Southwestern University

PHINMA
School of Medicine
Department of Legal Medicine

HOSPITALS AND THE LAW

Chapter 12

(Group Written Output)

Group Leader - Ere A. Clarang, Jr.,

Assistant Leader- James Ivan A. Baluran

Researchers: Edison B. Fariñas

Tatyannah Alexa Maristela
Biplav Singh & Manoj K.C.

PPT Creators: Ere A. Clarang, Jr.,

Lei Kathreen L. Presores
Sanisha Shrestha

Reporter: James Ivan A. Baluran

12.1. Hospital
➢ Is primarily a service institution whose concern is to serve the patient, the doctors and the
public.
➢ It also includes establishments which admit and take care of persons not sick but require
attention like:
a. childbirth,
b. body debility,
c. mental conditions among others.
➢ Is a place devoted primarily to the maintenance and operation of facilities for the diagnosis,
treatment and care of individuals suffering from illness, disease, injury or deformity.

12.2 Classification of hospitals.

1. Hospitals are classified as:

a. General hospital - a general hospital is one concerned with admission and treatment of a
substantial range of disease or injury.
Example: Philippine General Hospital
 b. Specialized hospital - a hospital established to admit specific illness, treatment, organ
affected or for a class of people. Specialized hospital may be devoted to:
I. Treatment of a particular type of illness or for a particular condition requiring a
particular range of treatment.
II. Treatment of patient suffering from disease of a particular organ or groups of organs.
III. Treatment of patient of a particular class.
Example: Lung Center Hospital

2. Functional classification:
a. Diagnostic hospital- Hospital devoted solely to the diagnosis of disease, injury, deformity,
or physical and mental conditions. It may be provided with x-ray and laboratory fatalities
for diagnostic purposes.
Example: United Diagnostic Laboratory Center- Manila
b. Maternal hospital— Hospital established for the reception, care and treatment of
expectant mothers and care of the newly-born infants.
Example: United Diagnostic Laboratory Center- Manila
c. Rehabilitation Hospital — Hospital established to enhance return of a disabled to his
usual activities and adapts his condition to a specific environment.
Example: Bridges of Hope Drug and Alcohol Rehabilitation Center Cebu
d. Surgical hospital- hospital where operative procedures are employed as a mode of
treatment.
Example: General Surgery- Chong Hua Hospital
e. Cosmetic hospital- hospital for the improvement of the physical or aesthetic condition
either by surgery or by physical means.
Example: De Leon Cosmetic Surgery Center - Cebu City

3. As to control and financial support.

a. Public government hospital- a hospital operated and maintained either partially or
Wholly by the national, provincial, municipal, or city government or other political
subdivision, or by any department, division, board or other agency thereof.

b. Private hospital- one which is privately owned, especially established and operated with
funds raised or contributed through donations, or private capital or other means, by
private individuals, association, corporations, religious organization, firm, company or
joint stock association.
 For determining liability for negligence, private hospitals are classified into:
I. Private charitable or eleemosynary hospital - This is a hospital established for
public benefit by private individuals or corporation and not conducted for
pecuniary gain of the management, officers or others. It declares no dividends;
no capital stock Seeks no profit and is supported by charitable donations.
II. Private pay hospital- hospital established by private individual or corporation for
profit.

12.3 Vicarious liability of hospital

1. Government or public hospital
➢ under the doctrine of state immunity from suit, a public or government hospital cannot be
sued. However, this rule has been modified that distinction is now drawn between
government hospital established for governmental function not liable and government
hospital for proprietary function—liable.
2. Private charitable, voluntary eleemosynary
➢ derives support from voluntary contributions or donations for the care and treatment of
charity patients.
➢ Thus, under the Trust Fund Doctrine, no fund is available for payment of damages.
Considering that it performs quasi-public functions, it is also immune from suit like
government hospitals under the Public Policy Theory.
➢ Under the Independent Contractor Theory, a patient who enters a private charitable
hospital does not have a contract with the hospital but with the attending physician.

3. Private hospital for profit

➢ may be held vicariously liable for the negligent acts of its agents or employees.
The following are the duties expected from hospitals under the doctrine of respondent
superior:
a. The use of reasonable care in the maintenance of safe and adequate facilities and
equipment;
b. The selection and retention of competent physician's;
c. The overseeing or supervision of all persons who practice medicine within its walls;
and
d. The formulation, adoption and enforcement of adequate rules and policies that
ensure quality care for its patients.
Doctrines and Theories applicable under Vicarious Liability of Hospital
● Doctrine of State of Immunity - The principle of state immunity from suit also rests on reasons of
public policy—that public service would be hindered, and the public endangered.
● Trust Fund Doctrine - The trust fund doctrine provides that the capital stock, property and other
assets of a corporation are regarded as equity in trust for the payment of corporate creditors
It also provides that subscriptions to the capital stock of a corporation constitute a fund to which
creditors have a right to look for the satisfaction of their claims.
● Public Policy Theory- Programs designed to provide financial support to needy individuals or
families are examples of redistributive public policy. Examples include programs like Temporary
Assistance for Needy Families (TANF), Medicaid, and Supplemental Nutritional Aid Program
(SNAP).
● Implied Wave Theory- The theory of the ‘implied waiver’ doctrine is that one who accepts the
benefits, accommodations, and services of such an institution enters into a relation with it
whereby he agrees to exempt it from liability for the negligence of any of its servants in
administering the charity, and that the patient thereby assumes the risk growing out of any
negligent act of any of those connected with administering the affairs of the institution.
● Independent Contractor Theory- An independent contractor is a self-employed
person or entity contracted to perform work for—or provide services
● Doctrine of Respondeat Superior- Doctrine of Respondeat Superior is a legal
doctrine that is commonly used in tort. This principle makes an employer or
principal legally responsible for the wrongful acts done by an employee or agent,
if such acts occur within the scope of the employment or agency.

Case Facts: This is a case of Spouses Agana vs. PSI/Dr. Ampil/Dr. Fuentes
On April 4, 1984, Mrs. Natividad Agana was rushed to the Medical City General Hospital, a
Professional Services Inc. (PSI) owned-hospital, because of difficulty of bowel movement and bloody
anal discharge. From then, she was diagnosed to have cancer of the sigmoid colon. The patient was
scheduled for an operation.
On April 11, 1984, Dr. Ampil, assisted by the medical staff of the Medical City General Hospital,
performed an anterior resection surgery on Mrs. Agana. He found that the malignancy in her sigmoid
area had spread on her left ovary, necessitating the removal of certain portions of it. As such, Dr.
Ampil obtained the consent of Natividad’s husband, Mr. Enrique Agana, to permit Dr. Juan Fuentes to
perform hysterectomy. 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
nurses noted that 2 pieces of gauze were missing. Nevertheless, Natividad was discharged. Later, she
complained of pain in her anal region so she consulted Drs. Ampil and Dr. Fuentes but they told her it
was just a natural consequence of the surgery. Natividad went to the US for further treatment. After
4 months, she was declared cancer-free so she returned to the Philippines.
On August 31, 1984, Mrs. Agana flew back to the Philippines, still suffering from pains. Two
weeks after, her daughter found a piece of gauze protruding from her vagina. Dr. Ampil went to her
house to extract the piece of gauze by hand and assured her that the pains would soon vanish. But
instead of relief, the pain got worse. As she was confined at another hospital, another foreign object
was detected in her vagina -- a foul smelling gauze measuring 1.5 inches in width which badly
infected her vaginal vault. A recto-vaginal fistula had formed in her reproductive organs which forced
stool to excrete through the vagina. Another surgery was needed to rectify the damage. Spouses
Agana filed a case for damages against Professional Services (Medical City).
On February 16, 1986, pending the outcome of the above cases, Natividad died and was
substituted by her children. The RTC found Dr. Ampil, Dr. Fuentes, and Professional Services, Inc.
(Medical City) liable for negligence and malpractice. The CA, however, acquitted Dr. Fuentes and
ruled that only Dr. Ampil and PSI were liable. Hence, the instant petition.

ISSUES IN THE CASE:

1. Whether or not CA erred in Holding Dr. Ampil liable for negligence and malpractice.
2. Whether or not CA erred in holding that Dr. Fuentes was not liable.
3. Whether or not PSI should be liable for the negligence of Dr. Ampil.

RULING/ DECISION OF THE COURT

1. Whether or not CA erred in holding Dr. Ampil liable for negligence and malpractice – NO
It is at least a prima facie negligence by the operating surgeon to leave gauzes or other foreign
substances in the wound after the incision has been closed. Dr. Ampil, who was the operating
surgeon had the duty to remove all foreign objects, such as gauzes, from Mrs. Angana’s body
before closure of the incision. Such act is considered so inconsistent with due care as to raise an
inference of negligence. The four elements of medical negligence – duty, breach, injury, and
proximate causation – were all present. It was also his duty to inform Mrs. Angana and his family
about what happened in the operating room as his operating surgeon.
Thereby, the two gauzes were later on extracted from Natividad’s vagina established the causal link
between Dr. Ampil’s negligence and the injury presented. Mrs. Angana’s injury was further
aggravated because of Dr. Ampil’s deliberate concealment of the missing gauzes from the
knowledge of Mrs. Angana and her family. Therefore, aside from Dr. Ampil’s initial act of
negligence, she deliberately deceived Mrs. Angana by his act of the concealment of truth.
2. Whether or not CA erred in holding that Dr. Fuentes was not liable – NO.
Spouses Agana’s assailed the dismissal by the trial court of the case against Dr. Fuentes, claiming
that such dismissal was contrary to the doctrine of res ipsa loquitur. The fact that the two pieces of
gauze were left inside the body was a prima facie evidence of Dr. Fuentes’ negligence.
Res ipsa loquitur means is that the thing speaks for itself. There are four requisites for res ipsa
loquitur to apply:
I. the occurrence of an injury;
II. the thing which caused the injury was under the control and management of the
defendant;
III. the occurrence was such that in the ordinary course of things, would not have happened if
those who had control or management used proper care; and
IV. the absence of explanation by the defendant. This means that the thing which caused the
injury is present, without the fault of the injured, is under the exclusive control of the
defendant and the injury is such that it should not have occurred if he, having such
control used proper care, it affords reasonable evidence, in the absence of explanation
that the injury arose from the defendant’s want of care, and the burden of proof is
shifted to him to establish that he has observed due care and diligence. In the present
case, element 2 was not present
Consider the following: Ampil was the lead surgeon of the operation on Natividad. He requested
Fuentes to perform the hysterectomy after finding the malignancy had spread to Natividad’s ovaries.
After Fuentes’ surgery, Fuentes allowed him to leave as he resumed the operation. Fuentes was not in
the room when Ampil directed that the incision be closed. Under the Captain of the Ship rule, the
operating surgeon is in complete charge of the surgery room and personnel connected with the
operation. As the lead surgeon, it was Dr. Ampil, not Dr. Fuentes, who had control and management
over the said incident.
Moreover, after Dr. Fuentes done the hysterectomy, he was allowed by Dr. Ampil to leave as he
resumed the operation. Fuentes was not in the room when Ampil directed that the incision be closed.

3. Whether or not PSI should be liable for the negligence of Dr. Ampil – YES.
It was made to take effect the employer-employee relationship so as to share the responsibility in
medical negligence cases. In situations like in the hospital, the hospital’s are responsible with their
attending, visiting physicians and other medical and auxillary staffs.
PSI's liability is also anchored upon the agency principle of apparent authority or agency by estoppel
and the doctrine of corporate negligence.
12.5. Jurisprudence on non-liability of hospital
ROGELIO E. RAMOS, et al. vs. COURT OF APPEALS
GR. No. 124354, December 29, 1999
We now discuss the responsibility of the hospital in this particular incident, The unique practice (among
private hospitals) of filling up staff with attending and visiting “consultants” of filling up specialist or
consultants,” who are not the hospital employees.
First of all, the hospital requites certain medical staff as either visiting or attending consultants.
They must present with valid documentation to be hired by the hospital such as the certificate of
registration, proof of residency and educational certification
We must also keep in the mind that the hospital as the full right to hire or fire a consultant,
according to their work of conduct after being accepted, either as a visiting or attending consultant, he
is normally required to attend clinico-pathological conferences, conduct bedside rounds for clerks,
interns and residents, moderate grand rounds and patient audits and perform other tasks and
responsibilities, for the privilege of being able to maintain a clinic in the hospital, and/or for the privilege
of admitting patients into the hospital. In other words, this simply means that the private hospital can
fire, hire and exercise real control over the attending consultants.
Accordingly, on the basis of the foregoing, we rule that for the purpose of allocating responsibility
in medical negligence cases, an employer-employee relationship in effect exists between hospitals and
their attending and visiting physicians. This being the case, the question now arises as to whether or not
respondent hospital is solitarily liable with respondent doctors for petitioner's condition.
The basis for holding an employer solitarily responsible for the negligence of its employee is found
in Article 2180 of the Civil Code which considers a person accountable not only for his own acts but also
for those of others based on the former's responsibility under a relationship of potestas.
Finally, In the instant case, respondent hospital, apart from a general denial of its responsibility
over respondent physicians, failed to adduce evidence showing that it exercised the diligence of a good
father of a family in the hiring and supervision of the matter. It failed to adduce evidence with regard to
the degree of supervision which it exercised over its physicians. In neglecting to offer such proof or
proof of a similar nature, respondent hospital thereby failed to discharge its burden, paragraph of
Article 2180.
 In conclusion this simply means that the hospital has the right to hire and fire the attending
consultant who is not the actual member of the hospital based on their credibility and work, also they
are not allowed to have an employee-employee relationship.

12.6 Attendance to emergencies or serious cases

o Physicians do not have unlimited discretion to refuse to accept a person as a new patient.
o Because much of medicine is involved with federal regulations, physicians cannot refuse to
o accept a person for ethnic, racial, or religious reasons.
o Under the Civil Rights Act of 1964, it is illegal for a healthcare provider to deny a patient
treatment based on the patient's age, sex, race, sexual orientation, religion, or national origin.

Sample case:
In one case, a senior patient who had difficulty breathing reportedly was refused admission by as
many as six hospitals that claimed they did not have vacant beds in their intensive care units. He later
died at home. Another patient was also turned away by nine hospitals without getting any emergency
treatment. The Philippine president ordered the Department of Justice to investigate the incidents, and
the justice secretary has indicated that the National Bureau of Investigation is looking into the matter.
The chair of the Senate Committee on Health and Demography has condemned the incidents
and stated that, under the Philippine Anti-Hospital Deposit Law (Republic Act 10932), it is illegal for
hospitals or medical clinics to unduly refuse to provide medical treatment to patients who need urgent
care. If a hospital does not have enough beds, patients may be transferred to other health care facilities
able to provide treatment. However, section 1 of the Act provides that “such transfer shall be done only
after necessary emergency treatment and support have been administered to stabilize the patient and
after it has been established that such transfer entails less risks than the patient’s continued
confinement.”
Those who are found to be in violation of the law may be punished with imprisonment of up to
six years and a fine. The hospital involved may also have its license to operate revoked after three
repeated violations are committed pursuant to management’s instructions. If an individual suffers
death, serious impairment of his or her health, or permanent disability as a result of denial of hospital
admission, a presumption of liability arises against the hospital and the officials, medics, or employees
involved.
12.7 Transfer of patient
Section 5 of R.A. 8344 "In emergency or serious cases, it shall be unlawful for any proprietor,
president, director, manager or any other officer, and/or medical practitioner or employee of a hospital
or medical clinic to request, solicit, demand or accept any deposit or any other form of advance
payment as a prerequisite for confinement or medical treatment of a patient in such hospital or medical
clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine
to prevent death or permanent disability:
Provided, That by reason of inadequacy of the medical capabilities of the hospital or medical
clinic, the attending physician may transfer the patient to a facility where appropriate care can be given,
after the patient or his next of kin consents to said transfer: Provided, however, That when the patient is
unconscious, incapable of giving consent and/or unaccompanied, the physician can transfer the patient
even without his consent, Provided, further, That such transfer shall be done only after the necessary
emergency treatment and support have been administered to stabilize the patient and after it has been
established that such transfer entails less risks than the patient's continued confinement: Provided,
finally, That strict compliance with the foregoing procedure on transfer shall not be construed as a
refusal made punishable by this Act."
Any official, medical practitioner or employee of the hospital or medical clinic who violates the
provisions of RA 8344 shall, upon conviction by final judgment, be punished by imprisonment of not less
than six (6) months and one (1) day but not more than two (2) years and four months, or a fine of not
less than Twenty Thousand Pesos (P20,000.00) but not more than One Hundred Thousand Pesos
(P100,000.00) or both at the discretion of the court:

Provided, however, that if such violation was committed pursuant to an established policy of the
hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic
responsible for the formulation and imprisonment of four (4) to six (6) years, or a fine of not less than
One Hundred Thousand Pesos (P100,000.00), but not more than Five Hundred Thousand Pesos
(P500,000.00) or both, at the discretion of the court.
12.8 Hospital Detention Law
The patient has a separate and independent right to leave the hospital premises, which cannot be
defeated by the mere fact that he failed to pay his hospital bill. Should a hospital insist on disallowing
the release of a patient due to non-payment of bill, the patient or his family may file appropriate actions
in court.

Sample case:
MANILA DOCTORS HOSPITAL vs. SO UN CHUA and VICKY TY G.R. No. 150355 July 31, 2006:
In the case of Manila Doctors Hospital vs. Chua (G.R. No. 150355, July 31, 2006), the Supreme
Court made a clear pronouncement that a hospital cannot detain a patient for non-payment of the
hospital bill. It held that detention of a patient is permitted only when certain circumstances are present
such as if the patient is a detained or convicted prisoner, is suffering from a very contagious disease or
mentally ill such that his release will endanger public health and safety, or in other exigent cases as may
be provided by law.
Habeas corpus is a special proceeding available to all cases of illegal confinement or detention by
which any person is deprived of his liberty, or by which the rightful custody of any person is withheld
from the person entitled thereto (Sec.1, Rule 102, Rules of Court). A patient may also consider filing a
criminal charge for illegal detention under Article 267 or 268 of the Revised Penal Code depending on
the surrounding circumstances of the case and provided all the elements of the crime can be sufficiently
established.
If the patient did not stay in a private room, he may also file a criminal case for violation of
Republic Act (RA) 9436, or the Anti-Detention in Hospital Act against the officers or employees of the
hospital or medical clinic responsible for releasing patients. This law guarantees the right of a patient to
leave the hospital or medical clinic, with a right to demand the issuance of the corresponding medical
certificate and other pertinent papers required for the release of the patient from the hospital or
medical clinic upon the execution of a promissory note covering the unpaid obligation and imposes a
corresponding penalty of imprisonment and/or fine against concerned officers of the hospital who
violate the law. Take note, however, that the law does not apply if the patient stayed in a private room.
(Sections 2 & 3, Ibid.)
But the hospital is also a business, and, as a business, it has a right to institute all measures of
efficiency commensurate to the ends for which it is designed, especially to ensure its economic viability
and survival.
 WHEREFORE, the petition is GRANTED. The Decision of the Court of Appeals dated October 2,
2001, together with the Decision dated September 30, 1997 of the Regional Trial Court in Civil Case No.
63958, is REVERSED and SET ASIDE. Another judgment is entered dismissing the Complaint and ordering
respondents, jointly and severally, to pay the petitioner the amount of P865,592.95, with stipulated
interest of 12 percent reckoned from the date of extrajudicial demand until full payment, and 12
percent of the total amount due as attorney's fees.
The evidence in the record overwhelmingly demonstrates that respondent Chua had been
adequately attended to, and this Court cannot understand why the courts a quo had declared that there
was an "utter lack of medical attendance," or that her health suffered during the period after the
removal of the facilities. The Court finds that the facilities in question are non-essential for the care of
respondent Chua and, hence, they may be lessened or removed by the petitioner for the sake of
economic necessity and survival

References:
❖ Baizer, B. (2017, May 25). Can a doctor deny me treatment? When, why, and what are my
options? Baizer Kolar Neiman P.C.
❖ Bellosillo, J. (2010) Basic of Philippines Medical Jurisprudence and Ethics
❖ Philippines: Hospitals investigated for denying treatment During pandemic. The Library of
Congress. (n.d.).
❖ Atty. Kapunan Lorna Pata. (2017, April 23) Immunity from suit
Website name: https://businessmirror.com.ph/2017/04/23/immunity-from-suit/
❖ Atty. Pamaos Fred 2019, April 28 the Trust Fund Doctrine in Corporate Law
❖ Website name: https://pnl-law.com/blog/the-trust-fund-doctrine-in-corporate-law/