RepublicofthePhilippinesSupremeCourt

Manila

FIRSTDIVISION

MANILADOCTORSHOSPITAL,

G.R.No.150355

Petitioner, Present:

versus PANGANIBAN,C.J.,

(Chairperson) YNARESSANTIAGO, AUSTRIAMARTINEZ,SOUNCHUAandVICKYTY,

CALLEJO,SR.andCHICONAZARIO,JJ.

Respondents. Promulgated:

July31,2006xx

DECISIONAUSTRIAMARTINEZ,J.:

Before thisCourt is aPetition forReviewonCertiorari underRule 45

questioningtheDecision[1]

datedOctober2,2001promulgatedby theCourtof Appeals (CA) in CAG.R. CV No. 61581, which affirmed the Decisiondated September 30, 1997 of the Regional Trial Court (RTC), Branch 159,PasigCity,butwhichreducedtheawardofdamages.

Thiscaseoriginated fromanaction fordamages filedwith theRTCbyrespondents So Un Chua and Vicky Ty against petitioner Manila Doctors

Hospital.[2]

The complaint is premised on the alleged unwarrantedactuations of the petitioner towards its patient, respondent So Un Chua(Chua),whowasconfinedforhypertension,diabetes,andrelatedillnesses.

Theantecedentsofthecasefollow:

OnDecember13,1993, respondents filedaComplaintaverring thatonOctober30,1990,respondentChua,themotherofrespondentVickyTy,wasadmitted in petitioners hospital for hypertension and diabetes that whilerespondentChuawasconfined,JudithChua,thesisterofrespondentTy,hadbeen likewise confined for injuries suffered in a vehicular accident thatpartial payments of the hospital billsweremade, totaling P435,800.00 thatafter the discharge of Judith Chua, respondent Chua remained inconfinement and the hospital bills for both patients accumulated thatrespondent Chua was pressured by the petitioner, through its Credit andCollection Department, to settle the unpaid bills that respondent Tyrepresented that she will settle the bills as soon as the funds becomeavailable that respondentTypleaded to themanagement that inviewof thephysical condition of her mother, respondent Chua, the correspondencesrelating to the settlement of the unpaid hospital bills should be relayed tothe former that these pleaswere unheeded by the petitioner that petitionerthreatened to implement unpleasant measures unless respondent Tyundertakes her mothers obligation as well as the obligation of her sister,Judith Chua, to pay the hospitalization expenses that petitionermade goodits threat and employed unethical, unpleasant and unlawful methods whichallegedly worsened the condition of respondent Chua, particularly, by (i)cuttingoff the telephone line inher roomand removing theairconditioningunit, television set, and refrigerator, (ii) refusing to render medicalattendanceand tochange thehospitalgownandbedsheets, and (iii)barringthe private nurses ormidwives from assisting the patient.Respondents thusprayed for the award of moral damages, exemplary damages, and attorneysfees.

In itsAnswer,AmendedAnswer,andRejoinder,petitionerspecificallydenied the material averments of the Complaint and Reply, and interposedits counterclaims arguing that as early as one week after respondent Chuahadbeenadmitted to itshospital,Dr.RodySy,her attendingphysician,hadalready given instructions for her to be discharged, but respondents insistedthat Chua remain in confinement that, through its staff, petitioneraccordingly administered medical examinations, all of which yieldednegative results that respondent Ty voluntarily undertook, jointly andseverally, to pay the hospital bills for both patients that althoughrespondent Ty paid up to P435,000.00, more or less, she reneged on hercommitment to pay the balance in violation of the Contract for AdmissionandAcknowledgment ofResponsibility forPayment datedOctober 30, 1990which she voluntarily executed that she signed a Promissory Note on June5,1992fortheunpaidbalanceofP1,075,592.95andissuedpostdatedchecksto cover the same that no such undue pressure had been imposed uponrespondent Chua to settle the bills, the truth being that, as a matter ofstandard procedure, the reminders to settle the billswere transmitted not tothe patients but to their relatives who usually undertook to pay the samethat respondentTydeliberatelyevadedthestaffof theCreditandCollectionDepartmentthatthecuttingoffofthetelephonelineandremovaloftheairconditioning unit, television set, and refrigerator cannot constituteunwarranted actuations, for the same were resorted to as costcuttingmeasures and to minimize respondents charges that were already piling up,especially after respondent Ty refused to settle the balance notwithstandingfrequent demands that respondent Ty evaded the staff when the latterattempted to inform her that the room facilities will be cut off tominimizethe rising charges and that respondents instituted the present civil casepurposelyasleverageagainstthepetitionerafterthelatterhadfiledcriminalcharges for violation of Batas Pambansa (B.P.) Blg. 22 against respondentTy for issuing checks, later dishonored, totaling P1,075,592.95, the amountreferring to the unpaid hospital bills. In its compulsory counterclaim,petitioner prayed, among other items, for the award of no less than

P1,000,000.00ascompensatorydamagesdue to thefilingofamaliciousandunfounded suit, and, in its permissive counterclaim, petitioner prayed forrespondents to pay P1,075,592.95, the amount representing the due anddemandable obligation under the Promissory Note dated June 5, 1992,including the stipulated interest therein and the 25 percent of the totalamountdueasattorneysfees.

During pretrial, the parties stipulated on the following issues: First,

whether the respondents are liable to the petitioner to pay the hospital billsarising from the hospitalization of respondent Chua and Judith Chua andsecond, 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 May 2, 1992 b)respondents failed topay thebalancedespite repeatedremindersc) thesaidreminders referred to thehospitalbillsof respondentChuaandJudithChuad)oneof theattendingphysiciansofrespondentChuawasDr.RodySyande) the petitioner ordered the removal of the facilities in question from theroom of its patient, respondent Chua, with the qualification that they wereconstrained to discontinue the same after the representative of respondentChua refused to update the hospital bills or refused to transfer her to semi

deluxeroomorwardtolessencosts.[4]

OnSeptember 30, 1997, theRTC rendered itsDecision in favor of the

respondents,thedispositiveportionofwhichstates:

WHEREFORE, premises considered, judgment on the complaint ishereby rendered in favorof the [respondents] as against the [petitioner] asfollows:

[O]rdering the [petitioner] topay the [respondents] the following, towit:

a) P200,000.00asmoraldamages

b) P100,000.00asexemplarydamagesand

c) P50,000.00asattorneysfeesandtheamountofP50,000.00aslitigationcosts.

SOORDERED.[5]

Inbrief,theRTCheldthattheremovalofthefacilitiesoftheroomtriggeredthehypertensionofrespondentChua that thepetitioneractedinbadfaithinremoving the facilities without prior notice that her condition wasaggravated by the pressure employed by the administration upon her to paythe hospital bills that the food always came late as compared to the otherpatients that the beddings and clothes of respondent Chua were no longerchanged and, as a result, bed sores emerged on her body that therewas anutter lack of medical attendance that, because of these, respondent Chuasuffered from selfpity and depression that petitioner clearly discriminatedagainst the respondents that respondent Ty had no choice but to sign thepromissory notes in order to secure the release of her mother, respondentChua that the foregoing actuations constitute an abuse of rights thatpetitioner failed to establish the pecuniary loss it suffered and, hence, it isnotentitled tocompensatorydamagesand that,since thepromissorynote isacontractofadhesion,thepetitionerisnotentitledtotheawardofattorneysfeesasstipulatedthereon.OnappealtotheCA,thepetitionerassignedthefollowingerrors:

A.THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERRORBY FINDING THE ACTUATIONS OF THE ADMINISTRATION OFDEFENDANTAPPELLANT TO BE IN BAD FAITH, OPPRESSIVE ANDUNNECESSARY AS TO MAKE IT LIABLE TO PLAINTIFFSAPPELLEESFORDAMAGESANDATTORNEYSFEES.

B.THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERRORBY NOT RULING UPON THE PERMISSIVE COUNTERCLAIM OFDEFENDANTAPPELLANT WITH RESPECT TO THE P1,075,592.95REPRESENTING THE HOSPITAL BILL OF PLAINTIFFSAPPELLEES,WHICHOBLIGATION ISNOTDISPUTEDANDWHICHAMOUNTWAS

NEVERCONTROVERTEDBYPLAINTIFFSAPPELLEES.[6]

OnOctober2,2001,theCApromulgateditsDecisionthedispositiveportionofwhichreads:

IN VIEW OF ALL THE FOREGOING, the appealed Decision isherebyAFFIRMED with themodification that theawardofmoraldamages,exemplary damages as well as attorneys fees is reduced to Seventy FiveThousand Pesos (P75,000.00), Thirty Thousand Pesos (P30,000.00) andTwenty Thousand Pesos (P20,000.00), respectively. Litigation costs areherebydeleted.Costsagainstappellant.

SOORDERED.[7]

Apart from the reduction in the award of damages, the CA affirmed allsalient portionsof theRTCDecision anddeclined to disturb the findingsoffact.Petitioner is now before this Court raising essentially the same groundsheardbytheCA.Incidentally,withrespect to therelatedcriminalcaseagainstrespondentTy,this Court, on September 27, 2004, promulgated its Decision entitled Ty v.

People of the Philippines,[8]

which affirmed the decisions of the lowercourts finding respondent Ty guilty of violating B.P. Blg. 22 and orderingher topay theprivatecomplainant,hereinpetitioner, the totalamountof thedishonoredchecks.Thepetitionisimpressedwithmerit.

While, as a rule, only questions of lawmay be raised in a petition forreviewoncertiorariunderRule45,undercertainexceptions, theCourtmayreexamine the evidence presented by the parties during the trial. At leastfour exceptions exist in this case, namely: (a) when the conclusion is afindinggroundedentirelyonspeculation, surmises,orconjectures (b)when

the judgment is based on amisapprehension of facts (c) when the findingsof fact are premised on the supposed absence of evidence and contradictedby the evidence on record and (d) when the courts a quo manifestlyoverlooked certain relevant facts not disputed by the parties and which, if

properlyconsidered,wouldjustifyadifferentconclusion.[9]

The principal questions are, first, whether the actuations of thepetitioner amount to actionable wrongs, and second, whether thecounterclaims of the petitioner can be backed up by the measure ofpreponderantevidence.

Inbrief, thecourtsaquo concurred in theholding that thepetitionerand itsstaff 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 airconditioner, telephonelines, television, and refrigerator, aggravated the condition of the patient,

triggered her hypertension, and caused her blood pressure to fluctuate,[11]

considering that therewasnoproperventilation in the room.[12]

In viewofthe foregoing, the courts a quo concluded that the actuations of the

petitioner were oppressive, unnecessary,[13]

and antisocial,[14]

done in

badfaithwithoutpropernotice,[15]

withnointentionotherthantoharassor

irritatetherespondents,[16]

allofwhichconstituteanabuseofrights.[17]

We do not agree. The conclusions of the courts a quo are either haphazardconjectures,or foundedonamisapprehensionof facts.The record is repletewithevidencethatjustifiesadifferentconclusion.

Indeed the operation of private pay hospitals and medical clinics isimpressed with public interest and imbued with a heavy socialresponsibility.Butthehospitalisalsoabusiness,and,asabusiness,ithasa

right to institute all measures of efficiency commensurate to the ends forwhich it is designed, especially to ensure its economic viability andsurvival. And in the legitimate pursuit of economic considerations, theextent to which the public may be served and cured is expanded, the pulseandlifeofthemedicalsectorquickens,andtheregenerationofthepeopleasa whole becomes more visibly attainable. In the institution of costcuttingmeasures, the hospital has a right to reduce the facilities and services thatare deemed to be nonessential, such that their reduction or removal would

not be detrimental to the medical condition of the patient.[18]

For themoment, the question to be considered is whether the subject facilities areindeed nonessential the airconditioner, telephone, television, andrefrigeratortheremovalofwhichwouldcausetheadversehealtheffectsandemotional trauma the respondents so claimed. Corollary to this question iswhether the petitioner observed the diligence of a good father of the

family[19]

in the course of ascertaining the possible repercussions of theremovalof thefacilitiesprior to theremoval itselfandforareasonable time

thereafter,withaviewtopreventdamage.[20]

After an extensive analysis of the record, it becomes ratherworrisometo thisCourt that thecourtsaquo unreservedlydrew their conclusions fromthe selfserving and uncorroborated testimonies of the respondents the

probative value of which is highly questionable.[21]

We hold that therespondentsfailedtoprovethedamagessoclaimed.

The evidence in the record firmly establishes that the staff of the petitionertook proactive steps to inform the relatives of respondent Chua of theremoval of facilities prior thereto, and to carry out the necessaryprecautionary measures to ensure that her health and wellbeing would notbe adversely affected: as early as around twoweeks after her admission onOctober 30, 1990, to the time when the facilities had been removed

sometime in themiddleofMay1992,[22]

andevenup to thepointwhensheactually left the premises of the hospital three weeks later, or during the

first week of June 1992,[23]

the medical condition of respondent Chua, asconsistently 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 bemy doctor and a very

good doctor[25]

at that, and whose statements at times had beencorroborated as well by SisterMary Philip Galeno, SPC, the Administratorof the hospital and who also happens to be a registered nurse, had been

relatively well,[26]

ambulatory,[27]

walking around in the room,[28]

andthat she was able to leave the hospital on her own without any assistance[29]

thatalthoughshecomplainedofsymptomssuchasdizziness,weakness,[30]

and abdominal discomfort,[31]

Dr. Sy requested several medicalexaminations, such as the laboratory tests, renal tests,MRI, ultrasound, and

CT scan,[32]

all of which were administered after procuring the consent of

respondent Chuas family[33]

as admitted by respondent Ty herself,[34]

andeven called on other specialists, such as a neurologist, endocrinologist, and

gastroenterologist, to look into her condition[35]

and conduct other tests as

well[36]

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 toher 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

anyacuteattack,[43]

nor likely to fall intoanyemergency,[44]

nor yet does

she requirecontinuousorprolongedhospitalization[45]

since shewas stableenough to be treated at home and on an outpatient basis, so much so thatDr.Syencouragedhertoexerciseandavoidrestingallthe

time,[46]

andrecommendedthatanytimeshemaybedischarged[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 notbeen for respondents insistence to stay in the hospital in view of their hope

for absolute recovery[50]

despite the admission of respondent Chua herself

thatshecannotanymorebetotallycured.[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]

ToSisterGaleno, also a registerednurse, thematter of removal anditspossiblerepercussionsonthehealthofthepatient,asamatterofhospitalpolicy,isacriticalandsensitivemaneuver,and,hence,it iscarriedoutonly

after discussing with the doctors to evaluate all important factors.[53]

The

fact of prior consultation[54]

as well as the medical determination to theeffect that it was safe to remove the facilities and would cause no harmful

effect[55]

had been amply corroborated by respondent Chuas own doctor

himself.[56]

When Dr. Sy testified as rebuttal witness for the respondentsthemselves and whose credibility respondents failed to impeach, hecategorically stated that he consented to the removal since the removal ofthe said facilities would not by itself be detrimental to the health of his

patient, respondent Chua.[57]

And in this respect, he had been advisingrespondentTy,thedaughterofthepatient,thatthefacilities,suchastheairconditioner, television, refrigerator, and telephone, are not absolutelynecessary, and, that although theymay add to the comfort of the patient, ifabsent, they will not cause any significant deterioration of her condition,[58]

given that, in his experience as a cardiologist, and after personallyattending respondent Chua on a daily basis before, during, and after the

removal and even up to the time of her actual discharge,[59]

he concludedthat many hypertensive and diabetic patients, as in her case, do not at allneed in particular an airconditioning unit, among the other facilities

aforementioned.[60]

And, contrary to the findings of the courts a quo andthe selfserving testimoniesof respondents that the lackofventilation, afterthe removal of the airconditioner, triggered her hypertension, Dr. Sycategorically stated that during his daily rounds with the patient he wascertain that, although admittedly the blood pressure in general wouldfluctuate 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]

andaccordingly,asconfirmedby themedical records,hemadenochange in

themedicationsthereafter.[63]

InsupportofDr.Sysfindings,SisterGaleno,testified thatsheknewtheconditionof theventilationof thepatientsdeluxeroom,locatedatthefifthfloor,evenwithouttheairconditioning,notablyintimes of brownout, and that there had been enough ventilation since thegrilled window of that room was large enough which, if opened, would

permit sufficient ventilation.[64]

The Court finds that the premise of theRTC judgment refers merely to hypothetical statements which fail toestablish any clear and direct link to the injury allegedly suffered by thepatient:

QYoufound it safe to remove these facilities fromthe roomof thepatientsufferingfromdiabetesandhypertension?

A Yes, Sir. Many hypertensive, diabetic patients do not need air

conditioning,orT.V.orrefrigerator.

Q Do you agree with me that hypertension is triggered sometimes byexcitement,angeror(sic)apersonsufferingfromsuchillness?

AHypertensioncanbetriggeredbyanything.

Court:

QAndeveninotherwordsthediscomfortcanalsotrigger?

ASometimesmentalstresscantrigger.

xxxx

Court:

QYoumentionedearlierthatthishypertensionmaybetriggeredmentally?

AYes,YourHonor.

Court:

QWill 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 removalwouldprove that fluctuation in bloodpressure arewithin acceptable

limits.[65]

Withrespecttothefindingsofthecourtsaquothatbedsoresappearedon the bodyof respondentChua, that she suffered fromdepression after thedisconnection of the said facilities, that her private midwives were barred,and that the delivery of food was delayed, this Court holds, as above, thatthese conclusions are bereft of sound evidentiary basis, selfserving anduncorroborated as they are. Again, Dr. Sy affirmed that during the dailyrounds 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]

Nordid he find any sign of depression, although, admittedly, he observed that

shehadbeenveryangrybecauseof the removalof the facilities.[67]

All thewhilehedidnotreceiveanycomplaintfromrespondentChuaindicatingthat

she suffered from the foregoing infirmities,[68]

considering that it is theresponsibility of the family of the patient to specifically inform theattending physician or the nurses during their rounds whatever they feel is

important,orif therewereanynewdevelopmentssincethelastvisit.[69]

Ascorroborated by Sister Galeno, throughout respondent Chuas confinement,sheneverreceivedanycomplaintfromthelatterorherrelativesthatshehad

notbeenattended toby thenursing staff.[70]

Worthnoting again is the factthatthenursingstaffandtheattendingphysicians,whichincludedDr.Sy,inaccordance with hospital policy, would routinely make their rounds on adaily 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 theotherhand,wouldmake their roundsmore frequently, that is,at least

once per shift, or every eight hours.[73]

Apart from the selfservingstatements of respondents, which by now have become rather indicative ofbeingmere afterthoughts, there is no clear showing from the record that thepetitioner and its medical staff deviated from the foregoing policy andpractice, nor had they been called upon to look into the alleged physicalreactions or emotional trauma respondent Chua claims to have sufferedduringandafter the removalof the facilities.Itmustbeemphasized that, asstated 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

employedaprivatemidwifewhoattendedtoherallthetime.[75]

The evidence in the record overwhelmingly demonstrates that

respondent Chua had been adequately attended to, and this Court cannotunderstandwhythecourtsaquohaddeclared that therewasanutter lackofmedical attendance, or that her health suffered during the period after theremoval of the facilities. The Court finds that the facilities in question arenonessential for the care of respondent Chua and, hence, they may belessenedorremovedbythepetitionerforthesakeofeconomicnecessityandsurvival.

Thoughhumanexperiencewould show that thedeactivationof the airconditioner may cause a temperature differential that may trigger somephysical discomfort, or that the removal of entertainment facilities such asthetelevisionset,orthedisconnectionofcommunicationdevicessuchasthetelephone,maycause someexasperationon thepartof theonewhobenefitsfrom these, nevertheless, all things considered, and given the degree ofdiligence the petitioner duly exerted, not every suppression of the thingsthatonehasgrownaccustomedtoenjoyamountstoanactionablewrong,nordoes every physical or emotional discomfort amount to the kind of anguishthat warrants the award of moral damages under the general principles oftort.The underlying basis for the award of tort damages is the premise thatan individualwas injured in contemplationof law.Thus, theremust first bethebreachofsomedutyandtheimpositionofliabilityforthatbreachbeforedamages may be awarded it is not sufficient to state that there should betort 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 applicationof medical knowledge, especially in the description of the causal linkbetween external or environmental factors, on one hand, and their effectunto the physical or emotional health of the patient, on the other, expert

opinion,asdiscussedinCruzv.CourtofAppeals,[77]

isgenerallyrequired:All three courts below bewail the inadequacy of the facilities of the

clinicand itsuntidiness the lackofprovisions suchasblood,oxygen,andcertainmedicines the failure to subject the patient to a cardiopulmonarytestpriortotheoperation theomissionofanyformofbloodtypingbeforetransfusion and even the subsequent transfer of Lydia to the San PabloHospital and the reoperationperformedonherby thepetitioner.Butwhileit may be true that the circumstances pointed out by the courts belowseemed beyond cavil to constitute reckless imprudence on the part of thesurgeon, this conclusion is still best arrived at not through the educatedsurmises nor conjectures of laymen, including judges, but by theunquestionable knowledge of expertwitnesses. Forwhether a physician orsurgeon has exercised the requisite degree of skill and care in thetreatment of his patient is, in the generality of cases, a matter of expertopinion. The deference of courts to the expert opinions of qualifiedphysicians stems from its realization that the latter possess unusualtechnical skills which laymen in most instances are incapable ofintelligently evaluating. Expert testimony should have been offered toprove that the circumstances cited by the courts below are constitutive ofconductfallingbelowthestandardofcareemployedbyotherphysiciansingoodstandingwhenperformingthesameoperation.It mustberememberedthat when the qualifications of a physician are admitted, as in the instantcase, there is an inevitable presumption that in proper cases he takes thenecessary precaution and employs the best of his knowledge and skill inattending to his clients, unless the contrary is sufficiently established.Thispresumption is rebuttablebyexpertopinionwhich is so sadly lacking

inthecaseatbench.[78]

With respect to theproprietyof thenoticeof removalof facilities, the

evidence shows that the hospital staff, accompanied by Sister Gladys Lim,

SPC, Finance Administrative Assistant of the hospital,[79]

through writtenand verbal notices as per hospital policy, forewarned the respondents,throughrespondentTyandhersister,JudithChua,oftheimpendingremoval

of the facilities over a week beforehand[80]

in view of their obstinate

refusal to vacate and transfer to a lower rate room[81]

or to update the

mounting hospital bills[82]

which, by then, had swollen to approximately

one million pesos.[83]

Respondent Ty refused to read many of the writtennoticessentbytheCredit

Department.[84]

After repeated attempts to contact respondent Ty[85]

and

before theactual removalof the facilities, the staffof thepetitioner tried to

personally serve the final notice datedApril 23, 1992,[86]

signed by SisterGladys Lim, addressed to respondent Ty, which adopted the tenor of theprior verbal warnings, and which expressly and sternly warned therespondents that the hospital shall be constrained to take legal action andthat 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 isthat SisterGaleno, testified that, as amatter of hospital policy the tenor ofwhich respondents, by virtue of the Contract for Admission dated October

30, 1990, agreed to complywith,[89]

the hospital can only cut off the non

essential facilities and only in extreme cases[90]

if the patient occupies aprivate room all to herself had the room been semiprivate shared by otherpatients,orhaditbeentheward,thehospitalcannotdisconnectthefacilitiessince this would unduly prejudice the other patients. But respondent Chuaherself insistedonstayinginaprivateroomdespiteherbeingfullyawareof

the ballooning charges,[91]

and even if she could have freely gone homeanytime to her condominium unitwhich, as admitted,was equippedwith an

airconditioner.[92]

Withrespecttothepressureandharassmentrespondentsallegedly suffered daily whenever the hospital staff would follow up the

billing during odd hours, or at 10pm, 11pm, 12midnight, 1am, or 2am,[93]

this averment had been convincingly refuted by the witnesses for thepetitioner,namely,EdithaL.Vecino, theHeadofCreditandCollection,andSisterGaleno, in that theCreditandCollectionDepartmentwouldonlyholdoffice hours from 8am to 5pm and, hence, it is impossible to harass the

respondentsduringthetimestheysoclaimed.[94]

The courts a quo found that respondent Ty had no choice but to sign

thepromissorynote inorderforhermother tobereleasedfromthehospital,[95]

thussuggesting that thehospital refused toactuallydischargeorbodilyrelease its patient, respondent Chua, until arrangements had been made tosettlethecharges.

While there are portions of the testimonies of the witnesses for thepetitioner which state that although, as per standard procedure, the patient

cannot leave[96]

the hospital without the discharge,[97]

clearance or gatepassissuedonlyafter

arrangements on the settlement of bills had beenmade,[98]

still, itmust beunderstood that these are only demonstrative of the precondition that apatient cannot step out of the premises without the consent of the hospital,or, in other words, that the clearance merely indicates that the hospital

expressly consented to the actual release of the patient,[99]

but, evenwithout its consent, the patient is still free to leave anytime as a matter of

policy, in spiteof the refusal to issueaclearanceorgatepass,[100]

or even

in caseswhere the accounts have not yet been liquidated or settled,[101]

oryetevenifnopromissorynoteorpostdatedcheckwereexecutedinfavorof

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 respondentsthat it shall withhold clearance, is simply exercising its right to protestagainst an absconding patient as a precursor to avail of other appropriatelegal remedies that, on the contrary, the respondents opted not to leavebecauseoftheirownpromisenottoleaveunlessthehospitalbillswerefully

settled[105]

that theaccusations found in theDemandLetterdatedMay19,

1992, and signed by the counsel for the respondents,[106]

particularly, thatthe petitioner refused to discharge the patient, [respondent Chua,] despite

orders from the attending physician, Dr. Rody Sy, had all been refuted bySister Galeno when she read its contents in front of the counsel forrespondents, emphatically telling him that we are not detaining his clientsthat[respondentTy]wastheonewhotoldusthattheyarenotgoingtoleave

the hospital unless they have fully paid the hospital[107]

and that, mostimportantly, no physical restraint upon the person of respondent Chua oruponthepersonofherrelativeshadbeenimposedbythestaff.Authorities, including those of common law origin, explicitly declare that apatientcannotbedetained inahospital fornonpaymentof thehospitalbill.If the patient cannot pay the hospital or physicians bill, the law provides aremedy for them to pursue, that is, by filing the necessary suit in court for

therecoveryofsuchfeeorbill.[108]

Ifthepatientispreventedfromleavingthe hospital for his inability to pay the bill, any person who can act on his

behalfcanapplyincourtfortheissuanceofthewritofhabeascorpus.[109]

Theformofrestraintmustbetotalmovementmustberestrainedinall

directions. If restraint is partial, e.g., in a particular directionwith freedom

to proceed in another, the restraint on the persons liberty is not total.[110]

However, the hospitalmay legally detain a patient against hiswillwhen heis a detained or convicted prisoner, or when the patient is suffering from avery contagious disease where his release will be prejudicial to publichealth,orwhenthepatient ismentallyillsuchthathisreleasewillendanger

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 atrespass to thepersontomomentarilypreventhimfromleavingthepremisesor any part thereof because he refuses to comply with some reasonablecondition subject to which he entered them. In all cases, the condition ofthis 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 theostensibleviolationof theseconditions,afterbeingmomentarilyinterrupted by the hospital staff for purposes of informing him of thosereasonableconditions,suchas theassessmentofwhether thepatient is fit toleave, insane, or suffering from a contagious disease, etc., or simply forpurposes of making a demand to settle the bill. If the patient chooses toabscond or leave without the consent of the hospital in violation of any oftheconditionsdeemedtobereasonableunderthecircumstances,thehospitalmay nonetheless register its protest and may choose to pursue the legalremedies available under law, provided that the hospitalmay not physicallydetainthepatient,unlessthecasefallsundertheexceptionsabovestated.

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, byeither 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 apatients injuries, it has an enforceable claim for full payment for its

services, regardless of the patients financial status.[115]

At this juncture, itmust be noted that there is testimony, though to a degree disputable, to theeffect that the execution of the promissory note and the issuance ofpostdated checks 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 therequirement tohave the relativeof respondentChua toexecuteapromissorynoteaspartofthearrangementtosettletheunpaidobligationsisaformalitythatconvertsany impliedcontract intowrittenformand,moreover,amountsto a reasonable condition, the nonfulfillment of which, in itself, however,as discussed, cannot allow thehospital to detain thepatient. Itmust alsobestressed,contrarytothefindingsofthecourtsaquo, thatsuchanagreement

embodied in a promissory note, as well as the Contract for Admission andAcknowledgment ofResponsibility for Payment datedOctober 30, 1990, donot 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 thatrespondent Ty signed the Promissory Note dated June 5, 1992 in the

presenceofcounselandactingunderhisadvise.[118]

But as to the propriety of the circumstances surrounding the issuance

of the postdated checks to cover the amount stated in the Promissory NotedatedJune5,1992, thisCourtmustrefer to thediscussionof therecentcase

of Ty v. People of the Philippines[119]

where this Court affirmed theconviction of respondent Ty for the issuance of bouncing checks addressedto the petitioner herein.While the instant case is to be distinguished fromtheTycase in nature, applicable law, the standards of evidence, and in thedefenses available to the parties, hence, the judgment of conviction in thatcaseshouldnotatallprejudice thedispositionof thiscase,even if the factscoincide, nonetheless, for purposes of convenience and instructive utility,theCourtquotestherelevantportions:

In thiscase,farfromit, thefear, ifany,harboredbyTywasnotreal

and imminent. Ty claims that she was compelled to issue the checks acondition the hospital allegedly demanded of her before her mother couldbedischargedforfearthathermothershealthmightdeterioratefurtherdueto the inhumane treatment of the hospital or worse, her mother mightcommit suicide. This is speculative fear it is not the uncontrollable fearcontemplatedbylaw.

Tobeginwith, therewasno showing that themothers illnesswas so

lifethreatening such that her continued stay in the hospital suffering allitsallegedunethical treatmentwould induceawellgroundedapprehensionof her death. Secondly, it is not the laws intent to say that any fearexempts one from criminal liability much less petitioners flimsy fear thathermothermightcommitsuicide.Inotherwords, the fear she invokeswasnot impending or insuperable as to deprive her of all volition and tomakeher a mere instrument without will, moved exclusively by the hospitalsthreatsordemands.

Ty has also failed to convince the Court that she was left with nochoice but to commit a crime. She did not take advantage of the manyopportunities available to her to avoid committing one. By her very ownwords, she admitted that the collateral or security the hospital requiredprior to the discharge of her mother may be in the form of postdatedchecks or jewelry.And if indeed shewas coerced to open an accountwiththe bank and issue the checks, she had all the opportunity to leave thescenetoavoidinvolvement.

Moreover, petitioner had sufficient knowledge that the issuance of

checks without funds may result in a violation of B.P. 22. She eventestified that her counsel advised her not to open a current account norissuepostdatedchecksbecause themoment Iwillnothave funds it will beabigproblem.Besides, apart frompetitionersbare assertion, the record isbereft of any evidence to corroborate and bolster her claim that she wascompelled or coerced to cooperate with and give in to the hospitalsdemands.

Ty likewise suggests . . . that the justifyingcircumstanceof stateof

necessity under par. 4, Art. 11 of the Revised Penal Code may findapplicationinthiscase.

Wedonotagree.The lawprescribes the presence of three requisites

to exempt the actor from liability under this paragraph: (1) that the evilsought to be avoided actually exists (2) that the injury feared be greaterthan the one done to avoid it (3) that there be no other practical and lessharmfulmeansofpreventingit .

In the instant case, the evil sought to be avoided ismerely expected

or anticipated. If the evil sought to be avoided is merely expected oranticipated ormay happen in the future, this defense is not applicable.Tycould have taken advantage of an available option to avoid committing acrime.By her own admission, she had the choice to give jewelry or otherformsofsecurityinsteadofpostdatedcheckstosecureherobligation.

Moreover, for the defense of state of necessity to be availing, the

greater injuryfearedshouldnothavebeenbroughtaboutby thenegligenceor imprudence,more so, thewillful inaction of the actor. In this case, theissuance of the bounced checks was brought about by Tys own failure topayhermothershospitalbills.

TheCourtalso thinks it ratherodd thatTyhaschosen theexempting

circumstance of uncontrollable fear and the justifying circumstance ofstateofnecessity toabsolveherof liability.It wouldnothavebeenhalfasbizarre hadTy been able to prove that the issuance of the bounced checkswasdonewithoutherfullvolition.Under thecircumstances,however, it isquite clear that neither uncontrollable fear nor avoidance of a greater evilorinjurypromptedtheissuanceofthebouncedchecks.

Parenthetically, the findingsof fact in theDecisionof the trialcourt

in the Civil Case for damages filed by Tys mother against the hospital iswholly irrelevant for purposes of disposing the case at bench. While thefindings therein may establish a claim for damages which, we may add,need only be supported by a preponderance of evidence, it does not

necessarilyengenderreasonabledoubtastofreeTyfromliability.[120]

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

quo committed serious errors in finding that the petitionerwas biased,[121]

discriminated against the respondents,[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 antisocial.[126]

The aforequoteddeclarationsof thewitnesses, significant portionsofwhichthis Court considers as expert testimony, are reliable and remainconsiderably trustworthy to controvert respondents assertions as well as toreverse the conclusions of fact and law of the CA and the RTC thatrespondent Chua suffered the physical and emotional anguish so claimed,and so, for these reasons, the Court holds that the petitioner inflicted noactionablewrong.This Court observes that the courts a quo awarded both respondents moraldamages. But it is wellsettled that in case of physical injuries, with some

exceptions,[127]

moral damages are recoverable only by the party injuredand not by her spouse, next of kin, or relativewho happened to sympathize

with the injuredparty.[128]

Hence, even if the courtsaquowere correct intheir basis for damages, they should have declined to award damages torespondentTy.Thelastissuetoberesolvedisthequestionwhetherthecounterclaimsofthepetitioneraresupportedbyapreponderanceofevidence.

We agree with the petitioner that the courts a quo seriously erred inmistaking the case of its compulsory counterclaim for its permissivecounterclaim and for failing to consider the evidence which impressivelysupports the latter.First,for failurewithout justifiablecauseof respondentscounsel to commenton thePartialFormalOfferofEvidencedatedFebruary

14, 1996[129]

filed by the petitioner, the RTC issued an order during thecourse of the trial, which counsel for respondents neither contested norraisedonappeal,admittingExhibits1to16,togetherwiththeirsubmarkings

and the purposes for which the same were offered,[130]

all of which hadalso been previously authenticated and their contents verified by the

witnesses for the petitioner.[131]

These documents include the Contract forAdmission of respondent Chua dated October 30, 1990, duly executed byrespondent Ty, incorporating therein the rules and regulations of the

hospital, including the duty to understand the same[132]

as well as theundertaking of respondent Ty to be jointly and severally liable for the

payment of thehospital bills of respondentChua[133]

the PromissoryNotedated June 5, 1992 in the amount of P1,075,592.95 duly executed byrespondentTy in favor of thepetitioner agreeing to be jointly and severallyliable to pay the unpaid obligations of respondent Chua and Judith Chua,

including interest and attorneys fees in case of default[134]

theUndertakings signed by respondent Ty dated March 3, 1992 and April 7,

1992tomaintainregulardeposits[135]

andthecreditmemosandstatements

of account that support the amount referring to the unpaid obligation.[136]

Second, the parties stipulated during pretrial that respondents failed to pay

the balance despite repeated reminders.[137]

And third, respondent Ty inopencourtidentifiedandadmittedthatshesignedtheContractofAdmissiondatedOctober30,1990aswellastheUndertakingsdatedMarch3,1992andApril7,1992butwhich,fornojustifiablereason,shedidnotbothertoread,

[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 asheretofore stated, it is still worth mentioning, at least for informativepurposes, the findings of this Court in Ty with respect to respondentsobligationstothepetitioner:

Tys mother and sister availed of the services and the facilities of thehospital. For the care given to her kin, Ty had a legitimate obligation topaythehospitalbyvirtueofherrelationshipwiththemandbyforceofhersignature on her mothers Contract of Admission acknowledgingresponsibility for payment, and on the promissory note she executed in

favorofthehospital.[140]

In view of all these findings, the Court earnestly disagrees with thesweepingconclusionof theCA that [Petitioner] failed topresentany iotaof

evidence to prove his claim,[141]

a statement apparently referring to thepermissive counterclaim of P1,075,592.95. However, with respect to thecompulsory counterclaim predicated on the filing of a baseless suit andinjury to its reputation, petitioner did not raise this matter on appeal and,hence,isdeemedtohavewaivedthesame.ButtheCourtinTymadeapartialfindingonthecivilliabilityofrespondentTy with respect to the amount covered by seven of the several dishonoredcheckssheissuedequivalentto

P210,000.00.[142]

Since this amount forms a fraction of her total civilliability,thenthisamount,indeferencetoTy,shouldbedeductedtherefrom.

The claim for attorneys fees, as stipulated under the Promissory Notedated June 5, 1992, should be reduced for being unreasonable under the

circumstances,from25percentto12percentofthetotalamountdue.[143]

As a final word, the Court takes judicial notice of the pending Senate Bill

No. 337, entitled AnAct Prohibiting the Detention of Patients in Hospitalsand Medical Clinics on Grounds of NonPayment of Hospital Bills orMedical Expenses, which declares, among others, that it shall be unlawfulfor any hospital or medical clinic to cause directly or indirectly thedetention of patients for nonpayment, in part or in full, of their hospital

bills,[144]

and, furthermore, requires patientswhohave fully recovered andare financially incapable to settle the hospitalization expenses to execute apromissorynote,cosignedbyanotherindividual,totheextentoftheunpaid

obligation before leaving the hospital.[145]

While this Court may havetoucheduponthesemattersintheadjudicationoftheinstantcase, itmustbestated that this decision should in no way preempt any constitutionalchallenge 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

review[146]

as well as the recognition that the tenor of the bill may adjustwith the times, or that the bill itself may fail to pass, according to thedynamism of the legislative process, especially in light of the objections

interposedbyinterestgroupstodate.[147]

WHEREFORE, the petition isGRANTED. TheDecision of the Court

of Appeals dated October 2, 2001, together with the Decision datedSeptember 30, 1997of theRegionalTrialCourt inCivilCaseNo. 63958, isREVERSED and SET ASIDE. Another judgment is entered dismissing theComplaint and ordering respondents, jointly and severally, to pay thepetitioner the amount of P865,592.95,with stipulated interest of 12 percentreckoned from the date of extrajudicial demand until full payment, and 12percentofthetotalamountdueasattorneysfees.

Nopronouncementastocosts.

SOORDERED.

MA.ALICIAAUSTRIAMARTINEZ

AssociateJusticeWECONCUR:

ARTEMIOV.PANGANIBANChiefJusticeChairperson

CONSUELOYNARESSANTIAGOROMEOJ.CALLEJO,SR.AssociateJusticeAssociateJustice

MINITAV.CHICONAZARIOAssociateJustice

CERTIFICATION

Pursuant to Section 13, Article VIII of the Constitution, it is herebycertified that the conclusions in the above Decision were reached inconsultationbefore thecasewasassigned to thewriterof theopinionof theCourtsDivision.

ARTEMIOV.PANGANIBANChiefJustice

[1 ] Penned by Associ a t e Ju st i ce Con rado M. Vasquez , Jr., w i th Associ a t e Ju st i ces Mart in S.

V i l l arama,Jr.and El i ezerR.DeLosSan to s,concu rring ,ro l lo , pp .38 50 .[2 ]

A l though the Complain t imp leaded the pet i t i oner as Man i l a Docto rs Hosp i t a l , d efendan t ,a l l eged ly a domest i c co rpo ra t i on , t he pe t i t i oner speci fi ca l l y den i ed t h i s avermen t andal l eged tha t Man i l a Docto rsHosp i t a l i smere ly a t radenameo fMan i l a Med ical Serv i ces, Inc .,t he rea l party i n i n t erest . Th i s a l l egat ion was no t d i spu ted by the responden t s, no r was anyco rrec t i on made by the cou rt s a quo .See Answer dat ed Feb ruary 4 , 1994 , i t em 2 Amended

Answer dat ed Feb ruary 10 , 1994 , i t em 2 Rejo inder da t ed March 28 , 1994 , i t em 3 reco rds,pp .1 ,15 ,25 ,42 The1997 Ru leso fCiv i l Procedu re ,Ru le 3 ,1 (1997 ) i d . Ru le 8 ,4 JuasingHardware v .Mendoza , 201 Ph i l . 369 (1982 ) Chiang Ka i Shek v . Court o f Appea l s , G .R. No .58028 ,Apri l 18 ,1989 ,172 SCRA389 .

[3 ]

Part i a l PreTri a l O rderda t ed May 2 ,1994 ,ro l lo , p .87 .[4 ]

Part i a l PreTri a l O rderda t ed May 4 ,1994 ,i d .a t 90 91 .[5 ]

Id .a t 107 .[6 ]

CAro l lo , p .39 .[7 ]

Ro l lo , p .50 .[8 ]

G .R.No .149275 ,Sep tember27 ,2004 ,439 SCRA220 ,238 .[9 ]

Heirs o f D icman v . Cario , G .R. No . 146459 , June 8 , 2006 Rivera v . Roman , G .R. No . 142402 ,Sep tember20 ,2005 ,470 SCRA276 ,287 Mercury Drug Corp . v .Libunao , G .R.No . 144458 ,Ju ly 14 , 2004 , 434 SCRA 404 , 413 414 The In su la r Li f e Assurance Company, Ltd . v . Courto f Appea l s , G .R.No .126850 ,Apri l 28 ,2004 ,428 SCRA79 ,86 Agu i rre v .Court o f Appea l s ,G .R. No . 122249 , January 29 , 2004 , 421 SCRA 310 , 319 C & S Fi sh fa rm Corpora t ion v .Court o f Appea l s , 442 Ph i l .279 ,288 (2002 ) Mart inezv .Court o f Appea l s , G .R.No .123547 ,May 21 ,2001 ,358 SCRA38 ,49 (2001 ).

[10 ]RTCDeci sion ,ro l lo , p .99 .

[11 ]Id .

[12 ]Id .a t 104 CADeci sion ,i d .a t 43 .

[13 ]Id .a t 103 CADeci sion ,i d .

[14 ]Id .a t 46 .

[15 ]Id .a t 103 104 .

[16 ]Id .a t 42 ,44 .

[17 ]Id . a t 104 CADeci sion , i d . a t 42 ,46 .See THECIVILCODEOFTHEPHILIPPINES, R.A . 386 ,

asamended ,A rt i c l es19 21 ,2219 (1950 ).[18 ]

See PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 322 (1988 ) (d i scussing the co rpo ra t el i ab i l i t y o fhosp i t a l sa ri sing fromthe fa i l u re t o fu rn i sh safe and re l i ab l e equ ipmen t ).

[19 ] See Ramos v . Court o f Appea l s, 378 Ph i l . 1198 , 1241 (1999 ), c i t i ng JOSE O . VITUG,

COMPENDIUMOFCIVILLAWANDJURISPRUDENCE822 (1993 ).[20 ]

The p rimary du t i es o f a hosp i t a l a re t o fu rn i sh safe and wel l main t a ined p remises, t o p rov ideadequate and safe equ ipmen t ,and to exerc i se reasonab le care i n t he se l ec t i on o f t he memberso f t he hosp i t a l st aff. See PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 310 11 , 321 29(1988 ). A hosp i t a l conducted fo r p riva t e ga in i s under a du ty t o exerc i se o rd inary care i nfu rn i sh ing i t s pa t i en t s a su i t ab l e and safe p l ace . If an unsafe cond i t i on o f t he hosp i t a l sp remises causes an i n ju ry , t here i s a b reach o f t he hosp i t a l s du ty . 40A AM. JUR. 2DHosp i ta l s and Asylums 35 (1999 ), c i t i ng Sharpe v . Sou th Caro l ina Dep t . o f Men ta l Hea l th ,281 S.C.242 ,315 S.E.2d 112 (1984 ) Uni t ed West ern Med ica l Cen ters v . Superio rCourt , 42Cal .App .4 th 500 ,49 Cal .Rp t r.2d 682 (4 th D i st .1996 ).Where t he pat i en t refu ses t o l eave ap riva t e hosp i t a l i n sp i t e o f t he o rder fo r h i s d i scharge , he may do so and con t inue t o st ay i nthat hosp i t a l , p rov ided the co rrespond ing hosp i t a l b i l l i s p roperly sa t i sfi ed and w i th t heconsen t o f t he a t t end ing physi c i an . PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 336(1988 ).The re l a t i onsh ip between the hosp i t a l as a p riva t e co rpo ra t e en t i t y and the admi t t edpat i en t i s one p rinc ipal ly governed by con t rac t .Th i s conclu sion st ems from the genera l ru l e

t h a t t he managemen t and opera t i on o fa p riva t e hosp i t a l a re governed by the ru l esapp l i ed i nthe case o f p riva t e co rpo ra t i ons genera l l y , excep t asmod i fi ed by st a tu t e .See 40AAM. JUR.2D Hosp i ta l s and Asylums 13 (1999 ), c i t i ng Burri s v .Morton F. Plan t Hosp i ta l , 204 So . 2d521 (1967 ).Thecon t rac t be tween the p riva t e hosp i t a l and the pat i en t no rmal ly st i pu l a t es t hecond i t i ons o f admission . See , e .g ., 9A AM. JUR. LEGAL FORMS 2D 136 :63 . As t hepet i t i oner i sa p riva t e hosp i t a l asopposed to a pub l i c one , i t i sg iven more l eeway in mak ingru l es and regu la t i ons as regard s t he admission o f pa t i en t s, hosp i t a l fac i l i t i es, se l ec t i on o fst aff, among o thers, p rov ided tha t such ru l es and regu la t i ons are no t arb i t rary ,d i scriminato ry , un reasonab le , monopo l i st i c , o r con t rary t o l aw o r pub l i c po l i cy , PEDRO P.SOLIS,MEDICALJURISPRUDENCE310 (1988 ).

[21 ]

See , e .g .,Tan v .Vi l l apaz , G .R.No . 160892 ,November 22 , 2005 , 475 SCRA 720 , 727 Nau t i caCann ing Corp . v . Yumu l , G .R. No . 164588 , October 19 , 2005 , 473 SCRA 415 , 423 Jard ineDavies, Inc .v .JRBRea l t y , Inc . , G .R.No .151438 , Ju ly 15 , 2005 , 463 SCRA555 , 561 Lim v .Chua toco , G .R. No . 161861 , March 11 , 2005 , 453 SCRA 308 , 316 Chico v . Court o fAppea l s , 348 Ph i l .37 ,43 (1998 ).

[22 ]TSN,October5 ,1995 ,pp .53 54 .

[23 ]TSN,Sep tember7 ,1995 ,p .13 .The exact da t e when responden t Chua ac tual ly l e ft t h e hosp i t a l

i sunderd i spu te ,wh ich i se i t herJune 4 o rJune 5 ,1992 .[24 ]

See TSN,August 22 , 1996 , p . 1 34 (o ffering Dr. Rody Sy as rebu t t a l w i tness fo r responden t sand whose cred ib i l i t y had no t been impeached ).

[25 ]TSN,June 24 ,1994 ,pp .16 ,32 .

[26 ]TSN,Sep tember7 ,1995 ,p .6 .

[27 ]Id .a t 8 ,13 .

[28 ]Id .a t 13 .

[29 ]Id .a t 8 9 .

[30 ]Id .a t 7 ,10 .

[31 ]TSN,August 22 ,1996 ,p .7 (t est i fy ing asw i tnessfo rt he responden t s).

[32 ]TSN,August 15 ,1996 ,p .13 .

[33 ]Sup ra no t e 31 .

[34 ]Sup ra no t e 32 .

[35 ]Sup ra no t e 31 .

[36 ]Id .a t 9 .

[37 ]TSN,Sep tember7 ,1995 ,p .10 .

[38 ]TSN,August 22 ,1996 ,p .22 .

[39 ]TSN,Sep tember7 ,1995 ,p .7 .

[40 ]Id .a t 15 .

[41 ]Sup ra no t e 37 .

[42 ]Sup ra no t e 38 .

[43 ]TSN,Sep tember7 ,1995 ,pp .12 13 .

[44 ]Id .

[45 ]Id .a t 14 .

[46 ]Id .a t 18 .

[47 ]Id .a t 6 7 .

[48 ]Id .a t 8 .

[49 ]Id .a t 11 .

[50 ]Id .a t 7 ,10 ,12 TSN,August 22 ,1996 ,sup ra .

[51 ]TSN,June 24 ,1994 ,p .32 .

[52 ]TSN,January 19 ,1996 ,p .12 TSN,October5 ,1995 ,pp .75 ,76 .

[53 ]TSN,October5 ,1995 ,p .76 .

[54 ] A l though there i s some inconsi st ency as t o t he exact da t es when the hosp i t a l admin i st ra to r,

Si st er Galeno , consu l t ed w i th t he docto rs, due t o memory l ap se o f t he w i tnesses, i t i s fa i rl yest ab l i shed tha t i t was done du ring a reasonab le t ime befo re t he removal . See TSN, October5 , 1995 , pp . 12 , 76 77 TSN, August 22 , 1996 , p . 17 (Dr. Rody Sy t est i fy ing fo r t heresponden t sasrebu t t a l w i tness).

[55 ]TSN,August 22 ,1996 ,p .13 .

[56 ]Id .a t 12 13 .

[57 ]Sup ra no t e 55 .

[58 ]Id .a t 18 .

[59 ]TSN,Sep tember7 ,1995 ,p .17 TSN,August 22 ,1996 ,p .19 .

[60 ]TSN,August 22 ,1996 ,p .14 .

[61 ]Id .a t 22 .

[62 ]Id .a t 19 .

[63 ]Id .a t 28 .

[64 ]

TSN,October5 ,1995 ,p .32 .[65 ]

Id .a t pp .14 ,18 19 .[66 ]

TSN,Sep tember7 ,1995 ,p .16 .[67 ]

Id .[68 ]

Id .a t 21 22 .[69 ]

Id .[70 ]

TSN,October5 ,1995 ,p .48 .[71 ]

TSN, Sep tember 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 ]

Sup ra no t e 46 .[74 ]

TSN,June 24 ,1994 ,pp .16 ,31 32 .[75 ]

Sup ra no t e 46 .[76 ]

SpousesCustod io v .Court o f Appea l s , 323 Ph i l .575 ,585 586 (1996 ).See Expert ravel &Tours,Inc . v . Court o f Appea l s , 368 Ph i l . 444 , 448 449 (1999 ) (summari z ing the ru l es on moraldamages).

[77 ]346 Ph i l .872 (1997 ).

[78 ]Id . at 884 885 .

[79 ]TSN,October5 ,1995 ,p .28 .

[80 ]Id .a t 12 ,27 .

[81 ]Id .a t 26 ,31 32 .

[82 ]Id .a t 12 ,31 ,42 .

[83 ]Id .a t 26 .

[84 ]Id .a t 5 .

[85 ]Id .a t 30 31 .

[86 ]Exh ib i t 5 .

[87 ]Id . TSN,October5 ,1995 ,p .29 .

[88 ]TSN,October27 ,1994 ,p .13 TSN,October5 ,1995 ,pp .27 29 .

[89 ]Exh ib i t 1 .

[90 ]TSN,October5 ,1995 ,p .17 .

[91 ]Id . a t 31 , 42 Part i a l PreTri a l O rder da t ed May 4 ,1994 ,ro l lo , pp . 90 91 RTCDeci sion , i d . a t

94 95 .[92 ]

TSN,June 24 ,1994 ,pp .27 28 TSN,August 15 ,1996 ,p .14 .[93 ]

TSN,June 24 ,1994 ,pp .6 ,9 ,36 .[94 ]

TSN,October27 ,1994 ,p .34 TSN,October5 ,1995 ,pp .44 45 .[95 ]

RTCDeci sion ,ro l lo , p .106 .Th i sconclu sion had been imp l i ed ly affi rmed by the CA.See TSN,Ju ly 1 ,1994 ,p .17 (responden t Ty t est i fy ing tha t she wasfo rced to sign t he p romisso ry no t esand execu te t he postdat ed checks as a cond i t i on fo r t he re l ease o r d i scharge o f her mo ther,responden t Chua).See al so i d .a t 21 .

[96 ]TSN,Sep tember14 ,1995 ,pp .18 19 ,23 .

[97 ]Id .a t 35 .

[98 ]Id . a t 17 18 , 22 , 32 TSN,October5 ,1995 , p . 25 . It can be observed from the t est imon ies t ha t

t he d i scharge o rder i ssued by the a t t end ing physi c i an i s a d i scharge from a med ica lst andpo in t , wh i l e t he d i scharge o r c l earance i ssued by the Nursing St a t i on , Accoun t ing ,Cash ier, Secu ri t y , o r t he o ther departmen t swhose funct ionsmay be admin i st ra t i ve i n na tu rerefer t o mat t ers no t so l e ly con fined to med ica l aspect s, such as t he se t t l emen t o f dues,deposi t s o r b reakage, a l l o f wh ich depend on the ru l es and regu la t i ons as wel l as hosp i t a l

po l i cy .[99 ]

TSN,October5 ,1995 ,p .26 TSN,Sep tember14 ,1995 ,p .23 24 .[100 ]

Id . i d .[101 ]

TSN,Sep tember14 ,1995 ,pp .23 24 .[102 ]

TSN,October5 ,1995 ,pp .26 27 ,48 49 .[103 ]

Sup ra no t e 101 .[104 ]

See PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 305 307 (1988 ) (d i scussing the variouscl assi fi ca t i onso fhosp i t a l s).

[105 ]TSN,October5 ,1995 ,pp .49 50 .

[106 ]Exh ib i t sBto B1 .

[107 ]TSN,October5 ,1995 ,pp .40 42 .

[108 ]

PEDROP.SOLIS,MEDICALJURISPRUDENCE338 (1988 ),c i t i ng Gadsden Genera l Hosp i ta lv .Hami l ton , 103 So .553 (1925 ).See LOUIS J.REGAN,DOCTORANDPATIENTANDTHELAW113 (1949 ),c i t i ng Cookv .H igh land Hosp i ta l , 84 S.E.352 In re Carl sen ,130 Fed .379 Re Baker, 29 How. Pr. (N .Y .) 485 Ol le t v . Pi t t sburgh , C .C. & St . L. R. Co . (Pa .), 50 A t l .1011 Lord v .Claxton (Ga.),8 S.E.2d 657 .

[109 ]PEDROP.SOLIS,MEDICALJURISPRUDENCE338 (1988 ).

[110 ] C.R.A . MARTIN, LAW RELATING TO MEDICAL PRACTICE 340 41 (1979 ) (c i t a t i onsomi t t ed ).

[111 ]PEDROP.SOLIS,MEDICALJURISPRUDENCE338 (1988 ).

[112 ]C.R.A .MARTIN,LAWRELATINGTOMEDICALPRACTICE41 (1979 )(c i t a t i onsomi t t ed ).

[113 ] As opposed to a p riva t e chari t ab l e o r e l eemosynary hosp i t a l . PEDRO P. SOLIS, MEDICALJURISPRUDENCE306 7 (1988 )

[114 ] 40A AM. JUR. 2D Hosp i ta l s and Asylums 8 (1999 ), c i t i ng Port er v . McPherson , 198 W. Va.158 ,479 S.E.2d 668 (1996 ).

[115 ]Id . c i t i ng Trevino v .HHLFinancia l Serv i ces,Inc . , 945 P.2d 1345 (Co lo .1997 ).

[116 ]TSN,October5 ,1995 ,pp .43 44 ,58 59 ,62 .

[117 ]See 40AAM.JUR.2D Hosp i ta l sand Asylums8 (1999 ), ci t i ng Heart land Hea l th Syst ems, Inc .v .Chamberl in , 871 S.W.2d 8 (1993 ).

[118 ]TSN,October27 ,1994 ,p .26 27 .

[119 ]G .R.No .149275 ,Sep tember27 ,2004 ,439 SCRA220 .

[120 ]Id . at 230 233 .

[121 ]Ro l lo , p .44 .

[122 ]Id .a t 103 .

[123 ]Id .a t 42 .

[124 ]Sup ra no t e 121 .

[125 ]Sup ra no t e 122 i d .a t 43 .

[126 ]Id .a t 46 .

[127 ] See THE CIVIL CODE OF THE PHILIPPINES, Repub l i c Act No . 386 , as amended , A rt i c l e2219 (1950 ).

[128 ]See Soberano v .Man i la Ra i l road Company , 124 Ph i l .1330 ,1337 (1966 ) S t rebel v . Figueras ,96 Ph i l .321 ,330 (1954 ) Araneta v .Arreg lado , 104 Ph i l .529 ,533 (1958 ).

[129 ]

Reco rds,pp .178 197 .[130 ]

TSN,August 15 ,1996 ,pp .4 5 .[131 ]

TSN,October 27 , 1994 , pp . 8 , 10 11 , 24 27 , 32 33 TSN,October 5 , 1995 , pp . 18 , 21 , 26 , 35 36 ,51 53 TSN,January 25 ,1996 ,8 9 ,12 .

[132 ]Exh ib i t 1 .

[133 ]Exh ib i t s1 a and 1 b .

[134 ]Exh ib i t s2 t o 2 c .

[135 ]Exh ib i t s3 t o 4 b .

[136 ]Exh ib i t s11 ,11 b Exh ib i t s13 t o 14 a Exh ib i t s16 t o 16 d .

[137 ]Ro l lo , pp .94 95 Part i a l PreTri a l O rderda t ed May 4 ,1994 ,i d .a t 90 91 .

[138 ]TSN,Ju ly 1 ,1994 ,pp .5 ,8 ,19 22 .

[139 ]Id .a t 5 ,9 10 .

[140 ]Tyv .Peop le o f t he Ph i l i pp ines,sup ra no t e 8 ,a t 234 .

[141 ]Ro l lo , p .47 .

[142 ]Thed i sposi t i ve po rt i on o fTyv .Peop le st a t es: \

WHEREFORE,t he i n st an t Pet i t i on i sDENIEDand the assa i l ed Deci sion o f t heCourt o f Appeal s, da t ed 31 Ju ly 2001 , fi nd ing pet i t i oner V icky C. Ty GUILTY o fv io l a t i ng BatasPambansa Bi l ang 22 i sAFFIRMEDwi th MODIFICATIONS. Pet i t i onerV icky C. Ty i s ORDERED to pay a FINE equ ival en t t o doub le t he amoun t o f eachd i shono red check sub jec t o f t he seven cases a t bar w i th subsid i ary impri sonmen t i ncase o f i n so lvency in acco rdance w i th Art i c l e 39 o f t he Rev i sed Penal Code. She i sa l so o rdered to pay p ri va t e comp la inan t , Man i la Docto rs' Hosp i ta l , t h e amoun t o fTwo Hundred Ten Thousand Pesos(P210 ,000 .00 )represen t ing the t o ta l amoun t o f t hed i shonored checks.Cost sagain st t he pe t i t i oner.

SO ORDERED.

(emphasi ssupp l i ed )

[143 ] THE CIVIL CODE OF THE PHILIPPINES, Repub l i c Act No . 386 , as amended , A rt . 2208(1950 ) (In a l l cases, t he a t t o rneys fees and expenses o f l i t i g a t i on must be reasonab le .). See ,e .g ., Paci f i c Mi l l s, Inc . v . Court o f Appea l s , G .R. No . 87182 , Feb ruary 17 , 1992 , 206 SCRA317 .

[144 ]Sect ion 1 o ft he d raft b i l l .

[145 ]Sect ion 2 o ft he d raft b i l l .

[146 ]Where quest i ons o f const i t u t i onal si gn i fi cance are ra i sed , t he Cou rt can exerc i se i t s power o fjud i c i a l rev i ew on ly i f t he fo l l ow ing requ i si t es are comp l i ed : Fi rst , t h ere must be befo re t heCourt an ac tual case ca l l i ng fo r t he exerc i se o f j ud i c i a l rev i ew . Second , t he quest i on befo re

t h e Cou rt must be ri pe fo rad jud i ca t i on .Th i rd , t he person chal l eng ing the val id i t y o f t he ac tmust have st and ing to chal l enge . Fou rth , t he quest i on o f const i t u t i onal i t y must have beenra i sed a t t he earl i est oppo rtun i ty , and l ast l y , t he i ssue o f const i t u t i onal i t y must be t he veryl i s mo ta o f t he case . Al l i ed Banking Corpora t ion v . Quezon Ci t y Governmen t , G .R. No ,154126 ,October11 ,2005 ,472 SCRA303 ,317 Board o f Op tomet ry v .Co le t , 328 Ph i l .1187 ,1205 (1996 ) Garcia v .Execu t i ve Secre ta ry , G .R.No . 100883 ,December 2 , 1991 , 204 SCRA516 , 522 San to s III v . Northwest Ori en t Ai rl i nes , G .R. No . 101538 , June 23 , 1992 , 210SCRA256 ,261 .

[147 ] See Posi t i on Paper da t ed Sep tember 22 , 2004 , submi t t ed by the Ph i l i pp ine Med icalAssoci a t i on fo r t he p resen t a t i on i n t he pub l i c hearing fo r t he Commi t t ee o f Heal th andDemography ,Senat e ,Repub l i c o ft he Ph i l i pp ines.