SC Rules Against Surgeon, Hospital


(Source: The Philippine Daily Inquirer)
Posted date: February 07, 2007

MANILA, Philippines -- The Supreme Court has affirmed a Court of Appeals decision finding the owner of Medical City General Hospital and a member of its surgical staff liable for the death of a patient as a result of complications arising from two pieces of gauze being left in her body during an operation.

The high court found Dr. Miguel Ampil liable for "medical negligence," and said the contention of Professional Services Inc. (PSI), the hospital owner, that it could not be held liable for his error did not stand.

It likewise upheld the awarding of more than P3 million in damages to the family of Natividad Agana, who died in 1986, two years after the surgery.

The tribunal's ruling affirming the appellate court's decision of Sept. 6, 1996, was written by Justice Angelina Sandoval Gutierrez and issued on Jan. 31.

Ampil operated on Agana in 1984, in the course of her treatment for cancer of the sigmoid. (The sigmoid colon joins the rectum, which in turn joins the anus, or the opening where solid waste passes out of the body.)

He found that the cancer had spread to the patient's left ovary. Dr. Juan Fuentes then conducted a hysterectomy, where portions of the stricken ovary were removed.

Nurses' report

It was Ampil who completed the surgery.

According to operation records, the attending nurses called Ampil's attention to the missing gauze ("sponge count lacking 2") and a search was conducted. But despite the fruitless search, the surgeon "continued[d] for closure."

Agana subsequently experienced "excruciating pain" in her anal region. The pieces of gauze measuring 1.5 inches in width were in time found -- one causing a grave infection in her vaginal vault.

Agana and her husband Enrique filed a complaint for damages before the Quezon City Regional Trial Court, which, on March 17, 1993, found PSI and the two surgeons liable. The case was later elevated to the appellate court.

But the Supreme Court cleared Fuentes of liability, saying Ampil had checked the other surgeon's work after the hysterectomy and allowed him to leave the operating room.

'Callous negligence'

In agreeing with the Quezon City RTC's invocation of the doctrine of corporate negligence in finding PSI liable, the Supreme Court said hospitals were obliged to monitor their medical staff as part of their responsibility to provide quality health care.

The tribunal also said that PSI exhibited "callous negligence" in failing to act on Agana's condition, and that it was expected to know about the procedures carried out on the patient as well as the nurses' report on the two missing pieces of gauze.

"Not only did PSI breach its duties to oversee or supervise all persons who practice medicine within its walls, it also failed to take an active step in fixing the negligence committed," the high court said.

"This renders PSI not only vicariously liable for the negligence of Dr. Ampil under Article 2180 of the Civil Code, but also directly liable for its own negligence," it said.

The high court pointed out that PSI profited financially from the actions of its doctors and, in turn, should be held liable for their mistakes as well.

Financial profit

It added that PSI had failed to prove that it had supervised Ampil with "the "diligence of a good father of a family."

The tribunal also said that an employer-employee relationship existed between PSI and Ampil, and that the hospital presented the latter as a doctor associated with it.

"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," the high court said.

The tribunal further said that by displaying in its lobby the names and specializations of its physicians, PSI was in effect endorsing their services:

"We concur with the Court of Appeals' conclusion that [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.'

"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."


As for Ampil, the Supreme Court said he had deceived Agana by not disclosing to her the information about the missing pieces of gauze.

"To our mind, what was initially an act of negligence by Dr. Ampil has ripened into a deliberate wrongful act of deceiving his patient. This is a clear case of medical malpractice or, more appropriately, medical negligence," the tribunal said.

Both surgeons had assured Agana that the pain she was feeling even after her discharge from the hospital was a natural result of the surgery.

Agana subsequently sought treatment in the United States, where she was found to be free of cancer.

It was after her return to the Philippines later in 1984 that the pieces of gauze were found in her body.

The Philippine Daily Inquirer sought out Marilyn Atienza, identified by the hospital's marketing staff as the hospital's spokesperson, for comment. But she could not be reached after repeated attempts up to press time. --- Leila B. Salaverria


Copyright 1998 Philip S. Chua, MD, FACS, FPCS
All Rights Reserved