Rpc

Chapter Five

ALTERNATIVE CIRCUMSTANCES

Article 15. Their concept. - Alternative circumstances are those which must be taken into consideration
as aggravating or mitigating according to the nature and effects of the crime and the other conditions
attending its commission. They are the relationship, intoxication and the degree of instruction and
education of the offender.

The alternative circumstance of relationship shall be taken into consideration when the offended party
in the spouse, ascendant, descendant, legitimate, natural, or adopted brother or sister, or relative by
affinity in the same degrees of the offender.

The intoxication of the offender shall be taken into consideration as a mitigating circumstances when
the offender has committed a felony in a state of intoxication, if the same is not habitual or subsequent
to the plan to commit said felony but when the intoxication is habitual or intentional, it shall be
considered as an aggravating circumstance.
Article 175. Using false certificates. - The penalty of arresto menor shall be imposed upon any one
who shall knowingly use any of the false certificates mentioned in the next preceding article.

Article 259. Abortion practiced by a physician or midwife and dispensing of abortives. - The

penalties provided in Article 256 shall be imposed in its maximum period, respectively, upon any
physician or midwife who, taking advantage of their scientific knowledge or skill, shall cause an
abortion or assist in causing the same.

Any pharmacist who, without the proper prescription from a physician, shall dispense any abortive
shall suffer arresto mayor and a fine not exceeding 1,000 pesos.

Article 347. Simulation of births, substitution of one child for another and concealment or
abandonment of a legitimate child. - The simulation of births and the substitution of one child for
another shall be punished by prision mayor and a fine of not exceeding 1,000 pesos.

The same penalties shall be imposed upon any person who shall conceal or abandon any legitimate
child with intent to cause such child to lose its civil status.

Any physician or surgeon or public officer who, in violation of the duties of his profession or office,
shall cooperate in the execution of any of the crimes mentioned in the two next preceding
paragraphs, shall suffer the penalties therein prescribed and also the penalty of temporary special
disqualification.

Article 365. Imprudence and negligence. - Any person who, by reckless imprudence, shall commit
any act which, had it been intentional, would constitute a grave felony, shall suffer the penalty
of arresto mayor in its maximum period to prision correccional in its medium period; if it would have
constituted a less grave felony, the penalty of arresto mayor in its minimum and medium periods
shall be imposed; if it would have constituted a light felony, the penalty of arresto menor in its
maximum period shall be imposed.

Any person who, by simple imprudence or negligence, shall commit an act which would otherwise
constitute a grave felony, shall suffer the penalty of arresto mayor in its medium and maximum
periods; if it would have constituted a less serious felony, the penalty of arresto mayor in its
minimum period shall be imposed.

When the execution of the act covered by this article shall have only resulted in damage to the
property of another, the offender shall be punished by a fine ranging from an amount equal to the
value of said damages to three times such value, but which shall in no case be less than twenty-five
pesos.

A fine not exceeding two hundred pesos and censure shall be imposed upon any person who, by
simple imprudence or negligence, shall cause some wrong which, if done maliciously, would have
constituted a light felony.

In the imposition of these penalties, the court shall exercise their sound discretion, without regard to
the rules prescribed in Article sixty-four.

The provisions contained in this article shall not be applicable:

1. When the penalty provided for the offense is equal to or lower than those provided in the
first two paragraphs of this article, in which case the court shall impose the penalty next
lower in degree than that which should be imposed in the period which they may deem
proper to apply.

2. When, by imprudence or negligence and with violation of the Automobile Law, to death of
a person shall be caused, in which case the defendant shall be punished by prision
correccional in its medium and maximum periods.

Reckless imprudence consists in voluntary, but without malice, doing or falling to do an act from
which material damage results by reason of inexcusable lack of precaution on the part of the person
performing of failing to perform such act, taking into consideration his employment or occupation,
degree of intelligence, physical condition and other circumstances regarding persons, time and
place.

Simple imprudence consists in the lack of precaution displayed in those cases in which the damage
impending to be caused is not immediate nor the danger clearly manifest.

The penalty next higher in degree to those provided for in this article shall be imposed upon the
offender who fails to lend on the spot to the injured parties such help as may be in this hand to give.
(As amended by R.A. 1790, approved June 21, 1957).

DR. NINEVETCH CRUZ, petitioner,

vs.

COURT OF APPEALS and LYDIA UMALI, respondents.

G.R. No. 122445 November 18, 1997

F:

-Lydia filed a case against Dr. Cruz under art. 365 of the RPC for alleged criminal negligence resulting in
the death of Lydia's mother.

-Lydia noticed that the clinic of Dr. Cruz was untidy which prompted her to ask her mother not to push
through with the surgery.

-Cruz urged them proceed with the surgery to which Lydia's mother consented.

-During the surgery, Dr. Cruz asked Lydia to buy medicine and blood for transfusion as they have no
supplies on hand.

-They also found out that the oxygen supply had ran out thus they had to transfer Lydia's mother to
another hospital.

-Lydia's mother, however, died. Such prompted Lydia to file the criminal case against the doctor.

-Lower courts ruled against Dr. Cruz. Courts also found out that the doctor did not conduct any pre-
operative evaluation before proceeding with the surgery.

-CA affirmed. Hence, the petition before the SC.

I:

WON the circumstances are sufficient to sustain a judgment of conviction against Dr. Cruz for reckless
imprudence resulting in homicide

H:

-No. The elements of reckless imprudence are: (1) that the offender does or fails to do an act; (2) that
the doing or the failure to do that act is voluntary; (3) that it be without malice; (4) that material damage
results from the reckless imprudence; and (5) that there is inexcusable lack of precaution on the part of
the offender, taking into consideration his employment or occupation, degree of intelligence, physical
condition, and other circumstances regarding persons, time and place.
 "inexcusable lack of precaution" in the treatment of his patient is to be determined according to the
standard of care observed by other members of the profession in good standing under similar
circumstances b

-In this case, prosecution did not present expert opinion(opinion of other doctors) to establish that the
circumstances/actions done by the doctor, attested by Lydia, was the proximate cause of the death of
her mother.
-Autopsy reports of other doctors established that the cause of the death was blood loss which they
admit that it may have been caused by other factors during the surgery, and not necessarily the acts of
Dr. Cruz.

-In sum, prosecution was not able to prove the 4th element of reckless immprudence, that the acts of
Dr. Cruz was the proximate cause of the death of Lydia's mother.

-Dr. Cruz was acquitted but was still held civilly liable.
Expert testimony is essential to establish standard of care of the profession, as well as that the physician’s
conduct in the treatment and care falls below such standard. It is also usually necessary to support the conclusion as
to causation. There is an absence of any expert testimony re: standard of care in the case records. NBI doctors
presented by the prosecution only testified as to the possible cause of death.

Ang v graged

After trial on the merits, the MeTC rendered judgment on March 4, 2002, acquitting
accused Grageda.4 The lower court ruled that the accused complied with the minimum
standards followed by physicians in the treatment of their patients; that liposuction of
the thighs is a minor surgery, hence, the clinical setting of accused was acceptable;
that in trying to save the life of Janet Ang, accused followed the standard procedure in
the conduct of the same; that all the elements of the crime of reckless imprudence are
not present in the case; that accused was not negligent; and that the liposuction
surgery was not the proximate cause of the death of Janet Ang. 

Petitioner, further, deliberately included in the instant petition a discussion of the merits
of his case, possibly to convince this Court to excuse her counsel's procedural lapses.
We are not, however, persuaded. Granting that we, indeed, spare petitioner's blind
disregard of the Rules, we still cannot possibly review the factual findings of the lower
court, as we are not a trier of facts; a Petition for Review under Rule 45 allows only
questions of law to be raised. Thus, the lower court's factual findings that respondent
was not negligent and that the liposuction surgery was not the proximate cause of the
death of Janet Ang, stand. This being so, such findings defeat any claim for civil liability
arising from the offense. As we discussed in Caiña v. People: 57

It is noted by the Court that in the dispositive portion of the decision of the Municipal
Trial Court, the accused' (petitioner in this case) acquittal was based on the ground that
his guilt was not proved beyond reasonable doubt making it possible for Dolores Perez
to prove and recover damages. (See Article 29, Civil Code) However, from a reading of
the decision of the Municipal Trial Court, there is a clear showing that the act from
which civil liability might arise does not exist. Civil liability is then extinguished.

DR. PEDRO DENNIS CERENO Vs CA, SPOUSES DIOGENES S. OLAVERE and FE R. SERRANO

Facts:
Raymond S. Olavere a victim of a stabbing incident, was rushed to the emergency room of the Bicol
Regional Medical Center (BRMC). He was attended to by Nurse Arlene Balares and Dr. Ruel Levy Realuyo
— the emergency room resident physician.
After extending initial medical treatment to Raymond, Dr. Realuyo recommended that the patient
undergo “emergency exploratory laparotomy.” Dr. Realuyo then requested the parents of Raymond to
procure 500 cc of type “O” blood needed for the operation. Complying with the request, Deogenes and
Andrew Olavere went to the Philippine National Red Cross to secure the required blood.

10:30 P.M: Raymond was wheeled inside the operating room. During that time, the hospital surgeons,
Drs. Zafe and Cereno, were busy operating on a gunshot victim with Dr. Rosalina Tatad who was the only
senior anesthesiologist on duty at BRMC that night.

10:59 P.M: Drs. Zafe and Cereno decided to defer the operation on Raymond because of other
emergency procedures needed for other patient. In the meantime, they examine Raymond and they
found that the latter’s blood pressure was normal and “nothing in him was significant. That based on the
xray result he interpreted, the fluid inside the thoracic cavity of Raymond was minimal.

12:15 A.M.: Petitioners immediately started their operation on Raymond. Upon opening of Raymond’s
thoracic cavity, they found that 3,200 cc of blood was stocked therein. The blood was evacuated and
petitioners found a puncture at the inferior pole of the left lung.

In his testimony, Dr. Cereno stated that considering the loss of blood suffered by Raymond, he did not
immediately transfuse blood because he had to control the bleeders first. Blood was finally transfused
on Raymond at 1:40 A.M. At 1:45 A.M., while the operation was on-going, Raymond suffered a cardiac
arrest. The operation ended at 1:50 A.M. and Raymond was pronounced dead at 2:30 A.M.

Raymond’s death certificate indicated that the immediate cause of death was “hypovolemic shock” or
the cessation of the functions of the organs of the body due to loss of blood.

Parents of Raymond claimed that there was negligence on the part of those who attended to their son
and filed a complaint for damages.

The trial court found petitioners negligent in not immediately conducting surgery on Raymond.It noted
that petitioners have already finished operating on Charles Maluluy-on as early as 10:30 in the evening,
and yet they only started the operation on Raymond at around 12:15 early morning of the following day.
The trial court held that had the surgery been performed promptly, Raymond would not have lost so
much blood and, therefore, could have been saved.

CA affirmed in toto the judgment rendered by the RTC

Issue:
WON CA ERRED IN RULING THAT PETITIONERS WERE GROSSLY NEGLIGENT IN THE PERFORMANCE OF
THEIR DUTIES

Held:
Yes, There were no expert witnesses presented to testify that the course of action taken by petitioners
were not in accord with those adopted by other reasonable surgeons in similar situations. Neither was
there any testimony given, except that of Dr. Tatad’s, on which it may be inferred that petitioners failed
to exercise the standard of care, diligence, learning and skill expected from practitioners of their
profession. Dr. Tatad, however, is an expert neither in the field of surgery nor of surgical practices and
diagnoses. Her expertise is in the administration of anesthesia and not in the determination of whether
surgery ought or not ought to be performed.
The alleged delay in the cross-matching of the blood, if there was any, cannot be attributed as the fault
of the petitioners. The petitioners were never shown to be responsible for such delay. It is highly
unreasonable and the height of injustice if petitioners were to be sanctioned for lapses in procedure
that does not fall within their duties and beyond their control.

Before the operation, Dr. Cereno explained that the reason why no blood transfusion was made on
Raymond was because they did not then see the need to administer such transfusion

Given that Dr. Tatad was already engaged in another urgent operation and that Raymond was not
showing any symptom of suffering from major blood loss requiring an immediate operation, Court find it
reasonable that petitioners decided to wait for Dr. Tatad to finish her surgery and not to call the standby
anesthesiologist anymore. There is, after all, no evidence that shows that a prudent surgeon faced with
similar circumstances would decide otherwise.

In medical negligence cases, it is settled that the complainant has the burden of establishing breach of
duty on the part of the doctors or surgeons. It must be proven that such breach of duty has a causal
connection to the resulting death of the patient. A verdict in malpractice action cannot be based on
speculation or conjecture. Causation must be proven within a reasonable medical probability based
upon competent expert testimony.

The parents of Raymond failed in this respect. Aside from their failure to prove negligence on the part of
the petitioners, they also failed to prove that it was petitioners’ fault that caused the injury. Their cause
stands on the mere assumption that Raymond’s life would have been saved had petitioner surgeons
immediately operated on him; had the blood been cross-matched immediately and had the blood been
transfused immediately. There was, however, no proof presented that Raymond’s life would have been
saved had those things been done. Those are mere assumptions and cannot guarantee their desired
result. Such cannot be made basis of a decision in this case, especially considering that the name,
reputation and career of petitioners are at stake.

In the case of Dr. Cruz v. CA, it was held that “[d]octors are protected by a special law. They are not
guarantors of care. They do not even warrant a good result. They are not insurers against mishaps or
unusual consequences. Furthermore, they are not liable for honest mistake of judgment

https://adrianantazo.com/2019/03/23/nilo-b-rosit-vs-davao-doctors-hospital-gr-no-210445-december-
7-2015/

rosit

A medical negligence case is a type of claim to redress a wrong committed by a medical

professional, that has caused bodily harm to or the death of a patient. There are four
elements involved in a medical negligence case, namely: duty, breach, injury,
and proximate causation.

Duty refers to the standard of behavior which imposes restrictions on one's conduct.
The standard in turn refers to the amount of competence associated with the proper
discharge of the profession. A physician is expected to use at least the same level of
care that any other reasonably competent doctor would use under the same
circumstances. Breach of duty occurs when the physician fails to comply with these
professional standards. If injury results to the patient as a result of this breach, the
physician is answerable for negligence. 

informed consent evolved into a general principle of law that a physician has a
duty to disclose what a reasonably prudent physician in the medical
community in the exercise of reasonable care would disclose to his patient as
to whatever grave risks of injury might be incurred from a proposed course of
treatment, so that a patient, exercising ordinary care for his own welfare, and
faced with a choice of undergoing the proposed treatment, or alternative
treatment, or none at all, may intelligently exercise his judgment by
reasonably balancing the probable risks against the probable benefits.

xxxx

There are four essential elements a plaintiff must prove in a malpractice action
based upon the doctrine of informed consent: "(1) the physician had a duty to
disclose material risks; (2) he failed to disclose or inadequately disclosed
those risks; (3) as a direct and proximate result of the failure to disclose, the
patient consented to treatment she otherwise would not have consented to;
and (4) plaintiff was injured by the proposed treatment." The gravamen in an
informed consent case requires the plaintiff to "point to significant undisclosed
information relating to the treatment which would have altered her decision to undergo
it."

Casumpang v cortejo

https://pdfcoffee.com/45-casumpang-v-cortejo-pdf-free.html

https://pdfcoffee.com/45-casumpang-v-cortejo-pdf-free.html

https://www.chanrobles.com/cralaw/2015marchdecisions.php?id=276

li v soliman

https://adrianantazo.com/2019/03/23/dr-li-vs-sps-soliman-g-r-no-165279-june-7-
2011/

ramos v ca 2002

https://pdfcoffee.com/4a33-ramos-v-ca-1999-and-2002-pdf-free.html

That they were working as a medical team is evident from the fact that Dr. Hosaka was keeping an
eye on the intubation of the patient by Dr. Gutierrez, and while doing so, he observed that the
patient’s nails had become dusky and had to call Dr. Gutierrez’s attention thereto. The Court also
notes that the counsel for Dr. Hosaka admitted that in practice, the anesthesiologist would also have
to observe the surgeon’s acts during the surgical process and calls the attention of the surgeon
whenever necessary in the course of the treatment. The duties of Dr. Hosaka and those of Dr.
39 

Gutierrez in the treatment of petitioner Erlinda are therefore not as clear-cut as respondents claim
them to be. On the contrary, it is quite apparent that they have a common responsibility to treat the
patient, which responsibility necessitates that they call each other’s attention to the condition of the
patient while the other physician is performing the necessary medical procedures.

CAYAO-LASAM VS RAMOLETE (GR NO. 159132 DECEMBER

18, 2002)
Cayao-Lasam vs Spouses Ramolete
GR No. 159132 December 18, 2002

Facts: On July 28, 1994, respondent 3 months pregnant Editha Ramolete was brought to Lorma Medical Center
(LMC) in San Fernando, La Union due to vaginal bleeding upon advise of petitioner related via telephone, Editha
was admitted to the LMC on the same day. A pelvic sonogram was then conducted on Editha revealing the fetus
weak cardiac pulsation. The following day, Editha repeat pelvic sonogram showed that aside from the fetus weak
cardiac pulsation, no fetal movement was also appreciated. Due to persistent and profuse vaginal bleeding, petitioner
advised her to undergo a D&C procedure. She was discharged the following day. On September 16, 1994, Editha
was once gain brought at the LMC, as she was suffering from vomiting ans severe abdominal pains. Editha was
attended by Drs. Dela Cruz, Mayo and Komiya. Dr. Mayo allegedly informed Editha that there was a dead fetus in
the latter’s womb, after Editha went laparectomy, she was found to have massive intra abdominal hemorrhage and
ruptured uterus. Thus, she had to go hysterectomy and as a result no more chance to bear a child.

Issue: Whether or not petitioner is liable for medical malpractice.

Held: No. Medical malpractice is a particular form of negligence which consists in the failure of a physician or
surgeon to apply to his practice of medicine that degree of care and skill which is ordinarily employed by the
profession generally under similar conditions, and in like surrounding circumstances. In order to successfully pursue
such a claim,  a patient must prove that the physician or surgeon either failed to do something which a reasonably
prudent physician or surgeon would not have done, and that the failure or action caused injury to the patient.

There are four elements involved in medical negligence cases: duty, breach, injury, and proximate cause..

, petitioner was duty-bound to use at least the same level of care that any reasonably competent
doctor would use to treat a condition under the same circumstances

To establish such, exp witness must be presented

Respo did not present any to establish their claim while pet. Did so

Exp wit presented by pet. Testified on such standard which according to him was followed by pet.

Proximate cause has been defined as that which, in natural and continuous sequence, unbroken by
any efficient intervening cause, produces injury, and without which the result would not have
occurred.

It is also undisputed that Editha did not return for a follow-up

evaluation, in defiance of the petitioners advise. Editha omitted the
diligence required by the circumstances which could have avoided the
injury. The omission in not returning for a follow-up evaluation played
a substantial part in bringing about Editha’s own injury. Had Editha
returned, petitioner could have conducted the proper medical tests
and procedure necessary to determine Editha’s health condition and
applied the corresponding treatment which could have prevented the
rupture of Editha’s uterus. The D&C procedure having been conducted
in accordance with the standard medical practice, it is clear that
Editha’s omission was the proximate cause of her own injury and not
merely a contributory negligence on her part.

Kho v halili
As a prerequisite to the practice of medicine, every candidate for board examination must be of good
moral character. Possession of such state of character is not only a condition sine qua non to take the
medical board examination and eventually be issued a Certificate of Registration upon passing the same,
but it is a continuing requirement to the practice of medicine

Thus, Section 24, Article III of Republic Act No. 2382, otherwise known as the Medical Act of 1959, which
governs the regulation of medical education, licensing and practice of medicine by physicians, provides
the following grounds upon which an erring physician may be disciplined: “Section 24. Grounds for
reprimand, suspension or revocation of registration certificate. Any of the following shall be sufficient
ground for reprimanding a physician, or for suspending or revoking a certificate of registration as
physician: (1) Conviction by a court of competent jurisdiction of any criminal offense involving moral
turpitude; (2) Immoral or dishonorable conduct;

Administrative Case No. A-373 filed by respondent before the Board of Medicine charges petitioner with
immorality, dishonorable and/or unethical conduct pursuant to Section 24(2) of RA 2382. In this
jurisdiction, an immoral conduct has been defined as "that conduct which is willful, flagrant, or
shameless, and which shows a moral indifference to the opinion of the good and respectable members
of the community"17 It may be well to state that nowhere is it required in the law that the complained
immorality and dishonorable conduct must bear connection with the practice of medicine.