G.R. No. 122445 November 18, 1997
DR. NINEVETCH CRUZ, petitioner, vs. COURT OF APPEALS and LYDIA UMALI, respondents.

FACTS

Petitioner Dr. Ninevetch Cruz, a surgeon, and Dr. Lina Ercillo, an anesthesiologist, were charged with reckless imprudence and negligence resulting in homicide for the death of Lydia Umali following a hysterectomy operation. The information alleged negligence, carelessness, imprudence, and incompetence, including failing to supply sufficient provisions and facilities necessary for the surgical operation. The MTCC convicted Dr. Cruz but acquitted Dr. Ercillo. The RTC affirmed the conviction, and the Court of Appeals affirmed with modification, ordering Dr. Cruz to pay indemnity. The prosecution’s evidence showed that on March 22, 1991, Lydia Umali and her daughter Rowena arrived at the Perpetual Help Clinic for a scheduled hysterectomy on March 23. Rowena observed the clinic was untidy and dusty. Before the operation, Rowena asked for a postponement, but Dr. Cruz persuaded Lydia to proceed. During the operation, relatives were asked to buy Tagamet ampules and type “A” blood. After the operation, they were asked to buy more blood, but none was available. The oxygen tank ran out, requiring a rush to another hospital for oxygen. Lydia’s condition deteriorated, and she was transferred to San Pablo District Hospital without prior consent of relatives for re-operation due to blood oozing from the incision. Dr. Bartolome Angeles was summoned but found Lydia in shock with no blood pressure. Lydia died on March 24, with the death certificate stating shock as the immediate cause and Disseminated Intravascular Coagulation (DIC) as the antecedent cause. The MTCC found negligence based on the untidy clinic, lack of provisions like blood and oxygen, absence of pre-operative cardio-pulmonary clearance or blood typing, and the need for re-operation. The Court of Appeals noted the lack of preparation for contingencies in an elective surgery.

ISSUE

Whether petitioner’s conviction for reckless imprudence resulting in homicide, arising from alleged medical malpractice, is supported by the evidence on record.

RULING

No. The Supreme Court reversed the decisions of the lower courts and acquitted Dr. Ninevetch Cruz. The Court held that the prosecution failed to prove beyond reasonable doubt that petitioner was guilty of reckless imprudence. The elements of reckless imprudence require that the negligent act be the proximate cause of the injury. The evidence established that Lydia Umali died due to Disseminated Intravascular Coagulation (DIC), a severe bleeding disorder that can occur even without negligence, as confirmed by expert witnesses Dr. Floresto Arizala and Dr. Nieto Salvador. Dr. Arizala testified that DIC could be caused by the myoma itself or the operation, and it is unpredictable and may occur despite competent management. Dr. Salvador stated that DIC is an unpredictable complication of surgery that does not necessarily imply negligence. The Court emphasized that doctors are not insurers of good results and are not liable for honest mistakes of judgment. The standard is whether the physician exercised that degree of skill, care, and learning expected of a reasonably prudent practitioner under similar circumstances. The prosecution did not present expert testimony to establish that petitioner’s conduct fell below this standard. The circumstances cited by the lower courts (untidy clinic, requests for blood and oxygen) do not conclusively prove negligence as the proximate cause of death, given the medical evidence on DIC. Therefore, petitioner’s conviction was not supported by sufficient evidence.