by Amie Perez

ROGELIO E. RAMOS v. CA, GR No. 124354, 1999-12-29

Facts:
Plaintiff Erlinda Ramos was, until the afternoon of June 17, 1985, a 47-year old (Exh. "A")
robust woman
Except for occasional complaints of discomfort due to pains allegedly caused by the
presence of a stone in her gall bladder (TSN,... January 13, 1988, pp. 4-5), she was as normal
as any other woman. Married to Rogelio E. Ramos, an executive of Philippine Long Distance
Telephone Company, she has three children whose names are Rommel Ramos, Roy Roderick
Ramos and Ron Raymond Ramos
She was advised to undergo an operation for the removal of a stone in her gall bladder... she
and her husband Rogelio met for the first time Dr. Orlino Hozaka... one of the defendants in
this case, on June 10, 1985. They agreed... that their date at the operating table at the
DLSMC (another defendant), would be on June 17, 1985 at 9:00 A.M.. Dr. Hosaka decided
that she should undergo a "cholecystectomy" operation after examining the documents
(findings from the Capitol Medical Center, FEU Hospital and
DLSMC) presented to him. Rogelio E. Ramos, however, asked Dr. Hosaka to look for a good
anesthesiologist. Dr. Hosaka, in turn, assured Rogelio that he will get a good
anesthesiologist. Dr. Hosaka charged a fee of P16,000.00, which was to include the
anesthesiologist's fee and... which was to be paid after the operation
At around 7:30 A.M. of June 17, 1985 and while still in her room, she was prepared for the
operation by the hospital staff.
Since that fateful afternoon of June 17, 1985, she has been in a... comatose condition. She
cannot do anything. She cannot move any part of her body. She cannot see or hear. She is
living on mechanical means. She suffered brain damage as a result of the absence of oxygen
in her brain for four to five minutes (TSN, November 9, 1989, pp. 21-22).
After being discharged from the hospital, she has been staying in their residence, still
needing constant medical attention, with her husband Rogelio incurring a monthly expense
ranging from P8,000.00 to P10,000.00 (TSN, October 19, 1989, pp. 32-34). She was also
diagnosed to be... suffering from "diffuse cerebral parenchymal damage" (Exh. "G"; see also
TSN, December 21, 1989, p. 6).
After considering the evidence from both sides, the Regional Trial Court rendered judgment
in favor of petitioners
Private respondents seasonably interposed an appeal to the Court of Appeals. The appellate
court rendered a Decision, dated 29 May 1995, reversing the findings of the trial court. The
decretal portion of the decision of the appellate court reads:
WHEREFORE, for the foregoing premises the appealed decision is hereby REVERSED, and
the complaint below against the appellants is hereby ordered DISMISSED.
Issues:
whether a surgeon, an anesthesiologist and a hospital should be made liable for the
unfortunate comatose condition of a patient scheduled for cholecystectomy.
whether the Court of Appeals erred in finding that private respondents were not negligent in
the care of Erlinda... during the anesthesia phase of the operation... he proximate cause of
Erlinda's comatose condition
Ruling:
Nevertheless, despite the fact that the scope of res ipsa loquitur has been measurably
enlarged, it does not automatically apply to all cases of medical negligence as to
mechanically shift the burden of proof to the defendant to show that he is not guilty of the
ascribed... negligence. Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily
used but a rule to be cautiously applied, depending upon the circumstances of each case. It
is generally restricted to situations in malpractice cases where a layman is able to say, as a
matter... of common knowledge and observation, that the consequences of professional care
were not as such as would ordinarily have followed if due care had been exercised.
We disagree with the findings of the Court of Appeals. We hold that private respondents
were unable to disprove the presumption of negligence on their part in the care of Erlinda
and their negligence was the proximate cause of her piteous condition.
With regard to Dra. Gutierrez, we find her negligent in the care of Erlinda during the
anesthesia phase.
As borne by the records, respondent Dra. Gutierrez failed to properly intubate the patient.
Erlinda's case was elective and this was known to respondent Dra. Gutierrez. Thus, she had
all the time to make a thorough evaluation of Erlinda's case prior to the operation and
prepare her for anesthesia.
We now discuss the responsibility of the hospital in this particular incident.
Principles:
Res ipsa loquitur is a Latin phrase which literally means "the thing or the transaction speaks
for itself." The phrase "res ipsa loquitur" is a maxim for the rule that the fact of the
occurrence of an injury, taken with the surrounding circumstances, may permit an...
inference or raise a presumption of negligence, or make out a plaintiff's prima facie case, and
present a question of fact for defendant to meet with an explanation.[13] Where the thing
which caused the injury complained of is shown to be under the... management of the
defendant or his servants and the accident is such as in ordinary course of things does not
happen if those who have its management or control use proper care, it affords reasonable
evidence, in the absence of explanation by the defendant, that the accident... arose from or
was caused by the defendant's want of care.[
The doctrine of res ipsa loquitur is simply a recognition of the postulate that, as a matter of
common knowledge and experience, the very nature of certain types of occurrences may
justify an inference of negligence on the part of the person who controls the
instrumentality... causing the injury in the absence of some explanation by the defendant
who is charged with negligence.[15] It is grounded in the superior logic of ordinary human
experience and on the basis of such experience or common knowledge, negligence may be
deduced... from the mere occurrence of the accident itself.[16] Hence, res ipsa loquitur is
applied in conjunction with the doctrine of common knowledge.
However, much has been said that res ipsa loquitur is not a rule of substantive law and, as
such, does not create or constitute an independent or separate ground of liability.
It is regarded as a mode of proof, or a mere procedural convenience since it furnishes a
substitute for, and relieves a plaintiff of, the burden of producing specific proof of
negligence.[19] In other words, mere... invocation and application of the doctrine does not
dispense with the requirement of proof of negligence. It is simply a step in the process of
such proof, permitting the plaintiff to present along with the proof of the accident, enough
of the attending circumstances to invoke... the doctrine, creating an inference or
presumption of negligence, and to thereby place on the defendant the burden of going
forward with the proof.
before resort to the doctrine may be allowed, the following requisites must be
satisfactorily... shown:
1. The accident is of a kind which ordinarily does not occur in the absence of someone's
negligence;
2. It is caused by an instrumentality within the exclusive control of the defendant or
defendants; and
3. The possibility of contributing conduct which would make the plaintiff responsible is
eliminated.
res ipsa loquitur is not available in a malpractice suit if the only showing is that the desired
result of an operation or treatment was not accomplished.
The real question, therefore, is whether or... not in the process of the operation any
extraordinary incident or unusual event outside of the routine performance occurred which
is beyond the regular scope of customary professional activity in such operations, which, if
unexplained would themselves reasonably speak to the... average man as the negligent cause
or causes of the untoward consequence.
In the present case, Erlinda submitted herself for cholecystectomy and expected a routine
general surgery to be performed on her gall bladder. On that fateful day she delivered her...
person over to the care, custody and control of private respondents who exercised complete
and exclusive control over her. At the time of submission, Erlinda was neurologically sound
and, except for a few minor discomforts, was likewise physically fit in mind and body.
However,... during the administration of anesthesia and prior to the performance of
cholecystectomy she suffered irreparable damage to her brain. Thus, without undergoing
surgery, she went out of the operating room already decerebrate and totally incapacitated.
Obviously, brain... damage, which Erlinda sustained, is an injury which does not normally
occur in the process of a gall bladder operation. In fact, this kind of situation does not
happen in the absence of negligence of someone in the administration of anesthesia and in
the use of endotracheal... tube. Normally, a person being put under anesthesia is not
rendered decerebrate as a consequence of administering such anesthesia if the proper
procedure was followed. Furthermore, the instruments used in the administration of
anesthesia, including the endotracheal tube, were... all under the exclusive control of private
respondents, who are the physicians-in-charge. Likewise, petitioner Erlinda could not have
been guilty of contributory negligence because she was under the influence of anesthetics
which rendered her unconscious.
Considering that a sound and unaffected member of the body (the brain) is injured or
destroyed while the patient is unconscious and under the immediate and exclusive control of
the physicians, we hold that a practical administration of justice dictates the application of
res... ipsa loquitur.
The basis for holding an employer solidarily responsible for the negligence of its employee is
found in Article 2180 of the Civil Code which considers a person accountable not only for
his own acts but also for those of others based on the former's responsibility under a...
relationship of patria potestas.