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ROGELIO P. NOGALES, for himself and on behalf of the minors, ROGER ANTHONY, ANGELICA, NANCY, and MICHAEL CHRISTOPHER, all surnamed NOGALES, petitioners, vs. CAPITOL MEDICAL CENTER, DR. OSCAR ESTRADA, DR. ELY VILLAFLOR, DR. ROSA UY, DR. JOEL ENRIQUEZ, DR. PERPETUA LACSON, DR. NOE ESPINOLA, and NURSE J. DUMLAO, respondents.
DECISION
CARPIO, J.: The Case This petition for review1 assails the 6 February 1998 Decision2 and 21 March 2000 Resolution3 of the Court of Appeals in CA-G.R. CV No. 45641. The Court of Appeals affirmed in toto the 22 November 1993 Decision4 of the Regional Trial Court of Manila, Branch 33, finding Dr. Oscar Estrada solely liable for damages for the death of his patient, Corazon Nogales, while absolving the remaining respondents of any liability. The Court of Appeals denied petitioners' motion for reconsideration. The Facts Pregnant with her fourth child, Corazon Nogales ("Corazon"), who was then 37 years old, was under the exclusive prenatal care of Dr. Oscar Estrada ("Dr. Estrada") beginning on her fourth month of pregnancy or as early as December 1975. While Corazon was on her last trimester of pregnancy, Dr. Estrada noted an increase in her blood pressure and development of leg edema5 indicating preeclampsia,6 which is a dangerous complication of pregnancy.7 Around midnight of 25 May 1976, Corazon started to experience mild labor pains prompting Corazon and Rogelio Nogales ("Spouses Nogales") to see Dr. Estrada at his home. After examining Corazon, Dr. Estrada advised her immediate admission to the Capitol Medical Center ("CMC"). On 26 May 1976, Corazon was admitted at 2:30 a.m. at the CMC after the staff nurse noted the written admission request8 of Dr. Estrada. Upon Corazon's admission at the CMC, Rogelio
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Footnotes
1 2
Penned by Associate Justice Artemio G. Tuquero, with Associate Justices Jorge S. Imperial and Eubulo G. Verzola, concurring. Rollo, pp. 42-48.
3
Penned by Associate Justice Eubulo G. Verzola, with Associate Justices Roberto A. Barrios and Eriberto U. Rosario, Jr., concurring.Id. at 49.
4 5
Edema is the accumulation of excess fluid. It is manifested by the swelling of the extremities. (http://www.preeclampsia.org/symptoms.asp)
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A syndrome occurring in late pregnancy marked by an increase in blood pressure, swelling of the ankles by fluid, and the appearance of albumin in the urine, associated with reduced blood flow to the placenta, therefore putting the fetus at risk of death, or stillbirth, and putting the mother at risk of complications from high blood pressure, convulsions (eclampsia), kidney failure, liver failure and death. Treated with drugs to lower the blood pressure and to prevent convulsions, while expediting the delivery of the baby. (http://www.jansen.com.au/Dictionary_PR.html)
7 8 9
Rollo, p. 42. Exh. "A-4," Folder of Exhibits. Exh."A-1," Folder of Exhibits. Exh. "A-2," Folder of Exhibits. Exh. "A-5," Folder of Exhibits. Exh. "A-8," Folder of Exhibits. Exh. "A-20," Folder of Exhibits. Rollo, p. 43. Docketed as Civil Case No. 131873. Then Court of First Instance. Records, pp. 92, 93. Records, pp. 639-644. Rollo, pp. 42-48. Id. at 49. Id. at 237-240. Id. at 238. Id. at 207. Id. at 258.
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
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Id. at 283-285. Id. at 312. 33 Ill.2d 326, 211 N.E.2d 253 (1965).
Citing Clary v. Hospital Authority of City of Marietta, 106 Ga.App. 134, 126 S.E.2d 470 (1962).
29
Citing Cramer v. Hoffman, 390 F.2d 19, 23 (1968); Holzberg v. Flower and Fifth Ave. Hospitals, 39 A.D.2d 526, 330 N.Y.S.2d 682, 684 (1972); Snelson v. Margaretville Hospital, 49 A.D.2d 991, 374 N.Y.S.2d 579, 581 (1975).
30 31 32 33 34
79 A.D.2d 43, 436 N.Y.S.2d 109 (1981). 118 A.D.2d 988, 499 N.Y.S.2d 993 (1986). Citing Davis v. Glaze, 182 Ga.App. 18, 354 S.E.2d 845, 849 (1987). Citing Ybarra v. Spangard, 25 Cal.2d 486, 154 P.2d 687 (1944).
40A Am.Jur.2d Hospitals and Asylums 46, 40A Am.Jur.2d Hospitals and Asylums 44.
35 36 37 38 39 40 41
TSN, 26 July 1984, pp. 31-32 (Rogelio Nogales). Id. at 43-44. TSN, 4 April 1983, pp. 48-49 (Rogelio Nogales). Records, pp. 43-44. 378 Phil. 1198 (1999). Id. at 1240-1241.
See Diggs v. Novant Health, Inc., 628 S.E.2d 851 (2006) citing Hylton v. Koontz, 138 N.C.App.629 (2000).
42 43
See Jones v. Tallahassee Memorial Regional Healthcare, Inc., 923 So.2d 1245 (2006).
See Hale v. Sheikholeslam, 724 F.2d 1205 (1984) where the US Court of Appeals, Fifth Circuit, found the physician an independent contractor since there is no evidence or
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Sometimes referred to as the apparent, or ostensible, agency theory. (King v. Mitchell, 31 A.D.3d 958, 819 N.Y.S.2d 169 [2006]).
46 47 48 49
156 Ill.2d 511, 622 N.E.2d 788 (1993). Diggs v. Novant Health, Inc., supra note 41. Id.
De Castro v. Ginete, 137 Phil. 453 (1969), citing Sec. 3, par. a, Rule 131 of the Rules of Court. See alsoKing v. Mitchell, 31 A.D.3d 958, 819 N.Y.S.2d 169 (2006) where the New York Supreme Court, Appellate Division, Third Department, stated as follows: As a general proposition, "[a] hospital may not be held for the acts of an anesthetist who was not an employee of the hospital, but one of a group of independent contractors." Vicarious liability for medical malpractice may be imposed, however, under an apparent, or ostensible, agency theory, "or, as it is sometimes called, agency by estoppel or by holding out." "Essential to the creation of apparent authority are words or conduct of the principal, communicated to a third party, that give rise to the appearance and belief that the agent possesses authority to act on behalf of the principal." Also, the third party must reasonably rely upon the appearance of authority created by the principal. Finally, the third party must accept the services of the agent in reliance upon the perceived relationship between the agent and the principal. (emphasis supplied and internal citations omitted)
50
In Gilbert v. Sycamore Municipal Hospital, supra note 46, cited in York v. RushPresbyterian-St. Luke's Medical Center (222 Ill.2d 147, 854 N.E.2d 635 [2006]), the Illinois Supreme Court made a similar observation, thus: x x x the language employed in the hospital's treatment consent form could have led plaintiff to reasonably believe that he would be treated by physicians and employees of the hospital. We concluded that, upon the record before us, the plaintiff adduced sufficient evidence to create a genuine issue of material fact with respect to the reliance element of the plaintiffs apparent agency claim against the hospital.
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Exh."A-1," Folder of Exhibits. Exh. "A-20," Folder of Exhibits. TSN, 17 February 1992, p. 69 (Dr. Franklin Atencio). Diggs v. Novant Health, Inc., supra note 41. TSN, 26 July 1984, pp. 12-13 (Rogelio Nogales). Id. at 37.
Supra note 41, citing Rabon v. Rowan Memorial Hospital, Inc., 269 N.C.1, 152 S.E.2d 485 (1967).
58
"Responsibility arising from negligence in the performance of every kind of obligation is also demandable, but such liability may be regulated by the courts, according to the circumstances."
59 60 61 62 63 64 65 66 67 68
Rollo, p. 258. CA rollo, pp. 78-79. Records, p. 76. Id. at 59. CA rollo, p. 89. Id. at 90. TSN, 11 November 1991, pp. 9-12. Id. at 14. 403 F.2d 366 (1968).
People v. Ocampo, G.R. No. 171731, 11 August 2006, citing People v. Torellos, 448 Phil. 287, 301 (2003). See also People v. Duban, G.R. No. 141217, 26 September 2003, 412 SCRA 131 and People v. De Vera, 371 Phil. 563 (1999).
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EN BANC PROFESSIONAL SERVICES, INC., Petitioner, G.R. No. 126297 Present: PUNO, C.J., CARPIO,
- versus -
CORONA, CARPIO MORALES, VELASCO, JR., NACHURA, LEONARDO-DE CASTRO, BRION, PERALTA, BERSAMIN,* DEL CASTILLO, ABAD, VILLARAMA, JR., PEREZ and MENDOZA, JJ.**
THE COURT OF APPEALS and NATIVIDAD and ENRIQUE AGANA, Respondents. x-------------------x NATIVIDAD [substituted by her children Marcelino Agana III, Enrique Agana, Jr., Emma Agana-Andaya, Jesus Agana and Raymund Agana] and ENRIQUE AGANA, Petitioners, versus G.R. No. 126467
x-------------------x MIGUEL AMPIL, Petitioner, - versus NATIVIDAD and ENRIQUE AGANA, Respondents.
Promulgated: February 2, 2010 x - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x RESOLUTION CORONA, J.: With prior leave of court,[1] petitioner Professional Services, Inc. (PSI) filed a second motion for reconsideration[2] urging referral thereof to the Court en banc and seeking modification of the decision dated January 31, 2007 and resolution dated February 11, 2008 which affirmed its vicarious and direct liability for damages to respondents Enrique Agana and the heirs of Natividad Agana (Aganas). Manila Medical Services, Inc. (MMSI),[3] Asian Hospital, Inc. (AHI),[4] and Private Hospital Association of the Philippines (PHAP)[5] all sought to intervene in these cases invoking the common ground that, unless modified, the assailed decision and resolution will jeopardize the financial viability of private hospitals and jack up the cost of health care.
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First, there existed between PSI and Dr. Ampil an employer-employee relationship as contemplated in the December 29, 1999 decision in Ramos v. Court of Appeals[18] that for purposes of allocating responsibility in medical negligence cases, an employer-employee relationship exists between hospitals and their consultants.[19] Although the Court in Ramos later issued a Resolution dated April 11, 2002[20] reversing its earlier finding on the existence of an employment relationship between hospital and doctor, a similar reversal was not warranted in the present case because the defense raised by PSI consisted of a mere general denial of control or responsibility over the actions of Dr. Ampil.[21] Second, by accrediting Dr. Ampil and advertising his qualifications, PSI created the public impression that he was its agent.[22] Enrique testified that it was on account of Dr. Ampil's accreditation with PSI that he conferred with said doctor about his wife's (Natividad's) condition.[23]After his meeting with Dr. Ampil, Enrique asked Natividad to personally consult Dr. Ampil.[24] In effect, when Enrigue and Natividad engaged the services of Dr. Ampil, at the back of their minds was that the latter was a staff member of a prestigious hospital. Thus, under the doctrine of apparent authority applied in Nogales, et al. v. Capitol Medical Center, et al.,[25] PSI was liable for the negligence of Dr. Ampil. Finally, as owner and operator of Medical City General Hospital, PSI was bound by its duty to provide comprehensive medical services to Natividad Agana, to exercise reasonable care to protect her from harm,[26] to oversee or supervise all persons who practiced medicine within its walls, and to take active steps in fixing any form of negligence committed within its
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premises.[27] PSI committed a serious breach of its corporate duty when it failed to conduct an immediate investigation into the reported missing gauzes.[28] PSI is now asking this Court to reconsider the foregoing rulings for these reasons: I The declaration in the 31 January 2007 Decision vis-a-vis the 11 February 2009 Resolution that the ruling in Ramos vs. Court of Appeals (G.R. No. 134354, December 29, 1999) that an employer-employee relations exists between hospital and their consultants stays should be set aside for being inconsistent with or contrary to the import of the resolution granting the hospital's motion for reconsideration in Ramos vs. Court of Appeals (G.R. No. 134354, April 11, 2002), which is applicable to PSI since the Aganas failed to prove an employer-employee relationship between PSI and Dr. Ampil and PSI proved that it has no control over Dr. Ampil. In fact, the trial court has found that there is no employer-employee relationship in this case and that the doctor's are independent contractors. II Respondents Aganas engaged Dr. Miguel Ampil as their doctor and did not primarily and specifically look to the Medical City Hospital (PSI) for medical care and support; otherwise stated, respondents Aganas did not select Medical City Hospital (PSI) to provide medical care because of any apparent authority of Dr. Miguel Ampil as its agent since the latter was chosen primarily and specifically based on his qualifications and being friend and neighbor. III PSI cannot be liable under doctrine of corporate negligence since the proximate cause of Mrs. Agana's injury was the negligence of Dr. Ampil, which is an element of the principle of corporate negligence.[29]
In their respective memoranda, intervenors raise parallel arguments that the Court's ruling on the existence of an employer-employee relationship between private hospitals and consultants will force a drastic and complex alteration in the long-established and currently
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prevailing relationships among patient, physician and hospital, with burdensome operational and financial consequences and adverse effects on all three parties.[30] The Aganas comment that the arguments of PSI need no longer be entertained for they have all been traversed in the assailed decision and resolution.[31] After gathering its thoughts on the issues, this Court holds that PSI is liable to the Aganas, not under the principle of respondeat superior for lack of evidence of an employment relationship with Dr. Ampil but under the principle of ostensible agency for the negligence of Dr. Ampil and, pro hac vice,under the principle of corporate negligence for its failure to perform its duties as a hospital. While in theory a hospital as a juridical entity cannot practice medicine,[32] in reality it utilizes doctors, surgeons and medical practitioners in the conduct of its business of facilitating medical and surgical treatment.[33] Within that reality, three legal relationships crisscross: (1) between the hospital and the doctor practicing within its premises; (2) between the hospital and the patient being treated or examined within its premises and (3) between the patient and the doctor. The exact nature of each relationship determines the basis and extent of the liability of the hospital for the negligence of the doctor. Where an employment relationship exists, the hospital may be held vicariously liable under Article 2176[34] in relation to Article 2180[35] of the Civil Code or the principle of respondeat superior. Even when no employment relationship exists but it is shown that the hospital holds out to the patient that the doctor is its agent, the hospital may still be vicariously liable under Article 2176 in relation to Article 1431[36] and Article 1869[37] of the Civil Code or the principle of apparent authority.[38] Moreover, regardless of its relationship with the doctor,
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the hospital may be held directly liable to the patient for its own negligence or failure to follow established standard of conduct to which it should conform as a corporation.[39] This Court still employs the control test to determine the existence of an employeremployee relationship between hospital and doctor. In Calamba Medical Center, Inc. v. National Labor Relations Commission, et al.[40] it held: Under the "control test", an employment relationship exists between a physician and a hospital if the hospital controls both the means and the details of the process by which the physician is to accomplish his task. xx xx xx As priorly stated, private respondents maintained specific work-schedules, as determined by petitioner through its medical director, which consisted of 24hour shifts totaling forty-eight hours each week and which were strictly to be observed under pain of administrative sanctions. That petitioner exercised control over respondents gains light from the undisputed fact that in the emergency room, the operating room, or any department or ward for that matter, respondents' work is monitored through its nursing supervisors, charge nurses and orderlies. Without the approval or consent of petitioner or its medical director, no operations can be undertaken in those areas. For control test to apply, it is not essential for the employer to actually supervise the performance of duties of the employee, it being enough that it has the right to wield the power. (emphasis supplied)
Even in its December 29, 1999 decision[41] and April 11, 2002 resolution[42] in Ramos, the Court found the control test decisive. In the present case, it appears to have escaped the Court's attention that both the RTC and the CA found no employment relationship between PSI and Dr. Ampil, and that the Aganas did not question such finding. In its March 17, 1993 decision, the RTC found that defendant
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By such statement, PSI virtually reinforced the public impression that Dr. Ampil was a physician of its hospital, rather than one independently practicing in it; that the medications and treatments he prescribed were necessary and desirable; and that the hospital staff was prepared to carry them out. PSI pointed out in its memorandum that Dr. Ampil's hospital affiliation was not the exclusive basis of the Aganas decision to have Natividad treated
in Medical City General Hospital, meaning that, had Dr. Ampil been affiliated with another hospital, he would still have been chosen by the Aganas as Natividad's surgeon.[54] The Court cannot speculate on what could have been behind the Aganas decision but would rather adhere strictly to the fact that, under the circumstances at that time, Enrique decided to consult Dr. Ampil for he believed him to be a staff member of a prominent and known hospital. After his meeting with Dr. Ampil, Enrique advised his wife Natividad to go
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PSI reiterated its admission when it stated that had Natividad Agana informed the hospital of her discomfort and pain, the hospital would have been obliged to act on it.[56] The significance of the foregoing statements is critical. First, they constitute judicial admission by PSI that while it had no power to control the means or method by which Dr. Ampil conducted the surgery on Natividad Agana, it had
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WE CONCUR:
REYNATO S. PUNO Chief Justice ANTONIO T. CARPIO Associate Justice CONCHITA CARPIO MORALES Associate Justice
CERTIFICATION Pursuant to Section 13, Article VIII of the Constitution, I certify that the conclusions in the above Resolution had been reached in consultation before the case was assigned to the writer of the opinion of the Court.
* ** [1] [2]
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p. 512.
[4]
Filed a motion for leave of court to intervene (by way of attached memorandum), id.,
Filed a motion to intervene and for leave to file memorandum-in-intervention, id., p. 534. AHI did not file any memorandum. [5] Filed a motion for intervention (by way of attached brief/memorandum), id., p. 602. [6] Resolution dated June 16, 2008, id., p. 647. [7] Resolution dated June 12, 2008, id., p. 645. [8] Resolution dated August 12, 2008, id., p. 649. [9] As per Advisory dated March 4, 2009. It should be borne in mind that the issues in G.R. No. 126467 on the exculpation of Dr. Juan Fuentes from liability, and in G.R. No. 127590 on the culpability of Dr. Miguel Ampil for negligence and medical malpractice, are deemed finally decided, no motion for reconsideration having been filed by the Heirs of Agana in G.R. No. 126467 nor by Dr. Miguel Ampil in G.R. No. 127467 from the January 31, 2007 Decision of the First Division of the Court. [10] Docketed as Civil Case No. Q-43322, record, p. 6. [11] Also referred to in the records as sponges. [12] Penned by then Presiding Judge and now Associate Justice of the Supreme Court Lucas Bersamin. [13] RTC Decision, record, p. 133. [14] CA decision dated September 6, 1996, penned by then Court of Appeals Associate Justice and later Supreme Court Associate Justice Cancio Garcia (Ret.); CA rollo, pp. 136-137. [15] G.R. Nos. 126297/126467/127590, 31 January 2007, 513 SCRA 478. [16] Rollo, p. 403. [17] G.R. Nos. 126297/126467/127590, 11 February 2008, 544 SCRA 170. [18] G.R. No. 124354, 29 December 1999, 321 SCRA 548. [19] Supra at 15, p. 499. [20] G.R. No. 124354, 11 April 2002, 380 SCRA 467. [21] Supra at 17, p. 179. [22] Supra at 15, p. 502. [23] Supra at 17, p. 181, citing TSN, April 12, 1985, pp. 25-26. [24] Id. [25] G.R. No. 142625, 19 December 2006, 511 SCRA 204. [26] Supra at 15, p. 505. [27] Supra at 17, p. 182. [28] Id. [29] Rollo (G.R. No. 126297), pp. 489-490. [30] Id., pp. 518-527, 605-613. [31] Id., p. 659. [32] Section 8, Republic Act No. 2382 (RA 2382) or The Medical Act of 1959. [33] See Acebedo Optical Co. Inc. v. CA, G.R. No. 100152, 31 March 2000, 314 SCRA 315.
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[35]
[36]
[37]
[38] [39]
Article 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no pre-existing contractual relation between the parties is called a quasi-delict and is governed by the provisions of this Chapter. 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 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. Article 1431. Through estoppel an admission or representation is rendered conclusive upon the person making it, and cannot be denied or disproved as against the person relying thereon. 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. Nogales v. Capitol Medical Center, et al., supra at 25. Pedro Solis, Medical Jurisprudence (The Practice of Medicine and the Law), Quezon City: R.P. Garcia Publishing Co., 1988, p. 321, citing U.S. district and appellate cases. See also Darling v. Charleston Community Memorial Hospital, 14 A.L.R. 3D 860 (Ill. September 29, 1965). G.R. No. 176484, 25 November 2008, 571 SCRA 585. Supra at 18. Supra at 20. Supra at 13, p. 126.
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Dr. Fuentes filed with the CA a petition for certiorari docketed as CA-G.R. SP No. 32198 (CA rollo, p. 1) while Dr. Ampil and PSI jointly filed an appeal docketed as CA-G.R. CV No. 42062 (CA rollo, pp. 40 and 152). Supra at 14, p. 135. Rollo (G.R. No. 126467), p. 8. Elsie Ang v. Dr. Erniefel Grageda, G.R. No. 166239, 8 June 2006, 490 SCRA 424. Through the patient's husband Enrique. Nogales v. Capitol Medical Center, et al., supra at 25. TSN, April 12, 1985, pp. 26-27. Second Motion for Reconsideration, rollo, pp. 495-496. Supra at 50, pp. 25-26. Exh. D-1, Exhibit Folder for Plaintiffs, p. 92. Petitioner's Memorandum with Compliance, pp. 57-58. Motion for Reconsideration, rollo, pp. 429-430. Id., p. 434. PSI has not denied its prominent place in the hospital industry but has in fact asserted such role in its 1967 brochure (Annex K to its Manifestation filed on May 14, 2009). Rollo, p. 505-506. Id., pp. 506-507. Luciano Tan v. Rodil Enterprises, G. R. No. 168071, 18 December 2006, 511 SCRA 162; Heirs of Pedro Clemena Y Zurbano v. Heirs of Irene B. Bien, G.R. No. 155508, 11 September 2006, 501 SCRA 405. Second Motion for Reconsideration, rollo, pp. 502-503. Id., p. 503, citing TSN, February 26, 1987, p. 36. Supra at 55. In Partido ng Manggagawa (PM) and Butil Farmers Party (Butil) v. Comelec (G.R. No. 164702, March 15, 2006, 484 SCRA 671), a ruling expressly qualified as pro hac vice is limited in application to one particular case only; it cannot be relied upon as a precedent to govern other cases. See Sps. Chua v. Hon. Jacinto Ang, et al., G.R. No. 156164, 4 September 2009. His last pleading was filed on May 13, 2001, rollo (G.R. No. 127590), p. 217.
[65] [66]
FIRST DIVISION
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ROGELIO E. RAMOS and ERLINDA RAMOS, in their own behalf and as natural guardians of the minors, ROMMEL RAMOS, ROY RODERICK RAMOS, and RON RAYMOND RAMOS, petitioners, vs. COURT OF APPEALS, DE LOS SANTOS MEDICAL CENTER, DR. ORLINO HOSAKA and DR. PERFECTA GUTIERREZ, respondents. RESOLUTION KAPUNAN, J.: Private respondents De Los Santos Medical Center, Dr. Orlino Hosaka and Dr. Perfecta Gutierrez move for a reconsideration of the Decision, dated December 29, 1999, of this Court holding them civilly liable for petitioner Erlinda Ramos comatose condition after she delivered herself to them for their professional care and management. For better understanding of the issues raised in private respondents respective motions, we will briefly restate the facts of the case as follows: 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 9:00 in the morning at private respondent De Los Santos Medical Center (DLSMC). Since neither petitioner Erlinda nor her husband, petitioner Rogelio, knew of any anesthesiologist, Dr. Hosaka recommended to them the services of Dr. Gutierrez. Petitioner Erlinda was admitted to the DLSMC the day before the scheduled operation. By 7:30 in the morning of the following day, petitioner Erlinda was already being prepared for operation. Upon the request of petitioner Erlinda, her sister-in-law, Herminda Cruz, who was then Dean of the College of Nursing at the Capitol Medical Center, was allowed to accompany her inside the operating room. At around 9:30 in the morning, Dr. Hosaka had not yet arrived so Dr. Gutierrez tried to get in touch with him by phone. Thereafter, Dr. Gutierrez informed Cruz that the operation might be delayed due to the late arrival of Dr. Hosaka. In the meantime, the patient, petitioner Erlinda said to Cruz, Mindy, inip na inip na ako, ikuha mo ako ng ibang Doctor. By 10:00 in the morning, when Dr. Hosaka was still not around, petitioner Rogelio already wanted to pull out his wife from the operating room. He met Dr. Garcia, who remarked that he was also tired of waiting for Dr. Hosaka. Dr. Hosaka finally arrived at the hospital at around 12:10 in the afternoon, or more than three (3) hours after the scheduled operation.
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A Q
A Q
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A Q A Q A Q A Q
A Q A Q
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A Q A Q A Q
We cannot thus give full credence to Dr. Gutierrez synopsis in light of her admission that it does not fully reflect the events that transpired during the administration of anesthesia on Erlinda. As pointed out by Dr. Estrella, there was a ten-minute gap in Dr. Gutierrez synopsis, i.e., the vital signs of Erlinda were not recorded during that time. The absence of these data is particularly significant because, as found by the trial court, it was the absence of oxygen supply for four (4) to five (5) minutes that caused Erlindas comatose condition. On the other hand, the Court has no reason to disbelieve the testimony of Cruz. As we stated in the Decision, she is competent to testify on matters which she is capable of observing such as, the statements and acts of the physician and surgeon, external appearances and manifest conditions which are observable by any one.[24] Cruz, Erlindas sister-in-law, was with her inside the operating room. Moreover, being a nurse and Dean of the Capitol Medical Center School of Nursing at that, she is not entirely ignorant of anesthetic procedure. Cruz narrated that she heard Dr. Gutierrez remark, Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan. She observed that the nailbeds of Erlinda became bluish and thereafter Erlinda was placed in trendelenburg position.[25] Cruz further averred that she noticed that the abdomen of Erlinda became distended.[26] The cyanosis (bluish discoloration of the skin or mucous membranes caused by lack of oxygen or abnormal hemoglobin in the blood) and enlargement of the stomach of Erlinda indicate that the endotracheal tube was improperly inserted into the esophagus instead of the trachea. Consequently, oxygen was delivered not to the lungs but to the gastrointestinal tract. This conclusion is supported by the fact that Erlinda was placed in trendelenburg position. This indicates that there was a decrease of blood supply to the patients brain. The brain was thus temporarily deprived of oxygen supply causing Erlinda to go into coma.
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See Decision, pp. 2-5. Rollo, p. 217. Id., at 226. Id., at 252-253. Id., at 469. Id., at 440. Id., at 454-455. Resolution, dated March 19, 2001, pp. 1-2; Rollo, pp. 543-544. TSN, March 19, 2001, p. 51. Id., at 182-184. Memorandum of Amicus Curiae Dr. Iluminada M. Camagay, Rollo, p. 620
Decision, p. 28, Id., at 197, citing Stoelting and Miller, Basics of Anesthesia, p. 103 (1994); Memorandum of Dr. Camagay, Id., at 616.
[13] [14]
Decision, Id.
To auscultate means to listen to the sounds arising within organs as an aid to diagnosis and treatment, the examination being made either by use of the stethoscope or by direct application of the ear to the body. (Websters Third New International Dictionary, p. 145 [1976]).
[15]
Decision, p. 29, Rollo, p. 198; see also Motion for Reconsideration of Dr. Gutierrez, Id., at 266.
[16] [17] [18] [19] [20] [21] [22]
Id., at 28-29; Id., at 197-198. TSN, March 19, 2001, pp. 77-78. Motion for Reconsideration, p. 54; Rollo, p. 305. Decision, p. 31; Id. at 200. TSN, March 19, 2001, pp. 211-212. Decision, p. 34, Rollo, p. 203. Second Motion for Reconsideration, pp. 6-7; Id., at 421-422.
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TSN, March 19, 2001, pp. 136-144. Decision, p. 25 citing Stockholm v. Hall, 65 P. 348 (1937); Rollo, p.194. Id., at 23-24; Rollo, pp. 192-193. Id., at 4. Decision, p. 20; Id., at 189. 364 P2d 955 (1961). Id., at 971.
The Captain-of-the-Ship Doctrine was discussed in McConnell v. Williams (65 A 2d 243 [1949]), where the Supreme Court of Pennsylvania stated that under this doctrine, a surgeon is likened to a captain of the ship, in that it is his duty to control everything going on in the operating room.
[31] [32] [33] [34] [35] [36] [37] [38]
Motion for Reconsideration of Dr. Hosaka, Rollo, p. 231. Id., at. 229. Id., at 231, citing Thomas vs. Raleigh General Hospital, 358 SE 2d 222 (1987). Supra. Id., at 225. TSN, March 19, 2001, pp. 11-12. Id., at 7. The following exchange between Justice Puno and Dr. Hosakas counsel is instructive: Counsel.
JUSTICE REYNATO S. PUNO: RET. JUSTICE HOFILEA: Yes, Your Honor. JUSTICE REYNATO S. PUNO: Well, your thesis is that Dr. Hosaka did not have complete control of the anesthesiologist in this case and therefore whatever is the negligent act of the anesthesiologist cannot be attributed to Dr. Hosaka, is that a correct appreciation of your thesis? RET. JUSTICE HOFILEA: Yes, Your Honor. JUSTICE REYNATO S. PUNO:
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RET. JUSTICE HOFILEA: I believe, Your Honor, that the, in the first place if the patient would have his own anesthesiologist, would prefer his own anesthesiologist, he can retain the services of another anesthesiologist but of his own but if he does not know of anybody and he asks the surgeon to provide one, then this surgeon can recommend. But I would like to emphasize, Your Honor, that the relationship is between the patient and the anesthesiologist. It is not that the anesthesiologist is the employee of the surgeon. JUSTICE REYNATO S. PUNO: But is there an agreement, expressed or implied, between the two (2), to the effect that, you know the anesthesiologist could say to the surgeon that you have no business interfering with my work as anesthesiologist. Is that how the relationship is defined? RET. JUSTICE HOFILEA: Once the start the (interrupted) JUSTICE REYNATO S. PUNO: Right from the very beginning? RET. JUSTICE HOFILEA: I believe Your Honor that on the matter of retaining the services of the anesthesiologist in the sense that the surgeon reposes confidence on the ability of the anesthesiologist, he hires him if he is authorized, he hires him on behalf of the patient if he is authorized to do that but once they are already performing their own task, then there should be no interference. JUSTICE REYNATO S. PUNO: agree? But the work of the two cannot be separated in watertight compartments, do you
RET. JUSTICE HOFILEA: I agree, Your Honor (TSN, March 19, 2001, pp. 14-23).
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Id., at 19. Memorandum of Amicus Curiae Dr. Iluminada Camagay, Rollo, p. 616. Websters Third New International Dictionary, p. 17 (1976). TSN, March 19, 2001, pp. 196. Id., at 205-206.
Batiquin vs. Court of Appeals, 258 SCRA 334, 346 (1996); Carillo vs. People, 229 SCRA 386, 396 (1994). Article 2180 states:
[45]
The obligation imposed by Article 2176 is demandable not only for ones 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 of their assigned tasks, even though the former are not engaged in any business or industry.
[46] [47] [48] [49] [50] [51] [52] [53] [54] [55]
Decision, p. 40; Rollo, p. 209. Traders Royal Bank vs. National Labor Relations Commission, 321 SCRA 467 (1999). Motion for Reconsideration of DLSMC, p. 10; Rollo, p. 477. Ibid. Id., at 478. Id., at 480. TSN, March 19, 2001, pp. 113-116. Decision, p. 48, Rollo, p. 217. Id., at 43-45; Id., at 212-214.
See letter dated November 4, 2000 of petitioner Rogelio E. Ramos addressed to Mr. Justice Santiago M. Kapunan, Id., at 489.
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JR.and DR.
Petitioners,
Present:
CARPIO,* J., PERALTA,** Acting Chairperson, - versus ABAD, PEREZ,*** and MENDOZA, JJ.
x --------------------------------------------------------------------------------------- x
DECISION
MENDOZA, J.:
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Even early on, patients have consigned their lives to the skill of their doctors. Time and again, it can be said that the most important goal of the medical profession is the preservation of life and health of the people. Corollarily, when a physician departs from his sacred duty and endangers instead the life of his patient, he must be made liable for the resulting injury. This Court, as this case would show, cannot and will not let the act go unpunished.[1] This is a petition for review under Rule 45 of the Rules of Court challenging the August 29, 2008 Decision[2] of the Court of Appeals (CA), and its May 19, 2009 Resolution[3] in CA-G.R. CR No. 29559, dismissing the appeal and affirming in toto the June 14, 2005 Decision[4] of the Regional Trial Court, Branch 43, Manila (RTC), finding the accused guilty beyond reasonable doubt of simple imprudence resulting to serious physical injuries. THE FACTS
Belinda Santiago (Mrs. Santiago) lodged a complaint with the National Bureau of Investigation(NBI) against the petitioners, Dr. Emmanuel Jarcia, Jr. (Dr. Jarcia) and Dr. Marilou Bastan (Dr. Bastan), for their alleged neglect of professional duty which caused her son, Roy Alfonso Santiago(Roy Jr.), to suffer serious physical injuries. Upon investigation, the NBI found that Roy Jr. was hit by a taxicab; that he was rushed to the Manila Doctors Hospital for an emergency medical treatment; that an X-ray of the victims ankle was ordered; that the X-ray result showed no fracture as read by Dr. Jarcia; that Dr. Bastan entered the emergency room (ER) and, after conducting her own examination of the victim, informed Mrs. Santiago that since it was only the ankle that was hit, there was no need to examine the upper leg; that eleven (11) days later, Roy Jr. developed fever, swelling of the right leg and misalignment of the right foot; that Mrs. Santiago brought him back to the hospital; and that the X-ray revealed a right mid-tibial fracture and a linear hairline fracture in the shaft of the bone. The NBI indorsed the matter to the Office of the City Prosecutor of Manila for preliminary investigation. Probable cause was found and a criminal case for reckless imprudence resulting to serious physical injuries, was filed against Dr. Jarcia, Dr. Bastan and Dr. Pamittan,[5] before the RTC, docketed as Criminal Case No. 01-196646.
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Considering all the evidence on record, The Court finds the accused guilty for simple imprudence resulting to physical injuries. Under Article 365 of the Revised Penal Code, the penalty provided for is arresto mayor in its minimum period.[7]
Dissatisfied, the petitioners appealed to the CA. As earlier stated, the CA affirmed the RTC decision in toto. The August 29, 2008 Decision of the CA pertinently reads: This Court holds concurrently and finds the foregoing circumstances sufficient to sustain a judgment of conviction against the accused-appellants for the crime of simple imprudence resulting in serious physical injuries. The elements of imprudence are: (1) that the offender does or fails to do an act; (2) that the doing or the failure to do that act is voluntary; (3) that it be without malice; (4) that material damage results from the imprudence; and (5) that there is inexcusable lack of precaution on the part of the offender, taking into consideration his employment or occupation, degree of intelligence, physical condition, and other circumstances regarding persons, time and place. Whether or not Dr. Jarcia and Dr. Bastan had committed an inexcusable lack of precaution in the treatment of their patient is to be determined according to the standard of care observed by other members of the profession in good standing under similar circumstances, bearing in mind the advanced state of the profession at the time of treatment or the present state of medical science. In the case of Leonila Garcia-Rueda v. Pascasio, the Supreme Court stated that, in accepting a case, a doctor in effect represents that, having the needed training and skill possessed by physicians and surgeons practicing in the same field, he will employ such training, care and skill in the treatment of his patients. He therefore has a duty to use at least the same level of care that any other reasonably competent doctor would use to treat a condition under the same circumstances. In litigations involving medical negligence, the plaintiff has the burden of establishing accused-appellants negligence, and for a reasonable conclusion of negligence, there must be proof of breach of duty on the part of the physician as well as a causal connection of such breach and the resulting injury of his
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Q: A:
Was there a resident doctor [who] came? Yes, Sir. Dra. Bastan arrived. Did you tell her what you want on you to be done? Yes, sir. What did you [tell] her? I told her, sir, while she was cleaning the wounds of my son, are you not going to x-ray up to the knee because my son was complaining pain from his ankle up to the middle part of the right leg. And what did she tell you? According to Dra. Bastan, there is no need to x-ray because it was the ankle part that was run over. What did you do or tell her? I told her, sir, why is it that they did not examine[x] the whole leg. They just lifted the pants of my son. So you mean to say there was no treatment made at all? None, sir. xxx xxx xxx
Q: A: Q: A: Q: A:
A:
I just listened to them, sir. And I just asked if I will still return my son. xxx xxx xxx
Q: A: Q:
And you were present when they were called? Yes, sir. And what was discussed then by Sis. Retoria?
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Still, before resort to the doctrine may be allowed, the following requisites must be satisfactorily shown: 1. 2. The accident is of a kind which ordinarily does not occur in the absence of someones negligence; It is caused by an instrumentality within the exclusive control of the defendant or defendants; and
3. The possibility of contributing conduct which would make the plaintiff responsible is eliminated. In the above requisites, the fundamental element is the control of the instrumentality which caused the damage. Such element of control must be shown to be within the dominion of the accused-appellants. In order to have the benefit of the rule, a plaintiff, in addition to proving injury or damage, must show a situation where it is applicable and must establish that the essential elements of the doctrine were present in a particular incident. The early treatment of the leg of Roy would have lessen his suffering if not entirely relieve him from the fracture. A boy of tender age whose leg was hit by a vehicle would engender a well-founded belief that his condition may worsen without proper medical attention. As junior residents who only practice general surgery and without specialization with the case consulted before them, they should have referred the matter to a specialist. This omission alone constitutes simple imprudence on their part. When Mrs. Santiago insisted on having another x-ray of her child on the upper part of his leg, they refused to do so. The mother would not have asked them if they had no exclusive control or prerogative to request an x-ray test. Such is a fact because a radiologist would only conduct the x-ray test upon request of a physician. The testimony of Mrs. Santiago was corroborated by a bone specialist Dr. Tacata. He further testified based on his personal knowledge, and not as an expert, as he examined himself the child Roy. He testified as follows: Fiscal Macapagal: Q: And was that the correct respon[se] to the medical problem that was presented to Dr. Jarcia and Dra. Bastan?
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Q: A:
Ordinarily, only physicians and surgeons of skill and experience are competent to testify as to whether a patient has been treated or operated upon with a reasonable degree of skill and care. However, testimony as to the statements and acts of physicians, external appearances, and manifest conditions which are observable by any one may be given by non-expert witnesses. Hence, in cases where the res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon proper proof of injury to the patient, without the aid of expert testimony, where the court from its fund of common knowledge can determine the proper standard of care. Where common knowledge and experience teach that a resulting injury would not have occurred to the patient if due care had been exercised, an inference of negligence may be drawn giving rise to an application of the doctrine of res ipsa loquitur without medical evidence, which is ordinarily required to show not only what occurred but how and why it occurred. In the case at bench, we give credence to the testimony of Mrs. Santiago by applying the doctrine of res ipsa loquitur. Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously applied, depending upon the circumstances of each case. It is generally restricted to situations in malpractice cases where a layman is able to say, as a matter of common knowledge and observation, that
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The petitioners filed a motion for reconsideration, but it was denied by the CA in its May 19, 2009 Resolution. Hence, this petition. The petitioners pray for the reversal of the decision of both the RTC and the CA anchored on the following GROUNDS1. IN AFFIRMING ACCUSED-PETITIONERS CONVICTION, THE COURT OF APPEALS ERRED IN NOT HOLDING THAT THE ACTUAL, DIRECT, IMMEDIATE, AND PROXIMATE CAUSE OF THE PHYSICAL INJURY OF THE PATIENT (FRACTURE OF THE LEG BONE OR TIBIA), WHICH REQUIRED MEDICAL ATTENDANCE FOR MORE THAN THIRTY (30) DAYS AND INCAPACITATED HIM FROM PERFORMING HIS CUSTOMARY DUTY DURING THE SAME PERIOD OF TIME, WAS THE VEHICULAR ACCIDENT WHERE THE PATIENTS RIGHT LEG WAS HIT BY A TAXI, NOT THE FAILURE OF THE ACCUSED-PETITIONERS TO SUBJECT THE PATIENTS WHOLE LEG TO AN X-RAY EXAMINATION. 2. THE COURT OF APPEALS ERRED IN DISREGARDING ESTABLISHED FACTS CLEARLY NEGATING PETITIONERS ALLEGED NEGLIGENCE OR IMPRUDENCE. SIGNIFICANTLY, THE COURT OF APPEALS UNJUSTIFIABLY DISREGARDED THE OPINION OF THE PROSECUTIONS EXPERT WITNESS, DR.
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The foregoing can be synthesized into two basic issues: [1] whether or not the doctrine of res ipsa loquitur is applicable in this case; and [2] whether or not the petitioners are liable for criminal negligence. THE COURTS RULING The CA is correct in finding that there was negligence on the part of the petitioners. After a perusal of the records, however, the Court is not convinced that the petitioners are
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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 facieevidence 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.[11]
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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.[12] In this case, the circumstances that caused patient Roy Jr.s injury and the series of tests that were supposed to be undergone by him to determine the extent of the injury suffered were not under the exclusive control of Drs. Jarcia and Bastan. It was established that they are mere residents of theManila Doctors Hospital at that time who attended to the victim at the emergency room.[13] While it may be true that the circumstances pointed out by the courts below seem doubtless to constitute reckless imprudence on the part of the petitioners, this conclusion is still best achieved, not through the scholarly assumptions of a layman like the patients mother, but by the unquestionable knowledge of expert witness/es. As to whether the petitioners have exercised the requisite degree of skill and care in treating patient Roy, Jr. is generally a matter of expert opinion. As to Dr. Jarcia and Dr. Bastans negligence The totality of the evidence on record clearly points to the negligence of the petitioners. At the risk of being repetitious, the Court, however, is not satisfied that Dr. Jarcia and Dr. Bastan are criminally negligent in this case. Negligence is defined as the failure to observe for the protection of the interests of another person that degree of care, precaution, and vigilance which the circumstances justly demand, whereby such other person suffers injury.[14] 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.[15]
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Q: A:
Q: A:
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Q: A: Q: A: Q: A: Q: A:
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xxx Q: A: You also said, Doctor, that Dr. Jarcia and Dra. Bastan are not even an orthopedic specialist. They are general surgeon residents. You have to man[x] the emergency room, including neurology, orthopedic, general surgery, they see everything at the emergency room. xxxx Q: But if initially, Alfonso Santiago, Jr. and his case was presented to you at the emergency room, you would have subjected the entire foot to x-ray even if the history that was given to Dr. Jarcia and Dra. Bastan is the same? I could not directly say yes, because it would still depend on my examination, we cannot subject the whole body for x-ray if we think that the damaged was only the leg. Not the entire body but the entire leg? I think, if my examination requires it, I would. So, you would conduct first an examination? Yes, sir. And do you think that with that examination that you would have conducted you would discover the necessity subjecting the entire foot for x-ray? It is also possible but according to them, the foot and the ankle were swollen and not the leg, which sometimes normally happens that the actual fractured bone do not get swollen. xxxx Q: A: Doctor, if you know that the patient sustained a fracture on the ankle and on the foot and the history that was told to you is the region that was hit is the region of the foot, will the doctor subject the entire leg for x-ray? I am an orthopedic surgeon, you have to subject an x-ray of the leg. Because you have to consider the kind of fracture that the patient sustained would you say the exact mechanism of injury. For example spiral, paikot yung bale nya, so it was possible that the leg was run
A:
Q: A: Q: A: Q: A:
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Established medical procedures and practices, though in constant instability, are devised for the purpose of preventing complications. In this case, the petitioners failed to observe the most prudent medical procedure under the circumstances to prevent the complications suffered by a child of tender age. As to the Award of Damages
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While no criminal negligence was found in the petitioners failure to administer the necessary medical attention to Roy Jr., the Court holds them civilly liable for the resulting damages to their patient. While it was the taxi driver who ran over the foot or leg of Roy Jr., their negligence was doubtless contributory. It appears undisputed that the amount of 3,850.00, as expenses incurred by patient Roy Jr., was adequately supported by receipts. The Court, therefore, finds the petitioners liable to pay this amount by way of actual damages. The Court is aware that no amount of compassion can suffice to ease the sorrow felt by the family of the child at that time. Certainly, the award of moral and exemplary damages in favor of Roy Jr. in the amount of 100,000.00 and 50,000.00, respectively, is proper in this case. It is settled that moral damages are not punitive in nature, but are designed to compensate and alleviate in some way the physical suffering, mental anguish, fright, serious anxiety, besmirched reputation, wounded feelings, moral shock, social humiliation, and similar injury unjustly inflicted on a person. Intended for the restoration of the psychological or emotional status quo ante, the award of moral damages is designed to compensate emotional injury suffered, not to impose a penalty on the wrongdoer.[23] The Court, likewise, finds the petitioners also liable for exemplary damages in the said amount. Article 2229 of the Civil Code provides that exemplary damages may be imposed by way of example or correction for the public good. WHEREFORE, the petition is PARTLY GRANTED. The Decision of the Court of Appeals dated August 29, 2008 is REVERSED and SET ASIDE. A new judgment is enteredACQUITTING Dr. Emmanuel Jarcia, Jr. and Dr. Marilou Bastan of the crime of reckless imprudence resulting to serious physical injuries but declaring them civilly liable in the amounts of:
(1) 3,850.00 as actual damages; (2) 100,000.00 as moral damages; (3) 50,000.00 as exemplary damages; and
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ATTESTATION I attest that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division.
DIOSDADO M. PERALTA Associate Justice Acting Chairperson, Third Division CERTIFICATION Pursuant to Section 13, Article VIII of the Constitution and the Division Acting Chairpersons Attestation, I certify that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division.
Designated as additional member in lieu of Associate Justice Presbitero J. Velasco, Jr., per Special Order No. 1185 dated February 10, 2012. ** Designated as Acting Chairperson, per Special Order No. 1184 dated February 10, 2012. *** Designated as additional member in lieu of Associate Justice Estela M. Perlas-Bernabe, per Special Order No. 1192 dated February 10, 2012. [1] See the case of Dr. Batiquin v. Court of Appeals, 327 Phil. 965 (1996). [2] Rollo, pp. 50-65. Penned by Associate Justice Isaias Dicdican, with Associate Justice Juan Q. Enriquez, Jr. and Associate Justice Marlene Gonzales-Sison, concurring. [3] Id. at 67-68. [4] Id. at 70-79. [5] No first name on record. [6] Rollo, p. 79. [7] Id. at 78. [8] Id. at 58-65. [9] Id. at 20-22.
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Also quoted in the case of Layugan v. Intermediate Appellate Court, 249 Phil. 363, 377 (1988). [11] Dr. Batiquin v. CA, supra note 1, at 979-980. [12] Reyes v. Sisters of Mercy Hospital, 396 Phil. 87, 98 (2000). [13] TSN, September 20, 2004, p. 13. [14] Gaid v. People, G.R. No. 171636, April 7, 2009, 584 SCRA 489, 497. [15] Id. at 495. [16] Id. at 497.
[17] [18]
TSN, September 20, 2004, pp. 9-24. Balitaosan v. The Secretary of Education, 457 Phil. 300, 304 (2003). [19] Del Rosario v. Bonga, 402 Phil. 949, 957-958 (2001). [20] G.R. No. 178763, April 21, 2009, 586 SCRA 173, 200. [21] TSN, September 20, 2004, p. 13. [22] As quoted in the case of Ruez, Jr. v. Jurado, 513 Phil. 101, 106 (2005). [23] Quezon City Govt. v. Dacara, 499 Phil. 228, 243 (2005). EN BANC DR. RUBI LI, Petitioner, G.R. No. 165279 Present: CORONA, C.J., CARPIO, CARPIO MORALES, VELASCO, JR., NACHURA, LEONARDO-DE CASTRO, BRION, PERALTA, BERSAMIN, DEL CASTILLO,* ABAD, VILLARAMA, JR., PEREZ, MENDOZA, and SERENO, JJ. Promulgated: June 7, 2011
- versus -
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SO ORDERED.[49] (Emphasis supplied.) Petitioner filed a motion for partial reconsideration which the appellate court denied. Hence, this petition. Petitioner assails the CA in finding her guilty of negligence in not explaining to the respondents all the possible side effects of the chemotherapy on their child, and in holding her liable for actual, moral and exemplary damages and attorneys fees. Petitioner emphasized that she was not negligent in the pre-chemotherapy procedures and in the administration of chemotherapy treatment to Angelica. On her supposed non-disclosure of all possible side effects of chemotherapy, including death, petitioner argues that it was foolhardy to imagine her to be allknowing/omnipotent. While the theoretical side effects of chemotherapy were explained by her to the respondents, as these should be known to a competent doctor, petitioner cannot possibly predict how a particular patients genetic make-up, state of mind, general health and body constitution would respond to the treatment. These are obviously dependent on too many known, unknown and immeasurable variables, thus requiring that Angelica be, as she was, constantly and closely monitored during the treatment. Petitioner asserts that she did everything within her professional competence to attend to the medical needs of Angelica.
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J.
Carpio
Opinion
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I join the separate opinion of Justice BrionIn the result: See Separate Opinion TERESITA J. LEONARDO-DE CASTRO ARTURO D. BRION Associate Justice Associate Justice
I join the dissent opinion of Jus. CarpioConcur in the result, and I join the DIOSDADO M. PERALTA Separate Opinion of J. Brion Associate Justice LUCAS P. BERSAMIN Associate Justice
provided J.
by
the
doctor-petitioner Antonio
herself. Carpio
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CERTIFICATION Pursuant to Section 13, Article VIII of the 1987 Constitution, I certify that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Court.
* [1]
[2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]
[16]
No part. Rollo, pp. 33-63. Penned by Associate Justice Mariano C. Del Castillo (now a Member of this Court) and concurred in by Associate Justices Roberto A. Barrios and Magdangal M. De Leon. Id. at 65. Id. at 119-162. Penned by Judge Salvador D. Silerio. Records, p. 174. Id. at 175. Id. at 254. Rollo, pp. 80-89. Id. at 95-108. TSN, January 26, 1995, p. 3. TSN, October 6, 1995, pp. 18-26, 60; TSN, January 27, 1997, pp. 4-5. Rollo, p. 35. Id. at 35 and 81. TSN, October 6, 1995, pp. 39-40; rollo, p. 123. Id. at 40. Cisplatin is in a class of drugs known as platinum-containing compounds. It slows or stops the growth of cancer cells inside the body. Source:http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684036.html. (Site visited on August 21, 2010.) Doxorubicin is an anti-cancer (antineoplastic or cytotoxic) chemotherapy drug. It is classified as an anthracycline antibiotic. Source:http://www.chemocare.com/bio/doxorubicin.asp (Site visited on August 21, 2010.)
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[18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] [49] [50] [51] [52] [53] [54]
Cosmegen is the trade name for Dactinomycin, an anti-cancer (antineoplastic or cytotoxic) chemotherapy drug classified as an alkylating agent. Source: http://www.chemocare.com/bio/cosmegen.asp (Site visited on August 21, 2010.) TSN, January 27, 1997, p. 9. Rollo, p. 124. TSN, April 22, 1996, pp. 11-12. Rollo, p. 35. Id. at 120. TSN, October 6, 1995, pp. 27-28. TSN, September 19, 1994, p. 18. Par. 11 of Answer, rollo, p. 100. TSN, September 19, 1994, p. 19; paragraph 16 of Complaint, rollo, p. 82. TSN, October 6, 1995, pp. 28-30; paragraphs 12, 13 & 14 of Answer, rollo, pp. 100-101. Rollo, p. 101. TSN, September 19, 1994, p. 22. Rollo, p. 36. Id. at 125-126. http://www.rxlist.com/bactrim-drug.htm (Site visited September 2, 2010.) Paragraph 14 of Answer, rollo, pp. 101-102. Paragraphs 19-20 of Complaint, rollo, pp. 83; paragraphs 15-17 of Answer, pp. 102-103. Paragraph 17 of Answer, rollo, p. 103. Paragraph 23 of Complaint, rollo, p. 83; TSN, September 19, 1994, pp. 24-25. TSN, December 15, 1994, pp. 13-21. Paragraph 17 of Answer, rollo, p. 103. Id. Rollo, p. 37. TSN, October 6, 1995, p. 33. Id. TSN, December 15, 1994, p. 22. TSN, December 14, 1994, pp. 15-38. TSN, April 28, 1995, pp. 23-25. TSN, May 26, 1996, pp. 5, 8-13, 23. 37 Phil. 809 (1918). Rollo, pp. 160-162. Id. at 58-59, 62-63. Id. at 18-23. Garcia-Rueda v. Pascasio, G.R. No. 118141, September 5, 1997, 278 SCRA 769, 778. Lucas v. Tuao, G.R. No. 178763, April 21, 2009, 586 SCRA 173, 201-202, citing Dr. Cruz v. Court of Appeals, 346 Phil. 872, 884-885 (1997). 105 N.E. 92, 93 (N.Y. 1914). Id.
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Blacks Law Dictionary, Fifth Edition, p. 701, citing Ze Barth v. Swedish Hospital Medical Center, 81 Wash.2d 12, 499 P.2d 1, 8. 464 F.2d 772 C.A.D.C., 1972. Id. at 784. Id. at 780-782. Id. at 782. Id. at 790, 791-792. 8 Cal.3d 229, 502 P.2d 1 Cal. 1972. Id. Id. Davis v. Kraff, N.E.2d 2010 WL 4026765 Ill.App. 1 Dist., 2010, citing Coryell v. Smith, 274 Ill.App.3d 543, 210 Ill.Dec.855, 653 N.E.2d 1317 (1995). Arato v. Avedon, 858 P.2d 598 (Cal. 1993). Mason v. Walsh, 26 Conn.App. 225, 229-30, 00 A.2d 326 (1991). Id., 230, citing Shenefield v. Greenwich Hospital Assn., 10 Conn.App. 239, 248-49, 522 A.2d 829 (1987). Informed Consent: From the Ambivalence of Arato to the Thunder of Thor Issues in Law & Medicine, Winter, 1994 by Armand Arabian. Sourced at Internet http://findarticles.com/p/articles/mi_m6875/is_n3_10/ai_n25022732/pg_37/?tag=conten t;col1
SECOND DIVISION DR. MILAGROS L. CANTRE, Petitioner, Present: G.R. No. 160889
QUISUMBING, J., Chairperson, CARPIO, - versus CARPIO MORALES, TINGA, and VELASCO, JR., JJ.
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For review on certiorari are the Decision[1] dated October 3, 2002 and Resolution[2] dated November 19, 2003 of the Court of Appeals in CA-G.R. CV No. 58184, which affirmed with modification the Decision[3] dated March 3, 1997 of the Regional Trial Court of Quezon City, Branch 98, in Civil Case No. Q-93-16562.
Petitioner Dr. Milagros L. Cantre is a specialist in Obstetrics and Gynecology at the Dr. Jesus Delgado Memorial Hospital. She was the attending physician of respondent Nora S. Go, who was admitted at the said hospital on April 19, 1992. At 1:30 a.m. of April 20, 1992, Nora gave birth to her fourth child, a baby boy. However, at around 3:30 a.m., Nora suffered profuse bleeding inside her womb due to some parts of the placenta which were not completely expelled from her womb after delivery. Consequently, Nora sufferedhypovolemic shock, resulting in a drop in her blood pressure to 40 over 0. Petitioner and the assisting resident physician performed various medical procedures to stop the bleeding and to restore Noras blood pressure. Her blood pressure was frequently monitored with the use of a sphygmomanometer. While petitioner was massaging Noras uterus for it to contract and stop bleeding, she ordered a droplight to warm Nora and her baby.[4] Nora remained unconscious until she recovered.
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While in the recovery room, her husband, respondent John David Z. Go noticed a fresh gaping wound two and a half (2 ) by three and a half (3 ) inches in the inner portion of her left arm, close to the armpit.[5] He asked the nurses what caused the injury. He was informed it was a burn. Forthwith, on April 22, 1992, John David filed a request for investigation.[6] In response, Dr. Rainerio S. Abad, the medical director of the hospital, called petitioner and the assisting resident physician to explain what happened. Petitioner said the blood pressure cuff caused the injury.
On May 7, 1992, John David brought Nora to the National Bureau of Investigation for a physical examination, which was conducted by medico-legal officer Dr. Floresto Arizala, Jr.[7] The medico-legal officer later testified that Noras injury appeared to be a burn and that a droplight when placed near the skin for about 10 minutes could cause such burn.[8] He dismissed the likelihood that the wound was caused by a blood pressure cuff as the scar was not around the arm, but just on one side of the arm.[9] On May 22, 1992, Noras injury was referred to a plastic surgeon at the Dr. Jesus Delgado Memorial Hospital for skin grafting.[10] Her wound was covered with skin sourced from her abdomen, which consequently bore a scar as well. About a year after, on April 30, 1993, scar revision had to be performed at the same hospital.[11] The surgical operation left a healed linear scar in Noras left arm about three inches in length, the thickest portion rising about onefourth (1/4) of an inch from the surface of the skin. The costs of the skin grafting and the scar revision were shouldered by the hospital.[12]
Unfortunately, Noras arm would never be the same. Aside from the unsightly mark, the pain in her left arm remains. When sleeping, she has to cradle her wounded arm. Her movements now are also restricted. Her children cannot play with the left side of her body as they might accidentally bump the injured arm, which aches at the slightest touch.
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In view of the foregoing consideration, judgment is hereby rendered in favor of the plaintiffs and against the defendants, directing the latters, (sic) jointly and severally (a) (b) (c) (d) (e) to pay the sum of Five Hundred Thousand Pesos (P500,000.00) in moral damages; to pay the sum of One Hundred Fifty Thousand Pesos (P150,000.00) exemplary damages; to pay the sum of Eighty Thousand Pesos (P80,000.00) nominal damages; to pay Fifty Thousand Pesos (P50,000.00) for and as attorneys fees; and to pay Six Thousand Pesos (P6,000.00) litigation expenses.
SO ORDERED.[14] Petitioner, Dr. Abad, and the hospital all appealed to the Court of Appeals, which affirmed with modification the trial court decision, thus:
WHEREFORE, in view of all the foregoing, and finding no reversible error in the appealed Decision dated March 3, 1997 of Branch 98 of the Regional Trial Court of Quezon City in Civil Case No. Q-93-16562, the same is hereby AFFIRMED, with the following MODIFICATIONS: 1. Ordering defendant-appellant Dra. Milagros [L.] Cantre only to pay plaintiffs-appellees John David Go and Nora S. Go the sum of P200,000.00 as moral damages;
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3.
4.
5.
SO ORDERED.[15]
Petitioners motion for reconsideration was denied by the Court of Appeals. Hence, the instant petition assigning the following as errors and issues: I. WHETHER OR NOT, THE LOWER COURT, AND THE COURT OF APPEALS COMMITTED GRAVE ABUSE OF THEIR DISCRETION WHEN, NOTWITHSTANDING THAT BOTH PARTIES HAVE RESTED THEIR RESPECTIVE CASES, THE LOWER COURT ADMITTED THE ADDITIONAL EXHIBITS FURTHER OFFERED BY RESPONDENTS NOT TESTIFIED TO BY ANY WITNESS AND THIS DECISION OF THE LOWER COURT WAS UPHELD BY THE COURT OF APPEALS LIKEWISE COMMITTING GRAVE ABUSE OF DISCRETION; II. WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS DISCRETION WHEN, CONTRARY TO PREPONDERANCE OF EVIDENCE PRESENTED BY THE PETITIONER, IT RULED THAT THE PETITIONER HAS NOT AMPLY SHOWED THAT THE DROPLIGHT DID NOT TOUCH THE BODY OF MRS. NORA GO, AND THIS DECISION OF THE LOWER COURT WAS UPHELD BY THE COURT OF APPEALS LIKEWISE COMMITTING GRAVE ABUSE OF DISCRETION; III.
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Petitioner contends that additional documentary exhibits not testified to by any witness are inadmissible in evidence because they deprived her of her constitutional right to confront the witnesses against her. Petitioner insists the droplight could not have touched Noras body. She maintains the injury was due to the constant taking of Noras blood pressure. Petitioner also insinuates the Court of Appeals was misled by the testimony of the medico-legal officer who never saw the original injury before plastic surgery was performed. Finally, petitioner stresses that plastic surgery was not intended to restore respondents injury to its original state but rather to prevent further complication.
Respondents, however, counter that the genuineness and due execution of the additional documentary exhibits were duly admitted by petitioners counsel. Respondents point out that petitioners blood pressure cuff theory is highly improbable, being unprecedented in medical history and that the injury was definitely caused by the droplight. At any rate, they argue, even if the injury was brought about by the blood pressure cuff, petitioner was still negligent in her duties as Noras attending physician.
Simply put, the threshold issues for resolution are: (1) Are the questioned additional exhibits admissible in evidence? (2) Is petitioner liable for the injury suffered by respondent Nora Go? Thereafter, the inquiry is whether the appellate court committed grave abuse of discretion in its assailed issuances.
As to the first issue, we agree with the Court of Appeals that said exhibits are admissible in evidence. We note that the questioned exhibits consist mostly of 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.
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Coming now to the substantive matter, is petitioner liable for the injury suffered by respondent Nora Go? The Hippocratic Oath mandates physicians to give primordial consideration to the wellbeing of their patients. If a doctor fails to live up to this precept, he is accountable for his acts. This notwithstanding, courts face a unique restraint in adjudicating medical negligence cases because physicians are not guarantors of care and, they never set out to intentionally cause injury to their patients. However, intent is immaterial in negligence cases because where negligence exists and is proven, it automatically gives the injured a right to reparation for the damage caused.[17]
In cases involving medical negligence, the doctrine of res ipsa loquitur allows the mere existence of an injury to justify a presumption of negligence on the part of the person who controls the instrument causing the injury, provided that the following requisites concur:
1. The accident is of a kind which ordinarily does not occur in the absence of someones negligence;
2. It is caused by an instrumentality within the exclusive control of the defendant or defendants; and 3. The possibility of contributing conduct which would make the plaintiff responsible is eliminated.[18]
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Second, whether the injury was caused by the droplight or by the blood pressure cuff is of no moment. Both instruments are deemed within the exclusive control of the physician in charge under the captain of the ship doctrine. This doctrine holds the surgeon in charge of an operation liable for the negligence of his assistants during the time when those assistants are under the surgeons control.[19]In this particular case, it can be logically inferred that petitioner, the senior consultant in charge during the delivery of Noras baby, exercised control over the assistants assigned to both the use of the droplight and the taking of Noras blood pressure. Hence, the use of the droplight and the blood pressure cuff is also within petitioners exclusive control.
Third, the gaping wound on Noras left arm, by its very nature and considering her condition, could only be caused by something external to her and outside her control as she was unconscious while in hypovolemic shock. Hence, Nora could not, by any stretch of the imagination, have contributed to her own injury.
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 wound on her arm,[20] for which petitioner cannot escape liability under the captain of the ship doctrine.
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Based on the foregoing, the presumption that petitioner was negligent in the exercise of her profession stands unrebutted. In this connection, the Civil Code provides:
ART. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done. ART. 2217. Moral damages include physical suffering, mental anguish, fright, serious anxiety, besmirched reputation, wounded feelings, moral shock, social humiliation, and similar injury. Though incapable of pecuniary computation, moral damages may be recovered if they are the proximate result of the defendants wrongful act or omission.
Clearly, under the law, petitioner is obliged to pay Nora for moral damages suffered by the latter as a proximate result of petitioners negligence.
We note, however, that petitioner has served well as Noras obstetrician for her past three successful deliveries. This is the first time petitioner is being held liable for damages due to negligence in the practice of her profession. The fact that petitioner promptly took care of Noras wound before infection and other complications set in is also indicative of petitioners good intentions. We also take note of the fact that Nora was suffering from a critical condition when the injury happened, such that saving her life became petitioners elemental concern. Nonetheless, it should be stressed that all these could not justify negligence on the part of petitioner. Hence, considering the specific circumstances in the instant case, we find no grave abuse of discretion in the assailed decision and resolution of the Court of Appeals. Further, we
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WE CONCUR:
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ATTESTATION
I attest that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division.
CERTIFICATION
Pursuant to Section 13, Article VIII of the Constitution, and the Division Chairpersons Attestation, I certify that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division.
[1]
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Id. at 40-41. Records, pp. 218-227. TSN, December 5, 1995, pp. 54-55. TSN, June 25, 1996, p. 9. Exhibit A, folder of exhibits, p. 1. TSN, September 16, 1994, p. 6; Exhibit D, folder of exhibits, p. 7. TSN, September 12, 1995, pp. 13-16. Id. at 23. Exhibit L, folder of exhibits, p. 42. TSN, January 31, 1994, pp. 35-36. TSN, April 29, 1994, p. 16; TSN, June 25, 1996, p. 23. Records, pp. 1-6. Id. at 227. Rollo, p. 67. Id. at 169-171. Ramos v. Court of Appeals, G.R. No. 124354, December 29, 1999, 321 SCRA 584, 628. Id. at 600. BLACKS LAW DICTIONARY 192, (5th ed., 1979). TSN, September 16, 1994, pp. 27-28. See Child Learning Center, Inc. v. Tagorio, G.R. No. 150920, November 25, 2005, 476 SCRA 236, 240. of the Philippines COURT
PEOPLE OF vs. JIMMY ALVERIO, Accused-Appellant. DECISION VELASCO, JR., J.: The Case
This is an appeal from the March 25, 2010 Decision1 of the Court of Appeals (CA) in CA-G.R. CRH.C. No. 00020, which affirmed the August 26, 2004 Decision in Criminal Case No. CB-02-195 of
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DEL
CASTILLO
PEREZ
Footnotes
1
Rollo, pp. 2-10. Penned by Associate Justice Edwin D. Sorongon and concurred in by Associate Justices Edgardo L. Delos Santos and Socorro B. Inting.
2 3
Any information to establish or compromise the identity of the victim, as well as those of her immediate family or household members, shall be withheld, and fictitious initials are used, pursuant to Republic Act No. 7610, "An Act Providing for Stronger Deterrence and Special Protection Against Child Abuse, Exploitation and Discrimination, and for Other Purposes"; Republic Act No. 9262, "An Act Defining Violence Against Women and Their Children, Providing for Protective Measures for Victims, Prescribing Penalties Therefor, and for Other Purposes"; Section 40 of A.M. No. 04-10-11-SC, known as the "Rule on Violence Against Women and Their Children," effective November 5, 2004; and People v. Cabalquinto, G.R. No. 167693, September 19, 2006, 502 SCRA 419.
4 5
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Id. at 5. Id. at 6. Id. at 7. Id. at 8. Id. at 8-9. Id. at 9. Id. at 9-12. Id. at 12. Id. at 13. TSN, February 24, 2004, pp. 7-10. Id. at 10. Id. at 11. Id. at 12. Id. at 15. Id. at 14. Id. at 20. TSN, March 8, 2004, pp. 1-12. TSN, May 4, 2004, pp. 1-9. CA rollo, p. 24. Rollo, p. 11. CA rollo, p. 69. G.R. No. 185724, June 5, 2009, 588 SCRA 817, 825.
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
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Id. People v. Malana, G.R. No. 185716, September 29, 2010. People v. Malate, G.R. No. 185724, June 5, 2009, 588 SCRA 817, 825. People v. Escoton, G.R. No. 183577, February 1, 2010, 611 SCRA 233, 243. People v. Burgos, G.R. No. 117451, September 29, 1997, 279 SCRA 697, 705. TSN, September 9, 2003, pp. 7-13. People v. Cabudbod, G.R No. 176348, April 16, 2009, 585 SCRA 499, 508. People v. Domingo, G.R. No. 177744, November 23, 2007, 538 SCRA 733, 737. People v. Gingos, G.R. No. 176632, September 11, 2007, 532 SCRA 670, 683. People v. Combate, G.R. No. 189301, December 15, 2010. of the Philippines COURT
G.R. No. 130612 May 11, 1999 PEOPLE OF THE PHILIPPINES, plaintiff-appellee, vs. BERNARDINO DOMANTAY, @ "JUNIOR OTOT," accused-appellant.
MENDOZA, J.: This case is here on appeal from the decision 1 of the Regional Trial Court of Dagupan City (Branch 57), finding accused-appellant guilty of rape with homicide and sentencing him to death, and to indemnify the heirs of the victim in the amount of P480,000.00, and to pay the costs.
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UNION MOTOR CORPORATION, petitioner, vs. NATIONAL LABOR RELATIONS COMMISSION and ALEJANDRO A. ETIS, respondents.
DECISION
CALLEJO, SR., J.: This is a petition for review on certiorari filed by petitioner Union Motor Corporation of the April 10, 2003 Decision1of the Court of Appeals (CA) in CA-G.R. SP No. 73602 which affirmed the decision of the National Labor Relations Commission (NLRC) holding that respondent Alejandro A. Etis was illegally dismissed from his employment. On October 23, 1993, the respondent was hired by the petitioner as an automotive mechanic at the service department in the latters Paco Branch. In 1994, he was transferred to the Caloocan City Branch, where his latest monthly salary was P6,330.00. During his employment, he was awarded the "Top Technician" for the month of May in 1995 and Technician of the Year (1995). He also became a member of the Exclusive P40,000.00 Club and received the Model Employee Award in the same year. On September 22, 1997, the respondent made a phone call to Rosita dela Cruz, the company nurse, and informed her that he had to take a sick leave as he had a painful and unbearable toothache. The next day, he again phoned Dela Cruz and told her that he could not report for work because he still had to consult a doctor. Finding that the respondents ailment was due to a tooth inflammation, the doctor referred him to a dentist for further management.2 Dr.
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Footnotes
1
Penned by Associate Justice Andres B. Reyes, Jr., with Associate Justices Eugenio S. Labitoria and Regalado E. Maambong, concurring.
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Rollo, p. 133. CA Rollo, p. 41. Rollo, p. 135. Id. at 148. CA Rollo, p. 35. Id. at 52. Id. at 22. Id. at 24. Id. at 7. Rollo, pp. 19-27. Id. at 9.
10 11 12 13
Suprelines Transportation Company, Inc. and Manolet Lavides v. ICC Leasing and Financing Corporation, 398 SCRA 508 (2003).
14 15 16 17 18 19 20 21 22
San Miguel Corporation v. MAERC Integrated Services, Inc., 405 SCRA 579 (2003). CA Rollo, pp. 21-22. 272 SCRA 408 (1997). Rollo, pp. 24-25. Supra. Stellar Industrial Services, Inc. v. NLRC, 252 SCRA 323 (1996). Bambalan v. Workmens Compensation Commission, 153 SCRA 166 (1987). See note 19. Nagusara v. NLRC, 290 SCRA 245 (1998).
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Santos v. San Miguel Corporation, 399 SCRA 172 (2003). Philippine Aeolus Automotive United Corporation v. NLRC, 331 SCRA 237 (2000).
FIRST DIVISION G.R. No. 200792 : November 14, 2012 PEOPLE OF THE PHILIPPINES, Plaintiff-Appellee, v. NEIL B. COLORADO, Accused-Appellant. DECISION REYES, J.: For the Court's review is the Decision1rll dated August 19,2011 of the Court of Appeals (CA) in CA-G.R. CR-HC No. 03767, which affirmed with modification the Decision2rll dated June 19, 2008 in Criminal Case No. 8-390 of the Regional Trial Court ( RTC), Burgos, Pangasinan, Branch 70 finding herein accused-appellant Neil B. Colorado (Colorado) guilty beyond reasonable doubt of the crime of rape. The Facts Accused-appellant Colorado was charged with the crime of rape in an Information that reads: That sometime in December, 2002 in the evening in Sitio x x x, Brgy. Iliw-Iliw, Burgos, Pangasinan, Philippines and within the jurisdiction of this Honorable Court, the above-named accused, being the brother of AAA,3rll inside their house, by means of force, threats and intimidation did then and there willfully, unlawfully and feloniously have carnal knowledge with AAA, a twelve (12) years (sic) old girl, against her will and consent, to her damage and prejudice.4rll Colorado pleaded "not guilty" upon arraignment. During the pre-trial, the parties stipulated on the following: (1) the existence of the Medico Legal Certificate and the Birth Certificate of AAA; (2) that Colorado is a full-blood brother of AAA; and (3) that Colorado and AAA lived under the same roof.5rll After pre-trial, trial on the merits ensued. Records indicate that AAA was born on October 10, 1990. She was the second to the youngest in a family of twelve siblings. Colorado was an older brother who lived with her, their parents and two other brothers, BBB and CCC, in Burgos, Pangasinan. AAA testified that sometime in December 2002, her parents attended a wedding celebration somewhere in Hermosa, Dasol, Pangasinan, leaving behind AAA, Colorado and their two other brothers in the house. When their parents had not yet arrived in the evening, Colorado
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rll Penned by Associate Justice Ricardo R. Rosario, with Associate Justices Hakim S. Abdulwahid and Ramon A. Cruz, concurring; rollo, pp. 2-14.
2 3
rll Under the sala of Executive Judge Ma.Ellen M. Aguilar; records, pp. 266-273. rll Under Republic Act No. 9262, also known as the "Anti-Violence Against Women and their
Children Act of 2004", and its implementing rules, the real name of the victim and those of her immediate family members are withheld; fictitious initials are instead used to protect the victims identity.
4 5 6
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rll Id. rll Id. at 273. rll Rollo, p. 13. rll People v. Arcillas, G.R. No. 181491, July 30, 2012. rll Records, p. 72. rll 439 Phil. 440, 470 (2002).
10 11 12 13
rll People v. Salazar, G.R. No. 181900, October 20, 2010, 634 SCRA 307, 319-320, citing People v. Ducabo, G.R. No. 175594, September 28, 2007, 534 SCRA 458, 467.
14 15 16
rll People v. Pangilinan, G.R. No. 183090, November 14, 2011, 660 SCRA 16, 32; see also People v. Dollano, Jr., G.R. No. 188851, October 19, 2011, 659 SCRA 740, 753-754.
17
rll People v. Platilla, 428 Phil. 520, 531 (2002), citing People v. Lapiz, 394 Phil. 160, 173 (2000) and People v. Watimar, 392 Phil. 711, 724 (2000).
18 19 20 21 22 23 24
rll People v. Espino, Jr., G.R. No. 176742, June 17, 2008, 554 SCRA 682, 702. rll People v. Estrada, G.R. No. 178318, January 15, 2010, 610 SCRA 222, 233. rll TSN, November 28, 2007, p. 6; Records, p. 230. rll G.R. No. 176153, September 21, 2007, 533 SCRA 760. rll Id. at 774. rll People v. Tagun, 427 Phil. 389, 403-404 (2002). rll See People v. Bodoso, G.R. No. 188129, July 5, 2010, 623 SCRA 580, 605-606.
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- versus -
Before us is a petition for review on certiorari under Rule 45 of the Rules of Court, assailing the Decision[1] dated September 22, 2006 of the Court of Appeals (CA) in CA-G.R. SP No. 87755. The CA dismissed the petition for certiorari filed by petitioner Rico Rommel Atienza (Atienza), which, in turn, assailed the Orders[2] issued by public respondent Board of Medicine (BOM) in Administrative Case No. 1882. The facts, fairly summarized by the appellate court, follow.
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The Formal Offer of Documentary Evidence of [Romeo Sioson], the Comments/Objections of [herein petitioner] Atienza, [therein respondents] De la Vega and Lantin, and the Manifestation of [therein] respondent Florendo are hereby ADMITTED by the [BOM] for whatever purpose they may serve in the resolution of this case. Let the hearing be set on July 19, 2004 all at 1:30 p.m. for the reception of the evidence of the respondents. SO ORDERED. Petitioner moved for reconsideration of the abovementioned Order basically on the same reasons stated in his comment/objections to the formal offer of exhibits. The [BOM] denied the motion for reconsideration of petitioner in its Order dated October 8, 2004. It concluded that it should first admit the evidence being offered so that it can determine its probative value when it decides the case. According to the Board, it can determine whether the evidence is relevant or not if it will take a look at it through the process of admission. x x x.[3]
Disagreeing with the BOM, and as previously adverted to, Atienza filed a petition for certiorariwith the CA, assailing the BOMs Orders which admitted Editha Siosons (Edithas) Formal Offer of Documentary Evidence. The CA dismissed the petition for certiorari for lack of merit. Hence, this recourse positing the following issues: I. PROCEDURAL ISSUE: WHETHER PETITIONER ATIENZA AVAILED OF THE PROPER REMEDY WHEN HE FILED THE PETITION FOR CERTIORARI DATED 06 DECEMBER 2004 WITH THE COURT OF APPEALS UNDER RULE 65 OF THE RULES OF COURT TO ASSAIL THE ORDERS DATED 26 MAY 2004 AND 08 OCTOBER 2004 OF RESPONDENT BOARD. II. SUBSTANTIVE ISSUE:
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We find no reason to depart from the ruling of the CA. Petitioner is correct when he asserts that a petition for certiorari is the proper remedy to assail the Orders of the BOM, admitting in evidence the exhibits of Editha. As the assailed Orders were interlocutory, these cannot be the subject of an appeal separate from the judgment that completely or finally disposes of the case.[5] At that stage, where there is no appeal, or any plain, speedy, and adequate remedy in the ordinary course of law, the only and remaining remedy left to petitioner is a petition for certiorari under Rule 65 of the Rules of Court on the ground of grave abuse of discretion amounting to lack or excess of jurisdiction. However, the writ of certiorari will not issue absent a showing that the BOM has acted without or in excess of jurisdiction or with grave abuse of discretion. Embedded in the CAs finding that the BOM did not exceed its jurisdiction or act in grave abuse of discretion is the issue of whether the exhibits of Editha contained in her Formal Offer of Documentary Evidence are inadmissible. Petitioner argues that the exhibits formally offered in evidence by Editha: (1) violate the best evidence rule; (2) have not been properly identified and authenticated; (3) are completely hearsay; and (4) are incompetent to prove their purpose. Thus, petitioner contends that the exhibits are inadmissible evidence. We disagree. To begin with, it is well-settled that the rules of evidence are not strictly applied in proceedings before administrative bodies such as the BOM.[6] Although trial courts are enjoined to observe strict enforcement of the rules of evidence,[7] in connection with evidence which may appear to be of doubtful relevancy, incompetency, or admissibility, we have held that:
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[I]t is the safest policy to be liberal, not rejecting them on doubtful or technical grounds, but admitting them unless plainly irrelevant, immaterial or incompetent, for the reason that their rejection places them beyond the consideration of the court, if they are thereafter found relevant or competent; on the other hand, their admission, if they turn out later to be irrelevant or incompetent, can easily be remedied by completely discarding them or ignoring them.[8] From the foregoing, we emphasize the distinction between the admissibility of evidence and the probative weight to be accorded the same pieces of evidence. PNOC Shipping and Transport Corporation v. Court of Appeals[9] teaches: Admissibility of evidence refers to the question of whether or not the circumstance (or evidence) is to be considered at all. On the other hand, the probative value of evidence refers to the question of whether or not it proves an issue.
Second, petitioners insistence that the admission of Edithas exhibits violated his substantive rights leading to the loss of his medical license is misplaced. Petitioner mistakenly relies on Section 20, Article I of the Professional Regulation Commission Rules of Procedure, which reads:
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The exhibits are certified photocopies of X-ray Request Forms dated December 12, 1996, January 30, 1997, March 16, 1996, and May 20, 1999, filed in connection with Edithas medical case. The documents contain handwritten entries interpreting the results of the examination. These exhibits were actually attached as annexes to Dr. Pedro Lantin IIIs counter affidavit filed with the Office of the City Prosecutor of Pasig City, which was investigating the criminal complaint for negligence filed by Editha against the doctors of Rizal Medical Center (RMC) who handled her surgical procedure. To lay the predicate for her case, Editha offered the exhibits in evidence to prove that her kidneys were both in their proper anatomical locations at the time of her operation. The fact sought to be established by the admission of Edithas exhibits, that her kidneys were both in their proper anatomical locations at the time of her operation, need not be proved as it is covered by mandatory judicial notice.[11] Unquestionably, the rules of evidence are merely the means for ascertaining the truth respecting a matter of fact.[12] Thus, they likewise provide for some facts which are established
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Sec. 3. Original document must be produced; exceptions. When the subject of inquiry is the contents of a document, no evidence shall be admissible other than the original document itself, except in the following cases: (a) When the original has been lost or destroyed, or cannot be produced in court, without bad faith on the part of the offeror; (b) When the original is in the custody or under the control of the party against whom the evidence is offered, and the latter fails to produce it after reasonable notice; (c) When the original consists of numerous accounts or other documents which cannot be examined in court without great loss of time and the fact sought to be established from them is only the general result of the whole; and (d) When the original is a public record in the custody of a public officer or is recorded in a public office.
The subject of inquiry in this case is whether respondent doctors before the BOM are liable for gross negligence in removing the right functioning kidney of Editha instead of the left non-functioning kidney, not the proper anatomical locations of Edithas kidneys. As previously discussed, the proper anatomical locations of Edithas kidneys at the time of her operation at the RMC may be established not only through the exhibits offered in evidence.
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SO ORDERED.
WE CONCUR:
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JOSE CATRAL MENDOZA Associate Justice TTESTATION I attest that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division. ANTONIO EDUARDO B. NACHURA Associate Justice Acting Chairperson, Second Division
CERTIFICATION Pursuant to Section 13, Article VIII of the Constitution and the Division Acting Chairperson's Attestation, I certify that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division.
Additional member in lieu of Associate Justice Antonio T. Carpio per Raffle dated August 2, 2010. ** Additional member in lieu of Associate Justice Roberto A. Abad per Raffle dated August 2, 2010. [1] Penned by Presiding Justice Ruben T. Reyes (a retired member of this Court), with Associate Justices Juan Q. Enrique, Jr. and Vicente S.E. Veloso, concurring; rollo, pp. 95-106. [2] Dated May 26, 2004 and October 8, 2004, respectively; id. at 408-411.
[3] [4]
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Raymundo v. Isagon Vda. de Suarez, G.R. No. 149017, November 28, 2008, 572 SCRA 384, 403-404. Bantolino v. Coca-Cola Bottlers Phils., Inc., 451 Phil. 839, 845-846 (2003). Francisco, EVIDENCE RULES 128-134 (3rd ed. 1996), p. 9. [8] Id., citing People v. Jaca, et al., 106 Phil. 572, 575 (1959). [9] 358 Phil. 38, 59 (1998). [10] Rollo, p. 101. [11] RULES OF COURT, Rule 129, Sec. 1. SECTION 1. Judicial notice, when mandatory. A court shall take judicial notice, without the introduction of evidence, of the existence and territorial extent of states, their political history, forms of government and symbols of nationality, the law of nations, the admiralty and maritime courts of the world and their seals, the political constitution and history of the Philippines, the official acts of the legislative, executive and judicial departments of the Philippines, the laws of nature, the measure of time, and the geographical divisions. [12] RULES OF COURT, Rule 128, Sec. 1. [13] RULES OF COURT, Rule 129, Sec. 2. SEC. 2. Judicial notice, when discretionary. A court may take judicial notice of matters which are of public knowledge, or are capable of unquestionable demonstration, or ought to be known to judges because of their judicial functions. [14] Science of life, definition of Websters Third New International Dictionary. [15] RULES OF COURT, Rule 130, Sec. 5. [16] TSN, July 17, 2003; rollo, pp. 347-348.
[7] [6]
EN BANC
BRIG. GEN. LUTHER A. CUSTODIO*, CAPT. ROMEO M. BAUTISTA, 2nd LT. JESUS D. CASTRO, SGT. CLARO L. LAT, SGT. ARNULFO B. DE MESA, C1C ROGELIO B. MORENO, C1C MARIO E. LAZAGA, SGT. FILOMENO D. MIRANDA, SGT. ROLANDO C. DE GUZMAN, SGT. ERNESTO M. MATEO, SGT. RODOLFO M. DESOLONG, A1C CORDOVA G. ESTELO, MSGT. PABLO S. MARTINEZ, SGT. RUBEN AQUINO, SGT. ARNULFO ARTATES, A1C FELIZARDO TARAN,petitioners, vs. SANDIGANBAYAN and PEOPLE OF THE PHILIPPINES,respondents. RESOLUTION PUNO, J.:
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b. c. d. e.
f. g.
METHODS: a. b. c. Review of the forensic exhibits presented in the court; Review of TSNs relevant to the forensic review; Study of and research on the guns, slugs and ammunitions allegedly involved in the crime;
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e. f. g. h.
i.
These materials were available to the parties during the trial and there was nothing that prevented the petitioners from using them at the time to support their theory that it was not the military, but Rolando Galman, who killed Senator Aquino. Petitioners, in their present motion, failed to present any new forensic evidence that could not have been obtained by the defense at the time of the trial even with the exercise of due diligence. If they really wanted to seek and offer the opinion of other forensic experts at the time regarding the physical evidence gathered at the scene of the crime, there was ample opportunity for them to do so before the case was finally submitted and decided.[19] A reading of the Sandiganbayan decision dated September 28, 1990 shows a thorough study by the court of the forensic evidence presented during the trial, viz: COURT FINDINGS As to the physical evidence Great significance has to be accorded the trajectory of the single bullet that penetrated the head and caused the death of Sen. Benigno Aquino, Jr. Basic to the question as to trajectory ought to be the findings during the autopsy. The prosector in the autopsy, Dr. Bienvenido Muoz, NBI Medico-Legal Officer, reported in his Autopsy Report No. N-83-22-36, that the trajectory of the gunshot, the wound of entrance having been located at the mastoid region, left, below the external auditory meatus, and the exit wound having been at the anterior
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Deceased. Rollo Vol. II, pp. 506-563. Galman vs. Sandiganbayan, 144 SCRA 43 (1986). Rollo Vol. I, pp. 71-260. Rollo Vol. I, pp. 433-435. Rollo Vol. I, p. 475. Rollo Vol. II, pp. 517-518. Rollo Vol. II, p. 562. Jose vs. Court of Appeals, 70 SCRA 257 (1976). People vs. Tamayo, 86 Phil. 209 (1950). Rollo Vol. I, p. 477. 58 Am Jur 2d 393. People vs. Li Ka Kim, G.R. No. 148586, May 25, 2004; People vs. Datu, 397 SCRA 695 (2003); People vs. Remudo, 364 SCRA 61 (2001); People vs. Ebias, 342 SCRA 675 (2000); Amper vs. Sandiganbayan, 279 SCRA 434 (1997); Tumang vs. Court of Appeals, 172 SCRA 328 (1989); Jose vs. Court of Appeals, 70 SCRA 257 (1976); People vs. Mangulabnan, et. al., 99 Phil. 992 (1956); Reyes vs. People, 71 Phil. 598 (1941); People vs. Luzon, 4 Phil. 343 (1905). 10 Ga 511 (1851).
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[13]
Argyrou vs. State, 349 Md 587, 709 A. 2d 1194 (1998). Tumang vs. CA, 172 SCRA 328 (1989). Ibid. Argyrou vs. State, supra, note 14. Annex S, Death On The Tarmac: The Credible View. A Forensic Review and Analysis of Criminal Case Nos. 10010 and 10011 (a.k.a. The Aquino-Galman Case), pp. 12-13; Rollo Vol. II, pp. 1005-1006. See Gaston vs. Finch, 246 Iowa 1360, 72 N.W. 2d 507 (1955). Sandiganbayan Decision dated September 28, 1990, pp. 130-136; Rollo Vol. I, pp. 200-206. Sandiganbayan Resolution dated November 15, 1990, Crim. Cases Nos. 10010-11, pp. 2-8; Rollo Vol. I, pp. 262-268. Resolution dated July 25, 1991, Rollo Vol. I, pp. 433-435. See June vs. Edward, 69 A.D. 2d 612, 419 N.Y.S. 2d 514 (1979). Testimonies of Pelagia Hilario, Lydia Morata, Augusto Fred Floresca and Jose Orias, Sandiganbayan Decision dated September 28, 1990, pp. 113-115; Rollo Vol. I, pp. 183185. People vs. Fajardo, 315 SCRA 283 (1999). People vs. Remudo, 364 SCRA 61 (2001). 15 Phil. 33 (1910).
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