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Dr. Milagros Cantre v. Sps.

John David and Nora Go

2007 / Quisumbing / Petition for review on certiorari of CA decision and


resolution

FACTS

Nora Go gave birth to her 4th child. Two hours later, she suffered profuse
bleeding inside her womb due to some placenta parts which were not
completely expelled after delivery. She then suffered hypovolemic shock, so
her BP dropped to 40/0. Dr. Milagros Cantre, an Ob-Gyne specialist and
Noras attending physician, together with an assisting resident physician,
performed various medical procedures to stop the bleeding and to restore
Noras BP. While Dr. Cantre was massaging Noras uterus for it to contract
and stop bleeding, she ordered a droplight to warm Nora and her baby. At
that time, she was unconscious.

While in the recovery room, Noras husband John David noticed a fresh
gaping wound (2 1/2 x 3 1/2 in) in the inner portion of her left arm near the
armpit. When he asked the nurses about the cause of the injury, he was
informed that it was due to a burn. John David filed a request for
investigation. Dr. Cantre said that what caused the injury was the blood
pressure cuff. John David brought Nora to the NBI for a physical examination.
The medico-legal said that the injury appeared to be a burn and that a
droplight when placed near the skin for about 10 minutes could cause such
burn. He dismissed the likelihood that the wound was caused by a blood
pressure cuff since the scar was not around the arm, but just on one side of
the arm. Noras injury was referred to a plastic surgeon for skin grafting.
However, her arm would never be the samethe surgery left an unsightly

scar, her movements are restricted, and the injured arm aches at the
slightest touch.

Sps. Go filed a complaint for damages against Dr. Cantre, the medical
director, and the hospital. In the RTC, parties have rested their respective
cases, but the court admitted additional exhibits [consist mostly of medical
records produced by the hospital during trial pursuant to a subpoena duces
tecum] offered by Sps. Go, which were not testified to by any witness. RTC
ruled in favor of the spouses. CA affirmed RTC with modification (complaint
dismissed with respect to the medical director and the hospital; only moral
damages awarded).

ISSUES AND HOLDING

1.WON the questioned additional exhibits are admissible in evidence. YES


2.WON Dr. Cantre is liable for the injury suffered by Nora Go. YES

RATIO

Preliminary discussion

Dr. Cantres counsel admitted the existence of the additional exhibits when
they were formally offered for admission by the RTC. In any case, given the
circumstances of this case, a ruling on Dr. Cantres negligence may be made
based on the res ipsa loquitur doctrine even in the absence of the additional
exhibits.

Backgrounder

The Hippocratic Oath mandates physicians to give primordial consideration


to their patients well-being, and if a doctor fails to live up to this precept, he
is accountable for his acts. This notwithstanding, courts face a unique
restraint in adjudicating medical negligence cases because physicians are
not guarantors of care, and they never set out to intentionally cause injury
to their patients. HOWEVER, intent is immaterial in these cases because
where negligence exists and is proven, it automatically gives the injured a
right to reparation for the damage caused.

Res ipsa loquitur x Medical negligence cases

In medical negligence cases, the doctrine of res ipsa loquitur allows the mere
existence of an injury to justify a presumption of negligence on the part of
the person who controls the instrument causing the injury, provided that the
following requisites concur:

1.Accident is of a kind which ordinarily does not occur absent someones


negligence Wound not an ordinary occurrence in the act of delivering a
baby; could not have happened unless negligence set in somewhere

2.Caused by an instrumentality within defendants exclusive control It


doesnt matter WON the injury was caused by the droplight or by the blood
pressure cuff, since both are within the exclusive control of the physician in
charge [Dr. Cantre] under the captain of the ship doctrine [surgeon in charge
of an operation is held liable for his assistants negligence during the time
when they are under the surgeons control].

3.Possibility of contributing conduct which would make plaintiff responsible is


eliminated Wound could only be caused by something external to and
outside the control of Nora since she was unconscious while in hypervolemic
shock.

On Dr. Cantres other arguments + what would have been her saving grace

BP cuff defense does not afford her an escape. The medical practice is to
deflate the cuff immediately after use, or else, it could cause an injury similar
to what happened to Nora. If the wound was caused by the constant taking
of BP, it must have been done so negligently as to inflict a gaping wound.
The argument that the failed plastic surgery was a measure to prevent
complication (and not intended as a cosmetic procedure) does not negate
negligence on Dr. Cantres part.
Dr. Cantre has been Noras ob-gyne for her past 3 deliveries, and this is the
first time that Dr. Cantre is being held liable for damages due to negligence
in the practice of her profession. She promptly took care of the wound before
infection set in. Since Nora was in a critical condition at that time, saving her
life became Dr. Cantres elemental concern. Still, her good intentions
characteristics do not justify negligence.

NCC provisions applied

NCC 2176. Whoever by act or omission causes damage to another, there


being fault or negligence, is obliged to pay for the damage done. []
NCC 2217. Moral damages include physical suffering, mental anguish,
fright, serious anxiety, besmirched reputation, wounded feelings, moral
shock, social humiliation, and similar injury. Though incapable of pecuniary
computation, moral damages may be recovered if they are the proximate
result of the defendants wrongful act or omission. [200k moral damages
awarded]
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