LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, and minors LLOYD and KRISTINE, all surnamed REYES,...

7/24/2019 LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, and minors LLOYD and KRISTINE, all surnamed REYES, represented …

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[G.R. No. 130547. October 3, 2000]

LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, a! "#or$ LLOYD a! %R&S'&NE, a(( $)ra"e!

REYES, re*re$ete! b+ te#r "oter, LEAH ALESNA REYES, petitioners, vs. S&S'ERS O-

ER/Y HOS&'AL, S&S'ER ROSE ALA/&O, DR. AR&E LANES, a! DR. ARLYN

R&/O,respondents.

D E / & S & O N

ENDOA, J .

This is a petition for review of the decision [1] of the Court of Appeals in CA-G.R. CV No. 3!!1 affir"in# the

decision of the Re#ional Trial Court$ %ranch &'$ Ce(u Cit) which dis"issed a co"plaint for da"a#es filed ()

petitioners a#ainst respondents.

The facts are as follows*

+etitioner ,eah Alesna Re)es is the wife of the late or#e Re)es. The other petitioners$ na"el)$ RoseNahda$ ohnn)$ ,lo)d$ and /ristine$ all surna"ed Re)es$ were their children. 0ive da)s (efore his death on

anuar) $ 12$ or#e had (een sufferin# fro" a recurrin# fever with chills. After he failed to #et relief fro"

so"e ho"e "edication he was ta4in#$ which consisted of anal#esic$ antip)retic$ and anti(iotics$ he decided to

see the doctor.

5n anuar) $ 12$ he was ta4en to the 6erc) Co""unit) Clinic () his wife. 7e was attended to ()

respondent 8r. 6arl)n Rico$ resident ph)sician and ad"ittin# ph)sician on dut)$ who #ave or#e a ph)sical

e9a"ination and too4 his "edical histor). :he noted that at the ti"e of his ad"ission$ or#e was conscious

a"(ulator)$ oriented$ coherent$ and with respirator) distress. [;] T)phoid fever was then prevalent in the localit)

as the clinic had (een #ettin# fro" 1! to ;< cases of t)phoid per "onth. [3] :uspectin# that or#e could (e

sufferin# fro" this disease$ 8r. Rico ordered a =idal Test$ a standard test for t)phoid fever$ to (e perfor"ed onor#e. %lood count$ routine urinal)sis$ stool e9a"ination$ and "alarial s"ear were also "ade.[>] After a(out an

hour$ the "edical technician su("itted the results of the test fro" which 8r. Rico concluded that or#e was

positive for t)phoid fever. As her shift was onl) up to !*<< p.".$ 8r. Rico indorsed or#e to respondent 8r

6arvie %lanes.

8r. 6arvie %lanes attended to or#e at around si9 in the evenin#. :he also too4 or#es histor) and #ave

hi" a ph)sical e9a"ination. ,i4e 8r. Rico$ her i"pression was that or#e had t)phoid fever. Anti(iotics (ein#

the accepted treat"ent for t)phoid fever$ she ordered that a co"pati(ilit) test with the anti(iotic chloro")cetin

(e done on or#e. :aid test was ad"inistered () nurse osephine +a#ente who also #ave the patient a dose

of tri#lo(e. As she did not o(serve an) adverse reaction () the patient to chloro")cetin$ 8r. %lanes ordered the

first five hundred "illi#ra"s of said anti(iotic to (e ad"inistered on or#e at around 2*<< p.". A second dose

was ad"inistered on or#e a(out three hours later ust (efore "idni#ht.

At around 1*<< a.". of anuar) 2$ 12$ 8r. %lanes was called as or#es te"perature rose to >1C. The

patient also e9perienced chills and e9hi(ited respirator) distress$ nausea$ vo"itin#$ and convulsions. 8r

%lanes put hi" under o9)#en$ used a suction "achine$ and ad"inistered h)drocortisone$ te"poraril) easin#

the patients convulsions. =hen he re#ained consciousness$ the patient was as4ed () 8r. %lanes whether he

had a previous heart ail"ent or had suffered fro" chest pains in the past. or#e replied he did not. [!] Afte

a(out 1! "inutes$ however$ or#e a#ain started to vo"it$ showed restlessness$ and his convulsions

returned. 8r. %lanes re-applied the e"er#enc) "easures ta4en (efore and$ in addition$ valiu" was

http://sc.judiciary.gov.ph/jurisprudence/2000/oct2000/130547.htm#_edn1













ad"inistered. or#e$ however$ did not respond to the treat"ent and slipped into c)anosis$ a (luish or purplish

discoloration of the s4in or "ucous "e"(rane due to deficient o9)#enation of the (lood. At around ;*<< a.".

or#e died. 7e was fort) )ears old. The cause of his death was Ventricular Arr)the"ia :econdar) to

7)perp)re9ia and t)phoid fever.

5n une 3$ 12$ petitioners filed (efore the Re#ional Trial Court of Ce(u Cit) a co"plaint[]for da"a#es

a#ainst respondents :isters of 6erc)$ :ister Rose +alacio$ 8r. 6arvie %lanes$ 8r. 6arl)n Rico$ and nurse

osephine +a#ente. 5n :epte"(er ;>$ 12$ petitioners a"ended their co"plaint to i"plead respondent

6erc) Co""unit) Clinic as additional defendant and to drop the na"e of osephine +a#ente as defendant

since she was no lon#er connected with respondent hospital. Their principal contention was that or#e did not

die of t)phoid fever .[]&nstead$ his death was due to the wron#ful ad"inistration of chloro")cetin. The)

contended that had respondent doctors e9ercised due care and dili#ence$ the) would not have reco""ended

and rushed the perfor"ance of the =idal Test$ hastil) concluded that or#e was sufferin# fro" t)phoid fever$

and ad"inistered chloro")cetin without first conductin# sufficient tests on the patients co"pati(ilit) with said

dru#. The) char#ed respondent clinic and its directress$ :ister Rose +alacio$ with ne#li#ence in failin# to

provide ade?uate facilities and in hirin# ne#li#ent doctors and nurses.[]

Respondents denied the char#es. 8urin# the pre-trial conference$ the parties a#reed to li"it the issues on

the followin#* @1 whether the death of or#e Re)es was due to or caused () the ne#li#ence$ carelessness$i"prudence$ and lac4 of s4ill or foresi#ht on the part of defendantsB @; whether respondent 6erc) Co""unit)

Clinic was ne#li#ent in the hirin# of its e"plo)eesB and @3 whether either part) was entitled to da"a#es. The

case was then heard () the trial court durin# which$ in addition to the testi"onies of the parties$ the testi"onies

of doctors as e9pert witnesses were presented.

+etitioners offered the testi"on) of 8r. Apolinar Vacalares$ Chief +atholo#ist at the Northern 6indanao

Trainin# 7ospital$ Ca#a)an de 5ro Cit). 5n anuar) 2$ 12$ 8r. Vacalares perfor"ed an autops) on or#e

Re)es to deter"ine the cause of his death. 7owever$ he did not open the s4ull to e9a"ine the (rain. 7is

findin#s[2] showed that the #astro-intestinal tract was nor"al and without an) ulceration or enlar#e"ent of the

nodules. 8r. Vacalares testified that or#e did not die of t)phoid fever. 7e also stated that he had not seen a

patient die of t)phoid fever within five da)s fro" the onset of the disease.

0or their part$ respondents offered the testi"onies of 8r. +eter Gotion# and 8r. &(arra +anopio. 8r

Gotion# is a diplo"ate in internal "edicine whose e9pertise is "icro(iolo#) and infectious diseases. 7e is also

a consultant at the Ce(u Cit) 6edical Center and an associate professor of "edicine at the :outh =estern

niversit) Colle#e of 6edicine in Ce(u Cit). 7e had treated over a thousand cases of t)phoid

patients. Accordin# to 8r. Gotion#$ the patients histor) and positive =idal Test results ratio of 1*3;< would

"a4e hi" suspect that the patient had t)phoid fever. As to 8r. Vacalares o(servation re#ardin# the a(sence of

ulceration in or#es #astro-intestinal tract$ 8r. Gotion# said that such h)perplasia in the intestines of a t)phoid

victi" "a) (e "icroscopic. 7e noted that since the to9ic effect of t)phoid fever "a) lead to "enin#itis$ 8r.

Vacalares autops) should have included an e9a"ination of the (rain.

[1<]

The other doctor presented was 8r. &(arra +anopio$ a "e"(er of the A"erican %oard of +atholo#)$

e9a"iner of the +hilippine %oard of +atholo#) fro" 12 to 1221$ fellow of the +hilippine :ociet) o

+atholo#ist$ associate professor of the Ce(u &nstitute of 6edicine$ and chief patholo#ist of the Andres :oriano

r. 6e"orial 7ospital in Toledo Cit). 8r. +anopio stated that althou#h he was partial to the use of the culture

test for its #reater relia(ilit) in the dia#nosis of t)phoid fever$ the =idal Test "a) also (e used. ,i4e 8r

Gotion#$ he a#reed that the 1*3;< ratio in or#es case was alread) the "a9i"u" () which a conclusion of

t)phoid fever "a) (e "ade. No additional infor"ation "a) (e deduced fro" a hi#her dilution. [11] 7e said tha

8r. Vacalares autops) on or#e was inco"plete and thus inconclusive.

















5n :epte"(er 1;$ 1221$ the trial court rendered its decision a(solvin# respondents fro" the char#es of

ne#li#ence and dis"issin# petitioners action for da"a#es. The trial court li4ewise dis"issed respondents

counterclai"$ holdin# that$ in see4in# da"a#es fro" respondents$ petitioners were i"pelled () the honest

(elief that or#es death was due to the latters ne#li#ence.

+etitioners (rou#ht the "atter to the Court of Appeals. 5n ul) 31$ 122$ the Court of Appeals affir"ed the

decision of the trial court.

7ence this petition.

+etitioners raise the followin# assi#n"ent of errors*

&. T7D 75N5RA%,D C5RT 50 A++DA,: C566&TTD8 A RDVDR:&%,D DRR5R =7DN &T

R,D8 T7AT T7D 85CTR&ND 50 RES IPSA LOQUITUR &: N5T A++,&CA%,D &N T7D &N:TANT

CA:D.

&&. T7D 75N5RA%,D C5RT 50 A++DA,: C566&TTD8 RDVDR:&%,D DRR5R =7DN &T 6A8D

AN N05N8D8 A::6+T&5N T7AT T7D ,DVD, 50 6D8&CA, +RACT&CD &: ,5=DR &N

&,&GAN C&TE.

&&&. T7D 75N5RA%,D C5RT 50 A++DA,: GRAVD,E DRRD8 =7DN &T R,D8 05R A ,D::DR

:TAN8AR8 50 CARD AN8 8DGRDD 50 8&,&GDNCD 05R 6D8&CA, +RACT&CD &N &,&GAN

C&TE =7DN &T A++RDC&ATD[8] N5 85CT5R: NDG,&GDNCD &N T7D TRDAT6DNT 50 5RGD

RDED:.

+etitioners action is for "edical "alpractice. This is a particular for" of ne#li#ence which consists in the

failure of a ph)sician or sur#eon to appl) to his practice of "edicine that de#ree of care and s4ill which is

ordinaril) e"plo)ed () the profession #enerall)$ under si"ilar conditions$ and in li4e surroundin#

circu"stances. [1;] &n order to successfull) pursue such a clai"$ a patient "ust prove that the ph)sician or

sur#eon either failed to do so"ethin# which a reasona(l) prudent ph)sician or sur#eon would have done$ orthat he or she did so"ethin# that a reasona(l) prudent ph)sician or sur#eon would not have done$ and that the

failure or action caused inur) to the patient. [13] There are thus four ele"ents involved in "edical ne#li#ence

cases$ na"el)* dut)$ (reach$ inur)$ and pro9i"ate causation.

&n the present case$ there is no dou(t that a ph)sician-patient relationship e9isted (etween respondent

doctors and or#e Re)es. Respondents were thus dut)-(ound to use at least the sa"e level of care that an)

reasona(l) co"petent doctor would use to treat a condition under the sa"e circu"stances. &t is (reach of this

dut) which constitutes actiona(le "alpractice.[1>] As to this aspect of "edical "alpractice$ the deter"ination of

the reasona(le level of care and the (reach thereof$ e9pert testi"on) is essential. &nas"uch as the causes of

the inuries involved in "alpractice actions are deter"ina(le onl) in the li#ht of scientific 4nowled#e$ it has

(een reco#niFed that e9pert testi"on) is usuall) necessar) to support the conclusion as to causation.[1!]

Res Ipsa Loquitur

There is a case when e9pert testi"on) "a) (e dispensed with$ and that is under the doctrine of res ipsa

loquitur . As held in Ramos v. Court of Appeals*[1]

Although generally, expert medical testimony is relied upon in malpractice suits to prove that a physician has done a

negligent act or that he has deviated from the standard medical procedure, when the doctrine of res ipsa loquitor is availed

by the plaintiff, the need for expert medical testimony is dispensed with because the injury itself provides the proof of














negligence. The reason is that the general rule on the necessity of 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 dfty. Ordinarily, only physicians and surgeons of skill and experience are

competent to testify as to whether a patient has been treated or operated upon with a reasonable degree of skill and

care. However, testimony as to the statements and acts of physicians and surgeons, external appearances, and manifest

conditions which are observable by any one may be given by nonexpert witnesses. Hence, 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. !here 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 giving rise to an application of the

doctrine of res ipsa loquitur without medical evidence, which is ordinarily re"uired to show not only what occurred but

how and why it occurred. !hen the doctrine is appropriate, all that the patient must do is prove a nexus between the

particular act or omission complained of and the injury sustained while under the custody and management of the

defendant without need to produce expert medical testimony to establish the standard of care. #esort to res ipsa loquitor is

allowed because there is no other way, under usual and ordinary conditions, by which the patient can obtain redress for

injury suffered by him.

Thus, courts of other jurisdictions have applied the doctrine in the following situations$ leaving of a foreign object in the

body of the patient after an operation, injuries sustained on a healthy part of the body which was not under, or in the area,of treatment, removal of the wrong part of the body when another part was intended, knocking out a tooth while a patients

jaw was under anesthetic for the removal of his tonsils, and loss of an eye while the patient was under the influence

of anesthetic, during or following an operation for appendicitis, among others.%&'(

+etitioners asserted in the Court of Appeals that the doctrine of res ipsa loquitur applies to the present

case (ecause or#e Re)es was "erel) e9periencin# fever and chills for five da)s and was full) conscious$

coherent$ and a"(ulant when he went to the hospital. Eet$ he died after onl) ten hours fro" the ti"e of his

ad"ission.

This contention was reected () the appellate court.

+etitioners now contend that all re?uisites for the application of res ipsa loquitur were present$ na"el)* @1

the accident was of a 4ind which does not ordinaril) occur unless so"eone is ne#li#entB @; the instru"entalit)

or a#enc) which caused the inur) was under the e9clusive control of the person in char#eB and @3 the inur)

suffered "ust not have (een due to an) voluntar) action or contri(ution of the person inured.[1]

The contention is without "erit. =e a#ree with the rulin# of the Court of Appeals. &n the Ramos case$ the

?uestion was whether a sur#eon$ an anesthesiolo#ist$ and a hospital should (e "ade lia(le for the co"atose

condition of a patient scheduled for cholec)stecto").[12] &n that case$ the patient was #iven anesthesia prior to

her operation. Notin# that the patient was neurolo#icall) sound at the ti"e of her operation$ the Court applied

the doctrine of res ipsa loquitur as "ental (rain da"a#e does not nor"all) occur in a #all(lader operation inthe a(sence of ne#li#ence of the anesthesiolo#ist. Ta4in# udicial notice that anesthesia procedures had

(eco"e so co""on that even an ordinar) person could tell if it was ad"inistered properl)$ we allowed the

testi"on) of a witness who was not an e9pert. &n this case$ while it is true that the patient died ust a few hours

after professional "edical assistance was rendered$ there is reall) nothin# unusual or e9traordinar) a(out his

death. +rior to his ad"ission$ the patient alread) had recurrin# fevers and chills for five da)s unrelieved () the

anal#esic$ antip)retic$ and anti(iotics #iven hi" () his wife. This shows that he had (een sufferin# fro" a

serious illness and professional "edical help ca"e too late for hi".











Respondents alle#ed failure to o(serve due care was not i""ediatel) apparent to a la)"an so as to

ustif) application of res ipsa loquitur . The ?uestion re?uired e9pert opinion on the alle#ed (reach ()

respondents of the standard of care re?uired () the circu"stances. 0urther"ore$ on the issue of the

correctness of her dia#nosis$ no presu"ption of ne#li#ence can (e applied to 8r. 6arl)n Rico. As held

in Ramos*

. . . . Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used but a rule to be cautiously applied,

depending upon the circumstances of each case. )t is generally restricted to situations in malpractice cases where a layman

is able to say, as a matter of common knowledge and observation, that the conse"uences of professional care were not as

such as would ordinarily have followed if due care had been exercised. A distinction must be made between the failure to

secure results, and the occurrence of something more unusual and not ordinarily found if the service or treatment rendered

followed the usual procedure of those skilled in that particular practice. )t must be conceded that the doctrine of res ipsa

loquitur can have no application in a suit against a physician or a surgeon which involves the merits of a diagnosis or of a

scientific treatment. The physician or surgeon is not re"uired at his peril to explain why any particular diagnosis was not

correct, or why any particular scientific treatment did not produce the desired result.%*+(

Specific Acts of Negligence

=e turn to the ?uestion whether petitioners have esta(lished specific acts of ne#li#ence alle#edl)co""itted () respondent doctors.

+etitioners contend that* @1 8r. 6arl)n Rico hastil) and erroneousl) relied upon the =idal test$ dia#nosed

or#es illness as t)phoid fever$ and i""ediatel) prescri(ed the ad"inistration of the anti(iotic chloro")cetin[;1] and @; 8r. 6arvie %lanes erred in orderin# the ad"inistration of the second dose of !<< "illi#ra"s of

chloro")cetin (arel) three hours after the first was #iven. [;;] +etitioners presented the testi"on) of 8r. Apolinar

Vacalares$ Chief +atholo#ist of the Northern 6indanao Trainin# 7ospital$ Ca#a)an de 5ro Cit)$ who perfor"ed

an autops) on the (od) of or#e Re)es. 8r. Vacalares testified that$ (ased on his findin#s durin# the autops)

or#e Re)es did not die of t)phoid fever (ut of shoc4 undeter"ined$ which could (e due to aller#ic reaction o

chloro")cetin overdose. =e are not persuaded.

-#r$t. =hile petitioners presented 8r. Apolinar Vacalares as an e9pert witness$ we do not find hi" to (e so

as he is not a specialist on infectious diseases li4e t)phoid fever.0urther"ore$ althou#h he "a) have had

e9tensive e9perience in perfor"in# autopsies$ he ad"itted that he had )et to do one on the (od) of a t)phoid

victi" at the ti"e he conducted the post"orte" on or#e Re)es. &t is also plain fro" his testi"on) that he has

treated onl) a(out three cases of t)phoid fever. Thus$ he testified that* [;3]

ATTE. +A:CA,*

=h)H 7ave )ou not testified earlier that )ou have never seen a patient who died of t)phoid feverH

A &n autops). %ut$ that was when & was a resident ph)sician )et.

%ut )ou have not perfor"ed an autops) of a patient who died of t)phoid feverH

A & have not seen one.

And )ou testified that )ou have never seen a patient who died of t)phoid fever within five da)sH

A & have not seen one.












7ow "an) t)phoid fever cases had )ou seen while )ou were in the #eneral practice of "edicineH

A &n our case we had no widal test that ti"e so we cannot consider that the t)phoid fever is li4e this and li4e

that. And the widal test does not specif) the ti"e of the t)phoid fever.

The ?uestion is* how "an) t)phoid fever cases had )ou seen in )our #eneral practice re#ardless of the

cases now )ou practiceH

A & had onl) seen three cases.

And that was wa) (ac4 in 12>H

A =a) (ac4 after ") trainin# in +.

Clinicall)H

A =a) (ac4 (efore ") trainin#.

7e is thus not ?ualified to prove that 8r. 6arl)n Rico erred in her dia#nosis. %oth lower courts were thereforecorrect in discardin# his testi"on)$ which is reall) inad"issi(le.

&n Ramos$ the defendants presented the testi"on) of a pul"onolo#ist to prove that (rain inur) was due to

o9)#en deprivation after the patient had (ronchospas"s[;>] tri##ered () her aller#ic response to a dru#$[;!] and

not due to fault) intu(ation () the anesthesiolo#ist. As the issue was whether the intu(ation was properl)

perfor"ed () an anesthesiolo#ist$ we reected the opinion of the pul"onolo#ist on the #round that he was not

@1 an anesthesiolo#ist who could enli#hten the court a(out anesthesia practice$ procedure$ and their

co"plicationsB nor @; an aller#olo#ist who could properl) advance e9pert opinion on aller#ic "ediated

processesB nor @3 a phar"acolo#ist who could e9plain the phar"acolo#ic and to9ic effects of the dru#

alle#edl) responsi(le for the (ronchospas"s.

Seco!. 5n the other hand$ the two doctors presented () respondents clearl) were e9perts on the

su(ect. The) vouched for the correctness of 8r. 6arl)n Ricos dia#nosis. 8r. +eter Gotion#$ a diplo"ate whose

specialiFation is infectious diseases and "icro(iolo#) and an associate professor at the :outhwestern

niversit) Colle#e of 6edicine and the Gullas Colle#e of 6edicine$ testified that he has alread) treated over a

thousand cases of t)phoid fever .[;] Accordin# to hi"$ when a case of t)phoid fever is suspected$ the =idal tes

is nor"all) used$[;]and if the 1*3;< results of the =idal test on or#e Re)es had (een presented to hi" alon#

with the patients histor)$ his i"pression would also (e that the patient was sufferin# fro" t)phoid fever. [;] As to

the treat"ent of the disease$ he stated that chloro")cetin was the dru# of choice. [;2] 7e also e9plained that

despite the "easures ta4en () respondent doctors and the intravenous ad"inistration of two doses of

chloro")cetin$ co"plications of the disease could not (e discounted. 7is testi"on) is as follows*[3<]

ATTE. +A:CA,*

&f with that count with the test of positive for 1 is to 3;<$ what treat"ent if an) would (e #ivenH

A &f those are the findin#s that would (e presented to "e$ the first thin# & would consider would (e t)phoid

fever.

And presentl) what are the treat"ents co""onl) usedH





















A 8ru# of choice of chlora"phenical.

8octor$ if #iven the sa"e patient and after )ou have ad"inistered chlora"phenical a(out 3 1I; hours

later$ the patient associated with chills$ te"perature - >1oC$ what could possi(l) co"e to )our "indH

A =ell$ when it is chan#e in the clinical findin#$ )ou have to thin4 of co"plication.

And what will )ou consider on the co"plication of t)phoidH

A 5ne "ust first understand that t)phoid fever is to9i"ia. The pro(le" is co"plications are caused ()

to9ins produced () the (acteria . . . whether )ou have suffered co"plications to thin4 of -- heart to9ic

")ocarditiesB then )ou can consider a to9ic "enin#itis and other co"plications and perforations and

(leedin# in the iliu".

Dven that ><-)ear old "arried patient who received "edication of chloro")cetin of !<< "illi#ra"s

intravenous$ after the s4in test$ and received a second dose of chloro")cetin of !<< "ili#ra"s$ 3 hours

later$ the patient developed chills . . . rise in te"perature to >1oC$ and then a(out >< "inutes later the

te"perature rose to 1<<o0$ cardiac rate of 1!< per "inute who appeared to (e coherent$ restless

nauseatin#$ with seiFures* what si#nificance could )ou attach to these clinical chan#esH

A & would then thin4 of to9e"ia$ which was to9ic "enin#itis and pro(a(l) a to9ic "enin#itis (ecause of the

hi#h cardiac rate.

Dven if the sa"e patient who$ after havin# #iven intra"uscular valiu"$ (eca"e conscious and coherent

a(out ;< "inutes later$ have seiFure and c)anosis and rollin# of e)e(alls and vo"ittin# . . . and

death* what si#nificance would )ou attach to this develop"entH

A =e are pro(a(l) dealin# with t)phoid to "enin#itis.

&n such case$ 8octor$ what findin# if an) could )ou e9pect on the post-"orte" e9a"inationH

A No$ the findin# would (e "ore on the "enin#es or coverin# of the (rain.

And in order to see those chan#es would it re?uire openin# the s4ullH

A Ees.

As re#ards 8r. Vacalares findin# durin# the autops) that the deceaseds #astro-intestinal tract was nor"al$ 8r

Rico e9plained that$ while h)perplasia[31] in the pa)ers patches or la)ers of the s"all intestines is present in

t)phoid fever$ the sa"e "a) not alwa)s (e #rossl) visi(le and a "icroscope was needed to see the te9ture of

the cells.[3;]

Respondents also presented the testi"on) of 8r. &(arra T. +anopio who is a "e"(er of the +hilippine and

A"erican %oard of +atholo#)$ an e9a"iner of the +hilippine %oard of +atholo#)$ and chief patholo#ist at the

6etroCe(u Co""unit) 7ospital$ +erpetual :uccor 7ospital$ and the Andres :oriano r. 6e"orial 6edica

Center. 7e stated that$ as a clinical patholo#ist$ he reco#niFed that the =idal test is used for t)phoid patients

althou#h he did not encoura#e its use (ecause a sin#le test would onl) #ive a presu"ption necessitatin# that

the test (e repeated$ (eco"in# "ore conclusive at the second and third wee4s of the disease.[33] 7e

corro(orated 8r. Gotion#s testi"on) that the dan#er with t)phoid fever is reall) the possi(le co"plications

which could develop li4e perforation$ he"orrha#e$ as well as liver and cere(ral co"plications. [3>] As re#ards the











1*3;< results of the =idal test on or#e Re)es$ 8r. +anopio stated that no additional infor"ation could (e

o(tained fro" a hi#her ratio.[3!] 7e also a#reed with 8r. Gotion# that h)perplasia in the pa)ers patches "a) (e

"icroscopic. [3]

&ndeed$ the standard conte"plated is not what is actuall) the avera#e "erit a"on# all 4nown practitioners

fro" the (est to the worst and fro" the "ost to the least e9perienced$ (ut the reasona(le avera#e "erit

a"on# the ordinaril) #ood ph)sicians.[3] 7ere$ 8r. 6arl)n Rico did not depart fro" the reasona(le standard

reco""ended () the e9perts as she in fact o(served the due care re?uired under the circu"stances. Thou#h

the =idal test is not conclusive$ it re"ains a standard dia#nostic test for t)phoid fever and$ in the present case

#reater accurac) throu#h repeated testin# was rendered uno(taina(le () the earl) death of the patient. The

results of the =idal test and the patients histor) of fever with chills for five da)s$ ta4en with the fact that t)phoid

fever was then prevalent as indicated () the fact that the clinic had (een #ettin# a(out 1! to ;< t)phoid cases

a "onth$ were sufficient to #ive upon an) doctor of reasona(le s4ill the i"pression that or#e Re)es had

t)phoid fever.

8r. Rico was also ustified in reco""endin# the ad"inistration of the dru# chloro")cetin$ the dru# of

choice for t)phoid fever. The (urden of provin# that or#e Re)es was sufferin# fro" an) other illness rested

with the petitioners. As the) failed to present e9pert opinion on this$ preponderant evidence to support their

contention is clearl) a(sent.

'#r!. +etitioners contend that respondent 8r. 6arvie %lanes$ who too4 over fro" 8r. Rico$ was ne#li#ent

in orderin# the intravenous ad"inistration of two doses of !<< "illi#ra"s of chloro")cetin at an interval of less

than three hours. +etitioners clai" that or#e Re)es died of anaph)lactic shoc4 [3] or possi(l) fro" overdose as

the second dose should have (een ad"inistered five to si9 hours after the first$ per instruction of 8r. 6arl)n

Rico. As held () the Court of Appeals$ however*

That chloromycetin was likewise a proper prescription is best established by medical authority. !ilson, et. al.,

in Harrisons rinciple of )nternal -edicine, &*th ed. write that chlorampenicol which is the generic of chloromycetin/ is

the drug of choice for typhoid fever and that no drug has yet proven better in promoting a favorable clinical response.

0hlorampenicol 0hloromycetin/ is specifically indicated for bacterial meningitis, typhoid fever, rickettsial infections,

bacteriodes infections, etc. )-1 Annual, &223, p. *&&/ The dosage likewise including the first administration of five

hundred milligrams (500 mg.) at around nine oclock in the evening and the second dose at around 11:0 the same night

was still within medicall! accepta"le limits# since the recommended dose of chlorom!cetin is one (1) gram ever! si$ (%)

hours. cf. ediatric 4rug Handbook, &st 5d., hilippine ediatric 1ociety, 0ommittee on Therapeutics and Toxicology,

&226/. The intravenous route is likewise correct. -ansser, O7ick, harmacology and Therapeutics/ 5ven if the test was

not administered by the physicianonduty, the evidence introduced that it was 4ra. 8lanes who interpreted the results

remain uncontroverted. 4ecision, pp. &6&'/Once more, this 0ourt rejects any claim of professional negligence in this

regard.

. . . .

As regards anaphylactic shock, the usual way of guarding against it prior to the administration of a drug, is the skin test of

which, however, it has been observed$ 1kin testing with haptenic drugs is generally not reliable. 0ertain drugs cause

nonspecific histamine release, producing a wealandflare reaction in normal individuals. )mmunologic activation of mast

cells re"uires a polyvalent allergen, so a negative skin test to a univalent haptenic drug does not rule out anaphylactic

sensitivity to that drug. Terr, Anaphylaxis and 9rticaria in 8asic and 0linical )mmunology, p. :32/ !hat all this means

legally is that even if the deceased suffered from an anaphylactic shock, this, of itself, would not yet establish the

negligence of the appelleephysicians for all that the law re"uires of them is that they perform the standard tests and

perform standard procedures. The law cannot re"uire them to predict every possible reaction to all drugs












administered. The onus probandi was on the appellants to establish, before the trial court, that the appelleephysicians

ignored standard medical procedure, prescribed and administered medication with recklessness and exhibited an absence

of the competence and skills expected of general practitioners similarly situated.%:2(

-o)rt. +etitioners correctl) o(serve that the "edical profession is one which$ li4e the (usiness of a

co""on carrier$ is affected with pu(lic interest. 6oreover$ the) assert that since the law i"poses upon

co""on carriers the dut) of o(servin# e9traordinar) dili#ence in the vi#ilance over the #oods and for the

safet) of the passen#ers$[><] ph)sicians and sur#eons should have the sa"e dut) toward their patients. [>1] The)

also contend that the Court of Appeals erred when it alle#edl) assu"ed that the level of "edical practice is

lower in &li#an Cit)$ there() reducin# the standard of care and de#ree of dili#ence re?uired fro" ph)sicians and

sur#eons in &li#an Cit).

The standard of e9traordinar) dili#ence is peculiar to co""on carriers. The Civil Code provides*

&rt. 1'. 0ommon carriers, from the nature of their business and for reasons of public policy, are bound to observe

extraordinary diligence in the vigilance over the goods and for the safety of the passengers transported by them, according

to the circumstances of each case. . . .

The practice of "edicine is a profession en#a#ed in onl) () ?ualified individuals. &t is a ri#ht earnedthrou#h )ears of education$ trainin#$ and () first o(tainin# a license fro" the state throu#h professional (oard

e9a"inations. :uch license "a)$ at an) ti"e and for cause$ (e revo4ed () the #overn"ent. &n addition to state

re#ulation$ the conduct of doctors is also strictl) #overned () the 7ippocratic 5ath$ an ancient code of

discipline and ethical rules which doctors have i"posed upon the"selves in reco#nition and acceptance of

their #reat responsi(ilit) to societ). Given these safe#uards$ there is no need to e9pressl) re?uire of doctors

the o(servance of e9traordinar) dili#ence. As it is now$ the practice of "edicine is alread) conditioned upon the

hi#hest de#ree of dili#ence. And$ as we have alread) noted$ the standard conte"plated for doctors is si"pl)

the reasona(le avera#e "erit a"on# ordinaril) #ood ph)sicians. That is reasona(le dili#ence for doctors or$ as

the Court of Appeals called it$ the reasona(le s4ill and co"petence . . . that a ph)sician in the sa"e or si"ilar

localit) . . . should appl).

HERE-ORE$ the instant petition is 8DN&D8 and the decision of the Court of Appeals is A00&R6D8.

SO ORDERED.

Bellosillo, (Cairma!", Quisum#i!$, Bue!a, and %e Leo!, &r., &&., concur.







LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, and minors LLOYD and KRISTINE, all surnamed REYES,...

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Transcript of LEAH ALESNA REYES, ROSE NAHDJA, JOHNNY, and minors LLOYD and KRISTINE, all surnamed REYES,...