PSI vs AGANA

FACTS

Natividad Agana was rushed to Medical City because of difficulty of bowel movement  and bloody anal
discharge. Dr. Ampil diagnosed her to be suffering from  cancer of the sigmoid. Dr. Ampil performed
an anterior resection surgery on her, and finding that the malignancy spread on her left ovary, he obtained
the consent of her husband, Enrique, to permit Dr. Fuentes to perform  hysterectomy on her. After the
hysterectomy, Dr. Fuentes showed his work to Dr. Ampil, who examined it and found it in order, so he
allowed Dr. Fuentes to leave the operating room. Dr. Ampil was about to complete the procedure when
the attending nurses made some remarks on the Record of Operation: “ sponge count lacking 2;
announced to surgeon search done but to no avail continue for closure ” (two pieces of gauze were
missing). A “diligent search” was conducted but they could not be found. Dr. Ampil then  directed that the
incision be closed.
          A couple of days after, she complained of pain in her anal region, but the doctors told her that it was
just a natural consequence of the surgery. Dr. Ampil recommended that she consult an oncologist to
examine the cancerous nodes which were not removed during the operation. After months of consultations
and examinations in the US, she was told that she was free of cancer. Weeks after coming back, her
daughter found a piece of gauze (1.5 in) protruding from her vagina, so Dr. Ampil manually extracted this,
assuring Natividad that the pains will go away. However, the pain worsened, so she sought treatment at a
hospital, where another 1.5 in piece of gauze was found in her vagina. She underwent another surgery.

          Sps. Agana filed a complaint for damages against PSI (owner of Medical City), Dr. Ampil, and Dr.
Fuentes, alleging that the latter are liable for  negligence for leaving 2 pieces of gauze in Natividad’s body,
and malpractice for concealing their acts of negligence. Enrique Agana also filed an  administrative
complaint for gross negligence and malpractice against the two doctors with the PRC (although only the
case against Dr. Fuentes was heard since Dr. Ampil was abroad). Pending the outcome of the
cases, Natividad died (now substituted by her children).

RULING:
The doctrine in Ramos v. Court of Appeals, 321 SCRA 584 (1999), still obtains, i.e., for the purpose of
allocating responsibility in medical negligence cases, an employer-employee relationship exists between
hospitals and their consultants.

While in general, a hospital is not liable for the negligence of an independent contractor-physician, the
hospital may be liable if the physician is the “ostensible” agent of the hospital, an exception also known as
the “doctrine of apparent authority” or sometimes referred to as the apparent or ostensible agency theory.
In this regard, the hospital need not make express representations to the patient that the treating
physician is an employee of the hospital; rather a representation may be general and implied.

The act of a hospital in displaying the names of physicians in the public directory at the lobby of the
hospital amounts to holding out to the public that it offers quality medical service through the listed
physicians; Under the doctrine of apparent authority, 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,
conversant with business usages and the nature of the particular business, is justified in presuming that
such agent has authority to perform the particular act in question.

The duty of providing quality medical service is no longer the sole prerogative and responsibility of the
physician because the modern hospital now tends to organize a highly-professional medical staff whose
competence and performance need also to be monitored by the hospital commensurate with its inherent
responsibility to provide quality medical care. Such responsibility includes the proper supervision of the
members of its medical staff. Accordingly, the hospital has the duty to make a reasonable effort to monitor
and oversee the treatment prescribed and administered by the physicians practicing in its premises.

The corporate negligence doctrine imposes several duties on a hospital: (1) to use reasonable care in the
maintenance of safe and adequate facilities and equipment; (2) to select and retain only competent
physicians; (3) to oversee as to patient care all persons who practice medicine within its walls; and (4) to
formulate, adopt, and enforce adequate rules and policies to ensure quality care for its patients. These
special tort duties arise from the special relationship existing between a hospital or nursing home and its
patients, which are based on the vulnerability of the physically or mentally ill persons and their inability to
provide care for themselves.