Case digest Facts: Facts: On July 28, 1994, respondent 3 months pregnant Editha Ramolete was brought to Lorma edi!al "enter #L"$ in %an &ernando, La 'nion due to (aginal bleeding upon ad(ise o) petitioner related (ia telephone, Editha was admitted to the L" on the same day* + pel(i! sonogram was then !ondu!ted on Editha re(ealing the )etus wea !ardia! pulsation* -he )ollowing day, Editha repeat pel(i! sonogram showed that aside )rom the )etus wea !ardia! pulsation, no )etal mo(ement was also appre!iated* .ue to persistent and pro)use (aginal bleeding, petitioner ad(ised her to undergo a ./" pro!edure* pro!edure* %he was dis!harged the )ollowing day* On %eptember 10, 1994, Editha was on!e gain brought at the L", as she was su))ering )rom (omiting ans se(ere abdominal pains* Editha was attended by .rs* .ela "ru, ayo and omiya* .r* ayo allegedly in)ormed Editha that there was a dead )etus in the latters womb, a)ter Editha went lapare!tomy, she was )ound to ha(e massi(e intra abdominal hemorrhage and ruptured uterus* -hus, she had to go hystere!tomy and as a result no more !han!e to bear a !hild* Issue: hether Issue: hether or not petitioner is liable )or medi!al malpra!ti!e* Held: 5o* Held: 5o* edi!al malpra!ti!e is a parti!ular )orm o) negligen!e whi!h !onsists in the )ailure o) a physi!ian or surgeon to apply to his pra!ti!e o) medi!ine that degree o) !are and sill whi!h is ordinarily employed by the pro)ession generally under similar !onditions, and in lie surrounding !ir!umstan!es* 6n order to su!!ess)ully pursue su!h a !laim, a patient must pro(e that the physi!ian or surgeon either )ailed to do something whi!h a reasonably prudent physi!ian or surgeon would not ha(e done, and that the )ailure or a!tion !aused in7ury to the patient* -here are )our elements in(ol(ed in medi!al negligen!e !ases duty, brea!h, in7ury, and proimate !ause** + physi!ian:patient relationship was !reated when Editha employed the ser(i!es o) the petitioner* +s Edithas physi!ian, petitioner was duty:bound to use at least the same le(el o) !are that any reasonably !ompetent do!tor would use to treat a !ondition under the same !ir!umstan!es* -he brea!h o) these pro)essional duties o) sill and !are, or their improper per)orman!e by a physi!ian surgeon, whereby the patients in7ured in body or in health, !onstitutes a!tionable malpra!ti!e, as to this aspe!t o) medi!al malpra!ti!e, the determination o) the reasonable le(el o) !are and the brea!h thereo), epert testimony is essential* &urther, in as mu!h as the !auses o) the in7uries in(ol(ed in malpra!ti!e a!tions are determinable only in the light o) s!ienti)i! nowledge, it has been re!ognied that epert testimony is usually ne!essary ne!essary to suspe!t the !on!lusion as to !ausation* 6t is undisputed that Editha did not return )or )ollow:up e(aluation, in de)ian!e o) the petitioners ad(i!e* -his is as )ound out is the proimate !ause o) the in7ury she sustained*
Full text G.R. No. 159132
December 1! 2""
F# C$%$&'($)$*! petitioner, C$%$&'($)$*! petitioner, (s* )+&,)#) C($R& a-d #DIH$ R$*&(##! respondents*; D#CI)I&N $,)RI$'*$RIN#/! J.:
o) the Rules o) "ourt )iled by .r* &e "ayao:Lasam #petitioner$ seeing to annul the .e!ision 1 dated July 4, 2??3 o) the "ourt o) +ppeals #"+$ in "+: @*R* %= 5o* 022?0* -he ante!edent )a!ts On July 28, 1994, respondent, three months pregnant Editha Ramolete #Editha$ was brought to the Lorma edi!al "enter #L"$ in %an &ernando, La 'nion due to (aginal bleeding* 'pon ad(i!e o) petitioner relayed via viatelephone, telephone, Editha was admitted to the L" on the same day* + pel(i! sonogram 2 was then !ondu!ted on Editha re(ealing the )etus wea !ardia! pulsation* 3 -he )ollowing day, Edithas repeat pel(i! sonogram4 showed that aside )rom the )etus wea !ardia! pulsation, no )etal mo(ement was also appre!iated*
.ue to persistent and pro)use (aginal bleeding, petitioner ad(ised Editha to undergo a .ilatation and "urettage =ro!edure #./"$ or Araspa.A On July 3?, 1994, petitioner per)ormed the ./" pro!edure* Editha was dis!harged )rom the hospital the )ollowing day* On %eptember 10, 1994, Editha was on!e again brought at the L", as she was su))ering )rom (omiting and se(ere abdominal pains* Editha was attended by .r* she was )ound to ha(e a massi(e intra:abdominal hemorrhage and a ruptured uterus* -hus, Editha had to undergo a pro!edure )or hystere!tomy 0 and as a result, she has no more !han!e to bear a !hild* On 5o(ember C, 1994, Editha and her husband "laro Ramolete #respondents$ )iled a "omplaint C )or @ross 5egligen!e and alpra!ti!e against petitioner be)ore the =ro)essional Regulations "ommission #=R"$* Respondents alleged that Edithas hystere!tomy was !aused by petitioners unmitigated negligen!e and pro)essional in!ompeten!e in !ondu!ting the ./" pro!edure and the petitioners )ailure to remo(e the )etus inside Edithas womb* 8 +mong the alleged a!ts o) negligen!e were first , petitioners )ailure to !he! up, (isit or administer medi!ation on Editha during her )irst day o) !on)inement at the L"D 9 second , petitioner re!ommended that a ./" pro!edure be per)ormed on Editha without !ondu!ting any internal eamination prior to the pro!edureD 1? third , petitioner immediately suggested a ./" pro!edure instead o) !losely monitoring the state o) pregnan!y o) Editha* 11 6n her +nswer,12 petitioner denied the allegations o) negligen!e and in!ompeten!e with the )ollowing eplanations upon Edithas !on)irmation that she would see admission at the L", petitioner immediately !alled the hospital to anti!ipate the arri(al o) Editha and ordered through the telephone the medi!ines Editha needed to tae, whi!h the nurses !arried outD petitioner (isited Editha on the morning o) July 28, 1994 during her roundsD on July 29, 1994, she per)ormed an internal eamination on Editha and she dis!o(ered that the latters !er(i was already open, thus, petitioner dis!ussed the possible ./" pro!edure, should the bleeding be!ome more pro)useD on July 3? 1994, she !ondu!ted another internal eamination on Editha, whi!h re(ealed that the latters !er(i was still openD Editha persistently !omplained o) her (aginal bleeding and her passing out o) some meaty mass in the pro!ess o) urination and bowel mo(ementD thus, petitioner ad(ised Editha to undergo ./" pro!edure whi!h the respondents !onsented toD petitioner was (ery (o!al in the operating room about not being able to see an abortusD 13 taing the words o) Editha to mean that she was passing out some meaty mass and !lotted blood, she assumed that the abortus must ha(e been epelled in the pro!ess o) bleedingD it was Editha who insisted that she wanted to be dis!hargedD petitioner agreed, but she ad(ised Editha to return )or !he!:up on +ugust >, 1994, whi!h the latter )ailed to do* =etitioner !ontended that it was Edithas gross negligen!e andor omission in insisting to be dis!harged on July 31, 1994 against do!tors ad(i!e and her un7usti)ied )ailure to return )or !he!:up as dire!ted by petitioner that !ontributed to her li)e:threatening !ondition on %eptember 10, 1994D that Edithas hystere!tomy was brought about by her (ery abnormal pregnan!y nown as placenta increta, whi!h was an etremely rare and (ery unusual !ase o) abdominal pla!ental implantation* =etitioner argued that whether or not a ./" pro!edure was done by her or any other do!tor, there would be no di))eren!e at all be!ause at any stage o) gestation be)ore term, the uterus would rupture 7ust the same* On ar!h 4, 1999, the
hen !omplainant Editha was admitted at Lorma edi!al "enter on July 28, 1994 due to (aginal bleeding, an ultra:sound was per)ormed upon her and the result o) the %onogram -est re(eals a morbid )etus but did not spe!i)y where the )etus was lo!ated* Obstetri!ians will assume that the pregnan!y is within the uterus unless so spe!i)ied by the %onologist who !ondu!ted the ultra:sound* Respondent #.r* Lasam$ !annot be )aulted i) she was not able to determine that !omplainant Editha is ha(ing an e!topi! pregnan!y interstitial* -he ./" !ondu!ted on Editha is ne!essary !onsidering that her !er(i is already open and so as to stop the pro)use bleeding* %imple !urettage !annot remo(e a )etus i) the patient is ha(ing an e!topi! pregnan!y, sin!e e!topi! pregnan!y is pregnan!y !on!ei(ed outside the uterus and !urettage is done only within the uterus* -here)ore, a more etensi(e operation needed in this !ase o) pregnan!y in order to remo(e the )etus* 1> &eeling aggrie(ed, respondents went to the =R" on appeal* On 5o(ember 22, 2???, the =R" rendered a .e!ision10 re(ersing the )indings o) the o) the Rules o) "ourt* 6n the .e!ision dated July 4, 2??3, the "+ held that the =etition )or Re(iew under Rule 43 o) the Rules o) "ourt was an improper remedy, as the enumeration o) the quasi-judicial agen!ies in Rule 43 is e!lusi(e* 19 =R" is not among the Guasi:7udi!ial bodies whose 7udgment or )inal orders are sub7e!t o) a petition )or re(iew to the "+, thus, the petition )or re(iew o) the =R" .e!ision, )iled at the "+, was improper* -he "+ )urther held that should the petition be treated as a petition )or certiorari under Rule 0>, the same would still be dismissed )or being improper and premature* "iting %e!tion 202? o) Republi! +!t #R*+*$ 5o* 2382 or the edi!al +!t o) 19>9, the "+ held that the plain, speedy and adeGuate remedy under the ordinary !ourse o) law whi!h petitioner should ha(e a(ailed hersel) o) was to appeal to the O))i!e o) the =resident* 21 Hen!e, herein petition, assailing the de!ision o) the "+ on the )ollowing grounds 1* -HE "O'R- O& +==E+L% ERRE. O5 + I'E%-6O5 O& L+ 65 HOL.65@ -H+- -HE =RO&E%%6O5+L RE@'L+-6O5%K "O6%%6O5 #=R"$ +% E"L'.E. +O5@ -HE I'+%6: J'.6"6+L +@E5"6E% "O5-E=L+-E. '5.ER R'LE 43 O& -HE R'LE% O& "6B6L =RO"E.'RED 2* EBE5 +%%'65@, ARGUENDO, -H+- =R" +% E"L'.E. &RO -HE ='RB6E O& R'LE 43 O& -HE R'LE% O& "6B6L =RO"E.'RE, -HE =E-6-6O5ER +% 5O- =RE"L'.E. &RO &6L65@ + =E-6-6O5 &OR "ER-6OR+R6 HERE -HE .E"6%6O5 +% +L%O 6%%'E. 65 E"E%% O& OR 6-HO'- J'R6%.6"-6O5, OR HERE -HE .E"6%6O5 +% + =+-E5- 5'LL6-MD 3* HERE65 RE%=O5.E5-%:%=O'%E% +RE 5O- +LLOE. * =R"% @R+BE O6%%6O5 -O +&&OR. HERE65 =E-6-O5ER + "H+5"E -O O& -HE R'LE% +5. RE@'L+-6O5% @OBER565@ -HE RE@'L+-6O5 +5. =R+"-6"E O& =RO&E%%6O5+L%D
C* =R" "O6--E. @R+BE +<'%E O& .6%"RE-6O5 65 REBO65@ =E-6-6O5ER% L6"E5%E -O =R+"-6"E E.6"65E 6-HO'- +5 E=ER- -E%-6O5M -O %'==OR- 6-% "O5"L'%6O5 +% -O -HE "+'%E O& RE%=O5.E5- E.6-H+- %6"K R+OLE-E% 65J'RMD 8* =R" "O6--E. +5 EBE5 @R+BER +<'%E O& .6%"RE-6O5 65 -O-+LLM .6%RE@+R.65@ -HE &65.65@ O& -HE o) the Rules and Regulations @o(erning the Regulation and =ra!ti!e o) =ro)essionals, whi!h pro(ides %e!* 3>* -he respondent may appeal the de!ision o) the 9,A to wit %e!tion 20* Appeal fro jud!ent * -he de!ision o) the 9 allows only the respondent in an administrati(e !ase to )ile an appeal with the "ommission while the !omplainant is not allowed to do so is double 7eopardy* =etitioner is o) the belie) that the re(o!ation o) li!ense to pra!ti!e a pro)ession is penal in nature* 24 -he "ourt does not agree* &or one, the prin!iple o) double 7eopardy )inds no appli!ation in administrati(e !ases* .ouble 7eopardy atta!hes only #1$ upon a (alid indi!tmentD #2$ be)ore a !ompetent !ourtD #3$ a)ter arraignmentD #4$ when a (alid plea has been enteredD and #>$ when the de)endant was a!Guitted or !on(i!ted, or the !ase was dismissed or otherwise terminated without the epress !onsent o) the a!!used* 2> -hese elements were not present in the pro!eedings be)ore the o) the Rules and Regulations @o(erning the Regulation and =ra!ti!e o) =ro)essionals !ited by petitioner was subseGuently amended to read %e!* 3>* -he com0lai-a-t6res0o-de-t may appeal the order, the resolution or the de!ision o) the
hate(er doubt was !reated by the pre(ious pro(ision was settled with said amendment* 6t is aiomati! that the right to appeal is not a natural right or a part o) due pro!ess, but a mere statutory pri(ilege that may be eer!ised only in the manner pres!ribed by law* 28 6n this !ase, the !lear intent o) the amendment is to render the right to appeal )rom a de!ision o) the $ days )rom re!eipt o) the de!ision, order or resolution without an appeal being per)e!ted or taen by either the respondent or the !omplainant* $ 0art aggrie8ed b te decisio-! order or resolutio- ma 4ile a -otice o4 a00eal 4rom te decisio-! order or resolutio- o4 te oard to te Commissio- iti- 4i4tee- 15 das 4rom recei0t tereo4! and ser(ing upon the ad(erse party a noti!e o) appeal together with the appellants brie) or memorandum on appeal, and paying the appeal and legal resear!h )ees* 29 -he abo(e:stated pro(ision does not Guali)y whether only the !omplainant or respondent may )ile an appealD rather, the new rules pro(ide that Aa party aggrie(edA may )ile a noti!e o) appeal* -hus, either the !omplainant or the respondent who has been aggrie(ed by the de!ision, order or resolution o) the C, @o(ernment %er(i!e 6nsuran!e %ystem, Employees "ompensation "ommission, +gri!ultural 6n(entions -he Rule epressly pro(ides that it should be applied to appeals )rom awards, 7udgments )inal orders or resolutions o4 a- Guasi:7udi!ial agen!y in the eer!ise o) its Guasi:7udi!ial )un!tions* -he phrase Aamong these agen!iesA !on)irms that the enumeration made in the Rule is not e!lusi(e to the agen!ies therein listed* 30 %pe!i)i!ally, the "ourt, in #an! v. Court of Appeals, 3C ruled that $atas %a&ansa #<*=*$ $l!. 12938 !on)erred upon the "+ e!lusi(e appellate 7urisdi!tion o(er appeals )rom de!isions o) the =R"* -he "ourt held
-he law has sin!e been !hanged, howe(er, at least in the matter o) the parti!ular !ourt to whi!h appeals )rom the "ommission should be taen* On +ugust 14, 1981, -he brea!h o) these pro)essional duties o) sill and !are, or their improper per)orman!e by a physi!ian surgeon, whereby the patient is in7ured in body or in health, !onstitutes a!tionable malpra!ti!e* 40 +s to this aspe!t o) medi!al malpra!ti!e, the determination o) the reasonable le(el o) !are and the brea!h thereo), epert testimony is essential* 4C &urther, inasmu!h as the !auses o) the in7uries in(ol(ed in malpra!ti!e a!tions are determinable only in the light o) s!ienti)i! nowledge, it has been re!ognied that epert testimony is usually ne!essary to support the !on!lusion as to !ausation* 48 6n the present !ase, respondents did not present any epert testimony to support their !laim that petitioner )ailed to do something whi!h a reasonably prudent physi!ian or surgeon would ha(e done* =etitioner, on the other hand, presented the testimony o) .r* +ugusto * analo, who was !learly an epert on the sub7e!t* @enerally, to Guali)y as an epert witness, one must ha(e a!Guired spe!ial nowledge o) the sub7e!t matter about whi!h he or she is to testi)y, either by the study o) re!ognied authorities on the sub7e!t or by pra!ti!al eperien!e*49 .r* analo spe!ialies in gyne!ology and obstetri!s, authored and !o:authored (arious publi!ations on the sub7e!t, and is a pro)essor at the 'ni(ersity o) the =hilippines* >? +!!ording to him, his diagnosis o) Edithas !ase was AE!topi! =regnan!y 6nterstitial #also re)erred to as "ornual$, Ruptured*A >1 6n stating that the ./" pro!edure was not the proimate !ause o) the rupture o) Edithas uterus resulting in her hystere!tomy, .r* analo testi)ied as )ollows +tty* Hidalgo I .o!tor, we want to be !lari)ied on this matter* -he !omplainant had testi)ied here that the ./" was the proimate !ause o) the rupture o) the uterus* -he !ondition whi!h she )ound hersel) in on the se!ond admission* ill you please tell us whether that is true or notN
+ Mah, I do -ot ti-> so 4or to reaso-s. One, as 6 ha(e said earlier, the instrument !annot rea!h the site o) the pregnan!y, )or it to )urther push the pregnan!y outside the uterus* +nd, 5o* 2, 6 was thining a while ago about another reason: well, why 6 dont thin so, be!ause it is the triggering )a!tor )or the rupture, it !ould ha(ethe rupture !ould ha(e o!!urred mu!h earlier, right a)ter the ./" or a )ew days a)ter the ./"* I 6n this parti!ular !ase, do!tor, the rupture o!!urred to ha(e happened minutes prior to the hystere!tomy or right upon admission on %eptember 1>, 1994 whi!h is about 1 P months a)ter the patient was dis!harged, a)ter the ./" was !ondu!ted* ould you tell us whether there is any relation at all o) the ./" and the rupture in this parti!ular instan!eN + I do-?t ti-> so 4or te to reaso-s tat I a8e ;ust me-tio-ed' tat it ould -ot be 0ossible 4or te i-strume-t to reac te site o4 0reg-a-c. +nd, 5o* 2, i) it is be!ause o) the ./" that rupture !ould ha(e o!!urred earlier* >2 #Emphases supplied$ "learly, )rom the testimony o) the epert witness and the reasons gi(en by him, it is e(ident that the ./" pro!edure was not the proimate !ause o) the rupture o) Edithas uterus* .uring his !ross:eamination, .r* analo testi)ied on h ow he would ha(e addressed Edithas !ondition should he be pla!ed in a similar !ir!umstan!e as the petitioner* He stated +tty* Ragonton I .o!tor, as a pra!ti!ing O<:@yne, when do you !onsider that you ha(e done a good, !orre!t and ideal dilatation and !urettage pro!edureN + ell, i) the patient re!o(ers* 6) the patient gets well*
-here was si!K some portions o) the )etal parts that were remo(edN
+
5o, it was des!ribed as s!anty s!raping i) 6 remember it rights!anty*
I
+nd you would not mind !he!ing those s!ant or those little parts that were remo(edN
+ ell, te 4act tat it as described mea-s! I assume tat it as cec>ed! Qno* 6t was des!ribed as s!anty and the !olor also, 6 thin was des!ribed* ecause it ould be 8er u-usual! e8e- im0robable tat it ould -ot be exami-ed! because e- ou scra0e! te s0ecime-s are rigt tere be4ore our ees. It?s i- 4ro-t o4 ou. %ou ca- touc it. I- 4act! some o4 tem ill stic> to te i-strume-t a-d tere4ore to 0eel it o44 4rom te i-strume-t! ou a8e to touc tem. )o! automaticall te are exami-ed closel. I
+s a matter o) )a!t, do!tor, you also gi(e telephone orders to your patients through telephoneN
+ Mes, yes, we do that, espe!ially here in anila be!ause you now, sometimes a do!tor !an also be tied:up somewhere and i) you ha(e to wait until he arri(e at a !ertain pla!e be)ore you gi(e the order, then it would be a lot o) time wasted*
-ot alloi-g tele0o-e orders u-less it is te 4irst time tat ou ill be e-cou-teri-g te 0atie-t. -hat you ha(e no idea what the problem is* I
+ %ometimes yes, depending on how )amiliar 6 am with the patient* e are on the Guestion o) telephone orders* 6 am not saying that that is the idle si!K thing to do, but I ti-> te realit o4 0rese-t da 0ractice someo ;usti4ies tele0o-e orders. 6 ha(e patients whom 6 ha(e 7usti)ied and then all o) a sudden, late in the a)ternoon or late in the e(ening, would suddenly !all they ha(e de!ided that they will go home inasmu!h as they anti!ipated that 6 will dis!harge them the )ollowing day* %o, 6 7ust !all and as our resident on duty or the nurse to allow them to go be!ause 6 ha(e seen that patient and 6 thin 6 ha(e )ull grasp o) her problems* %o, thats when 6 mae this telephone orders* +nd, o) !ourse be)ore gi(ing that order 6 as about how she )eels* >3 #Emphases supplied$ &rom the )oregoing testimony, it is !lear that the ./" pro!edure was !ondu!ted in a!!ordan!e with the standard pra!ti!e, with the same le(el o) !are that any reasonably !ompetent do!tor would use to treat a !ondition under the same !ir!umstan!es, and that there was nothing irregular in the way the petitioner dealt with Editha* edi!al malpra!ti!e, in our 7urisdi!tion, is o)ten brought as a !i(il a!tion )or damages under +rti!le 21C0 >4 o) the "i(il "ode* -he de)enses in an a!tion )or damages, pro(ided )or under +rti!le 21C9 o) the "i(il "ode are +rt* 21C9* @e- te 0lai-ti44?s o- -eglige-ce as te immediate a-d 0roximate cause o4 is i-;ur! e ca--ot reco8er damages. > +n in7ury or damage is proimately !aused by an a!t or a )ailure to a!t, whene(er it appears )rom the e(iden!e in the !ase that the a!t or omission played a substantial part in bringing about or a!tually !ausing the in7ury or damageD and that the in7ury or damage was either a dire!t result or a reasonably probable !onseGuen!e o) the a!t or omission*>0 6n the present !ase, the "ourt notes the )indings o) the C #Emphases supplied$ +lso, in the testimony o) .r* analo, he stated )urther that assuming that there was in )a!t a misdiagnosis, the same would ha(e been re!ti)ied i) Editha )ollowed the petitioners order to return )or a !he!:up on +ugust 4, 1994* .r* analo stated Gra-ti-g tat te obstetricia-'g-ecologist as bee- misled ;usti4iabl u0 to tus 0oi-t tat tere ould a8e bee- am0le o00ortu-it to recti4 te misdiag-osis! ad te 0atie-t retur-ed! as i-structed 4or er 4ollo'u0 e8aluatio-. It as o-e a-d a al4 mo-ts later tat te 0atie-t sougt co-sultatio- it a-oter doctor. -he !ontinued growth o) an e!topi! pregnan!y, until its e(entual rupture, is a dynami! pro!ess* u!h !hange in physi!al )indings !ould be epe!ted in 1 P months, in!luding the emergen!e o) suggesti(e ones* >8
6t is undisputed that Editha did not return )or a )ollow:up e(aluation, in de)ian!e o) the petitioners ad(ise* Editha omitted the diligen!e reGuired by the !ir!umstan!es whi!h !ould ha(e a(oided the in7ury* -he omission in not returning )or a )ollow:up e(aluation played a substantial part in bringing about Edithas own in7ury* Had Editha returned, petitioner !ould ha(e !ondu!ted the proper medi!al tests and pro!edure ne!essary to determine Edithas health !ondition and applied the !orresponding treatment whi!h !ould ha(e pre(ented the rupture o) Edithas uterus* -he ./" pro!edure ha(ing been !ondu!ted in a!!ordan!e with the standard medi!al pra!ti!e, it is !lear that Edithas omission was the proimate !ause o) her own in7ury and not merely a !ontributory negligen!e on her part* "ontributory negligen!e is the a!t or omission amounting to want o) ordinary !are on the part o) the person in7ured, whi!h, !on!urring with the de)endants negligen!e, is the proimate !ause o) the in7ury* >9 .i))i!ulty seems to be apprehended in de!iding whi!h a!ts o) the in7ured party shall be !onsidered immediate !auses o) the a!!ident*0? here the immediate !ause o) an a!!ident resulting in an in7ury is the plainti))s own a!t, whi!h !ontributed to the prin!ipal o!!urren!e as one o) its determining )a!tors, he !annot re!o(er damages )or the in7ury*01 $gai-! based o- te e8ide-ce 0rese-ted i- te 0rese-t case u-der re8ie! i- ic -o -eglige-ce ca- be attributed to te 0etitio-er! te immediate cause o4 te accide-t resulti-g i#dita?s i-;ur as er o- omissio- e- se did -ot retur- 4or a 4ollo'u0 cec> u0! ide4ia-ce o4 0etitio-er?s orders. e immediate cause o4 #dita?s i-;ur as er o- act7 tus! se ca--ot reco8er damages 4rom te i-;ur. Lastly, petitioner asserts that her right to due pro!ess was (iolated be!ause she was ne(er in)ormed by either respondents or by the =R" that an appeal was pending be)ore the =R"* 02 =etitioner !laims that a (eri)i!ation with the re!ords se!tion o) the =R" re(ealed that on +pril 1>, 1999, respondents )iled a emorandum on +ppeal be)ore the =R", whi!h did not atta!h the a!tual registry re!eipt but was merely indi!ated therein* 03 Respondents, on the other hand a(ers that i) the original registry re!eipt was not atta!hed to the emorandum on +ppeal, =R" would not ha(e entertained the appeal or a!!epted su!h pleading )or la! o) noti!e or proo) o) ser(i!e on the other party *04 +lso, the registry re!eipt !ould not be appended to the !opy )urnished to petitioners )ormer !ounsel, be!ause the registry re!eipt was already appended to the original !opy o) the emorandum o) +ppeal )iled with =R"* 0> 6t is a well:settled rule that when ser(i!e o) noti!e is an issue, the rule is that the person alleging that the noti!e was ser(ed must pro(e the )a!t o) ser(i!e* -he burden o) pro(ing noti!e rests upon the party asserting its eisten!e*00 6n the present !ase, respondents did not present any proo) that petitioner was ser(ed a !opy o) the emorandum on +ppeal* -hus, respondents were not able to satis)y the burden o) pro(ing that they had in )a!t in)ormed the petitioner o) the appeal pro!eedings be)ore the =R"* 6n ED'-"taff&uilders 'nternational, 'nc. v. National (a&or Relations Coission,0C in whi!h the 5ational Labor Relations "ommission )ailed to order the pri(ate respondent to )urnish the petitioner a !opy o) the +ppeal emorandum, the "ourt held that said )ailure depri(ed the petitioner o) pro!edural due pro!ess guaranteed by the "onstitution, whi!h !ould ha(e ser(ed as basis )or the nulli)i!ation o) the pro!eedings in the appeal* -he same holds true in the !ase at bar* -he "ourt )inds that the )ailure o) the respondents to )urnish the petitioner a !opy o) the emorandum o) +ppeal submitted to the =R" !onstitutes a (iolation o) due pro!ess* -hus, the pro!eedings be)ore the =R" were null and (oid* +ll told, do!tors are prote!ted by a spe!ial rule o) law* -hey are not guarantors o) !are* -hey are not insurers against mishaps or unusual !onseGuen!es 08 spe!ially so i) the patient hersel) did not eer!ise the proper diligen!e reGuired to a(oid the in7ury* @H#R#F&R#, the petition is GR$N#D. -he assailed .e!ision o) the "ourt o) +ppeals dated July 4, 2??3 in "+:@R %= 5o* 022?0 is hereby R##R)#D and )# $)ID#* -he .e!ision o) the