CASUMPANG, ET AL. V.

CORTEJO
G.R. No. 171127, March 11, 2015

Facts:
Edmer Cortejo (Edmer) was brought to the emergency room of San Juan de Dios Hospital
(SJDH) by his mother, Mrs. Jesusa Cortejo (Jesusa) due to difficulty in breathing, chest pains,
stomach pain, and fever. Dr. Ramoncito Livelo (Livelo), a family doctor, initially attended to Edmer and
after a few tests had the initial impression of Bronchopneumonia. Dr. Livelo then gave Edmer some
antibiotics to lessen his fever and loosen is phlegm.

Jesusa did not know anyone from SJDH. Jesusa used her fortune card and was referred to a Fortune Care
Coordinator, who was then absent. She got assigned to Dr. Noel Casumpang
(Casumpang) who appeared to be an employee of the hospital. Dr. Casumpang examined Edmer for the
first time and merely used a stethoscope and determined that it was Bronchopneumonia. Not satisfied, she
stated that Edmer had high fever, no colds or cough; Dr. Casumpang that it was normal for
Bronchopneumonia. The following day early morning, Edmer had now a fever, throat irritation and even
stomach and chest pains. Despite being known to such information, Dr. Casumpang mere inquired if
Edmer had asthma, reassured that the illness was Bronchopneumonia.

Later in the morning, Edmer began vomiting phlegm with blood streak. Nelson Cortejo
(Nelson), Edmers father, thus called for a doctor and Dr. Ruby Miranda-Sanga (Sanga) came to their call.
Dr. Sanga examined Edmer and found that he had a low grade non continuing fever, rashes that were not
typical of dengue fever. Dr. Rubi had told Dr. Casumpang of the symptoms.

She failed to positively diagnose the patient immediately because the blood streak was
washed by the Nelson, thus she ordered the next time it occurred Nelson should preserve the same. Upon
acquiring a sample she positively determined that it was Dengue Hemorrahgic Fever. Dr. Casumpang
advised that Edmer be bought to the ICU, to which the spouses Cortejo agreed to but the ICU was full,
thus they opted to go to Makati Medical Center. Upon arriving it was declared that it was already at stage
IV and thus irreversible. Edmer died.

Issues:
1.) Whether Drs. Casumpang and Sanga committed inexcusable lack of precaution in diagnosing and in
treating the patient.
2.) Whether SJDH is solidarily liable with the doctors.

Ruling:

1.) Only Dr. Casumapang was negligent; Dr. Sanga was not

DR. CASUMPANG WAS NEGLIGENT IN DIAGNOSIS: It will be recalled that during Dr.
Casumpang's first and second visits to Edmer, he already had knowledge of Edmer's laboratory test result
(CBC), medical history, and symptoms (i.e., fever, rashes, rapid breathing, chest and stomach pain, throat
irritation, difficulty in breathing, and traces of blood in the sputum). However, these information did not
lead Dr. Casumpang to the possibility that Edmer could be suffering from either dengue fever, or dengue
hemorrhagic fever, as he clung to his diagnosis of broncho pneumonia. This means that given the
symptoms exhibited, Dr. Casumpang already ruled out the possibility of other diseases like dengue.
In other words, it was lost on Dr. Casumpang that the characteristic symptoms of dengue (as Dr.
Jaudian testified) are: patient's rapid breathing; chest and stomach pain; fever; and the presence of blood
in his saliva. He was selective in appreciating the symptoms.

DR. CASUMPANG WAS NEGLIGENT IN THE TREATMENT AND MANAGEMENT OF DENGUE:

Dr. Casumpang failed to measure up to these standards. The evidence strongly suggests that he ordered a
transfusion of platelet concentrate instead of blood transfusion. The tourniquet test was only conducted
after Edmer's second episode of bleeding, and the medical management (as reflected in the records) did
not include antibiotic therapy and complete physical examination.

NO ANTIBIOTIC THERAPY AND COMPLETE PHYSICAL EXAMINATION

DR. MIRANDA IS NOT LIABLE FOR NEGLIGENCE: the medical care required is that of reasonably
careful physicians or hospital emergency room operators, not of interns or residents; Although she had
greater patient exposure, and was' subject to the same standard of care applicable to attending physicians,
we believe that a finding of negligence should also depend on several competing factors, among them, her
authority to make her own diagnosis, the degree of supervision of the attending physician over her, and
the shared responsibility between her and the attending physicians; Dr. Miranda likewise duly reported to
Dr. Casumpang, who admitted receiving updates regarding Edmer's condition. There is also evidence
supporting Dr. Miranda's claim that she extended diligent care to Edmer. In fact, when she suspected -
during Edmer's second episode of bleeding - that Edmer could be suffering from dengue fever, she wasted
no time in conducting the necessary tests, and promptly notified Dr. Casumpang about the incident.
Indubitably, her medical assistance led to the finding of dengue fever.

2. YES, under the doctrine of vicarious liability (apparent authority).

SJDH’S LIABILITY BASED ON THE DOCTRINE OF APPARENT AUTHORITY NOT

RESPONDEAT SUPERIOR

We hold that, under the doctrine of apparent authority, a hospital can be held vicariously
liable for the negligent acts of a physician providing care at the hospital, regardless of whether the
physician is an independent contractor, unless the patient knows, or should have known, that the
physician is an independent contractor.

The elements of the action have been set out as follows:

For a hospital to be liable under the doctrine of apparent authority, a plaintiff must show that:
(1) the hospital, or its agent, acted in a manner that would lead a reasonable person to conclude
that the individual who was alleged to be negligent was an employee or agent of the hospital; (2)
where the acts of the agent create the appearance of authority, the plaintiff must also prove that the
hospital had knowledge of and acquiesced in them; and (3) the plaintiff acted in reliance upon the
conduct of the hospital or its agent, consistent with ordinary care and prudence.