SECOND DIVISION G.R. No.

204095 June 15, 2015 had gastric acidity; that he slept most of the day; and his negligence or was the result of medical malpractice.
that he was in good physical condition before the Dr. Agas explained as follows:
DR. JAIME T. CRUZ, Petitioner, vs. FELICISIMO V. colonoscopy procedure. He asserted that at the time of
AGAS, JR., Respondent. the filing of the complaint, he was still weak, tired and in That the complication was due to the abnormal condition
pain. and configuration of the digestive system, colon in
D E C I S I O N MENDOZA, J.: particular, of the complainant and not from any negligent
Defense of Dr. Agas act in connection with the conduct of colonoscopy. The
This petition for review on certiorari under Rule 45 of the surgical findings (xxx) revealed marked adhesions in the
Rules of Court assails the May 22, 2012 Decision 1 and Dr. Agas, on the other hand, countered that Dr. Cruz sigmoid colon which is not and never within my control.
October 18, 2012 Resolution2 of the Court of Appeals failed to prove the basic elements of reckless
(CA), in CA-G.R. SP No. 111910, which affirmed the imprudence or negligence. He averred that Dr. Cruz That the tear in the serosa (the outermost layer of the
March 2, 20073 and September 23, 20094 Resolutions of unfairly made it appear that he did not know that he colonic wall which has 4 layers) happened likely because
the Secretary of Justice. The said resolutions let stand would perform the procedure. He explained that before of the marked interloop adhesions and tortuousity of the
the February 16, 2004 Resolution of the Office of the the start of the colonoscopy procedure, he was able to sigmoid segment of the colon. These adhesions that
Prosecutor of Quezon City, dismissing the complaint of confer with Dr. Cruz and review his medical history connect the serosa to the peritoneal lining of each loop
petitioner Dr. Jaime T. Cruz (Dr. Cruz) for Serious which was taken earlier by a fellow gastrointestinal detached from the serosa during the procedure. It is not
Physical Injuries through Reckless Imprudence and physician. He claimed that the gastroscopy and possible to detect the presence of marked adhesions
Medical Malpractice against respondent, Dr. Felicisimo colonoscopy procedures conducted on Dr. Cruz were prior to the endoscopic procedure because no clinical
V. Agas, Jr. (Dr. Agas). completely successful considering that the latter did not findings, laboratory tests or diagnostic imaging such as
manifest any significant adverse reaction or body x-ray, ultrasound or computed tomography (CT scan) of
The Antecedents resistance during the procedures and that his vital signs the abdomen can diagnose these conditions.
were normal throughout the procedure.6
In his Complaint-Affidavit for Serious Physical Injuries
5 This can only be detected by surgically opening up the
through Reckless Imprudence and Medical Malpractice Dr. Agas added that certifications and sworn statements abdomen. Moreover, marked adhesions and serosal
against Dr. Agas, Dr. Cruz alleged, among others, that were submitted by the Assistant Medical Director for tear, in particular, cannot likewise be detected by
sometime in May 2003, he engaged the services of St. Professional Services, the Director of the Institute of colonoscopy because they are in the outer wall of the
Luke’s Medical Center (SLMC)for a medical check-up; Digestive Diseases, the anesthesiologist, and the colon and only the inner lining of the colon is within the
that after being admitted in SLMC on May 28, 2003,he hospital nurse attesting to the fact that the intraperitonial view of the colonoscope (camera).9
underwent stool, urine, blood, and other body fluid tests bleeding which developed after the colonoscopy
conducted by the employees and doctors of the said procedure, was immediately recognized, evaluated, The CA further wrote that the counter-affidavit of Dr.
hospital; that on May 29, 2003, he was sent to the carefully managed, and corrected; that he provided an Agas was supported by the sworn affidavit of Dr. Jennifel
Gastro-Enterology Department for a scheduled adequate and reasonable standard of care to Dr. Cruz; S. Bustos, an anesthesiologist at the SLMC and the
gastroscopy and colonoscopy; that the endoscopist followed all precautionary affidavit of Evelyn E. Daulat, a nurse at SLMC, both
measures; that the colonoscopy procedure was done swearing under oath that Dr. Agas was not negligent in
that because the specialist assigned to perform the properly; that he was not negligent or reckless in conducting a gastroscopy and colonoscopy procedure
procedure was nowhere to be found, he gave the conducting the colonoscopy procedure; that he did not on Dr. Cruz and the certification issued by the Hospital
colonoscopy results to the attending female deviate from any standard medical norm, practice or Ethics Committee which stated that Dr. Cruz was given
anesthesiologist for the information and consideration of procedure; and that he exercised competence and an adequate and reasonable standard of care; that Dr.
the assigned specialist; that, thereafter, he was sedated diligence in rendering medical services to Dr. Cruz.
7
Agas followed all precautionary measures in
and the endoscopic examination was carried out; that safeguarding Dr. Cruz from any possible complications;
when he regained consciousness, he felt that something Antecedents at the Prosecution Level and that the colonoscopy was done properly.
went wrong during the procedure because he felt dizzy,
had cold clammy perspiration and experienced breathing On February 16, 2004, the Office of the City Prosecutor Hence, this petition.
difficulty; that he could not stand or sit upright because (OCP) issued a resolution dismissing the complaint for
he felt so exhausted and so much pain in his abdomen; Serious Physical Injuries through Reckless Imprudence ISSUE
that when he was about to urinate in the comfort room, and Medical Malpractice. Aggrieved, Dr. Cruz filed a
he collapsed; petition for review with the Department of Justice WHETHER OR NOT THE CA WAS
(DOJ)but the same was dismissed in its March 2, 2007 CORRECT IN AFFIRMING THE
that he tried to consult the specialist who performed the Resolution. Dr. Cruz filed a motion for reconsideration DECISION OF THE DOJ THAT NO
colonoscopy but he was nowhere to be found; and that but it was denied by the DOJ in its September 23, 2009 PROBABLE CAUSE EXISTS FOR
his cardiologist, Dra. Agnes Del Rosario, was able to Resolution.
8
FILING AN INFORMATION AGAINST
observe his critical condition and immediately referred THE RESPONDENT, THAT THE
him to the surgical department which suspected that he At the Court of Appeals RESPONDENT WAS NOT
had hemorrhage in his abdomen and advised him to NEGLIGENT AND THAT THERE
undergo an emergency surgical operation. Not satisfied, Dr. Cruz filed a petition for certiorari before WAS NO DENIAL OF DUE
the CA questioning the unfavorable DOJ resolutions. On PROCESS.
Dr. Cruz further averred that he agreed to the operation May 22, 2012, the CA rendered a decision affirming the
and upon waking up at the ICU on May 30, 2003, he said DOJ resolutions. The CA explained that, as a matter Non-interference with Executive
found out that the doctors did an exploratory laparatomy of sound judicial policy, courts would not interfere with
because of the internal bleeding; that he learned that the the public prosecutor’s wide discretion of determining Determination of Probable Cause
doctors cut a portion of the left side of his colon probable cause in a preliminary investigation unless
measuring 6-8 inches because it had a partial tear of the such executive determination was tainted with manifest in Preliminary Investigations
colonic wall which caused the internal bleeding; that error or grave abuse of discretion. It stated that the
despite the painkillers, he was under tremendous pain in public prosecutor’s finding of lack of probable cause
the incision area during his recovery period in the ICU against Dr. Agas was in accordance with law and that his
and had fever; and that he had intravenous tubes alleged negligence was not adequately established by
attached to his arms, subclavian artery on the left part of Dr. Cruz.
his chest and a nasogastric tube through his nose.
The CA also declared that Dr. Cruz failed to state in his
Dr. Cruz claimed that Dr. Agas admitted that he was the Complaint-Affidavit the specific procedures that Dr. Agas
one who performed the colonoscopy procedure but the failed to do which a reasonable prudent doctor would
latter insisted that nothing went wrong. On June 7, have done, or specific norms he failed to observe which
2003,he was discharged from SLMC. Nevertheless, he a reasonably prudent doctor would have complied with.
complained that he had a hard time digesting his food; The CA pointed out that Dr. Agas was able to
that he was frequently fed every two hours because he satisfactorily explain in his Counter-Affidavit that the
easily got full; that he had fresh blood stools every time complications suffered by Dr. Cruz was not caused by
he moved his bowel; that he had lost his appetite and
Under the doctrine of separation of powers, courts have In this case, the Court agrees with Dr. Agas that his
no right to directly decide on matters over which full purported negligence in performing the colonoscopy on
discretionary authority has been delegated to the Dr. Cruz was not immediately apparent to a layman to
Executive Branch of the Government, or to substitute justify the application of res ipsa loquitur doctrine.
their own judgment for that of the Executive Branch,
represented in this case by the Department of Justice. Dr. Agas was able to establish that the internal bleeding
The settled policy is that the courts will not interfere with sustained by Dr. Cruz was due to the abnormal condition
the executive determination of probable cause for the and configuration of his sigmoid colon which was beyond
purpose of filing an Information, in the absence of grave his control considering that the said condition could not
abuse of discretion. That abuse of discretion must be so be detected before a colonoscopic procedure. Dr. Agas
patent and gross as to amount to an evasion of a adequately explained that no clinical findings, laboratory
positive duty or a virtual refusal to perform a duty tests, or diagnostic imaging, such as x-rays, ultrasound
enjoined by law or to act at all in contemplation of law, or computed tomography (CT) scan of the abdomen,
such as where the power is exercised in an arbitrary and could have detected this condition prior to an endoscopic
despotic manner by reason of passion or hostility. procedure. Specifically, Dr. Agas wrote:

Medical Negligence and On the other hand, in the present case, the correlation
between petitioner’s injury, i.e., tear in the serosa of
Malpractice Not Established sigmoid colon, and the colonoscopy conducted by
respondent to the petitioner clearly requires the
In the case at bench, Dr. Cruz failed to show that the presentation of an expert opinion considering that no
DOJ gravely abused its discretion in finding that there perforation of the sigmoid colon was ever noted during
was lack of probable cause and dismissing the complaint the laparotomy. It cannot be overemphasized that the
against Dr. Agas for Serious Physical Injuries through colonoscope inserted by the respondent only passed
Reckless Imprudence and Medical Malpractice. through the inside of petitioner’s sigmoid colon while the
damaged tissue, i.e., serosa, which caused the bleeding,
A medical negligence case can prosper if the patient can is located in the outermost layer of the colon. It is
present solid proof that the doctor, like in this case, therefore impossible for the colonoscope to touch,
either failed to do something which a reasonably prudent scratch, or even tear the serosa since the said
doctor would have done, or that he did something that a membrane is beyond reach of the colonoscope in the
reasonably prudent doctor would not have done, and absence of perforation on the colon.13
such failure or action caused injury to the patient.
Dr. Cruz failed to rebut this.
To successfully pursue this kind of case, a patient must
only prove that a health care provider either failed to do WHEREFORE, the petition is DENIED.
something which a reasonably prudent health care
provider would have done, or that he did something that JOSE CATRAL MENDOZA
a reasonably prudent provider would not have done; and
that failure or action caused injury to the patient. Simply Associate Justice
put, the elements are duty, breach, injury and proximate
causation.10

In this case, Dr. Cruz has the burden of showing the

negligence or recklessness of Dr. Agas. Although there
is no dispute that Dr. Cruz sustained internal
hemorrhage due to a tear in the serosa of his sigmoid
colon, he failed to show that it was caused by Dr. Agas’s
negligent and reckless conduct of the colonoscopy
procedure. In other words, Dr. Cruz failed to show and
explain that particular negligent or reckless act or
omission committed by Dr. Agas. Stated differently, Dr.
Cruz did not demonstrate that there was "inexcusable
lack of precaution" on the part of Dr. Agas.

Res Ipsa Loquitur Doctrine

Not Applicable Against Respondent

Literally, res ipsa loquitur means the thing speaks for

itself. It is the rule that the fact of the occurrence of an
injury, taken with the surrounding circumstances, may
permit an inference or raise a presumption of
negligence, or make out a plaintiff’s prima facie case,
and present a question of fact for defendant to meet with
an explanation.11

The requisites for the applicability of the doctrine of res

ipsa loquitur are: (1) the occurrence of an injury; (2) the
thing which caused the injury was under the control and
management of the defendant; (3) the occurrence was
such that in the ordinary course of things, would not
have happened if those who had control or management
used proper care; and (4) the absence of explanation by
the defendant. Of the foregoing requisites, the most
instrumental is the control and management of the thing
which caused the injury.12