LEANDRO CARILLO vs PEOPLE OF THE PHILIPPINES

G.R. No. 86890, January 21, 1994

________________________________________________________________________

FACTS: Petitioner Dr. Leandro Carillo, an anesthesiologists, seeks review of the Decision
of the Court of Appeals dated 28 November 1988, which affirmed his conviction by the
Regional Trial Court of the crime of simple negligence resulting in homicide, for the death
of his thirteen (13) year old patient Catherine Acosta. The deceased, daughter of spouses
Domingo and Yolanda Acosta, complained to her father of pains in the lower part of her
abdomen. Catherine was then brought to Dr. Elva Peña. Dra. Peña called for Dr. Emilio
Madrid and the latter examined Catherine Acosta. According to Dr. Madrid, his findings
might be appendicitis. Then Dr. Peña told Catherine’s parents to bring the child to the
hospital in Baclaran so that the child will be observed. At the Baclaran General Hospital,
a nurse took blood sample form the child. The findings became known in the afternoon
and the child was scheduled for operation. When brought inside the operating room, the
child was feeling very well and they did not subject the child to ECG (electrocardiogram)
and X-ray.The appellant Dr. Emilio Madrid, a surgeon, operated on Catherine. He was
assisted by appellant, Dr. Leandro Carillo, an anesthesiologists. It has been established
that the deceased was not weighed before the administration of anesthesia on her. When
Catherine remained unconscious until noontime the next day, a neurologist examined her
and she was diagnosed as comatose. Three (3) days later, Catherine died without
regaining consciousness. The Court of Appeals held that Catherine had suffered from an
overdose of, or an adverse reaction to, anesthesia, leading to her death. The Court of
Appeals found criminal negligence on the part of petitioner Dr.Carillo and his co-accused
Dr. Madrid, holding that both had failed to observe the required standard of diligence in
the examination of Catherine prior to the actual administration of anesthesia.

ISSUE: Whether or not Dr.Carillo is guilty of the crime of simple negligence resulting in
homicide.

HELD: Yes. Simple negligence, penalized under what is now Article 365 of the Revised
Penal Code,is defined as “a mere lack of prevision in a situation where either the
threatened harm is not immediate or the danger not openly visible.” Put in a slightly
different way, the gravamen of the offense of simple negligence is the failure to exercise
the diligence necessitated or called for the situation which was not immediately life-
destructive but which culminated, in the present case, in the death of a human being
three (3) days later.

In the case at bar, the Court considered that the chain of circumstances above noted,
namely: (1) the failure of petitioner and Dr. Madrid to appreciate the serious post-surgery
condition of their patient and to monitor her condition and provide close patient care to
her; (2) the summons of petitioner by Dr. Madrid and the cardiologist after the patient’s
heart attack on the very evening that the surgery was completed; (3) the low level of care
and diligence exhibited by petitioner in failing to correct Dr. Madrid’s prescription of
Nubain for post-operative pain; (4) the extraordinary failure or refusal of petitioner and
Dr. Madrid to inform the parents of Catherine Acosta of her true condition after surgery,
in disregard of the requirements of the Code of Medical Ethics; and (5) the failure of
petitioner and Dr. Madrid to prove that they had in fact exercised the necessary and
appropriate degree of care and diligence to prevent the sudden decline in the condition
of Catherine Acosta and her death three (3) days later, leads the Court to the conclusion,
with moral certainty, that petitioner and Dr. Madrid were guilty of simple negligence
resulting in homicide.
 DR. VICRORIA L. BATIQUIN vs COURT OF APPEALS
G.R. No. 118231, July 5, 1996
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FACTS: Mrs. Villegas 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, along with other physicians and nurses, performed a caesarean operation on
Mrs. Villegas and successfully delivered the latter’s baby. After leaving the hospital, Mrs.
Villegas began to suffer abdominal pains and complained of being feverish. She also
gradually lost her appetite, soshe consulted Dr. Batiquin at the latter's polyclinic who
prescribed for her certain medicines. However, the pains still kept recurring. She then
consulted Dr.Ma. Salud Kho. After examining her, Dr Kho suggested that Mrs.Villegas
submit to another surgery.- 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 the ovarian cyst. The piece of rubber appeared to
be a part of a rubber glove. This was the cause of all of the infection of the ovaries and
consequently of all the discomfort suffered by Mrs. Villegas. The piece of rubber allegedly
found was not presented in court, and Dr. Kho testified that she sent it to a pathologist in
Cebu City for examination. Aside from Dr. Kho's testimony, the evidence which mentioned
the piece of rubber are a Medical Certificate, a Progress Record, an Anesthesia Record, a
Nurse's Record, and a Physician's Discharge Summary. 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- There was also doubts as to the whereabouts of the piece of rubber, as 2 versions
arose from Dr. Kho’s testimony: 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 served only to weaken
their claim against Defendant Batiquin. The trial court ruled in favor of the defendants.
The CA reversed the decision.

ISSUES: Procedural: Whether or not the court can review questions of fact.
Substantive: Whether or not Dr. Batiquin is liable.

HELD: Procedural: 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.

Substantive: The focal point of the appeal is Dr. Kho’s testimony. There were
inconsistencies within her own testimony, which led to the different decision of the RTC
and CA. The CA was correct in saying that the trial court erred when it isolated the
disputed portion of Dr. Kho’s testimony and did not consider it with other portions of Dr.
Kho’s testimony. Also, the phrase relied upon byte trial court does not negate the fact
that Dr. Kho saw a piece of rubber in private respondent Villegas' abdomen, and that she
sent it to a laboratory and then to Cebu City for examination by a pathologist.
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.
 LEONILA GARCIA-RUEDA vs WILFREDO L. PASCASIO
GR No. 118141, 1997-09-05G
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FACTS: Florencio V. Rueda, husband of petitioner Leonila Garcia-Rueda, underwent

surgical operation at the UST hospital for the removal of a stone blocking his ureter. He
was attended by Dr. Domingo Antonio, Jr. who was the surgeon, while Dr. Erlinda
Balatbat-Reyes was the anesthesiologist. Six hours after the surgery, however, Florencio
died of complications of “unknown cause,” according to officials of the UST Hospital. Not
satisfied with the findings of the hospital, petitioner requested the National Bureau of
Investigation (NBI) to conduct an autopsy on her husband’s body. Consequently, the NBI
ruled that Florencio’s death was due to lack of care by the attending physician in
administering anaesthesia. Pursuant to its findings, the NBI recommended that Dr.
Domingo Antonio and Dr. Erlinda Balatbat-Reyes be charged for Homicide through
Reckless Imprudence. The case was initially assigned to Prosecutor Antonio M. Israel, who
had to inhibit himself because he was related to the counsel of one of the doctors. The
case was re-raffled to Prosecutor Norberto G. Leono who was, however, disqualified on
motion of the petitioner. The case was then referred to Prosecutor Ramon O. Carisma,
who issued a resolution recommending that only Dr. Reyes be held criminally liable and
that the complaint against Dr. Antonio be dismissed. Assistant City Prosecutor Josefina
Santos Sioson, recommended that the case be re-raffled on the ground that Prosecutor
Carisma was partial to the petitioner. Thus, the case was transferred to Prosecutor
Leoncia R. Dimagiba, who endorsed that the complaint against Dr. Reyes be dismissed
and instead, a corresponding information be filed against Dr. Antonio. Petitioner filed a
motion for reconsideration, questioning the findings of Prosecutor Dimagiba. Pending the
resolution of petitioner’s motion for reconsideration regarding Prosecutor Dimagiba’s
resolution, the investigative “pingpong” continued when the case was again assigned to
another prosecutor, who recommended that Dr. Reyes be included in the criminal
information of Homicide through Reckless Imprudence. While the recommendation of
Prosecutor Gualberto was pending, the case was transferred to Senior State Prosecutor
Gregorio A. Arizala, who resolved to exonerate Dr. Reyes from any wrongdoing, a
resolution which was approved by both City Prosecutor Porfirio G. Macaraeg and City
Prosecutor Jesus F. Guerrero. Aggrieved, petitioner filed graft charges specifically for
violation of Section 3(e) of Republic Act No. 3019 against Prosecutors Guerrero, Macaraeg,
and Arizala for manifest partiality in favor of Dr. Reyes before the Office of the
Ombudsman. However, the Ombudsman issued the assailed resolution dismissing the
complaint for lack of evidence. In fine, petitioner assails the exercise of the discretionary
power of the Ombudsman to review the recommendations of the government
prosecutors and to approve and disapprove the same. Petitioner faults the Ombudsman
for, allegedly in grave abuse of discretion, refusing to find that there exists probable cause
to hold public respondent City Prosecutors liable for violation of Section 3(e) of R.A. No.
3019.

ISSUE: Whether there was negligence on the part of the physicians which resulted to the
death of Petitioner’s husband.

HELD: Yes. No less than the NBI pronounced after conducting an autopsy that there was
indeed negligence on the part of the attending physicians in administering the anesthesia.
The fact of want of competence or diligence is evidentiary in nature, the veracity of which
can best be passed upon after a full-blown trial for it is virtually impossible to ascertain
the merits of a medical negligence case without extensive investigation, research,
evaluation and consultations with medical experts. Clearly, the City Prosecutors are not
in a competent position to pass judgment on such a technical matter, especially when
there are conflicting evidence and findings. The bases of a party’s accusation and defenses
are better ventilated at the trial proper than at the preliminary investigation. There are
four elements involved in medical negligence cases: duty, breach, injury and proximate
causation. Evidently, when the victim employed the services of Dr. Antonio and Dr. Reyes,
a physician-patient relationship was created. In accepting the case, Dr. Antonio and Dr.
Reyes in effect represented that, having the needed training and skill possessed by
physicians and surgeons practicing in the same field, they will employ such training, care
and skill in the treatment of their patients. They have a duty to use at least the same level
of care that any other reasonably competent doctor would use to treat a condition under
the same circumstances. The breach of these professional duties of skill and care, or their
improper performance, by a physician surgeon whereby the patient is injured in body or
in health, constitutes actionable malpractice. 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. Moreover, in malpractice or
negligence cases involving the administration of anaesthesia, the necessity of expert
testimony and the availability of the charge of res ipsa loquitur to the plaintiff, have been
applied in actions against anesthesiologist 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. 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. Why these precautionary measures were disregarded must be sufficiently
explained.
 DR. NINEVETH CRUZ vs COURT OF APPEALS AND LYDIA UMALI
G.R. No. 122445, November 18, 1997
________________________________________________________________________

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 fora 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 it still pushed
through after the petitioner told Lydia that operation must be done 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 OR,
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, who was
attached to an oxygen tank, gasping for breath apparently, the oxygen tank is empty, so
her husband and petitioner’s driver bought an 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. After Lydia experienced shocks, she
died.

ISSUE: Whether or not petitioner has been negligent which caused the death of Lydia
Umali.

HELD: Yes. 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. A doctor in effect represents that,
having the needed training and skill possessed by physicians and surgeons practicing in
the same field, he will employ such training, care and skill in the treatment of his patients.
He therefore has a duty to use at least the same level of care that any other reasonably
competent doctor would use to treat a condition under the same circumstances. It is in
this aspect of medical malpractice that expert testimony is essential to establish not only
the standard of care of the profession but also that the physician’s conduct in the
treatment and care falls below such standard. Further, in as much as the causes of the
injuries involved in malpractice actions are determinable only in the light of scientific
knowledge, it has been recognized that expert testimony is usually necessary to the
conclusion as to causation.

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.

The elements of reckless imprudence are:

 That the offender does or fails to do an act;

 That the doing or the failure to do that act is voluntary;
 That it be without malice;
 That material damage results from the reckless imprudence; and
 That there is inexcusable lack of precaution on the part of the offender, taking into
consideration his employment or occupation, degree of intelligence, physical
condition, and other circumstances regarding persons, time, and place.

The possible causes of hemorrhage during an operation are: 1.) the failure of the surgeon
to tie or suture a cut blood vessel; 2.) allowing a cut blood vessel to get out of control; 3.)
the subsequent loosening of the tie or suture applied to a cut blood vessel; and 4.)and a
clotting defect known as DIC.
 SPOUSES RAMOS vs COURT OF APPEALS
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 comatose. 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 totaling 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: Whether or not 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.
 LEAH ALESNA REYES et al. vs SISTERS OF MERCY HOSPITAL et al.
G.R No. 130547, October 3, 2000
________________________________________________________________________

FACTS: Petitioner, Leah Alesna Reyes, is the wife of the deceased patient, Jorge Reyes.
Five days before the latter’s death, Jorge has been suffering from recurring fever with
chills. The doctors confirmed through the Widal test that Jorge has typhoid fever.
However, he did not respond to the treatment and died. The cause of his death was
“Ventricular Arrythemia Secondary to Hyperpyrexia and typhoid fever.” Consequently,
petitioner filed the instant case for damages before the Regional Trial Court of Cebu City,
which dismissed the case and was affirmed by the Court of Appeals.
The contention was that Jorge did not die of typhoid fever. Instead, his death was due to
the wrongful administration of chloromycetin. They contended that had respondent
doctors exercised due care and diligence, they would not have recommended and rushed
the performance of the Widal Test, hastily concluded that Jorge was suffering from
typhoid fever, and administered chloromycetin without first conducting sufficient tests
on the patient’s compatibility with said drug.

ISSUE: Whether or not Sisters of Mercy Hospital is liable for the death of Jorge Reyes.

RULING: Sisters of Mercy Hospital is not liable for the death of Jorge Reyes. 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 choloromycetin 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.