Speaking for itself

This is a novel case about medical malpractice or the liability of a surgeon, anesthesio logist and a hospital for damages due to the negligence in the performance of their duties to a patient. In this case, the court likewise explains the doctrine of Res Ipsa Loquitur which means the “thing or transaction speaks for itself,” and when it can be used in determining whether negligence really exists.

This case involves Marta, a 47-year-old robust woman married to Ramon, a telecommunications executive, with three sons, Romy, Ray and Randy. She is as normal as any other woman except for some discomforts that interfered with her normal ways. So she sought professional advice and was told to undergo an operation for the removal of a stone in her gall bladder. After a series of examinations which included blood and urine tests, she was found fit for surgery and was scheduled for operation.

On the day of the surgery, she went to the hospital and placed herself under the care, custody and control of Dr. Losada, the surgeon who will operate on her, and Dr. Cruz, the anesthesiologist recommended by Dr. Losada who will administer the anesthesia on her. On that day, Marta was neurologically sound, and except for a few minor discomforts, was physically fit in mind and body. However Dr. Losada was late for about three hours and during the administration of the anesthesia prior to the actual surgery, she suffered irreparable damage to her brain as a result of lack of oxygen for four to five minutes and was thus confined at the intensive care unit (ICU). She remained in the hospital for about four months during which Ramon had to spend P8,000 a month. And when she was discharged she still needed constant medical attention as she was diagnosed to be suffering from brain damage.

So a complaint for damages was filed before the Regional Trial Court (RTC) by Marta and Ramon and their children against Dr. Losada, Dr. Cruz and the hospital, alleging negligence in the treatment and care of Marta. Ramon and her sister Caridad who was dean of the college of nursing in another hospital and who was present during the surgical operation testified, to prove their complaint. Drs. Lozada, Cruz and the hospital denied the charge and claimed that Marta’s brain damage was due to her allergic reaction to the anesthetic agent.

After trial the RTC rendered judgment in favor of Ramon and Marta ruling that Dr. Losada, Dr. Cruz and the hospital are guilty of negligence in the performance of their duty to Marta. So Drs Lozada, Cruz and the hospital was ordered to pay the actual, moral, exemplary damages and attorney’s fees totaling P1,732,000. On appeal, the Court of Appeals (CA), reversed the decision of the RTC and dismissed the complaint. The CA even ordered Ramon et.al. to pay the unpaid hospital bills.

The Supreme Court however reversed the CA decision. The SC said that although generally, expert medical testimony is relied upon in malpractice suits to prove that a physician has done a negligent act or that he deviated from the standard medical procedure, such expert testimony applies only to such matters clearly within the domain of medical science and not to matters that are within the common knowledge of mankind which may be testified to by anyone familiar with the facts. In this case the doctrine of Res Ipsa Loquitur may be used because the injury itself provides the proof of negligence. Under this doctrine, 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. Here, the defendants were unable to disprove the presumption of negligence on their part in the care of Marta and their negligence was the cause of her piteous condition, based on said doctrine. So Dr. Cruz is negligent in the anesthesia phase as she failed to properly place the tube on the patient as testified by Caridad, the nurse- sister-in-law of Marta. In fact, the defendants themselves admitted that the first intubation was a failure thus necessitating another anesthesiologist. Dr. Losada is also negligent because of his failure to determine whether his anesthesiologist Dr. Cruz, properly intubated the patient. Besides he was also three hours late for the operation. The hospital is also liable here because it did not exercise the diligence of a good father of a family in the hiring and supervision of the doctors and consultant staff with whom it has employer-employee relationship, since it has control in their hiring and firing. So Ramon and Marta and their children should be awarded actual, moral temperate damages and attorney’s fees totaling P5,402,000.(Ramos etc. vs Court of Appeals et al., G.R. 124354, December 29, 1999).