Case Summary (G.R. No. 160889)
Investigations, expert examination, and treatment performed
On April 22, 1992 John David filed an investigation request. Hospital medical director Dr. Abad queried Dr. Cantre and the resident; Dr. Cantre attributed the injury to the blood pressure cuff. On May 7, 1992 medico-legal officer Dr. Floresto Arizala, Jr. conducted a physical examination and testified the injury appeared to be a burn and that a droplight placed near the skin for about ten minutes could cause such a burn; he regarded a blood pressure cuff as unlikely because the scar was localized to one side of the arm rather than encircling it. Nora’s wound underwent skin grafting at the hospital on May 22, 1992 (donor skin from abdomen) and later required scar revision on April 30, 1993. The hospital bore the costs of the grafting and revision. The resulting healed scar measured about three inches with a portion raised about one-fourth inch; Nora continued to experience pain, restricted movement, and functional and cosmetic impairment.
Trial court decision and awards
Respondents filed a civil complaint for damages on June 21, 1993 against Dr. Cantre, Dr. Abad, and the hospital. The RTC found in favor of respondents and imposed joint and several liability on the defendants, ordering payment of P500,000.00 moral damages, P150,000.00 exemplary damages, P80,000.00 nominal damages, P50,000.00 attorney’s fees, and P6,000.00 litigation expenses.
Court of Appeals disposition and modifications
On appeal the Court of Appeals affirmed the RTC decision with modification: it ordered only Dr. Milagros L. Cantre to pay respondents P200,000.00 as moral damages; it deleted the awards of exemplary damages, attorney’s fees, and litigation expenses; it dismissed the complaint against Dr. Abad and Delgado Clinic, Inc.; dismissed the defendants’ counterclaims; and ordered Dr. Cantre to pay costs. Petitioner’s motion for reconsideration in the CA was denied.
Issues raised in the Supreme Court petition
Petitioner challenged the CA rulings on multiple grounds, framed largely as grave abuse of discretion: (1) admissibility of additional documentary exhibits not testified to by any witness and alleged deprivation of right to confront witnesses; (2) factual findings that the droplight could have touched Nora and caused the injury; (3) alleged failure by petitioner to explain how the blisters occurred; (4) use by the CA of testimony from someone who allegedly had not seen the original injury; (5) an asserted CA finding that petitioner intended to inflict injury to save Nora’s life; (6) findings that petitioner left Nora to nursing staff despite detailed procedures; (7) characterization of plastic surgery as cosmetic and a “failure”; and (8) entitlement to damages despite alleged contrary testimonies and absence of evidence.
Admissibility of hospital records and other exhibits
The Supreme Court agreed with the CA that the additional exhibits (largely Nora’s medical records) were admissible. Those records were produced under subpoena duces tecum and their existence was formally admitted by petitioner’s counsel when offered at trial. The Court further noted that, even absent those exhibits, the presumption of negligence under res ipsa loquitur would allow resolution on negligence under the case circumstances.
Medico-legal testimony and timing issues
The Court rejected petitioner’s contention that the medico-legal officer never saw the original injury prior to plastic surgery. The record established that Dr. Arizala conducted his physical examination on May 7, 1992, while the grafting occurred on May 22, 1992 and revision in April 1993, so the medico-legal examiner did in fact see the fresh injury.
Legal standard: res ipsa loquitur and “captain of the ship”
The Court applied the res ipsa loquitur doctrine which permits a presumption of negligence where (1) the accident ordinarily does not occur without negligence; (2) the instrumentality causing harm was under the exclusive control of the defendant(s); and (3) plaintiff’s contributory conduct is eliminated. The Court also invoked the “captain of the ship” doctrine, imputing responsibility to the senior physician for acts of assistants under the senior’s control. Under these principles, the wound on an arm during delivery — remote from the birthing organs and while the patient was unconscious in hypovolemic shock — was an event that ordinarily would not occur absent negligence, involved instruments (droplight or blood pre
...continue readingCase Syllabus (G.R. No. 160889)
Case Citation and Procedural Posture
- Reported at 550 Phil. 637, Second Division, G.R. No. 160889, decided April 27, 2007.
- Petition for review on certiorari from the Decision dated October 3, 2002 and Resolution dated November 19, 2003 of the Court of Appeals in CA-G.R. CV No. 58184.
- Those rulings affirmed with modification the Regional Trial Court (RTC) of Quezon City, Branch 98, Decision dated March 3, 1997 in Civil Case No. Q-93-16562.
- Petition filed by Dr. Milagros L. Cantre (petitioner); respondents are spouses John David Z. Go and Nora S. Go.
- The Supreme Court DENIED the petition, AFFIRMED the Court of Appeals’ decision and resolution, and made no pronouncement as to costs.
Factual Background — Patient Admission, Delivery, and Immediate Postpartum Events
- Petitioner Dr. Milagros L. Cantre is an Obstetrics and Gynecology specialist at Dr. Jesus Delgado Memorial Hospital and was Nora Go’s attending physician.
- Nora Go was admitted on April 19, 1992; she gave birth to her fourth child at about 1:30 a.m. on April 20, 1992.
- At about 3:30 a.m. on April 20, 1992, Nora suffered profuse intrauterine bleeding due to retained placental parts, resulting in hypovolemic shock and an alleged drop in blood pressure to “40” over “0.”
- Petitioner and an assisting resident performed medical procedures to stop bleeding and restore blood pressure; blood pressure was frequently monitored using a sphygmomanometer.
- While petitioner massaged Nora’s uterus, she ordered a “droplight” to warm Nora and her baby.
- Nora remained unconscious until recovery; while in the recovery room, respondent John David Go observed a fresh, gaping wound about two and one-half by three and one-half inches on the inner portion of Nora’s left arm near the armpit.
Discovery of Injury, Medical Examination, and Surgical Interventions
- Upon discovery of the wound, nurses informed John David that the injury was a burn; he filed a request for investigation on April 22, 1992.
- Dr. Rainerio S. Abad, medical director, called petitioner and the resident to explain the occurrence; petitioner attributed the injury to the blood pressure cuff.
- On May 7, 1992, Nora was examined by medico-legal officer Dr. Floresto Arizala, Jr. at the National Bureau of Investigation; his testimony was that the injury appeared to be a burn and that a droplight placed near the skin for about ten minutes could cause such a burn.
- The medico-legal officer dismissed the blood pressure cuff as the likely cause because the scar was localized on one side rather than encircling the arm.
- On May 22, 1992, Nora’s injury was referred for skin grafting to a plastic surgeon at Dr. Jesus Delgado Memorial Hospital; abdominal skin was used to graft the wound, leaving a donor-site scar on her abdomen.
- On April 30, 1993, scar revision was performed; the ultimate healed linear scar on Nora’s left arm measured about three inches in length, with the thickest portion protruding about one-fourth of an inch.
- The costs of the skin grafting and the scar revision were borne by the hospital.
Postoperative Condition and Functional Impact
- Nora’s left arm bore a permanent unsightly scar, persistent pain, and restricted movements.
- She experiences pain on slightest touch, must cradle the wounded arm when sleeping, and her children avoid using the left side of her body to prevent bumping the injured arm.
- The record notes the arm would “never be the same,” indicating chronic sequelae following the surgical interventions.
Trial Proceedings and Trial Court Judgment
- On June 21, 1993, the spouses filed a complaint for damages against petitioner, Dr. Abad, and Delgado Clinic, Inc.
- The RTC found for plaintiffs and rendered judgment directing defendants, jointly and severally, to pay: P500,000.00 moral damages; P150,000.00 exemplary damages; P80,000.00 nominal damages; P50,000.00 attorney’s fees; and P6,000.00 litigation expenses.
- The RTC’s decision is documented at Records, pp. 218–227.
Court of Appeals Disposition and Modifications
- The Court of Appeals affirmed the RTC decision with modifications:
- Ordered Dr. Milagros L. Cantre alone to pay P200,000.00 as moral damages to John David and Nora Go.
- Deleted the award of exemplary damages, attorney’s fees, and litigation expenses.
- Dismissed the complaint against Dr. Rainerio S. Abad and Delgado Clinic, Inc.
- Dismissed defendants-appellants’ counterclaims for lack of merit.
- Ordered Dr. Cantre to pay costs.
- The CA’s Decision and subsequent denial of petitioner’s motion for reconsideration are the subject of the present petition.
Issues Raised in the Petition to the Supreme Court
- The petition enumerated multiple assignments of error, including:
- Alleged grave abuse for admitting additional exhibits not testified to by witnesses and thereby violating petitioner’s right to confront witnesses.
- Contesting the factual finding that the droplight touched Nora’s body and arguing the injury was due to repeated blood pressure cuff use.
- Alleged failure by petitioner to adequately explain how the blisters on Nora’s inner left arm occurred.
- Claim that the CA relied on testimony of someone who had not seen the original fresh injury.
- Protest that the CA effectively ruled petitioner intended to inflict the injury to save Nora’s life.
- Allegation that the lower courts erred in ruling that petitioner left Nora to the nursing staff despite detailed procedures undertaken by petitioner.
- Complaint that the RTC improperly characterized the cosmetic surgery as a failure and that