MEDICAL MALPRACTICE

1.Rogelio Ramos vs.CA

Facts: Plaintiff Erlinda Ramos was 47-years old, because the discomforts somehow interfered with her normal ways, she
sought professional advice. She was advised to undergo an operation for the removal of a stone in her gall bladder. She
underwent a series of examinations which included blood and which indicated she was fit for surgery.Through the
intercession of a mutual friend, Dr. Buenviaje, she and her husband Rogelio met for the first time Dr. Orlino Hozaka, one
of the defendants and they agreed that their date at the operating table at the DLSMC (another defendant). Dr. Hosaka
decided that she should undergo a "cholecystectomy" operation after examining the documents. Rogelio E. Ramos,
however, asked Dr. Hosaka to look for a good anesthesiologist. Dr. Hosaka, in turn, assured Rogelio that he will get a
good anesthesiologist.
Herminda Cruz, who was inside the operating room with the patient, heard somebody say that "Dr. Hosaka is
already here." She then saw people inside the operating room "moving, doing this and that, [and] preparing the patient
for the operation". As she held the hand of Erlinda Ramos, she then saw Dr. Gutierrez intubating the hapless patient. She
thereafter heard Dr. Gutierrez say, "ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan".
Because of the remarks of Dra. Gutierrez, she focused her attention on what Dr. Gutierrez was doing. She thereafter
noticed bluish discoloration of the nailbeds of the left hand of the hapless Erlinda even as Dr. Hosaka approached her. She
then heard Dr. Hosaka issue an order for someone to call Dr. Calderon, another anesthesiologist. After Dr. Calderon arrived
at the operating room, she saw this anesthesiologist trying to intubate the patient. The patient's nailbed became bluish
and the patient was placed in a trendelenburg position — a position where the head of the patient is placed in a position
lower than her feet which is an indication that there is a decrease of blood supply to the patient's brain. Immediately
thereafter, she went out of the operating room, and she told Rogelio E. Ramos "that something wrong was . . . happening".
Dr. Calderon was then able to intubate the patient.
The doctors were also asked by the hospital to explain what happened to the patient. The doctors explained the
patient had bronchospasm. Thereafter, Rogelio E. Ramos was able to talk to Dr. Hosaka. The latter informed the former
that something went wrong during the intubation. Since that fateful afternoon, she has been in a comatose condition. She
cannot move any part of her body, can’t see or hear and lives on mechanical means. She suffered brain damage as a result
of the absence of oxygen in her brain for 4-5 min.
Issue: Whether or not respondents are guilty of medical negligence?
Ruling: Yes. The Court in this case applied the doctrine of res ipsa loquitur. before resort to the doctrine may be allowed,
the following requisites must be satisfactorily shown:
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 which would make the plaintiff responsible is eliminated.
In the above requisites, the fundamental element is the "control of instrumentality" which caused the damage. Such
element of control must be shown to be within the dominion of the defendant. In order to have the benefit of the rule, a
plaintiff, in addition to proving injury or damage, must show a situation where it is applicable, and must establish that the
essential elements of the doctrine were present in a particular incident.
Hence, in cases where the res ipsa loquitur is applicable, the court is permitted to find a physician negligent upon proper
proof of injury to the patient, without the aid of expert testimony, where the court from its fund of common knowledge
can determine the proper standard of care. Where common knowledge and experience teach that a resulting injury would
not have occurred to the patient if due care had been exercised, an inference of negligence may be drawn giving rise to
an application of the doctrine of res ipsa loquitur without medical evidence, which is ordinarily required to show not only
what occurred but how and why it occurred.
We hold that private respondents were unable to disprove the presumption of negligence on their part in the care of
Erlinda and their negligence was the proximate cause of her piteous condition. There was negligence in the pre-operative
evaluation of a patient prior to the administration of anesthesia which is universally observed to lessen the possibility of
anesthetic accidents. Erlinda's case was elective and this was known to respondent Dra. Gutierrez. Thus, she had all the
time to make a thorough evaluation of Erlinda's case prior to the operation and prepare her for anesthesia. However, she
never saw the patient at the bedside. She herself admitted that she had seen petitioner only in the operating room on the
day of the operation. She negligently failed to take advantage of this important opportunity. As such, her attempt to
exculpate herself must fail.

2. Reyes vs. Sisters of Mercy Hospital G.R No. 130547 (October 3, 2000)
Facts: Petitioner, Leah Alesna Reyes, is the wife of the deceased patient, Jorge Reyes. Five days before the latter’s death,
Jorge has been suffering from recurring fever with chills. The doctors confirmed through the Widal test that Jorge has
typhoid fever. However, he did not respond to the treatment and died. The cause of his death was “Ventricular Arrythemia
Secondary to Hyperpyrexia and typhoid fever.” Consequently, petitioner filed the instant case for damages. The
contention was that Jorge did not die of typhoid fever. Instead, his death was due to the wrongful administration of
chloromycetin. They contended that had respondent doctors exercised due care and diligence, they would not have
recommended and rushed the performance of the Widal Test, hastily concluded that Jorge was suffering from typhoid
fever, and administered chloromycetin without first conducting sufficient tests on the patient’s compatibility with said
drug.

Issue: Whether or not Sisters of Mercy Hospital is liable for the death of Jorge Reyes.

Ruling: No. There is no showing that the attending physician in this case deviated from the usual course of treatment with
respect to typhoid fever. Jorge was given antibiotic choloromycetin and some dose of triglobe after compatibility test was
made by the doctor and found that no adverse reactions manifested which would necessitate replacement of the
medicines. Indeed, the standard contemplated is not what is actually the average merit among all known practitioners
from the best to the worst and from the most to the least experienced, but the reasonable average merit among the
ordinarily good physicians. Here, the doctors did not depart from the reasonable standard recommended by the experts
as they in fact observed the due care required under the circumstances.

In Medical Negligence cases, it is incumbent upon the plaintiff to establish that the usual procedure in treating the illness
is not followed by the doctor. Failure to prove this, the doctor is not liable. Physicians are not insurers of the success of
every procedure undertaken and if the procedure was shown to be properly done but did not work, they cannot be faulted
for such result.
3. Dr. Noel Casumpang vs. Nelson Cortejo
DOCTRINE GENERAL RULE: hospitals are not liable for the negligence of its independent contractors
EXCEPTION: Doctrine of apparent authority - if the physician or independent contractor acts as an ostensible agent of
the hospital.
FACTS: Mrs. Jesusa Cortejo brought her minor son Edmer to the ER because of difficulty in breathing, chest pain, stomach
pain and fever. Dr. Ramoncito Livelo diagnosed Edmer with bronchopneumonia and gave him antibiotic medication. By
virtue of her Fortune Care card, Mrs. Cortejo was then assigned to Dr. Noel Casumpang, a pediatrician accredited with
Fortune Care. Dr. Casumpang confirmed the diagnosis of Bronchopneumonia.
Next day, Edmer vomited phlegm with blood streak. Dr. Ruby Sanga-Miranda, a resident physician 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. 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 so Dr. Casumpang
suggested transfer hire a private nurse. Mrs. Cortejo insisted, 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 his blood pressure
to be stable, and noted 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 with his death certificate indicating “Hypovolemic Shock/hemorrhagic shock; Dengue
Hemorrhagic Fever Stage IV” as cause of death. Cortejo filed for damages against SJDH, Dr. Casumpang and Dr. Miranda
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. 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.

ISSUE : W/N doctors had committed inexcusable lack of precaution in diagnosing and in treating the patient.
RULING: YES. Medical malpractice suit–is an action available to victims to redress a wrong committed by medical
professionals who caused bodily harm to, or the death of, a patient. - Plaintiff must prove that the doctor either failed
to do what a reasonably prudent doctor would have done, or did what a reasonably prudent doctor would not have
done; and the act or omission had caused injury to the patient. - The patient's heir/s bears the burden of proving
his/her cause of action. Elements: (1) duty; - Dr. Casumpang: physician-patient relationship arose when parents of Edmer
sought his medical services - Dr. Miranda: PPR arose when she assumed obligation to provide resident supervision over
Edmer to determine the standard of care, expert testimony is crucial in determining first, the standard medical
examinations, tests, and procedures that the attending physicians should have undertaken in the diagnosis and
treatment of dengue fever; and second, the dengue fever signs and symptoms that the attending physicians should
have noticed and considered. According to the expert testimony of Dr., the standard of care is to administer oxygen
inhalation, analgesic, and fluid infusion or dextrose. If the patient had twice vomited fresh blood, the doctor should order
blood transfusion, monitoring of the patient every 30 minutes. Dr. Casumpang, as Edmer's attending physician, did not
act according to these standards and, hence, was guilty of breach of duty. (2) breach; - Dr. Casumpang's first and second
visits to Edmer: he already had knowledge of Edmer's laboratory test result (CBC), medical history, and symptoms. 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. Dr. Miranda, a junior resident, was not independently negligent. Although she had greater patient
exposure, and was subject to the same standard of care applicable to attending physicians, we believe that a finding of
negligence should also depend on several competing factors, among them, her authority to make her own diagnosis,
the degree of supervision of the attending physician over her, and the shared responsibility between her and the
attending physicians. (3) injury; and (4) proximate causation.

ISSUE: W/N hospital is solidarity liable with the doctors.

RULING: YES, but not on the basis of Art 2180 as respondents posits but on the basis of doctrine of apparent authority
or agency by estoppel. There is no employer-employee relationship because no evidence showing that SJDH exercised
any degree of control over the means, methods of procedure and manner by which the doctors conducted and performed
their medical profession. Petitioning Doctors are mere independent contractors.
GENERAL RULE: hospitals are not liable for the negligence of its independent contractors
EXCEPTION: Doctrine of apparent authority - if the physician or independent contractor acts as an ostensible agent of
the hospital. A hospital can be held vicariously liable for the negligent acts of a physician (or an independent contractor)
providing care at the hospital if the plaintiff can prove these two factors: 1) the hospital's manifestations ; and whether
the hospital acted in a manner that would lead a reasonable person to conclude that the individual alleged to be negligent
was an employee or agent of the hospital. Such representation may be express or implied. –
In this case, the court considered the act of the hospital of holding itself out as provider of complete medical care, and
considered the hospital to have impliedly created the appearance of authority 2) the patient's reliance - whether the
plaintiff acted in reliance on the conduct of the hospital or its agent , consistent with ordinary care and prudence; or,
whether the plaintiff is seeking care from the hospital itself or whether the plaintiff is looking to the hospital merely as a
place for his/her personal physician to provide medical care. - Thus, this requirement is deemed satisfied if the plaintiff
can prove that he/she relied upon the hospital to provide care and treatment, rather than upon a specific physician. - 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. Respondent did not know that Dr. Casmpang was an independent contractor. 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, not only as an accredited member of Fortune Care, but also 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 set in.

ISSUE: W/N there is a causal connection between the petitioners' negligent act/omission and the patient's resulting
death.
RULING: YES due to Dr. Casumpang's failure to timely diagnose, the latter was not immediately given the proper
treatment. In fact, even after Dr. Casumpang had discovered Edmer's real illness, he still failed to promptly perform the
standard medical procedure Dr. Noel Casumpang and San Juan de Dios Hospital as thus solidarity liable for negligent
medical practice.
4. Professional Services Inc. (PSI) v. Agana, G.R. No. 126297, 31 January 2007.
FACTS: Natividad Agana was rushed to the hospital because of difficulty of bowel movement and bloody anal discharge.
After a series of medical examinations, Dr. Miguel Ampil diagnosed her to be suffering from “cancer of the sigmoid.” Dr.
Ampil, assisted by the medical staff of the hospital, performed an anterior resection surgery on Natividad. He found that
the malignancy in her sigmoid area had spread on her left ovary, necessitating the removal of certain portions of it. Thus,
Dr. Ampil obtained the consent of Natividad’s husband to permit Dr. Juan Fuentes to perform hysterectomy on her.
Thereafter, Dr. Ampil took over, completed the operation and closed the incision. However, based on the record of the
hospital, the attending nurses indicated that 2 sponges were missing. The same was reported to Dr. Ampil but were not
found. After couple of days, Natividad complained of excruciating pain in her anal region. She consulted both Dr. Ampil
and Dr. Fuentes about it. They told her that the pain was the natural consequence of the surgery. Dr. Ampil then
recommended that she consult an oncologist to examine the cancerous nodes which were not removed during the
operation. Sometime after, Natividad’s daughter found a piece of gauze protruding from her vagina. Upon being informed
about it, Dr. Ampil proceeded to her house where he managed to extract by hand a piece of gauze measuring 1.5 inches
in width. He then assured her that the pains would soon vanish. But instead the pains intensified, prompting Natividad to
seek treatment in other hospital. While confined there, Dr. Ramon Gutierrez detected the presence of another foreign
object in her vagina the other gauze which badly infected her vaginal vault. A recto-vaginal fistula had formed in her
reproductive organs which forced stool to excrete through the vagina. Natividad underwent another surgical operation to
remedy the damage.
ISSUE(S): Are the following liable?
(1) Professional Services Inc., based on(a) “employer-employee relationship”;(b) “doctrine of apparent authority”;(c)
“corporate negligence”;
(2) Dr. Ampil, (a) for medical negligence;(b) under the “captain of the ship doctrine”;
(3) Dr. Fuentes, under the doctrine of res ipsa loquitor;
HELD:(1) YES. [P]rivate hospitals, hire, fire and exercise real control over their attending and visiting ‘consultant’ staff.
While ‘consultants’ are not, technically employees, x x x, the control exercised, the hiring, and the right to terminate
consultants all fulfill the important hallmarks of an employer-employee relationship, with the exception of the payment
of wages. Accordingly, we rule that for the purpose of allocating responsibility in medical negligence cases, an E-E
relationship in effect exists between hospitals and their attending and visiting physicians. (b) YES. Apparent authority,
or what is sometimes referred to as the “holding out” theory, or doctrine of ostensible agency or agency by estoppel,
has its origin from the law of agency. It “is now estopped from passing all the blame to the physicians whose names it
proudly paraded in the public directory leading the public to believe that it vouched for their skill and competence.” As
expected, these patients, accepted the services on the reasonable belief that such were being rendered by the hospital or
its employees, agents, or servants. (c) YES. Hospital’s corporate negligence extends to permitting a physician known to be
incompetent to practice at the hospital. xxx [A] patient who enters a hospital does so with the reasonable expectation
that it will attempt to cure him. Here, it was duly established that PSI operates the hospital for the purpose and under the
concept of providing comprehensive medical services to the public. It has the duty to exercise reasonable care to protect
from harm all patients admitted into its facility for medical treatment.
(2) YES. This is a clear case of medical malpractice or more appropriately, medical negligence. To successfully pursue this
kind of case, a patient must only prove that a health care provider either failed to do something which a reasonably
prudent health care provider would have done, or that he did something that a reasonably prudent provider would not
have done; and that failure or action caused injury to the patient. Dr, Ampil, as the lead surgeon, had the duty such gauzes,
from Natividad’s body before closure of the incision. When he failed to do so, it was his duty to inform Natividad about it.
That Dr. Ampil’s negligence is the proximate cause of Natividad’s injury could be traced from his act of closing the incision
despite the information given by the attending nurses that two pieces of gauze were still missing. That they were later on
extracted from Natividad’s vagina established the causal link between Dr. Ampil’s negligence and the injury. (b) YES. Under
the “Captain of the Ship” rule, the operating surgeon is the person in complete charge of the surgery room and all
personnel connected with the operation. he was the “Captain of the Ship.” That he discharged such role is evident from
his following conduct: (1) calling Dr. Fuentes to perform a hysterectomy; (2) examining the work of Dr. Fuentes and finding
it in order… and (4) ordering the closure of the incision. It was this act of ordering the closure of the incision
notwithstanding that two pieces of gauze remained unaccounted for, that caused injury to Natividad’s body. Clearly, the
control and management of the thing which caused the injury was in the hands of Dr. Ampil, not Dr. Fuentes.
(3) NO. We find the element of “control and management of the thing which caused the injury” to be wanting. The doctrine
of res ipsa loquitur will not lie. It was duly established that Dr. Ampil was the lead surgeon during the operation of
Natividad. He requested the assistance of Dr. Fuentes only to perform hysterectomy when he (Dr. Ampil) found that the
malignancy. Dr. Fuentes performed the surgery and reported and showed his work to Dr. Ampil. The latter examined it
and finding everything to be in order, allowed Dr. Fuentes to leave the operating room then resumed operating

5. Rosit vs. Davao Doctors Hospital

Facts: Rosit figured in a motorcycle accident. The X-ray taken the next day at the hospital showed that he fractured his
jaw. Rosit was then referred to Dr. Gestuvo, a specialist in mandibular injuries and operated on Rosit. During the operation,
Dr. Gestuvo used a metal plate fastened to the jaw with metal screws to immobilize the mandible. As the operation
required the smallest screws available, Dr. Gestuvo cut the screws on hand to make them smaller. Dr. Gestuvo knew that
there were smaller titanium screws available, but did not so inform Rosit supposing that the latter would not be able to
afford the same. After the procedure, Rosit could not properly open and close his mouth and was in pain. X-rays done
after the operation showed that the fracture in his jaw was aligned but the screws used on him touched his molar. Given
the X-ray results, Dr. Gestuvo referred Rosit to a dentist, Dr. Pangan, who opined that another operation is necessary.
Alleging that the dentist told him that the operation conducted on his mandible was improperly done, Rosit went back to
Dr. Gestuvo to demand a loan to defray the cost of the additional. Dr. Gestuvo gave Rosit P4,500. Rosit went, still suffering
from pain and could hardly open his mouth. In Cebu, Dr. Pangan replaced the ones installed with smaller titanium plate
and screws, as well as extracting Rosit’s molar and some bone fragments. Rosit was then able to open and close his mouth
normally. On his return to Davao, Rosit demanded that Dr. Gestuvo reimburse him for the cost of the operation and the
expenses.
Issue: Whether or not Dr. Gestuvo is liable for medical negligence
Ruling: Yes.The concept of a medical negligence case and the elements required for its prosecution: 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 ofthe 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.
To establish medical negligence, an expert testimony is generally required to define the standard of behavior by which
the court may determine whether the physician has properly performed the requisite duty toward the patient. This is so
considering that the requisite degree of skill and care in the treatment of a patient is usually a matter of expert opinion.
The doctrine of res ipsa loquitur as an exception to the requirement of an expert testimony in medical negligence cases
may be availed of if the following essential requisites are satisfied: (1) the accident was of a kind that does not ordinarily
occur unless someone is negligent; (2) the instrumentality or agency that caused the injury was under the exclusive control
of the person charged; and (3) the injury suffered must not have been due to any voluntary action or contribution of the
person injured. The doctrine of informed consent within the context of physician-patient relationships came From a
purely ethical norm, 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. 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.” Moreover, even if such
affidavit is considered as admissible and the testimony of an expert witness, the Court is not bound by such testimony.
The opinion of an expert should be considered by the court in view of all the facts and circumstances of the case. The
problem of the evaluation of expert testimony is left to the discretion of the trial court whose ruling thereupon is not
reviewable in the absence of an abuse of that discretion. Thus, the belief of Dr. Pangan whether Dr. Gestuvo is guilty of
negligence or not will not bind the Court.

6. MANILA DOCTORS HOSPITAL vs SO UN CHUA AND VICKY TY

FACTS: The complaint is premised on the alleged unwarranted actuations of the petitioner towards its patient,
respondent So Un Chua (Chua), who was confined for hypertension, diabetes, and related illnesses. Respondent Ty
represented that she will settle the bills as soon as the funds become available and pleaded to the management that
in view of the physical condition of her mother, respondent Chua, the correspondences relating to the settlement of
the unpaid hospital bills should be relayed to the former. These pleas were unheeded by the petitioner. Petitioner
threatened to implement unpleasant measures unless respondent Ty undertakes her mother's obligation as well as
the obligation of her sister to pay the hospitalization expenses. Petitioner made good its threat and employed
unethical, unpleasant and unlawful methods which allegedly worsened the condition of respondent Chua,
particularly, by (i) cutting off the telephone line in her room and removing the air-conditioning unit, television set…,
(ii) refusing to render medical attendance and to change the hospital gown and bed sheets, and (iii) barring the
private nurses from assisting the patient. Respondents thus prayed for damages based on her commitment to pay
the balance in violation of the Contract for Admission and Acknowledgment of Responsibility for Payment .
ISSUE: Whether or not the respondent is entitled to damages under TORTS.
HELD: NO. Though human experience would show that the deactivation of the air-conditioner may cause a
temperature differential that may trigger some physical discomfort, or that removal of entertainment facilities, or
the disconnection of communication devices, may cause some exasperation on the part of the one who benefits from
these, nevertheless, all things considered, and given the degree of diligence the petitioner duly exerted, not
every suppression of the things that one has grown accustomed to enjoy amounts to an actionable wrong,
nor does every physical or emotional discomfort amount to the kind of anguish that warrants the award of
moral damages under the general principles of tort. The underlying basis for the award of tort damages is the
premise that an individual was injured in contemplation of law. Thus, there must first be the breach of some
duty and the imposition of liability for that breach before damages may be awarded; it is not sufficient to state
that there should be tort liability merely because the plaintiff suffered some pain and suffering.
7. MERCURY DRUG VS DE LEON
FACTS:
Respondent Raul T. De Leon noticed that his left eye was reddish. He also had difficulty reading. On the same evening, he
met a friend for dinner who happened to be a doctor, Dr. Charles Milla, and had just arrived from abroad. De Leon
consulted Dr. Milla about his irritated left eye. The latter prescribed the drugs "Cortisporin Opthalmic" to relieve his eye
problems. Before heading to work the following morning, De Leon went to a branch of Mercury Drug to buy the prescribed
medicine. He showed his prescription to petitioner a pharmacist and bought the medicine handed over by Petitioner.

At his chambers, De Leon requested his sheriff to assist him in using the eye drops. Instead of relieving his irritation,
respondent felt searing pain. He immediately rinsed his eye with water, but the pain did not subside. Only then did he
discover that he was given ear drops. De Leon returned to the same Mercury Drug branch. When he confronted Petitioner
why he was given ear drops, he was brazenly replied that she was unable to fully read the prescription.

Mercury Drug denied that it was negligent and therefore liable for damages. It pointed out that the proximate cause of De
Leon’s unfortunate experience was his own negligence. He should have first read and checked to see if he had the right
eye solution before he used any on his eye. Moreover, even the piece of paper presented upon buying the medicine is not
considered as proper prescription. It lacked the required information on the attending doctor’s name and license number.
ISSUE: Whether or not petitioner should be held liable?
RULING: YES. Mercury Drug and Petitioner can not 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. 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.

One holding himself out as competent to handle drugs, having rightful access to them, and relied upon by those dealing
with him to exercise that high degree of caution and care called for by the peculiarly dangerous nature of the business,
cannot be heard to say that his mistake by which he furnishes a customer the mostdeadly of drugs for those comparatively
harmless, is not in itself gross negligence. 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.

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 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.

Moral damages are not intended to impose a penalty to the wrongdoer or to enrich the claimant at the expense of
defendant. There is no hard and fast rule in determining what would be a fair and reasonable amount of moral damages
since each case must be governed by its peculiar circumstances. However, the award of damages must be
commensurate to the loss or injury suffered.
8. Mercury Drug Corporation vs Baking, GR No. 156037, May 28, 2007
FACTS: Respondent Baking went to the clinic of Dr. Cesar Sy for a medical check-up. After undergoing an ECG, blood and
hematology examinations, and urinalysis, Dy. Sy found that respondent’s blood sugar and triglyceride were above normal
levels. Dy. Sy prescribed two medical prescriptions – Diamicron for his blood sugar and Benalize tablets for his triglyceride.
Respondent bought the prescribed medicines at petitioner Mercury Drug Store. However, the saleslady misread
the prescription for Diamicron for Domicrum, a potent sleeping tablet. Respondent then took the medicines for three
consecutive days unaware of the mistake of the saleslady. On the third day, he figured in a vehicular accident where his
car collided with another car driven by Jose Peralta. It turned out that respondent fell asleep while driving without idea
regarding the accident. Suspecting that the tablet he took may have caused the accident, he returned to Dr. Sy and the
latter was shocked because of the wrong medicine. Respondent thereafter filed with RTC a complaint for damages against
petitioner. RTC ruled in favor of the plaintiff which was affirmed in toto by the Court of Appeals.
ISSUE: Whether or not petitioner was negligent and if so, was it the proximate cause of the accident?
RULING: Yes. The Court cited Article 2176 of the New Civil Code which provides that “Whenever by act or omission causes
damage to another, there being fault of negligence, is obliged to pay for the damage done. Such fault or negligence, if
there is no pre-existing contractual relation between the parties, is called a quasi-delict.
The Court also enumerated the three elements of quasi-delict, to wit:
1. Damage suffered by the plaintiff;
2. Fault or negligence of the defendant;
3. Connection of the cause and effect between the fault or negligence of the defendant and the damage incurred
by the plaintiff.
The Court stressed that there is no dispute that respondent suffered damages. It is generally recognized that the
drugstore business is imbued with public interest. The health and safety of the people will be put into jeopardy if the
drugstore employee will not exercise the highest degree of care and diligence.
In this case, the petitioner’s employee was grossly negligent. The Court ruled that the proximate cause of the
accident was the petitioner’s employee’s negligence. The vehicular accident could have not occurred had the employee
been careful to his job.