Case Summary (G.R. No. L-35027)
Factual Background
Josephine underwent hysterectomy and myomectomy performed by Dr. Mendoza on February 13, 1993. After the operation, Josephine experienced recurring fever, nausea, and vomiting. Three months later, while taking a bath, she noticed something protruding from her genital. When she attempted to reach Dr. Mendoza, the latter was unavailable. Josephine sought treatment from another physician, Dr. Edna Jamandre-Gumban, who extracted a foul-smelling, partially expelled rolled gauze from Josephine’s cervix.
The discovery of the gauze and the illness she had suffered led Josephine to file an action for damages against Dr. Mendoza. Before the case could be tried to completion, Josephine died. Her husband, Adriano, and their children, Jennifer Adriane and John Andre, were substituted as plaintiffs. Josephine was a housewife and forty years old at the time of her death.
RTC Proceedings and Conflicting Rulings
On March 7, 2005, the RTC rendered judgment in favor of Josephine’s heirs. It found Dr. Mendoza guilty of neglect that caused Josephine’s illness and eventual death. It ordered Dr. Mendoza to pay the plaintiffs heirs actual damages of P50,000.00, moral damages of P200,000.00, and attorneys fees of P20,000.00, plus costs of suit.
On motion for reconsideration, the RTC reversed itself and dismissed the complaint in an order dated June 23, 2005. The reversal produced the basis for appellate review.
CA Ruling
The CA decision dated March 18, 2011 reinstated the RTC’s original judgment. The CA held that Dr. Mendoza breached her duty as a physician when a gauze remained inside the patient’s body after surgery. It denied Dr. Mendoza’s motion for reconsideration on July 18, 2011, prompting the present petition to the Supreme Court.
The Parties’ Contentions Before the Supreme Court
Dr. Mendoza insisted at the Supreme Court level that no gauze or surgical material was left in Josephine’s body after the surgery, pointing to the surgical sponge count in the hospital record. She also argued that the CA’s conclusions should not stand.
The Supreme Court noted, however, that Dr. Mendoza raised what was essentially a question of fact, since petitions for review on certiorari generally raise questions of law only. The Court further observed that the usual rule regarding the binding effect of the CA’s factual findings applied, and that none of the recognized exceptions to that rule was shown to obtain.
The Supreme Court also underscored the evidentiary and logical inferences drawn by the trial and appellate courts. It agreed with the RTC that Josephine did not undergo any other surgical operation and reasoned that it was highly unlikely for Josephine, or for any woman, to inject a rolled piece of gauze into her cervix.
Legal Basis and Reasoning
The Supreme Court relied on settled doctrine in Professional Services, Inc. v. Agana, holding that an operation is not complete until sponges are properly removed and that leaving sponges or other foreign substances in the wound after closure constitutes at least prima facie negligence. The Court explained that such an act is so inconsistent with due care that it raises an inference of negligence. The Court further noted that the doctrine is often treated as negligence per se for purposes of liability.
Consistent with the nature of a surgical operation, the Supreme Court reiterated that the surgeon bears responsibility for the procedure. The surgeon must personally ascertain that the counts of instruments and materials used before the surgery and before sewing the patient up were correctly done. This duty of constant vigilance reinforces the inference arising from the presence of foreign matter after the procedure.
The Court then addressed the issue of damages. It observed that neither the CA nor the RTC had awarded exemplary damages against Dr. Mendoza. It took the view that exemplary damages were proper in this case. It referred to Article 2229 of the Civil Code, under which exemplary damages are imposed by way of example or correction for the public good, and noted that exemplary damages may be awarded i
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Case Syllabus (G.R. No. L-35027)
- Mariter Mendoza filed a petition challenging the Court of Appeals (CA) decision reinstating the Regional Trial Court (RTC) of Iloilo City judgment in favor of Adriano Casumpang, Jennifer Adriane Casumpang, and John Andre Casumpang (all surnamed Casumpang).
- The respondents were substituted by Josephine Casumpang’s heirs after Josephine’s death before trial could end.
- The Supreme Court treated the petition as one that raised legal issues only insofar as they were properly reviewable on certiorari; it declined to disturb binding factual findings of the CA.
Parties and Procedural Posture
- Josephine Casumpang (substituted by her husband Adriano Casumpang and children Jennifer Adriane and John Andre, all surnamed Casumpang) filed an action for damages against Dr. Mariter Mendoza in 1993 before the RTC of Iloilo City.
- The RTC initially ruled in favor of the plaintiffs on March 7, 2005, then reversed itself on June 23, 2005 upon a motion for reconsideration by Dr. Mendoza and dismissed the complaint.
- On appeal, the CA issued a decision on March 18, 2011, reinstating the RTC’s original decision.
- The CA denied Dr. Mendoza’s motion for reconsideration on July 18, 2011, prompting the present petition before the Supreme Court.
Key Factual Allegations
- In 1993, Josephine Casumpang underwent hysterectomy and myomectomy performed by Dr. Mendoza at the Iloilo Doctors Hospital on February 13, 1993.
- After surgery, Josephine suffered recurring fever, nausea, and vomiting.
- Around three months after the operation, Josephine discovered while taking a bath something protruding from her genital.
- Josephine attempted to report the condition to Dr. Mendoza, but the latter was unavailable.
- Josephine consulted Dr. Edna Jamandre-Gumban, who extracted a foul smelling, partially expelled rolled gauze from Josephine’s cervix.
- The presence of the gauze and Josephine’s illness led to the damages suit against Dr. Mendoza.
- Josephine died before trial ended; her husband and children were substituted as plaintiffs.
- The RTC and CA proceeded on the circumstance that Josephine did not undergo any other surgical operation after the surgery in question.
Issues Raised
- The petition challenged whether a surgical material or gauze was left inside Josephine’s body after surgery.
- Dr. Mendoza relied on the hospital record surgical sponge count to assert that no gauze or surgical material remained.
- The petition also implicitly invoked the Court’s limitations on review of questions of fact on petitions for review on certiorari from the CA.
Parties’ Contentions
- Dr. Mendoza contended that no gauze or surgical material was left after surgery, pointing to the surgical sponge count in the hospital record.
- She argued at the Supreme Court level that the existence or non-existence of retained gauze was at issue, which she framed through the sponge-count evidence.
- The respondents, through the CA’s findings, contended that a gauze or foreign surgical material remained in Josephine’s body, demonstrating breach of the physician’s duty and supporting liability.
Review Limits on Factual Matters
- The Court emphasized that, with limited exceptions, factual findings of the CA are generally binding.
- The Court recognized that petitions for review on certiorari from the CA ordinarily allow review of questions of law, not re-evaluation of facts.
- The Court found that none of the exceptions to the binding character of CA factual findings applied to the case.
Statutory and Doctrinal Framework
- The CA applied the settled rule that a physician’s breach of duty may be inferred from retained surgical materials after an operation.
- The Supreme Court quoted Professional Services, Inc. v. Agana for the proposition tha