Republic of the
Supreme Court
THIRD
DIVISION
|
Dr. Emmanuel Jarcia, Jr. and Dr.
Marilou Bastan,
Petitioners, - versus - PEOPLE OF THE Respondent. |
|
G.R. No. 187926 Present: CARPIO,* J., PERALTA,** Acting Chairperson, ABAD, PEREZ,*** and MENDOZA, JJ. Promulgated: February
15, 2012 |
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D E C I S I O N
MENDOZA,
J.:
Even early
on, patients have consigned their lives to the skill of their doctors. Time and
again, it can be said that the most important goal of the medical profession is
the preservation of life and health of the people. Corollarily, when a
physician departs from his sacred duty and endangers instead the life of his
patient, he must be made liable for the resulting injury. This Court, as this
case would show, cannot and will not let the act go unpunished.[1]
This is a petition for review under
Rule 45 of the Rules of Court challenging the August 29, 2008 Decision[2] of the Court of Appeals (CA), and its May
19, 2009 Resolution[3] in
CA-G.R. CR No. 29559, dismissing the appeal and affirming in toto the June
14, 2005 Decision[4] of the Regional
Trial Court, Branch 43, Manila (RTC), finding the accused guilty beyond
reasonable doubt of simple imprudence resulting to serious physical injuries.
THE
FACTS
Belinda Santiago (Mrs. Santiago)
lodged a complaint with the National Bureau of Investigation (NBI)
against the petitioners, Dr. Emmanuel Jarcia, Jr. (Dr. Jarcia) and Dr.
Marilou Bastan (Dr. Bastan), for their alleged neglect of professional
duty which caused her son, Roy Alfonso Santiago (Roy Jr.), to suffer
serious physical injuries. Upon investigation, the NBI found that Roy Jr. was
hit by a taxicab; that he was rushed to the Manila Doctors Hospital for an
emergency medical treatment; that an X-ray of the victims ankle was ordered;
that the X-ray result showed no fracture as read by Dr. Jarcia; that Dr.
Bastan entered the emergency room (ER) and, after conducting her own
examination of the victim, informed Mrs. Santiago that since it was only the
ankle that was hit, there was no need to examine the upper leg; that eleven (11)
days later, Roy Jr. developed fever, swelling of the right leg and misalignment
of the right foot; that Mrs. Santiago brought him back to the hospital; and
that the X-ray revealed a right mid-tibial fracture and a linear hairline
fracture in the shaft of the bone.
The NBI indorsed the matter to the
Office of the City Prosecutor of Manila for preliminary investigation. Probable
cause was found and a criminal case for reckless imprudence resulting to
serious physical injuries, was filed against Dr. Jarcia, Dr. Bastan and Dr.
Pamittan,[5]
before the RTC, docketed as Criminal Case No. 01-196646.
On
WHEREFORE, premises considered, the Court
finds accused DR. EMMANUEL
JARCIA, JR.
and DR. MARILOU BASTAN GUILTY beyond
reasonable doubt of the crime of SIMPLE IMPRUDENCE RESULTING TO SERIOUS
PHYSICAL INJURIES and are hereby sentenced to suffer the penalty of ONE (1) MONTH and ONE (1) DAY to TWO (2) MONTHS and to indemnify MRS. BELINDA
SANTIAGO the amount of ₱3,850.00 representing
medical expenses without subsidiary imprisonment in case of insolvency and to
pay the costs.
It appearing that Dr. Pamittan has not
been apprehended nor voluntarily surrendered despite warrant issued for her
arrest, let warrant be issued for her arrest and the case against her be
ARCHIVED, to be reinstated upon her apprehension.
SO ORDERED.[6]
The
RTC explained:
After a thorough and in depth evaluation
of the evidence adduced by the prosecution and the defense, this court finds
that the evidence of the prosecution is the more credible, concrete and
sufficient to create that moral certainty in the mind of the Court that accused
herein [are] criminally responsible. The
Court believes that accused are negligent when both failed to exercise the
necessary and reasonable prudence in ascertaining the extent of injury of
Alfonso Santiago, Jr.
However,
the negligence exhibited by the two doctors does not approximate negligence of
a reckless nature but merely amounts to simple imprudence. Simple imprudence consists in the lack of
precaution displayed in those cases in which the damage impending to be caused
is not the immediate nor the danger clearly manifest. The elements of simple imprudence are as
follows.
1.
that there
is lack of precaution on the part of the offender; and
2.
that the
damage impending to be caused is not immediate of the danger is not clearly
manifest.
Considering all the evidence on record,
The Court finds the accused guilty for simple imprudence resulting to physical
injuries. Under Article 365 of the
Revised Penal Code, the penalty provided for is arresto mayor in its minimum
period.[7]
Dissatisfied,
the petitioners appealed to the CA.
As
earlier stated, the CA affirmed the RTC decision in toto. The
This Court holds concurrently and finds
the foregoing circumstances sufficient to sustain a judgment of conviction
against the accused-appellants for the crime of simple imprudence resulting in
serious physical injuries. The elements
of imprudence are: (1) that the offender
does or fails to do an act; (2) that the doing or the failure to do that act is
voluntary; (3) that it be without malice; (4) that material damage results from
the imprudence; and (5) that there is inexcusable lack of precaution on the
part of the offender, taking into consideration his employment or occupation,
degree of intelligence, physical condition, and other circumstances regarding
persons, time and place.
Whether
or not Dr. Jarcia and Dr. Bastan had committed an inexcusable lack of
precaution in the treatment of their patient is to be determined according to
the standard of care observed by other members of the profession in good
standing under similar circumstances,
bearing in mind the advanced state of the profession at the time of treatment
or the present state of medical science.
In the case of Leonila Garcia-Rueda v. Pascasio, the Supreme
Court stated that, in accepting a case, a doctor in effect represents that,
having the needed training and skill possessed by physicians and surgeons
practicing in the same field, he will employ such training, care and skill in
the treatment of his patients. He
therefore has a duty to use at least the same level of care that any other
reasonably competent doctor would use to treat a condition under the same
circumstances.
In
litigations involving medical negligence, the plaintiff has the burden of
establishing accused-appellants negligence, and for a reasonable conclusion of
negligence, there must be proof of breach of duty on the part of the physician
as well as a causal connection of such breach and the resulting injury of his
patient. The connection between the
negligence and the injury must be a direct and natural sequence of events,
unbroken by intervening efficient causes. In other words, the negligence must
be the proximate cause of the injury.
Negligence, no matter in what it consists, cannot create a right of
action unless it is the proximate cause of the injury complained of. The proximate cause of an injury is that
cause which, in natural and continuous sequence, unbroken by any efficient
intervening cause, produces the injury and without which the result would not
have occurred.
In
the case at bench, the accused-appellants questioned the imputation against
them and argued that there is no causal connection between their failure to
diagnose the fracture and the injury sustained by
We
are not convinced.
The
prosecution is however after the cause which prolonged the pain and suffering
of
For
a more logical presentation of the discussion, we shall first consider the
applicability of the doctrine of res ipsa loquitur to the instant
case. Res ipsa loquitur is a Latin phrase which literally means the
thing or the transaction speaks for itself. The doctrine of res ipsa
loquitur is simply a recognition of the postulate that, as a matter of
common knowledge and experience, the very nature of certain types of
occurrences may justify an inference of negligence on the part of the person
who controls the instrumentality causing the injury in the absence of some
explanation by the accused-appellant who is charged with negligence. It is grounded in the superior logic of
ordinary human experience and, on the basis of such experience or common
knowledge, negligence may be deduced from the mere occurrence of the accident
itself. Hence, res ipsa loquitur is
applied in conjunction with the doctrine of common knowledge.
The
specific acts of negligence was narrated by Mrs. Santiago who accompanied her son during the latters ordeal at the
hospital. She testified as follows:
Fiscal Formoso:
Q: Now,
he is an intern did you not consult the doctors, Dr. Jarcia or Dra. Pamittan to
confirm whether you should go home or not?
A: Dra.
Pamittan was inside the cubicle of the nurses and I asked her, you let us go
home and you dont even clean the wounds of my son.
Q: And
what did she [tell] you?
A: They
told me they will call a resident doctor, sir.
x
x x x x x x x x
Q: Was
there a resident doctor [who] came?
A: Yes,
Sir. Dra. Bastan arrived.
Q: Did
you tell her what you want on you to be done?
A: Yes,
sir.
Q: What
did you [tell] her?
A: I
told her, sir, while she was cleaning the wounds of my son, are you not going
to x-ray up to the knee because my son was complaining pain from his ankle up
to the middle part of the right leg.
Q: And
what did she tell you?
A: According
to Dra. Bastan, there is no need to x-ray because it was the ankle part that
was run over.
Q: What
did you do or tell her?
A: I
told her, sir, why is it that they did not examine[x] the whole leg. They just lifted the pants of my son.
Q: So
you mean to say there was no treatment made at all?
A: None,
sir.
x
x x x x x x x x
A: I
just listened to them, sir. And I just
asked if I will still return my son.
x
x x x x x x x x
Q: And
you were present when they were called?
A: Yes,
sir.
Q: And
what was discussed then by Sis. Retoria?
A: When
they were there they admitted that they have mistakes, sir.
Still, before resort to the doctrine may
be allowed, the following requisites must be satisfactorily shown:
1.
The
accident is of a kind which ordinarily does not occur in the absence of
someones negligence;
2.
It
is caused by an instrumentality within the exclusive control of the defendant
or defendants; and
3. The
possibility of contributing conduct which would make the plaintiff responsible
is eliminated.
In
the above requisites, the fundamental element is the control of the
instrumentality which caused the damage.
Such element of control must be shown to be within the dominion of the
accused-appellants. In order to have the benefit of the rule, a plaintiff, in
addition to proving injury or damage, must show a situation where it is
applicable and must establish that the essential elements of the doctrine were
present in a particular incident. The
early treatment of the leg of
The
testimony of Mrs. Santiago was corroborated by a bone specialist Dr. Tacata. He
further testified based on his personal knowledge, and not as an expert, as he
examined himself the child Roy. He testified as follows:
Fiscal Macapagal:
Q: And
was that the correct respon[se] to the medical problem that was presented to
Dr. Jarcia and Dra. Bastan?
A: I
would say at that stage, yes. Because they have presented the patient and the
history. At sabi nila, nadaanan lang po
ito. And then, considering their year
of residency they are still junior residents, and they are not also orthopedic
residents but general surgery residents, its entirely different thing. Because if you are an orthopedic resident, I
am not trying to saybut if I were an orthopedic resident, there would be more
precise and accurate decision compare to a general surgery resident in so far
as involved.
Q: You
mean to say there is no supervisor attending the emergency room?
A: At
the emergency room, at the Manila Doctors Hospital, the supervisor there is a
consultant that usually comes from a family medicine. They see where a certain
patient have to go and then if they cannot manage it, they refer it to the
consultant on duty. Now at that time, I dont [know] why they dont.Because at
that time, I think, it is the decision.
Since the x-rays.
Ordinarily, only physicians and surgeons
of skill and experience are competent to testify as to whether a patient has
been treated or operated upon with a reasonable degree of skill and care.
However, testimony as to the statements and acts of physicians, external
appearances, and manifest conditions which are observable by any one may be
given by non-expert witnesses. Hence, in
cases where the res ipsa loquitur is applicable, the court is permitted to find
a physician negligent upon proper proof of injury to the patient, without the
aid of expert testimony, where the court from its fund of common knowledge can
determine the proper standard of care. Where common knowledge and experience
teach that a resulting injury would not have occurred to the patient if due
care had been exercised, an inference of negligence may be drawn giving rise to
an application of the doctrine of res ipsa loquitur without medical
evidence, which is ordinarily required to show not only what occurred but how
and why it occurred. In the case at
bench, we give credence to the testimony of Mrs. Santiago by applying the
doctrine of res ipsa loquitur.
Res
ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used
but a rule to be cautiously applied, depending upon the circumstances of each
case. It is generally restricted to
situations in malpractice cases where a layman is able to say, as a matter of
common knowledge and observation, that the consequences of professional care were
not as such as would ordinarily have followed if due care had been exercised. A
distinction must be made between the failure to secure results and the
occurrence of something more unusual and not ordinarily found if the service or
treatment rendered followed the usual procedure of those skilled in that
particular practice. The latter
circumstance is the primordial issue that confronted this Court and we find
application of the doctrine of res ipsa loquitur to be in order.
WHEREFORE, in view of the foregoing, the appeal in this case is hereby DISMISSED and the assailed decision of the trial
court finding accused-appellants guilty beyond reasonable doubt of simple
imprudence resulting in serious physical injuries is hereby AFFIRMED in toto.
SO
ORDERED.[8]
The
petitioners filed a motion for reconsideration, but it was denied by the CA in
its
Hence, this petition.
The
petitioners pray for the reversal of the decision of both the RTC and the CA anchored
on the following
GROUNDS-
1. IN AFFIRMING ACCUSED-PETITIONERS CONVICTION, THE COURT OF
APPEALS ERRED IN NOT HOLDING THAT THE ACTUAL, DIRECT, IMMEDIATE, AND PROXIMATE
CAUSE OF THE PHYSICAL INJURY OF THE PATIENT (FRACTURE OF THE LEG BONE OR
TIBIA), WHICH REQUIRED MEDICAL ATTENDANCE FOR MORE THAN THIRTY (30) DAYS AND
INCAPACITATED HIM FROM PERFORMING HIS CUSTOMARY DUTY DURING THE SAME PERIOD OF
TIME, WAS THE VEHICULAR ACCIDENT WHERE THE PATIENTS RIGHT LEG WAS HIT BY A
TAXI, NOT THE FAILURE OF THE ACCUSED-PETITIONERS TO SUBJECT THE PATIENTS WHOLE
LEG TO AN X-RAY EXAMINATION.
2. THE COURT OF APPEALS ERRED IN DISREGARDING ESTABLISHED FACTS
CLEARLY NEGATING PETITIONERS ALLEGED NEGLIGENCE OR IMPRUDENCE. SIGNIFICANTLY,
THE COURT OF APPEALS UNJUSTIFIABLY DISREGARDED THE OPINION OF THE PROSECUTIONS
EXPERT WITNESS, DR. CIRILO TACATA, THAT PETITIONERS WERE NOT GUILTY OF
NEGLIGENCE OR IMPRUDENCE COMPLAINED OF.
3. THE COURT OF APPEALS ERRED IN HOLDING THAT THE FAILURE OF
PETITIONERS TO SUBJECT THE PATIENTS WHOLE LEG TO AN X-RAY EXAMINATION
PROLONGED THE PAIN AND SUFFERING OF THE PATIENT, SUCH CONCLUSION BEING
UNSUPPORTED BY, AND EVEN CONTRARY TO, THE EVIDENCE ON RECORD.
4. ASSUMING ARGUENDO THAT THE PATIENT EXPERIENCED PROLONGED
PAIN AND SUFFERING, THE COURT OF APPEALS ERRED IN NOT HOLDING THAT THE ALLEGED
PAIN AND SUFFERING WERE DUE TO THE UNJUSTIFIED FAILURE OF THE PATIENTS MOTHER,
A NURSE HERSELF, TO IMMEDIATELY BRING THE PATIENT BACK TO THE HOSPITAL, AS
ADVISED BY THE PETITIONERS, AFTER HE COMPLAINED OF SEVERE PAIN IN HIS RIGHT LEG
WHEN HE REACHED HOME AFTER HE WAS SEEN BY PETITIONERS AT THE HOSPITAL. THUS,
THE PATIENTS ALLEGED INJURY (PROLONGED PAIN AND SUFFERING) WAS DUE TO HIS OWN
MOTHERS ACT OR OMISSION.
5. THE COURT OF APPEALS ERRED IN NOT HOLDING THAT NO
PHYSICIAN-PATIENT RELATIONSHIP EXISTED BETWEEN PETITIONERS AND PATIENT ALFONSO
SANTIAGO, JR., PETITIONERS NOT BEING THE LATTERS ATTENDING PHYSICIAN AS THEY
WERE MERELY REQUESTED BY THE EMERGENCY ROOM (ER) NURSE TO SEE THE PATIENT WHILE
THEY WERE PASSING BY THE ER FOR THEIR LUNCH.
6. THE COURT OF APPEALS GRAVELY ERRED IN NOT ACQUITTING
ACCUSED-PETITIONERS OF THE CRIME CHARGED.[9]
The
foregoing can be synthesized into two basic issues: [1] whether or not the
doctrine of res ipsa loquitur is applicable in this case; and [2]
whether or not the petitioners are liable for criminal negligence.
THE
COURTS RULING
The CA is correct in finding that
there was negligence on the part of the petitioners. After a perusal of the
records, however, the Court is not convinced that the petitioners are guilty of
criminal negligence complained of. The Court is also of the view that the CA
erred in applying the doctrine of res
ipsa loquitur in this particular case.
As
to the Application of
The
Doctrine of Res Ipsa Loquitur
This doctrine of res ipsa loquitur means
"Where the thing which causes injury is shown to be under the management
of the defendant, and the accident is such as in the ordinary course of things
does not happen if those who have the management use proper care, it affords
reasonable evidence, in the absence of an explanation by the defendant, that
the accident arose from want of care." The Black's Law Dictionary defines the said
doctrine. Thus:
The thing speaks for
itself. Rebuttable presumption or inference that defendant was negligent, which
arises upon proof that the instrumentality causing injury was in defendant's
exclusive control, and that the accident was one which ordinarily does not
happen in absence of negligence. Res
ipsa loquitur is a rule of evidence whereby negligence of the alleged
wrongdoer may be inferred from the mere fact that the accident happened
provided the character of the accident and circumstances attending it lead
reasonably to belief that in the absence of negligence it would not have
occurred and that thing which caused injury is shown to have been under the
management and control of the alleged wrongdoer. Under this doctrine, the
happening of an injury permits an inference of negligence where plaintiff
produces substantial evidence that the injury was caused by an agency or
instrumentality under the exclusive control and management of defendant, and
that the occurrence was such that in the ordinary course of things would not
happen if reasonable care had been used.[10]
The doctrine of res
ipsa loquitur as a rule of evidence is unusual to the law of
negligence which recognizes that prima facie negligence may be
established without direct proof and furnishes a substitute for specific proof
of negligence. The doctrine,
however, is not a rule of substantive law, but merely a mode of proof or a mere
procedural convenience. The rule, when
applicable to the facts and circumstances of a given case, is not meant to and
does not dispense with the requirement of proof of culpable negligence on the
party charged. It merely determines and
regulates what shall be prima facie evidence thereof and helps
the plaintiff in proving a breach of the duty.
The doctrine can be invoked when and only when, under the circumstances
involved, direct evidence is absent and not readily available.[11]
The requisites for the application of the doctrine of res ipsa
loquitur are: (1) the accident was of a kind which does not ordinarily occur
unless someone is negligent; (2) the instrumentality or agency
which caused the injury was under the exclusive control of the person in
charge; and (3) the injury suffered must not have been due to any voluntary
action or contribution of the person injured.[12]
In this case, the circumstances that caused patient Roy
Jr.s injury and the series of tests that were supposed to be undergone by him
to determine the extent of the injury suffered were not under the exclusive control of Drs. Jarcia and Bastan. It was
established that they are mere residents of the
As to Dr. Jarcia
and
Dr. Bastans
negligence
The totality of the evidence on record clearly
points to the negligence of the petitioners. At the risk of being repetitious,
the Court, however, is not satisfied that Dr. Jarcia and Dr. Bastan are
criminally negligent in this case.
Negligence is defined as the failure
to observe for the protection of the interests of another person that degree of
care, precaution, and vigilance which the circumstances justly demand, whereby
such other person suffers injury.[14]
Reckless imprudence consists of
voluntarily doing or failing to do, without malice, an act from which material
damage results by reason of an inexcusable
lack of precaution on the part of the person performing or failing to
perform such act.[15]
The elements of simple negligence are:
(1) that there is lack of precaution on the part of the offender, and (2) that
the damage impending to be caused is not immediate or the danger is not clearly
manifest.[16]
In this case, the Court is not convinced with moral
certainty that the petitioners are guilty of reckless imprudence or simple
negligence. The elements thereof were not proved by the prosecution beyond
reasonable doubt.
The testimony of Dr. Cirilo R. Tacata (Dr.
Tacata), a specialist in pediatric orthopedic, although pointing to some
medical procedures that could have been done by Dr. Jarcia and Dr. Bastan, as
physicians on duty, was not clear as to whether the injuries suffered by patient
Roy Jr. were indeed aggravated by the petitioners judgment call and their diagnosis
or appreciation of the condition of the victim at the time they assessed him.
Thus:
Q: Will
you please tell us, for the record, doctor, what is your specialization?
A: At
present I am the chairman department of orthopedic in UP-PGH and I had special
training in pediatric orthopedic for two (2) years.
Q: In
June 1998, doctor, what was your position and what was your specialization at
that time?
A: Since
1980, I have been specialist in pediatric orthopedic.
Q: When
Alfonso Santiago, Jr. was brought to you by his mother, what did you do by way
of physicians as first step?
A: As
usual, I examined the patient physically and, at that time as I have said, the
patient could not walk so I [began] to suspect that probably he sustained a
fracture as a result of a vehicular accident. So I examined the patient at that
time, the involved leg, I dont know if that is left or right, the involved leg
then was swollen and the patient could not walk, so I requested for the x-ray
of [the] lower leg.
Q: What
part of the leg, doctor, did you request to be examined?
A: If we refer for an x-ray, usually, we
suspect a fracture whether in approximal, middle or lebistal tinial, we usually
x-ray the entire extremity.
Q: And
what was the result?
A: Well,
I can say that it was a spiral fracture of the mid-tibial, it is the bigger
bone of the leg.
Q: And
when you say spiral, doctor, how long was this fracture?
A: When
we say spiral, it is a sort of letter S, the length was about six (6) to eight
(8) centimeters.
Q: Mid-tibial,
will you please point to us, doctor, where the tibial is?
(Witness pointing to his lower leg)
A: The
tibial is here, there are two bones here, the bigger one is the tibial and the
smaller one is the fibula. The bigger one is the one that get fractured.
Q: And
in the course of your examination of Alfonso Santiago, Jr. did you ask for the
history of such injury?
A: Yes,
actually, that was a routine part of our examination that once a patient comes
in, before we actually examine the patient, we request for a detailed history.
If it is an accident, then, we request for the exact mechanism of injuries.
Q: And
as far as you can recall, Doctor, what was the history of that injury that was
told to you?
A: The
patient was sideswiped, I dont know if it is a car, but it is a vehicular
accident.
Q: Who
did you interview?
A: The
mother.
Q: How
about the child himself, Alfonso Santiago, Jr.?
A: Normally,
we do not interview the child because, usually, at his age, the answers are not
accurate. So, it was the mother that I interviewed.
Q: And
were you informed also of his early medication that was administered on Alfonso
Santiago, Jr.?
A: No,
not actually medication. I was informed that this patient was seen initially at
the emergency room by the two (2) physicians that you just mentioned, Dr.
Jarcia and Dra. Bastan, that time who happened to be my residents who were [on]
duty at the emergency room.
x
x x x
A: At the emergency room, at the Manila Doctors Hospital, the supervisor
there is a consultant that usually comes from a family medicine. They see where
a certain patient have to go and then if they cannot manage it, they refer it
to the consultant on duty. Now at that time, I dont why they dont Because
at that time, I think, it is the decision. Since the x-rays
x
x x
Q: You
also said, Doctor, that Dr. Jarcia and Dra. Bastan are not even an orthopedic
specialist.
A: They are general surgeon
residents. You have to man[x] the emergency room, including neurology,
orthopedic, general surgery, they see everything at the emergency room.
x
x x x
Q: But if initially, Alfonso
Santiago, Jr. and his case was presented to you at the emergency room, you
would have subjected the entire foot to x-ray even if the history that was
given to Dr. Jarcia and Dra. Bastan is the same?
A: I could not directly say
yes, because it would still depend on my examination, we cannot subject the
whole body for x-ray if we think that the damaged was only the leg.
Q: Not the entire body but
the entire leg?
A: I think, if my
examination requires it, I would.
Q: So, you would conduct
first an examination?
A: Yes, sir.
Q: And do you think that
with that examination that you would have conducted you would discover the
necessity subjecting the entire foot for x-ray?
A: It is also possible but
according to them, the foot and the ankle were swollen and not the leg, which
sometimes normally happens that the actual fractured bone do not get swollen.
x x x x
Q: Doctor, if you know that the patient sustained a fracture on
the ankle and on the foot and the history that was told to you is the region
that was hit is the region of the foot, will the doctor subject the entire leg
for x-ray?
A: I am an orthopedic surgeon, you have to subject an x-ray of
the leg. Because you have to consider the kind of fracture that the patient
sustained would you say the exact mechanism of injury. For example spiral,
paikot yung bale nya, so it was possible that the leg was run over, the
patient fell, and it got twisted. Thats why the leg seems to be fractured.[17]
[Emphases supplied]
It can be gleaned from the testimony of Dr. Tacata
that a thorough examination was not performed on Roy Jr. As residents on duty
at the emergency room, Dr. Jarcia and Dr. Bastan were expected to know the
medical protocol in treating leg fractures and in attending to victims of car
accidents. There was, however, no precise evidence and scientific explanation pointing
to the fact that the delay in the application of the cast to the patients
fractured leg because of failure to immediately diagnose the specific injury of
the patient, prolonged the pain of the child or aggravated his condition or even
caused further complications. Any person may opine that had patient Roy Jr.
been treated properly and given the extensive X-ray examination, the extent and
severity of the injury, spiral fracture of the mid-tibial part or the bigger
bone of the leg, could have been detected early on and the prolonged pain and
suffering of Roy Jr. could have been prevented. But still, that opinion, even
how logical it may seem would not, and could not, be enough basis to hold one
criminally liable; thus, a reasonable doubt as to the petitioners guilt.
Although the Court sympathizes with the plight of
the mother and the child in this case, the Court is bound by the dictates of
justice which hold inviolable the right of the accused to be presumed innocent
until proven guilty beyond reasonable doubt. The Court, nevertheless, finds the
petitioners civilly liable for their failure to sufficiently attend to Roy
Jr.s medical needs when the latter was rushed to the ER, for while a criminal conviction
requires proof beyond reasonable doubt, only a preponderance of evidence is required
to establish civil liability. Taken into account also was the fact that there
was no bad faith on their part.
Dr. Jarcia and Dr. Bastan cannot pass on the liability
to the taxi driver who hit the victim. It may be true that the actual, direct,
immediate, and proximate cause of the injury (fracture of the leg bone or
tibia) of Roy Jr. was the vehicular accident when he was hit by a taxi. The petitioners, however, cannot simply invoke
such fact alone to excuse themselves from any liability. If this would be so,
doctors would have a ready defense should they fail to do their job in
attending to victims of hit-and-run, maltreatment, and other crimes of violence
in which the actual, direct, immediate, and proximate cause of the injury is
indubitably the act of the perpetrator/s.
In failing to perform an extensive medical
examination to determine the extent of Roy Jr.s injuries, Dr. Jarcia and Dr.
Bastan were remiss of their duties as members of the medical profession.
Assuming for the sake of argument that they did not have the capacity to make
such thorough evaluation at that stage, they should have referred the patient
to another doctor with sufficient training and experience instead of assuring him
and his mother that everything was all right.
This Court cannot also stamp its imprimatur on the petitioners
contention that no physician-patient relationship existed between them and
patient Roy Jr., since they were not his attending physicians at that time.
They claim that they were merely requested by the ER nurse to see the patient
while they were passing by the ER for their lunch. Firstly, this issue
was never raised during the trial at the RTC or even before the CA. The
petitioners, therefore, raise the want of doctor-patient relationship for the
first time on appeal with this Court. It has been settled that issues raised for the first time on appeal cannot be
considered because a party is not permitted to change his theory on
appeal. To allow him to do so is unfair
to the other party and offensive to the rules of fair play, justice and due
process.[18]
Stated differently, basic
considerations of due process dictate that theories, issues and arguments not
brought to the attention of the trial court need not be, and ordinarily will
not be, considered by a reviewing court.[19]
Assuming again for the
sake of argument that the petitioners may still raise this issue of no
physicianpatient relationship, the Court finds and so holds that there was a
physicianpatient relationship in this case.
In the case of Lucas v. Tuao,[20]
the Court wrote that [w]hen a patient engages the services of a physician, a
physician-patient relationship is generated. And in accepting a case, the
physician, for all intents and purposes, represents that he has the needed training
and skill possessed by physicians and surgeons practicing in the same field;
and that he will employ such training, care, and skill in the treatment of the
patient. Thus, in treating his patient, a physician is under a duty
to exercise that degree of care, skill and diligence which physicians in the
same general neighborhood and in the same general line of practice ordinarily
possess and exercise in like cases. Stated otherwise, the physician has the obligation
to use at least the same level of care that any other reasonably competent
physician would use to treat the condition under similar circumstances.
Indubitably, a physician-patient
relationship exists between the petitioners and patient Roy Jr. Notably, the latter and his mother went to the
ER for an immediate medical attention. The petitioners allegedly passed by and
were requested to attend to the victim (contrary to the testimony of Dr.
Tacata that they were, at that time, residents on duty at the ER).[21]
They obliged and examined the victim, and later assured the mother that
everything was fine and that they could go home. Clearly, a physician-patient
relationship was established between the petitioners and the patient Roy Jr.
To repeat for clarity and emphasis, if these doctors
knew from the start that they were not in the position to attend to Roy Jr., a vehicular
accident victim, with the degree of diligence and commitment expected of every
doctor in a case like this, they should have not made a baseless assurance that
everything was all right. By doing so, they deprived Roy Jr. of
adequate medical attention that placed him in a more dangerous situation than
he was already in. What petitioners should have done, and could have done, was
to refer Roy Jr. to another doctor who could competently and thoroughly examine
his injuries.
All told, the petitioners were,
indeed, negligent but only civilly, and
not criminally, liable as the facts show.
Article II, Section 1 of the Code of
Medical Ethics of the Medical Profession in the
A physician should attend to his patients
faithfully and conscientiously. He should secure for them all possible
benefits that may depend upon his professional skill and care. As the sole
tribunal to adjudge the physicians failure to fulfill his obligation to his
patients is, in most cases, his own conscience, violation of this rule on his
part is discreditable and inexcusable.[22]
Established
medical procedures and practices, though in constant instability, are devised
for the purpose of preventing complications. In this case, the petitioners
failed to observe the most prudent medical procedure under the circumstances to
prevent the complications suffered by a child of tender age.
As to the Award of
Damages
While no criminal
negligence was found in the petitioners failure to administer the necessary
medical attention to Roy Jr., the Court holds them civilly liable for the
resulting damages to their patient. While it was the taxi driver who ran over the
foot or leg of Roy Jr., their negligence was doubtless contributory.
It appears undisputed that the amount
of ₱3,850.00, as expenses incurred by patient Roy Jr., was adequately
supported by receipts. The Court, therefore, finds the petitioners liable to
pay this amount by way of actual damages.
The Court is aware that
no amount of compassion can suffice to ease the sorrow felt by the family of
the child at that time. Certainly, the award of moral and exemplary damages in
favor of Roy Jr. in the amount of ₱100,000.00 and ₱50,000.00,
respectively, is proper in this case.
It is settled that moral damages are not
punitive in nature, but are designed to compensate and alleviate in some way
the physical suffering, mental anguish, fright, serious anxiety, besmirched
reputation, wounded feelings, moral shock, social humiliation, and similar
injury unjustly inflicted on a person. Intended for the restoration of the
psychological or emotional status quo ante, the award of moral damages is
designed to compensate emotional injury suffered, not to impose a penalty on
the wrongdoer.[23]
The Court, likewise, finds the petitioners
also liable for exemplary damages in the said amount. Article 2229 of the Civil
Code provides that exemplary damages may be imposed by way of example or
correction for the public good.
WHEREFORE, the petition is PARTLY GRANTED.
The Decision of the Court of Appeals dated
(1) ₱3,850.00 as actual damages;
(2)
₱100,000.00 as moral damages;
(3)
₱50,000.00 as exemplary damages; and
(4)
Costs of the suit.
with interest at the rate of 6% per
annum from the date of the filing of the Information. The rate shall be 12%
interest per annum from the finality of judgment until fully paid.
SO
ORDERED.
JOSE
CATRAL
Associate
Justice
WE CONCUR:
ANTONIO T. CARPIO
Associate Justice
DIOSDADO M. PERALTA ROBERTO
A. ABAD
Associate Justice Associate Justice
Acting Chairperson
JOSE
Associate Justice
A T T E S T A T I O N
I attest that the conclusions in the above Decision
had been reached in consultation before the case was assigned to the writer of
the opinion of the Courts Division.
DIOSDADO M. PERALTA
Associate Justice
Acting Chairperson, Third Division
C E R T I F I C A T I O N
Pursuant to Section 13, Article VIII of the
Constitution and the Division Acting Chairpersons Attestation, I certify that
the conclusions in the above Decision had been reached in consultation before
the case was assigned to the writer of the opinion of the Courts Division.
RENATO
C. CORONA
Chief Justice
* Designated as additional member in lieu of
Associate Justice Presbitero J. Velasco, Jr., per Special Order No. 1185 dated
** Designated
as Acting Chairperson, per Special Order No.
1184 dated
***
Designated as additional member in lieu of Associate Justice Estela M.
Perlas-Bernabe, per Special Order No.
1192 dated
[1] See the case of Dr. Batiquin v. Court of Appeals, 327 Phil. 965 (1996).
[2] Rollo, pp. 50-65. Penned by Associate Justice Isaias Dicdican, with Associate Justice Juan Q. Enriquez, Jr. and Associate Justice Marlene Gonzales-Sison, concurring.
[3]
[4]
[5] No first name on record.
[6] Rollo, p. 79.
[7]
[8]
[9]
[10] Also quoted in the case of Layugan v. Intermediate Appellate Court, 249 Phil. 363, 377 (1988).
[11] Dr. Batiquin v. CA, supra note 1, at 979-980.
[12] Reyes
v. Sisters of
[13] TSN,
[14] Gaid v. People, G.R. No. 171636,
[15]
[16]
[17] TSN,
[18] Balitaosan v. The Secretary of Education, 457 Phil. 300, 304 (2003).
[19] Del
Rosario v. Bonga, 402 Phil. 949, 957-958 (2001).
[20] G.R.
No. 178763,
[21] TSN,
[22] As quoted in the case of Ruez, Jr. v. Jurado, 513 Phil. 101, 106 (2005).
[23]