DIMAS, MAY ANN DIMAS

BSBA HRDM II

INSTRUCTOR: SIR: REY GALANG

Hydro Resources Contractors Corp. v. Pagaliluan

G.R. No. 62909. April 18, 1989

Gutierrez, J.

FACTS:

On October 24, 1978, petitioner corporation hired private respondent Aban as its “Legal
Assistant.” On September 4, 1980, Aban received a letter of termination because of his alleged
failure to perform his duties well. On October 6, 1980, Aban filed a complaint against the
petitioner for illegal dismissal.

ISSUE:

WON there was an employer-employee relationship between petitioner corporation and Aban.

RULING:

Yes. ABan worked solely for the petitioner and dealt only with legal matters involving said
corporation and its employees. It also assisted the Personnel Officer in processing appointment
papers for employees. This latter duty is not an act of lawyer in the exercise of his profession but
rather a duty for the benefit of the corporation.
 FILAMER CHRISTIAN INST. VS. IAC G.R. No. 75112 August 17, 1992

FACTS:

Kapunan, Sr. an 82 year old retired teacher, was struck by a jeepney owned by Filamer Christian
Institute and driven by its alleged employee, Funtecha. Kapunan was hospitalized for 20 days. He
thus instituted a criminal case against Funtecha alone, who was convicted for serious physical
injuries through reckless imprudence.

Thereafter, pursuant to his reservation, Kapunan instituted a civil case for damages against
Funtecha and Filamer and its president. The RTC and the CA found Filamer, the school, liable for
damages. Hence, this petition.

Filamer contends that it is not civilly liable because Funtecha was not its employee, as he was only
a working scholar assigned to clean the school premises for only two (2) hours in the morning of
each school day. Filamer anchors its contention on Section 14, Rule X of Book III of the Labor
Code,, which excludes working scholars from the employment coverage as far as substantive labor
provisions on working conditions, rest periods, and wages is concerned.

ISSUE:
Is Funtecha an employee of Filamer?

RULING:
YES. It is undisputed that Funtecha was a working student, being a part-time janitor and a scholar
of petitioner Filamer. He was, in relation to the school, an employee even if he was assigned to
clean the school premises for only two (2) hours in the morning of each school day.

In learning how to drive while taking the vehicle home in the direction of Allan ’s house, Funtecha
definitely was not having a joy ride. Funtecha was not driving for the purpose of his enjoyment or
for a “frolic of his own” but ultimately, for the service for which the jeep was intended by the
petitioner school. Therefore, the Court is constrained to conclude that the act of Funtecha in taking
over the steering wheel was one done for and in behalf of his employer for which act the
petitioner-school cannot deny any responsibility by arguing that it was done beyond the scope of
his janitorial duties.

Section 14, Rule X, Book III of the Rules implementing the Labor Code, on which the petitioner
anchors its defense, was promulgated by the Secretary of Labor and Employment only for the
purpose of administering and enforcing the provisions of the Labor Code on conditions of
employment. Particularly, Rule X of Book III provides guidelines on the manner by which the
powers of the Labor Secretary shall be exercised; on what records should be kept; maintained and
preserved; on payroll; and on the exclusion of working scholars from, and inclusion of resident
physicians in the employment coverage as far as compliance with the substantive labor provisions
on working conditions, rest periods, and wages, is concerned.

In other words, Rule X is merely a guide to the enforcement of the substantive law on labor. The
Court, thus, makes the distinction and so holds that Section 14, Rule X, Book III of the Rules is
not the decisive law in a civil suit for damages instituted by an injured person during a vehicular
accident against a working student of a school and against the school itself.

The present case does not deal with a labor dispute on conditions of employment between an
alleged employee and an alleged employer. It invokes a claim brought by one for damages for
injury caused by the patently negligent acts of a person, against both doer-employee and his
employer. Hence, the reliance on the implementing rule on labor to disregard the primary liability
of an employer under Article 2180 of the Civil Code is misplaced. An implementing rule on labor
cannot be used by an employer as a shield to avoid liability under the substantive provisions of the
Civil Code.

[G.R. No. L-7945. March 23, 1956.]

NATIONAL LABOR UNION, Petitioner, vs. BENEDICTO DINGLASAN, Respondent.

DECISION

FACT:
The Petitioner seeks a review and the setting aside of a resolution in banc of the Court of
Industrial Relations adopted on 23 June 1954 which held that there exists no employer-employee
relationship between the Respondent and the driver complainants represented by the Petitioner and
for that reason the Court of Industrial Relations dismissed the complaint filed by the acting
prosecutor of the Court. The resolution in banc complained of reversed an order of an Associate
Judge of the Court which declared that there was such relationship of employer-employee between
the Respondent and the complainants represented by the Petitioner. The last mentioned order of 16
February 1954 was just interlocutory but it was set aside by the resolution of 23 June 1954. The
National Labor Union in representation of the complainants appealed from said resolution
dismissing its complaint charging the Respondent with the commission of unfair labor practices.

In the resolution complained of there are no findings of facts. It merely states that — cralaw the
Court, in banc, finds that the said motion for reconsideration is well-taken and, therefore, it hereby
reconsider the order of February 16, 1954, and thereby declares that there is no employer-
employee relation between Respondent, Benedicto Dinglasan, and the driver-complainants in his
case. As a consequence, the motion to dismiss the complaint dated October 31, 1953, filed by the
Acting Prosecutor of the Court, is hereby granted. (Annex D.)

This resolution was adopted upon a motion for reconsideration of the previous order of 16
February 1954. As there are no findings of fact in the resolution those set forth in the previous
order must have been relied upon by the Court. They are as follows:chanroblesvirtuallawlibrary

(a) Respondent Dinglasan is the owner and operator of TPU jeepneys plying between España-
Quiapo-Pier and vice versa.

(b) Petitioners are drivers who had verbal contracts with Respondent for the use of the latter ’s
jeepneys upon payment of P7.50 for 10 hours use, otherwise known as the “boundary system ”.

(c) Said drivers did not receive salaries or wages from Mr. Dinglasan; chan
roblesvirtualawlibrarytheir day’s earnings being the excess over the P7.50 that they paid for the
use of the jeepneys. In the event that they did not earn more, Respondent did not have to pay them
anything;

(d) Mr. Dinglasan’s supervision over the drivers consisted in inspection of the jeepneys that they
took out when they passed his gasoline station for water, checking the route prescribed by the
Public Service Commission, or whether any driver was driving recklessly and washing and
changing the tires of jeepneys. (Annex C.)

The main question to determine is whether there exists a relationship of employer-employee

between the drivers of the jeeps and the owner thereof. The findings contained in the first order
are not disputed by both parties except the last to which the Respondent took exception. But in the
resolution setting aside the order of 16 February 1954 the Court of Industrial Relations in banc did
not state that such finding is not supported by evidence. It merely “declares that there is no
employer-employee relation between Respondent, Benedicto Dinglasan, and the driver-
complainants in this case.” If the findings to which the Respondent took exception is unsupported
by the evidence, a pronouncement to that effect would have been made by the Court in banc. In
the absence of such pronouncement we are not at liberty to ignore or disregard said finding. The
findings of the Court of Industrial Relations with respect to question of fact, if supported by
substantial evidence on the record shall be conclusive.” 1 Taking into consideration the findings of
fact made by the Court of Industrial Relations we find it difficult to uphold the conclusion of the
Court set forth in its resolution of 23 June 1954. The drivers did not invest a single centavo in the
business and the Respondent is the exclusive owner of the jeeps. The management of the business
is in the Respondent’s hands. For even if the drivers of the jeeps take material possession of the
jeeps, still the Respondent as owner thereof and holder of a certificate of public convenience is
entitled to exercise, as he does and under the law he must, supervision over the drivers by seeing
to it that they follow the route prescribed by the Public Service Commission and the rules and
regulations promulgated by it as regards their operation. And when they pass by the gasoline
station of the Respondent checking by his employees on the water tank, oil and tire pressure is
done. The only features that would make the relationship of lessor and lessee between the
Respondent and the drivers, members of the union, as contended by the Respondent, are the fact
that he does not pay them any fixed wage but their compensation is the excess of the total amount
of fares earned or collected by them over and above the amount of P7.50 which they agreed to pay
to the Respondent, the owner of the jeeps, and the fact that the gasoline burned by the jeeps is for
the account of the drivers. These two features are not, however, sufficient to withdraw the
relationship between them from that of employer-employee, because the estimated earnings for
fares must be over and above the amount they agreed to pay to the Respondent for a ten-hour shift
or ten-hour a day operation of the jeeps. Not having any interest in the business because they did
not invest anything in the acquisition of the jeeps and did not participate in the management
thereof, their service as drivers of the jeeps being their only contribution to the business, the
relationship of lessor and lessee cannot be sustained. 1 In the lease of chattels the lessor loses
complete control over the chattel leased although the lessee cannot make bad use thereof, for he
would be responsible for damages to the lessor should he do so. In this case there is a supervision
and a sort of control that the owner of the jeeps exercises over the drivers. It is an attempt by
ingenious scheme to withdraw the relationship between the owner of the jeeps and the drivers
thereof from the operation of the labor laws enacted to promote industrial peace.

As to the point that the National Labor Union is not the real party in interest to bring the
complaint, suffice it to say that “ ‘representative ’ includes a legitimate labor organization or any
officer or agent of such organization, whether or not employed by the employer or employees
whom he represents.” 2 And whenever it is charged by an offended party or his representative that
any person has engaged or is engaging in any unfair labor practice, the Court of Industrial
Relations must investigate such charge. 3 Therefore, the objection to the institution of the charge
for unfair labor practice by the National Labor Union is not well taken.

The order of 23 June 1904 is reversed and set aside and the case remanded to the Court of
Industrial Relations for such further proceedings as may be required by law, with costs against the
Respondent.

Paras, C.J., Bengzon, Reyes, A., Bautista Angelo, Labrador, Concepcion, Reyes, J. B. L. and
Endencia, JJ., concur.
 [G.R. No. 124354. April 11, 2002.]
ROGELIO E. RAMOS and ERLINDA RAMOS, in their own behalf and as natural
guardians of the minors, ROMMEL RAMOS, ROY RODERICK RAMOS, and RON
RAYMOND RAMOS, Petitioners, v. COURT OF APPEALS, DE LOS SANTOS MEDICAL
CENTER, DR. ORLINO HOSAKA and DR. PERFECTA GUTIERREZ, Respondents.

RESOLUTION

FACT:

KAPUNAN, J.:
Private respondents De Los Santos Medical Center, Dr. Orlino Hosaka and Dr. Perfecta Gutierrez
move for a reconsideration of the Decision, dated December 29, 1999, of this Court holding them
civilly liable for petitioner Erlinda Ramos� comatose condition after she delivered herself to
them for their professional care and management.chanrob1es virtua1 1aw 1ibrary

ISSUE
the better understanding of the issues raised in private respondents � respective motions, we will
briefly restate the facts of the cases.

RULING:

Petitioner Erlinda was admitted to the DLSMC the day before the scheduled operation. By 7:30 in
the morning of the following day, petitioner Erlinda was already being prepared for operation.
Upon the request of petitioner Erlinda, her sister-in-law, Herminda Cruz, who was then Dean of
the College of Nursing at the Capitol Medical Center, was allowed to accompany her inside the
operating room. At around 9:30 in the morning, Dr. Hosaka had not yet arrived so Dr. Gutierrez
tried to get in touch with him by phone. Thereafter, Dr. Gutierrez informed Cruz that the operation
might be delayed due to the late arrival of Dr. Hosaka. In the meantime, the patient, petitioner
Erlinda said to Cruz, "Mindy, inip na inip na ako, ikuha mo ako ng ibang Doctor."cralaw
virtua1aw library .By 10:00 in the morning, when Dr. Hosaka was still not around, petitioner
Rogelio already wanted to pull out his wife from the operating room. He met Dr. Garcia, who
remarked that he was also tired of waiting for Dr. Hosaka. Dr. Hosaka finally arrived at the
hospital at around 12:10 in the afternoon, or more than three (3) hours after the scheduled
operation.
Cruz, who was then still inside the operating room, heard about Dr. Hosaka �s arrival. While she
held the hand of Erlinda, Cruz saw Dr. Gutierrez trying to intubate the patient. Cruz heard Dr.
Gutierrez utter: "ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang tiyan."
Cruz noticed a bluish discoloration of Erlinda�s nailbeds on her left hand. She (Cruz) then heard
Dr. Hosaka instruct someone to call Dr. Calderon, another anesthesiologist. When he arrived, Dr.
Calderon attempted to intubate the patient. The nailbeds of the patient remained bluish, thus, she
was placed in a trendelenburg position � a position where the head of the patient is placed in a
position lower than her feet. At this point, Cruz went out of the operating room to express her
concern to petitioner Rogelio that Erlinda�s operation was not going well.

Cruz quickly rushed back to the operating room and saw that the patient was still in trendelenburg
position. At almost 3:00 in the afternoon, she saw Erlinda being wheeled to the Intensive Care
Unit (ICU). The doctors explained to petitioner Rogelio that his wife had bronchospasm. Erlinda
stayed in the ICU for a month. She was released from the hospital only four months later or on
November 15, 1985. Since the ill-fated operation, Erlinda remained in comatose condition until
she died on August 3, 1999. 1

Petitioners filed with the Regional Trial Court of Quezon City a civil case for damages against
private respondents. After due trial, the court a quo rendered judgment in favor of petitioners.
Essentially, the trial court found that private respondents were negligent in the performance of
their duties to Erlinda. On appeal by private respondents, the Court of Appeals reversed the trial
court�s decision and directed petitioners to pay their "unpaid medical bills" to private
respondents.

Petitioners filed with this Court a petition for review on certiorari. The private respondents were
then required to submit their respective comments thereon. On December 29, 1999, this Court
promulgated the decision which private respondents now seek to be reconsidered. The dispositive
portion of said Decision states:chanrob1es virtual 1aw library

WHEREFORE, the decision and resolution of the appellate court appealed from are hereby
modified so as to award in favor of petitioners, and solidarily against private respondents the
following: 1) P1,352,000.00 as actual damages computed as of the date of promulgation of this
decision plus a monthly payment of P8,000.00 up to the time that petitioner Erlinda Ramos
expires or miraculously survives; 2) P2,000,000.00 as moral damages, 3) P1,500,000.00 as
temperate damages; 4) P100,000.00 each exemplary damages and attorney �s fees; and 5) the
costs of the suit. 2

In his Motion for Reconsideration, private respondent Dr. Hosaka submits the following as
grounds therefor:chanrob1es virtual 1aw library

THE HONORABLE SUPREME COURT COMMITTED REVERSIBLE ERROR WHEN IT

HELD RESPONDENT DR. HOSAKA LIABLE ON THE BASIS OF THE "CAPTAIN-OF-THE-
SHIP" DOCTRINE.

II

THE HONORABLE SUPREME COURT ERRED IN HOLDING RESPONDENT DR. HOSAKA

LIABLE DESPITE THE FACT THAT NO NEGLIGENCE CAN BE ATTRIBUTABLE TO HIM.

III

ASSUMING WITHOUT ADMITTING THAT RESPONDENT DR. HOSAKA IS LIABLE, THE

HONORABLE SUPREME COURT ERRED IN AWARDING DAMAGES THAT WERE
CLEARLY EXCESSIVE AND WITHOUT LEGAL BASIS. 3

Private respondent Dr. Gutierrez, for her part, avers that:chanrob1es virtual 1aw library

A. THE HONORABLE SUPREME COURT MAY HAVE INADVERTENTLY

OVERLOOKED THE FACT THAT THE COURT OF APPEAL�S DECISION DATED 29 MAY
1995 HAD ALREADY BECOME FINAL AND EXECUTORY AS OF 25 JUNE 1995,
THEREBY DEPRIVING THIS HONORABLE COURT OF JURISDICTION OVER THE
INSTANT PETITION;

B. THE HONORABLE SUPREME COURT MAY HAVE INADVERTENTLY

OVERLOOKED SEVERAL MATERIAL FACTUAL CIRCUMSTANCES WHICH, IF
PROPERLY CONSIDERED, WOULD INDUBITABLY LEAD TO NO OTHER CONCLUSION
BUT THAT PRIVATE RESPONDENT DOCTORS WERE NOT GUILTY OF ANY
NEGLIGENCE IN RESPECT OF THE INSTANT CASE;

B.1 RESPONDENT DOCTOR PERFECTA GUTIERREZ HAS SUFFICIENTLY

DISCHARGED THE BURDEN OF EVIDENCE BY SUBSTANTIAL PROOF OF HER
COMPLIANCE WITH THE STANDARDS OF DUE CARE EXPECTED IN HER
RESPECTIVE FIELD OF MEDICAL SPECIALIZATION.

B.2 RESPONDENT DOCTOR PERFECTA GUTIERREZ HAS SUFFICIENTLY

DISCHARGED THE BURDEN OF EVIDENCE BY SUBSTANTIAL PROOF OF HER
HAVING SUCCESSFULLY INTUBATED PATIENT ERLINDA RAMOS

C. THE SUPREME COURT MAY HAVE INADVERTENTLY PLACED TOO MUCH

RELIANCE ON THE TESTIMONY OF PETITIONER�S WITNESS HERMINDA CRUZ,
DESPITE THE EXISTENCE OF SEVERAL FACTUAL CIRCUMSTANCES WHICH
RENDERS DOUBT ON HER CREDIBILITY

D. THE SUPREME COURT MAY HAVE INADVERTENTLY DISREGARDED THE

EXPERT TESTIMONY OF DR. JAMORA AND DRA. CALDERON

E. THE HONORABLE SUPREME COURT MAY HAVE INADVERTENTLY AWARDED

DAMAGES TO PETITIONERS DESPITE THE FACT THAT THERE WAS NO NEGLIGENCE
ON THE PART OF RESPONDENT DOCTOR. 4
Private respondent De Los Santos Medical Center likewise moves for reconsideration on the
following grounds:chanrob1es virtual 1aw library

THE HONORABLE COURT ERRED IN GIVING DUE COURSE TO THE INSTANT

PETITION AS THE DECISION OF THE HONORABLE COURT OF APPEALS HAD
ALREADY BECOME FINAL AND EXECUTORY

II

THE HONORABLE SUPREME COURT ERRED IN FINDING THAT AN EMPLOYER-

EMPLOYEE [RELATIONSHIP] EXISTS BETWEEN RESPONDENT DE LOS SANTOS
MEDICAL CENTER AND DRS. ORLINO HOSAKA AND PERFECTA GUTIERREZ

III

THE HONORABLE SUPREME COURT ERRED IN FINDING THAT RESPONDENT DE LOS

SANTOS MEDICAL CENTER IS SOLIDARILY LIABLE WITH RESPONDENT DOCTORS

IV

THE HONORABLE SUPREME COURT ERRED IN INCREASING THE AWARD OF

DAMAGES IN FAVOR OF PETITIONERS. 5

In the Resolution of February 21, 2000, this Court denied the motions for reconsideration of
private respondents Drs. Hosaka and Gutierrez. They then filed their respective second motions
for reconsideration. The Philippine College of Surgeons filed its Petition-in-Intervention
contending in the main that this Court erred in holding private respondent Dr. Hosaka liable under
the captain of the ship doctrine. According to the intervenor, said doctrine had long been
abandoned in the United States in recognition of the developments in modern medical and hospital
practice. 6 The Court noted these pleadings, in the Resolution of July 17, 2000. 7

On March 19, 2001, the Court heard the oral arguments of the parties, including the intervenor.
Also present during the hearing were the amicii curiae: Dr. Felipe A. Estrella, Jr., Consultant of the
Philippine Charity Sweepstakes, former Director of the Philippine General Hospital and former
Secretary of Health; Dr. Iluminada T. Camagay, President of the Philippine Society of
Anesthesiologists, Inc. and Professor and Vice-Chair for Research, Department of Anesthesiology,
College of Medicine-Philippine General Hospital, University of the Philippines; and Dr. Lydia M.
Egay, Professor and Vice-Chair for Academics, Department of Anesthesiology, College of
Medicine-Philippine General Hospital, University of the Philippines.

The Court enumerated the issues to be resolved in this case as follows:chanrob1es virtual 1aw
library

1. WHETHER OR NOT DR. ORLINO HOSAKA (SURGEON) IS LIABLE FOR

NEGLIGENCE;

2. WHETHER OR NOT DR. PERFECTA GUTIERREZ (ANESTHESIOLOGIST) IS LIABLE

FOR NEGLIGENCE; AND

3. WHETHER OR NOT THE HOSPITAL (DELOS SANTOS MEDICAL CENTER) IS

LIABLE FOR ANY ACT OF NEGLIGENCE COMMITTED BY THEIR VISITING
CONSULTANT SURGEON AND ANESTHESIOLOGIST. 8

We shall first resolve the issue pertaining to private respondent Dr. Gutierrez. She maintains that
the Court erred in finding her negligent and in holding that it was the faulty intubation which was
the proximate cause of Erlinda�s comatose condition. The following objective facts allegedly
negate a finding of negligence on her part: 1) That the outcome of the procedure was a comatose
patient and not a dead one; 2) That the patient had a cardiac arrest; and 3) That the patient was
revived from that cardiac arrest. 9 In effect, Dr. Gutierrez insists that, contrary to the finding of
this Court, the intubation she performed on Erlinda was successful.

Unfortunately, Dr. Gutierrez� claim of lack of negligence on her part is belied by the records of
the case. It has been sufficiently established that she failed to exercise the standards of care in the
administration of anesthesia on a patient. Dr. Egay enlightened the Court on what these standards
are:chanrob1es virtual 1aw library

What are the standards of care that an anesthesiologist should do before we administer anesthesia?
The initial step is the preparation of the patient for surgery and this is a pre-operative evaluation
because the anesthesiologist is responsible for determining the medical status of the patient,
developing the anesthesia plan and acquainting the patient or the responsible adult particularly if
we are referring with the patient or to adult patient who may not have, who may have some mental
handicaps of the proposed plans. We do pre-operative evaluation because this provides for an
opportunity for us to establish identification and personal acquaintance with the patient. It also
makes us have an opportunity to alleviate anxiety, explain techniques and risks to the patient,
given the patient the choice and establishing consent to proceed with the plan. And lastly, once this
has been agreed upon by all parties concerned the ordering of pre-operative medications. And
following this line at the end of the evaluation we usually come up on writing, documentation is
very important as far as when we train an anesthesiologist we always emphasize this because we
need records for our protection, well, records. And it entails having brief summary of patient
history and physical findings pertinent to anesthesia, plan, organize as a problem list, the plan
anesthesia technique, the plan post operative, pain management if appropriate, special issues for
this particular patient. There are needs for special care after surgery and if it so it must be written
down there and a request must be made known to proper authorities that such and such care is
necessary. And the request for medical evaluation if there is an indication. When we ask for a
cardio-pulmonary clearance it is not in fact to tell them if this patient is going to be fit for
anesthesia, the decision to give anesthesia rests on the anesthesiologist. What we ask them is
actually to give us the functional capacity of certain systems which may be affected by the
anesthetic agent or the technique that we are going to use. But the burden of responsibility in
terms of selection of agent and how to administer it rest on the anesthesiologist. 10

The conduct of a preanesthetic/preoperative evaluation prior to an operation, whether elective or

emergency, cannot be dispensed with. 11 Such evaluation is necessary for the formulation of a
plan of anesthesia care suited to the needs of the patient concerned.

Pre-evaluation for anesthesia involves taking the patient�s medical history, reviewing his current
drug therapy, conducting physical examination, interpreting laboratory data, and determining the
appropriate prescription of preoperative medications as necessary to the conduct of anesthesia. 12

Physical examination of the patient entails not only evaluating the patient �s central nervous
system, cardiovascular system and lungs but also the upper airway. Examination of the upper
airway would in turn include an analysis of the patient�s cervical spine mobility,
temporomandibular mobility, prominent central incisors, deceased or artificial teeth, ability to
visualize uvula and the thyromental distance. 13

Nonetheless, Dr. Gutierrez omitted to perform a thorough preoperative evaluation on Erlinda. As

she herself admitted, she saw Erlinda for the first time on the day of the operation itself, one hour
before the scheduled operation. She auscultated 14 the patient�s heart and lungs and checked the
latter�s blood pressure to determine if Erlinda was indeed fit for operation. 15 However, she did
not proceed to examine the patient�s airway. Had she been able to check petitioner Erlinda �s
airway prior to the operation, Dr. Gutierrez would most probably not have experienced difficulty
in intubating the former, and thus the resultant injury could have been avoided. As we have stated
in our Decision:chanrob1es virtual 1aw library

In the case at bar, respondent Dra. Gutierrez admitted that she saw Erlinda for the first time on the
day of the operation itself, on 17 June 1985. Before this date, no prior consultations with, or pre-
operative evaluation of Erlinda was done by her. Until the day of the operation, respondent Dra.
Gutierrez was unaware of the physiological make-up and needs of Erlinda. She was likewise not
properly informed of the possible difficulties she would face during the administration of
anesthesia to Erlinda. Respondent Dra. Gutierrez� act of seeing her patient for the first time only
an hour before the scheduled operative procedure was, therefore, an act of exceptional negligence
and professional irresponsibility. The measures cautioning prudence and vigilance in dealing with
human lives lie at the core of the physician �s centuries-old Hippocratic Oath. Her failure to
follow this medical procedure is, therefore, a clear indicia of her negligence. 16

Further, there is no cogent reason for the Court to reverse its finding that it was the faulty
intubation on Erlinda that caused her comatose condition. There is no question that Erlinda
became comatose after Dr. Gutierrez performed a medical procedure on her. Even the counsel of
Dr. Gutierrez admitted to this fact during the oral arguments:chanrob1es virtual 1aw library

CHIEF JUSTICE:chanrob1es virtual 1aw library

Mr. Counsel, you started your argument saying that this involves a comatose patient?

ATTY. GANA:chanrob1es virtual 1aw library

Yes, Your Honor.

CHIEF JUSTICE:chanrob1es virtual 1aw library

How do you mean by that, a comatose, a comatose after any other acts were done by Dr. Gutierrez
or comatose before any act was done by her?

ATTY. GANA:chanrob1es virtual 1aw library

No, we meant comatose as a final outcome of the procedure.

CHIEF JUSTICE:chanrob1es virtual 1aw library

Meaning to say, the patient became comatose after some intervention, professional acts have been
done by Dr. Gutierrez?

ATTY. GANA:chanrob1es virtual 1aw library

Yes, Your Honor.

CHIEF JUSTICE:chanrob1es virtual 1aw library

In other words, the comatose status was a consequence of some acts performed by D. Gutierrez?

ATTY. GANA:chanrob1es virtual 1aw library

It was a consequence of the well, (interrupted)

CHIEF JUSTICE:chanrob1es virtual 1aw library

An acts performed by her, is that not correct?

ATTY. GANA:chanrob1es virtual 1aw library

Yes, Your Honor.

CHIEF JUSTICE:chanrob1es virtual 1aw library
Thank you. 17

What is left to be determined therefore is whether Erlinda �s hapless condition was due to any
fault or negligence on the part of Dr. Gutierrez while she (Erlinda) was under the latter �s care.
Dr. Gutierrez maintains that the bronchospasm and cardiac arrest resulting in the patient �s
comatose condition was brought about by the anaphylactic reaction of the patient to Thiopental
Sodium (pentothal). 18 In the Decision, we explained why we found Dr. Gutierrez � theory
unacceptable. In the first place, Dr. Eduardo Jamora, the witness who was presented to support her
(Dr. Gutierrez) theory, was a pulmonologist. Thus, he could not be considered an authority on
anesthesia practice and procedure and their complications. 19

Secondly, there was no evidence on record to support the theory that Erlinda developed an allergic
reaction to pentothal. Dr. Camagay enlightened the Court as to the manifestations of an allergic
reaction in this wise:chanrob1es virtual 1aw library

DR. CAMAGAY:chanrob1es virtual 1aw library

All right, let us qualify an allergic reaction. In medical terminology an allergic reaction is
something which is not usual response and it is further qualified by the release of a hormone
called histamine and histamine has an effect on all the organs of the body generally release
because the substance that entered the body reacts with the particular cell, the mass cell, and the
mass cell secretes this histamine. In a way it is some form of response to take away that which is
not mine, which is not part of the body. So, histamine has multiple effects on the body. So, one of
the effects as you will see you will have redness, if you have an allergy you will have tearing of
the eyes, you will have swelling, very crucial swelling sometimes of the larynges which is your
voice box main airway, that swelling may be enough to obstruct the entry of air to the trachea and
you could also have contraction, constriction of the smaller airways beyond the trachea, you see
you have the trachea this way, we brought some visual aids but unfortunately we do not have a
projector. And then you have the smaller airways, the bronchi and then eventually into the mass of
the lungs you have the bronchus. The difference is that these tubes have also in their walls muscles
and this particular kind of muscles is smooth muscle so, when histamine is released they close up
like this and that phenomenon is known as bronco spasm. However, the effects of histamine also
on blood vessels are different. They dilate blood vessel open up and the patient or whoever has
this histamine release has hypertension or low blood pressure to a point that the patient may have
decrease blood supply to the brain and may collapse so, you may have people who have this. 20

These symptoms of an allergic reaction were not shown to have been extant in Erlinda �s case. As
we held in our Decision, "no evidence of stridor, skin reactions, or wheezing � some of the more
common accompanying signs of an allergic reaction � appears on record. No laboratory data
were ever presented to the court." 21

Dr. Gutierrez, however, insists that she successfully intubated Erlinda as evidenced by the fact that
she was revived after suffering from cardiac arrest. Dr. Gutierrez faults the Court for giving
credence to the testimony of Cruz on the matter of the administration of anesthesia when she
(Cruz), being a nurse, was allegedly not qualified to testify thereon. Rather, Dr. Gutierrez invites
the Court�s attention to her synopsis on what transpired during Erlinda �s intubation:chanrob1es
virtual 1aw library

12:15 p.m. Patient was inducted with sodium pentothal 2.5% (250 mg) given by slow IV. 02
was started by mask. After pentothal injection this was followed by IV injection of Norcuron 4
mg. After 2 minutes 02 was given by positive pressure for about one minute. Intubation with
endotracheal tube 7.5 m. in diameter was done with slight difficulty (short neck & slightly
prominent upper teeth) chest was examined for breath sounds & checked if equal on both sides.
The tube was then anchored to the mouth by plaster & cuff inflated. Ethrane 2% with 02 4 liters
was given. Blood pressure was checked 120/80 & heart rate regular and normal 90/min.

12:25 p.m. After 10 minutes patient was cyanotic. Ethrane was discontinued & 02 given alone.
Cyanosis disappeared. Blood pressure and heart beats stable.

12:30 p.m. Cyanosis again reappeared this time with sibilant and sonorous rales all over the
chest. D_5%_H2O & 1 ampule of aminophyline by fast drip was started. Still the cyanosis was
persistent. Patient was connected to a cardiac monitor. Another ampule of of [sic] aminophyline
was given and solu cortef was given.

12:40 p.m. There was cardiac arrest. Extra cardiac massage and intercardiac injection of
adrenalin was given & heart beat reappeared in less than one minute. Sodium bicarbonate &
another dose of solu cortef was given by IV. Cyanosis slowly disappeared & 02 continuously
given & assisted positive pressure. Laboratory exams done (see results in chart).

Patient was transferred to ICU for further management. 22

From the foregoing, it can be allegedly seen that there was no withdrawal (extubation) of the tube.
And the fact that the cyanosis allegedly disappeared after pure oxygen was supplied through the
tube proved that it was properly placed.

The Court has reservations on giving evidentiary weight to the entries purportedly contained in Dr.
Gutierrez� synopsis. It is significant to note that the said record prepared by Dr. Gutierrez was
made only after Erlinda was taken out of the operating room. The standard practice in anesthesia is
that every single act that the anesthesiologist performs must be recorded. In Dr. Gutierrez � case,
she could not account for at least ten (10) minutes of what happened during the administration of
anesthesia on Erlinda. The following exchange between Dr. Estrella, one of the amicii curiae, and
Dr. Gutierrez is instructive:chanrob1es virtual 1aw library

DR. ESTRELLA

Q. You mentioned that there were two (2) attempts in the intubation period?
DR. GUTIERREZ

Yes.

Q There were two attempts. In the first attempt was the tube inserted or was the laryngoscope
only inserted, which was inserted?

A All the laryngoscope.

Q All the laryngoscope. But if I remember right somewhere in the re-direct, a certain lawyer,
you were asked that you did a first attempt and the question was � did you withdraw the tube?
And you said � you never withdrew the tube, is that right?

A Yes.

Q Yes. And so if you never withdrew the tube then there was no, there was no insertion of the
tube during that first attempt. Now, the other thing that we have to settle here is � when cyanosis
occurred, is it recorded in the anesthesia record when the cyanosis, in your recording when did the
cyanosis occur?

A (sic)

Q Is it a standard practice of anesthesia that whatever you do during that period or from the
time of induction to the time that you probably get the patient out of the operating room that every
single action that you do is so recorded in your anesthesia record?

A I was not able to record everything I did not have time anymore because I did that after the,
when the patient was about to leave the operating room. When there was second cyanosis already
that was the (interrupted)

Q When was the first cyanosis?

A The first cyanosis when I was (interrupted)

Q What time, more or less?

A I think it was 12:15 or 12:16.

Q Well, if the record will show you started induction at 12:15?

A Yes, Your Honor.

Q And the first medication you gave was what?

A The first medication, no, first the patient was oxygenated for around one to two minutes.

Q Yes, so, that is about 12:13?

A Yes, and then, I asked the resident physician to start giving the pentothal very slowly and that
was around one minute.

Q So, that is about 12:13 no, 12:15, 12:17?

A Yes, and then, after one minute another oxygenation was given and after (interrupted)

Q 12:18?

A Yes, and then after giving the oxygen we start the menorcure which is a relaxant. After that
relaxant (interrupted)

Q After that relaxant, how long do you wait before you do any manipulation?

A Usually you wait for two minutes or three minutes.

Q So, if our estimate of the time is accurate we are now more or less 12:19, is that right?

A May be.

Q 12:19. And at that time, what would have been done to this patient?

A After that time you examine the, if there is relaxation of the jaw which you push it
downwards and when I saw that the patient was relax because that monorcure is a relaxant, you
cannot intubate the patient or insert the laryngoscope if it is not keeping him relax. So, my first
attempt when I put the laryngoscope on I saw the trachea was deeply interiorly. So, what I did ask
"mahirap ata ito ah." So, I removed the laryngoscope and oxygenated again the patient.

Q So, more or less you attempted to do an intubation after the first attempt as you claimed that
it was only the laryngoscope that was inserted.
A Yes.

Q And in the second attempt you inserted the laryngoscope and now possible intubation?

A Yes.

Q And at that point, you made a remark, what remark did you make?

A I said "mahirap ata ito" when the first attempt I did not see the trachea right away. That was
when I (interrupted)

Q That was the first attempt?

A Yes.

Q What about the second attempt?

A On the second attempt I was able to intubate right away within two to three seconds.

Q At what point, for purposes of discussion without accepting it, at what point did you make the
comment "na mahirap ata to intubate, mali ata ang pinasukan"

A I did not say "mali ata ang pinasukan" I never said that.

Q Well, just for the information of the group here the remarks I am making is based on the
documents that were forwarded to me by the Supreme Court. That is why for purposes of
discussion I am trying to clarify this for the sake of enlightenment. So, at what point did you ever
make that comment?

A Which one, sir?

Q The "mahirap intubate ito" assuming that you (interrupted)

A Iyon lang, that is what I only said "mahirap intubate (interrupted)

Q At what point?

A When the first attempt when I inserted the laryngoscope for the first time.

Q So, when you claim that at the first attempt you inserted the laryngoscope, right?

A Yes.

Q But in one of the recordings somewhere at the, somewhere in the transcript of records that
when the lawyer of the other party try to inquire from you during the first attempt that was the
time when "mayroon ba kayong hinugot sa tube, I do not remember the page now, but it seems to
me it is there. So, that it was on the second attempt that (interrupted)

A I was able to intubate.

Q And this is more or less about what time 12:21?

A May be, I cannot remember the time, Sir.

Q Okay, assuming that this was done at 12:21 and looking at the anesthesia records from 12:20
to 12:30 there was no recording of the vital signs. And can we presume that at this stage there was
already some problems in handling the patient?

A Not yet.

Q But why are there no recordings in the anesthesia record?

A I did not have time.

Q Ah, you did not have time, why did you not have time?

A Because it was so fast, I really (at this juncture the witness is laughing)

Q No, I am just asking. Remember I am not here not to pin point on anybody I am here just to
more or less clarify certainty more or less on the record.

A Yes, Sir.

Q And so it seems that there were no recording during that span of ten (10) minutes. From
12:20 to 12:30, and going over your narration, it seems to me that the cyanosis appeared ten (10)
minutes after induction, is that right?

A Yes.

Q And that is after induction 12:15 that is 12:25 that was the first cyanosis?

A Yes.

Q And that the 12:25 is after the 12:20?

A We cannot (interrupted)

Q Huwag ho kayong makuwan, we are just trying to enlighten, I am just going over the record
ano, kung mali ito kuwan eh di ano. So, ganoon po ano, that it seems to me that there is no
recording from 12:20 to 12:30, so, I am just wondering why there were no recordings during the
period and then of course the second cyanosis, after the first cyanosis. I think that was the time Dr.
Hosaka came in?

A No, the first cyanosis (interrupted). 23

We cannot thus give full credence to Dr. Gutierrez� synopsis in light of her admission that it does
not fully reflect the events that transpired during the administration of anesthesia on Erlinda. As
pointed out by Dr. Estrella, there was a ten-minute gap in Dr. Gutierrez � synopsis, i.e., the vital
signs of Erlinda were not recorded during that time. The absence of these data is particularly
significant because, as found by the trial court, it was the absence of oxygen supply for four (4) to
five (5) minutes that caused Erlinda�s comatose condition.

On the other hand, the Court has no reason to disbelieve the testimony of Cruz. As we stated in the
Decision, she is competent to testify on matters which she is capable of observing such as, the
statements and acts of the physician and surgeon, external appearances and manifest conditions
which are observable by any one. 24 Cruz, Erlinda�s sister-in-law, was with her inside the
operating room. Moreover, being a nurse and Dean of the Capitol Medical Center School of
Nursing at that, she is not entirely ignorant of anesthetic procedure. Cruz narrated that she heard
Dr. Gutierrez remark, "Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O lumalaki ang
tiyan." She observed that the nailbeds of Erlinda became bluish and thereafter Erlinda was placed
in trendelenburg position. 25 Cruz further averred that she noticed that the abdomen of Erlinda
became distended. 26

The cyanosis (bluish discoloration of the skin or mucous membranes caused by lack of oxygen or
abnormal hemoglobin in the blood) and enlargement of the stomach of Erlinda indicate that the
endotracheal tube was improperly inserted into the esophagus instead of the trachea.
Consequently, oxygen was delivered not to the lungs but to the gastrointestinal tract. This
conclusion is supported by the fact that Erlinda was placed in trendelenburg position. This
indicates that there was a decrease of blood supply to the patient �s brain. The brain was thus
temporarily deprived of oxygen supply causing Erlinda to go into coma.

The injury incurred by petitioner Erlinda does not normally happen absent any negligence in the
administration of anesthesia and in the use of an endotracheal tube. As was noted in our Decision,
the instruments used in the administration of anesthesia, including the endotracheal tube, were all
under the exclusive control of private respondents Dr. Gutierrez and Dr. Hosaka. 27 In Voss v.
Bridwell, 28 which involved a patient who suffered brain damage due to the wrongful
administration of anesthesia, and even before the scheduled mastoid operation could be
performed, the Kansas Supreme Court applied the doctrine of res ipsa loquitur, reasoning that the
injury to the patient therein was one which does not ordinarily take place in the absence of
negligence in the administration of an anesthetic, and in the use and employment of an
endotracheal tube. The court went on to say that" [o]rdinarily a person being put under anesthesia
is not rendered decerebrate as a consequence of administering such anesthesia in the absence of
negligence. Upon these facts and under these circumstances, a layman would be able to say, as a
matter of common knowledge and observation, that the consequences of professional treatment
were not as such as would ordinarily have followed if due care had been exercised. 29
Considering the application of the doctrine of res ipsa loquitur, the testimony of Cruz was properly
given credence in the case at bar.

For his part, Dr. Hosaka mainly contends that the Court erred in finding him negligent as a
surgeon by applying the Captain-of-the-Ship doctrine. 30 Dr. Hosaka argues that the trend in
United States jurisprudence has been to reject said doctrine in light of the developments in
medical practice. He points out that anesthesiology and surgery are two distinct and specialized
fields in medicine and as a surgeon, he is not deemed to have control over the acts of Dr.
Gutierrez. As anesthesiologist, Dr. Gutierrez is a specialist in her field and has acquired skills and
knowledge in the course of her training which Dr. Hosaka, as a surgeon, does not possess. 31 He
states further that current American jurisprudence on the matter recognizes that the trend towards
specialization in medicine has created situations where surgeons do not always have the right to
control all personnel within the operating room, 32 especially a fellow specialist. 33

Dr. Hosaka cites the case of Thomas v. Raleigh General Hospital, 34 which involved a suit filed
by a patient who lost his voice due to the wrongful insertion of the endotracheal tube preparatory
to the administration of anesthesia in connection with the laparotomy to be conducted on him. The
patient sued both the anesthesiologist and the surgeon for the injury suffered by him. The Supreme
Court of Appeals of West Virginia held that the surgeon could not be held liable for the loss of the
patient�s voice, considering that the surgeon did not have a hand in the intubation of the patient.
The court rejected the application of the "Captain-of-the-Ship Doctrine," citing the fact that the
field of medicine has become specialized such that surgeons can no longer be deemed as having
control over the other personnel in the operating room. It held that" [a]n assignment of liability
based on actual control more realistically reflects the actual relationship which exists in a modern
operating room." 35 Hence, only the anesthesiologist who inserted the endotracheal tube into the
patient�s throat was held liable for the injury suffered by the latter.

This contention fails to persuade.

That there is a trend in American jurisprudence to do away with the Captain-of-the-Ship doctrine
does not mean that this Court will ipso facto follow said trend. Due regard for the peculiar factual
circumstances obtaining in this case justify the application of the Captain-of-the-Ship doctrine.
From the facts on record it can be logically inferred that Dr. Hosaka exercised a certain degree of,
at the very least, supervision over the procedure then being performed on Erlinda.

First, it was Dr. Hosaka who recommended to petitioners the services of Dr. Gutierrez. In effect,
he represented to petitioners that Dr. Gutierrez possessed the necessary competence and skills.
Drs. Hosaka and Gutierrez had worked together since 1977. Whenever Dr. Hosaka performed a
surgery, he would always engage the services of Dr. Gutierrez to administer the anesthesia on his
patient. 36

Second, Dr. Hosaka himself admitted that he was the attending physician of Erlinda. Thus, when
Erlinda showed signs of cyanosis, it was Dr. Hosaka who gave instructions to call for another
anesthesiologist and cardiologist to help resuscitate Erlinda. 37

Third, it is conceded that in performing their responsibilities to the patient, Drs. Hosaka and
Gutierrez worked as a team. Their work cannot be placed in separate watertight compartments
because their duties intersect with each other. 38

While the professional services of Dr. Hosaka and Dr. Gutierrez were secured primarily for their
performance of acts within their respective fields of expertise for the treatment of petitioner
Erlinda, and that one does not exercise control over the other, they were certainly not completely
independent of each other so as to absolve one from the negligent acts of the other physician.

That they were working as a medical team is evident from the fact that Dr. Hosaka was keeping an
eye on the intubation of the patient by Dr. Gutierrez, and while doing so, he observed that the
patient�s nails had become dusky and had to call Dr. Gutierrez �s attention thereto. The Court
also notes that the counsel for Dr. Hosaka admitted that in practice, the anesthesiologist would
also have to observe the surgeon�s acts during the surgical process and calls the attention of the
surgeon whenever necessary 39 in the course of the treatment. The duties of Dr. Hosaka and those
of Dr. Gutierrez in the treatment of petitioner Erlinda are therefore not as clear-cut as respondents
claim them to be. On the contrary, it is quite apparent that they have a common responsibility to
treat the patient, which responsibility necessitates that they call each other �s attention to the
condition of the patient while the other physician is performing the necessary medical procedures.

It is equally important to point out that Dr. Hosaka was remiss in his duty of attending to petitioner
Erlinda promptly, for he arrived more than three (3) hours late for the scheduled operation. The
cholecystectomy was set for June 17, 1985 at 9:00 a.m., but he arrived at DLSMC only at around
12:10 p.m. In reckless disregard for his patient�s well being, Dr. Hosaka scheduled two
procedures on the same day, just thirty minutes apart from each other, at different hospitals. Thus,
when the first procedure (protoscopy) at the Sta. Teresita Hospital did not proceed on time, Erlinda
was kept in a state of uncertainty at the DLSMC.

The unreasonable delay in petitioner Erlinda�s scheduled operation subjected her to continued
starvation and consequently, to the risk of acidosis, 40 or the condition of decreased alkalinity of
the blood and tissues, marked by sickly sweet breath, headache, nausea and vomiting, and visual
disturbances. 41 The long period that Dr. Hosaka made Erlinda wait for him certainly aggravated
the anxiety that she must have been feeling at the time. It could be safely said that her anxiety
adversely affected the administration of anesthesia on her. As explained by Dr. Camagay, the
patient�s anxiety usually causes the outpouring of adrenaline which in turn results in high blood
pressure or disturbances in the heart rhythm:chanrob1es virtual 1aw library

DR. CAMAGAY:chanrob1es virtual 1aw library

. . . Pre-operative medication has three main functions: One is to alleviate anxiety. Second is to dry
up the secretions and Third is to relieve pain. Now, it is very important to alleviate anxiety because
anxiety is associated with the outpouring of certain substances formed in the body called
adrenalin. When a patient is anxious there is an outpouring of adrenalin which would have adverse
effect on the patient. One of it is high blood pressure, the other is that he opens himself to
disturbances in the heart rhythm, which would have adverse implications. So, we would like to
alleviate patient�s anxiety mainly because he will not be in control of his body there could be
adverse results to surgery and he will be opened up; a knife is going to open up his body. . . . 42

Dr. Hosaka cannot now claim that he was entirely blameless of what happened to Erlinda. His
conduct clearly constituted a breach of his professional duties to Erlinda:chanrob1es virtual 1aw
library

CHIEF JUSTICE:chanrob1es virtual 1aw library

Two other points. The first, Doctor, you were talking about anxiety, would you consider a
patient�s stay on the operating table for three hours sufficient enough to aggravate or magnify his
or her anxiety?

DR. CAMAGAY:chanrob1es virtual 1aw library

Yes.
CHIEF JUSTICE:chanrob1es virtual 1aw library

In other words, I understand that in this particular case that was the case, three hours waiting and
the patient was already on the operating table (interrupted)

DR. CAMAGAY:chanrob1es virtual 1aw library

Yes.

CHIEF JUSTICE:chanrob1es virtual 1aw library

Would you therefore conclude that the surgeon contributed to the aggravation of the anxiety of the
patient?

DR. CAMAGAY:chanrob1es virtual 1aw library

That this operation did not take place as scheduled is already a source of anxiety and most
operating tables are very narrow and that patients are usually at risk of falling on the floor so there
are restraints that are placed on them and they are never, never left alone in the operating room by
themselves specially if they are already pre-medicated because they may not be aware of some of
their movement that they make which would contribute to their injury.

CHIEF JUSTICE:chanrob1es virtual 1aw library

In other words due diligence would require a surgeon to come on time?

DR. CAMAGAY:chanrob1es virtual 1aw library

I think it is not even due diligence it is courtesy.

CHIEF JUSTICE:chanrob1es virtual 1aw library

Courtesy.

DR. CAMAGAY:chanrob1es virtual 1aw library

And care.

CHIEF JUSTICE:chanrob1es virtual 1aw library

Duty as a matter of fact?

DR. CAMAGAY:chanrob1es virtual 1aw library

Yes, Your Honor. 43

Dr. Hosaka�s irresponsible conduct of arriving very late for the scheduled operation of petitioner
Erlinda is violative, not only of his duty as a physician "to serve the interest of his patients with
the greatest solicitude, giving them always his best talent and skill," 44 but also of Article 19 of
the Civil Code which requires a person, in the performance of his duties, to act with justice and
give everyone his due.chanrob1es virtua1 1aw 1ibrary

Anent private respondent DLSMC�s liability for the resulting injury to petitioner Erlinda, we
held that respondent hospital is solidarily liable with respondent doctors therefor under Article
2180 of the Civil Code 45 since there exists an employer-employee relationship between private
respondent DLSMC and Drs. Gutierrez and Hosaka:chanrob1es virtual 1aw library

In other words, private hospitals, hire, fire and exercise real control over their attending and
visiting "consultant" staff. While "consultants" are not, technically employees, . . . 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 . . . 46

DLSMC however contends that applying the four-fold test in determining whether such a
relationship exists between it and the respondent doctors, the inescapable conclusion is that
DLSMC cannot be considered an employer of the respondent doctors.

It has been consistently held that in determining whether an employer-employee relationship

exists between the parties, the following elements must be present: (1) selection and engagement
of services; (2) payment of wages; (3) the power to hire and fire; and (4) the power to control not
only the end to be achieved, but the means to be used in reaching such an end. 47

DLSMC maintains that first, a hospital does not hire or engage the services of a consultant, but
rather, accredits the latter and grants him or her the privilege of maintaining a clinic and/or
admitting patients in the hospital upon a showing by the consultant that he or she possesses the
necessary qualifications, such as accreditation by the appropriate board (diplomate), evidence of
fellowship and references . 48 Second, it is not the hospital but the patient who pays the
consultant�s fee for services rendered by the latter. 49 Third, a hospital does not dismiss a
consultant; instead, the latter may lose his or her accreditation or privileges granted by the
hospital. 50 Lastly, DLSMC argues that when a doctor refers a patient for admission in a hospital,
it is the doctor who prescribes the treatment to be given to said patient. The hospital �s obligation
is limited to providing the patient with the preferred room accommodation, the nutritional diet and
medications prescribed by the doctor, the equipment and facilities necessary for the treatment of
the patient, as well as the services of the hospital staff who perform the ministerial tasks of
ensuring that the doctor�s orders are carried out strictly. 51

After a careful consideration of the arguments raised by DLSMC, the Court finds that respondent
hospital�s position on this issue is meritorious. There is no employer-employee relationship
between DLSMC and Drs. Gutierrez and Hosaka which would hold DLSMC solidarily liable for
the injury suffered by petitioner Erlinda under Article 2180 of the Civil Code.

As explained by respondent hospital, that the admission of a physician to membership in

DLSMC�s medical staff as active or visiting consultant is first decided upon by the Credentials
Committee thereof, which is composed of the heads of the various specialty departments such as
the Department of Obstetrics and Gynecology, Pediatrics, Surgery with the department head of the
particular specialty applied for as chairman. The Credentials Committee then recommends to
DLSMC�s Medical Director or Hospital Administrator the acceptance or rejection of the
applicant physician, and said director or administrator validates the committee �s
recommendation. 52 Similarly, in cases where a disciplinary action is lodged against a consultant,
the same is initiated by the department to whom the consultant concerned belongs and filed with
the Ethics Committee consisting of the department specialty heads. The medical director/hospital
administrator merely acts as ex-officio member of said committee.chanrob1es virtua1 1aw 1ibrary

Neither is there any showing that it is DLSMC which pays any of its consultants for medical
services rendered by the latter to their respective patients. Moreover, the contract between the
consultant in respondent hospital and his patient is separate and distinct from the contract between
respondent hospital and said patient. The first has for its object the rendition of medical services
by the consultant to the patient, while the second concerns the provision by the hospital of
facilities and services by its staff such as nurses and laboratory personnel necessary for the proper
treatment of the patient.

Further, no evidence was adduced to show that the injury suffered by petitioner Erlinda was due to
a failure on the part of respondent DLSMC to provide for hospital facilities and staff necessary for
her treatment.
For these reasons, we reverse the finding of liability on the part of DLSMC for the injury suffered
by petitioner Erlinda.

Finally, the Court also deems it necessary to modify the award of damages to petitioners in view
of the supervening event of petitioner Erlinda’s death. In the assailed Decision, the Court awarded
actual damages of One Million Three Hundred Fifty Two Thousand Pesos (P1,352,000.00) to
cover the expenses for petitioner Erlinda’s treatment and care from the date of promulgation of the
Decision up to the time the patient expires or survives. 53 In addition thereto, the Court awarded
temperate damages of One Million Five Hundred Thousand Pesos (P1,500,000.00) in view of the
chronic and continuing nature of petitioner Erlinda’s injury and the certainty of further pecuniary
loss by petitioners as a result of said injury, the amount of which, however, could not be made
with certainty at the time of the promulgation of the decision. The Court justified such award in
this manner:chanrob1es virtua1 1aw 1ibrary

Our rules on actual or compensatory damages generally assume that at the time of litigation, the
injury suffered as a consequence of an act of negligence has been completed and that the cost can
be liquidated. However, these provisions neglect to take into account those situations, as in this
case, where the resulting injury might be continuing and possible future complications directly
arising from the injury, while certain to occur, are difficult to predict.

In these cases, the amount of damages which should be awarded, if they are to adequately and
correctly respond to the injury caused, should be one which compensates for pecuniary loss
incurred and proved, up to the time of trial; and one which would meet pecuniary loss certain to be
suffered but which could not, from the nature of the case, be made with certainty. In other words,
temperate damages can and should be awarded on top of actual or compensatory damages in
instances where the injury is chronic and continuing. And because of the unique nature of such
cases, no incompatibility arises when both actual and temperate damages are provided for. The
reason is that these damages cover two distinct phases.

As it would not be equitable — and certainly not in the best interests of the administration of
justice — for the victim in such cases to constantly come before the courts and invoke their aid in
seeking adjustments to the compensatory damages previously awarded — temperate damages are
appropriate. The amount given as temperate damages, though to a certain extent speculative,
should take into account the cost of proper care.

In the instant case, petitioners were able to provide only home-based nursing care for a comatose
patient who has remained in that condition for over a decade. Having premised our award for
compensatory damages on the amount provided by petitioners at the onset of litigation, it would
be now much more in step with the interests of justice if the value awarded for temperate damages
would allow petitioners to provide optimal care for their loved one in a facility which generally
specializes in such care. They should not be compelled by dire circumstances to provide
substandard care at home without the aid of professionals, for anything less would be grossly
inadequate. Under the circumstances, an award of P1,500,000.00 in temperate damages would
therefore be reasonable. 54

However, subsequent to the promulgation of the Decision, the Court was informed by petitioner
Rogelio that petitioner Erlinda died on August 3, 1999. 55 In view of this supervening event, the
award of temperate damages in addition to the actual or compensatory damages would no longer
be justified since the actual damages awarded in the Decision are sufficient to cover the medical
expenses incurred by petitioners for the patient. Hence, only the amounts representing actual,
moral and exemplary damages, attorney’s fees and costs of suit should be awarded to
petitioners.chanrob1es virtua1 1aw 1ibrary

WHEREFORE, the assailed Decision is hereby modified as follows:chanrob1es virtual 1aw

library

(1) Private respondent De Los Santos Medical Center is hereby absolved from liability arising
from the injury suffered by petitioner Erlinda Ramos on June 17, 1985;

(2) Private respondents Dr. Orlino Hosaka and Dr. Perfecta Gutierrez are hereby declared to be
solidarily liable for the injury suffered by petitioner Erlinda on June 17, 1985 and are ordered to
pay petitioners —

(a) P1,352,000.00 as actual damages;

(b) P2,000,000.00 as moral damages;

(c) P100,000.00 as exemplary damages;

(d) P100,000.00 as attorney’s fees; and

(e) the costs of the suit.chanrob1es virtua1 1aw 1ibrary

 Sonza v. ABS-CBN Broadcasting Corporation
(G.R. No. 138051)

Facts:

Respondent ABS-CBN signed an Agreement with the Mel and Jay Management Development
Corporation where the latter agreed to provide petitioner Sonza’s services exclusively to ABS-
CBN as talent for radio and television. Later, Sonza tendered a letter rescinding their agreement
and filed a complaint before the DOLE for payment of his labor standard benefits. ABS-CBN
contends on the ground that no employer-employee relationship existed between the parties. The
Labor Arbiter found for respondent citing that Sonza as a ‘talent’ cannot be considered an
employee of petitioner. Both NLRC and CA affirmed.

Issue:

Whether or not employer-employee relationship existed between petitioner and ABS-CBN.

Ruling: NO.

Applying the control test to the present case, we find that SONZA is not an employee but an
independent contractor. The control test is the most important test our courts apply in
distinguishing an employee from an independent Contractor. This test is based on the extent of
control the hirer exercises over a worker. The greater the supervision and control the hirer
exercises, the more likely the worker is deemed an employee. The converse holds true as well –
the less control the hirer exercises, the more likely the worker is considered an independent
contractor.

We find that ABS-CBN was not involved in the actual performance that produced the finished
product of SONZA’s work. ABS-CBN did not instruct SONZA how to perform his job. ABS-CBN
merely reserved the right to modify the program format and airtime schedule “for more effective
programming.” ABS-CBN’s sole concern was the quality of the shows and their standing in the
ratings. Clearly, ABS-CBN did not exercise control over the means and methods of performance
of SONZA’s work.
In any event, not all rules imposed by the hiring party on the hired party indicate that the latter is
an employee of the former. In this case, SONZA failed to show that these rules controlled his
performance. We find that these general rules are merely guidelines towards the achievement of
the mutually desired result, which are top-rating television and radio programs that comply with
standards of the industry.
Being an exclusive talent does not by itself mean that SONZA is an employee of ABS-CBN. Even
an independent contractor can validly provide his services exclusively to the hiring party. In the
broadcast industry, exclusivity is not necessarily the same as control.

*Not every performance of services for a fee creates an employer-employee relationship. To hold
that every person who renders services to another for a fee is an employee – to give meaning to
the security of tenure clause – will lead to absurd results.