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PROFESSIONAL SERVICES, INC., Petitioner, - versus - NATIVIDAD and ENRIQUE Respondents. x
- - - - - - - - - - - - - - - - - - - - - - - x NATIVIDAD (Substituted by her children
MARCELINO AGANA III, ENRIQUE AGANA, JR., EMMA AGANA ANDAYA, JESUS AGANA, and RAYMUND
AGANA) and ENRIQUE AGANA, Petitioners, - versus - JUAN FUENTES, Respondent. x-
- - - - - - - - - - - - - - - - - - -- - - - x MIGUEL AMPIL, Petitioner, - versus - NATIVIDAD Respondents.
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G.R. No.
126297 G.R. No.
126467 G.R. No.
127590 Present:
PUNO, C.J., Chairperson Sandoval-Gutierrez, azcuna, and *GARCIA,
JJ. Promulgated:
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DECISION
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SANDOVAL-GUTIERREZ, J.:
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Hospitals, having undertaken one of mankind’s most
important and delicate endeavors, must assume the grave responsibility of
pursuing it with appropriate care. The
care and service dispensed through this high trust, however technical, complex
and esoteric its character may be, must meet standards of responsibility
commensurate with the undertaking to preserve and protect the health, and
indeed, the very lives of those placed in the hospital’s keeping.[1]
Assailed in these three consolidated petitions for review
on certiorari is the Court of Appeals’ Decision[2]
dated
The facts, as culled from the records, are:
On
On
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. In the
corresponding Record of Operation dated
“sponge count lacking 2
“announced to surgeon searched (sic) done but to no avail continue for closure.”
On P60,000.00.
After a couple of days, Natividad complained of
excruciating pain in her anal region. She consulted both Dr. Ampil and Dr.
Fuentes about it. They told her that the
pain was the natural consequence of the surgery. Dr.
Ampil then recommended that she consult an oncologist to examine the cancerous
nodes which were not removed during the operation.
On
On
Dr. Ampil’s assurance did not come true. Instead, the pains intensified, prompting
Natividad to seek treatment at the
On
Meanwhile, Enrique Agana also filed with the Professional
Regulation Commission (PRC) an administrative complaint for gross negligence
and malpractice against Dr. Ampil and Dr. Fuentes, docketed as Administrative
Case No. 1690. The PRC Board of
Medicine heard the case only with respect to Dr. Fuentes because it failed to
acquire jurisdiction over Dr. Ampil who was then in the
On February 16, 1986, pending the outcome of the above
cases, Natividad
died and was duly substituted by her above-named children (the Aganas).
On
WHEREFORE, judgment is hereby rendered
for the plaintiffs ordering the defendants PROFESSIONAL
SERVICES, INC., DR. MIGUEL AMPIL and
DR. JUAN FUENTES to pay to the plaintiffs, jointly and severally, except in
respect of the award for exemplary damages and the interest thereon which are
the liabilities of defendants Dr. Ampil and Dr. Fuentes only, as follows:
1.
As actual damages, the following amounts:
a.
The equivalent in Philippine Currency of the total of
US$19,900.00 at the rate of P21.60-US$1.00, as reimbursement of actual
expenses incurred in the United States of America;
b.
The sum of P4,800.00 as travel taxes of
plaintiffs and their physician daughter;
c.
The total sum of P45,802.50, representing the
cost of hospitalization at
2.
As moral damages, the sum of P2,000,000.00;
3.
As exemplary damages, the sum of P300,000.00;
4.
As attorney’s fees, the sum of P250,000.00;
5.
Legal interest on items 1 (a), (b), and (c); 2; and 3
hereinabove, from date of filing of the
complaint until full payment; and
6.
Costs of suit.
SO ORDERED.
Aggrieved,
PSI, Dr. Fuentes and Dr. Ampil interposed an appeal to the Court of Appeals,
docketed as CA-G.R. CV No. 42062.
Incidentally, on P451,275.00 and delivered the
amount to the Aganas.
Following their receipt of the money, the Aganas entered
into an agreement with PSI and Dr. Fuentes to indefinitely suspend any further
execution of the RTC Decision. However, not
long thereafter, the Aganas again filed a motion for an alias writ of execution
against the properties of PSI and Dr. Fuentes. On
On
Meanwhile, on
On
WHEREFORE, except for the
modification that the case against defendant-appellant Dr. Juan Fuentes is
hereby DISMISSED, and with the pronouncement that defendant-appellant
Dr. Miguel Ampil is liable to reimburse defendant-appellant Professional Services, Inc., whatever
amount the latter will pay or had paid to the plaintiffs-appellees, the
decision appealed from is hereby
AFFIRMED and the instant appeal DISMISSED.
Concomitant with the above, the
petition for certiorari and prohibition filed by herein defendant-appellant Dr.
Juan Fuentes in CA-G.R. SP No. 32198 is hereby GRANTED and the
challenged order of the respondent judge dated
Costs against defendants-appellants Dr. Miguel Ampil and Professional Services, Inc.
SO
ORDERED.
Only Dr.
Ampil filed a motion for reconsideration, but it was denied in a Resolution[7]
dated
Hence, the instant consolidated petitions.
In G.R. No. 126297,
PSI alleged in its petition that the Court of Appeals erred in holding that: (1) it is estopped from raising the
defense that Dr. Ampil is not its employee; (2) it is solidarily liable with Dr. Ampil; and (3) it is not entitled to its counterclaim against the Aganas. PSI contends that Dr. Ampil is not its
employee, but a mere consultant or independent contractor. As such, he alone should answer for his
negligence.
In G.R. No. 126467,
the Aganas maintain that the Court of Appeals erred in finding that Dr. Fuentes
is not guilty of negligence or medical malpractice, invoking the doctrine of res ipsa loquitur. They contend that the
pieces of gauze are prima facie proofs
that the operating surgeons have been negligent.
Finally, in G.R. No.
127590, Dr. Ampil asserts that the Court of Appeals erred in finding him
liable for negligence and malpractice sans
evidence that he left the two pieces of gauze in Natividad’s vagina. He
pointed to other probable causes, such as: (1) it was Dr. Fuentes who used gauzes in
performing the hysterectomy; (2) the
attending nurses’ failure to properly count the gauzes used during surgery; and
(3) the medical intervention of the American
doctors who examined Natividad in the
For our
resolution are these three vital issues: first,
whether the Court of Appeals erred in holding Dr. Ampil liable for negligence
and malpractice; second, whether the Court of Appeals erred in absolving
Dr. Fuentes of any liability; and third, whether PSI may be held solidarily
liable for the negligence of Dr. Ampil.
I - G.R. No. 127590
Whether
the Court of Appeals Erred in
Liable
for Negligence and Malpractice.
Dr. Ampil, in an attempt to absolve himself, gears the
Court’s attention to other possible causes of Natividad’s detriment. He argues that the Court should not discount
either of the following possibilities: first,
Dr. Fuentes left the gauzes in
Natividad’s body after performing hysterectomy; second, the attending nurses erred in counting the gauzes; and third, the American doctors were the
ones who placed the gauzes in Natividad’s body.
Dr.
Ampil’s arguments are purely conjectural and without basis. Records show that he
did not present any evidence to prove that the American doctors were the ones
who put or left the gauzes in Natividad’s body. Neither did he submit evidence to rebut the
correctness of the record of operation, particularly the number of gauzes used.
As to the alleged negligence of Dr. Fuentes, we are mindful that Dr. Ampil
examined his (Dr. Fuentes’) work and
found it in order.
The glaring truth is that all the major circumstances,
taken together, as specified by the Court of Appeals, directly point to Dr.
Ampil as the negligent party, thus:
First, it is not disputed
that the surgeons used gauzes as sponges to control the bleeding of the patient
during the surgical operation.
Second, immediately after the
operation, the nurses who assisted in the surgery noted in their report that
the ‘sponge count (was) lacking 2’; that
such anomaly was ‘announced to surgeon’ and that a ‘search was done but to no
avail’ prompting Dr. Ampil to ‘continue for closure’ x x x.
Third, after the operation,
two (2) gauzes were extracted from the same spot of the body of Mrs. Agana
where the surgery was performed.
An
operation requiring the placing of sponges in the incision is not complete
until the sponges are properly removed, and it is settled that the leaving of
sponges or other foreign substances in the wound after the incision has been
closed is at least prima facie
negligence by the operating surgeon.[8] To put it simply, such act is considered so
inconsistent with due care as to raise an inference of negligence. There are even legions of authorities to the
effect that such act is negligence per se.[9]
Of course, the Court is not blind to the reality that there are times when danger to a patient’s life precludes a surgeon from further searching missing sponges or foreign objects left in the body. But this does not leave him free from any obligation. Even if it has been shown that a surgeon was required by the urgent necessities of the case to leave a sponge in his patient’s abdomen, because of the dangers attendant upon delay, still, it is his legal duty to so inform his patient within a reasonable time thereafter by advising her of what he had been compelled to do. This is in order that she might seek relief from the effects of the foreign object left in her body as her condition might permit. The ruling in Smith v. Zeagler[10] is explicit, thus:
The removal of all sponges used is part of a surgical operation, and when
a physician or surgeon fails to remove a sponge he has placed in his patient’s
body that should be removed as part of the operation, he thereby leaves his
operation uncompleted and creates a new
condition which imposes upon him the legal duty of calling the new condition to
his patient’s attention, and endeavoring with the means he has at hand to
minimize and avoid untoward results likely to ensue therefrom.
Here,
Dr. Ampil did not inform Natividad about the missing two pieces of gauze. Worse,
he even misled her that the pain she was experiencing was the ordinary
consequence of her operation. Had he
been more candid, Natividad could have taken the immediate and appropriate
medical remedy to remove the gauzes from her body. To our
mind, what was initially an act of negligence by Dr. Ampil has ripened into a
deliberate wrongful act of deceiving his patient.
This is
a clear case of medical malpractice or more appropriately, medical negligence. To successfully pursue this kind of case, a
patient must only prove that a health care provider either failed to do
something which a reasonably prudent health care provider would have done, or
that he did something that a reasonably prudent provider would not have done;
and that failure or action caused injury to the patient.[11] Simply put, the elements are duty, breach, injury and proximate causation. Dr, Ampil, as the lead surgeon, had the duty
to remove all foreign objects, such as gauzes, from Natividad’s body before
closure of the incision. When he failed
to do so, it was his duty to inform Natividad about it. Dr. Ampil breached both duties. Such breach caused
injury to Natividad, necessitating her further examination by American doctors
and another surgery. That Dr. Ampil’s negligence
is the proximate cause[12]
of Natividad’s injury could be traced from his act of closing the incision despite the information given by the
attending nurses that two pieces of gauze were still missing. That they
were later on extracted from Natividad’s vagina established the causal link
between Dr. Ampil’s negligence and the injury. And what further aggravated such
injury was his deliberate concealment of the missing gauzes from the knowledge
of Natividad and her family.
II - G.R. No. 126467
Whether
the Court of Appeals Erred in Absolving
Dr.
Fuentes of any Liability
The Aganas assailed the dismissal by the trial court of the
case against Dr. Fuentes on the ground that it is contrary to the doctrine of res ipsa loquitur. According to them, the fact that the two pieces
of gauze were left inside Natividad’s body is a prima facie evidence of
Dr. Fuentes’ negligence.
We are not convinced.
Literally, res ipsa loquitur means “the thing speaks
for itself.” It is the rule that the
fact of the occurrence of an injury, taken with the surrounding circumstances,
may permit an inference or raise a presumption of negligence, or make out a
plaintiff’s prima facie case, and present a question of fact for
defendant to meet with an explanation.[13] Stated differently, where the thing which caused
the injury, 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.[14]
From the foregoing statements of the rule, the requisites
for the applicability of the doctrine of res ipsa loquitur are: (1) the occurrence of an injury; (2) the thing which caused the injury
was under the control and management of the defendant; (3) 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 (4) the absence of
explanation by the defendant. Of the foregoing requisites, the most
instrumental is the “control and
management of the thing which caused the injury.”[15]
We find the element of “control and management of the thing
which caused the injury” to be wanting. Hence, the doctrine of res ipsa
loquitur will not lie.
It was duly established that Dr. Ampil was the lead surgeon during the operation of
Natividad. He requested the assistance
of Dr. Fuentes only to perform hysterectomy when he (Dr. Ampil) found that the
malignancy in her sigmoid area had spread to her left ovary. Dr. Fuentes performed the surgery and
thereafter reported and showed his work to Dr. Ampil. The latter examined it and finding
everything to be in order, allowed Dr. Fuentes to leave the operating
room. Dr. Ampil then resumed operating on Natividad. He was about to finish the procedure when the
attending nurses informed him that two pieces
of gauze were missing. A “diligent search” was conducted, but the misplaced
gauzes were not found. Dr. Ampil then
directed that the incision be closed.
During this entire period, Dr. Fuentes was no longer in the operating
room and had, in fact, left the hospital.
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.[16] 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.
In
this jurisdiction, res ipsa loquitur is not a rule of substantive law, hence,
does not per se create or constitute an independent or separate ground
of liability, being a mere evidentiary rule.[17] In other words, mere invocation and
application of the doctrine does not dispense with the requirement of proof of
negligence. Here, the negligence was
proven to have been committed by Dr. Ampil and not by Dr. Fuentes.
III - G.R. No. 126297
Whether PSI Is
Liable for the Negligence of Dr. Ampil
The third issue
necessitates a glimpse at the historical development of hospitals and the resulting
theories concerning their liability for the negligence of physicians.
Until the mid-nineteenth century, hospitals were generally
charitable institutions, providing medical services to the lowest classes of
society, without regard for a patient’s ability to pay.[18] Those who could afford medical treatment were
usually treated at home by their doctors.[19] However, the days of house calls and
philanthropic health care are over. The
modern health care industry continues to distance itself from its charitable
past and has experienced a significant conversion from a not-for-profit health
care to for-profit hospital businesses. Consequently, significant changes in
health law have accompanied the business-related changes in the hospital
industry. One important legal change is an increase in hospital liability for medical
malpractice. Many courts now allow
claims for hospital vicarious liability under the theories of respondeat superior, apparent authority,
ostensible authority, or agency by estoppel. [20]
In this
jurisdiction, the statute governing liability for negligent acts is Article
2176 of the Civil Code, which reads:
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.
A
derivative of this provision is Article 2180, the rule governing vicarious liability
under the doctrine of respondeat superior, thus:
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.
x x x x x x
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.
x x x
x x x
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.
A prominent civilist commented that professionals engaged
by an employer, such as physicians, dentists, and pharmacists, are not “employees”
under this article because the manner in which they perform their work is not
within the control of the latter (employer).
In other words, professionals are
considered personally liable for the fault or negligence they commit in the
discharge of their duties, and their employer cannot be held liable for such fault
or negligence. In the context of the
present case, “a hospital cannot be held liable for the fault or negligence of
a physician or surgeon in the treatment or operation of patients.”[21]
The foregoing view is grounded on the traditional notion
that the professional status and the very nature of the physician’s calling
preclude him from being classed as an agent or employee of a hospital, whenever
he acts in a professional capacity.[22] It has been said that medical practice
strictly involves highly developed and specialized knowledge,[23] such
that physicians are generally free
to exercise their own skill and judgment in rendering medical services sans
interference.[24] Hence, when a doctor practices medicine in a
hospital setting, the hospital and its employees are deemed to subserve him in
his ministrations to the patient and his actions are of his own responsibility.[25]
The case of Schloendorff
v. Society of New York Hospital[26] was then considered an authority for this view.
The “Schloendorff doctrine” regards a physician, even if employed by a
hospital, as an independent contractor
because of the skill he exercises and the lack of control exerted over his
work. Under this doctrine, hospitals are
exempt from the application of the respondeat superior principle for fault or
negligence committed by physicians in the discharge of their profession.
However,
the efficacy of the foregoing doctrine has weakened with the significant developments
in medical care. Courts came to realize
that modern hospitals are increasingly taking active role in supplying and
regulating medical care to patients. No longer were a hospital’s functions
limited to furnishing room, food, facilities for treatment and operation, and
attendants for its patients. Thus, in Bing
v. Thunig,[27] the New York Court of Appeals deviated from
the Schloendorff doctrine, noting that modern hospitals actually do far
more than provide facilities for treatment. Rather, they regularly employ, on a salaried
basis, a large staff of physicians, interns, nurses, administrative and manual
workers. They charge patients for medical care and treatment, even collecting
for such services through legal action, if necessary. The court then concluded that there is no
reason to exempt hospitals from the universal rule of respondeat superior.
In our shores, the nature of the relationship between the
hospital and the physicians is rendered inconsequential in view of our categorical
pronouncement in Ramos v. Court of Appeals[28]
that for purposes of apportioning responsibility in medical negligence cases, an employer-employee relationship in effect
exists between hospitals and their attending and visiting physicians. This Court held:
“We now discuss the responsibility of the hospital in this particular
incident. The unique practice (among private hospitals) of filling up
specialist staff with attending and visiting “consultants,” who are allegedly
not hospital employees, presents problems in apportioning responsibility for
negligence in medical malpractice cases. However, the difficulty is more
apparent than real.
In the first place, hospitals
exercise significant control in the hiring and firing of consultants and in the
conduct of their work within the hospital premises. Doctors who apply for
‘consultant’ slots, visiting or attending, are required to submit proof of
completion of residency, their educational qualifications, generally, evidence
of accreditation by the appropriate board (diplomate), evidence of fellowship
in most cases, and references. These requirements are carefully scrutinized by
members of the hospital administration or by a review committee set up by the
hospital who either accept or reject the application. x
x x.
After a physician is 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 addition to these, the physician’s performance as a specialist is generally
evaluated by a peer review committee on the basis of mortality and morbidity
statistics, and feedback from patients, nurses, interns and residents. A consultant remiss in his duties, or a
consultant who regularly falls short of the minimum standards acceptable to the
hospital or its peer review committee, is normally politely terminated.
In other words, private
hospitals, hire, fire and exercise real control over their attending and
visiting ‘consultant’ staff. While ‘consultants’ are not, technically
employees, x x x,
the control exercised, the hiring, and the right to terminate consultants all
fulfill the important hallmarks of an employer-employee relationship, with the
exception of the payment of wages.
In assessing whether such a relationship in fact exists, the control test
is determining. 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.
”
But the Ramos pronouncement is not our only basis in sustaining
PSI’s liability. Its liability is also anchored
upon the agency principle of
apparent authority or agency by estoppel and the doctrine of
corporate negligence which have gained
acceptance in the determination of a hospital’s liability for negligent acts of
health professionals. The present case
serves as a perfect platform to test the applicability of these doctrines, thus,
enriching our jurisprudence.
Apparent authority, or what is sometimes referred to as the
“holding
out” theory, or doctrine of ostensible
agency or agency by estoppel,[29] 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.[30] The concept is essentially one of estoppel
and has been explained in this manner:
“The principal is bound by the acts of his
agent with the apparent authority which he knowingly permits the agent to
assume, or which he holds the agent out to the public as possessing. The
question in every case is whether the principal has by his voluntary act placed
the agent in such a situation that a person of ordinary prudence, conversant
with business usages and the nature of the particular business, is justified in
presuming that such agent has authority to perform the particular act in
question.[31]
The applicability of apparent
authority in the field of hospital liability was upheld long time ago in Irving v. Doctor Hospital of Lake Worth,
Inc.[32] There, it was explicitly stated that “there does not appear to be any rational basis for excluding the
concept of apparent authority from the field of hospital liability.” Thus, in cases where it can be shown that a
hospital, by its actions, has held out a particular physician as its agent
and/or employee and that a patient has accepted treatment from that physician
in the reasonable belief that it is being rendered in behalf of the hospital,
then the hospital will be liable for the physician’s negligence.
Our
jurisdiction recognizes the concept of an agency by implication or estoppel.
Article 1869 of the Civil Code reads:
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.
In this case, PSI publicly displays in the lobby of the
x x x regardless of the
education and status in life of the patient, he ought not be burdened with the
defense of absence of employer-employee relationship between the hospital and
the independent physician whose name and competence are certainly certified to
the general public by the hospital’s act of listing him and his specialty in
its lobby directory, as in the case herein. The high costs of today’s medical
and health care should at least exact on the hospital greater, if not broader,
legal responsibility for the conduct of treatment and surgery within its
facility by its accredited physician or surgeon, regardless of whether he is
independent or employed.”[33]
The wisdom of the foregoing
ratiocination is easy to discern. 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.
We now proceed to
the doctrine of corporate negligence
or corporate responsibility.
One allegation in the complaint in Civil Case No. Q-43332 for
negligence and malpractice is that PSI as owner, operator and manager of
We agree with the trial court.
Recent years have seen the doctrine of corporate negligence
as the judicial answer to the problem of allocating hospital’s liability for
the negligent acts of health practitioners, absent facts to support the application
of respondeat superior or apparent authority. Its formulation proceeds
from the judiciary’s acknowledgment that in these modern times, the duty of
providing quality medical service is no longer the sole prerogative and
responsibility of the physician. The modern hospitals have changed structure. Hospitals
now tend to organize a highly professional medical staff whose competence and
performance need to be monitored by the hospitals commensurate with their
inherent responsibility to provide quality medical care.[35]
The
doctrine has its genesis in Darling v. Charleston
Community Hospital.[36]
There, the Supreme Court of Illinois held that “the jury could have found a hospital negligent, inter alia, in failing to have a sufficient number of trained
nurses attending the patient; failing to require a consultation with or
examination by members of the hospital staff; and failing to review the
treatment rendered to the patient.” On the basis of Darling, other jurisdictions held that a hospital’s corporate negligence extends to permitting a physician
known to be incompetent to practice at the hospital.[37] 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.[38] Thus, in Tucson Medical Center, Inc. v.
Misevich,[39] it was
held that a hospital, following the doctrine of corporate responsibility, has
the duty to see that it meets the standards of responsibilities for the care of
patients. Such duty includes the proper
supervision of the members of its medical staff. And in Bost v. Riley,[40]
the court concluded that a patient who enters a hospital does so with the
reasonable expectation that it will attempt to cure him. The hospital accordingly has the duty to make a reasonable effort to
monitor and oversee the treatment prescribed and administered by the physicians
practicing in its premises.
In the present case, it was duly established that PSI
operates the
x x x PSI’s liability is
traceable to its failure to conduct an investigation of the matter reported in
the nota bene of the count nurse.
Such failure established PSI’s part in the dark conspiracy of silence and
concealment about the gauzes. Ethical considerations, if not also legal,
dictated the holding of an immediate inquiry into the events, if not for the
benefit of the patient to whom the duty is primarily owed, then in the interest
of arriving at the truth. The Court cannot accept that the medical and the
healing professions, through their members like defendant surgeons, and their
institutions like PSI’s hospital facility, can callously turn their backs on
and disregard even a mere probability of
mistake or negligence by refusing or failing to investigate a report of such
seriousness as the one in Natividad’s case.
It is worthy to note that Dr. Ampil and Dr. Fuentes operated
on Natividad with the assistance of the
x x x In recent
years, however, the duty of care owed to the patient by the hospital has
expanded. The emerging trend is to hold
the hospital responsible where the hospital has failed to monitor and review
medical services being provided within its walls.
Among the cases indicative of the
‘emerging trend’ is Purcell v. Zimbelman,
18
Subsequent to the Purcell decision,
the
x x x x x
x
In the amended complaint, the
plaintiffs did plead that the operation was performed at the hospital with its
knowledge, aid, and assistance, and that the negligence of the defendants was
the proximate cause of the patient’s injuries. We find that such general
allegations of negligence, along with the evidence produced at the trial of
this case, are sufficient to support the hospital’s liability based on the
theory of negligent supervision.”
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.
One
final word. 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.
WHEREFORE, we DENY all the petitions and AFFIRM
the challenged Decision of the Court of Appeals in CA-G.R. CV No. 42062 and
CA-G.R. SP No. 32198.
Costs
against petitioners PSI and Dr. Miguel Ampil.
SO ORDERED.
ANGELINA
SANDOVAL-GUTIERREZ
Associate Justice
WE
CONCUR:
Chief Justice
Chairperson
|
RENATO C. CORONA Associate Justice |
ADOLFO S. AZCUNA Associate Justice |
|
(No Part) CANCIO C. GARCIA Associate Justice |
|
Chief Justice
* No part. Ponente of the assailed Decision in the Court of Appeals.
[1] Beeck v. Tucson
General Hospital, 500 P. 2d 1153 (1972), citing Darling v. Charleston Community Memorial Hospital, 33
[2] Penned by Associate Justice Cancio C. Garcia (now a member of the Supreme Court) and concurred in by Associate Justices Eugenio S. Labitoria and Artemio G. Tuquero (both retired), Rollo, G.R. Nos. 126297, pp. 36-51; 126467, pp. 27-42; 127590, pp. 23-38.
[3] Penned by Judge Lucas P. Bersamin (now Justice of the Court of Appeals), Rollo, G.R. No. 126647, pp. 69-83.
[4] The medical staff was composed of physicians, both residents and interns, as well as nurses.
[5] The dispositive portion reads:
“WHEREFORE, let a writ of preliminary injunction be issued upon
petitioner’s posting of bond in the amount of P20,000.00, ENJOINING
public respondents from implementing the questioned order dated September 21,
1993 and from further taking any action in Civil Case No. Q-43322 entitled ‘Natividad
G. Agana, et al., plaintiffs, versus Professional
Services, Inc., et al., defendants’ pending resolution of the instant
petition.
SO ORDERED.” See Rollo, G.R. No. 126297, p. 42.
[6] Rollo of G.R. No. 126467, pp. 84-89.
[7] Rollo of G.R. No. 127590, p. 40.
[8] Rule
v. Cheeseman, 317 P. 2d 472 (1957), citing Russel v. Newman, 116
[9] Smith
v. Zeagler, 157 So. 328
[10] 157
So. 328
[11] Garcia-Rueda
v. Pascasio, G.R. No. 118141,
[12]
In the
leading case of Vda. de Bataclan v. Medina, (102 Phil. 181 [1957]), this
Court laid down the following definition
of proximate cause in this jurisdiction as follows:
[T]hat cause, which, in natural and continuous sequence unbroken by any efficient intervening cause, produces the injury and without which the result would not have occurred. And more comprehensively, the proximate cause is that acting first and producing the injury, either immediately or by setting other events in motion, all constituting a natural and continuous chain of events, each having a close causal connection with the immediate predecessor, the final event in the chain immediately effecting the injury as a natural and probable result of the cause which first acted, under which circumstances that the person responsible for the first event should, as an ordinarily prudent and intelligent person, have reasonable ground to expect at the moment of his act or default that an injury to some person might probably result therefrom.
[13] Ramos v. Court of Appeals, G.R. No.
124354,
[14]
[15] Ranos v. Court of Appeals, supra. In Ramos, the phrase used is “control of the instrumentality which caused the damage,” citing St. John’s Hospital and School of Nursing v. Chapman, 434 P2d 160 (1967).
[16] Rural Educational Assn v. Bush, 42
[17] Ramos v. Court of Appeals, supra at
footnote 13.
[18] Levin, Hospital
Vicarious Liability for Negligence by Independent Contractor Physicians: A New
Rule for New Times,
[19]
[20]
[21] Tolentino, The Civil Code of the
[22] Arkansas M.R. Co. v. Pearson, 98
Ark. 442, 153 SW 595 (1911); Runyan v. Goodrum, 147
[23] Arkansas M.R. Co. v. Pearson, id.; Nieto v. State, 952 P. 2d
834 (1997). But see Beeck v. Tucson
General Hosp., 18
[24] Fridena v. Evans, 127
[25] Kitto v. Gilbert, 39 Colo App 374, 570 P. 2d 544 (1977).
[26] 211 N.Y. 125, 105 N.E. 92, 52 L.R.A., N.S.,
505 (1914). The court in Schloendorff opined that a hospital does not
act through physicians but merely procures them to act on their own initiative
and responsibility. For subsequent
application of the doctrine, see for instance, Hendrickson v. Hodkin,
250 App. Div 649, 294 NYS 982, revd on other grounds, 276 NY 252, 11 NE 2d 899
(1937); Necolayff v. Genesee Hosp., 270 App. Div. 648, 61 NYS 2d 832,
affd 296 NY 936, 73 NE2d 117 (1946); Davie v. Lenox Hill Hosp., Inc., 81
NYS 2d 583 (1948); Roth v. Beth El Hosp., Inc., 279 App. Div 917, 110
NYS 2d 583 (1952); Rufino v. US, 126 F. Supp. 132 (1954); Mrachek v.
Sunshine Biscuit, Inc., 308 NY 116, 123 N.E. 2d 801 (1954).
[27] 2 NY 2d 656, 163 NYS 2d 3, 143 N.E. 2d 3 (1957).
[28] Supra at footnote 13.
[29] Black’s
Law Dictionary (6th Ed. 1990) 1100. The terms “ostensible agency,” “agency by
estoppel,” “apparent authority,” and “holding out” tend to be used
interchangeably by the courts to refer to this theory of liability. See for instance, Baker v. Werner,
654 P2d 263 (1982) and Adamski v. Tacoma Gen. Hosp., 20
[30]
[31] Id.,
citing Hudson v. C., Loan Assn., Inc. v.
Horowytz, 116 N.J.L. 605, 608, 186 A 437 (Sup.
[32] Supra.
[33] RTC Decision, p. 9, Rollo of G.R. No. 126467, p. 127.
[34] RTC Decision, p. 2, Rollo of G.R. No. 126467, p. 120.
[35] Purcell v. Zimbelman, 18
[36] Supra at footnote 1.
[37] Corleto v. Hospital,
138 N.J. Super. 302, 350 A. 2d 534 (Super. Ct. Law Div.1975); Purcell v. Zimbelman, 18
[38] Welsh v. Bulger, 548
[39] 115
[40] 262 S.E. 2d 391, cert denied 300 NC 194, 269 S.E. 2d 621 (1980).
[41] 127