PSI vs. Agana Ampil vs. Agana Fuentes vs. Agana Group 3 Ordoveza, Paderna, Pangan, Panlilio, Park

Case Summary On April 11, 1984, an anterior resection surgery of the colon and hysterectomy was perfomed on Natividad Agana at the Medical City Hospital after she was diagnosed with cancer at the sigmoid region. Dr. Miguel Ampil performed the colon resection. Because he found that the malignancy had spread to the ovaries, he requested Dr. Juan Fuentes to perform a hysterectomy. After granting Dr. Fuentes permission to leave afterwards, he closed the wound. The corresponding Record of Operation contained the following remarks: sponge count lacking 2 announced to surgeon searched [sic] done but to no avail continue for closure

Case Summary Natividad complained of excruciating pains a few days later but her doctors told her that the pain was the natural consequence of the surgery. Dr. Ampil further advised her to seek oncologic consult. She sought medical consult in the US, and was found to be free of cancer and was advised to go home. Natividad continued to suffer from pains and two weeks later, her daughter found a piece of gauze protruding from her vagina.

Case Summary The gauze was extracted by Dr. Ampil, who assured Natividad that the pains would soon vanish. However, the pains persisted, so she sought treatment at the Polymedic General Hospital. Another gauze that badly infected her vaginal vault was found, so she had surgery to remedy the damage from the resulting recto-vaginal fistula.

Case Summary On November 12, 1984, Natividad and her husband filed a complaint for damages against the Professional Services, Inc. (PSI), owner of the Medical City Hospital, Dr. Ampil, and Dr. Fuentes, alleging that the latter two are liable for negligence and medical malpractice. Enrique Agana also filed with the Professional Regulation Commission (PRC) an administrative complaint for gross negligence and malpractice against the two doctors. On February 16, 1986, pending the outcome of the above cases, Natividad died and was duly substituted by her children.

Case Summary 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. PSI, Dr. Fuentes and Dr. Ampil interposed an appeal to the Court of Appeals. 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.

Case Summary The Aganas entered into an agreement with PSI and Dr. Fuentes to indefinitely suspend any further execution of the RTC Decision. However, not long thereafter, the Aganas again filed a motion for an alias writ of execution against the properties of PSI and Dr. Fuentes. Dr. Fuentes filed a petition for certiorari and prohibition with the Court of Appeals.

Case Summary On January 23, 1995, the PRC Board of Medicine dismissed the case against Dr. Fuentes. On September 6, 1996, the Court of Appeals also dismissed the case against Dr. Fuentes, while Dr. Ampil and PSI were found liable for the damages to the Aganas. Only Dr. Ampil filed a motion for reconsideration, but it was denied.

Case Summary The instant consolidated petitions: PSI contends that Dr. Ampil is not its employee, but a mere consultant or independent contractor. As such, he alone should answer for his negligence. The Aganas maintain that the Court of Appeals erred in finding that Dr. Fuentes is not guilty of negligence or medical malpractice. Dr. Ampil asserts that the Court of Appeals erred in finding him liable for negligence and malpractice because there was no evidence that he left the two pieces of gauze in Natividad’s vagina, and he pointed to other probable causes.

Learning Issues Whether the Court of Appeals Erred in Holding Dr. Ampil Liable for Negligence and Malpractice Negligence Medical Mapractice Whether the Court of Appeals Erred in Absolving Dr. Fuentes of any Liability Res ipsa loquitur Captain of the Ship Whether PSI Is Liable for the Negligence of Dr. Ampil Ostensible Agent Corporate Negligence Reckless Imprudence

Negligence | Medical Malpractice Whether the Court of Appeals Erred in Holding Dr. Ampil Liable for Negligence and Malpractice

Negligence Entire want of care raising the presumption of gross indifference to consequences. An entire disregard for and indifference to the safety and welfare of others.

Medical Malpractice Any act or failure to act by a member of the medical profession that results to harm, injury, distress, prolonged physical or mental suffering or the termination of life to a patient while that patient is under the care of that medical professional.

Medical Malpractice Duty It is the responsibility of every doctor to practice medicine according to the ethical standards of his profession Dr. Ampil, as the lead surgeon, had the duty to remove all foreign objects from Natividad’s body before closure of the incision. When he failed to do so, it was also his duty to inform the patient about it.

Medical Malpractice Breach Dr. Ampil breached his duties. Unskillful practice by a physician or other professional in which the health or welfare of the patient is injured. Failure of a professional to follow the accepted standards of practice of his profession. Dr. Ampil breached his duties.

Medical Malpractice Injury Due to Dr. Ampil’s negligence, the patient suffered excruciating pains and a rectovaginal fistula.

Medical Malpractice Proximate causation That cause, which, in natural and continuous sequence unbroken by any efficient intervening cause, produces the injury and without which the result would not have occurred. He closed the incision despite the nurses’ claims of two missing gauzes. Injury was further aggravated when he deliberately concealed this from the family.

Res ipsa loquitur | Captain of the Ship Whether the Court of Appeals Erred in Absolving Dr. Fuentes of any Liability

Res ipsa loquitur In G.R. No. 126467, the Aganas maintain that the Court of Appeals erred in finding that Dr. Fuentes is not guilty of negligence or medical malpractice, invoking the doctrine of res ipsa loquitur. They contend that the pieces of gauze are prima facie proof that the operating surgeons have been negligent.

Res ipsa loquitur Res ipsa loquitur “The thing speaks for itself.” Nature of wrongful act or injury is suggestive of negligence. A rule of evidence which infers negligence from the nature of the injury sustained by the plaintiff. Solis, P. D (1998) Medical jurisprudence: The practice of medicine and the law. Quezon City: Garotech

Res ipsa loquitur Requisites for Its Application The accident must be of a kind which ordinarily does not occur in the absence of someone’s negligence. It must be caused by an agency or instrumentality within the exclusive control of the defendant. It must not have been due to any voluntary action or contribution on the part of the plantiff. Solis, P. D (1998) Medical jurisprudence: The practice of medicine and the law. Quezon City: Garotech

Res ipsa loquitur In This Case Object left in the patient’s body at the time of surgery. Solis, P. D (1998) Medical jurisprudence: The practice of medicine and the law. Quezon City: Garotech

Captain of the Ship Captain of the Ship 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.

Captain of the Ship Dr. Ampil is the lead surgeon as evidenced by: Calling Dr. Fuentes to perform a hysterectomy Examining the work of Dr. Fuentes and finding it in order Granting Dr. Fuentes permission to leave Ordering the closure of the incision

Whether PSI Is Liable for the Negligence of Dr. Ampil Ostensible Agent | Corporate Negligence | Reckless Imprudence Whether PSI Is Liable for the Negligence of Dr. Ampil

PSI’s liability is based on the following doctrines applied in medical malpractice cases: Doctrine of Ostensible agent Doctrine of Corporate Negligence

In G.R. No. 126297, PSI alleged in its petition that the Court of Appeals erred in holding that (1) it is estopped from raising the defense that Dr. Ampil is not its employee; (2) it is solidarily liable with Dr. Ampil; and (3) it is not entitled to its counterclaim against the Aganas. PSI contends that Dr. Ampil is not its employee, but a mere consultant or independent contractor. As such, he alone should answer for his negligence.

Doctrine of Ostensible Agent A person who has been given the appearance of being an employee or acting (an agent) for another (principal), which would make anyone dealing with the ostensible agent reasonably believe he/she was an employee or agent. They usually get a certain percentage of the fee paid to the hospital. They are considered members of the staff of the department and are appointed by the governing board of the hospital. http://legal-dictionary.thefreedictionary.com/ostensible+agent Solis, P. D (1998) Medical jurisprudence: The practice of medicine and the law. Quezon City: Garotech

Doctrine of Ostensible Agent The hospital must be held liable for negligent acts of ostensible agents. By accrediting Dr. Ampil & Dr. Fuentes and publicly advertising their qualifications the hospital created the impression that they were its agents.

Doctrine of Corporate Negligence Hospital/medical center or healthcare agency as an entity is negligent. Failure of the corporation to follow an established standard of conduct to which all healthcare corporations should conform in a given situation. The determination of negligence is based on violations of duty owed to the patient by the hospital. Parelli, R.J. (1997) Medicolegal issues for radiographers. Florida: CRC

Doctrine of Corporate Negligence Duties of the Hospital To furnish a safe and well maintained building and ground To furnish adequate and safe equipments To exercise reasonable care in the selection of the members of the hospital staff Solis, P. D (1998) Medical jurisprudence: The practice of medicine and the law. Quezon City: Garotech

Doctrine of Corporate Negligence Duties of the Hospital Medical City Hospital has the duty to exercise reasonable care to protect from harm all patients admitted into its facility for medical treatment which it failed to do so. The hospital also failed to conduct an investigation of the matter and inform the patient of the missing gauzes, amounting to callous negligence.

Reckless Imprudence Consists in voluntary, without malice, doing or failing to do an act from which material damage results by reason of inexcusable lack of precaution on the part of the parson performing or failing to perform such act, taking into consideration his employment or occupation, degree of intelligence, physical condition and other circumstances regarding persons, time and place.

Reckless Imprudence Elements That the offender does or fails to do an act. That the doing of or the failure to do the act is voluntary. That it is done without malice.

Reckless Imprudence Elements 4. That material damage or injury resulted from it. 5. That there is inexcusable lack of precaution on the part of the offender taking into consideration a. his employment or occupation b. degree of intelligence, physical condition; or c. other circumstances regarding the person(s), time and place