Professional Services Inc. (PSI) v.

Natividad and Eneique Agana

G.R. No. 126297
January 31, 2007

SANDOVAL-GUTIERREZ, J.:

STATEMENT OF FACTS:
Natividad Agana (Natividad) was rushed to Medical City General Hospitay (MCGH) because
of difficulty in bowel movement and bloody discharge. After a series of examinations, Dr. Miguel
Ampil (Ampil) diagnosed her to be suffering from cancer of the sigmoid. Natividad underwent
surgery under Dr. Ampil. Dr. Juan Fuentes (Fuentes) was then tasked to perform hysterectomy on
her, with consent obtained from her husband. Due to her left ovary was affected and thus some
portions of it was removed. It was found out after the operation that 2 sponges were missing. No
one informed Natividad of such fact.
Natividad was released from the hospital, but after a couple of days experienced
excruciating pain, thus they consulted with Dr. Ampil who said that it was normal after receiving the
surgery, and further suggested that they see an oncologist to examine the remaining cancerous
nodes that were not removed from the surgery.
They went to the US to seek futher treatment, and after 4 months she was told she was free
of cancer, and thus returned to the Philippines. Upon return she still felt pain. Her daughter then
found a piece of gauze sticking out from her vagina. They informed Dr. Ampil, who immediately
proceeded to her house and extracted the gauze, and reassured that the pains would stop. However,
the pain did not cease and further intensified. It was found later on that there was another gauze
found in her vagina which infected the same and necessitated surgery to heal the damage.

STATEMENT OF THE CASE:

Spouses Agana filed with the RTC of Quezon city a complaint for damages against PSI (owner
of MCGH), Dr. Ampil, and Dr. Fuentes. At the same time, they also filed an administrative complaint
before the Professional Regulation Commission (PRC) against said doctors.
The RTC ruled in favor of the Aganas which maid PSI and the doctors to be jointly and
severally liable for damages. During which, the PRC board of Medicine rendered its decision
dismissing the case Against Dr. Fuentes, as 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 the fact from
Natividad.
Dr. Ampil and PSI filed an appeal before the CA, but was denied. The CA dismissed the case
against Dr. Fuentes, and held Dr. Ampil and PSI liable. Dr. Ampil filed an MR but was denied, hence
this petition

ISSUE:

1.) Whether Dr. Ampil is liable for medical malpractice and negligence
2.) Whether it was proper for the court to dismiss the case of Dr. Fuentes
3.) Whether Psi is liable for damages due to the negligence of said doctors
RULING:
1.) YES. 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. Dr. Ampils contention that it might be Dr. Fuente are merely conjectures for he
has not provided with any evidence to support his claim.
To prove that there is medical malpractice or medical negligence it is tasked upon the patient to
prove the following: duty, breach, injury and proximate causation. 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. 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

2.) YES, Res Ipsa Loquitur will not lie because the absence of control and management of
the thing which caused the injury to be wanting. The following are the requisites of the doctrine.
(a) The occurrence of an injury;
(b) The thing which caused the injury was under the control and management of the
defendant;
(c) 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
(d) The absence of explanation by the defendant

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. 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.

3.) YES, under the following reasons

a) Ramos v. CA doctrine on E-E relationship
-For purposes of apportioning responsibility in medical negligence cases,
an employer-employee relationship in effect exists between hospitals and their
attending and visiting physicians.
b) Agency principle of apparent authority / agency by estoppel

- Imposes liability because of the actions of a principal or employer in

somehow misleading the public into believing that the relationship or
the authority exists [see NCC 1869]
- PSI publicly displays in the Medical City lobby the names and
specializations of their physicians. Hence, PSI is now estopped from
passing all the blame to the physicians whose names it proudly paraded
in the public directory, leading the public to believe that it vouched for
their skill and competence.
- If doctors do well, hospital profits financially, so when negligence mars
the quality of its services, the hospital should not be allowed to escape
liability for its agents acts.

c) Doctrine of corporate negligence / corporate responsibility

- This is 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.
- This provides for the duties expected [from hospitals]. In this case, PSI
failed to perform the duty of exercising reasonable care to protect from
harm all patients admitted into its facility for medical treatment. PSI
failed to conduct an investigation of the matter reported in the note
of the count nurse, and this established PSIs part in the dark
conspiracy of silence and concealment about the gauzes.
- PSI has actual / constructive knowledge of the matter, through the
report of the attending nurses + the fact that the operation was carried
on with the assistance of various hospital staff
- It also breached its duties to oversee or supervise all persons who
practice medicine within its walls and take an active step in fixing the
negligence committed