Dr. Eduardo Aquino; Dr. Alberto Reyes; Dr.

Divinia Unite, Petitioners, vs Heirs of

Raymunda Calayag, represented by Rodrigo
Calayag, respondents
(GR No. 158461; GR No. 158634; GR No. 158818)
 Facts and the Case
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Patient: Mrs. Raymunda Calayag (deceased), represented
by husband Mr. Rodrigo Calayag
Doctors: Dr. Divinia Unite (OB); Dr. Eduardo Aquino
(Anesthesiologist); Dr. Alberto Reyes (owned & operated
Sacred Heart Hospital (SHH)
 November 13, 1990, patient went into labor pains and
began bleeding – was brought to St. Michael’s Clinic
which was owned by Dr. Unite.
 Transferred to SHH for C/S after being examined by Dr.
Unite.
 Patient was admitted at 2:16pm of the same day. Dr.
Aquino, to prepare the patient for surgery, injected her
with a preliminary “hypnotic” at 2:30pm

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 2:48pm patient was administered spinal anesthesia.
 2:53pm, Dr. Unite delivered a stillborn 8-month old baby.
 3:00pm, patient became cyanotic. Blood darkened for lack of
oxygen, and all of a sudden, all vital signs were gone. Team
worked on her for about 5-7 mins until these were restored.
 After operation, Rodrigo noted that the patient’s skin
appeared dark and the white of her eyes showed. Asked Dr.
Unite about Raymunda’s appearance, was informed that it
was merely the effect of anesthesia – patient to regain
consciousness after 8hrs.

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◈ Raymunda was referred to an internist named Dr. Farinas
when her condition did not improve after a day.
◈ Dr. Farinas found that she suffered a cardiac arrest during
the operation, which explained her comatose state. Advised
the family to move the patient to s better-equipped hospital.
◈ November 16, 1990, SHH discharged her after 4 days of
admission to the Medical Center Manila (MCM) where Dr.
Rogelio Libarnes, a neurologist, examined her. He found
the patient in a “vegetative state” having suffered from an
anoxic inury due to cardio-respiratory arrest during
operation.

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◈ November 23, 1990, Dr. Unite went to MCM to remove the stitches
from Raymunda’s surgical wound. She noted that the wound had
dried with slight lochial discharge. Later that day, the wound split
open, causing the intestines to jut out. MCM’s Dr. Benito Chua re-
sutured the wound.
◈ Family was advised to take the patient home since she never
regained consciousness and that doctors could do no more to
improve her condition.
◈ November 30, 1990, MCM discharged her and she died 15 days
later on December 14, 1990.

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◈ Complaints were filed by Rodrigo, together with his 7 children,
for damages against Dr. Unite, Dr. Aquino and Dr. Reyes before
the RTC of Malolos. Rodrigo claimed that Dr. Unit and Dr.
Aquino failed to exercise diligence required for operating on
Raymunda. As for Dr. Reyes, he averred that he was negligent
in supervising the work of Dr. Unite and D. Aquino
◈ Defendant doctors denied the charge of negligence against
them
◈ August 22, 1994, RTC decided the 3 were liable for negligence.

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◈ Proximate cause of the cardiac arrest was an anesthetic
accident occasioned by the injecting her with a high spinal
anesthesia
◈ Operating doctors failed to correctly monitor the patient’s
condition, resulting in a critical delay in resuscitating her after
the cardiac arrest.
◈ RTC ordered the doctors to pay the heirs:
⬩ ₱153,270.80 – actual damages; ₱300,000 – moral damages;
₱80,000-attorney’s fees and cost of suit.

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⬩ Court of Appeals affirmed the findings of the RTC hence,
separate petitions were filed by the doctors.
⬩ Dr. Unite washed her hands of any responsibility in
Raymunda’s operation. She claimed that it was not her
suturing that caused the dehiscence. Claimed that
negligence should be traced to Dr. Aquino.
⬩ Dr. Aquino claims that the evidence was insufficient to
support the conclusion that anesthetic accident caused the
cardio-respiratory arrest since some factors may have
caused the same.

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Dr. Reyes claimed that he cannot be liable since the 2 were not
his employees. They merely used his hospital’s facilities for the
operation.

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ISSUES
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◈ Whether or not Dr. Unite and Dr. Aquino acted
negligently in handling the operation, causing
the patient’s death
◈ Whether or not Dr. Reyes is liable as hospital
owner for negligence of Dr. Unite and Dr.
Aquino.
COURT’S RULING
Medical Malpractice, Form of Negligence.

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 Plaintiff to establish 4 things:
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1. Duty-to use at least the same level of care that any
other reasonably competent physician would use to
treat the condition under similar circumstances
2. Breach-breach of duty of care, skill and diligence or
the improper performance of such duty
3. Injury-when patient is injured in body or in health
4. Proximate Causation-injury for which recovery is
sought must be consequence of the wrong done
 Rodrigo presented Dr. Libarnes and Dr. Chua as
witnesses
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◈ Dr. Libarnes explained that cyanosis or lack of oxygen in the brain
caused Raymunda’s vegetative state. Her brain began to starve for
oxygen from the moment she suffered cardio-respiratory arrest during
CS. That arrest could be traced to the anesthetic accident that resulted
when Dr. Aquino placed her under anesthesia.
◈ Doctors were not properly keeping track of her vs during the procedure
resulting in the failure to promptly address the cyanosis.
◈ Dr. Chua testified that the surgical wound would not have split open if
it had been properly closed.
 Defense presented Dr. Reyes as witness
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◈ Dr. Reyes, a general surgeon, claimed that the cardio-respiratory arrest
could have been caused by factors other than high spinal anesthesia,
like sudden increase of intra-abdominal pressure and amniotic-fluid
embolism.
◈ Dehiscence, could be due to poor nutrition as well as medications
contributed to the splitting open of the wound.
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Court cannot question
the expertise of Dr.
Reyes as a general
surgeon but they
cannot regard him as a
neutral witness.
18
In contrast, Dr. Libarnes, a
neurologist was in a better
position to explain the patient’s
condition. In his opinion, an
anesthetic accident caused the
arrest, depriving her brain of
oxygen. The damage could have
been averted had the doctors
promptly detected the situation
and resuscitated her on time
 Conclusion
19 ◈ Dr. Aquino administered to Raymunda a high spinal anesthesia when he should
have given her only low or mid-spinal anesthesia.
◈ Dr. Unite corroborated the fact that Raymunda suffered from cyanosis due to
deprivation of oxygen, which explained the appearance of the patient as seen by
the husband after the operation. Moreover, she admitted in her petition that the
proximate cause of Raymunda’s brain injury was Dr. Aquino’s act as
anesthesiologist.
◈ Dr. Unite cannot be exempt from liability since Dr. Aquino was on sick leave that
day meaning he was not feeling well. As surgeon in charge, she should not have
allowed Dr. Aquino to take part in the operation
◈ Record of operation contained no notation when patient has cardio-respiratory
arrest. This notation played a critical role since thee surgeons had between 6 to 8
minutes from the time of arrest called the golden period of reversibility. Absence
of notes is in itself a ground for malpractice.
 Conclusion
20 ◈ It took an internist for them to realize that the patient suffered cardio-respiratory
arrest.
◈ As for Dr. Reyes, there appears no concrete proof that Dr. Unite and dr. Aquino
were under the hospital’s payroll. No evidence has been presented that Raymunda
suffered her fate because of defective hospital facilities or poor staff support to
surgeons.
◈ Premises considered, the Court of Appeals affirms the decision of the RTC
subject to modification directing Dr. Unite and Dr. Aquino to pay the heirs of
Raymunda Calayag, ₱50,000, in addition to the damages that has been awarded
as death indemnity.