MANILA, Philippines -- Private hospitals warn that the Supreme Court ruling requiring Medical City to indemnify the heirs of a patient for the ?negligence? of its doctor could lead to the closure of private medical centers and to higher health care costs.

A surgeon at Medical City had left two pieces of gauze inside the patient?s body.

The Private Hospitals Association of the Philippines (PHAP), Asian Hospital Inc. and Manila Doctors Hospital have separately asked the Supreme Court to reverse the decision.

The high court denied with finality Medical City?s motion for reconsideration in February. Medical City has filed a second motion for reconsideration.

In a ruling in 2007, the court said Professional Services Inc. (PSI), owner of Medical City, was responsible not only for the negligence of surgeon Miguel Ampil, but also for its own negligence because it failed to immediately investigate the operation on Natividad Agana.

It ordered Ampil and the hospital to pay Agana?s heirs more than P3 million in damages.

Agana was operated on in 1984 for cancer of the sigmoid. Shortly after, she suffered ?excruciating pain? in her anal region. The pieces of gauze, 1.5 inches wide, were later found and one had infected her vaginal vault. She died in 1986.

In its motion to intervene, the PHAP disputed the high court?s ruling that consultants were considered hospital employees, saying that hospitals did not have control over the consultants? choice of patients and treatment.

It also disputed the court?s reliance on the doctrine of corporate negligence, saying it should only be applied to commercial goods. The services that hospitals provided, which included nursing services and the physical facilities, were different from those provided by consultants, it said.

?However, the hospital does not involve itself in the manner of how to cure or manage the condition of the patient even as this is the exclusive turf of the attending doctor consultant,? it said.

The PHAP argued that making hospitals civilly liable for the negligence of consultants would ?be disastrous to the already overstrained financial situations of hospitals in the country,? especially the smaller ones.

Hospitals could face a deluge of lawsuits because of the court ruling, even as they deal with doctors and nurses leaving for abroad, according to the association. They might also pass on the cost of the lawsuit to the patient, further raising hospitalization fees, it said.

The group pointed out that about 600 hospitals already closed down since 1998.

It said the Supreme Court decision could scare those intending to put up hospitals, especially in rural areas where medical services were needed.

Asian Hospital contended that since the high court ruled that consultants could be considered employees, hospitals would be burdened with regulating, monitoring, overseeing and supervising their consultants.

?In fact, this will radically change, and indeed will cause an upheaval in the entire hospital industry and medical profession, and will ultimately result in higher costs of health care?to the detriment of all concerned, including those requiring medical treatment in the Philippines,? Asia Hospital said.

It added that the ruling would require the less experienced doctors undergoing training in the hospital to supervise the more experienced consultants, who were specialists in their fields.

The hiring of specialists as permanent employees would also be difficult for hospitals because of the limited number of experts in a particular field, it said.

It said the small number of experts was the reason they tended to practice in more than one hospital so as to make their skills available to more people.

If hospitals could not shoulder the costs entailed in supervising all consultants or hiring experts, they might close down, Asia Hospital said. It asked the full court to hear the case instead of just the First Division.

Manila Doctors Hospital contested the high court?s finding that the consultant could be considered a hospital employee. The hospital is just providing the facilities for the patient to transact with the physician, but it is the patient who chooses the doctor who will attend to him or her, according to Manila Doctors.

The hospital would not share in the professional fee paid by the patient to the doctor, it said.

?Clearly, therefore, the physician is a free agent in relation to the hospital as well as the patient, and the patient chooses him as an individual practitioner and not as an employee of the hospital,? it said.

Manila Doctors warned of other drastic consequences if the court?s ruling was not reversed. Among these are the delays, inefficiencies and additional costs that would arise if the hospital, as an employer, would be involved in choosing a doctor for a patient.

This may also hamper the patient?s freedom to choose doctors, Manila Doctors said. It would be expensive for hospitals to put up a system to monitor doctors? performance, which would require hiring supervisors and technical people. The costs would then be passed on to the patient.

Hospitals would also have to acquire insurance, while doctors would not be able to determine their own fees.

But the Aganas? lawyer, Federico Agcaoili, questioned the decisions of the hospitals and the PHAP to raise the issues only now when the case was pending for many years and the ruling was handed down over a year ago. ?They are merely creating, in my mind, an attempt to restudy a question already resolved by the court,? he said.

He noted that the ruling, penned by retired Justice Angelina Sandoval Gutierrez, was already final.

He said the motions filed by the three parties could be considered a form of forum shopping because they might be hoping to reverse the decision in light of Gutierrez?s retirement in February.