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Hospital Liability

Primary Duties of a Hospital


1. The use of reasonable care in the maintenance of
safe and adequate facilities and equipment;
2. The selection and retention of competent physicians;
3. The overseeing or supervision of all persons who
practice medicine within its walls; and
4. The formulation, adoption and enforcement of
adequate rules and policies that ensure quality care
for its patients.
(PROFESSIONAL SERVICES, INC. vs. NATIVIDAD and ENRIQUE AGANA G.R. No.
126297)

Hospital liability vs. Medical


Negligence and Malpractice

Hospital Liability

Hospital
liability
happens
when
the
hospital violated the
accepted standard of
care by not requiring
adequate supervision to
all
its
medical
practitioners,
by not giving safe and
adequate facilities, and
deviating from its own
policies in ensuring
quality care for its
patients.

Medical Malpractice

It is defined as a
professional negligenc
e by act or omission by
a health care provider
in which there is a total
deviation from the
accepted standard of
practice
in
the medical community
and causes injury or
death to the patient,
with
most
cases
involving medical error.

Medical Negligence
Medical
negligence
occurs when a medical
professional fails to
provide the care or
does not comply with
standard of medical
care which is expected
in each case.

Hospital Liability in the Philippines


Hospital Liability in the Philippines is
based on quasi-delict and vicarious
liability under Articles 2176 and 2180
Over the years, at least 8 different
bills with different authors have been
filed in the senate and Lower House
seeking to legislate and criminally
penalize medical malpractice, but not
one of the bills has become law

Nevertheless there have been Various Civil


groups whose main advocacy is to
pressure Congress to legislate medical
malpractice laws.
Before, only physicians and those directly
involved in the Medical Profession were
made liable for negligent acts or omissions
causing injury to patients.
It was only when the case of Ramos vs. CA,
decided in 1999 when a hospital was
impleaded as defendant in a medical
negligence case.

Not all hospitals may be sued, in the


Philippines, hospitals may be run
either by the government or by
private individuals or corporations.
Government Hospitals are immune
from suit. The basis of immunity is
the recognition that government
charity hospitals are performing a
governmental function. Because of
this function, said hospitals would fall
within the rule that the state cannot
be sued without its consent.

Applicable Doctrines in
Hospital Liability
The issue of whether a Hospital can be
held liable may be determined by
applying the following doctrines:
1. Doctrine of Corporate Negligence
2. Doctrine of Apparent Authority
3. Doctrine of Vicarious Liability

Corporate Liabilities are those


arising from the failure of the hospitals
as corporations to provide necessary
accommodation and facilities or
observe the standard of conduct to
which corporation should conform.

Examples:
Failure to furnish safe and well-maintained
buildings and facilities.
Failure to provide safe and reliable
equipments.
Failure to make careful selection, review and
supervision of independent physicians who
are permitted to practice in the hospital

Doctrine of Corporate
Negligence
is the legal doctrine that holds healthcare
facilities,
such
as
hospitals,
responsible for the well-being of patients.
If the hospital fails to maintain a clean
and safe environment, hire competent
and properly trained employees, oversee
care and implement safety policies, it can
be held liable for any harm to patients.

Doctrine of Corporate
Negligence

Under the Doctrine of Corporate


Liability, the Hospital can be found
liable even if the surgeon was an
independent contractor.
Corporate Negligence provides for a
form of direct liability that subjects a
hospital to civil liability for its own
failures to adopt appropriate policies
and procedures to protect patients.

Doctrine of Vicarious
Liability
Vicarious liabilities refer to the
liabilities of hospitals for the acts of
its employees provided under Article
2180 of the Civil Code.
Vicarious liability, under the Civil
Code, is anchored on Articles 2180 in
relation to Article 2176.
based on respondeat superior or let
the master answer

However, Article 2180 requires as


sine qua non the existence of an
employer-employee relationship,
they rely on proving the existence of
an apparent agency.
3 distinct legal relationships that are
established when a patient goes to a
hospital:
1. Between the doctor and the patient
2. Between the hospital and the patient; and
3. Between the doctor and the hospital

In
Philippine
jurisprudence
employer-employee
relationship is established based on the primary test of
hiring, firing, payment of wages, and control.
It has been consistently held that in determining
whether an employer-employee relationship exists
between the parties, the following elements must be
present:
1.
2.
3.
4.

Selection and engagement of services;


Payment of wages;
The power to hire and fire; and
The power to control not only the end to be achieved,
but the means to be used in reaching such an end.
(Ramos vs. CA)

General Rule: Hospitals are NOT


liable for the negligence of an
independent contractor-physician
Exception:
Authority

Doctrine

of

Apparent

(Nogales vs. Capitol Medical Center)

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.
(Nogales vs. Capitol Medical Center)

Doctrine of Apparent
Authority
there are cases where a person may be
deemed an agent of a principal based on the
latters act of clothing the former with
apparent
authority.
Under
these
circumstances, the principal cannot be
permitted to deny the authority of such
person to act as his or her agent, to the
prejudice of innocent third parties dealing
with such person in good faith and in the
honest belief that he is what he appears to
be.

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 acquiesced in them; and
(3) the plaintiff acted in reliance upon the conduct of the
hospital or its agent, consistent with ordinary care and
prudence."

Illustrative Cases

PSI vs. CA
Facts:

Nogales vs. CMC


Facts:
Rogelio and his wife specifically chose Dr. Estrada to
handle Corazons delivery not only because of their
friends recommendation, but more importantly
because of Dr. Estradas connection with the reputable
hospital (CMC).
Dr. Estrada is granted by the CMC staff privileges and
extended medical staff and facilities.
Rogelio signed consent forms printed on CMC
letterhead. The letters did not mention that Dr. Estrada
was an independent contractor-physician.

During the operation, Dr. Estrada was assisted by


doctors of CMC. The baby came out in an apnic,
cyanotic, weak and injured condition and had to be
incubated and resuscitated by Drs. Enriquez and
Payumo.
Corazons blood pressure dropped, she had continuous
vaginal bleeding, was administered hemacel and
undergone immediate hysterectomy. Eventually, she
died at 9:15 a.m. with hemorrhage, post partum.
Hence, a complaint for damages was filed.

Issue:
Whether or not CMC is vicariously
liable for the negligence of Dr.
Estrada under Art. 2180 in relation to
Art. 2176 of the Civil Code.

Held:
Dr. Estrada is an independent
contractor. Applying the control test,
there is no evidence to CMCs
exercise of control over Dr. Estradas
treatment and management of
Corazons condition. The patient was
under the exclusive prenatal care of
Dr. Estrada. CMC merely allowed Dr.
Estrada to use its facilities when
Corazon was about to give birth,

But, even if Dr. Estrada is not an


employee of CMC, still CMC is
vicariously liable under the doctrine
of apparent authority.
the doctrine of apparent authority is
an exception to the general rule that
a hospital is not liable for the
negligence of an independent
contractor-physician.

The hospital 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.
the act of CMC giving Dr. Estrada staff
privileges and extended medical staff and
facilities is enough reason for the spouses
to believe that CMC had authority over Dr.
Estrada.

Ramos vs. CA
Facts:
Erlinda Ramos, a 47-year old robust woman, was normal except
for her experiencing occasional pain due to the presence of
stone in her gall bladder. She was advised to undergo an
operation for its removal.
The results in the examinations she underwent indicate that she
was fit for the operation. She and her husband Rogelio met Dr.
Hosaka, one of the defendants, who advised that she should
undergo cholecystectomy. Dr. Hosaka assured them that he will
get a good anaesthesiologist.
At 7:30 a.m. on the day of the operation at Delos Santos Medical
Center, Herminda Cruz, Erlindas sister-in-law and the dean of
the College of Nursing in Capitol Medical Center, was there to
provide moral support. Dr. Perfecta Gutierrez was to administer
the anaesthesia.

Dr. Hosaka arrived only at 12:15 p. m. Herminda saw Dr.


Gutierrez intubating the patient, and heard the latter say
Anghirap ma-intubate nito, maliyataangpagkakapasok.
O, lumalakiangtiyan. Herminda saw bluish discoloration
of the nailbeds of the patient..
She heard Dr. Hosaka issue an order for someone to call
Dr. Calderon. The doctor arrived and placed the patient in
trendelenburg position, wherein the head of the patient is
positioned lower than the feet, which indicates a
decrease of blood supply in the brain.
Herminda knew and told Rogelio that something wrong
was happening. Dr. Calderon was able to intubate the
patient. Erlinda was taken to the ICU and became
comatose.Rogelio filed a civil case for damages

ISSUE:
Whether or not the Hospital is liable

Held:
Hospitals hire, fire and exercise real control over their
attending and visiting "consultant" staff. While
"consultants" are not, technically employees, a point which
respondent hospital asserts in denying all responsibility for
the patient's condition, 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 employeremployee relationship in effect exists between hospitals
and their attending and visiting physicians.

The basis for holding an employer solidarily


responsible for the negligence of its
employee is found in Article 2180 of the Civil
Code which considers a person accountable
not only for his own acts but also for those of
others based on the former's responsibility
under a relationship ofpatria potestas.
Such responsibility ceases when the persons
or entity concerned prove that they have
observed the diligence of a good father of
the family to prevent damage.

In the instant case, respondent hospital, apart from a


general denial of its responsibility over respondent
physicians, failed to adduce evidence showing that it
exercised the diligence of a good father of a family in the
hiring and supervision of the latter. It failed to adduce
evidence with regard to the degree of supervision which
it exercised over its physicians.
In neglecting to offer such proof, or proof of a similar
nature, respondent hospital thereby failed to discharge
its burden under the last paragraph of Article 2180.
Having failed to do this, respondent hospital is
consequently solidarily responsible with its physicians for
Erlinda's condition.