FIRST DIVISION

OFFICE OF THE OMBUDSMAN, G.R. No. 159395

Petitioner,
Present:

PUNO, C.J., Chairperson,

CARPIO,
- versus - AZCUNA,
VELASCO, JR.,* and
LEONARDO-DE CASTRO, JJ.

COURT OF APPEALS and Promulgated:

DR. MERCEDITA J. MACABULOS,
Respondents. May 7, 2008

x--------------------------------------------------x
DECISION
CARPIO, J.:
The Case

This is a petition for review[1] of the Decision[2] dated 17 March

2003 and the Resolution dated 30 July 2003 of the Court of Appeals in CA-G.R. SP
No. 66411.

The Facts
On 31 March 1998, Dr. Minda L. Virtudes (Dr. Virtudes) executed a complaint-
affidavit[3] charging Dr. Mercedita J. Macabulos (Dr. Macabulos) with dishonesty,
grave misconduct, oppression, conduct grossly prejudicial to the best interest of the
service and acts unbecoming a public official in violation of the Civil Service Laws
and the Code of Conduct and Ethical Standards for Public Officials and Employees.
Dr. Macabulos, who held the position of Medical Officer V at the Department of
Education, Culture and Sports, National Capital Region (DECS-NCR), was the Chief of
theSchool Health and Nutrition Unit. Dr. Virtudes was then Supervising Dentist III
working under the supervision of Dr. Macabulos. Dr. Virtudes asserted in her
complaint that in May 1997, Dr. Macabulos required her to submit dental and
medical receipts for the liquidation of Dr. Macabulos cash advance in the year 1995
amounting to P45,000 for the purchase of dental medicines and
supplies. Dr. Virtudes did not submit receipts and invoices considering that she was
not yet assigned at the School Health and Nutrition Unit, DECS-NCR when
Dr. Macabulos incurred the cash advance.

Because of Dr. Virtudes failure to produce receipts and invoices,

Dr. Macabulos allegedly subjected Dr. Virtudes to several forms of harassment by: 1)
denying her request for the purchase of dental supplies and equipment; 2) requiring
her and her co-workers to sign an Attendance Log Book every time they arrived at
the office and again before leaving the office even if they were already using the
employees bundy clock and signing the Attendance Sheet in the office; 3)
threatening Dr. Virtudes and her co-workers with transfer of assignment; 4) sending
letters to Dr. Virtudes threatening to charge her with insubordination and disrespect;
and 5) threatening to kill her and her husband or do other harm to her and her
family.

In her counter-affidavit, Dr. Macabulos denied forcing Dr. Virtudes to make a

liquidation as the latter was not yet assigned to her unit at the time the cash
advance was made. Dr. Macabulos likewise claimed that while the P45,000 cash
advance was in her name being the only bonded employee in their unit, it was Dr.
Antonia Lopez-Dee (Dr. Dee), who was then the Supervising Dentist, who used the
money to purchase medical and dental supplies. Attached to Dr. Macabulos counter-
affidavit was an unnotarized affidavit[4] of Dr. Dee which admitted, among others,
that she requested Dr. Macabulos to make the cash advance.

Dr. Macabulos attributed the filing of the complaint against

her to professional jealousy. Dr. Virtudes allegedly resented Dr. Macabulos order,
requiring all employees under her supervision to sign an attendance log book.
Dr. Macabulos imposed the new requirement as a remedial measure to curb
Dr. Virtudes alleged practice of leaving the office without permission to engage in
private practice at the Philippine Lung Center where Dr. Virtudes husband was also
a dentist. Dr. Macabulos denied that she instigated the transfer of Dr. Virtudes and
her two friends to other units and alleged that it was Dr. Virtudes and her friends
who requested for the transfer of assignment.

In her reply-affidavit, Dr. Virtudes alleged that Dr. Macabulos, in enforcing the use of
the attendance log book, singled her out although there were others who failed to
sign the log book. Dr. Virtudes denied engaging in private
practice. Dr Virtudes pointed out that she confronted Dr. Dee, who disowned the
contents of her alleged affidavit which Dr. Macabulos attached to her counter-
affidavit. Dr. Virtudes claimed that it was Dr. Macabulos who made the P45,000 cash
advance, improperly spent the amount, and later tried to liquidate the same with
the tampered Sales Invoice No. 3366 issued by Medsordent Center to conform to
the amount of the cash advance.

On 29 December 2000, Graft Investigation Officer I Ulysis S. Calumpad (GIO

I Calumpad) rendered a decision absolving Dr. Macabulos from the administrative
charge. However, Overall Deputy Ombudsman Margarito P. Gervacio, Jr. (Overall
Deputy Ombudsman Gervacio) disapproved the decision of GIO I Calumpad.

Investigating further, the Ombudsman required Dr. Dee to confirm her statements in
her unnotarized affidavit dated 14 September 1998. In reply, Dr. Dee disowned the
statements in her unnotarized affidavit. In her sworn affidavit[5] dated 9 May 2001,
Dr. Dee stated that although she signed the unnotarized affidavit dated 14
September 1998, the contents of the first page were entirely different from the one
attached by Dr. Macabulos in her counter-affidavit. Dr. Dee asserted that as
Supervising Dentist, her job involved the requisition of the necessary health and
dental supplies but not the purchasing of supplies which was done by the
purchasing unit of the School Health and Nutrition Unit which
was under Dr. Macabulos. Dr. Dee denied encashing the check for P45,000 which
was in the name of Dr. Macabulos. Dr. Dee likewise denied purchasing the supplies
indicated in the Medsordent Center sales invoice which was submitted by
Dr. Macabulos to liquidate her P45,000 cash advance.
In a Memorandum[6] dated 13 June 2001, Graft Investigation Officer II Julita M.
Calderon (GIO II Calderon) reversed the decision of GIO I Calumpad. GIO II Calderon
found Dr. Macabulos guilty of dishonesty, falsification, grave misconduct, conduct
grossly prejudicial to the best interest of the service and violation of reasonable
office rules and regulations defined and penalized under the Civil Service Laws. The
Memorandum, approved by Overall Deputy
Ombudsman Gervacio and Ombudsman Aniano A. Desierto,imposed upon
Dr. Macabulos the penalty of dismissal from government service.

On 11 July 2001, Dr. Macabulos filed a motion for reconsideration, which was denied
in an Order dated 26 July 2001.

On 31 August 2001, Dr. Macabulos filed a petition for review with the Court of
Appeals. On 17 March 2003, the Court of Appeals rendered a decision,
the dispositive portion of which reads:

WHEREFORE, premises considered, the petition is GIVEN DUE COURSE. The assailed
memorandum dated June 13, 2001 and the order dated July 26, 2001 of the Office
of the Ombudsman in OMB Case No. 0-98-0438 are hereby REVERSED and SET
ASIDE. The earlier decision of the GOI I Ulysis S. Calumpad of the Office of the
Ombudsman is REINSTATED and the subject complaint DISMISSED. No
pronouncement as to costs.

SO ORDERED.[7]

The Ruling of the Court of Appeals

The Court of Appeals held that under Section 20(5) of Republic Act No. 6770 (RA
6770),[8] the Office of the Ombudsman (Ombudsman) can no longer investigate the
complaint since the acts complained of were committed more than one year from
the filing of the complaint. The Court of Appeals found irregular the reversal of the
earlier decision of GIOI Calumpad, absolving Dr. Macabulos from the administrative
charge, mainly on the basis of the recantation of Dr. Dee of her previous statements
contained in an affidavit.

The Court of Appeals held that Dr. Macabulos retirement from government service
did not render the administrative case moot and academic.

Lastly, citing Section 27 of RA 6770, the Court of Appeals ruled that the
Memorandum Order dated 13 June 2001 of the Ombudsman, imposing upon
Dr. Macabulos the penalty of dismissal from government service, is not
immediately executory.

The Issues
Petitioner raises the following issues:

1. THE INTERPRETATION OF THE COURT OF APPEALS OF SEC. 20(5), RA 6770 AS A

PRESCRIPTIVE PERIOD ON OMBUDSMAN ADMINISTRATIVE DISCIPLINARY CASES IS
UNCONSTITUTIONAL, AS THE SAME UNDULY IMPINGES ON THE INVESTIGATORY AUTHORITY
OF THE OMBUDSMAN ON ANY ACT OR OMISSION APPEARING TO BE ILLEGAL, UNJUST,
IMPROPER OR INEFFICIENT.

2. IN HIGHLY MERITORIOUS CASES, AS HERE, THE PETITIONER OFFICE OF THE

OMBUDSMAN HAS THE DISCRETIONARY AUTHORITY TO CONDUCT ADMINISTRATIVE
INVESTIGATION ON COMPLAINTS FILED MORE THAN ONE (1) YEAR FROM THE OCCURRENCE
OF THE ACT OR OMISSION COMPLAINED OF, AND THE RULING OF THE COURT OF APPEALS
THAT SUCH INVESTIGATION IS BARRED BY REASON OF PRESCRIPTION IS A GLARING NULLITY.

3. CONTRARY TO THE APPELLATE COURTS RULING, THERE IS MORE THAN SUBSTANTIAL

EVIDENCE PROVING PRIVATE RESPONDENTS GUILT, AND THE INCULPATORY SWORN
STATEMENT OF PRIVATE RESPONDENTS SUPPOSED OWN WITNESS, BEING ADMISSIBLE IN
EVIDENCE AND NOT REBUTTED BY PRIVATE RESPONDENT, WAS CORRECTLY APPRECIATED BY
THE OMBUDSMAN IN ADJUDGING PRIVATE RESPONDENT GUILTY OF GROSS MALFEASANCE
NECESSITATING HER DISMISSAL FROM SERVICE.

4. THE PENALTY OF DISMISSAL FROM THE SERVICE METED ON PRIVATE RESPONDENT IS

IMMEDIATELY EXECUTORY IN ACCORDANCE WITH THE VALID RULE OF EXECUTION PENDING
APPEAL UNIFORMLY OBSERVED IN ADMINISTRATIVE DISCIPLINARY CASES, AND THE RULING
OF THE COURT OF APPEALS TO THE CONTRARY IS A PATENT NULLITY.

5. CONTRARY TO THE APPELLATE COURTS RULING, THE PETITIONER OFFICE OF THE

OMBUDSMAN TIMELY AND RIGHTFULLY FILED ITS MOTIONS TO INTERVENE AND FOR
RECONSIDERATION ON A PATENTLY ERRONEOUS DECISION OF THE COURT OF APPEALS
WHICH HAS NOT YET ATTAINED FINALITY.[9]

The Ruling of the Court

We find the petition meritorious. The Court of Appeals should have granted the
motion for intervention filed by the Ombudsman. In its decision, the appellate court
not only reversed the order of the Ombudsman but also delved into the
investigatory power of the Ombudsman. Since the Ombudsman was
not impleaded as a party when the case was appealed to the Court of Appeals in
accordance with Section 6, Rule 43 of the Rules of Court, [10] the Ombudsman had no
other recourse but to move for intervention and reconsideration of the decision in
order to prevent the undue restriction of its constitutionally mandated investigatory
power.[11]

Prescription

The Court of Appeals held that under Section 20(5) of RA 6770, the Ombudsman is
already barred by prescription from investigating the complaint since it was filed
more than one year from the occurrence of the complained act. We find this
interpretation by the appellate court unduly restrictive of the duty of the
Ombudsman as provided under the Constitution to investigate on its own, or on
complaint by any person, any act or omission of any public official or employee,
office or agency, when such act or omission appears to be illegal, unjust, improper,
or inefficient.[12]

Section 20 of RA 6770 reads:

Sec. 20. Exceptions. The Office of the Ombudsman may not conduct the necessary
investigation of any administrative act or omission complained of if it believes that:
(1) The complainant has an adequate remedy in another judicial or quasi-judicial
body;
(2) The complaint pertains to a matter outside the jurisdiction of the Office of the
Ombudsman;
(3) The complaint is trivial, frivolous, vexatious or made in bad faith;
(4) The complainant has no sufficient personal interest in the subject matter of the
grievance; or
(5) The complaint was filed after one (1) year from the occurrence of the act or
omission complained of. (Emphasis supplied)

The use of the word may is ordinarily construed as permissive or directory,

indicating that a matter of discretion is involved. [13] Thus, the word may, when used
in a statute, does not generally suggest compulsion. The use of the word may in
Section 20(5) of RA 6770 indicates that it is within the discretion of the Ombudsman
whether to conduct an investigation when a complaint is filed after one year from
the occurrence of the complained act or omission.

In Filipino v. Macabuhay,[14] the Court interpreted Section 20(5) of RA 6770 in this

wise:
Petitioner argues that based on the abovementioned provision [Section 20(5) of RA
6770)], respondents complaint is barred by prescription considering that it was filed
more than one year after the alleged commission of the acts complained of.
Petitioners argument is without merit.
The use of the word may clearly shows that it is directory in nature and not
mandatory as petitioner contends. When used in a statute, it is permissive only and
operates to confer discretion; while the word shall is imperative, operating to
impose a duty which may be enforced. Applying Section 20(5), therefore, it is
discretionary upon the Ombudsman whether or not to conduct an investigation on a
complaint even if it was filed after one year from the occurrence of the act or
omission complained of. In fine, the complaint is not barred by prescription. [15]

Moreover, Section 20 of RA 6770 has been clarified by Administrative Order No.

17[16] (AO 17), which amended Administrative Order No. 07 (AO 07), otherwise
known as the Rules of Procedure of the Office of the Ombudsman. Section 4, Rule
III[17] of the amended Rules of Procedure of the Office of the Ombudsman reads:
Section 4. Evaluation. Upon receipt of the complaint, the same shall be evaluated to
determine whether the same may be:
a) dismissed outright for any grounds stated under Section 20 of Republic Act No.
6770, provided, however, that the dismissal thereof is not mandatory and shall be
discretionary on the part of the Ombudsman or the Deputy Ombudsman concerned;
b) treated as a grievance/request for assistance which may be referred to the Public
Assistance Bureau, this Office, for appropriate action under Section 2 , Rule IV of
this Rules;
c) referred to other disciplinary authorities under paragraph 2, Section 23, R.A. 6770
for the taking of appropriate administrative proceedings;
d) referred to the appropriate office/agency or official for the conduct of further fact-
finding investigation; or
e) docketed as an administrative case for the purpose of administrative adjudication
by the Office of the Ombudsman. (Emphasis supplied)
Thus, in this case, even if the complaint was filed more than one year after the
alleged occurrence of the act complained of, it was within the discretion of the
Ombudsman whether to pursue the investigation or dismiss the complaint.

Substantial Evidence Proving Guilt of Dr. Macabulos

Contrary to the appellate courts ruling, there was substantial evidence to hold
Dr. Macabulos administratively liable. In the Memorandum dated 13 June 2001, the
Ombudsman found that Dr. Macabulos purchased dental items
(dentrate and castone) which were not included in the DECS Dental Program, using
the P45,000 cash advance intended for the DECS Dental Program.
Dr. Macabulos was required to refund the amount for items which were disallowed
by the Commission on Audit (COA). Furthermore, the cash advance made on 28
March 1995 which was allegedly used for purchases made on 9 September 1995,
was only liquidated in September 1997. The delay in the liquidation of the cash
advance was a violation of Section 89 of Presidential Decree No. 1445 (PD 1445).
[18]
The Ombudsman also found that the dental supplies allegedly purchased were
neither inspected nor received by the Supply and Property Unit of DECS-NCR. [19]

Upon further investigation by the Ombudsman, it was also discovered that

Dr. Macabulos misled the Ombudsman by submitting a falsified affidavit of Dr. Dee
to support Dr. Macabulos claim that it was Dr. Dee who requested the cash
advance, encashed the check, and bought dental supplies. In her subsequent sworn
affidavit, Dr. Dee stated that when she was made to sign the other affidavit, the
contents of the first page were entirely different from the one submitted by
Dr. Macabulos. Dr. Dee denied encashing the check which was under the name of
Dr. Macabulos. As then Supervising Dentist, Dr. Dees job was to request for health
and dental supplies but the purchasing of supplies was done by the purchasing unit
of the School Health and Nutrition Unit which was under Dr. Macabulos. Contrary to
Dr. Macabulos claim, Dr. Dee emphatically denied that she purchased dental
supplies using the P45,000 cash advance of Dr. Macabulos.

Indeed, the records reveal that on 13 March 1998, the DECS-NCR Resident COA
Auditor issued an Audit Observation Memorandum (Audit Memorandum), [20] stating
that Invoice No. 3366 of Medsordent Center purportedly issued on 9 September
1995 in the amount of P45,015 was deliberately tampered to conform to the
amount of cash advance sought to be liquidated by Dr. Macabulos. The Audit
Memorandum also stated that the items dentrate and castone, which are generally
used by dental practitioners in making dental impression, were not included in the
DECS Dental Program. Dr. Macabulos then reimbursed the P2,037.50 representing
the price of dentrate and castone which COA disallowed. However, on 3 November
1998, the Resident Auditor, by virtue of Section 52(2) of PD 1445,[21] issued a
management letter opening the account of Dr. Macabulos. On 3 February 1999,
Dr. Macabulos paid P42,962.50[22] as final settlement of her cash advance.[23]

Thus, it appears from the records that Dr. Macabulos tried to liquidate with a
tampered invoice the cash advance she made two years earlier. The tampered
invoice also contained certain items which COA disallowed because the items were
not included in the Medical and Dental Program of DECS-NCR. It is highly
questionable whether the dental supplies purportedly purchased
from Medsordent Center were really distributed to the regional office and the
division offices since the Supply Officer of the DECS-NCR issued a certification that
the items enumerated in the invoice were neither inspected nor received by the
Supply and Property Unit. Furthermore, to evade responsibility,
Dr. Macabulossubmitted a falsified affidavit of Dr. Dee to make it appear that it was
Dr. Dee who requested the cash advance to purchase dental supplies. After the COA
issued a management letter opening Dr. Macabulos account, Dr. Macabulos had to
reimburse not only the amount of the disallowed items but also the whole amount
of the cash advance.

Clearly, there was substantial evidence to hold Dr. Macabulos liable for dishonesty,
falsification, grave misconduct, conduct grossly prejudicial to the best interest of the
service, and violation of reasonable office rules and regulations defined and
penalized under the Civil Service Laws. Under Section 27 of RA 6770, findings of fact
by the Ombudsman when supported by substantial evidence are conclusive.

Penalty of Dismissal and its Accessory Penalties

In Resolution No. 91-1631 dated 27 December 1991, the Civil Service Commission
(CSC) promulgated the Omnibus Civil Service Rules and Regulations (Omnibus
Rules), pursuant to Section 12(2), Chapter 3, Title I(A), Book V of Executive Order
No. 292 (EO 292).[24] Under Section 22, Rule XIV of the Omnibus Rules, dishonesty,
falsification of official document, and grave misconduct are grave offenses
punishable by dismissal. Conduct grossly prejudicial to the best interest of the
service is also a grave offense punishable by suspension for 6 months and 1 day to
1 year for the first offense while violation of reasonable office rules and regulations
is only a light offense punishable by reprimand for the first offense. Under Section
17 of Rule XIV of the Omnibus Rules, if the respondent is found guilty of two or more
charges or counts, the penalty to be imposed should be that corresponding to the
most serious charge or count and the rest shall be considered as aggravating
circumstances. Although the CSC, through Resolution No. 99-1936 dated 31 August
1999, adopted the new Uniform Rules in Administrative Cases in the Civil Service
(Uniform Rules), which took effect on 27 September 1999, the penalties imposed for
the offenses charged in this case are the same under the new Uniform Rules.
[25]
Thus, the Ombudsman correctly imposed upon Dr. Macabulos the penalty of
dismissal.

Under Section 9, Rule XIV of the Omnibus Rules, the penalty of dismissal from
service carries with it the cancellation of eligibility, forfeiture of leave credits and
retirement benefits, and the disqualification for reemployment in the government
service.[26] However, under the new Uniform Rules, forfeiture of leave credits was
deleted as an accessory penalty. Thus, under Section 58, Rule IV
of the Uniform Rules, the penalty of dismissal shall carry with it the cancellation of
eligibility, forfeiture of retirement benefits, and the perpetual disqualification for
reemployment in the government service, unless otherwise provided in the
decision.

Similarly, Section 10, Rule III of the Rules of Procedure of the Office of the
Ombudsman, as amended by AO 17, provides that the penalty of dismissal from the
service shall carry with it that of cancellation of eligibility, forfeiture of retirement
benefits, and the perpetual disqualification for reemployment in the government
service, unless otherwise provided in the decision.

In this case, since Dr. Macabulos has already retired from the government service,
her retirement benefits are forfeited but she is still entitled to receive her leave
credits. She is also perpetually disqualified for reemployment in the government
service and her civil service eligibility is cancelled.

Penalty of Dismissal is Executory Pending Appeal

The Court of Appeals held that the order of the Ombudsman imposing the penalty of
dismissal is not immediately executory. The Court of Appeals applied the ruling
in Lapid v. Court of Appeals,[27] that all other decisions of the Ombudsman which
impose penalties that are not enumerated in Section 27 of RA 6770 are neither final
nor immediately executory.
In Lapid v. Court of Appeals, the Court anchored its ruling mainly on Section 27 of
RA 6770, as supported by Section 7, Rule III of the Rules of Procedure of the Office
of the Ombudsman. The pertinent provisions read:

Section 27 of RA 6770:
SEC. 27. Effectivity and Finality of Decisions. (1) All provisionary orders at the Office
of the Ombudsman are immediately effective and executory.
A motion for reconsideration of any order, directive or decision of the Office of the
Ombudsman must be filed within five (5) days after receipt of written notice and
shall be entertained only on any of the following grounds:
(1) New evidence has been discovered which materially affects the order, directive
or decision;
(2) Errors of law or irregularities have been committed prejudicial to the interest of
the movant. The motion for reconsideration shall be resolved within three (3) days
from filing: Provided,That only one motion for reconsideration shall be entertained.
Findings of fact by the Office of the Ombudsman when supported by substantial
evidence are conclusive. Any order, directive or decision imposing the penalty of
public censure or reprimand, suspension of not more than one months salary shall
be final and unappealable.
In all administrative disciplinary cases, orders, directives, or decisions of the Office
of the Ombudsman may be appealed to the Supreme Court by filing a petition
for certiorari within ten (10) days from receipt of the written notice of the order,
directive or decision or denial of the motion for reconsideration in accordance with
Rule 45 of the Rules of Court.
The above rules may be amended or modified by the Office of the Ombudsman as
the interest of justice may require. (Emphasis supplied)

Section 7, Rule III of the Rules of Procedure of the Office of the Ombudsman (AO 07):
Sec. 7. Finality of decision. Where the respondent is absolved of the charge, and in
case of conviction where the penalty imposed is public censure or reprimand,
suspension of not more than one month, or a fine equivalent to one month salary,
the decision shall be final and unappealable. In all other cases, the decision shall
become final after the expiration of ten (10) days from receipt thereof by the
respondent, unless a motion for reconsideration or petition for certiorari, shall have
been filed by him as prescribed in Section 27 of RA 6770. (Emphasis supplied)

The Court held in Lapid v. Court of Appeals that the Rules of Procedure of the Office
of the Ombudsman mandate that decisions of the Office of the Ombudsman where
the penalty imposed is other than public censure or reprimand, suspension of not
more than one month salary are still appealable and hence, not final and executory.
[28]

Subsequently, on 17 August 2000, the Ombudsman issued Administrative Order No.

14-A (AO 14-A),[29] amending Section 7, Rule III of the Rules of Procedure of the
Office of the Ombudsman. The amendment aims to provide uniformity with other
disciplining authorities in the execution or implementation of judgments and
penalties in administrative disciplinary cases involving public officials and
employees. Section 7, Rule III of the Rules of Procedure of the Office of the
Ombudsman, as amended by AO 14-A, reads:

Section 7. Finality and execution of decision. Where the respondent is absolved of

the charge, and in case of conviction where the penalty imposed is public censure
or reprimand, suspension of not more than one month, or a fine equivalent to one
month salary, the decision shall be final and unappealable. In all other cases, the
decision may be appealed within ten (10) days from receipt of the written notice of
the decision or order denying the motion for reconsideration.

An appeal shall not stop the decision from being executory. In case the penalty is
suspension or removal and the respondent wins such appeal, he shall be considered
as having been under preventive suspension and shall be paid the salary and such
other emoluments that he did not receive by reason of the suspension or removal.
(Emphasis supplied)

On 15 September 2003, AO 17 was issued, amending Rule III of the Rules of

Procedure of the Office of the Ombudsman. Thus, Section 7, Rule III of the Rules of
Procedure of the Office of the Ombudsman was further amended and now reads:

Section 7. Finality and execution of decision. Where the respondent is absolved of

the charge, and in case of conviction where the penalty imposed is public censure
or reprimand, suspension of not more than one month, or a fine equivalent to one
month salary, the decision shall be final, executory and unappealable. In all other
cases, the decision may be appealed to the Court of Appeals on a verified petition
for review under the requirements and conditions set forth in Rule 43 of the Rules of
Court, within fifteen (15) days from the receipt of the written Notice of the Decision
or Order denying the Motion for Reconsideration.

An appeal shall not stop the decision from being executory. In case the penalty is
suspension or removal and the respondent wins such appeal, he shall be considered
as having been under preventive suspension and shall be paid the salary and such
other emoluments that he did not receive by reason of the suspension or removal.

A decision of the Office of the Ombudsman in administrative cases shall be

executed as a matter of course. The Office of the Ombudsman shall ensure that the
decision shall be strictly enforced and properly implemented. The refusal or failure
by any officer without just cause to comply with an order of the Office of the
Ombudsman to remove, suspend, demote, fine, or censure shall be ground for
disciplinary action against said officer. (Emphasis supplied)

Hence, in the case of In the Matter to Declare in Contempt of Court Hon. Simeon
A. Datumanong, Secretary of DPWH,[30] the Court noted that Section 7 of AO 17
provides for execution of the decisions pending appeal, which provision is similar to
Section 47 of the Uniform Rules on Administrative Cases in the Civil Service. [31]

More recently, in the 2007 case of Buencamino v. Court of Appeals,[32] the primary
issue was whether the decision of the Ombudsman suspending petitioner therein
from office for six months without pay was immediately executory even pending
appeal in the Court of Appeals. The Court held that the pertinent ruling in Lapid v.
Court of Appeals has already been superseded by the case of In the Matter to
Declare in Contempt of Court Hon. Simeon A. Datumanong, Secretary of DPWH,
which clearly held that decisions of the Ombudsman are
immediately executory even pending appeal.

Based on the foregoing, we hold that the Ombudsmans order imposing the penalty
of dismissal on Dr. Macabulos was immediately executory even pending appeal in
the Court of Appeals.
WHEREFORE, we GRANT the petition. We SET ASIDE the Decision dated 17 March
2003 and the Resolution dated 30 July 2003 of the Court of Appeals in CA-G.R. SP
No. 66411. We REINSTATE the Memorandum Order dated 13 June 2001 and the
Order dated 26 July 2001 of the Office of the Ombudsman, dismissing
Dr. Mercedita J. Macabulos from the government service. Since
Dr. Mercedita J. Macabulos has already retired from the government service, her
retirement benefits are forfeited except her accrued leave credits. She is also
perpetually disqualified for reemployment in the government service and her civil
service eligibility is cancelled.
SO ORDERED.

ANTONIO T. CARPIO
Associate Justice
WE CONCUR:
REYNATO S. PUNO
Chief Justice
Chairperson
ADOLFO S. AZCUNA PRESBITERO J. VELASCO, JR.
Associate Justice Associate Justice

TERESITA J. LEONARDO-DE CASTRO

Associate Justice

CERTIFICATION
Pursuant to Section 13, Article VIII of the Constitution, I certify that the conclusions
in the above Decision had been reached in consultation before the case was
assigned to the writer of the opinion of the Courts Division.

REYNATO S. PUNO
Chief Justice
EN BANC
DR. EDILBERTO ESTAMPA, JR., G.R. No. 190681
Petitioner,
Present:
CORONA, C.J.,
CARPIO,
CARPIO MORALES,
VELASCO, JR.,
NACHURA,
- versus - LEONARDO-DE CASTRO,
BRION,
PERALTA,
BERSAMIN,
DEL CASTILLO,
ABAD,
VILLARAMA, JR.,
PEREZ, and
MENDOZA, JJ.
CITY GOVERNMENT OF DAVAO,
Respondent. Promulgated:
June 21, 2010
x ---------------------------------------------------------------------------------------- x
DECISION
ABAD, J.:

This case is about the failure of a citys medical health officer and disaster
coordinator to respond to a catastrophic bombing incident upon the excuse that he
needed to attend first to the needs of his family.

The Facts and the Case

On February 1, 2001 the City Government of Davao appointed petitioner Dr.

Edilberto Estampa, Jr. as Medical Officer VI at its City Health Office. The position
made him head of a Task Force Unit assigned to deal with any untoward event
taking place in the city and Disaster Coordinator for the Davao City Health Office
under the Davao City Disaster Coordinating Council.

On March 4, 2003, at around 6 p.m., a powerful bomb exploded at the passengers

terminal of the Davao International Airport, killing 22 persons and injuring 113
others. Dr. Estampa had just arrived home at that time and was taking care of his
one-year-old daughter. He learned of the bombing incident between 7 to 8 p.m. His
wife arrived at 9 p.m. from her work at the Davao Medical Center where most of the
bombing victims were brought for treatment. She prevailed on Dr. Estampa to stay
home and he did.
On March 6, 2003 Dr. Roberto V. Alcantara, Officer-in-Charge of the Davao City
Health Office, required Dr. Estampa to explain in writing why he failed to respond to
the bombing incident. Dr. Estampa submitted his explanation. Apparently satisfied
with the explanation and believing that Dr. Estampas presence in the aftermath of
the bombing was not indispensable considering the presence of other medical
practitioners, Dr. Alcantara considered the case closed. The latter did not, however,
bother to endorse the case to a superior officer or to the City Legal Office with his
recommendation.

About 10 months later or on January 26, 2004 Dr. Josephine J. Villafuerte, the Davao
City Health Officer, queried the head of the Citys Human Resource Management
Office (HRMO) regarding the status of the case against Dr. Estampa for failing to
respond to the bombing incident. Reacting to this, the HRMO endorsed the matter to
the City Legal Office for verification and investigation. Subsequently, the Assistant
City Legal Officer required Dr. Estampa to answer the charge against him. But he did
not do so.

On March 19, 2004 the Assistant City Legal Officer submitted an Investigation
Report, finding a prima facie case against Dr. Estampa for neglect of duty [1] and
recommending the filing of a formal charge against him. The city mayor approved
the report and signed the formal charge. On receiving the same, Dr. Estampa filed
his answer and supporting documents.

At the pre-trial, Dr. Estampa waived his right to counsel. The parties agreed to
dispense with a formal hearing and to just submit their position papers or
memoranda. On November 12, 2004 the City Legal Officer found Dr. Estampa guilty
of grave neglect of duty and recommended his dismissal. On February 8, 2005 the
city mayor approved the recommendation and dismissed Dr. Estampa. The latter
moved for reconsideration but this was denied, prompting him to appeal to the Civil
Service Commission (CSC).

On June 2, 2006 the CSC denied Dr. Estampas appeal, corrected the denomination
of his offense to gross neglect of duty, and affirmed his dismissal. The CSC also
denied Dr. Estampas motion for reconsideration for lack of merit.

Dr. Estampa appealed to the Court of Appeals (CA) by petition for review under Rule
43. The CA denied his application for issuance of a TRO and writ of preliminary
injunction and eventually rendered a decision on March 30, 2009, denying his
petition and affirming the resolutions of the CSC. The CA also found no merit in his
motion for reconsideration.

The Issue Presented

The only issue presented in this case is whether or not the CA erred in affirming the
rulings of the City Legal Officer and the CSC that found Dr. Estampa guilty of gross
neglect of duty for failing to respond to the March 4, 2003 Davao City bombing.

The Ruling of the Court

Dr. Estampa points out that his dismissal was void because: (1) neither a proper
complaint nor a formal charge initiated the case against him; (2) the CA considered
and appreciated evidence not presented at the hearing before the City Legal Officer;
(3) the delay in the preliminary investigation of Dr. Estampas case violated his
rights to due process and speedy disposition of his case; (4) he could not be held
liable for gross neglect of duty since the charge against him was only for simple
neglect of duty; and (5) the evidence presented did not support the findings against
him.

1. But, as the Davao City government pointed out, Executive Order (E.O.) 292 (the
1987 Administrative Code)[2] and the CSC Uniform Rules on Administrative Cases
vest in heads of cities the power to investigate and decide disciplinary actions
against their officers and employees.[3] E.O. 292 also allows the heads of local units,
like the mayor, the authority to initiate administrative actions against subordinate
officials or employees[4] even without the complaints being subscribed and sworn to.
[5]
In these proceedings, a person is considered formally charged a) upon charges
initiated by the disciplining authority or b) upon the finding by such disciplining
authority of a prima facie case against him based on a private persons complaint. [6]

The Davao City Health Officers inquiry into the status of Dr. Estampas case did not
partake of a complaint under E.O. 292 as he suggests. That inquiry was a mere
follow up of the fact-finding investigation that Dr. Alcantara began. Nor did the City
Legal Officers order during the preliminary investigation, which required Dr.
Estampa to file his answer and supporting documents, constitute the complaint
under the law. That order was merely an incident of the preliminary investigation. [7]

The real formal charge against Dr. Estampa was that which the city mayor signed,
charging the doctor, in his capacity as Disaster Coordinator of the City Health Office,
with neglect of duty for failing to respond to the March 4, 2003 bombing
in Davao. That formal charge directed him to submit his answer, accompanied by
the sworn statements of his witnesses, and to indicate if he preferred a formal trial
or would rather waive it. He was thus properly charged.
2. Dr. Estampa claims that the CA considered and appreciated evidence that was
not presented before the City Legal Officer, in particular referring to the letters of
Dr. Villafuerte (to the HRMO inquiring about the status of the case against him), Mr.
Escalada, HRMO head (endorsing the case to the City Legal Office), and the affidavit
of Dr. Samuel G. Cruz, Assistant City Health Officer (that Dr. Estampa failed to
answer phone calls to him after the bombing and that he ignored the driver who
was sent to fetch him).Dr. Estampa was not furnished with copies of these
documents which were mentioned for the first time only on appeal to the CSC in the
City Governments Comment.

The letters of Dr. Villafuerte and Mr. Escalada are official communications and form
part of the records of the case. They are public documents. As to the affidavit of Dr.
Cruz, the City Government admits that it was not presented in evidence although it
still formed part of the case records since it was officially endorsed to the City Legal
Office by Dr. Cruz.

The decisions of the CSC and the CA are not based only on these documents. Dr.
Estampas guilt is evidenced by his own evidence and inaction, as will be shown
later on.The letters of Dr. Villafuerte and Mr. Escalada merely show the process of
investigation of the case. Dr. Cruzs affidavit is also merely corroborating at best and
may even be dispensed with.

3. Dr. Estampa cannot complain that he was not heard on his defense. The record
shows that, initially, his immediate superior asked him to explain why he did not
respond to the bombing incident and he submitted his explanation. In the next
instance, he was asked during the preliminary investigation to file his answer and
submit evidence in his defense although he chose not to do so. After being formally
charged, he was again asked to file his answer to the charge. And he filed one,
accompanied by supporting documents. He also took part at the pre-trial and
elected to have the case decided based on the parties position paper or
memorandum. Surely, Dr. Estampa has no reason to complain of denial of his right
to due process.

Dr. Estampa laments that almost a year passed from the time his immediate
superior asked him to submit a written explanation of the incident to the time when
preliminary investigation of his case began. The delay, according to him, violated
his right to the speedy disposition of his case.

But, Dr. Alcantaras action cannot be regarded as part of the administrative

proceeding against Dr. Estampa. It was but a fact-finding investigation done by an
immediate superior to determine whether disciplinary action was warranted in his
case. And, although Dr. Alcantara was later heard to say that he regarded the
matter closed after reading Dr. Estampas explanation, Dr. Alcantara took no step to
formalize his finding by reporting the matter to his superior, the Davao City Health
Officer, with his recommendation.

Besides, to reiterate what the CA said, the right to speedy disposition of cases may
be deemed violated only when the proceedings are attended by vexatious,
capricious, and oppressive delays. In this case, the Assistant City Legal Officer
finished the preliminary investigation of Dr. Estampas case in only a little over three
weeks from the time it began.
4. The claim of Dr. Estampa that he could not be found guilty of gross neglect of
duty when he was charged only with simple neglect of duty is unmeritorious. The
charge against the respondent in an administrative case need not be drafted with
the precision of the information in a criminal action. It is enough that he is informed
of the substance of the charge against him. And what controls is the allegation of
the acts complained of, not the designation of the offense in the formal charge.
[8]
Here, the formal charge accused him of failing to respond, as was his duty as
Disaster Coordinator of the City Health Office, to the March 4, 2003 bombing
incident that saw many people killed and maimed. It was a serious charge although
the formal charge failed to characterize it correctly as gross neglect of duty.

Gross neglect of duty denotes a flagrant and culpable refusal or unwillingness of a

person to perform a duty. [9] It has been held that gross negligence exists when a
public officials breach of duty is flagrant and palpable. [10]

5. Dr. Estampa claims that the city failed to show that he had an obligation to
respond to the Davao City bombing and that no one advised him of his duties and
responsibilities as city health offices Coordinator to the Disaster Coordinating
Council. But Dr. Estampa cannot claim ignorance of his duties. The local government
code, the provision of which he may be assumed to know, provides that a
government health officer has the duty, among others, to be in the frontline of the
delivery of health services, particularly during and in the aftermath of man-made
and natural disasters and calamities. [11] Furthermore, as Medical Officer VI, one of
his specified duties was to act as head of a task force unit for any untoward events
in his area of responsibility. It was precisely because of his position as Medical
Officer VI that he had been designated Disaster Coordinator for his office.

When Dr. Estampa accepted his post and swore to perform his duties, he entered
into a covenant with the city to act with dedication, speed, and courage in the face
of disasters like the bombing of populated places in the city. As the CA pointed out,
the bombing incident on March 4, 2003 caused so many deaths and injuries that the
victims had to be farmed out among several hospitals in the city. Plainly, the City
needed public health officers to come to the rescue of the victims in whatever way
their sufferings or those of their families could be assuaged. As disaster coordinator,
the city needed Dr. Estampa to organize and coordinate all efforts to meet the
emergency. Yet, although he knew of the bombing, he chose to stay at home.

In his letter-explanation, Dr. Estampa justified his absence from the emergency
rooms of the hospitals to attend to the bombing victims with the claim that he
needed to attend to his family first. Initially, he could not leave his one-year-old
daughter because they had no house help. When his wife arrived from work shortly,
he also could not leave because she was six months pregnant. Further, a bomb was
found some meters from their apartment a few weeks earlier. Dr. Estampa said in
his letter that he was unable from the beginning to give full commitment to his job
since he gave priority to his family. He simply was not the right person for the job of
disaster coordinator.

Dr. Estampas defense is not acceptable. A persons duty to his family is not
incompatible with his job-related commitment to come to the rescue of victims of
disasters.Disasters do not strike every day. Besides, knowing that his job as senior
medical health officer entailed the commitment to make a measure of personal
sacrifice, he had the choice to resign from it when he realized that he did not have
the will and the heart to respond.

Assuming that he had a one-year-old daughter in the house, he could have taken
her to relatives temporarily while his wife was still on her way from work. But he did
not.And when his wife arrived shortly at 9 p.m., he still did not leave under the
pretext that his wife was six months pregnant. Yet, he had in fact permitted her to
work away from home up to the evening. What marked his gross irresponsibility was
that he did not even care to call up his superior or associates to inform them of his
inability to respond to the emergency. As a result, the city health office failed to
provide the needed coordination of all efforts intended to cope with the
disaster. Who knows? Better coordination and dispatch of victims to the right
emergency rooms could have saved more lives.

The Court finds no excuse for reinstating Dr. Estampa to the position he abandoned
when it needed him.

WHEREFORE, the Court DISMISSES the petition and AFFIRMS the decision dated
March 30, 2009 and resolution dated November 20, 2009 of the Court of Appeals in
CA-G.R. SP 02191-MIN.
SO ORDERED.

ROBERTO A. ABAD
Associate Justice

WE CONCUR:
RENATO C. CORONA
Chief Justice

ANTONIO T. CARPIO CONCHITA CARPIO MORALES

Associate Justice Associate Justice

PRESBITERO J. VELASCO, JR. ANTONIO EDUARDO B. NACHURA

Associate Justice Associate Justice

TERESITA J. LEONARDO-DE CASTRO ARTURO D. BRION

Associate Justice Associate Justice

DIOSDADO M. PERALTA LUCAS P. BERSAMIN

Associate Justice Associate Justice

MARIANO C. DEL CASTILLO MARTIN S. VILLARAMA, JR.

Associate Justice Associate Justice

(On Leave)
JOSE PORTUGAL PEREZ JOSE CATRAL MENDOZA
Associate Justice Associate Justice
CERTIFICATION
Pursuant to Section 13, Article VIII of the Constitution, it is hereby certified that the
conclusions in the above Decision had been reached in consultation before the case
was assigned to the writer of the opinion of the Court.

RENATO C. CORONA
Chief Justice

Republic of the Philippines

SUPREME COURT
Manila
THIRD DIVISION
G.R. No. 203080 November 12, 2014
DR. IDOL L. BONDOC, Petitioner,
vs.
MARILOU R. MANTALA, Respondent.
DECISION
VILLARAMA, JR., J.:
Before us is a petition for review on certiorari assailing the Decision 1 dated May 24,
2012 and Resolution2 dated August 14, 2012 of the Court of Appeals (CA) in CA-G.R.
SP No. 120563. The CA affirmed the Decision 3 dated August 12, 2010 and
Order4 dated February 28, 2011 of the Office of the Deputy Ombudsman for Luzon in
OMB-L-A-09-0681-K.
The Facts
On November 6, 2009, Marilou R. Mantala (respondent) filed a complaint for grave
misconduct against Dr. Idol L. Bondoc (petitioner), Medical Officer III at the Oriental
Mindoro Provincial Hospital (OMPH).
Respondent was admitted at the OMPH on April 3, 2009, at around 11 :00 in the
morning, with referral5 from the Bansud Municipal Health Office (BMHO). She was
due to deliver her fifth child and was advised by the BMHO for a cesarean section
because her baby was big and there was excessive amniotic fluid in her womb. She
started to labor at 7:00 in the morning and was initially brought tothe Bongabon
Health Center. However, said health center also told her to proceed directly to the
hospital.
In her complaint-affidavit,6 respondent alleged that inside the delivery room of
OMPH, she was attended toby petitioner who instructed the midwife and two
younger assistants topress down on respondents abdomen and even demonstrated
to them how to insert their fingers into her vagina. Thereafter, petitioner went out of
the delivery room and later, his assistants also left. As she labored in pain, she felt
the movement of her baby inside her womb and the intermittent stiffening of her
abdomen.
At about 4:00 in the afternoon, petitioner returned to the delivery room and asked
her, "Hindi ka pa nanganganak?" Since she could no longer bear the pain, she
requested petitioner to perform a cesarean section but this was not done. The
midwife arrived and berated her for not yet sleeping and holding on to the steelbar.
The midwife and the younger assistants again pressed down on her abdomen
causing excruciating pain on her ribs and made her very weak. They repeatedly did
this pressing until the baby and placenta came out. When she regained
consciousness, she was already at the recovery room. She learned that an operation
was performed on her by petitioner to removeher ruptured uterus but what
depressed her most was her stillborn baby and the loss of her reproductive capacity.
The next day, she was transferred to a ward. She noticedher very swollen vulva and
her surgical wound open with liquid squirting from it. Her wound was regularly
cleaned by a nurse. On April 9, 2009, she was discharged notwithstanding that the
suture on her wound needs to be fixed and she still has a cough. At home, she took
the antibiotics, cough medicine and multivitamins prescribed by petitioner.
After two days, the opening in her wound widened.Her husband brought her to the
Bongabon Community Hospital but they were advised to have her wound re-stitched
by the samesurgeon (petitioner) who operated on her. Thus, on April 14, 2009,
theywent back to OMPH. She was attended to by a certain Dr. Gonzales who cleaned
her wound which now has a lot of pus, and the said doctor commented that
"problema ito ni Bondoc." On April 18, 2009, after she was given blood transfusion,
petitioner re-stitched her wound. Thereafter, it was Dr. Gonzales who regularly
checked on her condition.
On April 27, 2009, petitioner removed the sutures but still left open three of them.
She wondered then why petitioner suddenly showed kindness towards her. In the
evening of April 28, 2009, petitioner talked to her and said in a threatening tone
"Ikaw ang sadyang ayaw magpa-cs" and also told her that he just came from
Pinamalayan and Bansud and already talked to Dr. Atienza and Dr. Sales. Petitioner
then told the nurse on duty, "Papirmahin mo si Mantala, pauuwiin ko na yan bukas.
Tanggalin mo na rin ang tahi." He further said, "huwag sana akong idemanda ni
Mantala kasi kaya ko siyang baligtarin." The following day, she was discharged after
the nurse had removed the remaining sutures. At home, it was her sister who
cleaned the still open wound. Joel F. Mantala, respondents husband, and her sisters
Mylen R. Amistad and Lucia Rala, executed their respective affidavits 7 to corroborate
her story. In addition, respondent submitted the affidavit of Dr. Rosinico F. Fabon, the
anesthesiologist on duty during the operation performed by petitioner on April 3,
2009.
Joel Mantala claimed that at the OMPH at around 2:30 in the afternoon when her
wife was still laboring, petitioner talked to him and told her that the baby is too big
and if it comes out alive it will probably be abnormal so that it would be better ifthe
baby is stillborn. He further averred that despite the pleas of her wife for a cesarean
operation, petitioner insisted on a normal delivery during which she almost died. 8
On the other hand, Dr. Fabon narrated that in the afternoon of April 3, 2009, he was
attending to a patient being operated on by petitioner when he heard the latter
saying that "meron pa nga kami sa DR macrosomia, polyhydramnios pa, pero
paanakin na lang yon, abnormal din naman ang bata kahit mabuhay, kawawa lang
siya." After the operation, petitioner went out of the Operating Room (OR)and
proceeded towards the direction of the OB ward. At 5:35 in the afternoon, a Request
for Surgery9 was forwarded to the OR for Emergency Pelvic Laparotomy of
respondent with a diagnosis of T/C Ruptured Uterus.
When respondent was brought to the OR at 8:15 p.m., Dr. Fabon found her
conscious but very weak and pale, with abdominal pain and tenderness on very
slight palpation. He then heard from petitioner himself that it was the same patient
he was referring to earlier with a diagnosis of macrosomia, polyhydramnios.
Petitioner volunteered that respondent had just delivered her baby but that her
uterus probably ruptured in the process of childbirth. "Pinilit nong tatlong ungas,
ayon lumusot pero patay ang bata, tapos ito, mukhang pumutok," petitioner said.
Dr. Fabon immediately prepared respondent for General Anesthesia; respondent was
inducted at 8:35 p.m. while surgery began at 8:45 p.m. He continued to narrate
what transpired next and his observations, as follows:
That right after induction when patient was asleep already and dont feel any pain
at all her blood pressure suddenly dropped to 70/40 mmHg;
That after opening the abdomen, I saw massive hemoperitonium and the ruptured
uterus with bleeding from various directions. I immediately requested for additional
blood to be used intra-operatively while at the same time I established another
intravenous lineso as to cope with on-going surgical blood loss. I had now three big-
bore fast-dripping IV lines.
That in spite of this measure,blood pressure dropped to 50/30 mmHg. There was an
instance wherein I cannot even appreciate the blood pressure of the patient, her
pulse hardly noticeable on palpation and she was very pale that necessitates
turning the anesthetic gas off so as to keep her alive. She was given a dose of
Atropine after patientdid not respond to two 10mg doses of Ephedrine. I prescribed
Dobutamine and Dopamine drips to help improve her blood pressure and maintain
adequate urine output. Unfortunately, only Dopamine was available. I had to use
100% Oxygen at 3L/minute without mixture ofvolatile gas for several minutes. She
was maintained using musclerelaxants alone on controlled ventilation.
That Dr. Bondoc operated on the patient all by himself without the help of a
consultant or an assistant surgeon. Nowhere in the patient chart will show that he
referred this case tohis consultant; one thing that I was wondering why he was
doing the surgery alone. He utilized the scrub nurse to assist him making a delicate
and bloody surgery more bloody and difficult.
That after Dr. Bondoc had removed the ruptured uterus and the bleeding was
controlled, he made intra-operative referral to Dr. Ariel Tria, a resident surgeon, to
check on the urinary bladder and the ureters.
That the operation performed was Subtotal Hysterectomy with Unilateral
Salpingooophorectomy. I noticed that the operation technique was different from
that which Dr. Bondoc had written in the Surgical Memo and that the patient did
nottolerate the procedure well.
That the patient was very pale after the procedure with low blood pressure due to
massive blood loss. That her blood pressure started to improve at the Recovery
Room but the pulse rate remained considerably high for several hours. Her urine
outputwas inadequate and that it had to be maintained using Dopamine.
That when Leo Reyes, the Recovery Room nurse, referred the patient to me and I
checked the urinary catheter, I noticed her vagina to be massively swollen with
hematomas all over.
That the patient had to be referred to Internal Medicine for comanagement[.]
That Marilou Mantala stayed in the Recovery Room for almost eleven (11) hours.
She was transferred to Gyne Ward at 9:20 AM the following day. 10
In his counter-affidavit,11 petitioner averred thatwhen respondent was brought to
OMPH with referral form from BMHO, she had been in labor for more than twelve
(12) hours at home. He submitted his admitting diagnosis of the patient, "Gravida 5
Parity 4 (4004) Pregnancy Uterine 38 to 39 Weeks Age of Gestation by Last
Menstrual Period Cephalic in Labor; Macrosomia; Fetal Death in Utero."
Petitioner alleged that during his interview with respondent, the latter admitted to
him that she doesnt want tobe confined at any hospital because she was afraid to
be handled by medical doctors. Instead, she went to a traditional birth attendant
(TBA) or "hilot" which she voluntarily named as Apolonia Salcedo, residing at
Dalapian, Labasan, Bongabon, Oriental Mindoro. Respondent clearly defied the
advice of Drs. Theresa Atienza and Mario Sales not to give birth at home. As to her
swollen vulvar hematoma which was noticed by Dr. Fabon, it was the result of
prolonged labor.
As to the charge that he abandoned the respondent to his assistants, petitioner
claimed that between 12 noonand 2:00 oclock in the afternoon, he was busy
checking on pregnant patients at the out-patient department (OPD) of OMPH until
he was called for his first cesarean section (CS). Later at 4:00 oclock, without
resting and having lunch, he visited respondent and other admitted patients atthe
delivery room. Together with the nurse on duty, Mrs. Evelyn D. Morales, petitioner
said he explained to respondent her and her babys condition based on the referral
from BMHO (polyhydramnios)and initial findings that her abdomen and baby were
big and the babys heartbeat is not appreciated. He presented the respondent with
two options: have a normal delivery or undergo cesarean section, and the
consequences of each choice. Respondent chose the former believing that she can
handle this childbirth at home, and petitioner respected her decision.
After seeing other patients at the delivery room, petitioner was called for his second
CS that day. Thus, he was obliged to proceed to the OR and left the respondent
under the care of three assistants, one of whom is an experienced midwife. That he
was not the one who attended to the respondent during her delivery is confirmed by
the statements of respondent herself, Dr. Fabon and Mrs. Morales. Further,
petitioner claimed it has been a long-time practice at OMPH that whenever the
doctor is at the OR, the experienced midwives will take over the delivery of laboring
patients.
Petitioner blamed respondent for risking her own life in not seeking immediately a
higher level of medical care and instead preferring a TBA who is prohibited under a
2006 provincial circular tohandle deliveries at home. He emphasized that upon
admission the fetal heart tone is no longer appreciated and maintained that diligent
care was extended to respondent during her stay at OMPH. As to the complications
like cough and wound dehiscence, he explained that these were the effects of
anesthesia and surgery (loss of blood, massive bloodtransfusion and intravenous
fluid infusion), and also poor compliance withprescribed medication. He further
asserted that he had referred the patient to other co-doctors on duty like Dr. Romy
Lomio (Internal Medicine) for co-management.
On April 23, 2010, petitioner submitted a manifestation that he had resigned as
Medical Officer of OMPH effective March 5, 2010. He thus posited that the
administrative case isnow rendered moot and academic.
On August 12, 2010, the Office of the Deputy Ombudsman for Luzon rendered a
Decision finding the petitioner administratively liable. It held that by fully entrusting
to his subordinates the task of handling respondents complicated delivery,
petitioner exhibited an improper or wrongful conduct and dereliction of duty as
medical practitioner. Being the most competent person who should have rendered
the appropriate medical service to respondent, petitioner should have personally
attended to the latter. Such action or inaction of his part amounts tointentional or
willful neglect in discharging his sworn duty as a government physician which is also
equivalent to misconduct in office. The administrative case filed against the
respondent is also not rendered moot by his subsequent resignation in office.
The Decision of the OMB thus decreed:
WHEREFORE, judgment is hereby rendered finding respondent Medical Officer Idol L.
Bondoc of Oriental Mindoro Provincial Hospital (OMPH), Barangay Ilaya, Calapan
City, Oriental Mindoro, guilty of Grave Misconduct.
Respondent Idol L. Bondocis hereby meted the penalty of DISMISSALin the
Government Service pursuant to Section 10, Rule III, Administrative Order No. 07, as
amended by Administrative Order No. 17, in relation to Section 25 of Republic Act
No. 6770. The penalty of dismissal shall carry with it that of cancellation of
eligibility, forfeiture of the retirement benefits, and the perpetual disqualification for
reemployment in the government service pursuant to Section 58, Rule IV of the
Uniform Rules on Administrative Cases in the Civil Service.
The Honorable Governor of the Province of Oriental Mindoro, is hereby directed to
implement this DECISION immediately upon receipt thereof pursuant to Section 7,
Rule III of Administrative Order No. 7, as amended by Administrative Order No. 17
(Ombudsman Rules of Procedure) in relation to Memorandum Circular No. 1, series
of 2006 dated 11 April 2006 and to promptly inform this Office of the action taken
hereon.
SO DECIDED.12
The foregoing ruling was affirmedby the CA and petitioners motion for
reconsideration was denied.
The CA concurred that petitioner should have chosen to stay in the delivery room
and personally attend to the patient as he is the most competent person to render
medical service in view of respondents critical condition. It likewise faulted the
petitioner for deliberately leaving the laboring and unstable respondent tothe care
of his inexperienced subordinates at the time she was about to give birth. As to
petitioners excuse that he had to attend to an equally important cesarean
operation, the CA said there was no sufficient showing of the latters urgency and
assuming it to be true, still, petitioner should have exerted efforts to refer
respondents case to another competent doctor or one of his consultants.
Petitioner is now before this Court arguing that the CA erred in affirming the
Ombudsmans ruling that he is guilty of grave misconduct and imposing on him the
penalty of dismissal from the service. He reiterates that his failure to attend to
respondent was not without justification and that in the seven years he had been a
medical officer of OMPH, he has dutifully observed the sworn duties of the medical
profession and would not neglect his responsibilities nor commit misconductat the
risk of his medical career which he had nurtured through the years.
The petition has no merit.
Misconduct is defined as a transgression of some established and definite rule of
action, more particularly, unlawful behavior or gross negligence by a public
officer,13 a forbidden act, a dereliction of duty, willful in character, and implies
wrongful intent and not mere error in judgment. 14 It generally means wrongful,
improper or unlawful conduct motivated by a premeditated, obstinate or intentional
purpose. The term, however, does not necessarily imply corruption or criminal
intent. To constitute an administrative offense,misconduct should relate to or be
connected with the performance of the official functions and duties of a public
officer. On the other hand, whenthe elements of corruption, clear intent to violate
the law or flagrant disregard of established rule are manifest, the public officer shall
be liable for grave misconduct. 15
In this case, both the Ombudsman and CA found the petitioner guilty of grave
misconduct in failing to attend to respondent when she was having prolonged
difficult labor and vaginal delivery after being diagnosed with macrosamiaand
polyhydramnios.
Polyhydramniosis an abnormal condition occurring in pregnancy, characterized by
excessive amniotic fluid (the fluid surrounding the baby in the uterus). Apart from
protecting the baby from any external impact by providing a cushioning effect, the
clear or slightly yellowish fluid plays a vital role in proper fetal development aswell.
However, increased levels of the fluid can cause various complications during
different stages of pregnancy and childbirth. 16Intra-amniotic pressureis markedly
elevated in most patients with severe hydramnios. The incidence of cesarean
section is also increased as a result of unstable lie and placental abruption, which
may occur with the rapid decrease in intrauterine pressure that accompanies
membrane rupture.17 One of the known causes and risk factors of polyhydramniosis
fetal macrosomia (having a baby too large for the gestational age). 18
According to medical authorities,a macrosomic infant poses a different set of
complications. The incidences of shoulder dystocia, 19 birth injuries, perinatal death,
and low Apgar scores are increased in macrosomic infants. 20 In these cases, careful
attention to the patient, potential risk factors, clinical progress, and fetal size should
allow obstetricians to reduce the occurrence of maternaland neonatal
morbidity.21 Vaginal delivery of the macrosomic infant is associated with anincreased
incidence of birth trauma. The question whether to perform cesarean section thus
arises.22
If the estimated fetal weight is 4000 to 4500 g by ultrasonography and the patient
has a clinically adequate pelvis, labor may be allowed. If labor is protracted or the
second stage is prolonged, a cesarean section would avoid the possible trauma of a
difficult vaginal delivery. Because of the greater morbidity associated with infants
who weigh more than 4500 g, elective cesarean section is warranted. 23
On the other hand, prolonged labormay culminate in obstructed labor, and is
associated with maternal infection, uterine rupture and postpartum hemorrhage. 24
As per the admitting diagnosis 25 submitted by petitioner, the latter was aware of
macrosomia and the fetal heartbeat notappreciated. He also maintains that
respondents baby was already dead due to prolonged labor but she had insisted on
having a normal delivery. However, this claim is belied by the sworn statements of
respondent, her husband and her sisters, all of whom averred that they requested
for a cesarean section as per the advice given by Dr. Atienza who examined her in
March 2009, and as confirmed at the Bansud Health Center where she was told that
it would be risky for her to have a normal delivery.Moreover, Joel Mantala asserted
that what petitioner said to him was that the baby was too big and if born alive it
would probably have abnormalities so it would be better that the baby is stillborn.
The Court is more inclined to believe respondents version which was duly
corroborated by Dr. Fabon who heard petitioner saying that: "Meron pa nga kami sa
DR macrosomnia, polyhydramnios pa, pero paanakin na lang yon. Abnormal din
namanang bata kahit mabuhay." This puts into doubt petitioners supposed finding
that the baby was already dead upon respondents admission at OMPH and thatit
was respondent who insisted on a normal delivery. Even assuming that petitioner
had actually confirmed intrauterine fetal death, this only aggravates the patients
condition and it was incumbent upon petitioner as the obstetrician on duty to
personally attend to her and render appropriate management or treatment.
In deliberately leaving the respondent to a midwife and two inexperienced
assistants despite knowing that she was under prolonged painful labor and about to
give birth to a macrosomic baby by vaginal delivery, petitioner clearly committed a
dereliction of duty and a breach of his professional obligations. The gravity of
respondents condition is highlighted by the expected complications she suffered
her stillborn baby, a ruptured uterus that necessitated immediate surgery and blood
transfusion, and vulvar hematomas.
Article II, Section 1 of the Code of Medical Ethics of the Medical Profession in the
Philippines states:
A physician should attend to his patients faithfully and conscientiously. He should
secure for them all possible benefits that may depend upon his professional skill
and care. As the sole tribunal to adjudge the physicians failure to fulfill his
obligation to his patients is, in most cases, his own conscience, violation of this rule
on his part is discreditable and inexcusable. 26
A doctors duty to his patient is not required to be extraordinary. The standard
contemplated for doctors issimply the reasonable average merit among ordinarily
good physicians, i.e.reasonable skill and competence. 27 Even by this standard,
petitioner fell short when he routinely delegated an important task that requires his
professional skill and competence to his subordinates who have no requisite training
and capability to make crucial decisions in difficult childbirths.
Petitioners proffered excuse that it was the practice in OMPH to allow midwives to
administer to patients during deliveries, is unacceptable. No proof of such alleged
hospital practice such as an official written directive was presented. Besides, it is
doubtful whether hospital administrators would remedy personnel shortage by
permitting inexperienced staff, by themselves, to handle laboring patients with
high-risk pregnancies and maternal/fetal complications.
As to the two other scheduled CS performed by petitioner on the same day, this will
not exculpate him from administrative liability.1wphi1 As correctly pointed out by
the CA, there was no showing of similar urgency in the said operations, and
petitioner could have referred respondent to another competent physician. He could
have likewise arranged for adjustment in the operation schedules considering that
his personal attention and management is urgently needed in respondents difficult
and complicated delivery. But there is no indication in the records that petitioner
duly informed or referred the matter to the other doctors or the administrators of
OMPH.
We therefore hold that the CA correctly affirmed the Ombudsman in finding the
petitioner guilty of grave misconduct. His violation of the sworn duty to attend to his
patients faithfully and conscientiously is inexcusable. Such flagrant disregard of
established rule and improper conduct were proven by substantial evidence.
Not only did petitioner routinely delegate his responsibility to his subordinates, he
casually instructedthem to press down repeatedly on respondents abdomen,
unmindful of her critical condition as borne out by his very own findings. Worse,
petitioner haughtily and callously spoke of respondents case to the other doctors
and medical staff while performing a CS after he had briefly attended to her at the
delivery room "paanakin na lang yon, abnormal din naman ang bata kahit
mabuhay, kawawa lang siya." Such insensitive and derisive language was again
heard from the petitioner when he referred for the second time to respondents
traumatic delivery, saying that: "Pinilit nong tatlong ungas,ayon lumusot pero patay
ang bata, tapos ito, mukhang pumutok." As a government physician, petitioners
demeanor is unbecoming and bespeaks of his indifference to the well-being of his
patients.
Petitioner thus not only committed a dereliction of duty, but also transgressed the
ethical norms of his profession when he failed to render competent medical care
with compassion and respect for his patients dignity.
A physician should be dedicated to provide competent medical care with full
professional skill in accordance with the current standards of care, compassion,
independence and respect for human dignity. 28 (Italics supplied.)
Finally, we find no merit in petitioner's argument that the CA should have at least
considered as mitigating circumstances his being a first offender, 29 his 16 years in
government service, and that he had not acted in bad faith and with clear intent to
violate the law and established rules. Jurisprudence is replete with cases declaring
that a grave offense cannot be mitigated by the fact that the accused is a first time
offender or by the length of service of the accused. 30 While in most cases, length of
service is considered in favor of the respondent, it is not considered where the
offense committed is found to be serious or grave. 31 In Medina v. Commission on
Audit,32the Court stressed that dishonesty and grave misconduct have always been
and should remain anathema in the civil service. They inevitably reflect on the
fitness of a civil servant to continue in office. When an officer or employee is
disciplined, the object sought is not the punishment of such officer or employee but
the improvement of the public service and the preservation of the public's faith and
confidence in the government. WHEREFORE, the petition is DENIED for lack of merit.
The Decision dated May 24, 2012 and Resolution dated August 14, 2012 of the
Court of Appeals in CA-G.R. SP No. 120563 are AFFIRMED and UPHELD.
With costs against the petitioner.
SO ORDERED.
MARTIN S. VILLARAMA, JR.
Associate Justice
WE CONCUR:
PRESBITERO J. VELASCO, JR.
Associate Justice
Chairperson

BIENVENIDO L. REYES ESTELA M. PERLAS-BERNABE*

Associate Justice Associate Justice
FRANCIS H. JARDELEZA
Associate Justice
ATTESTATION
I attest that the conclusions in the above Decision had been reached in consultation
before the case was assigned to the writer of the opinion of the Court's Division.
PRESBITERO J. VELASCO, JR.
Associate Justice
Chairperson, Third Division
CERTIFICATION
Pursuant to Section 13, Article VIII of the 1987 Constitution and the Division
Chairperson's Attestation, I certify that the conclusions in the above Decision had
been reached in consultation before the case was assigned to the writer of the
opinion of the Court's Division.
ANTONIO T. CARPIO
Acting Chief Justice
 Republic of the Philippines
Supreme Court
Manila

THIRD DIVISION

FE CAYAO-LASAM, G.R. No. 159132

Petitioner,
Present:

YNARES-SANTIAGO, J.,
Chairperson,
- versus - AUSTRIA-MARTINEZ,
CHICO-NAZARIO,
NACHURA, and
REYES, JJ.
SPOUSES CLARO and
EDITHA RAMOLETE, Promulgated:
Respondents.* December 18, 2008
x-------------------------- -------------------------------x

DECISION

AUSTRIA-MARTINEZ, J.:

Before the Court is a Petition for Review on Certiorari under Rule 45 of the Rules of Court
filed by Dr. Fe Cayao-Lasam (petitioner) seeking to annul the Decision[1] dated July 4,
2003 of the Court of Appeals (CA) in CA-G.R. SP No. 62206.

The antecedent facts:

On July 28, 1994, respondent, three months pregnant Editha Ramolete (Editha) was
brought to the Lorma Medical Center (LMC) in San Fernando, La Union due to vaginal
bleeding.Upon advice of petitioner relayed via telephone, Editha was admitted to the LMC
on the same day. A pelvic sonogram[2] was then conducted on Editha revealing the fetus
weak cardiac pulsation.[3] The following day, Edithas repeat pelvic sonogram[4] showed that
aside from the fetus weak cardiac pulsation, no fetal movement was also appreciated. Due
to persistent and profuse vaginal bleeding, petitioner advised Editha to undergo a Dilatation
and Curettage Procedure (D&C) or raspa.

On July 30, 1994, petitioner performed the D&C procedure. Editha was discharged from the
hospital the following day.

On September 16, 1994, Editha was once again brought at the LMC, as she was suffering
from vomiting and severe abdominal pains. Editha was attended by Dr. Beatriz de la Cruz,
Dr. Victor B. Mayo and Dr. Juan V. Komiya. Dr. Mayo allegedly informed Editha that there was
a dead fetus in the latters womb. After, Editha underwent laparotomy,[5] she was found to
have a massive intra-abdominal hemorrhage and a ruptured uterus. Thus, Editha had to
undergo a procedure for hysterectomy[6] and as a result, she has no more chance to bear a
child.

On November 7, 1994, Editha and her husband Claro Ramolete (respondents) filed a
Complaint[7] for Gross Negligence and Malpractice against petitioner before the Professional
Regulations Commission (PRC).

Respondents alleged that Edithas hysterectomy was caused by petitioners unmitigated

negligence and professional incompetence in conducting the D&C procedure and the
petitioners failure to remove the fetus inside Edithas womb.[8] Among the alleged acts of
negligence were: first, petitioners failure to check up, visit or administer medication
on Editha during her first day of confinement at the LMC;[9] second, petitioner
recommended that a D&C procedure be performed on Editha without conducting any
internal examination prior to the procedure;[10] third, petitioner immediately suggested a
D&C procedure instead of closely monitoring the state of pregnancy of Editha.[11]

In her Answer,[12] petitioner denied the allegations of negligence and incompetence with the
following explanations: upon Edithas confirmation that she would seek admission at the
LMC, petitioner immediately called the hospital to anticipate the arrival of Editha and
ordered through the telephone the medicines Editha needed to take, which the nurses
carried out; petitioner visited Editha on the morning of July 28, 1994 during her rounds; on
July 29, 1994, she performed an internal examination on Editha and she discovered that the
latters cervix was already open, thus, petitioner discussed the possible D&C procedure,
should the bleeding become more profuse; on July 30 1994, she conducted another internal
examination on Editha, which revealed that the latters cervix was still
open; Editha persistently complained of her vaginal bleeding and her passing out of some
meaty mass in the process of urination and bowel movement; thus, petitioner
advised Editha to undergo D&C procedure which the respondents consented to; petitioner
was very vocal in the operating room about not being able to see an abortus;[13] taking the
words of Editha to mean that she was passing out some meaty mass and clotted blood, she
assumed that the abortus must have been expelled in the process of bleeding; it
was Editha who insisted that she wanted to be discharged; petitioner agreed, but she
advised Editha to return for check-up on August 5, 1994, which the latter failed to do.
Petitioner contended that it was Edithas gross negligence and/or omission in insisting to be
discharged on July 31, 1994 against doctors advice and her unjustified failure to return for
check-up as directed by petitioner that contributed to her life-threatening condition on
September 16, 1994; that Edithas hysterectomy was brought about by her very abnormal
pregnancy known as placenta increta, which was an extremely rare and very unusual case
of abdominal placental implantation. Petitioner argued that whether or not a D&C procedure
was done by her or any other doctor, there would be no difference at all because at any
stage of gestation before term, the uterus would rupture just the same.

On March 4, 1999, the Board of Medicine (the Board) of the PRC rendered a Decision,
[14]
exonerating petitioner from the charges filed against her. The Board held:

Based on the findings of the doctors who conducted

the laparotomy on Editha, hers is a case of Ectopic Pregnancy
Interstitial. This type of ectopic pregnancy is one that is being protected by
the uterine muscles and manifestations may take later than four (4) months
and only attributes to two percent (2%) of ectopic pregnancy cases.

When complainant Editha was admitted at Lorma Medical Center on July 28,
1994 due to vaginal bleeding, an ultra-sound was performed upon her and
the result of the Sonogram Test reveals a morbid fetus but did not specify
where the fetus was located. Obstetricians will assume that the pregnancy is
within the uterus unless so specified by the Sonologist who conducted the
ultra-sound. Respondent (Dr. Lasam) cannot be faulted if she was not able to
determine that complainant Editha is having an ectopic pregnancy
interstitial. The D&C conducted on Editha is necessary considering that her
cervix is already open and so as to stop the profuse bleeding. Simple
curettage cannot remove a fetus if the patient is having
an ectopic pregnancy, since ectopic pregnancy is pregnancy conceived
outside the uterus and curettage is done only within the uterus.Therefore, a
more extensive operation needed in this case of pregnancy in order to
remove the fetus.[15]

Feeling aggrieved, respondents went to the PRC on appeal. On November 22, 2000, the PRC
rendered a Decision[16] reversing the findings of the Board and revoking petitioners authority
or license to practice her profession as a physician.[17]

Petitioner brought the matter to the CA in a Petition for Review under Rule 43 of the Rules of
Court. Petitioner also dubbed her petition as one for certiorari[18] under Rule 65 of the Rules
of Court.
In the Decision dated July 4, 2003, the CA held that the Petition for Review under Rule 43 of
the Rules of Court was an improper remedy, as the enumeration of the quasi-
judicial agencies in Rule 43 is exclusive.[19] PRC is not among the quasi-judicial bodies whose
judgment or final orders are subject of a petition for review to the CA, thus, the petition for
review of the PRC Decision, filed at the CA, was improper. The CA further held that should
the petition be treated as a petition for certiorari under Rule 65, the same would still be
dismissed for being improper and premature. Citing Section 26[20] of Republic Act (R.A.) No.
2382 or the Medical Act of 1959, the CA held that the plain, speedy and adequate remedy
under the ordinary course of law which petitioner should have availed herself of was to
appeal to the Office of the President.[21]

Hence, herein petition, assailing the decision of the CA on the following grounds:

1. THE COURT OF APPEALS ERRED ON A

QUESTION OF LAW IN HOLDING THAT THE PROFESSIONAL
REGULATION[S] COMMISSION (PRC) WAS EXCLUDED AMONG THE
QUASI-JUDICIAL AGENCIES CONTEMPLATED UNDER RULE 43 OF THE
RULES OF CIVIL PROCEDURE;

2. EVEN ASSUMING, ARGUENDO, THAT PRC

WAS EXCLUDED FROM THE PURVIEW OF RULE 43 OF THE RULES OF
CIVIL PROCEDURE, THE PETITIONER WAS NOT PRECLUDED FROM
FILING A PETITION FOR CERTIORARI WHERE THE DECISION WAS ALSO
ISSUED IN EXCESS OF OR WITHOUT JURISDICTION, OR WHERE THE
DECISION WAS A PATENT NULLITY;

3. HEREIN RESPONDENTS-SPOUSES ARE

NOT ALLOWED BY LAW TO APPEAL FROM THE DECISION OF THE
BOARD OF MEDICINE TO THE PROFESSIONAL REGULATION[S]
COMMISSION;

4. THE COURT OF APPEALS COMMITTED

GRAVE ABUSE OF DISCRETION IN DENYING FOR IMPROPER FORUM
THE PETITION FOR REVIEW/PETITION FOR CERTIORARI WITHOUT
GOING OVER THE MERITS OF THE GROUNDS RELIED UPON BY THE
PETITIONER;

5. PRCS GRAVE OMISSION TO AFFORD

HEREIN PETITONER A CHANCE TO BE HEARD ON APPEAL IS A CLEAR
VIOLATION OF HER CONSTITUTIONAL RIGHT TO DUE PROCESS AND
HAS THE EFFECT OF RENDERING THE JUDGMENT NULL AND VOID;

6. COROLLARY TO THE FOURTH ASSIGNED

ERROR, PRC COMMITTED GRAVE ABUSE OF DISCRETION, AMOUNTING
TO LACK OF JURISDICTION, IN ACCEPTING AND CONSIDERING THE
MEMORANDUM ON APPEAL WITHOUT PROOF OF SERVICE TO HEREIN
PETITIONER, AND IN VIOLATION OF ART. IV, SEC. 35 OF THE RULES
AND REGULATIONS GOVERNING THE REGULATION AND PRACTICE OF
PROFESSIONALS;

7. PRC COMMITTED GRAVE ABUSE OF

DISCRETION IN REVOKING PETITIONERS LICENSE TO PRACTICE
MEDICINE WITHOUT AN EXPERT TESTIMONY TO SUPPORT ITS
CONCLUSION AS TO THE CAUSE OF RESPONDENT EDITHAT [SIC]
RAMOLETES INJURY;

8. PRC COMMITTED AN EVEN GRAVER ABUSE

OF DISCRETION IN TOTALLY DISREGARDING THE FINDING OF THE
BOARD OF MEDICINE, WHICH HAD THE NECESSARY COMPETENCE
AND EXPERTISE TO ESTABLISH THE CAUSE OF RESPONDENT EDITHAS
 INJURY, AS WELL AS THE TESTIMONY OF THE EXPERT WITNESS
AUGUSTO MANALO, M.D. ;[AND]

9. PRC COMMITTED GRAVE ABUSE OF DISCRETION IN

MAKING CONCLUSIONS OF FACTS THAT WERE NOT ONLY
UNSUPPORTED BY EVIDENCE BUT WERE ACTUALLY CONTRARY TO
EVIDENCE ON RECORD.[22]

The Court will first deal with the procedural issues.

Petitioner claims that the law does not allow complainants to appeal to the PRC from the
decision of the Board. She invokes Article IV, Section 35 of the Rules and Regulations
Governing the Regulation and Practice of Professionals, which provides:

Sec. 35. The respondent may appeal the decision of the Board within thirty
days from receipt thereof to the Commission whose decision shall be
final. Complainant, when allowed by law, may interpose an appeal
from the Decision of the Board within the same period. (Emphasis
supplied)

Petitioner asserts that a careful reading of the above law indicates that while the
respondent, as a matter of right, may appeal the Decision of the Board to the Commission,
the complainant may interpose an appeal from the decision of the Board only when so
allowed by law.[23] Petitioner cited Section 26 of Republic Act No. 2382 or The Medical Act of
1959, to wit:

Section 26. Appeal from judgment. The decision of the Board of Medical
Examiners (now Medical Board) shall automatically become final thirty days
after the date of its promulgation unless the respondent, during the same
period, has appealed to the Commissioner of Civil Service (now Professional
Regulations Commission) and later to the Office of the President of
the Philippines. If the final decision is not satisfactory, the respondent may ask
for a review of the case, or may file in court a petition for certiorari.

Petitioner posits that the reason why the Medical Act of 1959 allows only the respondent in
an administrative case to file an appeal with the Commission while the complainant is not
allowed to do so is double jeopardy. Petitioner is of the belief that the revocation of license to
practice a profession is penal in nature.[24]

The Court does not agree.

For one, the principle of double jeopardy finds no application in administrative cases. Double
jeopardy attaches only: (1) upon a valid indictment; (2) before a competent court; (3) after
arraignment; (4) when a valid plea has been entered; and (5) when the defendant was
acquitted or convicted, or the case was dismissed or otherwise terminated without the
express consent of the accused.[25] These elements were not present in the proceedings
before the Board of Medicine, as the proceedings involved in the instant case were
administrative and not criminal in nature. The Court has already held that double jeopardy
does not lie in administrative cases.[26]

Moreover, Section 35 of the Rules and Regulations Governing the Regulation and Practice of
Professionals cited by petitioner was subsequently amended to read:

Sec. 35. The complainant/respondent may appeal the order, the

resolution or the decision of the Board within thirty (30) days from receipt
thereof to the Commission whose decision shall be final
and executory.Interlocutory order shall not be appealable to the Commission.
(Amended by Res. 174, Series of 1990).[27] (Emphasis supplied)

Whatever doubt was created by the previous provision was settled with said
amendment. It is axiomatic that the right to appeal is not a natural right or a part of
due process, but a mere statutory privilege that may be exercised only in the
manner prescribed by law.[28] In this case, the clear intent of the amendment is to
render the right to appeal from a decision of the Board available to both
complainants and respondents.

Such conclusion is bolstered by the fact that in 2006, the PRC issued Resolution No. 06-
342(A), or the New Rules of Procedure in Administrative Investigations in the Professional
Regulations Commission and the Professional Regulatory Boards, which provides for the
method of appeal, to wit:

Sec. 1. Appeal; Period Non-Extendible.- The decision, order or resolution

of the Board shall be final and executory after the lapse of fifteen (15) days
from receipt of the decision, order or resolution without an appeal being
perfected or taken by either the respondent or the complainant. A party
aggrieved by the decision, order or resolution may file a notice of
appeal from the decision, order or resolution of the Board to the
Commission within fifteen (15) days from receipt thereof, and serving
upon the adverse party a notice of appeal together with the appellants brief
or memorandum on appeal, and paying the appeal and legal research fees.
x x x[29]

The above-stated provision does not qualify whether only the complainant or respondent
may file an appeal; rather, the new rules provide that a party aggrieved may file a notice of
appeal.Thus, either the complainant or the respondent who has been aggrieved by the
decision, order or resolution of the Board may appeal to the Commission. It is an elementary
rule that when the law speaks in clear and categorical language, there is no need, in the
absence of legislative intent to the contrary, for any interpretation. [30] Words and phrases
used in the statute should be given their plain, ordinary, and common usage or meaning.[31]

Petitioner also submits that appeals from the decisions of the PRC should be with the CA, as
Rule 43[32] of the Rules of Court was precisely formulated and adopted to provide for a
uniform rule of appellate procedure for quasi-judicial agencies.[33] Petitioner further contends
that a quasi-judicial body is not excluded from the purview of Rule 43 just because it is not
mentioned therein.[34]
On this point, the Court agrees with the petitioner.
Sec. 1, Rule 43 of the Rules of Court provides:

Section 1. Scope. - This Rule shall apply to appeals from judgments or

final orders of the Court of Tax Appeals, and from awards, judgments,
final orders or resolutions of or authorized by any quasi-judicial
agency in the exercise of its quasi-judicial functions. Among these
agencies are the Civil Service Commission, Central Board of Assessment
Appeals, Securities and Exchange Commission, Office of the President, Land
Registration Authority, Social Security Commission, Civil Aeronautics Board,
Bureau of Patents, Trademarks and Technology Transfer, National
Electrification Administration, Energy Regulatory Board, National
Telecommunications Commission, Department of Agrarian Reform under
Republic Act No. 6657, Government Service Insurance System, Employees
Compensation Commission, Agricultural Inventions Board, Insurance
Commission, Philippine Atomic Energy Commission, Board of Investments,
Construction Industry Arbitration Commission, and voluntary arbitrators
authorized by law. (Emphasis supplied)

Indeed, the PRC is not expressly mentioned as one of the agencies which are expressly
enumerated under Section 1, Rule 43 of the Rules of Court. However, its absence from the
enumeration does not, by this fact alone, imply its exclusion from the coverage of said Rule.
[35]
The Rule expressly provides that it should be applied to appeals from awards, judgments
final orders or resolutions of any quasi-judicial agency in the exercise of its quasi-judicial
functions. The phrase among these agencies confirms that the enumeration made in the
Rule is not exclusive to the agencies therein listed.[36]

Specifically, the Court, in Yang v. Court of Appeals,[37] ruled

[38]
that Batas Pambansa (B.P.) Blg. 129 conferred upon the CA exclusive appellate
jurisdiction over appeals from decisions of the PRC. The Court held:

The law has since been changed, however, at least in the matter of the
particular court to which appeals from the Commission should be
taken. On August 14, 1981, Batas Pambansa Bilang 129 became effective
and in its Section 29, conferred on the Court of Appeals exclusive appellate
jurisdiction over all final judgments, decisions, resolutions, orders or awards of
Regional Trial Courts and quasi-judicial agencies, instrumentalities, boards or
commissions except those falling under the appellate jurisdiction of the
Supreme Court. x x x. In virtue of BP 129, appeals from the
Professional Regulations Commission are now exclusively
cognizable by the Court of Appeals.[39] (Emphasis supplied)

Clearly, the enactment of B.P. Blg. 129, the precursor of the present Rules of Civil
Procedure,[40] lodged with the CA such jurisdiction over the appeals of decisions made by the
PRC.

Anent the substantive merits of the case, petitioner questions the PRC decision for being
without an expert testimony to support its conclusion and to establish the cause
of Edithas injury.Petitioner avers that in cases of medical malpractice, expert testimony is
necessary to support the conclusion as to the cause of the injury.[41]

Medical malpractice is a particular form of negligence which consists in the failure of a

physician or surgeon to apply to his practice of medicine that degree of care and skill which
is ordinarily employed by the profession generally, under similar conditions, and in like
surrounding circumstances.[42] In order to successfully pursue such a claim, a patient must
prove that the physician or surgeon either failed to do something which a reasonably
prudent physician or surgeon would not have done, and that the failure or action caused
injury to the patient.[43]
There are four elements involved in medical negligence cases: duty, breach, injury and
proximate causation.[44]
A physician-patient relationship was created when Editha employed the services of the
petitioner. As Edithas physician, petitioner was duty-bound to use at least the same level of
care that any reasonably competent doctor would use to treat a condition under the same
circumstances.[45] The breach of these professional duties of skill and care, or their improper
performance by a physician surgeon, whereby the patient is injured in body or in health,
constitutes actionable malpractice.[46] As to this aspect of medical malpractice, the
determination of the reasonable level of care and the breach thereof, expert testimony is
essential.[47] Further, inasmuch 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 support the conclusion as to causation.[48]

In the present case, respondents did not present any expert testimony to support their claim
that petitioner failed to do something which a reasonably prudent physician or surgeon
would have done.

Petitioner, on the other hand, presented the testimony of Dr. Augusto M. Manalo, who was
clearly an expert on the subject.

Generally, to qualify as an expert witness, one must have acquired special knowledge of the
subject matter about which he or she is to testify, either by the study of recognized
authorities on the subject or by practical experience.[49]

Dr. Manalo specializes in gynecology and obstetrics, authored and co-authored various
publications on the subject, and is a professor at the University of the Philippines.
[50]
According to him, his diagnosis of Edithas case was Ectopic Pregnancy Interstitial (also
referred to as Cornual), Ruptured.[51] In stating that the D&C procedure was not the
proximate cause of the rupture of Edithas uterus resulting in her hysterectomy,
Dr. Manalo testified as follows:

Atty. Hidalgo:
Q: Doctor, we want to be clarified on this matter. The complainant had
testified here that the D&C was the proximate cause of the rupture of
the uterus. The condition which she found herself in on the second
admission. Will you please tell us whether that is true or not?
A: Yah, I do not think so for two reasons. One, as I have said
earlier, the instrument cannot reach the site of the pregnancy, for it to
further push the pregnancy outside the uterus. And, No. 2, I was
thinking a while ago about another reason- well, why I dont think so,
because it is the triggering factor for the rupture, it could havethe
rupture could have occurred much earlier, right after the D&C or a few
days after the D&C.

Q: In this particular case, doctor, the rupture occurred to have

happened minutes prior to the hysterectomy or right upon admission
on September 15, 1994 which is about 1 months after the patient was
discharged, after the D&C was conducted. Would you tell us whether
there is any relation at all of the D&C and the rupture in this particular
instance?
A: I dont think so for the two reasons that I have just
mentioned- that it would not be possible for the instrument to
reach the site of pregnancy. And, No. 2, if it is because of the D&C
that rupture could have occurred earlier.[52] (Emphases supplied)

Clearly, from the testimony of the expert witness and the reasons given by him, it is evident
that the D&C procedure was not the proximate cause of the rupture of Edithas uterus.
During his cross-examination, Dr. Manalo testified on how he would have
addressed Edithas condition should he be placed in a similar circumstance as the
petitioner. He stated:

Atty. Ragonton:
Q: Doctor, as a practicing OB-Gyne, when do you consider that you
have done a good, correct and ideal dilatation and curettage
procedure?
 A: Well, if the patient recovers. If the patient gets well. Because even
after the procedure, even after the procedure you may feel that you
have scraped everything, the patient stops bleeding, she feels well, I
think you should still have some reservations, and wait a little more
time.

Q: If you were the OB-Gyne who performed the procedure on

patient Editha Ramolete, would it be your standard practice to check
the fetal parts or fetal tissues that were allegedly removed?
A: From what I have removed, yes. But in this particular case, I think it
was assumed that it was part of the meaty mass which was expelled
at the time she was urinating and flushed in the toilet. So theres no
way.

Q: There was [sic] some portions of the fetal parts that were removed?
A: No, it was described as scanty scraping if I remember it rightscanty.

Q: And you would not mind checking those scant or those little parts
that were removed?
A: Well, the fact that it was described means, I assume that it
was checked, no. It was described as scanty and the color also, I
think was described. Because it would be very unusual, even
improbable that it would not be examined, because when you
scrape, the specimens are right there before your eyes. Its in
front of you. You can touch it. In fact, some of them will stick
to the instrument and therefore to peel it off from the
instrument, you have to touch them. So, automatically they
are examined closely.
Q: As a matter of fact, doctor, you also give telephone orders to your
patients through telephone?
A: Yes, yes, we do that, especially here in Manila because you know,
sometimes a doctor can also be tied-up somewhere and if you have to
wait until he arrive at a certain place before you give the order, then it
would be a lot of time wasted. Because if you know your patient, if you
have handled your patient, some of the symptoms you can interpret
that comes with practice. And, I see no reason for not allowing
telephone orders unless it is the first time that you will be
encountering the patient. That you have no idea what the problem
is.

Q: But, doctor, do you discharge patients without seeing them?

A: Sometimes yes, depending on how familiar I am with the patient.
We are on the question of telephone orders. I am not saying that that
is the idle [sic] thing to do, but I think the reality of present day
practice somehow justifies telephone orders. I have patients
whom I have justified and then all of a sudden, late in the afternoon or
late in the evening, would suddenly call they have decided that they
will go home inasmuch as they anticipated that I will discharge them
the following day. So, I just call and ask our resident on duty or the
nurse to allow them to go because I have seen that patient and I think
I have full grasp of her problems. So, thats when I make this telephone
orders. And, of course before giving that order I ask about how she
feels.[53] (Emphases supplied)

From the foregoing testimony, it is clear that the D&C procedure was conducted in
accordance with the standard practice, with the same level of care that any reasonably
competent doctor would use to treat a condition under the same circumstances, and that
there was nothing irregular in the way the petitioner dealt with Editha.

Medical malpractice, in our jurisdiction, is often brought as a civil action for damages under
Article 2176[54] of the Civil Code. The defenses in an action for damages, provided for under
Article 2179 of the Civil Code are:
 Art. 2179. When the plaintiffs own negligence was the immediate and
proximate cause of his injury, he cannot recover damages. But if his
negligence was only contributory, the immediate and proximate cause of the
injury being the defendants lack of due care, the plaintiff may recover
damages, but the courts shall mitigate the damages to be awarded.

Proximate cause has been defined as that which, in natural and continuous sequence,
unbroken by any efficient intervening cause, produces injury, and without which the result
would not have occurred.[55] An injury or damage is proximately caused by an act or a failure
to act, whenever it appears from the evidence in the case that the act or omission played a
substantial part in bringing about or actually causing the injury or damage; and that the
injury or damage was either a direct result or a reasonably probable consequence of the act
or omission.[56]

In the present case, the Court notes the findings of the Board of Medicine:

When complainant was discharged on July 31, 1994, herein respondent

advised her to return on August 4, 1994 or four (4) days after the
D&C. This advise was clear in complainants Discharge
Sheet. However, complainant failed to do so. This being the case, the
chain of continuity as required in order that the doctrine of proximate cause
can be validly invoked was interrupted. Had she returned, the
respondent could have examined her thoroughly. [57] x x x (Emphases
supplied)

Also, in the testimony of Dr. Manalo, he stated further that assuming that there was in fact a
misdiagnosis, the same would have been rectified if Editha followed the petitioners order to
return for a check-up on August 4, 1994. Dr. Manalo stated:

Granting that the obstetrician-gynecologist has been misled

(justifiably) up to thus point that there would have been ample
opportunity to rectify the misdiagnosis, had the patient returned, as
instructed for her follow-up evaluation. It was one and a half months
later that the patient sought consultation with another doctor. The
continued growth of an ectopic pregnancy, until its eventual rupture, is a
dynamic process. Much change in physical findings could be expected in 1
months, including the emergence of suggestive ones.[58]

It is undisputed that Editha did not return for a follow-up evaluation, in defiance of the
petitioners advise. Editha omitted the diligence required by the circumstances which could
have avoided the injury. The omission in not returning for a follow-up evaluation played a
substantial part in bringing about Edithas own injury. Had Editha returned, petitioner could
have conducted the proper medical tests and procedure necessary to
determine Edithas health condition and applied the corresponding treatment which could
have prevented the rupture of Edithas uterus. The D&C procedure having been conducted
in accordance with the standard medical practice, it is clear that Edithas omission was the
proximate cause of her own injury and not merely a contributory negligence on her part.

Contributory negligence is the act or omission amounting to want of ordinary care on the
part of the person injured, which, concurring with the defendants negligence, is the
proximate cause of the injury.[59] Difficulty seems to be apprehended in deciding which acts
of the injured party shall be considered immediate causes of the accident. [60] Where the
immediate cause of an accident resulting in an injury is the plaintiffs own act, which
contributed to the principal occurrence as one of its determining factors, he cannot recover
damages for the injury.[61] Again, based on the evidence presented in the present
case under review, in which no negligence can be attributed to the petitioner,
the immediate cause of the accident resulting in Edithas injury was her own
omission when she did not return for a follow-up check up, in defiance of
petitioners orders. The immediate cause of Edithas injury was her own act; thus,
she cannot recover damages from the injury.
Lastly, petitioner asserts that her right to due process was violated because she was never
informed by either respondents or by the PRC that an appeal was pending before the PRC.
[62]
Petitioner claims that a verification with the records section of the PRC revealed that
on April 15, 1999, respondents filed a Memorandum on Appeal before the PRC, which did
not attach the actual registry receipt but was merely indicated therein.[63]
Respondents, on the other hand avers that if the original registry receipt was not attached to
the Memorandum on Appeal, PRC would not have entertained the appeal or accepted such
pleading for lack of notice or proof of service on the other party. [64] Also, the registry receipt
could not be appended to the copy furnished to petitioners former counsel, because the
registry receipt was already appended to the original copy of the Memorandum of Appeal
filed with PRC.[65]

It is a well-settled rule that when service of notice is an issue, the rule is that the person
alleging that the notice was served must prove the fact of service. The burden of proving
notice rests upon the party asserting its existence. [66] In the present case, respondents did
not present any proof that petitioner was served a copy of the Memorandum on
Appeal. Thus, respondents were not able to satisfy the burden of proving that they had in
fact informed the petitioner of the appeal proceedings before the PRC.

In EDI-Staffbuilders International, Inc. v. National Labor Relations Commission,[67] in which

the National Labor Relations Commission failed to order the private respondent to furnish
the petitioner a copy of the Appeal Memorandum, the Court held that said failure deprived
the petitioner of procedural due process guaranteed by the Constitution, which could have
served as basis for the nullification of the proceedings in the appeal. The same holds true in
the case at bar. The Court finds that the failure of the respondents to furnish the petitioner a
copy of the Memorandum of Appeal submitted to the PRC constitutes a violation of due
process. Thus, the proceedings before the PRC were null and void.

All told, doctors are protected by a special rule of law. They are not guarantors of care. They
are not insurers against mishaps or unusual consequences[68] specially so if the patient
herself did not exercise the proper diligence required to avoid the injury.

WHEREFORE, the petition is GRANTED. The assailed Decision of the Court of Appeals
dated July 4, 2003 in CA-GR SP No. 62206 is hereby REVERSED and SET ASIDE. The
Decision of the Board of Medicine dated March 4, 1999 exonerating petitioner
is AFFIRMED. No pronouncement as to costs.

SO ORDERED.

MA. ALICIA AUSTRIA-MARTINEZ

Associate Justice

WE CONCUR:

CONSUELO YNARES-SANTIAGO

Associate Justice
Chairperson

MINITA V. CHICO-NAZARIO ANTONIO EDUARDO B. NACHURA

Associate Justice Associate Justice

RUBEN T. REYES
Associate Justice
 ATTESTATION

I attest that the conclusions in the above Decision had been reached in consultation before
the case was assigned to the writer of the opinion of the Courts Division.

CONSUELO YNARES-SANTIAGO
Associate Justice
Chairperson, Third Division

CERTIFICATION

Pursuant to Section 13, Article VIII of the Constitution, and the Division Chairpersons
Attestation, it is hereby certified that the conclusions in the above Decision had been
reached in consultation before the case was assigned to the writer of the opinion of the
Courts Division.

REYNATO S. PUNO

Chief Justice

Republic of the Philippines

 Supreme Court
Manila

THIRD DIVISION

BOARD OF MEDICINE, G.R. No. 166097

DR. RAUL FLORES
(now DR. JOSE S. RAMIREZ), Present:
in his capacity as Chairman of the
Board, PROFESSIONAL QUISUMBING,* J.,
REGULATION COMMISSION, YNARES-SANTIAGO,
through its Chairman, Chairperson,
HERMOGENES POBRE AUSTRIA-MARTINEZ,
(now DR. ALCESTIS M. GUIANG), NACHURA, and
Petitioners, REYES, JJ.

-versus-

Promulgated:
YASUYUKI OTA, July 14, 2008
Respondent.
x -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- x
DECISION

AUSTRIA-MARTINEZ, J.:

Before the Court is a Petition for Review on Certiorari assailing the

Decision[1] of the Court of Appeals (CA) in CA-G.R. SP No.
[2] [3]
84945 dated November 16, 2004 which affirmed the Decision of the
Regional Trial Court (RTC), Branch 22, Manila, dated October 19, 2003.[4]

The facts are as follows:

Yasuyuki Ota (respondent) is a Japanese national, married to a Filipina, who

has continuously resided in the Philippines for more than 10 years. He
graduated from BicolChristian College of Medicine on April 21, 1991 with a
degree of Doctor of Medicine. [5] After successfully completing a one-year post
graduate internship training at the JoseReyes Memorial Medical Center, he
filed an application to take the medical board examinations in order to obtain
a medical license. He was required by the Professional Regulation
Commission (PRC) to submit an affidavit of undertaking, stating among
others that should he successfully pass the same, he would not practice
medicine until he submits proof that reciprocity exists between Japan and the
Philippines in admitting foreigners into the practice of medicine.[6]

Respondent submitted a duly notarized English translation of the Medical

Practitioners Law of Japan duly authenticated by the Consul General of the
Philippine Embassy to Japan, Jesus I. Yabes;[7] thus, he was allowed to take
the Medical Board Examinations in August 1992, which he subsequently
passed.[8]

In spite of all these, the Board of Medicine (Board) of the PRC, in a letter
dated March 8, 1993, denied respondent's request for a license to

practice medicine in the Philippines on the ground that the Board believes
that no genuine reciprocity can be found in the law of Japan as there is no
Filipino or foreigner who can possibly practice there.[9]

Respondent then filed a Petition for Certiorari and Mandamus against the
Board before the RTC of Manila on June 24, 1993, which petition was
amended on February 14, 1994 to implead the PRC through its Chairman.[10]

In his petition before the RTC, respondent alleged that the Board and the
PRC, in refusing to issue in his favor a Certificate of Registration and/or
license to practice medicine, had acted arbitrarily, in clear contravention of
the provision of Section 20 of Republic Act (R.A.) No. 2382 (The Medical Act
of 1959), depriving him of his legitimate right to practice his profession in the
Philippines to his great damage and prejudice.[11]

On October 19, 2003, the RTC rendered its Decision finding that respondent
had adequately proved that the medical laws of Japan allow foreigners like
Filipinos to be granted license and be admitted into the practice of medicine
under the principle of reciprocity; and that the Board had a ministerial duty
of issuing the Certificate of Registration and license to respondent, as it was
shown that he had substantially complied with the requirements under the
law.[12] The RTC then ordered the Board to issue in favor of respondent the
corresponding Certificate of Registration and/or license to practice medicine
in the Philippines.[13]

The Board and the PRC (petitioners) appealed the case to the CA, stating that
while respondent submitted documents showing that foreigners are allowed
to practice medicine in Japan, it was not shown that the conditions for the
practice of medicine there are practical and attainable by a foreign applicant,
hence, reciprocity was not established; also, the power of the PRC and the
Board to regulate and control the practice of medicine is discretionary and
not ministerial, hence, not compellable by a writ of mandamus.[14]
The CA denied the appeal and affirmed the ruling of the RTC.[15]

Hence, herein petition raising the following issue:

WHETHER THE COURT OF APPEALS COMMITTED A REVERSIBLE ERROR IN
FINDING THAT RESPONDENT HAD ESTABLISHED THE EXISTENCE OF
RECIPROCITY IN THE PRACTICE OF MEDICINE BETWEEN
THE PHILIPPINES AND JAPAN.[16]

Petitioners claim that: respondent has not established by competent and

conclusive evidence that reciprocity in the practice of medicine exists
between the Philippines and Japan. While documents state that foreigners
are allowed to practice medicine in Japan, they do not similarly show that the
conditions for the practice of medicine in said country are practical and
attainable by a foreign applicant. There is no reciprocity in this case, as the
requirements to practice medicine in Japan are practically impossible for a
Filipino to comply with. There are also ambiguities in the Medical
Practitioners Law of Japan, which were not clarified by respondent, i.e., what
are the provisions of the School Educations Laws, what are the criteria of the
Minister of Health and Welfare of Japan in determining whether the academic
and technical capability of foreign medical graduates are the same or better
than graduates of medical schools in Japan, and who can actually qualify to
take the preparatory test for the National Medical Examination. Consul
General Yabes also stated that there had not been a single Filipino who was
issued a license to practice medicine by the Japanese Government. The
publication showing that there were foreigners practicing medicine in Japan,
which respondent presented before the Court, also did not specifically show
that Filipinos were among those listed as practicing said profession.
[17]
Furthermore, under Professional Regulation Commission v. De Guzman,
[18]
the power of the PRC and the Board to regulate and control the practice of
medicine includes the power to regulate admission to the ranks of those
authorized to practice medicine, which power is discretionary and not
ministerial, hence, not compellable by a writ of mandamus.[19]

Petitioners pray that the CA Decision dated November 16, 2004 be reversed
and set aside, that a new one be rendered reinstating the Board Order
dated March 8, 1993 which disallows respondent to practice medicine in
the Philippines, and that respondent's petition before the trial court be
dismissed for lack of merit.[20]

In his Comment, respondent argues that: Articles 2 and 11 of the Medical

Practitioners Law of Japan and Section 9 of the Philippine Medical Act of 1959
show that reciprocity exists between the Philippines and Japan concerning
the practice of medicine. Said laws clearly state that both countries allow
foreigners to practice medicine in their respective jurisdictions as long as the
applicant meets the educational requirements, training or residency in
hospitals and pass the licensure examination given by either country. Consul
General Yabes in his letter dated January 28, 1992 stated that the Japanese
Government allows a foreigner to practice medicine in Japan after complying
with the local requirements. The fact that there is no reported Filipino who
has successfully penetrated the medical practice in Japan does not mean
that there is no reciprocity between the two countries, since it does not
follow that no Filipino will ever be granted a medical license by the Japanese
Government. It is not the essence of reciprocity that before a citizen of one
of the contracting countries can demand its application, it is necessary that
the interested citizens country has previously granted the same privilege to
the citizens of the other contracting country. [21] Respondent further argues
that Section 20 of the Medical Act of 1959 [22] indicates the mandatory
character of the statute and an imperative obligation on the part of the
Board inconsistent with the idea of discretion. Thus, a foreigner, just like a
Filipino citizen, who successfully passes the examination and has all the
qualifications and none of the disqualifications, is entitled as a matter of right
to the issuance of a certificate of registration or a physicians license, which
right is enforceable by mandamus.[23]

Petitioners filed a Reply[24] and both parties filed their respective

memoranda[25] reiterating their arguments.

The Court denies the petition for lack of merit.

There is no question that a license to practice medicine is a privilege or

franchise granted by the government. [26] It is a right that is earned through
years of education and training, and which requires that one must first
secure a license from the state through professional board examinations.[27]

Indeed,
[T]he regulation of the practice of medicine in all its branches has long been
recognized as a reasonable method of protecting the health and safety of the
public. That the power to regulate and control the practice of medicine
includes the power to regulate admission to the ranks of those authorized to
practice medicine, is also well recognized. Thus, legislation and administrative
regulations requiring those who wish to practice medicine first to take and
pass medical board examinations have long ago been recognized as valid
exercises of governmental power. Similarly, the establishment of minimum
medical educational requirements i.e., the completion of prescribed courses in
a recognized medical school for admission to the medical profession, has also
been sustained as a legitimate exercise of the regulatory authority of the
state.[28]

It must be stressed however that the power to regulate the exercise of

a profession or pursuit of an occupation cannot be exercised by the State or
its agents in an arbitrary, despotic, or oppressive manner. A political body
which regulates the exercise of a particular privilege has the authority to
both forbid and grant such privilege in accordance with certain conditions. As
the legislature cannot validly bestow an arbitrary power to grant or refuse a
license on a public agency or officer, courts will generally strike down license
legislation that vests in public officials discretion to grant or refuse a license
to carry on some ordinarily lawful business, profession, or activity without
prescribing definite rules and conditions for the guidance of said officials in
the exercise of their power.[29]
R.A. No. 2382 otherwise known as the Medical Act of 1959 states in Section 9
thereof that:
Section 9. Candidates for Board Examinations.- Candidates for Board
examinations shall have the following qualifications:

1. He shall be a citizen of the Philippines or a citizen of any foreign country

who has submitted competent and conclusive documentary evidence,
confirmed by the Department of Foreign Affairs, showing that his countrys
existing laws permit citizens of the Philippines to practice medicine under the
same rules and regulations governing citizens thereof;

xxxx

Presidential Decree (P.D.) No. 223[30] also provides in Section (j)

thereof that:

j) The [Professional Regulation] Commission may, upon the

recommendation of the Board concerned, approve the registration of and
authorize the issuance of a certificate of registration with or without
examination to a foreigner who is registered under the laws of his country:
Provided, That the requirement for the registration or licensing in said foreign
state or country are substantially the same as those required and
contemplated by the laws of the Philippines and that the laws of such foreign
state or country allow the citizens of the Philippines to practice the profession
on the same basis and grant the same privileges as the subject or citizens of
such foreign state or country: Provided, finally, That the applicant shall submit
competent and conclusive documentary evidence, confirmed by the
Department of Foreign Affairs, showing that his country's existing laws permit
citizens of the Philippines to practice the profession under the rules and
regulations governing citizens thereof. The Commission is also hereby
authorized to prescribe additional requirements or grant certain privileges to
foreigners seeking registration in the Philippines if the same privileges are
granted to or some additional requirements are required of citizens of
the Philippines in acquiring the same certificates in his country;

xxxx

As required by the said laws, respondent submitted a copy of the

Medical Practitioners Law of Japan, duly authenticated by the Consul General
of the Embassy of the Philippines in Japan, which provides in Articles 2 and
11, thus:

Article 2. Anyone who wants to be medical practitioner must pass the

national examination for medical practitioner and get license from the Minister
of Health and Welfare.

xxxx

Article 11. No one can take the National Medical Examination except
persons who conform to one of the following items:
 1. Persons who finished regular medical courses at a university based
on the School Education Laws (December 26, 1947) and graduated
from said university.

2. Persons who passed the preparatory test for the National Medical
Examination and practiced clinics and public sanitation more than
one year after passing the said test.

3. Persons who graduated from a foreign medical school or acquired

medical practitioner license in a foreign country, and also are
recognized to have the same or more academic ability and
techniques as persons stated in item 1 and item 2 of this article. [31]

Petitioners argue that while the Medical Practitioners Law of Japan

allows foreigners to practice medicine therein, said document does not show
that conditions for the practice of medicine in said country
are practical and attainable by a foreign applicant; and since the
requirements are practically impossible for a Filipino to comply with, there is
no reciprocity between the two countries, hence, respondent may not be
granted license to practice medicine in the Philippines.

The Court does not agree.

R.A. No. 2382, which provides who may be candidates for the medical
board examinations, merely requires a foreign citizen to submit competent
and conclusive documentary evidence, confirmed by the Department of
Foreign Affairs (DFA), showing that his countrys existing laws permit citizens
of the Philippines to practice medicine under the same rules and regulations
governing citizens thereof.

Section (j) of P.D. No. 223 also defines the extent of PRC's power to
grant licenses, i.e., it may, upon recommendation of the board, approve the
registration and authorize the issuance of a certificate of registration with or
without examination to a foreigner who is registered under the laws of his
country, provided the following conditions are met: (1) that the requirement
for the registration or licensing in said foreign state or country are
substantially the same as those required and contemplated by the laws of
the Philippines; (2) that the laws of such foreign state or country allow the
citizens of the Philippines to practice the profession on the same basis and
grant the same privileges as the subject or citizens of such foreign state or
country; and (3) that the applicant shall submit competent and conclusive
documentary evidence, confirmed by the DFA, showing that his country's
existing laws permit citizens of the Philippines to practice the profession
under the rules and regulations governing citizens thereof.

The said provision further states that the PRC is authorized to prescribe
additional requirements or grant certain privileges to foreigners seeking
registration in the Philippines if the same privileges are granted to or some
additional requirements are required of citizens of the Philippines in
acquiring the same certificates in his country.

Nowhere in said statutes is it stated that the foreign applicant must

show that the conditions for the practice of medicine in said country
are practical and attainable by Filipinos. Neither is it stated that it must first
be proven that a Filipino has been granted license and allowed to practice his
profession in said country before a foreign applicant may be given license to
practice in the Philippines. Indeed, the phrase used in both R.A. No. 2382 and
P.D. No. 223 is that:
[T]he applicant shall submit] competent and conclusive documentary
evidence, confirmed by the Department of Foreign Affairs, showing that his
country's existing laws permit citizens of the Philippines to practice the
profession [of medicine] under the [same] rules and regulations governing
citizens thereof. x x x (Emphasis supplied)

It is enough that the laws in the foreign country permit a Filipino to get
license and practice therein. Requiring respondent to prove first that a
Filipino has already been granted license and is actually practicing therein
unduly expands the requirements provided for under R.A. No. 2382 and P.D.
No. 223.

While it is true that respondent failed to give details as to the

conditions stated in the Medical Practitioners Law of Japan -- i.e., the
provisions of the School Educations Laws, the criteria of the Minister of
Health and Welfare of Japan in determining whether the academic and
technical capability of foreign medical graduates are the same as or better
than that of graduates of medical schools in Japan, and who can actually
qualify to take the preparatory test for the National Medical Examination
respondent, however, presented proof that foreigners are actually practicing
in Japan and that Filipinos are not precluded from getting a license to
practice there.

Respondent presented before the trial court a Japanese Government

publication, Physician-Dentist-Pharmaceutist Survey, showing that there are
a number of foreign physicians practicing medicine in Japan.[32] He also
presented a letter dated January 28, 1992 from Consul General Yabes,
[33]
which states:

Sir:

With reference to your letter dated 12 January 1993, concerning your

request for a Certificate of Confirmation for the purpose of establishing a
reciprocity with Japan in the practice of medical profession relative to the case
of Mr. Yasuyuki Ota, a Japanese national, the Embassy wishes to inform you
that inquiries from the Japanese Ministry of Foreign Affairs, Ministry of Health
and Welfare as well as Bureau of Immigration yielded the following
information:

1. They are not aware of a Filipino physician who was granted a license
by the Japanese Government to practice medicine in Japan;
 2. However, the Japanese Government allows a foreigner to
practice medicine in Japan after complying with the local
requirements such as holding a valid visa for the purpose of
taking the medical board exam, checking the applicant's
qualifications to take the examination, taking the national
board examination in Japanese and filing an application for the
issuance of the medical license.

Accordingly, the Embassy is not aware of a single Filipino

physician who was issued by the Japanese Government a license to
practice medicine, because it is extremely difficult to pass the
medical board examination in the Japanese language. Filipino doctors
here are only allowed to work in Japanese hospitals as trainees under the
supervision of a Japanese doctor.On certain occasions, they are allowed to
show their medical skills during seminars for demonstration purposes only.
(Emphasis supplied)

Very truly yours,

Jesus I. Yabes

Minister Counsellor &

Consul General

From said letter, one can see that the Japanese Government allows
foreigners to practice medicine therein provided that the local requirements
are complied with, and that it is not the impossibility or the prohibition
against Filipinos that would account for the absence of Filipino physicians
holding licenses and practicing medicine in Japan, but the difficulty of
passing the board examination in the Japanese language. Granting that there
is still no Filipino who has been given license to practice medicine in Japan, it
does not mean that no Filipino will ever be able to be given one.

Petitioners next argue that as held in De Guzman, its power to issue

licenses is discretionary, hence, not compellable by mandamus.

The Court finds that the factual circumstances of De Guzman are

different from those of the case at bar; hence, the principle applied therein
should be viewed differently in this case. In De Guzman, there were doubts
about the integrity and validity of the test results of the examinees from a
particular school which garnered unusually high scores in the two most
difficult subjects. Said doubts called for serious inquiry concerning the
applicants satisfactory compliance with the Board requirements. [34] And as
there was no definite showing that the requirements and conditions to be
granted license to practice medicine had been satisfactorily met, the Court
held that the writ of mandamus may not be granted to secure said privilege
without thwarting the legislative will.[35]

Indeed, to be granted the privilege to practice medicine, the applicant

must show that he possesses all the qualifications and none of the
disqualifications. It must also appear that he has fully complied with all the
conditions and requirements imposed by the law and the licensing authority.
[36]
 In De Guzman itself, the Court explained that:

A careful reading of Section 20 [37] of the Medical Act of 1959 discloses

that the law uses the word shall with respect to the issuance of certificates of
registration. Thus, the petitioners [PRC] shall sign and issue certificates of
registration to those who have satisfactorily complied with the requirements
of the Board. In statutory construction the term shall is a word of command. It
is given imperative meaning. Thus, when an examinee satisfies the
requirements for the grant of his physician's license, the Board is obliged to
administer to him his oath and register him as a physician, pursuant to
Section 20 and par. (1) of Section 22 of the Medical Act of 1959.[38]

In this case, there is no doubt as to the competence and qualifications

of respondent. He finished his medical degree from Bicol Christian College of
Medicine. He completed a one-year post graduate internship training at
the Jose Reyes Memorial Medical Center, a government hospital. Then he
passed the Medical Board Examinations which was given on August 8,
1992 with a general average of 81.83, with scores higher than 80 in 9 of the
12 subjects.

In fine, the only matter being questioned by petitioners is the alleged

failure of respondent to prove that there is reciprocity between the laws
of Japan and the Philippines in admitting foreigners into the practice of
medicine. Respondent has satisfactorily complied with the said requirement
and the CA has not committed any reversible error in rendering its Decision
dated November 16, 2004 and Resolution dated October 19, 2003.

WHEREFORE, the petition is hereby DENIED for lack of merit.

SO ORDERED.

MA. ALICIA AUSTRIA-MARTINEZ

Associate Justice

WE CONCUR:

LEONARDO A. QUISUMBING
Associate Justice

ANTONIO EDUARDO B. NACHURA

CONSUELO YNARES-SANTIAGO
Associate Justice
Associate Justice
Chairperson

RUBEN T. REYES
 Associate Justice

ATTESTATION

I attest that the conclusions in the above Decision had been reached in
consultation before the case was assigned to the writer of the opinion of the
Courts Division.

CONSUELO YNARES-SANTIAGO
Associate Justice
Chairperson, Third Division

CERTIFICATION

Pursuant to Section 13, Article VIII of the Constitution, and the Division
Chairpersons Attestation, it is hereby certified that the conclusions in the above
Decision had been reached in consultation before the case was assigned to the
writer of the opinion of the Courts Division.

REYNATO S. PUNO

Chief Justice

Republic of the Philippines

SUPREME COURT
Manila

EN BANC

G.R. No. L-32441 March 29, 1930

DOMINADOR GOMEZ, plaintiff-appellant,

vs.
HONORIO VENTURA, Secretary of the Interior of the Government of the
Philippine Islands, and the
BOARD OF MEDICAL EXAMINERS OF THE PHILIPPINE ISLANDS, defendants-
appellees.
Jose Varela Calderon for appellant.
Attorney-General Jaranilla for appellees.

ROMUALDEZ, J.:

In this cause, the plaintiff prays for judgment, as follows:

1. Annulling and setting aside the aforementioned investigation proceedings, and

particularly the decision of the Board of Medical Examiners of the Philippine
Islands dated March 30, 1926, forever revoking the plaintiff's license to practice
medicine and surgery.

2. Ordering the defendants to restore the plaintiff to his status before the
investigation and the decision of March 30, 1926, that is, as if there had never
been an investigation and an adverse decision.

3. Ordering said defendants to issue in favor of the plaintiff a license for the
practice of medicine and surgery in the Philippine Islands, such as he had prior to
the investigation and adverse decision.

4. Granting the plaintiff any proper legal remedy. (Pages 5 and 6, bill of
exemptions.)

The defendants answered with a general denial and prayed that the complaint be
dismissed.

After trial the Court of First Instance of Manila dismissed the complaint with costs
against the plaintiff.

Counsel for plaintiff contends that the court below erred:

1. In holding that Assistant Fiscal Alfonso Felix of the City of Manila was
authorized to appear and institute administrative proceedings against Dr.
Dominador Gomez before the Board of Medical Examiners of the Philippines.

2. In not holding that Assistant Fiscal Alfonso Felix, of the City of Manila, had
personality nor power to institute administrative proceedings against Dr.
Dominador Gomez before the Board of Medical Examiners of the Philippines.

3. In admitting in its decision that section 9 of Act No. 2381, known as the Opium
Law, is valid.

4. In not holding that section 9 of Act No. 2381, known as the Opium Law, is
unconstitutional, and therefore null and void.

5. In holding that section 9 Act No. 2381, known as the Opium Law, is in force.

6. In not holding that section 9 Act No. 2381 has been repealed, even on the
supposition that it was valid.

7. In rendering the judgment appealed from.

8. In denying the motion for avoidance, and for a new trial, filed by appellant.

The first two assignments of error relate to the validity of the charges against the
plaintiff, preferred by Assistant Fiscal Alfonso Felix of the City of Manila, who, according
to the plaintiff is not authorized by law to file charges with the Board of Medical
Examiners, which therefore acquired no jurisdiction over the matter.

According to section 780 of Administrative Code, as amended by Act No. 3111, the
procedure to be observed in revoking a certificate of registration is the following:

Proceedings for revocation of a certificate of registration shall be begun by filing

a written charge or charges against the accused. These charges may be
preferred by any person or persons, firm or corporation, or the Board of Medical
Examiners itself may direct its executive officer to prepare said charges. Said
charges shall be filed with the executive officer of the Board of Medical
 Examiners and a copy thereof, together with written notice of the time and place
when they will be heared and determined, shall be served upon the accused or
his counsel, at least two weeks before the date actually fixed for said hearing.
(Sec. 12, Act No. 3111.)

The law does not require that the charges be preferred by a public officer or by any
specified person; it even permits the Board of Medical Examiners itself to require its
executive officer to prefer said charges. From the wording of the law we infer that any
person, including a public officer, may prefer the charges referred to in the above-
quoted provision. Wherefore, the fact that the charges were filed by Assistant Fiscal
Alfonso Felix of the City of Manila, does not deprive the Board of Medical Examiners of
jurisdiction to hear said charges and to take the proper action according to law.

The appellant contends in his third and fourth assignments of error that section 9 of Act
No. 2381 is null and void on the ground of unconstitutionality, since said section is
foreign to the subject of said Act, in violation of section 3 of the Jones Law prohibiting
the enactment of any bill embracing more than one subject and providing that the
subject be expressed in the title of the bill.

Our opinion is that the matter contained in section 9 of Act No. 2381 is not foreign to
the end pursued in said Act, and that in view in the provision of said section it cannot be
maintained that Act No. 2381 includes more than one subject. The penalty provided in
said section for the physician or dentist who prescribes opium for a patient whose
physical condition does not require the use of said drug, is one of the means employed
by the Legislature to attain the purpose of Act No. 2381, which is, to prohibit
unnecessary use of opium; it is one of the details subordinate to the purpose in view.
Such punishment is not the end contemplated in Act No. 2381, but, as we have just
said, it is a means employed to regulate the use of opium.

In passing said Act No. 2381, the Legislature merely exercised the police power
expressly granted by the Act of Congress of March 3, 1905, for the protection of the
health, comfort, and general welfare of the people of the Philippine Islands.

ID.; ID.; POWER OF PHILIPPINE LEGISLATURE TO LEGISLATE UPON THE SUBJECT.

The Philippine Legislature is expressly authorized by the Act of Congress of
March 3, 1905, to adopt legislation upon the importation and sale of opium in the
Philippine Islands. The purpose of such legislation was to protect the health,
comfort, and general welfare of the people of the Philippine Islands. Such
legislation was an exercise of the police power of the State. (United
States vs. Wayne Shoup, 35 Phil., 56.)

And, as we have stated, the provisions contained in section 9 of Act No. 2381 relative to
the physicians and dentist are simply detailes and means conducive to the ultimate
purpose of said Act, which details and means need not be stated in the title of the Act
for the very reason that properly speaking, they are not foreign matter.

The general purpose of these provisions is accomplished when a law has but one
general object, which is fairly indicated by its title. To require every end and
means necessary or convenient for the accomplishment of this general object to
be provided for by a separate act relating to that alone, would not only be
unreasonable, but would actually render legislation impossible. (Cooley on
Constitutional Limitations, pp. 296-297.)

The constitutional requirement is addressed to the subject, not to the details of

the act. The subject must be single; the provisions, to accomplished the object
involved in that subject, may be multifarious. . . . None of the provisions of a
statute will be held unconstitutional when they all relate, directly or indirectly, to
the same subject, have natural connection, and are not foreign to the subject
expressed in the title. As very frequently expressed by the courts, any provisions
that are germane to the subject expressed in the title may properly be included
in the act. (I Sutherland on Stat. Const., par. 118.)

In order to hold that section 9 of Act No. 2381 is unconstitutional on the ground alleged
by the plaintiff, the violation of the constitutional provision must be substantial and
manifest. It is not so in the case at bar.

2. To warrant the setting aside of statutes because their subjects are not
expressed in the titles, the violation of the rule must be substantial and plain.
 (Posadas vs. Menzi, Decision of the United States Supreme Court, page 388, No.
11, May 15, 1929, United States Supreme Court Advance Opinions.)

At all events the validity of this Opium Law, Act No. 2381, has already been upheld by
this court, not only in the above cited case, United States vs. Wayne Shoup, supra, but
also in the subsequent case of United States vs. Jao Li Sing (37 Phil., 211).

Passing to the fifth and sixth assignments of error, wherein counsel for appellant
contends that even granting that section 9 of Act No. 2381 is valid, it was repealed by
Act No. 2493 and later by section 780 of the Administrative Code, we note, first, that
there is no express repeal of section 9 of Act No. 2381. Secondly, it cannot be held that
it has been impliedly repealed, for the reason that the provisions of section 9, Act No.
2381, are neither contrary to, nor incompatible with, the provisions of section 780 of the
Administrative Code, as amended. Upon this point, we approve and adopt the following
statements made by the trial judge:

Counsel contends, in support of the above, that Act No. 2493 being complete,
and "covering the field" by implication repealed all laws relating to the practice of
medicine, powers of the Board of Medical Examiners and allied matters; hence,
the said law, expressly providing the causes for revocation of medical licenses,
necessarily excluded all others, even though embodied in prior enactments.

Act No. 310 provided that the Board of medical Examiners could revoke licenses
for "unprofessional conduct," without defining the term. Act No. 1761 (the Opium
Law) provided that illegaly prescribing opium should be cause for revocation of
medical licenses. Clearly, the Opium Law did not repeal Act No. 310. Act No. 2381
also an Opium Law in its section 9, repeated the provision as to doctors and
dentists. The repetition did not repeal Act No. 310. Act No. 2493, section 11 (Ad.
Code, sec. 780), provided that certificates of physicians are revocable for
"unprofessional conduct," without defining the phrase. In other words, so far as
revocation of licenses is concerned, Act No. 2493 is mere reenactment of Act No.
310. The reenactment of the said portion of Act No. 310 did not repeal section 9
of the Opium Law. If said section 9 has been repealed, it must be by Act No.
3111, which amends Act No. 2493 (Ad. Code, sec. 780), by an addition after the
words "unprofessional conduct" of the following:

"The words "unprofessional conduct, immoral, or dishonorable conduct" as

used in this chapter shall be construed to include the following acts: (1)
Procuring, aiding or abeting a criminal abortion; (2) advertising, either in
his own name or in the name of any other person, firm, association, or
corporation, in any written or printed paper, or document, of medical
business in which untruthful or improbable promises are made, or being
employed by, or in the service of any person, firm, association or
corporation so advertising, or advertising in any obscene manner
derogatory to good morals; (3) habitual intemperance or addition to the
use of morphine, opium, cocaine or other drugs having a similar effect; (4)
conviction of a crime or misdemeanor involving dishonorable conduct; and
(5) willfully betraying a professional secret."

It cannot be seriously contended that aside from the five examples specified
there can be no other conduct of a physician deemed "unprofessional" conduct
theretofore deemed grounds for revocation licenses. The maxim expressio unius
est exclussio alterius should be applied only as a means of discovering legislative
intent and should not be permitted to defeat the plain indicated purpose of the
Legislature. It does not apply when words are mentioned by way of example, or
to remove doubts. (See Cyc., 1122.) If, therefore, there exists, "unprofessional
conduct" not specified in the laws, with more reason does the criminal use of
opium remain a specific cause for revocation of license. (Pages 11, 12 and 13, bill
of exceptions.)

As to the seventh and eighth assignments of error, we find the judgment and appealed
from correctly rendered, and the motion of avoidance and new trial properly denied.

As the Attorney-General correctly observes, the powers vested in the Board of Medical
Examiners to suspend or revoke a physician's certificate of registration and the
authority granted the Secretary of the Interior of confirming or reversing the decision of
said board of examiners, partake of a quasi-judicial character, that is, involve the use of
discretion. For this reason, the exercise thereof cannot be reviewed by mandamus,
which is the nature of this cause on its merits.
 As in the case of courts and judicial officers, it is a rule of general application
that mandamus will not lie to review or control the acts of executive officers and
boards of state and federal governments in respect of matters as to which they
are vested with discretion. In other words, they cannot be compelled to act or
render a decision in any particular way, and this is so, even though the exercise
of this discretion requires the construction and interpretation of statutes. Where
public officials exercise their discretion, it is said that their conclusions, although
disputable, are impregnable to mandamus. (38 C. J., 659-660.)

That this action is really a mandamus proceeding, appears clearly from the terms of the
complaint filed herein.

Finding no merit in the assignments of error, the judgment appealed from is affirmed,
with costs against the appellant. So ordered.

Malcolm, Ostrand, Johns and Villa-Real, JJ., concur.

Villamor, J., reserves his vote.