Borromeo Vs Family Care Hospital

Borromeo vs. Family Care Hospital, Inc.
and Ramon Inso

GR No. 191018 January 25, 2016
FACTS:
Lilian, the wife of petitioner Borromeo, was a patient of the respondent Family Care Hospital
(Family Care) under the care of respondent Dr. Ramon Inso. Petitioner brought and admitted his
wife to the Family Care. Respondent Dr. Inso suspected that Lilian might be suffering form acute
appendicitis and ordered Lilian’s confinement for testing and evaluation. Over the next 48 hours,
Lilian underwent multiple test, however, the tests were not enough to confirm that she had
appendicitis. Lilian’s condition did not improve and her abdominal pain worsened and suffered
from spiking fever.
After Dr. Inso examine the abdominal cavity and identify the cause of Lilian’s symtoms, Dr. Inso
obtained the patient’s consent and Lilian was brought to the operating room where the operation
was conducted. Dr. Inso confirmed that Lilian was suffering from acute appendicitis and
proceeded to remove her appendix which was already infected.
The operation was successful, however, roughly six (6) hours after Lilian was brought back to her
room, Dr. Inso informed that her blood pressure was low and infused more IV fluids to her. Dr.
Inso stayed in the hospital and saw Lilian was quite pale. Lilian did not respond to the blood
transfusion made by Dr. Inso. Dr. Inso suspected that Lilian had Disseminated Intravascular
Coagulation, a blood disorder characterized by bleeding in many parts of her body.
Dr. Inso and the nurses performed CPR on Lilian and Dr. Inso informed the family that they need
to re-operate her but she have to be put in an ICU, however, the hospital is only secondary and
was not required by the DOH to have one. Dr. Inso informed the family that Lilian would be
transferred. After Dr. Inso’s effort, they successfully found a hospital where Lilian would be
transferred but, unfortunately upon reaching the hospital, the medical team was on hand to
resuscitate Lilian but Lilian passed away despite efforts.
Petitioner requested that Lilian’s body be autopsied and Dr. Reyes who conducted it concluded
that Lilian’s death was hemorrhage due internal bleeding and could have been avoided if the site
was repaired with double suturing. Petitioner filed for damages against the Family Care and Dr.
Inso for medical negligence and presented Dr. Reyes as his expert witness. Dr. Reyes admitted
that he had little experience in the field of pathology.
Respondents presented Dr. Inso and expert witnesses – Dr. Ramos and Dr, Hernandez. Dr.
Ramos is a practicing pathologist with over 20 years of experience and Dr. Hernandez had been
practicing surgery for 20 years. Dr. Hernandez testified that the procedure Dr. Inso performed
was consistent with the usual surgical procedure.
Petitioner presented Dr. Avila as a rebuttal witness and also a lawyer, who testified that between
Dr. Reyes who autopsied the patient and Dr. Ramos whose findings were based on medical
record, Dr. Reyes testimony should prevail.
RTC rendered its decision in favor of petitioner and relied on Dr. Avila’s testimony and that Dr.
Inso was negligent. Respondent elevated the case to the CA. The CA reversed the RTC’s decision
and gave greater weight to the testimonies of Dr. Hernandez and Dr. Ramos over Dr. Reyes who
was not an expert in pathology. Hence, this petition.
ISSUE:
1. WON Dr. Inso and Family care were negligent in caring for Lilian before, during and after
her appendectomy and were responsible for her death.
2. WON the doctrine of res ipsa loquitor is applicable to this case
RULING:
1. No.
Whoever alleges a fact has the burden of proving it. This is a basic legal principle that equally
applies to civil and criminal cases. In a medical malpractice case, the plaintiff has the duty of
proving its elements, namely: (1) a duty of the defendant to his patient; (2) the defendant's breach
of this duty; (3) injury to the patient; and (4) proximate causation between the breach and the
injury suffered. In civil cases, the plaintiff must prove these elements by a preponderance of
evidence. A medical professional has the duty to observe the standard of care and exercise the
degree of skill, knowledge, and training ordinarily expected of other similarly trained medical
professionals acting under the same circumstances. A breach of the accepted standard of care
constitutes negligence or malpractice and renders the defendant liable for the resulting injury to
his patient.
Because medical malpractice cases are often highly technical, expert testimony is usually
essential to establish: (1) the standard of care that the defendant was bound to observe under
the circumstances; (2) that the defendant's conduct fell below the acceptable standard; and (3)
that the defendant's failure to observe the industry standard caused injury to his patient. The
petitioner failed to present an expert witness.
Dr. Reyes is not an expert witness who could prove Dr. Inso's alleged negligence. His testimony
could not have established the standard of care that Dr. Inso was expected to observe nor
assessed Dr. Inso's failure to observe this standard. The testimony of Dr. Avila also has no
probative value in determining whether Dr. Inso was at fault. On the other hand, the respondents
presented testimonies from Dr. Inso himself and from two expert witnesses in pathology and
surgery. To our mind, the testimonies of expert witnesses Dr. Hernandez and Dr. Ramos carry
far greater weight than that of Dr. Reyes. The petitioner's failure to present expert witnesses
resulted in his failure to prove the respondents' negligence. The preponderance of evidence
clearly tilts in favor of the respondents.
2. No, not applicable.

The petitioner cannot invoke the doctrine of res ipsa loquitur to shift the burden of evidence onto
the respondent. Res ipsa loquitur, literally, "the thing speaks for itself;" is a rule of evidence that
presumes negligence from the very nature of the accident itself using common human knowledge
or experience. The application of this rule requires: (1) that the accident was of a kind which does
not ordinarily occur unless someone is negligent; (2) that the instrumentality or agency which
caused the injury was under the exclusive control of the person charged with negligence; and (3)
that the injury suffered must not have been due to any voluntary action or contribution from the
injured person.
The concurrence of these elements creates a presumption of negligence that, if unrebutted,

overcomes the plaintiff's burden of proof. This doctrine is used in conjunction with the doctrine of
common knowledge. The rule is not applicable in cases such as the present one where the
defendant's alleged failure to observe due care is not immediately apparent to a layman. These
instances require expert opinion to establish the culpability of the defendant doctor. It is also not
applicable to cases where the actual cause of the injury had been identified or established.

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Borromeo vs. Family Care Hospital, Inc.

and Ramon Inso

2. No, not applicable.

The concurrence of these elements creates a presumption of negligence that, if unrebutted,

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