CAPTAIN OF THE SHIP DOCTRINE

MEANING
The “Captain-of the-Ship” doctrine is defined as the “doctrine imposing liability on a surgeon for
the actions of assistants who are under the surgeon’s control but who are employees of the hospital, not the
surgeon.”

INSIDE THE OPERATING ROOM

Surgeons – operate so as to treat disease, repair, injury, correct deformities and improve general
health of the patient. Head of the surgical team.
Anesthesiologists – those trained to administer anesthetics or use drugs and gases to render patients
unconscious during surgery.
Hospital nurses – are those who provide bedside nursing care and carry out the medical regimen
prescribed by physicians.

BACKGROUND and RELATED JURISPRUDENCE

 "The Captain-of-the-Ship Doctrine was discussed in McConnel v. Williams,1 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.

 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.

1
65 A.2d 243, 246 (pa. 1949) (U.S).

1
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.

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.

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.

2
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.