Professional Services vs.

Agana
G.R. No. 126297. January 31, 2007
FACTS:
On April 4, 1984, 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, petitioner in G.R. No. 127590,
diagnosed her to be suffering from "cancer of the sigmoid." On April
11, 1984, Dr. Ampil, assisted by the medical staff of the Medical City
Hospital, 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. 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 April 11, 1984, the attending nurses entered these
remarks: "sponge count lacking 2, announced to surgeon searched
(sic) done but to no avail continue for closure."
On April 24, 1984, 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. 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 May 9, 1984, 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. On August 31, 1984, 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. While confined there, Dr. Ramon Gutierrez detected
the presence of another foreign object 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 surgical
operation was needed to remedy the damage. Thus, in October 1984,
Natividad underwent another surgery.
ISSUE:
Whether Dr. Ampil liable for negligence and malpractice and the
Professional Services, Inc., may be held solidarily liable for Dr. Ampils
negligence?
HELD:

YES, petition is DENIED.

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. 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.
Clearly, the control and management of the thing which caused the
injury was in the hands of Dr. Ampil, not Dr. Fuentes. Hence, the
negligence was proven to have been committed by Dr. Ampil and not
by Dr. Fuentes.
Recent years have seen the doctrine of corporate negligence as the
judicial answer to the problem of allocating hospitals 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 judiciarys 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.
In the present case, it was duly established that PSI operates the
Medical City Hospital for the purpose and under the concept of
providing comprehensive medical services to the public. Accordingly,
it has the duty to exercise reasonable care to protect from harm all
patients admitted into its facility for medical treatment. Unfortunately,
PSI failed to perform such duty. The findings of the trial court are
convincing, thus: PSIs 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 PSIs 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
PSIs 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 Natividads
case.
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.

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.