Professional Services Inc. (PSI) v. Natividad and Eneique Agana G.R. No. 126297 January 31, 2007 SANDOVAL-GUTIERREZ, J.: STATEMENT OF FACTS: Natividad Agana (Natividad) was rushed to Medical City General Hospitay (MCGH) because of difficulty in bowel movement and bloody discharge. After a series of examinations, Dr. Miguel Ampil (Ampil) diagnosed her to be suffering from “cancer of the sigmoid”. Natividad underwent surgery under Dr. Ampil. Dr. Juan Fuentes (Fuentes) was then tasked to perform hysterectomy on her, with consent obtained from her husband. Due to her left ovary was affected and thus some portions of it was removed. It was found out after the operation that 2 sponges were missing. No one informed Natividad of such fact. Natividad was released from the hospital, but after a couple of days experienced excruciating pain, thus they consulted with Dr. Ampil who said that it was normal after receiving the surgery, and further suggested that they see an oncologist to examine the remaining cancerous nodes that were not removed from the surgery. They went to the US to seek futher treatment, and after 4 months she w as told she was free of cancer, and thus returned to the Philippines. Upon return she still felt pain. Her daughter then found a piece of gauze sticking out from her vagina. They informed Dr. Ampil, who immediately proceeded to her house and extracted the gauze, and reassured that the pains would stop. However, the pain did not cease and further intensified. It was found later on that there was another gauze found in her vagina which infected the same and necessitated surgery to heal the damage . STATEMENT OF THE CASE: Spouses Agana filed with the RTC o f Quezon city a complaint for damages against PSI (owner of MCGH), Dr. Ampil, and Dr. Fuentes. At the same time, they also filed an administrative complaint before the Professional Regulation Commission (PRC) against said doctors. The RTC ruled in favor of the Aganas which maid PSI and the doctors to be jointly and severally liable for damages. During which, the PRC board of Medicine rendered its decision dismissing the case Against Dr. Fuentes, as the prosecution failed to show that Dr. Fuentes was the one who left the 2 pieces of gauze inside Natividad’s body, and that he concealed the fact from Natividad. Dr. Ampil and PSI filed an appeal before the CA, but was denied. The C A dismissed the case against Dr. Fuentes, and held Dr. Ampil and PSI liable. Dr. Ampil filed an MR but was denied, hence this petition ISSUE: 1.) Whether Dr. Ampil is liable for medical malpractice and ne gligence 2.) Whether it was proper for the court to dismiss the case of Dr. Fuentes 3.) Whether Psi is liable for for damages due to the negligence of said said doctors
RULING: 1.) YES. An operation requiring the placing of sponges in the incision is not complete until the sponges are properly removed, and it is settled that the leaving of sponges or other foreign substances in the wound after the incision has been closed is at least prima facie negligence by the operating surgeon. To put it simply, such act is considered so inconsistent with due care as to raise an inference of negligence. There are even legions of authorities to the effect that such act is negligence per se. Dr. Ampil’s contention that it might be Dr. Fuente are merely conjectures for he has not provided with any evidence to support his claim. To prove that there is medical malpractice or medical negligence it is tasked upon the patient to prove the following: 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 o f gauze were still missing 2.) YES, Res Ipsa Loquitur will not lie because the absence of control and management of the thing which caused the injury to be wanting. The following are the requisites of t he doctrine. (a) The occurrence of an injury; (b) The thing which caused the injury was under the control and management of the defendant; (c) The occurrence was such that t hat in the ordinary course of things, would not have happened if those who had control or management used proper car e; and (d) The absence of explanation by the defendant Under the "Captain of the Ship" rule, the oper ating 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. D r. Ampil was the lead surgeon. In other words, he w as the "Captain of the Ship." That he discharged such role is evident from his following conduct: (1) calling Dr. Fuentes to perform a hysterectomy; (2) examining the work of Dr. Fuentes and finding it in order; (3) granting Dr. Fuentes’ permission to leave; and (4) ordering the closure of the incision. 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 Natividad’s body. Clearly, the control and management of the thing which caused the injury was in the hands of Dr. Ampil, not Dr. Fuentes. 3.) YES, under the following reasons a) Ramos v. CA doctrine on E-E relationship -For purposes of apportioning responsibility in medical negligence cases, an employer-employee relationship in effect exists between hospitals and their attending and visiting physicians.
b) Agency principle of apparent authority / agency by estoppel -
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Imposes liability because of the actions of a principal or employer in somehow misleading the public into believing that the relationship or the authority exists [see NCC 1869] PSI publicly displays in the Medical City lobby the names and specializations of their physicians. Hence, PSI is now estopped from passing all the blame to the physicians whose names it proudly paraded in the public directory, leading le ading the public to believe that it vouched for their skill and competence. If doctors do well, hospital profits financially, so when negligence mars the quality of its services, the hospital should not be allowed to escape liability for its agents’ acts.
c) Doctrine of corporate negligence / corporate responsibility -
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This is the judicial answer to the problem of allocating hospital’s liability for the negligent acts of health practitioners, absent facts to support the application of respondeat superior. This provides for the duties expected [from hospitals]. In this case, PSI failed to perform the duty of exercising reasonable care to protect from harm all patients admitted into its facility for medical treatment. PSI failed to conduct an investigation of the matter reported in the note of the count nurse, and this established PSI’s part in the dark conspiracy of silence and concealment about the gauzes. PSI has actual / constructive knowledge of the matter, through the report of the attending nurses + the fact that t he operation was carried on with the assistance of various hospital staff It also breached its duties t o oversee or supervise all persons who practice medicine within its walls and take an active step in fixing the negligence committed
