G.R. No.

167366

September 26, 2012

DR. PEDRO DENNIS CERENO, and DR. SANTOS ZAFE, Petitioners,

vs.
COURT OF APPEALS, SPOUSES DIOGENES S. OLAVERE and FE R.
SERRANO, Respondents.
DECISION
PEREZ, J.:
At about 9:15 in the evening, Raymond S. Olavere (Raymond), a victim of a stabbing
incident, was rushed to the emergency room of the Bicol Regional Medical Center (BRMC).
The emergency room resident physician recommended that the patient undergo
"emergency exploratory laparotomy and requested the parents of Raymond to procure 500
cc of type "O" blood needed for the operation.
At 10:30 P.M., Raymond was wheeled inside the operating room. During that time, the
hospital surgeons, herein petitioners, were conducting an operation on a gunshot victim.
Assisting them was the only senior anaesthesiologist on duty at BRMC that night, Dr. Tatad.
By the time the surgery finished, there was another emergency involving the birth of triplets
to which Dr. Tatad started working on. There being no other available anaesthesiologist to
assist the petitioners, they decided to defer the operation on Raymond
Drs. Zafe and Cereno, in the meantime, proceeded to examine Raymond and they found
that the latters blood pressure was normal and "nothing in him was significant."
At 11:15 P.M., the blood arrived.
At around 12:15 A.M., the petitioners started operating on Raymond and upon opening of
Raymonds thoracic cavity, they found that 3,200 cc of blood was stocked therein. The
blood was evacuated and petitioners found a puncture at the inferior pole of the left lung.
Dr. Cereno did not immediately transfuse blood because he had to control the bleeders first.
Blood was transfused on Raymond at 1:40 A.M. At 1:45 A.M., Raymond suffered a cardiac
arrest. The operation ended at 1:50 A.M. and Raymond was pronounced dead at 2:30 A.M.
Raymonds death certificate5 indicated that the immediate cause of death was "hypovolemic
shock" or the cessation of the functions of the organs of the body due to loss of blood.
ISSUE:
Whether or not petitioners were guilty of medical malpractice.

HELD:
No.
In medical negligence cases, it is settled that the complainant has the burden of
establishing breach of duty on the part of the doctors or surgeons. It must be proven that
such breach of duty has a causal connection to the resulting death of the patient. 22 A verdict
in malpractice action cannot be based on speculation or conjecture. Causation must be
proven within a reasonable medical probability based upon competent expert testimony.
The parents of Raymond failed in this respect. Their cause stands on the mere assumption
that Raymonds life would have been saved had petitioner surgeons immediately operated
on him; had the blood been cross-matched immediately and had the blood been transfused
immediately.
There is nothing in the testimony of Dr. Tatad, or in any evidence on the record for that
matter, which shows that the petitioners were aware of the "BRMC protocol" that the
hospital keeps a standby anesthesiologist available on call.
Given that Dr. Tatad was already engaged in another urgent operation and that Raymond
was not showing any symptom of suffering from major blood loss requiring an immediate
operation, petitioners deciding to wait for Dr. Tatad to finish her surgery and not to call the
standby anesthesiologist anymore was reasonable. There is no evidence that shows that a
prudent surgeon faced with similar circumstances would decide otherwise.
As to the failure of Dr. Cereno to transfuse blood immediately, his testimony was not
rebutted that there was a need first to control the bleeders otherwise the blood transfused
will be lost just the same.

G.R. No. 160889

April 27, 2007

DR. MILAGROS L. CANTRE, Petitioner,

vs.
SPS. JOHN DAVID Z. GO and NORA S. GO, Respondents.
DECISION
QUISUMBING, J.:
FACTS:

Nora gave birth to her fourth child, a baby boy. During the procedure, Nora suffered profuse
bleeding inside her womb due to some parts of the placenta which were not completely
expelled from her womb after delivery. Consequently, Nora suffered hypovolemic shock,
resulting in a drop in her blood pressure. Petitioner and the assisting resident physician
performed various medical procedures to stop the bleeding and to restore Noras blood
pressure. Her blood pressure was frequently monitored with the use of a
sphygmomanometer. While petitioner was massaging Noras uterus for it to contract and
stop bleeding, she ordered a droplight to warm Nora and her baby.4 In the recovery room,
her husband noticed a fresh gaping wound in the inner portion of her left arm, close to the
armpit.5 He was informed it was a burn. The husband filed a request for investigation.6 In
response, the medical director of the hospital, called the petitioner to explain what
happened. Petitioner said the blood pressure cuff caused the injury. John David brought
Nora to the National Bureau of Investigation for a physical examination, which was
conducted by medico-legal officer Dr. Floresto Arizala, Jr., who found that Noras injury
appeared to be a burn and that a droplight when placed near the skin for about 10 minutes.
Noras injury was referred to a plastic surgeon. About a year after, scar revision had to be
performed. The surgical operation left a healed linear scar in Noras left arm about three
inches in length, the thickest portion rising about one-fourth (1/4) of an inch from the surface
of the skin.
ISSUE:
Whether or not there was medical negligence.
HELD:
Yes.
In cases involving medical negligence, the doctrine of res ipsa loquitur allows the mere
existence of an injury to justify a presumption of negligence on the part of the person who
controls the instrument causing the injury, provided that the following requisites concur:

1. The accident is of a kind which ordinarily does not occur in the absence of
someones negligence;
2. It is caused by an instrumentality within the exclusive control of the defendant or
defendants; and
3. The possibility of contributing conduct which would make the plaintiff responsible
is eliminated.
As to the first requirement, the gaping wound on Noras arm is certainly not an ordinary
occurrence in the act of delivering a baby, far removed as the arm is from the organs
involved in the process of giving birth. Such injury could not have happened unless
negligence had set in somewhere
Second, whether the injury was caused by the droplight or by the blood pressure cuff is of
no moment. Both instruments are deemed within the exclusive control of the physician in
charge under the "captain of the ship" doctrine.
Third, the gaping wound on Noras left arm, by its very nature and considering her condition,
could only be caused by something external to her and outside her control as she was
unconscious while in hypovolemic shock. Hence, Nora could not, by any stretch of the
imagination, have contributed to her own injury.

G.R. No. 159132

December 18, 2008

FE CAYAO-LASAM, petitioner,
vs.
SPOUSES CLARO and EDITHA RAMOLETE, respondents.*
DECISION
AUSTRIA-MARTINEZ, J.:
FACTS:
Respondent, Editha Ramolete, three months pregnant, was brought to the Lorma Medical
Center (LMC) due to vaginal bleeding upon advice of petitioner relayed via telephone. A
pelvic sonogram showed the fetus weak cardiac pulsation. Another sonogram was
conducted the next day showing no fetal movement. Due to persistent and profuse vaginal
bleeding, respondent underwent a Dilatation and Curettage Procedure (D&C) or "raspa"
upon advise of petitioner. Subsequently, Editha was once again brought at the LMC, as she
was suffering from vomiting and severe abdominal pains. She was attended by different
doctors who found that there was a dead fetus in the latters womb. After, Editha underwent
laparotomy,5 she was found to have a massive intra-abdominal hemorrhage and a ruptured
uterus. Thus, Editha had to undergo a procedure for hysterectomy6 and as a result, she has
no more chance to bear a child.
ISSUE:
Whether or not respondent was guilty of medical negligence.
HELD:
None.
There are four elements involved in medical negligence cases: duty, breach, injury and
proximate causation.44
A physician-patient relationship was created when Editha employed the services of the
petitioner. As Edithas physician, petitioner was duty-bound to use at least the same level of
care that any reasonably competent doctor would use to treat a condition under the same
circumstances.45 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.46 As to this aspect of medical malpractice, the
determination of the reasonable level of care and the breach thereof, expert testimony is
essential.47 Further, inasmuch 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 support the conclusion as to causation. 48

In the present case, respondents did not present any expert testimony to support their claim that
petitioner failed to do something which a reasonably prudent physician or surgeon would have
done.
Respondent presented Dr. Manalo, specializing in gynecology and obstetrics. From his
testimony, it is evident that the D&C procedure was not the proximate cause of the rupture of
Edithas uterus for a reason that the instrument cannot reach the site of the pregnancy, for it to
further push the pregnancy outside the uterus. This is derived from the witness' diagnosis that
Editha's case was one of "Ectopic Pregnancy Interstitial (also referred to as Cornual), Ruptured.
It was clear that the D&C procedure was conducted in accordance with the standard practice,
with the same level of care that any reasonably competent doctor would use to treat a condition
under the same circumstances, and that there was nothing irregular in the way the petitioner
dealt with Editha.

G.R. No. 192123

March 10, 2014

DR. FERNANDO P. SOLIDUM, Petitioner,

vs.
PEOPLE OF THE PHILIPPINES, Respondent.
DECISION
BERSAMIN, J.:
FACTS:
Gerald Albert Gercayo (Gerald) was born with an imperforate anus. Two days after his birth,
Gerald underwent colostomy. Three years after, Gerald was admitted at the Ospital ng Maynila
for a pull-through operation. Among the members of the surgical team were three doctors and
three anaesthesiologist, one of whom is petitioner. During the operation, Gerald experienced
bradycardia,7 and went into a coma.8His coma lasted for two weeks,9 but he regained
consciousness only after a month.10 He could no longer see, hear or move.

ISSUE:
Whether or not petitioner is guilty of medical malpractice.
HELD:
No.

In order to allow resort to the doctrine, therefore, the following essential requisites must
first be satisfied, to wit: (1) the accident was of a kind that does not ordinarily occur
unless someone is negligent; (2) the instrumentality or agency that caused the injury
was under the exclusive control of the person charged; and (3) the injury suffered must
not have been due to any voluntary action or contribution of the person injured. 29
The Court considers the application here of the doctrine of res ipsa loquitur
inappropriate. Although it should be conceded without difficulty that the second and third
elements were present, considering that the anesthetic agent and the instruments were
exclusively within the control of Dr. Solidum, and that the patient, being then
unconscious during the operation, could not have been guilty of contributory negligence,
the first element was undeniably wanting. Luz delivered Gerald to the care, custody and
control of his physicians for a pull-through operation. Except for the imperforate anus,
Gerald was then of sound body and mind at the time of his submission to the
physicians. Yet, he experienced bradycardia during the operation, causing loss of his
senses and rendering him immobile. Hypoxia, or the insufficiency of oxygen supply to
the brain that caused the slowing of the heart rate, scientifically termed as bradycardia,
would not ordinarily occur in the process of a pull-through operation, or during the
administration of anesthesia to the patient, but such fact alone did not prove that the
negligence of any of his attending physicians, including the anesthesiologists, had

caused the injury. In fact, the anesthesiologists attending to him had sensed in the
course of the operation that the lack of oxygen could have been triggered by the vagovagal reflex, prompting them to administer atropine to the patient

G.R. No. 158996

November 14, 2008

SPOUSES FREDELICTO FLORES (deceased) and FELICISIMA

FLORES, petitioners,
vs.
SPOUSES DOMINADOR PINEDA and VIRGINIA SACLOLO, and
FLORENCIO, CANDIDA, MARTA, GODOFREDO, BALTAZAR and
LUCENA, all surnamed PINEDA, as heirs of the deceased TERESITA S.
PINEDA, and UNITED DOCTORS MEDICAL CENTER, INC., respondents.
DECISION
BRION, J.:
FACTS:

Teresita Pineda (Teresita) was a 51-year old unmarried woman consulted her
townmate, Dr. Fredelicto Flores, regarding her medical condition. She
complained of general body weakness, loss of appetite, frequent urination and
thirst, and on-and-off vaginal bleeding. He advised her to return the following
week or to go to the United Doctors Medical Center (UDMC) for a general
check-up. for a general check-up. for a general check-up. As for her other
symptoms, he suspected that Teresita might be suffering from diabetes. When
her condition persisted, she went to see Dr. Fredelicto at UDMC. There he
performed a routine check-up and directed the hospital staff to prepare the
patient for an "on call" D&C5 operation to be performed by his wife, Dr.
Felicisima. the hospital staff forthwith took her blood and urine samples for the
laboratory tests6 which Dr. Fredelicto ordered. On the same day, teresita was
taken to the operating room. At that time, only the results for the blood sugar
(BS), uric acid determination, cholesterol determination, and complete blood
count (CBC) were available. Based on these preparations, Dr. Felicisima
proceeded with the D&C operation with Dr. Fredelicto administering the
general anesthesia. A day after the operation Teresita was subjected to an
ultrasound examination as a confirmatory procedure and showed that she had
an enlarged uterus and myoma uteri. Teresita's complete laboratory
examination results came only on that day and her urinalysis showed a three
plus sign (+++) indicating that the sugar in her urine was very high. She was
then placed under the care of Dr. Amado Jorge, an internist. Teresita's
condition had worsened. She experienced difficulty in breathing and was

rushed to the intensive care unit. Further tests confirmed that she was
suffering from Diabetes Mellitus Type II.10 Insulin was administered on the
patient, but the medication might have arrived too late. Due to complications
induced by diabetes, Teresita died.
ISSUE:
Whether or not petitioners were guilty of medical negligence.
HELD:
YES.

A medical negligence case is a type of claim to redress a wrong committed

by a medical professional, that has caused bodily harm to or the death of a
patient. There are four elements involved in a medical negligence case,
namely: duty, breach, injury, and proximate causation.
The Court found that reasonable prudence would have shown that diabetes
and its complications were foreseeable harm that should have been taken into
consideration by the petitioner spouses. If a patient suffers from some
disability that increases the magnitude of risk to him, that disability
must be taken into account so long as it is or should have been known
to the physician.29 And when the patient is exposed to an increased risk, it is
incumbent upon the physician to take commensurate and adequate
precautions.
Stress, whether physical or emotional, is a factor that can aggravate diabetes;
a D&C operation is a form of physical stress. Thus, between the D&C and
death was the diabetic complication that could have been prevented with the
observance of standard medical precautions.