FACTS:

The petitioners in this case, the Lucas family, filed a complaint against Dr. Tuaño, an ophthalmologist, alleging that his prescription of Maxitrol for Peter's eye infection led to the development of glaucoma. The complaint was dismissed by the RTC and the decision was affirmed by the Court of Appeals.

The factual antecedents of the case include Peter's initial consult with Dr. Tuaño, where he was diagnosed with conjunctivitis and prescribed Spersacet-C eye drops. Peter later returned with Epidemic Kerato Conjunctivitis (EKC) and was prescribed Maxitrol. His condition continued to recur, and Dr. Tuaño prescribed Blephamide as a substitute when Maxitrol was out of stock. Peter's condition worsened, with high intraocular pressure (IOP) and decreased vision. Dr. Tuaño referred him to a specialist, Dr. Agulto, who confirmed significant glaucoma damage.

Peter sought a second opinion from Dr. Aquino, who diagnosed tubular vision in his right eye and recommended lifelong medication and follow-ups.

The petitioners filed a complaint for damages, alleging negligence in Dr. Tuaño's treatment. Dr. Tuaño argued that the treatment prescribed did not cause Peter's condition and that any elevation in IOP caused by steroids would be temporary.

The RTC dismissed the complaint due to lack of evidence establishing negligence, and stated that there was no bad faith or malice on the part of the petitioners.

ISSUES:

1. Whether or not the trial court erred in dismissing the complaint for damages against the respondent on the ground of insufficiency of evidence.

2. Whether or not the trial court erred in dismissing the complaint for damages against the respondent on the ground that no medical expert was presented by the petitioners to prove their claim for medical negligence against the respondent.

3. Whether or not the trial court erred in not finding the respondent liable to the petitioners for actual, moral and exemplary damages, attorney's fees, and costs of suit, as a result of his gross negligence.

4. Whether the Court of Appeals committed reversible error in affirming the judgment of the RTC that the petitioners failed to prove their claim for damages against Dr. Tuaño.

5. Whether or not there is a breach of the duty of care, skill, and diligence by the attending physician.

6. Whether or not there is a causal connection between the breach of duty and the resulting injury sustained by the patient.

7. Whether or not expert testimony is necessary to establish the breach of duty and the proximate cause of the injury.

8. Whether Dr. Tuaño's prescription of Maxitrol to the patient was in accordance with the standard of care required of ophthalmologists.

9. Whether Dr. Tuaño's alleged negligence caused the patient's glaucoma.

10. Whether there is sufficient evidence to prove the medical negligence of Dr. Tuaño in the treatment of the patient.

11. Whether the burden of proof was properly discharged by the plaintiffs.

RULING:

1. The Court of Appeals affirmed the RTC decision, holding that the trial court did not err in dismissing the complaint for insufficiency of evidence. The Court of Appeals also agreed with the trial court in ruling that petitioners failed to present a medical expert to prove their claim of medical negligence against the respondent. Finally, the Court of Appeals found no error in the trial court's decision of not awarding damages, attorney's fees, and costs of suit to the petitioners.

2. The issue involves a question of fact, which is not within the scope of the Court's power of review. The Court is not a trier of facts, and only errors of law are generally reviewable in petitions for review on certiorari. However, there are exceptions to this rule, such as when the finding of fact of the lower court is based on the supposed absence of evidence but is contradicted by the evidence on record. In this case, the Court found that the judgments of both the Court of Appeals and the RTC are in accord with the evidence on record, and it is accordingly bound by their factual findings.

3. There is a breach of the duty of care, skill, and diligence by the attending physician when the patient is injured, and this constitutes actionable malpractice. Proof of such breach must rest upon the testimony of an expert witness that the treatment failed to meet the standard level of care. In this case, the petitioners failed to present any expert testimony to establish the breach of duty.

4. In order to establish the proximate cause of the injury, the patient must use expert testimony to prove that the alleged professional negligence caused the injury. The expert's role is to present a realistic assessment of the likelihood that the physician's alleged negligence caused the injury.

5. Medical negligence cases are best proved by opinions of expert witnesses belonging in the same general neighborhood and line of practice as the defendant physician. Expert testimonies are necessary due to the specialized technical skills possessed by physicians and surgeons that laymen are incapable of evaluating.

6. The Court agrees with Dr. Tuaño's assertion that the prescription of Maxitrol was justified based on the patient's prior use of the medication without any adverse reaction. The doctor also followed the standard ocular routine examination in conducting tests/procedures every time the patient had a follow-up consultation. Dr. Tuaño's regular examinations and tests negate the basis of the complaint for damages. Therefore, Dr. Tuaño's actuations conformed to the standard of care and diligence required in the circumstances.

7. Even if Dr. Tuaño committed negligent acts, there is a need to establish the causal connection between his alleged negligence and the patient's glaucoma. Causation must be proven within a reasonable medical probability based on competent expert testimony. The plaintiff failed to prove that the glaucoma would not have occurred without Dr. Tuaño's alleged negligent conduct. Therefore, there is no sufficient evidence to establish the causal connection between Dr. Tuaño's negligence and the patient's injury.

8. There is no sufficient evidence to prove the medical negligence of Dr. Tuaño in the treatment of the patient. The plaintiffs failed to present expert medical opinions to support their claims of negligence on the part of the doctor. The court emphasized that the plaintiff in a civil case has the burden of proof and must establish their case by a preponderance of evidence. Without expert medical opinion, the court cannot determine whether there was a breach of the standard of care required in medical practice.

9. The burden of proof was not properly discharged by the plaintiffs. They failed to establish their case by a preponderance of evidence showing a reasonable connection between Dr. Tuaño's alleged breach of duty and the damage sustained by the patient. The court noted that the complaint for damages was merely based on a statement in the literature of the medication used and a comment from another doctor who was not presented as a witness. The court emphasized the importance of expert medical opinion in determining the standard of care in medical practice.

PRINCIPLES:

• In a medical negligence case, it is necessary to establish the duty required of a medical practitioner against which the treatment can be compared to determine negligence.

• The failure to present a medical expert or a medical doctor to establish the recognized standards of the medical community and causation may lead to the dismissal of the complaint for insufficiency of evidence.

• Hearsay testimony is inadmissible as evidence under Rule 130, Section 36 of the Rules of Court.

• Medical judgment plays a significant role in medical negligence cases and is given great weight by the court.

• The Court is not a trier of facts; only errors of law are generally reviewed in petitions for review on certiorari.

• Exceptions to the general rule exist, such as when the finding of fact of the lower court is based on the supposed absence of evidence but is contradicted by the evidence on record.

• In a medical negligence case, the patient or his heirs are required to prove by preponderance of evidence that the physician failed to exercise the degree of skill, care, and learning possessed by other persons in the same profession, and that as a result, the patient or his heirs suffered damages.

• Medical negligence cases are anchored on the alleged violation of Article 2176 of the Civil Code, which states that whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done.

• A physician has a duty to exercise a degree of care, skill, and diligence that physicians in the same general neighborhood and line of practice possess in similar cases.

• Proof of breach of duty and causal connection between the breach and the resulting injury must be established through expert medical testimony.

• The proximate cause of an injury is that cause which produces the injury in the natural and continuous sequence, unbroken by any efficient intervening cause.

• Expert testimonies are indispensable in medical malpractice cases due to the specialized knowledge and training of physicians.

• A physician is not an insurer of the good result of treatment. Mere lack of improvement or occurrence of a bad result does not automatically indicate a failure to exercise due care.

• The prescription of medication should be based on the doctor's evaluation of the patient's condition and previous reactions to the same medication.

• In a medical negligence case, the plaintiff must establish not only injury and fault but also the causal connection between the defendant's fault and the injury.

• The causal connection between a physician's negligence and a patient's injury should be proven within a reasonable medical probability based on competent expert testimony.

• The qualifications of a physician create a presumption that he/she takes necessary precautions and employs the best of knowledge and skill in attending to clients, unless the contrary is proven.

• The party having the burden of proof must establish their case by a preponderance of evidence.

• Preponderance of evidence refers to evidence that is of greater weight or more convincing than that which is offered in opposition to it.

• In determining preponderance of evidence, the court may consider all the facts and circumstances of the case, the witnesses' manner of testifying, their intelligence, their means and opportunity of knowing the facts, the nature of the facts, the probability or improbability of their testimony, their interest or want of interest, and their personal credibility.

• What constitutes proper medical treatment is a medical question that should be presented to experts. Without expert medical opinion, the courts cannot determine the standard of care required in medical practice.