571 SCRA 585 – Labor Law – Labr Relations – Labor Standards – Strike – Managerial Employees

– Control – Illegal Dismissal

Ronaldo Lanzanas and Merceditha Lanzanas are doctors employed by Calamba Medical Center,
Inc. They are given a retainer’s fee by the hospital as well as shares from fees obtained from
patients.

One time, Ronaldo was overheard by Dr. Trinidad talking to another doctor about how low the
admission rate to the hospital is. That conversation was reported to Dr. Desipeda who was then
the Medical Director of the hospital.

Eventually Ronaldo was suspended. Ronaldo filed a case for Illegal Suspension in March 1998.
In the same month, the rank and file employees organized a strike against the hospital for
unfair labor practices. Desipeda eventually fired Ronaldo for his alleged participation in the
strike, which is not allowed under the Labor Code for he is a managerial employee. Desipeda
also fired Merceditha on the ground that she is the wife of Ronaldo who naturally sympathizes
with him.

The Labor Arbiter ruled that there was no Illegal Suspension for there was no employer-
employee relationship because the hospital has no control over Ronaldo as he is a doctor who
even gets shares from the hospitals earnings.

The National Labor Relations Commission as well as the Court of Appeals reversed the LA.

ISSUE: Whether or not there is an employer-employee relationship?

HELD: Yes. Under the control test, an employment relationship exists between a physician and
a hospital if the hospital controls both the means and the details of the process by which the
physician is to accomplish his task. There is control in this case because of the fact that
Desipeda schedules the hours of work for Ronaldo and his wife.

The doctors are also registered by the hospital under the SSS which is premised on an
employer-employee relationship.

There is Illegal Dismissal committed against Rolando for there was no notice and hearing held.
It was never shown that Rolando joined the strike. But even if he did, he has the right to do so
for he is not a part of the managerial or supervisory employees. As a doctor, their decisions are
still subject to revocation or revision by Desipeda.

There is Illegal Dismissal committed against Merceditha for the ground therefor was not
mentioned in Article 282 of the Labor Code.

When is Control (One of the Four Tests of Employer-Employee Relationship) Absent?

Where a person who works for another does so more or less at his own pleasure and is not
subject to definite hours or conditions of work, and is compensated according to the result of
his efforts and not the amount thereof, the element of control is absent.
CASUMPANG V. CORTEJO
FACTS:
- 22-APR-88: 11AM; Mrs. Cortejo brought her son Edmer to the emergency room of the
San Juan De Dios Hospital (SJDH) because of difficulty in breathing , chest pain, stomach
pain, and fever
- Dr. Livelo (family doctor) initially attended to and examined Edmer; he took his medical
history, his vital signs, body temp, and bp initial diagnosis: bronchopneumonia; his
blood was also taen for testing, typing, and for purposes of administering antibiotics
Edmer was then given antibiotics to lessen his fever and loosen his phlegm
- Mrs. Cortejo did not know any doctor at SJDH. She used her Fortune Care card and was
referred to an accredited Fortune Care coordinator, who was then out of town. She was
thereafter assigned to Dr. Noel Casumpang (Dr. Casumpang), a pediatrician also
accredited with Fortune Care
- 0530 PM, Dr. Casumpang examined Edmer, confirmed the initial diagnosis of
bronchopneumonia Mrs. Cortejo didn’t agree with this Edmer only had fever, no
cough nor colds Dr. Casumpang: his bp is just being active
- 9AM: next visit of Dr. Casumpang
- Mrs. Cortejo again called Dr. Casumpang's attention and stated that Edmer had a fever,
throat irritation, as well as chest and stomach pain. Mrs. Cortejo also alerted Dr.
Casumpang about the traces of blood in Edmer's sputum. Despite these pieces of
information, however, Dr. Casumpang simply nodded, inquired if Edmer has an asthma,
and reassured Mrs. Cortejo that Edmer's illness is bronchopneumonia
- 1130am: Edmer vomited phlegm with blood strea 45 mins later, Dr. Miranda (resident
physician of SJDH) arrived [gave an excuse about how the specimen *vomit* was
washed away, etc.] examined Edmer results: low grade fever and rashes that are
not typical of dengue fever
- 3PM: Edmer again vomited blood; had stomach pain and had difficulty in moving his
right leg; had sputum with blood; this is when Dr. Miranda suspected that Edmer might
have dengue tourniquet test: NEGATIVE BP: normal
- Dr. Miranda called up Dr. Casumpang re: Edmer’s condition; the latter ased the former
to subject Edmer to several tests; it was after such tests (6PM) that that enable them to
find out that Edmer had Dengue, stage IV
- AT 7PM, Dr. Casumpang visited Edmer recommended he be transferred to the IC it
was full hire a private nurse na lang no, we’ll transfer him to Makati Med
- Respondent signed a waiver, checked Edmer for the last time ambulance driver not
found, Dr. Casumpang spent 600 pesos on a private ambulance (12mn)
- 24-APR-88: Edmer died
- Cortejo spouses instituted an action for damages against Dr. Casumpang and Dr.
Miranda on account of their negligence
RTC: RULED IN FAVOR OF THE CORTEJOS; NTENABLE WERE THE DOCTORS’ EXCSES THAT
EDMER’S SYMPTOMS DID NOT INDICATE DENGUE FEVER; THEY RELIED HEAVILY ON THE XRAY;
NO EVIDENCE THAT THEY PRESENTED PROPER MEDICAL ATTENTION; SDJH SOLIDARILY LIABLE
WITH PETITIONERS DOCTRINE OF APPRENT AUTHORITY because before the hospital
engaged his medical services, it scrutinized and determined his fitness, qualifications, and
competence as a medical practitioner; Dr. Miranda, as resident physician, is an employee of
SJDH because like Dr. Casumpang, the hospital, through its screening committee, scrutinized
and determined her qualifications, fitness, and competence before engaging her services; the
hospital also exercised control over her work

CA: AFFIRMED IN TOTO RTC DECISION SDJH AND ITS ATTENDING PHYSICIANS FAILED TO
EXERCISE MINIMUM MEDICAL CARE… FAILURE TO READ THE MOST BASIC SIGNS OF DENGUE
= MEDICAL NEGLIGENCE; DR. JAUDIAN’S (PATHOLOGIST) TESTIMONY WAS GIVEN CREDENCE:
DEGUE SHOULD HAVE BEEN CONSIDERED IN LIGHT OF HIS SYMPTOMS SDJH’S LIABILITY
BASED ON NCC 2118, RESPONDEAT SUPERIOR

PRESENT PETITIONS:
1. DR. CASUMPANG : GAVE EDMER MEDICAL TREATMENT ACCDG. TO THE BEST OF HIS
ABILITIES; DENGUE FEVER ONLY OCCURS AFTER SEVERAL DAYS OF CONFINEMENT; DR.
JAUDIAN, CREDIBLE?
2. DR. MIRANDA : DR. CASUMPANG WAS THE DOCTOR ASSIGNED; SHE EXERCISED
PRUDENCE; NO CAUSAL REL. BETWEEN THE INITIAL DIAGNOSIS TO THE CAUSE OF
DEATH; DR. JAUDIAN ALSO NOT CREDIBLE NO EVIDENCE OF CERT. OF FORMAL
RESIDENCY OR FELLOWSHIP IN PEDIATRICS
3. SDJH : DR. CASUMPANG AND DR. MIRANDA ARE MERE INDEPENDENT CONTRACTTORS;
NO EER; THEY DON’T HIRE CONSULTANTS, ONLY GRANT PRIVILEGES TOWARDS THEM;
DON’T PAY THEM WAGES; NO POWER OF CONTROL: OBSERVED PROPER DILIGENCE OF
A GOOD FATHER OF THE FAMILY
4. RESPONDENTS: THEY RAISE FACTUAL ISSUES, NOT REVIEWABLE BY THIS COURT; THE
DOCTORS WERE NEGLIGENT FAILED TO TIMELY DIAGNOSE, THEIR MEDICAL
EXAMINATION WAS NOT COMPREHENSIVE, EMPLOYED A GUESSING GAME; SDJH HAS
NO PROPER PAGING SYSTEM, NO BRONCHOSOPE, RATIO OF DOCTORS TO PATIENTS
LOW

NOTES: MEDICAL MALPRACTICE: an action available to victims to redress a wrong

committed by medical professionals who caused bodily harm to, or the death of, a patient;
the suit is brought whenever a medical practitioner or health care provider fails to meet the
standards demanded by his profession, or deviates from this standard, and causes injury to
the patient; must prove that the doctor either failed to do what a reasonably prudent
 doctor would have done, or did what a reasonably prudent doctor would not have done;
and the act or omission had caused injury to the patient; The elements of medical
negligence are: (1) duty; (2) breach; (3) injury; and (4) proximate causation; PHYSICIAN-
PATIEN REL. ESTABLISHED WHEN THE FORMER EXAMINES THE PATIENT

ISSUES + RULING
1. W/N THE DOCTORS WERE NEGLIGENT?
- DR. CASUMPANG, YES. DR. MIRANDA, NO.
- In the present case, expert testimony is crucial in determining first, the standard
medical examinations, tests, and procedures that the attending physicians should have
undertaken in the diagnosis and treatment of dengue fever; and second, the dengue
fever signs and symptoms that the attending physicians should have noticed and
considered

- DR. CASUMPANG WAS NEGLIGENT IN DIAGNOSIS: It will be recalled that during Dr.
Casumpang's first and second visits to Edmer, he already had knowledge of Edmer's
laboratory test result (CBC), medical history, and symptoms (i.e., fever, rashes, rapid
breathing, chest and stomach pain, throat irritation, difficulty in breathing, and traces of
blood in the sputum). However, these information did not lead Dr. Casumpang to the
possibility that Edmer could be suffering from either dengue fever, or dengue
hemorrhagic fever, as he clung to his diagnosis of broncho pneumonia. This means
that given the symptoms exhibited, Dr. Casumpang already ruled out the possibility of
other diseases like dengue.

In other words, it was lost on Dr. Casumpang that the characteristic symptoms of
dengue (as Dr. Jaudian testified) are: patient's rapid breathing; chest and stomach pain;
fever; and the presence of blood in his saliva.  HE FAILED TO APPRECIATE ALL
SYMPTOMS

- DR. CASUMPANG WAS NEGLIGENT IN THE TREATMENT AND MANAGEMENT OF

DENGUE: Dr. Casumpang failed to measure up to these standards. The evidence
strongly suggests that he ordered a transfusion of platelet concentrate instead of blood
transfusion. The tourniquet test was only conducted after Edmer's second episode of
bleeding, and the medical management (as reflected in the records) did not include
antibiotic therapy and complete physical examination NO ANTIBIOTIC THERAPY AND
COMPLETE PHY. EXAMINATION

- DR. MIRANDA IS NOT LIABLE FOR NEGLIGENCE: the medical care required is that of
reasonably careful physicians or hospital emergency room operators, not of interns or
residents; Although she had greater patient exposure, and was' subject to the same
standard of care applicable to attending physicians, we believe that a finding of
 negligence should also depend on several competing factors, among them, her authority
to make her own diagnosis, the degree of supervision of the attending physician over
her, and the shared responsibility between her and the attending physicians; Dr.
Miranda likewise duly reported to Dr. Casumpang, who admitted receiving updates
regarding Edmer's condition. There is also evidence supporting Dr. Miranda's claim that
she extended diligent care to Edmer. In fact, when she suspected - during Edmer's
second episode of bleeding - that Edmer could be suffering from dengue fever, she
wasted no time in conducting the necessary tests, and promptly notified Dr. Casumpang
about the incident. Indubitably, her medical assistance led to the finding of dengue
fever.

- THE CAUSATION B/W DR. CASUMPANG’S NEGLIGENCE AND EDMER’S DEATH WAS
ADEQUATELY PROVEN: To reiterate, Dr. Casumpang failed to timely diagnose Edmer
with dengue fever despite the presence of its characteristic symptoms; and as a
consequence of the delayed diagnosis, he also failed to promptly manage Edmer's
illness. Had he immediately conducted confirmatory tests, (i.e., tourniquet tests and
series of blood tests) and promptly administered the proper care and management
needed for dengue fever, the risk of complications or even death, could have been
substantially reduced.

- SJDH’S LIABILITY BASED ON THE DOCTRINE OF APPARENT AUTHORITY NOT

RESPONDEAT SUPERIOR

1. HOSPITAL’S MANIFESTATIONS: In this case, the court considered the act of the
hospital of holding itself out as provider of complete medical care, and considered
the hospital to have impliedly created the appearance of authority.
2. PATIENT’S RELIANCE: SDJH CLOTHED DR. CASUMPANG W/ APPARENT AUTHORITY
Based on the records, the respondent relied on SJDH rather than upon Dr.
Casumpang, to care and treat his son Edmer. His testimony during trial showed that
he and his wife did not know any doctors at SJDH;they also did not know that Dr.
Casumpang was an independent contractor. They brought their son to SJDH for
diagnosis because of their family doctor's referral. The referral did not specifically
point to Dr. Casumpang or even to Dr. Miranda, but to SJDH.

Significantly, the respondent had relied on SJDH's representation of Dr. Casumpang's

authority. To recall, when Mrs. Cortejo presented her Fortune Care card, she was
initially referred to the Fortune Care coordinator, who was then out of town. She
was thereafter referred to Dr. Casumpang, who is also accredited with Fortune Care.
In both instances, SJDH through its agent failed to advise Mrs. Cortejo that Dr.
Casumpang is an independent contractor.
Mrs. Cortejo accepted Dr. Casumpang's services on the reasonable belief that such
were being provided by SJDH or its employees, agents, or servants. By referring Dr.
Casumpang to care and treat for Edmer, SJDH impliedly held out Dr. Casumpang,
not only as an accredited member of Fortune Care, but also as a member of its
medical staff.