FACTS:

The present case is a medical malpractice suit filed by the heirs of Lydia Umali against the petitioner, Dra. Ninevetch Cruz. The Municipal Trial Court in Cities (MTCC) found the petitioner guilty, and the Regional Trial Court (RTC) and Court of Appeals affirmed her conviction. The petitioner filed a petition for review with the Supreme Court.

On March 22, 1991, Lydia Umali went to the Perpetual Help Clinic and General Hospital for a scheduled operation. The clinic was untidy, and Lydia's daughter, Rowena, tried to convince her to postpone the operation. Despite this, the petitioner insisted on proceeding. During the operation, the petitioner asked Rowena and her relatives to buy tagamet ampules and blood for Lydia. After a few hours, the petitioner informed them that the operation was finished but later asked for more blood. However, they were unable to comply. Lydia's condition deteriorated, and she was transferred to another hospital.

Lydia was re-operated on at the San Pablo District Hospital due to bleeding, but she went into shock and possibly died. The petitioner was convicted based on findings of negligence, unpreparedness, and lack of skill. The clinic's untidiness, lack of provision, and failure to conduct pre-operative evaluations were cited as evidence of negligence. The petitioner did not present evidence to refute the prosecution's version of events. Questions were also raised regarding the lack of pre-operative evaluations and consent for the operation.

In this case, the petitioner, a physician, was charged with reckless imprudence resulting in homicide for the death of Lydia Umali. The lower court convicted the petitioner based on testimonies claiming failure to provide proper instructions for the patient's care. The Supreme Court, however, found the circumstances insufficient to support a conviction for reckless imprudence resulting in homicide. The court emphasized the need for expert testimony to establish the standard of care and determine if the petitioner's conduct was negligent. Without such testimony, the court held that there was insufficient evidence to prove the petitioner's guilt.

ISSUES:

1. Whether or not the physician committed an "inexcusable lack of precaution" in the treatment of the patient.

2. Whether or not expert testimony is necessary to establish the standard of care and causation in medical malpractice cases.

3. Whether the cause of death was due to negligence on the part of the accused.

4. What could have caused the hemorrhagic shock?

5. Whether the bleeding during the operation was a result of the petitioner's fault or negligence.

6. Whether the cause of the bleeding and the subsequent death of the patient was DIC.

7. Whether or not the petitioner is guilty of reckless imprudence resulting in homicide.

8. Whether or not the petitioner is liable for civil liability, moral damages, and exemplary damages.

RULING:

1. The absence of any expert testimony on the standard of care employed by other physicians of good standing in the conduct of similar operations is apparent. The prosecution's expert witnesses did not provide insight into the standard of care that the petitioner should have exercised. Therefore, the matter of whether the physician committed an "inexcusable lack of precaution" has not been sufficiently established.

2. Expert testimony is usually necessary to establish the standard of care of the profession and to support the conclusion regarding causation in medical malpractice cases. In this case, expert testimony was lacking to prove that the circumstances cited by the courts below are constitutive of conduct falling below the standard of care employed by other physicians in good standing. Without expert opinion, the presumption that the physician took necessary precaution and employed knowledge and skill in attending to the patient prevails.

3. The Court ruled that the cause of death was due to the negligence of the accused. The testimony of Dr. Arizala, the examining doctor who conducted the autopsy, established that there were surgical sutures noted on the operative site and the ovaries and adnexal structures were missing. This evidence indicated that the deceased had undergone a previous surgical operation which the accused failed to disclose. The failure to disclose the previous surgery, as well as the missing ovaries and adnexal structures, were considered evidence of negligence and a breach of the duty to provide proper medical care.

4. The Court determined that the hemorrhagic shock was caused by the failure to replace blood lost during the surgery. The expert witnesses testified that hemorrhagic shock could be caused by various factors such as loss of control of the cut vessel, failure to ligate a vessel of considerable size, and clotting defects. In this case, the failure to replace blood lost during the operation was considered a possible cause of the hemorrhage.

5. The autopsy conducted on the deceased did not reveal any untied or unsutured cut blood vessels, nor was there any indication that the tie or suture of a cut blood vessel had become loose, thereby causing the hemorrhage. Both prosecution and defense witnesses testified that the possible causes of hemorrhage during an operation include the failure to tie or suture a cut blood vessel, allowing a cut blood vessel to get out of control, and the subsequent loosening of the tie or suture. However, the autopsy did not support these possible causes, leading to a reasonable doubt as to the petitioner's guilt of reckless imprudence resulting in homicide. As such, the petitioner was acquitted of the crime.

6. Both prosecution and defense witnesses testified that DIC could have caused the hemorrhage and subsequent death of the patient. DIC is a clotting defect that creates a serious bleeding tendency, and it cannot be prevented. The defense witness specifically stated that there was no fault on the part of the surgeon. The court found that there is a reasonable doubt that DIC was the cause of death, as there was no evidence to contradict this testimony. However, the court held that the petitioner is civilly liable for the death of the patient.

7. The petitioner is acquitted of the crime of reckless imprudence resulting in homicide.

8. The petitioner is held liable for civil liability in the amount of P50,000, moral damages in the amount of P100,000, and exemplary damages in the amount of P50,000.

PRINCIPLES:

• The standard of care observed by other members of the medical profession in good standing under similar circumstances must be considered in determining if a physician's conduct constitutes an "inexcusable lack of precaution."

• Expert testimony is necessary in medical malpractice cases to establish the standard of care of the profession and to determine causation, particularly in cases involving injuries that require scientific knowledge to understand.

• The principle of res ipsa loquitur which means "the thing speaks for itself" was applied. It means that negligence may be inferred from the mere occurrence of an injury, if it is the type of injury that would not have occurred in the absence of negligence.

• Negligence is the omission to do something which a reasonable person, guided by considerations that ordinarily regulate human affairs, would do, or the doing of something which a prudent and reasonable person would not do.

• The cause of death may be determined based on the postmortem findings and the testimony of expert witnesses.

• An accused has the right to be presumed innocent until proven guilty beyond a reasonable doubt.

• Only a preponderance of evidence is required to establish civil liability.

• A doctor is held to a higher standard of care when it comes to the safety and well-being of their patients.

• The award of moral and exemplary damages is proper in cases involving loss of life.

• The acquittal of the accused from the criminal charge does not necessarily absolve him or her from civil liability.