OUR LADY OF LOURDES HOSPITAL, Petitioner vs. SPOUSES ROMEO AND REGINA CAPANZANA, Respondents
G.R. No. 189218
Facts:
Regina Capanzana was pregnant with her third child. A week before her scheduled caesarean section (C-section), she went into active labor and was brought to Our Lady of Lourdes Hospital for an emergency C-section. She went into a pre-operative examination done by Dr. Ramos and Dr. Santos. They proceeded with the operation after having found Regina fit for anesthesia. The operation was successful and she gave birth to a baby boy.
Thirteen hours after her operation, Regina complained of a headache, a chilly sensation, restlessness and shortness of breath. She asked for oxygen and later became cyanotic. After undergoing x-ray, she was found to be suffering from pulmonary edema. Since her condition showed no improvement, she was transferred to the Cardinal Santos Hospital. The doctors in said hospital found that she was suffering from rheumatic heart disease mitral stenosis with mild pulmonary hypertension, which contributed to the onset of Fluid in her lung tissue (pulmonary edema). This development resulted in cardio-pulmonary arrest and, subsequently, brain damage.
Regina lost the use of her speech, eyesight, hearing and limbs. Due to this, spouses Capanzana filed a complaint for damages against Our Lady of Lourdes Hospital along with Dr. Ramos, Dr. Santos and the nurses on duty stationed on the second floor. During the course of the proceedings, Regina died and was substituted by her heirs.
The RTC found no negligence on the part of Dr. Ramos and Dr. Santos as they were compliant of the standard practices in attending to a patient during a C-Section. The court reasoned that the primary cause of Regina’s vegetative state, amniotic fluid embolism, was not within the control of the doctor to anticipate. The Court, however, found the nurses on duty liable for their failure to immediately administer the oxygen. This failure having contributed to the onset of hypoxic encephalopathy.
The Court held that the Our Lady of Lourdes Hospital is free from liability as it was able to discharge the burden of proof that it had exercised the diligence of a good father of a family in the selection and supervision of its employees. On appeal, the CA affirmed the ruling of the RTC except as to the liability of the midwife (Ballano) and the Our Lady of Lourdes Hospital. It was found that while there was evidence to prove that petitioner hospital showed diligence in its selection and hiring processes, there was no evidence to prove that it exercised the required diligence in the supervision of its nurses.
Issue:
Whether Our Lady of Lourdes Hospital is liable for damages due to its failure to exercise due diligence in the supervision of its nurses.
Ruling:
YES. The plaintiff must show the following elements by a preponderance of evidence: duty of the health professional, breach of that duty, injury of the patient, and proximate causation between the breach and the injury.
The Negligence of the Nurses
The SC found that there was sufficient evidence to prove that the nurses were negligent. When Regina was gasping for breath and turning cyanotic, it was the duty of the nurses to intervene immediately by informing the resident doctor. Had they done so, proper oxygenation could have been restored and other interventions performed without wasting valuable time.
According to the expert witness, the occurrence of “hypoxic encephalopathy” could have been avoided since lack or inadequate supply of oxygen to the brain for 5 minutes will cause damage to it. It was found that the nurses took 10- 15 minutes to respond to the call of Regina’s niece before going to the room. Also, it took about 20 minutes before the oxygen arrived. Another instance of negligence was the delay in the removal of Regina’s consumed dextrose which caused Regina discomfort. The nurses only attended to her after being called twice.
In Ramos, the SC defined “Proximate cause” as that which, in natural and continuous sequence, unbroken by any efficient intervening cause, produces injury, and without which the result would not have occurred. An injury or damage is proximately caused by an act or a failure to act, whenever it appears from the evidence in the case, that the act or omission played a substantial part in bringing about or actually causing the injury or damage; and that the injury or damage was either a direct result or a reasonably probable consequence of the act or omission. It is the dominant, moving or producing cause.
Applying the above definition to the facts in the present case, the omission of the nurses — their failure to check on Regina and to refer her to the resident doctor and, thereafter, to immediately provide oxygen — was clearly the proximate cause that led to the brain damage suffered by the patient. The liability of the hospital The Our Lady of Lourdes hospital is liable under Article 2180 in relation to Article 2176 of the Civil Code. Under Article 2180, an employer may be held liable for the negligence of its employees based on its responsibility under a relationship of patria potestas. The liability of the employer under this provision is “direct and immediate; it is not conditioned upon a prior recourse against the negligent employee or a prior showing of the insolvency of that employee.” The employer may only be relieved of responsibility upon a showing that it exercised the diligence of a good father of a family in the selection and supervision of its employees. The SC held that the hospital sufficiently proved due diligence in the selection of the nurses. The nurses undergo a series of examination, orientation, training, on the job observation and evaluation before they are hired as regular employees. However, it failed to prove due diligence in their supervision. The formulation of a supervisory hierarchy, company rules and regulations, and disciplinary measures upon employees in case of breach, is indispensable. However, to prove due diligence in the supervision of employees, it is not enough for an employer such as petitioner to emptily invoke the existence of such a formulation. What is more important is the actual implementation and monitoring of consistent compliance with the rules. In this case, it was found that there is failure on the part of the hospital to sanction the tardiness of the nurses which shows an utter lack of actual implementation and monitoring of compliance with the rules and ultimately of supervision over its nurses. Also, on the nights subject of the present controversy, there is failure to show who were the actual nurses on duty and who was supervising these nurses due to the conflicting accounts on the documents of the hospital. All these negate the due diligence on the part of the nurses, their supervisors, and ultimately, the hospital. Thus, petitioner was held liable for damages.