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Torts and Damages Case Digest: Ramos v. CA (1999)

G.R. No. 124354  December 29, 1999

Lessons Applicable: Personal Injury and Death (Torts and Damages)
Laws Applicable: 


  • June 17, 1985 afternoon: Erlinda Ramos, 47-year old robust woman underwent on an operation to the stone at her gall bladder removed after being tested that she was fit for "cholecystectomy" operation performed by Dr. Orlino Hozaka.  Dr. Hosaka charged a fee of P16,000.00, which was to include the anesthesiologist's fee and which was to be paid after the operation.  He assured Rogelio E. Ramos, husband that he will get a good anesthesiologist who was Dra. Perfecta Gutierrez.  Erlinda's hand was held by Herminda Cruz, her sister -in-law who was the Dean of the College of Nursing at the Capitol Medical Center together with her husband went down with her to the operating room. 
  • Instead of 9:30 am, Dr. Hosaka arrived at about 12:15 P.M.
  • Herminda noticing what Dra. Perfecta Gutierrez was doing, saw the nailbed of Erlinda becoming bluish and Dr. Hosaka called for another anesthesiologist  Dr. Calderon.  
  • She went out of the operating room to tell Rogelio that something is wrong. 
  • When she went back she saw Erlinda in a trendelenburg position and at 3 p.m. she was taken to the Intensive Care Unit (ICU) where she stayed for a month due to bronchospasm incurring P93,542.25 and she was since then comatosed. 
    • She suffered brain damage as a result of the absence of oxygen in her brain for four to five minutes. 
    • She was also diagnosed to be suffering from "diffuse cerebral parenchymal damage" 
  •  Monthly expenses ranged from P8,000 to P10,000
  • Spouses Ramos and their minors filed against Dr. Hosaka and Dra. Perfecta Gutierrez 
  • RTC: favored the Ramos' awarding P8,000 as actual monthly expenses totalling to P632,000 as of April 15, 1992, P100,000 atty. fees, P800,000 moral damages,P200,000 exemplary damages and cost of suit
  • CA: reversed ordering the Ramos' to pay their unpaid bills of P93,542.25 plus interest
ISSUE: W/N the Ramos' are entitled to damages

HELD: YES. CA modified in favor of petitioners, and solidarily against private respondents the following: 1) P1,352,000 actual damages computed as of the date of promulgation plus a monthly payment of P8,000.00 up to the time that petitioner Erlinda Ramos expires or miraculously survives; 2) P2,000,000 moral damages, 3) P1,500,000 temperate damages; 4) P100,000 exemplary damages and P100,000  attorney's fees; and, 5) the costs of the suit.

  • The application of res ipsa loquitur in medical negligence cases presents a question of law since it is a judicial function to determine whether a certain set of circumstances does, as a matter of law, permit a given inference. 
  • doctrine of res ipsa loquitur is availed by the plaintiff, the need for expert medical testimony is dispensed with because the injury itself provides the proof of negligence - applicable in this case
  • doctrine of res ipsa loquitur can have no application in a suit against a physician or surgeon which involves the merits of a diagnosis or of a scientific treatment
  • As borne by the records, respondent Dra. Gutierrez failed to properly intubate the patient according to witness Herminda
    • With her clinical background as a nurse, the Court is satisfied  with her testimony
  • Dra. Gutierrez' act of seeing her patient for the first time only an hour before the scheduled operative procedure was, therefore, an act of exceptional negligence and professional irresponsibility
  • Generally, to qualify as an expert witness, one must have acquired special knowledge of the subject matter about which he or she is to testify, either by the study of recognized authorities on the subject or by practical experience. 
    • Dr. Jamora, not an anesthesiologist, stated that oxygen deprivation which led to anoxic encephalopathy was due to an unpredictable drug reaction to the short-acting barbiturate was not accepted as expert opinion
  • Dr. Hosaka's negligence can be found in his failure to exercise the proper authority in not determining if his anesthesiologist observed proper anesthesia protocols
  • Dr. Hosaka had scheduled another procedure in a different hospital at the same time as Erlinda's cholecystectomy, and was in fact over three hours late for the latter's operation. Because of this, he had little or no time to confer with his anesthesiologist regarding the anesthesia delivery. This indicates that he was remiss in his professional duties towards his patient 
  • private hospitals, hire, fire and exercise real control over their attending and visiting "consultant" staff. While "consultants" are not, technically employees, a point which respondent hospital asserts in denying all responsibility for the patient's condition, the control exercised, the hiring, and the right to terminate consultants all fulfill the important hallmarks of an employer-employee relationship, with the exception of the payment of wages.
  • Art. 2199. — Except as provided by law or by stipulation, one is entitled to an adequate compensation only for such pecuniary loss suffered by him as he has duly proved. Such compensation is referred to as actual or compensatory damages.
  • temperate damages can and should be awarded on top of actual or compensatory damages in instances where the injury is chronic and continuing. And because of the unique nature of such cases, no incompatibility arises when both actual and temperate damages are provided for. The reason is that these damages cover two distinct phases.
  • They should not be compelled by dire circumstances to provide substandard care at home without the aid of professionals, for anything less would be grossly inadequate. Under the circumstances, an award of P1,500,000.00 in temperate damages would therefore be reasonable. 
  • the damage done to her would not only be permanent and lasting, it would also be permanently changing and adjusting to the physiologic changes which her body would normally undergo through the years.
  • Erlinda Ramos was in her mid-forties when the incident occurred. She has been in a comatose state for over fourteen years now
  • Ramos' are charged with the moral responsibility of the care of the victim. The family's moral injury and suffering in this case is clearly a real one. Award of P2,000,000 in moral damages would be appropriate.
  • Finally, by way of example, exemplary damages in the amount of P100,000.00 are hereby awarded. Considering the length and nature of the instant suit we are of the opinion that attorney's fees valued at P100,000 are likewise proper.