THE EFFECT OF ACQUITTAL ON THE CIVIL ACTION
Doctors Hospital of Lake
> The general rule is that the civil action is not necessarily
extinguished by the acquittal of the accused. Even if the accused is
acquitted, the court can still award civil liability in the following cases:
1. When the acquittal is based on reasonable doubt and there was
no negligence
2. When there is a declaration in the decision that the liability of the
accused is only civil
3. When the civil liability is not derived from or based on the
criminal act of which the accused is acquitted (independent civil
actions)
> However, if the decision contains a finding that the act from which
the civil liability may arise doesnt exist, the civil liability is
extinguished
WHAT ARE THE TWO TYPES OF ACQUITTAL?
1. Acquittal based on reasonable doubt
2. Acquittal based on the meritshe didn't commit the crime
CAN YOU COMPEL A JUDGE BY MANDAMUS TO AWARD CIVIL
DAMAGES?
> Yes, because every person criminally liable is also civilly liable
> Another reason is that even if the accused is acquitted, there are cases
when he is still civilly liable
WHAT IS THE REASON FOR ALLOWING CIVIL LIABILITY TO
SUBSIST IN SPITE OF THE ACQUITTAL OF THE ACCUSED?
> The reason is that the parties in the criminal and civil actions are
differentin the criminal action, the party is the state, while in the civil
action, the party is the private offended party
> Also, the two actions require different quantities of evidencethe
criminal action requires proof of guilt beyond reasonable doubt, the
civil action on the other hand, requires mere preponderance of evidence
1-2) DOCTRINE OF APPARENT AUTHORITY OR THE HOLDING OUT
THEORY; OR DOCTRINE OF OSTENSIBLE AGENCY OR AGENCY BY
ESTOPPEL
This doctrine imposes liability, not as the result of the reality of a
contractual relationship, but rather because of the actions of a principal
or an employer in somehow misleading the public into believing that the
relationship or the authority exists. (Irving v.
Worth, Inc., 415 So. 2d 55 (1982), quoting Arthur v. St. Peters Hospital, 169
N.J. 575, 405 A 2d 443 (1979)). The concept is essentially one of estoppel.
Under the rule, the principal is bound by the acts of his agent with the
apparent authority which he knowingly permits the agent to assume, or
which he holds to the agent out to the public as possessing. The question
in every case is whether the principal has by his voluntary act placed the
agent with business usages and the nature of the particular business, is
justified in presuming that such agent has authority to perform the
particular act in question. (Hudson C., Loan Assn., Inc. v. Horowytz, 116
N.J.L. 605, 608 A 437 (Supp. Ct. 1936).
The applicability of the doctrine of apparent authority in the field of
hospital liability has been upheld in Irving v. Doctor Hospital of Lake
Worth Inc.. In this case, it was said that there does not appear to be any
rational basis for excluding the concept of apparent authority from the
field of hospital liability. 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 the patient has accepted treatment from the
physician in the reasonable belief that it is being tendered in behalf of the
hospital, then the hospital will be liable for the physicians negligence.
The Civil Code recognizes the concept of agency by implication or
estoppel. Article 1869 of the Civil Code provides:
Agency may be express, or implied from the acts of the principal, from
his silence or lack of action, or his failure to repudiate the agency,
knowing that another person is acting on his behalf without authority.
The defendant Professional Services, Inc. displayed in the lobby of the
Medical City Hospital the names and specializations of the physicians
associated or accredited by it. It is estopped from passing all 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. That
is tantamount to holding out to the public that the hospital through its
accredited physicians, offers quality health care services. By accrediting
the doctors and publicly advertising their qualifications, the hospital
created the impression that they were agents, authorized to perform
medical and surgical services for its patients. As expected, the patients
accepted the services on the reasonable belief that such were being
rendered by the hospital or its employees, agents or servants.
As aptly said by the trial court:
x x x regardless of the education and status in life of the patient, he
ought not be burdened with the defense of absence of employer-
employee relationship between the hospital and the independent
physician whose name and competence are certainly certified to the
general public by the hospitals act of listing him and his specialty in its
lobby. The high costs of todays medical and health care should not at
least exact on the hospital greater, if not broader, legal responsibility for
the conduct of treatment and surgery within its facility by its accredited
physician or surgeon, regardless of whether he is independent or
employed.
The wisdom of such reasoning is easy to discern. Corporate entities like
hospitals are capable of acting only through other individuals like
physicians. If these accredited physicians do their job well, the hospital
succeeds in its mission of offering quality medical services and thus,
profits financially. Logically, where negligence mars the quality of its
services, the hospital should not be allowed to escape liability for the acts
of its ostensible agents. (Professional Services, Inc. v. Agana, G.R. No.
126297; Agana v. Juan Fuentes, G.R. No. 126467; Ampil v. Agana, G.R. No.
127590, January 31, 2007).
3.) Under the DOCTRINE OF HOSPITAL CORPORATE LIABILITY, a hospital
has a nondelegable, direct duty to provide adequate care to all of its
patients. 1 This duty is not a product of a master-servant or a principal-
agent relationship, 2 nor is hospital tort liability predicated on a showing
of vicarious liability, because the hospital's liability flows directly from the
hospital to its patients. 3 Consequently, a hospital may be liable for the
negligent act of an independent staff physician, even if that physician is
an independent contractor. 4 The corporate liability, or corporate
negligence, 5 doctrine thus extends potential liability beyond the sphere
of respondeat superior.
Although many courts have recognized corporate liability as an
"emerging trend" throughout the country, 6 reviewing courts should
consider carefully the reasons supporting the doctrine and the ways in
which many courts now apply it. As health care issues play an increasingly
greater role in American society, courts have a greater obligation to apply
articulable guidelines uniformly when determining hospital liability.
Unfortunately, despite the courts' ability to rectify the existing
uncertainty, they have treated corporate liability disparately thus far. The
corporate liability doctrine has a useful and practical application but only
when applied in limited and clearly defined circumstances.
Part II of this Note discusses hospitals' evolution into modern, health-care
providing entities. An examination of the emergence of the modern
hospital as a corporate institution provides the framework for the
creation and application.
4.) CAPTAIN OF THE SHIP RULE
Dr. Ampil was the lead surgeon during the operation of Natividad. He
requested the assistance of Dr. Fuentes only to perform hysterectomy
when he found that the malignancy in her sigmoid area had spread to her
left ovary. Dr. Fuentes performed the surgery and thereafter reported
and showed his work to Dr. Ampil. The latter examined it and finding
everything to be in order, allowed Dr. Fuentes to leave the operating
room. Dr. Ampil then resumed operating on Natividad. He was about to
finish the procedure when the attending nurses informed him that two
pieces of gauze were missing. A diligent search was conducted, but the
misplaced gauzes were not found. Dr. Ampil then directed that the
incision be closed. During this entire period, Dr. Fuentes was no longer in
the operating room and had, in fact, left the hospital.
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. Their duty is to obey his orders. (Rural Educational Assn. v.
Bush, 42 Tenn. App. 34, 298 S.W. 2d 761 (1956)). As stated before, Dr.
Ampil was the lead surgeon. In other words, he was the Captain of the
Ship. That he discharged such role is evidenced from his following
conduct: (1) calling Dr. Fuentes to perform a hysterectomy; (2) examining
the work of Dr. Fuentes and finding it in order; (3) granting Dr. Fuentes
permission to leave; and (4) ordering the closure of the incision. It was
this act of ordering the closure of the incision notwithstanding that two
pieces of gauze remained unaccounted for, that caused injury to
Natividads body. Clearly, the control and management of the thing which
caused the injury was in the hands of Dr. Ampil, not Dr. Fuentes.
In this jurisdiction, res ipsa loquitur is not a rule of substantive law, hence,
does not per se create or constitute an independent or separate ground
of liability, being a mere evidentiary rule. In other words, mere invocation
and application of the doctrine does not dispense with the requirement
of proof of negligence. Here, the negligence was proven to have been
committed by Dr. Ampil and not by Dr. Fuentes.
(3) Whether PSI is liable for the negligence of Dr. Ampil.
The third issue necessitates a glimpse at the historical development of
hospitals and the resulting theories concerning their liability for the
negligence of physicians.
Until the mid-nineteenth century, hospitals were generally charitable
institutions, providing medical services to the lowest classes of society,
without regard for a patients ability to pay. Those who could afford
medical treatment were usually treated at home by their doctors.
However, the days of house calls and philanthropic health care are over.
The modern health care industry continues to distance itself from its
charitable past and has experienced a significant conversion from a not-
for-profit health care to for-profit hospital business. Consequently,
significant changes in health law have accompanied the business-related
changes in the hospital industry. One important legal change is an
increase in hospital liability for medical malpractice. Many courts now
allow claims for hospital vicarious liability under the theories of
respondeat superior, apparent authority, ostensible authority, or agency
by estoppel.
The statute governing liability for negligent acts is Article 2176 of the Civil
Code, which reads:
Article 2176. Whoever by act or omission causes damage to another, there
being fault or negligence, is obliged to pay for the damage done. Such
fault or negligence, if there is no pre-existing contractual relation
between the parties, is called a quasi-delict and is governed by the
provisions of this Chapter.
A derivated of this provision is Article 2180, the rule governing vicarious
liability under the doctrine of respondeat superior, thus:
Article 2180. The obligation imposed by Article 2176 is demandable not
only for ones own acts or omissions, but also for those of persons for
whom one is responsible.
The owners and managers of an establishment or enterprise are likewise
responsible for damages caused by their employees in the service of the
branches in which the latter are employed or on the occasion of their
functions.
Employers shall be liable for the damages caused by their employees and
household helpers acting within the scope of their assigned tasks even
though the former are not engaged in any business or industry.
The responsibility treated of in this article shall cease when the persons
herein mentioned prove that they observed all the diligence of a good
father of a family to prevent damage.
Professionals engaged by an employer, such as physicians, dentists, and
pharmacists, are not employees under this article because the manner
in which they perform their work is not within the control of the latter
(employer). In other words, professionals are considered personally liable
for the fault or negligence they commit in the discharge of their duties,
and their employer cannot be held liable for such fault or negligence. In
the context of the present case, a hospital cannot be held liable for the
fault or negligence of a physician or surgeon in the treatment or
operation of patients.
Such view is grounded on the traditional notion that the professional
status and the very nature of the physicians calling preclude him from
being classed as an agent or employee of a hospital, whenever he acts in
a professional capacity. It has been said that medical practice strictly
involves highly developed and specialized knowledge, such that
physicians are generally free to exercise their own skill and judgment in
rendering medical services sans interference. Hence, when a doctor
practices medicine in a hospital setting, the hospital and its employees
are deemed to subserve him in his ministrations to the patient and his
actions are of his own responsibility.
5. The case of SCHLOENDORFF v. Society of New York Hospital, 211 N.Y.
125, 105 N.E. 92, 52 L.R.A., N.S. 505 (1914), was then considered an
authority for this view. The SCHLOENDORFF DOCTRINE regards a
physician, even if employed by a hospital, as an independent contractor
because of the skill he exercises and the lack of control exerted over his
work. Under this doctrine, hospitals are exempt from the application of
the respondeat superior principle for fault or negligence committed by
physicians in the discharge of their profession.
However, the efficacy of such doctrine has weakened with the significant
developments in medical care. Courts came to realize that modern
hospitals are increasingly taking active role in supplying and regulating
medical care to patients. No longer were a hospitals functions limited to
furnishing room, food, facilities for treatment and operation, and
attendants for its patients. Thus, in Bing v. Thunig, 2 N.Y. 2d 656, 163 NYS
2d 3, 143 (1957), the New York Court of Appeals deviated from the
Schloendorff doctrine, noting that modern hospitals actually do far more
than provide facilities for treatment. Rather, they regularly employ, on a
salaried basis, a large staff of physicians, interns, nurses, administrative
and manual workers. They charge patients for medical care and
treatment, even collecting for such services through legal action, if
necessary. The court then concluded that there is no reason to exempt
hospitals from the universal rule of respondeat superior.
In our shores, the nature of the relationship between the hospital and the
physicians is rendered inconsequential in view of our categorical
pronouncement in Ramos v. Court of Appeals, that for purposes of
apportioning responsibility in medical negligence cases, an employer-
employee relationship in effect exists between hospitals and their
attending and visiting physicians. Thus, it was held:
We now discuss the responsibility of the hospital in this particular
incident. The unique practice (among private hospitals) of filling up
specialist staff with attending and visiting consultants, who are
allegedly not hospital employees, presents problems in apportioning
responsibility for negligence in medical malpractice cases. However, the
difficulty is more apparent than real.
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. Doctors who apply for consultant slots, visiting or attending,
are required to submit proof of completion of residency, their
educational qualifications, generally, evidence of accreditation by the
appropriate board (diplomate), evidence of fellowship in most cases, and
references. These requirements are carefully scrutinized by members of
the hospital administration or by a review committee set up by the
hospital who either accept or reject the application.
After a physician is accepted, either as a visiting or attending consultant,
he is normally required to attend clinico-pathological conferences,
conduct bedside rounds for clerks, interns and residents, moderate grand
rounds and patient audits and perform other tasks and responsibilities,
for the privilege of being able to maintain a clinic in the hospital, and/or
for the privilege of admitting patients into the hospital. In addition to
these, the physicians performance as a specialist is generally evaluated
by a peer review committee on the basis of mortality and morbidity
statistics, and feedback from patients, nurses, interns and residents. A
consultant remiss in his duties, or a consultant who regularly falls short of
the minimum standards acceptable to the hospital or its peer review
committee, is normally politely terminated.
In other words, private hospitals, hire, fire and exercise real control over
their attending and visiting consultant staff. While consultants are not,
technically employees, x x x , 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. In assessing whether such a relationship in fact exists, the control
test is determining. Accordingly, on the basis of the foregoing, we rule
that 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.