Gerald Albert Gercayo (Gerald) was born on June 2, 1992 with an imperforate anus. Two days after his birth, Gerald underwent colostomy, a surgical procedure to bring one end of the large intestine out through the abdominal wall, enabling him to excrete through a colostomy bag attached to the side of his body. When Gerald was three years old, he was admitted at the Ospital ng Maynila for a pull-through operation. Dr. Leandro Resurreccion headed the surgical team, and was assisted by Dr. Luceño, Dr. Valeña and Dr. Tibio. The anesthesiologists included Dr. Abella, Dr. Razon and petitioner Dr. Fernando Solidum (Dr. Solidum). During the operation, Gerald experienced bradycardia , and went into a coma. His coma lasted for two weeks, but he regained consciousness only after a month. He could no longer see, hear or move.
A complaint for reckless imprudence resulting in serious physical injuries was filed by Gerald’s parents against the team of doctors. Upon a finding of probable cause, the City Prosecutor’s Office filed an information solely against Dr. Solidum.
The RTC rendered Dr. Solidum guilty beyond reasonable doubt of reckless imprudence resulting in serious physical injuries and ordering her to indemnify, jointly and severally with the Ospital ng Maynila, private complainant Luz Gercayo, for damages. The CA affirmed the ruling of RTC and applied the doctrine of res ipsa loquitur in the case.
1. Whether the doctrine of res ipsa loquitur was applicable in the case.
2. Whether Dr. Solidum is liable for criminal negligence.
1. No, the doctrine of res ipsa loquitur will not apply in this case. The doctrine of res ipsaloquitor means that where the thing which causes injury is shown to be under the management of the defendant, and the accident is such as in ordinary course of things does not happen if those who have management use proper care, it affords reasonable evidence, in the absence of an explanation by defendant that the accident arose from want of care.
The doctrine is generally restricted to situations in malpractice cases where a layman is able to say, as a matter of common knowledge and observation, that the consequences of professional care were not as such as would ordinarily have followed if due care had been exercised.
For the doctrine to apply, the following requisites must be 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; (3) the injury suffered must not have been due to any voluntary action or contribution of the person injured.
In this case, the application of the doctrine is inappropriate. Although the second and third elements were present, considering that the anesthetic agent and the instruments were exclusively within the control of Dr. Solidum, and that the patient, being then unconscious during the operation has no contributory negligence, the first element is wanting. Indeed, the patient experienced bradycardia during the operation, but such fact alone did not prove that the negligence of any of his attending physicians, including the anesthesiologists, had caused the injury. In fact, the anesthesiologists attending to him had sensed in the course of the operation that the lack of oxygen could have been trigerred by the vago-vagal reflex, prompting them to administer atropine to the patient.
2. No, Dr. Solidum is not liable for criminal negligence. Negligence is defined as the failure to observe for the protection of the interests of another person that degree of care, precaution, and vigilance that the circumstances justly demand, whereby such other person suffers injury. The negligence must be the proximate cause of the injury.
An action upon medical negligence calls for the plaintiff to prove by competent evidence the following elements: (a) the duty owed by the physician to the patient, as created by the physician-patient relationship, to act in accordance with the specific norms or standards established by his profession; (b) the breach of the duty by the physician’s failing to act in accordance with the applicable standard of care; (c) the causation, i.e, there must be a reasonably close and casual connection between the negligent act or omission and the resulting injury; and d.) the damages suffered by the patient.
In the medical profession, specific norms on standard of care to protect the patient against unreasonable risk, commonly referred to as standards of care, set the duty of the physician in respect of the patient. In attempting to fix a standard by which a court may determine whether the physician has properly performed the requisite duty toward the patient, expert medical testimony from both plaintiff and defense experts is required.
In this case, the Prosecution presented no witnesses with special medical qualifications in anesthesia to provide guidance to the trial court on what standard of care was applicable. It would consequently be truly difficult, if not impossible, to determine whether the first three elements of a negligence and malpractice action were attendant.
Dr. Solidum was criminally charged for “failing to monitor and regulate properly the levels of anesthesia administered to Gerald and using 100% halothane and other anesthetic medications.” However, the foregoing circumstances, taken together, did not prove beyond reasonable doubt that Dr. Solidum had been recklessly imprudent in administering the anesthetic agent to Gerald. Indeed, Dr. Vertido’s findings did not preclude the probability that other factors related to Gerald’s major operation, which could or could not necessarily be attributed to the administration of the anesthesia, had caused the hypoxia and had then led Gerald to experience bradycardia. Dr. Vertido revealingly concluded in his report, instead, that “although the anesthesiologist followed the normal routine and precautionary procedures, still hypoxia and its corresponding side effects did occur.”
The Supreme Court stated that “the existence of the probability about other factors causing the hypoxia has engendered in the mind of the Court a reasonable doubt as to Dr. Solidum’s guilt, and moves us to acquit him of the crime of reckless imprudence resulting to serious physical injuries.”
WHEREFORE, the Court GRANTS the petition for review on certiorari; REVERSES AND SETS ASIDE the decision promulgated on January 20, 2010; ACQUITS Dr. Fernando P. Solidum of the crime of reckless imprudence resulting to serious physical injuries; and MAKES no pronouncement on costs of suit.
Additional Notes: The Supreme Court also addressed in this case the error committed by the RTC and CA in holding the Ospital ng Maynila jointly and severally liable with Dr. Solidum with regard to indemnification for damages.
In criminal prosecutions, the civil action for the recovery of civil liability that is deemed instituted with the criminal action refers only to that arising from the offense charged. The Supreme Court, in this case, stated, “ It is puzzling, how the RTC and the CA could have adjudged Ospital ng Maynila jointly and severally liable with Dr. Solidum despite the obvious fact that Ospital ng Maynila, being an artificial entity, had not been charged along with Dr. Solidum”.
The Ospital ng Maynila was not at all a party in the proceedings. Hence, its fundamental right to be heard was not respected from the outset. No person can be prejudiced by a ruling rendered in an action or proceeding in which he was not made a party. Such a rule would enforce the constitutional guarantee of due process of law.
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