DR. RUBI LI VS. SPS.
REYNALDO & LINA SOLIMAN and proximate result of the failure to disclose, the patient consented to treatment she
G.R. NO. 165279
En Banc, June 7, 2011
Justice Villarama
FACTS:
On February 21, 1994, respondent spouses filed a damage suit against herein
petitioner charging her with negligence and disregard of their 11-year old daughter, Angelica
Solimans safety, health, and welfare by her careless administration of the chemotherapy
drugs, failure to observe the essential precaution in detecting early the symptoms of fatal
blood platelet decrease and stopping early on the chemotherapy, which bleeding led to
hypovolemic shock that caused Angelicas untimely demise. Angelica was suffering from
osteosarcoma, a high-grade (highly malignant) cancer of the bone which usually afflicts
teenage children.
On September 5, 1997, the RTC of Legazpi City, Branch 8, dismissed the complaint
holding that petitioner was not liable for damages as she observed the best known
procedures and employed her highest skill and knowledge in the administration of
chemotherapy drugs on Angelica but despite all efforts said patient died.
On appeal, the CA, while concurring with the trial courts finding that there was no
negligence in the administration of chemotherapy treatment to Angelica, found that
petitioner as her attending physician failed to fully explain to the respondents all the known
side effects of chemotherapy which gravely affected their child. Thus, the appeal was
granted and the trial courts decision was modified and entitled the respondents to their
claim for damages. Hence, this petition.
ISSUE:
WON the petitioner can be held liable for failure to fully disclose serious side
effects to the parents of the child patient who died while undergoing chemotherapy, despite
the absence of finding that petitioner was negligent in administering the said treatment.
RULING OF THE COURT:
The petition for review on certiorari is granted. The CA Decision is set aside and
the trial courts decision is reinstated and upheld.
HELD:
There are four essential elements a plaintiff must prove in a malpractice action
based upon the doctrine of informed consent: 1) the physician had a duty to disclose
material risks; 2) he failed to disclose or inadequately disclosed those risks; 3) as a direct
otherwise would not have consented to; and 4) plaintiff was injured by the proposed
treatment. The gravamen in an informed consent case requires the plaintiff to point to
significant undisclosed information relating to the treatment which would have altered her
decision to undergo it.
The element of ethical duty to disclose material risks in the proposed medical
treatment cannot thus be reduced to one simplistic formula applicable in all instances.
Further, it a medical malpractice action based on lack of informed consent, the plaintiff must
prove both the duty and the breach of that duty through expert testimony. Such expert
testimony must show the customary standard of care of physicians in the same practice as
that of the defendant doctor.
In this case, the testimony of the doctors presented as witnesses does not qualify
as expert testimony to establish the standard of care in obtaining consent for chemotherapy
treatment. In the absence of expert testimony in this regard, the Court feels hesitant in
defining the scope of mandatory disclosure in cases of malpractice based on lack of informed
consent, much less set a standard of disclosure that, even in foreign jurisdiction, has been
noted to be an evolving one.
PROFESSIONAL SERVICES, INC. VS. NATIVIDAD & ENRIQUE AGANA
G.R. NO. 126297
First Division, January 31, 2007
Justice Sandoval-Gutierrez
FACTS:
The case stemmed from a complaint for damages filed at the RTC Branch 96,
Quezon City by respondents-spouses Agana against herein petitioner, Professional Services
Inc., owner of Medical City Hospital, together with Dr. Miguel Ampil and Dr. Juan Fuentes,
who performed an anterior resection surgery and hysterectomy operation on Natividad,
respectively. Respondents alleged that the two doctors are liable for negligence for leaving
two pieces of gauze inside Natividads body, and malpractice for concealing their acts of
negligence. Apparently, Natividad was diagnosed to have malignancy in her sigmoid area
and it had spread on her left ovary, necessitating the removal of certain portions of it.
On March 17, 1993, the trial court rendered its Decision in favour of the spouses
Agana. However, on appeal, the CA dismissed the case against Dr. Fuentes for lack of
evidence and pronouncing Dr. Ampil as the sole liable for the damages caused by negligence
and malpractice. Hence, this petition.
ISSUES:
1. WON the CA erred in holding Dr. Ampil liable for negligence and malpractice.
2. WON the CA erred in absolving Dr. Fuentes of any liability.
3. WON the PSI may be held solidarily liable for the negligence of Dr. Ampil.
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RULING OF THE COURT:
Petition denied. The CA Decision is affirmed with costs against PSI and Dr. Miguel
Ampil.
HELD:
1. This is a clear case of medical malpractice or more appropriately, medical negligence.
To successfully pursue this kind of case, a patient must prove that a health care
provided either failed to do something which a reasonably prudent health care provider
would have done, or that he did something that a reasonably prudent provider would
not have done, and that failure or action caused injury to patient. Simply put, the
elements are duty, breach, injury and proximate causation. Dr. Ampil, as the lead
surgeon, had the duty to remove all foreign objects, such as gauzes, from Natividads
body before closure of the incision. When he failed to do so, it was his duty to inform
Natividad about it. Dr. Ampil breached both duties. Such breach caused injury to
Natividad, necessitating her further examination by American doctors and another
surgery. That Dr. Ampils negligence is the proximate cause of Natividads injury could
be traced from his act of closing the incision despite the information given by the
attending nurses that two pieces of gauze were still missing. That they were later on
extracted from Natividads vagina established the causal link between Dr. Ampils
negligence and the injury. And what further aggravated such injury was his deliberate
concealment of the missing gauzes from the knowledge of Natividad and her family.
2. 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. Their duty
is to obey his orders. As stated before, Dr. Ampil was the lead surgeon. In other words,
he was the Captain of the Ship. That he discharged such role is evident from his
following conduct: 1) calling Dr. Fuente to perform a hysterectomy; 2) examining the
work of Dr. Fuentes and finding it in order; 3) granting Dr. Fuentes permission to leave;
and 4) ordering the closure of the incision. To our mind, it was this act of ordering the
closure of the incision notwithstanding the two pieces of gauze remained unaccounted
for, that caused injury to Natividads body. Clearly, the control and management of the
thing which caused the injury was in the hands of Dr. Ampil, not Dr. Fuentes.
In this jurisdiction, res ipsa loquitur is not a rule of substantive law, hence, does not per
se create or constitute an independent or separate ground of liability, being a mere
evidentiary rule. In other words, mere invocation and application of the doctrine does
not dispense with the requirement of proof of negligence. Here, the negligence was
proven to have been committed by Dr. Ampil and not by Dr. Fuentes.
3. Principle of Apparent Authority in cases where it can be shown that a hospital, by its
actions, has held out a particular physician as its agent and/or employee and that a
patient has accepted treatment from that physician in the reasonable belief that it is
being rendered in behalf of the hospital, then the hospital will be liable for the
physicians negligence.
Concept of an Agency by Estoppel the hospital is now stopped 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. X x x Corporate
entities like PSI are capable of acting only through other individuals, such as physicians.
If these accredited physicians do their job well, the hospital succeeds in its mission of
offering quality medical services and thus profits financially. Logicially, where
negligence mars the quality of its services, the hospital should not be allowed to escape
liability for the acts of its ostensible agents.
Corporate Negligence or Corporate Responsibility clearly, the hospital failed to exercise
their duties such as 1) the use of reasonable care in the maintenance of safe and adequate
facilities and equipments; 2) the selection and retention of competent physicians; 3) the
overseeing or supervision of all persons who practice medicine within its walls; and 4) the
formulation, adoption and enforcement of adequate rules and policies that ensure quality
care for its patients.
DR. NINEVETCH CRUZ VS. CA
G.R. NO. 122445
Third Division, November 18, 1997
Justice Francisco
FACTS:
The case stemmed from a medical malpractice suit filed with the MTCC of San
Pablo City charging herein petitioner and one Dr. Lina Ercillo with reckless imprudence and
negligence resulting to homicide of one Lydia Umali. The inferior court acquitted Dr. Lina
Ercillo for insufficiency of evidence, while held the petitioner sole responsible for the death
of the victim, found her guilty under Art. 365 of the RPC and was sentenced to suffer the
penalty of 2 months and 1 day of arresto mayor with costs. The RTC, on appeal, affirmed in
toto the MTCCs decision, which prompted the petitioner to file a petition for review with the
CA but to no avail. Hence, this petition.
ISSUE:
WON petitioners conviction of the crime reckless imprudence resulting to
homicide arising from an alleged medical malpractice, is supported by the evidence on
record.
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RULING:
Petitioner was acquitted but is ordered to pay the heirs civil liability and damages.
HELD:
x x x The deference of courts to the expert opinion of qualified physicians stems
from its realization that the latter possess unusual technical skills which laymen in most
instances are incapable of intelligently evaluating. Expert testimony should have been
offered to prove that the circumstances cited by the courts below are constitutive of conduct
falling below the standard of care employed by other physicians in good standing when
performing the same operation. It must be remembers that when the qualifications of a
physician are admitted, as in the instant case, there is an inevitable presumption that in
proper cases he takes the necessary precaution and employs the best of his knowledge and
skill in attending to his clients, unless the contrary is sufficiently established. This
presumption is rebuttable by expert opinion which is so sadly lacking in the case at bench.
In litigations involving medical negligence, the plaintiff has the burden of
establishing appellants negligence and for a reasonable conclusion of negligence, there must
be proof of breach of duty on the part of the surgeon as well as a casual connection of such
breach and the resulting death of his patient.
SPS. FREDELICTO FLORES VS. SPS. DOMINADOR PINEDA
G.R. NO. 158996
Second Division, November 14, 2008
Justice Brion
FACTS:
This petition involves a medical negligence case that stemmed from the RTC of
Nueva Ecija, Branch 37 against herein petitioners, Dr. Fredelicto Flores and Felicisima Flores.
The victim, Teresita Pineda, sought the medical help of Dr. Fredelicto as she was complaining
general body weakness, loss of appetite, frequent urination and thirst, and on-and-off vaginal
bleeding. On April 28, 1987, Teresita went to Dr. Fredelictos clinic at UDMC and after
conducting a routine check-up, he prepared the patient for an on call D&C operation
together with his wife, Dr. Felicisima Flores. A day after the operation, Teresita was
subjected to an ultrasound examination and the results yielded an enlarged uterus and
myoma uteri. Teresitas condition had worsened and she was rushed to the ICU. Further
tests confirmed that she was suffering from Diabetes Mellitus Type II. Insulin was
administered on Teresita but the medication might have arrived too late. Due to
complications induced by diabetes, Teresita died in the morning of May 6, 1987.
The trial court ruled in favour of Teresitas family. The CA affirmed the judgment,
but modified the amount of damages awarded. Hence, this recourse.
ISSUE:
WON the trial court and the CA were correct in holding petitioners liable for
medical negligence.
RULING:
The trial court and the CA Decision were affirmed, likewise the amount of damages
awarded.
HELD:
A medical negligence case is a type of claim to redress a wrong committed by a
medical professional, that has caused bodily harm to or the death of a patient. There are
four elements involved in a medical negligence case, namely: duty, breach, injury and
proximate causation.
Duty refers to the standard of behaviour which imposes restrictions on ones
conduct. The standard in turn refers to the amount of competence associated with the
proper discharge of the profession. A physician is expected to use at least the same level of
care that any other reasonably competent doctor would use under the same circumstances.
Breach of duty occurs when the physician fails to comply with these professional standards.
If injury results to the patient as a result of this breach, the physician is answerable for
negligence.
As in any civil action, the burden to prove the existence of the necessary elements
rests with the plaintiff. To successfully pursue a claim, the plaintiff must prove by
preponderance of evidence that, one, the physician either failed to do something which a
reasonably prudent health care provider would have done, or that he did something that a
reasonably prudent provider would not have done; and two, the failure or action caused
injury to patient. Expert testimony is therefore essential since the factual issue of whether a
physician or surgeon has exercised the requisite degree of skill and care in the treatment of
his patient is generally a matter of expert opinion.
DR. FERNANDO SOLIDUM VS. PEOPLE
G.R. NO. 192123
First Division, March 10, 2014
Justice Bersamin
FACTS:
The case stemmed from a complaint for reckless imprudence resulting in serious
physical injuries filed with the RTC Manila by Ma. Luz Gercayo, mother of the patient Gerald
Albert Gercayo, against the attending physicians of the Ospital ng Maynila who conducted a
pull through operation (an operation for anal opening) to the 3-year old baby boy Gerald
who was born with an imperforate anus. However, upon a finding of probable cause, the
City Prosecutors Office filed an information solely against herein petitioner, Dr. Solidum,
being then the anesthesiologist tasked to administer the anesthesia on the patient. During
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the operation, Gerald allegedly experienced bradycardia and went into a coma for two weeks
and after regaining consciousness, he could no longer see, hear or move.
On July 19, 2004, the RTC rendered its judgment finding Dr. Solidum guilty beyond
reasonable doubt of the crime charged. On appeal, the CA affirmed the conviction of the
petitioner. Hence, this petition.
ISSUES:
1. WON the doctrine of res ipsa loquitur was applicable herein.
2. WON Dr. Soliman was liable for criminal negligence.
RULING OF THE COURT:
The Court grants the petition for review on certiorari, reversed and set aside the
decision of the trial court and the CA and acquitted Dr. Solidum.
HELD:
1. It must be conceded that the doctrine of res ipsa loquitur can have no application in a
suit against a physician or surgeon which involves the merits of a diagnosis or of a
scientific treatment. The physician or surgeon is not required at his peril to explain why
any particular diagnosis was not correct, or any particular scientific treatment did not
produce the desired result. Thus, res ipsa loquitur is not available in a malpractice suit if
the only showing is that the desired result of an operation or treatment was not
accomplished.
In order to allow resort to the doctrine, therefore, the following essential requisites
must first be satisfied, to wit: 1) the accident was of a kind that does not ordinarily occur
unless someone is negligent; 2) the instrumentality or agency that caused the injury was
under the exclusive control of the person charged; and 3) the injury suffered must not
have been due to any voluntary action or contribution of the person injured.
The Court considers the application here of the doctrine of res ipsa loquitur
inappropriate. Although the second and third elements were present, the first element
was undeniably wanting. Hypoxia would not ordinarily occur in the process of a pull-
through operation, or during the administration of anesthesia to the patient, but such
fact alone did not prove that the negligence of any of his attending physicians, including
the anesthesiologists, had caused the injury.
2. The prosecution did not prove the elements of reckless imprudence beyond reasonable
doubt because the circumstances cited by the CA were insufficient to establish that Dr.
Solidum had been guilty of inexcusable lack of precaution in monitoring the
administration of the anesthetic agent to Gerald. xxx In litigations involving medical
negligence, the plaintiff has the burden of establishing appellants negligence and for a
reasonable conclusion of negligence, there must be proof of breach of duty on the part
of the surgeon as well as a causal connection of such breach and the resulting death of
his patient.
FE CAYAO-LASAM VS. SPS. CLARO & EDITHA RAMOLETE
G.R. NO. 159132
Third Division, December 18, 2008
Justice Austria-Martinez
FACTS:
Respondent Editha Ramolete was three months pregnant when she was brought to
the Lorma Medical Center due to vaginal bleeding. Upon conduct of a pelvic sonogram, a
fetus weak cardiac pulsation was revealed and no fetal movement was appreciated, coupled
with persistent and profuse vaginal bleeding, thus petitioner advised Editha to undergo a
dilatation and curettage procedure (raspa).
On September 16, 1994, barely two months after, Editha was once again brought
to LMC as she was suffering from vomiting and severe abdominal pains. It was found out by
the doctors that there was a dead fetus in her womb and to have a massive intra-abdominal
hemorrhage and ruptured uterus. She underwent a procedure for hysterectomy, as a result
of which she can no longer bear a child. This prompted Editha and her husband Claro to file a
complaint for gross negligence and malpractice against petitioner before the PRC.
On March 4, 1999, the Board of Medicine of the PRC rendered a Decision
exonerating petitioner from the charges filed against her. However, on appeal, the PRC
reversed the findings of the Board and revoked petitioners authority or license to practice
her profession as a physician.
Petitioner elevated the matter to the CA for review under Rule 43 but the same
was dismissed for being improper and premature. Hence, this petition.
ISSUE:
WON petitioner is liable for gross negligence and malpractice.
RULING OF THE COURT:
The SC granted the petition and affirmed the Decision of the Board of Medicine
exonerating the petitioner from charges against her.
HELD:
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 Medical malpractice is a particular form of negligence which consists in the failure
of a physician or surgeon to apply to his practice of medicine that degree fo care and skill
which is ordinarily employed by the profession generally, under similar conditions, and in like
surrounding circumstances. In order to successfully pursue such a claim, a patient must
prove that the physician or surgeon either failed to do something which a reasonably
prudent physician or surgeon would not have done, and that the failure or action caused
injury to the patient. There are four elements involved in medical negligence cases: duty,
breach, injury, and proximate causation.
A physician-patient relationship was created when Editha employed the services of
the petitioner. As Edithas physician, petitioner was duty-bound to use at least the same
level of care that any reasonably competent doctor would use to treat a condition under the
same circumstances. The breach of these professional duties of skill and care, or their
improper performance by a physician surgeon, whereby the patient is injured in body or in
health, constitutes actionable malpractice. As to this aspect of medical malpractice, the
determination of the reasonable level of care and the breach thereof, expert testimony is
essential. Further, inasmuch as the causes of the injuries involved in malpractice actions are
determinable only in the light of scientific knowledge, it has been recognized that expert
testimony is usually necessary to support the conclusion as to causation.
In the present case, respondents did not present any expert testimony to support
their claim that petitioner failed to do something which a reasonably prudent physician or
surgeon would have done.
ROGELIO NOGALES, et al. VS. CAPITOL MEDICAL CENTER, et al.
G.R. NO. 142625
Third Division, December 19, 2006
Justice Carpio
FACTS:
On May 14, 1980 petitioners filed a complaint for damages with the RTC of Manila
against herein respondents for the death of Corazon Nogales. Petitioners contended that
respondents were negligent in the treatment and management of Corazons condition.
Corazon died due to hemorrhage, post partum.
The trial court rendered judgment on November 22, 1993 finding Dr. Oscar Estrada
solely liable for damages holding that the victim was under his pre-natal care, apparently, his
fault began from his incorrect and inadequate management and lack of treatment of the pre-
eclamptic condition of his patient. Petitioners appealed the trial courts decision claiming
that the remaining respondents should be held equally liable for negligence. However, the
CA affirmed the lower courts decision. Hence, this petition.
ISSUE:
WON Capitol Medical Center is vicariously liable for the negligence of Dr. Estrada.
RULING OF THE COURT:
The SC partly grants the petition. It found respondent CMC vicariously liable for
the negligence of Dr. Oscar Estrada.
HELD:
In general, a hospital is not liable for the negligence of an independent contractor-
physician. There is, however, an exception to his principle. The hospital may be liable if the
physician is the ostensible agent of the hospital. This exception is also known as the doctrine
of apparent authority.
The doctrine of apparent authority essentially involves two factors to determine
the liability of an independent contractor-physician. The first factor focuses on the hospitals
manifestations and is sometimes described as an inquiry whether the hospital acted in a
manner which would lead a reasonable person to conclude that the individual who was
alleged to be negligent was an employee or agent of the hospital. In this regard, the hospital
need not make express representations to the patient that the treating physician is an
employee of the hospital; rather a representation may be general and implied. The doctrine
of apparent authority is a species of the doctrine of estoppels. Article 1431 of the Civil Code
provides that through estoppels, an admission or representation is rendered conclusive
upon the person making it, and cannot be denied or disproved as against the person relying
thereon. Estoppel rests on this rule: Whenever a party has, by his own declaration, act or
omission, intentionally and deliberately led another to believe a particular thing true, and to
act upon such belief, he cannot, in any litigation arising out of such declaration, act or
omission, be permitted to falsify it.
In the instant case, CMC impliedly held out Dr. Estrada as a member of its medical
staff. Through CMCs acts, CMC clothed Dr. Estrada with apparent authority thereby leading
the Spouses Nogales to believe that Dr. Estrada was an employee or agent of CMC. CMC
cannot now repudiate such authority.
DR. MILAGROS CANTRE VS. SPS. JOHN DAVID & NORA GO
G.R. NO. 160889
Second Division, April 27, 2007
Justice Quisumbing
FACTS:
Page 5 of 8
 On April 20, 1992, respondent Nora Go gave birth to her fourth child. However,
two hours after giving delivery, she suffered profuse bleeding inside her womb due to some
parts of the placenta which were not completely expelled from her womb. Consequently,
Nora suffered hypovolemic shock resulting in a drop in her blood pressure to 40 over 0. After
recovery, Noras husband noticed a fresh gaping would 2 by 3 inches in the inner portion
of her left arm. When asked, the nurses informed him that it was a burn, but petitioner Dr.
Cantre said the blood pressure cuff caused the injury. The spouses went to the NBI for a
physical examination of Noras injury to which the medico legal testified to be a burn and not
a wound caused by a blood pressure cuff. Noras injury was referred to a plastic surgeon,
unfortunately, her arm would never be the same as it bore unsightly mark and the pain
therein remains. Thus, on June 21,1993, respondent spouses filed a complaint for damages
against petitioner where the trial court ruled in their favor. On appeal, the CA affirmed the
decision of the lower court. Hence, this petition.
ISSUE:
1. WON the questioned additional exhibits are admissible in evidence.
2. WON petition is liable for the injury suffered by respondent Nora Go.
3. WON the appellate court committed grave abuse of discretion in its assailed issuances.
RULING OF THE COURT:
The petition is denied. The Decision of the trial court and the CA are both affirmed.
HELD:
1. The exhibits are admissible in evidence since it consist mostly of Noras medical records
which were produced by the hospital during trial pursuant to a subpoena duces tecum.
Petitioners 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.
2. Petitioners defense that Noras 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 Noras wound was caused by the blood
pressure cuff, then the taking of Noras blood pressure must have been done so
negligently as to have inflicted a gaping would on her arm, for which petitioner cannot
escape liability under the captain of the ship doctrine. Further, petitioners 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.
3. Considering the specific circumstances in the instant case, the Court find no grave abuse
of discretion in the assailed decision and resolution of the CA.
ROGELIO RAMOS, ET AL. VS. CA
G.R. NO. 124354
First Division, April 11, 2002
Justice Kapunan
FACTS:
Sometime in 1985, petitioner Erlinda Ramos, after seeking professional medical
help, was advised to undergo an operation for the removal of a stone in her gall bladder
(cholecystectomy). She was referred to Dr. Hosaka, a surgeon, who agreed to perform the
operation on her. The operation was scheduled for June 17, 1985 at 9AM at Delos Santos
Medical Center. On the day of the operation, Dr. Hosaka arrived late and it was disclosed by
Herminda Cruz, sister-in-law of the patient, that the latter was intubated and that the
operation was not going well. The patient then was brought to the ICU and was revealed to
be suffering from bronchospasm. Erlinda stayed in the ICU for a month and since the ill-fated
operation, she remained in comatose condition until she died on August 3, 1999.
Thus, petitioners filed with the RTC of Quezon City a civil case for damages against
herein private respondents. After due trial, the trial court rendered judgment in favor of
petitioners holding private respondents guilty of negligence in the performance of their
duties to Erlinda. On appeal, the CA reversed the trial courts decision.
However, upon petition for review on certiorari, the Highest Tribunal affirmed and
modified the trial courts decision, thus prompted the private respondents to file their
motion for reconsideration.
ISSUES:
1. WON Dr. Orlino Hosaka is liable for negligence.
2. WON Dr. Perfecta Gutierrez is liable for negligence.
3. WON the DSMC is liable for any act of negligence committed by their visiting consultant
surgeon and anesthesiologist.
RULING:
The assailed Decision is again modified. Private respondent DSMC was absolved
from liability, while Dr. Hosaka and Dr. Gutierrez were declared to be solidarily liable for the
injury suffered by Erlina Ramos and were ordered to pay damages.
HELD:
1. Dr. Hosaka cannot claim that he was entirely blameless of what happened to Erlinda.
His conduct clearly constituted a breach of his professional duties to Erlinda. Dr. Hosaka
was remiss in his duty of attending to petitioner Erlinda promptly, for he arrived more
than three hours late for the scheduled operation. The unreasonable delay in Erlindas
Page 6 of 8
 scheduled operation subjected her to continued starvation and consequently, to the risk
of acidosis, or the condition of decreased alkalinity of the blood and tissues, marked by
sickly sweet breath, headache, nausea and vomiting, and visual disturbances. The long
period that Dr. Hosaka made Erlinda wait for him certainly aggravated the anxiety that
she must have been feeling at the time. It could be safely said that her anxiety
adversely affected the administration of anesthesia on her. As explained by Dr.
Camagay, the patients anxiety usually causes the outpouring of adrenaline which in turn
results in high blood pressure or disturbances in the heart rhythm.
2. Dr. Gutierrezs claim of lack of negligence on her part is belied by the records of the
case. It has been sufficiently established that she failed to exercise the standards of
care in the administration of anesthesia on a patient. The injury incurred by petitioner
Erlinda does not normally happen absent any negligence in the administration of
anesthesia and in the use of an endotracheal tube. As was noted in our Decision, the
instruments used in the administration of anesthesia including the endotracheal tube,
were all under the exclusive control of private respondents Dr. Gutierrez and Dr.
Hosaka.
2. After a careful consideration of the arguments raised by DLSMC, the Court finds
that respondent hospitals position on this issue is meritorious. There is no
employer-employee relationship between the hospital and Drs. Hosaka and
Gutierrez which would hold the former solidarily liable for the injury suffered by
petitioner Erlinda under Art. 2180 of the Civil Code.
DR. EMMANUEL JARCIA, JR., ET AL. VS. PEOPLE
G.R. NO. 187926
Third Division, February 15, 2012
Justice Mendoza
FACTS:
Belinda Santiago lodged a complaint with the NBI against herein petitioners for
their alleged neglect of professional duty which caused her son, Roy Alfonso Santiago, to
suffer serious physical injuries. Upon investigation, the NBI found that Roy was hit by a
taxicab; that he was rushed to Manila Doctors Hospital for an emergency medical treatment;
that an Xray of the victims ankle was ordered and showed no fracture as read by Dr. Jarcia;
that Dr. Bastan informed her that since it was only the ankle that was hit, there was no need
to examine the upper leg; that eleven days later, Roy developed fever, swelling of the right
leg and misalignment of the right foot. When Belinda brought Roy back to the hospital, it
was revealed on the X-ray that a right mid-tibial fracture and a linear hairline fracture in the
shaft of the bone.
After due trial, the RTC found the petitioners guilty beyond reasonable doubt of the
crime of Simple Imprudence Resulting to Serious Physical Injuries. On appeal, the CA
affirmed the decision of the lower court. Hence, this petition.
ISSUES:
1. WON the doctrine of res ipsa loquitur is applicable in this case.
2. WON the petitioners are liable for criminal negligence.
RULING OF THE COURT:
The petition is partly granted. The Decision of the CA and the trial court is reversed
and set aside. The petitioners are acquitted of the crime charged but were declared civilly
liable to the private complainants. The CA erred in applying the doctrine of res ipsa loquitur
in this particular case.
HELD:
1. This doctrine of res ipsa loquitur (the thing speaks for itself) 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 happened 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 doctrine of res ipsa loquitur, as a rule of evidence is unusual to the law of negligence
which recognizes that prima facie negligence may be established without direct proof
and furnishes a substitute for specific proof of negligence. The doctrine, 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.
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 Roys 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.
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2. 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. Batan are criminally negligent in this case.

Negligence is defined as 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. 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.

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