January 31, 2007
Ponente: Sandoval-Gutierrez, J.
FACTS:
·
On April 4, 1984, Natividad Agana was rushed
to the Medical City General Hospital because of difficulty of bowel movement
and bloody anal discharge. She was diagnosed to have cancer of the sigmoid
(colon).
·
On April 11, 1984, Dr. Ampil, assisted by the
medical staff of the Medical City, 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. As such, Dr. Ampil obtained the consent of Natividad’s
husband, Enrique Agana, to permit Dr. Juan Fuentes to perform hysterectomy.
·
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; the nurses noted that 2
pieces of gauze were missing.
·
Nevertheless, Natividad was discharged. Later,
she complained of pain in her anal region so she consulted Drs. Ampil and
Fuentes but they told her it was just a natural consequence of the surgery.
·
Natividad went to the US for further
treatment. After 4 months, she was declared cancer-free so she returned to the
Philippines.
·
On August 31, 1984, Natividad flew back to the
Philippines, still suffering from pains.
Two weeks after, her daughter found a piece of gauze protruding from her
vagina. Dr. Ampil went to her house to extract the piece of gauze by hand and
assured her that the pains would soon vanish.
·
But the pain got worse. While confined at
another hospital, another foreign object was detected in her vagina -- a
foul-smelling gauze measuring 1.5 inches in width which badly infected her
vaginal vault. A recto-vaginal fistula
had formed in her reproductive organs which forced stool to excrete through the
vagina. Another surgery was needed to rectify the damage.
·
Spouses Agana filed a case for damages against
Professional Services (Medical City). On February 16, 1986, pending the outcome
of the above cases, Natividad died and
was substituted by her children.
·
The RTC found Dr. Ampil, Dr. Fuentes, and
Professional Services, Inc. (Medical City) liable for negligence and
malpractice. The CA, however, acquitted Dr. Fuentes and ruled that only Dr.
Ampil and PSI were liable. Hence, the instant petition.
RULING:
Whether or
not CA erred in Holding Dr. Ampil liable for negligence and malpractice – NO.
·
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. Such act is considered so inconsistent with
due care as to raise an inference of negligence.
·
The elements of medical negligence – duty,
breach, injury, and proximate causation – were all present.
·
As the lead surgeon, Dr. Ampil had the duty to
remove all foreign objects, such as gauzes, from Natividad’s body before
closure of the incision. When hefailed to do so, it was his duty to inform
Natividad about it. That the pices of gauze were later on extracted from
Natividad’s vagina established the causal link between Dr. Ampil’s negligence
and the injury. What further aggravated such injury was his deliberate
concealment of the missing gauzes from the knowledge of Natividad and her
family. So what was initially an act of negligence by Dr. Ampil had ripened
into a deliberate wrongful act of deceiving his patient.
Whether or
not CA erred in holding that Dr. Fuentes was not liable – NO.
·
The Aganas assailed the dismissal by the trial
court of the case against Dr. Fuentes, claiming that such dismissal was
contrary to the doctrine of res ipsa loquitur. According to them, the fact that
the two pieces of gauze were left inside Natividad’s body was a prima facie
evidence of Dr. Fuentes’ negligence.
·
Res ipsa loquitur (the thing speaks for
itself): where the thing which caused the injury, without the fault of the
injured, is under the exclusive control of the defendant and the injury is such
that it should not have occurred if he, having such control used proper care,
it affords reasonable evidence, in the absence of explanation that the injury
arose from the defendant’s want of care, and the burden of proof is shifted to
him to establish that he has observed due care and diligence.
·
There are four requisites for res ipsa
loquitur to apply :(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. In the present case, element 2 was not present.
·
Consider the following: Ampil was the lead
surgeon of the operation on Natividad. He requested Fuentes to perform the
hysterectomy after finding the malignancy had spread to Natividad’s ovaries.
After Fuentes’ surgery, Fuentes allowed him to leave as he resumed the
operation. Fuentes was not in the room when Ampil directed that the incision be
closed. Under the Captain of the Ship rule, the operating surgeon is in complete
charge of the surgery room and personnel connected with the operation. As the
lead surgeon, it was Dr. Ampil, not Dr. Fuentes, who had control and management
over the said incident.
Whether or
not PSI should be liable for the negligence of Dr. Ampil – YES.
·
For purposes of apportioning responsibility in
medical negligence cases, an employer- employee relationship in effect exists
between hospitals and their attending and visiting physicians (Ramos v. CA).
·
PSI's liability is also anchored upon the
agency principle of apparent authority or agency by estoppel and the doctrine
of corporate negligence.