Professional

Services Inc. v.
Agana
Professional Services Inc. (PSI) v. Natividad and
Enrique Agana
Natividad and Enrique Agana v. Juan Fuentes
Miguel Ampil v. Natividad and Enrique Agana
2007 / Sandoval-Gutierrez / Petition for review on
certiorari of CA decisions
Standard of conduct > Experts > Medical
professionals
FACTS
Natividad Agana was rushed to Medical City because 1.
of difficulty of bowel movement and bloody anal
discharge. Dr. Ampil diagnosed her to be suffering
from cancer of the sigmoid. Dr. Ampil performed 2.
an anterior resection surgery on her, and finding that
the malignancy spread on her left ovary, he obtained 3.
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
Natividads 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). RTC found PSI and the two doctors liable
for negligence and malpractice. PRC dismissed the
case against Dr. Fuentes. CA dismissed only the case
against Fuentes.
ISSUE AND HOLDING
WON CA erred in holding Dr. Ampil liable for
negligence and malpractice. NO; DR. AMPIL IS
GUILTY
WON CA erred in absolving Dr. Fuentes of any
liability. NO
WON PSI may be held solidarily liable for Dr.
Ampils negligence. YES
RATIO
DR. AMPIL IS LIABLE FOR NEGLIGENCE AND
MALPRACTICE
His arguments are without basis [did not prove that
the American doctors were the ones who put / left the
gauzes; did not submit evidence to rebut the
correctness of the operation record (re: number of
gauzes used); re: Dr. Fuentes alleged negligence,
Dr. Ampil examined his work and found it in order].
Leaving foreign substances in the wound after
incision has been closed is at least prima
facie negligence by the operating surgeon. Even if it
has been shown that a surgeon was required to leave
a sponge in his patients abdomen because of the
dangers attendant upon delay, still, it is his legal duty
to inform his patient within a reasonable time by
advising her of what he had been compelled to do, so
she can seek relief from the effects of the foreign
object left in her body as her condition might permit.
Whats worse in this case is that he misled her by
saying that the pain was an ordinary consequence of
her operation.
Medical negligence; standard of diligence
To successfully pursue this case of medical
negligence, a patient must only prove that a health
care provider either failed to do something [or did
something] which a reasonably prudent health care

provider would have done [or wouldnt have done],

and that the failure or action caused injury to the
patient.
Duty to remove all foreign objects from the body
before closure of the incision; if he fails to do so, it
was his duty to inform the patient about it

Breach failed to remove foreign objects; failed to

inform patient
Injury suffered pain that necessitated examination
and another surgery
Proximate Causation breach caused this
injury; could be traced from his act of closing the
incision despite information given by the attendant
nurses that 2 pieces of gauze were still missing; what
established causal link: gauze pieces later extracted
from patients vagina
DR. FUENTES NOT LIABLE
The res
ipsa
loquitur [thing
speaks
for
itself] argument of the Aganas does not convince
the court. Mere invocation and application of this
doctrine does not dispense with the requirement of
proof of negligence.

Requisites for the applicability of res ipsa loquitur

1. Occurrence of injury

2. Thing which caused injury was under the control and

management
of
the
defendant
[DR.
FUENTES] LACKING
SINCE CTRL+MGT
WAS WITH DR. AMPIL
3. Occurrence was such that in the ordinary course of
things, would not have happened if those who had
control or management used proper care

4. Absence of explanation by defendant

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. That Dr. Ampil discharged such role is
evident from the following:
He called Dr. Fuentes to perform a hysterectomy
He examined Dr. Fuentes work and found it in
order
He granted Dr. Fuentes permission to leave
He ordered the closure of the incision
HOSPITAL OWNER PSI SOLIDARILY LIABLE
WITH DR. AMPIL [NCC 2180], AND DIRECTLY
LIABLE TO SPS. AGANAS [NCC 2176]

Previously, employers cannot be held liable for the

fault or negligence of its professionals. However, this
doctrine has weakened since courts came to realize
that modern hospitals are taking a more active role in
supplying and regulating medical care to its patients,

by employing staff of physicians, among others.

Hence, there is no reason to exempt hospitals from
the universal rule of respondeat superior. Here are the
Courts bases for sustaining PSIs liability:
Ramos v. CA doctrine on E-E relationship
For purposes of apportioning responsibility in
medical negligence cases, an employer-employee
relationship in effect exists between hospitals and
their attending and visiting physicians. [LABOR
LESSON: power to hire, fire, power of control]
Agency principle of apparent authority / agency by
estoppel
Imposes liability because of the actions of a principal
or employer in somehow misleading the public into
believing that the relationship or the authority exists
[see NCC 1869]
PSI publicly displays in the Medical City lobby the
names and specializations of their physicians. Hence,
PSI 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.
If doctors do well, hospital profits financially, so
when negligence mars the quality of its services, the
hospital should not be allowed to escape liability for
its agents acts.
Doctrine of corporate negligence / corporate
responsibility
This is the judicial answer to the problem of
allocating hospitals liability for the negligent acts
of health practitioners, absent facts to support the
application of respondeat superior.
This provides for the duties expected [from
hospitals]. In this case, PSI failed to perform the duty
of exercising reasonable care to protect from harm all
patients admitted into its facility for medical
treatment. PSI failed to conduct an investigation of
the matter reported in the note of the count nurse, and
this established PSIs part in the dark conspiracy of
silence and concealment about the gauzes.
PSI has actual / constructive knowledge of the matter,
through the report of the attending nurses + the fact
that the operation was carried on with the assistance
of various hospital staff
It also breached its duties to oversee or supervise all
persons who practice medicine within its

walls and take an active step in fixing the negligence

committed
PSI also liable under NCC 2180
It failed to adduce evidence to show that it exercised
the diligence of a good father of the family in the
accreditation and supervision of Dr. Amp

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
FACTS:
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 Natividads
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 preexisting 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 ones 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 Hospitals staff, composed
of resident doctors, nurses, and interns

SPS. BUENAVENTURA JAYME AND ROSARIO

JAYME, petitioners,
vs.
RODRIGO APOSTOL, FIDEL LOZANO,
ERNESTO SIMBULAN, MAYOR FERNANDO
Q.
MIGUEL,
MUNICIPALITY
OF
KORONADAL (NOW CITY OF KORONADAL),
PROVINCE
OF
SOUTH
COTABATO,
represented by the MUNICIPAL TREASURER
and/or MUNICIPAL MAYOR FERNANDO Q.
MIGUEL, and THE FIRST INTEGRATED
BONDING AND INSURANCE COMPANY,
INC., respondents.
G.R. No. 163609
FACTS:

[November 27, 2008]

On February 5, 1989, Mayor Miguel of Koronadal,

South Cotabato was on board the Isuzu pick-up truck
driven by Fidel Lozano, an employee of the
Municipality of Koronadal. The pick-up truck was
registered under the name of Rodrigo Apostol, but it
was then in the possession of Ernesto Simbulan.
Lozano borrowed the pick-up truck from Simbulan to
bring Miguel to Buayan Airport at General Santos
City
to
catch
his
Manila
flight.
The pick-up truck accidentally hit Marvin C. Jayme,
a minor, who was then crossing the National
Highway in South Cotabato. The intensity of the
collision sent Marvin some 50 meters away from the
point of impact, a clear indication that Lozano was
driving at a very high speed at the time of the
accident. Marvin sustained severe head injuries.
Despite medical attention, Marvin expired six (6)
days after the accident.
ISSUE:
MAY a municipal mayor be held solidarily liable for
the negligent acts of the driver assigned to him
MAY an LGU be held liable for the tortuous act of a
government employee.
RULING:
1. It is uncontested that Lozano was employed as a
driver by the municipality. That he was subsequently
assigned to Mayor Miguel during the time of the
accident is of no moment. The Municipality of
Koronadal remains to be Lozanos employer
notwithstanding Lozanos assignment to Mayor
Miguel. Even assuming arguendo that Mayor Miguel
had authority to give instructions or directions to
Lozano, he still cannot be held liable. In Benson v.
Sorrell, the New England Supreme Court ruled that
mere giving of directions to the driver does not
establish that the passenger has control over the
vehicle. Neither does it render one the employer of
the
driver.
Mayor Miguel was neither Lozanos employer nor
the vehicles registered owner. There existed no
causal relationship between him and Lozano or the
vehicle used that will make him accountable for
Marvins death. Mayor Miguel was a mere
passenger at the time of the accident.
2. The municipality may not be sued because it is an
agency of the State engaged in governmental
functions and, hence, immune from suit. This
immunity is illustrated in Municipality of San

Fernando, La Union v. Firme, where the Court held

that municipal corporations are suable because their
charters grant them the competence to sue and be
sued. Nevertheless, they are generally not liable for
torts committed by them in the discharge of
governmental functions and can only be held
answerable only if it can be shown that they were
acting in proprietary capacity. In permitting such
entities to be sued, the State merely gives the
claimant the right to show that the defendant was not
acting in governmental capacity when the injury was
committed or that the case comes under the
exceptions recognized by law. Failing this, the
claimant
cannot
recover.
Liability attaches to the registered owner, the
negligent driver and his direct employer. Settled is
the rule that the registered owner of a vehicle is
jointly and severally liable with the driver for
damages incurred by passengers and third persons as
a consequence of injuries or death sustained in the
operation of said vehicles. Regardless of who the
actual owner of the vehicle is, the operator of record
continues to be the operator of the vehicle as regards
the public and third persons, and as such is directly
and primarily responsible for the consequences
incident
to
its
operation.
The petition is DENIED.