Professional Services Inc.

(PSI) vs Natividad and Enrique Agana

SUBJECT MATTER: Court held hospital liable with doctor on the principle of res ipsa loquitur.
NOTE that in the denial of the 2nd motion for reconsideration, hospital was still liable, but
because of ostensible agency.
Facts: On April 4, 1984, Natividad Agana was rushed to the Medical City General 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. 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 on 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 after searching for the missing 2 gauzes as
indicated by the assisting nurses but failed to locate it. After a couple of days, Natividad
complained of excruciating pains in her anal region but Dr. Ampil said it is a natural consequence
of the operation/surgery and recommended that she consult an oncologist to examine the cancerous
nodes which were not removed during the operation. Natividad and her husband went to the US to
seek further treatment and she was declared free from cancer. A piece of gauze portruding from
Natividads vagina was found by her daughter which was then removed by hand by Dr. Ampil and
assured that the pains will vanished. However, it didnt. The pains intensified prompting Natividad
to seek treatment at the Polymedic General Hospital. While confined there, Dr. Ramon Guttierez
detected the presence of another foreign object in her vagina a foul smelling gauze measuring
1.5 inches in width which badly infected her vagina. A recto-vaginal fistula had forced stool to
excrete through her vagina. Another surgical operation was needed to remedy the damage.

Issue: Whether or not Dr. Ampil and Fuentes are liable for medical malpractice and the PSI for
damages due to the negligence of the said doctors.

Held: Yes. No. 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
inference of negligence. There are even legions of authorities to the effect that such act is
negligence per se.
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 puts 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 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 2 pieces of gauze
were still missing. 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 this missing gauzes from the knowledge of Natividad and her family.
The requisites for the applicability of the doctrine of res ipsa liquitor are:
1. 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, the most instrumental is the Control and management of the thing which caused
the injury.
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.
The knowledge of any of the staff of Medical City constitutes knowledge of PSI.
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. The hospital accordingly has the duty to make a reasonable
effort to monitor and oversee the treatment prescribed and administered by the physician
practicing in its premises.

NOTE: See the 2nd case (2nd MR) for the modified final decision