Directly liable

This case is about the responsibility of a hospital for negligence in medical malpractice cases of its attending physicians. This is the case of the spouses Naty and Ike against PSI, a corporation that owns and operates a prominent and well known hospital, the MCGH, and its consultant Dr. Mike.

When Naty started experiencing certain difficulties in some parts of her body and felt sickly, her husband Ike decided to see Dr. Mike, their neighbor whom he knew to be a staff member of MCGH since his name was even in the directory posted at the hospital’s public lobby. After he told Dr. Mike about the case of his wife, the latter asked him to bring Naty to the hospital for examination. The examination revealed that Naty was suffering from “cancer of the sigmoid” that required an anterior resection surgery. During the surgery, Dr. Mike found that the malignancy had spread to the left ovary so he asked Ike’s consent to allow Dr. Fred, another doctor of the hospital to perform hysterectomy upon Naty.

After both operations were completed, Dr. Mike closed the incision. However there seemed to be some flaw as appearing in the record prepared by the attending nurses because of 2 missing sponges which the nurses “announced to the surgeon who made the search to no avail and just continued the closure”.

Thereafter Naty complained of excruciating pain in her anal region. But both doctors told her it was just the natural consequence of the surgical operation. When the pain persisted, Naty and Ike were forced to go to US to seek further treatment only to be told 4 months later that she was free of cancer and advised to return to the Philippines.

Upon her return, the pain still persisted. But two weeks later, Naty’s daughter found a piece of gauze measuring 1.5 inches in width protruding from Naty’s private parts. When informed, Dr. Mike extracted it by hand and told Naty that the pain would soon vanish.

But the pain persisted and even intensified forcing Naty to seek treatment in another hospital where another doctor detected the presence of another gauze measuring 1.5 inches that badly infected her reproductive organ and required another surgery.

Thus Naty and Ike already filed a complaint for damages against PSI, Dr. Mike and Dr. Fred before the Regional Trial Court. But Naty did not live to see the outcome of their suit as she died about two years from its filing. It was only nine years later that the RTC finally decided in their favor finding PSI, Dr. Mike and Dr. Fred jointly and severally liable for damages. On appeal to the Court of Appeals (CA), the latter affirmed the RTC decision except that the complaint against Dr. Fred was dismissed.

PSI however still insisted that it is not jointly and severally liable with Dr. Mike, the attending physician because: there was no employer-employee relationship between them; the spouses failed to establish that they relied on the representation of the hospital in engaging Dr. Mike’s services so the doctrine of ostensible agency or agency by estoppel cannot apply; and the proximate cause of Naty’s injury was Dr. Mike’s negligence so the doctrine of corporate negligence cannot likewise be applied. Was PSI correct?

No. For the purpose of allocating responsibility in medical negligence cases, an employer-employee relationship in effect exists between hospitals and their attending and visiting physicians. In the first place, hospitals exercise significant control in the hiring and firing of consultants and in the conduct of their work within the hospital premises. While consultants are not, technically, employees, 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.

Even assuming that consultants like Dr. Mike are independent contractors, not employees of the hospital, still PSI is liable to the spouses under the doctrine of apparent authority or ostensible agency essentially involving two factors: the general and implied representation made by the hospital to the patient that the treating physician is an employee of the hospital; and the patient’s reliance. In this case, the hospital displayed Dr. Mike’s name and those of other physicians in the public directory at the lobby and Ike himself chose Dr. Mike, their neighbor because he knew him to be a staff member of MCGH, a prominent and well known hospital. This was proof of their reliance on the representation of the hospital that Dr. Mike is its employee contrary to PSI’s contention.

As part of its inherent responsibility to provide quality medical care, the hospital also has the duty to make a reasonable effort to monitor and oversee the treatment prescribed and administered by the physicians practicing in its premises. In this case, PSI has been remiss in its duty. It did not conduct an immediate investigation of the missing gauzes to the great prejudice and agony of its patient. Not only did it breach its duty to oversee and supervise all persons who practice medicine within its walls, it also failed to take active steps in fixing the negligence committed. Thus it is not only vicariously liable for the negligence of Dr. Mike under Article 2180 of the Civil Code but also directly liable under Article 2176 (Professional Services Inc. vs. Court of Appeals et. al. G.R. 126297; Agana etc vs. Court of Appeals et.al. G.R. 126467; Ampil vs. Court of Appeals, G.R. 127590, February 11, 2008)  

Note: Books containing compilation of my articles on Labor Law and Criminal Law (Vols. I and II) are now available. Call tel. 7249445.

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