Jarcia, Jr. v. People, G.R. No. 187926, February 15, 2012, 666 SCRA 336, 351.

G.R. No. 187926;

February 15, 2012

This doctrine of res ipsa loquitur means "Where the thing which causes injury is shown to
be under the management of the defendant, and the accident is such as in the ordinary
course of things does not happen if those who have the management use proper care, it
affords reasonable evidence, in the absence of an explanation by the defendant, that the
accident arose from want of care."
The thing speaks for itself. Rebuttable presumption or inference that defendant was
negligent, which arises upon proof that the instrumentality causing injury was in
defendant's exclusive control, and that the accident was one which ordinarily does not
happen in absence of negligence. Res ipsa loquitur is a rule of evidence whereby
negligence of the alleged wrongdoer may be inferred from the mere fact that the accident
happened provided the character of the accident and circumstances attending it lead
reasonably to belief that in the absence of negligence it would not have occurred and that
thing which caused injury is shown to have been under the management and control of
the alleged wrongdoer. Under this doctrine, the happening of an injury permits an
inference of negligence where plaintiff produces substantial evidence that the injury was
caused by an agency or instrumentality under the exclusive control and management of
defendant, and that the occurrence was such that in the ordinary course of things would
not happen if reasonable care had been used.
The doctrine of res ipsa loquitur as a rule of evidence is unusual to the law of negligence
which recognizes that prima facie negligence may be established without direct proof and
furnishes a substitute for specific proof of negligence. The doctrine, however, is not a
rule of substantive law, but merely a mode of proof or a mere procedural
convenience. The rule, when applicable to the facts and circumstances of a given case, is
not meant to and does not dispense with the requirement of proof of culpable negligence
on the party charged. It merely determines and regulates what shall
be prima facie evidence thereof and helps the plaintiff in proving a breach of the
duty. The doctrine can be invoked when and only when, under the circumstances
involved, direct evidence is absent and not readily available.
The requisites for the application of the doctrine of res ipsa loquitur are: (1) the accident
was of a kind which does not ordinarily occur unless someone is negligent; (2) the
instrumentality or agency which caused the injury was under the exclusive control of the
person in charge; and (3) the injury suffered must not have been due to any voluntary
action or contribution of the person injured.
In this case, the circumstances that caused patient Roy Jr.s injury and the series of tests
that were supposed to be undergone by him to determine the extent of the injury suffered
were not under the exclusive control of Drs. Jarcia and Bastan. It was established that
they are mere residents of the Manila Doctors Hospital at that time who attended to the

victim at the emergency room. While it may be true that the circumstances pointed out by
the courts below seem doubtless to constitute reckless imprudence on the part of the
petitioners, this conclusion is still best achieved, not through the scholarly assumptions of
a layman like the patients mother, but by the unquestionable knowledge of expert
witness/es. As to whether the petitioners have exercised the requisite degree of skill and
care in treating patient Roy, Jr. is generally a matter of expert opinion.
Res ipsa loquitur; Simple negligence; Elements of negligence; Damages. The doctrine
of res ipsa loquitur as a rule of evidence is unusual to the law of negligence which
recognizes that prima facie negligence may be established without direct proof and
furnishes a substitute for specific proof of negligence. The doctrine, however, is not a
rule of substantive law, but merely a mode of proof or a mere procedural convenience.
The rule, when applicable to the facts and circumstances of a given case, is not meant to
and does not dispense with the requirement of proof of culpable negligence on the party
charged. It merely determines and regulates what shall be prima facieevidence thereof
and helps the plaintiff in proving a breach of the duty. The doctrine can be invoked
when and only when, under the circumstances involved, direct evidence is absent and not
readily available. The requisites for the application of the doctrine of res ipsa
loquitur are: (1) the accident was of a kind which does not ordinarily occur unless
someone is negligent; (2) the instrumentality or agency which caused the injury was
under the exclusive control of the person in charge; and (3) the injury suffered must not
have been due to any voluntary action or contribution of the person injured.
Negligence is defined as the failure to observe for the protection of the interests of
another person that degree of care, precaution, and vigilance, which the circumstances
justly demand, whereby such other person suffers injury. The elements of simple
negligence are: (1) that there is lack of precaution on the part of the offender, and (2) that
the damage impending to be caused is not immediate or the danger is not clearly manifest
Moral damages are not punitive in nature, but are designed to compensate and alleviate in
some way the physical suffering, mental anguish, fright, serious anxiety, besmirched
reputation, wounded feelings, moral shock, social humiliation, and similar injury unjustly
inflicted on a person. Intended for the restoration of the psychological or emotional status
quo ante, the award of moral damages is designed to compensate emotional injury
suffered, not to impose a penalty on the wrongdoer.

G.R. No. 124354 December 29, 1999

ROGELIO E. RAMOS and ERLINDA RAMOS, in their own behalf and as natural
guardians of the minors, ROMMEL RAMOS, ROY RODERICK RAMOS and RON
RAYMOND RAMOS, petitioners,
vs.
COURT OF APPEALS, DELOS SANTOS MEDICAL CENTER, DR. ORLINO
HOSAKA and DRA. PERFECTA GUTIERREZ, respondents.
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 faciecase,
and present a question of fact for defendant to meet with an explanation. 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. 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. 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. Instead,
it is considered as merely evidentiary or in the nature of a procedural rule. It is regarded
as a mode of proof, or a mere procedural of convenience since it furnishes a substitute
for, and relieves a plaintiff of, the burden of producing specific proof of negligence. 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. Still, 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.
In the above requisites, the fundamental element is the "control of instrumentality" which
caused the damage. Such element of control must be shown to be within the dominion of

the defendant. In order to have the benefit of the rule, a plaintiff, in addition to proving
injury or damage, must show a situation where it is applicable, and must establish that the
essential elements of the doctrine were present in a particular incident.
Medical malpractice cases do not escape the application of this doctrine. Thus, res ipsa
loquitur has been applied when the circumstances attendant upon the harm are themselves
of such a character as to justify an inference of negligence as the cause of that harm. The
application of res ipsa loquitur in medical negligence cases presents a question of law
since it is a judicial function to determine whether a certain set of circumstances does, as
a matter of law, permit a given inference.
Although generally, expert medical testimony is relied upon in malpractice suits to prove
that a physician has done a negligent act or that he has deviated from the standard
medical procedure, when the doctrine of res ipsa loquitur is availed by the plaintiff, the
need for expert medical testimony is dispensed with because the injury itself provides the
proof of negligence. The reason is that the general rule on the necessity of expert
testimony applies only to such matters clearly within the domain of medical science, and
not to matters that are within the common knowledge of mankind which may be testified
to by anyone familiar with the facts. Ordinarily, only physicians and surgeons of skill and
experience are competent to testify as to whether a patient has been treated or operated
upon with a reasonable degree of skill and care. However, testimony as to the statements
and acts of physicians and surgeons, external appearances, and manifest conditions which
are observable by any one may be given by non-expert witnesses. Hence, in cases where
the res ipsa loquitur is applicable, the court is permitted to find a physician negligent
upon proper proof of injury to the patient, without the aid of expert testimony, where the
court from its fund of common knowledge can determine the proper standard of
care. Where common knowledge and experience teach that a resulting injury would not
have occurred to the patient if due care had been exercised, an inference of negligence
may be drawn giving rise to an application of the doctrine of res ipsa loquiturwithout
medical evidence, which is ordinarily required to show not only what occurred but how
and why it occurred. When the doctrine is appropriate, all that the patient must do is
prove a nexus between the particular act or omission complained of and the injury
sustained while under the custody and management of the defendant without need to
produce expert medical testimony to establish the standard of care. Resort to res ipsa
loquitur is allowed because there is no other way, under usual and ordinary conditions, by
which the patient can obtain redress for injury suffered by him.
Thus, courts of other jurisdictions have applied the doctrine in the following situations:
leaving of a foreign object in the body of the patient after an operation, injuries sustained
on a healthy part of the body which was not under, or in the area, of treatment, removal
of the wrong part of the body when another part was intended, knocking out a tooth while
a patient's jaw was under anesthetic for the removal of his tonsils, and loss of an eye
while the patient plaintiff was under the influence of anesthetic, during or following an
operation for appendicitis, among others.
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. A distinction must be made between the failure to secure results, and the
occurrence of something more unusual and not ordinarily found if the service or
treatment rendered followed the usual procedure of those skilled in that particular
practice. It must be conceded that the doctrine of res ipsa loquitur can have no application
in a suit against a physician or surgeon which involves the merits of a diagnosis or of a
scientific treatment. The physician or surgeon is not required at his peril to explain why
any particular diagnosis was not correct, or why any particular scientific treatment did not
produce the desired result. Thus, 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. If there was such
extraneous interventions, the doctrine of res ipsa loquitur may be utilized and the
defendant is called upon to explain the matter, by evidence of exculpation, if he could.
The unique practice (among private hospitals) of filling up specialist staff with attending
and visiting "consultants," who are allegedly not hospital employees, presents problems
in apportioning responsibility for negligence in medical malpractice cases. However, the
difficulty is only more apparent than real.
In the first place, hospitals exercise significant control in the hiring and firing of
consultants and in the conduct of their work within the hospital premises. Doctors who
apply for "consultant" slots, visiting or attending, are required to submit proof of
completion of residency, their educational qualifications; generally, evidence of
accreditation by the appropriate board (diplomate), evidence of fellowship in most cases,
and references. These requirements are carefully scrutinized by members of the hospital
administration or by a review committee set up by the hospital who either accept or
reject the application. This is particularly true with respondent hospital.
After a physician is accepted, either as a visiting or attending consultant, he is normally
required to attend clinico-pathological conferences, conduct bedside rounds for clerks,
interns and residents, moderate grand rounds and patient audits and perform other tasks
and responsibilities, for the privilege of being able to maintain a clinic in the hospital,
and/or for the privilege of admitting patients into the hospital. In addition to these, the
physician's performance as a specialist is generally evaluated by a peer review committee
on the basis of mortality and morbidity statistics, and feedback from patients, nurses,
interns and residents. A consultant remiss in his duties, or a consultant who regularly falls
short of the minimum standards acceptable to the hospital or its peer review committee, is
normally politely terminated.

In other words, private hospitals, hire, fire and exercise real control over their attending
and visiting "consultant" staff. While "consultants" are not, technically employees, a
point which respondent hospital asserts in denying all responsibility for the patient's
condition, the control exercised, the hiring, and the right to terminate consultants all
fulfill the important hallmarks of an employer-employee relationship, with the exception
of the payment of wages. In assessing whether such a relationship in fact exists, the
control test is determining. Accordingly, on the basis of the foregoing, we rule that for the
purpose of allocating responsibility in medical negligence cases, an employer-employee
relationship in effect exists between hospitals and their attending and visiting physicians.
This being the case, the question now arises as to whether or not respondent hospital is
solidarily liable with respondent doctors for petitioner's condition.

[G.R. No. 130547. October 3, 2000]

LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, and minors LLOYD
and KRISTINE, all surnamed REYES, represented by their mother, LEAH ALESNA
REYES, petitioners, vs. SISTERS OF MERCY HOSPITAL, SISTER ROSE PALACIO,
DR. MARVIE BLANES, and DR. MARLYN RICO, respondents.
[G.R. No. 130547. October 3, 2000]
LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, and minors LLOYD
and KRISTINE, all surnamed REYES, represented by their mother, LEAH ALESNA
REYES, petitioners, vs. SISTERS OF MERCY HOSPITAL, SISTER ROSE PALACIO,
DR. MARVIE BLANES, and DR. MARLYN RICO, respondents.
Petitioners action is for medical malpractice. This is a particular form
of negligence which consists in the failure of a physician or surgeon to apply to his
practice of medicine that degree of care and skill which is ordinarily employed by the
profession generally, under similar conditions, and in like surrounding circumstances. In
order to successfully pursue such a claim, a patient must prove that the physician or
surgeon either failed to do something which a reasonably prudent physician or surgeon
would have done, or that he or she did something that a reasonably prudent physician or
surgeon would not have done, and that the failure or action caused injury to the patient.
There are thus four elements involved inmedical negligence cases, namely: duty,
breach, injury, and proximate causation.
Elements of Medical Malpractice
duty the existence of a physician-patient relationship
breach of duty
injury caused
causal connection between the breach of duty and the injury caused
Evidentiary Rule
TWO-PRONGED EVIDENCE:
evidence of the recognized standards
the physician negligently departed from these standards
EXPERT TESTIMONY ESSENTIAL:
In the present case, there is no doubt that a physician-patient relationship existed
between respondentdoctors and Jorge Reyes. Respondents were thus duty-bound to use at
least the same level of care that any reasonably competent doctor would use to treat a
condition under the same circumstances. It is breach of this duty which constitutes
actionable malpractice. As to this aspect of medical malpractice, the determination of the
reasonable level of care and the breach thereof, expert testimony is essential. Inasmuch as
the causes of the injuries involved in malpractice actions are determinable only in the
light of scientific knowledge, it has been recognized that expert testimony is usually

necessary to support the conclusion as to causation. (Reyes vs. Sisters of Mercy Hospital,
supra)
EXCEPTION:
There is a case when expert testimony may be dispensed with, and that is under the
doctrine of res ipsa loquitur. As held in Ramos v. Court of Appeals:
Although generally, expert medical testimony is relied upon in malpractice suits to prove
that a physician has done a negligent act or that he has deviated from the
standard medical procedure, when the doctrine of res ipsa loquitor is availed by the
plaintiff, the need for expert medical testimony is dispensed with because the injury itself
provides the proof of negligence. The reason is that the general rule on the necessity of
expert testimony applies only to such matters clearly within the domain
of medical science, and not to matters that are within the common knowledge of mankind
which may be testified to by anyone familiar with the facts. Ordinarily, only physicians
and surgeons of skill and experience are competent to testify as to whether a patient has
been treated or operated upon with a reasonable degree of skill and care. However,
testimony as to the statements and acts of physicians and surgeons, external appearances,
and manifest conditions which are observable by any one may be given by non-expert
witnesses. Hence, in cases where the res ipsa loquitur is applicable, the court is
permitted to find a physician negligent upon proper proof of injury to the patient, without
the aid of expert testimony, where the court from its fund of common knowledge can
determine the proper standard of care. Where common knowledge and experience teach
that a resulting injury would not have occurred to the patient if due care had been
exercised, an inference of negligence may be drawn giving rise to an application of the
doctrine of res ipsa loquitur without medical evidence, which is ordinarily required to
show not only what occurred but how and why it occurred. When the doctrine is
appropriate, all that the patient must do is prove a nexus between the particular act or
omission complained of and the injury sustained while under the custody and
management of the defendant without need to produce expert medical testimony to
establish the standard of care. Resort to res ipsa loquitor is allowed because there is no
other way, under usual and ordinary conditions, by which the patient can obtain redress
for injury suffered by him. (Reyes vs. Sisters of Mercy Hospital, supra)
Standard of Diligence Required
- the standard of care in the locality (Locality Rule)
- a physician is not liable for error in judgment (Error in Judgment Rule), provided he
applied reasonable skill and care
STANDARD OF DILIGENCE REQUIRED:
Indeed, the standard contemplated is not what is actually the average merit among all
known practitioners from the best to the worst and from the most to the least experienced,
but the reasonable average merit among the ordinarily good physicians.

STANDARD IS NOT EXTRAORDINARY DILIGENCE:

The standard of extraordinary diligence is peculiar to common carriers. The Civil Code
provides: "Art. 1733. Common carriers, from the nature of their business and for reasons
of public policy, are bound to observe extraordinary diligence in the vigilance over the
goods and for the safety of the passengers transported by them, according to the
circumstances of each case. . . ."
The practice of medicine is a profession engaged in only by qualified individuals. It is a
right earned through years of education, training, and by first obtaining a license from the
state through professional board examinations. Such license may, at any time and for
cause, be revoked by the government. In addition to state regulation, the conduct of
doctors is also strictly governed by the Hippocratic Oath, an ancient code of discipline
and ethical rules which doctors have imposed upon themselves in recognition and
acceptance of their great responsibility to society. Given these safeguards, there is no
need to expressly require of doctors the observance of extraordinary diligence. As it is
now, the practice of medicine is already conditioned upon the highest degree of diligence.
And, as we have already noted, the standard contemplated for doctors is simply the
reasonable average merit among ordinarily good physicians. That is reasonable diligence
for doctors or, as the Court of Appeals called it, the reasonable skill and competence . . .
that a physician in the same or similar locality . . . should apply. (Reyes vs. Sisters of
Mercy Hospital, supra)
Petitioners asserted in the Court of Appeals that the doctrine of res ipsa loquitur applies to
the present case because Jorge Reyes was merely experiencing fever and chills for five
days and was fully conscious, coherent, and ambulant when he went to the hospital.Yet,
he died after only ten hours from the time of his admission.
This contention was rejected by the appellate court.
Petitioners now contend that all requisites for the application of res ipsa loquitur were
present, namely: (1) the accident was of a kind which does not ordinarily occur unless
someone is negligent; (2) the instrumentality or agency which caused the injury was
under the exclusive control of the person in charge; and (3) the injury suffered must not
have been due to any voluntary action or contribution of the person injured.
The contention is without merit. We agree with the ruling of the Court of Appeals. In
the Ramos case, the question was whether a surgeon, an anesthesiologist, and a hospital
should be made liable for the comatose condition of a patient scheduled for
cholecystectomy. In that case, the patient was given anesthesia prior to her operation.
Noting that the patient was neurologically sound at the time of her operation, the Court
applied the doctrine of res ipsa loquitur as mental brain damage does not normally occur
in a gallblader operation in the absence of negligence of the anesthesiologist. Taking
judicial notice that anesthesia procedures had become so common that even an ordinary
person could tell if it was administered properly, we allowed the testimony of a witness
who was not an expert. In this case, while it is true that the patient died just a few hours
after professional medical assistance was rendered, there is really nothing unusual or

extraordinary about his death. Prior to his admission, the patient already had recurring
fevers and chills for five days unrelieved by the analgesic, antipyretic, and antibiotics
given him by his wife. This shows that he had been suffering from a serious illness and
professional medical help came too late for him.
Respondents alleged failure to observe due care was not immediately apparent to a
layman so as to justify application of res ipsa loquitur. The question required expert
opinion on the alleged breach by respondents of the standard of care required by the
circumstances. Furthermore, on the issue of the correctness of her diagnosis, no
presumption of negligence can be applied to Dr. Marlyn Rico. As held in Ramos:
. . . . 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. A
distinction must be made between the failure to secure results, and the occurrence of
something more unusual and not ordinarily found if the service or treatment rendered
followed the usual procedure of those skilled in that particular practice. It must be
conceded that the doctrine of res ipsa loquitur can have no application in a suit against a
physician or a surgeon which involves the merits of a diagnosis or of a scientific
treatment. The physician or surgeon is not required at his peril to explain why any
particular diagnosis was not correct, or why any particular scientific treatment did not
produce the desired result.

G.R. No. 192123

March 10, 2014
DR. FERNANDO P. SOLIDUM, Petitioner,
vs.
PEOPLE OF THE PHILIPPINES, Respondent.
Negligence; Medical negligence; four elements the plaintiff must prove by competent
evidence. An action upon medical negligence whether criminal, civil or administrative
calls for the plaintiff to prove by competent evidence each of the following four
elements, namely: (a) the duty owed by the physician to the patient, as created by the
physician-patient relationship, to act in accordance with the specific norms or standards
established by his profession; (b) the breach of the duty by the physicians failing to act in
accordance with the applicable standard of care; (3) the causation, i.e., there must be a
reasonably close and causal connection between the negligent act or omission and the
resulting injury; and (4) the damages suffered by the patient.
Negligence is defined as the failure to observe for the protection of the interests of
another person that degree of care, precaution, and vigilance that the circumstances justly
demand, whereby such other person suffers injury. Reckless imprudence, on the other
hand, consists of voluntarily doing or failing to do, without malice, an act from which
material damage results by reason of an inexcusable lack of precaution on the part of the
person performing or failing to perform such act.
The Court aptly explained in Cruz v. Court of Appeals that: Whether or not a physician
has committed an inexcusable lack of precaution in the treatment of his patient is to be
determined according to the standard of care observed by other members of the
profession in good standing under similar circumstances bearing in mind the advanced
state of the profession at the time of treatment or the present state of medical science. In
the recent case of Leonila Garcia-Rueda v. Wilfred L. Pacasio,et. al., this Court stated that
in accepting a case, a doctor in effect represents that, having the needed training and skill
possessed by physicians and surgeons practicing in the same field, he will employ such
training, care and skill in the treatment of his patients. He therefore has a duty to use at
least the same level of care that any other reasonably competent doctor would use to treat
a condition under the same circumstances. It is in this aspect of medical malpractice that
expert testimony is essential to establish not only the standard of care of the profession
but also that the physicians conduct in the treatment and care falls below such standard.
Further, inasmuch as the causes of the injuries involved in malpractice actions are
determinable only in the light of scientific knowledge, it has been recognized that expert
testimony is usually necessary to support the conclusion as to causation.
Negligence; Medical negligence; standard of care; an objective standard by which the
conduct of a physician sued for negligence or malpractice may be measured.In the
medical profession, specific norms or standards to protect the patient against
unreasonable risk, commonly referred to as standards of care, set the duty of the
physician to act in respect of the patient. Unfortunately, no clear definition of the duty of
a particular physician in a particular case exists. Because most medical malpractice cases
are highly technical, witnesses with special medical qualifications must provide guidance

by giving the knowledge necessary to render a fair and just verdict. As a result, the
standard of medical care of a prudent physician must be determined from expert
testimony in most cases; and in the case of a specialist (like an anesthesiologist), the
standard of care by which the specialist is judged is the care and skill commonly
possessed and exercised by similar specialists under similar circumstances. The specialty
standard ofcare may be higher than that required of the general practitioner.

s, as a matter of law, permit a given inference.

Although generally, expert medical testimony is relied upon in malpractice suits to prove
that a physician has done a negligent act or that he has deviated from the standard
medical procedure, when the doctrine of res ipsa loquitur is availed by the plaintiff, the
need for expert medical testimony is dispensed with because the injury itself provides the
proof of negligence. The reason is that the general rule on the necessity of expert
testimony applies only to such matters clearly within the domain of medical science, and
not to matters that are within the common knowledge of mankind which may be testified
to by anyone familiar with the facts. Ordinarily, only physicians and surgeons of skill and
experience are competent to testify as to whether a patient has been treated or operated
upon with a reasonable degree of skill and care. However, testimony as to the statements
and acts of physicians and surgeons, external appearances, and manifest conditions which
are observable by any one may be given by non-expert witnesses. Hence, in cases where
the res ipsa loquitur is applicable, the court is permitted to find a physician negligent
upon proper proof of injury to the patient, without the aid of expert testimony, where the
court from its fund of common knowledge can determine the proper standard of care.
Where common knowledge and experience teach that a resulting injury would not have
occurred to the patient if due care had been exercised, an inference of negligence may be
drawn giving rise to an application of the doctrine of res ipsa loquitur without medical
evidence, which is ordinarily required to show not only what occurred but how and why
it occurred. When the doctrine is appropriate, all that the patient must do is prove a nexus
between the particular act or omission complained of and the injury sustained while under
the custody and management of the defendant without need to produce expert medical
testimony to establish the standard of care. Resort to res ipsa loquitur is allowed because
there is no other way, under usual and ordinary conditions, by which the patient can
obtain redress for injury suffered by him.
Thus, courts of other jurisdictions have applied the doctrine in the following situations:
leaving of a foreign object in the body of the patient after an operation, injuries sustained
on a healthy part of the body which was not under, or in the area, of treatment, removal of
the wrong part of the body when another part was intended, knocking out a tooth while a
patient's jaw was under anesthetic for the removal of his tonsils, and loss of an eye while
the patient plaintiff was under the influence of anesthetic, during or following an
operation for appendicitis, among others.
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. A distinction must be made between the failure to secure results, and the
occurrence of something more unusual and not ordinarily found if the service or
treatment rendered followed the usual procedure of those skilled in that particular
practice. It must be conceded that the doctrine of res ipsa loquitur can have no application
in a suit against a physician or surgeon which involves the merits of a diagnosis or of a
scientific treatment. The physician or surgeon is not required at his peril to explain why
any particular diagnosis was not correct, or why any particular scientific treatment did not
produce the desired result. Thus, 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. If there was such
extraneous intervention, the doctrine of res ipsa loquitur may be utilized and the
defendant is called upon to explain the matter, by evidence of exculpation, if he could."
(citing Ramos vs. Court of Appeals, G.R. No. 124354, 29 December 1999; emphasis and
underscoring supplied)