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Professional Services, Inc. vs. Agana: - First Division
Professional Services, Inc. vs. Agana: - First Division
SANDOVAL-GUTIERREZ, J.:
Hospitals, having undertaken one of mankind’s most important
and delicate endeavors, must assume the grave responsibility of
pursuing it with appropriate care. The care and service dispensed
through this high trust, however technical, complex and esoteric
its character may be, must meet standards of responsibility
commensurate with the undertaking to preserve and protect the
health, and indeed, the very lives of those placed in the hospital’s
keeping. 1
the Regional Trial Court (RTC), Branch 96, Quezon City in Civil
Case No. Q-43322 and nullifying its Order dated September 21,
1993.
The facts, as culled from the records, are:
On April 4, 1984, Natividad Agana was rushed to the Medical City
General Hospital (Medical City Hospital) because of difficulty of
bowel movement and bloody anal discharge. After a series of
medical examinations, Dr. Miguel Ampil, petitioner in G.R. No.
127590, diagnosed her to be suffering from “cancer of the
sigmoid.”
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1 Beeck v. Tucson General Hospital, 500 P. 2d 1153 (1972), citing Darling v.
Charleston Community Memorial Hospital, 33 Ill. 2d 326, 211 N.E. 2d 253.
2 Penned by Associate Justice Cancio C. Garcia (now a member of the Supreme
Court) and concurred in by Associate Justices Eugenio S. Labitoria and Artemio
G. Tuquero (both retired), Rollo, G.R. No. 126297, pp. 36-51; 126467, pp. 27-42;
127590, pp. 23-38.
3 Penned by Judge Lucas P. Bersamin (now Justice of the Court of Appeals),
Rollo, G.R. No. 126647, pp. 69-83.
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484 SUPREME COURT REPORTS ANNOTATED
Professional Services, Inc. vs. Agana
On April 11, 1984, Dr. Ampil, assisted by the medical staff of the 4
On March 17, 1993, the RTC rendered its Decision in favor of the
Aganas, finding PSI, Dr. Ampil and Dr. Fuentes liable for
negligence and malpractice, the decretal part of which reads:
“WHEREFORE, judgment is hereby rendered for the plaintiffs ordering
the defendants PROFESSIONAL SERVICES, INC., DR. MIGUEL AMPIL
and DR. JUAN FUENTES to pay to the plaintiffs, jointly and severally,
except in respect of the award for exemplary damages and the interest
thereon which are the liabilities of defendants Dr. Ampil and Dr. Fuentes
only, as follows:
1. 1.
As actual damages, the following amounts:
2. a.
The equivalent in Philippine Currency of the total of US$19,900.00
at the rate of P21.60-US$1.00, as reimbursement of actual
expenses incurred in the United States of America;
3. b.
The sum of P4,800.00 as travel taxes of plaintiffs and their
physician daughter;
4. c.
The total sum of P45,802.50, representing the cost of
hospitalization at Polymedic Hospital, medical fees, and cost of the
saline solution;
1. 2.
As moral damages, the sum of P2,000,000.00;
2. 3.
As exemplary damages, the sum of P300,000.00;
3. 4.
As attorney’s fees, the sum of P250,000.00;
4. 5.
Legal interest on items 1 (a), (b), and (c); 2; and 3 hereinabove,
from date of filing of the complaint until full payment; and
5. 6.
Costs of suit.
SO ORDERED.”
Aggrieved, PSI, Dr. Fuentes and Dr. Ampil interposed an appeal
to the Court of Appeals, docketed as CA-G.R. CV No. 42062.
Incidentally, on April 3, 1993, the Aganas filed with the RTC a
motion for a partial execution of its Decision, which was granted in
an Order dated May 11, 1993. Thereafter, the sheriff levied upon
certain properties of Dr. Ampil and sold
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Professional Services, Inc. vs. Agana
dated October 29, 1993 granting Dr. Fuentes’ prayer for injunctive
relief.
On January 24, 1994, CA-G.R. SP No. 32198 was consolidated
with CA-G.R. CV No. 42062.
Meanwhile, on January 23, 1995, the PRC Board of Medicine
rendered its Decision in Administrative Case No. 1690 dismissing
6
the case against Dr. Fuentes. The Board held that the prosecution
failed to show that Dr. Fuentes was the one who left the two
pieces of gauze inside Natividad’s body; and that he concealed
such fact from Natividad.
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5 The dispositive portion reads:
“WHEREFORE, let a writ of preliminary injunction be issued upon petitioner’s posting of
bond in the amount of P20,000.00, ENJOINING public respondents from implementing the
questioned order dated September 21, 1993 and from further taking any action in Civil Case
No. Q-43322 entitled ‘Natividad G. Agana, et al., plaintiffs, versus Professional Services,
Inc., et al., defendants’ pending resolution of the instant petition.
SO ORDERED.” See Rollo, G.R. No. 126297, p. 42.
6 Rollo of G.R. No. 126467, pp. 84-89.
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488 SUPREME COURT REPORTS ANNOTATED
Professional Services, Inc. vs. Agana
On September 6, 1996, the Court of Appeals rendered its
Decision jointly disposing of CA-G.R. CV No. 42062 and CA-G.R.
SP No. 32198, thus:
“WHEREFORE, except for the modification that the case against
defendant-appellant Dr. Juan Fuentes is hereby DISMISSED, and with
the pronouncement that defendant-appellant Dr. Miguel Ampil is liable to
reimburse defendant-appellant Professional Services, Inc., whatever
amount the latter will pay or had paid to the plaintiffs-appellees, the
decision appealed from is hereby AFFIRMED and the instant appeal
DISMISSED.
Concomitant with the above, the petition for certiorari and prohibition
filed by herein defendant-appellant Dr. Juan Fuentes in CA-G.R. SP No.
32198 is hereby GRANTED and the challenged order of the respondent
judge dated September 21, 1993, as well as the alias writ of execution
issued pursuant thereto are hereby NULLIFIED and SET ASIDE. The
bond posted by the petitioner in connection with the writ of preliminary
injunction issued by this Court on November 29, 1993 is hereby
cancelled.
Costs against defendants-appellants Dr. Miguel Ampil and Professional
Services, Inc.
SO ORDERED.”
Only Dr. Ampil filed a motion for reconsideration, but it was
denied in a Resolution dated December 19, 1996.
7
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8 Rule v. Cheeseman, 317 P. 2d 472 (1957), citing Russel v. Newman, 116 Kan.
268 P. 752; Bernsden v. Johnson, 174 Kan. 230, 255 P. 2d 1033.
9 Smith v. Zeagler, 157 So. 328 Fla. (1934), citing Ruth v. Johnson, (C.C.A.) 172
F. 191; Reeves v. Lutz, 179 Mo. App. 61, 162 S.W. 280; Rayburn v. Day, 126 Or.
135, 68 P. 1002, 59 A.L.R. 1062; Wynne v. Harvey, 96 Wash. 379, 165 P. 67;
Harris v. Fall (C.C.A.), 177 F. 79,
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Professional Services, Inc. vs. Agana
Of course, the Court is not blind to the reality that there are times
when danger to a patient’s life precludes a surgeon from further
searching missing sponges or foreign objects left in the body. But
this does not leave him free from any obligation. Even if it has
been shown that a surgeon was required by the urgent
necessities of the case to leave a sponge in his patient’s
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. The
ruling in Smith v. Zeagler is explicit, thus:
10
From the foregoing statements of the rule, the requisites for the
applicability of the doctrine of res ipsa loquitur are: (1) the
occurrence of an injury; (2) the thing which caused the injury was
under the control and management of the defen-
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13 Ramos v. Court of Appeals, G.R. No. 124354, December 29, 1999, 321 SCRA
584.
14 Africa v. Caltex (Phils.) Inc., 123 Phil. 280; 16 SCRA 448 (1966).
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494 SUPREME COURT REPORTS ANNOTATED
Professional Services, Inc. vs. Agana
dant; (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.” 15
stated before, Dr. Ampil was the lead surgeon. In other words, he
was the “Captain of the Ship.” That he discharged such role is
evident from his following
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15 Ranos v. Court of Appeals, supra. In Ramos, the phrase used is “control of the
instrumentality which caused the damage,” citing St. John’s Hospital and School
of Nursing v. Chapman, 434 P2d 160 (1967).
16 Rural Educational Assn v. Bush, 42 Tenn. App. 34, 298 S.W. 2d 761 (1956).
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Professional Services, Inc. vs. Agana
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.
A prominent civilist commented that professionals engaged by an
employer, such as physicians, dentists, and pharmacists, are not
“employees” under this article because the manner in which they
perform their work is not within the control of the latter (employer).
In other words, professionals are considered personally liable for
the fault or negligence they commit in the discharge of their
duties, and their employer cannot be held liable for such fault or
negligence. In the context of the present case, “a hospital cannot
be held liable for the fault or negligence of a physician or surgeon
in the treatment or operation of patients.” 21
privilege of being able to maintain a clinic in the hospital, and/or for the
privilege of admitting patients into the hospital. In addition to these, the
physician’s performance as a specialist is generally evaluated by a peer
review committee on the basis of mortality and morbidity statistics, and
feedback from patients, nurses, interns and residents. A consultant
remiss in his duties, or a consultant who regularly falls short of the
minimum standards acceptable to the hospital or its peer review
committee, is normally politely terminated.
In other words, private hospitals, hire, fire and exercise real control
over their attending and visiting ‘consultant’ staff. While ‘consultants’ are
not, technically employees, x x x, the control exercised, the hiring, and
the right to terminate consultants all fulfill the important hallmarks of an
employer-employee relationship, with the exception of the payment of
wages. In assessing whether such a relationship in fact exists, the
control test is determining. Accordingly, on the basis of the foregoing, we
rule that for the purpose of allocating responsibility in medical negligence
cases, an employeremployee relationship in effect exists between
hospitals and their attending and visiting physicians.”
But the Ramos pronouncement is not our only basis in sustaining
PSI’s liability. Its liability is also anchored upon the agency
principle of apparent authority or agency by estoppel and the
doctrine of corporate negligence which have gained acceptance
in the determination of a hospital’s liability for negligent acts of
health professionals. The present case serves as a perfect
platform to test the applicability of these doctrines, thus, enriching
our jurisprudence.
Apparent authority, or what is sometimes referred to as the
“holding out” theory, or doctrine of ostensible agency or agency
by estoppel, has its origin from the law of agency. It
29
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29 Black’s Law Dictionary (6th Ed. 1990) 1100. The terms “ostensible agency,”
“agency by estoppel,” “apparent authority,” and “holding out” tend to be used
interchangeably by the courts to refer to this theory of liability. See for instance,
Baker v. Werner, 654 P2d 263 (1982) and Adamski v. Tacoma Gen. Hosp., 20
Wash App. 98,
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Professional Services, Inc. vs. Agana
pital of Lake Worth, Inc. There, it was explicitly stated that “there
32
does not appear to be any rational basis for excluding the concept
of apparent authority from the field of hospital liability.” Thus, in
cases where it can be shown that a hospital, by its actions, has
held out a particular physician as its agent and/or employee and
that a patient has accepted treatment from that physician in the
reasonable belief that it is being rendered in behalf of the hospital,
then the hospital will be liable for the physician’s negligence.
Our jurisdiction recognizes the concept of an agency by
implication or estoppel. Article 1869 of the Civil Code reads:
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.
In this case, PSI publicly displays in the lobby of the Medical City
Hospital the names and specializations of the physicians
associated or accredited by it, including those of Dr. Ampil and Dr.
Fuentes. We concur with the Court of Appeals’ conclusion that it
“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.” Indeed, PSI’s act is tantamount to holding out to the
public that Medical City Hospital, through its accredited
physicians, offers quality health care services. 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.
As expected, these patients, Natividad being one of them,
accepted the services on the reasonable belief that such were
being rendered by the hospital or its employees, agents, or
servants. The trial court correctly pointed out:
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32 Supra.
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Professional Services, Inc. vs. Agana
and policies that ensure quality care for its patients. Thus, in 38