gr 124354 case

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FIRST DIVISION[G.R. No. 124354. April 11, 2002]

ROGELIO E. RAMOSand ERLINDA RAMOS, in their own behalf and as natural guardians of the minors,ROMMEL RAMOS, ROY RODERICK RAMOS, and RON RAYMOND RAMOS,petitioners,vs.COUR O! A""EALS, DE LOS SANOS MEDICAL CENER, DR. ORLINO #OSAKAand DR."ER!ECA GUIERRE$, respondents.

R E S O L U I O N

KA"UNAN, J.%

Private resondents De !os Santos "edi#al $enter, Dr. Orlino %osa&a and Dr. Perfe#ta 'utierre( move fora re#onsideration of the De#ision, dated De#ember )*, +***, of this $ourt holding them #ivill liable foretitioner -rlinda Ramos #omatose #ondition after she delivered herself to them for their rofessional #are andmanagement.

For better understanding of the issues raised in rivate resondents rese#tive motions, we will brieflrestate the fa#ts of the #ase as follows

Sometime in +*/0, etitioner -rlinda Ramos, after see&ing rofessional medi#al hel, was advised toundergo an oeration for the removal of a stone in her gall bladder 1 cholecystectomy2. She was referred to Dr%osa&a, a surgeon, who agreed to erform the oeration on her. The oeration was s#heduled for 3une +4, +*/0at *55 in the morning at rivate resondent De !os Santos "edi#al $enter 1D!S"$2. Sin#e neither etitioner-rlinda nor her husband, etitioner Rogelio, &new of an anesthesiologist, Dr. %osa&a re#ommended to themthe servi#es of Dr. 'utierre(.

Petitioner -rlinda was admitted to the D!S"$ the da before the s#heduled oeration. 6 475 in themorning of the following da, etitioner -rlinda was alread being reared for oeration. 8on the re9uest ofetitioner -rlinda, her sister:in:law, %erminda $ru(, who was then Dean of the $ollege of Nursing at the$aitol "edi#al $enter, was allowed to a##oman her inside the oerating room.

;t around *75 in the morning, Dr. %osa&a had not et arrived so Dr. 'utierre( tried to get in tou#h withhim b hone. Thereafter, Dr. 'utierre( informed $ru( that the oeration might be delaed due to the latearrival of Dr. %osa&a. In the meantime, the atient, etitioner -rlinda said to $ru(, "ind, inip na inip na akoikuha mo ako ng ibang Doctor.

6 +555 in the morning, when Dr. %osa&a was still not around, etitioner Rogelio alread wanted to ullout his wife from the oerating room. %e met Dr. 'ar#ia, who remar&ed that he was also tired of waiting for Dr.%osa&a. Dr. %osa&a finall arrived at the hosital at around +)+5 in the afternoon, or more than three 172hours after the s#heduled oeration.

$ru(, who was then still inside the oerating room, heard about Dr. %osa&as arrival.

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#ourt found that rivate resondents were negligent in the erforman#e of their duties to -rlinda. On aeal brivate resondents, the $ourt of ;eals reversed the trial #ourts de#ision and dire#ted etitioners to a theirunaid medi#al bills to rivate resondents.

Petitioners filed with this $ourt a etition for review on #ertiorari. The rivate resondents were thenre9uired to submit their rese#tive #omments thereon. On De#ember )*, +***, this $ourt romulgated thede#ision whi#h rivate resondents now see& to be re#onsidered. The disositive ortion of said De#isionstates

ERE!ORE, the de#ision and resolution of the aellate #ourt aealed from are herebmodified so as to award in favor of etitioners, and solidaril against rivate resondents thefollowing +2 P+,70),555.55 as a#tual damages #omuted as of the date of romulgation of thisde#ision lus a monthl ament of P/,555.55 u to the time that etitioner -rlinda Ramos e=iresor mira#ulousl survives@ )2 P),555,555.55 as moral damages, 72 P+,055,555.55 as temeratedamages@ A2 P+55,555.55 ea#h e=emlar damages and attornes fees@ and 02 the #osts of the suit. ii

In his "otion for Re#onsideration, rivate resondent Dr. %osa&a submits the following as groundstherefor

I

T%- %ONOR;6!- S8PR-"- $O8RT $O""ITT-D R-V-RSI6!- -RROR

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T-STI"ONC OF DR. 3;"OR; ;ND DR;. $;!D-RON

-. T%- %ONOR;6!- S8PR-"- $O8RT ";C %;V- IN;DV-RT-NT!C ;

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has been suffi#ientl established that she failed to e=er#ise the standards of #are in the administration ofanesthesia on a atient. Dr. -ga enlightened the $ourt on what these standards are

= = =

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-rlinda that #aused her #omatose #ondition. There is no 9uestion that -rlinda be#ame #omatose after Dr.'utierre( erformed a medi#al ro#edure on her. -ven the #ounsel of Dr. 'utierre( admitted to this fa#t duringthe oral arguments

$%I-F 38STI$-

"r. $ounsel, ou started our argument saing that this involves a #omatose atientH

;TTC. ';N;

Ces, Cour %onor.

$%I-F 38STI$-

%ow do ou mean b that, a #omatose, a #omatose after an other a#ts were done b Dr. 'utierre( or#omatose before an a#t was done b herH

;TTC. ';N;

No, we meant #omatose as a final out#ome of the ro#edure.

$%I-F 38STI$-

"eaning to sa, the atient be#ame #omatose after some intervention, rofessional a#ts have been doneb Dr. 'utierre(H

;TTC. ';N;

Ces, Cour %onor.

$%I-F 38STI$-

In other words, the #omatose status was a #onse9uen#e of some a#ts erformed b D. 'utierre(H

;TTC. ';N;

It was a #onse9uen#e of the well, 1interruted2

$%I-F 38STI$-

;n a#ts erformed b her, is that not #orre#tH

;TTC. ';N;

Ces, Cour %onor.

$%I-F 38STI$-

Than& ou.=vii

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In a wa it is some form of resonse to ta&e awa that whi#h is not mine, whi#h is not art of the bod.So, histamine has multile effe#ts on the bod. So, one of the effe#ts as ou will see ou will haveredness, if ou have an allerg ou will have tearing of the ees, ou will have swelling, ver #ru#ialswelling sometimes of the larnges whi#h is our voi#e bo= main airwa, that swelling ma be enough toobstru#t the entr of air to the tra#hea and ou #ould also have #ontra#tion, #onstri#tion of the smallerairwas beond the tra#hea, ou see ou have the tra#hea this wa, we brought some visual aids butunfortunatel we do not have a ro?e#tor. ;nd then ou have the smaller airwas, the bron#hi and theneventuall into the mass of the lungs ou have the bron#hus. The differen#e is that these tubes have alsoin their walls mus#les and this arti#ular &ind of mus#les is smooth mus#le so, when histamine is

released the #lose u li&e this and that henomenon is &nown as bron#o sasm. %owever, the effe#ts ofhistamine also on blood vessels are different. The dilate blood vessel oen u and the atient or

whoever has this histamine release has hertension or low blood ressure to a oint that the atientma have de#rease blood sul to the brain and ma #ollase so, ou ma have eole who have this. ==

These smtoms of an allergi# rea#tion were not shown to have been e=tant in -rlindas #ase. ;s we held inour De#ision, no eviden#e of stridor, s&in rea#tions, or whee(ing some of the more #ommon a##omaningsigns of an allergi# rea#tion aears on re#ord. No laborator data were ever resented to the #ourt. ==i

Dr. 'utierre(, however, insists that she su##essfull intubated -rlinda as eviden#ed b the fa#t that she wasrevived after suffering from #ardia# arrest. Dr. 'utierre( faults the $ourt for giving #reden#e to the testimon of$ru( on the matter of the administration of anesthesia when she 1$ru(2, being a nurse, was allegedl not9ualified to testif thereon. Rather, Dr. 'utierre( invites the $ourts attention to her snosis on what

transired during -rlindas intubation

12:15 p.m.Patient was indu#ted with sodium entothal ).0J 1)05 mg2 given b slow IV. 5) was startedb mas&. ;fter entothal in?e#tion this was followed b IV in?e#tion of Nor#uron Amg. ;fter) minutes 5) was given b ositive ressure for about one minute. Intubation withendotra#heal tube 4.0 m in diameter was done with slight diffi#ult 1short ne#& K slightlrominent uer teeth2 #hest was e=amined for breath sounds K #he#&ed if e9ual on bothsides. The tube was then an#hored to the mouth b laster K #uff inflated. -thrane )J with5) A liters was given. 6lood ressure was #he#&ed +)5/5 K heart rate regular and normal*5min.

12:25 p.m.;fter +5 minutes atient was #anoti#. -thrane was dis#ontinuedK 5) given alone.$anosis disaeared. 6lood ressure and heart beats stable.

12:! p.m. $anosis again reaeared this time with sibilant and sonorous rales all over the #hest.DL0JL%)5 K + amule of aminohline b fast dri was started. Still the #anosis wasersistent. Patient was #onne#ted to a #ardia# monitor. ;nother amule of of si#Gaminohline was given and solu #ortef was given.

12:"! p.m. There was #ardia# arrest. -=tra #ardia# massage and inter#ardia# in?e#tion of adrenalinwas given K heart beat reaeared in less than one minute. Sodium bi#arbonate K anotherdose of solu #ortef was given b IV. $anosis slowl disaeared K 5) #ontinuousl given Kassisted ositive ressure. !aborator e=ams done 1see results in #hart2.

Patient was transferred to I$8 for further management.==ii

From the foregoing, it #an be allegedl seen that there was no withdrawal 1e=tubation2 of the tube. ;nd the

fa#t that the #anosis allegedl disaeared after ure o=gen was sulied through the tube roved that it wasroerl la#ed.

The $ourt has reservations on giving evidentiar weight to the entries urortedl #ontained in Dr.'utierre( snosis. It is signifi#ant to note that the said re#ord reared b Dr. 'utierre( was made onl after-rlinda was ta&en out of the oerating room. The standard ra#ti#e in anesthesia is that ever single a#t thatthe anesthesiologist erforms must be re#orded. In Dr. 'utierre( #ase, she #ould not a##ount for at least ten1+52 minutes of what haened during the administration of anesthesia on -rlinda. The following e=#hange

between Dr. -strella, one of the amicii curiae, and Dr. 'utierre( is instru#tive

DR. -STR-!!;

Cou mentioned that there were two 1)2 attemts in the intubation eriodH

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DR. '8TI-RR-E

Ces.

>There were two attemts. In the first attemt was the tube inserted or was the larngos#oe onl inserted,whi#h was insertedH

; ;ll the larngos#oe.

> ;ll the larngos#oe. 6ut if I remember right somewhere in the re:dire#t, a #ertain lawer, ou wereas&ed that ou did a first attemt and the 9uestion was did ou withdraw the tubeH ;nd ou said ounever withdrew the tube, is that rightH

; Ces.

> Ces. ;nd so if ou never withdrew the tube then there was no, there was no insertion of the tube duringthat first attemt. Now, the other thing that we have to settle here is when #anosis o##urred, is itre#orded in the anesthesia re#ord when the #anosis, in our re#ording when did the #anosis o##urH

; 1si#2

> Is it a standard ra#ti#e of anesthesia that whatever ou do during that eriod or from the time ofindu#tion to the time that ou robabl get the atient out of the oerating room that ever singlea#tion that ou do is so re#orded in our anesthesia re#ordH

; I was not able to re#ord everthing I did not have time anmore be#ause I did that after the, when theatient was about to leave the oerating room. ;nd the first medi#ation ou gave was whatH

; The first medi#ation, no, first the atient was o=genated for around one to two minutes.

> Ces, so, that is about +)+7H

; Ces, and then, I as&ed the resident hsi#ian to start giving the entothal ver slowl and that wasaround one minute.

> So, that is about +)+7 no, +)+0, +)+4H

; Ces, and then, after one minute another o=genation was given and after 1interruted2

> +)+/H

; Ces, and then after giving the o=gen we start the menor#ure whi#h is a rela=ant. ;fter that rela=ant1interruted2

> ;fter that rela=ant, how long do ou wait before ou do an maniulationH

; 8suall ou wait for two minutes or three minutes.

> So, if our estimate of the time is a##urate we are now more or less +)+*, is that rightH

; "abe.

> +)+*. ;nd at that time, what would have been done to this atientH

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; ;fter that time ou e=amine the, if there is rela=ation of the ?aw whi#h ou ush it downwards and whenI saw that the atient was rela= be#ause that monor#ure is a rela=ant, ou #annot intubate the atient orinsert the larngos#oe if it is not &eeing him rela=. So, m first attemt when I ut the larngos#oeon I saw the tra#hea was deel interiorl. So, what I did as& mahira ata ito ah. So, I removed thelarngos#oe and o=genated again the atient.

> So, more or less ou attemted to do an intubation after the first attemt as ou #laimed that it was onlthe larngos#oe that was inserted.

; Ces.

> ;nd in the se#ond attemt ou inserted the larngos#oe and now ossible intubationH

; Ces.

> ;nd at that oint, ou made a remar&, what remar& did ou ma&eH

; I said mahira ata ito when the first attemt I did not see the tra#hea right awa. That was when I1interruted2

> That was the first attemtH

; Ces.

> ;t what oint, for uroses of dis#ussion without a##eting it, at what oint did ou ma&e the #ommentna mahira ata to intubate, mali ata ang inasu&an

; I did not sa mali ata ang inasu&an I never said that.

> ;t what ointH

; So, when ou #laim that at the first attemt ou inserted the larngos#oe, rightH

; Ces.

> 6ut in one of the re#ordings somewhere at the, somewhere in the trans#rit of re#ords that when thelawer of the other art tr to in9uire from ou during the first attemt that was the time whenmaroon ba &aong hinugot sa tube, I do not remember the age now, but it seems to me it is there. So,

that it was on the se#ond attemt that 1interruted2; I was able to intubate.

> ;nd this is more or less about what time +))+H

; "abe, I #annot remember the time, Sir.

> O&a, assuming that this was done at +))+ and loo&ing at the anesthesia re#ords from +))5 to +)75there was no re#ording of the vital signs. ;nd #an we resume that at this stage there was alread someroblems in handling the atientH

; Not et.

> 6ut wh are there no re#ordings in the anesthesia re#ordH

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; I did not have time.

> ;h, ou did not have time, wh did ou not have timeH

; 6e#ause it was so fast, I reall 1at this ?un#ture the witness is laughing2

> No, I am ?ust as&ing. Remember I am not here not to in oint on anbod I am here ?ust to more orless #larif #ertaint more ore less on the re#ord.

; Ces, Sir.

> ;nd so it seems that there were no re#ording during that san of ten 1+52 minutes. From +))5 to +)75,and going over our narration, it seems to me that the #anosis aeared ten 1+52 minutes afterindu#tion, is that rightH

; Ces.

> ;nd that is after indu#tion +)+0 that is +))0 that was the first #anosisH

; Ces.

> ;nd that the +))0 is after the +))5H

; %uwag ho &aong ma&uwan, we are ?ust tring to enlighten, I am ?ust going over the re#ord ano, &ung

mali ito &uwan eh di ano. So, ganoon o ano, that it seems to me that there is no re#ording from +))5to +)75, so, I am ?ust wondering wh there were no re#ordings during the eriod and then of #ourse these#ond #anosis, after the first #anosis. I thin& that was the time Dr. %osa&a #ame inH

; No, the first #anosis 1interruted2.==iii

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rendered de#erebrate as a #onse9uen#e of administering su#h anesthesia in the absen#e of negligen#e. 8onthese fa#ts and under these #ir#umstan#es, a laman would be able to sa, as a matter of #ommon &nowledgeand observation, that the #onse9uen#es of rofessional treatment were not as su#h as would ordinaril havefollowed if due #are had been e=er#ised.==i=$onsidering the ali#ation of the do#trine of res ipsa loquitur, thetestimon of $ru( was roerl given #reden#e in the #ase at bar.

For his art, Dr. %osa&a mainl #ontends that the $ourt erred in finding him negligent as a surgeon baling the $atain:of:the:Shi do#trine.===Dr. %osa&a argues that the trend in 8nited States ?urisruden#ehas been to re?e#t said do#trine in light of the develoments in medi#al ra#ti#e. %e oints out that

anesthesiolog and surger are two distin#t and se#iali(ed fields in medi#ine and as a surgeon, he is notdeemed to have #ontrol over the a#ts of Dr. 'utierre(. ;s anesthesiologist, Dr. 'utierre( is a se#ialist in herfield and has a#9uired s&ills and &nowledge in the #ourse of her training whi#h Dr. %osa&a, as a surgeon, doesnot ossess.===i%e states further that #urrent ;meri#an ?urisruden#e on the matter re#ogni(es that the trendtowards se#iali(ation in medi#ine has #reated situations where surgeons do not alwas have the right to#ontrol all ersonnel within the oerating room,===iiese#iall a fellow se#ialist.===iii

Dr. %osa&a #ites the #ase of (homas v. )aleigh *eneral +ospital,'''ivwhi#h involved a suit filed b aatient who lost his voi#e due to the wrongful insertion of the endotra#heal tube rearator to theadministration of anesthesia in #onne#tion with the laarotom to be #ondu#ted on him. The atient sued boththe anesthesiologist and the surgeon for the in?ur suffered b him. The Sureme $ourt of ;eals of

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resonsibilit to treat the atient, whi#h resonsibilit ne#essitates that the #all ea#h others attention to the#ondition of the atient while the other hsi#ian is erforming the ne#essar medi#al ro#edures.

It is e9uall imortant to oint out that Dr. %osa&a was remiss in his dut of attending to etitioner-rlinda romtl, for he arrived more than three 172 hours late for the s#heduled oeration. Thecholecystectomywas set for 3une +4, +*/0 at *55 a.m., but he arrived at D!S"$ onl at around +)+5 .m. Inre#&less disregard for his atients well being, Dr. %osa&a s#heduled two ro#edures on the same da, ?ust thirtminutes aart from ea#h other, at different hositals. Thus, when the first ro#edure 1rotos#o2 at the StaTeresita %osital did not ro#eed on time, -rlinda was &et in a state of un#ertaint at the D!S"$.

The unreasonable dela in etitioner -rlindas s#heduled oeration sub?e#ted her to #ontinued starvationand #onse9uentl, to the ris& of a#idosis,=lor the #ondition of de#reased al&alinit of the blood and tissues,mar&ed b si#&l sweet breath, heada#he, nausea and vomiting, and visual disturban#es. =liThe long eriod thatDr. %osa&a made -rlinda wait for him #ertainl aggravated the an=iet that she must have been feeling at thetime. It #ould be safel said that her an=iet adversel affe#ted the administration of anesthesia on her. ;se=lained b Dr. $amaga, the atients an=iet usuall #auses the outouring of adrenaline whi#h in turnresults in high blood ressure or disturban#es in the heart rhthm

DR. $;";';C

= = = Pre:oerative medi#ation has three main fun#tions One is to alleviate an=iet. Se#ond is todr u the se#retions and Third is to relieve ain. Now, it is ver imortant to alleviate an=iet be#ausean=iet is asso#iated with the outouring of #ertain substan#es formed in the bod #alled adrenalin

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In other words due diligen#e would re9uire a surgeon to #ome on timeH

DR. $;";';C

I thin& it is not even due diligen#e it is #ourtes.

$%I-F 38STI$-

$ourtes.

DR. $;";';C

;nd #are.

$%I-F 38STI$-

Dut as a matter of fa#tH

DR. $;";';C

Ces, Cour %onor.=liii

Dr. %osa&as irresonsible #ondu#t of arriving ver late for the s#heduled oeration of etitioner -rlinda isviolative, not onl of his dut as a hsi#ian to serve the interest of his atients with the greatest soli#itudegiving them alwas his best talent and s&ill, =livbut also of ;rti#le +* of the $ivil $ode whi#h re9uires a erson, inthe erforman#e of his duties, to a#t with ?usti#e and give everone his due.

;nent rivate resondent D!S"$s liabilit for the resulting in?ur to etitioner -rlinda, we held thatresondent hosital is solidaril liable with resondent do#tors therefor under ;rti#le )+/5 of the $ivil $ode =l

sin#e there e=ists an emloer:emloee relationshi between rivate resondent D!S"$ and Drs. 'utierre(and %osa&a

In other words, rivate hositals, hire, fire and e=er#ise real #ontrol over their attending andvisiting #onsultant staff.

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staff as a#tive or visiting #onsultant is first de#ided uon b the $redentials $ommittee thereof, whi#h is#omosed of the heads of the various se#ialt deartments su#h as the Deartment of Obstetri#s and'ne#olog, Pediatri#s, Surger with the deartment head of the arti#ular se#ialt alied for as #hairman.The $redentials $ommittee then re#ommends to D!S"$s "edi#al Dire#tor or %osital ;dministrator thea##etan#e or re?e#tion of the ali#ant hsi#ian, and said dire#tor or administrator validates the #ommitteesre#ommendation.liiSimilarl, in #ases where a dis#ilinar a#tion is lodged against a #onsultant, the same isinitiated b the deartment to whom the #onsultant #on#erned belongs and filed with the -thi#s $ommittee#onsisting of the deartment se#ialt heads. The medi#al dire#torhosital administrator merel a#ts as e=:offi#io member of said #ommittee.

Neither is there an showing that it is D!S"$ whi#h as an of its #onsultants for medi#al servi#esrendered b the latter to their rese#tive atients. "oreover, the #ontra#t between the #onsultant in resondenthosital and his atient is searate and distin#t from the #ontra#t between resondent hosital and saidatient. The first has for its ob?e#t the rendition of medi#al servi#es b the #onsultant to the atient, while these#ond #on#erns the rovision b the hosital of fa#ilities and servi#es b its staff su#h as nurses and laboratorersonnel ne#essar for the roer treatment of the atient.

Further, no eviden#e was addu#ed to show that the in?ur suffered b etitioner -rlinda was due to afailure on the art of resondent D!S"$ to rovide for hosital fa#ilities and staff ne#essar for her treatment.

For these reasons, we reverse the finding of liabilit on the art of D!S"$ for the in?ur suffered betitioner -rlinda.

Finall, the $ourt also deems it ne#essar to modif the award of damages to etitioners in view of thesuervening event of etitioner -rlindas death. In the assailed De#ision, the $ourt awarded a#tual damages ofOne "illion Three %undred Fift Two Thousand Pesos 1P+,70),555.552 to #over the e=enses for etitioner-rlindas treatment and #are from the date of romulgation of the De#ision u to the time the atient e=ires orsurvives.liiiIn addition thereto, the $ourt awarded temerate damages of One "illion Five %undred ThousandPesos 1P+,055,555.552 in view of the #hroni# and #ontinuing nature of etitioner -rlindas in?ur and the#ertaint of further e#uniar loss b etitioners as a result of said in?ur, the amount of whi#h, however, #ouldnot be made with #ertaint at the time of the romulgation of the de#ision. The $ourt ?ustified su#h award inthis manner

Our rules on a#tual or #omensator damages generall assume that at the time of litigation, thein?ur suffered as a #onse9uen#e of an a#t of negligen#e has been #omleted and that the #ost #an be

li9uidated. %owever, these rovisions negle#t to ta&e into a##ount those situations, as in this #ase,where the resulting in?ur might be #ontinuing and ossible future #omli#ations dire#tl arising fromthe in?ur, while #ertain to o##ur, are diffi#ult to redi#t.

In these #ases, the amount of damages whi#h should be awarded, if the are to ade9uatel and#orre#tl resond to the in?ur #aused, should be one whi#h #omensates for e#uniar loss in#urredand roved, u to the time of trial@ andone whi#h would meet e#uniar loss #ertain to be suffered but

whi#h #ould not, from the nature of the #ase, be made with #ertaint. In other words, temeratedamages #an and should be awarded on to of a#tual or #omensator damages in instan#es where thein?ur is #hroni# and #ontinuing. ;nd be#ause of the uni9ue nature of su#h #ases, no in#omatibilitarises when both a#tual and temerate damages are rovided for. The reason is that these damages#over two distin#t hases.

;s it would not be e9uitableand #ertainl not in the best interests of the administration of?usti#efor the vi#tim in su#h #ases to #onstantl #ome before the #ourts and invo&e their aid in see&ingad?ustments to the #omensator damages reviousl awardedtemerate damages are aroriate.The amount given as temerate damages, though to a #ertain e=tent se#ulative, should ta&e intoa##ount the #ost of roer #are.

In the instant #ase, etitioners were able to rovide onl home:based nursing #are for a #omatoseatient who has remained in that #ondition for over a de#ade. %aving remised our award for#omensator damages on the amount rovided b etitioners at the onset of litigation, it would benow mu#h more in ste with the interests of ?usti#e if the value awarded for temerate damages wouldallow etitioners to rovide otimal #are for their loved one in a fa#ilit whi#h generall se#iali(es insu#h #are. The should not be #omelled b dire #ir#umstan#es to rovide substandard #are at home

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without the aid of rofessionals, for anthing less would be grossl inade9uate. 8nder the#ir#umstan#es, an award of P+,055,555.55 in temerate damages would therefore be reasonable. liv

%owever, subse9uent to the romulgation of the De#ision, the $ourt was informed b etitioner Rogeliothat etitioner -rlinda died on ;ugust 7, +***. lvIn view of this suervening event, the award of temeratedamages in addition to the a#tual or #omensator damages would no longer be ?ustified sin#e the a#tualdamages awarded in the De#ision are suffi#ient to #over the medi#al e=enses in#urred b etitioners for theatient. %en#e, onl the amounts reresenting a#tual, moral and e=emlar damages, attornes fees and #ostsof suit should be awarded to etitioners.

ERE!ORE, the assailed De#ision is hereb modified as follows

1+2 Private resondent De !os Santos "edi#al $enter is hereb absolved from liabilit arising from thein?ur suffered b etitioner -rlinda Ramos on 3une +4, +*/0@

1)2 Private resondents Dr. Orlino %osa&a and Dr. Perfe#ta 'utierre( are hereb de#lared to be solidarilliable for the in?ur suffered b etitioner -rlinda on 3une +4, +*/0 and are ordered to a etitioners

1a2P+,70),555.55 as a#tual damages@

1b2 P),555,555.55 as moral damages@

1#2 P+55,555.55 as e=emlar damages@

1d2 P+55,555.55 as attornes fees@ and1e2 the #osts of the suit.

SO ORDERED.

Davide, r., .., /hairman0, uno, and nares-3antiago, ., #on#ur.

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iSee Decision, pp. 2-5.

iiRollo, p. 217.

iiiId., at 226.

ivId., at 252-253.

vId., at 469.

viId., at 440.

viiId., at 454-455.

viiiResolution, dated Marc 19, 2001, pp. 1-2! Rollo, pp. 543-544.

i"#S$, Marc 19, 2001, p. 51.

"Id., at 1%2-1%4.

"iMe&orandu& o' (&icus )uriae Dr. *lu&inada M. )a&a+a, Rollo, p. 620

"iiDecision, p. 2%, Id.,at 197, citin+ Stoeltin+ and Miller, asics o' (nestesia, p.103

1994/! Me&orandu& o' Dr. )a&a+a, Id., at 616.

"iiiDecision, Id.

"iv#o auscultate &eans to listen to te sounds arisin+ itin or+ans as an aid to

dia+nosis and treat&ent, te e"a&ination ein+ &ade eiter use o' te stetoscope or

direct application o' te ear to te od. esters #ird $e *nternational Dictionar,

p. 145 1976/.

"vDecision, p. 29, Rollo,p. 19%! see also Motion 'or Reconsideration o' Dr. utierre, Id.,at 266.

"viId., at 2%-29! Id., at 197-19%.

"vii#S$, Marc 19, 2001, pp. 77-7%.

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"viiiMotion 'or Reconsideration, p. 54! Rollo, p. 305.

"i"Decision, p. 31! Id.at 200.

""#S$, Marc 19, 2001, pp. 211-212.

""iDecision, p. 34, Rollo, p. 203.

""iiSecond Motion 'or Reconsideration, pp. 6-7! Id., at 421-422.

""iii#S$, Marc 19, 2001, pp. 136-144.

""ivDecision, p. 25 citin+ Stockholm v. Hall, 65 . 34% 1937/! Rollo, p.194.

""vId., at 23-24! Rollo, pp. 192-193.

""viId., at 4.

""viiDecision, p. 20! Id., at 1%9.

""viii364 2d 955 1961/.

""i"Id., at 971.

"""#e )aptain-o'-te-Sip Doctrine as discussed in McConnell v. Williams65 ( 2d 243

1949/, ere te Supre&e )ourt o' ennslvania stated tat under tis doctrine, a

sur+eon is li8ened to a captain o' te sip, in tat it is is dut to control evertin+ +oin+

on in te operatin+ roo&.

"""iMotion 'or Reconsideration o' Dr. osa8a, Rollo, p. 231.

"""iiId., at. 229.

"""iiiId., at 231, citin+ Thomas vs. Raleigh General Hospital, 35% S: 2d 222 19%7/.

"""ivSupra.

"""vId., at 225.

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"""vi#S$, Marc 19, 2001, pp. 11-12.

"""viiId., at 7.

xxxviii The following exchange between Justice Puno and Dr. Hosakas counsel is instructive:JUSTI! "!#$%T& S.

PU$&:

ounsel.

"!T. JUSTI! H&'I(!%:

#es) #our Honor.

JUSTI! "!#$%T& S. PU$&:

*ell) +our thesis is that Dr. Hosaka did not have co,-lete control of the anesthesiologist in this case and therefore

whatever is the negligent act of the anesthesiologist cannot be attributed to Dr. Hosaka) is that a correct a--reciation of +ourthesis


#es) #our Honor.

JUSTI! "!#$%T& S. PU$&:

/ut would +ou agree that even if Dr. Hosaka did not have that co,-lete control nevertheless he had a degree ofsu-ervision over the anesthesiologist


If #our Honor -lease) I think that neither the evidence in this case nor the develo-,ents in the field of ,edicine)

the usual -ractice in these da+s) would lead to that conclusion that he had a degree of su-ervision over the anesthesiologist.

JUSTI! "!#$%T& S. PU$&:

#ou are sa+ing that the surgeon is co,-letel+ inde-endent of the anesthesiologist in the discharge of their

res-ective functions and vice versa


#es) #our Honor.

JUSTI! "!#$%T& S. PU$&:

/ut the record of the case will show that it was Dr. Hosaka who got the services of Dr. 0utierre1) isnt it


#es) #our Honor) when he was given the authorit+ to secure) I understand.

JUSTI! "!#$%T& S. PU$&:

%nd in fact the -atient here did not know of an+ anesthesiologist that is wh+) she gave the authorit+ to Dr. Hosaka

to get the anesthesiologist who will assist hi,


That is correct) #our Honor.

JUSTI! "!#$%T& S. PU$&:

$ow) in the course of the -roceedings in the hos-ital the records would show that it was Dr. Hosaka who observed

the dusk+ nails of the -atient


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#es) #our Honor.

JUSTI! "!#$%T& S. PU$&:

%t a certain 2uncture and this ,eans that c+anosis was setting in) lack of ox+gen on the -art of the -atient


#es) #our Honor.

JUSTI! "!#$%T& S. PU$&:

$ow) if the two) Dra. 0utierre1 and Dr. Hosaka) are co,-letel+ inde-endent of each other) wh+ is it that Dr.Hosaka has to call the attention of Dra. 0utierre1 on this develo-,ent about this c+anosis of the -atient


In the first -lace) #our Honor) I was infor,ed that according to Dr. Hosaka in his testi,on+) he said that it is his

habit to take a look at the hands of the -atient while the+ are undergoing anesthesia and when he noticed the duskiness ofthe nailbeds he infor,ed Dr. 0utierre1 about it. /ut he left her entirel+ free to do whatever ste-s she would like to take) as

in this case) I understand that she sto--ed the ad,inistration 3of4 the anesthesia and 5interru-ted6

JUSTI! "!#$%T& S. PU$&:

#es) but that does show that the surgeon) Dr. Hosaka should not be co,-letel+ indifferent to what is ha--ening tothe -atient while in the hands of the anesthesiologist) isnt it


In a sense) #our Honor) +es) the+ coordinate in that sense) #our Honor) but not) I would not sa+ that one is under

the control of the other.

JUSTI! "!#$%T& S. PU$&:

#es) not under the control) now) +ou used the word coordinate) so +ou are now conceding that there is that degree

of su-ervision on the -art of the surgeon over the anesthesiologist) as a ,atter of defining that degree of su-ervision) the+

are not co,-letel+ inde-endent of each other


#our Honor) I would not use the word su-ervision but working together) -erha-s is a better ter,.

JUSTI! "!#$%T& S. PU$&:

*orking together.


#es) #our Honor.

JUSTI! "!#$%T& S. PU$&:

*hich ,eans that so,ehow their duties intersect with each other


%s I said before 5interru-ted6

JUSTI! "!#$%T& S. PU$&:

There is an area where both of the, have to work together in order that the life of the -atient would be -rotected


#es) #our Honor. %s I said before if on the other hand it is the anesthesiologist who notices because he ,onitors

the condition of the -atient during the surger+ and he calls the attention of the surgeon also.

JUSTI! "!#$%T& S. PU$&:

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%nd in accord with the conce-t of tea,work) is it not true also that it was Dr. Hosaka who called for a secondanesthesiologist


#our Honor) that is not so) #our Honor) I was told that the second anesthesiologist was 2ust nearb+ and it is their

habit to look in so,e o-erations taking -lace. In this -articular case the second anesthesiologist was -assing b+ and she

noticed that there was so,e kind of a) not reall+ a co,,otion but so,e kind of) increased activit+ and so she decided to

take a look.

JUSTI! "!#$%T& S. PU$&:

*ho gave the order for Dra. alderon to hel- in the intubation of the -atient


I understand) #our Honor that she did it voluntaril+) she 2ust ha--ened to -ass b+.

JUSTI! "!#$%T& S. PU$&:

%nd Dr. Hosaka did not ob2ect


$o) #our Honor) because his -osition is that this is outside of his ex-ertise) Dr. alderon is also an anesthesiologistso) he 2ust left the, alone.

JUSTI! "!#$%T& S. PU$&:

How long have Dr. Hosaka and Dr. 0utierre1 worked together as a tea,


The+ started their association wa+ back in 7899) #our Honor) at the ti,e of this incident about eight +ears) #ourHonor.

JUSTI! "!#$%T& S. PU$&:

*ould +ou know how the relationshi- of Dr. Hosaka and Dr. 0utierre1 is defined b+ an+ kind of agree,ent) oral or

written) or is it defined b+ the standard -ractice of the -rofession


I would sa+ it would be in accordance of the standard -ractice of the -rofession) #our Honor. There is no -articular

agree,ent between the,.

JUSTI! "!#$%T& S. PU$&:

*hat do +ou sa+ is the standard -ractice) how would the -ractice var+ fro, case to case


I believe) #our Honor) that the) in the first -lace if the -atient would have his own anesthesiologist) would -refer

his own anesthesiologist) he can retain the services of another anesthesiologist but of his own but if he does not know of

an+bod+ and he asks the surgeon to -rovide one) then this surgeon can reco,,end. /ut I would like to e,-hasi1e) #our

Honor) that the relationshi- is between the -atient and the anesthesiologist. It is not that the anesthesiologist is the e,-lo+eeof the surgeon.

JUSTI! "!#$%T& S. PU$&:

/ut is there an agree,ent) ex-ressed or i,-lied) between the two 56) to the effect that) +ou know the

anesthesiologist could sa+ to the surgeon that +ou have no business interfering with ,+ work as anesthesiologist. Is that

how the relationshi- is defined


&nce the start the 5interru-ted6

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JUSTI! "!#$%T& S. PU$&:

"ight fro, the ver+ beginning


I believe #our Honor that on the ,atter of retaining the services of the anesthesiologist in the sense that the

surgeon re-oses confidence on the abilit+ of the anesthesiologist) he hires hi, if he is authori1ed) he hires hi, on behalf of

the -atient if he is authori1ed to do that but once the+ are alread+ -erfor,ing their own task) then there should be nointerference.

JUSTI! "!#$%T& S. PU$&:

/ut the work of the two cannot be se-arated in watertight co,-art,ents) do +ou agree


I agree) #our Honor 5TS$) ;arch 78)

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"lviiTraders Ro%al Bank vs. &ational 'a(or Relations Commission ,321 S)R( 467 1999/.

"lviiiMotion 'or Reconsideration o' D;SM), p. 10! Rollo, p. 477.

"li"I(id.

lId.,at 47%.

liId.,at 4%0.

lii#S$, Marc 19, 2001, pp. 113-116.

liiiDecision, p. 4%, Rollo, p. 217.

livId., at 43-45! Id., at 212-214.

lvSee letter dated $ove&er 4, 2000 o' petitioner Ro+elio :. Ra&os addressed to Mr.

gr 124354 case

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