PSI vs AGANA

FACTS

Natividad Agana was rushed to Medical City because of difficulty of bowel movement and bloody
anal discharge. Dr. Ampil diagnosed her to be suffering from cancer of the sigmoid. Dr. Ampil
performed an anterior resection surgery on her, and finding that the malignancy spread on her left
ovary, he obtained the consent of her husband, Enrique, to permit Dr. Fuentes to
perform hysterectomy on her. After the hysterectomy, Dr. Fuentes showed his work to Dr. Ampil,
who examined it and found it in order, so he allowed Dr. Fuentes to leave the operating room. Dr.
Ampil was about to complete the procedure when the attending nurses made some remarks on the
Record of Operation: “sponge count lacking 2; announced to surgeon search done but to no avail
continue for closure” (two pieces of gauze were missing). A “diligent search” was conducted but they
could not be found. Dr. Ampil then directed that the incision be closed.
A couple of days after, she complained of pain in her anal region, but the doctors told her that
it was just a natural consequence of the surgery. Dr. Ampil recommended that she consult an
oncologist to examine the cancerous nodes which were not removed during the operation. After
months of consultations and examinations in the US, she was told that she was free of cancer. Weeks
after coming back, her daughter found a piece of gauze (1.5 in) protruding from her vagina, so Dr.
Ampil manually extracted this, assuring Natividad that the pains will go away. However, the pain
worsened, so she sought treatment at a hospital, where another 1.5 in piece of gauze was found in her
vagina. She underwent another surgery.
Sps. Agana filed a complaint for damages against PSI (owner of Medical City), Dr. Ampil, and
Dr. Fuentes, alleging that the latter are liable for negligence for leaving 2 pieces of gauze in
Natividad’s body, and malpractice for concealing their acts of negligence. Enrique Agana also filed
an administrative complaint for gross negligence and malpractice against the two doctors with the
PRC (although only the case against Dr. Fuentes was heard since Dr. Ampil was abroad). Pending
the outcome of the cases, Natividad died (now substituted by her children).

RULING:
The doctrine in Ramos v. Court of Appeals, 321 SCRA 584 (1999), still obtains, i.e., for the purpose of
allocating responsibility in medical negligence cases, an employer-employee relationship exists
between hospitals and their consultants.

While in general, a hospital is not liable for the negligence of an independent contractor-physician,
the hospital may be liable if the physician is the “ostensible” agent of the hospital, an exception also
known as the “doctrine of apparent authority” or sometimes referred to as the apparent or ostensible
agency theory. In this regard, the hospital need not make express representations to the patient that
the treating physician is an employee of the hospital; rather a representation may be general and
implied.

The act of a hospital in displaying the names of physicians in the public directory at the lobby of the
hospital amounts to holding out to the public that it offers quality medical service through the listed
physicians; Under the doctrine of apparent authority, the question in every case is whether the
principal has by his voluntary act placed the agent in such a situation that a person of ordinary
prudence, conversant with business usages and the nature of the particular business, is justified in
presuming that such agent has authority to perform the particular act in question.

The duty of providing quality medical service is no longer the sole prerogative and responsibility of
the physician because the modern hospital now tends to organize a highly-professional medical staff
whose competence and performance need also to be monitored by the hospital commensurate with its
inherent responsibility to provide quality medical care. Such responsibility includes the proper
supervision of the members of its medical staff. Accordingly, the hospital has the duty to make a
reasonable effort to monitor and oversee the treatment prescribed and administered by the
physicians practicing in its premises.

The corporate negligence doctrine imposes several duties on a hospital: (1) to use reasonable care in
the maintenance of safe and adequate facilities and equipment; (2) to select and retain only
competent physicians; (3) to oversee as to patient care all persons who practice medicine within its
walls; and (4) to formulate, adopt, and enforce adequate rules and policies to ensure quality care for
its patients. These special tort duties arise from the special relationship existing between a hospital
or nursing home and its patients, which are based on the vulnerability of the physically or mentally
ill persons and their inability to provide care for themselves.