Solidum v. People

G.R. No. 192123March 10, 2014Bersamin, J.First Division

Res ipsa loquitur cannot convict a physician where the injury is not one that ordinarily bespeaks negligence; absent expert proof of the standard of care and its breach, criminal negligence is not proved beyond reasonable doubt.

Doctrine

In medical negligence cases, res ipsa loquitur applies only where (1) the accident is of a kind that does not ordinarily occur unless someone is negligent, (2) the instrumentality was under the exclusive control of the person charged, and (3) the injury was not due to the patient's voluntary act; the doctrine is a mere mode of proof and cannot substitute for proof of culpable negligence. Absent common-knowledge negligence, the plaintiff/prosecution must prove duty, breach, causation and damages through expert testimony establishing the standard of care applicable to the specialist. An employer's liability for an employee's delict is only subsidiary and cannot be imposed on an entity that was never charged or impleaded.

Facts

Three-year-old Gerald Gercayo, born with an imperforate anus, underwent a pull-through operation at Ospital ng Maynila where Dr. Fernando Solidum was one of the anesthesiologists. During surgery the child suffered bradycardia and cardiac arrest, lapsed into a coma, and emerged with hypoxic encephalopathy leaving him blind, deaf and immobile. Solidum alone was charged with reckless imprudence resulting in serious physical injuries for allegedly failing to monitor and regulate the anesthesia and using 100% halothane. The RTC convicted him and the CA affirmed, applying res ipsa loquitur, and both courts also held Ospital ng Maynila solidarily liable for damages.

Issues and how the Court ruled

Whether the doctrine of res ipsa loquitur was applicable to establish Dr. Solidum's negligence.

No. While the second and third requisites were present — the anesthetic agents and instruments were under Solidum's exclusive control, and the unconscious child could not have contributed to the injury — the first requisite was wanting. Bradycardia and hypoxia, though not ordinary occurrences in a pull-through operation, do not by themselves prove that any attending physician was negligent; a rare or bad result alone does not invoke the doctrine. Indeed, the anesthesiologists sensed the vago-vagal reflex as the trigger and responded with atropine, an explanation consistent with due care (citing Swanson v. Brigham).

Whether the Prosecution proved Dr. Solidum's criminal negligence beyond reasonable doubt.

No. Medical negligence, whether criminal, civil or administrative, requires proof of duty, breach, causation and damages, and the standard of care of a specialist like an anesthesiologist must ordinarily be established by expert testimony. The Prosecution presented no witness with special qualifications in anesthesia; Dr. Sulit's committee report in fact exonerated Solidum as complying with universally accepted standards, and Dr. Vertido recanted the 100% halothane figure, admitting the record showed no such figure. With the overdosing theory — the gravamen of the Information — unproven, the inexcusable lack of precaution required for reckless imprudence was not established.

Whether Ospital ng Maynila could be held solidarily liable for the damages awarded.

No. Ospital ng Maynila was neither charged as an accused nor impleaded as a party, so condemning it to pay violated its right to due process and its right to be heard. Employer liability for an employee's delict under the Revised Penal Code is only subsidiary, arises only upon the employee's conviction and proof of insolvency, and presupposes that the employer is engaged in industry — none of which was shown. The acquittal of Solidum in any event removed the basis for such liability.

Ratio

Res ipsa loquitur is only a mode of proof and does not dispense with proof of culpable negligence; it requires, first, that the accident be of a kind that does not ordinarily occur absent negligence. A rare or unfortunate surgical result, susceptible of a non-negligent explanation, fails this requisite. Hence the Prosecution had to prove duty, breach, causation and damage by expert evidence on the specialist standard of care; having presented none — and its own witnesses tending to exculpate the accused — it failed to overcome the presumption of innocence.

Remember it as

💡 The anesthesiologist and the '100% halothane' that was never written: the NBI expert recanted, the thing did NOT speak for itself, and the boy's tragedy alone could not convict.

From the Supreme Court's own index

ConceptDefined as the failure to observe for the protection of the interests of another person, that degree of care, precaution and vigilance which the circumstances justly demand, whereby such other person suffers injury.
Medical negligenceAn action upon medical negligence – whether criminal, civil or administrative – calls for the plaintiff to prove by competent evidence each of the following four elements, namely: (1) the duty owed by the physician to the patient, as created by the physician-patient relationship, to act in accordance with the specificnorms or standards established by his profession; (2) the breach of the duty by the physician failing to act in accordance with the applicable standard of care; (3) the causation, i.e. there must be a reasonably close and casual connection between the negligent act or omission and the resulting injury; and (4) the damages suffered by the patient.
Reckless imprudenceConsists of voluntarily doing or failing to do, without malice, an act from which material damage results by reason of an inexcusable lack of precaution on the part of the person performing or failing to perform such act.
Civil action deemed instituted with the criminal actionRefers only to that arising from the offense charged and not applicable to a party who was not charged.
Doctrine ofIn order to allow resort to the doctrine, the following essential requisites must first be satisfied, to wit: (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; and (3)the injury suffered must not have been due to any voluntary action or contribution of the person injured.
Doctrine ofMeans that “where the thing which causes injury is shown to be under the management of the defendant, and the accident is such as in the ordinary course of things does not happen if those who have the management use proper care, it affords reasonable evidence, in the absence of an explanation by the defendant, that the accident arose from want of care.”

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