[G.R.

126297]
 Case Summary
 Learning Issues
 Whether the Court of Appeals Erred in Holding Dr. Ampil Liable for
Negligence and Malpractice
 Whether the Court of Appeals Erred in Absolving Dr. Fuentes of any Liability
 Whether PSI Is Liable for the Negligence of Dr. Ampil
 Court Decision
• On April 11, 1984, an anterior resection surgery of the
colon and hysterectomy was performed on Natividad
Agana at the Medical City Hospital after she was
diagnosed with cancer at the sigmoid region. Dr. Miguel
Ampil performed the colon resection. Because he found
that the malignancy had spread to the ovaries, he
requested Dr. Juan Fuentes to perform a hysterectomy.
After granting Dr. Fuentes permission to leave afterwards,
he closed the wound. The corresponding Record of
Operation contained the following remarks: sponge count
lacking 2 announced to surgeon searched [sic] done but to
no avail continue for closure.
• Natividad complained of excruciating pains a
few days later but her doctors told her that the
pain was the natural consequence of the
surgery. Dr. Ampil further advised her to seek
oncologic consult. She sought medical consult in
the US, and was found to be free of cancer and
was advised to go home. Natividad continued
to suffer from pains and two weeks later, her
daughter found a piece of gauze protruding
from her vagina.
• The gauze was extracted by Dr. Ampil,
who assured Natividad that the pains
would soon vanish. However, the pains
persisted, so she sought treatment at the
Polymedic General Hospital. Another
gauze that badly infected her vaginal
vault was found, so she had surgery to
remedy the damage from the resulting
recto-vaginal fistula.
• On November 12, 1984, Natividad and her husband
filed a complaint for damages against the
Professional Services, Inc. (PSI), owner of the Medical
City Hospital, Dr. Ampil, and Dr. Fuentes, alleging that
the latter two are liable for negligence and medical
malpractice. Enrique Agana also filed with the
Professional Regulation Commission (PRC) an
administrative complaint for gross negligence and
malpractice against the two doctors. On February 16,
1986, pending the outcome of the above cases,
Natividad died and was duly substituted by her
children.
• On March 17, 1993, the RTC rendered its
Decision in favor of the Aganas, finding PSI,
Dr. Ampil and Dr. Fuentes liable for
negligence and malpractice. PSI, Dr. Fuentes
and Dr. Ampil interposed an appeal to the
Court of Appeals. On April 3, 1993, the
Aganas filed with the RTC a motion for a
partial execution of its Decision, which was
granted in an Order dated May 11, 1993.
• The Aganas entered into an agreement with
PSI and Dr. Fuentes to indefinitely suspend
any further execution of the RTC Decision.
However, not long thereafter, the Aganas
again filed a motion for an alias writ of
execution against the properties of PSI and
Dr. Fuentes. Dr. Fuentes filed a petition for
certiorari and prohibition with the Court of
Appeals.
• On January 23, 1995, the PRC Board
of Medicine dismissed the case against
Dr. Fuentes. On September 6, 1996, the
Court of Appeals also dismissed the
case against Dr. Fuentes, while Dr. Ampil
and PSI were found liable for the
damages to the Aganas. Only Dr. Ampil
filed a motion for reconsideration, but it
was denied.
• PSI contends that Dr. Ampil is not its
employee, but a mere consultant or
independent contractor. As such, he alone
should answer for his negligence.
• The Aganas maintain that the Court of
Appeals erred in finding that Dr. Fuentes is
not guilty of negligence or medical
malpractice.
• Dr. Ampil asserts that the Court of
Appeals erred in finding him liable for
negligence and malpractice because
there was no evidence that he left the
two pieces of gauze in Natividad’s
vagina, and he pointed to other
probable causes.
(1) it was Dr. Fuentes who used gauzes in
performing the hysterectomy;
(2) the attending nurses failure to properly count
the gauzes used during surgery; and
(3) the medical intervention of the American doctors
who examined Natividad in the United States of
America
•Whether the Court of Appeals
Erred in Holding Dr. Ampil
Liable for Negligence and
Malpractice
 Negligence
 Medical Malpractice
 •Whether the Court of
Appeals Erred in Absolving
Dr. Fuentes of any Liability
Res ipsa loquitur
Captain of the Ship
•Whether PSI Is Liable for the
Negligence of Dr. Ampil
Ostensible Agent
Corporate Negligence
Reckless Imprudence
•Whether the Court of Appeals
Erred in Holding Dr. Ampil
Liable for Negligence and
Malpractice
 Negligence
 Medical Malpractice
•Entire want of care raising the
presumption of gross
indifference to consequences.
An entire disregard for and
indifference to the safety and
welfare of others.
• Any act or failure to act by a
member of the medical profession
that results to harm, injury, distress,
prolonged physical or mental
suffering or the termination of life
to a patient while that patient is
under the care of that medical
professional.
• It is the responsibility of every doctor to
practice medicine according to the ethical
standards of his profession Dr. Ampil, as
the lead surgeon, had the duty to remove
all foreign objects from Natividad’s body
before closure of the incision. When he
failed to do so, it was also his duty to
inform the patient about it.
• Unskillful practice by a physician or
other professional in which the health or
welfare of the patient is injured. Failure
of a professional to follow the
accepted standards of practice of his
profession. Dr. Ampil breached his
duties.
•Due to Dr. Ampil’s
negligence, the patient
suffered excruciating
pains and a rectovaginal
fistula.
• That cause, which, in natural and continuous
sequence unbroken by any efficient
intervening cause, produces the injury and
without which the result would not have
occurred. He closed the incision despite the
nurses’ claims of two missing gauzes. Injury
was further aggravated when he
deliberately concealed this from the family.
 •Whether the Court of
Appeals Erred in Absolving
Dr. Fuentes of any Liability
Res ipsa loquitur
Captain of the Ship
 • “The thing speaks for itself.”
• It is a rule of evidence that allows
injured parties to bypass the usual
proof of negligence in their claim to
recover damages from the responsible
parties. The plaintiff's own negligent
actions did not contribute to the
accident.
• The Aganas maintain that the Court of
Appeals erred in finding that Dr.
Fuentes is not guilty of negligence or
medical malpractice, invoking the
doctrine of res ipsa loquitur. They
contend that the pieces of gauze are
proof that the operating surgeons have
been negligent.
 • Requisites for Its Application
• The accident must be of a kind which
ordinarily does not occur in the absence
of someone’s negligence. It must be
caused by an agency or instrumentality
within the exclusive control of the
defendant. It must not have been due to
any voluntary action or contribution on the
part of the plantiff.
Solis, P. D (1998) Medical jurisprudence: The practice of
medicine and the law. Quezon City: Garotech
 •In This Case
•Object left in the patient’s
body at the time of surgery.

Solis, P. D (1998) Medical jurisprudence: The practice

of medicine and the law. Quezon City: Garotech
•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 is the lead surgeon as
evidenced by:
 Calling Dr. Fuentes to perform a
hysterectomy
 Examining the work of Dr. Fuentes and
finding it in order
 Granting Dr. Fuentes permission to leave
 Ordering the closure of the incision
Solis, P. D (1998) Medical jurisprudence: The practice of medicine and the law.
Quezon City: Garotech
•Whether PSI Is Liable for the
Negligence of Dr. Ampil
Ostensible Agent
Corporate Negligence
Reckless Imprudence
(1) it is estopped from raising the
defense that Dr. Ampil is not its
employee;
(2) it is solitarily liable with Dr. Ampil;
and
(3) it is not entitled to its counterclaim
against the Aganas.
•PSI contends that Dr. Ampil is
not its employee, but a mere
consultant or independent
contractor. As such, he alone
should answer for his
negligence.
• A person who has been given the
appearance of being an employee
or acting (an agent) for another
(principal), which would make
anyone dealing with the ostensible
agent reasonably believe he/she
was an employee or agent.
•They usually get a certain
percentage of the fee paid to
the hospital. They are considered
members of the staff of the
department and are appointed
by the governing board of the
hospital.
• The hospital must be held liable
for negligent acts of ostensible
agents. By accrediting Dr. Ampil &
Dr. Fuentes and publicly advertising
their qualifications the hospital
created the impression that they
were its agents.
• Hospital/medical center or
healthcare agency as an entity is
negligent. Failure of the corporation
to follow an established standard of
conduct to which all healthcare
corporations should conform in a
given situation.
•The determination of negligence
is based on violations of duty
owed to the patient by the
hospital.

Parelli, R.J. (1997) Medicolegal issues for

radiographers. Florida: CRC
 • Duties of the Hospital
 To furnish a safe and well maintained
building and ground
 To furnish adequate and safe equipment
 To exercise reasonable care in the
selection of the members of the hospital
staff

Solis, P. D (1998) Medical jurisprudence: The practice of

medicine and the law. Quezon City: Garotech
 •Duties of the Hospital
Medical City Hospital has the duty to
exercise reasonable care to protect
from harm all patients admitted into
its facility for medical treatment which
it failed to do so. The hospital also
failed to conduct an investigation of
the matter and inform the patient of
the missing gauzes, amounting to
callous negligence.
• Consists in voluntary, without malice, doing
or failing to do an act from which material
damage results by reason of inexcusable
lack of precaution on the part of the parson
performing or failing to perform such act,
taking into consideration his employment or
occupation, degree of intelligence, physical
condition and other circumstances regarding
persons, time and place.
 • Elements
That the offender does or fails to do an
act.
That the doing of or the failure to do
the act is voluntary.
That it is done without malice.
That material damage or injury resulted
from it.
 • Elements
 That there is inexcusable lack of precaution
on the part of the offender taking into
consideration
a. his employment or occupation
b. degree of intelligence, physical condition;
c. other circumstances regarding the person(s),
time and place
 The RTC rendered its Decision in favor of the
Aganas, finding PSI, Dr. Ampil and Dr. Fuentes
liable for negligence and malpractice
WHEREFORE, judgment is hereby rendered for the
plaintiffs ordering the defendants PROFESSIONAL
SERVICES, INC., DR. MIGUEL AMPIL and DR.
JUAN FUENTES to pay to the plaintiffs, jointly and
severally, except in respect of the award for
exemplary damages and the interest thereon which
are the liabilities of defendants Dr. Ampil and Dr.
Fuentes only, as follows:
a. The equivalent in Philippine
Currency of the total of
US$19,900.00 at the rate
of P21.60-US$1.00, as
reimbursement of actual expenses
incurred in the United States of
America;
b. The sum of P4,800.00 as travel
taxes of plaintiffs and their physician
daughter;
c. The total sum of P45, 802.50,
representing the cost of hospitalization
at Polymedic Hospital, medical fees,
and cost of the saline solution;
2. As moral damages, the
sum of P2,000,000.00;
3. As exemplary
damages, the sum
of P300,000.00;
4. As attorneys fees, the
sum of P250,000.00;
5. Legal interest on items
1 (a), (b), and (c); 2; and
3 hereinabove, from date
of filing of the complaint
until full payment; and
6. Costs of suit.