Cruz vs CA (GR No. 122445 November 18, 1997)

Cruz vs Court of Appeals
GR No. 122445 November 18, 1997

Facts: On March 22, 1991, prosecution witness, Rowena Umali de Ocampo, accompanied her mother to the Perpetual Help Clinic and General Hospital situated in Balagtas Street, San Pablo City, Laguna. They arrived at the said hospital at around 4:30 in the afternoon of the same day. Prior to March 22, 1991, Lydia was examined by the petitioner who found a “Myoma” in her uterus, and scheduled her for a hysterectomy operation on March 23, 1991. Rowena and her mother slept in the clinic on the evening of March 22, 1991 as the latter was to be operated on the next day at 1pm. According to Rowena, she noticed that the clinic was untidy and the windows and the floor were very dusty prompting her to ask the attendant fora rag to wipe the window and floor with. Prior to the operation, Rowena tried to convince her mother to not proceed with the operation and even asked petitioner for it to be postponed, however it still pushed through after the petitioner told Lydia that operation must be done as scheduled. During the operation, the assisting doctor of the petitioner, Dr. Ercillo went out of the operating room and asked that tagmet ampules be bought which was followed by another instruction to buy a bag of blood. After the operation, when Lydia came out of the OR, another bag of blood was requested to be bought, however, the same was not bought due to unavailability of type A from the blood bank. Thereafter a person arrived to donate blood which was later transferred to Lydia. Rowena then noticed her mother, who was attached to an oxygen tank, gasping for breathe apparently, the oxygen tank is empty, so her husband and petitioner’s driver bought an oxygen. Later, without the knowledge of Lydia’s relatives,she was decided by the doctors to be transferred to San Pablo District Hospital were she was supposed to be re-operated. After Lydia experienced shocks, she died.

Issue: Whether or not petitioner has been negligent which caused the death of Lydia Umali.

Held: Yes. Whether or not a physician has committed an “inexcusable lack of precaution” in the treatment of his patient 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. 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. It is in this aspect of medical malpractice that expert testimony is essential to establish not only the standard of care of the profession but also that the physician’s conduct in the treatment and care falls below such standard. Further, in as much as the causes of the injuries involved in malpractice actions are determinable only in the light of scientific knowledge, it has been recognized that expert testimony is usually necessary to the conclusion as to causation.

In litigations involving medical negligence, the plaintiff has the burden of establishing appellant’s negligence and for a reasonable conclusion of negligence, there must be proof of breach of duty on the part of the surgeon as well as  causal connection of such breach and the resulting death of his patient.

In order that there may be recovery for an injury, however, it must be shown that the injury for which recovery is sought must be legitimate consequence of the wrong done; the connection between the negligence and the injury must be a direct and natural reference of events, unbroken by intervening efficient causes. In other words, the negligence must be the proximate cause of the injury. For negligence, no matter what it consists, cannot create a right of action unless it is the proximate cause of the injury complained of and 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 have occurred.

The elements of reckless 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 reckless 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.

The possible causes of hemorrhage during an operation are: 1.) the failure of the surgeon to tie or suture a cut blood vessel; 2.) allowing a cut blood vessel to get out of control; 3.) the subsequent loosening of the tie or suture applied to a cut blood vessel; and 4.)and a clotting defect known as DIC.


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