FACTS:

The accused, Dr. Cabugao and Dr. Ynzon, were the attending physicians of ten-year-old Rodolfo Palma Jr. (JR) who complained of abdominal pain. Initial tests suggested acute appendicitis, but the accused only prescribed medications and ordered observation for 24 hours. They did not personally monitor JR and failed to properly evaluate his condition. The accused did not further investigate the possibility of acute appendicitis despite the worsening symptoms. They only treated the symptoms and disregarded them as signs of a more serious health problem. JR died due to septicemia two and a half days after admission. The Court of Appeals affirmed their conviction for gross negligence, as acute appendicitis requires prompt recognition and treatment. The accused's inaction, neglect, and indifference resulted in JR's deterioration and eventual death.

The case involves the conviction of Dr. Cabugao and Dr. Ynzon for reckless imprudence resulting in homicide. The patient, JR, was admitted to the hospital with abdominal pain. The doctors failed to perform immediate surgery despite the worsening symptoms and only provided medications. It was later determined that immediate surgery was necessary. Dr. Ynzon was found to have failed to meet the standard of care expected from doctors.

In the trial, the doctor mentioned that acute appendicitis is generally considered a 24-hour disease, but the time frame may vary depending on the patient's condition. If there are changes indicating possible appendicitis, a decision should be made promptly, and the observation period should not be prolonged.

ISSUES:

1. Whether the attending physician failed to observe the required standard of care expected from doctors.

2. Whether the failure to perform immediate surgery on the patient was a breach of duty.

3. Whether Dr. Ynzon failed to practice the required degree of skill and care in the treatment of his patient.

4. Whether Dr. Cabugao is guilty of reckless imprudence.

5. Whether Dr. Cabugao should be held liable for reckless imprudence resulting in homicide

6. Whether Dr. Cabugao should be held civilly liable for the death of the patient

7. Whether the death of the accused pending appeal extinguishes his criminal liability

8. Whether the civil liability of the accused still subsists despite his death

9. Whether a separate civil action may be filed against the executor/administrator or the estate of the accused

10. Whether or not the obligation of Dr. Ynzon to pay the amounts stated in the receipts is civil in nature.

11. Whether or not the doctrine of procedural technicality is applicable in this case.

RULING:

1. The attending physician failed to observe the required standard of care expected from doctors. The expert witnesses, including the prosecution's witness, testified that surgery was necessary to prevent the patient's death due to appendicitis. The attending physician's failure to perform surgery in a timely manner resulted in the patient's deterioration and eventual death.

2. The failure to perform immediate surgery on the patient was indeed a breach of duty. The expert witnesses testified that, in cases of acute appendicitis, surgery should be decided upon within 24 hours. Delaying surgery when there are changes in the patient's condition pointing towards appendicitis would be a breach of duty.

3. The court found that Dr. Ynzon failed to practice the required degree of skill and care in the treatment of his patient. He neglected to effectively monitor the developments and changes in the patient's condition and failed to act when the patient's condition worsened. He also failed to provide a reasonable cause for ruling out surgery despite the initial diagnosis of appendicitis.

4. The court found that Dr. Cabugao is not guilty of reckless imprudence. He is not a surgeon and thus not in a position to perform the required appendectomy on the patient. He referred the patient to Dr. Ynzon, who was the attending surgeon.

5. Dr. Cabugao cannot be held liable for reckless imprudence resulting in homicide. The evidence on record clearly points to the reckless imprudence of Dr. Ynzon, the surgeon, but there is no evidence to show that Dr. Cabugao was negligent or lacked precaution in his performance of duty as a family doctor. There was an endorsement to the surgeon and frequent communication with the surgeon to ensure the patient's condition was being monitored.

6. Since the case is still pending appeal and Dr. Ynzon, the co-accused, has died, his criminal liability is extinguished. However, his civil liability may still be pursued through a separate civil action.

7. The death of the accused pending appeal extinguishes his criminal liability.

8. The civil liability of the accused still subsists as it is not based on delict but by contract and reckless imprudence.

9. A separate civil action may be filed against the executor/administrator or the estate of the accused, depending on the source of obligation upon which the same are based.

10. The obligation of Dr. Ynzon to pay the amounts stated in the receipts is deemed quasi-contractual rather than civil in nature.

11. The doctrine of procedural technicality does not apply in this case.

PRINCIPLES:

• A doctor has a duty to observe the required standard of care in providing medical treatment.

• Surgery may be necessary to prevent certain death in cases of acute appendicitis. Delaying surgery when there are changes in the patient's condition pointing towards appendicitis can be considered a breach of duty.

• The determination of whether a physician or surgeon has exercised the required degree of skill and care in the treatment of a patient is usually a matter of expert opinion.

• Quasi-offenses penalize the mental attitude or condition behind the act, the dangerous recklessness, the lack of care or foresight, unlike willful offenses which punish intentional criminal acts.

• A doctor has a duty to use at least the same level of care that any other reasonably competent doctor would use to treat a condition under the same circumstances.

• A non-surgeon doctor cannot be held liable for failure to perform surgery if they are not in a position to do so and have referred the patient to a specialist.

• The attending physician has a duty to monitor the patient's condition and exercise the necessary precaution, even after referral to a specialist. Negligence or lack of precaution must be proven.

• Conspiracy is not applicable in cases of reckless imprudence resulting from culpa. Each accused must be individually assessed for their actions or lack thereof.

• Death of the accused pending appeal extinguishes criminal liability, but civil liability may still be pursued through a separate civil action.

• The death of the accused extinguishes his criminal liability but not his civil liability.

• The civil liability of the accused may be enforced through a separate civil action.

• The separate civil action may be enforced against the executor/administrator or the estate of the accused, depending on the source of obligation.

• Obligations can either be civil or quasi-contractual, depending on the source of obligation upon which they are based.

• The doctrine of procedural technicality may not be applied in certain circumstances.