SC: Clinics must pay damages for wrong test results


This is a petition for review[2] under Rule 45 of the Rules of Court assailing the February 27, 2004 Decision[3] of the Court of Appeals in CA-G.R. CV No. 58668 finding petitioner Orlando D. Garcia liable for gross negligence; and its June 16, 2005 Resolution[4] denying petitioner's motion for reconsideration.

On October 1, 1993, respondent Ranida D. Salvador started working as a trainee in the Accounting Department of Limay Bulk Handling Terminal, Inc. (the Company). As a prerequisite for regular employment, she underwent a medical examination at the Community Diagnostic Center (CDC). Garcia who is a medical technologist, conducted the HBs Ag (Hepatitis B Surface Antigen) test and on October 22, 1993, CDC issued the test result[5] indicating that Ranida was "HBs Ag: Reactive." The result bore the name and signature of Garcia as examiner and the rubber stamp signature of Castro as pathologist.

When Ranida submitted the test result to Dr. Sto. Domingo, the Company physician, the latter apprised her that the findings indicated that she is suffering from Hepatitis B, a liver disease. Thus, based on the medical report[6] submitted by Sto. Domingo, the Company terminated Ranida's employment for failing the physical examination.[7]

When Ranida informed her father, Ramon, about her ailment, the latter suffered a heart attack and was confined at the Bataan Doctors Hospital. During Ramon's confinement, Ranida underwent another HBs Ag test at the said hospital and the result[8] indicated that she is non-reactive. She informed Sto. Domingo of this development but was told that the test conducted by CDC was more reliable because it used the Micro-Elisa Method.

Thus, Ranida went back to CDC for confirmatory testing, and this time, the Anti-HBs test conducted on her indicated a "Negative" result.[9]

Ranida also underwent another HBs Ag test at the Bataan Doctors Hospital using the Micro-Elisa Method. The result indicated that she was non-reactive.[10]

Ranida submitted the test results from Bataan Doctors Hospital and CDC to the Executive Officer of the Company who requested her to undergo another similar test before her re-employment would be considered. Thus, CDC conducted another HBs Ag test on Ranida which indicated a "Negative" result.[11] Ma. Ruby G. Calderon, Med-Tech Officer-in-Charge of CDC, issued a Certification correcting the initial result and explaining that the examining medical technologist (Garcia) interpreted the delayed reaction as positive or reactive.[12]

Thereafter, the Company rehired Ranida.

On July 25, 1994, Ranida and Ramon filed a complaint[13] for damages against petitioner Garcia and a purportedly unknown pathologist of CDC, claiming that, by reason of the erroneous interpretation of the results of Ranida's examination, she lost her job and suffered serious mental anxiety, trauma and sleepless nights, while Ramon was hospitalized and lost business opportunities.

On September 26, 1994, respondents amended their complaint[14] by naming Castro as the "unknown pathologist."

Garcia denied the allegations of gross negligence and incompetence and reiterated the scientific explanation for the "false positive" result of the first HBs Ag test in his December 7, 1993 letter to the respondents.[15]

For his part, Castro claimed that as pathologist, he rarely went to CDC and only when a case was referred to him; that he did not examine Ranida; and that the test results bore only his rubber-stamp signature.

On September 1, 1997,[16] the trial court dismissed the complaint for failure of the respondents to present sufficient evidence to prove the liability of Garcia and Castro. It held that respondents should have presented Sto. Domingo because he was the one who interpreted the test result issued by CDC. Likewise, respondents should have presented a medical expert to refute the testimonies of Garcia and Castro regarding the medical explanation behind the conflicting test results on Ranida.[17]

Respondents appealed to the Court of Appeals which reversed the trial court's findings, the dispositive portion of which states:
WHEREFORE, the decision appealed from is REVERSED and SET ASIDE and another one entered ORDERING defendant-appellee Orlando D. Garcia, Jr. to pay plaintiff-appellant Ranida D. Salvador moral damages in the amount of P50,000.00, exemplary damages in the amount of P50,000.00 and attorney's fees in the amount of P25,000.00.

The appellate court found Garcia liable for damages for negligently issuing an erroneous HBs Ag result. On the other hand, it exonerated Castro for lack of participation in the issuance of the results.

After the denial of his motion for reconsideration, Garcia filed the instant petition.

The main issue for resolution is whether the Court of Appeals, in reversing the decision of the trial court, correctly found petitioner liable for damages to the respondents for issuing an incorrect HBsAG test result.

Garcia maintains he is not negligent, thus not liable for damages, because he followed the appropriate laboratory measures and procedures as dictated by his training and experience; and that he did everything within his professional competence to arrive at an objective, impartial and impersonal result.

At the outset, we note that the issues raised are factual in nature. Whether a person is negligent or not is a question of fact which we cannot pass upon in a petition for review on certiorari which is limited to reviewing errors of law.[19]

Negligence is the failure to observe for the protection of the interest of another person that degree of care, precaution and vigilance which the circumstances justly demand,[20] whereby such other person suffers injury. For health care providers, the test of the existence of negligence is: did the health care provider either fail to do something which a reasonably prudent health care provider would have done, or that he or she did something that a reasonably prudent health care provider would not have done; and that failure or action caused injury to the patient;[21] if yes, then he is guilty of negligence.

Thus, the elements of an actionable conduct are: 1) duty, 2) breach, 3) injury, and 4) proximate causation.

All the elements are present in the case at bar.

Owners and operators of clinical laboratories have the duty to comply with statutes, as well as rules and regulations, purposely promulgated to protect and promote the health of the people by preventing the operation of substandard, improperly managed and inadequately supported clinical laboratories and by improving the quality of performance of clinical laboratory examinations.[22] Their business is impressed with public interest, as such, high standards of performance are expected from them.

In F.F. Cruz and Co., Inc. v. Court of Appeals, we found the owner of a furniture shop liable for the destruction of the plaintiff's house in a fire which started in his establishment in view of his failure to comply with an ordinance which required the construction of a firewall. In Teague v. Fernandez, we stated that where the very injury which was intended to be prevented by the ordinance has happened, non-compliance with the ordinance was not only an act of negligence, but also the proximate cause of the death.[23]

In fine, violation of a statutory duty is negligence. Where the law imposes upon a person the duty to do something, his omission or non-performance will render him liable to whoever may be injured thereby.

Section 2 of Republic Act (R.A.) No. 4688, otherwise known as The Clinical Laboratory Law, provides:
Sec. 2. It shall be unlawful for any person to be professionally in-charge of a registered clinical laboratory unless he is a licensed physician duly qualified in laboratory medicine and authorized by the Secretary of Health, such authorization to be renewed annually.

No license shall be granted or renewed by the Secretary of Health for the operation and maintenance of a clinical laboratory unless such laboratory is under the administration, direction and supervision of an authorized physician, as provided for in the preceding paragraph.
Corollarily, Sections 9(9.1)(1), 11 and 25(25.1)(1) of the DOH Administrative Order No. 49-B Series of 1988, otherwise known as the Revised Rules and Regulations Governing the Registration, Operation and Maintenance of Clinical Laboratories in the Philippines, read:
Sec. 9. Management of the Clinical Laboratory:

9.1 Head of the Clinical Laboratory: The head is that person who assumes technical and administrative supervision and control of the activities in the laboratory.

For all categories of clinical laboratories, the head shall be a licensed physician certified by the Philippine Board of Pathology in either Anatomic or Clinical Pathology or both provided that:

(1) This shall be mandatory for all categories of free-standing clinical laboratories; all tertiary category hospital laboratories and for all secondary category hospital laboratories located in areas with sufficient available pathologist.

x x x x

Sec. 11. Reporting: All laboratory requests shall be considered as consultations between the requesting physician and pathologist of the laboratory. As such all laboratory reports on various examinations of human specimens shall be construed as consultation report and shall bear the name of the pathologist or his associate. No person in clinical laboratory shall issue a report, orally or in writing, whole portions thereof without a directive from the pathologist or his authorized associate and only to the requesting physician or his authorized representative except in emergencies when the results may be released as authorized by the pathologist.

x x x x

Sec. 25. Violations:

25.1 The license to operate a clinical laboratory may be suspended or revoked by the Undersecretary of Health for Standards and Regulation upon violation of R.A. 4688 or the rules and regulations issued in pursuance thereto or the commission of the following acts by the persons owning or operating a clinical laboratory and the persons under their authority.
(1) Operation of a Clinical Laboratory without a certified pathologist or qualified licensed physician authorized by the Undersecretary of Health or without employing a registered medical technologist or a person not registered as a medical technologist in such a position.
And Section 29(b) of R.A. No. 5527, otherwise known as The Philippine Medical Technology Act of 1969, reads:
Section 29. Penal Provisions.- Without prejudice to the provision of the Medical Act of 1959, as amended relating to illegal practice of Medicine, the following shall be punished by a fine of not less than two thousand pesos nor more than five thousand pesos, or imprisonment for not less than six months nor more than two years, or both, in the discretion of the court:

x x x x

(b) Any medical technologist, even if duly registered, who shall practice medical technology in the Philippines without the necessary supervision of a qualified pathologist or physician authorized by the Department of Health;
From the foregoing laws and rules, it is clear that a clinical laboratory must be administered, directed and supervised by a licensed physician authorized by the Secretary of Health, like a pathologist who is specially trained in methods of laboratory medicine; that the medical technologist must be under the supervision of the pathologist or a licensed physician; and that the results of any examination may be released only to the requesting physician or his authorized representative upon the direction of the laboratory pathologist.

These rules are intended for the protection of the public by preventing performance of substandard clinical examinations by laboratories whose personnel are not properly supervised. The public demands no less than an effective and efficient performance of clinical laboratory examinations through compliance with the quality standards set by laws and regulations.We find that petitioner Garcia failed to comply with these standards.

First, CDC is not administered, directed and supervised by a licensed physician as required by law, but by Ma. Ruby C. Calderon, a licensed Medical Technologist.[24] In the License to Open and Operate a Clinical Laboratory for the years 1993 and 1996 issued by Dr. Juan R. Nañagas, M.D., Undersecretary for Health Facilities, Standards and Regulation, defendant-appellee Castro was named as the head of CDC.[25] However, in his Answer with Counterclaim, he stated:
3. By way of affirmative and special defenses, defendant pathologist further avers and plead as follows:
Defendant pathologist is not the owner of the Community Diagnostic Center nor an employee of the same nor the employer of its employees. Defendant pathologist comes to the Community Diagnostic Center when and where a problem is referred to him. Its employees are licensed under the Medical Technology Law (Republic Act No. 5527) and are certified by, and registered with, the Professional Regulation Commission after having passed their Board Examinations. They are competent within the sphere of their own profession in so far as conducting laboratory examinations and are allowed to sign for and in behalf of the clinical laboratory. The defendant pathologist, and all pathologists in general, are hired by laboratories for purposes of complying with the rules and regulations and orders issued by the Department of Health through the Bureau of Research and Laboratories. Defendant pathologist does not stay that long period of time at the Community Diagnostic Center but only periodically or whenever a case is referred to him by the laboratory. Defendant pathologist does not appoint or select the employees of the laboratory nor does he arrange or approve their schedules of duty.[26]
Castro's infrequent visit to the clinical laboratory barely qualifies as an effective administrative supervision and control over the activities in the laboratory. "Supervision and control" means the authority to act directly whenever a specific function is entrusted by law or regulation to a subordinate; direct the performance of duty; restrain the commission of acts; review, approve, revise or modify acts and decisions of subordinate officials or units.[27]

Second, Garcia conducted the HBsAG test of respondent Ranida without the supervision of defendant-appellee Castro, who admitted that:
[He] does not know, and has never known or met, the plaintiff-patient even up to this time nor has he personally examined any specimen, blood, urine or any other tissue, from the plaintiff-patient otherwise his own handwritten signature would have appeared in the result and not merely stamped as shown in Annex "B" of the Amended Complaint.[28]
Last, the disputed HBsAG test result was released to respondent Ranida without the authorization of defendant-appellee Castro.[29]

Garcia may not have intended to cause the consequences which followed after the release of the HBsAG test result. However, his failure to comply with the laws and rules promulgated and issued for the protection of public safety and interest is failure to observe that care which a reasonably prudent health care provider would observe. Thus, his act or omission constitutes a breach of duty.

Indubitably, Ranida suffered injury as a direct consequence of Garcia's failure to comply with the mandate of the laws and rules aforequoted. She was terminated from the service for failing the physical examination; suffered anxiety because of the diagnosis; and was compelled to undergo several more tests. All these could have been avoided had the proper safeguards been scrupulously followed in conducting the clinical examination and releasing the clinical report.

Article 20 of the New Civil Code provides:
Art. 20. Every person who, contrary to law, willfully or negligently causes damage to another, shall indemnify the latter for the same.
The foregoing provision provides the legal basis for the award of damages to a party who suffers damage whenever one commits an act in violation of some legal provision.[30]This was incorporated by the Code Commission to provide relief to a person who suffers damage because another has violated some legal provision.[31]

We find the Court of Appeals' award of moral damages reasonable under the circumstances bearing in mind the mental trauma suffered by respondent Ranida who thought she was afflicted by Hepatitis B, making her "unfit or unsafe for any type of employment."[32] Having established her right to moral damages, we see no reason to disturb the award of exemplary damages and attorney's fees. Exemplary damages are imposed, by way of example or correction for the public good, in addition to moral, temperate, liquidated or compensatory damages,[33] and attorney's fees may be recovered when, as in the instant case, exemplary damages are awarded.[34]

WHEREFORE, the Decision of the Court of Appeals in CA-G.R. CV No. 58668 dated February 27, 2004 finding petitioner Orlando D. Garcia, Jr. guilty of gross negligence and liable to pay to respondents P50,000.00 as moral damages, P50,000.00 as exemplary damages, and P25,000.00 as attorney's fees, is AFFIRMED.


Austria-Martinez, Chico-Nazario, and Nachura, JJ., concur.
Callejo, Sr., J., on leave.

[1] Did not appeal from the Decision of the Court of Appeals.

[2] Rollo, pp. 7-45.

[3] Id. at 48-63. Penned by Associate Justice Marina L. Buzon and concurred in by Associate Justices Sergio L. Pestaño and Aurora Santiago-Lagman.

[4] Id. at 46-47.

[5] Records, p. 186.

[6] Id. at 199.

[7] Id. at 187.

[8] Id. at 188.

[9] Id. at 189.

[10] Id. at 190.

[11] Id. at 192.

[12] Id. at 209.

[13] Id. at 1-7.

[14] Id. at 45-51.

[15] Id. at 31-41.

[16] CA Rollo, pp. 51-61. Penned by Judge Lorenzo R. Silva, Jr.

[17] Id. at 59.

[18] Rollo, p. 63.

[19] Estacion v. Bernardo, G.R. No. 144723, February 27, 2006, 483 SCRA 222, 231.

[20] Child Learning Center, Inc. v. Tagorio, G.R. No. 150920, November 25, 2005, 476 SCRA 236, 242.

[21] Garcia-Rueda v. Pascasio, 344 Phil. 323, 331 (1997).

[22] Department of Health (DOH) Administrative Order 49-B (1988), Sec. 3.

[23] Cipriano v. Court of Appeals, 331 Phil. 1019, 1025 (1996).

[24] Records, p. 193.

[25] Id. at 456-457.

[26] Id. at 72-73.

[27] Jalandoni v. Drilon, 383 Phil. 855, 868 (2000).

[28] Records, p. 73.

[29] Id.

[30] Carpio v. Valmonte, G.R. No. 151866, September 9, 2004, 438 SCRA 38, 47-48.

[31] Sanco, Cezar S., Torts and Damages (1994), Volume II, p. 748.

[32] Records, p. 199.

[33] Civil Code, Article 2229.

[34] Civil Code, Article 2208.