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DR. PEDRO DENNIS CERENO v. CA

FACTS:

On the evening of September 16, 1995, Raymond Olavere was brought to the Bicol Regional Medical Center (BRMC) after being stabbed. Dr. Realuyo recommended an emergency operation and requested Raymond's parents to procure blood. However, Drs. Zafe and Cereno, who were occupied with another surgery, found out that they couldn't operate on Raymond immediately due to the absence of an anesthesiologist. Raymond's parents returned with the requested blood at 11:15 PM. The operation started at 12:15 AM of September 17, 1995, and it was discovered that there was a significant amount of blood in Raymond's chest. The operation ended at 1:50 AM, and Raymond was pronounced dead at 2:30 AM. The cause of death indicated on his death certificate was hypovolemic shock due to loss of blood. Raymond's parents filed a complaint for damages against Nurse Balares, Dr. Realuyo, and Drs. Zafe and Cereno, alleging negligence. The trial court found Drs. Zafe and Cereno liable for negligence and ordered them to pay damages to Raymond's heirs.

The accused medical professionals filed a petition for review on certiorari before the Supreme Court, arguing several grounds for appeal. The Court of Appeals had affirmed the trial court's decision.

The Supreme Court recognized that only questions of law can be raised in a petition for review. Factual findings of the lower courts are generally final, but there are exceptions to this rule. In this case, the exceptions (1) and (4) were found to be applicable.

The case involved a claim of medical negligence or malpractice. To succeed in such a claim, the patient must prove that the healthcare provider failed to do something a reasonable provider would have done, or did something a reasonable provider would not have done, and that this failure or action caused injury to the patient. Expert testimonies from qualified physicians are often necessary to prove these elements.

The trial court found negligence on the part of the accused for their failure to immediately operate on the patient. The excuse of non-availability of an anesthesiologist was rejected, as there was a protocol at the Bicol Medical Center that allows for the calling of a consultant in emergencies. The testimony of Dr. Tatad supported this claim and identified a specific consultant who could have been called upon. The Supreme Court considered these testimonies in analyzing the issue of negligence.

ISSUES:

  1. Whether the petitioners were negligent in failing to perform the operation immediately after the previous surgery.

  2. Whether the petitioners were negligent in failing to request the standby anesthesiologist.

  3. Whether the petitioners were negligent in failing to immediately transfuse blood to the patient.

  4. Whether there was negligence on the part of the petitioners for their failure to have the blood ready for transfusion.

  5. Whether the delay in the transfusion of blood was caused by the petitioners or beyond their control.

  6. Whether or not the petitioners can be held liable for the death of the victim.

  7. Whether or not the BRMC is an indispensable party in the case.

RULING:

  1. The court disagreed with the trial court's conclusion that the petitioners were negligent in not performing the operation immediately after the previous surgery. There was no evidence to prove that the petitioners were aware of the "BRMC protocol" that the hospital keeps a standby anesthesiologist available on call. Without prior knowledge of the protocol, it was reasonable for the petitioners to assume that anesthesia matters are the concern of the Anesthesiology Department, while surgical matters fall under the surgeons' concern.

  2. Even if there was such a protocol and the petitioners were aware of it, their failure to request the standby anesthesiologist was reasonable. The protocol required the petitioners to request the standby anesthesiologist through the head of the Department of Anesthesiology. However, the head of the department was already engaged in another urgent operation, and the patient did not show any symptoms requiring immediate surgery. Given these circumstances, it was reasonable for the petitioners to wait for the head of the department to finish her surgery.

  3. The court did not find any evidence that the petitioners' failure to immediately transfuse blood to the patient was negligent. There were no expert witnesses presented to testify that the petitioners' course of action was not in line with other reasonable surgeons. The witness who testified on this matter was an expert in anesthesia, not in surgical practices and diagnoses.

  4. The alleged delay in the cross-matching of the blood cannot be attributed to the fault of the petitioners. They were never shown to be responsible for such delay. It is unreasonable to sanction them for lapses in procedure that do not fall within their duties and beyond their control.

  5. The delay in the transfusion of blood was justified by the attending physician, who explained that there was no need to administer the transfusion before the operation and that immediate transfusion was not feasible during the operation due to the need to control bleeding and inspect for other injuries. The parents of the patient failed to present any expert witness to dispute the course of action taken by the petitioners.

  6. The petitioners cannot be held liable for the death of the victim. Despite the unfortunate outcome, it was evident that the petitioners exerted earnest efforts to save the victim's life. Doctors are not guarantors of care and are not liable for honest mistakes of judgment.

  7. The BRMC is not an indispensable party in the case. The cause of action against the petitioners can be prosecuted without impleading the hospital where they are employed. The liability of the petitioners can be determined without the involvement of the BRMC.

PRINCIPLES:

  • Negligence cannot be imputed to a party if there is no evidence to prove that the party was aware of a particular protocol or practice.

  • The standard of care expected from practitioners in a particular profession may vary depending on the circumstances.

  • Expert testimony is necessary to determine whether a party's actions were negligent compared to the expected standard of care in similar situations.

  • In medical negligence cases, the burden of proof is on the complainant to establish breach of duty and a causal connection to the resulting injury or death of the patient.

  • A verdict in a malpractice action cannot be based on speculation or conjecture. Causation must be proven within a reasonable medical probability based on competent expert testimony.

  • Doctors are protected by a special law and are not guarantors of care or good results. They are not liable for honest mistakes of judgment.

  • Impleading a hospital as a party in a medical negligence case is not always necessary. The determination of liability can be made without involving the hospital as an indispensable party.