Republic
of the
Supreme Court
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G.R.
No. 150355 |
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Petitioner, |
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Present: |
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- versus - |
PANGANIBAN, C.J., (Chairperson) |
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YNARES-SANTIAGO, |
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AUSTRIA-MARTINEZ, |
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SO
UN CHUA and VICKY TY, |
CALLEJO, SR. and CHICO-NAZARIO, JJ. |
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Respondents. |
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Promulgated: July
31, 2006 |
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D E C I S I O N
AUSTRIA-MARTINEZ,
J.:
Before this Court is a Petition for
Review on Certiorari under Rule 45 questioning the Decision[1]
dated
This case originated from an action
for damages filed with the RTC by respondents So Un Chua and Vicky Ty against
petitioner
The antecedents of the case follow:
On December 13, 1993, respondents
filed a Complaint averring that on October 30, 1990, respondent Chua, the
mother of respondent Vicky Ty, was admitted in petitioner’s hospital for
hypertension and diabetes; that while respondent Chua was confined, Judith
Chua, the sister of respondent Ty, had been likewise confined for injuries
suffered in a vehicular accident; that partial payments of the hospital bills
were made, totaling P435,800.00; that after the discharge of Judith
Chua, respondent Chua remained in confinement and the hospital bills for both
patients accumulated; that respondent Chua was pressured by the petitioner,
through its Credit and Collection Department, to settle the unpaid bills; that
respondent Ty represented that she will settle the bills as soon as the funds
become available; that respondent Ty pleaded to the management that in view of
the physical condition of her mother, respondent Chua, the correspondences
relating to the settlement of the unpaid hospital bills should be relayed to
the former; that these pleas were unheeded by the petitioner; that petitioner
threatened to implement unpleasant measures unless respondent Ty undertakes her
mother’s obligation as well as the obligation of her sister, Judith Chua, to
pay the hospitalization expenses; that petitioner made good its threat and
employed unethical, unpleasant and unlawful methods which allegedly worsened
the condition of respondent Chua, particularly, by (i) cutting off the
telephone line in her room and removing the air-conditioning unit, television
set, and refrigerator, (ii) refusing to render medical attendance and to change
the hospital gown and bed sheets, and (iii) barring the private nurses or
midwives from assisting the patient.
Respondents thus prayed for the award of moral damages, exemplary
damages, and attorney’s fees.
In its Answer, Amended Answer, and Rejoinder,
petitioner specifically denied the material averments of the Complaint and
Reply, and interposed its counterclaims arguing that as early as one week after
respondent Chua had been admitted to its hospital, Dr. Rody Sy, her attending
physician, had already given instructions for her to be discharged, but
respondents insisted that Chua remain in confinement; that, through its staff,
petitioner accordingly administered medical examinations, all of which yielded negative results; that
respondent Ty voluntarily undertook, jointly and severally, to pay the hospital
bills for both patients; that although respondent Ty paid up to P435,000.00,
more or less, she reneged on her commitment to pay the balance in violation of
the Contract for Admission and Acknowledgment of Responsibility for Payment
dated October 30, 1990 which she voluntarily executed; that she signed a
Promissory Note on June 5, 1992 for the unpaid balance of P1,075,592.95
and issued postdated checks to cover the same; that no such undue pressure had
been imposed upon respondent Chua to settle the bills, the truth being that, as
a matter of standard procedure, the reminders to settle the bills were
transmitted not to the patients but to their relatives who usually undertook to
pay the same; that respondent Ty deliberately evaded the staff of the Credit
and Collection Department; that the cutting-off of the telephone line and
removal of the air-conditioning unit, television set, and refrigerator cannot
constitute unwarranted actuations, for the same were resorted to as
cost-cutting measures and to minimize respondents’ charges that were already piling
up, especially after respondent Ty refused to settle the balance
notwithstanding frequent demands; that respondent Ty evaded the staff when the
latter attempted to inform her that the room facilities will be cut off to
minimize the rising charges; and that respondents instituted the present civil
case purposely as leverage against the petitioner after the latter had filed
criminal charges for violation of Batas Pambansa (B.P.) Blg. 22 against
respondent Ty for issuing checks, later dishonored, totaling P1,075,592.95,
the amount referring to the unpaid hospital bills. In its compulsory counterclaim, petitioner
prayed, among other items, for the award of no less than P1,000,000.00
as compensatory damages due to the filing of a malicious and unfounded suit,
and, in its permissive counterclaim, petitioner prayed for respondents to pay P1,075,592.95,
the amount representing the due and demandable obligation under the Promissory
Note dated June 5, 1992, including the stipulated interest therein and the 25
percent of the total amount due as attorney’s fees.
During pre-trial, the parties stipulated on the
following issues: First, whether the respondents are liable to the
petitioner to pay the hospital bills arising from the hospitalization of
respondent Chua and Judith Chua; and second, whether the parties are
entitled to their respective claims for damages.[3] Furthermore, the parties stipulated on the
following facts: a) Judith Chua was confined from June 14, 1991 to May 2, 1992;
b) respondents failed to pay the balance despite repeated reminders; c) the
said reminders referred to the hospital bills of respondent Chua and Judith
Chua; d) one of the attending physicians of respondent Chua was Dr. Rody Sy; and
e) the petitioner ordered the removal of the facilities in question from the
room of its patient, respondent Chua, with the qualification that they were
constrained to discontinue the same after the representative of respondent Chua
refused to update the hospital bills or refused to transfer her to semi-deluxe
room or ward to lessen costs.[4]
On
WHEREFORE, premises considered, judgment on the complaint is hereby rendered in favor of the [respondents] as against the [petitioner] as follows:
[O]rdering the [petitioner] to pay the [respondents] the following, to wit:
a) P200,000.00 as moral damages;
b) P100,000.00 as exemplary damages; and
c) P50,000.00 as attorney’s fees and the amount of P50,000.00 as
litigation costs.
SO ORDERED.[5]
In brief, the RTC held that the
removal of the facilities of the room triggered the hypertension of respondent
Chua; that the petitioner acted in bad faith in removing the facilities without
prior notice; that her condition was aggravated by the pressure employed by the
administration upon her to pay the hospital bills; that the food always came
late as compared to the other patients; that the beddings and clothes of
respondent Chua were no longer changed and, as a result, bed sores emerged on
her body; that there was an utter lack of medical attendance; that, because of
these, respondent Chua suffered from self-pity and depression; that petitioner
clearly discriminated against the respondents; that respondent Ty had no choice
but to sign the promissory notes in order to secure the release of her mother,
respondent Chua; that the foregoing actuations constitute an abuse of rights;
that petitioner failed to establish the pecuniary loss it suffered and, hence,
it is not entitled to compensatory damages; and that, since the promissory note
is a contract of adhesion, the petitioner is not entitled to the award of
attorney’s fees as stipulated thereon.
On appeal to the
CA, the petitioner assigned the following errors:
A.
THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERROR BY FINDING THE ACTUATIONS OF THE ADMINISTRATION OF DEFENDANT-APPELLANT TO BE IN BAD FAITH, OPPRESSIVE AND UNNECESSARY AS TO MAKE IT LIABLE TO PLAINTIFFS-APPELLEES FOR DAMAGES AND ATTORNEY’S FEES.
B.
THE HONORABLE TRIAL COURT COMMITTED
REVERSIBLE ERROR BY NOT RULING UPON THE PERMISSIVE COUNTERCLAIM OF
DEFENDANT-APPELLANT WITH RESPECT TO THE P1,075,592.95 REPRESENTING THE
HOSPITAL BILL OF PLAINTIFFS-APPELLEES, WHICH OBLIGATION IS NOT DISPUTED AND
WHICH AMOUNT WAS NEVER CONTROVERTED BY PLAINTIFFS-APPELLEES.[6]
On
IN VIEW OF ALL THE
FOREGOING, the appealed Decision is hereby AFFIRMED with the
modification that the award of moral damages, exemplary damages as well as
attorney’s fees is reduced to Seventy Five Thousand Pesos (P75,000.00),
Thirty Thousand Pesos (P30,000.00) and Twenty Thousand Pesos (P20,000.00),
respectively. Litigation costs are
hereby deleted. Costs against appellant.
SO ORDERED.[7]
Apart from the
reduction in the award of damages, the CA affirmed all salient portions of the
RTC Decision and declined to disturb the
findings of fact.
Petitioner is
now before this Court raising essentially the same grounds heard by the
CA.
Incidentally,
with respect to the related criminal case against respondent Ty, this Court, on
The petition is
impressed with merit.
While, as a rule, only
questions of law may be raised in a petition for review on certiorari under
Rule 45, under certain exceptions, the Court may re-examine the evidence presented by the parties
during the trial. At least four exceptions exist in this case, namely: (a) when the
conclusion is a finding grounded entirely on speculation, surmises, or
conjectures; (b) when the judgment is based on a misapprehension of facts; (c) when
the findings of fact are premised on the supposed absence of evidence and
contradicted by the evidence on record; and (d) when
the courts a quo manifestly overlooked certain relevant facts not
disputed by the parties and which, if properly considered, would justify a
different conclusion.[9]
The principal questions
are, first, whether the actuations of the petitioner
amount to actionable wrongs, and second, whether
the counterclaims of the petitioner can be backed up by the measure of
preponderant evidence.
In
brief, the courts a quo concurred in the holding that the petitioner and
its staff failed to take into consideration the physical condition of its
patient, respondent Chua, when it removed the facilities provided in her room;[10]
that the removal of these facilities, namely, the air-conditioner, telephone
lines, television, and refrigerator, aggravated the condition of the patient,
triggered her hypertension, and caused her blood pressure to fluctuate,[11]
considering that there was no proper ventilation in the room.[12] In view of the foregoing, the courts a quo
concluded that the actuations of the petitioner were oppressive, unnecessary,[13]
and anti-social,[14]
done in bad faith without proper notice,[15]
with no intention other than to harass or irritate the respondents,[16]
all of which constitute an abuse of rights.[17]
We do not
agree. The conclusions of the courts a
quo are either haphazard conjectures, or founded on a misapprehension of
facts. The record is replete with
evidence that justifies a different conclusion.
Indeed the
operation of private pay hospitals and medical clinics is impressed with public
interest and imbued with a heavy social responsibility. But the hospital is also a business, and, as
a business, it has a right to institute all measures of efficiency commensurate
to the ends for which it is designed, especially to ensure its economic
viability and survival. And in the
legitimate pursuit of economic considerations, the extent to which the public
may be served and cured is expanded, the pulse and life of the medical sector
quickens, and the regeneration of the people as a whole becomes more visibly
attainable. In the institution of
cost-cutting measures, the hospital has a right to reduce the facilities and
services that are deemed to be non-essential, such that their reduction
or removal would not be detrimental to the medical condition of the patient.[18] For the moment, the question to be considered
is whether the subject facilities are indeed non-essential – the
air-conditioner, telephone, television, and refrigerator – the removal of which
would cause the adverse health effects and emotional trauma the respondents so
claimed. Corollary to this question is
whether the petitioner observed the diligence of a good father of the family[19]
in the course of ascertaining the possible repercussions of the removal of the
facilities prior to the removal itself and for a reasonable time thereafter,
with a view to prevent damage.[20]
After an extensive analysis of the
record, it becomes rather worrisome to this Court that the courts a quo unreservedly drew their conclusions from the self-serving and
uncorroborated testimonies of the respondents the probative value of which is
highly questionable.[21] We hold that the respondents failed to prove
the damages so claimed.
The
evidence in the record firmly establishes that the staff of the petitioner took
proactive steps to inform the relatives of respondent Chua of the removal of
facilities prior thereto, and to carry out the necessary precautionary measures
to ensure that her health and well-being would not be adversely affected: as
early as around two weeks after her admission on October 30, 1990, to the time
when the facilities had been removed sometime in the middle of May 1992,[22]
and even up to the point when she actually left the premises of the hospital
three weeks later, or during the first week of June 1992,[23]
the medical condition of respondent Chua, as consistently and indisputably
confirmed by her attending physician, Dr. Rody Sy, a cardiologist, who was
called as witness for both parties,[24]
whom even respondent Chua repeatedly praised to be “my doctor” and “a very good
doctor”[25]
at that, and whose statements at times had been corroborated as well by Sister
Mary Philip Galeno, SPC, the Administrator of the hospital and who also happens
to be a registered nurse, had been “relatively well,”[26]
“ambulatory,”[27]
“walking around in the room,”[28]
and that she was “able to leave the hospital on her own without any
assistance;”[29]
that although she complained of symptoms such as dizziness, weakness,[30]
and abdominal discomfort,[31]
Dr. Sy requested several medical examinations, such as the laboratory tests,
renal tests, MRI, ultrasound, and CT scan,[32]
all of which were administered after procuring the consent of respondent Chua’s
family[33]
as admitted by respondent Ty herself,[34]
and even called on other specialists, such as a neurologist, endocrinologist,
and gastroenterologist, to look into her condition[35]
and conduct other tests as well[36]
according to their fields of specialty, all of which yielded no serious
finding;[37]
that her illnesses were “lifelong illnesses”[38]
at a stage where they cannot be totally removed or abolished,[39]
making it clear to her family that “one hundred percent recovery is not
possible” despite being given daily medication in the hospital;[40]
but that her condition, nonetheless, is not serious,[41]
as the blood pressure is more or less controlled and within acceptable limits,[42]
“not that critical to precipitate any acute attack,”[43]
nor likely to fall into any emergency,[44]
nor yet does she require continuous or prolonged hospitalization[45]
since she was stable enough to be treated at home and on an “out-patient”
basis, so much so that Dr. Sy encouraged her to exercise and avoid
resting all the
time,[46]
and recommended that “anytime she may be
discharged”[47]
even in just “two weeks
after confinement,”[48]
the propriety of his order of discharge concurred upon by the other specialists
as well,[49]
had it not been for respondents’ insistence to stay in the hospital in view of
their hope for absolute recovery[50]
despite the admission of respondent Chua herself that she cannot anymore be totally cured.[51]
It is also undisputed that the hospital administrator, Sister Galeno, prior to the removal of the facilities, consulted the attending physician, Dr. Sy.[52] To Sister Galeno, also a registered nurse, the matter of removal and its possible repercussions on the health of the patient, as a matter of hospital policy, is a critical and sensitive maneuver, and, hence, it is carried out only after discussing with the doctors to evaluate all important factors.[53] The fact of prior consultation[54] as well as the medical determination to the effect that it was safe to remove the facilities and would cause no harmful effect[55] had been amply corroborated by respondent Chua’s own doctor himself.[56] When Dr. Sy testified as rebuttal witness for the respondents themselves and whose credibility respondents failed to impeach, he categorically stated that he consented to the removal since the removal of the said facilities would not by itself be detrimental to the health of his patient, respondent Chua.[57] And in this respect, he had been advising respondent Ty, the daughter of the patient, that the facilities, such as the air-conditioner, television, refrigerator, and telephone, are not absolutely necessary, and, that although they may add to the comfort of the patient, if absent, they will not cause any significant deterioration of her condition,[58] given that, in his experience as a cardiologist, and after personally attending respondent Chua on a daily basis before, during, and after the removal and even up to the time of her actual discharge,[59] he concluded that many hypertensive and diabetic patients, as in her case, do not at all need in particular an air-conditioning unit, among the other facilities aforementioned.[60] And, contrary to the findings of the courts a quo and the self-serving testimonies of respondents that the lack of ventilation, after the removal of the air-conditioner, triggered her hypertension, Dr. Sy categorically stated that during his daily rounds with the patient he was certain that, although admittedly the blood pressure in general would fluctuate daily, there had been no adverse effect on her, and that her blood pressure were within acceptable limits,[61] especially considering that he treated the patient on a daily basis up to the point of actual discharge,[62] and accordingly, as confirmed by the medical records, he made no change in the medications thereafter.[63] In support of Dr. Sy’s findings, Sister Galeno, testified that she knew the condition of the ventilation of the patient’s deluxe room, located at the fifth floor, even without the air-conditioning, notably in times of brownout, and that there had been enough ventilation since the grilled window of that room was large enough which, if opened, would permit sufficient ventilation.[64] The Court finds that the premise of the RTC judgment refers merely to hypothetical statements which fail to establish any clear and direct link to the injury allegedly suffered by the patient:
Q— You found it safe to remove these facilities from the room of the patient suffering from diabetes and hypertension?
A— Yes, Sir. Many hypertensive, diabetic patients do not need air-conditioning, or T.V. or refrigerator.
Q— Do you agree with me that hypertension is triggered sometimes by excitement, anger or (sic) a person suffering from such illness?
A— Hypertension can be triggered by anything.
Court:
Q— And even in other words the discomfort can also trigger?
A— Sometimes mental stress can trigger.
x x x x
Court:
Q— You mentioned earlier that this hypertension may be triggered mentally?
A— Yes, Your Honor.
Court:
Q— Will the removal of these facilities not affect the patient including the relatives?
A— It may to a certain extent. And well, maybe the days after the removal would prove that fluctuation in blood pressure are within acceptable limits.[65]
With respect to the findings of the
courts a quo that bed sores appeared
on the body of respondent Chua, that she suffered from depression after the
disconnection of the said facilities, that her private midwives were barred,
and that the delivery of food was delayed, this Court holds, as above, that
these conclusions are bereft of sound evidentiary basis, self-serving and
uncorroborated as they are. Again, Dr.
Sy affirmed that during the daily rounds he would make on the patient, he did
not detect any skin lesion or any other abnormality up to the time she was
actually discharged.[66] Nor did he find any sign of depression,
although, admittedly, he observed that she had been “very angry” because of the
removal of the facilities.[67] All the while he did not receive any
complaint from respondent Chua indicating that she suffered from the foregoing
infirmities,[68]
considering that it is the responsibility of the family of the patient to
specifically inform the attending physician or the nurses during their rounds
whatever they feel is important, or if there were any new developments since
the last visit.[69] As corroborated by Sister Galeno, throughout
respondent Chua’s confinement, she never received any complaint from the latter
or her relatives that she had not been attended to by the nursing staff.[70] Worth noting again is the fact that the
nursing staff and the attending physicians, which included Dr. Sy, in
accordance with hospital policy, would routinely make their rounds on a daily
basis, or would visit the patient whenever they are called for any problem,[71]
and, in the case of the specialists other than the attending physician, they
would visit the patient about once a week.[72] The nurses, on the other hand, would make
their rounds more frequently, that is, at least once per shift, or every eight
hours.[73]
Apart from the self-serving statements of respondents, which by now have become
rather indicative of being mere afterthoughts, there is no clear showing from
the record that the petitioner and its medical staff deviated from the
foregoing policy and practice, nor had they been called upon to look into the
alleged physical reactions or emotional trauma respondent Chua claims to have
suffered during and after the removal of the facilities. It must be emphasized that, as stated above,
respondent Chua herself explicitly found Dr. Sy to be a “very good doctor”
because he personally attended to her “almost every hour.”[74] And throughout her confinement, Dr. Sy
positively stated that her family employed a private midwife who attended to
her all the time.[75]
The evidence in the record
overwhelmingly demonstrates that respondent Chua had been adequately attended
to, and this Court cannot understand why the courts a quo had declared that there was an “utter lack of medical
attendance,” or that her health suffered during the period after the removal of
the facilities. The Court finds that the facilities in question are non-essential
for the care of respondent Chua and, hence, they may be lessened or removed by
the petitioner for the sake of economic necessity and survival.
Though human experience would show
that the deactivation of the air-conditioner may cause a temperature
differential that may trigger some physical discomfort, or that the removal of
entertainment facilities such as the television set, or the disconnection of communication devices such as the
telephone, may cause some exasperation on the part of the one who benefits from
these, nevertheless, all things considered, and given the degree of
diligence the petitioner duly exerted, not every suppression of the things that
one has grown accustomed to enjoy amounts to an actionable wrong, nor does
every physical or emotional discomfort amount to the kind of anguish that
warrants the award of moral damages under the general principles of tort. The underlying basis for the award of tort
damages is the premise that an individual was injured in contemplation of
law. Thus, there must first be the
breach of some duty and the imposition of liability for that breach before
damages may be awarded; it is not sufficient to state that there should be tort
liability merely because the plaintiff suffered some pain and suffering.[76]
Moreover, this Court must reiterate the standard of tort to arrive at a proper award for damages premised on matters that suggest the application of medical knowledge, especially in the description of the causal link between external or environmental factors, on one hand, and their effect unto the physical or emotional health of the patient, on the other, expert opinion, as discussed in Cruz v. Court of Appeals,[77] is generally required:
All three courts below bewail the inadequacy of the facilities of the clinic and its untidiness; the lack of provisions such as blood, oxygen, and certain medicines; the failure to subject the patient to a cardio-pulmonary test prior to the operation; the omission of any form of blood typing before transfusion; and even the subsequent transfer of Lydia to the San Pablo Hospital and the reoperation performed on her by the petitioner. But while it may be true that the circumstances pointed out by the courts below seemed beyond cavil to constitute reckless imprudence on the part of the surgeon, this conclusion is still best arrived at not through the educated surmises nor conjectures of laymen, including judges, but by the unquestionable knowledge of expert witnesses. For whether a physician or surgeon has exercised the requisite degree of skill and care in the treatment of his patient is, in the generality of cases, a matter of expert opinion. The deference of courts to the expert opinions of qualified physicians stems from its realization that the latter possess unusual technical skills which laymen in most instances are incapable of intelligently evaluating. Expert testimony should have been offered to prove that the circumstances cited by the courts below are constitutive of conduct falling below the standard of care employed by other physicians in good standing when performing the same operation. It must be remembered that when the qualifications of a physician are admitted, as in the instant case, there is an inevitable presumption that in proper cases he takes the necessary precaution and employs the best of his knowledge and skill in attending to his clients, unless the contrary is sufficiently established. This presumption is rebuttable by expert opinion which is so sadly lacking in the case at bench.[78]
With respect to the propriety of the
notice of removal of facilities, the evidence shows that the hospital staff,
accompanied by Sister Gladys Lim, SPC, Finance Administrative Assistant of the
hospital,[79]
through written and verbal notices as per hospital policy, forewarned the
respondents, through respondent Ty and her sister, Judith Chua, of the
impending removal of the facilities over a week beforehand[80]
in view of their obstinate refusal to vacate and transfer to a lower rate room[81]
or to update the mounting hospital bills[82]
which, by then, had swollen to approximately one million pesos.[83] Respondent Ty refused to read many of the written notices sent by the Credit
Department.[84]
After repeated attempts to contact respondent Ty[85]
and before the actual removal of the facilities, the staff of the petitioner
tried to personally serve the final notice dated April 23, 1992,[86]
signed by Sister Gladys Lim, addressed to respondent Ty, which adopted the
tenor of the prior verbal warnings, and which expressly and sternly warned the
respondents that the hospital shall be constrained to take legal action and
that they shall be compelled to transfer the patient, respondent Chua, to a
lower rate room unless the balance could be satisfied.[87] Respondent Ty, for no justifiable reason, and
sticking to her inclination to avoid the staff, refused to receive or acknowledge
this letter as well.[88] Worth noting is that Sister Galeno, testified
that, as a matter of hospital policy the tenor of which respondents, by virtue
of the Contract for Admission dated October 30, 1990, agreed to comply with,[89]
the hospital can only cut off the non-essential facilities – and only in
extreme cases[90] –
if the patient occupies a private room all to herself; had the room been
semi-private shared by other patients, or had it been the ward, the hospital
cannot disconnect the facilities since this would unduly prejudice the other
patients. But respondent Chua herself
insisted on staying in a private room despite her being fully aware of the
ballooning charges,[91]
and even if she could have freely gone home anytime to her condominium unit
which, as admitted, was equipped with an air-conditioner.[92]
With respect to the “pressure” and “harassment” respondents allegedly suffered
daily whenever the hospital staff would follow up the billing during odd hours,
or at 10pm, 11pm, 12 midnight, 1am, or 2am,[93]
this averment had been convincingly refuted by the witnesses for the
petitioner, namely, Editha L. Vecino, the Head of Credit and Collection, and
Sister Galeno, in that the Credit and Collection
Department would only hold office hours from 8am to 5pm and, hence, it is
impossible to “harass” the respondents during the times they so claimed.[94]
The courts a quo found that respondent Ty had “no choice but to sign the
promissory note in order for her mother to be released from the hospital,”[95]
thus suggesting that the hospital refused to actually discharge or bodily
release its patient, respondent Chua, until arrangements had been made to
settle the charges.
While there are portions of the
testimonies of the witnesses for the petitioner which state that although, as
per standard procedure, the patient “cannot
leave”[96]
the hospital without the “discharge,”[97]
“clearance” or “gate pass”
issued only after
arrangements on the settlement of
bills had been made,[98]
still, it must be understood that these are only demonstrative of the
precondition that a patient cannot step out of the premises “without the
consent” of the hospital, or, in other words, that the “clearance” merely
indicates that the hospital expressly consented to the actual release of the
patient,[99]
but, even without its consent, the patient is still free to leave “anytime” as
a matter of policy, in spite of the refusal to issue a “clearance” or “gate
pass,”[100]
or even in cases where the accounts have not yet been liquidated or settled,[101]
or yet even if no promissory note or post-dated check were executed in favor of
the petitioner, as testified by no less than Sister Galeno,[102]
and corroborated by Editha Vecino;[103]
and that, petitioner, a private hospital established for profit,[104]
being also a business, by warning respondents that it shall withhold clearance,
is simply exercising its right to protest against an absconding patient as a
precursor to avail of other appropriate legal remedies; that, on the contrary,
the respondents opted not to leave because of their own promise not to leave
unless the hospital bills were fully settled;[105]
that the accusations found in the Demand Letter dated May 19, 1992, and signed
by the counsel for the respondents,[106]
particularly, that the petitioner “refused to discharge the patient,
[respondent Chua,] despite orders from the attending physician, Dr. Rody Sy,”
had all been refuted by Sister Galeno when she read its contents in front of
the counsel for respondents, emphatically telling him that “we are not
detaining his clients;” that “[respondent Ty] was the one who told us that they
are not going to leave the hospital unless they have fully paid the hospital;”[107]
and that, most importantly, no physical restraint upon the person of respondent
Chua or upon the person of her relatives had been imposed by the staff.
Authorities,
including those of common law origin, explicitly declare that a patient cannot
be detained in a hospital for non-payment of the hospital bill. If the patient cannot pay the hospital or
physician’s bill, the law provides a remedy for them to pursue, that is, by
filing the necessary suit in court for the recovery of such fee or bill.[108] If the patient is prevented from leaving the
hospital for his inability to pay the bill, any person who can act on his
behalf can apply in court for the issuance of the writ of habeas corpus.[109]
The form of restraint must be total;
movement must be restrained in all directions.
If restraint is partial, e.g., in a particular direction with
freedom to proceed in another, the restraint on the person’s liberty is not
total.[110] However, the hospital may legally detain a
patient against his will when he is a detained or convicted prisoner, or when
the patient is suffering from a very contagious disease where his release will
be prejudicial to public health, or when the patient is mentally ill such that
his release will endanger public safety,[111]
or in other exigent cases as may be provided by law. Moreover, under the common law doctrines on
tort, it does not constitute a trespass to the person to momentarily prevent
him from leaving the premises or any part thereof because he refuses to comply
with some reasonable condition subject to which he entered them. In all cases, the condition of this kind of
restraint must be reasonable in the light of the circumstances.[112] At any rate, as stated above, the patient is
free to leave the premises, even in the ostensible violation of these
conditions, after being momentarily interrupted by the hospital staff for
purposes of informing him of those reasonable conditions, such as the
assessment of whether the patient is fit to leave, insane, or suffering from a
contagious disease, etc., or simply for purposes of making a demand to settle
the bill. If the patient chooses to
abscond or leave without the consent of the hospital in violation of any of the
conditions deemed to be reasonable under the circumstances, the hospital may
nonetheless register its protest and may choose to pursue the legal remedies
available under law, provided that the hospital may not physically detain the
patient, unless the case falls under the exceptions abovestated.
Authorities are of the view
that, ordinarily, a hospital, especially if it is a private pay hospital,[113]
is entitled to be compensated for its services, by either an express or an
implied contract, and if no express contract exists, there is generally an
implied agreement that the patient will pay the reasonable value of the
services rendered;[114]
when a hospital treats a patient’s injuries, it has an enforceable claim for
full payment for its services, regardless of the patient’s financial status.[115] At this juncture, it must be noted that there
is testimony, though to a degree disputable, to the effect that the execution
of the promissory note and the issuance of postdated checks were conditions
imposed not by the petitioner but voluntarily offered by the counsel for
respondents.[116] At any rate, however, this Court holds, in
view of the foregoing authorities, that the requirement to have the relative of
respondent Chua to execute a promissory note as part of the arrangement to
settle the unpaid obligations is a formality that converts any implied contract
into written form and, moreover, amounts to a reasonable condition, the
non-fulfillment of which, in itself, however, as discussed, cannot allow the
hospital to detain the patient. It must
also be stressed, contrary to the findings of the courts a quo, that such an agreement embodied in a promissory note, as
well as the Contract for Admission and Acknowledgment of Responsibility for
Payment dated October 30, 1990, do not become contracts of adhesion simply
because the person signing it was under stress that was not the result of the
actions of the hospital,[117]
especially taking into account that there is testimony to the effect that
respondent Ty signed the Promissory Note dated June 5, 1992 in the presence of
counsel and acting under his advise.[118]
But as to the propriety of the
circumstances surrounding the issuance of the postdated checks to cover the
amount stated in the Promissory Note dated June 5, 1992, this Court must refer
to the discussion of the recent case of Ty
v. People of the Philippines[119]
where this Court affirmed the conviction of respondent Ty for the issuance
of bouncing checks addressed to the petitioner herein. While the instant case is to be distinguished
from the Ty case in nature,
applicable law, the standards of evidence, and in the defenses available to the
parties, hence, the judgment of conviction in that case should not at all
prejudice the disposition of this case, even if the facts coincide,
nonetheless, for purposes of convenience and instructive utility, the Court quotes
the relevant portions:
In this case, far from it, the fear, if any,
harbored by Ty was not real and imminent.
Ty claims that she was compelled to issue the checks a condition the
hospital allegedly demanded of her before her mother could be discharged for
fear that her mother’s health might deteriorate further due to the inhumane
treatment of the hospital or worse, her mother might commit suicide. This is speculative fear; it is not the
uncontrollable fear contemplated by law.
To begin with, there was no showing that the
mother’s illness was so life-threatening such that her continued stay in the
hospital suffering all its alleged unethical treatment would induce a
well-grounded apprehension of her death.
Secondly, it is not the law’s intent to say that any fear exempts one
from criminal liability much less petitioner’s flimsy fear that her mother
might commit suicide. In other words,
the fear she invokes was not impending or insuperable as to deprive her of all
volition and to make her a mere instrument without will, moved exclusively by
the hospital’s threats or demands.
Ty has also failed to convince the Court that
she was left with no choice but to commit a crime. She did not take advantage of the many
opportunities available to her to avoid committing one. By her very own words, she admitted that the
collateral or security the hospital required prior to the discharge of her
mother may be in the form of postdated checks or jewelry. And if indeed she was
coerced to open an account with the bank and issue the checks, she had all the
opportunity to leave the scene to avoid involvement.
Moreover, petitioner had sufficient knowledge
that the issuance of checks without funds may result in a violation of B.P.
22. She even testified that her counsel
advised her not to open a current account nor issue postdated checks “because
the moment I will not have funds it will be a big problem.” Besides, apart from
petitioner’s bare assertion, the record is bereft of any evidence to
corroborate and bolster her claim that she was compelled or coerced to
cooperate with and give in to the hospital’s demands.
Ty likewise suggests . . . that the
justifying circumstance of state of necessity under par. 4, Art. 11 of the
Revised Penal Code may find application in this case.
We do not agree. The law prescribes the presence of three
requisites to exempt the actor from liability under this paragraph: (1) that the evil sought to be avoided
actually exists; (2) that the injury feared be greater than the one done to
avoid it; (3) that there be no other practical and less harmful means of
preventing it.
In the instant case, the evil sought to be
avoided is merely expected or anticipated.
If the evil sought to be avoided is merely expected or anticipated or
may happen in the future, this defense is not applicable. Ty could have taken advantage of an available
option to avoid committing a crime. By her
own admission, she had the choice to give jewelry or other forms of security
instead of postdated checks to secure her obligation.
Moreover, for the defense of state of
necessity to be availing, the greater injury feared should not have been
brought about by the negligence or imprudence, more so, the willful inaction of
the actor. In this case, the issuance of
the bounced checks was brought about by Ty’s own failure to pay her mother’s
hospital bills.
The Court also thinks it rather odd that Ty
has chosen the exempting circumstance of uncontrollable fear and the justifying
circumstance of state of necessity to absolve her of liability. It would not have been half as bizarre had Ty
been able to prove that the issuance of the bounced checks was done without her
full volition. Under the circumstances,
however, it is quite clear that neither uncontrollable fear nor avoidance of a
greater evil or injury prompted the issuance of the bounced checks.
Parenthetically, the findings of fact in the
Decision of the trial court in the Civil Case for damages filed by Ty’s mother
against the hospital is wholly irrelevant for purposes of disposing the case at
bench. While the findings therein may
establish a claim for damages which, we may add, need only be supported by a
preponderance of evidence, it does not necessarily engender reasonable doubt as
to free Ty from liability.[120]
In view of the foregoing, the Court
therefore holds that the courts a quo
committed serious errors in finding that the petitioner was “biased,”[121]
“discriminated” against the respondents,[122]
and “purposely intended to irritate”[123]
or “harass”[124]
them; that it “acted in bad faith in removing the facilities without prior
notice;”[125]
and that its acts were “anti-social.”[126] The aforequoted declarations of the
witnesses, significant portions of which this Court considers as expert
testimony, are reliable and remain considerably trustworthy to controvert
respondents’ assertions as well as to reverse the conclusions of fact and law
of the CA and the RTC that respondent Chua suffered the physical and emotional
anguish so claimed, and so, for these reasons, the Court holds that the
petitioner inflicted no actionable wrong.
This Court
observes that the courts a quo
awarded both respondents moral damages.
But it is well-settled that in case of physical injuries, with some
exceptions,[127]
moral damages are recoverable only by the party injured and not by her spouse,
next of kin, or relative who happened to sympathize with the injured party.[128] Hence, even if the courts a quo were correct in their basis for
damages, they should have declined to award damages to respondent Ty.
The last issue to be resolved is the
question whether the counterclaims of the petitioner are supported by a
preponderance of evidence.
We
agree with the petitioner that the courts a
quo seriously erred in mistaking the case of its compulsory counterclaim
for its permissive counterclaim and for failing to consider the evidence which
impressively supports the latter. First, for failure without justifiable
cause of respondents’ counsel to comment on the Partial Formal Offer of
Evidence dated February 14, 1996[129]
filed by the petitioner, the RTC issued an order during the course of the
trial, which counsel for respondents neither contested nor raised on appeal,
admitting Exhibits “1” to “16”, together with their submarkings and the
purposes for which the same were offered,[130]
all of which had also been previously authenticated and their contents verified
by the witnesses for the petitioner.[131] These documents include the Contract for
Admission of respondent Chua dated October 30, 1990, duly executed by
respondent Ty, incorporating therein the rules and regulations of the hospital,
including the duty to understand the same[132]
as well as the undertaking of respondent Ty to be jointly and severally liable
for the payment of the hospital bills of respondent Chua;[133]
the Promissory Note dated June 5, 1992 in the amount of P1,075,592.95
duly executed by respondent Ty in favor of the petitioner agreeing to be
jointly and severally liable to pay the unpaid obligations of respondent Chua
and Judith Chua, including interest and attorney’s fees in case of default;[134]
the Undertakings signed by respondent Ty dated March 3, 1992 and April 7, 1992
to maintain regular deposits;[135]
and the credit memos and statements of account that support the amount
referring to the unpaid obligation.[136] Second,
the parties stipulated during pre-trial that respondents failed to pay the
balance despite repeated reminders.[137]
And third, respondent Ty in open
court identified and admitted that she signed the Contract of Admission dated
October 30, 1990 as well as the Undertakings dated March 3, 1992 and April 7,
1992 but which, for no justifiable reason, she “did not bother to read,”[138]
and, what is more, she repeatedly admitted during the course of the trial that
she failed to fully settle the foregoing hospital bills.[139] In fact, while the Ty case cannot control the incidents of the instant case as
heretofore stated, it is still worth mentioning, at least for informative
purposes, the findings of this Court in Ty with respect to respondents’
obligations to the petitioner:
Ty’s mother and sister availed of the
services and the facilities of the hospital.
For the care given to her kin, Ty had a legitimate obligation to pay the
hospital by virtue of her relationship with them and by force of her signature
on her mother’s Contract of Admission acknowledging responsibility for payment,
and on the promissory note she executed in favor of the hospital.[140]
In view of all these findings, the
Court earnestly disagrees with the sweeping conclusion of the CA that
“[Petitioner] failed to present any iota of evidence to prove his claim,”[141]
a statement apparently referring to the permissive counterclaim of P1,075,592.95.
However, with respect to the compulsory counterclaim predicated on the filing
of a baseless suit and injury to its reputation, petitioner did not raise this
matter on appeal and, hence, is deemed to have waived the same.
But
the Court in Ty made a partial finding on the civil liability of
respondent Ty with respect to the amount covered by seven of the
several dishonored checks she issued
equivalent to
P210,000.00.[142] Since this amount forms a fraction of her
total civil liability, then this amount, in deference to Ty, should be
deducted therefrom.
The claim for attorney’s fees, as
stipulated under the Promissory Note dated
As a final word,
the Court takes judicial notice of the pending Senate Bill No. 337, entitled
“An Act Prohibiting the Detention of Patients in Hospitals and Medical Clinics
on Grounds of Non-Payment of Hospital Bills or Medical Expenses,” which declares,
among others, that it shall be unlawful for any hospital or medical clinic to
cause directly or indirectly the detention of patients for non-payment, in part
or in full, of their hospital bills,[144]
and, furthermore, requires patients who have fully recovered and are
financially incapable to settle the hospitalization expenses to execute a
promissory note, co-signed by another individual, to the extent of the unpaid
obligation before leaving the hospital.[145] While this Court may have touched upon these
matters in the adjudication of the instant case, it must be stated that this
decision should in no way preempt any constitutional challenge to the
provisions of Senate Bill No. 337 if passed into law, bearing in mind the
standards for the exercise of the power of judicial review[146]
as well as the recognition that the tenor of the bill may adjust with the
times, or that the bill itself may fail to pass, according to the dynamism of
the legislative process, especially in light of the objections interposed by interest
groups to date.[147]
WHEREFORE, the petition is GRANTED.
The Decision of the Court of Appeals dated P865,592.95, with stipulated interest
of 12 percent reckoned from the date of extrajudicial demand until full
payment, and 12 percent of the total amount due as attorney’s fees.
No pronouncement as to costs.
SO ORDERED.
MA. ALICIA AUSTRIA-MARTINEZ
Associate Justice
WE
CONCUR:
ARTEMIO V. PANGANIBAN
Chief Justice
Chairperson
CONSUELO YNARES-SANTIAGO ROMEO J. CALLEJO, SR.
Associate Justice Associate Justice
MINITA V. CHICO-NAZARIO
Associate Justice
CERTIFICATION
Pursuant
to Section 13, Article VIII of the Constitution, it is hereby certified that
the conclusions in the above Decision were reached in consultation before the
case was assigned to the writer of the opinion of the Court’s Division.
ARTEMIO V.
PANGANIBAN
Chief Justice
[1] Penned by Associate Justice Conrado M. Vasquez, Jr., with Associate Justices Martin S. Villarama, Jr. and Eliezer R. De Los Santos, concurring, rollo, pp. 38-50.
[2]
Although the Complaint impleaded
the petitioner as “
[3]
Partial Pre-Trial Order dated
[4]
Partial Pre-Trial Order dated
[5]
[6] CA rollo, p. 39.
[7] Rollo, p. 50.
[8] G.R.
No. 149275,
[9] Heirs of Dicman v. Cariño, G.R. No.
146459, June 8, 2006; Rivera v. Roman, G.R. No. 142402, September 20,
2005, 470 SCRA 276, 287; Mercury Drug
Corp. v. Libunao, G.R. No. 144458,
July 14, 2004, 434 SCRA 404, 413-414; The Insular Life Assurance
Company, Ltd. v. Court of Appeals, G.R. No. 126850, April 28, 2004, 428
SCRA 79, 86; Aguirre v. Court of Appeals, G.R. No. 122249, January 29,
2004, 421 SCRA 310, 319; C & S Fishfarm Corporation v. Court of Appeals,
442 Phil. 279, 288 (2002); Martinez v.
Court of Appeals, G.R. No. 123547, May 21, 2001, 358 SCRA 38, 49 (2001).
[10] RTC Decision, rollo, p. 99.
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18] See Pedro P. Solis, Medical Jurisprudence 322 (1988) (discussing the corporate liability of hospitals arising from the failure to furnish safe and reliable equipment).
[19] See Ramos v. Court of Appeals, 378 Phil. 1198, 1241 (1999), citing Jose O. Vitug, Compendium of Civil Law and Jurisprudence 822 (1993).
[20] The
primary duties of a hospital are to furnish safe and well maintained premises,
to provide adequate and safe equipment, and to exercise reasonable care in the
selection of the members of the hospital staff.
See Pedro P. Solis, Medical Jurisprudence 310-11, 321-29
(1988). A hospital conducted for private
gain is under a duty to exercise ordinary care in furnishing its patients a
suitable and safe place. If an unsafe
condition of the hospital’s premises causes an injury, there is a breach of the
hospital’s duty. 40A Am. Jur. 2d Hospitals and Asylums § 35 (1999), citing Sharpe v. South Carolina Dept. of Mental
Health, 281 S.C. 242, 315 S.E.2d 112 (1984); United Western
Medical Centers v. Superior Court, 42 Cal. App. 4th 500, 49 Cal.
Rptr. 2d 682 (4th Dist. 1996).
Where the patient refuses to leave a private hospital inspite of the
order for his discharge, he may do so and continue to stay in that hospital,
provided the corresponding hospital bill is properly satisfied and with the
consent of the attending physician. Pedro
P. Solis, Medical Jurisprudence 336 (1988). The relationship between the hospital as a
private corporate entity and the admitted patient is one principally governed
by contract. This conclusion stems from
the general rule that the management and operation of a private hospital are
governed by the rules applied in the case of private corporations generally,
except as modified by statute. See 40A Am. Jur. 2d Hospitals
and Asylums §13 (1999), citing Burris
v. Morton F. Plant Hospital, 204 So. 2d 521 (1967). The contract between the private hospital and
the patient normally stipulates the conditions of admission. See, e.g., 9A Am. Jur. Legal Forms 2d § 136:63. As the petitioner is a private hospital as
opposed to a public one, it is given more leeway in making rules and regulations
as regards the admission of patients, hospital facilities, selection of staff,
among others, provided that such rules and regulations are not arbitrary,
discriminatory, unreasonable, monopolistic, or contrary to law or public
policy, Pedro P. Solis, Medical
Jurisprudence 310 (1988).
[21] See, e.g., Tan v. Villapaz, G.R. No. 160892, November 22, 2005, 475 SCRA 720, 727; Nautica Canning Corp. v. Yumul, G.R. No. 164588, October 19, 2005, 473 SCRA 415, 423; Jardine Davies, Inc. v. JRB Realty, Inc., G.R. No. 151438, July 15, 2005, 463 SCRA 555, 561; Lim v. Chuatoco, G.R. No. 161861, March 11, 2005, 453 SCRA 308, 316; Chico v. Court of Appeals, 348 Phil. 37, 43 (1998).
[22]
TSN,
[23]
TSN,
[24] See TSN,
[25]
TSN,
[26] TSN,
[27]
[28]
[29]
[30]
[31]
TSN,
[32]
TSN,
[33] Supra note 31.
[34] Supra
note 32.
[35] Supra note 31.
[36]
[37]
TSN,
[38]
TSN,
[39]
TSN,
[40]
[41] Supra note 37.
[42] Supra note 38.
[43]
TSN,
[44]
[45]
[46]
[47]
[48]
[49]
[50]
[51]
TSN,
[52] TSN,
[53]
TSN,
[54] Although there is some inconsistency
as to the exact dates when the hospital administrator, Sister Galeno, consulted
with the doctors, due to memory lapse of the witnesses, it is fairly
established that it was done during a reasonable time before the removal. See
TSN,
[55]
TSN,
[56]
[57] Supra note 55.
[58]
[59]
TSN,
[60] TSN,
[61]
[62]
[63]
[64]
TSN,
[65]
[66]
TSN,
[67]
[68]
[69]
[70]
TSN,
[71] TSN,
September 7, 1995, p. 20; TSN, August 22, 1996, pp. 6, 8, 24; TSN, October 5,
1995, p. 13.
[72]
TSN,
[73] Supra note 46.
[74] TSN,
[75] Supra note 46.
[76] Spouses Custodio v. Court of Appeals,
323 Phil. 575, 585-586 (1996). See Expertravel & Tours, Inc. v. Court of
Appeals, 368 Phil. 444, 448-449 (1999) (summarizing the rules on moral
damages).
[77] 346 Phil. 872 (1997).
[78]
[79]
TSN,
[80]
[81]
[82]
[83]
[84]
[85]
[86] Exhibit “5.”
[87]
[88]
TSN,
[89] Exhibit
“1”.
[90]
TSN,
[91]
[92] TSN,
[93]
TSN,
[94] TSN,
[95]
RTC Decision, rollo, p.
106. This conclusion had been impliedly affirmed by the CA. See TSN,
[96]
TSN,
[97]
[98]
[99]
TSN,
[100]
[101]
TSN,
[102]
TSN,
[103] Supra note 101.
[104] See Pedro P. Solis, Medical Jurisprudence 305-307 (1988) (discussing the various classifications of hospitals).
[105]
TSN,
[106] Exhibits “B” to “B-1.”
[107]
TSN,
[108] Pedro
P. Solis, Medical Jurisprudence 338 (1988), citing Gadsden General Hospital v. Hamilton, 103 So. 553
(1925). See Louis J. Regan,
Doctor and Patient and the Law 113 (1949), citing Cook v.
[109] Pedro P. Solis, Medical Jurisprudence 338 (1988).
[110] C.R.A. Martin, Law Relating to Medical Practice 340-41 (1979) (citations omitted).
[111] Pedro P. Solis, Medical Jurisprudence 338 (1988).
[112] C.R.A. Martin, Law Relating to Medical Practice 41 (1979) (citations omitted).
[113] As opposed to a private charitable or eleemosynary hospital. Pedro P. Solis, Medical Jurisprudence 306-7 (1988)
[114] 40A Am.
Jur. 2d Hospitals and Asylums §8
(1999), citing Porter
v. McPherson, 198 W.
[115]
[116]
TSN,
[117] See 40A Am. Jur. 2d Hospitals and Asylums §8 (1999), citing Heartland Health Systems, Inc. v. Chamberlin, 871 S.W.2d 8 (1993).
[118] TSN,
[119]
G.R. No. 149275,
[120]
[121] Rollo, p. 44.
[122]
[123]
[124] Supra note 121.
[125] Supra note 122; id. at 43.
[126]
[127] See The Civil Code of the Philippines, Republic Act No. 386, as amended, Article 2219 (1950).
[128] See Soberano
v. Manila Railroad Company, 124 Phil. 1330, 1337 (1966); Strebel v.
Figueras, 96 Phil. 321, 330 (1954); Araneta v. Arreglado, 104 Phil. 529, 533 (1958).
[129] Records, pp. 178-197.
[130]
TSN,
[131] TSN,
October 27, 1994, pp. 8, 10-11, 24-27, 32-33; TSN, October 5, 1995, pp. 18, 21,
26, 35-36, 51-53; TSN, January 25, 1996, 8-9, 12.
[132] Exhibit “1”.
[133] Exhibits “1-a” and “1-b”.
[134] Exhibits “2” to “2-c.”
[135] Exhibits “3” to “4-b.”
[136] Exhibits “11”, “11-b”; Exhibits “13” to “14-a”; Exhibits “16” to “16-d.”
[137] Rollo, pp. 94-95; Partial
Pre-Trial Order dated
[138]
TSN,
[139]
[140]
Ty v. People of the
[141] Rollo, p. 47.
[142] The dispositive portion of Ty v. People states:\
WHEREFORE,
the instant Petition is DENIED and the assailed Decision of the Court of
Appeals, dated
SO ORDERED.
(emphasis supplied)
[143] The
Civil Code of the
[144] Section 1 of the draft bill.
[145] Section 2 of the draft bill.
[146] Where questions of constitutional
significance are raised, the Court can exercise its power of judicial review
only if the following requisites are complied:
First, there must be before the Court an actual case calling for the
exercise of judicial review. Second, the
question before the Court must be ripe for adjudication. Third, the person challenging the validity of
the act must have standing to challenge.
Fourth, the question of constitutionality must have been raised at the
earliest opportunity, and lastly, the issue of constitutionality must be the
very lis mota of the case. Allied
Banking Corporation v.
[147] See Position Paper dated