Batiquin v.

Court of Appeals
Davide, Jr. G.R. No. 118231July 5, 1996| 258 SCRA 334
FACTS
On Sept 1988, Petitioner Dr. Batiquin performed a simple caesarean
section on Respondent Mrs. Villegas when the latter gave birth. Soon
after leaving the hospital, respondent began to suffer abdominal pains
and complained of being feverish. The abdominal pains and fever
kept on recurring and this prompted respondent to consult with
another doctor, Dr. Kho (not Hayden). When Dr. Kho opened the
abdomen of respondent to check her out respondents infection, she
discovered that a piece of rubber material, which looked like a piece of
rubber glove and was deemed a foreign body, was the cause of the
respondents infection. Respondent then sued petitioner for
damages. RTC held in favor of petitioner. CA reversed, ruling for the
respondent.
ISSUES & ARGUMENTS
W/N petitioner is liable to respondent
HOLDING & RATIO DECIDENDI
YES,
UNDER THE RULE OF RES IPSA LOQUITUR, DR. BATIQUIN IS
LIABLE.
Res ipsa loquitur. The thing speaks for itself. Rebuttable presumption
or inference that defendant was negligent, which arises upon proof
that the instrumentality causing injury was in defendant's exclusive
control, and that the accident was one which ordinary does not happen
in absence of negligence. Res ipsa loquitur is a rule of evidence
whereby negligence of the alleged wrongdoer may be inferred from the
mere fact that the accident happened provided the character of the
accident and circumstances attending it lead reasonably to belief that
in the absence of negligence it would not have occurred and that thing
which caused injury is shown to have been under the management and
control of the alleged wrongdoer. Under this doctrine the happening of
an injury permits an inference of negligence where plaintiff produces
substantial evidence that the injury was caused by an agency or
instrumentality under the exclusive control and management of
defendant, and that the occurrence was such that in the ordinary
course of things would not happen if reasonable care had been used.
The doctrine of res ipsa loquitur as a rule of evidence is peculiar to the
law of negligence which recognizes that prima facie negligence may be
established without direct proof and furnishes a substitute for specific
proof of negligence. The doctrine is not a rule of substantive law, but
merely a mode of proof or a mere procedural convenience. The rule,

when applicable to the facts and circumstances of a particular case, is

not intended to and does not dispense with the requirement of proof of
culpable negligence on the party charged. It merely determines and
regulates what shall be prima facie evidence thereof and facilitates the
burden of plaintiff of proving a breach of the duty of due care. The
doctrine can be invoked when and only when, under the circumstances
involved, direct evidence is absent and not readily available. In the
instant case, all the requisites for recourse to the doctrine are present.
First, the entire proceedings of the caesarean section were under the
exclusive control of Dr. Batiquin. In this light, the private respondents
were bereft of direct evidence as to the actual culprit or the exact
cause of the foreign object finding its way into private respondent
Villegas's body, which, needless to say, does not occur unless through
the intersection of negligence. Second, since aside from the caesarean
section, private respondent Villegas underwent no other operation
which could have caused the offending piece of rubber to appear in her
uterus, it stands to reason that such could only have been a by-product
of the caesarean section performed by Dr. Batiquin. The petitioners, in
this regard, failed to overcome the presumption of negligence arising
from resort to the doctrine of res ipsa loquitur. Dr. Batiquin is therefore
liable for negligently leaving behind a piece of rubber in private
respondent Villegas's abdomen and for all the adverse effects thereof.

G.R. No. 118141 September 5, 1997

LEONILA GARCIA-RUEDA, petitioner,
vs.
WILFRED L. PASCASIO, RAUL R. ARNAU, ABELARDO L. APORTADERA JR., Honorable
CONRADO M. VASQUEZ, all of the Office of the Ombudsman; JESUS F. GUERRERO,
PORFIRIO MACARAEG, and GREGORIO A. ARIZALA, all of the Office of the City
Prosecutor, Manila, respondents.
May this Court review the findings of the Office of the Ombudsman? The general
rule has been enunciated in Ocampo v. Ombudsman 1 which states:
In the exercise of its investigative power, this Court has consistently
held that courts will not interfere with the discretion of the fiscal or
the Ombudsman to determine the specificity and adequacy of the
averments of the offense charged. He may dismiss the complaint
forthwith if he finds it to be insufficient in form and substance or if
he otherwise finds no ground to continue with the inquiry; or he
may proceed with the investigation of the complaint if, in his view,
it is in due and proper form.
Does the instant case warrant a departure from the foregoing general rule? When
a patient dies soon after surgery under circumstances which indicate that the
attending surgeon and anaesthesiologist may have been guilty of negligence but
upon their being charged, a series of nine prosecutors toss the responsibility of
conducting a preliminary investigation to each other with contradictory
recommendations, "ping-pong" style, perhaps the distraught widow is not to be
blamed if she finally decides to accuse the City Prosecutors at the end of the line
for partiality under the Anti-Graft and Corrupt Practices Act. Nor may she be
entirely faulted for finally filing a petition before this Court against the
Ombudsman for grave abuse of discretion in dismissing her complaint against
said City Prosecutors on the ground of lack of evidence. Much as we sympathize
with the bereaved widow, however, this Court is of the opinion that the general
rule still finds application in instant case. In other words, the respondent
Ombudsman did not commit grave abuse of discretion in deciding against filing
the necessary information against public respondents of the Office of the City
Prosecutor.
The following facts are borne out by the records.
Florencio V. Rueda, husband of petitioner Leonila Garcia-Rueda, underwent
surgical operation at the UST hospital for the removal of a stone blocking his
ureter. He was attended by Dr. Domingo Antonio, Jr. who was the surgeon, while
Dr. Erlinda Balatbat-Reyes was the anaesthesiologist. Six hours after the surgery,
however, Florencio died of complications of "unknown cause," according to
officials of the UST Hospital. 2

Not satisfied with the findings of the hospital, petitioner requested the National
Bureau of Investigation (NBI) to conduct an autopsy on her husband's body.
Consequently, the NBI ruled that Florencio's death was due to lack of care by the
attending physician in administering anaesthesia. Pursuant to its findings, the
NBI recommended that Dr. Domingo Antonio and Dr. Erlinda Balatbat-Reyes be
charged for Homicide through Reckless Imprudence before the Office of the City
Prosecutor.
During the preliminary investigation, what transpired was a confounding series of
events which we shall try to disentangle. The case was initially assigned to
Prosecutor Antonio M. Israel, who had to inhibit himself because he was related
to the counsel of one of the doctors. As a result, the case was re-raffled to
Prosecutor Norberto G. Leono who was, however, disqualified on motion of the
petitioner since he disregarded prevailing laws and jurisprudence regarding
preliminary investigation. The case was then referred to Prosecutor Ramon O.
Carisma, who issued a resolution recommending that only Dr. Reyes be held
criminally liable and that the complaint against Dr. Antonio be dismissed.
The case took another perplexing turn when Assistant City Prosecutor Josefina
Santos Sioson, in the "interest of justice and peace of mind of the parties,"
recommended that the case be re-raffled on the ground that Prosecutor Carisma
was partial to the petitioner. Thus, the case was transferred to Prosecutor Leoncia
R. Dimagiba, where a volte face occurred again with the endorsement that the
complaint against Dr. Reyes be dismissed and instead, a corresponding
information be filed against Dr. Antonio. Petitioner filed a motion for
reconsideration, questioning the findings of Prosecutor Dimagiba.
Pending the resolution of petitioner's motion for reconsideration regarding
Prosecutor Dimagiba's resolution, the investigative "pingpong" continued when
the case was again assigned to another prosecutor, Eudoxia T. Gualberto, who
recommended that Dr. Reyes be included in the criminal information of Homicide
through Reckless Imprudence. While the recommendation of Prosecutor
Gualberto was pending, the case was transferred to Senior State Prosecutor
Gregorio A. Arizala, who resolved to exonerate Dr. Reyes from any wrongdoing, a
resolution which was approved by both City Prosecutor Porfirio G. Macaraeg and
City Prosecutor Jesus F. Guerrero.
Aggrieved, petitioner filed graft charges specifically for violation of Section 3(e)
of Republic Act No. 3019 3 against Prosecutors Guerrero, Macaraeg, and Arizala for
manifest partiality in favor of Dr. Reyes before the Office of the Ombudsman.
However, on July 11, 1994, the Ombudsman issued the assailed resolution dismissing
the complaint for lack of evidence.
In fine, petitioner assails the exercise of the discretionary power of the
Ombudsman to review the recommendations of the government prosecutors and
to approve and disapprove the same. Petitioner faults the Ombudsman for,
allegedly in grave abuse of discretion, refusing to find that there exists probable
cause to hold public respondent City Prosecutors liable for violation of Section
3(e) of R.A. No. 3019.
Preliminarily, the powers and functions of the Ombudsman have generally been
categorized into the following: investigatory powers, prosecutory power, public

assistance function, authority to inquire and obtain information, and function to

adopt, institute and implement preventive measures. 4
As protector of the people, the Office of the Ombudsman has the power, function
and duty "to act promptly on complaints filed in any form or manner against
public officials" and "to investigate any act or omission of any public official when
such act or omission appears to be illegal, unjust, improper or inefficient." 5
While the Ombudsman has the full discretion to determine whether or not a
criminal case should be filed, this Court is not precluded from reviewing the
Ombudsman's action when there is an abuse of discretion, in which case Rule 65
of the Rules of Court may exceptionally be invoked pursuant to Section I, Article
VIII of the 1987 Constitution. 6
In this regard, "grave abuse of discretion" has been defined as "where a power is
exercised in an arbitrary or despotic manner by reason of passion or personal
hostility so patent and gross as to amount to evasion of positive duty or virtual
refusal to perform a duty enjoined by, or in contemplation of law. 7
From a procedural standpoint, it is certainly odd why the successive transfers
from one prosecutor to another were not sufficiently explained in the Resolution
of the Ombudsman. Being the proper investigating authority with respect to
misfeasance, non-feasance and malfeasance of public officials, the Ombudsmans
should have been more vigilant and assiduous in determining the reasons behind
the "buckpassing" to ensure that no irregularity took place.
Whether such transfers were due to any outside pressure or ulterior motive is a
matter of evidence. One would have expected the Ombudsman, however, to
inquire into what could hardly qualify as "standard operating procedure," given
the surrounding circumstances of the case.
While it is true that a preliminary investigation is essentially inquisitorial, and is
often the only means to discover who may be charged with a crime, its function
is merely to determine the existence of probable cause. 8 Probable cause has been
defined as "the existence of such fact and circumstances as would excite the belief,
in a reasonable mind, acting on the facts within the knowledge of the prosecution,
that the person charged was guilty of the crime for which he was prosecuted." 9
"Probable cause is a reasonable ground of presumption that a matter is, or may
be, well founded, such a state of facts in the mind of the prosecutor as would
lead a person of ordinary caution and prudence to believe, or entertain an honest
or strong suspicion, that a thing is so." The term does not meanactual and
positive cause nor does it import absolute certainty. It is merely based on opinion
and reasonable belief. Thus, a finding of probable cause does not require an
inquiry into whether there is sufficient evidence to procure a conviction. It is
enough that it is believed that the act or omission complained of constitutes the
offense charged. Precisely, there is a trial for the reception of evidence of the
prosecution in support of the charge. 10
In the instant case, no less than the NBI pronounced after conducting an autopsy
that there was indeed negligence on the part of the attending physicians in

administering the anaesthesia. 11 The fact of want of competence or diligence is

evidentiary in nature, the veracity of which can best be passed upon after a fullblown trial for it is virtually impossible to ascertain the merits of a medical negligence
case without extensive investigation, research, evaluation and consultations with
medical experts. Clearly, the City Prosecutors are not in a competent position to pass
judgment on such a technical matter, especially when there are conflicting evidence
and findings. The bases of a party's accusation and defenses are better ventilated at
the trial proper than at the preliminary investigation.
A word on medical malpractice or negligence cases.
In its simplest terms, the type of lawsuit which has been called
medical malpractice or, more appropriately, medical negligence, is
that type of claim which a victim has available to him or her to
redress a wrong committed by a medical professional which has
caused bodily harm.
In order to successfully pursue such a claim, a patient must prove
that a health care provider, in most cases a physician, either failed
to do something which a reasonably prudent health care provider
would have done, or that he or she did something that a reasonably
prudent provider would not have done; and that that failure or
action caused injury to the patient. 12
Hence, there are four elements involved in medical negligence cases: duty,
breach, injury and proximate causation.
Evidently, when the victim employed the services of Dr. Antonio and Dr. Reyes, a
physician-patient relationship was created. In accepting the case, Dr. Antonio and
Dr. Reyes in effect represented that, having the needed training and skill
possessed by physicians and surgeons practicing in the same field, they will
employ such training, care and skill in the treatment of their patients. 13 They
have a duty to use at least the same level of care that any other reasonably
competent doctor would use to treat a condition under the same circumstances. The
breach of these professional duties of skill and care, or their improper performance,
by a physician surgeon whereby the patient is injured in body or in health, constitutes
actionable malpractice. 14Consequently, in the event that any injury results to the
patient from want of due care or skill during the operation, the surgeons may be held
answerable in damages for negligence. 15
Moreover, in malpractice or negligence cases involving the administration of
anaesthesia, the necessity of expert testimony and the availability of the charge
of res ipsa loquitur to the plaintiff; have been applied in actions against
anaesthesiologists to hold the defendant liable for the death or injury of a patient
under excessive or improper anaesthesia. 16 Essentially, it requires two-pronged
evidence: evidence as to the recognized standards of the medical community in the
particular kind of case, and a showing that the physician in question negligently
departed from this standard in his treatment. 17
Another element in medical negligence cases is causation which is divided into
two inquiries: whether the doctor's actions in fact caused the harm to the patient
and whether these were the proximate cause of the patient's

injury. 18 Indeed here, a causal connection is discernible from the occurrence of the
victim's death after the negligent act of the anaesthesiologist in administering the
anesthesia, a fact which, if confirmed, should warrant the filing of the appropriate
criminal case. To be sure, the allegation of negligence is not entirely baseless.
Moreover, the NBI deduced that the attending surgeons did not conduct the
necessary interview of the patient prior to the operation. It appears that the cause of
the death of the victim could have been averted had the proper drug been applied to
cope with the symptoms of malignant hyperthermia. Also, we cannot ignore the fact
that an antidote was readily available to counteract whatever deleterious effect the
anaesthesia might produce. 19 Why these precautionary measures were disregarded
must be sufficiently explained.
The City Prosecutors were charged with violating Section 3(e) of the Anti-Graft
and Corrupt Practices Act which requires the following facts:
1. The accused is a public officer discharging administrative or
official functions or private persons charged in conspiracy with
them;
2. The public officer committed the prohibited act during the
performance of his official duty or in relation to his public position;
3. The public officer acted with manifest partiality, evident bad faith
or gross, inexcusable negligence; and
4. His action caused undue injury to the Government or any private
party, or gave any party any unwarranted benefit, advantage or
preference to such parties. 20
Why did the complainant, petitioner in instant case, elect to charge respondents
under the above law?
While a party who feels himself aggrieved is at liberty to choose the appropriate
"weapon from the armory," it is with no little surprise that this Court views the
choice made by the complainant widow.
To our mind, the better and more logical remedy under the circumstances would
have been to appeal the resolution of the City Prosecutors dismissing the criminal
complaint to the Secretary of Justice under the Department of Justice's Order No.
223, 21 otherwise known as the "1993 Revised Rules on Appeals From Resolutions In
Preliminary Investigations/Reinvestigations," as amended by Department Order No.
359, Section 1 of which provides:
Sec. 1. What May Be Appealed. Only resolutions of the Chief
State Prosecutor/Regional State Prosecutor/Provincial or City
Prosecutor dismissing a criminal complaint may be the subject of an
appeal to the Secretary of Justice except as otherwise provided in
Section 4 hereof.
What action may the Secretary of Justice take on the appeal? Section 9 of Order
No. 223 states: "The Secretary of Justice may reverse, affirm or modify the

appealed resolution." On the other hand, "He may motu proprio or on motion of
the appellee, dismiss outright the appeal on specified grounds." 22
In exercising his discretion under the circumstances, the Ombudsman acted
within his power and authority in dismissing the complaint against the
Prosecutors and this Court will not interfere with the same.
WHEREFORE, in view of the foregoing, the instant petition is DISMISSED, without
prejudice to the filing of an appeal by the petitioner with the Secretary of Justice
assailing the dismissal of her criminal complaint by the respondent City
Prosecutors. No costs.

Dr. Rubi Li, Petitioner, vs. Spouses Reynaldo and Lina Soliman, as
parents/heirs of deceased Angelica Soliman, Respondents.
G.R. No. 165279
June 7, 2011
Legal Issue: How is medical malpractice proven?
Legal Facts:
Respondents 11-year old daughter, Angelica Soliman, underwent
a biopsy of the mass located in her lower extremity at the St. Lukes
Medical Center (SLMC) on July 7, 1993 and results showed that
Angelica was suffering from osteosarcoma, osteoblastic type, (highly
malignant) cancer of the bone because of that a necessity of
amputation was conducted by Dr, Tamayo on Angelicas right leg in
order to remove the tumor and to prevent the metastasis that
chemotherapy was suggested by Dr. Tamayo, which he referred to
petitioner Dr. Rubi Li, a medical oncologist. The respondent was
admitted to SLMC on August 18, 1993; however, she died eleven (11)
days after the (intravenous) administration of chemotherapy first cycle.
Respondents brought their daughters body to the Philippine National
Police (PNP) Crime Laboratory at Camp Crame for post-mortem
examination after the refusal of the hospital to release the death
certificate without full payment of bills. The Medico-Legal Report
showed that the cause of death as "Hypovolemic shock secondary to
multiple organ hemorrhages and Disseminated Intravascular
Coagulation. The respondents filed charges against the SLMC and
physicians involve for negligence and failure to observe the essential
precautions in to prevent Angelicas untimely death. Petitioner denied
the allegation for damages as she observed best known procedures,
highest skill and knowledge in the administration of chemotherapy
drugs despite all efforts the patient died. The trial court was in favor of

the petitioner and ordered to pay their unpaid hospital bill in the
amount of P139, 064.43, but the Court of Appeals reversed the
decision supporting the respondents pray.
Holding:
In this case medical malpractice is proven because the four
essential elements of such action are present based upon the doctrine
of informed consent.
Reasoning:
There are four essential elements a plaintiff must prove in a
malpractice action based upon the doctrine of informed consent: "(1)
the physician had a duty to disclose material risks; (2) he failed to
disclose or inadequately disclosed those risks; (3) as a direct and
proximate result of the failure to disclose, the patient consented to
treatment she otherwise would not have consented to; and (4) plaintiff
was injured by the proposed treatment." Informed consent case
requires the plaintiff to "point to significant undisclosed information
relating to the treatment that would alter her decision to undergo. The
physician is not expected to give the patient a short medical
education, the disclosure rule only requires of him a reasonable
general explanation in nontechnical terms.
Policy Formation:
In all sorts of medical procedures either invasive or not, medical
institution must have a certificate of competency in rendering
standards of care to delicate medical procedures before initiating a
general protocol that would establish a guideline principle in a form of
proper disclosure of such procedure and presenting a consent or
waiver to their patients so that possible future medico-legal suits will
be
prevented.
Synthesis:
In Dr. Rubi Li, vs. Spouses Reynaldo and Lina Soliman, as
parents/heirs of deceased Angelica Soliman, Respondents, G.R. No.
165279, promulgated on June 7, 2011, the Court ruled that medical
malpractice is proved base on lack/impaired informed consent, and
reasonable expert testimony subject a breach of duty causing gross
injury to its patient.

Solidum vs People of the Philippines

GR No. 192123 March 10, 2014
Facts: Gerald Albert Gercayo was born on June 2, 1992 with an
imperforate anus. Two days after his birth, Gerald under went
colostomy, a surgical procedure to bring one end of the large
intestine out through the abdominal walls, enabling him to
excrete through a colostomy bag attached to the side of his
body. On May 17, 1995, Gerald was admitted at the Ospital ng
Maynila
for
a
pull-through
operation.
Dr.
Leandro
Resurreccionheaded the surgical team, and was assisted by Dr.
Joselito Lucerio, Dr.Donatella Valeria and Dr. Joseph Tibio. The
anesthesiologist included Drs. Abella, Razon and Solidum.
During the operation, Gerald experienced bradycardia and
went into a coma. His coma lasted for two weeks , but he
regained consciousness only after a month. He could no longer
see, hear, or move. A complaint for reckless imprudence
resulting in serious physical injuries were filed by Geralds

parents against the team of doctors alleging that there was

failure in monitoring the anesthesia administered to Gerald.
Issues: Whether
negligence.

or

not

petitioner

is

liable

for

medical

Whether or not res ipsa liquitor can be resorted to in medical

negligence cases.
Held: No. Negligence is defined as the failure to observe for
the protection of the interests of another person that degree of
care, precaution, and vigilance that the circumstances justly
demand, whereby such other person suffers injury. Reckless
imprudence, on the other hand, consists of voluntarily doing or
failing to do, without malice, an act from which material
damage results by reason of an inexcusable lack of precaution
on the part of the person to perform or failing to perform such
act.
The negligence must be the proximate cause of the injury. For,
negligence no matter in what it consists, cannot create a right
of action unless it is the proximate cause of the injury
complained of. And the proximate cause of an injury is that
cause, which, in natural and continuous sequence and
unbroken by any efficient intervening cause, produces the
injury, and without which the result would not have occurred.
An action upon medical negligence whether criminal, civil or
administrative calls for the plaintiff to prove by competent
evidence each of the following four elements namely: a.) the
duty owed by the physician to the patient, as created by the
physician-patient relationship, to act in accordance with the
specific norms or standards established by his profession; b.)
the breach of the duty by the physicians failing to act in
accordance with the applicable standard of care; c.) the
causation, is, there must be a reasonably close and casual

connection between the negligent act or omission and the

resulting injury; and d.) the damages suffered by the patient.
In the medical profession, specific norms on standard of care to
protect the patient against unreasonable risk, commonly
referred to as standards of care, set the duty of the physician
in respect of the patient. The standard of care is an objective
standard which conduct of a physician sued for negligence or
malpractice may be measured, and it does not depend
therefore, on any individuals physicians own knowledge
either. In attempting to fix a standard by which a court may
determine whether the physician has properly performed the
requisite duty toward the patient, expert medical testimony
from both plaintiff and defense experts is required.
The doctrine of res ipsa liquitor means that where the thing
which causes injury is shown to be under the management of
the defendant, and the accident is such as in ordinary course
of things does not happen if those who have management use
proper care, it affords reasonable evidence, in the absence of
an explanation by defendant that the accident arose from want
of care.
Nevertheless, despite the fact that the scope of res ipsa
liquitor has been measurably enlarged, it does not
automatically apply to all cases of medical negligence as to
mechanically shift the burden of proof to the defendant to
show that he is not guilty of the ascribed negligence.Res ipsa
liquitor is not a rigid or ordinary doctrine to be perfunctorily
used but a rule to be cautiously applied, depending upon the
circumstances of each case. It is generally restricted to
situations in malpractice cases where a layman is able to say,
as a matter of common knowledge and observation, that the
consequences of professional care were not as such as would
ordinarily have followed if due care had been exercised. A

distinction must be made between the failure to secure results,

and the occurrence of something more unusual and not
ordinarily found if the service or treatment rendered followed
the usual procedure of those skilled in that particular practice.
It must be conceded that the doctrine of res ipsa liquitor can
have no application in a suit against a physician or surgeon
which involves the merits of a diagnosis or of a scientific
treatment. The physician or surgeon is not required at his peril
to explain why any particular diagnosis was not correct, or why
any particular scientific treatment did not produce the desired
results. Thus, res ipsa liquitor is not available in a malpractice
suit if the only showing is that the desired result of an
operation or treatment was not accomplished. The real
question, therefore, is whether or not in the process of the
operation any extraordinary incident or unusual event outside
the routine performance occurred which is beyond the regular
scope of customary professional activity in such operations,
which if unexplained would themselves reasonably speak to
the average man as the negligent case or causes of the
untoward consequence. If there was such extraneous
intervention, the doctrine of res ipsa liquitor may be utilized
and the dependent is called upon to explain the matter, by
evidence of exculpation, if he could.

CASUMPANG VS CORTEJO
FACTS:
Mrs. Jesusa Cortejo brought her 11-year old son, EdmerCortejo
(Edmer), to the Emergency Room of the San Juan de Dios Hospital
(SJDH) because of difficulty in breathing, chest pain, stomach pain, and
fever. Dr Casumpang, the attending physician using only a
stethoscope, he confirmed the initial diagnosis of "Bronchopneumonia."
Mrs.Cortejo recalled entertaining doubts on the doctor's diagnosis. She
immediately advised Dr.Casumpang that Edmer had a high fever, and
had no colds or cough but Dr.Casumpang merely told her that her son's
"bloodpressure is just being active," and remarked that "that's the
usual bronchopneumonia, no colds, no phlegm."Dr.Casumpang next
visited and examined Edmer at 9:00 in the morning the following day.
Still suspicious about his son's illness, Mrs.Cortejo again called
Dr.Casumpang's attention and stated that Edmer had a fever, throat
irritation, as well as chest and stomach pain. Mrs.Cortejo also alerted
Dr.Casumpang about the traces of blood in Edmer's sputum.
Dr.Casumpang simply nodded, inquired if Edmer has an asthma, and
reassured Mrs.Cortejo that Edmer's illness is bronchopneumonia. At
around 11:30 in the morning of April 23, 1988, Edmer vomited "phlegm
with blood streak" prompting the respondent (Edmer's father) to
request for a doctor at the nurses' station. Forty-five minutes later, Dr.
Ruby Sanga-Miranda (Dr. Miranda), one of the resident physicians of
SJDH, arrived. She claimed that although aware that Edmer had
vomited "phlegm with blood streak," she failed to examine the blood
specimen because the respondent washed it away. She then advised

the respondent to preserve the specimen for examination. Thereafter,

Dr. Miranda conducted a physical check-up covering Edmer's head,
eyes, nose, throat, lungs, skin and abdomen; and found that Edmer
had a low-grade non-continuing fever, and rashes that were not typical
of dengue fever. Dr. Miranda then examined Edmer's "sputum with
blood" and noted that he was bleeding. At 4:40 in the afternoon, Dr.
Miranda called up Dr.Casumpang at his clinic and told him about
Edmer's condition. Upon being informed, Dr.Casumpang ordered
several procedures done including:hematocrit, hemoglobin, blood
typing, blood transfusion and tourniquet tests. Dr. Miranda advised
Edmer's parents that the blood test results showed that Edmer was
suffering from "Dengue Hemorrhagic Fever." One hour later,
Dr.Casumpang arrived at Edmer's room and he recommended his
transfer to the Intensive Care Unit (ICU), to which the respondent
consented. Since the ICU was then full, Dr.Casumpang suggested to
the respondent that they hire a private nurse. The respondent,
however, insisted on transferring his son to Makati Medical Center.
After the respondent had signed the waiver, Dr.Casumpang, for the last
time, checked Edmer's condition, found that his blood pressure was
stable, and noted that he was "comfortable." The respondent
requested for an ambulance but he was informed that the driver was
nowhere to be found. This prompted him to hire a private ambulance
that cost him P600.00. At 12:00 midnight, Edmer, accompanied by his
parents and by Dr.Casumpang, was transferred to Makati Medical
Center. Dr.Casumpang immediately gave the attending physician the
patient's clinical history and laboratory exam results. Upon
examination, the attending physician diagnosed "Dengue Fever Stage
IV" that was already in its irreversible stage. Edmer died at 4:00 in the
morning of April 24, 1988 His Death Certificate indicated the cause of
death as "Hypovolemic Shock/hemorrhagic shock;" "Dengue
Hemorrhagic Fever Stage IV." Believing that Edmer's death was caused

by the negligent and erroneous diagnosis of his doctors, the

respondent instituted an action for damages against SJDH, and its
attending physicians: Dr.Casumpang and Dr. Miranda (collectively
referred to as the "petitioners") before the RTC of Makati City.
ISSUE:
1. Whether or not the petitioning doctors had committed
"inexcusable lack of
precaution" in diagnosing and in treating the patient;
2. Whether or not the petitioner hospital is solidarity liable with
the petitioning
doctors;
3. Whether or not there is a causal connection between the
petitioners' negligent act/omission and the patient's resulting death;
RULING: (1)The doctor committed inexcusable lack of precaution
in diagnosing and treating the patient. Medical Malpractice Suit as a
Specialized Area of Tort Law The claim for damages is based on the
petitioning doctors' negligence in diagnosing and treating the
deceased Edmer, the child of the respondent. It is a medical
malpractice suit, an action available to victims to redress a wrong
committed by medical professionals who caused bodily harm to, or the
death of, a patient. As the term is used, the suit is brought whenever a
medical practitioner or health care provider fails to meet the standards
demanded by his profession, or deviates from this standard, and
causes injury to the patient. The Elements of a Medical Malpractice Suit
The elements of medical negligence are: (1) duty; (2) breach; (3)
injury; and (4) proximate causation. In the present case, the physicianpatient relationship between Dr.Casumpang and Edmer was created
when the latter's parents sought the medical services of
Dr.Casumpang, and the latter knowingly accepted Edmer as a patient.

With respect to Dr. Miranda, her professional relationship with Edmer

arose when she assumed the obligation to provide resident supervision
over the latter. Whether or not Dr.Casumpang and Dr. Miranda
committed a breach of duty is to be measured by the yardstick of
professional standards observed by the other members of the medical
profession in good standing under similar circumstances. We find that
Dr.Casumpang, as Edmer's attending physician, did not act according
to these standards and, hence, was guilty of breach of duty. We do not
find Dr. Miranda liable for the reasons discussed below.
Dr.Casumpang's Negligence a. Negligence in the Diagnosis At the trial,
Dr.Casumpang declared that a doctor's impression regarding a
patient's illness is 90% based on the physical examination, the
information given by the patient or the latter's parents, and the
patient's medical history. It will be recalled that during Dr.Casumpang's
first and second visits to Edmer, he already had knowledge of Edmer's
laboratory test result (CBC), medical history, and symptoms (i.e., fever,
rashes, rapid breathing, chest and stomach pain, throat irritation,
difficulty in breathing, and traces of blood in the sputum). However,
these information did not lead Dr. Casumpang to the possibility that
Edmer could be suffering from either dengue fever, or dengue
hemorrhagic fever, as he clung to his diagnosis of bronchopneumonia.
This means that given the symptoms exhibited, Dr.Casumpang already
ruled out the possibility of other diseases like dengue. In the present
case, evidence on record established that in confirming the diagnosis
of bronchopneumonia, Dr.Casumpang selectively appreciated some
and not all of the symptoms presented, and failed to promptly conduct
the appropriate tests to confirm his findings. In sum, Dr. Casumpang
failed to timely detect dengue fever, which failure, especially when
reasonable prudence would have shown that indications of dengue
were evident and/or foreseeable, constitutes negligence. a. Negligence
in the Treatment and Management of Dengue Apart from failing to

promptly detect dengue fever, Dr. Casumpang also failed to promptly

undertake the proper medical management needed for this disease.
Dr. Miranda is Not Liable for Negligence In considering the case of Dr.
Miranda, the junior resident physician who was on-duty at the time of
Edmer's confinement, we see the need to draw distinctions between
the responsibilities and corresponding liability of Dr. Casumpang, as
the attending physician, and that of Dr. Miranda. Dr. Miranda was not
entirely faultless. Nevertheless, her failure to discern the import of
Edmer's second bleeding does not necessarily amount to negligence as
the respondent himself admitted that Dr. Miranda failed to examine the
blood specimen because he washed it away. In addition, considering
the diagnosis previously made by two doctors, and the uncontroverted
fact that the burden of final diagnosis pertains to the attending
physician (in this case, Dr. Casumpang), we believe that Dr. Miranda's
error was merely an honest mistake of judgment influenced in no small
measure by her status in the hospital hierarchy; hence, she should not
be held liable for medical negligence. (2) We now discuss the liability of
the hospital. The respondent submits that SJDH should not only be held
vicariously liable for the petitioning doctors' negligence but also for its
own negligence. He claims that SJDH fell short of its duty of providing
its patients with the necessary facilities and equipment as shown by
the following circumstances: (a) SJDH was not equipped with proper
paging system; (b) the number of its doctors is not proportionate to the
number of patients; (c) SJDH was not equipped with a bronchoscope;
(d) when Edmer's oxygen was removed, the medical staff did not
immediately provide him with portable oxygen; (e) when Edmer was
about to be transferred to another hospital, SJDH's was not ready and
had no driver; and (f) despite Edmer's critical condition, there was no
doctor attending to him from 5:30 p.m. of April 22, to 9:00 a.m. of April
23, 1988. SJDH on the other hand disclaims liability by claiming that
the petitioning doctors are not its employees but are mere consultants

and independent contractors. We affirm the hospital's liability not on

the basis of Article 2180 of the Civil Code, but on the basis of the
doctrine of apparent authority or agency by estoppel. (3) The
Causation Between Dr. Casumpang's Negligent Act/Omission, and the
Patient's Resulting Death was Adequately Proven Dr. Jaudian's
testimony strongly suggests that due to Dr. Casumpang's failure to
timely diagnose Edmer with dengue, the latter was not immediately
given the proper treatment. In fact, even after Dr.Casumpang had
discovered Edmer's real illness, he still failed to promptly perform the
standard medical procedure. We agree with these findings.

DR. PEDRO DENNIS CERENO, and DR. SANTOS ZAFE, Petitioners, v. COURT OF
APPEALS, SPOUSES DIOGENES S. OLAVERE and FE R. SERRANO, Respondents.
PEREZ, J.:
FACTS: At about 9:15 in the evening of 16 September 1995, Raymond S. Olavere
(Raymond), a victim of a stabbing incident, was rushed to the Bicol Regional Medical
Center (BRMC). Dr. Realuyo, the emergency room resident physician, recommended that
Raymond should undergo blood transfusion. At 10:30 P.M., Raymond was brought inside
the operating room. During that time, the hospital surgeons, Drs. Zafe and Cereno, were
busy operating on gunshot victim Charles Maluluy-on. Assisting them in the said
operation was Dr. Rosalina Tatad (Dr. Tatad), who was the only senior anesthesiologist on
duty at BRMC that night. Just before the operation on Maluluy-on was finished, another
emergency case involving Lilia Aguila, a woman who was giving birth to triplets, was
brought to the operating room. Drs. Zafe and Cereno, in the meantime, proceeded to
examine Raymond and they found that the latters blood pressure was normal and
"nothing in him was significant." There being no other available anesthesiologist to assist
them, Drs. Zafe and Cereno decided to defer the operation on Raymond. At 11:15 P.M.,
the relatives of Raymond brought the bag of blood to be used for blood transfusion. Drs.
Cereno and Zafe immediately started their operation on Raymond at around 12:15 A.M.
of 17 September 1995. Upon opening of Raymonds thoracic cavity, they found that 3,200
cc of blood was stocked therein. Dr. Cereno did not immediately transfuse the blood since
the bleeders had to be controlled first. Blood was finally transfused on Raymond at 1:40

A.M. However, during the operation, Raymond died due to massive loss of blood.
Claiming that there was negligence on the part of those who attended to their son, the
parents of Raymond (herein respondents) filed a complaint for damages against Drs. Zafe
and Cereno. The RTC found Drs. Zafe and Cereno negligent for not immediately
conducting surgery on Raymond. On appeal, the CA affirmed RTCs findings.
ISSUE: Whether or not Drs. Zafe and Cereno are guilty of gross negligence in the
performance of their duties?
HELD: The petition is granted. CIVIL LAW: medical negligence The type of lawsuit
which has been called medical malpractice or, more appropriately, medical negligence, is
that type of claim which a victim has available to him or her to redress a wrong
committed by a medical professional which has caused bodily harm. In order to
successfully pursue such a claim, a patient must prove that a health care provider, in most
cases a physician, either failed to do something which a reasonably prudent health care
provider would have done, or that he or she did something that a reasonably prudent
provider would not have done; and that the failure or action caused injury to the patient.
Given that Dr. Tatad was already engaged in another urgent operation and that Raymond
was not showing any symptom of suffering from major blood loss requiring an
immediate operation, We find it reasonable that petitioners decided to wait for Dr. Tatad
to finish her surgery and not to call the standby anesthesiologist anymore. There is, after
all, no evidence that shows that a prudent surgeon faced with similar circumstances
would decide otherwise. In medical negligence cases, it is settled that the complainant
has the burden of establishing breach of duty on the part of the doctors or surgeons. It
must be proven that such breach of duty has a causal connection to the resulting death of
the patient. Upon opening of his thoracic cavity, it was discovered that there was gross
bleeding inside the body. Thus, the need for petitioners to control first what was causing
the bleeding. Petition is GRANTED. The CA is REVERSED and SET ASIDE.

Dr. Ninevetch Cruz v. CA and Lydia Umali

1997 / Francisco / Petition for review on certiorari of a CA decision
Standard of conduct > Experts > Medical professionals

FACTS
Medical malpractice suit - type of claim which a victim has available to him/her to
redress a wrong committed by a medical professional which has caused bodily harm;
most often brought as a civil action for damages under NCC 2176 or a criminal case
under RPC 365, with which a civil action for damages is impliedly instituted.
Lydia Umali was examined by Dr. Cruz who found a myoma [benign tumor] in her
uterus, and scheduled her for a hysterectomy operation [removal of uterus] on 23
Mar 1991. Rowena Umali de Ocampo accompanied her mother to the hospital a day
before the operation, and they spent the night there. Rowena noticed that the clinic
was untidy, so she tried to persuade her mother not to proceed with the operation.
The following day, Rowena asked Dr. Cruz if the operation could be postponed, but
Lydia told her daughter that Dr. Cruz said that the operation must go on as
scheduled.
While Lydia's relatives were waiting, Dr. Ercillo (anesthesiologist) told them to
buy tagamet ampules, and Rowena's sister went out to buy some. An hour later, Dr.
Ercillo asked them to buy blood for Lydia, so they did. A few hours later, the
operation was finished, but later, Dr. Cruz asked the family to buy additional blood,

but there was no more type A blood available in the blood bank. A person arrived
to donate blood which was later transfused to Lydia. Rowena noticed that her
mother was gasping for breath--apparently, the oxygen supply had run out, so
the family went out to buy oxygen. Later in the evening, she went into shock and
her blood pressure dropped. She was then transferred to another hospital so
she could be connected to a respirator and further examined. However, this
transfer was without the consent of the relatives, who only found out about
it when an ambulance came to take Lydia to the other hospital.
In the new hospital, she was re-operated upon by Dr. Cruz and Dr. Ercillo
because blood was oozing out from her incision. They summoned Dr. Angeles, ObGyne head of the new hospital, but when he arrived, Lydia was already
in shock and possibly dead (BP: 0/0). Dr. Angeles told Drs. Cruz and Ercillo that
there was nothing he could do. Lydia died while Dr. Cruz was closing her abdominal
wall. Immediate cause of death is shock; disseminated intravascular
coagulation (DIC) as antecedent cause.
Dr. Cruz and Dr. Ercillo were charged with reckless imprudence and
negligence resulting in homicide of Lydia Umali. The Municipal Trial Court in
Cities (MTCC) found Dr. Ercillo not guilty for insufficiency of evidence against her,
but held Dr. Cruz responsible for Umali's death.RTC and CA affirmed MTCC.
Manifestation of negligence

untidiness of clinic

lack of provision of supplies

the fact that the transfer was needed meant that there was something wrong
in the way Dr. Cruz conducted operation

no showing that pre-surgery procedure (clearance, blood typing/tests) was

conducted
ISSUE AND HOLDING
WON the circumstances are sufficient to sustain a judgment of conviction against Dr.
Cruz for reckless imprudence resulting in homicide. NO. DR. CRUZ IS ACQUITTED,
BUT SHE IS STILL CIVILLY LIABLE (50K civil liability; 100k moral damages, 50k
exemplary damages).

1.
2.
3.
4.
5.

RATIO
Elements of reckless imprudence
Offender does / fails to do an act
Doing / failure to do act is voluntary
Without malice
Material damage results from reckless imprudence
There is inexcusable lack of precaution, taking into consideration offender's
employment, degree of intelligence, physical condition, other circumstances re:
persons, time, place
Standard of care

Standard of care observed by other members of the profession in good standing

under similar circumstances, bearing in mind the advanced state of the profession at
the time of treatment or the present state of medical science
When the physician's qualifications are admitted, there is an
inevitable presumption that in proper cases, he takes the necessary precaution and
employs the best of his knowledge and skill in attending to his clients, unless the
contrary is sufficiently established by expert testimony.
Expert testimony
Expert testimony is essential to establish standard of care of the profession, as
well as that the physician's conduct in the treatment and care falls below such
standard. It is also usually necessary to support the conclusion as to causation. There
is an absence of any expert testimony re: standard of care in the case records.
NBI doctors presented by the prosecution only testified as to the possible cause of
death.
While it may be true that the circumstances pointed out by the lower
courts constitute reckless imprudence, this conclusion is still best arrived
not through the educated surmises nor conjectures of laymen, including
judges, but by the unquestionable knowledge of expert witnesses. The
deference of courts to the expert opinion of qualified physicians stems from the
realization that the latter possess unusual technical skills which laymen are
incapable of intelligently evaluating.
Burden of establishing medical negligence on plaintif
Plaintiff has the burden to establish this, and for a reasonable conclusion of
negligence, there must be proof of breach of duty on the part of the surgeon, as well
as a causal connection of such breach and the resulting death of patient. Negligence
cannot create a right of action unless it is the proximate cause of the injury
complained of (Chan Lugay v. St. Luke's Hospital, Inc.). In this case, no cogent proof
exists that the circumstances caused Lydia's death, so the 4th element of reckless
imprudence is missing.
The
testimonies
of
the
doctors
presented
by
the
prosecution
establish hemorrhage / hemorrhagic shock as the cause of death, which may be
caused by several different factors. Autopsy did not reveal any untied cut blood
vessel, nor was there a tie of a cut blood vessel that became loose. The findings of
the doctors do not preclude the probability that a clotting defect (DIC)
caused the hemorrhage and consequently, Lydia's death.
The Court has no recourse but to rely on the expert testimonies that substantiate Dr.
Cruz' allegation that the cause of Lydia's death was DIC, which cannot be attributed
to Dr. Cruz' fault or negligence. This probability was unrebutted during trial.

Ramos vs court of appeals

ROGELIO NOGALES vs. CAPITOL MEDICAL CENTER et al.

G.R. No. 142625
December 19, 2006
Facts: Pregnant with her fourth child, Corazon Nogales ("Corazon"), who was then 37 years
old, was under the exclusive prenatal care of Dr. Oscar Estrada ("Dr. Estrada") beginning on
her fourth month of pregnancy or as early as December 1975. Around midnight of 25 May
1976, Corazon started to experience mild labor pains prompting Corazon and Rogelio
Nogales ("Spouses Nogales") to see Dr. Estrada at his home. After examining Corazon, Dr.
Estrada advised her immediate admission to the Capitol Medical Center ("CMC"). t 6:13
a.m., Corazon started to experience convulsionsAt 6:22 a.m., Dr. Estrada, assisted by Dr.
Villaflor, applied low forceps to extract Corazon's baby. In the process, a 1.0 x 2.5 cm. piece

of cervical tissue was allegedly torn.At 6:27 a.m., Corazon began to manifest moderate
vaginal bleeding which rapidly became profuse. Corazon died at 9:15 a.m. The cause of
death was "hemorrhage, post partum.
Issue: Whether or not CMC is vicariously liable for the negligence of Dr. Estrada.
Ruling: Private hospitals, hire, fire and exercise real control over their attending and visiting
"consultant" staff. The basis for holding an employer solidarily responsible for the negligence
of its employee is found in Article 2180 of the Civil Code which considers a person
accountable not only for his own acts but also for those of others based on the former's
responsibility under a relationship of patria potestas.
In general, a hospital is not liable for the negligence of an independent contractor-physician.
There is, however, an exception to this principle. The hospital may be liable if the physician is
the "ostensible" agent of the hospital. This exception is also known as the "doctrine of
apparent authority.
For a hospital to be liable under the doctrine of apparent authority, a plaintiff must show that:
(1) the hospital, or its agent, 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; (2) where the acts of the agent create the appearance of authority, the plaintiff
must also prove that the hospital had knowledge of and acquiesced in them; and (3) the
plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with
ordinary care and prudence. In the instant case, CMC impliedly held out Dr. Estrada as a
member of its medical staff. Through CMC's acts, CMC clothed Dr. Estrada with apparent
authority thereby leading the Spouses Nogales to believe that Dr. Estrada was an employee
or agent of CMC.

PROFESSIONAL SERVICES, INC. vs NATIVIDAD AND ENRIQUE

AGANA GR No. 126297, 31 January 2007 -------------- NATIVIDAD
(substituted by her children MARCELINO AGANA III, ENRIQUE
AGANA, JR., EMMA AGANA ANDAYA, JESUS AGANA, and
RAYMUND AGANA) AND ENRIQUE AGANA vs JUAN FUENTES GR
No. 126467, 31 January 2007 -------------- MIGUEL AMPIL vs
NATIVIDAD AGANA AND ENRIQUE AGANA GR No. 127590, 31
January 2007
FACTS: On 14 April 1984, Natividad Agana was rushed to The Medical
City General Hospital due to bowel movement difficulty and bloody
anal discharge. She was diagnosed by Dr. Miguel Ampil to be suffering
from cancer of the sigmoid. Upon performing anterior resection

surgery on Natividad, Dr. Ampil found that cancer had spread on her
left ovary. Dr. Ampil sought the consent of Enrique Agana (Natividads
husband) to permit Dr. Juan Fuentes to perform hysterectomy on her.
After Dr. Fuentes completed hysterectomy, Dr. Ampil took over to
complete the operation and to close the incision. However, the
operation appeared to be flawed. A couple of days after her release,
Natividad complained of excruciating pain in her anal region. Her
doctors told her that said pain was the consequence of her operation.
Dr. Ampil recommended that she consult an oncologist to examine the
cancerous node they were not able to remove. Natividad then went to
the US for further treatment and was later found free from cancer. She
then returned to the Philippines. Two weeks after Natividads arrival,
her daughter found a piece of gauze protruding from her vagina. Dr.
Ampil removed said piece, and assured her that the pains would vanish
soon. Still suffering from pain, Natividad sought help from Polymedic
General Hospital where it was found that another piece of gauze badly
infected her vaginal vault. She took another surgery to remove the
same. The spouses Agana then filed a complaint for damages against
Professional Services, Inc (owner of The Medical City), Dr. Ampil and Dr.
Fuentes. Enrique likewise filed administrative cases against Dr. Ampil
(who was unfortunately abroad at that time, so case did not proceed)
and Dr. Fuentes. Pending said cases, Natividad died and was
substituted by her children. RTC favored the spouses, but the
administrative complaint against Dr. Fuentes was dismissed. CA
affirmed that Dr. Ampil was liable for damages but exonerated Dr.
Fuentes from liability. Hence, these three consolidated petitions for
review on certiorari.
ISSUE (As to GR No. 126297): Whether PSI should be liable for the
negligence of Dr. Ampil.
HOLDING: YES. Courts came to realize that modern hospitals are
increasingly taking active role in supplying and regulating medical care
to patients. No longer were a hospitals functions limited to furnishing
room, food, facilities for treatment and operation, and attendants for
its patients. Thus, in Bing v. Thunig, the New York Court of Appeals
deviated from the Schloendorff doctrine, noting that modern hospitals
actually do far more than provide facilities for treatment. Rather, they
regularly employ, on a salaried basis, a large staff of physicians,
interns, nurses, administrative and manual workers. They charge
patients for medical care and treatment, even collecting for such
services through legal action, if necessary. The court then concluded
that there is no reason to exempt hospitals from the universal rule of
respondeat superior. In our shores, the nature of the relationship
between the hospital and the physicians is rendered inconsequential in
view of our categorical pronouncement in Ramos v. Court of

Appealsthat for purposes of apportioning responsibility in medical

negligence cases, an employer-employee relationship in effect exists
between hospitals and their attending and visiting physicians. But the
Ramos pronouncement is not our only basis in sustaining PSIs liability.
Its liability is also anchored upon the agency principle ofapparent
authority or agency by estoppel and the doctrine of corporate
negligence which have gained acceptance in the determination of a
hospitals liability for negligent acts of health professionals. The
present case serves as a perfect platform to test the applicability of
these doctrines, thus, enriching our jurisprudence. Apparent authority,
or what is sometimes referred to as the holding out theory, or
doctrine of ostensible agency or agency by estoppel, has its origin from
the law of agency. It imposes liability, not as the result of the reality of
a contractual relationship, but rather because of the actions of a
principal or an employer in somehow misleading the public into
believing that the relationship or the authority exists. The concept is
essentially one of estoppel and has been explained in this manner:
The principal is bound by the acts of his agent with the apparent
authority which he knowingly permits the agent to assume, or which
he holds the agent out to the public as possessing. The question in
every case is whether the principal has by his voluntary act placed the
agent in such a situation that a person of ordinary prudence,
conversant with business usages and the nature of the particular
business, is justified in presuming that such agent has authority to
perform the particular act in question. The applicability of apparent
authority in the field of hospital liability was upheld long time ago in
Irving v. Doctor Hospital of Lake Worth, Inc. There, it was explicitly
stated that there does not appear to be any rational basis for
excluding the concept of apparent authority from the field of hospital
liability. Thus, in cases where it can be shown that a hospital, by its
actions, has held out a particular physician as its agent and/or
employee and that a patient has accepted treatment from that
physician in the reasonable belief that it is being rendered in behalf of
the hospital, then the hospital will be liable for the physicians
negligence. Our jurisdiction recognizes the concept of an agency by
implication or estoppel. Article 1869 of the Civil Code reads: ART. 1869.
Agency may be express, or implied from the acts of the principal, from
his silence or lack of action, or his failure to repudiate the agency,
knowing that another person is acting on his behalf without authority.
In this case, PSI publicly displays in the lobby of the Medical City
Hospital the names and specializations of the physicians associated or
accredited by it, including those of Dr. Ampil and Dr. Fuentes. We
concur with the Court of Appeals conclusion that it 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. Indeed, PSIs act is

tantamount to holding out to the public that Medical City Hospital,

through its accredited physicians, offers quality health care services.
By accrediting Dr. Ampil and Dr. Fuentes and publicly advertising their
qualifications, the hospital created the impression that they were its
agents, authorized to perform medical or surgical services for its
patients. As expected, these patients, Natividad being one of them,
accepted the services on the reasonable belief that such were being
rendered by the hospital or its employees, agents, or servants. The
trial court correctly pointed out: x x x regardless of the education and
status in life of the patient, he ought not be burdened with the defense
of absence of employer-employee relationship between the hospital
and the independent physician whose name and competence are
certainly certified to the general public by the hospitals act of listing
him and his specialty in its lobby directory, as in the case herein. The
high costs of todays medical and health care should at least exact on
the hospital greater, if not broader, legal responsibility for the conduct
of treatment and surgery within its facility by its accredited physician
or surgeon, regardless of whether he is independent or employed.[33]
The wisdom of the foregoing ratiocination is easy to discern. Corporate
entities, like PSI, are capable of acting only through other individuals,
such as physicians. If these accredited physicians do their job well, the
hospital succeeds in its mission of offering quality medical services and
thus profits financially. Logically, where negligence mars the quality of
its services, the hospital should not be allowed to escape liability for
the acts of its ostensible agents.

Petron vs sps jovero

SERVICES,
INC.
VS
AGANA
JUAN
FUENTES
31,
Facts:
2007
rushed
the
Medical
City
Ampil
Hospital
diagnosed
Dr.
Miguel
cancer
of
the
sigmoid.
Dr.
surgery
Ampil
and
performed
found
the
the
sigmoid
necessitating
the
removal.
performs
Dr.
hysterectomy
Juan
Fuentes
completed
the
operation
and
incision.
closed
The
the
attending
nurse
2.
Since
sponge
nowhere
count
to
lacking
be
found
the
surgeon
After
Natividad
a
couple
complained
of
days,
of
excruciating
pain
she
doctors
told
that
about
it
was
it
natural
but
they
consequence
surgery.
the
to
the
United
States
after
four
consultation
months
of
and
laboratory
free
flew
of
back
cancer.
to
the
Natividad
Philippines,
from
still
suffering
protruding
from
her
pain
Vagina.
intensified,
Then
after
seek
treatment.
Dr.
Ramon
the
presence
Gutierez
of
another
detected
vagina
to
a
foul-smelling
infected
gauze
which
her
vaginal
badly
vault.
another
remedy
the
surgery
damage.
to
husband
filed
with
RTC,
Quezon
for
City
damages
a
Services,
Inc.
(PSI),
owner
Hospital,
Medical
Ampil,
City
and
Agana
also
filed
with
the
Professional
Commission
Regulation
(PRC)
an
complaint
for
gross
malpractice
against
Dr.
and
of
Medicine
but
failed
heard
to
acquire
jurisdiction
over
United
States.
The
case
was
pending;
died
and
was
duly
named
Aganas).
children
RTC
rendered
(the
its
Decision
in
favor
of
PSI,
Fuentes
Dr.
Ampil
liable
and
for
negligence
malpractice,
PROFESSIONAL
and
INC.,
Dr.
Juan
Dr
Miguel
plaintiffs,
jointly
in
respect
severally,
of
the
except
award
for
which
interest
are
thereon
liabilities
of
defendants
Dr.
Fuentes.
Dr.
Ampil
Fuentes
and
Dr.
Ampil
interposed
Court
of
an
Appeals,
appeal
to
a
motion
for
a
partial
Aganas
again
of
its
filed
Decision.
a
execution
against
the
properties
Fuentes.
RTC
of
PSI
granted
and
Dr.
corresponding
writ,
prompting
file
with
the
Dr.
Court
Fuentes
of
to
certiorari
and
prohibition,
with
preliminary
prayer
injunction.
for
During
its
Appeals
Resolution
issued
a
prayer
relief.
for
injunctive
5