G.R. No. 191018 January 25, 2016
CARLOS BORROMEO, Petitioner, vs. FAMILY CARE HOSPITAL, INC. and RAMON S. INSO, M.D., Respondents.

FACTS

Petitioner Carlos Borromeo brought his wife, Lilian, to respondent Family Care Hospital on July 13, 1999, due to acute abdominal pain and fever. Respondent Dr. Ramon Inso, after tests were inconclusive for appendicitis, performed an exploratory laparotomy on July 15, 1999, confirming acute appendicitis and successfully removing her appendix. Post-operation, Lilian’s condition initially improved. However, around 1:30 A.M. on July 16, her blood pressure dropped. Despite interventions, including blood transfusion, her condition deteriorated, showing signs of petechiae. Dr. Inso suspected Disseminated Intravascular Coagulation (DIC), a blood clotting disorder. As Family Care Hospital lacked an Intensive Care Unit, Dr. Inso arranged her transfer to Muntinlupa Medical Center, where she died around 10:00 A.M. An autopsy by Dr. Emmanuel Reyes of the PNP Crime Laboratory found 3,000 ml of blood in the peritoneal cavity and a 0.5 x 0.5 cm opening at the appendiceal stump repair site, concluding death was due to hemorrhage from this opening, which could have been avoided with double suturing. Based on this, Carlos Borromeo filed a complaint for damages against the hospital and Dr. Inso for medical negligence. The Regional Trial Court found respondents liable. The Court of Appeals reversed this decision, dismissing the complaint. Petitioner sought review by the Supreme Court.

ISSUE

Whether the Court of Appeals erred in reversing the RTC decision and in finding that respondents were not liable for medical negligence in the care and treatment of Lilian Borromeo.

RULING

The Supreme Court DENIED the petition and AFFIRMED the Court of Appeals’ decision. The Court found no negligence on the part of Dr. Inso and Family Care Hospital. The elements of a medical negligence case are: (1) duty owed by the physician to the patient, (2) breach of that duty, (3) injury caused by that breach. The burden of proof rests on the plaintiff. Expert testimony is crucial to establish the standard of care and a deviation from it. The Court found the testimony of the petitioner’s expert, Dr. Reyes, unreliable. Dr. Reyes admitted to having very little experience in pathology and no experience with appendectomy-related deaths, and that he conducted the autopsy without crucial clinical and laboratory information. In contrast, the defense experts, Dr. Ramos (an experienced pathologist) and Dr. Hernandez (a general surgeon), credibly testified that the cause of death was DIC, not the suturing. They explained that the amount of hemorrhaging and its presence in multiple organs (lungs, stomach, bowels) was inconsistent with bleeding from a single surgical site but characteristic of DIC. Dr. Ramos also noted that a 0.5 cm opening from an appendiceal vessel would cause death within minutes, not hours after surgery. The Court held that Dr. Inso exercised the degree of skill, care, and learning expected of a reasonably prudent surgeon under similar circumstances. His actions—from diagnosis, to surgery, to post-operative care and emergency transfer—were appropriate and timely. The hospital’s lack of an ICU did not constitute negligence as it was a secondary hospital not required to have one, and Dr. Inso promptly facilitated transfer. Therefore, no breach of duty was proven, and the petition was denied.