BOARD OF MEDICINE vs.

YASUYUKI OTA
G.R. No. 166097, July 14, 2008

Law and Practice of Medicine

Facts: Yasuyuki Ota is a Japanese national who continuously resided in

the Philippines for more than ten (10) years. He graduated Medicine
in Bicol Christian College. After completing internship at Jose Reyes
Medical Center, he filed an application to take the medical board
examinations to obtain a license. He was further required by Professional
Regulation Commission (PRC) to submit a documentary proof that
reciprocity exists between Japan and Philippines in admitting foreigners to
practice of medicine. In spite of passing the licensure examination and
submitting proof that reciprocity exists, the Board of Medicine of the PRC
still denied Ota’s request on the ground that no reciprocity can be found,
and even if there is, it is impractical and impossible.

Issue: Can Ota Practice Medicine in the Philippines?

Ruling: Ota can practice Medicine in the Philippines. Under RA 2382 or

the Medical Act of 1959, it merely requires a foreign citizen to submit
competent and conclusive documentary evidence, confirmed by the
Department of Foreign Affairs, showing that his country’s existing laws
permit citizens of the Philippines to practice medicine under the same
rules and regulations governing citizens. Nowhere in said statute is it
stated that the foreign applicant must show that the conditions of practice
of Medicine in said country are practical and attainable by Filipinos. It is
enough that the laws in a foreign country permit a Filipino to get license
and practice therein. Thus, since Oto has all the qualification and does not
possess any of the disqualifications, he can practice medicine in the
Philippines.

GARCIA-RUEDA vs PASCASIO
G.R. No. 118141, September 5, 1997
FACTS: Florencio Rueda underwent surgery, and was attended by Dr.
Antonio Jr (as surgeon) and Br. Balatbat-Reyes (anesthesiologist). Six
hours after surgery, Florencio died of complications. Thus, his wife filed a
case against the doctors. The case was bolstered when the NBI
pronounced that after conducting an autopsy, there was indeed
negligence on the part of the physicians.

ISSUE: Is Medical Malpractice committed by the doctors?

RULING: Yes, medical malpractice was committed. Medical malpractice

is committed when the following elements are present:
1. Duty
2. Breach of Duty
3. Proximate Causation
4. Injury or Death

Here, the doctors are duty-bound to take care of Florencio in

accordance with standards established by its profession. However, they
breached such duty when they wrongfully administered the anesthesia.
Indeed here, a causal connection is discernible from the occurrence of
Florencio’s death after the negligent act. Therefore, the doctors are liable
for Medical Malpractice.

CASUMPANG v. CORTEJO
G.R. No. 171127 | March 11, 2015

FACTS:

 On April 22, 1988, at about 11:30 in the morning, Mrs. Cortejo brought her 11-year
old son, Edmer, to the Emergency Room of the San Juan de Dios Hospital (SJDH)
because of difficulty in breathing, chest pain, stomach pain, and fever. Thereafter,
she was referred and assigned to Dr. Casumpang, a pediatrician. At 5:30 in the
afternoon of the same day, Dr. Casumpang, upon examination using only a
stethoscope, confirmed the diagnosis of Bronchopneumonia. Mrs. Cortejo
immediately advised Dr. Casumpang that Edmer had a high fever, and had no colds
or cough but Dr. Casumpang merely told her that her son's bloodpressure is just
being active and remarked that that's the usual bronchopneumonia, no colds, no
phlegm.
 Dr. Casumpang next visited the following day. Mrs. Cortejo again called Dr.
Casumpang's attention and stated that Edmer had a fever, throat irritation, as well as
chest and stomach pain. Mrs. Cortejo also alerted Dr. Casumpang about the traces
of blood in Edmer's sputum. Despite these pieces of information, however, Dr.
Casumpang simply nodded and reassured Mrs. Cortejo that Edmer's illness is
bronchopneumonia.

 At around 11:30 in the morning of April 23, 1988, Edmer vomited phlegm with blood
streak prompting the Edmer's father to request for a doctor. Later, Miranda, one of
the resident physicians of SJDH, arrived. She claimed that although aware that
Edmer had vomited phlegm with blood streak she failed to examine the blood
specimen. She then advised the respondent to preserve the specimen for
examination. Thereafter, Dr. Miranda conducted a check-up on Edmer and found that
Edmer had a low-grade fever and rashes.

 At 3:00 in the afternoon, Edmer once again vomited blood. Dr. Miranda then
examined Edmer's sputum with blood and noted that he was bleeding. Suspecting
that he could be afflicted with dengue, Dr. Miranda conducted a tourniquet test, which
turned out to be negative. Dr. Miranda then called up Dr. Casumpang at his clinic and
told him about Edmer's condition. Upon being informed, Dr. Casumpang ordered
several procedures done. Dr. Miranda advised Edmer's parents that the blood test
results showed that Edmer was suffering from Dengue Hemorrhagic Fever. Dr.
Casumpang recommended Edmer’s transfer to the ICU, but since the ICU was then
full, the respondent, insisted on transferring his son to Makati Medical Center.

 At 12:00 midnight, Edmer, accompanied by his parents and by Dr. Casumpang, was
transferred to Makati Medical Center. Upon examination, the attending physician
diagnosed Dengue Fever Stage IV that was already in its irreversible stage. Edmer
died at 4:00 in the morning of April 24, 1988. His Death Certificate indicated the
cause of death as Hypovolemic Shock/hemorrhagic shock/Dengue Hemorrhagic
Fever Stage IV.

 Believing that Edmer's death was caused by the negligent and erroneous diagnosis
of his doctors, the respondent instituted an action for damages against SJDH, and its
attending physicians: Dr. Casumpang and Dr. Miranda.

 Dr. Casumpang contends that he gave his patient medical treatment and care to the
best of his abilities, and within the proper standard of care required from physicians
under similar circumstances.

 Dr. Miranda argued that the function of making the diagnosis and undertaking the
medical treatment devolved upon Dr. Casumpang, the doctor assigned to Edmer. Dr.
Miranda also alleged that she exercised prudence in performing her duties as a
physician, underscoring that it was her professional intervention that led to the
correct diagnosis of Dengue Hemorrhagic Fever.

 SJDH, on the other hand, disclaims liability by asserting that Dr. Casumpang and Dr.
Miranda are mere independent contractors and consultants (not employees) of the
hospital; hence, Article 2180 of the Civil Code does not apply.

ISSUES:

1. W/N Casumpang had committed inexcusable lack of precaution in diagnosing and in

treating the patient

2. W/N Miranda had committed inexcusable lack of precaution in diagnosing and in

treating the patient

3. W/N Whether or not the petitioner hospital is solidarity liable with the petitioner
doctors

4. W/N or not there is a causal connection between the petitioners' negligent

act/omission and the patient's resulting death

HELD/RATIO:

1. YES, Casumpang was negligent.

 Even assuming that Edmer's symptoms completely coincided with the diagnosis of
bronchopneumonia, we still find Dr. Casumpang guilty of negligence. Wrong
diagnosis is not by itself medical malpractice. Physicians are generally not liable for
damages resulting from a bona fide error of judgment and from acting according to
acceptable medical practice standards. Nonetheless, when the physician's erroneous
diagnosis was the result of negligent conduct, it becomes an evidence of medical
malpractice.

 In the present case, evidence on record established that in confirming the diagnosis
of bronchopneumonia, Dr. Casumpang selectively appreciated some and not all of
the symptoms presented, and failed to promptly conduct the appropriate tests to
confirm his findings. In sum, Dr. Casumpang failed to timely detect dengue fever,
which failure, especially when reasonable prudence would have shown that
indications of dengue were evident and/or foreseeable, constitutes negligence. Apart
from failing to promptly detect dengue fever, Dr. Casumpang also failed to promptly
undertake the proper medical management needed for this disease. Dr. Casumpang
failed to measure up to the acceptable medical standards in diagnosing and treating
dengue fever.

 Dr. Casumpang's claim that he exercised prudence and due diligence in handling
Edmer's case, sside from being self-serving, is not supported by competent
evidence. He failed, as a medical professional, to observe the most prudent medical
procedure under the circumstances in diagnosing and treating Edmer.

2. No, Dr. Miranda is not liable for negligence.

 We find that Dr. Miranda was not independently negligent. Although she was subject
to the same standard of care applicable to attending physicians, as a resident
physician, she merely operates as a subordinate who usually refer to the attending
physician on the decision to be made and on the action to be taken. We also believe
that a finding of negligence should also depend on several competing factors. In this
case, before Dr. Miranda attended to Edmer, Dr. Casumpang had diagnosed Edmer
with bronchopneumonia. There is also evidence supporting Dr. Miranda's claim that
she extended diligent care to Edmer. In fact, when she suspected, during Edmer's
second episode of bleeding, that Edmer could be suffering from dengue, she wasted
no time in conducting the necessary tests, and promptly notified Dr. Casumpang
about the incident. Indubitably, her medical assistance led to the finding of dengue
fever. Dr. Miranda's error was merely an honest mistake of judgment; hence, she
should not be held liable for medical negligence.

3. Yes, causal connection between the petitioners' negligence and the patient's
resulting death was established

 Casumpang failed to timely diagnose Edmer with dengue fever despite the presence
of its characteristic symptoms; and as a consequence of the delayed diagnosis, he
also failed to promptly manage Edmer's illness. Had he immediately conducted
confirmatory tests, and promptly administered the proper care and management
needed for dengue fever, the risk of complications or even death, could have been
substantially reduced. That Edmer later died of Dengue Hemorrhagic Fever Stage IV,
a severe and fatal form of dengue fever, established the causal link between Dr.
Casumpang's negligence and the injury. The element of causation is successfully
proven.

4. YES, SJDH is solidarily liable.

 As a rule, hospitals are not liable for the negligence of its independent contractors.
However, it may be found liable if the physician or independent contractor acts as an
ostensible agent of the hospital. This exception is also known as the doctrine of
apparent authority.

 SJDH impliedly held out and clothed Dr. Casumpang with apparent authority leading
the respondent to believe that he is an employee or agent of the hospital. Based on
the records, the respondent relied on SJDH rather than upon Dr. Casumpang, to care
and treat his son Edmer. His testimony during trial showed that he and his wife did
not know any doctors at SJDH; they also did not know that Dr. Casumpang was an
independent contractor. They brought their son to SJDH for diagnosis because of
their family doctor's referral. The referral did not specifically point to Dr. Casumpang
or even to Dr. Miranda, but to SJDH.
 Mrs. Cortejo accepted Dr. Casumpang's services on the reasonable belief that such
were being provided by SJDH or its employees, agents, or servants. By referring Dr.
Casumpang to care and treat for Edmer, SJDH impliedly held out Dr. Casumpang as
a member of its medical staff. SJDH cannot now disclaim liability since there is no
showing that Mrs. Cortejo or the respondent knew, or should have known, that Dr.
Casumpang is only an independent contractor of the hospital. In this case, estoppel
has already set in.

Reyes vs. Sisters of Mercy Hospital

FACTS:

Petitioner, Leah Alesna Reyes, is the wife of the deceased patient, Jorge Reyes.
Five days before the latter’s death, Jorge has been suffering from recurring fever with
chills. The doctors confirmed through the Widal test that Jorge has typhoid fever.
However, he did not respond to the treatment and died. The cause of his death was
“Ventricular Arrythemia Secondary to Hyperpyrexia and typhoid fever.” Consequently,
petitioner filed the instant case for damages before the Regional Trial Court of Cebu City,
which dismissed the case and was affirmed by the Court of Appeals.

The contention was that Jorge did not die of typhoid fever. Instead, his death was
due to the wrongful administration of chloromycetin. They contended that had respondent
doctors exercised due care and diligence, they would not have recommended and rushed
the performance of the Widal Test, hastily concluded that Jorge was suffering from
typhoid fever, and administered chloromycetin without first conducting sufficient tests on
the patient’s compatibility with said drug.

ISSUE: Whether the death of Jorge Reyes was due to or caused by the
negligence, carelessness, imprudence, and lack of skill or foresight on the part of
defendant

RULING:

No, the death of Jorge Reyes was due to or caused by the negligence,
carelessness, imprudence, and lack of skill or foresight on the part of defendant

There is no showing that the attending physician in this case deviated from the
usual course of treatment with respect to typhoid fever. Jorge was given antibiotic
choloromycetin and some dose of triglobe after compatibility test was made by the doctor
and found that no adverse reactions manifested which would necessitate replacement of
the medicines. Indeed, the standard contemplated is not what is actually the average
merit among all known practitioners from the best to the worst and from the most to the
least experienced, but the reasonable average merit among the ordinarily good
physicians. Here, the doctors did not depart from the reasonable standard recommended
by the experts as they in fact observed the due care required under the circumstances.

In Medical Negligence cases, it is incumbent upon the plaintiff to establish that

the usual procedure in treating the illness is not followed by the doctor. Failure to prove
this, the doctor is not liable. Physicians are not insurers of the success of every
procedure undertaken and if the procedure was shown to be properly done but did not
work, they cannot be faulted for such result.

Dr. Victoria L. Batiquin, et al. vs. Court of Appeals, G.R.

No. 118231, July 5, 1996
 Petitioner: Dr. Batiquin was a Resident Physician at the Negros
Oriental Provincial Hospital, Dumaguete City.

Respondents: Mrs. Villegas is a married woman who submitted to

Dr. Batiquin for prenatal care as the latter's private
patient.

Witness: Dr. Ma. Salud Kho

Facts:

In the morning of September 21, 1988 Dr. Batiquin, with the assistance of Dr.
Doris Teresita Sy who was also a Resident Physician at the same Hospital, C.I.
and O.R. Nurse Arlene Diones and some student nurses performed a simple
cesarean section on Mrs. Villegas.

Mrs. Villegas delivered her first child and on September 28, 1988, Mrs. Villegas
checked out of the Hospital. Soon after leaving the Hospital Mrs. Villegas began
to suffer abdominal pains and complained of being feverish.

She consulted Dr. Batiquin at the latter's polyclinic who prescribed for her certain
medicines and issued her a Medical Certificate certifying to her physical fitness to
return to her work.

The abdominal pains and fever kept on recurring and bothered Mrs.
Villegas. When the pains become unbearable and she was rapidly losing weight
she consulted Dr. Ma. Salud Kho. . Upon examination she felt an abdominal mass
one finger below the umbilicus which she suspected to be either a tumor of the
uterus or an ovarian cyst, Dr. Kho suggested to Mrs. Villegas that she submits to
another surgery to which the latter agreed.
When Dr. Kho opened the abdomen of Mrs. Villegas she found whitish-yellow
discharge inside, an ovarian cyst on each of the left and right ovaries which gave
out pus, dirt and pus behind the uterus, and a piece of rubber materials This piece
of rubber material which Dr. Kho described as a "foreign body" looked like a
piece of a "rubber glove”. And this foreign body was the cause of the infection of
the ovaries and consequently of all the discomfort suffered by Mrs. Villegas.
The trial court, after hearing the case, considered respondent’s witness’ testimony
as a matter of hearsay and rendered a decision in favor of the petitioners.
The Court of Appeals reversed the decision which they deemed Dr. Kho's positive
testimony to definitely establish that a piece of rubber was found near private
respondent Villegas' uterus.
Hence, petitioners appealed to this Court claiming that the appellate court; (1)
committed grave abuse of discretion by resorting to findings of fact not supported
by the evidence on record, and (2) exceeded its discretion, amounting to lack or
excess of jurisdiction, when it gave credence to testimonies punctured with
contradictions and falsities.

Issue:
1. W/N the Dr. Kho is a credible witness which would allow the court to
admit her positive testimony over petitioner’s negative testimony on the
case?
2. W/N petitioner is liable to the defendant?
Held:
1. Yes. Dr. Kho was frank throughout her turn on the witness
stand. Furthermore, no motive to state any untruth was ever imputed
against Dr. Kho, leaving her trustworthiness unimpaired. She positively
testified that a piece of rubber was indeed found in private respondent
Villegas' abdomen. While petitioner testified that no rubber drain was used
in the operation, and that there was neither any tear on the gloves after the
operation nor blood smears on her hands upon removing her gloves are all
denials or negative testimonies. Well-settled is the rule that positive
testimony is stronger than negative testimony.

Moreover, it has been aptly said that even when a witness is found to have
deliberately falsified in some material particulars, it is not required that the
whole of his uncorroborated testimony be rejected, but such portions
thereof deemed worthy of belief may be credited.
2. Yes. Considering that we have assessed Dr. Kho to be a credible
witness, her positive testimony prevails over the negative testimony in
favor of the petitioners.
As such, the rule of res ipsa loquitur (the thing speaks for itself) comes to
fore. Under [this] doctrine . . . the happening of an injury permits an
inference of negligence where plaintiff produces substantial evidence that
[the] injury was caused by an agency or instrumentality under [the]
exclusive control and management of defendant, and that the occurrence
[sic] was such that in the ordinary course of things would not happen if
reasonable care had been used.
The doctrine of res ipsa loquitur as a rule of evidence is peculiar to the law
of negligence which recognizes that prima facie negligence may be
established without direct proof and furnishes a substitute for specific
proof of negligence.
In the instant case, all the requisites for recourse to the doctrine are
present. First, the entire proceedings of the cesarean section were under
the exclusive control of Dr. Batiquin. Second, since aside from the
cesarean section, private respondent Villegas underwent no other
operation which could have caused the offending piece of rubber to appear
in her uterus, it stands to reason that such could only have been a by-
product of the cesarean section performed by Dr. Batiquin. The
petitioners, in this regard, failed to overcome the presumption of
negligence arising from resort to the doctrine of res ipsa loquitur. Dr.
Batiquin is therefore liable for negligently leaving behind a piece of
rubber in private respondent Villegas' abdomen and for all the adverse
effects thereof.
 Jarcia vs People of the Philippines
GR No. 187926 February 15, 2012

Facts:

Belinda Santiago lodged a complaint with the National Bureau of Investigation (NBI)
against the petitioners, Dr. Emanuel Jarcia and Dr. Marilou Bastan, for their alleged
neglect of professional duty which caused her son, Roy Alfonso Santiago, to suffer
physical injuries. Upon investigation, the NBI found that Roy Jr. was hit by a taxicab; that
he was rushed to the Manila Doctors Hospital for an emergency medical treatment; that
an X-ray of the victim’s ankle was ordered; that the X-ray result showed no fracture as
read by Dr. Jarcia; that Dr. Bastan entered the emergency room and, after conducting her
own examination of the victim, informed Mrs. Santiago that since it was only the ankle
that was hit there was no need to examine the upper leg; that 11 days later, Roy
developed fever, swelling of the right leg and misalignment of the right foot; that Mrs.
Santiago brought him back to the hospital; and that the x-ray revealed a right mid-tibial
fracture and a linear hairline fracture in the shaft of the bone. A complaint for reckless
imprudence resulting physical injuries was filed against the petitioners for the alleged
misconduct in the handling of the illness of Roy.

Issue: Whether the petitioners failed to exercise the degree of care expected of them as
doctors and are liable for negligence to the private respondent.

Held:

Yes. The Supreme Court considered the applicability of the doctrine of res ipsa
loquitur to the instant case. Res ipsa loquitur is a Latin phrase which literally means the
thing or the transaction speaks for itself. The doctrine of res ipsa loquitur is simply a
recognition of the postulate that, as a matter of common knowledge and experience,
the very nature of certain types of occurrences may justify an inference of negligence on
the part of the person who controls the instrumentality causing the injury in the absence
of some explanation by the accused-appellant who is charged with negligence. It is
grounded in the superior logic of ordinary human experience and, on the basis of such
experience or common knowledge, negligence may be deduced from the mere
occurrence of the accident itself.

The doctrine of res ipsa liquitor as a rule of evidence is unusual to the law of negligence
which recognizes that prima facie negligencce may be established without direct proof
and furnishes a substitute for specific proof of negligence. Hence, res ipsa loquitur is
applied in conjunction with the doctrine of common knowledge. The doctrine however,
is not a rule of substantive law, but merely a mode of proof or a mere procedural
convenience the rule when applicable to the facts and circumstances of a given case, is
not meant to and does not dispense with the requirement of proof of culpable
negligence on the party charged. It merely determines and regulates what shall be prima
facie evidence thereof and helps the plaintiff in proving a breach of duty. The doctrine
can be invoked when and only when, under the circumstances involved, direct evidence
is absolute and not readily available.

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

The accident was of a kind which does not ordinarily occur unless someone is negligent;

The instrumentality or agency which caused the injury was under the exclusive control
of the person in charge; and
The injury suffered must not have been due to any voluntary action or contribution of
the person injured.

Negligence is defined as the failure to observe for the protection of the interests of
another person that degree of care, precaution and vigilance which the circumstances
justly demand whereby such other person suffers injury.

Reckless imprudence consists of voluntarily doing or failing to do, without malice, an act
from which material damage results by reason of an inexcusable lack of precaution on
the part of the person performing or failing to perform such act.

In failing to perform an extensive medical examination to determine the extent of Roy’s

injuries, Dr. Jarcia and Dr. Bastan were remiss of their duties as members of the medical
profession. Assuming for the sake of argument that they did not have the capacity to
make such thorough evaluation at that stage they should have referred the patient to
another doctor with sufficient training and experience instead of assuring him and his
mother that everything was all right.

Res ipsa loquitur is not a rigid or ordinary doctrine to be perfunctorily used but a rule to
be cautiously applied, depending upon the circumstances of each case. It is generally
restricted to situations in malpractice cases where a layman is able to say, as a matter of
common knowledge and observation, that the consequences of professional care were
not as such as would ordinarily have followed if due care had been exercised. A
distinction must be made between the failure to secure results and the occurrence of
something more unusual and not ordinarily found if the service or treatment rendered
followed the usual procedure of those skilled in that particular practice. The latter
circumstance is the primordial issue that confronted this Court and we find application
of the doctrine of res ipsa loquitur to be in order.

PROFESSIONAL SERVICES INC., vs CA and AGANA

FACTS:
Natividad Agana suffered injuries due to non-removal of 2 gauzes inside her body which
was used during her surgery conducted by Dr. Miguel Ampil and Dr. Juan Fuentes on
April 11, 1984 at the Medical City General Hospital. Thus, Enrique and Natividad Agana
filed a complaint for damages before the RTC of Quezon City against the said doctors
and Professional Services Inc., being the owner, operator and manager of the hospital.
RTC held PSI solidarily liable with Dr. Ampil and Dr. Fuentes for damages. However, the
CA, absolved Dr. Fuentes but affirmed the liability of Dr. Ampil and PSI, subject to the
right of PSI to claim reimbursement from Dr. Ampil deciding that PSI committed a serious
breach of its corporate duty when it failed to conduct an immediate investigation into
the reported missing gauzes.

ISSUE: May a hospital may be held liable for the negligence of physicians-consultants
allowed to practice in its premises?

HELD: Yes. While in theory a hospital as a juridical entity cannot practice medicine, in
reality it utilizes doctors, surgeons and medical practitioners in the conduct of its
business of facilitating medical and surgical treatment. Within that reality, three legal
relationships crisscross: (1) between the hospital and the doctor practicing within its
premises; (2) between the hospital and the patient being treated or examined within its
premises and (3) between the patient and the doctor. The exact nature of each
relationship determines the basis and extent of the liability of the hospital for the
negligence of the doctor.
In the instant case, PSI took no heed of the record of operation and consequently did
not initiate a review of what transpired during Natividad’s operation. By its inaction, PSI
failed its own standard of hospital care. It committed corporate negligence which is
different from the medical negligence attributed to Dr. Ampil. The duties of the hospital
are distinct from those of the doctor-consultant practicing within its premises in relation
to the patient; hence, the failure of PSI to fulfill its duties as a hospital corporation gave
rise to a direct liability to the Aganas distinct from that of Dr. Ampil.
The liability of PSI arose from an implied agency with Dr. Ampil and an admitted
corporate duty to Natividad.

Nogales vs Capitol Medical Center

GR No. 142625 December 19, 2006

Facts: Pregnant with her fourth child, Corazon Nogales, who was then 37 y/o was under
the exclusive prenatal care of Dr. Oscar Estrada beginning on her fourth month of
pregnancy or as early as December 1975. While Corazon was on her last trimester of
pregnancy, Dr. Estrada noted an increase in her blood pressure and development of leg
edemas indicating preeclampsia which is a dangerous complication of pregnancy.
Around midnight of May 26, 1976, Corazon started to experience mild labor pains
prompting Corazon and Rogelio Nogales to see Dr. Estrada at his home. After examining
Corazon, Dr. Estrada advised her immediate admission to Capitol Medical Center (CMC).
Upon her admission, an internal examination was conducted upon her by a resident-
physician. Based on the doctor’s sheet, around 3am, Dr. Estrada advised for 10mg valium
to be administered immediately by intramuscular injection, he later ordered the start of
intravenous administration of syntociron admixed with dextrose, 5% in lactated ringer’s
solution, at the rate of 8-10 micro-drops per minute. When asked if he needed the
services of anesthesiologist, he refused. Corazon’s bag of water ruptured spontaneously
and her cervix was fully dilated and she experienced convulsions. Dr. Estrada ordered
the injection of 10g of magnesium sulfate but his assisting Doctor, Dr. Villaflor, only
administered 2.5g. She also applied low forceps to extract Corazon’s baby. In the
process, a 10 x 2.5cm piece of cervical tissue was allegedly torn. The baby came out in
an apric, cyanatic weak and injured condition. Consequently the baby had to be
intubated and resuscitated. Corazon had professed vaginal bleeding where a blood
typing was ordered and she was supposed to undergo hysterectomy, however, upon the
arrival of the doctor, she was already pronounced dead due to hemorrhage.

Issue: Whether or not in the conduct of child delivery, the doctors and the respondent
hospital is liable for negligence.

Held: Yes. In general, a hospital is not liable for the negligence of an independent
contractor-physician. There is, however an exception to this principle. The hospital may
be liable if the physician is the ostensible agent of the hospital. This exception is also
known as the doctrine of apparent authority.

Under the doctrine of apparent authority a hospital can be held vicariously liable for the
negligent acts of a physician providing care at the hospital, regardless of whether the
physician is an independent contractor, unless the patient knows, or should have known,
that the physician is an independent contractor.
For a hospital to be liable under the doctrine of apparent authority, a plaintiff must show
that 1.) the hospital, or its agent, acted in a manner that would lead a reasonable person
to conclude that the individual who was alleged to be negligent was an employee or
agent of the hospital; 2.) Where the acts of the agent create the appearance of
authority, the plaintiff must also prove that the hospital had knowledge of and acquired
in them; and 3.) the plaintiff acted in reliance upon the conduct of the hospital or its
agent, consistent with ordinary care and prudence.

Borrowed servant doctrine provides that once a surgeon enters the operating room and
takes charge of the acts or omissions of operating room personnel and any negligence
associated with each acts or omissions are imputable to the surgeon, while the assisting
physicians and nurses may be employed by the hospital, or engaged by the patient, they
normally become the temporary servants or agents of the surgeon in charge while the
operation is in progress, and liability may be imposed upon the surgeon for their
negligent acts under the doctrine of respondeat superior.