G.R. No.

150355

July 31, 2006

MANILA DOCTORS HOSPITAL, petitioner,

vs.
SO UN CHUA and VICKY TY, respondents.
DECISION
AUSTRIA-MARTINEZ, J.:
Before this Court is a Petition for Review on Certiorari under Rule 45 questioning the
Decision1 dated October 2, 2001 promulgated by the Court of Appeals (CA) in CA-G.R. CV
No. 61581, which affirmed the Decision dated September 30, 1997 of the Regional Trial
Court (RTC), Branch 159, Pasig City, but which reduced the award of damages.
This case originated from an action for damages filed with the RTC by respondents So Un
Chua and Vicky Ty against petitioner Manila Doctors Hospital. 2 The complaint is premised
on the alleged unwarranted actuations of the petitioner towards its patient, respondent So
Un Chua (Chua), who was confined for hypertension, diabetes, and related illnesses.
The antecedents of the case follow:
On December 13, 1993, respondents filed a Complaint averring that on October 30, 1990,
respondent Chua, the mother of respondent Vicky Ty, was admitted in petitioner's hospital
for hypertension and diabetes; that while respondent Chua was confined, Judith Chua, the
sister of respondent Ty, had been likewise confined for injuries suffered in a vehicular
accident; that partial payments of the hospital bills were made, totaling P435,800.00; that
after the discharge of Judith Chua, respondent Chua remained in confinement and the
hospital bills for both patients accumulated; that respondent Chua was pressured by the
petitioner, through its Credit and Collection Department, to settle the unpaid bills; that
respondent Ty represented that she will settle the bills as soon as the funds become
available; that respondent Ty pleaded to the management that in view of the physical
condition of her mother, respondent Chua, the correspondences relating to the settlement
of the unpaid hospital bills should be relayed to the former; that these pleas were
unheeded by the petitioner; that petitioner threatened to implement unpleasant measures
unless respondent Ty undertakes her mother's obligation as well as the obligation of her
sister, Judith Chua, to pay the hospitalization expenses; that petitioner made good its
threat and employed unethical, unpleasant and unlawful methods which allegedly
worsened the condition of respondent Chua, particularly, by (i) cutting off the telephone
line in her room and removing the air-conditioning unit, television set, and refrigerator, (ii)
refusing to render medical attendance and to change the hospital gown and bed sheets,
and (iii) barring the private nurses or midwives from assisting the patient. Respondents
thus prayed for the award of moral damages, exemplary damages, and attorney's fees.
In its Answer, Amended Answer, and Rejoinder, petitioner specifically denied the material
averments of the Complaint and Reply, and interposed its counterclaims arguing that as
early as one week after respondent Chua had been admitted to its hospital, Dr. Rody Sy,
her attending physician, had already given instructions for her to be discharged, but
respondents insisted that Chua remain in confinement; that, through its staff, petitioner
accordingly administered medical examinations, all of which yielded negative results; that
respondent Ty voluntarily undertook, jointly and severally, to pay the hospital bills for both
patients; that although respondent Ty paid up to P435,000.00, more or less, she reneged
on her commitment to pay the balance in violation of the Contract for Admission and
Acknowledgment of Responsibility for Payment dated October 30, 1990 which she
voluntarily executed; that she signed a Promissory Note on June 5, 1992 for the unpaid
balance of P1,075,592.95 and issued postdated checks to cover the same; that no such
undue pressure had been imposed upon respondent Chua to settle the bills, the truth
being that, as a matter of standard procedure, the reminders to settle the bills were

transmitted not to the patients but to their relatives who usually undertook to pay the
same; that respondent Ty deliberately evaded the staff of the Credit and Collection
Department; that the cutting-off of the telephone line and removal of the air-conditioning
unit, television set, and refrigerator cannot constitute unwarranted actuations, for the
same were resorted to as cost-cutting measures and to minimize respondents' charges
that were already piling up, especially after respondent Ty refused to settle the balance
notwithstanding frequent demands; that respondent Ty evaded the staff when the latter
attempted to inform her that the room facilities will be cut off to minimize the rising
charges; and that respondents instituted the present civil case purposely as leverage
against the petitioner after the latter had filed criminal charges for violation of Batas
Pambansa (B.P.) Blg. 22 against respondent Ty for issuing checks, later dishonored, totaling
P1,075,592.95, the amount referring to the unpaid hospital bills. In its compulsory
counterclaim, petitioner prayed, among other items, for the award of no less than
P1,000,000.00 as compensatory damages due to the filing of a malicious and unfounded
suit, and, in its permissive counterclaim, petitioner prayed for respondents to pay
P1,075,592.95, the amount representing the due and demandable obligation under the
Promissory Note dated June 5, 1992, including the stipulated interest therein and the 25
percent of the total amount due as attorney's fees.
During pre-trial, the parties stipulated on the following issues: First, whether the
respondents are liable to the petitioner to pay the hospital bills arising from the
hospitalization of respondent Chua and Judith Chua; and second, whether the parties are
entitled to their respective claims for damages. 3 Furthermore, the parties stipulated on the
following facts: a) Judith Chua was confined from June 14, 1991 to May 2, 1992; b)
respondents failed to pay the balance despite repeated reminders; c) the said reminders
referred to the hospital bills of respondent Chua and Judith Chua; d) one of the attending
physicians of respondent Chua was Dr. Rody Sy; and e) the petitioner ordered the removal
of the facilities in question from the room of its patient, respondent Chua, with the
qualification that they were constrained to discontinue the same after the representative
of respondent Chua refused to update the hospital bills or refused to transfer her to semideluxe room or ward to lessen costs.4
On September 30, 1997, the RTC rendered its Decision in favor of the respondents, the
dispositive portion of which states:
WHEREFORE, premises considered, judgment on the complaint is hereby
rendered in favor of the [respondents] as against the [petitioner] as follows:
[O]rdering the [petitioner] to pay the [respondents] the following, to wit:
a) P200,000.00 as moral damages;
b) P100,000.00 as exemplary damages; and
c) P50,000.00 as attorney's fees and the amount of P50,000.00 as
litigation costs.
SO ORDERED.5
In brief, the RTC held that the removal of the facilities of the room triggered the
hypertension of respondent Chua; that the petitioner acted in bad faith in removing the
facilities without prior notice; that her condition was aggravated by the pressure employed
by the administration upon her to pay the hospital bills; that the food always came late as
compared to the other patients; that the beddings and clothes of respondent Chua were no
longer changed and, as a result, bed sores emerged on her body; that there was an utter
lack of medical attendance; that, because of these, respondent Chua suffered from selfpity and depression; that petitioner clearly discriminated against the respondents; that
respondent Ty had no choice but to sign the promissory notes in order to secure the
release of her mother, respondent Chua; that the foregoing actuations constitute an abuse
of rights; that petitioner failed to establish the pecuniary loss it suffered and, hence, it is
not entitled to compensatory damages; and that, since the promissory note is a contract of
adhesion, the petitioner is not entitled to the award of attorney's fees as stipulated
thereon.
On appeal to the CA, the petitioner assigned the following errors:

A.
THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERROR BY FINDING THE
ACTUATIONS OF THE ADMINISTRATION OF DEFENDANT-APPELLANT TO BE IN BAD
FAITH, OPPRESSIVE AND UNNECESSARY AS TO MAKE IT LIABLE TO PLAINTIFFSAPPELLEES FOR DAMAGES AND ATTORNEY'S FEES.
B.
THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERROR BY NOT RULING
UPON THE PERMISSIVE COUNTERCLAIM OF DEFENDANT-APPELLANT WITH
RESPECT TO THE P1,075,592.95 REPRESENTING THE HOSPITAL BILL OF
PLAINTIFFS-APPELLEES, WHICH OBLIGATION IS NOT DISPUTED AND WHICH
AMOUNT WAS NEVER CONTROVERTED BY PLAINTIFFS-APPELLEES. 6
On October 2, 2001, the CA promulgated its Decision the dispositive portion of which
reads:
IN VIEW OF ALL THE FOREGOING, the appealed Decision is hereby AFFIRMED with
the modification that the award of moral damages, exemplary damages as well as
attorney's fees is reduced to Seventy Five Thousand Pesos (P75,000.00), Thirty
Thousand Pesos (P30,000.00) and Twenty Thousand Pesos (P20,000.00),
respectively. Litigation costs are hereby deleted. Costs against appellant.
SO ORDERED.7
Apart from the reduction in the award of damages, the CA affirmed all salient portions of
the RTC Decision and declined to disturb the findings of fact.
Petitioner is now before this Court raising essentially the same grounds heard by the CA.
Incidentally, with respect to the related criminal case against respondent Ty, this Court, on
September 27, 2004, promulgated its Decision entitled Ty v. People of the
Philippines,8 which affirmed the decisions of the lower courts finding respondent Ty guilty
of violating B.P. Blg. 22 and ordering her to pay the private complainant, herein petitioner,
the total amount of the dishonored checks.
The petition is impressed with merit.
While, as a rule, only questions of law may be raised in a petition for review
on certiorari under Rule 45, under certain exceptions, the Court may re-examine the
evidence presented by the parties during the trial. At least four exceptions exist in this
case, namely: (a) when the conclusion is a finding grounded entirely on speculation,
surmises, or conjectures; (b) when the judgment is based on a misapprehension of facts;
(c) when the findings of fact are premised on the supposed absence of evidence and
contradicted by the evidence on record; and (d) when the courts a quo manifestly
overlooked certain relevant facts not disputed by the parties and which, if properly
considered, would justify a different conclusion. 9
The principal questions are, first, whether the actuations of the petitioner amount to
actionable wrongs, andsecond, whether the counterclaims of the petitioner can be backed
up by the measure of preponderant evidence.
In brief, the courts a quo concurred in the holding that the petitioner and its staff failed to
take into consideration the physical condition of its patient, respondent Chua, when it
removed the facilities provided in her room; 10 that the removal of these facilities, namely,
the air-conditioner, telephone lines, television, and refrigerator, aggravated the condition
of the patient, triggered her hypertension, and caused her blood pressure to
fluctuate,11 considering that there was no proper ventilation in the room. 12 In view of the
foregoing, the courts a quo concluded that the actuations of the petitioner were
oppressive, unnecessary,13 and anti-social,14 done in bad faith without proper notice, 15 with
no intention other than to harass or irritate the respondents, 16 all of which constitute an
abuse of rights.17

We do not agree. The conclusions of the courts a quo are either haphazard conjectures, or
founded on a misapprehension of facts. The record is replete with evidence that justifies a
different conclusion.
Indeed the operation of private pay hospitals and medical clinics is impressed with public
interest and imbued with a heavy social responsibility. But the hospital is also a business,
and, as a business, it has a right to institute all measures of efficiency commensurate to
the ends for which it is designed, especially to ensure its economic viability and survival.
And in the legitimate pursuit of economic considerations, the extent to which the public
may be served and cured is expanded, the pulse and life of the medical sector quickens,
and the regeneration of the people as a whole becomes more visibly attainable. In the
institution of cost-cutting measures, the hospital has a right to reduce the facilities and
services that are deemed to be non-essential, such that their reduction or removal would
not be detrimental to the medical condition of the patient. 18 For the moment, the question
to be considered is whether the subject facilities are indeed non-essential the airconditioner, telephone, television, and refrigerator the removal of which would cause the
adverse health effects and emotional trauma the respondents so claimed. Corollary to this
question is whether the petitioner observed the diligence of a good father of the family 19 in
the course of ascertaining the possible repercussions of the removal of the facilities prior
to the removal itself and for a reasonable time thereafter, with a view to prevent
damage.20
After an extensive analysis of the record, it becomes rather worrisome to this Court that
the courts a quounreservedly drew their conclusions from the self-serving and
uncorroborated testimonies of the respondents the probative value of which is highly
questionable.21 We hold that the respondents failed to prove the damages so claimed.
The evidence in the record firmly establishes that the staff of the petitioner took proactive
steps to inform the relatives of respondent Chua of the removal of facilities prior thereto,
and to carry out the necessary precautionary measures to ensure that her health and wellbeing would not be adversely affected: as early as around two weeks after her admission
on October 30, 1990, to the time when the facilities had been removed sometime in the
middle of May 1992,22 and even up to the point when she actually left the premises of the
hospital three weeks later, or during the first week of June 1992, 23 the medical condition of
respondent Chua, as consistently and indisputably confirmed by her attending physician,
Dr. Rody Sy, a cardiologist, who was called as witness for both parties, 24 whom even
respondent Chua repeatedly praised to be "my doctor" and "a very good doctor" 25 at that,
and whose statements at times had been corroborated as well by Sister Mary Philip
Galeno, SPC, the Administrator of the hospital and who also happens to be a registered
nurse, had been "relatively well," 26 "ambulatory,"27 "walking around in the room,"28 and
that she was "able to leave the hospital on her own without any assistance;" 29 that
although she complained of symptoms such as dizziness, weakness, 30 and abdominal
discomfort,31 Dr. Sy requested several medical examinations, such as the laboratory tests,
renal tests, MRI, ultrasound, and CT scan, 32 all of which were administered after procuring
the consent of respondent Chua's family 33 as admitted by respondent Ty herself,34 and
even called on other specialists, such as a neurologist, endocrinologist, and
gastroenterologist, to look into her condition 35 and conduct other tests as well36 according
to their fields of specialty, all of which yielded no serious finding; 37 that her illnesses were
"lifelong illnesses"38 at a stage where they cannot be totally removed or
abolished,39 making it clear to her family that "one hundred percent recovery is not
possible" despite being given daily medication in the hospital; 40 but that her condition,
nonetheless, is not serious,41 as the blood pressure is more or less controlled and within
acceptable limits,42 "not that critical to precipitate any acute attack," 43 nor likely to fall into
any emergency,44 nor yet does she require continuous or prolonged hospitalization 45 since
she was stable enough to be treated at home and on an "out-patient" basis, so much so
that Dr. Sy encouraged her to exercise and avoid resting all the time, 46 and recommended
that "anytime she may be discharged" 47 even in just "two weeks after confinement," 48 the
propriety of his order of discharge concurred upon by the other specialists as well, 49 had it
not been for respondents' insistence to stay in the hospital in view of their hope for
absolute recovery50 despite the admission of respondent Chua herself that she cannot
anymore be totally cured.51

It is also undisputed that the hospital administrator, Sister Galeno, prior to the removal of
the facilities, consulted the attending physician, Dr. Sy. 52 To Sister Galeno, also a registered
nurse, the matter of removal and its possible repercussions on the health of the patient, as
a matter of hospital policy, is a critical and sensitive maneuver, and, hence, it is carried
out only after discussing with the doctors to evaluate all important factors. 53The fact of
prior consultation54 as well as the medical determination to the effect that it was safe to
remove the facilities and would cause no harmful effect 55 had been amply corroborated by
respondent Chua's own doctor himself. 56 When Dr. Sy testified as rebuttal witness for the
respondents themselves and whose credibility respondents failed to impeach, he
categorically stated that he consented to the removal since the removal of the said
facilities would not by itself be detrimental to the health of his patient, respondent
Chua.57 And in this respect, he had been advising respondent Ty, the daughter of the
patient, that the facilities, such as the air-conditioner, television, refrigerator, and
telephone, are not absolutely necessary, and, that although they may add to the comfort
of the patient, if absent, they will not cause any significant deterioration of her
condition,58 given that, in his experience as a cardiologist, and after personally attending
respondent Chua on a daily basis before, during, and after the removal and even up to the
time of her actual discharge, 59 he concluded that many hypertensive and diabetic patients,
as in her case, do not at all need in particular an air-conditioning unit, among the other
facilities aforementioned.60 And, contrary to the findings of the courts a quo and the selfserving testimonies of respondents that the lack of ventilation, after the removal of the airconditioner, triggered her hypertension, Dr. Sy categorically stated that during his daily
rounds with the patient he was certain that, although admittedly the blood pressure in
general would fluctuate daily, there had been no adverse effect on her, and that her blood
pressure were within acceptable limits,61 especially considering that he treated the patient
on a daily basis up to the point of actual discharge, 62 and accordingly, as confirmed by the
medical records, he made no change in the medications thereafter. 63 In support of Dr. Sy's
findings, Sister Galeno, testified that she knew the condition of the ventilation of the
patient's deluxe room, located at the fifth floor, even without the air-conditioning, notably
in times of brownout, and that there had been enough ventilation since the grilled window
of that room was large enough which, if opened, would permit sufficient ventilation. 64 The
Court finds that the premise of the RTC judgment refers merely to hypothetical statements
which fail to establish any clear and direct link to the injury allegedly suffered by the
patient:
Q You found it safe to remove these facilities from the room of the patient
suffering from diabetes and hypertension?
A Yes, Sir. Many hypertensive, diabetic patients do not need air-conditioning, or
T.V. or refrigerator.
Q Do you agree with me that hypertension is triggered sometimes by
excitement, anger or (sic) a person suffering from such illness?
A Hypertension can be triggered by anything.
Court:
Q And even in other words the discomfort can also trigger?
A Sometimes mental stress can trigger.
xxxx
Court:
Q You mentioned earlier that this hypertension may be triggered mentally?
A Yes, Your Honor.
Court:
Q Will the removal of these facilities not affect the patient including the
relatives?
A It may to a certain extent. And well, maybe the days after the removal would
prove that fluctuation in blood pressure are within acceptable limits. 65
With respect to the findings of the courts a quo that bed sores appeared on the body of
respondent Chua, that she suffered from depression after the disconnection of the said
facilities, that her private midwives were barred, and that the delivery of food was
delayed, this Court holds, as above, that these conclusions are bereft of sound evidentiary
basis, self-serving and uncorroborated as they are. Again, Dr. Sy affirmed that during the
daily rounds he would make on the patient, he did not detect any skin lesion or any other
abnormality up to the time she was actually discharged. 66 Nor did he find any sign of
depression, although, admittedly, he observed that she had been "very angry" because of

the removal of the facilities. 67 All the while he did not receive any complaint from
respondent Chua indicating that she suffered from the foregoing infirmities, 68 considering
that it is the responsibility of the family of the patient to specifically inform the attending
physician or the nurses during their rounds whatever they feel is important, or if there
were any new developments since the last visit. 69 As corroborated by Sister Galeno,
throughout respondent Chua's confinement, she never received any complaint from the
latter or her relatives that she had not been attended to by the nursing staff. 70 Worth
noting again is the fact that the nursing staff and the attending physicians, which included
Dr. Sy, in accordance with hospital policy, would routinely make their rounds on a daily
basis, or would visit the patient whenever they are called for any problem, 71 and, in the
case of the specialists other than the attending physician, they would visit the patient
about once a week.72 The nurses, on the other hand, would make their rounds more
frequently, that is, at least once per shift, or every eight hours. 73 Apart from the selfserving statements of respondents, which by now have become rather indicative of being
mere afterthoughts, there is no clear showing from the record that the petitioner and its
medical staff deviated from the foregoing policy and practice, nor had they been called
upon to look into the alleged physical reactions or emotional trauma respondent Chua
claims to have suffered during and after the removal of the facilities. It must be
emphasized that, as stated above, respondent Chua herself explicitly found Dr. Sy to be a
"very good doctor" because he personally attended to her "almost every hour." 74 And
throughout her confinement, Dr. Sy positively stated that her family employed a private
midwife who attended to her all the time.75
The evidence in the record overwhelmingly demonstrates that respondent Chua had been
adequately attended to, and this Court cannot understand why the courts a quo had
declared that there was an "utter lack of medical attendance," or that her health suffered
during the period after the removal of the facilities. The Court finds that the facilities in
question are non-essential for the care of respondent Chua and, hence, they may be
lessened or removed by the petitioner for the sake of economic necessity and survival.
Though human experience would show that the deactivation of the air-conditioner may
cause a temperature differential that may trigger some physical discomfort, or that the
removal of entertainment facilities such as the television set, or the disconnection of
communication devices such as the telephone, may cause some exasperation on the part
of the one who benefits from these, nevertheless, all things considered, and given the
degree of diligence the petitioner duly exerted, not every suppression of the things that
one has grown accustomed to enjoy amounts to an actionable wrong, nor does every
physical or emotional discomfort amount to the kind of anguish that warrants the award of
moral damages under the general principles of tort. The underlying basis for the award of
tort damages is the premise that an individual was injured in contemplation of law. Thus,
there must first be the breach of some duty and the imposition of liability for that breach
before damages may be awarded; it is not sufficient to state that there should be tort
liability merely because the plaintiff suffered some pain and suffering. 76
Moreover, this Court must reiterate the standard of tort to arrive at a proper award for
damages premised on matters that suggest the application of medical knowledge,
especially in the description of the causal link between external or environmental factors,
on one hand, and their effect unto the physical or emotional health of the patient, on the
other, expert opinion, as discussed in Cruz v. Court of Appeals,77 is generally required:
All three courts below bewail the inadequacy of the facilities of the clinic and its
untidiness; the lack of provisions such as blood, oxygen, and certain medicines;
the failure to subject the patient to a cardio-pulmonary test prior to the operation;
the omission of any form of blood typing before transfusion; and even the
subsequent transfer of Lydia to the San Pablo Hospital and the reoperation
performed on her by the petitioner. But while it may be true that the
circumstances pointed out by the courts below seemed beyond cavil to constitute
reckless imprudence on the part of the surgeon, this conclusion is still best
arrived at not through the educated surmises nor conjectures of laymen,
including judges, but by the unquestionable knowledge of expert witnesses. For

whether a physician or surgeon has exercised the requisite degree of skill and
care in the treatment of his patient is, in the generality of cases, a matter of
expert opinion. The deference of courts to the expert opinions of qualified
physicians stems from its realization that the latter possess unusual technical
skills which laymen in most instances are incapable of intelligently evaluating.
Expert testimony should have been offered to prove that the circumstances cited
by the courts below are constitutive of conduct falling below the standard of care
employed by other physicians in good standing when performing the same
operation. It must be remembered that when the qualifications of a physician are
admitted, as in the instant case, there is an inevitable presumption that in proper
cases he takes the necessary precaution and employs the best of his knowledge
and skill in attending to his clients, unless the contrary is sufficiently established.
This presumption is rebuttable by expert opinion which is so sadly lacking in the
case at bench.78
With respect to the propriety of the notice of removal of facilities, the evidence shows that
the hospital staff, accompanied by Sister Gladys Lim, SPC, Finance Administrative
Assistant of the hospital, 79 through written and verbal notices as per hospital policy,
forewarned the respondents, through respondent Ty and her sister, Judith Chua, of the
impending removal of the facilities over a week beforehand 80 in view of their obstinate
refusal to vacate and transfer to a lower rate room81 or to update the mounting hospital
bills82 which, by then, had swollen to approximately one million pesos.83 Respondent Ty
refused to read many of the written notices sent by the Credit
Department.84 After repeated attempts to contact respondent Ty 85 and before the actual
removal of the facilities, the staff of the petitioner tried to personally serve the final notice
dated April 23, 1992,86 signed by Sister Gladys Lim, addressed to respondent Ty, which
adopted the tenor of the prior verbal warnings, and which expressly and sternly warned
the respondents that the hospital shall be constrained to take legal action and that they
shall be compelled to transfer the patient, respondent Chua, to a lower rate room unless
the balance could be satisfied. 87Respondent Ty, for no justifiable reason, and sticking to her
inclination to avoid the staff, refused to receive or acknowledge this letter as well. 88 Worth
noting is that Sister Galeno, testified that, as a matter of hospital policy the tenor of which
respondents, by virtue of the Contract for Admission dated October 30, 1990, agreed to
comply with,89 the hospital can only cut off the non-essential facilities and only in
extreme cases90 if the patient occupies a private room all to herself; had the room been
semi-private shared by other patients, or had it been the ward, the hospital cannot
disconnect the facilities since this would unduly prejudice the other patients. But
respondent Chua herself insisted on staying in a private room despite her being fully
aware of the ballooning charges, 91 and even if she could have freely gone home anytime to
her condominium unit which, as admitted, was equipped with an air-conditioner. 92 With
respect to the "pressure" and "harassment" respondents allegedly suffered daily whenever
the hospital staff would follow up the billing during odd hours, or at 10pm, 11pm, 12
midnight, 1am, or 2am,93 this averment had been convincingly refuted by the witnesses for
the petitioner, namely, Editha L. Vecino, the Head of Credit and Collection, and Sister
Galeno, in that the Credit and Collection Department would only hold office hours from
8am to 5pm and, hence, it is impossible to "harass" the respondents during the times they
so claimed.94
The courts a quo found that respondent Ty had "no choice but to sign the promissory note
in order for her mother to be released from the hospital," 95 thus suggesting that the
hospital refused to actually discharge or bodily release its patient, respondent Chua, until
arrangements had been made to settle the charges.
While there are portions of the testimonies of the witnesses for the petitioner which state
that although, as per standard procedure, the patient "cannot leave" 96 the hospital without
the "discharge,"97 "clearance" or "gate pass" issued only after
arrangements on the settlement of bills had been made, 98 still, it must be understood that
these are only demonstrative of the precondition that a patient cannot step out of the

premises "without the consent" of the hospital, or, in other words, that the "clearance"
merely indicates that the hospital expressly consented to the actual release of the
patient,99 but, even without its consent, the patient is still free to leave "anytime" as a
matter of policy, in spite of the refusal to issue a "clearance" or "gate pass," 100 or even in
cases where the accounts have not yet been liquidated or settled, 101 or yet even if no
promissory note or post-dated check were executed in favor of the petitioner, as testified
by no less than Sister Galeno,102 and corroborated by Editha Vecino;103 and that, petitioner,
a private hospital established for profit, 104 being also a business, by warning respondents
that it shall withhold clearance, is simply exercising its right to protest against an
absconding patient as a precursor to avail of other appropriate legal remedies; that, on the
contrary, the respondents opted not to leave because of their own promise not to leave
unless the hospital bills were fully settled; 105 that the accusations found in the Demand
Letter dated May 19, 1992, and signed by the counsel for the respondents, 106 particularly,
that the petitioner "refused to discharge the patient, [respondent Chua,] despite orders
from the attending physician, Dr. Rody Sy," had all been refuted by Sister Galeno when she
read its contents in front of the counsel for respondents, emphatically telling him that "we
are not detaining his clients;" that "[respondent Ty] was the one who told us that they are
not going to leave the hospital unless they have fully paid the hospital;" 107 and that, most
importantly, no physical restraint upon the person of respondent Chua or upon the person
of her relatives had been imposed by the staff.
Authorities, including those of common law origin, explicitly declare that a patient cannot
be detained in a hospital for non-payment of the hospital bill. If the patient cannot pay the
hospital or physician's bill, the law provides a remedy for them to pursue, that is, by filing
the necessary suit in court for the recovery of such fee or bill. 108 If the patient is prevented
from leaving the hospital for his inability to pay the bill, any person who can act on his
behalf can apply in court for the issuance of the writ of habeas corpus.109
The form of restraint must be total; movement must be restrained in all directions. If
restraint is partial, e.g., in a particular direction with freedom to proceed in another, the
restraint on the person's liberty is not total. 110However, the hospital may legally detain a
patient against his will when he is a detained or convicted prisoner, or when the patient is
suffering from a very contagious disease where his release will be prejudicial to public
health, or when the patient is mentally ill such that his release will endanger public
safety,111 or in other exigent cases as may be provided by law. Moreover, under the
common law doctrines on tort, it does not constitute a trespass to the person to
momentarily prevent him from leaving the premises or any part thereof because he
refuses to comply with some reasonable condition subject to which he entered them. In all
cases, the condition of this kind of restraint must be reasonable in the light of the
circumstances.112 At any rate, as stated above, the patient is free to leave the premises,
even in the ostensible violation of these conditions, after being momentarily interrupted by
the hospital staff for purposes of informing him of those reasonable conditions, such as the
assessment of whether the patient is fit to leave, insane, or suffering from a contagious
disease, etc., or simply for purposes of making a demand to settle the bill. If the patient
chooses to abscond or leave without the consent of the hospital in violation of any of the
conditions deemed to be reasonable under the circumstances, the hospital may
nonetheless register its protest and may choose to pursue the legal remedies available
under law, provided that the hospital may not physically detain the patient, unless the
case falls under the exceptions abovestated.
Authorities are of the view that, ordinarily, a hospital, especially if it is a private pay
hospital,113 is entitled to be compensated for its services, by either an express or an
implied contract, and if no express contract exists, there is generally an implied agreement
that the patient will pay the reasonable value of the services rendered; 114when a hospital
treats a patient's injuries, it has an enforceable claim for full payment for its services,
regardless of the patient's financial status. 115 At this juncture, it must be noted that there is
testimony, though to a degree disputable, to the effect that the execution of the
promissory note and the issuance of postdated checks were conditions imposed not by the
petitioner but voluntarily offered by the counsel for respondents. 116 At any rate, however,
this Court holds, in view of the foregoing authorities, that the requirement to have the
relative of respondent Chua to execute a promissory note as part of the arrangement to

settle the unpaid obligations is a formality that converts any implied contract into written
form and, moreover, amounts to a reasonable condition, the non-fulfillment of which, in
itself, however, as discussed, cannot allow the hospital to detain the patient. It must also
be stressed, contrary to the findings of the courts a quo, that such an agreement
embodied in a promissory note, as well as the Contract for Admission and
Acknowledgment of Responsibility for Payment dated October 30, 1990, do not become
contracts of adhesion simply because the person signing it was under stress that was not
the result of the actions of the hospital, 117 especially taking into account that there is
testimony to the effect that respondent Ty signed the Promissory Note dated June 5, 1992
in the presence of counsel and acting under his advise. 118
But as to the propriety of the circumstances surrounding the issuance of the postdated
checks to cover the amount stated in the Promissory Note dated June 5, 1992, this Court
must refer to the discussion of the recent case of Ty v. People of the Philippines 119 where
this Court affirmed the conviction of respondent Ty for the issuance of bouncing checks
addressed to the petitioner herein. While the instant case is to be distinguished from the
Ty case in nature, applicable law, the standards of evidence, and in the defenses available
to the parties, hence, the judgment of conviction in that case should not at all prejudice
the disposition of this case, even if the facts coincide, nonetheless, for purposes of
convenience and instructive utility, the Court quotes the relevant portions:
In this case, far from it, the fear, if any, harbored by Ty was not real and
imminent. Ty claims that she was compelled to issue the checks a condition the
hospital allegedly demanded of her before her mother could be discharged for
fear that her mother's health might deteriorate further due to the inhumane
treatment of the hospital or worse, her mother might commit suicide. This is
speculative fear; it is not the uncontrollable fear contemplated by law.
To begin with, there was no showing that the mother's illness was so lifethreatening such that her continued stay in the hospital suffering all its alleged
unethical treatment would induce a well-grounded apprehension of her death.
Secondly, it is not the law's intent to say that any fear exempts one from criminal
liability much less petitioner's flimsy fear that her mother might commit suicide.
In other words, the fear she invokes was not impending or insuperable as to
deprive her of all volition and to make her a mere instrument without will, moved
exclusively by the hospital's threats or demands.
Ty has also failed to convince the Court that she was left with no choice but to
commit a crime. She did not take advantage of the many opportunities available
to her to avoid committing one. By her very own words, she admitted that the
collateral or security the hospital required prior to the discharge of her mother
may be in the form of postdated checks or jewelry. And if indeed she was coerced
to open an account with the bank and issue the checks, she had all the
opportunity to leave the scene to avoid involvement.
Moreover, petitioner had sufficient knowledge that the issuance of checks without
funds may result in a violation of B.P. 22. She even testified that her counsel
advised her not to open a current account nor issue postdated checks "because
the moment I will not have funds it will be a big problem." Besides, apart from
petitioner's bare assertion, the record is bereft of any evidence to corroborate and
bolster her claim that she was compelled or coerced to cooperate with and give in
to the hospital's demands.
Ty likewise suggests . . . that the justifying circumstance of state of necessity
under par. 4, Art. 11 of the Revised Penal Code may find application in this case.
We do not agree. The law prescribes the presence of three requisites to exempt
the actor from liability under this paragraph: (1) that the evil sought to be
avoided actually exists; (2) that the injury feared be greater than the one done to

avoid it; (3) that there be no other practical and less harmful means of preventing
it.
In the instant case, the evil sought to be avoided is merely expected or
anticipated. If the evil sought to be avoided is merely expected or anticipated or
may happen in the future, this defense is not applicable. Ty could have taken
advantage of an available option to avoid committing a crime. By her own
admission, she had the choice to give jewelry or other forms of security instead of
postdated checks to secure her obligation.
Moreover, for the defense of state of necessity to be availing, the greater injury
feared should not have been brought about by the negligence or imprudence,
more so, the willful inaction of the actor. In this case, the issuance of the bounced
checks was brought about by Ty's own failure to pay her mother's hospital bills.
The Court also thinks it rather odd that Ty has chosen the exempting
circumstance of uncontrollable fear and the justifying circumstance of state of
necessity to absolve her of liability. It would not have been half as bizarre had Ty
been able to prove that the issuance of the bounced checks was done without her
full volition. Under the circumstances, however, it is quite clear that neither
uncontrollable fear nor avoidance of a greater evil or injury prompted the
issuance of the bounced checks.
Parenthetically, the findings of fact in the Decision of the trial court in the Civil
Case for damages filed by Ty's mother against the hospital is wholly irrelevant for
purposes of disposing the case at bench. While the findings therein may establish
a claim for damages which, we may add, need only be supported by a
preponderance of evidence, it does not necessarily engender reasonable doubt as
to free Ty from liability. 120
In view of the foregoing, the Court therefore holds that the courts a quo committed serious
errors in finding that the petitioner was "biased,"121 "discriminated" against the
respondents,122 and "purposely intended to irritate" 123or "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 aforequoted declarations of the witnesses, significant portions of which this
Court considers as expert testimony, are reliable and remain considerably trustworthy to
controvert respondents' assertions as well as to reverse the conclusions of fact and law of
the CA and the RTC that respondent Chua suffered the physical and emotional anguish so
claimed, and so, for these reasons, the Court holds that the petitioner inflicted no
actionable wrong.
This Court observes that the courts a quo awarded both respondents moral damages. But
it is well-settled that in case of physical injuries, with some exceptions, 127 moral damages
are recoverable only by the party injured and not by her spouse, next of kin, or relative
who happened to sympathize with the injured party. 128 Hence, even if the courts a
quo were correct in their basis for damages, they should have declined to award damages
to respondent Ty.
The last issue to be resolved is the question whether the counterclaims of the petitioner
are supported by a preponderance of evidence.
We agree with the petitioner that the courts a quo seriously erred in mistaking the case of
its compulsory counterclaim for its permissive counterclaim and for failing to consider the
evidence which impressively supports the latter. First, for failure without justifiable cause
of respondents' counsel to comment on the Partial Formal Offer of Evidence dated
February 14, 1996129 filed by the petitioner, the RTC issued an order during the course of
the trial, which counsel for respondents neither contested nor raised on appeal, admitting
Exhibits "1" to "16", together with their submarkings and the purposes for which the same

were offered,130 all of which had also been previously authenticated and their contents
verified by the witnesses for the petitioner. 131 These documents include the Contract for
Admission of respondent Chua dated October 30, 1990, duly executed by respondent Ty,
incorporating therein the rules and regulations of the hospital, including the duty to
understand the same132 as well as the undertaking of respondent Ty to be jointly and
severally liable for the payment of the hospital bills of respondent Chua; 133 the Promissory
Note dated June 5, 1992 in the amount of P1,075,592.95 duly executed by respondent Ty
in favor of the petitioner agreeing to be jointly and severally liable to pay the unpaid
obligations of respondent Chua and Judith Chua, including interest and attorney's fees in
case of default;134 the Undertakings signed by respondent Ty dated March 3, 1992 and
April 7, 1992 to maintain regular deposits;135 and the credit memos and statements of
account that support the amount referring to the unpaid obligation. 136 Second, the parties
stipulated during pre-trial that respondents failed to pay the balance despite repeated
reminders.137 Andthird, respondent Ty in open court identified and admitted that she
signed the Contract of Admission dated October 30, 1990 as well as the Undertakings
dated March 3, 1992 and April 7, 1992 but which, for no justifiable reason, she "did not
bother to read,"138 and, what is more, she repeatedly admitted during the course of the
trial that she failed to fully settle the foregoing hospital bills. 139 In fact, while the Ty case
cannot control the incidents of the instant case as heretofore stated, it is still worth
mentioning, at least for informative purposes, the findings of this Court in Ty with respect
to respondents' obligations to the petitioner:
Ty's mother and sister availed of the services and the facilities of the hospital. For
the care given to her kin, Ty had a legitimate obligation to pay the hospital by
virtue of her relationship with them and by force of her signature on her mother's
Contract of Admission acknowledging responsibility for payment, and on the
promissory note she executed in favor of the hospital. 140
In view of all these findings, the Court earnestly disagrees with the sweeping conclusion of
the CA that "[Petitioner] failed to present any iota of evidence to prove his claim," 141 a
statement apparently referring to the permissive counterclaim of P1,075,592.95. However,
with respect to the compulsory counterclaim predicated on the filing of a baseless suit and
injury to its reputation, petitioner did not raise this matter on appeal and, hence, is
deemed to have waived the same.

dynamism of the legislative process, especially in light of the objections interposed by

interest groups to date.147
WHEREFORE, the petition is GRANTED. The Decision of the Court of Appeals dated
October 2, 2001, together with the Decision dated September 30, 1997 of the Regional
Trial Court in Civil Case No. 63958, is REVERSEDand SET ASIDE. Another judgment is
entered dismissing the Complaint and ordering respondents, jointly and severally, to pay
the petitioner the amount of P865,592.95, with stipulated interest of 12 percent reckoned
from the date of extrajudicial demand until full payment, and 12 percent of the total
amount due as attorney's fees.
No pronouncement as to costs.
SO ORDERED.
Panganiban, C.J., Ynares-Santiago, Callejo, Sr., Chico-Nazario, J.J., concur.

HOSPITAL
MANAGEMENT
- MEDICALCENTER MANILA,
Petitioner,

SERVICES,

INC.

- versus HOSPITAL
MANAGEMENT
SERVICES,
INC. MEDICALCENTER MANILA
EMPLOYEES
ASSOCIATION-AFW and EDNA R. DE CASTRO,
Respondents.

G.R. No. 176287

Present:
CARPIO, J., Chairperson,
NACHURA,
PERALTA,
ABAD, and
MENDOZA, JJ.
Promulgated:
January 31, 2011

But the Court in Ty made a partial finding on the civil liability of respondent Ty with respect
to the amount covered by seven of the several dishonored checks she issued equivalent to
P210,000.00.142 Since this amount forms a fraction of her total civil liability, then this
amount, in deference to Ty, should be deducted therefrom.
The claim for attorney's fees, as stipulated under the Promissory Note dated June 5, 1992,
should be reduced for being unreasonable under the circumstances, from 25 percent to 12
percent of the total amount due.143
As a final word, the Court takes judicial notice of the pending Senate Bill No. 337, entitled
"An Act Prohibiting the Detention of Patients in Hospitals and Medical Clinics on Grounds of
Non-Payment of Hospital Bills or Medical Expenses," which declares, among others, that it
shall be unlawful for any hospital or medical clinic to cause directly or indirectly the
detention of patients for non-payment, in part or in full, of their hospital bills, 144 and,
furthermore, requires patients who have fully recovered and are financially incapable to
settle the hospitalization expenses to execute a promissory note, co-signed by another
individual, to the extent of the unpaid obligation before leaving the hospital. 145 While this
Court may have touched upon these matters in the adjudication of the instant case, it
must be stated that this decision should in no way preempt any constitutional challenge to
the provisions of Senate Bill No. 337 if passed into law, bearing in mind the standards for
the exercise of the power of judicial review 146 as well as the recognition that the tenor of
the bill may adjust with the times, or that the bill itself may fail to pass, according to the

x-----------------------------------------------------------------------------------------x
DECISION
PERALTA, J.:
Before this Court is a petition for review on certiorari seeking to set aside the
Decision[1] dated May 24, 2006 and Resolution[2] dated January 10, 2007 of the Court of
Appeals (CA), Special First Division, in CA-G.R. SP No. 73189, entitled Hospital
Management Services, Inc.-Medical Center Manila Employees Association-AFW and Edna
R. De Castro v. National Labor Relations Commission, Hospital Management Services, Inc.Medical Center Manila and Asuncion Abaya-Morido, which reversed and set aside the
Decision[3] dated February 28, 2002 of the National Labor Relations Commission (NLRC),
Second Division, in NLRC NCR No. 00-07-07716-99 (CA No. 027766-01), and its
Resolution[4] dated May 31, 2002. The assailed CA decision ordered petitioner Hospital
Management Services, Inc.-Medical Center Manila to reinstate respondent Edna R. De
Castro to her former position without loss of seniority rights or by payroll reinstatement,

pursuant to the Labor Arbiter's Decision dated January 18, 2001, but with payment of full
backwages and other benefits or their monetary equivalent, computed from the expiration
of the 14-day suspension period up to actual reinstatement.

payment of full backwages without loss of seniority rights, P20,000.00 moral

damages, P10,000.00 exemplary damages, and 10% of the total monetary award as
attorney's fees.

The antecedent facts are as follows:

On January 18, 2001, the Labor Arbiter rendered a Decision, [8] ordering petitioner hospital
to reinstate respondent De Castro to her former position or by payroll reinstatement, at the
option of the former, without loss of seniority rights, but without backwages and, also,
directing petitioners to notify her to report to work. Her prayer for damages and attorney's
fees was denied. The Labor Arbiter concluded that although respondent De Castro
committed the act complained of, being her first offense, the penalty to be meted should
not be dismissal from the service, but merely 7 to 14 days suspension as the same was
classified as a less serious offense under the Employees Handbook.

Respondent De Castro started working as a staff nurse at petitioner hospital since

September 28, 1990, until she was dismissed on July 20, 1999.
Between 2:00 a.m. to 3:00 a.m. of March 24, 1999, while respondent De Castro and wardclerk orientee Gina Guillergan were at the nurse station on night duty (from 10:00 p.m. of
March 23, 1999 to 6:00 a.m. of March 24, 1999), one Rufina Causaren, an 81-year-old
patient confined at Room 724-1 of petitioner hospital for gangrenous wound on her right
anterior leg and right forefoot and scheduled for operation on March 26, 1999, fell from the
right side of the bed as she was trying to reach for the bedpan. Because of what
happened, the niece of patient Causaren staying in the room was awakened and she
sought assistance from the nurse station. Instead of personally seeing the patient,
respondent De Castro directed ward-clerk orientee Guillergan to check the patient. The
vital signs of the patient were normal. Later, the physician on duty and the nursing staff on
duty for the next shift again attended to patient Causaren.

On appeal by respondent De Castro, the NLRC rendered a Decision dated February 28,
2002, reversing the findings of the Labor Arbiter and dismissing the complaint against the
petitioners. It observed that respondent De Castro lacked diligence and prudence in
carrying out her duty when, instead of personally checking on the condition of patient
Causaren after she fell from the bed, she merely sent ward-clerk orientee Guillergan to do
the same in her behalf and for influencing her staff to conceal the incident.
On May 31, 2002, the NLRC denied respondent De Castro's Motion for Reconsideration
dated April 16, 2002.

Chief Nurse Josefina M. Villanueva informed Dr. Asuncion Abaya-Morido, president and
hospital director, about the incident and requested for a formal investigation. On May 11,
1999, the legal counsel of petitioner hospital directed respondent De Castro and three
other nurses on duty, Staff Nurse Janith V. Paderes and Nursing Assistants Marilou Respicio
and Bertilla T. Tatad, to appear before the Investigation Committee on May 13, 1999, 2:00
p.m., at the conference room of petitioner hospital. During the committee investigation,
respondent De Castro explained that at around 2:30 a.m. to 3:00 a.m., she was attending
to a newly-admitted patient at Room 710 and, because of this, she instructed Nursing
Assistant Tatad to check the vital signs of patient Causaren, with ward-clerk orientee
Guillergan accompanying the latter. When the two arrived at the room, the patient was in
a squatting position, with the right arm on the bed and the left hand holding on to a chair.
In the Investigation Report[5] dated May 20, 1999, the Investigation Committee found that
the subject incident happened between 11:00 a.m. to 11:30 a.m. of March 23, 1999. The
three other nurses for the shift were not at the nurse station. Staff Nurse Paderes was then
in another nurse station encoding the medicines for the current admissions of patients,
while Nursing Assistant Respicio was making the door name tags of admitted patients and
Nursing Assistant Tatad delivered some specimens to the laboratory. The committee
recommended that despite her more than seven years of service, respondent De Castro
should be terminated from employment for her lapse in responding to the incident and for
trying to manipulate and influence her staff to cover-up the incident. As for Staff Nurse
Paderes and Nursing Assistants Respicio and Tatad, the committee recommended that they
be issued warning notices for failure to note the incident and endorse it to the next duty
shift and, although they did not have any knowledge of the incident, they should be
reminded not to succumb to pressure from their superiors in distorting the facts.
On July 5, 1999, Janette A. Calixijan, HRD Officer of petitioner hospital, issued a notice of
termination, duly noted by Dr. Abaya-Morido, upon respondent De Castro, effective at the
close of office hours of July 20, 1999, for alleged violation of company rules and
regulations, particularly paragraph 16 (a), Item 3, Chapter XI of the Employee's Handbook
and Policy Manual of 1996 (Employee's Handbook): [6] (1) negligence to follow company
policy on what to do with patient Rufina Causaren who fell from a hospital bed; (2) failure
to record and refer the incident to the physician-[on- duty and] allow[ing] a significant
lapse of time before reporting the incident; (3) deliberately instructing the staff to follow
her version of the incident in order to cover up the lapse; and (4) negligence and
carelessness in carrying out her duty as staff nurse-on-duty when the incident happened.
On July 21, 1999, respondent De Castro, with the assistance of respondent Hospital
Management Services Inc.-Medical Center Manila Employees Association-AFW, filed a
Complaint[7] for illegal dismissal against petitioners with prayer for reinstatement and

On May 24, 2006, the CA reversed and set aside the Decision of the NLRC and reinstated
the Decision of the Labor Arbiter, with modification that respondent De Castro should be
entitled to payment of full backwages and other benefits, or their monetary equivalent,
computed from the expiration of the 14-day-suspension period up to actual
reinstatement. The CA ruled that while respondent De Castro's failure to personally attend
to patient Causeran amounted to misconduct, however, being her first offense, such
misconduct could not be categorized as serious or grave that would warrant the extreme
penalty of termination from the service after having been employed for almost 9 years. It
added that the subject infraction was a less serious offense classified under commission of
negligent or careless acts during working time or on company property that resulted in the
personal injury or property damage causing expenses to be incurred by the company
stated in subparagraph 11, paragraph 3 (B), Chapter XI [on the Rules on Discipline] of the
Employee's Handbook[9] of petitioner hospital. The CA did not sustain the NLRC's ruling
that respondent De Castro's dismissal was proper on the ground that her offense was
aggravated to serious misconduct on account of her alleged act of asking her coemployees to lie for her as this fact was not proven.
Petitioners' motion for reconsideration was denied by the CA in the Resolution dated
January 10, 2007.
Hence, this present petition.
Petitioners allege that the deliberate refusal to attend to patient Causaren after the latter
fell from the bed justifies respondent De Castro's termination from employment due to
serious misconduct. They claim that respondent De Castro failed to: (a) personally assist
the patient; (b) check her vital signs and examine if she sustained any injury; (c) refer the
matter to the patient's attending physician or any physician-on-duty; and (d) note the
incident in the report sheet for endorsement to the next shift for proper monitoring. They
also aver that respondent De Castro persuaded her co-nurses to follow her version of what
transpired so as to cover up her nonfeasance.
In her Comment, respondent De Castro counters that there was no serious misconduct or
gross negligence committed, but simple misconduct or minor negligence which would
warrant the penalty of 7 to 14 days of suspension under the Employee's Handbook of
petitioner hospital. She denies exerting influence over the four nursing personnel, but
points out that it was Chief Nurse Villanueva, a close friend of patient Causaren's niece,
who persuaded the four nursing staff to retract their statements appearing in the incident
reports as to the approximate time of occurrence, from 2:00 a.m. to 3:00 a.m. of March 24,
1999 to 11:00 p.m. to 11:30 p.m. of March 23, 1999, so as to pin her for negligence. She

appeals for leniency, considering that the subject infraction was her first offense in a span
of almost nine years of employment with petitioner hospital.

omission that falls short of the required degree of care and diligence amounts to serious
misconduct which constitutes a sufficient ground for dismissal.

We affirm with modification the CA ruling which declared petitioners guilty of illegal
dismissal.
Article 282 (b) of the Labor Code provides that an employer may terminate an
employment for gross and habitual neglect by the employee of his duties. The CA ruled
that per the Employees Handbook of petitioner hospital, respondent De Castros infraction
is classified as a less serious offense for commission of negligent acts during working time
as set forth in subparagraph 11, paragraph 3 (B) of Chapter XI [10] thereof. Petitioners
anchor respondent De Castros termination of employment on the ground of serious
misconduct for failure to personally attend to patient Causaren who fell from the bed as
she was trying to reach for the bedpan. Based on her evaluation of the situation,
respondent De Castro saw no necessity to record in the chart of patient Causaren the fact
that she fell from the bed as the patient did not suffer any injury and her vital signs were
normal. She surmised that the incident was not of a magnitude that would require medical
intervention as even the patient and her niece did not press charges against her by reason
of the subject incident.

However, in some cases, the Court had ruled that sanctioning an erring employee
with suspension would suffice as the extreme penalty of dismissal would be too harsh.
[13]
Considering that this was the first offense of respondent De Castro in her nine (9) years
of employment with petitioner hospital as a staff nurse without any previous derogatory
record and, further, as her lapse was not characterized by any wrongful motive or deceitful
conduct, the Court deems it appropriate that, instead of the harsh penalty of dismissal,
she would be suspended for a period of six (6) months without pay, inclusive of the
suspension for a period of 14 days which she had earlier served. Thereafter, petitioner
hospital should reinstate respondent Edna R. De Castro to her former position without loss
of seniority rights, full backwages, inclusive of allowances and other benefits, or their
monetary equivalent, computed from the expiration of her suspension of six (6) months up
to the time of actual reinstatement.

It is incumbent upon respondent De Castro to ensure that patients, covered by

the nurse station to which she was assigned, be accorded utmost health care at all times
without any qualification or distinction. Respondent De Castros failure to personally assist
patient Causaren, check her vital signs and examine if she sustained any injury, refer the
matter to the patient's attending physician or any physician-on-duty, and note the incident
in the report sheet for endorsement to the next shift for proper monitoring constitute
serious misconduct that warrants her termination of employment. After attending to the
toxic patients under her area of responsibility, respondent De Castro should have
immediately proceeded to check the health condition of patient Causaren and, if
necessary, request the physician-on-duty to diagnose her further. More importantly,
respondent De Castro should make everything of record in the patients chart as there
might be a possibility that while the patient may appear to be normal at the time she was
initially examined, an injury as a consequence of her fall may become manifest only in the
succeeding days of her confinement. The patients chart is a repository of ones medical
history and, in this regard, respondent De Castro should have recorded the subject
incident in the chart of patient Causaren so that any subsequent discomfort or injury of the
patient arising from the incident may be accorded proper medical treatment.
Neglect of duty, to be a ground for dismissal, must be both gross and
habitual. Gross negligence connotes want of care in the performance of one's
duties. Habitual neglect implies repeated failure to perform one's duties for a period of
time, depending upon the circumstances. A single or isolated act of negligence does not
constitute a just cause for the dismissal of the employee. [11] Despite our finding of
culpability against respondent De Castro; however, we do not see any wrongful intent,
deliberate refusal, or bad faith on her part when, instead of personally attending to patient
Causaren, she requested Nursing Assistant Tatad and ward-clerk orientee Guillergan to see
the patient, as she was then attending to a newly-admitted patient at Room 710. It was
her judgment call, albeit an error of judgment, being the staff nurse with presumably more
work experience and better learning curve, to send Nursing Assistant Tatad and ward-clerk
orientee Guillergan to check on the health condition of the patient, as she deemed it best,
under the given situation, to attend to a newly-admitted patient who had more concerns
that needed to be addressed accordingly. Being her first offense, respondent De Castro
cannot be said to be grossly negligent so as to justify her termination of
employment. Moreover, petitioners allegation, that respondent De Castro exerted undue
pressure upon her co-nurses to alter the actual time of the incident so as to exculpate her
from any liability, was not clearly substantiated.
Negligence is defined as the failure to exercise the standard of care that a
reasonably prudent person would have exercised in a similar situation. [12] The Court
emphasizes that the nature of the business of a hospital requires a higher degree of
caution and exacting standard of diligence in patient management and health care as
what is involved are lives of patients who seek urgent medical assistance. An act or

WHEREFORE, the petition is DENIED. The Decision dated May 24, 2006 and Resolution
dated January 10, 2007 of the Court of Appeals, Special First Division, in CA-G.R. SP No.
73189, which reversed and set aside the Decision dated February 28, 2002 and Resolution
dated May 31, 2002 of the National Labor Relations Commission, Second Division,
are AFFIRMED WITH MODIFICATION insofar as respondent Edna R. De Castro is found
guilty of gross negligence and is SUSPENDED for a period of SIX (6) MONTHS without
pay, inclusive of the suspension for a period of 14 days which she had earlier
served. Petitioner
Hospital
Management
Services,
Inc.-Medical
Center
Manila
is ORDERED to reinstate respondent Edna R. De Castro to her former position without loss
of seniority rights, full backwages, inclusive of allowances and other benefits, or their
monetary equivalent, computed from the expiration of her suspension of six (6) months up
to the time of actual reinstatement.
SO ORDERED.

DENT v. STATE OF WEST VIRGINIA.

129 U.S. 114 (9 S.Ct. 231, 32 L.Ed. 623)
Decided: January 14, 1889

opinion, FIELD [HTML]

This case comes from the supreme court of appeals of West Virginia. It involves the validity
of the statute of that state which requires every practitioner of medicine in it to obtain a
certificate from the state board of health that he is a graduate of a reputable medical
college in the school of medicine to which he belongs; or that he has practiced medicine in
the state continously for the period of 10 years prior to the 8th day of March, 1881; or that
he has been found, upon examination by the board, to be qualified to practice medicine in

all its departments; and makes the practice of, or the attempt by any person to practice,
medicine, surgery, or obstetrics in the state without such certificate, unless called from
another state to treat a particular case, a misdemeanor punishable by fine or
imprisonment, or both, in the discretion of the court. The statute in question is found in
sections 9 and 15 of an act of the state, c. 93, passed March 15, 1882, amending a chapter
of its Code concerning the public health. St. 1882, pp. 245, 246, 248. These sections are as
follows:
'Sec. 9. The following persons, and no others, shall hereafter be permitted to practice
medicine in this state, viz.: First. All persons who are graduates of a repntable medical
college in the school of medicine to which the person desiring to practice belongs. Every
such person shall, if he has not already done so and obtained the certificate hereinafter
mentioned, present his diploma to the state board of health, or to the two members
thereof in his congressional district, and if the same is found to be genuine, and was
issued by such medical college, as is hereinafter mentioned, and the person presenting the
same be the graduate named therein, the said board, or said two members thereof, (as
the case may be,) shall issue and deliver to him a certificate to that effect, and such
diploma and certificate shall entitle the person named in such diploma to practice
medicine in all its departments in this state. Second. All persons who have practiced
medicine in this state continuously for the period of ten years prior to the 8th day of
March, one thousand eight hundred and eighty-one. Every such person shall make and file
with the two members of the state board of health in the congressional district in which he
resides, or if he resides out of the state in the district nearest his residence, an affidavit of
the number of years he has continuously practiced in this state; and, if the number of
years therein stated be ten or more, the said board, or said two members thereof, shall,
unless they ascertain such affidavit to be false, give him a certificate to that fact, and
authorizing him to practice medicine in all its departments in this state. Third. A person
who is not such graduate, and who has not so practiced in this state for a period of ten
years, desiring to practice medicine in this state, shall, if he has not already done so,
present himself for examination before the state board of health, or before the said two
members thereof in the congressional district in which he resides, or, if he resides out of
the state, to the said two members of the state board of health in the congressional
district nearest his place of residence, who, together with a member of the local board of
health, who is a physician (if there be such member of the local board) of the county in
which the examination is held, shall examine him as herein provided, and if, upon full
examination, they find him qualified to practice medicine in all its departments, they, or a
majority of them, shall grant him a certificate to that effect, and thereafter he shall have
the right to practice medicine in this state to the same extent as if he had the diploma and
certificate hereinbefore mentioned. The members of the state board of health in each
congressional district shall, by publication in some newspaper printed in the county in
which their meeting is to be held, or, if no such paper is printed therein, in some
newspaper of general circulation in such district, give at least twenty-one days' notice of
the time and place at which they will meet for the examination of applicants for permission
to practice medicine, which notice shall be published at least once in each week for three
successive weeks before the day of such meeting; but this section shall not apply to a
physician or surgeon who is called from another state to treat a particular case, or to
perform a particular surgical operation, in this state, and who does not otherwise practice
in this state.'
'Sec. 15. If any person shall practice, or attempt to practice, medicine, surgery, or
obstetrics in this state, without having complied with the provisions of section 9 of this
chapter, except as therein provided, he shall be guilty of a misdemeanor, and fined for
every such offense not less than fifty nor more than five hundred dollars, or imprisoned in
the county jail not less than one month nor more than twelve months, or be punished by
both such fine and imprisonment, at the discretion of the court. And if any person shall file,
or attempt to file, as his own, the diploma or certificate of another, or shall file, or attempt
to file, a false or forged affidavit of his identity, or shall willfully swear falsely to any
question which may be propounded to him on his examination, as herein provided for, or
to any affidavit herein required to be made or filed by him, he shall, upon conviction
thereof, be confined in the pemtentiary not less than one nor more than three years, or
imprisoned in the county jail not less than six nor more than twelve months, and fined not
less than one hundred nor more than five hundred dollars, at the discretion of the court.'

Under this statute, the plaintiff in error was indicted in the state circuit court of Preston
county, W. Va., for unlawfully engaging in the practice of medicine in that state in June,
1882, without a diploma, certificate, or license therefor, as there required; not being a
physician or surgeon called from another state to treat a particular case, or to perform a
particular surgical operation. To this indictment the defendant pleaded not guilty, and, a
jury having been called, the state by its prosecuting attorney, and the defendant by his
attorney, agreed upon the following statement of facts, namely: 'That the defendant was
engaged in the practice of medicine in the town of Newburg, Preston county, W Va., at the
time charged in the indictment, and had been so engaged since the year 1876
continuously to the present time, and has during all said time enjoyed a lucrative practice,
publicly professing to be a physician, prescribing for the sick, and appending to his name
the letters, 'M. D.;' that he was not then and there a physician and surgeon called from
another state to treat a particular case, or to perform a particular surgical operation, nor
was he then and there a commissioned officer of the United States army and navy and
hospital service; that he has no certificate, as required by section 9, c. 93, Acts Leg. W. Va.,
passed March 15, 1882, but has a diploma from the 'American Medical Eclectic College of
Cincinnati, Ohio;' that he presented said diploma to the members of the board of health
who reside in his congressional district, and asked for the certificate as required by law,
but they, after retaining said diploma for some time, returned it to defendant with their
refusal to grant him a certificate asked, because, as they claimed, said college did not
come under the word 'reputable,' as defined by said board of health; that if the defendant
had been or should be prevented from practicing medicine it would be a great injury to
him, as it would deprive him of his only means of supporting himself and family; that at
the time of the passage of the act of 1882 he had not been practicing medicine ten years,
but had only been practicing six, as aforesaid, from the year 1876.' These were all the
facts in the case. Upon them the jury found the defendant guilty, and thereupon he moved
an arrest of judgment on the ground that the act of the legislature was unconstitutional
and void so far as it interfered with his vested right in relation to the practice of medicine,
which motion was overruled, and to the ruling an exception was taken. The court
thereupon sentenced the defendant to pay a fine of $50 and the costs of the proceedings.
The case being taken on writ of error to the supreme court of appeals of the state, the
judgment was affirmed, and to review this judgment the case is brought here.
M. H. Dent, for plaintiff in error.
Argument of Counsel from pages 118-120 intentionally omitted
Alfred Caldwell, for defendant in error.
TOP

Mr. Justice FIELD, after stating the facts as above, delivered the opinion of the court.
Whether the indictment upon which the plaintiff in error was tried and found guilty is open
to objection for want of sufficient certainty in its averments is a question which does not
appear to have been raised either on the trial or before the supreme court of the state.
The presiding justice of the latter court, in its opinion, states that the counsel for the
defendant expressly waived all objections to defects in form or substance of the
indictment, and based his claim for a review of the judgment on the ground that the
statute of West Virginia is unconstitutional and void. The unconstitutionality asserted
consists in its alleged conflict with the clause of the fourteenth amendment which declares
that no state shall deprive any person of life, liberty, or property without due process of
law; the denial to the defendant of the right to practice his profession without the
certificate required constituting the deprivation of his vested right and estate in his
profession, which he had previously acquired.
It is undoubtedly the right of every citizen of the United States to follow any lawful calling,
business, or profession he may choose, subject only to such restrictions as are imposed
upon all persons of like age, sex, and condition. This right may in many respects be
considered as a distinguishing feature of our republican institutions. Here all vocations are
open to every one on like conditions. All may be pursued as sources of livelihood, some

requiring years of study and great learning for their successful prosecution. The interest,
or, as it is sometimes termed, the 'estate,' acquired in themthat is, the right to continue
their prosecutionis often of great value to the possessors, and cannot be arbitrarily taken
from them, any more than their real or personal property can be thus taken. But there is
no arbitrary deprivation of such right where its exercise is not permitted because of a
failure to comply with conditions imposed by the state for the protection of society. The
power of the state to provide for the general welfare of its people authorizes it to prescribe
all such regulations as in its judgment will secure or tend to secure them against the
consequences of ignorance and incapacity, as well as of deception and fraud. As one
means to this end it has been the practice of different states, from time immemorial, to
exact in many pursuits a certain degree of skill and learning upon which the community
may confidently rely; their possession being generally ascertained upon an examination of
parties by competent persons, or inferred from a certificate to them in the form of a
diploma or license from an institution established for instruction on the subjects, scientific
and otherwise, with which such pursuits have to deal. The nature and extent of the
qualifications required must depend primarily upon the judgment of the state as to their
necessity. If they are appropriate to the calling or profession, and attainable by reasonable
study or application, no objection to their validity can be raised because of their stringency
or difficulty. It is only when they have no relation to such calling or profession, or are
unattainable by such reasonable study and application, that they can operate to deprive
one of his right to pursue a lawful vocation.
Few professions require more careful preparation by one who seeks to enter it than that of
madicine. It has to deal with all those subtle and mysterious influences upon which health
and life depend, and requires not only a knowledge of the properties of vegetable and
mineral substances, but of the human body in all its complicated parts, and their relation
to each other, as well as their influence upon the mind. The physician must be able to
detect readily the presence of disease, and prescribe appropriate remedies for its removal.
Every one may have occasion to consult him, but comparatively few can judge of the
qualifications of learning and skill which he possesses. Reliance must be placed upon the
assurance given by his license, issued by an authority competent to judge in that respect,
that he possesses the requisite qualifications. Due consideration, therefore, for the
protection of society may well induce the state to exclude from practice those who have
not such a license, or who are found upon examination not to be fully qualified. The same
reasons which control in imposing conditions, upon compliance with which the physician is
allowed to practice in the first instance, may call for further conditions as new modes of
treating disease are discovered, or a more thorough acquaintance is obtained of the
remedial properties of vegetable and mineral substances, or a more accurate knowledge is
acquired of the human system and of the agencies by which it is affected. It would not be
deemed a matter for serious discussion that a knowledge of the new acquisitions of the
profession, as it from time to time advances in its attainments for the relief of the sick and
suffering, should be required for continuance in its practice, but for the earnestness with
which the plaintiff in error insists that by being compelled to obtain the certificate
required, and prevented from continuing in his practice without it, he is deprived of his
right and estate in his profession without due process of law. We perceive nothing in the
statute which indicates an intention of the legislature to deprive one of any of his rights.
No one has a right to practice medicine without having the necessary qualifications of
learning and skill; and the statute only requires that whoever assumes, by offering to the
community his services as a physician, that he possesses such learning and skill, shall
present evidence of it by a certificate or license from a body designated by the state as
competent to judge of his qualifications.
As we have said on more than one occasion, it may be difficult, if not impossible, to give to
the terms 'due process of law' a definition which will embrace every permissible exertion
of power affecting private rights, and exclude such as are forbidden. They come to us from
the law of England, from which country our jurisprudence is to a great extent derived; and
their requirement was there designed to secure the subject against the arbitrary action of
the crown, and place him under the protection of the law. They were deemed to be
equivalent to 'the law of the land.' In this country the requirement is intended to have a
similar effect against legislative power; that is, to secure the citizen against any arbitrary
deprivation of his rights, whether relating to his life, his liberty, or his property. Legislation
must necessarily vary with the different objects upon which it is designed to operate. It is

sufficient, for the purposes of this case, to say that legislation is not open to the charge of
depriving one of his rights without due process of law, if it be general in its operation upon
the subjects to which it relates, and is enforceable in the usual modes established in the
administration of government with respect to kindred matters; that is, by process or
proceedings adapted to the nature of the case. The great purpose of the requirement is to
exclude everything that is arbitrary and capricious in legislation affecting the rights of the
citizen. As said by this court in Yick Wo v. Hopkins, speaking by Mr. Justice MATTHEWS:
'When we consider the nature and the theory of our institutions of government, the
principles upon which they are supposed to rest, and review the history of their
development, we are constrained to conclude that they do not mean to leave room for the
play and action of purely personal and arbitrary power.' 118 U. S. 356, 369, 6 Sup. Ct. Rep.
1064. See, also, Pennoyer v. Neff, 95 U. S. 714, 733; Davidson v. New Orleans, 96 U. S. 97,
104, 107; Hurtado v. California, 110 U. S. 516, 4 Sup. Ct. Rep. 111; Railroad Co. v.
Humes, 115 U. S. 512, 519, 6 Sup. Ct. Rep. 110.
There is nothing of an arbitrary character in the provisions of the statute in question. It
applies to all physicians, except those who may be called for a special case from another
state. It imposes no conditions which cannot be readily met; and it is made enforceable in
the mode usual in kindred matters,that is, by regular proceedings adapted to the case. It
authorizes an examination of the applicant by the board of health as to his qualifications
when he has no evidence of them in the diploma of a reputable medical college in the
school of medicine to which he belongs, or has not practiced in the state a designated
period before March, 1881. If, in the proceedings under the statute, there should be any
unfair or unjust action on the part of the board in refusing him a certificate, we doubt not
that a remedy would be found in the courts of the state. But no such imputation can be
made, for the plaintiff in error did not submit himself to the examination of the board after
it had decided that the diploma he presented was insufficient.
The cases of Cummings v. State of Missouri, 4 Wall. 277, and of Ex parte Garland, Id. 333,
upon which much reliance is placed, do not, in our judgment, support the contention of the
plaintiff in error. In the first of these cases it appeared that the constitution of Missouri,
adopted in 1865, prescribed an oath to be taken by persons holding certain offices and
trusts, and following certain pursuits within its limits. They were required to deny that they
had done certain things, or had manifested by act or word certain desires or sympathies.
The oath which they were to take embraced 30 distinct affirmations respecting their past
conduct, extending even to their words, desires, and sympathies. Every person unable to
take this oath was declared incapable of holding in the state 'any office of honor, trust, or
profit under its authority, or of being an officer, councilman, director, or trustee, or other
manager of any corporation, public or private,' then existing or thereafter established by
its authority; or 'of acting as a professor or teacher in any educational institution, or in any
common or other school, or of holding any real estate or other property in trust for the use
of any church, religious society, or congregation.' And every person holding, at the time
the constitution took effect, any of the offices, trusts, or positions mentioned, was
required, within 60 days thereafter, to take the oath, and, if he failed to comply with this
requirement, it was declared that his office, trust, or position should, ipso facto, become
vacant. No person, after the expiration of the 60 days, was allowed, without taking the
oath, 'to practice as an attorney or counselor at law,' nor after that period could 'any
person be competent as a bishop, priest, deacon, minister, elder, or other clergyman of
any religious persuasion, sect, or denomination to teach or preach, or solemnize
marriages.' Fine and imprisonment were prescribed as a punishment for holding or
exercising any of the 'offices, positions, trusts, professions, or functions' specified, without
taking the oath, and false swearing or affirmation in taking it was declared to be perjury,
punishable by imprisonment in the penitentiary. A priest of the Roman Catholic Church was
indicted in a circuit court of Missouri, and convicted of the crime of teaching and preaching
as a priest and minister of that religious denomination without having first taken the oath,
and was sentenced to pay a fine of $500, and to be committed to jail until the same was
paid. On appeal to the supreme court of the state the judgment was affirmed, and the
case was brought on error to this court. As many of the acts from which the parties were
obliged to purge themselves by the oath had no relation to their fitness for the pursuits
and professions designated, the court held that the oath was not required as a means of
ascertaining whether the parties were qualified for those pursuits and professions, but was
exacted because it was thought that the acts deserved punishment, and that for many of

them there was no way of inflicting punishment except by depriving the parties of their
offices and trusts. A large portion of the people of Missouri were unable to take the oath,
and as to them the court held that the requirement of its constitution amounted to a
legislative deprivation of their rights. Many of the acts which parties were bound to deny
that they had ever done were innocent at the time they were committed, and the
deprivation of a right to continue in their offices if the oath were not taken was held to be
a penalty for a past act, which was violative of the constitution. The doctrine of this case
was affirmed in Pierce v. Carskadon, 16 Wall. 234.
In the second case mentionedthat of Ex parte Garlandit appeared that on the 2d of
July, 1862, congress had passed an act prescribing an oath to be taken by every person
elected or appointed to any office of honor or profit under the United States, either in the
civil, military, or naval departments of the government, except the president, before
entering upon the duties of his office, and before being entitled to his salary or other
emoluments. On the 24th of January, 1865, congress, by a supplemental act, extended its
provisions so as to embrace attorneys and counselors of the courts of the United States.
This latter act, among other things, provided that after its passage no person should be
admitted as an attorney and counselor to the bar of the supreme court, and, after the 4th
of March, 1865, to the bar of any circuit or district court of the United States, or of the
court of claims, or be allowed to appear and be heard by virtue of any previous admission,
until he had taken and subscribed the oath prescribed by the act of July 2, 1862. The oath
related to past acts, and its object was to exclude from practice in the courts parties who
were unable to affirm that they had not done the acts specified; and, as it could not be
taken by large classes of persons, it was held to operate against them as a legislative
decree of perpetual exclusion. Mr. Garland had been admitted to the bar of the supreme
court of the United States, previous to the passage of the act. He was a citizen of
Arkansas, and when that state passed an ordinance of secession which purported to
withdraw her from the Union, and by another ordinance attached herself to the so-called
'Confederate States,' he followed the state, and was one of her representatives, first in the
lower house, and afterwards in the senate of the congress of the Confederacy, and was a
member of that senate at the time of the surrender of the Confederate forces to the
armies of the United States, Subsequently, in 1865, he received from the president of the
United States a full pardon for all offenses committed by his participation, direct or
implied, in the rebellion. He produced this pardon, and asked permission to continue as an
attorney and counselor of this court without taking the oath required by the act of January
24, 1865, and the rule of the court which had adopted the clause requiring its
administration in conformity with the act of congress. The court held that the law, in
exacting the oath as to his past conduct as a condition of his continuing in the practice of
his profession, imposed a penalty for a past act, and in that respect was subject to the
same objection as that made to the clauses of the constitution of Missouri, and was
therefore invalid.
There is nothing in these decisions which supports the positions for which the plaintiff in
error contends. They only determine that one who is in the enjoyment of a right to preach
and teach the Christian religion as a priest of a regular church, and one who has been
admitted to practice the profession of the law, cannot be deprived of the right to continue
in the exercise of their respective professions by the exaction from them of an oath as to
their past conduct, respecting matters which have no connection with such professions.
Between this doctrine and that for which the plaintiff in error contends there is no analogy
or resemblance. The constitution of Missouri and the act of congress in question in those
cases were designed to deprive parties of their right to continue in their professions for
past acts, or past expressions of desires and sympathies, many of which had no bearing
upon their fitness to continue in their professions. The law of West Virginia was intended to
secure such skill and learning in the profession of medicine that the community might trust
with confidence those receiving a license under authority of the state. Judgment affirmed.

of graduation from said medical college as sufficient proof of proficiency in medical

knowledge to admit a graduate to the examinations held in these Islands; and as late as
October 29, 1923, said board accepted favorably upon the application of one Dr. Mariano
M. Lazatin, who was graduated from said school in the year 1921. At the time said
candidate was admitted, however, the regulations denying the requisite status to the
Chicago Medical College had not been made effective, and they had been made effective
by proper authority before the present petitioner had submitted his application.
In the argument for the petitioner it is admitted that under Act No. 3111, and the
regulations now in force, the petitioner is disqualified to take the examinations; but it is
pointed out that at the time he began and even when he conducted his course in the
Chicago Medical School, said institution was still recognized as a reputable medical
institution; and the question submitted is whether the petitioner's case should be
governed by the law and regulations in force at the time of his enrollment in and
graduation from the Chicago Medical School, or by those in force at the time he filed his
application for admission, on or about September 26, 1924. It is submitted for the
petitioner that his case should be governed by the law and regulations at the time of his
graduation. To hold otherwise, it is insisted, is to make the law retroactive in effect and to
do irreparable damage to the petitioner, who has pursued his work in the institution
referred to in good faith, believing that said school had the status necessary to qualify him
from examination.

G.R. No. L-24119

August 8, 1925

FELIX MARQUEZ, petitioner,

vs.
THE BOARD OF MEDICAL EXAMINERS and THE SECRETARY-TREASURER OF THE
BOARD OF MEDICAL EXAMINERS, respondent.
M.H. de Joya for petitioner.
Acting Attorney-General Reyes for respondents.
STREET, J.:
This is an original proceeding in this court by which the petitioner, Felix Marquez, seeks to
obtain a writ ofmandamus against the respondents, the Board of Medical Examiners,
requiring them to admit the petitioner to the physicians' examinations conducted, or to be
conducted by the respondents in the City of Manila. To the original complaint the
respondents answered, and to the answer a demurrer was interposed in behalf of the
petitioner.
It appears that petitioner is a graduate of the Chicago Medical College, having received the
degree of M.D. from said institution on June 8, of the year 1922. No question appears to
have been made by the respondents with respect to the petitioner's qualifications of the
physician's examinations in other respects, but they have denied him admission to the
examinations on the grounds that the Chicago Medical College, where the petitioner was
graduated, has been classified as a Class C medical college by the National Medical State
Board of the United States. For this reason the respondents, in accordance with the
regulations of the board now in effect, have denied the requisite standing to said
institution and excluded petitioner.
It is not denied by the respondents that prior to the adoption of the present regulations,
and prior to the date when the Chicago Medical School was classified as a Class C medical
college, the Board of Medical Examiners for the Philippine Islands had accepted diplomas

The position taken by the petitioner is, we think, untenable. The question whether a
medical institution is "a reputable medical school," in the sense intended by the law, is
vested in the Board of Medical Examiners, and although the action taken by them may
conceivably, in isolated cases, result in hardship, nevertheless the interests of the public
require that the board should be free to exercise its judgment and discretion without
reference to the effect of the determination of the question in particular instances. There
can in the nature of things be no vested right in an existing law, which would preclude its
change or repeal. No one who has commenced preparation in a particular institution has
any inchoate right on account of that fact. If the law were otherwise upon this point, it
would be impossible for the Board of Medical Examiners to give effect to the knowledge
which they from time to time acquire as to the standing of medical schools; and an
intending physician, upon matriculating in a particular college, takes upon himself the risk
of changes that may be made in the standing of the institution by the board.
The demurrer to the answer is not well taken. The answer is therefore declared sufficient,
and the petition dismissed, with costs, So ordered.
Avancea, C.J., Johnson, Malcolm, Villamor, Johns, and Villa-Real, JJ., concur.

SEC. 771. Persons exempt from registration. Registration shall not be required
of the following classes of persons: . . .
(e) In cases of epidemic or in municipalities where there is no legally qualified
practicing physician, or when the circumstances require it, in the interest of the
public health, the Director of Health may issue special authorizations, to all
medical students who have completed the first three years of their studies, or to
persons who have qualified in medicine, and to graduate or registered nurses,
who may request it.
This authority was revoked, on November 8, 1960, by the then Secretary of Health, upon
the ground that "the conditions under which it was granted no longer obtained in Lamitan
Basilan City, there being enough practising physicians in that locality." Said officer restored
the authority on December 19, 1960, to be revoked again, on January 22, 1963. It was
renewed once more, on September 1, 1963, and, once again, it was revoked on February
10, 1964, upon the recommendation of the Board of Medical Examiners hereinafter
referred to as the Board. On motion for reconsideration filed by respondent, the Board
issued, on April 6, 1965, its Resolution No. 25, series of 1965, which was approved by the
President, granting respondent a certificate to practice medicine in the Philippines without
the examination required in Republic Act No. 2882, otherwise known as the Medical Act of
1959. The resolution relied therefor upon The Treaty on the Validity of Academic Degrees
and The Exercise of the Professions between the Republic of the Philippines and the
Spanish State, signed at Manila on March 4, 1949, and ratified on May 19, 1949. 1

G.R. No. L-25135

September 21, 1968

PHILIPPINE MEDICAL ASSOCIATION, petitioner,

vs.
BOARD OF MEDICAL EXAMINERS and JOSE MA. TORRES, respondents.
Seva-Albert-Vergara and Julio V. Presbitero for petitioner.
Regino Hermosisima, Jr., for respondent Jose Ma. Torres.
Solicitor General for respondent Board of Medical Examiners.
CONCEPCION, C.J.:
Original action for certiorari and mandamus, against the Board of Medical Examiners and
Jose Ma. Torres, to annul a resolution of the former and a certificate issued by the same
authorizing the latter to practice medicine in the Philippines without examination.
The facts are not disputed. Jose Ma. Torres hereinafter referred to as respondent is a
Spanish subject and a member of the Missionary Sons of the Immaculate Heart of Mary,
otherwise known as the Claretian Missionaries. Having graduated from the University of
Barcelona, Spain, with the degree of Licentiate in Medicine and Surgery, he is entitled,
under the laws of Spain, to practice medicine and surgery throughout the territory thereof.
On January 21, 1955, respondent was granted special authority to practice medicine in
Lamitan, Basilan City, where he resides, pursuant to Section 771(e) of the Revised
Administrative Code reading:

Petitioner herein, Philippine Medical Association, is a domestic corporation. On June 14,

1965, it addressed the Chairman of the Board a communication requesting reconsideration
of said resolution No. 25, upon the ground that, pursuant to said Medical Act of 1959,
respondent has to take and pass the examination therein prescribed, before he can be
allowed to practice medicine in the Philippines. This letter was followed by another, dated
October 6, 1965, to which said Chairman replied on October 8, 1965, stating "that the final
decision on the matter will have to come from the President of the Philippines upon whose
authority said resolution has been finally approved and implemented."
Thereupon, or, on October 18, 1965, petitioner commenced the present action, for the
purpose stated at the beginning of this decision, upon the theory that the Board had
violated Republic Act No. 2882 in granting respondent's certificate for the general practice
of medicine in the Philippines without the examination prescribed in said Act; that the
Board had exceeded its authority in passing said Resolution, because of which the same is
null and void; that the Board should, therefore, be ordered to cancel the certificate issued
in pursuance of said resolution; and that petitioner has no other plain, adequate and
speedy remedy in the ordinary course of law.
In their respective answers, respondents admit the basic facts, but not the conclusions
drawn therefrom by the petitioner and allege that the resolution in question is sanctioned
by the provisions of the Treaty above referred to; that petitioner has no cause of action;
and that the petition should be dismissed for failure of the petitioner to exhaust the
available administrative remedies.
Respondents cite the cases of Costas vs. Aldanese2 and Almario vs. City Mayor 3 in support
of the theory that petitioner herein has no sufficient interest or "personality" to maintain
the present case. In the first case, it was held that the President of the Association of
Philippine (Marine) Engineers4 had no particular "individual" interest, and, hence,no cause
of action for mandamus to compel the Collector of Customs to implement section 1203(j)
of the Administrative Code, providing that steamers making round trips of more than 48
hours or travelling at night shall carry the complement of marine engineers therein
specified. In the second case, a citizen of the Philippines, as such, who is not an Applicant
for any stall or booth, or the representative of any such applicant, stallholder orany
association of persons who are deprived of the right to occupy stalls in said market, "is not
the real party in interest who has the capacity, right or personality" to bring an action

for mandamus, to compel the office of Pasay City to comply with the provisions of Republic
Act No. 37, by ejecting, from the public market of said City, stallholders who are not
nationals of the Philippines.
Said cases are not in point. To begin with, both are actions for mandamus, whereas the
case at bar is mainly one for certiorari. Although, petitioner herein, likewise, seeks a writ
of mandamus, directing the Board to cancel the certificate of registration issued to the
respondent, this would be a necessary consequence of the writ of certiorariannulling the
disputed resolution. Moreover, said two (2) cases were commenced by individuals, who, as
such, had no special interest in the relief therein prayed for. Indeed, in the Almario case it
was intimated that the result might have been otherwise had it been brought by an
"association" whose members have an interest in the subject matter of the action.
This was confirmed by PHILCONSA vs. Gimenez,5 in which we sustained the right of the
Philippine Constitution Association to assail the constitutionality of Republic Act No. 3836,
insofar as it allowed retirement gratuity and commutation of vacation and sick leave to
members of Congress and to elective officials thereof. Further authority in favor of
petitioner herein is supplied by Nacionalista Party vs. F. Bautista Angelo 6 in which the
Nacionalista Party successfully impugned the validity of the designation of the then
Solicitor General as Acting Member of the Commission on Elections.
It is our considered opinion that the view adopted in the last three (3) cases should be
maintained and that, in line therewith, petitioner herein has sufficient interest to prosecute
the case at bar and a cause of action against respondents herein.
As regards their objection based upon petitioner's failure to appeal to the President, suffice
it to say that the rule requiring exhaustion of administrative remedies is concededly
subject to exceptions, among which are cases involving only questions of law or when
jurisdiction is in issue7or the action complained of bears the approval of a department
secretary, as the disputed resolution, which was approved by the Executive Secretary "by
authority of the President," or as an alter ego of the Executive. 8 The case at bar falls under
these exceptions to said rule.1awphl.nt
The main issue herein hinges on the interpretation of Article I of the Treaty
aforementioned, reading as follows:
The nationals of both countries who shall have obtained degrees or diplomas to
practice the liberal professions in either of the Contracting States, issued by
competent national authorities, shall be deemed competent to exercise said
professions in the territory of the Other, subject to the laws and regulations of the
latter. When the degree or diploma of Bachelor, issued by competent national
authorities allows its holder without requiring further evidence of proficiency to
pursue normally higher courses of study, he shall also be deemed qualified to
continue his studies in the territory of either Party in conformity with the
applicable laws and regulations of the State which recognizes the validity of the
title or diploma in question, and with the rules and regulations of the particular
educational institution in which he intends to pursue his studies.
This Treaty provision was the subject matter of our resolution of August 15, 1961, in
connection with the petition of Arturo Efren Garcia for admission to the Philippine Bar
without taking the Bar Examinations. After completing, in Spain, the course prescribed
therefor, Garcia had been graduated from the College of Law of the Universidad Central de
Madrid with the degree of "Licenciado en Derecho", which entitled him to practice law in
Spain. Having invoked the provisions of said treaty in support of his claim of exemption
from the requisite bar examinations, this Court denied his petition upon the ground,
among others ". . . that the privileges provided in the Treaty invoked by the applicant are
made expressly subject to the laws and regulations of the contracting State in whose
territory it is desired to exercise the legal profession; and Section 1 of Rule 127, in
connection with Sections 2, 9, and 16 thereof, which have the force of law, require that

before anyone can practice the legal profession in the Philippines he must first successfully
pass the required bar examinations; . . ."
We find no plausible reason to depart from this view. On the contrary, we reiterate the
same, inasmuch as the theory of respondent herein cannot be accepted without placing
graduates from our own educational institutions at a disadvantage vis-a-vis Spanish
graduates from Spanish schools, colleges or universities. Indeed, the latter could under
respondent's pretense engage in the practice of medicine in the Philippines without
taking the examination prescribed in Republic Act No. 2882, whereas the former would
have to take and pass said examination. Worse still, since as we ruled in the Garcia case
the benefits of the aforementioned Treaty cannot be availed of in the Philippines except
by Spanish subjects, the result would be should respondent's contention be sustained
that graduates from Spanish schools of medicine would be entitled to practice medicine in
the Philippines without examination, if they were Spanish subjects, but not if they are
Filipinos.
Surely said treaty was not made to discriminate against Philippine schools, colleges or
universities, much less against nationals of the Philippines.
WHEREFORE, we hold that said Treaty merely extended to diplomas issued or degrees
conferred by educational institutions of Spain the same recognition and treatment that we
accord to similar diplomas or degrees from local institutions of learning; that holders of
said Spanish diplomas or degrees must take the examination prescribed by our laws for
holders of similar diplomas or degrees from educational institutions in the Philippines; that
resolution No. 25, series of 1965, of respondent Board is violative of Republic Act No. 2882
and hence, null and void; and that, respondent Board of Medical Examiners should be, as it
is hereby ordered to cancel the certificate of registration, for the practice of medicine in
the Philippines, issued in favor of respondent Jose Ma. Torres, without special
pronouncement as to costs. It is so ordered.
Reyes, J.B.L., Dizon, Makalintal, Zaldivar, Sanchez, Castro, Angeles and Fernando, JJ.,
concur.

Anatolio S. Tuazon, Jr. for intervenors.

NARVASA, J.:
Petitioners, the Board of Medical Education, the government agency which supervises and
regulates the country's medical colleges, and Secretary Lourdes R. Quisumbing of the
Department of Education, Culture and Sports, as Chairperson of the Board, pray for a writ
of certiorari to nullify and set aside the order issued by respondent Judge Daniel P. Alfonso,
Regional Trial Court, Antipolo, Rizal, in Civil Case No. 1385 restraining the enforcement of
petitioner Quisumbing's order of closure of the respondent Philippine Muslim-Christian
College of Medicine Foundation, Inc. (hereafter simply the College).lwph1.t
The, College, a private educational institution, was founded in 1981 for the avowed
purpose of producing physicians who will "emancipate Muslim citizens from age-old
attitudes on health." The, unstable peace and order situation in Mindanao led to the
establishment of the College in Antipolo, Rizal, which granted it a temporary permit to
operate in the municipality, instead of in Zamboanga City where the school was first
proposed to be located. It has since adopted Antipolo as its permanent site and changed
its name to the Rizal College of Medicine.
In 1985, the Department of Education, Culture and Sports (DECS) and the Board of Medical
Education (BME) authorized the Commission on Medical Education to conduct a study of all
medical schools in the Philippines. The, report of the Commission showed that the College
fell very much short of the minimum standards set for medical schools. 1 The, team of
inspectors, composed of Doctors Florentino Herrera, Jr., Elena Ines Cuyegkeng, Horacio
Estrada, Jose V. Silao, Jr. and Andres L. Reyes, recommended the closure of the
school 2 upon the following findings, to wit:
(a) the College was not fulfilling the purpose for which it had been
created because of its inappropriate location and the absence in its
curriculum of subjects relating to Muslim culture and welfare;
(b) its lack of university affiliation hindered its students from obtaining a
"balanced humanistic and scientific" education;
(c) it did not have its philosophy base hospital for the training of its
students in the major clinical disciplines, as required by the DECS;
(d) more than 60% of the college faculty did not teach in the College fulltime, resulting in shortened and irregular class hours, subject
overloading, and in general, poor quality teaching.

G.R. No. 88259 August 10, 1989

THE BOARD OF MEDICAL EDUCATION and the HON. LOURDES R. QUISUMBING, in
her capacity as Secretary of the Department of Education, Culture and Sports
and Chairman, Board of Medical Education, petitioners,
vs.
HON. DANIEL P. ALFONSO, Presiding Judge of the Regional Trial Court, Branch
74, Fourth Judicial Region, Antipolo, Rizal, and the PHILIPPINE MUSLIMCHRISTIAN COLLEGE OF MEDICINE FOUNDATION, INC., respondents.
Carpio, Villaraza & Cruz for private respondent.

The, school disputed these findings as biased and discriminatory. At its request, the Board
of Medical Education, in May, 1987, sent another team of doctors 3 for a re-evaluation of
the College. After inspection, the team confirmed the previous findings and recommended
the phase-out of the school. 4
The, first two reports were verified on June 23, 1987 by a third team of inspectors. 5 A year
thereafter, the College failed another test what was in effect the fourth evaluation of its
fitness to continue as a medical school conducted on March 4 and 5, 1988 by a team from
the Board of Medical Education determining the eligibility of medical schools for
government recognition. The, College was adjudged "inadequate" in all aspects of the
survey, to wit, college, curriculum, facilities, teaching hospital, and studentry. 6 The,
inspectors, Doctors Nilo Rosas, Macario Tan and Elena Ines Cuyegkeng, accordingly
recommended denial of government; recognition.

Accordingly, the Board of Medical Education recommended to the DECS the closure of the
College, effective the end of the school year 1988-1989. The, College however succeeded
in having the Board form yet another team to review the previous findings. Doctors Elena
Ines Cuyegkeng, Alberto Romualdez, Artemio Ordinaria Joven Cuanang and Nilo L. Rosas
conducted their inspection on June 18, 1988. Their findings: although there had been a
"major effort to improve the physical plant for classroom instructions and the library,
serious deficiencies remain(ed) in the areas of clinical facilities and library operations;"
"faculty continue(d) to be quite inadequate with no prospects for satisfactory growth and
development;" "student profile ... (was) below par from the point of view of credentials
(NMAT and transfer records) as well as level knowledge and preparedness at various
stages of medical education," and "the most serious deficiency ... (was) the almost total
lack of serious development efforts in academic medicine i.e., seeming lack of
philosophy of teaching, no serious effort to study curricula, almost non-existent innovative
approaches." Again, the recommendation was to close the College with provisions for the
dispersal of its students to other medical schools. 7
In her letter of June 23, 1988, Secretary Quisumbing informed the Chairman of the
College's Board of Trustees, Mr. Victor Sumulong, of the decision of the Board of Medical
Education to close the College. Mr. Sumulong instead proposed a gradual phase-out
starting the school year 1989-1990 in order not to dislocate the students and staff and to
minimize financial loss. 8 The, Board subsequently allowed the College to continue its
operations but only until May, 1989, after which it was to be closed, this decision being
"final and unappealable." The, College was, however, assured of assistance in the
relocation of its students and in its rehabilitation as an institution for health-related and
paramedical courses. 9
The, College appealed the decision to the Office of the President, imputing grave abuse of
discretion to the Secretary. 10 On February 16, 1989, Executive Secretary Catalino
Macaraig, Jr., finding "no reason to disturb" the contested decision, affirmed it. 11
On March 2, 1989, the College went to court. It filed Civil Case No. 1385 in the court of
respondent Judge Daniel P. Alfonso against Secretary Quisumbing in her capacity as
Secretary of Education, Culture and Sports, questioning the decision as illegal, oppressive,
arbitrary and discriminatory and applied for a writ of preliminary injunction to restrain its
implementation.
The, writ issued as prayed for by order of the respondent Judge dated May 10, 1989. 12 His
Honor ruled that the inspection of June 18, 1988 was the principal basis of the closure
order, and on such basis sustained the claim of the College that the inspection was done in
an "arbitrary and haphazard manner" by a team of inspectors who had already prejudged
the school. Judge Alfonso held that there was no evidence supporting the findings in the
report of June 18, 1988, and declared that his philosophy ocular inspection of the College
disclosed that the deficiencies mentioned in the report were non-existent, and that on the
contrary, the laboratory and library areas were "big enough," and in the operations of the
proposed base hospital were going on smoothly at the time of the ocular inspection."
The, school thereupon promptly advertised in major newspaper dailies for enrollees in all
levels of the medical college and in its pre-board review classes. 13
Hence the present petition, assailing the order of injunction dated May 10, 1989 as having
been issued with grave abuse of discretion, and praying for a restraining order against its
enforcement as well as for the dismissal of the action instituted in the court a quo. The,
Court on June 1, 1989 ordered the respondent College to desist from advertising and
admitting students, and the respondent judge to refrain from enforcing his injunction
order.
The, College in its Comment would justify its entitlement to the questioned injunction on
the ground that the closure order against which it was directed was issued without factual
basis and in violation of the right of the College to due process of law, and that it violates

MECS Order No. 5 (Series of 1986) to the effect that the penalty of closure cannot be
imposed earlier than three (3) years from the last evaluation, which in this instance was
made, on June 18, 1988.
Resort to the Courts to obtain a reversal of the determination by the Secretary of
Education, Culture and Sports that the College is unfit to continue its operations is in this
case clearly unavailing. There is, to begin with, no law authorizing an appeal from
decisions or orders of the Secretary of Education, Culture and Sports to this Court or any
other Court. It is not the function of this Court or any other Court to review the decisions
and orders of the Secretary on the issue of whether or not an educational institution meets
the norms and standards required for permission to operate and to continue operating as
such. On this question, no Court has the power or prerogative to substitute its opinion for
that of the Secretary. Indeed, it is obviously not expected that any Court would have the
competence to do so.
The, only authority reposed in the Courts in the matter is the determination of whether or
not the Secretary of Education, Culture and Sports has acted within the scope of powers
granted him by law and the Constitution. As long as it appears that he has done so, any
decision rendered by him should not and will not be subject to review and reversal by any
court.
Of course, if it should be made, to appear to the Court that those powers were in a case
exercised so whimsically, capriciously, oppressively, despotically or arbitrarily as to call for
peremptory correction or stated otherwise, that the Secretary had acted with grave
abuse of discretion, or had unlawfully neglected the performance of an act which the law
specifically enjoins as a duty, or excluded another from the use or enjoyment of a right or
office to which such other is entitled it becomes the Court's duty to rectify such action
through the extraordinary remedies of certiorari, prohibition, or mandamus, whichever
may properly apply. Yet even in these extreme instances, where a Court finds that there
has been abuse of powers by the Secretary and consequently nullifies and/or forbids such
an abuse of power, or compliance whatever is needful to keep its exercise within bounds,
the Court, absent any compelling reason to do otherwise, should still leave to the
Secretary the ultimate determination of the issue of the satisfy action or fulfillment by an
educational institution of the standards set down for its legitimate operation, as to which it
should not ordinarily substitute its over judgment for that of said office.
In any case, the recorded facts quite clearly fail to support the College's claim of grave
abuse of discretion containing the order of closure, and on the contrary convincingly show
the challenged decision to be correct. From 1985, no less than five (5) surveys were
conducted of respondent institution to determine its compliance with the minimum
standards established for a medical college. The, first survey, that undertaken by the
Commission on Medical Education, disclosed such various and significant deficiencies in
the school as to constrain the inspectors to recommend its closure. Four (4) other surveys
were thereafter made by as many different committees or teams, at the school's instance
or otherwise, all of which basically confirmed the results of that first survey. Moreover, the
findings of all five (5) surveys were affirmed by the Office of the President. Indeed, the
petitioner, through the Chairman of its Board of Trustees, to all intents and purposes
accepted the validity of the findings of those five (5) survey groups when it proposed, in
1988, a gradual phase-out of the school starting in 1989. The, respondent College knew
that the recommendation for its closure was made, as early as 1986, that recommendation
was reiterated and reaffirmed four (4) times thereafter until it was finally approved and
acted upon by the Secretary, whose action was confirmed by the Office of the President.
Said respondent was given notice in June 1988, that in consequence of all these, the time
for its definite closure had been unalterably set at May, 1989, a notice which was
accompanied by assurances of assistance in the relocation of its students before June,
1989 and in its rehabilitation as a school for other courses. After having resorted to the
whole range of administrative remedies available to it, without success, it sought to obtain
from the respondent Court the relief it could not obtain from those sources, and what can
only be described as a deliberate attempt to frustrate and obstruct implementation of the

decision for its closure as of June, 1989 openly solicited, by newspaper advertisements or
otherwise, enrollment of new and old students.
Given these facts, and it being a matter of law that the Secretary of Education, Culture and
Sports exercises the power to enjoin compliance with the requirements laid down for
medical schools and to mete out sanctions where he finds that violations thereof have
been committed, it was a grave abuse of discretion for the respondent judge to issue the
questioned injunction and thereby thwart official action, in the premises correctly taken,
allowing the College to operate without the requisite government permit. A single ocular
inspection, done after the College had been pre-warned thereof, did not, in the
circumstances, warrant only the findings of more qualified inspectors about the true state
of the College, its faculty, facilities, operations, etc. The, members of the evaluating team
came from the different sectors in the fields of education and medicine, 14 and their
judgment in this particular area is certainly better than that of the respondent Judge whose
sole and only visit to the school could hardly have given him much more to go on than a
brief look at the physical plant and facilities and into the conduct of the classes and other
school activities. Respondent Judge gravely abused his discretion in substituting his
judgment for theirs. It is well-settled doctrine that courts of justice should not generally
interfere with purely administrative and discretionary functions; that courts have no
supervisory power over the proceedings and actions of the administrative departments of
the government; involving the exercise of judgment and findings of facts, because by
reason of their special knowledge and expertise over matters falling under their
jurisdiction, the latter are in a better position to pass judgment on such matters andn their
findings of facts in that regard are generally accorded respect, if not finality, by the
courts. 15 There are, to be sure, exceptions to this general rule but none of them obtains in
this case.
The, claim of denial of due process likewise holds no water, as the record clearly shows
that the College was given every opportunity to so improve itself as to come up to
requirements, but remained sadly sub-standard after the inspections conducted by the
evaluating teams. It had, in fact, admitted its failure to have up to the desired standards
when it proposed its gradual phase-out in its letter dated June 27, 1988 to Secretary
Quisumbing. It was also precisely because of its complaints of bias and prejudice that the
Board of Medical Education dispatched new teams to survey and re-evaluate its
performance. It had even gone all the way up to the Office of the President to seek a
reversal of the order of closure. There is thus no reason for it to complain of a lack of
opportunity to be heard and to explain its side as well as to seek reconsideration of the
ruling complained of.
There is also no merit in respondent College's argument that the closure violated NMCS
ORDER No. 5, Series of 1986, because it was sought to be effected before the lapse of the
three-year period therein snowed, which in this case is sought to be counted from June 18,
1988, or the date of the last evaluation. The, provision referred to reads:
The following sanction shall be applied against any medical school, for
failure to comply with the specific requirements of the essentials, viz.:
xxx
c. Withdrawal or cancellation of the school's government; authority to
operate,
for
failure
to
fully
comply
with
the
prescribed
requirements after three (3) years from the last evaluation conducted on
the school.
It must at once be obvious from a reading of the provision, paragraph c, that the situation
therein contemplated where a school is found to have failed to "fully comply with the
prescribed requirements," i.e., has not complied with some requirements and has failed to
do so within three (3) years from the last evaluation is quite distinct from that obtaining in
the case at bar where respondent school was found to have deficiencies so serious as to

warrant its immediate closure. Said paragraph c should not be construed to prohibit
absolutely the withdrawal or cancellation of government; authority to operate until after
three (3) years from the last evaluation conducted on the school; or, stated otherwise, it
does not unexceptionally prescribe a three-year waiting period before authority to operate
may be withdrawn. Rather, it should be read as giving the Secretary of Education the
discretion, depending on the seriousness of the discovered deficiencies, to afford an
educational institution which has failed to comply with some requirement or other, time
not exceeding three (3) years to correct the deficiencies before applying the sanction of
withdrawal or cancellation of the government; authority to operate. The, circumstances in
the case at bar are far from nominal and, to repeat, are different from those obviously
envisioned by the paragraph in question. There had never been a recommendation that
the College be granted an opportunity to comply with certain requirements. From the
outset, the proposal had been that it be forthwith closed, its discovered deficiencies as a
medical college being of so serious a character as to be irremediable. The, other four (4)
surveys were conducted, not to determine if in the course of time the petitioner school had
already fully complied with all the prescribed requisites, but rather, whether or not the
original recommendation for its closure was correct and should be sustained. And, as
already mentioned, the subsequent surveys, over a period of more than three (3) years,
served but to confirm the validity of that initial proposal for its closure. Under these
circumstances, therefore, even if it be assumed that the provision, paragraph c, applied to
petitioner school, it must be held that there has been substantial compliance therewith.
Having thus disposed of the issues raised by the facts of the case, the Court sees no useful
purpose to be served by remanding the case to the Trial Court for further proceedings.
The, only acceptable reason for such a remand would be so that the Trial Court may
determine whether or not the petitioners' first have acted within the scope of their powers
or grossly abused them, a matter that this Court has already passed upon here. Such a
remand cannot be justified on the theory that the Trial Court will make its philosophy
independent determination of whether or not respondent medical institution has complied
with the minimum standards laid down for its continued operation, since, as here ruled, it
has not that power.
WHEREFORE, premises considered, the petition is hereby granted and the temporary
restraining order issued by the Court is made, permanent. The, questioned writ of
preliminary injunction dated May 10, 1989 is set aside and respondent Judge is ordered to
dismiss Civil Case No. 1385.
SO ORDERED.
Fernan, (C.J.), Gutierrez, Jr., Cruz, Paras, Feliciano, Gancayco, Padilla, Bidin, Cortes, Gri;oAquino, Medialdea and Regalado, JJ., concur.
Melencio-Herrera, and Sarmiento JJ., took no part.

G.R. No. 89572 December 21, 1989

DEPARTMENT OF EDUCATION, CULTURE AND SPORTS (DECS) and DIRECTOR OF
CENTER FOR EDUCATIONAL MEASUREMENT, petitioners,
vs.
ROBERTO REY C. SAN DIEGO and JUDGE TERESITA DIZON-CAPULONG, in her
capacity as Presiding Judge of the Regional Trial Court of Valenzuela, Metro
Manila, Branch 172, respondents.
Ramon M. Guevara for private respondent.
CRUZ, J.:
The issue before us is mediocrity. The question is whether a person who has thrice failed
the National Medical Admission Test (NMAT) is entitled to take it again.
The petitioner contends he may not, under its rule thath) A student shall be allowed only three (3) chances to take the NMAT.
After three (3) successive failures, a student shall not be allowed to take
the NMAT for the fourth time.
The private respondent insists he can, on constitutional grounds.
But first the facts.
The private respondent is a graduate of the University of the East with a degree of
Bachelor of Science in Zoology. The petitioner claims that he took the NMAT three times
and flunked it as many times. 1 When he applied to take it again, the petitioner rejected his
application on the basis of the aforesaid rule. He then went to the Regional Trial Court of
Valenzuela, Metro Manila, to compel his admission to the test.
In his original petition for mandamus, he first invoked his constitutional rights to academic
freedom and quality education. By agreement of the parties, the private respondent was
allowed to take the NMAT scheduled on April 16, 1989, subject to the outcome of his
petition. 2 In an amended petition filed with leave of court, he squarely challenged the

constitutionality of MECS Order No. 12, Series of 1972, containing the above-cited rule.
The additional grounds raised were due process and equal protection.
After hearing, the respondent judge rendered a decision on July 4, 1989, declaring the
challenged order invalid and granting the petition. Judge Teresita Dizon-Capulong held that
the petitioner had been deprived of his right to pursue a medical education through an
arbitrary exercise of the police power. 3
We cannot sustain the respondent judge. Her decision must be reversed.
In Tablarin v. Gutierrez, 4 this Court upheld the constitutionality of the NMAT as a measure
intended to limit the admission to medical schools only to those who have initially proved
their competence and preparation for a medical education. Justice Florentino P. Feliciano
declared for a unanimous Court:
Perhaps the only issue that needs some consideration is whether there is
some reasonable relation between the prescribing of passing the NMAT
as a condition for admission to medical school on the one hand, and the
securing of the health and safety of the general community, on the other
hand. This question is perhaps most usefully approached by recalling
that the regulation of the pratice of medicine in all its branches has long
been recognized as a reasonable method of protecting the health and
safety of the public. That the power to regulate and control the practice
of medicine includes the power to regulate admission to the ranks of
those authorized to practice medicine, is also well recognized. Thus,
legislation and administrative regulations requiring those who wish to
practice medicine first to take and pass medical board examinations
have long ago been recognized as valid exercises of governmental
power. Similarly, the establishment of minimum medical educational
requirements-i.e., the completion of prescribed courses in a recognized
medical school-for admission to the medical profession, has also been
sustained as a legitimate exercise of the regulatory authority of the
state. What we have before us in the instant case is closely related: the
regulation of access to medical schools. MECS Order No. 52, s. 1985, as
noted earlier, articulates the rationale of regulation of this type: the
improvement of the professional and technical quality of the graduates
of medical schools, by upgrading the quality of those admitted to the
student body of the medical schools. That upgrading is sought by
selectivity in the process of admission, selectivity consisting, among
other things, of limiting admission to those who exhibit in the required
degree the aptitude for medical studies and eventually for medical
practice. The need to maintain, and the difficulties of maintaining, high
standards in our professional schools in general, and medical schools in
particular, in the current state of our social and economic development,
are widely known.
We believe that the government is entitled to prescribe an admission
test like the NMAT as a means of achieving its stated objective of
"upgrading the selection of applicants into [our] medical schools" and of
"improv[ing] the quality of medical education in the country." Given the
widespread use today of such admission tests in, for instance, medical
schools in the United States of America (the Medical College Admission
Test [MCAT] and quite probably, in other countries with far more
developed educational resources than our own, and taking into account
the failure or inability of the petitioners to even attempt to prove
otherwise, we are entitled to hold that the NMAT is reasonably related to
the securing of the ultimate end of legislation and regulation in this area.
That end, it is useful to recall, is the protection of the public from the
potentially deadly effects of incompetence and ignorance in those who
would undertake to treat our bodies and minds for disease or trauma.

However, the respondent judge agreed with the petitioner that the said case was not
applicable. Her reason was that it upheld only the requirement for the admission test and
said nothing about the so-called "three-flunk rule."
We see no reason why the rationale in the Tablarin case cannot apply to the case at bar.
The issue raised in both cases is the academic preparation of the applicant. This may be
gauged at least initially by the admission test and, indeed with more reliability, by the
three-flunk rule. The latter cannot be regarded any less valid than the former in the
regulation of the medical profession.
There is no need to redefine here the police power of the State. Suffice it to repeat that the
power is validly exercised if (a) the interests of the public generally, as distinguished from
those of a particular class, require the interference of the State, and (b) the means
employed are reasonably necessary to the attainment of the object sought to be
accomplished and not unduly oppressive upon individuals. 5
In other words, the proper exercise of the police power requires the concurrence of a lawful
subject and a lawful method.
The subject of the challenged regulation is certainly within the ambit of the police power. It
is the right and indeed the responsibility of the State to insure that the medical profession
is not infiltrated by incompetents to whom patients may unwarily entrust their lives and
health.
The method employed by the challenged regulation is not irrelevant to the purpose of the
law nor is it arbitrary or oppressive. The three-flunk rule is intended to insulate the medical
schools and ultimately the medical profession from the intrusion of those not qualified to
be doctors.
While every person is entitled to aspire to be a doctor, he does not have a constitutional
right to be a doctor. This is true of any other calling in which the public interest is involved;
and the closer the link, the longer the bridge to one's ambition. The State has the
responsibility to harness its human resources and to see to it that they are not dissipated
or, no less worse, not used at all. These resources must be applied in a manner that will
best promote the common good while also giving the individual a sense of satisfaction.
A person cannot insist on being a physician if he will be a menace to his patients. If one
who wants to be a lawyer may prove better as a plumber, he should be so advised and
adviced. Of course, he may not be forced to be a plumber, but on the other hand he may
not force his entry into the bar. By the same token, a student who has demonstrated
promise as a pianist cannot be shunted aside to take a course in nursing, however
appropriate this career may be for others.
The right to quality education invoked by the private respondent is not absolute. The
Constitution also provides that "every citizen has the right to choose a profession or
course of study, subject to fair, reasonable and equitable admission and academic
requirements. 6
The private respondent must yield to the challenged rule and give way to those better
prepared. Where even those who have qualified may still not be accommodated in our
already crowded medical schools, there is all the more reason to bar those who, like him,
have been tested and found wanting.
The contention that the challenged rule violates the equal protection clause is not welltaken. A law does not have to operate with equal force on all persons or things to be
conformable to Article III, Section 1 of the Constitution.

There can be no question that a substantial distinction exists between medical students
and other students who are not subjected to the NMAT and the three-flunk rule. The
medical profession directly affects the very lives of the people, unlike other careers which,
for this reason, do not require more vigilant regulation. The accountant, for example, while
belonging to an equally respectable profession, does not hold the same delicate
responsibility as that of the physician and so need not be similarly treated.
There would be unequal protection if some applicants who have passed the tests are
admitted and others who have also qualified are denied entrance. In other words, what the
equal protection requires is equality among equals.
The Court feels that it is not enough to simply invoke the right to quality education as a
guarantee of the Constitution: one must show that he is entitled to it because of his
preparation and promise. The private respondent has failed the NMAT five times. 7 While
his persistence is noteworthy, to say the least, it is certainly misplaced, like a hopeless
love.
No depreciation is intended or made against the private respondent. It is stressed that a
person who does not qualify in the NMAT is not an absolute incompetent unfit for any work
or occupation. The only inference is that he is a probably better, not for the medical
profession, but for another calling that has not excited his interest.
In the former, he may be a bungler or at least lackluster; in the latter, he is more likely to
succeed and may even be outstanding. It is for the appropriate calling that he is entitled to
quality education for the full harnessing of his potentials and the sharpening of his latent
talents toward what may even be a brilliant future.
We cannot have a society of square pegs in round holes, of dentists who should never
have left the farm and engineers who should have studied banking and teachers who
could be better as merchants.
It is time indeed that the State took decisive steps to regulate and enrich our system of
education by directing the student to the course for which he is best suited as determined
by initial tests and evaluations. Otherwise, we may be "swamped with mediocrity," in the
words of Justice Holmes, not because we are lacking in intelligence but because we are a
nation of misfits.
WHEREFORE, the petition is GRANTED. The decision of the respondent court dated January
13, 1989, is REVERSED, with costs against the private respondent. It is so ordered.
Fernan, C.J., Narvasa Melencio-Herrera, Gutierrez, Jr., Paras, Feliciano, Gancayco, Padilla,
Bidin, Sarmiento, Cortes, Grio-Aquino, Medialdea and Regalado, JJ., concur.

G.R. No. 144681

June 21, 2004

PROFESSIONAL REGULATION COMMISSION (PRC), CHAIRMAN HERMOGENES P.

POBRE, ASSOCIATE COMMISSIONER ARMANDO PASCUAL, BOARD OF MEDICINE,
CHAIRMAN RODOLFO P. DE GUZMAN, JOSE S. RAMIREZ, JUANITO B. BILLOTE,
RUBEN R. POLICARPIO, EDGARDO T. FERNANDO and RICARDO D. FULGENCIO
II, petitioners,
vs.
ARLENE V. DE GUZMAN, VIOLETA V. MENESES, CELERINA S. NAVARRO, JOSE
RAMONCITO P. NAVARRO, ARNEL V. HERRERA and GERALDINE ELIZABETH M.
PAGILAGAN, ELNORA R. RAQUENO, MARISSA A. REGODON, LAURA M. SANTOS,
KARANGALAN D. SERRANO, DANILO A. VILLAVER, MARIA ROSARIO L. LEONOR,
ALICIA S. LIZANO, MARITEL M. ECHIVERRI, BERNADETTE T. MENDOZA, FERNANDO
F. MANDAPAT, ALELI A. GOLLAYAN, ELCIN C. ARRIOLA, HERMINIGILDA E.
CONEJOS, SALLY B. BUNAGAN, ROGELIO B. ANCHETA, OSCAR H. PADUA, JR.,
EVELYN D. GRAJO, EVELYN S. ACOSTA, MARGARITA BELINDA L. VICENCIO,
VALENTINO P. ARBOLEDA, EVELYN O. RAMOS, ACHILLES J. PERALTA, CORAZON M.
CRUZ, LEUVINA P. CHICO, JOSEPH A. JAO, MA. LUISA S. GUTIERREZ, LYDIA C.
CHAN, OPHELIA C. HIDALGO, FERNANDO T. CRUZ, MELVIN M. USITA, RAFAEL I.
TOLENTINO, GRACE E. UY, CHERYL R. TRIGUERO, MICHAEL L. SERRANO,
FEDERICO L. CASTILLO, MELITA J. CAEDO, SAMUEL B. BANGOY, BERNARDITA B.
SY, GLORIA T. JULARBAL, FREDERICK D. FRANCISCO, CARLOS M. BERNARDO, JR.,

HUBERT S. NAZARENO, CLARISSA B. BACLIG, DAYMINDA G. BONTUYAN,

BERNADETTE H. CABUHAT, NANCY J. CHAVEZ, MARIO D. CUARESMA, ERNESTO L.
CUE, EVELYN C. CUNDANGAN, RHONEIL R. DEVERATURDA, DERILEEN D. DORADO,
SAIBZUR N. EDDING, VIOLETA C. FELIPE, HERMINIO V. FERNANDEZ, JR., MARIA
VICTORIA M. LACSAMANA, NORMA G. LAFAVILLA, RUBY B. LANTIN, MA. ELOISA Q.
MALLARI, CLARISA SJ. NICOLAS, PERCIVAL H. PANGILINAN, ARNULFO A.
SALVADOR, ROBERT B. SANCHEZ, MERLY D. STA. ANA and YOLANDA P.
UNICA, respondents.
DECISION
TINGA, J.:
This petition for review under Rule 45 of the 1997 Rules of Civil Procedure seeks to nullify
the D E C I S I O N,1dated May 16, 2000, of the Court of Appeals in CA-G.R. SP No. 37283.
The appellate court affirmed the judgment2 dated December 19, 1994, of the Regional Trial
Court (RTC) of Manila, Branch 52, in Civil Case No. 93-66530. The trial court allowed the
respondents to take their physicians oath and to register as duly licensed physicians.
Equally challenged is the R E S O L U T I O N 3 promulgated on August 25, 2000 of the Court
of Appeals, denying petitioners Motion for Reconsideration.
The facts of this case are as follows:
The respondents are all graduates of the Fatima College of Medicine, Valenzuela
City, Metro Manila. They passed the Physician Licensure Examination conducted
in February 1993 by the Board of Medicine (Board). Petitioner Professional
Regulation Commission (PRC) then released their names as successful examinees
in the medical licensure examination.
Shortly thereafter, the Board observed that the grades of the seventy-nine
successful examinees from Fatima College in the two most difficult subjects in the
medical licensure exam, Biochemistry (Bio-Chem) and Obstetrics and Gynecology
(OB-Gyne), were unusually and exceptionally high. Eleven Fatima examinees
scored 100% in Bio-Chem and ten got 100% in OB-Gyne, another eleven got 99%
in Bio-Chem, and twenty-one scored 99% in OB-Gyne. The Board also observed
that many of those who passed from Fatima got marks of 95% or better in both
subjects, and no one got a mark lower than 90%. A comparison of the
performances of the candidates from other schools was made. The Board
observed that strangely, the unusually high ratings were true only for Fatima
College examinees. It was a record-breaking phenomenon in the history of the
Physician Licensure Examination.
On June 7, 1993, the Board issued Resolution No. 19, withholding the registration as
physicians of all the examinees from the Fatima College of Medicine. 4 The PRC asked the
National Bureau of Investigation (NBI) to investigate whether any anomaly or irregularity
marred the February 1993 Physician Licensure Examination.
Prior to the NBI investigation, the Board requested Fr. Bienvenido F. Nebres, S.J., an expert
mathematician and authority in statistics, and later president of the Ateneo de Manila
University, to conduct a statistical analysis of the results in Bio-Chem and Ob-Gyne of the
said examination.
On June 10, 1993, Fr. Nebres submitted his report. He reported that a comparison of the
scores in Bio-Chem and Ob-Gyne, of the Fatima College examinees with those of
examinees from De La Salle University and Perpetual Help College of Medicine showed
that the scores of Fatima College examinees were not only incredibly high but unusually
clustered close to each other. He concluded that there must be some unusual reason
creating the clustering of scores in the two subjects. It must be a cause "strong enough to

eliminate the normal variations that one should expect from the examinees [of Fatima
College] in terms of talent, effort, energy, etc." 5
For its part, the NBI found that "the questionable passing rate of Fatima examinees in the
[1993] Physician Examination leads to the conclusion that the Fatima examinees gained
early access to the test questions." 6
On July 5, 1993, respondents Arlene V. De Guzman, Violeta V. Meneses, Celerina S.
Navarro, Jose Ramoncito P. Navarro, Arnel V. Herrera, and Geraldine Elizabeth M. Pagilagan
(Arlene V. De Guzman et al., for brevity) filed a special civil action for mandamus, with
prayer for preliminary mandatory injunction docketed as Civil Case No. 93-66530 with the
Regional Trial Court (RTC) of Manila, Branch 52. Their petition was adopted by the other
respondents as intervenors.
Meanwhile, the Board issued Resolution No. 26, dated July 21, 1993, charging respondents
with "immorality, dishonest conduct, fraud, and deceit" in connection with the Bio-Chem
and Ob-Gyne examinations. It recommended that the test results of the Fatima examinees
be nullified. The case was docketed as Adm. Case No. 1687 by the PRC.
On July 28, 1993, the RTC issued an Order in Civil Case No. 93-66530 granting the
preliminary mandatory injunction sought by the respondents. It ordered the petitioners to
administer the physicians oath to Arlene V. De Guzman et al., and enter their names in
the rolls of the PRC.
The petitioners then filed a special civil action for certiorari with the Court of Appeals to set
aside the mandatory injunctive writ, docketed as CA-G.R. SP No. 31701.
On October 21, 1993, the appellate court decided CA-G.R. SP No. 31701, with the
dispositive portion of theDecision ordaining as follows:
WHEREFORE, this petition is GRANTED. Accordingly, the writ of preliminary
mandatory injunction issued by the lower court against petitioners is hereby
nullified and set aside.
SO ORDERED.7
Arlene V. de Guzman, et al., then elevated the foregoing Decision to this Court in G.R. No.
112315. In ourResolution dated May 23, 1994, we denied the petition for failure to show
reversible error on the part of the appellate court.
Meanwhile, on November 22, 1993, during the pendency of the instant petition, the pretrial conference in Civil Case No. 93-66530 was held. Then, the parties, agreed to reduce
the testimonies of their respective witnesses to sworn questions-and-answers. This was
without prejudice to cross-examination by the opposing counsel.
On December 13, 1993, petitioners counsel failed to appear at the trial in the mistaken
belief that the trial was set for December 15. The trial court then ruled that petitioners
waived their right to cross-examine the witnesses.
On January 27, 1994, counsel for petitioners filed a Manifestation and Motion stating the
reasons for her non-appearance and praying that the cross-examination of the witnesses
for the opposing parties be reset. The trial court denied the motion for lack of notice to
adverse counsel. It also denied the Motion for Reconsideration that followed on the ground
that adverse counsel was notified less than three (3) days prior to the hearing.

Meanwhile, to prevent the PRC and the Board from proceeding with Adm. Case No. 1687,
the respondents herein moved for the issuance of a restraining order, which the lower
court granted in its Order dated April 4, 1994.
The petitioners then filed with this Court a petition for certiorari docketed as G.R. No.
115704, to annul the Ordersof the trial court dated November 13, 1993, February 28,
1994, and April 4, 1994. We referred the petition to the Court of Appeals where it was
docketed as CA-G.R. SP No. 34506.
On August 31, 1994, the appellate court decided CA-G.R. SP No. 34506 as follows:
WHEREFORE, the present petition for certiorari with prayer for temporary
restraining order/preliminary injunction is GRANTED and the Orders of December
13, 1993, February 7, 1994, February 28, 1994, and April 4, 1994 of the RTCManila, Branch 52, and all further proceedings taken by it in Special Civil Action
No. 93-66530 are hereby DECLARED NULL and VOID. The said RTC-Manila is
ordered to allow petitioners counsel to cross-examine the respondents
witnesses, to allow petitioners to present their evidence in due course of trial, and
thereafter to decide the case on the merits on the basis of the evidence of the
parties. Costs against respondents.
IT IS SO ORDERED.8

It should be made clear that this decision is without prejudice to any

administrative disciplinary action which may be taken against any of the
petitioners for such causes and in the manner provided by law and consistent
with the requirements of the Constitution as any other professionals.
No costs.
SO ORDERED.10
As a result of these developments, petitioners filed with this Court a petition for review on
certiorari docketed as G.R. No. 118437, entitled Professional Regulation Commission v.
Hon. David G. Nitafan, praying inter alia, that (1) G.R. No. 118437 be consolidated with
G.R. No. 117817; (2) the decision of the Court of Appeals dated August 31, 1994 in CA-G.R.
SP No. 34506 be nullified for its failure to decree the dismissal of Civil Case No. 93-66530,
and in the alternative, to set aside the decision of the trial court in Civil Case No. 9366530, order the trial court judge to inhibit himself, and Civil Case No. 93-66530 be reraffled to another branch.
On December 26, 1994, the petitioners herein filed their Notice of Appeal11 in Civil Case
No. 93-66530, thereby elevating the case to the Court of Appeals, where it was docketed
as CA-G.R. SP No. 37283.
In our Resolution of June 7, 1995, G.R. No. 118437 was consolidated with G.R. No. 117817.

The trial was then set and notices were sent to the parties.
A day before the first hearing, on September 22, 1994, the petitioners filed an Urgent ExParte Manifestation and Motion praying for the partial reconsideration of the appellate
courts decision in CA-G.R. SP No. 34506, and for the outright dismissal of Civil Case No.
93-66530. The petitioners asked for the suspension of the proceedings.
In its Order dated September 23, 1994, the trial court granted the aforesaid motion,
cancelled the scheduled hearing dates, and reset the proceedings to October 21 and 28,
1994.
Meanwhile, on October 25, 1994, the Court of Appeals denied the partial motion for
reconsideration in CA-G.R. SP No. 34506. Thus, petitioners filed with the Supreme Court a
petition for review docketed as G.R. No. 117817, entitled Professional Regulation
Commission, et al. v. Court of Appeals, et al.
On November 11, 1994, counsel for the petitioners failed to appear at the trial of Civil
Case No. 93-66530. Upon motion of the respondents herein, the trial court ruled that
herein petitioners waived their right to cross-examine the herein respondents. Trial was
reset to November 28, 1994.
On November 25, 1994, petitioners counsel moved for the inhibition of the trial court
judge for alleged partiality. On November 28, 1994, the day the Motion to Inhibit was to be
heard, petitioners failed to appear. Thus, the trial court denied the Motion to Inhibit and
declared Civil Case No. 93-66530 deemed submitted for decision.
On December 19, 1994, the trial court handed down its judgment in Civil Case No. 9366530, the fallo of which reads:
WHEREFORE, judgment is rendered ordering the respondents to allow the
petitioners and intervenors (except those with asterisks and footnotes in pages 1
& 2 of this decision) [sic],9 to take the physicians oath and to register them as
physicians.

On July 9, 1998, we disposed of G.R. Nos. 117817 and 118437 in this wise:
WHEREFORE, the petition in G.R. No. 117817 is DISMISSED for being moot. The
petition in G.R. No. 118437 is likewise DISMISSED on the ground that there is a
pending appeal before the Court of Appeals. Assistant Solicitor General Amparo
M. Cabotaje-Tang is advised to be more circumspect in her dealings with the
courts as a repetition of the same or similar acts will be dealt with accordingly.
SO ORDERED.12
While CA-G.R. SP No. 37283 was awaiting disposition by the appellate court, Arnel V.
Herrera, one of the original petitioners in Civil Case No. 93-66530, joined by twenty-seven
intervenors, to wit: Fernando F. Mandapat, Ophelia C. Hidalgo, Bernadette T. Mendoza,
Ruby B. Lantin-Tan, Fernando T. Cruz, Marissa A. Regodon, Ma. Eloisa Q. Mallari-Largoza,
Cheryl R. Triguero, Joseph A. Jao, Bernadette H. Cabuhat, Evelyn S. Acosta-Cabanes, Laura
M. Santos, Maritel M. Echiverri, Bernadette C. Escusa, Carlosito C. Domingo, Alicia S.
Lizano, Elnora R. Raqueno-Rabaino, Saibzur N. Edding, Derileen D. Dorado-Edding, Robert
B. Sanchez, Maria Rosario L. Leonor-Lacandula, Geraldine Elizabeth M. Pagilagan-Palma,
Margarita Belinda L. Vicencio-Gamilla, Herminigilda E. Conejos, Leuvina P. Chico-Paguio,
Elcin C. Arriola-Ocampo, and Jose Ramoncito P. Navarro, manifested that they were no
longer interested in proceeding with the case and moved for its dismissal. A similar
manifestation and motion was later filed by intervenors Mary Jean I. Yeban-Merlan, Michael
L. Serrano, Norma G. Lafavilla, Arnulfo A. Salvador, Belinda C. Rabara, Yolanda P. Unica,
Dayminda G. Bontuyan, Clarissa B. Baclig, Ma. Luisa S. Gutierrez, Rhoneil R. Deveraturda,
Aleli A. Gollayan, Evelyn C. Cundangan, Frederick D. Francisco, Violeta V. Meneses, Melita J.
Caedo, Clarisa SJ. Nicolas, Federico L. Castillo, Karangalan D. Serrano, Danilo A. Villaver,
Grace E. Uy, Lydia C. Chan, and Melvin M. Usita. The Court of Appeals ruled that its
decision in CA-G.R. SP No. 37283 would not apply to them.
On May 16, 2000, the Court of Appeals decided CA-G.R. SP No. 37283, with the
following fallo, to wit:

WHEREFORE, finding no reversible error in the decision appealed from, We hereby

AFFIRM the same and DISMISS the instant appeal.
No pronouncement as to costs.
SO ORDERED.13
In sustaining the trial courts decision, the appellate court ratiocinated that the
respondents complied with all the statutory requirements for admission into the licensure
examination for physicians in February 1993. They all passed the said examination. Having
fulfilled the requirements of Republic Act No. 2382, 14 they should be allowed to take their
oaths as physicians and be registered in the rolls of the PRC.
Hence, this petition raising the following issues:
I
WHETHER OR NOT RESPONDENTS HAVE A VALID CAUSE OF ACTION FOR
MANDAMUS AGAINST PETITIONERS IN THE LIGHT OF THE RESOLUTION OF THIS
HONORABLE COURT IN G.R. NO. 112315 AFFIRMING THE COURT OF APPEALS
DECISION DECLARING THAT IF EVER THERE IS SOME DOUBT AS TO THE MORAL
FITNESS OF EXAMINEES, THE ISSUANCE OF LICENSE TO PRACTICE MEDICINE IS
NOT AUTOMATICALLY GRANTED TO THE SUCCESSFUL EXAMINEES.
II
WHETHER OR NOT THE PETITION FOR MANDAMUS COULD PROCEED DESPITE THE
PENDENCY OF ADMINISTRATIVE CASE NO. 1687, WHICH WAS PRECISELY LODGED
TO DETERMINE THE MORAL FITNESS OF RESPONDENTS TO BECOME DOCTORS.15
To our mind, the only issue is: Did the Court of Appeals commit a reversible error of law in
sustaining the judgment of the trial court that respondents are entitled to a writ of
mandamus?
The petitioners submit that a writ of mandamus will not lie in this case. They point out that
for a writ of mandamus to issue, the applicant must have a well-defined, clear and certain
legal right to the thing demanded and it is the duty of the respondent to perform the act
required. Thus, mandamus may be availed of only when the duty sought to be performed
is a ministerial and not a discretionary one. The petitioners argue that the appellate
courts decision in CA-G.R. SP No. 37283 upholding the decision of the trial court in Civil
Case No. 93-66530 overlooked its own pronouncement in CA-G.R. SP No. 31701. The Court
of Appeals held in CA-G.R. SP No. 31701 that the issuance of a license to engage in the
practice of medicine becomes discretionary on the PRC if there exists some doubt that the
successful examinee has not fully met the requirements of the law. The petitioners stress
that this Courts Resolution dated May 24, 1994 in G.R. No. 112315 held that there was no
showing "that the Court of Appeals had committed any reversible error in rendering the
questioned judgment" in CA-G.R. SP No. 31701. The petitioners point out that
our Resolution in G.R. No. 112315 has long become final and executory.
Respondents counter that having passed the 1993 licensure examinations for physicians,
the petitioners have the obligation to administer to them the oath as physicians and to
issue their certificates of registration as physicians pursuant to Section 20 16 of Rep. Act No.
2382. The Court of Appeals in CA-G.R. SP No. 37283, found that respondents complied with
all the requirements of Rep. Act No. 2382. Furthermore, respondents were admitted by the
Medical Board to the licensure examinations and had passed the same. Hence, pursuant to
Section 20 of Rep. Act No. 2382, the petitioners had the obligation to administer their
oaths as physicians and register them.

Mandamus is a command issuing from a court of competent jurisdiction, in the name of

the state or the sovereign, directed to some inferior court, tribunal, or board, or to some
corporation or person requiring the performance of a particular duty therein specified,
which duty results from the official station of the party to whom the writ is directed, or
from operation of law. 17 Section 3 of Rule 6518 of the 1997 Rules of Civil Procedure outlines
two situations when a writ of mandamus may issue, when any tribunal, corporation, board,
officer or person unlawfully (1) neglects the performance of an act which the law
specifically enjoins as a duty resulting from an office, trust, or station; or (2) excludes
another from the use and enjoyment of a right or office to which the other is entitled.
We shall discuss the issues successively.
1. On The Existence of a Duty of the Board of Medicine To Issue Certificates of Registration
as Physicians under Rep. Act No. 2382.
For mandamus to prosper, there must be a showing that the officer, board, or official
concerned, has a clear legal duty, not involving discretion. 19 Moreover, there must be
statutory authority for the performance of the act, 20 and the performance of the duty has
been refused.21 Thus, it must be pertinently asked now: Did petitioners have the duty to
administer the Hippocratic Oath and register respondents as physicians under the Medical
Act of 1959?
As found by the Court of Appeals, on which we agree on the basis of the records:
It bears emphasizing herein that petitioner-appellees and intervenor-appellees
have fully complied with all the statutory requirements for admission into the
licensure examinations for physicians conducted and administered by the
respondent-appellants on February 12, 14, 20 and 21, 1993. Stress, too, must be
made of the fact that all of them successfully passed the same examinations. 22
The crucial query now is whether the Court of Appeals erred in concluding that petitioners
should allow the respondents to take their oaths as physicians and register them, steps
which would enable respondents to practice the medical profession 23 pursuant to Section
20 of the Medical Act of 1959?
The appellate court relied on a single provision, Section 20 of Rep. Act No. 2382, in
concluding that the petitioners had the ministerial obligation to administer the Hippocratic
Oath to respondents and register them as physicians. But it is a basic rule in statutory
construction that each part of a statute should be construed in connection with every
other part to produce a harmonious whole, not confining construction to only one
section.24 The intent or meaning of the statute should be ascertained from the statute
taken as a whole, not from an isolated part of the provision. Accordingly, Section 20, of
Rep. Act No. 2382, as amended should be read in conjunction with the other provisions of
the Act. Thus, to determine whether the petitioners had the ministerial obligation to
administer the Hippocratic Oath to respondents and register them as physicians, recourse
must be had to the entirety of the Medical Act of 1959.
A careful reading of Section 20 of the Medical Act of 1959 discloses that the law uses the
word "shall" with respect to the issuance of certificates of registration. Thus, the
petitioners "shall sign and issue certificates of registration to those who have satisfactorily
complied with the requirements of the Board." In statutory construction the term "shall" is
a word of command. It is given imperative meaning. Thus, when an examinee satisfies the
requirements for the grant of his physicians license, the Board is obliged to administer to
him his oath and register him as a physician, pursuant to Section 20 and par. (1) of Section
2225 of the Medical Act of 1959.
However, the surrounding circumstances in this case call for serious inquiry concerning the
satisfactory compliance with the Board requirements by the respondents. The unusually

high scores in the two most difficult subjects was phenomenal, according to Fr. Nebres, the
consultant of PRC on the matter, and raised grave doubts about the integrity, if not
validity, of the tests. These doubts have to be appropriately resolved.
Under the second paragraph of Section 22, the Board is vested with the power to conduct
administrative investigations and "disapprove applications for examination or registration,"
pursuant to the objectives of Rep. Act No. 2382 as outlined in Section 1 26 thereof. In this
case, after the investigation, the Board filed before the PRC, Adm. Case No. 1687 against
the respondents to ascertain their moral and mental fitness to practice medicine, as
required by Section 927 of Rep. Act No. 2382. In its Decision dated July 1, 1997, the Board
ruled:
WHEREFORE, the BOARD hereby CANCELS the respondents[] examination papers
in the Physician Licensure Examinations given in February 1993 and further
DEBARS them from taking any licensure examination for a period of ONE (1) YEAR
from the date of the promulgation of this DECISION. They may, if they so desire,
apply for the scheduled examinations for physicians after the lapse of the period
imposed by the BOARD.
SO ORDERED.28
Until the moral and mental fitness of the respondents could be ascertained, according to
petitioners, the Board has discretion to hold in abeyance the administration of the
Hippocratic Oath and the issuance of the certificates to them. The writ of mandamus does
not lie to compel performance of an act which is not duly authorized.
The respondents nevertheless argue that under Section 20, the Board shall not issue a
certificate of registration only in the following instances: (1) to any candidate who has
been convicted by a court of competent jurisdiction of any criminal offense involving moral
turpitude; (2) or has been found guilty of immoral or dishonorable conduct after the
investigation by the Board; or (3) has been declared to be of unsound mind. They aver that
none of these circumstances are present in their case.
Petitioners reject respondents argument. We are informed that in Board Resolution No.
26,29 dated July 21, 1993, the Board resolved to file charges against the examinees from
Fatima College of Medicine for "immorality, dishonesty, fraud, and deceit in the ObstetricsGynecology and Biochemistry examinations." It likewise sought to cancel the examination
results obtained by the examinees from the Fatima College.
Section 830 of Rep. Act No. 2382 prescribes, among others, that a person who aspires to
practice medicine in the Philippines, must have "satisfactorily passed the corresponding
Board Examination." Section 22, in turn, provides that the oath may only be administered
"to physicians who qualified in the examinations." The operative word here is
"satisfactorily," defined as "sufficient to meet a condition or obligation" or "capable of
dispelling doubt or ignorance." 31 Gleaned from Board Resolution No. 26, the licensing
authority apparently did not find that the respondents "satisfactorily passed" the licensure
examinations. The Board instead sought to nullify the examination results obtained by the
respondents.
2. On the Right Of The Respondents To Be Registered As Physicians
The function of mandamus is not to establish a right but to enforce one that has been
established by law. If no legal right has been violated, there can be no application of a
legal remedy, and the writ of mandamus is a legal remedy for a legal right. 32 There must
be a well-defined, clear and certain legal right to the thing demanded. 33 It is long
established rule that a license to practice medicine is a privilege or franchise granted by
the government.34

It is true that this Court has upheld the constitutional right35 of every citizen to select a
profession or course of study subject to a fair, reasonable, and equitable admission and
academic requirements.36 But like all rights and freedoms guaranteed by the Charter, their
exercise may be so regulated pursuant to the police power of the State to safeguard
health, morals, peace, education, order, safety, and general welfare of the people. 37 Thus,
persons who desire to engage in the learned professions requiring scientific or technical
knowledge may be required to take an examination as a prerequisite to engaging in their
chosen careers. This regulation takes particular pertinence in the field of medicine, to
protect the public from the potentially deadly effects of incompetence and ignorance
among those who would practice medicine. In a previous case, it may be recalled, this
Court has ordered the Board of Medical Examiners to annul both its resolution and
certificate authorizing a Spanish subject, with the degree of Licentiate in Medicine and
Surgery from the University of Barcelona, Spain, to practice medicine in the Philippines,
without first passing the examination required by the Philippine Medical Act. 38 In another
case worth noting, we upheld the power of the State to upgrade the selection of applicants
into medical schools through admission tests.39
It must be stressed, nevertheless, that the power to regulate the exercise of a profession
or pursuit of an occupation cannot be exercised by the State or its agents in an arbitrary,
despotic, or oppressive manner. A political body that regulates the exercise of a particular
privilege has the authority to both forbid and grant such privilege in accordance with
certain conditions. Such conditions may not, however, require giving up ones
constitutional rights as a condition to acquiring the license. 40 Under the view that the
legislature cannot validly bestow an arbitrary power to grant or refuse a license on a public
agency or officer, courts will generally strike down license legislation that vests in public
officials discretion to grant or refuse a license to carry on some ordinarily lawful business,
profession, or activity without prescribing definite rules and conditions for the guidance of
said officials in the exercise of their power. 41
In the present case, the aforementioned guidelines are provided for in Rep. Act No. 2382,
as amended, which prescribes the requirements for admission to the practice of medicine,
the qualifications of candidates for the board examinations, the scope and conduct of the
examinations, the grounds for denying the issuance of a physicians license, or revoking a
license that has been issued. Verily, to be granted the privilege to practice medicine, the
applicant must show that he possesses all the qualifications and none of the
disqualifications. Furthermore, it must appear that he has fully complied with all the
conditions and requirements imposed by the law and the licensing authority. Should doubt
taint or mar the compliance as being less than satisfactory, then the privilege will not
issue. For said privilege is distinguishable from a matter of right, which may be demanded
if denied. Thus, without a definite showing that the aforesaid requirements and conditions
have been satisfactorily met, the courts may not grant the writ of mandamus to secure
said privilege without thwarting the legislative will.
3. On the Ripeness of the Petition for Mandamus
Lastly, the petitioners herein contend that the Court of Appeals should have dismissed the
petition for mandamus below for being premature. They argue that the administrative
remedies had not been exhausted. The records show that this is not the first time that
petitioners have sought the dismissal of Civil Case No. 93-66530. This issue was raised in
G.R. No. 115704, which petition we referred to the Court of Appeals, where it was docketed
as CA-G.R. SP No. 34506. On motion for reconsideration in CA-G.R. SP No. 34506, the
appellate court denied the motion to dismiss on the ground that the prayers for the
nullification of the order of the trial court and the dismissal of Civil Case No. 93-66530
were inconsistent reliefs. In G.R. No. 118437, the petitioners sought to nullify the decision
of the Court of Appeals in CA-G.R. SP No. 34506 insofar as it did not order the dismissal of
Civil Case No. 93-66530. In our consolidated decision, dated July 9, 1998, in G.R. Nos.
117817 & 118437, this Court speaking through Justice Bellosillo opined that:
Indeed, the issue as to whether the Court of Appeals erred in not ordering the
dismissal of Civil Case No. 93-66530 sought to be resolved in the instant petition

has been rendered meaningless by an event taking place prior to the filing of this
petition and denial thereof should follow as a logical consequence. 42 There is no
longer any justiciable controversy so that any declaration thereon would be of no
practical use or value. 43 It should be recalled that in its decision of 19 December
1994 the trial court granted the writ of mandamus prayed for by private
respondents, which decision was received by petitioners on 20 December 1994.
Three (3) days after, or on 23 December 1994, petitioners filed the instant
petition. By then, the remedy available to them was to appeal the decision to the
Court of Appeals, which they in fact did, by filing a notice of appeal on 26
December 1994.44
The petitioners have shown no cogent reason for us to reverse the aforecited ruling. Nor
will their reliance upon the doctrine of the exhaustion of administrative remedies in the
instant case advance their cause any.
Section 2645 of the Medical Act of 1959 provides for the administrative and judicial
remedies that respondents herein can avail to question Resolution No. 26 of the Board of
Medicine, namely: (a) appeal the unfavorable judgment to the PRC; (b) should the PRC
ruling still be unfavorable, to elevate the matter on appeal to the Office of the President;
and (c) should they still be unsatisfied, to ask for a review of the case or to bring the case
to court via a special civil action of certiorari. Thus, as a rule, mandamus will not lie when
administrative remedies are still available. 46 However, the doctrine of exhaustion of
administrative remedies does not apply where, as in this case, a pure question of law is
raised.47 On this issue, no reversible error may, thus, be laid at the door of the appellate
court in CA-G.R. SP No. 37283, when it refused to dismiss Civil Case No. 93-66530.
As we earlier pointed out, herein respondents Arnel V. Herrera, Fernando F. Mandapat,
Ophelia C. Hidalgo, Bernadette T. Mendoza, Ruby B. Lantin-Tan, Fernando T. Cruz, Marissa
A. Regodon, Ma. Eloisa Q. Mallari-Largoza, Cheryl R. Triguero, Joseph A. Jao, Bernadette H.
Cabuhat, Evelyn S. Acosta-Cabanes, Laura M. Santos, Maritel M. Echiverri, Bernadette C.
Escusa, Carlosito C. Domingo, Alicia S. Lizano, Elnora R. Raqueno-Rabaino, Saibzur N.
Edding, Derileen D. Dorado-Edding, Robert B. Sanchez, Maria Rosario Leonor-Lacandula,
Geraldine Elizabeth M. Pagilagan-Palma, Margarita Belinda L. Vicencio-Gamilla,
Herminigilda E. Conejos, Leuvina P. Chico-Paguio, Elcin C. Arriola-Ocampo, and Jose
Ramoncito P. Navarro manifested to the Court of Appeals during the pendency of CA-G.R.
SP No. 37283, that they were no longer interested in proceeding with the case and moved
for its dismissal insofar as they were concerned. A similar manifestation and motion were
later filed by intervenors Mary Jean I. Yeban-Merlan, Michael L. Serrano, Norma G. Lafavilla,
Arnulfo A. Salvador, Belinda C. Rabarra, Yolanda P. Unica, Dayminda G. Bontuyan, Clarissa
B. Baclig, Ma. Luisa S. Gutierrez, Rhoneil R. Deveraturda, Aleli A. Gollayan, Evelyn C.
Cundangan, Frederick D. Francisco, Violeta V. Meneses, Melita J. Caedo, Clarisa SJ.
Nicolas, Federico L. Castillo, Karangalan D. Serrano, Danilo A. Villaver, Grace E. Uy, Lydia C.
Chan, and Melvin M. Usita. Following these manifestations and motions, the appellate
court in CA-G.R. SP No. 37283 decreed that its ruling would not apply to them. Thus,
inasmuch as the instant case is a petition for review of the appellate courts ruling in CAG.R. SP No. 37283, a decision which is inapplicable to the aforementioned respondents will
similarly not apply to them.
As to Achilles J. Peralta, Evelyn O. Ramos, Sally B. Bunagan, Rogelio B. Ancheta, Oscar H.
Padua, Jr., Evelyn D. Grajo, Valentino P. Arboleda, Carlos M. Bernardo, Jr., Mario D.
Cuaresma, Violeta C. Felipe, Percival H. Pangilinan, Corazon M. Cruz and Samuel B.
Bangoy, herein decision shall not apply pursuant to the Orders of the trial court in Civil
Case No. 93-66530, dropping their names from the suit.
Consequently, this Decision is binding only on the remaining respondents, namely: Arlene
V. de Guzman, Celerina S. Navarro, Rafael I. Tolentino, Bernardita B. Sy, Gloria T. Jularbal,
Hubert S. Nazareno, Nancy J. Chavez, Ernesto L. Cue, Herminio V. Fernandez, Jr., Maria
Victoria M. Lacsamana and Merly D. Sta. Ana, as well as the petitioners.

WHEREFORE, the instant petition is GRANTED. Accordingly, (1) the assailed decision
dated May 16, 2000, of the Court of Appeals, in CA-G.R. SP No. 37283, which affirmed the
judgment dated December 19, 1994, of the Regional Trial Court of Manila, Branch 52, in
Civil Case No. 93-66530, ordering petitioners to administer the physicians oath to herein
respondents as well as the resolution dated August 25, 2000, of the appellate court,
denying the petitioners motion for reconsideration, are REVERSED and SET ASIDE; and (2)
the writ of mandamus, issued in Civil Case No. 93-66530, and affirmed by the appellate
court in CA-G.R. SP No. 37283 is NULLIFIED AND SET ASIDE.
SO ORDERED.

Before the Court is a Petition for Review on Certiorari assailing the Decision[1] of the Court
of Appeals (CA) in CA-G.R. SP No. 84945 [2] dated November 16, 2004 which affirmed the
Decision[3] of the Regional Trial Court (RTC), Branch 22, Manila, dated October 19, 2003.[4]
The facts are as follows:
Yasuyuki Ota (respondent) is a Japanese national, married to a Filipina, who has
continuously resided in the Philippines for more than 10 years. He graduated
from Bicol Christian College of Medicine on April 21, 1991 with a degree of Doctor of
Medicine.[5] After successfully completing a one-year post graduate internship training at
the Jose Reyes Memorial Medical Center, he filed an application to take the medical board
examinations in order to obtain a medical license. He was required by the Professional
Regulation Commission (PRC) to submit an affidavit of undertaking, stating among others
that should he successfully pass the same, he would not practice medicine until he
submits proof that reciprocity exists between Japan and the Philippines in admitting
foreigners into the practice of medicine.[6]
Respondent submitted a duly notarized English translation of the Medical Practitioners Law
of Japan duly authenticated by the Consul General of the Philippine Embassy to Japan,
Jesus I. Yabes;[7] thus, he was allowed to take the Medical Board Examinations in August
1992, which he subsequently passed.[8]
In spite of all these, the Board of Medicine (Board) of the PRC, in a letter dated March 8,
1993, denied respondent's request for a license to practice medicine in the
Philippines on the ground that the Board believes that no genuine reciprocity can be found
in the law of Japan as there is no Filipino or foreigner who can possibly practice there. [9]
Respondent then filed a Petition for Certiorari and Mandamus against the Board before the
RTC of Manila on June 24, 1993, which petition was amended on February 14,
1994 to implead the PRC through its Chairman.[10]
In his petition before the RTC, respondent alleged that the Board and the PRC, in refusing
to issue in his favor a Certificate of Registration and/or license to practice medicine, had
acted arbitrarily, in clear contravention of the provision of Section 20 of Republic Act (R.A.)
No. 2382 (The Medical Act of 1959), depriving him of his legitimate right to practice his
profession in the Philippines to his great damage and prejudice. [11]

.
BOARD OF MEDICINE,
DR. RAUL FLORES
(now DR. JOSE S. RAMIREZ),
in his capacity as Chairman of the
Board, PROFESSIONAL
REGULATION COMMISSION,
through its Chairman,
HERMOGENES POBRE
(now DR. ALCESTIS M. GUIANG),
Petitioners,

G.R. No. 166097

Present:
QUISUMBING,* J.,
YNARES-SANTIAGO,
Chairperson,
AUSTRIA-MARTINEZ,
NACHURA, and
REYES, JJ.

-versusPromulgated:
July 14, 2008

YASUYUKI OTA,

Respondent.
x -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- x
DECISION
AUSTRIA-MARTINEZ, J.:

On October 19, 2003, the RTC rendered its Decision finding that respondent had
adequately proved that the medical laws of Japan allow foreigners like Filipinos to be
granted license and be admitted into the practice of medicine under the principle of
reciprocity; and that the Board had a ministerial duty of issuing the Certificate of
Registration and license to respondent, as it was shown that he had substantially complied
with the requirements under the law. [12] The RTC then ordered the Board to issue in favor of
respondent the corresponding Certificate of Registration and/or license to practice
medicine in thePhilippines.[13]
The Board and the PRC (petitioners) appealed the case to the CA, stating that while
respondent submitted documents showing that foreigners are allowed to practice medicine
in Japan, it was not shown that the conditions for the practice of medicine there are
practical and attainable by a foreign applicant, hence, reciprocity was not established;
also, the power of the PRC and the Board to regulate and control the practice of medicine
is discretionary and not ministerial, hence, not compellable by a writ of mandamus.[14]
The CA denied the appeal and affirmed the ruling of the RTC.[15]
Hence, herein petition raising the following issue:
WHETHER THE COURT OF APPEALS COMMITTED A REVERSIBLE ERROR IN
FINDING THAT RESPONDENT HAD ESTABLISHED THE EXISTENCE OF
RECIPROCITY
IN
THE
PRACTICE
OF
MEDICINE
BETWEEN
THE PHILIPPINES AND JAPAN.[16]
Petitioners claim that: respondent has not established by competent and conclusive
evidence
that
reciprocity
in
the
practice
of
medicine
exists
between

the Philippines and Japan. While documents state that foreigners are allowed to practice
medicine in Japan, they do not similarly show that the conditions for the practice of
medicine in said country are practical and attainable by a foreign applicant. There is no
reciprocity in this case, as the requirements to practice medicine in Japan are practically
impossible for a Filipino to comply with. There are also ambiguities in the Medical
Practitioners Law of Japan, which were not clarified by respondent, i.e., what are the
provisions of the School Educations Laws, what are the criteria of the Minister of Health
and Welfare of Japan in determining whether the academic and technical capability of
foreign medical graduates are the same or better than graduates of medical schools in
Japan, and who can actually qualify to take the preparatory test for the National Medical
Examination. Consul General Yabes also stated that there had not been a single Filipino
who was issued a license to practice medicine by the Japanese Government. The
publication showing that there were foreigners practicing medicine in Japan, which
respondent presented before the Court, also did not specifically show that Filipinos were
among those listed as practicing said profession. [17] Furthermore, underProfessional
Regulation Commission v. De Guzman,[18] the power of the PRC and the Board to regulate
and control the practice of medicine includes the power to regulate admission to the ranks
of those authorized to practice medicine, which power is discretionary and not ministerial,
hence, not compellable by a writ of mandamus.[19]
Petitioners pray that the CA Decision dated November 16, 2004 be reversed and set aside,
that a new one be rendered reinstating the Board Order dated March 8, 1993 which
disallows respondent to practice medicine in the Philippines, and that respondent's petition
before the trial court be dismissed for lack of merit. [20]
In his Comment, respondent argues that: Articles 2 and 11 of the Medical Practitioners Law
of Japan and Section 9 of the Philippine Medical Act of 1959 show that reciprocity exists
between the Philippinesand Japan concerning the practice of medicine. Said laws clearly
state that both countries allow foreigners to practice medicine in their respective
jurisdictions as long as the applicant meets the educational requirements, training or
residency in hospitals and pass the licensure examination given by either country. Consul
General Yabes in his letter dated January 28, 1992 stated that the Japanese Government
allows a foreigner to practice medicine in Japan after complying with the local
requirements. The fact that there is no reported Filipino who has successfully penetrated
the medical practice in Japan does not mean that there is no reciprocity between the two
countries, since it does not follow that no Filipino will ever be granted a medical license by
the Japanese Government. It is not the essence of reciprocity that before a citizen of one of
the contracting countries can demand its application, it is necessary that the interested
citizens country has previously granted the same privilege to the citizens of the other
contracting country.[21] Respondent further argues that Section 20 of the Medical Act of
1959[22] indicates the mandatory character of the statute and an imperative obligation on
the part of the Board inconsistent with the idea of discretion. Thus, a foreigner, just like a
Filipino citizen, who successfully passes the examination and has all the qualifications and
none of the disqualifications, is entitled as a matter of right to the issuance of a certificate
of registration or a physicians license, which right is enforceable by mandamus.[23]
Petitioners filed a Reply [24] and both parties filed their respective memoranda [25] reiterating
their arguments.
The Court denies the petition for lack of merit.
There is no question that a license to practice medicine is a privilege or franchise
granted by the government.[26] It is a right that is earned through years of education and
training, and which requires that one must first secure a license from the state through
professional board examinations.[27]
Indeed,
[T]he regulation of the practice of medicine in all its branches has long
been recognized as a reasonable method of protecting the health and
safety of the public. That the power to regulate and control the practice
of medicine includes the power to regulate admission to the ranks of
those authorized to practice medicine, is also well recognized. Thus,
legislation and administrative regulations requiring those who wish to

practice
medicine
first to
take
and
pass
medical
board
examinations have long ago been recognized as valid exercises of
governmental power. Similarly, the establishment of minimum medical
educational requirements i.e., the completion of prescribed courses in a
recognized medical school for admission to the medical profession, has
also been sustained as a legitimate exercise of the regulatory authority
of the state.[28]
It must be stressed however that the power to regulate the exercise of a
profession or pursuit of an occupation cannot be exercised by the State or its agents in an
arbitrary, despotic, or oppressive manner.A political body which regulates the exercise of a
particular privilege has the authority to both forbid and grant such privilege in accordance
with certain conditions. As the legislature cannot validly bestow an arbitrary power to
grant or refuse a license on a public agency or officer, courts will generally strike down
license legislation that vests in public officials discretion to grant or refuse a license to
carry on some ordinarily lawful business, profession, or activity without prescribing definite
rules and conditions for the guidance of said officials in the exercise of their power. [29]
R.A. No. 2382 otherwise known as the Medical Act of 1959 states in Section 9 thereof that:
Section 9. Candidates for Board Examinations.- Candidates for Board
examinations shall have the following qualifications:
1. He shall be a citizen of the Philippines or a citizen of any foreign
country who has submitted competent and conclusive documentary
evidence, confirmed by the Department of Foreign Affairs, showing that
his countrys existing laws permit citizens of the Philippines to practice
medicine under the same rules and regulations governing citizens
thereof;
xxxx
Presidential Decree (P.D.) No. 223[30] also provides in Section (j) thereof that:
j) The [Professional Regulation] Commission may, upon the
recommendation of the Board concerned, approve the registration of and
authorize the issuance of a certificate of registration with or without
examination to a foreigner who is registered under the laws of his
country: Provided, That the requirement for the registration or licensing
in said foreign state or country are substantially the same as those
required and contemplated by the laws of the Philippines and that the
laws of such foreign state or country allow the citizens of the Philippines
to practice the profession on the same basis and grant the same
privileges as the subject or citizens of such foreign state or country:
Provided, finally, That the applicant shall submit competent and
conclusive documentary evidence, confirmed by the Department of
Foreign Affairs, showing that his country's existing laws permit citizens of
the Philippines to practice the profession under the rules and regulations
governing citizens thereof. The Commission is also hereby authorized to
prescribe additional requirements or grant certain privileges to
foreigners seeking registration in the Philippines if the same privileges
are granted to or some additional requirements are required of citizens
of the Philippines in acquiring the same certificates in his country;
xxxx
As required by the said laws, respondent submitted a copy of the Medical
Practitioners Law of Japan, duly authenticated by the Consul General of the Embassy of
the Philippines in Japan, which provides in Articles 2 and 11, thus:

Article 2. Anyone who wants to be medical practitioner must

pass the national examination for medical practitioner and get license
from the Minister of Health and Welfare.
xxxx
Article 11. No one can take the National Medical Examination
except persons who conform to one of the following items:
1.

Persons who finished regular medical courses at a

university based on the School Education Laws (December
26, 1947) and graduated from said university.

2.

Persons who passed the preparatory test for the National

Medical Examination and practiced clinics and public
sanitation more than one year after passing the said test.

3.

Persons who graduated from a foreign medical school or

acquired medical practitioner license in a foreign country,
and also are recognized to have the same or more
academic ability and techniques as persons stated in item
1 and item 2 of this article.[31]

Petitioners argue that while the Medical Practitioners Law of Japan allows
foreigners to practice medicine therein, said document does not show that conditions for
the practice of medicine in said country are practical and attainable by a foreign applicant;
and since the requirements are practically impossible for a Filipino to comply with, there is
no reciprocity between the two countries, hence, respondent may not be granted license
to practice medicine in the Philippines.
The Court does not agree.
R.A. No. 2382, which provides who may be candidates for the medical board
examinations, merely requires a foreign citizen to submit competent and conclusive
documentary evidence, confirmed by the Department of Foreign Affairs (DFA), showing
that his countrys existing laws permit citizens of the Philippines to practice medicine under
the same rules and regulations governing citizens thereof.
Section (j) of P.D. No. 223 also defines the extent of PRC's power to grant
licenses, i.e., it may, upon recommendation of the board, approve the registration and
authorize the issuance of a certificate of registration with or without examination to a
foreigner who is registered under the laws of his country, provided the following conditions
are met: (1) that the requirement for the registration or licensing in said foreign state or
country are substantially the same as those required and contemplated by the laws of the
Philippines; (2) that the laws of such foreign state or country allow the citizens of the
Philippines to practice the profession on the same basis and grant the same privileges as
the subject or citizens of such foreign state or country; and (3) that the applicant shall
submit competent and conclusive documentary evidence, confirmed by the DFA, showing
that his country's existing laws permit citizens of the Philippines to practice the profession
under the rules and regulations governing citizens thereof.
The said provision further states that the PRC is authorized to prescribe additional
requirements or grant certain privileges to foreigners seeking registration in
the Philippines if the same privileges are granted to or some additional requirements are
required of citizens of the Philippines in acquiring the same certificates in his country.
Nowhere in said statutes is it stated that the foreign applicant must show that the
conditions for the practice of medicine in said country are practical and attainable by
Filipinos. Neither is it stated that it must first be proven that a Filipino has been granted
license and allowed to practice his profession in said country before a foreign applicant

may be given license to practice in the Philippines. Indeed, the phrase used in both R.A.
No. 2382 and P.D. No. 223 is that:
[T]he applicant shall submit] competent and conclusive documentary
evidence, confirmed by the Department of Foreign Affairs, showing that
his country's existing laws permit citizens of the Philippines to
practice the profession [of medicine] under the [same] rules and
regulations governing citizens thereof. x x x (Emphasis supplied)
It is enough that the laws in the foreign country permit a Filipino to get license
and practice therein. Requiring respondent to prove first that a Filipino has already been
granted license and is actually practicing therein unduly expands the requirements
provided for under R.A. No. 2382 and P.D. No. 223.
While it is true that respondent failed to give details as to the conditions stated in
the Medical Practitioners Law of Japan -- i.e., the provisions of the School Educations Laws,
the criteria of the Minister of Health and Welfare of Japan in determining whether the
academic and technical capability of foreign medical graduates are the same as or better
than that of graduates of medical schools in Japan, and who can actually qualify to take
the preparatory test for the National Medical Examination respondent, however, presented
proof that foreigners are actually practicing in Japan and that Filipinos are not precluded
from getting a license to practice there.
Respondent presented before the trial court a Japanese Government
publication, Physician-Dentist-Pharmaceutist Survey, showing that there are a number of
foreign physicians practicing medicine inJapan. [32] He also presented a letter dated January
28, 1992 from Consul General Yabes,[33] which states:

Sir:

In De Guzman itself, the Court explained that:

With reference to your letter dated 12 January 1993, concerning

your request for a Certificate of Confirmation for the purpose of
establishing a reciprocity with Japan in the practice of medical profession
relative to the case of Mr. Yasuyuki Ota, a Japanese national, the
Embassy wishes to inform you that inquiries from the Japanese Ministry
of Foreign Affairs, Ministry of Health and Welfare as well as Bureau of
Immigration yielded the following information:
1.
2.

They are not aware of a Filipino physician who was granted a

license by the Japanese Government to practice medicine
in Japan;
However, the Japanese Government allows a foreigner to
practice medicine in Japan after complying with the local
requirements such as holding a valid visa for the
purpose of taking the medical board exam, checking the
applicant's qualifications to take the examination, taking
the national board examination in Japanese and filing an
application for the issuance of the medical license.

Accordingly, the Embassy is not aware of a single Filipino

physician who was issued by the Japanese Government a license
to practice medicine, because it is extremely difficult to pass the
medical board examination in the Japanese language. Filipino
doctors here are only allowed to work in Japanese hospitals as trainees
under the supervision of a Japanese doctor. On certain occasions, they
are allowed to show their medical skills during seminars for
demonstration purposes only. (Emphasis supplied)
Very truly yours,
Jesus I. Yabes
Minister Counsellor &
Consul General
From said letter, one can see that the Japanese Government allows foreigners to
practice medicine therein provided that the local requirements are complied with, and that
it is not the impossibility or the prohibition against Filipinos that would account for the
absence of Filipino physicians holding licenses and practicing medicine in Japan, but the
difficulty of passing the board examination in the Japanese language. Granting that there
is still no Filipino who has been given license to practice medicine in Japan, it does not
mean that no Filipino will ever be able to be given one.
Petitioners next argue that as held in De Guzman, its power to issue licenses is
discretionary, hence, not compellable by mandamus.
The Court finds that the factual circumstances of De Guzman are different from
those of the case at bar; hence, the principle applied therein should be viewed differently
in this case. In De Guzman, there were doubts about the integrity and validity of the test
results of the examinees from a particular school which garnered unusually high scores in
the two most difficult subjects. Said doubts called for serious inquiry concerning the
applicants satisfactory compliance with the Board requirements. [34] And as there was no
definite showing that the requirements and conditions to be granted license to practice
medicine had been satisfactorily met, the Court held that the writ of mandamus may not
be granted to secure said privilege without thwarting the legislative will. [35]
Indeed, to be granted the privilege to practice medicine, the applicant must show
that he possesses all the qualifications and none of the disqualifications. It must also
appear that he has fully complied with all the conditions and requirements imposed by the
law and the licensing authority.[36]

A careful reading of Section 20 [37] of the Medical Act of 1959

discloses that the law uses the word shall with respect to the issuance of
certificates of registration. Thus, the petitioners [PRC] shall sign and
issue certificates of registration to those who have satisfactorily
complied with the requirements of the Board. In statutory construction
the term shall is a word of command. It is given imperative meaning.
Thus, when an examinee satisfies the requirements for the grant of his
physician's license, the Board is obliged to administer to him his oath
and register him as a physician, pursuant to Section 20 and par.
(1) of Section 22 of the Medical Act of 1959.[38]
In this case, there is no doubt as to the competence and qualifications of
respondent. He finished his medical degree from Bicol Christian College of Medicine. He
completed
a
one-year
post
graduate
internship
training
at
the Jose Reyes Memorial Medical Center, a government hospital. Then he passed the
Medical Board Examinations which was given on August 8, 1992 with a general average of
81.83, with scores higher than 80 in 9 of the 12 subjects.
In fine, the only matter being questioned by petitioners is the alleged failure of
respondent to prove that there is reciprocity between the laws of Japan and
the Philippines in admitting foreigners into the practice of medicine. Respondent has
satisfactorily complied with the said requirement and the CA has not committed any
reversible error in rendering its Decision dated November 16, 2004 and Resolution
dated October 19, 2003.
WHEREFORE, the petition is hereby DENIED for lack of merit.
SO ORDERED.