Group 2

Rogacion, Raymond R.
Sayson, Nikki U.
Siocco, Princess
Pimentel, Mark Anthony V.
Macabeo, Kate Emlac

Hospital Liability
In determining Hospital liability, it is important that to know first the primary duties of a
hospital.

Primary Duties of a Hospital

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.
(PSI vs. NATIVIDAD and ENRIQUE AGANA G.R. No. 126297)
Failure to perform the above duties can be a sufficient ground in holding a hospital liable
based similar to cases of ordinary corporations.

Hospital liability vs. Medical Negligence and Malpractice

Hospital Liability in the Philippines

Hospital Liability in the Philippines is based on quasi-delict and vicarious liability

under Articles 2176 and 2180

Over the years, at least 8 different bills with different authors have been filed in
the senate and Lower House seeking to legislate and criminally penalize medical
malpractice, but not one of the bills has become law.

Nevertheless there have been Various Civil groups whose main advocacy is to
pressure Congress to legislate medical malpractice laws.

Before, only physicians and those directly involved in the Medical Profession
were made liable for negligent acts or omissions causing injury to patients.

It was only when the case of Ramos vs. CA, decided in 1999 when a hospital
was impleaded as defendant in a medical negligence case.

Not all hospitals may be sued, in the Philippines, hospitals may be run either by
the government or by private individuals or corporations.

Government Hospitals are immune from suit. The basis of immunity is the
recognition that government charity hospitals are performing a governmental
function. Because of this function, said hospitals would fall within the rule that the
state cannot be sued without its consent.

Similar with Medical Malpractice and Medical Negligence, there are no specific laws or
special laws that clearly provides for the liabilities of a Hospital in cases where there is
Negligence or Malpractice in the performance of the medical profession of their
physicians.

Applicable Doctrines in Hospital Liability

The issue of whether a Hospital can be held liable may be determined by

applying the following doctrines:
1. Doctrine of Corporate Negligence
2. Doctrine of Apparent Authority
3. Doctrine of Vicarious Liability

Doctrine of Corporate Negligence

The Doctrine of Corporate Negligence is the legal doctrine that holds health-care
facilities, such as hospitals, responsible for the well-being of patients.

Corporate Liabilities are those arising from the failure of the hospitals as
corporations to provide necessary accommodation and facilities or observe the
standard of conduct to which corporation should conform.
Examples:

Failure to furnish safe and well-maintained buildings and facilities.

Failure to provide safe and reliable equipments.

Failure to make careful selection, review and supervision of independent

physicians who are permitted to practice in the hospital

If the hospital fails to maintain a clean and safe environment, hire competent and
properly trained employees, oversee care and implement safety policies, it can
be held liable for any harm to patients.

Under the Doctrine of Corporate Liability, the Hospital can be found liable even if
the surgeon was an independent contractor.

Corporate Negligence provides for a form of direct liability that subjects a hospital
to civil liability for its own failures to adopt appropriate policies and procedures to
protect patients.

Doctrine of Vicarious Liability

Vicarious liability, under the Civil Code, is anchored on Articles 2180 in relation to
Article 2176.
Article 2176 of the Civil Code
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.
Article 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.
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. (1903a)

Based on respondeat superior or let the master answer

However, Article 2180 requires as sine qua non the existence of an employeremployee relationship, they rely on proving the existence of an apparent agency.

3 distinct legal relationships that are established when a patient goes to a

hospital:
1. Between the doctor and the patient
2. Between the hospital and the patient; and
3. Between the doctor and the hospital

In Philippine jurisprudence employer-employee relationship is established based

on the primary test of hiring, firing, payment of wages, and control.
It has been consistently held that in determining whether an employer-employee
relationship exists between the parties, the following elements must be present:
1. Selection and engagement of services;
2. Payment of wages;
3. The power to hire and fire; and
4. The power to control not only the end to be achieved, but the means to be used
in reaching such an end.
(Ramos vs. CA)

General Rule: Hospitals are NOT liable for the negligence of an independent
contractor-physician
Exception: Doctrine of Apparent Authority
(Nogales vs. Capitol Medical Center)

Doctrine of Apparent Authority

A hospital can be held vicariously liable for the negligent acts of a physician providing
care at the hospital, regardless of whether the physician is an independent contractor,
unless the patient knows, or should have known, that the physician is an independent
contractor.(Nogales vs. Capitol Medical Center)

There are cases where a person may be deemed an agent of a principal based on the
latters act of clothing the former with apparent authority. Under these circumstances,
the principal cannot be permitted to deny the authority of such person to act as his or
her agent, to the prejudice of innocent third parties dealing with such person in good
faith and in the honest belief that he is what he appears to be.

There are cases where a person may be deemed an agent of a principal based on the
latters act of clothing the former with apparent authority. Under these circumstances,
the principal cannot be permitted to deny the authority of such person to act as his or
her agent, to the prejudice of innocent third parties dealing with such person in good
faith and in the honest belief that he is what he appears to be.

Illustrative Cases

PSI vs. CA

Nogales vs. CMC

Facts:
Rogelio and his wife specifically chose Dr. Estrada to handle Corazons delivery not only
because of their friends recommendation, but more importantly because of Dr.
Estradas connection with the reputable hospital (CMC).
Dr. Estrada is granted by the CMC staff privileges and extended medical staff and
facilities.
Rogelio signed consent forms printed on CMC letterhead. The letters did not mention
that Dr. Estrada was an independent contractor-physician.
During the operation, Dr. Estrada was assisted by doctors of CMC. The baby came out
in an apnic, cyanotic, weak and injured condition and had to be incubated and
resuscitated by Drs. Enriquez and Payumo.
Corazons blood pressure dropped, she had continuous vaginal bleeding, was
administered hemacel and undergone immediate hysterectomy. Eventually, she died at
9:15 a.m. with hemorrhage, post partum.
Hence, a complaint for damages was filed.

Issue:
Whether or not CMC is vicariously liable for the negligence of Dr. Estrada under Art.
2180 in relation to Art. 2176 of the Civil Code.

Held:
Dr. Estrada is an independent contractor. Applying the control test, there is no evidence
to CMCs exercise of control over Dr. Estradas treatment and management of
Corazons condition. The patient was under the exclusive prenatal care of Dr. Estrada.
CMC merely allowed Dr. Estrada to use its facilities when Corazon was about to give
birth, which CMC considered an emergency.
Dr. Estrada is an independent contractor. Applying the control test, there is no evidence
to CMCs exercise of control over Dr. Estradas treatment and management of
Corazons condition. The patient was under the exclusive prenatal care of Dr. Estrada.
CMC merely allowed Dr. Estrada to use its facilities when Corazon was about to give
birth, which CMC considered an emergency.
But, even if Dr. Estrada is not an employee of CMC, still CMC is vicariously liable under
the doctrine of apparent authority.
The doctrine of apparent authority is an exception to the general rule that a hospital is
not liable for the negligence of an independent contractor-physician.
The hospital acted in a manner that would lead a reasonable person to conclude that
the individual who was alleged to be negligent was an employee or agent of the
hospital.
The act of CMC giving Dr. Estrada staff privileges and extended medical staff and
facilities is enough reason for the spouses to believe that CMC had authority over Dr.
Estrada.

Ramos vs. CA
Facts:
Erlinda Ramos, a 47-year old robust woman, was normal except for her experiencing
occasional pain due to the presence of stone in her gall bladder. She was advised to
undergo an operation for its removal.
The results in the examinations she underwent indicate that she was fit for the
operation. She and her husband Rogelio met Dr. Hosaka, one of the defendants, who
advised that she should undergo cholecystectomy. Dr. Hosaka assured them that he will
get a good anaesthesiologist.
At 7:30 a.m. on the day of the operation at Delos Santos Medical Center, Herminda
Cruz, Erlindas sister-in-law and the dean of the College of Nursing in Capitol Medical
Center, was there to provide moral support. Dr. Perfecta Gutierrez was to administer the
anaesthesia.
Dr. Hosaka arrived only at 12:15 p. m. Herminda saw Dr. Gutierrez intubating the
patient, and heard the latter say Anghirap ma-intubate nito, maliyataangpagkakapasok.
O, lumalakiangtiyan. Herminda saw bluish discoloration of the nailbeds of the patient..
She heard Dr. Hosaka issue an order for someone to call Dr. Calderon. The doctor
arrived and 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 was taken to the ICU and became
comatose.Rogelio filed a civil case for damages

Issue:
Whether or not the Hospital is liable

Held:
Hospitals hire, fire and exercise real control over their attending and visiting "consultant"
staff. While "consultants" are not, technically employees, a point which respondent
hospital asserts in denying all responsibility for the patient's condition, 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.

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 latter. 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 under the last paragraph of Article 2180.

Having failed to do this, respondent hospital is consequently solidarily responsible with

its physicians for Erlinda's condition.

References:

PDF
Ateneo Law Journal

Cases
PSI vs. NATIVIDAD and ENRIQUE AGANA
Nogales vs. Capitol Medical Center
Ramos vs. CMC