PROFESSIONAL SERVICES v. NATIVIDAD

FACTS:

On April 4, 1984, Natividad Agana underwent surgery performed by Dr. Miguel Ampil and assisted by Dr. Juan Fuentes. After the operation, it was discovered that two gauzes were missing. Despite efforts to find them, the gauzes were not recovered. Dr. Ampil did not inform Natividad about the missing gauzes and misled her by stating that her pain was a normal consequence of the surgery. Natividad continued to experience pain and sought further treatment in the United States. She eventually returned to the Philippines and another piece of gauze was extracted from her body. Natividad underwent another surgery to remedy the damage caused by the gauze. On November 12, 1984, Natividad and her husband filed a complaint for damages against PSI, Dr. Ampil, and Dr. Fuentes. Natividad passed away in February 1986, and her children were substituted as plaintiffs in the case.

The Regional Trial Court found Dr. Ampil and Dr. Fuentes, as well as PSI, liable for negligence and ordered them to pay damages. The defendants appealed to the Court of Appeals, but the plaintiffs filed a motion for partial execution, resulting in the seizure and sale of properties belonging to Dr. Ampil. However, the parties agreed to suspend further execution. The plaintiffs later filed a motion for an alias writ of execution against PSI and Dr. Fuentes, which was granted. Dr. Fuentes filed a petition for certiorari before the Court of Appeals, which granted his prayer for injunctive relief. The appeals of both cases were consolidated. During the appeals, the PRC Board of Medicine dismissed the case against Dr. Fuentes. The Court of Appeals affirmed the liability of PSI and Dr. Ampil but dismissed the case against Dr. Fuentes. PSI and Dr. Ampil separately filed petitions for review before the Supreme Court, raising issues regarding their liability.

ISSUES:

  1. Whether the doctrine of res ipsa loquitur applies in this case.

  2. Whether PSI is liable for the negligence of Dr. Ampil.

  3. Whether or not a hospital can be held liable for the fault or negligence of a physician in the treatment or operation of patients.

  4. Whether or not an employer-employee relationship exists between hospitals and their attending and visiting physicians.

  5. Whether the doctrine of apparent authority is applicable in hospital liability cases.

  6. Whether the hospital can be held liable for the negligence of its accredited physicians under the doctrine of apparent authority.

  7. Whether the doctrine of corporate negligence can be applied to hold the hospital directly liable for the negligence of its healthcare practitioners.

  8. Whether or not PSI, as the operator of Medical City Hospital, has the duty to exercise reasonable care to protect patients admitted into its facility.

  9. Whether or not PSI is directly liable for its own negligence in failing to investigate and inform the patient concerning the missing gauzes.

  10. Whether the hospital can be held liable for the patient's injuries based on the theory of negligent supervision.

  11. Whether PSI is solidarily liable with Dr. Ampil for damages.

RULING:

  1. The doctrine of res ipsa loquitur does not apply in this case. The essential element of "control and management of the thing which caused the injury" is lacking. Dr. Ampil, as the lead surgeon, was in complete charge of the surgery room, and it was his order to close the incision despite the missing gauzes. Therefore, the control and management of the thing which caused the injury was in the hands of Dr. Ampil, not Dr. Fuentes.

  2. PSI is not liable for the negligence of Dr. Ampil. Under Article 2176 of the Civil Code, whoever causes damage to another by act or omission due to fault or negligence is obliged to pay for the damage done. A derivative of this provision is Article 2180, which governs vicarious liability under the doctrine of respondeat superior. However, professionals engaged by an employer, such as physicians, dentists, and pharmacists, are not considered "employees" under Article 2180 because the employer does not have control over how they perform their work. Therefore, in this case, the negligence was proven to have been committed by Dr. Ampil and not by PSI.

  3. Yes, a hospital can be held liable for the fault or negligence of a physician in the treatment or operation of patients based on the doctrine of apparent authority or agency by estoppel and the doctrine of corporate negligence.

  4. An employer-employee relationship exists between hospitals and their attending and visiting physicians based on the control test and the exercise of significant control in the hiring, firing, and conduct of work within the hospital premises.

  5. The doctrine of apparent authority is applicable in hospital liability cases.

  6. The hospital can be held liable for the negligence of its accredited physicians under the doctrine of apparent authority.

  7. The doctrine of corporate negligence can be applied to hold the hospital directly liable for the negligence of its healthcare practitioners.

  8. Yes, PSI, as the operator of Medical City Hospital, has the duty to exercise reasonable care to protect patients admitted into its facility.

  9. Yes, PSI is directly liable for its own negligence in failing to investigate and inform the patient concerning the missing gauzes.

  10. The hospital can be held liable for the patient's injuries based on the theory of negligent supervision. The court found that the hospital's alleged negligence in supervising its employees, particularly Dr. Ampil, was the proximate cause of the patient's injuries. The general allegations of negligence, along with the evidence presented during the trial, were deemed sufficient to support the hospital's liability.

  11. PSI is solidarily liable with Dr. Ampil for damages. PSI, in its defense, failed to provide evidence showing that it exercised the diligence of a good father of a family in accrediting and supervising Dr. Ampil. The court held that PSI's failure to meet its burden of proof under Article 2180 of the Civil Code renders it solidarily liable with Dr. Ampil.

PRINCIPLES:

  • The doctrine of res ipsa loquitur requires the occurrence of an injury, the thing causing the injury was under the control and management of the defendant, the occurrence would not have happened if proper care was used, and the absence of explanation by the defendant.

  • Under the "Captain of the Ship" rule, the operating surgeon is in complete charge of the surgery room and all personnel connected with the operation, and their duty is to obey the orders of the lead surgeon.

  • Res ipsa loquitur is not a rule of substantive law but a mere evidentiary rule. Its invocation does not dispense with the requirement of proof of negligence.

  • Liability for negligent acts is governed by Article 2176 of the Civil Code. Vicarious liability under the doctrine of respondeat superior is governed by Article 2180. However, professionals engaged by an employer are not considered "employees" under Article 2180 because the employer does not have control over how they perform their work.

  • Professionals, such as physicians, are 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.

  • The traditional notion considers physicians as independent contractors due to their highly developed and specialized knowledge and the lack of control exerted over their work.

  • 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.

  • Modern hospitals are increasingly taking an active role in supplying and regulating medical care to patients, thus weakening the efficacy of the "Schloendorff doctrine."

  • The New York Court of Appeals deviated from the "Schloendorff doctrine" in Bing v. Thunig, concluding that there is no reason to exempt hospitals from the universal rule of respondeat superior.

  • In the Philippines, an employer-employee relationship exists between hospitals and their attending and visiting physicians, based on the control test and the exercise of significant control in the hiring, firing, and conduct of work within the hospital premises.

  • Private hospitals exercise control, hire and fire, and evaluate the performance of their attending and visiting consultants, fulfilling the important hallmarks of an employer-employee relationship, except for the payment of wages.

  • Apparent authority or agency by estoppel and the doctrine of corporate negligence are additional bases for a hospital's liability for the negligent acts of health professionals.

  • Apparent authority, also known as the "holding out" theory or doctrine of ostensible agency or agency by estoppel, imposes liability on a principal or employer based on its actions in misleading the public into believing that a relationship or authority exists. The principal is bound by the acts of its agent with apparent authority, which the principal knowingly permits the agent to assume or which the principal holds the agent out to the public as possessing. The hospital will be liable for the physician's negligence if it holds out the physician as its agent and the patient accepts treatment in the reasonable belief that it is being rendered on behalf of the hospital.

  • Our jurisdiction recognizes the concept of an agency by implication or estoppel. It may be implied from the acts of the principal, from its silence or lack of action, or its failure to repudiate the agency, knowing that another person is acting on its behalf without authority.

  • The doctrine of corporate negligence holds hospitals directly liable for the negligent acts of health practitioners, absent facts to support the application of respondeat superior or apparent authority. Hospitals have a duty to provide quality medical service and need to monitor the competence and performance of their medical staff.

  • Hospitals have a duty to exercise reasonable care in the maintenance of safe and adequate facilities and equipment.

  • Hospitals have a duty to select and retain competent physicians and oversee or supervise all persons who practice medicine within its walls.

  • Hospitals have a duty to formulate, adopt, and enforce adequate rules and policies that ensure quality care for its patients.

  • Hospitals can be held responsible for the negligence of physicians practicing within its premises.

  • Hospitals have a duty to investigate and address reports of mistake or negligence concerning patients' treatment.

  • The knowledge of any staff member of a hospital is deemed knowledge of the hospital itself.

  • Hospitals can be held liable for failing to monitor and review medical services provided within its walls and for employing medical practitioners who fall below the recognized standard of care.

  • Once a physician undertakes the treatment and care of a patient, the law imposes certain obligations on him. He must possess the reasonable degree of learning, skill, and experience required by his profession. He must also apply reasonable care, diligence, and judgment in the exercise of his skill and knowledge.

  • A hospital can be held liable for the negligence of its employees and agents, such as physicians, under the theory of negligent supervision.

  • In determining the liability of the hospital, the court may consider general allegations of negligence along with the evidence presented during trial.

  • A party claiming negligent supervision must show that the negligence of the supervisor was the proximate cause of the injuries suffered by the patient.

  • The burden of proof is on the party claiming that the employer or principal is liable for the tortious acts of its employee or agent.

  • A party claiming that a party is solidarily liable with another must provide sufficient evidence to prove such liability.