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Case Name: Professional Services, Inc. vs Natividad and Enrique Agana By: Ivan S.

GR No. 126297 Topic: Medical Malpractice
Date: January 31, 2007

Natividad Agana was rushed to the Medical City Hospital because of difficulty of bowel movement and bloody anal
discharge. After a series of examinations, Dr. Miguel Ampil diagnosed her to be suffering from "cancer of the sigmoid."
Dr. Ampil, assisted by the medical staff of the Medical City Hospital, performed an anterior resection surgery on
Natividad. He found that the malignancy in her sigmoid area had spread on her left ovary, necessitating the removal of
certain portions of it. Thus, Dr. Ampil obtained the consent of Natividads husband, Enrique Agana, to permit Dr. Juan
Fuentes to perform hysterectomy on her.
After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the operation and closed the incision.
However, the operation appeared to be flawed. In the corresponding Record of Operation dated April 11, 1984, the
attending nurses entered these remarks:
"sponge count lacking 2 and announced to surgeon searched (sic) done but to no avail continue for closure."
After a couple of days, Natividad complained of excruciating pain in her anal region. She consulted both Dr. Ampil and Dr.
Fuentes about it. They told her that the pain was the natural consequence of the surgery. Dr. Ampil then recommended that
she consult an oncologist to examine the cancerous nodes which were not removed during the operation.
Natividad, accompanied by her husband, went to the United States to seek further treatment. After four months of
consultations and laboratory examinations, Natividad was told she was free of cancer. Hence, she was advised to return to
the Philippines.
Natividad flew back to the Philippines, still suffering from pains. Two weeks thereafter, her daughter found a piece of
gauze protruding from her vagina.
Natividad later on died and this case was filed against Professional Services, Inc. and the 2 doctors for medical malpractice
and negligence.
1. WON Dr.Ampil is liable for negligence and malpractice
2. WON Dr. Fuentes is also liable
1. An operation requiring the placing of sponges in the incision is not complete until the sponges are properly removed, and it is
settled that the leaving of sponges or other foreign substances in the wound after the incision has been closed is at least prima
facie negligence by the operating surgeon. To put it simply, such act is considered so inconsistent with due care as to raise an
inference of negligence. There are even legions of authorities to the effect that such act is negligence per se.
Even if it has been shown that a surgeon was required by the urgent necessities of the case to leave a sponge in his patients
abdomen, because of the dangers attendant upon delay, still, it is his legal duty to so inform his patient within a reasonable
time thereafter by advising her of what he had been compelled to do. This is in order that she might seek relief from the
effects of the foreign object left in her body as her condition might permit.
Here, 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. Had he been more candid, Natividad could have
taken the immediate and appropriate medical remedy to remove the gauzes from her body. To our mind, what was initially
an act of negligence by Dr. Ampil has ripened into a deliberate wrongful act of deceiving his patient.

2. The requisites for the applicability of the doctrine of res ipsa loquiur are: (1) the occurrence of an injury; (2) the thing which
caused the injury was under the control and management of the defendant; (3) the occurrence was such that in the ordinary
course of things, would not have happened if those who had control or management used proper care; and (4) the absence of
explanation by the defendant. Of the foregoing requisites, the most instrumental is the control and management of the thing
which caused the injury.
We find the element of control and management of the thing which caused the injury to be wanting. Hence, the doctrine
of res ipsa loquitur will not lie. It was duly established that Dr. Ampil was the lead surgeon during the operation of
Natividad. A diligent search was conducted, but the misplaced gauzes were not found. Dr. Ampil then directed that the
incision be closed. During this entire period, Dr. Fuentes was no longer in the operating room and had, in fact, left the
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. Their duty is to obey his orders. As stated before, Dr. Ampil was the lead surgeon.
In other words, he was the Captain of the Ship. Clearly, the control and management of the thing which caused the injury
was in the hands of Dr. Ampil, not Dr. Fuentes.
Doctrine Notes
To successfully pursue medical malpractice, 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.