NOGALES v.
CAPITOL MEDICAL CENTER o The hospital must have the right to control both the means and the details of the
GR No. 142625 / December 19, 2006 / CARPIO, J./ LABOR 1 Control test /RLAurellano
NATURE Petition for certiorari to review of the decision of the NLRC
PETITIONERS Rogelio Nogales, for himself and on behalf of minor Roger Anthony,
Angelica, Nancy, and Michael Christopher, all Nogaleses
RESPONDENTS Capitol Medical Center; Dr. Oscar Estrada; Dr. Ely Villaflor; Dr. Rosa Uy;
Dr. Joel Enriquez; Dr. Perpetua Lacson; Dr. Noe Espinola; and Nurse J.
Dumlao
SUMMARY. Petitioner Nogaless wife died in childbirth. He is suing Dr. Estrada, their prima-
ry OBGYNE, and Capitol Medical center (CMC) for negligence in causing Corazons death. SC
held that Dr. Estrada is NOT CMCs EE he is but an independent contractor. BUT CMC was
still held vicariously liable under the doctrine of apparent authority
DOCTRINE. Control test for hospital-dr. relationships: The hospital must have the right to
control both the means and the details of the process by which the dr. is to accomplish his
task.
FACTS.
The wife of petitioner Nogales, Corazon, died in childbirth. He is accusing respondent
Capitol Medical (CMC) and Dr. Estrada, the primary doctor of Corazon
[Medical things] On Corazons last trimester, Dr. Estrada noted an increase in her blood
pressure, and things indicating preeclampsia
o One day, Corazon started to experience mild labor pains, so she and Nogales went to Dr.
Estrada who immediately recommended their admission in CMC
o After Corazons water broke, and her cervix was fully dilated, and she experienced con-
vulsions, Dr. Estrada ordered that she be injected with 10g of magnesium sulfate. As-
sisting dr. Dr. Villaflor only administered 2.5g
o Dr. Estrada applied low forceps to extract the baby. A piece of cervical tissue got torn
o The baby came out not okay1. After the baby came out, Corazon started bleeding pro-
fusely
o Bags of blood arrived 1 hr after the bleeding started
o Emergency hysterectomy recommended by CMCs OBGYNE Dept head, but it was not
performed
o In the end, Corazon died because of hemorrhage
RTC: Dr. Estrada held civilly liable to Nogales. Complaint as to other respondents dis-
missed
CA: RTC affirmed
Note: Dr. Estradas liability is established, so the issue in this case in WON CMC is liable
ISSUES & RATIO.
1. WON Dr. Estrada is CMCs EE NO, he is an independent contractor
SC used the control test2: whether an employment relationship exists between a physi-
cian and a hospital based on the exercise of control over the physician as to details.
1
apric, cyanatic weak and injured condition
2
As suggested (but not expounded upon) in Ramos v. CA
process by which the dr. is to accomplish his task.
The Court finds no evidence pointing to CMCs exercise of control over Dr. Estrada
o Corazon was under the exclusive pre-natal care of Dr. Estrada. During Corazons la-
bor, Dr. Estrada was assisted by Dr. Villaflor. There was no showing that CMC had a
part in diagnosing Corazons condition
o CMC merely allowed Dr. Estrada to use its facilities, as Corazons birth was consid-
ered an emergency. Also, his staff privileges did not make him CMCs EE
Considering these circumstances, Dr. Estrada is not CMCs EE, but an independent
contractor
2. WON CMC could be held vicariously liable for Corazons death YES, under the doc-
trine of apparent authority, which is an exception to the general rule.
Nogales seeks to make CMC liable under NCC 2180, or under the ERs responsibility un-
der patria potestas
In general, a hospital is not liable for the negligence of an independent contractor-
physician. There is, however, an exception to this principle. The hospital may be liable
if the physician is the "ostensible" agent of the hospital. This exception is also known
as the "doctrine of apparent authority.
For a hospital to be liable under the doctrine of apparent authority, a plaintiff must
show that:
o (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;
o (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
o (3) the plaintiff acted in reliance upon the conduct of the hospital or its agent, con-
sistent with ordinary care and prudence.
Factors to consider:
o An inquiry on whether the hospital acted in a manner which would lead a reasonable
person to conclude that the individual who was alleged to be negligent was an employ-
ee or agent of the hospital. The hospital need not make express representations to the
patient that the treating physician is an employee of the hospital; rather a representa-
tion may be general and implied.
As to this factor, CMC impliedly held out Dr. Estrada as a member of its medical staff
CMC granted staff privileges to Dr. Estrada and extended its medical staff and fa-
cilities to him
CMC made Nogales sign consent forms printed with the CMC letter head. These
forms did not indicate the Dr. Estrada was an independent contractor. Nogales
and Corazon were not informed by anyone of this.
When Dr. Estrada referred Corazons profuse vaginal bleeding to Dr. Espinola,
Head of CMCs OBGYNE Dept, it gave he impression that Dr. Estrada, as a mem-
ber of CMCs medical staff, was collaborating with other CMC-employed people
o An inquiry on whether the plaintiff acted in reliance upon the conduct of the hospital or
its agent, consistent with ordinary care and prudence
As to this factor, Nogales testified that he and Corazon chose Dr. Estrada partly be-
cause of his connections to CMC.
 Dr. Estradas relationship with CMC played a significant role in Nogales and Cora-
zons decision to accept Dr. Estradas services.
The SC cited El Hogar, saying than an employer cannot be legally compelled to contin-
ue with the employment of a person who was admittedly guilty of misfeasance or mal-
feasance. They also believe that this situation is not unlike a hijack, because Vir-Jen was
coerced, threatened and intimidated when it was generally without recourse but to
yield to the peril of irreparable loss

3. What about the other respondents?

Dr. Villaflor (Assisting Dr) Not liable. Dr. Villaflor administered a lower dosage of
magnesium sulfate because Corazons BP went down to dangerous levels. The lower
dosage was known to, and was approved by Dr. Estrada
Dr. Uy (random resident physician at CMC) - Not liable. Did not participate in delivery,
and its not even sure that she was in the delivery room. That she makes a routine inter-
nal examiniation of Corazon does not make her ipso facto liable. Also, shes like, second
year resident physicial
Dr. Enriquez (anaesthesiologist) - Not liable. Not an expert in OBGYNE things lol
Dr. Lacson (blood bank supervisor) Not liable. No unreasonable delay in giving blood
to Corazon. She stated that the blood would be ready in 45-60 mins. Also, no evidence
that she neglected her duties
Dr. Espinola (CMCs OBGYNE Dept head) Not liable. Believed in good faith that hys-
terectomy was the correct remedy, based on info he received over the phone.
Nurse Dumlao Not liable. No showing of her failure to follow Dr. Estradas instructions

DECISION.
Petition partly granted. CMC held vicariously liable