Ramos vs.

CA
G.R. No. 124354 December 29, 1999

FACTS:

June 17, 1985 afternoon: Erlinda Ramos, 47-year old robust woman
underwent on an operation to the stone at her gall bladder removed after
being tested that she was fit for "cholecystectomy" operation performed
by Dr. Orlino Hozaka. Dr. Hosaka charged a fee of P16,000.00, which was to
include the anesthesiologist's fee and which was to be paid after the
operation. He assured Rogelio E. Ramos, husband that he will get a
good anesthesiologist who was Dra. Perfecta Gutierrez. Erlinda's hand was
held by Herminda Cruz, her sister -in-law who was the Dean of the College of
Nursing at the Capitol Medical Center together with her husband went down
with her to the operating room.

Instead of 9:30 am, Dr. Hosaka arrived at about 12:15 P.M. Herminda noticing
what Dra. Perfecta Gutierrez was doing, saw the nailbed of Erlinda becoming
bluish and Dr. Hosaka called for another anesthesiologist Dr. Calderon. She
went out of the operating room to tell Rogelio that something is wrong. When
she went back she saw Erlinda in a trendelenburg position and at 3 p.m. she
was taken to the Intensive Care Unit (ICU) where she stayed for a month due
to bronchospasm incurring P93,542.25 and she was since then
comatosed. She suffered brain damage as a result of the absence of oxygen
in her brain for four to five minutes. She was also diagnosed to be suffering
from "diffuse cerebral parenchymal damage." Monthly expenses ranged from
P8,000 to P10,000.

Spouses Ramos and their minors filed against Dr. Hosaka and Dra. Perfecta
Gutierrez. RTC: favored the Ramos' awarding P8,000 as actual monthly
expenses totalling to P632,000 as of April 15, 1992, P100,000 atty.
fees, P800,000 moral damages,P200,000 exemplary damages and cost of
suit. CA: reversed ordering the Ramos' to pay their unpaid bills of P93,542.25
plus interest.

ISSUE:
W/N the Ramos' are entitled to damages

HELD:
YES. CA modified in favor of petitioners, and solidarily against private
respondents the following: 1) P1,352,000 actual damages computed as of
the date of promulgation plus a monthly payment of P8,000.00 up to the
time that petitioner Erlinda Ramos expires or miraculously survives; 2)
P2,000,000 moral damages, 3) P1,500,000 temperate damages; 4) P100,000
exemplary damages and P100,000 attorney's fees; and, 5) the costs of the
suit.

The application of res ipsa loquitur in medical negligence cases presents a

question of law since it is a judicial function to determine whether a certain
set of circumstances does, as a matter of law, permit a given inference.
Doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert
medical testimony is dispensed with because the injury itself provides the
proof of negligence - applicable in this case. It can have no application in a
suit against a physician or surgeon which involves the merits of a diagnosis
or of a scientific treatment

As borne by the records, respondent Dra. Gutierrez failed to properly

intubate the patient according to witness Herminda. With her clinical
background as a nurse, the Court is satisfied with her testimony. Dra.
Gutierrez' act of seeing her patient for the first time only an hour before the
scheduled operative procedure was, therefore, an act of exceptional
negligence and professional irresponsibility

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.

Dr. Jamora, not an anesthesiologist, stated that oxygen deprivation which led
to anoxic encephalopathy was due to an unpredictable drug reaction to the
short-acting barbiturate was not accepted as expert opinion

Dr. Hosaka's negligence can be found in his failure to exercise the proper
authority in not determining if his anesthesiologist observed proper
anesthesia protocols. Dr. Hosaka had scheduled another procedure in a
different hospital at the same time as Erlinda's cholecystectomy, and was in
fact over three hours late for the latter's operation. Because of this, he had
little or no time to confer with his anesthesiologist regarding the anesthesia
delivery. This indicates that he was remiss in his professional duties towards
his patient .

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.
Art. 2199. Except as provided by law or by stipulation, one is entitled to an
adequate compensation only for such pecuniary loss suffered by him as he
has duly proved. Such compensation is referred to as actual or compensatory
damages.

Temperate damages can and should be awarded on top of actual or

compensatory damages in instances where the injury is chronic and
continuing. And because of the unique nature of such cases, no
incompatibility arises when both actual and temperate damages are
provided for. The reason is that these damages cover two distinct phases.

They should not be compelled by dire circumstances to provide substandard

care at home without the aid of professionals, for anything less would be
grossly inadequate. Under the circumstances, an award of P1,500,000.00 in
temperate damages would therefore be reasonable.
The damage done to her would not only be permanent and lasting, it would
also be permanently changing and adjusting to the physiologic changes
which her body would normally undergo through the years.

Erlinda Ramos was in her mid-forties when the incident occurred. She has
been in a comatose state for over fourteen years now. Ramos' are charged
with the moral responsibility of the care of the victim. The family's moral
injury and suffering in this case is clearly a real one. Award of P2,000,000 in
moral damages would be appropriate.

Finally, by way of example, exemplary damages in the amount of

P100,000.00 are hereby awarded. Considering the length and nature of the
instant suit we are of the opinion that attorney's fees valued at P100,000 are
likewise proper.