1. Alano vs. Magud-Logmao

G.R.No.175540. April7,2014.*

DR. FILOTEO A. ALANO, petitioner, vs. ZENAIDAMAGUDLOGMAO,respondent.

Civil Law; Damages; Organ Transplants; Permission orauthorization to retrieve and remove the internal organs of thedeceased was being given only if the provisions of the applicablelaw had been complied with. Such instructions reveal thatpetitioner acted prudently by directing his subordinates to exhaustall reasonable means of locating the relatives of the deceased.—Petitioner instructed his subordinates to “make certain” that “allreasonable efforts” are exerted to locate the patient’s next of kin,evenenumeratingwaysinwhichtoensurethatnoticesofthedeathofthepatientwouldreachsaidrelatives.Italsoclearlystatedthatpermission or authorization to retrieve and remove the internalorgansofthedeceasedwasbeinggivenONLYIFtheprovisionsoftheapplicablelawhadbeencompliedwith.Suchinstructionsrevealthat petitioner acted prudently by directing his subordinates toexhaust all reasonable means of locating the relatives of thedeceased. He could not have made his directives any clearer. Heeven specifically mentioned that permission is only beinggranted IF theDepartment of Surgery has compliedwith all therequirements of the law. Verily, petitioner could not have beenfaultedforhavingfullconfidenceintheabilityofthedoctorsintheDepartmentofSurgerytocomprehendtheinstructions,obeyingallhisdirectives,andactingonlyinaccordancewiththerequirementsofthelaw.

Remedial Law; Evidence; Burden of Proof; Preponderance ofEvidence; In civil cases, it is a basic rule that the party makingallegations has the burden of proving them by a preponderance ofevidence.—It is respondent’s failure to adduce adequate evidencethat doomed this case. As stated inOtero v. Tan, 678 SCRA 583(2012), “[i]n civil cases, it is a basic rule that the party makingallegationshastheburdenofprovingthembyapreponderanceofevidence. The parties must rely on the strength of their ownevidenceandnotupontheweaknessofthedefenseofferedbytheiropponent.”Here,thereistoproofthat,indeed,theperiodofaround

24hoursfromthetime

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*THIRDDIVISION.

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notices were disseminated, cannot be considered as reasonableunderthecircumstances.Theyfailedtopresentanyexpertwitnesstoprove thatgiven themedical technologyandknowledgeat thattime in the1980’s, thedoctors couldor shouldhavewaited longerbeforeharvestingtheinternalorgansfortransplantation.

Civil Law; Damages; Organ Transplants; Internal organs ofthe deceased were removed only after he had been declared braindead; thus, the emotional pain suffered by respondent due to thedeath of her son cannot in any way be attributed to petitioner.—Finding petitioner liable for damages is improper. It should beemphasizedthattheinternalorgansofthedeceasedwereremovedonly after he had been declared brain dead; thus, the emotionalpainsufferedbyrespondentduetothedeathofhersoncannot inany way be attributed to petitioner. Neither can the Court findevidenceonrecordtoshowthatrespondent’semotionalsufferingatthe sight of the pitiful state in which she found her son’s lifelessbodybecategoricallyattributedtopetitioner’sconduct.

LEONEN, J.,Concurring Opinion:

Remedial Law; Civil Procedure; Appeals; Petition for Review onCertiorari; View that as a general rule, only questions of law are tobe considered in a petition for review under Rule 45.—Asageneralrule, only questions of law are to be considered in a petition forreviewunderRule45.Thereare,however,recognizedexceptionstotherule,oneofwhichiswhen“theCourtofAppealsfailstonoticecertain relevant facts which, if properly considered, will justify adifferentconclusionxxx.”

Civil Law; QuasiDelicts; View that in order to be actionable,the act should have been committed with the intention of injuringthe plaintiff or was committed recklessly or negligently or onewhich, even when done with the proper care, held such high risk forinjury to others that it will be presumed by law to be actionable.—

Incasesinvolvingquasidelictandtorts,theplaintiffcomplainsthatthe acts of a defendant caused him or her injury. In order to beactionable, theact shouldhavebeencommittedwith the intentionof injuring theplaintiff orwas committed recklessly ornegligentlyoronewhich,evenwhendonewiththepropercare,heldsuchhighrisk for injury to others that it will be presumed by law to beactionable.

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Same; Same; View on the elements of quasidelicts.—Theelements of a quasidelict are: (1) an act or omission; (2) thepresence of fault or negligence in the performance or nonperformanceoftheact; (3) injury; (4)acausalconnectionbetweenthenegligentactandtheinjury;and(5)nopreexistingcontractualrelation. Jurisprudence, however, specifies four (4) essentialelements: “(1) duty; (2) breach; (3) injury; and (4) proximatecausation.”

Same; Same; Human Relations; View that Article 19 of theCivil Code is the general rule which governs the conduct of humanrelations.—Article19isthegeneralrulewhichgovernstheconductofhumanrelations.Byitself,itisnotthebasisofanactionabletort.Article19describesthedegreeofcarerequiredsothatanactionabletortmayarisewhenit isallegedtogetherwithArticle20orArticle21.

Same; Same; Damages; Organ Transplants; Doctrine ofInformed Consent; View that the Supreme Court ruled that liabilitymay arise in cases where the physician fails to obtain the consent ofthe patient before performing any medical procedure.—Thedoctrineof informed consent was introduced in this jurisdiction only veryrecently inDr. Li v. Spouses Soliman, 651 SCRA 32 (2011). Thiscourtruledthatliabilitymayariseincaseswherethephysicianfailstoobtaintheconsentofthepatientbeforeperforminganymedicalprocedure, thus: The doctrine of informed consent within thecontextofphysicianpatientrelationshipsgoesfarbackintoEnglishcommonlaw.Asearlyas1767,doctorswerechargedwiththetortof“battery” (i.e., an unauthorized physical contactwith a patient) ifthey had not gained the consent of their patients prior toperforming a surgery or procedure. In the United States, theseminalcasewasSchoendorff v. Society of New York Hospital which

involved unwanted treatment performed by a doctor. JusticeBenjaminCardozo’s oftquoted opinionupheld the basic right of apatient to give consent to any medical procedure or treatment:“Everyhumanbeingofadultyearsandsoundmindhasarighttodetermine what shall be done with his own body; and a surgeonwho performs an operation without his patient’s consent, commitsanassault,forwhichheisliableindamages.”Fromapurelyethicalnorm, informed consent evolved into a general principle oflaw that a physician has a duty to disclose what areasonably prudent physician in the medical community inthe exercise of reasonable care would disclose

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to his patient as to whatever grave risks of injury might beincurred from a proposed course of treatment, so that apatient, exercising ordinary care for his own welfare, andfaced with a choice of undergoing the proposed treatment,or alternative treatment, or none at all, may intelligentlyexercise his judgment by reasonably balancing theprobable risks against the probable benefits.Subsequently,inCanterbury v. Spence[,]thecourtobservedthatthedutytodiscloseshouldnotbelimitedtomedicalusageastoarrogatethedecisiononrevelation to the physician alone. Thus, respect for the patient’sright of selfdetermination on particular therapy demands astandard set by law for physicians rather than one whichphysiciansmayormaynotimposeuponthemselves.

Same; Same; Same; Same; View that those who consent to usingtheir organs upon their death for the benefit of another can maketheir consent known prior to their death by following therequirements of the law.—Thosewhoconsenttousingtheirorgansupontheirdeathforthebenefitofanothercanmaketheirconsentknownpriortotheirdeathbyfollowingtherequirementsofthelaw.Should a patient die prior tomaking his or her informed consentknown,thelawprovidesalistofpersonswhomayconsentonhisorher behalf, that is, “substituted” informed consent. Since theincident in this case occurred in 1988, Republic Act No. 349, asamendedbyRepublicActNo.1056,isthelawthatapplies.Section2 of the law states that: SEC. 2. The authorization referred to insection one of this Act must: be in writing; specify the person orinstitutiongrantedtheauthorization;theorgan,partorpartstobe

detached,thespecificuseorusestowhichtheorgan,partorpartsare to be employed; and, signed by the grantor and twodisinterestedwitnesses.Ifthegrantorisaminororanincompetentperson,theauthorizationmaybeexecutedbyhisguardianwiththeapprovalofthecourt;indefaultthereof,bythelegitimatefatherormother, in the order, named. Married women may grant theauthorityreferredtoinsectiononeofthisAct,withouttheconsentof the husband. After the death of the person, authority to usehuman organs or any portion or portions of the human body formedical, surgical or scientific purposesmayalsobegrantedbyhisnearest relative or guardian at the time of his death or in theabsencethereof,bythepersonorheadofthehospital,orinstitutionhaving custody of the body of the deceased:Provided, however,That the said person or head of the hospital

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or institution has exerted reasonable efforts to locate theaforesaid guardian or relative. A copy of every suchauthorizationmustbefurnishedtheSecretaryofHealth.

Same; Same; Same; Same; View that consent to organ retrievalafter the patient’s death may be given first and foremost by thepatient’s nearest relative or guardian at the time of death. It is onlyin the event that these relatives cannot be contacted despitereasonable efforts that the head of the hospital or institution havingcustody of the body may give consent for organ retrieval on behalf ofthe patient.—Under this law, consent to organ retrieval after thepatient’s death may be given first and foremost by the patient’snearest relativeorguardianat the timeofdeath. It is only in theevent that these relatives cannot be contacted despite reasonableeffortsthattheheadofthehospitalorinstitutionhavingcustodyofthe body may give consent for organ retrieval on behalf of thepatient. Failing this, liability for damages arises.Considering thatRepublic Act No. 349, as amended, does not provide a remedy incaseofviolation,anapplicationofthedoctrineofinformedconsentvisàvisArticle20of theCivilCodemaygiverisetoanaction fordamages.Inthiscase,Dr.Alanomustfirstbeshowntohaveactedwillfully andnegligentlytothedamageandprejudiceofZenaida.

Same; Same; Negligence; Words and Phrases; View that

negligence has been defined by law as the failure to observe, for theprotection of the interests of another person, that degree of care,precaution and vigilance which the circumstances justly demand,whereby such other person suffers injury.—Negligence has beendefinedbylawas“[t]hefailuretoobserve,fortheprotectionoftheinterests of another person, that degree of care, precaution andvigilance which the circumstances justly demand, whereby suchotherpersonsuffersinjury.”

Same; Same; Organ Donations; View that the organ retrievalperformed by the National Kidney Institute cannot be termed as“disrespect to the dead.” Organ donation is allowed by law. A sterilemedical operation surely is not tantamount to grave robbery ormutilation.—ThelowercourtsarealsoinagreementthatDr.Alanodid not cause the death of Zenaida’s son. Neither is this caseanalogous to any of the situations mentioned in the provision.Contrary to the ruling of the trial court, this situation is also notcoveredbyArticle309of theCivilCode,whichstates:Article309.Anypersonwho

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showsdisrespecttothedead,orwrongfullyinterfereswithafuneralshall be liable to the family of thedeceased fordamages,materialandmoral.Theorgan retrievalperformedby theNationalKidneyInstitute cannot be termed as “disrespect to the dead.” Organdonationisallowedbylaw.Asterilemedicaloperationsurelyisnottantamounttograverobberyormutilation.

Same; Damages; Exemplary Damages; View that since Zenaidahas not proven her claim to moral damages, she is also not entitledto exemplary damages.—SinceZenaidahasnotprovenherclaimtomoral damages, she is also not entitled to exemplary damages.Article 2234 of the Civil Code provides: Article 2234. While theamountoftheexemplarydamagesneednotbeproved,theplaintiffmustshowthathe isentitledtomoral, temperateorcompensatorydamagesbefore thecourtmayconsider thequestionofwhetherornotexemplarydamagesshouldbeawarded.

Same; Same; QuasiDelicts; Attorney’s Fees; View that since theaward of exemplary damages is not justified, there is no reason to

award attorney’s fees, in accordance with Article 2208 of the CivilCode.—Sincetheawardofexemplarydamagesisnotjustified,thereis no reason to award attorney’s fees, in accordance with Article2208 of the Civil Code, which allows the award of attorney’s feesonly“whenexemplarydamagesareawarded.”

PETITION for review on certiorari of the decision andresolutionoftheCourtofAppeals.

ThefactsarestatedintheopinionoftheCourt.

Pelaez, Gregorio, Gregorio & Limforpetitioner.

Manuel Mendozaforrespondent.

PERALTA, J.:

This deals with the Petition for Review on Certiorariunder Rule 45 of the Rules of Court praying that theDecision[1]ofthe

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[1] Penned by Associate Justice Marina L. Buzon, with Associate

Justices Aurora SantiagoLagman and Arcangelita RomillaLontok,

concurring;Rollo, pp.7196.

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Court of Appeals (CA), dated March 31, 2006, adjudgingpetitioner liable for damages, and the Resolution[2] datedNovember 22, 2006, denying petitioner’s motion forreconsiderationthereof,bereversedandsetaside.

TheCA’snarrationoffactsisaccurate,towit:PlaintiffappelleeZenaidaMagudLogmaoisthemother

of deceased Arnelito Logmao. Defendantappellant Dr.Filoteo Alano is the Executive Director of the NationalKidneyInstitute(NKI).

Ataround9:50intheeveningofMarch1,1988,ArnelitoLogmao, then eighteen (18) years old,was brought to theEast AvenueMedical Center (EAMC) in Quezon City bytwo sidewalk vendors, who allegedly saw the former fallfrom the overpass near the Farmers’ Market in Cubao,QuezonCity.Thepatient’sdatasheetidentifiedthepatient

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as Angelito Lugmoso of Boni Avenue, Mandaluyong.However, the clinical abstract prepared byDr. PaternoF.Cabrera, the surgical resident onduty at the EmergencyRoom of EAMC, stated that the patient is Angelito[Logmao].Dr.Cabrerareportedthat [Logmao]wasdrowsywithalcoholicbreath,wasconsciousandcoherent;thattheskullxrayshowednofracture;thatataround4:00o’clockinthe morning of March 2, 1988, [Logmao] developedgeneralized seizures and was managed by the neurosurgery resident onduty; that the condition of [Logmao]progressivelydeterioratedandhewasintubatedandambubagging support was provided; that admission to theIntensive Care Unit (ICU) and mechanical ventilatorsupportbecamenecessary,buttherewasnovacancyattheICUandalltheventilatorunitswerebeingusedbyotherpatients;thataresidentphysicianofNKI,whowasrotatingatEAMC,suggestedthat[Logmao]betransferredtoNKI;and that after arrangements were made, [Logmao] wastransferredtoNKIat10:10inthemorning.

AttheNKI,thenameAngelito[Logmao]wasrecordedasAngelito Lugmoso. Lugmosowas immediately attended toand given the necessary medical treatment. As Lugmosohad no relatives around, Jennifer B. Misa, TransplantCoordinator, was asked to locate his family by enlistingpoliceandmediaassistance.Dr.EnriqueT.Ona,ChairmanoftheDepartmentofSurgery,observedthattheseverity

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[2]Id., atpp.98101.

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of the brain injury of Lugmoso manifested symptoms ofbrain death. He requested the Laboratory Section toconduct a tissue typing and tissue crossmatchingexamination, so that should Lugmoso expire despite thenecessarymedicalcareandmanagementandhewouldbefound to be a suitable organ donor and his family wouldconsenttoorgandonation,theorgansthusdonatedcouldbedetached and transplanted promptly to any compatiblebeneficiary.

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JenniferMisaverifiedonthesameday,March2,1988,fromEAMCtheidentityofLugmosoand,uponherrequest,she was furnished by EAMC a copy of the patient’s datesheet which bears the name Angelito Lugmoso, withaddressatBoniAvenue,Mandaluyong.ShethencontactedseveralradioandtelevisionstationstorequestforairtimeforthepurposeoflocatingthefamilyofAngelitoLugmosoofBoniAvenue,Mandaluyong,whowas confinedatNKI forsevere head injury after allegedly falling from theCubaooverpass, as well as Police Station No. 5, Eastern PoliceDistrict, whose area of jurisdiction includes Boni Avenue,Mandaluyong, for assistance in locating the relatives ofAngelitoLugmoso.CertificationswereissuedbyChannel4,ABSCBNandGMAattestingthattherequestmadebytheNKIonMarch2,1988toairitsappealtolocatethefamilyand relatives of Angelito Lugmoso of Boni Avenue,Mandaluyong was accommodated. A Certification waslikewise issued by Police Station No. 5, Eastern PoliceDistrict,MandaluyongattestingtothefactthatonMarch2,1988, at about 6:00 p.m., Jennifer Misa requested forassistancetoimmediatelylocatethefamilyandrelativesofAngelito Lugmoso and that she followed up her requestuntilMarch9,1988.

OnMarch3,1988,atabout7:00o’clockinthemorning,Dr.OnawasinformedthatLugmosohadbeenpronouncedbraindeadbyDr.AbdiasV.Aquino,aneurologist,andbyDr. Antonio Rafael, a neurosurgeon and attendingphysician of Lugmoso, and that a repeatelectroencephalogram(EEG)wasinprogresstoconfirmthediagnosis of brain death. Two hours later, Dr. Ona wasinformed that theEEG recording exhibited a flat tracing,thereby confirming that Lugmoso was brain dead. UponlearningthatLugmosowasasuitableorgandonorandthatsomeNKIpatientsawaitingorgandonationhadbloodandtissue types compatible with Lugmoso, Dr. Ona inquiredfromJenniferMisawhether the relatives ofLugmosohadbeen located so that the necessary consent for organdonationcouldbeobtained.AstheextensivesearchfortherelativesofLugmoso

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yieldednopositiveresultandtimebeingof theessence inthesuccessoforgantransplantation,Dr.OnarequestedDr.Filoteo A. Alano, Executive Director of NKI, to authorizetheremovalofspecificorgansfromthebodyofLugmosofortransplantation purposes. Dr. Ona likewise instructed Dr.Rose Marie RoseteLiquete to secure permission for theplanned organ retrieval and transplantation from theMedicoLegalOfficeoftheNationalBureauofInvestigation(NBI),ontheassumptionthattheincidentwhichleadtothebraininjuryanddeathofLugmosowasamedicolegalcase.

On March 3, 1988, Dr. Alano issued to Dr. Ona aMemorandum,whichreadsasfollows:

This is in connection with the use of the humanorgansoranyportionorportionsofthehumanbodyofthedeceasedpatient,identifiedasacertainMr.AngelitoLugmoso who was brought to the National KidneyInstitute on March 2, 1988 from the East AvenueMedicalCenter.

Asshownbythemedicalrecords,thesaidpatientdiedonMarch3, 1988at9:10 in themorningdue to craniocerebralinjury. Please make certain that your Department hasexertedallreasonableeffortstolocatetherelativesornextofkin of the saiddeceasedpatient suchasappeal through theradios and television as well as through police and othergovernment agencies and that the NBI [MedicoLegal]Sectionhasbeennotifiedandisawareofthecase.

If all the above has been complied with, in accordancewiththeprovisionsofRepublicActNo.349asamendedandP.D.856,permissionand/orauthority isherebygivento theDepartment of Surgery to retrieve and remove the kidneys,pancreas,liverandheartofthesaiddeceasedpatientandtotransplant the said organs to any compatible patient whomaybeinneedofsaidorganstoliveandsurvive.

ACertificationdatedMarch10,1988wasissuedbyDr.Maximo Reyes, MedicoLegal Officer of the NBI, statingthathereceivedatelephonecallfromDr.LiqueteonMarch3,1988at9:15a.m.regardingthecaseofLugmoso,whowasdeclaredbraindead;thatdespiteeffortstolocatethelatter’srelatives,nooneresponded;

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thatDr.Liquetesoughtfromhimasecondopinionfororganretrieval for donation purposes even in the absence ofconsent from the family of the deceased; and that heverballyagreedtoorganretrieval.

At 3:45 in the afternoon of March 3, 1988, a medicalteam, composed ofDr.EnriqueOna, as principal surgeon,Drs.ManuelChuaChiaco,Jr.,RoseMarieRoseteLiquete,Aurea Ambrosio, Ludivino de Guzman, Mary Litonjua,JaimeVelasquez,RicardoFernando,andMyrnaMendoza,removed the heart, kidneys, pancreas, liver and spleen ofLugmoso.Themedicalteamthentransplantedakidneyandthe pancreas of Lugmoso to Lee Tan Hoc and the otherkidney of Lugmoso to Alexis Ambustan. The transplantoperation was completed at around 11:00 o’clock in theeveningofMarch3,1988.

OnMarch4,1988,Dr.AntonioR.Paraiso,Headof theCadaverOrganRetrieval Effort (CORE) program ofNKI,made arrangements with La Funeraria Oro for theembalmmentofthecadaverofLugmosogoodforaperiodoffifteen (15) days to afford NKI more time to continuesearching for the relativesof the latter.On the sameday,RobertoOrtega,FuneralConsultant ofLaFunerariaOro,sentarequestforautopsytotheNBI.TheAutopsyReportandCertificationofPostMortemExaminationissuedbytheNBI stated that the cause of death of Lugmoso wasintracranialhemorrhagesecondarytoskullfracture.

On March 11, 1988, the NKI issued a press releaseannouncing its successful double organ transplantation.AidaDoromal,acousinofplaintiff,heardthenewsairedontelevisionthatthedonorwasaneighteen(18)yearoldboywhoseremainswereatLaFunerariaOro inQuezonCity.As the name of the donor sounded like Arnelito Logmao,Aidainformedplaintiffofthenewsreport.

It appears that on March 3, 1988, Arlen Logmao, abrother of Arnelito, whowas then a resident of 17C SanPedroStreet,Mandaluyong,reportedtoPoliceStationNo.5,EasternPoliceDistrict,Mandaluyongthatthelatterdidnot return home after seeing a movie in Cubao, QuezonCity,asevidencedbyaCertificationissuedbysaidStation;and that the relatives of Arnelito were likewise informedthatthelatterwasmissing.Uponreceivingthenewsfrom

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Aida,plaintiffandherotherchildrenwenttoLaFunerariaOro,wheretheysawArnelitoinsideacheapcasket.

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OnApril29,1988,plaintiff filedwiththecourta quo acomplaint for damages against Dr. Emmanuel Lenon,TaureanProtectorsAgency, represented by itsProprietor,CelsoSantiago,NationalKidney Institute, representedbyitsDirector,Dr.FiloteoA.Alano,JenniferMisa,Dr.MaximoReyes,Dr.EnriqueT.Ona,Dr.ManuelChuaChiaco, Jr.,Dr.RoseMarieO.RoseteLiquete,Dr.AureaZ.Ambrosio,Dr. Ludivino de Guzman, Dr. Mary Litonjua, Dr. JaimeVelasquez,Dr.RicardoFernando,Dr.MyrnaMendoza,LeeTan Koc, Alexis Ambustan, Dr. Antonio R. Paraiso, LaFunerariaOro, Inc., representedby itsPresident,GermanE.Ortega,RobertoOrtegaaliasBobbyOrtega,Dr.MarianoB. Cueva, Jr., John Doe, Peter Doe, and Alex Doe inconnection with the death of her son Arnelito. Plaintiffalleged thatdefendants conspired to remove theorgansofArnelito while the latter was still alive and that theyconcealedhistrueidentity.

OnJanuary17,2000,thecourta quo renderedjudgmentfindingonlyDr.FiloteoAlanoliablefordamagestoplaintiffanddismissingthecomplaintagainsttheotherdefendantsforlackoflegalbasis.[3]

After finding petitioner liable for a quasidelict, theRegional Trial Court of Quezon City (RTC) orderedpetitioner to pay respondent P188,740.90 as actualdamages; P500,000.00 as moral damages; P500,000.00 asexemplary damages; P300,000.00 as attorney’s fees; andcostsofsuit.PetitionerappealedtotheCA.

On March 31, 2006, the CA issued its Decision, thedispositiveportionofwhichreadsasfollows:

WHEREFORE, the Decision appealed from is AFFIRMED,withMODIFICATION byDELETING theawardofP188,740.90asactualdamagesandREDUCING the award ofmoral damagesto P250,000.00, the award of exemplary damages to P200,000.00andtheawardofattorney’sfeestoP100,000.00.

SOORDERED.[4]

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[3]Id., atpp.7379.(Citationsomitted)

[4]Id., atp.95.(Emphasisintheoriginal)

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Petitioner then elevated thematter to thisCourtvia apetitionforreviewoncertiorari,wherethefollowingissuesarepresentedforresolution:A. WHETHER THE COURT OF APPEALSDISREGARDED EXISTING JURISPRUDENCEPRONOUNCED BY THIS HONORABLE SUPREMECOURT IN HOLDING PETITIONER DR. FILOTEOALANO LIABLE FOR MORAL AND EXEMPLARYDAMAGES AND ATTORNEY’S FEES DESPITE THEFACT THAT THEACTOF THE PETITIONER ISNOTTHE PROXIMATE CAUSE NOR IS THERE ANYFINDINGTHATTHEACTOFTHEPETITIONERWASTHE PROXIMATE CAUSE OF THE INJURY ORDAMAGEALLEGEDLYSUSTAINEDBYRESPONDENTZENAIDAMAGUDLOGMAO.B. WHETHER THE COURT OF APPEALS GRAVELYERREDINREFUSINGAND/ORFAILINGTODECLARETHAT PETITIONER DR. ALANO ACTED IN GOODFAITHAND PURSUANT TO LAWWHENHE ISSUEDTHEAUTHORIZATIONTOREMOVEANDRETRIEVETHE ORGANS OF ANGELITO LUGMOSO (LATERIDENTIFIED TO BE IN FACT ARNELITO LOGMAO)CONSIDERING THAT NO NEGLIGENCE CAN BEATTRIBUTED OR IMPUTED ON HIM IN HISPERFORMANCEOFANACTMANDATEDBYLAW.C. WHETHER THE COURT OF APPEALS GRAVELYERRED IN AWARDING RESPONDENT ZENAIDAMAGUDLOGMAO MORAL AND EXEMPLARYDAMAGESANDATTORNEY’SFEESTHATARENOTINACCORDANCE WITH AND ARE CONTRARY TOESTABLISHEDJURISPRUDENCE.[5]

Thefirsttwoissuesboildowntothequestionofwhetherrespondent’s sufferingswere brought about by petitioner’s

alleged negligence in granting authorization for theremovalor retrievalof the internalorgansof respondent’ssonwhohadbeendeclaredbraindead.

Petitioner maintains that when he gave authorizationfor the removal of some of the internal organs to betransplantedtootherpatients,hedidsoinaccordancewiththeletterofthe

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[5]Id., atpp.408409.

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law, Republic Act (R.A.) No. 349, as amended byPresidentialDecree(P.D.)856,i.e.,givinghissubordinatesinstructions to exert all reasonable efforts to locate therelatives or next of kin of respondent’s son. In fact,announcements were made through radio and television,theassistanceofpoliceauthoritieswassought,andtheNBIMedicoLegalSectionwasnotified.Thus, petitioner insiststhat he should not be held responsible for any damageallegedlysufferedbyrespondentduetothedeathofhersonandtheremovalofherson’sinternalorgansfortransplantpurposes.

Theappellatecourtaffirmedthetrialcourt’sfindingthattherewasnegligenceonpetitioner’spartwhenhefailedtoensure that reasonable time had elapsed to locate therelativesofthedeceasedbeforegivingtheauthorizationtoremove said deceased’s internal organs for transplantpurposes.However,acloseexaminationoftherecordsofthiscase would reveal that this case falls under one of theexceptions to the general rule that factual findings of thetrial court, when affirmed by the appellate court, arebinding on this Court. There are some importantcircumstances that the lower courts failed to consider inascertainingwhether it was the actions of petitioner thatbroughtaboutthesufferingsofrespondent.[6]

The Memorandum dated March 3, 1988 issued bypetitioner,statedthus:

Asshownbythemedicalrecords,thesaidpatientdiedonMarch

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3,1988at9:10inthemorningduetocraniocerebralinjury.Pleasemake certain that your Department has exerted allreasonable efforts to locate the relatives or nextofkin ofthe said deceased patient, suchasappealthroughtheradiosandtelevision,aswellasthroughpoliceandothergovernmentagenciesand that theNBI [MedicoLegal] Section has been notified and isawareofthecase.

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[6]E.Y. Industrial Sales, Inc. vs. Shen Dar Electricity and Machinery Co., Ltd.,

G.R.No.184850,October20,2010,634SCRA363.

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If all the above has been complied with, in accordancewith the provisions of Republic Act No. 349 as amended andP.D. 856, permission and/or authority is hereby given to theDepartment of Surgery to retrieve and remove the kidneys,pancreas, liver and heart of the said deceased patient and totransplantthesaidorganstoanycompatiblepatientwhomaybeinneedofsaidorganstoliveandsurvive.[7]

A careful reading of the above shows that petitioner

instructed his subordinates to “make certain” that “allreasonableefforts”areexertedtolocatethepatient’snextofkin,evenenumeratingwaysinwhichtoensurethatnoticesofthedeathofthepatientwouldreachsaidrelatives.Italsoclearly stated that permission or authorization to retrieveandremovetheinternalorgansofthedeceasedwasbeinggiven ONLY IF the provisions of the applicable law hadbeencompliedwith.Suchinstructionsrevealthatpetitioneractedprudentlybydirectinghissubordinatestoexhaustallreasonablemeansoflocatingtherelativesofthedeceased.Hecouldnothavemadehisdirectivesanyclearer.Heevenspecifically mentioned that permission is only beinggranted IF theDepartmentofSurgeryhascompliedwithalltherequirementsofthelaw.Verily,petitionercouldnothavebeenfaultedforhavingfullconfidenceintheabilityofthedoctorsintheDepartmentofSurgerytocomprehendtheinstructions, obeying all his directives, and acting only in

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accordancewiththerequirementsofthelaw.Furthermore, as found by the lower courts from the

records of the case, the doctors and personnel of NKIdisseminatednoticesofthedeathofrespondent’ssontothemedia and sought the assistance of the appropriate policeauthoritiesasearlyasMarch2,1988,evenbeforepetitionerissuedtheMemorandum.Priortoperformingtheprocedurefor retrieval of the deceased’s internal organs, the doctorsconcernedalso

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[7]Exhibits“19”and“33,”Records,p.1019.(Emphasissupplied)

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soughttheopinionandapprovaloftheMedicoLegalOfficeroftheNBI.

Thus, there can be no cavil that petitioner employedreasonablemeans to disseminate notifications intended toreachtherelativesofthedeceased.Theonlyquestionthatremains pertains to the sufficiency of time allowed fornoticestoreachtherelativesofthedeceased.

Ifrespondentfailedtoimmediatelyreceivenoticeofherson’s death because the notices did not properly state thename or identity of the deceased, fault cannot be laid atpetitioner’sdoor.Thetrialandappellatecourtsfoundthatitwas theEAMC,whohad the opportunity to ascertain thenameofthedeceased,whorecordedthewronginformationregardingthedeceased’sidentitytoNKI.TheNKIcouldnothave obtained the information about his name from thepatient,becauseasfoundbythelowercourts,thedeceasedwasalreadyunconsciousbythetimehewasbroughttotheNKI.

Ultimately,itisrespondent’sfailuretoadduceadequateevidencethatdoomedthiscase.AsstatedinOtero v. Tan,[8]“[i]n civil cases, it is a basic rule that the party makingallegations has the burden of proving them by apreponderance of evidence. The parties must rely on thestrengthoftheirownevidenceandnotupontheweaknessofthedefense offeredby their opponent.”[9]Here, there is to

Edwin Jr. Cacayorin

Edwin Jr. Cacayorin

Edwin Jr. Cacayorin

proof that, indeed, theperiodofaround24hours fromthetime notices were disseminated, cannot be considered asreasonableunderthecircumstances.Theyfailedtopresentany expert witness to prove that given the medicaltechnology and knowledge at that time in the 1980’s, thedoctors could or should have waited longer beforeharvestingtheinternalorgansfortransplantation.

Verily, theCourt cannot, in conscience, agreewith thelower court. Finding petitioner liable for damages isimproper.Itshouldbeemphasizedthattheinternalorgansofthede

_______________

[8]G.R.No.200134,August15,2012,678SCRA583.

[9]Id., atp.598.

680



ceasedwereremovedonlyafterhehadbeendeclaredbraindead;thus,theemotionalpainsufferedbyrespondentduetothe death of her son cannot in any way be attributed topetitioner.NeithercantheCourtfindevidenceonrecordtoshow that respondent’s emotional suffering at the sight ofthepitifulstateinwhichshefoundherson’slifelessbodybecategoricallyattributedtopetitioner’sconduct.

WHEREFORE, the petition is GRANTED. TheDecisionoftheCourtofAppeals,datedMarch31,2006, isREVERSED and SET ASIDE. The complaint againstpetitionerisherebyDISMISSED.

SO ORDERED.

Velasco, Jr., (Chairperson), Abad and Mendoza, JJ.,concur.

Leonen, J.,SeeConcurringOpinion.

CONCURRINGOPINION

“What you leave behind is not what is

engraved in stone monuments, but what is

woveninthelivesofothers.”

Edwin Jr. Cacayorin

Edwin Jr. Cacayorin

Pericles

LEONEN, J.:On February 28, 2014, the Philippines broke the

Guinness World Record for the most number of peoplesigningup tobeorgandonorswithinanhourona singlesite. A total of 3,548 people trooped to the PolytechnicUniversityofthePhilippinestopledgetheirorgansaspartofthe“I’maLifeline”campaignofthePhilippineNetworkforOrganSharingundertheDepartmentofHealth.[1]

_______________

[1]PH beat world record for most number of organ donors in one

hour, February28,2014,PhilippineDailyInquirer,<http://global

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Thiscourtisnowfacedwiththeopportunitytoconfrontthe issues concerning organdonation and transplantationforthefirsttimesincetheprocedurewasintroducedinthiscountryin1983.

Beforeus is a petition for reviewunderRule 45 of theRules of Court, assailing the decision[2] of the Court ofAppeals dated March 31, 2006 and its resolution datedNovember 22, 2006 in CAG.R. CV No. 67399 entitledZenaida MagudLogmao v. Dr. Emmanuel Lenon, et al. Theappellate court affirmed the decision[3] dated January 17,2000 of theRegional Trial Court ofQuezonCity, Branch100,whichfoundDr.FiloteoA.Alano,thentheExecutiveDirector of the National Kidney Institute,[4] liable fordamagestoZenaidaLogmao.

Thefacts,asfoundbythelowercourts,areasfollows:On March 1, 1988, at 9:50 p.m., Arnelito Logmao, 18

yearsold,wasbroughttotheEastAvenueMedicalCenterinQuezonCitybytwosidewalkvendorswhoallegedlysawhimfallfromtheoverpassnearFarmer’sMarket,Cubao.[5]The security guards of the hospital noted in their blotterthatwhenhewasadmittedtothehospital,hewasdrunk.[6]HegavehisnameasArnelitoLogmaoandhisaddressasBoniAvenue,Mandaluyong.[7]

Intheemergencyroom,ArnelitoLogmaowasconscious

andwasinterviewedbyDr.PaternoCabrera,thedutyresi

_______________

nation.inquirer.net/99654/phbeatworldrecordformostnumberoforgandonorsinonehour>(visitedApril3,2014).

[2] Rollo, pp. 7196, penned by Justice Marina L. Buzon and

concurred in by Justice Aurora SantiagoLagman and Justice

ArcangelitaRomillaLontok.

[3] Id., at pp. 103111, penned by Hon. Justice Mariano C. Del

Castillo, then the Presiding Judge of the Branch 100 of the Regional

TrialCourtofQuezonCity.

[4] This hospital is now known as the National Kidney and

TransplantInstituteorNKTI.

[5]Rollo,p.73;CADecision,p.3.

[6]Id., atp.103;RTCDecision,p.1.

[7]Id.

682



dentphysician.[8]Thepatient’sdatasheet,preparedbyDr.Cabrera, identified the patient as Angelito Lugmoso (andnotArnelitoLogmao)ofBoniAvenue,Mandaluyong.[9]Hewassubjectedtoanxrayexamination,buttheexaminationdidnotshowhimsufferingfromanyskullfracturesorheadinjuries.[10]

At around 4:00 a.m. on March 2, 1988, the patientdeveloped generalized seizures, and his conditionprogressively deteriorated.[11] Admission to the IntensiveCare Unit (ICU) and mechanical ventilatory supportbecame necessary, but there was no vacancy at the EastAvenue Medical Center ICU.[12] A resident physician atNationalKidneyInstitute,Dr.EmmanuelLenon,whowasthen conducting rounds at East Avenue Medical Center,suggested that the patient be transferred to theNationalKidney Institute.[13] After arrangements were made, thepatientwastransferredtotheNationalKidneyInstituteat10:10a.m.onthesameday.[14]

When the patient arrived at the National KidneyInstitute, hisnamewas recordedasAngelitoLugmoso.[15]As the patientwas admittedwithout any relatives by hisside,JenniferB.Misa,TransplantCoordinator,wasasked

tolocatethepatient’sfamilybyenlistingpoliceandmediaassistance.[16] Dr. Enrique T. Ona, Chairman of theDepartment of Surgery, observed that the patient’s braininjurywassoseverethat itmanifestedsymptomsofbraindeath.[17] Upon his request, the Laboratory Sectionconductedatissuetypingandtissuecross

_______________

[8]Id.

[9]Id., atp.73;CADecision,p.3.

[10]Id.

[11]Id.

[12]Id.

[13]Id.

[14]Id.

[15]Id., atp.74.

[16]Id.

[17]Id.

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VOL.720,APRIL7,2014 683


matchingexaminationon thepatient.[18]The requestwasdoneonthebasisthatifthedeceasedpatientisfoundtobea suitable organ donor and has his family’s consent, theorgans could be harvested and transplanted promptly toanyofthecompatiblebeneficiaries.[19]

JenniferMisaverifiedtheidentityofthepatientwiththeEastAvenueMedicalCenteronthesamedayorMarch2,1988.[20] Upon her request, the hospital furnished her acopy of the patient’s data sheet which bore the nameAngelitoLugmosowithBoniAvenue,Mandaluyong,ashisaddress.[21]Shethencontactedseveralradioandtelevisionstations and requested for airtime in her search for thefamilyofAngelitoLugmoso.[22]HerrequestwasgrantedbyChannel 4, ABSCBN, andGMA.[23] Police StationNo. 5,EasternPoliceDistrict,Mandaluyong,issuedacertificationattestingthatonMarch2,1988,atabout6:00p.m.,JenniferMisa requested for assistance to immediately locate thefamily and relatives of Angelito Lugmoso and that she

followedupherrequestuntilMarch9,1988.[24]On March 3, 1988 at about 7:00 a.m., Dr. Ona was

informedthatthepatientwaspronouncedbraindeadbyDr.Abdias V. Aquino, a neurologist, and Dr. Antonio Rafael,the attending physician of the patient, and that anotherelectroencephalogram(EEG)wasinprogresstoconfirmthediagnosis.[25]Atabout9:00a.m.,Dr.OnawasinformedthattheEEG recording showed a flat tracing, confirming thatthepatientwasbraindead.[26]

_______________

[18]Id.

[19]Id.

[20]Id.

[21]Id.

[22]Id.

[23]Id.


[25]Id.

[26]Id.

684



Upon learning that the patient was a suitable organdonorandthatthereweresomeNationalKidneyInstitutepatientswhowerecompatibledonees,Dr.OnainquiredfromJennifer Misa whether the patient’s relatives have beenlocated so that the necessary consent for organ donationcouldbeobtained.[27]

Since no relatives of Angelito Lugmoso could be founddespitetheongoingsearch,Dr.OnarequestedDr.FiloteoA.Alano,ExecutiveDirectoroftheNationalKidneyInstitute,toauthorizetheremovalofspecificorgansfromthebodyfortransplantationpurposes.[28]Dr.OnalikewiserequestedDr.RoseMarie RoseteLiquete to secure permission from theNationalBureauof Investigation’sMedicoLegalOffice fororganretrievalandtransplantation,ontheassumptionthatthe incident which led to the death of the patient was amedicolegalcase.[29]

On March 3, 1988, Dr. Alano issued to Dr. Ona amemorandumwhichstates:

This is in connectionwith theuse of thehumanorgansoranyportion or portions of the human body of the deceased patient,identified as a certainMr. Angelito Lugmosowhowas brought tothe National Kidney Institute on March 2, 1988 from the EastAvenueMedicalCenter.

Asshownbythemedicalrecords,thesaidpatientdiedonMarch3,1988at9:10inthemorningduetocraniocerebralinjury.Pleasemake certain that your Department has exerted allreasonable efforts to locate the relatives or next of kin ofthe said deceased patient such as appeal through the radiosand television as well as through police and othergovernment agencies and that the NBI Medicolegal Sectionhas been notified and is aware of the case.

If all the above has been complied with, in accordancewith the provisions of Republic Act No. 349 as amended andP.D. 856, permission and/or authority is hereby given to the

_______________

[27]Id.

[28]Id.

[29]Id.

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VOL.720,APRIL7,2014 685


Department of Surgery to retrieve and remove the kidneys,pancreas, liver and heart of the said deceased patient andto transplant the said organs to any compatible patient whomaybe in need of said organs to live and survive.[30](Emphasissupplied)

Dr.MaximoReyes,MedicoLegalOfficeroftheNational

BureauofInvestigation,issuedacertificationdatedMarch10,1988,statingthathereceivedatelephonecallfromDr.Liquete on March 3, 1988 at 9:15 a.m. regarding thecase.[31]He certified that despite efforts to locateAngelitoLugmoso’s relatives, no one responded. Dr. Liquete alsosoughtfromDr.Reyesasecondopiniononorgandonation

even in the absence of consent from the family of thedeceased patient, and Dr. Reyes verbally agreed to theorganretrieval.[32]

OnMarch3,1988at3:45p.m.,amedicalteamledbyDr.Onaremovedtheheart,kidneys,pancreas,liver,andspleenof the deceased patient.[33] The medical team thentransplantedakidneyandthepancreastoLeeTanKocandthe other kidney to Alexis Ambustan.[34] The transplantoperation was completed around 11:00 p.m. on the sameday.[35]

OnMarch4,1988,Dr.AntonioR.Paraiso,Headof theCadaver Organ Retrieval Effort (CORE) program of theNational Kidney Institute, made arrangements with LaFunerariaOrofortheembalmingofthecadaverforupto15days to give the National Kidney Institute more time tocontinue searching for the relatives of the deceasedpatient.[36]

OnMarch11,1988,theNationalKidneyInstituteissuedapressreleaseannouncingitsfirstsuccessfuldoubleorgan

_______________


[31]Id., atpp.7677;CADecision,pp.67.


[33]Id.

[34]Id.

[35]Id.

[36]Id.

686



transplantation.[37] Aida Doromal, a relative of Arnelito’smother,ZenaidaLogmao, saw thenewson television thatthedonorwasan18yearoldboywhoseremainswerelaidatLaFunerariaOroinQuezonCity.[38]Sincethenameofthe donor sounded like Arnelito Logmao, Aida informedZenaida.[39] Upon receiving the news from Aida, Zenaidaand her other children went to La Funeraria Oro wheretheywereabletoretrieveArnelito’sbody.[40]

OnApril29,1988,ZenaidafiledwiththeRegionalTrialCourtacomplaintfordamagesagainstDr.Lenon,TaureanProtectors Agency, National Kidney Institute, JenniferMisa,Dr.Alano,Dr.Reyes,Dr.Ona,Dr.Liquete,theentiremedicalteamthatconductedthetransplant,LeeTanKoc,Alexis Ambustan, Dr. Paraiso, La Funeraria Oro, Dr.MarianoB.Cueva,Jr.,JohnDoe,PeterDoe,andAlexDoein connection with the death of her son, Arnelito.[41] Sheallegedthatallof themconspiredtoremovetheorgansofArnelitowhenhewasstillaliveandthattheyconcealedhistrueidentity.[42]

OnJanuary17,2000,theRegionalTrialCourtrenderedjudgment[43] dismissing the complaint against alldefendants but findingDr. Alano liable for damages. ThetrialcourtfoundDr.AlanonegligentunderArticle2176oftheCivilCodeforauthorizingtheretrievalofthedeceasedpatient’sorganswithoutfirstexertingreasonableeffortstolocatehisrelatives,indirectviolationofthelaw.Accordingtothetrialcourt:

xxx.In the natural course of things, a search or inquiry ofanything requires at least two days of probing and seekingto be actually considered as having made said earnestefforts.

_______________


[38]Id.

[39]Id.

[40]Id.

[41]Id., atpp.7879.


[43]Id., atpp.103111.

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Butaonedaycampaign,especiallywithregardtoasubjectmatteras important as a person’s disposal into the afterlife certainlywarrants a longer time for investigation. Indeed, what is“reasonable” is a relative term, dependent on the attendantcircumstances of the case (Philippine Law Dictionary, citing

Katague vs. Lagana, CV 70164,March 7, 1986). Here, what wasinvolved was the detachment of the vital organs of plaintiff’s 18year[]old son from his body without her knowledge and consent,and which act was upon the authority issued by defendant Dr.Alano as head of the hospital. Thematter at handwas of a verysensitive nature that an inquiry of less than one day cannot bedeemedassufficientandreasonabletoexculpatehimfromliability.xxx.[44](Emphasissupplied)

Dr. Alano appealed[45] the ruling with the Court ofAppeals.

OnMarch 31, 2006, the Court of Appeals rendered itsdecision[46]affirmingtherulingoftheRegionalTrialCourtwithmodifications.

Theappellatecourtdeletedtheawardforactualdamagesrepresenting the expenses for autopsy fees, andwakeandfuneral services, since Arnelito’s family would have stillincurredthoseexpensesevenifnoorganretrievalwasdoneon thebody.[47] It alsodeleted theawardof compensatorydamagesofP50,000.00perorganretrievedsinceitwasnotshown that Dr. Alano was the recipient of the organtransplantsorthathereceivedanyconsiderationfromthetransplant patients.[48] Finally, it affirmed the award ofdamagesbut reducedmoraldamages fromP500,000.00 toP250,000.00, exemplary damages from P500,000.00 toP200,000.00, and attorney’s fees from P300,000.00 toP100,000.00.[49]

_______________

[44]Id., atp.106;RTCDecision,p.4.

[45]Id., atpp.112144.

[46]Id., atpp.7196.


[48]Id.

[49]Id., atpp.9395;CADecision,pp.2325.

688



Dr.Alanonowcomesbeforethiscourtviaapetition forreviewoncertiorari.Heargues[50] that therewasno legal

basisfortheCourtofAppealstoholdhimliablefordamagessincetherewasnofindingthathewastheproximatecauseof the injury or damage sustained by Zenaida. He alsoarguesthatheactedingoodfaithandpursuanttolawwhenheissuedtheauthorizationfortheorganretrieval.

Thus, the issue before this court is whether Dr. Alanoshould be held liable for his alleged negligence inauthorizingtheremovalandretrievalofArnelito’sinternalorganswithoutZenaida’sconsent.

Iagreewiththeponencia thatDr.Alanoshouldnotbefoundliable,butItakethisopportunitytofurtherexpoundontheissuespresentedtothiscourt.

As a general rule, only questions of law are to beconsideredinapetitionforreviewunderRule45.Thereare,however,recognizedexceptionstotherule,oneofwhichiswhen“theCourtofAppealsfailstonoticecertainrelevantfacts which, if properly considered, will justify a differentconclusionxxx.”[51]

Dr. Alano’s acts were not reckless, negligent orunreasonable. It was not his acts that caused the allegedinjury to the deceased patient’s relatives.Considering thecircumstancesthathehadtoface,thesearchheorderedforthe deceased patient’s relatives were all that ordinaryprudence required. His retrieval of the deceased patient’sorgans was done legally and after allowing a reasonabletime to lapse. The conclusions of the trial court and theappellate courtwere, therefore, correctly reversed and setaside.

_______________

[50]Id., atpp.401459,Memorandumforthepetitioner.

[51]Spouses Alcazar v. Evelyn Arante, G.R. No. 177042, December

10, 2012, 687 SCRA 507, 516 [Per J. Peralta, Third Division], citing

Vallacar Transit, Inc. v. Catubig, G.R. No. 175512,May 30, 2011, 649

SCRA281,294[PerJ.LeonardoDeCastro,FirstDivision].

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VOL.720,APRIL7,2014 689


The elements of a quasidelictIn cases involving quasidelict and torts, the plaintiff

complains that the acts of a defendant caused him or her

injury.Inordertobeactionable,theactshouldhavebeencommittedwiththeintentionofinjuringtheplaintifforwascommitted recklessly or negligently or one which, evenwhen done with the proper care, held such high risk forinjury to others that it will be presumed by law to beactionable.

The lower courts are all in agreement thatDr.Alano’sparticipation in the organ retrieval constituted a quasidelict under Article 2176 of the Civil Code for which heshouldbeliablefordamages.

Thisconclusioniserroneous.Article 2176may not be the proper legal basis for the

causeofaction.Thisarticledefinesaquasidelictas:

Article 2176. Whoever by act or omission causes damage toanother, there being fault or negligence, is obliged to pay for thedamage done. Such fault or negligence, if there is no preexistingcontractualrelationbetweentheparties,iscalledaquasidelictandisgovernedbytheprovisionsofthisChapter.

Theelementsofaquasidelictare:(1)anactoromission;

(2)thepresenceoffaultornegligenceintheperformanceornonperformance of the act; (3) injury; (4) a causalconnectionbetweenthenegligentactandtheinjury;and(5)no preexisting contractual relation. Jurisprudence,however,specifies four(4)essentialelements:“(1)duty; (2)breach;(3)injury;and(4)proximatecausation.”[52]

Asageneralrule,anyactoromissioncomingunderthepurviewofArticle2176givesrisetoacauseofactionunder

_______________

[52]Garcia, Jr. v. Salvador, 547 Phil. 463, 470; 518 SCRA 568, 575

(2007) [Per J. YnaresSantiago, Third Division]; Lucas v. Tuaño, 604

Phil.98,121;586SCRA173,199200(2009)[PerJ.ChicoNazario,Third

Division].

690



quasidelict. This, in turn, gives the basis for a claim ofdamages.Verily,Article1157oftheCivilCodeprovidesasfollows:

Article 1157. Obligationsarisefrom:(1) Law;(2) Contracts;(3) Quasicontracts;(4) Actsoromissionspunishedbylaw;and(5) Quasidelicts.(Emphasissupplied)

Article2176 isnotanallencompassingenumerationof

allactionablewrongswhichcangiverisetotheliabilityfordamages. Under the Civil Code, acts done in violation ofArticles19,20,and21willalsogiverise todamages.Theprovisionsstateasfollows:

Article 19. Everypersonmust,intheexerciseofhisrightsandinthe performance of his duties, act with justice, give everyone hisdue,andobservehonestyandgoodfaith.Article 20. Every person who, contrary to law, willfully ornegligentlycausesdamagetoanother,shallindemnifythelatterforthesame.Article 21. Any person who willfully causes loss or injury toanother in amanner that is contrary tomorals, good customs, orpublicpolicyshallcompensatethelatterforthedamage.

Baksh v. Court of Appeals[53]elaboratesonthedistinctions:x x x. Quasidelict, known in Spanish legal treatises as culpaaquiliana,isacivillawconceptwhiletorts isanAngloAmericanorcommon lawconcept.Torts ismuch broader than culpa aquilianabecause it includesnot onlynegligence, but international criminalacts as well such as assault and battery, false imprisonment anddeceit. In the general scheme of the Philippine legal systemenvisionedbytheCommissionresponsiblefordraftingtheNewCivilCode,inten

_______________

[53]G.R.No.97336,February19,1993,219SCRA115[PerJ.Davide,Third

Division].

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VOL.720,APRIL7,2014 691


tional and malicious acts, with certain exceptions, are to begoverned by the Revised Penal Code while negligent acts or

omissions are to be covered by Article 2176 of the Civil Code. Inbetween these opposite spectrums are injurious acts which,in the absence of Article 21, would have been beyondredress. Thus, Article 21 fills that vacuum. It is evenpostulated that together with Articles 19 and 20 of the CivilCode, Article 21 has greatly broadened the scope of the lawon civil wrongs; it has become much more supple andadaptable than the AngloAmerican law on torts.[54](Emphasissupplied)

Yuchengco v. Manila Chronicle Publishing

Corporation[55] further elaborates on tort based on theconceptofabuseofright:

TheprincipleofabuseofrightsasenshrinedinArticle19oftheCivilCodeprovides:

Art. 19. Every person must, in the exercise of hisrights and in the performance of his duties, act withjustice, give everyone his due, and observe honesty andgoodfaith.

Thisprovisionof lawsets standardswhichmustbeobserved inthe exercise of one’s rights as well as in the performance of itsduties,towit:toactwithjustice;giveeveryonehisdue;andobservehonestyandgoodfaith.

In Globe Mackay Cable and Radio Corporation v. Court ofAppeals, it was elucidated thatwhile Article 19 “lays down arule of conduct for the government of human relations andfor the maintenance of social order, it does not provide aremedy for its violation. Generally, an action for damagesunder either Article 20 or Article 21 would be proper.” TheCourtsaid:

_______________

[54]Id., atpp.127128,citing ReportoftheCodeCommission,pp.161162,

andA.M.TOLENTINO,COMMENTARIESANDJURISPRUDENCEONTHECIVILCODEOFTHE

PHILIPPINES72(Vol.1,1985).

[55]G.R.No.184315,November28,2011,661SCRA392 [PerJ.Peralta,

SpecialThirdDivision].

692



OneofthemorenotableinnovationsoftheNewCivilCodeisthecodificationof“somebasicprinciplesthataretobeobservedfortherightfulrelationshipbetweenhumanbeingsandforthestabilityofthe social order.” [REPORT ON THE CODE COMMISSION ONTHE PROPOSED CIVIL CODE OF THE PHILIPPINES, p. 39].The framers of the Code, seeking to remedy the defect of the oldCodewhichmerelystatedtheeffectsofthelaw,butfailedtodrawoutitsspirit,incorporatedcertainfundamentalpreceptswhichwere“designedtoindicatecertainnormsthatspringfromthefountainofgoodconscience”andwhichwerealsomeanttoserveas“guidesforhuman conduct [that] should run as golden threads throughsociety,totheendthatlawmayapproachitssupremeideal,whichistheswayanddominanceof justice.” (Id.)Foremostamong theseprinciplesisthatpronouncedinArticle19whichprovides:

Art. 19. Everypersonmust, intheexerciseofhisrightsandintheperformanceofhisduties,actwithjustice,giveeveryonehisdue,andobservehonestyandgoodfaith.

This article, known to contain what is commonlyreferred to as the principle of abuse of rights, sets certainstandards which must be observed not only in the exerciseof one’s rights, but also in the performance of one’s duties.These standards are the following: to act with justice; togive everyone his due; and to observe honesty and goodfaith. The law, therefore, recognizes a primordial limitationon all rights; that in their exercise, the norms of humanconduct set forth in Article 19 must be observed. A right,though by itself legal because recognized or granted by lawas such, may nevertheless become the source of someillegality. When a right is exercised in a manner which doesnot conform with the norms enshrined in Article 19 andresults in damage to another, a legal wrong is therebycommitted for which the wrongdoer must be heldresponsible.ButwhileArticle19 laysdownaruleof conduct forthegovernmentof

693

VOL.720,APRIL7,2014 693


humanrelationsandforthemaintenanceofsocialorder,itdoesnotprovidearemedyforitsviolation.Generally,anactionfordamagesundereitherArticle20orArticle21wouldbeproper.

Corollarily, Article 20 provides that “every person who,contrary to law, willfully or negligently causes damage toanother shall indemnify the latter for the same.” It speaks ofthe general sanctions of all other provisions of law whichdo not especially provide for its own sanction.Whenarightis exercised inamannerwhichdoesnot conform to the standardsset forth inthesaidprovisionandresults indamagetoanother,alegalwrongistherebycommittedforwhichthewrongdoermustberesponsible.Thus,iftheprovisiondoesnotprovidearemedyforitsviolation,anactionfordamagesundereitherArticle20orArticle21oftheCivilCodewouldbeproper.[56](Emphasissupplied)

Article19isthegeneralrulewhichgovernstheconduct

of human relations. By itself, it is not the basis of anactionable tort. Article 19 describes the degree of carerequired so that an actionable tort may arise when it isallegedtogetherwithArticle20orArticle21.

Article20concernsviolationsofexistinglawasbasisforan injury. It allows recovery should the act have beenwillfulornegligent.Willfulmayrefertotheintentiontodothe act and the desire to achieve the outcome which isconsidered by the plaintiff in tort action as injurious.Negligence may refer to a situation where the act wasconsciouslydonebutwithoutintendingtheresultwhichtheplaintiffconsidersasinjurious.

Article21,ontheotherhand,concernsinjuriesthatmaybe causedbyactswhicharenotnecessarilyproscribedbylaw.Thisarticlerequiresthattheactbewillful,thatis,thatthere

_______________

[65]Id., atpp.402403,citing GF Equity, Inc. v. Valenzona,501Phil.

153, 164; 462 SCRA 466, 479480 (2005) [Per J. CarpioMorales, Third

Division]; Globe Mackay Cable and Radio Corporation v. Court of

Appeals, 257 Phil. 783; 176 SCRA 778 (1989) [Per J. Cortes, Third

Division];Manuel v. People, 512Phil. 818, 847; 476SCRA461, 491492

(2005)[PerJ.Callejo,Sr.,SecondDivision].

694



wasan intentiontodotheactandadesiretoachievethe

outcome.IncasesunderArticle21,thelegalissuesrevolvearoundwhethersuchoutcomeshouldbeconsideredalegalinjuryonthepartoftheplaintifforwhetherthecommissionof the act was done in violation of the standards of carerequiredinArticle19.

Article2176coverssituationswherean injuryhappensthrough an act or omission of the defendant. When itinvolvesapositiveact,theintentiontocommittheoutcomeis irrelevant. The act itself must not be a breach of anexistinglaworapreexistingcontractualobligation.Whatwillbeconsiderediswhetherthereis“faultornegligence”attendingthecommissionoftheactwhichnecessarilyleadstotheoutcomeconsideredasinjuriousbytheplaintiff.Therequireddegreeofdiligencewillthenbeassessedinrelationtothecircumstancesofeachandeverycase.

Article2176shouldnothavebeenthebasisforthecauseofactioninthiscase.Rather,itshouldhavebeenArticle20,whichisapplicablewhenthereisaviolationoflaw.

The law that is applicable is the third paragraph ofSection 2 of Republic Act No. 349,[57] as amended byRepublic Act No. 1056,[58] which provides for a way todetermine substituted informed consent for deceasedpatientsforpurposesoforgandonation.

_______________

[57]Entitled“ANACT TOLEGALIZEPERMISSIONS TOUSEHUMANORGANS

ORANYPORTIONORPORTIONSOF THEHUMANBODYFORMEDICAL,SURGICAL,

ORSCIENTIFICPURPOSES,UNDERCERTAINCONDITIONS,”approvedonMay17,

1949.This lawhas sincebeen supersededbyRepublicActNo.7170or

“The Organ Donation Act of 1991,” approved on January 7, 1992.

Section 9 of Republic Act No. 7170 now specifically provides that the

searchforthedonor’srelativesmustbedonewithin48hours.

[58] Entitled “AN ACT TO AMEND REPUBLIC ACT NUMBERED THREE

HUNDRED ANDFORTYNINE,ENTITLED ‘AN ACT TO LEGALIZE PERMISSIONS TO

USEHUMANORGANSORANYPORTIONORPORTIONSOFTHEHUMANBODYFOR

MEDICAL,SURGICAL,ORSCIENTIFICPURPOSES,UNDERCERTAINCONDITIONS,’”

approvedonJune12,1954.

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VOL.720,APRIL7,2014 695


The doctrine of informed consent

Thedoctrineofinformedconsentwasintroducedinthisjurisdiction only very recently in Dr. Li v. SpousesSoliman.[59] This court ruled that liability may arise incaseswherethephysicianfailstoobtaintheconsentofthepatientbeforeperforminganymedicalprocedure,thus:

The doctrine of informed consent within the context ofphysicianpatient relationships goes far back into Englishcommon law.Asearlyas1767,doctorswere chargedwiththetortof “battery” (i.e.,anunauthorizedphysicalcontactwithapatient) if theyhadnotgainedtheconsentof theirpatientspriortoperformingasurgeryorprocedure.IntheUnitedStates,theseminalcasewasSchoendorff v. Societyof New York Hospital which involvedunwanted treatmentperformed by a doctor. Justice Benjamin Cardozo’s oftquoted opinionupheld the basic right of a patient to giveconsent to any medical procedure or treatment: “Everyhumanbeingofadultyearsandsoundmindhasarighttodetermine what shall be done with his own body; and asurgeon who performs an operation without his patient’sconsent, commits an assault, for which he is liable indamages.”Fromapurelyethicalnorm,informed consentevolved into a general principle of law that aphysician has a duty to disclose what a reasonablyprudent physician in the medical community in theexercise of reasonable care would disclose to hispatient as to whatever grave risks of injury mightbe incurred from a proposed course of treatment, sothat a patient, exercising ordinary care for his ownwelfare, and faced with a choice of undergoing theproposed treatment, or alternative treatment, ornone at all, may intelligently exercise his judgmentby reasonably balancing the probable risks againstthe probable benefits.

Subsequently, in Canterbury v. Spence[,] the courtobservedthatthedutytodiscloseshouldnotbe limitedtomedicalusageasto

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[59]G.R.No.165279,June7, 2011,651SCRA32 [PerJ. Villarama,

En Banc, CJ. Corona, JJ. Perez and Abad, concurring; JJ. Brion,

Nachura, LeonardoDe Castro, Bersamin, andMendoza, concurring in

the result; JJ. Carpio, CarpioMorales, Velasco, Peralta, and Sereno,

dissenting].

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arrogatethedecisiononrevelationtothephysicianalone.Thus,respectforthepatient’srightofselfdeterminationonparticular therapy demands a standard set by law forphysicians rather than onewhich physiciansmay ormaynotimposeuponthemselves.xxx.[60]

Those who consent to using their organs upon theirdeath for the benefit of another can make their consentknownpriortotheirdeathbyfollowingtherequirementsofthe law. Should a patient die prior to making his or herinformedconsentknown,thelawprovidesalistofpersonswhomayconsentonhisorherbehalf,thatis,“substituted”informedconsent.

Sincetheincidentinthiscaseoccurredin1988,RepublicActNo.349,asamendedbyRepublicActNo.1056, is thelawthatapplies.Section2ofthelawstatesthat:

SEC. 2. The authorization referred to in section one of this Actmust: be in writing; specify the person or institution granted theauthorization; the organ,part orparts tobedetached, the specificuse or uses towhich the organ, part or parts are to be employed;and,signedbythegrantorandtwodisinterestedwitnesses.If the grantor is a minor or an incompetent person, theauthorizationmaybeexecutedbyhisguardianwiththeapprovalofthecourt; indefaultthereof,bythelegitimatefatherormother, intheorder,named.MarriedwomenmaygranttheauthorityreferredtoinsectiononeofthisAct,withouttheconsentofthehusband.After the death of the person, authority to use human organs oranyportionorportionsof thehumanbody formedical,surgicalorscientific purposesmay also be granted by his nearest relative orguardianatthetimeofhisdeathorintheabsencethereof,bythepersonorheadofthehospital,orinstitutionhavingcustodyofthebodyofthedeceased:Provided, however, That the said personor head

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[60]Id., atpp.5657,citing Schoendorff v. Society of New York Hospital,105

N.E.92,93(N.Y.1914);Black’s Law Dictionary, FifthEdition,p.701,citing Ze

Barth v. Swedish Hospital Medical Center, 81 Wash.2d 12, 499 P.2d 1, 8;

Canterbury v. Spence, 464F.2d772C.A.D.C.,1972.

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of the hospital or institution has exerted reasonable effortsto locate the aforesaid guardian or relative.AcopyofeverysuchauthorizationmustbefurnishedtheSecretaryofHealth.(Emphasissupplied)

Under this law, consent to organ retrieval after the

patient’s death may be given first and foremost by thepatient’snearestrelativeorguardianatthetimeofdeath.Itisonlyintheeventthattheserelativescannotbecontacteddespite reasonable efforts that the head of the hospital orinstitutionhavingcustodyofthebodymaygiveconsentfororgan retrieval on behalf of the patient. Failing this,liabilityfordamagesarises.

ConsideringthatRepublicActNo.349,asamended,doesnotprovidearemedyincaseofviolation,anapplicationofthedoctrineof informedconsentvisàvisArticle 20 of theCivilCodemaygiverisetoanactionfordamages.Inthiscase,Dr.AlanomustfirstbeshowntohaveactedwillfullyandnegligentlytothedamageandprejudiceofZenaida.

Petitioner did not willfullyor negligently, in a mannercontrary to law, authorizthe retrieval of the organs

Dr. Alano did not violate the provisions of the lawwillfully or negligently. In accordance with therequirementsofthethirdparagraphofSection2ofRepublicAct No. 349, as amended, he caused the discharge of“reasonable efforts” to locate the relatives, allowed for areasonabletimetopass,andharvestedtheorganswithcareandprudence.

Negligencehas beendefined by lawas “[t]he failure toobserve,fortheprotectionoftheinterestsofanotherperson,thatdegreeofcare,precautionandvigilancewhichthecir

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cumstances justly demand, whereby such other person

suffersinjury.”[61]InPicart v. Smith,[62]thetestfornegligenceisasfollows:

Thetestbywhichtodeterminetheexistenceofnegligence inaparticular case may be stated as follows:Did the defendant indoing the alleged negligent act use that reasonable careand caution which an ordinarily prudent person wouldhave used in the same situation? If not, then he is guilty ofnegligence.Thelawhereineffectadoptsthestandardsupposedtobesuppliedby the imaginaryconductof thediscreetpaterfamiliasoftheRomanlaw.Theexistenceofnegligenceinagivencaseisnotdeterminedbyreferencetothepersonaljudgmentoftheactorinthesituation before him. The law considers what would be reckless,blameworthy,ornegligent inthemanofordinary intelligenceandprudenceanddeterminesliabilitybythat.

The question as to what would constitute the conduct of aprudent man in a given situation must of course be alwaysdetermined in the light of human experience and in view of thefacts involved in the particular case. Abstract speculation cannothere be of much value but this much can be profitably said:Reasonablemen govern their conduct by the circumstanceswhichare before them or known to them. They are not, and are notsupposed to be, omniscient of the future. Hence they can beexpectedtotakecareonlywhenthere issomethingbeforethemtosuggest orwarnofdanger.Could a prudent man, in the caseunder consideration, foresee harm as a result of the courseactually pursued? If so, it was the duty of the actor to takeprecautions to guard against that harm. Reasonable foresight ofharm, followed by the ignoring of the suggestion born of thisprevision,isalwaysnecessarybeforenegligencecanbeheldtoexist.Stated in these terms, the proper criterion for determining theexistenceofnegligenceinagivencaseisthis:Conductissaidtobenegligent when a prudent man in the position of the tortfeasorwould have foreseen that an effect harmful to another wassufficiently

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[61]United States v. Barias, 23 Phil. 434, 437 (1912) [Per J. Carson, En

Banc],citing JudgeCooleyinhisworkonTorts,3rded.,1324.

[62]37Phil.809(1918)[PerJ.Street,En Banc].

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probabletowarranthis foregoingtheconductorguardingagainstitsconsequences.[63](Emphasissupplied)

As correctly found by the majority, Zenaida failed to

prove thatDr.Alano did not exercise the reasonable careandcautionofanordinarilyprudentperson.

Incompliancewiththedutyreposedonhimbythelaw,Dr.Alano,astheExecutiveDirectoroftheNationalKidneyInstitute, directed Jennifer B. Misa, TransplantCoordinator, to locate Arnelito’s relatives. Radioannouncements overRadyo ng Bayan and DZMM Radio,televisednoticesonChannels2,7,9,and13,andapoliceblotter in theEasternPoliceDistrictNo.5,Mandaluyong,were done on March 2, 1988, with a publishedadvertisement also appearing on the People’s Journal onMarch 20, 1988.[64] Assistance was also sought from theNationalBureau of Investigation.These findingswere, infact, adopted by the trial court. Dr. Enrique T. Ona alsotestifiedthatthesearchforthedeceasedpatient’srelativescontinuedevenaftertheorganretrieval,thus:

Q: After the retrieval of the organs from the patient and the

transplantationoftheorganstoMr.AmbustanandTan[K]ocLee,did

thehospitalstop in itseffort to locatethe familyof thepatient,Mr.

Witness?

A:SincethispatientisaJohnDoeandevenafterwehadretrievedthe

organsandtransplantedittothe2recipients,Iwasalsomadeaware

that no relatives could still be located.Specific instruction were

[sic] given to the transplant coordinator to continue looking for

the relatives.[65](Emphasissupplied)

The trial court and the appellate court, however, took

exception to the period of time taken by Dr. Alano inconducting

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[63]Id., atp.813.

[64]Rollo,p.106;RTCDecision,p.4.

[65]Id., atpp.323324;TSN,October2,1995,pp.3536.

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the search for the deceased patient’s relatives before heauthorizedtheorganretrieval.

Whatthelowercourtsfailedtoconsiderwasthatthiswasan unusual situation wherein time was of the essence.Organretrievalmustalwaystakeintoaccounttheviabilityoftheorgans.

AsexplainedbyDr.Onainhistestimonybeforethetrialcourt:

Q:Doesthetimehaveanyfactoralsowithrespecttotheviabilityof

theseorgans,Mr.Witness[?]

A:Yes,sir.

Q:Willyoupleaseexplainthis,Mr.Witness?

A:When we remove the organs say, the kidney from the cadaver

we put that into [a] special solution for preservation and ideally

we would like to transplant that kidney within 24 hours

although oftentimes we extend it to 48 hours and even

stretching it to 72 hours, sir.

Court: Ijustwanttoclarifythisissue.

Q:Isthereanyparticularreasonwhytheretrievaloftheorganshaveto

bedoneevenwhenthepatientisnotyetdead,aswhatweknowheart

beating [sic] stops but even at that stage when classified as brain

dead,whytherushtoopenitup,isthereanyparticularreasonorcould

itreferperhapstothesuccessfuloperationmaybefortheorganstofit

welltotherec[i]pient?

A:Yes,YourHonor.The viability of the organ as I mentioned earlier

the kidney is viable for several hours, as I mentioned 24 hours,

48 hours up to 72 hours but for the liver, Your [Honor], during

that time in 1988 the liver can be preserved only for about 6 to 8

hours and for the heart it should be connected for 4 hours, Your

Honor.

Q:So,inthisparticularcase,thekidney,howmanyhoursmoreorless?

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A: At that time itwasstretched into24hours,YourHonorandthe

pa[n]creasmaybe4hoursso that it is the leng[th]of timewhenthe

organsmostlikelytobeviableafterthatmostlikelydidnotfunction

anymore[sic].

Q:Butyoudoretrievalalsotothosedeadonarrival,isthatnot?

A: Inthisparticularcase,YourHonor, it ispossibleforexamplethe

deadonarrival isbroughttotheemergencyroom,thepreparationof

theoperatingroomandthegettingof[sic]theconsentitwilltaketime,

YourHonor, so in this particular case, YourHonor there is nomore

heartbeatthatcannotbeviableanymore[.][66](Emphasissupplied)

This testimony is supported by several studies, which

tend to show that the viability of organs in an organdonation may depend on the length of time between thedeclarationofbraindeathandorganretrieval.

Onestudyshowsthatwidespreadphysiologicalchangesoccur during brain death. “In addition to acute changes,which if untreated lead to rapiddeterioration and cardiacarrest (even ifventilation is continued), thereareongoinggeneralizedinflammatoryandhormonalchangesassociatedwith brain death which adversely affect donor organfunction andpropensity to rejection.”[67] Another study[68]shows that the time period between declaration of braindeath and organ retrieval was a “significant predictivefactor”[69]inrecipientmortalityfor

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[66]Id., atpp.375379;TSN,October2,1995,pp.8791.

[67]D.W.McKeown,R.S.Bonser,andJ.A.Kellum,Management of

the heartbeating braindead organ donor,BritishJournalofAnaesthesia

108(S1):i96i107(2012).

[68] S.Ramjug,N.Hussain, andN.Yonan,Prolonged time between

donor brain death and organ retrieval results in an increased risk of

mortality in cardiac transplant recipients, Interactive CardioVascular

andThoracicSurgery12,pp.938942(2011).

[69]Id., atp.939.

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cardiactransplants.Thereisalsoastudy[70]thatshowsthat“[t]herearecleardatathatboth[braindeath]andprolonged[braindeathduration]resultin[kidney]graftdamage,andsuccessful organ retrieval after [brain death] definitely

reliesonintensivedonormanagement.”[71]UponashowingbytheTransplantCoordinatorthatthe

deceased patient’s relatives could not be found despite allher efforts in locating them, Dr. Alano exercised hisprofessionaljudgmentandorderedtheretrievalbearinginmind the short length of time the organs could be viableafter the declaration of brain death. He exercised all thereasonablecareandcautionthatanordinarilyprudentmanwouldhaveexercisedinthesamesituation.

Dr.Alano, therefore, should not have been found to benegligent.He did not violate Article 20 of the Civil CodebecausehecompliedwithallhisdutiesinRepublicActNo.349,asamended.

There is no causal connectionbetween the alleged negligentact and the damage suffered byrespondent

Thetrialcourt,byusingthecodaldefinitionofaquasidelict, identifiedtheactoromissionasthatofauthorizingthe retrieval of the deceased patient’s organs withoutseeking permission from his relatives; the presence ofnegligence as the failure to exert reasonable efforts insearching for the deceased patient’s relatives; and thedamage pertaining to Zenaida’s discovery of her son’slifelessbody“mangled,robbed

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[70] K. Kunert, S. Weiß, K. Kotsch, and J. Pratschke, Prolonged

brain death duration — does it improve graft quality?, Transplant

International2010EuropeanSociety forOrganTransplantation24,pp.

1213(2011).

[71]Id., atp.13.

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ofitsvitalorgansandxxxsewnuplikexxxaragdoll.”[72]Thecourtalsofoundnopreexistingcontractualrelation.

The trial court ismistaken.Clearly, there is no causalconnectionbetween theallegednegligentact ofDr.AlanoandthedamagesufferedbyZenaida.

First, Zenaida alleged before the trial court that thedamageshesufferedwasthelossofherson’slife.Thetrialcourt, however, conceded that “the extent of Logmao’sinjuries were such that the possibility of survival wouldhavebeenhighlyimprobable,ifnotimpossiblexxx.”[73]Itthen concluded that there was still damage suffered byZenaida, in that her son’s lifeless body was “mangled,robbedofitsvitalorgansandxxxsewnuplikesomeragdoll, without her knowledge, much more her consent.”[74]The Court of Appeals agreed, stating that “the pain andanguish of amother in seeing the lifelessbody ofher sonlike a slaughteredpig in the funeral parlor x x x ismorethanonecantake.”[75]

The“painandanguish”[76]ofZenaidaindeedmayhaveresultedfromtheloss of her son.However,Dr.Alanooranyofhis subordinatesdidnot cause the loss ofher son’s life.EvenifDr.Alanodidnotordertheorganretrieval,Zenaidawouldstillfindthebodyofhersonlifeless.

It was, therefore, erroneous to impute the emotionalsufferingofZenaidaasbeingcausedbyDr.Alano’sfailuretoexertreasonableeffortstolocateherbeforeorderingtheorganretrieval.

Second, the failure to locate Zenaida to secure herpermission for the organ retrieval was not caused by Dr.Alano.

TherecordsshowthatthedifficultyinlocatingZenaidastemmedfromtheerroneousinformationfoundonthede

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[72]Rollo,p.107;RTCDecision,p.5.

[73]Id.

[74]Id.

[75]Id., atpp.9394.

[76]Id., atp.93.

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ceased’s patient data sheet, which indicated his name asAngelitoLugmoso,notArnelitoLogmao.ItwasthestaffofEastAvenueMedicalCenter,notDr.Alanoandthestaffofthe National Kidney Institute, which provided the

erroneousinformationonthepatientdatasheet.Itcanbeconcededthattherewasadutyonthepartof

theNationalKidneyInstitutetoverifytheinformationonthe patient data sheetwith the patient himself.However,whenArnelitowas transferred fromEastAvenueMedicalCenter to the National Kidney Institute, he was already“intubated and ambubagging support was providedxxx.”[77]Thismeansthathewouldnothavebeencoherentenoughorevenconsciousenoughtobeabletoansweranyquerybythemedicalstaff.ThestaffoftheNationalKidneyInstitute would have had no choice but to rely on theinformation provided to them by East Avenue MedicalCenterconsideringtheurgencyofArnelito’ssituation.

Theerroneousinformationonthepatientdatasheetwaseventually the cause of the failure of the TransplantCoordinator to locate Zenaida. The radio and televisionannouncements, together with the newspaperadvertisements,were rendered futileby the fact that theywere simply looking for the wrong person. Even if theTransplantCoordinatorspentmorethan24hours lookingforthedeceasedpatient’srelatives,itwasdoubtfulwhetherthey could have been found, considering that they werelookingfortherelativesofAngelitoLugmoso,notArnelitoLogmao.

Respondent should notbe awarded damages

Moraldamageswereawardedbythelowercourtsonthebasis that it was Dr. Alano’s alleged negligence whichcaused the emotional suffering of Zenaida. This iserroneous.

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[77]Id., atp.73.

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The pertinent provisions of the Civil Code on moraldamagesare:

Article 2217. Moral damages include physical suffering,mentalanguish, fright, serious anxiety, besmirched reputation, wounded

feelings,moralshock,socialhumiliation,andsimilarinjury.Thoughincapable of pecuniary computation, moral damages may berecovered if they are the proximate result of the defendant’swrongfulactoromission.Article 2219. Moral damagesmay be recovered in the followingandanalogouscases:(1) Acriminaloffenseresultinginphysicalinjuries;(2) Quasidelictscausingphysicalinjuries;(3) Seduction,abduction,rape,orotherlasciviousacts;(4) Adulteryorconcubinage;(5) Illegalorarbitrarydetentionorarrest;(6) Illegalsearch;(7) Libel,slanderoranyotherformofdefamation;(8) Maliciousprosecution;(9) ActsmentionedinArticle309;(10) ActsandactionsreferredtoinArticles21,26,27,28,29,30,32,34,and35.The parents of the female seduced, abducted, raped, or abused,referredtoinNo.3ofthisarticle,mayalsorecovermoraldamages.Thespouse,descendants,ascendants,andbrothersandsistersmaybring the action mentioned in No. 9 of this article, in the ordernamed.

IthasalreadybeenestablishedthatZenaida’semotional

sufferingwasnotcausedbytheactsofDr.Alano.HealsodidnotcommitanyactinviolationofArticles19,20or21oftheCivilCode.Thisisalsonotacasewhereintheallegedquasidelict resulted inphysical injuries.The lower courtsare also in agreement that Dr. Alano did not cause thedeathofZenaida’sson.Neitheristhiscaseanalogoustoanyofthesituationsmentionedintheprovision.Contrarytotherulingofthetrialcourt,thissituationisalsonotcoveredbyArticle309oftheCivilCode,whichstates:

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Article 309. Any person who shows disrespect to the dead, orwrongfullyinterfereswithafuneralshallbeliabletothefamilyofthedeceasedfordamages,materialandmoral.

The organ retrieval performed by theNationalKidney

Institute cannot be termed as “disrespect to the dead.”Organ donation is allowed by law. A sterile medicaloperation surely is not tantamount to grave robbery ormutilation.

Since Zenaida has not proven her claim to moraldamages,sheisalsonotentitledtoexemplarydamages.

Article2234oftheCivilCodeprovides:

Article 2234. While the amount of the exemplary damagesneed not be proved, the plaintiffmust show that he is entitled tomoral, temperate or compensatory damages before the court mayconsiderthequestionofwhetherornotexemplarydamagesshouldbeawarded.xxx.

Since the award of exemplary damages is not justified,there is no reason to award attorney’s fees, in accordancewithArticle2208oftheCivilCode,whichallowstheawardof attorney’s fees only “when exemplary damages areawarded.”

ACCORDINGLY,ICONCURandvotetoGRANTthepetition.

Petition granted, judgment reversed and set aside.

Notes.—Section1,Rule131oftheRulesofCourtdefines“burdenofproof”as“thedutyofapartytopresentevidenceon the facts in issue necessary to establish his claim ordefense by the amount of evidence required by law.” (DeLeon vs. Bank of the Philippine Islands, 710 SCRA 443[2013])

Hewhoallegeshastheburdenofprovinghisallegationbypreponderanceofevidenceorgreaterweightofcredibleevidence.(Dela Llana vs. Biong, 711SCRA 522[2013])

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1. Alano vs. Magud-Logmao

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