RAMOS v. CA
G.R. No.
124354
December 29,
1999
321 SCRA 584
FACTS: Plaintiff Erlinda Ramos was experiencing occasional pains allegedly caused
by stones in her gall bladder. She was told to
undergo an operation and after some tests and exams,
she was indicated fit for surgery.
Dr. Orlino
Hozaka, defendant, decided that Erlinda should undergo a “cholecystectomy”
operation. Rogelio, husband of Erlinda, asked Dr. Hosaka to look for a good
anesthesiologist.
Around 7:30 AM of
June 17, 1985, Herminda (sister-in-law of Erlinda) accompanied Erlinda to the
operating room and saw Dr. Gutierrez, the other defendant, who was to
administer anesthesia. Dr. Hosaka only arrived around
12:15 PM, three hours late. Nonetheless, the operation continued and Herminda then saw Dr.
Gutierrez intubating the patient and heard her saying “and hirap ma-intubate nito, mali yata ang pagkakapasok”.
Thereafter, bluish discoloration of the nailbeds appeared on the patient.
Hence, Dr. Hosaka issued an order for someone to call Dr. Calderon, another anesthesiologist.
The patient was placed in a trendelenburg position for decrease of blood supply
in her brain. At 3:00 PM, the patient was taken to the ICU.
Four months after,
the patient was released from the hospital. However, the patient has been in a comatose condition.
Hence, the petition
filed a civil case for damages against herein private respondents alleging
negligence in the management and care of Erlinda Ramos.
Petitioners
contended that the faulty management of her airway casused the lack of oxygen
in the patient’s brain. On the respondent’s part, they contended that the brain
damage was Erlinda's allergic reaction to the anesthetic agent.
ISSUES: (1) Will the doctrine of res
ipsa loquitur apply in this case? and (2) Did the negligence of the
respondents cause the unfortunate comatose condition of petitioner Erlinda
Ramos?
RULING: (1) Yes. The Court finds the doctrine of res ipsa loquitur appropriate
in the case at bar.
The doctrine of res ipsa loquitur is where the thing
which caused the injury complained of is shown to be under the management of
the defendant or his servants and the accident is such as in ordinary course of
things does not happen if those who have its management or control use proper
care, it affords reasonable evidence, in the absence of explanation by the
defendant, that the accident arose from or was caused by the defendant's want
of care.
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.
Erlinda submitted
herself soundly and fit for surgery. However, during the administration of
anesthesia and prior to the performance of cholecystectomy she suffered
irreparable damage to her brain. Thus, without undergoing surgery, she went out
of the operating room already decerebrate and totally incapacitated. Obviously,
brain damage, which Erlinda sustained, is an injury which does not normally
occur in the process of a gall bladder operation.
Considering that a
sound and unaffected member of the body (the brain) is injured or destroyed
while the patient is unconscious and under the immediate and exclusive control
of the physicians, we hold that a practical administration of justice dictates
the application of res ipsa loquitur.
(2a) With regard to
Dra. Gutierrez, the court find her negligent during the
anesthesia phase. As borne by the records, respondent Dra. Gutierrez failed to
properly intubate the patient which she admitted.
During intubation,
such distention indicates that air has entered the gastrointestinal tract
through the esophagus instead of the lungs through the trachea. Entry into the
esophagus would certainly cause some delay in oxygen delivery into the lungs as
the tube which carries oxygen is in the wrong place.
Even granting that
the tube was successfully inserted during the second attempt, it was obviously
too late.
An experienced
anesthesiologist, adequately alerted by a thorough pre-operative evaluation,
would have had little difficulty going around the short neck and protruding
teeth.
Hence, she was negligent.
(2b) For Dr. Orlino Hosaka, as the head of the
surgical team and as the so-called captain of the ship, it is the surgeons
responsibility to see to it that those under him perform their task in the
proper manner
Respondent Dr.
Hosakas negligence can be found in his failure to exercise the proper authority
(as the captain of the operative team) in not determining if his
anesthesiologist observed proper anesthesia protocols. In fact, no evidence on
record exists to show that respondent Dr. Hosaka verified if respondent Dra.
Gutierrez properly intubated the patient. Furthermore, it does not escape the court that respondent Dr. Hosaka had scheduled another procedure in a different
hospital at the same time as Erlinda's operation, and was in fact over
three hours late for the latter's operation. Because of this, he had little or
no time to confer with his anesthesiologist regarding the anesthesia delivery.
This indicates that he was remiss in his professional duties towards his
patient.
Thus, he shares equal responsibility for the events which resulted in
Erlindas condition.
(2c) As for the hospital (employer) itself, the Court ruled that
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.
In the instant case,
respondent hospital, apart from a general denial of its responsibility over
respondent physicians, failed to adduce evidence showing that it exercised the
diligence of a good father of a family in the hiring and supervision of the
latter. It failed to adduce evidence with regard to the degree of supervision
which it exercised over its physicians. In neglecting to offer such proof, or proof
of a similar nature, respondent hospital thereby failed to discharge its burden
under the last paragraph of Article 2180.
Having failed to do this, respondent
hospital is consequently solidarily responsible with its physicians for
Erlindas condition.
