Cabugao vs. People

12/19/21, 6:16 PM SUPREME COURT REPORTS ANNOTATED VOLUME 731
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G.R. No. 163879. July 30, 2014.*

DR. ANTONIO P. CABUGAO, petitioner, vs. PEOPLE OF THE
PHILIPPINES and SPOUSES RODOLFO M. PALMA and
ROSARIO F. PALMA, respondents.
G.R. No. 165805. July 30, 2014.*
DR. CLENIO YNZON, petitioner, vs. PEOPLE OF THE

PHILIPPINES and SPOUSES RODOLFO M. PALMA and
ROSARIO F. PALMA, respondents.
Criminal Law; Reckless Imprudence; Reckless imprudence consists of

voluntarily doing or failing to do, without malice, an act from which
material damage results by reason of an inexcusable lack of precaution on
the part of the person performing or failing to perform such act.—Reckless
imprudence consists of voluntarily doing or failing to do, without malice, an
act from which material damage results by reason of an inexcusable lack of
precaution on the part of the person performing or failing to perform such
act. The elements of reckless imprudence are: (1) that the offender does or
fails to do an act; (2) that the doing or the failure to do that act is voluntary;
(3) that it be without malice; (4) that material damage results from the
reckless imprudence; and (5) that there is inexcusable lack of precaution on
the part of the offender, taking into consideration his employment or
occupation, degree of intelligence, physical condition, and other
circumstances regarding persons, time and place.
Remedial Law; Evidence; Expert Witnesses; Whether a physician or
surgeon has exercised the requisite degree of skill and care in the treatment
of his patient is, in the generality of cases, a matter of expert opinion.—
Verily, whether a physician or surgeon has exercised the requisite degree of
skill and care in the treatment of his patient is, in the generality of cases, a
matter of expert opinion. The deference of courts to the expert opinions of
qualified physicians stems from its realization that the latter possess unusual
technical skills which laymen in most instances are incapable of
intelligently
_______________
* THIRD DIVISION.
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Cabugao vs. People
evaluating. From the testimonies of the expert witnesses presented, it was

irrefutably proven that Dr. Ynzon failed to practice that degree of skill and
care required in the treatment of his patient.
Criminal Law; Reckless Imprudence; Among the elements constitutive
of reckless imprudence, what perhaps is most central to a finding of guilt is
the conclusive determination that the accused has exhibited, by his
voluntary act without malice, an inexcusable lack of precaution.—Among
the elements constitutive of reckless imprudence, what perhaps is most
central to a finding of guilt is the conclusive determination that the accused
has exhibited, by his voluntary act without malice, an inexcusable lack of
precaution. It is that which supplies the criminal intent so indispensable as
to bring an act of mere negligence and imprudence under the operation of
the penal law. This is because a conscious indifference to the consequences
of the conduct is all that is required from the standpoint of the frame of
mind of the accused. Quasi-offenses penalize the mental attitude or
condition behind the act, the dangerous recklessness, the lack of care or
foresight, the “imprudencia punible,” unlike willful offenses which punish
the intentional criminal act. This is precisely where this Court found Dr.
Ynzon to be guilty of — his seemingly indifference to the deteriorating
condition of JR that he as a consequence, failed to exercise lack of
precaution which eventually led to JR’s death.
Same; Actions; Prosecution of Offenses; Every criminal conviction
requires of the prosecution to prove two things — the fact of the crime, i.e.,
the presence of all the elements of the crime for which the accused stands
charged, and the fact that the accused is the perpetrator of the crime.—
Every criminal conviction requires of the prosecution to prove two things —
the fact of the crime, i.e., the presence of all the elements of the crime for
which the accused stands charged, and the fact that the accused is the
perpetrator of the crime. Based on the above disquisitions, however, the
prosecution failed to prove these two things. The Court is not convinced
with moral certainty that Dr. Cabugao is guilty of reckless imprudence as
the elements thereof were not proven by the prosecution beyond a
reasonable doubt.
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Cabugao vs. People
Same; Death of the Accused; In People v. Bayotas, 236 SCRA 239

(1994), the Supreme Court (SC) laid down the rules in case the accused dies
prior to final judgment.—While this case is pending appeal, counsel for
petitioner Dr. Ynzon informed the Court that the latter died on December
23, 2011 due to “multi-organ failure” as evidenced by a copy of death
certificate. Thus, the effect of death, pending appeal of his conviction of
petitioner Dr. Ynzon with regard to his criminal and pecuniary liabilities
should be in accordance to People v. Bayotas, 236 SCRA 239 (1994),
wherein the Court laid down the rules in case the accused dies prior to final
judgment: 1. Death of the accused pending appeal of his conviction
extinguishes his criminal liability as well as the civil liability based solely
thereon. As opined by Justice Regalado, in this regard, “the death of the
accused prior to final judgment terminates his criminal liability and only the
civil liability directly arising from and based solely on the offense
committed, i.e., civil liability ex delicto in senso strictiore.” 2. Corollarily,
the claim for civil liability survives notwithstanding the death of accused,
if the same may also be predicated on a source of obligation other than
delict. Article 1157 of the Civil Code enumerates these other sources of
obligation from which the civil liability may arise as a result of the same
act or omission: a) Law b) Contracts c) Quasi-contracts d)
x x x x x x x x x e) Quasi-delicts 3. Where the civil liability survives, as
explained in Number 2 above, an action for recovery therefor may be
pursued but only by way of filing a separate civil action and subject to
Section 1, Rule 111 of the 1985 Rules on Criminal Procedure as amended.
This separate civil action may be enforced either against the
executor/administrator or the estate of the accused, depending on the
source of obligation upon which the same is based as explained above. 4.
Finally, the private offended party need not fear a forfeiture of his right to
file this separate civil action by prescription, in cases where during the
prosecution of the criminal action and prior to its extinction, the private-
offended party instituted together therewith the civil action. In such case, the
statute of limitations on the civil liability is deemed interrupted during the
pendency of the criminal case, conformably with provisions of Article 1155
of the Civil Code, that should thereby avoid any apprehension on a possible
privation of right by prescription.
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Same; Same; The death of the accused Dr. Ynzon pending appeal of his
conviction extinguishes his criminal liability.—It is clear that the death of
the accused Dr. Ynzon pending appeal of his conviction extinguishes his
criminal liability. However, the recovery of civil liability subsists as the
same is not based on delict but by contract and the reckless imprudence he
was guilty of under Article 365 of the Revised Penal Code. For this reason,
a separate civil action may be enforced either against the
executor/administrator or the estate of the accused, depending on the source
of obligation upon which the same is based, and in accordance with Section
4, Rule 111 of the Rules on Criminal Procedure.
Same; Damages; Independent Civil Action; Upon the extinction of the
criminal liability and the offended party desires to recover damages from
the same act or omission complained of, the party may file a separate civil
action based on the other sources of obligation in accordance with Section
4, Rule 111.—Upon the extinction of the criminal liability and the offended
party desires to recover damages from the same act or omission complained
of, the party may file a separate civil action based on the other sources of
obligation in accordance with Section 4, Rule 111. If the same act or
omission complained of arises from quasi-delict, as in this case, a separate
civil action must be filed against the executor or administrator of the estate
of the accused, pursuant to Section 1, Rule 87 of the Rules of Court.
PETITIONS for review on certiorari of a decision of the Court of

Appeals.
The facts are stated in the opinion of the Court.
Alexander G. Castro for petitioner Dr. Cabugao.
Arthur Autea & Associates for petitioner Dr. Clenio Ynzon.
Rodolfo M. Palma for private respondents.
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Cabugao vs. People
PERALTA, J.:
Before this Court are appeals via Rule 45 from the Decision1
dated June 4, 2004 of the Court of Appeals in C.A.-G.R. CR No.
27293, affirming the Decision2 dated February 28, 2003 of the
Regional Trial Court (RTC), convicting petitioners Dr. Antonio P.
Cabugao (Dr. Cabugao) and Dr. Clenio Ynzon (Dr. Ynzon) of the
crime of Reckless Imprudence Resulting to Homicide.
The Information3 alleged —
That on or about June 17, 2000 in the City of Dagupan, Philippines, and
within the jurisdiction of this Honorable Court, the above named accused,
DR. ANTONIO P. CABUGAO and DR. CLENIO YNZON, being then the
attending physicians of one RODOLFO PALMA, JR., a minor 10 years old,
confederating and acting jointly with one another, did, then and there,
willfully, unlawfully and feloniously fail through negligence, carelessness
and imprudence to perform immediate operation upon their patient,
RODOLFO PALMA, JR. of acute appendicitis, when they, the said
physicians, should have been done so considering that examinations
conducted upon their patient Rodolfo Palma, Jr. seriously manifest to do so,
causing by such negligence, carelessness, and imprudence the victim,
RODOLFO PALMA, JR., to die due to:
“CARDIORESPIRATORY ARREST, METABOLIC

ENCEPHALOPATHY, SEPTICEMIA (ACUTE APPENDICITIS),
CEREBRAL ANEURYSM RUPTURED (?)”
_______________
1 Penned by Associate Justice Martin S. Villarama, Jr. (now a member of the Supreme
Court), with Associate Justices Regalado E. Maambong and Lucenito N. Tagle, concurring;
Rollo (G.R. No. 163879), pp. 25-46.
2 Rollo (G.R. No. 165805), pp. 106-112.
3 Id., at pp. 103-104.
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As per Certificate of Death issued by accused Dr. Antonio P. Cabugao, to

the damage and prejudice of the legal heirs of said deceased RODOLFO
PALMA, JR. and other consequential damages relative thereto.
CONTRARY to Article 365, 1st par. of the Revised Penal Code.
Dagupan City, Philippines, January 29, 2001.
Arising from the same events, the Court resolved to

consolidate these cases.4 The facts, as culled from the records, are as
follows: On June 14, 2000, at around 4 o’clock in the afternoon, ten
(10)-year old Rodolfo F. Palma, Jr. (JR) complained of abdominal
pain to his mother, Rosario Palma. At 5 o’clock that same afternoon,
Palma’s mother and father, Atty. Rodolfo Palma Sr., brought JR to
the clinic of accused Dr. Cabugao. Dr. Cabugao, a general
practitioner, specializing in family medicine gave medicines for the
pain and told Palma’s parents to call him up if his stomach pains
continue. Due to persistent abdominal pains, at 4:30 in the early
morning of June 15, 2000, they returned to Dr. Cabugao, who
advised them to bring JR to the Nazareth General Hospital in
Dagupan City, for confinement. JR was admitted at the said hospital
at 5:30 in the morning.5
Blood samples were taken from JR for laboratory testing. The
complete blood count conveyed the following result: wbc – 27.80 x
10 9/L; lymphocytes – 0.10 and neutrophils – 0.90. Diagnostic
ultrasound was likewise conducted on the patient’s lower abdomen
by radiologist, Dr. Ricky V. Querubin, with the following findings:
Normal liver, bile ducts, gallbladder, pancreas, spleen, kidneys and urinary
bladder.
_______________
4 Resolution dated August 2, 2006; id., at p. 611.
5 Rollo (G.R. No. 163879), p. 26.
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There is no free peritoneal fluid.

There is localized tenderness in the paraumbilical region, more so in the
supra and right paraumbilical areas.
There is a vague elongated hypoechoic focus in the right periumbilical
region roughly about 47 x 18 mm surrounded by undistended gas-filled
bowels. This is suggestive of an inflammatory process wherein
appendiceal or periappendiceal pathology cannot be excluded. Clinical
correlation is essential.6
Dr. Cabugao did a rectal examination noting the following:

“rectal: good sphincter, negative tenderness, negative mass.” The
initial impression was Acute Appendicitis,7 and hence, he referred
the case to his co-accused, Dr. Ynzon, a surgeon.8 In the later part of
the morning of June 15, 2000, Dr. Ynzon went to the hospital and
read the CBC and ultrasound results. The administration of massive
antibiotics and pain reliever to JR were ordered. Thereafter, JR was
placed on observation for twenty-four (24) hours.
In the morning of June 16, 2000, JR complained again of
abdominal pain and his parents noticed a swelling in his scrotum. In
the afternoon of the same day, JR vomitted out greenish stuff three
(3) times and had watery bowels also three (3) times. The nurses on
duty relayed JR’s condition to Dr. Ynzon who merely gave orders
via telephone.9 Accused continued medications to alleviate JR’s
abdominal spasms and diarrhea. By midnight, JR again vomitted
twice, had loose bowel movements and was unable to sleep. The
following morning, June 17, 2000, JR’s condition worsened, he had
a running fever of 38oC. JR’s fever remained uncontrolled and he
became unconscious, he was given Aeknil (1 ampule) and Valium (1
ampule). JR’s condition continued to deteriorate
_______________
6 Exhibit “C,” Records, p. 23. (Emphasis ours)
7 Exhibit “D-2,” id., at p. 331.
8 Rollo, p. 27.
9 Pre-trial Order; Records, p. 181.
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that by 2 o’clock in the afternoon, JR’s temperature soared to 42oC,

had convulsions and finally died.
The Death Certificate10 dated June 19, 2000 prepared by Dr.
Cabugao indicated the following causes of death:
Immediate cause: CARDIORESPIRATORY ARREST

Antecedent cause: METABOLIC ENCEPHALOPATHY
Underlying cause: SEPTICEMIA (ACUTE APPENDICITIS)
Other significant conditions contributing to death:
CEREBRAL ANEURYSM RUPTURED (?)
No post-mortem examination was conducted on JR. On

February 1, 2001, an Information was filed against accused for
reckless imprudence resulting to homicide. At their arraignment,
both accused, duly assisted by counsel, pleaded not guilty to the
charge.
On February 28, 2003, in convicting both the accused, the trial
court found the following circumstances as sufficient basis to
conclude that accused were indeed negligent in the performance of
their duties:
It is unquestionable that JR was under the medical care of the accused

from the time of his admission for confinement at the Nazareth General
Hospital until his death. Upon his admission, the initial working diagnosis
was to consider acute appendicitis. To assist the accused in the consideration
of acute appendicitis, Dr. Cabugao requested for a complete blood count
(CBC) and a diagnostic ultrasound on JR. The findings of the CBC and
ultrasound showed that an inflammatory process or infection was going on
inside the body of JR. Said inflammatory process was happening in the
periumbilical region where the appendix could be located. The initial
diagnosis of acute appendicitis appears to be a distinct possibility. x x x.
_______________
10 Exhibit “E,” id., at p. 6.
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Cabugao vs. People
Dr. Ynzon ordered medications to treat the symptoms being manifested

by JR. Thereafter, he ordered that JR be observed for 24 hours. However,
the accused, as the attending physicians, did not personally monitor JR in
order to check on subtle changes that may occur. Rather, they left the
monitoring and actual observation to resident physicians who are just on
residency training and in doing so, they substituted their own expertise, skill
and competence with those of physicians who are merely new doctors still
on training. Not having personally observed JR during this 24-hour critical
period of observation, the accused relinquished their duty and thereby were
unable to give the proper and correct evaluation as to the real condition of
JR. In situations where massive infection is going on as shown by the
aggressive medication of antibiotics, the condition of the patient is serious
which necessitated personal, not delegated, attention of attending
physicians, namely JR and the accused in this case.
xxxx
Throughout the course of the hospitalization and treatment of JR, the
accused failed to address the acute appendicitis which was the initial
diagnosis. They did not take steps to find out if indeed acute appendicitis
was what was causing the massive infection that was ongoing inside the
body of JR even when the inflammatory process was located at the
paraumbilical region where the appendix can be located. x x x
There may have been other diseases but the records do not show that the
accused took steps to find out what disease exactly was plaguing JR. It was
their duty to find out the disease causing the health problem of JR, but they
did not perform any process of elimination. Appendicitis, according to
expert testimonies, could be eliminated only by surgery but no surgery was
done by the accused. But the accused could not have found out the real
disease of JR because they were treating merely and exclusively the
symptoms by means of the different medications to arrest the manifested
symptoms. In fact, by treating the symptoms alone, the accused were reck-
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lessly and wantonly ignoring the same as signs of the graver health problem
of JR. This gross negligence on the part of the accused allowed the infection
to spread inside the body of JR unabated. The infection obviously spread so
fast and was so massive that within a period of only two and a half (2 1/2)
days from the day of admission to the hospital on June 15, 2000, JR who
was otherwise healthy died [of] Septicemia (Acute Appendicitis) on June
17, 2000.11
On June 4, 2004, in affirming the accused’s conviction, the Court

of Appeals gave similar observations, to wit:
The foregoing expert testimony clearly revealed such want of reasonable

skill and care on the part of JR’s attending physicians, appellants Dr.
Cabugao and Dr. Ynzon in neglecting to monitor effectively and sufficiently
the developments/changes during the observation period and act upon the
situation after said 24-hour period when his abdominal pain subsisted, his
condition even worsened with the appearance of more serious symptoms of
nausea, vomiting and diarrhea. Considering the brief visit only made on
regular rounds, the records clearly show such gross negligence in failing to
take appropriate steps to determine the real cause of JR’s abdominal pain so
that the crucial decision to perform surgery (appendectomy) had even been
ruled out precisely because of the inexcusable neglect to undertake such
efficient diagnosis by process of elimination, as correctly pointed out by the

trial court. As has been succinctly emphasized by Dr. Mateo, acute
appendicitis was the working diagnosis, and with the emergence of
symptoms after the 24-hour observation (high fever, vomiting, diarrhea)
still, appellants ruled out surgery, not even considering exploratory
laparoscopy. Dr. Mateo also expressed the opinion that the decision to
operate could have been made after the result of the ultrasound test,
considering
_______________
11 Rollo (G.R. No. 165805), pp. 110-111.
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Cabugao vs. People
that acute appendicitis was the initial diagnosis by Dr. Cabugao after he had
conducted a rectal examination.
Medical records buttress the trial court’s finding that in treating JR,
appellants have demonstrated indifference and neglect of the patient’s
condition as a serious case. Indeed, appendicitis remains a clinical
emergency and a surgical disease, as correctly underscored by Dr. Mateo, a
practicing surgeon who has already performed over a thousand
appendectomy. In fact, appendectomy is the only rational therapy for acute
appendicitis; it avoids clinical deterioration and may avoid chronic or
recurrent appendicitis. Although difficult, prompt recognition and
immediate treatment of the disease prevent complications. Under the factual
circumstances, the inaction, neglect and indifference of appellants who, after
the day of admission and after being apprised of the ongoing infection from
the CBC and initial diagnosis as acute appendicitis from rectal examination
and ultrasound test and only briefly visited JR once during regular rounds
and gave medication orders by telephone — constitutes gross negligence
leading to the continued deterioration of the patient, his infection having
spread in so fast a pace that he died within just two and a half (2 1/2) days’
stay in the hospital. Authorities state that if the clinical picture is unclear a
short period of 4 to 6 hours of watchful waiting and a CT scan may improve
diagnostic accuracy and help to hasten diagnosis. Even assuming that JR’s
case had an atypical presentation in view of the location of his appendix,
laboratory tests could have helped to confirm diagnosis, as Dr. Mateo opined
that the possibility of JR having a retrocecal appendicitis should have been a
strong consideration. Lamentably, however, as found by the trial court,
appellants had not taken steps towards correct diagnosis and demonstrated
laxity even when JR was already running a high fever in the morning of
June 17, 2000 and continued vomiting with diarrhea, his abdominal pain
becoming more intense. This is the reason why private complainants were
not even apprised of the progress of appellants’ diagnosis — appellants have
noth-
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ing to report because they did nothing towards the end and merely gave
medications to address the symptoms.12
Thus, these appeals brought before this Court raising the

following arguments:
I
WHETHER THE CAUSE OF ACCUSATION AS CONTAINED IN
THE INFORMATION IS FAILURE TO PERFORM IMMEDIATE
OPERATION UPON THE PATIENT RODOLFO PALMA, JR. OF ACUTE
APPENDICITIS;
II
WHETHER THE SUBJECT INFORMATION APPEARS TO HAVE
ACCUSED BOTH ACCUSED DOCTORS OF CONSPIRACY AND THE
APPEALED DECISION SEEMS TO HAVE TREATED BOTH ACCUSED
DOCTORS TO BE IN CONSPIRACY;
III
WHETHER PETITIONER DR. CABUGAO IS A GENERAL
PRACTITIONER (NOT A SURGEON) AND HAVE EXCLUDED
SURGERY FROM THE LIMITS OF HIS PRACTICE, AND IT WAS NOT
AND NEVER HIS DUTY TO OPERATE THE PATIENT RODOLFO
PALMA, JR., THAT WAS WHY HE REFERRED SUBJECT PATIENT TO
A SURGEON, DR. CLENIO YNZON;
IV
WHETHER THE DEFENSE NEVER STATED THAT THERE IS
GUARANTEE THAT DOING SURGERY WOULD HAVE SAVED THE
PATIENT;
_______________
12 Rollo (G.R. No. 163879), pp. 44-45. (Citations omitted; italics in the original)
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Cabugao vs. People
V
WHETHER THE WITNESSES FOR THE PROSECUTION
INCLUDING PROSECUTION’S EXPERT WITNESSES EVER
DECLARED/TESTIFIED THAT PETITIONER DR. CABUGAO HAD
THE DUTY TO PERFORM IMMEDIATE OPERATION ON RODOLFO
PALMA, JR., AND THEY FAILED TO STATE/SHOW THAT THE
PROXIMATE CAUSE OF DEATH OF JR WAS ACUTE APPENDICITIS;
VI
WHETHER THE EXPERT WITNESSES PRESENTED BY THE
PROSECUTION EVER QUESTIONED THE MANAGEMENT AND
CARE APPLIED BY PETITIONER DR. CABUGAO;
VII
WHETHER THE EXPERT WITNESSES PRESENTED BY THE
DEFENSE ARE UNANIMOUS IN APPROVING THE METHOD OF
TREATMENT APPLIED BY BOTH ACCUSED DOCTORS ON
SUBJECT PATIENT, AND THEY DECLARED/AFFIRMED THAT THEY
WOULD FIRST PLACE SUBJECT THE PATIENT UNDER
OBSERVATION, AND WOULD NOT PERFORM IMMEDIATE
OPERATION;
VIII
WHETHER THE CONVICTION OF PETITIONER DR. YNZON WAS
ESTABLISHED WITH THE REQUIRED QUANTUM OF PROOF
BEYOND REASONABLE DOUBT THAT THE PATIENT WAS
SPECIFICALLY SUFFERING FROM AND DIED OF ACUTE
APPENDICITIS; and
IX
WHETHER THE FAILURE TO CONDUCT THE SPECIFIC
SURGICAL OPERATION KNOWN AS APPENDECTOMY
CONSTITUTED CRIMINAL NEGLIGENCE.
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In a nutshell, the petition brought before this Court raise the
issue of whether or not petitioners’ conviction of the crime of
reckless imprudence resulting in homicide, arising from an alleged
medical malpractice, is supported by the evidence on record.
Worth noting is that the assigned errors are actually factual in
nature, which as a general rule, findings of fact of the trial court and
the Court of Appeals are binding and conclusive upon this Court,
and we will not normally disturb such factual findings unless the
findings of the court are palpably unsupported by the evidence on
record or unless the judgment itself is based on misapprehension of
facts. In the instant case, we find the need to make certain exception.
As To Dr. Ynzon’s Liability:
Reckless imprudence consists of voluntarily doing or failing to
do, without malice, an act from which material damage results by
reason of an inexcusable lack of precaution on the part of the person
performing or failing to perform such act.13 The elements of reckless
imprudence are: (1) that the offender does or fails to do an act; (2)
that the doing or the failure to do that act is voluntary; (3) that it be
without malice; (4) that material damage results from the reckless
imprudence; and (5) that there is inexcusable lack of precaution on
the part of the offender, taking into consideration his employment or

occupation, degree of intelligence, physical condition, and other
circumstances regarding persons, time and place.14
With respect to Dr. Ynzon, all the requisites of the offense have
been clearly established by the evidence on record. The court a quo
and the appellate court were one in concluding
_______________
13 Gaid v. People, G.R. No. 171636, April 7, 2009, 584 SCRA 489, 495.
14 Dr. Cruz v. Court of Appeals, 346 Phil. 872, 883; 282 SCRA 188, 199-200
(1997).
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Cabugao vs. People
that Dr. Ynzon failed to observe the required standard of care

expected from doctors.
In the instant case, it was sufficiently established that to prevent
certain death, it was necessary to perform surgery on JR
immediately. Even the prosecution’s own expert witness, Dr.
Antonio Mateo,15 testified during cross-examination that he would
perform surgery on JR:
ATTY. CASTRO:
Q Given these data soft non-tender abdomen, ambulatory, watery
diarrhea, Exhibit C which is the ultrasound result, with that laboratory
would you operate the patient?
A Yes, I would do surgery.
Q And you should have done surgery with this particular case?
A Yes, sir.16
xxxx
COURT:
Q You stated a while ago doctor that you are going to [do] surgery to
the patient, why doctor, if you are not going to do surgery, what will
happen?
A If this would be appendicitis, the usual progress would be that it
would be ruptured and generalized peritonitis and eventually septicemia, sir.
Q What do you mean by that doctor?
A That means that infection would spread throughout the body, sir.
_______________
15 The prosecution has presented Dr. Antonio Mateo as an expert witness having performed
more than a thousand appendectomy in his seventeen (17) years as a practicing surgeon and
holds the position of Chief of the Department of Surgery of the Rizal Provincial Hospital and a
Regular Fellow of the Philippine College of Surgeons.
16 TSN, June 29, 2001, p. 68. (Emphases ours)
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Q If unchecked doctor, what will happen?

A It will result to death.17
xxxx
Q And what would have you done if you entertain other
considerations from the time the patient was admitted?
A From the time the patient was admitted until the report of the
sonologist, I would have made a decision by then.
Q And when to decide the surgery would it be a particular exact
time, would it be the same for all surgeons?
A If you are asking acute appendicitis, it would be about 24 hours
because acute appendicitis is a 24-hour disease, sir.
Q And would it be correct to say that it depends on the changes on the
condition of the patient?
A Yes, sir.
Q So, are you saying more than 24 hours when there are changes?
A If there are changes in the patient pointing towards appendicitis then
you have to decide right there and then, sir.
Q So if there are changes in the patient pointing to appendicitis?
A It depends now on what you are trying to wait for in the observation
period, sir.
Q So precisely if the change is a condition which bring you in doubt that
there is something else other than appendicitis, would you extend over a
period of 24 hours?
A It depends on the emergent development, sir.
Q That is the point, if you are the attending physician and there is
a change not pointing to
_______________
17 Id., at p. 69. (Emphases ours)
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Cabugao vs. People
appendicitis, would you extend over a period of 24 hours?

A In 24 hours you have to decide, sir.
xxxx
Q And that is based on the assessment of the attending physician?
A Yes, sir.18
Dr. Mateo further testified on cross-examination:
ATTY. CASTRO:
Q So you will know yourself, as far as the record is concerned, because
if you will agree with me, you did not even touch the patient?
A Yes, I based my opinion on what is put on record, sir. The records
show that after the observation period, the abdominal pain is still there
plus there are already other signs and symptoms which are not seen or
noted.
Q But insofar as you yourself not having touched the abdomen of the
patient, would you give a comment on that?
A Yes, based on the record, after 24 hours of observation, the pain
apparently was still there and there was more vomiting and there was
diarrhea. In my personal opinion, I think the condition of the patient was
deteriorating.
Q Even though you have not touched the patient?
A I based on what was on the record, sir.19
From the foregoing, it is clear that if JR’s condition remained

unchecked it would ultimately result in his death, as what actually
happened in the present case. Another expert witness for the
defense, Dr. Vivencio Villaflor, Jr. testified on
_______________
18 Id., at pp. 73-74. (Emphasis ours)
19 TSN, July 18, 2001, p. 11. (Emphases ours)
231
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Cabugao vs. People
direct examination that he would perform a personal and thorough

physical examination of the patient as frequent as every 4 to 6
hours, to wit:
ATTY. CASTRO:
Q As an expert doctor, if you were faced with a history of abdominal
pain with nausea, vomiting, fever, anurecia (sic), elevated white blood cell
count, physical examination of a positive psoas sign, observation of the
sonologist of abdominal tenderness and the ultrasound findings of the
probability of appendiceal (sic) pathology, what will you do if you have
faced these problems, Doctor?
A I will examine the patient thoroughly and it will depend on my
physical examination and that is probably every 4 to 6 hours, sir.20
On cross-examination, Dr. Villaflor affirmed:
Cross Exam. by Atty. Marteja:

Q x x x However, there are corrections and admissions made at that time,
your Honor, do I understand that T/C does not mean ruled out but rather to
consider the matter?

A Yes, now that I have seen the records of the patient, it says here,
impression and T/C means to consider the appendicitis.
Q Isn’t it that it is worth then to say that the initial working diagnosis on
Rodolfo Palma, Jr., otherwise known as JR, to whom I shall now refer to as
JR, the primary consideration then is acute appendicitis, is that correct to
say Doctor?
A I think so, that is the impression.
Q x x x Now if it is to be considered as the primary consideration in the
initial working diagnosis, isn’t
_______________
20 TSN (Dr. Vivencio Villaflor, Jr.), September 7, 2001, p. 17. (Emphasis ours)
232

Cabugao vs. People
it a fact that it has to be ruled out in order to consider it as not the disease of
JR?
A Yes. Sir.
Q Isn’t it a fact that to rule out acute appendicitis as not the disease of
JR, surgery or operation must be done, isn’t it Doctor?
A You have to correlate all the findings.
Q Is it yes or no, Doctor?
A Yes.
Q So, you are saying then that in order to rule out acute
appendicitis there must be an operation, that is right Doctor?
A. No, sir. If your diagnosis is to really determine if it is an acute
appendicitis, you have to operate.21
xxxx
Q. Now Doctor, considering the infection, considering that there was a
[symptom] that causes pain, considering that JR likewise was feverish and
that he was vomiting, does that not show a disease of acute appendicitis
Doctor?
A Its possible.
Q So that if that is possible, are we getting the impression then
Doctor what you have earlier mentioned that the only way to rule out the
suspect which is acute appendicitis is by surgery, you have said that
earlier Doctor, I just want any confirmation of it?
A Yes, sir.22
Verily, whether a physician or surgeon has exercised the

requisite degree of skill and care in the treatment of his pa-
_______________
21 TSN (Dr. V. Villaflor, Jr.), March 20, 2002, pp. 4-5. (Emphases ours)
22 Id., at p. 17. (Emphases ours)
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Cabugao vs. People
tient is, in the generality of cases, a matter of expert opinion. The

deference of courts to the expert opinions of qualified physicians
stems from its realization that the latter possess unusual technical
skills which laymen in most instances are incapable of intelligently
evaluating.23 From the testimonies of the expert witnesses presented,
it was irrefutably proven that Dr. Ynzon failed to practice that
degree of skill and care required in the treatment of his patient.
As correctly observed by the appellate court, Dr. Ynzon revealed
want of reasonable skill and care in attending to the needs of JR by
neglecting to monitor effectively the developments and changes on
JR’s condition during the observation period, and to act upon the
situation after the 24-hour period when his abdominal pain persisted
and his condition worsened. Lamentable, Dr. Ynzon appeared to
have visited JR briefly only during regular rounds in the mornings.
He was not there during the crucial times on June 16, 2000 when
JR’s condition started to deteriorate until JR’s death. As the
attending surgeon, he should be primarily responsible in monitoring
the condition of JR, as he is in the best position considering his skills
and experience to know if the patient’s condition had deteriorated.
While the resident-doctors-on-duty could likewise monitor the
patient’s condition, he is the one directly responsible for the patient
as the attending surgeon. Indeed, it is reckless and gross negligence
of duty to relegate his personal responsibility to observe the
condition of the patient. Again, acute appendicitis was the working
diagnosis, and with the emergence of graver symptoms after the 24-
hour observation, Dr. Ynzon ruled out surgery for no apparent
reason. We, likewise, note that the records are devoid of showing of
any reasonable cause which would lead Dr. Ynzon to overrule
appendectomy despite the initial diagnosis of appendicitis. Neither
was there any showing that he was entertain-
_______________
23 Supra note 14 at p. 885; p. 201.
234

Cabugao vs. People
ing another diagnosis nor he took appropriate steps towards another

diagnosis.
Among the elements constitutive of reckless imprudence, what
perhaps is most central to a finding of guilt is the conclusive
determination that the accused has exhibited, by his voluntary act
without malice, an inexcusable lack of precaution. It is that which
supplies the criminal intent so indispensable as to bring an act of
mere negligence and imprudence under the operation of the penal
law. This is because a conscious indifference to the consequences of
the conduct is all that is required from the standpoint of the frame of
mind of the accused.24 Quasi-offenses penalize the mental attitude or
condition behind the act, the dangerous recklessness, the lack of care
or foresight, the “imprudencia punible,” unlike willful offenses
which punish the intentional criminal act.25 This is precisely where
this Court found Dr. Ynzon to be guilty of — his seemingly
indifference to the deteriorating condition of JR that he as a
consequence, failed to exercise lack of precaution which eventually
led to JR’s death.
To be sure, whether or not a physician has committed an
“inexcusable lack of precaution” in the treatment of his patient is to
be determined according to the standard of care observed by other
members of the profession in good standing under similar
circumstances bearing in mind the advanced state of the profession
at the time of treatment or the present state of medical science. In
accepting a case, a doctor in effect represents that, having the needed
training and skill possessed by physicians and surgeons practicing in
the same field, he will employ such training, care and skill in the
treatment of his patients. He, therefore, has a duty to use at least the
same level of care that any other reasonably compe-
_______________
24 Caminos, Jr. v. People, 605 Phil. 402, 435; 587 SCRA 348, 358 (2009).
25 Ivler v. Modesto-San Pedro, G.R. No. 172716, November 17, 2010, 635 SCRA
191, 223.
235
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Cabugao vs. People
tent doctor would use to treat a condition under the same

circumstances.26 Sadly, Dr. Ynzon did not display that degree of care
and precaution demanded by the circumstances.
As To Dr. Cabugao’s Liability:
Every criminal conviction requires of the prosecution to prove
two things — the fact of the crime, i.e., the presence of all the
elements of the crime for which the accused stands charged, and the
fact that the accused is the perpetrator of the crime. Based on the
above disquisitions, however, the prosecution failed to prove these

two things. The Court is not convinced with moral certainty that Dr.
Cabugao is guilty of reckless imprudence as the elements thereof
were not proven by the prosecution beyond a reasonable doubt.
Both the trial court and the appellate court bewail the failure to
perform appendectomy on JR, or the failure to determine the source
of infection which caused the deterioration of JR’s condition.
However, a review of the records fail to show that Dr. Cabugao is in
any position to perform the required appendectomy.
Immediately apparent from a review of the records of this case is
the fact that Dr. Cabugao is not a surgeon, but a general practitioner
specializing in family medicine;27 thus, even if he wanted to, he
cannot do an operation, much less an appendectomy on JR. It is
precisely for this reason why he referred JR to Dr. Ynzon after he
suspected appendicitis. Dr. Mateo, the prosecution’s expert witness,
emphasized the role of the surgeon during direct examination, to wit:
ATTY. MARTEJA:
Q You had mentioned that under this circumstances and condition,
you have mentioned that surgery is
_______________
26 Garcia-Rueda v. Pascasio, 344 Phil. 323, 332; 278 SCRA 769, 778 (1997).
27 Annex “D-13,” Records, p. 39.
236

Cabugao vs. People
the solution, would you have allowed then a 24 hour observation?

A If there is a lingering doubt, in short period of observation of 18-
24 hours can be allowed provided that there would be close monitoring of
the patient, sir.
Q Would you please tell us who would be doing the monitoring
doctor?
A The best person should be the first examiner, the best surgeon,
sir.
Q So that would you say that it is incumbent on the surgeon
attending to the case to have been the one to observe within the period of
observation?
A Yes, because he will be in the best position to observe the sudden
changes in the condition of the patient, sir.
Q And how often would in your experience doctor, how often
would the surgeon re-assist (sic) the condition of the patient during the
period of observation?
A Most foreign authors would recommend every four (4) hours,
some centers will recommend hourly or every two hours but here in the
Philippines, would recommend for 4 to 6 hours, sir.28
Dr. Cabugao’s supervision does not cease upon his

endorsement of his patient to the surgeon. Here, Dr. Cabugao has
shown to have exerted all efforts to monitor his patient and under
these circumstances he did not have any cause to doubt Dr. Ynzon’s
competence and diligence. Expert testimonies have been offered to
prove the circumstances surrounding the case of JR and the need to
perform an operation. Defense witness, Dr. Villaflor, on cross-
examination testified, to wit:
_______________
28 TSN, June 29, 2001, pp. 35-36. (Emphasis ours)
237
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Cabugao vs. People
Q Isn’t it a fact that to rule out acute appendicitis as not the disease
of JR, surgery or operation must be done, isn’t it Doctor?
A You have to [correlate] all the findings.
Q Is it yes or no, Doctor?
A Yes.
Q So, you are saying then that in order to rule out acute appendicitis
there must be an operation, that is right Doctor?
A No, sir. If your diagnosis is to really determine if it is an acute
appendicitis, you have to operate.29
xxxx
Q Now Doctor, considering the infection, considering that there was
a [symptom] that causes pain, considering that JR likewise was feverish and
that he was vomitting, does that not show a disease of acute appendicitis
Doctor?
A It’s possible.
Q So that if that is possible, are we getting the impression then
Doctor what you have earlier mentioned that the only way to rule out the
suspect which is acute appendicitis is by surgery, you have said that earlier
Doctor, I just want any confirmation of it?
A Yes, sir.30
Neither do we find evidence that Dr. Cabugao has been

negligent or lacked the necessary precaution in his performance of
his duty as a family doctor. On the contrary, a perusal of the medical
records would show that during the 24-hour monitoring on JR, it
was Dr. Cabugao who frequently made orders on the administration
of antibiotics and pain relievers. There was also repetitive
instructions from Dr. Cabugao to refer JR to Dr. Ynzon as it
appeared that he is suspecting
_______________
29 TSN (Dr. Vivencio Villaflor, Jr.), March 20, 2002, p. 5.

30 Id., at p. 17.
238

Cabugao vs. People
appendicitis. The referral of JR to Dr. Ynzon, a surgeon, is actually

an exercise of precaution as he knew that appendicitis is not within
his scope of expertise. This clearly showed that he employed the
best of his knowledge and skill in attending to JR’s condition, even
after the referral of JR to Dr. Ynzon. To be sure, the calculated
assessment of Dr. Cabugao to refer JR to a surgeon who has
sufficient training and experience to handle JR’s case belies the
finding that he displayed inexcusable lack of precaution in handling
his patient.31
We likewise note that Dr. Cabugao was out of town when JR’s
condition began to deteriorate. Even so, before he left, he made
endorsement and notified the resident-doctor and nurses-on-duty that
he will be on leave.
Moreover, while both appeared to be the attending physicians of
JR during his hospital confinement, it cannot be said that the finding
of guilt on Dr. Ynzon necessitates the same finding on the co-
accused Dr. Cabugao. Conspiracy is inconsistent with the idea of a
felony committed by means of culpa.32 Thus, the accused-doctors to
be found guilty of reckless imprudence resulting in homicide, it
must be shown that both accused doctors demonstrated an act
executed without malice or criminal intent — but with lack of
foresight, carelessness, or negligence. Noteworthy, the evidence on
record clearly points to the reckless imprudence of Dr. Ynzon;
however, the same cannot be said in Dr. Cabugao’s case.
As To Civil Liability:
While this case is pending appeal, counsel for petitioner Dr.
Ynzon informed the Court that the latter died on December
_______________
31 See Jarcia, Jr. v. People, G.R. No. 187926, February 15, 2012, 666 SCRA 336,
358.
32 Villareal v. People, G.R. No. 151258, G.R. No. 154984, G.R. No. 155101, G.R.
Nos. 178057 and 17800, February 1, 2012, 664 SCRA 519, 559.
239
VOL. 731, JULY 30, 2014 239

Cabugao vs. People
23, 2011 due to “multi-organ failure” as evidenced by a copy of

death certificate.33 Thus, the effect of death, pending appeal of his
conviction of petitioner Dr. Ynzon with regard to his criminal and
pecuniary liabilities should be in accordance to People v. Bayotas,34
wherein the Court laid down the rules in case the accused dies prior
to final judgment:
1. Death of the accused pending appeal of his conviction extinguishes his
criminal liability as well as the civil liability based solely thereon. As opined
by Justice Regalado, in this regard, “the death of the accused prior to final
judgment terminates his criminal liability and only the civil liability directly
arising from and based solely on the offense committed, i.e., civil liability
ex delicto in senso strictiore.”
2. Corollarily, the claim for civil liability survives notwithstanding the
death of accused, if the same may also be predicated on a source of
obligation other than delict. Article 1157 of the Civil Code enumerates
these other sources of obligation from which the civil liability may arise as
a result of the same act or omission:
a) Law
b) Contracts
c) Quasi-contracts
d) x x x x x x x x x
e) Quasi-delicts
3. Where the civil liability survives, as explained in Number 2 above, an
action for recovery therefor may be pursued but only by way of filing a
separate civil action and subject to Section 1, Rule 111 of the 1985 Rules
on Criminal Procedure as amended. This separate civil action may be
enforced either against the executor/administrator or the estate of
_______________
33 Rollo (G.R. No. 163879), pp. 303-307.
34 G.R. No. 102007, September 2, 1994, 236 SCRA 239.
240

Cabugao vs. People
the accused, depending on the source of obligation upon which the same
is based as explained above.
4. Finally, the private offended party need not fear a forfeiture of his right
to file this separate civil action by prescription, in cases where during the
prosecution of the criminal action and prior to its extinction, the private-
offended party instituted together therewith the civil action. In such case, the
statute of limitations on the civil liability is deemed interrupted during the
pendency of the criminal case, conformably with provisions of Article 1155
of the Civil Code, that should thereby avoid any apprehension on a possible
privation of right by prescription.35
In view of the foregoing, it is clear that the death of the

accused Dr. Ynzon pending appeal of his conviction extinguishes his
criminal liability. However, the recovery of civil liability subsists as
the same is not based on delict but by contract and the reckless
imprudence he was guilty of under Article 365 of the Revised Penal
Code. For this reason, a separate civil action may be enforced either
against the executor/administrator or the estate of the accused,
depending on the source of obligation upon which the same is
based,36 and in accordance with Section 4, Rule 111 of the Rules on
Criminal Procedure, we quote:
Sec. 4. Effect of death on civil actions.—The death of the accused

after arraignment and during the pendency of the criminal action shall
extinguish the civil liability arising from the delict. However, the
independent civil action instituted under Section 3 of this Rule or which
thereafter is instituted to enforce liability arising from other sources of
obligation may be continued against the estate or legal representative of
the accused after proper substitution or
_______________
35 Id., at pp. 255-256. (Citations omitted; emphases ours)
36 See People v. Abungan, 395 Phil. 456, 461; 341 SCRA 258, 262 (2000).
241
VOL. 731, JULY 30, 2014 241

Cabugao vs. People
against said estate, as the case may be. The heirs of the accused may be
substituted for the deceased without requiring the appointment of an
executor or administrator and the court may appoint a guardian ad litem
for the minor heirs.
The court shall forthwith order said legal representative or
representatives to appear and be substituted within a period of thirty (30)
days from notice.
A final judgment entered in favor of the offended party shall be enforced
in the manner especially provided in these rules for prosecuting claims
against the estate of the deceased.
If the accused dies before arraignment, the case shall be dismissed
without prejudice to any civil action the offended party may file against the
estate of the deceased. (Emphases ours)
In sum, upon the extinction of the criminal liability and the

offended party desires to recover damages from the same act or
omission complained of, the party may file a separate civil action
based on the other sources of obligation in accordance with Section
4, Rule 111.37 If the same act or omission complained of arises from
quasi-delict, as in this case, a separate civil action must be filed
against the executor or administrator of the estate of the accused,

pursuant to Section 1, Rule 87 of the Rules of Court:38
Section 1. Actions which may and which may not be brought against
executor or administrator.—No action upon a claim for the recovery of
money or debt or interest thereon shall be commenced against the executor
or administrator; but to recover real or personal property, or an interest
therein, from the estate, or to enforce a lien thereon, and actions to recover
damages for an injury to person or property, real or personal, may be
commenced against him. (Emphases ours)
_______________
37 2000 Rules on Criminal Procedure, as amended.
38 Supra note 34 at p. 254.
242

Cabugao vs. People
Conversely, if the offended party desires to recover damages

from the same act or omission complained of arising from contract,
the filing of a separate civil action must be filed against the estate,
pursuant to Section 5, Rule 86 of the Rules of Court, to wit:
Section 5. Claims which must be filed under the notice. If not filed,
barred; exceptions.—All claims for money against the decent, arising from
contract, express or implied, whether the same be due, not due, or
contingent, all claims for funeral expenses and expense for the last sickness
of the decedent, and judgment for money against the decent, must be filed
within the time limited in the notice; otherwise they are barred forever,
except that they may be set forth as counterclaims in any action that the
executor or administrator may bring against the claimants. Where an
executor or administrator commences an action, or prosecutes an action
already commenced by the deceased in his lifetime, the debtor may set forth
by answer the claims he has against the decedent, instead of presenting them
independently to the court as herein provided, and mutual claims may be set
off against each other in such action; and if final judgment is rendered in
favor of the defendant, the amount so determined shall be considered the
true balance against the estate, as though the claim had been presented
directly before the court in the administration proceedings. Claims not yet
due, or contingent, may be approved at their present value.
As a final note, we reiterate that the policy against double

recovery requires that only one action be maintained for the same
act or omission whether the action is brought against the executor or
administrator, or the estate.39 The heirs of JR must choose which of
the available causes of action for damages they will bring.
_______________
39 See Maniago v. Court of Appeals, 324 Phil. 34, 39; 253 SCRA 674, 687 (1996).
243
VOL. 731, JULY 30, 2014 243

Cabugao vs. People
WHEREFORE, premises considered, petitioner DR. ANTONIO

P. CABUGAO is hereby ACQUITTED of the crime of reckless
imprudence resulting to homicide.
Due to the death of accused Dr. Clenio Ynzon prior to the
disposition of this case, his criminal liability is extinguished;
however, his civil liability subsists. A separate civil action may be
filed either against the executor/administrator, or the estate of Dr.
Ynzon, depending on the source of obligation upon which the same
are based.
SO ORDERED.
Velasco, Jr. (Chairperson), Bersamin,** Mendoza and Leonen,

JJ., concur.
Petitioner Dr. Antonio P. Cabugao acquitted. Dr. Clenio Ynzon’s

criminal liability is extinguished due to his death but his civil
liability subsists.
Notes.—The action filed by the heirs for the recovery of damages

arising from breach of contract of carriage is an independent civil
action which is separate and distinct from the criminal action for
reckless imprudence resulting in homicide filed by the heirs by
reason of the same incident. (Heirs of Jose Marcial K. Ochoa vs. G
& S Transport Corporation, 645 SCRA 93 [2011])
The extinction of the penal action does not necessarily carry with
it the extinction of the civil action, whether the latter is instituted
with or separately from the criminal action. (Co vs. Muñoz, Jr., 711
SCRA 508 [2013])
——o0o——
_______________
** Designated acting member per Special Order No. 1691-L dated May 22, 2014,
in view of the vacancy in the Third Division.
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12/19/21, 6:16 PM SUPREME COURT REPORTS ANNOTATED VOLUME 731

...Page Edit Line Top

G.R. No. 163879. July 30, 2014.*

G.R. No. 165805. July 30, 2014.*

DR. CLENIO YNZON, petitioner, vs. PEOPLE OF THE

Criminal Law; Reckless Imprudence; Reckless imprudence consists of

VOL. 731, JULY 30, 2014 215