Professional Documents
Culture Documents
Petitioner,
- versus -
Respondents.
x-----------------------x
Petitioners,
- versus -
JUAN FUENTES,
Respondent.
x- - - - - - - - - - - - - - - - - - - -- - - - x
MIGUEL AMPIL,
Petitioner,
- versus -
Present:
CORONA,
AZCUNA, and
*GARCIA, JJ.
Promulgated:
SANDOVAL-GUTIERREZ, J.:
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 Natividad’s 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.
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.
Dr. Ampil’s 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 vagina -- a 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 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 Natividad’s body and malpractice for concealing their acts
of negligence.
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:
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 them for P451,275.00 and delivered the amount to the
Aganas.
SO ORDERED.
Only Dr. Ampil filed a motion for reconsideration, but it 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.
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 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 Natividad’s 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.
Third, after the operation, two (2) gauzes were extracted from the
same spot of the body of Mrs. Agana where the surgery was performed.
Of course, the Court is not blind to the reality that there are times
when danger to a patient’s 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 patient’s 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 her condition might permit. The ruling in Smith v. Zeagler is
explicit, thus:
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.
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 Natividad’s 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
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 defendant’s 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 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.”
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. 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 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
Natividad’s 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 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.
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 Appeals 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. 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.
“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.
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, PSI’s 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:
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 x x x
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 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.
SO ORDERED.
ANGELINA SANDOVAL-GUTIERREZ
Associate Justice
WE CONCUR:
REYNATO S. PUNO
Chief Justice
Chairperson
RENATO C. CORONA ADOLFO S. AZCUNA
(No Part)
CANCIO C. GARCIA
Associate Justice
CERTIFICATION
REYNATO S. PUNO
Chief Justice
* No part. Ponente of the assailed Decision in the Court of Appeals.
Garcia-Rueda v. Pascasio, G.R. No. 118141, September 5, 1997, 278 SCRA 769.
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: