G.R. No. 118231 - Batiquin vs. Court of Appeals

Case Summary (G.R. No. 118231)

Factual Background

DR. VICTORIA L. BATIQUIN was a Resident Physician at the Negros Oriental Provincial Hospital from January 9, 1978 to September 1989 and from 1987 until September 1989 served as Acting Head of Obstetrics and Gynecology. Flotilde G. Villegas submitted to DR. BATIQUIN for prenatal care as a private patient and underwent a simple cesarean section performed by DR. BATIQUIN with the assistance of Dr. Doris Teresita Sy on September 21, 1988, delivering a child that same morning. Villegas remained confined until September 27, 1988 and paid DR. BATIQUIN P1,500.00 as professional fee upon checkout. Soon after discharge she experienced recurrent abdominal pains, fever, and progressive debilitation despite continuing treatment from DR. BATIQUIN and returned to work in November 1988 after a medical certificate dated October 31, 1988. On January 20, 1989 Villegas consulted Dr. Ma. Salud Kho, who found signs of intra-abdominal infection, an abdominal mass, and laboratory evidence of infection. Dr. Kho performed a second operation and reported whitish-yellow discharge, pus-filled ovarian cysts, and a piece of rubber approximately two inches by three-quarters of an inch on the right side of the uterus embedded in an ovarian cyst. Dr. Kho described the object as resembling a torn section of a surgeon's glove or a rubber drain.

Evidence Presented and Preservation Issues

The piece of rubber allegedly recovered during Dr. Kho's operation was not produced in court. Dr. Kho testified that she sent the object to a pathologist in Cebu City, yet the pathologist's Surgical Pathology Report made no mention of the rubber. Documentary references to the foreign object included a Medical Certificate, Progress Record, Anesthesia Record, Nurse's Record, and Physician's Discharge Summary. The trial court treated those documents as hearsay because their preparers did not testify and because Dr. Kho had merely affixed her signature to some of them. The trial court also recorded that when confronted by DR. BATIQUIN, Dr. Kho allegedly told DR. BATIQUIN that she had thrown the rubber away; that oral statement was not denied by Dr. Kho at trial.

Trial Court Proceedings and Findings

The trial court found that the documented assertions regarding the rubber were hearsay and that Dr. Kho "may not have had first-hand knowledge" of the foreign object, relying in part on Dr. Kho's statement that she had "heard somebody" say there was a foreign body and that she did not know where the rubber was. The trial court also credited DR. BATIQUIN's testimony that no rubber drain had been used, that her gloves were intact after the operation, and that her assistant Dr. Sy corroborated the absence of a rubber drain. On that basis the trial court resolved the factual conflicts in favor of the petitioners and dismissed the complaint for damages.

Court of Appeals Decision

The Court of Appeals reviewed Dr. Kho's entire testimony and concluded that she positively observed a piece of rubber in Villegas' abdomen and that the trial court had taken portions of her testimony out of context. The appellate court deemed the presence of the foreign object to establish negligence by DR. BATIQUIN, reasoning that the instrumentality causing the injury had been under the exclusive control of the operating physician and that the object would not have been inside the patient but for negligence. The Court of Appeals reversed the trial court and awarded plaintiffs P17,000.00 actual damages; P100,000.00 moral damages; P20,000.00 exemplary damages; and P25,000.00 attorney's fees, plus costs of litigation.

Issues on Appeal to the Supreme Court

The petition to the Supreme Court asserted two principal grounds: (1) that the Court of Appeals committed grave abuse of discretion by drawing factual findings not supported by the record, and (2) that the appellate court exceeded its jurisdiction by crediting testimony alleged to contain contradictions and falsities. The petitioners principally contested the Court of Appeals' acceptance of Dr. Kho's testimony as establishing firsthand observation of the foreign object, arguing that portions of Dr. Kho's testimony revealed that her knowledge was hearsay and therefore unreliable.

Supreme Court's Ruling and Disposition

The Supreme Court affirmed the Court of Appeals' decision in toto. The Court held that the contested portions of Dr. Kho's testimony, when read in context, contained positive, firsthand statements that she actually found a piece of rubber in the patient's abdomen and that she sent it for examination. The Supreme Court found Dr. Kho to be a credible witness who was frank on cross-examination and who had no apparent motive to fabricate. The Court rejected the petitioners' contention that the trial court's interpretation of isolated testimony required reversal. The petitioners failed to overcome the appellate court's factfinding and credibility assessment.

Legal Basis and Reasoning

The Supreme Court emphasized the evidentiary rule embodied in the doctrine of res ipsa loquitur. The Court recited the doctrine's requisites: (1) the instrumentality causing injury was under the exclusive control and management of the defendant; (2) the occurrence is such that it ordinarily would not happen in the absence of negligence; and (3) direct evidence of the defendant's negligence is absent or not readily available. Applying those principles, the Court concluded that the cesarean operation was under the exclusive control of DR. BATIQUIN, that no intervening operation could explain the foreign object, and that the presence of the rubber was an occurrence that would not ordinarily happen absent negligence. The Court further observed that positive testimony establishing an operative fact outweighs negative testimony denying its existence. The trial court's preference for denials over the direct and consistent testimony of Dr. Kho was not justified. On this composite of credibility and legal inference, the Court h

Case Syllabus (G.R. No. 118231)

Parties and Procedural Posture

DR. VICTORIA L. BATIQUIN AND ALLAN BATIQUIN were the petitioners before the Supreme Court.
COURT OF APPEALS was the respondent in the petition for review on certiorari.
SPOUSES QUEDO D. ACOGIDO AND FLOTILDE G. VILLEGAS were plaintiffs below and private respondents in this Court.
The petition assailed the decision of the Court of Appeals in CA-G.R. CV No. 30851 which reversed the decision of Branch 30 of the Regional Trial Court of Negros Oriental in Civil Case No. 9492.
The trial court rendered judgment dismissing the complaint for damages, and the Court of Appeals reversed and awarded damages and fees.

Key Facts

Dr. Victoria L. Batiquin served as a Resident Physician at Negros Oriental Provincial Hospital from January 9, 1978 to September 1989 and was Acting Head of Obstetrics and Gynecology between 1987 and September 1989.
Flotilde G. Villegas submitted to Dr. Batiquin for prenatal care and underwent a simple cesarean section on September 21, 1988 at Negros Oriental Provincial Hospital.
The operation resulted in delivery of a child, and Flotilde G. Villegas was discharged from the hospital on September 28, 1988 after paying Dr. Batiquin P1,500.00 as professional fee.
After discharge, Flotilde G. Villegas suffered recurring abdominal pains, fever, and weight loss despite follow-up with Dr. Batiquin and prescribed medications until December 1988.
On January 20, 1989 Flotilde G. Villegas consulted Dr. Ma. Salud Kho who, upon exploratory laparotomy, found pus in the abdominal cavity, bilateral ovarian cysts with pus, and a piece of rubber two inches by three quarters inch in size on the right side embedded in an ovarian cyst.
Dr. Kho testified that the piece of rubber resembled a torn section of a surgeon’s glove or a rubber drain and that she sent it to a pathologist in Cebu City for examination.
The alleged piece of rubber was not produced in evidence and the pathologist’s Surgical Pathology Report did not mention it.

Trial Evidence

Dr. Ma. Salud Kho testified to firsthand observation of pus, ovarian cysts, and discovery of a piece of rubber in Flotilde G. Villegas’s abdomen during the second operation.
Documentary records including a Medical Certificate, Progress Record, Anesthesia Record, Nurse’s Record, and Physician’s Discharge Summary referenced the presence of a foreign body.
Dr. Batiquin and her assistant Dr. Doris Teresita Sy testified that no rubber drain was used and that no tear was observed on gloves after the operation.
Dr. Batiquin testified that upon confronting Dr. Kho she was told that a rubber was found but that Dr. Kho threw it away; that statement was not objected to at trial.

Trial Court Findings

The trial court found the documentary evidence mentioning the rubber to be hearsay and excluded weight therefrom because the preparers did not testify.
The trial court questioned Dr. Kho’s firsthand knowledge based on a portion of her testimony that stated she had "heard somebody" mention a foreign body and that she did not know where the rubber was.
The trial court credited the negative testimony of Drs. Batiquin and Sy and resolved credibility in favor of the petitioners, thereby dismissing the plaintiffs’ complaint.

Court of Appeals Ruling

The Court of Appeals reviewed Dr. Kho’s entire test