Cruz Vs CA

DR.
NINEVETCH CRUZ, petitioner,

vs
COURT OF APPEALS and LYDIA UMALI, respondents.
Facts:
On March 22, 1991, prosecution witness, Rowena Umali de Ocampo, accompanied her mother to
the Perpetual Help Clinic and General Hospital situated in Balagtas Street, San Pablo City, Laguna. They
arrived at the said hospital at around 4:30 in the afternoon of the same day. Prior to March 22, 1991, Lydia
was examined by the petitioner who found a “Myoma” in her uterus, and scheduled her for a hysterectomy
operation on March 23, 1991. Rowena and her mother slept in the clinic on the evening of March 22, 1991
as the latter was to be operated on the next day at 1pm. According to Rowena, she noticed that the clinic
was untidy and the windows and the floor were very dusty prompting her to ask the attendant for a rag to
wipe the window and floor with. Prior to the operation, Rowena tried to convince her mother to not proceed
with the operation and even asked petitioner for it to be postponed, however it still pushed through after the
petitioner told Lydia that operation must be done as scheduled. During the operation, the assisting doctor
of the petitioner, Dr. Ercillo went out of the operating room and asked that tagmet ampules be bought which
was followed by another instruction to buy a bag of blood. After the operation, when Lydia came out of the
OR, another bag of blood was requested to be bought, however, the same was not bought due to
unavailability of type A from the blood bank. Thereafter a person arrived to donate blood which was later
transferred to Lydia. Rowena then noticed her mother, who was attached to an oxygen tank, gasping for
breathe apparently, the oxygen tank is empty, so her husband and petitioner’s driver bought an oxygen.
Later, without the knowledge of Lydia’s relatives,she was decided by the doctors to be transferred to San
Pablo District Hospital were she was supposed to be re-operated. After Lydia experienced shocks, she died.
Issue:
Whether or not petitioner has been negligent which caused the death of Lydia Umali.
Held:
Yes. Whether or not a physician has committed an “inexcusable lack of precaution” in the treatment of his
patient to be determined according to the standard of care observed by other members of the profession in
good standing under similar circumstances bearing in mind the advanced state of the profession at the time
of treatment or the present state of medical science. A doctor in effect represents that, having the needed
training and skill possessed by physicians and surgeons practicing in the same field, he will employ such
training, care and skill in the treatment of his patients. He therefore 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. It is in this aspect of medical malpractice that expert testimony is essential to establish not
only the standard of care of the profession but also that the physician’s conduct in the treatment and care
falls below such standard. Further, in as much as the causes of the injuries involved in malpractice actions
are determinable only in the light of scientific knowledge, it has been recognized that expert testimony is
usually necessary to the conclusion as to causation.
In litigations involving medical negligence, the plaintiff has the burden of establishing appellant’s
negligence and for a reasonable conclusion of negligence, there must be proof of breach of duty on the part
of the surgeon as well as causal connection of such breach and the resulting death of his patient.
In order that there may be recovery for an injury, however, it must be shown that the injury for which
recovery is sought must be legitimate consequence of the wrong done; the connection between the
negligence and the injury must be a direct and natural reference of events, unbroken by intervening efficient
causes. In other words, the negligence must be the proximate cause of the injury. For negligence, no matter
what it consists, cannot create a right of action unless it is the proximate cause of the injury complained of
and the proximate cause of an injury is that cause, which in natural and continuous sequence, unbroken by
any efficient intervening cause, produces the injury and without which the result would have occurred.
The elements of reckless imprudence are:
1. That the offender does or fails to do an act;

2. That the doing or the failure to do that act is voluntary;
3. That it be without malice;
4. That material damage results from the reckless imprudence; and
5. That there is inexcusable lack of precaution on the part of the offender, taking into consideration
his employment or occupation, degree of intelligence, physical condition, and other circumstances
regarding persons, time, and place.
The possible causes of hemorrhage during an operation are: 1.) the failure of the surgeon to tie or suture a
cut blood vessel; 2.) allowing a cut blood vessel to get out of control; 3.) the subsequent loosening of the
tie or suture applied to a cut blood vessel; and 4.)and a clotting defect known as DIC.
This Court has no recourse but to rely on the expert testimonies rendered by both prosecution and defense
witnesses that substantiate rather than contradict petitioner's allegation that the cause of Lydia's death was
DIC which, as attested to by an expert witness, cannot be attributed to the petitioner's fault or negligence.
The probability that Lydia's death was caused by DIC was unrebutted during trial and has engendered in
the mind of this Court a reasonable doubt as to the petitioner's guilt. Thus, her acquittal of the crime of
reckless imprudence resulting in homicide. While we condole with the family of Lydia Umali, our hands
are bound by the dictates of justice and fair dealing which hold inviolable the right of an accused to be
presumed innocent until proven guilty beyond reasonable doubt. Nevertheless, this Court finds the
petitioner civilly liable for the death of Lydia Umali, for while a conviction of a crime requires proof beyond
reasonable doubt, only a preponderance of evidence is required to establish civil liability.

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DR.

NINEVETCH CRUZ, petitioner,

The elements of reckless imprudence are:

1. That the offender does or fails to do an act;

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