Dr. Ninevetch Cruz v. CA and Lydia Umali

FACTS:

Lydia Umali was examined by Dr. Cruz who found a myoma [benign tumor] in her uterus, and scheduled her for a hysterectomy operation [removal of uterus] on 23 Mar 1991. On March 22, Rowena Umali accompanied her mother to the hospital and spent the night there, for the operation was to be conducted on the following day. Rowena noticed that the clinic was untidy, so she tried to persuade her mother not to proceed with the operation. On the day of the operation, Rowena asked Dr. Cruz if the operation could be postponed. Because of this, Dr. Cruz called Lydia in her office. Consequently, Lydia informed Rowena that the operation must go on as scheduled.

While Lydia’s relatives were waiting, Dr. Ercillo (anesthesiologist) told them to buy tagamet ampules, and Rowena’s sister went out to buy some. An hour later, Dr. Ercillo asked them to buy blood for Lydia, so they did. A few hours later, the operation was finished. However, Dr. Cruz asked again the family to buy additional blood, but there was no more type A blood available in the blood bank. A person arrived to donate blood which was later transfused to Lydia. Rowena noticed that her mother was gasping for breath–apparently, the oxygen supply had run out, so the family went out to buy oxygen. Later in the evening, she went into shock and her blood pressure dropped. She was then transferred to another hospital so she could be connected to a respirator and further examined. However, this transfer was without the consent of the relatives, who only found out about it when an ambulance came to take Lydia to the other hospital.

In the new hospital, she was re-operated upon by Dr. Cruz and Dr. Ercillo because blood was oozing out from her incision. They summoned Dr. Angeles, Ob-Gyne head of the new hospital, but when he arrived, Lydia was already in shock and possibly dead (BP: 0/0). Dr. Angeles told Drs. Cruz and Ercillo that there was nothing he could do. Lydia died while Dr. Cruz was closing her abdominal wall. Immediate cause of death is shock; disseminated intravascular coagulation (DIC) as antecedent cause.

Dr. Cruz and Dr. Ercillo were charged with reckless imprudence and negligence resulting in homicide of Lydia Umali. The Municipal Trial Court in Cities (MTCC) found Dr. Ercillo not guilty for insufficiency of evidence against her, but held Dr. Cruz responsible for Umali’s death. RTC and CA affirmed MTCC.

Manifestation of negligence:
1. untidiness of clinic
2. lack of provision of supplies
3. the fact that the transfer was needed meant that there was something wrong in the way Dr. Cruz conducted operation
4. no showing that pre-surgery procedure (clearance, blood typing/tests) was conducted

ISSUE:

WON the circumstances are sufficient to sustain a judgment of conviction against Dr. Cruz for reckless imprudence resulting in homicide.

HELD:

NO. DR. CRUZ IS ACQUITTED, BUT SHE IS STILL CIVILLY LIABLE (50K civil liability; 100k moral damages, 50k exemplary damages).

Elements of reckless imprudence
1. Offender does / fails to do an act
2. Doing / failure to do act is voluntary
3. Without malice
4. Material damage results from reckless imprudence
5. There is inexcusable lack of precaution, taking into consideration offender’s employment, degree of intelligence, physical condition, other circumstances re: persons, time, place

Burden of establishing medical negligence on plaintiff.

Plaintiff has the burden to establish this, and for a reasonable conclusion of negligence, there must be proof of breach of duty on the part of the surgeon, as well as a causal connection of such breach and the resulting death of patient. Negligence cannot create a right of action unless it is the proximate cause of the injury complained of (Chan Lugay v. St. Luke’s Hospital, Inc.). In this case, no cogent proof exists that the circumstances caused Lydia’s death, so the 4th element of reckless imprudence is missing.

The testimonies of the doctors presented by the prosecution establish hemorrhage / hemorrhagic shock as the cause of death, which may be caused by several different factors. Autopsy did not reveal any untied cut blood vessel, nor was there a tie of a cut blood vessel that became loose. The findings of the doctors do not preclude the probability that a clotting defect (DIC) caused the hemorrhage and consequently, Lydia’s death.

The Court has no recourse but to rely on the expert testimonies that substantiate Dr. Cruz’ allegation that the cause of Lydia’s death was DIC, which cannot be attributed to Dr. Cruz’ fault or negligence. This probability was unrebutted during trial.

Credit:

Dome Cabias

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