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PART SIXMEDICAL NEGLIGENCE

I. Definition of Medical Negligence

1 Garcia-Rueda !. Pa!ca!io" G.R. No. 11#1$1" Se%te&'er (" 1))*SEC+ND DI,ISI+N

[G.R. No. 118141. September 5, 1997]

LEONILA GARCIA-RUEDA,petitioner, vs. IL!REDO L. "ASCASIO, RAUL R.ARNAU, A#ELARDO L. A"OR$ADERA %R., &o'or(b)e CONDRADO *.+ASUE, ()) o t/e O0e o t/e Omb23m(' %ESUS !. GUERRERO,"OR!IRIO *ACARAEG, ('3 GREGORIO A. ARIALA, ()) o t/e O0e o t/eC0t6 "roe2tor, *('0)(, respondents.

D E C I S I O N

RO*ERO, J.

Ma ti! Court reie/ te finding! of te +ffice of te +&'ud!&an0 Te general rulea! 'een enunciated in +ca&%o . +&'ud!&an 12 /ic !tate!3

4In te e5erci!e of it! ine!tigatie %o/er" ti! Court a! con!i!tentl eld tat court! /illnot interfere /it te di!cretion of te fi!cal or te +&'ud!&an to deter&ine te !%ecificitand ade6uac of te aer&ent! of te offen!e carged. 7e &a di!&i!! te co&%laintfort/it if e find! it to 'e in!ufficient in for& and !u'!tance or if e oter/i!e find! noground to continue /it te in6uir8 or e &a %roceed /it te ine!tigation of teco&%laint if" in i! ie/" it i! in due and %ro%er for&.9

Doe! te in!tant ca!e /arrant a de%arture fro& te foregoing general rule0 :en a%atient die! !oon after !urger under circu&!tance! /ic indicate tat te attending!urgeon and anae!te!iologi!t &a ae 'een guilt of negligence 'ut u%on teir 'eingcarged" a !erie! of nine %ro!ecutor! to!! te re!%on!i'ilit of conducting a %reli&inarine!tigation to eac oter /it contradictor reco&&endation!" 4%ing-%ong9 !tle" %era%!te di!traugt /ido/ i! not to 'e 'la&ed if !e finall decide! to accu!e te CitPro!ecutor! at te end of te line for %artialit under te Anti-Graft and Corru%t Practice!Act. Nor &a !e 'e entirel faulted for finall filing a %etition 'efore ti! Court again!t te+&'ud!&an for grae a'u!e of di!cretion in di!&i!!ing er co&%laint again!t !aid CitPro!ecutor! on te ground of lac; of eidence. Muc a! /e !&%ati

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Te follo/ing fact! are 'orne out ' te record!.

=lorencio ,. Rueda" u!'and of %etitioner Leonila Garcia-Rueda" under/ent !urgicalo%eration at te >ST o!%ital for te re&oal of a !tone 'loc;ing i! ureter. 7e /a!attended ' Dr. Do&ingo Antonio" ?r. /o /a! te !urgeon" /ile Dr. Erlinda @alat'at-Ree! /a! te anae!te!iologi!t. Si5 our! after te !urger" o/eer" =lorencio died of

co&%lication! of 4un;no/n cau!e"9 according to official! of te >ST 7o!%ital.2

Not !ati!fied /it te finding! of te o!%ital" %etitioner re6ue!ted te National @ureauof Ine!tigation BN@I to conduct an auto%! on er u!'and! 'od. Con!e6uentl" teN@I ruled tat =lorencio! deat /a! due to lac; of care ' te attending %!ician inad&ini!tering anae!te!ia. Pur!uant to it! finding!" te N@I reco&&ended tat Dr.Do&ingo Antonio and Dr. Erlinda @alat'at-Ree! 'e carged for 7o&icide trougRec;le!! I&%rudence 'efore te +ffice of te Cit Pro!ecutor.

During te %reli&inar ine!tigation" /at tran!%ired /a! a confounding !erie! ofeent! /ic /e !all tr to di!entangle. Te ca!e /a! initiall a!!igned to Pro!ecutor

Antonio M. I!rael" /o ad to ini'it i&!elf 'ecau!e e /a! related to te coun!el of oneof te doctor!. A! a re!ult" te ca!e /a! re-raffled to Pro!ecutor Nor'erto G. Leono /o/a!" o/eer" di!6ualified on &otion of te %etitioner !ince e di!regarded %reailing la/!and uri!%rudence regarding %reli&inar ine!tigation. Te ca!e /a! ten referred toPro!ecutor Ra&on +. Cari!&a" /o i!!ued a re!olution reco&&ending tat onl Dr.Ree! 'e eld cri&inall lia'le and tat te co&%laint again!t Dr. Antonio 'e di!&i!!ed.

Te ca!e too; anoter %er%le5ing turn /en A!!i!tant Cit Pro!ecutor ?o!efina Santo!Sio!on" in te 4intere!t of u!tice and %eace of &ind of te %artie!"9 reco&&ended tat teca!e 'e re-raffled on te ground tat Pro!ecutor Cari!&a /a! %artial to te%etitioner. Tu!" te ca!e /a! tran!ferred to Pro!ecutor Leoncia R. Di&agi'a" /erea olte face occurred again /it te endor!e&ent tat te co&%laint again!t Dr. Ree! 'edi!&i!!ed and in!tead" a corre!%onding infor&ation 'e filed again!t Dr. Antonio. Petitionerfiled a &otion for recon!ideration" 6ue!tioning te finding! of Pro!ecutor Di&agi'a.

Pending te re!olution of %etitioner! &otion for recon!ideration regarding Pro!ecutorDi&agi'a! re!olution" te ine!tigatie 4%ing%ong9 continued /en te ca!e /a! againa!!igned to anoter %ro!ecutor" Eudo5ia T. Gual'erto" /o reco&&ended tat Dr. Ree!'e included in te cri&inal infor&ation of 7o&icide troug Rec;le!! I&%rudence. :ilete reco&&endation of Pro!ecutor Gual'erto /a! %ending" te ca!e /a! tran!ferred toSenior State Pro!ecutor Gregorio A. Ari

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Preli&inaril" te %o/er! and function! of te +&'ud!&an ae generall 'eencategori

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eracit of /ic can 'e!t 'e %a!!ed u%on after a full-'lo/n trial for it i! irtualli&%o!!i'le to a!certain te &erit! of a &edical negligence ca!e /itout e5ten!ieine!tigation" re!earc" ealuation and con!ultation! /it &edical e5%ert!. Clearl" teCit Pro!ecutor! are not in a co&%etent %o!ition to %a!! udg&ent on !uc a tecnical&atter" e!%eciall /en tere are conflicting eidence and finding!. Te 'a!e! of a %art!accu!ation and defen!e! are 'etter entilated at te trial %ro%er tan at te %reli&inar

ine!tigation.

A /ord on &edical &al%ractice or negligence ca!e!.

4In it! !i&%le!t ter&!" te t%e of la/!uit /ic a! 'een called &edical &al%ractice or"&ore a%%ro%riatel" &edical negligence" i! tat t%e of clai& /ic a icti& a! aaila'leto i& or er to redre!! a /rong co&&itted ' a &edical %rofe!!ional /ic a! cau!ed'odil ar&.

In order to !ucce!!full %ur!ue !uc a clai&" a %atient &u!t %roe tat a ealt care%roider" in &o!t ca!e! a %!ician" eiter failed to do !o&eting /ic a rea!ona'l%rudent ealt care %roider /ould ae done" or tat e or !e did !o&eting tat a

rea!ona'l %rudent %roider /ould not ae done8 and tat tat failure or action cau!edinur to te %atient.912

7ence" tere are four ele&ent! inoled in &edical negligence ca!e!3 dut" 'reac"inur and %ro5i&ate cau!ation.

Eidentl" /en te icti& e&%loed te !erice! of Dr. Antonio and Dr. Ree!" a%!ician-%atient relation!i% /a! created. In acce%ting te ca!e" Dr. Antonio and Dr.Ree! in effect re%re!ented tat" aing te needed training and !;ill %o!!e!!ed '%!ician! and !urgeon! %racticing in te !a&e field" te /ill e&%lo !uc training" careand !;ill in te treat&ent of teir %atient!.1F2Te ae a dut to u!e at lea!t te !a&eleel of care tat an oter rea!ona'l co&%etent doctor /ould u!e to treat a conditionunder te !a&e circu&!tance!. Te 'reac of te!e %rofe!!ional dutie! of !;ill and care"or teir i&%ro%er %erfor&ance" ' a %!ician !urgeon /ere' te %atient i! inured in'od or in ealt" con!titute! actiona'le &al%ractice.1$2Con!e6uentl" in te eent tatan inur re!ult! to te %atient fro& /ant of due care or !;ill during te o%eration" te!urgeon! &a 'e eld an!/era'le in da&age! for negligence.1(2

Moreoer" in &al%ractice or negligence ca!e! inoling te ad&ini!tration ofanae!te!ia" te nece!!it of e5%ert te!ti&on and te aaila'ilit of te carge of res ipsaloquiturto te %laintiff" ae 'een a%%lied in action! again!t anae!te!iologi!t! to old te

defendant lia'le for te deat or inur of a %atient under e5ce!!ie or i&%ro%eranae!te!ia.1H2E!!entiall" it re6uire! t/o-%ronged eidence3 eidence a! to terecogni

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cau!e of te deat of te icti& could ae 'een aerted ad te %ro%er drug 'een a%%liedto co%e /it te !&%to&! of &alignant %erter&ia. Al!o" /e cannot ignore te fact tatan antidote /a! readil aaila'le to counteract /ateer deleteriou! effect te anae!te!ia&igt %roduce. 1)2: te!e %recautionar &ea!ure! /ere di!regarded &u!t 'e!ufficientl e5%lained.

Te Cit Pro!ecutor! /ere carged /it iolating Section FBe of te Anti-Graft andCorru%t Practice! Act /ic re6uire! te follo/ing fact!3

41. Te accu!ed i! a %u'lic officer di!carging ad&ini!tratie or official function! or%riate %er!on! carged in con!%irac /it te&8

. Te %u'lic officer co&&itted te %roi'ited act during te %erfor&ance of i! officialdut or in relation to i! %u'lic %o!ition8

F. Te %u'lic officer acted /it &anife!t %artialit" eident 'ad fait or gro!!"ine5cu!a'le negligence8 and

$. 7i! action cau!ed undue inur to te Goern&ent or an %riate %art" or gae an

%art an un/arranted 'enefit" adantage or %reference to !uc %artie!.9 2

: did te co&%lainant" %etitioner in in!tant ca!e" elect to carge re!%ondent! underte a'oe la/0

:ile a %art /o feel! i&!elf aggrieed i! at li'ert to coo!e te a%%ro%riate4/ea%on fro& te ar&or"9 it i! /it no little !ur%ri!e tat ti! Court ie/! te coice &ade' te co&%lainant /ido/.

To our &ind" te 'etter and &ore logical re&ed under te circu&!tance! /ould ae'een to a%%eal te re!olution of te Cit Pro!ecutor! di!&i!!ing te cri&inal co&%laint to

te Secretar of ?u!tice under te De%art&ent of ?u!tice! +rder No. F" 12oter/i!e;no/n a! te 41))F Rei!ed Rule! on A%%eal! =ro& Re!olution! In Preli&inarIne!tigation!Reine!tigation!"9 a! a&ended ' De%art&ent +rder No. F()" Section 1 of/ic %roide!3

4Section 1. :at Ma @e A%%ealed. - +nl re!olution! of te Cief StatePro!ecutorRegional State Pro!ecutorProincial or Cit Pro!ecutor di!&i!!ing a cri&inalco&%laint &a 'e te !u'ect of an a%%eal to te Secretar of ?u!tice e5ce%t a! oter/i!e%roided in Section $ ereof.9

:at action &a te Secretar of ?u!tice ta;e on te a%%eal0 Section ) of +rder No.

F !tate!3 4Te Secretar of ?u!tice &a reer!e" affir& or &odif te a%%ealedre!olution.9 +n te oter and" 47e &a motu proprioor on &otion of te a%%ellee"di!&i!! outrigt te a%%eal on !%ecified ground!.9 2

In e5erci!ing i! di!cretion under te circu&!tance!" te +&'ud!&an acted /itin i!%o/er and autorit in di!&i!!ing te co&%laint again!t te Pro!ecutor! and ti! Court /illnot interfere /it te !a&e.

&ERE!ORE" in ie/ of te foregoing" te in!tant %etition i! DISMISSED ,/itout%reudice to te filing of an a%%eal ' te %etitioner /it te Secretar of ?u!tice a!!ailingte di!&i!!al of er cri&inal co&%laint ' te re!%ondent Cit Pro!ecutor!. No co!t!.

SO ORDERED.
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Regalado, (Chairman), Puno, Mendoza, andTorres, Jr., JJ., concur.

II. Ele&ent! of &edical negligence3

PETER PA>L PATRICJ L>CAS" =ATIMA GLADKS L>CAS" A@@EKGAIL L>CAS ANDGILLIAN L>CAS !. DR. PR+SPER+ MA. C. T>A+" G.R. No. 1*#*HF. A%ril 1" ).2

$&IRD DI+ISION"E$ER "AUL "A$RIC LUCAS,!A$I*A GLADS LUCAS,A##EGAIL LUCAS AND GILLIANLUCAS"

Petitioner!"

- versus -

DR. "ROS"ERO *A. C. $UA:O,

Re!%ondent.

G. R. No. 1787;STRIA-MARTINE"C7IC+-NAARI+"NAC7>RA" andPERALTA" JJ.

Pro&ulgated3

A%ril 1" )5 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5

D E C I S I + N

C&ICO-NAARIO, J.

In ti! %etition for reie/ on certiorari12under Rule $( of te Rei!ed Rule! of Court"

%etitioner! Peter Paul Patric; Luca!" =ati&a Glad! Luca!" A''egail Luca! and Gillian

Luca! !ee; te reer!al of te * Se%te&'er H ecision2and F ?ul

* Resolution,F2'ot of te Court of A%%eal! in CA-G.R. C, No. H#HHH" entitled 4Peter

Paul Patric; Luca!" =ati&a Glad! Luca!" A''egail Luca! and Gillian Luca! . Pro!%ero

Ma. C. Tuao.9

In te 6ue!tioned deci!ion and re!olution" te Court of A%%eal! affir&ed te 1$ ?ul

ecisionof te Regional Trial Court BRTC" @ranc 1(" Ma;ati Cit" di!&i!!ing te
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co&%laint filed ' %etitioner! in a ciil ca!e entitled" 4Peter Paul Patric! "ucas, #atima

$lad%s "ucas, &''e%gail "ucas and $illian "ucas v. Prospero Ma. C. Tuao,doc;eted a!

Ciil Ca!e No. )-$#.

=ro& te record of te ca!e" te e!ta'li!ed factual antecedent! of te %re!ent %etition

are3

So&eti&e in Augu!t 1)##" %etitioner Peter Paul Patric; Luca! BPeter contracted 4!ore

ee!9 in i! rigt ee.

+n Se%te&'er 1)##" co&%laining of a red rigt ee and !/ollen eelid" Peter &ade u!e

of i! ealt care in!urance i!!ued ' Pila&care 7ealt S!te&!" Inc. BPila&care" for a

%o!!i'le con!ult. Te Pila&care Coordinator" Dr. Ed/in +ca" M.D." referred Peter to

re!%ondent" Dr. Pro!%ero Ma. C. Tuao" M.D. BDr. Tuao" an o%tal&ologi!t at St.

Lu;e! Medical Center" for an ee con!ult.

>%on con!ultation /it Dr. Tuao" Peter narrated tat it ad 'een nine B) da! !ince te

%ro'le& /it i! rigt ee 'egan8 and tat e /a! alread ta;ing Ma*itrolto addre!! te

%ro'le& in i! ee. According to Dr. Tuao" e %erfor&ed 4ocular routine e5a&ination9 on

Peter! ee!" /erein3 B1 a gro!! e5a&ination of Peter! ee! and teir !urrounding area

/a! &ade8 B Peter! i!ual acuit /ere ta;en8 BF Peter! ee! /ere %al%ated to cec;

te intraocular %re!!ure of eac8 B$ te &otilit of Peter! ee! /a! o'!ered8 and B( te

o%tal&o!co%$2on Peter! ee! /a! u!ed. +n tat %articular con!ultation" Dr.

Tuao diagno!ed tat Peter /a! !uffering fro& con+unctivitis(2or 4!ore ee!.9 Dr. Tuao

ten %re!cri'ed persacet-CH2ee dro%! for Peter and told te latter to return for follo/-

u% after one /ee;.

A! in!tructed" Peter /ent 'ac; to Dr. Tuao on ) Se%te&'er 1)##. >%on e5a&ination" Dr.

Tuao told Peter tat te 4!ore ee!9 in te latter! rigt ee ad alread cleared u% and e

could di!continue te persacet-C. 7o/eer" te !a&e ee

deelo%ed pidemiceratoCon+unctivitisBEJC"*2a iral infection. To addre!! te ne/

%ro'le& /it Peter! rigt ee" Dr. Tuao %re!cri'ed to te for&er a !teroid-'a!ed ee

dro% called Ma*itrol"#2a do!age of !i5 BH dro%! %er da.)2To recall" Peter ad alread'een u!ingMa*itrol%rior to i! con!ult /it Dr. Tuao.
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+n 1 Se%te&'er 1)##" Peter !a/ Dr. Tuao for a follo/-u% con!ultation. After e5a&ining

'ot of Peter! ee!" Dr. Tuao in!tructed te for&er to ta%er do/n12 te do!age

of Ma*itrol,'ecau!e te EJC in i! rigt ee ad alread re!oled. Dr. Tuao !%ecificall

cautioned Peter tat" 'eing a !teroid" Ma*itrolad to 'e /itdra/n graduall8 oter/i!e"

te EJC &igt recur.112

Co&%laining of feeling a! if tere /a! !o&eting in i! ee!" Peter returned to Dr. Tuao

for anoter cec;-u% on H +cto'er 1)##. Dr. Tuao e5a&ined Peter! ee! and found tat

te rigt ee ad once &ore deelo%ed EJC. So" Dr. Tuao in!tructed Peter to re!u&e

te u!e of Ma*itrolat !i5 BH dro%! %er da.

+n i! /a o&e" Peter /a! una'le to get a old of Ma*itrol,a! it /a! out of !toc;.

Con!e6uentl" Peter /a! told ' Dr. Tuano to ta;e" in!tead" /lephamide12anoter

!teroid-'a!ed &edication" 'ut /it a lo/er concentration" a! !u'!titute for te

unaaila'le Ma*itrol" to 'e u!ed tree BF ti&e! a da for fie B( da!8 t/o B ti&e! a da

for fie B( da!8 and ten u!t once a da.1F2

Seeral da! later" on 1# +cto'er 1)##" Peter /ent to !ee Dr. Tuao at i! clinic" alleging

!eere ee %ain" feeling a! if i! ee! /ere a'out to 4%o%-out"9 a eadace and 'lurred

i!ion. Dr. Tuao e5a&ined Peter! ee! and di!coered tat te EJC /a! again %re!ent

in i! rigt ee. A! a re!ult" Dr. Tuao told Peter to re!u&e te &a5i&u& do!age

of /lephamide.

Dr. Tuao !a/ Peter once &ore at te for&er! clinic on $ Noe&'er 1)##. Dr. Tuao!

e5a&ination !o/ed tat onl te %eri%er of Peter! rigt ee /a! %o!itie for EJC8

ence" Dr. Tuao %re!cri'ed a lo/er do!age of /lephamide.

It /a! al!o a'out ti! ti&e tat =ati&a Glad! Luca! B=ati&a" Peter! !%ou!e" read te

acco&%aning literature of Ma*itroland found terein te follo/ing /arning again!t te

%rolonged u!e of !uc !teroid!3:ARNING3

Prolonged u!e &a re!ult in glauco&a" /it da&age to te o%tic nere"defect! in i!ual acuit and field! of i!ion" and %o!terior" !u'ca%!ularcataract for&ation. Prolonged u!e &a !u%%re!! te o!t re!%on!e and tu!
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increa!e te a

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>%on /a;ing in te &orning of 1F Dece&'er 1)##" Peter ad no i!ion in i! rigt

ee. =ati&a o'!ered tat Peter! rigt ee a%%eared to 'e 'lood and !/ollen.1(2Tu!"

!%ou!e! Peter and =ati&a ru!ed to te clinic of Dr. Tuao. Peter re%orted to Dr. Tuao

tat e ad 'een !uffering fro& con!tant eadace in te afternoon and 'lurring of i!ion.

>%on e5a&ination" Dr. Tuao noted te ardne!! of Peter! rigt ee. :it te u!e of

a tonometer1H2to erif te e5act intraocularpressure1*2BI+P of Peter! ee!" Dr.

Tuao di!coered tat te ten!ion in Peter! rigt ee /a! " /ile tat of i! left

/a! 1*. 7g.1#2 Since te ten!ion in Peter! rigt ee /a! /a oer te 'orm() IO""

/ic &erel ranged fro& 1=.= &> to ?1.= &>"1)2Dr. Tuao ordered2i& to

i&&ediatel di!continue te u!e of Ma*itroland %re!cri'ed to te

latter iamo*12and0ormoglaucon" in!tead.2Dr. Tuao al!o re6uired Peter to go for

dail cec;-u% in order for te for&er to clo!el &onitor te %re!!ure of te latter! ee!.

+n 1( Dece&'er 1)##" te tono&eter reading of Peter! rigt ee ielded a /0>/ 'orm()

)e@e), i.e.,?1.= &>. 7ence" Dr. Tuao told Peter to continue

u!ing iamo*and0ormoglaucon. @ut u%on Peter! co&%laint of 4!to&ac %ain! and

tingling !en!ation in i! finger!"9F2Dr. Tuao di!continued Peter! u!e of iamo*.$2

Peter /ent to !ee anoter o%tal&ologi!t" Dr. Ra&on T. @atung'acal BDr. @atung'acal"

on 1 Dece&'er 1)##" /o allegedl conducted a co&%lete o%tal&ological e5a&ination

of Peter! ee!. Dr. @atung'acal! diagno!i! /a! $laucoma[25]1..H27e

reco&&ended "aserTra'eculoplast%*2for Peter! rigt ee.

:en Peter returned to Dr. Tuao on F Dece&'er 1)##"#2te tono&eter &ea!ured te

I+P of Peter! rigt ee to 'e 41.= &>")2again" /a a'oe nor&al. Dr. Tuao addre!!ed

te %ro'le& ' adi!ing Peter to re!u&e ta;ing iamo*along /it 0ormoglaucon.

During te Cri!t&a! olida!" Peter !u%%o!edl !taed in 'ed &o!t of te ti&e and /a!

not a'le to cele'rate te !ea!on /it i! fa&il 'ecau!e of te de'ilitating effect!

ofiamo*.F2

+n # Dece&'er 1)##" during one of Peter! regular follo/-u%! /it Dr. Tuao" te doctor

conducted anoter ocular routine e5a&ination of Peter! ee!. Dr. Tuao noted terecurrence of EJC in Peter! rigt ee. Con!idering" o/eer" tat te I+P of Peter! rigt
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ee /a! !till 6uite ig at 41.= &>" Dr. Tuao /a! at a lo!! a! to o/ to 'alance te

treat&ent of Peter! EJC vis-2-viste %re!ence of glaucomain te !a&e ee. Dr. Tuao"

tu!" referred Peter to Dr. Manuel @. Agulto" M.D. BDr. Agulto" anoter o%tal&ologi!t

!%eciali

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Peter /ent to !ee Dr. Tuao on F1 Dece&'er 1)##" 'earing Dr. Agulto! afore&entioned

letter. Toug Peter! rigt and left ee! ten ad nor&al I+P of ?1.= &>and 1*. 7g"

re!%ectiel" Dr. Tuao !till gae i& a %re!cri%tion for [email protected]. !o Peter could

i&&ediatel !tart u!ing !aid &edication. Regretta'l" [email protected]. /a! out of !toc;" !o

Dr. Tuao in!tructed Peter to u!t continue u!ing iamo*and 0ormoglauconin te

&eanti&e.

?u!t t/o da! later" on ?anuar 1)#)" te I+P of Peter! rigt ee re&ained eleated

at ?1.= &>,[4?]a! e ad 'een /itout iamo*for te %a!t tree BF da!.

+n $ ?anuar 1)#)" Dr. Tuao conducted a visual 3ield stud%[43]of Peter! ee!" /ic

reealed tat te latter ad tu'ularvision$$2 in i! rigt ee" /ile tat of i! left ee

re&ained nor&al. Dr. Tuao directed Peter to religiou!l u!e

te iamo*and 0ormoglaucon,a! te ten!ion of te latter! rigt ee /ent u% een furter

to 41.= &>in u!t a &atter of t/o B da!" in te &eanti&e tat [email protected].

and 4epi3rin/ere !till not aaila'le in te &ar;et. Again" Dr. Tuao adi!ed Peter to co&e

for regular cec;-u% !o i! I+P could 'e &onitored.

+'edientl" Peter /ent to !ee Dr. Tuao on te *t"1Ft" 1Htand tof ?anuar 1)#)

for cec;-u% and I+P &onitoring.

In te interregnu&" o/eer" Peter /a! %rodded ' i! friend! to !ee; a !econd &edical

o%inion. +n 1F ?anuar 1)#)" Peter con!ulted Dr. ?ai&e La%u

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In Ma 1)) and ?une 1))1" Peter under/ent t/o B %rocedure! of la!er tra'eculo%la!t

to atte&%t to control te ig I+P of i! rigt ee.

Clai&ing to ae steroid-induced glaucoma$(2and 'la&ing Dr. Tuao for te

!a&e" Peter" oined '3 B1 =ati&a" i! !%ou!e$H28 B A''egail" i! natural cild$*28 and

BF Gillian" i! legiti&ate cild$#2/it =ati&a" in!tituted on 1 Se%te&'er 1))" a ciil

co&%laint for da&age! again!t Dr. Tuao" 'efore te RTC" @ranc 1(" ue

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%raed tat Dr. Tuao 'e adudged lia'le for te follo/ing a&ount!3

1. Te a&ount of P"". to %laintiff Peter Luca!a! and ' /a of co&%en!ation for i! i&%aired i!ion.

. Te a&ount of PF". to !%ou!e! Luca! a! and' /a of actual da&age! %lu! !uc additional a&ount!tat &a 'e %roen during trial.F. Te a&ount of P1"". a! and ' /a of&oral da&age!.$. Te a&ount of P(". a! and ' /a ofe5e&%lar da&age!.

(. Te a&ount of P". a! and ' /a ofattorne! fee! %lu! co!t! of !uit.($2

In re'utting %etitioner! co&%laint" Dr. Tuao a!!erted tat te 4treat&ent &ade ' i&2

&ore tan tree ear! ago a! no cau!al connection to Peter!2 %re!ent glauco&a or

condition.9((2 Dr. Tuao e5%lained tat 4d2rug-induced glauco&a i! te&%orar and

cura'le" !teroid! ae te !ide effect of increa!ing intraocular %re!!ure. Steroid! are

%re!cri'ed to treat E%ide&ic Jerato Conunctiiti! or EJC /ic i! an infiltration of tecornea a! a re!ult of conunctiiti! or !ore ee!.9(H2Dr. Tuao al!o clarified tat B1

4c2ontrar to %etitioner!2 fallaciou! clai&" e2 did N+T continuall %re!cri'e te drug

Ma5itrol /ic contained !teroid! for an %rolonged %eriod9 (*2and 4t2e trut /a! te

Ma5itrol /a! di!continued 5 5 5 a! !oon a! EJC di!a%%eared and /a! re!u&ed onl /en

EJC rea%%eared9(#28 B te entire ti&e e /a! treating Peter" e 4continuall &onitored

te intraocular %re!!ure of Peter! ee!2 ' %al%ating te ee! and ' %utting %re!!ure on

te ee'all!"9 and no ardening of te !a&e could 'e detected" /ic &eant tat tere/a! no increa!e in te ten!ion or I+P" a %o!!i'le !ide reaction to te u!e of !teroid

&edication!8 and BF it /a! onl on 1F Dece&'er 1)## tat Peter co&%lained of a

eadace and 'lurred i!ion in i! rigt ee" and u%on &ea!uring te I+P of !aid ee" it

/a! deter&ined for te fir!t ti&e tat te I+P of te rigt ee ad an eleated alue.

@ut granting for te !a;e of argu&ent tat te 4!teroid treat&ent of Peter!2 EJC cau!ed

te !teroid induced glauco&a"9()2Dr. Tuao argued tat3S2uc condition" i.e." eleated intraocular %re!!ure" i! te&%orar. A! !oon

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court cannot acce%t %etitioner!2 clai& tat te u!e of !teroid i! te %ro5i&ate cau!e of te

da&age !u!tained ' Peter!2 ee.9H(2

Corre!%ondingl" te RTC acce%ted Dr. Tuao! &edical o%inion tat 4Peter Paul &u!t

ae 'een !uffering fro& nor&al ten!ion glauco&a" &eaning" o%tic nere da&age /a!

a%%ening 'ut no eleation of te ee %re!!ure i! &anife!ted" tat te !teroid treat&ent

actuall un&a!;ed te condition tat re!ulted in te earlier treat&ent of te glauco&a.

Tere i! noting in te record to contradict !uc te!ti&on. In fact" %laintiff! E5i'it S

een tend! to !u%%ort te&.9

>ndaunted" %etitioner! a%%ealed te foregoing RTC deci!ion to te Court of

A%%eal!. Teir a%%eal /a! doc;eted a! CA-G.R. C, No. H#HHH.

+n * Se%te&'er H" te Court of A%%eal! rendered a deci!ion in CA-G.R. C, No.

H#HHH dening %etitioner! recour!e and affir&ing te a%%ealed RTC ecision. Te3alloof

te udg&ent of te a%%ellate court !tate!3

:7ERE=+RE" te Deci!ion a%%ealed fro& i! A==IRMED.HH2

Te Court of A%%eal! faulted %etitioner! 'ecau!e te

D2id not %re!ent an &edical e5%ert to te!tif tat Dr. Tuano! %re!cri%tion ofMa5itrol and @le%a&ide for te treat&ent of EJC on Peter! rigt ee /a!not %ro%er and tat i! %al%ation of Peter! rigt ee /a! not enoug todetect ader!e reaction to !teroid. Peter te!tified tat Dr. Manuel Agulto toldi& tat e !ould not ae u!ed !teroid for te treat&ent of EJC or tat e!ould ae u!ed it onl for t/o B /ee;!" a! EJC i! onl a iral infection/ic /ill cure ' it!elf. 7o/eer" Dr. Agulto /a! not %re!ented '

%etitioner!2 a! a /itne!! to confir& /at e allegedl told Peter and"terefore" te latter! te!ti&on i! ear!a. >nder Rule 1F" Section FH of teRule! of Court" a /itne!! can te!tif onl to to!e fact! /ic e ;no/! ofi! o/n %er!onal ;no/ledge" 5 5 5. =a&iliar and funda&ental i! te rule tatear!a te!ti&on i! inad&i!!i'le a! eidence.H*2

Li;e te RTC" te Court of A%%eal! gae great /eigt to Dr. Tuao! &edical udg&ent"

!%ecificall te latter! e5%lanation tat3:2en a doctor !ee! a %atient" e cannot deter&ine /eter or not te latter/ould react ader!el to te u!e of !teroid!" tat it /a! onl on Dece&'er1F" 1)#)" /en Peter co&%lained for te fir!t ti&e of eadace and 'lurred
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i!ion tat e o'!ered tat te %re!!ure of te ee of Peter /a! eleated"and it /a! onl ten tat e !u!%ected tat Peter 'elong! to te (U of te%o%ulation /o react! ader!el to !teroid!.H#2

Petitioner! Motion 3or Reconsideration/a! denied ' te Court of A%%eal! in

a Re!olution dated F ?ul *.

7ence" ti! Petition for Reie/ on Certiorariunder Rule $( of te Rei!ed Rule! of Court

%re&i!ed on te follo/ing a!!ign&ent of error!3

I.T7E C+>RT += APPEALS C+MMITTED GRA,E RE,ERSI@LE ERR+R IN

A==IRMING T7E DECISI+N += T7E TRIAL C+>RT DISMISSING T7EPETITI+NERS C+MPLAINT =+R DAMAGES AGAINST T7ERESP+NDENT +N T7E GR+>ND += INS>==ICIENCK += E,IDENCE8II.T7E C+>RT += APPEALS C+MMITTED GRA,E RE,ERSI@LE ERR+R INDISMISSING T7E PETITI+NERS C+MPLAINT =+R DAMAGES AGAINSTT7E RESP+NDENT +N T7E GR+>ND T7AT N+ MEDICAL EXPERT :ASPRESENTED @K T7E PETITI+NERS T+ PR+,E T7EIR CLAIM =+RMEDICAL NEGLIGENCE AGAINST T7E RESP+NDENT8 ANDIII.T7E C+>RT += APPEALS C+MMITTED GRA,E RE,ERSI@LE ERR+R INN+T =INDING T7E RESP+NDENT LIA@LE T+ T7E PETITI+NERS =+RACT>AL" M+RAL AND EXEMPLARK DAMAGES" ASIDE =R+MATT+RNEKS =EES" C+STS += S>IT" AS A RES>LT += 7IS GR+SSNEGLIGENCE.H)2

A reading of te afore-6uoted reer!i'le error! !u%%o!edl co&&itted ' te Court of

A%%eal! in it! ecisionand Resolution/ould reeal tat %etitioner! are funda&entall

a!!ailing te finding of te Court of A%%eal! tat te eidence on record i! in!ufficient to

e!ta'li! %etitioner! entitle&ent to an ;ind of da&age. Terefore" it could 'e !aid tat te

!ole i!!ue for our re!olution in te Petition at 'ar i! /eter te Court of A%%eal!

co&&itted reer!i'le error in affir&ing te udg&ent of te RTC tat %etitioner! failed to

%roe" ' %re%onderance of eidence" teir clai& for da&age! again!t Dr. Tuao.

Eidentl" !aid i!!ue con!titute! a 6ue!tion of fact" a! /e are a!;ed to rei!it ane/ te
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factual finding! of te Court of A%%eal!" a! /ell a! of te RTC. In effect" %etitioner! /ould

ae u! !ift troug te eidence on record and %a!! u%on /eter tere i! !ufficient

'a!i! to e!ta'li! Dr. Tuao! negligence in i! treat&ent of Peter! ee condition. Ti!

6ue!tion clearl inole! a factual in6uir" te deter&ination of /ic i! not /itin te

a&'it of ti! Court! %o/er of reie/ under Rule $( of te 1))* Rule! Ciil Procedure" a!

a&ended.*2

Ele&entar i! te %rinci%le tat ti! Court i! not a trier of fact!8 onl error! of la/ are

generall reie/ed in %etition! for reie/ on certiorari critici

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tat 4d2e!%ite Dr. Tuao!2 ;no/ledge tat (U of te %o%ulation react! ader!el

to Ma*itrol" e2 ad no 6ual&! /at!oeer in %re!cri'ing !aid !teroid to Peter /itout fir!t

deter&ining /eter or not te (sic)Peter 'elong! to te (U.9*$2

:e are not coninced. Te udg&ent! of 'ot te Court of A%%eal! and te RTC are in

accord /it te eidence on record" and /e are accordingl 'ound ' te finding! of fact

&ade terein.

Petitioner! %o!ition" in !u&" i! tat Peter! glauco&a i! te direct re!ult of Dr. Tuao!

negligence in i! i&%ro%er ad&ini!tration of te drug Ma*itrol8 4tu!" te latter2 !ould 'e

lia'le for all te da&age! !uffered and to 'e !uffered ' %etitioner!2.9*(2Clearl" te

%re!ent controer! i! a cla!!ic illu!tration of a &edical negligence ca!e again!t a

%!ician 'a!ed on te latter! %rofe!!ional negligence. In ti! t%e of !uit" te %atient or

i! eir!" in order to %reail" i! re6uired to %roe ' %re%onderance of eidence tat te

%!ician failed to e5erci!e tat degree of !;ill" care" and learning %o!!e!!ed ' oter

%er!on! in te !a&e %rofe!!ion8 and tat a! a %ro5i&ate re!ult of !uc failure" te %atient

or i! eir! !uffered da&age!.

=or lac; of a !%ecific la/ geared to/ard! te t%e of negligence co&&itted ' &e&'er! of

te &edical %rofe!!ion" !uc clai& for da&age! i! al&o!t al/a! ancored on te alleged

iolation of Article 1*H of te Ciil Code" /ic !tate! tat3

ART. 1*H. :oeer ' act or o&i!!ion cau!e! da&age to anoter" tere'eing fault or negligence" i! o'liged to %a for te da&age done. Suc faultor negligence" if tere i! no %re-e5i!ting contractual relation 'et/een te%artie!" i! called a quasi-delict and i! goerned ' te %roi!ion! of ti!

Ca%ter.

In &edical negligence ca!e!" al!o called &edical &al%ractice !uit!" tere e5i!t a %!ician-

%atient relation!i% 'et/een te doctor and te icti&. @ut u!t li;e an oter %roceeding

for da&age!" four e!!ential B$ ele&ent! i.e." B1 dut8 B 'reac8 BF inur8 and B$

%ro5i&ate cau!ation"*H2&u!t 'e e!ta'li!ed ' te %laintiff!. All te four B$ ele&ent!

&u!t co-e5i!t in order to find te %!ician negligent and" tu!" lia'le for da&age!.

:en a %atient engage! te !erice! of a %!ician" a %!ician-%atient relation!i% i!
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generated. And in acce%ting a ca!e" te %!ician" for all intent! and %ur%o!e!" re%re!ent!

tat e a! te needed training and !;ill %o!!e!!ed ' %!ician! and !urgeon! %racticing

in te !a&e field8 and tat e /ill e&%lo !uc training" care" and !;ill in te treat&ent of

te %atient.**2Tu!" in treating i! %atient" a %!ician i! under a dutyto te for&er2 to

e5erci!e tat degree of care" !;ill and diligence /ic %!ician! in te !a&e general

neig'orood and in te !a&e general line of %ractice ordinaril %o!!e!! and e5erci!e in

li;e ca!e!.*#2Stated oter/i!e" te %!ician a! te dut to u!e at lea!t te !a&e leel

of care tat an oter rea!ona'l co&%etent %!ician /ould u!e to treat te condition

under !i&ilar circu&!tance!.

Ti! !tandard leel of care" !;ill and diligence i! a &atter 'e!t addre!!ed ' e5%ert

&edical te!ti&on" 'ecau!e te !tandard of care in a &edical &al%ractice ca!e i! a &atter

%eculiarl /itin te ;no/ledge of e5%ert! in te field.*)2

Tere i! breachof dut of care" !;ill and diligence" or te i&%ro%er %erfor&ance of !uc

dut" ' te attending %!ician /en tepatient isinjuredin 'od or in ealt and ti!2

con!titute! te actiona'le &al%ractice.#2 Proof of !uc 'reac &u!t li;e/i!e re!t u%on

te te!ti&on of an e5%ert /itne!! tat te treat&ent accorded to te %atient failed to &eet

te !tandard leel of care" !;ill and diligence /ic %!ician! in te !a&e general

neig'orood and in te !a&e general line of %ractice ordinaril %o!!e!! and e5erci!e in

li;e ca!e!.

Een !o" %roof of 'reac of dut on te %art of te attending %!ician i! in!ufficient" for

tere &u!t 'e a cau!al connection 'et/een !aid 'reac and te re!ulting inur !u!tained

' te %atient. Put in anoter /a" in order tat tere &a 'e a recoer for an inur" it

&u!t 'e !o/n tat te 4inur for /ic recoer i! !ougt &u!t 'e te legiti&ate

con!e6uence of te /rong done8 te connection 'et/een te negligence and te inur

&u!t 'e a direct and natural !e6uence of eent!" un'ro;en ' interening efficient

cau!e!98#12tat i!" te negligence &u!t 'e teproximate causeof te inur. And te

%ro5i&ate cau!e of an inur i! tat cau!e" /ic" in te natural and continuou! !e6uence"

un'ro;en ' an efficient interening cau!e" %roduce! te inur" and /itout /ic te

re!ult /ould not ae occurred.#2

?u!t a! /it te ele&ent! of dut and 'reac of te !a&e" in order to e!ta'li! te

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%ro5i&ate cau!e of te inur2 ' a %re%onderance of te eidence in a &edical

&al%ractice action" te %atient2 &u!t !i&ilarl u!e e5%ert te!ti&on" 'ecau!e te 6ue!tion

of /eter te alleged %rofe!!ional negligence cau!ed te %atient!2 inur i! generall

one for !%ecialinfortunatel" in ti! ca!e" tere /a! a'!olute failure on te %art of

%etitioner! to %re!ent an e5%ert te!ti&on to e!ta'li!3 B1 te !tandard of care to 'e

i&%le&ented ' co&%etent %!ician! in treating te !a&e condition a! Peter! under

!i&ilar circu&!tance!8 B tat" in i! treat&ent of Peter" Dr. Tuao failed in i! dut to

e5erci!e !aid !tandard of care tat an oter co&%etent %!ician /ould u!e in treating

te !a&e condition a! Peter! under !i&ilar circu&!tance!8 and BF tat te inur orda&age to Peter! rigt ee" i.e." i! glauco&a" /a! te re!ult of i! u!e of Ma*itrol" a!
http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn83http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn84http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn85http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn86http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn83http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn84http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn85http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn86

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%re!cri'ed ' Dr. Tuao. Petitioner! failure to %roe te fir!t ele&ent alone i! alread fatal

to teir cau!e.

Petitioner! &aintain tat Dr. Tuao failed to follo/ in Peter! ca!e te re6uired %rocedure

for te %rolonged u!e of Ma*itrol. @ut /at i! actuall te re6uired %rocedure in !ituation!

!uc a! in te ca!e at 'ar0 To 'e %reci!e" /at i! te !tandard o%erating %rocedure /en

o%tal&ologi!t! %re!cri'e !teroid &edication! /ic" ad&ittedl" carr !o&e &odicu& of

ri!;0

A'!ent a definitie !tandard of care or diligence re6uired of Dr. Tuao under te

circu&!tance!" /e ae no &ean! to deter&ine /eter e /a! a'le to co&%l /it te

!a&e in i! diagno!i! and treat&ent of Peter. Ti! Court a! no ard!tic; u%on /ic to

ealuate or /eig te attendant fact! of ti! ca!e to 'e a'le to !tate /it confidence tat

te act! co&%lained of" indeed" con!tituted negligence and" tu!" !ould 'e te !u'ect of

%ecuniar re%aration.

Petitioner! a!!ert tat %rior to %re!cri'ing Ma*itrol" Dr. Tuao !ould ae deter&ined fir!t

/eter Peter /a! a 4!teroid re!%onder.9#*2 Ket again" %etitioner! did not %re!ent an

conincing %roof tat !uc deter&ination i! actuall %art of te !tandard o%erating

%rocedure /ic o%tal&ologi!t! !ould unerringl follo/ %rior to %re!cri'ing !teroid

&edication!.

In contra!t" Dr. Tuao /a! a'le to clearl e5%lain tat /at i! onl re6uired of

o%tal&ologi!t!" in ca!e! !uc a! Peter!" i! te conduct of !tandard te!t!%rocedure!

;no/n a! 4ocular routine e5a&ination"9##2co&%o!ed of fie B( te!t!%rocedure!

!%ecificall" gro!! e5a&ination of te ee! and te !urrounding area8 ta;ing of te i!ual

acuit of te %atient8 cec;ing te intraocular %re!!ure of te %atient8 cec;ing te &otilit

of te ee!8 and u!ing o%tal&o!co% on te %atient! ee and e did all to!e

te!t!%rocedure! eer ti&e Peter /ent to !ee i& for follo/-u% con!ultation andor cec;-

u%.

:e cannot 'ut agree /it Dr. Tuao! a!!ertion tat /en a doctor !ee! a %atient" e

cannot deter&ine i&&ediatel /eter te latter /ould react ader!el to te u!e of!teroid!8 all te doctor can do i! &a% out a cour!e of treat&ent recogni

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te !tandard! of te &edical %rofe!!ion. It &u!t 'e re&e&'ered tat a %!ician i! not an

in!urer of te good re!ult of treat&ent. Te &ere fact tat te %atient doe! not get /ell or

tat a 'ad re!ult occur! doe! not in it!elf indicate failure to e5erci!e due care. #)2Te

re!ult i! not deter&inatie of te %erfor&ance of te %!ician2 and e i! not re6uired to

'e infalli'le.)2

Moreoer" tat Dr. Tuao !a/ it fit to %re!cri'e Ma*itrolto Peter /a! u!tified ' te fact

tat te latter /a! alread u!ing te !a&e &edication /en e fir!t ca&e to !ee Dr. Tuao

on Se%te&'er 1)## and ad e5i'ited no %reiou! unto/ard reaction to tat %articular

drug. )12

Al!o" Dr. Tuao categoricall denied %etitioner! clai& tat e neer &onitored te ten!ion

of Peter! ee! /ile te latter /a! on Ma*itrol. Dr. Tuao te!tified tat e %al%ated

Peter! ee! eer ti&e te latter ca&e for a cec;-u% a! %art of te doctor! ocular

routine e5a&ination" a fact /ic %etitioner! failed to re'ut. Dr. Tuao! regular conduct of

e5a&ination! and te!t! to a!certain te !tate of Peter! ee! negate te er 'a!i! of

%etitioner! co&%laint for da&age!. A! to /eter Dr. Tuao! actuation! confor&ed to te

!tandard of care and diligence re6uired in li;e circu&!tance!" it i! %re!u&ed to ae !o

confor&ed in te a'!ence of eidence to te contrar.

Een if /e are to a!!u&e tat Dr. Tuao co&&itted negligent act! in i! treat&ent of

Peter! condition" te cau!al connection 'et/een Dr. Tuao! !u%%o!ed negligence and

Peter! inur !till needed to 'e e!ta'li!ed. Te critical and clincing factor in a &edical

negligence ca!e i! %roof of te cau!al connection 'et/een te negligence /ic te

eidence e!ta'li!ed and te %laintiff! inurie!.)2 Te %laintiff &u!t %lead and %roe not

onl tat e a! 'een inured and defendant a! 'een at fault" 'ut al!o tat te

defendant! fault cau!ed te inur. A erdict in a &al%ractice action cannot 'e 'a!ed on

!%eculation or conecture. Cau!ation &u!t 'e %roen /itin a rea!ona'le &edical

%ro'a'ilit 'a!ed u%on co&%etent e5%ert te!ti&on.)F2

Te cau!ation 'et/een te %!ician! negligence and te %atient! inur &a onl 'e

e!ta'li!ed ' te %re!entation of %roof tat Peter! glauco&a /ould not ae occurred

'ut for Dr. Tuao! !u%%o!ed negligent conduct. +nce &ore" %etitioner! failed in ti!regard.
http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn89http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn90http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn91http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn92http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn93http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn89http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn90http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn91http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn92http://sc.judiciary.gov.ph/jurisprudence/2009/april2009/178763.htm#_ftn93

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Dr. Tuao doe! not den tat te u!e of Ma*itrolinole! te ri!; of increa!ing a %atient!

I+P. In fact" ti! /a! te rea!on / e &ade it a %oint to %al%ate Peter! ee! eer ti&e

te latter /ent to !ee i& -- !o e could &onitor te ten!ion of Peter! ee!. @ut to !a

tat !aid &edication conclu!iel cau!ed Peter! glauco&a i! %urel !%eculatie. Peter

/a! diagno!ed /it open-angleglauco&a. Ti! ;ind of glauco&a i! caracterinier!it of te Pili%%ine!-Pili%%ine General 7o!%ital and St.

Lu;e! Medical Center" re!%ectiel8 and tat e eld an a!!ort&ent of %o!ition! in

nu&erou! &edical organi

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client!" unle!! te contrar i! !ufficientl e!ta'li!ed.)#2In &a;ing te udg&ent call of

treating Peter! EJC /it Ma*itrol" Dr. Tuao too; te nece!!ar %recaution ' %al%ating

Peter! ee! to &onitor teir I+P eer ti&e te latter /ent for a cec;-u%" and e

e&%loed te 'e!t of i! ;no/ledge and !;ill earned fro& ear! of training and %ractice.

In contra!t" /itout !u%%orting e5%ert &edical o%inion!" %etitioner! 'are a!!ertion! of

negligence on Dr. Tuao! %art" /ic re!ulted in Peter! glauco&a" de!ere !cant credit.

+ur di!%o!ition of te %re!ent controer! &igt ae 'een a!tl different ad %etitioner!

%re!ented a &edical e5%ert to e!ta'li! teir teor re!%ecting Dr. Tuao! !o-called

negligence. In fact" te record of te ca!e reeal! tat %etitioner! coun!el recogni

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7erein" te 'urden of %roof /a! clearl u%on %etitioner!" a! %laintiff! in te lo/er court" to

e!ta'li! teir ca!e ' a %re%onderance of eidence !o/ing a rea!ona'le connection

'et/een Dr. Tuao! alleged 'reac of dut and te da&age !u!tained ' Peter! rigt

ee. Ti!" te did not do. In realit" %etitioner! co&%laint for da&age! i! &erel ancored

on a !tate&ent in te literature of Ma*itrolidentifing te ri!;! of it! u!e" and te %ur%orted

co&&ent of Dr. Agulto anoter doctor not %re!ented a! /itne!! 'efore te RTC

concerning te %rolonged u!e of Ma*itrolfor te treat&ent of EJC.

It !ee&! 'a!ic tat /at con!titute! %ro%er &edical treat&ent i! a &edical 6ue!tion tat

!ould ae 'een %re!ented to e5%ert!. If no !tandard i! e!ta'li!ed troug e5%ert

&edical /itne!!e!" ten court! ae no !tandard ' /ic to gauge te 'a!ic i!!ue of

'reac tereof ' te %!ician or !urgeon. Te RTC and Court of A%%eal!" and een ti!

Court" could not 'e e5%ected to deter&ine on it! o/n /at &edical tecni6ue !ould ae

'een utili

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Su%erior8C. Troug te %!ician! failure to o'tain te infor&ed con!ent of te %atient

%rior to treat&ent8D. Troug 'reac of %!ician-%atient contractual relation!i% Bi.e."

a'andoning %atient" di!clo!ing confidential infor&ation" or guaranteeing acure or !o&e oter !%ecific re!ult8 and

E. Troug te negligence of te %!ician! %artner!.

I,. Standard of Care3 Te !tandard of care for %!ician! and ealt care %roider!re6uire! tat te e5erci!e tat degree of !;ill" ;no/ledge and care ordinaril %o!!e!!edand e5erci!ed ' oter &e&'er! of te %rofe!!ion acting under !i&ilar condition! andcircu&!tance!.

A. Garcia-Rueda !. Pa!ca!io" !u%ra.@. PETER PA>L PATRICJ L>CAS" =ATIMA GLADKS L>CAS" A@@EKGAIL

L>CAS AND GILLIAN L>CAS !. DR. PR+SPER+ MA. C. T>A+" G.R.No. 1*#*HF. A%ril 1" ).2" !u%ra.

C. So&e doctrine! on !tandard of care3

1. No &atter /at a ealtcare %roider doe!" e /ill not 'e found lia'leif te !tandard of care i! &aintained. A %ractitioner /o conduct!i&!elf in confor&it /it te !tandard of care /ill not 'e eld lia'leeen if te treat&ent %roed un!ucce!!ful.

. Te e5i!tence of %oor treat&ent or !urger re!ult doe! not in an /arai!e a %re!u&%tion of te iolation of te !tandard of care. Plaintiff&u!t !till %roe a !tandard of care iolation.

F. :ere a ealtcare %roider &a;e! an error in udg&ent" if tere i! no!tandard of care iolation" te %laintiff a! no ca!e.

$. Te !tandard of care doe! not call for a %ractitioner to u!e te ige!t!;ill ;no/n to &edical !cience.

(. >nder &o!t circu&!tance!" if eidence !ugge!t! tat tere /erealternatie recogni

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[G.R. No. 1?4

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Ca%itol Medical Center" =E> 7o!%ital and DLSMC %re!ented to i&. Rogelio E. Ra&o!"o/eer" a!;ed Dr. 7o!a;a to loo; for a good ane!te!iologi!t. Dr. 7o!a;a" in turn"a!!ured Rogelio tat e /ill get a good ane!te!iologi!t. Dr. 7o!a;a carged a feeof P1H"." /ic /a! to include te ane!te!iologi!t! fee and /ic /a! to 'e %aidafter te o%eration BTSN" +cto'er 1)" 1)#)" %%. 1$-1(" -F" F1-FF8 TSN" =e'ruar *"1))" %. 1F8 and TSN" Noe&'er )" 1)#)" %%. F-$" 1" 1*.

A da 'efore te !ceduled date of o%eration" !e /a! ad&itted at one of te roo&! of teDLSMC" located along E. Rodrigue< Aenue" ue

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to intu'ate te %atient. Te %atient! nail'ed 'eca&e 'lui! and te %atient /a! %laced ina trendelen'urg %o!ition - a %o!ition /ere te ead of te %atient i! %laced in a %o!itionlo/er tan er feet /ic i! an indication tat tere i! a decrea!e of 'lood !u%%l to te%atient! 'rain BId." %%. 1)-. I&&ediatel tereafter" !e /ent out of te o%erating roo&"and !e told Rogelio E. Ra&o! 4tat !o&eting /rong /a! 5 5 5 a%%ening9 BI'id.. Dr.Calderon /a! ten a'le to intu'ate te %atient BTSN" ?ul (" 1))1" %. ).

Mean/ile" Rogelio" /o /a! out!ide te o%erating roo&" !a/ a re!%irator &acine'eing ru!ed to/ard! te door of te o%erating roo&. 7e al!o !a/ !eeral doctor!ru!ing to/ard! te o%erating roo&. :en infor&ed ' 7er&inda Cru< tat !o&eting/rong /a! a%%ening" e told er B7er&inda to 'e 'ac; /it te %atient in!ide teo%erating roo& BTSN" +cto'er 1)" 1)#)" %%. (-#.

7er&inda Cru< i&&ediatel ru!ed 'ac;" and !a/ tat te %atient /a! !till intrendelen'urg %o!ition BTSN" ?anuar 1F" 1)##" %. . At al&o!t F3 P.M. of tat fatefulda" !e !a/ te %atient ta;en to te Inten!ie Care >nit BIC>.

A'out t/o da! tereafter" Rogelio E. Ra&o! /a! a'le to tal; to Dr. 7o!a;a. Te latterinfor&ed te for&er tat !o&eting /ent /rong during te intu'ation. Reacting to /at/a! told to i&" Rogelio re&inded te doctor tat te condition of i! /ife /ould not aea%%ened" ad e BDr. 7o!a;a loo;ed for a good ane!te!iologi!t BTSN" +cto'er 1)"1)#)" %. F1.

Doctor! Gutierre< and 7o!a;a /ere al!o a!;ed ' te o!%ital to e5%lain /at a%%enedto te %atient. Te doctor! e5%lained tat te %atient ad 'ronco!%a!& BTSN" Noe&'er1(" 1))" %%. H-*.

Erlinda Ra&o! !taed at te IC> for a &ont. A'out four &ont! tereafter or onNoe&'er 1(" 1)#(" te %atient /a! relea!ed fro& te o!%ital.

During te /ole %eriod of er confine&ent" !e incurred o!%ital 'ill! a&ounting

to P)F"($.( /ic i! te !u'ect of a %ro&i!!or note and affidait of underta;inge5ecuted ' Rogelio E. Ra&o! in faor of DLSMC. Since tat fateful afternoon of ?une 1*"1)#(" !e a! 'een in a co&ato!e condition. Se cannot do anting. Se cannot &oean %art of er 'od. Se cannot !ee or ear. Se i! liing on &ecanical &ean!. Se!uffered 'rain da&age a! a re!ult of te a'!ence of o5gen in er 'rain for four to fie&inute! BTSN" Noe&'er )" 1)#)" %%. 1-. After 'eing di!carged fro& te o!%ital"!e a! 'een !taing in teir re!idence" !till needing con!tant &edical attention" /it eru!'and Rogelio incurring a &ontl e5%en!e ranging fro& P#". to P1".BTSN" +cto'er 1)" 1)#)" %%. F-F$. Se /a! al!o diagno!ed to 'e !uffering fro& 4diffu!ecere'ral %arenc&al da&age9 BE5. 4G98 !ee al!o TSN" Dece&'er 1" 1)#)" %. H.(2

Tu!" on # ?anuar 1)#H" %etitioner! filed a ciil ca!eH2for da&age! /it teRegional Trial Court of ue

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udg&ent in faor of %etitioner!" to /it3

After ealuating te eidence a! !o/n in te finding of fact! !et fort earlier" and a%%lingte aforecited %roi!ion! of la/ and uri!%rudence to te ca!e at 'ar" ti! Court find! and!o old! tat defendant! are lia'le to %laintiff! for da&age!. Te defendant! /ere guiltof" at te er lea!t" negligence in te %erfor&ance of teir dut to %laintiff-%atient ErlindaRa&o!.

+n te %art of Dr. Perfecta Gutierre

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court. Te decretal %ortion of te deci!ion of te a%%ellate court read!3

:7ERE=+RE" for te foregoing %re&i!e! te a%%ealed deci!ion i! ere' RE,ERSED"and te co&%laint 'elo/ again!t te a%%ellant! i! ere' ordered DISMISSED. Tecounterclai& of a%%ellant De Lo! Santo! Medical Center i! GRANTED 'ut onl in!ofar a!a%%ellee! are ere' ordered to %a te un%aid o!%ital 'ill! a&ounting to P)F"($.("%lu! legal intere!t for u!tice &u!t 'e te&%ered /it &erc.

S+ +RDERED.#2

Te deci!ion of te Court of A%%eal! /a! receied on ) ?une 1))( ' %etitionerRogelio Ra&o! /o /a! &i!ta;enl addre!!ed a! 4Att. Rogelio Ra&o!.9 No co% of tedeci!ion" o/eer" /a! !ent nor receied ' te Coronel La/ +ffice" ten coun!el onrecord of %etitioner!. Rogelio referred te deci!ion of te a%%ellate court to a ne/ la/er"Att. Lig!a" onl on ?une 1))(" or four B$ da! 'efore te e5%iration of teregle&entar %eriod for filing a &otion for recon!ideration. +n te !a&e da" Att. Lig!a"filed /it te a%%ellate court a &otion for e5ten!ion of ti&e to file a &otion forrecon!ideration. Te &otion for recon!ideration /a! !u'&itted on $ ?ul 1))(. 7o/eer"

te a%%ellate court denied te &otion for e5ten!ion of ti&e in it! Re!olution dated ( ?ul1))(.)2Mean/ile %etitioner! engaged te !erice! of anoter coun!el" Att. Sillano" tore%lace Att. Lig!a. Att. Sillano filed on * Augu!t 1))( a &otion to ad&it te &otion forrecon!ideration contending tat te %eriod to file te a%%ro%riate %leading on te a!!aileddeci!ion ad not et co&&enced to run a! te Dii!ion Cler; of Court of te Court ofA%%eal! ad not et !ered a co% tereof to te coun!el on record. De!%ite ti!e5%lanation" te a%%ellate court !till denied te &otion to ad&it te &otion forrecon!ideration of %etitioner! in it! Re!olution" dated ) Marc 1))H" %ri&aril on teground tat te fifteen-da B1( %eriod for filing a &otion for recon!ideration ad alreade5%ired" to /it3

:e !aid in our Re!olution on ?ul (" 1))(" tat te filing of a Motion for Recon!iderationcannot 'e e5tended8 %reci!el" te Motion for E5ten!ion BRollo" %. 1 /a! denied. It i!" onte oter and" ad&itted in te latter Motion tat %laintiff!a%%ellee! receied a co% of tedeci!ion a! earl a! ?une )" 1))(. Co&%utation /i!e" te %eriod to file a Motion forRecon!ideration e5%ired on ?une $. Te Motion for Recon!ideration" in turn" /a!receied ' te Court of A%%eal! alread on ?ul $" nece!!aril" te 1(-da %eriod alread%a!!ed. =or tat alone" te latter !ould 'e denied.

Een a!!u&ing ad&i!!i'ilit of te Motion for Recon!ideration" 'ut after con!idering teCo&&ent+%%o!ition" te for&er" for lac; of &erit" i! ere' DENIED.

S+ +RDERED.12

A co% of te a'oe re!olution /a! receied ' Att. Sillano on 11 A%ril 1))H. Tene5t da" or on 1 A%ril 1))H" Att. Sillano filed 'efore ti! Court a &otion for e5ten!ion ofti&e to file te %re!ent %etition forcertiorariunder Rule $(. Te Court granted te &otionfor e5ten!ion of ti&e and gae %etitioner! additional tirt BF da! after te e5%iration ofte fifteen-da B1( %eriod counted fro& te recei%t of te re!olution of te Court ofA%%eal! /itin /ic to !u'&it te %etition. Te due date fell on * Ma 1))H. Te%etition /a! filed on ) Ma 1))H" /ell /itin te e5tended %eriod gien ' te Court.

Petitioner! a!!ail te deci!ion of te Court of A%%eal! on te follo/ing ground!3

I

IN P>TTING M>C7 RELIANCE +N T7E TESTIM+NIES += RESP+NDENTS DRA.
http://sc.judiciary.gov.ph/jurisprudence/1999/dec99/124354.htm#_edn8http://sc.judiciary.gov.ph/jurisprudence/1999/dec99/124354.htm#_edn9http://sc.judiciary.gov.ph/jurisprudence/1999/dec99/124354.htm#_edn10http://sc.judiciary.gov.ph/jurisprudence/1999/dec99/124354.htm#_edn8http://sc.judiciary.gov.ph/jurisprudence/1999/dec99/124354.htm#_edn9http://sc.judiciary.gov.ph/jurisprudence/1999/dec99/124354.htm#_edn10

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G>TIERRE" DRA. CALDER+N AND DR. ?AM+RA8

II

IN =INDING T7AT T7E NEGLIGENCE += T7E RESP+NDENTS DID N+T CA>SE T7E>N=+RT>NATE C+MAT+SE C+NDITI+N += PETITI+NER ERLINDA RAM+S8

III

IN N+T APPLKING T7E D+CTRINE += RES IPSA L+>IT>R.112

@efore /e di!cu!! te &erit! of te ca!e" /e !all fir!t di!%o!e of te %rocedural i!!ueon te ti&eline!! of te %etition in relation to te &otion for recon!ideration filed '%etitioner! /it te Court of A%%eal!. In teir Co&&ent"12%riate re!%ondent! contendtat te %etition !ould not 'e gien due cour!e !ince te &otion for recon!ideration of te%etitioner! on te deci!ion of te Court of A%%eal! /a! alidl di!&i!!ed ' te a%%ellatecourt for aing 'een filed 'eond te regle&entar %eriod. :e do not agree.

A careful reie/ of te record! reeal! tat te rea!on 'eind te dela in filing te&otion for recon!ideration i! attri'uta'le to te fact tat te deci!ion of te Court ofA%%eal! /a! not !ent to ten coun!el on record of %etitioner!" te Coronel La/ +ffice. Infact" a co% of te deci!ion of te a%%ellate court /a! in!tead !ent to and receied '%etitioner Rogelio Ra&o! on ) ?une 1))( /erein e /a! &i!ta;enl addre!!ed a! Att.Rogelio Ra&o!. @a!ed on te oter co&&unication! receied ' %etitioner RogelioRa&o!" te a%%ellate court a%%arentl &i!too; i& for te coun!el on record. Tu!" noco% of te deci!ion of te a%%ellate court /a! furni!ed to te coun!el onrecord. Petitioner" not 'eing a la/er and una/are of te %re!cri%tie %eriod for filing a&otion for recon!ideration" referred te !a&e to a legal coun!el onl on ?une 1))(.

It i! ele&entar tat /en a %art i! re%re!ented ' coun!el" all notice! !ould 'e !entto te %art! la/er at i! gien addre!!. :it a fe/ e5ce%tion!" notice to a litigant/itout notice to i! coun!el on record i! no notice at all. In te %re!ent ca!e" !ince aco% of te deci!ion of te a%%ellate court /a! not !ent to te coun!el on record of%etitioner" tere can 'e no !ufficient notice to !%ea; of. 7ence" te dela in te filing of te&otion for recon!ideration cannot 'e ta;en again!t %etitioner. Moreoer" !ince te Courtof A%%eal! alread i!!ued a !econd Re!olution" dated ) Marc 1))H" /ic !u%er!ededte earlier re!olution i!!ued on ( ?ul 1))(" and denied te &otion for recon!ideration of%etitioner" /e 'eliee tat te recei%t of te for&er !ould 'e con!idered in deter&iningte ti&eline!! of te filing of te %re!ent %etition. @a!ed on ti!" te %etition 'efore u! /a!

!u'&itted on ti&e.After re!oling te foregoing %rocedural i!!ue" /e !all no/ loo; into te &erit! of te

ca!e. =or a &ore logical %re!entation of te di!cu!!ion /e !all fir!t con!ider te i!!ue onte a%%lica'ilit of te doctrine of res ipsa loquitur to te in!tant ca!e. Tereafter" te fir!tt/o a!!igned error! !all 'e tac;led in relation to te res ipsa loquitur doctrine.

Res ipsa loquitur i! a Latin %ra!e /ic literall &ean! 4te ting or te tran!action!%ea;! for it!elf.9 Te %ra!e 4res ipsa loquitur9 i! a &a5i& for te rule tat te fact of teoccurrence of an inur" ta;en /it te !urrounding circu&!tance!" &a %er&it aninference or rai!e a %re!u&%tion of negligence" or &a;e out a %laintiff!prima 3acieca!e"

and %re!ent a 6ue!tion of fact for defendant to &eet /it an e5%lanation. 1F2:ere teting /ic cau!ed te inur co&%lained of i! !o/n to 'e under te &anage&ent of tedefendant or i! !erant! and te accident i! !uc a! in ordinar cour!e of ting! doe! not

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a%%en if to!e /o ae it! &anage&ent or control u!e %ro%er care" it afford! rea!ona'leeidence" in te a'!ence of e5%lanation ' te defendant" tat te accident aro!e fro& or/a! cau!ed ' te defendant! /ant of care.1$2

Te doctrine of res ipsa loquitur i! !i&%l a recognition of te %o!tulate tat" a! a&atter of co&&on ;no/ledge and e5%erience" te er nature of certain t%e! of

occurrence! &a u!tif an inference of negligence on te %art of te %er!on /o control!te in!tru&entalit cau!ing te inur in te a'!ence of !o&e e5%lanation ' te defendant/o i! carged /it negligence.1(2It i! grounded in te !u%erior logic of ordinar u&ane5%erience and on te 'a!i! of !uc e5%erience or co&&on ;no/ledge" negligence &a'e deduced fro& te &ere occurrence of te accident it!elf.1H27ence" res ipsaloquitur i! a%%lied in conunction /it te doctrine of co&&on ;no/ledge.

7o/eer" &uc a! 'een !aid tat res ipsa loquitur i! not a rule of !u'!tantie la/and" a! !uc" doe! not create or con!titute an inde%endent or !e%arate ground of lia'ilit.1*2In!tead" it i! con!idered a! &erel eidentiar or in te nature of a %rocedural rule.1#2It i! regarded a! a &ode of %roof" or a &ere %rocedural conenience !ince it furni!e!

a !u'!titute for" and reliee! a %laintiff of" te 'urden of %roducing !%ecific %roof ofnegligence.1)2In oter /ord!" &ere inocation and a%%lication of te doctrine doe! notdi!%en!e /it te re6uire&ent of %roof of negligence. It i! !i&%l a !te% in te %roce!! of!uc %roof" %er&itting te %laintiff to %re!ent along /it te %roof of te accident" enougof te attending circu&!tance! to ino;e te doctrine" creating an inference or%re!u&%tion of negligence" and to tere' %lace on te defendant te 'urden of goingfor/ard /it te %roof.2Still" 'efore re!ort to te doctrine &a 'e allo/ed" te follo/ingre6ui!ite! &u!t 'e !ati!factoril !o/n3

1. Te accident i! of a ;ind /ic ordinaril doe! not occur in te a'!ence of!o&eone! negligence8

. It i! cau!ed ' an in!tru&entalit /itin te e5clu!ie control of te defendantor defendant!8 and

F. Te %o!!i'ilit of contri'uting conduct /ic /ould &a;e te %laintiffre!%on!i'le i! eli&inated.12

In te a'oe re6ui!ite!" te funda&ental ele&ent i! te 4control of te in!tru&entalit9/ic cau!ed te da&age.2Suc ele&ent of control &u!t 'e !o/n to 'e /itin tedo&inion of te defendant. In order to ae te 'enefit of te rule" a %laintiff" in addition to

%roing inur or da&age" &u!t !o/ a !ituation /ere it i! a%%lica'le" and &u!t e!ta'li!tat te e!!ential ele&ent! of te doctrine /ere %re!ent in a %articular incident.F2

Medical &al%ractice$2ca!e! do not e!ca%e te a%%lication of ti! doctrine. Tu!" resipsa loquitur a! 'een a%%lied /en te circu&!tance! attendant u%on te ar& arete&!ele! of !uc a caracter a! to u!tif an inference of negligence a! te cau!e of tatar&.(2Te a%%lication of res ipsa loquitur in &edical negligence ca!e! %re!ent! a6ue!tion of la/ !ince it i! a udicial function to deter&ine /eter a certain !et ofcircu&!tance! doe!" a! a &atter of la/" %er&it a gien inference.H2

Altoug generall" e5%ert &edical te!ti&on i! relied u%on in &al%ractice !uit! to

%roe tat a %!ician a! done a negligent act or tat e a! deiated fro& te !tandard&edical %rocedure" /en te doctrine of res ipsa loquitur i! aailed ' te %laintiff" teneed for e5%ert &edical te!ti&on i! di!%en!ed /it 'ecau!e te inur it!elf %roide! te
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%roof of negligence.*2Te rea!on i! tat te general rule on te nece!!it of e5%ertte!ti&on a%%lie! onl to !uc &atter! clearl /itin te do&ain of &edical !cience" andnot to &atter! tat are /itin te co&&on ;no/ledge of &an;ind /ic &a 'e te!tified to' anone fa&iliar /it te fact!.#2+rdinaril" onl %!ician! and !urgeon! of !;ill ande5%erience are co&%etent to te!tif a! to /eter a %atient a! 'een treated or o%eratedu%on /it a rea!ona'le degree of !;ill and care. 7o/eer" te!ti&on a! to te !tate&ent!

and act! of %!ician! and !urgeon!" e5ternal a%%earance!" and &anife!t condition!/ic are o'!era'le ' an one &a 'e gien ' non-e5%ert /itne!!e!. )27ence" inca!e! /ere te res ipsa loquitur i! a%%lica'le" te court i! %er&itted to find a %!iciannegligent u%on %ro%er %roof of inur to te %atient" /itout te aid of e5%ert te!ti&on"/ere te court fro& it! fund of co&&on ;no/ledge can deter&ine te %ro%er !tandard ofcare.F2:ere co&&on ;no/ledge and e5%erience teac tat a re!ulting inur /ouldnot ae occurred to te %atient if due care ad 'een e5erci!ed" an inference ofnegligence &a 'e dra/n giing ri!e to an a%%lication of te doctrine of res ipsaloquitur/itout &edical eidence" /ic i! ordinaril re6uired to !o/ not onl /atoccurred 'ut o/ and / it occurred.F12:en te doctrine i! a%%ro%riate" all tat te%atient &u!t do i! %roe a ne5u! 'et/een te %articular act or o&i!!ion co&%lained of and

te inur !u!tained /ile under te cu!tod and &anage&ent of te defendant /itoutneed to %roduce e5%ert &edical te!ti&on to e!ta'li! te !tandard of care. Re!ort to resipsa loquitur i! allo/ed 'ecau!e tere i! no oter /a" under u!ual and ordinarcondition!" ' /ic te %atient can o'tain redre!! for inur !uffered ' i&.

Tu!" court! of oter uri!diction! ae a%%lied te doctrine in te follo/ing!ituation!3 leaing of a foreign o'ect in te 'od of te %atient after an o%eration"F2inurie! !u!tained on a ealt %art of te 'od /ic /a! not under" or in te area" oftreat&ent"FF2re&oal of te /rong %art of te 'od /en anoter %art /a! intended"F$2;noc;ing out a toot /ile a %atient! a/ /a! under ane!tetic for te re&oal of i!ton!il!"F(2 and lo!! of an ee /ile te %atient %laintiff /a! under te influence ofane!tetic" during or follo/ing an o%eration for a%%endiciti!"FH2a&ong oter!.

Neertele!!" de!%ite te fact tat te !co%e of res ipsa loquitura! 'een &ea!ura'lenlarged" it doe! not auto&aticall a%%l to all ca!e! of &edical negligence a! to&ecanicall !ift te 'urden of %roof to te defendant to !o/ tat e i! not guilt of tea!cri'ed negligence. Res ipsa loquituri! not a rigid or ordinar doctrine to 'e %erfunctorilu!ed 'ut a rule to 'e cautiou!l a%%lied" de%ending u%on te circu&!tance! of eacca!e. It i! generall re!tricted to !ituation! in &al%ractice ca!e! /ere a la&an i! a'le to!a" a! a &atter of co&&on ;no/ledge and o'!eration" tat te con!e6uence! of%rofe!!ional care /ere not a! !uc a! /ould ordinaril ae follo/ed if due care ad 'een

e5erci!ed.F*2A di!tinction &u!t 'e &ade 'et/een te failure to !ecure re!ult!" and teoccurrence of !o&eting &ore unu!ual and not ordinaril found if te !erice or treat&entrendered follo/ed te u!ual %rocedure of to!e !;illed in tat %articular %ractice. It &u!t'e conceded tat te doctrine of res ipsa loquitur can ae no a%%lication in a !uit again!ta %!ician or !urgeon /ic inole! te &erit! of a diagno!i! or of a !cientific treat&ent.F#2Te %!ician or !urgeon i! not re6uired at i! %eril to e5%lain / an %articulardiagno!i! /a! not correct" or / an %articular !cientific treat&ent did not %roduce tede!ired re!ult.F)2Tu!" res ipsa loquituri! not aaila'le in a &al%ractice !uit if te onl!o/ing i! tat te de!ired re!ult of an o%eration or treat&ent /a! not acco&%li!ed.$2Te real 6ue!tion" terefore" i! /eter or not in te %roce!! of te o%eration ane5traordinar incident or unu!ual eent out!ide of te routine %erfor&ance occurred /ic

i! 'eond te regular !co%e of cu!to&ar %rofe!!ional actiit in !uc o%eration!" /ic" ifune5%lained /ould te&!ele! rea!ona'l !%ea; to te aerage &an a! te negligentcau!e or cau!e! of te unto/ard con!e6uence.$12If tere /a! !uc e5traneou!
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interention!" te doctrine of res ipsa loquitur &a 'e utili%on te!e fact! and under te!e circu&!tance! a la&an /ould'e a'le to !a" a! a &atter of co&&on ;no/ledge and o'!eration" tat te con!e6uence!of %rofe!!ional treat&ent /ere not a! !uc a! /ould ordinaril ae follo/ed if due caread 'een e5erci!ed.

7ere te %laintiff could not ae 'een guilt of contri'utor negligence 'ecau!e e /a!under te influence of ane!tetic! and uncon!ciou!" and te circu&!tance! are !uc tatte true e5%lanation of eent i! &ore acce!!i'le to te defendant! tan to te %laintiff forte ad te e5clu!ie control of te in!tru&entalitie! of ane!te!ia.

>%on all te fact!" condition! and circu&!tance! alleged in Count II it i! eld tat a cau!eof action i! !tated under te doctrine of res ipsa loquitur.$$2

Indeed" te %rinci%le! enunciated in te afore6uoted ca!e a%%l /it e6ual forceere. In te %re!ent ca!e" Erlinda !u'&itted er!elf for cholec%stectom% and e5%ected aroutine general !urger to 'e %erfor&ed on er gall 'ladder. +n tat fateful da !edeliered er %er!on oer to te care" cu!tod and control of %riate re!%ondent! /oe5erci!ed co&%lete and e5clu!ie control oer er. At te ti&e of !u'&i!!ion" Erlinda /a!neurologicall !ound and" e5ce%t for a fe/ &inor di!co&fort!" /a! li;e/i!e %!icall fit in&ind and 'od. 7o/eer" during te ad&ini!tration of ane!te!ia and %rior to te%erfor&ance of cholec%stectom% !e !uffered irre%ara'le da&age to er 'rain. Tu!"

/itout undergoing !urger" !e /ent out of te o%erating roo& alread decere'rate andtotall inca%acitated. +'iou!l" 'rain da&age" /ic Erlinda !u!tained" i! an inur /icdoe! not nor&all occur in te %roce!! of a gall 'ladder o%eration. In fact" ti! ;ind of!ituation doe! not a%%en in te a'!ence of negligence of !o&eone in te ad&ini!trationof ane!te!ia and in te u!e of endotraceal tu'e. Nor&all" a %er!on 'eing %ut underane!te!ia i! not rendered decere'rate a! a con!e6uence of ad&ini!tering !ucane!te!ia if te %ro%er %rocedure /a! follo/ed. =urter&ore" te in!tru&ent! u!ed in tead&ini!tration of ane!te!ia" including te endotraceal tu'e" /ere all under te e5clu!iecontrol of %riate re!%ondent!" /o are te %!ician!-in-carge. Li;e/i!e" %etitionerErlinda could not ae 'een guilt of contri'utor negligence 'ecau!e !e /a! under teinfluence of ane!tetic! /ic rendered er uncon!ciou!.

Con!idering tat a !ound and unaffected &e&'er of te 'od Bte 'rain i! inured orde!troed /ile te %atient i! uncon!ciou! and under te i&&ediate and e5clu!ie control

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of te %!ician!" /e old tat a %ractical ad&ini!tration of u!tice dictate! te a%%licationof res ipsa loquitur. >%on te!e fact! and under te!e circu&!tance! te Court /ould 'ea'le to !a" a! a &atter of co&&on ;no/ledge and o'!eration" if negligence attended te&anage&ent and care of te %atient. Moreoer" te lia'ilit of te %!ician! and teo!%ital in ti! ca!e i! not %redicated u%on an alleged failure to !ecure te de!ired re!ult!of an o%eration nor on an alleged lac; of !;ill in te diagno!i! or treat&ent a! in fact no

o%eration or treat&ent /a! eer %erfor&ed on Erlinda. Tu!" u%on all te!e initialdeter&ination a ca!e i! &ade out for te a%%lication of te doctrine of res ipsa loquitur.

Nonetele!!" in olding tat res ipsa loquitur i! aaila'le to te %re!ent ca!e /e arenot !aing tat te doctrine i! a%%lica'le in an and all ca!e! /ere inur occur! to a%atient /ile under ane!te!ia" or to an and all ane!te!ia ca!e!. Eac ca!e &u!t 'eie/ed in it! o/n ligt and !crutini

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effect3

ATTK. PA?ARES3

3 In %articular" /at did Dra. Perfecta Gutierre< do" if an on te %atient0

A3 In %articular" I could !ee tat !e /a! intu'ating te %atient.

3 Do ou ;no/ /at a%%ened to tat intu'ation %roce!! ad&ini!tered ' Dra.Gutierre

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3 :at did !2e do" if an0

A3 S2e tried to intu'ate te %atient.

3 :at a%%ened to te %atient0

A3 :en Dr. Calderon tr B!ic to intu'ate te %atient" after a /ile te %atient!nail'ed 'eca&e 'lui! and I !a/ te %atient /a! %laced in trendelen'urg %o!ition.

5 5 5

3 Do ou ;no/ te rea!on / te %atient /a! %laced in tat trendelen'urg%o!ition0

A3 A! far a! I ;no/" /en a %atient i! in tat %o!ition" tere i! a decrea!e of 'lood!u%%l to te 'rain.$H2

5 5 5

Te a%%ellate court" o/eer" di!'elieed Dean Cru

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At an rate" /itout dou't" %etitionerV! /itne!!" an e5%erienced clinical nur!e /o!elong e5%erience and !colar!i% led to er a%%oint&ent a! Dean of te Ca%itol MedicalCenter Scool of Nur!ing" /a! full ca%a'le of deter&ining /eter or not te intu'ation/a! a !ucce!!. Se ad e5ten!ie clinical e5%erience !tarting a! a !taff nur!e in Cicago"Illinoi!8 !taff nur!e and clinical in!tructor in a teacing o!%ital" te =E>-NRM=8 Dean ofte Laguna College of Nur!ing in San Pa'lo Cit8 and ten Dean of te Ca%itol Medical

Center Scool of Nur!ing.(2Reie/ing /itne!! Cru

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Te %re-o%eratie ealuation of a %atient %rior to te ad&ini!tration of ane!te!ia i!unier!all o'!ered to le!!en te %o!!i'ilit of ane!tetic accident!. Pre-o%eratieealuation and %re%aration for ane!te!ia 'egin! /en te ane!te!iologi!t reie/! te%atient! &edical record! and i!it! /it te %atient" traditionall" te da 'efore electie!urger.(F2It include! ta;ing te %atient! &edical i!tor" reie/ of current drug tera%"%!ical e5a&ination and inter%retation of la'orator data.($2Te %!ical e5a&ination

%erfor&ed ' te ane!te!iologi!t i! directed %ri&aril to/ard te central nerou! !!te&"cardioa!cular !!te&" lung! and u%%er air/a.((2A toroug anal!i! of te %atientV!air/a nor&all inole! ine!tigating te follo/ing3 cerical !%ine &o'ilit"te&%oro&andi'ular &o'ilit" %ro&inent central inci!or!" di!ea!ed or artificial teet" a'ilitto i!uali

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&etod of ane!te!ia" te drug! to 'e u!ed" and teir %o!!i'le a!uall" te %re-o%eratie a!!e!!&ent i! conducted at lea!t one da'efore te intended !urger" /en te %atient i! rela5ed and coo%eratie.

Erlinda! ca!e /a! electie and ti! /a! ;no/n to re!%ondent Dra. Gutierre

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A3 No.

3 In oter /ord!" our ;no/ledge a'out %entotal i! 'a!ed onl on /at ou aeread fro& 'oo;! and not ' our o/n %er!onal a%%lication of te &edicine%entotal0

A3 @a!ed on & %er!onal e5%erience al!o on %entotal.

3 7o/ &an ti&e! ae ou u!ed %entotal0

A3 Te u!ed it on &e. I /ent into 'ronco!%a!& during & a%%endecto&.

3 And 'ecau!e te ae u!ed it on ou and on account of our o/n %er!onale5%erience ou feel tat ou can te!tif on %entotal ere /it &edical autorit0

A3 No. Tat i! / I u!ed reference! to !u%%ort & clai&!.H12

An ane!tetic accident cau!ed ' a rare drug-induced 'ronco!%a!& %ro%erl fall!/itin te field! of ane!te!ia" internal &edicine-allerg" and clinical %ar&acolog. Tere!ulting ano5ic ence%alo%at 'elong! to te field of neurolog. :ile ad&ittedl" &an'ronco!%a!tic-&ediated %ul&onar di!ea!e! are /itin te e5%erti!e of %ul&onar&edicine" Dr. ?a&oraV! field" te ane!tetic drug-induced" allergic &ediated 'ronco!%a!&alleged in ti! ca!e i! /itin te di!ci%line! of ane!te!iolog" allergolog and%ar&acolog. +n te 'a!i! of te foregoing tran!cri%t" in /ic te %ul&onologi!t i&!elfad&itted tat e could not te!tif a'out te drug /it &edical autorit" it i! clear tat tea%%ellate court erred in giing /eigt to Dr. ?a&ora! te!ti&on a! an e5%ert in tead&ini!tration of Tio%ental Sodiu&.

Te %roi!ion in te rule! of eidenceH2regarding e5%ert /itne!!e! !tate!3

Sec. $). 1pinion o3 e*pert 7itness. - Te o%inion of a /itne!! on a &atter re6uiring!%ecial ;no/ledge" !;ill" e5%erience or training /ic e i! !o/n to %o!!e!!" &a 'ereceied in eidence.

Generall" to 6ualif a! an e5%ert /itne!!" one &u!t ae ac6uired !%ecial ;no/ledgeof te !u'ect &atter a'out /ic e or !e i! to te!tif" eiter ' te !tud of recogni

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Tio%ental-allerg teor igorou!l a!!erted ' %riate re!%ondent! /a! a &ereaftertougt. Suc an e5%lanation /a! adanced in order to a'!ole te& of an and allre!%on!i'ilit for te %atient! condition.

In ie/ of te eidence at and" /e are inclined to 'eliee %etitioner! !tand tat it /a!te fault intu'ation /ic /a! te %ro5i&ate cau!e of Erlinda! co&ato!e condition.

Pro5i&ate cau!e a! 'een defined a! tat /ic" in natural and continuou! !e6uence"un'ro;en ' an efficient interening cau!e" %roduce! inur" and /itout /ic te re!ult/ould not ae occurred.H$2An inur or da&age i! %ro5i&atel cau!ed ' an act or afailure to act" /eneer it a%%ear! fro& te eidence in te ca!e" tat te act or o&i!!ion%laed a !u'!tantial %art in 'ringing a'out or actuall cau!ing te inur or da&age8 andtat te inur or da&age /a! eiter a direct re!ult or a rea!ona'l %ro'a'le con!e6uenceof te act or o&i!!ion.H(2It i! te do&inant" &oing or %roducing cau!e.

A%%ling te a'oe definition in relation to te eidence at and" fault intu'ation i!undenia'l te %ro5i&ate cau!e /ic triggered te cain of eent! leading to Erlinda!

'rain da&age and" ulti&atel" er co&ato!ed condition.

Priate re!%ondent! te&!ele! ad&itted in teir te!ti&on tat te fir!t intu'ation/a! a failure. Ti! fact /a! li;e/i!e o'!ered ' /itne!! Cru< /en !e eardre!%ondent Dra. Gutierre< re&ar;ed" 4Ang ira% &a-intu'ate nito" &ali ata ang%ag;a;a%a!o;. + lu&ala;i ang tian.9 Tereafter" /itne!! Cru< noticed a'do&inaldi!tention on te 'od of Erlinda. Te deelo%&ent of a'do&inal di!tention" togeter /itre!%irator e&'arra!!&ent indicate! tat te endotraceal tu'e entered te e!o%agu!in!tead of te re!%irator tree. In oter /ord!" in!tead of te intended endotracealintu'ation /at actuall too; %lace /a! an e!o%ageal intu'ation. During intu'ation" !ucdi!tention indicate! tat air a! entered te ga!trointe!tinal tract troug te e!o%agu!in!tead of te lung! troug te tracea. Entr

LM part 6 - vii

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