Spouses Flores vs Spouses Pineda

GR No. 158996 November 14, 2008

Facts: Teresita Pineda consulted her townmate Dr.
Fredelicto Flores regarding her medical condition,
complaining about general body weakness, loss of
appetite, frequent urination and thirst, and on-and-of
vaginal
bleeding.
After
interviewing
Teresita,
Dr.
Fredelicto advised her to go to United Doctors Medical
Center (UDMC) in Quezon City for a general check-up the
following week but the former did not. As for her other
symptoms, he suspected that Teresita might be sufering
from diabetes and told her to continue her medications.
When her conditions persisted, she went to UDMC where
Dr. Fredelictor check-up her and ordered her admission
and further indicate on call D&C operation to be
performed by his wife, Dra. Felicisima Flores, an Ob-Gyne.
Laboratory tests were done on Teresita including internal
vaginal examination, however, only the blood sugar and
CBC results came out prior to operation which indicated of
diabetes. D&C operations were still done and thereafter,
Dra. Felicisima advised her that she can go home and
continue to rest at home but Teresita opted otherwise.
Two days after the operation, her condition worsened
prompting further test to be done which resulted that
Teresita have diabetes melitus type II. Insulin was
administered but it might arrived late, she died.
Issue: Whether or not spouses petitioners are liable for
medical negligence.
Held: Yes. A medical negligence case is a type of claim to
redress a wrong committed by a medical professional, that
caused a bodily harm to or the death of a patient. There

are four elements involved in a medical negligence case,

namely: duty, breach, injury, and proximate cause.
Duty refers to the standard of behavior which imposes
restrictions on ones conduct. The standard in turn refers
to the amount of competence associated with the proper
discharge of the profession. A physician is expected to use
at least the same level of case that any other reasonably
competent
doctor
would
use
under
the
same
circumstances. Breach of duty occurs when the physician
fails to comply with those professional standards. If injury
results to the patient as a result of this breach, the
physician is answerable for negligence.
If a patient sufers from some disability that increases the
magnitude of risk to him, that disability must be taken
into account as long as it is or should have been known to
the physician.
Stress, whether physical or emotional, is a factor that can
aggravate diabetes; a D&C operation is a form of physical
stress. Dr. Mendoza explained how surgical stress can
aggravate the patients hyperglycemia: when stress
occurs, the diabetics body, especially the autonomic
system, reacts by secreting hormones which are counterregulatory; she can have prolonged hyperglycemia which,
if unchecked, could lead to death. Medical lecture further
explains that if the blood sugar has become very high, the
patient becomes comatose (diabetic coma). When this
happens over several days, the body uses its own fats to
produce energy, and the result is high level of waste
products in the blood and urine.
These findings leads us to the conclusion that the decision
to proceed with the D&C operation notwithstanding

Teresitas
hyperglycemia
and
without
adequately
preparing her for the procedure, was contrary to the
standards observed by the medical profession. Deviation
from this standard amounted to a breach of duty which
resulted in the patients death. Due to this negligent
conduct, liability must attach to the petitioner spouses.

Cayao-Lasam vs Spouses Ramolete

GR No. 159132 December 18, 2002
Facts: On July 28, 1994, respondent 3 months pregnant
Editha Ramolete was brought to Lorma Medical Center
(LMC) in San Fernando, La Union due to vaginal bleeding
upon advise of petitioner related via telephone, Editha
was admitted to the LMC on the same day. A pelvic
sonogram was then conducted on Editha revealing the
fetus weak cardiac pulsation. The following day, Editha
repeat pelvic sonogram showed that aside from the fetus
weak cardiac pulsation, no fetal movement was also
appreciated. Due to persistent and profuse vaginal
bleeding, petitioner advised her to undergo a D&C
procedure. She was discharged the following day. On
September 16, 1994, Editha was once gain brought at the
LMC, as she was sufering from vomiting ans severe
abdominal pains. Editha was attended by Drs. Dela Cruz,
Mayo and Komiya. Dr. Mayo allegedly informed Editha that
there was a dead fetus in the latters womb, after Editha
went laparectomy, she was found to have massive intra
abdominal hemorrhage and ruptured uterus. Thus, she
had to go hysterectomy and as a result no more chance to
bear a child.
Issue: Whether or not petitioner is liable for medical
malpractice.

Held: No. 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. In order to successfully
pursue such a claim, a patient must prove that the
physician or surgeon either failed to do something which a
reasonably prudent physician or surgeon would not have
done, and that the failure or action caused injury to the
patient.
There are four elements involved in medical negligence
cases: duty, breach, injury, and proximate cause..
A physician-patient relationship was created when Editha
employed the services of the petitioner. As Edithas
physician, petitioner was duty-bound to use at least the
same level of care that any reasonably competent doctor
would use to treat a condition under the same
circumstances. The breach of these professional duties of
skill and care, or their improper performance by a
physician surgeon, whereby the patients injured in body
or in health, constitutes actionable malpractice, as to this
aspect of medical malpractice, the determination of the
reasonable level of care and the breach thereof, expert
testimony is essential. Further, in as much 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 suspect the conclusion as to causation.
It is undisputed that Editha did not return for follow-up
evaluation, in defiance of the petitioners advice. This is as

found out is the proximate cause of the injury she

sustained.

G.R. 178763 Peter Paul Patrick Lucas et al v. Dr.

Prospero Ma. Tuano, April 2009
Facts:
Sometime in 1988, petitioner Peter Paul Patrick Lucas contracted "sore eyes" in his right eye. Upon consultation with Dr. Tuano,
Peter narrated that it has been 9 days since the problem with his right eye began, and that he was already taking Maxitrol to address
the eye problem. According to Dr. Tuano, he performed "ocular routine examination" on Peter's eyes, wherein: 1. a cross
examination Peter's eyes and their surrounding area was made, and 2. Peter's visual acuity were taken, 3. Peter's eyes were
palpated to check the intraocular pressure of each; 4. the mortility of Peter's eyes were observed, and 5. the ophthalmoscopy on
Peter's eyes was used.
On that particular consultation, Dr. Tuano diagnosed that Peter was suffering from conjunctivitis or sore eyes. He then prescribed
Spersacet C-eye drops for Peter and told the latter to return for follow-up after one week.
As instructed, Peter returned and Dr. Tuano discovered that the right eye developed Epidemic Kerato Conjunctivitis, EKC, a viral
infection. To address the problem, Dr. Tuano prescribed Maxitrol, for a dosage of 6 times a day.
However, the EKC was getting worse yet Dr. Tuano still continued on advising the use of Maxittrol, despite Peter's discovery of the
inscribed warning written in its label.
Upon examination, Dr. Tuano noted the hardness in Peter's right eye and discovered that the tension in Peter's right eye was 39.0
Hg. Since the tension was way over the normal IOP which only ranged from 10.0 Hg to 21.0 Hg, Dr. Tuano then ordered him to
immediately discontinue the use of Maxitrol and prescribed to the latter Diamox and Normoglaucon instead. He also required Peter
to go for a daily check-up in order for the former to closely monitor the pressure of the latter' eyes.
During one of Peter's regular follow-ups, Dr. Tuano noted the recurrence of EKC in Peter's right eye. Thus, he referred Peter to Dr.
Manuel Agulto, M.D., another opthalmologist specializing in glaucoma treatment.
Eventually, Peter, in claiming to have "steroid-induced glaucoma" and blaming Dr. Tuano for the same, filed a civil complaint for
damages against Dr. Tuano. In their complaint, petitioners averred that as the direct consequence of Peter's prolonged use of
Maxitrol, he suffered from steroid-induced glaucoma which caused the elevation of his intra-ocular pressure, which caused the
impairment of his vision which may lead to total blindness.
In rebutting petitioner's claim, Dr. Tuano asserted that the treatment made by him more than three years ago has no causal
connection to Peter's glaucoma. He further explained that 'drug-induced glaucoma is temporary and curable, steroids have the side
effect of increasing intraocular pressure. Steroids are prescribed to treat Epidemic Kerato Conjunctivitis or EKC which is an
infiltration of the cornea as a result of conjunctivitis or sore eyes'. Hence, the steroid treatment of Peter's EKC caused the steroidinduced glaucoma.
RTC Ruling
The RTC dismissed the Civil Case for insufficiency of evidence, opining that petitioners failed to prove by preponderance of
evidence that Dr. Tuano was negligent in his treatment of Peter's condition. The trial court reasoned hat the recognized standards of
the medical community has not been established in thiss case, much less has causation been established to render Dr. Tuano
liable. Further, absence of any medical evidence to the contrary, the RTC ruled that it cannot accept petitioner's claim that the use of
steroid is the proximate cause of the damage sustained by Peter's eye.
Court of Appeals Ruling
The CA faulted petitioners because they failed to present any medical expert to testify that Dr. Tuano's prescription of Maxitrol and
Blephamide for the treatment of EKC on petiitioner's right eye was not proper and that his palpation of Peter's right eye was not
enough to detect adverse reaction to steroid.
During the trial in CA, Peter testified that Dr. Manuel Agulto told him that he should not have used steroid for the treatment of EKC or
that he should have used it only for two weeks, as EKC iss only a viral infection which will cure in tself. However, Dr. Agulto was not
presented by petitioners as a witness to confirm what he allegedly told Peter and therefore, the latter's testimony is hearsay. Under
Rule 130, Section 36 of the Rules of Court, a witness can testify only to those facts which he knows of and his own personal
knowledge. Familiar and fundamental is the rule that hearsay testimony is inadmissible as evidence.
Petitioner's Motion for Reconsideration was denied by resolution, hence, this appeal.

Issue: Did the petitioners failed to prove by preponderance of evidence their claim for damages against Dr. Tuano?
Court Ruling:
Only questions of law may be raised under Rule 45 of the Rules of Court as this court is not a trier of facts.
The said issue constitutes a question of fact, as the Supreme Court is asked to revisit anew the factual findings of the RTC and the
CA. While this general rule admits of certain exceptions, such as the circumstance when the finding of fact of the Court of Appeals is
premised on the supposed absence of evidence, but is contradicted by the evidence on record.
The fact of want of competence or diligence is evidentiary in nature, the veracity of which can best be passed upon after a
full-blown trial for it is virtually impossible to ascertain the merits of a medical negligence case without extensive
investigation, research, evaluation and consultation with the medical experts.
Petitioner's position in sum is that Peter's glaucoma is the direct result of Dr. Tuano's negligence in his improper administration of
the drug Maxitrol. Clearly, the present controversy is a classic illustration of a medical negligence case against a physician based on
the latter's professional negligence. In this type of suit, the patient or his heirs, in order to prevail, is required to prove by is required
to prove by preponderance of evidence that the physician failed to exercise that degree of skill, care and learning possessed by
other persons in the same profession; and that as a proximate result of such faiure, the patient or his heirs suffered damages.
For lack of a specific law geared towards the type of negligence committed by members of the medical profession, such claim for
damages is almost always anchored on the alleged violation of Article 2176 of the Civil Code which states that "whoever by act or
omission, causes damage to another, there being no fault or negligence, is obliged to pay for the damage done. Such fault or
negligence, is there is no pre-existing contractual relation between the parties is called quasi-delict.
In medical negligence cases, the four essential elements are the following: 1. duty 2. breach 3. injury 4. proximate cause, which
must be established by the plaintiffs.
In order that there may be a recovery for an injury, it must be shown that the injury for which the recovery is sought must be the
legitimate consequence of the wrong done, the connection between the negligence and the injury must be a direct and natural
sequence of events, unbroken by intervening efficient causes.
Criminal Law- Proximate cause: It is the cause, which is the natural and continuous sequence, unbroken by any efficient
intervening cause, produces the injury, and without which the result would not have occurred. That is, the negligence
must be the proximate cause of the injury.
Just as with the elements of duty and breach of the same, in order to establish the proximate cause by preponderance of evidence,
the patient must similarly use expert testimony, because the question of whether the alleged professional negligence caused the
patient's injury is generally one for specialized expert knowledge beyond the ken of the average layperson; using the specialized
knowledge and training of his field, the expert's role is to present to the court a realistic assessment of the likelihood that the
physician's alleged negligence caused the patient's injury.
In this case, Dr. Tuano was able to clearly explain what is only required of ophthalmologists, in cases such as Peter's is the conduct
of standard tests/ procedures known as "ocular routine examination" composed of five (5) test procedures, specifically: gross
examination of the eyes and the surrounding area, taking of the visual acuity of the patient, checking the intraocular pressure of the
patient, checking the motility of the eyes--and he did all those tests every time Peter went to see him for follow-up consultation
and/or check-up.
Even if we are to assume that Dr. Tuano committed negligent acts in his treatment of Peter's condition, the causal connection
between Dr. Tuano's supposed negligence and Peter's injury still needed to be established. The critical and clinching factor in a
medical negligence case is proof of the causal connection between the negligence which the evidence established and the
plaintiff's injuries.
Civil procedure, burden of proof: In civil cases, the party having the burden of proof must establish his case by a
preponderance of evidence, or evidence which is more convincing to the court as worthy of belief than that which is
offered in opposition thereto. The party having the burden of proof must establish his case by a preponderance of evidence or
"evidence which is of greater weight or more convincing that that which is offered in opposition to it; in the last analysis, it means the
probability of truth.
It seems basic that what constitutes proper medical treatment is a medical question that should have been presented to experts. If
no standard is established through expert medical witnesses, then courts have no standard by which to gauge the basic issue of
breach by the physician or surgeon. The RTC, Court of Appeals and even the Supreme Court; could not be expected to determine
on its own what medical technique should have been utilized for a certain disease or injury. Absent expert medical opinion, the
courts would be dangerously engaging in speculations.

Dr. Rubi Li, Petitioner, vs. Spouses Reynaldo and Lina Soliman, as parents/heirs of deceased Angelica Soliman, Respondents.
G.R. No. 165279
June 7, 2011

Legal Issue: How is medical malpractice proven?

Legal Facts:
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) on July 7, 1993 and results showed that Angelica was suffering from osteosarcoma, osteoblastic type, (highly malignant) cancer of the bone because of
that a necessity of amputation was conducted by Dr, Tamayo on Angelicas right leg in order to remove the tumor and to prevent the metastasis that chemotherapy
was suggested by Dr. Tamayo, which he referred to petitioner Dr. Rubi Li, a medical oncologist. The respondent was admitted to SLMC on August 18, 1993;
however, she died eleven (11) days after the (intravenous) administration of chemotherapy first cycle. Respondents brought their daughters body to the Philippine
National Police (PNP) Crime Laboratory at Camp Crame for post-mortem examination after the refusal of the hospital to release the death certificate without full
payment of bills. The Medico-Legal Report showed that the cause of death as "Hypovolemic shock secondary to multiple organ hemorrhages and Disseminated
Intravascular Coagulation. The respondents filed charges against the SLMC and physicians involve for negligence and failure to observe the essential precautions
in to prevent Angelicas untimely death. Petitioner denied the allegation for damages as she observed best known procedures, highest skill and knowledge in the
administration of chemotherapy drugs despite all efforts the patient died. The trial court was in favor of the petitioner and ordered to pay their unpaid hospital bill in
the amount of P139, 064.43, but the Court of Appeals reversed the decision supporting the respondents pray.
Holding:
In this case medical malpractice is proven because the four essential elements of such action are present based upon the doctrine of informed consent.
Reasoning:
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." Informed consent case
requires the plaintiff to "point to significant undisclosed information relating to the treatment that would alter her decision to undergo. The physician is not expected
to give the patient a short medical education, the disclosure rule only requires of him a reasonable general explanation in nontechnical terms.
Policy Formation:
In all sorts of medical procedures either invasive or not, medical institution must have a certificate of competency in rendering standards of care to
delicate medical procedures before initiating a general protocol that would establish a guideline principle in a form of proper disclosure of such procedure and
presenting
a
consent
or
waiver
to
their
patients
so
that
possible
future
medico-legal
suits
will
be
prevented.
Synthesis:
In Dr. Rubi Li, vs. Spouses Reynaldo and Lina Soliman, as parents/heirs of deceased Angelica Soliman, Respondents, G.R. No. 165279, promulgated
on June 7, 2011, the Court ruled that medical malpractice is proved base on lack/impaired informed consent, and reasonable expert testimony subject a breach of
duty causing gross injury to its patient.

ATIENZA V BOARD OF MEDICINE

G.R. No. 177407 | February 9, 2011 | J. Nachura
Facts:
1. Due to her lumbar pains, private respondent Editha Sioson went to Rizal Medical Center (RMC) for check-up on February 1995.
2. 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. She underwent
kidney operation after the tests revealed that her left kidney is non-functioning and non-visualizing.
3. Private respondents husband Romeo Sioson then filed a complaint for gross negligence and/or incompetence before the Board of Medicine for the removal of Edithas fully
functional right kidney, instead of the left, against the doctors who allegedly participated in the kidney operation, namely: Dr. Judd dela Vega, Dr. Pedro Lantin, III, Dr. Gerardo
Antonio Florendo and petitioner Rico Rommel Atienza.
4. After Romeo Sioson presented his evidence, Editha filed her formal offer of documentary evidence, which consisted of certified photocopies of X-Ray request forms where
interpretation of the ultrasound results were written, for the purpose of proving that her kidneys were both in their proper anatomical locations at the time she was operated.
5. Petitioner filed his comments/objections to Edithas formal offer of exhibits, alleging that said exhibits are inadmissible because the same are mere photocopies, not properly
identified and authenticated, intended to establish matters which are hearsay, and incompetent to prove the purpose for which they are offered.
6. The formal offer of documentary exhibits of private respondent was admitted by the BOM. Petitioner moved for reconsideration of the Order, which was denied on the ground
that BOM should first admit the evidence being offered so that it can determine its probative value when it decides the case, and later on determine whether the evidence is
relevant or not.
7. Disagreeing with the BOM, Atienza filed a petition for certiorari with the CA. The CA dismissed the petition for certiorari for lack of merit. Hence, the present petition for
review on certiorari.
Issue:
W/N the exhibits are inadmissible in evidence
Held:
No. Petition denied. 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. Although
trial courts are enjoined to observe strict enforcement of the rules of evidence, in connection with evidence which may appear to be of doubtful relevancy, incompetency, or
admissibility, we have held that, it 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.
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 in light of Section 20,
Article I of the Professional Regulation Commission Rules of Procedure. 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 on Disputable presumptions.
The exhibits are certified photocopies of X-ray Request Forms filed in connection with Edithas medical case, which contained handwritten entries interpreting the results of the
examination. 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. These exhibits do not constitute hearsay evidence of the anatomical locations of Edithas kidneys
because the position and removal may still be established through a belated ultrasound or x-ray of her abdominal area.
Contrary to the assertion of petitioner, the best evidence rule is also 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.
In fact, the introduction of secondary evidence, such as copies of the exhibits, is allowed, especially as one of the witnesses 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 and ultimately, the originals cannot be produced.

Jarcia vs People of the Philippines

GR No. 187926 February 15, 2012
Facts: Belinda Santiago lodged a complaint with the National Bureau of Investigation (NBI) against the
petitioners, Dr. Emanuel Jarcia and Dr. Marilou Bastan, for their alleged neglect of professional duty
which caused her son, Roy Alfonso Santiago, to suffer 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 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 11 days later, Roy 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. A complaint for reckless imprudence resulting physical injuries was filed against the
petitioners for the alleged misconduct in the handling of the illness of Roy.
Issue: Whether or not the petitioners failed to exercise the degree of care expected of them as doctors
and are liable for negligence to the private respondent.
Held: Yes. The doctrine of res ipsa liquitor as a rule of evidence is unusual to the law of negligence
which recognizes that prima facie negligencce 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 duty. The doctrine can be invoked
when and only when, under the circumstances involved, direct evidence is absolute and not readily
available.
The requisites for the application of the doctrine of res ipsa liquitor 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.
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.
Reckless imprudence consists of voluntarily doing or failing to do, without malice, an act from which
material damage results by reason of an inexcusable lack of precaution on the part of the person
performing or failing to perform such act.
In failing to perform an extensive medical examination to determine the extent of Roys 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.