FIRST DIVISION PROFESSIONAL SERVICES, INC., Petitioner, - versus NATIVIDAD and ENRIQUE AGANA, Respondents.
x-----------------------x NATIVIDAD (Substituted by her children MARCELINO AGANA III, ENRIQUE AGANA, JR., EMMA AGANA ANDAYA, JESUS AGANA, and RAYMUND AGANA) and ENRIQUE AGANA, Petitioners, - versus JUAN FUENTES, Respondent. x- - - - - - - - - - - - - - - - - - - -- - - - x MIGUEL AMPIL, Petitioner, - versus NATIVIDAD AGANA, AGANA and ENRIQUE G.R. No. 127590 Present: PUNO, C.J., Chairperson SANDOVAL-GUTIERREZ, CORONA, AZCUNA, and * GARCIA, JJ. Promulgated: January 31, 2007 x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - x G.R. No. 126467 G.R. No. 126297
SANDOVAL-GUTIERREZ, J.: Hospitals, having undertaken one of mankind’s most important and delicate endeavors, must assume the grave responsibility of pursuing it with appropriate care. The care and service dispensed through this high trust, however technical, complex and esoteric its character may be, must meet standards of responsibility
No part. Ponente of the assailed Decision in the Court of Appeals.
commensurate with the undertaking to preserve and protect the health, and indeed, the very lives of those placed in the hospital’s keeping.1 Assailed in these three consolidated petitions for review on certiorari is the Court of Appeals’ Decision2 dated September 6, 1996 in CA-G.R. CV No. 42062 and CA-G.R. SP No. 32198 affirming with modification the Decision3 dated March 17, 1993 of the Regional Trial Court (RTC), Branch 96, Quezon City in Civil Case No. Q43322 and nullifying its Order dated September 21, 1993. The facts, as culled from the records, are: On April 4, 1984, Natividad Agana was rushed to the Medical City General Hospital (Medical City Hospital) because of difficulty of bowel movement and bloody anal discharge. After a series of medical examinations, Dr. Miguel Ampil, petitioner in G.R. No. 127590, diagnosed her to be suffering from “cancer of the sigmoid.” On April 11, 1984, Dr. Ampil, assisted by the medical staff4 of the Medical City Hospital, performed an anterior resection surgery on Natividad. removal of certain portions of it. He found that the malignancy in her sigmoid area had spread on her left ovary, necessitating the Thus, Dr. Ampil obtained the consent of Natividad’s husband, Enrique Agana, to permit Dr. Juan Fuentes, respondent in G.R. No. 126467, to perform hysterectomy on her. After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the operation and closed the incision. However, the operation appeared to be flawed. In the corresponding Record of Operation dated April 11, 1984, the attending nurses entered these remarks:
“sponge count lacking 2 “announced to surgeon searched (sic) done but to no avail continue for closure.”
On April 24, 1984, Natividad was released from the hospital. Her hospital and medical bills, including the doctors’ fees, amounted to P60,000.00. 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.
Dr. Ampil then
Beeck v. Tucson General Hospital, 500 P. 2d 1153 (1972), citing Darling v. Charleston Community Memorial Hospital, 33 Ill. 2d 326, 211 N.E. 2d 253.
Penned by Associate Justice Cancio C. Garcia (now a member of the Supreme Court) and concurred in by Associate Justices Eugenio S. Labitoria and Artemio G. Tuquero (both retired), Rollo, G.R. Nos. 126297, pp. 36-51; 126467, pp. 2742; 127590, pp. 23-38.
Penned by Judge Lucas P. Bersamin (now Justice of the Court of Appeals), Rollo, G.R. No. 126647, pp. 69-83. The medical staff was composed of physicians, both residents and interns, as well as nurses.
After four months of consultations and laboratory examinations. and Dr. the pains intensified.
On May 9. On February 16. owner of the Medical City Hospital. docketed as Administrative Case No. Fuentes. she was advised to return to the Philippines. Ampil’s assurance did not come true.5 inches in width. in October 1984. accompanied by her husband.5 inches in width which badly infected her vaginal vault. died and was duly substituted by her above-named children (the Aganas). On November 12. Meanwhile. Ampil who was then in the United States. Fuentes. Two weeks thereafter. Ampil. still suffering from pains. Quezon City a complaint for damages against the Professional Services. Dr. Ampil proceeded to her house where he managed to extract by hand a piece of gauze measuring 1. They alleged that the latter are liable for negligence for leaving two pieces of gauze inside Natividad’s body and malpractice for concealing their acts of negligence. On August 31. prompting Natividad to seek treatment at the Polymedic General Hospital. Natividad flew back to the Philippines. docketed as Civil Case No. Fuentes because it
surgical operation was needed to remedy the damage. Natividad The PRC Board of Medicine heard the case only with respect to Dr. Natividad and her husband filed with the RTC. Dr. 1984. Hence. Natividad. A recto-vaginal fistula had formed in her Another reproductive organs which forced stool to excrete through the vagina. Branch 96. 1986. Natividad underwent another surgery.
. Natividad was told she was free of cancer. failed to acquire jurisdiction over Dr. Enrique Agana also filed with the Professional Regulation Commission (PRC) an administrative complaint for gross negligence and malpractice against Dr. While confined there. Instead.recommended that she consult an oncologist to examine the cancerous nodes which were not removed during the operation. Thus. 1690. Inc. (PSI). Upon being informed about it. He then assured her that the pains would soon vanish. Ampil and Dr. pending the outcome of the above cases. Dr. 1984. Dr. went to the United States to seek further treatment. her daughter found a piece of gauze protruding from her vagina. Q-43322. 1984. Ramon Gutierrez detected the presence of another foreign object in her vagina -.a foul-smelling gauze measuring 1.
the sheriff levied upon certain properties of Dr. However. Thereafter. As exemplary damages.000. Fuentes and Dr.000. the Aganas entered into an agreement with PSI and Dr. 1993. Dr. Dr. docketed as CA-G. PSI. Ampil and Dr.00.
b.00. the RTC rendered its Decision in favor of the Aganas. the sum of P250. the Aganas filed with the RTC a motion for a partial execution of its Decision.000. 4. Fuentes.
SO ORDERED. Legal interest on items 1 (a). the decretal part of which reads:
WHEREFORE. c. not long thereafter. the Aganas again filed a motion for an alias writ of execution against the properties of PSI and Dr. As actual damages.802. the following amounts: a. on April 3.
2. 5.00. (b).800. Fuentes to indefinitely suspend any further execution of the RTC Decision.00 as travel taxes of plaintiffs and their physician daughter. 42062. Incidentally.
Aggrieved. MIGUEL AMPIL and DR. CV No. The total sum of P45. jointly and severally. finding PSI.00 and delivered the amount to the Aganas. Fuentes only.50. as reimbursement of actual expenses incurred in the United States of America. JUAN FUENTES to pay to the plaintiffs. INC. which was granted in an Order dated May 11. On September 21. judgment is hereby rendered for the plaintiffs ordering the defendants PROFESSIONAL SERVICES. 1993.
As moral damages. 6. 1993. medical fees. The equivalent in Philippine Currency of the total of US$19. Following their receipt of the money. and (c).000. and cost of the saline solution. and Costs of suit.60-US$1. Fuentes liable for negligence and malpractice. except in respect of the award for exemplary damages and the interest thereon which are the liabilities of defendants Dr.00.R. and 3 hereinabove. 3. as follows: 1.On March 17. the sum of P300. Ampil and Dr. from date of filing of the complaint until full payment. representing the cost of hospitalization at Polymedic Hospital.. The sum of P4. 2. DR. the sum of P2.275. As attorney’s fees.00 at the rate of P21.900. Ampil and sold them for P451. Ampil interposed an appeal to the Court of Appeals.
Miguel Ampil is liable to reimburse defendant-appellant Professional Services. versus Professional Services.
The dispositive portion reads:
“WHEREFORE. the decision appealed from is hereby AFFIRMED and the instant appeal DISMISSED. The bond posted by the petitioner in connection with the writ of preliminary injunction issued by this Court on November 29.. Meanwhile. thus:
WHEREFORE. but it was denied in a Resolution7 dated December 19. 1995. 42062. 127590. Fuentes’ prayer for injunctive relief. 32198 is hereby GRANTED and the challenged order of the respondent judge dated September 21. CA-G. Inc. the Court of Appeals issued a Resolution5 dated October 29.R. Fuentes was the one who left the two pieces of gauze inside Natividad’s body. Costs against defendants-appellants Professional Services. except for the modification that the case against defendant-appellant Dr. 32198.R. CV No. the RTC granted the motion and issued the corresponding writ. Dr. Juan Fuentes is hereby DISMISSED.R. Miguel Ampil and
pendency. No. as well as the alias writ of execution issued pursuant thereto are hereby NULLIFIED and SET ASIDE. 1996.R. 32198 was consolidated with CA-G.1993. 1996.R.R. 1994. on January 23. G. SP No. Q-43322 entitled ‘Natividad G. No.” See Rollo. et al. pp. Rollo of G. 42062 and CA-G. No. SP No. 40. 1993. et al. with prayer for preliminary injunction.R. SO ORDERED. Fuentes to file with the Court of Appeals a petition for certiorari and prohibition. prompting Dr. On January 24. CV No. 84-89. SP No. Juan Fuentes in CA-G.R. p. Ampil filed a motion for reconsideration. whatever amount the latter will pay or had paid to the plaintiffs-appellees. The Board held that the prosecution failed to show that Dr. On September 6. defendants’ pending resolution of the instant petition. docketed as CA-G. let a writ of preliminary injunction be issued upon petitioner’s posting of bond in the amount of P20.000..00. 42.
. Concomitant with the above. 1993 is hereby cancelled. and that he concealed such fact from Natividad. SP No. ENJOINING public respondents from implementing the questioned order dated September 21. the PRC Board of Medicine rendered its Decision6 in Administrative Case No. plaintiffs. 1993 and from further taking any action in Civil Case No.. 32198. SO ORDERED. the Court of Appeals rendered its Decision jointly disposing of CA-G. the petition for certiorari and prohibition filed by herein defendant-appellant Dr. granting Dr. 126467. Fuentes.. and with the pronouncement that defendant-appellant Dr. Inc. 126297. p.
6 7  
Rollo of G. Inc. 1993
Only Dr. 1690 dismissing the case against Dr.R. Agana.
he alone should answer for his negligence. but a mere consultant or independent contractor. Ampil is not its employee. and third. the Aganas maintain that the Court of Appeals erred in finding that Dr. Ampil. Dr.R. No. PSI contends that Dr. whether the Court of Appeals erred in holding Dr.
. He pointed to other probable causes.G. second. Dr. Ampil liable for negligence and malpractice. As such. Finally. No. and (3) it is not entitled to its counterclaim against the Aganas. 126467. and third.Hence. in an attempt to absolve himself. and (3) the medical intervention of the American doctors who examined Natividad in the United States of America. second. Fuentes left the gauzes in Natividad’s body after performing hysterectomy. He argues that the Court should not discount either of the following possibilities: first. gears the Court’s attention to other possible causes of Natividad’s detriment. (2) it is solidarily liable with Dr.
I . 127590.R. In G. Dr. the instant consolidated petitions. the attending nurses erred in counting the gauzes. In G. Fuentes is not guilty of negligence or medical malpractice. 127590 Whether the Court of Appeals Erred in Holding Dr. whether the Court of Appeals erred in absolving Dr. in G. (2) the attending nurses’ failure to properly count the gauzes used during surgery. the American doctors were the ones who placed the gauzes in Natividad’s body. Ampil. They contend that the pieces of gauze are prima facie proofs that the operating surgeons have been negligent. 126297. such as: (1) it was Dr. Ampil. No. Fuentes who used gauzes in performing the hysterectomy.R. Fuentes of any liability.R. Ampil asserts that the Court of Appeals erred in finding him liable for negligence and malpractice sans evidence that he left the two pieces of gauze in Natividad’s vagina. invoking the doctrine of res ipsa loquitur. For our resolution are these three vital issues: first. whether PSI may be held solidarily liable for the negligence of Dr. PSI alleged in its petition that the Court of Appeals erred in holding that: (1) it is estopped from raising the defense that Dr. Ampil is not its employee. No. Ampil Liable for Negligence and Malpractice.
Fuentes.9 Of course. Ampil as the negligent party. 283. thus:
First. Cheeseman.C. Johnson.W. Zeagler.C. 328 Fla. citing Russel v. 191. as specified by the Court of Appeals. the nurses who assisted in the surgery noted in their report that the ‘sponge count (was) lacking 2’. Day. 1062.A. Harris v. Johnson.C.) 172 F. 162 S. 379. Reeves v. 27 L. directly point to Dr. because of the dangers attendant upon delay. particularly the number of gauzes used. 126 Or. (Tex. 2d 1033. Fall (C. L.R. App.R. Neither did he submit evidence to rebut the correctness of the record of operation.
.A. we are mindful that Dr.Dr. it is his legal duty to so inform his patient within a reasonable time thereafter by advising her of what he had been compelled to do. Newman.
Smith v. 174 Kan. 752. two (2) gauzes were extracted from the same spot of the body of Mrs. 280. 2d 472 (1957). 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.W. it is not disputed that the surgeons used gauzes as sponges to control the bleeding of the patient during the surgical operation.8 To put it simply.L. 179 Mo. This is in order that she might seek relief
Rule v. such act is considered so inconsistent with due care as to raise an inference of negligence. Even if it has been shown that a surgeon was required by the urgent necessities of the case to leave a sponge in his patient’s abdomen. Records show that he did not present any evidence to prove that the American doctors were the ones who put or left the gauzes in Natividad’s body. App.268 P. 21 R.) 1174. 268 P. 67. Lutz. 157 So. 165 P. 255 P. Ampil examined his (Dr. Rayburn v. 317 P. after the operation. Ivey. But this does not leave him free from any obligation. (1934). Ampil’s arguments are purely conjectural and without basis. The glaring truth is that all the major circumstances. 59 A. still. 230. As to the alleged negligence of Dr. 135. Moore v.
An operation requiring the placing of sponges in the incision is not complete until the sponges are properly removed. Agana where the surgery was performed. Third. 1002. Second. 388. Bernsden v.A.) 264 S. (C. 96 Wash. citing Ruth v.) 177 F. the Court is not blind to the reality that there are times when danger to a patient’s life precludes a surgeon from further searching missing sponges or foreign objects left in the body. 61.S. Civ. immediately after the operation. Wynne v. taken together. that such anomaly was ‘announced to surgeon’ and that a ‘search was done but to no avail’ prompting Dr. There are even legions of authorities to the effect that such act is negligence per se. 116 Kan. Harvey. Ampil to ‘continue for closure’ x x x. Fuentes’) work and found it in order. (N. 79.
under which circumstances that the person responsible for the first event should. Ampil’s negligence is the proximate cause12 of Natividad’s injury could be traced from his act of
Had he been more candid. breach. remove the gauzes from her body. Ampil breached both duties. 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. and that failure or action caused injury to the patient. he even misled her that the pain she was experiencing was the ordinary consequence of her operation. September 5. all constituting a natural and continuous chain of events. each having a close causal connection with the immediate predecessor. either immediately or by setting other events in motion. in natural and continuous sequence unbroken by any efficient intervening cause.
. which. the proximate cause is that acting first and producing the injury. This is a clear case of medical malpractice or more appropriately. 118141. thus:
The removal of all sponges used is part of a surgical operation. Medina. The ruling in Smith v. such as gauzes. have reasonable ground to expect at the moment of his act or default that an injury to some person might probably result therefrom. Worse. medical negligence. Dr. patient. necessitating her further examination by American doctors and another surgery. (102 Phil. Pascasio. it was his duty to inform Natividad about it. and endeavoring with the means he has at hand to minimize and avoid untoward results likely to ensue therefrom. Zeagler10 is explicit. And more comprehensively. this Court laid down the following definition of proximate cause in this jurisdiction as follows: [T]hat cause. No. or that he did something that a reasonably prudent provider would not have done. from Natividad’s body before closure of the incision. and when a physician or surgeon fails to remove a sponge he has placed in his patient’s body that should be removed as part of the operation. had the duty to remove all foreign objects. as an ordinarily prudent and intelligent person. produces the injury and without which the result would not have occurred. 278 SCRA 769. as the lead surgeon. Ampil has ripened into a deliberate wrongful act of deceiving his
157 So. he thereby leaves his operation uncompleted and creates a new condition which imposes upon him the legal duty of calling the new condition to his patient’s attention. the elements are duty.11 Simply put.
Natividad could have taken the immediate and appropriate medical remedy to To our mind. 181 ). 328 Fla. That Dr.
In the leading case of Vda. Ampil. injury and proximate causation. When he failed to do so. Ampil did not inform Natividad about the missing two pieces of gauze.from the effects of the foreign object left in her body as her condition might permit. Dr. the final event in the chain immediately effecting the injury as a natural and probable result of the cause which first acted. what was initially an act of negligence by Dr. de Bataclan v. G.R. Such breach caused injury to Natividad. Dr.
Here. 1997. To successfully pursue this kind of case. (1934) Garcia-Rueda v.
December 29. Literally. taken with the surrounding circumstances. res ipsa loquitur means “the thing speaks for itself. without the fault of the injured. may permit an inference or raise a presumption of negligence. where the thing which caused the injury. Africa v. the fact that the two pieces of gauze were left inside Natividad’s body is a prima facie evidence of Dr.R. and present a question of fact for defendant to meet with an explanation. Caltex (Phils. No. II . Fuentes on the ground that it is contrary to the doctrine of res ipsa loquitur. and the burden of proof is shifted to him to establish that he has observed due care and diligence. That they were later on extracted from Natividad’s vagina established the causal link between Dr. We are not convinced. in the absence of explanation that the injury arose from the defendant’s want of care. (2) the thing which caused the injury was under the control and management of the defendant. According to them. having such control used proper care. Of the foregoing requisites.) Inc. And what further aggravated such injury was his deliberate concealment of the missing gauzes from the knowledge of Natividad and her family. 124354.G. 14
From the foregoing statements of the rule. Court of Appeals. would not have happened if those who had control or management used proper care.
. 280 (1966). No. is under the exclusive control of the defendant and the injury is such that it should not have occurred if he. Ampil’s negligence and the injury. it affords reasonable evidence. 321 SCRA 584. 1999.” It is the rule that the fact of the occurrence of an injury. Fuentes of any Liability The Aganas assailed the dismissal by the trial court of the case against Dr. the requisites for the applicability of the doctrine of res ipsa loquitur are: (1) the occurrence of an injury.closing the incision despite the information given by the attending nurses that two pieces of gauze were still missing.. or make out a plaintiff’s prima facie case. G. 123 Phil. (3) the occurrence was such that in the ordinary course of things. the most
Ramos v. Fuentes’ negligence. 126467 Whether the Court of Appeals Erred in Absolving Dr. and (4) the absence of explanation by the defendant.R.13 Stated differently.
Their duty is to obey his orders.
. supra. Fuentes to perform a hysterectomy. To our mind. Ampil then resumed operating on Natividad. Fuentes and finding it in order. the lead surgeon. the doctrine of res ipsa loquitur will not lie.
Rural Educational Assn v. Fuentes performed the surgery and thereafter Dr. the phrase used is “control of the instrumentality which caused the damage. but the misplaced gauzes were not found. Clearly. mere invocation and application
Ranos v. 42 Tenn. Chapman. hence. Ampil. 34.17 In other words. 2d 761 (1956). 298 S. allowed room. that caused injury to Natividad’s body. Court of Appeals. Dr. John’s Hospital and School of Nursing v. Fuentes to leave the operating hysterectomy when he (Dr. Ramos v. res ipsa loquitur is not a rule of substantive law.” citing St. He was about to finish the procedure when the attending nurses informed him that two pieces of gauze were missing. being a mere evidentiary rule. He requested the assistance of Dr. Dr. The latter examined it and finding everything to be in order. not Dr.W. Ampil was the lead surgeon during the operation of Natividad. the control and management of the thing which caused the injury was in the hands of Dr.”15 We find the element of “control and management of the thing which caused the injury” to be wanting.”
discharged such role is evident from his following conduct: (1) calling Dr. Ampil. (2) examining the work of Dr. (3) granting Dr. does not per se create or constitute an independent or separate ground of liability.instrumental is the “control and management of the thing which caused the injury. Under the “Captain of the Ship” rule. he was the “Captain of the Ship. Hence. and (4) ordering the closure of the incision. Ampil then directed that the incision be closed. it was this act of ordering the closure of the incision notwithstanding that two pieces of gauze remained unaccounted for. Fuentes only to perform Dr. During this entire period. Dr. Ampil) found that the malignancy in her sigmoid area had spread to her left ovary. Fuentes was no longer in the operating room and had. Ampil was That he In other words.16 As stated before. left the hospital. supra at footnote 13. In this jurisdiction. In Ramos. in fact. It was duly established that Dr. Court of Appeals. the operating surgeon is the person in complete charge of the surgery room and all personnel connected with the operation. Bush. Fuentes. Fuentes’ permission to leave. 434 P2d 160 (1967). App. A “diligent search” was conducted. Dr. reported and showed his work to Dr.
if there is no pre-existing contractual relation between the parties. One important legal change is an increase in hospital liability for medical malpractice. Whoever by act or omission causes damage to another. 20 In this jurisdiction.G. Such fault or negligence. apparent authority. there being fault or negligence. Here. Fuentes. but also for those of persons for whom one is responsible. thus:
ART. No. Many courts now allow claims for hospital vicarious liability under the theories of respondeat superior. the statute governing liability for negligent acts is Article 2176 of the Civil Code.
Id.18 Those who could afford medical treatment were usually treated at home by their doctors.R. without regard for a patient’s ability to pay.
A derivative of this provision is Article 2180.
III . 126297 Whether PSI Is Liable for the Negligence of Dr. or agency by estoppel. 2180. hospitals were generally charitable institutions.of the doctrine does not dispense with the requirement of proof of negligence. Id. the days of house calls and philanthropic health care are over. is called a quasi-delict and is governed by the provisions of this Chapter. 2005.
Levin. providing medical services to the lowest classes of society. is obliged to pay for the damage done. October 17. The modern health care industry continues to distance itself from its charitable past and has experienced a significant conversion from a not-for-profit health care to for-profit hospital businesses. Ampil The third issue necessitates a glimpse at the historical development of hospitals and the resulting theories concerning their liability for the negligence of physicians.19 However. 2176. Consequently. the rule governing vicarious liability under the doctrine of respondeat superior. ostensible authority. Ampil and not by Dr. which reads:
Art. The obligation imposed by Article 2176 is demandable not only for one’s own acts or omissions. Until the mid-nineteenth century. the negligence was proven to have been committed by Dr. significant changes in health law have accompanied the businessrelated changes in the hospital industry. Hospital Vicarious Liability for Negligence by Independent Contractor Physicians: A New Rule for New Times.
Fridena v. Rossi. 442. Brochner. 522 P. 395 Mass. and pharmacists. 682 P. v. 682 P. Runyan v. Tucson General Hosp. 2d 944 (1962). Denver. 127 Ariz. 1992 Ed. and their employer cannot be held liable for such fault or negligence. whenever he acts in a professional capacity.x x x x x x The owners and managers of an establishment or enterprise are likewise responsible for damages caused by their employees in the service of the branches in which the latter are employed or on the occasion of their functions. State. 13 ALR 1403 (1921). 430. Rosane v. Employers shall be liable for the damages caused by their employees and household helpers acting within the scope of their assigned tasks even though the former are not engaged in any business or industry. 50 ALR 4th 225 (1984). dentists. 18 Ariz. when a doctor practices medicine in a hospital setting. are not “employees” under this article because the manner in which they perform their work is not within the control of the latter (employer). Co..22 It has been said that medical practice strictly involves highly developed and specialized knowledge. 363. v. 2d 1153 (1972).R. 2d 1213 (1983).
Arkansas M. Austin v. professionals are considered personally liable for the fault or negligence they commit in the discharge of their duties. Senger. 165. Co. 98 Ark. such as physicians.R. Mercy Hosp. 153 SW 595 (1911). Co. In other words.. Volume V.”21 The foregoing view is grounded on the traditional notion that the professional status and the very nature of the physician’s calling preclude him from being classed as an agent or employee of a hospital. Western Ins. Pearson.
Arkansas M. p. 702 P.23 such that physicians are generally free to exercise their own skill and judgment in rendering medical services sans interference. 228 SW 397. Pearson.
. 2d 372 (superseded by statute on other grounds). 481 NE 2d 1340 (1985) which held that a physician’s professional status does not prevent him or her from being a servant or agent of the hospital. 952 P...24 Hence. The Civil Code of the Philippines. Nieto v. 147 Ark. 683 SW 2d 255 (1985). “a hospital cannot be held liable for the fault or negligence of a physician or surgeon in the treatment or operation of patients. App. 373 P. 281. Litvak. Moon v. 112 Colo.. Paintsville Hosp. 659. 149 P. Co. 500 P. 516. But see Beeck v. In the context of the present case. Kelley v.
A prominent civilist commented that professionals engaged by an employer. 2d 1349 (1984). Goodrum. Evans. 2d 834 (1997). Rodriguez v. 2d 463 (1980). 150 Col. id. 2d 41. x x x x x x The responsibility treated of in this article shall cease when the persons herein mentioned prove that they observed all the diligence of a good father of a family to prevent damage.
. 132 (1954). the nature of the relationship between the hospital and the physicians is rendered inconsequential in view of our categorical pronouncement in Ramos v. Hendrickson v. food. Roth v. affd 296 NY 936. revd on other grounds.E.Y.. 143 N. Div 649. However. 81 NYS 2d 583 (1948).
211 N. Rufino v. as an independent contractor because of the skill he exercises and the lack of control exerted over his work. interns. 294 NYS 982.. Society of New York Hospital26 was then considered an authority for this view.. 279 App. Davie v. 125. on a salaried basis. The “Schloendorff doctrine” regards a physician. noting that modern hospitals actually do far more than provide facilities for treatment.the hospital and its employees are deemed to subserve him in his ministrations to the patient and his actions are of his own responsibility. 505 (1914).
2 NY 2d 656. Necolayff v. Courts came to realize that modern hospitals are increasingly taking active role in supplying and regulating medical care to patients. 73 NE2d 117 (1946). Sunshine Biscuit. Supp. administrative and manual workers. Inc. 308 NY 116. an employer-employee relationship in effect exists between hospitals and their attending and visiting physicians. 92. They charge patients for medical care and treatment. Supra at footnote 13.
. The court then concluded that there is no reason to exempt hospitals from the universal rule of respondeat superior. Lenox Hill Hosp.. even if employed by a hospital.. in Bing v. Beth El Hosp. 276 NY 252. held:
25 26  
principle for fault or negligence committed by physicians in the discharge of their
Kitto v. 52 L. 250 App. The court in Schloendorff opined that a hospital does not act through physicians but merely procures them to act on their own initiative and responsibility.25 The case of Schloendorff v. In our shores.. Div 917. and attendants for its patients. No longer were a hospital’s functions limited to furnishing room. Mrachek v. For subsequent application of the doctrine. 2d 801 (1954). Div. N. Thunig. 105 N. hospitals are exempt from the application of the profession. they regularly employ. 570 P. 123 N. 11 NE 2d 899 (1937). facilities for treatment and operation. Gilbert. 270 App. a large staff of physicians.A.E. Thus. 61 NYS 2d 832. 163 NYS 2d 3.S. Court of Appeals28 that for purposes of apportioning responsibility in medical negligence cases. see for instance. Rather. US. Inc..R. 110 NYS 2d 583 (1952). 126 F. 2d 544 (1977). if necessary. nurses. Genesee Hosp. the efficacy of the foregoing doctrine has weakened with the significant developments in medical care.27 the New York Court of Appeals deviated from the Schloendorff doctrine. 2d 3 (1957). Hodkin. 39 Colo App 374. even collecting for such services through legal action.E. Under this doctrine. 648. Inc.
The present case serves as a perfect these doctrines. or a consultant who regularly falls short of the minimum standards acceptable to the hospital or its peer review committee. with the exception of the payment of wages. x x x. evidence of accreditation by the appropriate board (diplomate). we rule that for the purpose of allocating responsibility in medical negligence cases. the control exercised. their educational qualifications. generally. interns and residents. he is normally required to attend clinico-pathological conferences. In the first place. technically employees. and references. conduct bedside rounds for clerks. platform to test the applicability of jurisprudence. moderate grand rounds and patient audits and perform other tasks and responsibilities. and/or for the privilege of admitting patients into the hospital. Doctors who apply for ‘consultant’ slots. nurses. thus. private hospitals. While ‘consultants’ are not. are required to submit proof of completion of residency. Its liability is also anchored upon the agency principle of apparent authority or agency by estoppel and the doctrine of corporate negligence which have gained acceptance in the determination of a hospital’s liability for negligent acts of health professionals. Accordingly. is normally politely terminated. the physician’s performance as a specialist is generally evaluated by a peer review committee on the basis of mortality and morbidity statistics.” who are allegedly not hospital employees. hospitals exercise significant control in the hiring and firing of consultants and in the conduct of their work within the hospital premises. an employer-employee relationship in effect exists between hospitals and their attending and visiting physicians. for the privilege of being able to maintain a clinic in the hospital. In other words. hire. ”
But the Ramos pronouncement is not our only basis in sustaining PSI’s liability. enriching our
. either as a visiting or attending consultant. These requirements are carefully scrutinized by members of the hospital administration or by a review committee set up by the hospital who either accept or reject the application. the hiring. the control test is determining. the difficulty is more apparent than real. evidence of fellowship in most cases. The unique practice (among private hospitals) of filling up specialist staff with attending and visiting “consultants. and the right to terminate consultants all fulfill the important hallmarks of an employer-employee relationship. presents problems in apportioning responsibility for negligence in medical malpractice cases. After a physician is accepted. and feedback from patients. visiting or attending. In addition to these. However. on the basis of the foregoing. interns and residents. fire and exercise real control over their attending and visiting ‘consultant’ staff.“We now discuss the responsibility of the hospital in this particular incident. In assessing whether such a relationship in fact exists. x x x. A consultant remiss in his duties.
it was explicitly stated that “there does not appear to be any rational basis for excluding the concept of apparent authority from the field of hospital liability. 605. 2d 55 (1982). 169 N. though he never in fact.” BLACK’s. or doctrine of ostensible agency or agency by estoppel. p.
. professedly as agent for the other. 415 So. has held out a particular physician as its agent and/or employee and that a patient has accepted treatment from that physician in the reasonable belief that it is being rendered in behalf of the hospital.. citing Hudson v. Inc. 1990) 1100.. Supra.” Apparent authority refers to “the power to affect the legal relations of another person by transactions with third persons. Werner.30 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. allows agent to exercise powers not granted to him. but is in reality based entirely upon estoppel. Loan Assn. Peters Hospital. C. thus justifying others in believing the agent possesses requisite authority.J. 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. is justified in presuming that such agent has authority to perform the particular act in question.Apparent authority.. 1936). by its actions.J. Doctor Hospital of Lake Worth. or which he holds the agent out to the public as possessing. Arises where principal by negligence in failing to supervise agent’s affairs. It is. 654 P2d 263 (1982) and Adamski v.” and “holding out” tend to be used interchangeably by the courts to refer to this theory of liability. Inc. Doctors Hospital of Lake Worth. 20 Wash App.” Supra. p. 575. It imposes liability. Baker v. 116 N. induces another to believe that a third person is his agent.29 has its origin from the law of agency. not as the result of the reality of a contractual relationship. Agency by estoppel is defined as “one created by operation of law and established by proof of such acts of the principal as reasonably lead third persons to the conclusion of its existence.. An ostensible agency is “an implied or presumptive agency which exists where one.
Irving v. 608. 98. St. then the hospital will be liable for the physician’s negligence.” “apparent authority. 96. but rather because of the actions of a principal or an employer in somehow misleading the public into believing that the relationship or the authority exists. quoting Arthur v. strictly speaking. Tacoma Gen. v. Article 1869 of the Civil Code reads:
BLACK’S LAW DICTIONARY (6th Ed. Horowytz. See for instance. 186 A 437 (Sup. Ct. employed him. or what is sometimes referred to as the “holding out” theory. Inc.L. arising from and in accordance with the other’s manifestations to such third persons. 405 A. 62. no agency at all. 579 P2d 970 (1978). Hosp.” Thus.” “agency by estoppel.
Id. conversant with business usages and the nature of the particular business. in cases where it can be shown that a hospital.32 There.31
The concept is essentially one of estoppel and has been
The applicability of apparent authority in the field of hospital liability was upheld long time ago in Irving v. The terms “ostensible agency. 2d 443 (1979). either intentionally or from want of ordinary care. Our jurisdiction recognizes the concept of an agency by implication or estoppel.. supra.
The trial court correctly pointed out:
x x x regardless of the education and status in life of the patient. or his failure to repudiate the agency. Fuentes and publicly advertising their qualifications. as in the case herein. legal responsibility for the conduct of treatment and surgery within its facility by its accredited physician or surgeon. p. Agency may be express. By accrediting Dr. he ought not be burdened with the defense of absence of employeremployee relationship between the hospital and the independent physician whose name and competence are certainly certified to the general public by the hospital’s act of listing him and his specialty in its lobby directory. Ampil and Dr. the hospital succeeds in its mission of offering quality medical services and thus profits financially. or implied from the acts of the principal. The high costs of today’s medical and health care should at least exact on the hospital greater. Logically. If these accredited physicians do their job well. One allegation in the complaint in Civil Case No. such as physicians. PSI’s act is tantamount to holding out to the public that Medical City Hospital. 9. where negligence mars the quality of its services. Natividad being one of them. p. PSI publicly displays in the lobby of the Medical City Hospital the names and specializations of the physicians associated or accredited by it.
In this case.” Indeed. Corporate entities.
. like PSI. 126467.R. regardless of whether he is independent or employed. Ampil and Dr. 127. knowing that another person is acting on his behalf without authority. We concur with the Court of Appeals’ conclusion that 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. or servants. are capable of acting only through other individuals. accepted the services on the reasonable belief that such were being rendered by the hospital or its employees. As expected. No. Q-43332 for negligence and malpractice is that PSI as owner.”33
The wisdom of the foregoing ratiocination is easy to discern. the hospital should not be allowed to escape liability for the acts of its ostensible agents. if not broader. 1869. through its accredited physicians.
RTC Decision. We now proceed to the doctrine of corporate negligence or corporate responsibility.ART. these patients. offers quality health care services. Rollo of G. including those of Dr. the hospital created the impression that they were its agents. authorized to perform medical or surgical services for its patients. from his silence or lack of action. operator and manager of Medical City Hospital. Fuentes. agents.
Zimbelman. 75.36 There. 500 P2d 335 (1972).“did not perform the necessary supervision nor exercise diligent efforts in the supervision of Drs. 140.”34 of duty. App. Charleston Community Hospital. and medical interns who assisted Drs. the duty of providing quality medical service is no longer the sole prerogative and responsibility of the physician.J.35 The doctrine has its genesis in Darling v. Purcell v.500 P. failing to require a consultation with or examination by members of the hospital staff.” On the basis of Darling.E. Ampil and Fuentes and its nursing staff. Hospitals now tend to organize a highly professional medical staff whose competence and performance need to be monitored by the hospitals commensurate with their inherent responsibility to provide quality medical care. 75. Ampil and Fuentes in the performance of their duties as surgeons. Super. 2d 335 (1972). Supra at footnote 1. (2) the selection and retention of competent physicians. Zimbelman. p. Its formulation proceeds from the judiciary’s acknowledgment that in these modern times. and (4) the formulation. p. 120. resident doctors. Hospital Authority v. Ct. Recent years have seen the doctrine of corporate negligence as 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 or apparent authority. 126467. Rollo of G.189 S. among them: (1) the use of reasonable care in the maintenance of safe and adequate facilities and equipment. inter alia. the Supreme Court of Illinois held that “the jury could have found a hospital negligent.37 With the passage of time. We agree with the trial court. 302. 350 A. in failing to have a sufficient number of trained nurses attending the patient. 18 Ariz.1975). 2. App. 18 Ariz. and failing to review the treatment rendered to the patient.R.
Corleto v. 229 Ga. The modern hospitals have changed structure. other jurisdictions held that a hospital’s corporate negligence extends to permitting a physician known to be incompetent to practice at the hospital. Purcell v. (3) the overseeing or supervision of all persons who practice medicine within its walls. Joiner. 138 N. Hospital.
. 2d 412 (1972). adoption and enforcement of adequate rules and
34 35 36 37    
Premised on the doctrine of
corporate negligence. 2d 534 (Super. more duties were expected from hospitals. the trial court held that PSI is directly liable for such breach
RTC Decision. No. Law Div.
it is reasonable to conclude that PSI. can callously turn their backs on and disregard even a mere probability of mistake or negligence by refusing or failing to investigate a report of such seriousness as the one in Natividad’s case. In Fridena v. 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. 262 S.E. nurses. 2d 463 (1980). thus:
x x x PSI’s liability is traceable to its failure to conduct an investigation of the matter reported in the nota bene of the count nurse. 622 P. 115 Ariz. has the duty to see that it meets the standards of responsibilities for the care of patients. The findings of the trial court are convincing. 504.policies that ensure quality care for its patients. composed of resident doctors. Ethical considerations. and interns. has actual or constructive knowledge of the procedures carried out. 2d 391. if not for the benefit of the patient to whom the duty is primarily owed. and their institutions like PSI’s hospital facility. 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. Inc. if not also legal.E. through their members like defendant surgeons. in Tucson Medical
Center.2d 581 (1997). dictated the holding of an immediate inquiry into the events.40 the court concluded that a patient who enters a hospital does so with the reasonable expectation that it will attempt to cure him. Misevich.
It is worthy to note that Dr. 548 Pa. 269 S.39 it was held that a hospital. And in Bost v.41 it was held that a corporation is bound by the knowledge acquired by or notice given to its agents or officers within the scope of their authority and in reference to a matter to which their authority
38 39 40 41    
Welsh v. then in the interest of arriving at the truth. The Court cannot accept that the medical and the healing professions. As such. following the doctrine of corporate responsibility. In the present case. 516. Such failure established PSI’s part in the dark conspiracy of silence and concealment about the gauzes. Ampil and Dr. 2d 621 (1980). cert denied 300 NC 194. it has the duty to exercise reasonable care to protect from harm all patients admitted into its facility for medical treatment. 34. as the operator of the hospital. Evans. Accordingly.
. Riley. Unfortunately. 127 Ariz. 545 P2d 958 (1976). Such duty includes the proper supervision of the members of its medical staff. PSI failed to perform such duty. v. Bulger.38
Thus. 698 A. particularly the report of the attending nurses that the two pieces of gauze were missing. Fuentes operated on Natividad with the assistance of the Medical City Hospital’s staff.
and that the negligence of the defendants was the proximate cause of the patient’s injuries. despite the attending nurses’ report. the Supreme Court of Arizona held:
x x x In recent years. Subsequent to the Purcell decision. Ampil under Article 2180 of the Civil Code. let it be emphasized that PSI. See Kahn Hospital Malpractice Prevention. In Fridena. Beeck v. the plaintiffs did plead that the operation was performed at the hospital with its knowledge. We find that such general allegations of negligence. 75. App. x x x x x x In the amended complaint. 27 De Paul . it also failed to take an active step in fixing the negligence committed. Now. not only vicariously liable for the negligence of Dr. 18 Ariz. the duty of care owed to the patient by the hospital has expanded. Ampil for damages. 23 (1977). Zimbelman. apart from a general denial of its responsibility. x x x. aid. In
. to investigate and inform Natividad regarding the missing gauzes amounts to callous negligence. the hospital argued that it could not be held liable for the malpractice of a medical practitioner because he was an independent contractor within the hospital. The emerging trend is to hold the hospital responsible where the hospital has failed to monitor and review medical services being provided within its walls. are sufficient to support the hospital’s liability based on the theory of negligent supervision. The Court of Appeals pointed out that the hospital had created a professional staff whose competence and performance was to be monitored and reviewed by the governing body of the hospital. and the court held that a hospital would be negligent where it had knowledge or reason to believe that a doctor using the facilities was employing a method of treatment or care which fell below the recognized standard of care.”
Anent the corollary issue of whether PSI is solidarily liable with Dr.extends.500 P. 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. Rev. however. Among the cases indicative of the ‘emerging trend’ is Purcell v. 2d 335 (1972). App. Tucson General Hospital. In Purcell. 165. and assistance. 18 Ariz. This means that the knowledge of any of the staff of Medical City Hospital constitutes knowledge of PSI. 500 P. the failure of PSI. This court has confirmed the rulings of the Court of Appeals that a hospital has the duty of supervising the competence of the doctors on its staff. but also directly liable for its own negligence under Article 2176. the Arizona Court of Appeals held that a hospital has certain inherent responsibilities regarding the quality of medical care furnished to patients within its walls and it must meet the standards of responsibility commensurate with this undertaking. This renders PSI. 2d 1153 (1972). Not only did PSI breach its duties to oversee or supervise all persons who practice medicine within its walls. along with the evidence produced at the trial of this case.
the law imposes on him certain obligations. AZCUNA Associate Justice (No Part) CANCIO C. The SC said that courts in holding a hospital liable for damages. No. Ampil v. Ampil.R. he must possess that reasonable degree of learning.R. skill and experience required by his profession. No. v. we DENY all the petitions and AFFIRM the challenged Decision of the Court of Appeals in CA-G. CV No. having undertaken one of
. et al. Agana. PSI is also directly liable to the Aganas. Agana. WHEREFORE. 127590.neglecting to offer such proof. G. must be adjudged solidarily liable with Dr.R. 126297. 32198. as we have discussed. SO ORDERED. G. Moreover. No.R. Miguel Ampil. therefore. Once a physician undertakes the treatment and care of a patient. Agana. 42062 and CA-G.R. 126467. Costs against petitioners PSI and Dr. January 31. One final word. Fuentes. and exert his best
ANGELINA SANDOVAL-GUTIERREZ Associate Justice WE CONCUR: REYNATO S. and. At the same time. PUNO Chief Justice Chairperson RENATO C. CORONA Associate Justice ADOLFO S. judgment. GARCIA Associate Justice
The case of Professional Services. he must apply reasonable care and diligence in the exercise of his skill and the application of his knowledge. PSI failed to discharge its burden under the last paragraph of Article 2180 cited earlier. SP No. Inc. or even consultants.. 2007 set the precedent for the liability of hospitals for the negligence of doctors employed by it. v. et al. G. In order to escape liability.
They told her that the pain is the natural consequence of the surgery. Hence. Dr. necessitating the removal of certain portions of it. she died and was duly substituted by her children. 2d 326. pending the outcome of the above case. Another surgical operation was needed to remedy the damage.” Natividad was released from the hospital. Dr. 2d 1153 (1972). After her return to the Philippines.5 inches in width badly infected her vaginal vault. A recto-vaginal fistula had formed in her reproductive organs which forced stool to excrete through the vagina. After Dr. Upon being informed about it. the very lives of those placed in the hospital’s keeping. He found that the malignancy in her sigmoid area had spread on her left ovary. On February 16. Dr. He then assured her that the pains would soon vanish. Ampil then recommended that she consult an oncologist to examine the cancerous nodes which were not removed during the operation. Tuzon General Hospital. Dr. complex and esoteric its character may be. 500 P. to permit Dr. Dr. While confined there.5 inches in width. 1986. Accompanied by her husband she went to the United States to seek further treatment. Ramon Gutierrez detected the presence of another foreign object in her vagina – a foul-smelling gauze measuring 1.
. The care and service dispensed through this high trust. however technical. Ampil obtained the consent of Natividad’s husband. completed the operation and closed the incision. citing Darling v. Dr. she was told she was free of cancer. Fuentes had completed the hysterectomy. and indeed. Dr. Instead. Thus. Thus. in October 1984. The spouses filed a complaint for damages alleging that the doctors are liable for negligence for leaving two pieces of gauze inside Natividad’s body and malpractice for concealing their acts of negligence. Ampil took over. because the attending nurse entered these remarks: “sponge count lacking 2 “announced to surgeon searched (sic) done but to no avail continue for closure. Ampil’s assurance did not come true. but later on complained of excruciating pain in her anal region. her daughter found a piece of gauze protruding from her vagina. assisted by the medical staff of the Medical City Hospital. Charleston Community Memorial Hospital. The operation appeared to be flawed.E. 2d 253). the pains intensified.mankind’s most important and delicate endeavors. must meet standards of responsibility commensurate with the undertaking to preserve and protect the health. After four months of consultations and laboratory examinations. Ampil proceeded to her house where he managed to extract by hand a piece of gauze measuring 1. Ampil. Enrique Agana. she was advised to return to the Philippines. 33 Ill. (Beeck v. she underwent another surgery. 211 N. She consulted both doctors about it. performed an anterior resection surgery on Natividad. to perform hysterectomy on her. must assume the grave responsibility of pursuing it with appropriate care. Juan Fuentes. prompting Natividad to seek treatment at the Polymedic General Hospital.
Ampil as the negligent party. The glaring truth is that all the major circumstances. PSI alleged in its petition that the Court of Appeals erred in holding that: (1) it is estopped from raising the defense that Dr. Fuentes is not guilty of negligence or medical malpractice. but was denied. Fuentes who used gauzes in performing the hysterectomy. and third. Ampil liable for negligence and malpractice. Neither did he submit evidence to rebut the correctness of the record of operation. The issues submitted to the court were: first. Ampil asserted that the Court of Appeals erred in finding him liable for negligence and malpractice sans evidence that he left the two pieces of gauze in Natividad’s vagina. Ampil solidarily liable. Ampil argued that the Court should not discount either of the following possibilities: first. They contended that the pieces of gauze are prima facie proofs that the operating surgeons have been negligent. On appeal. but a mere consultant or independent contractor. Fuentes left the gauzes in Natividad’s body after performing hysterectomy. he alone should answer for his negligence. Fuentes and holding PSI and Dr. Dr. The Aganas maintained that the Court of Appeals erred in finding that Dr. As such. directly point to Dr. and (3) the medical intervention of the American doctors who examined Natividad in the United States of America. Dr. the Court of Appeals rendered its Decision jointly disposing of CA-GR CV No. taken together. second.The trial court rendered a judgment holding the doctors liable for negligence and malpractice. thus:
. and (3) it is not entitled to its counterclaim against the Aganas. the CA dismissed the case against Dr. Only Dr. Fuentes but affirmed the judgment against Dr. the attending nurses erred in counting the gauzes. such as: (1) it was Dr. Fuentes. The arguments are purely conjectural and without basis. Ampil filed a motion for reconsideration. (2) the attending nurses’ failure to properly count the gauzes used during surgery. (2) it is solidarily liable with Dr. Ampil is not its employee. the American doctors were the ones who placed the gauzes in Natividad’s body. Dr. Dr. Records show that he did not present any evidence to prove that the American doctors were the ones who put or left the gauzes in Natividad’s body. Ampil examined his work and found it in order. as specified by the Court of Appeals. Ampil is not its employee. PSI contended that Dr. Ampil. Ampil and the hospital. Ampil. second. 1996. On September 6. Fuentes of any liability. 42062 and CA-GR SP No. dismissing the case against Dr. and third. whether the Court of Appeals erred in holding Dr. whether PSI may be held solidarily liable for the negligence of Dr. As to the alleged negligence of Dr. particularly the number of gauzes used. invoking the doctrine of res ipsa loquitur. Ampil liable for negligence and malpractice. He pointed to other probable cause. whether the Court of Appeals erred in absolving Dr. 32198. Held: (1) Whether the Court of Appeals erred in holding Dr.
thus: “The removal of all sponges used is part of a surgical operation. from Natividad’s body before closure of the incision. Dr. necessitating her further examination by American doctors and another surgery. 278 SCRA 769). When he failed to do so. But this does not leave him free from any obligation. Pascasio. To put simply. 1997. Third. 116 Kan. September 5. Ampil’s negligence is the proximate cause of Natividad’s injury could
. two (2) gauzes were extracted from the same spot of the body of Mrs. the elements are duty. Zeagler. (Rule v. 328 Pla. Dr. breach. after the operation. and endeavoring with the means he has at hand to minimize and avoid untoward results likely to ensue therefrom. Worse. Bernsden v. Ampil. and that failure or action caused injury to the patient. he even misled her that the pain she was experiencing was the ordinary consequence of her operation. 268 P. 230. such as gauzes. The SC further ruled that it is not blind to the reality that there are times when danger to a patient’s life precludes a surgeon from further searching missing sponges or foreign objects left in the body. Even if it has been shown that a surgeon was required by the urgent necessities of the case to leave a sponge in his patient’s abdomen.R. There are even legions of authorities to the effect that such act is negligence per se. such act is considered so inconsistent with due care as to raise an inference of negligence. immediately after the operation. 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. it was his duty to inform Natividad about it. Newman. Agana where the surgery was performed. Ampil breached both duties. That Dr. Simply put. This is in order that she might seek relief from the effects of the foreign object left in her body as her condition might permit. What was initially an act of negligence by Dr. because of the dangers attendant upon delay. Dr. Johnson. it was ruled. Cheeseman. citing Russel v. (1934)). that such anomaly was ‘announced to surgeon’ and that a ‘search was done but to no avail’ prompting Dr. still. (157 So. 255 P. 317 P. it is not disputed that the surgeons used gauzes as sponges to control the bleeding of the patient during the surgical operation. Second. 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. An operation requiring the placing of sponges in the incision is not complete until the sponges are properly removed.First. Had he been more candid. it is his legal duty to so inform his patient within a reasonable time thereafter by advising her of what he had been compelled to do. Such breach caused injury to Natividad. had the duty to remove all foreign objects. the nurses who assisted in the surgery noted in their support that the ‘sponge count (was) lacking 2’. In Smith v. 118141. G. injury and proximate causation. 752. Ampil has ripened into a deliberate wrongful act of deceiving his patient. 174 Kan. he thereby leaves his operation uncompleted and creates a new condition which imposes upon him the legal duty of calling the new condition to his patient’s attention. No. 2d 472 (1957). (Garcia-Rueda v. Ampil did not inform Natividad about the missing two pieces of gauze. To successfully pursue this kind of case. or that he did something that a reasonably prudent provider would not have done. as the lead surgeon. Ampil to ‘continue for closure’ x x x. and when a physician or surgeon fails to remove a sponge he has placed in his patient’s body that should be removed as part of the operation. 2d 1033). Natividad could have taken the immediate and appropriate medical remedy to remove the gauzes from her body.
According to them. The element of “control and management of the thing which caused the injury” are wanting in the case.. the most instrumental is the “control and management of the thing which cause the injury”. or make out a plaintiff’s prima facie case. having such control used proper care. where the thing which caused the injury. may permit an inference or raise a presumption of negligence. 124354. taken with the surrounding circumstances. No. it affords reasonable evidence. Fuentes on the ground that it is contrary to the doctrine of res ipsa loquitur.
. the requisites for the applicability of the doctrine of res ipsa loquitur are: (1) the occurrence of an injury. Caltex (Phils. Fuentes’ negligence. 123 Phil. It is the rule that the fact of the occurrence of an injury. (2) the thing which caused the injury was under the control and management of the defendant.) Inc. 280).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. and (4) the absence of explanation by the defendant. The Aganas assailed the dismissal by the trial court of the case against Dr. the fact that the two pieces of gauze were left inside Natividad’s body is a prima facie evidence of Dr. Stated differently. G. would not have happened if those who had control or management used proper care. the doctrine of res ipsa loquitur will not lie. Hence. and the burden of proof is shifted to him to establish that he has observed due care and diligence. CA. (Ramos v. December 29. (2) Whether the Court of Appeals erred in absolving Dr. is under the exclusive control of the defendant and the injury is such that it should not have occurred if he. Of the foregoing requisites. and present a question of fact for defendant to meet with an explanation. That they were later on extracted from Natividad’s vagina established the causal link between Dr. And what further aggravated such injury was his deliberate concealment of the missing gauzes from the knowledge of Natividad and her family. 1999. (3) the occurrence was such that in the ordinary course of things. Fuentes of any liability. res ipsa loquitur means “the thing speaks for itself”. without the fault of the injured. Ampil’s negligence and the injury. 321 SCRA 584).R. From the foregoing statements of the rule. Literally. Held: The SC ruled otherwise. (Africa v. in the absence of explanation that the injury arose from the defendant’s want of care.