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G.R. No. 124354. December 29, 1999.
Ponente: Kapunan


Erlinda Ramos underwent a surgical procedure to remove stone from her gall bladder
(cholecystectomy). They hired Dr. Hosaka, a surgeon, to conduct the surgery at the De Los Santos
Medical Center (DLSMC). Hosaka assured them that he would find a good anesthesiologist. But the
operation did not go as planned, Dr. Hosaka arrived 3 hours late for the operation, Dra. Gutierrez, the
anesthesiologist “botched” the administration of the anesthesia causing Erlinda to go into a coma and
suffer brain damage. The botched operation was witnessed by Herminda Cruz, sister in law of Erlinda
and Dean of College of Nursing of Capitol Medical Center.

The family of Ramos (petitioners) sued the hospital, the surgeon and the anesthesiologist for damages.
The petitioners showed expert testimony showing that Erlinda's condition was caused by the
anesthesiologist in not exercising reasonable care in “intubating” Erlinda. Eyewitnesses heard the
anesthesiologist saying “Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan.”

Diagnostic tests prior to surgery showed that Erlinda was robust and fit to undergo surgery.

The RTC held that the anesthesiologist ommitted to exercise due care in intubating the patient, the
surgeon was remiss in his obligation to provide a “good anesthesiologist” and for arriving 3 hours late
and the hospital is liable for the negligence of the doctors and for not cancelling the operation after the
surgeon failed to arrive on time. The surgeon, anesthesiologist and the DLSMC were all held jointly and
severally liable for damages to petitioners. The CA reversed the decision of the Trial Court.


Whether or not the private respondents were negligent and thereby caused the comatose condition of


Yes, private respondents were all negligent and are solidarily liable for the damages.

Res ipsa loquitur – a procedural or evidentiary rule which means “the thing or the transaction speaks for
itself.” It is a maxim for the rule that the fact of the occurrence of an injury, taken with the surrounding
circumstances, may permit an inference or raise a presumption of negligence, or make out a plaintiff’s
prima facie case, and present a question of fact for defendant to meet with an explanation, where
ordinarily in a medical malpractice case, the complaining party must present expert testimony to prove
that the attending physician was negligent.

This doctrine finds application in this case. On the day of the operation, Erlinda Ramos already
surrendered her person to the private respondents who had complete and exclusive control over her.
Apart from the gallstone problem, she was neurologically sound and fit. Then, after the procedure, she
was comatose and brain damaged—res ipsa loquitur!—the thing speaks for itself!
Negligence – Private respondents were not able to disprove the presumption of negligence on their part
in the care of Erlinda and their negligence was the proximate cause of her condition. One need not be an
anesthesiologist in order to tell whether or not the intubation was a success. [res ipsa loquitur applies
here]. The Supreme Court also found that the anesthesiologist only saw Erlinda for the first time on the
day of the operation which indicates unfamiliarity with the patient and which is an act of negligence and

The head surgeon, Dr. Hosaka was also negligent. He failed to exercise the proper authority as the
“captain of the ship” in determining if the anesthesiologist observed the proper protocols. Also, because
he was late, he did not have time to confer with the anesthesiologist regarding the anesthesia delivery.

The hospital failed to adduce evidence showing that it exercised the diligence of a good father of the
family in hiring and supervision of its doctors (Art. 2180). The hospital was negligent since they are the
one in control of the hiring and firing of their “consultants”. While these consultants are not employees,
hospitals still exert significant controls on the selection and termination of doctors who work there
which is one of the hallmarks of an employer-employee reationship. Thus, the hospital was allocated a
share in the liability.

Damages – temperate damages can and should be awarded on top of actual or compensatory damages
in instances where the injury is chronic and continuing.