Professional Services v.

Agana (2007)

FACTS:

Natividad Agana was rushed to the Medical City Hospital (Medical City) because of difficulty of bowel
movement and bloody anal discharge. After a series of medical examinations, Dr. Ampil, diagnosed her to
be suffering from "cancer of the sigmoid." (Trivia: The  sigmoid is the lower third of your large intestine.
It is connected to your rectum, and it is the part of your body where fecal matter stays until you go to
the bathroom.)

Dr. Ampil, assisted by the medical staff, performed an anterior resection surgery on Natividad. He found
that the malignancy in 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.

However, the operation appeared to be flawed. In the corresponding Record of Operation, the
attending nurses entered these remarks:

"sponge count lacking 2

"announced to surgeon searched (sic) done but to no avail continue
 for closure."

Natividad was released from 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 surgery. Dr. Ampil then recommended that she consult an
oncologist to examine the cancerous nodes which were not removed during the operation.

Natividad, accompanied by her husband, went to the United States to seek further treatment. After four
months of consultations and laboratory examinations, Natividad was told she was free of cancer. Hence,
she was advised to return to the Philippines. When Natividad flew back to the Philippines, still suffering
from pains. Two weeks thereafter, her daughter found a piece of gauze protruding from her vagina. Upon
being informed about it, Dr. Ampil proceeded to her house where he managed to extract by hand a piece
of gauze measuring 1.5 inches in width (dafuq). He then assured her that the pains would soon vanish.

Dr. Ampil's assurance did not come true. Instead, the pains intensified, prompting Natividad to seek
treatment at the Polymedic General Hospital (Polymedic). While confined there, Dr. Ramon Gutierrez
detected the presence of another foreign object in her vagina — a foul-smelling gauze measuring 1.5
inches in width which badly infected her vaginal vault. A recto-vaginal fistula had formed in her
reproductive organs which forced stool to excrete through the vagina (huhu kahadlok). Another surgical
operation was needed to remedy the damage. Thus, Natividad underwent another surgery.

Natividad and her husband filed with the RTC in Quezon City a complaint for damages against
the Professional Services, Inc. (PSI), owner of the Medical City Hospital, Dr. Ampil, and Dr. Fuentes.
They alleged that the latter are liable for negligence for leaving two pieces of gauze inside Natividad's
body and malpractice for concealing their acts of negligence. 

Meanwhile, Enrique Agana also filed with the Professional Regulation Commission (PRC) an administrative

complaint for gross negligence and malpractice against Dr. Ampil and Dr. Fuentes. The PRC Board of
Medicine heard the case only with respect to Dr. Fuentes because it failed to acquire jurisdiction over Dr.
Ampil who was then in the United States.

Pending the outcome of the above cases, Natividad died and was duly substituted by her above-named
children (the Aganas).

PRC Board of Medicine (Administrative Complaint):

The PRC Board of Medicine rendered its Decision dismissing the case against Dr. Fuentes. The Board held
that the prosecution failed to show that Dr. Fuentes was the one who left the two pieces of gauze inside
Natividad's body; and that he concealed such fact from Natividad.

RTC Ruling (Complaint for Damages):

RTC rendered its Decision in favor of the Aganas, finding PSI, Dr. Ampil and Dr. Fuentes liable for
negligence and malpractice.

CA Ruling:

Dismissed the case against Dr. Juan Fuentes and held that defendant-appellant Dr. Miguel Ampil is liable
to reimburse Professional Services, Inc., whatever amount the latter will pay or had paid to Agana.

ISSUES:

1. Whether the CA erred in holding Dr. Ampil liable for negligence and malpractice
2. Whether the CA erred in absolving Dr. Fuentes of any liability
3. Whether PSI may be held solidarily liable for the negligence of Dr. Ampil

HELD:

1. No. All the major circumstances, taken together, as specified by the Court of Appeals, directly point
to Dr. Ampil as the negligent party, thus:
First, it is not disputed that the surgeons used gauzes as sponges to control
the bleeding of the patient during the surgical operation. EHTCAa
Second, immediately after the operation, the nurses who assisted in the
surgery noted in their report that the ‘sponge count (was) lacking 2'; that such
anomaly was 'announced to surgeon' and that a 'search was done but to no
avail' prompting Dr. Ampil to 'continue for closure' . . . .
Third, after the operation, two (2) gauzes were extracted from the same spot
of the body of Mrs. Agana where the surgery was performed.

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 an inference of negligene.
There are even legions of authorities to the effect that such act is negligence  per se.

Of course, the Court is not blind to the reality that there are times when danger to a patient's life
precludes a surgeon from further searching missing sponges or foreign objects left in the body. But this
does not leave him free from any obligation. Even if it has been shown that a surgeon was required
by the urgent necessities of the case to leave a sponge in his patient's abdomen, because of the dangers
attendant upon delay, still, it is his legal duty to so inform his patient within a reasonable time
thereafter by advising her of what he had been compelled to do.
Here, Dr. Ampil did not inform Natividad about the missing two pieces of gauze. Worse, he
even misled her that the pain she was experiencing was the ordinary consequence of her
operation. Had he been more candid, Natividad could have taken the immediate and appropriate
medical remedy to remove the gauzes from her body. To our mind, what was initially an act of
negligence by Dr. Ampil has ripened into a deliberate wrongful act of deceiving his patient.

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 put, 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 two 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 the
missing gauzes from the knowledge of Natividad and her family. 

2. No. Literally, res ipsa loquitur means "the thing speaks for itself." It is the rule that the fact of the
occurrence of an injury, taken with the surrounding circumstances, may permit an inference or raise a
presumption of negligence, or make out a plaintiff's  prima facie case, and present a question of fact for
defendant to meet with an explanation. 13 Stated differently, where the thing which caused the injury,
without the fault of the injured, is under the exclusive control of the defendant and the injury is such that
it should not have occurred if he, having such control used proper care, it affords reasonable
evidence, in the absence of explanation that the injury arose from the defendant's want of care, and the
burden of proof is shifted to him to establish that he has observed due care and diligence. 14
From the foregoing statements of the rule, the requisites for the applicability of the doctrine
of res ipsa loquitur are: (1) the 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 requisites, the most instrumental
is the "control and management of the thing which caused the injury." 15
We find the element of "control and management of the thing which caused the injury" to be
wanting. Hence, the doctrine of res ipsa loquitur will not lie.

It was duly established that 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.

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. 16 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 evident 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. To our mind, it was this act
of ordering the closure of the incision notwithstanding that two pieces of gauze remained
unaccounted for, that caused injury to Natividad's 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.

III — G.R. No. 126297

Whether PSI Is Liable for the Negligence of Dr. Ampil

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.

In this jurisdiction, the statute governing liability for negligent acts is Article 2176 of the Civil
Code, which reads:

Art. 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 derivative of this provision is Article 2180, the rule governing vicarious liability under the
doctrine of respondeat superior, thus:

ART. 2180. The obligation imposed by Article 2176 is demandable not only for
one's own acts or omissions, but also for those of persons for whom one is responsible.
xxx xxx xxx
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.
xxx xxx xxx
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.

A prominent civilist commented that 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.
The foregoing view is grounded on the traditional notion that the professional status and the
very nature of the physician's calling preclude him from being classed as an agent or employee of a
hospital, whenever he acts in a professional capacity. 22 It has been said that medical practice strictly
involves highly developed and specialized knowledge, 23 such that physicians are generally free to
exercise their own skill and judgment in rendering medical services sans interference. 24 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. 25
The case of Schloendorff v. Society of New York Hospital 26 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 the foregoing 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 hospital's functions limited to
furnishing room, food, facilities for treatment and operation, and attendants for its patients. Thus,
in Bing  v. Thunig, 27 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 28 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.
This Court 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. HIACac
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 physician's 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. caTESD
In other words, private hospitals, hire, fire and exercise real control
over their attending and visiting 'consultant' staff. While 'consultants' are
not, technically employees, . . . , 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."
But the Ramos pronouncement is not our only basis in sustaining PSI's liability. Its liability is also
anchored upon the agency principle of apparent authority or agency by estoppel and the doctrine
of corporate negligence which have gained acceptance in the determination of a hospital's liability for
negligent acts of health professionals. The present case serves as a perfect platform to test the
applicability of these doctrines, thus, enriching our jurisprudence. TaISEH
Apparent authority, or what is sometimes referred to as the "holding out" theory, or doctrine
of ostensible agency or agency by estoppel, 29 has its origin from the law of agency. It 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. 30 The concept is essentially one of estoppel and has been explained in this manner:
"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 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 in such a situation that a person of ordinary prudence,
conversant 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. 31
The applicability of apparent authority in the field of hospital liability was upheld long time ago
in Irving  v. Doctor Hospital of Lake Worth,  Inc.  32 There, it was explicitly stated that "there does not
appear to be any rational basis for excluding the concept of apparent authority from the field
of hospital liability." Thus, 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 a patient has accepted treatment from that
physician in the reasonable belief that it is being rendered in behalf of the hospital, then the hospital will
be liable for the physician's negligence.
Our jurisdiction recognizes the concept of an agency by implication or estoppel. Article 1869 of
the Civil Code reads:
ART. 1869. 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.
In this case, PSI publicly displays in the lobby of the Medical City Hospital the names and
specializations of the physicians associated or accredited by it, including those of Dr. Ampil and Dr.
Fuentes. We concur with the Court of Appeals' conclusion that it "is now estopped from passing all
the 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." Indeed, PSI's act is
tantamount to holding out to the public that Medical City Hospital, through its accredited physicians,
offers quality health care services. By accrediting Dr. Ampil and Dr. Fuentes and publicly advertising their
qualifications, the hospital created the impression that they were its agents, authorized to perform
medical or surgical services for its patients. As expected, these patients, Natividad being one of them,
accepted the services on the reasonable belief that such were being rendered by the hospital or its
employees, agents, or servants. The trial court correctly pointed out:
 . . . 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
hospital's act of listing him and his specialty in its lobby directory, as in the
case herein. The high costs of today's medical and health care should 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." 33
The wisdom of the foregoing ratiocination is easy to discern. Corporate entities, like PSI, are
capable of acting only through other individuals, such as 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. DCSTAH
We now proceed to the doctrine of corporate negligence or corporate responsibility.
One allegation in the complaint in Civil Case No. Q-43332 for negligence and malpractice is that
PSI as owner, operator and manager of Medical City Hospital, "did not perform the necessary
supervision nor exercise diligent efforts in the supervision of Drs. Ampil and Fuentes and its
nursing staff, resident doctors, and medical interns who assisted Drs. Ampil and Fuentes in
the performance of their duties as surgeons." 34 Premised on the doctrine of corporate negligence,
the trial court held that PSI is directly liable for such breach of duty.
We agree with the trial court.
Recent years have seen the doctrine of corporate negligence as the judicial answer to the
problem of allocating hospital's liability for the negligent acts of health practitioners, absent facts to
support the application of respondeat superior or apparent authority. Its formulation proceeds from the
judiciary's acknowledgment that in these modern times, the duty of providing quality medical service is
no longer the sole prerogative and responsibility of the physician. The modern hospitals have changed
structure. Hospitals now tend to organize a highly professional medical staff whose competence and
performance need to be monitored by the hospitals commensurate with their inherent responsibility to
provide quality medical care. 35
The doctrine has its genesis in Darling v. Charleston Community Hospital. 36 There, the
Supreme Court of Illinois held that "the jury could have found a hospital negligent, inter alia, in
failing to have a sufficient number of trained nurses attending the patient; failing to require
a consultation with or examination by members of the hospital staff; and failing to review
the treatment rendered to the patient.". . . On the basis of Darling, other jurisdictions held that a
hospital's corporate negligence extends to permitting a physician known to be incompetent
to practice at the hospital. 37 With the passage of time, more duties were expected from hospitals,
among them: (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. 38 Thus, in Tucson Medical Center,  Inc.  v. Misevich, 39 it was held that a hospital, following
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. And in Bost v. Riley, 40 the court concluded that a patient who enters a hospital does so
with the reasonable expectation that it will attempt to cure him. The hospital accordingly has the
duty to make a reasonable effort to monitor and oversee the treatment prescribed and
administered by the physicians practicing in its premises.
In the present case, it was duly established that PSI operates the Medical City Hospital for the
purpose and under the concept of providing comprehensive medical services to the public. Accordingly, it
has the duty to exercise reasonable care to protect from harm all patients admitted into its
facility for medical treatment. Unfortunately, PSI failed to perform such duty. The findings of the trial
court are convincing, thus:
. . . PSI's liability is traceable to its failure to conduct an investigation
of the matter reported in the nota bene of the count nurse. Such failure
established PSI's part in the dark conspiracy of silence and concealment
about the gauzes. Ethical considerations, if not also legal, dictated the holding of an
immediate inquiry into the events, if not for the benefit of the patient to whom the
duty is primarily owed, then in the interest of arriving at the truth. The Court cannot
accept that the medical and the healing professions, through their members like
defendant surgeons, and their institutions like PSI's hospital facility, can callously turn
their backs on and disregard even a mere probability of mistake or negligence by
refusing or failing to investigate a report of such seriousness as the one in Natividad's
case. ECaScD
It is worthy to note that Dr. Ampil and Dr. Fuentes operated on Natividad with the assistance of
the Medical City Hospital's staff, composed of resident doctors, nurses, and interns. As such, it is
reasonable to conclude that PSI, as the operator of the hospital, has actualor constructive knowledge
of the procedures carried out, particularly the report of the attending nurses that the two pieces
of gauze were missing. In Fridena  v. Evans, 41 it was held that a corporation is bound by the
knowledge acquired by or notice given to its agents or officers within the scope of their authority and in
reference to a matter to which their authority extends. This means that the knowledge of any of the staff
of Medical City Hospital constitutes knowledge of PSI. Now, the failure of PSI, despite the attending
nurses' report, to investigate and inform Natividad regarding the missing gauzes amounts to callous
negligence. Not only did PSI breach its duties 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. In Fridena, the
Supreme Court of Arizona held:
. . . In recent years, however, the duty of care owed to the patient by the
hospital has expanded. The emerging trend is to hold the hospital responsible
where the hospital has failed to monitor and review medical services being
provided within its walls. See Kahn Hospital Malpractice Prevention, 27 De Paul
Rev. 23 (1977).
Among the cases indicative of the 'emerging trend' is  Purcell  v. Zimbelman, 18
Ariz. App. 75,500 P. 2d 335 (1972). In Purcell, the hospital argued that it could not be
held liable for the malpractice of a medical practitioner because he was an independent
contractor within the hospital. The Court of Appeals pointed out that the hospital
had created a professional staff whose competence and performance was to
be monitored and reviewed by the governing body of the hospital, and the
court held that a hospital would be negligent where it had knowledge or
reason to believe that a doctor using the facilities was employing a method
of treatment or care which fell below the recognized standard of care.
Subsequent to the Purcell decision, the Arizona Court of Appeals held
that a hospital has certain inherent responsibilities regarding the quality of
medical care furnished to patients within its walls and it must meet the
standards of responsibility commensurate with this undertaking. Beeck v.
Tucson General Hospital, 18 Ariz. App. 165, 500 P. 2d 1153 (1972). This court has
confirmed the rulings of the Court of Appeals that a hospital has the duty of
supervising the competence of the doctors on its staff. . . . .
xxx xxx xxx
In the amended complaint, the plaintiffs did plead that the operation was
performed at the hospital with its knowledge, aid, and assistance, and that the
negligence of the defendants was the proximate cause of the patient's injuries. We
find that such general allegations of negligence, along with the evidence
 produced at the trial of this case, are sufficient to support the hospital's
liability based on the theory of negligent supervision."
Anent the corollary issue of whether PSI is solidarily liable with Dr. Ampil for damages, let it be
emphasized that PSI, apart from a general denial of its responsibility, failed to adduce evidence showing
that it exercised the diligence of a good father of a family in the accreditation and supervision of the
latter. In neglecting to offer such proof, PSI failed to discharge its burden under the last paragraph of
Article 2180 cited earlier, and, therefore, must be adjudged solidarily liable with Dr. Ampil. Moreover, as
we have discussed, PSI is also directly liable to the Aganas.
One final word. Once a physician undertakes the treatment and care of a patient, the law
imposes on him certain obligations. In order to escape liability, he must possess that reasonable degree
of learning, skill and experience required by his profession. At the same time, he must apply reasonable
care and diligence in the exercise of his skill and the application of his knowledge, and exert his best
judgment. aEACcS
WHEREFORE, we DENY all the petitions and AFFIRM the challenged Decision of the Court of
Appeals in CA-G.R. CV No. 42062 and CA-G.R. SP No. 32198.
Costs against petitioners PSI and Dr. Miguel Ampil.
SO ORDERED.
Puno, C.J., Corona and Azcuna, JJ., concur.
Garcia, J., took no part.
|||  (Professional Services, Inc. v. Natividad, G.R. Nos. 126297, 126467 & 127590, [January 31, 2007],
542 PHIL 464-496)