G.R. No. 191018. Jan a 25, 2016.

CARLOS BORROMEO, pe i ione , vs. FAMILY CARE

HOSPITAL, INC. and RAMON S. INSO, M.D., e ponden .

Remedial Law; Civil Procedure; Appeals; Petition for Review on

Certiorari; The factual ndings of the Court of Appeals (CA) are, as a
general rule, conclusive upon the Supreme Court (SC); Exceptions. Unde
Sec ion 1 of R le 45, a pe i ion fo e ie on certiorari hall onl ai e
q e ion of la . The S p eme Co i no a ie of fac and i i no o
f nc ion o anal e and eigh e idence ha he lo e co had al ead
pa ed pon. The fac al nding of he Co of Appeal a e, a a gene al
le, concl i e pon hi Co . Ho e e , j i p dence ha al o ca ed
o ecogni ed e cep ion o hi le, o i : (1) hen he nding a e
g o nded en i el on pec la ion, mi e , o conjec e ; (2) hen he
infe ence made i manife l mi aken, ab d, o impo ible; (3) hen
he e i g a e ab e of di c e ion; (4) hen he j dgmen i ba ed on a
mi app ehen ion of fac ; (5) hen he nding of fac a e con ic ing; (6)
hen in making i nding he Co of Appeal en be ond he i e of
he ca e, o i nding a e con a o he admi ion of bo h he appellan
and he appellee; (7)
; (8) hen he nding a e concl ion i ho ci a ion of peci c
e idence on hich he a e ba ed; (9) hen he fac e fo h in he pe i ion
a ell a in he pe i ione main and epl b ief a e no di p ed b he
e pon-

_______________

* SECOND DIVISION.

52

528 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.

den ; (10) hen he nding of fac a e p emi ed on he ppo ed

ab ence of e idence and con adic ed b he e idence on eco d; and (11)
 hen he Co of Appeal manife l o e looked ce ain ele an fac no
di p ed b he pa ie , hich, if p ope l con ide ed, o ld j if a
diffe en concl ion.
Same; Evidence; Burden of Proof; Medical Malpractice; In a medical
malpractice case, the plaintiff has the duty of proving its elements, namely:
(1) a duty of the defendant to his patient; (2) the defendant s breach of this
duty; (3) injury to the patient; and (4) proximate causation between the
breach and the injury suffered. Whoe e allege a fac ha he b den of
p o ing i . Thi i a ba ic legal p inciple ha eq all applie o ci il and
c iminal ca e . In a medical malp ac ice ca e, he plain iff ha he d of
p o ing i elemen , namel : (1) a duty of he defendan o hi pa ien ; (2)
he defendan breach of hi d ; (3) injury o he pa ien ; and (4)
proximate causation be een he b each and he inj ffe ed. In ci il
ca e , he plain iff m p o e he e elemen b a p eponde ance of
e idence.
Medical Malpractice; A breach of the accepted standard of care
constitutes negligence or malpractice and renders the defendant liable for
the resulting injury to his patient. A medical p ofe ional ha he d o
ob e e he standard of care and e e ci e he deg ee of kill, kno ledge,
and aining o dina il e pec ed of o he imila l ained medical
p ofe ional ac ing nde he ame ci c m ance . A b each of he accep ed
anda d of ca e con i e negligence o malp ac ice and ende he
defendan liable fo he e l ing inj o hi pa ien . The anda d i ba ed
on he no m ob e ed b o he ea onabl compe en membe of he
p ofe ion . Beca e medical
malp ac ice ca e a e of en highl echnical, e pe e imon i all
e en ial o e abli h: (1) he anda d of ca e ha he defendan a bo nd
o ob e e nde he ci c m ance ; (2) ha he defendan cond c fell
belo he accep able anda d; and (3) ha he defendan fail e o
ob e e he ind anda d ca ed inj o hi pa ien .

52

VOL. 781, JANUARY 25, 2016 529

Borromeo vs. Family Care Hospital, Inc.

Remedial Law; Evidence; Res Ipsa Loquitur; Words and Phrases; Res
ipsa loquitur, literally, “the thing speaks for itself”; is a rule of evidence
that presumes negligence from the very nature of the accident itself using
common human knowledge or experience. The pe i ione canno in oke
he doc ine of res ipsa loquitur o hif he b den of e idence on o he
e ponden . Res ipsa loquitur, li e all , he hing peak fo i elf ; i a le
of e idence ha p e me negligence f om he e na e of he acciden
i elf ing common human knowledge o e pe ience. The applica ion of
 hi le eq i e : (1) ha he acciden a of a kind hich doe no
o dina il occ nle omeone i negligen ; (2) ha he in men ali o
agenc hich ca ed he inj a nde he e cl i e con ol of he
pe on cha ged i h negligence; and (3) ha he inj ffe ed m no
ha e been d e o an ol n a ac ion o con ib ion f om he inj ed
pe on. The conc ence of he e elemen c ea e a p e mp ion of
negligence ha , if n eb ed, o e come he plain iff b den of p oof.
Thi doc ine i ed in conj nc ion i h he doctrine of common
knowledge. We ha e applied hi doc ine in he follo ing ca e in ol ing
medical p ac i ione : a. Whe e a pa ien ho a ched led fo a
cholec ec om ( emo al of gall one ) b a o he i e heal h ffe ed
i epa able b ain damage af e being admini e ed ane he ia p io o he
ope a ion; b. Whe e af e gi ing bi h, a oman oke p i h a gaping b n
o nd clo e o he lef a mpi ; c. The emo al of he ong bod pa
d ing he ope a ion; and d. Whe e an ope a ing geon lef a fo eign
objec (i.e., bbe glo e ) in ide he bod of he pa ien .

PETITION fo e ie on ce io a i of a deci ion of he Co of

Appeal .
The fac a e a ed in he opinion of he Co .
  Christian Joseph Marie F. Fajardo fo pe i ione .
  Jimeno, Cope & David Law Of ces fo e ponden .

BRION, J.:

Ca lo Bo omeo lo hi ife Lillian hen he died af e

nde going a o ine appendec om . The ho pi al and he a ending
geon bmi ha Lillian bled o dea h d e o a

530

530 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.

a e, life- h ea ening condi ion ha p e en ed he blood f om

clo ing no mall . Ca lo belie e , ho e e , ha he ho pi al and he
geon e e impl negligen in he ca e of hi la e ife.
On Jan a 22, 2010, he Co of Appeal (CA) in C.A.-G.R.
C N . 890961 di mi ed Ca lo complain and h e e ed he
Ap il 10, 2007 deci ion of he Regional T ial Co (RTC) in C
C N . 2000-603-MK2 hich fo nd he e ponden liable fo
medical negligence.
The p e en pe i ion fo e ie on certiorari eek o e e e he
CA Jan a 22, 2010 deci ion.

A ecede
 The pe i ione , Ca lo Bo omeo, a he h band of he la e
Lilian V. Bo omeo (Lilian). Lilian a a pa ien of he e ponden
Famil Ca e Ho pi al, Inc. (Family Care) nde he ca e of
e ponden D . Ramon In o (Dr. Inso).
On J l 13, 1999, he pe i ione b o gh hi ife o he Famil
Ca e Ho pi al beca e he had been complaining of ac e pain a he
lo e omach a ea and fe e fo o da . She a admi ed a he
ho pi al and placed nde he ca e of D . In o.
D . In o pec ed ha Lilian migh be ffe ing f om ac e
appendici i . Ho e e , he e a in f cien da a o le o o he
po ible ca e and o p oceed i h an appendec om . Th , he
o de ed Lilian con nemen fo e ing and e al a ion.
O e he ne 48 ho , Lilian nde en m l iple e ch a
comple e blood co n , inal i , ool e am, pel ic

_______________

1 Penned b A ocia e J ice I aia Dicdican and conc ed in b A ocia e

J ice Romeo F. Ba a and An onio L. Villamo , Rollo, pp. 9-32.
2 Ma ikina Ci , B anch 273 h o gh P e iding J dge Man el S. Q imbo.

531

VOL. 781, JANUARY 25, 2016 531

Borromeo vs. Family Care Hospital, Inc.

l a o nd, and a p egnanc e . Ho e e , he e e e no

concl i e eno gh o con m ha he had appendici i .
Mean hile, Lilian condi ion did no imp o e. She ffe ed
f om piking fe e and he abdominal pain o ened. The inc ea ing
ende ne of he omach, hich a p e io l con ned o he
lo e igh ide, had al o e ended o he lo e lef ide. Lilian
ab p l de eloped an acute surgical abdomen.
On J l 15, 1999, D . In o decided o cond c an e plo a o
lapa o om on Lilian beca e of he nding on he abdomen and
hi fea ha he migh ha e a p ed appendi . E plo a o
lapa o om i a gical p oced e in ol ing a la ge inci ion on he
abdominal all ha o ld enable D . In o o e amine he
abdominal ca i and iden if he ca e of Lilian mp om . Af e
e plaining he i a ion, D . In o ob ained he pa ien con en o
he lapa o om .
A a o nd 3:45 PM, Lilian a b o gh o he ope a ing oom
he e D . In o cond c ed he ge . D ing he ope a ion, D . In o
con med ha Lilian a ffe ing f om ac e appendici i . He
p oceeded o emo e he appendi hich a al ead infec ed and
conge ed i h p .
The ope a ion a cce f l. Lilian appea ance and i al ign
imp o ed. A a o nd 7:30 PM, Lilian a b o gh back o he
p i a e oom f om he eco e oom.
A a o nd 1:30 AM on J l 16, 1999, o ghl i ho af e
Lilian a b o gh back o he oom, D . In o a info med ha he
blood p e e a lo . Af e a e ing he condi ion, he o de ed
he inf ion of mo e in a eno (IV) id hich omeho ai ed
he blood p e e.
De pi e he la e ho , D . In o emained in he ho pi al o moni o
Lilian condi ion. S b eq en l , a n e info med him ha Lilian
a becoming e le . D . In o immedia el en o Lilian and a
ha he a q i e pale. He immedia el eq e ed a blood
an f ion.

532

532 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.

Lilian did no e pond o he blood an f ion e en af e

ecei ing o 500 cc- ni of blood. Va io d g, ch a
ad enaline o epineph ine, e e admini e ed.
E en all , an endo acheal be connec ed o an o gen ank
a in e ed in o Lilian o en e he ai a a clea and o
compen a e fo he lack of ci c la ing o gen in he bod f om he
lo of ed blood cell . Ne e hele , he condi ion con in ed o
de e io a e.
D . In o ob e ed ha Lilian a de eloping petechiae in a io
pa of he bod . Petechiae a e mall b i e ca ed b bleeding
nde he kin ho e p e ence indica e a blood-coag la ion
p oblem a defec in he abili of blood o clo . A hi poin , D .
In o pec ed ha Lilian had Disseminated Intravascular
Coagulation (DIC), a blood di o de cha ac e i ed b bleeding in
man pa of he bod ca ed b he con mp ion o he lo of he
clo ing fac o in he blood. Ho e e , D . In o did no ha e he
l o cond c f he e beca e he immedia e need a o
e ci a e Lilian.
D . In o and he n e pe fo med ca diop lmona e ci a ion
(CPR) on Lilian. D . In o al o info med he famil ha he e ma be
a need o eope a e on he , b he o ld ha e o be p in an
In en i e Ca e Uni (ICU). Unfo na el , Famil Ca e did no ha e
an ICU beca e i a onl a econda ho pi al and a no
eq i ed b he Depa men of Heal h o ha e one. D . In o info med
 he pe i ione ha Lilian o ld ha e o be an fe ed o ano he
ho pi al.
A a o nd 3:30 AM, D . In o pe onall called he Pe pe al
Help Medical Cen e o a ange Lilian an fe , b he la e had
no a ailable bed in i ICU. D . In o hen pe onall coo dina ed
i h he M n inl pa Medical Cen e (MMC) hich had an a ailable
bed.
A a o nd 4:00 AM, Lilian a aken o he MMC b amb lance
accompanied b he e iden doc o on d and a n e. D . In o
follo ed clo el behind in hi o n ehicle.

533

VOL. 781, JANUARY 25, 2016 533

Borromeo vs. Family Care Hospital, Inc.

Upon eaching he MMC, a medical eam a on hand o

e ci a e Lilian. A na oga ic be (NGT) a in e ed and IV
id e e immedia el admini e ed o he . D . In o a ked fo a
pla ma e pande . Unfo na el , a a o nd 10:00 AM, Lilian pa ed
a a de pi e effo o e ci a e he .
A he eq e of he pe i ione , Lilian bod a a op ied a
he Philippine Na ional Police (PNP) Camp C ame C ime
Labo a o . D . Emman el Re e (Dr. Reyes), he medico-legal
a igned o he labo a o , cond c ed he a op . D . Re e
mma i ed hi no able nding a :

I opened p he bod and in ide he abdominal ca i

hich o call pe i oneal ca i he e e e 3,000 ml of clo
and nclo blood acc m la ed he ea . The pe i oneal ca i
a al o f ee f om an adhe ion. Then, I opened p he head
and he b ain e ealed pape hi e in colo and he hea
e ealed ab ndan pe echial hemo hage f om he face and
i a no mal. The al la lea e e e of and pliable, and
of co e, he no mal colo i eddi h b o n a no ed. And he
co ona a e ie hich ppl he hea e e no mal and
n ema kable. Ne , he l ng appea [sic] hemo hagic. Tha
a he igh l ng hile he lef l ng a collap ed and paled.
Fo he in e ine , I no ed h o gho he en i e leng h of he
mall and la ge in e ine e e hemo hagic a ea . No ed
ab en i he appendi a he ileo-colic a ea b he e e e
con in o e epai done he ea . Ho e e , he e a a
0.5 0.5 cm opening o lef n epai ed a ha ime. The e a
an opening on ha epai i e. Meaning i a no epai ed.
The e e e al o a ha ime clo and nclo blood fo nd
adhe en he eon. The li e and he e of he i ce al o gan
 e e no ed e hibi [sic] ome deg ee of pallo b ee
o he i e no mal. The omach con ain one gla f l abo
400 o 500 ml.3

_______________

3 TSN da ed Ma ch 5, 2002, p. 14, q o ed in he RTC Deci ion; ee Rollo, pp.

143-144.

534

534 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.

D . Re e concl ded ha he ca e of Lilian dea h a

hemo hage d e o bleeding pe echial blood e el : in e nal
bleeding. He f he concl ded ha he in e nal bleeding a ca ed
b he 0.5 0.5 cm opening in he epai i e. He opined ha he
bleeding co ld ha e been a oided if he i e a epai ed i h
do ble ing in ead of he ingle con in o e epai ha he
fo nd.
Ba ed on he a op , he pe i ione led a complain fo
damage again Famil Ca e and again D . In o fo medical
negligence.
D ing he ial, he pe i ione p e en ed D . Re e a hi e pe
i ne . D . Re e e i ed a o hi nding d ing he a op and
hi opinion ha Lilian dea h co ld ha e been a oided if D . In o
had epai ed he i e i h do ble e a he han a ingle e.
Ho e e , D . Re e admi ed ha he had e li le e pe ience in
he eld of pa holog and hi onl e pe ience a an on- he-job
aining a he V. L na Ho pi al he e he a onl on ob e e
a . He f he admi ed ha he had no e pe ience in appendici i
o appendec om and ha Lilian ca e a hi a op
in ol ing a dea h f om appendec om .
Mo eo e , D . Re e admi ed ha he a no in elligen l
g ided d ing he a op beca e he a no f ni hed i h
clinical, ph ical, g o , hi opa h, and labo a o info ma ion ha
e e impo an fo an acc a e concl ion. D . Re e al o admi ed
ha an appendical mp i ini iall ollen hen ed and ha
he i che ma loo en d ing he healing p oce hen he ini ial
elling b ide.
In hei defen e, D . In o and Famil Ca e p e en ed D . In o,
and e pe i ne e D . Cel o Ramo (Dr. Ramos) and D .
He minio He nande (Dr. Hernandez).
 D . Ramo i a p ac icing pa hologi i h o e 20 ea of
e pe ience. He i an a ocia e p ofe o a he Depa men of
S ge of he Fa ima Medical Cen e , he Manila Cen al

535

VOL. 781, JANUARY 25, 2016 535

denting
Borromeo vs. Family Care Hospital, Inc.
are
Uni e i , and he Pe pe al Help Medical Cen e . He i a
Fello of he Philippine College of S geon , a Diploma e of he
Philippine Boa d of S ge , and a Fello of he Philippine Socie
of Gene al S geon .
D . Ramo di c edi ed D . Re e heo ha he 0.5 0.5 cm
opening a he epai i e ca ed Lilian in e nal bleeding.
Acco ding o D . Ramo , appendical e el mea e onl 0.1 o
0.15 cm, a claim ha a no ef ed b he pe i ione . If he 0.5
0.5 cm opening had ca ed Lilian hemo hage, he o ld no ha e
i ed fo o e 16 ho ; he o ld ha e died immedia el , i hin
20 o 30 min e , af e ge .
D . Ramo bmi ed ha he ca e of Lilian dea h a
hemo hage d e o DIC, a blood di o de ha lead o he fail e of
he blood o coag la e. D . Ramo con ide ed he ab ndan pe echial
hemo hage in he m oca dic ec ion and he hemo hagic igh
l ng; he m l iple bleeding poin indica e ha Lilian a af ic ed
i h DIC.
Mean hile, D . He nande i a gene al geon and a ho pi al
admini a o ho had been p ac icing ge fo en ea a of
he da e of hi e imon .
D . He nande e i ed ha Lilian dea h co ld no be a ib ed
o he alleged ong ing. He bmi ed ha he p e ence of
blood in he l ng , in he omach, and in he en i e leng h of he
bo el canno be econciled i h D . Re e heo ha he
hemo hage e l ed f om a ingle- ed appendi .
D . He nande e i ed ha Lilian had ncon ollable bleeding in
he mic oci c la ion a a e l of DIC. In DIC, blood oo e f om
e mall blood e el beca e of a p oblem in he clo ing fac o
of he blood e el . The mic oci c la ion i oo mall o be een b
he naked e e; he ed cell i e en malle han he ip of a needle.
The efo e, he alleged ong ing co ld no ha e ca ed he
amo n of hemo haging ha ca ed Lilian dea h.

536
536 SUPREME COURT REPORTS ANNOTATED
Borromeo vs. Family Care Hospital, Inc.

D . He nande f he e i ed ha he p oced e ha D . In o
pe fo med a con i en i h he al gical p oced e and he
o ld no ha e done an hing diffe en l .4
The pe i ione p e en ed D . R d a d A ila III (Dr. Avila) a a
eb al i ne . D . A ila, al o a la e , a p e en ed a an e pe
in medical j i p dence. D . A ila e i ed ha be een D . Re e
ho a op ied he pa ien and D . Ramo ho e nding e e ba ed
on medical eco d , g ea e eigh ho ld be gi en o D . Re e
e imon .
On Ap il 10, 2007, he RTC ende ed i deci ion a a ding he
pe i ione P88,077.50 a compen a o damage ; P50,000.00 a
dea h indemni ; P3,607,910.30 a lo of ea ning ; P50,000.00 a
mo al damage ; P30,000.00 a e empla damage ; P50,000.00 a
a o ne fee , and he co of he i .
The RTC elied on D . A ila opinion and ga e mo e eigh o
D . Re e nding ega ding he ca e of Lilian dea h. I held ha
D . In o a negligen in ing a ingle e on he epai i e
ca ing Lilian dea h b in e nal hemo hage. I applied he
doc ine of res ipsa loquitur, holding ha a pa ien dea h doe no
o dina il occ d ing an appendec om .
The e ponden ele a ed he ca e o he CA and he appeal a
docke ed a C.A.-G.R. C N . 89096.
On Jan a 22, 2010, he CA e e ed he RTC deci ion and
di mi ed he complain . The CA ga e g ea e eigh o he
e imonie of D . He nande and D . Ramo o e he nding of D .
Re e beca e he la e a no an e pe in pa holog ,
appendec om , no in ge . I di ega ded D . A ila opinion
beca e he ba ic p emi e of hi e imon a ha he doc o ho
cond c ed he a op i a pa hologi of eq al o of g ea e
e pe i e han D . Ramo o D . He nande .

_______________

4 TSN da ed No embe 19, 2003, pp. 27, 29 and 36.

537

VOL. 781, JANUARY 25, 2016 537

Borromeo vs. Family Care Hospital, Inc.

The CA held ha he e a no ca al connec ion be een he

alleged omi ion of D . In o o e a do ble e and he ca e of
Lilian dea h. I al o fo nd ha D . In o did, in fac , e a do ble
e liga ion i h a hi d ilk einfo cemen liga ion on he epai
i e hich, a D . Re e admi ed on c o -e amina ion, loo ened p
af e he ini ial elling of he mp b ided.
The CA denied he applicabili of he doc ine of res ipsa
loquitur beca e he elemen of ca a ion be een he
in men ali nde he con ol and managemen of D . In o and
he inj ha ca ed Lilian dea h a ab en ; he e ponden
f cien l e abli hed ha he ca e of Lilian dea h a DIC.
On Ma ch 18, 2010, he pe i ione led he p e en pe i ion fo
e ie on certiorari.

The Pe i i

The pe i ione a g e : (1) ha D . In o and Famil Ca e e e

negligen in ca ing fo Lilian befo e, d ing, and af e he
appendec om and e e e pon ible fo he dea h; and (2) ha he
doc ine of res ipsa loquitur i applicable o hi ca e.
In hei Commen , he e ponden co n e : (1) ha he i e
ai ed b he pe i ione a e no p e q e ion of la ; (2) ha he
e e ci ed mo ca e and diligence in he ea men of Lilian; (3)
ha D . In o did no de ia e f om he anda d of ca e ob e ed
nde imila ci c m ance b o he membe of he p ofe ion in
good anding; (4) ha res ipsa loquitur i no applicable beca e
di ec e idence a o he ca e of Lilian dea h and he
p e ence/ab ence of negligence i a ailable; and (5) ha doc o a e
no g a an o of ca e and canno be held liable fo he dea h of hei
pa ien hen he e e ci ed diligence and did e e hing o a e
he pa ien .

53

538 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.

O R i g

The e i i i e
fac a e i .

Unde Sec ion 1 of R le 45, a pe i ion fo e ie on certiorari

hall onl ai e q e ion of la . The S p eme Co i no a ie of
fac and i i no o f nc ion o anal e and eigh e idence ha
he lo e co had al ead pa ed pon.
The fac al nding of he Co of Appeal a e, a a gene al
le, concl i e pon hi Co . Ho e e , j i p dence ha al o
ca ed o ecogni ed e cep ion 5 o hi le, o i : (1) hen he
nding a e g o nded en i el on pec la ion, mi e , o
6
conjec e ; (2) hen he infe ence made i manife l mi aken,
ab d, o impo ible;7 (3) hen he e i g a e ab e of di c e ion;8
(4) hen he j dgmen i ba ed on a mi app ehen ion of fac ;9 (5)
hen he nding of fac a e con ic ing;10 (6) hen in making i
nding he Co of Appeal en be ond he i e of he ca e, o
i nding a e con a o he admi ion of bo h he appellan and
he appellee;11 (7)
;12 (8) hen he nding a e concl ion

_______________

5 New City Builders, Inc. v. NLRC, 499 Phil. 207, 212-213; 460 SCRA 220, 227
(2005), ci ing Insular Life Assurance Company, Ltd. v. Court of Appeals, 472 Phil. 7;
428 SCRA 79 (2004).
6 Joaquin v. Navarro, 93 Phil. 257, 270 (1953).
7 De Luna v. Linatoc, 74 Phil. 15 (1942).
8 Buyco v. People, 95 Phil. 453 (1954).
9 De la Cruz v. Sosing, 94 Phil. 26 (1953).
10 Casica v. Villaseca, 101 Phil. 1205 (1957).
11 Lim Yhi Luya v. Court of Appeals, No. L-40258, Sep embe 11, 1980, 99
SCRA 668, 689.
12 Sacay v. Sandiganbayan, No . L-66497-98, J l 10, 1986, 142 SCRA 593.

53

VOL. 781, JANUARY 25, 2016 539

Borromeo vs. Family Care Hospital, Inc.

i ho ci a ion of peci c e idence on hich he a e ba ed;13

(9) hen he fac e fo h in he pe i ion a ell a in he
pe i ione main and epl b ief a e no di p ed b he
e ponden ;14 (10) hen he nding of fac a e p emi ed on he
ppo ed ab ence of e idence and con adic ed b he e idence on
eco d;15 and (11) hen he Co of Appeal manife l o e looked
ce ain ele an fac no di p ed b he pa ie , hich, if p ope l
con ide ed, o ld j if a diffe en concl ion.16
Con ide ing ha he CA nding i h e pec o he ca e of
Lilian dea h con adic ho e of he RTC, hi ca e fall nde one
of he e cep ion . The Co ill h gi e d e co e o he pe i ion
o di pel an pe cep ion ha e denied he pe i ione j ice.

The e i i e f e ab i hi g
edica a ac ice
 Whoe e allege a fac ha he b den of p o ing i . Thi i a
ba ic legal p inciple ha eq all applie o ci il and c iminal ca e .
In a medical malp ac ice ca e, he plain iff ha he d of p o ing
i elemen , namel : (1) a duty of he defendan o hi pa ien ; (2)
he defendan breach of hi d ; (3) injury o he pa ien ; and (4)
proximate causation be een he b each and he inj ffe ed.17 In
ci il ca e , he plain iff m p o e he e elemen b a
p eponde ance of e idence.

_______________

13 Universal Motors v. Court of Appeals, No. L-47432, Jan a 27, 1992, 205
SCRA 448.
14 Alsua-Betts v. Court of Appeals, No . L-46430-31, J l 30, 1979, 92 SCRA
332.
15 Medina v. Asistio, Jr., G.R. No. 75450, No embe 8, 1990, 191 SCRA 218.
16 Abellana v. Dosdos, 121 Phil. 241; 13 SCRA 244 (1965).
17 Garcia-Rueda v. Pascasio, 344 Phil. 323, 331-332; 278 SCRA 769, 778
(1997); Flores v. Pineda, 591 Phil. 699, 706; 571 SCRA 83, 91 (2008); Reyes v.
Sisters of Mercy Hospital, 396 Phil. 87, 95-96; 341 SCRA 760, 769 (2000).

540

540 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.

A medical p ofe ional ha he d o ob e e he standard of

care and e e ci e he deg ee of kill, kno ledge, and aining
o dina il e pec ed of o he imila l ained medical p ofe ional
ac ing nde he ame ci c m ance .18 A b each of he accep ed
anda d of ca e con i e negligence o malp ac ice and ende
he defendan liable fo he e l ing inj o hi pa ien .19
The anda d i ba ed on he no m ob e ed b o he ea onabl
compe en membe of he p ofe ion
.20 Beca e medical malp ac ice ca e a e of en highl
echnical, e pe e imon i all e en ial o e abli h: (1) he
anda d of ca e ha he defendan a bo nd o ob e e nde he
ci c m ance ; (2) ha he defendan cond c fell belo he
accep able anda d; and (3) ha he defendan fail e o ob e e
he ind anda d ca ed inj o hi pa ien .21
The e pe i ne m be a imila l ained and e pe ienced
ph ician. Th , a p lmonologi i no q ali ed o e if a o he
anda d of ca e eq i ed of an ane he iologi 22 and an a op
e pe i no q ali ed o e if a a peciali in infec io
di ea e .23

_______________

18 Garcia-Rueda v. Pascasio, id., a p. 332; p. 778; Cruz v. Court of Appeals, 346

Phil. 872, 883-884; 282 SCRA 188, 200 (1997); Reyes v. Sisters of Mercy Hospital,
id., a p. 104; p. 769.
19 Flores v. Pineda, supra no e 17.
20 Cruz v. Court of Appeals, supra a p. 884; p. 200; Cabugao v. People, G.R. No.
163879, J l 30, 2014, 731 SCRA 214, 234.
21 Cruz v. Court of Appeals, id., a p. 885; pp. 200-201.
22 Ramos v. Court of Appeals, 378 Phil. 1198, 1236; 321 SCRA 584, 601-602
(1999).
23 Reyes v. Sisters of Mercy Hospital, supra no e 17.

541

VOL. 781, JANUARY 25, 2016 541

Borromeo vs. Family Care Hospital, Inc.

The e i i e fai ed ee
a e e i e .

In ling again he e ponden , he RTC elied on he nding

of D . Re e in he ligh of D . A ila opinion ha he fo me
e imon ho ld be gi en g ea e eigh han he nding of D .
Ramo and D . He nande . On he o he hand, he CA did no
con ide D . Re e o D . A ila a e pe i ne e and di ega ded
hei e imonie in fa o of D . Ramo and D . He nande . The
ba ic i e, he efo e, i ho e e imonie ho ld ca g ea e
eigh ?
CA.
O he han hei concl ion on he c lpabili of he e ponden ,
he CA and he RTC ha e imila fac al nding . The RTC led
again he e ponden ba ed p ima il on he follo ing e imon
of D . Re e .

Wi ne : Well, I
, d ing he ope a ion of he
appendi , o Hono , i ho ld eall be ed ice hich
e call do ble.
Co : Wha o ld be he e l if he e i onl ingle?
 Wi ne : We canno g a an [sic] he bleeding of he
ed blood e el , o Hono .
Co : So, he bleeding of he pa ien a ca ed b he
ingle e?
Wi ne : I .24

D . Re e e i ed ha he g ad a ed f om he Manila Cen al
Uni e i (MCU) College of Medicine and pa ed he medical
boa d e am in 1994.25 He e abli hed hi pe onal

_______________

24 TSN da ed Ma ch 5, 2002, pp. 22-23 (Di ec E amina ion of D . Emman el

Re e ).
25 C o -E amina ion, TSN da ed Ma ch 19, 2002, p. 3.

542

542 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.

p ac ice a hi ho e clinic befo e being accep ed a an on- he-job

ainee in he Depa men of Pa holog a he V. L na Ho pi al in
1994. In Jan a 1996, he joined he PNP Medico-Legal Di i ion
and a a igned o he C ime Labo a o in Camp C ame. He
c en l head he So he n Police Di ic Medico-Legal
26
di i ion. Hi p ima d ie a e o e amine ic im of iolen
c ime and o cond c a ma ic a op ie o de e mine he ca e of
dea h.
Af e ha ing cond c ed o e a ho and a ma ic a op ie , D .
Re e can be con ide ed an e pe in a ma ic a op ie o
a op ie in ol ing iolen dea h . Ho e e , hi e pe i e in
a ma ic a op ie doe no nece a il make him an e pe in
clinical and pa hological a op ie o in ge .
Mo eo e , D . Re e c o -e amina ion e eal ha he a le
han candid abo hi q ali ca ion d ing hi ini ial e imon :
A . Ca o: D . Re e , o men ioned d ing o di ec e imon la Ma ch 5,
2002 ha o g ad a ed in Ma ch of 1994, i ha co ec ?
Wi ne : Ye , i .
A . Ca o: Yo e e a ked b A . Faja do, he co n el fo he plain iff, hen
did o ni h o medical o k , and o an e ed he follo ing ea of
o g ad a ion hich a in 1994?
Wi ne : N 1994, 1984, i .
A . Ca o: And af e o g ad a ed M . Wi ne , e e he e f he d ha
o nde go af e g ad a ion? [sic]
_______________

26 TSN da ed Ma ch 5, 2002, pp. 3-11 (Di ec E amina ion of D . Emman el

Re e ).

543

VOL. 781, JANUARY 25, 2016 543

Borromeo vs. Family Care Hospital, Inc.

Wi ne : I a d ing m e ice onl a he police o gani a ion ha I a gi en

he chance o a end he aining, one- ea co e.
A . Ca o: Did o call ha ha o call a po g ad a e in e n hip?
Wi ne : Re idenc .
A . Ca o: Since o call ha a po g ad a e, o e e no nde go po
g ad a e? [sic]
Wi ne : I did.
A . Ca o: Whe e did o nde go a po g ad a e in e n hip?
Wi ne : Befo e I ook he boa d e amina ion in he ea 1984, i .
A . Ca o: Tha a he e?
Wi ne : MCU Ho pi al, i .
A . Ca o: Af e he po g ad a e in e n hip ha a he ime o ook he
boa d e amina ion?
Wi ne : Ye , i .
A . Ca o: And I ppo ed ha o did i fo he ake?
Wi ne : Ye , i .
A . Ca o: A e o e of ha ?
Wi ne : Ye , i .
A . Ca o: Af e o ook he boa d e amina ion, did o p e an d ?
Wi ne : D ing ha ime, no i .
A . Ca o: Yo al o e i ed d ing he la hea ing ha page 6 of Ma ch 5,
2002, an e of he i ne : hen I a accep ed a on he job aining a he
V. L na Ho pi al a he Depa men of Pa hologi in 1994, co ld o e plain
b ie all of hi M . i ne ?
Wi ne : I a gi en an o de ha I co ld a end he aining onl a a ci ilian no
a a membe of he AFP beca e a ha ime

544

544 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.
 he e e al ead in he p oce of di cha ging ci ilian f om nde going aining.
A . Ca o: So in he Depa men of Pa holog , ha e e o a igned o?
Wi ne : O .
A . Ca o: So o onl ob e ed.
Wi ne : Ye , i .
A . Ca o: And on he ame da e d ing o di ec e imon on Ma ch 5, 2002,
pa of hich ead ell if I emembe igh d ing m e idenc in m
e en i e aining d ing he ope a ion of he appendi , ha do o mean
b ha M . i ne ?
Wi ne : I a efe ing o m , i.
A . Ca o: So hi i ?
Wi ne : N , .
A . Ca o: Thi i no a pecial aining?
Wi ne : No, i .
A . Ca o: Thi a he ime he ea befo e o ook he boa d e amina ion?
Wi ne : Tha igh , i . Ye , i .
A . Ca o: Yo ee ?
Wi ne : N , .
A . Ca o: And o al o men ioned d ing he la hea ing ho n b page 8 of
he ame an c ip of he enog aphic no e , da ed Ma ch 5, 2002 and I q o e
and ha i o e idence a ignmen ? and o an e ed e , i . Wha
a he meaning of o an e ? Wha do o mean hen o a e, i?

Wi ne : Oka , I S P D F
B .

545

VOL. 781, JANUARY 25, 2016 545

Borromeo vs. Family Care Hospital, Inc.

A . Ca o: So hi i no efe ing o an kind of aining?

Wi ne : No, i .
A . Ca o: Thi i no in an a ela ed o appendici i ?
27
Wi ne : No, i .

D . Re e appea o ha e in a ed hi q ali ca ion d ing hi

di ec e imon . Fi , hi e en i e aining d ing [hi ]
e idenc a nei he e en i e ac al aining, no pa of medical
e idenc . Hi a ignmen o he V. L na Ho pi al a no a an on-
he-job ainee b a a me e observer. Thi a ignmen a al o
before he a actually licen ed a a doc o . D . Re e al o loo el
ed he e m e idence and e idenc e m ha ca a
echnical meaning i h e pec o medical p ac ice d ing hi
ini ial e imon 28 o efe o (1) hi ph ical place of d elling and
(2) hi in e n hip befo e aking he medical boa d e am . Thi
mi led he ial co in o belie ing ha he a mo e q ali ed o
gi e hi opinion on he ma e han he ac all a .
Pe hap no hing i mo e elling abo D . Re e lack of
e pe i e in he bjec ma e han he pe i ione co n el o n
admi ion d ing D . Re e c o -e amina ion.
A . Ca o: Ho long e e o a igned o ob e e i h he Depa men of
Pa holog ?
Wi ne : Onl 6 mon h , i .
A . Ca o: D ing o die in he medical chool, M . Wi ne , do o ecall
a ending o ha ing pa icipa ed o [sic] ha o call mo i i mo ali
comple ?
A . Faja do: Yo hono , ha i he ma e iali ?

546

546 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.

A . Ca o: Tha i acco ding o hi backg o nd, o hono . Thi i a p oced e

hich co ld mo e o le mea e hi kno ledge in a op p oceeding
hen he a in medical chool and compa ed o ha he i ac all doing
no .
A . Faja do: T , o hono .
A . Ca o: He i being p e en ed a an e pe i ne , o hono .29

When A . Ca o a emp ed o p obe D . Re e abo hi

kno ledge on he bjec of medical o pa hological a op ie , D.
Faja do objec ed on he g o nd ha D . Re e a no an e pe in
he eld. Hi e imon a offe ed o p o e ha D . In o a
negligen d ing he ge i ho nece a il offe ing him a an
e pe i ne .
A . Faja do: The p po e of hi i ne i o e abli h ha he e a
negligence on he gical ope a ion of he appendi o in he cond c of he
appendec om b he defendan doc o on he decea ed Lilian Villa an
30
Bo omeo.

D . Re e i no an e pe i ne ho co ld p o e D . In o
alleged negligence. Hi e imon co ld no ha e e abli hed he
anda d of ca e ha D . In o a e pec ed o ob e e no a e ed
D . In o fail e o ob e e hi anda d. Hi e imon canno be
elied pon o de e mine if D . In o commi ed e o d ing he
ope a ion, he e e i of he e e o , hei impac on Lilian
p obabili of i al,

_______________

29 C o -E amina ion of D . Re e , TSN da ed Ma ch 19, 2002, pp. 30-31.

30 Di ec E amina ion of D . Re e , TSN da ed Ma ch 5, 2002, p. 4.

547

VOL. 781, JANUARY 25, 2016 547

Borromeo vs. Family Care Hospital, Inc.

and he e i ence of o he di ea e /condi ion ha migh o migh

no ha e ca ed o con ib ed o Lilian dea h.
The e imon of D . A ila al o ha no p oba i e al e in
de e mining he he D . In o a a fa l . D . A ila e i ed in hi
capaci a an e pe in medical j i p dence, no a an e pe in
medicine, ge , o pa holog . Hi e imon fail o hed an ligh
on he ac al ca e of Lilian dea h.
On he o he hand, he e ponden p e en ed e imonie f om
D . In o him elf and f om o e pe i ne e in pa holog and
ge .
D . Ramo g ad a ed f om he Fa Ea e n Uni e i , Nicano
Re e Medical Fo nda ion, in 1975. He ook p hi po -g ad a e
in e n hip a he Q e on Memo ial Ho pi al in L cena Ci , befo e
aking he boa d e am . Af e ob aining hi p ofe ional licen e, he
nde en e idenc aining in pa holog a he Jo e R. Re e
Memo ial Cen e f om 1977 o 1980. He pa ed he e amina ion in
Ana omic, Clinical, and Ph ical Pa holog in 1980 and a
ind c ed in 1981. He al o ook he e amina ion in ana omic
pa holog in 1981 and a ind c ed in 1982.31
A he ime of hi e imon , D . Ramo a an a ocia e
p ofe o in pa holog a he Pe pe al Help Medical School in
Bi an, Lag na, and a he De La Salle Uni e i in Da ma i a ,
Ca i e. He a he head of he Ba anga Gene al Ho pi al Teaching
and T aining Ho pi al he e he al o headed he Pa holog
Depa men . He al o headed he Pe pe al Help Gene al Ho pi al
Pa holog depa men .32
Mean hile, D . He nande a ha ime a a Gene al S geon
i h 27 ea of e pe ience a a Gene al P ac i ione and 20 ea of
e pe ience a a Gene al S geon. He ob ained hi medical deg ee
f om he Uni e i of San o Toma befo e

_______________
 31 Di ec E amina ion of D . Ramo , TSN da ed J ne 6, 2003, p. 13.
32 Id., a p. 14.

54

548 SUPREME COURT REPORTS ANNOTATED

Borromeo vs. Family Care Hospital, Inc.

nde going e ea of e idenc aining a a geon a he

Ve e an Memo ial Cen e Ho pi al. He a ce i ed a a geon in
1985. He al o hold a ma e deg ee in Ho pi al Admini a ion
f om he A eneo de Manila Uni e i .33
He a a p ac icing geon a he: S . L ke Medical Cen e ,
Fa ima Medical Cen e , Unciano Medical Cen e in An ipolo,
Manila Ea Medical Cen e of Ta a , and Pe pe al Help Medical
Cen e in Bi an.34 He a al o an a ocia e p ofe o a he
Depa men of S ge a he Fa ima Medical Cen e , he Manila
Cen al Uni e i , and he Pe pe al Help Medical Cen e . He al o
chai ed he Depa men of S ge a he Fa ima Medical Cen e .35
D . He nande i a Fello of he Ame ican College of S geon ,
he Philippine College of S geon , and he Philippine Socie of
Gene al S geon . He i a Diploma e of he Philippine Boa d of
S ge and a membe of he Philippine Medical A ocia ion and
he An ipolo Ci Medical Socie .36
D . He nande af med ha D . In o did no de ia e f om he
al gical p oced e.37 Bo h e pe ag eed ha Lilian co ld no
ha e died f om bleeding of he appendical e el. The iden i ed
Lilian ca e of dea h a ma i e blood lo e l ing f om DIC.
To o mind, he e imonie of e pe i ne e D . He nande
and D . Ramo ca fa g ea e eigh han ha of D . Re e . The
pe i ione fail e o p e en e pe i ne e e l ed in hi fail e
o p o e he e ponden negligence. The p eponde ance of
e idence clea l il in fa o of he e ponden .

_______________

33 Di ec E amina ion of D . He nande , TSN da ed No embe 19, 2003, pp. 5-

10.
34 Id., a p. 9.
35 Id., a p. 10.
36 Id., a p. 11.
37 Id., a pp. 27, 29 and 36.
 54

VOL. 781, JANUARY 25, 2016 549

Borromeo vs. Family Care Hospital, Inc.

Re i a i i a icab e
he he fai e b e ed e
ca e i i edia e a a e
he a a .

The pe i ione canno in oke he doc ine of res ipsa loquitur o

hif he b den of e idence on o he e ponden . Res ipsa loquitur,
li e all , he hing peak fo i elf ; i a le of e idence ha
p e me negligence f om he e na e of he acciden i elf ing
common human knowledge o e pe ience.
The applica ion of hi le eq i e : (1) ha he acciden a of
a kind hich doe no o dina il occ nle omeone i negligen ;
(2) ha he in men ali o agenc hich ca ed he inj a
nde he e cl i e con ol of he pe on cha ged i h negligence;
and (3) ha he inj ffe ed m no ha e been d e o an
ol n a ac ion o con ib ion f om he inj ed pe on.38 The
conc ence of he e elemen c ea e a p e mp ion of negligence
ha , if n eb ed, o e come he plain iff b den of p oof.
Thi doc ine i ed in conj nc ion i h he doctrine of common
knowledge. We ha e applied hi doc ine in he follo ing ca e
in ol ing medical p ac i ione :
a. Whe e a pa ien ho a ched led fo a
cholec ec om ( emo al of gall one ) b a o he i e
heal h ffe ed i epa able b ain damage af e being
admini e ed ane he ia p io o he ope a ion;39
b. Whe e af e gi ing bi h, a oman oke p i h a
gaping b n o nd clo e o he lef a mpi ;40

_______________

38 Malayan Insurance Co. v. Alberto, G.R. No. 194320, Feb a 1, 2012, 664
SCRA 791, 803-804.
39 Supra no e 22.
40 Cantre v. Go, 550 Phil. 637; 522 SCRA 547 (2007).

550

550 SUPREME COURT REPORTS ANNOTATED

 Borromeo vs. Family Care Hospital, Inc.

c. The emo al of he ong bod pa d ing he

ope a ion; and
d. Whe e an ope a ing geon lef a fo eign objec (i.e.,
bbe glo e ) in ide he bod of he pa ien .41

The le i no applicable in ca e ch a he p e en one he e

he defendan alleged fail e o ob e e d e ca e i no
immedia el appa en o a la man.42 The e in ance eq i e e pe
opinion o e abli h he c lpabili of he defendan doc o . I i al o
no applicable o ca e he e he ac al ca e of he inj had been
43
iden i ed o e abli hed.
While hi Co mpa hi e i h he pe i ione lo , he
pe i ione failed o p e en f cien con incing e idence o
e abli h: (1) he anda d of ca e e pec ed of he e ponden and (2)
he fac ha D . In o fell ho of hi e pec ed anda d.
Con ide ing f he ha he e ponden e abli hed ha he ca e of
Lilian ncon ollable bleeding (and, l ima el , he dea h) a a
medical di o de Disseminated Intravascular Coagulation e
nd no e e ible e o in he CA di mi al of he complain on
appeal.
HEREFORE, e he eb DEN he pe i ion fo lack of me i .
No co .
SO ORDERED.

Carpio (Chairperson), Del Castillo, Mendoza and Leonen, JJ.,

conc .

Petition denied.

_______________

41 Batiquin v. Court of Appeals, 327 Phil. 965, 971; 258 SCRA 334, 340 (1996).
42 Reyes v. Sisters of Mercy Hospital, supra no e 17 a p. 98; p. 772.
43 See Professional Services, Inc. v. Agana, 542 Phil. 464, 484; 513 SCRA 478,
495 (2007).

551

VOL. 781, JANUARY 25, 2016 551

Borromeo vs. Family Care Hospital, Inc.

N . Medical malp ac ice i a fo m of negligence hich

con i in he ph ician o geon fail e o appl o hi p ac ice
ha deg ee of ca e and kill ha he p ofe ion gene all and
 o dina il emplo nde imila condi ion and ci c m ance .
(Aquino vs. Heirs of Raymunda Calayag, 678 SCRA 609 [2012])
To cce f ll mo n a medical malp ac ice ac ion, he plain iff
ho ld e abli h fo ba ic hing : (1) d ; (2) b each; (3) inj ;
and (4) p o ima e ca a ion. (Id.)

o0o

C gh 2020 Ce a B S , I c. A gh e e ed.