Republic of the Philippines

SUPREME COURT
Manila
SECOND DIVISION
G.R. No. 160889 April 27, 2007
DR. MILAGROS L. CANTRE, Petitioner,
vs.
SPS. JOHN DAVID Z. GO and NORA S. GO, Respondents.
DECISION
QUISUMBING, J.:
For review on certiorari are the Decision 1 dated October 3, 2002 and Resolution 2 dated November 19,
2003 of the Court of Appeals in CA-G.R. CV No. 58184, which affirmed with modification the
Decision3 dated March 3, 1997 of the Regional Trial Court of Quezon City, Branch 98, in Civil Case
No. Q-93-16562.
The facts, culled from the records, are as follows:
Petitioner Dr. Milagros L. Cantre is a specialist in Obstetrics and Gynecology at the Dr. Jesus Delgado
Memorial Hospital. She was the attending physician of respondent Nora S. Go, who was admitted at
the said hospital on April 19, 1992.
At 1:30 a.m. of April 20, 1992, Nora gave birth to her fourth child, a baby boy. However, at around
3:30 a.m., Nora suffered profuse bleeding inside her womb due to some parts of the placenta which
were not completely expelled from her womb after delivery. Consequently, Nora suffered hypovolemic
shock, resulting in a drop in her blood pressure to "40" over "0." Petitioner and the assisting resident
physician performed various medical procedures to stop the bleeding and to restore Noras blood
pressure. Her blood pressure was frequently monitored with the use of a sphygmomanometer. While
petitioner was massaging Noras uterus for it to contract and stop bleeding, she ordered a droplight to
warm Nora and her baby.4 Nora remained unconscious until she recovered.
While in the recovery room, her husband, respondent John David Z. Go noticed a fresh gaping wound
two and a half (2 ) by three and a half (3 ) inches in the inner portion of her left arm, close to the
armpit.5 He asked the nurses what caused the injury. He was informed it was a burn. Forthwith, on
April 22, 1992, John David filed a request for investigation. 6 In response, Dr. Rainerio S. Abad, the
medical director of the hospital, called petitioner and the assisting resident physician to explain what
happened. Petitioner said the blood pressure cuff caused the injury.
On May 7, 1992, John David brought Nora to the National Bureau of Investigation for a physical
examination, which was conducted by medico-legal officer Dr. Floresto Arizala, Jr. 7 The medico-legal
officer later testified that Noras injury appeared to be a burn and that a droplight when placed near the
skin for about 10 minutes could cause such burn. 8 He dismissed the likelihood that the wound was
caused by a blood pressure cuff as the scar was not around the arm, but just on one side of the arm.9
On May 22, 1992, Noras injury was referred to a plastic surgeon at the Dr. Jesus Delgado Memorial
Hospital for skin grafting.10 Her wound was covered with skin sourced from her abdomen, which
consequently bore a scar as well. About a year after, on April 30, 1993, scar revision had to be
performed at the same hospital.11 The surgical operation left a healed linear scar in Noras left arm
about three inches in length, the thickest portion rising about one-fourth (1/4) of an inch from the
surface of the skin. The costs of the skin grafting and the scar revision were shouldered by the
hospital.12
Unfortunately, Noras arm would never be the same.1a\^/phi1.net Aside from the unsightly mark, the
pain in her left arm remains. When sleeping, she has to cradle her wounded arm. Her movements now
are also restricted. Her children cannot play with the left side of her body as they might accidentally
bump the injured arm, which aches at the slightest touch.
Thus, on June 21, 1993, respondent spouses filed a complaint13 for damages against petitioner, Dr.
Abad, and the hospital. Finding in favor of respondent spouses, the trial court decreed:
In view of the foregoing consideration, judgment is hereby rendered in favor of the plaintiffs and
against the defendants, directing the latters, (sic) jointly and severally
(a) to pay the sum of Five Hundred Thousand Pesos (P500,000.00) in moral damages;
(b) to pay the sum of One Hundred Fifty Thousand Pesos (P150,000.00) exemplary damages;
(c) to pay the sum of Eighty Thousand Pesos (P80,000.00) nominal damages;
(d) to pay Fifty Thousand Pesos (P50,000.00) for and as attorneys fees; and
(e) to pay Six Thousand Pesos (P6,000.00) litigation expenses.
SO ORDERED.14
Petitioner, Dr. Abad, and the hospital all appealed to the Court of Appeals, which affirmed with
modification the trial court decision, thus:
WHEREFORE, in view of all the foregoing, and finding no reversible error in the appealed Decision
dated March 3, 1997 of Branch 98 of the Regional Trial Court of Quezon City in Civil Case No. Q-93-
16562, the same is hereby AFFIRMED, with the following MODIFICATIONS:
1. Ordering defendant-appellant Dra. Milagros [L.] Cantre only to pay plaintiffs-appellees John
David Go and Nora S. Go the sum of P200,000.00 as moral damages;
2. Deleting the award [of] exemplary damages, attorneys fees and expenses of
litigation;1awphi1.nt
3. Dismissing the complaint with respect to defendants-appellants Dr. Rainerio S. Abad and
Delgado Clinic, Inc.;
4. Dismissing the counterclaims of defendants-appellants for lack of merit; and
5. Ordering defendant-appellant Dra. Milagros [L.] Cantre only to pay the costs.
SO ORDERED.15
Petitioners motion for reconsideration was denied by the Court of Appeals. Hence, the instant petition
assigning the following as errors and issues:
I.

WHETHER OR NOT, THE LOWER COURT, AND THE COURT OF APPEALS

COMMITTED GRAVE ABUSE OF THEIR DISCRETION WHEN,
NOTWITHSTANDING THAT BOTH PARTIES HAVE RESTED THEIR RESPECTIVE
CASES, THE LOWER COURT ADMITTED THE ADDITIONAL EXHIBITS FURTHER
OFFERED BY RESPONDENTS NOT TESTIFIED TO BY ANY WITNESS AND THIS
DECISION OF THE LOWER COURT WAS UPHELD BY THE COURT OF APPEALS
LIKEWISE COMMITTING GRAVE ABUSE OF DISCRETION;

II.

WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS

DISCRETION WHEN, CONTRARY TO PREPONDERANCE OF EVIDENCE
PRESENTED BY THE PETITIONER, IT RULED THAT THE PETITIONER HAS NOT
AMPLY SHOWED THAT THE DROPLIGHT DID NOT TOUCH THE BODY OF MRS.
NORA GO, AND THIS DECISION OF THE LOWER COURT WAS UPHELD BY THE
COURT OF APPEALS LIKEWISE COMMITTING GRAVE ABUSE OF DISCRETION;

III.

WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF ITS

DISCRETION WHEN, CONTRARY TO PREPONDERANCE OF EVIDENCE
PRESENTED BY THE PETITIONER, IT RULED THAT PETITIONER DRA. CANTRE
WAS NOT ABLE TO AMPLY EXPLAIN HOW THE INJURY (BLISTERS) IN THE
LEFT INNER ARM OF RESPONDENT MRS. GO CAME ABOUT;

IV.

WHETHER OR NOT THE COURT OF APPEALS COMMITTED GRAVE ABUSE OF

ITS DISCRETION WHEN IT MADE A RULING ON THE RESPONDENTS INJURY
QUOTING THE TESTIMONY OF SOMEONE WHO WAS NOT PRESENT AND HAS
NOT SEEN THE ORIGINAL, FRESH INJURY OF RESPONDENT MRS. NORA GO;

V.

WHETHER OR NOT THE COURT OF APPEALS GRAVELY ABUSING ITS

DISCRETION RULED THAT PETITIONER DRA. CANTRE SHOULD HAVE
INTENDED TO INFLICT THE INJURY TO SAVE THE LIFE OF RESPONDENT MRS.
GO;

VI.

WHETHER OR NOT THE LOWER COURT AND THE COURT [OF] APPEALS
COMMITTED GRAVE ABUSE OF DISCRETION WHEN, CONTRARY TO THE
DETAILED PROCEDURES DONE BY PETITIONER, BOTH RULED THAT THE
RESPONDENT WAS LEFT TO THE CARE OF THE NURSING STAFF;

VII.

WHETHER OR NOT THE LOWER COURT COMMITTED GRAVE ABUSE OF

DISCRETION WHEN, CONTRARY TO THE MEDICAL PURPOSES OF COSMETIC
SURGERY, IT RULED THAT THE COSMETIC SURGERY MADE THE SCARS EVEN
MORE UGLY AND DECLARED THE COSMETIC SURGERY A FAILURE;

VIII.
 WHETHER OR NOT THE LOWER COURT GRAVELY ABUSE OF (SIC) DISCRETION
WHEN, CONTRARY TO RESPONDENTS CONTRARY TESTIMONIES AND THE
ABSENCE OF ANY TESTIMONY, IT RULED THAT THEY ARE ENTITLED TO
DAMAGES AND WHICH WAS UPHELD, ALTHOUGH MODIFIED, BY THE COURT
OF APPEALS LIKEWISE ABUSING ITS DISCRETION.16

Petitioner contends that additional documentary exhibits not testified to by any witness are
inadmissible in evidence because they deprived her of her constitutional right to confront the witnesses
against her. Petitioner insists the droplight could not have touched Noras body. She maintains the
injury was due to the constant taking of Noras blood pressure. Petitioner also insinuates the Court of
Appeals was misled by the testimony of the medico-legal officer who never saw the original injury
before plastic surgery was performed. Finally, petitioner stresses that plastic surgery was not intended
to restore respondents injury to its original state but rather to prevent further complication.
Respondents, however, counter that the genuineness and due execution of the additional documentary
exhibits were duly admitted by petitioners counsel. Respondents point out that petitioners blood
pressure cuff theory is highly improbable, being unprecedented in medical history and that the injury
was definitely caused by the droplight. At any rate, they argue, even if the injury was brought about by
the blood pressure cuff, petitioner was still negligent in her duties as Noras attending physician.
Simply put, the threshold issues for resolution are: (1) Are the questioned additional exhibits admissible
in evidence? (2) Is petitioner liable for the injury suffered by respondent Nora Go? Thereafter, the
inquiry is whether the appellate court committed grave abuse of discretion in its assailed issuances.
As to the first issue, we agree with the Court of Appeals that said exhibits are admissible in evidence.
We note that the questioned exhibits consist mostly of Noras medical records, which were produced by
the hospital during trial pursuant to a subpoena duces tecum. Petitioners counsel admitted the existence
of the same when they were formally offered for admission by the trial court. In any case, given the
particular circumstances of this case, a ruling on the negligence of petitioner may be made based on the
res ipsa loquitur doctrine even in the absence of such additional exhibits.
Petitioners contention that the medico-legal officer who conducted Noras physical examination never
saw her original injury before plastic surgery was performed is without basis and contradicted by the
records. Records show that the medico-legal officer conducted the physical examination on May 7,
1992, while the skin grafting and the scar revision were performed on Nora on May 22, 1992 and April
30, 1993, respectively.
Coming now to the substantive matter, is petitioner liable for the injury suffered by respondent Nora
Go?
The Hippocratic Oath mandates physicians to give primordial consideration to the well-being of their
patients. If a doctor fails to live up to this precept, he is accountable for his acts. This notwithstanding,
courts face a unique restraint in adjudicating medical negligence cases because physicians are not
guarantors of care and, they never set out to intentionally cause injury to their patients. However, intent
is immaterial in negligence cases because where negligence exists and is proven, it automatically gives
the injured a right to reparation for the damage caused.17
In cases involving medical negligence, the doctrine of res ipsa loquitur allows the mere existence of an
injury to justify a presumption of negligence on the part of the person who controls the instrument
causing the injury, provided that the following requisites concur:
1. The accident is of a kind which ordinarily does not occur in the absence of someones
negligence;
 2. It is caused by an instrumentality within the exclusive control of the defendant or defendants;
and
3. The possibility of contributing conduct which would make the plaintiff responsible is
eliminated.18
As to the first requirement, the gaping wound on Noras arm is certainly not an ordinary occurrence in
the act of delivering a baby, far removed as the arm is from the organs involved in the process of giving
birth. Such injury could not have happened unless negligence had set in somewhere.
Second, whether the injury was caused by the droplight or by the blood pressure cuff is of no moment.
Both instruments are deemed within the exclusive control of the physician in charge under the "captain
of the ship" doctrine. This doctrine holds the surgeon in charge of an operation liable for the negligence
of his assistants during the time when those assistants are under the surgeons control. 19 In this
particular case, it can be logically inferred that petitioner, the senior consultant in charge during the
delivery of Noras baby, exercised control over the assistants assigned to both the use of the droplight
and the taking of Noras blood pressure. Hence, the use of the droplight and the blood pressure cuff is
also within petitioners exclusive control.
Third, the gaping wound on Noras left arm, by its very nature and considering her condition, could
only be caused by something external to her and outside her control as she was unconscious while in
hypovolemic shock. Hence, Nora could not, by any stretch of the imagination, have contributed to her
own injury.
Petitioners defense that Noras wound was caused not by the droplight but by the constant taking of
her blood pressure, even if the latter was necessary given her condition, does not absolve her from
liability. As testified to by the medico-legal officer, Dr. Arizala, Jr., the medical practice is to deflate the
blood pressure cuff immediately after each use. Otherwise, the inflated band can cause injury to the
patient similar to what could have happened in this case. Thus, if Noras wound was caused by the
blood pressure cuff, then the taking of Noras blood pressure must have been done so negligently as to
have inflicted a gaping wound on her arm,20 for which petitioner cannot escape liability under the
"captain of the ship" doctrine.
Further, petitioners argument that the failed plastic surgery was not intended as a cosmetic procedure,
but rather as a measure to prevent complication does not help her case. It does not negate negligence on
her part.
Based on the foregoing, the presumption that petitioner was negligent in the exercise of her profession
stands unrebutted. In this connection, the Civil Code provides:
ART. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is
obliged to pay for the damage done.
ART. 2217. Moral damages include physical suffering, mental anguish, fright, serious anxiety,
besmirched reputation, wounded feelings, moral shock, social humiliation, and similar injury. Though
incapable of pecuniary computation, moral damages may be recovered if they are the proximate result
of the defendants wrongful act or omission.
Clearly, under the law, petitioner is obliged to pay Nora for moral damages suffered by the latter as a
proximate result of petitioners negligence.
We note, however, that petitioner has served well as Noras obstetrician for her past three successful
deliveries. This is the first time petitioner is being held liable for damages due to negligence in the
practice of her profession. The fact that petitioner promptly took care of Noras wound before infection
and other complications set in is also indicative of petitioners good intentions. We also take note of the
fact that Nora was suffering from a critical condition when the injury happened, such that saving her
life became petitioners elemental concern. Nonetheless, it should be stressed that all these could not
justify negligence on the part of petitioner.
Hence, considering the specific circumstances in the instant case, we find no grave abuse of discretion
in the assailed decision and resolution of the Court of Appeals. Further, we rule that the Court of
Appeals award of Two Hundred Thousand Pesos (P200,000) as moral damages in favor of respondents
and against petitioner is just and equitable.21
WHEREFORE, the petition is DENIED. The Decision dated October 3, 2002 and Resolution dated
November 19, 2003 of the Court of Appeals in CA-G.R. CV No. 58184 are AFFIRMED.
No pronouncement as to costs.
SO ORDERED.
LEONARDO A. QUISUMBING
Associate Justice
WE CONCUR:

Republic of the Philippines

SUPREME COURT
Manila
THIRD DIVISION

G.R. No. 118231 July 5, 1996

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

vs.
COURT OF APPEALS, SPOUSES QUEDO D. ACOGIDO and FLOTILDE G. VILLEGAS, respondents.

DAVIDE, JR., J.:p

Throughout history, patients have consigned their fates and lives to the skill of their doctors. For a breach of this trust, men have been quick to demand
1 then already provided: "If a physician make a deep incision upon a
retribution. Some 4,000 years ago, the Code of Hammurabi
man with his bronze lancet and cause the man's death, or operate on the eye socket of a man with his bronze
lancet and destroy the man's eyes, they shall cut off his hand." 2 Subsequently, Hippocrates 3 wrote what was to
become part of the healer's oath: "I will follow that method of treatment which according to my ability and
judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and
mischievous. . . . While I continue to keep this oath unviolated may it be granted me to enjoy life and practice the
art, respected by all men at all times but should I trespass and violate this oath, may the reverse be my lot." At
present, the primary objective of the medical profession if the preservation of life and maintenance of the health
of the people. 4
Needless to say then, when a physician strays from his sacred duty and endangers instead the life of his patient,
he must be made to answer therefor. Although society today cannot and will not tolerate the punishment meted
out by the ancients, neither will it and this Court, as this case would show, let the act go uncondemned.
The petitioners appeal from the decision 5 of the Court of Appeals of 11 May 1994 in CA-G.R. CV No. 30851,
which reversed the decision 6 of 21 December 1990 of Branch 30 of the Regional Trial Court (RTC) of Negros
Oriental in Civil Case No. 9492.
The facts, as found by the trial court, are as follows:
 Dr. Batiquin was a Resident Physician at the Negros Oriental Provincial Hospital, Dumaguete
City from January 9, 1978 to September 1989. Between 1987 and September, 1989 she was
also the Actg. Head of the Department of Obstetrics and Gynecology at the said Hospital.
Mrs. Villegas is a married woman who submitted to Dr. Batiquin for prenatal care as the latter's
private patient sometime before September 21, 1988.
In the morning of September 21, 1988 Dr. Batiquin, with the assistance of Dr. Doris Teresita Sy
who was also a Resident Physician at the same Hospital, C.I. and O.R. Nurse Arlene Diones and
some student nurses performed a simple caesarean section on Mrs. Villegas at the Negros
Oriental Provincial Hospital and after 45 minutes Mrs. Villegas delivered her first child, Rachel
Acogido, at about 11:45 that morning. Thereafter, Plaintiff remained confined at the Hospital until
September 27, 1988 during which period of confinement she was regularly visited by Dr.
Batiquin. On September 28, 1988 Mrs. Villegas checked out of the Hospital. . . and on that same
day she paid Dr. Batiquin, thru the latter's secretary, the amount of P1,500.00 as "professional
fee". . . .
Soon after leaving the Hospital Mrs. Villegas began to suffer abdominal pains and complained of
being feverish. She also gradually lost her appetite, so she consulted Dr. Batiquin at the latter's
polyclinic who prescribed for her certain medicines. . . which she had been taking up to
December, 1988.
In the meantime, Mrs. Villegas was given a Medical Certificate by Dr. Batiquin on October 31,
1988. . . certifying to her physical fitness to return to her work on November 7, 1988. So, on the
second week of November, 1988 Mrs. Villegas returned to her work at the Rural Bank of
Ayungon, Negros Oriental.
The abdominal pains and fever kept on recurring and bothered Mrs. Villegas no end despite the
medications administered by Dr. Batiquin. When the pains became unbearable and she was
rapidly losing weight she consulted Dr. Ma. Salud Kho at the Holy Child's Hospital in Dumaguete
City on January 20, 1989.
The evidence of Plaintiffs show that when Dr. Ma. Salud Kho examined Mrs. Villegas at the Holy
Child's Hospital on January 20, 1989 she found Mrs. Villegas to be feverish, pale and was
breathing fast. Upon examination she felt an abdominal mass one finger below the umbilicus
which she suspected to be either a tumor of the uterus or an ovarian cyst, either of which could
be cancerous. She had an x-ray taken of Mrs. Villegas' chest, abdomen and kidney. She also
took blood tests of Plaintiff. A blood count showed that Mrs. Villegas had [an] infection inside her
abdominal cavity. The results of all those examinations impelled Dr. Kho to suggest that Mrs.
Villegas submit to another surgery to which the latter agreed.
When Dr. Kho opened the abdomen of Mrs. Villegas she found whitish-yellow discharge inside,
an ovarian cyst on each of the left and right ovaries which gave out pus, dirt and pus behind the
uterus, and a piece of rubber material on the right side of the uterus embedded on [sic] the
ovarian cyst, 2 inches by 3/4 inch in size. This piece of rubber material which Dr. Kho described
as a "foreign body" looked like a piece of a "rubber glove". . . and which is [sic] also "rubber-drain
like". . . . It could have been a torn section of a surgeon's gloves or could have come from other
sources. And this foreign body was the cause of the infection of the ovaries and consequently of
all the discomfort suffered by Mrs. Villegas after her delivery on September 21, 1988. 7
The piece of rubber allegedly found near private respondent Flotilde Villegas's uterus was not presented in court,
and although Dr. Ma. Salud Kho Testified that she sent it to a pathologist in Cebu City for examination, 8 it was
not mentioned in the pathologist's Surgical Pathology Report. 9
Aside from Dr. Kho's testimony, the evidence which mentioned the piece of rubber are a Medical Certificate, 10 a
Progress Record, 11 an Anesthesia Record, 12 a Nurse's Record, 13 and a Physician's Discharge Summary. 14
The trial court, however, regarded these documentary evidence as mere hearsay, "there being no showing that
the person or persons who prepared them are deceased or unable to testify on the facts therein stated. . . .
Except for the Medical Certificate (Exhibit "F"), all the above documents were allegedly prepared by persons
other than Dr. Kho, and she merely affixed her signature on some of them to express her agreement
thereto. . . ." 15 The trial court also refused to give weight to Dr. Kho's testimony regarding the subject piece of
rubber as Dr. Kho "may not have had first-hand knowledge" thereof, 16 as could be gleaned from her statement,
thus:
A . . . I have heard somebody that [sic] says [sic] there is [sic] a foreign body that
goes with the tissues but unluckily I don't know where the rubber was. 17
The trial court deemed vital Dr. Victoria Batiquin's testimony that when she confronted Dr. Kho regarding the
piece of rubber, "Dr. Kho answered that there was rubber indeed but that she threw it away." 18 This statement,
the trial court noted, was never denied nor disputed by Dr. Kho, leading it to conclude:
There are now two different versions on the whereabouts of that offending "rubber" (1) that it
was sent to the Pathologist in Cebu as testified to in Court by Dr. Kho and (2) that Dr. Kho threw
it away as told by her to Defendant. The failure of the Plaintiffs to reconcile these two different
versions serve only to weaken their claim against Defendant Batiquin. 19
All told, the trial court held in favor of the petitioners herein.
The Court of Appeals reviewed the entirety of Dr. Kho's testimony and, even without admitting the private
respondents' documentary evidence, deemed Dr. Kho's positive testimony to definitely establish that a piece of
rubber was found near private respondent Villegas's uterus. Thus, the Court of Appeals reversed the decision of
the trial court, holding:
4. The fault or negligence of appellee Dr. Batiquin is established by preponderance of evidence.
The trial court itself had narrated what happened to appellant Flotilde after the caesarean
operation made by appellee doctor. . . . After the second operation, appellant Flotilde became
well and healthy. Appellant Flotilde's troubles were caused by the infection due to the "rubber"
that was left inside her abdomen. Both appellant; testified that after the operation made by
appellee doctor, they did not go to any other doctor until they finally decided to see another
doctor in January, 1989 when she was not getting any better under the care of appellee Dr.
Batiquin. . . . Appellee Dr. Batiquin admitted on the witness stand that she alone decided when to
close the operating area; that she examined the portion she operated on before closing the
same. . . Had she exercised due diligence, appellee Dr. Batiquin would have found the rubber
and removed it before closing the operating area. 20
The appellate court then ruled:
Appellants' evidence show[s] that they paid a total of P17,000.00 [deposit of P7,100.00 (Exh. G-
1-A) plus hospital and medical expenses together with doctor's fees in the total amount
P9,900.00 (Exhs. G and G-2)] for the second operation that saved her life.
For the miseries appellants endured for more than three (3) months, due to the negligence of
appellee Dr. Batiquin they are entitled to moral damages in the amount of P100,000.00;
exemplary damages in the amount of P20,000.00 and attorney's fees in the amount of
P25,000.00.
The fact that appellant Flotilde can no longer bear children because her uterus and ovaries were
removed by Dr. Kho is not taken into consideration as it is not shown that the removal of said
organs were the direct result of the rubber left by appellee Dr. Batiquin near the uterus. What is
established is that the rubber left by appellee caused infection, placed the life of appellant
Flotilde in jeopardy and caused appellant fear, worry and anxiety. . . .
WHEREFORE, the appealed judgment, dismissing the complaint for damages is REVERSED
and SET ASIDE. Another judgment is hereby entered ordering defendants-appellees to pay
plaintiffs-appellants the amounts of P17,000.00 as and for actual damages; P100,000.00 as and
for moral damages; P20,000.00 as and for exemplary damages; and P25,000.00 as and for
attorney's fees plus the costs of litigation.
SO ORDERED. 21
From the above judgment, the petitioners appealed to this Court claiming that the appellate court: (1) committed
grave abuse of discretion by resorting to findings of fact not supported by the evidence on record, and (2)
exceeded its discretion, amounting to lack or excess of jurisdiction, when it gave credence to testimonies
punctured with contradictions and falsities.
The private respondents commented that the petition raised only questions of fact, which were not proper for
review by this Court.
While the rule is that only questions of law may be raised in a petition for review on certiorari, there are
exceptions, among which are when the factual findings of the trial court and the appellate court conflict, when the
appealed decision is clearly contradicted by the evidence on record, or when the appellate court
misapprehended the facts. 22
After deciphering the cryptic petition, we find that the focal point of the instant appeal is the appreciation of Dr.
Kho's testimony. The petitioners contend that the Court of Appeals misappreciated the following portion of Dr.
Kho's testimony:
Q What is the purpose of the examination?
A Just in case, I was just thinking at the back of my mind, just in case this would
turn out to be a medico-legal case, I have heard somebody that [sic] says [sic]
there is [sic] a foreign body that goes with the tissues but unluckily I don't know
where the rubber was. It was not in the Lab, it was not in Cebu. 23 (emphasis
supplied)
The petitioners prefer the trial court's interpretation of the above testimony, i.e., that Dr. Kho's knowledge
of the piece of rubber was based on hearsay. The Court of Appeals, on the other hand, concluded that
the underscored phrase was taken out of context by the trial court. According to the Court of Appeals,
the trial court should have likewise considered the other portions of Dr. Kho's testimony, especially the
following:
Q So you did actually conduct the operation on her?
A Yes, I did.
Q And what was the result?
A Opening up her abdomen, there was whitish-yellow discharge inside the
abdomen, there was an ovarian cyst on the left and side and there was also an
ovarian cyst on the right which, on opening up or freeing it up from the uterus,
turned out to be pus. Both ovaries turned out. . . to have pus. And then, cleaning
up the uterus, at the back of the uterus it was very dirty, it was full of pus. And
there was a [piece of] rubber, we found a [piece of] rubber on the right
side. 24
We agree with the Court of Appeals. The phrase relied upon by the trial court does not negate the fact that Dr.
Kho saw a piece of rubber in private respondent Villegas's abdomen, and that she sent it to a laboratory and
then to Cebu City for examination by a pathologist. 25 Not even the Pathologist's Report, although devoid of any
mention of a piece of rubber, could alter what Dr. Kho saw. Furthermore, Dr. Kho's knowledge of the piece of
rubber could not be based on other than first-hand knowledge for, as she asserted before the trial court:
Q But you are sure you have seen [the piece of rubber]?
A Oh yes. I was not the only one who saw it. 26

The petitioners emphasize that the private respondents never reconciled Dr. Kho's testimony with Dr. Batiquin's
claim on the witness stand that when Dr. Batiquin confronted Dr. Kho about the foreign body, the latter said that
there was a piece of rubber but that she threw it away. Although hearsay, Dr. Batiquin's claim was not objected
to, and hence, the same is admissible 27 but it carries no probative value. 28 Nevertheless, assuming otherwise,
Dr. Batiquin's statement cannot belie the fact that Dr. Kho found a piece of rubber near private respondent
Villegas's uterus. And even if we were to doubt Dr. Kho as to what she did to the piece of rubber, i.e., whether
she threw it away or sent it to Cebu City, we are not justified in distrusting her as to her recovery of a piece of
rubber from private respondent Villegas's abdomen. On this score, it is perfectly reasonable to believe the
testimony of a witness with respect to some facts and disbelieve his testimony with respect to other facts. And it
has been aptly said that even when a witness is found to have deliberately falsified in some material particulars,
it is not required that the whole of his uncorroborated testimony be rejected, but such portions thereof deemed
worthy of belief may be credited. 29
It is here worth noting that the trial court paid heed to the following portions of Dr. Batiquin's testimony: that no
rubber drain was used in the operation, 30 and that there was neither any tear on Dr. Batiquin's gloves after the
operation nor blood smears on her hands upon removing her gloves. 31 Moreover, the trial court pointed out that
the absence of a rubber drain was corroborated by Dr. Doris Sy, Dr. Batiquin's assistant during the operation on
private respondent Villegas. 32 But the trial court failed to recognize that the assertions of Drs. Batiquin and Sy
were denials or negative testimonies. Well-settled is the rule that positive testimony is stronger than negative
testimony. 33 Of course, as the petitioners advocate, such positive testimony must come from a credible source,
which leads us to the second assigned error.
While the petitioners claim that contradictions and falsities punctured Dr. Kho's testimony, a regarding of the said
testimony reveals no such infirmity and establishes Dr. Kho as a credible witness. Dr. Kho was frank throughout
her turn on the witness stand. Furthermore, no motive to state any untruth was ever imputed against Dr. Kho,
leaving her trustworthiness unimpaired. 34 The trial court's following declaration shows that while it was critical of
the lack of care with which Dr. Kho handled the piece of rubber, it was not prepared to doubt Dr. Kho's credibility,
thus only supporting our appraisal of Dr. Kho's trustworthiness:
This is not to say that she was less than honest when she testified about her findings, but it can
also be said that she did not take the most appropriate precaution to preserve that "piece of
rubber" as an eloquent evidence of what she would reveal should there be a "legal problem"
which she claim[s] to have anticipated. 35
Considering that we have assessed Dr. Kho to be a credible witness, her positive testimony [that a piece of
rubber was indeed found in private respondent Villega's abdomen] prevails over the negative testimony in favor
of the petitioners.
As such, the rule of res ipsa loquitur comes to fore. This Court has had occasion to delve into the nature and
operation of this doctrine:
This doctrine [res ipsa loquitur] is stated thus: "Where the thing which causes injury is shown to
be under the management of the defendant, and the accident is such as in the ordinary course
of things does not happen in those who have the management use proper care, it affords
reasonable evidence, in the absence of an explanation by the defendant, that the accident arose
from want of care." Or as Black's Law Dictionary puts it:
Res ipsa loquitur. The thing speaks for itself. Rebuctable presumption or
inference that defendant was negligent, which arises upon proof that [the]
instrumentality causing injury was in defendant's exclusive control, and that the
accident was one which ordinary does not happen in absence of negligence.
Res ipsa loquitur is [a] rule of evidence whereby negligence of [the] alleged
wrongdoer may be inferred from [the] mere fact that [the] accident happened
provided [the] character of [the] accident and circumstances attending it lead
reasonably to belief that in [the] absence of negligence it would not have
occurred and that thing which caused injury is shown to have been under [the]
management and control of [the] alleged wrongdoer. . . . Under [this] doctrine
. . . the happening of an injury permits an inference of negligence where plaintiff
produces substantial evidence that [the] injury was caused by an agency or
instrumentality under [the] exclusive control and management of defendant, and
that the occurrence [sic] was such that in the ordinary course of things would not
happen if reasonable care had been used.
xxx xxx xxx
The doctrine of [r]es ipsa loquitur as a rule of evidence is peculiar to the law of
negligence which recognizes that prima facie negligence may be established
without direct proof and furnishes a substitute for specific proof of negligence.
The doctrine is not a rule of substantive law, but merely a mode of proof or a
mere procedural convenience. The rule, when applicable to the facts and
circumstances of a particular case, is not intended to and does not dispense with
the requirement of proof of culpable negligence on the party charged. It merely
determines and regulates what shall be prima facie evidence thereof and
facilitates the burden of plaintiff of proving a breach of the duty of due care. The
doctrine can be invoked when and only when, under the circumstances involved,
direct evidence is absent and not readily available. 36
In the instant case, all the requisites for recourse to the doctrine are present. First, the entire proceedings of the
caesarean section were under the exclusive control of Dr. Batiquin. In this light, the private respondents were
bereft of direct evidence as to the actual culprit or the exact cause of the foreign object finding its way into
private respondent Villegas's body, which, needless to say, does not occur unless through the intersection of
negligence. Second, since aside from the caesarean section, private respondent Villegas underwent no other
operation which could have caused the offending piece of rubber to appear in her uterus, it stands to reason that
such could only have been a by-product of the caesarean section performed by Dr. Batiquin. The petitioners, in
this regard, failed to overcome the presumption of negligence arising from resort to the doctrine of res ipsa
loquitur. Dr. Batiquin is therefore liable for negligently leaving behind a piece of rubber in private respondent
Villegas's abdomen and for all the adverse effects thereof.
As a final word, this Court reiterates its recognition of the vital role the medical profession plays in the lives of the
people, 37 and the State's compelling interest to enact measures to protect the public from "the potentially deadly
effects of incompetence and ignorance in those who would undertake to treat our bodies and minds for disease
or trauma." 38 Indeed, a physician is bound to serve the interest of his patients "with the greatest of solicitude,
giving them always his best talent and skill." 39 Through her tortious conduct, the petitioner endangered the life of
Flotilde Villegas, in violation of her profession's rigid ethical code and in contravention of the legal standards set
forth for professionals, in general, 40 and members of the medical profession, 41 in particular.
WHEREFORE, the challenged decision of 11 May 1994 of the Court of Appeals in CA-G.R. CV No. 30851 is
hereby AFFIRMED in toto.
Costs against the petitioners.
SO ORDERED

Republic of the Philippines

Supreme Court
Manila
THIRD DIVISION
FE CAYAO-LASAM, G.R. No. 159132

Petitioner,

Present:

YNARES-SANTIAGO, J.,

Chairperson,

- versus - AUSTRIA-MARTINEZ,

CHICO-NAZARIO,

NACHURA, and

REYES, JJ.

SPOUSES CLARO and

EDITHA RAMOLETE, Promulgated:

Respondents. December 18, 2008

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

The antecedent facts:

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

On July 30, 1994, petitioner performed the D&C procedure. Editha was discharged from
the hospital the following day.

On September 16, 1994, Editha was once again brought at the LMC, as she was
suffering from vomiting and severe abdominal pains. Editha was attended by Dr. Beatriz
de la Cruz, Dr. Victor B. Mayo and Dr. Juan V. Komiya. Dr. Mayo allegedly informed
Editha that there was a dead fetus in the latters womb. After, Editha underwent
laparotomy,[5] she was found to have a massive intra-abdominal hemorrhage and a
ruptured uterus. Thus, Editha had to undergo a procedure for hysterectomy[6] and as a
result, she has no more chance to bear a child.

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

Respondents alleged that Edithas hysterectomy was caused by petitioners unmitigated

negligence and professional incompetence in conducting the D&C procedure and the
petitioners failure to remove the fetus inside Edithas womb.[8] Among the alleged acts
of negligence were: first, petitioners failure to check up, visit or administer medication
on Editha during her first day of confinement at the LMC;[9] second, petitioner
recommended that a D&C procedure be performed on Editha without conducting any
internal examination prior to the procedure;[10] third, petitioner immediately suggested
a D&C procedure instead of closely monitoring the state of pregnancy of Editha.[11]

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

with the following explanations: upon Edithas confirmation that she would seek
admission at the LMC, petitioner immediately called the hospital to anticipate the arrival
of Editha and ordered through the telephone the medicines Editha needed to take, which
the nurses carried out; petitioner visited Editha on the morning of July 28, 1994 during
her rounds; on July 29, 1994, she performed an internal examination on Editha and she
discovered that the latters cervix was already open, thus, petitioner discussed the
possible D&C procedure, should the bleeding become more profuse; on July 30 1994,
she conducted another internal examination on Editha, which revealed that the latters
cervix was still open; Editha persistently complained of her vaginal bleeding and her
passing out of some meaty mass in the process of urination and bowel movement; thus,
petitioner advised Editha to undergo D&C procedure which the respondents consented
to; petitioner was very vocal in the operating room about not being able to see an
abortus;[13] taking the words of Editha to mean that she was passing out some meaty
mass and clotted blood, she assumed that the abortus must have been expelled in the
process of bleeding; it was Editha who insisted that she wanted to be discharged;
petitioner agreed, but she advised Editha to return for check-up on August 5, 1994,
which the latter failed to do.

Petitioner contended that it was Edithas gross negligence and/or omission in insisting to
be discharged on July 31, 1994 against doctors advice and her unjustified failure to
return for check-up as directed by petitioner that contributed to her life-threatening
condition on September 16, 1994; that Edithas hysterectomy was brought about by her
very abnormal pregnancy known as placenta increta, which was an extremely rare and
very unusual case of abdominal placental implantation. Petitioner argued that whether or
not a D&C procedure was done by her or any other doctor, there would be no difference
at all because at any stage of gestation before term, the uterus would rupture just the
same.

On March 4, 1999, the Board of Medicine (the Board) of the PRC rendered a Decision,
[14] exonerating petitioner from the charges filed against her. The Board held:

Based on the findings of the doctors who conducted the laparotomy on Editha, hers is a case of Ectopic
Pregnancy Interstitial. This type of ectopic pregnancy is one that is being protected by the uterine
muscles and manifestations may take later than four (4) months and only attributes to two percent (2%)
of ectopic pregnancy cases.
When complainant Editha was admitted at Lorma on due to vaginal bleeding, an ultra-sound was
performed upon her and the result of the Sonogram Test reveals a morbid fetus but did not specify
where the fetus was located. Obstetricians will assume that the pregnancy is within the uterus unless so
specified by the Sonologist who conducted the ultra-sound. Respondent (Dr. Lasam) cannot be faulted
if she was not able to determine that complainant Editha is having an ectopic pregnancy interstitial. The
D&C conducted on Editha is necessary considering that her cervix is already open and so as to stop the
profuse bleeding. Simple curettage cannot remove a fetus if the patient is having an ectopic pregnancy,
since ectopic pregnancy is pregnancy conceived outside the uterus and curettage is done only within
the uterus. Therefore, a more extensive operation needed in this case of pregnancy in order to remove
the fetus.[15]
Feeling aggrieved, respondents went to the PRC on appeal. On November 22, 2000, the
PRC rendered a Decision[16] reversing the findings of the Board and revoking
petitioners authority or license to practice her profession as a physician.[17]
Petitioner brought the matter to the CA in a Petition for Review under Rule 43 of the
Rules of Court. Petitioner also dubbed her petition as one for certiorari[18] under Rule
65 of the Rules of Court.

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

Hence, herein petition, assailing the decision of the CA on the following grounds:

1. THE COURT OF APPEALS ERRED ON A QUESTION OF LAW IN

HOLDING THAT THE PROFESSIONAL REGULATION[S] COMMISSION (PRC) WAS
EXCLUDED AMONG THE QUASI-JUDICIAL AGENCIES CONTEMPLATED UNDER RULE 43
OF THE RULES OF CIVIL PROCEDURE;
2. EVEN ASSUMING, ARGUENDO, THAT PRC WAS EXCLUDED FROM
THE PURVIEW OF RULE 43 OF THE RULES OF CIVIL PROCEDURE, THE PETITIONER WAS
NOT PRECLUDED FROM FILING A PETITION FOR CERTIORARI WHERE THE DECISION
WAS ALSO ISSUED IN EXCESS OF OR WITHOUT JURISDICTION, OR WHERE THE
DECISION WAS A PATENT NULLITY;
3. HEREIN RESPONDENTS-SPOUSES ARE NOT ALLOWED BY LAW TO
APPEAL FROM THE DECISION OF THE BOARD OF MEDICINE TO THE PROFESSIONAL
REGULATION[S] COMMISSION;
4. THE COURT OF APPEALS COMMITTED GRAVE ABUSE OF
DISCRETION IN DENYING FOR IMPROPER FORUM THE PETITION FOR REVIEW/PETITION
FOR CERTIORARI WITHOUT GOING OVER THE MERITS OF THE GROUNDS RELIED UPON
BY THE PETITIONER;
5. PRCS GRAVE OMISSION TO AFFORD HEREIN PETITONER A
CHANCE TO BE HEARD ON APPEAL IS A CLEAR VIOLATION OF HER CONSTITUTIONAL
RIGHT TO DUE PROCESS AND HAS THE EFFECT OF RENDERING THE JUDGMENT NULL
AND VOID;
6. COROLLARY TO THE FOURTH ASSIGNED ERROR, PRC
COMMITTED GRAVE ABUSE OF DISCRETION, AMOUNTING TO LACK OF JURISDICTION,
IN ACCEPTING AND CONSIDERING THE MEMORANDUM ON APPEAL WITHOUT PROOF
OF SERVICE TO HEREIN PETITIONER, AND IN VIOLATION OF ART. IV, SEC. 35 OF THE
RULES AND REGULATIONS GOVERNING THE REGULATION AND PRACTICE OF
PROFESSIONALS;
7. PRC COMMITTED GRAVE ABUSE OF DISCRETION IN REVOKING
PETITIONERS LICENSE TO PRACTICE MEDICINE WITHOUT AN EXPERT TESTIMONY TO
SUPPORT ITS CONCLUSION AS TO THE CAUSE OF RESPONDENT EDITHAT [SIC]
RAMOLETES INJURY;
8. PRC COMMITTED AN EVEN GRAVER ABUSE OF DISCRETION IN
TOTALLY DISREGARDING THE FINDING OF THE BOARD OF MEDICINE, WHICH HAD THE
NECESSARY COMPETENCE AND EXPERTISE TO ESTABLISH THE CAUSE OF
RESPONDENT EDITHAS INJURY, AS WELL AS THE TESTIMONY OF THE EXPERT WITNESS
AUGUSTO MANALO, M.D. ;[AND]
9. PRC COMMITTED GRAVE ABUSE OF DISCRETION IN MAKING CONCLUSIONS
OF FACTS THAT WERE NOT ONLY UNSUPPORTED BY EVIDENCE BUT WERE ACTUALLY
CONTRARY TO EVIDENCE ON RECORD.[22]
The Court will first deal with the procedural issues.

Petitioner claims that the law does not allow complainants to appeal to the PRC from the
decision of the Board. She invokes Article IV, Section 35 of the Rules and Regulations
Governing the Regulation and Practice of Professionals, which provides:

Sec. 35. The respondent may appeal the decision of the Board within thirty days from receipt thereof to
the Commission whose decision shall be final. Complainant, when allowed by law, may interpose
an appeal from the Decision of the Board within the same period. (Emphasis supplied)
Petitioner asserts that a careful reading of the above law indicates that while the
respondent, as a matter of right, may appeal the Decision of the Board to the
Commission, the complainant may interpose an appeal from the decision of the Board
only when so allowed by law.[23] Petitioner cited Section 26 of Republic Act No. 2382
or The Medical Act of 1959, to wit:

Section 26. Appeal from judgment. The decision of the Board of Medical Examiners (now Medical
Board) shall automatically become final thirty days after the date of its promulgation unless the
respondent, during the same period, has appealed to the Commissioner of Civil Service (now
Professional Regulations Commission) and later to the Office of the President of the . If the final
decision is not satisfactory, the respondent may ask for a review of the case, or may file in court a
petition for certiorari.
Petitioner posits that the reason why the Medical Act of 1959 allows only the respondent
in an administrative case to file an appeal with the Commission while the complainant is
not allowed to do so is double jeopardy. Petitioner is of the belief that the revocation of
license to practice a profession is penal in nature.[24]

The Court does not agree.

For one, the principle of double jeopardy finds no application in administrative cases.
Double jeopardy attaches only: (1) upon a valid indictment; (2) before a competent
court; (3) after arraignment; (4) when a valid plea has been entered; and (5) when the
defendant was acquitted or convicted, or the case was dismissed or otherwise terminated
without the express consent of the accused.[25] These elements were not present in the
proceedings before the Board of Medicine, as the proceedings involved in the instant
case were administrative and not criminal in nature. The Court has already held that
double jeopardy does not lie in administrative cases.[26]

Moreover, Section 35 of the Rules and Regulations Governing the Regulation and
Practice of Professionals cited by petitioner was subsequently amended to read:

Sec. 35. The complainant/respondent may appeal the order, the resolution or the decision of the
Board within thirty (30) days from receipt thereof to the Commission whose decision shall be final and
executory. Interlocutory order shall not be appealable to the Commission. (Amended by Res. 174,
Series of 1990).[27] (Emphasis supplied)
Whatever doubt was created by the previous provision was settled with said amendment.
It is axiomatic that the right to appeal is not a natural right or a part of due process, but a
mere statutory privilege that may be exercised only in the manner prescribed by law.[28]
In this case, the clear intent of the amendment is to render the right to appeal from a
decision of the Board available to both complainants and respondents.

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

Sec. 1. Appeal; Period Non-Extendible.- The decision, order or resolution of the Board shall be final
and executory after the lapse of fifteen (15) days from receipt of the decision, order or resolution
without an appeal being perfected or taken by either the respondent or the complainant. A party
aggrieved by the decision, order or resolution may file a notice of appeal from the decision, order
or resolution of the Board to the Commission within fifteen (15) days from receipt thereof, and
serving upon the adverse party a notice of appeal together with the appellants brief or memorandum on
appeal, and paying the appeal and legal research fees. x x x[29]
The above-stated provision does not qualify whether only the complainant or respondent
may file an appeal; rather, the new rules provide that a party aggrieved may file a notice
of appeal. Thus, either the complainant or the respondent who has been aggrieved by the
decision, order or resolution of the Board may appeal to the Commission. It is an
elementary rule that when the law speaks in clear and categorical language, there is no
need, in the absence of legislative intent to the contrary, for any interpretation.[30]
Words and phrases used in the statute should be given their plain, ordinary, and common
usage or meaning.[31]

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

On this point, the Court agrees with the petitioner.

Sec. 1, Rule 43 of the Rules of Court provides:

Section 1. Scope. - This Rule shall apply to appeals from judgments or final orders of the Court of
Tax Appeals, and from awards, judgments, final orders or resolutions of or authorized by any
quasi-judicial agency in the exercise of its quasi-judicial functions. Among these agencies are the
Civil Service Commission, Central Board of Assessment Appeals, Securities and Exchange
Commission, Office of the President, Land Registration Authority, Social Security Commission, Civil
Aeronautics Board, Bureau of Patents, Trademarks and Technology Transfer, National Electrification
Administration, Energy Regulatory Board, National Telecommunications Commission, Department of
Agrarian Reform under Republic Act No. 6657, Government Service Insurance System, Employees
Compensation Commission, Agricultural Inventions Board, Insurance Commission, Philippine Atomic
Energy Commission, Board of Investments, Construction Industry Arbitration Commission, and
voluntary arbitrators authorized by law. (Emphasis supplied)
Indeed, the PRC is not expressly mentioned as one of the agencies which are expressly
enumerated under Section 1, Rule 43 of the Rules of Court. However, its absence from
the enumeration does not, by this fact alone, imply its exclusion from the coverage of
said Rule.[35] The Rule expressly provides that it should be applied to appeals from
awards, judgments final orders or resolutions of any quasi-judicial agency in the
exercise of its quasi-judicial functions. The phrase among these agencies confirms that
the enumeration made in the Rule is not exclusive to the agencies therein listed.[36]

Specifically, the Court, in Yang v. Court of Appeals,[37] ruled that Batas Pambansa
(B.P.) Blg. 129[38] conferred upon the CA exclusive appellate jurisdiction over appeals
from decisions of the PRC. The Court held:

The law has since been changed, however, at least in the matter of the particular court to which appeals
from the Commission should be taken. On August 14, 1981, Batas Pambansa Bilang 129 became
effective and in its Section 29, conferred on the Court of Appeals exclusive appellate jurisdiction over
all final judgments, decisions, resolutions, orders or awards of Regional Trial Courts and quasi-judicial
agencies, instrumentalities, boards or commissions except those falling under the appellate jurisdiction
of the Supreme Court. x x x. In virtue of BP 129, appeals from the Professional Regulations
Commission are now exclusively cognizable by the Court of Appeals.[39] (Emphasis supplied)
Clearly, the enactment of B.P. Blg. 129, the precursor of the present Rules of Civil
Procedure,[40] lodged with the CA such jurisdiction over the appeals of decisions made
by the PRC.

Anent the substantive merits of the case, petitioner questions the PRC decision for being
without an expert testimony to support its conclusion and to establish the cause of
Edithas injury. Petitioner avers that in cases of medical malpractice, expert testimony is
necessary to support the conclusion as to the cause of the injury.[41]

Medical malpractice is a particular form of negligence which consists in the failure of a

physician or surgeon to apply to his practice of medicine that degree of care and skill
which is ordinarily employed by the profession generally, under similar conditions, and
in like surrounding circumstances.[42] In order to successfully pursue such a claim, a
patient must prove that the physician or surgeon either failed to do something which a
reasonably prudent physician or surgeon would not have done, and that the failure or
action caused injury to the patient.[43]

There are four elements involved in medical negligence cases: duty, breach, injury and
proximate causation.[44]

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

In the present case, respondents did not present any expert testimony to support their
claim that petitioner failed to do something which a reasonably prudent physician or
surgeon would have done.

Petitioner, on the other hand, presented the testimony of Dr. Augusto M. Manalo, who
was clearly an expert on the subject.

Generally, to qualify as an expert witness, one must have acquired special knowledge of
the subject matter about which he or she is to testify, either by the study of recognized
authorities on the subject or by practical experience.[49]

Dr. Manalo specializes in gynecology and obstetrics, authored and co-authored various
publications on the subject, and is a professor at the University of the Philippines.[50]
According to him, his diagnosis of Edithas case was Ectopic Pregnancy Interstitial (also
referred to as Cornual), Ruptured.[51] In stating that the D&C procedure was not the
proximate cause of the rupture of Edithas uterus resulting in her hysterectomy, Dr.
Manalo testified as follows:

Atty. Hidalgo:
Q: Doctor, we want to be clarified on this matter. The complainant had testified here that the D&C was
the proximate cause of the rupture of the uterus. The condition which she found herself in on the
second admission. Will you please tell us whether that is true or not?
A: Yah, I do not think so for two reasons. One, as I have said earlier, the instrument cannot reach the
site of the pregnancy, for it to further push the pregnancy outside the uterus. And, No. 2, I was thinking
a while ago about another reason- well, why I dont think so, because it is the triggering factor for the
rupture, it could havethe rupture could have occurred much earlier, right after the D&C or a few days
after the D&C.
Q: In this particular case, doctor, the rupture occurred to have happened minutes prior to the
hysterectomy or right upon admission on September 15, 1994 which is about 1 months after the patient
was discharged, after the D&C was conducted. Would you tell us whether there is any relation at all of
the D&C and the rupture in this particular instance?
A: I dont think so for the two reasons that I have just mentioned- that it would not be possible for
the instrument to reach the site of pregnancy. And, No. 2, if it is because of the D&C that rupture
could have occurred earlier.[52] (Emphases supplied)
Clearly, from the testimony of the expert witness and the reasons given by him, it is
evident that the D&C procedure was not the proximate cause of the rupture of Edithas
uterus.

During his cross-examination, Dr. Manalo testified on how he would have addressed
Edithas condition should he be placed in a similar circumstance as the petitioner. He
stated:

Atty. Ragonton:
Q: Doctor, as a practicing OB-Gyne, when do you consider that you have done a good, correct and
ideal dilatation and curettage procedure?
A: Well, if the patient recovers. If the patient gets well. Because even after the procedure, even after the
procedure you may feel that you have scraped everything, the patient stops bleeding, she feels well, I
think you should still have some reservations, and wait a little more time.
Q: If you were the OB-Gyne who performed the procedure on patient Editha Ramolete, would it be
your standard practice to check the fetal parts or fetal tissues that were allegedly removed?
A: From what I have removed, yes. But in this particular case, I think it was assumed that it was part of
the meaty mass which was expelled at the time she was urinating and flushed in the toilet. So theres no
way.
Q: There was [sic] some portions of the fetal parts that were removed?
A: No, it was described as scanty scraping if I remember it rightscanty.
Q: And you would not mind checking those scant or those little parts that were removed?
A: Well, the fact that it was described means, I assume that it was checked, no. It was described as
scanty and the color also, I think was described. Because it would be very unusual, even improbable
that it would not be examined, because when you scrape, the specimens are right there before
your eyes. Its in front of you. You can touch it. In fact, some of them will stick to the instrument
and therefore to peel it off from the instrument, you have to touch them. So, automatically they
are examined closely.
Q: As a matter of fact, doctor, you also give telephone orders to your patients through telephone?
A: Yes, yes, we do that, especially here in Manila because you know, sometimes a doctor can also be
tied-up somewhere and if you have to wait until he arrive at a certain place before you give the order,
then it would be a lot of time wasted. Because if you know your patient, if you have handled your
patient, some of the symptoms you can interpret that comes with practice. And, I see no reason for not
allowing telephone orders unless it is the first time that you will be encountering the patient. That
you have no idea what the problem is.
Q: But, doctor, do you discharge patients without seeing them?
A: Sometimes yes, depending on how familiar I am with the patient. We are on the question of
telephone orders. I am not saying that that is the idle [sic] thing to do, but I think the reality of
present day practice somehow justifies telephone orders. I have patients whom I have justified and
then all of a sudden, late in the afternoon or late in the evening, would suddenly call they have decided
that they will go home inasmuch as they anticipated that I will discharge them the following day. So, I
just call and ask our resident on duty or the nurse to allow them to go because I have seen that patient
and I think I have full grasp of her problems. So, thats when I make this telephone orders. And, of
course before giving that order I ask about how she feels.[53] (Emphases supplied)
From the foregoing testimony, it is clear that the D&C procedure was conducted in
accordance with the standard practice, with the same level of care that any reasonably
competent doctor would use to treat a condition under the same circumstances, and that
there was nothing irregular in the way the petitioner dealt with Editha.

Medical malpractice, in our jurisdiction, is often brought as a civil action for damages
under Article 2176[54] of the Civil Code. The defenses in an action for damages,
provided for under Article 2179 of the Civil Code are:

Art. 2179. When the plaintiffs own negligence was the immediate and proximate cause of his
injury, he cannot recover damages. But if his negligence was only contributory, the immediate and
proximate cause of the injury being the defendants lack of due care, the plaintiff may recover damages,
but the courts shall mitigate the damages to be awarded.
Proximate cause has been defined as that which, in natural and continuous sequence,
unbroken by any efficient intervening cause, produces injury, and without which the
result would not have occurred.[55] An injury or damage is proximately caused by an
act or a failure to act, whenever it appears from the evidence in the case that the act or
omission played a substantial part in bringing about or actually causing the injury or
damage; and that the injury or damage was either a direct result or a reasonably probable
consequence of the act or omission.[56]

In the present case, the Court notes the findings of the Board of Medicine:

When complainant was discharged on July 31, 1994, herein respondent advised her to return on
August 4, 1994 or four (4) days after the D&C. This advise was clear in complainants Discharge
Sheet. However, complainant failed to do so. This being the case, the chain of continuity as required
in order that the doctrine of proximate cause can be validly invoked was interrupted. Had she
returned, the respondent could have examined her thoroughly.[57] x x x (Emphases supplied)
Also, in the testimony of Dr. Manalo, he stated further that assuming that there was in
fact a misdiagnosis, the same would have been rectified if Editha followed the
petitioners order to return for a check-up on August 4, 1994. Dr. Manalo stated:

Granting that the obstetrician-gynecologist has been misled (justifiably) up to thus point that
there would have been ample opportunity to rectify the misdiagnosis, had the patient returned, as
instructed for her follow-up evaluation. It was one and a half months later that the patient sought
consultation with another doctor. The continued growth of an ectopic pregnancy, until its eventual
rupture, is a dynamic process. Much change in physical findings could be expected in 1 months,
including the emergence of suggestive ones.[58]
It is undisputed that Editha did not return for a follow-up evaluation, in defiance of the
petitioners advise. Editha omitted the diligence required by the circumstances which
could have avoided the injury. The omission in not returning for a follow-up evaluation
played a substantial part in bringing about Edithas own injury. Had Editha returned,
petitioner could have conducted the proper medical tests and procedure necessary to
determine Edithas health condition and applied the corresponding treatment which could
have prevented the rupture of Edithas uterus. The D&C procedure having been
conducted in accordance with the standard medical practice, it is clear that Edithas
omission was the proximate cause of her own injury and not merely a contributory
negligence on her part.

Contributory negligence is the act or omission amounting to want of ordinary care on the
part of the person injured, which, concurring with the defendants negligence, is the
proximate cause of the injury.[59] Difficulty seems to be apprehended in deciding which
acts of the injured party shall be considered immediate causes of the accident.[60]
Where the immediate cause of an accident resulting in an injury is the plaintiffs own act,
which contributed to the principal occurrence as one of its determining factors, he
cannot recover damages for the injury.[61] Again, based on the evidence presented in
the present case under review, in which no negligence can be attributed to the
petitioner, the immediate cause of the accident resulting in Edithas injury was her
own omission when she did not return for a follow-up check up, in defiance of
petitioners orders. The immediate cause of Edithas injury was her own act; thus,
she cannot recover damages from the injury.

Lastly, petitioner asserts that her right to due process was violated because she was
never informed by either respondents or by the PRC that an appeal was pending before
the PRC.[62] Petitioner claims that a verification with the records section of the PRC
revealed that on April 15, 1999, respondents filed a Memorandum on Appeal before the
PRC, which did not attach the actual registry receipt but was merely indicated therein.
[63]

Respondents, on the other hand avers that if the original registry receipt was not attached
to the Memorandum on Appeal, PRC would not have entertained the appeal or accepted
such pleading for lack of notice or proof of service on the other party.[64] Also, the
registry receipt could not be appended to the copy furnished to petitioners former
counsel, because the registry receipt was already appended to the original copy of the
Memorandum of Appeal filed with PRC.[65]

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

In EDI-Staffbuilders International, Inc. v. National Labor Relations Commission,[67] in

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

All told, doctors are protected by a special rule of law. They are not guarantors of care.
They are not insurers against mishaps or unusual consequences[68] specially so if the
patient herself did not exercise the proper diligence required to avoid the injury.

WHEREFORE, the petition is GRANTED. The assailed Decision of the Court of

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

SO ORDERED.

Republic of the Philippines

SUPREME COURT
Manila
THIRD DIVISION
G.R. No. 142625 December 19, 2006
ROGELIO P. NOGALES, for himself and on behalf of the minors, ROGER ANTHONY,
ANGELICA, NANCY, and MICHAEL CHRISTOPHER, all surnamed NOGALES, petitioners,
vs.
CAPITOL MEDICAL CENTER, DR. OSCAR ESTRADA, DR. ELY VILLAFLOR, DR. ROSA
UY, DR. JOEL ENRIQUEZ, DR. PERPETUA LACSON, DR. NOE ESPINOLA, and NURSE J.
DUMLAO, respondents.

DECISION

CARPIO, J.:
 The Case
This petition for review1 assails the 6 February 1998 Decision 2 and 21 March 2000 Resolution3 of the
Court of Appeals in CA-G.R. CV No. 45641. The Court of Appeals affirmed in toto the 22 November
1993 Decision4 of the Regional Trial Court of Manila, Branch 33, finding Dr. Oscar Estrada solely
liable for damages for the death of his patient, Corazon Nogales, while absolving the remaining
respondents of any liability. The Court of Appeals denied petitioners' motion for reconsideration.
The Facts
Pregnant with her fourth child, Corazon Nogales ("Corazon"), who was then 37 years old, was under
the exclusive prenatal care of Dr. Oscar Estrada ("Dr. Estrada") beginning on her fourth month of
pregnancy or as early as December 1975. While Corazon was on her last trimester of pregnancy, Dr.
Estrada noted an increase in her blood pressure and development of leg edema5 indicating
preeclampsia,6 which is a dangerous complication of pregnancy.7
Around midnight of 25 May 1976, Corazon started to experience mild labor pains prompting Corazon
and Rogelio Nogales ("Spouses Nogales") to see Dr. Estrada at his home. After examining Corazon, Dr.
Estrada advised her immediate admission to the Capitol Medical Center ("CMC").
On 26 May 1976, Corazon was admitted at 2:30 a.m. at the CMC after the staff nurse noted the written
admission request8 of Dr. Estrada. Upon Corazon's admission at the CMC, Rogelio Nogales
("Rogelio") executed and signed the "Consent on Admission and Agreement" 9 and "Admission
Agreement."10 Corazon was then brought to the labor room of the CMC.
Dr. Rosa Uy ("Dr. Uy"), who was then a resident physician of CMC, conducted an internal examination
of Corazon. Dr. Uy then called up Dr. Estrada to notify him of her findings.
Based on the Doctor's Order Sheet,11 around 3:00 a.m., Dr. Estrada ordered for 10 mg. of valium to be
administered immediately by intramuscular injection. Dr. Estrada later ordered the start of intravenous
administration of syntocinon admixed with dextrose, 5%, in lactated Ringers' solution, at the rate of
eight to ten micro-drops per minute.
According to the Nurse's Observation Notes,12 Dr. Joel Enriquez ("Dr. Enriquez"), an anesthesiologist
at CMC, was notified at 4:15 a.m. of Corazon's admission. Subsequently, when asked if he needed the
services of an anesthesiologist, Dr. Estrada refused. Despite Dr. Estrada's refusal, Dr. Enriquez stayed
to observe Corazon's condition.
At 6:00 a.m., Corazon was transferred to Delivery Room No. 1 of the CMC. At 6:10 a.m., Corazon's
bag of water ruptured spontaneously. At 6:12 a.m., Corazon's cervix was fully dilated. At 6:13 a.m.,
Corazon started to experience convulsions.
At 6:15 a.m., Dr. Estrada ordered the injection of ten grams of magnesium sulfate. However, Dr. Ely
Villaflor ("Dr. Villaflor"), who was assisting Dr. Estrada, administered only 2.5 grams of magnesium
sulfate.
At 6:22 a.m., Dr. Estrada, assisted by Dr. Villaflor, applied low forceps to extract Corazon's baby. In the
process, a 1.0 x 2.5 cm. piece of cervical tissue was allegedly torn. The baby came out in an apnic,
cyanotic, weak and injured condition. Consequently, the baby had to be intubated and resuscitated by
Dr. Enriquez and Dr. Payumo.
At 6:27 a.m., Corazon began to manifest moderate vaginal bleeding which rapidly became profuse.
Corazon's blood pressure dropped from 130/80 to 60/40 within five minutes. There was continuous
profuse vaginal bleeding. The assisting nurse administered hemacel through a gauge 19 needle as a side
drip to the ongoing intravenous injection of dextrose.
At 7:45 a.m., Dr. Estrada ordered blood typing and cross matching with bottled blood. It took
approximately 30 minutes for the CMC laboratory, headed by Dr. Perpetua Lacson ("Dr. Lacson"), to
comply with Dr. Estrada's order and deliver the blood.
At 8:00 a.m., Dr. Noe Espinola ("Dr. Espinola"), head of the Obstetrics-Gynecology Department of the
CMC, was apprised of Corazon's condition by telephone. Upon being informed that Corazon was
bleeding profusely, Dr. Espinola ordered immediate hysterectomy. Rogelio was made to sign a
"Consent to Operation."13
Due to the inclement weather then, Dr. Espinola, who was fetched from his residence by an ambulance,
arrived at the CMC about an hour later or at 9:00 a.m. He examined the patient and ordered some
resuscitative measures to be administered. Despite Dr. Espinola's efforts, Corazon died at 9:15 a.m. The
cause of death was "hemorrhage, post partum."14
On 14 May 1980, petitioners filed a complaint for damages 15 with the Regional Trial Court16 of Manila
against CMC, Dr. Estrada, Dr. Villaflor, Dr. Uy, Dr. Enriquez, Dr. Lacson, Dr. Espinola, and a certain
Nurse J. Dumlao for the death of Corazon. Petitioners mainly contended that defendant physicians and
CMC personnel were negligent in the treatment and management of Corazon's condition. Petitioners
charged CMC with negligence in the selection and supervision of defendant physicians and hospital
staff.
For failing to file their answer to the complaint despite service of summons, the trial court declared Dr.
Estrada, Dr. Enriquez, and Nurse Dumlao in default.17 CMC, Dr. Villaflor, Dr. Uy, Dr. Espinola, and
Dr. Lacson filed their respective answers denying and opposing the allegations in the complaint.
Subsequently, trial ensued.
After more than 11 years of trial, the trial court rendered judgment on 22 November 1993 finding Dr.
Estrada solely liable for damages. The trial court ruled as follows:
The victim was under his pre-natal care, apparently, his fault began from his incorrect and
inadequate management and lack of treatment of the pre-eclamptic condition of his patient. It is
not disputed that he misapplied the forceps in causing the delivery because it resulted in a large
cervical tear which had caused the profuse bleeding which he also failed to control with the
application of inadequate injection of magnesium sulfate by his assistant Dra. Ely Villaflor. Dr.
Estrada even failed to notice the erroneous administration by nurse Dumlao of hemacel by way
of side drip, instead of direct intravenous injection, and his failure to consult a senior
obstetrician at an early stage of the problem.
On the part however of Dra. Ely Villaflor, Dra. Rosa Uy, Dr. Joel Enriquez, Dr. Lacson, Dr.
Espinola, nurse J. Dumlao and CMC, the Court finds no legal justification to find them civilly
liable.
On the part of Dra. Ely Villaflor, she was only taking orders from Dr. Estrada, the principal
physician of Corazon Nogales. She can only make suggestions in the manner the patient maybe
treated but she cannot impose her will as to do so would be to substitute her good judgment to
that of Dr. Estrada. If she failed to correctly diagnose the true cause of the bleeding which in
this case appears to be a cervical laceration, it cannot be safely concluded by the Court that Dra.
Villaflor had the correct diagnosis and she failed to inform Dr. Estrada. No evidence was
introduced to show that indeed Dra. Villaflor had discovered that there was laceration at the
cervical area of the patient's internal organ.
On the part of nurse Dumlao, there is no showing that when she administered the hemacel as a
side drip, she did it on her own. If the correct procedure was directly thru the veins, it could
only be because this was what was probably the orders of Dr. Estrada.
While the evidence of the plaintiffs shows that Dr. Noe Espinola, who was the Chief of the
Department of Obstetrics and Gynecology who attended to the patient Mrs. Nogales, it was only
at 9:00 a.m. That he was able to reach the hospital because of typhoon Didang (Exhibit 2).
While he was able to give prescription in the manner Corazon Nogales may be treated, the
prescription was based on the information given to him by phone and he acted on the basis of
facts as presented to him, believing in good faith that such is the correct remedy. He was not
with Dr. Estrada when the patient was brought to the hospital at 2:30 o'clock a.m. So, whatever
errors that Dr. Estrada committed on the patient before 9:00 o'clock a.m. are certainly the errors
of Dr. Estrada and cannot be the mistake of Dr. Noe Espinola. His failure to come to the hospital
on time was due to fortuitous event.
On the part of Dr. Joel Enriquez, while he was present in the delivery room, it is not incumbent
upon him to call the attention of Dr. Estrada, Dra. Villaflor and also of Nurse Dumlao on the
alleged errors committed by them. Besides, as anesthesiologist, he has no authority to control
the actuations of Dr. Estrada and Dra. Villaflor. For the Court to assume that there were errors
being committed in the presence of Dr. Enriquez would be to dwell on conjectures and
speculations.
On the civil liability of Dr. Perpetua Lacson, [s]he is a hematologist and in-charge of the blood
bank of the CMC. The Court cannot accept the theory of the plaintiffs that there was delay in
delivering the blood needed by the patient. It was testified, that in order that this blood will be
made available, a laboratory test has to be conducted to determine the type of blood, cross
matching and other matters consistent with medical science so, the lapse of 30 minutes maybe
considered a reasonable time to do all of these things, and not a delay as the plaintiffs would
want the Court to believe.
Admittedly, Dra. Rosa Uy is a resident physician of the Capitol Medical Center. She was sued
because of her alleged failure to notice the incompetence and negligence of Dr. Estrada.
However, there is no evidence to support such theory. No evidence was adduced to show that
Dra. Rosa Uy as a resident physician of Capitol Medical Center, had knowledge of the
mismanagement of the patient Corazon Nogales, and that notwithstanding such knowledge, she
tolerated the same to happen.
In the pre-trial order, plaintiffs and CMC agreed that defendant CMC did not have any hand or
participation in the selection or hiring of Dr. Estrada or his assistant Dra. Ely Villaflor as
attending physician[s] of the deceased. In other words, the two (2) doctors were not employees
of the hospital and therefore the hospital did not have control over their professional conduct.
When Mrs. Nogales was brought to the hospital, it was an emergency case and defendant CMC
had no choice but to admit her. Such being the case, there is therefore no legal ground to apply
the provisions of Article 2176 and 2180 of the New Civil Code referring to the vicarious
liability of an employer for the negligence of its employees. If ever in this case there is fault or
negligence in the treatment of the deceased on the part of the attending physicians who were
employed by the family of the deceased, such civil liability should be borne by the attending
physicians under the principle of "respondeat superior".
WHEREFORE, premises considered, judgment is hereby rendered finding defendant Dr.
Estrada of Number 13 Pitimini St. San Francisco del Monte, Quezon City civilly liable to pay
plaintiffs: 1) By way of actual damages in the amount of P105,000.00; 2) By way of moral
damages in the amount of P700,000.00; 3) Attorney's fees in the amount of P100,000.00 and to
 pay the costs of suit.
For failure of the plaintiffs to adduce evidence to support its [sic] allegations against the other
defendants, the complaint is hereby ordered dismissed. While the Court looks with disfavor the
filing of the present complaint against the other defendants by the herein plaintiffs, as in a way
it has caused them personal inconvenience and slight damage on their name and reputation, the
Court cannot accepts [sic] however, the theory of the remaining defendants that plaintiffs were
motivated in bad faith in the filing of this complaint. For this reason defendants' counterclaims
are hereby ordered dismissed.
SO ORDERED.18
Petitioners appealed the trial court's decision. Petitioners claimed that aside from Dr. Estrada, the
remaining respondents should be held equally liable for negligence. Petitioners pointed out the extent
of each respondent's alleged liability.
On 6 February 1998, the Court of Appeals affirmed the decision of the trial court. 19 Petitioners filed a
motion for reconsideration which the Court of Appeals denied in its Resolution of 21 March 2000.20
Hence, this petition.
Meanwhile, petitioners filed a Manifestation dated 12 April 2002 21 stating that respondents Dr. Estrada,
Dr. Enriquez, Dr. Villaflor, and Nurse Dumlao "need no longer be notified of the petition because they
are absolutely not involved in the issue raised before the [Court], regarding the liability of [CMC]." 22
Petitioners stressed that the subject matter of this petition is the liability of CMC for the negligence of
Dr. Estrada.23
The Court issued a Resolution dated 9 September 200224 dispensing with the requirement to submit the
correct and present addresses of respondents Dr. Estrada, Dr. Enriquez, Dr. Villaflor, and Nurse
Dumlao. The Court stated that with the filing of petitioners' Manifestation, it should be understood that
they are claiming only against respondents CMC, Dr. Espinola, Dr. Lacson, and Dr. Uy who have filed
their respective comments. Petitioners are foregoing further claims against respondents Dr. Estrada, Dr.
Enriquez, Dr. Villaflor, and Nurse Dumlao.
The Court noted that Dr. Estrada did not appeal the decision of the Court of Appeals affirming the
decision of the Regional Trial Court. Accordingly, the decision of the Court of Appeals, affirming the
trial court's judgment, is already final as against Dr. Oscar Estrada.
Petitioners filed a motion for reconsideration 25 of the Court's 9 September 2002 Resolution claiming
that Dr. Enriquez, Dr. Villaflor and Nurse Dumlao were notified of the petition at their counsels' last
known addresses. Petitioners reiterated their imputation of negligence on these respondents. The Court
denied petitioners' Motion for Reconsideration in its 18 February 2004 Resolution.26
The Court of Appeals' Ruling
In its Decision of 6 February 1998, the Court of Appeals upheld the trial court's ruling. The Court of
Appeals rejected petitioners' view that the doctrine in Darling v. Charleston Community Memorial
Hospital27 applies to this case. According to the Court of Appeals, the present case differs from the
Darling case since Dr. Estrada is an independent contractor-physician whereas the Darling case
involved a physician and a nurse who were employees of the hospital.
Citing other American cases, the Court of Appeals further held that the mere fact that a hospital
permitted a physician to practice medicine and use its facilities is not sufficient to render the hospital
liable for the physician's negligence.28 A hospital is not responsible for the negligence of a physician
who is an independent contractor.29
The Court of Appeals found the cases of Davidson v. Conole30 and Campbell v. Emma Laing Stevens
Hospital31 applicable to this case. Quoting Campbell, the Court of Appeals stated that where there is no
proof that defendant physician was an employee of defendant hospital or that defendant hospital had
reason to know that any acts of malpractice would take place, defendant hospital could not be held
liable for its failure to intervene in the relationship of physician-patient between defendant physician
and plaintiff.
On the liability of the other respondents, the Court of Appeals applied the "borrowed servant" doctrine
considering that Dr. Estrada was an independent contractor who was merely exercising hospital
privileges. This doctrine provides that once the surgeon enters the operating room and takes charge of
the proceedings, the acts or omissions of operating room personnel, and any negligence associated with
such acts or omissions, are imputable to the surgeon. 32 While the assisting physicians and nurses may
be employed by the hospital, or engaged by the patient, they normally become the temporary servants
or agents of the surgeon in charge while the operation is in progress, and liability may be imposed upon
the surgeon for their negligent acts under the doctrine of respondeat superior.33
The Court of Appeals concluded that since Rogelio engaged Dr. Estrada as the attending physician of
his wife, any liability for malpractice must be Dr. Estrada's sole responsibility.
While it found the amount of damages fair and reasonable, the Court of Appeals held that no interest
could be imposed on unliquidated claims or damages.
The Issue
Basically, the issue in this case is whether CMC is vicariously liable for the negligence of Dr. Estrada.
The resolution of this issue rests, on the other hand, on the ascertainment of the relationship between
Dr. Estrada and CMC. The Court also believes that a determination of the extent of liability of the other
respondents is inevitable to finally and completely dispose of the present controversy.
The Ruling of the Court
The petition is partly meritorious.
On the Liability of CMC
Dr. Estrada's negligence in handling the treatment and management of Corazon's condition which
ultimately resulted in Corazon's death is no longer in issue. Dr. Estrada did not appeal the decision of
the Court of Appeals which affirmed the ruling of the trial court finding Dr. Estrada solely liable for
damages. Accordingly, the finding of the trial court on Dr. Estrada's negligence is already final.
Petitioners maintain that CMC is vicariously liable for Dr. Estrada's negligence based on Article 2180
in relation to Article 2176 of the Civil Code. These provisions pertinently state:
Art. 2180. The obligation imposed by article 2176 is demandable not only for one's own acts or
omissions, but also for those of persons for whom one is responsible.
xxxx
Employers shall be liable for the damages caused by their employees and household helpers
acting within the scope of their assigned tasks, even though the former are not engaged in any
business or industry.
xxxx
The responsibility treated of in this article shall cease when the persons herein mentioned prove
 that they observed all the diligence of a good father of a family to prevent damage.
Art. 2176. Whoever by act or omission causes damage to another, there being fault or
negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no pre-
existing contractual relation between the parties, is called a quasi-delict and is governed by the
provisions of this Chapter.
Similarly, in the United States, a hospital which is the employer, master, or principal of a physician
employee, servant, or agent, may be held liable for the physician's negligence under the doctrine of
respondeat superior.34
In the present case, petitioners maintain that CMC, in allowing Dr. Estrada to practice and admit
patients at CMC, should be liable for Dr. Estrada's malpractice. Rogelio claims that he knew Dr.
Estrada as an accredited physician of CMC, though he discovered later that Dr. Estrada was not a
salaried employee of the CMC.35 Rogelio further claims that he was dealing with CMC, whose primary
concern was the treatment and management of his wife's condition. Dr. Estrada just happened to be the
specific person he talked to representing CMC.36 Moreover, the fact that CMC made Rogelio sign a
Consent on Admission and Admission Agreement37 and a Consent to Operation printed on the
letterhead of CMC indicates that CMC considered Dr. Estrada as a member of its medical staff.
On the other hand, CMC disclaims liability by asserting that Dr. Estrada was a mere visiting physician
and that it admitted Corazon because her physical condition then was classified an emergency
obstetrics case.38
CMC alleges that Dr. Estrada is an independent contractor "for whose actuations CMC would be a total
stranger." CMC maintains that it had no control or supervision over Dr. Estrada in the exercise of his
medical profession.
The Court had the occasion to determine the relationship between a hospital and a consultant or visiting
physician and the liability of such hospital for that physician's negligence in Ramos v. Court of
Appeals,39 to wit:
In the first place, hospitals exercise significant control in the hiring and firing of consultants and
in the conduct of their work within the hospital premises. Doctors who apply for "consultant"
slots, visiting or attending, are required to submit proof of completion of residency, their
educational qualifications; generally, evidence of accreditation by the appropriate board
(diplomate), evidence of fellowship in most cases, and references. These requirements are
carefully scrutinized by members of the hospital administration or by a review committee set up
by the hospital who either accept or reject the application. This is particularly true with
respondent hospital.
After a physician is accepted, either as a visiting or attending consultant, he is normally required
to attend clinico-pathological conferences, conduct bedside rounds for clerks, interns and
residents, moderate grand rounds and patient audits and perform other tasks and responsibilities,
for the privilege of being able to maintain a clinic in the hospital, and/or for the privilege of
admitting patients into the hospital. In addition to these, the physician's performance as a
specialist is generally evaluated by a peer review committee on the basis of mortality and
morbidity statistics, and feedback from patients, nurses, interns and residents. A consultant
remiss in his duties, or a consultant who regularly falls short of the minimum standards
acceptable to the hospital or its peer review committee, is normally politely terminated.
In other words, private hospitals, hire, fire and exercise real control over their attending and
visiting "consultant" staff. While "consultants" are not, technically employees, a point
 which respondent hospital asserts in denying all responsibility for the patient's condition,
the control exercised, the hiring, and the right to terminate consultants all fulfill the
important hallmarks of an employer-employee relationship, with the exception of the
payment of wages. In assessing whether such a relationship in fact exists, the control test is
determining. Accordingly, on the basis of the foregoing, we rule that for the purpose of
allocating responsibility in medical negligence cases, an 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.
The basis for holding an employer solidarily responsible for the negligence of its employee is
found in Article 2180 of the Civil Code which considers a person accountable not only for his
own acts but also for those of others based on the former's responsibility under a relationship of
patria potestas. x x x40 (Emphasis supplied)
While the Court in Ramos did not expound on the control test, such test essentially determines whether
an employment relationship exists between a physician and a hospital based on the exercise of control
over the physician as to details. Specifically, the employer (or the hospital) must have the right to
control both the means and the details of the process by which the employee (or the physician) is to
accomplish his task.41
After a thorough examination of the voluminous records of this case, the Court finds no single evidence
pointing to CMC's exercise of control over Dr. Estrada's treatment and management of Corazon's
condition. It is undisputed that throughout Corazon's pregnancy, she was under the exclusive prenatal
care of Dr. Estrada. At the time of Corazon's admission at CMC and during her delivery, it was Dr.
Estrada, assisted by Dr. Villaflor, who attended to Corazon. There was no showing that CMC had a part
in diagnosing Corazon's condition. While Dr. Estrada enjoyed staff privileges at CMC, such fact alone
did not make him an employee of CMC.42 CMC merely allowed Dr. Estrada to use its facilities43 when
Corazon was about to give birth, which CMC considered an emergency. Considering these
circumstances, Dr. Estrada is not an employee of CMC, but an independent contractor.
The question now is whether CMC is automatically exempt from liability considering that Dr. Estrada
is an independent contractor-physician.
In general, a hospital is not liable for the negligence of an independent contractor-physician. There is,
however, an exception to this principle. The hospital may be liable if the physician is the "ostensible"
agent of the hospital.44 This exception is also known as the "doctrine of apparent authority." 45 In
Gilbert v. Sycamore Municipal Hospital,46 the Illinois Supreme Court explained the doctrine of
apparent authority in this wise:
[U]nder the doctrine of apparent authority a hospital can be held vicariously liable for the
negligent acts of a physician providing care at the hospital, regardless of whether the physician
is an independent contractor, unless the patient knows, or should have known, that the physician
is an independent contractor. The elements of the action have been set out as follows:
"For a hospital to be liable under the doctrine of apparent authority, a plaintiff must show that:
(1) the hospital, or its agent, acted in a manner that would lead a reasonable person to conclude
that the individual who was alleged to be negligent was an employee or agent of the hospital;
(2) where the acts of the agent create the appearance of authority, the plaintiff must also prove
that the hospital had knowledge of and acquiesced in them; and (3) the plaintiff acted in reliance
upon the conduct of the hospital or its agent, consistent with ordinary care and prudence."
 The element of "holding out" on the part of the hospital does not require an express
representation by the hospital that the person alleged to be negligent is an employee. Rather, the
element is satisfied if the hospital holds itself out as a provider of emergency room care without
informing the patient that the care is provided by independent contractors.
The element of justifiable reliance on the part of the plaintiff is satisfied if the plaintiff relies
upon the hospital to provide complete emergency room care, rather than upon a specific
physician.
The doctrine of apparent authority essentially involves two factors to determine the liability of an
independent-contractor physician.
The first factor focuses on the hospital's manifestations and is sometimes described as an inquiry
whether the hospital acted in a manner which would lead a reasonable person to conclude that the
individual who was alleged to be negligent was an employee or agent of the hospital. 47 In this regard,
the hospital need not make express representations to the patient that the treating physician is an
employee of the hospital; rather a representation may be general and implied.48
The doctrine of apparent authority is a species of the doctrine of estoppel. Article 1431 of the Civil
Code provides that "[t]hrough estoppel, an admission or representation is rendered conclusive upon the
person making it, and cannot be denied or disproved as against the person relying thereon." Estoppel
rests on this rule: "Whenever a party has, by his own declaration, act, or omission, intentionally and
deliberately led another to believe a particular thing true, and to act upon such belief, he cannot, in any
litigation arising out of such declaration, act or omission, be permitted to falsify it."49
In the instant case, CMC impliedly held out Dr. Estrada as a member of its medical staff. Through
CMC's acts, CMC clothed Dr. Estrada with apparent authority thereby leading the Spouses Nogales to
believe that Dr. Estrada was an employee or agent of CMC. CMC cannot now repudiate such authority.
First, CMC granted staff privileges to Dr. Estrada. CMC extended its medical staff and facilities to Dr.
Estrada. Upon Dr. Estrada's request for Corazon's admission, CMC, through its personnel, readily
accommodated Corazon and updated Dr. Estrada of her condition.
Second, CMC made Rogelio sign consent forms printed on CMC letterhead. Prior to Corazon's
admission and supposed hysterectomy, CMC asked Rogelio to sign release forms, the contents of
which reinforced Rogelio's belief that Dr. Estrada was a member of CMC's medical staff. 50 The
Consent on Admission and Agreement explicitly provides:
KNOW ALL MEN BY THESE PRESENTS:
I, Rogelio Nogales, of legal age, a resident of 1974 M. H. Del Pilar St., Malate Mla., being the
father/mother/brother/sister/spouse/relative/ guardian/or person in custody of Ma. Corazon, and
representing his/her family, of my own volition and free will, do consent and submit said Ma.
Corazon to Dr. Oscar Estrada (hereinafter referred to as Physician) for cure, treatment,
retreatment, or emergency measures, that the Physician, personally or by and through the
Capitol Medical Center and/or its staff, may use, adapt, or employ such means, forms or
methods of cure, treatment, retreatment, or emergency measures as he may see best and
most expedient; that Ma. Corazon and I will comply with any and all rules, regulations,
directions, and instructions of the Physician, the Capitol Medical Center and/or its staff;
and, that I will not hold liable or responsible and hereby waive and forever discharge and hold
free the Physician, the Capitol Medical Center and/or its staff, from any and all claims of
whatever kind of nature, arising from directly or indirectly, or by reason of said cure, treatment,
or retreatment, or emergency measures or intervention of said physician, the Capitol Medical
 Center and/or its staff.
x x x x51 (Emphasis supplied)
While the Consent to Operation pertinently reads, thus:
I, ROGELIO NOGALES, x x x, of my own volition and free will, do consent and submit said
CORAZON NOGALES to Hysterectomy, by the Surgical Staff and Anesthesiologists of
Capitol Medical Center and/or whatever succeeding operations, treatment, or emergency
measures as may be necessary and most expedient; and, that I will not hold liable or responsible
and hereby waive and forever discharge and hold free the Surgeon, his assistants,
anesthesiologists, the Capitol Medical Center and/or its staff, from any and all claims of
whatever kind of nature, arising from directly or indirectly, or by reason of said operation or
operations, treatment, or emergency measures, or intervention of the Surgeon, his assistants,
anesthesiologists, the Capitol Medical Center and/or its staff.52 (Emphasis supplied)
Without any indication in these consent forms that Dr. Estrada was an independent contractor-
physician, the Spouses Nogales could not have known that Dr. Estrada was an independent contractor.
Significantly, no one from CMC informed the Spouses Nogales that Dr. Estrada was an independent
contractor. On the contrary, Dr. Atencio, who was then a member of CMC Board of Directors, testified
that Dr. Estrada was part of CMC's surgical staff.53
Third, Dr. Estrada's referral of Corazon's profuse vaginal bleeding to Dr. Espinola, who was then the
Head of the Obstetrics and Gynecology Department of CMC, gave the impression that Dr. Estrada as a
member of CMC's medical staff was collaborating with other CMC-employed specialists in treating
Corazon.
The second factor focuses on the patient's reliance. It is sometimes characterized as an inquiry on
whether the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with
ordinary care and prudence.54
The records show that the Spouses Nogales relied upon a perceived employment relationship with
CMC in accepting Dr. Estrada's services. Rogelio testified that he and his wife specifically chose Dr.
Estrada to handle Corazon's delivery not only because of their friend's recommendation, but more
importantly because of Dr. Estrada's "connection with a reputable hospital, the [CMC]." 55 In other
words, Dr. Estrada's relationship with CMC played a significant role in the Spouses Nogales' decision
in accepting Dr. Estrada's services as the obstetrician-gynecologist for Corazon's delivery. Moreover, as
earlier stated, there is no showing that before and during Corazon's confinement at CMC, the Spouses
Nogales knew or should have known that Dr. Estrada was not an employee of CMC.
Further, the Spouses Nogales looked to CMC to provide the best medical care and support services for
Corazon's delivery. The Court notes that prior to Corazon's fourth pregnancy, she used to give birth
inside a clinic. Considering Corazon's age then, the Spouses Nogales decided to have their fourth child
delivered at CMC, which Rogelio regarded one of the best hospitals at the time.56 This is precisely
because the Spouses Nogales feared that Corazon might experience complications during her delivery
which would be better addressed and treated in a modern and big hospital such as CMC. Moreover,
Rogelio's consent in Corazon's hysterectomy to be performed by a different physician, namely Dr.
Espinola, is a clear indication of Rogelio's confidence in CMC's surgical staff.
CMC's defense that all it did was "to extend to [Corazon] its facilities" is untenable. The Court cannot
close its eyes to the reality that hospitals, such as CMC, are in the business of treatment. In this regard,
the Court agrees with the observation made by the Court of Appeals of North Carolina in Diggs v.
Novant Health, Inc.,57 to wit:
 "The conception that the hospital does not undertake to treat the patient, does not undertake to
act through its doctors and nurses, but undertakes instead simply to procure them to act upon
their own responsibility, no longer reflects the fact. Present day hospitals, as their manner of
operation plainly demonstrates, do far more than furnish facilities for treatment. They
regularly employ on a salary basis a large staff of physicians, nurses and internes [sic], as
well as administrative and manual workers, and they charge patients for medical care and
treatment, collecting for such services, if necessary, by legal action. Certainly, the person
who avails himself of 'hospital facilities' expects that the hospital will attempt to cure him,
not that its nurses or other employees will act on their own responsibility." x x x (Emphasis
supplied)
Likewise unconvincing is CMC's argument that petitioners are estopped from claiming damages based
on the Consent on Admission and Consent to Operation. Both release forms consist of two parts. The
first part gave CMC permission to administer to Corazon any form of recognized medical treatment
which the CMC medical staff deemed advisable. The second part of the documents, which may
properly be described as the releasing part, releases CMC and its employees "from any and all claims"
arising from or by reason of the treatment and operation.
The documents do not expressly release CMC from liability for injury to Corazon due to negligence
during her treatment or operation. Neither do the consent forms expressly exempt CMC from liability
for Corazon's death due to negligence during such treatment or operation. Such release forms, being in
the nature of contracts of adhesion, are construed strictly against hospitals. Besides, a blanket release in
favor of hospitals "from any and all claims," which includes claims due to bad faith or gross
negligence, would be contrary to public policy and thus void.
Even simple negligence is not subject to blanket release in favor of establishments like hospitals but
may only mitigate liability depending on the circumstances. 58 When a person needing urgent medical
attention rushes to a hospital, he cannot bargain on equal footing with the hospital on the terms of
admission and operation. Such a person is literally at the mercy of the hospital. There can be no clearer
example of a contract of adhesion than one arising from such a dire situation. Thus, the release forms of
CMC cannot relieve CMC from liability for the negligent medical treatment of Corazon.
On the Liability of the Other Respondents
Despite this Court's pronouncement in its 9 September 2002 59 Resolution that the filing of petitioners'
Manifestation confined petitioners' claim only against CMC, Dr. Espinola, Dr. Lacson, and Dr. Uy, who
have filed their comments, the Court deems it proper to resolve the individual liability of the remaining
respondents to put an end finally to this more than two-decade old controversy.
a) Dr. Ely Villaflor
Petitioners blame Dr. Ely Villaflor for failing to diagnose the cause of Corazon's bleeding and to
suggest the correct remedy to Dr. Estrada.60 Petitioners assert that it was Dr. Villaflor's duty to correct
the error of Nurse Dumlao in the administration of hemacel.
The Court is not persuaded. Dr. Villaflor admitted administering a lower dosage of magnesium sulfate.
However, this was after informing Dr. Estrada that Corazon was no longer in convulsion and that her
blood pressure went down to a dangerous level. 61 At that moment, Dr. Estrada instructed Dr. Villaflor
to reduce the dosage of magnesium sulfate from 10 to 2.5 grams. Since petitioners did not dispute Dr.
Villaflor's allegation, Dr. Villaflor's defense remains uncontroverted. Dr. Villaflor's act of administering
a lower dosage of magnesium sulfate was not out of her own volition or was in contravention of Dr.
Estrada's order.
b) Dr. Rosa Uy
Dr. Rosa Uy's alleged negligence consisted of her failure (1) to call the attention of Dr. Estrada on the
incorrect dosage of magnesium sulfate administered by Dr. Villaflor; (2) to take corrective measures;
and (3) to correct Nurse Dumlao's wrong method of hemacel administration.
The Court believes Dr. Uy's claim that as a second year resident physician then at CMC, she was
merely authorized to take the clinical history and physical examination of Corazon. 62 However, that
routine internal examination did not ipso facto make Dr. Uy liable for the errors committed by Dr.
Estrada. Further, petitioners' imputation of negligence rests on their baseless assumption that Dr. Uy
was present at the delivery room. Nothing shows that Dr. Uy participated in delivering Corazon's baby.
Further, it is unexpected from Dr. Uy, a mere resident physician at that time, to call the attention of a
more experienced specialist, if ever she was present at the delivery room.
c) Dr. Joel Enriquez
Petitioners fault Dr. Joel Enriquez also for not calling the attention of Dr. Estrada, Dr. Villaflor, and
Nurse Dumlao about their errors.63 Petitioners insist that Dr. Enriquez should have taken, or at least
suggested, corrective measures to rectify such errors.
The Court is not convinced. Dr. Enriquez is an anesthesiologist whose field of expertise is definitely
not obstetrics and gynecology. As such, Dr. Enriquez was not expected to correct Dr. Estrada's errors.
Besides, there was no evidence of Dr. Enriquez's knowledge of any error committed by Dr. Estrada and
his failure to act upon such observation.
d) Dr. Perpetua Lacson
Petitioners fault Dr. Perpetua Lacson for her purported delay in the delivery of blood Corazon
needed.64 Petitioners claim that Dr. Lacson was remiss in her duty of supervising the blood bank staff.
As found by the trial court, there was no unreasonable delay in the delivery of blood from the time of
the request until the transfusion to Corazon. Dr. Lacson competently explained the procedure before
blood could be given to the patient.65 Taking into account the bleeding time, clotting time and cross-
matching, Dr. Lacson stated that it would take approximately 45-60 minutes before blood could be
ready for transfusion.66 Further, no evidence exists that Dr. Lacson neglected her duties as head of the
blood bank.
e) Dr. Noe Espinola
Petitioners argue that Dr. Espinola should not have ordered immediate hysterectomy without
determining the underlying cause of Corazon's bleeding. Dr. Espinola should have first considered the
possibility of cervical injury, and advised a thorough examination of the cervix, instead of believing
outright Dr. Estrada's diagnosis that the cause of bleeding was uterine atony.
Dr. Espinola's order to do hysterectomy which was based on the information he received by phone is
not negligence. The Court agrees with the trial court's observation that Dr. Espinola, upon hearing such
information about Corazon's condition, believed in good faith that hysterectomy was the correct
remedy. At any rate, the hysterectomy did not push through because upon Dr. Espinola's arrival, it was
already too late. At the time, Corazon was practically dead.
f) Nurse J. Dumlao
In Moore v. Guthrie Hospital Inc.,67 the US Court of Appeals, Fourth Circuit, held that to recover, a
patient complaining of injuries allegedly resulting when the nurse negligently injected medicine to him
intravenously instead of intramuscularly had to show that (1) an intravenous injection constituted a lack
of reasonable and ordinary care; (2) the nurse injected medicine intravenously; and (3) such injection
was the proximate cause of his injury.
In the present case, there is no evidence of Nurse Dumlao's alleged failure to follow Dr. Estrada's
specific instructions. Even assuming Nurse Dumlao defied Dr. Estrada's order, there is no showing that
side-drip administration of hemacel proximately caused Corazon's death. No evidence linking
Corazon's death and the alleged wrongful hemacel administration was introduced. Therefore, there is
no basis to hold Nurse Dumlao liable for negligence.
On the Award of Interest on Damages
The award of interest on damages is proper and allowed under Article 2211 of the Civil Code, which
states that in crimes and quasi-delicts, interest as a part of the damages may, in a proper case, be
adjudicated in the discretion of the court.68
WHEREFORE, the Court PARTLY GRANTS the petition. The Court finds respondent Capitol
Medical Center vicariously liable for the negligence of Dr. Oscar Estrada. The amounts of P105,000 as
actual damages and P700,000 as moral damages should each earn legal interest at the rate of six percent
(6%) per annum computed from the date of the judgment of the trial court. The Court affirms the rest of
the Decision dated 6 February 1998 and Resolution dated 21 March 2000 of the Court of Appeals in
CA-G.R. CV No. 45641.
SO ORDERED.
Quisumbing, J., Chairperson, Carpio Morales, Tinga, and Velasco, Jr., JJ., concur