Lucas v. Tuaño

8/10/2019 Lucas v. Tuao

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Torts and DamagesRepublic of the Philippines

SUPREME COURTManila

THIRD DIVISION

G.R. No. 178763 April 21, 2009

PETER PAUL PATRICK LUCAS, ATIMA GLA!"S LUCAS,A##E"GAIL LUCAS AN! GILLIAN LUCAS,Petitioners,vs.!R. PROSPERO MA. C. TUA$O,Respondent.

D ! I S I O N

C%ICO&NA'ARIO, J.:

In this petition for revie" on certiorari#under Rule $% of the RevisedRules of !ourt, petitioners Peter Paul Patric& 'ucas, (ati)a *lad+s'ucas, bbe+-ail 'ucas and *illian 'ucas see& the reversal of the /Septe)ber 001 Decisionand 2 3ul+ 00/ Resolution,2both of the!ourt of ppeals in !4*.R. !V No. 15111, entitled 6Peter PaulPatric& 'ucas, (ati)a *lad+s 'ucas, bbe+-ail 'ucas and *illian'ucas v. Prospero Ma. !. Tua7o.6

In the 8uestioned decision and resolution, the !ourt of ppealsaffir)ed the #$ 3ul+ 000 Decision of the Re-ional Trial !ourt 9RT!:,;ranch #%0, Ma&ati !it+, dis)issin- the co)plaint filed b+ petitioners

in a civil case entitled, 6Peter Paul Patric& 'ucas, (ati)a *lad+s'ucas, bbe+-ail 'ucas and *illian 'ucas v. Prospero Ma. !. Tua7o,6doc&eted as !ivil !ase No. s Medical !enter, for an e+e consult.

?pon consultation "ith Dr. Tua7o, Peter narrated that it had been nine9s e+es,"herein= 9#: a -ross eAa)ination of Peter>s e+es and theirsurroundin- area "as )ade@ 9: Peter>s visual acuit+ "ere ta&en@ 92:Peter>s e+es "ere palpated to chec& the intraocular pressure of each@9$: the )otilit+ of Peter>s e+es "as observed@ and 9%: theophthal)oscop+$on Peter>s e+es "as used. On that particularconsultation, Dr. Tua7o dia-nosed that Peter "as sufferin- fro)conBunctivitis%or 6sore e+es.6 Dr. Tua7o then prescribed Spersacet4!1e+e drops for Peter and told the latter to return for follo"4up after one"ee&.

s instructed, Peter "ent bac& to Dr. Tua7o on < Septe)ber #s ri-ht e+e had alread+ cleared up and he could discontinue theSpersacet4!. Ho"ever, the sa)e e+e developed pide)ic Cerato!onBunctivitis 9C!:,/a viral infection. To address the ne" proble)"ith Peter>s ri-ht e+e, Dr. Tua7o prescribed to the for)er a steroid4based e+e drop called MaAitrol,5a dosa-e of siA 91: drops per da+.


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Torts and DamagesTua7o eAa)ined Peter>s e+es and found that the ri-ht e+e had once)ore developed C!. So, Dr. Tua7o instructed Peter to resu)e theuse of MaAitrol at siA 91: drops per da+.

On his "a+ ho)e, Peter "as unable to -et a hold of MaAitrol, as it"as out of stoc& . !onse8uentl+, Peter "as told b+ Dr. Tuano to ta&e,instead, ;lepha)ide#another steroid4based )edication, but "ith alo"er concentration, as substitute for the unavailable MaAitrol, to beused three 92: ti)es a da+ for five 9%: da+s@ t"o 9: ti)es a da+ for five9%: da+s@ and then Bust once a da+.#2

Several da+s later, on #5 October #s e+es and discovered that the C! "as a-ain present in hisri-ht e+e. s a result, Dr. Tua7o told Peter to resu)e the )aAi)u)dosa-e of ;lepha)ide.

Dr. Tua7o sa" Peter once )ore at the for)er>s clinic on $ Nove)ber#s eAa)ination sho"ed that onl+ the peripher+ ofPeter>s ri-ht e+e "as positive for C!@ hence, Dr. Tua7o prescribed alo"er dosa-e of ;lepha)ide.

It "as also about this ti)e that (ati)a *lad+s 'ucas 9(ati)a:, Peter>sspouse, read the acco)pan+in- literature of MaAitrol and foundtherein the follo"in- "arnin- a-ainst the prolon-ed use of suchsteroids=

RNIN*=

Prolon-ed use )a+ result in -lauco)a, "ith da)a-e to the opticnerve, defects in visual acuit+ and fields of vision, and posterior,subcapsular cataract for)ation. Prolon-ed use )a+ suppress the hostresponse and thus increase the haEard of secondar+ ocularinfractions, in those diseases causin- thinnin- of the cornea or sclera,perforations have been &no"n to occur "ith the use of topicalsteroids. In acute purulent conditions of the e+e, steroids )a+ )as&infection or enhance eAistin- infection. If these products are used for#0 da+s or lon-er, intraocular pressure should be routinel+ )onitored

even thou-h it )a+ be difficult in children and uncooperative patients.

)plo+)ent of steroid )edication in the treat)ent of herpes si)pleAre8uires -reat caution.

A A A A

DVRS R!TIONS=

dverse reactions have occurred "ith steroidFanti4infectiveco)bination dru-s "hich can be attributed to the steroid co)ponent,the anti4infective co)ponent, or the co)bination. Aact incidencefi-ures are not available since no deno)inator of treated patients isavailable.

Reactions occurrin- )ost often fro) the presence of the anti4infectivein-redients are aller-ic sensitiEations. The reactions due to the steroidco)ponent in decreasin- order to fre8uenc+ are elevation of intra4ocular pressure 9IOP: "ith possible develop)ent of -lauco)a,

infre8uent optic nerve da)a-e@ posterior subcapsular cataractfor)ation@ and dela+ed "ound healin-.

Secondar+ infection= The develop)ent of secondar+ has occurredafter use of co)bination containin- steroids and anti)icrobials.(un-al infections of the correa are particularl+ prone to developcoincidentall+ "ith lon-4ter) applications of steroid. The possibilit+ offun-al invasion )ust be considered in an+ persistent cornealulceration "here steroid treat)ent has been used.

Secondar+ bacterial ocular infection follo"in- suppression of host

responses also occurs.

On 1 Nove)ber #s clinic,co)plainin- of 6feelin- "orse.6#$It appeared that the C! had spreadto the "hole of Peter >s ri-ht e+e +et a-ain. Thus, Dr. Tua7o instructedPeter to resu)e the use of MaAitrol. Petitioners averred that Peteralread+ )ade )ention to Dr. Tua7o durin- said visit of the above48uoted "arnin- a-ainst the prolon-ed use of steroids, but Dr. Tua7osupposedl+ brushed aside Peter>s concern as )ere paranoia, evenassurin- hi) that the for)er "as ta&in- care of hi) 9Peter:.

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Torts and DamagesPetitioners further alle-ed that after Peter>s 1 Nove)ber #s ri-ht e+e.ith the use of a tono)eter#1to verif+ the eAact intraocular pressure#/9IOP: of Peter>s e+es, Dr. Tua7o discovered that the tension in Peter>sri-ht e+e "as 39.0 %(, "hile that of his left "as #/.0 H-.#5Since thetension in Peter>s ri-ht e+e "as "a+ over the )or*+l IOP, "hich

)erel+ ran-ed fro) 10.0 %( o 21.0 %(,#s e+es.

On #% Dece)ber #s ri-ht e+e+ielded a -i(- )or*+l l/l, i.e.,21.0 %(. Hence, Dr. Tua7o toldPeter to continue usin- Dia)oA and Nor)o-laucon. ;ut upon Peter>sco)plaint of 6sto)ach pains and tin-lin- sensation in his fin-ers,62Dr. Tua7o discontinued Peter>s use of Dia)oA.$

Peter "ent to see another ophthal)olo-ist, Dr. Ra)on T. ;atun-bacal9Dr. ;atun-bacal:, on # Dece)ber #) in a fiA "hether to resu)ethe steroid or not considerin- that the IOP is still uncontrolled.2

On < Dece)ber #s condition. Dr. -ulto "rote Dr. Tua7o a letter containin- thefollo"in- findin-s and reco))endations=

Than&s for sendin- Peter 'ucas. On eAa)ination conducted vision"as 0F% R and 0F0'. Tension curve #< R and #% ' at ##0 H"hile on Nor)o-laucon ;ID OD Dia)oA tab ever+ 1h po.

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Torts and DamagesSlit la)p evaluation22disclosed subepithelial corneal defect outer OD.There "as circu)ferential peripheral iris atroph+, OD. The lenses"ere clear.

(unduscop+2$sho"ed vertical cup disc of 0.5% R and 0.1 ' "ithte)poral slope RJ'.

Keiss -onioscop+2%revealed basicall+ open an-les both e+es "ithoccasional PS,21OD.

Roll+, I feel that Peter 'ucas has reall+ sustained si-nificant -lauco)ada)a-e. I su--est that "e do a baseline visual fields and push)edication to lo"est possible levels. If I )a+ su--est further, I thin&"e should prescribe Ti)olol2/;ID25OD in lieu of Nor)o-laucon. If theIOP is still inade8uate, "e )a+ tr+ D>epifrin2epifrin "ere still not available in the )ar&et. -ain, Dr. Tua7oadvised Peter to co)e for re-ular chec&4up so his IOP could be)onitored.

Obedientl+, Peter "ent to see Dr. Tua7o on the /th,#2th, #1th and0th of 3anuar+ #s dia-nosis of tubular vision in Peter>s ri-ht e+e. Petitionersclai)ed that Dr. 8uino essentiall+ told Peter that the latter>s condition"ould re8uire lifeti)e )edication and follo"4ups.

In Ma+ #


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Torts and DamagesPetitioners additionall+ alle-ed that the visual i)pair)ent of Peter>sri-ht e+e caused hi) and his fa)il+ so )uch -rief. ;ecause of hispresent condition, Peter no" needed close )edical supervisionforever@ he had alread+ under-one t"o 9: laser sur-eries, "ith thepossibilit+ that )ore sur-eries "ere still needed in the future@ hiscareer in sports castin- had suffered and "as continuin- to suffer@%0his anticipated inco)e had been -reatl+ reduced as a result of his6li)ited6 capacit+@ he continuall+ suffered fro) 6headaches, nausea,diEEiness, heart palpitations, rashes, chronic rhinitis, sinusitis,6%#etc.@Peter>s relationships "ith his spouse and children continued to bestrained, as his condition )ade hi) hi-hl+ irritable and sensitive@ his)obilit+ and social life had suffered@ his spouse, (ati)a, beca)e thebread"inner in the fa)il+@%and his t"o children had been deprived ofthe opportunit+ for a better life and educational prospects. !ollectivel+,petitioners lived in constant fear of Peter beco)inco)pletel+ blind.%2

In the end, petitioners sou-ht pecuniar+ a"ard for their supposed painand sufferin-, "hich "ere ulti)atel+ brou-ht about b+ Dr. Tua7o>s-rossl+ ne-li-ent conduct in prescribin- to Peter the )edicine MaAitrolfor a period of three 92: )onths, "ithout )onitorin- Peter>s IOP, asre8uired in cases of prolon-ed use of said )edicine, andnot"ithstandin- Peter>s constant co)plaint of intense e+e pain "hileusin- the sa)e. Petitioners particularl+ pra+ed that Dr. Tua7o beadBud-ed liable for the follo"in- a)ounts=

#. The a)ount of P,000,000.00 to plaintiff Peter 'ucas as andb+ "a+ of co)pensation for his i)paired vision.

. The a)ount of P200,000.00 to spouses 'ucas as and b+"a+ of actual da)a-es plus such additional a)ounts that )a+be proven durin- trial.

2. The a)ount of P#,000,000.00 as and b+ "a+ of )oralda)a-es.

$. The a)ount of P%00,000.00 as and b+ "a+ of eAe)plar+da)a-es.

%. The a)ount of P00,000.00 as and b+ "a+ of attorne+>s

fees plus costs of suit.%$

In rebuttin- petitioners> co)plaint, Dr. Tua7o asserted that the6treat)ent )ade b+ hi) )ore than three +ears a-o has no causalconnection to Peter>s present -lauco)a or condition.6%%Dr. Tua7oeAplained that 6dru-4induced -lauco)a is te)porar+ and curable,steroids have the side effect of increasin- intraocular pressure.Steroids are prescribed to treat pide)ic Cerato !onBunctivitis or C!"hich is an infiltration of the cornea as a result of conBunctivitis or soree+es.6%1Dr. Tua7o also clarified that 9#: 6contrar+ to petitioners>fallacious clai), he did NOT continuall+ prescribe the dru- MaAitrol"hich contained steroids for an+ prolon-ed period6%/and 6the truth"as the MaAitrol "as discontinued A A A as soon as C! disappearedand "as resu)ed onl+ "hen C! reappeared6%5@ 9: the entire ti)ehe "as treatin- Peter, he 6continuall+ )onitored the intraocularpressure of Peter>s e+es b+ palpatin- the e+es and b+ puttin-pressure on the e+eballs,6 and no hardenin- of the sa)e could bedetected, "hich )eant that there "as no increase in the tension orIOP, a possible side reaction to the use of steroid )edications@ and 92:it "as onl+ on #2 Dece)ber #s -lauco)a can onl+ be lon-standin- -lauco)a, open an-le -lauco)a, because of the lar-e !=Dratio. The steroids provo&ed the latest -lauco)a to be revealed earlieras Peter re)ained as+)pto)atic prior to steroid application. Hence,the steroid treat)ent "as in fact beneficial to Peter as it revealed theincipient open an-le -lauco)a of Peter to allo" earlier treat)ent of

the sa)e.10

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Torts and DamagesIn a Decision dated #$ 3ul+ 000, the RT! dis)issed !ivil !ase No.scondition. In particular, the record of the case "as bereft of an+evidence to establish that the steroid )edication and its dosa-e, asprescribed b+ Dr. Tua7o, caused Peter>s -lauco)a. The trial courtreasoned that the 6reco-niEed standards of the )edical co))unit+has not been established in this case, )uch less has causation beenestablished to render Tua7o liable.612ccordin- to the RT!=

Petitioners failed to establish the dut+ re8uired of a )edicalpractitioner a-ainst "hich Peter Paul>s treat)ent b+ defendant can beco)pared "ith. The+ did not present an+ )edical eApert or even a)edical doctor to convince and eApertl+ eAplain to the court theestablished nor) or dut+ re8uired of a ph+sician treatin- a patient, or"hether the non ta&in- 9sic: b+ Dr. Tua7o of Peter Paul>s pressure adeviation fro) the nor) or his non4discover+ of the -lauco)a in thecourse of treat)ent constitutes ne-li-ence. It is i)portant andindispensable to establish such a standard because once it isestablished, a )edical practitioner "ho departed thereof breaches his

dut+ and co))its ne-li-ence renderin- hi) liable. ithout suchtesti)on+ or enli-hten)ent fro) an eApert, the court is at a loss as to"hat is then the established nor) of dut+ of a ph+sician a-ainst "hichdefendant>s conduct can be co)pared "ith to deter)ine ne-li-ence.1$

The RT! added that in the absence of 6an+ )edical evidence to thecontrar+, this court cannot accept petitioners> clai) that the use ofsteroid is the proAi)ate cause of the da)a-e sustained b+ Peter>se+e.61%

!orrespondin-l+, the RT! accepted Dr. Tua7o>s )edical opinion that

6Peter Paul )ust have been sufferin- fro) nor)al tension -lauco)a,

)eanin-, optic nerve da)a-e "as happenin- but no elevation of thee+e pressure is )anifested, that the steroid treat)ent actuall+un)as&ed the condition that resulted in the earlier treat)ent of the-lauco)a. There is nothin- in the record to contradict such testi)on+.In fact, plaintiff>s Ahibit S> even tends to support the).6

?ndaunted, petitioners appealed the fore-oin- RT! decision to the!ourt of ppeals. Their appeal "as doc&eted as !4*.R. !V No.15111.

On / Septe)ber 001, the !ourt of ppeals rendered a decision in!4*.R. !V No. 15111 den+in- petitioners> recourse and affir)in- theappealed RT! Decision. The fallo of the Bud-)ent of the appellatecourt states=

HR(OR, the Decision appealed fro) is ((IRMD.11

The !ourt of ppeals faulted petitioners because the+ L

Did not present an+ )edical eApert to testif+ that Dr. Tuano>sprescription of MaAitrol and ;lepha)ide for the treat)ent of C! onPeter>s ri-ht e+e "as not proper and that his palpation of Peter>s ri-hte+e "as not enou-h to detect adverse reaction to steroid. Petertestified that Dr. Manuel -ulto told hi) that he should not have usedsteroid for the treat)ent of C! or that he should have used it onl+ fort"o 9: "ee&s, as C! is onl+ a viral infection "hich "ill cure b+ itself.Ho"ever, Dr. -ulto "as not presented b+ petitioners as a "itness toconfir) "hat he alle-edl+ told Peter and, therefore, the latter>s

testi)on+ is hearsa+. ?nder Rule #20, Section 21 of the Rules of!ourt, a "itness can testif+ onl+ to those facts "hich he &no"s of hiso"n personal &no"led-e, A A A. (a)iliar and funda)ental is the rulethat hearsa+ testi)on+ is inad)issible as evidence.1/

'i&e the RT!, the !ourt of ppeals -ave -reat "ei-ht to Dr. Tua7o>s)edical Bud-)ent, specificall+ the latter>s eAplanation that=

hen a doctor sees a patient, he cannot deter)ine "hether or notthe latter "ould react adversel+ to the use of steroids, that it "as onl+on Dece)ber #2, #


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Torts and Damagesheadache and blurred vision that he observed that the pressure of thee+e of Peter "as elevated, and it "as onl+ then that he suspected thatPeter belon-s to the %Q of the population "ho reacts adversel+ tosteroids.15

Petitioners> Motion for Reconsideration "as denied b+ the !ourt ofppeals in a Resolution dated 2 3ul+ 00/.

Hence, this Petition for Revie" on !ertiorari under Rule $% of theRevised Rules of !ourt pre)ised on the follo"in- assi-n)ent oferrors=

I.

TH !O?RT O( PP'S !OMMITTD *RV RVRSI;'RROR IN ((IRMIN* TH D!ISION O( TH TRI' !O?RTDISMISSIN* TH PTITIONRS> !OMP'INT (OR DM*S

*INST TH RSPONDNT ON TH *RO?ND O(INS?((I!IN! O( VIDN!@

II.

TH !O?RT O( PP'S !OMMITTD *RV RVRSI;'RROR IN DISMISSIN* TH PTITIONRS> !OMP'INT (ORDM*S *INST TH RSPONDNT ON TH *RO?ND THTNO MDI!' PRT S PRSNTD ; TH PTITIONRSTO PROV THIR !'IM (OR MDI!' N*'I*N! *INSTTH RSPONDNT@ ND

III.

TH !O?RT O( PP'S !OMMITTD *RV RVRSI;'RROR IN NOT (INDIN* TH RSPONDNT 'I;' TO THPTITIONRS> (OR !T?', MOR' ND MP'RDM*S, SID (ROM TTORN>S (S, !OSTS O( S?IT, S RS?'T O( HIS *ROSS N*'I*N!.1


8/12

Torts and Damagesaffectin- Peter>s e+e@ and 9: "hether or not ne-li-ence attended Dr.Tua7o>s treat)ent of Peter, because, in their "ords L

That Dr. Tua7o "as -rossl+ ne-li-ent in the treat)ent of Peter>ssi)ple e+e ail)ent is a si)ple case of cause and effect. ith )eredocu)entar+ evidence and based on the facts presented b+ thepetitioners, respondent can readil+ be held liable for da)a-es even"ithout an+ eApert test i)on+. In an+ case, ho"ever, and contrar+ tothe findin- of the trial court and the !ourt of ppeals, there "as a)edical eApert presented b+ the petitioner sho"in- the rec&lessnessco))itted b+ Dr. Tua7o L Dr. Tua7o hi)self. )phasis supplied.

The+ insist that Dr. Tua7o hi)self -ave sufficient evidence to establishhis -ross ne-li-ence that ulti)atel+ caused the i)pair)ent of thevision of Peter>s ri-ht e+e,/2i.e., that 6despite Dr. Tua7o>s&no"led-e that %Q of the population reacts adversel+ to MaAitrol, hehad no 8ual)s "hatsoever in prescribin- said steroid to Peter "ithout

first deter)inin- "hether or not the 9sic: Peter belon-s to the %Q.6

/$

e are not convinced. The Bud-)ents of both the !ourt of ppealsand the RT! are in accord "ith the evidence on record, and "e areaccordin-l+ bound b+ the findin-s of fact )ade therein.

Petitioners> position, in su), is that Peter>s -lauco)a is the directresult of Dr. Tua7o>s ne-li-ence in his i)proper ad)inistration of thedru- MaAitrol@ 6thus, the latter should be liable for all the da)a-essuffered and to be suffered b+ petitioners.6/%!learl+, the presentcontrovers+ is a classic illustration of a )edical ne-li-ence case

a-ainst a ph+sician based on the latter>s professional ne-li-ence. Inthis t+pe of suit, the patient or his heirs, in order to prevail, is re8uiredto prove b+ preponderance of evidence that the ph+sician failed toeAercise that de-ree of s&ill, care, and learnin- possessed b+ otherpersons in the sa)e profession@ and that as a proAi)ate result ofsuch failure, the patient or his heirs suffered da)a-es.

(or lac& of a specific la" -eared to"ards the t+pe of ne-li-enceco))itted b+ )e)bers of the )edical profession, such clai) forda)a-es is al)ost al"a+s anchored on the alle-ed violation of rticle#/1 of the !ivil !ode, "hich states that=

RT. #/1. hoever b+ act or o)ission causes da)a-e to another,there bein- fault or ne-li-ence, is obli-ed to pa+ for the da)a-e done.Such fault or ne-li-ence, if there is no pre4eAistin- contractual relationbet"een the parties, is called a 8uasi4delict and is -overned b+ theprovisions of this !hapter.

In )edical ne-li-ence cases, also called )edical )alpractice suits,there eAist a ph+sician4patient relationship bet"een the doctor and thevicti). ;ut Bust li&e an+ other proceedin- for da)a-es, four essential9$: ele)ents i.e., 9#: dut+@ 9: breach@ 92: inBur+@ and 9$: proAi)atecausation,/1)ust be established b+ the plaintiffFs. ll the four 9$:ele)ents )ust co4eAist in order to find the ph+sician ne-li-ent and,thus, liable for da)a-es.

hen a patient en-a-es the services of a ph+sician, a ph+sician4patient relationship is -enerated. nd in acceptin- a case, theph+sician, for all intents and purposes, represents that he has the

needed trainin- and s&ill possessed b+ ph+sicians and sur-eonspracticin- in the sa)e field@ and that he "ill e)plo+ such trainin-,care, and s&ill in the treat)ent of the patient.//Thus, in treatin- hispatient, a ph+sician is under a dut+ to the for)er to eAercise thatde-ree of care, s&ill and dili-ence "hich ph+sicians in the sa)e-eneral nei-hborhood and in the sa)e -eneral line of practiceordinaril+ possess and eAercise in li&e cases./5Stated other"ise, theph+sician has the dut+ to use at least the sa)e level of care that an+other reasonabl+ co)petent ph+sician "ould use to treat the conditionunder si)ilar circu)stances.

This standard level of care, s&ill and dili-ence is a )atter bestaddressed b+ eApert )edical testi)on+, because the standard of carein a )edical )alpractice case is a )atter peculiarl+ "ithin the&no"led-e of eAperts in the field./


9/12

Torts and Damages"hich ph+sicians in the sa)e -eneral nei-hborhood and in the sa)e-eneral line of practice ordinaril+ possess and eAercise in li&e cases.

ven so, proof of breach of dut+ on the part of the attendin- ph+sicianis insufficient, for there )ust be a causal connection bet"een saidbreach and the resultin- inBur+ sustained b+ the patient. Put in another"a+, in order that there )a+ be a recover+ for an inBur+, it )ust besho"n that the 6inBur+ for "hich recover+ is sou-ht )ust be thele-iti)ate conse8uence of the "ron- done@ the connection bet"eenthe ne-li-ence and the inBur+ )ust be a direct and natural se8uenceof events, unbro&en b+ intervenin- efficient causes6@5#that is, thene-li-ence )ust be the proAi)ate cause of the inBur+. nd theproAi)ate cause of an inBur+ is that cause, "hich, in the natural andcontinuous se8uence, unbro&en b+ an+ efficient intervenin- cause,produces the inBur+, and "ithout "hich the result "ould not haveoccurred.5

3ust as "ith the ele)ents of dut+ and breach of the sa)e, in order toestablish the proAi)ate cause of the inBur+ b+ a preponderance ofthe evidence in a )edical )alpractice action, the patient )ustsi)ilarl+ use eApert testi)on+, because the 8uestion of "hether thealle-ed professional ne-li-ence caused the patient>s inBur+ is-enerall+ one for specialiEed eApert &no"led-e be+ond the &en of theavera-e la+person@ usin- the specialiEed &no"led-e and trainin- ofhis field, the eApert>s role is to present to the court a realisticassess)ent of the li&elihood that the ph+sician>s alle-ed ne-li-encecaused the patient>s inBur+.52

(ro) the fore-oin-, it is apparent that )edical ne-li-ence cases arebest proved b+ opinions of eApert "itnesses belon-inin the sa)e-eneral nei-hborhood and in the sa)e -eneral line of practice asdefendant ph+sician or sur-eon. The deference of courts to the eApertopinion of 8ualified ph+sicians or sur-eons ste)s fro) the for)er>srealiEation that the latter possess unusual technical s&ills "hichla+)en in )ost instances are incapable of intelli-entl+ evaluatin-@5$hence, the indispensabilit+ of eApert testi)onies.

In the case at bar, there is no 8uestion that a ph+sician4patientrelationship developed bet"een Dr. Tua7o and Peter "hen Peter "ent

to see the doctor on Septe)ber #s -lauco)a.

Ho"ever, as correctl+ pointed out b+ the !ourt of ppeals, 6the onusprobandi "as on the patient to establish before the trial court that theph+sicians i-nored standard )edical procedure, prescribed andad)inistered )edication "ith rec&lessness and eAhibited an absenceof the co)petence and s&ills eApected of -eneral practitionerssi)ilarl+ situated.651?nfortunatel+, in this case, there "as absolutefailure on the part of petitioners to present an+ eApert testi)on+ toestablish= 9#: the standard of care to be i)ple)ented b+ co)petentph+sicians in treatin- the sa)e condition as Peter>s under si)ilarcircu)stances@ 9: that, in his treat)ent of Peter, Dr. Tua7o failed inhis dut+ to eAercise said standard of care that an+ other co)petentph+sician "ould use in treatin- the sa)e condition as Peter>s undersi)ilar circu)stances@ and 92: that the inBur+ or da)a-e to Peter>sri-ht e+e, i.e., his -lauco)a, "as the result of his use of MaAitrol, asprescribed b+ Dr. Tua7o. Petitioners> failure to prove the first ele)entalone is alread+ fatal to their cause.

Petitioners )aintain that Dr. Tua7o failed to follo" in Peter >s case there8uired procedure for the prolon-ed use of MaAitrol. ;ut "hat isactuall+ the re8uired procedure in situations such as in the case atbar To be precise, "hat is the standard operatin- procedure "henophthal)olo-ists prescribe steroid )edications "hich, ad)ittedl+,carr+ so)e )odicu) of ris&

bsent a definitive standard of care or dili-ence re8uired of Dr. Tua7ounder the circu)stances, "e have no )eans to deter)ine "hether he"as able to co)pl+ "ith the sa)e in his dia-nosis and treat)ent ofPeter. This !ourt has no +ardstic& upon "hich to evaluate or "ei-hthe attendant facts of this case to be able to state "ith confidence thatthe acts co)plained of, indeed, constituted ne-li-ence and, thus,should be the subBect of pecuniar+ reparation.

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10/12

Torts and DamagesPetitioners assert that prior to prescribin- MaAitrol, Dr. Tua7o shouldhave deter)ined first "hether Peter "as a 6steroid responder.65/eta-ain, petitioners did not present an+ convincin- proof that suchdeter)ination is actuall+ part of the standard operatin- procedure"hich ophthal)olo-ists should unerrin-l+ follo" prior to prescribin-steroid )edications.

In contrast, Dr. Tua7o "as able to clearl+ eAplain that "hat is onl+re8uired of ophthal)olo-ists, in cases such as Peter>s, is the conductof standard testsFprocedures &no"n as 6ocular routine eAa)ination,655

co)posed of five 9%: testsFprocedures L specificall+, -rosseAa)ination of the e+es and the surroundin- area@ ta&in- of the visualacuit+ of the patient@ chec&in- the intraocular pressure of the patient@chec&in- the )otilit+ of the e+es@ and usin- ophthal)oscop+ on thepatient>s e+e L and he did all those testsFprocedures ever+ ti)e Peter"ent to see hi) for follo"4up consultation andFor chec&4up.

e cannot but a-ree "ith Dr. Tua7o>s assertion that "hen a doctorsees a patient, he cannot deter)ine i))ediatel+ "hether the latter"ould react adversel+ to the use of steroids@ all the doctor can do is)ap out a course of treat)ent reco-niEed as correct b+ the standardsof the )edical profession. It )ust be re)e)bered that a ph+sician isnot an insurer of the -ood result of treat)ent. The )ere fact that thepatient does not -et "ell or that a bad result occurs does not in itselfindicate failure to eAercise due care.5s

re-ular conduct of eAa)inations and tests to ascertain the state of

Peter>s e+es ne-ate the ver+ basis of petitioners> co)plaint forda)a-es. s to "hether Dr. Tua7o>s actuations confor)ed to thestandard of care and dili-ence re8uired in li&e circu)stances, it ispresu)ed to have so confor)ed in the absence of evidence to thecontrar+.

ven if "e are to assu)e that Dr. Tua7o co))itted ne-li-ent acts inhis treat)ent of Peter>s condition, the causal connection bet"een Dr.Tua7o>s supposed ne-li-ence and Peter>s inBur+ still needed to beestablished. The critical and clinchin- factor in a )edical ne-li-encecase is proof of the causal connection bet"een the ne-li-ence "hichthe evidence established and the plaintiff>s inBuries.s fault caused the inBur+. verdict in a )alpractice action cannot be based on speculation orconBecture. !ausation )ust be proven "ithin a reasonable )edicalprobabilit+ based upon co)petent eApert testi)on+.ssupposed ne-li-ent conduct. Once )ore, petitioners failed in thisre-ard.

Dr. Tua7o does not den+ that the use of MaAitrol involves the ris& ofincreasin- a patient>s IOP. In fact, this "as the reason "h+ he )ade ita point to palpate Peter>s e+es ever+ ti)e the latter "ent to see hi) 44so he could )onitor the tension of Peter>s e+es. ;ut to sa+ that said

)edication conclusivel+ caused Peter>s -lauco)a is purel+speculative. Peter "as dia-nosed "ith open4an-le -lauco)a. This&ind of -lauco)a is characteriEed b+ an al)ost co)plete absence ofs+)pto)s and a chronic, insidious course.


11/12

Torts and Damagesho bet"een petitioners and Dr. Tua7o is in a better position todeter)ine and evaluate the necessit+ of usin- MaAitrol to cure Peter>sC! vis4G4vis the attendant ris&s of usin- the sa)e

That Dr. Tua7o has the necessar+ trainin- and s&ill to practice hischosen field is be+ond cavil. Petitioners do not dispute Dr. Tua7o>s8ualifications L that he has been a ph+sician for close to a decadeand a half at the ti)e Peter first ca)e to see hi)@ that he has hadvarious )edical trainin-@ that he has authored nu)erous papers in thefield of ophthal)olo-+, here and abroad@ that he is a Diplo)ate of thePhilippine ;oard of Ophthal)olo-+@ that he occupies various teachin-posts 9at the ti)e of the filin- of the present co)plaint, he "as the!hair of the Depart)ent of Ophthal)olo-+ and an ssociateProfessor at the ?niversit+ of the Philippines4Philippine *eneralHospital and St. 'u&e>s Medical !enter, respectivel+:@ and that he heldan assort)ent of positions in nu)erous )edical or-aniEations li&e thePhilippine Medical ssociation, Philippine cade)+ of Ophthal)olo-+,Philippine ;oard of Ophthal)olo-+, Philippine Societ+ of Ophthal)icPlastic and Reconstructive Sur-er+, Philippine 3ournal ofOphthal)olo-+, ssociation of Philippine Ophthal)olo-+ Professors,et al.

It )ust be re)e)bered that "hen the 8ualifications of a ph+sician aread)itted, as in the instant case, there is an inevitable presu)ptionthat in proper cases, he ta&es the necessar+ precaution and e)plo+sthe best of his &no"led-e and s&ill in attendin- to his clients, unlessthe contrar+ is sufficientl+ established.s C! "ith MaAitrol, Dr. Tua7o too& the necessar+precaution b+ palpatin- Peter>s e+es to )onitor their IOP ever+ ti)ethe latter "ent for a chec&4up, and he e)plo+ed the best of his&no"led-e and s&ill earned fro) +ears of trainin- and practice.

In contrast, "ithout supportin- eApert )edical opinions, petitioners>bare assertions of ne-li-ence on Dr. Tua7o>s part, "hich resulted inPeter>s -lauco)a, deserve scant credit.

Our disposition of the present controvers+ )i-ht have been vastl+different had petitioners presented a )edical eApert to establish theirtheor+ respectin- Dr. Tua7o>s so4called ne-li-ence. In fact, the record

of the case reveals that petitioners> counsel reco-niEed the necessit+

of presentin- such evidence. Petitioners even -ave an underta&in- tothe RT! Bud-e that Dr. -ulto or Dr. 8uino "ould be presented. las,no follo"4throu-h on said underta&in- "as )ade.1avvphi1

The plaintiff in a civil case has the burden of proof as he alle-es theaffir)ative of the issue. Ho"ever, in the course of trial in a civil case,once plaintiff )a&es out a pri)a facie case in his favor, the dut+ or theburden of evidence shifts to defendant to controvert plaintiff>s pri)afacie case@ other"ise, a verdict )ust be returned in favor of plaintiff.


12/12

Torts and DamagesIt see)s basic that "hat constitutes proper )edical treat)ent is a)edical 8uestion that should have been presented to eAperts. If nostandard is established throu-h eApert )edical "itnesses, then courtshave no standard b+ "hich to -au-e the basic issue of breach thereofb+ the ph+sician or sur-eon. The RT! and !ourt of ppeals, and eventhis !ourt, could not be eApected to deter)ine on its o"n "hat)edical techni8ue should have been utiliEed for a certain disease or

inBur+. bsent eApert )edical opinion, the courts "ould bedan-erousl+ en-a-inin speculations.

ll told, "e are hard pressed to find Dr. Tua7o liable for an+ )edicalne-li-ence or )alpractice "here there is no evidence, in the nature ofeApert testi)on+, to establish that in treatin- Peter, Dr. Tua7o failed toeAercise reasonable care, dili-ence and s&ill -enerall+ re8uired in)edical practice. Dr. Tua7o>s testi)on+, that his treat)ent of Peterconfor)ed in all respects to standard )edical practice in this localit+,stands unrefuted. !onse8uentl+, the RT! and the !ourt of ppealscorrectl+ held that the+ had no basis at all to rule that petitioners "eredeservin- of the various da)a-es pra+ed for in their !o)plaint.

%EREORE, pre)ises considered, the instant petition is DNIDfor lac& of )erit. The assailed Decision dated / Septe)ber 001 andResolution dated 2 3ul+ 00/, both of the !ourt of ppeals in !4*.R.!V No. 15111, are hereb+ ((IRMD. No cost.

SO ORDRD.

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Lucas v. Tuaño

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Transcript of Lucas v. Tuaño