RAMOS VS CA, 380 SCRA 467: Facts

35.
RAMOS VS CA, 380 SCRA 467
FACTS:
Plaintiff Erlinda Ramos was experiencing occasional pains allegedly caused by stones in her gall
bladder. After some tests and exams, she was advised for surgery. Dr. Orlino Hozaka, surgeon-
defendant, decided that Erlinda should undergo a “cholecystectomy” operation, a removal of
the gallstones.
Around 7:30 AM of June 17, 1985, Herminda, sister-in-law of Erlinda, accompanied Erlinda to
the operating room and saw Dr. Gutierrez, the anesthesiologist-defendant. Dr. Hosaka only
arrived around 12:15 PM, three hours late. Nonetheless, the operation continued and Herminda
then saw Dr. Gutierrez intubating the patient and heard her saying “and hirap ma-intubate nito,
mali yata ang pagkakapasok” . Thereafter, bluish discoloration of the nailbeds appeared on the
patient. Hence, Dr. Hosaka issued an order for someone to call Dr. Calderon, another
anesthesiologist. The patient was placed in a Trendelenburg position for decrease of blood
supply in her brain. At 3:00 PM, the patient was taken to the ICU. Four months after, the
patient was released from the hospital. However, the patient has been in a comatose condition.
Hence, the petitioners filed a civil case for damages against herein private respondents alleging
negligence in the management and care of Erlinda Ramos. Petitioners contended that the faulty
management of her airway caused the lack of oxygen in the patient’s brain. On the
respondent’s part, they contended that the brain damage was Erlinda's allergic reaction to the
anesthetic agent.
ISSUES:
1. Whether or not negligence of respondent Doctors Hosaka and Gutierrez caused the
unfortunate comatose condition of Erlinda Ramos;
2. Whether or not hospital De Los Santos Medical Center (DLSMC) is liable for the
negligence of exhibited by Doctors Hosaka and Gutierrez.
RULING:
1. Yes. As for Dr. Gutierrez, the court find her negligent during the anesthesia phase. As borne
by the records, respondent Dra. Gutierrez failed to properly intubate the patient which she
admitted.
During intubation, such distention indicates that air has entered the gastrointestinal tract
through the esophagus instead of the lungs through the trachea. Entry into the esophagus
would certainly cause some delay in oxygen delivery into the lungs as the tube which carries
oxygen is in the wrong place. Even granting that the tube was successfully inserted during
the second attempt, it was obviously too late. An experienced anesthesiologist, adequately
alerted by a thorough pre-operative evaluation, would have had little difficulty going around
the short neck and protruding teeth. Hence, she was negligent.
As for Dr. Hosaka, as head of the surgical team and as the so-called captain of the ship, it is
the surgeon’s responsibility to see to it that those under him perform their task in the proper
manner. His negligence can be found in his failure to exercise the proper authority (as the
captain of the operative team) in not determining if his anesthesiologist observed proper
anesthesia protocols. In fact, no evidence on record exists to show that respondent Dr.
Hosaka verified if respondent Dra. Gutierrez properly intubated the patient. Furthermore, it
does not escape the court that respondent Dr. Hosaka had scheduled another procedure in a
different hospital at the same time as Erlinda's operation, and was in fact over three hours
late for the latter's operation. Because of this, he had little or no time to confer with his
anesthesiologist regarding the anesthesia delivery. This indicates that he was remiss in his
professional duties towards his patient. Hence, he will share equal responsibility for the
events which resulted in Erlinda’s condition.
2. Yes. DLSMC is solidarily liable with Hosaka and Gutierrez.
Hospitals hire, fire and exercise real control over their attending and visiting "consultant"
(doctors) staff. While "consultants" are not technically employees (a point which respondent
hospital asserts in denying all responsibility for the patient's condition), the control exercised,
the hiring, and the right to terminate consultants all fulfill the important hallmarks of an
employer-employee relationship, with the exception of the payment of wages. In assessing
whether such a relationship in fact exists, the control test is determining. Accordingly, on the
basis of the foregoing, the Court ruled that for the purpose of allocating responsibility in
medical negligence cases, an employer-employee relationship in effect exists between
hospitals and their attending and visiting physicians.
The basis for holding an employer solidarily responsible for the negligence of its employee is
found in Article 2180 of the Civil Code which considers a person accountable not only for his
own acts but also for those of others based on the former's responsibility under a
relationship of patria potestas. Such responsibility ceases when the persons or entity
concerned prove that they have observed the diligence of a good father of the family to
prevent damage. In the instant case, respondent hospital, apart from a general denial of its
responsibility over respondent physicians, failed to adduce evidence showing that it exercised
the diligence of a good father of a family in the hiring and supervision of the latter. It failed
to adduce evidence with regard to the degree of supervision which it exercised over its
physicians. In neglecting to offer such proof, or proof of a similar nature, respondent hospital
thereby failed to discharge its burden under the last paragraph of Article 2180. Having failed
to do this, respondent hospital is consequently solidarily responsible with its physicians for
Erlinda's condition.

RAMOS VS CA, 380 SCRA 467: Facts

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35.

RAMOS VS CA, 380 SCRA 467

2. Yes. DLSMC is solidarily liable with Hosaka and Gutierrez.

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