G.R. No. 122445 November 18, 1997
FACTS
Rowena Umali De Ocampo accompanied
her mother to Perpetual Help Clinic and General Hospital in Laguna. Lydia
Umali, private respondent, was examined by the petitioner. The finding was that
Lydia has myoma in her uterus and that she is scheduled for hysterectomy the
next day. Rowena noticed the undtidy state of the clinic prompting her to
persuade her mother not to proceed with the operation. The petitioner told the
patient that she must be operated as scheduled. Rowena and her relatives waited
outside the operating room. During the operation, Dr. Ercillo (the
anaesthesiologists) went out of the operating room and instructed them to buy
tagamet ampules and blood for Lydia. After the operation, they were instructed
to buy more blood but unfortunately, the blood type of Lydia is not available
anymore from the blood bank thus resorting to blood donation by another person
for transfusion. Rowena noticed thereafter that her mother is gasping for
breath as a result of the low oxygen supply. Rowena’s husband had to go to
another hospital to get oxygen. A few hours later, Lydia went into shock and
her BP dropped. Due to her unstable condition, she was transferred to San Pablo
District Hospital without the prior consent of neither Rowena nor her
relatives. Upon arrival, she was sent to the OR and underwent re-operation by
petitioner and Dr. Ercillo because of blood oozing from the abdominal incision.
Dr. Angeles, head of Obstetrics and Gynecology Department of the San Pablo
Hospital, was summoned but upon arrival, Lydia was already in shock with a
blood pressure of 0/0. Lydia was pronounced dead with “shock as immediate cause
and “Disseminated Intravascular Coagulation” as the antecedent cause in her
death certificate. The MTCC convicted the petitioner with
"reckless imprudence and negligence resulting to (sic)
homicide"which was affirmed by the
RTC and CA.
ISSUE
Whether or not the petitioner
is guilty as charged
RULING
The Court holds differently and finds the foregoing
circumstances insufficient to sustain a judgment of conviction against the
petitioner for the crime of reckless imprudence resulting in homicide. 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. Whether or not a physician has committed an "inexcusable lack of
precaution" in the treatment of his patient is 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.
Immediately apparent from a review of the records of
this case is the absence of any expert testimony on the matter of the standard
of care employed by other physicians of good standing in the conduct of similar
operations. The prosecution's expert witnesses from the NBI only testified as
to the possible cause of death but did not venture to illuminate the court on
the matter of the standard of care that petitioner should have exercised.
Even granting arguendo that the inadequacy of the facilities
and untidiness of the clinic; the lack of provisions; the failure to conduct
pre-operation tests on the patient; and the subsequent transfer of Lydia to the
San Pablo Hospital and the reoperation performed on her by the petitioner do
indicate, even without expert testimony, that petitioner was recklessly
imprudent in the exercise of her duties as a surgeon, no cogent proof exists
that any of these circumstances caused petitioner's death. Thus, the absence of the fourth element of
reckless imprudence: that the injury to the person or property was a
consequence of the reckless imprudence.
The testimonies of both doctors establish hemorrhage or
hemorrhagic shock as the cause of death. However, as likewise testified to by
the expert witnesses in open court, hemorrhage or hemorrhagic shock during
surgery may be caused by several different factors.
According to both doctors, 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. It is significant to
state at this juncture that the autopsy conducted by Dr. Arizala on the body of
Lydia did not reveal any untied or unsutured cut blood vessel nor was there any
indication that the tie or suture of a cut blood vessel had become loose
thereby causing the hemorrhage.
On the other hand, the findings of all three doctors do
not preclude the probability that DIC caused the hemorrhage and consequently,
Lydia's death. DIC which is a clotting defect creates a serious bleeding
tendency and when massive DIC occurs as a complication of surgery leaving raw
surface, major hemorrhage occurs. And
as testified to by defense witness, Dr. Bu C. Castro, hemorrhage due to DIC
"cannot be prevented, it will happen to anyone, anytime."
The Court has no recourse but to rely on the expert
testimonies rendered by both prosecution and defense witnesses 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.
CONCLUSION
Therefore,
the petitioner is acquitted of the crime of reckless imprudence resulting in
homicide. Nevertheless, the 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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