CAPTAIN OF THE

SHIP DOCTRINE
Legal Medicine
Dr. Jose Montemayor
Definition

■ Captain-of-the-Ship Doctrine is a principle of medical-malpractice

law, holding a surgeon liable for the actions of assistants who
are under the surgeon's control but who are employees of the
hospital, not the surgeon.
■ The surgeon as "the captain of the ship," is directly responsible
for an alleged error or act of alleged negligence because he or
she controls and directs the actions of those in assistance. This
common law doctrine is often used in operating room situations.
BACKGROUND and RELATED
JURISPRUDENCE
"The Captain-of-the-Ship Doctrine was discussed in McConnel v. Williams, where the
Supreme Court of Pennsylvania stated that under this doctrine, a surgeon is likened to a
captain of the ship, in that it is his duty to control everything going on in the operating
room."
Note:
This doctrine, however, has already been abandoned in most American
jurisdictions.
65 A.2d 243, 246 (pa. 1949) (U.S).
BACKGROUND and RELATED
JURISPRUDENCE
The doctrine was introduced in Philippine Jurisprudence in:
Ramos vs. Court of Appeals
G.R. No. 124354 December 29, 1999
FACTS:
Erlinda Ramos underwent a surgical procedure to remove stone from her gall bladder
(cholecystectomy). They hired Dr. Osaka, a surgeon, to conduct the surgery. Hosaka
assured them that he would find a good anesthesiologist. But the operation did not go
as planned, Dr. Hosaka arrived 3 hours late for the operation, Dra. Gutierrez, the
anesthesiologist “botched” the administration of the anesthesia causing Erlinda to go
into a coma and suffer brain damage.
BACKGROUND and RELATED
JURISPRUDENCE
HELD:
Respondents were all negligent and are solidarily liable for the damages. The Court,
speaking through Justice Kapunan defined the doctrine of “Captain-of-the-Ship” as
follows:
Under this doctrine, the surgeon is likened to a ship captain who must not only be
responsible for the safety of the crew but also of the passengers of the vessel. The
head surgeon is made responsible for everything that goes wrong within the four
corners of the operating room. It enunciates the liability of the surgeon not only for
the wrongful acts of those who are under his physical control but also those
wherein he has extension of control.
Thus, the Supreme Court declared that a surgeon, as the so called “captain of the
ship”, has the responsibility to see to it that those under him perform their task in the
proper manner which necessarily transcends physical presence.
BACKGROUND and RELATED
JURISPRUDENCE
PROFESSIONAL SERVICES, INC. VS. AGANA
G.R. No. 126297 January 31, 2007
FACTS:
Dr. Ampil was the lead surgeon during the operation of Natividad. He requested the
assistance of Dr. Fuentes only to perform hysterectomy when he found that the malignancy
in her sigmoid area had spread to her left ovary. Dr. Fuentes performed the surgery and
thereafter reported and showed his work to Dr. Ampil. The latter examined it and finding
everything to be in order, allowed Dr. Fuentes to leave the operating room. Dr. Ampil then
resumed operating on Natividad. He was about to finish the procedure when the attending
nurses informed him that two pieces of gauze were missing. A “diligent search” was
conducted, but the misplaced gauzes were not found. Dr. Ampil then directed that the
incision be closed. During this entire period, Dr. Fuentes was no longer in the operating room
and had, in fact, left the hospital.
BACKGROUND and RELATED
JURISPRUDENCE
HELD:
■ Dr. Ampil was liable because the Court considered him as the negligent party. 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. As stated before, Dr. Ampil was the lead surgeon. In other
words, he was the “Captain of the Ship”. This was based on Dr. Ampil’s acts of
calling Dr. Fuentes, examining the work of the latter, granting the latter permission to
leave, and ordering the closure of the incision.
■ The Supreme Court extended the application of the doctrine to include instruments
within the exclusive control of the physician. It was held that surgeon’s control over
the assistants inside the operating room also translates to exclusive control over the
instruments operated by the same assistants making any injury caused thereby,
directly imputable on the surgeon.
REASONS FOR DECREASING POPULARITY
OF THE CAPTAIN OF SHIP DOCTRINE
1. Increasing complexity and sophistication of the operating
room facilities requiring technical knowledge beyond the scope
of knowledge of the surgeon thereby making supervision
impossible;
2. Importance of encouraging the surgeon to concentrate on
his own job;
3. Liability for damage suit has shifted from surgeon to
hospital.
Note:
Although it is true that American jurisprudence, the source of
the doctrine, has already abandoned the Captain of the Ship
doctrine, the Philippine Supreme Court in determining whether
the said doctrine still applies in the Philippine setting, needs
only examine the current state of the medical profession in the
country in the context of its practices inside the operating
room.