PSI v.

CA
Doctrine: 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.
Nature: 2nd MR to SC decision (Jan 31, 2007) and resolution (Feb 11, 2008) which both found
Professional Services, Inc. (PSI) vicariously liable for medical malpractice of its doctors
Parties:
Patient: Natividad Agana
Doctors: Dr. Miguel Ampil and Dr. Juan Fuentes
Hospital: Medical City owned, operated and managed by PSI
Facts:
Natividad had surgery at Medical City
Dr. Ampil (Natividad's neighbor and friend) and Dr. Fuentes were unable to remove from her body two
gauzes used in the surgery
Natividad suffered as a result (more detailedand disgusting!--facts in first SC decision)
Natividad and husband Enrique filed for damages
RTC held PSI solidarily liable with Dr. Ampil and Dr. Fuentes
CA: Ampil and PSI liable; Fuentes not liable
SC affirmed CA
employer-employee relationship exists between Dr. Ampil and PSI
PSI accredited Dr. Ampil and advertised his qualifications: impression that he's an agent (doctrine of
apparent authority)
Also, PSI has corporate duty to exercise reasonable care to protect patients in its hospital, supervise
doctors, staff
PSI filed 1st MR, SC denied
PSI filed 2nd MR
PSI has no control over Dr. Ampil
proximate cause is negligence of Dr. Ampil, not PSI
Issue: Whether or not a hospital may be held liable for the negligence of physicians-consultants
allowed to practice in its premises? YES
Ruling: PSI liable for negligence of Dr. Ampil (ostensible agency) and for corporate negligence for
failure to perform duty as a hospital
Ratio:
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.
Where an employment relationship exists, the hospital may be held vicariously liable under Article
2176 in relation to Article 2180 of the Civil Code or the principle of respondeat superior.
Even when no employment relationship exists but it is shown that the hospital holds out to the patient
that the doctor is its agent, the hospital may still be vicariously liable under Article 2176 in relation to
Article 1431 and Article 1869 of the Civil Code or the principle of apparent authority.
Also, regardless of its relationship with the doctor, the hospital may be held directly liable to the patient
for its own negligence or failure to follow established standard of conduct to which it should conform
as a corporation.
To determine ER-EE relationship: control test (if the hospital controls both the means and the details of
the process by which the physician is to accomplish his task)
Here, there was insufficient evidence that PSI exercised the power of control or wielded such power
over the means and the details of the specific process by which Dr. Ampil applied his skills in the
treatment of Natividad. Thus, PSI cannot be held vicariously liable for the negligence of Dr. Ampil
under the principle of respondeat superior.
BUT since PSI held out to the patient Natividad that Dr. Ampil was its agent,