DR. VICTORIA L. BATIQUIN and ALLAN BATIQUIN, petitioners, vs. COURT OF APPEALS, SPOUSES QUEDO D. ACOGIDO and FLOTILDE G. VILLEGAS, respondents.
FACTS: Dr. Batiquin with the assistance of other doctors performed a simple cesarian section on Mrs. Villegas, the respondent. After delivering her first child, she remained confined in the hospital for about seven days. After leaving the hospital, Mrs. Villegas began to suffer abdominal pains and complained of being feverish. She also suffered loss of appetite. She consulted Dr. Batiquin about it and the doctor prescribed her medicines which Mrs. Villegas took for about three months. The pains and fever however kept up and became even worse. She also lost weight rapidly. She consulted with another doctor, Dr. Kho who examined her. Dr. Kho took an x-ray of Mrs. Villegas chest, abdomen and kidney and found a mass inside her abdominal cavity. She suggested another surgery to which Mrs. Villegas agreed. When Dr. Kho opened the abdomen of Mrs. Villegas, she found whitish-yellow discharge inside, an ovarian cyst on both the left and right ovaries which gave out pus, dirt and pus behind the uterus and a rubber material on the right side of the uterus. This rubber material found could have been a torn section of a surgeons gloves, causing infection to the ovaries, a reason why Mrs. Villegas has been suffering the symptoms. Upon learning that she was being charged, Dr. Batiquin confronted Dr. Kho about the rubber material and the latter doctor replied that there was indeed rubber but she threw it away.
The trial court ruled in favour of Dr. Batiquin seeing that there were inconsistencies between Dr. Kho and Mrs. Villegas statement wherein Dr. Kho stated that she sent this rubber material to a phatologist and Dr. Batiquin stated that Dr. Kho threw it away. On appeal, the CA reversed the decision of the trial court, finding that the fault or negligence of Dr. Batiquin needs only preponderance of evidence. And the testimony of Dr. Kho has made it credible that there was indeed a rubber material that was found inside the abdomen of Mrs. Villegas.
ISSUE: Whether or not Dr. Batiquin was negligent for leaving the piece of rubber inside her patients abdomen.
RULING: YES.
The rule of res ipsa loquitur comes to force. This doctrine [res ipsa loquitur] is stated thus: "Where the thing which causes injury is shown to be under the management of the defendant, and the accident is such as in the ordinary course of things does not happen if those who have the management use proper care, it affords reasonable evidence, in the absence of an explanation by the defendant, that the accident arose from want of care."
In the instant case, all the requisites for recourse to the doctrine are present. First, the entire proceedings of the cesarean section were under the exclusive control of Dr. Batiquin. In this light, the private respondents were bereft of direct evidence as to the actual culprit or the exact cause of the foreign object finding its way into private respondent Villegas' body, which, needless to say, does not occur unless through the intervention of negligence. Second, since aside from the cesarean section, private respondent Villegas underwent no other operation which could have caused the offending piece of rubber to appear in her uterus, it stands to reason that such could only have been a by-product of the cesarean section performed by Dr. Batiquin. The petitioners, in this regard, failed to overcome the presumption of negligence arising from resort to the doctrine of res ipsa loquitur. Dr. Batiquin is therefore liable for negligently leaving behind a piece of rubber in private respondent Villegas' abdomen and for all the adverse effects thereof. ROGELIO E. RAMOS and ERLINDA RAMOS, in their own behalf and as natural guardians of the minors, ROMMEL RAMOS, ROY RODERICK RAMOS and RON RAYMOND RAMOS, petitioners, vs. COURT OF APPEALS, DELOS SANTOS MEDICAL CENTER, DR. ORLINO HOSAKA and DRA. PERFECTA GUTIERREZ, respondents. FACTS: When Erlinda Ramos suffered discomfort, she sought for professional advice and was advised to undergo an operation for the removal of a stone in her gall bladder. She and her husband met up with Dr. Orlino Hozoka who decided that Ramos should undergo a cholecystectomy. He agreed to choose the anaesthesiologist and charged a fee of Php 16,000 which shall cover the anesthesiologists fee, payable after the operation. During the operation, Herminda Cruz, Erlindas sister-in-law stayed in the operating room as the patients moral support. The plan was to operate Elinda on June 13, 1988 at 9:00 in the morning. However, that day of the operation, the operation started past 1200 in the noon because Dr. Hosaka came very late about three hours after the scheduled operation. They prepared the patient for operation. Dr. Gutierrez, the assigned anesthesiologist started intubating the patient, however she remarked that ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan. Herminda noticed bluish discoloration of the nailbeds of the left hand of Erlinda. Dr. Hosaka called for another anesthesiologist, Dr. Calderon. The patient was placed in a trendelenburg position - a position where the head of the patient is placed in a position lower than her feet which is an indication that there is a decrease of blood supply to the patients brain. By 3:00 in the afternoon, Erlinda was taken to the ICU. The hospital asked Drs Guttierez and Hosaka to explain what happened, they said that the patient had bronchospasm (constriction in the muscles of the bronchioles). Erlinda, on the other hand, has been in a comatose condition. She suffered brain damage as a result of the absence of oxygen in her brain for four to five minutes. She also stayed in the hospital for four months with one month in the ICU. Even after release, she still needs constant medical attention. She was diagnose to be suffering from diffuse cerebral parenchymal damage. The petitioners filed a civil case for damages against the doctors and the hospital. RTC of Q.C. ruled against the respondents for negligence. On appeal, the CA reversed the decision of the RTC, finding that the negligence of the respondents did not cause the comatose condition of petitioner. ISSUE: Whether or not Dr. Guttierez, Dr. Hosaka and the hospital were negligent. RULING: YES. The Court of Appeals erred for not applying the DOCTRINE OF RES IPSA LOQUITUR. Before resort to the doctrine may be allowed, the following requisites must be satisfactorily shown: 1. The accident is of a kind which ordinarily does not occur in the absence of someones negligence; 2. It is caused by an instrumentality within the exclusive control of the defendant or defendants; and 3. The possibility of contributing conduct which would make the plaintiff responsible is eliminated. In the above requisites, the fundamental element is the control of the instrumentality. The Supreme Court finds that the damage sustained by Erlinda in her brain prior to a scheduled gall bladder operation presents a case for the application of res ipsa loquitur. Before the operation, Erlina's brain was sound and unaffected. However, after the procedure, this part - the brain - was affected and was injured or destroyed. Erlinda was unconscious when the damage took place and during that time, it was under the immediate and exclusive control of the doctors. Dra. Guiterrez was negligent when she failed to properly intubate the patient. Her defense that she had a hard time inserting the tube in Erlinda's treachea since the latter was obese and has a short neck and has protuding teeth were not convincing. She did not make a prior assessment before starting the procedure, thus, her averment was a mere afterthought, as a means of defense. Pre-operative evaluation of a patient prior to the administration of anesthesia is universally observed to lessen the possibility of anesthetic accidents. This was not properly observed by Dr. Guttierez. And for that, she should be charged for their negligence. Is Dr. Orlino Hosaka liable? YES. It was his responsibility to see to it that those under him perform their task in the proper manner. His negligence can be found in his failure to to determine if his anesthesiologist observed proper anesthesia protocols. No records could state that he verified if Dra Guttierez indeed porperly intubated the patient. He was even three hours late because he was scheduled with another procedure in another hospital. This gave him no time to confer with his anesthesiologist regarding the anesthesia delivery. G.R. No. 150355 July 31, 2006 MANILA DOCTORS HOSPITAL, petitioner, vs. SO UN CHUA and VICKY TY, respondents. FACTS: So Un Chua was admitted in the Manila Doctors Hospital for hypertension and diabetes. Her sister, Judith, was likewise confined for injuries suffered in a vehicular accident. Judith eas later discharged but So Un remained in the hospital. Their balance when Judith left was P435,800. This was later accumulated and Chua was pressured by the hospitla through its Credit and Collection Department to settle her unpaid bills. Chua's daughter, Vicky, promised that she will settle the bills as soon as funds were available. When the balance remain unpaid, the hospital threatened that it will implement "unpleasant measures" if the bill is unsettled. It later made good of its threat by (1) cutting the telephone line and removing the air-con unit of the patient's room; (2) refusing to render medical attendance and to chang the beds and sheets; (3) barring the private nurses or midwives from assisting the patients. Vicky claimed that this has worsened Chua's condition. In addition to the cutting of facilities and "neglect", Vicky and So Un Chua then filed a complaint against the hospital for damages. In its answer, the hospital denied their allegations, claiming that the patient's doctor has advised Chua to be discharged after being confined for one week. The hospital said that Chua insisted on staying. The cutting off of the telephone line and the removal of the aircon unit was also the hospital's way of cost-cutting the patient's bills, which were piling up. The RTC ruled inf favor of Chua and Vicky, saying that the hospital was in bad faith where the actions of the hospital has worsened Chua's condition. On appeal, the CA affirmed the trial court's decision. ISSUE: Whether or not the hospital was guilty of medical negligence. RULING: NO. Evidence shows that there was no harassment on the hospital's part. It sent notices to Vicky who refused to acknowledge the notices and who has avoided the staff. After sending its final notice, the hospital said that if there were no actions to settle the bill, it will be compelled to transfer the patient to a room with a lower rate and to file a legal action against Vicky and her mother. When Vicky won't still acknowledge the bill, the facilities were removed as per hospital policy - "if the patient occupies a private room all to herself; had the room been semi-private shared by other patients, or had it been the ward, the hospital cannot disconnect the facilities since this would unduly prejudice the other patients". Also, there were no medical neglect that occurred as the hospital was diligent in giving the patient the proper care she really needed. As for the facilities, it should be noted that hospital is also a business, and, as a business, it has a right to institute all measures of efficiency commensurate to the ends for which it is designed, especially to ensure its economic viability and survival. In the institution of cost-cutting measures, the hospital has a right to reduce the facilities and services that are deemed to be non-essential, such that their reduction or removal would not be detrimental to the medical condition of the patient. The aircon unit and telephone were non-essential for the care of Chua. They were removed for the sake of the economic necessity and survival. There was also no evidence showing that the hospital neglected the patient. The underlying basis for the award of tort damages is the premise that an individual was injured in contemplation of law. Thus, there must first be the breach of some duty and the imposition of liability for that breach before damages may be awarded; it is not sufficient to state that there should be tort liability merely because the plaintiff suffered some pain and suffering. Spouses Flores vs Spouses Pineda, et.al. (GR 158996) After consultation with Dr. Flores, Teresita was suspected of having diabetes. Her symptoms persisted so she went to UDMC for further consultation with Dr. Flores. Teresita arrived at the hospital, feeling weak. Dr. Flores arrived and did a routine check-up on her. He then ordered the admission of Teresita and to prepare her for an on-call D&C operation to be performed by his wife, Dr. Felicima Flores. Samples of urine and blood from Teresita were taken for laboratory examination. The results of the lab exam were later sent to the spouse doctors, however they were incomplete since they consisted only of the results on the blood sugar and blood count. The doctors, after interviewing the patient and conducting a vaginal exam, performed the D&C operation which lasted only for 10 to 15 minutes. The next day, Teresita was subjected to an ultrasound exam showing that she has an enlarged uterus and myoma uteri. The complete lab test results came in stating that the sugar in her urine was very high. Her conditioned worsened and she was taken to the ICU. It was later found that she has Diabetes Mellitus Type II. Insulin was administered on her but it was too late. She died the next day. Teresitas family instituted a complaint for damages against the two doctors and UDMC, claiming that the death of Teresita was caused by their negligence. The doctors contended that their main concern was to stop the vaginal bleeding. Medical expert witnesses said that the operation should have been suspended, given that the blood test shows that the patient might have diabetes. The RTC and on appeal, the CA, ruled in favour of the Pinedas. Issue: Whether or not Doctros Pineda were negligent in the performance of their duties as medical professionals. Ruling: YES. As in any civil action, the burden to prove the existence of the necessary elements rests with the plaintiff. To successfully pursue a claim, the plaintiff must prove by preponderance of evidence that, one, the physician 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 two, the failure or action caused injury to the patient. Dr. Fredelicto knew before hand that Teresita might be suffering from diabetes, given the symptoms she has complained to him the day she consulted with him. And that day of the operation, the lab results werent complete. The couple doctors should have waited for the full results before subjecting the patient with D&C. Their contention that their main concern was to stop the vaginal bleeding cannot also save them from what they have done. They should have taken into account the increased risk to the patient caused by diabetes. The S.C. states that, If a patient suffers from some disability that increases the magnitude of risk to him, that disability must be taken into account so long as it is or should have been known to the physician. Further, the D&C operation is merely an elective procedure and not an emergency case. The physician must conduct a thorough pre- operative evaluation of the patient first to adequately prepare the patient for the operation and minimize possible risks and complications. They should have also injected insulin in her before they start the operation. In this case, the insulin was administered two days after the operation. Professional Services, Inc vs Natividad and Enrique Agana (G.R. No. 126297 ) Natividad Agana was diagnosed from cancer of the sigmoind. The malignancy of her sigmoind area had spread on her left ovary, necessating the removal of certain portions of it. He obtained the consent from the patients husband, Enrique, to permit Dr. Juan Fuentes to perform hysterectomy on Natividad. Dr. Fuentes completed the hysterectomy while Dr. Ampil completed the operation and closed the incision. However, the operation appeared to be flawed. The attending nurses entered the remarks sponge count lacking 2 and announced to surgeon searched done but to no avail continue for closure in the Record of Operation. Natividad was released a few days later. After two days, Natividad complained of excruciating pain in her anal region. She consulted the doctors who operated on her but was told that the pain was a natural consequence of the operation. She was also recommended to consult an oncologist to examine the cancerous nodes which were not removed during the operation. Natividad went to the US with her husband to seek further treatment. She was told that she was free of cancer. She returned to the Philippines, still suffering from pains. Later, a piece of gauze was found protruding from her vagina. She informed Dr. Ampil about it and the gauze was removed by hand. He informed her that the pain will disappear. However, the pains instensified and Natividad sought treatment at the Polymedic General Hospital. Dr. Ramon Gutierrez detected another gauze, which has now badly infected her vaginal vault. Another surgery was needed to remedy the damage. So, Natividad underwent another surgery. Natividad and her husband filed a complaint against the Professional Services, Inc. (PSI) (owner of the Medical City Hospital), Dr. Ampil and Dr. Fuentes, for negligence, having left two pieces of gauze inside Natividads body. The trial court ruled in favour of Natividad. On appeal, the Court of Appeals found that Dr. Fuentes was not guilty of negligence, invoking the doctrine of res ipsa loquitur. Dr. Ampil, on the other hand, together with the hospital are solidary liable for damages. ISSUE: (1) Whether or not Dr. Ampil was negligent RULING: YES. The elements of medical negligence are: duty, breach, injury and proximate causation. The removal of all sponges is part of a surgical operation. It was Dr. Ampils duty. And if he fails to do so, he leaves the operation incomplete and creates a new condition wherein he has to tell his patient of the new condition and to perform acts that would minimize and avoid untoward results likely to ensue therefrom. In this case, Dr. Ampil was about to close the wound when one of the attending nurses informed him that there were two pieces of gauze missing. They diligently searched the area but found none of the misplaced gauzes so Dr. Ampil directed the closing of the wound. After this, he did not inform Natividad about the two missing pieces of gauze. He even misled her that the pain was a natural consequence to her operation. If he told her earlier about the gauzes, they might have done something about it immediately. Here, the proximate cause is Dr. Ampils negligence. He knew that there were two gauzes missing after the operation, yet he did not inform his patient about them. Worse, he even misled Natividad that everything was normal. (2) Is Dr. Fuentes Negligent? No. The cause of the injury was the fact that there were two pieces of gauze missing and that Dr. Ampil did not act on this problem immediately, further worsening the situation by concealing it to the patient. 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. After Dr. Feuntes completed hysterectomy, he was allowed to leave the operating room. It was then when Dr. Ampil took over and completed the operation. When he was closing the wound and when the nurses discovered the lost gauzes, Dr. Fuentes was out of the hospital.