Case Digest (G.R. No. 250919) Core Legal Reasoning
Core Legal Reasoning
Facts:
In Jude Carlo M. Allarey, et al. v. Dr. Ma. Ditas F. Dela Cruz and Manila East Medical Center, Inc. (G.R. No. 250919, November 10, 2021), petitioners Jude Carlo M. Allarey, Hero B. Allarey, Jude Carlo B. Allarey, Jr. (by their natural guardian Jude Carlo M. Allarey), minor Karen Valerie B. Salazar (guardian ad litem), and spouses Rufo C. Baco, Jr. and Rosalie C. Baco sued Dr. Ma. Ditas F. Dela Cruz and Manila East Medical Center, Inc. (MEMCI) for damages based on quasi-delict. Jude was the common-law partner of the late Marissa Baco, who died on August 29, 2006 after premature delivery of Julia Carla Allarey, who herself passed away on August 30, 2006. Marissa, a high-risk fourth-gravida with a prior cesarean section, experienced vaginal bleeding and preterm labor on August 28, 2006. Dr. Dela Cruz admitted her to MEMCI, ordered tocolysis with D-5 LRS and Isoxilan, and monitored her in the OR/DR overnight. The next day, after intermittent minimal bleeding, Marissa suffered profus Case Digest (G.R. No. 250919) Expanded Legal Reasoning
Expanded Legal Reasoning
Facts:
- Parties and antecedents
- Petitioners: Jude Carlo M. Allarey (partner of the deceased Marissa Baco), their minor children Hero B. Allarey and Jude Carlo B. Allarey, Jr., minor Karen Valerie B. Salazar (Marissa’s daughter) as represented by a guardian ad litem, and Marissa’s parents, spouses Rufo and Rosalie Baco. They sued for damages based on quasi-delict.
- Respondents: Dr. Ma. Ditas F. Dela Cruz (obstetrician-gynecologist) and Manila East Medical Center, Inc. (MEMCI).
- Background: Dr. Dela Cruz performed Marissa’s cesarean section (CS) in August 2005. On March 18, 2006, she confirmed Marissa’s fourth pregnancy (EDD November 4, 2006). Prenatal visits followed on April 22, June 10, July 18 (with ultrasound showing “anterior placenta”), and August 3, 2006.
- Events of August 28–29, 2006 (Marissa’s confinement and death)
- August 28, 2006: At 30–31 weeks AOG, Marissa experienced vaginal bleeding. Upon Dr. Dela Cruz’s advice, she was seen at the clinic, internally examined, and endorsed to MEMCI’s OR/DR. She was admitted at 6:00 p.m. Orders included tocolysis (D5LRS with Isoxilan), Diprospan IM, CBC and blood typing. She was placed on strict bed rest and NPO initially. Hospital pharmacy lacked some drugs; family sourced outside. At 8:00 p.m., Dr. Dela Cruz examined her and described her as “ok,” recommending overnight stay and transfer to a regular room once bleeding stopped.
- Overnight to morning: From 8:30 p.m. of August 28 until around 1:00 p.m. of August 29, records note minimal to no contraction/bleeding; vital signs stable. She was allowed soft diet, and later moved to Room 511.
- August 29, early afternoon: Around 1:00 p.m., after being informed of possible discharge later that day or next day, Marissa suddenly experienced profuse bleeding. Plans for emergency CS and bilateral tubal ligation were explained; instructions were given to staff; pediatrician placed on standby. She was wheeled back to the OR around 2:20 p.m. Two units of type AB FWB were requested preoperatively.
- Perioperative course: At ~3:00 p.m., profuse bleeding recurred; vitals reportedly still stable. CS started 3:10 p.m.; infant Julia Carla delivered at 3:34 p.m. with prematurity complications. Massive hemorrhage ensued. Placenta was abnormally adherent; emergency hysterectomy commenced around 3:40 p.m.; uterus removed at 4:20 p.m. Blood transfusions (type AB FWB) commenced; urology and cardiology referrals were requested intraoperatively. Difficulties in sourcing rare type AB blood were documented; hospital sourced from an outside facility (Fabella), with availability delayed by about two hours. Despite measures, Marissa was pronounced dead at about 5:45 p.m.
- Cause of death per death certificate: Cardiorespiratory arrest secondary to hypovolemic shock; placenta accreta; to consider amniotic fluid embolism.
- August 30, 2006 (infant’s death): The pediatrician urgently required a ventilator for Julia Carla. After payment, the ventilator arrived and was used past 12:00 noon, later than the promised 11:00 a.m. The infant died at 2:30 p.m.
- Pleadings and defenses
- Complaint: Petitioners alleged negligence in diagnosing and managing Marissa’s high-risk pregnancy, failure to timely perform ultrasound/MRI to detect placenta accreta, inadequate preparation for blood requirements, demand for monetary deposit to re-admit to OR/DR, and delays that resulted in the deaths of Marissa and the infant.
- Dr. Dela Cruz’s Answer: Denied negligence; asserted standard obstetrical management was implemented (tocolysis, monitoring, emergency CS, hysterectomy); emphasized placenta accreta is a pregnancy complication not within a physician’s control; negative outcome does not ipso facto imply negligence.
- MEMCI’s Answer: Disclaimed liability for physician’s acts due to consultant/visiting status (no employer-employee relationship); claimed diligence in selection and accreditation; asserted patient was personal patient of Dr. Dela Cruz; treatment decisions are made by consultants.
- Evidence for petitioners: Testimonies of Jude and family members regarding events, deposit issues, blood sourcing and ventilator delays; medico-legal report by Dr. Olga M. Bausa stating death due to hypovolemic shock secondary to postpartum bleeding due to placenta previa-associated accreta, manner of death “natural.” Dr. Bausa’s testimony was stricken for failure to appear for cross-examination.
- Evidence for respondents: Medical records and expert testimony of obstetrician Dr. German Tan Cardozo supporting that diagnosis/management were within standards; that ultrasound may not conclusively detect accreta and could delay management; and that transfusions cannot control bleeding if source persists.
- Lower court rulings
- RTC (July 8, 2017): Dismissed complaint against both respondents; found petitioners failed to prove negligence by preponderance for lack of competent expert testimony; credited respondents’ evidence that management (CS and hysterectomy) was standard; recognized high mortality in placenta accreta and difficulty in sourcing AB blood; physicians are not guarantors of results. MR denied.
- CA (May 30, 2019; Nov. 13, 2019): Affirmed RTC; rejected petitioners’ internet and book clippings as unsubstantied by experts and post-dating 2006; relied on Dr. Cardozo’s testimony; held placenta accreta is beyond anyone’s control; ultrasound could only raise suspicion and might delay management; found no causation proven within reasonable medical probability; res ipsa loquitur inapplicable.
- Petition to the Supreme Court
- Assigned errors: (a) Courts should have applied res ipsa loquitur; (b) Dr. Dela Cruz was negligent in not diagnosing accreta early via ultrasound/MRI and in failing to prepare blood given high-risk factors; (c) MEMCI liable; (d) award of damages warranted.
- Respondents’ positions: Maintain non-applicability of res ipsa; no negligence; lack of plaintiffs’ expert testimony; MEMCI adopted Dr. Dela Cruz’s Comment.
Issues:
- Whether the doctrine of res ipsa loquitur applies to the circumstances surrounding Marissa’s death and the infant’s death.
- Whether placenta accreta and its sequelae are of a kind that ordinarily do not occur absent negligence, were within respondents’ exclusive control, and exclude contributory causes.
- Whether Dr. Dela Cruz and MEMCI were negligent in the management and treatment of Marissa’s high-risk pregnancy and preterm bleeding, proximately causing the deaths.
- Whether failure to timely conduct ultrasound/MRI and to prepare blood units constituted a breach of the standard of care.
- Whether proximate causation between the breach and the harm was established.
- Whether MEMCI is vicariously liable for Dr. Dela Cruz’s negligence under Article 2180 of the Civil Code and the doctrine of apparent authority.
- Whether the Supreme Court may review factual findings under Rule 45 due to exceptions (misapprehension of facts or overlooked material facts).
- Assuming liability, what damages and interest are due, and at what rates and reckoning points.
Ruling:
- (Subscriber-Only)
Ratio:
- (Subscriber-Only)