Cantre v. Sps. Go While Dr.

Cantre was massaging Noras

uterus for it to contract and stop bleeding,
Dr. Milagros Cantre v. Sps. John David she ordered a droplight to warm Nora and
her baby. At that time, she was unconscious.
and Nora Go
2007 / Quisumbing / While in the recovery room, Noras
husband John David noticed a fresh
Petition for review on certiorari of CA decision gaping wound (2 1/2 x 3 1/2 in) in the inner
and resolution portion of her left arm near the armpit.

FACTS When he asked the nurses about the cause

Nora Go gave birth to her 4th child.
Two hours later, she suffered profuse
bleeding inside her womb due to some
placenta parts which were not completely
expelled after delivery.
She then suffered hypovolemic shock, so
her BP dropped to 40/0.
Dr. Milagros Cantre, an Ob-Gyne
specialist and Noras attending physician,
together with an assisting resident physician,
performed various medical procedures to stop
the bleeding and to restore Noras BP.
of the injury, he was informed that it was due
to a burn.
John David filed a request for investigation.
Dr. Cantre said that the caused the injury was
the blood pressure cuff.
John David brought Nora to the NBI for a
physical examination.
The medico-legal (Dr. Floresto Arizala, Jr) said that
the injury appeared to be a burn and when the
droplight placed near the skin for about 10
minutes could cause such burn.

1
He dismissed the likelihood that the wound
was caused by a blood pressure cuff since the
scar was not around the arm, but just on one
side of the arm.
Noras injury was referred to a plastic surgeon
(Dr. Jesus Delgado) for skin grafting. However, her
arm would never be the same
Because surgery left an unsightly scar, her
movements are restricted, and the injured arm
pains at the slightest touch.
Sps. Go filed a complaint for damages against
Dr. Cantre, the medical director, and the
hospital.
In the RTC, parties have rested their
respective cases, but the court admitted
additional exhibits [consist mostly of medical
records produced by the hospital during trial
pursuant to a subpoena duces tecum] offered
by Sps. Go, which were not testified to by any
witness.
RTC ruled in favor of the spouses.
CA affirmed RTC with modification
(complaint dismissed with respect to the
medical director and the hospital; only moral
damages awarded).
Preliminary discussion
Dr. Cantres counsel admitted the existence of
the additional exhibits when they were
formally offered for admission by the RTC.
In any case, given the circumstances of this
case, a ruling on Dr. Cantres negligence may
be made based on the res ipsa loquitur
doctrine (the principle that the occurrence of an
accident implies negligence.) even in the
absence of the additional exhibits.
ISSUES AND HOLDING
1. WON the questioned additional exhibits
are admissible in evidence. YES
2. WON Dr. Cantre is liable for the injury
suffered by Nora Go. YES
2

RATIO
Backgrounder
The Hippocratic Oath mandates physicians
to give primordial consideration to their
patients well-being, and if a doctor fails to live
up to this precept, he is accountable for his
acts.
In medical negligence cases, 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. Accident is of a kind which ordinarily
does not occur absent someones
negligence

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.
2.
HOWEVER, intent is immaterial in these
cases because where negligence exists
and is proven, it automatically gives the
injured a right to reparation for the
damage caused.
Res ipsa loquitur x Medical negligence cases
o The injury suffered by Nora, is not
an ordinary occurrence in the act of
delivering a baby, thus, could not have
happened unless negligence set in
somewhere
Caused by an instrumentality
within defendants exclusive control
o It doesnt matter WON the injury
was caused by the droplight or by the
blood pressure cuff, since both are within
the exclusive control of the physician in
charge [Dr. Cantre] under the captain of

3
 the ship doctrine [surgeon in charge of an
operation is held liable for his assistants
negligence during the time when they are
under the surgeons control].
3. Possibility of contributing
conduct which would make plaintiff
responsible is eliminated
o Wound could only be caused by
something external to and outside the
control of Nora since she was
unconscious while in hypervolemic shock.
On Dr. Cantres other arguments + what
would have been her saving grace
BP cuff defense does not afford her
an escape. The medical practice is to
deflate the cuff immediately after use, or
else, it could cause an injury similar to what
happened to Nora. If the wound was caused
by the constant taking of BP, it must have
been done so negligently as to inflict a
gaping wound.
The argument that the failed plastic
surgery was a measure to prevent
complication (and not intended as a
cosmetic procedure) does not negate
negligence on Dr. Cantres part.
Dr. Cantre has been Noras ob-gyne for
her past 3 deliveries, and this is the first
time that Dr. Cantre is being held liable for
damages due to negligence in the practice of
her profession.
She promptly took care of the wound
before infection set in. Since Nora was in a
critical condition at that time, saving her life
became Dr. Cantres elemental concern.
Still, her good intentions
characteristics do not justify
negligence.
NCC provisions applied
NCC 2176. Whoever by act or omission
causes damage to another, there being fault
4
 or negligence, is obliged to pay for the
damage done. []

NCC 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 defendants wrongful
act or omission. [200k moral damages
awarded]
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
Professional Services Inc. v. Agana
Two Hundred Thousand Pesos (P200,000) as moral damages in favor
of respondents and against petitioner is just and equitable.21
Professional Services Inc. (PSI) v.
WHEREFORE, the petition is DENIED. The Decision dated October 3, Natividad and Enrique Agana
2002 and Resolution dated November 19, 2003 of the Court of Appeals Natividad and Enrique Agana v. Juan
in CA-G.R. CV No. 58184 are AFFIRMED.
Fuentes
Miguel Ampil v. Natividad and Enrique
Agana
2007 / Sandoval-Gutierrez / Petition for review
on certiorari of CA decisions
Standard of conduct > Experts > Medical
professionals

5

FACTS
Natividad Agana was rushed to Medical
City because of difficulty of bowel
movement and bloody anal discharge.
Dr. Ampil diagnosed her to be suffering
from cancer of the sigmoid.
Dr. Ampil performed an anterior resection
surgery on her, and finding that the
malignancy spread on her left ovary, he
obtained the consent of her husband, Enrique,
to permit Dr. Fuentes to
perform hysterectomy on her.
After the hysterectomy, Dr. Fuentes showed
his work to Dr. Ampil, who examined it and
found it in order, so he allowed Dr. Fuentes to
leave the operating room.
Dr. Ampil was about to complete the
procedure when the attending nurses made
some remarks on the Record of Operation:
sponge count lacking 2; announced to
surgeon search done but to no avail
continue for closure (two pieces of gauze
were missing).
A diligent search was conducted but they
could not be found.
Dr. Ampil then directed that the incision be
closed.
A couple of days after, she complained of pain
in her anal region, but the doctors told her
that it was just a natural consequence of the
surgery.
Dr. Ampil recommended that she consult an
oncologist to examine the cancerous nodes
which were not removed during the operation.
After months of consultations and
examinations in the US, she was told that she
was free of cancer.
Weeks after coming back, her daughter found
a piece of gauze (1.5 in) protruding from her
vagina, so Dr. Ampil manually extracted this,
assuring Natividad that the pains will go away.
6
However, the pain worsened, so she sought CA dismissed only the case against
treatment at a hospital, where another 1.5 in Fuentes.
piece of gauze was found in her vagina. She
underwent another surgery.

Sps. Agana filed a complaint for

damages against PSI (owner of Medical City),
Dr. Ampil, and Dr. Fuentes, alleging that the ISSUE AND HOLDING
latter are liable for negligence for leaving 2
pieces of gauze in Natividads body, 1. WON CA erred in holding Dr. Ampil liable
and malpractice for concealing their acts of for negligence and malpractice. NO; DR.
negligence. AMPIL IS GUILTY
2. WON CA erred in absolving Dr. Fuentes of
Enrique Agana also filed an administrative any liability. NO
complaint for gross negligence and
malpractice against the two doctors with the 3. WON PSI may be held solidarily liable for
PRC (although only the case against Dr. Dr. Ampils negligence. YES
Fuentes was heard since Dr. Ampil was
abroad). RATIO

Pending the outcome of the cases, Natividad DR. AMPIL IS LIABLE FOR NEGLIGENCE
died (now substituted by her children). AND MALPRACTICE

RTC found PSI and the two doctors liable His arguments are without basis because he
for negligence and malpractice. PRC failed to prove that the American doctors were
dismissed the case against Dr. Fuentes. the ones who put / left the gauzes; he did not
submit any pieces of evidences to rebut the

7
correctness of the operation record (re:
number of gauzes used); re: Dr. Fuentes
alleged negligence, Dr. Ampil examined his
work and found it in order].
Leaving foreign substances in the
wound after incision has been closed is
at least prima facie negligence by the
operating surgeon.
Even if it has been shown that a surgeon was
required to leave a sponge in his patients
abdomen because of the dangers attendant
upon delay, still, it is his legal duty to inform
his patient within a reasonable time by
advising her of what he had been compelled
to do, so she can seek relief from the effects of
the foreign object left in her body as her
condition might permit.
Whats worse in this case is that he misled her
by saying that the pain was an ordinary
consequence of her operation.
Medical negligence; standard of
diligence
To successfully pursue this case of medical
negligence, a patient must only prove that a
health care provider either failed to do
something [or did something] which a
reasonably prudent health care provider would
have done [or wouldnt have done], and that
the failure or action caused injury to the
patient.
Duty to remove all foreign objects from
the body before closure of the incision; if he
fails to do so, it was his duty to inform the
patient about it
Breach failed to remove foreign objects;
failed to inform patient
Injury suffered pain that necessitated
examination and another surgery
Proximate Causation breach caused this
injury; could be traced from his act of closing
the incision despite information given by the
attendant nurses that 2 pieces of gauze were
still missing; what established causal
link: gauze pieces later extracted from
patients vagina
8

DR. FUENTES NOT LIABLE
The res ipsa loquitur [thing speaks for
itself] argument of the Aganas does not
convince the court.
Mere invocation and application of this
doctrine does not dispense with the
requirement of proof of negligence.
Requisites for the applicability of res
ipsa loquitur
1. Occurrence of injury
2. Thing which caused injury was under
the control and management of the
defendant [DR. FUENTES] LACKING
SINCE CTRL+MGT WAS WITH DR. AMPIL
3. Occurrence was such that in the ordinary
course of things, would not have happened
if those who had control or management
used proper care
4. Absence of explanation by defendant
Under the Captain of the Ship rule,
the operating surgeon is the person in
complete charge of the surgery room and all
personnel connected with the operation. That
Dr. Ampil discharged such role is evident from
the following:
He called Dr. Fuentes to perform a
hysterectomy
He examined Dr. Fuentes work and found
it in order
He granted Dr. Fuentes permission to
leave
He ordered the closure of the incision
HOSPITAL OWNER PSI SOLIDARILY LIABLE
WITH DR. AMPIL [NCC 2180], AND
DIRECTLY LIABLE TO SPS. AGANAS [NCC
2176]
Previously, employers cannot be held
liable for the fault or negligence of its
professionals.
However, this doctrine has weakened since
courts came to realize that modern hospitals
are taking a more active role in supplying and
9
regulating medical care to its patients, by
employing staff of physicians, among others.
Hence, there is no reason to exempt hospitals
from the universal rule of respondeat superior.
Here are the Courts bases for sustaining PSIs
liability:
Ramos v. CA doctrine on E-E relationship
o For purposes of apportioning
responsibility in medical negligence cases,
an employer-employee relationship in
effect exists between hospitals and their
attending and visiting physicians. [LABOR
LESSON: power to hire, fire, power of
control]
Agency principle of apparent authority /
agency by estoppel
o Imposes liability because of the
actions of a principal or employer in
somehow misleading the public into
believing that the relationship or the
authority exists [see NCC 1869]
Art. 1869. Agency may be express, or implied from the acts
of the principal, from his silence or lack of action, or his
failure to repudiate the agency, knowing that another
person is acting on his behalf without authority.
Agency may be oral, unless the law requires a specific
form. (1710a)
o PSI publicly displays in the Medical
City lobby the names and specializations of
their physicians. Hence, PSI is now
estopped from passing all the blame to the
physicians whose names it proudly
paraded in the public directory, leading the
public to believe that it vouched for their
skill and competence.
If doctors do well, hospital
profits financially, so when negligence
mars the quality of its services, the
hospital should not be allowed to escape
liability for its agents acts.
Doctrine of corporate negligence /
corporate responsibility
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o This is the judicial answer to the
problem of allocating hospitals liability for
the negligent acts of health practitioners,
absent facts to support the application
of respondeat superior.
o This provides for the duties
expected [from hospitals]. In this case, PSI
failed to perform the duty of
exercising reasonable care to protect from
harm all patients admitted into its facility
for medical treatment. PSI failed to
conduct an investigation of the matter
reported in the note of the count
nurse, and this established PSIs part
in the dark conspiracy of silence and
concealment about the gauzes.
PSI has actual / constructive
knowledge of the matter, through the
report of the attending nurses + the fact
that the operation was carried on with
the assistance of various hospital staff
o It also breached its duties
to oversee or supervise all persons who
practice medicine within its walls and take
an active step in fixing the negligence
committed
PSI also liable under NCC 2180
o It failed to adduce evidence to show
that it exercised the diligence of a good
father of the family in the accreditation and
supervision of Dr. Ampil
Art. 2180. The obligation imposed by Article 2176 is
demandable not only for one's own acts or omissions, but
also for those of persons for whom one is responsible.
The father and, in case of his death or incapacity, the
mother, are responsible for the damages caused by the
minor children who live in their company.
Guardians are liable for damages caused by the minors or
incapacitated persons who are under their authority and
live in their company.
The owners and managers of an establishment or
enterprise are likewise responsible for damages caused by
their employees in the service of the branches in which the
latter are employed or on the occasion of their functions.
Employers shall be liable for the damages caused by their
employees and household helpers acting within the scope
11
of their assigned tasks, even though the former are not
engaged in any business or industry.
The State is responsible in like manner when it acts through
a special agent; but not when the damage has been caused
by the official to whom the task done properly pertains, in
which case what is provided in Article 2176 shall be
applicable.
Lastly, teachers or heads of establishments of arts and
trades shall be liable for damages caused by their pupils
and students or apprentices, so long as they remain in their
custody.
The responsibility treated of in this article shall cease when
the persons herein mentioned prove that they observed all
the diligence of a good father of a family to prevent
damage. (1903a)
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