PROFESSIONAL SERVICES, INC. vs.

AGANA
G.R. No. 126297 | January 31, 2007
FACTS:
Natividad Agana was diagnosed with cancer of the sigmoid which also
affected her ovaries. She underwent surgical operations to remove the
cancer. However, after receiving treatments and being declared free of
cancer, she still felt excruciating pains in her rectal and vaginal area. It turns
out that the pains were caused by the pieces of gauze left inside her body.
Thus, a complaint for damages was filed against PSI, Drs. Ampil and
Fuentes. Enrique Agana also filed before the PRC an administrative
complaint for gross negligence and malpractice against Dr. Ampil and Dr.
Fuentes. Pending the outcome of the cases, Natividad died.
Eventually, RTC ruled in favor of the Aganas, finding PSI, Dr. Ampil and Dr.
Fuentes liable for negligence and malpractice and awarded actual, moral,
and exemplary damages and attorneys fees. Meanwhile, the administrative
cases before the PRC were dismissed. On appeal, CA absolved Dr. Fuentes,
but held PSI and Dr. Ampil solidarily liable.
PSI and Dr. Ampil, and also the Aganas went up to the SC. PSI contended
that Dr. Ampil is not its employee, but a mere consultant or independent
contractor. As such, he alone should answer for his negligence. Meanwhile,
the Aganas argued that CA erred in absolving Dr. Fuentes. On the other
hand, Dr. Ampil insisted that he is not guilty of negligence, and imputed the
damage to other factors/causes.
ISSUES:
(1) Is Dr. Ampil guilty of negligence and malpractice? YES.
(2) Is Dr. Fuentes liable also? NO.
(3) Is PSI liable for the negligence of the surgeons? YES.
RULING:
(1) YES. Dr. Ampils arguments are purely conjectural and without basis. All
the major circumstances, taken together, directly point to Dr. Ampil as the
negligent party. During the operation, it was announced that two gauzes were
lacking but still Dr. Ampil proceeded with the closure. Dr. Ampil did not inform
Natividad about the missing two pieces of gauze. Worse, he even misled her
that the pain she was experiencing was the ordinary consequence of her
operation.
This is a clear case of medical malpractice or more appropriately, medical
negligence. To successfully pursue this kind of case, a patient must only
prove that a health care provider either failed to do something which a
reasonably prudent health care provider would have done, or that he did

something that a reasonably prudent provider would not have done; and that
failure or action caused injury to the patient. Simply put, the elements
are duty, breach, injury and proximate causation. Dr, Ampil, as the lead
surgeon, had the duty to remove all foreign objects, such as gauzes, from
Natividads body before closure of the incision. When he failed to do so, it
was his duty to inform Natividad about it. Dr. Ampil breached both duties.
Such breach caused injury to Natividad, necessitating her further
examination by American doctors and another surgery. That Dr. Ampils
negligence is the proximate cause of Natividads injury could be traced from
his act of closing the incision despite the information given by the attending
nurses that two pieces of gauze were still missing. That they were later on
extracted from Natividads vagina established the causal link between Dr.
Ampils negligence and the injury. And what further aggravated such injury
was his deliberate concealment of the missing gauzes from the knowledge of
Natividad and her family.
(2) NO. The plaintiffs invoked the doctrine of res ipsa loquitur. To our mind, it
was this act of ordering the closure of the incision notwithstanding that two
pieces of gauze remained unaccounted for, that caused injury to Natividads
body. Clearly, the control and management of the thing which caused the
injury was in the hands of Dr. Ampil, not Dr. Fuentes. Mere invocation and
application of the doctrine of res ipsa loquitur does not dispense with
the requirement of proof of negligence. Here, the negligence was proven
to have been committed by Dr. Ampil and not by Dr. Fuentes.
(3) Premised on the doctrine of corporate negligence, the trial court held that
PSI is directly liable for such breach of duty. In the present case, it was duly
established that PSI operates the Medical City Hospital for the purpose and
under the concept of providing comprehensive medical services to the public.
Accordingly, it has the duty to exercise reasonable care to protect from
harm all patients admitted into its facility for medical treatment.
Unfortunately, PSI failed to perform such duty. PSIs liability is traceable to its
failure to conduct an investigation of the matter reported in the nota bene of
the count nurse. Such failure established PSIs part in the dark conspiracy of
silence and concealment about the gauzes.
It is reasonable to conclude that PSI, as the operator of the hospital, has
actual or constructive knowledge of the procedures carried out, particularly
the report of the attending nurses that the two pieces of gauze were missing.
The failure of PSI, despite the attending nurses report, to investigate and
inform Natividad regarding the missing gauzes amounts to callous
negligence. Not only did PSI breach its duties to oversee or supervise all
persons who practice medicine within its walls, it also failed to take an active
step in fixing the negligence committed. This renders PSI, not only
vicariously liable for the negligence of Dr. Ampil under Article 2180 of the Civil
Code, but alsodirectly liable for its own negligence under Article 2176.

Anent the corollary issue of whether PSI is solidarily liable with Dr. Ampil for
damages, let it be emphasized that PSI, apart from a general denial of its
responsibility, failed to adduce evidence showing that it exercised the
diligence of a good father of a family in the accreditation and supervision of

the latter. In neglecting to offer such proof, PSI failed to discharge its burden
under the last paragraph of Article 2180 cited earlier, and, therefore, must be
adjudged solidarily liable with Dr. Ampil. Moreover, as we have discussed,
PSI is also directly liable to the Aganas.