Batiquin vs. Court of Appeals

A physician who has exclusive control over a surgical procedure is presumed negligent when a foreign object is left inside the patient's body, pursuant to the doctrine of res ipsa loquitur, where the accident is of a kind that does not ordinarily occur in the absence of negligence and the instrumentality causing injury was under the defendant's exclusive management and control.

Dr. Victoria Batiquin was a Resident Physician at the Negros Oriental Provincial Hospital in Dumaguete City from January 9, 1978 to September 1989, and served as Acting Head of the Department of Obstetrics and Gynecology at the same hospital between 1987 and September 1989. Flotilde Villegas was a married woman who submitted to Dr. Batiquin for prenatal care as the latter's private patient sometime before September 21, 1988. The dispute arose from a caesarean section performed by Dr. Batiquin on Villegas, after which a foreign body was discovered inside Villegas's abdomen during a subsequent operation by another physician, giving rise to a claim for damages grounded on medical negligence.

Dr. Victoria Batiquin was a Resident Physician at the Negros Oriental Provincial Hospital in Dumaguete City from January 9, 1978 to September 1989, and between 1987 and September 1989 she also served as Acting Head of the Department of Obstetrics and Gynecology at the same hospital. Flotilde Villegas, a married woman, became Dr. Batiquin's private patient for prenatal care sometime before September 21, 1988.

On the morning of September 21, 1988, Dr. Batiquin, assisted by Dr. Doris Teresita Sy, C.I. and O.R. Nurse Arlene Diones, and some student nurses, performed a simple caesarean section on Villegas at the Negros Oriental Provincial Hospital. After 45 minutes, Villegas delivered her first child, Rachel Acogido, at about 11:45 that morning. Villegas remained confined at the hospital until September 27, 1988, during which period she was regularly visited by Dr. Batiquin. On September 28, 1988, Villegas checked out of the hospital and paid Dr. Batiquin, through the latter's secretary, ₱1,500.00 as a professional fee.

Soon after leaving the hospital, Villegas began to suffer abdominal pains and complained of being feverish. She also gradually lost her appetite, prompting her to consult Dr. Batiquin at the latter's polyclinic, who prescribed certain medicines that Villegas continued taking through December 1988. On October 31, 1988, Dr. Batiquin issued a medical certificate certifying Villegas's physical fitness to return to work on November 7, 1988, and Villegas resumed work at the Rural Bank of Ayungon, Negros Oriental in the second week of November. The abdominal pains and fever kept recurring despite the medications.

When the pains became unbearable and Villegas was rapidly losing weight, she consulted Dr. Ma. Salud Kho at the Holy Child's Hospital in Dumaguete City on January 20, 1989. Dr. Kho found Villegas feverish, pale, and breathing fast, and upon examination felt an abdominal mass one finger below the umbilicus, suspected to be either a tumor of the uterus or an ovarian cyst, either of which could be cancerous. Blood tests revealed infection inside the abdominal cavity, and the results of all examinations impelled Dr. Kho to recommend surgery, to which Villegas agreed.

Upon opening Villegas's abdomen, Dr. Kho found whitish-yellow discharge inside, ovarian cysts on both the left and right ovaries discharging pus, dirt and pus behind the uterus, and a piece of rubber material on the right side of the uterus embedded in the ovarian cyst, approximately 2 inches by 3/4 inch in size. Dr. Kho described this piece as a "foreign body" that looked like a piece of a "rubber glove" and was also "rubber-drain like." This foreign body was the cause of the infection of the ovaries and consequently of all the discomfort Villegas suffered after her delivery on September 21, 1988.

The piece of rubber was not presented in court. Although Dr. Kho testified that she sent it to a pathologist in Cebu City for examination, it was not mentioned in the pathologist's Surgical Pathology Report. According to Dr. Batiquin's testimony, when she confronted Dr. Kho about the rubber, Dr. Kho answered that there was rubber indeed but that she threw it away — a statement Dr. Kho never denied or disputed. The trial court regarded the documentary evidence mentioning the rubber as hearsay and refused to give weight to Dr. Kho's testimony, finding two unreconciled versions of the rubber's whereabouts. The Court of Appeals, however, reviewed the entirety of Dr. Kho's testimony and concluded that a piece of rubber was definitely found near Villegas's uterus, reversing the trial court's dismissal and holding Dr. Batiquin negligent.

• Grave Abuse of Discretion: Petitioners argued that the Court of Appeals committed grave abuse of discretion by resorting to findings of fact not supported by the evidence on record.
• Credibility of Testimony: Petitioners maintained that the Court of Appeals exceeded its discretion, amounting to lack or excess of jurisdiction, when it gave credence to testimonies punctured with contradictions and falsities, particularly Dr. Kho's testimony.
• Hearsay Evidence: Petitioners contended that Dr. Kho's knowledge of the piece of rubber was based on hearsay, as shown by her statement that she "heard somebody that says there is a foreign body that goes with the tissues but unluckily I don't know where the rubber was," and that the trial court correctly so interpreted it.
• Unreconciled Contradictions: Petitioners emphasized that the private respondents never reconciled Dr. Kho's testimony that she sent the rubber to a pathologist in Cebu with Dr. Batiquin's claim that Dr. Kho told her she threw it away, and that this failure weakened the respondents' claim.

• Improper Petition: Private respondents commented that the petition raised only questions of fact, which were not proper for review by the Supreme Court in a petition for review on certiorari.

• Appreciation of Evidence: Whether the Court of Appeals erred in crediting Dr. Kho's testimony that a piece of rubber was found in Villegas's abdomen, notwithstanding the trial court's contrary finding based on an allegedly hearsay statement.
• Credibility of Witness: Whether Dr. Kho was a credible witness despite the petitioners' claims that her testimony was punctured with contradictions and falsities.
• Negligence: Whether Dr. Batiquin was negligent for leaving a piece of rubber inside Villegas's abdomen, warranting the application of the doctrine of res ipsa loquitur.

• Appreciation of Evidence: No. The Court of Appeals correctly appreciated Dr. Kho's testimony, the phrase relied upon by the trial court having been taken out of context and not negating the fact that Dr. Kho personally saw the piece of rubber during surgery.
• Credibility of Witness: Yes. Dr. Kho was a credible witness, her positive testimony prevailing over the negative testimonies of Drs. Batiquin and Sy, no motive to state an untruth having been imputed against her.
• Negligence: Yes. All requisites of res ipsa loquitur were present — the caesarean section was under Dr. Batiquin's exclusive control, and a foreign object does not ordinarily appear inside a patient's body absent negligence — establishing Dr. Batiquin's negligence.

• Appreciation of Evidence: The trial court interpreted Dr. Kho's statement — "I have heard somebody that says there is a foreign body that goes with the tissues but unluckily I don't know where the rubber was" — as indicating her knowledge of the rubber was based on hearsay. The Court of Appeals correctly concluded this was taken out of context. Other portions of Dr. Kho's testimony clearly established that she personally found the rubber during surgery: she testified that upon opening Villegas's abdomen, "there was a [piece of] rubber, we found a [piece of] rubber on the right side." Dr. Kho also affirmed on cross-examination: "Oh yes. I was not the only one who saw it." The Pathologist's Report, although devoid of any mention of the rubber, could not alter what Dr. Kho saw. Her knowledge could not have been based on anything other than first-hand experience.

• Credibility of Witness: Dr. Kho was frank throughout her testimony, and no motive to state any untruth was ever imputed against her, leaving her trustworthiness unimpaired. The trial court itself was not prepared to doubt her credibility, noting only that she failed to take the most appropriate precaution to preserve the rubber as evidence. Her positive testimony prevailed over the negative testimonies of Drs. Batiquin and Sy, who claimed no rubber drain was used and no tear appeared on Dr. Batiquin's gloves after the operation. Positive testimony is stronger than negative testimony. Even assuming Dr. Batiquin's hearsay claim that Dr. Kho threw the rubber away were admissible, it carried no probative value and could not belie the fact that Dr. Kho found the rubber. It is perfectly reasonable to believe a witness's testimony on some facts and disbelieve it on others; even when a witness has deliberately falsified in some material particulars, portions deemed worthy of belief may still be credited.

• Negligence: All requisites for recourse to the doctrine of res ipsa loquitur were present. First, the entire proceedings of the caesarean section were under the exclusive control of Dr. Batiquin, leaving private respondents bereft of direct evidence as to the actual culprit or the exact cause of the foreign object's presence, which does not occur unless through the intercession of negligence. Second, aside from the caesarean section, Villegas underwent no other operation that could have caused the piece of rubber to appear in her uterus, so it could only have been a by-product of the caesarean section performed by Dr. Batiquin. The petitioners failed to overcome the presumption of negligence arising from the doctrine. Dr. Batiquin admitted she alone decided when to close the operating area and that she examined the portion she operated on before closing; had she exercised due diligence, she would have found and removed the rubber.

• Res Ipsa Loquitur — A rule of evidence peculiar to the law of negligence that recognizes prima facie negligence may be established without direct proof, furnishing a substitute for specific proof of negligence. It is not a rule of substantive law but merely a mode of proof or procedural convenience. The requisites are: (1) the instrumentality or agency causing injury was under the exclusive control and management of the defendant, and (2) the accident is of a kind that ordinarily does not happen in the absence of negligence. The doctrine does not dispense with the requirement of proof of culpable negligence but merely determines what constitutes prima facie evidence thereof and facilitates the plaintiff's burden of proving a breach of the duty of due care. In this case, the doctrine applied because the caesarean section was under Dr. Batiquin's exclusive control and a foreign object does not ordinarily appear inside a patient's body absent negligence, and Villegas underwent no other surgery that could have introduced the rubber.

• Positive Testimony vs. Negative Testimony — Positive testimony is stronger than negative testimony. A witness who testifies affirmatively that a fact occurred prevails over a witness who merely denies it. In this case, Dr. Kho's positive testimony that she found a piece of rubber in Villegas's abdomen prevailed over the negative testimonies of Drs. Batiquin and Sy that no rubber drain was used and no tear appeared on Dr. Batiquin's gloves.

• Partial Credibility of Witness — It is perfectly reasonable to believe a witness's testimony with respect to some facts and disbelieve it with respect to others. Even when a witness is found to have deliberately falsified in some material particulars, it is not required that the whole of the uncorroborated testimony be rejected; such portions deemed worthy of belief may be credited. In this case, even if doubt existed as to what Dr. Kho did with the rubber — whether she threw it away or sent it to Cebu — that did not justify distrusting her testimony that she recovered a piece of rubber from Villegas's abdomen.

• "The doctrine of res ipsa loquitur as a rule of evidence is peculiar to the law of negligence which recognizes that prima facie negligence may be established without direct proof and furnishes a substitute for specific proof of negligence." — This passage defines the essential nature and function of res ipsa loquitur, clarifying that it is a mode of proof rather than a rule of substantive law, and is the canonical formulation relied upon in this decision.

• "Well-settled is the rule that positive testimony is stronger than negative testimony." — This states the evidentiary principle that was decisive in resolving the conflict between Dr. Kho's affirmative account and the petitioners' denials, and is frequently cited in subsequent jurisprudence on witness credibility.

• "In the instant case, all the requisites for recourse to the doctrine are present. First, the entire proceedings of the caesarean section were under the exclusive control of Dr. Batiquin. . . . Second, since aside from the caesarean section, private respondent Villegas underwent no other operation which could have caused the offending piece of rubber to appear in her uterus, it stands to reason that such could only have been a by-product of the caesarean section performed by Dr. Batiquin." — This passage applies the two requisites of res ipsa loquitur to the facts, demonstrating how exclusive control and the unusual nature of the accident give rise to a presumption of negligence.

• Layugan vs. Intermediate Appellate Court, 167 SCRA 363 (1988) — Controlling precedent on the doctrine of res ipsa loquitur; the Court quoted extensively from this case to define the doctrine's nature, requisites, and operation as a rule of evidence.
• Africa vs. Caltex (Phil.) Inc., 16 SCRA 448 (1966) — Cited in connection with the discussion of res ipsa loquitur, as one of the early Philippine cases exploring the doctrine.
• People vs. Antonio, 233 SCRA 283 (1994) — Cited for the rule that positive testimony is stronger than negative testimony, which was decisive in resolving the evidentiary conflict.
• People vs. Ducay, 225 SCRA 1 (1993); People vs. Cañeja, 235 SCRA 328 (1994) — Cited for the rule that a witness's testimony may be believed in part and disbelieved in part, supporting the Court's acceptance of Dr. Kho's account of finding the rubber despite doubts about what she did with it.
• Remalante vs. Tibe, 158 SCRA 138 (1988) — Cited for the exceptions allowing factual questions in a petition for review on certiorari, including when the factual findings of the trial court and the appellate court conflict.

• Section 3, Article 1, 1960 Code of Ethics of the Medical Profession in the Philippines — Cited for the standard that a physician is bound to serve the interest of patients "with the greatest of solicitude, giving them always his best talent and skill." The Court invoked this ethical standard to underscore the gravity of Dr. Batiquin's departure from professional duty.
• Article 2176, Civil Code (implied) — While not cited by article number, the decision is grounded on quasi-delict/tort liability, holding Dr. Batiquin answerable for negligence causing injury to her patient.

Narvasa, C.J., Melo, Francisco, and Panganiban, JJ., concurred.