consolidated cases.docx

7/26/2019 Consolidated Cases.docx

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1The Mandatory Four Elements in Medical Malpractice Law

There are essentially four elements that must be proven in a

medical malpractice personal injury case:

1. Duty

2. Breach of Duty

3. Damage

4. Cause

1. Duty A duty must have been owed to a patient by a

healthcare practitioner charged with that patients care.

The doctor-patient relationship is a common example of a

situation where that duty would exist.

2. Breach of Duty The healthcare practitioner who had the

duty of care for that patient must have failed in his/her

duty by not exercising the degree of care or medical skill

that another healthcare professional in the same

specialty would have used in an equal situation. (This is

when an expert is often called in to testify as to what an

appropriate standard of care would be.)

3. Damage The patient must have suffered emotional or

physical injury while in the care of the healthcare

practitioner. The injury can be a new one, or an

aggravation of an existing injury.

4. Cause There must be solid proof that the breach ofduty by the healthcare practitioner caused the patients

injury.

G.R. Nos. 78813-14 November 8, 1993

PEOPLE OF THE PHILIPPINES vs. FARHAD HATANI

QUIASON,J.:

FACTS:

Farhad Hatani has not satisfactorily passed the

corresponding Board Examination, neither is he a holder

of a valid Certificate of Registration duly issued by the

Board of Medical Examiners, as in fact he does not even

appear to have taken or completed the course leading to

a medical degree.

On July 6, 1979, Agustina Borja visited, Maura

Fontreras, hercomadreand requestedmalunggayleaves

as medication for her 16-year old daughter, Precila, who

had high fever and loose bowel movement. Upon learning

that Precila was sick, Marita, Maura's daughter,

introduced Agustina to her husband, Farhad, whom she

said was a medical doctor. Marita suggested that her

husband treat Precila and Agustina agreed.

Farhad and Marita went to the Borja residence, where he

examined Precila. He gave her tablets to take and

administered two injections (to her), one in the morning

and the second at noon. After each injection, Precila

would feel dizzy and fall asleep.

Farhads diagnosis: Precila was a drug addict and

required further observation and treatment. He offered to

attend to Precila at his house and again, Agustina agreed

in the belief that her daughter was a drug addict.

Precila was fetched by spouses Farhad and Marita and

was brought to their house. Again, Precila was given an

injection which caused her to sleep. When she awoke

she realized that she was naked and her entire body was

in pain.

Farhad was seated on the bed and was fondling her

private parts. Shocked, Precila called for her mother and

tried to get up. Farhad, however, punched her on the

chest and forced her to lie down. He pressed a pillow on

her face and injected her again, causing her to fal

asleep.

When Precila awoke the second time, she found

appellant in bed with her. He was naked and fondling her

private parts. The pain all over her body lingered. WhenPrecila touched her private parts, she saw blood stains

on her hand. She tried to stand up but she was too

weak. Farhad gave her another injection rendering her

unconscious.

The following morning, Agustina found Precila and

Farhad both asleep and naked. She hurriedly dressed up

Precila and brought her home.

That evening, Precila's oldest sister, Josefina, a nurse by

profession, came home and saw Precila looking very

weak. Her mother, who was crying narrated what shehad witnessed that morning. She also told Josefina that

Farhad was in the other bedroom, treating another sister

Wilma whom he also diagnosed as a drug addict

Josefina immediately proceeded to the bedroom and saw

appellant about to inject Wilma.

Josefina saw the open bag of appellant, which contained

empty capsules of dalmane and empty vials of valium

She inquired on the need of the injection and appellan

replied that a second shot of plain distilled water was

required to cure Wilma of her drug addiction. Josefina

told appellant to stop but he persisted. Only upon threatthat she would call the police did appellant stop. Farhad

and his wife then left the Borja residence.

Borjas filed a case and a search warrant was secured

and later on assorted drugs, such as dalmane, valium

and mogadon, as well as prescription pads in the

name of Dr. Jesus Yap (but with handwriting o

Farhad) and other medical instruments, such as a

"thermometer, a "hygomonometer, stethoscope

syringes and needles, were seized.
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1The trial court rendered two separate decisions for the

separate informations for rape and violation of R.A. No.

2382 The Medical act of 1959 and convicted the Farhad

of both crimes. The Professional Regulation Commission

certified that Farhad is not among the list of

registered physicians nor among those with special

permit to practice medicine in a limited scope.

Issue: Whether or not Farhad is guilty of Medical Act of 1959 for

illegal practice of Medicine?

SC Ruling.

Yes.

With respect to his conviction of illegal practice ofmedicine, appellant presented inconsistent claims. On

one hand, he claims that the drugs and other

paraphernalia were planted by the raiding team; while on

the other hand, he claims that these were seized without

any warrant.

If indeed the evidence were all planted, how can

appellant explain his handwriting on the prescription

pads in the name of Dr. Jesus Yap? A perusal of the

photographs showing accused during the raid, fails to

indicate any protestation by him.

The evidence is overwhelming that appellant actually

treated and diagnosed Precila and Wilma Borja reports

and prove that he was engaged in the practice of

medicine like:

1. The positive testimony of Agustina, Precila, Wilma

and Josefina Borja;

2. The medico-legal reports which attest to the needle

marks;

3. The Handwriting Identification Report inprescription pad of Dr. Jesus Yap

4. The photographs showing assorted drugs and

medical equipment in appellant's room; and the

chemistry.

And as to his allegation that there was no proof of

payment, the law specifically punishes said act

whether or not done for a fee.

G.R. No. 72964 January 7, 1988

FILOMENO URBANO vs. IAC

GUTIERREZ,JR.,J.:

FACTS:

October 23, 1980, Filomeno Urbano went to his ricefield

at Barangay Anonang, San Fabian, Pangasinan located

at about 100 meters from the tobacco seedbed of Marcelo

Javier.

He found his palay flooded with water coming from the

irrigation canal nearby which had overflowed. Urbano

went to the elevated portion of the canal to see wha

happened and there he saw Marcelo Javier and Emilio

Erfe cutting grass. He asked them who was responsiblefor the opening of the irrigation canal and Javie

admitted that he was the one.

A quarrel between them ensued. Urbano unsheathed his

bolo (about 2 feet long, including the handle, by 2 inches

wide) and hacked Javier hitting him on the right palm o

his hand, which was used in parrying the bolo hack.

Javier who was then unarmed ran away from Urbano but

was overtaken by Urbano who hacked him again hitting

Javier on the left leg with the back portion of said bolo

causing a swelling on said leg.

Javier was brought to Dr. Guillermo Padilla, rural health

physician of San Fabian, who did not attend to Javier bu

instead suggested that they go to Dr. Mario Meneses

because Padilla had no available medicine. was treated

by Dr. Meneses, he and his companions returned to Dr

Guillermo Padilla who conducted a medico-lega

examination. Dr. Padilla issued a medico-legal certificate

that certified the wounds of Javier to be:

1 -Incised wound 2 inches in length at the

upper portion of the lesser palmar prominence

right. As to my observation the incapacitation is

from(7-9) days period.

Urbano and Javier agreed to settle their differences

Urbano promised to pay P700.00 for the medica

expenses of Javier.

At about 1:30 a.m. on November 14, 1980 (after 3

weeks), Javier was rushed to the Nazareth Genera

Hospital in avery serious condition. When admitted to

the hospital, Javier had lockjaw and was having


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1convulsions. Dr. Edmundo Exconde who personally

attended to Javier found that the latter's serious

condition was caused bytetanus toxin.He noticed the

presence of a healing wound in Javier's palm which could

have been infected by tetanus.

On November 15, 1980 at exactly 4:18 p.m., Javier died

in the hospital.

In an information dated April 10, 1981, Filomeno Urbano

was charged with the crime of homicide before the then

Circuit Criminal Court of Dagupan City, Third Judicial

District.

Trial Court: Urbano is guilty

Appellate court: affirmed the verdict

MR on Appellate court: Motion for New trial because of

the affidavit of Barangay Captain Menardo Soliven that

he saw while I was conducting survey on November 5,

1980, Marcelo Javier catching fish in the shallow

irrigation canals with some companions; BUT MR

DENIED.

Hence, the petition

Issue:

Whether or not there was an efficient intervening cause fromthe time Javier was wounded until his death which would

acquit Urbano from any liability for Javier's death?

SC Ruling:

Yes, there was an efficient intervening cause thus, Urbano is

acquitted.

The case involves the application of Article 4 of the

Revised Penal Code which provides that "Criminalliability shall be incurred: (1) By any person committing

a felony (delito) although the wrongful act done be

different from that which he intended ..." Pursuant to

this provision "an accused is criminally responsible for

acts committed by him in violation of lawand for all the

natural and logical consequences resulting

therefrom."

Petitioner Contention: The proximate cause of the

death of Marcelo Javier was due tohis own negligence,

that Dr. Mario Meneses found no tetanus in the injury

and that Javier got infected with tetanus when after two

weeks he returned to his farm and tended his tobacco

plants with his bare hands exposing the wound to

harmful elements like tetanus germs.

Trial court and Appellate court contention:Deceased

did not die right away from his wound, but the cause o

his death was due to said wound which was inflicted by

the appellant. Said wound which was in the process o

healing got infected with tetanus which ultimately

caused his death.The proximate cause of the victim's

death was the wound which got infected with

tetanus. And the settled rule in this jurisdiction is that

an accused is liable for all the consequences of his

unlawful act.

Proximate cause definitions cited in the case:

1. "that cause, which, in natural and continuous

sequence, unbroken by any efficient intervening

cause, produces the injury, and without which the

result would not have occurred."

2. "the proximate legal cause is that acting first and

producing the injury, either immediately or by setting

other events in motion, all constituting a natural and

continuous chain of events, each having a close

causal connection with its immediate predecessor, the

final event in the chain immediately effecting the

injury as a natural and probable result of the cause

which first acted, under such circumstances that the

person responsible for the first event should, as an

ordinarily prudent and intelligent person, have

reasonable ground to expect at the moment of his ac

or default that an injury to some person might

probably result therefrom."

The incubation period of tetanus, i.e., the time between

injury and the appearance of unmistakable symptoms

ranges from 2 to 56 days.However, over 80 percent o

patients become symptomatic within 14 days. A shor

incubation period indicates severe disease, and when

symptoms occur within 2 or 3 days of injury the

mortality rate approaches 100 percent.

Mild tetanus is characterized by an incubation period of a

least 14 days and an onset time of more than 6 days.The

criteria for severe tetanus include a short incubation

time, and an onset time of 72 hrs., or less, severe

trismus, dysphagia and rigidity and frequent prolonged

generalized convulsive spasms. Therefore, medically

speaking, the reaction to tetanus found inside a man's

body depends on the incubation period of the disease.


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1The more credible conclusion is that at the time

Javier's wound was inflicted by the appellant, the

severe form of tetanus that killed him was not yet

present. Consequently, Javier's wound could have

been infected with tetanus after the hacking

incident. Considering the circumstance surrounding

Javier's death, his wound could have been infected by

tetanus 2 or 3 or a few but not 20 to 22 days beforehe died.

The medical findings, however, lead us to a distinct

possibility that the infection of the wound by tetanus was

an efficient intervening cause later or between the time

Javier was wounded to the time of his death.The

infection was, therefore, distinct and foreign to the

crime.

Remote cause vs. Proximate cause. Doubts are present.

There is a likelihood that the wound was but theremote

cause and its subsequent infection, for failure to takenecessary precautions, with tetanus may have been the

proximatecause of Javier's death with which the

petitioner had nothing to do

"A prior and remote cause cannot be made to be

of an action if such remote cause did nothing

more than furnish the condition or give rise to

the occasion by which the injury was made

possible, if there intervened between such prior

or remote cause and the injury a distinct,

successive, unrelated, and efficient cause of the

injury, even though such injury would not havehappened but for such condition or occasion. If

no danger existed in the condition except

because of the independent cause, such

condition was not the proximate cause. And if

an independent negligent act or defective

condition sets into operation the instances

which result in injury because of the prior

defective condition, such subsequent act or

condition is the proximate cause."

Criminal and civil Liability. The two liabilities are

separate and distinct from each other. One affects the

social order and the other, private rights. One is for the

punishment or correction of the offender while the other

is for reparation of damages suffered by the aggrieved

party.

It is just and proper that, for the purposes of the

imprisonment of or fine upon the accused, the offense

should be proved beyond reasonable doubt. But for the

purpose of indemnity the complaining party, why should

the offense also be proved beyond reasonable doubt? Is

not the invasion or violation of every private right to be

proved only by a preponderance of evidence? Is the righ

of the aggrieved person any less private because the

wrongful act is also punishable by the criminal law?

[G.R. No. 65295. March 10, 1987.]Phoenix Construction and Carbonel vs IAC and Dionisio

PONENTE: Justice Feliciano

FACTS:

1. In the early morning of 15 November 1975 at about

1:30 a.m. private respondent Leonardo Dionisio was

on his way home from a cocktails-and-dinner meeting

with his boss, the general manager of a marketing

corporation. During the cocktails phase of the evening

Dionisio had taken "a shot or two" of liquor.

2. Dionisio was driving his Volkswagen car and had just

crossed the intersection of General Lacuna and Genera

Santos Streets at Bangkal, Makati, not far from hishome, and was proceeding down General Lacuna Street

when his car headlights suddenly failed. He switched his

headlights on "bright" and thereupon he saw a Ford

dump truck looming some 2-1/2 meters away from his

car.

3. The dump truck, owned by and registered in the name o

petitioner Phoenix Construction Inc. ("Phoenix"), was

parked on the right hand side of General Lacuna Stree

(i.e., on the right hand side of a person facing in the

same direction toward which Dionisio's car was

proceeding), facing the oncoming traffic. The dump truck

was parked askew (not parallel to the street curb) in such

a manner as to stick out onto the street, partly blockingthe way of oncoming traffic. There were no lights nor any

so-called "early warning" reflector devices set anywhere

near the dump truck, front or rear.

4. The dump truck had earlier that evening been driven

home by petitioner Armando U. Carbonel, its regular

driver, with the permission of his employer Phoenix, in

view of work scheduled to be carried out early the

following morning. Dionisio claimed that he tried to avoid

a collision by swerving his car to the left but it was too

late and his car smashed into the dump truck. As a

result of the collision, Dionisio suffered some physica

injuries including some permanent facial scars, a

"nervous breakdown" and loss of two gold bridge

dentures.

5. Dionisio commenced an action for damages in the Cour

of First Instance of Pampanga basically claiming that the

legal and proximate cause of his injuries was the

negligent manner in which Carbonel had parked the

dump truck entrusted to him by his employer Phoenix

Phoenix and Carbonel, on the other hand, countered

that the proximate cause of Dionisio's injuries was his

own recklessness in driving fast at the time of the

accident, while under the influence of liquor, without his

headlights on and without a curfew pass. Phoenix also


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1sought to establish that it had exercised due care in the

selection and supervision of the dump truck driver.

ISSUE:

Whether or not Urbano, driver of Phoenix Corporation

negligence was merely a passive and static condition and

that Dionisio was the efficient intervening cause and regarded

as the legal and proximate cause of the accident.

RULING:

1. The SC agree with the Court of First Instance and the

Intermediate Appellate Court that the legal and

proximate cause of the accident and of Dionisio's injuries

was the wrongful or negligent manner in which the dump

truck was parked.

2. The collision of Dionisio's car with the dump truck was a

natural and foreseeable consequence of the truck driver's

negligence.The truck driver's negligence far from being a

"passive and static condition" was rather an

indispensable and efficient cause. The collision between

the dump truck and the private respondent's car would

in all probability not have occurred had the dump trucknot been parked askew without any warning lights or

reflector devices.

3. The improper parking of the dump truck created an

unreasonable risk of injury for anyone driving down

General Lacuna Street and for having so created this

risk, the truck driver must be held responsible. In our

view, Dionisio's negligence, although later in point of

time than the truck driver's negligence and therefore

closer to the accident, was not an efficient intervening or

independent cause. What the petitioners describe as an

"intervening cause" was no more than a foreseeable

consequence of the risk created by the negligent manner

in which the truck driver had parked the dump truck.

4. In other words, the petitioner truck driver owed a duty to

private respondent Dionisio and others similarly situated

not to impose upon them the very risk the truck driver

had created. Dionisio's negligence was not of an

independent and overpowering nature as to cut, as it

were, the chain of causation in fact between the improper

parking of the dump truck and the accident, nor to sever

the juris vinculum of liability.

928 P.2d 1202, 1996 Alaska

David LYONS, individually and as the personal representativeof the Estate of Esther Jane Hunter-Lyons, and as father and

legal guardian of Benjamin Murphy Lyons, Joshua Caleb

Lyons,

MacAaron Hunter-Lyons, Robert Jack Hunter-Lyons, and

Duley

Everett Lyons, Appellants,

v.

MIDNIGHT SUN TRANSPORTATION SERVICES, INC., Appellee.

FACTS:

Hunter-Lyons was killed when her Volkswagen van was struck

broadside by a truck driven by David Jette (Jette) and owned by

Defendant. When the accident occurred, Jette was driving south

in the right-hand lane of a thoroughfare in Anchorage, Alaska

Hunter-Lyons pulled out of a parking lot in front of him. Jette

braked and steered to the left, but Hunter-Lyons continued to pul

out further into the traffic lane. Jettes truck collided with Hunter

Lyonss vehicle. David Lyons, the deceaseds husband, (Plaintiff

filed suit, asserting that Jette had been speeding and driving

negligently.

ISSUE:Whether or not the jury instruction concerning the sudden

emergency doctrine is improper?

RULING:

The court affirmed the trial courts decision that Jette was not a

fault in the accident, but that the primary cause was the decedent

pulling out in front of Jette. The use of the sudden emergency

instruction was harmless error. The sudden emergency doctrine

which arises in Lyons, has at times caused confusion with respect

to the degree of care a party may owe another. The idea is, if a

person, through no fault of his or her own, is faced with a sudden

emergency, they are not to be held to the same correctness o

judgment and action as if he had time and opportunity to fully

consider the situation. The individual is, however, expected to

exercise that care which a reasonably prudent person would have

exercised under the same or similar circumstances. As the cour

explains, The sudden emergency doctrine arose as a method o

ameliorating the, sometimes harsh, all or nothing rule in

contributory negligence systems. The American Law Institute

articulates the doctrine: In determining whether conduct is

negligent toward another, the fact that the actor is confronted with

a sudden emergency which requires rapid decision is a factor in

determining the reasonable character of his choice of action. The

modern trend, as is reflected in Lyons, is to move away from

instructing juries on the sudden emergency doctrine because

rather than explaining to the jury that emergency circumstances

are a factor in determining the reasonableness of the defendants

actions, the instruction has a tendency to elevate its principles

above what is required to be proven in a negligence action.

Perkins v. Texas

Facts.The Plaintiffs husband was killed in a collision between

the car he was a passenger in and a freight train operated by the

Defendant, New Orleans Railroad Co. At the intersection of the

road and rail crossing where the accident occurred, a large

warehouse obstructed the view of both the cars driver and the

trains engineer and brakeman. The trains engineer andbrakeman were aware of the obstruction and while approaching

the intersection rang the trains bell and whistle and put its

headlights on. The intersection also had warning signals to warn

drivers of approaching trains. These signals were operating at the

time of the accident. Of the three railway employees in the forward

engine of the train only two, the brakeman and a fireman saw the

car emerge from the intersection. The third, the engineer did not

see the car due to the obstructed view, but applied the emergency

brakes when his companions alerted him to the presence of the

car. At the time of the accident the trainwas between 30 to 60 fee

from the car. Both parties have conceded that the driver of the

car, who was also killed, was negligent in driving upon the train

track with the signal lights on. The parties have also conceded


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1that the train was traveling at 37 miles per hour when the self-

imposed speed limit for the intersection was 25 miles per hour.

Issue.Whether the negligence of the Defendant was a substantial

factor in causing the accident.

Discussion.By traveling twelve miles over the self-imposed speed

limit, the engineer was negligent. The engineer testified that even

at a rate of 25 mph, the train could not have avoided the car.

Based on this testimony, the court finds that the speed of thetrain was not a substantial factor in the crash. Because the

accident would have occurred even if the train had been traveling

within the speed limit, the negligence of the trains operator is not

a substantial factor in the collision.

Sps. Santos v Pizardo

Facts:

Dionisio M. Sibayan was charged with reckless imprudence

resulting to multiple homicide and multiple physical injuries due

to the vehicle collision between Viron Transit bus driven by

Sibayan and a Lite Van Ace. However the municipal circuit trial

court was no pronouncement of civil liability. The petitioners filed

a complaint for damages to the respondents pursuant to theirreservation to file a separate civil action citing Sibayans judgment

conviction. And it was moved to dismiss by the Viron Transit. The

petitioners opposed and contends that the motion to dismiss that

be ten (10) years from the judgment of criminal action is the

prescription and therefore it is within the period since it was just

barely two (2)years had elapse. The complaint was dismissed by

the trial court due to the ground that the cause of action had

prescribed; based on quasi-delict that it prescribes four (4) years

from the accrual of the cause of action. Again the petitioners filed

a reconsideration that the complaint is not based on quasi- delict

but on the final judgment of conviction in the criminal case which

prescribes ten(10) years upon the finality of the judgment. The

motion for reconsideration of the petitioners was denied by the

trial court based on quasi-delict in Article 1146 of the Civil Codethat the complaint was filed more than four (4) years after the

vehicular activities therefore it prescribes already. On the petition

for certiorari the petitioners filed to the Court of Appeals it was

dismissed the same error in the choice or mode of appeal. It also

denies the petitioners motion for and the petitioners failed to

allege that the petition was brought within the recognized

exceptions for the allowance of certiorari in lieu of appeal.

Petitioners insist that it should been forced in the complaint that

arose in ex delicto and not based on quasi-delict. Since the action

is based on the criminal liability of private respondents, the cause

of action accrued from the finality of the judgment of conviction.

Private respondents insisted, pointing out the averments in the

complaint make out a cause of action for quasi delict in Article

2176 and 2180of the Civil Code. The prescriptive period of four (4)

years should be reckoned from the time the accident took place.

Viron transit also alleges that its subsidiary liability cannot be

enforced since Sibayan was not ordered to pay damages in the

criminal case, in sitting Art. 103 of Revised Penal Code the civil

aspect of the case were instituted in the criminal case and no

reservation to file a separate civil case was made. Respondents

likewise allege that the petitioners should have appealed the

adverse order of the trial court. Petitioners filed a reply and the

private respondents also filled a rejoinder both in reiteration of

their arguments. Hence this petition.

Issues:

Whether or not the dismissal of the action was based on culpa

aquiliana is a bar to the enforcement of the subsidiary liability of

the employer?

Held:

The dismissal of the action based on culpa aquiliana is not a bar

to the subsidiary liability of the employer. Because the Article 103

of the R.P.C. operates with controlling force to obviate the

possibility of the aggrieved party being deprived of indemnity even

after the rendition of a final judgment convicting the employeeThe trial court should not have dismissed the complaint on the

ground of prescription, but instead allowed the complaint for

damages ex delicto to be prosecuted on the merits, this does not

offend the policy that the reservation or institution of a separate

civil waives the other civil actions but this is merely an avoidance

of multiple suits. The action for damages based on quasi- delict

should be considered waived no occasion for petitioners to file

multiple suits against private respondents as available to them is

to pursue damages ex delicto.

PRESCRIPTION

THIRD DIVISION

[G.R. No. 145391. August 26, 2002.]AVELINO CASUPANAN and ROBERTO CAPITULO, petitioners

vs. MARIO LLAVORE LAROYA, respondent.

[G.R. No. 145391. August 26, 2002.]

FACTS:

As a result of a vehicular accident between two vehicles, one

driven by Mario Llavore Laroya and the other owned by Roberto

Capitulo and driven by Avelino Casupanan, two cases were filed

before the Municipal Circuit Trial Court (MCTC) of Capas, Tarlac

Laroya filed a criminal case against Casupanan for reckless

imprudence resulting in damage to property. This case was on its

preliminary investigation stage when Casupanan and Capitulo

filed a civil case against Laroya for quasi-delict. However, upon

motion of Laroya on the ground of forum-shopping, the MCTCdismissed the civil case. Casupanan and Capitulo then filed a

petition for certiorari before the Regional Trial Court (RTC) o

Capas, Tarlac. But the RTC ruled that the order of dismissa

issued by the MCTC is a final order which disposes of the case

and therefore, the proper remedy should have been an appeal

Hence, Casupanan and Capitulo filed this petition.

ISSUE:

Whether an accused in a pending criminal case for reckless

imprudence can validly file, simultaneously and independently, a

separate civil action for quasi-delict against the private

complainant in the criminal case.

HELD:The Court held that the MCTC dismissed the civil action for quasi

delict on the ground of forum-shopping did not state in its order of

dismissal that the dismissal was with prejudice. Under the

Administrative Circular, the order of dismissal is without prejudice

to refiling the complaint, unless the order of dismissal expressly

states that it is with prejudice. Thus, the MCTC's dismissal, being

silent on the matter, is a dismissal without prejudice. Section 1 of

Rule 41 provides that an order dismissing an action withou

prejudice is not appealable.The remedy of the aggrieved party

is to file a special civil action under Rule 65.Clearly, the Capas

RTC's order dismissing the petition for certiorari on the ground

that the proper remedy is an ordinary appeal,is erroneous. (Mal


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1ang trial court kasi without prejudice ang dismissal so tama ang

Special civil action for certiorari . mali DIN and MTC sa

pagdismiss dahil sa forum shopping kasi magkaiba yung cause of

action kasi ex delicto yung sa criminal action, yun yung civil

action deemed instituted upon institution of criminal action,

taposaction based on culpa aquiliana yung sa civil action (quasi

delict) so magkaiba talaga. It can be filed independent of the

criminal action kasi di naman siya pwede magcounterclaim sa

civil aspect ng criminal action tapos pwede nya pa din ifile ang

civil action kasi preliminary investigation pa lang di panakakapagpresent ng evidence ang prosecution so pwede pa

siyang either mag waive or mag reserve ng filing ng independent

civil action.

The prescriptive period on the civil actions based on these

articles of the Civil Code continues to run even with the filing

of the criminal action. Verily, the civil actions based on these

articles of the Civil Code are separate, distinct and

independent of the civil action "deemed instituted" in the

criminal action.

[T]here is no forum-shopping in the instant case because the law

and the rules expressly allow the filing of a separate civil action

which can proceed independently of the criminal action.

Further, the accused can file a civil action for quasi-delict for the

same act or omission he is accused of in the criminal case. This isexpressly allowed in paragraph 6, Section 1 of the present Rule

111 which states that the counterclaim of the accused "may be

litigated in a separate civil action." Thus, the civil action based on

quasi-delict filed separately by Casupanan and Capitulo is proper.

The order of dismissal by the MCTC of the civil case on the ground

of forum shopping is erroneous.

WHEREFORE, the petition for review on certiorari is

hereby

GRANTED.The Resolutions dated December 28, 1999

and August 24, 2000 in Special Civil Action No. 17-C (99) are

ANNULLEDand Civil Case No. 2089 isREINSTATED

SYLLABUS(inawan ko ang syllabus)1. REMEDIAL LAW; CIVIL PROCEDURE; ORDER OF

DISMISSAL; ABSENT A DECLARATION THAT THE DISMISSAL IS

WITH PREJUDICE, THE SAME IS DEEMED WITHOUT

PREJUDICE. The MCTC dismissed the civil action for quasi-

delict on the ground of forum-shopping under Supreme Court

Administrative Circular No. 04-94. The MCTC did not state in its

order of dismissal that the dismissal was with prejudice. Under

the Administrative Circular, the order of dismissal is without

prejudice to refiling the complaint, unless the order of dismissal

expressly states it is with prejudice. Absent a declaration that the

dismissal is with prejudice, the same is deemed without prejudice.

Thus, the MCTC's dismissal, being silent on the matter, is a

dismissal without prejudice. HAEDCT

2. ID.; ID.; ID.; DISMISSAL WITHOUT PREJUDICE IS NOTAPPEALABLE. Section 1 of Rule 41 provides that an order

dismissing an action without prejudice is not appealable. The

remedy of the aggrieved party is to file a special civil action under

Rule 65. Section 1 of Rule 41 expressly states that "where the

judgment or final order is not appealable, the aggrieved party may

file an appropriate special civil action under Rule 65." Clearly, the

Capas RTC's order dismissing the petition for certiorari, on the

ground that the proper remedy is an ordinary appeal, is

erroneous.

3. ID.; ID.; FORUM-SHOPPING; ELUCIDATED. The

essence of forum-shopping is the filing of multiple suits involving

the same parties for the same cause of action, either

simultaneously or successively, to secure a favorable judgment.

Forum-shopping is present when in the two or more cases

pending, there is identity of parties, rights of action and reliefs

sought. HIaTDS

4. ID.; ID.; ID.; NOT APPLICABLE IN CASE AT BAR.

[T]here is no forum-shopping in the instant case because the law

and the rules expressly allow the filing of a separate civil action

which can proceed independently of the criminal action. Laroya

filed the criminal case for reckless imprudence resulting in

damage to property based on the Revised Penal Code while

Casupanan and Capitulo filed the civil action for damages basedon Article 2176 of the Civil Code. Although these two actions

arose from the same act or omission, they have different causes o

action. The criminal case is based on culpa criminal punishable

under the Revised Penal Code while the civil case is based on

culpa aquiliana actionable under Articles 2176 and 2177 of the

Civil Code.

5. ID.; 2000 RULES ON CRIMINAL PROCEDURE

PROSECUTION OF CIVIL ACTION; PRIVATE COMPLAINANT OR

THE ACCUSED CAN FILE A SEPARATE CIVIL ACTION. Any

aggrieved person can invoke [Articles 2176 and 2177 of the Civi

Code] provided he proves, by preponderance of evidence, that he

has suffered damage because of the fault or negligence of another

Either the private complainant or the accused can file a separate

civil action under these articles. There is nothing in the law or

rules that state only the private complainant in a criminal case

may invoke these articles. ESITcH

6. ID.; ID.; ID.; REQUIRES THE ACCUSED TO LITIGATE

HIS COUNTERCLAIM, CROSS-CLAIM OR THIRD-PARTY

COMPLAINT IN A SEPARATE CIVIL ACTION. [P]aragraph 6

Section 1, Rule 111 of the 2000 Rules on Criminal Procedure

("2000 Rules" for brevity) expressly requires the accused to litigate

his counterclaim in a separate civil action, to wit: "SECTION 1

Institution of criminal and civil actions. (a) . . . . No

counterclaim, cross-claim or third-party complaint may be filed by

the accused in the criminal case, but any cause of action which

could have been the subject thereof may be litigated in a separate

civil action." Since the present Rules require the accused in a

criminal action to file his counterclaim in a separate civil action

there can be no forum-shopping if the accused files such separatecivil action. SaCIAE

7. ID.; ID.; ID.; CIVIL ACTION ARISING FROM THE CRIME

THE ONLY CIVIL ACTION DEEMED INSTITUTED WITH THE

CRIMINAL ACTION. Under Section 1 of the present Rule 111

what is "deemed instituted" with the criminal action is only the

action to recover civil liability arising from the crime or ex-delicto

All the other civil actions under Articles 32, 33, 34 and 2176 o

the Civil Code are no longer "deemed instituted," and may be filed

separately and prosecuted independently even without any

reservation in the criminal action. The failure to make a

reservation in the criminal action is not a waiver of the right to file

a separate and independent civil action based on these articles of

the Civil Code. The prescriptive period on the civil actions based

on these articles of the Civil Code continues to run even with thefiling of the criminal action. Verily, the civil actions based on these

articles of the Civil Code are separate, distinct and independent of

the civil action "deemed instituted" in the criminal action.

8. ID.; ID.; ID.; ID.; MAY BE FILED SEPARATELY BY

RESERVING SUCH RIGHT IN THE CRIMINAL ACTION OR IF

SEPARATELY FILED, MAY BE CONSOLIDATED WITH THE

CRIMINAL ACTION. Under the present Rule 111, the offended

party is still given the option to file a separate civil action to

recover civil liability ex-delicto by reserving such right in the

criminal action before the prosecution presents its evidence. Also

the offended party is deemed to make such reservation if he files a

separate civil action before filing the criminal action. If the civi


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1action to recover civil liability ex-delicto is filed separately but its

trial has not yet commenced, the civil action may be consolidated

with the criminal action. The consolidation under this Rule does

not apply to separate civil actions arising from the same act or

omission filed under Articles 32, 33, 34 and 2176 of the Civil

Code. TaHIDS

9. ID.; ID.; ID.; ID.; IF IT IS RESERVED, IT COULD NOT BE

FILED UNTIL AFTER FINAL JUDGMENT OF THE CRIMINAL

ACTION OR IF SEPARATELY FILED, IT IS SUSPENDED UPON

THE FILING OF THE CRIMINAL ACTION. Under Section 2, Rule111 of the amended 1985 Rules, a separate civil action, if reserved

in the criminal action, could not be filed until after final judgment

was rendered in the criminal action. If the separate civil action

was filed before the commencement of the criminal action, the

civil action, if still pending, was suspended upon the filing of the

criminal action until final judgment was rendered in the criminal

action. This rule applied only to the separate civil action filed to

recover liability ex-delicto. The rule did not apply to independent

civil actions based on Articles 32, 33, 34 and 2176 of the Civil

Code, which could proceed independently regardless of the filing

of the criminal action. . . . Thus, Section 2, Rule 111 of the

present Rules did not change the rule that the separate civil

action, filed to recover damages ex-delicto, is suspended upon the

filing of the criminal action. Section 2 of the present Rule 111 also

prohibits the filing, after commencement of the criminal action, of

a separate civil action to recover damages ex-delicto. ISDHcT

10. ID.; ID.; ID.; INDEPENDENT CIVIL ACTION IN ARTICLES

32, 33, 34 AND 2176 OF THE CIVIL CODE MAY BE FILED

SEPARATELY BY THE OFFENDED PARTY EVEN WITHOUT

RESERVATION. Under Section I of the present Rule 111, the

independent civil action in Articles 32, 33, 34 and 2176 of the

Civil Code is not deemed instituted with the criminal action but

may be filed separately by the offended party even without

reservation. The commencement of the criminal action does not

suspend the prosecution of the independent civil action under

these articles of the Civil Code. The suspension in Section 2 of the

present Rule 111 refers only to the civil action arising from the

crime, if such civil action is reserved or filed before thecommencement of the criminal action.

11. ID.; ID.; ID.; OFFENDED PARTY CAN SEPARATELY FILE

A CRIMINAL CASE AND A CIVIL CASE FOR QUASI-DELICT,

WITHOUT VIOLATING THE RULE ON NON-FORUM SHOPPING.

[T]he offended party can file two separate suits for the same act or

omission. The first, a criminal case where the civil action to

recover civil liability ex-delicto is deemed instituted, and the other

a civil case for quasi-delict without violating the rule on non-

forum shopping. The two cases can proceed simultaneously and

independently of each other. The commencement or prosecution of

the criminal action will not suspend the civil action for quasi-

delict. The only limitation is that the offended party cannot

recover damages twice for the same act or omission of the

defendant. In most cases, the offended party will have no reasonto file a second civil action since he cannot recover damages twice

for the same act or omission of the accused. In some instances,

the accused may be insolvent, necessitating the filing of another

case against his employer or guardians. cDaEAS

12. ID.; ID.; ID.; ACCUSED CAN FILE A CIVIL ACTION FOR

QUASI-DELICT FOR THE SAME ACT OR OMISSION HE IS

ACCUSED OF IN THE CRIMINAL CASE. [T]he accused can file a

civil action for quasi-delict for the same act or omission he is

accused of in the criminal case. This is expressly allowed in

paragraph 6, Section 1 of the present Rule 111 which states that

the counterclaim of the accused "may be litigated in a separate

civil action." This is only fair for two reasons. First, the accused is

prohibited from setting up any counterclaim in the civil aspect

that is deemed instituted in the criminal case. The accused is

therefore forced to litigate separately his counterclaim against the

offended party. If the accused does not file a separate civil action

for quasi-delict, the prescriptive period may set in since the period

continues to run until the civil action for quasi-delict is filed

Second, the accused, who is presumed innocent, has a right to

invoke Article 2177 of the Civil Code, in the same way that the

offended party can avail of this remedy which is independent o

the criminal action. To disallow the accused from filing a separate

civil action for quasi-delict, while refusing to recognize hiscounterclaim in the criminal case, is to deny him due process of

law, access to the courts, and equal protection of the law

cTaDHS

13. ID.; ID.; ID.; INDEPENDENT CIVIL ACTION MAY

PROCEED INDEPENDENTLY OF THE CRIMINAL PROCEEDINGS

AND REGARDLESS OF THE RESULT OF THE LATTER. We

make this ruling aware of the possibility that the decision of the

trial court in the criminal case may vary with the decision of the

trial court in the independent civil action. This possibility has

always been recognized ever since the Civil Code introduced in

1950 the concept of an independent civil action under Articles 32

33, 34 and 2176 of the Code. But the law itself, in Article 31 o

the Code, expressly provides that the independent civil action

"may proceed independently of the criminal proceedings and

regardless of the result of the latter." In Azucena vs. Potenciano

the Court declared: ". . . . There can indeed be no other logica

conclusion than this, for to subordinate the civil action

contemplated in the said articles to the result of the crimina

prosecution whether it be conviction or acquittal would

render meaningless the independent character of the civil action

and the clear injunction in Article 31 that this action 'may

proceed independently of the criminal proceedings and regardless

of the result of the latter.'" More than half a century has passed

since the Civil Code introduced the concept of a civil action

separate and independent from the criminal action although

arising from the same act or omission. The Court, however, has

yet to encounter a case of conflicting and irreconcilable decisions

of trial courts, one hearing the criminal case and the other the

civil action for quasi-delict. The fear of conflicting andirreconcilable decisions may be more apparent than real. In any

event, there are sufficient remedies under the Rules of Court to

deal with such remote possibilities. ECDAcS

14. ID.; ID.; RETROACTIVE EFFECT; APPLICABLE IN CASE

AT BAR. The Revised Rules on Criminal Procedure took effect

on December 1, 2000 while the MCTC issued the order o

dismissal on December 28, 1999 or before the amendment of the

rules. The Revised Rules on Criminal Procedure must be given

retroactive effect considering the well-settled rule that ". .

statutes regulating the procedure of the court will be construed as

applicable to actions pending and undetermined at the time o

their passage. Procedural laws are retroactive in that sense and to

that extent."

(PRESCRIPTION)

[G.R. No. 133978. November 12, 2002.]

JOSE S. CANCIO, JR., represented by ROBERTO L. CANCIO

petitioner, vs. EMERENCIANA ISIP, respondent.

Federico S. Tolentino, Jr. for petitioner.

Norbin P. Dimalanta for respondent.

FACTS:

Petitioner filed three cases of violation of B.P. No. 22 and three

cases of estafa against respondent. All six criminal cases were

dismissed for various reasons. As to the three cases of estafa, it

was the prosecution that moved for its dismissal with reservation


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1as to its right to file a separate civil action arising from the said

criminal cases. Thereafter, the petitioner filed a case for collection

of sum of money, seeking to recover the amount of the checks

subject of the estafa cases.The court, however, dismissed the

case on the ground that the dismissal of the criminal cases

against the respondent on the ground of lack of interest or

failure to prosecute was an adjudication on the merits, which

amounted to res judicata on the civil case for collection. It further

held that the filing of the civil case amounted to forum-shopping.

The trial court denied the petitioner's motion for reconsideration,hence, this petition.

ISSUE:

Whether the dismissal of the estafa cases against respondent bars

the institution of a civil action for collection of the value of the

checks subject of the estafa cases and whether the filing of said

civil action violated the anti-forum-shopping rule.

HELD:

The Supreme Court held that from a reading of the complaint filed

by the petitioner,his cause of action was based on culpa

contractual, an independent civil action. Hence, an

independent civil action arising from contracts, as in the

instant case, may be filed separately and prosecuted

independently even without reservation in the criminal

action.As such, it was distinct and independent from the estafa

case filed against the offender and may proceed regardless of the

result of the criminal proceedings. In the same vain, the filing of

the collection case after the dismissal of the estafa cases against

respondent did not amount to forum-shopping because the law

expressly allows the filing of a separate civil action which can

proceed independently of the criminal action. The instant petition

was granted.

WHEREFORE, in view of all the foregoing, the instant petition is

GRANTED. The March 20, 1998 and June 1, 1998 Orders of the

Regional Trial Court of Pampanga, Branch 49, in Civil Case No. G-3272 areREVERSED and SET ASIDE. The instant case is

REMANDED to the trial court for further proceedings.

SYLLABUS

1. CIVIL LAW; QUASI-DELICTS; CIVIL LIABILITY;

INCURRED WHEN AN ACT OR OMISSION CAUSED DAMAGE TO

ANOTHER; EFFECT THEREOF. An act or omission causing

damage to another may give rise to two separate civil liabilities on

the part of the offender, i.e., (1) civil liability ex delicto, under 100

of the Revised Penal Code; and (2) independent civil liabilities,

such as those (a) not arising from an act or omission complained

of as felony [e.g. culpa contractual or obligations arising from law

under Article 31 of the Civil Code, intentional torts under Articles

32 and 34, and culpa aquiliana under Article 2176 of the CivilCode]; or (b) where the injured party is granted a right to file an

action independent and distinct from the criminal action [Article

33, Civil Code]. Either of these two possible liabilities may be

enforced against the offender subject, however, to the caveat

under Article 2177 of the Civil Code that the offended party

"cannot recover damages twice for the same act or omission" or

under both causes. cTACIa

2. REMEDIAL LAW; CRIMINAL PROCEDURE;

INDEPENDENT CIVIL ACTION; WHEN PROPER. Under the

1985 Rules on Criminal Procedure, as amended in 1988 and

under the present Rules, the civil liability ex-delicto is deemed

instituted with the criminal action, but the offended party is given

the option to file a separate civil action before the prosecution

starts to present evidence. Anent the independent civil actions

under Articles 31, 32, 33, 34 and 2176 of the Civil Code, the old

rules considered them impliedly instituted with the civil liability

ex-delicto in the criminal action, unless the offended party waives

the civil action, reserves his right to institute it separately, or

institutes the civil action prior to the criminal action. Under the

present Rules, however, the independent civil actions may be filed


reservation in the criminal action. The failure to make a

reservation in the criminal action is not a waiver of the right to filea separate and independent civil action based on these articles of

the Civil Code.

3. ID.; CIVIL PROCEDURE; ACTIONS; CAUSE OF ACTION

DETERMINED BY THE ALLEGATIONS IN THE COMPLAINT.

The nature of a cause of action is determined by the facts alleged

in the complaint as constituting the cause of action. The purpose

of an action or suit and the law to govern it is to be determined

not by the claim of the party filing the action, made in his

argument or brief, but rather by the complaint itself, its

allegations and prayer for relief. CSaHDT

4. ID.; CIVIL PROCEDURE; INDEPENDENT CIVIL

ACTIONS; WHEN ARISING FROM CONTRACTS; CIVIL ACTION

MAY PROCEED INDEPENDENTLY OF THE CRIMINAL

PROCEEDINGS; RATIONALE. To reiterate, an independent civi

action arising from contracts, as in the instant case, may be filed


reservation in the criminal action. Under Article 31 of the Civi

Code "[w]hen the civil action is based on an obligation not arising

from the act or omission complained of as a felony, [e.g. culpa

contractual] such civil action may proceed independently of the

criminal proceedings and regardless of the result of the latter.

Thus, in Vitola, et al. v. Insular Bank of Asia and America, the

Court, applying Article 31 of the Civil Code, held that a civil case

seeking to recover the value of the goods subject of a Letter o

Credit-Trust Receipt is a civil action ex contractu and not ex

delicto. As such, it is distinct and independent from the estafa

case filed against the offender and may proceed regardless of the

result of the criminal proceedings.

5. ID.; CIVIL PROCEDURE; ACTIONS; FORUM-SHOPPINGNOT PRESENT IN THE FILING OF COLLECTION CASE AFTER

DISMISSAL OF ESTAFA CASES; APPLICATION IN CASE AT BAR

In the same vein, the filing of the collection case after the

dismissal of the estafa cases against respondent did not amount

to forum-shopping. The essence of forum-shopping is the filing of

multiple suits involving the same parties for the same cause o

action, either simultaneously or successively, to secure a favorable

judgment. Although the cases filed by petitioner arose from the

same act or omission of respondent, they are, however, based on

different causes of action. The criminal cases for estafa are based

on culpa criminal while the civil action for collection is anchored

on culpa contractual. Moreover, there can be no forum-shopping

in the instant case because the law expressly allows the filing of a

separate civil action which can proceed independently of thecriminal action. ADcHES

RAMOS vs. COURT OF APPEALS

G.R. No. 124354. December 29, 1999.

Ponente:Kapunan

FACTS:

Erlinda Ramos underwent a surgical procedure to remove stone

from her gall bladder (cholecystectomy). They hired Dr. Hosaka, a

surgeon, to conduct the surgery at the De Los Santos Medica

Center (DLSMC). Hosaka assured them that he would find a good


10/13

1anaesthesiologist. But the operation did not go as planned, Dr.

Hosaka arrived 3 hours late for the operation, Dra. Gutierrez, the

anaesthesiologist botched the administration of the anaesthesia

causing Erlinda to go into a coma and suffer brain damage. The

botched operation was witnessed by Herminda Cruz, sister in law

of Erlinda and Dean of College of Nursing of Capitol Medical

Center.

The family of Ramos (petitioners) sued the hospital, the surgeon

and the anaesthesiologist for damages. The petitioners showedexpert testimony showing that Erlinda's condition was caused by

the anaesthesiologist in not exercising reasonable care in

intubating Erlinda. Eyewitnesses heard the anesthesiologist

saying Ang hirap ma-intubate nito, mali yata ang pagkakapasok.

O lumalaki ang tiyan.

Diagnostic tests prior to surgery showed that Erlinda was robust

and fit to undergo surgery.

The RTC held that the anaesthesiologist omitted to exercise due

care in intubating the patient, the surgeon was remiss in his

obligation to provide a good anaesthesiologist and for arriving 3

hours late and the hospital is liable for the negligence of the

doctors and for not cancelling the operation after the surgeonfailed to arrive on time. The surgeon, anaesthesiologist and the

DLSMC were all held jointly and severally liable for damages to

petitioners. The CA reversed the decision of the Trial Court.

ISSUES:Whether or not the private respondents were negligent

and thereby caused the comatose condition of Ramos.

HELD:

Yes, private respondents were all negligent and are solidarily liable

for the damages.

RATIO:

Res ipsa loquitur a procedural or evidentiary rule which meansthe thing or the transaction speaks for itself. It is a maxim for

the rule that the fact of the occurrence of an injury, taken with

the surrounding circumstances, may permit an inference or raise

a presumption of negligence, or make out a plaintiffs prima facie

case, and present a question of fact for defendant to meet with an

explanation, where ordinarily in a medical malpractice case, the

complaining party must present expert testimony to prove that the

attending physician was negligent.

This doctrine finds application in this case. On the day of the

operation, Erlinda Ramos already surrendered her person to the

private respondents who had complete and exclusive control over

her. Apart from the gallstone problem, she was neurologically

sound and fit. Then, after the procedure, she was comatose and

brain damagedres ipsa loquitur!the thing speaks for itself!

Negligence Private respondents were not able to disprove the

presumption of negligence on their part in the care of Erlinda and

their negligence was the proximate cause of her condition. One

need not be an anaesthesiologist in order to tell whether or not the

intubation was a success. [res ipsa loquitur applies here]. The

Supreme Court also found that the anaesthesiologist only saw

Erlinda for the first time on the day of the operation which

indicates unfamiliarity with the patient and which is an act of

negligence and irresponsibility.

The head surgeon, Dr. Hosaka was also negligent. He failed to

exercise the proper authority as the captain of the ship in

determining if the anaesthesiologist observed the proper protocols

Also, because he was late, he did not have time to confer with the

anaesthesiologist regarding the anaesthesia delivery.

The hospital failed to adduce evidence showing that it exercised

the diligence of a good father of the family in hiring and

supervision of its doctors (Art. 2180). The hospital was negligent

since they are the one in control of the hiring and firing of theirconsultants. While these consultants are not employees

hospitals still exert significant controls on the selection and

termination of doctors who work there which is one of the

hallmarks of an employer-employee relationship. Thus, the

hospital was allocated a share in the liability.

Nogales v Capitol Medical G.R. No. 142625 December 19

2006

Theme/Doctrine/Subject: Doctrine of Vicarious Liability

Doctrine of Apparent Authority

Facts

Dr. Oscar Estrada ("Dr. Estrada") renderedexclusive prenatacareof Corazon Nogales ("Corazon") beginning on her fourth

month of pregnancy or as early as December 1975 when she was

pregnant with her fourth child.

On her last trimester of pregnancy, Dr. Estrada noted anincrease

in her blood pressure and development of leg

edema indicating preeclampsia,adangerous complication o

pregnancy.

On 26 May 1976, Corazon was admitted at 2:30 a.m. at the

Capitol Medical Center (CMC) and brought to the labor room o

the CMC.

Dr. Rosa Uy ("Dr. Uy"), who was then a resident physician of CMC

conducted an internal examination of Corazon. Dr. Uy then called

up Dr. Estrada to notify him of her findings.

At 3:00 a.m., Dr. Estrada ordered for 10 mg. of valium to be

administered immediately by intramuscular injection. Dr. Estrada

later ordered the start of intravenous administration of syntocinon

admixed with dextrose, 5%, in lactated Ringers' solution, at the

rate of eight to ten micro-drops per minute.

At 4:15 a.m., Dr. Joel Enriquez ("Dr. Enriquez"), an

anesthesiologist at CMC, was notified of Corazon's admission

However, when asked if he needed the services of an

anesthesiologist,Dr. Estrada refused. Despite Dr. Estrada's

refusal, Dr. Enriquez stayed to observe Corazon's condition.

At 6:00 a.m., Corazon was transferred to Delivery Room No. 1

where her bag of water ruptured spontaneously. At 6:12 a.m.

Corazon's cervix was fully dilated. At 6:13 a.m., Corazon started

to experience convulsions.

At 6:15 a.m., Dr. Estrada ordered the injection of ten grams omagnesium sulfate. However, Dr. Ely Villaflor ("Dr. Villaflor"), who

was assisting Dr. Estrada,administered only 2.5 grams o

magnesium sulfate.

At 6:22 a.m., Dr. Estrada, assisted by Dr. Villaflor, applied low

forceps to extract Corazon's baby. In the process, a 1.0 x 2.5 cm

piece of cervical tissue was allegedly torn.

The baby came out in an apnic, cyanotic, weak and injured

condition.Consequently, the baby had to be intubated and

resuscitated by Dr. Enriquez and Dr. Payumo.

At 6:27 a.m., Corazon began to manifest moderate vagina

bleeding which rapidly became profuse, her blood pressure

dropped from 130/80 to 60/40 within five minutes. There was


11/13

1continuous profuse vaginal bleeding. The assisting nurse

administered hemacel through a gauge 19 needle as a side drip to

the ongoing intravenous injection of dextrose.

At 7:45 a.m., Dr. Estrada ordered blood typing and cross matching

with bottled blood.It took approximately 30 minutesfor the

CMC laboratory, headed by Dr. Perpetua Lacson ("Dr. Lacson"), to

comply with Dr. Estrada's order and deliver the blood.

At 8:00 a.m., Dr. Noe Espinola ("Dr. Espinola"), head of the

Obstetrics-Gynecology Department of the CMC, was informed of

Corazon's condition by telephone. Upon being informed thatCorazon was bleeding profusely, Dr. Espinolaordered immediate

hysterectomy.

Due to the inclement weather then, Dr. Espinola, arrived at the

CMC at 9:00 a.m. Despite Dr. Espinola's efforts to resuscitate,

Corazon died at 9:15 a.m.The cause of death was "hemorrhage,

post partum."14

On 14 May 1980, petitioners filed a complaint for damages15with

the Regional Trial Court16of Manila against CMC, Dr. Estrada, Dr.

Villaflor, Dr. Uy, Dr. Enriquez, Dr. Lacson, Dr. Espinola, and a

certain Nurse J. Dumlao for the death of Corazon. Petitioners

mainly contended that defendant physicians and CMC personnel

were negligent in the treatment and management of Corazon's

condition. Petitioners charged CMC with negligence in the

selection and supervision of defendant physicians and hospitalstaff.

Issue

WoN CMC is vicariously liable for the negligence of Dr. Estrada

Held

To resolve the issue, first it must be determined: what is the

relationship between Dr. Estrada and CMC?

Relationship of Dr Estrada and CMC

The Court held that CMC did not exercise control over Dr.

Estrada's treatment and management of Corazon's condition.

It is undisputed that throughout Corazon's pregnancy, she wasunder the exclusive prenatal care of Dr. Estrada. At the time of

Corazon's admission at CMC and during her delivery, it was Dr.

Estrada, assisted by Dr. Villaflor, who attended to Corazon. There

was no showing that CMC had a part in diagnosing Corazon's

condition. While Dr. Estrada enjoyed staff privileges at CMC, such

fact alone did not make him an employee of CMC.42 CMC merely

allowed Dr. Estrada to use its facilities43 when Corazon was about

to give birth, which CMC considered an emergency.

Hence, Dr. Estrada is not an employee of CMC, but an

independent contractor.

Liability of CMC

The question now is whether CMC is automatically exempt fromliability considering that Dr. Estrada is an independent

contractor-physician.

In general, a hospital is not liable for the negligence of an

independent contractor-physician. There is, however, an exception

to this principle. The hospital may be liable if the physician is the

"ostensible" agent of the hospital.

In the instant case, CMC impliedly held out Dr. Estrada as a

member of its medical staff. Through CMC's acts, CMC clothed Dr.

Estrada with apparent authority thereby leading the Spouses

Nogales to believe that Dr. Estrada was an employee or agent of

CMC. CMC cannot now repudiate such authority.

First, CMC granted staff privileges to Dr. Estrada. CMC extended

its medical staff and facilities to Dr. Estrada. Upon Dr. Estrada's

request for Corazon's admission, CMC, through its personnel

readily accommodated Corazon and updated Dr. Estrada of her

condition.

Second, CMC made Rogelio sign consent forms printed on CMC

letterhead. Prior to Corazon's admission and supposed

hysterectomy, CMC asked Rogelio to sign release forms, thecontents of which reinforced Rogelio's belief that Dr. Estrada was a

member of CMC's medical staff.

Doctrine of Apparent Authority

This exception is also known as the "doctrine of apparent

authority."

Two factors to determine the liability of an independent-contractor

physician:

First factor. It focuses on thehospital's manifestations and is

sometimes described as an inquiry whether the hospital acted

in a manner which would lead a reasonable person to

conclude that the individual who was alleged to be negligentwas an employee or agent of the hospital.

In this regard, the hospital need not make express representations

to the patient that the treating physician is an employee of the

hospital; rather a representation may be general and implied.

Second factor. The second factor focuses on the patient's

reliance. It is sometimes characterized as an inquiry on whether

the plaintiff acted in reliance upon the conduct of the hospital or

itsagent, consistent with ordinary care and prudence.54

The records show that the Spouses Nogales relied upon a

perceived employment relationship with CMC in accepting Dr

Estrada's services. Rogelio testified that he and his wife

specifically chose Dr. Estrada to handle Corazon's delivery no

only because of their friend's recommendation, but moreimportantly because of Dr. Estrada's "connection with a reputable

hospital, the [CMC]."55 In other words, Dr. Estrada's relationship

with CMC played a significant role in the Spouses Nogales

decision in accepting Dr. Estrada's services as the obstetrician

gynecologist for Corazon's delivery. Moreover, as earlier stated

there is no showing that before and during Corazon's confinement

at CMC, the Spouses Nogales knew or should have known that Dr

Estrada was not an employee of CMC.

The Court finds respondent Capitol Medical Center vicariously

liable for the negligence of Dr. Oscar Estrada.

PROFESSIONAL SERVICES, INC. (PSI) vs. NATIVIDAD and

ENRIQUE AGANA, G.R. No. 126297 January 31, 2007

Themes/Subjects:medical malpractice, medical negligence

negligence that ripened into a wrongful act of deceit, deliberate

concealment, res ipsa loquitur

Facts

On April 11, 1984, Dr. Miguel Ampil, assisted by the medica

staff of the Medical City General Hospital (Medical City Hospital)

performed an anterior resection surgery on Natividad Agana due

to cancer of the sigmoid. The malignancy spread on her lef

ovary, hence, the removal of certain portions of it. Thus, Dr. Ampi
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1obtained the consent of Natividads husband, Enrique, to permit

Dr. Juan Fuentes, to perform hysterectomy on her.

After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took

over, completed the operation and closed the incision.

The operation appeared to be flawed, the attending nurses entered

these remarks: "sponge count lacking 2, announced to

surgeon, searched (sic) done but to no avail, continue for

closure."

On April 24, Natividad was released. She then complained of

excruciating pain in her anal region several days after and

consulted both Dr. Ampil and Dr. Fuentes. They told her that the

pain was the natural consequence of the surgery. Dr. Ampil

recommended that she consult an oncologist to examine the

cancerous nodes which were not removed during the operation.

On May 9, Natividad, with Enrique, went to the US to seek

treatment. After four months of consultations and lab

examinations, she was told she was free of cancer.

On August 31, Natividad flew back to the Philippines, still

suffering from pains. Two weeks after, her daughter found a pieceof gauze protruding from her vagina. Upon being informed about

it, Dr. Ampil proceeded to her house where he managed to extract

by hand a piece of gauze measuring 1.5 inches in width. He then

assured her that the pains would soon vanish.

Natividads pains intensified, prompting her to seek treatment at

the Polymedic General Hospital.

While confined, Dr. Ramon Gutierrez detected the presence of

another foreign object in her vagina a foul-smelling gauze, 1.5

inches in width which badly infected her vaginal vault. A recto-

vaginal fistula had formed in her reproductive organs which forced

stool to excrete through the vagina. Thus, in October 1984,

Natividad underwent another surgery.

On November 12, 1984, Natividad and her husband filed with the

RTC, Quezon City a complaint for damages against the

Professional Services, Inc. (PSI), owner of the MCH, Dr. Ampil, and

Dr. Fuentes. They alleged that the latter are liable for negligence

for leaving two pieces of gauze inside Natividads body and

malpractice for concealing their acts of negligence.

Enrique also filed with the Professional Regulation Commission

(PRC) an administrative complaint for gross negligence and

malpractice against Dr. Ampil and Dr. Fuentes. The PRC Board of

Medicine heard the case only with respect to Dr. Fuentes because

it failed to acquire jurisdiction over Dr. Ampil who was then in the

United States.

On February 16, 1986, pending the outcome of the above cases,

Natividad died and wassubstituted by her above-named children

(the Aganas).

On March 17, 1993, the RTC rendered its Decision in favor of the

Aganas, finding PSI, Dr. Ampil and Dr. Fuentes liable for

negligence and malpractice.

On January 23, 1995, the PRC Board of Medicine rendered its

Decision6in Administrative Case No. 1690 dismissing the case

against Dr. Fuentes. The Board held that the prosecution failed to

show that Dr. Fuentes was the one who left the two pieces of

gauze inside Natividads body; and that he concealed such fac

from Natividad.

On September 6, 1996, the CA dismissed the case against Dr

Juan Fuentes and that Dr. Ampil is liable to reimburse PSI

whatever amount the latter will pay or had paid to the Aganas.

Issues

I Whether the Court of Appeals Erred in Holding Dr. Ampil liableII Whether the Court of Appeals Erred in Absolving Dr. Fuentes

of any Liability

III Whether PSI Is Liable for the Negligence of Dr. Ampil

Held

I The CA was correct in holding Dr. Ampil liable.

The removal of all sponges used is part of a surgical operation

and when a physician or surgeon fails to remove a sponge he has

placed in his patients body that should be removed as part of the

operation, he thereby leaves his operation uncompleted and

creates a new condition which imposes upon him the legal duty o

calling the new condition to his patients attention, andendeavoring with the means he has at hand to minimize and avoid

untoward results likely to ensue therefrom.

Dr. Ampil did not inform Natividad about the missing two

pieces of gauze.Worse, he even misled her that the pain she was

experiencing was the ordinary consequence of her operation. Had

he been more candid, Natividad could have taken the immediate

and appropriate medical remedy to remove the gauzes from her

body. To our mind, what was initiallyan act of negligence by Dr

Ampil has ripened into a deliberate wrongful act of deceiving

his patient.

This is a clear case of medical malpractice or more appropriately

medical negligence. The elements are duty, breach, injury andproximate causation. To successfully pursue this kind of case, a

patient must only prove that a health care provider either failed to

do something which a reasonably prudent health care provider

would have done, or that he did something that a reasonably

prudent provider would not have done; and that failure or action

caused injury to the patient.

Dr, Ampil, as the lead surgeon, had the duty to remove all foreign

objects, such as gauzes, from Natividads body before closure o

the incision.

When he failed to do so, it was his duty to inform Natividad abou

it. Dr. Ampil breached both duties. Such breach caused injury to

Natividad, necessitating her further examination by Americandoctors and another surgery. Dr. Ampils negligence is the

proximate cause of Natividads injury and could be traced from his

act of closing the incision despite the information given by the

attending nurses that two pieces of gauze were still missing. That

they were later on extracted from Natividads vagina established

the causal link between Dr. Ampils negligence and the injury. And

what further aggravated such injury was his deliberate

concealment of the missing gauzes from the knowledge o

Natividad and her family.

II The CA was correct in absolving Dr. Fuentes
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1The Aganas assailed the dismissal by the trial court of the case

against Dr. Fuentes on the ground that it is contrary to the

doctrine of res ipsa loquitur. According to them, the fact that the

two pieces of gauze were left inside Natividads body is a prima

facie evidence of Dr. Fuentes negligence.

Res ipsa loquiturmeans "the thing speaks for itself." Where the

thing which caused the injury, without the fault of the injured, is

under the exclusive control of the defendant and the injury is

such that it should not have occurred if he, having such controlused proper care, it affords reasonable evidence, in the absence of

explanation that the injury arose from the defendants want of

care, and the burden of proof is shifted to him to establish that he

has observed due care and diligence.

From the foregoing statements of the rule, the requisites for the

applicability of the doctrine of res ipsa loquitur are: (1) the

occurrence of an injury; (2) the thing which caused the injury was

under the control and management of the defendant; (3) the

occurrence was such that in the ordinary course of things, would

not have happened if those who had control or management used

proper care; and (4) the absence of explanation by the defendant.

Of the foregoing requisites, the most instrumental is the "control

and management of the thing which caused the injury."

We find the element of "control and management of the thing

which caused the injury" to be wanting. Hence, the doctrine of res

ipsa loquitur will not lie.

Dr. Ampil was the lead surgeon during the operation of Natividad.

He requested the assistance of Dr. Fuentes only to perform

hysterectomy when he (Dr. Ampil) found that the malignancy in

her sigmoid area had spread to her left ovary. Dr. Fuentes

performed the surgery and thereafter reported and showed his

work to Dr. Ampil. The latter examined it and finding everything to

be in order, allowed Dr. Fuentes to leave the operating room. Dr

Ampil then resumed operating on Natividad. He was about to

finish the procedure when the attending nurses informed him that

two pieces of gauze were missing. A "diligent search" was

conducted, but the misplaced gauzes were not found. Dr. Ampi

then directed that the incision be closed. During this entireperiod, Dr. Fuentes was no longer in the operating room and had

in fact, left the hospital.

III - Whether PSI Is Liable for the Negligence of Dr. Ampil

Yes, PSI is also liable.

PSIs liability is traceable to its failure to conduct an investigation

of the matter reported in the nota bene of the count nurse. Such

failure established PSIs part in the dark conspiracy of silence and

concealment about the gauzes. Ethical considerations, if not also

legal, dictated the holding of an immediate inquiry into the events

if not for the benefit of the patient to whom the duty is primarily

owed, then in the interest of arriving at the truth. The Cour

cannot accept that the medical and the healing professions

through their members like defendant surgeons, and their

institutions like PSIs hospital facility, can callously turn their

backs on and disregard even a mere probability of mistake or

negligence by refusing or failing to investigate a report of such

seriousness as the one in Natividads case.

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