PSI vs Agana (GR No. 126297 January 31, 2007)

Professional Services Inc. vs Agana
GR No. 126297 January 31, 2007

Facts: On April 4, 1984, Natividad Agana was rushed to the Medical City General Hospital because of difficulty of bowel movement and bloody anal discharge. After a series of medical examinations, Dr. Miguel Ampil diagnosed her to be suffering from Cancer of the sigmoid. On April 11, 1984, Dr. Ampil assisted by the medical staff of the Medical City Hospital performed an Anterior resection surgery on Natividad. He found that the malignancy on her sigmoid area had spread on her left ovary, necessitating the removal of certain portions of it. Thus, Dr. Ampil obtained the consent of Natividad’s husband, Enrique Agana, to permit Dr. Juan Fuentes to perform hysterectomy on her. After Dr. Fuentes had completed the hysterectomy, Dr. Ampil took over, completed the operation and closed the incision after searching for the missing 2 gauzes as indicated by the assisting nurses but failed to locate it. After a couple of days, Natividad complained of excruciating pains in her anal region but Dr. Ampil said it is a natural consequence of the operation/surgery and recommended that she consult an oncologist to examine the cancerous nodes which were not removed during the operation. Natividad and her husband went to the US to seek further treatment and she was declared free from cancer. A piece of gauze portruding from Natividad’s vagina was found by her daughter which was then removed by hand by Dr. Ampil and assured that the pains will vanished. However, it didn’t. The pains intensified prompting Natividad to seek treatment at the Polymedic General Hospital. While confined there, Dr. Ramon Guttierez detected the presence of another foreign object in her vagina – a foul smelling gauze measuring 1.5 inches in width which badly infected her vagina. A recto-vaginal fistula had forced stool to excrete through her vagina. Another surgical operation was needed to remedy the damage.

Issue: Whether or not Dr. Ampil and Fuentes are liable for medical malpractice and the PSI for damages due to the negligence of the said doctors.

Held: Yes. No. Yes. An operation requiring the placing of sponges in the incision is not complete until the sponges are properly removed and it is settled that the leaving of sponges or other foreign substances in the wound after the incision has been closed is at least prima facie negligence by the operating surgeon. To put it simply, such act is considered so inconsistent with due care as to raise inference of negligence. There are even legions of authorities to the effect that such act is negligence per se.

This is a clear case of medical malpractice or more appropriately, medical negligence. To successfully pursue this kind of case, a patient must only prove that a health care provider either failed to do something which a reasonably prudent health care provider would have done, or that he did something that a reasonably prudent provider would not have done; and that failure or action caused injury to the patient. Simply puts the elements are duty, breach, injury, and proximate causation. Dr. Ampil, as the lead surgeon, had the duty to remove all foreign objects, such as gauzes, from Natividad’s body before closure of the incision. When he failed to do so, it was his duty to inform Natividad about it. Dr. Ampil breached both duties. Such breach caused injury to Natividad, necessitating her further examination by American doctors and another surgery. That Dr. Ampil’s negligence is the proximate cause of Natividad’s injury could be traced from his act of closing the incision despite the information given by the attending nurses that 2 pieces of gauze were still missing. That they were later on extracted from Natividad’s vagina established the causal link between Dr. Ampil’s negligence and the injury. And what further aggravated such injury was his deliberate concealment of this missing gauzes from the knowledge of Natividad and her family.

The requisites for the applicability of the doctrine of res ipsa liquitor are:

  1. Occurrence of an injury;
  2. The thing which caused the injury was under the control and management of the defendant;
  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, the most instrumental is the “Control and management of the thing which caused the injury.”

Under the “Captain of the ship” rule, the operating surgeon is the person in complete charge of the surgery room and all personnel connected with the operation.

The knowledge of any of the staff of Medical City constitutes knowledge of PSI.

The doctrine of corporate responsibility, has the duty to see that it meets the standards of responsibilities for the care of patients. Such duty includes the proper supervision of the members of its medical staff. The hospital accordingly has the duty to make a reasonable effort to monitor and over see the treatment prescribed and administered by the physician practicing in its premises.


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