Res Ipsa Loquitur; Medical Negligence Cases

Once again, the SC in Dr. Milagros Cantre v. Sps. Go, G.R. No. 160889, April 27, 2007, had the occasion to say that the Hippocratic Oath mandates physicians to give primordial consideration to the well-being of their patients. If a doctor fails to live up to this precept, he is accountable for his acts. This notwithstanding, courts face a unique restraint in adjudicating medical negligence cases because physicians are not guarantors of case and, they never set out to intentionally cause injury to their patients. However, intent is immaterial in negligence cases because where negligence exists and is proven, it automatically gives the injured a right to reparation for the damage caused. (Ramos v. CA, G.R. No. 124354, December 29, 1999, 321 SCRA 584).

In cases involving medical negligence, the doctrine of res ipsa loquitur allows the mere existence of an injury to justify a presumption of negligence on the part of the person who controls the instrument causing the injury, provided that the following requisites concur:

1. The accident is of a kind which ordinarily does not occur in the absence of someone’s negligence;

2. It is caused by an instrumentality within the exclusive control of the defendant or defendants; and

3. the possibility of contributing conduct would make the plaintiff responsible is eliminated.

In this case, a woman gave birth. Due to the operation, there was profuse bleeding inside her womb, hence, the doctors performed various medical procedures. Her blood pressure was monitored with the use of a sphygmomamometer. It was observed later on that there was a fresh gaping wound in the inner portion of her left arm. The NBI-Medico Legal found out that it appeared to be a burn resulting in the placing of a droplight near her skin. Despite surgical operation, there was an unsightly mark in her left arm and the pain remained and her movements were restricted. A complaint was filed praying for damages where the RTC rendered judgment holding the doctor liable. The CA affirmed, but modified the judgment. On appeal to the SC it was contended that the wound was not caused by the droplight but by the constant taking of her blood pressure.

The SC said that, that is immaterial. The medical practice is to deflate the blood pressure cuff immediately after each use. Otherwise, the inflated band can cause injury to the patient similar to what could have happened in this case. Thus, if the wound was caused by the blood pressure cuff, then the taking of the blood pressure must have been done so negligently as to have inflicted a gaping wound on her arm, for which the defendant cannot escape liability under the “captain of the ship” doctrine.

The argument that the failed plastic surgery was not intended as a cosmetic procedure, but rather as a measure to prevent complication does not help her case. It does not negate negligence on her part.

Based on the foregoing, the presumption that defendant was negligent in the exercise of her profession stands unrebutted. In this connection, the Civil Code provides:

ART. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done…

ART. 2217. Moral damages include physical suffering, mental anguish, fright, serious anxiety, besmirched reputation, wounded feelings, moral shock, social humiliation, and similar injury. Though incapable of pecuniary computation, moral damages may be recovered if they are the proximate result of the defendant’s wrongful act or omission.

Clearly, under the law, the defendant is obliged to pay plaintiff for moral damages suffered by the latter as a proximate result of her negligence.

On the presumption of negligence under the principle of res ipsa loquitur, the SC in applying the requirements of the rule said:

As to the first requirement, the gaping wound the plaintiff’s certainly not an ordinary occurrence in the act of delivering a baby, far removed as the arm is from the organs involved in the process of giving birth. Such injury could not have happened unless negligence had set in somewhere.

Second, whether the injury was caused by the droplight or by the blood pressure cuff is of no moment. Both instruments are deemed within the exclusive control of the physician in charge under the “captain of the ship” doctrine. This doctrine holds the surgeon in charge of an operation liable for the negligence of his assistants during the time when those assistants are under the surgeon’s control. (Black Law Dictionary, 192 (5th ed., 1979). In this particular case, it can be logically inferred that defendant, the senior consultant in charge during the delivery of the baby, exercised control over the assistants assigned to both the use of the droplight and the taking of the plaintiff’s blood pressure. Hence, the use of the droplight and the blood pressure cuff is also within her exclusive control.

Third, the gaping wound on the plaintiff’s left arm, by its very nature and considering her condition, could only be caused by something external to her and outside her control as she was unconscious while in hypovolemic shock. Hence, plaintiff could not, by any stretch of the imagination, have contributed to her own injury.

The defense that the wound was caused not by the droplight but by the constant taking of her blood pressure, even if the latter was necessary given her condition, does not absolve her from liability.