Jurisprudence (NCM 105)

Patricia Shane D. Lingad BSN IV-O

Natividad and Agana Case

As the hospital industry changes, so must the laws and jurisprudence governing hospital liability. The immunity
from medical malpractice traditionally accorded to hospitals has to be eroded if we are to balance the interest of the
patients and hospitals under the present setting.

On April 4, 1984, Natividad Agana was admitted at the Medical City General Hospital (Medical City) because of
difficulty of bowel movement and bloody anal discharge. Dr. Ampil diagnosed her to be suffering from cancer of the
sigmoid. Thus, on April 11, 1984, Dr. Ampil, assisted by the medical staff of Medical City, performed an anterior
resection surgery upon her. During the surgery, he found that the malignancy in her sigmoid area had spread to her left
ovary, necessitating the removal of certain portions of it. Thus, Dr. Ampil obtained the consent of Atty. Enrique Agana,
Natividad’s husband, to permit Dr. Juan Fuentes, to perform hysterectomy upon Natividad. Dr. Fuentes performed and
completed the hysterectomy. Afterwards, Dr. Ampil took over, completed the operation and closed the incision. However,
the operation appeared to be flawed. In the corresponding Record of Operation dated April 11, 1984, the attending nurses
entered these remarks; “Sponge count lacking two. Announced to surgeon searched done but to no avail continue for
closure”.

Dr. Ampil was the lead surgeon during the operation of Natividad. He requested the assistance of Dr. Fuentes
only to perform hysterectomy when he (Dr. Ampil) 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.

After a couple of days, Natividad complained of excruciating pain in her anal region. She consulted both Dr.
Ampil and Dr. Fuentes about it. They told her that the pain was the natural consequence of the surgical operation
performed upon her. Dr. Ampil recommended that Natividad consult an oncologist to treat the cancerous nodes which
were not removed during the operation.

On May 9, 1984, Natividad, accompanied by her husband, went to the United States to seek further treatment.
After four (4) months of consultations and laboratory examinations, Natividad was told that she was free of cancer.
Hence, she was advised to return to the Philippines.

On August 31, 1984, Natividad flew back to the Philippines, still suffering from pains. Two (2) weeks thereafter,
her daughter found a piece of gauze protruding from her vagina. Dr. Ampil was immediately informed. He proceeded to
Natividad’s house where he managed to extract by hand a piece of gauze measuring 1.5 inches in width. Dr. Ampil then
assured Natividad that the pains would soon vanish. Despite Dr. Ampil’s assurance, the pains intensified, prompting
Natividad to seek treatment at the Polymedic General Hospital. While confined thereat, Dr. Ramon Gutierrez detected the
presence of a foreign object in her vagina -- a foul-smelling gauze measuring 1.5 inches in width. The gauze had badly
infected her vaginal vault. A recto-vaginal fistula had formed in her reproductive organ which forced stool to excrete
through the vagina. Another surgical operation was needed to remedy the situation. Thus, in October 1984, Natividad
underwent another surgery.

On November 12, 1984, Natividad and her husband filed with the Regional Trial Court, Branch 96, Quezon City a
complaint for damages against PSI (owner of Medical City), Dr. Ampil and Dr. Fuentes.
 Here are some arguments presented:
Q
Did the hospital do anything about the missing gauzes?
A
The hospital left it up to the surgeon who was doing the operation, sir.

Q
Did the hospital investigate the surgeon who did the operation?
A
I am not in the position to answer that, sir.

Q
You never did hear the hospital investigating the doctors involved in this case of those missing sponges, or did you hear
something?
A
I think we already made a report by just saying that two sponges were missing, it is up to the hospital to make the move.

(Atty. Agana) Q Precisely, I am asking you if the hospital did a move, if the hospital did a move.
A
I cannot answer that.

(Court) Q By that answer, would you mean to tell the Court that you were aware if there was such a move done by the
hospital?
A
I cannot answer that, your honor, because I did not have any more follow-up of the case that happened until now.

The above testimony obviously shows Dr. Jocson’s lack of concern for the patients. Such conduct is reflective of
the hospital’s manner of supervision. Not only did PSI breach its duty to oversee or supervise all persons who practice
medicine within its walls, it also failed to take an active step in fixing the negligence committed. This renders PSI, not
only vicariously liable for the negligence of Dr. Ampil under Article 2180 of the Civil Code, but also directly liable for its
own negligence under Article 2176. Moreover, there is merit in the trial court’s finding that the failure of PSI to conduct
an investigation established PSI’s part in the dark conspiracy of silence and concealment about the gauzes. The following
testimony of Atty. Agana supports such findings, thus:

Q
You said you relied on the promise of Dr. Ampil and despite the promise you were not able to obtain the said record. Did
you go back to the record custodian?
A
I did not because I was talking to Dr. Ampil. He promised me.

Q
After your talk to Dr. Ampil, you went to the record custodian?
A
I went to the record custodian to get the clinical record of my wife, and I was given a portion of the records consisting of
the findings, among them, the entries of the dates, but not the operating procedure and operative report.

On February 16, 1986, pending the outcome of the above case, Natividad died. She was duly substituted by her
above-named children (the Aganas).

On March 17, 1993, the trial court rendered judgment in favor of spouses Agana finding PSI, Dr. Ampil and Dr.
Fuentes jointly and severally liable. On appeal, the Court of Appeals, in its Decision dated September 6, 1996, affirmed
the assailed judgment with modification in the sense that the complaint against Dr. Fuentes was dismissed.