MALPRACTICE - Negligence of Health Care Professionals At 11:15 P.M.

, Raymond’s relatives returned to the BRMC with a bag

containing the requested 500 cc type "O" blood. They handed over the bag
DR. PEDRO DENNIS CERENO, and DR. SANTOS ZAFE vs. COURT OF of blood to Dr. Realuyo. Drs. Zafe and Cereno immediately started their
APPEALS, SPOUSES DIOGENES S. OLAVERE and FE R. SERRANO operation on Raymond at around 12:15 A.M. of September 17, 1995. Upon
G.R. No. 167366 | September 26, 2012 opening of Raymond’s thoracic cavity, they found that 3,200 cc of blood
Ratio: The type of lawsuit which has been called medical malpractice or, was stocked therein. Considering the loss of blood suffered by Raymond,
more appropriately, medical negligence, is that type of claim which a victim Dr. Cereno did not immediately transfuse blood because he had to control
has available to him or her to redress a wrong committed by a medical the bleeders first.
professional which has caused bodily harm. In order to successfully pursue
such a claim, a patient must prove that a health care provider, in most At 1:40 A.M., blood was finally transfused on Raymond. At 1:45 A.M., while
cases a physician, either failed to do something which a reasonably the operation was on-going, Raymond suffered a cardiac arrest. The
prudent health care provider would have done, or that he or she did operation ended at 1:50 A.M. and Raymond was pronounced dead at 2:30
something that a reasonably prudent provider would not have done; A.M. Raymond’s death certificate indicated that the immediate cause of
and that the failure or action caused injury to the patient. Stated death was "hypovolemic shock" or the cessation of the functions of the
otherwise, the complainant must prove: (1) that the health care provider, organs of the body due to loss of blood.
either by his act or omission, had been negligent, and (2) that such act or
omission proximately caused the injury complained of. Claiming that there was negligence on the part of those who attended to
Facts: At about 9:15 P.M. of September 16, 1995, Raymond S. Olavere their son, the parents of Raymond filed before the RTC a complaint for
(Raymond), a victim of a stabbing incident, was rushed to the emergency damages against the attending nurse, Dr. Realuyo, and attending surgeons
room of the Bicol Regional Medical Center (BRMC). After extending initial Dr. Cereno and Dr. Zafe.
medical treatment to Raymond, Dr. Ruel Levy Realuyo (Dr. Realuyo), the
emergency room resident physician, recommended that Raymond undergo
RTC: The trial court found Drs. Zafe and Cereno (petitioners) negligent in
"emergency exploratory laparotomy." Dr. Realuyo then requested the
parents of Raymond to procure 500 cc of type "O" blood needed for the not immediately conducting surgery on Raymond. It noted that petitioners
have already finished operating on Charles Maluluy-on as early as 10:30 in
operation. Complying with the request, Raymond’s relatives went to the
Philippine National Red Cross to secure the required blood. the evening, and yet they only started the operation on Raymond at around
12:15 early morning of the following day. Had the surgery been performed
promptly, Raymond would not have lost so much blood and, therefore,
At 10:30 P.M., Raymond was wheeled inside the operating room. During could have been saved.
that time, the hospital surgeons, Drs. Zafe and Cereno (herein petitioners),
were busy operating on gunshot victim Charles Maluluy-on. Assisting them
The trial court also held that the non-availability of Dr. Tatad after the
in the said operation was Dr. Rosalina Tatad (Dr. Tatad), who was the only
senior anesthesiologist on duty at BRMC that night. Just before the operation on Maluluy-on was not a sufficient excuse for the petitioners to
not immediately operate on Raymond.
operation on Maluluy-on was finished, another emergency case involving
Lilia Aguila, a woman who was giving birth to triplets, was brought to the
operating room. Lastly, the trial court faulted petitioners for the delay in the transfusion of
blood on Raymond.
At 10:59 P.M., the operation on Charles Maluluy-on was finished. By that
time, however, Dr. Tatad was already working with the obstetricians who CA: On appeal, the CA affirmed in toto the judgment rendered by the RTC
will perform surgery on Lilia Aguila. There being no other available finding petitioners guilty of gross negligence in the performance of their
anesthesiologist to assist them, Drs. Zafe and Cereno decided to defer the duties and awarding damages to private respondents.
operation on Raymond. Drs. Zafe and Cereno, in the meantime, proceeded Issue: Whether or not petitioners Drs. Zafe and Cereno were grossly
to examine Raymond and they found that the latter’s blood pressure was negligent in the performance of their duties.
normal and "nothing in him was significant." Held: NO. The type of lawsuit which has been called 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 proven within a reasonable medical probability based upon competent
medical professional which has caused bodily harm. In order to successfully expert testimony.
pursue such a claim, a patient must prove that a health care provider, in
most cases a physician, either failed to do something which a The parents of Raymond failed in this respect. Aside from their failure to
reasonably prudent health care provider would have done, or that he prove negligence on the part of the petitioners, they also failed to prove that
or she did something that a reasonably prudent provider would not it was petitioners’ fault that caused the injury. Their cause stands on the
have done; and that the failure or action caused injury to the patient. mere assumption that Raymond’s life would have been saved had petitioner
Stated otherwise, the complainant must prove: (1) that the health care surgeons immediately operated on him; had the blood been cross-matched
provider, either by his act or omission, had been negligent, and (2) that immediately and had the blood been transfused immediately. There was,
such act or omission proximately caused the injury complained of. however, no proof presented that Raymond’s life would have been saved
had those things been done. Those are mere assumptions and cannot
Given that Dr. Tatad was already engaged in another urgent operation and guarantee their desired result. Such cannot be made basis of a decision in
that Raymond was not showing any symptom of suffering from major blood this case, especially considering that the name, reputation and career of
loss requiring an immediate operation, We find it reasonable that petitioners petitioners are at stake.
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 It was noted that Raymond, who was a victim of a stabbing incident, had
prudent surgeon faced with similar circumstances would decide otherwise. multiple wounds when brought to the hospital. Upon opening of his thoracic
cavity, it was discovered that there was gross bleeding inside the body.
Another ground relied upon by the trial court in holding petitioners negligent Thus, the need for petitioners to control first what was causing the bleeding.
was their failure to immediately transfuse blood on Raymond. Such failure
allegedly led to the eventual death of Raymond through "hypovolemic In the case of Dr. Cruz v. CA, it was held that "[d]octors are protected by a
shock." Again, such is a mistaken conclusion. special law. They are not guarantors of care. They do not even warrant a
good result. They are not insurers against mishaps or unusual
First, the alleged delay in the cross-matching of the blood, if there was any, consequences. Furthermore, they are not liable for honest mistake of
cannot be attributed as the fault of the petitioners. The petitioners were judgment…"
never shown to be responsible for such delay. It is highly unreasonable and DISPOSITIVE PORTION: IN THE LIGHT OF THE FOREGOING, the
the height of injustice if petitioners were to be sanctioned for lapses in instant Petition for Review on Certiorari is hereby GRANTED. The Court of
procedure that does not fall within their duties and beyond their control. Appeals decision is hereby REVERSED and SET ASIDE. No costs.
Case Digest: Garcia, A.R.G.
Second, Dr. Cereno, in his unchallenged testimony, aptly explained the
apparent delay in the transfusion of blood on Raymond before and during
the operation. 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. The testimonies of Dr.
Cereno went unchallenged or unrebutted. The parents of Raymond were
not able to present any expert witness to dispute the course of action taken
by the petitioners.

Causation Not Proven

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