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1. G.R No. L-15079 Pp vs.

Ventura
Facts:
The accused Guillermo Ventura was charged with illegal practice of medicine,
punishable under Section 770 in connection with Sec. 2678 of the Revised
Administrative Code. He allegedly employed electricity, water and hand on
treating human ailments he had diagnosed himself. The accused admitted this but
denied that such acts constituted the practice of medicine. He alleged that his
practice was a drugless system of healing, a separate and distinct profession, not
covered by the Medical Law.

He further alleged that for the past 35 years, he had been practicing as a
naturopathic physician, without a license to practice medicine, but with an implied
license to practice, which he obtained because he was permitted by the Chairman
of the Board of Medical Examiners to serve free in the Central Luzon Sanitarium.
He had treated about 500,000 patients, about 90% of whom were healed, and that
he had studied drugless healing in Chicago for about four years.

Issue:
Whether or not the defendant’s acts constituted illegal practice of medicine?

Ruling:
Yes. The statutory definition as to what acts constitute illegal practice of medicine
in Section 770 includes the acts and practices performed by appellant. By his own
statements, he admitted to have continuously diagnosed and treated about 500,000
instances of different kinds of human ailments and to have prescribed remedies
therefor.

There is no such thing as implied license to practice drugless healing from the
permission of the Chairman of the Board of Medical Examiners, regardless
whether there are countless people who have persisted in engaging his services.
Such patients might have contracted his services on the mistaken notion that he
was duly licensed to practice his profession; for another, a repetition of illegal acts
can never make them legal.

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2. G.R No. 89572 DECS vs San Diego
Facts:
The private respondent is a Zoology graduate of the University of the East. He took
and failed the National Medical Admission Test (NMAT) three times. He was not
allowed by the petitioner to take it again. In the RTC of Valenzuela, he petitioned
to take it again, invoking his constitutional rights to academic freedom and quality
education. While the case was still pending, he took it twice more and failed twice
more. His petition was granted by the judge, holding that he was deprived of his
right to pursue a medical education through an arbitrary exercise of police power.

Issue:
Whether or not the respondent should be allowed to take the NMAT again?

Ruling:
No. The court has already upheld the constitutionality of the NMAT as a measure
intended to limit the admission to medical schools only to those who have initially
proved their competence and preparation for a medical education. The regulation
of the practice of medicine in all its branches has long been recognized as a
reasonable method of protecting the health and safety of the public. Such
regulation includes the power to regulate admission to the ranks of those
authorized to practice medicine. Legislation and administrative regulations
requiring those who wish to practice medicine first to take and pass medical board
examinations have long been recognized as valid exercises of governmental power.

While every person is entitled to be a doctor, he does not have a constitutional


right to be a doctor. This is true of any other calling in which the public interest is
involved. The State has the responsibility to harness its human resources and to see
to it that they are not dissipated or not used at all. A person cannot insist on being a
physician if he will be a menace to his patients.

The right to quality education invoked by the private respondent is not absolute.
The constitution provides that, “every citizen has the right to choose a profession
or course of study, subject to fair, reasonable and equitable admission and
academic requirements.” The private respondent must yield to the challenged
three-flunk rule and give way to those better prepared. Where even those who have
qualified may still not be accommodated in the already crowded medical schools,
there is more reason to bar those who, like him, have been tested and found
wanting. It is not enough to simply invoke the right to quality education as a
guarantee of the Constitution: one must show that he is entitled to it because of his
preparation and promise. The private respondent has failed the NMAT five times.
While his persistence is noteworthy, it is certainly misplaced, like a hopeless love.

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3. G.R Nos. 89095 & 89555 Crisostomo vs SEC
Facts:
The petitioner and his group owned 40% of the outstanding capital stock of the
United Doctors Medical Center (UDMC). Despite their minority, they still
managed UDMC.

UDMC defaulted in paying its loan obligation of P55 million to the DBP. Its
assets, principally its hospital, which had been given as collateral to the DBP,
faced foreclosure. To stave off the threatened foreclosure, UDMC, through its
principal officers persuaded the Yamadas, some of whom were Japanese doctors,
and Enatsu, a Japanese doctor whose wife was a Filipina. They invested P57
million, amounting to a subscription of 82.09% of the outstanding shares of
UDMC.

After the infusion of capital, the petitioner filed a case with the SEC against the
board of directors, asking the SEC to disqualify the Japanese investors from
holding a controlling interest in UDMC and from being elected directors or
officers of the same. He alleged that the investments of the Japanese doctors
amounted to a violation of the prohibition of foreigners practicing a profession in
the Philippines because they do not practice their profession of medicine in the
Philippines nor have they applied for a license to do so.

Issue:
Whether or not the investments of the Japanese doctors in the UDMC amounts to
the practice of medicine?

Ruling:
No. The investments of UDMC of the Japanese doctors do not violate the
Constitutional prohibition against foreigners practicing a profession in the
Philippines, for they do not practice their profession of medicine in the Philippines,
neither have they applied for a license to do so. They only own shares of stock in a
corporation that operates a hospital. No law limits the sale of hospital shares of
stock to doctors only. The ownership of such shares does not amount to illegally
engaging in the practice of medicine. Otherwise, the petitioner’s stockholding in
the UDMC would also be illegal.

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4. G.R No. 118231 July 5, 1996 Dr. Victoria L Batiquin, et al vs. CA
Doctrine: The doctrine of res 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.

Facts:
Dr. Batiquin, was a Resident Physician at the Negros Oriental Provincial Hospital
from 1978 to 1989 and also became the Actg. Head of the Dept. of Obstetrics and
Gynecology at the said hospital. Consequently, Dr. Batiquin with the assistance of
Dr. Sy and some student nurses performed a simple cesarean section on Dr.
Batiquin’s private patient Mrs. Villegas on September 21, 1988. She remained
confined and was regularly visited by Dr. Batiquin until her release from
confinement On September 28, 1988.

Mrs. Villegas began to suffer abdominal pains and complained of being feverish
and she also gradually lost her appetite so she consulted Dr. Batiquin at the latter's
polyclinic who prescribed for her certain medicines and a medical certificate
indicating that she was fit to go back to work. However, the abdominal pains and
fever kept recurring.
When the pains became unbearable she consulted Dr. Ma. Salud Kho at the Holy
Child's Hospital Dumaguete and she was found to have an infection inside her
abdominal cavity and an abdominal mass below the umbilicus and suggested
another surgery. Dr. Kho during the operation found ovarian cysts on each ovary
and a piece of rubber ("rubber glove”) on the right side of the uterus. This foreign
body was the cause of the infection of the ovaries.

The trial court held in favor of Dr. Batiquin saying that based on Dr. Kho's
testimony, the presence of rubber is mere hearsay. The Court of Appeals reversed
the decision of the trial court holding that the fault or negligence of Dr. Batiquin is
established by preponderance of evidence.

Issue:
Whether or not Dr. Batiquin is liable for negligence?

Ruling:
Yes. The phrase relied upon by the trial court does not negate the fact that Dr. Kho
saw a piece of rubber in private respondent's abdomen and that it was sent to a
laboratory. Dr. Batiquin testified that no rubber drain was used in the operation
which was corroborated by Dr. Sy but such statements are mere denial or negative
testimonies.

Given the situation the Court applies the doctrine of res ipsa loquitur: "Where the
thing which causes injury is shown to be under the management of the defendant,
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and the accident is such as in the ordinary course of things does not happen if those
who have the management use proper care, it affords reasonable evidence, in the
absence of an explanation by the defendant, that the accident arose from want of
care."
All the requisites of res ipsa loquitur exist in this case.
(1) First, the entire proceedings of the caesarean section were under the
exclusive control of Dr. Batiquin.
(2) 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 cesarean section performed by Dr. Batiquin.
Thus, 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.

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5. GR No. 122445 Leonila Garcia-Rueda vs. Wilfred L. Pascasio, et al
Doctrine: In order to successfully pursue such of medical negligence, a patient
must prove that a health care provider, in most cases a physician, either failed to do
something which a reasonably prudent health care provider would have done, or
that he or she did something that a reasonably prudent provider would not have
done; and that that failure or action caused injury to the patient." Hence, there are
four elements involved in medical negligence cases: duty, breach, injury and
proximate causation

Facts:
Florencio V. Rueda, husband of herein petitioner, underwent surgical operation at
the UST Hospital for the removal of a stone blocking his ureter. He was attended
by a surgeon, Dr. Domingo Antonio, Jr. and an anaesthesiologist, Dr. Erlinda
Balatbat-Reyes. However, six hours after the surgery, Florencio died of
complications of unknown cause. Petitioner sought the help of the NBI to conduct
an autopsy on her husband's body and its finding was that Florencio's death was
due to lack of care by the attending physician in administering anaesthesia.

A formal complaint for Homicide through Reckless Imprudence was then led
before the Manila City Prosecutors Office. In said office, petitioner's case was
transferred from one prosecutor to another who came out with contradictory
recommendations. When the case was transferred to Senior State Prosecutor
Arizala, the latter resolved to exonerate Dr. Reyes from any wrongdoing.
Aggrieved petitioner led graft charges against Prosecutors Guerrero, Macaraeg and
Arizala for manifest partiality in favor of Dr. Reyes in the Office of the
Ombudsman. The Ombudsman, however, dismissed the complaint for lack of
evidence.

Issue:
Whether or not expert testimony is necessary to prove the negligent act of the
respondent?

Ruling:
Yes. In medical malpractice or negligence cases, this is the type of claim which a
victim has available to him or her to redress a wrong committed by a medical
professional which has caused bodily harm. In order to successfully pursue such a
claim, a patient must prove that a health care provider, in most cases a physician,
either failed to do something which a reasonably prudent health care provider
would have done, or that he or she did something that a reasonably prudent
provider would not have done; and that that failure or action caused injury to the
patient. Hence, there are four elements involved in medical negligence cases: duty,
breach, injury and proximate causation. Consequently, in the event that any injury
results to the patient from want of due care or skill during the operation, the
surgeons may be held answerable in damages for negligence.
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Thus, in malpractice or negligence cases involving the administration of
anesthesia, the necessity of expert testimony and the availability of the charge of
res ipsa loquitur to the plaintiff, have been applied in actions against
anesthesiologists to hold the defendant liable for the death or injury of a patient
under excessive or improper anesthesia. Essentially, it requires two-pronged
evidence: evidence as to the recognized standards of the medical community in the
particular kind of case, and a showing that the physician in question negligently
departed from this standard in his treatment.

Another element in medical negligence cases is causation which is divided into


two inquiries: whether the doctor’s actions in fact caused the harm to the patient
and whether these were the proximate cause of the patient’s injury. Indeed here, a
causal connection is discernible from the occurrence of the victim’s death after the
negligent act of the anesthesiologist in administering the anesthesia, a fact which,
if confirmed, should warrant the filing of the appropriate criminal case. To be sure,
the allegation of negligence is not entirely baseless. Moreover, the NBI deduced
that the attending surgeons did not conduct the necessary interview of the patient
prior to the operation. It appears that the cause of the death of the victim could
have been averted had the proper drug been applied to cope with the symptoms of
malignant hyperthermia. Also, we cannot ignore the fact that an antidote was
readily available to counteract whatever deleterious effect the anesthesia might
produce.

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6. G.R No. 122445 November 18, 1997 Dr. Ninevetch Cruz vs. CA.
Doctrine: In order that there may be a recovery for an injury, however, it must be
shown that the 'injury for which recovery is sought must be the legitimate
consequence of the wrong done; the connection between the negligence and the
injury must be a direct and natural sequence of events, unbroken by intervening
efficient causes. In other words, the negligence must be the proximate cause of the
injury. For, 'negligence, no matter in what it consists, cannot create a right of
action unless it is the proximate cause of the injury complained of.' And 'the
proximate cause of an injury is that cause, which, in natural and continuous
sequence, unbroken by any efficient intervening cause, produces the injury, and
without which the result would not have occurred.

Facts:
On March 22, 1991, prosecution witness, Rowena Umali de Ocampo, accompanied
her mother to the Perpetual Help Clinic and General Hospital situated in Balagtas
Street, San Pablo City, Laguna. They arrived at the said hospital at around 4:30 in
the afternoon of the same day. Prior to March 22, 1991, Lydia was examined by
the petitioner who found a “Myoma” in her uterus, and scheduled her for a
hysterectomy operation on March 23, 1991. Rowena and her mother slept in the
clinic on the evening of March 22, 1991 as the latter was to be operated on the next
day at 1pm.

According to Rowena, she noticed that the clinic was untidy and the windows and
the floor were very dusty prompting her to ask the attendant for a rag to wipe the
window and floor with. Prior to the operation, Rowena tried to convince her
mother to not proceed with the operation and even asked petitioner for it to be
postponed. However, Lydia then informed Rowena that the petitioner told her that
she must be operated on as scheduled.

During the operation, the assisting doctor of the petitioner, Dr. Ercillo went out of
the operating room and asked that tagmet ampules be bought which was followed
by another instruction to buy a bag of blood. After the operation, when Lydia came
out of the operating room, another bag of blood was requested to be bought,
however, the same was not bought due to unavailability of type “A” from the blood
bank. Thereafter, a person arrived to donate blood which was later transferred to
Lydia. Rowena then noticed her mother, gasping for breath as the oxygen tank is
empty, so her husband and petitioner’s driver bought oxygen. Later, without the
knowledge of Lydia’s relatives, she was decided by the doctors to be transferred to
San Pablo District Hospital where she was supposed to be re-operated. While the
petitioner was closing the abdominal wall, the patient died After Lydia experienced
shocks, she died. Her death certificate states "shock" as the immediate cause of
death and "Disseminated Intravascular Coagulation (DIC)" as the antecedent cause.

Issue:

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Whether or not petitioner’s negligence caused the death of Lydia Umali?

Ruling:
No. When the qualifications of a physician are admitted, there is an inevitable
presumption that he takes the necessary precaution and employs the best of his
knowledge and skill in attending to his clients, unless the contrary is sufficiently
established. The presumption may be rebutted by expert opinion, which is lacking
herein. Petitioner, therefore, was acquitted of the crime of reckless imprudence
resulting in homicide, but she was held civilly liable for the death of the victim.

Whether or not a physician has committed an “inexcusable lack of precaution” in


the treatment of his patient to be determined according to the standard of care
observed by other members of the profession in good standing under similar
circumstances bearing in mind the advanced state of the profession at the time of
treatment or the present state of medical science. In litigations involving medical
negligence, the plaintiff has the burden of establishing appellant’s negligence and
for a reasonable conclusion of negligence, there must be proof of breach of duty on
the part of the surgeon as well as causal connection of such breach and the
resulting death of his patient.

In order that there may be recovery for an injury, however, it must be shown that
the injury for which recovery is sought must be legitimate consequence of the
wrong done; the connection between the negligence and the injury must be a direct
and natural reference of events, unbroken by intervening efficient causes. In other
words, the negligence must be the proximate cause of the injury. For negligence,
no matter what it consists, cannot create a right of action unless it is the proximate
cause of the injury complained of and the proximate cause of an injury is that
cause, which in natural and continuous sequence, unbroken by any efficient
intervening cause, produces the injury and without which the result would have
occurred. In this case, no cogent proof exists that any of these circumstances
caused petitioner's death.

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7. G.R No. 124354 Rogelio E. Ramos, et al. v. CA
Facts: Erlinda Ramos underwent a surgical procedure (Cholecystectomy) to
remove stones from her gall bladder. They hired Dr. Hosaka, a surgeon, to conduct
the surgery at the De Los Santos Medical Center (DLSMC). Dr. Hosaka assured
them that he would find a good anesthesiologist. But the operation did not go as
planned, Dr. Hosaka arrived 3 hours late for the operation, Dra. Gutierrez, the
anesthesiologist “botched” the administration of the anesthesia causing Erlinda to
go into a coma and suffer brain damage. The botched operation was witnessed by
Herminda Cruz, sister in law of Erlinda and Dean of College of Nursing of Capitol
Medical Center.

Sps. Ramos (petitioners) sued the hospital, the surgeon and the anesthesiologist for
damages. The petitioners showed expert testimony showing that Erlinda's
condition was caused by the anesthesiologist in not exercising reasonable care in
“intubating” Erlinda. Eyewitnesses heard the anesthesiologist saying “Ang hirap
ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan.” Diagnostic
tests prior to surgery showed that Erlinda was robust and fit to undergo surgery.

Issue: Whether Dr. Hosaka and Dr. Gutierrez were negligent and are solidarily
liable for the damages?

Ruling: Yes. Erlinda submitted herself for cholecystectomy and expected a routine
general surgery to be performed on her gall bladder. She delivered her person over
to the care, custody and control of private respondents who exercised complete and
exclusive control over her. At the time of submission, Erlinda was neurologically
sound and, except for a few minor discomforts, was likewise physically fit in mind
and body. However, during the administration of anesthesia and prior to the
performance of cholecystectomy she suffered irreparable damage to her brain.
Obviously, brain damage, which Erlinda sustained, is an injury which does not
normally occur in the process of a gall bladder operation. In fact, this kind of
situation does not happen in the absence of negligence of someone in the
administration of anesthesia and in the use of endotracheal tube. Considering that
a sound and unaffected member of the body (the brain) is injured or destroyed
while the patient is unconscious and under the immediate and exclusive control of
the physicians, we hold that a practical administration of justice dictates the
application of res ipsa loquitur.

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8. G.R No. 130547 Leah Alsena Reyes, et al. vs. Sisters of Mercy Hospital, etal.
Facts:
Jorge Reyes, petitioner’s husband, has been suffering from recurring fever with
chills for several days. Home medication afforded him no relief so he went to
Mercy Community Clinic where he was found positive for typhoid fever, attended
by Dr. Marlyn Rico Thereafter, Dr. Marlyn Rico endorsed Jorge Reyes to Dr.
Marvie Blanes. Dr. Marvie Blanes ordered that Jorge be tested for compatibility
with chloromycetin, an antibiotic. Such test was conducted by Nurse Pagente. As
there was no adverse reaction to the antibiotic, Dr. Blanes administered 500 mg of
the antibiotic. Another dose was given 3 hours later. Subsequently, Jorge Reyes
developed high fever and experienced vomiting and convulsions. He then turned
blue due to deficiency in oxygen – cyanosis – and died. The cause of death was
stated to be “ventricular arrhythmia secondary to hyperpyrexia and typhoid fever.”
The heirs of Reyes filed with the RTC a complaint for damages against Sisters of
Mercy, Sister Rose Palacio, Dr. Blanes, Dr. Rico and Mercy Community Clinic
contending that the death of Jorge was due to the wrongful administration of
chloromycetin. RTC ruled in favor of the respondents. The CA affirmed in toto the
RTC decision. Hence, this appeal.

Issue:
Whether or not Sisters of Mercy Hospital and its doctors are liable for the death of
Jorge Reyes?

Ruling:
No. There is no showing that the attending physician in this case deviated from the
usual course of treatment with respect to typhoid fever. Jorge was given antibiotic
Chloromycetin and some dose of Triglobe after compatibility test was made by the
doctor and found that no adverse reactions manifested which would necessitate
replacement of the medicines. Indeed, the standard contemplated is not what is
actually the average merit among all known practitioners from the best to the worst
and from the most to the least experienced, but the reasonable average merit
among the ordinarily good physicians. Here, the doctors did not depart from the
reasonable standard recommended by the experts as they in fact observed the due
care required under the circumstances.

In Medical Negligence cases, it is incumbent upon the plaintiff to establish that the
usual procedure in treating the illness is not followed by the doctor. Failure to
prove this, the doctor is not liable. Physicians are not insurers of the success of
every procedure undertaken and if the procedure was shown to be properly done
but did not work, they cannot be faulted for such result.

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9. G.R No. 126297 Professional Services, Inc. vs. Natividad and Enrique
Agana
Facts:
Natividad Agana was rushed to the Medical City General Hospital because of
difficulty of bowel movement and bloody anal discharge. After a series of medical
examinations, Dr. Ampil diagnosed her to be suffering from cancer of the sigmoid,
thus an anterior resection surgery was done on Natividad. Dr. Ampil found that the
malignancy on her sigmoid area had spread on her left ovary, necessitating the
removal of certain portions of it. Thus, Dr. Ampil obtained the consent of
Natividad’s husband, Enrique Agana, to permit Dr. Juan Fuentes to perform
hysterectomy on her. After Dr. Fuentes had completed the hysterectomy, Dr.
Ampil took over, completed the operation and closed the incision after searching
for the missing 2 gauzes as indicated by the assisting nurses but failed to locate it.
After a couple of days, Natividad complained of excruciating pains in her anal
region but Dr. Ampil said it is a natural consequence of the operation/surgery and
recommended that she consult an oncologist to examine the cancerous nodes which
were not removed during the operation. Natividad and her husband went to the US
to seek further treatment and she was declared free from cancer. A piece of gauze
portruding from Natividad’s vagina was found by her daughter which was then
removed by hand by Dr. Ampil and assured that the pains will vanish. However, it
didn’t. The pains intensified prompting Natividad to seek treatment at the
Polymedic General Hospital. While confined there, Dr. Ramon Gutierrez detected
the presence of another foreign object in her vagina – a foul smelling gauze
measuring 1.5 inches in width which badly infected her vagina. Another surgical
operation was needed to remedy the damage.

Issue:
Whether Dr. Ampil is liable for negligence and malpractice?

Ruling:
Yes. Leaving foreign substances in the wound after incision has been closed is at
least prima facie negligence by the operating surgeon. Even if it has been shown
that a surgeon was required to leave a sponge in his patient’s abdomen because of
the dangers attendant upon delay, still, it is his legal duty to inform his patient
within a reasonable time by advising her of what he had been compelled to do, so
she can seek relief from the effects of the foreign object left in her body as her
condition might permit. What’s worse in this case is that he misled her by saying
that the pain was an ordinary consequence of her operation. To successfully pursue
a case of medical negligence, a patient must only prove that a health care provider
failed to do something which a reasonably prudent health care provider would have
done and that the failure or action caused injury to the patient.

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10. G.R. No. 187926 Dr. Emmanuel Jarcia, Jr. and Dr. Marilou Bastan vs.
People of the Philippines
Facts:
Belinda Santiago lodged a complaint with the National Bureau of Investigation
(NBI) against the petitioners, Dr. Emanuel Jarcia and Dr. Marilou Bastan, for their
alleged neglect of professional duty which caused her son, Roy Alfonso Santiago,
to suffer physical injuries. Upon investigation, the NBI found that Roy Jr. was hit
by a taxicab;

That he was rushed to the Manila Doctors Hospital for an emergency medical
treatment; that an X-ray of the victim’s ankle was ordered;

That the X-ray result showed no fracture as read by Dr. Jarcia;

That Dr. Bastan entered the emergency room and, after conducting her own
examination of the victim, informed Mrs. Santiago that since it was only the ankle
that was hit there was no need to examine the upper leg;

That 11 days later, Roy developed fever, swelling of the right leg and
misalignment of the right foot;

That Mrs. Santiago brought him back to the hospital; and that the x-ray revealed a
right mid-tibial fracture and a linear hairline fracture in the shaft of the bone.

A complaint for reckless imprudence resulting physical injuries was filed against
the petitioners for the alleged misconduct in the handling of the illness of Roy.

Issue:
Whether or not the petitioners failed to exercise the degree of care expected of
them as doctors and are liable for negligence to the private respondent?

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

As a rule of evidence, is unusual to the law of negligence which recognizes that


prima facie negligence may be established without direct proof and furnishes a
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substitute for specific proof of negligence. The doctrine however, is not a rule of
substantive law, but merely a mode of proof or a mere procedural convenience the
rule when applicable to the facts and circumstances of a given case, is not meant to
and does not dispense with the requirement of proof of culpable negligence on the
party charged. It merely determines and regulates what shall be prima facie
evidence thereof and helps the plaintiff in proving a breach of duty. The doctrine
can be invoked when and only when, under the circumstances involved, direct
evidence is absolute and not readily available.

The requisites for the application of the doctrine of res ipsa liquitor are:
1. The accident was of a kind which does not ordinarily occur unless
someone is negligent;
2. The instrumentality or agency which caused the injury was under the
exclusive control of the person in charge; and
3. The injury suffered must not have been due to any voluntary action or
contribution of the person injured.

Negligence is defined as the failure to observe for the protection of the interests of
another person that degree of care, precaution and vigilance, which the
circumstances justly demand whereby such other person suffers injury.
Reckless imprudence consists of voluntarily doing or failing to do, without malice,
an act from which material damage results by reason of an inexcusable lack of
precaution on the part of the person performing or failing to perform such act.

In failing to perform an extensive medical examination to determine the extent of


Roy’s injuries, Dr. Jarcia and Dr. Bastan were remiss of their duties as members of
the medical profession. Assuming for the sake of argument that they did not have
the capacity to make such thorough evaluation at that stage they should have
referred the patient to another doctor with sufficient training and experience
instead of assuring him and his mother that everything was all right.

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11. G.R No. 192123 Dr. Fernando P. Solidum vs. People of the Philippines
Doctrine: The doctrine of res ipsa loquitor is applicable in the case at bar and is
literally translated as “the thing or the transaction speaks for itself.” It means that
“where the thing which causes injury is shown to be under the management of the
defendant, and the accident is such as in the ordinary course of things does not
happen if those who have the management use proper case, it affords reasonable
evidence, in the absence of an explanation by the defendant, that the accident arose
from want of case.” It is applied in conjunction with the doctrine of common
knowledge.

Facts:
Gerald Albert Gercayo was born with an imperforate anus. 2 days after his birth,
Gerald underwent colostomy. (A surgical procedure to bring one end of the large
intestine out through the abdominal wall, enabling him to excrete through a
colostomy bag attached to the side of his body.)

3 year after, Gerald was admitted at the Ospital ng Maynila for a pull-through
operation. Petitioner Dr. Solidum was one of the anesthesiologists. During the
operation, Gerald experiences bradycardia (An abnormally slow heart rate of less
than 60 beats per minute. A normal heartbeat is between 60 and 100 beats per
minute.), and went into a come.

His coma lasted for 2 weeks, but he regained consciousness only after a month. He
could no longer see, hear or move.

Agitated by her son’s helpless and unexpected condition, Ma Luz Gercayo lodged
a complaint for reckless imprudence resulting in serious physical injuries.

The Regional Trial Court ruled that the defendants are guilty of reckless
imprudence resulting in serious physical injuries. Solidum failed to monitor and to
properly regulate the level of anesthetic agent administered on Gerald.

The Court of Appeals Affirmed. Applied the doctrine of res ipsa liquitor.

Issues:
Whether or not the doctrine of res ipsa loquitor was applicable?
Whether or not Dr. Solidum was liable for criminal negligence?

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
Ruling:
Yes. The doctrine of res ipsa loquitor is applicable in the case at bar and is literally
translated as “the thing or the transaction speaks for itself.” It means that “where
the thing which causes injury is shown to be under the management of the
defendant, and the accident is such as in the ordinary course of things does not
happen if those who have the management use proper case, it affords reasonable
evidence, in the absence of an explanation by the defendant, that the accident arose
from want of case.” It is applied in conjunction with the doctrine of common
knowledge.

However, the doctrine is not a rule of substantive law, but merely a mode of proof
or a mere procedural convenience. The doctrine, when applicable to the facts and
circumstances of a given case, is not meant to and does not dispense with the
requirement of proof of culpable negligence against the party charged. It merely
determines or regulates what shall be prima facie evidence thereof, and help the
plaintiff in proving a breach of duty. It can be invoked on when, under the
circumstances involved, direct evidence is absent and not readily available.

Essential requisites:
a) The accident was of a kind that does not ordinarily occur unless someone
is negligent;
b) The instrumentality or agency that caused the injury under the exclusive
control of the person charged; and
c) The injury suffered must not have been due to any voluntary action or
contribution of the person injured.

Although is the 2nd and 3rd element are present, considering that the anesthetic
agent and the instruments were exclusively within the control of Dr. Solidum, and
that the patient, being then unconscious during the operation, could not have been
guilty of contributory negligence, the 1st element was undeniably wanting.
Bradcardia would not ordinarily occur during the process of a pull-through
operation.

Dr. Solidum is NOT liable for criminal negligence, since negligence is defined as
the failure to observe for the protection of the interest of another person that degree
of care, precaution, and vigilance that the circumstances justly demand, whereby
such other person suffers injury.

Reckless imprudence, on the other hand, consists of voluntarily doing or failing to


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

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
The prosecution did not prove the elements of reckless imprudence BRD because
the circumstances cited by the CA were insufficient to establish that Dr. Solidum
had been guilty of inexcusable lack of precaution in monitoring the administration
of the anesthetic agent of Gerald.

An action upon medical negligence – whether criminal, civil or administrative –


calls for the plaintiff to prove by competent evidence each of the following 4
elements, namely;

a) The duty owned by the physician to the patient, as created by the


physician-patient relationship, to act in accordance with the specific norms or
standards established by his profession;
b) The breach of the duty by the physician’s failing to act in accordance with
the applicable standard of care;
c) The causation, i.e., there must be a reasonably close and causal connection
between the negligent act or omission and the resulting injury; and
d) The damages suffered by the patient.

The standard of care is an objective standard by which the conduct of a physician


sued for negligence or malpractice may be measured, and it does not depend,
therefore, on any individual physician's own knowledge either. In attempting to fix
a standard by which a court may determine whether the physician has properly
performed the requisite duty toward the patient, expert medical testimony from
both plaintiff and defense experts is required. The judge, as the trier of fact,
ultimately determines the standard of care, after listening to the testimony of all
medical experts
The testimonies the prosecution presented did not prove beyond reasonable doubt
that Dr. Solidum had been recklessly imprudent in administering the anesthetic
agent to Gerald. Dr. Solidum was criminally charged for “failing to monitor and
regulate properly the levels of anesthesia administered to said Gerla and using
100% halothan and other anesthetic medications.” However, the findings of Dr.
Vertido, one of the anesthesiologist, was revealingly concluded that “although the
anesthesiologists followed the normal routine and precautionary procedures, still
hyproxia (Deficiency in the amount of the oxygen reaching the tissues). and its
corresponding side effects did occur.” Hence, 100% halothan is not what should be
administered, it should be 100% oxygen.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
12. G.R No. 165279 Dr. Rubi Li vs. Spouses Reynaldo and Lina Soliman as
parents/ heirs of deceased Angelica Soliman
DOCTRINE: The doctrine of informed consent within the context of physician-
patient relationships goes as far back into english common law. As early as 1767,
doctors were charged with the tort of battery if they have not gained the consent of
their patients prior to performing a surgery or procedure. In the United States, the
seminal case was Schoendorff vs Society of New York Hospital which involved
unwanted treatment performed by a doctor. Justice Bejamin Cardozo oft-quoted
opinion upheld the basic right of a patient to give consent to any medical procedure
or treatment; every human being of adult year and sound mind has a right to
determine what shall be done with his own body; and a surgeon who performs an
operation without his patient’s consent commits an assault, for which he is liable in
damages. From a purely ethical norm, informed consent evolved into a general
principle of law that a physician has a duty to disclose what a reasonably prudent
physician in the medical community in the exercise of reasonable care would
disclose to his patient as to whatever grave risk of injury might be incurred from a
proposed course of treatment, so that a patient, exercising ordinary care for her
own welfare and faced with a choice of undergoing the proposed treatment, as
alternative treatment, or none at all, may intelligently exercise his judgement by
reasonably balancing the probable risk against the probable benefits.

There are four essential elements a plaintiff must be proved in a malpractice action
based upon the doctrine of informed consent: 1.) the physician had a duty to
disclose material risks; 2.) he failed to disclose or inadequately disclosed those
risks; 3.) as a direct and proximate result of the failure to disclose, the patient
consented to treatment she otherwise would not have consented to; and 4.) plaintiff
was injured by the proposed treatment. The gravamen in an informed consent
requires the plaintiff to point to significant undisclosed information relating to the
treatment which could have altered her decision to undergo it.

Facts:
On July 7, 1993, respondents 11 year old daughter, Angelica Soliman underwent a
biopsy of the mass located in her lower extremity at the St. Lukes Medical Center
(SLMC). Results showed that Angelica was suffering from osteosaucoma,
ostiobiostic type, a high-grade (highly malignant) cancer of the bone which usually
affects teenage children. Following this diagnosis, Angelica’s right leg was
amputated by Dr. Tamayo in order to remove the tumor. As a adjuvant treatment to
eliminate any remaining cancer cells, and hence minimizing the chances of
recurrence and prevent the decease from spreading to other parts of the patient’s
body, chemotherapy was suggested by Dr. Tamayo and referred Angelica to
another doctor at SLMC, herein petitioner Dr. Rubi Li, a medical oncologist.

On July 23, 1993, petitioner saw the respondents at the hospital after Angelica’s
surgery and discussed with them Angelica’s condition. Petitioner told respondents
that Angelica should be given 2-3 weeks to recover from the operation before
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starting the chemotherapy. Respondents were apprehensive due to financial
constraints as Reynaldo earns only from P70,000-150,000 a year from his jewelry
and watching repair business. Petitioner, however, assured them not to worry about
her professional fee and told them to just save up for medicines to be used.

As the chemotherapy session started, day by day, Angelica experience worsening


condition and other physical effect on the body such as discoloration, nausea, and
vomiting.

Petitioner claimed, that she explained to respondents that even when a tumor is
removed, there are still small lesions undetectable to the naked eye and that
adjuvant chemotherapy is needed to clean out the small lesions in order to lessen
the chance of cancer to recur. She did not give the respondents any assurance that
chemotherapy will cure Angelica’s cancer. During these consultations with
respondents, she explained the following side effects of chemotherapy treatment to
respondents: 1.) Falling hair; 2.) nausea and vomiting; 3.) loss of appetite; 4.) low
count of WBC, RBC, and platelets; 5.) possible sterility due to the effects on
Angelica’s ovary; 6.) Damage to kidney and heart; 7.) darkening of the skin
especially when exposed to sunlight. She actually talked to the respondents four
times, once at the hospital after the surgery, twice at her clinic and fourth when
Angelica’s mother called her through long distance. This was disputed by
respondents who countered that petitioner gave them assurance that there is 95%
chance of healing for Angelica if she undergoes chemotherapy and that the only
side effects were nausea, vomiting and hair loss. Those were the only side effects
of chemotherapy mentioned by petitioner.

Issue:
Whether or not petitioner committed medical malpractice?

Ruling:
No. The type of lawsuit which has been called medical malpractice or more
appropriately, medical negligence, is that type of claim which a victim has
available to him or her to redress a wrong committed by a medical professional
which has caused bodily harm. In order to successfully pursue such claim, a patient
must prove that a health care provider in most cases a physician, either failed to do
something which a reasonably prudent health care provider would have done or
that he or she did something that a reasonably health care provider would not have
done; and that failure or action caused injury to the patient.

Medical negligence cases are best proved by opinions of expert witnesses


belonging in the same general neighborhood and in the same general line of
practice as defendant physician or surgeon. The deference of courts to the expert
opinion of qualified physicians stems from the former’s realization that the latter

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
possess unusual technical skills which layman in most instances are incapable of
intelligently evaluating, hence the indispensability of expert testimonies.

The doctrine of informed consent within the context of physician-patient


relationships goes as far back into english common law. As early as 1767, doctors
were charged with the tort of battery if they have not gained the consent of their
patients prior to performing a surgery or procedure. In the United States, the
seminal case was Schoendorff vs Society of New York Hospital which involved
unwanted treatment performed by a doctor. Justice Bejamin Cardozo oft-quoted
opinion upheld the basic right of a patient to give consent to any medical procedure
or treatment; every human being of adult year and sound mind has a right to
determine what shall be done with his own body; and a surgeon who performs an
operation without his patient’s consent commits an assault, for which he is liable in
damages. From a purely ethical norm, informed consent evolved into a general
principle of law that a physician has a duty to disclose what a reasonably prudent
physician in the medical community in the exercise of reasonable care would
disclose to his patient as to whatever grave risk of injury might be incurred from a
proposed course of treatment, so that a patient, exercising ordinary care for her
own welfare and faced with a choice of undergoing the proposed treatment, as
alternative treatment, or none at all, may intelligently exercise his judgement by
reasonably balancing the probable risk against the probable benefits.

There are four essential elements a plaintiff must proved in a malpractice action
based upon the doctrine of informed consent: 1.) the physician had a duty to
disclose material risks; 2.) he failed to disclose or inadequately disclosed those
risks; 3.) as a direct and proximate result of the failure to disclose, the patient
consented to treatment she otherwise would not have consented to; and 4.) plaintiff
was injured by the proposed treatment. The gravamen in an informed consent
requires the plaintiff to point to significant undisclosed information relating to the
treatment which could have altered her decision to undergo it.

Examining the evidence, we hold that there was adequate disclosure of material
risks inherent in chemotherapy procedure performed with the consent of
Angelica’s parents. Respondents could not have been unaware in the course of
initial treatment and amputation of Angelica’s lower extremity that her immune
system was already weak on account of the malignant tumor in her knee.

When petitioner informed the respondents beforehand of the side effects of


chemotherapy which includes lowered counts of white and red blood cells,
decrease in blood platelets, possible kidney or heart damage and skin darkening,
there is reasonable expectation on the part of the doctor that the respondents
understood very well that the severity of these side effects will not be the same for
all patients undergoing the procedure.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
In other words, by the nature of the disease itself, each patients reaction to the
chemical agents even with pre-treatment laboratory tests cannot be precisely
determined by the physician. That death can possibly result from complications of
the treatment or the underlying cancer itself, immediately or sometime after the
administration of chemotherapy drugs, is a risk that cannot be ruled out, as with
most other major medical procedures, but such conclusion can be reasonably
drawn from the general side effects of chemotherapy already disclosed.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
13. G.R No. 175540 Alano vs. Logmao
Facts:
Plaintiff-appellee Zeniada Magud-Logmao is the mother of deceased Arnelito
Logmao. Defendant-appellant Dr. Filoteo Alano is the Executive Director of the
National Kidney Institute (NKI).

On March 1, 1988, Arnelito Logmao was brought to the East Avenue Medical
Center (EAMC) in Quezon City after falling from the overpass in Quezon City.
The patient’s data sheet identified the patient as Angelito Lugmoso of Boni
Avenue, Mandaluyong. However, the clinical abstract prepared by Dr. Cabrera,
the surgical resident on-duty at the Emergency Room of EAMC, stated that the
patient is Angelito [Logmao]. Lugmoso’s condition worsened and admission to the
ICU and mechanical ventilator support became necessary, but there was no
vacancy at the ICU and available ventilator at EAMC.

Angelito was transferred to NKI. At the NKI, the name Angelito [Logmao] was
recorded as Angelito Lugmoso. As Lugmoso had no relatives around, Jennifer B.
Misa, NKI’s Transplant Coordinator, was asked to locate his family by enlisting
police and media assistance. Dr. Enrique T. Ona, Chairman of the Department of
Surgery, observed that the severity of the brain injury of Lugmoso manifested
symptoms of brain death and requested the Laboratory Section to conduct a tissue
typing and tissue cross-matching examination, so that should Lugmoso expire and
he would be found to be a suitable organ donor and his family would consent to
organ donation, the organs could be detached and transplanted promptly to any
compatible beneficiary. Radio, television stations and police assistance were
sought for the purpose of locating the family of Angelito Lugmoso.
Angelito was later pronounced brain dead. Dr. Ona was informed that the EEG
recording confirmed that Lugmoso was brain dead. Upon learning that Lugmoso
was a suitable organ donor and that some NKI patients awaiting organ donation
had blood and tissue types compatible with Lugmoso, Dr. Ona inquired from
Jennifer Misa whether the relatives of Lugmoso had been located so that the
necessary consent for organ donation could be obtained.

The extensive search for the relatives of Lugmoso proved futile and time being of
the essence in the success of organ transplantation, Dr. Ona requested Dr. Filoteo
A. Alano, Executive Director of NKI, to authorize the removal of specific organs
from the body of Lugmoso for transplantation purposes. Dr. Ona likewise
instructed Dr. Rose Marie Rosete-Liquete to secure permission for the planned
organ retrieval and transplantation from the Medico-Legal Office of the NBI.

Dr. Alano issued to Dr. Ona a Memorandum, stating to “make certain that your
Department has exerted all reasonable efforts to locate the relatives or next of
kin of the said deceased patient such as appeal through the radios and television
as well as through police and other government agencies and that the NBI

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
[Medico-Legal] Section has been notified and is aware of the case. If all the above
has been complied with, in accordance with the provisions of Republic Act No.
349 as amended and P.D. 856, permission and/or authority is hereby given to
the Department of Surgery to retrieve and remove the kidneys, pancreas, liver and
heart of the said deceased patient and to transplant the said organs to any
compatible patient who maybe in need of said organs to live and survive.

Aida Doromal, a cousin of plaintiff, heard the news aired on television about a
successful double organ transplantation and that the donor was an eighteen (18)
year old boy whose name sounded like Arnelito Logmao and that the body was at
La Funeraria Oro, Aida informed plaintiff of the news report. Upon receiving the
news from Aida, plaintiff and her other children went to La Funeraria Oro, where
they saw Arnelito inside a cheap casket.

Plaintiff filed a complaint for damages. RTC rendered judgment finding only Dr.
Filoteo Alano liable for damages to plaintiff and dismissing the complaint against
the other defendants for lack of legal basis. The CA affirmed the finding of the
lower court but deleted and reduced the amount of damages.

Issue:
Whether or not respondents failed to obtain consent prior the organ donation?

Ruling:
No. Those who consent to using their organs upon their death for the benefit of
another can make their consent known prior to their death by following the
requirements of the law. Should a patient die prior to making his or her informed
consent known, the law provides a list of persons who may consent on his or her
behalf, that is, “substituted” informed consent. Since the incident in this case
occurred in 1988, Republic Act No. 349, as amended by Republic Act No. 1056, is
the law that applies. Section 2 of the law states that: SEC. 2. The authorization
referred to in section one of this Act must: be in writing; specify the person or
institution granted the authorization; the organ, part or parts to be detached, the
specific use or uses to which the organ, part or parts are to be employed; and,
signed by the grantor and two disinterested witnesses. If the grantor is a minor or
an incompetent person, the authorization may be executed by his guardian with the
approval of the court; in default thereof, by the legitimate father or mother, in the
order, named. Married women may grant the authority referred to in section one of
this Act, without the consent of the husband. After the death of the person,
authority to use human organs or any portion or portions of the human body
for medical, surgical or scientific purposes may also be granted by his nearest
relative or guardian at the time of his death or in the absence thereof, by the
person or head of the hospital, or institution having custody of the body of the
deceased: Provided, however, That the said person or head of the hospital or
institution has exerted reasonable efforts to locate the aforesaid guardian or

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relative. A copy of every such authorization must be furnished the Secretary of
Health.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
14. G.R No. 91114 Nelly Lim vs. CA
Facts:
Juan Sim filed a petition for annulment of his marriage with Lim on the ground
that the latter has been allegedly suffering from schizophrenia before, during and
after the marriage and until the present. During trial, Sim’s counsel announced that
he would present Dr. Lydia Acampado as a witness, a Doctor of Medicine who
specializes in Psychiatry. Petitioner’s counsel opposed the motion on the ground
that the testimony sought to be elicited from the witness is privileged since the
latter had examined the Nelly Lim in a professional capacity and had diagnosed her
to be suffering from schizophrenia. Sim’s counsel contended that Dr. Acampado
would be presented as an expert witness and would not testify on any information
acquired while attending to Nelly Lim in a professional capacity. The trial court
denied the motion and allowed the witness to testify. Dr. Acampado thus took the
witness stand as an expert witness and was asked hypothetical questions related to
her field of expertise. She neither revealed the illness she examined and treated
Nelly for nor disclosed the results of her examination and the medicines she had
prescribed.

Issue:
Whether or not the testimony violated the physician-patient privileged
communication?

Ruling:
No. The physician may be considered to be acting in his professional capacity
when he attends to the patient for curative, preventive, or palliative treatment.
Thus, only disclosures which would have been made to the physician to enable him
"safely and efficaciously to treat his patient" are covered by the privilege. It is to be
emphasized that "it is the tenor only of the communication that is privileged. The
mere fact of making a communication, as well as the date of a consultation and the
number of consultations, are therefore not privileged from disclosure, so long as
the subject communicated is not stated." One who claims this privilege must prove
the presence of these aforementioned requisites.

Dr. Acampado was presented and qualified as an expert witness. She did not
disclose anything obtained in the course of her examination, interview and
treatment of the petitioner; moreover, the facts and conditions alleged in the
hypothetical problem did not refer to and had no bearing on whatever information
or findings the doctor obtained while attending to the patient. There is, as well, no
showing that Dr. Acampado’s answers to the questions propounded to her relating
to the hypothetical problem were influenced by the information obtained from the
petitioner. Otherwise stated, her expert opinion excluded whatever information
or knowledge she had about the petitioner which was acquired by reason of

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
the physician-patient relationship existing between them. As an expert witness,
her testimony before the trial court cannot then be excluded.

In order that the disqualification by reason of physician-patient privilege be


successfully claimed, the following requisites should concur: (1) the privilege
is claimed in a civil case; (2) the person against whom the privilege is claimed
is one duly authorized to practice medicine, surgery or obstetrics; (3) such
person acquired the information while he was attending to the patient in his
professional capacity; (4) the information was necessary to enable him to act
in that capacity; (5) the information was confidential and if disclosed, would
blacken the reputation of the patient.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
15. G.R No. 108854 Ma. Paz Fernandez Krohn vs. CA
Facts:
Edgar Krohn Jr. filed a petition for annulment of marriage with Ma. Paz Hernandez
before the trial court. In his petition, he cited the Confidential Psychiatric
Evaluation Report which Ma. Paz merely denied in her Answer as "either
unfounded or irrelevant.

Edgar took the witness stand and tried to testify on the contents of the Confidential
Psychiatric Evaluation Report. This was objected to on the ground that it violated
the rule on privileged communication between physician and patient.
Subsequently, Ma. Paz filed a Manifestation expressing her "continuing objection"
to any evidence, oral or documentary, "that would thwart the physician-patient
privileged communication rule.

Issue:
Whether or not there was a violation of the physician-patient privileged
communication?

Ruling:
No. In the instant case, the person against whom the privilege is claimed is not one
duly authorized to practice medicine, surgery or obstetrics. He is simply the
patient’s husband who wishes to testify on a document executed by medical
practitioners. Plainly and clearly, this does not fall within the claimed prohibition.
Neither can his testimony be considered a circumvention of the prohibition because
his testimony cannot have the force and effect of the testimony of the physician
who examined the patient and executed the report.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
16. G.R No. 86159-60 People vs. Rogelio Pelones
Facts:
Jose Malto and Guillermo Solina were co-employees of Rogelio Pelones in the
New Star Farm located at Talisay, Tiaong, Quezon. Pelones was however
subsequently dismissed from the service when Solina reported to Rudy Tan, owner
of the farm, that he (Pelones) stole chickens and brought a girl to the nipa hut in
the farm. Shortly before midnight of 18 August 1986, Malto and Solina were inside
the poultry farmhouse when Pelones, together with five others, armed with bladed
weapons, suddenly appeared, forcibly dragged the two outside, and made them
face the wall. In attempting to reverse the verdict of the trial court, appellant
engages in pathetic excuses, concocting a scenario of what might have happened
instead, and posing questions that should have been asked during the trial. Worse,
without questioning the competence of the doctor who conducted post-mortem
examination on the remains of victim Solina, appellant challenges as without basis
the doctor's findings that wounds Nos. 1 and 2 of Solina were fatal and
instantaneous cause of death, absent any indication that such wounds penetrated
the heart. In the same vein, appellant asserts that "the probability is strong that the
wounds were inflicted much . . . earlier than ten (10) hours before 10:30 a.m. of
August 18 because death due to loss of blood is not instantaneous upon infliction
of the wound." Under the Rules of Court, the opinion of a witness on a matter
requiring special knowledge, skill, experience or training, may be received in
evidence only when he is shown to possess such competence.3 Hence, the
supposed medical evaluation made by appellant or his counsel, without showing
their competence in the field of medicine, must give way to the expert testimony of
the examining physical that Solina's wounds Nos. 1 and 2 were fatal and that he
expired about midnight of 18 August 1986. At any rate, the transcript of
stenographic notes evidently shows the competence of Dr. Vicente G. Umali, a
1957 graduate of the College of Medicine, University of Santo Tomas, who has
been in medical practice since then, a municipal health officer from 13 March
1971, and has performed more than 100 autopsies and post mortem examinations.

Issue:
Whether or not the respondent is guilty of murder?

Ruling:
Yes. While we agree with the court a quo that appellant is guilty, we nevertheless
should make certain clarifications. Firstly, we cannot accept the presence of the
aggravating circumstance of evident premeditation because there was no "proof as
to how and when the plan to kill was hatched or what time elapsed before it was
carried out." But, just the same, the killings could be categorized as murder and
frustrated murder because the circumstance of superior strength was alleged in the
informations and proved at the trial. The conspirators outnumbered the unarmed
victims two to one, and at least two (2) of them were armed as may be drawn from
the fact that the two (2) victims were stabbed almost simultaneously.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
As regards the aggravating circumstance of nocturnity, it is not automatically
appreciated considering that the scene of the crime was lighted, which enable
Malto to identify appellant. In like manner, the aggravating circumstance that the
crime was committed by a band under Art. 14, par. 6, of the Revised Penal Code
finds no sufficient factual basis since the testimony of Malto does not disclose that
at least four (4) of the aggressors were armed.

While it was not shown that Pelones also stabbed Malto, Pelones is nonetheless
liable therefor since conspiracy among the perpetrators was indubitable as may be
gleaned from their concerted, harmonious and methodical movements without
need of express instructions, thereby proving undeniably an agreement to commit
the crimes he actually perpetrated.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
17. G.R No. 122445 Dr. Ninevetech Cruz vs. CA
Facts:
Lydia Umali was examined by Dr. Cruz who found a myoma [benign tumor] in her
uterus, and scheduled her for a hysterectomy operation [removal of uterus] on 23
Mar 1991. Rowena Umali de Ocampo accompanied her mother to the hospital a
day before the operation, and they spent the night there. Rowena noticed that the
clinic was untidy, so she tried to persuade her mother not to proceed with the
operation. The following day, Rowena asked Dr. Cruz if the operation could be
postponed, but Lydia told her daughter that Dr. Cruz said that the operation must
go on as scheduled.

While Lydia’s relatives were waiting, Dr. Ercillo (anesthesiologist) told them to
buy tagamet ampules, and Rowena’s sister went out to buy some. An hour later,
Dr. Ercillo asked them to buy blood for Lydia, so they did. A few hours later, the
operation was finished, but later, Dr. Cruz asked the family to buy additional
blood, but there was no more type A blood available in the blood bank. A person
arrived to donate blood which was later transfused to Lydia. Rowena noticed that
her mother was gasping for breath–apparently, the oxygen supply had run out, so
the family went out to buy oxygen. Later in the evening, she went into shock and
her blood pressure dropped. She was then transferred to another hospital so she
could be connected to a respirator and further examined. However, this transfer
was without the consent of the relatives, who only found out about it when an
ambulance came to take Lydia to the other hospital.

In the new hospital, she was re-operated upon by Dr. Cruz and Dr. Ercillo because
blood was oozing out from her incision. They summoned Dr. Angeles, Ob-Gyne
head of the new hospital, but when he arrived, Lydia was already in shock and
possibly dead (BP: 0/0). Dr. Angeles told Drs. Cruz and Ercillo that there was
nothing he could do. Lydia died while Dr. Cruz was closing her abdominal wall.
Immediate cause of death is shock; disseminated intravascular coagulation (DIC)
as antecedent cause.

Dr. Cruz and Dr. Ercillo were charged with reckless imprudence and negligence
resulting in homicide of Lydia Umali. The Municipal Trial Court in Cities (MTCC)
found Dr. Ercillo not guilty for insufficiency of evidence against her, but held Dr.
Cruz responsible for Umali’s death. RTC and CA affirmed MTCC.

Issue:
Whether or not the circumstances are sufficient to sustain a judgment of conviction
against Dr. Cruz for reckless imprudence resulting in homicide?

Ruling:
NO. Dr. Cruz is acquitted, but she is till civilly liable. (50K civil liability; 100k
moral damages, 50k exemplary damages).
Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
Elements of reckless imprudence:
1. Offender does / fails to do an act
2. Doing / failure to do act is voluntary
3. Without malice
4. Material damage results from reckless imprudence
5. There is inexcusable lack of precaution, taking into consideration offender’s
employment, degree of intelligence, physical condition, other circumstances re:
persons, time, place

Standard of care observed by other members of the profession in good standing


under similar circumstances, bearing in mind the advanced state of the profession
at the time of treatment or the present state of medical science

When the physician’s qualifications are admitted, there is an inevitable


presumption that in proper cases, he takes the necessary precaution and employs
the best of his knowledge and skill in attending to his clients, unless the contrary is
sufficiently established by expert testimony.

Expert testimony is essential to establish standard of care of the profession, as well


as that the physician’s conduct in the treatment and care falls below such standard.
It is also usually necessary to support the conclusion as to causation. There is an
absence of any expert testimony re: standard of care in the case records. NBI
doctors presented by the prosecution only testified as to the possible cause of
death.

While it may be true that the circumstances pointed out by the lower courts
constitute reckless imprudence, this conclusion is still best arrived not through the
educated surmises nor conjectures of laymen, including judges, but by the
unquestionable knowledge of expert witnesses. The deference of courts to the
expert opinion of qualified physicians stems from the realization that the latter
possess unusual technical skill.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
18. G.R No. 78164 Tablarin v Gutierrez
Facts:
The petitioners sought to enjoin the Secretary of Education, Culture and Sports, the
Board of Medical Education and the Center for Educational Measurement from
enforcing Section 5 (a) and (f) of Republic Act No. 2382, as amended, and MECS
Order No. 52, series of 1985, dated 23 August 1985 and from requiring the taking
and passing of the NMAT as a condition for securing certificates of eligibility for
admission, from proceeding with accepting applications for taking the NMAT and
from administering the NMAT as scheduled on 26 April 1987 and in the future.
The trial court denied said petition on 20 April 1987. The NMAT was conducted
and administered as previously scheduled.

Republic Act 2382, as amended by Republic Acts Nos. 4224 and 5946, known as
the "Medical Act of 1959" defines its basic objectives in the following manner:

"SECTION 1. Objectives. — This Act provides for and shall govern (a) the
standardization and regulation of medical education; (b) the examination for
registration of physicians; and (c) the supervision, control and regulation of
the practice of medicine in the Philippines."

The statute, among other things, created a Board of Medical Education. Its
functions as specified in Section 5 of the statute include the following:

"(a) To determine and prescribe requirements for admission into a


recognized college of medicine;

xxx

(f) To accept applications for certification for admission to a medical school


and keep a register of those issued said certificate; and to collect from said
applicants the amount of twenty-five pesos each which shall accrue to the
operating fund of the Board of Medical Education;”

Section 7 prescribes certain minimum requirements for applicants to medical


schools:

"Admission requirements. — The medical college may admit any student


who has not been convicted by any court of competent jurisdiction of any
offense involving moral turpitude and who presents (a) a record of
completion of a bachelor's degree in science or arts; (b) a certificate of
eligibility for entrance to a medical school from the Board of Medical
Education; (c) a certificate of good moral character issued by two former
professors in the college of liberal arts; and (d) birth certificate. Nothing in
Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
this act shall be construed to inhibit any college of medicine from
establishing, in addition to the preceding, other entrance requirements that
may be deemed admissible.”

MECS Order No. 52, s. 1985, issued by the then Minister of Education, Culture
and Sports and dated 23 August 1985, established a uniform admission test called
the National Medical Admission Test (NMAT) as an additional requirement for
issuance of a certificate of eligibility for admission into medical schools of the
Philippines, beginning with the school year 1986-1987. This Order goes on to state
that: "2. The NMAT, an aptitude test, is considered as an instrument toward
upgrading the selection of applicants for admission into the medical schools and its
calculated to improve the quality of medical education in the country. The cutoff
score for the successful applicants, based on the scores on the NMAT, shall be
determined every year by the Board of Medical Education after consultation with
the Association of Philippine Medical Colleges. The NMAT rating of each
applicant, together with the other admission requirements as presently called for
under existing rules, shall serve as a basis for the issuance of the prescribed
certificate of eligibility for admission into the medical colleges.

Issue:
Whether or not Section 5 (a) and (f) of Republic Act No. 2382, as amended, and
MECS Order No. 52, s. 1985 are constitutional?

Ruling:
Yes. We conclude that prescribing the NMAT and requiring certain minimum
scores therein as a condition for admission to medical schools in the Philippines,
do not constitute an unconstitutional imposition.

The police power, it is commonplace learning, is the pervasive and non-waivable


power and authority of the sovereign to secure and promote all the important
interests and needs — in a word, the public order — of the general community. An
important component of that public order is the health and physical safety and
well-being of the population, the securing of which no one can deny is a legitimate
objective of governmental effort and regulation. Perhaps the only issue that needs
some consideration is whether there is some reasonable relation between the
prescribing of passing the NMAT as a condition for admission to medical school
on the one hand, and the securing of the health and safety of the general
community, on the other hand. This question is perhaps most usefully approached
by recalling that the regulation of the practice of medicine in all its branches has
long been recognized as a reasonable method of protecting the health and safety of
the public.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
19. G.R No. 144681 PRC v De Guzman
Facts:
Respondents are all graduates of the Fatima College of Medicine, Valenzuela City.
Petitioner PRC released the names of successful examinees in the medical
licensure examination. Shortly thereafter, the Board observed that the grades of 79
successful examinees from Fatima College in the two most difficult subjects (Bio-
Chem and OB-Gyne) were unusually high. A comparison of the performances of
the candidates from other schools was made.
The PRC asked the NBI to investigate whether any anomaly marred the February
1993 Physician Licensure Examination. NBI found that the questionable passing
rate of Fatima examinees was because Fatima examinees gained early access to the
test questions.
Respondents filed a special civil action for mandamus with prayer of preliminary
mandatory injunction. Meanwhile, the Board issued Resolution No. 26 charging
respondents with immorality, dishonest conduct, fraud and deceit. It recommended
that the test results of the Fatima examinees be nullified.

Issue:
Whether or not respondents are entitled to a writ of mandamus?

Ruling:
No. For a writ of mandamus to issue, the applicant must have a well-defined, clear
and certain legal right to the thing demanded and it is the duty of the respondent to
perform the act required. Thus, mandamus may be availed of only when the duty
sought to be performed is a ministerial and not a discretionary one.
The power to regulate the exercise of a profession or pursuit of an occupation
cannot be exercised by the State or its agents in an arbitrary, despotic or oppressive
manner. A political body that regulates the exercise of a particular privilege has the
authority to both forbid and grant such privilege in accordance with certain
conditions. Such conditions may not, however, require giving up one’s
constitutional rights as a condition to acquiring the license.
In the present case, RA 2382 prescribes the requirements for admission to the
practice of medicine, qualification of candidates for the board examinations, the
scope and conduct of the examinations, the grounds for denying the issuance of a
physician’s license, or revoking a license that has been issued. Should doubt taint
the compliance as being less than satisfactory, then the privilege will not issue.
Thus, without a definite showing that the requirements and conditions have been
satisfactorily met, the courts may not grant the writ of mandamus to secure said
privilege without thwarting the legislative will.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando
20. G.R No. 166097 Board of Medicine v Ota
Facts:
Respondent Ota is a Japanese national. Ota graduated from Bicol Christian College
of Medicine with a degree of Doctor of Medicine. After successfully completing a
1 year post graduate internship training at the Jose Reyes Memorial Medical
Center, he filed an application to take the medical board exams to obtain medical
license. He was required by the PRC to submit an affidavit, stating that should he
pass, he would not practice medicine until he submits proof that reciprocity exists
between Japan and Philippines in admitting foreigners into the practice of
medicine.

Respondent submitted the Medical Practicioners Law of Japan authenticated by the


Consul General of the Philippine Embassy to Japan Yabes. Thus, he was allowed
to take the Medical Board Examinations in August 1992, which he passed.

In spite all these, the Board of Medicine of PRC, denied respondent’s request for a
license to practice medicine in the Philippines on the ground that the Board
believes that no genuine reciprocity can be found in the law of Japan.

Ota filed a petition for certiorari and mandamus against the Board before RTC
Manila. RTC ruled in favor of Ota. CA affirmed the ruling of RTC.

Issue:
Whether or not Ota has established the reciprocity of laws between Philippines and
Japan?

Ruling:
Yes. Nowhere in the statutes stated that the foreign applicant must show that the
conditions for the practice of medicine in said country are practical and attainable
by Filipinos. Neither is it stated that it must first be proven that a Filipino has been
granted license and allowed to practice his profession in said country before a
foreign applicant may be given license to practice in the Philippines.
In this case, there is no doubt as to the competence and qualifications of the
respondent. He finished his medical degree, completed a one-year post graduate
internship training and passed the Medical Board Examinations. Likewise,
respondent Ota has satisfactorily complied with the said requirement of proving
reciprocity of laws.

Legal Medicine G02 Ching • Layug • Lipana • Montenegro • Nalupta • Untalan • Villapando