whom his professional obligations. The
complications. The incidences of shoulder averred that they requested for a gravity of respondent's condition is
dystocia,19 birth injuries, perinatal death, cesarean section as per the advice given highlighted by the expected complications
and low Apgar scores are increased in by Dr. Atienza who examined her in March she suffered - her stillborn baby, a
macrosomic infants.20 In these cases, 2009, and as confirmed at the Bansud ruptured uterus that necessitated
careful attention to the patient, potential Health Center where she was told that it immediate surgery and blood transfusion,
risk factors, clinical progress, and fetal would be risky for her to have a normal and vulvar hematomas.
size should allow obstetricians to reduce delivery. Moreover, Joel Mantala asserted
the occurrence of maternal and neonatal that what petitioner said to him was that
morbidity.21 Vaginal delivery of the the baby was too big and if born alive it Article II, Section 1 of the Code of Medical
macrosomic infant is associated with an would probably have abnormalities so it Ethics of the Medical Profession in the
increased incidence of birth trauma. The would be better that the baby is stillborn. Philippinesstates:
question whether to perform cesarean
The Court is more inclined to believe A physician should attend to his patients
section thus arises.22
respondent's version which was duly faithfully and conscientiously. He should
If the estimated fetal weight is 4000 to corroborated by Dr. Fabon who heard secure for them all possible benefits that
4500 g by ultrasonography and the petitioner saying that: "Meron pa nga may depend upon his professional skill
patient has a clinically adequate pelvis, kami sa DR macrosomnia, polyhydramnios and care. As the sole tribunal to adjudge
labor may be allowed. If labor is protracted pa, pero paanakin na long 'yon. Abnormal the physician's failure to fulfill his
or the second stage is prolonged, a din naman ang bata kahit mabuhay." This obligation to his patients is, in most cases,
cesarean section would avoid the possible puts into doubt petitioner's supposed his own conscience, violation of this rule
trauma of a difficult vaginal delivery. finding that the baby was already dead on his part is discreditable and
Because of the greater morbidity upon respondent's admission at OMPH and inexcusable.26
associated with infants who weigh more that it was respondent who insisted on a
than 4500 g, elective cesarean section is normal delivery. Even assuming that
A doctor's duty to his patient is not
warranted. On the other hand, prolonged petitioner had actually confirmed
required to be extraordinary. The standard
labor may culminate in obstructed labor, intrauterine fetal death, this only
contemplated for doctors is simply the
and is associated with maternal infection, aggravates the patient's condition and it
reasonable average merit among
uterine rupture and postpartum was incumbent upon petitioner as the
ordinarily good physicians, i.e. reasonable
hemorrhage.24 obstetrician on duty to personally attend
skill and competence.27 Even by this
to her and render appropriate
standard, petitioner fell short when he
management or treatment.
As per the admitting routinely delegated an important task that
diagnosis[25 submitted by petitioner, the requires his professional skill and
latter was aware of macrosomia and the In deliberately leaving the respondent to a competence to his subordinates who have
fetal heartbeat not appreciated. He also midwife and two inexperienced assistants no requisite training and capability to
maintains that respondent's baby was despite knowing that she was under make crucial decisions in difficult
already dead due to prolonged labor but prolonged painful labor and about to give childbirths.
she had insisted on having a normal birth to a macrosomic baby by vaginal
Petitioner's proffered excuse that it was of established rule and improper independence and respect for human
the practice in OMPH to allow midwives to conduct were proven by substantial dignity.28 (Italics supplied.)
administer to patients during deliveries, is evidence.
unacceptable. No proof of such alleged
hospital practice such as an official written Not only did petitioner routinely delegate Finally, we find no merit in petitioner's
directive was presented. Besides, it is his responsibility to his subordinates, he argument that the CA should have at least
doubtful whether hospital administrators casually instructed them to press down considered as mitigating circumstances
would remedy personnel shortage by repeatedly on respondent's abdomen, his being a first offender,29 his 16 years in
permitting inexperienced staff, by unmindful of her critical condition as borne government service, and that he had not
themselves, to handle laboring patients out by his very own findings. Worse, acted in bad faith and with clear intent to
with high-risk pregnancies and petitioner haughtily and callously spoke of violate the law and established rules.
maternal/fetal complications. respondent's case to the other doctors
and medical staff while performing a CS Jurisprudence is replete with cases
after he had briefly attended to her at the declaring that a grave offense cannot
As to the two other scheduled CS delivery room "...paanakin na long 'yon, be mitigated by the fact that the
performed by petitioner on the same day, abnormal din naman ang bata kahit accused is a first time offender or by
this will not exculpate him from mabuhay, kawawa lang siya." Such the length of service of the
administrative liability. As correctly insensitive and derisive language was accused. 30

pointed out by the CA, there was no again heard from the petitioner when he
showing of similar urgency in the said referred for the second time to While in most cases, length of service is
operations, and petitioner could have respondent's traumatic delivery, saying considered in favor of the respondent, it is
referred respondent to another competent that: "Pinilit no 'ng tatlong ungas, ayon not considered where the offense
physician. He could have likewise lumusot pero patay ang bata, tapos ito, committed is found to be serious or
arranged for adjustment in the operation mukhang pumutok" As a government grave.31 In Medina v. Commission on
schedules considering that his personal physician, petitioner's demeanor is Audit,32 the Court stressed that dishonesty
attention and management is urgently unbecoming and bespeaks of his and grave misconduct have always been
needed in respondent's difficult and indifference to the well-being of his and should remain anathema in the civil
complicated delivery. But there is no patients. service. They inevitably reflect on the
indication in the records that petitioner fitness of a civil servant to continue in
duly informed or referred the matter to the Petitioner thus not only committed a office. When an officer or employee is
other doctors or the administrators of dereliction of duty, but also transgressed disciplined, the object sought is not the
OMPH. the ethical norms of his profession when punishment of such officer or employee
he failed to render competent medical but the improvement of the public service
We therefore hold that the CA care with compassion and respect for his and the preservation of the public's faith
correctly affirmed the Ombudsman in patient's dignity. and confidence in the government.
finding the petitioner guilty of grave
A physician should be dedicated to WHEREFORE, the petition is DENIED for
misconduct. His violation of the
provide competent medical care with full lack of merit. The Decision dated May 24,
sworn duty to attend to his patients
professional skill in accordance with the 2012 and Resolution dated August 14,
faithfully and conscientiously is
current standards of care, compassion, 2012 of the Court of Appeals in CA-G.R. SP
inexcusable. Such flagrant disregard
No. 120563 are AFFIRMED and UPHELD.
15. SPS. ALFREDO BONTILAO AND U-splint on Allen Key then sent him RTC: Applying the doctrine of res ipsa
SHERLINA BONTILAO, petitioners, vs. DR. home. On June 4, 1992, Allen refracted the loquitor, found Dr. Carlos and Dr. Vicente
CARLOS GERONA, respondent. same wrist, where x-ray examination solidarily liable and ordered them to pay
showed a complete fracture and damages.
displacement of the bone. Dr. Carlos then
performed a closed reduction procedure Out of this decision, only Dr. Carlos
Notes: It is a rule of evidence whereby with Dr. Vicente as anaesthesiologist. After appealed to the Court of Appeals, as Dr.
negligence of the alleged wrongdoer may the post-reduction x-ray showed that the Vicente opted not to file his appeal.
be inferred from the mere fact that the bones were properly aligned, Allen was
accident happened, provided that the sent home with instruction to bring him for CA: Reversed the RTC ruling, holding that
character of the accident and re-tightening not later than June 15, 1992. Dr. Carlos is not liable under the doctrine
circumstances attending it lead It was later that Allen was brought to the of res ipsa loquitor, and in applying the
reasonably to the belief that in the hospital. Because no retightening captain of the ship doctrine in the case.
absence of negligence it would not have happened, a rotational deformity had Here, the anaesthesiologist was chosen by
occurred and that the thing which caused developed in Allens arm, caused by a re- the spouses, and no negligence was
injury is shown to have been under the displacement of the bone fragments, attributable to Dr. Carlos.
management and control of the alleged necessitating an open reduction surgery
wrongdoer. which was set on June 24, 1992 by Dr. The spouses then elevated their case
Carlos as surgeon and again Dr. Vicente as against Dr. Carlos to the Supreme Court:
Res ipsa loquitur is a rebuttable anaesthesiologist. Sherlina was allowed to
presumption or inference that the observe the procedure. After five SC: The trial court erred in applying
defendant was negligent. The attempts, Dr. Vicente failed to intubate the doctrine of res ipsa loquitur to
presumption only arises upon proof that Allen Key, so anaesthesia was pin liability on respondent for Allens
the instrumentality causing injury was in administered through a gas mask. When death. Res ipsa loquitur is a rebuttable
the defendants exclusive control, and that Dr. Carlos asked if the operation should presumption or inference that the
the accident was one (1) which ordinarily continue with the failure to intubate, Dr. defendant was negligent. The presumption
does not happen in the absence of Vicente gave the go-ahead. Dr. Carlos only arises upon proof that the
negligence. checked if Allen Key was breathing instrumentality causing injury was in the
properly before proceeding with the defendants exclusive control, and that the
Res ipsa loquitur is not a rigid or ordinary surgery. Sherlina went out temporarily accident was one (1) which ordinarily does
doctrine to be perfunctorily used but a to make a telephone call when she not happen in the absence of negligence.
rule to be cautiously applied, depending saw Dr. Carlos about to finish the It is a rule of evidence whereby negligence
upon the circumstances of each case. In suturing, but was informed that her of the alleged wrongdoer may be inferred
malpractice cases, the doctrine is son died at the operating table due to from the mere fact that the accident
generally restricted to situations where a asphyxia due to congestion and happened, provided that the character of
layman is able to say, as a matter of edema of the epiglottis. the accident and circumstances attending
common knowledge and observation, that it lead reasonably to the belief that in the
the consequences of professional care Allen Keys parents then filed criminal absence of negligence it would not have
were not as such as would ordinarily have and administrative charges against Dr. occurred and that the thing which caused
followed if due care had been exercised. Carlos and Dr. Vicente, as well as injury is shown to have been under the
instituted a civil case for damages against management and control of the alleged
Facts of the case: both doctors, alleging incompetence and wrongdoer.
negligence in the performance of their
Allen Key, 8-year old son of Alfredo and duty. Under this doctrine, the happening of an
Sherlina, was treated by Dr. Carlos for a injury permits an inference of negligence
fractured right wrist. He administered a where the plaintiff produces substantial
evidence that the injury was caused by an Jabagat failed in the intubation, considered. Lastly, it appears that Allen
agency or instrumentality under the respondent inquired from the latter, who started experiencing difficulty in breathing
exclusive control and management of the was the expert on the matter of only after the operation, when respondent
defendant, and that the injury was such administering anesthesia, whether the was already about to jot down his post-
that in the ordinary course of things would surgery should be postponed considering operation notes in the adjacent room.
not happen if reasonable care had been the failure to intubate. X X X Respondent was called back to the
used. operating room after Dr. Jabagat failed to
xxx appreciate a heartbeat on the patient. He
However, res ipsa loquitur is not a rigid or acted promptly and called for other
ordinary doctrine to be perfunctorily used Respondent further verified that Allen doctors to assist and revive Allen, but to
but a rule to be cautiously applied, was still breathing by looking at his chest no avail.
depending upon the circumstances of to check that there was excursion before
each case. In malpractice cases, the proceeding with the surgery. That Moreover, we note that in the instant case,
doctrine is generally restricted to respondent decided to continue with the the instrument which caused the damage
situations where a layman is able to say, surgery even though there was a failure to or injury was not even within respondents
as a matter of common knowledge and intubate also does not tend to establish exclusive management and control as Dr.
observation, that the consequences of liability, contrary to the trial courts ruling. Jabagat was exclusively in control and
professional care were not as such as Petitioners failed to present substantial management of the anesthesia and the
would ordinarily have followed if due care proof that intubation was an indispensable endotracheal tube. The doctrine of res
had been exercised. In other words, as prerequisite for the operation and that it ipsa loquitur allows the mere existence of
held in Ramos v. Court of Appeals,[14] the would be grave error for any surgeon to an injury to justify a presumption of
real question is whether or not in the continue with the operation under such negligence on the part of the person who
process of the operation, any circumstances. In fact, the testimony of controls the instrument causing the injury,
extraordinary incident or unusual the expert witness presented by the provided that the following requisites
event outside of the routine prosecution in the criminal proceedings concur:
performance occurred which is and admitted into evidence at the RTC,
beyond the regular scope of was even to the effect that the anesthesia 1. The accident is of a kind which
professional activity in such could be administered by alternative ordinarily does not occur in the absence of
operations, and which, if means such as a mask and that the someones negligence:
unexplained, would themselves operation could proceed even without
reasonably speak to the average man intubation. 2. It is caused by an instrumentality
as the negligent cause or causes of within the exclusive control of the
the untoward consequence. There was also no indication in the records defendant or defendants; and
that respondent saw or should have seen
Here, we find that the CA correctly found that something was wrong as to prompt 3. The possibility of contributing conduct
that petitioners failed to present him to act differently than he did in this which would make the plaintiff responsible
substantial evidence of any specific act of case. The anesthesia used in the operation is eliminated.
negligence on respondents part or of the was the same anesthesia used in the
surrounding facts and circumstances previous closed reduction procedure, and Here, the respondent could only supervise
which would lead to the reasonable Allen did not register any adverse reaction Dr. Jabagat to make sure that he was
inference that the untoward consequence to it. In fact, respondent knows the performing his duties. But respondent
was caused by respondents negligence. anesthesia Ketalar to be safe for children. could not dictate upon Dr. Jabagat the
In fact, under the established facts, Dr. Jabagat was also a specialist and more particular anesthesia to administer, the
respondent appears to have observed the competent than respondent to determine dosage thereof, or that it be administered
proper amount of care required under the whether the patient has been properly in any particular way not deemed
circumstances. Having seen that Dr. anesthetized for the operation, all things appropriate by Dr. Jabagat. Respondents
specialization not being in the field of Under the above circumstances, although
anesthesiology, it would be dangerous for the Court commiserates with the In civil cases, the burden of proof to be
him to substitute his judgment for Dr. petitioners on their infinitely sorrowful established by preponderance of evidence
Jabagats decisions in matters that fall loss, the Court cannot properly declare is on the plaintiff who is asserting the
appropriately within the scope of Dr. that respondent failed to exercise the affirmative of an issue. Unless the party
Jabagats expertise. required standard of care as lead surgeon asserting the affirmative of an issue
as to hold him liable for damages for sustains the burden of proof, his or her
Allens death. cause will not succeed.