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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
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SYLLABUS
1. REMEDIAL LAW; CIVIL PROCEDURE; MOTION FOR
RECONSIDERATION; NO DELAY OF FILING IN CASE AT BAR. 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Resolution, dated 29 March 1996, which superseded the earlier resolution issued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
believe 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.
2. CIVIL LAW; DOCTRINE OF RES IPSA LOQUITUR;
ELUCIDATED. 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 plaintiffs prima facie case, and present a question of fact
for defendant to meet with an explanation. 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. 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. 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
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itself. 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. Instead, it is considered as merely evidentiary or in the
nature of a procedural rule. It is regarded as a mode of proof, or a mere procedural
convenience since it furnishes a substitute for, and relieves a plaintiff of, the
burden of producing specific proof of negligence. 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. 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. 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 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.
TaHDAS
physicians and surgeons, 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. 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, injuries sustained on a
healthy part of the body which was not under, or in the area, of treatment, removal
of the wrong part of the body when another part was intended, knocking out a
tooth while a patient's jaw was under anesthetic for the removal of his tonsils, and
loss of an eye while the patient plaintiff was under the influence of anesthetic,
during or following an operation for appendicitis, 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. 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. 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. 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. The real question, therefore, is whether or not in
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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. 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.
4. ID.; ID.; APPLICABLE IN CASE AT BAR. We find the doctrine
of res ipsa loquitur appropriate in the case at bar. . . . 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 happen 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.
CaTSEA
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. 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.
11 ID.; EXTRA-CONTRACTUAL OBLIGATIONS; QUASI-DELICTS;
EMPLOYER-EMPLOYEE RELATIONSHIP EXISTS BETWEEN HOSPITALS
AND CONSULTANTS FOR THE PURPOSE OF ALLOCATING
RESPONSIBILITY IN MEDICAL NEGLIGENCE CASES. 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 employer-employee relationship in effect exists
between hospitals and their attending and visiting physicians.
DCTSEA
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. 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. 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.
13. ID.; DAMAGES; ACTUAL AND TEMPERATE DAMAGES;
PROPER IN CASE AT BAR. 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. 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. 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
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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.
TCacIA
DECISION
KAPUNAN, J :
p
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(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
mag-alaala, 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
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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 ma-intubate 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).
prLL
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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(5)
Thus, on 8 January 1986, petitioners filed a civil case 6(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 damage 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:
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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
14
money, to wit:
1)
2)
3)
4)
SO ORDERED. 7(7)
15
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
15-day period already passed. For that alone, the latter should be denied.
Even assuming admissibility of the Motion for Reconsideration, but
after considering the Comment/Opposition, the former, for lack of merit, is
hereby DENIED.
SO ORDERED. 10(10)
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16
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(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.
cdphil
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 appellate court was furnished to 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
believe 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
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17
that the fact of the occurrence of an injury, taken with the surrounding
circumstances, may permit an inference or raise a presumption of negligence, or
make out a plaintiff's prima facie case, and present a question of fact for defendant
to meet with an explanation. 13(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(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(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(16) Hence, res ipsa loquitur is applied in
conjunction with the doctrine of common knowledge.
However, much has been said the res ipsa loquitur is not a ruled of
substantive law and, as such, does not create or constitute an independent or
separate ground of liability. 17(17) Instead, it is considered as merely evidentiary
or in the nature of a procedural rule. 18(18) It is regarded as a mode of proof, of a
mere procedural convenience since it furnishes a substitute for, and relieves a
plaintiff of, the burden of producing specific proof of negligence. 19(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(20) Still, before resort to the doctrine may be
allowed, the following requisites must be satisfactorily shown:
1.
2.
3.
18
instrumentality" which caused the damage. 22(22) Such 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(23)
Medical malpractice 24(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(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(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(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(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 non-expert witnesses. 29(29)
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. 30(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(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
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situations: leaving of a foreign object in the body of the patient after an operation,
32(32) injuries sustained on a healthy part of the body which was not under, or in
the area, of treatment, 33(33) removal of the wrong part of the body when another
part was intended, 34(34) knocking out a tooth while a patient's jaw was under
anesthetic for the removal of his tonsils, 35(35) and loss of an eye while the
patient plaintiff was under the influence of anesthetic, during or following an
operation for appendicitis, 36(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(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(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(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(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(41) If there was such extraneous interventions, the doctrine or res ipsa loquitur
may be utilized and the defendant is called upon to explain the matter, by evidence
of exculpation, if he could. 42(42)
We find the doctrine of res ipsa loquitur appropriate in the case 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.
LLjur
A case strikingly similar to the one before us is Voss vs. Bridwell, 43(43)
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where the Kansas Supreme Court in applying the res 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(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 happen 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
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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(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
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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:
cdasia
Q:
A:
Q:
ATTY. ALCERA:
She will be incompetent Your Honor.
COURT:
Witness may answer if she knows.
A:
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As I have said, I was with the patient, I was beside the stretcher
holding the left hand of the patient and all of a sudden I heard some
remarks coming from Dra. Perfecta Gutierrez herself. She was saying
CD Technologies Asia, Inc.
23
xxx
xxx
ATTY. PAJARES:
Q:
From whom did you hear those words "lumalaki ang tiyan"?
A:
xxx
xxx
Q.
After hearing the phrase "lumalaki ang tiyan," what did you notice
on the person of the patient?
A:
Q:
A:
Q:
A:
Q:
Did Dr. Calderon, upon being called, arrive inside the operating
room?
A:
Yes sir.
Q:
A:
Q:
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:
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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(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 as 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(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(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 of 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
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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.
50(50) Reviewing 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:
DRA. GUTIERREZ:
A:
Yes sir.
Q:
A:
Q:
A:
Q:
When you said "mahirap yata ito," what were you referring to?
A:
Q:
A:
Yes, because of (sic) my first attempt, I did not see right away.
51(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(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.
cdphil
The argument does not convince us. If this was indeed observed, private
respondents adduced no evidence demonstrating that they proceeded to make a
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27
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:
28
ATTY. LIGSAY:
Q:
DR. JAMORA:
A:
Q:
A:
No.
Q:
A:
Q:
A:
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
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30
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(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(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(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(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
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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(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(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(70) As stated beforehand, respondent Dra. Gutierrez failed to observe the
proper pre-operative 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(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(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.
cda
32
attending and visiting "consultants," 74(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(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(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
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34
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:
ARTICLE 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.
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(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.
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xxx
xxx
xxx
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. 84(84) The 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
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llcd
2.
3.
4.
5.
6.
7.
In the United States alone, a great number of people die every year as a result of
medical mishaps. The 13 December 1999 issue of TIME MAGAZINE featured an
article on medical negligence entitled "Doctors' Deadly Mistakes" which is quoted
in part: "It is hardly news that medical professionals make mistakes even
dumb, deadly mistakes. What is shocking is how often it happens. Depending on
which statistics you believe, the number of Americans killed by medical
screw-ups is somewhere between 44,000 and 98,000 every year the eight
leading cause of death even by the more conservative figure, ahead of car crashes,
breast cancer and AIDS. More astonishing than the huge numbers themselves,
though, is the fact that public health officials had known about the problem for
years and hadn't made a concerted effort to do something about it."
Cholecystectomy is the surgical excision of the gall bladder.
CA Rollo, pp. 129-140.
Records, pp. 270-279.
Id. at 270-275.
Docketed as Civil Case No. Q-46885.
Records, pp. 276-278.
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8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
CA Rollo, p. 166.
Id. at 145.
Id. at 195.
Rollo, p. 19.
Id. at 91-98.
57B Am Jur 2d, 493 (1989).
Africa, et al vs. Caltex (Phil.), Inc., et al, 16 SCRA 449, 454 (1966).
57B Am Jur 2d, supra note 13 at 499.
Ibid.
Id. at 502.
Ibid.
Id.
Id. at 503.
Voss vs. Bridwell, 364 P2d 955, 970 (1961) citing Worden v. Union Gas System,
182 Kan. 686, 324 P.2d 501; Lamb v. Hartford Accident and Indemnity Co.,
Primm v. Kansas Power & Light Co., 173 Kan. 443, 249 P.2d 647.
St. John's Hospital and School of Nursing vs. Chapman, 434 P.2d 160, 166
(1967).
57B Am Jur 2d, supra note 13, at 513.
It is the 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.
(Garcia-Rueda vs. Pascasio, 278 SCRA 769, 778 [1997]).
Voss vs. Bridwell, supra note 21.
Turney vs. Anspaugh, 581 P.2d 1301, 1304 (1978).
SOLIS, MEDICAL JURISPRUDENCE, 239 (1988).
Voss vs. Bridwell, supra note 21, at 968 citing McMillen vs. Foncannon, 127 Kan.
573, 274 P.237.
Stockham vs. Hall, 65 P. 348, 349 (1937) citing Yard vs. Gibbons, 95 Kan. 802,
149 P. 422, 423.
SOLIS, supra note 27, at 239.
Voss vs. Bridwell, supra note 21 at 970-971.
Armstrong vs. Wallace, 47 P.2d 740 (1935).
Thomsen vs. Burgeson, 79 P.2d 136 (1938).
Griffin vs. Norman, 192 NYS 322 (1922).
Brown vs. Shortilledge, 277 P.134 (1929).
Meadows vs. Patterson, 109 S.W. 2d 417 (1937).
Voss vs. Bridwell, supra note 21, at 969.
Id. at 968.
Rhodes vs. De Haan, 337 P. 2d. 1043, 1047 (1959).
Voss vs. Bridwell, supra note 21, at 968.
Sanders vs. Smith, 27 So. 2d 889, 893 (1946).
Ibid.
Voss vs. Bridwell, supra note 21.
Id. at 971.
It is the method of intubating a patient through the oral cavity. Under this
procedure, after the patient has been preoxygenated and paralyzed and is no longer
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46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
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76.
77.
78.
79.
80.
81.
82.
83.
84.
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Endnotes
1 (Popup - Popup)
1.
In the United States alone, a great number of people die every year as a result of
medical mishaps. The 13 December 1999 issue of TIME MAGAZINE featured an
article on medical negligence entitled "Doctors' Deadly Mistakes" which is quoted
in part: "It is hardly news that medical professionals make mistakes even
dumb, deadly mistakes. What is shocking is how often it happens. Depending on
which statistics you believe, the number of Americans killed by medical
screw-ups is somewhere between 44,000 and 98,000 every year the eight
leading cause of death even by the more conservative figure, ahead of car crashes,
breast cancer and AIDS. More astonishing than the huge numbers themselves,
though, is the fact that public health officials had known about the problem for
years and hadn't made a concerted effort to do something about it."
2 (Popup - Popup)
2.
3 (Popup - Popup)
3.
4 (Popup - Popup)
4.
5 (Popup - Popup)
5.
Id. at 270-275.
6 (Popup - Popup)
6.
7 (Popup - Popup)
7.
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8 (Popup - Popup)
8.
CA Rollo, p. 166.
9 (Popup - Popup)
9.
Id. at 145.
10 (Popup - Popup)
10.
Id. at 195.
11 (Popup - Popup)
11.
Rollo, p. 19.
12 (Popup - Popup)
12.
Id. at 91-98.
13 (Popup - Popup)
13.
14 (Popup - Popup)
14.
Africa, et al vs. Caltex (Phil.), Inc., et al, 16 SCRA 449, 454 (1966).
15 (Popup - Popup)
15.
16 (Popup - Popup)
16.
Ibid.
17 (Popup - Popup)
17.
Id. at 502.
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18 (Popup - Popup)
18.
Ibid.
19 (Popup - Popup)
19.
Id.
20 (Popup - Popup)
20.
Id. at 503.
21 (Popup - Popup)
21.
Voss vs. Bridwell, 364 P2d 955, 970 (1961) citing Worden v. Union Gas System,
182 Kan. 686, 324 P.2d 501; Lamb v. Hartford Accident and Indemnity Co.,
Primm v. Kansas Power & Light Co., 173 Kan. 443, 249 P.2d 647.
22 (Popup - Popup)
22.
St. John's Hospital and School of Nursing vs. Chapman, 434 P.2d 160, 166
(1967).
23 (Popup - Popup)
23.
24 (Popup - Popup)
24.
It is the 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.
(Garcia-Rueda vs. Pascasio, 278 SCRA 769, 778 [1997]).
25 (Popup - Popup)
25.
26 (Popup - Popup)
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26.
27 (Popup - Popup)
27.
28 (Popup - Popup)
28.
Voss vs. Bridwell, supra note 21, at 968 citing McMillen vs. Foncannon, 127 Kan.
573, 274 P.237.
29 (Popup - Popup)
29.
Stockham vs. Hall, 65 P. 348, 349 (1937) citing Yard vs. Gibbons, 95 Kan. 802,
149 P. 422, 423.
30 (Popup - Popup)
30.
31 (Popup - Popup)
31.
32 (Popup - Popup)
32.
33 (Popup - Popup)
33.
34 (Popup - Popup)
34.
35 (Popup - Popup)
35.
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36 (Popup - Popup)
36.
37 (Popup - Popup)
37.
38 (Popup - Popup)
38.
Id. at 968.
39 (Popup - Popup)
39.
40 (Popup - Popup)
40.
41 (Popup - Popup)
41.
42 (Popup - Popup)
42.
Ibid.
43 (Popup - Popup)
43.
44 (Popup - Popup)
44.
Id. at 971.
45 (Popup - Popup)
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45.
It is the method of intubating a patient through the oral cavity. Under this
procedure, after the patient has been preoxygenated and paralyzed and is no longer
breathing on his own, the anesthetist inserts an instrument called a laryngoscope
into the patient's oral pharynx. The patient's neck is hyperextended, that is, bent
back as far as possible so that the anesthetist can see or "visualize" the patient's
epiglottis and vocal cords. The anesthetist will then thread the endotracheal tube
between the patient's vocal cords into the trachea, and then hook the tube to the
breathing bag and anesthetic machine.
46 (Popup - Popup)
46.
47 (Popup - Popup)
47.
48 (Popup - Popup)
48.
49 (Popup - Popup)
49.
50 (Popup - Popup)
50.
51 (Popup - Popup)
51.
52 (Popup - Popup)
52.
53 (Popup - Popup)
53.
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54 (Popup - Popup)
54.
Ibid.
55 (Popup - Popup)
55.
56 (Popup - Popup)
56.
Id. at 106.
57 (Popup - Popup)
57.
Id.
58 (Popup - Popup)
58.
59 (Popup - Popup)
59.
60 (Popup - Popup)
60.
61 (Popup - Popup)
61.
62 (Popup - Popup)
62.
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63 (Popup - Popup)
63.
64 (Popup - Popup)
64.
65 (Popup - Popup)
65.
Ibid.
66 (Popup - Popup)
66.
67 (Popup - Popup)
67.
68 (Popup - Popup)
68.
Records, p. 274.
69 (Popup - Popup)
69.
70 (Popup - Popup)
70.
Ibid.
71 (Popup - Popup)
71.
72 (Popup - Popup)
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72.
Id.
73 (Popup - Popup)
73.
Under this doctrine, the surgeon is likened to a ship captain who must not only be
responsible for the safety of the crew but also of the passengers of the vessel. The
head surgeon is made responsible for everything that goes wrong within the four
corners of the operating room. It enunciates the liability of the surgeon not only
for the wrongful acts of those who are under his physical control but also those
wherein he has extension of control.
74 (Popup - Popup)
74.
75 (Popup - Popup)
75.
These requirements are in fact found in the standard application forms for visiting
and attending physicians of respondent hospital.
76 (Popup - Popup)
76.
The hospital's control over respondent physicians is all the more significant when
one considers the fact that it controls everything which occurs in an operating
room, through its nursing supervisors and charge nurses. No operations can be
undertaken without the hospital's direct or indirect consent.
77 (Popup - Popup)
77.
78 (Popup - Popup)
78.
79 (Popup - Popup)
79.
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80 (Popup - Popup)
80.
81 (Popup - Popup)
81.
Should petitioner remain in the same condition for another ten years, the amount
awarded in the form of temperate damages would in fact, be inadequate.
82 (Popup - Popup)
82.
83 (Popup - Popup)
83.
Id. at 327-328.
84 (Popup - Popup)
84.
Id. at 328.
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