TORTS AND DAMAGES (June 1, 2020) | Atty.
Pandi | EH 401 Tala Nation 2019-2020
STRICT LIABILITY TORTS
Possessor of Animals
Art. 2183. The possessor of an animal or whoever may
make use of the same is responsible for the damage
which it may cause, although it may escape or be lost.
This responsibility shall cease only in case the
damage should come from force majeure or from the
fault of the person who has suffered damage.
One of the more contentious issues in the Strict Liability Torts is
the possessor of animals. A good example of that is the very
interesting question in the bar exam.
(Bar Exam 2010)
Primo owns a pet iguana which he keeps in a man-made pond
enclosed by a fence situated in his residential lot. A typhoon
knocked down the fence of the pond and the iguana crawled
out of the gate of Primo’s residence. N, a neighbor who was
passing by, started throwing stones at the iguana, drawing
the iguana to move toward him. N panicked and ran but
tripped on something and suffered a broken leg.
Is anyone liable for N’s injuries? Explain.
SUGGESTED ANSWER:
No one is liable. The possessor of an animal or whoever may
make use of the same is responsible for the damage which it
may cause, although it may escape or be lost. This
responsibility shall cease only in case the damage should
come from force majeure or from the fault of the person who
has suffered damage (Art. 2183, New Civil Code)
RVP: Vestil case is very different from the bar question because
it will be hard-pressed on the part of Vestil to argue that there
was force majeure, when in fact there was none. In this case,
there was an accident that happened at the house of her father.
VESTIL v. CA
FACTS:
Theness Tan Uy was bitten by a dog while she was playing
with a child of the petitioners in the house of the father of
Purita Vestil. She was rushed to the hospital and was treated
and administered with an antirabies vaccine. Then she was
discharged but was readmitted due to "vomiting of saliva."
The following day the child died with broncho-pneumonia.
The Uys sued the petitioners for damages. They alleged that
petitioners were liable as possessors of “Andoy”, the dog.
Purita Vestil insists that she is not the owner of the house or
of the dog left by her father as his estate has not yet been
partitioned and there are other heirs to the property that it
was a tame animal, and that no one had seen it bite Theness.
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ISSUE:
WON the Vestils are in possession of the dog thereby making
them liable for damages.
HELD:
YES. Art. 2183 of the Civil Code stipulates that the possessor
of an animal or whoever may make use of the same is
responsible for the damage which it may cause, although it
may escape or be lost. This responsibility shall cease only in
case the damage should come from force majeure or from
the fault of the person who has suffered damage.
The Supreme Court said that although the Vestils were not
the owner of the house, which was still part of Miranda’s
estate, there’s no doubt that they were the possessors at the
time of the incident. Purita’s the only heir residing in Cebu
City who could take care of the property, which was only 6km
from her house. There is also evidence showing that once or
twice a week, they go to the house and use it virtually as a
second house. And the dog remained in the house even after
Miranda’s death.
The court further explained that first, Theness developed
hydrophobia, a symptom of rabies, as a result of the dog
bites, and second, that asphyxia broncho-pneumonia, which
ultimately caused her death, was a complication of rabies.
Theness became afraid of water after she was bitten by the
dog. Also, it was proven by the testimony of Dr. Tautjo that
a person who has rabies may die of complications such as
broncho-pneumonia.
Their contention that they could not be expected to exercise
remote control of the dog is not acceptable. Article 2183 of
the Civil Code holds the possessor liable even if the animal
should "escape or be lost" and so be removed from his
control. They also contended that the dog was tame and was
merely provoked by the child into biting her. The law does
not speak only of vicious animals but covers even tame ones
as long as they cause injury. As for the alleged provocation
Theness was only three years old at the time she was
attacked and can hardly be faulted for whatever she might
have done to the animal.
According to Manresa, the obligation imposed by Article 2183
of the Civil Code is not based on negligence or on the
presumed lack of vigilance of the possessor or user of the
animal causing the damage. It is based on natural equity and
on the principle of social interest that he who possesses
animals for his utility, pleasure or service must answer for the
damage which such animals may cause.
WHEREFORE, the petition is DENIED.
RVP: The SC said that they have to exercise remote control
because the only defense available under Article 2183 is the
force majeure. And without any proof as to the existence of
force majeure, the possessor of the animal will be held liable.
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
SPECIAL TORTS
It is called Special Torts because most of the torts (that was
discussed so far) are types of quasi-delicts, which requires a
certain degree of negligence, where there has to be fault on the
part of the defendant; and in this kind of torts, they do not
require negligence. What is required is malice or bad faith.
They are referred to as tortuous acts that are intentional in
nature, which is one of the exceptions to the primary elements
as to what constitutes quasi-delict.
Also, they are called Special Torts because they govern human
relations (Persons and Family Relations). Articles 19 to 21 of
the New Civil Code govern human relations.
Abuse of Rights Principle or
Acts Contra Bonos Mores
Art. 19. Every person must, in the exercise of his
rights and in the performance of his duties, act with
justice, give everyone his due, and observe honesty
and good faith.
Elements:
(1) There exists a legal right or duty
(2) Which is exercised in bad faith
(3) For the sole intent of prejudicing or injuring another
(most important element)
RVP: Abuse of Rights Principle is a catch basin, a desperate
argument on the part of the litigants. However, you cannot
simply invoke it because you have to allege malice and for the
sole intent of prejudicing or injuring another.
Malicious Interference or
Tortuous Interference
Art. 1314. Any third person who induces another to
violate his contract shall be liable for damages to the
other contracting party.
Elements:
(1) The existence of a valid contract
(2) Knowledge on the part of the third person of the
existence of the contract
(3) Interference of the third person is without legal
justification or excuse
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DBP v. CA, ET AL.
FACTS:
Spouses Gotangco contracted a loan with the DBP and the 7
parcels of land of the spouses were executed as collateral.
Later on, the spouses entered a contract to sell with Cucio
and agreed that Cucio will pay DBP Php50, 000 for 2
installments. (Cucio was able to pay however, the DBP
considered it as his deposits) Upon full payment, DBP will
return the titles to the spouses, and in return, the spouses
will execute a deed of absolute sale in favor of Cucio. When
the spouses failed to comply with their obligation. DBP
enforced them by sending demand letters, but the spouses
did not heed to such demands. Instead of complying with the
demands, they filed for a writ of preliminary injunction which
supported the extrajudicial foreclosure.
ISSUE:
WON Spouses Gotangco is entitled with moral damages.
HELD:
NO. The court finds no sufficient basis for the award of moral
damages in favor of Sps Gotangco based on Art. 19 of the
New Civil Code as a result of petitioner’s application for
foreclosure of REM. For one thing, the wife did not testify.
There is no factual basis for the award of moral damages in
her favor.
Abuse of Rights under Article 19 of the New Civil Code states
that every person must, in the exercise of his rights and in
the performance of his duties, act with justice, give everyone
his due, and observe honesty and good faith.
The elements are: (1) there exists a legal right or duty; (2)
which is exercised in bad faith; (3) for the sole intent of
prejudicing or injuring another.
Bad faith or malice is at the core of the said provision. Good
faith is presumed and he who alleges bad faith has the duty
to prove the same. Good faith refers to the state of the mind
which is manifested by the acts of the individual concerned.
It consists of the intention to abstain from taking an
unconscionable and unscrupulous advantage of another. Bad
faith does not simply connote bad judgment or simple
negligence, dishonest purpose or some moral obliquity and
conscious doing of a wrong, a breach of known duty due to
some motives or interest or ill-will that partakes of the nature
of fraud. Malice connotes ill-will or spite and speaks not in
response to duty. It implies an intention to do ulterior and
unjustifiable harm. Malice is bad faith or bad motive. The
Spouses Gotangco failed to prove malice on the part of DBP.
However, the bare fact that the DBP filed its application of
the extrajudicial foreclosure of the mortgage,
notwithstanding those differences, cannot thereby give rise
to the conclusion that the DBP did so with malice, to harass
the Spouses Gotangco. The records show that, time and
again, DBP had sent notices to Spouses Gotangco and
demanded the updating of their account and the payment of
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
the balance thereof, but Spouses Gotangco failed to comply.
In the meantime, interests and penalties on the loan
considerably accrued. Under the terms of the real estate
mortgage and its charter, DBP had the right to foreclose the
said mortgage extrajudicially. Hence, DBP was constrained to
file its application for the extrajudicial foreclosure of the
mortgage for Spouses Gotangco's past due obligation.
RVP: In your Persons and Family relations, good faith is always
presumed and he who alleges bad faith has the burden of
proving that there was indeed bad faith.
U-BIX v. MILLIKEN
FACTS:
Respondent Milliken & Company (M&C) designated petitioner
U-Bix Corporation as its authorized dealer of Milliken carpets
in the Philippines. Under the dealership agreement, petitioner
undertook to market Milliken carpets and to keep on hand
samples for the local market and stock sufficient to cover
market demand. M&C, on the other hand, bound itself to
support petitioner's marketing efforts and projects. Thus,
once petitioner had specified a project (i.e., submitted an
accomplished dealer project registration form), M&C was to
exclusively designate thesaid project as petitioner's. In 1999,
M&C informed petitioner (at that time its lone Philippine
dealer) that an international corporate client, Chase
Manhattan Bank (CMB), was furnishing its Manila office.
Petitioner immediately formed a team headed by its creative
vice president, Carmen Huang, (with respondent Onofre Eser
as team member) to work on the CMB project. They
conducted presentations and submitted product samples to
CMB project director Gerry Shirley and interior designer
Group Three. The team, however, failed to impress CMB. On
December 10, 1999, CMB awarded the supply contract to
respondent Projexx Creator, Inc. (Projexx) which, like
petitioner, had in the meantime become a dealer of Milliken
carpets. Eser resigned from petitioner and joined Projexx. On
April 3, 2000, petitioner filed a complaint for breach of
contract, torts and damages against M&C, Sylvan Chemical
Company (Sylvan), Wilfred Batara, Projexx and Eser.
ISSUE:
Are respondents guilty of malicious interference?
HELD:
NO. To prove that respondents were guilty of
malicious interference, petitioner had to show the
following: the existence of a valid contract,
knowledge by respondents that such a contract
existed and acts (done in bad faith and without legal
basis) by respondents which interfered in the due
performance by the contracting parties of their
respective obligations under the contract. Apart from
the fact that these matters were factual (and therefore
beyond our mandate to review), petitioner failed to prove
entitlement to the relief it was seeking. Factual findings of the
trial court, when affirmed by the CA, are generally binding on
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this Court. In this case, both the RTC and the CA found that
respondents were not guilty of malicious interference
because no contract was ever perfected between petitioner
and CMB. Because all petitioner presented to us were
reiterations of its arguments in the courts a quo, we find no
reason to disturb the decision of the CA.
RVP: There was no valid contract. One of the important
elements in tortuous interference is the existence of a valid
contract. The petitioner failed to establish this first element. No
contract was ever awarded. When the project was awarded to
another distributor, that other distributor could not be guilty of
tortuous interference because there was no contract to speak
of.
LAGON v. CA
FACTS:
In 1982, petitioner Lagon purchased from the estate of Bai
Tonina Sepi, through an intestate court, two parcels of land
located at Tacurong, Sultan Kudarat. A few months after the
sale, private respondent Lapuz filed a complaint for torts and
damages against petitioner before the Regional Trial Court
(RTC) of Sultan Kudarat. In the said complaint, private
respondent Lapuz alleged that the said property was subject
of a leasehold agreement between him and Bai Tonina. One
of the provisions agreed upon was for Lapuz to put up
commercial buildings which would, in turn, be leased to new
tenants. The rentals to be paid by those tenants would
answer for the rent private respondent was obligated to pay
Bai Tonina Sepi for the lease of the land. In 1974, the lease
contract was renewed. When Bai Tonina Sepi died, Lapuz
started remitting his rent to the court-appointed
administrator of her estate. But when the administrator
advised him to stop collecting rentals from the tenants of the
buildings he constructed. Later, he discovered that petitioner,
representing himself as the new owner of the property, had
been collecting rentals from the tenants. He thus filed a
complaint against the latter, accusing petitioner of inducing
the heirs of Bai Tonina Sepi to sell the property to him,
thereby violating his leasehold rights over it.
Petitioner Lagon denied the foregoing allegations and
contended that he was unaware of the leasehold contract
between private respondent and Bai Tonina Sepi. He also
alleged that he conducted a personal investigation on the said
property and found no encumbrance whatsoever.
ISSUE:
Whether the purchase by petitioner of the subject property,
during the supposed existence of private respondent's lease
contract with the late Bai Tonina Sepi, constituted tortuous
interference for which petitioner should be held liable for
damages
HELD:
NO. Not all of the three elements to hold petitioner liable for
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
tortuous interference are present.
Article 1314 of the Civil Code provides that any third
person who induces another to violate his contract shall be
liable for damages to the other contracting party. The tort
recognized in that provision is known as interference with
contractual relations. The interference is penalized
because it violates the property rights of a party in a
contract to reap the benefits that should result
therefrom. Citing the case of So Ping Bun vs CA, the Court
laid down the following elements of Tortuous
Interference, to wit: (a) existence of a valid contract;
(b)knowledge on the part of the third person of the existence
of the contract and (c) interference of the third person
without legal justification or excuse. As regards the first
element, the existence of a valid contract must be duly
established. The second element, on the other hand,
requires that there be knowledge on the part of the
interferer that the contract exists. Knowledge of the
subsistence of the contract is an essential element to state a
cause of action for tortuous interference. A defendant in
such a case cannot be made liable for interfering with
a contract he is unaware of. While it is not necessary to
prove actual knowledge, he must nonetheless be
aware of the facts which, if followed by a reasonable
inquiry, will lead to a complete disclosure of the contractual
relations and rights of the parties in the contract. As to the
third element,. Petitioner may be held liable only when there
was no legal justification or excuse for his action or
when his conduct was stirred by a wrongful motive.
To sustain a case for tortuous interference, the defendant
must have acted with malice or must have been driven by
purely impious reasons to injure the plaintiff. In other words,
his act of interference cannot be justified.
ITCAB, only the first element was proved.
First Element:
Private respondent presented in court notarized copy of the
purported lease renewal. While the contract appeared as duly
notarized, the notarization thereof, however, only proved its
due execution and delivery but not the veracity of its
contents. Nonetheless, after undergoing the rigid scrutiny of
petitioner's counsel and after the trial court declared it to be
valid and subsisting, the notarized copy of the lease
contract presented in court appeared to be
incontestable proof that private respondent and the
late Bai Tonina Sepi actually renewed their lease
contract. Settled is the rule that until overcome by clear,
strong and convincing evidence, a notarized document
continues to be prima facie evidence of the facts that gave
rise to its execution and delivery.
Second Element:
In this case, a careful perusal of the records show that when
the petitioner conducted his own personal investigation, he
encountered no suspicious circumstance that would have
made a cautious man probe deeper and watch out for any
conflicting claim over the property. An examination of the
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entire property's title bore no indication of the leasehold
interest of the private respondent. Even the registry of
property had no record of the same.
Third Element:
Private respondent was unable to prove malice or bad
faith on the part of petitioner in purchasing the property.
Petitioner's purchase of the subject property was merely an
advancement of his financial or economic interests,
absent any proof that he was enthused by improper motives.
This case is one of damnum absque injuria or damage
without injury. "Injury" is the legal invasion of a legal right
while "damage" is the hurt, loss or harm which results from
the injury. There can be damage without injury where the
loss or harm is not the result of a violation of a legal duty. In
that instance, the consequences must be borne by the injured
person alone since the law affords no remedy for damages
resulting from an act which does not amount to legal injury
or wrong. Indeed, lack of malice in the conduct complained
of precludes recovery of damages. Therefore, the claim of
tortuous interference was never established.
RVP: This case is a good case because it analyzes one-by-one
the existence or non-existence of the three elements.
In the first question on whether there was an existence of a
valid contract, although there was a dispute regarding the
existence of renewal of contract, the SC acknowledged that the
presumption in favour of a notarized deed of sale or a notarized
contract has not been controverted so therefore the existence
of a valid contract was present was a presence of an existing
valid contract is present.
For the second element, SC noticed that Lagon actually made
his own independent investigation as to the circumstances
surrounding the property (he asked around, he made diligent
inquiry, went to the Clerk of Court and Registry of Property to
check the status of the property) there was no irregular which
would impel him to exercise heightened diligence or heightened
inquiry so he basically settled to the idea that there was no
contract and therefore he can validly go on to enter to another
contract with the successors of interest. But the SC said, even
if we are to assume that there was knowledge on the part of
Lagon and there was an existing contract of lease, it has not
been proven that there was malicious interference and that
Lagon was impelled by ulterior motives or that there was bad
faith because Malice rise at the core of tortuous interference that
why it is also called malicious interference. It has not been
proven that he was impelled by bad faith, by an ulterior motive,
by moral obliquity in entering into a contract.
What has been proven however is that maybe he was impelled
by something else, maybe there was a purely personal business
interest maybe for economic gain but SC said that is not enough
to hold him liable for damages for tortuous interference. In
absence of any showing that the interference without legal
justification or excuse, a case for tortuous interference will less
likely prosper.
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
Emotional Distress Tort Action
(Tort of Outrage)
Civil action filed by an individual to assuage the injuries to his
emotional tranquillity due to personal attacks on his character.
Our manners, and with them our law, have not progressed to
the point where we are able to afford a remedy in the form of
tort damages for all intended mental disturbance.
MVRS PUBLICATIONS v. ISLMAIC DA’WAH COUNCIL
OF THE PHILS.
FACTS:
Islamic Da’wah Council of the Philippines, Inc. (Islamic), a
local federation of more than seventy (70) Muslim religious
organizations, and individual Muslims and individual Muslims
Linzag, Arcilla, Abdul RASHID de Guzman, da Saliva and Junio
(Respondents) filed in the RTC of Manila a complaint for
damages on their own behalf and as a class suit in behalf of
the Muslim members nationwide against MVRS
Publications,Laconsay, Aguja and Binegas (Petitioners),
arising from an article published in the issue of Bulgar, a daily
tabloid. The complaint alleged that the libelous statement
was insulting and damaging to the Muslims; that these words
alluding to the pig as the God of the Muslims was not only
published out of sheer ignorance but with intent to hurt the
feelings, cast insult and disparage the Muslims and Islam, as
a religion in this country, in violation of law, public policy,
good morals and human relations; that on account of these
libelous words Bulgar insulted not only the Muslims in the
Philippines but the entire Muslim world, especially every
Muslim individual in non-Muslim countries. Petitioners in their
defense, contended that the article did not mention
respondents as the object of the article and therefore were
not entitled to damages; and, that the article was merely an
expression of belief or opinion and was published without
malice nor intention to cause damage, prejudice or injury to
Muslims.
ISSUE:
Whether or not the elements of libel exist.
HELD:
NO. In the present case, there was no fairly identifiable
person who was allegedly injured by the Bulgar article. Since
the persons allegedly defamed could not be identifiable,
private respondents have no individual causes of action;
hence, they cannot sue for a class allegedly disparaged.
Private respondents must have a cause of action in common
with the class to which they belong to in order for the case
to prosper.
The Restatement of Torts defines a defamatory statement as
one that tends to so harm the reputation of another as to
lower him in the estimation of the community or to deter third
persons from associating or dealing with him. Consequently
as a prerequisite to recovery, it is necessary for the plaintiff
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to prove as part of his prima facie case that the defendant
(1) published a statement that was (2) defamatory (3) of and
concerning the plaintiff. This principle is of vital importance
in cases where a group or class is defamed since, usually, the
larger the collective, the more difficult it is for an individual
member to show that he was the person at whom the
defamation was directed. The statements published by
petitioners in the instant case did not specifically identify nor
refer to any particular individuals who were purportedly the
subject of the alleged libelous publication. Respondents can
scarcely claim to having been singled out for social censure
pointedly resulting in damages. A contrary view is expressed
that what is involved in the present case is an intentional
tortuous act causing mental distress and not an action for
libel. The SC did not agree. Primarily, an "emotional distress"
tort action is personal in nature, i.e., it is a civil action filed
by an individual to assuage the injuries to his emotional
tranquility due to personal attacks on his character. It has no
application in the instant case since no particular individual
was identified in the disputed article of Bulgar.
Also, the purported damage caused by the article, assuming
there was any, falls under the principle of relational harm
which includes harm to social relationships in the community
in the form of defamation; as distinguished from the principle
of reactive harm which includes injuries to individual
emotional tranquility in the form of an infliction of emotional
distress. In their complaint, respondents clearly asserted an
alleged harm to the standing of Muslims in the community,
especially to their activities in propagating their faith in Metro
Manila and in other non-Muslim communities in the country.
It is thus beyond cavil that the present case falls within the
application of the relational harm principle of tort actions for
defamation, rather than the reactive harm principle on which
the concept of emotional distress properly belongs.
RVP: It is important to establish that the article is libellous to
fall under Article 2219 of the Civil Code where moral damages
may be awarded. Unfortunately because of the interplay
between freedom of speech, freedom of expression and the
alleged (emotional sufferings suffered haha) emotional distress
suffered by the Muslim community, the court did not award
damages because:
(1) Importance of freedom of speech.
(2) Our courts are not prepared to transpose emotional
distress tort action as they deal with it in the US or in
the common law systems, in our country. SC said that
emotional distress has a very high threshold. There has
to be an extreme suffering. How do you know if there
is an extreme suffering? It must be one that typically
involves those who are trained to assess mental health
or mental disability. SC said that we are all expected to
toughen it up or to maintain a certain degree of
willingness and receptiveness to pain and to suffering.
Unless it is of such nature as to morally shock the
conscience of almost everyone, every reasonable
member of the community will take up arms against
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
the person then that would qualify for a tort distress
action.
It is very interesting, because more than the law, the SC made
two really important pronouncements:
(1) Opens up a wide vista of litigation in the field of bad
manners. At the end of the day, somebody else’s action
will cause hurting, suffering, emotional pain. How do
calibrate even pain, amount of emotional distress and
damages?
(2) Appropriate remedy is to toughening of the mental hide
(suck it up!). Have a strong character, just swim with
the tide. We cannot be expected to go to the court
each and every time somebody else has hurt our
feelings. Unless you have suffered such psychological
disorder or mental disability as to have been diagnosed
by a medical professional then you can launch an
emotional distress tort action.
Emotional Distress Tort Action
A civil action filed by an individual to relieve or lessen the injuries
to his emotional tranquility caused by personal attacks on his
character.
An emotional distress tort action has a very high threshold. It
must involve extreme suffering. Only one who is trained in
assessing mental health or mental disability can determine if
there has been such extreme suffering.
With this, the Supreme Court also said that we are all expected
to toughen it up, and maintain a certain degree of willingness
and receptiveness to pain,unless it is of such nature as to
morally shock the conscience of almost everyone, and every
member of that community will take up arms against that
person, then such will qualify as an emotional distress tort
action.
Requisites for Recovery:
Plaintiff must show the following:
(1) the conduct of the defendant was intentional or in
reckless disregard of the plaintiff;
(2) the conduct was extreme and outrageous;
(3) there’s a causal connection between the defendant’s
conduct and the plaintiff’s mental distress;
(4) the mental distress is extreme and severe
PRONOUNCEMENT OF OUR SUPREME COURT:
That if we grant damages to this case now, it may open
floodgates to a vista of litigation in the field of bad manners.
One’s actions will cause hurting, pain or suffering to another,
but how will we calibrate pain, the emotional distress, or
damages? The appropriate remedy is to toughen up the mental
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hide. We cannot be expected to go to court each and every time
our feelings are hurt, unless you have suffered or been
diagnosed with a psychological disability caused by it.”
KINDRED TORTS
Medical Negligence/Malpractice
A medical negligence/malpractice case is a type of claim to
redress a wrong committed by a medical practitioner who
caused bodily harm or death to a patient.
Elements:
(1) Duty
(2) Breach
(3) Injury
(4) Proximate Causation
Duty requires that proof of professional relationship between
physician and patient must be established.
If there is no duty, then there can be no breach to speak of.
In a doctor-patient relationship, it need not be reduced into
writing. The mere fact that the doctor has examined the patient
and given his diagnosis and has prescribed a treatment is
already an acknowledgment or acceptance, on his part, of the
doctor-patient relationship.
General Rule:
Physicians are not liable for bona fide error in judgments or
wrong diagnosis (they’re not expected to know everything).
Exception:
If such wrong diagnosis of error in judgment is caused by
negligence of the physician
Examples of negligence by physician:
(1) When the physician does not examine the patient days
before the operation.
(2) When the physician closes its eyes to other symptoms
which he has been persistently informed of.
SPS. FLORES v. SPS. PINEDA
FACTS:
Teresita Pineda consulted her townmate, Dr. Fredelicto Flores
regarding her medical condition. She complained of general
body weakness, loss of appetite, frequent urination and thirst,
and on-and-off vaginal bleeding. Dr. Fredelicto initially
interviewed the patient and advised her to return the following
week or to go to the United Doctors Medical Center (UDMC) in
Quezon City for a general check-up. He suspected that Teresita
might be suffering from diabetes and told her to continue her
medications. Teresita did not return the next week as advised.
However, when her condition persisted, she went to further
consult Dr. Flores at his UDMC clinic. When Dr. Fredelicto
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
arrived, he did a routine check-up and ordered Teresita's
admission to the hospital directing the staff to prepare the
patient for an "on call" D&C operation to be performed by his
wife, Dr. Felicisima Flores. The hospital staff took her blood and
urine samples for the laboratory tests which Dr. Fredelicto
ordered. That same day, Teresita was taken to the operating
room. She met Dr. Felicisima, an obstetrician and gynecologist.
The two doctors conferred on the patient’s medical records. Dr.
Felicisima also interviewed and conducted an internal vaginal
examination on her for about 15 minutes. Dr. Felicisima
thereafter called up the laboratory for the results of the tests
which at that time, the only the results are the blood sugar, uric
acid determination, cholesterol determination, and complete
blood count. Dr. Felicisima proceeded with the D&C operation
with Dr. Fredelicto administering the general anesthesia.
Thereafter, Teresita's condition eventually worsened and was
rushed to the intensive care unit. Further tests confirmed that
she was suffering from Diabetes Mellitus Type II. Insulin was
administered on her but due to complications induced by
diabetes, Teresita died. Believing that Teresita's death resulted
from the negligent handling of her medical needs, her family
instituted an action for damages against the two doctors.
ISSUE:
WON there is medical negligence on the part of the petitioner.
HELD:
YES. A medical negligence case is a type of claim to redress a
wrong committed by a medical professional, that has caused
bodily harm to or the death of a patient. There are four elements
involved in a medical negligence case, namely: duty, breach,
injury, and proximate causation. Duty refers to the standard of
behavior which imposes restrictions on one's conduct. The
standard in turn refers to the amount of competence associated
with the proper discharge of the profession. A physician is
expected to use at least the same level of care that any other
reasonably competent doctor would use under the same
circumstances. Breach of duty occurs when the physician fails
to comply with these professional standards. If injury results to
the patient as a result of this breach, the physician is answerable
for negligence.
ITCAB, Teresita was already suspected of having diabetes. This
suspicion again arose right before the D&C operation.
Unfortunately, the petitioner spouses did not wait for the full
medical laboratory results before proceeding with the D&C.
According to plaintiffs’ expert witness, failure to recognize the
existence of diabetes constitutes negligence. Moreover,
petitioner spouses cannot claim that their principal concern was
vaginal bleeding. This is a very narrow and self-serving view that
even reflects on their competence.
Dr. Fredelicto's negligence is not solely the act of ordering an
"on call" D&C operation when he was mainly an
anaesthesiologist who had made a very cursory examination of
the patient's vaginal bleeding complaint. Rather, it was his
failure from the very start to identify and confirm, despite the
patient's complaints and his own suspicions, that diabetes was
a risk factor that should be guarded against, and his
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participation in the imprudent decision to proceed with the D&C
operation despite his early suspicion and the confirmatory early
laboratory results. The conclusion that the decision to proceed
with the D&C operation, notwithstanding Teresita's
hyperglycemia and without adequately preparing her for the
procedure, was contrary to the standards observed by the
medical profession. Deviation from this standard amounted to a
breach of duty which resulted in the patient's death. Due to this
negligent conduct, liability must attach to the petitioner spouses.
Elements of Medical Malpractice
Duty requires proof of professional relationship between the
physician and the patient.
Physicians are generally not liable for damages resulting from a
bona fide error of judgment or wrong diagnosis.
Injury pertains to injury in body or in health.
Examples:
(1) Death
(2) Foreign substances (e..g, gauze) found in certain parts
of the body which were left during operation
(3) Amputation due to accident
The causation analysis is divided into two inquiries:
(1) whether the doctor’s actions in fact caused the harm
to the patient and
(2) whether these were the proximate cause of the
patient’s injury
Captain of the Ship Doctrine
This doctrine holds the surgeon in charge of an operation liable
for the negligence of her assistants during the time when those
assistants are under his/her control.
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 (Ramos v. CA).
RAMOS v. CA
FACTS:
Plaintiff Erlinda Ramos was, robust woman. Except for
occasional complaints of discomfort due to pains allegedly
caused by the presence of a stone in her gall bladder, she
was as normal as any other woman. She is married to Rogelio
Ramos. Because the discomforts somehow interfered with
her normal ways, she sought professional advice. She was
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
advised to undergo an operation for the removal of a stone
in her gall bladder.
She underwent a series of examinations which included blood
and urine tests which indicated she was fit for surgery.
Through the intercession of a mutual friend, Dr. Buenviaje ,
she and her husband Rogelio met Dr. Orlino Hosaka for the
first time, one of the defendants in this case, who advised
that she should undergo cholecystectomy. Dr. Hosaka
assured Rogelio that he will get a good anesthesiologist.
At 7:30 AM on the day of the operation at Delos Santos
Medical Center, Herminda Cruz, Erlinda’s sister-in-law and
the Dean of the College of Nursing at the Capitol Medical
Center, was also there for moral support. She reiterated her
previous request for Herminda to be with her even during the
operation. After praying, she was given injections. Her hands
were held by Herminda as they went down from her room to
the operating room . Her husband, Rogelio, was also with
her. At the operating room, Herminda saw about two or three
nurses and Dr. Perfecta Gutierrez, the other defendant, who
was to administer anesthesia. Although not a member of the
hospital staff, Herminda introduced herself as Dean of the
College of Nursing at the Capitol Medical Center who was to
provide moral support to the patient, to them. Herminda was
allowed to stay inside the operating room.
Dr. Hosaka arrived only at 12:15 PM Herminda saw Dr.
Gutierrez intubating the patient, and heard the latter say
“Ang hirap ma-intubate nito, mali yata ang pagkakapasok. O,
lumalaki ang tiyan.” Herminda saw bluish discoloration of the
nailbeds of the left hand hapless Erlinda even as Dr. Hosaka
approached her. She then heard Dr. Hosaka issue an order
for someone to call Dr. Calderon, another anesthesiologist.
After Dr. Calderon arrived, the doctor placed the patient in
trendelenburg position, wherein the head of the patient is
positioned lower than the feet, which indicates a decrease of
blood supply in the brain. Herminda knew and told Rogelio
that something wrong was happening. Dr. Calderon was able
to intubate the patient. Erlinda stayed at the ICU and became
comatose. Rogelio filed a civil case for damages.
ISSUE:
WON Dr. Hosaka, as head of the surgical team, is liable under
the Captain of the Ship Doctrine.
(Note: Other relevant issues are discussed in the compiled
case digests file.)
HELD:
YES. Dr. Orlino Hosaka as the head of the surgical team. As
the so-called "captain of the ship," it is the surgeon's
responsibility to see to it that those under him perform their
task in the proper manner. Respondent Dr. Hosaka's
negligence can be found in his failure to exercise the proper
authority (as the "captain" of the operative team) in not
determining if his anesthesiologist observed proper
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anesthesia protocols. In fact, no evidence on record exists to
show that respondent Dr. Hosaka verified if respondent Dra.
Gutierrez properly intubated the patient. Furthermore, it does
not escape us that respondent Dr. Hosaka had scheduled
another procedure in a different hospital at the same time as
Erlinda's cholecystectomy, and was in fact over three hours
late for the latter's operation. Because of this, he had little or
no time to confer with his anesthesiologist regarding the
anesthesia delivery. This indicates that he was remiss in his
professional duties towards his patient. Thus, he shares equal
responsibility for the events which resulted in Erlinda's
condition.
PROFESSIONAL SERVICES INC. v. AGANA- 2007 AND
2010
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."
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.
Evidentiary Rules in Medical Malpractice
Type of Evidence Required
Medical negligence cases require evidence as to:
(1) the recognized standards of the medical community;
and
(2) the physician’s departure from those standards.
Laymen as Expert Witnesses
Testimonies as statements and acts of physicians, external
appearances, and manifest conditions may be given by non-
expert witnesses.
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
RAMOS v. CA, supra
Although witness Herminda Cruz, who was the Dean of the
College of Nursing, is not an anesthesiologist, she can very
well testify upon matters on which she is capable of observing
such as, the statements and acts of the physician and
surgeon, external appearances, and manifest conditions
which are observable by any one.
This is precisely allowed under the doctrine of res ipsa
loquitur where the testimony of expert witnesses is not
required. It is the accepted rule that expert testimony is not
necessary for the proof of negligence in non-technical
matters or those of which an ordinary person may be
expected to have knowledge, or where the lack of skill or
want of care is so obvious as to render expert testimony
unnecessary. The Court can take judicial notice of the fact
that anesthesia procedures have become so common, that
even an ordinary person can tell if it was administered
properly. As such, it would not be too difficult to tell if the
tube was properly inserted. This kind of observation, we
believe, does not require a medical degree to be acceptable.
Weight Rather than Admissibility
The sole function of a medical expert witness is to afford
assistance to the courts on medical matters and to explain the
medical facts in issue.
The Court said that we would look into weight rather than
admissibility. This means that just because you are not a
specialist does not mean that you will never be considered as
an expert witness and that you will never be heard on what you
can say on the matter.
RVP: There is a very good case about this and you might also
want to check that out. (Case name was not mentioned.)
Quantum of Proof
Elements:
And just like in all civil cases, only Preponderance of
Evidence is required to prove medical negligence.
Doctrine of Informed Consent
The gravamen in an informed consent case requires the plaintiff
to "point to significant undisclosed information relating to the
treatment which would have altered her decision to undergo it
(Dr. Li v. Sps. Soliman)
DR. LI v. SPS. SOLIMAN
FACTS:
11-year old Angelica was diagnosed with a high-grade (highly
malignant) bone cancer. Her right leg was amputated.
However, the orthopedic surgeon in performing the
amputation told the parents that it was not enough to cut off
the part where the cancer cells originated and that the child
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must undergo chemotherapy in order to completely eliminate
the cancer cells and to prevent such from spreading
throughout the rest of her body. Hence, Dr. Rubi Li entered
into the picture. She is a medical oncologist, a doctor
specializing in cancer treatment.The very issue in this case
was the consultation between the parents and the doctor
because according to the parents, they were misled into
allowing or consenting to the chemotherapy session as they
were told that the child has 95% chance of survival if she
undergoes chemotherapy. On the other hand, Dr. Li argued
that, she did not only inform the parents of the three possible
side effects, but she also told them of the possible skin
discoloration, sterility, damage to the heart, lungs and kidney
as well as low white and red blood cells, and platelet counts
due to the administration of chemotherapy session.
ISSUE:
Whether or not the information given by Dr. Li was
reasonable that would have affected the parents’ decision in
allowing their child to undergo chemotherapy
HELD:
YES. The responsibility of the doctor is not only to treat the
patient with due diligence and care but also to inform the
patient about the possible extent and effect if the patient
undergoes the chemotherapy. However, this doctrine of
informed consent does not require the doctor to disclose
everything to the patient. What must be disclosed are only
material information that would affect the decision-making
process of the patient or possible consequences that are
reasonable from the operation.
In this case, the court said that the doctor gave a reasonable
information to the patient’s parents. The parents could have
and should have known the side effects of chemotherapy.
There is no legal requirement to disclose the statistical
chance of survival. What is required is that there be a
reasonable notice.
(1) The disclosure rule only requires a reasonable
explanation in nontechnical terms as to what is
at stake.
The doctor is not expected to give a medical education
or medical lecture to the patient but the doctor should
inform the patient as to the alternative treatments,
risks, what’s going to happen, how long will the
operation last, etc. So long as the doctor is able to
inform these matters to the patient, then such
obligation has been discharged.
(2) The scope of the disclosure must be measured
by the patient’s need.
This means how much information does the patient
need to make an informed decision as to whether to
go to treatment or not.
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
(3) The test for determining whether a potential
peril must be divulged is its materiality to the
patient’s decision.
The Doctrine of Informed consent is basically designed
to give the patient an informed choice, or an informed
decision.
(4) Scope of mandatory disclosure must be proved
by expert testimony.
As with all the other medical negligence cases, there
has to be expert testimony. Such expert will testify as
to what is the basic standard in the medical community
as to what should be disclosed to the patient before
the latter agrees to surrender his/her body for the
treatment.
Crisscrossing Legal Relationships
The exact nature of each relationship determines the basis and
extent of the liability of the hospital for the negligence of the
doctor.
1. Hospital and Doctor
If it can be proven that there is employer-employee relationship,
the principle of respondeat superior will be applied and the
hospital is made liable.
2. Hospital and Patient
If it can be proven that the hospital failed to provide services,
nurses, etc. hospital will be directly liable.
3. Doctor and Patient
Whether or not there was a physician-client relationship,
whether or not there was acceptance by the doctor etc.
Sources of Liability of Hospitals
We have already shied away from the traditional view that
doctors are independent contractors.
Principle of Respondeat Superior
Art. 2176. Whoever by act or omission causes damage
to another, there being fault or negligence, is obliged
to pay for the damage done. Such fault or negligence,
if there is no pre-existing contractual relation
between the parties, is called a quasi-delict and is
governed by the provisions of this Chapter.
Art. 2180. The obligation imposed by article 2176 is
demandable not only for one's own acts or omissions,
but also for those of persons for whom one is
responsible.
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The father and, in case of his death or incapacity, the
mother, are responsible for the damages caused by
the minor children who live in their company.
Guardians are liable for damages caused by the
minors or incapacitated persons who are under their
authority and live in their company.
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.
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.
The State is responsible in like manner when it acts
through a special agent; but not when the damage
has been caused by the official to whom the task done
properly pertains, in which case what is provided in
article 2176 shall be applicable.
Lastly, teachers or heads of establishments of arts
and trades shall be liable for damages caused by their
pupils and students or apprentices, so long as they
remain in their custody.
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.
Where an employment relationship exists, the hospital may be
held vicariously liable under Article 2176 in relation to Article
2180 of the Civil Code or the principle of respondeat superior.
Vicarious liability of an employer who is supposed to exercise
due diligence in the selection and supervision of the employee.
Doctrine of Apparent Authority
Art. 1431. Through estoppel an admission or
representation is rendered conclusive upon the
person making it, and cannot be denied or disproved
as against the person relying thereon.
Art. 1869. Agency may be express, or implied from the
acts of the principal, from his silence or lack of action,
or his failure to repudiate the agency, knowing that
another person is acting on his behalf without
authority.
Agency may be oral, unless the law requires a specific
form.
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020
Even when no employment relationship exists, but it is shown
that the hospital holds out to the patient that the doctor is its
agent, the hospital may still be vicariously liable under Article
2176 in relation to Article 1431 and Article 1869 of the Civil Code
or the principle of apparent authority.
Otherwise known as holding out theory or doctrine of
ostensible agency. This happens when the hospital holds
someone out as its agent, which means that the act of the agent
is the act of the principal.
Manifestation-Reliance Requirement
A hospital can be held vicariously liable for the negligent acts of
a physician (or an independent contractor) providing care at the
hospital if the plaintiff can prove these two factors: first, the
hospital’s manifestations and second, the patient’s reliance.
The important consideration in determining a patient's reliance
is: whether the plaintiff is seeking care from the hospital itself
or whether the plaintiff is looking to the hospital merely as a
place for his/her personal physician to provide medical care.
Instances where SC found the existence of Apparent
Authority:
1. Display of Specialization
PROFESSIONAL SERVICES INC. v. AGANA- 2007 AND
2010
FACTS:
Dr. Ampil performed an anterior resection surgery on Natividad.
He found that the malignancy in her sigmoid area had spread
on her left ovary, necessitating the removal of certain portions
of it. Thus, Dr. Ampil obtained the consent of Enrique,
Natividad's husband, to permit Dr. Juan Fuentes, 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. The attending nurses entered remarks in their record
stating that there were 2 pieces of sponge (gauze) missing.
Natividad, complaining of excruciating pain, went to the United
States to seek further treatment with her husband. After four
months of consultations and laboratory examinations, Natividad
was told she was free of cancer. Hence, she was advised to
return to the Philippines. When Natividad flew back to the
Philippines, she was still suffering from pains. Two weeks
thereafter, her daughter found a piece of gauze protruding from
her vagina. Upon being informed about it, Dr. Ampil proceeded
to her house where he managed to extract by hand a piece of
gauze measuring 1.5 inches in width (dafuq). The pains did not
vanish. Instead, the pains intensified, prompting Natividad to
seek treatment at the Polymedic General Hospital. While
confined there, Dr. Ramon Gutierrez detected the presence of
another foreign object in her vagina — a foul smelling gauze
measuring 1.5 inches in width which badly infected her vaginal
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vault. A recto-vaginal fistula had formed in her reproductive
organs which forced stool to excrete through the vagina (huhu
kahadlok). Another surgical operation was needed to remedy
the damage. Thus, Natividad underwent another surgery. This
led to Natividad and her husband filing a complaint for damages
against the Professional Services, Inc. (PSI) (owner of the
Medical City Hospital) Dr. Ampil, and Dr. Fuentes.
ISSUE:
Whether PSI may be held solidarily liable for the negligence of
Dr. Ampil
HELD:
YES. The agency principle of apparent authority, or what is
sometimes referred to as the "holding out" theory, or doctrine
of ostensible agency or agency by estoppel, has its origin from
the law of agency. It imposes liability, not as the result of the
reality of a contractual relationship, 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.
In this case, PSI publicly displays in the lobby of the
Medical City Hospital the names and specializations of
the physicians associated or accredited by it, including
those of Dr. Ampil and Dr. Fuentes. 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." Indeed, PSI's act is tantamount
to holding out to the public that Medical City Hospital, through
its accredited physicians, offers quality health care services. By
accrediting Dr. Ampil and Dr. Fuentes and publicly advertising
their qualifications, the hospital created the impression that they
were its agents, authorized to perform medical or surgical
services for its patients. Corporate entities, like PSI, are capable
of acting only through other individuals, such as physicians. If
these accredited physicians do their job well, the hospital
succeeds in its mission of offering quality medical services and
thus profits financially. Logically, where negligence mars the
quality of its services, the hospital should not be allowed to
escape liability for the acts of its ostensible agents.
2. Consent form established apparent authority
PROFESSIONAL SERVICES INC. v. AGANA- 2007 AND
2010, supra
Clearly, the decision made by Enrique for Natividad to consult
Dr. Ampil was significantly influenced by the impression that Dr.
Ampil was a staff member of Medical City General Hospital, and
that said hospital was well known and prominent. Enrique
looked upon Dr. Ampil not as independent of but as integrally
related to Medical City. PSI's acts tended to confirm and
reinforce, rather than negate, Enrique's view. It is of record that
PSI required a "consent for hospital care" to be signed
preparatory to the surgery of Natividad. The form reads:
Permission is hereby given to the medical, nursing and
TORTS AND DAMAGES (June 1, 2020) | Atty. Pandi | EH 401 Tala Nation 2019-2020

laboratory staff of the Medical City General Hospital to perform (ICU), to which the respondent consented. Since the ICU was
such diagnostic procedures and to administer such medications then full, Dr. Casumpang suggested to the respondent that they
and treatments as may be deemed necessary or advisable by hire a private nurse. The respondent, however, insisted on
the physicians of this hospital for and during the confinement of transferring his son to Makati Medical Center. After the
.... respondent had signed the waiver, Dr. Casumpang, for the last
time, checked Edmer's condition, found that his blood pressure
By such statement, PSI virtually reinforced the public impression was stable, and noted that he was "comfortable." The
that Dr. Ampil was a physician of its hospital, rather than one respondent requested for an ambulance but he was informed
independently practicing in it; that the medications and that the driver was nowhere to be found. This prompted him to
treatments he prescribed were necessary and desirable; and hire a private ambulance. At midnight, Edmer, accompanied by
that the hospital staff was prepared to carry them out. his parents and by Dr. Casumpang, was transferred to Makati
Medical Center. Dr. Casumpang immediately gave the attending
physician the patient's clinical history and laboratory exam
3. Patient treated primarily in emergency section results. Upon examination, the attending physician diagnosed
"Dengue Fever Stage IV" that was already in its irreversible
stage. Unfortunately, Edmer died the next day.
CASUMPANG v. CORTEJO
ISSUE:
FACTS:
WON SJDH is solidarily liable
Mrs. Cortejo brought her 11- year old son, Edmer to the
Emergency Room of the San Juan de Dios Hospital (SJDH)
HELD:
because of difficulty in breathing, chest pain, stomach pain, and
YES. As a rule, hospitals are not liable for the negligence of its
fever. His son was initially attended to by their family doctor who
independent contractors. However, it may be found liable if the
diagnosed Edmer with "bronchopneumonia." Since Mrs. Cortejo
physician or independent contractor acts as an ostensible agent
did not know any doctor at SJDH, she used her Fortune Care
of the hospital. This exception is also known as the "doctrine of
card. She was thereafter assigned to Dr. Casumpang. On the
apparent authority”. A hospital can be held vicariously liable for
same day, Dr. Casumpang for the first time examined Edmer in
the negligent acts of a physician (or an independent contractor)
his room. He confirmed the initial diagnosis of
providing care at the hospital if the plaintiff can prove these two
"Bronchopneumonia." Mrs. Cortejo immediately advised Dr.
factors: first, the hospital's manifestations; and second , the
Casumpang that Edmer had a high fever, and had no colds or
patient's reliance.”
cough but Dr. Casumpang merely told her that her son's "blood
pressure is just being active," and remarked that "that's the
a. Hospital’s manifestations: It involves an inquiry on whether
usual bronchopneumonia, no colds, no phlegm." The following
the hospital acted in a manner that would lead a reasonable
day, Dr. Casumpang visited and examined Edmer. Still
person to conclude that the individual alleged to be negligent
suspicious about his son's illness, Mrs. Cortejo again called Dr.
was an employee or agent of the hospital. The hospital need not
Casumpang's attention and stated that Edmer had a fever,
make express representations to the patient that the physician
throat irritation, as well as chest and stomach pain. Mrs. Cortejo
or independent contractor is an employee of the hospital;
also alerted Dr. Casumpang about the traces of blood in Edmer's
Representation may be general and implied. In this case, the
sputum. Dr. Casumpang simply nodded, inquired if Edmer has
court considered the act of the hospital of holding itself out as
asthma, and reassured Mrs. Cortejo that Edmer's illness is
provider of complete medical care, and considered the hospital
bronchopneumonia. The next day, Edmer vomited "phlegm with
to have impliedly created the appearance of authority.
blood streak" prompting Edmer's father to request for a doctor
at the nurses' station. Thereafter, Dr. Miranda conducted a
b. Patient's reliance involves an inquiry on whether the plaintiff
physical check-up and found that Edmer had a low-grade
acted in reliance on the conduct of the hospital or its agent,
noncontinuing fever, and rashes that were not typical of dengue
consistent with ordinary care and prudence. The important
fever. Edmer once again vomited blood. Upon seeing Dr.
consideration in determining the patient's reliance is: whether
Miranda, the respondent showed her Edmer's blood specimen,
the plaintiff is seeking care from the hospital itself or whether
and reported that Edmer had complained of severe stomach
the plaintiff is looking to the hospital merely as a place for
pain and difficulty in moving his right leg. Dr. Miranda then
his/her personal physician to provide medical care. Thus, this
examined Edmer's "sputum with blood" and noted that he was
requirement is deemed satisfied if the plaintiff can prove that
bleeding. She ordered the monitoring of the patient's blood
he/she relied upon the hospital to provide care and
pressure and some blood tests. Edmer's blood pressure was
treatment, rather than upon a specific physician.
later found to be normal. Dr. Miranda called up Dr. Casumpang
at his clinic and told him about Edmer's condition. Upon being
In this case, the determination of the hospital's apparent
informed, Dr. Casumpang ordered several procedures done. Dr.
authority shall be limited to Dr. Casumpang, in view of the
Miranda advised Edmer's parents that the blood test results
court’s finding that Dr. Miranda is not liable for negligence. SJDH
showed that Edmer was suffering from "Dengue Hemorrhagic
impliedly held out and clothed Dr. Casumpang with apparent
Fever." One hour later, Dr. Casumpang arrived at Edmer's room
authority leading the respondent to believe that he is an
and he recommended his transfer to the Intensive Care Unit
employee or agent of the hospital. Based on the records, the

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respondent relied on SJDH rather than upon Dr. Casumpang, to
care and treat his son Edmer. His testimony during trial showed
that he and his wife did not know any doctors at SJDH; they also
did not know that Dr. Casumpang was an independent
contractor. They brought their son to SJDH for diagnosis
because of their family doctor's referral. The referral did not
specifically point to Dr. Casumpang or even to Dr. Miranda, but
to SJDH. Significantly, the respondent had relied on SJDH's
representation of Dr. Casumpang's authority. By referring Dr.
Casumpang to care and treat for Edmer, SJDH impliedly held
out Dr. Casumpang, not only as an accredited member of
Fortune Care, but also as a member of its medical staff.
4. Patient relied upon the hospital to provide care
and treatment, rather than upon a specific
physician.
Doctrine of Corporate Negligence
Regardless of its relationship with the doctor, the hospital may
be held directly liable to the patient for its own negligence or
failure to follow established standard of conduct to which it
should conform as a corporation.
This is brought about by the modern trend in hospital relations
which makes the hospital directly liable to the patient for its
own omission to provide medical facilities and equipment,
nurses etc.
With the passage of time, more duties were expected of
hospitals, among them:
(1) the use of reasonable care in the maintenance of safe
and adequate facilities and equipment;
(2) the selection and retention of competent officials;
(3) the overseeing or supervision of all persons who
practice medicine within its walls; and
(4) the formulation, adoption and enforcement of
adequate rules and policies that ensure quality care for
its patients.
of providing comprehensive medical services to the public.
Accordingly, it has the duty to exercise reasonable care to
protect from harm all patients admitted into its facility for
medical treatment. Unfortunately, PSI failed to perform such
duty. It is worthy to note that Dr. Ampil and Dr. Fuentes
operated on Natividad with the assistance of the Medical City
Hospital's staff, composed of resident doctors, nurses, and
interns. As such, it is reasonable to conclude that PSI, as the
operator of the hospital, has actual or constructive knowledge
of the procedures carried out, particularly the report of the
attending nurses that the two pieces of gauze were missing.
Anent the corollary issue of whether PSI is solidarily liable with
Dr. Ampil for damages, let it be emphasized that PSI, apart from
a general denial of its responsibility, 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. In
neglecting to offer such proof, PSI failed to discharge its burden
under the last paragraph of Article 2180 cited earlier, and,
therefore, must be adjudged solidarily liable with Dr. Ampil.
Moreover, as we have discussed, PSI is also directly liable to the
Aganas. Once a physician undertakes the treatment and care of
a patient, the law imposes on him certain obligations. In order
to escape liability, he must possess that reasonable degree of
learning, skill and experience required by his profession. At the
same time, he must apply reasonable care and diligence in the
exercise of his skill and the application of his knowledge, and
exert his best judgment.
(END)
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PROFESSIONAL SERVICES INC. v. AGANA- 2007 AND

2010, supra

On the basis of the Darling case, other jurisdictions held that a

hospital's corporate negligence extends to permitting a
physician known to be incompetent to practice at the hospital.
With the passage of time, more duties were expected from
hospitals, among them: (1) the use of reasonable care in the
maintenance of safe and adequate facilities and equipment; (2)
the selection and retention of competent physicians; (3) the
overseeing or supervision of all persons who practice medicine
within its walls; and (4) the formulation, adoption and
enforcement of adequate rules and policies that ensure quality
care for its patients.

In the present case, it was duly established that PSI operates

the Medical City Hospital for the purpose and under the concept

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