Professional Services, Inc. v.

Natividad and Enrique Agana

Facts:

Natividad Agana was rushed to the Medical City General Hospital (Medical
City Hospital) because of difficulty of bowel movement and bloody anal
discharge. After a series of medical examinations, Dr. Miguel Ampil diagnosed
her to be suffering from "cancer of the sigmoid."
Dr. Ampil, assisted by medical staff, 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 Natividads husband, Enrique Agana, to permit
Dr. Juan Fuentes to perform hysterectomy on her.
However, the operation appeared to be flawed, with the attending nurses
including in the Record of Operation that 2 sponges were missing, but closure
was nonetheless ordered.
Natividad was released from the hospital. Her hospital and medical bills,
including the doctors fees, amounted to P60,000.00. After a couple of days,
Natividad complained of excruciating pain in her anal region.
Natividad, accompanied by her husband, went to the United States to seek
further treatment. 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.
Natividad flew back to the Philippines, 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.
He then assured her that the pains would soon vanish.
Dr. Ampils assurance did not come true. Instead, the pains intensified,
prompting Natividad to seek treatment at the Polymedic General Hospital. A
foul-smelling gauze was detected, measuring 1.5 inches in width which badly
infected her vaginal vault. A rectovaginal fistula had formed in her
reproductive organs which forced stool to excrete through the vagina.
Another surgical operation was needed to remedy the damage. Thus, in
October 1984, Natividad underwent another surgery.
Natividad and her husband filed with the RTC, Branch 96, Quezon
City a complaint for damages against the Professional Services, Inc.
(PSI), owner of the Medical City Hospital, Dr. Ampil, and Dr. Fuentes
for negligence in leaving 2 pieces of gauze inside Natividads body,
and malpractice for concealing their acts of negligence.
Enrique Agana also filed with the Professional Regulation
Commission (PRC) an administrative complaint for gross negligence
and malpractice against Dr. Ampil and Dr. Fuentes.
The RTC found PSI, Dr. Ampil and Dr. Fuentes guilty.
Pending appeal before the CA, a motion for partial execution of the RTC
decision was granted.
The PRC Board of Medicine held that the prosecution failed to show that Dr.
Fuentes was the one who left the 2 pieces of gauze inside Natividads body;
and that he concealed such fact from Natividad.

Issue:

Is Dr. Ampil liable for negligence and malpractice?

Is Dr. Fuentes liable for negligence and malpractice?
Is PSI liable for the negligence of Dr. Ampil?

Ruling:
AS TO DR. AMPIL

YES, Dr. Ampil is liable for negligence and malpractice.

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.
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. 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.
Even if it has been shown that a surgeon was required by the urgent
necessities of the case to leave a sponge in his patients 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.
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.
Simply put, the elements are duty, breach, injury and proximate causation.
o Dr, Ampil, as the lead surgeon, had the duty to remove all foreign
objects, such as gauzes, from Natividads 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.
o Such breach caused injury to Natividad, necessitating her further
examination by American doctors and another surgery. That Dr. Ampils
negligence is the proximate cause of Natividads 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.
o That they were later on extracted from Natividads vagina established
the causal link between Dr. Ampils 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.

AS TO DR. FUENTES
NO, Dr. Fuentes is not liable for negligence & malpractice
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 Natividads
body.
Clearly, the control and management of the thing which caused the injury
was in the hands of Dr. Ampil, not Dr. Fuentes.
AS TO PSI
YES, PSI is liable for the negligence of Dr. Ampil.
It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with
the assistance of the Medical City Hospitals 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.
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 patients injuries.
The Court found that such general allegations of negligence, along with the
evidence produced at the trial of this case, are sufficient to support the
hospitals liability based on the theory of negligent supervision.