Professional Services v Natividad Agana

[G.R. No. 126297; January 31, 2007] AUTHOR: Louis Tan

TOPIC: Torts
PONENTE: Sandoval Gutierrez, J.

DOCTRINE: AS hospital may be liable not only vicariously for the negligence of their physicians under Art.
2180, but also directly under Art. 2176, based on the doctrine of corporate negligence.

FACTS:
 Natividad Agana was rushed to Medical City Hospital because of difficulty of bowel movement and bloody
anal discharge.
 Dr. Ampil diagnosed her tot have cancer of the sigmoid and performed an anterior resection surgery on her.
 Upon finding out that the malignancy has spread on her left ovary, necessitating the removal of portions of
it, Dr. Ampil, with the consent of the husband, asked Dr. Fuentes to perform hysterectomy.
 After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the operation and
closed the incision.
 However, the nurses reported that 2 sponges were lacking, which they reported to the surgeon.
 After a couple of days, Natividad complained of excruciating pain in her anal region. She consulted both Dr.
Ampil and Dr. Fuentes about it. They told her that the pain was the natural consequence of the surgery.
 Natividad was cured of cancer but the 2 pieces of sponge was later found out inside her vagina, which badly
infected her vaginal vault, which required another operation.
 Natividad and her husband filed with the RTC a complaint for damages against Professional Services, Inc.
(PSI), owner of Medical City Hospital, Dr. Ampil, and Dr. Duentes, alleging that the latter are liable for
negligence for leaving two pieces of gauze inside Natividad’s body and malprac tice for concealing the
negligence.
 Natividad during the pendency of the case.
ISSUE/S & RATIO:
1. WON Dr. Ampil is liable for negligence and malpractice.
 Yes, the glaring truth is that all the major circumstances, taken together, directly point to Dr. Ampil
as the negligent party.
 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
Natividad’s 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. Ampil’s
negligence is the proximate cause of Natividad’s 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 Natividad’s vagina established the causal link
between Dr. Ampil’s 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. WON Dr. Fuentes is liable.
 No, Dr. Fuentes did not have control and management of the thing that lead to the injury.
 The Aganas grounded their argument on the doctrine of res ipsa loquitur.
 Literally, res ipsa loquitur means "the thing speaks for itself." The requisites for the applicability of
the doctrine of res ipsa loquitur are: (1) the occurrence of an injury; (2) the thing which caused the
injury was under the control and management of the defendant; (3) the occurrence was such that in
the ordinary course of things, would not have happened if those who had control or management
used proper care; and (4) the absence of explanation by the defendant. Of the foregoing requisites,
the most instrumental is the "control and management of the thing which caused the injury."
  Here, the element of "control and management of the thing which caused the injury" to be wanting.
Hence, the doctrine of res ipsa loquitur will not lie.
 Dr. Ampil was the lead surgeon during the operation of Natividad. Dr. Fuentes only performed the
hysterectomy and thereafter left the operating room. Dr. Ampil then resumed operating on
Natividad. During the time when the attending nurses noticed that the two pieces of gauze were
missing up to the time when Dr. Ampil directed the incision to be closed, Dr. Fuentes was no
longer in the operating room.
 Under the "Captain of the Ship" rule, the operating surgeon is the person in complete charge of the
surgery room and all personnel connected with the operation. Their duty is to obey his orders. Dr.
Ampil was the lead surgeon. In other words, he was the "Captain of the Ship." Clearly, the control
and management of the thing which caused the injury was in the hands of Dr. Ampil, not Dr.
Fuentes.
3. WON PCI, as the hospital, is solidarily liable with Dr. Ampil and Dr. Fuentes.
 Yes, based on the ruling in the case of Ramos v CA; the doctrine of apparent authority; and the
doctrine of corporate negligence, the hospital is not only vicariously liable under Art. 2180, but also
directly liable under Art. 2176.
The Ramos pronouncement.
 The nature of the relationship between the hospital and the physicians in view of the ruling in
Ramos v. Court of Appeals that for purposes of apportioning responsibility in medical negligence
cases, an employer-employee relationship in effect exists between hospitals and their attending and
visiting physicians.
 Private hospitals, hire, fire and exercise real control over their attending and visiting ‘consultant’
staff. While ‘consultants’ are not, technically employees, the control exercised, the hiring, and the
right to terminate consultants all fulfill the important hallmarks of an employer-employee
relationship, with the exception of the payment of wages.
 But the Ramos pronouncement is not our only basis in sustaining PSI’s liability. Its liability is also
anchored upon the agency principle of apparent authority or agency by estoppel and the doctrine
of corporate negligence.
Doctrine of Apparent Authority
 Apparent authority, or what is sometimes referred to as the "holding out" theory, or doctrine of
ostensible agency or agency by estoppel is explained in this manner: "The principal is bound by the
acts of his agent with the apparent authority which he knowingly permits the agent to assume, or
which he holds the agent out to the public as possessing. The question in every case is whether the
principal has by his voluntary act placed the agent in such a situation that a person of ordinary
prudence, conversant with business usages and the nature of the particular business, is justified in
presuming that such agent has authority to perform the particular act in question.
 The applicability of apparent authority in the field of hospital liability was upheld long time ago in
Irving v. Doctor Hospital of Lake Worth, Inc. Our jurisdiction recognizes the concept of an agency
by implication or estoppel in Article 1869 of the Civil Code
 In this case, PSI publicly displays in the lobby of the Medical City Hospital the names and
specializations of the physicians associated or accredited by it, including those of Dr. Ampil and
Dr. Fuentes. it "is now estopped from passing all the blame to the physicians whose names it
proudly paraded in the public directory leading the public to believe that it vouched for their skill
and competence."
 Indeed, PSI’s act is tantamount to holding out to the public that Medical City Hospital, through its
accredited physicians, offers quality health care services. By accrediting Dr. Ampil and Dr. Fuentes
and publicly advertising their qualifications, the hospital created the impression that they were its
agents, authorized to perform medical or surgical services for its patients. As expected, these
patients, Natividad being one of them, accepted the services on the reasonable belief that such were
being rendered by the hospital or its employees, agents, or servants.
Doctrine of Corporate Negligence
 A patient who enters a hospital does so with the reasonable expectation that it will attempt to cure
him. The hospital accordingly has the duty to make a reasonable effort to monitor and oversee the
treatment prescribed and administered by the physicians practicing in its premises.
  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.
 Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance of the Medical City
Hospital’s staff, composed of resident doctors, nurses, and interns. As such, 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 also directly liable for its own
negligence under Article 2176.

RULING: Petition Denied, Judgment affirmed. Dr. Ampil is liable for medical negligence. Dr. Fuentes cannot be held liable
because he did not have control and management of the thing which lead to the injury. PCI is liable not only vicariously for the
negligence of Dr. Ampil under Art. 2180, but also directly under Art. 2176.