14 Professional Services, Inc. v. Agana PDF

SUPREME COURT REPORTS ANNOTATED VOLUME 513
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SUPREME COURT REPORTS ANNOTATED

Professional Services, Inc. vs. Agana
*
G.R. No. 126297. January 31, 2007.
PROFESSIONAL SERVICES, INC., petitioner,

NATIVIDAD and ENRIQUE AGANA, respondents.
vs.
G.R. No. 126467. January 31, 2007.
NATIVIDAD and ENRIQUE AGANA, respondents.

NATIVIDAD (Substituted by her children MARCELINO
AGANA III, ENRIQUE AGANA, JR., EMMA AGANA
ANDAYA, JESUS AGANA, and RAYMUND AGANA) and
ENRIQUE AGANA, petitioners, vs. JUAN FUENTES,
respondent.
*
G.R. No. 127590. January 31, 2007.
MIGUEL AMPIL, petitioner, vs. NATIVIDAD AGANA and

ENRIQUE AGANA, respondents.
_______________
*
FIRST DIVISION.
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Civil Law; Damages; Negligence; The leaving of sponges or
other foreign substances in the wound after the incision has been
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closed is at least prima facie negligence by the operating surgeon.

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.
Same; Same; Same; To the mind of the Court, what was
initially an act of negligence by Dr. Ampil has ripened into a
deliberate wrongful act of deceiving his patient.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. Had he been more candid,
Natividad could have taken the immediate and appropriate medical
remedy to remove the gauzes from her body. To our mind, what was
initially an act of negligence by Dr. Ampil has ripened into a
deliberate wrongful act of deceiving his patient.
Same; Same; Same; Doctrine of Res Ipsa Loquitur; Requisites
for the Applicability of the Doctrine.Literally, res ipsa loquitur
means the thing speaks for itself. It is the rule that the fact of the
occurrence of an injury, taken with the surrounding circumstances,
may permit an inference or raise a presumption of negligence, or
make out a plaintiff s prima facie case, and present a question of
fact for defendant to meet with an explanation. Stated differently,
where the thing which caused the injury, without the fault of the
injured, is under the exclusive control of the defendant and the
injury is such that it should not have occurred if he, having such
control used proper care, it affords reasonable evidence, in the
absence of explanation that the injury arose from the defendants
want of care, and the burden of proof is shifted to him to establish
that he has observed due care and diligence. From the foregoing
statements of the rule, the requisites for the applicability of the
doctrine of res ipsa loquitur are: (1) the 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
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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 requisites, the most instrumental is the control and
management of the thing which caused the injury.
Same; Same; Same; Same; Res ipsa loquitur is not a rule of
substantive law, hence, does not per se create or constitute an
independent or separate ground of liability, being a mere evidentiary
rule.In this jurisdiction, res ipsa loquitur is not a rule of
substantive law, hence, does not per se create or constitute an
independent or separate ground of liability, being a mere
evidentiary rule. In other words, mere invocation and application of
the doctrine does not dispense with the requirement of proof of
negligence. Here, the negligence was proven to have been
committed by Dr. Ampil and not by Dr. Fuentes.
Same; Same; Same; Professionals are considered personally
liable for the fault or negligence they commit in the discharge of
their duties and their employer cannot be held liable for such fault
or negligence.A prominent civilist commented that professionals
engaged by an employer, such as physicians, dentists, and
pharmacists, are not employees under this article because the
manner in which they perform their work is not within the control
of the latter (employer). In other words, professionals are considered
personally liable for the fault or negligence they commit in the
discharge of their duties, and their employer cannot be held liable
for such fault or negligence. In the context of the present case, a
hospital cannot be held liable for the fault or negligence of a
physician or surgeon in the treatment or operation of patients.
Same; Same; Same; In this jurisdiction, the nature of the
relationship between the hospital and the physicians is rendered
inconsequential in view of the pronouncement in Ramos vs. Court of
Appeals, 321 SCRA 584 (1999), that for purposes of apportioning
responsibility in medical negligence cases, an employer-employee
relationship in effect exists between hospitals and their attending
and visiting physicians.In our shores, the nature of the
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relationship between the hospital and the physicians is rendered

inconsequential in view of our categorical pronouncement in Ramos
v. Court of Appeals, 321 SCRA 584 (1999), that for purposes of
apportioning responsibility in
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medical negligence cases, an employer-employee relationship in
effect exists between hospitals and their attending and visiting
physicians.
Same;Same; Same; PSIs liability is also anchored upon the
agency principle of apparent authority or agency by estoppel and the
doctrine of corporate negligence.But the Ramos pronouncement is
not our only basis in sustaining PSIs liability. Its liability is also
anchored upon the agency principle of apparent 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.
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Same; Same; Same; 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.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., 415 So. 2d 55 (1982). 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
482
482

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.
Same; Same; Same; 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.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
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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.
PETITION for review on certiorari of the decisions of the

Court of Appeals.
The facts are stated in the opinion of the Court.
Bengzon, Narciso, Cudala, Pecson, Bengzon &
Jimenez for petitioner Professional Services, Inc.
Enrique Agana & Associates for petitioners Natividad
and Enrique Agana.
The Law Firm of Raymundo M. Armovit for
petitioner Miguel Ampil.
Agcaoili Law Offices collaborating counsel for Heirs
of Natividad Agana.
Benjamin M. Tongol for Juan Fuentes.
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SANDOVAL-GUTIERREZ, J.:
Hospitals, having undertaken one of mankinds most
important and delicate endeavors, must assume the grave
responsibility of pursuing it with appropriate care. The
care and service dispensed through this high trust,
however technical, complex and esoteric its character may
be, must meet standards of responsibility commensurate
with the undertaking to preserve and protect the health,
and indeed,
the very lives of those placed in the hospitals
1
keeping.
Assailed in these three consolidated petitions for2 review
on certiorari is the Court of Appeals Decision dated
September 6, 1996 in CA-G.R. CV No. 42062 and CA-G.R.3
SP No. 32198 affirming with modification the Decision
dated March 17, 1993 of the Regional Trial Court (RTC),
Branch 96, Quezon City in Civil Case No. Q-43322 and
nullifying its Order dated September 21, 1993.
The facts, as culled from the records, are:
On April 4, 1984, Natividad Agana was rushed to the
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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.
_______________
Beeck v. Tucson General Hospital, 500 P. 2d 1153 (1972), citing
Darling v. Charleston Community Memorial Hospital, 33 Ill. 2d 326, 211

N.E. 2d 253.
2
Penned by Associate Justice Cancio C. Garcia (now a member of the
Supreme Court) and concurred in by Associate Justices Eugenio S.

Labitoria and Artemio G. Tuquero (both retired), Rollo, G.R. No. 126297,
pp. 36-51; 126467, pp. 27-42; 127590, pp. 23-38.
3
Penned by Judge Lucas P. Bersamin (now Justice of the Court of
Appeals), Rollo, G.R. No. 126647, pp. 69-83.

484
484

4
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,
respondent in G.R. No. 126467, 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.
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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.
_______________
4
The medical staff was composed of physicians, both residents and
interns, as well as nurses.

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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 vaginaa 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
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the vagina. Another surgical operation was needed to

remedy the damage. Thus, in October 1984, Natividad
underwent another surgery.
On November 12, 1984, 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, docketed as Civil Case No. Q-43322. They alleged
that the latter are liable for negligence for leaving two
pieces of gauze inside Natividads body and malpractice for
concealing their acts of negligence.
Meanwhile, Enrique Agana also filed with the
Professional
Regulation
Commission
(PRC)
an
administrative complaint for gross negligence and
malpractice against Dr. Ampil and Dr. Fuentes, docketed as
Administrative Case No. 1690. The PRC Board of Medicine
heard the case only with respect to Dr. Fuentes because it
failed to acquire jurisdiction over Dr. Ampil who was then
in the United States.
On February 16, 1986, pending the outcome of the above
cases, Natividad died and was duly substituted by her
abovenamed children (the Aganas).
486
486

On March 17, 1993, the RTC rendered its Decision in favor

of the Aganas, finding PSI, Dr. Ampil and Dr. Fuentes
liable for negligence and malpractice, the decretal part of
which reads:
WHEREFORE, judgment is hereby rendered for the plaintiffs
ordering the defendants PROFESSIONAL SERVICES, INC., DR.
MIGUEL AMPIL and DR. JUAN FUENTES to pay to the
plaintiffs, jointly and severally, except in respect of the award for
exemplary damages and the interest thereon which are the
liabilities of defendants Dr. Ampil and Dr. Fuentes only, as follows:
1. As actual damages, the following amounts:
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a. The equivalent in Philippine Currency of the total of

US$19,900.00 at the rate of P21.60-US$1.00, as
reimbursement of actual expenses incurred in the United
States of America;
b. The sum of P4,800.00 as travel taxes of plaintiffs and their
physician daughter;
c. The total sum of P45,802.50, representing the cost of
hospitalization at Polymedic Hospital, medical fees, and cost
of the saline solution;
2. As moral damages, the sum of P2,000,000.00;
3. As exemplary damages, the sum of P300,000.00;
4. As attorneys fees, the sum of P250,000.00;
5. Legal interest on items 1 (a), (b), and (c); 2; and 3
hereinabove, from date of filing of the complaint until full
payment; and
6. Costs of suit.
SO ORDERED.
Aggrieved, PSI, Dr. Fuentes and Dr. Ampil interposed an

appeal to the Court of Appeals, docketed as CA-G.R. CV
No. 42062.
Incidentally, on April 3, 1993, the Aganas filed with the
RTC a motion for a partial execution of its Decision, which
was granted in an Order dated May 11, 1993. Thereafter,
the sheriff levied upon certain properties of Dr. Ampil and
sold
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them for P451,275.00 and delivered the amount to the
Aganas.
Following their receipt of the money, the Aganas entered
into an agreement with PSI and Dr. Fuentes to indefinitely
suspend any further execution of the RTC Decision.
However, not long thereafter, the Aganas again filed a
motion for an alias writ of execution against the properties
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of PSI and Dr. Fuentes. On September 21, 1993, the RTC

granted the motion and issued the corresponding writ,
prompting Dr. Fuentes to file with the Court of Appeals a
petition for certiorari and prohibition, with prayer for
preliminary injunction, docketed as CA-G.R. SP No. 32198.
During its5 pendency, the Court of Appeals issued a
Resolution dated October 29, 1993 granting Dr. Fuentes
prayer for injunctive relief.
On January 24, 1994, CA-G.R. SP No. 32198 was
consolidated with CA-G.R. CV No. 42062.
Meanwhile, on January 23,
1995, the PRC Board of
6
Medicine rendered its Decision in Administrative Case No.
1690 dismissing the case against Dr. Fuentes. The Board
held that the prosecution failed to show that Dr. Fuentes
was the one who left the two pieces of gauze inside
Natividads body; and that he concealed such fact from
Natividad.
_______________
5
The dispositive portion reads:
WHEREFORE, let a writ of preliminary injunction be issued upon

petitioners posting of bond in the amount of P20,000.00, ENJOINING public
respondents from implementing the questioned order dated September 21,
1993 and from further taking any action in Civil Case No. Q-43322 entitled
Natividad G. Agana, et al., plaintiffs, versus Professional Services, Inc., et al.,
defendants pending resolution of the instant petition.
SO ORDERED. See Rollo, G.R. No. 126297, p. 42.
6
Rollo of G.R. No. 126467, pp. 84-89.

488
488

On September 6, 1996, the Court of Appeals rendered its

Decision jointly disposing of CA-G.R. CV No. 42062 and
CA-G.R. SP No. 32198, thus:
WHEREFORE, except for the modification that the case against
defendant-appellant Dr. Juan Fuentes is hereby DISMISSED, and
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with the pronouncement that defendant-appellant Dr. Miguel Ampil

is liable to reimburse defendant-appellant Professional Services,
Inc., whatever amount the latter will pay or had paid to the
plaintiffs-appellees, the decision appealed from is hereby
AFFIRMED and the instant appeal DISMISSED.
Concomitant with the above, the petition for certiorari and
prohibition filed by herein defendant-appellant Dr. Juan Fuentes in
CA-G.R. SP No. 32198 is hereby GRANTED and the challenged
order of the respondent judge dated September 21, 1993, as well as
the alias writ of execution issued pursuant thereto are hereby
NULLIFIED and SET ASIDE. The bond posted by the petitioner
in connection with the writ of preliminary injunction issued by this
Court on November 29, 1993 is hereby cancelled.
Costs against defendants-appellants Dr. Miguel Ampil and
Professional Services, Inc.
SO ORDERED.
Only Dr. Ampil filed a motion

for reconsideration, but it
7
was denied in a Resolution dated December 19, 1996.
Hence, the instant consolidated petitions.
In G.R. No. 126297, PSI alleged in its petition that the
Court of Appeals erred in holding that: (1) it is estopped
from raising the defense that Dr. Ampil is not its employee;
(2) it is solidarily liable with Dr. Ampil; and (3) it is not
entitled to its counterclaim against the Aganas. PSI
contends that Dr. Ampil is not its employee, but a mere
consultant or independent contractor. As such, he alone
should answer for his negligence.
_______________
7
Rollo of G.R. No. 127590, p. 40.

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In G.R. No. 126467, the Aganas maintain that the Court of
Appeals erred in finding that Dr. Fuentes is not guilty of
negligence or medical malpractice, invoking the doctrine of
res ipsa loquitur. They contend that the pieces of gauze are
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prima facie proofs that the operating surgeons have been

negligent.
Finally, in G.R. No. 127590, Dr. Ampil asserts that the
Court of Appeals erred in finding him liable for negligence
and malpractice sans evidence that he left the two pieces of
gauze in Natividads vagina. He pointed to other probable
causes, such as: (1) it was Dr. Fuentes who used gauzes in
performing the hysterectomy; (2) the attending nurses
failure to properly count the gauzes used during surgery;
and (3) the medical intervention of the American doctors
who examined Natividad in the United States of America.
For our resolution are these three vital issues: first,
whether the Court of Appeals erred in holding Dr. Ampil
liable for negligence and malpractice; second, whether the
Court of Appeals erred in absolving Dr. Fuentes of any
liability; and third, whether PSI may be held solidarily
liable for the negligence of Dr. Ampil.
IG.R. No. 127590
Whether the Court of Appeals Erred in Holding Dr.
Ampil Liable for Negligence and Malpractice.
Dr. Ampil, in an attempt to absolve himself, gears the
Courts attention to other possible causes of Natividads
detriment. He argues that the Court should not discount
either of the following possibilities: first, Dr. Fuentes left
the gauzes in Natividads body after performing
hysterectomy; second, the attending nurses erred in
counting the gauzes; and third, the American doctors were
the ones who placed the gauzes in Natividads body.
Dr. Ampils arguments are purely conjectural and
without basis. Records show that he did not present any
evidence to prove that the American doctors were the ones
who put or left
490
490

the gauzes in Natividads body. Neither did he submit

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evidence to rebut the correctness of the record of operation,

particularly the number of gauzes used. As to the alleged
negligence of Dr. Fuentes, we are mindful that Dr. Ampil
examined his (Dr. Fuentes) work and found it in order.
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, thus:
First, it is not disputed that the surgeons used gauzes as sponges to
control the bleeding of the patient during the surgical operation.
Second, immediately after the operation, the nurses who assisted
in the surgery noted in their report that the sponge count (was)
lacking 2; that such anomaly was announced to surgeon and
that a search was done but to no avail prompting Dr. Ampil
to continue for closure x x x.
Third, after the operation, two (2) gauzes were extracted from
the same spot of the body of Mrs. Agana where the surgery was
performed.
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 is8 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 of9 authorities to the
effect that such act is negligence per se.
_______________
8
Rule v. Cheeseman, 317 P. 2d 472 (1957), citing Russel v. Newman,
116 Kan. 268 P. 752; Bernsden v. Johnson, 174 Kan. 230, 255 P. 2d 1033.
9
Smith v. Zeagler, 157 So. 328 Fla. (1934), citing Ruth v. Johnson,
(C.C.A.) 172 F. 191; Reeves v. Lutz, 179 Mo. App. 61, 162 S.W. 280;
Rayburn v. Day, 126 Or. 135, 68 P. 1002, 59 A.L.R. 1062; Wynne v.
Harvey, 96 Wash. 379, 165 P. 67; Harris v. Fall (C.C.A.), 177 F. 79,
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Of course, the Court is not blind to the reality that there

are times when danger to a patients life precludes a
surgeon from further searching missing sponges or foreign
objects left in the body. But this does not leave him free
from any obligation. 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 10
her condition might
permit. The ruling in Smith v. Zeagler is explicit, thus:
The removal of all sponges used is part of a surgical operation, and
when a physician or surgeon fails to remove a sponge he has placed
in his patients body that should be removed as part of the
operation, he thereby leaves his operation uncompleted and
creates a new condition which imposes upon him the legal
duty of calling the new condition to his patients attention,
and endeavoring with the means he has at hand to minimize
and avoid untoward results likely to ensue therefrom.
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. Had he been more candid, Natividad could
have taken the immediate and appropriate medical remedy
to remove the gauzes from her body. To our mind, what was
initially an act of negligence by Dr. Ampil has ripened into
a deliberate wrongful act of deceiving his patient.
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
_______________
27 L.R.A. (N.S.) 1174; Moore v. Ivey, (Tex. Civ. App.) 264 S.W. 283; 21
R.C. L. 388.
10
157 So. 328 Fla. (1934)

492
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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
11
patient. Simply put, 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
12
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. 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
_______________
11
Garcia-Rueda v. Pascasio, G.R. No. 118141, September 5, 1997, 278
SCRA 769.
12
In the leading case of Vda. de Bataclan v. Medina, (102 Phil. 181
[1957]), this Court laid down the following definition of proximate cause
in this jurisdiction as follows:
[T]hat cause, which, in natural and continuous sequence unbroken by any
efficient intervening cause, produces the injury and without which the result
would not have occurred. And more comprehensively, the proximate cause is
that acting first and producing the injury, either immediately or by setting
other events in motion, all constituting a natural and continuous chain of
events, each having a close causal connection with the immediate predecessor,
the final event in the chain immediately effecting the injury as a natural and
probable result of the cause which first acted, under which circumstances that
the person responsible for the first event should, as an ordinarily prudent and
intelligent person, have reasonable ground to expect at the moment of his act
or default that an injury to some person might probably result therefrom.
Page 16 of 34
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493
VOL. 513, JANUARY 31, 2007
493

his deliberate concealment of the missing gauzes from the
knowledge of Natividad and her family.
IIG.R. No. 126467
Whether the Court of Appeals Erred in Absolving Dr.
Fuentes of any Liability
The Aganas assailed the dismissal by the trial court of the
case against Dr. Fuentes on the ground that it is contrary
to the doctrine of res ipsa loquitur. According to them, the
fact that the two pieces of gauze were left inside
Natividads body is a prima facie evidence of Dr. Fuentes
negligence.
We are not convinced.
Literally, res ipsa loquitur means the thing speaks for
itself. It is the rule that the fact of the occurrence of an
injury, taken with the surrounding circumstances, may
permit an inference or raise a presumption of negligence, or
make out a plaintiff s prima facie case, and present a
question of13 fact for defendant to meet with an
explanation. Stated differently, where the thing which
caused the injury, without the fault of the injured, is under
the exclusive control of the defendant and the injury is
such that it should not have occurred if he, having such
control used proper care, it affords reasonable evidence, in
the absence of explanation that the injury arose from the
defendants want of care, and the burden of proof is shifted
to him to14 establish that he has observed due care and
diligence.
From the foregoing statements of the rule, the requisites
for the applicability of the doctrine of res ipsa loquitur are:
(1) the occurrence of an injury; (2) the thing which caused
the injury was under the control and management of the
defen_______________
Page 17 of 34
13
8/31/16, 11:42 PM
Ramos v. Court of Appeals, G.R. No. 124354, December 29, 1999,
321 SCRA 584.

14
Africa v. Caltex (Phils.) Inc., 123 Phil. 280; 16 SCRA 448 (1966).
494
494

dant; (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
requisites, the most instrumental is the control
and
15
management of the thing which caused the injury.
We find the element of control and management of the
thing which caused the injury to be wanting. Hence, the
doctrine of res ipsa loquitur will not lie.
It was duly established that Dr. Ampil was the lead
surgeon during the operation of Natividad. He requested
the assistance of Dr. Fuentes only to perform hysterectomy
when he (Dr. Ampil) found that the malignancy in her
sigmoid area had spread to her left ovary. Dr. Fuentes
performed the surgery and thereafter reported and showed
his work to Dr. Ampil. The latter examined it and finding
everything to be in order, allowed Dr. Fuentes to leave the
operating room. Dr. Ampil then resumed operating on
Natividad. He was about to finish the procedure when the
attending nurses informed him that two pieces of gauze
were missing. A diligent search was conducted, but the
misplaced gauzes were not found. Dr. Ampil then directed
that the incision be closed. During this entire period, Dr.
Fuentes was no longer in the operating room and had, in
fact, left the hospital.
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
16
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
Page 18 of 34
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_______________
15
Ranos v. Court of Appeals, supra. In Ramos, the phrase used is
control of the instrumentality which caused the damage, citing St.

Johns Hospital and School of Nursing v. Chapman, 434 P2d 160 (1967).
16
Rural Educational Assn v. Bush, 42 Tenn. App. 34, 298 S.W. 2d 761
(1956).
495
VOL. 513, JANUARY 31, 2007
495

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.
In this jurisdiction, res ipsa loquitur is not a rule of
substantive law, hence, does not per se create or constitute
an independent or separate
ground of liability, being a
17
mere evidentiary rule. In other words, mere invocation
and application of the doctrine does not dispense with the
requirement of proof of negligence. Here, the negligence
was proven to have been committed by Dr. Ampil and not
by Dr. Fuentes.
IIIG.R. No. 126297
Whether PSI Is Liable for the Negligence of Dr. Ampil
The third issue necessitates a glimpse at the historical
development of hospitals and the resulting theories
concerning their liability for the negligence of physicians.
Until the mid-nineteenth century, hospitals were
generally charitable institutions, providing medical
services to the lowest classes
of society, without regard for a
18
patients ability to pay. Those who could afford medical
19
treatment were usually treated at home by their doctors.
Page 19 of 34
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However, the days of house calls and philanthropic health

care are over. The modern health care industry continues
to distance itself from its
_______________
17
Ramos v. Court of Appeals, supra at footnote 13.
18
Levin, Hospital Vicarious Liability for Negligence by Independent
Contractor Physicians: A New Rule for New Times, October 17, 2005.
19
Id.
496
496

charitable past and has experienced a significant

conversion from a not-for-profit health care to for-profit
hospital businesses. Consequently, significant changes in
health law have accompanied the business-related changes
in the hospital industry. One important legal change is an
increase in hospital liability for medical malpractice. Many
courts now allow claims for hospital vicarious liability
under the theories of respondeat superior, apparent
20
authority, ostensible authority, or agency by estoppel.
In this jurisdiction, the statute governing liability for
negligent acts is Article 2176 of the Civil Code, which
reads:
Art. 2176. Whoever by act or omission causes damage to another,
there being fault or negligence, is obliged to pay for the damage
done. Such fault or negligence, if there is no pre-existing
contractual relation between the parties, is called a quasi-delict and
is governed by the provisions of this Chapter.
A derivative of this provision is Article 2180, the rule

governing vicarious liability under the doctrine of
respondeat superior, thus:
ART. 2180. The obligation imposed by Article 2176 is demandable
not only for ones own acts or omissions, but also for those of
persons for whom one is responsible.
xxx
xxx
Page 20 of 34
8/31/16, 11:42 PM
The owners and managers of an establishment or enterprise are

likewise responsible for damages caused by their employees in the
service of the branches in which the latter are employed or on the
occasion of their functions.
Employers shall be liable for the damages caused by their
employees and household helpers acting within the scope of their
assigned tasks even though the former are not engaged in any
business or industry.
xxx
xxx
_______________
20
Id.
497
VOL. 513, JANUARY 31, 2007
497

The responsibility treated of in this article shall cease when the
persons herein mentioned prove that they observed all the diligence
of a good father of a family to prevent damage.
A prominent civilist commented that professionals engaged

by an employer, such as physicians, dentists, and
pharmacists, are not employees under this article because
the manner in which they perform their work is not within
the control of the latter (employer). In other words,
professionals are considered personally liable for the fault
or negligence they commit in the discharge of their duties,
and their employer cannot be held liable for such fault or
negligence. In the context of the present case, a hospital
cannot be held liable for the fault or negligence of a
physician 21or surgeon in the treatment or operation of
patients.
The foregoing view is grounded on the traditional notion
that the professional status and the very nature of the
physicians calling preclude him from being classed as an
agent or employee of22a hospital, whenever he acts in a
professional capacity. It has been said that medical
practice strictly
involves highly developed and specialized
23
knowledge, such that physicians are generally free to
Page 21 of 34
8/31/16, 11:42 PM
exercise their own skill

_______________
21
Tolentino, The Civil Code of the Philippines, Volume V, 1992 Ed., p.
616.
22
Arkansas M.R. Co. v. Pearson, 98 Ark. 442, 153 SW 595 (1911);
Runyan v. Goodrum, 147 Ark. 281, 228 SW 397, 13 ALR 1403 (1921);
Rosane v. Senger, 112 Colo. 363, 149 P. 2d 372 (superseded by statute on
other grounds); Moon v. Mercy Hosp., 150 Col. 430, 373 P. 2d 944 (1962);
Austin v. Litvak, 682 P. 2d 41, 50 ALR 4th 225 (1984); Western Ins. Co. v.
Brochner, 682 P. 2d 1213 (1983); Rodriguez v. Denver, 702 P. 2d 1349
(1984).
23
Arkansas M.R. Co. v. Pearson, Id.; Nieto v. State, 952 P. 2d 834
(1997). But see Beeck v. Tucson General Hosp., 18 Ariz. App. 165, 500 P.
2d 1153 (1972); Paintsville Hosp. Co., 683 SW 2d 255 (1985); Kelley v.
Rossi, 395 Mass. 659, 481 NE 2d 1340 (1985) which held that a
physicians professional status does not prevent him or her from being a
servant or agent of the hospital.
498
498

and judgment
in rendering medical services sans
24
interference. Hence, when a doctor practices medicine in a
hospital setting, the hospital and its employees are deemed
to subserve him in his ministrations25 to the patient and his
actions are of his own responsibility.
The 26
case of Schloendorff v. Society of New York
Hospital was then considered an authority for this view.
The Schloendorff doctrine regards a physician, even if
employed by a hospital, as an independent contractor
because of the skill he exercises and the lack of control
exerted over his work. Under this doctrine, hospitals are
exempt from the application of the respondeat superior
principle for fault or negligence committed by physicians in
the discharge of their profession.
However, the efficacy of the foregoing doctrine has
weakened with the significant developments in medical
care. Courts came to realize that modern hospitals are
Page 22 of 34
8/31/16, 11:42 PM
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,27 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
_______________
24
Fridena v. Evans, 127 Ariz. 516, 522 P. 2d 463 (1980).
25
Kitto v. Gilbert, 39 Colo App 374, 570 P. 2d 544 (1977).
26
211 N.Y. 125, 105 N.E. 92, 52 L.R.A., N.S., 505 (1914). The court in
Schloendorff opined that a hospital does not act through physicians but
merely procures them to act on their own initiative and responsibility.
For subsequent application of the doctrine, see for instance, Hendrickson
v. Hodkin, 250 App. Div 649, 294 NYS 982, revd on other grounds, 276
NY 252, 11 NE 2d 899 (1937); Necolayff v. Genesee Hosp., 270 App. Div.
648, 61 NYS 2d 832, affd 296 NY 936, 73 NE2d 117 (1946); Davie v.
Lenox Hill Hosp., Inc., 81 NYS 2d 583 (1948); Roth v. Beth El Hosp., Inc.,
279 App. Div 917, 110 NYS 2d 583 (1952); Rufino v. US, 126 F. Supp. 132
(1954); Mrachek v. Sunshine Biscuit, Inc., 308 NY 116, 123 N.E. 2d 801
(1954).
27
2 NY 2d 656, 163 NYS 2d 3, 143 N.E. 2d 3 (1957).

499
VOL. 513, JANUARY 31, 2007
499

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
28
Appeals that for purposes of apportioning responsibility in
Page 23 of 34
8/31/16, 11:42 PM
medical
negligence
cases,
an
employer-employee
relationship in effect exists between hospitals and their
attending and visiting physicians. This Court held:
We now discuss the responsibility of the hospital in this particular
incident. The unique practice (among private hospitals) of filling up
specialist staff with attending and visiting consultants, who are
allegedly not hospital employees, presents problems in apportioning
responsibility for negligence in medical malpractice cases. However,
the difficulty is more apparent than real.
In the first place, hospitals exercise significant control in
the hiring and firing of consultants and in the conduct of
their work within the hospital premises. Doctors who apply
for consultant slots, visiting or attending, are required to
submit proof of completion of residency, their educational
qualifications, generally, evidence of accreditation by the
appropriate board (diplomate), evidence of fellowship in
most cases, and references. These requirements are
carefully scrutinized by members of the hospital
administration or by a review committee set up by the
hospital who either accept or reject the application. x x x.
After a physician is accepted, either as a visiting or
attending consultant, he is normally required to attend
clinicopathological conferences, conduct bedside rounds for
clerks, interns and residents, moderate grand rounds and
patient audits and perform other tasks and responsibilities,
for the
_______________
28
Supra at footnote 13.
500
500

privilege of being able to maintain a clinic in the hospital,

and/or for the privilege of admitting patients into the
hospital. In addition to these, the physicians performance as a
specialist is generally evaluated by a peer review committee on the
basis of mortality and morbidity statistics, and feedback from
Page 24 of 34
8/31/16, 11:42 PM
patients, nurses, interns and residents. A consultant remiss in

his duties, or a consultant who regularly falls short of the
minimum standards acceptable to the hospital or its peer
review committee, is normally politely terminated.
In other words, private hospitals, hire, fire and exercise
real control over their attending and visiting consultant
staff. While consultants are not, technically employees, x x
x, the control exercised, the hiring, and the right to
terminate consultants all fulfill the important hallmarks of
an employer-employee relationship, with the exception of
the payment of wages. In assessing whether such a relationship
in fact exists, the control test is determining. Accordingly, on the
basis of the foregoing, we rule that for the purpose of
allocating responsibility in medical negligence cases, an
employeremployee 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 of apparent 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
29
agency by estoppel, has its origin from the law of agency. It
_______________
29
Blacks Law Dictionary (6th Ed. 1990) 1100. The terms ostensible
agency, agency by estoppel, apparent authority, and holding out

tend to be used interchangeably by the courts to refer to this theory of
liability. See for instance, Baker v. Werner, 654 P2d 263 (1982) and
Adamski v. Tacoma Gen. Hosp., 20 Wash App. 98,
501
VOL. 513, JANUARY 31, 2007
501

Page 25 of 34
8/31/16, 11:42 PM
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 30into 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
31
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 Hos_______________
579 P2d 970 (1978). Agency by estoppel is defined as one created by
operation of law and established by proof of such acts of the principal as
reasonably lead third persons to the conclusion of its existence. Arises
where principal by negligence in failing to supervise agents affairs,
allows agent to exercise powers not granted to him, thus justifying others
in believing the agent possesses requisite authority. Blacks, supra, p.
62. An ostensible agency is an implied or presumptive agency which
exists where one, either intentionally or from want of ordinary care,
induces another to believe that a third person is his agent, though he
never in fact, employed him. It is, strictly speaking, no agency at all, but
is in reality based entirely upon estoppel. Apparent authority refers to
the power to affect the legal relations of another person by transactions
with third persons, professedly as agent for the other, arising from and in
accordance with the others manifestations to such third persons. Supra,
p. 96.
30
Irving v. Doctors Hospital of Lake Worth, Inc., 415 So. 2d 55 (1982),
quoting Arthur v. St. Peters Hospital, 169 N.J. 575, 405 A. 2d 443 (1979).
31
Id., citing Hudson v. C., Loan Assn., Inc. v. Horowytz, 116 N.J.L.
605, 608, 186 A 437 (Sup. Ct. 1936).

502
Page 26 of 34
502
8/31/16, 11:42 PM

32
pital 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:
Page 27 of 34
8/31/16, 11:42 PM
_______________
32
Supra.
503
VOL. 513, JANUARY 31, 2007
503

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
33
independent or employed.
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.
We now proceed to the doctrine of corporate negligence or
corporate responsibility.
One allegation in the complaint in Civil Case No. Q43332 for negligence and malpractice is that PSI as owner,
operator and manager of Medical City Hospital, did not
perform the necessary supervision nor exercise diligent
efforts in the supervision of Drs. Ampil and Fuentes and its
nursing staff, resident doctors, and medical interns who
assisted Drs. Ampil 34and Fuentes in the performance of their
duties as surgeons. Premised on the doctrine of corporate
negligence, the trial court held that PSI is directly liable for
Page 28 of 34
8/31/16, 11:42 PM
such breach of duty.

We agree with the trial court.
_______________
33
RTC Decision, p. 9, Rollo of G.R. No. 126467, p. 127.
34
RTC Decision, p. 2, Rollo of G.R. No. 126467, p. 120.

504
504

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
35
inherent responsibility to provide quality medical care.
The doctrine has 36its genesis in Darling v. Charleston
Community Hospital. There, the Supreme Court of Illinois
held that the jury could have found a hospital negligent,
inter alia, in failing to have a sufficient number of trained
nurses attending the patient; failing to require a
consultation with or examination by members of the
hospital staff; and failing to review the treatment rendered
to the patient. On the basis of Darling, other jurisdictions
held that a hospitals corporate negligence extends to
permitting a physician
known to be incompetent to practice
37
at the hospital. With the passage of time, more duties
were expected from hospitals, among them: (1) the use of
reasonable care in the maintenance of safe and adequate
facilities and equipment; (2) the selection and retention of
competent physicians; (3) the overseeing or supervision of all
persons who practice medicine within its walls; and (4) the
Page 29 of 34
8/31/16, 11:42 PM
formulation, adoption and enforcement of adequate rules

_______________
35
Purcell v. Zimbelman, 18 Ariz. App. 75, 500 P2d 335 (1972).
36
Supra at footnote 1.
37
Corleto v. Hospital, 138 N.J. Super. 302, 350 A. 2d 534 (Super. Ct.
Law Div.1975); Purcell v. Zimbelman, 18 Ariz. App. 75,500 P. 2d 335

(1972); Hospital Authority v. Joiner, 229 Ga. 140,189 S.E. 2d 412 (1972).
505
VOL. 513, JANUARY 31, 2007
505

38
and policies that ensure quality care for its patients.

39
Thus, in Tucson Medical Center, Inc. v. Misevich, it was
held that a hospital, following 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 supervision40of the members of its
medical staff. And in Bost v. Riley, the court concluded
that a patient who enters a hospital does so with the
reasonable expectation that it will attempt to cure him. The
hospital accordingly has the duty to make a reasonable
effort to monitor and oversee the treatment prescribed and
administered by the physicians practicing in its premises.
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:
x x x 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
Page 30 of 34
8/31/16, 11:42 PM
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.
_______________
38
Welsh v. Bulger, 548 Pa. 504, 698 A.2d 581 (1997).
39
115 Ariz. 34, 545 P2d 958 (1976).
40
262 S.E. 2d 391, cert denied 300 NC 194, 269 S.E. 2d 621 (1980).
506
506

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
41
were missing. In Fridena v. Evans, it was held that a
corporation is bound by the knowledge acquired by or
notice given to its agents or officers within the scope of
their authority and in reference to a matter to which their
authority extends. This means that the knowledge of any of
the staff of Medical City Hospital constitutes knowledge of
PSI. Now, the failure of PSI, despite the attending nurses
report, to investigate and inform Natividad regarding the
missing gauzes amounts to callous negligence. Not only did
PSI breach its duties to oversee or supervise all persons who
practice medicine within its walls, it also failed to take an
active step in fixing the negligence committed. This renders
PSI, not only vicariously liable for the negligence of Dr.
Ampil under Article 2180 of the Civil Code, but also
directly liable for its own negligence under Article 2176.
In Fridena, the Supreme Court of Arizona held:
Page 31 of 34
8/31/16, 11:42 PM
x x x In recent years, however, the duty of care owed to the patient

by the hospital has expanded. The emerging trend is to hold the
hospital responsible where the hospital has failed to
monitor and review medical services being provided within
its walls. See Kahn Hospital Malpractice Prevention, 27 De Paul
Rev. 23 (1977).
Among the cases indicative of the emerging trend is Purcell v.
Zimbelman, 18 Ariz. App. 75,500 P. 2d 335 (1972). In Purcell, the
hospital argued that it could not be held liable for the malpractice of
a medical practitioner because he was an independent contractor
within the hospital. The Court of Appeals pointed out that the
hospital had created a professional staff whose competence
_______________
41
127 Ariz. 516, 622 P. 2d 463 (1980).
507
VOL. 513, JANUARY 31, 2007
507

and performance was to be monitored and reviewed by the
governing body of the hospital, and the court held that a
hospital would be negligent where it had knowledge or
reason to believe that a doctor using the facilities was
employing a method of treatment or care which fell below
the recognized standard of care.
Subsequent to the Purcell decision, the Arizona Court of
Appeals held that a hospital has certain inherent
responsibilities regarding the quality of medical care
furnished to patients within its walls and it must meet the
standards of responsibility commensurate with this
undertaking. Beeck v. Tucson General Hospital, 18 Ariz. App. 165,
500 P. 2d 1153 (1972). This court has confirmed the rulings of the
Court of Appeals that a hospital has the duty of supervising the
competence of the doctors on its staff. x x x.
xxx
xxx
In the amended complaint, 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. We find that such
Page 32 of 34
8/31/16, 11:42 PM
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.
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.
One final word. 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
508
508

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.
WHEREFORE, we DENY all the petitions and AFFIRM
the challenged Decision of the Court of Appeals in CA-G.R.
CV No. 42062 and CA-G.R. SP No. 32198.
Costs against petitioners PSI and Dr. Miguel Ampil.
SO ORDERED.
Puno (C.J., Chairperson), Corona and Azcuna, JJ.,
concur.
Garcia, J., No part.
Petitions denied, challenged CA decision in CA-G.R. No.
CV No. 42062 and CA-G.R. SP No. 32198 affirmed.
Note.Under
the
Captain-of-the-Ship
Doctrine,
a
Page 33 of 34
8/31/16, 11:42 PM
surgeon is likened to a captain of the ship in that it is his

duty to control everything going on in the operating room.
(Ramos vs. Court of Appeals, 380 SCRA 467 [2002])
o0o
509
Copyright 2016 Central Book Supply, Inc. All rights reserved.
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SUPREME COURT REPORTS ANNOTATED VOLUME 513

SUPREME COURT REPORTS ANNOTATED

G.R. No. 126297. January 31, 2007.

PROFESSIONAL SERVICES, INC., petitioner,

G.R. No. 126467. January 31, 2007.

NATIVIDAD and ENRIQUE AGANA, respondents.

G.R. No. 127590. January 31, 2007.

MIGUEL AMPIL, petitioner, vs. NATIVIDAD AGANA and

VOL. 513, JANUARY 31, 2007

Professional Services, Inc. vs. Agana

SUPREME COURT REPORTS ANNOTATED VOLUME 513

closed is at least prima facie negligence by the operating surgeon.

SUPREME COURT REPORTS ANNOTATED VOLUME 513

SUPREME COURT REPORTS ANNOTATED

not have happened if those who had control or management used

SUPREME COURT REPORTS ANNOTATED VOLUME 513

relationship between the hospital and the physicians is rendered

VOL. 513, JANUARY 31, 2007

Professional Services, Inc. vs. Agana

SUPREME COURT REPORTS ANNOTATED VOLUME 513

Same; Same; Same; In cases where it can be shown that a

SUPREME COURT REPORTS ANNOTATED

that a patient has accepted treatment from that physician in the

SUPREME COURT REPORTS ANNOTATED VOLUME 513

for its patients. As expected, these patients, Natividad being one of

PETITION for review on certiorari of the decisions of the

VOL. 513, JANUARY 31, 2007

Professional Services, Inc. vs. Agana

SUPREME COURT REPORTS ANNOTATED VOLUME 513

Medical City General Hospital (Medical City Hospital)

Darling v. Charleston Community Memorial Hospital, 33 Ill. 2d 326, 211

Penned by Associate Justice Cancio C. Garcia (now a member of the

Supreme Court) and concurred in by Associate Justices Eugenio S.

Penned by Judge Lucas P. Bersamin (now Justice of the Court of

Appeals), Rollo, G.R. No. 126647, pp. 69-83.

SUPREME COURT REPORTS ANNOTATED

On April 11, 1984, Dr. Ampil, assisted by the medical staff

SUPREME COURT REPORTS ANNOTATED VOLUME 513

On April 24, 1984, Natividad was released from the

The medical staff was composed of physicians, both residents and

interns, as well as nurses.

VOL. 513, JANUARY 31, 2007

Professional Services, Inc. vs. Agana

SUPREME COURT REPORTS ANNOTATED VOLUME 513

the vagina. Another surgical operation was needed to

SUPREME COURT REPORTS ANNOTATED

On March 17, 1993, the RTC rendered its Decision in favor

SUPREME COURT REPORTS ANNOTATED VOLUME 513

a. The equivalent in Philippine Currency of the total of

Aggrieved, PSI, Dr. Fuentes and Dr. Ampil interposed an

VOL. 513, JANUARY 31, 2007

Professional Services, Inc. vs. Agana

SUPREME COURT REPORTS ANNOTATED VOLUME 513

of PSI and Dr. Fuentes. On September 21, 1993, the RTC

The dispositive portion reads:

WHEREFORE, let a writ of preliminary injunction be issued upon

Rollo of G.R. No. 126467, pp. 84-89.

SUPREME COURT REPORTS ANNOTATED

On September 6, 1996, the Court of Appeals rendered its

SUPREME COURT REPORTS ANNOTATED VOLUME 513

with the pronouncement that defendant-appellant Dr. Miguel Ampil

Only Dr. Ampil filed a motion

Rollo of G.R. No. 127590, p. 40.