1

The Mandatory Four Elements in Medical Malpractice Law

There are essentially four elements that must be proven in a
medical malpractice personal injury case:
1. Duty
2. Breach of Duty
3. Damage
4. Cause
1.

2.

3.

4.

Duty A duty must have been owed to a patient by a

healthcare practitioner charged with that patients care.
The doctor-patient relationship is a common example of a
situation where that duty would exist.
Breach of Duty The healthcare practitioner who had the
duty of care for that patient must have failed in his/her
duty by not exercising the degree of care or medical skill
that another healthcare professional in the same
specialty would have used in an equal situation. (This is
when an expert is often called in to testify as to what an
appropriate standard of care would be.)
Damage The patient must have suffered emotional or
physical injury while in the care of the healthcare
practitioner. The injury can be a new one, or an
aggravation of an existing injury.
Cause There must be solid proof that the breach of
duty by the healthcare practitioner caused the patients
injury.

Farhads diagnosis: Precila was a drug addict and

required further observation and treatment. He offered to
attend to Precila at his house and again, Agustina agreed
in the belief that her daughter was a drug addict.

Precila was fetched by spouses Farhad and Marita and

was brought to their house. Again, Precila was given an
injection which caused her to sleep. When she awoke,
she realized that she was naked and her entire body was
in pain.

Farhad was seated on the bed and was fondling her

private parts. Shocked, Precila called for her mother and
tried to get up. Farhad, however, punched her on the
chest and forced her to lie down. He pressed a pillow on
her face and injected her again, causing her to fall
asleep.

When

Precila

awoke

the

second

time,

she

found

appellant in bed with her. He was naked and fondling her

private parts. The pain all over her body lingered. When
Precila touched her private parts, she saw blood stains
on her hand. She tried to stand up but she was too
weak. Farhad gave her another injection rendering her
unconscious.

G.R. Nos. 78813-14 November 8, 1993

The following morning, Agustina found Precila and

Farhad both asleep and naked. She hurriedly dressed up

PEOPLE OF THE PHILIPPINES vs. FARHAD HATANI

Precila and brought her home.

QUIASON, J.:

profession, came home and saw Precila looking very

weak. Her mother, who was crying narrated what she

FACTS:

had witnessed that morning. She also told Josefina that

Farhad

Hatani

has

not

satisfactorily

passed

Farhad was in the other bedroom, treating another sister,

the

Wilma whom he also diagnosed as a drug addict.

corresponding Board Examination, neither is he a holder

Josefina immediately proceeded to the bedroom and saw

of a valid Certificate of Registration duly issued by the

appellant about to inject Wilma.

Board of Medical Examiners, as in fact he does not even

appear to have taken or completed the course leading to
a medical degree.

On

July

6,

1979,

Agustina

Borja

visited,

She inquired on the need of the injection and appellant

Maura

replied that a second shot of plain distilled water was

required to cure Wilma of her drug addiction. Josefina

as medication for her 16-year old daughter, Precila, who

told appellant to stop but he persisted. Only upon threat

had high fever and loose bowel movement. Upon learning

that

Precila

was

Josefina saw the open bag of appellant, which contained

empty capsules of dalmane and empty vials of valium.

Fontreras, her comadre and requested malunggay leaves

sick,

Marita,

Maura's

that she would call the police did appellant stop. Farhad

daughter,

and his wife then left the Borja residence.

introduced Agustina to her husband, Farhad, whom she

said was a medical doctor. Marita suggested that her
husband treat Precila and Agustina agreed.

That evening, Precila's oldest sister, Josefina, a nurse by

Farhad and Marita went to the Borja residence, where he

Borjas filed a case and a search warrant was secured

and later on assorted drugs, such as dalmane, valium
and mogadon, as well as prescription pads in the

examined Precila. He gave her tablets to take and

name of Dr. Jesus Yap (but with handwriting of

administered two injections (to her), one in the morning

Farhad) and other medical instruments, such as a

and the second at noon. After each injection, Precila

"thermometer,

would feel dizzy and fall asleep.

syringes and needles, were seized.

"hygomonometer,

stethoscope,

The trial court rendered two separate decisions for the

separate informations for rape and violation of R.A. No.

2382 The Medical act of 1959 and convicted the Farhad
of both crimes. The Professional Regulation Commission
certified that Farhad

is

not

among

the

list

of

registered physicians nor among those with special

permit to practice medicine in a limited scope.

G.R. No. 72964 January 7, 1988

FILOMENO URBANO vs. IAC
GUTIERREZ, JR., J.:
FACTS:

Issue: Whether or not Farhad is guilty of Medical Act of 1959 for

illegal practice of Medicine?

October 23, 1980, Filomeno Urbano went to his ricefield

at Barangay Anonang, San Fabian, Pangasinan located
at about 100 meters from the tobacco seedbed of Marcelo
Javier.

SC Ruling.

He found his palay flooded with water coming from the

irrigation canal nearby which had overflowed. Urbano

Yes.

went to the elevated portion of the canal to see what

happened and there he saw Marcelo Javier and Emilio

With respect to his conviction of illegal practice of

Erfe cutting grass. He asked them who was responsible

medicine, appellant presented inconsistent claims. On

for the opening of the irrigation canal and Javier

one

admitted that he was the one.

hand,

he

claims

that

the

drugs

and

other

paraphernalia were planted by the raiding team; while on

the other hand, he claims that these were seized without
any warrant.

A quarrel between them ensued. Urbano unsheathed his

bolo (about 2 feet long, including the handle, by 2 inches
wide) and hacked Javier hitting him on the right palm of

If indeed the evidence were all planted, how can

his hand, which was used in parrying the bolo hack.

appellant explain his handwriting on the prescription

pads in the name of Dr. Jesus Yap? A perusal of the
photographs showing accused during the raid, fails to

Javier who was then unarmed ran away from Urbano but
was overtaken by Urbano who hacked him again hitting

indicate any protestation by him.

Javier on the left leg with the back portion of said bolo,
causing a swelling on said leg.

The evidence is overwhelming that appellant actually

treated and diagnosed Precila and Wilma Borja reports
and prove that he was engaged in the practice of

Javier was brought to Dr. Guillermo Padilla, rural health

physician of San Fabian, who did not attend to Javier but

medicine like:

instead suggested that they go to Dr. Mario Meneses

because Padilla had no available medicine. was treated

1.

The positive testimony of Agustina, Precila, Wilma

by Dr. Meneses, he and his companions returned to Dr.

and Josefina Borja;

Guillermo

Padilla

who

conducted

medico-legal

examination. Dr. Padilla issued a medico-legal certificate

2.

that certified the wounds of Javier to be:

The medico-legal reports which attest to the needle

marks;

1 -Incised wound 2 inches in length at the

3.

The

Handwriting

Identification

Report

upper portion of the lesser palmar prominence,

in

right. As to my observation the incapacitation is

prescription pad of Dr. Jesus Yap

4.

The

photographs

showing

assorted

from (7-9) days period.

drugs

and

medical equipment in appellant's room; and the

Urbano promised to pay P700.00 for the medical

chemistry.

And as to his allegation that there was no proof of

payment, the law specifically punishes said act
whether or not done for a fee.

Urbano and Javier agreed to settle their differences.

expenses of Javier.

At about 1:30 a.m. on November 14, 1980 (after 3

weeks), Javier was rushed to the Nazareth General
Hospital in a very serious condition. When admitted to
the hospital, Javier had lockjaw and was

having

that Dr. Mario Meneses found no tetanus in the injury,

attended to Javier found that the latter's serious

and that Javier got infected with tetanus when after two

condition was caused by tetanus toxin. He noticed the

weeks he returned to his farm and tended his tobacco

presence of a healing wound in Javier's palm which could

plants with his bare hands exposing the wound to

have been infected by tetanus.

harmful elements like tetanus germs.

convulsions. Dr. Edmundo Exconde who personally

On November 15, 1980 at exactly 4:18 p.m., Javier died

Trial court and Appellate court contention: Deceased

did not die right away from his wound, but the cause of

in the hospital.

his death was due to said wound which was inflicted by

the appellant. Said wound which was in the process of

In an information dated April 10, 1981, Filomeno Urbano

healing got infected with tetanus which ultimately

was charged with the crime of homicide before the then

Circuit Criminal Court of Dagupan City, Third Judicial

caused his death. The proximate cause of the victim's

District.

death was the wound which got infected with

tetanus. And the settled rule in this jurisdiction is that
an accused is liable for all the consequences of his

Trial Court: Urbano is guilty

Appellate court: affirmed the verdict

unlawful act.

Proximate cause definitions cited in the case:

MR on Appellate court: Motion for New trial because of

1.

the affidavit of Barangay Captain Menardo Soliven that

"that cause, which, in natural and continuous

he saw while I was conducting survey on November 5,

sequence, unbroken by any efficient intervening

1980, Marcelo Javier catching fish in the shallow

cause, produces the injury, and without which the

irrigation canals with some companions; BUT MR

result would not have occurred."

DENIED.
2.

"the proximate legal cause is that acting first and

producing the injury, either immediately or by setting

Hence, the petition

other events in motion, all constituting a natural and

continuous chain of events, each having a close
causal connection with its immediate predecessor, the
final event in the chain immediately effecting the

Issue:

injury as a natural and probable result of the cause

which first acted, under such circumstances that the

Whether or not there was an efficient intervening cause from

person responsible for the first event should, as an

the time Javier was wounded until his death which would

ordinarily prudent and intelligent person, have

acquit Urbano from any liability for Javier's death?

reasonable ground to expect at the moment of his act

or default that an injury to some person might
probably result therefrom."

SC Ruling:

injury and the appearance of unmistakable symptoms,

Yes, there was an efficient intervening cause thus, Urbano is

ranges from 2 to 56 days. However, over 80 percent of

acquitted.

patients become symptomatic within 14 days. A short

incubation period indicates severe disease, and when

The case involves the application of Article 4 of the

symptoms occur within 2 or 3 days of injury the

Revised Penal Code which provides that "Criminal

mortality rate approaches 100 percent.

liability shall be incurred: (1) By any person committing

a felony (delito) although the wrongful act done be
different from that which he intended ..." Pursuant to
this provision "an accused is criminally responsible for
acts committed by him in violation of law and for all the
natural

The incubation period of tetanus, i.e., the time between

and

logical

consequences

resulting

therefrom."

Mild tetanus is characterized by an incubation period of at

least 14 days and an onset time of more than 6 days. The
criteria for severe tetanus include a short incubation
time, and an onset time of 72 hrs., or less, severe
trismus, dysphagia and rigidity and frequent prolonged,
generalized

convulsive

spasms.

Therefore,

medically

speaking, the reaction to tetanus found inside a man's

Petitioner Contention: The proximate cause of the

death of Marcelo Javier was due to his own negligence,

body depends on the incubation period of the disease.

The more credible conclusion is that at the time

proved only by a preponderance of evidence? Is the right

Javier's wound was inflicted by the appellant, the

of the aggrieved person any less private because the

wrongful act is also punishable by the criminal law?

severe form of tetanus that killed him was not yet

present. Consequently, Javier's wound could have
been

infected

with

tetanus

after

the

hacking

incident. Considering the circumstance surrounding

Javier's death, his wound could have been infected by
tetanus 2 or 3 or a few but not 20 to 22 days before
he died.

The medical findings, however, lead us to a distinct

possibility that the infection of the wound by tetanus was
an efficient intervening cause later or between the time
Javier was wounded to the time of his death. The
infection was, therefore, distinct and foreign to the
crime.

Remote cause vs. Proximate cause. Doubts are present.

[G.R. No. 65295. March 10, 1987.]

Phoenix Construction and Carbonel vs IAC and Dionisio
PONENTE: Justice Feliciano
FACTS:
1. In the early morning of 15 November 1975 at about
1:30 a.m. private respondent Leonardo Dionisio was
on his way home from a cocktails-and-dinner meeting
with his boss, the general manager of a marketing
corporation. During the cocktails phase of the evening,
Dionisio had taken "a shot or two" of liquor.
2.

Dionisio was driving his Volkswagen car and had just

crossed the intersection of General Lacuna and General
Santos Streets at Bangkal, Makati, not far from his
home, and was proceeding down General Lacuna Street,
when his car headlights suddenly failed. He switched his
headlights on "bright" and thereupon he saw a Ford
dump truck looming some 2-1/2 meters away from his
car.

3.

The dump truck, owned by and registered in the name of

petitioner Phoenix Construction Inc. ("Phoenix"), was
parked on the right hand side of General Lacuna Street
(i.e., on the right hand side of a person facing in the
same direction toward which Dionisio's car was
proceeding), facing the oncoming traffic. The dump truck
was parked askew (not parallel to the street curb) in such
a manner as to stick out onto the street, partly blocking
the way of oncoming traffic. There were no lights nor any
so-called "early warning" reflector devices set anywhere
near the dump truck, front or rear.

4.

The dump truck had earlier that evening been driven

home by petitioner Armando U. Carbonel, its regular
driver, with the permission of his employer Phoenix, in
view of work scheduled to be carried out early the
following morning. Dionisio claimed that he tried to avoid
a collision by swerving his car to the left but it was too
late and his car smashed into the dump truck. As a
result of the collision, Dionisio suffered some physical
injuries including some permanent facial scars, a
"nervous breakdown" and loss of two gold bridge
dentures.

5.

Dionisio commenced an action for damages in the Court

of First Instance of Pampanga basically claiming that the
legal and proximate cause of his injuries was the
negligent manner in which Carbonel had parked the
dump truck entrusted to him by his employer Phoenix.
Phoenix and Carbonel, on the other hand, countered
that the proximate cause of Dionisio's injuries was his
own recklessness in driving fast at the time of the
accident, while under the influence of liquor, without his
headlights on and without a curfew pass. Phoenix also

There is a likelihood that the wound was but the remote

cause and its subsequent infection, for failure to take
necessary precautions, with tetanus may have been the
proximate cause of Javier's death with which the
petitioner had nothing to do
"A prior and remote cause cannot be made to be
of an action if such remote cause did nothing
more than furnish the condition or give rise to
the occasion by which the injury was made
possible, if there intervened between such prior
or remote cause and the injury a distinct,
successive, unrelated, and efficient cause of the
injury, even though such injury would not have
happened but for such condition or occasion. If
no danger existed in the condition except
because

of

the

independent

cause,

such

condition was not the proximate cause. And if

an

independent

negligent

act

or

defective

condition sets into operation the instances

which result in injury because of the prior
defective condition, such subsequent act or
condition is the proximate cause."

Criminal and civil Liability. The two liabilities are

separate and distinct from each other. One affects the
social order and the other, private rights. One is for the
punishment or correction of the offender while the other
is for reparation of damages suffered by the aggrieved
party.

It is just and proper that, for the purposes of the

imprisonment of or fine upon the accused, the offense
should be proved beyond reasonable doubt. But for the
purpose of indemnity the complaining party, why should
the offense also be proved beyond reasonable doubt? Is
not the invasion or violation of every private right to be

sought to establish that it had exercised due care in the

selection and supervision of the dump truck driver.
ISSUE:
Whether or not Urbano, driver of Phoenix Corporation
negligence was merely a passive and static condition and
that Dionisio was the efficient intervening cause and regarded
as the legal and proximate cause of the accident.
RULING:
1.

The SC agree with the Court of First Instance and the

Intermediate Appellate Court that the legal and
proximate cause of the accident and of Dionisio's injuries
was the wrongful or negligent manner in which the dump
truck was parked.

2.

The collision of Dionisio's car with the dump truck was a

natural and foreseeable consequence of the truck driver's
negligence.The truck driver's negligence far from being a
"passive and static condition" was rather an
indispensable and efficient cause. The collision between
the dump truck and the private respondent's car would
in all probability not have occurred had the dump truck
not been parked askew without any warning lights or
reflector devices.

3.

The improper parking of the dump truck created an

unreasonable risk of injury for anyone driving down
General Lacuna Street and for having so created this
risk, the truck driver must be held responsible. In our
view, Dionisio's negligence, although later in point of
time than the truck driver's negligence and therefore
closer to the accident, was not an efficient intervening or
independent cause. What the petitioners describe as an
"intervening cause" was no more than a foreseeable
consequence of the risk created by the negligent manner
in which the truck driver had parked the dump truck.

4.

In other words, the petitioner truck driver owed a duty to

private respondent Dionisio and others similarly situated
not to impose upon them the very risk the truck driver
had created. Dionisio's negligence was not of an
independent and overpowering nature as to cut, as it
were, the chain of causation in fact between the improper
parking of the dump truck and the accident, nor to sever
the juris vinculum of liability.

928 P.2d 1202, 1996 Alaska

David LYONS, individually and as the personal representative

of the Estate of Esther Jane Hunter-Lyons, and as father and
legal guardian of Benjamin Murphy Lyons, Joshua Caleb
Lyons,
MacAaron Hunter-Lyons, Robert Jack Hunter-Lyons, and
Duley
Everett
Lyons,
Appellants,
v.
MIDNIGHT SUN TRANSPORTATION SERVICES, INC., Appellee.
FACTS:
Hunter-Lyons was killed when her Volkswagen van was struck
broadside by a truck driven by David Jette (Jette) and owned by

Defendant. When the accident occurred, Jette was driving south

in the right-hand lane of a thoroughfare in Anchorage, Alaska.
Hunter-Lyons pulled out of a parking lot in front of him. Jette
braked and steered to the left, but Hunter-Lyons continued to pull
out further into the traffic lane. Jettes truck collided with HunterLyonss vehicle. David Lyons, the deceaseds husband, (Plaintiff)
filed suit, asserting that Jette had been speeding and driving
negligently.
ISSUE:
Whether or not the jury instruction concerning the sudden
emergency doctrine is improper?
RULING:
The court affirmed the trial courts decision that Jette was not at
fault in the accident, but that the primary cause was the decedent
pulling out in front of Jette. The use of the sudden emergency
instruction was harmless error. The sudden emergency doctrine,
which arises in Lyons, has at times caused confusion with respect
to the degree of care a party may owe another. The idea is, if a
person, through no fault of his or her own, is faced with a sudden
emergency, they are not to be held to the same correctness of
judgment and action as if he had time and opportunity to fully
consider the situation. The individual is, however, expected to
exercise that care which a reasonably prudent person would have
exercised under the same or similar circumstances. As the court
explains, The sudden emergency doctrine arose as a method of
ameliorating the, sometimes harsh, all or nothing rule in
contributory negligence systems. The American Law Institute
articulates the doctrine: In determining whether conduct is
negligent toward another, the fact that the actor is confronted with
a sudden emergency which requires rapid decision is a factor in
determining the reasonable character of his choice of action. The
modern trend, as is reflected in Lyons, is to move away from
instructing juries on the sudden emergency doctrine because,
rather than explaining to the jury that emergency circumstances
are a factor in determining the reasonableness of the defendants
actions, the instruction has a tendency to elevate its principles
above what is required to be proven in a negligence action.

Perkins v. Texas
Facts. The Plaintiffs husband was killed in a collision between
the car he was a passenger in and a freight train operated by the
Defendant, New Orleans Railroad Co. At the intersection of the
road and rail crossing where the accident occurred, a large
warehouse obstructed the view of both the cars driver and the
trains engineer and brakeman. The trains engineer and
brakeman were aware of the obstruction and while approaching
the intersection rang the trains bell and whistle and put its
headlights on. The intersection also had warning signals to warn
drivers of approaching trains. These signals were operating at the
time of the accident. Of the three railway employees in the forward
engine of the train only two, the brakeman and a fireman saw the
car emerge from the intersection. The third, the engineer did not
see the car due to the obstructed view, but applied the emergency
brakes when his companions alerted him to the presence of the
car. At the time of the accident the trainwas between 30 to 60 feet
from the car. Both parties have conceded that the driver of the
car, who was also killed, was negligent in driving upon the train
track with the signal lights on. The parties have also conceded

that the train was traveling at 37 miles per hour when the selfimposed speed limit for the intersection was 25 miles per hour.
Issue. Whether the negligence of the Defendant was a substantial
factor in causing the accident.
Discussion. By traveling twelve miles over the self-imposed speed
limit, the engineer was negligent. The engineer testified that even
at a rate of 25 mph, the train could not have avoided the car.
Based on this testimony, the court finds that the speed of the
train was not a substantial factor in the crash. Because the
accident would have occurred even if the train had been traveling
within the speed limit, the negligence of the trains operator is not
a substantial factor in the collision.
Sps. Santos v Pizardo
Facts:
Dionisio M. Sibayan was charged with reckless imprudence
resulting to multiple homicide and multiple physical injuries due
to the vehicle collision between Viron Transit bus driven by
Sibayan and a Lite Van Ace. However the municipal circuit trial
court was no pronouncement of civil liability. The petitioners filed
a complaint for damages to the respondents pursuant to their
reservation to file a separate civil action citing Sibayans judgment
conviction. And it was moved to dismiss by the Viron Transit. The
petitioners opposed and contends that the motion to dismiss that
be ten (10) years from the judgment of criminal action is the
prescription and therefore it is within the period since it was just
barely two (2)years had elapse. The complaint was dismissed by
the trial court due to the ground that the cause of action had
prescribed; based on quasi-delict that it prescribes four (4) years
from the accrual of the cause of action. Again the petitioners filed
a reconsideration that the complaint is not based on quasi- delict
but on the final judgment of conviction in the criminal case which
prescribes ten(10) years upon the finality of the judgment. The
motion for reconsideration of the petitioners was denied by the
trial court based on quasi-delict in Article 1146 of the Civil Code
that the complaint was filed more than four (4) years after the
vehicular activities therefore it prescribes already. On the petition
for certiorari the petitioners filed to the Court of Appeals it was
dismissed the same error in the choice or mode of appeal. It also
denies the petitioners motion for and the petitioners failed to
allege that the petition was brought within the recognized
exceptions for the allowance of certiorari in lieu of appeal.
Petitioners insist that it should been forced in the complaint that
arose in ex delicto and not based on quasi-delict. Since the action
is based on the criminal liability of private respondents, the cause
of action accrued from the finality of the judgment of conviction.
Private respondents insisted, pointing out the averments in the
complaint make out a cause of action for quasi delict in Article
2176 and 2180of the Civil Code. The prescriptive period of four (4)
years should be reckoned from the time the accident took place.
Viron transit also alleges that its subsidiary liability cannot be
enforced since Sibayan was not ordered to pay damages in the
criminal case, in sitting Art. 103 of Revised Penal Code the civil
aspect of the case were instituted in the criminal case and no
reservation to file a separate civil case was made. Respondents
likewise allege that the petitioners should have appealed the
adverse order of the trial court. Petitioners filed a reply and the
private respondents also filled a rejoinder both in reiteration of
their arguments. Hence this petition.
Issues:

Whether or not the dismissal of the action was based on culpa

aquiliana is a bar to the enforcement of the subsidiary liability of
the employer?
Held:
The dismissal of the action based on culpa aquiliana is not a bar
to the subsidiary liability of the employer. Because the Article 103
of the R.P.C. operates with controlling force to obviate the
possibility of the aggrieved party being deprived of indemnity even
after the rendition of a final judgment convicting the employee.
The trial court should not have dismissed the complaint on the
ground of prescription, but instead allowed the complaint for
damages ex delicto to be prosecuted on the merits, this does not
offend the policy that the reservation or institution of a separate
civil waives the other civil actions but this is merely an avoidance
of multiple suits. The action for damages based on quasi- delict
should be considered waived no occasion for petitioners to file
multiple suits against private respondents as available to them is
to pursue damages ex delicto.

PRESCRIPTION
THIRD DIVISION
[G.R. No. 145391. August 26, 2002.]
AVELINO CASUPANAN and ROBERTO CAPITULO, petitioners,
vs. MARIO LLAVORE LAROYA, respondent.
[G.R. No. 145391. August 26, 2002.]
FACTS:
As a result of a vehicular accident between two vehicles, one
driven by Mario Llavore Laroya and the other owned by Roberto
Capitulo and driven by Avelino Casupanan, two cases were filed
before the Municipal Circuit Trial Court (MCTC) of Capas, Tarlac.
Laroya filed a criminal case against Casupanan for reckless
imprudence resulting in damage to property. This case was on its
preliminary investigation stage when Casupanan and Capitulo
filed a civil case against Laroya for quasi-delict. However, upon
motion of Laroya on the ground of forum-shopping, the MCTC
dismissed the civil case. Casupanan and Capitulo then filed a
petition for certiorari before the Regional Trial Court (RTC) of
Capas, Tarlac. But the RTC ruled that the order of dismissal
issued by the MCTC is a final order which disposes of the case
and therefore, the proper remedy should have been an appeal.
Hence, Casupanan and Capitulo filed this petition.
ISSUE:
Whether an accused in a pending criminal case for reckless
imprudence can validly file, simultaneously and independently, a
separate civil action for quasi-delict against the private
complainant in the criminal case.
HELD:
The Court held that the MCTC dismissed the civil action for quasidelict on the ground of forum-shopping did not state in its order of
dismissal that the dismissal was with prejudice. Under the
Administrative Circular, the order of dismissal is without prejudice
to refiling the complaint, unless the order of dismissal expressly
states that it is with prejudice. Thus, the MCTC's dismissal, being
silent on the matter, is a dismissal without prejudice. Section 1 of
Rule 41 provides that an order dismissing an action without
prejudice is not appealable. The remedy of the aggrieved party
is to file a special civil action under Rule 65. Clearly, the Capas
RTC's order dismissing the petition for certiorari on the ground
that the proper remedy is an ordinary appeal, is erroneous. (Mali

ang trial court kasi without prejudice ang dismissal so tama ang
Special civil action for certiorari . mali DIN and MTC sa
pagdismiss dahil sa forum shopping kasi magkaiba yung cause of
action kasi ex delicto yung sa criminal action, yun yung civil
action deemed instituted upon institution of criminal action,
tapos action based on culpa aquiliana yung sa civil action (quasi
delict) so magkaiba talaga. It can be filed independent of the
criminal action kasi di naman siya pwede magcounterclaim sa
civil aspect ng criminal action tapos pwede nya pa din ifile ang
civil action kasi preliminary investigation pa lang di pa
nakakapagpresent ng evidence ang prosecution so pwede pa
siyang either mag waive or mag reserve ng filing ng independent
civil action.
The prescriptive period on the civil actions based on these
articles of the Civil Code continues to run even with the filing
of the criminal action. Verily, the civil actions based on these
articles of the Civil Code are separate, distinct and
independent of the civil action "deemed instituted" in the
criminal action.
[T]here is no forum-shopping in the instant case because the law
and the rules expressly allow the filing of a separate civil action
which can proceed independently of the criminal action.
Further, the accused can file a civil action for quasi-delict for the
same act or omission he is accused of in the criminal case. This is
expressly allowed in paragraph 6, Section 1 of the present Rule
111 which states that the counterclaim of the accused "may be
litigated in a separate civil action." Thus, the civil action based on
quasi-delict filed separately by Casupanan and Capitulo is proper.
The order of dismissal by the MCTC of the civil case on the ground
of forum shopping is erroneous.
WHEREFORE, the petition for review on certiorari is
hereby
GRANTED. The Resolutions dated December 28, 1999
and August 24, 2000 in Special Civil Action No. 17-C (99) are
ANNULLED and Civil Case No. 2089 is REINSTATED
SYLLABUS (inawan ko ang syllabus)
1.
REMEDIAL LAW; CIVIL PROCEDURE; ORDER OF
DISMISSAL; ABSENT A DECLARATION THAT THE DISMISSAL IS
WITH PREJUDICE, THE SAME IS DEEMED WITHOUT
PREJUDICE. The MCTC dismissed the civil action for quasidelict on the ground of forum-shopping under Supreme Court
Administrative Circular No. 04-94. The MCTC did not state in its
order of dismissal that the dismissal was with prejudice. Under
the Administrative Circular, the order of dismissal is without
prejudice to refiling the complaint, unless the order of dismissal
expressly states it is with prejudice. Absent a declaration that the
dismissal is with prejudice, the same is deemed without prejudice.
Thus, the MCTC's dismissal, being silent on the matter, is a
dismissal without prejudice. HAEDCT
2.
ID.; ID.; ID.; DISMISSAL WITHOUT PREJUDICE IS NOT
APPEALABLE. Section 1 of Rule 41 provides that an order
dismissing an action without prejudice is not appealable. The
remedy of the aggrieved party is to file a special civil action under
Rule 65. Section 1 of Rule 41 expressly states that "where the
judgment or final order is not appealable, the aggrieved party may
file an appropriate special civil action under Rule 65." Clearly, the
Capas RTC's order dismissing the petition for certiorari, on the
ground that the proper remedy is an ordinary appeal, is
erroneous.
3.
ID.; ID.; FORUM-SHOPPING; ELUCIDATED. The
essence of forum-shopping is the filing of multiple suits involving
the same parties for the same cause of action, either
simultaneously or successively, to secure a favorable judgment.

Forum-shopping is present when in the two or more cases

pending, there is identity of parties, rights of action and reliefs
sought. HIaTDS
4.
ID.; ID.; ID.; NOT APPLICABLE IN CASE AT BAR.
[T]here is no forum-shopping in the instant case because the law
and the rules expressly allow the filing of a separate civil action
which can proceed independently of the criminal action. Laroya
filed the criminal case for reckless imprudence resulting in
damage to property based on the Revised Penal Code while
Casupanan and Capitulo filed the civil action for damages based
on Article 2176 of the Civil Code. Although these two actions
arose from the same act or omission, they have different causes of
action. The criminal case is based on culpa criminal punishable
under the Revised Penal Code while the civil case is based on
culpa aquiliana actionable under Articles 2176 and 2177 of the
Civil Code.
5.
ID.; 2000 RULES ON CRIMINAL PROCEDURE;
PROSECUTION OF CIVIL ACTION; PRIVATE COMPLAINANT OR
THE ACCUSED CAN FILE A SEPARATE CIVIL ACTION. Any
aggrieved person can invoke [Articles 2176 and 2177 of the Civil
Code] provided he proves, by preponderance of evidence, that he
has suffered damage because of the fault or negligence of another.
Either the private complainant or the accused can file a separate
civil action under these articles. There is nothing in the law or
rules that state only the private complainant in a criminal case
may invoke these articles. ESITcH
6.
ID.; ID.; ID.; REQUIRES THE ACCUSED TO LITIGATE
HIS
COUNTERCLAIM,
CROSS-CLAIM
OR
THIRD-PARTY
COMPLAINT IN A SEPARATE CIVIL ACTION. [P]aragraph 6,
Section 1, Rule 111 of the 2000 Rules on Criminal Procedure
("2000 Rules" for brevity) expressly requires the accused to litigate
his counterclaim in a separate civil action, to wit: "SECTION 1.
Institution of criminal and civil actions. (a) . . . . No
counterclaim, cross-claim or third-party complaint may be filed by
the accused in the criminal case, but any cause of action which
could have been the subject thereof may be litigated in a separate
civil action." Since the present Rules require the accused in a
criminal action to file his counterclaim in a separate civil action,
there can be no forum-shopping if the accused files such separate
civil action. SaCIAE
7.
ID.; ID.; ID.; CIVIL ACTION ARISING FROM THE CRIME;
THE ONLY CIVIL ACTION DEEMED INSTITUTED WITH THE
CRIMINAL ACTION. Under Section 1 of the present Rule 111,
what is "deemed instituted" with the criminal action is only the
action to recover civil liability arising from the crime or ex-delicto.
All the other civil actions under Articles 32, 33, 34 and 2176 of
the Civil Code are no longer "deemed instituted," and may be filed
separately and prosecuted independently even without any
reservation in the criminal action. The failure to make a
reservation in the criminal action is not a waiver of the right to file
a separate and independent civil action based on these articles of
the Civil Code. The prescriptive period on the civil actions based
on these articles of the Civil Code continues to run even with the
filing of the criminal action. Verily, the civil actions based on these
articles of the Civil Code are separate, distinct and independent of
the civil action "deemed instituted" in the criminal action.
8.
ID.; ID.; ID.; ID.; MAY BE FILED SEPARATELY BY
RESERVING SUCH RIGHT IN THE CRIMINAL ACTION OR IF
SEPARATELY FILED, MAY BE CONSOLIDATED WITH THE
CRIMINAL ACTION. Under the present Rule 111, the offended
party is still given the option to file a separate civil action to
recover civil liability ex-delicto by reserving such right in the
criminal action before the prosecution presents its evidence. Also,
the offended party is deemed to make such reservation if he files a
separate civil action before filing the criminal action. If the civil

action to recover civil liability ex-delicto is filed separately but its

trial has not yet commenced, the civil action may be consolidated
with the criminal action. The consolidation under this Rule does
not apply to separate civil actions arising from the same act or
omission filed under Articles 32, 33, 34 and 2176 of the Civil
Code. TaHIDS
9.
ID.; ID.; ID.; ID.; IF IT IS RESERVED, IT COULD NOT BE
FILED UNTIL AFTER FINAL JUDGMENT OF THE CRIMINAL
ACTION OR IF SEPARATELY FILED, IT IS SUSPENDED UPON
THE FILING OF THE CRIMINAL ACTION. Under Section 2, Rule
111 of the amended 1985 Rules, a separate civil action, if reserved
in the criminal action, could not be filed until after final judgment
was rendered in the criminal action. If the separate civil action
was filed before the commencement of the criminal action, the
civil action, if still pending, was suspended upon the filing of the
criminal action until final judgment was rendered in the criminal
action. This rule applied only to the separate civil action filed to
recover liability ex-delicto. The rule did not apply to independent
civil actions based on Articles 32, 33, 34 and 2176 of the Civil
Code, which could proceed independently regardless of the filing
of the criminal action. . . . Thus, Section 2, Rule 111 of the
present Rules did not change the rule that the separate civil
action, filed to recover damages ex-delicto, is suspended upon the
filing of the criminal action. Section 2 of the present Rule 111 also
prohibits the filing, after commencement of the criminal action, of
a separate civil action to recover damages ex-delicto. ISDHcT
10.
ID.; ID.; ID.; INDEPENDENT CIVIL ACTION IN ARTICLES
32, 33, 34 AND 2176 OF THE CIVIL CODE MAY BE FILED
SEPARATELY BY THE OFFENDED PARTY EVEN WITHOUT
RESERVATION. Under Section I of the present Rule 111, the
independent civil action in Articles 32, 33, 34 and 2176 of the
Civil Code is not deemed instituted with the criminal action but
may be filed separately by the offended party even without
reservation. The commencement of the criminal action does not
suspend the prosecution of the independent civil action under
these articles of the Civil Code. The suspension in Section 2 of the
present Rule 111 refers only to the civil action arising from the
crime, if such civil action is reserved or filed before the
commencement of the criminal action.
11.
ID.; ID.; ID.; OFFENDED PARTY CAN SEPARATELY FILE
A CRIMINAL CASE AND A CIVIL CASE FOR QUASI-DELICT,
WITHOUT VIOLATING THE RULE ON NON-FORUM SHOPPING.
[T]he offended party can file two separate suits for the same act or
omission. The first, a criminal case where the civil action to
recover civil liability ex-delicto is deemed instituted, and the other
a civil case for quasi-delict without violating the rule on nonforum shopping. The two cases can proceed simultaneously and
independently of each other. The commencement or prosecution of
the criminal action will not suspend the civil action for quasidelict. The only limitation is that the offended party cannot
recover damages twice for the same act or omission of the
defendant. In most cases, the offended party will have no reason
to file a second civil action since he cannot recover damages twice
for the same act or omission of the accused. In some instances,
the accused may be insolvent, necessitating the filing of another
case against his employer or guardians. cDaEAS
12.
ID.; ID.; ID.; ACCUSED CAN FILE A CIVIL ACTION FOR
QUASI-DELICT FOR THE SAME ACT OR OMISSION HE IS
ACCUSED OF IN THE CRIMINAL CASE. [T]he accused can file a
civil action for quasi-delict for the same act or omission he is
accused of in the criminal case. This is expressly allowed in
paragraph 6, Section 1 of the present Rule 111 which states that
the counterclaim of the accused "may be litigated in a separate
civil action." This is only fair for two reasons. First, the accused is
prohibited from setting up any counterclaim in the civil aspect

that is deemed instituted in the criminal case. The accused is

therefore forced to litigate separately his counterclaim against the
offended party. If the accused does not file a separate civil action
for quasi-delict, the prescriptive period may set in since the period
continues to run until the civil action for quasi-delict is filed.
Second, the accused, who is presumed innocent, has a right to
invoke Article 2177 of the Civil Code, in the same way that the
offended party can avail of this remedy which is independent of
the criminal action. To disallow the accused from filing a separate
civil action for quasi-delict, while refusing to recognize his
counterclaim in the criminal case, is to deny him due process of
law, access to the courts, and equal protection of the law.
cTaDHS
13.
ID.; ID.; ID.; INDEPENDENT CIVIL ACTION MAY
PROCEED INDEPENDENTLY OF THE CRIMINAL PROCEEDINGS
AND REGARDLESS OF THE RESULT OF THE LATTER. We
make this ruling aware of the possibility that the decision of the
trial court in the criminal case may vary with the decision of the
trial court in the independent civil action. This possibility has
always been recognized ever since the Civil Code introduced in
1950 the concept of an independent civil action under Articles 32,
33, 34 and 2176 of the Code. But the law itself, in Article 31 of
the Code, expressly provides that the independent civil action
"may proceed independently of the criminal proceedings and
regardless of the result of the latter." In Azucena vs. Potenciano,
the Court declared: ". . . . There can indeed be no other logical
conclusion than this, for to subordinate the civil action
contemplated in the said articles to the result of the criminal
prosecution whether it be conviction or acquittal would
render meaningless the independent character of the civil action
and the clear injunction in Article 31 that this action 'may
proceed independently of the criminal proceedings and regardless
of the result of the latter.'" More than half a century has passed
since the Civil Code introduced the concept of a civil action
separate and independent from the criminal action although
arising from the same act or omission. The Court, however, has
yet to encounter a case of conflicting and irreconcilable decisions
of trial courts, one hearing the criminal case and the other the
civil action for quasi-delict. The fear of conflicting and
irreconcilable decisions may be more apparent than real. In any
event, there are sufficient remedies under the Rules of Court to
deal with such remote possibilities. ECDAcS
14.
ID.; ID.; RETROACTIVE EFFECT; APPLICABLE IN CASE
AT BAR. The Revised Rules on Criminal Procedure took effect
on December 1, 2000 while the MCTC issued the order of
dismissal on December 28, 1999 or before the amendment of the
rules. The Revised Rules on Criminal Procedure must be given
retroactive effect considering the well-settled rule that ". . .
statutes regulating the procedure of the court will be construed as
applicable to actions pending and undetermined at the time of
their passage. Procedural laws are retroactive in that sense and to
that extent."
(PRESCRIPTION)
[G.R. No. 133978. November 12, 2002.]
JOSE S. CANCIO, JR., represented by ROBERTO L. CANCIO,
petitioner, vs. EMERENCIANA ISIP, respondent.
Federico S. Tolentino, Jr. for petitioner.
Norbin P. Dimalanta for respondent.
FACTS:
Petitioner filed three cases of violation of B.P. No. 22 and three
cases of estafa against respondent. All six criminal cases were
dismissed for various reasons. As to the three cases of estafa, it
was the prosecution that moved for its dismissal with reservation

as to its right to file a separate civil action arising from the said
criminal cases. Thereafter, the petitioner filed a case for collection
of sum of money, seeking to recover the amount of the checks
subject of the estafa cases. The court, however, dismissed the
case on the ground that the dismissal of the criminal cases
against the respondent on the ground of lack of interest or
failure to prosecute was an adjudication on the merits, which
amounted to res judicata on the civil case for collection. It further
held that the filing of the civil case amounted to forum-shopping.
The trial court denied the petitioner's motion for reconsideration,
hence, this petition.
ISSUE:
Whether the dismissal of the estafa cases against respondent bars
the institution of a civil action for collection of the value of the
checks subject of the estafa cases and whether the filing of said
civil action violated the anti-forum-shopping rule.
HELD:
The Supreme Court held that from a reading of the complaint filed
by the petitioner, his cause of action was based on culpa
contractual, an independent civil action. Hence, an
independent civil action arising from contracts, as in the
instant case, may be filed separately and prosecuted
independently even without reservation in the criminal
action. As such, it was distinct and independent from the estafa
case filed against the offender and may proceed regardless of the
result of the criminal proceedings. In the same vain, the filing of
the collection case after the dismissal of the estafa cases against
respondent did not amount to forum-shopping because the law
expressly allows the filing of a separate civil action which can
proceed independently of the criminal action. The instant petition
was granted.
WHEREFORE, in view of all the foregoing, the instant petition is
GRANTED. The March 20, 1998 and June 1, 1998 Orders of the
Regional Trial Court of Pampanga, Branch 49, in Civil Case No. G3272 are REVERSED and SET ASIDE. The instant case is
REMANDED to the trial court for further proceedings.
SYLLABUS
1.
CIVIL
LAW;
QUASI-DELICTS;
CIVIL
LIABILITY;
INCURRED WHEN AN ACT OR OMISSION CAUSED DAMAGE TO
ANOTHER; EFFECT THEREOF. An act or omission causing
damage to another may give rise to two separate civil liabilities on
the part of the offender, i.e., (1) civil liability ex delicto, under 100
of the Revised Penal Code; and (2) independent civil liabilities,
such as those (a) not arising from an act or omission complained
of as felony [e.g. culpa contractual or obligations arising from law
under Article 31 of the Civil Code, intentional torts under Articles
32 and 34, and culpa aquiliana under Article 2176 of the Civil
Code]; or (b) where the injured party is granted a right to file an
action independent and distinct from the criminal action [Article
33, Civil Code]. Either of these two possible liabilities may be
enforced against the offender subject, however, to the caveat
under Article 2177 of the Civil Code that the offended party
"cannot recover damages twice for the same act or omission" or
under both causes. cTACIa
2.
REMEDIAL
LAW;
CRIMINAL
PROCEDURE;
INDEPENDENT CIVIL ACTION; WHEN PROPER. Under the
1985 Rules on Criminal Procedure, as amended in 1988 and
under the present Rules, the civil liability ex-delicto is deemed
instituted with the criminal action, but the offended party is given
the option to file a separate civil action before the prosecution

starts to present evidence. Anent the independent civil actions

under Articles 31, 32, 33, 34 and 2176 of the Civil Code, the old
rules considered them impliedly instituted with the civil liability
ex-delicto in the criminal action, unless the offended party waives
the civil action, reserves his right to institute it separately, or
institutes the civil action prior to the criminal action. Under the
present Rules, however, the independent civil actions may be filed
separately and prosecuted independently even without any
reservation in the criminal action. The failure to make a
reservation in the criminal action is not a waiver of the right to file
a separate and independent civil action based on these articles of
the Civil Code.
3.
ID.; CIVIL PROCEDURE; ACTIONS; CAUSE OF ACTION;
DETERMINED BY THE ALLEGATIONS IN THE COMPLAINT.
The nature of a cause of action is determined by the facts alleged
in the complaint as constituting the cause of action. The purpose
of an action or suit and the law to govern it is to be determined
not by the claim of the party filing the action, made in his
argument or brief, but rather by the complaint itself, its
allegations and prayer for relief. CSaHDT
4.
ID.;
CIVIL
PROCEDURE;
INDEPENDENT
CIVIL
ACTIONS; WHEN ARISING FROM CONTRACTS; CIVIL ACTION
MAY
PROCEED
INDEPENDENTLY
OF
THE
CRIMINAL
PROCEEDINGS; RATIONALE. To reiterate, an independent civil
action arising from contracts, as in the instant case, may be filed
separately and prosecuted independently even without any
reservation in the criminal action. Under Article 31 of the Civil
Code "[w]hen the civil action is based on an obligation not arising
from the act or omission complained of as a felony, [e.g. culpa
contractual] such civil action may proceed independently of the
criminal proceedings and regardless of the result of the latter."
Thus, in Vitola, et al. v. Insular Bank of Asia and America, the
Court, applying Article 31 of the Civil Code, held that a civil case
seeking to recover the value of the goods subject of a Letter of
Credit-Trust Receipt is a civil action ex contractu and not ex
delicto. As such, it is distinct and independent from the estafa
case filed against the offender and may proceed regardless of the
result of the criminal proceedings.
5.
ID.; CIVIL PROCEDURE; ACTIONS; FORUM-SHOPPING;
NOT PRESENT IN THE FILING OF COLLECTION CASE AFTER
DISMISSAL OF ESTAFA CASES; APPLICATION IN CASE AT BAR.
In the same vein, the filing of the collection case after the
dismissal of the estafa cases against respondent did not amount
to forum-shopping. The essence of forum-shopping is the filing of
multiple suits involving the same parties for the same cause of
action, either simultaneously or successively, to secure a favorable
judgment. Although the cases filed by petitioner arose from the
same act or omission of respondent, they are, however, based on
different causes of action. The criminal cases for estafa are based
on culpa criminal while the civil action for collection is anchored
on culpa contractual. Moreover, there can be no forum-shopping
in the instant case because the law expressly allows the filing of a
separate civil action which can proceed independently of the
criminal action. ADcHES
RAMOS vs. COURT OF APPEALS
G.R. No. 124354. December 29, 1999.
Ponente: Kapunan
FACTS:
Erlinda Ramos underwent a surgical procedure to remove stone
from her gall bladder (cholecystectomy). They hired Dr. Hosaka, a
surgeon, to conduct the surgery at the De Los Santos Medical
Center (DLSMC). Hosaka assured them that he would find a good

anaesthesiologist. But the operation did not go as planned, Dr.

Hosaka arrived 3 hours late for the operation, Dra. Gutierrez, the
anaesthesiologist botched the administration of the anaesthesia
causing Erlinda to go into a coma and suffer brain damage. The
botched operation was witnessed by Herminda Cruz, sister in law
of Erlinda and Dean of College of Nursing of Capitol Medical
Center.

The head surgeon, Dr. Hosaka was also negligent. He failed to

exercise the proper authority as the captain of the ship in
determining if the anaesthesiologist observed the proper protocols.
Also, because he was late, he did not have time to confer with the
anaesthesiologist regarding the anaesthesia delivery.

The family of Ramos (petitioners) sued the hospital, the surgeon

and the anaesthesiologist for damages. The petitioners showed
expert testimony showing that Erlinda's condition was caused by
the anaesthesiologist in not exercising reasonable care in
intubating Erlinda. Eyewitnesses heard the anesthesiologist
saying Ang hirap ma-intubate nito, mali yata ang pagkakapasok.
O lumalaki ang tiyan.

The hospital failed to adduce evidence showing that it exercised

the diligence of a good father of the family in hiring and
supervision of its doctors (Art. 2180). The hospital was negligent
since they are the one in control of the hiring and firing of their
consultants. While these consultants are not employees,
hospitals still exert significant controls on the selection and
termination of doctors who work there which is one of the
hallmarks of an employer-employee relationship. Thus, the
hospital was allocated a share in the liability.

Diagnostic tests prior to surgery showed that Erlinda was robust

and fit to undergo surgery.

Nogales v Capitol Medical G.R. No. 142625 December 19,

2006

The RTC held that the anaesthesiologist omitted to exercise due

care in intubating the patient, the surgeon was remiss in his
obligation to provide a good anaesthesiologist and for arriving 3
hours late and the hospital is liable for the negligence of the
doctors and for not cancelling the operation after the surgeon
failed to arrive on time. The surgeon, anaesthesiologist and the
DLSMC were all held jointly and severally liable for damages to
petitioners. The CA reversed the decision of the Trial Court.

Theme/Doctrine/Subject: Doctrine
Doctrine of Apparent Authority

ISSUES: Whether or not the private respondents were negligent

and thereby caused the comatose condition of Ramos.
HELD:
Yes, private respondents were all negligent and are solidarily liable
for the damages.
RATIO:
Res ipsa loquitur a procedural or evidentiary rule which means
the thing or the transaction speaks for itself. It 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 plaintiffs prima facie
case, and present a question of fact for defendant to meet with an
explanation, where ordinarily in a medical malpractice case, the
complaining party must present expert testimony to prove that the
attending physician was negligent.
This doctrine finds application in this case. On the day of the
operation, Erlinda Ramos already surrendered her person to the
private respondents who had complete and exclusive control over
her. Apart from the gallstone problem, she was neurologically
sound and fit. Then, after the procedure, she was comatose and
brain damagedres ipsa loquitur!the thing speaks for itself!
Negligence Private respondents were not able to disprove the
presumption of negligence on their part in the care of Erlinda and
their negligence was the proximate cause of her condition. One
need not be an anaesthesiologist in order to tell whether or not the
intubation was a success. [res ipsa loquitur applies here]. The
Supreme Court also found that the anaesthesiologist only saw
Erlinda for the first time on the day of the operation which
indicates unfamiliarity with the patient and which is an act of
negligence and irresponsibility.

of

Vicarious

Liability,

Facts
Dr. Oscar Estrada ("Dr. Estrada") rendered exclusive prenatal
care of Corazon Nogales ("Corazon") beginning on her fourth
month of pregnancy or as early as December 1975 when she was
pregnant with her fourth child.
On her last trimester of pregnancy, Dr. Estrada noted an increase
in
her
blood
pressure
and
development
of
leg
edema indicating preeclampsia, a dangerous complication of
pregnancy.
On 26 May 1976, Corazon was admitted at 2:30 a.m. at the
Capitol Medical Center (CMC) and brought to the labor room of
the CMC.
Dr. Rosa Uy ("Dr. Uy"), who was then a resident physician of CMC,
conducted an internal examination of Corazon. Dr. Uy then called
up Dr. Estrada to notify him of her findings.
At 3:00 a.m., Dr. Estrada ordered for 10 mg. of valium to be
administered immediately by intramuscular injection. Dr. Estrada
later ordered the start of intravenous administration of syntocinon
admixed with dextrose, 5%, in lactated Ringers' solution, at the
rate of eight to ten micro-drops per minute.
At 4:15 a.m., Dr. Joel Enriquez ("Dr. Enriquez"), an
anesthesiologist at CMC, was notified of Corazon's admission.
However, when asked if he needed the services of an
anesthesiologist, Dr. Estrada refused. Despite Dr. Estrada's
refusal, Dr. Enriquez stayed to observe Corazon's condition.
At 6:00 a.m., Corazon was transferred to Delivery Room No. 1
where her bag of water ruptured spontaneously. At 6:12 a.m.,
Corazon's cervix was fully dilated. At 6:13 a.m., Corazon started
to experience convulsions.
At 6:15 a.m., Dr. Estrada ordered the injection of ten grams of
magnesium sulfate. However, Dr. Ely Villaflor ("Dr. Villaflor"), who
was assisting Dr. Estrada, administered only 2.5 grams of
magnesium sulfate.
At 6:22 a.m., Dr. Estrada, assisted by Dr. Villaflor, applied low
forceps to extract Corazon's baby. In the process, a 1.0 x 2.5 cm.
piece of cervical tissue was allegedly torn.
The baby came out in an apnic, cyanotic, weak and injured
condition. Consequently, the baby had to be intubated and
resuscitated by Dr. Enriquez and Dr. Payumo.
At 6:27 a.m., Corazon began to manifest moderate vaginal
bleeding which rapidly became profuse, her blood pressure
dropped from 130/80 to 60/40 within five minutes. There was

continuous profuse vaginal bleeding. The assisting nurse

administered hemacel through a gauge 19 needle as a side drip to
the ongoing intravenous injection of dextrose.
At 7:45 a.m., Dr. Estrada ordered blood typing and cross matching
with bottled blood. It took approximately 30 minutes for the
CMC laboratory, headed by Dr. Perpetua Lacson ("Dr. Lacson"), to
comply with Dr. Estrada's order and deliver the blood.
At 8:00 a.m., Dr. Noe Espinola ("Dr. Espinola"), head of the
Obstetrics-Gynecology Department of the CMC, was informed of
Corazon's condition by telephone. Upon being informed that
Corazon was bleeding profusely, Dr. Espinola ordered immediate
hysterectomy.
Due to the inclement weather then, Dr. Espinola, arrived at the
CMC at 9:00 a.m. Despite Dr. Espinola's efforts to resuscitate,
Corazon died at 9:15 a.m. The cause of death was "hemorrhage,
post partum."14
On 14 May 1980, petitioners filed a complaint for damages 15 with
the Regional Trial Court16 of Manila against CMC, Dr. Estrada, Dr.
Villaflor, Dr. Uy, Dr. Enriquez, Dr. Lacson, Dr. Espinola, and a
certain Nurse J. Dumlao for the death of Corazon. Petitioners
mainly contended that defendant physicians and CMC personnel
were negligent in the treatment and management of Corazon's
condition. Petitioners charged CMC with negligence in the
selection and supervision of defendant physicians and hospital
staff.

First, CMC granted staff privileges to Dr. Estrada. CMC extended

its medical staff and facilities to Dr. Estrada. Upon Dr. Estrada's
request for Corazon's admission, CMC, through its personnel,
readily accommodated Corazon and updated Dr. Estrada of her
condition.
Second, CMC made Rogelio sign consent forms printed on CMC
letterhead. Prior to Corazon's admission and supposed
hysterectomy, CMC asked Rogelio to sign release forms, the
contents of which reinforced Rogelio's belief that Dr. Estrada was a
member of CMC's medical staff.
Doctrine of Apparent Authority
This exception is also known as the "doctrine of apparent
authority."
Two factors to determine the liability of an independent-contractor
physician:
First factor. It focuses on the hospital's manifestations and is
sometimes described as an inquiry whether the hospital acted
in a manner which would lead a reasonable person to
conclude that the individual who was alleged to be negligent
was an employee or agent of the hospital.

It is undisputed that throughout Corazon's pregnancy, she was

under the exclusive prenatal care of Dr. Estrada. At the time of
Corazon's admission at CMC and during her delivery, it was Dr.
Estrada, assisted by Dr. Villaflor, who attended to Corazon. There
was no showing that CMC had a part in diagnosing Corazon's
condition. While Dr. Estrada enjoyed staff privileges at CMC, such
fact alone did not make him an employee of CMC.42 CMC merely
allowed Dr. Estrada to use its facilities43 when Corazon was about
to give birth, which CMC considered an emergency.

In this regard, the hospital need not make express representations

to the patient that the treating physician is an employee of the
hospital; rather a representation may be general and implied.
Second factor. The second factor focuses on the patient's
reliance. It is sometimes characterized as an inquiry on whether
the plaintiff acted in reliance upon the conduct of the hospital or
its agent, consistent with ordinary care and prudence. 54
The records show that the Spouses Nogales relied upon a
perceived employment relationship with CMC in accepting Dr.
Estrada's services. Rogelio testified that he and his wife
specifically chose Dr. Estrada to handle Corazon's delivery not
only because of their friend's recommendation, but more
importantly because of Dr. Estrada's "connection with a reputable
hospital, the [CMC]."55 In other words, Dr. Estrada's relationship
with CMC played a significant role in the Spouses Nogales'
decision in accepting Dr. Estrada's services as the obstetriciangynecologist for Corazon's delivery. Moreover, as earlier stated,
there is no showing that before and during Corazon's confinement
at CMC, the Spouses Nogales knew or should have known that Dr.
Estrada was not an employee of CMC.

Hence, Dr. Estrada is not an employee of CMC, but an

independent contractor.

The Court finds respondent Capitol Medical Center vicariously

liable for the negligence of Dr. Oscar Estrada.

Liability of CMC
The question now is whether CMC is automatically exempt from
liability considering that Dr. Estrada is an independent
contractor-physician.

PROFESSIONAL SERVICES, INC. (PSI) vs. NATIVIDAD and

ENRIQUE AGANA, G.R. No. 126297
January 31, 2007

Issue
WoN CMC is vicariously liable for the negligence of Dr. Estrada
Held
To resolve the issue, first it must be determined: what is the
relationship between Dr. Estrada and CMC?
Relationship of Dr Estrada and CMC
The Court held that CMC did not exercise control over Dr.
Estrada's treatment and management of Corazon's condition.

In general, a hospital is not liable for the negligence of an

independent contractor-physician. There is, however, an exception
to this principle. The hospital may be liable if the physician is the
"ostensible" agent of the hospital.
In the instant case, CMC impliedly held out Dr. Estrada as a
member of its medical staff. Through CMC's acts, CMC clothed Dr.
Estrada with apparent authority thereby leading the Spouses
Nogales to believe that Dr. Estrada was an employee or agent of
CMC. CMC cannot now repudiate such authority.

Themes/Subjects: medical malpractice, medical negligence,

negligence that ripened into a wrongful act of deceit, deliberate
concealment, res ipsa loquitur
Facts
On April 11, 1984, Dr. Miguel Ampil, assisted by the medical
staff of the Medical City General Hospital (Medical City Hospital),
performed an anterior resection surgery on Natividad Agana due
to cancer of the sigmoid. The malignancy spread on her left
ovary, hence, the removal of certain portions of it. Thus, Dr. Ampil

gauze inside Natividads body; and that he concealed such fact

from Natividad.

After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took
over, completed the operation and closed the incision.

On September 6, 1996, the CA dismissed the case against Dr.

Juan Fuentes and that Dr. Ampil is liable to reimburse PSI,
whatever amount the latter will pay or had paid to the Aganas.

obtained the consent of Natividads husband, Enrique, to permit

Dr. Juan Fuentes, to perform hysterectomy on her.

The operation appeared to be flawed, the attending nurses entered

these remarks:
"sponge count lacking 2, announced to
surgeon, searched (sic) done but to no avail, continue for
closure."
On April 24, Natividad was released. She then complained of
excruciating pain in her anal region several days after and
consulted both Dr. Ampil and Dr. Fuentes. They told her that the
pain was the natural consequence of the surgery. Dr. Ampil
recommended that she consult an oncologist to examine the
cancerous nodes which were not removed during the operation.
On May 9, Natividad, with Enrique, went to the US to seek
treatment. After four months of consultations and lab
examinations, she was told she was free of cancer.
On August 31, Natividad flew back to the Philippines, still
suffering from pains. Two weeks after, her daughter found a piece
of gauze protruding from her vagina. Upon being informed about
it, Dr. Ampil proceeded to her house where he managed to extract
by hand a piece of gauze measuring 1.5 inches in width. He then
assured her that the pains would soon vanish.
Natividads pains intensified, prompting her to seek treatment at
the Polymedic General Hospital.
While confined, Dr. Ramon Gutierrez detected the presence of
another foreign object in her vagina a foul-smelling gauze, 1.5
inches in width which badly infected her vaginal vault. A rectovaginal fistula had formed in her reproductive organs which forced
stool to excrete through the vagina. Thus, in October 1984,
Natividad underwent another surgery.
On November 12, 1984, Natividad and her husband filed with the
RTC, Quezon City a complaint for damages against the
Professional Services, Inc. (PSI), owner of the MCH, Dr. Ampil, and
Dr. Fuentes. They alleged that the latter are liable for negligence
for leaving two pieces of gauze inside Natividads body and
malpractice for concealing their acts of negligence.
Enrique also filed with the Professional Regulation Commission
(PRC) an administrative complaint for gross negligence and
malpractice against Dr. Ampil and Dr. Fuentes. The PRC Board of
Medicine heard the case only with respect to Dr. Fuentes because
it failed to acquire jurisdiction over Dr. Ampil who was then in the
United States.
On February 16, 1986, pending the outcome of the above cases,
Natividad died and wassubstituted by her above-named children
(the Aganas).
On March 17, 1993, the RTC rendered its Decision in favor of the
Aganas, finding PSI, Dr. Ampil and Dr. Fuentes liable for
negligence and malpractice.
On January 23, 1995, the PRC Board of Medicine rendered its
Decision6 in Administrative Case No. 1690 dismissing the case
against Dr. Fuentes. The Board held that the prosecution failed to
show that Dr. Fuentes was the one who left the two pieces of

Issues
I Whether the Court of Appeals Erred in Holding Dr. Ampil liable
II Whether the Court of Appeals Erred in Absolving Dr. Fuentes
of any Liability
III Whether PSI Is Liable for the Negligence of Dr. Ampil
Held
I The CA was correct in holding Dr. Ampil liable.
The removal of all sponges used is part of a surgical operation,
and when a physician or surgeon fails to remove a sponge he has
placed in his patients body that should be removed as part of the
operation, he thereby leaves his operation uncompleted and
creates a new condition which imposes upon him the legal duty of
calling the new condition to his patients attention, and
endeavoring with the means he has at hand to minimize and avoid
untoward results likely to ensue therefrom.
Dr. Ampil did not inform Natividad about the missing two
pieces of gauze. Worse, he even misled her that the pain she was
experiencing was the ordinary consequence of her operation. Had
he been more candid, Natividad could have taken the immediate
and appropriate medical remedy to remove the gauzes from her
body. To our mind, what was initially an act of negligence by Dr.
Ampil has ripened into a deliberate wrongful act of deceiving
his patient.
This is a clear case of medical malpractice or more appropriately,
medical negligence. The elements are duty, breach, injury and
proximate causation. To successfully pursue this kind of case, a
patient must only prove that a health care provider either failed to
do something which a reasonably prudent health care provider
would have done, or that he did something that a reasonably
prudent provider would not have done; and that failure or action
caused injury to the patient.
Dr, Ampil, as the lead surgeon, had the duty to remove all foreign
objects, such as gauzes, from Natividads body before closure of
the incision.
When he failed to do so, it was his duty to inform Natividad about
it. Dr. Ampil breached both duties. Such breach caused injury to
Natividad, necessitating her further examination by American
doctors and another surgery. Dr. Ampils negligence is the
proximate cause of Natividads injury and could be traced from his
act of closing the incision despite the information given by the
attending nurses that two pieces of gauze were still missing. That
they were later on extracted from Natividads vagina established
the causal link between Dr. Ampils negligence and the injury. And
what further aggravated such injury was his deliberate
concealment of the missing gauzes from the knowledge of
Natividad and her family.
II The CA was correct in absolving Dr. Fuentes

The Aganas assailed the dismissal by the trial court of the case
against Dr. Fuentes on the ground that it is contrary to the
doctrine of res ipsa loquitur. According to them, the fact that the
two pieces of gauze were left inside Natividads body is a prima
facie evidence of Dr. Fuentes negligence.
Res ipsa loquitur means "the thing speaks for itself." Where the
thing which caused the injury, without the fault of the injured, is
under the exclusive control of the defendant and the injury is
such that it should not have occurred if he, having such control
used proper care, it affords reasonable evidence, in the absence of
explanation that the injury arose from the defendants want of
care, and the burden of proof is shifted to him to establish that he
has observed due care and diligence.
From the foregoing statements of the rule, the requisites for the
applicability of the doctrine of res ipsa loquitur are: (1) the
occurrence of an injury; (2) the thing which caused the injury was
under the control and management of the defendant; (3) the
occurrence was such that in the ordinary course of things, would
not have happened if those who had control or management used
proper care; and (4) the absence of explanation by the defendant.
Of the foregoing requisites, the most instrumental is the "control
and management of the thing which caused the injury."
We find the element of "control and management of the thing
which caused the injury" to be wanting. Hence, the doctrine of res
ipsa loquitur will not lie.
Dr. Ampil was the lead surgeon during the operation of Natividad.
He requested the assistance of Dr. Fuentes only to perform

hysterectomy when he (Dr. Ampil) found that the malignancy in

her sigmoid area had spread to her left ovary. Dr. Fuentes
performed the surgery and thereafter reported and showed his
work to Dr. Ampil. The latter examined it and finding everything to
be in order, allowed Dr. Fuentes to leave the operating room. Dr.
Ampil then resumed operating on Natividad. He was about to
finish the procedure when the attending nurses informed him that
two pieces of gauze were missing. A "diligent search" was
conducted, but the misplaced gauzes were not found. Dr. Ampil
then directed that the incision be closed. During this entire
period, Dr. Fuentes was no longer in the operating room and had,
in fact, left the hospital.
III - Whether PSI Is Liable for the Negligence of Dr. Ampil
Yes, PSI is also liable.
PSIs liability is traceable to its failure to conduct an investigation
of the matter reported in the nota bene of the count nurse. Such
failure established PSIs part in the dark conspiracy of silence and
concealment about the gauzes. Ethical considerations, if not also
legal, dictated the holding of an immediate inquiry into the events,
if not for the benefit of the patient to whom the duty is primarily
owed, then in the interest of arriving at the truth. The Court
cannot accept that the medical and the healing professions,
through their members like defendant surgeons, and their
institutions like PSIs hospital facility, can callously turn their
backs on and disregard even a mere probability of mistake or
negligence by refusing or failing to investigate a report of such
seriousness as the one in Natividads case.