Case Name: Ramos vs.

CA By: Kylee Navarro

GR No. 124354 Topic: Medical Malpractice
Date: December 29, 1999
FACTS
Erlinda Ramos had occasional discomforts due to pains caused by the presence of a gall bladder stone. She was advised by a
professional to undergo an operation for the removal of the stone after a series of examinations. Dr. Orlino Hozaka, a doctor of
DLSMC, was to perform a cholecystectomy operation to Erlinda. On the other hand, Dr. Perfecta Gutierrez was to administer
the anesthesia.

On the day of the operation, a family member of Erlinda and the Dean of the College of Nursing, was allowed to stay inside the
operating room with Erlinda. When Dr. Gutierrez was intubating Erlinda, Herminda noticed a bluish discoloration of the
nailbeds of the left hand of Erlinda. She called another anesthesiologist, Dr. Calderon, who intubated Erlinda again and placed
her in a trendelenburg position - a position where the head of the patient is placed in a position lower than her feet which is an
indication that there is a decrease of blood supply on her brain. A few moments later, Erlinda was taken to the ICU. Dr. Hozaka
explained that something went wrong with the intubation and explained that Erlinda had bronchospasm.

Erlinda was in a comatose condition for about four months, hence her hospital bills ballooned. Even after her discharge,
Rogelio still incurs monthly expenses because of Erlindas constant need for medical attention. Thus, he filed a case for
Damages with RTC against for alleged negligence in the management and care of Erlinda Ramos. However, the respondents
countered that the damage sustained by Erlinda was caused by her allergic reaction to the anesthetic agent.

The RTC ruled in favor of the petitioners, holding the respondents liable for negligence in the performance of their duties. The
CA, however, reversed the RTCs decision and granted DLSMCs counterclaim and ordered the petitioners to pay the unpaid
hospital bills plus legal interest.
ISSUE: Whether or not respondent physicians and hospital are liable for negligence in the performance of their duties
HELD: YES. The Supreme Court applied the doctrine of res ipsa loquitur in finding that the respondents negligence
caused the damages sustained by Erlinda.

Res ipsa loquitur is a maxim for the rule that the fact of the occurrence of an injury, taken with the surrounding circumstances,
may permit an inference or raise a presumption of negligence, or make out a plaintiffs prima facie case, and present a question
of fact for defendant to meet with an explanation. However, the same is not available in a malpractice suit if the only showing is
that the desired result of an operation or treatment was not accomplished. In this case, however, the doctrine can be
appropriately applied. The brain damage which Erlinda sustained is an injury which does not normally occur in the process of a
gall bladder operation An injury or damage is proximately caused by an act or a failure to act, whenever it appears from the
evidence in the case, that the act or omission played a substantial part in bringing about or actually causing the injury or
damage; and that the injury or damage was either a direct result or a reasonably probable consequence of the act or omission.
Thus, the Court concluded that the wrongful intubation of Erlinda was the proximate cause of her comatose condition.

Dra. Gutierrez was exceptionally negligent in the care of Erlinda during the anesthesia phase as she failed to properly intubate
the patient. Moreover, there was no prior consultations with or pre-operative evaluation of Erlinda done by her. As to Dr.
Hozaka, he was negligent in his failure to exercise the proper authority, as the head of the surgical team, in not determining if
his anesthesiologist observed proper anesthesia protocols. As to DLSMC, it failed to provide proof of its exercise the diligence
of a good father of a family in the hiring and supervision of the respondent physicians. For the purpose of allocating
responsibility in medical negligence cases, an employer-employee relationship in effect exists between hospitals and their
attending and visiting physicians. Consequently, it is solidarily responsible with the doctors for Erlindas condition.

Hence, the respondents were unable to disprove the presumption of negligence on their part in the care of Erlinda and their
negligence was the proximate cause of her piteous condition.
Doctrine: Notes
Res ipsa loquitur is a maxim for the rule that the fact of the occurrence of an Before the doctrine may be allowed, the
injury, taken with the surrounding circumstances, may permit an inference or raise following requisites must be shown: (1)The
a presumption of negligence, or make out a plaintiffs prima facie case, and accident is of a kind which ordinarily does
present a question of fact for defendant to meet with an explanation. However, the not occur in the absence of someones
negligence; (2) It is caused by an
same is not available in a malpractice suit if the only showing is that the desired instrumentality within the exclusive control
result of an operation or treatment was not accomplished. of the defendant/s; and (3) The possibility
of contributing conduct which would make
An injury or damage is proximately caused by an act or a failure to act, whenever the plaintiff responsible is eliminated.
it appears from the evidence in the case, that the act or omission played a Amount of damages awarded may be a
substantial part in bringing about or actually causing the injury or damage; and continuing one where the injury is chronic
that the injury or damage was either a direct result or a reasonably probable and continuing, as when the patient is
consequence of the act or omission. comatose.