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Torts and Damages Case Digest: Professional Services, Inc. v. Natividad and Enrique Agana (2007)

G.R. No. 157906   November 2, 2006
Lessons Applicable: Res ipsa loquitur (Torts and Damages)
Laws Applicable: Art. 2176 Art. 2180  and  Art. 1869 of the Civil Code

  • April 4, 1984: Natividad Agana was rushed to the Medical City General Hospital because of difficulty of bowel movement and bloody anal discharge. Dr. Miguel Ampil diagnosed her to be suffering from cancer of the sigmoid.
  • April 11, 1984: Dr. Ampil performed an anterior resection surgery on Natividad and found that the malignancy in her sigmoid area had spread on her left ovary, necessitating the removal of certain portions of it
  • Dr. Ampil obtained the consent of Natividad’s husband, Enrique Agana to perform hysterectomy.
  • After a couple of days, Natividad consulted both Dr. Ampil and Dr. Fuentes about the excruciating pain in her anal region. Dr. Ampil recommended that she consult an oncologist.
  • May 9, 1984: The Aganas went to the United States to seek further treatment and was told she was FREE from cancer.
  • August 31, 1984: Natividad's daughter found a piece of gauze protruding from her vagina.  Dr. Ampil proceeded to her house and extracted by hand a piece of gauze measuring 1.5 inches in width and assuring that the pain will vanish. 
  • When the pain intensified, Nativided went to Polymedic General Hospital where Dr. Ramon Gutierrez  found a foul-smelling gauze measuring 1.5 inches in width which badly infected her vaginal vault which formed a recto-vaginal fistula forcign her stool to excrete through the vagina.
  • October 1984: Natividad underwent another surgery to remedy the damage
  • February 16, 1986: Natividad died so she was substituted by her children
  • RTC: PSI solidarily liable with Dr. Ampil and Dr. Fuentes for damages for negligence and malpractice
  • CA: absolved Dr. Fuentes upon the same advise from the PRC Board of Medicine for failure to show that he placed the guages or concealed the fact from Natividad 
ISSUE: W/N  Dr. Fuentes may be held liable under the principle of res ipso loquitor

HELD: NO.  CA affirmed
  • Dr. Ampil as the negligent party
    • surgeons used gauzes as sponges to control the bleeding of the patient during the surgical operation
    • immediately after the operation, the nurses who assisted in the surgery noted in their report 2 sponges lacking
    • 2 gauzes were extracted from the same spot of the body of Mrs. Agana
  • element 3 "control and management of the thing which caused the injury" to be wanting 
    • Dr. Fuentes performed the surgery and thereafter reported and showed his work to Dr. Ampil who allowed Dr. Fuentes to leave the operating room
    • 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
  • res ipsa loquitur
    • 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
    • mere invocation and application of the doctrine does not dispense with the requirement of proof of negligence
  • Art. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for the damage done. Such fault or negligence, if there is no pre-existing contractual relation between the parties, is called a quasi-delict and is governed by the provisions of this Chapter.
  • 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.
The owners and managers of an establishment or enterprise are likewise responsible for damages caused by their employees in the service of the branches in which the latter are employed or on the occasion of their functions.

Employers shall be liable for the damages caused by their employees and household helpers acting within the scope of their assigned tasks even though the former are not engaged in any business or industry.

   x   x   x                                                                        x    x    x
The responsibility treated of in this article shall cease when the persons herein mentioned prove that they observed all the diligence of a good father of a family to prevent damage.
  • failed to adduce evidence showing that it exercised the diligence of a good father of a family in the accreditation and supervision 
  • private hospitals, hire, fire and exercise real control over their attending and visiting ‘consultant’ staff
  • control test is determining
    • 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
  • 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.
  • 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
  • doctrine of corporate negligence or corporate responsibility
    • knowledge of any of the staff of Medical City Hospital constitutes knowledge of PSI
      • It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance of the Medical City Hospital’s staff, composed of resident doctors, nurses, and interns