[G.R.
No 142625 | December 19, 2006] [Obligations, General Provisions of the Civil Code]
[Nogales v CMC]
I. Recit-ready Summary
Corazon Nogales was pregnant with her 4th child. Due to her old age she was
taken to Capitol Medical Center (CMC) so that specialized doctors may take
care of probable complications. She was under the care of Dr. Estrada who
was an independent-contractor physician (not a regular employee of CMC)
who directed other medical staff on how to treat Corazon’s condition.
Her child was born in a very fragile state. Corazon died due to complications
such as blood loss caused by alleged negligence of Dr. Estrada and other
medical staff.
Dr. Estrada was found guilty of negligence by the court. While the rest of
the medical staff were absolved from liability showing that they were
merely under the instruction of Dr. Estrada and lack of evidence showing
attributable negligence to them.
W/N CMC is vicariously liable due to Dr. Estrada’s negligence? YES [
Under the Civil Code,
Art. 2180. The obligation imposed by article 2176 is demandable not
only for one's own acts or omissions, but also for those of persons for whom
one is responsible.
So therefore, only exist vicarious liability if it can be shown that Estrada
is an employee of CMC. Since only then will CMC have responsibility
over the negligence of Estrada
BUT CMC ARGUES that it is NOT liable since Dr. Estrada is NOT one of
their regular employees and is an independent-contractor physician.
Hospitals can still be liable for the acts of independent-contractor physicians
if the patient was led to believe the doctor was actually part of the regular
medical staff [DOCTRINE OF ESTOPPEL APPLIES]
In this case, since the Nogales’ were led to believe that Dr. Estrada was
actually part of their regular medical staff, CMC is estopped from claiming
the defense that Dr. Estrada was merely an independent-contractor physician.
Block B 2023
DIGEST AUTHOR: Christine Joyce L. Sumaway
[Nogales v CMC]
WHEREFORE, the Court PARTLY GRANTS the petition. The Court finds
respondent Capitol Medical Center vicariously liable for the negligence
of Dr. Oscar Estrada.
II. Facts of the Case
Pregnant with her fourth child, Corazon Nogales ("Corazon"), who was then
37 years old, was under the exclusive prenatal care of Dr. Oscar Estrada ("Dr.
Estrada") beginning on her fourth month of pregnancy or as early as
December 1975. While Corazon was on her last trimester of pregnancy, Dr.
Estrada noted an increase in her blood pressure and development of leg
edema 5 indicating preeclampsia, which is a dangerous complication of
pregnancy.
Corazon began to manifest moderate vaginal bleeding which rapidly
became profuse. Corazon's blood pressure dropped from 130/80 to 60/40
within five minutes. There was continuous profuse vaginal bleeding.
Because of this, Corazon died.
Dr. Estrada was found guilty of negligence by the court. While the rest of the
medical staff were absolved from liability showing that they were merely
under the instruction of Dr. Estrada and lack of evidence showing attributable
negligence to them
CMC claims that it is not liable for the malpractice of Dr. Estrada as he was
merely an independent-contractor physician who is not a part of the regular
medical staff of CMC.
III. Issue/s
W/N CMC can he held liable for Estrada’s negligence? YES
IV. Holding/s
W/N CMC can he held liable for Estrada’s negligence? YES
Basically, the issue in this case is whether CMC is vicariously liable for the
negligence of Dr. Estrada. The resolution of this issue rests, on the other
PETITIONER/APPELLANT: Rogelo Nogales
RESPONDENT: CMC
 [G.R. No 142625 | December 19, 2006]
[Nogales v CMC]
hand, on the ascertainment of the relationship between Dr. Estrada and
CMC. The Court also believes that a determination of the extent of liability
of the other respondents is inevitable to finally and completely dispose of
the present controversy.
CMC disclaims liability by asserting that Dr. Estrada was a mere visiting
physician and that it admitted Corazon because her physical condition then
was classified an emergency obstetrics case.
The case of Ramos v CA states that:
While "consultants" are not, technically employees, a point which
respondent hospital asserts in denying all responsibility for the patient's
condition, 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
While the Court in Ramos did not expound on the control test, such test
essentially determines whether an employment relationship exists between a
physician and a hospital based on the exercise of control over the physician
as to details. Specifically, the employer (or the hospital) must have the right
to control both the means and the details of the process by which the
employee (or the physician) is to accomplish his task.
While Dr. Estrada enjoyed staff privileges at CMC, such fact alone did not
make him an employee of CMC
The question now is whether CMC is automatically exempt from liability
considering that Dr. Estrada is an independent contractor-physician.
In general, a hospital is not liable for the negligence of an independent
contractor-physician. There is, however, an exception to this principle. The
Block B 2023
DIGEST AUTHOR: Christine Joyce L. Sumaway
[Obligations, General Provisions of the Civil Code]
[Nogales v CMC]
hospital may be liable if the physician is the "ostensible" agent of the hospital.
This exception is also known as the "doctrine of apparent authority." (please
refer to the doctrine portion)
the individual who was alleged to be negligent was an employee or agent of
the hospital. 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 doctrine of apparent
authority is a species of the doctrine of estoppel.
Article 1431 of the Civil Code provides that "[t]hrough estoppel, an
admission or representation is rendered conclusive upon the person making
it, and cannot be denied or disproved as against the person relying thereon."
Estoppel rests on this rule: "Whenever a party has, by his own declaration,
act, or omission, intentionally and deliberately led another to believe a
particular thing true, and to act upon such belief, he cannot, in any litigation
arising out of such declaration, act or omission, be permitted to
falsify it."
In the instant case, CMC impliedly held out Dr. Estrada as a member of its
medical staff. Through CMC's acts, CMC clothed Dr. Estrada with apparent
authority thereby leading the Spouses Nogales to believe that Dr. Estrada was
an employee or agent of CMC. CMC cannot now repudiate such authority.
These are the following facts that made the Nogales’ believe that Dr.
Estrada was a regular medical staff:
(1) CMC granted staff privileges to Dr. Estrada. CMC extended its
medical staff and facilities to Dr. Estrada.
(2) CMC made Rogelio sign consent forms printed on CMC
letterhead.
Without any indication in these consent forms that Dr. Estrada was an
independent contractor-physician, the Spouses Nogales could not have
known that Dr. Estrada was an independent contractor
(3) Dr. Estrada's referral of Corazon's profuse vaginal bleeding to
Dr. Espinola, who was then the Head of the Obstetrics and Gynecology
Department of CMC, gave the impression that Dr. Estrada as a member of
CMC's medical staff was collaborating with other CMC-employed specialists
in treating Corazon.
2
PETITIONER/APPELLANT: Rogelo Nogales
RESPONDENT: CMC
 [G.R. No 142625 | December 19, 2006] [Obligations, General Provisions of the Civil Code]
[Nogales v CMC] [Nogales v CMC]

Also known as “take it or leave it contracts” leaves the other party with no
The records show that the Spouses Nogales relied upon a perceived option but to accept the terms
employment relationship with CMC in accepting Dr. Estrada's services.
Rogelio testified that he and his wife specifically chose Dr. Estrada to handle VI. Disposition
Corazon's delivery not only because of their friend's recommendation, but WHEREFORE, the Court PARTLY GRANTS the petition. The Court finds
more importantly because of Dr. Estrada's "connection with a reputable respondent Capitol Medical Center vicariously liable for the negligence
hospital, the CMC of Dr. Oscar Estrada. The amounts of P105,000 as actual damages and
P700,000 as moral damages should each earn legal interest at the rate of six
MOREOVER, expressly exempt CMC from liability for Corazon's death percent (6%) per annum computed from the date of the judgment of the trial
due to negligence during such treatment or operation. Such release forms, court. The Court affirms the rest of the Decision dated 6 February 1998 and
being in the nature of contracts of adhesion, are construed strictly against Resolution dated 21 March 2000 of the Court of Appeals in CA-G.R. CV
hospitals. Besides, a blanket release in favor of hospitals "from any and all No. 45641. S
claims," which includes claims due to bad faith or gross negligence, would
be contrary to public policy and thus void. SO ORDERED.
VII. Quisumbing, Carpio Morales, Tinga and Velasco, Jr., JJ., concur.
V. Law or Doctrine Applied
Doctrine of Apparent Authority (stemming from the principle of
Estoppel)
-[U]nder the doctrine of apparent authority a hospital can be held vicariously
liable for the negligent acts of a physician providing care at the hospital,
regardless of whether the physician is an independent contractor, unless the
patient knows, or should have known, that the physician is an independent
contractor. The elements of the action have been set out as follows: "For a
hospital to be liable under the doctrine of apparent authority, a plaintiff must
show that:

(1) the hospital, or its agent, acted in a manner that would lead a reasonable
person to conclude that the individual who was alleged to be negligent was
an employee or agent of the hospital;

(2) where the acts of the agent create the appearance of authority, the
plaintiff must also prove that the hospital had knowledge of and acquiesced
in them; and

(3) the plaintiff acted in reliance upon the conduct of the hospital or its
agent, consistent with ordinary care and prudence."

Contract of adhesion
3

Block B 2023 PETITIONER/APPELLANT: Rogelo Nogales

DIGEST AUTHOR: Christine Joyce L. Sumaway RESPONDENT: CMC