Facts:

April 4, 1984 - Natividad Agana was under the care of Medical City General Hospital (MCH) owned by PSI, examined by Dr.
Ampil for cancer of the sigmoid. During her Operation by Dr. Ampil and Dr. Fuentes sponges were left inside her body after
closing the incision. After her discharge she complained of extreme pain in her anal region. Dr. Ampil and Fuentes told her these
were natural due to surgery. Dr Ampil suggested she seek further examination for her cancer.
Agana then went to the US but after 4 months of examinations was told that she was cancer free. After returning to the
Philippines, still suffering, her daughter found a 1.5 inch gauze protruding from her vagina. Dr. Ampil was called and extracted
the gauze, assuring her that her pains would vanish, instead the pains intensified soon after.
Agana then went to PGHospital where Dr. Gutierrez found another gauze 1.5 inside her vagina. In October 1984 she had
another surgery.
RTC,CA, PRC - PSI and Ampil were found liable, Fuentes was absolved.
Issues:
1) is Dr. Ampil liable for negligence and malpractice;
2) is Dr. Fuentes absolved of any liability;
3) may PSI be held solidarily liable for the negligence of Dr. Ampil.
Held:
1) Yes. Ampil was in charge of the operation and closing the incision, despite warning from the nurses of missing sponge count.
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. Even if there were emergencies necessitating the prompt closure despite the sponge count
(which he failed to show), the Dr is still duty bound to inform the patient of the consequences of such act. 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. What was initially an act of negligence by Dr. Ampil has ripened into a deliberate
wrongful act of deceiving his patient.
The Patient must only prove that a health care provider either failed to do something which a reasonably prudent health care
provider would have done, or that he did something that a reasonably prudent provider would not have done; and that failure or
action caused injury to the patient.
Medical malpractice and negligence - the elements are: duty, breach, injury and proximate causation.
2) Dr. Fuentes is absolved of any Liability he cannot be liable under res ipsa loquitur.
Doctrine of res ipsa loquitur: (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 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." We find the element of
"control and management of the thing which caused the injury" to be wanting in this case. Hence, the doctrine of res ipsa
loquitur will not lie.
Dr. Ampil was the lead surgeon. He requested Dr. Fuentes only to perform hysterectomy, Ampil latter examined Fuentes' work
and finding everything to be in order, allowed Dr. Fuentes to leave the operating room, after Fuentes was no longer in the
operating room, Dr. Ampil was informed of missing sponges but ordered closing the incision.
Under the "Captain of the Ship" rule, the operating surgeon is the person in complete charge of the surgery room and all
personnel connected with the operation. Their duty is to obey his orders. the control and management of the thing which caused
the injury was in the hands of Dr. Ampil, not Dr. Fuentes.
3) Yes. Psi is liable for the negligence of Dr. Ampil * Ramos v. Court of Appeals - for purposes of apportioning responsibility in medical negligence cases, an employer-employee
relationship in effect exists between hospitals and their attending and visiting physicians.
Private hospitals, hire, fire and exercise real control over their attending and visiting consultant staff. While consultants are
not, technically employees, 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 employer-employee relationship in effect exists between hospitals
and their attending and visiting physicians. "
** Apparent authority, or what is sometimes referred to as the "holding out" theory, or doctrine of ostensible agency or agency
by estoppel,
"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.
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. 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."
*** the Doctrine of Corporate Negligence or Corporate Responsibility.

Duties expected from hospitals: (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 formulation, adoption and enforcement of adequate rules and policies that ensure quality care for its
patients.
the duty to see that it meets the standards of responsibilities for the care of patients. Such duty includes the proper supervision
of the members of its medical staff.
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.
PSI is liable for failure to conduct investigation of the matter reported in the sponge count record. PSI became part of the
concealment of the gauzes. The operation was also assisted by MCH staff.
In Fridena v. Evans (US case), 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.
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.
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.