Atienza vs. Board of Medicine

In administrative proceedings, rules of evidence are applied liberally, and the best evidence rule does not bar the admission of secondary evidence when the subject of inquiry is a party's negligence rather than the contents of a document; moreover, the anatomical location of human organs is subject to mandatory judicial notice as a law of nature.

Editha Sioson underwent a kidney operation at Rizal Medical Center in September 1999 after diagnostic tests revealed her left kidney was non-functioning and non-visualizing while her right kidney was normal. Following the surgery, it was alleged that the attending physicians, including petitioner Rico Rommel Atienza, removed her fully functional right kidney instead of the diseased left one.

• The Medical Procedure: Editha Sioson sought treatment at Rizal Medical Center for lumbar pains. Diagnostic tests showed a normal right kidney and a non-functioning left kidney. She underwent kidney surgery in September 1999.
• The Administrative Complaint: Romeo Sioson, Editha’s husband, filed a complaint for gross negligence and/or incompetence before the Board of Medicine (BOM) against Dr. Judd dela Vega, Dr. Pedro Lantin III, Dr. Gerardo Antonio Florendo, and Dr. Rico Rommel Atienza. The complaint alleged the doctors removed Editha's fully functional right kidney instead of the left non-functioning kidney.
• Formal Offer of Evidence: Editha Sioson offered Exhibits "A" to "D," consisting of certified photocopies of X-ray request forms dated December 12, 1996, January 30, 1997, March 16, 1996, and May 20, 1999. The exhibits contained handwritten entries interpreting examination results and were originally attached to Dr. Lantin’s counter-affidavit in a related criminal complaint. The purpose of the offer was to prove that both kidneys were in their proper anatomical locations at the time of the operation.
• Objections to the Exhibits: Atienza objected to the formal offer, arguing the exhibits were inadmissible because they were mere photocopies violating the best evidence rule, were not properly identified and authenticated, constituted hearsay, and were incompetent to prove their intended purpose.
• BOM Rulings: The BOM admitted the formal offer of documentary evidence in its Order dated May 26, 2004, reasoning that it must first admit the evidence to determine its probative value upon resolution of the case. Atienza's motion for reconsideration was denied on October 8, 2004.

• Propriety of Certiorari: Petitioner asserted that a petition for certiorari under Rule 65 was the proper remedy to assail the BOM's interlocutory orders admitting the evidence.
• Admissibility of Evidence: Petitioner argued that the BOM committed grave abuse of discretion in admitting the exhibits because they are inadmissible. He maintained that the exhibits violate the best evidence rule, lack proper identification and authentication, constitute hearsay, and are incompetent to prove the anatomical locations of the kidneys.
• Prejudice to Substantive Rights: Petitioner contended that the admission of incompetent evidence prejudices his substantive rights, potentially resulting in the loss of his professional license and livelihood, contrary to Section 20, Article I of the PRC Rules of Procedure.

• No Prejudice to Substantive Rights: Respondent countered, and the Court of Appeals found, that the admission of the exhibits did not prejudice petitioner's substantive rights because the fact sought to be proved—that the kidneys were in their proper anatomical locations—is presumed under the disputable presumptions regarding the ordinary course of nature and is subject to judicial notice.
• Liberal Application of Rules: Respondent maintained that the rules of evidence are not strictly applied in administrative proceedings, justifying the BOM's liberal admission of the exhibits to determine their probative value later.

• Propriety of Certiorari: Whether a petition for certiorari under Rule 65 is the proper remedy to assail the BOM's interlocutory orders admitting documentary evidence.
• Admissibility of Documentary Exhibits: Whether the Court of Appeals erred in upholding the BOM's admission of the exhibits despite petitioner's objections based on the best evidence rule, lack of authentication, hearsay, and competency.

• Propriety of Certiorari: Certiorari was the proper remedy. The assailed BOM orders were interlocutory and could not be the subject of a separate appeal. Absent any plain, speedy, and adequate remedy in the ordinary course of law, certiorari under Rule 65 is available to challenge interlocutory orders issued with grave abuse of discretion.
• Admissibility of Documentary Exhibits: The admission of the exhibits was upheld. The rules of evidence are not strictly applied in proceedings before administrative bodies such as the BOM; thus, liberal admission is preferred over technical rejection, as the probative weight of the evidence can be discarded later if found irrelevant or incompetent. Furthermore, the admission did not prejudice petitioner's substantive rights because the fact sought to be proved by the exhibits—that the kidneys were in their proper anatomical locations—is a law of nature subject to mandatory judicial notice under Rule 129, Section 1 of the Rules of Court. The best evidence rule is inapplicable because the subject of inquiry is the doctors' negligence, not the contents of the X-ray request forms. Finally, the exhibits do not constitute inadmissible hearsay; the originals were lost when the hospital transferred buildings, making secondary evidence permissible under Rule 130, Section 5.

• Liberal Application of Rules of Evidence in Administrative Proceedings — Rules of evidence are not strictly applied in administrative bodies. Evidence of doubtful relevancy, incompetency, or admissibility should be liberally admitted rather than rejected on technical grounds, as their admission allows the tribunal to consider them if later found relevant, while their rejection places them beyond consideration entirely.
• Distinction Between Admissibility and Probative Weight — Admissibility refers to whether the evidence is to be considered at all, while probative value refers to whether the evidence proves an issue. A tribunal may admit evidence for whatever purpose it may serve and later determine its probative weight.
• Mandatory Judicial Notice of Laws of Nature — Courts must take judicial notice, without the introduction of evidence, of the laws of nature, which include the physical sciences and the structural make-up and composition of living things such as human beings. The proper anatomical locations of human organs fall under this doctrine.

• "Admissibility of evidence refers to the question of whether or not the circumstance (or evidence) is to be considered at all. On the other hand, the probative value of evidence refers to the question of whether or not it proves an issue." — Cited from PNOC Shipping and Transport Corporation v. Court of Appeals to delineate the threshold for admission versus the ultimate weight given to evidence.
• "Laws of nature involving the physical sciences, specifically biology, include the structural make-up and composition of living things such as human beings. In this case, we may take judicial notice that Editha’s kidneys before, and at the time of, her operation, as with most human beings, were in their proper anatomical locations." — Establishes the application of mandatory judicial notice to human anatomy, rendering proof of anatomical location unnecessary.

• Raymundo v. Isagon Vda. de Suarez, G.R. No. 149017, November 28, 2008 — Followed. Interlocutory orders cannot be the subject of an appeal separate from the judgment that completely disposes of the case, justifying the resort to certiorari.
• Bantolino v. Coca-Cola Bottlers Phils., Inc., 451 Phil. 839 (2003) — Followed. Rules of evidence are not strictly applied in proceedings before administrative bodies.
• PNOC Shipping and Transport Corporation v. Court of Appeals, 358 Phil. 38 (1998) — Followed. Defined the distinction between the admissibility of evidence and its probative value.
• People v. Jaca, 106 Phil. 572 (1959) — Followed. Liberal admission of evidence of doubtful relevancy is the safest policy, as rejection places it beyond the court's consideration.

• Rule 65, Rules of Court — Governs certiorari. Applied to authorize the remedy against the BOM's interlocutory orders, which could not be appealed separately.
• Section 20, Article I, Professional Regulation Commission Rules of Procedure — Provides that the Rules of Court apply suppletorily in PRC proceedings and that technical errors in the admission of evidence which do not prejudice substantive rights shall not vitiate proceedings. Interpreted to mean that the admission of the exhibits did not prejudice substantive rights because the fact proved was subject to judicial notice.
• Rule 129, Section 1, Rules of Court — Mandatory judicial notice. Applied to mandate judicial notice of the laws of nature, specifically the anatomical location of human kidneys.
• Rule 130, Section 3, Rules of Court — Best Evidence Rule. Distinguished and held inapplicable because the subject of inquiry was the doctors' negligence, not the contents of the X-ray request forms.
• Rule 130, Section 5, Rules of Court — Secondary evidence. Applied to justify the admission of the photocopies of the X-ray request forms after it was established that the originals were lost due to the hospital's transfer to a new building.
• Rule 131, Section 3(y), Rules of Court — Disputable presumptions. Cited to note that things happen according to the ordinary course of nature, further supporting the premise that the kidneys were in their proper anatomical locations.

Diosdado M. Peralta, Mariano C. del Castillo, Martin S. Villarama, Jr., Jose Catral Mendoza