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PRACTICE OF MEDICINE

G.R. No. 144681

June 21, 2004

PROFESSIONAL REGULATION COMMISSION (PRC), CHAIRMAN HERMOGENES P.


POBRE, ASSOCIATE COMMISSIONER ARMANDO PASCUAL, BOARD OF MEDICINE,
CHAIRMAN RODOLFO P. DE GUZMAN, JOSE S. RAMIREZ, JUANITO B. BILLOTE,
RUBEN R. POLICARPIO, EDGARDO T. FERNANDO and RICARDO D. FULGENCIO
II, petitioners,
vs.
ARLENE V. DE GUZMAN, VIOLETA V. MENESES, CELERINA S. NAVARRO, JOSE
RAMONCITO P. NAVARRO, ARNEL V. HERRERA and GERALDINE ELIZABETH M.
PAGILAGAN, ELNORA R. RAQUENO, MARISSA A. REGODON, LAURA M. SANTOS,
KARANGALAN D. SERRANO, DANILO A. VILLAVER, MARIA ROSARIO L. LEONOR,
ALICIA S. LIZANO, MARITEL M. ECHIVERRI, BERNADETTE T. MENDOZA, FERNANDO
F. MANDAPAT, ALELI A. GOLLAYAN, ELCIN C. ARRIOLA, HERMINIGILDA E. CONEJOS,
SALLY B. BUNAGAN, ROGELIO B. ANCHETA, OSCAR H. PADUA, JR., EVELYN D.
GRAJO, EVELYN S. ACOSTA, MARGARITA BELINDA L. VICENCIO, VALENTINO P.
ARBOLEDA, EVELYN O. RAMOS, ACHILLES J. PERALTA, CORAZON M. CRUZ,
LEUVINA P. CHICO, JOSEPH A. JAO, MA. LUISA S. GUTIERREZ, LYDIA C. CHAN,
OPHELIA C. HIDALGO, FERNANDO T. CRUZ, MELVIN M. USITA, RAFAEL I.
TOLENTINO, GRACE E. UY, CHERYL R. TRIGUERO, MICHAEL L. SERRANO,
FEDERICO L. CASTILLO, MELITA J. CAEDO, SAMUEL B. BANGOY, BERNARDITA B.
SY, GLORIA T. JULARBAL, FREDERICK D. FRANCISCO, CARLOS M. BERNARDO, JR.,
HUBERT S. NAZARENO, CLARISSA B. BACLIG, DAYMINDA G. BONTUYAN,
BERNADETTE H. CABUHAT, NANCY J. CHAVEZ, MARIO D. CUARESMA, ERNESTO L.
CUE, EVELYN C. CUNDANGAN, RHONEIL R. DEVERATURDA, DERILEEN D. DORADO,
SAIBZUR N. EDDING, VIOLETA C. FELIPE, HERMINIO V. FERNANDEZ, JR., MARIA
VICTORIA M. LACSAMANA, NORMA G. LAFAVILLA, RUBY B. LANTIN, MA. ELOISA Q.
MALLARI, CLARISA SJ. NICOLAS, PERCIVAL H. PANGILINAN, ARNULFO A.
SALVADOR, ROBERT B. SANCHEZ, MERLY D. STA. ANA and YOLANDA P.
UNICA, respondents.
DECISION
TINGA, J.:
This petition for review under Rule 45 of the 1997 Rules of Civil Procedure seeks to nullify
the D E C I S I O N,1dated May 16, 2000, of the Court of Appeals in CA-G.R. SP No. 37283.
The appellate court affirmed the judgment2 dated December 19, 1994, of the Regional Trial
Court (RTC) of Manila, Branch 52, in Civil Case No. 93-66530. The trial court allowed the
respondents to take their physicians oath and to register as duly licensed physicians.
Equally challenged is the R E S O L U T I O N3 promulgated on August 25, 2000 of the Court
of Appeals, denying petitioners Motion for Reconsideration.
The facts of this case are as follows:
The respondents are all graduates of the Fatima College of Medicine, Valenzuela
City, Metro Manila. They passed the Physician Licensure Examination conducted in
February 1993 by the Board of Medicine (Board). Petitioner Professional Regulation
Commission (PRC) then released their names as successful examinees in the
medical licensure examination.
Shortly thereafter, the Board observed that the grades of the seventy-nine successful
examinees from Fatima College in the two most difficult subjects in the medical
licensure exam, Biochemistry (Bio-Chem) and Obstetrics and Gynecology (OBGyne), were unusually and exceptionally high. Eleven Fatima examinees scored
100% in Bio-Chem and ten got 100% in OB-Gyne, another eleven got 99% in BioChem, and twenty-one scored 99% in OB-Gyne. The Board also observed that many

of those who passed from Fatima got marks of 95% or better in both subjects, and no
one got a mark lower than 90%. A comparison of the performances of the candidates
from other schools was made. The Board observed that strangely, the unusually high
ratings were true only for Fatima College examinees. It was a record-breaking
phenomenon in the history of the Physician Licensure Examination.
On June 7, 1993, the Board issued Resolution No. 19, withholding the registration as
physicians of all the examinees from the Fatima College of Medicine.4 The PRC asked the
National Bureau of Investigation (NBI) to investigate whether any anomaly or irregularity
marred the February 1993 Physician Licensure Examination.
Prior to the NBI investigation, the Board requested Fr. Bienvenido F. Nebres, S.J., an expert
mathematician and authority in statistics, and later president of the Ateneo de Manila
University, to conduct a statistical analysis of the results in Bio-Chem and Ob-Gyne of the
said examination.
On June 10, 1993, Fr. Nebres submitted his report. He reported that a comparison of the
scores in Bio-Chem and Ob-Gyne, of the Fatima College examinees with those of
examinees from De La Salle University and Perpetual Help College of Medicine showed that
the scores of Fatima College examinees were not only incredibly high but unusually
clustered close to each other. He concluded that there must be some unusual reason
creating the clustering of scores in the two subjects. It must be a cause "strong enough to
eliminate the normal variations that one should expect from the examinees [of Fatima
College] in terms of talent, effort, energy, etc."5
For its part, the NBI found that "the questionable passing rate of Fatima examinees in the
[1993] Physician Examination leads to the conclusion that the Fatima examinees gained
early access to the test questions."6
On July 5, 1993, respondents Arlene V. De Guzman, Violeta V. Meneses, Celerina S.
Navarro, Jose Ramoncito P. Navarro, Arnel V. Herrera, and Geraldine Elizabeth M.
Pagilagan (Arlene V. De Guzman et al., for brevity) filed a special civil action for mandamus,
with prayer for preliminary mandatory injunction docketed as Civil Case No. 93-66530 with
the Regional Trial Court (RTC) of Manila, Branch 52. Their petition was adopted by the other
respondents as intervenors.
Meanwhile, the Board issued Resolution No. 26, dated July 21, 1993, charging respondents
with "immorality, dishonest conduct, fraud, and deceit" in connection with the Bio-Chem and
Ob-Gyne examinations. It recommended that the test results of the Fatima examinees be
nullified. The case was docketed as Adm. Case No. 1687 by the PRC.
On July 28, 1993, the RTC issued an Order in Civil Case No. 93-66530 granting the
preliminary mandatory injunction sought by the respondents. It ordered the petitioners to
administer the physicians oath to Arlene V. De Guzman et al., and enter their names in the
rolls of the PRC.
The petitioners then filed a special civil action for certiorari with the Court of Appeals to set
aside the mandatory injunctive writ, docketed as CA-G.R. SP No. 31701.
On October 21, 1993, the appellate court decided CA-G.R. SP No. 31701, with the
dispositive portion of theDecision ordaining as follows:
WHEREFORE, this petition is GRANTED. Accordingly, the writ of preliminary
mandatory injunction issued by the lower court against petitioners is hereby nullified
and set aside.
SO ORDERED.7

Arlene V. de Guzman, et al., then elevated the foregoing Decision to this Court in G.R. No.
112315. In ourResolution dated May 23, 1994, we denied the petition for failure to show
reversible error on the part of the appellate court.
Meanwhile, on November 22, 1993, during the pendency of the instant petition, the pre-trial
conference in Civil Case No. 93-66530 was held. Then, the parties, agreed to reduce the
testimonies of their respective witnesses to sworn questions-and-answers. This was without
prejudice to cross-examination by the opposing counsel.
On December 13, 1993, petitioners counsel failed to appear at the trial in the mistaken belief
that the trial was set for December 15. The trial court then ruled that petitioners waived their
right to cross-examine the witnesses.
On January 27, 1994, counsel for petitioners filed a Manifestation and Motion stating the
reasons for her non-appearance and praying that the cross-examination of the witnesses for
the opposing parties be reset. The trial court denied the motion for lack of notice to adverse
counsel. It also denied the Motion for Reconsideration that followed on the ground that
adverse counsel was notified less than three (3) days prior to the hearing.
Meanwhile, to prevent the PRC and the Board from proceeding with Adm. Case No. 1687,
the respondents herein moved for the issuance of a restraining order, which the lower court
granted in its Order dated April 4, 1994.
The petitioners then filed with this Court a petition for certiorari docketed as G.R. No.
115704, to annul the Ordersof the trial court dated November 13, 1993, February 28, 1994,
and April 4, 1994. We referred the petition to the Court of Appeals where it was docketed as
CA-G.R. SP No. 34506.
On August 31, 1994, the appellate court decided CA-G.R. SP No. 34506 as follows:
WHEREFORE, the present petition for certiorari with prayer for temporary restraining
order/preliminary injunction is GRANTED and the Orders of December 13, 1993,
February 7, 1994, February 28, 1994, and April 4, 1994 of the RTC-Manila, Branch
52, and all further proceedings taken by it in Special Civil Action No. 93-66530 are
hereby DECLARED NULL and VOID. The said RTC-Manila is ordered to allow
petitioners counsel to cross-examine the respondents witnesses, to allow petitioners
to present their evidence in due course of trial, and thereafter to decide the case on
the merits on the basis of the evidence of the parties. Costs against respondents.
IT IS SO ORDERED.8
The trial was then set and notices were sent to the parties.
A day before the first hearing, on September 22, 1994, the petitioners filed an Urgent ExParte Manifestation and Motion praying for the partial reconsideration of the appellate courts
decision in CA-G.R. SP No. 34506, and for the outright dismissal of Civil Case No. 93-66530.
The petitioners asked for the suspension of the proceedings.
In its Order dated September 23, 1994, the trial court granted the aforesaid motion,
cancelled the scheduled hearing dates, and reset the proceedings to October 21 and 28,
1994.
Meanwhile, on October 25, 1994, the Court of Appeals denied the partial motion for
reconsideration in CA-G.R. SP No. 34506. Thus, petitioners filed with the Supreme Court a
petition for review docketed as G.R. No. 117817, entitled Professional Regulation
Commission, et al. v. Court of Appeals, et al.
On November 11, 1994, counsel for the petitioners failed to appear at the trial of Civil Case
No. 93-66530. Upon motion of the respondents herein, the trial court ruled that herein

petitioners waived their right to cross-examine the herein respondents. Trial was reset to
November 28, 1994.
On November 25, 1994, petitioners counsel moved for the inhibition of the trial court judge
for alleged partiality. On November 28, 1994, the day the Motion to Inhibit was to be heard,
petitioners failed to appear. Thus, the trial court denied the Motion to Inhibit and declared
Civil Case No. 93-66530 deemed submitted for decision.
On December 19, 1994, the trial court handed down its judgment in Civil Case No. 9366530, the fallo of which reads:
WHEREFORE, judgment is rendered ordering the respondents to allow the
petitioners and intervenors (except those with asterisks and footnotes in pages 1 & 2
of this decision) [sic],9 to take the physicians oath and to register them as physicians.
It should be made clear that this decision is without prejudice to any administrative
disciplinary action which may be taken against any of the petitioners for such causes
and in the manner provided by law and consistent with the requirements of the
Constitution as any other professionals.
No costs.
SO ORDERED.10
As a result of these developments, petitioners filed with this Court a petition for review on
certiorari docketed as G.R. No. 118437, entitled Professional Regulation Commission v. Hon.
David G. Nitafan, praying inter alia, that (1) G.R. No. 118437 be consolidated with G.R. No.
117817; (2) the decision of the Court of Appeals dated August 31, 1994 in CA-G.R. SP No.
34506 be nullified for its failure to decree the dismissal of Civil Case No. 93-66530, and in
the alternative, to set aside the decision of the trial court in Civil Case No. 93-66530, order
the trial court judge to inhibit himself, and Civil Case No. 93-66530 be re-raffled to another
branch.
On December 26, 1994, the petitioners herein filed their Notice of Appeal11 in Civil Case No.
93-66530, thereby elevating the case to the Court of Appeals, where it was docketed as CAG.R. SP No. 37283.
In our Resolution of June 7, 1995, G.R. No. 118437 was consolidated with G.R. No. 117817.
On July 9, 1998, we disposed of G.R. Nos. 117817 and 118437 in this wise:
WHEREFORE, the petition in G.R. No. 117817 is DISMISSED for being moot. The
petition in G.R. No. 118437 is likewise DISMISSED on the ground that there is a
pending appeal before the Court of Appeals. Assistant Solicitor General Amparo M.
Cabotaje-Tang is advised to be more circumspect in her dealings with the courts as a
repetition of the same or similar acts will be dealt with accordingly.
SO ORDERED.12
While CA-G.R. SP No. 37283 was awaiting disposition by the appellate court, Arnel V.
Herrera, one of the original petitioners in Civil Case No. 93-66530, joined by twenty-seven
intervenors, to wit: Fernando F. Mandapat, Ophelia C. Hidalgo, Bernadette T. Mendoza,
Ruby B. Lantin-Tan, Fernando T. Cruz, Marissa A. Regodon, Ma. Eloisa Q. Mallari-Largoza,
Cheryl R. Triguero, Joseph A. Jao, Bernadette H. Cabuhat, Evelyn S. Acosta-Cabanes,
Laura M. Santos, Maritel M. Echiverri, Bernadette C. Escusa, Carlosito C. Domingo, Alicia S.
Lizano, Elnora R. Raqueno-Rabaino, Saibzur N. Edding, Derileen D. Dorado-Edding, Robert
B. Sanchez, Maria Rosario L. Leonor-Lacandula, Geraldine Elizabeth M. Pagilagan-Palma,
Margarita Belinda L. Vicencio-Gamilla, Herminigilda E. Conejos, Leuvina P. Chico-Paguio,
Elcin C. Arriola-Ocampo, and Jose Ramoncito P. Navarro, manifested that they were no

longer interested in proceeding with the case and moved for its dismissal. A similar
manifestation and motion was later filed by intervenors Mary Jean I. Yeban-Merlan, Michael
L. Serrano, Norma G. Lafavilla, Arnulfo A. Salvador, Belinda C. Rabara, Yolanda P. Unica,
Dayminda G. Bontuyan, Clarissa B. Baclig, Ma. Luisa S. Gutierrez, Rhoneil R. Deveraturda,
Aleli A. Gollayan, Evelyn C. Cundangan, Frederick D. Francisco, Violeta V. Meneses, Melita
J. Caedo, Clarisa SJ. Nicolas, Federico L. Castillo, Karangalan D. Serrano, Danilo A.
Villaver, Grace E. Uy, Lydia C. Chan, and Melvin M. Usita. The Court of Appeals ruled that its
decision in CA-G.R. SP No. 37283 would not apply to them.
On May 16, 2000, the Court of Appeals decided CA-G.R. SP No. 37283, with the
following fallo, to wit:
WHEREFORE, finding no reversible error in the decision appealed from, We hereby
AFFIRM the same and DISMISS the instant appeal.
No pronouncement as to costs.
SO ORDERED.13
In sustaining the trial courts decision, the appellate court ratiocinated that the respondents
complied with all the statutory requirements for admission into the licensure examination for
physicians in February 1993. They all passed the said examination. Having fulfilled the
requirements of Republic Act No. 2382,14 they should be allowed to take their oaths as
physicians and be registered in the rolls of the PRC.
Hence, this petition raising the following issues:
I
WHETHER OR NOT RESPONDENTS HAVE A VALID CAUSE OF ACTION FOR
MANDAMUS AGAINST PETITIONERS IN THE LIGHT OF THE RESOLUTION OF
THIS HONORABLE COURT IN G.R. NO. 112315 AFFIRMING THE COURT OF
APPEALS DECISION DECLARING THAT IF EVER THERE IS SOME DOUBT AS
TO THE MORAL FITNESS OF EXAMINEES, THE ISSUANCE OF LICENSE TO
PRACTICE MEDICINE IS NOT AUTOMATICALLY GRANTED TO THE
SUCCESSFUL EXAMINEES.
II
WHETHER OR NOT THE PETITION FOR MANDAMUS COULD PROCEED
DESPITE THE PENDENCY OF ADMINISTRATIVE CASE NO. 1687, WHICH WAS
PRECISELY LODGED TO DETERMINE THE MORAL FITNESS OF
RESPONDENTS TO BECOME DOCTORS.15
To our mind, the only issue is: Did the Court of Appeals commit a reversible error of law in
sustaining the judgment of the trial court that respondents are entitled to a writ of
mandamus?
The petitioners submit that a writ of mandamus will not lie in this case. They point out that for
a writ of mandamus to issue, the applicant must have a well-defined, clear and certain legal
right to the thing demanded and it is the duty of the respondent to perform the act required.
Thus, mandamus may be availed of only when the duty sought to be performed is a
ministerial and not a discretionary one. The petitioners argue that the appellate courts
decision in CA-G.R. SP No. 37283 upholding the decision of the trial court in Civil Case No.
93-66530 overlooked its own pronouncement in CA-G.R. SP No. 31701. The Court of
Appeals held in CA-G.R. SP No. 31701 that the issuance of a license to engage in the
practice of medicine becomes discretionary on the PRC if there exists some doubt that the
successful examinee has not fully met the requirements of the law. The petitioners stress
that this Courts Resolution dated May 24, 1994 in G.R. No. 112315 held that there was no

showing "that the Court of Appeals had committed any reversible error in rendering the
questioned judgment" in CA-G.R. SP No. 31701. The petitioners point out that
our Resolution in G.R. No. 112315 has long become final and executory.
Respondents counter that having passed the 1993 licensure examinations for physicians,
the petitioners have the obligation to administer to them the oath as physicians and to issue
their certificates of registration as physicians pursuant to Section 20 16 of Rep. Act No. 2382.
The Court of Appeals in CA-G.R. SP No. 37283, found that respondents complied with all the
requirements of Rep. Act No. 2382. Furthermore, respondents were admitted by the Medical
Board to the licensure examinations and had passed the same. Hence, pursuant to Section
20 of Rep. Act No. 2382, the petitioners had the obligation to administer their oaths as
physicians and register them.
Mandamus is a command issuing from a court of competent jurisdiction, in the name of the
state or the sovereign, directed to some inferior court, tribunal, or board, or to some
corporation or person requiring the performance of a particular duty therein specified, which
duty results from the official station of the party to whom the writ is directed, or from
operation of law.17 Section 3 of Rule 6518 of the 1997 Rules of Civil Procedure outlines two
situations when a writ of mandamus may issue, when any tribunal, corporation, board, officer
or person unlawfully (1) neglects the performance of an act which the law specifically enjoins
as a duty resulting from an office, trust, or station; or (2) excludes another from the use and
enjoyment of a right or office to which the other is entitled.
We shall discuss the issues successively.
1. On The Existence of a Duty of the Board of Medicine To Issue Certificates of Registration
as Physicians under Rep. Act No. 2382.
For mandamus to prosper, there must be a showing that the officer, board, or official
concerned, has a clear legal duty, not involving discretion.19 Moreover, there must be
statutory authority for the performance of the act,20 and the performance of the duty has been
refused.21 Thus, it must be pertinently asked now: Did petitioners have the duty to administer
the Hippocratic Oath and register respondents as physicians under the Medical Act of 1959?
As found by the Court of Appeals, on which we agree on the basis of the records:
It bears emphasizing herein that petitioner-appellees and intervenor-appellees have
fully complied with all the statutory requirements for admission into the licensure
examinations for physicians conducted and administered by the respondentappellants on February 12, 14, 20 and 21, 1993. Stress, too, must be made of the
fact that all of them successfully passed the same examinations.22
The crucial query now is whether the Court of Appeals erred in concluding that petitioners
should allow the respondents to take their oaths as physicians and register them, steps
which would enable respondents to practice the medical profession 23 pursuant to Section 20
of the Medical Act of 1959?
The appellate court relied on a single provision, Section 20 of Rep. Act No. 2382, in
concluding that the petitioners had the ministerial obligation to administer the Hippocratic
Oath to respondents and register them as physicians. But it is a basic rule in statutory
construction that each part of a statute should be construed in connection with every other
part to produce a harmonious whole, not confining construction to only one section. 24 The
intent or meaning of the statute should be ascertained from the statute taken as a whole, not
from an isolated part of the provision. Accordingly, Section 20, of Rep. Act No. 2382, as
amended should be read in conjunction with the other provisions of the Act. Thus, to
determine whether the petitioners had the ministerial obligation to administer the Hippocratic
Oath to respondents and register them as physicians, recourse must be had to the entirety of
the Medical Act of 1959.

A careful reading of Section 20 of the Medical Act of 1959 discloses that the law uses the
word "shall" with respect to the issuance of certificates of registration. Thus, the petitioners
"shall sign and issue certificates of registration to those who have satisfactorily complied
with the requirements of the Board." In statutory construction the term "shall" is a word of
command. It is given imperative meaning. Thus, when an examinee satisfies the
requirements for the grant of his physicians license, the Board is obliged to administer to him
his oath and register him as a physician, pursuant to Section 20 and par. (1) of Section
2225 of the Medical Act of 1959.
However, the surrounding circumstances in this case call for serious inquiry concerning the
satisfactory compliance with the Board requirements by the respondents. The unusually high
scores in the two most difficult subjects was phenomenal, according to Fr. Nebres, the
consultant of PRC on the matter, and raised grave doubts about the integrity, if not validity, of
the tests. These doubts have to be appropriately resolved.
Under the second paragraph of Section 22, the Board is vested with the power to conduct
administrative investigations and "disapprove applications for examination or registration,"
pursuant to the objectives of Rep. Act No. 2382 as outlined in Section 126 thereof. In this
case, after the investigation, the Board filed before the PRC, Adm. Case No. 1687 against
the respondents to ascertain their moral and mental fitness to practice medicine, as required
by Section 927 of Rep. Act No. 2382. In its Decision dated July 1, 1997, the Board ruled:
WHEREFORE, the BOARD hereby CANCELS the respondents[] examination
papers in the Physician Licensure Examinations given in February 1993 and further
DEBARS them from taking any licensure examination for a period of ONE (1) YEAR
from the date of the promulgation of this DECISION. They may, if they so desire,
apply for the scheduled examinations for physicians after the lapse of the period
imposed by the BOARD.
SO ORDERED.28
Until the moral and mental fitness of the respondents could be ascertained, according to
petitioners, the Board has discretion to hold in abeyance the administration of the
Hippocratic Oath and the issuance of the certificates to them. The writ of mandamus does
not lie to compel performance of an act which is not duly authorized.
The respondents nevertheless argue that under Section 20, the Board shall not issue a
certificate of registration only in the following instances: (1) to any candidate who has been
convicted by a court of competent jurisdiction of any criminal offense involving moral
turpitude; (2) or has been found guilty of immoral or dishonorable conduct after the
investigation by the Board; or (3) has been declared to be of unsound mind. They aver that
none of these circumstances are present in their case.
Petitioners reject respondents argument. We are informed that in Board Resolution No.
26,29 dated July 21, 1993, the Board resolved to file charges against the examinees from
Fatima College of Medicine for "immorality, dishonesty, fraud, and deceit in the ObstetricsGynecology and Biochemistry examinations." It likewise sought to cancel the examination
results obtained by the examinees from the Fatima College.
Section 830 of Rep. Act No. 2382 prescribes, among others, that a person who aspires to
practice medicine in the Philippines, must have "satisfactorily passed the corresponding
Board Examination." Section 22, in turn, provides that the oath may only be administered "to
physicians who qualified in the examinations." The operative word here is "satisfactorily,"
defined as "sufficient to meet a condition or obligation" or "capable of dispelling doubt or
ignorance."31 Gleaned from Board Resolution No. 26, the licensing authority apparently did
not find that the respondents "satisfactorily passed" the licensure examinations. The Board
instead sought to nullify the examination results obtained by the respondents.
2. On the Right Of The Respondents To Be Registered As Physicians

The function of mandamus is not to establish a right but to enforce one that has been
established by law. If no legal right has been violated, there can be no application of a legal
remedy, and the writ of mandamus is a legal remedy for a legal right.32 There must be a welldefined, clear and certain legal right to the thing demanded. 33 It is long established rule that a
license to practice medicine is a privilege or franchise granted by the government. 34
It is true that this Court has upheld the constitutional right 35 of every citizen to select a
profession or course of study subject to a fair, reasonable, and equitable admission and
academic requirements.36 But like all rights and freedoms guaranteed by the Charter, their
exercise may be so regulated pursuant to the police power of the State to safeguard health,
morals, peace, education, order, safety, and general welfare of the people. 37 Thus, persons
who desire to engage in the learned professions requiring scientific or technical knowledge
may be required to take an examination as a prerequisite to engaging in their chosen
careers. This regulation takes particular pertinence in the field of medicine, to protect the
public from the potentially deadly effects of incompetence and ignorance among those who
would practice medicine. In a previous case, it may be recalled, this Court has ordered the
Board of Medical Examiners to annul both its resolution and certificate authorizing a Spanish
subject, with the degree of Licentiate in Medicine and Surgery from the University of
Barcelona, Spain, to practice medicine in the Philippines, without first passing the
examination required by the Philippine Medical Act.38 In another case worth noting, we
upheld the power of the State to upgrade the selection of applicants into medical schools
through admission tests.39
It must be stressed, nevertheless, that the power to regulate the exercise of a profession or
pursuit of an occupation cannot be exercised by the State or its agents in an arbitrary,
despotic, or oppressive manner. A political body that regulates the exercise of a particular
privilege has the authority to both forbid and grant such privilege in accordance with certain
conditions. Such conditions may not, however, require giving up ones constitutional rights as
a condition to acquiring the license.40 Under the view that the legislature cannot validly
bestow an arbitrary power to grant or refuse a license on a public agency or officer, courts
will generally strike down license legislation that vests in public officials discretion to grant or
refuse a license to carry on some ordinarily lawful business, profession, or activity without
prescribing definite rules and conditions for the guidance of said officials in the exercise of
their power.41
In the present case, the aforementioned guidelines are provided for in Rep. Act No. 2382, as
amended, which prescribes the requirements for admission to the practice of medicine, the
qualifications of candidates for the board examinations, the scope and conduct of the
examinations, the grounds for denying the issuance of a physicians license, or revoking a
license that has been issued. Verily, to be granted the privilege to practice medicine, the
applicant must show that he possesses all the qualifications and none of the
disqualifications. Furthermore, it must appear that he has fully complied with all the
conditions and requirements imposed by the law and the licensing authority. Should doubt
taint or mar the compliance as being less than satisfactory, then the privilege will not issue.
For said privilege is distinguishable from a matter of right, which may be demanded if denied.
Thus, without a definite showing that the aforesaid requirements and conditions have been
satisfactorily met, the courts may not grant the writ of mandamus to secure said privilege
without thwarting the legislative will.
3. On the Ripeness of the Petition for Mandamus
Lastly, the petitioners herein contend that the Court of Appeals should have dismissed the
petition for mandamus below for being premature. They argue that the administrative
remedies had not been exhausted. The records show that this is not the first time that
petitioners have sought the dismissal of Civil Case No. 93-66530. This issue was raised in
G.R. No. 115704, which petition we referred to the Court of Appeals, where it was docketed
as CA-G.R. SP No. 34506. On motion for reconsideration in CA-G.R. SP No. 34506, the
appellate court denied the motion to dismiss on the ground that the prayers for the
nullification of the order of the trial court and the dismissal of Civil Case No. 93-66530 were

inconsistent reliefs. In G.R. No. 118437, the petitioners sought to nullify the decision of the
Court of Appeals in CA-G.R. SP No. 34506 insofar as it did not order the dismissal of Civil
Case No. 93-66530. In our consolidated decision, dated July 9, 1998, in G.R. Nos. 117817 &
118437, this Court speaking through Justice Bellosillo opined that:
Indeed, the issue as to whether the Court of Appeals erred in not ordering the
dismissal of Civil Case No. 93-66530 sought to be resolved in the instant petition has
been rendered meaningless by an event taking place prior to the filing of this petition
and denial thereof should follow as a logical consequence.42 There is no longer any
justiciable controversy so that any declaration thereon would be of no practical use or
value.43 It should be recalled that in its decision of 19 December 1994 the trial court
granted the writ of mandamus prayed for by private respondents, which decision was
received by petitioners on 20 December 1994. Three (3) days after, or on 23
December 1994, petitioners filed the instant petition. By then, the remedy available to
them was to appeal the decision to the Court of Appeals, which they in fact did, by
filing a notice of appeal on 26 December 1994.44
The petitioners have shown no cogent reason for us to reverse the aforecited ruling. Nor will
their reliance upon the doctrine of the exhaustion of administrative remedies in the instant
case advance their cause any.
Section 2645 of the Medical Act of 1959 provides for the administrative and judicial remedies
that respondents herein can avail to question Resolution No. 26 of the Board of Medicine,
namely: (a) appeal the unfavorable judgment to the PRC; (b) should the PRC ruling still be
unfavorable, to elevate the matter on appeal to the Office of the President; and (c) should
they still be unsatisfied, to ask for a review of the case or to bring the case to court via a
special civil action of certiorari. Thus, as a rule, mandamus will not lie when administrative
remedies are still available.46 However, the doctrine of exhaustion of administrative remedies
does not apply where, as in this case, a pure question of law is raised. 47 On this issue, no
reversible error may, thus, be laid at the door of the appellate court in CA-G.R. SP No.
37283, when it refused to dismiss Civil Case No. 93-66530.
As we earlier pointed out, herein respondents Arnel V. Herrera, Fernando F. Mandapat,
Ophelia C. Hidalgo, Bernadette T. Mendoza, Ruby B. Lantin-Tan, Fernando T. Cruz, Marissa
A. Regodon, Ma. Eloisa Q. Mallari-Largoza, Cheryl R. Triguero, Joseph A. Jao, Bernadette
H. Cabuhat, Evelyn S. Acosta-Cabanes, Laura M. Santos, Maritel M. Echiverri, Bernadette
C. Escusa, Carlosito C. Domingo, Alicia S. Lizano, Elnora R. Raqueno-Rabaino, Saibzur N.
Edding, Derileen D. Dorado-Edding, Robert B. Sanchez, Maria Rosario Leonor-Lacandula,
Geraldine Elizabeth M. Pagilagan-Palma, Margarita Belinda L. Vicencio-Gamilla,
Herminigilda E. Conejos, Leuvina P. Chico-Paguio, Elcin C. Arriola-Ocampo, and Jose
Ramoncito P. Navarro manifested to the Court of Appeals during the pendency of CA-G.R.
SP No. 37283, that they were no longer interested in proceeding with the case and moved
for its dismissal insofar as they were concerned. A similar manifestation and motion were
later filed by intervenors Mary Jean I. Yeban-Merlan, Michael L. Serrano, Norma G. Lafavilla,
Arnulfo A. Salvador, Belinda C. Rabarra, Yolanda P. Unica, Dayminda G. Bontuyan, Clarissa
B. Baclig, Ma. Luisa S. Gutierrez, Rhoneil R. Deveraturda, Aleli A. Gollayan, Evelyn C.
Cundangan, Frederick D. Francisco, Violeta V. Meneses, Melita J. Caedo, Clarisa SJ.
Nicolas, Federico L. Castillo, Karangalan D. Serrano, Danilo A. Villaver, Grace E. Uy, Lydia
C. Chan, and Melvin M. Usita. Following these manifestations and motions, the appellate
court in CA-G.R. SP No. 37283 decreed that its ruling would not apply to them. Thus,
inasmuch as the instant case is a petition for review of the appellate courts ruling in CA-G.R.
SP No. 37283, a decision which is inapplicable to the aforementioned respondents will
similarly not apply to them.
As to Achilles J. Peralta, Evelyn O. Ramos, Sally B. Bunagan, Rogelio B. Ancheta, Oscar H.
Padua, Jr., Evelyn D. Grajo, Valentino P. Arboleda, Carlos M. Bernardo, Jr., Mario D.
Cuaresma, Violeta C. Felipe, Percival H. Pangilinan, Corazon M. Cruz and Samuel B.
Bangoy, herein decision shall not apply pursuant to the Orders of the trial court in Civil Case
No. 93-66530, dropping their names from the suit.

Consequently, this Decision is binding only on the remaining respondents, namely: Arlene V.
de Guzman, Celerina S. Navarro, Rafael I. Tolentino, Bernardita B. Sy, Gloria T. Jularbal,
Hubert S. Nazareno, Nancy J. Chavez, Ernesto L. Cue, Herminio V. Fernandez, Jr., Maria
Victoria M. Lacsamana and Merly D. Sta. Ana, as well as the petitioners.
WHEREFORE, the instant petition is GRANTED. Accordingly, (1) the assailed decision
dated May 16, 2000, of the Court of Appeals, in CA-G.R. SP No. 37283, which affirmed the
judgment dated December 19, 1994, of the Regional Trial Court of Manila, Branch 52, in Civil
Case No. 93-66530, ordering petitioners to administer the physicians oath to herein
respondents as well as the resolution dated August 25, 2000, of the appellate court, denying
the petitioners motion for reconsideration, are REVERSED and SET ASIDE; and (2) the writ
of mandamus, issued in Civil Case No. 93-66530, and affirmed by the appellate court in CAG.R. SP No. 37283 is NULLIFIED AND SET ASIDE.
SO ORDERED.
Puno, Quisumbing, Austria-Martinez, and Callejo, Sr., JJ., concur.

G.R. No. 89572 December 21, 1989


DEPARTMENT OF EDUCATION, CULTURE AND SPORTS (DECS) and DIRECTOR OF
CENTER FOR EDUCATIONAL MEASUREMENT, petitioners,
vs.
ROBERTO REY C. SAN DIEGO and JUDGE TERESITA DIZON-CAPULONG, in her
capacity as Presiding Judge of the Regional Trial Court of Valenzuela, Metro Manila,
Branch 172, respondents.
Ramon M. Guevara for private respondent.

CRUZ, J.:
The issue before us is mediocrity. The question is whether a person who has thrice failed the
National Medical Admission Test (NMAT) is entitled to take it again.
The petitioner contends he may not, under its rule thath) A student shall be allowed only three (3) chances to take the NMAT. After
three (3) successive failures, a student shall not be allowed to take the NMAT
for the fourth time.
The private respondent insists he can, on constitutional grounds.
But first the facts.
The private respondent is a graduate of the University of the East with a degree of Bachelor
of Science in Zoology. The petitioner claims that he took the NMAT three times and flunked it
as many times. 1 When he applied to take it again, the petitioner rejected his application on the
basis of the aforesaid rule. He then went to the Regional Trial Court of Valenzuela, Metro Manila,
to compel his admission to the test.
In his original petition for mandamus, he first invoked his constitutional rights to academic
freedom and quality education. By agreement of the parties, the private respondent was
allowed to take the NMAT scheduled on April 16, 1989, subject to the outcome of his
petition. 2 In an amended petition filed with leave of court, he squarely challenged the
constitutionality of MECS Order No. 12, Series of 1972, containing the above-cited rule. The
additional grounds raised were due process and equal protection.
After hearing, the respondent judge rendered a decision on July 4, 1989, declaring the
challenged order invalid and granting the petition. Judge Teresita Dizon-Capulong held that
the petitioner had been deprived of his right to pursue a medical education through an
arbitrary exercise of the police power. 3
We cannot sustain the respondent judge. Her decision must be reversed.
In Tablarin v. Gutierrez, 4 this Court upheld the constitutionality of the NMAT as a measure
intended to limit the admission to medical schools only to those who have initially proved their
competence and preparation for a medical education. Justice Florentino P. Feliciano declared for
a unanimous Court:
Perhaps the only issue that needs some consideration is whether there is
some reasonable relation between the prescribing of passing the NMAT as a
condition for admission to medical school on the one hand, and the securing
of the health and safety of the general community, on the other hand. This
question is perhaps most usefully approached by recalling that the regulation
of the pratice of medicine in all its branches has long been recognized as a

reasonable method of protecting the health and safety of the public. That the
power to regulate and control the practice of medicine includes the power to
regulate admission to the ranks of those authorized to practice medicine, is
also well recognized. Thus, legislation and administrative regulations
requiring those who wish to practice medicine first to take and pass medical
board examinations have long ago been recognized as valid exercises of
governmental power. Similarly, the establishment of minimum medical
educational requirements-i.e., the completion of prescribed courses in a
recognized medical school-for admission to the medical profession, has also
been sustained as a legitimate exercise of the regulatory authority of the
state. What we have before us in the instant case is closely related: the
regulation of access to medical schools. MECS Order No. 52, s. 1985, as
noted earlier, articulates the rationale of regulation of this type: the
improvement of the professional and technical quality of the graduates of
medical schools, by upgrading the quality of those admitted to the student
body of the medical schools. That upgrading is sought by selectivity in the
process of admission, selectivity consisting, among other things, of limiting
admission to those who exhibit in the required degree the aptitude for
medical studies and eventually for medical practice. The need to maintain,
and the difficulties of maintaining, high standards in our professional schools
in general, and medical schools in particular, in the current state of our social
and economic development, are widely known.
We believe that the government is entitled to prescribe an admission test like
the NMAT as a means of achieving its stated objective of "upgrading the
selection of applicants into [our] medical schools" and of "improv[ing] the
quality of medical education in the country." Given the widespread use today
of such admission tests in, for instance, medical schools in the United States
of America (the Medical College Admission Test [MCAT] and quite probably,
in other countries with far more developed educational resources than our
own, and taking into account the failure or inability of the petitioners to even
attempt to prove otherwise, we are entitled to hold that the NMAT is
reasonably related to the securing of the ultimate end of legislation and
regulation in this area. That end, it is useful to recall, is the protection of the
public from the potentially deadly effects of incompetence and ignorance in
those who would undertake to treat our bodies and minds for disease or
trauma.
However, the respondent judge agreed with the petitioner that the said case was not
applicable. Her reason was that it upheld only the requirement for the admission test and
said nothing about the so-called "three-flunk rule."
We see no reason why the rationale in the Tablarin case cannot apply to the case at bar. The
issue raised in both cases is the academic preparation of the applicant. This may be gauged
at least initially by the admission test and, indeed with more reliability, by the three-flunk rule.
The latter cannot be regarded any less valid than the former in the regulation of the medical
profession.
There is no need to redefine here the police power of the State. Suffice it to repeat that the
power is validly exercised if (a) the interests of the public generally, as distinguished from
those of a particular class, require the interference of the State, and (b) the means employed
are reasonably necessary to the attainment of the object sought to be accomplished and not
unduly oppressive upon individuals. 5
In other words, the proper exercise of the police power requires the concurrence of a lawful
subject and a lawful method.

The subject of the challenged regulation is certainly within the ambit of the police power. It is
the right and indeed the responsibility of the State to insure that the medical profession is not
infiltrated by incompetents to whom patients may unwarily entrust their lives and health.
The method employed by the challenged regulation is not irrelevant to the purpose of the law
nor is it arbitrary or oppressive. The three-flunk rule is intended to insulate the medical
schools and ultimately the medical profession from the intrusion of those not qualified to be
doctors.
While every person is entitled to aspire to be a doctor, he does not have a constitutional right
to be a doctor. This is true of any other calling in which the public interest is involved; and the
closer the link, the longer the bridge to one's ambition. The State has the responsibility to
harness its human resources and to see to it that they are not dissipated or, no less worse,
not used at all. These resources must be applied in a manner that will best promote the
common good while also giving the individual a sense of satisfaction.
A person cannot insist on being a physician if he will be a menace to his patients. If one who
wants to be a lawyer may prove better as a plumber, he should be so advised and adviced.
Of course, he may not be forced to be a plumber, but on the other hand he may not force his
entry into the bar. By the same token, a student who has demonstrated promise as a pianist
cannot be shunted aside to take a course in nursing, however appropriate this career may be
for others.
The right to quality education invoked by the private respondent is not absolute. The
Constitution also provides that "every citizen has the right to choose a profession or course
of study, subject to fair, reasonable and equitable admission and academic requirements. 6
The private respondent must yield to the challenged rule and give way to those better
prepared. Where even those who have qualified may still not be accommodated in our
already crowded medical schools, there is all the more reason to bar those who, like him,
have been tested and found wanting.
The contention that the challenged rule violates the equal protection clause is not well-taken.
A law does not have to operate with equal force on all persons or things to be conformable to
Article III, Section 1 of the Constitution.
There can be no question that a substantial distinction exists between medical students and
other students who are not subjected to the NMAT and the three-flunk rule. The medical
profession directly affects the very lives of the people, unlike other careers which, for this
reason, do not require more vigilant regulation. The accountant, for example, while belonging
to an equally respectable profession, does not hold the same delicate responsibility as that
of the physician and so need not be similarly treated.
There would be unequal protection if some applicants who have passed the tests are
admitted and others who have also qualified are denied entrance. In other words, what the
equal protection requires is equality among equals.
The Court feels that it is not enough to simply invoke the right to quality education as a
guarantee of the Constitution: one must show that he is entitled to it because of his
preparation and promise. The private respondent has failed the NMAT five times. 7 While his
persistence is noteworthy, to say the least, it is certainly misplaced, like a hopeless love.
No depreciation is intended or made against the private respondent. It is stressed that a
person who does not qualify in the NMAT is not an absolute incompetent unfit for any work or
occupation. The only inference is that he is a probably better, not for the medical profession,
but for another calling that has not excited his interest.
In the former, he may be a bungler or at least lackluster; in the latter, he is more likely to
succeed and may even be outstanding. It is for the appropriate calling that he is entitled to

quality education for the full harnessing of his potentials and the sharpening of his latent
talents toward what may even be a brilliant future.
We cannot have a society of square pegs in round holes, of dentists who should never have
left the farm and engineers who should have studied banking and teachers who could be
better as merchants.
It is time indeed that the State took decisive steps to regulate and enrich our system of
education by directing the student to the course for which he is best suited as determined by
initial tests and evaluations. Otherwise, we may be "swamped with mediocrity," in the words
of Justice Holmes, not because we are lacking in intelligence but because we are a nation of
misfits.
WHEREFORE, the petition is GRANTED. The decision of the respondent court dated
January 13, 1989, is REVERSED, with costs against the private respondent. It is so ordered.
Fernan, C.J., Narvasa Melencio-Herrera, Gutierrez, Jr., Paras, Feliciano, Gancayco, Padilla,
Bidin, Sarmiento, Cortes, Grio-Aquino, Medialdea and Regalado, JJ., concur.

MEDICAL NEGLIGENCE CASES

DR. MILAGROS L. CANTRE,


Petitioner,

G.R. No. 160889


Present:

- versus -

QUISUMBING, J., Chairperson,


CARPIO,
CARPIO MORALES,
TINGA, and
VELASCO, JR., JJ.

SPS. JOHN DAVID Z. GO and


Promulgated:
NORA S. GO,
Respondents.
April 27, 2007
x------------------------------------------------x
DECISION
QUISUMBING, J.:
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.
The facts, culled from the records, are as follows:
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
suffered hypovolemic 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.

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 medicolegal officer Dr. FlorestoArizala, 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 one-fourth (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.
Thus, on June 21, 1993, respondent spouses filed a complaint [13] for
damages against petitioner, Dr. Abad, and the hospital. Finding in favor of
respondent spouses, the trial court decreed:
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)

to pay the sum of Five Hundred Thousand Pesos


(P500,000.00) in moral damages;

(b)

to pay the sum of One Hundred Fifty Thousand Pesos


(P150,000.00) exemplary damages;

(c)

to pay the sum of Eighty Thousand Pesos


(P80,000.00) nominal damages;

(d)

to pay Fifty Thousand Pesos (P50,000.00) for and as


attorneys fees; and

(e)

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;

2.

Deleting the award [of] exemplary


attorneys fees and expenses of litigation;

3.

Dismissing the complaint with respect to defendantsappellants Dr. Rainerio S. Abad and Delgado Clinic,
Inc.;

4.

Dismissing the counterclaims


appellants for lack of merit; and

of

defendants-

5.

Ordering
defendant-appellant Dra.
[L.] Cantre only to pay the costs.

Milagros

damages,

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.
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 PETITIONER DRA. CANTRE
WAS NOT ABLE TO AMPLY EXPLAIN HOW THE INJURY
(BLISTERS) IN THE LEFT INNER ARM OF RESPONDENT
MRS. GO CAME ABOUT;
IV.
WHETHER OR NOT THE COURT OF APPEALS
COMMITTED GRAVE ABUSE OF ITS DISCRETION WHEN
IT MADE A RULING ON THE RESPONDENTS INJURY
QUOTING THE TESTIMONY OF SOMEONE WHO WAS NOT
PRESENT AND HAS NOT SEEN THE ORIGINAL, FRESH
INJURY OF RESPONDENT MRS. NORA GO;
V.
WHETHER OR NOT THE COURT OF APPEALS GRAVELY
ABUSING ITS DISCRETION RULED THAT PETITIONER
DRA. CANTRE SHOULD HAVE INTENDED TO INFLICT
THE INJURY TO SAVE THE LIFE OF RESPONDENT MRS.
GO;
VI.
WHETHER OR NOT THE LOWER COURT AND THE COURT
[OF] APPEALS COMMITTED GRAVE ABUSE OF
DISCRETION WHEN, CONTRARY TO THE DETAILED
PROCEDURES DONE BY PETITIONER, BOTH RULED

THAT THE RESPONDENT WAS LEFT TO THE CARE OF


THE NURSING STAFF;
VII.
WHETHER OR NOT THE LOWER COURT COMMITTED
GRAVE ABUSE OF DISCRETION WHEN, CONTRARY TO
THE MEDICAL PURPOSES OF COSMETIC SURGERY, IT
RULED THAT THE COSMETIC SURGERY MADE THE
SCARS EVEN MORE UGLY AND DECLARED THE
COSMETIC SURGERY A FAILURE;
VIII.
WHETHER OR NOT THE LOWER COURT GRAVELY ABUSE
OF (SIC) DISCRETION WHEN, CONTRARY TO
RESPONDENTS CONTRARY TESTIMONIES AND THE
ABSENCE OF ANY TESTIMONY, IT RULED THAT THEY
ARE ENTITLED TO DAMAGES AND WHICH WAS UPHELD,
ALTHOUGH MODIFIED, BY THE COURT OF APPEALS
LIKEWISE ABUSING ITS DISCRETION.[16]

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 medicolegal 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 ipsaloquitur doctrine even in the absence of such additional exhibits.
Petitioners contention that the medico-legal officer who conducted
Noras physical examination never saw her original injury before plastic
surgery was performed is without basis and contradicted by the records.
Records show that the medico-legal officer conducted the physical
examination on May 7, 1992, while the skin grafting and the scar revision
were performed on Nora on May 22, 1992 and April 30, 1993, respectively.
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 well-being 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]
As to the first requirement, the gaping wound on Noras arm is
certainly not an ordinary occurrence in the act of delivering a baby, far

removed as the arm is from the organs involved in the process of giving
birth. Such injury could not have happened unless negligence had set in
somewhere.
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.
Further, petitioners argument that the failed plastic surgery was not
intended as a cosmetic procedure, but rather as a measure to prevent
complication does not help her case. It does not negate negligence on her
part.
Based on the foregoing, the presumption that petitioner was negligent
in the exercise of her profession stands unrebutted. 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 rule that the Court of Appeals award of
Two Hundred Thousand Pesos (P200,000) as moral damages in favor of
respondents and against petitioner is just and equitable.[21]
WHEREFORE, the petition is DENIED. The Decision
dated October 3, 2002 and Resolution dated November 19, 2003 of the
Court of Appeals in CA-G.R. CV No. 58184 are AFFIRMED.
No pronouncement as to costs.
SO ORDERED.

[G.R. No. 118231. July 5, 1996]

DR. VICTORIA L. BATIQUIN and ALLAN BATIQUIN, petitioners,


vs. COURT OF APPEALS, SPOUSES QUEDO D. ACOGIDO
and FLOTILDE G. VILLEGAS, respondents.
DECISION
DAVIDE, JR., J.:

Throughout history, patients have consigned their fates and lives to


the skill of their doctors. For a breach of this trust, men have been quick
to demand retribution. Some 4,000 years ago, the Code of
Hammurabi[1] then already provided: "If a physician make a deep
incision upon a man with his bronze lancet and cause the man's death,
or operate on the eye socket of a man with his bronze lancet and
destroy the man's eyes, they shall cut off his hand." [2] Subsequently,
Hippocrates[3] wrote what was to become part of the healer's oath: "I will
follow that method of treatment which according to my ability and
judgment, I consider for the benefit of my patients, and abstain from
whatever is deleterious and mischievous . . . . While I continue to keep
this oath unviolated may it be granted me to enjoy life and practice the
art, respected by all men at all times but should I trespass and violate
this oath, may the reverse be my lot." At present, the primary objective
of the medical profession is the preservation of life and maintenance of
the health of the people.[4]
Needless to say then, when a physician strays from his sacred duty
and endangers instead the life of his patient, he must be made to
answer therefor. Although society today cannot and will not tolerate the
punishment meted out by the ancients, neither will it and this Court, as
this case would show, let the act go uncondemned.
The petitioners appeal from the decision[5] of the Court of Appeals of
11 May 1994 in CA-G.R. CV No. 30851, which reversed the
decision[6] of 21 December 1990 of Branch 30 of the Regional Trial
Court (RTC) of Negros Oriental in Civil Case No. 9492.
The facts, as found by the trial court, are as follows:
Dr. Batiquin was a Resident Physician at the Negros Oriental Provincial
Hospital, Dumaguete City from January 9, 1978 to September
1989. Between 1987 and September, 1989 she was also the Actg. Head
of the Department of Obstetrics and Gynecology at the said Hospital.

Mrs. Villegas is a married woman who submitted to Dr. Batiquin for


prenatal care as the latter's private patient sometime before September
21, 1988.
In the morning of September 21, 1988 Dr. Batiquin, with the
assistance of Dr. Doris Teresita Sy who was also a Resident Physician
at the same Hospital, C.I. and O.R. Nurse Arlene Diones and some
student nurses performed a simple cesarean section on Mrs. Villegas at
the Negros Oriental Provincial Hospital and after 45 minutes Mrs.
Villegas delivered her first child, Rachel Acogido, at about 11:45 that
morning. Thereafter, Plaintiff remained confined at the Hospital until
September 27, 1988 during which period of confinement she was
regularly visited by Dr. Batiquin. On September 28, 1988, Mrs. Villegas
checked out of the Hospital . . . and on the same day she paid Dr.
Batiquin, thru the latter's secretary, the amount of P1,500.00 as
"professional fee" . . . .
Soon after leaving the Hospital Mrs. Villegas began to suffer
abdominal pains and complained of being feverish. She also gradually
lost her appetite, so she consulted Dr. Batiquin at the latter's polyclinic
who prescribed for her certain medicines . . . which she had been taking
up to December, 1988.
In the meantime, Mrs. Villegas was given a Medical Certificate by Dr.
Batiquin on October 31, 1988 . . . certifying to her physical fitness to
return to her work on November 7, 1988. So, on the second week of
November, 1988 Mrs. Villegas returned to her work at the Rural Bank of
Ayungon, Negros Oriental.
The abdominal pains and fever kept on recurring and bothered Mrs.
Villegas no end and despite the medications administered by Dr.
Batiquin. When the pains become unbearable and she was rapidly
losing weight she consulted Dr. Ma. Salud Kho at the Holy Child's
Hospital in Dumaguete City on January 20, 1989.
The evidence of Plaintiffs show that when Dr. Ma. Salud Kho
examined Mrs. Villegas at the Holy Child's Hospital on January 20, 1989
she found Mrs. Villegas to be feverish, pale and was breathing
fast. Upon examination she felt an abdominal mass one finger below the
umbilicus which she suspected to be either a tumor of the uterus or an
ovarian cyst, either of which could be cancerous. She had an x-ray
taken of Mrs. Villegas' chest, abdomen and kidney. She also took blood
tests of Plaintiff. A blood count showed that Mrs. Villegas had [an]
infection inside her abdominal cavity. The result of all those
examinations impelled Dr. Kho to suggest that Mrs. Villegas submit to
another surgery to which the latter agreed.

When Dr. Kho opened the abdomen of Mrs. Villegas she found
whitish-yellow discharge inside, an ovarian cyst on each of the left and
right ovaries which gave out pus, dirt and pus behind the uterus, and a
piece of rubber materials on the right side of the uterus embedded on
[sic] the ovarian cyst, 2 inches by 3/4 inch in size. This piece of rubber
material which Dr. Kho described as a "foreign body" looked like a piece
of a "rubber glove" . . . and which is [sic] also "rubber-drain like . . . . It
could have been a torn section of a surgeon's gloves or could have
come from other sources. And this foreign body was the cause of the
infection of the ovaries and consequently of all the discomfort suffered
by Mrs. Villegas after her delivery on September 21, 1988.[7]
The piece of rubber allegedly found near private respondent Flotilde
Villegas' uterus was not presented in court, and although Dr. Ma. Salud
Kho testified that she sent it to a pathologist in Cebu City for
examination,[8] it was not mentioned in the pathologist's Surgical
Pathology Report.[9]
Aside from Dr. Kho's testimony, the evidence which mentioned the
piece of rubber are a Medical Certificate, [10] a Progress Record,[11] an
Anesthesia Record,[12] a Nurse's Record,[13] and a Physician's Discharge
Summary.[14] The trial court, however, regarded these documentary
evidence as mere hearsay, "there being no showing that the person or
persons who prepared them are deceased or unable to testify on the
facts therein stated . . . . Except for the Medical Certificate (Exhibit "F"),
all the above documents were allegedly prepared by persons other than
Dr. Kho, and she merely affixed her signature on some of them to
express her agreement thereto . . . ."[15] The trial court also refused to
give weight to Dr. Kho's testimony regarding the subject piece of rubber
as Dr. Kho "may not have had first-hand knowledge" thereof, [16] as could
be gleaned from her statement, thus:
A . . . I have heard somebody that [sic] says [sic] there is [sic] a foreign body that
goes with the tissues but unluckily I don't know where the rubber was.[17]

The trial court deemed vital Dr. Victoria Batiquin's testimony that
when she confronted Dr. Kho regarding the piece of rubber, "Dr. Kho
answered that there was rubber indeed but that she threw it
away."[18] This statement, the trial court noted, was never denied nor
disputed by Dr. Kho, leading it to conclude:
There are now two different versions on the whereabouts of that offending
"rubber" (1) that it was sent to the Pathologist in Cebu as testified to in Court
by Dr. Kho and (2) that Dr. Kho threw it away as told by her to Defendant. The
failure of the Plaintiffs to reconcile these two different versions serve only to
weaken their claim against Defendant Batiquin. [19]
All told, the trial court held in favor of the petitioners herein.

The Court of Appeals reviewed the entirety of Dr. Kho's testimony


and, even without admitting the private respondents' documentary
evidence, deemed Dr. Kho's positive testimony to definitely establish
that a piece of rubber was found near private respondent Villegas'
uterus. Thus, the Court of Appeals reversed the decision of the trial
court, holding:
4. The fault or negligence of appellee Dr. Batiquin is established by
preponderance of evidence. The trial court itself had narrated what happened to
appellant Flotilde after the cesarean operation made by appellee
doctor . . . . After the second operation, appellant Flotilde became well and
healthy. Appellant Flotilde's troubles were caused by the infection due to the
"rubber" that was left inside her abdomen.Both appellants testified that after the
operation made by appellee doctor, they did not go to any other doctor until
they finally decided to see another doctor in January, 1989 when she was not
getting any better under the care of appellee Dr. Batiquin . . . . Appellee Dr.
Batiquin admitted on the witness stand that she alone decided when to close the
operating area; that she examined the portion she operated on before closing the
same . . . . Had she exercised due diligence, appellee Dr. Batiquin would have
found the rubber and removed it before closing the operating area. [20]
The appellate court then ruled:
Appellants' evidence show[s] that they paid a total of P17,000.00 [deposit of
P7,100.00 (Exh. G-1-A) plus hospital and medical expenses together with
doctor's fees in the total amount P9,900.00 (Exhs. G and G-2)] for the second
operation that saved her life.
For the miseries appellants endured for more than three (3) months, due to the
negligence of appellee Dr. Batiquin, they are entitled to moral damages in the
amount of P100,000.00; exemplary damages in the amount of P20,000.00 and
attorney's fees in the amount of P25,000.00.
The fact that appellant Flotilde can no longer bear children because her uterus
and ovaries were removed by Dr. Kho is not taken into consideration as it is not
shown that the removal of said organs were the direct result of the rubber left
by appellee Dr. Batiquin near the uterus. What is established is that the rubber
left by appellee cause infection, placed the life of appellant Flotilde in jeopardy
and caused appellants fear, worry and anxiety . . . .
WHEREFORE, the appealed judgment, dismissing the complaint for damages
is REVERSED and SET ASIDE. Another judgment is hereby entered ordering
defendants-appellees to pay plaintiffs-appellants the amounts of P17,000.00 as
and for actual damages; P100,000.00 as and for moral damages; P20,000.00 as
and for exemplary damages; and P25,000.00 as and for attorney's fees plus the
cost of litigation.
SO ORDERED.[21]

From the above judgment, the petitioners appealed to this Court


claiming that the appellate court; (1) committed grave abuse of
discretion by resorting to findings of fact not supported by the evidence
on record, and (2) exceeded its discretion, amounting to lack or excess
of jurisdiction, when it gave credence to testimonies punctured with
contradictions and falsities.
The private respondents commented that the petition raised only
questions of fact, which were not proper for review by this Court.
While the rule is that only questions of law may be raised in a
petition for review on certiorari, there are exceptions, among which are
when the factual findings of the trial court and the appellate court
conflict, when the appealed decision is clearly contradicted by the
evidence on record, or when the appellate court misapprehended the
facts.[22]
After deciphering the cryptic petition, we find that the focal point of
the instant appeal is the appreciation of Dr. Kho's testimony. The
petitioners contend that the Court of Appeals misappreciated the
following portion of Dr. Kho's testimony:
Q What is the purpose of the examination?
A Just in case, I was just thinking at the back of my mind, just in case this would turn
out to be a medico-legal case, I have heard somebody that [sic] says [sic] there
is [sic] a foreign body that goes with the tissues but unluckily I don't know where
the rubber was. It was not in the Lab, it was not in Cebu.[23] (Italics supplied)

The petitioners prefer the trial court's interpretation of the above


testimony, i.e., that Dr. Kho's knowledge of the piece of rubber was
based on hearsay. The Court of Appeals, on the other hand, concluded
that the underscored phrase was taken out of context by the trial
court. According to the Court of Appeals, the trial court should have
likewise considered the other portions of Dr. Kho's testimony, especially
the following:
Q So you did actually conduct the operation on her?
A Yes, I did.
Q And what was the result?
A Opening up her abdomen, there was whitish-yellow discharge inside the
abdomen, there was an ovarian cyst on the left and side and there was also an
ovarian cyst on the right which, on opening up or freeing it up from the uterus,
turned out to be pus. Both ovaries turned out . . . to have pus. And then,
cleaning up the uterus, at the back of the uterus it was very dirty, it was full of
pus. And there was a [piece of] rubber, we found a [piece of] rubber on the right
side.[24]

We agree with the Court of Appeals. The phrase relied upon by the
trial court does not negate the fact that Dr. Kho saw a piece of rubber in
private respondent Villegas' abdomen, and that she sent it to a
laboratory and then to Cebu City for examination by a pathologist. [25] Not
even the Pathologist's Report, although devoid of any mention of a
piece of rubber, could alter what Dr. Kho saw. Furthermore, Dr. Kho's
knowledge of the piece of rubber could not be based on other than first
hand knowledge for, as she asserted before the trial court:
Q But you are sure you have seen [the piece of rubber]?
A Oh yes. I was not the only one who saw it.[26]

The petitioners emphasize that the private respondents never


reconciled Dr. Kho's testimony with Dr. Batiquin's claim on the witness
stand that when Dr. Batiquin confronted Dr. Kho about the foreign body,
the latter said that there was a piece of rubber but that she threw it
away. Although hearsay, Dr. Batiquin's claim was not objected to, and
hence, the same is admissible[27] but it carries no probative value.
[28]
Nevertheless, assuming otherwise, Dr. Batiquin's statement cannot
belie the fact that Dr. Kho found a piece of rubber near private
respondent Villegas' uterus. And even if we were to doubt Dr. Kho as to
what she did to the piece of rubber, i.e., whether she threw it away or
sent it to Cebu City, we are not justified in distrusting her as to her
recovery of a piece of rubber from private respondent Villegas'
abdomen. On this score, it is perfectly reasonable to believe the
testimony of a witness with respect to some facts and disbelieve his
testimony with respect to other facts. And it has been aptly said that
even when a witness is found to have deliberately falsified in some
material particulars, it is not required that the whole of his
uncorroborated testimony be rejected, but such portions thereof
deemed worthy of belief may be credited.[29]
It is here worth nothing that the trial court paid heed to the following
portions of Dr. Batiquin's testimony: that no rubber drain was used in the
operation,[30] and that there was neither any tear on Dr. Batiquin's gloves
after the operation nor blood smears on her hands upon removing her
gloves.[31] Moreover, the trial court pointed out that the absence of a
rubber drain was corroborated by Dr. Doris Sy, Dr. Batiquin's assistant
during the operation on private respondent Villegas.[32] But the trial court
failed to recognize that the assertions of Drs. Batiquin and Sy were
denials or negative testimonies. Well-settled is the rule that positive
testimony is stronger than negative testimony.[33] Of course, as the
petitioners advocate, such positive testimony must come from a credible
source, which leads us to the second assigned error.
While the petitioners claim that contradictions and falsities punctured
Dr. Kho's testimony, a reading of the said testimony reveals no such

infirmity and establishes Dr. Kho as a credible witness. Dr. Kho was
frank throughout her turn on the witness stand. Furthermore, no motive
to state any untruth was ever imputed against Dr. Kho, leaving her
trustworthiness unimpaired.[34] The trial court's following declaration
shows that while it was critical of the lack of care with which Dr. Kho
handled the piece of rubber, it was not prepared to doubt Dr. Kho's
credibility, thus only supporting out appraisal of Dr. Kho's
trustworthiness:
This is not to say that she was less than honest when she testified
about her findings, but it can also be said that she did not take the most
appropriate precaution to preserve that "piece of rubber" as an eloquent
evidence of what she would reveal should there be a "legal problem"
which she claim[s] to have anticipated.[35]
Considering that we have assessed Dr. Kho to be a credible
witness, her positive testimony [that a piece of rubber was indeed found
in private respondent Villegas' abdomen] prevails over the negative
testimony in favor of the petitioners.
As such, the rule of res ipsa loquitur comes to fore. This Court has
had occasion to delve into the nature and operation of this doctrine:
This doctrine [res ipsa loquitur] is stated thus: "Where the thing
which causes injury is shown to be under the management of the
defendant, and the accident is such as in the ordinary course of things
does not happen if those who have the management use proper care, it
affords reasonable evidence, in the absence of an explanation by the
defendant, that the accident arose from want of care." Or as Black's
Law Dictionary puts it:
Res ipsa loquitur. The thing speaks for itself. Rebuttable presumption or
inference that defendant was negligent, which arises upon proof that [the]
instrumentality causing injury was in defendant's exclusive control, and that the
accident was one which ordinary does not happen in absence of
negligence. Res ipsa loquitur is [a] rule of evidence whereby negligence of
[the] alleged wrongdoer may be inferred from [the] mere fact that [the] accident
happened provided [the] character of [the] accident and circumstances
attending it lead reasonably to belief that in [the] absence of negligence it
would not have occurred and that thing which caused injury is shown to have
been under [the] management and control of [the] alleged
wrongdoer . . . . Under [this] doctrine . . . the happening of an injury permits an
inference of negligence where plaintiff produces substantial evidence that [the]
injury was caused by an agency or instrumentality under [the] exclusive control
and management of defendant, and that the occurrence [sic] was such that in
the ordinary course of things would not happen if reasonable care had been
used.

xxx xxx xxx


The doctrine of [r]es ipsa loquitur as a rule of evidence is peculiar 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 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 particular case, is
not intended to and does not dispense with the requirement of proof of
culpable negligence on the party charged. It merely determines and
regulates what shall be prima facie evidence thereof and facilitates the
burden of plaintiff of proving a breach of the duty of due care. The
doctrine can be invoked when and only when, under the circumstances
involved, direct evidence is absent and not readily available.[36]
In the instant case, all the requisites for recourse to the doctrine are
present. First, the entire proceedings of the cesarean section were
under the exclusive control of Dr. Batiquin. In this light, the private
respondents were bereft of direct evidence as to the actual culprit or the
exact cause of the foreign object finding its way into private respondent
Villegas' body, which, needless to say, does not occur unless through
the intervention of negligence. Second, since aside from the cesarean
section, private respondent Villegas underwent no other operation which
could have caused the offending piece of rubber to appear in her uterus,
it stands to reason that such could only have been a by-product of the
cesarean section performed by Dr. Batiquin. The petitioners, in this
regard, failed to overcome the presumption of negligence arising from
resort to the doctrine of res ipsa loquitur. Dr. Batiquin is therefore liable
for negligently leaving behind a piece of rubber in private respondent
Villegas' abdomen and for all the adverse effects thereof.
As a final word, this Court reiterates its recognition of the vital role
the medical profession plays in the lives of the people, [37] and State's
compelling interest to enact measures to protect the public from "the
potentially deadly effects of incompetence and ignorance in those who
would undertake to treat our bodies and minds for disease or
trauma."[38] Indeed, a physician is bound to serve the interest of his
patients "with the greatest of solicitude, giving them always his best
talent and skill."[39] Through her tortious conduct, the petitioner
endangered the life of Flotilde Villegas, in violation of her profession's
rigid ethical code and in contravention of the legal standards set forth for
professionals, in the general,[40] and members of the medical profession,
[41]
in particular.
WHEREFORE, the challenged decision of 11 May 1994 of the Court
of Appeals in CA-G.R. CV No. 30851 is hereby AFFIRMED in toto.

Costs against the petitioners.


SO ORDERED.
Narvasa,
JJ., concur.

C.J.,

(Chairman),

Melo,

Francisco, and Panganiban,

THIRD DIVISION

FE CAYAO-LASAM,

G.R. No. 159132

Petitioner,
Present:
YNARES-SANTIAGO, J.,
Chairperson,
- versus -

AUSTRIA-MARTINEZ,
CHICO-NAZARIO,
NACHURA, and
REYES, JJ.

SPOUSES CLARO and


EDITHA RAMOLETE,

Promulgated:

Respondents.

December 18, 2008

x-------------------------- ------------------------------x

DECISION

AUSTRIA-MARTINEZ, J.:

Before the Court is a Petition for Review on Certiorari under Rule 45 of the
Rules of Court filed by Dr. Fe Cayao-Lasam (petitioner) seeking to annul the
Decision[1] dated July 4, 2003 of the Court of Appeals (CA) in CA-G.R. SP No.
62206.

The antecedent facts:

On July
28,
1994,
respondent,
three
months
pregnant Editha Ramolete (Editha)
was
brought
to
the Lorma Medical Center (LMC) in San Fernando, La Union due
to
vaginal
bleeding.Upon
advice
of
petitioner
relayed via telephone, Editha was admitted to the LMC on the
same
day. A
pelvic
sonogram[2] was
then
conducted
on Editha revealing the fetus weak cardiac pulsation.[3] The
following day, Edithas repeat pelvic sonogram[4] showed that
aside from the fetus weak cardiac pulsation, no fetal movement
was also appreciated. Due to persistent and profuse vaginal
bleeding, petitioner advised Editha to undergo a Dilatation and
Curettage Procedure (D&C) or raspa.

On July 30, 1994, petitioner performed the D&C


procedure. Editha was discharged from the hospital the following
day.

On September 16, 1994, Editha was once again brought at the


LMC, as she was suffering from vomiting and severe abdominal
pains. Editha was attended by Dr. Beatriz de la Cruz, Dr. Victor B.
Mayo and Dr. Juan V. Komiya. Dr. Mayo allegedly
informed Editha that there was a dead fetus in the latters
womb. After, Editha underwent laparotomy,[5] she was found to
have a massive intra-abdominal hemorrhage and a ruptured
uterus. Thus, Editha had
to
undergo
a
procedure
for
[6]
hysterectomy and as a result, she has no more chance to bear
a child.

On November
7,
1994, Editha and
her
[7]
husband Claro Ramolete (respondents) filed a Complaint for
Gross Negligence and Malpractice against petitioner before the
Professional Regulations Commission (PRC).

Respondents alleged that Edithas hysterectomy was


caused by petitioners unmitigated negligence and professional
incompetence in conducting the D&C procedure and the
petitioners failure to remove the fetus inside Edithas womb.
[8]
Among the alleged acts of negligence were: first, petitioners
failure to check up, visit or administer medication

on Editha during her first day of confinement at the LMC;


[9]
second, petitioner recommended that a D&C procedure be
performed
on Editha without
conducting
any
internal
[10]
examination prior to the procedure; third, petitioner
immediately suggested a D&C procedure instead of closely
monitoring the state of pregnancy of Editha.[11]

In her Answer,[12] petitioner denied the allegations of negligence


and
incompetence
with
the
following
explanations:
upon Edithas confirmation that she would seek admission at the
LMC, petitioner immediately called the hospital to anticipate the
arrival of Editha and ordered through the telephone the
medicines Editha needed to take, which the nurses carried out;
petitioner visitedEditha on the morning of July 28, 1994 during
her rounds; on July 29, 1994, she performed an internal
examination on Editha and she discovered that the latters cervix
was already open, thus, petitioner discussed the possible D&C
procedure, should the bleeding become more profuse; on July 30
1994, she conducted another internal examination on Editha,
which
revealed
that
the
latters
cervix
was
still
open; Editha persistently complained of her vaginal bleeding and
her passing out of some meaty mass in the process of urination
and bowel movement; thus, petitioner advised Editha to undergo
D&C procedure which the respondents consented to; petitioner
was very vocal in the operating room about not being able to see
an abortus;[13] taking the words ofEditha to mean that she was
passing out some meaty mass and clotted blood, she assumed
that the abortus must have been expelled in the process of
bleeding; it was Editha who insisted that she wanted to be
discharged; petitioner agreed, but she advised Editha to return
for check-up on August 5, 1994, which the latter failed to do.
Petitioner contended that it was Edithas gross negligence and/or
omission in insisting to be discharged on July 31, 1994 against
doctors advice and her unjustified failure to return for check-up
as directed by petitioner that contributed to her life-threatening
condition on September 16, 1994; that Edithas hysterectomy
was brought about by her very abnormal pregnancy known
as placentaincreta, which was an extremely rare and very
unusual case of abdominal placental implantation. Petitioner
argued that whether or not a D&C procedure was done by her or
any other doctor, there would be no difference at all because at

any stage of gestation before term, the uterus would rupture just
the same.

On March 4, 1999, the Board of Medicine (the Board) of the PRC


rendered a Decision,[14] exonerating petitioner from the charges
filed against her. The Board held:

Based on the findings of the doctors who conducted


the laparotomy on Editha, hers is a case of Ectopic Pregnancy
Interstitial. This type of ectopic pregnancy is one that is being protected
by the uterine muscles and manifestations may take later than four (4)
months and only attributes to two percent (2%) of ectopic pregnancy
cases.

When
complainant Editha was
admitted
at Lorma Medical Center on July 28, 1994 due to vaginal bleeding, an
ultra-sound was performed upon her and the result of the Sonogram Test
reveals a morbid fetus but did not specify where the fetus was located.
Obstetricians will assume that the pregnancy is within the uterus unless
so specified by the Sonologist who conducted the ultrasound. Respondent (Dr. Lasam) cannot be faulted if she was not able to
determine that complainant Editha is having an ectopic pregnancy
interstitial. The D&C conducted on Editha is necessary considering that
her cervix is already open and so as to stop the profuse bleeding. Simple
curettage cannot remove a fetus if the patient is having
an ectopic pregnancy, since ectopic pregnancy is pregnancy conceived
outside the uterus and curettage is done only within the uterus.Therefore,
a more extensive operation needed in this case of pregnancy in order to
remove the fetus.[15]

Feeling aggrieved, respondents went to the PRC on appeal. On November


22, 2000, the PRC rendered a Decision[16] reversing the findings of the Board and
revoking petitioners authority or license to practice her profession as a physician.[17]
Petitioner brought the matter to the CA in a Petition for Review under Rule
43 of the Rules of Court. Petitioner also dubbed her petition as one
for certiorari[18] under Rule 65 of the Rules of Court.

In the Decision dated July 4, 2003, the CA held that the Petition for Review
under Rule 43 of the Rules of Court was an improper remedy, as the enumeration of
the quasi-judicial agencies in Rule 43 is exclusive.[19] PRC is not among the quasijudicial bodies whose judgment or final orders are subject of a petition for review to
the CA, thus, the petition for review of the PRC Decision, filed at the CA, was
improper. The CA further held that should the petition be treated as a petition
for certiorari under Rule 65, the same would still be dismissed for being improper
and premature. Citing Section 26[20] of Republic Act (R.A.) No. 2382 or the
Medical Act of 1959, the CA held that the plain, speedy and adequate remedy under
the ordinary course of law which petitioner should have availed herself of was to
appeal to the Office of the President.[21]

Hence, herein petition, assailing the decision of the CA on the


following grounds:

1.

THE COURT OF APPEALS ERRED ON A


QUESTION OF LAW IN HOLDING THAT THE
PROFESSIONAL
REGULATION[S]
COMMISSION
(PRC) WAS EXCLUDED AMONG THE QUASIJUDICIAL AGENCIES CONTEMPLATED UNDER RULE
43 OF THE RULES OF CIVIL PROCEDURE;

2.

EVEN ASSUMING, ARGUENDO, THAT PRC


WAS EXCLUDED FROM THE PURVIEW OF RULE 43
OF THE RULES OF CIVIL PROCEDURE, THE
PETITIONER WAS NOT PRECLUDED FROM FILING A
PETITION FOR CERTIORARI WHERE THE DECISION
WAS ALSO ISSUED IN EXCESS OF OR
WITHOUT JURISDICTION,
OR
WHERE
THE
DECISION WAS A PATENT NULLITY;

3.

HEREIN RESPONDENTS-SPOUSES ARE


NOT ALLOWED BY LAW TO APPEAL FROM THE
DECISION OF THE BOARD OF MEDICINE TO THE
PROFESSIONAL REGULATION[S] COMMISSION;

4.

THE COURT OF APPEALS COMMITTED


GRAVE ABUSE OF DISCRETION IN DENYING FOR
IMPROPER
FORUM
THE
PETITION
FOR

REVIEW/PETITION FOR CERTIORARI WITHOUT


GOING OVER THE MERITS OF THE GROUNDS
RELIED UPON BY THE PETITIONER;

5.

PRCS GRAVE OMISSION TO AFFORD


HEREIN PETITONER A CHANCE TO BE HEARD ON
APPEAL IS A CLEAR VIOLATION OF HER
CONSTITUTIONAL RIGHT TO DUE PROCESS AND
HAS THE EFFECT OF RENDERING THE JUDGMENT
NULL AND VOID;

6.

COROLLARY TO THE FOURTH ASSIGNED


ERROR, PRC COMMITTED GRAVE ABUSE OF
DISCRETION,
AMOUNTING
TO
LACK
OF
JURISDICTION, IN ACCEPTING AND CONSIDERING
THE MEMORANDUM ON APPEAL WITHOUT PROOF
OF SERVICE TO HEREIN PETITIONER, AND IN
VIOLATION OF ART. IV, SEC. 35 OF THE RULES AND
REGULATIONS GOVERNING THE REGULATION AND
PRACTICE OF PROFESSIONALS;

7.

PRC COMMITTED GRAVE ABUSE OF


DISCRETION IN REVOKING PETITIONERS LICENSE
TO PRACTICE MEDICINE WITHOUT AN EXPERT
TESTIMONY TO SUPPORT ITS CONCLUSION AS TO
THE CAUSE OF RESPONDENT EDITHAT [SIC]
RAMOLETES INJURY;

8.

PRC COMMITTED AN EVEN GRAVER


ABUSE OF DISCRETION IN TOTALLY DISREGARDING
THE FINDING OF THE BOARD OF MEDICINE, WHICH
HAD THE NECESSARY COMPETENCE AND
EXPERTISE TO ESTABLISH THE CAUSE OF
RESPONDENT EDITHAS INJURY, AS WELL AS THE
TESTIMONY OF THE EXPERT WITNESS AUGUSTO
MANALO, M.D. ;[AND]

9.

PRC COMMITTED GRAVE ABUSE OF DISCRETION


IN MAKING CONCLUSIONS OF FACTS THAT WERE
NOT ONLY UNSUPPORTED BY EVIDENCE BUT WERE
ACTUALLY CONTRARY TO EVIDENCE ON RECORD.[22]

The Court will first deal with the procedural issues.


Petitioner claims that the law does not allow complainants to
appeal to the PRC from the decision of the Board. She invokes
Article IV, Section 35 of the Rules and Regulations Governing the
Regulation and Practice of Professionals, which provides:
Sec. 35. The respondent may appeal the decision of the Board
within thirty days from receipt thereof to the Commission whose
decision shall be final. Complainant, when allowed by law, may
interpose an appeal from the Decision of the Board within the same
period. (Emphasis supplied)

Petitioner asserts that a careful reading of the above law indicates that while
the respondent, as a matter of right, may appeal the Decision of the Board to the
Commission, the complainant may interpose an appeal from the decision of the
Board only when so allowed by law.[23] Petitioner cited Section 26 of Republic Act
No. 2382 or The Medical Act of 1959, to wit:

Section 26. Appeal from judgment. The decision of the Board of


Medical Examiners (now Medical Board) shall automatically become
final thirty days after the date of its promulgation unless the respondent,
during the same period, has appealed to the Commissioner of Civil
Service (now Professional Regulations Commission) and later to the
Office of the President of the Philippines. If the final decision is not
satisfactory, the respondent may ask for a review of the case, or may file
in court a petition for certiorari.

Petitioner posits that the reason why the Medical Act of 1959 allows only the
respondent in an administrative case to file an appeal with the Commission while
the complainant is not allowed to do so is double jeopardy. Petitioner is of the belief
that the revocation of license to practice a profession is penal in nature.[24]
The Court does not agree.

For one, the principle of double jeopardy finds no application in


administrative cases. Double jeopardy attaches only: (1) upon a
valid indictment; (2) before a competent court; (3) after
arraignment; (4) when a valid plea has been entered; and (5)
when the defendant was acquitted or convicted, or the case was
dismissed or otherwise terminated without the express consent
of the accused.[25] These elements were not present in the
proceedings before the Board of Medicine, as the proceedings
involved in the instant case were administrative and not criminal
in nature. The Court has already held that double jeopardy does
not lie in administrative cases.[26]
Moreover, Section 35 of the Rules and Regulations Governing the
Regulation and Practice of Professionals cited by petitioner was
subsequently amended to read:
Sec. 35. The complainant/respondent may appeal the order, the
resolution or the decision of the Board within thirty (30) days from
receipt thereof to the Commission whose decision shall be final
and executory.Interlocutory order shall not be appealable to the
Commission. (Amended by Res. 174, Series of 1990).[27] (Emphasis
supplied)

Whatever doubt was created by the previous provision was settled


with said amendment. It is axiomatic that the right to appeal is not a natural
right or a part of due process, but a mere statutory privilege that may be
exercised only in the manner prescribed by law.[28] In this case, the clear
intent of the amendment is to render the right to appeal from a decision of
the Board available to both complainants and respondents.

Such conclusion is bolstered by the fact that in 2006, the PRC issued
Resolution No. 06-342(A), or the New Rules of Procedure in Administrative
Investigations in the Professional Regulations Commission and the Professional
Regulatory Boards, which provides for the method of appeal, to wit:

Sec. 1. Appeal; Period Non-Extendible.- The decision, order or


resolution of the Board shall be final and executory after the lapse of
fifteen (15) days from receipt of the decision, order or resolution without

an appeal being perfected or taken by either the respondent or the


complainant. A party aggrieved by the decision, order or resolution
may file a notice of appeal from the decision, order or resolution of
the Board to the Commission within fifteen (15) days from receipt
thereof, and serving upon the adverse party a notice of appeal together
with the appellants brief or memorandum on appeal, and paying the
appeal and legal research fees. x x x[29]

The above-stated provision does not qualify whether only the complainant or
respondent may file an appeal; rather, the new rules provide that a party aggrieved
may file a notice of appeal.Thus, either the complainant or the respondent who has
been aggrieved by the decision, order or resolution of the Board may appeal to the
Commission. It is an elementary rule that when the law speaks in clear and
categorical language, there is no need, in the absence of legislative intent to the
contrary, for any interpretation.[30] Words and phrases used in the statute should be
given their plain, ordinary, and common usage or meaning.[31]

Petitioner also submits that appeals from the decisions of


the PRC should be with the CA, as Rule 43[32] of the Rules of Court
was precisely formulated and adopted to provide for a uniform
rule of appellate procedure for quasi-judicial agencies.
[33]
Petitioner further contends that a quasi-judicial body is not
excluded from the purview of Rule 43 just because it is not
mentioned therein.[34]

On this point, the Court agrees with the petitioner.


Sec. 1, Rule 43 of the Rules of Court provides:
Section 1. Scope. - This Rule shall apply to
appeals from judgments or final orders of the Court of
Tax Appeals, and from awards, judgments, final
orders or resolutions of or authorized by any
quasi-judicial agency in the exercise of its quasijudicial functions. Among these agencies are the Civil
Service Commission, Central Board of Assessment
Appeals, Securities and Exchange Commission, Office of
the President, Land Registration Authority, Social
Security Commission, Civil Aeronautics Board, Bureau of
Patents, Trademarks and Technology Transfer, National

Electrification Administration, Energy Regulatory Board,


National Telecommunications Commission, Department
of Agrarian Reform under Republic Act No. 6657,
Government Service Insurance System, Employees
Compensation Commission, Agricultural Inventions
Board, Insurance Commission, Philippine Atomic Energy
Commission, Board of Investments, Construction
Industry Arbitration Commission, and voluntary
arbitrators authorized by law.(Emphasis supplied)

Indeed, the PRC is not expressly mentioned as one of the agencies which are
expressly enumerated under Section 1, Rule 43 of the Rules of Court. However, its
absence from the enumeration does not, by this fact alone, imply its exclusion from
the coverage of said Rule.[35] The Rule expressly provides that it should be applied
to appeals from awards, judgments final orders or resolutions of any quasi-judicial
agency in the exercise of its quasi-judicial functions. The phrase among these
agencies confirms that the enumeration made in the Rule is not exclusive to the
agencies therein listed.[36]

Specifically, the Court, in Yang v. Court of Appeals,[37] ruled


that Batas Pambansa (B.P.) Blg. 129[38] conferred upon the CA
exclusive appellate jurisdiction over appeals from decisions of the
PRC. The Court held:
The law has since been changed, however, at least
in the matter of the particular court to which appeals
from the Commission should be taken. On August 14,
1981, Batas Pambansa Bilang 129 became effective
and in its Section 29, conferred on the Court of Appeals
exclusive appellate jurisdiction over all final judgments,
decisions, resolutions, orders or awards of Regional Trial
Courts and quasi-judicial agencies, instrumentalities,
boards or commissions except those falling under the
appellate jurisdiction of the Supreme Court. x x x. In
virtue of BP 129, appeals from the Professional
Regulations Commission are now exclusively
cognizable by the Court of Appeals.[39] (Emphasis
supplied)

Clearly, the enactment of B.P. Blg. 129, the precursor of the present Rules of
Civil Procedure,[40] lodged with the CA such jurisdiction over the appeals of
decisions made by the PRC.
Anent the substantive merits of the case, petitioner questions the
PRC decision for being without an expert testimony to support its
conclusion and to establish the cause of Edithas injury.Petitioner
avers that in cases of medical malpractice, expert testimony is
necessary to support the conclusion as to the cause of the injury.
[41]

Medical malpractice is a particular form of negligence which


consists in the failure of a physician or surgeon to apply to his
practice of medicine that degree of care and skill which is
ordinarily employed by the profession generally, under similar
conditions, and in like surrounding circumstances.[42] In order to
successfully pursue such a claim, a patient must prove that the
physician or surgeon either failed to do something which a
reasonably prudent physician or surgeon would not have done,
and that the failure or action caused injury to the patient.[43]
There are four elements involved in medical negligence cases:
duty, breach, injury and proximate causation.[44]

A
physician-patient
relationship
was
created
when Editha employed
the
services
of
the
petitioner. As Edithas physician, petitioner was duty-bound to use
at least the same level of care that any reasonably competent
doctor would use to treat a condition under the same
circumstances.[45] The breach of these professional duties of skill
and care, or their improper performance by a physician surgeon,
whereby the patient is injured in body or in health, constitutes
actionable malpractice.[46] As to this aspect of medical
malpractice, the determination of the reasonable level of care
and the breach thereof, expert testimony is essential. [47] Further,
inasmuch as the causes of the injuries involved in malpractice
actions are determinable only in the light of scientific knowledge,
it has been recognized that expert testimony is usually necessary
to support the conclusion as to causation.[48]

In the present case, respondents did not present any expert


testimony to support their claim that petitioner failed to do
something which a reasonably prudent physician or surgeon
would have done.

Petitioner, on the other hand, presented the testimony of


Dr. Augusto M. Manalo, who was clearly an expert on the subject.

Generally, to qualify as an expert witness, one must have


acquired special knowledge of the subject matter about which he
or she is to testify, either by the study of recognized authorities
on the subject or by practical experience.[49]

Dr. Manalo specializes in gynecology and obstetrics,


authored and co-authored various publications on the subject,
and is a professor at the University of the Philippines.
[50]
According
to
him,
his
diagnosis
of Edithas case
was Ectopic Pregnancy Interstitial (also referred to as Cornual),
Ruptured.[51] In stating that the D&C procedure was not the
proximate cause of the rupture ofEdithas uterus resulting in her
hysterectomy, Dr. Manalo testified as follows:
Atty. Hidalgo:
Q: Doctor, we want to be clarified on this matter. The
complainant had testified here that the D&C was
the proximate cause of the rupture of the
uterus. The condition which she found herself in on
the second admission. Will you please tell us
whether that is true or not?
A: Yah, I do not think so for two reasons. One, as I
have said earlier, the instrument cannot reach the
site of the pregnancy, for it to further push the
pregnancy outside the uterus. And, No. 2, I was
thinking a while ago about another reason- well,
why I dont think so, because it is the triggering
factor for the rupture, it could havethe rupture
could have occurred much earlier, right after the
D&C or a few days after the D&C.

Q: In this particular case, doctor, the rupture occurred to


have happened minutes prior to the hysterectomy
or right upon admission on September 15,
1994 which is about 1 months after the patient
was
discharged,
after
the
D&C
was
conducted. Would you tell us whether there is any
relation at all of the D&C and the rupture in this
particular instance?
A: I dont think so for the two reasons that I have
just mentioned- that it would not be possible
for the instrument to reach the site of
pregnancy. And, No. 2, if it is because of the D&C
that rupture could have occurred earlier.
[52]
(Emphases supplied)

Clearly, from the testimony of the expert witness and the


reasons given by him, it is evident that the D&C procedure was
not the proximate cause of the rupture of Edithas uterus.
During his cross-examination, Dr. Manalo testified on how
he would have addressed Edithas condition should he be placed
in a similar circumstance as the petitioner. He stated:
Atty. Ragonton:
Q: Doctor, as a practicing OB-Gyne, when do you
consider that you have done a good, correct and
ideal dilatation and curettage procedure?
A: Well, if the patient recovers. If the patient gets well.
Because even after the procedure, even after the
procedure you may feel that you have scraped
everything, the patient stops bleeding, she feels
well, I think you should still have some
reservations, and wait a little more time.

Q: If you were the OB-Gyne who performed the


procedure on patient Editha Ramolete, would it be
your standard practice to check the fetal parts or
fetal tissues that were allegedly removed?
A: From what I have removed, yes. But in this particular
case, I think it was assumed that it was part of the

meaty mass which was expelled at the time she


was urinating and flushed in the toilet. So theres
no way.

Q: There was [sic] some portions of the fetal parts that


were removed?
A: No, it was described as scanty scraping if I remember
it rightscanty.

Q: And you would not mind checking those scant or


those little parts that were removed?
A: Well, the fact that it was described means, I
assume that it was checked, no. It was
described as scanty and the color also, I think was
described. Because it would be very unusual,
even improbable that it would not be
examined, because when you scrape, the
specimens are right there before your eyes.
Its in front of you. You can touch it. In fact,
some of them will stick to the instrument
and therefore to peel it off from the
instrument, you have to touch them. So,
automatically they are examined closely.
Q: As a matter of fact, doctor, you also give telephone
orders to your patients through telephone?
A: Yes, yes, we do that, especially here in Manila
because you know, sometimes a doctor can also
be tied-up somewhere and if you have to wait until
he arrive at a certain place before you give the
order, then it would be a lot of time
wasted. Because if you know your patient, if you
have handled your patient, some of the symptoms
you can interpret that comes with practice. And, I
see no reason for not allowing telephone
orders unless it is the first time that you will
be encountering the patient. That you have no
idea what the problem is.

Q: But, doctor, do you discharge patients without seeing


them?

A: Sometimes yes, depending on how familiar I am with


the patient. We are on the question of telephone
orders. I am not saying that that is the idle [sic]
thing to do, but I think the reality of present
day practice somehow justifies telephone
orders. I have patients whom I have justified and
then all of a sudden, late in the afternoon or late in
the evening, would suddenly call they have
decided that they will go home inasmuch as they
anticipated that I will discharge them the following
day. So, I just call and ask our resident on duty or
the nurse to allow them to go because I have seen
that patient and I think I have full grasp of her
problems. So, thats when I make this telephone
orders. And, of course before giving that order I ask
about how she feels.[53] (Emphases supplied)

From the foregoing testimony, it is clear that the D&C procedure was
conducted in accordance with the standard practice, with the same level of care that
any reasonably competent doctor would use to treat a condition under the same
circumstances, and that there was nothing irregular in the way the petitioner dealt
with Editha.

Medical malpractice, in our jurisdiction, is often brought as a


civil action for damages under Article 2176[54] of the Civil
Code. The defenses in an action for damages, provided for under
Article 2179 of the Civil Code are:
Art. 2179. When the plaintiffs own negligence
was the immediate and proximate cause of his
injury, he cannot recover damages. But if his
negligence was only contributory, the immediate and
proximate cause of the injury being the defendants lack
of due care, the plaintiff may recover damages, but the
courts shall mitigate the damages to be awarded.

Proximate cause has been defined as that which, in natural and continuous
sequence, unbroken by any efficient intervening cause, produces injury, and without
which the result would not have occurred. [55] An injury or damage is proximately

caused by an act or a failure to act, whenever it appears from the evidence in the
case that the act or omission played a substantial part in bringing about or actually
causing the injury or damage; and that the injury or damage was either a direct
result or a reasonably probable consequence of the act or omission.[56]

In the present case, the Court notes the findings of the


Board of Medicine:
When complainant was discharged on July 31, 1994,
herein respondent
advised
her
to
return
on August 4, 1994 or four (4) days after the
D&C. This advise was clear in complainants
Discharge Sheet.However, complainant failed to
do so. This being the case, the chain of continuity as
required in order that the doctrine of proximate cause
can be validly invoked was interrupted. Had she
returned, the respondent could have examined
her thoroughly.[57] x x x (Emphases supplied)

Also, in the testimony of Dr. Manalo, he stated further that


assuming that there was in fact a misdiagnosis, the same would
have been rectified if Editha followed the petitioners order to
return for a check-up on August 4, 1994. Dr. Manalo stated:
Granting that the obstetrician-gynecologist has
been misled (justifiably) up to thus point that
there would have been ample opportunity to
rectify the misdiagnosis, had the patient
returned, as instructed for her follow-up
evaluation. It was one and a half months later
that the patient sought consultation with another
doctor. The continued growth of an ectopic pregnancy,
until its eventual rupture, is a dynamic process. Much
change in physical findings could be expected in 1
months, including the emergence of suggestive ones.[58]

It is undisputed that Editha did not return for a follow-up


evaluation, in defiance of the petitioners advise. Editha omitted
the diligence required by the circumstances which could have

avoided the injury. The omission in not returning for a follow-up


evaluation
played
a
substantial
part
in
bringing
about Edithas own injury. Had Editha returned, petitioner could
have conducted the proper medical tests and procedure
necessary to determine Edithas health condition and applied the
corresponding treatment which could have prevented the rupture
of Edithas uterus. The D&C procedure having been conducted in
accordance with the standard medical practice, it is clear
that Edithas omission was the proximate cause of her own injury
and not merely a contributory negligence on her part.

Contributory negligence is the act or omission amounting to


want of ordinary care on the part of the person injured, which,
concurring with the defendants negligence, is the proximate
cause of the injury.[59] Difficulty seems to be apprehended in
deciding which acts of the injured party shall be considered
immediate causes of the accident.[60] Where the immediate cause
of an accident resulting in an injury is the plaintiffs own act, which
contributed to the principal occurrence as one of its determining
factors, he cannot recover damages for the injury.[61] Again,
based on the evidence presented in the present case
under review, in which no negligence can be attributed to
the petitioner, the immediate cause of the accident
resulting in Edithas injury was her own omission when
she did not return for a follow-up check up, in defiance of
petitioners orders. The immediate cause of Edithas injury
was her own act; thus, she cannot recover damages from
the injury.
Lastly, petitioner asserts that her right to due process was
violated because she was never informed by either respondents
or by the PRC that an appeal was pending before the PRC.
[62]
Petitioner claims that a verification with the records section of
the PRC revealed that on April 15, 1999, respondents filed a
Memorandum on Appeal before the PRC, which did not attach the
actual registry receipt but was merely indicated therein.[63]
Respondents, on the other hand avers that if the original registry
receipt was not attached to the Memorandum on Appeal, PRC
would not have entertained the appeal or accepted such
pleading for lack of notice or proof of service on the other party.
[64]
Also, the registry receipt could not be appended to the copy
furnished to petitioners former counsel, because the registry

receipt was already appended to the original copy of the


Memorandum of Appeal filed with PRC.[65]

It is a well-settled rule that when service of notice is an issue, the


rule is that the person alleging that the notice was served must
prove the fact of service. The burden of proving notice rests upon
the party asserting its existence.[66] In the present case,
respondents did not present any proof that petitioner was served
a copy of the Memorandum on Appeal. Thus, respondents were
not able to satisfy the burden of proving that they had in fact
informed the petitioner of the appeal proceedings before the PRC.

In EDI-Staffbuilders International, Inc. v. National Labor


Relations Commission,[67] in which the National Labor Relations
Commission failed to order the private respondent to furnish the
petitioner a copy of the Appeal Memorandum, the Court held that
said failure deprived the petitioner of procedural due process
guaranteed by the Constitution, which could have served as basis
for the nullification of the proceedings in the appeal. The same
holds true in the case at bar. The Court finds that the failure of
the respondents to furnish the petitioner a copy of the
Memorandum of Appeal submitted to the PRC constitutes a
violation of due process. Thus, the proceedings before the PRC
were null and void.

All told, doctors are protected by a special rule of law. They


are not guarantors of care. They are not insurers against mishaps
or unusual consequences[68] specially so if the patient herself did
not exercise the proper diligence required to avoid the injury.

WHEREFORE, the petition is GRANTED. The assailed


Decision of the Court of Appeals dated July 4, 2003 in CA-GR SP
No. 62206 is hereby REVERSED and SET ASIDE. The Decision
of the Board of Medicine dated March 4, 1999 exonerating
petitioner is AFFIRMED. No pronouncement as to costs. SO
ORDERED.
THIRD DIVISION
G.R. No. 142625

December 19, 2006

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 Nogales ("Rogelio") executed and signed the "Consent on Admission and
Agreement"9 and "Admission Agreement."10 Corazon was then brought to the labor room of
the CMC.
Dr. Rosa Uy ("Dr. Uy"), who was then a resident physician of CMC, conducted an internal
examination of Corazon. Dr. Uy then called up Dr. Estrada to notify him of her findings.
Based on the Doctor's Order Sheet,11 around 3:00 a.m., Dr. Estrada ordered for 10 mg. of
valium to be administered immediately by intramuscular injection. Dr. Estrada later ordered
the start of intravenous administration of syntocinon admixed with dextrose, 5%, in lactated
Ringers' solution, at the rate of eight to ten micro-drops per minute.
According to the Nurse's Observation Notes,12 Dr. Joel Enriquez ("Dr. Enriquez"), an
anesthesiologist at CMC, was notified at 4:15 a.m. of Corazon's admission. Subsequently,
when asked if he needed the services of an anesthesiologist, Dr. Estrada refused. Despite
Dr. Estrada's refusal, Dr. Enriquez stayed to observe Corazon's condition.

At 6:00 a.m., Corazon was transferred to Delivery Room No. 1 of the CMC. At 6:10 a.m.,
Corazon's bag of water ruptured spontaneously. At 6:12 a.m., Corazon's cervix was fully
dilated. At 6:13 a.m., Corazon started to experience convulsions.
At 6:15 a.m., Dr. Estrada ordered the injection of ten grams of magnesium sulfate. However,
Dr. Ely Villaflor ("Dr. Villaflor"), who was assisting Dr. Estrada, administered only 2.5 grams of
magnesium sulfate.
At 6:22 a.m., Dr. Estrada, assisted by Dr. Villaflor, applied low forceps to extract Corazon's
baby. In the process, a 1.0 x 2.5 cm. piece of cervical tissue was allegedly torn. The baby
came out in an apnic, cyanotic, weak and injured condition. Consequently, the baby had to
be intubated and resuscitated by Dr. Enriquez and Dr. Payumo.
At 6:27 a.m., Corazon began to manifest moderate vaginal bleeding which rapidly became
profuse. Corazon's blood pressure dropped from 130/80 to 60/40 within five minutes. There
was continuous profuse vaginal bleeding. The assisting nurse administered hemacel through
a gauge 19 needle as a side drip to the ongoing intravenous injection of dextrose.
At 7:45 a.m., Dr. Estrada ordered blood typing and cross matching with bottled blood. It took
approximately 30 minutes for the CMC laboratory, headed by Dr. Perpetua Lacson ("Dr.
Lacson"), to comply with Dr. Estrada's order and deliver the blood.
At 8:00 a.m., Dr. Noe Espinola ("Dr. Espinola"), head of the Obstetrics-Gynecology
Department of the CMC, was apprised of Corazon's condition by telephone. Upon being
informed that Corazon was bleeding profusely, Dr. Espinola ordered immediate
hysterectomy. Rogelio was made to sign a "Consent to Operation." 13
Due to the inclement weather then, Dr. Espinola, who was fetched from his residence by an
ambulance, arrived at the CMC about an hour later or at 9:00 a.m. He examined the patient
and ordered some resuscitative measures to be administered. Despite Dr. Espinola's efforts,
Corazon died at 9:15 a.m. The cause of death was "hemorrhage, post partum." 14
On 14 May 1980, petitioners filed a complaint for damages15 with the Regional Trial Court16 of
Manila against CMC, Dr. Estrada, Dr. Villaflor, Dr. Uy, Dr. Enriquez, Dr. Lacson, Dr. Espinola,
and a certain Nurse J. Dumlao for the death of Corazon. Petitioners mainly contended that
defendant physicians and CMC personnel were negligent in the treatment and management
of Corazon's condition. Petitioners charged CMC with negligence in the selection and
supervision of defendant physicians and hospital staff.
For failing to file their answer to the complaint despite service of summons, the trial court
declared Dr. Estrada, Dr. Enriquez, and Nurse Dumlao in default.17 CMC, Dr. Villaflor, Dr. Uy,
Dr. Espinola, and Dr. Lacson filed their respective answers denying and opposing the
allegations in the complaint. Subsequently, trial ensued.
After more than 11 years of trial, the trial court rendered judgment on 22 November 1993
finding Dr. Estrada solely liable for damages. The trial court ruled as follows:
The victim was under his pre-natal care, apparently, his fault began from his incorrect
and inadequate management and lack of treatment of the pre-eclamptic condition of
his patient. It is not disputed that he misapplied the forceps in causing the delivery
because it resulted in a large cervical tear which had caused the profuse bleeding
which he also failed to control with the application of inadequate injection of
magnesium sulfate by his assistant Dra. Ely Villaflor. Dr. Estrada even failed to notice
the erroneous administration by nurse Dumlao of hemacel by way of side drip,
instead of direct intravenous injection, and his failure to consult a senior obstetrician
at an early stage of the problem.
On the part however of Dra. Ely Villaflor, Dra. Rosa Uy, Dr. Joel Enriquez, Dr.
Lacson, Dr. Espinola, nurse J. Dumlao and CMC, the Court finds no legal justification
to find them civilly liable.

On the part of Dra. Ely Villaflor, she was only taking orders from Dr. Estrada, the
principal physician of Corazon Nogales. She can only make suggestions in the
manner the patient maybe treated but she cannot impose her will as to do so would
be to substitute her good judgment to that of Dr. Estrada. If she failed to correctly
diagnose the true cause of the bleeding which in this case appears to be a cervical
laceration, it cannot be safely concluded by the Court that Dra. Villaflor had the
correct diagnosis and she failed to inform Dr. Estrada. No evidence was introduced
to show that indeed Dra. Villaflor had discovered that there was laceration at the
cervical area of the patient's internal organ.
On the part of nurse Dumlao, there is no showing that when she administered the
hemacel as a side drip, she did it on her own. If the correct procedure was directly
thru the veins, it could only be because this was what was probably the orders of Dr.
Estrada.
While the evidence of the plaintiffs shows that Dr. Noe Espinola, who was the Chief
of the Department of Obstetrics and Gynecology who attended to the patient Mrs.
Nogales, it was only at 9:00 a.m. That he was able to reach the hospital because of
typhoon Didang (Exhibit 2). While he was able to give prescription in the manner
Corazon Nogales may be treated, the prescription was based on the information
given to him by phone and he acted on the basis of facts as presented to him,
believing in good faith that such is the correct remedy. He was not with Dr. Estrada
when the patient was brought to the hospital at 2:30 o'clock a.m. So, whatever errors
that Dr. Estrada committed on the patient before 9:00 o'clock a.m. are certainly the
errors of Dr. Estrada and cannot be the mistake of Dr. Noe Espinola. His failure to
come to the hospital on time was due to fortuitous event.
On the part of Dr. Joel Enriquez, while he was present in the delivery room, it is not
incumbent upon him to call the attention of Dr. Estrada, Dra. Villaflor and also of
Nurse Dumlao on the alleged errors committed by them. Besides, as
anesthesiologist, he has no authority to control the actuations of Dr. Estrada and Dra.
Villaflor. For the Court to assume that there were errors being committed in the
presence of Dr. Enriquez would be to dwell on conjectures and speculations.
On the civil liability of Dr. Perpetua Lacson, [s]he is a hematologist and in-charge of
the blood bank of the CMC. The Court cannot accept the theory of the plaintiffs that
there was delay in delivering the blood needed by the patient. It was testified, that in
order that this blood will be made available, a laboratory test has to be conducted to
determine the type of blood, cross matching and other matters consistent with
medical science so, the lapse of 30 minutes maybe considered a reasonable time to
do all of these things, and not a delay as the plaintiffs would want the Court to
believe.
Admittedly, Dra. Rosa Uy is a resident physician of the Capitol Medical Center. She
was sued because of her alleged failure to notice the incompetence and negligence
of Dr. Estrada. However, there is no evidence to support such theory. No evidence
was adduced to show that Dra. Rosa Uy as a resident physician of Capitol Medical
Center, had knowledge of the mismanagement of the patient Corazon Nogales, and
that notwithstanding such knowledge, she tolerated the same to happen.
In the pre-trial order, plaintiffs and CMC agreed that defendant CMC did not have any
hand or participation in the selection or hiring of Dr. Estrada or his assistant Dra. Ely
Villaflor as attending physician[s] of the deceased. In other words, the two (2) doctors
were not employees of the hospital and therefore the hospital did not have control
over their professional conduct. When Mrs. Nogales was brought to the hospital, it
was an emergency case and defendant CMC had no choice but to admit her. Such
being the case, there is therefore no legal ground to apply the provisions of Article
2176 and 2180 of the New Civil Code referring to the vicarious liability of an
employer for the negligence of its employees. If ever in this case there is fault or
negligence in the treatment of the deceased on the part of the attending physicians
who were employed by the family of the deceased, such civil liability should be borne
by the attending physicians under the principle of "respondeat superior".

WHEREFORE, premises considered, judgment is hereby rendered finding defendant


Dr. Estrada of Number 13 Pitimini St. San Francisco del Monte, Quezon City civilly
liable to pay plaintiffs: 1) By way of actual damages in the amount of P105,000.00; 2)
By way of moral damages in the amount of P700,000.00; 3) Attorney's fees in the
amount of P100,000.00 and to pay the costs of suit.
For failure of the plaintiffs to adduce evidence to support its [sic] allegations against
the other defendants, the complaint is hereby ordered dismissed. While the Court
looks with disfavor the filing of the present complaint against the other defendants by
the herein plaintiffs, as in a way it has caused them personal inconvenience and
slight damage on their name and reputation, the Court cannot accepts [sic] however,
the theory of the remaining defendants that plaintiffs were motivated in bad faith in
the filing of this complaint. For this reason defendants' counterclaims are hereby
ordered dismissed.
SO ORDERED.18
Petitioners appealed the trial court's decision. Petitioners claimed that aside from Dr.
Estrada, the remaining respondents should be held equally liable for negligence. Petitioners
pointed out the extent of each respondent's alleged liability.
On 6 February 1998, the Court of Appeals affirmed the decision of the trial court. 19 Petitioners
filed a motion for reconsideration which the Court of Appeals denied in its Resolution of 21
March 2000.20
Hence, this petition.
Meanwhile, petitioners filed a Manifestation dated 12 April 2002 21 stating that respondents Dr.
Estrada, Dr. Enriquez, Dr. Villaflor, and Nurse Dumlao "need no longer be notified of the
petition because they are absolutely not involved in the issue raised before the [Court],
regarding the liability of [CMC]."22 Petitioners stressed that the subject matter of this petition
is the liability of CMC for the negligence of Dr. Estrada.23
The Court issued a Resolution dated 9 September 200224 dispensing with the requirement to
submit the correct and present addresses of respondents Dr. Estrada, Dr. Enriquez, Dr.
Villaflor, and Nurse Dumlao. The Court stated that with the filing of petitioners' Manifestation,
it should be understood that they are claiming only against respondents CMC, Dr. Espinola,
Dr. Lacson, and Dr. Uy who have filed their respective comments. Petitioners are foregoing
further claims against respondents Dr. Estrada, Dr. Enriquez, Dr. Villaflor, and Nurse Dumlao.
The Court noted that Dr. Estrada did not appeal the decision of the Court of Appeals
affirming the decision of the Regional Trial Court. Accordingly, the decision of the Court of
Appeals, affirming the trial court's judgment, is already final as against Dr. Oscar Estrada.
Petitioners filed a motion for reconsideration25 of the Court's 9 September 2002 Resolution
claiming that Dr. Enriquez, Dr. Villaflor and Nurse Dumlao were notified of the petition at their
counsels' last known addresses. Petitioners reiterated their imputation of negligence on
these respondents. The Court denied petitioners' Motion for Reconsideration in its 18
February 2004 Resolution.26
The Court of Appeals' Ruling
In its Decision of 6 February 1998, the Court of Appeals upheld the trial court's ruling. The
Court of Appeals rejected petitioners' view that the doctrine in Darling v. Charleston
Community Memorial Hospital27 applies to this case. According to the Court of Appeals, the
present case differs from the Darling case since Dr. Estrada is an independent contractorphysician whereas the Darling case involved a physician and a nurse who were employees
of the hospital.
Citing other American cases, the Court of Appeals further held that the mere fact that a
hospital permitted a physician to practice medicine and use its facilities is not sufficient to

render the hospital liable for the physician's negligence. 28 A hospital is not responsible for the
negligence of a physician who is an independent contractor.29
The Court of Appeals found the cases of Davidson v. Conole30 and Campbell v. Emma Laing
Stevens Hospital31applicable to this case. Quoting Campbell, the Court of Appeals stated that
where there is no proof that defendant physician was an employee of defendant hospital or
that defendant hospital had reason to know that any acts of malpractice would take place,
defendant hospital could not be held liable for its failure to intervene in the relationship of
physician-patient between defendant physician and plaintiff.
On the liability of the other respondents, the Court of Appeals applied the "borrowed servant"
doctrine considering that Dr. Estrada was an independent contractor who was merely
exercising hospital privileges. This doctrine provides that once the surgeon enters the
operating room and takes charge of the proceedings, the acts or omissions of operating
room personnel, and any negligence associated with such acts or omissions, are imputable
to the surgeon.32 While the assisting physicians and nurses may be employed by the
hospital, or engaged by the patient, they normally become the temporary servants or agents
of the surgeon in charge while the operation is in progress, and liability may be imposed
upon the surgeon for their negligent acts under the doctrine of respondeat superior.33
The Court of Appeals concluded that since Rogelio engaged Dr. Estrada as the attending
physician of his wife, any liability for malpractice must be Dr. Estrada's sole responsibility.
While it found the amount of damages fair and reasonable, the Court of Appeals held that no
interest could be imposed on unliquidated claims or damages.
The Issue
Basically, the issue in this case is whether CMC is vicariously liable for the negligence of Dr.
Estrada. The resolution of this issue rests, on the other hand, on the ascertainment of the
relationship between Dr. Estrada and CMC. The Court also believes that a determination of
the extent of liability of the other respondents is inevitable to finally and completely dispose
of the present controversy.
The Ruling of the Court
The petition is partly meritorious.
On the Liability of CMC
Dr. Estrada's negligence in handling the treatment and management of Corazon's condition
which ultimately resulted in Corazon's death is no longer in issue. Dr. Estrada did not appeal
the decision of the Court of Appeals which affirmed the ruling of the trial court finding Dr.
Estrada solely liable for damages. Accordingly, the finding of the trial court on Dr. Estrada's
negligence is already final.
Petitioners maintain that CMC is vicariously liable for Dr. Estrada's negligence based on
Article 2180 in relation to Article 2176 of the Civil Code. These provisions pertinently state:
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.
xxxx
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.
xxxx

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.
Art. 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 quasidelict and is governed by the provisions of this Chapter.
Similarly, in the United States, a hospital which is the employer, master, or principal of a
physician employee, servant, or agent, may be held liable for the physician's negligence
under the doctrine of respondeat superior.34
In the present case, petitioners maintain that CMC, in allowing Dr. Estrada to practice and
admit patients at CMC, should be liable for Dr. Estrada's malpractice. Rogelio claims that he
knew Dr. Estrada as an accredited physician of CMC, though he discovered later that Dr.
Estrada was not a salaried employee of the CMC.35 Rogelio further claims that he was
dealing with CMC, whose primary concern was the treatment and management of his wife's
condition. Dr. Estrada just happened to be the specific person he talked to representing
CMC.36 Moreover, the fact that CMC made Rogelio sign a Consent on Admission and
Admission Agreement37 and a Consent to Operation printed on the letterhead of CMC
indicates that CMC considered Dr. Estrada as a member of its medical staff.
On the other hand, CMC disclaims liability by asserting that Dr. Estrada was a mere visiting
physician and that it admitted Corazon because her physical condition then was classified an
emergency obstetrics case.38
CMC alleges that Dr. Estrada is an independent contractor "for whose actuations CMC would
be a total stranger." CMC maintains that it had no control or supervision over Dr. Estrada in
the exercise of his medical profession.
The Court had the occasion to determine the relationship between a hospital and a
consultant or visiting physician and the liability of such hospital for that physician's
negligence in Ramos v. Court of Appeals,39 to wit:
In the first place, hospitals exercise significant control in the hiring and firing of
consultants and in the conduct of their work within the hospital premises. Doctors
who apply for "consultant" slots, visiting or attending, are required to submit proof of
completion of residency, their educational qualifications; generally, evidence of
accreditation by the appropriate board (diplomate), evidence of fellowship in most
cases, and references. These requirements are carefully scrutinized by members of
the hospital administration or by a review committee set up by the hospital who either
accept or reject the application. This is particularly true with respondent hospital.
After a physician is accepted, either as a visiting or attending consultant, he is
normally required to attend clinico-pathological conferences, conduct bedside rounds
for clerks, interns and residents, moderate grand rounds and patient audits and
perform other tasks and responsibilities, for the privilege of being able to maintain a
clinic in the hospital, and/or for the privilege of admitting patients into the hospital. In
addition to these, the physician's performance as a specialist is generally evaluated
by a peer review committee on the basis of mortality and morbidity statistics, and
feedback from patients, nurses, interns and residents. A consultant remiss in his
duties, or a consultant who regularly falls short of the minimum standards acceptable
to the hospital or its peer review committee, is normally politely terminated.
In other words, private hospitals, hire, fire and exercise real control over their
attending and visiting "consultant" staff. While "consultants" are not, technically
employees, a point which respondent hospital asserts in denying all
responsibility for the patient's condition, the control exercised, the hiring, and
the right to terminate consultants all fulfill the important hallmarks of an
employer-employee relationship, with the exception of the payment of wages.
In assessing whether such a relationship in fact exists, the control test is

determining. Accordingly, on the basis of the foregoing, we rule that for the
purpose of allocating responsibility in medical negligence cases, an employeremployee relationship in effect exists between hospitals and their attending
and visiting physicians. This being the case, the question now arises as to whether
or not respondent hospital is solidarily liable with respondent doctors for petitioner's
condition.
The basis for holding an employer solidarily responsible for the negligence of its
employee is found in Article 2180 of the Civil Code which considers a person
accountable not only for his own acts but also for those of others based on the
former's responsibility under a relationship of patria potestas. x x x40(Emphasis
supplied)
While the Court in Ramos did not expound on the control test, such test essentially
determines whether an employment relationship exists between a physician and a hospital
based on the exercise of control over the physician as to details. Specifically, the employer
(or the hospital) must have the right to control both the means and the details of the process
by which the employee (or the physician) is to accomplish his task.41
After a thorough examination of the voluminous records of this case, the Court finds no
single evidence pointing to CMC's exercise of control over Dr. Estrada's treatment and
management of Corazon's condition. It is undisputed that throughout Corazon's pregnancy,
she was under the exclusive prenatal care of Dr. Estrada. At the time of Corazon's admission
at CMC and during her delivery, it was Dr. Estrada, assisted by Dr. Villaflor, who attended to
Corazon. There was no showing that CMC had a part in diagnosing Corazon's condition.
While Dr. Estrada enjoyed staff privileges at CMC, such fact alone did not make him an
employee of CMC.42 CMC merely allowed Dr. Estrada to use its facilities43 when Corazon was
about to give birth, which CMC considered an emergency. Considering these circumstances,
Dr. Estrada is not an employee of CMC, but an independent contractor.
The question now is whether CMC is automatically exempt from liability considering that Dr.
Estrada is an independent contractor-physician.
In general, a hospital is not liable for the negligence of an independent contractor-physician.
There is, however, an exception to this principle. The hospital may be liable if the physician is
the "ostensible" agent of the hospital.44This exception is also known as the "doctrine of
apparent authority."45 In Gilbert v. Sycamore Municipal Hospital,46 the Illinois Supreme Court
explained the doctrine of apparent authority in this wise:
[U]nder the doctrine of apparent authority a hospital can be held vicariously liable for
the negligent acts of a physician providing care at the hospital, regardless of whether
the physician is an independent contractor, unless the patient knows, or should have
known, that the physician is an independent contractor. The elements of the action
have been set out as follows:
"For a hospital to be liable under the doctrine of apparent authority, a plaintiff must
show that: (1) the hospital, or its agent, acted in a manner that would lead a
reasonable person to conclude that the individual who was alleged to be negligent
was an employee or agent of the hospital; (2) where the acts of the agent create the
appearance of authority, the plaintiff must also prove that the hospital had knowledge
of and acquiesced in them; and (3) the plaintiff acted in reliance upon the conduct of
the hospital or its agent, consistent with ordinary care and prudence."
The element of "holding out" on the part of the hospital does not require an express
representation by the hospital that the person alleged to be negligent is an employee.
Rather, the element is satisfied if the hospital holds itself out as a provider of
emergency room care without informing the patient that the care is provided by
independent contractors.
The element of justifiable reliance on the part of the plaintiff is satisfied if the plaintiff
relies upon the hospital to provide complete emergency room care, rather than upon
a specific physician.

The doctrine of apparent authority essentially involves two factors to determine the liability of
an independent-contractor physician.
The first factor focuses on the hospital's manifestations and is sometimes described as an
inquiry whether the hospital acted in a manner which would lead a reasonable person to
conclude that the individual who was alleged to be negligent was an employee or agent of
the hospital.47 In this regard, the hospital need not make express representations to the
patient that the treating physician is an employee of the hospital; rather a
representation may be general and implied.48
The doctrine of apparent authority is a species of the doctrine of estoppel. Article 1431 of the
Civil Code provides that "[t]hrough 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." Estoppel rests on this rule: "Whenever a party has, by his own
declaration, act, or omission, intentionally and deliberately led another to believe a particular
thing true, and to act upon such belief, he cannot, in any litigation arising out of such
declaration, act or omission, be permitted to falsify it." 49
In the instant case, CMC impliedly held out Dr. Estrada as a member of its medical staff.
Through CMC's acts, CMC clothed Dr. Estrada with apparent authority thereby leading the
Spouses Nogales to believe that Dr. Estrada was an employee or agent of CMC. CMC
cannot now repudiate such authority.
First, CMC granted staff privileges to Dr. Estrada. CMC extended its medical staff and
facilities to Dr. Estrada. Upon Dr. Estrada's request for Corazon's admission, CMC, through
its personnel, readily accommodated Corazon and updated Dr. Estrada of her condition.
Second, CMC made Rogelio sign consent forms printed on CMC letterhead. Prior to
Corazon's admission and supposed hysterectomy, CMC asked Rogelio to sign release
forms, the contents of which reinforced Rogelio's belief that Dr. Estrada was a member of
CMC's medical staff.50 The Consent on Admission and Agreement explicitly provides:
KNOW ALL MEN BY THESE PRESENTS:
I, Rogelio Nogales, of legal age, a resident of 1974 M. H. Del Pilar St., Malate Mla.,
being the father/mother/brother/sister/spouse/relative/ guardian/or person in custody
of Ma. Corazon, and representing his/her family, of my own volition and free will, do
consent and submit said Ma. Corazon to Dr. Oscar Estrada (hereinafter referred to
as Physician) for cure, treatment, retreatment, or emergency measures, that the
Physician, personally or by and through the Capitol Medical Center and/or its
staff, may use, adapt, or employ such means, forms or methods of cure,
treatment, retreatment, or emergency measures as he may see best and most
expedient; that Ma. Corazon and I will comply with any and all rules,
regulations, directions, and instructions of the Physician, the Capitol Medical
Center and/or its staff; and, that I will not hold liable or responsible and hereby
waive and forever discharge and hold free the Physician, the Capitol Medical Center
and/or its staff, from any and all claims of whatever kind of nature, arising from
directly or indirectly, or by reason of said cure, treatment, or retreatment, or
emergency measures or intervention of said physician, the Capitol Medical Center
and/or its staff.
x x x x51 (Emphasis supplied)
While the Consent to Operation pertinently reads, thus:
I, ROGELIO NOGALES, x x x, of my own volition and free will, do consent and
submit said CORAZON NOGALES to Hysterectomy, by the Surgical Staff and
Anesthesiologists of Capitol Medical Centerand/or whatever succeeding
operations, treatment, or emergency measures as may be necessary and most
expedient; and, that I will not hold liable or responsible and hereby waive and forever
discharge and hold free the Surgeon, his assistants, anesthesiologists, the Capitol
Medical Center and/or its staff, from any and all claims of whatever kind of nature,

arising from directly or indirectly, or by reason of said operation or operations,


treatment, or emergency measures, or intervention of the Surgeon, his assistants,
anesthesiologists, the Capitol Medical Center and/or its staff. 52 (Emphasis supplied)
Without any indication in these consent forms that Dr. Estrada was an independent
contractor-physician, the Spouses Nogales could not have known that Dr. Estrada was an
independent contractor. Significantly, no one from CMC informed the Spouses Nogales that
Dr. Estrada was an independent contractor. On the contrary, Dr. Atencio, who was then a
member of CMC Board of Directors, testified that Dr. Estrada was part of CMC's surgical
staff.53
Third, Dr. Estrada's referral of Corazon's profuse vaginal bleeding to Dr. Espinola, who was
then the Head of the Obstetrics and Gynecology Department of CMC, gave the impression
that Dr. Estrada as a member of CMC's medical staff was collaborating with other CMCemployed specialists in treating Corazon.
The second factor focuses on the patient's reliance. It is sometimes characterized as an
inquiry on whether the plaintiff acted in reliance upon the conduct of the hospital or its agent,
consistent with ordinary care and prudence.54
The records show that the Spouses Nogales relied upon a perceived employment
relationship with CMC in accepting Dr. Estrada's services. Rogelio testified that he and his
wife specifically chose Dr. Estrada to handle Corazon's delivery not only because of their
friend's recommendation, but more importantly because of Dr. Estrada's "connection with a
reputable hospital, the [CMC]."55 In other words, Dr. Estrada's relationship with CMC played a
significant role in the Spouses Nogales' decision in accepting Dr. Estrada's services as the
obstetrician-gynecologist for Corazon's delivery. Moreover, as earlier stated, there is no
showing that before and during Corazon's confinement at CMC, the Spouses Nogales knew
or should have known that Dr. Estrada was not an employee of CMC.
Further, the Spouses Nogales looked to CMC to provide the best medical care and support
services for Corazon's delivery. The Court notes that prior to Corazon's fourth pregnancy,
she used to give birth inside a clinic. Considering Corazon's age then, the Spouses Nogales
decided to have their fourth child delivered at CMC, which Rogelio regarded one of the best
hospitals at the time.56 This is precisely because the Spouses Nogales feared that Corazon
might experience complications during her delivery which would be better addressed and
treated in a modern and big hospital such as CMC. Moreover, Rogelio's consent in
Corazon's hysterectomy to be performed by a different physician, namely Dr. Espinola, is a
clear indication of Rogelio's confidence in CMC's surgical staff.
CMC's defense that all it did was "to extend to [Corazon] its facilities" is untenable. The Court
cannot close its eyes to the reality that hospitals, such as CMC, are in the business of
treatment. In this regard, the Court agrees with the observation made by the Court of
Appeals of North Carolina in Diggs v. Novant Health, Inc.,57 to wit:
"The conception that the hospital does not undertake to treat the patient, does not
undertake to act through its doctors and nurses, but undertakes instead simply to
procure them to act upon their own responsibility, no longer reflects the fact. Present
day hospitals, as their manner of operation plainly demonstrates, do far more
than furnish facilities for treatment. They regularly employ on a salary basis a
large staff of physicians, nurses and internes [sic], as well as administrative
and manual workers, and they charge patients for medical care and treatment,
collecting for such services, if necessary, by legal action. Certainly, the person
who avails himself of 'hospital facilities' expects that the hospital will attempt
to cure him, not that its nurses or other employees will act on their own
responsibility." x x x (Emphasis supplied)
Likewise unconvincing is CMC's argument that petitioners are estopped from claiming
damages based on the Consent on Admission and Consent to Operation. Both release forms
consist of two parts. The first part gave CMC permission to administer to Corazon any form
of recognized medical treatment which the CMC medical staff deemed advisable. The
second part of the documents, which may properly be described as the releasing part,

releases CMC and its employees "from any and all claims" arising from or by reason of the
treatment and operation.
The documents do not expressly release CMC from liability for injury to Corazon due to
negligence during her treatment or operation. Neither do the consent forms expressly
exempt CMC from liability for Corazon's death due to negligence during such treatment or
operation. Such release forms, being in the nature of contracts of adhesion, are construed
strictly against hospitals. Besides, a blanket release in favor of hospitals "from any and all
claims," which includes claims due to bad faith or gross negligence, would be contrary to
public policy and thus void.
Even simple negligence is not subject to blanket release in favor of establishments like
hospitals but may only mitigate liability depending on the circumstances. 58 When a person
needing urgent medical attention rushes to a hospital, he cannot bargain on equal footing
with the hospital on the terms of admission and operation. Such a person is literally at the
mercy of the hospital. There can be no clearer example of a contract of adhesion than one
arising from such a dire situation. Thus, the release forms of CMC cannot relieve CMC from
liability for the negligent medical treatment of Corazon.
On the Liability of the Other Respondents
Despite this Court's pronouncement in its 9 September 200259 Resolution that the filing of
petitioners' Manifestation confined petitioners' claim only against CMC, Dr. Espinola, Dr.
Lacson, and Dr. Uy, who have filed their comments, the Court deems it proper to resolve the
individual liability of the remaining respondents to put an end finally to this more than twodecade old controversy.
a) Dr. Ely Villaflor
Petitioners blame Dr. Ely Villaflor for failing to diagnose the cause of Corazon's bleeding and
to suggest the correct remedy to Dr. Estrada.60 Petitioners assert that it was Dr. Villaflor's
duty to correct the error of Nurse Dumlao in the administration of hemacel.
The Court is not persuaded. Dr. Villaflor admitted administering a lower dosage of
magnesium sulfate. However, this was after informing Dr. Estrada that Corazon was no
longer in convulsion and that her blood pressure went down to a dangerous level. 61 At that
moment, Dr. Estrada instructed Dr. Villaflor to reduce the dosage of magnesium sulfate from
10 to 2.5 grams. Since petitioners did not dispute Dr. Villaflor's allegation, Dr. Villaflor's
defense remains uncontroverted. Dr. Villaflor's act of administering a lower dosage of
magnesium sulfate was not out of her own volition or was in contravention of Dr. Estrada's
order.
b) Dr. Rosa Uy
Dr. Rosa Uy's alleged negligence consisted of her failure (1) to call the attention of Dr.
Estrada on the incorrect dosage of magnesium sulfate administered by Dr. Villaflor; (2) to
take corrective measures; and (3) to correct Nurse Dumlao's wrong method of hemacel
administration.
The Court believes Dr. Uy's claim that as a second year resident physician then at CMC, she
was merely authorized to take the clinical history and physical examination of
Corazon.62 However, that routine internal examination did not ipso facto make Dr. Uy liable
for the errors committed by Dr. Estrada. Further, petitioners' imputation of negligence rests
on their baseless assumption that Dr. Uy was present at the delivery room. Nothing shows
that Dr. Uy participated in delivering Corazon's baby. Further, it is unexpected from Dr. Uy, a
mere resident physician at that time, to call the attention of a more experienced specialist, if
ever she was present at the delivery room.
c) Dr. Joel Enriquez

Petitioners fault Dr. Joel Enriquez also for not calling the attention of Dr. Estrada, Dr. Villaflor,
and Nurse Dumlao about their errors.63 Petitioners insist that Dr. Enriquez should have taken,
or at least suggested, corrective measures to rectify such errors.
The Court is not convinced. Dr. Enriquez is an anesthesiologist whose field of expertise is
definitely not obstetrics and gynecology. As such, Dr. Enriquez was not expected to correct
Dr. Estrada's errors. Besides, there was no evidence of Dr. Enriquez's knowledge of any
error committed by Dr. Estrada and his failure to act upon such observation.
d) Dr. Perpetua Lacson
Petitioners fault Dr. Perpetua Lacson for her purported delay in the delivery of blood Corazon
needed.64Petitioners claim that Dr. Lacson was remiss in her duty of supervising the blood
bank staff.
As found by the trial court, there was no unreasonable delay in the delivery of blood from the
time of the request until the transfusion to Corazon. Dr. Lacson competently explained the
procedure before blood could be given to the patient. 65 Taking into account the bleeding time,
clotting time and cross-matching, Dr. Lacson stated that it would take approximately 45-60
minutes before blood could be ready for transfusion.66 Further, no evidence exists that Dr.
Lacson neglected her duties as head of the blood bank.
e) Dr. Noe Espinola
Petitioners argue that Dr. Espinola should not have ordered immediate hysterectomy without
determining the underlying cause of Corazon's bleeding. Dr. Espinola should have first
considered the possibility of cervical injury, and advised a thorough examination of the
cervix, instead of believing outright Dr. Estrada's diagnosis that the cause of bleeding was
uterine atony.
Dr. Espinola's order to do hysterectomy which was based on the information he received by
phone is not negligence. The Court agrees with the trial court's observation that Dr. Espinola,
upon hearing such information about Corazon's condition, believed in good faith that
hysterectomy was the correct remedy. At any rate, the hysterectomy did not push through
because upon Dr. Espinola's arrival, it was already too late. At the time, Corazon was
practically dead.
f) Nurse J. Dumlao
In Moore v. Guthrie Hospital Inc.,67 the US Court of Appeals, Fourth Circuit, held that to
recover, a patient complaining of injuries allegedly resulting when the nurse negligently
injected medicine to him intravenously instead of intramuscularly had to show that (1) an
intravenous injection constituted a lack of reasonable and ordinary care; (2) the nurse
injected medicine intravenously; and (3) such injection was the proximate cause of his injury.
In the present case, there is no evidence of Nurse Dumlao's alleged failure to follow Dr.
Estrada's specific instructions. Even assuming Nurse Dumlao defied Dr. Estrada's order,
there is no showing that side-drip administration of hemacel proximately caused Corazon's
death. No evidence linking Corazon's death and the alleged wrongful hemacel administration
was introduced. Therefore, there is no basis to hold Nurse Dumlao liable for negligence.
On the Award of Interest on Damages
The award of interest on damages is proper and allowed under Article 2211 of the Civil Code,
which states that in crimes and quasi-delicts, interest as a part of the damages may, in a
proper case, be adjudicated in the discretion of the court.68
WHEREFORE, the Court PARTLY GRANTS the petition. The Court finds respondent Capitol
Medical Center vicariously liable for the negligence of Dr. Oscar Estrada. The amounts
of P105,000 as actual damages andP700,000 as moral damages should each earn legal
interest at the rate of six percent (6%) per annum computed from the date of the judgment of

the trial court. The Court affirms the rest of the Decision dated 6 February 1998 and
Resolution dated 21 March 2000 of the Court of Appeals in CA-G.R. CV No. 45641.
SO ORDERED.
Quisumbing, J., Chairperson, Carpio Morales, Tinga, and Velasco, Jr., JJ., concur.

G.R. No. 126297

January 31, 2007

PROFESSIONAL SERVICES, INC., Petitioner,


vs.
NATIVIDAD and ENRIQUE AGANA, Respondents.
x-----------------------x
G.R. No. 126467

January 31, 2007

NATIVIDAD (Substituted by her children MARCELINO AGANA III, ENRIQUE AGANA,


JR., EMMA AGANA ANDAYA, JESUS AGANA, and RAYMUND AGANA) and ENRIQUE
AGANA, Petitioners,
vs.
JUAN FUENTES, Respondent.
x- - - - - - - - - - - - - - - - - - - -- - - - x
G.R. No. 127590

January 31, 2007

MIGUEL AMPIL, Petitioner,


vs.
NATIVIDAD AGANA and ENRIQUE AGANA, Respondents.
DECISION
SANDOVAL-GUTIERREZ, J.:
Hospitals, having undertaken one of mankinds most important and delicate endeavors, must
assume the grave responsibility of pursuing it with appropriate care. The care and service
dispensed through this high trust, however technical, complex and esoteric its character may
be, must meet standards of responsibility commensurate with the undertaking to preserve
and protect the health, and indeed, the very lives of those placed in the hospitals keeping. 1
Assailed in these three consolidated petitions for review on certiorari is the Court of Appeals
Decision2 dated September 6, 1996 in CA-G.R. CV No. 42062 and CA-G.R. SP No. 32198
affirming with modification the Decision3 dated March 17, 1993 of the Regional Trial Court
(RTC), Branch 96, Quezon City in Civil Case No. Q-43322 and nullifying its Order dated
September 21, 1993.
The facts, as culled from the records, are:
On April 4, 1984, Natividad Agana was rushed to the Medical City General Hospital (Medical
City Hospital) because of difficulty of bowel movement and bloody anal discharge. After a
series of medical examinations, Dr. Miguel Ampil, petitioner in G.R. No. 127590, diagnosed
her to be suffering from "cancer of the sigmoid."
On April 11, 1984, Dr. Ampil, assisted by the medical staff4 of the Medical City Hospital,
performed an anterior resection surgery on Natividad. He found that the malignancy in her
sigmoid area had spread on her left ovary, necessitating the removal of certain portions of it.
Thus, Dr. Ampil obtained the consent of Natividads husband, Enrique Agana, to permit Dr.
Juan Fuentes, respondent in G.R. No. 126467, to perform hysterectomy on her.
After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the
operation and closed the incision.
However, the operation appeared to be flawed. In the corresponding Record of Operation
dated April 11, 1984, the attending nurses entered these remarks:
"sponge count lacking 2

"announced to surgeon searched (sic) done but to no avail continue for closure."
On April 24, 1984, Natividad was released from the hospital. Her hospital and medical bills,
including the doctors fees, amounted to P60,000.00.
After a couple of days, Natividad complained of excruciating pain in her anal region. She
consulted both Dr. Ampil and Dr. Fuentes about it. They told her that the pain was the natural
consequence of the surgery. Dr. Ampil then recommended that she consult an oncologist to
examine the cancerous nodes which were not removed during the operation.
On May 9, 1984, Natividad, accompanied by her husband, went to the United States to seek
further treatment. After four months of consultations and laboratory examinations, Natividad
was told she was free of cancer. Hence, she was advised to return to the Philippines.
On August 31, 1984, Natividad flew back to the Philippines, still suffering from pains. Two
weeks thereafter, her daughter found a piece of gauze protruding from her vagina. Upon
being informed about it, Dr. Ampil proceeded to her house where he managed to extract by
hand a piece of gauze measuring 1.5 inches in width. He then assured her that the pains
would soon vanish.
Dr. Ampils assurance did not come true. Instead, the pains intensified, prompting Natividad
to seek treatment at the Polymedic General Hospital. While confined there, Dr. Ramon
Gutierrez detected the presence of another foreign object in her vagina -- a foul-smelling
gauze measuring 1.5 inches in width which badly infected her vaginal vault. A recto-vaginal
fistula had formed in her reproductive organs which forced stool to excrete through the
vagina. Another surgical operation was needed to remedy the damage. Thus, in October
1984, Natividad underwent another surgery.
On November 12, 1984, Natividad and her husband filed with the RTC, Branch 96, Quezon
City a complaint for damages against the Professional Services, Inc. (PSI), owner of the
Medical City Hospital, Dr. Ampil, and Dr. Fuentes, docketed as Civil Case No. Q-43322. They
alleged that the latter are liable for negligence for leaving two pieces of gauze inside
Natividads body and malpractice for concealing their acts of negligence.
Meanwhile, Enrique Agana also filed with the Professional Regulation Commission (PRC) an
administrative complaint for gross negligence and malpractice against Dr. Ampil and Dr.
Fuentes, docketed as Administrative Case No. 1690. The PRC Board of Medicine heard the
case only with respect to Dr. Fuentes because it failed to acquire jurisdiction over Dr. Ampil
who was then in the United States.
On February 16, 1986, pending the outcome of the above cases, Natividad died and was
duly substituted by her above-named children (the Aganas).
On March 17, 1993, the RTC rendered its Decision in favor of the Aganas, finding PSI, Dr.
Ampil and Dr. Fuentes liable for negligence and malpractice, the decretal part of which
reads:
WHEREFORE, judgment is hereby rendered for the plaintiffs ordering the defendants
PROFESSIONAL SERVICES, INC., DR. MIGUEL AMPIL and DR. JUAN FUENTES to pay to
the plaintiffs, jointly and severally, except in respect of the award for exemplary damages and
the interest thereon which are the liabilities of defendants Dr. Ampil and Dr. Fuentes only, as
follows:
1. As actual damages, the following amounts:
a. The equivalent in Philippine Currency of the total of US$19,900.00 at the
rate of P21.60-US$1.00, as reimbursement of actual expenses incurred in
the United States of America;
b. The sum of P4,800.00 as travel taxes of plaintiffs and their physician
daughter;

c. The total sum of P45,802.50, representing the cost of hospitalization at


Polymedic Hospital, medical fees, and cost of the saline solution;
2. As moral damages, the sum of P2,000,000.00;
3. As exemplary damages, the sum of P300,000.00;
4. As attorneys fees, the sum of P250,000.00;
5. Legal interest on items 1 (a), (b), and (c); 2; and 3 hereinabove, from date of filing
of the complaint until full payment; and
6. Costs of suit.
SO ORDERED.
Aggrieved, PSI, Dr. Fuentes and Dr. Ampil interposed an appeal to the Court of Appeals,
docketed as CA-G.R. CV No. 42062.
Incidentally, on April 3, 1993, the Aganas filed with the RTC a motion for a partial execution
of its Decision, which was granted in an Order dated May 11, 1993. Thereafter, the sheriff
levied upon certain properties of Dr. Ampil and sold them for P451,275.00 and delivered the
amount to the Aganas.
Following their receipt of the money, the Aganas entered into an agreement with PSI and Dr.
Fuentes to indefinitely suspend any further execution of the RTC Decision. However, not
long thereafter, the Aganas again filed a motion for an alias writ of execution against the
properties of PSI and Dr. Fuentes. On September 21, 1993, the RTC granted the motion and
issued the corresponding writ, prompting Dr. Fuentes to file with the Court of Appeals a
petition for certiorari and prohibition, with prayer for preliminary injunction, docketed as CAG.R. SP No. 32198. During its pendency, the Court of Appeals issued a Resolution 5 dated
October 29, 1993 granting Dr. Fuentes prayer for injunctive relief.
On January 24, 1994, CA-G.R. SP No. 32198 was consolidated with CA-G.R. CV No. 42062.
Meanwhile, on January 23, 1995, the PRC Board of Medicine rendered its Decision 6 in
Administrative Case No. 1690 dismissing the case against Dr. Fuentes. The Board held that
the prosecution failed to show that Dr. Fuentes was the one who left the two pieces of gauze
inside Natividads body; and that he concealed such fact from Natividad.
On September 6, 1996, the Court of Appeals rendered its Decision jointly disposing of CAG.R. CV No. 42062 and CA-G.R. SP No. 32198, thus:
WHEREFORE, except for the modification that the case against defendant-appellant Dr.
Juan Fuentes is hereby DISMISSED, and with the pronouncement that defendant-appellant
Dr. Miguel Ampil is liable to reimburse defendant-appellant Professional Services, Inc.,
whatever amount the latter will pay or had paid to the plaintiffs-appellees, the decision
appealed from is hereby AFFIRMED and the instant appeal DISMISSED.
Concomitant with the above, the petition for certiorari and prohibition filed by herein
defendant-appellant Dr. Juan Fuentes in CA-G.R. SP No. 32198 is hereby GRANTED and
the challenged order of the respondent judge dated September 21, 1993, as well as the alias
writ of execution issued pursuant thereto are hereby NULLIFIED and SET ASIDE. The bond
posted by the petitioner in connection with the writ of preliminary injunction issued by this
Court on November 29, 1993 is hereby cancelled.
Costs against defendants-appellants Dr. Miguel Ampil and Professional Services, Inc.
SO ORDERED.

Only Dr. Ampil filed a motion for reconsideration, but it was denied in a Resolution 7 dated
December 19, 1996.
Hence, the instant consolidated petitions.
In G.R. No. 126297, PSI alleged in its petition that the Court of Appeals erred in holding that:
(1) it is estopped from raising the defense that Dr. Ampil is not its employee; (2) it is solidarily
liable with Dr. Ampil; and (3) it is not entitled to its counterclaim against the Aganas. PSI
contends that Dr. Ampil is not its employee, but a mere consultant or independent contractor.
As such, he alone should answer for his negligence.
In G.R. No. 126467, the Aganas maintain that the Court of Appeals erred in finding that Dr.
Fuentes is not guilty of negligence or medical malpractice, invoking the doctrine of res ipsa
loquitur. They contend that the pieces of gauze are prima facie proofs that the operating
surgeons have been negligent.
Finally, in G.R. No. 127590, Dr. Ampil asserts that the Court of Appeals erred in finding him
liable for negligence and malpractice sans evidence that he left the two pieces of gauze in
Natividads vagina. He pointed to other probable causes, such as: (1) it was Dr. Fuentes who
used gauzes in performing the hysterectomy; (2) the attending nurses failure to properly
count the gauzes used during surgery; and (3) the medical intervention of the American
doctors who examined Natividad in the United States of America.
For our resolution are these three vital issues: first, whether the Court of Appeals erred in
holding Dr. Ampil liable for negligence and malpractice; second, whether the Court of
Appeals erred in absolving Dr. Fuentes of any liability; and third, whether PSI may be held
solidarily liable for the negligence of Dr. Ampil.
I - G.R. No. 127590
Whether the Court of Appeals Erred in Holding Dr. Ampil
Liable for Negligence and Malpractice.
Dr. Ampil, in an attempt to absolve himself, gears the Courts attention to other possible
causes of Natividads detriment. He argues that the Court should not discount either of the
following possibilities: first, Dr. Fuentes left the gauzes in Natividads body after performing
hysterectomy; second, the attending nurses erred in counting the gauzes; and third, the
American doctors were the ones who placed the gauzes in Natividads body.
Dr. Ampils arguments are purely conjectural and without basis. Records show that he did not
present any evidence to prove that the American doctors were the ones who put or left the
gauzes in Natividads body. Neither did he submit evidence to rebut the correctness of the
record of operation, particularly the number of gauzes used. As to the alleged negligence of
Dr. Fuentes, we are mindful that Dr. Ampil examined his (Dr. Fuentes) work and found it in
order.
The glaring truth is that all the major circumstances, taken together, as specified by the Court
of Appeals, directly point to Dr. Ampil as the negligent party, thus:
First, it is not disputed that the surgeons used gauzes as sponges to control the
bleeding of the patient during the surgical operation.
Second, immediately after the operation, the nurses who assisted in the surgery
noted in their report that the sponge count (was) lacking 2; that such anomaly was
announced to surgeon and that a search was done but to no avail prompting Dr.
Ampil to continue for closure x x x.
Third, after the operation, two (2) gauzes were extracted from the same spot of the
body of Mrs. Agana where the surgery was performed.

An operation requiring the placing of sponges in the incision is not complete until the
sponges are properly removed, and it is settled that the leaving of sponges or other foreign
substances in the wound after the incision has been closed is at least prima facie negligence
by the operating surgeon.8 To put it simply, such act is considered so inconsistent with due
care as to raise an inference of negligence. There are even legions of authorities to the effect
that such act is negligence per se.9
Of course, the Court is not blind to the reality that there are times when danger to a patients
life precludes a surgeon from further searching missing sponges or foreign objects left in the
body. But this does not leave him free from any obligation. Even if it has been shown that a
surgeon was required by the urgent necessities of the case to leave a sponge in his patients
abdomen, because of the dangers attendant upon delay, still, it is his legal duty to so inform
his patient within a reasonable time thereafter by advising her of what he had been
compelled to do. This is in order that she might seek relief from the effects of the foreign
object left in her body as her condition might permit. The ruling in Smith v. Zeagler 10 is
explicit, thus:
The removal of all sponges used is part of a surgical operation, and when a physician or
surgeon fails to remove a sponge he has placed in his patients body that should be removed
as part of the operation, he thereby leaves his operation uncompleted and creates a new
condition which imposes upon him the legal duty of calling the new condition to his patients
attention, and endeavoring with the means he has at hand to minimize and avoid untoward
results likely to ensue therefrom.
Here, Dr. Ampil did not inform Natividad about the missing two pieces of gauze. Worse, he
even misled her that the pain she was experiencing was the ordinary consequence of her
operation. Had he been more candid, Natividad could have taken the immediate and
appropriate medical remedy to remove the gauzes from her body. To our mind, what was
initially an act of negligence by Dr. Ampil has ripened into a deliberate wrongful act of
deceiving his patient.
This is a clear case of medical malpractice or more appropriately, medical negligence. To
successfully pursue this kind of case, a patient must only prove that a health care provider
either failed to do something which a reasonably prudent health care provider would have
done, or that he did something that a reasonably prudent provider would not have done; and
that failure or action caused injury to the patient.11 Simply put, the elements are duty, breach,
injury and proximate causation. Dr, Ampil, as the lead surgeon, had the duty to remove all
foreign objects, such as gauzes, from Natividads body before closure of the incision. When
he failed to do so, it was his duty to inform Natividad about it. Dr. Ampil breached both duties.
Such breach caused injury to Natividad, necessitating her further examination by American
doctors and another surgery. That Dr. Ampils negligence is the proximate cause12 of
Natividads injury could be traced from his act of closing the incision despite the information
given by the attending nurses that two pieces of gauze were still missing. That they were
later on extracted from Natividads vagina established the causal link between Dr. Ampils
negligence and the injury. And what further aggravated such injury was his deliberate
concealment of the missing gauzes from the knowledge of Natividad and her family.
II - G.R. No. 126467
Whether the Court of Appeals Erred in Absolving
Dr. Fuentes of any Liability
The Aganas assailed the dismissal by the trial court of the case against Dr. Fuentes on the
ground that it is contrary to the doctrine of res ipsa loquitur. According to them, the fact that
the two pieces of gauze were left inside Natividads body is a prima facie evidence of Dr.
Fuentes negligence.
We are not convinced.
Literally, res ipsa loquitur means "the thing speaks for itself." It is the rule that the fact of the
occurrence of an injury, taken with the surrounding circumstances, may permit an inference

or raise a presumption of negligence, or make out a plaintiffs prima facie case, and present
a question of fact for defendant to meet with an explanation.13 Stated differently, where the
thing which caused the injury, without the fault of the injured, is under the exclusive control of
the defendant and the injury is such that it should not have occurred if he, having such
control used proper care, it affords reasonable evidence, in the absence of explanation that
the injury arose from the defendants want of care, and the burden of proof is shifted to him
to establish that he has observed due care and diligence. 14
From the foregoing statements of the rule, the requisites for the applicability of the doctrine
of res ipsa loquitur are: (1) the occurrence of an injury; (2) the thing which caused the injury
was under the control and management of the defendant; (3) the occurrence was such that
in the ordinary course of things, would not have happened if those who had control or
management used proper care; and (4) the absence of explanation by the defendant. Of the
foregoing requisites, the most instrumental is the "control and management of the thing
which caused the injury."15
We find the element of "control and management of the thing which caused the injury" to be
wanting. Hence, the doctrine of res ipsa loquitur will not lie.
It was duly established that Dr. Ampil was the lead surgeon during the operation of Natividad.
He requested the assistance of Dr. Fuentes only to perform hysterectomy when he (Dr.
Ampil) found that the malignancy in her sigmoid area had spread to her left ovary. Dr.
Fuentes performed the surgery and thereafter reported and showed his work to Dr. Ampil.
The latter examined it and finding everything to be in order, allowed Dr. Fuentes to leave the
operating room. Dr. Ampil then resumed operating on Natividad. He was about to finish the
procedure when the attending nurses informed him that two pieces of gauze were missing. A
"diligent search" was conducted, but the misplaced gauzes were not found. Dr. Ampil then
directed that the incision be closed. During this entire period, Dr. Fuentes was no longer in
the operating room and had, in fact, left the hospital.
Under the "Captain of the Ship" rule, the operating surgeon is the person in complete charge
of the surgery room and all personnel connected with the operation. Their duty is to obey his
orders.16 As stated before, Dr. Ampil was the lead surgeon. In other words, he was the
"Captain of the Ship." That he discharged such role is evident from his following conduct: (1)
calling Dr. Fuentes to perform a hysterectomy; (2) examining the work of Dr. Fuentes and
finding it in order; (3) granting Dr. Fuentes permission to leave; and (4) ordering the closure
of the incision. To our mind, it was this act of ordering the closure of the incision
notwithstanding that two pieces of gauze remained unaccounted for, that caused injury to
Natividads body. Clearly, the control and management of the thing which caused the injury
was in the hands of Dr. Ampil, not Dr. Fuentes.
In this jurisdiction, res ipsa loquitur is not a rule of substantive law, hence, does not per se
create or constitute an independent or separate ground of liability, being a mere evidentiary
rule.17 In other words, mere invocation and application of the doctrine does not dispense with
the requirement of proof of negligence. Here, the negligence was proven to have been
committed by Dr. Ampil and not by Dr. Fuentes.
III - G.R. No. 126297
Whether PSI Is Liable for the Negligence of Dr. Ampil
The third issue necessitates a glimpse at the historical development of hospitals and the
resulting theories concerning their liability for the negligence of physicians.
Until the mid-nineteenth century, hospitals were generally charitable institutions, providing
medical services to the lowest classes of society, without regard for a patients ability to
pay.18 Those who could afford medical treatment were usually treated at home by their
doctors.19 However, the days of house calls and philanthropic health care are over. The
modern health care industry continues to distance itself from its charitable past and has
experienced a significant conversion from a not-for-profit health care to for-profit hospital
businesses. Consequently, significant changes in health law have accompanied the
business-related changes in the hospital industry. One important legal change is an increase

in hospital liability for medical malpractice. Many courts now allow claims for hospital
vicarious liability under the theories of respondeat superior, apparent authority, ostensible
authority, or agency by estoppel. 20
In this jurisdiction, the statute governing liability for negligent acts is Article 2176 of the Civil
Code, which reads:
Art. 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.
A derivative of this provision is Article 2180, the rule governing vicarious liability under the
doctrine of respondeat superior, thus:
ART. 2180. 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.
x x x

x x x

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.
x x x

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.
A prominent civilist commented that professionals engaged by an employer, such as
physicians, dentists, and pharmacists, are not "employees" under this article because the
manner in which they perform their work is not within the control of the latter (employer). In
other words, professionals are considered personally liable for the fault or negligence they
commit in the discharge of their duties, and their employer cannot be held liable for such
fault or negligence. In the context of the present case, "a hospital cannot be held liable for
the fault or negligence of a physician or surgeon in the treatment or operation of patients." 21
The foregoing view is grounded on the traditional notion that the professional status and the
very nature of the physicians calling preclude him from being classed as an agent or
employee of a hospital, whenever he acts in a professional capacity.22 It has been said that
medical practice strictly involves highly developed and specialized knowledge, 23 such that
physicians are generally free to exercise their own skill and judgment in rendering medical
services sans interference.24 Hence, when a doctor practices medicine in a hospital setting,
the hospital and its employees are deemed to subserve him in his ministrations to the patient
and his actions are of his own responsibility.25
The case of Schloendorff v. Society of New York Hospital26 was then considered an authority
for this view. The "Schloendorff doctrine" regards a physician, even if employed by a
hospital, as an independent contractor because of the skill he exercises and the lack of
control exerted over his work. Under this doctrine, hospitals are exempt from the application
of the respondeat superior principle for fault or negligence committed by physicians in the
discharge of their profession.
However, the efficacy of the foregoing doctrine has weakened with the significant
developments in medical care. Courts came to realize that modern hospitals are increasingly
taking active role in supplying and regulating medical care to patients. No longer were a
hospitals functions limited to furnishing room, food, facilities for treatment and operation, and
attendants for its patients. Thus, in Bing v. Thunig,27 the New York Court of Appeals deviated

from the Schloendorff doctrine, noting that modern hospitals actually do far more than
provide facilities for treatment. Rather, they regularly employ, on a salaried basis, a large
staff of physicians, interns, nurses, administrative and manual workers. They charge patients
for medical care and treatment, even collecting for such services through legal action, if
necessary. The court then concluded that there is no reason to exempt hospitals from the
universal rule of respondeat superior.
In our shores, the nature of the relationship between the hospital and the physicians is
rendered inconsequential in view of our categorical pronouncement in Ramos v. Court of
Appeals28 that for purposes of apportioning responsibility in medical negligence cases, an
employer-employee relationship in effect exists between hospitals and their attending and
visiting physicians. This Court held:
"We now discuss the responsibility of the hospital in this particular incident. The unique
practice (among private hospitals) of filling up specialist staff with attending and visiting
"consultants," who are allegedly not hospital employees, presents problems in apportioning
responsibility for negligence in medical malpractice cases. However, the difficulty is more
apparent than real.
In the first place, hospitals exercise significant control in the hiring and firing of consultants
and in the conduct of their work within the hospital premises. Doctors who apply for
consultant slots, visiting or attending, are required to submit proof of completion of
residency, their educational qualifications, generally, evidence of accreditation by the
appropriate board (diplomate), evidence of fellowship in most cases, and references. These
requirements are carefully scrutinized by members of the hospital administration or by a
review committee set up by the hospital who either accept or reject the application. x x x.
After a physician is accepted, either as a visiting or attending consultant, he is normally
required to attend clinico-pathological conferences, conduct bedside rounds for clerks,
interns and residents, moderate grand rounds and patient audits and perform other tasks
and responsibilities, for the privilege of being able to maintain a clinic in the hospital, and/or
for the privilege of admitting patients into the hospital. In addition to these, the physicians
performance as a specialist is generally evaluated by a peer review committee on the basis
of mortality and morbidity statistics, and feedback from patients, nurses, interns and
residents. A consultant remiss in his duties, or a consultant who regularly falls short of the
minimum standards acceptable to the hospital or its peer review committee, is normally
politely terminated.
In other words, private hospitals, hire, fire and exercise real control over their attending and
visiting consultant staff. While consultants are not, technically employees, x x x, the control
exercised, the hiring, and the right to terminate consultants all fulfill the important hallmarks
of an employer-employee relationship, with the exception of the payment of wages. In
assessing whether such a relationship in fact exists, the control test is determining.
Accordingly, on the basis of the foregoing, we rule that for the purpose of allocating
responsibility in medical negligence cases, an employer-employee relationship in effect
exists between hospitals and their attending and visiting physicians. "
But the Ramos pronouncement is not our only basis in sustaining PSIs liability. Its liability is
also anchored upon the agency principle of apparent authority or agency by estoppel and the
doctrine of corporate negligence which have gained acceptance in the determination of a
hospitals liability for negligent acts of health professionals. The present case serves as a
perfect platform to test the applicability of these doctrines, thus, enriching our jurisprudence.
Apparent authority, or what is sometimes referred to as the "holding
out" theory, or doctrine of ostensible agency or agency by estoppel,29 has its origin from the
law of agency. It imposes liability, not as the result of the reality of a contractual relationship,
but rather because of the actions of a principal or an employer in somehow misleading the
public into believing that the relationship or the authority exists.30 The concept is essentially
one of estoppel and has been explained in this manner:

"The principal is bound by the acts of his agent with the apparent authority which he
knowingly permits the agent to assume, or which he holds the agent out to the public as
possessing. The question in every case is whether the principal has by his voluntary act
placed the agent in such a situation that a person of ordinary prudence, conversant with
business usages and the nature of the particular business, is justified in presuming that such
agent has authority to perform the particular act in question. 31
The applicability of apparent authority in the field of hospital liability was upheld long time
ago in Irving v. Doctor Hospital of Lake Worth, Inc.32 There, it was explicitly stated that "there
does not appear to be any rational basis for excluding the concept of apparent authority from
the field of hospital liability." Thus, in cases where it can be shown that a hospital, by its
actions, has held out a particular physician as its agent and/or employee and that a patient
has accepted treatment from that physician in the reasonable belief that it is being rendered
in behalf of the hospital, then the hospital will be liable for the physicians negligence.
Our jurisdiction recognizes the concept of an agency by implication or estoppel. Article 1869
of the Civil Code reads:
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.
In this case, PSI publicly displays in the lobby of the Medical City Hospital the names and
specializations of the physicians associated or accredited by it, including those of Dr. Ampil
and Dr. Fuentes. We concur with the Court of Appeals conclusion that it "is now estopped
from passing all the blame to the physicians whose names it proudly paraded in the public
directory leading the public to believe that it vouched for their skill and competence." Indeed,
PSIs act is tantamount to holding out to the public that Medical City Hospital, through its
accredited physicians, offers quality health care services. By accrediting Dr. Ampil and Dr.
Fuentes and publicly advertising their qualifications, the hospital created the impression that
they were its agents, authorized to perform medical or surgical services for its patients. As
expected, these patients, Natividad being one of them, accepted the services on the
reasonable belief that such were being rendered by the hospital or its employees, agents, or
servants. The trial court correctly pointed out:
x x x regardless of the education and status in life of the patient, he ought not be burdened
with the defense of absence of employer-employee relationship between the hospital and the
independent physician whose name and competence are certainly certified to the general
public by the hospitals act of listing him and his specialty in its lobby directory, as in the case
herein. The high costs of todays medical and health care should at least exact on the
hospital greater, if not broader, legal responsibility for the conduct of treatment and surgery
within its facility by its accredited physician or surgeon, regardless of whether he is
independent or employed."33
The wisdom of the foregoing ratiocination is easy to discern. Corporate entities, like PSI, are
capable of acting only through other individuals, such as physicians. If these accredited
physicians do their job well, the hospital succeeds in its mission of offering quality medical
services and thus profits financially. Logically, where negligence mars the quality of its
services, the hospital should not be allowed to escape liability for the acts of its ostensible
agents.
We now proceed to the doctrine of corporate negligence or corporate responsibility.
One allegation in the complaint in Civil Case No. Q-43332 for negligence and malpractice is
that PSI as owner, operator and manager of Medical City Hospital, "did not perform the
necessary supervision nor exercise diligent efforts in the supervision of Drs. Ampil and
Fuentes and its nursing staff, resident doctors, and medical interns who assisted Drs. Ampil
and Fuentes in the performance of their duties as surgeons." 34 Premised on the doctrine of
corporate negligence, the trial court held that PSI is directly liable for such breach of duty.
We agree with the trial court.

Recent years have seen the doctrine of corporate negligence as the judicial answer to the
problem of allocating hospitals liability for the negligent acts of health practitioners, absent
facts to support the application of respondeat superior or apparent authority. Its formulation
proceeds from the judiciarys acknowledgment that in these modern times, the duty of
providing quality medical service is no longer the sole prerogative and responsibility of the
physician. The modern hospitals have changed structure. Hospitals now tend to organize a
highly professional medical staff whose competence and performance need to be monitored
by the hospitals commensurate with their inherent responsibility to provide quality medical
care.35
The doctrine has its genesis in Darling v. Charleston Community Hospital.36 There, the
Supreme Court of Illinois held that "the jury could have found a hospital negligent, inter alia,
in failing to have a sufficient number of trained nurses attending the patient; failing to require
a consultation with or examination by members of the hospital staff; and failing to review the
treatment rendered to the patient." On the basis of Darling, other jurisdictions held that a
hospitals corporate negligence extends to permitting a physician known to be incompetent to
practice at the hospital.37 With the passage of time, more duties were expected from
hospitals, among them: (1) the use of reasonable care in the maintenance of safe and
adequate facilities and equipment; (2) the selection and retention of competent physicians;
(3) the overseeing or supervision of all persons who practice medicine within its walls; and
(4) the formulation, adoption and enforcement of adequate rules and policies that ensure
quality care for its patients.38 Thus, in Tucson Medical Center, Inc. v. Misevich,39 it was held
that a hospital, following the doctrine of corporate responsibility, has the duty to see that it
meets the standards of responsibilities for the care of patients. Such duty includes the proper
supervision of the members of its medical staff. And in Bost v. Riley,40 the court concluded
that a patient who enters a hospital does so with the reasonable expectation that it will
attempt to cure him. The hospital accordingly has the duty to make a reasonable effort to
monitor and oversee the treatment prescribed and administered by the physicians practicing
in its premises.
In the present case, it was duly established that PSI operates the Medical City Hospital for
the purpose and under the concept of providing comprehensive medical services to the
public. Accordingly, it has the duty to exercise reasonable care to protect from harm all
patients admitted into its facility for medical treatment. Unfortunately, PSI failed to perform
such duty. The findings of the trial court are convincing, thus:
x x x PSIs liability is traceable to its failure to conduct an investigation of the matter reported
in the nota bene of the count nurse. Such failure established PSIs part in the dark
conspiracy of silence and concealment about the gauzes. Ethical considerations, if not also
legal, dictated the holding of an immediate inquiry into the events, if not for the benefit of the
patient to whom the duty is primarily owed, then in the interest of arriving at the truth. The
Court cannot accept that the medical and the healing professions, through their members
like defendant surgeons, and their institutions like PSIs hospital facility, can callously turn
their backs on and disregard even a mere probability of mistake or negligence by refusing or
failing to investigate a report of such seriousness as the one in Natividads case.
It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance
of the Medical City Hospitals staff, composed of resident doctors, nurses, and interns. As
such, it is reasonable to conclude that PSI, as the operator of the hospital, has actual or
constructive knowledge of the procedures carried out, particularly the report of the attending
nurses that the two pieces of gauze were missing. In Fridena v. Evans,41 it was held that a
corporation is bound by the knowledge acquired by or notice given to its agents or officers
within the scope of their authority and in reference to a matter to which their authority
extends. This means that the knowledge of any of the staff of Medical City Hospital
constitutes knowledge of PSI. Now, the failure of PSI, despite the attending nurses report, to
investigate and inform Natividad regarding the missing gauzes amounts to callous
negligence. Not only did PSI breach its duties to oversee or supervise all persons who
practice medicine within its walls, it also failed to take an active step in fixing the negligence
committed. This renders PSI, not only vicariously liable for the negligence of Dr. Ampil under
Article 2180 of the Civil Code, but also directly liable for its own negligence under Article
2176. In Fridena, the Supreme Court of Arizona held:

x x x In recent years, however, the duty of care owed to the patient by the hospital has
expanded. The emerging trend is to hold the hospital responsible where the hospital has
failed to monitor and review medical services being provided within its walls. See Kahn
Hospital Malpractice Prevention, 27 De Paul . Rev. 23 (1977).
Among the cases indicative of the emerging trend is Purcell v. Zimbelman, 18 Ariz. App.
75,500 P. 2d 335 (1972). In Purcell, the hospital argued that it could not be held liable for the
malpractice of a medical practitioner because he was an independent contractor within the
hospital. The Court of Appeals pointed out that the hospital had created a professional staff
whose competence and performance was to be monitored and reviewed by the governing
body of the hospital, and the court held that a hospital would be negligent where it had
knowledge or reason to believe that a doctor using the facilities was employing a method of
treatment or care which fell below the recognized standard of care.
Subsequent to the Purcell decision, the Arizona Court of Appeals held that a hospital has
certain inherent responsibilities regarding the quality of medical care furnished to patients
within its walls and it must meet the standards of responsibility commensurate with this
undertaking. Beeck v. Tucson General Hospital, 18 Ariz. App. 165, 500 P. 2d 1153 (1972).
This court has confirmed the rulings of the Court of Appeals that a hospital has the duty of
supervising the competence of the doctors on its staff. x x x.
x

In the amended complaint, the plaintiffs did plead that the operation was performed at the
hospital with its knowledge, aid, and assistance, and that the negligence of the defendants
was the proximate cause of the patients injuries. We find that such general allegations of
negligence, along with the evidence produced at the trial of this case, are sufficient to
support the hospitals liability based on the theory of negligent supervision."
Anent the corollary issue of whether PSI is solidarily liable with Dr. Ampil for damages, let it
be emphasized that PSI, apart from a general denial of its responsibility, failed to adduce
evidence showing that it exercised the diligence of a good father of a family in the
accreditation and supervision of the latter. In neglecting to offer such proof, PSI failed to
discharge its burden under the last paragraph of Article 2180 cited earlier, and, therefore,
must be adjudged solidarily liable with Dr. Ampil. Moreover, as we have discussed, PSI is
also directly liable to the Aganas.
One final word. Once a physician undertakes the treatment and care of a patient, the law
imposes on him certain obligations. In order to escape liability, he must possess that
reasonable degree of learning, skill and experience required by his profession. At the same
time, he must apply reasonable care and diligence in the exercise of his skill and the
application of his knowledge, and exert his best judgment.
WHEREFORE, we DENY all the petitions and AFFIRM the challenged Decision of the Court
of Appeals in CA-G.R. CV No. 42062 and CA-G.R. SP No. 32198.
Costs against petitioners PSI and Dr. Miguel Ampil.
SO ORDERED.

G.R. No. 124354 December 29, 1999


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, DELOS SANTOS MEDICAL CENTER, DR. ORLINO HOSAKA and
DRA. PERFECTA GUTIERREZ, respondents.

KAPUNAN, J.:
The Hippocratic Oath mandates physicians to give primordial consideration to the health and
welfare of their patients. If a doctor fails to live up to this precept, he is made accountable for
his acts. A mistake, through gross negligence or incompetence or plain human error, may
spell the difference between life and death. In this sense, the doctor plays God on his
patient's fate. 1
In the case at bar, the Court is called upon to rule whether a surgeon, an anesthesiologist
and a hospital should be made liable for the unfortunate comatose condition of a patient
scheduled for cholecystectomy. 2
Petitioners seek the reversal of the decision 3 of the Court of Appeals, dated 29 May 1995,
which overturned the decision 4 of the Regional Trial Court, dated 30 January 1992, finding
private respondents liable for damages arising from negligence in the performance of their
professional duties towards petitioner Erlinda Ramos resulting in her comatose condition.
The antecedent facts as summarized by the trial court are reproduced hereunder:
Plaintiff Erlinda Ramos was, until the afternoon of June 17, 1985, a 47-year
old (Exh. "A") robust woman (TSN, October 19, 1989, p. 10). Except for
occasional complaints of discomfort due to pains allegedly caused by the
presence of a stone in her gall bladder (TSN, January 13, 1988, pp. 4-5), she
was as normal as any other woman. Married to Rogelio E. Ramos, an
executive of Philippine Long Distance Telephone Company, she has three
children whose names are Rommel Ramos, Roy Roderick Ramos and Ron
Raymond Ramos (TSN, October 19, 1989, pp. 5-6).
Because the discomforts somehow interfered with her normal ways, she
sought professional advice. She was advised to undergo an operation for the
removal of a stone in her gall bladder (TSN, January 13, 1988, p. 5). She
underwent a series of examinations which included blood and urine tests
(Exhs. "A" and "C") which indicated she was fit for surgery.
Through the intercession of a mutual friend, Dr. Buenviaje (TSN, January 13,
1988, p. 7), she and her husband Rogelio met for the first time Dr. Orlino
Hozaka (should be Hosaka; see TSN, February 20, 1990, p. 3), one of the
defendants in this case, on June 10, 1985. They agreed that their date at the
operating table at the DLSMC (another defendant), would be on June 17,
1985 at 9:00 A.M.. Dr. Hosaka decided that she should undergo a
"cholecystectomy" operation after examining the documents (findings from
the Capitol Medical Center, FEU Hospital and DLSMC) presented to him.
Rogelio E. Ramos, however, asked Dr. Hosaka to look for a good
anesthesiologist. Dr. Hosaka, in turn, assured Rogelio that he will get a good
anesthesiologist. Dr. Hosaka charged a fee of P16,000.00, which was to
include the anesthesiologist's fee and which was to be paid after the
operation (TSN, October 19, 1989, pp. 14-15, 22-23, 31-33; TSN, February
27, 1990, p. 13; and TSN, November 9, 1989, pp. 3-4, 10, 17).

A day before the scheduled date of operation, she was admitted at one of the
rooms of the DLSMC, located along E. Rodriguez Avenue, Quezon City
(TSN, October 19,1989, p. 11).
At around 7:30 A.M. of June 17, 1985 and while still in her room, she was
prepared for the operation by the hospital staff. Her sister-in-law, Herminda
Cruz, who was the Dean of the College of Nursing at the Capitol Medical
Center, was also there for moral support. She reiterated her previous request
for Herminda to be with her even during the operation. After praying, she was
given injections. Her hands were held by Herminda as they went down from
her room to the operating room (TSN, January 13, 1988, pp. 9-11). Her
husband, Rogelio, was also with her (TSN, October 19, 1989, p. 18). At the
operating room, Herminda saw about two or three nurses and Dr. Perfecta
Gutierrez, the other defendant, who was to administer anesthesia. Although
not a member of the hospital staff, Herminda introduced herself as Dean of
the College of Nursing at the Capitol Medical Center who was to provide
moral support to the patient, to them. Herminda was allowed to stay inside
the operating room.
At around 9:30 A.M., Dr. Gutierrez reached a nearby phone to look for Dr.
Hosaka who was not yet in (TSN, January 13, 1988, pp. 11-12). Dr. Gutierrez
thereafter informed Herminda Cruz about the prospect of a delay in the
arrival of Dr. Hosaka. Herminda then went back to the patient who asked,
"Mindy, wala pa ba ang Doctor"? The former replied, "Huwag kang magalaala, darating na iyon" (Ibid.).
Thereafter, Herminda went out of the operating room and informed the
patient's husband, Rogelio, that the doctor was not yet around (id., p. 13).
When she returned to the operating room, the patient told her, "Mindy, inip na
inip na ako, ikuha mo ako ng ibang Doctor." So, she went out again and told
Rogelio about what the patient said (id., p. 15). Thereafter, she returned to
the operating room.
At around 10:00 A.M., Rogelio E. Ramos was "already dying [and] waiting for
the arrival of the doctor" even as he did his best to find somebody who will
allow him to pull out his wife from the operating room (TSN, October 19,
1989, pp. 19-20). He also thought of the feeling of his wife, who was inside
the operating room waiting for the doctor to arrive (ibid.). At almost 12:00
noon, he met Dr. Garcia who remarked that he (Dr. Garcia) was also tired of
waiting for Dr. Hosaka to arrive (id., p. 21). While talking to Dr. Garcia at
around 12:10 P.M., he came to know that Dr. Hosaka arrived as a nurse
remarked, "Nandiyan na si Dr. Hosaka, dumating na raw." Upon hearing
those words, he went down to the lobby and waited for the operation to be
completed (id., pp. 16, 29-30).
At about 12:15 P.M., Herminda Cruz, who was inside the operating room with
the patient, heard somebody say that "Dr. Hosaka is already here." She then
saw people inside the operating room "moving, doing this and that, [and]
preparing the patient for the operation" (TSN, January 13, 1988, p. 16). As
she held the hand of Erlinda Ramos, she then saw Dr. Gutierrez intubating
the hapless patient. She thereafter heard Dr. Gutierrez say, "ang hirap maintubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan" (id., p. 17).
Because of the remarks of Dra. Gutierrez, she focused her attention on what
Dr. Gutierrez was doing. She thereafter noticed bluish discoloration of the
nailbeds of the left hand of the hapless Erlinda even as Dr. Hosaka
approached her. She then heard Dr. Hosaka issue an order for someone to
call Dr. Calderon, another anesthesiologist (id., p. 19). After Dr. Calderon
arrived at the operating room, she saw this anesthesiologist trying to intubate
the patient. The patient's nailbed became bluish and the patient was placed

in a trendelenburg position a position where the head of the patient is


placed in a position lower than her feet which is an indication that there is a
decrease of blood supply to the patient's brain (Id., pp. 19-20). Immediately
thereafter, she went out of the operating room, and she told Rogelio E.
Ramos "that something wrong was . . . happening" (Ibid.). Dr. Calderon was
then able to intubate the patient (TSN, July 25, 1991, p. 9).
Meanwhile, Rogelio, who was outside the operating room, saw a respiratory
machine being rushed towards the door of the operating room. He also saw
several doctors rushing towards the operating room. When informed by
Herminda Cruz that something wrong was happening, he told her (Herminda)
to be back with the patient inside the operating room (TSN, October 19,
1989, pp. 25-28).
Herminda Cruz immediately rushed back, and saw that the patient was still in
trendelenburg position (TSN, January 13, 1988, p. 20). At almost 3:00 P.M. of
that fateful day, she saw the patient taken to the Intensive Care Unit (ICU).
About two days thereafter, Rogelio E. Ramos was able to talk to Dr. Hosaka.
The latter informed the former that something went wrong during the
intubation. Reacting to what was told to him, Rogelio reminded the doctor
that the condition of his wife would not have happened, had he (Dr. Hosaka)
looked for a good anesthesiologist (TSN, October 19, 1989, p. 31).
Doctors Gutierrez and Hosaka were also asked by the hospital to explain
what happened to the patient. The doctors explained that the patient had
bronchospasm (TSN, November 15, 1990, pp. 26-27).
Erlinda Ramos stayed at the ICU for a month. About four months thereafter
or on November 15, 1985, the patient was released from the hospital.
During the whole period of her confinement, she incurred hospital bills
amounting to P93,542.25 which is the subject of a promissory note and
affidavit of undertaking executed by Rogelio E. Ramos in favor of DLSMC.
Since that fateful afternoon of June 17, 1985, she has been in a comatose
condition. She cannot do anything. She cannot move any part of her body.
She cannot see or hear. She is living on mechanical means. She suffered
brain damage as a result of the absence of oxygen in her brain for four to five
minutes (TSN, November 9, 1989, pp. 21-22). After being discharged from
the hospital, she has been staying in their residence, still needing constant
medical attention, with her husband Rogelio incurring a monthly expense
ranging from P8,000.00 to P10,000.00 (TSN, October 19, 1989, pp. 32-34).
She was also diagnosed to be suffering from "diffuse cerebral parenchymal
damage" (Exh. "G"; see also TSN, December 21, 1989,
p. 6). 5
Thus, on 8 January 1986, petitioners filed a civil case 6 for damages with the Regional Trial
Court of Quezon City against herein private respondents alleging negligence in the management
and care of Erlinda Ramos.
During the trial, both parties presented evidence as to the possible cause of Erlinda's injury.
Plaintiff presented the testimonies of Dean Herminda Cruz and Dr. Mariano Gavino to prove
that the sustained by Erlinda was due to lack of oxygen in her brain caused by the faulty
management of her airway by private respondents during the anesthesia phase. On the
other hand, private respondents primarily relied on the expert testimony of Dr. Eduardo
Jamora, a pulmonologist, to the effect that the cause of brain damage was Erlinda's allergic
reaction to the anesthetic agent, Thiopental Sodium (Pentothal).

After considering the evidence from both sides, the Regional Trial Court rendered judgment
in favor of petitioners, to wit:
After evaluating the evidence as shown in the finding of facts set forth earlier,
and applying the aforecited provisions of law and jurisprudence to the case at
bar, this Court finds and so holds that defendants are liable to plaintiffs for
damages. The defendants were guilty of, at the very least, negligence in the
performance of their duty to plaintiff-patient Erlinda Ramos.
On the part of Dr. Perfecta Gutierrez, this Court finds that she omitted to
exercise reasonable care in not only intubating the patient, but also in not
repeating the administration of atropine (TSN, August 20, 1991, pp. 5-10),
without due regard to the fact that the patient was inside the operating room
for almost three (3) hours. For after she committed a mistake in intubating
[the] patient, the patient's nailbed became bluish and the patient, thereafter,
was placed in trendelenburg position, because of the decrease of blood
supply to the patient's brain. The evidence further shows that the hapless
patient suffered brain damage because of the absence of oxygen in her
(patient's) brain for approximately four to five minutes which, in turn, caused
the patient to become comatose.
On the part of Dr. Orlino Hosaka, this Court finds that he is liable for the acts
of Dr. Perfecta Gutierrez whom he had chosen to administer anesthesia on
the patient as part of his obligation to provide the patient a good
anesthesiologist', and for arriving for the scheduled operation almost three (3)
hours late.
On the part of DLSMC (the hospital), this Court finds that it is liable for the
acts of negligence of the doctors in their "practice of medicine" in the
operating room. Moreover, the hospital is liable for failing through its
responsible officials, to cancel the scheduled operation after Dr. Hosaka
inexcusably failed to arrive on time.
In having held thus, this Court rejects the defense raised by defendants that
they have acted with due care and prudence in rendering medical services to
plaintiff-patient. For if the patient was properly intubated as claimed by them,
the patient would not have become comatose. And, the fact that another
anesthesiologist was called to try to intubate the patient after her (the
patient's) nailbed turned bluish, belie their claim. Furthermore, the defendants
should have rescheduled the operation to a later date. This, they should have
done, if defendants acted with due care and prudence as the patient's case
was an elective, not an emergency case.
xxx xxx xxx
WHEREFORE, and in view of the foregoing, judgment is rendered in favor of
the plaintiffs and against the defendants. Accordingly, the latter are ordered to
pay, jointly and severally, the former the following sums of money, to wit:
1) the sum of P8,000.00 as actual monthly expenses for the
plaintiff Erlinda Ramos reckoned from November 15, 1985 or
in the total sum of P632,000.00 as of April 15, 1992, subject
to its being updated;
2) the sum of P100,000.00 as reasonable attorney's fees;
3) the sum of P800,000.00 by way of moral damages and the
further sum of P200,000,00 by way of exemplary damages;
and,

4) the costs of the suit.


SO ORDERED. 7
Private respondents seasonably interposed an appeal to the Court of Appeals. The appellate
court rendered a Decision, dated 29 May 1995, reversing the findings of the trial court. The
decretal portion of the decision of the appellate court reads:
WHEREFORE, for the foregoing premises the appealed decision is hereby
REVERSED, and the complaint below against the appellants is hereby
ordered DISMISSED. The counterclaim of appellant De Los Santos Medical
Center is GRANTED but only insofar as appellees are hereby ordered to pay
the unpaid hospital bills amounting to P93,542.25, plus legal interest for
justice must be tempered with mercy.
SO ORDERED. 8
The decision of the Court of Appeals was received on 9 June 1995 by petitioner Rogelio
Ramos who was mistakenly addressed as "Atty. Rogelio Ramos." No copy of the decision,
however, was sent nor received by the Coronel Law Office, then counsel on record of
petitioners. Rogelio referred the decision of the appellate court to a new lawyer, Atty. Ligsay,
only on 20 June 1995, or four (4) days before the expiration of the reglementary period for
filing a motion for reconsideration. On the same day, Atty. Ligsay, filed with the appellate
court a motion for extension of time to file a motion for reconsideration. The motion for
reconsideration was submitted on 4 July 1995. However, the appellate court denied the
motion for extension of time in its Resolution dated 25 July 1995. 9Meanwhile, petitioners
engaged the services of another counsel, Atty. Sillano, to replace Atty. Ligsay. Atty. Sillano filed on
7 August 1995 a motion to admit the motion for reconsideration contending that the period to file
the appropriate pleading on the assailed decision had not yet commenced to run as the Division
Clerk of Court of the Court of Appeals had not yet served a copy thereof to the counsel on record.
Despite this explanation, the appellate court still denied the motion to admit the motion for
reconsideration of petitioners in its Resolution, dated 29 March 1996, primarily on the ground that
the fifteen-day (15) period for filing a motion for reconsideration had already expired, to wit:
We said in our Resolution on July 25, 1995, that the filing of a Motion for
Reconsideration cannot be extended; precisely, the Motion for Extension
(Rollo, p. 12) was denied. It is, on the other hand, admitted in the latter
Motion that plaintiffs/appellees received a copy of the decision as early as
June 9, 1995. Computation wise, the period to file a Motion for
Reconsideration expired on June 24. The Motion for Reconsideration, in turn,
was received by the Court of Appeals already on July 4, necessarily, the 15day period already passed. For that alone, the latter should be denied.
Even assuming admissibility of the Motion for the Reconsideration, but after
considering the Comment/Opposition, the former, for lack of merit, is hereby
DENIED.
SO ORDERED. 10
A copy of the above resolution was received by Atty. Sillano on 11 April 1996. The next day,
or on 12 April 1996, Atty. Sillano filed before this Court a motion for extension of time to file
the present petition for certiorari under Rule 45. The Court granted the motion for extension
of time and gave petitioners additional thirty (30) days after the expiration of the fifteen-day
(15) period counted from the receipt of the resolution of the Court of Appeals within which to
submit the petition. The due date fell on 27 May 1996. The petition was filed on 9 May 1996,
well within the extended period given by the Court.
Petitioners assail the decision of the Court of Appeals on the following grounds:

I
IN PUTTING MUCH RELIANCE ON THE TESTIMONIES OF
RESPONDENTS DRA. GUTIERREZ, DRA. CALDERON AND DR. JAMORA;
II
IN FINDING THAT THE NEGLIGENCE OF THE RESPONDENTS DID NOT
CAUSE THE UNFORTUNATE COMATOSE CONDITION OF PETITIONER
ERLINDA RAMOS;
III
IN NOT APPLYING THE DOCTRINE OF RES IPSA LOQUITUR. 11
Before we discuss the merits of the case, we shall first dispose of the procedural issue on
the timeliness of the petition in relation to the motion for reconsideration filed by petitioners
with the Court of Appeals. In their
Comment, 12 private respondents contend that the petition should not be given due course since
the motion for reconsideration of the petitioners on the decision of the Court of Appeals was
validly dismissed by the appellate court for having been filed beyond the reglementary period. We
do not agree.
A careful review of the records reveals that the reason behind the delay in filing the motion
for reconsideration is attributable to the fact that the decision of the Court of Appeals was not
sent to then counsel on record of petitioners, the Coronel Law Office. In fact, a copy of the
decision of the appellate court was instead sent to and received by petitioner Rogelio Ramos
on 9 June 1995 wherein he was mistakenly addressed as Atty. Rogelio Ramos. Based on the
other communications received by petitioner Rogelio Ramos, the appellate court apparently
mistook him for the counsel on record. Thus, no copy of the decision of the counsel on
record. Petitioner, not being a lawyer and unaware of the prescriptive period for filing a
motion for reconsideration, referred the same to a legal counsel only on 20 June 1995.
It is elementary that when a party is represented by counsel, all notices should be sent to the
party's lawyer at his given address. With a few exceptions, notice to a litigant without notice
to his counsel on record is no notice at all. In the present case, since a copy of the decision
of the appellate court was not sent to the counsel on record of petitioner, there can be no
sufficient notice to speak of. Hence, the delay in the filing of the motion for reconsideration
cannot be taken against petitioner. Moreover, since the Court of Appeals already issued a
second Resolution, dated 29 March 1996, which superseded the earlier resolution issued on
25 July 1995, and denied the motion for reconsideration of petitioner, we believed that the
receipt of the former should be considered in determining the timeliness of the filing of the
present petition. Based on this, the petition before us was submitted on time.
After resolving the foregoing procedural issue, we shall now look into the merits of the case.
For a more logical presentation of the discussion we shall first consider the issue on the
applicability of the doctrine of res ipsa loquitur to the instant case. Thereafter, the first two
assigned errors shall be tackled in relation to the res ipsa loquitur doctrine.
Res ipsa loquitur is a Latin phrase which literally means "the thing or the transaction speaks
for itself." The phrase "res ipsa loquitur'' is a maxim for the rule that the fact of the
occurrence of an injury, taken with the surrounding circumstances, may permit an inference
or raise a presumption of negligence, or make out a plaintiff's prima faciecase, and present a
question of fact for defendant to meet with an explanation. 13 Where the thing which caused the
injury complained of is shown to be under the management of the defendant or his servants and
the accident is such as in ordinary course of things does not happen if those who have its
management or control use proper care, it affords reasonable evidence, in the absence of
explanation by the defendant, that the accident arose from or was caused by the defendant's
want of care. 14

The doctrine of res ipsa loquitur is simply a recognition of the postulate that, as a matter of
common knowledge and experience, the very nature of certain types of occurrences may
justify an inference of negligence on the part of the person who controls the instrumentality
causing the injury in the absence of some explanation by the defendant who is charged with
negligence. 15 It is grounded in the superior logic of ordinary human experience and on the basis
of such experience or common knowledge, negligence may be deduced from the mere
occurrence of the accident itself. 16 Hence, res ipsa loquitur is applied in conjunction with the
doctrine of common knowledge.
However, much has been said that res ipsa loquitur is not a rule of substantive law and, as
such, does not create or constitute an independent or separate ground of liability. 17 Instead, it
is considered as merely evidentiary or in the nature of a procedural rule. 18 It is regarded as a
mode of proof, or a mere procedural of convenience since it furnishes a substitute for, and
relieves a plaintiff of, the burden of producing specific proof of negligence. 19 In other words, mere
invocation and application of the doctrine does not dispense with the requirement of proof of
negligence. It is simply a step in the process of such proof, permitting the plaintiff to present along
with the proof of the accident, enough of the attending circumstances to invoke the doctrine,
creating an inference or presumption of negligence, and to thereby place on the defendant the
burden of going forward with the proof. 20 Still, before resort to the doctrine may be allowed, the
following requisites must be satisfactorily shown:
1. The accident is of a kind which ordinarily does not occur in
the absence of someone's 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. 21
In the above requisites, the fundamental element is the "control of instrumentality" which
caused the damage. 22Such element of control must be shown to be within the dominion of the
defendant. 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. 23
Medical malpractice 24 cases do not escape the application of this doctrine. Thus, res ipsa
loquitur has been applied when the circumstances attendant upon the harm are themselves of
such a character as to justify an inference of negligence as the cause of that harm. 25 The
application of res ipsa loquitur in medical negligence cases presents a question of law since it is a
judicial function to determine whether a certain set of circumstances does, as a matter of law,
permit a given inference. 26
Although generally, expert medical testimony is relied upon in malpractice suits to prove that
a physician has done a negligent act or that he has deviated from the standard medical
procedure, when the doctrine of res ipsa loquitur is availed by the plaintiff, the need for
expert medical testimony is dispensed with because the injury itself provides the proof of
negligence. 27 The reason is that the general rule on the necessity of expert testimony applies
only to such matters clearly within the domain of medical science, and not to matters that are
within the common knowledge of mankind which may be testified to by anyone familiar with the
facts. 28 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 and surgeons, external
appearances, and manifest conditions which are observable by any one may be given by nonexpert witnesses. 29 Hence, in cases where theres 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. 30 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. 31 When the doctrine is appropriate, all that the patient must do is prove a nexus
between the particular act or omission complained of and the injury sustained while under the
custody and management of the defendant without need to produce expert medical testimony to
establish the standard of care. Resort to res ipsa loquitur is allowed because there is no other
way, under usual and ordinary conditions, by which the patient can obtain redress for injury
suffered by him.

Thus, courts of other jurisdictions have applied the doctrine in the following situations:
leaving of a foreign object in the body of the patient after an operation, 32 injuries sustained on
a healthy part of the body which was not under, or in the area, of treatment, 33 removal of the
wrong part of the body when another part was intended, 34 knocking out a tooth while a patient's
jaw was under anesthetic for the removal of his tonsils, 35 and loss of an eye while the patient
plaintiff was under the influence of anesthetic, during or following an operation for
appendicitis, 36 among others.
Nevertheless, despite the fact that the scope of res ipsa loquitur has been measurably
enlarged, it does not automatically apply to all cases of medical negligence as to
mechanically shift the burden of proof to the defendant to show that he is not guilty of the
ascribed negligence. 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 the consequences of professional care
were not as such as would ordinarily have followed if due care had been
exercised. 37 A distinction must be made between the failure to secure results, and the
occurrence of something more unusual and not ordinarily found if the service or treatment
rendered followed the usual procedure of those skilled in that particular practice. It must be
conceded that the doctrine of res ipsa loquitur can have no application in a suit against a
physician or surgeon which involves the merits of a diagnosis or of a scientific treatment. 38 The
physician or surgeon is not required at his peril to explain why any particular diagnosis was not
correct, or why any particular scientific treatment did not produce the desired result. 39 Thus, res
ipsa loquitur is not available in a malpractice suit if the only showing is that the desired result of
an operation or treatment was not accomplished. 40 The real question, therefore, is whether or not
in the process of the operation any extraordinary incident or unusual event outside of the routine
performance occurred which is beyond the regular scope of customary professional activity in
such operations, which, if unexplained would themselves reasonably speak to the average man
as the negligent cause or causes of the untoward consequence. 41 If there was such extraneous
interventions, the doctrine of res ipsa loquitur may be utilized and the defendant is called upon to
explain the matter, by evidence of exculpation, if he could. 42
We find the doctrine of res ipsa loquitur appropriate in the case at bar. As will hereinafter be
explained, the damage sustained by Erlinda in her brain prior to a scheduled gall bladder
operation presents a case for the application of res ipsa loquitur.
A case strikingly similar to the one before us is Voss vs. Bridwell, 43 where the Kansas
Supreme Court in applying theres ipsa loquitur stated:
The plaintiff herein submitted himself for a mastoid operation and delivered
his person over to the care, custody and control of his physician who had
complete and exclusive control over him, but the operation was never
performed. At the time of submission he was neurologically sound and
physically fit in mind and body, but he suffered irreparable damage and injury
rendering him decerebrate and totally incapacitated. The injury was one
which does not ordinarily occur in the process of a mastoid operation or in
the absence of negligence in the administration of an anesthetic, and in the
use and employment of an endoctracheal tube. Ordinarily a person being put
under anesthesia is not rendered decerebrate as a consequence of
administering such anesthesia in the absence of negligence. Upon these
facts and under these circumstances a layman would be able to say, as a
matter of common knowledge and observation, that the consequences of
professional treatment were not as such as would ordinarily have followed if
due care had been exercised.

Here the plaintiff could not have been guilty of contributory negligence
because he was under the influence of anesthetics and unconscious, and the
circumstances are such that the true explanation of event is more accessible
to the defendants than to the plaintiff for they had the exclusive control of the
instrumentalities of anesthesia.
Upon all the facts, conditions and circumstances alleged in Count II it is held
that a cause of action is stated under the doctrine of res ipsa loquitur. 44
Indeed, the principles enunciated in the aforequoted case apply with equal force here. In the
present case, Erlinda submitted herself for cholecystectomy and expected a routine general
surgery to be performed on her gall bladder. On that fateful day she delivered her person
over to the care, custody and control of private respondents who exercised complete and
exclusive control over her. At the time of submission, Erlinda was neurologically sound and,
except for a few minor discomforts, was likewise physically fit in mind and body. However,
during the administration of anesthesia and prior to the performance of cholecystectomy she
suffered irreparable damage to her brain. Thus, without undergoing surgery, she went out of
the operating room already decerebrate and totally incapacitated. Obviously, brain damage,
which Erlinda sustained, is an injury which does not normally occur in the process of a gall
bladder operation. In fact, this kind of situation does not in the absence of negligence of
someone in the administration of anesthesia and in the use of endotracheal tube. Normally, a
person being put under anesthesia is not rendered decerebrate as a consequence of
administering such anesthesia if the proper procedure was followed. Furthermore, the
instruments used in the administration of anesthesia, including the endotracheal tube, were
all under the exclusive control of private respondents, who are the physicians-in-charge.
Likewise, petitioner Erlinda could not have been guilty of contributory negligence because
she was under the influence of anesthetics which rendered her unconscious.
Considering that a sound and unaffected member of the body (the brain) is injured or
destroyed while the patient is unconscious and under the immediate and exclusive control of
the physicians, we hold that a practical administration of justice dictates the application of res
ipsa loquitur. Upon these facts and under these circumstances the Court would be able to
say, as a matter of common knowledge and observation, if negligence attended the
management and care of the patient. Moreover, the liability of the physicians and the hospital
in this case is not predicated upon an alleged failure to secure the desired results of an
operation nor on an alleged lack of skill in the diagnosis or treatment as in fact no operation
or treatment was ever performed on Erlinda. Thus, upon all these initial determination a case
is made out for the application of the doctrine of res ipsa loquitur.
Nonetheless, in holding that res ipsa loquitur is available to the present case we are not
saying that the doctrine is applicable in any and all cases where injury occurs to a patient
while under anesthesia, or to any and all anesthesia cases. Each case must be viewed in its
own light and scrutinized in order to be within the res ipsa loquitur coverage.
Having in mind the applicability of the res ipsa loquitur doctrine and the presumption of
negligence allowed therein, the Court now comes to the issue of whether the Court of
Appeals erred in finding that private respondents were not negligent in the care of Erlinda
during the anesthesia phase of the operation and, if in the affirmative, whether the alleged
negligence was the proximate cause of Erlinda's comatose condition. Corollary thereto, we
shall also determine if the Court of Appeals erred in relying on the testimonies of the
witnesses for the private respondents.
In sustaining the position of private respondents, the Court of Appeals relied on the
testimonies of Dra. Gutierrez, Dra. Calderon and Dr. Jamora. In giving weight to the
testimony of Dra. Gutierrez, the Court of Appeals rationalized that she was candid enough to
admit that she experienced some difficulty in the endotracheal intubation 45 of the patient and
thus, cannot be said to be covering her negligence with falsehood. The appellate court likewise
opined that private respondents were able to show that the brain damage sustained by Erlinda
was not caused by the alleged faulty intubation but was due to the allergic reaction of the patient
to the drug Thiopental Sodium (Pentothal), a short-acting barbiturate, as testified on by their

expert witness, Dr. Jamora. On the other hand, the appellate court rejected the testimony of Dean
Herminda Cruz offered in favor of petitioners that the cause of the brain injury was traceable to
the wrongful insertion of the tube since the latter, being a nurse, was allegedly not knowledgeable
in the process of intubation. In so holding, the appellate court returned a verdict in favor of
respondents physicians and hospital and absolved them of any liability towards Erlinda and her
family.

We disagree with the findings of the Court of Appeals. We hold that private respondents
were unable to disprove the presumption of negligence on their part in the care of Erlinda
and their negligence was the proximate cause of her piteous condition.
In the instant case, the records are helpful in furnishing not only the logical scientific
evidence of the pathogenesis of the injury but also in providing the Court the legal nexus
upon which liability is based. As will be shown hereinafter, private respondents' own
testimonies which are reflected in the transcript of stenographic notes are replete of
signposts indicative of their negligence in the care and management of Erlinda.
With regard to Dra. Gutierrez, we find her negligent in the care of Erlinda during the
anesthesia phase. As borne by the records, respondent Dra. Gutierrez failed to properly
intubate the patient. This fact was attested to by Prof. Herminda Cruz, Dean of the Capitol
Medical Center School of Nursing and petitioner's sister-in-law, who was in the operating
room right beside the patient when the tragic event occurred. Witness Cruz testified to this
effect:
ATTY. PAJARES:
Q: In particular, what did Dra. Perfecta Gutierrez do, if any on
the patient?
A: In particular, I could see that she was intubating the
patient.
Q: Do you know what happened to that intubation process
administered by Dra. Gutierrez?
ATTY. ALCERA:
She will be incompetent Your Honor.
COURT:
Witness may answer if she knows.
A: As have said, I was with the patient, I was beside the
stretcher holding the left hand of the patient and all of a
sudden heard some remarks coming from Dra. Perfecta
Gutierrez herself. She was saying "Ang hirap ma-intubate
nito, mali yata ang pagkakapasok. O lumalaki ang tiyan.
xxx xxx xxx
ATTY. PAJARES:
Q: From whom did you hear those words "lumalaki ang
tiyan"?
A: From Dra. Perfecta Gutierrez.
xxx xxx xxx

Q: After hearing the phrase "lumalaki ang tiyan," what did you
notice on the person of the patient?
A: I notice (sic) some bluish discoloration on the nailbeds of
the left hand where I was at.
Q: Where was Dr. Orlino Ho[s]aka then at that particular
time?
A: I saw him approaching the patient during that time.
Q: When he approached the patient, what did he do, if any?
A: He made an order to call on the anesthesiologist in the
person of Dr. Calderon.
Q: Did Dr. Calderon, upon being called, arrive inside the
operating room?
A: Yes sir.
Q: What did [s]he do, if any?
A: [S]he tried to intubate the patient.
Q: What happened to the patient?
A: When Dr. Calderon try (sic) to intubate the patient, after a
while the patient's nailbed became bluish and I saw the
patient was placed in trendelenburg position.
xxx xxx xxx
Q: Do you know the reason why the patient was placed in that
trendelenburg position?
A: As far as I know, when a patient is in that position, there is
a decrease of blood supply to the brain. 46
xxx xxx xxx

The appellate court, however, disbelieved Dean Cruz's testimony in the trial court by
declaring that:
A perusal of the standard nursing curriculum in our country will show that
intubation is not taught as part of nursing procedures and techniques.
Indeed, we take judicial notice of the fact that nurses do not, and cannot,
intubate. Even on the assumption that she is fully capable of determining
whether or not a patient is properly intubated, witness Herminda Cruz,
admittedly, did not peep into the throat of the patient. (TSN, July 25, 1991, p.
13). More importantly, there is no evidence that she ever auscultated the
patient or that she conducted any type of examination to check if the
endotracheal tube was in its proper place, and to determine the condition of
the heart, lungs, and other organs. Thus, witness Cruz's categorical
statements that appellant Dra. Gutierrez failed to intubate the appellee
Erlinda Ramos and that it was Dra. Calderon who succeeded in doing so
clearly suffer from lack of sufficient factual bases. 47

In other words, what the Court of Appeals is trying to impress is that being a nurse, and
considered a layman in the process of intubation, witness Cruz is not competent to testify on
whether or not the intubation was a success.
We do not agree with the above reasoning of the appellate court. Although witness Cruz is
not an anesthesiologist, she can very well testify upon matters on 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. 48 This is precisely
allowed under the doctrine of res ipsa loquitur where the testimony of expert witnesses is not
required. It is the accepted rule that expert testimony is not necessary for the proof of negligence
in non-technical matters or those of which an ordinary person may be expected to have
knowledge, or where the lack of skill or want of care is so obvious as to render expert testimony
unnecessary. 49 We take judicial notice of the fact that anesthesia procedures have become so
common, that even an ordinary person can tell if it was administered properly. As such, it would
not be too difficult to tell if the tube was properly inserted. This kind of observation, we believe,
does not require a medical degree to be acceptable.
At any rate, without doubt, petitioner's witness, an experienced clinical nurse whose long
experience and scholarship led to her appointment as Dean of the Capitol Medical Center
School at Nursing, was fully capable of determining whether or not the intubation was a
success. She had extensive clinical experience starting as a staff nurse in Chicago, Illinois;
staff nurse and clinical instructor in a teaching hospital, the FEU-NRMF; Dean of the Laguna
College of Nursing in San Pablo City; and then Dean of the Capitol Medical Center School of
Nursing. 50Reviewing witness Cruz' statements, we find that the same were delivered in a
straightforward manner, with the kind of detail, clarity, consistency and spontaneity which would
have been difficult to fabricate. With her clinical background as a nurse, the Court is satisfied that
she was able to demonstrate through her testimony what truly transpired on that fateful day.
Most of all, her testimony was affirmed by no less than respondent Dra. Gutierrez who
admitted that she experienced difficulty in inserting the tube into Erlinda's trachea, to wit:
ATTY. LIGSAY:
Q: In this particular case, Doctora, while you were intubating
at your first attempt (sic), you did not immediately see the
trachea?
DRA. GUTIERREZ:
A: Yes sir.
Q: Did you pull away the tube immediately?
A: You do not pull the . . .
Q: Did you or did you not?
A: I did not pull the tube.
Q: When you said "mahirap yata ito," what were you referring
to?
A: "Mahirap yata itong i-intubate," that was the patient.
Q: So, you found some difficulty in inserting the tube?
A: Yes, because of (sic) my first attempt, I did not see right
away. 51

Curiously in the case at bar, respondent Dra. Gutierrez made the haphazard defense that
she encountered hardship in the insertion of the tube in the trachea of Erlinda because it was
positioned more anteriorly (slightly deviated from the normal anatomy of a person) 52 making
it harder to locate and, since Erlinda is obese and has a short neck and protruding teeth, it made
intubation even more difficult.
The argument does not convince us. If this was indeed observed, private respondents
adduced no evidence demonstrating that they proceeded to make a thorough assessment of
Erlinda's airway, prior to the induction of anesthesia, even if this would mean postponing the
procedure. From their testimonies, it appears that the observation was made only as an
afterthought, as a means of defense.
The pre-operative evaluation of a patient prior to the administration of anesthesia is
universally observed to lessen the possibility of anesthetic accidents. Pre-operative
evaluation and preparation for anesthesia begins when the anesthesiologist reviews the
patient's medical records and visits with the patient, traditionally, the day before elective
surgery. 53 It includes taking the patient's medical history, review of current drug therapy, physical
examination and interpretation of laboratory data. 54 The physical examination performed by the
anesthesiologist is directed primarily toward the central nervous system, cardiovascular system,
lungs and upper airway. 55 A thorough analysis of the patient's airway normally involves
investigating the following: cervical spine mobility, temporomandibular mobility, prominent central
incisors, diseased or artificial teeth, ability to visualize uvula and the thyromental
distance. 56 Thus, physical characteristics of the patient's upper airway that could make tracheal
intubation difficult should be studied. 57 Where the need arises, as when initial assessment
indicates possible problems (such as the alleged short neck and protruding teeth of Erlinda) a
thorough examination of the patient's airway would go a long way towards decreasing patient
morbidity and mortality.
In the case at bar, respondent Dra. Gutierrez admitted that she saw Erlinda for the first time
on the day of the operation itself, on 17 June 1985. Before this date, no prior consultations
with, or pre-operative evaluation of Erlinda was done by her. Until the day of the operation,
respondent Dra. Gutierrez was unaware of the physiological make-up and needs of Erlinda.
She was likewise not properly informed of the possible difficulties she would face during the
administration of anesthesia to Erlinda. Respondent Dra. Gutierrez' act of seeing her patient
for the first time only an hour before the scheduled operative procedure was, therefore, an
act of exceptional negligence and professional irresponsibility. The measures cautioning
prudence and vigilance in dealing with human lives lie at the core of the physician's
centuries-old Hippocratic Oath. Her failure to follow this medical procedure is, therefore, a
clear indicia of her negligence.
Respondent Dra. Gutierrez, however, attempts to gloss over this omission by playing around
with the trial court's ignorance of clinical procedure, hoping that she could get away with it.
Respondent Dra. Gutierrez tried to muddle the difference between an elective surgery and
an emergency surgery just so her failure to perform the required pre-operative evaluation
would escape unnoticed. In her testimony she asserted:
ATTY. LIGSAY:
Q: Would you agree, Doctor, that it is good medical practice
to see the patient a day before so you can introduce yourself
to establish good doctor-patient relationship and gain the trust
and confidence of the patient?
DRA. GUTIERREZ:
A: As I said in my previous statement, it depends on the
operative procedure of the anesthesiologist and in my case,
with elective cases and normal cardio-pulmonary clearance
like that, I usually don't do it except on emergency and on
cases that have an abnormalities (sic). 58

However, the exact opposite is true. In an emergency procedure, there is hardly enough time
available for the fastidious demands of pre-operative procedure so that an anesthesiologist
is able to see the patient only a few minutes before surgery, if at all. Elective procedures, on
the other hand, are operative procedures that can wait for days, weeks or even months.
Hence, in these cases, the anesthesiologist possesses the luxury of time to be at the
patient's beside to do a proper interview and clinical evaluation. There is ample time to
explain the method of anesthesia, the drugs to be used, and their possible hazards for
purposes of informed consent. Usually, the pre-operative assessment is conducted at least
one day before the intended surgery, when the patient is relaxed and cooperative.
Erlinda's case was elective and this was known to respondent Dra. Gutierrez. Thus, she had
all the time to make a thorough evaluation of Erlinda's case prior to the operation and
prepare her for anesthesia. However, she never saw the patient at the bedside. She herself
admitted that she had seen petitioner only in the operating room, and only on the actual date
of the cholecystectomy. She negligently failed to take advantage of this important
opportunity. As such, her attempt to exculpate herself must fail.
Having established that respondent Dra. Gutierrez failed to perform pre-operative evaluation
of the patient which, in turn, resulted to a wrongful intubation, we now determine if the faulty
intubation is truly the proximate cause of Erlinda's comatose condition.
Private respondents repeatedly hammered the view that the cerebral anoxia which led to
Erlinda's coma was due to bronchospasm 59 mediated by her allergic response to the drug,
Thiopental Sodium, introduced into her system. Towards this end, they presented Dr. Jamora, a
Fellow of the Philippine College of Physicians and Diplomate of the Philippine Specialty Board of
Internal Medicine, who advanced private respondents' theory that the oxygen deprivation which
led to anoxic encephalopathy, 60 was due to an unpredictable drug reaction to the short-acting
barbiturate. We find the theory of private respondents unacceptable.
First of all, Dr. Jamora cannot be considered an authority in the field of anesthesiology
simply because he is not an anesthesiologist. Since Dr. Jamora is a pulmonologist, he could
not have been capable of properly enlightening the court about anesthesia practice and
procedure and their complications. Dr. Jamora is likewise not an allergologist and could not
therefore properly advance expert opinion on allergic-mediated processes. Moreover, he is
not a pharmacologist and, as such, could not have been capable, as an expert would, of
explaining to the court the pharmacologic and toxic effects of the supposed culprit,
Thiopental Sodium (Pentothal).
The inappropriateness and absurdity of accepting Dr. Jamora's testimony as an expert
witness in the anesthetic practice of Pentothal administration is further supported by his own
admission that he formulated his opinions on the drug not from the practical experience
gained by a specialist or expert in the administration and use of Sodium Pentothal on
patients, but only from reading certain references, to wit:
ATTY. LIGSAY:
Q: In your line of expertise on pulmonology, did you have any
occasion to use pentothal as a method of management?
DR. JAMORA:
A: We do it in conjunction with the anesthesiologist when they
have to intubate our patient.
Q: But not in particular when you practice pulmonology?
A: No.

Q: In other words, your knowledge about pentothal is based


only on what you have read from books and not by your own
personal application of the medicine pentothal?
A: Based on my personal experience also on pentothal.
Q: How many times have you used pentothal?
A: They used it on me. I went into bronchospasm during my
appendectomy.
Q: And because they have used it on you and on account of
your own personal experience you feel that you can testify on
pentothal here with medical authority?
A: No. That is why I used references to support my claims. 61
An anesthetic accident caused by a rare drug-induced bronchospasm properly falls within
the fields of anesthesia, internal medicine-allergy, and clinical pharmacology. The resulting
anoxic encephalopathy belongs to the field of neurology. While admittedly, many
bronchospastic-mediated pulmonary diseases are within the expertise of pulmonary
medicine, Dr. Jamora's field, the anesthetic drug-induced, allergic mediated bronchospasm
alleged in this case is within the disciplines of anesthesiology, allergology and pharmacology.
On the basis of the foregoing transcript, in which the pulmonologist himself admitted that he
could not testify about the drug with medical authority, it is clear that the appellate court erred
in giving weight to Dr. Jamora's testimony as an expert in the administration of Thiopental
Sodium.
The provision in the rules of evidence 62 regarding expert witnesses states:
Sec. 49. Opinion of expert witness. The opinion of a witness on a matter
requiring special knowledge, skill, experience or training which he is shown to
possess, may be received in evidence.
Generally, to qualify as an expert witness, one must have acquired special knowledge of the
subject matter about which he or she is to testify, either by the study of recognized
authorities on the subject or by practical experience. 63 Clearly, Dr. Jamora does not qualify as
an expert witness based on the above standard since he lacks the necessary knowledge, skill,
and training in the field of anesthesiology. Oddly, apart from submitting testimony from a specialist
in the wrong field, private respondents' intentionally avoided providing testimony by competent
and independent experts in the proper areas.
Moreover, private respondents' theory, that Thiopental Sodium may have produced Erlinda's
coma by triggering an allergic mediated response, has no support in evidence. No evidence
of stridor, skin reactions, or wheezing some of the more common accompanying signs of
an allergic reaction appears on record. No laboratory data were ever presented to the
court.
In any case, private respondents themselves admit that Thiopental induced, allergicmediated bronchospasm happens only very rarely. If courts were to accept private
respondents' hypothesis without supporting medical proof, and against the weight of
available evidence, then every anesthetic accident would be an act of God. Evidently, the
Thiopental-allergy theory vigorously asserted by private respondents was a mere
afterthought. Such an explanation was advanced in order to advanced in order to absolve
them of any and all responsibility for the patient's condition.
In view of the evidence at hand, we are inclined to believe petitioners' stand that it was the
faulty intubation which was the proximate cause of Erlinda's comatose condition.

Proximate cause has been defined as that which, in natural and continuous sequence,
unbroken by any efficient intervening cause, produces injury, and without which the result
would not have occurred. 64 An injury or damage is proximately caused by an act or a failure to
act, whenever it appears from the evidence in the case, that the act or omission played a
substantial part in bringing about or actually causing the injury or damage; and that the injury or
damage was either a direct result or a reasonably probable consequence of the act or
omission. 65 It is the dominant, moving or producing cause.
Applying the above definition in relation to the evidence at hand, faulty intubation is
undeniably the proximate cause which triggered the chain of events leading to Erlinda's brain
damage and, ultimately, her comatosed condition.
Private respondents themselves admitted in their testimony that the first intubation was a
failure. This fact was likewise observed by witness Cruz when she heard respondent Dra.
Gutierrez remarked, "Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki
ang tiyan." Thereafter, witness Cruz noticed abdominal distention on the body of Erlinda. The
development of abdominal distention, together with respiratory embarrassment indicates that
the endotracheal tube entered the esophagus instead of the respiratory tree. In other words,
instead of the intended endotracheal intubation what actually took place was an esophageal
intubation. During intubation, such distention indicates that air has entered the
gastrointestinal tract through the esophagus instead of the lungs through the trachea. Entry
into the esophagus would certainly cause some delay in oxygen delivery into the lungs as
the tube which carries oxygen is in the wrong place. That abdominal distention had been
observed during the first intubation suggests that the length of time utilized in inserting the
endotracheal tube (up to the time the tube was withdrawn for the second attempt) was fairly
significant. Due to the delay in the delivery of oxygen in her lungs Erlinda showed signs of
cyanosis. 66 As stated in the testimony of Dr. Hosaka, the lack of oxygen became apparent only
after he noticed that the nailbeds of Erlinda were already blue. 67 However, private respondents
contend that a second intubation was executed on Erlinda and this one was successfully done.
We do not think so. No evidence exists on record, beyond private respondents' bare claims,
which supports the contention that the second intubation was successful. Assuming that the
endotracheal tube finally found its way into the proper orifice of the trachea, the same gave no
guarantee of oxygen delivery, the hallmark of a successful intubation. In fact, cyanosis was again
observed immediately after the second intubation. Proceeding from this event (cyanosis), it could
not be claimed, as private respondents insist, that the second intubation was accomplished. Even
granting that the tube was successfully inserted during the second attempt, it was obviously too
late. As aptly explained by the trial court, Erlinda already suffered brain damage as a result of the
inadequate oxygenation of her brain for about four to five minutes. 68
The above conclusion is not without basis. Scientific studies point out that intubation
problems are responsible for one-third (1/3) of deaths and serious injuries associated with
anesthesia. 69 Nevertheless, ninety-eight percent (98%) or the vast majority of difficult intubations
may be anticipated by performing a thorough evaluation of the patient's airway prior to the
operation. 70 As stated beforehand, respondent Dra. Gutierrez failed to observe the proper preoperative protocol which could have prevented this unfortunate incident. Had appropriate
diligence and reasonable care been used in the pre-operative evaluation, respondent physician
could have been much more prepared to meet the contingency brought about by the perceived
anatomic variations in the patient's neck and oral area, defects which would have been easily
overcome by a prior knowledge of those variations together with a change in technique. 71 In other
words, an experienced anesthesiologist, adequately alerted by a thorough pre-operative
evaluation, would have had little difficulty going around the short neck and protruding
teeth. 72 Having failed to observe common medical standards in pre-operative management and
intubation, respondent Dra. Gutierrez' negligence resulted in cerebral anoxia and eventual coma
of Erlinda.
We now determine the responsibility of respondent Dr. Orlino Hosaka as the head of the
surgical team. As the so-called "captain of the ship," 73 it is the surgeon's responsibility to see to
it that those under him perform their task in the proper manner. Respondent Dr. Hosaka's
negligence can be found in his failure to exercise the proper authority (as the "captain" of the
operative team) in not determining if his anesthesiologist observed proper anesthesia protocols.
In fact, no evidence on record exists to show that respondent Dr. Hosaka verified if respondent

Dra. Gutierrez properly intubated the patient. Furthermore, it does not escape us that respondent
Dr. Hosaka had scheduled another procedure in a different hospital at the same time as Erlinda's
cholecystectomy, and was in fact over three hours late for the latter's operation. Because of this,
he had little or no time to confer with his anesthesiologist regarding the anesthesia delivery. This
indicates that he was remiss in his professional duties towards his patient. Thus, he shares equal
responsibility for the events which resulted in Erlinda's condition.

We now discuss the responsibility of the hospital in this particular incident. The unique
practice (among private hospitals) of filling up specialist staff with attending and visiting
"consultants," 74 who are allegedly not hospital employees, presents problems in apportioning
responsibility for negligence in medical malpractice cases. However, the difficulty is only more
apparent than real.
In the first place, hospitals exercise significant control in the hiring and firing of consultants
and in the conduct of their work within the hospital premises. Doctors who apply for
"consultant" slots, visiting or attending, are required to submit proof of completion of
residency, their educational qualifications; generally, evidence of accreditation by the
appropriate board (diplomate), evidence of fellowship in most cases, and references. These
requirements are carefully scrutinized by members of the hospital administration or by a
review committee set up by the hospital who either accept or reject the application. 75 This is
particularly true with respondent hospital.
After a physician is accepted, either as a visiting or attending consultant, he is normally
required to attend clinico-pathological conferences, conduct bedside rounds for clerks,
interns and residents, moderate grand rounds and patient audits and perform other tasks
and responsibilities, for the privilege of being able to maintain a clinic in the hospital, and/or
for the privilege of admitting patients into the hospital. In addition to these, the physician's
performance as a specialist is generally evaluated by a peer review committee on the basis
of mortality and morbidity statistics, and feedback from patients, nurses, interns and
residents. A consultant remiss in his duties, or a consultant who regularly falls short of the
minimum standards acceptable to the hospital or its peer review committee, is normally
politely terminated.
In other words, private hospitals, hire, fire and exercise real control over their attending and
visiting "consultant" staff. While "consultants" are not, technically employees, a point which
respondent hospital asserts in denying all responsibility for the patient's condition, the control
exercised, the hiring, and the right to terminate consultants all fulfill the important hallmarks
of an employer-employee relationship, with the exception of the payment of wages. In
assessing whether such a relationship in fact exists, the control test is determining.
Accordingly, on the basis of the foregoing, we rule that for the purpose of allocating
responsibility in medical negligence cases, an employer-employee relationship in effect
exists between hospitals and their attending and visiting physicians. This being the case, the
question now arises as to whether or not respondent hospital is solidarily liable with
respondent doctors for petitioner's condition. 76
The basis for holding an employer solidarily responsible for the negligence of its employee is
found in Article 2180 of the Civil Code which considers a person accountable not only for his
own acts but also for those of others based on the former's responsibility under a relationship
of patria potestas. 77 Such responsibility ceases when the persons or entity concerned prove that
they have observed the diligence of a good father of the family to prevent damage. 78 In other
words, while the burden of proving negligence rests on the plaintiffs, once negligence is shown,
the burden shifts to the respondents (parent, guardian, teacher or employer) who should prove
that they observed the diligence of a good father of a family to prevent damage.
In the instant case, respondent hospital, apart from a general denial of its responsibility over
respondent physicians, failed to adduce evidence showing that it exercised the diligence of a
good father of a family in the hiring and supervision of the latter. It failed to adduce evidence
with regard to the degree of supervision which it exercised over its physicians. In neglecting
to offer such proof, or proof of a similar nature, respondent hospital thereby failed to
discharge its burden under the last paragraph of Article 2180. Having failed to do this,

respondent hospital is consequently solidarily responsible with its physicians for Erlinda's
condition.
Based on the foregoing, we hold that the Court of Appeals erred in accepting and relying on
the testimonies of the witnesses for the private respondents. Indeed, as shown by the above
discussions, private respondents were unable to rebut the presumption of negligence. Upon
these disquisitions we hold that private respondents are solidarily liable for damages under
Article 2176 79 of the Civil Code.
We now come to the amount of damages due petitioners. The trial court awarded a total of
P632,000.00 pesos (should be P616,000.00) in compensatory damages to the plaintiff,
"subject to its being updated" covering the period from 15 November 1985 up to 15 April
1992, based on monthly expenses for the care of the patient estimated at P8,000.00.
At current levels, the P8000/monthly amount established by the trial court at the time of its
decision would be grossly inadequate to cover the actual costs of home-based care for a
comatose individual. The calculated amount was not even arrived at by looking at the actual
cost of proper hospice care for the patient. What it reflected were the actual expenses
incurred and proved by the petitioners after they were forced to bring home the patient to
avoid mounting hospital bills.
And yet ideally, a comatose patient should remain in a hospital or be transferred to a hospice
specializing in the care of the chronically ill for the purpose of providing a proper milieu
adequate to meet minimum standards of care. In the instant case for instance, Erlinda has to
be constantly turned from side to side to prevent bedsores and hypostatic pneumonia.
Feeding is done by nasogastric tube. Food preparation should be normally made by a
dietitian to provide her with the correct daily caloric requirements and vitamin supplements.
Furthermore, she has to be seen on a regular basis by a physical therapist to avoid muscle
atrophy, and by a pulmonary therapist to prevent the accumulation of secretions which can
lead to respiratory complications.
Given these considerations, the amount of actual damages recoverable in suits arising from
negligence should at least reflect the correct minimum cost of proper care, not the cost of the
care the family is usually compelled to undertake at home to avoid bankruptcy. However, the
provisions of the Civil Code on actual or compensatory damages present us with some
difficulties.
Well-settled is the rule that actual damages which may be claimed by the plaintiff are those
suffered by him as he has duly proved. The Civil Code provides:
Art. 2199. Except as provided by law or by stipulation, one is entitled to an
adequate compensation only for such pecuniary loss suffered by him as he
has duly proved. Such compensation is referred to as actual or
compensatory damages.
Our rules on actual or compensatory damages generally assume that at the time of litigation,
the injury suffered as a consequence of an act of negligence has been completed and that
the cost can be liquidated. However, these provisions neglect to take into account those
situations, as in this case, where the resulting injury might be continuing and possible future
complications directly arising from the injury, while certain to occur, are difficult to predict.
In these cases, the amount of damages which should be awarded, if they are to adequately
and correctly respond to the injury caused, should be one which compensates for pecuniary
loss incurred and proved, up to the time of trial; and one which would meet pecuniary loss
certain to be suffered but which could not, from the nature of the case, be made with
certainty. 80 In other words, temperate damages can and should be awarded on top of actual or
compensatory damages in instances where the injury is chronic and continuing. And because of
the unique nature of such cases, no incompatibility arises when both actual and temperate
damages are provided for. The reason is that these damages cover two distinct phases.

As it would not be equitable and certainly not in the best interests of the administration of
justice for the victim in such cases to constantly come before the courts and invoke their
aid in seeking adjustments to the compensatory damages previously awarded temperate
damages are appropriate. The amount given as temperate damages, though to a certain
extent speculative, should take into account the cost of proper care.
In the instant case, petitioners were able to provide only home-based nursing care for a
comatose patient who has remained in that condition for over a decade. Having premised
our award for compensatory damages on the amount provided by petitioners at the onset of
litigation, it would be now much more in step with the interests of justice if the value awarded
for temperate damages would allow petitioners to provide optimal care for their loved one in
a facility which generally specializes in such care. They should not be compelled by dire
circumstances to provide substandard care at home without the aid of professionals, for
anything less would be grossly inadequate. Under the circumstances, an award of
P1,500,000.00 in temperate damages would therefore be reasonable. 81
In Valenzuela vs. Court of Appeals, 82 this Court was confronted with a situation where the injury
suffered by the plaintiff would have led to expenses which were difficult to estimate because while
they would have been a direct result of the injury (amputation), and were certain to be incurred by
the plaintiff, they were likely to arise only in the future. We awarded P1,000,000.00 in moral
damages in that case.
Describing the nature of the injury, the Court therein stated:
As a result of the accident, Ma. Lourdes Valenzuela underwent a traumatic
amputation of her left lower extremity at the distal left thigh just above the
knee. Because of this, Valenzuela will forever be deprived of the full
ambulatory functions of her left extremity, even with the use of state of the art
prosthetic technology. Well beyond the period of hospitalization (which was
paid for by Li), she will be required to undergo adjustments in her prosthetic
devise due to the shrinkage of the stump from the process of healing.
These adjustments entail costs, prosthetic replacements and months of
physical and occupational rehabilitation and therapy. During the lifetime, the
prosthetic devise will have to be replaced and readjusted to changes in the
size of her lower limb effected by the biological changes of middle-age,
menopause and aging. Assuming she reaches menopause, for example, the
prosthetic will have to be adjusted to respond to the changes in bone
resulting from a precipitate decrease in calcium levels observed in the bones
of all post-menopausal women. In other words, the damage done to her
would not only be permanent and lasting, it would also be permanently
changing and adjusting to the physiologic changes which her body would
normally undergo through the years. The replacements, changes, and
adjustments will require corresponding adjustive physical and occupational
therapy. All of these adjustments, it has been documented, are painful.
xxx xxx xxx
A prosthetic devise, however technologically advanced, will only allow a
reasonable amount of functional restoration of the motor functions of the
lower limb. The sensory functions are forever lost. The resultant anxiety,
sleeplessness, psychological injury, mental and physical pain are
inestimable.83
The injury suffered by Erlinda as a consequence of private respondents' negligence is
certainly much more serious than the amputation in the Valenzuela case.
Petitioner Erlinda Ramos was in her mid-forties when the incident occurred. She has been in
a comatose state for over fourteen years now. The burden of care has so far been heroically

shouldered by her husband and children, who, in the intervening years have been deprived
of the love of a wife and a mother.
Meanwhile, the actual physical, emotional and financial cost of the care of petitioner would
be virtually impossible to quantify. Even the temperate damages herein awarded would be
inadequate if petitioner's condition remains unchanged for the next ten years.
We recognized, in Valenzuela that a discussion of the victim's actual injury would not even
scratch the surface of the resulting moral damage because it would be highly speculative to
estimate the amount of emotional and moral pain, psychological damage and injury suffered
by the victim or those actually affected by the victim's condition. 84The husband and the
children, all petitioners in this case, will have to live with the day to day uncertainty of the patient's
illness, knowing any hope of recovery is close to nil. They have fashioned their daily lives around
the nursing care of petitioner, altering their long term goals to take into account their life with a
comatose patient. They, not the respondents, are charged with the moral responsibility of the care
of the victim. The family's moral injury and suffering in this case is clearly a real one. For the
foregoing reasons, an award of P2,000,000.00 in moral damages would be appropriate.
Finally, by way of example, exemplary damages in the amount of P100,000.00 are hereby
awarded. Considering the length and nature of the instant suit we are of the opinion that
attorney's fees valued at P100,000.00 are likewise proper.
Our courts face unique difficulty in adjudicating medical negligence cases because
physicians are not insurers of life and, they rarely set out to intentionally cause injury or
death to their patients. However, intent is immaterial in negligence cases because where
negligence exists and is proven, the same automatically gives the injured a right to
reparation for the damage caused.
Established medical procedures and practices, though in constant flux are devised for the
purpose of preventing complications. A physician's experience with his patients would
sometimes tempt him to deviate from established community practices, and he may end a
distinguished career using unorthodox methods without incident. However, when failure to
follow established procedure results in the evil precisely sought to be averted by observance
of the procedure and a nexus is made between the deviation and the injury or damage, the
physician would necessarily be called to account for it. In the case at bar, the failure to
observe pre-operative assessment protocol which would have influenced the intubation in a
salutary way was fatal to private respondents' case.
WHEREFORE, the decision and resolution of the appellate court appealed from are hereby
modified so as to award in favor of petitioners, and solidarily against private respondents the
following: 1) P1,352,000.00 as actual damages computed as of the date of promulgation of
this decision plus a monthly payment of P8,000.00 up to the time that petitioner Erlinda
Ramos expires or miraculously survives; 2) P2,000,000.00 as moral damages, 3)
P1,500,000.00 as temperate damages; 4) P100,000.00 each as exemplary damages and
attorney's fees; and, 5) the costs of the suit.
SO ORDERED.
Davide, Jr., C.J., Puno, Pardo and Ynares-Santiago, JJ., concur.

G.R. No. 167366

September 26, 2012

DR. PEDRO DENNIS CERENO, and DR. SANTOS ZAFE, Petitioners,


vs.
COURT OF APPEALS, SPOUSES DIOGENES S. OLAVERE and FE R.
SERRANO, Respondents.
DECISION
PEREZ, J.:
Before the Court is a Petition for Review on Certiorari 1 under Rule 45 of the Rules of Court
seeking the annulment and setting aside of the 21 February 2005 decision2 of the Court of
Appeals (CA) in CA-G.R. CV No. 65800. In the assailed decision, the CA affirmed in toto the
decision of the Regional Trial Court (R TC), Branch 22, Nag a City finding herein petitioners
Dr. Pedro Dennis Cereno (Dr. Cereno) and Dr. Santos Zafe (Dr. Zafe) liable for damages.
Culled from the records are the following antecedent facts:
At about 9:15 in the evening of 16 September 1995, Raymond S. Olavere (Raymond), a
victim of a stabbing incident, was rushed to the emergency room of the Bicol Regional
Medical Center (BRMC). There, Raymond was attended to by Nurse Arlene Balares (Nurse
Balares) and Dr. Ruel Levy Realuyo (Dr. Realuyo) the emergency room resident
physician.
Subsequently, the parents of Raymondthe spouses Deogenes Olavere (Deogenes) and Fe
R. Serranoarrived at the BRMC. They were accompanied by one Andrew Olavere, the
uncle of Raymond.
After extending initial medical treatment to Raymond, Dr. Realuyo recommended that the
patient undergo "emergency exploratory laparotomy." Dr. Realuyo then requested the
parents of Raymond to procure 500 cc of type "O" blood needed for the operation.
Complying with the request, Deogenes and Andrew Olavere went to the Philippine National
Red Cross to secure the required blood.
At 10:30 P.M., Raymond was wheeled inside the operating room. During that time, the
hospital surgeons, Drs. Zafe and Cereno, were busy operating on gunshot victim Charles
Maluluy-on. Assisting them in the said operation was Dr. Rosalina Tatad (Dr. Tatad), who was
the only senior anesthesiologist on duty at BRMC that night. Dr. Tatad also happened to be
the head of Anesthesiology Department of the BRMC.
Just before the operation on Maluluy-on was finished, another emergency case involving
Lilia Aguila, a woman who was giving birth to triplets, was brought to the operating room.
At 10:59 P.M., the operation on Charles Maluluy-on was finished. By that time, however, Dr.
Tatad was already working with the obstetricians who will perform surgery on Lilia Aguila.
There being no other available anesthesiologist to assist them, Drs. Zafe and Cereno
decided to defer the operation on Raymond.
Drs. Zafe and Cereno, in the meantime, proceeded to examine Raymond and they found
that the latters blood pressure was normal and "nothing in him was significant." 3 Dr. Cereno
reported that based on the xray result he interpreted, the fluid inside the thoracic cavity of
Raymond was minimal at around 200-300 cc.
At 11:15 P.M., Deogenes and Andrew Olavere returned to the BRMC with a bag containing
the requested 500 cc type "O" blood. They handed over the bag of blood to Dr. Realuyo.
After Dr. Tatad finished her work with the Lilia Aguila operation, petitioners immediately
started their operation on Raymond at around 12:15 A.M. of 17 September 1995. Upon

opening of Raymonds thoracic cavity, they found that 3,200 cc of blood was stocked therein.
The blood was evacuated and petitioners found a puncture at the inferior pole of the left
lung.
In his testimony, Dr. Cereno stated that considering the loss of blood suffered by Raymond,
he did not immediately transfuse blood because he had to control the bleeders first. 4
Blood was finally transfused on Raymond at 1:40 A.M. At 1:45 A.M., while the operation was
on-going, Raymond suffered a cardiac arrest. The operation ended at 1:50 A.M. and
Raymond was pronounced dead at 2:30 A.M.
Raymonds death certificate5 indicated that the immediate cause of death was "hypovolemic
shock" or the cessation of the functions of the organs of the body due to loss of blood. 6
Claiming that there was negligence on the part of those who attended to their son, the
parents of Raymond, on 25 October 1995, filed before the RTC, Branch 22, Naga City a
complaint for damages7 against Nurse Balares, Dr. Realuyo and attending surgeons Dr.
Cereno and Dr. Zafe.
During trial, the parents of Raymond testified on their own behalf. They also presented the
testimonies of Andrew Olavere and one Loira Oira, the aunt of Raymond. On the other hand,
Dr. Cereno, Dr. Realuyo, Nurse Balares and Security Guard Diego Reposo testified for the
defense. On rebuttal, the parents of Raymond presented Dr. Tatad, among others.
On 15 October 1999, the trial court rendered a decision8 the dispositive portion of which
reads:
WHEREFORE, premises considered, this Court hereby renders judgment:
1. Dismissing the case against Dr. Ruel Levy Realuyo and Arlene Balares for lack of
merit;
2. Ordering defendants Dr. Santos Zafe and Dr. Dennis Cereno to pay the heirs of
Raymond Olavere, jointly and severally the following amounts:
1. P 50,000.00 for the death of the victim;
2. P 150,000.00 as moral damages;
3. P 100,000.00 as exemplary damages;
4. P 30,000.00 for attorneys fees; and
5. Cost of suit.9
x x x x.
The trial court found petitioners negligent in not immediately conducting surgery on
Raymond. It noted that petitioners have already finished operating on Charles Maluluy-on as
early as 10:30 in the evening, and yet they only started the operation on Raymond at around
12:15 early morning of the following day. The trial court held that had the surgery been
performed promptly, Raymond would not have lost so much blood and, therefore, could have
been saved.10
The trial court also held that the non-availability of Dr. Tatad after the operation on Maluluyon was not a sufficient excuse for the petitioners to not immediately operate on Raymond. It
called attention to the testimony of Dr. Tatad herself, which disclosed the possibility of calling

a standby anesthesiologist in that situation. The trial court opined that the petitioners could
have just requested for the standby anesthesiologist from Dr. Tatad, but they did not.
Lastly, the trial court faulted petitioners for the delay in the transfusion of blood on Raymond.
On appeal, the CA in a decision dated 21 February 2005 affirmed in toto the judgment
rendered by the RTC finding herein petitioners guilty of gross negligence in the performance
of their duties and awarding damages to private respondents.
Hence, this petition for review on certiorari under Rule 45 of the Rules of Court assailing the
CA decision on the following grounds:
1. THAT THE CA ERRED IN RULING THAT PETITIONERS WERE GROSSLY
NEGLIGENT IN THE PERFORMANCE OF THEIR DUTIES;
2. THAT THE CA ERRED IN NOT CONSIDERING THE BICOL REGIONAL
MEDICAL CENTER AS AN INDISPENSABLE PARTY AND SUBSIDIARILY LIABLE
SHOULD PETITIONERS BE FOUND LIABLE FOR DAMAGES; and
3. THAT THE CA ERRED IN NOT FINDING THE AWARD OF MORAL AND
EXEMPLARY DAMAGES AS WELL AS ATTORNEYS FEES EXORBITANT OR
EXCESSIVE.
We grant the petition
It is well-settled that under Rule 45 of the Rules of Court, only questions of law may be
raised. The reason behind this is that this Court is not a trier of facts and will not re-examine
and re-evaluate the evidence on record.11Factual findings of the CA, affirming that of the trial
court, are therefore generally final and conclusive on this Court. This rule is subject to the
following exceptions: (1) the conclusion is grounded on speculations, surmises or
conjectures; (2) the inference is manifestly mistaken, absurd or impossible; (3) there is grave
abuse of discretion; (4) the judgment is based on a misapprehension of facts; (5) the findings
of fact are conflicting; (6) there is no citation of specific evidence on which the factual
findings are based; (7) the findings of absence of fact are contradicted by the presence of
evidence on record; (8) the findings of the CA are contrary to those of the trial court; (9) the
CA manifestly overlooked certain relevant and undisputed facts that, if properly considered,
would justify a different conclusion; (10) the findings of the CA are beyond the issues of the
case; and (11) such findings are contrary to the admissions of both parties. 12 In this case, We
find exceptions (1) and (4) to be applicable.
The type of lawsuit which has been called medical malpractice or, more appropriately,
medical negligence, is that type of claim which a victim has available to him or her to redress
a wrong committed by a medical professional which has caused bodily harm. In order to
successfully pursue such a claim, a patient must prove that a health care provider, in most
cases a physician, either failed to do something which a reasonably prudent health
care provider would have done, or that he or she did something that a reasonably
prudent provider would not have done; and that the failure or action caused injury to
the patient.13 Stated otherwise, the complainant must prove: (1) that the health care
provider, either by his act or omission, had been negligent, and (2) that such act or omission
proximately caused the injury complained of.
The best way to prove these is through the opinions of expert witnesses belonging in the
same neighborhood and in the same general line of practice as defendant physician or
surgeon. The deference of courts to the expert opinion of qualified physicians stems from the
formers realization that the latter possess unusual technical skills which laymen in most
instances are incapable of intelligently evaluating, hence, the indispensability of expert
testimonies.14
Guided by the foregoing standards, We dissect the issues at hand.

Petitioners Not Negligent


The trial court first imputed negligence on the part of the petitioners by their failure to perform
the operation on Raymond immediately after finishing the Maluluy-on operation. It rejected
as an excuse the nonavailability of Dr. Tatad. The trial court relied on the testimony of Dr.
Tatad about a "BRMC protocol" that introduces the possibility that a standby anesthesiologist
could have been called upon. The pertinent portions of the testimony of Dr. Tatad provides:
Q: Aside from you and Dr. Rebancos, who was the standby anesthesiologist?
A: We have a protocol at the Bicol Medical Center to have a consultant who is on call.
Q: How many of them?
A: One.
Q: Who is she?
A: Dra. Flores.
Q: What is the first name?
A: Rosalina Flores.
Q: Is she residing in Naga City?
A: In Camaligan.
Q: She is on call anytime when there is an emergency case to be attended to in the Bicol
Medical Center?
A: Yes sir.15
Dr. Tatad further testified:
Q: Alright (sic), considering that you said you could not attend to Raymond Olavere because
another patient was coming in the person of Lilia Aguila, did you not suggest to Dr. Cereno to
call the standby anesthesiologist?
A: They are not ones to do that. They have no right to call for the standby anesthesiologist.
Q: Then, who should call for the standby anesthesiologist?
A: It is me if the surgeon requested.
Q: But in this case, the surgeon did not request you?
A: No. It is their prerogative.
Q: I just want to know that in this case the surgeon did not request you to call for the standby
anesthesiologist?
A: No sir.16
From there, the trial court concluded that it was the duty of the petitioners to request Dr.
Tatad to call on Dr. Rosalina Flores, the standby anesthesiologist. Since petitioners failed to
do so, their inability to promptly perform the operation on Raymond becomes negligence on
their part.

This Court does not agree with the aforesaid conclusion.


First. There is nothing in the testimony of Dr. Tatad, or in any evidence on the record for that
matter, which shows that the petitioners were aware of the "BRMC protocol" that the hospital
keeps a standby anesthesiologist available on call. Indeed, other than the testimony of Dr.
Tatad, there is no evidence that proves that any such "BRMC protocol" is being practiced by
the hospitals surgeons at all.
Evidence to the effect that petitioners knew of the "BRMC protocol" is essential, especially in
view of the contrary assertion of the petitioners that the matter of assigning anesthesiologists
rests within the full discretion of the BRMC Anesthesiology Department. Without any prior
knowledge of the "BRMC protocol," We find that it is quite reasonable for the petitioners to
assume that matters regarding the administration of anesthesia and the assignment of
anesthesiologists are concerns of the Anesthesiology Department, while matters pertaining
to the surgery itself fall under the concern of the surgeons. Certainly, We cannot hold
petitioners accountable for not complying with something that they, in the first place, do not
know.
Second. Even assuming ex gratia argumenti that there is such "BRMC protocol" and that
petitioners knew about it, We find that their failure to request for the assistance of the
standby anesthesiologist to be reasonable when taken in the proper context. There is simply
no competent evidence to the contrary.
From the testimony of Dr. Tatad herself, it is clear that the matter of requesting for a standby
anaesthesiologist is not within the full discretion of petitioners. The "BRMC protocol"
described in the testimony requires the petitioners to course such request to Dr. Tatad who,
as head of the Department of Anesthesiology, has the final say of calling the standby
anesthesiologist.
As revealed by the facts, however, after the Maluluy-on operation, Dr. Tatad
was already assisting in the Lilia Aguila operation. Drs. Zafe and Cereno then proceeded to
examine Raymond and they found that the latters blood pressure was normal and "nothing
in him was significant."17 Dr. Cereno even concluded that based on the x-ray result he
interpreted, the fluid inside the thoracic cavity of Raymond was minimal at around 200-300
cc. Such findings of Drs. Cereno and Zafe were never challenged and were unrebutted.
Given that Dr. Tatad was already engaged in another urgent operation and that Raymond
was not showing any symptom of suffering from major blood loss requiring an immediate
operation, We find it reasonable that petitioners decided to wait for Dr. Tatad to finish her
surgery and not to call the standby anesthesiologist anymore. There is, after all, no evidence
that shows that a prudent surgeon faced with similar circumstances would decide otherwise.
Here, there were no expert witnesses presented to testify that the course of action taken by
petitioners were not in accord with those adopted by other reasonable surgeons in similar
situations. Neither was there any testimony given, except that of Dr. Tatads, on which it may
be inferred that petitioners failed to exercise the standard of care, diligence, learning and skill
expected from practitioners of their profession. Dr. Tatad, however, is an expert neither in the
field of surgery nor of surgical practices and diagnoses. Her expertise is in the administration
of anesthesia and not in the determination of whether surgery ought or not ought to be
performed.
Another ground relied upon by the trial court in holding petitioners negligent was their failure
to immediately transfuse blood on Raymond. Such failure allegedly led to the eventual death
of Raymond through "hypovolemic shock." The trial court relied on the following testimony of
Dr. Tatad:
Q: In this case of Raymond Olavere was blood transfused to him while he was inside the
operating room?

A: The blood arrived at 1:40 a.m. and that was the time when this blood was hooked to the
patient.
xxxx
Q: Prior to the arrival of the blood, you did not request for blood?
A: I requested for blood.
Q: From whom?
A: From the attending physician, Dr. Realuyo.
Q: What time was that?
xxxx
A: 9:30.
xxxx
Q: Had this blood been given to you before the operation you could have transfused the
blood to the patient?
A: Of course, yes.
Q: And the blood was transfused only after the operation?
A: Because that was the time when the blood was given to us.
xxxx
Q: Have you monitored the condition of Raymond Olavere?
A: I monitored the condition during the time when I would administer anesthesia.
Q: What time was that?
A: 11:45 already.
Q: What was the condition of the blood pressure at that time?
A: 60/40 initial.
Q: With that kind of blood pressure the patient must have been in critical condition?
A: At the time when the blood pressure was 60/40 I again told Dr. Cereno that blood was
already needed.
Q: With that condition, Doctor, that the patient had 60/40 blood pressure you did not decide
on transfusing blood to him?
A: I was asking for blood but there was no blood available.
Q: From whom did you ask?
A: From the surgeon. According to Dr. Zafe there was only 500 cc but still for crossmatching.18

From the aforesaid testimony, the trial court ruled that there was negligence on the part of
petitioners for their failure to have the blood ready for transfusion. It was alleged that at 11:15
P.M., the 500 cc of blood was given to Dr. Realuyo by Raymonds parents. At 11:45 P.M.,
when Dr. Tatad was asking for the blood, 30 minutes had passed. Yet, the blood was not
ready for transfusion as it was still being cross-matched. 19 It took another two hours before
blood was finally transfused to Raymond at 1:40 A.M. of 17 September 1995.
Again, such is a mistaken conclusion.
First, the alleged delay in the cross-matching of the blood, if there was any, cannot be
attributed as the fault of the petitioners. The petitioners were never shown to be responsible
for such delay. It is highly unreasonable and the height of injustice if petitioners were to be
sanctioned for lapses in procedure that does not fall within their duties and beyond their
control.
Second, Dr. Cereno, in his unchallenged testimony, aptly explained the apparent delay in the
transfusion of blood on Raymond before and during the operation.
Before the operation, Dr. Cereno explained that the reason why no blood transfusion was
made on Raymond was because they did not then see the need to administer such
transfusion, viz:
Q: Now, you stated in your affidavit that prior to the operation you were informed that there
was 500 cc of blood available and was still to be cross-matched. What time was that when
you were informed that 500 cc of blood was due for crossmatching?
A: I am not sure of the time.
Q: But certainly, you learned of that fact that there was 500 cc of blood, which was due for
crossmatching immediately prior to the operation?
A: Yes, sir.
Q: And the operation was done at 12:15 of September 17?
A: Yes, sir.
Q: And that was the reason why you could not use the blood because it was being
crossmatched?
A: No, sir. That was done only for a few minutes. We did not transfuse at that time because
there was no need.There is a necessity to transfuse blood when we saw there is gross
bleeding inside the body. 20(Emphasis supplied)
During the operation, on the other hand, Dr. Cereno was already able to discover that 3,200
cc of blood was stocked in the thoracic cavity of Raymond due to the puncture in the latters
left lung. Even then, however, immediate blood transfusion was not feasible because:
Q: Now considering the loss of blood suffered by Raymund Olavere, why did you not
immediately transfuse blood to the patient and you waited for 45 minutes to elapse before
transfusing the blood?
A: I did not transfuse blood because I had to control the bleeders. If you will transfuse
blood just the same the blood that you transfuse will be lost. After evacuation of blood
and there is no more bleeding
Q: It took you 45 minutes to evacuate the blood?

A: The evacuation did not take 45 minutes.


Q: So what was the cause of the delay why you only transfuse blood after 45 minutes?
A: We have to look for some other lesions. It does not mean that when you slice the
chest you will see the lesions already.21
(Emphasis supplied)
Again, the foregoing testimonies of Dr. Cereno went unchallenged or unrebutted. The
parents of Raymond were not able to present any expert witness to dispute the course of
action taken by the petitioners.
Causation Not Proven
In medical negligence cases, it is settled that the complainant has the burden of establishing
breach of duty on the part of the doctors or surgeons. It must be proven that such breach of
duty has a causal connection to the resulting death of the patient. 22 A verdict in malpractice
action cannot be based on speculation or conjecture. Causation must be proven within a
reasonable medical probability based upon competent expert testimony.
The parents of Raymond failed in this respect. Aside from their failure to prove negligence on
the part of the petitioners, they also failed to prove that it was petitioners fault that caused
the injury. Their cause stands on the mere assumption that Raymonds life would have been
saved had petitioner surgeons immediately operated on him; had the blood been crossmatched immediately and had the blood been transfused immediately. There was, however,
no proof presented that Raymonds life would have been saved had those things been done.
Those are mere assumptions and cannot guarantee their desired result. Such cannot be
made basis of a decision in this case, especially considering that the name, reputation and
career of petitioners are at stake.
The Court understands the parents grief over their sons death. That notwithstanding, it
cannot hold petitioners liable. It was noted that Raymond, who was a victim of a stabbing
incident, had multiple wounds when brought to the hospital. Upon opening of his thoracic
cavity, it was discovered that there was gross bleeding inside the body. Thus, the need for
petitioners to control first what was causing the bleeding. Despite the situation that evening
i.e. numerous patients being brought to the hospital for emergency treatment considering
that it was the height of the Peafrancia Fiesta, it was evident that petitioners exerted
earnest efforts to save the life of Raymond. It was just unfortunate that the loss of his life was
not prevented.
1wphi1

In the case of Dr. Cruz v. CA, it was held that "[d]octors are protected by a special law. They
are not guarantors of care. They do not even warrant a good result. They are not insurers
against mishaps or unusual consequences. Furthermore, they are not liable for honest
mistake of judgment"23
This Court affirms the ruling of the CA that the BRMC is not an indispensible party. The core
issue as agreed upon by the parties and stated in the pre-trial order is whether petitioners
were negligent in the performance of their duties. It pertains to acts/omissions of petitioners
for which they could be held liable. The cause of action against petitioners may be
prosecuted fully and the determination of their liability may be arrived at without impleading
the hospital where they are employed. As such, the BRMC cannot be considered an
indispensible party without whom no final determination can be had of an action. 24
IN THE LIGHT OF THE FOREGOING, the instant Petition for Review on Certiorari is
hereby GRANTED. The Court of Appeals decision dated 21 February 2005 in CA-G.R. CV
No. 65800 is hereby REVERSED and SET ASIDE. No costs.
SO ORDERED.

DR. EMMANUEL JARCIA,


JR.and DR.
MARILOU
BASTAN,
Petitioners,

G.R. No. 187926

Present:

CARPIO,* J.,
PERALTA,** Acting Chairperson,
ABAD,
- versus -

PEREZ,*** and
MENDOZA, JJ.

Promulgated:

PEOPLE OF
THEPHILIPPINES,

February 15, 2012

Respondent.

x
-------------------------------------------------------------------------------------- x

DECISION

MENDOZA, J.:

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.
On June 14, 2005, the RTC found the petitioners
guilty beyond reasonable doubt of the crime of Simple
Imprudence Resulting to Serious Physical Injuries. The
decretal portion of the RTC decision reads:
WHEREFORE, premises considered, the Court finds accused DR.
EMMANUEL JARCIA, JR. and DR. MARILOU BASTAN GUILTY
beyond reasonable doubt of the crime of SIMPLE IMPRUDENCE
RESULTING TO SERIOUS PHYSICAL INJURIES and are hereby
sentenced to suffer the penalty of ONE (1) MONTH and ONE (1)
DAY to TWO (2) MONTHS and to indemnify MRS. BELINDA
SANTIAGO the amount of 3,850.00 representing medical expenses
without subsidiary imprisonment in case of insolvency and to pay the
costs.
It appearing that Dr. Pamittan has not been apprehended nor
voluntarily surrendered despite warrant issued for her arrest, let warrant

be issued for her arrest and the case against her be ARCHIVED, to be
reinstated upon her apprehension.
SO ORDERED.[6]

The RTC explained:


After a thorough and in depth evaluation of the
evidence adduced by the prosecution and the defense, this
court finds that the evidence of the prosecution is the more
credible, concrete and sufficient to create that moral
certainty in the mind of the Court that accused herein [are]
criminally responsible. The Court believes that accused are
negligent when both failed to exercise the necessary and
reasonable prudence in ascertaining the extent of injury of
Alfonso Santiago, Jr.

However, the negligence exhibited by the two doctors does


not approximate negligence of a reckless nature but merely
amounts to simple imprudence. Simple imprudence consists
in the lack of precaution displayed in those cases in which
the damage impending to be caused is not the immediate
nor the danger clearly manifest. The elements of simple
imprudence are as follows.
1.

that there is lack of precaution on the part


of the offender; and

2.

that the damage impending to be caused is


not immediate of the danger is not clearly
manifest.

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 patient. The connection between the negligence
and the injury must be a direct and natural sequence of
events, unbroken by intervening efficient causes. In other
words, the negligence must be the proximate cause of the
injury. Negligence, no matter in what it consists, cannot
create a right of action unless it is the proximate cause of the

injury complained of. The proximate cause of an injury is


that cause which, in natural and continuous sequence,
unbroken by any efficient intervening cause, produces the
injury and without which the result would not have
occurred.
In the case at bench, the accused-appellants questioned the
imputation against them and argued that there is no causal
connection between their failure to diagnose the fracture
and the injury sustained by Roy.
We are not convinced.
The prosecution is however after the cause which prolonged
the pain and suffering of Roy and not on the failure of the
accused-appellants to correctly diagnose the extent of the
injury sustained by Roy.
For a more logical presentation of the discussion, we shall
first consider the applicability of the doctrine of res ipsa
loquitur to the instant case. Res ipsa loquitur is a Latin
phrase which literally means the thing or the transaction
speaks for itself. The doctrine of res ipsa loquitur is simply a
recognition of the postulate that, as a matter of common
knowledge and experience, the very nature of certain types
of occurrences may justify an inference of negligence on the
part of the person who controls the instrumentality causing
the injury in the absence of some explanation by the
accused-appellant who is charged with negligence. It is
grounded in the superior logic of ordinary human
experience and, on the basis of such experience or common
knowledge, negligence may be deduced from the mere
occurrence of the accident itself. Hence, res ipsa loquitur is
applied in conjunction with the doctrine of common
knowledge.
The specific acts of negligence was narrated by Mrs.
Santiago who accompanied her son during the latters ordeal
at the hospital. She testified as follows:
Fiscal Formoso:

Q: Now, he is an intern did you not consult the


doctors, Dr. Jarcia or Dra. Pamittan to
confirm whether you should go home or
not?
A: Dra. Pamittan was inside the cubicle of the
nurses and I asked her, you let us go
home and you dont even clean the
wounds of my son.
Q: And what did she [tell] you?
A: They told me they will call a resident
doctor, sir.
xxxxxxxxx
Q: Was there a resident doctor [who] came?
A: Yes, Sir. Dra. Bastan arrived.
Q: Did you tell her what you want on you to be
done?
A: Yes, sir.
Q: What did you [tell] her?
A: I told her, sir, while she was cleaning the
wounds of my son, are you not going to xray up to the knee because my son was
complaining pain from his ankle up to the
middle part of the right leg.
Q: And what did she tell you?
A: According to Dra. Bastan, there is no need to
x-ray because it was the ankle part that
was run over.
Q: What did you do or tell her?

A: I told her, sir, why is it that they did not


examine[x] the whole leg. They just lifted
the pants of my son.
Q: So you mean to say there was no treatment
made at all?
A: None, sir.
xxxxxxxxx
A: I just listened to them, sir. And I just asked if
I will still return my son.
xxxxxxxxx
Q: And you were present when they were
called?
A: Yes, sir.
Q: And what was
Sis. Retoria?

discussed

then

by

A: When they were there they admitted that


they have mistakes, sir.
Still, before resort to the doctrine may be allowed, the
following requisites must be satisfactorily shown:
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.
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 wellfounded 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?
A: I would say at that stage, yes. Because they
have presented the patient and the
history. At sabi nila, nadaanan lang po
ito. And then, considering their year of
residency they are still junior residents,

and they are not also orthopedic residents


but general surgery residents, its entirely
different thing. Because if you are an
orthopedic resident, I am not trying to
saybut if I were an orthopedic resident,
there would be more precise and accurate
decision compare to a general surgery
resident in so far as involved.
Q: You mean to say there is no supervisor
attending the emergency room?
A: At the emergency room, at the Manila
Doctors Hospital, the supervisor there is a
consultant that usually comes from a
family medicine. They see where a certain
patient have to go and then if they cannot
manage it, they refer it to the consultant
on duty. Now at that time, I dont [know]
why they dont.Because at that time, I
think, it is the decision. Since the x-rays.
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 the consequences of professional care
were not as such as would ordinarily have followed if due
care had been exercised. A distinction must be made
between the failure to secure results and the occurrence of
something more unusual and not ordinarily found if the
service or treatment rendered followed the usual procedure
of those skilled in that particular practice. The latter
circumstance is the primordial issue that confronted this
Court and we find application of the doctrine of res ipsa
loquitur to be in order.
WHEREFORE, in view of the foregoing, the appeal in this
case is hereby DISMISSED and the assailed decision of the
trial court finding accused-appellants guilty beyond
reasonable doubt of simple imprudence resulting in serious
physical injuries is hereby AFFIRMED in toto.
SO ORDERED.[8]

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. CIRILO TACATA, THAT PETITIONERS
WERE NOT GUILTY OF NEGLIGENCE OR IMPRUDENCE
COMPLAINED OF.
3. THE COURT OF APPEALS ERRED IN HOLDING
THAT THE FAILURE OF PETITIONERS TO SUBJECT THE
PATIENTS WHOLE LEG TO AN X-RAY EXAMINATION
PROLONGED THE PAIN AND SUFFERING OF THE PATIENT,
SUCH CONCLUSION BEING UNSUPPORTED BY, AND EVEN
CONTRARY TO, THE EVIDENCE ON RECORD.
4. ASSUMING ARGUENDO THAT THE PATIENT
EXPERIENCED PROLONGED PAIN AND SUFFERING, THE
COURT OF APPEALS ERRED IN NOT HOLDING THAT THE
ALLEGED PAIN AND SUFFERING WERE DUE TO THE
UNJUSTIFIED FAILURE OF THE PATIENTS MOTHER, A
NURSE HERSELF, TO IMMEDIATELY BRING THE PATIENT
BACK TO THE HOSPITAL, AS ADVISED BY THE
PETITIONERS, AFTER HE COMPLAINED OF SEVERE PAIN IN
HIS RIGHT LEG WHEN HE REACHED HOME AFTER HE WAS
SEEN BY PETITIONERS AT THE HOSPITAL. THUS, THE
PATIENTS ALLEGED INJURY (PROLONGED PAIN AND
SUFFERING) WAS DUE TO HIS OWN MOTHERS ACT OR
OMISSION.
5. THE COURT OF APPEALS ERRED IN NOT HOLDING
THAT NO PHYSICIAN-PATIENT RELATIONSHIP EXISTED
BETWEEN
PETITIONERS
AND
PATIENT
ALFONSO
SANTIAGO, JR., PETITIONERS NOT BEING THE LATTERS
ATTENDING
PHYSICIAN
AS
THEY
WERE
MERELY
REQUESTED BY THE EMERGENCY ROOM (ER) NURSE TO
SEE THE PATIENT WHILE THEY WERE PASSING BY THE ER
FOR THEIR LUNCH.
6. THE COURT OF APPEALS GRAVELY ERRED IN NOT
ACQUITTING ACCUSED-PETITIONERS OF THE CRIME
CHARGED.[9]

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
guilty of criminal negligence complained of. The Court is also

of the view that the CA erred in applying the doctrine of res


ipsa loquitur in this particular case.
As to the Application of
The Doctrine of Res Ipsa Loquitur

This doctrine of res ipsa loquitur means "Where the thing which
causes injury is shown to be under the management of the defendant, and the
accident is such as in the ordinary course of things does not happen if those
who have the management use proper care, it affords reasonable evidence, in
the absence of an explanation by the defendant, that the accident arose from
want of care." The Black's Law Dictionary defines the said doctrine. Thus:

The thing speaks for itself. Rebuttable presumption or


inference that defendant was negligent, which arises upon proof
that the instrumentality causing injury was in defendant's exclusive
control, and that the accident was one which ordinarily does not
happen in absence of negligence. Res ipsa loquitur is a rule of
evidence whereby negligence of the alleged wrongdoer may be
inferred from the mere fact that the accident happened provided
the character of the accident and circumstances attending it lead
reasonably to belief that in the absence of negligence it would not
have occurred and that thing which caused injury is shown to have
been under the management and control of the alleged wrongdoer.
Under this doctrine, the happening of an injury permits an
inference of negligence where plaintiff produces substantial
evidence that the injury was caused by an agency or instrumentality
under the exclusive control and management of defendant, and that
the occurrence was such that in the ordinary course of things would
not happen if reasonable care had been used.[10]

The doctrine of res ipsa loquitur as a rule of evidence is


unusual to the law of negligence which recognizes that prima
facie negligence may be established without direct proof and
furnishes a substitute for specific proof of negligence. The
doctrine, however, is not a rule of substantive law, but
merely a mode of proof or a mere procedural
convenience. The rule, when applicable to the facts and
circumstances of a given case, is not meant to and does not

dispense with the requirement of proof of culpable


negligence on the party charged. It merely determines and
regulates what shall be prima facie evidence thereof and
helps the plaintiff in proving a breach of the duty. The
doctrine can be invoked when and only when, under the
circumstances involved, direct evidence is absent and not
readily available.[11]

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
the Manila 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


failing to do, without malice, an act from which
damage results by reason of an inexcusable
precaution on the part of the person performing or
perform such act.[15]

doing or
material
lack of
failing to

The elements of simple negligence are: (1) that there is


lack of precaution on the part of the offender, and (2) that
the damage impending to be caused is not immediate or the
danger is not clearly manifest.[16]

In this case, the Court is not convinced with moral certainty that the
petitioners are guilty of reckless imprudence or simple negligence. The
elements thereof were not proved by the prosecution beyond reasonable
doubt.

The testimony of Dr. Cirilo R. Tacata (Dr. Tacata), a specialist in


pediatric orthopedic, although pointing to some medical procedures that
could have been done by Dr. Jarcia and Dr. Bastan, as physicians on duty,
was not clear as to whether the injuries suffered by patient Roy Jr. were
indeed aggravated by the petitioners judgment call and their diagnosis or
appreciation of the condition of the victim at the time they assessed him.
Thus:

Q: Will you please tell us, for the record, doctor, what is
your specialization?
A: At present I am the chairman department of orthopedic
in UP-PGH and I had special training in pediatric
orthopedic for two (2) years.

Q: In June 1998, doctor, what was your position and what


was your specialization at that time?
A: Since 1980, I have been specialist in pediatric orthopedic.

Q: When Alfonso Santiago, Jr. was brought to you by his


mother, what did you do by way of physicians as first
step?
A: As usual, I examined the patient physically and, at that
time as I have said, the patient could not walk so I
[began] to suspect that probably he sustained a fracture
as a result of a vehicular accident. So I examined the
patient at that time, the involved leg, I dont know if that
is left or right, the involved leg then was swollen and
the patient could not walk, so I requested for the x-ray
of [the] lower leg.

Q: What part of the leg, doctor, did you request to be


examined?
A: If we refer for an x-ray, usually, we suspect a fracture
whether in approximal, middle or lebistal tinial, we
usually x-ray the entire extremity.

Q: And what was the result?


A: Well, I can say that it was a spiral fracture of the midtibial, it is the bigger bone of the leg.

Q: And when you say spiral, doctor, how long was this
fracture?
A: When we say spiral, it is a sort of letter S, the length was
about six (6) to eight (8) centimeters.

Q: Mid-tibial, will you please point to us, doctor, where the


tibial is?

(Witness pointing to his lower leg)


A: The tibial is here, there are two bones here, the bigger
one is the tibial and the smaller one is the fibula. The
bigger one is the one that get fractured.

Q: And in the course of your examination of Alfonso


Santiago, Jr. did you ask for the history of such injury?
A: Yes, actually, that was a routine part of our examination
that once a patient comes in, before we actually
examine the patient, we request for a detailed history. If
it is an accident, then, we request for the exact
mechanism of injuries.

Q: And as far as you can recall, Doctor, what was the history
of that injury that was told to you?
A: The patient was sideswiped, I dont know if it is a car, but
it is a vehicular accident.

Q: Who did you interview?


A: The mother.

Q: How about the child himself, Alfonso Santiago, Jr.?


A: Normally, we do not interview the child because, usually,
at his age, the answers are not accurate. So, it was the
mother that I interviewed.

Q: And were you informed also of his early medication that


was administered on Alfonso Santiago, Jr.?
A: No, not actually medication. I was informed that this
patient was seen initially at the emergency room by the
two (2) physicians that you just mentioned, Dr. Jarcia
and Dra. Bastan, that time who happened to be my
residents who were [on] duty at the emergency room.

xxxx

A: At the emergency room, at the Manila Doctors Hospital,


the supervisor there is a consultant that usually comes
from a family medicine. They see where a certain
patient have to go and then if they cannot manage it,
they refer it to the consultant on duty. Now at that time,
I dont why they dont Because at that time, I think, it is
the decision. Since the x-rays

xxx

Q: You also said, Doctor, that Dr. Jarcia and Dra. Bastan are
not even an orthopedic specialist.
A: 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?
A: I could not directly say yes, because it would still depend on
my examination, we cannot subject the whole body for xray if we think that the damaged was only the leg.

Q: Not the entire body but the entire leg?


A: I think, if my examination requires it, I would.

Q: So, you would conduct first an examination?


A: Yes, sir.

Q: 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?
A: 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: 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?
A: 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 over, the
patient fell, and it got twisted. Thats why the leg seems to
be fractured.[17] [Emphases supplied]

It can be gleaned from the testimony of Dr. Tacata that a thorough


examination was not performed on Roy Jr. As residents on duty at the
emergency room, Dr. Jarcia and Dr. Bastan were expected to know the
medical protocol in treating leg fractures and in attending to victims of car
accidents. There was, however, no precise evidence and scientific
explanation pointing to the fact that the delay in the application of the cast to
the patients fractured leg because of failure to immediately diagnose the
specific injury of the patient, prolonged the pain of the child or aggravated
his condition or even caused further complications. Any person may opine

that had patient Roy Jr. been treated properly and given the extensive X-ray
examination, the extent and severity of the injury, spiral fracture of the midtibial part or the bigger bone of the leg, could have been detected early on
and the prolonged pain and suffering of Roy Jr. could have been prevented.
But still, that opinion, even how logical it may seem would not, and could
not, be enough basis to hold one criminally liable; thus, a reasonable doubt
as to the petitioners guilt.

Although the Court sympathizes with the plight of the mother and the
child in this case, the Court is bound by the dictates of justice which hold
inviolable the right of the accused to be presumed innocent until proven
guilty beyond reasonable doubt. The Court, nevertheless, finds the
petitioners civilly liable for their failure to sufficiently attend to Roy Jr.s
medical needs when the latter was rushed to the ER, for while a criminal
conviction requires proof beyond reasonable doubt, only a preponderance of
evidence is required to establish civil liability. Taken into account also was
the fact that there was no bad faith on their part.

Dr. Jarcia and Dr. Bastan cannot pass on the liability to the taxi driver
who hit the victim. It may be true that the actual, direct, immediate, and
proximate cause of the injury (fracture of the leg bone or tibia) of Roy Jr.
was the vehicular accident when he was hit by a taxi. The petitioners,
however, cannot simply invoke such fact alone to excuse themselves from
any liability. If this would be so, doctors would have a ready defense should
they fail to do their job in attending to victims of hit-and-run, maltreatment,
and other crimes of violence in which the actual, direct, immediate, and
proximate cause of the injury is indubitably the act of the perpetrator/s.

In failing to perform an extensive medical examination to determine


the extent of Roy Jr.s injuries, Dr. Jarcia and Dr. Bastan were remiss of their
duties as members of the medical profession. Assuming for the sake of
argument that they did not have the capacity to make such thorough
evaluation at that stage, they should have referred the patient to another
doctor with sufficient training and experience instead of assuring him and
his mother that everything was all right.
This Court cannot also stamp its imprimatur on the petitioners
contention that no physician-patient relationship existed between them and

patient Roy Jr., since they were not his attending physicians at that time.
They claim that they were merely requested by the ER nurse to see the
patient while they were passing by the ER for their lunch. Firstly, this issue
was never raised during the trial at the RTC or even before the CA. The
petitioners, therefore, raise the want of doctor-patient relationship for the
first time on appeal with this Court. It has been settled that issues raised for
the first time on appeal cannot be considered because a party is not permitted
to change his theory on appeal. To allow him to do so is unfair to the other
party and offensive to the rules of fair play, justice and due process. [18] Stated
differently, basic considerations of due process dictate that theories, issues
and arguments not brought to the attention of the trial court need not be, and
ordinarily will not be, considered by a reviewing court.[19]

Assuming again for the sake of argument that the petitioners may still
raise this issue of no physicianpatient relationship, the Court finds and so
holds that there was a physicianpatient relationship in this case.

In the case of Lucas v. Tuao,[20] the Court wrote that


[w]hen a patient engages the services of a physician, a
physician-patient relationship is generated. And in accepting
a case, the physician, for all intents and purposes,
represents that he has the needed training and skill
possessed by physicians and surgeons practicing in the
same field; and that he will employ such training, care, and
skill in the treatment of the patient. Thus, in treating his
patient, a physician is under a duty to exercise that degree
of care, skill and diligence which physicians in the same
general neighborhood and in the same general line of
practice ordinarily possess and exercise in like cases. Stated
otherwise, the physician has the obligation to use at least
the same level of care that any other reasonably competent
physician would use to treat the condition under similar
circumstances.

Indubitably, a physician-patient relationship exists


between the petitioners and patient Roy Jr. Notably, the
latter and his mother went to the ER for an immediate
medical attention. The petitioners allegedly passed by and
were requested to attend to the victim (contrary to the

testimony of Dr. Tacata that they were, at that time,


residents on duty at the ER).[21] They obliged and examined
the victim, and later assured the mother that everything was
fine and that they could go home. Clearly, a physicianpatient relationship was established between the petitioners
and the patient Roy Jr.

To repeat for clarity and emphasis, if these doctors knew from the
start that they were not in the position to attend to Roy Jr., a vehicular
accident victim, with the degree of diligence and commitment expected of
every doctor in a case like this, they should have not made a baseless
assurance that everything was all right. By doing so, they deprived Roy Jr. of
adequate medical attention that placed him in a more dangerous situation
than he was already in. What petitioners should have done, and could have
done, was to refer Roy Jr. to another doctor who could competently and
thoroughly examine his injuries.

All told, the petitioners were, indeed, negligent but only


civilly, and not criminally, liable as the facts show.

Article II, Section 1 of the Code of Medical Ethics of the


Medical Profession in the Philippines states:
A physician should attend to his patients faithfully
and conscientiously. He should secure for them all possible
benefits that may depend upon his professional skill and
care. As the sole tribunal to adjudge the physicians failure to
fulfill his obligation to his patients is, in most cases, his own
conscience, violation of this rule on his part is discreditable
and inexcusable.[22]

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

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
entered ACQUITTING 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
(4) Costs of the suit.

with interest at the rate of 6% per annum from the date of


the filing of the Information. The rate shall be 12%
interest per annum from the finality of judgment until fully
paid.
SO ORDERED.

EN BANC
DR. RUBI LI,
Petitioner,

G.R. No. 165279


Present:

- versus -

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.

SPOUSES REYNALDO and LINA Promulgated:


SOLIMAN, as parents/heirs of
June 7, 2011
deceased Angelica Soliman,
Respondents.
x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x

DECISION
VILLARAMA, JR., J.:
Challenged in this petition for review on certiorari is the
Decision[1] dated June 15, 2004 as well as the Resolution[2] dated September
1, 2004 of the Court of Appeals (CA) in CA-G.R. CV No. 58013 which
modified
the
Decision[3] dated September
5,
1997 of
the Regional Trial Court of Legazpi City, Branch 8 in Civil Case No. 8904.
The factual antecedents:
On July 7, 1993, respondents 11-year old daughter, Angelica Soliman,
underwent a biopsy of the mass located in her lower extremity at the St.
Lukes Medical Center (SLMC).Results showed that Angelica was suffering
from osteosarcoma, osteoblastic type,[4] a high-grade (highly malignant)
cancer of the bone which usually afflicts teenage children.Following this
diagnosis and as primary intervention, Angelicas right leg was amputated by

Dr. Jaime Tamayo in order to remove the tumor. As adjuvant treatment to


eliminate any remaining cancer cells, and hence minimize the chances of
recurrence and prevent the disease from spreading to other parts of the
patients body (metastasis), chemotherapy was suggested by Dr. Tamayo. Dr.
Tamayo referred Angelica to another doctor at SLMC, herein petitioner Dr.
Rubi Li, a medical oncologist.
On August 18, 1993, Angelica was admitted to SLMC. However, she died
on September 1, 1993, just eleven (11) days after the (intravenous)
administration of the first cycle of the chemotherapy regimen. Because
SLMC refused to release a death certificate without full payment of their
hospital bill, respondents brought the cadaver of Angelica to the Philippine
National Police (PNP) Crime Laboratory at Camp Crame for post-mortem
examination. The Medico-Legal Report issued by said institution indicated
the cause of death as Hypovolemic shock secondary to multiple organ
hemorrhages and Disseminated Intravascular Coagulation.[5]
On the other hand, the Certificate of Death[6] issued by SLMC stated the
cause of death as follows:
Immediate cause : a. Osteosarcoma, Status Post AKA
Antecedent cause : b. (above knee amputation)
Underlying cause : c. Status Post Chemotherapy

On February 21, 1994, respondents filed a damage suit[7] against petitioner,


Dr. Leo Marbella, Mr. Jose Ledesma, a certain Dr. Arriete and SLMC.
Respondents charged them with negligence and disregard of Angelicas
safety, health and welfare by their careless administration of the
chemotherapy drugs, their failure to observe the essential precautions in
detecting early the symptoms of fatal blood platelet decrease and stopping
early on the chemotherapy, which bleeding led to hypovolemic shock that
caused Angelicas untimely demise. Further, it was specifically averred that
petitioner assured the respondents that Angelica would recover in view of
95% chance of healing with chemotherapy (Magiging normal na ang anak
nyo basta ma-chemo. 95% ang healing) and when asked regarding the side
effects, petitioner mentioned only slight vomiting, hair loss and weakness
(Magsusuka ng kaunti. Malulugas ang buhok. Manghihina). Respondents
thus claimed that they would not have given their consent to chemotherapy
had petitioner not falsely assured them of its side effects.
In her answer,[8] petitioner denied having been negligent in administering the
chemotherapy drugs to Angelica and asserted that she had fully explained to
respondents how the chemotherapy will affect not only the cancer cells but
also the patients normal body parts, including the lowering of white and red
blood cells and platelets. She claimed that what happened to Angelica can be
attributed to malignant tumor cells possibly left behind after surgery. Few as
they may be, these have the capacity to compete for nutrients such that the

body becomes so weak structurally (cachexia) and functionally in the form


of lower resistance of the body to combat infection. Such infection becomes
uncontrollable and triggers a chain of events (sepsis or septicemia) that may
lead to bleeding in the form of Disseminated Intravascular Coagulation
(DIC), as what the autopsy report showed in the case of Angelica.
Since the medical records of Angelica were not produced in court, the trial
and appellate courts had to rely on testimonial evidence, principally the
declarations of petitioner and respondents themselves. The following
chronology of events was gathered:
On July 23, 1993, petitioner saw the respondents at the hospital after
Angelicas surgery and discussed with them Angelicas condition. Petitioner
told respondents that Angelica should be given two to three weeks to recover
from the operation before starting chemotherapy. Respondents were
apprehensive due to financial constraints as Reynaldo earns only
from P70,000.00 to P150,000.00 a year from his jewelry and watch repairing
business.[9] Petitioner, however, assured them not to worry about her
professional fee and told them to just save up for the medicines to be used.
Petitioner claimed that she explained to respondents that even when a
tumor is removed, there are still small lesions undetectable to the naked eye,
and that adjuvant chemotherapy is needed to clean out the small lesions in
order to lessen the chance of the cancer to recur. She did not give the
respondents any assurance that chemotherapy will cure Angelicas
cancer. During these consultations with respondents, she explained the
following side effects of chemotherapy treatment to respondents: (1) falling
hair; (2) nausea and vomiting; (3) loss of appetite; (4) low count of white
blood cells [WBC], red blood cells [RBC] and platelets; (5) possible sterility
due to the effects on Angelicas ovary; (6) damage to the heart and kidneys;
and (7) darkening of the skin especially when exposed to sunlight. She
actually talked with respondents four times, once at the hospital after the
surgery, twice at her clinic and the fourth time when Angelicas mother called
her through long distance.[10] This was disputed by respondents who
countered that petitioner gave them assurance that there is 95% chance of
healing for Angelica if she undergoes chemotherapy and that the only side
effects were nausea, vomiting and hair loss.[11] Those were the only sideeffects of chemotherapy treatment mentioned by petitioner.[12]
On July 27, 1993, SLMC discharged Angelica, with instruction from
petitioner that she be readmitted after two or three weeks for the
chemotherapy.
On August 18, 1993, respondents brought Angelica to SLMC for
chemotherapy, bringing with them the results of the laboratory tests
requested by petitioner: Angelicas chest x-ray, ultrasound of the liver,

creatinine and complete liver function tests.[13] Petitioner proceeded with the
chemotherapy by first administering hydration fluids to Angelica.[14]
The following day, August 19, petitioner began administering three
chemotherapy
drugs
Cisplatin,[15] Doxorubicin[16] and
Cosmegen[17] intravenously. Petitioner was supposedly assisted by her
trainees Dr. Leo Marbella[18] and Dr. Grace Arriete.[19] In his testimony, Dr.
Marbella denied having any participation in administering the said
chemotherapy drugs.[20]
On the second day of chemotherapy, August 20, respondents noticed
reddish discoloration on Angelicas face.[21] They asked petitioner about it,
but she merely quipped,Wala yan. Epekto ng gamot.[22] Petitioner recalled
noticing the skin rashes on the nose and cheek area of Angelica. At that
moment, she entertained the possibility that Angelica also had systemic
lupus and consulted Dr. Victoria Abesamis on the matter.[23]
On the third day of chemotherapy, August 21, Angelica had difficulty
breathing and was thus provided with oxygen inhalation apparatus. This
time, the reddish discoloration on Angelicas face had extended to her neck,
but petitioner dismissed it again as merely the effect of medicines.
[24]
Petitioner testified that she did not see any discoloration on Angelicas
face, nor did she notice any difficulty in the childs breathing. She claimed
that Angelica merely complained of nausea and was given ice chips.[25]
On August 22, 1993, at around ten oclock in the morning, upon seeing
that their child could not anymore bear the pain, respondents pleaded with
petitioner to stop the chemotherapy. Petitioner supposedly replied: Dapat 15
Cosmegen pa iyan. Okay, lets observe. If pwede na, bigyan uli ng chemo. At
this point, respondents asked petitioners permission to bring their child
home. Later in the evening, Angelica passed black stool and reddish urine.
[26]
Petitioner countered that there was no record of blackening of stools but
only an episode of loose bowel movement (LBM). Petitioner also testified
that what Angelica complained of was carpo-pedal spasm, not convulsion or
epileptic attack, as respondents call it (petitioner described it in the
vernacular as naninigas ang kamay at paa). She then requested for a serum
calcium determination and stopped the chemotherapy. When Angelica was
given calcium gluconate, the spasm and numbness subsided.[27]
The following day, August 23, petitioner yielded to respondents
request to take Angelica home. But prior to discharging Angelica, petitioner
requested for a repeat serum calcium determination and explained to
respondents that the chemotherapy will be temporarily stopped while she
observes Angelicas muscle twitching and serum calcium level.Take-home
medicines were also prescribed for Angelica, with instructions to
respondents that the serum calcium test will have to be repeated after seven

days. Petitioner told respondents that she will see Angelica again after two
weeks, but respondents can see her anytime if any immediate problem
arises.[28]
However, Angelica remained in confinement because while still in the
premises of SLMC, her convulsions returned and she also had
LBM. Angelica was given oxygen and administration of calcium continued.
[29]

The next day, August 24, respondents claimed that Angelica still
suffered from convulsions. They also noticed that she had a fever and had
difficulty breathing.[30]Petitioner insisted it was carpo-pedal spasm, not
convulsions. She verified that at around 4:50 that afternoon, Angelica
developed difficulty in breathing and had fever. She then requested for an
electrocardiogram analysis, and infused calcium gluconate on the patient at a
stat dose. She further ordered that Angelica be given Bactrim,[31] a synthetic
antibacterial combination drug,[32] to combat any infection on the childs body.
[33]

By August 26, Angelica was bleeding through the mouth.


Respondents also saw blood on her anus and urine. When Lina asked
petitioner what was happening to her daughter, petitioner replied, Bagsak
ang platelets ng anak mo. Four units of platelet concentrates were then
transfused to Angelica. Petitioner prescribed Solucortef. Considering that
Angelicas fever was high and her white blood cell count was low, petitioner
prescribed Leucomax. About four to eight bags of blood, consisting of
packed red blood cells, fresh whole blood, or platelet concentrate, were
transfused to Angelica. For two days (August 27 to 28), Angelica continued
bleeding, but petitioner claimed it was lesser in amount and in
frequency. Petitioner also denied that there were gadgets attached to
Angelica at that time.[34]
On August 29, Angelica developed ulcers in her mouth, which
petitioner said were blood clots that should not be removed. Respondents
claimed that Angelica passed about half a liter of blood through her anus at
around seven oclock that evening, which petitioner likewise denied.
On August 30, Angelica continued bleeding. She was restless as
endotracheal and nasogastric tubes were inserted into her weakened body.
An aspiration of the nasogastric tube inserted to Angelica also revealed a
bloody content. Angelica was given more platelet concentrate and fresh
whole blood, which petitioner claimed improved her condition.Petitioner
told Angelica not to remove the endotracheal tube because this may induce
further bleeding.[35] She was also transferred to the intensive care unit to
avoid infection.

The next day, respondents claimed that Angelica became hysterical,


vomited blood and her body turned black. Part of Angelicas skin was also
noted to be shredding by just rubbing cotton on it. Angelica was so restless
she removed those gadgets attached to her, saying Ayaw ko na; there were
tears in her eyes and she kept turning her head.Observing her daughter to be
at the point of death, Lina asked for a doctor but the latter could not answer
her anymore.[36] At this time, the attending physician was Dr. Marbella who
was shaking his head saying that Angelicas platelets were down and
respondents should pray for their daughter. Reynaldo claimed that he was
introduced to a pediatrician who took over his daughters case, Dr. Abesamis
who also told him to pray for his daughter. Angelica continued to have
difficulty in her breathing and blood was being suctioned from her
stomach. A nurse was posted inside Angelicas room to assist her breathing
and at one point they had to revive Angelica by pumping her chest.
Thereafter, Reynaldo claimed that Angelica already experienced difficulty in
urinating and her bowel consisted of blood-like fluid. Angelica requested for
an electric fan as she was in pain. Hospital staff attempted to take blood
samples from Angelica but were unsuccessful because they could not even
locate her vein. Angelica asked for a fruit but when it was given to her, she
only smelled it. At this time, Reynaldo claimed he could not find either
petitioner or Dr. Marbella. That night, Angelica became hysterical and
started removing those gadgets attached to her. At three oclock in the
morning of September 1, a priest came and they prayed before Angelica
expired. Petitioner finally came back and supposedly told respondents that
there was malfunction or bogged-down machine.[37]
By petitioners own account, Angelica was merely irritable that day
(August 31). Petitioner noted though that Angelicas skin was indeed
sloughing off.[38] She stressed that at 9:30 in the evening, Angelica pulled out
her endotracheal tube.[39] On September 1, exactly two weeks after being
admitted at SLMC for chemotherapy, Angelica died.[40]The cause of death,
according to petitioner, was septicemia, or overwhelming infection, which
caused Angelicas other organs to fail.[41] Petitioner attributed this to the
patients poor defense mechanism brought about by the cancer itself.[42]
While he was seeking the release of Angelicas cadaver from SLMC,
Reynaldo claimed that petitioner acted arrogantly and called him names. He
was asked to sign a promissory note as he did not have cash to pay the
hospital bill.[43]
Respondents also presented as witnesses Dr. Jesusa Nieves-Vergara,
Medico-Legal Officer of the PNP-Crime Laboratory who conducted the
autopsy on Angelicas cadaver, and Dr. Melinda Vergara Balmaceda who is a
Medical Specialist employed at the Department of Health (DOH) Operations
and Management Services.

Testifying on the findings stated in her medico-legal report, Dr.


Vergara noted the following: (1) there were fluids recovered from the
abdominal cavity, which is not normal, and was due to hemorrhagic shock
secondary to bleeding; (2) there was hemorrhage at the left side of the heart;
(3) bleeding at the upper portion of and areas adjacent to, the esophagus; (4)
lungs were heavy with bleeding at the back and lower portion, due to
accumulation of fluids; (4) yellowish discoloration of the liver; (5) kidneys
showed appearance of facial shock on account of hemorrhages; and (6)
reddishness on external surface of the spleen. All these were the end result of
hypovolemic shock secondary to multiple organ hemorrhages and
disseminated intravascular coagulation. Dr. Vergara opined that this can be
attributed to the chemical agents in the drugs given to the victim, which
caused platelet reduction resulting to bleeding sufficient to cause the victims
death. The time lapse for the production of DIC in the case of Angelica
(from the time of diagnosis of sarcoma) was too short, considering the
survival rate of about 3 years. The witness conceded that the victim will also
die of osteosarcoma even with amputation or chemotherapy, but in this case
Angelicas death was not caused by osteosarcoma. Dr. Vergara admitted that
she is not a pathologist but her statements were based on the opinion of an
oncologist whom she had interviewed. This oncologist supposedly said that
if the victim already had DIC prior to the chemotherapy, the hospital staff
could have detected it.[44]
On her part, Dr. Balmaceda declared that it is the physicians duty to
inform and explain to the patient or his relatives every known side effect of
the procedure or therapeutic agents to be administered, before securing the
consent of the patient or his relatives to such procedure or therapy. The
physician thus bases his assurance to the patient on his personal assessment
of the patients condition and his knowledge of the general effects of the
agents or procedure that will be allowed on the patient. Dr. Balmaceda
stressed that the patient or relatives must be informed of all known side
effects based on studies and observations, even if such will aggravate the
patients condition.[45]
Dr. Jaime Tamayo, the orthopaedic surgeon who operated on
Angelicas lower extremity, testified for the defendants. He explained that in
case of malignant tumors, there is no guarantee that the ablation or removal
of the amputated part will completely cure the cancer. Thus, surgery is not
enough. The mortality rate of osteosarcoma at the time of modern
chemotherapy and early diagnosis still remains at 80% to 90%. Usually,
deaths occur from metastasis, or spread of the cancer to other vital organs
like the liver, causing systemic complications. The modes of therapy
available are the removal of the primary source of the cancerous growth and
then the residual cancer cells or metastasis should be treated with
chemotherapy. Dr. Tamayo further explained that patients with osteosarcoma
have poor defense mechanism due to the cancer cells in the blood stream. In
the case of Angelica, he had previously explained to her parents that after the

surgical procedure, chemotherapy is imperative so that metastasis of these


cancer cells will hopefully be addressed. He referred the patient to petitioner
because he felt that petitioner is a competent oncologist. Considering that
this type of cancer is very aggressive and will metastasize early, it will cause
the demise of the patient should there be no early intervention (in this case,
the patient developed sepsis which caused her death). Cancer cells in the
blood cannot be seen by the naked eye nor detected through bone scan. On
cross-examination, Dr. Tamayo stated that of the more than 50 child patients
who had osteogenic sarcoma he had handled, he thought that probably all of
them died within six months from amputation because he did not see them
anymore after follow-up; it is either they died or had seen another doctor.[46]
In dismissing the complaint, the trial court held that petitioner was not liable
for damages as she observed the best known procedures and employed her
highest skill and knowledge in the administration of chemotherapy drugs on
Angelica but despite all efforts said patient died. It cited the testimony of Dr.
Tamayo who testified that he considered petitioner one of the most proficient
in the treatment of cancer and that the patient in this case was afflicted with
a very aggressive type of cancer necessitating chemotherapy as adjuvant
treatment. Using the standard of negligence laid down in Picart v. Smith,
[47]
the trial court declared that petitioner has taken the necessary precaution
against the adverse effect of chemotherapy on the patient, adding that a
wrong decision is not by itself negligence. Respondents were ordered to pay
their unpaid hospital bill in the amount of P139,064.43.[48]
Respondents appealed to the CA which, while concurring with the trial
courts finding that there was no negligence committed by the petitioner in
the administration of chemotherapy treatment to Angelica, found that
petitioner as her attending physician failed to fully explain to the
respondents all the known side effects of chemotherapy. The appellate court
stressed that since the respondents have been told of only three side effects
of chemotherapy, they readily consented thereto. Had petitioner made known
to respondents those other side effects which gravely affected their child -such as carpo-pedal spasm, sepsis, decrease in the blood platelet count,
bleeding, infections and eventual death -- respondents could have decided
differently or adopted a different course of action which could have delayed
or prevented the early death of their child.
The CA thus declared:
Plaintiffs-appellants child was suffering from a malignant
disease. The attending physician recommended that she undergo
chemotherapy treatment after surgery in order to increase her chances of
survival. Appellants consented to the chemotherapy treatment because
they believed in Dr. Rubi Lis representation that the deceased would have
a strong chance of survival after chemotherapy and also because of the
representation of appellee Dr. Rubi Li that there were only three possible
side-effects of the treatment. However, all sorts of painful side-effects
resulted from the treatment including the premature death of

Angelica. The appellants were clearly and totally unaware of these


other side-effects which manifested only during the chemotherapy
treatment. This was shown by the fact that every time a problem
would take place regarding Angelicas condition (like an unexpected
side-effect manifesting itself), they would immediately seek
explanation from Dr. Rubi Li. Surely, those unexpected side-effects
culminating in the loss of a love[d] one caused the appellants so much
trouble, pain and suffering.
On this point therefore, [w]e find defendant-appellee Dr. Rubi Li
negligent which would entitle plaintiffs-appellants to their claim for
damages.
xxxx
WHEREFORE,
the
instant
appeal
is
hereby
GRANTED. Accordingly, the assailed decision is hereby modified to the
extent that defendant-appellee Dr. Rubi Li is ordered to pay the plaintiffsappellants the following amounts:
1. Actual damages of P139,064.43, plus P9,828.00 for funeral
expenses;
2. Moral damages of P200,000.00;
3. Exemplary damages of P50,000.00;
4. Attorneys fee of P30,000.00.
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
all-knowing/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.
Citing numerous trainings, distinctions and achievements in her field
and her current position as co-director for clinical affairs of the Medical
Oncology, Department of Medicine of SLMC, petitioner contends that in the
absence of any clear showing or proof, she cannot be charged with
negligence in not informing the respondents all the side effects of
chemotherapy or in the pre-treatment procedures done on Angelica.
As to the cause of death, petitioner insists that Angelica did not die of
platelet depletion but of sepsis which is a complication of the cancer
itself. Sepsis itself leads to bleeding and death. She explains that the
response rate to chemotherapy of patients with osteosarcoma is high, so
much so that survival rate is favorable to the patient. Petitioner then points to
some probable consequences if Angelica had not undergone chemotherapy.
Thus, without chemotherapy, other medicines and supportive treatment, the
patient might have died the next day because of massive infection, or the
cancer cells might have spread to the brain and brought the patient into a
coma, or into the lungs that the patient could have been hooked to a
respirator, or into her kidneys that she would have to undergo
dialysis. Indeed, respondents could have spent as much because of these
complications. The patient would have been deprived of the chance to
survive the ailment, of any hope for life and her quality of life surely
compromised. Since she had not been shown to be at fault, petitioner
maintains that the CA erred in holding her liable for the damages suffered by
the respondents.[50]
The issue to be resolved is whether the petitioner can be held liable for
failure to fully disclose serious side effects to the parents of the child patient
who died while undergoing chemotherapy, despite the absence of finding
that petitioner was negligent in administering the said treatment.
The petition is meritorious.
The type of lawsuit which has been called medical malpractice or,
more appropriately, medical negligence, is that type of claim which a victim
has available to him or her to redress a wrong committed by a medical
professional which has caused bodily harm. In order to successfully pursue
such a claim, a patient must prove that a health care provider, in most cases a
physician, either failed to do something which a reasonably prudent health
care provider would have done, or that he or she did something that a
reasonably prudent provider would not have done; and that that failure or
action caused injury to the patient.[51]

This Court has recognized that medical negligence cases are best proved by
opinions of expert witnesses belonging in the same general neighborhood
and in the same general line of practice as defendant physician or surgeon.
The deference of courts to the expert opinion of qualified physicians stems
from the formers realization that the latter possess unusual technical skills
which laymen in most instances are incapable of intelligently evaluating,
hence the indispensability of expert testimonies.[52]
In this case, both the trial and appellate courts concurred in finding that the
alleged negligence of petitioner in the administration of chemotherapy drugs
to respondents child was not proven considering that Drs. Vergara and
Balmaceda, not being oncologists or cancer specialists, were not qualified to
give expert opinion as to whether petitioners lack of skill, knowledge and
professional competence in failing to observe the standard of care in her line
of practice was the proximate cause of the patients death. Furthermore,
respondents case was not at all helped by the non-production of medical
records by the hospital (only the biopsy result and medical bills were
submitted to the court). Nevertheless, the CA found petitioner liable for her
failure to inform the respondents on all possible side effects of
chemotherapy before securing their consent to the said treatment.
The doctrine of informed consent within the context of physician-patient
relationships goes far back into English common law. As early as 1767,
doctors were charged with the tort of battery (i.e., an unauthorized physical
contact with a patient) if they had not gained the consent of their patients
prior to performing a surgery or procedure. In the United States, the seminal
case was Schoendorff v. Society of New York Hospital [53] which involved
unwanted treatment performed by a doctor. Justice Benjamin Cardozos oftquoted opinion upheld the basic right of a patient to give consent to any
medical procedure or treatment: Every human being of adult years and
sound mind has a right to determine what shall be done with his own body;
and a surgeon who performs an operation without his patients consent,
commits an assault, for which he is liable in damages. [54] From a purely
ethical norm, informed consent evolved into a general principle of law that a
physician has a duty to disclose what a reasonably prudent physician in the
medical community in the exercise of reasonable care would disclose to his
patient as to whatever grave risks of injury might be incurred from a
proposed course of treatment, so that a patient, exercising ordinary care for
his own welfare, and faced with a choice of undergoing the proposed
treatment, or alternative treatment, or none at all, may intelligently exercise
his judgment by reasonably balancing the probable risks against the probable
benefits.[55]
Subsequently, in Canterbury v. Spence[56] the court observed that the duty to
disclose should not be limited to medical usage as to arrogate the decision
on revelation to the physician alone. Thus, respect for the patients right of

self-determination on particular therapy demands a standard set by law for


physicians rather than one which physicians may or may not impose upon
themselves.[57] The scope of disclosure is premised on the fact that patients
ordinarily are persons unlearned in the medical sciences. Proficiency in
diagnosis and therapy is not the full measure of a physicians responsibility. It
is also his duty to warn of the dangers lurking in the proposed treatment and
to impart information which the patient has every right to expect. Indeed, the
patients reliance upon the physician is a trust of the kind which traditionally
has exacted obligations beyond those associated with armslength
transactions.[58] The physician is not expected to give the patient a short
medical education, the disclosure rule only requires of him a reasonable
explanation, which means generally informing the patient in nontechnical
terms as to what is at stake; the therapy alternatives open to him, the goals
expectably to be achieved, and the risks that may ensue from particular
treatment or no treatment.[59] As to the issue of demonstrating what risks are
considered material necessitating disclosure, it was held that experts are
unnecessary to a showing of the materiality of a risk to a patients decision on
treatment, or to the reasonably, expectable effect of risk disclosure on the
decision. Such unrevealed risk that should have been made known must
further materialize, for otherwise the omission, however unpardonable, is
without legal consequence.And, as in malpractice actions generally, there
must be a causal relationship between the physicians failure to divulge and
damage to the patient.[60]
Reiterating the foregoing considerations, Cobbs v. Grant[61] deemed it as
integral part of physicians overall obligation to patient, the duty of
reasonable disclosure of available choices with respect to proposed therapy
and of dangers inherently and potentially involved in each. However, the
physician is not obliged to discuss relatively minor risks inherent in common
procedures when it is common knowledge that such risks inherent in
procedure of very low incidence. Cited as exceptions to the rule that the
patient should not be denied the opportunity to weigh the risks of surgery or
treatment are emergency cases where it is evident he cannot evaluate data,
and where the patient is a child or incompetent. [62] The court thus concluded
that the patients right of self-decision can only be effectively exercised if the
patient possesses adequate information to enable him in making an
intelligent choice. The scope of the physicians communications to the
patient, then must be measured by the patients need, and that need is
whatever information is material to the decision. The test therefore for
determining whether a potential peril must be divulged is its materiality to
the patients decision.[63]
Cobbs v. Grant further reiterated the pronouncement in Canterbury v.
Spence that for liability of the physician for failure to inform patient, there
must be causal relationship between physicians failure to inform and the

injury to patient and such connection arises only if it is established that, had
revelation been made, consent to treatment would not have been given.
There are four essential elements a plaintiff must prove in a malpractice
action based upon the doctrine of informed consent: (1) the physician had a
duty to disclose material risks; (2) he failed to disclose or inadequately
disclosed those risks; (3) as a direct and proximate result of the failure to
disclose, the patient consented to treatment she otherwise would not have
consented to; and (4) plaintiff was injured by the proposed treatment. The
gravamen in an informed consent case requires the plaintiff to point to
significant undisclosed information relating to the treatment which would
have altered her decision to undergo it.[64]
Examining the evidence on record, we hold that there was adequate
disclosure of material risks inherent in the chemotherapy procedure
performed with the consent of Angelicas parents. Respondents could not
have been unaware in the course of initial treatment and amputation of
Angelicas lower extremity, that her immune system was already weak on
account of the malignant tumor in her knee. When petitioner informed the
respondents beforehand of the side effects of chemotherapy which includes
lowered counts of white and red blood cells, decrease in blood platelets,
possible kidney or heart damage and skin darkening, there is reasonable
expectation on the part of the doctor that the respondents understood very
well that the severity of these side effects will not be the same for all patients
undergoing the procedure. In other words, by the nature of the disease itself,
each patients reaction to the chemical agents even with pre-treatment
laboratory tests cannot be precisely determined by the physician. That
death can possibly result from complications of the treatment or the
underlying cancer itself, immediately or sometime after the administration of
chemotherapy drugs, is a risk that cannot be ruled out, as with most other
major medical procedures, but such conclusion can be reasonably drawn
from the general side effects of chemotherapy already disclosed.
As a physician, petitioner can reasonably expect the respondents to
have considered the variables in the recommended treatment for their
daughter afflicted with a life-threatening illness. On the other hand, it is
difficult to give credence to respondents claim that petitioner told them of
95% chance of recovery for their daughter, as it was unlikely for doctors like
petitioner who were dealing with grave conditions such as cancer to have
falsely assured patients of chemotherapys success rate. Besides, informed
consent laws in other countries generally require only a reasonable
explanation of potential harms, so specific disclosures such as statistical
data, may not be legally necessary.[65]
The element of ethical duty to disclose material risks in the proposed
medical treatment cannot thus be reduced to one simplistic formula

applicable in all instances. Further, in a medical malpractice action based on


lack of informed consent, the plaintiff must prove both the duty and the
breach of that duty through expert testimony.[66] Such expert testimony must
show the customary standard of care of physicians in the same practice as
that of the defendant doctor.[67]
In this case, the testimony of Dr. Balmaceda who is not an oncologist but a
Medical Specialist of the DOHs Operational and Management Services
charged with receiving complaints against hospitals, does not qualify as
expert testimony to establish the standard of care in obtaining consent for
chemotherapy treatment. In the absence of expert testimony in this regard,
the Court feels hesitant in defining the scope of mandatory disclosure in
cases of malpractice based on lack of informed consent, much less set a
standard of disclosure that, even in foreign jurisdictions, has been noted to
be an evolving one.
As society has grappled with the juxtaposition between
personal autonomy and the medical profession's intrinsic impetus
to cure, the law defining adequate disclosure has undergone a
dynamic evolution. A standard once guided solely by the
ruminations of physicians is now dependent on what a reasonable
person in the patients position regards as significant. This change
in perspective is especially important as medical breakthroughs
move practitioners to the cutting edge of technology, ever
encountering new and heretofore unimagined treatments for
currently incurable diseases or ailments. An adaptable standard is
needed to account for this constant progression. Reasonableness
analyses permeate our legal system for the very reason that they
are determined by social norms, expanding and contracting with
the ebb and flow of societal evolution.
As we progress toward the twenty-first century, we now realize
that the legal standard of disclosure is not subject to construction as a
categorical imperative. Whatever formulae or processes we adopt are
only useful as a foundational starting point; the particular quality or
quantity of disclosure will remain inextricably bound by the facts of
each case. Nevertheless, juries that ultimately determine whether a
physician properly informed a patient are inevitably guided by what they
perceive as the common expectation of the medical consumera reasonable
person in the patients position when deciding to accept or reject a
recommended medical procedure.[68] (Emphasis supplied.)

WHEREFORE, the petition for review on certiorari is GRANTED. The


Decision dated June 15, 2004 and the Resolution dated September 1, 2004 of
the Court of Appeals in CA-G.R. CV No. 58013 are SET ASIDE.

The
Decision
dated September
5,
1997 of
the Regional Trial Court of Legazpi City, Branch 8, in Civil Case No. 8904
is REINSTATED and UPHELD.
No costs.
SO ORDERED.

MEDICAL WITNESS AND EVIDENCE


G.R. No. 194259

March 16, 2011

PEOPLE OF THE PHILIPPINES, Plaintiff-Appellee,


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.
CR-H.C. No. 00020, which affirmed the August 26, 2004 Decision in Criminal Case No. CB02-195 of the Regional Trial Court (RTC), Branch 37 in Caibiran, Naval, Biliran. 2 The RTC
convicted accused Jimmy Alverio (Alverio) of rape.
The Facts
The charge against Alverio stemmed from the following Information:
That on or about the 3rd day of June, 2002, at about 2:00 oclock early dawn, more or less,
at [PPP],3 Philippines, and within the jurisdiction of this Honorable Court, while [AAA] was on
her way to her grandmothers house from the benefit dance, herein accused, a cousin of
herein complainant, with lewd designs, and by means of force and intimidation, get hold of
her arm and did then and there drag her to the back of the barangay hall, by holding her hair
and forcibly laid her to the ground, willfully, unlawfully and feloniously poked her a short
bladed weapon known as pisao forcibly took off her pants and panty and succeeded in
having carnal knowledge with her against her will to her damage and prejudice.
Contrary to law.4
On July 3, 2003, Alverio, with the assistance of his counsel de oficio, was arraigned, and he
pleaded "not guilty" to the charge against him. After the pre-trial, trial on the merits ensued.
During the trial, the prosecution offered the sole testimony of the private complainant. On the
other hand, the defense presented accused Alverio, Henry Toledo (Toledo), and Lily Toledo
as its witnesses.
The Prosecutions Version of Facts
In the afternoon of June 2, 2002, AAA, along with her friends Belen Sabanag (Sabanag) and
Aileen Sinangote (Sinangote), went to the house of her grandmother to attend a dance
event.5 At around 8:30 in the evening, they proceeded to the dance hall because the dance
would start at around 9 oclock.6 During the dance, Sabanag and Sinangote danced with
Alverio but AAA did not.7 At 2 oclock in the morning of June 3, 2002, AAA noticed that her
friends were no longer at the dance so she decided to go home to her grandmothers house. 8
As she was nearing the barangay hall, Alverio suddenly appeared and took hold of AAA. She
tried to resist him but he was too strong and he managed to pull her away. AAA started to cry
while she was being dragged towards the back of the barangay hall. 9 There, Alverio held her
hair, undressed her, and started to kiss her.10 AAA kept on resisting and even punched
Alverio after he kissed her, at which point, Alverio told her that it was painful and that he
might retaliate if she continued.11 This caused AAA to stop resisting and Alverio then
proceeded to insert his penis in her vagina repeatedly.12

After having carnal knowledge with her, Alverio stood up and put on his clothes. He warned
AAA that if she told anyone about what happened, he will kill her.13 After threatening her, he
left.
During this entire incident, Alverio was armed with a knife which he used to poke AAAs side.
Dazed, AAA could not muster enough strength to go home. She just sat on the road beside
the barangay hall until 5 oclock in the morning when her Uncle Intoy passed by. He brought
her home to her parents but she did not tell him anything. Upon reaching home, AAA told her
parents about what happened.14
Version of the Defense
Alverios defense, on the other hand, was confined to his denial of the accusation and an
alibi, to wit:
Sometime around 7:30 in the evening of June 2, 2002, Alverio recalled that he was in the
barangay chapel with his friend, Toledo, waiting for the dance to begin. 15 The dance hall was
just adjacent to the barangay chapel. At 8:30 in the evening, the dance started. He danced
with some persons whose names he could no longer recall. 16But he categorically
remembered that he did not see AAA in the dance area. 17
At 12:00 midnight, Alverio and Toledo walked home to Toledos house, where Alverio was
staying.18 On their way home, they passed by the barangay hall.19 Upon reaching home, they
slept and woke up at 5:30 in the morning of June 3, 2002.20
In his testimony, Alverio admitted that he and AAA are cousins, their mothers being sisters. 21
His testimony was corroborated by Toledo22 and Toledos mother, Lily Toledo.23
Ruling of the Trial Court
After trial, the RTC convicted Alverio. The dispositive portion of its August 26, 2004 Decision
reads:
WHEREFORE, premises considered, judgment is hereby rendered finding the accused
JIMMY ALVERIO guilty beyond reasonable doubt of the crime of rape. With no aggravating
or mitigating circumstance, he is sentenced to the lesser penalty of reclusion perpetua; to
indemnify [AAA] Fifty Thousand (P50,000.00) Pesos; and to pay the costs.
SO ORDERED.24
On appeal to the CA, Alverio disputed the trial courts finding of his guilt beyond reasonable
doubt of the crime charged. He argued that the presumption of innocence should prevail
especially considering that the prosecution only had a single testimony to support the charge
of rape.
Ruling of the Appellate Court
On March 25, 2010, the CA affirmed the judgment of the RTC. The dispositive portion of the
CA Decision reads:
IN LIGHT OF ALL THE FOREGOING, the Decision of the Regional Trial Court, Branch 37,
Caibiran, Naval, Biliran in Criminal Case No. CB-02-195 convicting the accused-appellant is
AFFIRMED with MODIFICATION in that he is also hereby adjudged liable to pay the victim
the amount of Php50,000.00 as moral damages.
His penalty of reclusion perpetua and the award of civil indemnity of Php50,000.00 stands.

Costs against the accused-appellant.


SO ORDERED.25
The Issue
Alverio now comes before this Court with the lone assignment of error contending that "[t]he
trial court gravely erred in finding the accused-appellant guilty beyond reasonable doubt of
rape."26
The Courts Ruling
We sustain Alverios conviction.
In his Brief, Alverio argues that the trial court should have taken the lone testimony of the
complainant with caution and that the testimony should have been weighed carefully, taking
into consideration the constitutional precept that in all criminal prosecutions, the accused
must be presumed innocent unless the contrary is proved.
Alverio raises three (3) grounds in support of his argument. First, he assails the trial court for
giving credence to the sole testimony of the victim. He claims that the prosecution should
have presented other witnesses to corroborate the testimony of the victim. Second, he
contends that the medical certificate presented as evidence was not testified to by the
signatory himself and should therefore not be considered as corroborative evidence. Lastly,
he claims that the trial court gravely erred in convicting him of the crime of rape for failure of
the prosecution to prove his guilt beyond reasonable doubt.
After a careful perusal of the records of this case, however, the Court is satisfied that the
prosecutions evidence sufficiently established Alverios guilt with moral certainty.
In People v. Malate,27 We reiterated the principles with which courts are guided in
determining the guilt or innocence of the accused in rape cases, viz:
x x x (1) an accusation of rape can be made with facility and while the accusation is difficult
to prove, it is even more difficult for the person accused, though innocent, to disprove the
charge; (2) considering that, in the nature of things, only two persons are usually involved in
the crime of rape, the testimony of the complainant should be scrutinized with great caution;
and (3) the evidence of the prosecution must stand or fall on its own merit, and cannot be
allowed to draw strength from the weakness of the evidence for the defense.
Moreover, in that same case, this Court held that "in cases involving the prosecution for
forcible rape x x x corroboration of the victims testimony is not a necessary condition to a
conviction for rape where the victims testimony is credible, or clear and convincing or
sufficient to prove the elements of the offense beyond a reasonable doubt."28 As such,
appellate courts generally do not disturb the findings of the trial court with regard to the
assessment of the credibility of witnesses,29 the reason being that the trial court has the
"unique opportunity to observe the witnesses first hand and note their demeanor, conduct
and attitude under grilling examination."30 More importantly, courts generally give full
credence to the testimony of a complainant for rape, especially one who is only a minor.31
The exceptions to this rule are when the trial courts findings of facts and conclusions are not
supported by the evidence on record, or when certain facts of substance and value likely to
change the outcome of the case have been overlooked by the lower court, or when the
assailed decision is based on a misapprehension of facts.32However, this Court finds none of
these exceptions present in the instant case.
The victim testified in a steadfast and straightforward manner, to wit:
PROS. JOCOBO:

Q Now can you tell now [since] there are no more persons around except you and
the accused can tell to the Court, or were you able to reach in the house of your lola?
A When I was walking I was suddenly held by Jimmy Alverio.
Q Where were you already walking did Jimmy Alverio suddenly held you?
A Near Brgy. Hall of Brgy. Maurang.
Q What happened next after you were held by Jimmy Alverio near the brgy. hall of
Maurang?
A He tried to pull me but then I resisted, and Jimmy insisted by pulling me until I
cried.
Q Then even if you were already crying what next happened?
A He drag me towards the back of the Brgy hall.
Q Did you in fact drag to the brgy. hall?
A Yes sir.
Q While you were at the back of the brgy. hall can you tell this Honorable Court what
happened?
A [He] held my hair and he tried to undressed me but I resisted.
Q Since he tried to undressed [sic] you and you were resisted [sic] was he able or
was he successful in undressing you?
A Yes sir.
Q Despite of your resistance?
A Yes sir.
Q When you were already undressed what happened, can you tell this to the
Honorable Court?
A He tried kissed [sic] me several times and I resisted and I boxed him.
Q After you have boxed him after kissing you what next happened?
A He said that is painful I might retaliate with you.
Q After hearing on that what did Jimmy had done to you?
A I just cried I did not mind him anymore.
Q How about Jimmy what was he doing?
A He continued kissing me.
Q After kissing you what next follow?
ATTY. SABANDAL:

I would like to request Your Honor that the prosecution would discontinue and
encouraging very much because its up to the witness to answer Your Honor the
question. Since previously it would [seem] that the witness could be able to answer
only after so much question
PROS. JOBOCO:
Your Honor please according to the circular on examining minors we will to give full
support and we to understand the minors especially if victims of minor cases.
ATTY. SABANDAL:
It was not established that she is a minor, Your Honor.
COURT:
She is 14 years old.
FROM THE COURT:
Q Now you said that you were undressed by Jimmy Alverio, do you mean to say that
you were already naked when you said undressed?
A Yes sir.
Q And when Jimmy Alverio kissing you several times were you already naked?
A Yes sir.
xxxx
Q What did Jimmy do more while he was kissing several times and you were naked?
COURT INTERPRETER:
At this juncture Your Honor the witness is crying.
COURT:
Q And when you were naked was Jimmy also naked?
A Yes sir.
xxxx
Q You were naked and Jimmy Alverio was also naked and Jimmy Alverio was kissing
you so many times, what more did Jimmy Alverio do to you?
A He inserted his penis.
Q What were your position, were you standing, or you were lying down?
A Lying position.
Q Or something was placed on the ground?
A On the ground.

COURT:
Alright Pros. Joboco you can proceed the continuation of your direct examination.
PROS. JOBOCO:
Q When you said when Jimmy Alverio was inserted his penis where was inserted?
A to my vagina.
Q And when Jimmy inserted his penis to your vagina what did you feel?
A I felt pain.
Q And when you felt pain what did you do?
A I kept on crying.
PROS. JOBOCO:
I think that would be all Your Honor I think the witness already crying.
COURT:
How many times did Jimmy insert his penis to your vagina?
A three (3) times.
Q After the three (3) times intercourse with you what did Jimmy do to you?
A He stood up and he dressed himself and he left me.
Q Did he not leave words to you?
A He told me that if you will told anybody in your family, your mother and your father I
will kill you.
Q Was she have arm [sic] at that time of the incident?
A Yes sir.
Q What arm or firearm or what?
A a knife.
Q Did he use that in forcing you to do the sexual acts?
A Yes sir.
Q By what means did he threatened you?
A He poke it at my side.
Q Now what would you mean, he poke it at my side, what did you do?
A I remain there crying.33

It is strikingly clear from the above transcript that AAAs testimony was very coherent and
candid. Thus, We find no reason to overturn the findings of the trial court.
In addition, Alverio submits that although the medical certificate was presented as evidence,
its contents were never testified to by the signatory himself and, as such, cannot be
considered as corroborative of the claim of the victim that she was raped.
Such argument, however, cannot prosper. Medical evidence is dispensable and merely
corroborative in proving the crime of rape. Besides, a medical certificate is not even
necessary to prove the crime of rape.34 The gravamen of rape is carnal knowledge of a
woman through force and intimidation.35
The elements needed to prove the crime of rape under paragraph 1(a) of Article 266-A of the
Revised Penal Code are: (1) the offender is a man; (2) the offender had carnal knowledge of
a woman; and (3) the act is accomplished by using force or intimidation. All these elements
were sufficiently proved by the prosecution. The testimony of AAA overwhelmingly proves
that Alverio raped her with the use of force and intimidation.
Furthermore, Alverios defense of alibi cannot stand versus the positive identification of AAA.
Nothing is more settled in criminal law jurisprudence than the rule that alibi and denial cannot
prevail over the positive and categorical testimony and identification of the accused by the
complainant.36
Accordingly, We find that the prosecution has discharged its burden of proving the guilt of
Alverio beyond reasonable doubt.
As to the award of damages, the CA was correct in awarding PhP 50,000 as moral damages
without need of proof. However, in line with current jurisprudence, 37 an additional award of
PhP 30,000 as exemplary damages should likewise be given, as well as interest of six
percent (6%) per annum on all damages awarded from the finality of judgment until fully
paid.
WHEREFORE, the appeal is DENIED. The CA Decision in CA-G.R. CR-H.C. No. 00020
finding accused-appellant Jimmy Alverio guilty of the crime charged is AFFIRMED with
MODIFICATION. As modified, the ruling of the trial court should read as follows:
WHEREFORE, premises considered, judgment is hereby rendered finding the accused
JIMMY ALVERIO guilty beyond reasonable doubt of the crime of rape. With no aggravating
or mitigating circumstance, he is sentenced to the lesser penalty of reclusion perpetua; to
pay [AAA] Fifty Thousand (P50,000.00) Pesos as civil indemnity, Fifty Thousand
(P50,000.00) as moral damages and Thirty Thousand (P30,000.00) as exemplary damages
with interest of six percent (6%) per annum on all awards of damages from the finality of
judgment until fully paid; and to pay the costs.
SO ORDERED.

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.
The facts hark back to the afternoon of October 17, 1996, at around 4 o'clock, when the body
of six-year old Jennifer Domantay was found sprawled amidst a bamboo grove in Guilig,
Malasiqui, Pangasinan. The child's body bore several stab wounds. Jennifer had been
missing since lunch time.
The medical examination conducted the following day by Dr. Ma. Fe Leticia Macaranas, the
rural health physician of Malasiqui, showed that Jennifer died of multiple organ failure and
hypovolemic shock secondary to 38 stab wounds at the back. Dr. Macaranas found no
lacerations or signs of inflammation of the outer and inner labia and the vaginal walls of the
victim's genitalia, although the vaginal canal easily admitted the little finger with minimal
resistance. Noting possible commission of acts of lasciviousness, Dr. Macaranas
recommended an autopsy by a medico-legal expert of the NBI. 2
The investigation by the Malasiqui police pointed to accused-appellant Bernardino
Domantay, a cousin of the victim's grandfather, as the lone suspect in the gruesome crime.
At around 6:30 in the evening of that day, police officers Montemayor, de la Cruz, and de
Guzman of the Malasiqui Philippine National Police (PNP) picked up accused-appellant at
the Malasiqui public market and took him to the police station where accused-appellant,
upon questioning by SPO1 Antonio Espinoza, confessed to killing Jennifer Domantay. He
likewise disclosed that at around 3:30 that afternoon, he had given the fatal weapon used, a
bayonet, to Elsa and Jorge Casingal, his aunt and uncle respectively, in Poblacion Sur,
Bayambang, Pangasinan. The next day, October 18, 1996, SPO1 Espinoza and another
policeman took accused-appellant to Bayambang and recovered the bayonet from a tricycle
belonging to the Casingal spouses. The police officers executed a receipt to evidence the
confiscation of the weapon. 3
On the basis of the post-mortem findings of Dr. Macaranas, SPO4 Juan Carpizo, the
Philippine National Police chief investigator at Malasiqui, filed, on October 21, 1996, a
criminal complaint for murder against accused-appellant before the Municipal Trial Court
(MTC) of Malasiqui. On October 25, 1996, Dr. Ronald Bandonill, medico-legal expert of the
NBI, performed an autopsy on the embalmed body of Jennifer. The result of his examination
of the victim's genitalia indicated that the child's hymen had been completely lacerated on
the right side. Based on this finding, SPO4 Carpizo amended the criminal complaint against
accused-appellant to rape with homicide. Subsequently, the following information was filed: 4
That on or about the 17th day of October, 1996, in the afternoon, in barangay
Guilig, Municipality of Malasiqui, province of Pangasinan, Philippines and
within the jurisdiction of this Honorable Court, the above-named accused,
with lewd design and armed with a bayonnete, did then and there, wilfully,
unlawfully and feloniously have sexual intercourse with Jennifer Domantay, a
minor of 6 years old against her will and consent, and on the same occasion,
the said accused with intent to kill, then and there, wilfully, unlawfully and
feloniously stab with the use of a bayonnete, the said Jennifer Domantay,
inflicting upon her multiple stab wounds, which resulted to her death, to the
damage and prejudice of her heirs.

At the trial, the prosecution presented seven witnesses, namely, Edward, Jiezl, Lorenzo, all
surnamed Domantay, Joselito Mejia, Antonio Espinoza, Celso Manuel, and Dr. Ronald
Bandonill, to establish its charge that accused-appellant had raped and killed Jennifer
Domantay.
Edward Domantay testified that in the morning of October 17, 1996, accused-appellant and
his two brothers-in-law, Jaime Caballero and Daudencio Macasaeb, had a round of drinks in
front of the latter's house in Guilig, Malasiqui, Pangasinan. Edward Domantay said that he
was in front of Macasaeb's house, tending to some pigeons in his yard. 5 After the group had
consumed several bottles of San Miguel gin, accused-appellant gave money to Edward
Domantay and asked him to buy two bottles of gin and a bottle of Sprite. 6 Edward said he joined
the group and sat between Daudencio Macasaeb and accused-appellant. 7 Edward said that
accused-appellant, who, apparently had one too many then, rolled up his shirt and said: "No diad
Antipolo tan L[i]pa et walay massacre, diad Guilig wala, walay massacren kod dia, walay onakisakis" ("In Antipolo and Lipa, there were massacres; here in Guilig, there will also be a massacre. I
will massacre somebody here, and they will cry and cry"). Edward Domantay saw that tucked in
the left side of accused-appellant's waistline was a bayonet without a cover handle. 8 It was not
the first time that Edward had seen accused-appellant with the knife as the latter usually carried it
with him. 9
Jiezl Domantay, 10, likewise testified. She said that, at about 2 o'clock in the afternoon on
October 17, 1996, she and four other children were playing in front of their house in Guilig,
Malasiqui, Pangasinan. Jiezl saw accused-appellant and Jennifer Domantay walking towards
the bamboo grove of Amparo Domantay where Jennifer's body was later found. Accusedappellant was about two meters ahead of Jennifer. The bamboo grove was about 8 to 10
meters from the house of Jiezl Domantay. 10
Lorenzo Domantay, a relative of the victim, corroborated Jiezl's testimony that accusedappellant had gone to Amparo Domantay's bamboo grove in the afternoon of October 17,
1996. Lorenzo said that afternoon, on his way to his farm, he saw accused-appellant about
30 meters away, standing at the spot in the bamboo grove where Jennifer's body was later
found. Accused-appellant appeared restless and worried as he kept looking around.
However, as Lorenzo was in a hurry, he did not try to find out why accused-appellant
appeared to be nervous. 11
Prosecution witness Joselito Mejia, a tricycle driver, said that, in the afternoon of October 17,
1996, he was about to take his lunch at home in Alacan, a neighboring barangay about half a
kilometer from Guilig, when accused-appellant implored Mejia to take him to Malasiqui at
once. Mejia told accused-appellant that he was going to take his lunch first, but the latter
pleaded with him, saying they will not be gone for long. Mejia, therefore, agreed. Mejia
noticed that accused-appellant was nervous and afraid. Accused-appellant later changed his
mind. Instead of going to the town proper, he alighted near the Mormon's church, outside
Malasiqui. 12
In addition, the prosecution presented SPO1 Antonio Espinoza and Celso Manuel who
testified that, on separate occasions, accused-appellant had confessed to the brutal killing of
Jennifer Domantay.
SPO1 Espinoza testified that he investigated accused-appellant after the latter had been
brought to the Malasiqui police station in the evening of October 17, 1996. Before he
commenced his questioning, he apprised accused-appellant of his constitutional right to
remain silent and to have competent and independent counsel, in English, which was later
translated into Pangasinense. 13 According to SPO1 Espinoza, accused-appellant agreed to
answer the questions of the investigator even in the absence of counsel and admitted killing the
victim. Accused-appellant also disclosed the location of the bayonet he used in killing the
victim. 14 On cross-examination, Espinoza admitted that at no time during the course of his
questioning was accused-appellant assisted by counsel. Neither was accused-appellant's
confession reduced in writing. 15 Espinoza's testimony was admitted by the trial court over the
objection of the defense.

Celso Manuel, for his part, testified that he is a radio reporter of station DWPR, an AM station
based in Dagupan City. He covers the third district of Pangasinan, including Malasiqui.
Sometime in October 1996, an uncle of the victim came to Dagupan City and informed the
station about Jennifer Domantay's case. 16 On October 23, 1996, Manuel went to Malasiqui to
interview accused-appellant who was then detained in the municipal jail. He described what
transpired during the interview thus: 17
PROS. QUINIT:
Q Did you introduce yourself as a media practitioner?
A Yes, sir.
Q How did you introduce yourself to the accused?
A I showed to Bernardino Domantay alias "Junior Otot" my
I.D. card and I presented myself as a media practitioner with
my tape recorder [in] my hand, sir.
Q What was his reaction to your request for an interview?
A He was willing to state what had happened, sir.
Q What are those matters which you brought out in that
interview with the accused Bernardino Domantay alias "Junior
Otot"?
A I asked him what was his purpose for human interest's sake
as a reporter, why did he commit that alleged crime. And I
asked also if he committed the crime and he answered "yes."
That's it.
xxx xxx xxx
PROS. QUINIT:
Q You mentioned about accused admitting to you on the
commi[ssion] of the crime, how did you ask him that?
A I asked him very politely.
Q More or less what have you asked him on that particular
matter?
A I asked "Junior Otot," Bernardino Domantay, "Kung
pinagsisisihan mo ba ang iyong ginawa?" "Opo" sabi niya,
"Ibig mo bang sabihin Jun, ikaw ang pumatay kay Jennifer?",
"Ako nga po" The [l]ast part of my interview, "Kung nakikinig
ang mga magulang ni Jennifer, ano ang gusto mong
iparating?", "kung gusto nilang makamtan ang hustisya ay
tatanggapin ko". That is what he said, and I also asked Junior
Otot, what was his purpose, and he said, it was about the
boundary dispute, and he used that little girl in his revenge.
On cross-examination, Manuel explained that the interview was conducted in the jail, about
two to three meters away from the police station. An uncle of the victim was with him and the
nearest policemen present were about two to three meters from him, including those who
were in the radio room. 18 There was no lawyer present. Before interviewing accused-appellant,
Manuel said he talked to the chief of police and asked permission to interview accused-

appellant. 19 On questioning by the court, Manuel said that it was the first time he had been called
to testify regarding an interview he had conducted. 20 As in the case of the testimony of SPO1
Espinoza, the defense objected to the admission of Manuel's testimony, but the lower court
allowed it.

Dr. Bandonill, the NBI medico-legal who conducted an autopsy of the victim on October 25,
1996, testified that Jennifer Domantay died as a result of the numerous stab wounds she
sustained on her back, 21 the average depth of which was six inches. 22 He opined that the
wounds were probably caused by a "pointed sharp-edged instrument." 23 He also noted on the
aforehead, neck, and breast bone of the victim. 24 As for the results of the genital examination of
the victim, Dr. Bandonill said he found that the laceration on the right side of the hymen was
caused within 24 hours of her death. He added that the genital area showed signs of
inflammation. 25
Pacifico Bulatao, the photographer who took the pictures of the scene of the crime and of the
victim after the latter's body was brought to her parents' house, identified and authenticated
the five pictures (Exhibits A, B, C, D, and E) offered by the prosecution.
The defense then presented accused-appellant as its lone witness. Accused-appellant
denied the allegation against him. He testified he is an uncle of Jennifer Domantay (he and
her grandfather are cousins) and that he worked as a janitor at the Malasiqui Municipal Hall.
He said that at around 1 o'clock in the afternoon of October 17, 1996, he was bathing his
pigs outside in the house of his brother-in-law Daudencio Macasaeb in Guilig, Malasiqui,
Pangasinan. He confirmed that Daudencio was then having drinks in front of his
(Macasaeb's) house. Accused-appellant claimed, however, that he did not join in the drinking
and that it was Edward Domantay, whom the prosecution had presented as witness, and a
certain Jaime Caballero who joined the party. He also claimed that it was he whom
Macasaeb had requested to buy some more liquor, for which reason he gave money to
Edward Domantay so that the latter could get two bottles of gin, a bottle of Sprite, and a pack
of cigarettes. 26 He denied Edward Domantay's claim that he (accused-appellant) had raised his
shirt to show a bayonet tucked in his waistline and that he had said he would massacre someone
in Guilig. 27
Accused-appellant also confirmed that, at about 2 o'clock in the afternoon, he went to Alacan
passing on the trail beside the bamboo grove of Amparo Domantay. But he said he did not
know that Jennifer Domantay was following him. He further confirmed that in Alacan, he took
a tricycle to Malasiqui. The tricycle was driven by Joselito Mejia. He said he alighted near the
Mormon church, just outside of the town proper of Malasiqui to meet his brother. As his
brother did not come, accused-appellant proceeded to town and reported for work. That
night, while he was in the Malasiqui public market, he was picked up by three policemen and
brought to the Malasiqui police station where he was interrogated by SPO1 Espinoza
regarding the killing of Jennifer Domantay. He denied having owned to the killing of Jennifer
Domantay to SPO1 Espinoza. He denied he had a grudge against the victim's parents
because of a boundary dispute. 28 With respect to his extrajudicial confession to Celso Manuel,
he admitted that he had been interviewed by the latter, but he denied that he ever admitted
anything to the former. 29
As already stated, the trial court found accused-appellant guilty as charged. The dispositive
portion of its decision reads: 30
WHEREFORE, in light of all the foregoing, the Court hereby finds the
accused, Bernardino Domantay @ "Junior Otot" guilty beyond reasonable
doubt with the crime of Rape with Homicide defined and penalized under
Article 335 of the Revised Penal Code in relation and as amended by
Republic Act No. 7659 and accordingly, the Court hereby sentences him to
suffer the penalty of death by lethal injection, and to indemnify the heirs of
the victim in the total amount of Four Hundred Eighty Thousand Pesos
(P480,000.00), 31 and to pay the costs.
SO ORDERED.

In this appeal, accused-appellant alleges that: 32


I
THE COURT A QUO ERRED IN APPRECIATING THE EXTRAJUDICIAL
CONFESSION[S] MADE BY THE ACCUSED-APPELLANT.
II
THE COURT A QUO ERRED IN CONVICTING THE ACCUSED DESPITE
FAILURE OF THE PROSECUTION TO PROVE HIS GUILT BEYOND
REASONABLE DOUBT.
First. Accused-appellant contends that his alleged confessions to SPO1 Antonio Espinoza
and Celso Manuel are inadmissible in evidence because they had been obtained in violation
of Art. III, 12(1) of the Constitution and that, with these vital pieces of evidence excluded,
the remaining proof of his alleged guilt, consisting of circumstantial evidence, is inadequate
to establish his guilt beyond reasonable doubt. 33
Art. III, 12 of the Constitution in part provides:
(1) Any person under investigation for the commission of an offense shall
have the right to be informed of his right to remain silent and to have
competent and independent counsel preferably of his own choice. If the
person cannot afford the services of counsel, he must be provided with one.
These rights cannot be waived except in writing and in the presence of
counsel.
xxx xxx xxx
(3) Any confession or admission obtained in violation of this section or
section 17 hereof shall be inadmissible in evidence.
This provision applies to the stage of custodial investigation, that is, "when the investigation
is no longer a general inquiry into an unsolved crime but starts to focus on a particular
person as a suspect." 34 R.A. No. 7438 has extended the constitutional guarantee to situations in
which an individual has not been formally arrested but has merely been "invited" for
questioning. 35
Decisions 36 of this Court hold that for an extrajudicial confession to be admissible, it must satisfy
the following requirements: (1) it must be voluntary; (2) it must be made with the assistance of
competent and independent counsel; (3) it must be express; and (4) it must be in writing.
In the case at bar, when accused-appellant was brought to the Malasiqui police station in the
evening of October 17, 1996, 37 he was already a suspect, in fact the only one, in the brutal
slaying of Jennifer Domantay. He was, therefore, already under custodial investigation and the
rights guaranteed in Art. III, 12(1) of the Constitution applied to him. SPO1 Espinoza narrated
what transpired during accused-appellant's interrogation: 38
[I] interrogated Bernardino Domantay, prior to the interrogation conducted to
him, I informed him of his constitutional right as follows; that he has the right
to remain silent; that he has the right to a competent lawyer of his own choice
and if he can not afford [a counsel] then he will be provided with one, and
further informed [him] that all he will say will be reduced into writing and will
be used the same in the proceedings of the case, but he told me that he will
cooperate even in the absence of his counsel; that he admitted to me that he
killed Jennifer Domantay, and he revealed also the weapon used [and] where
he gave [it] to.

But though he waived the assistance of counsel, the waiver was neither put in writing nor
made in the presence of counsel. For this reason, the waiver is invalid and his confession is
inadmissible. SPO1 Espinoza's testimony on the alleged confession of accused-appellant
should have been excluded by the trial court. So is the bayonet inadmissible in evidence,
being, as it were, the "fruit of the poisonous tree." As explained in People v. Alicando: 39
. . . According to this rule, once the primary source (the "tree") is shown to
have been unlawfully obtained, any secondary or derivative evidence (the
"fruit") derived from it is also inadmissible. Stated otherwise, illegally seized
evidence is obtained as a direct result of the illegal act, whereas the "fruit of
the poisonous tree" is at least once removed from the illegally seized
evidence, but it is equally inadmissible. The rule is based the principle that
evidence illegally obtained by the State should not be used to gain other
evidence because the originally illegal obtained evidence taints all evidence
subsequently obtained.
We agree with the Solicitor General, however, that accused-appellant's confession to the
radio reporter, Celso Manuel, is admissible. In People v.
Andan, 40 the accused in a rape with homicide case confessed to the crime during interviews with
the media. In holding the confession admissible, despite the fact that the accused gave his
answers without the assistance of counsel, this Court said: 41
[A]ppellant's [oral] confessions to the newsmen are not covered by Section
12(1) and (3) of Article III of the Constitution. The Bill of Rights does not
concern itself with the relation between a private individual and another
individual. It governs the relationship between the individual and the State.
The prohibitions therein are primarily addressed to the State and its agents.
Accused-appellant claims, however, that the atmosphere in the jail when he was interviewed
was "tense and intimidating" and was similar to that which prevails in a custodial
investigation. 42 We are not persuaded. Accused-appellant was interviewed while he was inside
his cell. The interviewer stayed outside the cell and the only person besides him was an uncle of
the victim. Accused-appellant could have refused to be interviewed, but instead, he agreed. He
answered questions freely and spontaneously. According to Celso Manuel, he said he was willing
to accept the consequences of his act.
Celso Manuel admitted that there were indeed some police officers around because about
two to three meters from the jail were the police station and the radio room. 43 We do not think
the presence of the police officers exerted any undue pressure or influence on accused-appellant
and coerced him into giving his confession.
Accused-appellant contends that "it is . . . not altogether improbable for the police
investigators to ask the police reporter (Manuel) to try to elicit some incriminating information
from the accused." 44 This is pure conjecture. Although he testified that he had interviewed
inmates before, there is no evidence to show that Celso was a police beat reporter. Even
assuming that he was, it has not been shown that, in conducting the interview in question, his
purpose was to elicit incriminating information from accused-appellant. To the contrary, the media
are known to take an opposite stance against the government by exposing official wrongdoings.
Indeed, there is no showing that the radio reporter was acting for the police or that the
interview was conducted under circumstances where it is apparent that accused-appellant
confessed to the killing our of fear. As already stated, the interview was conducted on
October 23, 1996, 6 days after accused-appellant had already confessed to the killing to the
police.
Accused-appellant's extrajudicial confession is corroborated by evidence of corpus delicti,
namely, the fact of death of Jennifer Domantay. In addition, the circumstantial evidence
furnished by the other prosecution witnesses dovetails in material points with his confession.
He was seen walking toward the bamboo grove, followed by the victim. Later, he was seen

standing near the bamboo grove where the child's body was found. Rule 133 of the Revised
Rules on Evidence provides:
3. Extrajudicial confession, not sufficient ground for conviction. An
extrajudicial confession made by an accused, shall not be sufficient ground
for conviction, unless corroborated by evidence ofcorpus delicti.
4. Evidence necessary in treason cases. No person charged with treason
shall be convicted unless on the testimony of two witnesses to the same
overt act, or on confession in open court.
Accused-appellant argues that it was improbable for a brutal killing to have been committed
without the children who were playing about eight to ten meters from Amparo Domantay's
grove, where the crime took place, having heard any commotion. 45 The contention has no
merit. Accused-appellant could have covered the young child's mouth to prevent her from making
any sound. In fact, Dr. Bandonill noted a five by two inch (5" x 2") contusion on the left side of the
victim's forehead, which he said could have been caused by a hard blunt instrument or by impact
as her head hit the ground.46 The blow could have rendered her unconscious, thus precluding her
from shouting or crying.
Accused-appellant also contends that the testimony of Jiezl Domantay contradicts that of
Lorenzo Domantay because while Jiezl said she had seen accused-appellant walking
towards the bamboo grove, followed by the victim, at around 2 o'clock in the afternoon on
October 17, 1996. Lorenzo said he saw accused-appellant standing near the bamboo grove
at about the same time.
These witnesses, however, did not testify concerning what they saw exactly the same time.
What they told the court was what they had seen "at around" 2 o'clock in the afternoon.
There could have been a between difference in time, however little it was, between the time
Jiezl saw accused-appellant and the victim walking and the time Lorenzo saw accusedappellant near the place where the victim's body was later found. Far from contradicting each
other, these witnesses confirmed what each had said each one saw. What is striking about
their testimonies is that while Jiezl said she saw accused-appellant going toward the bamboo
grove followed by the victim "at around" 2 o'clock in the afternoon on October 17, 1996,
Lorenzo said he had seen accused-appellant near the bamboo grove "at around" that time.
He described accused-appellant as nervous and worried. There is no reason to doubt the
claim of these witnesses. Lorenzo is a relative of accused-appellant. There is no reason he
would testified falsely against the latter. Jiezl, on the other hand, is also surnamed Domantay
and could also be related to accused-appellant and has not been shown to have any reason
to testify falsely against accused-appellant. At the time of the incident, she was only 10 years
old.
For the foregoing reasons, the Court is convinced of accused-appellant's guilt with respect to
the killing of the child. It is clear that the prosecution has proven beyond reasonable doubt
that accused-appellant is guilty of homicide. Art. 249 of the Revised Penal Code provides:
Any person who, not falling within the provisions of Article 246 [parricide]
shall kill another without the attendance of any of the circumstances
enumerated in the next preceding article [murder], shall be deemed guilty of
homicide and be punished by reclusion temporal.
The killing was committed with the generic aggravating circumstance of abuse of superior
strength. The record shows that the victim, Jennifer Domantay, was six years old at the time
of the killing. She was a child of small build, 46" in height. 47 It is clear then that she could not
have put up much of a defense against accused-appellant's assault, the latter being a fully grown
man of 29 years. Indeed, the physical evidence supports a finding of abuse of superior strength:
accused-appellant had a weapon, while the victim was not shown to have had any; there were 38
stab wounds; and all the knife wounds are located at the back of Jennifer's body.

But we think the lower court erred in finding that the killing was committed with cruelty. 48 The
trial court appears to have been led to this conclusion by the number of wounds inflicted on the
victim. But the number of wounds is not a test for determining whether there was
circumstance. 49 "The rest . . . is whether the accused deliberately and sadistically augmented the
victim's suffering thus . . . there must be proof that the victim was made to agonize before the [the
accused] rendered the blow which snuffed out [her] life." 50 In this case, there is no such proof of
cruelty. Dr. Bandonill testified that any of the major wounds on the victim's back could have
caused her death as they penetrated her heart, lungs and liver, kidney and intestines. 51
Second. There is, however, no sufficient evidence to hold accused-appellant guilty of raping
Jennifer Domantay. Art. 335. of the Revised Penal Code, as amended, in part provides:
Art. 335. When and how rape is committed. Rape is committed by having
carnal knowledge of a woman under any of the following circumstances.
1. By using force or intimidation;
2. When the woman is deprive of reason or otherwise unconscious; and
3. When the woman is under twelve years of age or is demented.
As the victim here was six years old, only carnal knowledge had to be proved to
establish rape. Carnal knowledge is defined as the act of a man having sexual
intercourse or sexual bodily connections with a woman. 52 For this purpose, it is
enough if there was even the slightest contact of the male sex organ with the labia of the
victim's genitalia. 53 However, there must be proof, by direct or indirect evidence, of such
contact.
Dr. Ronald Bandonill's report on the genital examination he had performed on the deceased
reads: 54
GENITAL EXAMINATION; showed a complete laceration of the right side of
the hymen. The surrounding genital area shows signs of inflammation.
xxx xxx xxx
REMARKS: 1) Findings at the genital area indicate the probability of
penetration of that area by a hard, rigid instrument.
Hymenal laceration is not necessary to prove rape; 55 neither does its presence prove its
commission. As held inPeople v. Ulili, 56 a medical certificate or the testimony of the physician is
presented not to prove that the victim was raped but to show that the latter had lost her virginity.
Consequently, standing alone, a physician's finding that the hymen of the alleged victim was
lacerated does not prove rape. It is only when this is corroborated by other evidence proving
carnal knowledge that rape may be deemed to have been established. 57
This conclusion is based on the medically accepted fact that a hymenal tear may be caused
by objects other than the male sex organ 58 or may arise from other causes. 59 Dr. Bandonill
himself admitted this. He testified that the right side of the victim's hymen had been completely
lacerated while the surrounding genital area showed signs of inflammation. 60 He opined that the
laceration had been inflicted within 24 hours of the victim's death and that the inflammation was
due to a trauma in that area. 61 When asked by the private prosecutor whether the lacerations of
the hymen could have been caused by the insertion of a male organ he said this was possible.
But he also said when questioned by the defense that the lacerations could have been caused by
something blunt other than the male organ. Thus, he testified: 62
PROS. F. QUINIT:
Q Now, what might have caused the complete laceration of
the right side of the hymen,doctor?

A Well, sir, if you look at my report there is a remark and it


says there; findings at the genital area indicated the
probability of penetration of that area by a hard rigid
instrument.
Q Could it have been caused by a human organ?
A If the human male organ is erect, fully erect and hard then it
is possible, sir.
xxx xxx xxx
ATTY. VALDEZ:
Q In your remarks; finding at the genital area indicates the
probability of penetration of that area by a hard rigid
instrument, this may have also been caused by a dagger
used in the killing of Jennifer Domantay is that correct?
A Well, sir when I say hard rigid instrument it should not be
sharp pointed and share rigid, it should be a hard bl[u]nt
instrument.
Q Do you consider a bolo a bl[u] instrument, or a dagger?
A The dagger is a sharp rigid but it is not a bl[u]nt instrument,
sir.
Q This Genital Examination showed a complete laceration of
the right side of the hymen, this may have been possibly
caused by a dagger, is it not?
A No, sir. I won't say that this would have been caused by a
dagger, because a dagger would have made at its incision . . .
not a laceration, sir.
Q But this laceration may also have been caused by other
factors other the human male organ, is that correct?
A A hard bl[u]nt instrument, sir could show.
Q My question is other than the human male organ?
A Possible, sir.
xxx xxx xxx
COURT:
Q You mentioned that the hymen was lacerated on the right
side?
A Yes, your Honor.
Q And if there is a complete erection by a human organ is
this possible that the laceration can only be on the right side
of the hymen?

A Yes, your Honor, its possible.


Q How about if the penetration was done by a finger, was it
the same as the human organ?
A Well, it defends on the size of the finger that penetrat[es]
that organ, if the finger is small it could the superficial
laceration, and if the finger is large then it is possible your
honor.
Q How about two fingers?
A Possible, sir.
To be sure, this Court has sustained a number of convictions for rape with homicide based
on purely circumstantial evidence. In those instances, however, the prosecution was able to
present other tell-tale signs of rape such as the location and description of the victim's
clothings, especially her undergarments, the position of the body when found and the
like. 63 In People v. Macalino, 64 for instance, the Court affirmed a conviction for the rape of a twoyear old child on the basis of circumstantial evidence. 65
The Court notes that the testimony or medical opinion of Dr. Gajardo that the
fresh laceration had been produced by sexual intercourse is corroborated by
the testimony given by complainant. Elizabeth that when she rushed upstairs
upon hearing her daughter suddenly cry out, she found appellant Macalino
beside the child buttoning his own pants and that she found some sticky fluid
on the child's buttocks and some blood on her private part.(Emphasis in the
original)
In contrast, in the case at bar, there is no circumstantial evidence from which to infer that
accused-appellant sexually abused the victim. The only circumstance from which such
inference might be made is that accused-appellant was seen with the victim walking toward
the place where the girl's body was found. Maybe he raped the girl. Maybe he did not.
Maybe he simply inserted a blunt object into her organ, thus causing the lacerations in the
hymen. Otherwise, there is no circumstance from which it might reasonably be inferred that
he abused her, e.g., that he was zipping up his pants, that there was spermatozoa in the
girl's vaginal canal.
Indeed, the very autopsy report of Dr. Bandonill militates against the finding of rape. In
describing the stab wounds on the body of the victim, he testified: 66
[A]fter examining the body I took note that were several stab wounds . . .
these were all found at the back area sir . . . extending from the back
shoulder down to the lower back area from the left to the right.
Considering the relative physical positions of the accused and the victim in crimes of
rape, the usual location of the external bodily injuries of the victim is on the
face, 67 neck, 68 and anterior portion 69 of her body. Although it is not unnatural to find
contusions on the posterior side, these are usually caused by the downward pressure on
the victim's body during the sexual assault. 70 It is unquestionably different when, as in this
case, all the stab wounds (except for a minor cut in the lower left leg) had their entry
points at the back running from the upper left shoulder to the lower right buttocks.
It is noteworthy that the deceased was fully clothed in blue shorts and white shirt when her
body was immediately after it was found. 71 Furthermore, there is a huge bloodstain in the back
portion of her shorts. 72 This must be because she wearing this piece of clothing when the stab
wounds were inflicated or immediately thereafter, thus allowing the blood to seep into her shorts
to such an extent. As accused-appellant would naturally have to pull down the girl's lower
garments in order to consummate the rape, then, he must have, regardless of when the stab

wounds were inflicted, pulled up the victim's shorts and undergarments after the alleged rape,
otherwise, the victim's shorts would not have been stained so extensively. Again, this is contrary
to ordinary human experience.

Even assuming that Jennifer had been raped, there is no sufficient proof that it was accusedappellant who had raped her. He did not confess to having raped the victim.
From the foregoing, we cannot find that accused-appellant also committed rape. In the
special complex crime of rape with homicide, both the rape and the homicide must be
established beyond reasonable doubt. 73
Third. The trial court ordered accused-appellant to pay the heirs of Jennifer Domantay the
amount of P30,000.00 as actual damages. However, the list of expenses produced by the
victim's father, Jaime Domantay, only totaled P28,430.00. Of this amount, only P12,000.00
was supported by a receipt. Art. 2199 of the Civil Code provides that a party may recover
actual or compensatory damages only for such loss as he has duly proved. Therefore, the
award of actual damages should be reduced to P12,000.00.
In addition, the heirs of Jennifer Domantay are entitled to recover exemplary damages in
view of the presence of the aggravating circumstance of abuse of superior strength. Art.
2230 of the Civil Code provides for the payment of exemplary damages when the crime is
committed with one or more aggravating circumstance. An amount of P25,000.00 is deemed
appropriate. 74
In accordance with our rulings in People v. Robles 75 and People v. Mengote, 76 the indemnity
should be fixed at P50,000.00 and the moral damages at P50,000.00. 77
WHEREFORE, the judgment of the trial court is SET ASIDE and another one is rendered
FINDING accused-appellant guilty of homicide with the aggravating circumstance of abuse
of superior strength and sentencing him to a prison term of 12 years of prision mayor, as
minimum, to 20 years of reclusion temporal, as maximum, and ORDERING him to pay the
heirs of Jennifer Domantay the amounts of P50,000.00, as indemnity, P50,000.00, as moral
damages, P25,000.00, as exemplary damages, and P12,000.00, as actual damages, and
the costs.
1wphi1.nt

SO ORDERED.
Davide, Jr., C.J., Romero, Bellosillo, Melo, Puno, Vitug, Kapunan, Panganiban, Quisumbing,
Pardo, Gonzaga-Reyes and Ynares-Santiago, JJ., concur.
Purisima and Buena, JJ., no took part.

G.R. No. 159738

December 9, 2004

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. Rodolfo Pamor, a dentist, then scheduled the respondents tooth
extraction on September 27, 1997, hoping that, by that time, the inflammation would have
subsided. Upon instructions from the management, Mr. Dumagan, a company security
guard, visited the respondent in his house on September 24, 1997 and confirmed that the
latter was ill.
On September 27, 1997, Dr. Pamor rescheduled the respondents tooth extraction on
October 4, 1997 because the inflammation had not yet subsided and recommended that he
rest. Thus, the respondent was not able to report for work due to the painful and unbearable
toothache.
On October 2, 1997, the petitioner issued an Inter Office Memorandum 3 through Angelo B.
Nicolas, the manager of its Human Resources Department, terminating the services of the
respondent for having incurred more than five (5) consecutive absences without proper
notification. The petitioner considered the consecutive absences of the respondent as
abandonment of office under Section 6.1.1, Article III of the Company Rules.
On October 4, 1997, Dr. Pamor successfully extracted the respondents tooth. As soon as he
had recovered, the respondent reported for work, but was denied entry into the companys
premises. He was also informed that his employment had already been terminated. The
respondent sought help from the union which, in turn, included his grievance in the
arbitration before the National Conciliation and Mediation Board (NCMB). Pending the
resolution thereof, the respondent wrote to the petitioner asking for the reconsideration of his
dismissal,4 which was denied. Sometime thereafter, the unions complaints were dismissed
by the NCMB.

Left with no other recourse, the respondent filed, on May 18, 1999, a complaint for illegal
dismissal before the arbitration branch of the NLRC against the petitioner and/or Benito Cua,
docketed as NLRC-NCR Case No. 00-05-05691-99.5
The respondent alleged that he was dismissed from his employment without just and legal
basis. For its part, the petitioner averred that his dismissal was justified by his ten (10)
unauthorized absences. It posited that, under Article 282 of the Labor Code, an employees
gross and habitual neglect of his duties is a just cause for termination. It further alleged that
the respondents repetitive and habitual acts of being absent without notification constituted
nothing less than abandonment, which is a form of neglect of duties. 6
On October 19, 2000, the Labor Arbiter rendered a Decision dismissing the complaint. The
Labor Arbiter ruled that the respondents failure to report for work for ten (10) days without an
approved leave of absence was equivalent to gross neglect of duty, and that his claim that he
had been absent due to severe toothache leading to a tooth extraction was unsubstantiated.
The Labor Arbiter stressed that "unnotarized medical certificates were self-serving and had
no probative weight."
Aggrieved, the respondent appealed the decision to the NLRC, docketed as NLRC NCR CA
No. 027002-01. He alleged therein that
I
THE HONORABLE LABOR ARBITER COMMITTED GRAVE ABUSE OF
DISCRETION IN DISMISSING THE COMPLAINT.
II
THERE ARE SERIOUS ERRORS IN THE FINDINGS OF FACTS WHICH WOULD
CAUSE GRAVE OR IRREPARABLE DAMAGE OR INJURY TO HEREIN
COMPLAINANT.7
On November 29, 2001, the NLRC issued a Resolution reversing the decision of the Labor
Arbiter. The dispositive portion of the resolution reads:
WHEREFORE, the assailed decision dated October 19, 2000 is SET ASIDE and
REVERSED. Accordingly, the respondent-appellee is hereby ordered to immediately
reinstate complainant to his former position without loss of seniority rights and other
benefits and payment of his full backwages from the time of his actual dismissal up to
the time of his reinstatement.
All other claims are dismissed for lack of merit.8
The NLRC upheld the claim of the respondent that his successive absences due to severe
toothache was known to management. It ruled that the medical certificates issued by the
doctor and dentist who attended to the respondent substantiated the latters medical
problem. It also declared that the lack of notarization of the said certificates was not a valid
justification for their rejection as evidence. The NLRC declared that the respondents
absence for ten (10) consecutive days could not be classified as gross and habitual neglect
of duty under Article 282 of the Labor Code.
The NLRC resolved to deny the motion for reconsideration of the petitioner, per its
Resolution9 dated August 26, 2002.
The petitioner, thereafter, filed a petition for certiorari under Rule 65 of the Rules of Court
before the CA, docketed as CA-G.R. SP No. 73602. It raised the following issues:
Whether or not the public respondent gravely abused it[s] discretion, amounting to
lack or excess of jurisdiction in reversing the decision of the labor arbiter a quo and
finding that private respondent Alejandro A. Etis was illegally dismissed.

Whether or not public respondent gravely abused its discretion in reinstating private
respondent Alejandro A. Etis to his former position without loss of seniority rights and
awarding him full backwages.10
In its Decision11 dated April 10, 2003, the CA affirmed in toto the November 29, 2001
Resolution of the NLRC.
The CA agreed with the ruling of the NLRC that medical certificates need not be notarized in
order to be admitted in evidence and accorded full probative weight. It held that the medical
certificates which bore the names and licenses of the doctor and the dentist who attended to
the respondent adequately substantiated the latters illness, as well as the tooth extraction
procedure performed on him by the dentist. The CA concluded that since the respondents
absences were substantiated, the petitioners termination of his employment was without
legal and factual basis.
The CA similarly pointed out that even if the ten-day absence of the respondent was
unauthorized, the same was not equivalent to gross and habitual neglect of duty. The CA
took into consideration the respondents unblemished service, from 1993 up to the time of his
dismissal, and the latters proven dedication to his job evidenced by no less than the
following awards: Top Technician of the Year (1995), Member of the ExclusiveP40,000.00
Club, and Model Employee of the Year (1995).
The motion for reconsideration of the petitioner was denied by the appellate court. Hence,
the petition at bar.
The petitioner raises the following issues for the Courts resolution:
I
WHETHER OR NOT THE HONORABLE COURT OF APPEALS COMMITTED
REVERSIBLE ERROR IN GIVING MUCH EVIDENTIARY WEIGHT TO THE
MEDICAL CERTIFICATES SUBMITTED BY THE PRIVATE RESPONDENT.
II
WHETHER OR NOT THE HONORABLE LABOR ARBITER COMMITTED A
REVERSIBLE ERROR IN RULING THAT PRIVATE RESPONDENT WAS
ILLEGALLY DISMISSED.12
As had been enunciated in numerous cases, the issues that can be delved with in a petition
for review under Rule 45 are limited to questions of law. The Court is not tasked to calibrate
and assess the probative weight of evidence adduced by the parties during trial all over
again.13 Well-established is the principle that findings of fact of quasi-judicial bodies, like the
NLRC, are accorded with respect, even finality, if supported by substantial
evidence.14 However, if, as in this case, the findings of the Labor Arbiter clash with those of
the NLRC and CA, this Court is compelled to go over the records of the case, as well as the
submissions of the parties, and resolve the factual issues.
The petitioner avers that the respondents absences were unauthorized, and that the latter
failed to notify the petitioner in writing of such absences, the reasons therefor, and his
(respondents) whereabouts as prescribed by the company rules. The petitioner avers that its
security guard caught the respondent at home, fit to work. The petitioner further asserts that
it was justified in dismissing the respondent under Section 6.1.1, Article III of the Company
Rules which reads:
An employee who commits unauthorized absences continuously for five (5)
consecutive working days without notice shall be considered as having abandoned
his job and shall be terminated for cause with applicable laws.
The petitioner contends that the respondents dismissal was also justified under Article
282(b) of the Labor Code, which provides that an employer may dismiss an employee due to
gross and habitual neglect of his duties.

The contention of the petitioner has no merit.


The NLRC ruled that the respondent notified the petitioner of his illness through the company
nurse, and that the petitioner even dispatched a security guard to the respondents house to
ascertain the reason of his absences, thus:
The termination by respondent-appellee of complainants service despite knowledge
of complainants ailment, as shown by the telephone calls made by the latter to the
company nurse and the actual confirmation made by respondents company guard,
who personally visited complainants residence, clearly establishes the illegality of
complainants dismissal. The documentary testimonies of the nurse, Miss Rosita dela
Cruz, regarding complainants telephone calls and the confirmation made by
respondents security guard, Mr. Dumagan, are evidentiary matters which are
relevant and material and must be considered to the fullest by the Labor Arbiter a
quo. These circumstantial facts were miserably set aside by the Labor Arbiter a quo
wherein he concluded that complainant committed gross neglect of duty on alleged
continued absences is to our mind, not fully substantiated and ought not be given
credence by this Commission. Time and again, this Tribunal impresses that, in labor
proceedings, in case of doubt, the doubt must be reasonably in favor of labor. Maybe
doubts hang in this case but these doubts must be resolved in favor of labor as
mandated by law and our jurisprudence. From the facts of this case, it is only but
reasonable to conclude that complainants service was, indeed, terminated without
legal or valid cause. Where the law protects the right of employer to validly exercise
management prerogative such as to terminate the services of an employee, such
exercise must be with legal cause as enumerated in Article 282 of the Labor Code or
by authorized cause as defined in Article 283 of the Labor Code. 15
The CA affirmed the findings of facts of the NLRC.
We agree with the rulings of the NLRC and the CA. We note that the company rules do not
require that the notice of an employees absence and the reasons therefor be in writing and
for such notice to be given to any specific office and/or employee of the petitioner. Hence,
the notice may be verbal; it is enough then that an officer or employee of the petitioner,
competent and responsible enough to receive such notice for and in behalf of the petitioner,
was informed of such absence and the corresponding reason.
The evidence on record shows that the respondent informed the petitioner of his illness
through the company nurse. The security guard who was dispatched by the petitioner to
verify the information received by the company nurse, confirmed the respondents illness.
We find and so hold that the respondent complied with the requisite of giving notice of his
illness and the reason for his absences to the petitioner.
We reject the petitioners contention that the medical certificates adduced in evidence by the
respondent to prove (a) his illness, the nature and the duration of the procedures performed
by the dentist on him; and (b) the period during which he was incapacitated to work are
inadmissible in evidence and barren of probative weight simply because they were not
notarized, and the medical certificate dated September 23, 1997 was not written on paper
bearing the dentists letterhead. Neither do we agree with the petitioners argument that even
assuming that the respondent was ill and had been advised by his dentist to rest, the same
does not appear on the medical certificate dated September 23, 1997; hence, it behooved
the respondent to report for work on September 23, 1997. The ruling of the Court in Maligsa
v. Atty. Cabanting16 is not applicable in this case.
It bears stressing that the petitioner made the same arguments in the NLRC and the CA, and
both tribunals ruled as follows:
First, We concur with the ratiocination of respondent NLRC when it ruled that a
medical certificate need not be notarized, to quote:
xxx. He was dismissed by reason of the fact that the Medical Certificate
submitted by the complainant should not be given credence for not being

notarized and that no affidavit was submitted by the nurse to prove that the
complainant, indeed, called the respondents office by telephone.
After full scrutiny and judicious evaluation of the records of this case, We find
the appeal to be meritorious. Regrettably, the Labor Arbiter a quo clearly
failed to appreciate complainants pieces of evidence. Nowhere in our
jurisprudence requires that all medical certificates be notarized to be
accepted as a valid evidence. In this case, there is [neither] difficulty nor an
obstacle to claim that the medical certificates presented by complainant are
genuine and authentic. Indeed, the physician and the dentist who examined
the complainant, aside from their respective letterheads, had written their
respective license numbers below their names and signatures. These facts
have not been impugned nor rebutted by respondent-appellee throughout the
proceedings of his case. Common sense dictates that an ordinary worker
does not need to have these medical certificates to be notarized for proper
presentation to his company to prove his ailment; hence, the Labor Arbiter a
quo, in cognizance with the liberality and the appreciation on the rules on
evidence, must not negate the acceptance of these medical certificates as
valid pieces of evidence.
We believe, as we ought to hold, that the medical certificates can prove
clearly and convincingly the complainants allegation that he consulted a
physician because of tooth inflammation on September 23, 1997 and a
dentist who later advised him to rest and, thus, clinically extended his tooth
extraction due to severe pain and inflammation. Admittingly, it was only on
October 4, 1997 that complainants tooth was finally extracted.

From these disquisitions, it is clear that the absences of private respondent are
justifiable.17
We agree with the NLRC and the appellate court. In light of the findings of facts of the NLRC
and the CA, the petitioner cannot find solace in the ruling of this Court in Maligsa v. Atty.
Cabantnig.18
While the records do not reveal that the respondent filed the required leave of absence for
the period during which he suffered from a toothache, he immediately reported for work upon
recovery, armed with medical certificates to attest to the cause of his absence. The
respondent could not have anticipated the cause of his illness, thus, to require prior approval
would be unreasonable.19 While it is true that the petitioner had objected to the veracity of the
medical certificates because of lack of notarization, it has been said that verification of
documents is not necessary in order that the said documents could be considered as
substantial evidence.20 The medical certificates were properly signed by the physicians;
hence, they bear all the earmarks of regularity in their issuance and are entitled to full
probative weight.21
The petitioner, likewise, failed to prove the factual basis for its dismissal of the respondent on
the ground of gross and habitual negligence under Article 282(b) of the Labor Code of the
Philippines, or even under Section 6.1.1, Rule III of the Company Rules.
Dismissal is the ultimate penalty that can be meted to an employee. Thus, it must be based
on just cause and must be supported by clear and convincing evidence. 22 To effect a valid
dismissal, the law requires not only that there be just and valid cause for termination; it,
likewise, enjoins the employer to afford the employee the opportunity to be heard and to
defend himself.23 Article 282 of the Labor Code enumerates the just causes for the
termination of employment by the employer:
ART. 282. TERMINATION BY EMPLOYER
An employer may terminate an employment for any of the following causes:

(a) Serious misconduct or willful disobedience by the employee of the lawful orders
of his employer or representative in connection with his work;
(b) Gross and habitual neglect by the employee of his duties.
To warrant removal from service, the negligence should not merely be gross but also
habitual. Gross negligence implies a want or absence of or failure to exercise slight care or
diligence, or the entire absence of care. It evinces a thoughtless disregard of consequences
without exerting any effort to avoid them.24 The petitioner has not sufficiently shown that the
respondent had willfully disobeyed the company rules and regulation. The petitioner also
failed to prove that the respondent abandoned his job. The bare fact that the respondent
incurred excusable and unavoidable absences does not amount to an abandonment of his
employment.
The petitioners claim of gross and habitual neglect of duty pales in comparison to the
respondents unblemished record. The respondent did not incur any intermittent absences.
His only recorded absence was the consecutive ten-day unauthorized absence, albeit due to
painful and unbearable toothache. The petitioners claim that the respondent had manifested
poor work attitude was belied by its own recognition of the respondents dedication to his job
as evidenced by the latters awards: Top Technician of the Year (1995), Member of the
ExclusiveP40,000.00 Club, and Model Employee of the Year (1995).
IN LIGHT OF ALL THE FOREGOING, the petition is DENIED DUE COURSE. The Decision
of the Court of Appeals in CA-G.R. SP No. 73602 is AFFIRMED.
SO ORDERED

G.R. No. 200792

November 14, 2012

PEOPLE OF THE PHILIPPINES, Plaintiff-Appellee,


vs.
NEIL B. COLORADO, Accused-Appellant.
DECISION
REYES, J.:
For the Court's review is the Decision1 dated August 19,2011 of the Court of Appeals (CA) in
CA-G.R. CR-HC No. 03767, which affirmed with modification the Decision2 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,3 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.4
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.5 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
committed the dastardly act against AAA. She was twelve (12) years old at that time, while
Colorado was already twenty-four (24) years old. He approached AAA, held her two hands,
even threatened her with a knife and covered her mouth with a handkerchief. He then
removed AAAs shorts and panty, inserted his penis into the young girls vagina, then made a
push and pull movement. AAA tried to resist her brothers sexual aggression, but miserably
failed despite her efforts because of her brothers greater strength. Colorado later left AAA,
who put back her shorts and underwear, but remained awake because of fear and trauma
with what she had gone through.
On that same night, Colorado raped AAA twice more, unmindful of the presence of their two
other brothers who were then sleeping inside the room where Colorado ravished AAA. In
both instances, Colorado still threatened AAA with a knife, removed her shorts and panty,
inserted his penis into his sisters vagina, then performed the push and pull movement.
Colorado warned AAA that he would stab her should she report to anyone what he had done.
AAA then did not dare reveal these incidents to anybody, until she had the courage to report
them to their mother.
Also in her testimony before the trial court, AAA disclosed that she had been raped by
Colorado when she was just nine (9) years old. She also revealed having been ravished on
different dates by another brother, DDD, and a brother-in-law.

A Medico-Legal Certificate6 prepared by Dr. Ma. Teresa Sanchez (Dr. Sanchez), Medical
Officer III of the Western Pangasinan District Hospital who examined AAA on January 10,
2003, contained the following findings:
=INTERNAL EXAM FINDINGS:
-Nonparous Introitus-Hymenal laceration at 6 oclock position with bleeding-Vagina admits 2 fingers with slight resistance-Uterus small-(+) bleedingx x x x7
Colorado testified for his defense. He denied having raped AAA, arguing that he was not
living with AAA in their parents house in December 2002. Allegedly, he was at that time
staying with an older sister in Osmea, Dasol. Colorado claimed that on the night of the
alleged incident, he was fishing with his brother-in-law, and that they returned to Osmea,
Dasol in the morning of the following day.
The Ruling of the RTC
On June 19, 2008, the RTC rendered its decision finding Colorado guilty beyond reasonable
doubt of the crime of qualified rape, and sentencing him to suffer the penalty of reclusion
perpetua. He was also ordered to pay AAA the amount of P50,000.00 as moral damages and
P75,000.00 as civil indemnity. The dispositive portion of its decision reads:
WHEREFORE, in view of the foregoing, this Court finds accused NEIL B. COLORADO,
GUILTY beyond reasonable doubt of the crime of rape. In view of the enactment of Republic
Act [No.] 9346 prohibiting the imposition of death penalty this Court sentences the accused
to suffer the penalty of RECLUSION PERPETUA.
Further, accused shall indemnify [AAA] the amount of Php 50,000.00 as moral damages and
Php 75,000.00 as civil indemnity. (People vs. Ambray, 303 SCRA 709).
SO ORDERED.8
Feeling aggrieved, Colorado appealed from the RTCs decision to the CA, reiterating in his
appeal the defenses of denial and alibi. He further sought his acquittal by arguing that the
hymenal lacerations discovered by AAAs examining doctor, and considered by the trial court
in determining his culpability, could have been caused not by him, but by the sexual
aggressions committed by their brother DDD or their brother-in-law unto AAA.
The Ruling of the CA
The CA affirmed Colorados conviction, but modified his civil liability. The decretal portion of
its Decision dated August 19, 2011 reads:
WHEREFORE, the appealed Decision of the Regional Trial Court of Burgos, Pangasinan
(Branch 70), dated 19 June 2008, is AFFIRMED with the MODIFICATION that, in addition to
the civil indemnity of Seventy-Five Thousand Pesos (P75,000.00), appellant is ordered to
pay the victim moral damages of Seventy-Five Thousand Pesos (P75,000.00) instead of Fifty
Thousand Pesos (P50,000.00), and to pay exemplary damages of Thirty Thousand Pesos
(P30,000.00).

SO ORDERED.9
Hence, this appeal. Both Colorado and the Office of the Solicitor General, as counsel for
plaintiff-appellee People of the Philippines, dispensed with the filing with the Court of
supplemental briefs, and adopted instead their respective briefs with the CA.
This Courts Ruling
The appeal lacks merit.
Colorado was charged with the crime of rape, qualified by the victims minority and her
relationship to her ravisher, as defined and penalized under Article 266-A, in relation to
Article 266-B, of the Revised Penal Code (RPC), as follows:
Art. 266-A. Rape; When and How Committed. Rape is committed:
1) By a man who shall have carnal knowledge of a woman under any of the following
circumstances:
a. Through force, threat or intimidation;
b. When the offended party is deprived of reason or otherwise unconscious;
c. By means of fraudulent machination or grave abuse of authority; and
d. When the offended party is under twelve (12) years of age or is demented, even
though none of the circumstances mentioned above be present.
xxxx
Art. 266-B. Penalties. x x x.
xxxx
The death penalty shall also be imposed if the crime of rape is committed with any of the
following aggravating/qualifying circumstances:
1) When the victim is under eighteen (18) years of age and the offender is a parent,
ascendant, stepparent, guardian, relative by consanguinity or affinity within the third civil
degree, or the common-law spouse of the parent of the victim;
xxxx
Both the RTC and the CA correctly ruled on the concurrence of the following elements of
qualified rape, as defined in the aforequoted provisions of the RPC: (1) that the victim is a
female over 12 years but under 18 years of age; (2) that the offender is a parent, ascendant,
stepparent, guardian or relative by consanguinity or affinity within the third civil degree, or the
common-law spouse of the parent of the victim; and (3) that the offender has carnal
knowledge of the victim either through force, threat or intimidation; or when she is deprived
of reason or is otherwise unconscious; or by means of fraudulent machinations or grave
abuse of authority.10
The age of the victim at the time of the crimes commission is undisputed. During the pretrial, the parties agreed on the existence of AAAs Certificate of Live Birth, 11 a "certified
true/xerox copy" of which forms part of the records and provides that AAA was born on
October 10, 1990. AAA was then only 12 years old in December 2002, a significant fact that
was sufficiently alleged in the Information. In People v. Pruna, 12 we held that the best

evidence to prove the age of the offended party is an original or certified true copy of the
certificate of live birth of such party.
As to the second element, there is no dispute that Colorado is a full-blood brother of AAA, as
this was also among the parties stipulated facts during the cases pre-trial.
The grounds now being raised by Colorado to justify his exoneration delve mainly on the
alleged absence of the crimes third element. He denies AAAs claim that he had ravished
her, raising the defense of alibi and the alleged doubt and suspicion that should be ascribed
to AAAs accusations. On this matter, settled is the rule that the findings of the trial court on
the credibility of a witness deserve great weight, given the clear advantage of a trial judge in
the appreciation of testimonial evidence. We have repeatedly recognized that the trial court
is in the best position to assess the credibility of witnesses and their testimonies, because of
its unique opportunity to observe the witnesses first hand and to note their demeanor,
conduct, and attitude under grueling examination. These are significant factors in evaluating
the sincerity of witnesses, in the process of unearthing the truth. The rule finds even more
stringent application where the said findings are sustained by the CA. Thus, except for
compelling reasons, we are doctrinally bound by the trial courts assessment of the credibility
of witnesses.13
We then take due consideration of the trial courts findings of fact, its assessment of AAAs
credibility, her testimony and the manner by which her statements were relayed, as
discussed in the RTCs Decision convicting Colorado and which reads in part:
AAA testified directly and categorically how she was raped by the accused Neil Colorado
who is her full-blood brother sometime in the night of December 2002.
That while AAA was sleeping with her older brother BBB and her younger brother CCC,
accused went near her and held her two (2) hands, covered her mouth with handkerchief.
Thereafter, accused removed her short pants and underwear, and inserted his penis into her
vagina. After removing his penis, accused went back to sleep.
AAA however could no longer sleep because she was already afraid that the accused will
return which the accused did. For the second time, accused raped AAA. Accused covered
her mouth with a handkerchief, inserted his penis into her vagina and accused did the push
and pull movement.
xxxx
When AAA declares that she has been raped, she says in effect all that would be necessary
to show that rape did take place (PP. vs. Maglantay, 304 SCRA 272), for as long as the
testimony of AAA is free from serious or major incongruence and unbridled by suspicion or
doubt. The testimony of AAA is simple, candid, straightforward and consistent on material
points detailing every single bestial act of her brother in ravishing her. Moreover, AAA on
several occasions (August 1, 2006 and September 19, 2006) was on the verge of crying and
in fact shed tears during her direct examination. Crying of the victim during her testimony is
evidence of the credibility of the rape charge with the verity born out of human nature and
experience (PP. vs. Agustin, 365 SCRA 167; PP vs. Garcia, supra). Though a medical
certificate is not necessary to prove the commission of rape (PP. vs. Bares, 355 SCRA 435),
but when the victims testimony is corroborated by the physicians findings of penetration
(Exh. "A") or hymenal laceration as when the hymen is no longer intact, there is sufficient
foundation to find the existence of the essential requisite of carnal knowledge (PP. vs.
Montejo, 355 SCRA 210; PP. vs. Bation, 305 SCRA 253). Further, no young and decent
woman in her right mind especially of tender age as that of AAA who is fifteen (15) years old
would concoct a story of defloration, allow an examination of her private parts and thereafter
pervert herself by being subjected to a public trial, if she was not motivated solely by her
desire to obtain justice for the wrong committed against her. (PP. vs. Albior, 352 SCRA 35;
PP. vs. Vidal, 353 SCRA 194)14 (Emphasis ours)

These observations were affirmed by the CA on appeal, as it held:


A conscientious review of the records shows that AAAs testimonies in this case bear the
marks of truthfulness, spontaneity and sincerity. She was crying while answering questions
about the rape incident. Obviously, the process called to her mind not only the mere details
of the sexual abuse but the lingering hurt and pain that come with it. Her tears were
unimpeachable testaments to the truth of her allegations.
xxxx
During cross-examination, AAA remained steadfast, unwavering and spontaneous.
Significantly also, her testimony is supported by the medical evidence on record, which
showed that she had a laceration in her hymen and was thus in a non-virgin
state.15 (Citations omitted and emphasis ours)
The Court finds no cogent reasons to overturn these findings. Indeed, it was established that
Colorado succeeded in having carnal knowledge of the victim, employing force, threat and
intimidation that allowed him to consummate his bestial act. AAA had positively identified
Colorado as her rapist. Such identification of Colorado could not have been difficult for AAA
considering that Colorado was a brother who lived with her in their parents house. Even the
failure of AAA to identify the exact date of the crimes commission is inconsequential to
Colorados conviction. In rape cases, the date of commission is not an essential element of
the offense; what is material is its occurrence,16 a fact that was sufficiently established given
AAAs and her testimonys credibility.
Contrary to Colorados contention, AAAs claim that two other siblings were sleeping in the
same room where she was raped did not render her statements incredible. Time and again,
we have taken into consideration how rapists are not deterred by the presence of people
nearby, such as the members of their own family inside the same room, with the likelihood of
being discovered, since lust respects no time, locale or circumstance. 17
As against AAAs credible testimony, Colorados defenses lack persuasion. While Colorado
denied in his testimony that he lived with AAA, such fact was already admitted by the parties
during the pre-trial. His defense that he was in Osmea, Dasol at the time of the crimes
commission was even uncorroborated by any other witness. By jurisprudence, denial is an
intrinsically weak defense which must be buttressed by strong evidence of non-culpability to
merit credibility. Mere denial, without any strong evidence to support it, can scarcely
overcome the positive declaration by the child-victim of the identity of the appellant and his
involvement in the crime attributed to him.18 Moreover, for the defense of alibi to prosper, two
requisites must concur: first, the appellant was at a different place at the time the crime was
committed; and second, it was physically impossible for him to be at the crime scene at the
time of its commission.19 The defense failed to establish these requisites. On the contrary,
Colorado testified that from Osmea, where he claimed to have lived with an older sister, he
could normally reach his parents house by a three-hour walk. There were also other means
of transportation in these two places,20 which then could have allowed Colorado to travel the
distance over a shorter period of time.
1wphi1

Colorado also questions the weight of Dr. Sanchezs medico-legal certificate, arguing that
AAAs hymenal lacerations could have resulted from the sexual aggressions allegedly
committed against her by DDD and their brother-in-law. Such contention, however, deserves
no consideration, given that results of an offended partys medical examination are merely
corroborative in character. As explained by the Court in People v. Balonzo, 21 a medical
certificate is not necessary to prove the commission of rape, as even a medical examination
of the victim is not indispensable in a prosecution for rape. Expert testimony is merely
corroborative in character and not essential to conviction. An accused can still be convicted
of rape on the basis of the sole testimony of the private complainant.22 Furthermore,
laceration of the hymen, even if considered the most telling and irrefutable physical evidence
of sexual assault, is not always essential to establish the consummation of the crime of rape.
In the context that is used in the RPC, "carnal knowledge," unlike its ordinary connotation of

sexual intercourse, does not necessarily require that the vagina be penetrated or that the
hymen be ruptured.23 Thus, even granting that AAAs lacerations were not caused by
Colorado, the latter could still be declared guilty of rape, after it was established that he
succeeded in having carnal knowledge of the victim.
Given the foregoing, the CA did not err in affirming the trial court's conviction of Colorado.
The crime is qualified by the victim's minority and her relationship to Colorado, yet the
appellate court correctly explained that the imposable penalty is reclusion pe1petua, in lieu
of death, taking into account the provisions of Republic Act (R.A.) No. 9346 that prohibit the
imposition of death penalty in criminal cases. We however clarify that Colorado shall be
ineligible for parole, a requirement under Section 3 of R.A. No. 9346 that was not mentioned
in the assailed CA decision and which, must then be rectified by this Decision. 24 The civil
indemnity, moral damages and exemplary damages, as modified and awarded by the CA,
conform to prevailing jurisprudence.
WHEREFORE, in view of the foregoing, the Decision dated August 19, 2011 of the Com1 of
Appeals in CA-G.R. CR-HC No. 03767 is AFFIRMED with MODIFICATION in that accusedappellant Neil B. Colorado is sentenced to suffer the penalty of reclusion pe1petua, without
eligibility for parole. The accused is likewise ordered to pay legal interest on all damages
awarded at the legal rate of 6% from the date of finality of this Decision until fully satisfied.
SO ORDERED.

SECOND DIVISION
RICO ROMMEL ATIENZA,
Petitioner,

G.R. No. 177407


Present:
NACHURA,
Acting Chairperson,
PERALTA,
DEL CASTILLO,*
VILLARAMA, JR.,** and
MENDOZA, JJ.

- versus -

Promulgated:
BOARD OF MEDICINE and EDITHA
SIOSON,
Respondents.

February 9, 2011

x------------------------------------------------------------------------------------x
DECISION
NACHURA, J.:
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.

Due to her lumbar pains, private respondent Editha Sioson went to


Rizal Medical Center (RMC) for check-up on February 4, 1995.
Sometime in 1999, due to the same problem, she was referred to
Dr. Pedro Lantin III of RMC who, accordingly, ordered several
diagnostic laboratory tests. The tests revealed that her right kidney
is normal. It was ascertained, however, that her left kidney is nonfunctioning and non-visualizing. Thus, she underwent kidney
operation in September, 1999.
On February 18, 2000, private respondents husband, Romeo
Sioson (as complainant), filed a complaint for gross negligence

and/or incompetence before the [BOM] against the doctors who


allegedly participated in the fateful kidney operation, namely: Dr.
Judd dela Vega, Dr. Pedro Lantin, III, Dr. Gerardo Antonio
Florendo and petitioner Rico Rommel Atienza.
It was alleged in the complaint that the gross negligence and/or
incompetence committed by the said doctors, including petitioner,
consists of the removal of private respondents fully functional
right kidney, instead of the left non-functioning and nonvisualizing kidney.
The complaint was heard by the [BOM]. After complainant
Romeo Sioson presented his evidence, private respondent Editha
Sioson, also named as complainant there, filed her formal offer of
documentary evidence. Attached to the formal offer of
documentary evidence are her Exhibits A to D, which she offered
for the purpose of proving that her kidneys were both in their
proper anatomical locations at the time she was operated. She
described her exhibits, as follows:
EXHIBIT A the certified photocopy of the X-ray
Request form dated December 12, 1996, which is
also marked as Annex 2 as it was actually originally
the Annex to x x x Dr. Pedro Lantin, IIIs counter
affidavit filed with the City Prosecutor of Pasig City
in connection with the criminal complaint filed by
[Romeo Sioson] with the said office, on which are
handwritten entries which are the interpretation of
the results of the ultrasound examination.
Incidentally, this exhibit happens to be the same as
or identical to the certified photocopy of the
document marked as Annex 2 to the CounterAffidavit dated March 15, 2000, filed by x x x Dr.
Pedro Lantin, III, on May 4, 2000, with this
Honorable Board in answer to this complaint;
EXHIBIT B the certified photo copy of the X-ray
request form dated January 30, 1997, which is also
marked as Annex 3 as it was actually likewise
originally an Annex to x x x Dr. Pedro Lantin, IIIs
counter-affidavit filed with the Office of the City
Prosecutor of Pasig City in connection with the
criminal complaint filed by the herein complainant
with the said office, on which are handwritten entries
which are the interpretation of the results of the
examination. Incidentally, this exhibit happens to be
also the same as or identical to the certified photo
copy of the document marked as Annex 3 which is
likewise dated January 30, 1997, which is appended
as such Annex 3 to the counter-affidavit dated March

15, 2000, filed by x x x Dr. Pedro Lantin, III on May


4, 2000, with this Honorable Board in answer to this
complaint.
EXHIBIT C the certified photocopy of the X-ray
request form dated March 16, 1996, which is also
marked as Annex 4, on which are handwritten entries
which are the interpretation of the results of the
examination.
EXHIBIT D the certified photocopy of the X-ray
request form dated May 20, 1999, which is also
marked as Annex 16, on which are handwritten
entries which are the interpretation of the results of
the examination. Incidentally, this exhibit appears to
be the draft of the typewritten final report of the
same examination which is the document appended
as Annexes 4 and 1 respectively to the counteraffidavits filed by x x x Dr. Judd dela Vega and Dr.
Pedro Lantin, III in answer to the complaint. In the
case of Dr. dela Vega however, the document which
is marked as Annex 4 is not a certified photocopy,
while in the case of Dr. Lantin, the document marked
as Annex 1 is a certified photocopy. Both documents
are of the same date and typewritten contents are the
same as that which are written on Exhibit D.
Petitioner filed his comments/objections to private respondents
[Editha Siosons] formal offer of exhibits. He alleged that said
exhibits are inadmissible because the same are mere photocopies,
not properly identified and authenticated, and intended to
establish matters which are hearsay. He added that the exhibits are
incompetent to prove the purpose for which they are offered.
Dispositions of the Board of
Medicine
The formal offer of documentary exhibits of private respondent
[Editha Sioson] was admitted by the [BOM] per its Order dated
May 26, 2004. It reads:
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 certiorari with 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:
WHETHER THE COURT OF APPEALS COMMITTED GRAVE
REVERSIBLE ERROR AND DECIDED A QUESTION
OF SUBSTANCE IN A WAY NOT IN ACCORDANCE
WITH LAW AND THE APPLICABLE DECISIONS OF
THE HONORABLE COURT WHEN IT UPHELD THE
ADMISSION
OF
INCOMPETENT
AND
INADMISSIBLE EVIDENCE BY RESPONDENT
BOARD, WHICH CAN RESULT IN THE DEPRIVATION
OF PROFESSIONAL LICENSE A PROPERTY RIGHT
OR ONES LIVELIHOOD.[4]

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:
[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


Appeals[9] teaches:

and

Transport

Corporation

v. Court

of

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:

Section 20. Administrative investigation shall be conducted in


accordance with these Rules. The Rules of Court shall only apply in these
proceedings by analogy or on a suppletory character and whenever
practicable and convenient. Technical errors in the admission of evidence
which do not prejudice the substantive rights of either party shall not
vitiate the proceedings.[10]

As pointed out by the appellate court, the admission of the exhibits did not
prejudice the substantive rights of petitioner because, at any rate, the fact
sought to be proved thereby, that the two kidneys of Editha were in their
proper anatomical locations at the time she was operated on, is presumed
under Section 3, Rule 131 of the Rules of Court:
Sec. 3. Disputable presumptions. The following presumptions are
satisfactory if uncontradicted, but may be contradicted and
overcome by other evidence:
xxxx
(y) That things have happened according to the ordinary course of
nature and the ordinary habits of life.

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 and need not be proved, such as
those covered by judicial notice, both mandatory and discretionary.[13] Laws
of nature involving the physical sciences, specifically biology,[14] include the

structural make-up and composition of living things such as human beings.


In this case, we may take judicial notice that Edithas kidneys before, and at
the time of, her operation, as with most human beings, were in their proper
anatomical locations.
Third, contrary to the assertion of petitioner, the best evidence rule is
inapplicable. Section 3 of Rule 130 provides:
1. Best Evidence Rule
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.
Finally, these exhibits do not constitute hearsay evidence of the
anatomical locations of Edithas kidneys. To further drive home the point, the
anatomical positions, whether left or right, of Edithas kidneys, and the
removal of one or both, may still be established through a belated ultrasound
or x-ray of her abdominal area.
In fact, the introduction of secondary evidence, such as copies of the
exhibits, is allowed.[15] Witness Dr. Nancy Aquino testified that the Records
Office of RMC no longer had the originals of the exhibits because [it]

transferred from the previous building, x x x to the new building.


[16]
Ultimately, since the originals cannot be produced, the BOM properly
admitted Edithas formal offer of evidence and, thereafter, the BOM shall
determine the probative value thereof when it decides the case.
WHEREFORE, the petition is DENIED. The Decision of the Court
of Appeals in CA-G.R. SP No. 87755 is AFFIRMED. Costs against
petitioner.
SO ORDERED.

G.R. Nos. 96027-28

March 08, 2005

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.:
Before us is a Motion To Re-Open Case With Leave Of Court filed by petitioners who were
convicted and sentenced to reclusion perpetua by the Sandiganbayan in Criminal Cases
Nos. 10010 and 10011 for the double murder of Senator Benigno Aquino, Jr. and Rolando
Galman on August 21, 1983.1
Petitioners were members of the military who acted as Senator Aquinos security detail upon
his arrival in Manila from his three-year sojourn in the United States. They were charged,
together with several other members of the military, before the Sandiganbayan for the killing
of Senator Aquino who was fatally shot as he was coming down from the aircraft of China
Airlines at the Manila International Airport. Petitioners were also indicted for the killing of
Rolando Galman who was also gunned down at the airport tarmac.
On December 2, 1985, the Sandiganbayan rendered a Decision in Criminal Cases Nos.
10010-10011 acquitting all the accused, which include the petitioners. However, the
proceedings before the Sandiganbayan were later found by this Court to be a sham trial. The
Court thus nullified said proceedings, as well as the judgment of acquittal, and ordered a retrial of the cases.2
A re-trial ensued before the Sandiganbayan.
In its decision dated September 28, 1990, the Sandiganbayan, while acquitting the other
accused, found the petitioners guilty as principals of the crime of murder in both Criminal
Cases Nos. 10010 and 10011. It sentenced them to reclusion perpetua in each case.3 The
judgment became final after this Court denied petitioners petition for review of the
Sandiganbayan decision for failure to show reversible error in the questioned decision, 4 as
well as their subsequent motion for reconsideration. 5
In August 2004, petitioners sought legal assistance from the Chief Public Attorney who, in
turn, requested the Independent Forensic Group of the University of the Philippines to make
a thorough review of the forensic evidence in the double murder case. The petitioners,
assisted by the Public Attorneys Office, now want to present the findings of the forensic
group to this Court and ask the Court to allow the re-opening of the cases and the holding of
a third trial to determine the circumstances surrounding the death of Senator Benigno
Aquino, Jr. and Rolando Galman.
Petitioners invoke the following grounds for the re-opening of the case:
I
Existence of newly discovered pieces of evidence that were not available during the
second trial of the above-entitled cases which could have altered the judgment of the
Sandiganbayan, specifically:

A) Independent forensic evidence uncovering the false forensic claims that


led to the unjust conviction of the petitioners-movants.
B) A key defense eyewitness to the actual killing of Senator Benigno Aquino,
Jr.
II
There was a grave violation of due process by reason of:
A) Insufficient legal assistance of counsel;
B) Deprivation of right to counsel of choice;
C) Testimonies of defense witnesses were under duress;
D) Willful suppression of evidence;
E) Use of false forensic evidence that led to the unjust conviction of the
petitioners-movants.
III
There was serious misapprehension of facts on the part of the Sandiganbayan based
on false forensic evidence, which entitles petitioners-movants to a re-trial. 6
Petitioners seek to present as new evidence the findings of the forensic group composed of
Prof. Jerome B. Bailen, a forensic anthropologist from the University of the Philippines, Atty.
Erwin P. Erfe, M.D., a medico-legal practitioner, Benito E. Molino, M.D., a forensic consultant
and Human Rights and Peace Advocate, and Anastacio N. Rosete, Jr., D.M.D., a forensic
dentistry consultant. Their report essentially concludes that it was not possible, based on the
forensic study of the evidence in the double murder case, that C1C Rogelio Moreno fired at
Senator Aquino as they descended the service stairway from the aircraft. They posit that
Senator Aquino was shot while he was walking on the airport tarmac toward the waiting
AVSECOM van which was supposed to transport him from the airport to Fort Bonifacio. This
is contrary to the finding of the Sandiganbayan in the second trial that it was C1C Moreno,
the security escort positioned behind Senator Aquino, who shot the latter. The report also
suggests that the physical evidence in these cases may have been misinterpreted and
manipulated to mislead the court. Thus, petitioners assert that the September 28, 1990
decision of the Sandiganbayan should be voided as it was based on false forensic evidence.
Petitioners submit that the review by the forensic group of the physical evidence in the
double murder case constitutes newly discovered evidence which would entitle them to a
new trial under Rule 121 of the 2000 Rules of Criminal Procedure. In addition to the report of
the forensic group, petitioners seek to present the testimony of an alleged eyewitness, the
driver of the waiting AVSECOM van, SPO4 Ruben M. Cantimbuhan. In his affidavit submitted
to this Court, SPO4 Cantimbuhan states that he saw a man in blue uniform similar to that of
the Philippine Airlines maintenance crew, suddenly fire at Senator Aquino as the latter was
about to board the van. The man in blue was later identified as Rolando Galman.
Petitioners pray that the Court issue a resolution:
1. [a]nnulling and setting aside this Honorable Courts Resolutions dated July 23,
1991 and September 10, 1991;
2. [a]nnulling and setting aside the Decision of the Sandiganbayan (3rd Division)
dated September 28, 1990 in People vs. Custodio, et al., Case No. 10010-10011[;]
3. [o]rdering the re-opening of this case; [and]

4. [o]rdering the Sandiganbayan to allow the reception of additional defense


evidence/re-trial in the above entitled cases.7
The issue now is whether petitioners are entitled to a third trial under Rule 121 of the 2000
Rules of Criminal Procedure.
The pertinent sections of Rule 121 of the 2000 Rules of Criminal Procedure provide:
Section 1. New Trial or reconsideration. At any time before a judgment of
conviction becomes final, the court may, on motion of the accused or at its own
instance but with the consent of the accused, grant a new trial or reconsideration.
Sec. 2. Grounds for a new trial. The court shall grant a new trial on any of the
following grounds:
(a) That errors of law or irregularities prejudicial to the substantial rights of the
accused have been committed during the trial;
(b) That new and material evidence has been discovered which the
accused could not with reasonable diligence have discovered and
produced at the trial and which if introduced and admitted would
probably change the judgment.
xxx
Sec. 6. Effects of granting a new trial or reconsideration. The effects of
granting a new trial or reconsideration are the following:
(a) When a new trial is granted on the ground of errors of law or irregularities
committed during the trial, all the proceedings and evidence affected thereby
shall be set aside and taken anew. The court may, in the interest of justice,
allow the introduction of additional evidence.
(b) When a new trial is granted on the ground of newly discovered evidence,
the evidence already adduced shall stand and the newly-discovered and
such other evidence as the court may, in the interest of justice, allow to be
introduced shall be taken and considered together with the evidence already
in the record.
(c) In all cases, when the court grants new trial or reconsideration, the
original judgment shall be set aside or vacated and a new judgment rendered
accordingly. (emphasis supplied)
In line with the objective of the Rules of Court to set guidelines in the dispensation of justice,
but without shackling the hands that dispense it, the remedy of new trial has been described
as "a new invention to temper the severity of a judgment or prevent the failure of
justice."8 Thus, the Rules allow the courts to grant a new trial when there are errors of law or
irregularities prejudicial to the substantial rights of the accused committed during the trial, or
when there exists newly discovered evidence. In the proceedings for new trial, the errors of
law or irregularities are expunged from the record or new evidence is introduced. Thereafter,
the original judgment is vacated and a new one is rendered. 9
Under the Rules, a person convicted of a crime may avail of the remedy of new trial before
the judgment of conviction becomes final. Petitioners admit that the decision of the
Sandiganbayan in Criminal Cases Nos. 10010 and 10011 became final and executory upon
denial of their petition for review filed before this Court and their motion for reconsideration.
Entry of judgment has in fact been made on September 30, 1991.10 Nonetheless, they
maintain that equitable considerations exist in this case to justify the relaxation of the Rules

and re-open the case to accord petitioners the opportunity to present evidence that will
exonerate them from the charges against them. We do not find merit in their submission.
Petitioners anchor their motion on the ground of newly discovered evidence. Courts are
generally reluctant in granting motions for new trial on the ground of newly discovered
evidence for it is presumed that the moving party has had ample opportunity to prepare his
case carefully and to secure all the necessary evidence before the trial. Such motions
are treated with great caution due to the danger of perjury and the manifest injustice of
allowing a party to allege that which may be the consequence of his own neglect to defeat an
adverse judgment. Hence, the moving party is often required to rebut a presumption that the
judgment is correct and that there has been a lack of due diligence, and to establish other
facts essential to warrant the granting of a new trial on the ground of newly discovered
evidence.11 This Court has repeatedly held that before a new trial may be granted on the
ground of newly discovered evidence, it must be shown (1) that the evidence was
discovered after trial; (2) that such evidence could not have been discovered and produced
at the trial even with the exercise of reasonable diligence; (3) that it is material, not merely
cumulative, corroborative, or impeaching; and (4) the evidence is of such weight that it would
probably change the judgment if admitted. If the alleged newly discovered evidence could
have been very well presented during the trial with the exercise of reasonable diligence, the
same cannot be considered newly discovered.12
These standards, also known as the "Berry" rule, trace their origin to the 1851 case
of Berry vs. State of Georgia13 where the Supreme Court of Georgia held:
Applications for new trial on account of newly discovered evidence, are not favored
by the Courts. x x x Upon the following points there seems to be a pretty general
concurrence of authority, viz; that it is incumbent on a party who asks for a new trial,
on the ground of newly discovered evidence, to satisfy the Court, 1 st. That the
evidence has come to his knowledge since the trial. 2d. That it was not owing to the
want of due diligence that it did not come sooner. 3d. That it is so material that it
would produce a different verdict, if the new trial were granted. 4 th. That it is not
cumulative only viz; speaking to facts, in relation to which there was evidence on
the trial. 5th. That the affidavit of the witness himself should be produced, or its
absence accounted for. And 6th, a new trial will not be granted, if the only object of the
testimony is to impeach the character or credit of a witness. (citations omitted)
These guidelines have since been followed by our courts in determining the propriety of
motions for new trial based on newly discovered evidence.
It should be emphasized that the applicant for new trial has the burden of showing that the
new evidence he seeks to present has complied with the requisites to justify the holding of a
new trial.
The threshold question in resolving a motion for new trial based on newly discovered
evidence is whether the proferred evidence is in fact a "newly discovered evidence which
could not have been discovered by due diligence." The question of whether evidence is
newly discovered has two aspects: a temporal one, i.e., when was the evidence
discovered, and a predictive one, i.e., when should or could it have been discovered. It is to
the latter that the requirement of due diligence has relevance.14 We have held that in order
that a particular piece of evidence may be properly regarded as newly discovered to justify
new trial, what is essential is not so much the time when the evidence offered first sprang
into existence nor the time when it first came to the knowledge of the party now submitting it;
what is essential is that the offering party had exercised reasonable diligence in seeking to
locate such evidence before or during trial but had nonetheless failed to secure it. 15
The Rules do not give an exact definition of due diligence, and whether the movant has
exercised due diligence depends upon the particular circumstances of each
case.16 Nonetheless, it has been observed that the phrase is often equated with "reasonable
promptness to avoid prejudice to the defendant." In other words, the concept of due diligence

has both a time component and a good faith component. The movant for a new trial must
not only act in a timely fashion in gathering evidence in support of the motion; he must act
reasonably and in good faith as well. Due diligence contemplates that the defendant acts
reasonably and in good faith to obtain the evidence, in light of the totality of the
circumstances and the facts known to him.17
Applying the foregoing tests, we find that petitioners purported evidence does not qualify as
newly discovered evidence that would justify the re-opening of the case and the holding of a
third trial.
The report of the forensic group may not be considered as newly discovered evidence as
petitioners failed to show that it was impossible for them to secure an independent forensic
study of the physical evidence during the trial of the double murder case. It appears from
their report that the forensic group used the same physical and testimonial evidence
proferred during the trial, but made their own analysis and interpretation of said
evidence. They cited the materials and methods that they used for their study, viz:
MATERIALS AND METHODS
MATERIALS:
a. Court records of the case, especially photographs of: a) the stairway where the
late Sen. Aquino and his escorts descended; b) the part of the tarmac where the
lifeless bodies of the late Sen. Aquino and Galman fell; and c) the autopsy conducted
by the NBI Medico-legal team headed by Dr. Mu[]oz; and the autopsy report of the
late Sen. Benigno Aquino[,] Jr. signed by Dr. Mu[]oz and Dr. Solis;
b. The gun and live ammunitions collected at the crime scene;
c. A reference human skull photos and X-rays of the same to demonstrate wound
location and bullet trajectory;
d. The reports of interviews and statements by the convicted military escorts, and
other witnesses;
e. Re-enactment of the killing of Aquino based on the military escorts[] version, by
the military escorts themselves in the Bilibid Prison and by volunteers at the NAIA
Tarmac;
f. Various books and articles on forensic and the medico-legal field[;]
g. Results of Forensic experiments conducted in relation to the case.
METHODS:
a. Review of the forensic exhibits presented in the court;
b. Review of TSNs relevant to the forensic review;
c. Study of and research on the guns, slugs and ammunitions allegedly involved in
the crime;
d. Interviews/re-enactment of the crime based on the militarys accounts, both in the
Bilibid Prison where the convicts are confined and the MIA (now NAIA) stairway and
tarmac;
e. Conduct of ocular inspection and measurements on the actual crime scene
(stairway and tarmac) at the old Manila International Airport (now NAIA);

f. Retracing the slugs trajectory based on the autopsy reports and experts
testimonies using an actual human skull;
g. X-rays of the skull with the retraced trajectory based on the autopsy report and
experts testimonies;
h. Evaluation of the presented facts and opinions of local experts in relation to
accepted forensic findings in international publications on forensic science,
particularly on guns and [gunshot] wound injuries;
i. Forensic experiments and simulations of events in relation to this case. 18
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 portion of the mandible, was
"forward, downward and medially." (Autopsy Report No. N-83-22-36, Exhibit "NNNN2-t-2")
A controversy as to this trajectory came about when, upon being cross-examined by
counsel for the defense, Dr. Bienvenido Muoz made a significant turn-about by
stating that the correct trajectory of the fatal bullet was "upward, downward, and
medially." The present position of Dr. Muoz is premised upon the alleged fact that
he found the petrous bone fractured, obviously hit by the fatal bullet. He concluded,
in view of this finding, that the fatal bullet must have gone upward from the wound of
entrance. Since the fatal bullet exited at the mandible, it is his belief that the petrous
bone deflected the trajectory of the bullet and, thus, the bullet proceeded downwards
from the petrous bone to the mandible.
This opinion of Dr. Bienvenido Muoz in this regard notwithstanding, We hold that the
trajectory of the fatal bullet which killed Sen. Benigno Aquino, Jr. was, indeed,
"forward, downward and medially." For the reason that the wound of entrance was at
a higher elevation than the wound of exit, there can be no other conclusion but that
the trajectory was downward. The bullet when traveling at a fast rate of speed takes
a straight path from the wound of entrance to the wound of exit. It is unthinkable that
the bullet, while projected upwards, would, instead of exiting to the roof of the head,
go down to the mandible because it was allegedly deflected by a petrous bone which
though hard is in fact a mere spongy protuberance, akin to a cartilage.

Clear is proof of the downward trajectory of the fatal bullet; First, as Dr. Pedro Solis
and Dr. Ceferino Cunanan, the immediate superiors of Dr. Bienvenido Muoz,
manifested before the Court, that, since the wound of entrance appeared ovaloid and
there is what is known as a contusion collar which was widest at the superior portion,
indicating an acute angle of approach, a downward trajectory of the bullet is
indicated. This phenomenon indicates that the muzzle of the fatal gun was at a level
higher than that of the point of entry of the fatal bullet.
There was no showing as to whether a probe could have been made from the wound
of entrance to the petrous bone. Out of curiosity, Dr. Juanito Billote tried to insert a
probe from the wound of exit into the petrous bone. He was unsuccessful
notwithstanding four or five attempts. If at all, this disproves the theory of Dr. Muoz
that the trajectory was upward, downward and medially. On the other hand, Dr.
Juanito Billote and photographer Alexander Loinaz witnessed the fact that Dr.
Muoz[s] understudy, Alejandrino Javier, had successfully made a probe from the
wound of entrance directly towards the wound of exit. Alejandrino Javier shouted with
excitement upon his success and Alexander Loinaz promptly photographed this
event with Alejandrino Javier holding the protruding end of the probe at the mandible.
(Exhibit "XXXXX-39-A")
To be sure, had the main bullet hit the petrous bone, this spongy mash of cartilage
would have been decimated or obliterated. The fact that the main bullet was of such
force, power and speed that it was able to bore a hole into the mandible and crack it,
is an indication that it could not have been stopped or deflected by a mere petrous
bone. By its power and force, it must have been propelled by a powerful gun. It would
have been impossible for the main bullet to have been deflected form an upward
course by a mere spongy protuberance. Granting that it was so deflected, however, it
could not have maintained the same power and force as when it entered the skull at
the mastoid region so as to crack the mandible and make its exit there.
But what caused the fracture of the petrous bone? Was there a cause of the fracture,
other than that the bullet had hit it? Dr. Pedro Solis, maintaining the conclusion that
the trajectory of the bullet was downward, gave the following alternative explanations
for the fracture of the petrous bone:
First, the petrous bone could have been hit by a splinter of the main bullet,
particularly, that which was found at the temporal region; and,
Second, the fracture must have been caused by the kinetic force applied to the point
of entrance at the mastoid region which had the tendency of being radiated towards
the petrous bone.
Thus, the fracture in the occipital bone, of the temporal bone, and of the parietal
bone, Dr. Pedro Solis pointed out, had been caused by the aforesaid kinetic force.
When a force is applied to the mastoid region of the head, Dr. Pedro Solis
emphasized, a radiation of forces is distributed all over the cranial back, including,
although not limited to, the parietal bone. The skull, Dr. Solis explains, is a box-like
structure. The moment you apply pressure on the portion, a distortion, tension or
some other mechanical defect is caused. This radiation of forces produces what is
known as the "spider web linear fracture" which goes to different parts of the body.
The so-called fracturing of the petrous portion of the left temporal bone is one of the
consequences of the kinetic force forcefully applied to the mastoid region.
The fact that there was found a fracture of the petrous bone is not necessarily
indicative of the theory that the main bullet passed through the petrous bone.
Doubt was expressed by Dr. Pedro Solis as to whether the metal fragments alleged
by Dr. Bienvenido Muoz to have been found by him inside the skull or at the wound
of exit were really parts of the main bullet which killed the Senator. When Dr. Pedro

Solis examined these fragments, he found that two (2) of the fragments were larger
in size, and were of such shapes, that they could not have gone out of the wound of
exit considering the size and shape of the exit wound.
Finding of a downward
trajectory of the
fatal bullet fatal
to the credibility
of defense witnesses.
The finding that the fatal bullet which killed Sen. Benigno Aquino, Jr. was directed
downwards sustains the allegation of prosecution eyewitnesses to the effect that
Sen. Benigno Aquino, Jr. was shot by a military soldier at the bridge stairs while he
was being brought down from the plane. Rebecca Quijano saw that the senator was
shot by the military man who was directly behind the Senator while the Senator and
he were descending the stairs. Rebecca Quijanos testimony in this regard is echoed
by Jessie Barcelona, Ramon Balang, Olivia Antimano, and Mario Laher, whose
testimonies this Court finds likewise as credible.
The downward trajectory of the bullet having been established, it stands to reason
that the gun used in shooting the Senator was fired from an elevation higher than
that of the wound of entrance at the back of the head of the Senator. This is
consistent with the testimony of prosecution witnesses to the effect that the actual
killer of the Senator shot as he stood at the upper step of the stairs, the second or
third behind Senator Aquino, while Senator Aquino and the military soldiers bringing
him were at the bridge stairs. This is likewise consistent with the statement of Sandra
Jean Burton that the shooting of Senator Aquino occurred while the Senator was still
on the bridge stairs, a conclusion derived from the fact that the fatal shot was fired
ten (10) seconds after Senator Aquino crossed the service door and was led down
the bridge stairs.
It was the expert finding of Dr. Matsumi Suzuki that, as was gauged from the sounds
of the footsteps of Senator Aquino, as the Senator went down the bridge stairs, the
shooting of the Senator occurred while the Senator had stepped on the 11th step from
the top.
At the ocular inspection conducted by this Court, with the prosecution and the
defense in attendance, it should be noted that the following facts were established as
regards the bridge stairs:
"Observations:
The length of one block covering the tarmac 196";
The width of one block covering the tarmac 10;
The distance from the base of the staircase leading to the emergency tube to the
Ninoy marker at the tarmac 126";
There are 20 steps in the staircase including the landing;
The distance from the first rung of the stairway up to the 20th rung which is the
landing of stairs 208";
Distance from the first rung of the stairway up to the 20th rung until the edge of the
exit door 2311";
Distance from the 4th rung up to the exit door 21;

Distance from the 5th rung up to the exit door 1911";


Length of one rung including railpost 34";
Space between two rungs of stairway 9";
Width of each rung 11-1/2";
Length of each rung (end to end) 29":
Height of railpost from edge of rung to railing 25".
(underlining supplied)20
The Sandiganbayan again exhaustively analyzed and discussed the forensic evidence in its
resolution dated November 15, 1990 denying the motion for reconsideration filed by the
convicted accused. The court held:
The Autopsy Report No. N-83-2236, Exhibit "NNNN-2-t-2" indicated a downward trajectory of
the fatal bullet when it stated that the fatal bullet was "forward, downward, and medially . . ."
xxx
II
The wound of entrance having been at a higher elevation than the wound of exit,
there can be no other conclusion but that the trajectory was downward. The fatal
bullet, whether it be a Smith and Wesson Caliber .357 magnum revolver or a .45
caliber, must have traveled at a fast rate of speed and it stands to reason that it took
a straight path from the wound of entrance to the wound of exit. A hole indicating this
straight path was proven to have existed. If, as contended on cross-examination by
Dr. Bienvenido Muoz, that the bullet was projected upwards, it ought to have exited
at the roof of the head. The theory that the fatal bullet was deflected by a mere
petrous bone is inconceivable.
III
Since the wound of entrance appeared ovaloid and there is what is known as a
contusion collar which was widest at the superior portion, indicating an acute angle of
approach, a downward trajectory of the fatal bullet is conclusively indicated. This
phenomenon indicates that the muzzle of the fatal gun was at a level higher than that
of the point of entry of the fatal bullet.
IV
There was no hole from the petrous bone to the mandible where the fatal bullet had
exited and, thus, there is no support to the theory of Dr. Bienvenido Muoz that the
fatal bullet had hit the petrous bone on an upward trajectory and had been deflected
by the petrous bone towards the mandible. Dr. Juanito Billotes testimony in this
regard had amplified the matter with clarity.
xxx
These physical facts, notwithstanding the arguments and protestations of counsel for
the defense as now and heretofore avowed, compel the Court to maintain the
holding: (1) that the trajectory of the fatal bullet which hit and killed Senator Benigno
Aquino, Jr. was "forward, downward and medially"; (2) that the Senator was shot by a
person who stood at a higher elevation than he; and (3) that the Senator was shot

and killed by CIC Rogelio Moreno on the bridge stairs and not on the tarmac, in
conspiracy with the rest of the accused convicted herein.21
This Court affirmed said findings of the Sandiganbayan when it denied the petition for review
in its resolution of July 25, 1991. The Court ruled:
The Court has carefully considered and deliberated upon all the contentions of the
petitioners but finds no basis for the allegation that the respondent Sandiganbayan
has gravely erred in resolving the factual issues.
The attempt to place a constitutional dimension in the petition is a labor in vain.
Basically, only questions of fact are raised. Not only is it axiomatic that the factual
findings of the Sandiganbayan are final unless they fall within specifically recognized
exceptions to the rule but from the petition and its annexes alone, it is readily
apparent that the respondent Court correctly resolved the factual issues.
xxx
The trajectory of the fatal bullet, whether or not the victim was descending the
stairway or was on the tarmac when shot, the circumstances showing conspiracy, the
participants in the conspiracy, the individual roles of the accused and their respective
parts in the conspiracy, the absence of evidence against thirteen accused and their
co-accused Col. Vicente B. Tigas, Jr., the lack of credibility of the witnesses against
former Minister Jose D. Aspiras, Director Jesus Z. Singson, Col. Arturo A. Custodio,
Hermilo Gosuico, Major General Prospero Olivas, and the shooting of Rolando
Galman are all factual matters w[h]ich the respondent court discussed with fairness
and at length. The petitioners insistence that a few witnesses in their favor should be
believed while that of some witnesses against them should be discredited goes into
the question of credibility of witnesses, a matter which under the records of this
petition is best left to the judgment of the Sandiganbayan.22
The report of the forensic group essentially reiterates the theory presented by the
defense during the trial of the double murder case. Clearly, the report is not newly
discovered, but rather recently sought, which is not allowed by the Rules. 23 If at all, it only
serves to discredit the version of the prosecution which had already been weighed and
assessed, and thereafter upheld by the Sandiganbayan.
The same is true with the statement of the alleged eyewitness, SPO4 Cantimbuhan. His
narration merely corroborates the testimonies of other defense witnesses during the trial that
they saw Senator Aquino already walking on the airport tarmac toward the AVSECOM van
when a man in blue-gray uniform darted from behind and fired at the back of the Senators
head.24 The Sandiganbayan, however, did not give weight to their account as it found the
testimonies of prosecution eyewitnesses Rebecca Quijano and Jessie Barcelona more
credible. Quijano and Barcelona testified that they saw the soldier behind Senator Aquino on
the stairway aim and fire a gun on the latters nape. As earlier quoted, the Sandiganbayan
found their testimonies to be more consistent with the physical evidence. SPO4
Cantimbuhans testimony will not in any way alter the courts decision in view of the
eyewitness account of Quijano and Barcelona, taken together with the physical evidence
presented during the trial. Certainly, a new trial will only be allowed if the new evidence is
of such weight that it would probably change the judgment if admitted.25 Also, new
trial will not be granted if the new evidence is merely cumulative, corroborative or
impeaching.
As additional support to their motion for new trial, petitioners also claim that they were
denied due process because they were deprived of adequate legal assistance by counsel.
We are not persuaded. The records will bear out that petitioners were ably represented by
Atty. Rodolfo U. Jimenez during the trial and when the case was elevated to this Court. An
experienced lawyer in criminal cases, Atty. Jimenez vigorously defended the petitioners
cause throughout the entire proceedings. The records show that the defense presented a

substantial number of witnesses and exhibits during the trial. After the Sandiganbayan
rendered its decision, Atty. Jimenez filed a petition for review with this Court, invoking all
conceivable grounds to acquit the petitioners. When the Court denied the petition for review,
he again filed a motion for reconsideration exhausting his deep reservoir of legal talent. We
therefore find petitioners claim to be unblushingly unsubstantiated. We note that they did not
allege any specific facts in their present motion to show that Atty. Jimenez had been remiss
in his duties as counsel. Petitioners are therefore bound by the acts and decisions of their
counsel as regards the conduct of the case. The general rule is that the client is bound by
the action of his counsel in the conduct of his case and cannot be heard to complain that the
result of the litigation might have been different had his counsel proceeded differently.26 We
held in People vs. Umali:27
In criminal as well as civil cases, it has frequently been held that the fact that
blunders and mistakes may have been made in the conduct of the proceedings in the
trial court, as a result of the ignorance, inexperience, or incompetence of counsel,
does not furnish a ground for a new trial.
If such grounds were to be admitted as reasons for reopening cases, there would
never be an end to a suit so long as new counsel could be employed who could
allege and show that prior counsel had not been sufficiently diligent, or experienced,
or learned.
So it has been held that mistakes of attorneys as to the competency of a witness, the
sufficiency, relevancy, materiality, or immateriality of a certain evidence, the proper
defense, or the burden of proof are not proper grounds for a new trial; and in general
the client is bound by the action of his counsel in the conduct of his case, and can
not be heard to complain that the result of the litigation might have been different had
counsel proceeded differently. (citations omitted)
Finally, we are not moved by petitioners assertion that the forensic evidence may have been
manipulated and misinterpreted during the trial of the case. Again, petitioners did not allege
concrete facts to support their crass claim. Hence, we find the same to be unfounded and
purely speculative.
IN VIEW WHEREOF, the motion is DENIED.
SO ORDERED.