Professional Services, Inc. v. Agana
NEW DOCTRINEFacts
The Antecedents: Natividad Agana sought treatment at Medical City Hospital for difficulty with bowel movement and bloody anal discharge. Dr. Miguel Ampil diagnosed her with "cancer of the sigmoid." On April 11, 1984, Dr. Ampil, assisted by hospital staff, performed an anterior resection surgery. Due to the spread of malignancy to her left ovary, Dr. Juan Fuentes was called to perform a hysterectomy, after which Dr. Ampil completed the operation. During the surgery, a critical error occurred: the nurses' report indicated two sponges were missing, and despite a search, they were not found before the incision was closed. Natividad was discharged on April 24, 1984, but soon experienced excruciating pain. She was later informed by Dr. Ampil that the pain was a consequence of the surgery. Upon returning to the Philippines after seeking treatment in the U.S., a piece of gauze was discovered and extracted from her vagina by Dr. Ampil. Subsequently, at Polymedic General Hospital, another gauze was found, causing severe infection and the formation of a recto-vaginal fistula, necessitating further surgery. Procedural History: On November 12, 1984, Natividad and her husband filed a complaint for damages against Professional Services, Inc. (PSI), Dr. Ampil, and Dr. Fuentes, alleging negligence and malpractice for leaving gauze inside Natividad and for concealing this act. Concurrently, an administrative complaint was filed with the Professional Regulation Commission (PRC) against Dr. Ampil and Dr. Fuentes. Following Natividad's death on February 16, 1986, her children substituted her. The Regional Trial Court (RTC) ruled in favor of the Aganas, holding PSI, Dr. Ampil, and Dr. Fuentes liable. The defendants appealed to the Court of Appeals. The PRC dismissed the case against Dr. Fuentes. On September 6, 1996, the Court of Appeals affirmed the RTC decision in part, dismissing the case against Dr. Fuentes, holding Dr. Ampil liable to reimburse PSI for any payments made to the Aganas, and affirming the liability of PSI and Dr. Ampil. The appellate court also nullified the RTC's order for alias writ of execution against Dr. Fuentes. Dr. Ampil's motion for reconsideration was denied. The Petition: Three consolidated petitions for review on certiorari were filed. In G.R. No. 126297, PSI argued it was not estopped from denying Dr. Ampil's employment, was not solidarily liable with him, and was entitled to its counterclaim. In G.R. No. 126467, the Aganas argued the Court of Appeals erred in absolving Dr. Fuentes, invoking the doctrine of res ipsa loquitur. In G.R. No. 127590, Dr. Ampil asserted the Court of Appeals erred in finding him liable without sufficient evidence, pointing to other potential causes for the gauze being left behind. The Supreme Court addressed three main issues: Dr. Ampil's liability for negligence and malpractice, Dr. Fuentes's liability, and PSI's solidary liability for Dr. Ampil's negligence.
Issue(s)
Whether the Court of Appeals erred in holding Dr. Ampil liable for negligence and malpractice. Whether the Court of Appeals erred in absolving Dr. Fuentes of any liability. Whether PSI may be held solidarily liable for the negligence of Dr. Ampil.
Ruling
The Supreme Court denied all petitions and affirmed the decision of the Court of Appeals. PSI and Dr. Miguel Ampil were ordered to pay costs.
Ratio Decidendi
On the issue of Dr. Ampil's liability for negligence and malpractice: The Court held that Dr. Ampil was liable for medical negligence. The fact that two pieces of gauze were left inside the patient's body after surgery, as indicated by the nurses' report and confirmed by the extraction of the gauzes, constitutes at least prima facie negligence. Dr. Ampil's failure to inform Natividad about the missing gauzes and his misleading assurance that her pain was a normal consequence of the surgery constituted a breach of his duty and aggravated her injury. The elements of duty, breach, injury, and proximate causation were established. Dr. Ampil's act of closing the incision despite the missing gauzes was the proximate cause of Natividad's injury, further compounded by his deliberate concealment. On the issue of Dr. Fuentes' liability: The Court affirmed the Court of Appeals' decision absolving Dr. Fuentes. The doctrine of res ipsa loquitur was found inapplicable because the element of "control and management of the thing which caused the injury" was wanting. Dr. Ampil was the lead surgeon and the "Captain of the Ship." Dr. Fuentes performed the hysterectomy as requested by Dr. Ampil, and after Dr. Ampil examined his work and found it in order, Dr. Fuentes left the operating room. Dr. Ampil then resumed the operation and ordered the closure of the incision despite the missing gauzes, at which point Dr. Fuentes was no longer present or in control. On the issue of PSI's liability: The Court held PSI solidarily liable with Dr. Ampil. While Dr. Ampil was not technically an employee, PSI, as the owner and operator of Medical City Hospital, is liable under the doctrines of apparent authority and corporate negligence. PSI's act of publicly displaying the names and specializations of accredited physicians, including Dr. Ampil, created the impression that they were its agents, estopping PSI from denying liability. Furthermore, PSI was directly liable for corporate negligence for failing to exercise reasonable care in supervising its medical staff and for its "conspiracy of silence" in not investigating the missing gauzes. PSI failed to discharge its burden of proving it exercised the diligence of a good father of a family.
Main Doctrine
Hospitals are liable for the negligence of physicians practicing within their premises under the doctrines of respondeat superior, apparent authority, and corporate negligence, especially when the hospital exercises control over the physicians and holds them out as its agents to the public. The operating surgeon is primarily liable for leaving foreign objects in a patient's body and for failing to disclose such fact.