Case Summary (G.R. No. 126297)
Petitioner and Respondents
• Petitioners: PSI (G.R. No. 126297), Aganas (G.R. No. 126467), Dr. Ampil (G.R. No. 127590)
• Respondents: Aganas, Dr. Fuentes, PSI, Dr. Ampil (depending on petition)
Key Dates
• April 4–11, 1984: Admission and surgery at Medical City Hospital.
• April 24, 1984: Patient discharged; later pain complaints.
• May–August 1984: U.S. treatment and return to Philippines; gauzes discovered.
• October 1984: Second surgery to repair recto‐vaginal fistula.
• November 12, 1984: Complaint for damages filed in RTC, Q.C.
• March 17, 1993: RTC decision in favor of Aganas.
• September 6, 1996: Court of Appeals decision affirming liability of PSI and Dr. Ampil, dismissing claims against Dr. Fuentes.
• January 31, 2007: Supreme Court decision under 1987 Constitution.
Applicable Law
• 1987 Philippine Constitution – provisions on right to health and due process.
• Civil Code, Art. 2176 (Quasi‐delict), Art. 2180 (Respondeat superior).
• Doctrine of Res Ipsa Loquitur (evidentiary rule).
• Agency principles: Apparent authority/agency by estoppel, corporate negligence.
• Medical negligence standard: duty, breach, causation, injury.
Factual Background
Natividad was admitted for obstructed bowel and diagnosed with sigmoid cancer. Dr. Ampil performed anterior resection; Dr. Fuentes performed hysterectomy upon consent. Post‐op sponge count revealed two missing gauzes, announced to Dr. Ampil, but incision was closed. Patient later suffered pain; U.S. doctors found no cancer but returned to Philippines still in pain; pieces of gauze extruded, infection ensued, and a recto‐vaginal fistula developed. A second corrective surgery followed.
Issue I – Liability of Dr. Ampil for Negligence and Malpractice
Dr. Ampil’s failure to retrieve and timely disclose two intraoperative gauzes breached his duty as lead surgeon. The nurses’ report of missing sponges, his order to “continue for closure,” and the subsequent retrieval of gauzes from the surgical site constitute prima facie negligence per se. His misrepresentation of patient pain as normal post‐operative consequence aggravated the breach. Under the four elements—duty, breach, injury, and proximate cause—Dr. Ampil’s conduct directly caused further surgeries, infection, and physical injury.
Issue II – Liability of Dr. Fuentes and Res Ipsa Loquitur
The Court denied application of res ipsa loquitur against Dr. Fuentes, finding he performed his designated hysterectomy, reported his work to Dr. Ampil, and left before gauze count issues arose. Control of the surgical field lay with the “captain of the ship” (Dr. Ampil) at the time the gauzes went unaccounted. Res ipsa loquitur requires exclusive control of the instrumentality by the defendant, which was absent as to Dr. Fuentes.
Issue III – Liability of PSI for Dr. Ampil’s Negligence
- Vicarious Liability (Respondeat Superior)
– Under Art. 2180, hospitals are liable for negligent acts of its staff “in the service of the branches” and must prove they exercised “all diligence of a good father of a family.” PSI failed to demonstrate such diligence in accrediting and supervising Dr. Ampil. - Apparent Authority/Agency by Estoppel
– PSI held out Drs. Ampil a
Case Syllabus (G.R. No. 126297)
Facts of the Case
- On April 4, 1984, Natividad Agana was admitted to The Medical City General Hospital for difficulty of bowel movement and bloody anal discharge.
- Dr. Miguel Ampil diagnosed sigmoid cancer and on April 11, 1984 performed an anterior resection, finding malignancy spread to the left ovary.
- With Enrique Agana’s consent, Dr. Juan Fuentes performed a hysterectomy; Dr. Ampil then completed the operation and closed the incision.
- Nurses’ Record of Operation noted “sponge count lacking 2—announced to surgeon—search done but to no avail—continue for closure.”
- Natividad was discharged April 24; total hospital and medical bills amounted to ₱60,000.00.
- Shortly after, she experienced excruciating anal pain; doctors attributed it to normal postoperative effects and advised oncologic follow-up.
- On May 9, 1984, Natividad and her husband went to the United States; after four months of treatment she was declared cancer-free but still in pain.
- Returning to the Philippines August 31, 1984, Natividad’s daughter discovered a piece of gauze protruding from her vagina.
- Dr. Ampil extracted a 1.5-inch gauze at home but pain worsened; subsequent hospital admission revealed a second infected gauze and a recto-vaginal fistula.
- In October 1984, Natividad underwent a second surgery to repair the fistula.
- On November 12, 1984, Natividad and Enrique Agana filed Civil Case No. Q-43322 against PSI, Dr. Ampil, and Dr. Fuentes for negligence (retained gauzes) and concealment.
- Enrique Agana also filed Administrative Case No. 1690 with the PRC Board of Medicine for gross negligence and malpractice against both doctors.
- Natividad died February 16, 1986; her children substituted as plaintiffs.
Procedural History
- March 17, 1993: RTC Branch 96, Quezon City rendered decision in favor of the Aganas, awarding:
- Reimbursement of US$19,900 at ₱21.60/US$1; travel taxes ₱4,800; hospital and medical costs ₱45,802.50
- Moral damages ₱2,000,000; exemplary damages ₱300,000; attorney’s fees ₱250,000; legal interest; costs
- May 11, 1993: Partial execution ordered; sheriff levied and sold Dr. Ampil’s properties (₱451,275).
- Aganas agreed with PSI