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6. RAMOS VS CA.

FACTS:

June 17, 1985 afternoon: Erlinda Ramos, 47-year old robust womanunderwent on an operation to the stone at her gall bladder removed after being

tested that she was fit for "cholecystectomy" operation performed by Dr. OrlinoHozaka. Dr. Hosaka charged a fee of P16,000.00, which was to include the

anesthesiologist's fee and which was to be paid after the operation. He

assured Rogelio E. Ramos, husband that he will get a good anesthesiologist whowas Dra. Perfecta Gutierrez. Erlinda's hand was held by Herminda Cruz, her sister -

in-law who was the Dean of the College of Nursing at the Capitol Medical Centertogether with her husband went down with her to the operating room. Instead of

9:30 am, Dr. Hosaka arrived at about 12:15 P.M.Herminda noticing what Dra.Perfecta Gutierrez was doing, saw the nailbed of Erlinda becoming bluish and Dr.

Hosaka called for another anesthesiologist Dr. Calderon. She went out of the

operating room to tell Rogelio that something is wrong. When she went back she sawErlinda in a trendelenburg positionand at 3 p.m. she was taken to the Intensive Care

Unit(ICU) where she stayed for a month due to bronchospasm incurring P93,542.25

and she was since then comatosed. She suffered brain damage as a result of theabsence of oxygen in her brain for four to five minutes. She was also diagnosed tobe suffering from "diffuse cerebral parenchymal damage". Monthly expenses ranged

from P8,000 to P10,000. Spouses Ramos and their minors filed against Dr. Hosaka

and Dra. Perfecta Gutierrez. RTC: favored the Ramos' awarding P8,000 as actualmonthly expenses totalling to P632,000 as of April 15, 1992, P100,000 atty.fees, P800,000 moral damages,P200,000 exemplary damages and cost of suit.Respondents appealed. CA: reversed ordering the Ramos' to pay their unpaid bills

of P93,542.25 plus interest

ISSUE: W/N the Ramos' are entitled to damages

HELD: YES. CA modified in favor of petitioners, and solidarily against privaterespondents the following: 1) P1,352,000 actual damages computed as of the date

of promulgation plus a monthly payment of P8,000.00 up to the time that petitioner

Erlinda Ramos expires or miraculously survives; 2) P2,000,000 moral damages, 3)P1,500,000 temperate damages; 4) P100,000 exemplary damagesand P100,000 attorney's fees; and, 5) the costs of the suit.

The application of res ipsa loquitur in medical negligence cases presents a

question of law since it is a judicial function to determine whether a certain set ofcircumstances does, as a matter of law, permit a given inference.

doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert

medical testimony is dispensed with because the injury itself provides the proof of

negligence - applicable in this case doctrine of res ipsa loquitur can have no application in a suit against a

physician or surgeon which involves the merits of a diagnosis or of a scientific

treatment

As borne by the records, respondent Dra. Gutierrez failed to properly intubatethe patient according to witness Herminda

o With her clinical background as a nurse, the Court is satisfied with hertestimony

Dra. Gutierrez' act of seeing her patient for the first time only an hour before

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the scheduled operative procedure was, therefore, an act of exceptional negligence

and professional irresponsibility

Generally, to qualify as an expert witness, one must have acquired specialknowledge of the subject matter about which he or she is to testify, either by the

study of recognized authorities on the subject or by practical experience.o Dr. Jamora, not an anesthesiologist, stated that oxygen deprivation

which led to anoxic encephalopathy was due to an unpredictable drug reactionto the short-acting barbiturate was not accepted as expert opinion

Dr. Hosaka's negligence can be found in his failure to exercise the properauthority in not determining if his anesthesiologist observed proper anesthesia

protocols

Dr. Hosaka had scheduled another procedure in a different hospital at thesame time as Erlinda's cholecystectomy, and was in fact over three hours late for the

latter's operation. Because of this, he had little or no time to confer with his

anesthesiologist regarding the anesthesia delivery. This indicates that he was remissin his professional duties towards his patient

private hospitals, hire, fire and exercise real control over their attending and

visiting "consultant" staff. While "consultants" are not, technically employees, a point

which respondent hospital asserts in denying all responsibility for the patient's

condition, the control exercised, the hiring, and the right to terminate consultants allfulfill the important hallmarks of an employer-employee relationship, with the

exception of the payment of wages.

Art. 2199. Except as provided by law or by stipulation, one is entitled toan adequate compensation only for such pecuniary loss suffered by him as he has

duly proved. Such compensation is referred to as actual or compensatory damages.

temperate damages can and should be awarded on top of actual orcompensatory damages in instances where the injury is chronic and continuing. Andbecause of the unique nature of such cases, no incompatibility arises when both

actual and temperate damages are provided for. The reason is that these damagescover two distinct phases.

They should not be compelled by dire circumstances to provide substandard

care at home without the aid of professionals, for anything less would be grosslyinadequate. Under the circumstances, an award of P1,500,000.00 in temperatedamages would therefore be reasonable.

the damage done to her would not only be permanent and lasting, it would

also be permanently changing and adjusting to the physiologic changes which herbody would normally undergo through the years.

Erlinda Ramos was in her mid-forties when the incident occurred. She has

been in a comatose state for over fourteen years now

Ramos' are charged with the moral responsibility of the care of the victim.The family's moral injury and suffering in this case is clearly a real one. Award ofP2,000,000 in moral damages would be appropriate.

Finally, by way of example, exemplary damages in the amount ofP100,000.00 are hereby awarded. Considering the length and nature

of the instant suit we are of the opinion that attorney's fees valued atP100,000 are likewise proper