Cantre v. Sps. Go

Dr. Milagros Cantre v. Sps. John David and Nora Go

2007 / Quisumbing / Petition for review on certiorari of CA decision and resolution

FACTS

Nora Go gave birth to her 4th child. Two hours later, she suffered profuse bleeding inside her womb due to some placenta parts which were not completely expelled after delivery. She then suffered hypovolemic shock, so her BP dropped to 40/0. Dr. Milagros Cantre, an Ob-Gyne specialist and Nora's attending physician, together with an assisting resident physician, performed various medical procedures to stop the bleeding and to restore Nora's BP. While Dr. Cantre was massaging Nora's uterus for it to contract and stop bleeding, she ordered a droplight to warm Nora and her baby. At that time, she was unconscious.

     While in the recovery room, Nora's husband John David noticed a fresh gaping wound (2 1/2 x 3 1/2 in) in the inner portion of her left arm near the armpit. When he asked the nurses about the cause of the injury, he was informed that it was due to a burn. John David filed a request for investigation. Dr. Cantre said that what caused the injury was the blood pressure cuff. John David brought Nora to the NBI for a physical examination. The medico-legal said that the injury appeared to be a burn and that a droplight when placed near the skin for about 10 minutes could cause such burn. He dismissed the likelihood that the wound was caused by a blood pressure cuff since the scar was not around the arm, but just on one side of the arm. Nora's injury was referred to a plastic surgeon for skin grafting. However, her arm would never be the same--the surgery left an unsightly scar, her movements are restricted, and the injured arm aches at the slightest touch.

     Sps. Go filed a complaint for damages against Dr. Cantre, the medical director, and the hospital. In the RTC, parties have rested their respective cases, but the court admitted additional exhibits [consist mostly of medical records produced by the hospital during trial pursuant to a subpoena duces tecum] offered by Sps. Go, which were not testified to by any witness. RTC ruled in favor of the spouses. CA affirmed RTC with modification (complaint dismissed with respect to the medical director and the hospital; only moral damages awarded).

ISSUES AND HOLDING

1. WON the questioned additional exhibits are admissible in evidence. YES
2. WON Dr. Cantre is liable for the injury suffered by Nora Go. YES

RATIO

Preliminary discussion

Dr. Cantre's counsel admitted the existence of the additional exhibits when they were formally offered for admission by the RTC. In any case, given the circumstances of this case, a ruling on Dr. Cantre's negligence may be made based on the res ipsa loquitur doctrine even in the absence of the additional exhibits.

Backgrounder

The Hippocratic Oath mandates physicians to give primordial consideration to their patients' well-being, and if a doctor fails to live up to this precept, he is accountable for his acts. This notwithstanding, courts face a unique restraint in adjudicating medical negligence cases because physicians are not guarantors of care, and they never set out to intentionally  cause injury to their patients. HOWEVER, intent is immaterial in these cases because where negligence exists and is proven, it automatically gives the injured a right to reparation for the damage caused.

Res ipsa loquitur x Medical negligence cases

In medical negligence cases, the doctrine of res ipsa loquitur allows the mere existence of an injury to justify a presumption of negligence on the part of the person who controls the instrument causing the injury, provided that the following requisites concur:

1. Accident is of a kind which ordinarily does not occur absent someone's negligence
   • Wound not an ordinary occurrence in the act of delivering a baby; could not have happened unless negligence set in somewhere
2. Caused by an instrumentality within defendant's exclusive control
   • It doesn't matter WON the injury was caused by the droplight or by the blood pressure cuff, since both are within the exclusive control of the physician in charge [Dr. Cantre] under the captain of the ship doctrine [surgeon in charge of an operation is held liable for his assistants' negligence during the time when they are under the surgeon's control].
3. Possibility of contributing conduct which would make plaintiff responsible is eliminated
   • Wound could only be caused by something external to and outside the control of Nora since she was unconscious while in hypervolemic shock.

On Dr. Cantre's other arguments + what would have been her saving grace

• BP cuff defense does not afford her an escape. The medical practice is to deflate the cuff immediately after use, or else, it could cause an injury similar to what happened to Nora. If the wound was caused by the constant taking of BP, it must have been done so negligently as to inflict a gaping wound.
• The argument that the failed plastic surgery was a measure to prevent complication (and not intended as a cosmetic procedure) does not negate negligence on Dr. Cantre's part.
• Dr. Cantre has been Nora's ob-gyne for her past 3 deliveries, and this is the first time that Dr. Cantre is being held liable for damages due to negligence in the practice of her profession. She promptly took care of the wound before infection set in. Since Nora was in a critical condition at that time, saving her life became Dr. Cantre's elemental concern. Still, her good intentions characteristics do not justify negligence. 

NCC provisions applied

• NCC 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done. [...]
• NCC 2217. Moral damages include physical suffering, mental anguish, fright, serious anxiety, besmirched reputation, wounded feelings, moral shock, social humiliation, and similar injury. Though incapable of pecuniary computation, moral damages may be recovered if they are the proximate result of the defendant's wrongful act or omission. [200k moral damages awarded]