Note.—The violation of an employee’s right to statutory due

process by the employer warrants the payment of indemnity in
the form of nominal damages, the amount of which is addressed
to the sound discretion of the court taking into account the
relevant circumstances. (Agabon vs. National Labor Relations
Commission, 442 SCRA 573 [2004])

——o0o——

G.R. No. 150355. July 31, 2006.*

MANILA DOCTORS HOSPITAL, petitioner, vs. SO UN

CHUA and VICKY TY, respondents.

Remedial Law; Certiorari; While as a rule, only questions of law

may be raised in a petition for review on certiorari under Rule 45,
under certain exceptions, the Court may re-examine the evidence
presented by the parties during the trial.—While, as a rule, only
questions of law may be raised in a petition for review on certiorari
under Rule 45, under certain exceptions, the Court may re-examine the
evidence presented by the parties during the trial. At least four
exceptions exist in this case, namely: (a) when the conclusion is a
finding grounded entirely on speculation, surmises, or conjectures; (b)
when the judgment is based on a misapprehension of facts; (c) when
the findings of fact are premised on the supposed absence of evidence
and contradicted by the evidence on record; and (d) when the courts a
quo manifestly overlooked certain relevant facts not disputed by the
parties and which, if properly considered, would justify a different
conclusion.
 Damages; The underlying basis for the award of tort damages is
the premise that an individual was injured in contemplation of law.—
Though human experience would show that the deactivation of the air-
conditioner may cause a temperature differential that may trigger some
physical discomfort, or that the removal of entertain-

_______________

* FIRST DIVISION.

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VOL. 497, JULY 31, 2006 231

Manila Doctors Hospitals vs. So Un Chua

ment facilities such as the television set, or the disconnection of

communication devices such as the telephone, may cause some
exasperation on the part of the one who benefits from these,
nevertheless, all things considered, and given the degree of diligence
the petitioner duly exerted, not every suppression of the things that one
has grown accustomed to enjoy amounts to an actionable wrong, nor
does every physical or emotional discomfort amount to the kind of
anguish that warrants the award of moral damages under the general
principles of tort. The underlying basis for the award of tort damages is
the premise that an individual was injured in contemplation of law.
Thus, there must first be the breach of some duty and the imposition of
liability for that breach before damages may be awarded; it is not
sufficient to state that there should be tort liability merely because the
plaintiff suffered some pain and suffering.
Same; Civil Law; A patient cannot be detained in a hospital for
nonpayment of the hospital bill.—Authorities, including those of
common law origin, explicitly declare that a patient cannot be detained
in a hospital for nonpayment of the hospital bill. If the patient cannot
pay the hospital or physician’s bill, the law provides a remedy for them
to pursue, that is, by filing the necessary suit in court for the recovery
of such fee or bill. If the patient is prevented from leaving the hospital
for his inability to pay the bill, any person who can act on his behalf
can apply in court for the issuance of the writ of habeas corpus.
Civil Law; When a hospital treats a patient’s injuries, it has an
enforceable claim for full payment for its services regardless of the
patient’s financial status.—Authorities are of the view that, ordinarily,
a hospital, especially if it is a private pay hospital, is entitled to be
compensated for its services, by either an express or an implied
contract, and if no express contract exists, there is generally an implied
agreement that the patient will pay the reasonable value of the services
rendered; when a hospital treats a patient’s injuries, it has an
enforceable claim for full payment for its services, regardless of the
patient’s financial status.
Damages; In case of physical injuries, with some exceptions,
moral damages are recoverable only by the party injured and not by
her spouse, next of kin, or relative who happened to sympathize with
the injured party.—This Court observes that the courts a quo

232

232 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

awarded both respondents moral damages. But it is well-settled that in

case of physical injuries, with some exceptions, moral damages are
recoverable only by the party injured and not by her spouse, next of
kin, or relative who happened to sympathize with the injured party.
Hence, even if the courts a quo were correct in their basis for
damages, they should have declined to award damages to respondent
Ty.
Civil Law; Court takes judicial notice of the pending Senate Bill
No. 337, entitled “An Act Prohibiting the Detention of Patients in
Hospitals and Medical Clinics on Grounds of Nonpayment of Hospital
Bills or Medical Expenses.”—The Court takes judicial notice of the
pending Senate Bill No. 337, entitled “An Act Prohibiting the
Detention of Patients in Hospitals and Medical Clinics on Grounds of
Nonpayment of Hospital Bills or Medical Expenses,” which declares,
among others, that it shall be unlawful for any hospital or medical
clinic to cause directly or indirectly the detention of patients for
nonpayment, in part or in full, of their hospital bills, and, furthermore,
requires patients who have fully recovered and are financially
incapable to settle the hospitalization expenses to execute a promissory
note, co-signed by another individual, to the extent of the unpaid
obligation before leaving the hospital.

PETITION for review on certiorari of a decision of the Court of

Appeals.
   The facts are stated in the opinion of the Court.
  Santiago, Corpuz & Ejercito Law Offices for petitioner.
  Marvin L. Herrera for respondents So Un Chua and Vicky
C. Ty.

AUSTRIA-MARTINEZ, J.:

Before this Court is a Petition for Review on Certiorari

under Rule 45 questioning the Decision1 dated October 2, 2001

_______________

1 Penned by Associate Justice Conrado M. Vasquez, Jr., with Associate

Justices Martin S. Villarama, Jr. and Eliezer R. De Los Santos, concurring,
Rollo, pp. 38-50.

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Manila Doctors Hospitals vs. So Un Chua

promulgated by the Court of Appeals (CA) in CA-G.R. CV No.

61581, which affirmed the Decision dated September 30, 1997
of the Regional Trial Court (RTC), Branch 159, Pasig City, but
which reduced the award of damages.
This case originated from an action for damages filed with
the RTC by respondents So Un Chua and Vicky Ty against
petitioner Manila Doctors Hospital.2 The complaint is premised
on the alleged unwarranted actuations of the petitioner towards
its patient, respondent So Un Chua (Chua), who was confined
for hypertension, diabetes, and related illnesses.
 The antecedents of the case follow:
On December 13, 1993, respondents filed a Complaint
averring that on October 30, 1990, respondent Chua, the mother
of respondent Vicky Ty, was admitted in petitioner’s hospital
for hypertension and diabetes; that while respondent Chua was
confined, Judith Chua, the sister of respondent Ty, had been
likewise confined for injuries suffered in a vehicular accident;
that partial payments of the hospital bills were made, totaling
P435,800.00; that after the discharge of Judith Chua, respondent
Chua remained in confinement and the hospital bills for both
patients accumulated; that respondent Chua was pressured by
the petitioner, through its Credit and Collection Department, to
settle the unpaid bills; that respondent Ty represented that she
will settle the bills as soon as

_______________

2 Although the Complaint impleaded the petitioner as “Manila Doctors

Hospital, defendant,” allegedly a domestic corporation, the petitioner
specifically denied this averment and alleged that “Manila Doctors Hospital” is
merely a tradename of “Manila Medical Services, Inc.,” the real party in
interest. This allegation was not disputed by the respondents, nor was any
correction made by the courts a quo. See Answer dated February 4, 1994, item
2; Amended Answer dated February 10, 1994, item 2; Rejoinder dated March
28, 1994, item 3; Records, pp. 1, 15, 25, 42; The 1997 Rules of Civil Procedure,
Rule 3, §1 (1997); Id., Rule 8, §4; Juasing Hardware v. Mendoza, 201 Phil. 369;
115 SCRA 783 (1982); Chiang Kai Shek v. Court of Appeals, G.R. No. 58028,
April 18, 1989, 172 SCRA 389.

234

234 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

the funds become available; that respondent Ty pleaded to

the management that in view of the physical condition of her
mother, respondent Chua, the correspondences relating to the
settlement of the unpaid hospital bills should be relayed to the
former; that these pleas were unheeded by the petitioner; that
petitioner threatened to implement unpleasant measures unless
respondent Ty undertakes her mother’s obligation as well as the
obligation of her sister, Judith Chua, to pay the hospitalization
expenses; that petitioner made good its threat and employed
unethical, unpleasant and unlawful methods which allegedly
worsened the condition of respondent Chua, particularly, by (i)
cutting off the telephone line in her room and removing the air-
conditioning unit, television set, and refrigerator, (ii) refusing to
render medical attendance and to change the hospital gown and
bed sheets, and (iii) barring the private nurses or midwives from
assisting the patient. Respondents thus prayed for the award of
moral damages, exemplary damages, and attorney’s fees.
In its Answer, Amended Answer, and Rejoinder, petitioner
specifically denied the material averments of the Complaint and
Reply, and interposed its counterclaims arguing that as early as
one week after respondent Chua had been admitted to its
hospital, Dr. Rody Sy, her attending physician, had already
given instructions for her to be discharged, but respondents
insisted that Chua remain in confinement; that, through its staff,
petitioner accordingly administered medical examinations, all
of which yielded negative results; that respondent Ty
voluntarily undertook, jointly and severally, to pay the hospital
bills for both patients; that although respondent Ty paid up to
P435,000.00, more or less, she reneged on her commitment to
pay the balance in violation of the Contract for Admission and
Acknowledgment of Responsibility for Payment dated October
30, 1990 which she voluntarily executed; that she signed a
Promissory Note on June 5, 1992 for the unpaid balance of
P1,075,592.95 and issued postdated checks to cover the same;
that no such undue pressure had been imposed upon respondent
Chua to settle the bills, the 

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Manila Doctors Hospitals vs. So Un Chua

truth being that, as a matter of standard procedure, the

reminders to settle the bills were transmitted not to the patients
but to their relatives who usually undertook to pay the same;
that respondent Ty deliberately evaded the staff of the Credit
and Collection Department; that the cutting-off of the telephone
line and removal of the air-conditioning unit, television set, and
refrigerator cannot constitute unwarranted actuations, for the
same were resorted to as cost-cutting measures and to minimize
respondents’ charges that were already piling up, especially
after respondent Ty refused to settle the balance
notwithstanding frequent demands; that respondent Ty evaded
the staff when the latter attempted to inform her that the room
facilities will be cut off to minimize the rising charges; and that
respondents instituted the present civil case purposely as
leverage against the petitioner after the latter had filed criminal
charges for violation of Batas Pambansa (B.P.) Blg. 22 against
respondent Ty for issuing checks, later dishonored, totaling
P1,075,592.95, the amount referring to the unpaid hospital bills.
In its compulsory counterclaim, petitioner prayed, among other
items, for the award of no less than P1,000,000.00 as
compensatory damages due to the filing of a malicious and
unfounded suit, and, in its permissive counterclaim, petitioner
prayed for respondents to pay P1,075,592.95, the amount
representing the due and demandable obligation under the
Promissory Note dated June 5, 1992, including the stipulated
interest therein and the 25 percent of the total amount due as
attorney’s fees.
During pre-trial, the parties stipulated on the following
issues: First, whether the respondents are liable to the petitioner
to pay the hospital bills arising from the hospitalization of
respondent Chua and Judith Chua; and second, whether the
parties are entitled to their respective claims for damages.3
Furthermore, the parties stipulated on the following facts: a)
Judith Chua was confined from June 14, 1991 to

_______________

3 Partial Pre-Trial Order dated May 2, 1994, Rollo, p. 87.

236

236 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua
May 2, 1992; b) respondents failed to pay the balance despite
repeated reminders; c) the said reminders referred to the
hospital bills of respondent Chua and Judith Chua; d) one of the
attending physicians of respondent Chua was Dr. Rody Sy; and
e) the petitioner ordered the removal of the facilities in question
from the room of its patient, respondent Chua, with the
qualification that they were constrained to discontinue the same
after the representative of respondent Chua refused to update
the hospital bills or refused to transfer her to semi-deluxe room
or ward to lessen costs.4
On September 30, 1997, the RTC rendered its Decision in
favor of the respondents, the dispositive portion of which states:

“WHEREFORE, premises considered, judgment on the complaint

is hereby rendered in favor of the [respondents] as against the
[petitioner] as follows:
[O]rdering the [petitioner] to pay the [respondents] the following, to
wit:
a) P200,000.00 as moral damages;
b) P100,000.00 as exemplary damages; and
c) P50,000.00 as attorney’s fees and the amount of
P50,000.00 as litigation costs.
SO ORDERED.”5

In brief, the RTC held that the removal of the facilities of the
room triggered the hypertension of respondent Chua; that the
petitioner acted in bad faith in removing the facilities without
prior notice; that her condition was aggravated by the pressure
employed by the administration upon her to pay the hospital
bills; that the food always came late as compared to the other
patients; that the beddings and clothes of respondent Chua were
no longer changed and, as a result, bed sores emerged on her
body; that there was an utter lack of medical

_______________

4 Partial Pre-Trial Order dated May 4, 1994, Id., at pp. 90-91.

5 Id., at p. 107.

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 VOL. 497, JULY 31, 2006 237
Manila Doctors Hospitals vs. So Un Chua

attendance; that, because of these, respondent Chua suffered

from self-pity and depression; that petitioner clearly
discriminated against the respondents; that respondent Ty had
no choice but to sign the promissory notes in order to secure the
release of her mother, respondent Chua; that the foregoing
actuations constitute an abuse of rights; that petitioner failed to
establish the pecuniary loss it suffered and, hence, it is not
entitled to compensatory damages; and that, since the
promissory note is a contract of adhesion, the petitioner is not
entitled to the award of attorney’s fees as stipulated thereon.
On appeal to the CA, the petitioner assigned the following
errors:

A.
THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE
ERROR BY FINDING THE ACTUATIONS OF THE
ADMINISTRATION OF DEFENDANT-APPELLANT TO BE IN
BAD FAITH, OPPRESSIVE AND UNNECESSARY AS TO MAKE
IT LIABLE TO PLAINTIFFS-APPELLEES FOR DAMAGES AND
ATTORNEY’S FEES.
B.
THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE
ERROR BY NOT RULING UPON THE PERMISSIVE
COUNTERCLAIM OF DEFENDANT-APPELLANT WITH
RESPECT TO THE P1,075,592.95 REPRESENTING THE
HOSPITAL BILL OF PLAINTIFFS-APPELLEES, WHICH
OBLIGATION IS NOT DISPUTED AND WHICH AMOUNT WAS
NEVER CONTROVERTED BY PLAINTIFFS-APPELLEES.6

 
On October 2, 2001, the CA promulgated its Decision the
dispositive portion of which reads:

“IN VIEW OF ALL THE FOREGOING, the appealed Decision is

hereby AFFIRMED with the modification that the award of moral
damages, exemplary damages as well as attorney’s fees is reduced to
Seventy Five Thousand Pesos (P75,000.00), Thirty Thousand Pesos
_______________

6 CA Rollo, p. 39.

238

238 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

(P30,000.00) and Twenty Thousand Pesos (P20,000.00), respectively.

Litigation costs are hereby deleted. Costs against appellant.
SO ORDERED.”7

Apart from the reduction in the award of damages, the CA

affirmed all salient portions of the RTC Decision and declined
to disturb the findings of fact.
Petitioner is now before this Court raising essentially the
same grounds heard by the CA.
Incidentally, with respect to the related criminal case against
respondent Ty, this Court, on September 27, 2004, promulgated
its Decision entitled Ty v. People of the Philippines,8 which
affirmed the decisions of the lower courts finding respondent Ty
guilty of violating B.P. Blg. 22 and ordering her to pay the
private complainant, herein petitioner, the total amount of the
dishonored checks.
The petition is impressed with merit.
While, as a rule, only questions of law may be raised in a
petition for review on certiorari under Rule 45, under certain
exceptions, the Court may re-examine the evidence presented
by the parties during the trial. At least four exceptions exist in
this case, namely: (a) when the conclusion is a finding grounded
entirely on speculation, surmises, or conjectures; (b) when the
judgment is based on a misapprehension of facts; (c) when the
findings of fact are premised on the supposed absence of
evidence and contradicted by the evidence on record; and (d)
when the courts a quo manifestly overlooked certain relevant
facts not disputed by the parties and which, if properly
considered, would justify a different conclusion.9

_______________
 7 Rollo, p. 50.
8  G.R. No. 149275, September 27, 2004, 439 SCRA 220, 238.
9 Heirs of Dicman v. Cariño, G.R. No. 146459, June 8, 2006, 490 SCRA
240; Rivera v. Roman, G.R. No. 142402, September 20, 2005, 470 SCRA 276,
287; Mercury Drug Corp. v. Libunao, G.R. No. 144458, July 14, 2004, 434
SCRA 404, 413-414; The Insular Life Assurance Company, Ltd. v. Court of
Appeals, G.R. No. 126850, April

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VOL. 497, JULY 31, 2006 239

Manila Doctors Hospitals vs. So Un Chua

The principal questions are, first, whether the actuations of

the petitioner amount to actionable wrongs, and second,
whether the counterclaims of the petitioner can be backed up by
the measure of preponderant evidence.
In brief, the courts a quo concurred in the holding that the
petitioner and its staff failed to take into consideration the
physical condition of its patient, respondent Chua, when it
removed the facilities provided in her room;10 that the removal
of these facilities, namely, the air-conditioner, telephone lines,
television, and refrigerator, aggravated the condition of the
patient, triggered her hypertension, and caused her blood
pressure to fluctuate,11 considering that there was no proper
ventilation in the room.12 In view of the foregoing, the courts a
quo concluded that the actuations of the petitioner were
oppressive, unnecessary,13 and anti-social,14 done in bad faith
without proper notice,15 with no intention other than to harass
or irritate the respondents,16 all of which constitute an abuse of
rights.17
We do not agree. The conclusions of the courts a quo are
either haphazard conjectures, or founded on a misapprehension
of facts. The record is replete with evidence that justifies a
different conclusion.

_______________
28, 2004, 428 SCRA 79, 86; Aguirre v. Court of Appeals, G.R. No. 122249,
January 29, 2004, 421 SCRA 310, 319; C & S Fishfarm Corporation v. Court of
Appeals, 442 Phil. 279, 288; 394 SCRA 82, 88 (2002); Martinez v. Court of
Appeals, G.R. No. 123547, May 21, 2001, 358 SCRA 38, 49 (2001).

10 RTC Decision, Rollo, p. 99.

11 Id.
12 Id., at p. 104; CA Decision, Id., at p. 43.
13 Id., at p. 103; CA Decision, Id.
14 Id., at p. 46.
15 Id., at pp. 103-104.
16 Id., at pp. 42, 44.
17 Id., at p. 104; CA Decision, Id., at pp. 42, 46. See THE CIVIL CODE OF THE

PHILIPPINES, R.A. 386, as amended, Articles 19-21, 2219 (1950).

240

240 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

Indeed the operation of private pay hospitals and medical

clinics is impressed with public interest and imbued with a
heavy social responsibility. But the hospital is also a business,
and, as a business, it has a right to institute all measures of
efficiency commensurate to the ends for which it is designed,
especially to ensure its economic viability and survival. And in
the legitimate pursuit of economic considerations, the extent to
which the public may be served and cured is expanded, the
pulse and life of the medical sector quickens, and the
regeneration of the people as a whole becomes more visibly
attainable. In the institution of cost-cutting measures, the
hospital has a right to reduce the facilities and services that are
deemed to be non-essential, such that their reduction or removal
would not be detrimental to the medical condition of the
patient.18 For the moment, the question to be considered is
whether the subject facilities are indeed non-essential—the air-
conditioner, telephone, television, and refrigerator—the
removal of which would cause the adverse health effects and
emotional trauma the respondents so claimed. Corollary to this
question is whether the petitioner observed the diligence of a
good father of the family19 in the course of ascertaining the
possible repercussions of the removal of the facilities prior to
the removal itself and for a reasonable time thereafter, with a
view to prevent damage.20
 

_______________

18 See PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 322 (1988) (discussing the

corporate liability of hospitals arising from the failure to furnish safe and
reliable equipment).
19 See Ramos v. Court of Appeals, 378 Phil. 1198, 1241; 302 SCRA 589,
622 (1999), citing JOSE O. VITUG, COMPENDIUM OF CIVIL LAW AND JURISPRUDENCE
822 (1993).
20 The primary duties of a hospital are to furnish safe and well maintained
premises, to provide adequate and safe equipment, and to exercise reasonable
care in the selection of the members of the hospital staff. See PEDRO P. SOLIS,
MEDICAL JURISPRUDENCE 310-11, 321-29 (1988). A hospital conducted for private
gain is under a duty to exercise ordinary care in furnishing its patients a suitable
and safe place. If an unsafe condition of the hospital’s premises

241

VOL. 497, JULY 31, 2006 241

Manila Doctors Hospitals vs. So Un Chua

After an extensive analysis of the record, it becomes rather

worrisome to this Court that the courts a quo unreservedly drew
their conclusions from the self-serving and uncorroborated
testimonies of the respondents the probative value of which is
highly questionable.21 We hold that the respondents failed to
prove the damages so claimed.

_______________

causes an injury, there is a breach of the hospital’s duty. 40A AM. JUR. 2D
Hospitals and Asylums § 35 (1999), citing Sharpe v. South Carolina Dept. of
Mental Health, 281 S.C. 242, 315 S.E.2d 112 (1984); United Western Medical
Centers v. Superior Court, 42 Cal. App. 4th 500, 49 Cal. Rptr. 2d 682 (4th Dist.
1996). Where the patient refuses to leave a private hospital in spite of the order
for his discharge, he may do so and continue to stay in that hospital, provided
the corresponding hospital bill is properly satisfied and with the consent of the
attending physician. PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 336
(1988). The relationship between the hospital as a private corporate entity and
the admitted patient is one principally governed by contract. This conclusion
stems from the general rule that the management and operation of a private
hospital are governed by the rules applied in the case of private corporations
generally, except as modified by statute. See 40A AM. JUR. 2d Hospitals and
Asylums §13 (1999), citing Burris v. Morton F. Plant Hospital, 204 So. 2d 521
(1967). The contract between the private hospital and the patient normally
stipulates the conditions of admission. See, e.g., 9A AM. JUR. LEGAL FORMS 2D
§136:63. As the petitioner is a private hospital as opposed to a public one, it is
given more leeway in making rules and regulations as regards the admission of
patients, hospital facilities, selection of staff, among others, provided that such
rules and regulations are not arbitrary, discriminatory, unreasonable,
monopolistic, or contrary to law or public policy, PEDRO P. SOLIS, MEDICAL
JURISPRUDENCE 310 (1988).

21  See, e.g., Tan v. Villapaz, G.R. No. 160892, November 22, 2005, 475
SCRA 720, 727; Nautica Canning Corp. v. Yumul, G.R. No. 164588, October
19, 2005, 473 SCRA 415, 423; Jardine Davies, Inc. v. JRB Realty, Inc., G.R.
No. 151438, July 15, 2005, 463 SCRA 555, 561; Lim v. Chuatoco, G.R. No.
161861, March 11, 2005, 453 SCRA 308, 316; Chico v. Court of Appeals, 348
Phil. 37, 43; 284 SCRA 33, 37 (1998).

242

242 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

The evidence in the record firmly establishes that the staff of

the petitioner took proactive steps to inform the relatives of
respondent Chua of the removal of facilities prior thereto, and
to carry out the necessary precautionary measures to ensure that
her health and well-being would not be adversely affected: as
early as around two weeks after her admission on October 30,
1990, to the time when the facilities had been removed
sometime in the middle of May 1992,22 and even up to the point
when she actually left the premises of the hospital three weeks
later, or during the first week of June 1992,23 the medical
condition of respondent Chua, as consistently and indisputably
confirmed by her attending physician, Dr. Rody Sy, a
cardiologist, who was called as witness for both parties,24
whom even respondent Chua repeatedly praised to be “my
doctor” and “a very good doctor”25 at that, and whose
statements at times had been corroborated as well by Sister
Mary Philip Galeno, SPC, the Administrator of the hospital and
who also happens to be a registered nurse, had been “relatively
well,”26 “ambulatory,”27 “walking around in the room,”28 and
that she was “able to leave the hospital on her own without any
assistance”;29 that although she complained of symptoms such
as dizziness, weakness,30 and abdominal discom-

_______________

22 TSN, October 5, 1995, pp. 53-54.

23  TSN, September 7, 1995, p. 13. The exact date when respondent Chua
actually left the hospital is under dispute, which is either June 4 or June 5, 1992.
24  See TSN, August 22, 1996, p. 1-34 (offering Dr. Rody Sy as rebuttal
witness for respondents and whose credibility had not been impeached).
25 TSN, June 24, 1994, pp. 16, 32.
26 TSN, September 7, 1995, p. 6.
27 Id., at pp. 8, 13.
28 Id., at p. 13.
29 Id., at pp. 8-9
30 Id., at pp. 7, 10.

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Manila Doctors Hospitals vs. So Un Chua

fort,31 Dr. Sy requested several medical examinations, such

as the laboratory tests, renal tests, MRI, ultrasound, and CT
scan,32 all of which were administered after procuring the
consent of respondent Chua’s family33 as admitted by
respondent Ty herself,34 and even called on other specialists,
such as a neurologist, endocrinologist, and gastroenterologist, to
look into her condition35 and conduct other tests as well36
according to their fields of specialty, all of which yielded no
serious finding;37 that her illnesses were “lifelong illnesses”38 at
a stage where they cannot be totally removed or abolished,39
making it clear to her family that “one hundred percent
recovery is not possible” despite being given daily medication
in the hospital;40 but that her condition, nonetheless, is not
serious,41 as the blood pressure is more or less controlled and
within acceptable limits,42 “not that critical to precipitate any
acute attack,”43 nor likely to fall into any emergency,44 nor yet
does she require continuous or prolonged hospitalization45 since
she was stable enough to be treated at home and on an “out-
patient” basis, so much so that Dr. Sy encouraged her to
exercise and avoid resting all the time,46 and recommended

_______________

31 TSN, August 22, 1996, p. 7 (testifying as witness for the respondent).

32 TSN, August 15, 1996, p. 13.
33 Supra note 31.
34 Supra note 32.
35 Supra note 31.
36 Id., at p. 9.
37 TSN, September 7, 1995, p. 10.
38 TSN, August 22, 1996, p. 22.
39 TSN, September 7, 1995, p. 7.
40 Id., at p. 15.
41 Supra note 37.
42 Supra note 38.
43 TSN, September 7, 1995, pp. 12-13.
44 Id.
45 Id., at p. 14.
46 Id., at p. 18.

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244 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

that “anytime she may be discharged”47 even in just “two weeks

after confinement,”48 the propriety of his order of discharge
concurred upon by the other specialists as well,49 had it not
been for respondents’ insistence to stay in the hospital in view
of their hope for absolute recovery50 despite the admission of
respondent Chua herself that she cannot anymore be totally
cured.51
It is also undisputed that the hospital administrator, Sister
Galeno, prior to the removal of the facilities, consulted the
attending physician, Dr. Sy.52 To Sister Galeno, also a registered
nurse, the matter of removal and its possible repercussions on
the health of the patient, as a matter of hospital policy, is a
critical and sensitive maneuver, and, hence, it is carried out only
after discussing with the doctors to evaluate all important
factors.53 The fact of prior consultation54 as well as the medical
determination to the effect that it was safe to remove the
facilities and would cause no harmful effect55 had been amply
corroborated by respondent Chua’s own doctor himself.56 When
Dr. Sy testified as rebuttal witness for the respondents
themselves and whose credibility respondents failed to
impeach, he categorically stated that he consented to

_______________

47 Id., at pp. 6-7.

48 Id., at p. 8.
49 Id., at p. 11.
50 Id., at p. 7, 10, 12; TSN, August 22, 1996, supra.
51 TSN, June 24, 1994, p. 32.
52 TSN, January 19, 1996, p. 12; TSN, October 5, 1995, pp. 75, 76.
53 TSN, October 5 1995, p. 76.
54  Although there is some inconsistency as to the exact dates when the
hospital administrator, Sister Galeno, consulted with the doctors, due to
memory lapse of the witnesses, it is fairly established that it was done during a
reasonable time before the removal. See TSN, October 5, 1995, pp. 12, 76-77;
TSN, August 22, 1996, p. 17 (Dr. Rody Sy testifying for the respondents as
rebuttal witness).
55 TSN, August 22, 1996, p. 13.
56 Id., at pp. 12-13.

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Manila Doctors Hospitals vs. So Un Chua

the removal since the removal of the said facilities would not
by itself be detrimental to the health of his patient, respondent
Chua.57 And in this respect, he had been advising respondent
Ty, the daughter of the patient, that the facilities, such as the air-
conditioner, television, refrigerator, and telephone, are not
absolutely necessary, and, that although they may add to the
comfort of the patient, if absent, they will not cause any
significant deterioration of her condition,58 given that, in his
experience as a cardiologist, and after personally attending
respondent Chua on a daily basis before, during, and after the
removal and even up to the time of her actual discharge,59 he
concluded that many hypertensive and diabetic patients, as in
her case, do not at all need in particular an air-conditioning unit,
among the other facilities aforementioned.60 And, contrary to
the findings of the courts a quo and the self-serving testimonies
of respondents that the lack of ventilation, after the removal of
the air-conditioner, triggered her hypertension, Dr. Sy
categorically stated that during his daily rounds with the patient
he was certain that, although admittedly the blood pressure in
general would fluctuate daily, there had been no adverse effect
on her, and that her blood pressure were within acceptable
limits,61 especially considering that he treated the patient on a
daily basis up to the point of actual discharge,62 and
accordingly, as confirmed by the medical records, he made no
change in the medications thereafter.63 In support of Dr. Sy’s
findings, Sister Galeno, testified that she knew the condition of
the ventilation of the patient’s deluxe room, located at the fifth
floor, even without the air-conditioning, notably in times of
brownout, and that

_______________

57 Supra note 55.

58 Id., at p. 18.
59 TSN, September 7, 1995, p. 17; TSN, August 22, 1996, p. 19.
60 TSN, August 22, 1996, p. 14.
61 Id., at p. 22.
 62 Id., at p. 19.
63 Id., at p. 28

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246 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

there had been enough ventilation since the grilled window of

that room was large enough which, if opened, would permit
sufficient ventilation.64 The Court finds that the premise of the
RTC judgment refers merely to hypothetical statements which
fail to establish any clear and direct link to the injury allegedly
suffered by the patient:
Q You found it safe to remove these facilities from the room of the patient
suffering from diabetes and hypertension?
A Yes, Sir. Many hypertensive, diabetic patients do not need air-conditioning,
or T.V. or refrigerator.
Q Do you agree with me that hypertension is triggered sometimes by
excitement, anger or (sic) a person suffering from such illness?
A Hypertension can be triggered by anything.
Court:
Q And even in other words the discomfort can also trigger?
A Sometimes mental stress can trigger.
xxxx
Court:
Q You mentioned earlier that this hypertension may be triggered mentally?
A Yes, Your Honor.
Court:
Q Will the removal of these facilities not affect the patient including the
relatives?
A It may to a certain extent. And well, maybe the days after the removal
would prove that fluctuation in blood pressure are within acceptable
limits.65

With respect to the findings of the courts a quo that bed

sores appeared on the body of respondent Chua, that she
suffered from depression after the disconnection of the said
facilities, that her private midwives were barred, and that the
delivery of food was delayed, this Court holds, as above, that

_______________

64 TSN, October 5, 1995, p. 32.

65 Id., at p. 14, 18-19.

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these conclusions are bereft of sound evidentiary basis, self-

serving and uncorroborated as they are. Again, Dr. Sy affirmed
that during the daily rounds he would make on the patient, he
did not detect any skin lesion or any other abnormality up to the
time she was actually discharged.66 Nor did he find any sign of
depression, although, admittedly, he observed that she had been
“very angry” because of the removal of the facilities.67 All the
while he did not receive any complaint from respondent Chua
indicating that she suffered from the foregoing infirmities,68
considering that it is the responsibility of the family of the
patient to specifically inform the attending physician or the
nurses during their rounds whatever they feel is important, or if
there were any new developments since the last visit.69 As
corroborated by Sister Galeno, throughout respondent Chua’s
confinement, she never received any complaint from the latter
or her relatives that she had not been attended to by the nursing
staff.70 Worth noting again is the fact that the nursing staff and
the attending physicians, which included Dr. Sy, in accordance
with hospital policy, would routinely make their rounds on a
daily basis, or would visit the patient whenever they are called
for any problem,71 and, in the case of the specialists other than
the attending physician, they would visit the patient about once
a week.72 The nurses, on the other hand, would make their
rounds more frequently, that is, at least once per shift, or every
eight hours.73 Apart from the self-serving statements of
respondents, which by now have become rather indicative of
being mere afterthoughts, there is
_______________

66 TSN, September 7, 1995, p. 16.

67 Id.
68 Id., at pp. 21-22.
69 Id.
70 TSN, October 5, 1995, p. 48.
71 TSN, September 7, 1995, p. 20; TSN, August 22, 1996, pp. 6, 8, 24; TSN,
October 5, 1995, p. 13.
72 TSN, August 22, 1996, p. 8.
73 Supra note 46.

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248 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

no clear showing from the record that the petitioner and its
medical staff deviated from the foregoing policy and practice,
nor had they been called upon to look into the alleged physical
reactions or emotional trauma respondent Chua claims to have
suffered during and after the removal of the facilities. It must be
emphasized that, as stated above, respondent Chua herself
explicitly found Dr. Sy to be a “very good doctor” because he
personally attended to her “almost every hour.”74 And
throughout her confinement, Dr. Sy positively stated that her
family employed a private midwife who attended to her all the
time.75
The evidence in the record overwhelmingly demonstrates
that respondent Chua had been adequately attended to, and this
Court cannot understand why the courts a quo had declared that
there was an “utter lack of medical attendance,” or that her
health suffered during the period after the removal of the
facilities. The Court finds that the facilities in question are non-
essential for the care of respondent Chua and, hence, they may
be lessened or removed by the petitioner for the sake of
economic necessity and survival.
Though human experience would show that the deactivation
of the air-conditioner may cause a temperature differential that
may trigger some physical discomfort, or that the removal of
entertainment facilities such as the television set, or the
disconnection of communication devices such as the telephone,
may cause some exasperation on the part of the one who
benefits from these, nevertheless, all things considered, and
given the degree of diligence the petitioner duly exerted, not
every suppression of the things that one has grown accustomed
to enjoy amounts to an actionable wrong, nor does every
physical or emotional discomfort amount to the kind of anguish
that warrants the award of moral damages under the general
principles of tort. The underlying basis for

_______________

74 TSN, June 24, 1994, pp. 16, 31-32.

75 Supra note 46.

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Manila Doctors Hospitals vs. So Un Chua

the award of tort damages is the premise that an individual was

injured in contemplation of law. Thus, there must first be the
breach of some duty and the imposition of liability for that
breach before damages may be awarded; it is not sufficient to
state that there should be tort liability merely because the
plaintiff suffered some pain and suffering.76
Moreover, this Court must reiterate the standard of tort to
arrive at a proper award for damages premised on matters that
suggest the application of medical knowledge, especially in the
description of the causal link between external or environmental
factors, on one hand, and their effect unto the physical or
emotional health of the patient, on the other, expert opinion, as
discussed in Cruz v. Court of Appeals,77 is generally required:

“All three courts below bewail the inadequacy of the facilities of

the clinic and its untidiness; the lack of provisions such as blood,
oxygen, and certain medicines; the failure to subject the patient to a
cardio-pulmonary test prior to the operation; the omission of any form
of blood typing before transfusion; and even the subsequent transfer of
Lydia to the San Pablo Hospital and the reoperation performed on her
by the petitioner. But while it may be true that the circumstances
pointed out by the courts below seemed beyond cavil to constitute
reckless imprudence on the part of the surgeon, this conclusion is still
best arrived at not through the educated surmises nor conjectures of
laymen, including judges, but by the unquestionable knowledge of
expert witnesses. For whether a physician or surgeon has exercised the
requisite degree of skill and care in the treatment of his patient is, in
the generality of cases, a matter of expert opinion. The deference of
courts to the expert opinions of qualified physicians stems from its
realization that the latter possess unusual technical skills which laymen
in most instances are incapable of intelligently evaluating. Expert
testimony should have been

_______________

76 Spouses Custodio v. Court of Appeals, 323 Phil. 575, 585-586; 253 SCRA 483,
490-491 (1996). See Expertravel & Tours, Inc. v. Court of Appeals, 368 Phil. 444, 448-
449; 309 SCRA 141, 145-146 (1999).
77 346 Phil. 872; 282 SCRA 188 (1997).

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250 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

offered to prove that the circumstances cited by the courts below are
constitutive of conduct falling below the standard of care employed by
other physicians in good standing when performing the same
operation. It must be remembered that when the qualifications of a
physician are admitted, as in the instant case, there is an inevitable
presumption that in proper cases he takes the necessary precaution and
employs the best of his knowledge and skill in attending to his clients,
unless the contrary is sufficiently established. This presumption is
rebuttable by expert opinion which is so sadly lacking in the case at
bench.”78

With respect to the propriety of the notice of removal of

facilities, the evidence shows that the hospital staff,
accompanied by Sister Gladys Lim, SPC, Finance
Administrative Assistant of the hospital,79 through written and
verbal notices as per hospital policy, forewarned the
respondents, through respondent Ty and her sister, Judith Chua,
of the impending removal of the facilities over a week
beforehand80 in view of their obstinate refusal to vacate and
transfer to a lower rate room81 or to update the mounting
hospital bills82 which, by then, had swollen to approximately
one million pesos.83 Respondent Ty refused to read many of the
written notices sent by the Credit Department.84 After repeated
attempts to contact respondent Ty85 and before the actual
removal of the facilities, the staff of the petitioner tried to
personally serve the final notice dated April 23, 1992,86 signed
by Sister Gladys Lim, addressed to respondent Ty, which
adopted the tenor of the prior verbal warnings, and which
expressly and sternly warned the respondents that the hospital
shall be constrained

_______________

78 Id., at pp. 884-885; pp. 201-202.

79 TSN, October 5, 1995, p. 28.
80 Id., at pp. 12, 27.
81 Id., at pp. 26, 31-32.
82 Id., at pp. 12, 31, 42.
83 Id., at p. 26.
84 Id., at p. 5.
85 Id., at pp. 30-31.
86 Exhibit “5.”

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to take legal action and that they shall be compelled to transfer

the patient, respondent Chua, to a lower rate room unless the
balance could be satisfied.87 Respondent Ty, for no justifiable
reason, and sticking to her inclination to avoid the staff, refused
to receive or acknowledge this letter as well.88 Worth noting is
that Sister Galeno, testified that, as a matter of hospital policy
the tenor of which respondents, by virtue of the Contract for
Admission dated October 30, 1990, agreed to comply with,89
the hospital can only cut off the non-essential facilities—and
only in extreme cases90—if the patient occupies a private room
all to herself; had the room been semi-private shared by other
patients, or had it been the ward, the hospital cannot disconnect
the facilities since this would unduly prejudice the other
patients. But respondent Chua herself insisted on staying in a
private room despite her being fully aware of the ballooning
charges,91 and even if she could have freely gone home anytime
to her condominium unit which, as admitted, was equipped with
an air-conditioner.92 With respect to the “pressure” and
“harassment” respondents allegedly suffered daily whenever the
hospital staff would follow up the billing during odd hours, or
at 10pm, 11pm, 12 midnight, 1am, or 2am,93 this averment had
been convincingly refuted by the witnesses for the petitioner,
namely, Editha L. Vecino, the Head of Credit and Collection,
and Sister Galeno, in that the Credit and Collection Department
would only hold office

_______________

87 Id., TSN, October 5, 1995, p. 29.

88 TSN, October 27, 1994, p. 13; TSN, October 5, 1995, pp. 27-29
89 Exhibit “1.”
90 TSN, October 5, 1995, p. 17.
91 Id., at pp. 31, 42; Partial Pre-Trial Order dated May 4, 1994, Rollo, pp.
90-91; RTC Decision, Id., at pp. 94-95.
92 TSN, June 24, 1994, pp. 27-28; TSN, August 15, 1996, p. 14.
93 TSN, June 4, 1994, pp. 6, 9, 36.

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252 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

hours from 8am to 5pm and, hence, it is impossible to “harass”

the respondents during the times they so claimed.94
The courts a quo found that respondent Ty had “no choice
but to sign the promissory note in order for her mother to be
released from the hospital,”95 thus suggesting that the hospital
refused to actually discharge or bodily release its patient,
respondent Chua, until arrangements had been made to settle
the charges.
While there are portions of the testimonies of the witnesses
for the petitioner which state that although, as per standard
procedure, the patient “cannot leave”96 the hospital without the
“discharge,”97 “clearance” or “gate pass” issued only after
arrangements on the settlement of bills had been made,98 still, it
must be understood that these are only demonstrative of the
precondition that a patient cannot step out of the premises
“without the consent” of the hospital, or, in other words, that the
“clearance” merely indicates that the hospital ex-

_______________

94 TSN, October 27, 1994, p. 34; TSN, October 5, 1995, pp. 44-45.
95  RTC Decision, Rollo, p. 106. This conclusion had been impliedly
affirmed by the CA. See TSN, July 1, 1994, p. 17 (respondent Ty testifying that
she was “forced to sign” the promissory notes and execute the postdated checks
as a condition for the release or discharge of her mother, respondent Chua). See
also Id., at p. 21.
96 TSN, September 14, 1995, pp. 18-19, 23.
97 Id., at p. 35.
98 Id., at pp. 17-18, 22, 32; TSN, October 5, 1995, p. 25. It can be observed
from the testimonies that the discharge order issued by the attending physician
is a discharge from a medical standpoint, while the discharge or clearance
issued by the Nursing Station, Accounting, Cashier, Security, or the other
departments whose functions may be administrative in nature refer to matters
not solely confined to medical aspects, such as the settlement of dues, deposits
or breakage, all of which depend on the rules and regulations as well as hospital
policy.

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Manila Doctors Hospitals vs. So Un Chua

pressly consented to the actual release of the patient,99 but, even

without its consent, the patient is still free to leave “anytime” as
a matter of policy, in spite of the refusal to issue a “clearance”
or “gate pass,”100 or even in cases where the accounts have not
yet been liquidated or settled,101 or yet even if no promissory
note or post-dated check were executed in favor of the
petitioner, as testified by no less than Sister Galeno,102 and
corroborated by Editha Vecino;103 and that, petitioner, a private
hospital established for profit,104 being also a business, by
warning respondents that it shall withhold clearance, is simply
exercising its right to protest against an absconding patient as a
precursor to avail of other appropriate legal remedies; that, on
the contrary, the respondents opted not to leave because of their
own promise not to leave unless the hospital bills were fully
settled;105 that the accusations found in the Demand Letter
dated May 19, 1992, and signed by the counsel for the
respondents,106 particularly, that the petitioner “refused to
discharge the patient, [respondent Chua,] despite orders from
the attending physician, Dr. Rody Sy,” had all been refuted by
Sister Galeno when she read its contents in front of the counsel
for respondents, emphatically telling him that “we are not
detaining his clients”; that “[respondent Ty] was the one who
told us that they are not going to leave the hospital unless they
have fully paid the hospital”;107 and that, most importantly, no
physical restraint upon the person of

_______________

99  TSN, October 5, 1995, p. 26; TSN, September 14, 1995, pp. 23-24.
100 Id.; Id.
101 TSN, September 14, 1995, pp. 23-24.
102 TSN, October 5, 1995, pp. 26-27, 48-49
103 Supra note 101.
104 See PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 305-307 (1988)
(discussing the various classifications of hospitals).
105 TSN, October 5, 1995, pp. 49-50.
106 Exhibits “B” to “B-1.”
107 TSN, October 5, 1995, pp. 40-42.

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254 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua
respondent Chua or upon the person of her relatives had been
imposed by the staff.
Authorities, including those of common law origin,
explicitly declare that a patient cannot be detained in a hospital
for nonpayment of the hospital bill. If the patient cannot pay the
hospital or physician’s bill, the law provides a remedy for them
to pursue, that is, by filing the necessary suit in court for the
recovery of such fee or bill.108 If the patient is prevented from
leaving the hospital for his inability to pay the bill, any person
who can act on his behalf can apply in court for the issuance of
the writ of habeas corpus.109
The form of restraint must be total; movement must be
restrained in all directions. If restraint is partial, e.g., in a
particular direction with freedom to proceed in another, the
restraint on the person’s liberty is not total.110 However, the
hospital may legally detain a patient against his will when he is
a detained or convicted prisoner, or when the patient is suffering
from a very contagious disease where his release will be
prejudicial to public health, or when the patient is mentally ill
such that his release will endanger public safety,111 or in other
exigent cases as may be provided by law. Moreover, under the
common law doctrines on tort, it does not constitute a trespass
to the person to momentarily prevent him from leaving the
premises or any part thereof because he

_______________

108  PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 338 (1988), citing

Gadsden General Hospital v. Hamilton, 103 So. 553 (1925). See LOUIS J.
REAGAN, DOCTOR AND PATIENT AND THE LAW 113 (1949), citing Cook v.
Highland Hospital, 84 S.E. 352; In re Carlsen, 130 Fed. 379; Re Baker, 29
How. Pr. (N.Y.) 485; Ollet v. Pittsburgh, C.C. & St. L.R. Co. (Pa.), 50 Atl. 1011;
Lord v. Claxton (Ga.), 8 S.E.2d 657.
109 PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 338 (1988).
110 C.R.A. MARTIN, LAW RELATING TO MEDICAL PRACTICE 340-41
(1979) (citations omitted).
111 PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 338 (1988).

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Manila Doctors Hospitals vs. So Un Chua

refuses to comply with some reasonable condition subject to

which he entered them. In all cases, the condition of this kind of
restraint must be reasonable in the light of the circumstances.112
At any rate, as stated above, the patient is free to leave the
premises, even in the ostensible violation of these conditions,
after being momentarily interrupted by the hospital staff for
purposes of informing him of those reasonable conditions, such
as the assessment of whether the patient is fit to leave, insane,
or suffering from a contagious disease, etc., or simply for
purposes of making a demand to settle the bill. If the patient
chooses to abscond or leave without the consent of the hospital
in violation of any of the conditions deemed to be reasonable
under the circumstances, the hospital may nonetheless register
its protest and may choose to pursue the legal remedies
available under law, provided that the hospital may not
physically detain the patient, unless the case falls under the
exceptions abovestated.
Authorities are of the view that, ordinarily, a hospital,
especially if it is a private pay hospital,113 is entitled to be
compensated for its services, by either an express or an implied
contract, and if no express contract exists, there is generally an
implied agreement that the patient will pay the reasonable value
of the services rendered;114 when a hospital treats a patient’s
injuries, it has an enforceable claim for full payment for its
services, regardless of the patient’s financial status.115 At this
juncture, it must be noted that there is testimony, though to a
degree disputable, to the effect that the execution of the
promissory note and the issuance of postdated checks

_______________

112  C.R.A. MARTIN, LAW RELATING TO MEDICAL PRACTICE 41

(1979) (citations omitted).
113 As opposed to a private charitable or eleemosynary hospital. PEDRO P.
SOLIS, MEDICAL JURISPRUDENCE 306-307 (1988).
114  40A AM. JUR. 2D Hospitals and Asylums §8 (1999), citing Porter v.
McPherson, 198 W. Va. 158, 479 S.E.2d 668 (1996).
 115 Id., citing Trevino v. HHL Financial Services, Inc., 945 P.2d 1345 (Colo.
1997).

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256 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

were conditions imposed not by the petitioner but voluntarily

offered by the counsel for respondents.116 At any rate, however,
this Court holds, in view of the foregoing authorities, that the
requirement to have the relative of respondent Chua to execute
a promissory note as part of the arrangement to settle the unpaid
obligations is a formality that converts any implied contract into
written form and, moreover, amounts to a reasonable condition,
the non-fulfillment of which, in itself, however, as discussed,
cannot allow the hospital to detain the patient. It must also be
stressed, contrary to the findings of the courts a quo, that such
an agreement embodied in a promissory note, as well as the
Contract for Admission and Acknowledgment of Responsibility
for Payment dated October 30, 1990, do not become contracts
of adhesion simply because the person signing it was under
stress that was not the result of the actions of the hospital,117
especially taking into account that there is testimony to the
effect that respondent Ty signed the Promissory Note dated
June 5, 1992 in the presence of counsel and acting under his
advise.118
But as to the propriety of the circumstances surrounding the
issuance of the postdated checks to cover the amount stated in
the Promissory Note dated June 5, 1992, this Court must refer
to the discussion of the recent case of Ty v. People of the
Philippines119 where this Court affirmed the conviction of
respondent Ty for the issuance of bouncing checks addressed to
the petitioner herein. While the instant case is to be
distinguished from the Ty case in nature, applicable law, the
standards of evidence, and in the defenses available to the
parties, hence, the judgment of conviction in that case should
not at all prejudice the disposition of this case, even if the
_______________

116 TSN, October 5, 1995, pp. 43-44, 58-59, 62.

117  See 40A AM. JUR. 2D Hospitals and Asylums §8 (1999), citing
Heartland Health Systems, Inc. v. Chamberlin, 871 S.W. 2d 8 (1993).
118 TSN, October 27, 1994, pp. 26-27.
119 G.R. No. 149275, September 27, 2004, 439 SCRA 220.

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facts coincide, nonetheless, for purposes of convenience and

instructive utility, the Court quotes the relevant portions:

“In this case, far from it, the fear, if any, harbored by Ty was not
real and imminent. Ty claims that she was compelled to issue the
checks a condition the hospital allegedly demanded of her before her
mother could be discharged for fear that her mother’s health might
deteriorate further due to the inhumane treatment of the hospital or
worse, her mother might commit suicide. This is speculative fear; it is
not the uncontrollable fear contemplated by law.
To begin with, there was no showing that the mother’s illness was
so life-threatening such that her continued stay in the hospital suffering
all its alleged unethical treatment would induce a well-grounded
apprehension of her death. Secondly, it is not the law’s intent to say
that any fear exempts one from criminal liability much less petitioner’s
flimsy fear that her mother might commit suicide. In other words, the
fear she invokes was not impending or insuperable as to deprive her of
all volition and to make her a mere instrument without will, moved
exclusively by the hospital’s threats or demands.
Ty has also failed to convince the Court that she was left with no
choice but to commit a crime. She did not take advantage of the many
opportunities available to her to avoid committing one. By her very
own words, she admitted that the collateral or security the hospital
required prior to the discharge of her mother may be in the form of
postdated checks or jewelry. And if indeed she was coerced to open an
account with the bank and issue the checks, she had all the opportunity
to leave the scene to avoid involvement.
 Moreover, petitioner had sufficient knowledge that the issuance of
checks without funds may result in a violation of B.P. 22. She even
testified that her counsel advised her not to open a current account nor
issue postdated checks “because the moment I will not have funds it
will be a big problem.” Besides, apart from petitioner’s bare assertion,
the record is bereft of any evidence to corroborate and bolster her
claim that she was compelled or coerced to cooperate with and give in
to the hospital’s demands.
Ty likewise suggests . . . that the justifying circumstance of state of
necessity under par. 4, Art. 11 of the Revised Penal Code may find
application in this case.

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258 SUPREME COURT REPORTS ANNOTATED

Manila Doctors Hospitals vs. So Un Chua

We do not agree. The law prescribes the presence of three requisites

to exempt the actor from liability under this paragraph: (1) that the evil
sought to be avoided actually exists; (2) that the injury feared be
greater than the one done to avoid it; (3) that there be no other practical
and less harmful means of preventing it.
In the instant case, the evil sought to be avoided is merely expected
or anticipated. If the evil sought to be avoided is merely expected or
anticipated or may happen in the future, this defense is not applicable.
Ty could have taken advantage of an available option to avoid
committing a crime. By her own admission, she had the choice to give
jewelry or other forms of security instead of postdated checks to secure
her obligation.
Moreover, for the defense of state of necessity to be availing, the
greater injury feared should not have been brought about by the
negligence or imprudence, more so, the willful inaction of the actor. In
this case, the issuance of the bounced checks was brought about by
Ty’s own failure to pay her mother’s hospital bills.
The Court also thinks it rather odd that Ty has chosen the
exempting circumstance of uncontrollable fear and the justifying
circumstance of state of necessity to absolve her of liability. It would
not have been half as bizarre had Ty been able to prove that the
issuance of the bounced checks was done without her full volition.
Under the circumstances, however, it is quite clear that neither
uncontrollable fear nor avoidance of a greater evil or injury prompted
the issuance of the bounced checks.
Parenthetically, the findings of fact in the Decision of the trial court
in the Civil Case for damages filed by Ty’s mother against the hospital
is wholly irrelevant for purposes of disposing the case at bench. While
the findings therein may establish a claim for damages which, we may
add, need only be supported by a preponderance of evidence, it does
not necessarily engender reasonable doubt as to free Ty from
liability.”120

In view of the foregoing, the Court therefore holds that the

courts a quo committed serious errors in finding that the
petitioner was “biased,”121 “discriminated” against the res-

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120 Id., at pp. 230-233.

121 Rollo, p. 44.

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pondents,122 and “purposely intended to irritate”123 or

“harass”124 them; that it “acted in bad faith in removing the
facilities without prior notice”;125 and that its acts were “anti-
social.”126 The aforequoted declarations of the witnesses,
significant portions of which this Court considers as expert
testimony, are reliable and remain considerably trustworthy to
controvert respondents’ assertions as well as to reverse the
conclusions of fact and law of the CA and the RTC that
respondent Chua suffered the physical and emotional anguish
so claimed, and so, for these reasons, the Court holds that the
petitioner inflicted no actionable wrong.
This Court observes that the courts a quo awarded both
respondents moral damages. But it is well-settled that in case of
physical injuries, with some exceptions,127 moral damages are
recoverable only by the party injured and not by her spouse,
next of kin, or relative who happened to sympathize with the
injured party.128 Hence, even if the courts a quo were correct in
their basis for damages, they should have declined to award
damages to respondent Ty.
The last issue to be resolved is the question whether the
counterclaims of the petitioner are supported by a
preponderance of evidence.
We agree with the petitioner that the courts a quo seriously
erred in mistaking the case of its compulsory counterclaim for
its permissive counterclaim and for failing to consider the
evidence which impressively supports the latter.

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122 Id., at p. 103.
123 Id., at p. 42.
124 Supra note 121.
125 Supra note 122; Id., at p. 43.
126 Id., at p. 46.
127 See THE CIVIL CODE OF THE PHILIPPINES, Republic Act No. 386,
as amended, Article 2219 (1950).
128  See Soberano v. Manila Railroad Company, 124 Phil. 1330, 1337; 18
SCRA 732, 738 (1966); Strebel v. Figueras, 96 Phil. 321, 330 (1954); Araneta
v. Arreglado, 104 Phil. 529, 533 (1958).

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Manila Doctors Hospitals vs. So Un Chua

First, for failure without justifiable cause of respondents’

counsel to comment on the Partial Formal Offer of Evidence
dated February 14, 1996129 filed by the petitioner, the RTC
issued an order during the course of the trial, which counsel for
respondents neither contested nor raised on appeal, admitting
Exhibits “1” to “16,” together with their submarkings and the
purposes for which the same were offered,130 all of which had
also been previously authenticated and their contents verified by
the witnesses for the petitioner.131 These documents include the
Contract for Admission of respondent Chua dated October 30,
1990, duly executed by respondent Ty, incorporating therein the
rules and regulations of the hospital, including the duty to
understand the same132 as well as the undertaking of respondent
Ty to be jointly and severally liable for the payment of the
hospital bills of respondent Chua;133 the Promissory Note dated
June 5, 1992 in the amount of P1,075,592.95 duly executed by
respondent Ty in favor of the petitioner agreeing to be jointly
and severally liable to pay the unpaid obligations of respondent
Chua and Judith Chua, including interest and attorney’s fees in
case of default;134 the Undertakings signed by respondent Ty
dated March 3, 1992 and April 7, 1992 to maintain regular
deposits;135 and the credit memos and statements of account
that support the amount referring to the unpaid obligation.136
Second, the parties stipulated during pre-trial that respondents

_______________

129 Records, pp. 178-197.

130 TSN, August 15, 1996, pp. 4-5.
131 TSN, October 27, 1994, pp. 8, 10-11, 24-27; TSN, October 5, 1995, pp.
18, 21, 26, 35-36, 51-53; TSN, January 25, 1996, pp. 8-9, 12.
132 Exhibit “1.”
133 Exhibits “1-a” and “1-b.”
134 Exhibits “2” to “2-c.”
135 Exhibits “3” to “4-b.”
136 Exhibits “11,” “11-b”; Exhibits “13” to “14-a”; Exhibits “16” to 16-d.”

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failed to pay the balance despite repeated reminders.137 And

third, respondent Ty in open court identified and admitted that
she signed the Contract of Admission dated October 30, 1990 as
well as the Undertakings dated March 3, 1992 and April 7, 1992
but which, for no justifiable reason, she “did not bother to
read,”138 and, what is more, she repeatedly admitted during the
course of the trial that she failed to fully settle the foregoing
hospital bills.139 In fact, while the Ty case cannot control the
incidents of the instant case as heretofore stated, it is still worth
mentioning, at least for informative purposes, the findings of
this Court in Ty with respect to respondents’ obligations to the
petitioner:

“Ty’s mother and sister availed of the services and the facilities of the
hospital. For the care given to her kin, Ty had a legitimate obligation to
pay the hospital by virtue of her relationship with them and by force of
her signature on her mother’s Contract of Admission acknowledging
responsibility for payment, and on the promissory note she executed in
favor of the hospital.”140

In view of all these findings, the Court earnestly disagrees

with the sweeping conclusion of the CA that “[Petitioner] failed
to present any iota of evidence to prove his claim,”141 a
statement apparently referring to the permissive counterclaim of
P1,075,592.95. However, with respect to the compulsory
counterclaim predicated on the filing of a baseless suit and
injury to its reputation, petitioner did not raise this matter on
appeal and, hence, is deemed to have waived the same.
But the Court in Ty made a partial finding on the civil
liability of respondent Ty with respect to the amount covered by
seven of the several dishonored checks she issued equiva-

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137 Rollo, pp. 94-95; Partial Pre-Trial Order dated May 4, 1994, Id., at pp.
90-91.
138 TSN, July 1, 1994, PP. 5, 8, 19-22.
139 Id., at pp. 5, 9-10.
140 Ty v. People of the Philippines, supra note 8, at p. 234.
141 Rollo, p. 47.

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262 SUPREME COURT REPORTS ANNOTATED

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lent to P210,000.00.142 Since this amount forms a fraction of

her total civil liability, then this amount, in deference to Ty,
should be deducted therefrom.
 The claim for attorney’s fees, as stipulated under the
Promissory Note dated June 5, 1992, should be reduced for
being unreasonable under the circumstances, from 25 percent to
12 percent of the total amount due.143
As a final word, the Court takes judicial notice of the
pending Senate Bill No. 337, entitled “An Act Prohibiting the
Detention of Patients in Hospitals and Medical Clinics on
Grounds of Nonpayment of Hospital Bills or Medical
Expenses,” which declares, among others, that it shall be
unlawful for any hospital or medical clinic to cause directly or
indirectly the detention of patients for nonpayment, in part or in
full, of their hospital bills,144 and, furthermore, requires patients
who have fully recovered and are financially incapable

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142 The dispositive portion of Ty v. People states:

WHEREFORE, the instant Petition is DENIED and the assailed
Decision of the Court of Appeals, dated 31 July 2001, finding petitioner
Vicky C. Ty GUILTY of violating Batas Pambansa Bilang 22 is
affirmed with MODIFICATIONS. Petitioner Vicky C. Ty is ORDERED
to pay a FINE equivalent to double the amount of each dishonored
check subject of the seven cases at bar with subsidiary imprisonment in
case of insolvency in accordance with Article 39 of the Revised Penal
Code. She is also ordered to pay private complainant, Manila Doctors’
Hospital, the amount of Two Hundred Ten Thousand Pesos (210,000.00)
representing the total amount of the dishonored checks. Costs against
the petitioner.
SO ORDERED.
(emphasis supplied).
143 THE CIVIL CODE OF THE PHILIPPINES, Republic Act No. 386, as
amended, Art. 2208 (1950) (“In all cases, the attorney’s fees and expenses of
litigation must be reasonable.”). See, e.g., Pacific Mills, Inc. v. Court of
Appeals, G.R. No. 87182, February 17, 1992, 206 SCRA 317.
144 Section 1 of the draft bill.

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to settle the hospitalization expenses to execute a promissory
note, co-signed by another individual, to the extent of the
unpaid obligation before leaving the hospital.145 While this
Court may have touched upon these matters in the adjudication
of the instant case, it must be stated that this decision should in
no way preempt any constitutional challenge to the provisions
of Senate Bill No. 337 if passed into law, bearing in mind the
standards for the exercise of the power of judicial review146 as
well as the recognition that the tenor of the bill may adjust with
the times, or that the bill itself may fail to pass, according to the
dynamism of the legislative process, especially in light of the
objections interposed by interest groups to date.147
WHEREFORE, the petition is GRANTED. The Decision of
the Court of Appeals dated October 2, 2001, together with the
Decision dated September 30, 1997 of the Regional Trial Court
in Civil Case No. 63958, is REVERSED and SET

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145 Section 2 of the draft bill.

146 Where questions of constitutional significance are raised, the Court can
exercise its power of judicial review only if the following requisites are
complied: First, there must be before the Court an actual case calling for the
exercise of judicial review. Second, the question before the Court must be ripe
for adjudication. Third, the person challenging the validity of the act must have
standing to challenge. Fourth, the question of constitutionality must have been
raised at the earliest opportunity and lastly, the issue of constitutionality must be
the very lis mota of the case. Allied Banking Corporation v. Quezon City
Government, G.R. No. 154126, October 11, 2005, 472 SCRA 303, 317; Board
of Optometry v. Colet, 328 Phil. 1187, 1205; 260 SCRA 88, 103 (1996); Garcia
v. Executive Secretary, G.R. No. 100883, December 2, 1991, 204 SCRA 516,
522; Santos III v. Northwest Orient Airlines, G.R. No. 101538, June 23, 1992,
210 SCRA 256, 261.
147  See Position Paper dated September 22, 2004, submitted by the
Philippine Medical Association for the presentation in the public hearing for the
Committee of Health and Demography, Senate, Republic of the Philippines.
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