Cereno vs. Court of Appeals

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MALPRACTICE - Negligence of Health Care Professionals of blood to Dr. Realuyo. Drs.

Zafe and Cereno immediately started their


operation on Raymond at around 12:15 A.M. of September 17, 1995. Upon
DR. PEDRO DENNIS CERENO, and DR. SANTOS ZAFE vs. COURT OF opening of Raymond’s thoracic cavity, they found that 3,200 cc of blood was
APPEALS, SPOUSES DIOGENES S. OLAVERE and FE R. SERRANO stocked therein. Considering the loss of blood suffered by Raymond, Dr.
G.R. No. 167366 | September 26, 2012 Cereno did not immediately transfuse blood because he had to control the
Ratio: The type of lawsuit which has been called medical malpractice or, bleeders first.
more appropriately, medical negligence, is that type of claim which a victim
has available to him or her to redress a wrong committed by a medical At 1:40 A.M., blood was finally transfused on Raymond. At 1:45 A.M., while
professional which has caused bodily harm. In order to successfully pursue the operation was on-going, Raymond suffered a cardiac arrest. The
such a claim, a patient must prove that a health care provider, in most operation ended at 1:50 A.M. and Raymond was pronounced dead at 2:30
cases a physician, either failed to do something which a reasonably A.M. Raymond’s death certificate indicated that the immediate cause of
prudent health care provider would have done, or that he or she did death was "hypovolemic shock" or the cessation of the functions of the
something that a reasonably prudent provider would not have done; and organs of the body due to loss of blood.
that the failure or action caused injury to the patient. Stated otherwise,
the complainant must prove: (1) that the health care provider, either by his Claiming that there was negligence on the part of those who attended to their
act or omission, had been negligent, and (2) that such act or omission son, the parents of Raymond filed before the RTC a complaint for damages
proximately caused the injury complained of. against the attending nurse, Dr. Realuyo, and attending surgeons Dr. Cereno
Facts: At about 9:15 P.M. of September 16, 1995, Raymond S. Olavere and Dr. Zafe.
(Raymond), a victim of a stabbing incident, was rushed to the emergency
room of the Bicol Regional Medical Center (BRMC). After extending initial RTC: The trial court found Drs. Zafe and Cereno (petitioners) negligent in not
medical treatment to Raymond, Dr. Ruel Levy Realuyo (Dr. Realuyo), the immediately conducting surgery on Raymond. It noted that petitioners have
emergency room resident physician, recommended that Raymond undergo already finished operating on Charles Maluluy-on as early as 10:30 in the
"emergency exploratory laparotomy." Dr. Realuyo then requested the evening, and yet they only started the operation on Raymond at around 12:15
parents of Raymond to procure 500 cc of type "O" blood needed for the early morning of the following day. Had the surgery been performed promptly,
operation. Complying with the request, Raymond’s relatives went to the Raymond would not have lost so much blood and, therefore, could have been
Philippine National Red Cross to secure the required blood. saved.

At 10:30 P.M., Raymond was wheeled inside the operating room. During that The trial court also held that the non-availability of Dr. Tatad after the
time, the hospital surgeons, Drs. Zafe and Cereno (herein petitioners), were operation on Maluluy-on was not a sufficient excuse for the petitioners to not
busy operating on gunshot victim Charles Maluluy-on. Assisting them in the immediately operate on Raymond.
said operation was Dr. Rosalina Tatad (Dr. Tatad), who was the only senior
anesthesiologist on duty at BRMC that night. Just before the operation on Lastly, the trial court faulted petitioners for the delay in the transfusion of
Maluluy-on was finished, another emergency case involving Lilia Aguila, a blood on Raymond.
woman who was giving birth to triplets, was brought to the operating room.
CA: On appeal, the CA affirmed in toto the judgment rendered by the RTC
At 10:59 P.M., the operation on Charles Maluluy-on was finished. By that finding petitioners guilty of gross negligence in the performance of their duties
time, however, Dr. Tatad was already working with the obstetricians who will and awarding damages to private respondents.
perform surgery on Lilia Aguila. There being no other available Issue: Whether or not petitioners Drs. Zafe and Cereno were grossly
anesthesiologist to assist them, Drs. Zafe and Cereno decided to defer the negligent in the performance of their duties.
operation on Raymond. Drs. Zafe and Cereno, in the meantime, proceeded Held: NO. The type of lawsuit which has been called medical malpractice or,
to examine Raymond and they found that the latter’s blood pressure was more appropriately, medical negligence, is that type of claim which a victim
normal and "nothing in him was significant." has available to him or her to redress a wrong committed by a medical
professional which has caused bodily harm. In order to successfully pursue
At 11:15 P.M., Raymond’s relatives returned to the BRMC with a bag such a claim, a patient must prove that a health care provider, in most
containing the requested 500 cc type "O" blood. They handed over the bag cases a physician, either failed to do something which a reasonably
prudent health care provider would have done, or that he or she did it was petitioners’ fault that caused the injury. Their cause stands on the mere
something that a reasonably prudent provider would not have done; and assumption that Raymond’s life would have been saved had petitioner
that the failure or action caused injury to the patient. Stated otherwise, surgeons immediately operated on him; had the blood been cross-matched
the complainant must prove: (1) that the health care provider, either by his immediately and had the blood been transfused immediately. There was,
act or omission, had been negligent, and (2) that such act or omission however, no proof presented that Raymond’s life would have been saved had
proximately caused the injury complained of. those things been done. Those are mere assumptions and cannot guarantee
their desired result. Such cannot be made basis of a decision in this case,
Given that Dr. Tatad was already engaged in another urgent operation and especially considering that the name, reputation and career of petitioners are
that Raymond was not showing any symptom of suffering from major blood at stake.
loss requiring an immediate operation, We find it reasonable that petitioners
decided to wait for Dr. Tatad to finish her surgery and not to call the standby It was noted that Raymond, who was a victim of a stabbing incident, had
anesthesiologist anymore. There is, after all, no evidence that shows that a multiple wounds when brought to the hospital. Upon opening of his thoracic
prudent surgeon faced with similar circumstances would decide otherwise. cavity, it was discovered that there was gross bleeding inside the body. Thus,
the need for petitioners to control first what was causing the bleeding.
Another ground relied upon by the trial court in holding petitioners negligent
was their failure to immediately transfuse blood on Raymond. Such failure In the case of Dr. Cruz v. CA, it was held that "[d]octors are protected by a
allegedly led to the eventual death of Raymond through "hypovolemic shock." special law. They are not guarantors of care. They do not even warrant a
Again, such is a mistaken conclusion. good result. They are not insurers against mishaps or unusual
consequences. Furthermore, they are not liable for honest mistake of
First, the alleged delay in the cross-matching of the blood, if there was any, judgment…"
cannot be attributed as the fault of the petitioners. The petitioners were never DISPOSITIVE PORTION: IN THE LIGHT OF THE FOREGOING, the instant
shown to be responsible for such delay. It is highly unreasonable and the Petition for Review on Certiorari is hereby GRANTED. The Court of Appeals
height of injustice if petitioners were to be sanctioned for lapses in procedure decision is hereby REVERSED and SET ASIDE. No costs.
that does not fall within their duties and beyond their control. Case Digest: Garcia, A.R.G.

Second, Dr. Cereno, in his unchallenged testimony, aptly explained the


apparent delay in the transfusion of blood on Raymond before and during the
operation. Before the operation, Dr. Cereno explained that the reason why
no blood transfusion was made on Raymond was because they did not then
see the need to administer such transfusion. The testimonies of Dr. Cereno
went unchallenged or unrebutted. The parents of Raymond were not able to
present any expert witness to dispute the course of action taken by the
petitioners.

Causation Not Proven

In medical negligence cases, it is settled that the complainant has the burden
of establishing breach of duty on the part of the doctors or surgeons. It must
be proven that such breach of duty has a causal connection to the resulting
death of the patient. A verdict in malpractice action cannot be based on
speculation or conjecture. Causation must be proven within a reasonable
medical probability based upon competent expert testimony.

The parents of Raymond failed in this respect. Aside from their failure to
prove negligence on the part of the petitioners, they also failed to prove that

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