-
RepublicofthePhilippinesSupremeCourt
Manila
FIRSTDIVISION
MANILADOCTORSHOSPITAL,
G.R.No.150355
Petitioner, Present:
versus PANGANIBAN,C.J.,
(Chairperson) YNARESSANTIAGO,
AUSTRIAMARTINEZ,SOUNCHUAandVICKYTY,
CALLEJO,SR.andCHICONAZARIO,JJ.
Respondents. Promulgated:
July31,2006xx
DECISIONAUSTRIAMARTINEZ,J.:
Before thisCourt is aPetition forReviewonCertiorari underRule
45
questioningtheDecision[1]
datedOctober2,2001promulgatedby theCourtof Appeals (CA) in
CAG.R. CV No. 61581, which affirmed the Decisiondated September 30,
1997 of the Regional Trial Court (RTC), Branch
159,PasigCity,butwhichreducedtheawardofdamages.
Thiscaseoriginated fromanaction fordamages filedwith
theRTCbyrespondents So Un Chua and Vicky Ty against petitioner
Manila Doctors
-
Hospital.[2]
The complaint is premised on the alleged unwarrantedactuations
of the petitioner towards its patient, respondent So Un
Chua(Chua),whowasconfinedforhypertension,diabetes,andrelatedillnesses.
Theantecedentsofthecasefollow:
OnDecember13,1993, respondents filedaComplaintaverring
thatonOctober30,1990,respondentChua,themotherofrespondentVickyTy,wasadmitted
in petitioners hospital for hypertension and diabetes that
whilerespondentChuawasconfined,JudithChua,thesisterofrespondentTy,hadbeen
likewise confined for injuries suffered in a vehicular accident
thatpartial payments of the hospital billsweremade, totaling
P435,800.00 thatafter the discharge of Judith Chua, respondent Chua
remained inconfinement and the hospital bills for both patients
accumulated thatrespondent Chua was pressured by the petitioner,
through its Credit andCollection Department, to settle the unpaid
bills that respondent Tyrepresented that she will settle the bills
as soon as the funds becomeavailable that respondentTypleaded to
themanagement that inviewof thephysical condition of her mother,
respondent Chua, the correspondencesrelating to the settlement of
the unpaid hospital bills should be relayed tothe former that these
pleaswere unheeded by the petitioner that petitionerthreatened to
implement unpleasant measures unless respondent Tyundertakes her
mothers obligation as well as the obligation of her sister,Judith
Chua, to pay the hospitalization expenses that petitionermade
goodits threat and employed unethical, unpleasant and unlawful
methods whichallegedly worsened the condition of respondent Chua,
particularly, by (i)cuttingoff the telephone line inher roomand
removing theairconditioningunit, television set, and refrigerator,
(ii) refusing to render medicalattendanceand tochange
thehospitalgownandbedsheets, and (iii)barringthe private nurses
ormidwives from assisting the patient.Respondents thusprayed for
the award of moral damages, exemplary damages, and
attorneysfees.
-
In
itsAnswer,AmendedAnswer,andRejoinder,petitionerspecificallydenied
the material averments of the Complaint and Reply, and
interposedits counterclaims arguing that as early as one week after
respondent Chuahadbeenadmitted to itshospital,Dr.RodySy,her
attendingphysician,hadalready given instructions for her to be
discharged, but respondents insistedthat Chua remain in confinement
that, through its staff, petitioneraccordingly administered medical
examinations, all of which yieldednegative results that respondent
Ty voluntarily undertook, jointly andseverally, to pay the hospital
bills for both patients that althoughrespondent Ty paid up to
P435,000.00, more or less, she reneged on hercommitment to pay the
balance in violation of the Contract for AdmissionandAcknowledgment
ofResponsibility forPayment datedOctober 30, 1990which she
voluntarily executed that she signed a Promissory Note on
June5,1992fortheunpaidbalanceofP1,075,592.95andissuedpostdatedchecksto
cover the same that no such undue pressure had been imposed
uponrespondent Chua to settle the bills, the truth being that, as a
matter ofstandard procedure, the reminders to settle the billswere
transmitted not tothe patients but to their relatives who usually
undertook to pay the samethat
respondentTydeliberatelyevadedthestaffof
theCreditandCollectionDepartmentthatthecuttingoffofthetelephonelineandremovaloftheairconditioning
unit, television set, and refrigerator cannot constituteunwarranted
actuations, for the same were resorted to as costcuttingmeasures
and to minimize respondents charges that were already piling
up,especially after respondent Ty refused to settle the balance
notwithstandingfrequent demands that respondent Ty evaded the staff
when the latterattempted to inform her that the room facilities
will be cut off tominimizethe rising charges and that respondents
instituted the present civil
casepurposelyasleverageagainstthepetitionerafterthelatterhadfiledcriminalcharges
for violation of Batas Pambansa (B.P.) Blg. 22 against respondentTy
for issuing checks, later dishonored, totaling P1,075,592.95, the
amountreferring to the unpaid hospital bills. In its compulsory
counterclaim,petitioner prayed, among other items, for the award of
no less than
-
P1,000,000.00ascompensatorydamagesdue to
thefilingofamaliciousandunfounded suit, and, in its permissive
counterclaim, petitioner prayed forrespondents to pay
P1,075,592.95, the amount representing the due anddemandable
obligation under the Promissory Note dated June 5, 1992,including
the stipulated interest therein and the 25 percent of the
totalamountdueasattorneysfees.
During pretrial, the parties stipulated on the following issues:
First,
whether the respondents are liable to the petitioner to pay the
hospital billsarising from the hospitalization of respondent Chua
and Judith Chua andsecond, whether the parties are entitled to
their respective claims for
damages.[3]
Furthermore, the parties stipulated on the following facts:
a)Judith Chua was confined from June 14, 1991 to May 2, 1992
b)respondents failed topay thebalancedespite repeatedremindersc)
thesaidreminders referred to thehospitalbillsof
respondentChuaandJudithChuad)oneof
theattendingphysiciansofrespondentChuawasDr.RodySyande) the
petitioner ordered the removal of the facilities in question from
theroom of its patient, respondent Chua, with the qualification
that they wereconstrained to discontinue the same after the
representative of respondentChua refused to update the hospital
bills or refused to transfer her to semi
deluxeroomorwardtolessencosts.[4]
OnSeptember 30, 1997, theRTC rendered itsDecision in favor of
the
respondents,thedispositiveportionofwhichstates:
WHEREFORE, premises considered, judgment on the complaint
ishereby rendered in favorof the [respondents] as against the
[petitioner] asfollows:
[O]rdering the [petitioner] topay the [respondents] the
following, towit:
a) P200,000.00asmoraldamages
b) P100,000.00asexemplarydamagesand
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c)
P50,000.00asattorneysfeesandtheamountofP50,000.00aslitigationcosts.
SOORDERED.[5]
Inbrief,theRTCheldthattheremovalofthefacilitiesoftheroomtriggeredthehypertensionofrespondentChua
that thepetitioneractedinbadfaithinremoving the facilities without
prior notice that her condition wasaggravated by the pressure
employed by the administration upon her to paythe hospital bills
that the food always came late as compared to the otherpatients
that the beddings and clothes of respondent Chua were no
longerchanged and, as a result, bed sores emerged on her body that
therewas anutter lack of medical attendance that, because of these,
respondent Chuasuffered from selfpity and depression that
petitioner clearly discriminatedagainst the respondents that
respondent Ty had no choice but to sign thepromissory notes in
order to secure the release of her mother, respondentChua that the
foregoing actuations constitute an abuse of rights thatpetitioner
failed to establish the pecuniary loss it suffered and, hence, it
isnotentitled tocompensatorydamagesand that,since thepromissorynote
isacontractofadhesion,thepetitionerisnotentitledtotheawardofattorneysfeesasstipulatedthereon.OnappealtotheCA,thepetitionerassignedthefollowingerrors:
A.THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERRORBY FINDING
THE ACTUATIONS OF THE ADMINISTRATION OFDEFENDANTAPPELLANT TO BE IN
BAD FAITH, OPPRESSIVE ANDUNNECESSARY AS TO MAKE IT LIABLE TO
PLAINTIFFSAPPELLEESFORDAMAGESANDATTORNEYSFEES.
B.THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERRORBY NOT
RULING UPON THE PERMISSIVE COUNTERCLAIM OFDEFENDANTAPPELLANT WITH
RESPECT TO THE P1,075,592.95REPRESENTING THE HOSPITAL BILL OF
PLAINTIFFSAPPELLEES,WHICHOBLIGATION
ISNOTDISPUTEDANDWHICHAMOUNTWAS
-
NEVERCONTROVERTEDBYPLAINTIFFSAPPELLEES.[6]
OnOctober2,2001,theCApromulgateditsDecisionthedispositiveportionofwhichreads:
IN VIEW OF ALL THE FOREGOING, the appealed Decision
isherebyAFFIRMED with themodification that
theawardofmoraldamages,exemplary damages as well as attorneys fees
is reduced to Seventy FiveThousand Pesos (P75,000.00), Thirty
Thousand Pesos (P30,000.00) andTwenty Thousand Pesos (P20,000.00),
respectively. Litigation costs
areherebydeleted.Costsagainstappellant.
SOORDERED.[7]
Apart from the reduction in the award of damages, the CA
affirmed allsalient portionsof theRTCDecision anddeclined to
disturb the findingsoffact.Petitioner is now before this Court
raising essentially the same
groundsheardbytheCA.Incidentally,withrespect to
therelatedcriminalcaseagainstrespondentTy,this Court, on September
27, 2004, promulgated its Decision entitled Ty v.
People of the Philippines,[8]
which affirmed the decisions of the lowercourts finding
respondent Ty guilty of violating B.P. Blg. 22 and orderingher
topay theprivatecomplainant,hereinpetitioner, the totalamountof
thedishonoredchecks.Thepetitionisimpressedwithmerit.
While, as a rule, only questions of lawmay be raised in a
petition forreviewoncertiorariunderRule45,undercertainexceptions,
theCourtmayreexamine the evidence presented by the parties during
the trial. At leastfour exceptions exist in this case, namely: (a)
when the conclusion is afindinggroundedentirelyonspeculation,
surmises,orconjectures (b)when
-
the judgment is based on amisapprehension of facts (c) when the
findingsof fact are premised on the supposed absence of evidence
and contradictedby the evidence on record and (d) when the courts a
quo manifestlyoverlooked certain relevant facts not disputed by the
parties and which, if
properlyconsidered,wouldjustifyadifferentconclusion.[9]
The principal questions are, first, whether the actuations of
thepetitioner amount to actionable wrongs, and second, whether
thecounterclaims of the petitioner can be backed up by the measure
ofpreponderantevidence.
Inbrief, thecourtsaquo concurred in theholding that
thepetitionerand itsstaff failed to take into consideration the
physical condition of its patient,
respondent Chua, when it removed the facilities provided in her
room[10]
that the removal of these facilities, namely, the
airconditioner, telephonelines, television, and refrigerator,
aggravated the condition of the patient,
triggered her hypertension, and caused her blood pressure to
fluctuate,[11]
considering that therewasnoproperventilation in the
room.[12]
In viewofthe foregoing, the courts a quo concluded that the
actuations of the
petitioner were oppressive, unnecessary,[13]
and antisocial,[14]
done in
badfaithwithoutpropernotice,[15]
withnointentionotherthantoharassor
irritatetherespondents,[16]
allofwhichconstituteanabuseofrights.[17]
We do not agree. The conclusions of the courts a quo are either
haphazardconjectures,or foundedonamisapprehensionof facts.The
record is repletewithevidencethatjustifiesadifferentconclusion.
Indeed the operation of private pay hospitals and medical
clinics isimpressed with public interest and imbued with a heavy
socialresponsibility.Butthehospitalisalsoabusiness,and,asabusiness,ithasa
-
right to institute all measures of efficiency commensurate to
the ends forwhich it is designed, especially to ensure its economic
viability andsurvival. And in the legitimate pursuit of economic
considerations, theextent to which the public may be served and
cured is expanded, the
pulseandlifeofthemedicalsectorquickens,andtheregenerationofthepeopleasa
whole becomes more visibly attainable. In the institution of
costcuttingmeasures, the hospital has a right to reduce the
facilities and services thatare deemed to be nonessential, such
that their reduction or removal would
not be detrimental to the medical condition of the
patient.[18]
For themoment, the question to be considered is whether the
subject facilities areindeed nonessential the airconditioner,
telephone, television,
andrefrigeratortheremovalofwhichwouldcausetheadversehealtheffectsandemotional
trauma the respondents so claimed. Corollary to this question
iswhether the petitioner observed the diligence of a good father of
the
family[19]
in the course of ascertaining the possible repercussions of
theremovalof thefacilitiesprior to theremoval
itselfandforareasonable time
thereafter,withaviewtopreventdamage.[20]
After an extensive analysis of the record, it becomes
ratherworrisometo thisCourt that thecourtsaquo unreservedlydrew
their conclusions fromthe selfserving and uncorroborated
testimonies of the respondents the
probative value of which is highly questionable.[21]
We hold that therespondentsfailedtoprovethedamagessoclaimed.
The evidence in the record firmly establishes that the staff of
the petitionertook proactive steps to inform the relatives of
respondent Chua of theremoval of facilities prior thereto, and to
carry out the necessaryprecautionary measures to ensure that her
health and wellbeing would notbe adversely affected: as early as
around twoweeks after her admission onOctober 30, 1990, to the time
when the facilities had been removed
-
sometime in themiddleofMay1992,[22]
andevenup to thepointwhensheactually left the premises of the
hospital three weeks later, or during the
first week of June 1992,[23]
the medical condition of respondent Chua, asconsistently and
indisputably confirmed by her attending physician, Dr.
Rody Sy, a cardiologist, who was called as witness for both
parties,[24]
whom even respondent Chua repeatedly praised to bemy doctor and
a very
good doctor[25]
at that, and whose statements at times had beencorroborated as
well by SisterMary Philip Galeno, SPC, the Administratorof the
hospital and who also happens to be a registered nurse, had
been
relatively well,[26]
ambulatory,[27]
walking around in the room,[28]
andthat she was able to leave the hospital on her own without
any assistance[29]
thatalthoughshecomplainedofsymptomssuchasdizziness,weakness,[30]
and abdominal discomfort,[31]
Dr. Sy requested several medicalexaminations, such as the
laboratory tests, renal tests,MRI, ultrasound, and
CT scan,[32]
all of which were administered after procuring the consent
of
respondent Chuas family[33]
as admitted by respondent Ty herself,[34]
andeven called on other specialists, such as a neurologist,
endocrinologist, and
gastroenterologist, to look into her condition[35]
and conduct other tests as
well[36]
according to their fields of specialty, all of which yielded
no
serious finding[37]
that her illnesses were lifelong illnesses[38]
at a stage
where they cannot be totally removed or abolished,[39]
making it clear toher family that one hundred percent recovery
is not possible despite being
given daily medication in the hospital[40]
but that her condition,
nonetheless, is not serious,[41]
as the blood pressure is more or less
-
controlled and within acceptable limits,[42]
not that critical to precipitate
anyacuteattack,[43]
nor likely to fall intoanyemergency,[44]
nor yet does
she requirecontinuousorprolongedhospitalization[45]
since shewas stableenough to be treated at home and on an
outpatient basis, so much so
thatDr.Syencouragedhertoexerciseandavoidrestingallthe
time,[46]
andrecommendedthatanytimeshemaybedischarged[47]
even in just two weeks after confinement,[48]
the propriety of his order of
discharge concurred upon by the other specialists as
well,[49]
had it notbeen for respondents insistence to stay in the
hospital in view of their hope
for absolute recovery[50]
despite the admission of respondent Chua herself
thatshecannotanymorebetotallycured.[51]
It is also undisputed that the hospital administrator, Sister
Galeno,prior to the removal of the facilities, consulted the
attending physician,Dr.
Sy.[52]
ToSisterGaleno, also a registerednurse, thematter of removal
anditspossiblerepercussionsonthehealthofthepatient,asamatterofhospitalpolicy,isacriticalandsensitivemaneuver,and,hence,it
iscarriedoutonly
after discussing with the doctors to evaluate all important
factors.[53]
The
fact of prior consultation[54]
as well as the medical determination to theeffect that it was
safe to remove the facilities and would cause no harmful
effect[55]
had been amply corroborated by respondent Chuas own doctor
himself.[56]
When Dr. Sy testified as rebuttal witness for the
respondentsthemselves and whose credibility respondents failed to
impeach, hecategorically stated that he consented to the removal
since the removal ofthe said facilities would not by itself be
detrimental to the health of his
-
patient, respondent Chua.[57]
And in this respect, he had been
advisingrespondentTy,thedaughterofthepatient,thatthefacilities,suchastheairconditioner,
television, refrigerator, and telephone, are not
absolutelynecessary, and, that although theymay add to the comfort
of the patient, ifabsent, they will not cause any significant
deterioration of her condition,[58]
given that, in his experience as a cardiologist, and after
personallyattending respondent Chua on a daily basis before,
during, and after the
removal and even up to the time of her actual discharge,[59]
he concludedthat many hypertensive and diabetic patients, as in
her case, do not at allneed in particular an airconditioning unit,
among the other facilities
aforementioned.[60]
And, contrary to the findings of the courts a quo andthe
selfserving testimoniesof respondents that the lackofventilation,
afterthe removal of the airconditioner, triggered her hypertension,
Dr. Sycategorically stated that during his daily rounds with the
patient he wascertain that, although admittedly the blood pressure
in general wouldfluctuate daily, there had been no adverse effect
on her, and that her blood
pressure were within acceptable limits,[61]
especially considering that he
treated the patient on a daily basis up to the point of actual
discharge,[62]
andaccordingly,asconfirmedby themedical records,hemadenochange
in
themedicationsthereafter.[63]
InsupportofDr.Sysfindings,SisterGaleno,testified
thatsheknewtheconditionof theventilationof
thepatientsdeluxeroom,locatedatthefifthfloor,evenwithouttheairconditioning,notablyintimes
of brownout, and that there had been enough ventilation since
thegrilled window of that room was large enough which, if opened,
would
permit sufficient ventilation.[64]
The Court finds that the premise of theRTC judgment refers
merely to hypothetical statements which fail toestablish any clear
and direct link to the injury allegedly suffered by thepatient:
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QYoufound it safe to remove these facilities fromthe roomof
thepatientsufferingfromdiabetesandhypertension?
A Yes, Sir. Many hypertensive, diabetic patients do not need
air
conditioning,orT.V.orrefrigerator.
Q Do you agree with me that hypertension is triggered sometimes
byexcitement,angeror(sic)apersonsufferingfromsuchillness?
AHypertensioncanbetriggeredbyanything.
Court:
QAndeveninotherwordsthediscomfortcanalsotrigger?
ASometimesmentalstresscantrigger.
xxxx
Court:
QYoumentionedearlierthatthishypertensionmaybetriggeredmentally?
AYes,YourHonor.
Court:
QWill the removal of these facilities not affect the patient
including the
relatives?
A It may to a certain extent.And well, maybe the days after the
removalwouldprove that fluctuation in bloodpressure arewithin
acceptable
limits.[65]
Withrespecttothefindingsofthecourtsaquothatbedsoresappearedon
the bodyof respondentChua, that she suffered fromdepression after
thedisconnection of the said facilities, that her private midwives
were barred,and that the delivery of food was delayed, this Court
holds, as above, thatthese conclusions are bereft of sound
evidentiary basis, selfserving anduncorroborated as they are.
Again, Dr. Sy affirmed that during the dailyrounds he would make on
the patient, he did not detect any skin lesion or
any other abnormality up to the time she was actually
discharged.[66]
Nordid he find any sign of depression, although, admittedly, he
observed that
-
shehadbeenveryangrybecauseof the removalof the
facilities.[67]
All
thewhilehedidnotreceiveanycomplaintfromrespondentChuaindicatingthat
she suffered from the foregoing infirmities,[68]
considering that it is theresponsibility of the family of the
patient to specifically inform theattending physician or the nurses
during their rounds whatever they feel is
important,orif
therewereanynewdevelopmentssincethelastvisit.[69]
Ascorroborated by Sister Galeno, throughout respondent Chuas
confinement,sheneverreceivedanycomplaintfromthelatterorherrelativesthatshehad
notbeenattended toby thenursing staff.[70]
Worthnoting again is the
factthatthenursingstaffandtheattendingphysicians,whichincludedDr.Sy,inaccordance
with hospital policy, would routinely make their rounds on adaily
basis, or would visit the patient whenever they are called for
any
problem,[71]
and, in the case of the specialists other than the attending
physician, they would visit the patient about once a
week.[72]
The nurses,on theotherhand,wouldmake their roundsmore
frequently, that is,at least
once per shift, or every eight hours.[73]
Apart from the selfservingstatements of respondents, which by
now have become rather indicative ofbeingmere afterthoughts, there
is no clear showing from the record that thepetitioner and its
medical staff deviated from the foregoing policy andpractice, nor
had they been called upon to look into the alleged
physicalreactions or emotional trauma respondent Chua claims to
have sufferedduringandafter the removalof the
facilities.Itmustbeemphasized that, asstated above, respondent Chua
herself explicitly found Dr. Sy to be a very
good doctor because he personally attended to her almost every
hour.[74]
And throughout her confinement, Dr. Sy positively stated that
her family
employedaprivatemidwifewhoattendedtoherallthetime.[75]
The evidence in the record overwhelmingly demonstrates that
-
respondent Chua had been adequately attended to, and this Court
cannotunderstandwhythecourtsaquohaddeclared that therewasanutter
lackofmedical attendance, or that her health suffered during the
period after theremoval of the facilities. The Court finds that the
facilities in question arenonessential for the care of respondent
Chua and, hence, they may
belessenedorremovedbythepetitionerforthesakeofeconomicnecessityandsurvival.
Thoughhumanexperiencewould show that thedeactivationof the
airconditioner may cause a temperature differential that may
trigger somephysical discomfort, or that the removal of
entertainment facilities such
asthetelevisionset,orthedisconnectionofcommunicationdevicessuchasthetelephone,maycause
someexasperationon thepartof theonewhobenefitsfrom these,
nevertheless, all things considered, and given the degree
ofdiligence the petitioner duly exerted, not every suppression of
the
thingsthatonehasgrownaccustomedtoenjoyamountstoanactionablewrong,nordoes
every physical or emotional discomfort amount to the kind of
anguishthat warrants the award of moral damages under the general
principles oftort.The underlying basis for the award of tort
damages is the premise thatan individualwas injured in
contemplationof law.Thus, theremust first
bethebreachofsomedutyandtheimpositionofliabilityforthatbreachbeforedamages
may be awarded it is not sufficient to state that there should
betort liability merely because the plaintiff suffered some pain
and suffering.[76]
Moreover, this Court must reiterate the standard of tort to
arrive at a
proper award for damages premised on matters that suggest the
applicationof medical knowledge, especially in the description of
the causal linkbetween external or environmental factors, on one
hand, and their effectunto the physical or emotional health of the
patient, on the other, expert
opinion,asdiscussedinCruzv.CourtofAppeals,[77]
isgenerallyrequired:All three courts below bewail the inadequacy
of the facilities of the
-
clinicand itsuntidiness the lackofprovisions
suchasblood,oxygen,andcertainmedicines the failure to subject the
patient to a cardiopulmonarytestpriortotheoperation
theomissionofanyformofbloodtypingbeforetransfusion and even the
subsequent transfer of Lydia to the San PabloHospital and the
reoperationperformedonherby thepetitioner.Butwhileit may be true
that the circumstances pointed out by the courts belowseemed beyond
cavil to constitute reckless imprudence on the part of thesurgeon,
this conclusion is still best arrived at not through the
educatedsurmises nor conjectures of laymen, including judges, but
by theunquestionable knowledge of expertwitnesses. Forwhether a
physician orsurgeon has exercised the requisite degree of skill and
care in thetreatment of his patient is, in the generality of cases,
a matter of expertopinion. The deference of courts to the expert
opinions of qualifiedphysicians stems from its realization that the
latter possess unusualtechnical skills which laymen in most
instances are incapable ofintelligently evaluating. Expert
testimony should have been offered toprove that the circumstances
cited by the courts below are constitutive
ofconductfallingbelowthestandardofcareemployedbyotherphysiciansingoodstandingwhenperformingthesameoperation.It
mustberememberedthat when the qualifications of a physician are
admitted, as in the instantcase, there is an inevitable presumption
that in proper cases he takes thenecessary precaution and employs
the best of his knowledge and skill inattending to his clients,
unless the contrary is sufficiently established.Thispresumption is
rebuttablebyexpertopinionwhich is so sadly lacking
inthecaseatbench.[78]
With respect to theproprietyof thenoticeof removalof facilities,
the
evidence shows that the hospital staff, accompanied by Sister
Gladys Lim,
SPC, Finance Administrative Assistant of the hospital,[79]
through writtenand verbal notices as per hospital policy,
forewarned the
respondents,throughrespondentTyandhersister,JudithChua,oftheimpendingremoval
of the facilities over a week beforehand[80]
in view of their obstinate
refusal to vacate and transfer to a lower rate room[81]
or to update the
mounting hospital bills[82]
which, by then, had swollen to approximately
one million pesos.[83]
Respondent Ty refused to read many of the
writtennoticessentbytheCredit
Department.[84]
After repeated attempts to contact respondent Ty[85]
and
-
before theactual removalof the facilities, the staffof
thepetitioner tried to
personally serve the final notice datedApril 23, 1992,[86]
signed by SisterGladys Lim, addressed to respondent Ty, which
adopted the tenor of theprior verbal warnings, and which expressly
and sternly warned therespondents that the hospital shall be
constrained to take legal action andthat they shall be compelled to
transfer the patient, respondent Chua, to a
lower rate room unless the balance could be satisfied.[87]
Respondent Ty,for no justifiable reason, and sticking to her
inclination to avoid the staff,
refused to receive or acknowledge this letter as well.[88]
Worth noting isthat SisterGaleno, testified that, as amatter of
hospital policy the tenor ofwhich respondents, by virtue of the
Contract for Admission dated October
30, 1990, agreed to complywith,[89]
the hospital can only cut off the non
essential facilities and only in extreme cases[90]
if the patient occupies aprivate room all to herself had the
room been semiprivate shared by
otherpatients,orhaditbeentheward,thehospitalcannotdisconnectthefacilitiessince
this would unduly prejudice the other patients. But respondent
Chuaherself
insistedonstayinginaprivateroomdespiteherbeingfullyawareof
the ballooning charges,[91]
and even if she could have freely gone homeanytime to her
condominium unitwhich, as admitted,was equippedwith an
airconditioner.[92]
Withrespecttothepressureandharassmentrespondentsallegedly
suffered daily whenever the hospital staff would follow up the
billing during odd hours, or at 10pm, 11pm, 12midnight, 1am, or
2am,[93]
this averment had been convincingly refuted by the witnesses for
thepetitioner,namely,EdithaL.Vecino,
theHeadofCreditandCollection,andSisterGaleno, in that
theCreditandCollectionDepartmentwouldonlyholdoffice hours from 8am
to 5pm and, hence, it is impossible to harass the
respondentsduringthetimestheysoclaimed.[94]
The courts a quo found that respondent Ty had no choice but to
sign
-
thepromissorynote inorderforhermother
tobereleasedfromthehospital,[95]
thussuggesting that thehospital refused
toactuallydischargeorbodilyrelease its patient, respondent Chua,
until arrangements had been made tosettlethecharges.
While there are portions of the testimonies of the witnesses for
thepetitioner which state that although, as per standard procedure,
the patient
cannot leave[96]
the hospital without the discharge,[97]
clearance or gatepassissuedonlyafter
arrangements on the settlement of bills had beenmade,[98]
still, itmust beunderstood that these are only demonstrative of
the precondition that apatient cannot step out of the premises
without the consent of the hospital,or, in other words, that the
clearance merely indicates that the hospital
expressly consented to the actual release of the
patient,[99]
but, evenwithout its consent, the patient is still free to leave
anytime as a matter of
policy, in spiteof the refusal to
issueaclearanceorgatepass,[100]
or even
in caseswhere the accounts have not yet been liquidated or
settled,[101]
oryetevenifnopromissorynoteorpostdatedcheckwereexecutedinfavorof
the petitioner, as testified by no less than Sister
Galeno,[102]
and
corroborated by Editha Vecino[103]
and that, petitioner, a private hospital
established for profit,[104]
being also a business, by warning respondentsthat it shall
withhold clearance, is simply exercising its right to
protestagainst an absconding patient as a precursor to avail of
other appropriatelegal remedies that, on the contrary, the
respondents opted not to
leavebecauseoftheirownpromisenottoleaveunlessthehospitalbillswerefully
settled[105]
that theaccusations found in theDemandLetterdatedMay19,
1992, and signed by the counsel for the respondents,[106]
particularly, thatthe petitioner refused to discharge the
patient, [respondent Chua,] despite
-
orders from the attending physician, Dr. Rody Sy, had all been
refuted bySister Galeno when she read its contents in front of the
counsel forrespondents, emphatically telling him that we are not
detaining his
clientsthat[respondentTy]wastheonewhotoldusthattheyarenotgoingtoleave
the hospital unless they have fully paid the hospital[107]
and that, mostimportantly, no physical restraint upon the person
of respondent Chua
oruponthepersonofherrelativeshadbeenimposedbythestaff.Authorities,
including those of common law origin, explicitly declare that
apatientcannotbedetained inahospital fornonpaymentof
thehospitalbill.If the patient cannot pay the hospital or
physicians bill, the law provides aremedy for them to pursue, that
is, by filing the necessary suit in court for
therecoveryofsuchfeeorbill.[108]
Ifthepatientispreventedfromleavingthe hospital for his inability
to pay the bill, any person who can act on his
behalfcanapplyincourtfortheissuanceofthewritofhabeascorpus.[109]
Theformofrestraintmustbetotalmovementmustberestrainedinall
directions. If restraint is partial, e.g., in a particular
directionwith freedom
to proceed in another, the restraint on the persons liberty is
not total.[110]
However, the hospitalmay legally detain a patient against
hiswillwhen heis a detained or convicted prisoner, or when the
patient is suffering from avery contagious disease where his
release will be prejudicial to publichealth,orwhenthepatient
ismentallyillsuchthathisreleasewillendanger
public safety,[111]
or in other exigent cases as may be provided by law.Moreover,
under the common law doctrines on tort, it does not constitute
atrespass to
thepersontomomentarilypreventhimfromleavingthepremisesor any part
thereof because he refuses to comply with some reasonablecondition
subject to which he entered them. In all cases, the condition
ofthis kind of restraint must be reasonable in the light of the
circumstances.
-
[112]At any rate, as stated above, the patient is free to leave
the premises,
even in theostensibleviolationof
theseconditions,afterbeingmomentarilyinterrupted by the hospital
staff for purposes of informing him of
thosereasonableconditions,suchas theassessmentofwhether thepatient
is fit toleave, insane, or suffering from a contagious disease,
etc., or simply forpurposes of making a demand to settle the bill.
If the patient chooses toabscond or leave without the consent of
the hospital in violation of any
oftheconditionsdeemedtobereasonableunderthecircumstances,thehospitalmay
nonetheless register its protest and may choose to pursue the
legalremedies available under law, provided that the hospitalmay
not
physicallydetainthepatient,unlessthecasefallsundertheexceptionsabovestated.
Authorities are of the view that, ordinarily, a hospital,
especially if it is a
private pay hospital,[113]
is entitled to be compensated for its services, byeither an
express or an implied contract, and if no express contract
exists,there is generally an implied agreement that the patient
will pay the
reasonable value of the services rendered[114]
when a hospital treats apatients injuries, it has an enforceable
claim for full payment for its
services, regardless of the patients financial status.[115]
At this juncture, itmust be noted that there is testimony,
though to a degree disputable, to theeffect that the execution of
the promissory note and the issuance ofpostdated checks were
conditions imposed not by the petitioner but
voluntarily offered by the counsel for respondents.[116]
At any rate,however, this Court holds, in view of the foregoing
authorities, that therequirement tohave the relativeof
respondentChua
toexecuteapromissorynoteaspartofthearrangementtosettletheunpaidobligationsisaformalitythatconvertsany
impliedcontract intowrittenformand,moreover,amountsto a reasonable
condition, the nonfulfillment of which, in itself, however,as
discussed, cannot allow thehospital to detain thepatient. Itmust
alsobestressed,contrarytothefindingsofthecourtsaquo,
thatsuchanagreement
-
embodied in a promissory note, as well as the Contract for
Admission andAcknowledgment ofResponsibility for Payment
datedOctober 30, 1990, donot become contracts of adhesion simply
because the person signing it was
under stress that was not the result of the actions of the
hospital,[117]
especially taking into account that there is testimony to the
effect thatrespondent Ty signed the Promissory Note dated June 5,
1992 in the
presenceofcounselandactingunderhisadvise.[118]
But as to the propriety of the circumstances surrounding the
issuance
of the postdated checks to cover the amount stated in the
Promissory NotedatedJune5,1992, thisCourtmustrefer to
thediscussionof therecentcase
of Ty v. People of the Philippines[119]
where this Court affirmed theconviction of respondent Ty for the
issuance of bouncing checks addressedto the petitioner herein.While
the instant case is to be distinguished fromtheTycase in nature,
applicable law, the standards of evidence, and in thedefenses
available to the parties, hence, the judgment of conviction in
thatcaseshouldnotatallprejudice thedispositionof thiscase,even if
the factscoincide, nonetheless, for purposes of convenience and
instructive utility,theCourtquotestherelevantportions:
In thiscase,farfromit, thefear, ifany,harboredbyTywasnotreal
and imminent. Ty claims that she was compelled to issue the
checks acondition the hospital allegedly demanded of her before her
mother
couldbedischargedforfearthathermothershealthmightdeterioratefurtherdueto
the inhumane treatment of the hospital or worse, her mother
mightcommit suicide. This is speculative fear it is not the
uncontrollable fearcontemplatedbylaw.
Tobeginwith, therewasno showing that themothers illnesswas
so
lifethreatening such that her continued stay in the hospital
suffering allitsallegedunethical treatmentwould
induceawellgroundedapprehensionof her death. Secondly, it is not
the laws intent to say that any fearexempts one from criminal
liability much less petitioners flimsy fear
thathermothermightcommitsuicide.Inotherwords, the fear she
invokeswasnot impending or insuperable as to deprive her of all
volition and tomakeher a mere instrument without will, moved
exclusively by the hospitalsthreatsordemands.
-
Ty has also failed to convince the Court that she was left with
nochoice but to commit a crime. She did not take advantage of the
manyopportunities available to her to avoid committing one. By her
very ownwords, she admitted that the collateral or security the
hospital requiredprior to the discharge of her mother may be in the
form of postdatedchecks or jewelry.And if indeed shewas coerced to
open an accountwiththe bank and issue the checks, she had all the
opportunity to leave thescenetoavoidinvolvement.
Moreover, petitioner had sufficient knowledge that the issuance
of
checks without funds may result in a violation of B.P. 22. She
eventestified that her counsel advised her not to open a current
account norissuepostdatedchecksbecause themoment Iwillnothave funds
it will beabigproblem.Besides, apart frompetitionersbare assertion,
the record isbereft of any evidence to corroborate and bolster her
claim that she wascompelled or coerced to cooperate with and give
in to the hospitalsdemands.
Ty likewise suggests . . . that the justifyingcircumstanceof
stateof
necessity under par. 4, Art. 11 of the Revised Penal Code may
findapplicationinthiscase.
Wedonotagree.The lawprescribes the presence of three
requisites
to exempt the actor from liability under this paragraph: (1)
that the evilsought to be avoided actually exists (2) that the
injury feared be greaterthan the one done to avoid it (3) that
there be no other practical and lessharmfulmeansofpreventingit
.
In the instant case, the evil sought to be avoided ismerely
expected
or anticipated. If the evil sought to be avoided is merely
expected oranticipated ormay happen in the future, this defense is
not applicable.Tycould have taken advantage of an available option
to avoid committing acrime.By her own admission, she had the choice
to give jewelry or
otherformsofsecurityinsteadofpostdatedcheckstosecureherobligation.
Moreover, for the defense of state of necessity to be availing,
the
greater injuryfearedshouldnothavebeenbroughtaboutby
thenegligenceor imprudence,more so, thewillful inaction of the
actor. In this case, theissuance of the bounced checks was brought
about by Tys own failure topayhermothershospitalbills.
TheCourtalso thinks it ratherodd thatTyhaschosen
theexempting
circumstance of uncontrollable fear and the justifying
circumstance ofstateofnecessity toabsolveherof liability.It
wouldnothavebeenhalfasbizarre hadTy been able to prove that the
issuance of the bounced checkswasdonewithoutherfullvolition.Under
thecircumstances,however, it isquite clear that neither
uncontrollable fear nor avoidance of a greater
evilorinjurypromptedtheissuanceofthebouncedchecks.
Parenthetically, the findingsof fact in theDecisionof the
trialcourt
-
in the Civil Case for damages filed by Tys mother against the
hospital iswholly irrelevant for purposes of disposing the case at
bench. While thefindings therein may establish a claim for damages
which, we may add,need only be supported by a preponderance of
evidence, it does not
necessarilyengenderreasonabledoubtastofreeTyfromliability.[120]
In view of the foregoing, the Court therefore holds that the
courts a
quo committed serious errors in finding that the petitionerwas
biased,[121]
discriminated against the respondents,[122]
and purposely intended to
irritate[123]
or harass[124]
them that it acted in bad faith in removing the
facilities without prior notice[125]
and that its acts were antisocial.[126]
The aforequoteddeclarationsof thewitnesses, significant
portionsofwhichthis Court considers as expert testimony, are
reliable and remainconsiderably trustworthy to controvert
respondents assertions as well as toreverse the conclusions of fact
and law of the CA and the RTC thatrespondent Chua suffered the
physical and emotional anguish so claimed,and so, for these
reasons, the Court holds that the petitioner inflicted
noactionablewrong.This Court observes that the courts a quo awarded
both respondents moraldamages. But it is wellsettled that in case
of physical injuries, with some
exceptions,[127]
moral damages are recoverable only by the party injuredand not
by her spouse, next of kin, or relativewho happened to
sympathize
with the injuredparty.[128]
Hence, even if the courtsaquowere correct intheir basis for
damages, they should have declined to award damages
torespondentTy.Thelastissuetoberesolvedisthequestionwhetherthecounterclaimsofthepetitioneraresupportedbyapreponderanceofevidence.
-
We agree with the petitioner that the courts a quo seriously
erred inmistaking the case of its compulsory counterclaim for its
permissivecounterclaim and for failing to consider the evidence
which impressivelysupports the latter.First,for failurewithout
justifiablecauseof respondentscounsel to commenton
thePartialFormalOfferofEvidencedatedFebruary
14, 1996[129]
filed by the petitioner, the RTC issued an order during
thecourse of the trial, which counsel for respondents neither
contested
norraisedonappeal,admittingExhibits1to16,togetherwiththeirsubmarkings
and the purposes for which the same were offered,[130]
all of which hadalso been previously authenticated and their
contents verified by the
witnesses for the petitioner.[131]
These documents include the Contract forAdmission of respondent
Chua dated October 30, 1990, duly executed byrespondent Ty,
incorporating therein the rules and regulations of the
hospital, including the duty to understand the same[132]
as well as theundertaking of respondent Ty to be jointly and
severally liable for the
payment of thehospital bills of respondentChua[133]
the PromissoryNotedated June 5, 1992 in the amount of
P1,075,592.95 duly executed byrespondentTy in favor of
thepetitioner agreeing to be jointly and severallyliable to pay the
unpaid obligations of respondent Chua and Judith Chua,
including interest and attorneys fees in case of
default[134]
theUndertakings signed by respondent Ty dated March 3, 1992 and
April 7,
1992tomaintainregulardeposits[135]
andthecreditmemosandstatements
of account that support the amount referring to the unpaid
obligation.[136]
Second, the parties stipulated during pretrial that respondents
failed to pay
the balance despite repeated reminders.[137]
And third, respondent Ty
inopencourtidentifiedandadmittedthatshesignedtheContractofAdmissiondatedOctober30,1990aswellastheUndertakingsdatedMarch3,1992andApril7,1992butwhich,fornojustifiablereason,shedidnotbothertoread,
-
[138] and, what is more, she repeatedly admitted during the
course of the
trial that she failed to fully settle the foregoing hospital
bills.[139]
In fact,while the Ty case cannot control the incidents of the
instant case asheretofore stated, it is still worth mentioning, at
least for informativepurposes, the findings of this Court in Ty
with respect to respondentsobligationstothepetitioner:
Tys mother and sister availed of the services and the facilities
of thehospital. For the care given to her kin, Ty had a legitimate
obligation
topaythehospitalbyvirtueofherrelationshipwiththemandbyforceofhersignature
on her mothers Contract of Admission acknowledgingresponsibility
for payment, and on the promissory note she executed in
favorofthehospital.[140]
In view of all these findings, the Court earnestly disagrees
with thesweepingconclusionof theCA that [Petitioner] failed
topresentany iotaof
evidence to prove his claim,[141]
a statement apparently referring to thepermissive counterclaim
of P1,075,592.95. However, with respect to thecompulsory
counterclaim predicated on the filing of a baseless suit andinjury
to its reputation, petitioner did not raise this matter on appeal
and,hence,isdeemedtohavewaivedthesame.ButtheCourtinTymadeapartialfindingonthecivilliabilityofrespondentTy
with respect to the amount covered by seven of the several
dishonoredcheckssheissuedequivalentto
P210,000.00.[142]
Since this amount forms a fraction of her total
civilliability,thenthisamount,indeferencetoTy,shouldbedeductedtherefrom.
The claim for attorneys fees, as stipulated under the Promissory
Notedated June 5, 1992, should be reduced for being unreasonable
under the
circumstances,from25percentto12percentofthetotalamountdue.[143]
As a final word, the Court takes judicial notice of the pending
Senate Bill
-
No. 337, entitled AnAct Prohibiting the Detention of Patients in
Hospitalsand Medical Clinics on Grounds of NonPayment of Hospital
Bills orMedical Expenses, which declares, among others, that it
shall be unlawfulfor any hospital or medical clinic to cause
directly or indirectly thedetention of patients for nonpayment, in
part or in full, of their hospital
bills,[144]
and, furthermore, requires patientswhohave fully recovered
andare financially incapable to settle the hospitalization expenses
to execute
apromissorynote,cosignedbyanotherindividual,totheextentoftheunpaid
obligation before leaving the hospital.[145]
While this Court may
havetoucheduponthesemattersintheadjudicationoftheinstantcase,
itmustbestated that this decision should in no way preempt any
constitutionalchallenge to the provisions of Senate Bill No. 337 if
passed into law,bearing in mind the standards for the exercise of
the power of judicial
review[146]
as well as the recognition that the tenor of the bill may
adjustwith the times, or that the bill itself may fail to pass,
according to thedynamism of the legislative process, especially in
light of the objections
interposedbyinterestgroupstodate.[147]
WHEREFORE, the petition isGRANTED. TheDecision of the Court
of Appeals dated October 2, 2001, together with the Decision
datedSeptember 30, 1997of theRegionalTrialCourt inCivilCaseNo.
63958, isREVERSED and SET ASIDE. Another judgment is entered
dismissing theComplaint and ordering respondents, jointly and
severally, to pay thepetitioner the amount of P865,592.95,with
stipulated interest of 12 percentreckoned from the date of
extrajudicial demand until full payment, and
12percentofthetotalamountdueasattorneysfees.
Nopronouncementastocosts.
SOORDERED.
-
MA.ALICIAAUSTRIAMARTINEZ
AssociateJusticeWECONCUR:
ARTEMIOV.PANGANIBANChiefJusticeChairperson
CONSUELOYNARESSANTIAGOROMEOJ.CALLEJO,SR.AssociateJusticeAssociateJustice
MINITAV.CHICONAZARIOAssociateJustice
CERTIFICATION
Pursuant to Section 13, Article VIII of the Constitution, it is
herebycertified that the conclusions in the above Decision were
reached inconsultationbefore thecasewasassigned to thewriterof
theopinionof theCourtsDivision.
ARTEMIOV.PANGANIBANChiefJustice
[1 ] Penned by Associ a t e Ju st i ce Con rado M. Vasquez ,
Jr., w i th Associ a t e Ju st i ces Mart in S.
V i l l arama,Jr.and El i ezerR.DeLosSan to s,concu rring ,ro l
lo , pp .38 50 .[2 ]
A l though the Complain t imp leaded the pet i t i oner as Man i
l a Docto rs Hosp i t a l , d efendan t ,a l l eged ly a domest i c
co rpo ra t i on , t he pe t i t i oner speci fi ca l l y den i ed
t h i s avermen t andal l eged tha t Man i l a Docto rsHosp i t a l
i smere ly a t radenameo fMan i l a Med ical Serv i ces, Inc .,t he
rea l party i n i n t erest . Th i s a l l egat ion was no t d i
spu ted by the responden t s, no r was anyco rrec t i on made by
the cou rt s a quo .See Answer dat ed Feb ruary 4 , 1994 , i t em 2
Amended
-
Answer dat ed Feb ruary 10 , 1994 , i t em 2 Rejo inder da t ed
March 28 , 1994 , i t em 3 reco rds,pp .1 ,15 ,25 ,42 The1997 Ru
leso fCiv i l Procedu re ,Ru le 3 ,1 (1997 ) i d . Ru le 8 ,4
JuasingHardware v .Mendoza , 201 Ph i l . 369 (1982 ) Chiang Ka i
Shek v . Court o f Appea l s , G .R. No .58028 ,Apri l 18 ,1989
,172 SCRA389 .
[3 ]
Part i a l PreTri a l O rderda t ed May 2 ,1994 ,ro l lo , p .87
.[4 ]
Part i a l PreTri a l O rderda t ed May 4 ,1994 ,i d .a t 90 91
.[5 ]
Id .a t 107 .[6 ]
CAro l lo , p .39 .[7 ]
Ro l lo , p .50 .[8 ]
G .R.No .149275 ,Sep tember27 ,2004 ,439 SCRA220 ,238 .[9 ]
Heirs o f D icman v . Cario , G .R. No . 146459 , June 8 , 2006
Rivera v . Roman , G .R. No . 142402 ,Sep tember20 ,2005 ,470
SCRA276 ,287 Mercury Drug Corp . v .Libunao , G .R.No . 144458 ,Ju
ly 14 , 2004 , 434 SCRA 404 , 413 414 The In su la r Li f e
Assurance Company, Ltd . v . Courto f Appea l s , G .R.No .126850
,Apri l 28 ,2004 ,428 SCRA79 ,86 Agu i rre v .Court o f Appea l s
,G .R. No . 122249 , January 29 , 2004 , 421 SCRA 310 , 319 C &
S Fi sh fa rm Corpora t ion v .Court o f Appea l s , 442 Ph i l
.279 ,288 (2002 ) Mart inezv .Court o f Appea l s , G .R.No .123547
,May 21 ,2001 ,358 SCRA38 ,49 (2001 ).
[10 ]RTCDeci sion ,ro l lo , p .99 .
[11 ]Id .
[12 ]Id .a t 104 CADeci sion ,i d .a t 43 .
[13 ]Id .a t 103 CADeci sion ,i d .
[14 ]Id .a t 46 .
[15 ]Id .a t 103 104 .
[16 ]Id .a t 42 ,44 .
[17 ]Id . a t 104 CADeci sion , i d . a t 42 ,46 .See
THECIVILCODEOFTHEPHILIPPINES, R.A . 386 ,
asamended ,A rt i c l es19 21 ,2219 (1950 ).[18 ]
See PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 322 (1988 ) (d i
scussing the co rpo ra t el i ab i l i t y o fhosp i t a l sa ri
sing fromthe fa i l u re t o fu rn i sh safe and re l i ab l e equ
ipmen t ).
[19 ] See Ramos v . Court o f Appea l s, 378 Ph i l . 1198 ,
1241 (1999 ), c i t i ng JOSE O . VITUG,
COMPENDIUMOFCIVILLAWANDJURISPRUDENCE822 (1993 ).[20 ]
The p rimary du t i es o f a hosp i t a l a re t o fu rn i sh
safe and wel l main t a ined p remises, t o p rov ideadequate and
safe equ ipmen t ,and to exerc i se reasonab le care i n t he se l
ec t i on o f t he memberso f t he hosp i t a l st aff. See PEDRO
P. SOLIS, MEDICAL JURISPRUDENCE 310 11 , 321 29(1988 ). A hosp i t
a l conducted fo r p riva t e ga in i s under a du ty t o exerc i
se o rd inary care i nfu rn i sh ing i t s pa t i en t s a su i t
ab l e and safe p l ace . If an unsafe cond i t i on o f t he hosp
i t a l sp remises causes an i n ju ry , t here i s a b reach o f t
he hosp i t a l s du ty . 40A AM. JUR. 2DHosp i ta l s and Asylums
35 (1999 ), c i t i ng Sharpe v . Sou th Caro l ina Dep t . o f Men
ta l Hea l th ,281 S.C.242 ,315 S.E.2d 112 (1984 ) Uni t ed West
ern Med ica l Cen ters v . Superio rCourt , 42Cal .App .4 th 500
,49 Cal .Rp t r.2d 682 (4 th D i st .1996 ).Where t he pat i en t
refu ses t o l eave ap riva t e hosp i t a l i n sp i t e o f t he
o rder fo r h i s d i scharge , he may do so and con t inue t o st
ay i nthat hosp i t a l , p rov ided the co rrespond ing hosp i t a
l b i l l i s p roperly sa t i sfi ed and w i th t heconsen t o f t
he a t t end ing physi c i an . PEDRO P. SOLIS, MEDICAL
JURISPRUDENCE 336(1988 ).The re l a t i onsh ip between the hosp i
t a l as a p riva t e co rpo ra t e en t i t y and the admi t t
edpat i en t i s one p rinc ipal ly governed by con t rac t .Th i s
conclu sion st ems from the genera l ru l e
-
t h a t t he managemen t and opera t i on o fa p riva t e hosp i
t a l a re governed by the ru l esapp l i ed i nthe case o f p riva
t e co rpo ra t i ons genera l l y , excep t asmod i fi ed by st a
tu t e .See 40AAM. JUR.2D Hosp i ta l s and Asylums 13 (1999 ), c i
t i ng Burri s v .Morton F. Plan t Hosp i ta l , 204 So . 2d521
(1967 ).Thecon t rac t be tween the p riva t e hosp i t a l and the
pat i en t no rmal ly st i pu l a t es t hecond i t i ons o f
admission . See , e .g ., 9A AM. JUR. LEGAL FORMS 2D 136 :63 . As t
hepet i t i oner i sa p riva t e hosp i t a l asopposed to a pub l
i c one , i t i sg iven more l eeway in mak ingru l es and regu la
t i ons as regard s t he admission o f pa t i en t s, hosp i t a l
fac i l i t i es, se l ec t i on o fst aff, among o thers, p rov
ided tha t such ru l es and regu la t i ons are no t arb i t rary
,d i scriminato ry , un reasonab le , monopo l i st i c , o r con t
rary t o l aw o r pub l i c po l i cy , PEDRO
P.SOLIS,MEDICALJURISPRUDENCE310 (1988 ).
[21 ]
See , e .g .,Tan v .Vi l l apaz , G .R.No . 160892 ,November 22
, 2005 , 475 SCRA 720 , 727 Nau t i caCann ing Corp . v . Yumu l ,
G .R. No . 164588 , October 19 , 2005 , 473 SCRA 415 , 423 Jard
ineDavies, Inc .v .JRBRea l t y , Inc . , G .R.No .151438 , Ju ly
15 , 2005 , 463 SCRA555 , 561 Lim v .Chua toco , G .R. No . 161861
, March 11 , 2005 , 453 SCRA 308 , 316 Chico v . Court o fAppea l s
, 348 Ph i l .37 ,43 (1998 ).
[22 ]TSN,October5 ,1995 ,pp .53 54 .
[23 ]TSN,Sep tember7 ,1995 ,p .13 .The exact da t e when
responden t Chua ac tual ly l e ft t h e hosp i t a l
i sunderd i spu te ,wh ich i se i t herJune 4 o rJune 5 ,1992
.[24 ]
See TSN,August 22 , 1996 , p . 1 34 (o ffering Dr. Rody Sy as
rebu t t a l w i tness fo r responden t sand whose cred ib i l i t
y had no t been impeached ).
[25 ]TSN,June 24 ,1994 ,pp .16 ,32 .
[26 ]TSN,Sep tember7 ,1995 ,p .6 .
[27 ]Id .a t 8 ,13 .
[28 ]Id .a t 13 .
[29 ]Id .a t 8 9 .
[30 ]Id .a t 7 ,10 .
[31 ]TSN,August 22 ,1996 ,p .7 (t est i fy ing asw i tnessfo rt
he responden t s).
[32 ]TSN,August 15 ,1996 ,p .13 .
[33 ]Sup ra no t e 31 .
[34 ]Sup ra no t e 32 .
[35 ]Sup ra no t e 31 .
[36 ]Id .a t 9 .
[37 ]TSN,Sep tember7 ,1995 ,p .10 .
[38 ]TSN,August 22 ,1996 ,p .22 .
[39 ]TSN,Sep tember7 ,1995 ,p .7 .
[40 ]Id .a t 15 .
-
[41 ]Sup ra no t e 37 .
[42 ]Sup ra no t e 38 .
[43 ]TSN,Sep tember7 ,1995 ,pp .12 13 .
[44 ]Id .
[45 ]Id .a t 14 .
[46 ]Id .a t 18 .
[47 ]Id .a t 6 7 .
[48 ]Id .a t 8 .
[49 ]Id .a t 11 .
[50 ]Id .a t 7 ,10 ,12 TSN,August 22 ,1996 ,sup ra .
[51 ]TSN,June 24 ,1994 ,p .32 .
[52 ]TSN,January 19 ,1996 ,p .12 TSN,October5 ,1995 ,pp .75 ,76
.
[53 ]TSN,October5 ,1995 ,p .76 .
[54 ] A l though there i s some inconsi st ency as t o t he
exact da t es when the hosp i t a l admin i st ra to r,
Si st er Galeno , consu l t ed w i th t he docto rs, due t o
memory l ap se o f t he w i tnesses, i t i s fa i rl yest ab l i
shed tha t i t was done du ring a reasonab le t ime befo re t he
removal . See TSN, October5 , 1995 , pp . 12 , 76 77 TSN, August 22
, 1996 , p . 17 (Dr. Rody Sy t est i fy ing fo r t heresponden t
sasrebu t t a l w i tness).
[55 ]TSN,August 22 ,1996 ,p .13 .
[56 ]Id .a t 12 13 .
[57 ]Sup ra no t e 55 .
[58 ]Id .a t 18 .
[59 ]TSN,Sep tember7 ,1995 ,p .17 TSN,August 22 ,1996 ,p .19
.
[60 ]TSN,August 22 ,1996 ,p .14 .
[61 ]Id .a t 22 .
[62 ]Id .a t 19 .
[63 ]Id .a t 28 .
[64 ]
TSN,October5 ,1995 ,p .32 .[65 ]
Id .a t pp .14 ,18 19 .[66 ]
TSN,Sep tember7 ,1995 ,p .16 .[67 ]
Id .[68 ]
Id .a t 21 22 .[69 ]
Id .[70 ]
TSN,October5 ,1995 ,p .48 .[71 ]
TSN, Sep tember 7 , 1995 , p . 20 TSN,August 22 , 1996 , pp . 6
, 8 , 24 TSN,October 5 , 1995 , p .
-
13 .[72 ]
TSN,August 22 ,1996 ,p .8 .[73 ]
Sup ra no t e 46 .[74 ]
TSN,June 24 ,1994 ,pp .16 ,31 32 .[75 ]
Sup ra no t e 46 .[76 ]
SpousesCustod io v .Court o f Appea l s , 323 Ph i l .575 ,585
586 (1996 ).See Expert ravel &Tours,Inc . v . Court o f Appea l
s , 368 Ph i l . 444 , 448 449 (1999 ) (summari z ing the ru l es
on moraldamages).
[77 ]346 Ph i l .872 (1997 ).
[78 ]Id . at 884 885 .
[79 ]TSN,October5 ,1995 ,p .28 .
[80 ]Id .a t 12 ,27 .
[81 ]Id .a t 26 ,31 32 .
[82 ]Id .a t 12 ,31 ,42 .
[83 ]Id .a t 26 .
[84 ]Id .a t 5 .
[85 ]Id .a t 30 31 .
[86 ]Exh ib i t 5 .
[87 ]Id . TSN,October5 ,1995 ,p .29 .
[88 ]TSN,October27 ,1994 ,p .13 TSN,October5 ,1995 ,pp .27 29
.
[89 ]Exh ib i t 1 .
[90 ]TSN,October5 ,1995 ,p .17 .
[91 ]Id . a t 31 , 42 Part i a l PreTri a l O rder da t ed May 4
,1994 ,ro l lo , pp . 90 91 RTCDeci sion , i d . a t
94 95 .[92 ]
TSN,June 24 ,1994 ,pp .27 28 TSN,August 15 ,1996 ,p .14 .[93
]
TSN,June 24 ,1994 ,pp .6 ,9 ,36 .[94 ]
TSN,October27 ,1994 ,p .34 TSN,October5 ,1995 ,pp .44 45 .[95
]
RTCDeci sion ,ro l lo , p .106 .Th i sconclu sion had been imp l
i ed ly affi rmed by the CA.See TSN,Ju ly 1 ,1994 ,p .17 (responden
t Ty t est i fy ing tha t she wasfo rced to sign t he p romisso ry
no t esand execu te t he postdat ed checks as a cond i t i on fo r
t he re l ease o r d i scharge o f her mo ther,responden t
Chua).See al so i d .a t 21 .
[96 ]TSN,Sep tember14 ,1995 ,pp .18 19 ,23 .
[97 ]Id .a t 35 .
[98 ]Id . a t 17 18 , 22 , 32 TSN,October5 ,1995 , p . 25 . It
can be observed from the t est imon ies t ha t
t he d i scharge o rder i ssued by the a t t end ing physi c i
an i s a d i scharge from a med ica lst andpo in t , wh i l e t he
d i scharge o r c l earance i ssued by the Nursing St a t i on ,
Accoun t ing ,Cash ier, Secu ri t y , o r t he o ther departmen t
swhose funct ionsmay be admin i st ra t i ve i n na tu rerefer t o
mat t ers no t so l e ly con fined to med ica l aspect s, such as t
he se t t l emen t o f dues,deposi t s o r b reakage, a l l o f wh
ich depend on the ru l es and regu la t i ons as wel l as hosp i t
a l
-
po l i cy .[99 ]
TSN,October5 ,1995 ,p .26 TSN,Sep tember14 ,1995 ,p .23 24 .[100
]
Id . i d .[101 ]
TSN,Sep tember14 ,1995 ,pp .23 24 .[102 ]
TSN,October5 ,1995 ,pp .26 27 ,48 49 .[103 ]
Sup ra no t e 101 .[104 ]
See PEDRO P. SOLIS, MEDICAL JURISPRUDENCE 305 307 (1988 ) (d i
scussing the variouscl assi fi ca t i onso fhosp i t a l s).
[105 ]TSN,October5 ,1995 ,pp .49 50 .
[106 ]Exh ib i t sBto B1 .
[107 ]TSN,October5 ,1995 ,pp .40 42 .
[108 ]
PEDROP.SOLIS,MEDICALJURISPRUDENCE338 (1988 ),c i t i ng Gadsden
Genera l Hosp i ta lv .Hami l ton , 103 So .553 (1925 ).See LOUIS
J.REGAN,DOCTORANDPATIENTANDTHELAW113 (1949 ),c i t i ng Cookv .H
igh land Hosp i ta l , 84 S.E.352 In re Carl sen ,130 Fed .379 Re
Baker, 29 How. Pr. (N .Y .) 485 Ol le t v . Pi t t sburgh , C .C.
& St . L. R. Co . (Pa .), 50 A t l .1011 Lord v .Claxton
(Ga.),8 S.E.2d 657 .
[109 ]PEDROP.SOLIS,MEDICALJURISPRUDENCE338 (1988 ).
[110 ] C.R.A . MARTIN, LAW RELATING TO MEDICAL PRACTICE 340 41
(1979 ) (c i t a t i onsomi t t ed ).
[111 ]PEDROP.SOLIS,MEDICALJURISPRUDENCE338 (1988 ).
[112 ]C.R.A .MARTIN,LAWRELATINGTOMEDICALPRACTICE41 (1979 )(c i t
a t i onsomi t t ed ).
[113 ] As opposed to a p riva t e chari t ab l e o r e l
eemosynary hosp i t a l . PEDRO P. SOLIS, MEDICALJURISPRUDENCE306 7
(1988 )
[114 ] 40A AM. JUR. 2D Hosp i ta l s and Asylums 8 (1999 ), c i
t i ng Port er v . McPherson , 198 W. Va.158 ,479 S.E.2d 668 (1996
).
[115 ]Id . c i t i ng Trevino v .HHLFinancia l Serv i ces,Inc .
, 945 P.2d 1345 (Co lo .1997 ).
[116 ]TSN,October5 ,1995 ,pp .43 44 ,58 59 ,62 .
[117 ]See 40AAM.JUR.2D Hosp i ta l sand Asylums8 (1999 ), ci t i
ng Heart land Hea l th Syst ems, Inc .v .Chamberl in , 871 S.W.2d 8
(1993 ).
[118 ]TSN,October27 ,1994 ,p .26 27 .
[119 ]G .R.No .149275 ,Sep tember27 ,2004 ,439 SCRA220 .
[120 ]Id . at 230 233 .
[121 ]Ro l lo , p .44 .
[122 ]Id .a t 103 .
[123 ]Id .a t 42 .
[124 ]Sup ra no t e 121 .
[125 ]Sup ra no t e 122 i d .a t 43 .
-
[126 ]Id .a t 46 .
[127 ] See THE CIVIL CODE OF THE PHILIPPINES, Repub l i c Act No
. 386 , as amended , A rt i c l e2219 (1950 ).
[128 ]See Soberano v .Man i la Ra i l road Company , 124 Ph i l
.1330 ,1337 (1966 ) S t rebel v . Figueras ,96 Ph i l .321 ,330
(1954 ) Araneta v .Arreg lado , 104 Ph i l .529 ,533 (1958 ).
[129 ]
Reco rds,pp .178 197 .[130 ]
TSN,August 15 ,1996 ,pp .4 5 .[131 ]
TSN,October 27 , 1994 , pp . 8 , 10 11 , 24 27 , 32 33
TSN,October 5 , 1995 , pp . 18 , 21 , 26 , 35 36 ,51 53 TSN,January
25 ,1996 ,8 9 ,12 .
[132 ]Exh ib i t 1 .
[133 ]Exh ib i t s1 a and 1 b .
[134 ]Exh ib i t s2 t o 2 c .
[135 ]Exh ib i t s3 t o 4 b .
[136 ]Exh ib i t s11 ,11 b Exh ib i t s13 t o 14 a Exh ib i t
s16 t o 16 d .
[137 ]Ro l lo , pp .94 95 Part i a l PreTri a l O rderda t ed
May 4 ,1994 ,i d .a t 90 91 .
[138 ]TSN,Ju ly 1 ,1994 ,pp .5 ,8 ,19 22 .
[139 ]Id .a t 5 ,9 10 .
[140 ]Tyv .Peop le o f t he Ph i l i pp ines,sup ra no t e 8 ,a
t 234 .
[141 ]Ro l lo , p .47 .
[142 ]Thed i sposi t i ve po rt i on o fTyv .Peop le st a t es:
\
WHEREFORE,t he i n st an t Pet i t i on i sDENIEDand the assa i
l ed Deci sion o f t heCourt o f Appeal s, da t ed 31 Ju ly 2001 ,
fi nd ing pet i t i oner V icky C. Ty GUILTY o fv io l a t i ng
BatasPambansa Bi l ang 22 i sAFFIRMEDwi th MODIFICATIONS. Pet i t i
onerV icky C. Ty i s ORDERED to pay a FINE equ ival en t t o doub
le t he amoun t o f eachd i shono red check sub jec t o f t he
seven cases a t bar w i th subsid i ary impri sonmen t i ncase o f
i n so lvency in acco rdance w i th Art i c l e 39 o f t he Rev i
sed Penal Code. She i sa l so o rdered to pay p ri va t e comp la
inan t , Man i la Docto rs' Hosp i ta l , t h e amoun t o fTwo
Hundred Ten Thousand Pesos(P210 ,000 .00 )represen t ing the t o ta
l amoun t o f t hed i shonored checks.Cost sagain st t he pe t i t
i oner.
SO ORDERED.
(emphasi ssupp l i ed )
[143 ] THE CIVIL CODE OF THE PHILIPPINES, Repub l i c Act No .
386 , as amended , A rt . 2208(1950 ) (In a l l cases, t he a t t o
rneys fees and expenses o f l i t i g a t i on must be reasonab le
.). See ,e .g ., Paci f i c Mi l l s, Inc . v . Court o f Appea l s
, G .R. No . 87182 , Feb ruary 17 , 1992 , 206 SCRA317 .
[144 ]Sect ion 1 o ft he d raft b i l l .
[145 ]Sect ion 2 o ft he d raft b i l l .
[146 ]Where quest i ons o f const i t u t i onal si gn i fi
cance are ra i sed , t he Cou rt can exerc i se i t s power o fjud
i c i a l rev i ew on ly i f t he fo l l ow ing requ i si t es are
comp l i ed : Fi rst , t h ere must be befo re t heCourt an ac tual
case ca l l i ng fo r t he exerc i se o f j ud i c i a l rev i ew .
Second , t he quest i on befo re
-
t h e Cou rt must be ri pe fo rad jud i ca t i on .Th i rd , t
he person chal l eng ing the val id i t y o f t he ac tmust have st
and ing to chal l enge . Fou rth , t he quest i on o f const i t u
t i onal i t y must have beenra i sed a t t he earl i est oppo rtun
i ty , and l ast l y , t he i ssue o f const i t u t i onal i t y
must be t he veryl i s mo ta o f t he case . Al l i ed Banking
Corpora t ion v . Quezon Ci t y Governmen t , G .R. No ,154126
,October11 ,2005 ,472 SCRA303 ,317 Board o f Op tomet ry v .Co le t
, 328 Ph i l .1187 ,1205 (1996 ) Garcia v .Execu t i ve Secre ta ry
, G .R.No . 100883 ,December 2 , 1991 , 204 SCRA516 , 522 San to s
III v . Northwest Ori en t Ai rl i nes , G .R. No . 101538 , June
23 , 1992 , 210SCRA256 ,261 .
[147 ] See Posi t i on Paper da t ed Sep tember 22 , 2004 ,
submi t t ed by the Ph i l i pp ine Med icalAssoci a t i on fo r t
he p resen t a t i on i n t he pub l i c hearing fo r t he Commi t
t ee o f Heal th andDemography ,Senat e ,Repub l i c o ft he Ph i l
i pp ines.