Borromeo Vs Family Care Hospital
Borromeo Vs Family Care Hospital
Borromeo Vs Family Care Hospital
AND
RAMON S. INSO, M.D., RESPONDENTS.
DECISION
BRION, J.:
Carlos Borromeo lost his wife Lillian when she died after undergoing a routine appendectomy. The hospital
and the attending surgeon submit that Lillian bled to death due to a rare, life-threatening condition that
prevented her blood from clotting normally. Carlos believes, however, that the hospital and the surgeon were
On January 22, 2010, the Court of Appeals (CA) in CA-G.R CV No. 89096[1] dismissed Carlos' complaint and
thus reversed the April 10, 2007 decision of the Regional Trial Court (RTC) in Civil Case No. 2000-603-MK[2]
The present petition for review on certiorari seeks to reverse the CA's January 22, 2010 decision.
ANTECEDENTS
The petitioner, Carlos Borromeo, was the husband of the late Lilian V. Borromeo (Lilian). Lilian was a patient
of the respondent Family Care Hospital, Inc. (Family Care) under the care of respondent Dr. Ramon Inso (Dr.
Inso).
On July 13, 1999, the petitioner brought his wife to the Family Care Hospital because she had been
complaining of acute pain at the lower stomach area and fever for two days. She was admitted at the hospital
Dr. Inso suspected that Lilian might be suffering from acute appendicitis. However, there was insufficient data
to rule out other possible causes and to proceed with an appendectomy. Thus, he ordered Lilian's
| Page 1 of 20
Over the next 48 hours, Lilian underwent multiple tests such as complete blood count, urinalysis, stool exam,
pelvic ultrasound, and a pregnancy test. However, the tests were not conclusive enough to confirm that she
had appendicitis.
Meanwhile, Lilian's condition did not improve. She suffered from spiking fever and her abdominal pain
worsened. The increasing tenderness of her stomach, which was previously confined to her lower right side,
had also extended to her lower left side. Lilian abruptly developed an acute surgical abdomen.
On July 15, 1999, Dr. Inso decided to conduct an exploratory laparotomy on Lilian because of the findings on
her abdomen and his fear that she might have a ruptured appendix. Exploratory laparotomy is a surgical
procedure involving a large incision on the abdominal wall that would enable Dr. Inso to examine the
abdominal cavity and identify the cause of Lilian's symptoms. After explaining the situation, Dr. Inso obtained
At around 3:45 P.M., Lilian was brought to the operating room where Dr. Inso conducted the surgery. During
the operation, Dr. Inso confirmed that Lilian was suffering from acute appendicitis. He proceeded to remove
her appendix which was already infected and congested with pus.
The operation was successful. Lilian's appearance and vital signs improved. At around 7:30 P.M., Lilian was
At around 1:30 A.M. on July 16, 1999, roughly six hours after Lilian was brought back to her room, Dr. Inso
was informed that her blood pressure was low. After assessing her condition, he ordered the infusion of more
Despite the late hour, Dr. Inso remained in the hospital to monitor Lilian's condition. Subsequently, a nurse
informed him that Lilian was becoming restless. Dr. Inso immediately went to Lilian and saw that she was
Lilian did not respond to the blood transfusion even after receiving two 500 cc-units of blood. Various drugs,
| Page 2 of 20
Eventually, an endotracheal tube connected to an oxygen tank was inserted into Lilian to ensure her airway
was clear and to compensate for the lack of circulating oxygen in her body from the loss of red blood cells.
Dr. Inso observed that Lilian was developing petechiae in various parts of her body. Petechiae are small
bruises caused by bleeding under the skin whose presence indicates a blood-coagulation problem - a defect
in the ability of blood to clot. At this point, Dr. Inso suspected that Lilian had Disseminated Intravascular
Coagulation(DIC), a blood disorder characterized by bleeding in many parts of her body caused by the
consumption or the loss of the clotting factors in the blood. However, Dr. Inso did not have the luxury to
conduct further tests because the immediate need was to resuscitate Lilian.
Dr. Inso and the nurses performed cardiopulmonary resuscitation (CPR) on Lilian. Dr. Inso also informed her
family that there may be a need to re-operate on her, but she would have to be put in an Intensive Care Unit (
ICU). Unfortunately, Family Care did not have an ICU because it was only a secondary hospital and was not
required by the Department of Health to have one. Dr. Inso informed the petitioner that Lilian would have to
At around 3:30 A.M., Dr. Inso personally called the Perpetual Help Medical Center to arrange Lilian's transfer,
but the latter had no available bed in its ICU. Dr. Inso then personally coordinated with the Muntinlupa
At around 4:00 A.M., Lilian was taken to the MMC by ambulance accompanied by the resident doctor on duty
and a nurse. Dr. Inso followed closely behind in his own vehicle.
Upon reaching the MMC, a medical team was on hand to resuscitate Lilian. A nasogastric tube (NGT) was
inserted and IV fluids were immediately administered to her. Dr. Inso asked for a plasma expander.
Unfortunately, at around 10:00 A.M., Lilian passed away despite efforts to resuscitate her.
At the request of the petitioner, Lilian's body was autopsied at the Philippine National Police (PNP) Camp
Crame Crime Laboratory. Dr. Emmanuel Reyes (Dr. Reyes), the medico-legal assigned to the laboratory,
conducted the autopsy. Dr. Reyes summarized his notable findings as:
| Page 3 of 20
x x x I opened up the body and inside the abdominal cavity which you call peritoneal cavity there were
3,000 ml of clot and unclot blood accumulated thereat. The peritoneal cavity was also free from any
adhesion. Then, I opened up the head and the brain revealed paper white in color and the heart
revealed abundant petechial hemorrhages from the surface and it was normal. The valvular leaflets
were soft and pliable, and of course, the normal color is reddish brown as noted. And the coronary
arteries which supply the heart were normal and unremarkable. Next, the lungs appears [sic]
hemorrhagic. That was the right lung while the left lung was collapsed and paled. For the intestines, I
noted throughout the entire lengths of the small and large intestine were hemorrhagic areas. Noted
absent is the appendix at the ileo-colic area but there were continuous suture repair done thereat.
However, there was a 0.5 x 0.5 cm opening or left unrepaired at that time. There was an opening on
that repair site. Meaning it was not repaired. There were also at that time clot and unclot blood found
adherent thereon. The liver and the rest of the visceral organs were noted exhibit [sic] some degree of
pallor but were otherwise normal. The stomach contains one glassful about 400 to 500 ml.[3]
Dr. Reyes concluded that the cause of Lilian's death was hemorrhage due to bleeding petechial blood vessels:
internal bleeding. He further concluded that the internal bleeding was caused by the 0.5 x 0.5 cm opening in
the repair site. He opined that the bleeding could have been avoided if the site was repaired with double
Based on the autopsy, the petitioner filed a complaint for damages against Family Care and against Dr. Inso
During the trial, the petitioner presented Dr. Reyes as his expert witness. Dr. Reyes testified as to his findings
during the autopsy and his opinion that Lilian's death could have been avoided if Dr. Inso had repaired the
However, Dr. Reyes admitted that he had very little experience in the field of pathology and his only
experience was an on-the-job training at the V. Luna Hospital where he was only on observer status. He
further admitted that he had no experience in appendicitis or appendectomy and that Lilian's case was his first
| Page 4 of 20
Moreover, Dr. Reyes admitted that he was not intelligently guided during the autopsy because he was not
furnished with clinical, physical, gross, histopath, and laboratory information that were important for an
accurate conclusion. Dr. Reyes also admitted that an appendical stump is initially swollen when sutured and
that the stitches may loosen during the healing process when the initial swelling subside.
In their defense, Dr. Inso and Family Care presented Dr. Inso, and expert witnesses Dr. Celso Ramos (Dr.
Dr. Ramos is a practicing pathologist with over 20 years of experience. He is an associate professor at the
Department of Surgery of the Fatima Medical Center, the Manila Central University, and the Perpetual Help
Medical Center. He is a Fellow of the Philippine College of Surgeons, a Diplomate of the Philippine Board of
Dr. Ramos discredited Dr. Reyes' theory that the 0.5 x 0.5 cm opening at the repair site caused Lilian's
internal bleeding. According to Dr. Ramos, appendical vessels measure only 0.1 to 0.15 cm, a claim that was
not refuted by the petitioner. If the 0.5 x 0.5 cm opening had caused Lilian's hemorrhage, she would not have
survived for over 16 hours; she would have died immediately, within 20 to 30 minutes, after surgery.
Dr. Ramos submitted that the cause of Lilian's death was hemorrhage due to DIC, a blood disorder that leads
to the failure of the blood to coagulate; Dr. Ramos considered the abundant petechial hemorrhage in the
myocardic sections and the hemorrhagic right lung; the multiple bleeding points indicate that Lilian was
Meanwhile, Dr. Hernandez is a general surgeon and a hospital administrator who had been practicing surgery
Dr. Hernandez testified that Lilian's death could not be attributed to the alleged wrong suturing. He submitted
that the presence of blood in the lungs, in the stomach, and in the entire length of the bowels cannot be
reconciled with Dr. Reyes' theory that the hemorrhage resulted from a single-sutured appendix.
Dr., Hernandez testified that Lilian had uncontrollable bleeding in the microcirculation as a result of DIC. In
| Page 5 of 20
DIC, blood oozes from very small blood vessels because of a problem in the clotting factors of the blood
vessels. The microcirculation is too small to be seen by the naked eye; the red cell is even smaller than the tip
of a needle. Therefore, the alleged wrong suturing could not have caused the amount of hemorrhaging that
Dr. Hernandez further testified that the procedure that Dr. Inso performed was consistent with the usual
The petitioner presented Dr. Rudyard Avila III (Dr. Avila) as a rebuttal witness. Dr. Avila, also a lawyer, was
presented as an expert in medical jurisprudence. Dr. Avila testified that between Dr. Reyes who autopsied the
patient and Dr. Ramos whose findings were based on medical records, greater weight should be given to Dr.
Reyes' testimony.
On April 10, 2007, the RTC rendered its decision awarding the petitioner P88,077.50 as compensatory
damages; P50,000.00 as death indemnity; P3,607,910.30 as loss of earnings; P50,000.00 as moral damages;
P30,000.00 as exemplary damages; P50,000.00 as attorney's fees, and the costs of the suit.
The RTC relied on Dr. Avila's opinion and gave more weight to Dr. Reyes' findings regarding the cause of
Lilian's death. It held that Dr. Inso was negligent in using a single suture on the repair site causing Lilian's
death by internal hemorrhage. It applied the doctrine of res ipsa loquitur, holding that a patient's death does
The respondents elevated the case to the CA and the appeal was docketed as CA-G.R. CV No. 89096.
On January 22, 2010, the CA reversed the RTC's decision and dismissed the complaint. The CA gave greater
weight to the testimonies of Dr. Hernandez and Dr. Ramos over the findings of Dr. Reyes because the latter
was not an expert in pathology, appendectomy, nor in surgery. It disregarded Dr. Avila's opinion because the
basic premise of his testimony was that the doctor who conducted the autopsy is a pathologist of equal or of
The CA held that there was no causal connection between the alleged omission of Dr. Inso to use a double
| Page 6 of 20
suture and the cause of Lilian's death. It also found that Dr. Inso did, in fact, use a double suture ligation with
a third silk reinforcement ligation on the repair site which, as Dr. Reyes admitted on cross-examination,
The CA denied the applicability of the doctrine of res ipsa loquitur because the element of causation between
the instrumentality under the control and management of Dr. Inso and the injury that caused Lilian's death
was absent; the respondents sufficiently established that the cause of Lilian's death was DIC.
On March 18, 2010, the petitioner filed the present petition for review on certiorari.
THE PETITION
The petitioner argues: (1) that Dr. Inso and Family Care were negligent in caring for Lilian before, during, and
after her appendectomy and were responsible for her death; and (2) that the doctrine of res ipsa loquitur is
In their Comment, the respondents counter: (1) that the issues raised by the petitioner are not pure questions
of law; (2) that they exercised utmost care and diligence in the treatment of Lilian; (3) that Dr. Inso did not
deviate from the standard of care observed under similar circumstances by other members of the profession
in good standing; (4) that res ipsa loquitur is not applicable because direct evidence as to the cause of Lilian's
death and the presence/absence of negligence is available; and (5) that doctors are not guarantors of care
and cannot be held liable for the death of their patients when they exercised diligence and did everything to
OUR RULING
Under Section 1 of Rule 45, a petition for review on certiorari shall only raise questions of law. The Supreme
Court is not a trier of facts and it is not our function to analyze and weigh evidence that the lower courts had
| Page 7 of 20
The factual findings of the Court of Appeals are, as a general rule, conclusive upon this Court. However,
jurisprudence has also carved out recognized exceptions[5] to this rule, to wit: (1) when the findings are
grounded entirely on speculation, surmises, or conjectures;[6] (2) when the inference made is manifestly
mistaken, absurd, or impossible;[7] (3) when there is grave abuse of discretion;[8] (4) when the judgment is
based on a misapprehension of facts;[9] (5) when the findings of facts are conflicting;[10] (6) when in making its
findings the Court of Appeals went beyond the issues of the case, or its findings are contrary to the
admissions of both the appellant and the appellee;[11] (7) when the findings are contrary to those of the
trial court's;[12] (8) when the findings are conclusions without citation of specific evidence on which they are
based;[13] (9) when the facts set forth in the petition as well as in the petitioner's main and reply briefs are not
disputed by the respondent;[14](10) when the findings of fact are premised on the supposed absence of
evidence and contradicted by the evidence on record;[15] and (11) when the Court of Appeals manifestly
overlooked certain relevant facts not disputed by the parties, which, if properly considered, would justify a
different conclusion.[16]
Considering that the CA's findings with respect to the cause of Lilian's death contradict those of the RTC, this
case falls under one of the exceptions. The Court will thus give due course to the petition to dispel any
Whoever alleges a fact has the burden of proving it. This is a basic legal principle that equally applies to civil
and criminal cases. In a medical malpractice case, the plaintiff has the duty of proving its elements, namely:
(1) a duty of the defendant to his patient; (2) the defendant's breach of this duty; (3) injury to the patient; and
(4)proximate causation between the breach and the injury suffered.[17] In civil cases, the plaintiff must prove
A medical professional has the duty to observe the standard of care and exercise the degree of skill,
knowledge, and training ordinarily expected of other similarly trained medical professionals acting under the
same circumstances.[18] A breach of the accepted standard of care constitutes negligence or malpractice and
renders the defendant liable for the resulting injury to his patient.[19]
| Page 8 of 20
The standard is based on the norm observed by other reasonably competent members of the profession
practicing the same field of medicine.[20] Because medical malpractice cases are often highly technical,
expert testimony is usually essential to establish: (1) the standard of care that the defendant was bound to
observe under the circumstances; (2) that the defendant's conduct fell below the acceptable standard; and (3)
that the defendant's failure to observe the industry standard caused injury to his patient.[21]
The expert witness must be a similarly trained and experienced physician. Thus, a pulmonologist is not
qualified to testify as to the standard of care required of an anesthesiologist[22] and an autopsy expert is not
In ruling against the respondents, the RTC relied on the findings of Dr. Reyes in the light of Dr. Avila's opinion
that the former's testimony should be given greater weight than the findings of Dr. Ramos and Dr. Hernandez.
On the other hand, the CA did not consider Dr. Reyes or Dr. Avila as expert witnesses and disregarded their
testimonies in favor of Dr. Ramos and Dr. Hernandez. The basic issue, therefore, is whose testimonies should
Other than their conclusion on the culpability of the respondents, the CA and the RTC have similar factual
findings. The RTC ruled against the respondents based primarily on the following testimony of Dr. Reyes.
Well, if I remember right during my residency in my extensive training, during the operation of
Witness:
the appendix, your Honor, it should really be sutured twice which we call double.
Witness: We cannot guarranty [sic] the bleeding of the sutured blood vessels, your Honor.
Court: So, the bleeding of the patient was caused by the single suture?
| Page 9 of 20
Witness: It is possible.[24]
Dr. Reyes testified that he graduated from the Manila Central University (MCU) College of Medicine and
passed the medical board exams in 1994.[25] He established his personal practice at his house clinic before
being accepted as an on-the-job trainee in the Department of Pathology at the V. Luna Hospital in 1994. In
January 1996, he joined the PNP Medico-Legal Division and was assigned to the Crime Laboratory in Camp
Crame. He currently heads the Southern Police District Medico-Legal division.[26] His primary duties are to
examine victims of violent crimes and to conduct traumatic autopsies to determine the cause of death.
After having conducted over a thousand traumatic autopsies, Dr. Reyes can be considered an expert in
traumatic autopsies or autopsies involving violent deaths. However, his expertise in traumatic autopsies does
not necessarily make him an expert in clinical and pathological autopsies or in surgery.
Moreover, Dr. Reyes' cross-examination reveals that he was less than candid about his qualifications during
Dr. Reyes, you mentioned during your direct testimony last March 5, 2002 that you graduated in
Atty. Castro:
March of 1994, is that correct?
You were asked by Atty. Fajardo, the counsel for the plaintiff, when did you finish your medical
Atty. Castro:
works, and you answered the following year of your graduation which was in 1994?
And after you graduated Mr. Witness, were there further study that you undergo after graduation?
Atty. Castro:
[sic]
It was during my service only at the police organization that I was given the chance to attend the
Witness:
training, one year course.
Atty. Castro: Did you call that what you call a post graduate internship?
Witness: Residency.
| Page 10 of 20
Atty. Castro: Since you call that a post graduate, you were not undergo post graduate? [sic]
Witness: I did.
Witness: Before I took the board examination in the year 1984, sir.
Atty. Castro: After the post graduate internship that was the time you took the board examination?
Atty. Castro: And I supposed that you did it for the first take?
Atty. Castro: After you took the board examination, did you pursue any study?
You also testified during the last hearing that "page 6 of March 5, 2002, answer of the witness:
Atty. Castro: then I was accepted as on the job training at the V. Luna Hospital at the Department of
Pathologist in 1994", could you explain briefly all of this Mr. witness?
| Page 11 of 20
I was given an order that I could attend the training only as a civilian not as a member of the
Witness: AFP because at that time they were already in the process of discharging civilian from
undergoing training.
Atty. Castro: So in the Department of Pathology, what were you assigned to?
And on the same date during your direct testimony on March 5, 2002, part of which reads "well if
Atty. Castro: I remember right during my residency in my extensive training during the operation of the
appendix," what do you mean by that Mr. witness?
Atty. Castro: This was the time the year before you took the board examination?
| Page 12 of 20
And you also mentioned during the last hearing shown by page 8 of the same transcript of the
stenographic notes, dated March 5,2002 and I quote "and that is your residence assignment?",
Atty. Castro:
and you answered "yes, sir." What was the meaning of your answer? What do you mean when
you say yes, sir?
xxxx
Witness: Okay, I stayed at the barracks of the Southern Police District Fort Bonifacio.
Atty. Reyes appears to have inflated his qualifications during his direct testimony. First, his "extensive training
during [his] residency" was neither extensive actual training, nor part of medical residency. His assignment to
the V. Luna Hospital was not as an on-the-job trainee but as a mere observer. This assignment was also
beforehe was actually licensed as a doctor. Dr. Reyes also loosely used the terms "residence" and "residency"
- terms that carry a technical meaning with respect to medical practice -during his initial testimony[28] to refer to
(1) his physical place of dwelling and (2) his internship before taking the medical board exams. This misled
the trial court into believing that he was more qualified to give his opinion on the matter than he actually was.
Perhaps nothing is more telling about Dr. Reyes' lack of expertise in the subject matter than the petitioner's
Atty. Castro: How long were you assigned to observe with the Department of Pathology?
During your studies in the medical school, Mr. Witness, do you recall attending or having
Atty. Castro:
participated or [sic] what you call motivity mortality complex?
| Page 13 of 20
Atty. Fajardo: Your honor, what is the materiality?
That is according to his background, your honor. This is a procedure which could more or less
Atty. Castro: measure his knowledge in autopsy proceedings when he was in medical school and compared
to what he is actually doing now.
When Atty. Castro attempted to probe Dr. Reyes about his knowledge on the subject of medical or
pathological autopsies, Dr. Fajardo objected on the ground that Dr. Reyes was not an expert in the field. His
testimony was offered to prove that Dr. Inso was negligent during the surgery without necessarily offering him
as an expert witness.
x x x The purpose of this witness is to establish that there was negligence on the surgical
Atty. Fajardo: operation of the appendix or in the conduct of the appendectomy by the defendant doctor on
the deceased Lilian Villaran Borromeo.[30]
Dr. Reyes is not an expert witness who could prove Dr. Inso's alleged negligence. His testimony could not
have established the standard of care that Dr. Inso was expected to observe nor assessed Dr. Inso's failure to
observe this standard. His testimony cannot be relied upon to determine if Dr. Inso committed errors during
the operation, the severity of these errors, their impact on Lilian's probability of survival, and the existence of
other diseases/conditions that might or might not have caused or contributed to Lilian's death.
The testimony of Dr. Avila also has no probative value in determining whether Dr. Inso was at fault. Dr. Avila
testified in his capacity as an expert in medical jurisprudence, not as an expert in medicine, surgery, or
pathology. His testimony fails to shed any light on the actual cause of Lilian's death.
On the other hand, the respondents presented testimonies from Dr. Inso himself and from two expert
Dr. Ramos graduated from the Far Eastern University, Nicanor Reyes Medical Foundation, in 1975. He took
up his post-graduate internship at the Quezon Memorial Hospital in Lucena City, before taking the board
exams. After obtaining his professional license, he underwent residency training in pathology at the Jose R.
Reyes Memorial Center from 1977 to 1980. He passed the examination in Anatomic, Clinical, and Physical
| Page 14 of 20
Pathology in 1980 and was inducted in 1981. He also took the examination in anatomic pathology in 1981 and
At the time of his testimony, Dr. Ramos was an associate professor in pathology at the Perpetual Help
Medical School in Biñan, Laguna, and at the De La Salle University in Dasmariñas, Cavite. He was the head
of the Batangas General Hospital Teaching and Training Hospital where he also headed the Pathology
Department. He also headed the Perpetual Help General Hospital Pathology department.[32]
Meanwhile, Dr. Hernandez at that time was a General Surgeon with 27 years of experience as a General
Practitioner and 20 years of experience as a General Surgeon. He obtained his medical degree from the
University of Santo Tomas before undergoing five years of residency training as a surgeon at the Veterans
Memorial Center hospital. He was certified as a surgeon in 1985. He also holds a master's degree in Hospital
He was a practicing surgeon at the: St. Luke's Medical Center, Fatima Medical Center, Unciano Medical
Center in Antipolo, Manila East Medical Center of Taytay, and Perpetual Help Medical Center in Biñan.[34] He
was also an associate professor at the Department of Surgery at the Fatima Medical Center, the Manila
Central University, and the Perpetual Help Medical Center. He also chaired the Department of Surgery at the
Dr. Hernandez is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the
Philippine Society of General Surgeons. He is a Diplomate of the Philippine Board of Surgery and a member
of the Philippine Medical Association and the Antipolo City Medical Society.[36]
Dr. Hernandez affirmed that Dr. Inso did not deviate from the usual surgical procedure.[37] Both experts agreed
that Lilian could not have died from bleeding of the appendical vessel. They identified Lilian's cause of death
To our mind, the testimonies of expert witnesses Dr. Hernandez and Dr. Ramos carry far greater weight than
that of Dr. Reyes. The petitioner's failure to present expert witnesses resulted in his failure to prove the
respondents' negligence. The preponderance of evidence clearly tilts in favor of the respondents.
| Page 15 of 20
Res ipsa loquitur is not applicable when the failure to observe due care is not immediately apparent to
the layman.
The petitioner cannot invoke the doctrine of res ipsa loquitur to shift the burden of evidence onto the
respondent. Res ipsa loquitur, literally, "the thing speaks for itself;" is a rule of evidence that presumes
negligence from the very nature of the accident itself using common human knowledge or experience.
The application of this rule requires: (1) that the accident was of a kind which does not ordinarily occur unless
someone is negligent; (2) that the instrumentality or agency which caused the injury was under the exclusive:
control of the person charged with negligence; and (3) that the injury suffered must not have been due to any
voluntary action or contribution from the injured person.[38] The concurrence of these elements creates a
This doctrine is used in conjunction with the doctrine of common knowledge. We have applied this doctrine in
1. Where a patient who was scheduled for a cholecystectomy (removal of gall stones) but was otherwise
healthy suffered irreparable brain damage after being administered anesthesia prior to the operation.[39]
2. Where after giving birth, a woman woke up with a gaping burn wound close to her left armpit;[40]
3. The removal of the wrong body part during the operation; and
4. Where an operating surgeon left a foreign object (i.e., rubber gloves) inside the body of the patient.[41]
The rule is not applicable in cases such as the present one where the defendant's alleged failure to observe
due care is not immediately apparent to a layman.[42] These instances require expert opinion to establish the
culpability of the defendant doctor. It is also not applicable to cases where the actual cause of the injury had
While this Court sympathizes with the petitioner's loss, the petitioner failed to present sufficient convincing
evidence to establish: (1) the standard of care expected of the respondent and (2) the fact that Dr. Inso fell
short of this expected standard. Considering further that the respondents established that the cause of Lilian's
| Page 16 of 20
uncontrollable bleeding (and, ultimately, her death) was a medical disorder - Disseminated Intravascular
Coagulation — we find no reversible errors in the CA's dismissal of the complaint on appeal.
SO ORDERED.
_____________________________________
[1]
Penned by Associate Justice Isaias Dicdican and concurred in by Associate Justices Romeo F. Barza and
[2]
Marikina City, Branch 273 through Presiding Judge Manuel S. Quimbo.
[3]
TSN dated March 5,2002, p. 14, quoted in the RTC Decision; see rollo, pp. 143-144.
[4]
TSN dated November 19,2003, pp. 27, 29 and 36.
[5]
New City Builders, Inc. v. NLRC, 499 Phil. 207, 212-213 (2005), citing Insular Life Assurance Company, Ltd.
[6]
Joaquin v. Navarro, 93 Phil. 257-270 (1953).
[7]
De Luna v. Linatoc, 74 Phil. 15 (1942).
[8]
Buyco v. People, 95 Phil. 453 (1954).
[9]
Cruz v. Sosing, 94 Phil. 26 (1953).
[10]
Casica v. Villaseca, 101 Phil. 1205 (1957).
| Page 17 of 20
[11]
Lim Yhi Luya v. Court of Appeals, G.R. No. L-40258, September 11, 1980, 99 SCRA 668-669.
[12]
Sacay v. Sandiganbayan, G.R. No. L-66497-98, July 10, 1986, 142 SCRA 593.
[13]
Universal Motors v. Court of Appeals, G.R. No. L-47432, January 27, 1992, 205 SCRA 448.
[14]
Alsua-Betts v. Court of Appeals, G.R. No. L-46430-31, July 30, 1979, 92 SCRA 332.
[15]
Medina v. Asistio, G.R. No. 75450, November 8, 1990, 191 SCRA 218.
[16]
Abellana v. Dosdos, 121 Phil. 241 (1965).
[17]
Garcia-Rueda v. Pascasio, 344 Phil. 323, 331-332 (1997); Sps. Flores v. Sps. Pineda, 591 Phil. 699, 706
(2008); Reyes v. Sisters of Mercy Hospital, 396 Phil. 87, 95-96 (2000).
[18]
Garcia-Rueda v. Pascasio, supra note 17, at 332; Dr. Cruz v. CA, 346 Phil. 872, 883-884 (1997); Reyes v.
[19]
Sps. Flores v. Sps. Pineda, supra note 17.
[20]
Dr. Cruz v. CA, supra note 18, at 884; Cabugao v. People of the Philippines, G.R. No. 163879, July 30,
[21]
Dr. Cruz v. CA, supra note 18, at 885.
[22]
Ramos v. CA, 378 Phil. 1198, 1236 (1999).
[23]
Reyes v. Sisters of Mercy Hospital, supra note 17.
[24]
TSN dated March 5, 2002, pp. 22-23 (Direct Examination of Dr. Emmanuel Reyes).
| Page 18 of 20
[25]
Cross Examination, TSN dated March 19, 2002, p. 3.
[26]
TSN dated March 5, 2002, pp. 3-11 (Direct Examination of Dr. Emmanuel Reyes).
[27]
Cross Examination of Dr. Reyes, TSN dated March 19, 2002, pp. 4-11.
[28]
See Direct Examination of Dr. Reyes, TSN dated March 5,2002, pp. 8 and 22.
[29]
Cross Examination of Dr. Reyes, TSN dated March 19, 2002, pp. 30-31.
[30]
Direct Examination of Dr. Reyes, TSN dated March 5, 2002, p. 4.
[31]
Direct Examination of Dr. Ramos, TSN dated June 6,2003, p. 13.
[32]
Id. at 14.
[33]
Direct Examination of Dr. Hernandez, TSN dated November 19, 2003, pp. 5-10.
[34]
Id. at 9.
[35]
Id. at 10.
[36]
Id. at 11.
[37]
Id. at 27, 29 and 36.
[38]
Malayan Insurance Co. v. Alberto, G.R. No. 194320, February 1, 2012, 664 SCRA 791, 803-804.
[39]
Ramos v. CA, supra note 22.
[40]
Dr. Cantre v. Spouses Go, 550 Phil. 637 (2007).
| Page 19 of 20
[41]
Batiquin v. Court of Appeals, 321 Phil. 965-971 (1996).
[42]
Reyes v. Sisters of Mercy Hospital, supra note 17, at 98.
[43]
See Professional Services, Inc. v. Agana, 542 Phil. 464, 484 (2007).
| Page 20 of 20