MERCURY DRUG CORPORATION and AURMELA GANZON vs.

RAUL DE LEON
G.R. No. 165622. October 17, 2008.
REYES, R.T., J.:

FACTS:

Respondent Raul T. De Leon, a judge, noticed that his left eye was reddish. He also
had difficulty reading.  On the same evening, he met a friend who happened to be a
doctor, Dr. Charles Milla. The latter prescribed the drugs “Cortisporin Opthalmic” and
“Ceftin” to relieve his eye problems.  Before heading to work the following morning, De
Leon went to the Betterliving, Parañaque, branch of Mercury Drug Store Corporation to
buy the prescribed medicines.  He showed his prescription to petitioner
AurmelaGanzon, a pharmacist assistant.  At his chambers, De Leon requested his
sheriff to assist him in using the eye drops.  As instructed, the sheriff applied 2-3 drops
on respondent’s left eye. Instead of relieving his irritation, respondent felt searing pain.  
He immediately rinsed the affected eye with water, but the pain did not subside.  Only
then did he discover that he was given the wrong medicine, “CortisporinOtic Solution.”
De Leon returned to the same Mercury Drug branch, with his left eye still red and teary. 
When he confronted Ganzon why he was given ear drops, instead of the prescribed eye
drops, she did not apologize and instead brazenly replied that she was unable to fully
read the prescription and it was her supervisor who apologized and informed De Leon
that they do not have stock of the needed CortisporinOpthalmic. De Leon wrote Mercury
Drug, through its president, Ms. Vivian K. Askuna, about the day’s incident. Instead, two
sales persons went to his office and informed him that their supervisor was busy with
other matters. Having been denied his simple desire for a written apology and
explanation, De Leon filed a complaint for damages against Mercury Drug.

ISSUE:

Whether or not the Mercury Drug and Ganzon are liable.

RULING:

Yes. Mercury Drug and Ganzon cannot exculpate themselves from any liability.
As active players in the field of dispensing medicines to the public, the highest degree of
care and diligence is expected of them.  Likewise, numerous decisions, both here and
abroad, have laid salutary rules for the protection of human life and human health.  In
the United States case of Tombari v. Conners,  it was ruled that the profession of
pharmacy demands care and skill, and druggists must exercise care of a specially high
degree, the highest degree of care known to practical men. In other words, druggists
must exercise the highest practicable degree of prudence and vigilance, and the most
exact and reliable safeguards consistent with the reasonable conduct of the business,
so that human life may not constantly be exposed to the danger flowing from the
substitution of deadly poisons for harmless medicines.
In cases where an injury is caused by the negligence of an employee, there instantly
arises a presumption of law that there has been negligence on the part of the employer,
either in the selection or supervision of one’s employees. This presumption may be
rebutted by a clear showing that the employer has exercised the care and diligence of a
good father of the family. Mercury Drug failed to overcome such presumption.

Petitioners Mercury Drug and Ganzon have similarly failed to live up to high standard of
diligence expected of them as pharmacy professionals. They were grossly negligent in
dispensing ear drops instead of the prescribed eye drops to De Leon.

As a buyer, De Leon relied on the expertise and experience of Mercury Drug and its
employees in dispensing to him the right medicine.  This Court has ruled that in the
purchase and sale of drugs, the buyer and seller do not stand at arms length. There
exists an imperative duty on the seller or the druggist to take precaution to prevent
death or injury to any person who relies on one’s absolute honesty and peculiar
learning.

DR. NINEVETCH CRUZ vs. COURT OF APPEALS and LYDIA UMALI

G.R. No. 122445 November 18, 1997
FRANCISCO, J.:

FACTS:

Rowena Umali de Ocampo (Rowena) accompanied her mother to the Perpetual Help
Clinic and General Hospital in San Pablo City to have her examined. It was found out
that her mother, Lydia de Ocampo (Lydia), had myoma in her uterus and was scheduled
for a hysterectomy operation. Rowena and her mother slept in the clinic to await the
operation the next day. Rowena noticed that the clinic was untidy and the floor and
windows very dusty, she thus tried to convince her mother to transfer hospitals to which
the latter refused. The operation proceeded and during which Rowena was tasked by
Dr. Lina Ercillo (Ercillo) to get additional blood packs and Tagamet ampules to which
she immediately procured. After the operation, additional blood and oxygen tank were
required. The procurement of the oxygen tank was too late and Rowena’s mother was
put into “shock”. Lydia had to be transferred to a better hospital, and was done so
without notice and consent to Rowena. When Lydia was wheeled into the operating
room of San Pablo District Hospital, Dr. Bartolome Angeles (Angeles) arrived upon call
and saw that Lydia has blood coming out rom her abdominal incision and saw that she
was in shock and that her blood pressure was already at 0/0. Dr. Angeles informed Dr.
Ercillo and Rowena that it was too late and that there was nothing he could to save the
patient. A death certificate was issued which stated that the immediate cause of death
was Disseminated Intravascular Coagulation DIC as the antecedent cause.

STATEMENT OF THE CASE: A case was filed before the MTCC of San Pablo City
against Dr. Ercillo for reckless imprudence and negligence resulting to homicide. The
MTCC ruled Dr. Ercillo not guilty, while the co-accused Dr. Cruz was held responsible
for the death of Lydia Umali and was thus guilty of Art. 365 of the RPC. Cruz Appealed
before the RTC which affirmed in toto the decision of the MTCC. Cruz appealed before
the CA who upheld the decision of the RTC wit modification to the damages. Hence the
petition before the SC.

ISSUE: Whether or not there was any reckless imprudence on the part of Dra. Cruz
resulting to the death of Lydia.

RULING: No, in litigations involving medical negligence, the plaintiff has the burden of
establishing appellant's negligence and for a reasonable conclusion of negligence, there
must be proof of breach of duty on the part of the surgeon as well as a casual
connection of such breach and the resulting death of his patient. All three courts below
bewail the inadequacy of the facilities of the clinic and its untidiness; the lack of
provisions such as blood, oxygen, and certain medicines; the failure to subject the
patient to a cardio-pulmonary test prior to the operation; the omission of any form of
blood typing before transfusion; and even the subsequent transfer of Lydia to the San
Pablo Hospital and the reoperation performed on her by the petitioner. But while it may
be true that the circumstances pointed out by the courts below seemed beyond cavil to
constitute reckless imprudence on the part of the surgeon, this conclusion is still best
arrived at not through the educated surmises nor conjectures of laymen, including
judges, but by the unquestionable knowledge of expert witnesses. For whether a
physician or surgeon has exercised the requisite degree of skill and care in the
treatment of his patient is, in the generality of cases, a matter of expert opinion. For
whether a physician or surgeon has exercised the requisite degree of skill and care in
the treatment of his patient is, in the generality of cases, a matter of expert opinion. The
deference of courts to the expert opinion of qualified physicians stems from its
realization that the latter possess unusual technical skills which laymen in most
instances are incapable of intelligently evaluating. Expert testimony should have been
offered to prove that the circumstances cited by the courts below are constitutive of
conduct falling below the standard of care employed by other physicians in good
standing when performing the same operation. One cannot merely rely on the
statements of a layman, but instead depend on the opinion of expert witnesses to which
all advised that it was highly improbable that it was the fault of Dra. Cruz since the
doctors who examined the autopsy had seen that all the sutures were closed, and this
was the only possible source of fault of the surgeon. Being closed, the surgeon properly
performed his duties to his patient. The other cause was hemorrhage which cannot be
prevented, as stated by multiple expert witnesses.
 PEDRITO DELA TORRE VS. DR. ARTURO IMBUIDO, DRA. NORMA IMBUIDO in
their capacity as owners and operators of DIVINE SPIRIT GENERAL HOSPITAL
AND/OR DR. NESTOR PASAMBA, RESPONDENTS.
G.R. No. 192973 September 29, 2014.
REYES, J.:

FACTS:

At around 3:00pm of February 3, 1992, Carmen was brought to Divine Spirit General
Hospital’s operating room for her caesarian section operation, which was to be
performed by Dr. Nestor. By 5:30pm, of the same day, Pedrito was informed by his
wife’s delivery of a baby boy. In the early morning of February 4, 1992, Carmen
experienced abdominal pains and difficulty in urinating. She was diagnosed to be
suffering from urinary tract infection (UTI), and was prescribed medication by Dr.
Norma. On February 10, 1992, Pedrito noticed that Carmen’s stomach was getting
bigger, but Dr. Norma dismissed the patient’s condition as mere fratulence. When
Carmen’s stomach still grow bigger despite medications, Dr. Norma advised Pedrito of
the possibility of a second operation on Carmen. Dr. Norma, however, provided no
details on its purpose and the doctor who would perform it. At around 3:00pm on
February 12, 1992 Carmen had her second operation. Later in the evening, Dr. Norma
informed Pedrito that “everything was going on fine with his wife.” The condition of
Carmen, however, did not improve. It instead worsened that on February 13, 1992, she
vomited dark red blood. At 9:30pm of the same day, Carmen died. Per her death
certificate upon information provided by the hospital, the immediate cause of Carmen’s
death was cardio-respiratory arrest secondary to cerebro vascular accident,
hypertension and chronic nephritis induced by pregnancy. An autopsy report prepared
by Dr. Partilano, medico-legal officer designate of Olongapo City, however, provided
that the cause of Carmen’s death was shock due to peritonitis severe with multiple
intestinal adhesions; status post caesarian section and exploratory laparotomy. Pedrito
claimed in his complaint that the respondents failed to exercise the degree of diligence
required of them as members of the medical profession, and were negligent for
practicing surgery on Carmen in the most unskilled, ignorant, and cruel manner.

ISSUE: Whether or not respondents were liable for medical malpractice that resulted to
Carmen’s death.

RULING: No. Medical malpractice or, more appropriately, medical negligence, is that

type of claim which a victim has available to him or her to redress a wrong committed by
a medical professional which has caused bodily harm. In order to successfully pursue
such a claim, a patient, or his or her family as in this case, must prove that healthcare
provider, in most cases, a physician, either failed to do something which a reasonably
prudent health care provider would have done, or that he or she did something that a
reasonably prudent provider would not have done; and that failure or action caused
injury to the patient.

Four essential elements must be established namely:

1.) duty;
2.) breach;
3.) injury and
4.) proximate causation. All four elements must be present in order to find the physician
negligent and thus, liable for damages.

For the trial court to give weight to Dr. Partilano’s report, it was necessary to show first
Dr. Partilano’s specialization and competence to testify on the degree of care, skill and
diligence needed for the treatment of Carmen’s case. Considering that it was not duly
established that Dr. Partilano practiced and was an expert on the fields that involved
Carmen’s condition, he could not have accurately identified the said degree of care, skill
and diligence and the medical procedure, that should have been applied.

NOEL CASUMPANG, RUBY SANGA-MIRANDA AND SAN JUAN DE DIOS

HOSPITAL vs. NELSON CORTEJO
G.R. No. 171127. March 11, 2015.
BRION, J.:

FACTS:
Mrs. Jesusa Cortejo brought his 11-year old son Edmer to the ER of San Juan de Dios
Hospital because of difficulty in breathing, chest pain, stomach pain and fever. Dr.
Ramoncito Livelo diagnosed Edmer with bronchopneumonia and gave him antibiotic
medication to lessen his fever and to loosen his plegm.
By virtue of her Fortune Care card, Mrs. Corteho was then assigned to Dr. Noel
Casumpang, a pediatrician accredited with Fortune Care. Dr. Casumpang confirmed the
initial diagnosis of Bronchopneumonia.
Next day, Edmer vomited phlegm with blood streak. Dr. Ruby Sanga-Miranda, a
resident physician at SJDH came to examine the blood specimen, however, Mrs.
Cortejo washed it away. So she just conducted physical check-up and found out that
Edmer’s symptoms are not typical of dengue fever. In the afternoon. Edmer vomited
blood again. Dr. Miranda then examined the blood specimen. Suspecting she could be
afflicted with dengue, she inserted a plastic tume in his nose, drained liquid from his
stomach with ice cold normal saline solution, and gave an instruction not to pull out the
tube, or give the patient any oral medication.
Blood tests showed that Edmer was suffering from Dengue Hemorrhagic Fever. Dr.
Casumpang then recommended transfer of Edmer to the ICU to which Mrs. Cortejo
consented. However, the ICU was full to Dr. Casumpang suggested transfer hire a
private nurse. Mrs. Cortejo insisted, however, to transfer his son to Makati Medical
Center.
After the respondent had signed the waiver, Dr. Casumpang, for the last time, checked
Edmer's condition, found that his blood pressure was stable, and noted that he was
"comfortable." By midnight, Edmer was transferred to MakatiMed via private ambulance.
Upon examination of patient’s clinical history and lab exam results, attending physician
diagnosed Edmer with Dengue Fever Stage IV that was already in its irreversible stage.
Edmer died at 4am with his death certificate indicating “Hypovolemic
Shock/hemorrhagic shock;" "Dengue Hemorrhagic Fever Stage IV” as cause of death.
Cortejo filed an action for damages against SJDH, Dr. Casumpang and Dr. Miranda
before RTC Makati alleging that Edmer’s death was caused by the negligent and
erroneous diagnosis of the doctors.
RTC ruled that doctors were negligent and also held SJDH solidarily liable for damages,
finding that Dr. Casumpang as consultant is an ostensible agent of SJDH while Dr.
Miranda as resident physician is an employee of SJDH as their qualifications, fitness,
and competence are scrutinized and determined by screening committee of hospital
before engaging their services.

CA affirmed RTC ruling en toto finding that SJDH and its attending physicians failed to
exercise the minimum medical care, attention, and treatment expected of an ordinary
doctor under like circumstances. CA ruled that the hospital's liability is based on Article
2180 of the Civil Code. The CA opined that the control which the hospital exercises over
its consultants, the hospital's power to hire and terminate their services, all fulfill the
employer-employee relationship requirement under Article 2180. It also found that
SJDH failed to show that it exercised diligence of a good father of a family in hiring and
supervision of its physician.

ISSUES:
1. Whether or not Casumpang had committed inexcusable lack of precaution in
diagnosing and in treating the patient

2. Whether or not Miranda had committed inexcusable lack of precaution in

diagnosing and in treating the patient

3. Whether or not the petitioner hospital is solidarity liable with the petitioner doctors

4. Whether or not there is a causal connection between the petitioners' negligent

act/omission and the patient's resulting death
RULING:

1. YES, Casumpang was negligent.

Even assuming that Edmer's symptoms completely coincided with the diagnosis of
bronchopneumonia, we still find Dr. Casumpang guilty of negligence. Wrong diagnosis
is not by itself medical malpractice. Physicians are generally not liable for damages
resulting from a bona fide error of judgment and from acting according to acceptable
medical practice standards. Nonetheless, when the physician's erroneous diagnosis
was the result of negligent conduct, it becomes an evidence of medical malpractice.
In the present case, evidence on record established that in confirming the diagnosis of
bronchopneumonia, Dr. Casumpang selectively appreciated some and not all of the
symptoms presented, and failed to promptly conduct the appropriate tests to confirm his
findings. In sum, Dr. Casumpang failed to timely detect dengue fever, which failure,
especially when reasonable prudence would have shown that indications of dengue
were evident and/or foreseeable, constitutes negligence. Apart from failing to promptly
detect dengue fever, Dr. Casumpang also failed to promptly undertake the proper
medical management needed for this disease. Dr. Casumpang failed to measure up to
the acceptable medical standards in diagnosing and treating dengue fever.
Dr. Casumpang's claim that he exercised prudence and due diligence in handling
Edmer's case, sside from being self-serving, is not supported by competent evidence.
He failed, as a medical professional, to observe the most prudent medical procedure
under the circumstances in diagnosing and treating Edmer.

2. No, Dr. Miranda is not liable for negligence.

We find that Dr. Miranda was not independently negligent. Although she was subject to
the same standard of care applicable to attending physicians, as a resident physician,
she merely operates as a subordinate who usually refer to the attending physician on
the decision to be made and on the action to be taken. We also believe that a finding of
negligence should also depend on several competing factors. In this case, before Dr.
Miranda attended to Edmer, Dr. Casumpang had diagnosed Edmer with
bronchopneumonia. There is also evidence supporting Dr. Miranda's claim that she
extended diligent care to Edmer. In fact, when she suspected, during Edmer's second
episode of bleeding, that Edmer could be suffering from dengue, she wasted no time in
conducting the necessary tests, and promptly notified Dr. Casumpang about the
incident. Indubitably, her medical assistance led to the finding of dengue fever. Dr.
Miranda's error was merely an honest mistake of judgment; hence, she should not be
held liable for medical negligence.
3. Yes, causal connection between the petitioners' negligence and the patient's
resulting death was established
Casumpang failed to timely diagnose Edmer with dengue fever despite the presence of
its characteristic symptoms; and as a consequence of the delayed diagnosis, he also
failed to promptly manage Edmer's illness. Had he immediately conducted confirmatory
tests, and promptly administered the proper care and management needed for dengue
fever, the risk of complications or even death, could have been substantially reduced.
That Edmer later died of Dengue Hemorrhagic Fever Stage IV, a severe and fatal form
of dengue fever, established the causal link between Dr. Casumpang's negligence and
the injury. The element of causation is successfully proven.

4. YES, SJDH is solidarily liable.

As a rule, hospitals are not liable for the negligence of its independent contractors.
However, it may be found liable if the physician or independent contractor acts as an
ostensible agent of the hospital. This exception is also known as the doctrine of
apparent authority.
SJDH impliedly held out and clothed Dr. Casumpang with apparent authority leading the
respondent to believe that he is an employee or agent of the hospital. Based on the
records, the respondent relied on SJDH rather than upon Dr. Casumpang, to care and
treat his son Edmer. His testimony during trial showed that he and his wife did not know
any doctors at SJDH; they also did not know that Dr. Casumpang was an independent
contractor. They brought their son to SJDH for diagnosis because of their family doctor's
referral. The referral did not specifically point to Dr. Casumpang or even to Dr. Miranda,
but to SJDH.
Mrs. Cortejo accepted Dr. Casumpang's services on the reasonable belief that such
were being provided by SJDH or its employees, agents, or servants. By referring Dr.
Casumpang to care and treat for Edmer, SJDH impliedly held out Dr. Casumpang as a
member of its medical staff. SJDH cannot now disclaim liability since there is no
showing that Mrs. Cortejo or the respondent knew, or should have known, that Dr.
Casumpang is only an independent contractor of the hospital. In this case, estoppel has
already
 OUR LADY OF LOURDES HOSPITAL vs. SPOUSES ROMEO AND
REGINA CAPANZANA
G.R. No. 189218. March 22, 2017
SERENO, C.J.:

FACTS:
Regina was scheduled for her third caesarean section (C-section) on 2 January 1998.
However, a week earlier, on 26 December 1997, she went into active labor and was
brought to petitioner hospital for an emergency C-section. She first underwent a
preoperative physical examination by Dr. Miriam Ramos (Dr. Ramos) and Dr. Milagros
Joyce Santos, (Dr. Santos) the same attending physicians in her prior childbirths. She
was found fit for anesthesia after she responded negatively to questions about
tuberculosis, rheumatic fever, and cardiac diseases. On that same day, she gave birth
to a baby boy. When her condition stabilized, she was discharged from the recovery
room and transferred to a regular hospital room.
At 2:30 a.m. the following day, or 13 hours after her operation, Regina who was then
under watch by her niece, Katherine L. Balad (Balad), complained of a headache, a
chilly sensation, restlessness, and shortness of breath. She asked for oxygen and later
became cyanotic. After undergoing an x-ray, she was found to be suffering from
pulmonary edema. She was eventually transferred to the Intensive Care Unit, where
she was hooked to a mechanical ventilator. The impression then was that she was
showing signs of amniotic fluid embolism.
On 2 January 1998, when her condition still showed no improvement, Regina was
transferred to the Cardinal Santos Hospital. The doctors thereat found that she was
suffering from rheumatic heart disease mitral stenosis with mild pulmonary
hypertension, which contributed to the onset of fluid in her lung tissue (pulmonary
edema). This development resulted in cardiopulmonary arrest and, subsequently, brain
damage. Regina lost the use of her speech, eyesight, hearing and limbs. She was
discharged, still in a vegetative state, on 19January 1998.
Respondent spouses Capanzana filed a complaint for damages against petitioner
hospital, along with co-defendants: Dr. Miriam Ramos, an obstetrician/gynecologist; Dr.
Milagros Joyce Santos, an anesthesiologist; and Jane Does, the nurses on duty
stationed on the second floor of petitioner hospital on 26-27 December 1997.
RTC held Drs and nurses liable.
CA ruled that petitioner hospital should be held liable based on the doctrine of corporate
responsibility. It was found that while there was evidence to prove that petitioner
hospital showed diligence in its selection and hiring processes, there was no evidence
to prove that it exercised the required diligence in the supervision of its nurses. Also, the
appellate court ruled that the non-availability of an oxygen unit on the hospital floor, a
fact that was admitted, constituted gross negligence on the part of petitioner hospital.
The CA stressed that, as borne out by the records, there was only one tank in the ward
section of 27 beds. It said that petitioner hospital should have devised an effective way
for the staff to properly and timely respond to a need for an oxygen tank in a situation of
acute distress.
ISSUE: Whether or not the hospital is liable.
RULING: The Supreme Court ruled in affirmative. The Court has emphasized that a
higher degree of caution and an exacting standard of diligence in patient management
and health care are required of a hospital’s staff, as they deal with the lives of patients
who seek urgent medical assistance. It is incumbent upon nurses to take precautions or
undertake steps to safeguard patients under their care from any possible injury that may
arise in the course of the latter’s treatment and care.
The Court further notes that the immediate response of the nurses was especially
imperative, since Regina herself had asked for oxygen. They should have been
prompted to respond immediately when Regina herself expressed her needs, especially
in that emergency situation when it was not easy to determine with certainty the cause
of her breathing difficulty. Indeed, even if the patient had not asked for oxygen, the mere
fact that her breathing was labored to an abnormal degree should have impelled the
nurses to immediately call the doctor and to administer oxygen.
In this regard, both courts found that there was a delay in the administration of oxygen
to the patient, caused by the delayed response of the nurses of petitioner hospital. They
committed a breach of their duty to respond immediately to the needs of Regina,
considering her precarious situation and her physical manifestations of oxygen
deprivation.
We affirm the findings of the courts below that the negligent delay on the part of the
nurses was the proximate cause of the brain damage suffered by Regina.

CARLOS BORROMEO vs. FAMILY CARE HOSPITAL, INC. and RAMON S. INSO,
M.D.
G.R. No. 191018. January 25, 2016.
BRION, J.:

FACTS:
Borromeo brought his wife to the family care hospital because of acute pain at the lower
stomach area and fever for 2 days, he was admitted in said hospital and placed under
the care of Dr. Inso. Dr. Inso conducted the surgery and by then he confirmed his
hypothesis that Lillian has an acute appendicitis. The operation was successfully done
however after 16 hours, Lilian was returned to her room where she starts to become
restless and dropped her blood pressure, she was not even responded to blood
transfusion hence the tube connected to oxygen tank was inserted by dr. Inso into Lilian
and order her to put into in an Intensive care unit. Though being a secondary hospital, it
does not. Have. An ICU, dr. Inso arranged with other hospital with ICU and transfer
there Lilian. Unfortunately, Lilian passed away there despite of trying to resuscitate her.
In his autopsy report, Dr. Reyes concluded that Lilian died due to hemorrhage and
concluded that the internal bleeding was caused by .5 x .5 cm opening in the repair site.
Further, he opined that it could be avoided if the site was repaired with double suturing
instead of the single continuing suture repair that he found. Hence the petitioner filed a
complaint against family care hospital and Dr. Inso for. Medical malpractice basing it to
the autopsy report made by Reyes and pursue the case with having Reyes as the
witness.
RTC ruled in favor of the petitioner, believing in the theory of Dr. Reyes on the. 5x. 5cm.
And applied the doctrine of res ipsa loquitor. And ordered the respondents to pay for
damages, death indemnity, moral and exemplary, loss of earning payment, atty.’s fees,
cost of suit.
When the respondents appealed, CA reversed. Hence this petition for certiorari of
Carlos Boromeo

ISSUE:
Whether respondents are guilty of medical malpractice and that the doctrine of res ipsa
loquitor can be applied in the case.

RULING:
No. The basic legal principle that equally applies to both civil and criminal cases that
whoever alleges the fact has the burden of proof. Petitioner’s failure to present expert
witnesses resulted in his failure to prove petitioners' negligence.
During the investigation Reyes found to be not an expert in the subject matter having no
training residency in pathology nor in surgery after he passed the medical board exam.
On the other hand, the respondent shows as a witnesses Dr. Ramos.
Dr. Ramos graduated from the Far Eastern University, Nicanor Reyes Medical
Foundation, in 1975. He took up his post-graduate internship at the Quezon Memorial
Hospital in Lucena City, before taking the board exams. After obtaining his professional
license, he underwent residency training in pathology at the Jose R. Reyes Memorial
Center from 1977 to 1980. He passed the examination in Anatomic, Clinical, and
Physical Pathology in 1980 and was inducted in 1981. He also took the examination in
anatomic pathology in 1981 and was inducted in 1982. At the time of his testimony, Dr.
Ramos is a practicing pathologist with over 20 years of experience. He is an associate
professor at the Department of Surgery of the Fatima Medical Center, the Manila
Central University, and the Perpetual Help Medical Center. He is a Fellow of the
Philippine College of Surgeons, a Diplomate of the Philippine Board of Surgery, and a
Fellow of the Philippine Society of General Surgeons. He also headed the Perpetual
Help General Hospital Pathology department as well as the Batangas general hospital.
Being an expert in the subject matter, the testimony of Dr. Ramos carry greater than od
Dr. Reyes. Dr. Ramos discredited Dr. Reyes' theory that the 0.5 x 0.5 cm opening at the
repair site caused Lilian's internal bleeding. According to Dr. Ramos, appendicle vessels
measure only 0.1 to 0.15 cm, a claim that was not refuted by the petitioner. If the 0.5 x
0.5 cm opening had caused Lilian's hemorrhage, she would not have survived for over
16 hours; she would have died immediately, within 20 to 30 minutes, after surgery.
Dr. Ramos submitted that the cause of Lilian's death was hemorrhage due to
DIC, a blood disorder that leads to the failure of the blood to clot; Dr. Ramos considered
the abundant petechial hemorrhage in the myocardia sections and the hemorrhagic
right lung; the multiple bleeding points indicate that Lilian was afflicted with DIC.
The court denies the petition for lack of merit.