THIRD DIVISION

ORLANDO D. GARCIA, JR.,

COMMUNITY DIAGNOSTIC
CENTER and BU CASTRO,[1]
Petitioners,

- versus -

RANIDA D. SALVADOR and

RAMON SALVADOR,
Respondents.

G.R. No. 168512

Present:
Ynares-Santiago, J. (Chairperson),
Austria-Martinez,
Callejo, Sr.,
Chico-Nazario, and
Nachura, JJ.
Promulgated:

March 20, 2007

x ---------------------------------------------------------------------------------------- x

DECISION
YNARES-SANTIAGO, J.:
This is a petition for review[2] under Rule 45 of the Rules of Court assailing
the February 27, 2004 Decision[3] of the Court of Appeals in CA-G.R. CV No.
58668 finding petitioner Orlando D. Garcia liable for gross negligence; and its
June 16, 2005 Resolution[4] denying petitioners motion for reconsideration.
On October 1, 1993, respondent Ranida D. Salvador started working as a
trainee in the Accounting Department of Limay Bulk Handling Terminal, Inc. (the
Company). As a prerequisite for regular employment, she underwent a medical
examination at the Community Diagnostic Center (CDC). Garcia who is a medical
technologist, conducted the HBs Ag (Hepatitis B Surface Antigen) test and
on October 22, 1993, CDC issued the test result[5] indicating that Ranida was HBs
Ag: Reactive. The result bore the name and signature of Garcia as examiner and
the rubber stamp signature of Castro as pathologist.

When Ranida submitted the test result to Dr. Sto. Domingo, the Company
physician, the latter apprised her that the findings indicated that she is suffering
from Hepatitis B, a liver disease. Thus, based on the medical report[6] submitted by
Sto. Domingo, the Company terminated Ranidas employment for failing the
physical examination.[7]
When Ranida informed her father, Ramon, about her ailment, the latter
suffered a heart attack and was confined at the Bataan Doctors Hospital. During
Ramons confinement, Ranida underwent another HBs Ag test at the said hospital
and the result[8] indicated that she is non-reactive. She informed Sto. Domingo of
this development but was told that the test conducted by CDC was more reliable
because it used the Micro-Elisa Method.
Thus, Ranida went back to CDC for confirmatory testing, and this time, the
Anti-HBs test conducted on her indicated a Negative result.[9]
Ranida
also
underwent
another
HBs
Ag
test
at
the Bataan Doctors Hospital using the Micro-Elisa Method. The result indicated
that she was non-reactive.[10]
Ranida submitted the test results from Bataan Doctors Hospital and CDC to
the Executive Officer of the Company who requested her to undergo another
similar test before her re-employment would be considered. Thus, CDC conducted
another HBs Ag test on Ranida which indicated a Negative result.[11] Ma. Ruby
G. Calderon, Med-Tech Officer-in-Charge of CDC, issued a Certification
correcting the initial result and explaining that the examining medical technologist
(Garcia) interpreted the delayed reaction as positive or reactive.[12]
Thereafter, the Company rehired Ranida.
On July 25, 1994, Ranida and Ramon filed a complaint[13] for damages
against petitioner Garcia and a purportedly unknown pathologist of CDC, claiming
that, by reason of the erroneous interpretation of the results of Ranidas

examination, she lost her job and suffered serious mental anxiety, trauma and
sleepless nights, while Ramon was hospitalized and lost business opportunities.
On September 26, 1994, respondents amended their complaint[14] by naming
Castro as the unknown pathologist.
Garcia denied the allegations of gross negligence and incompetence and
reiterated the scientific explanation for the false positive result of the first HBs
Ag test in his December 7, 1993 letter to the respondents.[15]
For his part, Castro claimed that as pathologist, he rarely went to CDC and
only when a case was referred to him; that he did not examine Ranida; and that the
test results bore only his rubber-stamp signature.
On September 1, 1997,[16] the trial court dismissed the complaint for failure
of the respondents to present sufficient evidence to prove the liability of Garcia and
Castro. It held that respondents should have presented Sto. Domingo because he
was the one who interpreted the test result issued by CDC. Likewise, respondents
should have presented a medical expert to refute the testimonies of Garcia and
Castro regarding the medical explanation behind the conflicting test results on
Ranida.[17]
Respondents appealed to the Court of Appeals which reversed the trial
courts findings, the dispositive portion of which states:
WHEREFORE, the decision appealed from is REVERSED and
SET ASIDE and another one entered ORDERING defendant-appellee
Orlando D. Garcia, Jr. to pay plaintiff-appellant Ranida D. Salvador
moral damages in the amount of P50,000.00, exemplary damages in the
amount of P50,000.00 and attorneys fees in the amount of P25,000.00.
SO ORDERED.[18]

The appellate court found Garcia liable for damages for negligently issuing
an erroneous HBs Ag result. On the other hand, it exonerated Castro for lack of
participation in the issuance of the results.

After the denial of his motion for reconsideration, Garcia filed the instant
petition.
The main issue for resolution is whether the Court of Appeals, in reversing
the decision of the trial court, correctly found petitioner liable for damages to the
respondents for issuing an incorrect HBsAG test result.
Garcia maintains he is not negligent, thus not liable for damages, because he
followed the appropriate laboratory measures and procedures as dictated by his
training and experience; and that he did everything within his professional
competence to arrive at an objective, impartial and impersonal result.
At the outset, we note that the issues raised are factual in nature. Whether a
person is negligent or not is a question of fact which we cannot pass upon in a
petition for review on certiorari which is limited to reviewing errors of law.[19]
Negligence is the failure to observe for the protection of the interest of
another person that degree of care, precaution and vigilance which the
circumstances justly demand,[20] whereby such other person suffers injury. For
health care providers, the test of the existence of negligence is: did the health care
provider either fail to do something which a reasonably prudent health care
provider would have done, or that he or she did something that a reasonably
prudent health care provider would not have done; and that failure or action caused
injury to the patient;[21] if yes, then he is guilty of negligence.
Thus, the elements of an actionable conduct are: 1) duty, 2) breach, 3)
injury, and 4) proximate causation.
All the elements are present in the case at bar.
Owners and operators of clinical laboratories have the duty to comply with
statutes, as well as rules and regulations, purposely promulgated to protect and
promote the health of the people by preventing the operation of substandard,
improperly managed and inadequately supported clinical laboratories and by

improving the quality of performance of clinical laboratory examinations.[22] Their

business is impressed with public interest, as such, high standards of performance
are expected from them.
In F.F. Cruz and Co., Inc. v. Court of Appeals, we found the owner of a
furniture shop liable for the destruction of the plaintiffs house in a fire which
started in his establishment in view of his failure to comply with an ordinance
which required the construction of a firewall. In Teague v. Fernandez, we stated
that where the very injury which was intended to be prevented by the ordinance
has happened, non-compliance with the ordinance was not only an act of
negligence, but also the proximate cause of the death.[23]
In fine, violation of a statutory duty is negligence. Where the law imposes
upon a person the duty to do something, his omission or non-performance will
render him liable to whoever may be injured thereby.
Section 2 of Republic Act (R.A.) No. 4688, otherwise known as The Clinical
Laboratory Law, provides:
Sec. 2. It shall be unlawful for any person to be professionally incharge of a registered clinical laboratory unless he is a licensed
physician duly qualified in laboratory medicine and authorized by the
Secretary of Health, such authorization to be renewed annually.
No license shall be granted or renewed by the Secretary of Health
for the operation and maintenance of a clinical laboratory unless such
laboratory is under the administration, direction and supervision of an
authorized physician, as provided for in the preceding paragraph.

Corollarily, Sections 9(9.1)(1), 11 and 25(25.1)(1) of the DOH

Administrative Order No. 49-B Series of 1988, otherwise known as
the Revised Rules and Regulations Governing the Registration, Operation and
Maintenance of Clinical Laboratories in the Philippines, read:
Sec. 9. Management of the Clinical Laboratory:

9.1

Head of the Clinical Laboratory: The head is that

person who assumes technical and administrative
supervision and control of the activities in the
laboratory.
For all categories of clinical laboratories, the
head shall be a licensed physician certified by the
Philippine Board of Pathology in either Anatomic or
Clinical Pathology or both provided that:
(1)
This shall be mandatory for all categories of
free-standing clinical laboratories; all tertiary
category hospital laboratories and for all secondary
category hospital laboratories located in areas with
sufficient available pathologist.

xxxx
Sec. 11. Reporting: All laboratory requests shall be considered as
consultations between the requesting physician and pathologist of the
laboratory. As such all laboratory reports on various examinations of
human specimens shall be construed as consultation report and shall bear
the name of the pathologist or his associate. No person in clinical
laboratory shall issue a report, orally or in writing, whole portions
thereof without a directive from the pathologist or his authorized
associate and only to the requesting physician or his authorized
representative except in emergencies when the results may be released as
authorized by the pathologist.
xxxx
Sec. 25. Violations:
25.1 The license to operate a clinical laboratory may be
suspended or revoked by the Undersecretary of Health for Standards and
Regulation upon violation of R.A. 4688 or the rules and regulations
issued in pursuance thereto or the commission of the following acts by
the persons owning or operating a clinical laboratory and the persons
under their authority.

(1)

Operation of a Clinical Laboratory without a

certified pathologist or qualified licensed physician
authorized by the Undersecretary of Health or
without employing a registered medical technologist
or a person not registered as a medical technologist
in such a position.

And Section 29(b) of R.A. No. 5527, otherwise known as The Philippine
Medical Technology Act of 1969, reads:
Section 29. Penal Provisions.- Without prejudice to the provision of the
Medical Act of 1959, as amended relating to illegal practice of
Medicine, the following shall be punished by a fine of not less than two
thousand pesos nor more than five thousand pesos, or imprisonment for
not less than six months nor more than two years, or both, in the
discretion of the court:
xxxx
(b)
Any medical technologist, even if duly registered, who
shall practice medical technology in the Philippines without the
necessary supervision of a qualified pathologist or physician authorized
by the Department of Health;

From the foregoing laws and rules, it is clear that a clinical laboratory must
be administered, directed and supervised by a licensed physician authorized by the
Secretary of Health, like a pathologist who is specially trained in methods of
laboratory medicine; that the medical technologist must be under the supervision of
the pathologist or a licensed physician; and that the results of any examination may
be released only to the requesting physician or his authorized representative upon
the direction of the laboratory pathologist.
These rules are intended for the protection of the public by preventing
performance of substandard clinical examinations by laboratories whose personnel
are not properly supervised. The public demands no less than an effective and
efficient performance of clinical laboratory examinations through compliance with
the quality standards set by laws and regulations.

We find that petitioner Garcia failed to comply with these standards.

First, CDC is not administered, directed and supervised by a licensed
physician as required by law, but by Ma. Ruby C. Calderon, a licensed Medical
Technologist.[24] In the License to Open and Operate a Clinical Laboratory for the
years 1993 and 1996 issued by Dr. Juan R. Naagas, M.D., Undersecretary for
Health Facilities, Standards and Regulation, defendant-appellee Castro was named
as the head of CDC.[25] However, in his Answer with Counterclaim, he stated:
3. By way of affirmative and special defenses, defendant pathologist
further avers and plead as follows:
Defendant
pathologist
is
not
the
owner
of
the Community Diagnostic Center nor an employee of the same nor the
employer of its employees. Defendant pathologist comes to
theCommunity Diagnostic Center when and where a problem is referred
to him. Its employees are licensed under the Medical Technology Law
(Republic Act No. 5527) and are certified by, and registered with, the
Professional Regulation Commission after having passed their Board
Examinations. They are competent within the sphere of their own
profession in so far as conducting laboratory examinations and are
allowed to sign for and in behalf of the clinical laboratory. The
defendant pathologist, and all pathologists in general, are hired by
laboratories for purposes of complying with the rules and regulations and
orders issued by the Department of Health through the Bureau of
Research and Laboratories. Defendant pathologist does not stay that
long period of time at the Community Diagnostic Center but only
periodically or whenever a case is referred to him by the
laboratory. Defendant pathologist does not appoint or select the
employees of the laboratory nor does he arrange or approve their
schedules of duty.[26]

Castros infrequent visit to the clinical laboratory barely qualifies as an

effective administrative supervision and control over the activities in the
laboratory. Supervision and control means the authority to act directly whenever
a specific function is entrusted by law or regulation to a subordinate; direct the
performance of duty; restrain the commission of acts; review, approve, revise or
modify acts and decisions of subordinate officials or units.[27]

Second, Garcia conducted the HBsAG test of respondent Ranida without the
supervision of defendant-appellee Castro, who admitted that:
[He] does not know, and has never known or met, the plaintiffpatient even up to this time nor has he personally examined any
specimen, blood, urine or any other tissue, from the plaintiff-patient
otherwise his own handwritten signature would have appeared in the
result and not merely stamped as shown in Annex B of the Amended
Complaint.[28]

Last, the disputed HBsAG test result was released to respondent Ranida
without the authorization of defendant-appellee Castro.[29]
Garcia may not have intended to cause the consequences which followed
after the release of the HBsAG test result. However, his failure to comply with the
laws and rules promulgated and issued for the protection of public safety and
interest is failure to observe that care which a reasonably prudent health care
provider would observe. Thus, his act or omission constitutes a breach of duty.
Indubitably, Ranida suffered injury as a direct consequence of Garcias
failure to comply with the mandate of the laws and rules aforequoted. She was
terminated from the service for failing the physical examination; suffered anxiety
because of the diagnosis; and was compelled to undergo several more tests. All
these could have been avoided had the proper safeguards been scrupulously
followed in conducting the clinical examination and releasing the clinical report.
Article 20 of the New Civil Code provides:
Art. 20. Every person who, contrary to law, willfully or
negligently causes damage to another, shall indemnify the latter for the
same.

The foregoing provision provides the legal basis for the award of damages to
a party who suffers damage whenever one commits an act in violation of some
legal provision.[30] This was incorporated by the Code Commission to provide

relief to a person who suffers damage because another has violated some legal
provision.[31]
We find the Court of Appeals award of moral damages reasonable under the
circumstances bearing in mind the mental trauma suffered by respondent Ranida
who thought she was afflicted by Hepatitis B, making her unfit or unsafe for any
type of employment.[32] Having established her right to moral damages, we see no
reason to disturb the award of exemplary damages and attorneys fees. Exemplary
damages are imposed, by way of example or correction for the public good, in
addition to moral, temperate, liquidated or compensatory damages,[33] and
attorneys fees may be recovered when, as in the instant case, exemplary damages
are awarded.[34]
WHEREFORE, the Decision of the Court of Appeals in CA-G.R. CV No.
58668 dated February 27, 2004 finding petitioner Orlando D. Garcia, Jr. guilty of
gross negligence and liable to pay to respondents P50,000.00 as moral
damages, P50,000.00 as exemplary damages, and P25,000.00 as attorneys fees,
isAFFIRMED.
SO ORDERED.