PROFESSIONAL SERVICES, INC. vs. AGANAG.R. No. 126297 | January 31, 2007

FACTS:Natividad Agana was diagnosed with cancer of the sigmoid which also affected her ovaries. She underwent surgical operations to remove the cancer. However, after receiving treatments and being declared free of cancer, she still felt excruciating pains in her rectal and vaginal area. It turns out that the pains were caused by the pieces of gauze left inside her body.

Thus, a complaint for damages was filed against PSI, Drs. Ampil and Fuentes. Enrique Agana also filed before the PRC an administrative complaint for gross negligence and malpractice against Dr. Ampil and Dr. Fuentes. Pending the outcome of the cases, Natividad died.

Eventually, RTC ruled in favor of the Aganas, finding PSI, Dr. Ampil and Dr. Fuentes liable for negligence and malpractice and awarded actual, moral, and exemplary damages and attorney’s fees. Meanwhile, the administrative cases before the PRC were dismissed. On appeal, CA absolved Dr. Fuentes, but held PSI and Dr. Ampil solidarily liable.

PSI and Dr. Ampil, and also the Aganas went up to the SC. PSI contended that Dr. Ampil is not its employee, but a mere consultant or independent contractor. As such, he alone should answer for his negligence. Meanwhile, the Aganas argued that CA erred in absolving Dr. Fuentes. On the other hand, Dr. Ampil insisted that he is not guilty of negligence, and imputed the damage to other factors/causes.

ISSUES:(1) Is Dr. Ampil guilty of negligence and malpractice? YES.(2) Is Dr. Fuentes liable also? NO.(3) Is PSI liable for the negligence of the surgeons? YES.

RULING:(1) YES. Dr. Ampil’s arguments are purely conjectural and without basis. All the major circumstances, taken together, directly point to Dr. Ampil as the negligent party. During the operation, it was announced that two gauzes were lacking but still Dr. Ampil proceeded with the closure. 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.

This is a clear case of medical malpractice or more appropriately, medical negligence. To successfully pursue this kind of case, a patient must only prove that a health care provider either failed to do something which a reasonably prudent health care provider would have done, or that he did

something that a reasonably prudent provider would not have done; and that failure or action caused injury to the patient. Simply put, the elements are duty, breach, injury and proximate causation. Dr, Ampil, as the lead surgeon, had the duty to remove all foreign objects, such as gauzes, from Natividad’s body before closure of the incision. When he failed to do so, it was his duty to inform Natividad about it. Dr. Ampil breached both duties. Such breach caused injury to Natividad, necessitating her further examination by American doctors and another surgery. That Dr. Ampil’s negligence is the proximate cause of Natividad’s injury could be traced from his act of closing the incision despite the information given by the attending nurses that two pieces of gauze were still missing. That they were later on extracted from Natividad’s vagina established the causal link between Dr. Ampil’s negligence and the injury. And what further aggravated such injury was his deliberate concealment of the missing gauzes from the knowledge of Natividad and her family.

(2) NO. The plaintiffs invoked the doctrine of res ipsa loquitur. 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. Mere invocation and application of the doctrine of res ipsa loquitur 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.

(3) Premised on the doctrine of corporate negligence, the trial court held that PSI is directly liable for such breach of duty. 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. PSI’s liability is traceable to its failure to conduct an investigation of the matter reported in the nota bene of the count nurse. Such failure established PSI’s part in the dark conspiracy of silence and concealment about the gauzes.

It is reasonable to conclude that PSI, as the operator of the hospital, has actual or constructive knowledge of the procedures carried out, particularly the report of the attending nurses that the two pieces of gauze were missing. The failure of PSI, despite the attending nurses’ report, to investigate and inform Natividad regarding the missing gauzes amounts to callous negligence. Not only did PSI breach its duties to oversee or supervise all persons who practice medicine within its walls, it also failed to take an active step in fixing the negligence committed. This renders PSI, not only vicariously liable for the negligence of Dr. Ampil under Article 2180 of the Civil Code, but alsodirectly liable for its own negligence under Article 2176.

Anent the corollary issue of whether PSI is solidarily liable with Dr. Ampil for damages, let it be emphasized that PSI, apart from a general denial of its responsibility, failed to adduce evidence showing that it exercised the diligence of a good father of a family in the accreditation and supervision of the latter. In neglecting to offer such proof, PSI failed to discharge its burden under the last paragraph of Article 2180 cited earlier, and, therefore, must be adjudged solidarily liable with Dr. Ampil. Moreover, as we have discussed, PSI is also directly liable to the Aganas.