Our Lady of Lourdes Hospital vs. Capanzana

12/19/21, 6:17 PM SUPREME COURT REPORTS ANNOTATED 821

G.R. No. 189218. March 22, 2017.*

OUR LADY OF LOURDES HOSPITAL, petitioner, vs. SPOUSES
ROMEO and REGINA CAPANZANA, respondents.
Remedial Law; Civil Procedure; Appeals; Petition for Review on

Certiorari; Only questions of law are entertained in a Rule 45 petition.—
We reiterate the elementary rule that only questions of law are entertained in
a Rule 45 petition. Findings of fact of the lower courts are generally
conclusive and binding on this Court whose function is not to analyze or
weigh the evidence all over again. While there are exceptional cases in
which this Court may review findings of fact of the CA, none of these
exceptions is present in the case at bar. We see no compelling reason to
deviate from this general rule now. We therefore defer to the pertinent
factual findings of the lower courts, especially because these are well-
supported by the records. It is in this light that we affirm the findings of both
the trial and the appellate courts which found negligence on the part of the
nurses.
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* FIRST DIVISION.

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Our Lady of Lourdes Hospital vs. Capanzana
Quasi-delicts; Medical Negligence; In order to successfully pursue a

claim in a medical negligence case, the plaintiff must prove that a health
professional either failed to do something which a reasonably prudent
health professional would have or have not done; and that the action or
omission caused injury to the patient.—In order to successfully pursue a
claim in a medical negligence case, the plaintiff must prove that a health
professional either failed to do something which a reasonably prudent health
professional would have or have not done; and that the action or omission
caused injury to the patient. Proceeding from this guideline, the plaintiff
must show the following elements by a preponderance of evidence: duty of
the health professional, breach of that duty, injury of the patient, and
proximate causation between the breach and the injury. Meanwhile, in fixing
a standard by which a court may determine whether the physician properly
performed the requisite duty toward the patient, expert medical testimonies
from both plaintiff and defense are resorted to. In this case, the expert
testimony of witness for the respondent Dr. Godfrey Robeniol, a
neurosurgeon, provided that the best time to treat hypoxic encephalopathy is
at the time of its occurrence; i.e., when the patient is experiencing difficulty
in breathing and showing signs of cardiac arrest.
Same; Same; The Supreme Court (SC) has emphasized that a higher
degree of caution and an exacting standard of diligence in patient
management and health care are required of a hospital’s staff, as they deal
with the lives of patients who seek urgent medical assistance.—We agree
with the courts below in their finding that when she was gasping for breath
and turning cyanotic, it was the duty of the nurses to intervene immediately
by informing the resident doctor. Had they done so, proper oxygenation
could have been restored and other interventions performed without wasting
valuable time. That such high degree of care and responsiveness was needed
cannot be overemphasized — considering that according to expert medical
evidence in the records, it takes only five minutes of oxygen deprivation for
irreversible brain damage to set in. Indeed, the Court has emphasized that a
higher degree of caution and an exacting standard of diligence in patient
management and health care are required of a hospital’s staff, as they deal
with the lives of patients who seek urgent medical assistance. It is
incumbent upon nurses to take precautions or undertake steps to safeguard
patients

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under their care from any possible injury that may arise in the course of
the latter’s treatment and care.
Same; Same; There was a delay in the administration of oxygen to the
patient, caused by the delayed response of the nurses of petitioner hospital.
—The Court further notes that the immediate response of the nurses was
especially imperative, since Regina herself had asked for oxygen. They
should have been prompted to respond immediately when Regina herself
expressed her needs, especially in that emergency situation when it was not
easy to determine with certainty the cause of her breathing difficulty.
Indeed, even if the patient had not asked for oxygen, the mere fact that her
breathing was labored to an abnormal degree should have impelled the
nurses to immediately call the doctor and to administer oxygen. In this
regard, both courts found that there was a delay in the administration of
oxygen to the patient, caused by the delayed response of the nurses of
petitioner hospital. They committed a breach of their duty to respond
immediately to the needs of Regina, considering her precarious situation and
her physical manifestations of oxygen deprivation.
Same; Same; The records also show another instance of negligence,
such as the delay in the removal of Regina’s consumed dextrose, a condition
that was already causing her discomfort.—The records also show another
instance of negligence, such as the delay in the removal of Regina’s
consumed dextrose, a condition that was already causing her discomfort. In
fact, Balad had to inform the nurses and the patient had to instruct one of
them, on what to do.
Same; Same; Proximate Cause; A failure to act may be the proximate
cause if it plays a substantial part in bringing about an injury.—We affirm
the findings of the courts below that the negligent delay on the part of the
nurses was the proximate cause of the brain damage suffered by Regina. In
Ramos v. Court of Appeals, 321 SCRA 584 (1999), the Court defines
proximate cause as follows: Proximate cause has been defined as that which,
in natural and continuous sequence, unbroken by any efficient intervening
cause, produces injury, and without which the result would not have
occurred. An injury or damage is proximately caused by an act or a failure
to act, whenever it appears from the evidence in the case, that the act or
omission played a substantial part in bringing about

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or actually causing the injury or damage; and that the injury or damage
was either a direct result or a reasonably probable consequence of the act or
omission. It is the dominant, moving or producing cause. (Underscoring
supplied; citations omitted) Thus, a failure to act may be the proximate
cause if it plays a substantial part in bringing about an injury. Note also that
the omission to perform a duty may also constitute the proximate cause of
an injury, but only where the omission would have prevented the injury. The
Court also emphasizes that the injury need only be a reasonably probable
consequence of the failure to act. In other words, there is no need for
absolute certainty that the injury is a consequence of the omission. Applying
the above definition to the facts in the present case, the omission of the
nurses — their failure to check on Regina and to refer her to the resident
doctor and, thereafter, to immediately provide oxygen — was clearly the
proximate cause that led to the brain damage suffered by the patient. As the
trial court and the CA both held, had the nurses promptly responded, oxygen
would have been immediately administered to her and the risk of brain
damage lessened, if not avoided.
Same; Same; Vicarious Liability; For the negligence of its nurses,
petitioner is thus liable under Article 2180 in relation to Article 2176 of the
Civil Code. Under Article 2180, an employer like petitioner hospital may be
held liable for the negligence of its employees based on its responsibility
under a relationship of patria potestas.—For the negligence of its nurses,
petitioner is thus liable under Article 2180 in relation to Article 2176 of the
Civil Code. Under Article 2180, an employer like petitioner hospital may be
held liable for the negligence of its employees based on its responsibility
under a relationship of patria potestas. The liability of the employer under
this provision is “direct and immediate; it is not conditioned upon a prior
recourse against the negligent employee or a prior showing of the
insolvency of that employee.” The employer may only be relieved of
responsibility upon a showing that it exercised the diligence of a good father
of a family in the selection and supervision of its employees. The rule is that
once negligence of the employee is shown, the burden is on the employer to
overcome the presumption of negligence on the latter’s part by proving
observance of the required diligence.
Same; Same; Same; While the question of diligent supervision depends
on the circumstances of employment, the Supreme Court

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(SC) finds that by the very nature of a hospital, the proper supervision
of the attendance of its nurses, who are its frontline health professionals, is
crucial considering that patients’ conditions can change drastically in a

matter of minutes.—There is no proof of actual supervision of the
employees’ work or actual implementation and monitoring of consistent
compliance with the rules. The testimony of petitioner’s Assistant Nursing
Service Director, Lourdes H. Nicolas is belied by the actual records of
petitioner. These show that Nurses David and Padolina had been observed to
be latecomers and absentees; yet they were never sanctioned by those
supposedly supervising them. While the question of diligent supervision
depends on the circumstances of employment, we find that by the very
nature of a hospital, the proper supervision of the attendance of its nurses,
who are its frontline health professionals, is crucial considering that
patients’ conditions can change drastically in a matter of minutes.
Petitioner’s Employee Handbook recognized exactly this as it decreed the
proper procedure in availing of unavoidable absences and the commensurate
penalties of verbal reprimand, written warning, suspension from work, and
dismissal in instances of unexcused absence or tardiness. Petitioner’s failure
to sanction the tardiness of the defendant nurses shows an utter lack of
actual implementation and monitoring of compliance with the rules and
ultimately of supervision over its nurses.
PETITION for review on certiorari of the decision and resolution of

the Court of Appeals.
The facts are stated in the opinion of the Court.
Zamora, Poblador, Vasquez & Bretaña for petitioner.
Padilla, Asuncion, Bote-Veguillas, Matta, Cariño Law Offices
for respondents.
SERENO, CJ.:

We resolve the instant Petition for Review on Certiorari1
_______________
1 Rollo, pp. 127-205.

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assailing the Decision2 and Resolution3 rendered by the Court of

Appeals (CA), Second Division, in C.A.-G.R. CV No. 89030.

The Antecedent Facts

Regina Capanzana (Regina), a 40-year-old nurse and clinical

instructor pregnant with her third child, was scheduled for her third
caesarean section (C-section) on 2 January 1998. However, a week
earlier, on 26 December 1997, she went into active labor and was
brought to petitioner hospital for an emergency C-section. She first
underwent a preoperative physical examination by Dr. Miriam
Ramos4 (Dr. Ramos) and Dr. Milagros Joyce Santos,5 (Dr. Santos)
the same attending physicians in her prior childbirths. She was
found fit for anesthesia after she responded negatively to questions
about tuberculosis, rheumatic fever, and cardiac diseases. On that
same day, she gave birth to a baby boy. When her condition
stabilized, she was discharged from the recovery room and
transferred to a regular hospital room.6
At 2:30 a.m. the following day, or 13 hours after her operation,
Regina who was then under watch by her niece, Katherine L. Balad
(Balad), complained of a headache, a chilly sensation, restlessness,
and shortness of breath. She asked for oxygen and later became
cyanotic. After undergoing an x-ray,
_______________
2 Id., at pp. 10-40, dated 24 October 2008; penned by Associate Justice Portia
Aliño-Hormachuelos and concurred in by Associate Justices Hakim S. Abdulwahid
and Teresita Dy-Liacco Flores.
3 Id., at pp. 42-43, dated 12 August 2009; penned by Associate Justice Portia
Aliño-Hormachuelos and concurred in by Associate Justices Hakim S. Abdulwahid
and Fernanda Lampas-Peralta.
4 There are references to her as Dr. Mirriam Ramos but the pleadings she
submitted in this case indicate the name Dr. Miriam Ramos.
5 The complaint referred to her as Dr. Jocelyn Santos but she filed her Answer
clarifying that she should be referred to as Dr. Milagros Joyce Santos.
6 Rollo, p. 838.

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she was found to be suffering from pulmonary edema. She was

eventually transferred to the Intensive Care Unit, where she was
hooked to a mechanical ventilator. The impression then was that she
was showing signs of amniotic fluid embolism.7
On 2 January 1998, when her condition still showed no
improvement, Regina was transferred to the Cardinal Santos
Hospital. The doctors thereat found that she was suffering from
rheumatic heart disease mitral stenosis with mild pulmonary

hypertension, which contributed to the onset of fluid in her lung
tissue (pulmonary edema). This development resulted in cardio-
pulmonary arrest and, subsequently, brain damage. Regina lost the
use of her speech, eyesight, hearing and limbs. She was discharged,
still in a vegetative state, on 19 January 1998.8
Respondent spouses Capanzana filed a complaint for damages9
against petitioner hospital, along with codefendants: Dr. Miriam
Ramos, an obstetrician/gynecologist; Dr. Milagros Joyce Santos, an
anesthesiologist; and Jane Does, the nurses on duty stationed on the
second floor of petitioner hospital on 26-27 December 1997.10
Respondents imputed negligence to Drs. Ramos and Santos for
the latter’s failure to detect the heart disease of Regina, resulting in
failure not only to refer her to a cardiologist for cardiac clearance,
but also to provide the appropriate medical management before,
during, and after the operation. They further stated that the nurses
were negligent for not having promptly given oxygen, and that the
hospital was equally
_______________
7 Id.
8 Id.
9 Records (Vol. I), pp. 22-29; dated 24 February 1998 and docketed as Civil Case
No. MC-98-149.
10 Rollo, pp. 838-839.

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negligent for not making available and accessible the oxygen unit on
that same hospital floor at the time.11
They prayed for actual damages amounting to P814,645.80;
compensatory damages, P3,416,278.40; moral damages, P5,000,000;
exemplary damages, P2,000,000; attorney’s fees, P500,000 as well
as P5,000 per hearing and the costs of suit. They likewise prayed for
other just and equitable reliefs.12
Petitioner hospital, defendants Dr. Ramos and Dr. Santos filed
their respective Answers.13 On the other hand, the service of
summons on the nurses was unsuccessful, as they were no longer
connected with the hospital. Thus, only defendant Florita Ballano
(Ballano), who was later proven to be a midwife and not a nurse,
filed her Answer.14
Petitioner hospital and defendant Ballano claimed that there was

no instruction to the hospital or the staff to place Regina in a room
with a standby oxygen tank. They also claimed that the nurses on
duty had promptly attended to her needs. They prayed that the
complaint be dismissed and respondents ordered to pay unpaid
medical bills.15
Meanwhile, defendant Dr. Ramos claimed that in all of the
consultations and prenatal checkups of Regina in the latter’s three
pregnancies, she never complained nor informed the doctor of any
symptom or sign of a heart problem. Before the last C-section of
Regina, Dr. Ramos examined her and found no abnormal cardiac
sound, murmur or sign of rheumatic heart ailment. The doctor
further claimed that since the operation was an emergency, she had
no time or chance to have Regina undergo any cardiac examination
and secure a cardiac clearance. Moreover, Dr. Ramos claimed that
the cardio-
_______________
11 Id.
12 Id., at pp. 293, 839.
13 Records (Vol. I), pp. 88-93 (for Dr. Ramos), pp. 131-143 (for Dr. Santos), and
pp. 156-166 (for petitioner hospital).
14 Records (Vol. VI), pp. 1624-1634.
15 Rollo, pp. 839-840.

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pulmonary arrest took place 14 hours after the operation, long after
she had performed the operation. She prayed that judgment be
rendered ordering spouses Capanzana to pay her moral damages
amounting to P500,000; exemplary damages, P200,000; and
attorney’s fees, P100,000.16
On the other hand, defendant Dr. Santos claimed that she was the
anesthesiologist in Regina’s first and second childbirths via C-
section. The doctor further stated that prior to the third emergency
C-section, she conducted a preoperative evaluation, and Regina
showed no sign or symptom of any heart problem or abnormality in
the latter’s cardiovascular, respiratory, or central nervous systems.
She then administered the anesthesia to Regina. She also stated that
Regina’s condition before, during, and after the operation was stable.
Dr. Santos prayed that the complaint against her be dismissed.17
Trial ensued. Plaintiffs presented Dr. Erwin Dizon, a cardiologist;

Dr. Godfrey Robeniol, a neurologist; Mrs. Elizabeth Tayag; Dr.
Eleonor Lopez, a cardiologist; Kathleen Lucero Balad; Romeo
Capanzana; and Dr. Asuncion Ranezes, a physician.18
After the plaintiffs rested their case, an amended complaint was
filed, this time identifying and impleading as defendants the nurses
on duty who included Czarina Ocampo, H.R. Bolatete, Evelyn S.
David, and Angelica Concepcion.19 After conducting a deposition of
the person in charge of the nurses’ schedule, spouses Capanzana
further amended their complaint to implead nurses Rochelle
Padolina and Florita Ballano, while dropping defendants Czarina
Ocampo, H.R. Bolatete, and Angelica Concepcion.20
_______________
18 Id., at p. 842.
17 Id., at p. 840.
16 Id., at pp. 840-841.
19 Records (Vol. III), pp. 811-819.
20 Id. (Vol. V), pp. 1508-1516.

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The trial continued with the presentation of defense evidence.

The defense presented Dr. Santos; Dr. Ramos; Atty. Nicolas Lutero
III, director of the Bureau of Licensing and Facilities of the
Department of Health; Lourdes H. Nicolas, the assistant nursing
service director; Dr. Grace de los Angeles; Ma. Selerina Cuvin, the
account receivable clerk; and Milagros de Vera, the administrative
supervisor of the hospital.21
On 11 May 2005, and pending the resolution of the case before
the trial court, Regina died and was substituted by her heirs
represented by Romeo Capanzana.22

The Ruling of the RTC

On 29 December 2006, the RTC rendered judgment, finding no
negligence on the part of Dr. Ramos or Dr. Santos. It found that the
medical community’s recognized standard practices in attending to a
patient in connection with a C-section had been duly observed by
the doctors.23
The RTC also found that the primary cause of Regina’s

vegetative state was amniotic fluid embolism, an unfortunate
condition that was not within the control of any doctor to anticipate
or prevent. This condition was the root cause of the pulmonary
edema that led to hypoxic encephalopathy, brain damage and,
ultimately, Regina’s vegetative state. On the other hand, the trial
court noted that hypoxic encephalopathy was manageable. It could
have been prevented, or at least minimized, had there been a timely
administration of oxygen.24
On the strength of the testimony of Balad, the RTC found that
negligence on the part of the nurses contributed to the
_______________
21 Rollo, pp. 847-851.

22 Id., at p. 838.
23 Id., at pp. 852-856.
24 Id., at p. 859.

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injury of Regina. It found that they failed to respond immediately

when Regina was experiencing shortness of breath. It took the
nurses more or less 10 minutes after being informed of the condition
of Regina before they checked on her, called for the resident doctor,
and requested oxygen. While the trial court acknowledged that the
immediate administration of oxygen was not a guarantee that
Regina’s condition would improve, it gave credence to the testimony
of the expert witness. The latter opined that the delay contributed to
the onset of hypoxic encephalopathy or diffuse brain damage due to
lack of oxygen in Regina’s brain. The expert witness also said that
had there been a timely administration of oxygen the risk of brain
damage would have been lessened, if not avoided, and the onset of
hypoxic encephalopathy reduced. The RTC therefore found the
nurses liable for contributory negligence.25
On the issue of whether petitioner hospital could be held liable
for the negligence of its nurses, the RTC ruled that the hospital was
able to discharge the burden of proof that it had exercised the
diligence of a good father of a family in the selection and
supervision of its employees. The trial court arrived at this finding
on the basis of the testimony of the assistant nursing director,
Lourdes Nicolas. She stated that the selection and hiring of their
nurses was a rigorous process, whereby the applicants underwent a

series of procedures —examination, orientation, training, on-the-job
observation, and evaluation — before they were hired as regular
employees. The nurses were supervised by their head nurses and the
charge nurse. The nurses were also inspected by their clinical
supervisor and nursing director. Consequently, only the nurses were
held liable to pay damages. However, since the trial court acquired
jurisdiction only over Ballano among those on duty on that day, she
was the only one held liable.26 The dispositive portion of the RTC
decision states:
_______________
25 Id., at pp. 856-857.

26 Id., at pp. 857-858.

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WHEREFORE, all foregoing considered, judgment is rendered as

follows:
A. Ordering the defendant FLORITA BALLANO to pay the plaintiff
Romeo R. Capanzana and the children of the spouses Capanzana, namely:
Roxanne, Rizelle, and Reginald (all minors) who are represented by plaintiff
Romeo R. Capanzana in respect to the children’s right to the interest of their
deceased mother Regina in this case:
1. The amount of Pesos: Two Hundred Ninety-Nine Thousand One Hundred
Two and 04/100 (P299,102.04), as and by way of actual damages;
2. The amount of Pesos: One Hundred Thousand (P100,000.00), as and by
way of moral damages;
3. The amount of Pesos: One Million Nine Hundred Fifty Thousand Two
Hundred Sixty-Nine and 80/100 (P1,950,269.80), as and by way of
compensatory damages;
4. The amount of Pesos: One Hundred Thousand (P100,000.00), as and by
way of attorney’s fees;
5. The cost of suit.
B. Ordering the DISMISSAL of the case as against defendants Our
Lady of Lourdes Hospital, Inc., Dr. Mirriam Ramos and Dr. Milagros Joyce
(Jocelyn) Santos; and
C. DISMISSING the counterclaims of the defendants.
SO ORDERED.27
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27 Id., at pp. 860-861.

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Respondents Capanzana filed their appeal28 before the CA,

arguing that the RTC committed error in holding that amniotic fluid
embolism, which could not have been foreseen or prevented by the
exercise of any degree of diligence and care by defendants, caused
the cardio-pulmonary arrest, brain damage, and death of the patient
(instead of rheumatic heart mitral valve stenosis which could have
been detected and managed). Respondents further argued that it was
error for the trial court to hold that defendants Dr. Ramos and Dr.
Santos and petitioner hospital exercised due diligence and to absolve
them from liability for the untimely death of Regina.29
Petitioner hospital also filed its notice of appeal.30 It imputed
error to the trial court for holding that the nurses had not exercised
due diligence in attending to the needs of Regina, particularly
because (1) respondent spouses failed to prove any breach of duty
on the part of the nurses, particularly Ballano; (2) there was no delay
in the delivery of oxygen to Regina; and (3) Regina was afflicted
with amniotic fluid embolism, a condition that could not have been
foreseen or prevented by any degree of care by defendants.31 Also,
petitioner hospital decried the dismissal of its counterclaims and the
exclusion of the material testimony of one of the hospital nurses.32

The Ruling of the CA

The CA rendered the assailed decision affirming the RTC ruling
with modification. The appellate court upheld the find-
_______________
28 CA Rollo, p. 44.

29 Rollo, pp. 945-1017.
30 CA Rollo, pp. 45-46.
31 Rollo, p. 889.
32 Id., at pp. 757-767. A Motion for Leave dated 20 December 2004 was filed by
petitioner hospital to take the deposition of a witness, nurse-on-duty defendant Evelyn
David, but the Motion was denied by the trial court in an Order dated 12 April 2005.

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ing of the trial court that the proximate cause of Regina’s condition
was hypoxic encelopathy, a diffuse brain damage secondary to lack
of oxygen in the brain. Specifically, the cause was hypoxic
encelopathy secondary to pulmonary cardiac arrest on the
background of pulmonary edema. The CA decreed that the failure of
Dr. Ramos to diagnose the rheumatic heart disease of Regina was
not the proximate cause that brought about the latter’s vegetative
condition as a probable or natural effect thereof. Even if the
appellate court were to concede that Regina indeed suffered from
rheumatic heart mitral valve stenosis, it was not established that Dr.
Ramos ignored standard medical procedure and exhibited an
absence of the competence and skill expected of practitioners
similarly situated.33
The CA especially took note of the fact that when Regina was
operated on for the third time, albeit in an emergency situation, she
had the benefit of her complete medical history. Also, even the
expert witness presented by the plaintiffs, Dr. Dizon, testified that
most patients suffering from mild mitral valve stenosis are
asymptomatic, so the disease cannot be detected on physical
examination. He further testified that a request for cardio-pulmonary
clearance is discretionary, and that a referral to a pulmonologist can
be done away with if the attending physician finds the patient’s heart
normal. Thus, the appellate court upheld the ruling of the trial court
absolving Dr. Ramos.34
On the issue of the liability of Dr. Santos, the CA discredited the
theory of Dr. Dizon that the normal post-operation dosage of 3 liters
of intravenous fluid for 24 hours, or 1 liter every 8 hours, could be
fatal to a patient with a heart problem. It ruled that Dr. Dizon was
presented as an expert witness on cardiology, and not on
anesthesiology. Upholding the RTC, the appellate court gave more
credence to the testimony
_______________
33 Id., at pp. 22-25.

34 Id., at p. 25.

272

of Dr. Santos, who was accepted as an expert witness in the fields of

anesthesiology and obstetric anesthesiology. She had testified that
even if the dosage was beyond the recommended amount, no
harmful effect would have ensued if the patient’s kidney were
functioning properly. She examined Regina before the operation and
found no edema — an indication that the latter’s kidney was
functioning well. The testimony of Dr. Santos remained
uncontroverted. The CA also upheld the ruling that respondents
similarly failed to prove that Dr. Santos had ignored standard
medical procedure and exhibited an absence of the competence and
skill expected of practitioners similarly situated. Consequently, the
appellate court also upheld the ruling of the trial court absolving Dr.
Santos.35
Meanwhile, the CA absolved Ballano. Like the RTC, the
appellate court found evidence that the nurses were negligent. But
contrary to the trial court, the CA held that there was no showing
whether Ballano, who was later identified as a midwife, was
negligent in attending to the needs of Regina. Further, it was not
shown whether Ballano was even one of the nurses on duty who had
attended to Regina. The appellate court also noted that the execution
of health care procedures and essential primary health care is a
nurse’s (not a midwife’s) duty.36
Finally, the CA ruled that petitioner hospital should be held liable
based on the doctrine of corporate responsibility. It was found that
while there was evidence to prove that petitioner hospital showed
diligence in its selection and hiring processes, there was no evidence
to prove that it exercised the required diligence in the supervision of
its nurses. Also, the appellate court ruled that the nonavailability of
an oxygen unit on the hospital floor, a fact that was admitted,
constituted gross negligence on the part of petitioner hospital. The
CA stressed that, as borne out by the records, there was only
_______________
35 Id., at pp. 26-27.

36 Id., at pp. 34-35.

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one tank in the ward section of 27 beds. It said that petitioner

hospital should have devised an effective way for the staff to
properly and timely respond to a need for an oxygen tank in a
situation of acute distress.37
Accordingly, the CA awarded to respondents exactly the same
amounts decreed by the RTC. This time, however, instead of
Ballano, petitioner hospital was deemed directly liable to pay for
those amounts.38
Only petitioner hospital filed a Motion for Reconsideration,39
which the CA denied. The denial came after a finding that the errors
raised in support of the motion were substantially a mere reiteration
of those already passed upon and considered in the assailed
decision.40
Hence, this petition.
Petitioner hospital is now before this Court assailing the rulings.
First, it argues that the CA ruled contrary to law and evidence,
because there was no proof of any breach of duty on the part of the
nurses. Petitioner argues that even if there was a failure to provide
oxygen, it did not cause the injury sustained by Regina. It
emphasizes that she suffered from amniotic fluid embolism, a
condition that could not be detected or prevented by any degree of
care on the part of the hospital or its nurses. Second, it argues that it
was an error for the CA to hold the former liable on the basis of the
doctrine of corporate responsibility. Third, it alleges that the
appellate court erroneously neglected to find respondents liable for
the unpaid hospital bill. Fourth, it claims that the CA supposedly
erred in upholding the exclusion of the testimony of defendant
David.41 Petitioner ultimately prays that the present petition be
granted, the assailed rulings of the CA
_______________
37 Id., at pp. 35-39.

38 Id., at p. 39.
39 Id., at pp. 243-283.
40 Id., at pp. 241-242.
41 Id., at pp. 153-154.

274

reversed and set aside, the second amended complaint dismissed,

and petitioner’s counterclaims granted.42
Respondents filed their Comment,43 saying that the CA

committed no error in finding petitioner liable for the negligence of
the nurses to timely administer oxygen to Regina. Neither did the
appellate court, they claim, err in applying the doctrine of res ipsa
loquitur or in decreeing that petitioner hospital had failed to exercise
due diligence in the selection and supervision of the latter’s nurses.
They further claim that the CA was correct in holding petitioner
liable under the doctrines of vicarious liability and corporate
negligence. Respondents also insist that Regina did not die of
amniotic fluid embolism.44 Hence, they pray that the instant petition
be denied and that the assailed ruling of the CA, which affirmed that
of the RTC, be upheld.45
Petitioner filed its Reply.46 It vehemently protests the idea that
Regina died at its hands. It reiterates that respondents failed to prove
that its purported negligent act caused the injury she sustained, and
that the administration of oxygen would have prevented the brain
damage she later suffered. Petitioner also disputes the ruling that the
nurses were negligent in attending to her needs. It bewails the
exclusion of the testimony of one of the defendant nurses who could
have debunked the testimony of Balad. It restates its prayer that the
present petition be granted and the assailed rulings of the CA
reversed and set aside. Further, it prays that the second amended
complaint be dismissed and its counterclaims granted. Additionally,
albeit belatedly, it asks that the case be remanded to the trial court
for the reception of the testimony of defendant nurse David.
_______________
42 Id., at p. 203.
43 Id., at pp. 1461-1526.
44 Id., at pp. 1463-1525.
45 Id., at p. 1525.
46 Id., at pp. 1544-1575.

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Our Ruling

We find the petition partially meritorious.
We reiterate the elementary rule that only questions of law are
entertained in a Rule 45 petition.47 Findings of fact of the lower
courts are generally conclusive and binding on this Court whose
function is not to analyze or weigh the evidence all over again.

While there are exceptional cases in which this Court may review
findings of fact of the CA, none of these exceptions is present in the
case at bar.48 We see no compelling reason to deviate from this
general rule now. We therefore defer to the pertinent factual findings
of the lower courts, especially because these are well-supported by
the records. It is in this light that we affirm the findings of both the
trial and the appellate courts which found negligence on the part of
the nurses.
In order to successfully pursue a claim in a medical negligence
case, the plaintiff must prove that a health professional either failed
to do something which a reasonably prudent health professional
would have or have not done; and that the action or omission caused
injury to the patient. Proceeding from this guideline, the plaintiff
must show the following elements by a preponderance of evidence:
duty of the health professional, breach of that duty, injury of the
patient, and proximate causation between the breach and the
injury.49
_______________
47 Rules of Court, Rule 45. See Pascual v. Burgos, G.R. No. 171722, January
11, 2016, 778 SCRA 189; Lynvil Fishing Enterprises, Inc. v. Ariola, 680 Phil. 696;
664 SCRA 679 (2012); Abad v. Guimba, 503 Phil. 321; 465 SCRA 356 (2005);
Collector of Customs v. Court of Appeals, 242 Phil. 26; 158 SCRA 293 (1988).
48 Rosaldes v. People, G.R. No. 173988, October 8, 2014, 737 SCRA 592;
Castillo v. Court of Appeals, 329 Phil. 150; 260 SCRA 374 (1996).
49 Solidum v. People, G.R. No. 192123, March 10, 2014, 718 SCRA 263; Flores
v. Pineda, 591 Phil. 699; 571 SCRA 83 (2008); Reyes v. Sisters of Mercy Hospital,
396 Phil. 87; 341 SCRA 760 (2000).

276

Meanwhile, in fixing a standard by which a court may determine

whether the physician properly performed the requisite duty toward
the patient, expert medical testimonies from both plaintiff and
defense are resorted to.50
In this case, the expert testimony of witness for the respondent
Dr. Godfrey Robeniol, a neurosurgeon, provided that the best time to
treat hypoxic encephalopathy is at the time of its occurrence; i.e.,
when the patient is experiencing difficulty in breathing and showing
signs of cardiac arrest.51
To recall, the records, including petitioner’s Nurses’ Notes,

indisputably show that Regina complained of difficulty in breathing
before eventually showing signs of cyanosis.52 We agree with the
courts below in their finding that when she was gasping for breath
and turning cyanotic, it was the duty of the nurses to intervene
immediately by informing the resident doctor. Had they done so,
proper oxygenation could have been restored and other interventions
performed without wasting valuable time. That such high degree of
care and responsiveness was needed cannot be overemphasized —
considering that according to expert medical evidence in the records,
it takes only five minutes of oxygen deprivation for irreversible
brain damage to set in.53 Indeed, the Court has emphasized that a
higher degree of caution and an exacting standard of diligence in
patient management and health care are required of a hospital’s staff,
as they deal with the lives of patients who seek urgent medical
assistance.54 It is incumbent upon nurses to take precautions or
undertake steps to safeguard patients
_______________
50 Casumpang v. Cortejo, 752 Phil. 379; 752 SCRA 379 (2015); Solidum v.
People, id.; Li v. Soliman, 66 Phil. 29; 651 SCRA 32 (2011).
51 Rollo, p. 999.
52 Id., at p. 159.
53 Id., at pp. 856-857.
54 Hospital Management Services, Inc.-Medical Center Manila v. Hospital
Management Services, Inc.-Medical Center Manila Employees Association-AFW, 656
Phil. 57; 641 SCRA 59 (2011).

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under their care from any possible injury that may arise in the course
of the latter’s treatment and care.55
The Court further notes that the immediate response of the nurses
was especially imperative, since Regina herself had asked for
oxygen. They should have been prompted to respond immediately
when Regina herself expressed her needs, especially in that
emergency situation when it was not easy to determine with
certainty the cause of her breathing difficulty. Indeed, even if the
patient had not asked for oxygen, the mere fact that her breathing
was labored to an abnormal degree should have impelled the nurses
to immediately call the doctor and to administer oxygen.
In this regard, both courts found that there was a delay in the
administration of oxygen to the patient, caused by the delayed
response of the nurses of petitioner hospital. They committed a
breach of their duty to respond immediately to the needs of Regina,
considering her precarious situation and her physical manifestations
of oxygen deprivation. We quote below the crucial finding of the
trial court:
[W]hen Kathleen [Balad] went to the nurse station to inform the nurses
thereat that her aunt was experiencing shortness of breathing and needed
oxygen nobody rushed to answer her urgent call. It took more or less 10
minutes for these nurses to go inside the room to attend and to check the
condition of their patient. When the nurse came in she saw the patient was
having chilly sensation with difficulty in breathing [and was] at the same
time asking for oxygen. The nurse learned from Kathleen that the patient
was having an asthma attack. The nurse immediately called resident
physician Dr. De Los Angeles
_______________
55 Sec. 27 of Article V of Republic Act No. (R.A.) 7164 or an “Act Regulating

the Practice of Nursing in the Philippines” effective on 21 November 1991 although
this was later repealed by R.A. 9173 or an “Act Providing for a More Responsive
Nursing Profession, Repealing for the Purpose Republic Act No. 7164” effective 21
October 2002.

278

to proceed to room 328 and the hospital aide to bring in the oxygen tank in
the said room. Thereafter, resident doctors Gonzalez and de Los Angeles
arrived and followed by the hospital aide with the oxygen tank. It was clear
that the oxygen tank came late because the request for it from the nurses
also came late. Had the nurses exercised certain degree of promptness and
diligence in responding to the patient[’]s call for help[,] the occurrence of
“hypoxic encephalopathy” could have been avoided since lack or inadequate
supply of oxygen to the brain for 5 minutes will cause damage to it.
(Underscoring supplied)56
56 Rollo, pp. 20-21, 836-857.

The CA agreed with the trial court’s factual finding of delay in
the administration of oxygen as competently testified to by Balad.
Her testimony, which is uncontroverted in the records, proceeded as
follows:
Q [Atty. Diokno]: During this time from about 1:30 in the morning up to
approximately 2:00 in the morning, did any nurse enter the room that
you were in?
A [Balad]: None, sir.
Q: After that conversation between your aunt when she’s asking you to
[turn] off the aircon and turning on [sic] again and then turned it off, do
you have any occasion to talk with her?
A: None, sir.
Q: How did you describe her physical appearance when she was telling you
that “hinihika yata ako?”
A: She feels [sic] very cold even if several blankets were placed in [sic] her
body and she is [sic] coughing at the same time.

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Q: What about during the time that you dropped some pillows at her back?
A: She was running her breath sir, “at inaalala niya ang operasyon niya.”
Q: Seeing her condition like that what did you do if anything to get any help
for her?
A: I buzzered, sir.
Q: About how many time[s] did you buzz for help?
A: Several times, sir, because I saw Tita Regie [Regina] as if she doesn’t
[sic] take it anymore, sir.
Q: How long did it take before any nurse come [sic] to the room?
A: Ten (10) to fifteen (15 minutes) because they were not in the nurse’s
station, sir.
x x x x
Q: What did the nurse do when she entered the room?
A: She asked me if we have an [sic] history of asthma, sir, in the family.
Q: What was your answer.
A: We have, sir, then she hold [sic] the hand of Tita Regie.
Q: What, if anything, did Tita Regie saying [sic] at that time when the nurse
was inside the room?
A: She was running her breath and she was mentioning “oxygen, oxygen,”
sir.
Q: What happened after that?
A: The nurse went out, sir, I was holding Tita Regie at the same time I
called up Tito Romy, sir.
x x x x

280

Q: Going back to the time when the nurse came in and asked you if your
family has an [sic] history of asthma. After that and after touching the
hands of Regina, what did the nurse do?
A: She went out because Tita Regie was asking for an oxygen, sir.
Q: Did the nurse say anything or give any instruction before leaving the
room?
A: I cannot recall, sir, because I was already afraid of the color [cyanosis] of
Tita Regie, sir.
Q: How long did it take before any oxygen arrived if ever?
A: About 20 minutes, sir. 57 (Emphases supplied)

The appellate court also correctly noted that even the witness for
petitioner, resident physician Dr. Grace de los Angeles, noticed that
it took some time before the oxygen arrived as shown in her
testimony:
Q [Atty. Tanada]: But do you know how much time elapsed from the time
oxygen was first requested since you were not yet there?
x x x x
A [Dr. Delos Angeles]: The one who first orders not considering the nurse’s
order, it was me who first ordered for the oxygen.
_______________
57 TSN, 25 February 1999, pp. 31-36.

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Q: A nurse made an earlier order also?

A: Yes, sir.
x x x x
Q: Do you recall having heard a statement made by any doctor to the effect
why did the oxygen tank just arrive[d] at that moment?
x x x x
A: When the nurse, said ‘nagpakuha na ng oxygen,’ I could not recall if it is
[sic] me or Dra. Gonzales, we asked her ‘Bakit wala pa?’
Q: So your answer is there was somebody who made that comment?

A: Yes, Your Honor.58 (Underscoring supplied)

The CA also found that there was negligent delay in referring
Regina to the physicians.59 In fact, a member of the medical staff
chided the nurses for not immediately referring the patient’s
condition to the physicians as the following excerpt shows:
Q [Atty. Diokno]: Without mentioning anymore whom you believed to be

the speaker. Could you just relay what were the things that you heard,
said at that time.
x x x x
A [Balad]: “Why is it that the dextrose is only now, why did you not ask for
assis-
_______________
58 TSN, 26 September 2003, pp. 29-30.

59 Rollo, p. 34.

282

tance immediately,” sir.60 (Underscoring supplied)

The records also show another instance of negligence, such as the
delay in the removal of Regina’s consumed dextrose, a condition
that was already causing her discomfort. In fact, Balad had to inform
the nurses and the patient had to instruct one of them, on what to do
as can be seen in this part of Balad’s testimony:
Q [Atty. Diokno]: Would you try to recall what were the words that were
used by your aunt in telling you about the dextrose?
A [Balad]: According to her you call [the] nurse at the nurse station for her
to remove the dextrose from my hand, sir.
x x x x
Q: When you saw that [sic] two (2) nurses there at the nurse station, what
were they doing?
A: The other one is sitting eating pansit, sir, and the other one is standing
holding a bottle, sir.
Q: What did you tell them, if anything, when you arrived at the nurse
station?
A: I told them that the dextrose at Room 238 was already finished, sir.
x x x x
Q: How long did it take before any nurse arrived inside Room 238?
A: I went back to the nurse station because no one responded from [sic] my
call, sir.
_______________
60 TSN, 25 February 1999, pp. 38-40.

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Q: About how many minutes had elapsed from the time you went to the
nurse station for the first time and from the time you went for the second
time?
A: About three (3) to five (5) minutes, sir. “Yung pangalawang tawag ko na
sa kanya ay nakasunod na siya sa akin,” sir.
Q: The second time when the nurse was already following you back to the
room. What happened there when you go [sic] inside the room?
A: The nurse approached my Tita Regie and according to my Tita Regie,
“Nurse, please remove it because my hand was already bulging,” sir.
Q: What is the response of the nurse to that comment of your auntie?
A: She was following the instruction of my Tita Regie and then she told me
to get a towel, sir, to be placed on her hand, “namaga na,” sir. 61
(Underscoring supplied)

Taken together, the above instances of delay convinced the courts
below, as well as this Court, that there was a breach of duty on the
part of the hospital’s nurses. The CA therefore correctly affirmed the
finding of the trial court that the nurses responded late, and that
Regina was already cyanotic when she was referred to the resident
doctor.
Regina suffered from brain damage, particularly hypoxic
encephalopathy, which is caused by lack of oxygen in the brain. The
testimonies of Dr. Dizon and Dr. Robeniol proved this fact. And the
proximate cause of the brain damage was
_______________
61 Id., at pp. 22-26.


284

the delay in responding to Regina’s call for help and for oxygen. The
trial court said:
Had the nurses exercised certain degree of promptness and diligence in

responding to the patient[’]s call for help[,] the occurrence of “hypoxic
encephalopathy” could have been avoided since lack or inadequate supply
of oxygen to the brain for 5 minutes will cause damage to it.62

The CA affirmed the above ruling of the RTC, that whatever the
cause of the oxygen deprivation was, its timely and efficient
management would have stopped the chain of events that led to
Regina’s condition.
We affirm the findings of the courts below that the negligent
delay on the part of the nurses was the proximate cause of the brain
damage suffered by Regina. In Ramos, the Court defines proximate
cause as follows:
Proximate cause has been defined as that which, in natural and

continuous sequence, unbroken by any efficient intervening cause, produces
injury, and without which the result would not have occurred. An injury or
damage is proximately caused by an act or a failure to act, whenever it
appears from the evidence in the case, that the act or omission played a
substantial part in bringing about or actually causing the injury or damage;
and that the injury or damage was either a direct result or a reasonably
probable consequence of the act or omission. It is the dominant, moving or
producing cause. (Underscoring supplied; citations omitted)63

Thus, a failure to act may be the proximate cause if it plays a
substantial part in bringing about an injury. Note also that the
omission to perform a duty may also constitute the proxi-
_______________
62 Rollo, pp. 856-857.

63 Ramos v. Court of Appeals, 378 Phil. 1198; 321 SCRA 584 (1999).

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mate cause of an injury, but only where the omission would have
prevented the injury.64 The Court also emphasizes that the injury
need only be a reasonably probable consequence of the failure to act.
In other words, there is no need for absolute certainty that the injury
is a consequence of the omission.65
Applying the above definition to the facts in the present case, the
omission of the nurses — their failure to check on Regina and to
refer her to the resident doctor and, thereafter, to immediately
provide oxygen — was clearly the proximate cause that led to the
brain damage suffered by the patient. As the trial court and the CA
both held, had the nurses promptly responded, oxygen would have
been immediately administered to her and the risk of brain damage
lessened, if not avoided.
For the negligence of its nurses, petitioner is thus liable under
Article 218066 in relation to Article 217667 of the Civil
64 Sangco, Cesar J., Philippine Law on Torts and Damages, p. 263

(1984 rev. ed.).
65 Supra note 63.
66 Art. 2180. The obligation imposed by Article 2176 is demandable
not only for one’s own acts or omissions, but also for those of persons for
whom one is responsible.
x x x x
The owners and managers of an establishment or enterprise are likewise
responsible for damages caused by their employees in the service of the
branches in which the latter are employed or on the occasion of their
functions.
Employers shall be liable for the damages caused by their employees and
household helpers acting within the scope of their assigned tasks, even
though the former are not engaged in any business or industry.
x x x x
The responsibility treated of in this article shall cease when the persons
herein mentioned prove that they observed all the diligence of a good father
of a family to prevent damage.
67 Art. 2176. Whoever by act or omission causes damage to another,
there being fault or negligence, is obliged to pay for the damage done. Such
fault or negligence, if there is no preexisting

286

Code. Under Article 2180, an employer like petitioner hospital may

be held liable for the negligence of its employees based on its
responsibility under a relationship of patria potestas.68 The liability
of the employer under this provision is “direct and immediate; it is
not conditioned upon a prior recourse against the negligent
employee or a prior showing of the insolvency of that employee.”69
The employer may only be relieved of responsibility upon a showing
that it exercised the diligence of a good father of a family in the
selection and supervision of its employees. The rule is that once
negligence of the employee is shown, the burden is on the employer
to overcome the presumption of negligence on the latter’s part by
proving observance of the required diligence.70
In the instant case, there is no dispute that petitioner was the
employer of the nurses who have been found to be negligent in the
performance of their duties. This fact has never been in issue.
Hence, petitioner had the burden of showing that it exercised the
diligence of a good father of a family not only in the selection of the
negligent nurses, but also in their supervision.
On this point, the rulings of the RTC and the CA diverge. While
the trial court found due diligence in both the selection and the
supervision of the nurses, the appellate court found that petitioner
proved due diligence only in the selection, but not in the
supervision, of the nurses.
After a careful review of the records, we find that the
preponderance of evidence supports the finding of the CA that the
hospital failed to discharge its burden of proving due
_______________
contractual relation between the parties, is called a quasi-delict and is governed by the
provisions of this Chapter.
68 Supra note 63.
69 Manliclic v. Calaunan, 541 Phil. 617; 512 SCRA 642 (2007).
70 OMC Carriers v. Nabua, 636 Phil. 634; 622 SCRA 624 (2010); Syki v. Begasa,
460 Phil. 381; 414 SCRA 237 (2003); Metro Manila Transit Corp. v. Court of
Appeals, G.R. No. 104408, June 21, 1993, 223 SCRA 521.

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diligence in the supervision of its nurses and is therefore liable for

their negligence. It must be emphasized that even though it proved
due diligence in the selection of its nurses, the hospital was able to
dispose of only half the burden it must overcome.71
We therefore note with approval this finding of the CA:
While Lourdes Hospital adduced evidence in the selection and hiring

processes of its employees, it failed to adduce evidence showing the degree
of supervision it exercised over its nurses. In neglecting to offer such proof,
or proof of similar nature, respondent [herein petitioner] hospital failed to
discharge its burden under the last paragraph of Article 2180. Consequently,
it should be held liable for the negligence of its nurses which caused damage
to Regina.72

Indeed, whether or not the diligence of a good father of a family
has been exercised by petitioner is a matter of proof,73 which under
the circumstances in the case at bar has not been clearly established.
The Court finds that there is not enough evidence on record that
would overturn the presumption of negligence. In explaining its
basis for saying that petitioner proved due diligence in the
supervision of the nurses, the trial court merely said:
As testified to by Ms. Lourdes Nicolas, the assistant nursing director, the

process of selection and hiring of their nurses was a rigorous process
whereby the applicants undergo series of examination, orientation, training,
on-the-job observation and evaluation before they are hired as regular
employees. The nurses are supervised by their head nurses and the charge
nurse and inspected by their clinical supervisor and nursing director. Based
from this
_______________
71 Valenzuela v. Court of Appeals, 323 Phil. 374; 253 SCRA 303 (1996).
72 Rollo, p. 37.
73 Metro Manila Transit Corp. v. Court of Appeals, supra note 70.

288

evidence the court believes that defendant hospital had exercised prudence
and diligence required of it. The nurses it employed were equipped with
sufficient knowledge and instructions and are able to perform their work and
familiar with the duties and responsibilities assigned to them.74
Indeed, the formulation of a supervisory hierarchy, company

rules and regulations, and disciplinary measures upon employees in
case of breach, is indispensable. However, to prove due diligence in
the supervision of employees, it is not enough for an employer such
as petitioner to emptily invoke the existence of such a formulation.
What is more important is the actual implementation and monitoring
of consistent compliance with the rules. Understandably, this actual
implementation and monitoring should be the constant concern of
the employer, acting through dependable supervisors who should
regularly report on their supervisory functions. Thus, there must be
proof of diligence in the actual supervision of the employees’
work.75
In the present case, there is no proof of actual supervision of the
employees’ work or actual implementation and monitoring of
consistent compliance with the rules. The testimony of petitioner’s
Assistant Nursing Service Director, Lourdes H. Nicolas is belied by
the actual records76 of petitioner. These show that Nurses David and
Padolina had been observed to be latecomers and absentees; yet they
were never sanctioned by those supposedly supervising them. While
the question of
_______________
74 Rollo, p. 857.
75 Pleyto v. Lomboy, 476 Phil. 373; 432 SCRA 329 (2004). See also Metro
Manila Transit Corp. v. Court of Appeals, supra note 70.
76 The Terminating Employee Appraisal signed by the nursing supervisor, Sister
Vicencia, and noted by Sister Estrella showed defendant David as an occasional
latecomer and absentee and as dishonest and insincere (Records [Vol. VII], p. 2024)
while the Terminating Employee Appraisal signed by the supervisor, Sister Hirene,
showed defendant Padolina as a habitual latecomer and absentee (Records [Vol. VII],
p. 2045).

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diligent supervision depends on the circumstances of employment,77

we find that by the very nature of a hospital, the proper supervision
of the attendance of its nurses, who are its frontline health
professionals, is crucial considering that patients’ conditions can
change drastically in a matter of minutes. Petitioner’s Employee
Handbook78 recognized exactly this as it decreed the proper
procedure in availing of unavoidable absences and the
commensurate penalties of verbal reprimand, written warning,

suspension from work, and dismissal in instances of unexcused
absence or tardiness.79 Petitioner’s failure to sanction the tardiness
of the defendant nurses shows an utter lack of actual implementation
and monitoring of compliance with the rules and ultimately of
supervision over its nurses.
More important, on that fatal night, it was not shown who were
the actual nurses on duty and who was supervising these nurses.
Although Lourdes H. Nicolas explained in her testimony that two
nurses are assigned at the nurses’ station for each shift and that they
are supervised by the head nurses or the charge nurses, the
documents of petitioner show conflicting accounts of what happened
on the fateful days of 26 and 27 of December 1997.
The schedule of nurses initially submitted by the director of the
nursing service of petitioner hospital, Sister Estrella Crisologo,
indicated that David was on duty from 2 p.m. to 11 p.m. on 26
December 1997 and that Padolina and Ballano were on duty from 10
p.m. of 26 December 1997 to 6 a.m. of 27 December 1997. Ballano,
however, was employed as a midwife and not a nurse.80 Also, the
oral deposition of Sister Estrella Criso-
_______________
77 Supra note 71.

78 Records (Vol. VII), p. 2022.
79 Rollo, p. 646.
80 In a Manifestation dated 15 May 2001, petitioner stated that Bailano was a
midwife and not a nurse. (Records [Vol. VI], pp. 1521-1522). In her Answer with
Compulsory Counterclaims dated 11 September

290

logo indicated that a certain Molina, a nurse, did not report for work
from 10 p.m. of 26 December 1997 to 6 a.m. of 27 December 1997
leaving only Padolina as the nurse on duty during the said period
while Evelyn David was on duty only from 2 p.m. to 11 p.m. on 26
December 1997.81 However, in a Manifestation82 dated 15 July
1999, petitioner submitted a revised and more accurate schedule of
nurses prepared by the nurse supervisor, Charina G. Ocampo, which
curiously contained erasures on the portion pertaining to Evelyn
David in that David was now shown to be on duty from 10 p.m. on
26 December 1997 to 6 a.m. on 27 December 1997.83
Another piece of documentary evidence, the Nurses’ Notes, was

also not without inconsistencies. In a Manifestation and Motion84
dated 3 June 2003, petitioner admitted to having inadvertently failed
to include an entry or page in the Nurses’ Notes initially submitted
to the trial court.85 That entry was the Nurse’s Observation and
Report on Capanzana from 8 p.m. of 26 December 1997 to 3:20 a.m.
of 27 December 1997 signed by David.86 Moreover, in the testimony
of witness for petitioner, Milagros de Vera, the administrative
supervisor of the hospital, it was revealed that entries in the Nurses’
Notes were made in different colors of ink depending on the shift of
the nurse: blue ink for the morning shift, black for afternoon, and red
for night. Interestingly, as manifested by the counsel for
respondents, the entries made from 2:45 to 2:50 a.m. of 27
December 1997 were in both blue and red.87
_______________
2001, Ballano claimed that she was employed as a midwife. (Records [Vol. VI], p.
1625)
81 TSN, 11 December 2000, pp. 15-17.
82 Records (Vol. II), pp. 542-543.
83 Id., at pp. 545-547.
84 Records (Vol. VI), pp. 1847-1849.
85 Id. (Vol. III), pp. 821-842.
86 Id. (Vol. VI), p. 1851.
87 TSN, 12 November 2004, pp. 20-21.

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All these negate the due diligence on the part of the nurses, their
supervisors, and ultimately, the hospital.
We therefore affirm the appellate court in finding petitioner
directly liable for the negligence of its nurses under Article 2180 in
relation to Article 2176 of the Civil Code.
We are left with two minor issues that need to be addressed in
order to completely resolve the petition. To recall, petitioner
questioned before the CA not only the trial court’s denial of
petitioner’s Motion for Leave to take the deposition of a witness but
also the denial of its counterclaims. In the assailed Decision and
Resolution, the appellate court failed to make a pronouncement
expressly addressing the issues. Petitioner now prays that we remand
the case to the trial court for the reception of the testimony of its
witness and that we grant its counterclaims.
In support of the first issue, petitioner invokes our
pronouncements in Hyatt Manufacturing Corp. v. Ley Construction
Development Corp.,88 in which this Court affirmed the appellate
court’s ruling to remand the case to the trial court and to order the
deposition-taking to proceed. To bring this issue to a close, we see
the need to present a nuanced parsing of the difference between the
circumstances in Hyatt and in the present petition. First, in the cited
case, the party opposing the deposition made unwarranted claims of
delay. This Court found that it was not the request for deposition, but
the voluminous pleadings filed by the opposing party, that caused the
delay in the court proceedings. In this case, however, there is reason
to suspect that the request was indeed meant to delay because the
intended deposition in 2004 was meant to be an additional sur-
rebuttal evidence to Balad’s testimony which, we characteristically
take note, was given in 1999, a long five years before. Moreover, the
trial court reasoned that the case had been tried for many years and
was about to be decided:
_______________
88 519 Phil. 272; 484 SCRA 286 (2006).

292

The timeliness of the motion for leave of court to take deposition through
written interrogatories cast doubt whether or not it was intended to further
delay the proceedings of this case. The instant case has obtained
considerable length in its adjudication and to allow movant-defendants to
take deposition of Ms. David [the witness-deponent] would only further
delay its disposition and would certainly defeat the purpose of a disposition
which is to expedite proceedings.89

Second, in Hyatt, the trial court arbitrarily cancelled the taking of
depositions, which had been scheduled previously. In other words,
everything had been set, and the deponents were available for
deposition. Delay, if any, would have been minimal. In the present
case, no deposition was ever scheduled, and the availability of the
supposed deponent was not even ascertained. In fact, the uncertainty
in the taking of the deposition was one of the reasons cited by the
trial court when it denied the Motion for Leave.90
Third, the RTC in this case noted that petitioner had agreed to a
self-imposed deadline for the submission of its sur-rebuttal evidence.
When the scheduled hearing came, petitioner’s counsel failed to
attend purportedly because he was indisposed. But as curiously
observed by the trial court, the reception of sur-rebuttal evidence on
that date could not have proceeded anyway since petitioner had no
witnesses.91 The trial court likewise noted that petitioner failed to
state any solid ground to justify the grant of the taking of that
deposition, except for the latter’s naked assertion that the witness to
be deposed was out of the country.92 The Court finds that these
considerations, taken together, provided one of the reasons for the
RTC to properly deny the Motion for Leave to take the deposition of
a witness. In Hyatt, the
_______________
89 Rollo, p. 769.
90 Id., at p. 768.
91 Id., at pp. 768-769.
92 Id., at p. 769.

293
VOL. 821, MARCH 22, 2017 293

movant was completely faultless; in the present case, petitioner

failed not only to be present at the scheduled hearing for the
submission of its sur-rebuttal evidence, but also to show good faith
in its request.
Fourth, the movant in Hyatt was clearly prejudiced by the denial
of its request, which it had promptly made before pretrial. The same
cannot be said in the present case because petitioner filed the motion
to take deposition six years after trial had started. In fact, petitioner
was confident enough to agree to a deadline for the submission of its
sur-rebuttal evidence, a deadline that had long passed when it filed a
Motion for Leave. Petitioner is, therefore, estopped from claiming
that it was ever prejudiced.
All in all, petitioner’s argument regarding the trial court’s denial
of petitioner’s Motion for Leave to take the deposition fails to
impress us.
This notwithstanding, we find merit in another argument
successively raised by petitioner before the Court of Appeals and
before this Court with respect to the unpaid hospital bill of
respondents — an issue not addressed again by the CA in the
assailed ruling. The unpaid hospital bill at petitioner hospital

amounted to P20,141.60 as of 30 October 1998.93 This fact was
uncontroverted by respondents. Since the amount for actual damages
as listed by respondents in their complaint was already inclusive of
the hospital bills incurred at petitioner hospital and at Cardinal
Santos Hospital, we deem it proper to deduct the unpaid hospital bill
from the actual damages decreed by the lower court and affirmed by
the appellate court. However, we additionally impose the payment of
interest on the resulting amount to conform with prevailing
jurisprudence.94
_______________
93 Id., at p. 922.
94 Nacar v. Gallery Frames, G.R. No. 189871, August 13, 2013, 703 SCRA 439,
456-459.

294

WHEREFORE, premises considered, we AFFIRM with

MODIFICATION the Decision and Resolution rendered by the
Court of Appeals in C.A.-G.R. CV No. 89030 in that petitioner is
hereby declared liable for the payment to respondents of the total
amount of P299,102.04 as actual damages minus P20,141.60
representing the unpaid hospital bill as of 30 October 1998;
P1,950,269.80 as compensatory damages; P100,000.00 as moral
damages; P100,000.00 as and by way of attorney’s fees; and the
costs of suit, as well as interest at the rate of six percent (6%) per
annum on the resulting amount from the finality of this judgment
until full payment.
SO ORDERED.
Leonardo-De Castro, Del Castillo, Perlas-Bernabe and

Caguioa, JJ., concur.
Judgment and resolution affirmed with modification.
Notes.—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 medical professional
which has caused bodily harm. (Li vs. Soliman, 651 SCRA 32
[2011])
Court has recognized that medical negligence cases are best

proved by opinions of expert witnesses belonging in the same
general neighborhood and in the same general line of practice as
defendant physician or surgeon. (Id.)

——o0o——
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12/19/21, 6:17 PM SUPREME COURT REPORTS ANNOTATED 821

G.R. No. 189218. March 22, 2017.*

Remedial Law; Civil Procedure; Appeals; Petition for Review on

VOL. 821, MARCH 22, 2017 259

Quasi-delicts; Medical Negligence; In order to successfully pursue a

260 SUPREME COURT REPORTS ANNOTATED

VOL. 821, MARCH 22, 2017 261

262 SUPREME COURT REPORTS ANNOTATED

crucial considering that patients’ conditions can change drastically in a

PETITION for review on certiorari of the decision and resolution of

1 Rollo, pp. 127-205.

VOL. 821, MARCH 22, 2017 263

assailing the Decision2 and Resolution3 rendered by the Court of

Regina Capanzana (Regina), a 40-year-old nurse and clinical

264 SUPREME COURT REPORTS ANNOTATED

she was found to be suffering from pulmonary edema. She was

rheumatic heart disease mitral stenosis with mild pulmonary

VOL. 821, MARCH 22, 2017 265

Petitioner hospital and defendant Ballano claimed that there was

266 SUPREME COURT REPORTS ANNOTATED

Trial ensued. Plaintiffs presented Dr. Erwin Dizon, a cardiologist;

VOL. 821, MARCH 22, 2017 267

The trial continued with the presentation of defense evidence.

The RTC also found that the primary cause of Regina’s

21 Rollo, pp. 847-851.

268 SUPREME COURT REPORTS ANNOTATED

injury of Regina. It found that they failed to respond immediately

nurses was a rigorous process, whereby the applicants underwent a

25 Id., at pp. 856-857.

VOL. 821, MARCH 22, 2017 269

WHEREFORE, all foregoing considered, judgment is rendered as

27 Id., at pp. 860-861.

270 SUPREME COURT REPORTS ANNOTATED

Respondents Capanzana filed their appeal28 before the CA,

28 CA Rollo, p. 44.

VOL. 821, MARCH 22, 2017 271

33 Id., at pp. 22-25.

272 SUPREME COURT REPORTS ANNOTATED

Our Lady of Lourdes Hospital vs. Capanzana

of Dr. Santos, who was accepted as an expert witness in the fields of

35 Id., at pp. 26-27.

VOL. 821, MARCH 22, 2017 273

one tank in the ward section of 27 beds. It said that petitioner

37 Id., at pp. 35-39.

274 SUPREME COURT REPORTS ANNOTATED

reversed and set aside, the second amended complaint dismissed,

Respondents filed their Comment,43 saying that the CA

VOL. 821, MARCH 22, 2017 275

function is not to analyze or weigh the evidence all over again.

276 SUPREME COURT REPORTS ANNOTATED

Meanwhile, in fixing a standard by which a court may determine

To recall, the records, including petitioner’s Nurses’ Notes,

VOL. 821, MARCH 22, 2017 277

55 Sec. 27 of Article V of Republic Act No. (R.A.) 7164 or an “Act Regulating

278 SUPREME COURT REPORTS ANNOTATED

56 Rollo, pp. 20-21, 836-857.

VOL. 821, MARCH 22, 2017 279