Legal Medicine

LEGAL MEDICINE STATE REGULATION OF HOSPITAL OPERATION RA 4226 - AN ACT REQUIRING THE LICENSURE OF ALL HOSPITALS IN THE PHILIPPINES AND AUTHORIZING THE BUREAU OF MEDICAL SERVICES TO SERVE AS THE LICENSING AGENCY Section 1. This Act shall also be known as the Hospital Licensure Act. Section 2. Definitions. – As used in this Act – (a) ‘Hospital’ means a place devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment and care of individuals suffering from illness, disease, injury or deformity, or in need of obstetrical or other medical and nursing care. The term ‘hospital shall also be construed as any institution, building or place where there are installed beds, or cribs, or bassinets for twenty-four-hour use or longer by patients in the treatment of diseases, diseased-conditions, injuries, deformities, or abnormal physical and mental states, maternity cases, and all institutions such as those for convalescence, sanitarial or sanitarial care, infirmities, nurseries, dispensaries and such other names by which they may designated. (b) ‘Government hospital’ means a hospital operated and maintained either partially or wholly by the national, provincial, municipal or city government or other political subdivision, or by any department, division, board or other agency thereof. (c) ‘Private hospital’ means one which is privately owned, established and operated with funds raised or contributed through donations, or by private capital or other means, by private individuals, association, corporation, religious organization, firm, company or joint stock association. (d) ‘Clinic’ means a place in which patients avail of medical consultations or treatments on an out-patient basis. However, any clinic or dispensary where there is at least six beds or cribs or bassinets installed for twenty-four-hour use by patients shall be construed to fall within the definition of a hospital as described in this Act. (e) ‘Licensee’ is the person or persons granted a license to operate and maintain a hospital according to an approved minimum standard. Section 3. Construction Permit. – No hospital, government or private, shall be constructed unless plans have been approved and construction permit issued by the licensing agency as defined in this Act. Section 4. Registration and license. – No hospital shall operate or be opened to the public unless it shall have been registered and a license for its operation obtained from the licensing agency provided in this Act.

Section 5. Licensing Agency. – For purposes of setting standards in hospital construction and operation, the Bureau of Medical Services in addition to its present duties shall act as the licensing agency. The Secretary of Health shall reorganize this Bureau to include a staff of hospital architects, hospital administrators, sanitary engineers and such personnel as may be necessary to carry out the purposes of this Act without necessarily increasing the present personnel strength of this Bureau. Section 6. Powers and duties of the licensing agency. – The Bureau of Medical Services, or the licensing agency shall have the following powers and duties: a. To conduct an ocular survey of all existing hospitals in the Philippines, government or private, with a view to determine their fitness to operate considering their facilities and physical plant. b. To prescribe standard plans for government hospital plants in consultation with the Division of Architecture, Bureau of Public Works. c. To approve plans for hospital plants, government or private, and to issue permits or authority to construct hospitals in accordance with the provisions of this Act. d. To keep a permanent register of approved hospitals or those issued licenses to operate indicating the name of the hospital, address or location, type of hospital, name of the director or administrator, ownership, number of authorized beds and bassinets and such other pertinent data as may be necessary. e. To grant licenses for the operation and maintenance of hospitals or revoke the same in accordance with the provisions of this Act. f. To make periodic inspection of all hospitals so as to check compliance with rules and regulations legally promulgated or with the provisions of this Act and to make recommendations to directors or administrators of hospitals for the correction of defects found during such inspections. g. To publish yearly a list of all approved hospitals indicating the name, location, type, authorized beds, and name of the director or administrator. h. To submit yearly reports to the Secretary of Health, the Speaker of the House of Representatives, the President of the Senate and the chairmen and members of the Committees on Health of both Houses of Congress, such reports to include a list of approved hospitals indicating the name of the hospital, location, bed capacity and name of the director or administrator and make recommendations on hospital needs or requirements for hospital service in certain communities that do not enjoy such hospital services. Section 7. Filing of Application for Construction Permit. – Application for a permit to construct a hospital shall be submitted to the Office of the Director, Bureau of Medical Services in a form prescribed by the latter and accompanied by a plan of the hospital plant proposed to be constructed. The

application shall state the name of the hospital, ownership, number of beds proposed to be operated, location and type of hospital to be constructed. Section 8. Minimum Standards of Construction. – In order that a permit to construct a hospital can be issued the hospital plan shall provide sufficient bed space for the hospital bed capacity proposed, a laboratory room, an operating room, including work rooms for sterilization, anesthesia preparation, etc., an X-ray or radiology room, pharmacy, dispensary or outpatient department, delivery room, isolation rooms, autopsy room or morgue, sufficient quarters for residents, nurses, attendants and helpers and sufficient number of toilet facilities. Wards shall be constructed such that segregation of the sexes is observed and as far as practicable classified as to the type of cases to be confined. Section 9. Application for Registration and Issuance of License. – Application for registration of a hospital and for the issuance of a license for its operation and maintenance shall be filed with the Bureau of Medical Services on a form prescribed by it. Registration may be made and license issued upon compliance with the provisions of Section eight hereof and the rules and regulations prescribed by the licensing agency pursuant to the provisions of this Act. Section 10. Inspection. – Permit to construct a hospital or a major portion thereof and license to operate and maintain the same shall be issued by the licensing agency only after a representative of the licensing agency has conducted an ocular inspection and certified that the applicant has satisfactorily complied with requisites prescribed in this Act. The license to operate and maintain a hospital shall be renewed every year upon payment of the prescribed fees. Section 11. Revocation of License. – The licensing agency may suspend or revoke a license already issued for any of the following grounds: (a) repeated violation by the licensee of any provision of this Act or of any other existing law; (b) repeated violation of rules and regulations prescribed in the implementation of this Act; or (c) repeated failure to make necessary corrections or adjustments required by the licensing agency in the improvement of facilities and services. Section 12. Hearing. – Any person, association, corporation, or any other private entity who has been refused a license to operate and maintain a hospital or whose license for such hospital has been suspended or revoked shall be entitled to an administrative hearing to be conducted by the Secretary of Health and his two undersecretaries to determine the justifiability of such denial, suspension or revocation of the license: provided, that the licensee may resort to the courts, as in other cases provided by law.

Section 13. Separate Licenses Required. – Separate licenses shall be required for hospitals or branches thereof maintained in separate premises, even though they are operated under the same management: provided, however, that separate licenses shall not be required for separate buildings in the same compound: provided, further, that permits for construction or alteration of buildings within the same compound shall also be secured from the licensing agency to determine compliance with standards and requirements herein authorized. Section 14. License not transferable. – License for the operation of hospitals shall not be transferable. The licensing agency shall be notified of any change in ownership, change of name of the hospital, and transfer of location and in the latter case, an application for a new license should be submitted. Section 15. Rules and Regulations. – The Bureau of Medical Services acting as a licensing agency and subject to the approval of the Secretary of Health, shall promulgate rules and regulations to implement the provisions of this Act. Section 16. Classification of Hospitals. – The licensing agency shall study and adopt a system of classifying hospitals in the Philippines as to: (1) general or special; (2) hospital services capabilities; (3) size or bed capacity and (4) class of hospital whether training or not. Section 17. Fees. – Each applicant for a permit to construct a hospital shall pay the amount of five pesos as permit fee. A registration fee of five pesos and an annual license fee of ten pesos shall likewise be collected for each hospital and for each approved license: provided, that a government hospital shall be exempt from the payment of such fees. The amount herein collected shall be officially receipted by the licensing agency and shall constitute as a revolving fund for the use of the licensing agency. Section 18. Penalties. – Any person, partnership, association, or corporation who establishes, operates, conducts, manages or maintains a hospital or hospital clinic within the meaning of this Act without first obtaining a license as provided for in this Act or violates any provision hereof shall be guilty of a misdemeanor, and upon conviction thereof shall be liable to a fine of not more than five hundred pesos for the first offense and not more than one thousand pesos for each subsequent offense, and each day that the hospital shall operate after the first conviction shall be considered a subsequent offense. Section 19. Repeal. – Any law or laws or parts thereof inconsistent with the provisions of this Act are hereby repealed. Section 20. Effectivity. – This Act shall take effect upon its approval.

Approved, June 19, 1965.

EO 292 TITLE IX

SECTION 3. Powers and Functions.—The Department shall: (1) Define the national health policy and formulate and implement a national health plan within the framework of the government’s general policies and plans, and present proposals to appropriate authorities on national issues which have health implications; (2) Provide for health programs, services, facilities and other requirements as may be needed, subject to availability of funds and administrative rules and regulations; (3) Coordinate or collaborate with, and assist local communities, agencies and interested groups including international organizations in activities related to health; (4) Administer all laws, rules and regulations in the field of health, including quarantine laws and food and drug safety laws; (5) Collect, analyze and disseminate statistical and other relevant information on the country’s health situation, and require the reporting of such information from appropriate sources; (6) Propagate health information and educate the population on important health, medical and environmental matters which have health implications; (7) Undertake health and medical research and conduct training in support of its priorities, programs and activities; (8) Regulate the operation of and issue licenses and permits to government and private hospitals, clinics and dispensaries, laboratories, blood banks, drugstores and such other establishments which by the nature of their functions are required to be regulated by the Department; (9) Issue orders and regulations concerning the implementation of established health policies; and (10) Perform such other functions as may be provided by law. SECTION 14. Office for Hospital and Facilities Services.—The Office for Hospital and Facilities Services, headed by an Undersecretary who shall be supported by an Assistant Secretary, shall include four (4) staff services involved in policy formulation, standards development, program monitoring and provision of specialized assistance in the operations of hospitals and the management of facilities, which are as follows: (1) Hospital Operations and Management Service which shall formulate and implement plans, programs, policies, standards and techniques related to management improvement and quality control of hospital operations; provide consultative, training

and advisory services to field offices in relation to the supervision and management of hospital components; and conduct studies and research related to hospital operations and management; (2) Radiation Health Service which shall formulate and implement plans, programs, policies, standards and techniques to ensure radiation health safety; provide consultative, monitoring, training and advisory services to private and government facilities with radiation-emitting apparatus; and conduct studies and research related to radiation health; (3) Hospital Maintenance Service which shall formulate and implement plans, programs, policies, standards and techniques related to assuring the proper maintenance of Department equipment; provide consultative, training and advisory services to implementing agencies in relation to preservation, repair and maintenance of medical and non-medical equipment of the Department; and conduct studies and research related to equipment and facility maintenance; (4) Health Infrastructure Service which shall formulate and implement plans, policies, programs, standards and techniques related to development and preservation of health infrastructure; provide consultative, training and advisory services to implementing agencies in relation to infrastructure projects to assure economical and efficient implementation; and conduct studies and research related to infrastructure development and utilization. SECTION 15. Office for Standards and Regulations.—The Office for Standards and Regulations, headed by an Undersecretary and supported by an Assistant Secretary, shall include three (3) bureaus and one (1) national office that shall be responsible for the formulation of regulatory policies and standards over the various areas of concern in the health sector, whose implementation shall be the general responsibility of the Department’s regional field offices. The same bureaus shall also be responsible for those areas of activity covered by regulatory policy to provide the Secretary with current information on the status of these regulated areas of activity and to provide the Secretary with a basis for preliminary evaluation of the efficiency of the Department’s field offices in performing their regulatory functions. The same bureaus shall conduct studies and research pertinent to their areas of responsibility. In certain instances the bureaus may also perform consultative, training and advisory services to the practitioners and institutions in the area of regulated activity. The same bureaus and national office are the following: (1) Bureau of Research and Laboratories which shall develop and formulate plans, standards and policies, for the establishment and accreditation and licensing of laboratories; blood banks and entities handling biological products; provide consultative, training and advisory services to public and private laboratories; and conduct studies and research related to laboratory procedures and operations;

(2) Bureau of Food and Drugs which shall act as the policy formulation and sector monitoring arm of the Secretary on matters pertaining to foods, drugs, traditional medicines, cosmetics and household products containing hazardous substances, and the formulation of rules, regulations and standards in accordance with Republic Act 3720 (1963), as amended by Executive Order No. 175, s. 1987, and other pertinent laws for their proper enforcement; prescribe general standards and guidelines with respect to the veracity of nutritional and medicinal claims in the advertisement of food, drugs and cosmetics in the various media, to monitor such advertisements; advise the Department’s field offices to call upon any erring manufacturer, distributor, or advertiser to desist from such inaccurate or misleading nutritional or medicinal claims in their advertising; should such manufacturer, distributor, or advertiser refuse or fail to obey the desistance order issued by the Bureau, he shall be subject to the applicable penalties as may be prescribed by law and regulations; the Bureau shall provide consultative, training and advisory services to all agencies and organizations involved in food and drug manufacturing and distribution with respect to assuring safety and efficacy of food and drugs; conduct studies and research related to food and drug safety; maintain a corps of specially trained food and drugs inspectors for assignment to the various field offices of the Department; while these inspectors shall be under the technical supervision and guidance of the Bureau, they shall be under the administrative supervision of the head of the field offices to which they shall be assigned, the latter being responsible for regulatory program implementation within the geographic area of his jurisdiction; (3) Bureau of Licensing and Regulation which shall formulate policies and establish the standards for the licensing and regulation of hospitals, clinics and other health facilities; establish standards that shall be the basis of inspections and licensure procedures of the Department’s field offices; and provide consultative, training and advisory services to field offices on the conduct of licensing and regulatory functions over hospitals, clinics and other health facilities. (4) National Quarantine Office which shall formulate and implement quarantine laws and regulations and, through its field offices, exercise supervision over rat-proof zones in designated international ports and airports and over medical examination of aliens for immigration purposes.

REPUBLIC ACT NO. 9439

April 27, 2007

AN ACT PROHIBITING THE DETENTION OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS ON GROUNDS OF NONPAYMENT OF HOSPITAL BILLS OR MEDICAL EXPENSES Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled: SECTION 1. It shall be unlawful for any hospital or medical clinic in the country to detain or to otherwise cause, directly or indirectly, the detention of patients who have fully or partially recovered or have been adequately attended to or who may have died, for reasons of nonpayment in part or in full of hospital bills or medical expenses. SEC. 2. Patients who have fully or partially recovered and who already wish to leave the hospital or medical clinic but are financially incapable to settle, in part or in full, their hospitalization expenses, including professional fees and medicines, shall be allowed to leave the hospital or medical clinic, with a right to demand the issuance of the corresponding medical certificate and other pertinent papers required for the release of the patient from the hospital or medical clinic upon the execution of a promissory note covering the unpaid obligation. The promissory note shall be secured by either a mortgage or by a guarantee of a co-maker, who will be jointly and severally liable with the patient for the unpaid obligation. In the case of a deceased patient, the corresponding death certificate and other documents required for interment and other purposes shall be released to any of his surviving relatives requesting for the same: Provided, however, That patients who stayed in private rooms shall not be covered by this Act. SEC. 3. Any officer or employee of the hospital or medical clinic responsible for releasing patients, who violates the provisions of this Act shall be punished by a fine of not less than Twenty thousand pesos (P20,000.00), but not more than Fifty thousand pesos (P50,000.00), or imprisonment of not less than one month, but not more than six months, or both such fine and imprisonment, at the discretion of the proper court. SEC. 4. The Department of Health shall promulgate the necessary rules and regulations to carry out the provisions of this Act. SEC. 5. If any provision of this Act is declared void and unconstitutional the remaining provisions hereof not affected thereby shall remain in full force and effect. SEC. 6. All laws, decrees, orders, rules and regulations or part thereof inconsistent with this Act are hereby repealed or amended accordingly. SEC. 7. This Act shall take effect fifteen (15) days after its publication in two national newspapers of general circulation. Approved, MANNY VILLAR President of the Senate

JOSE DE VENECIA JR. Speaker of the House of Representatives

This Act which originated in the House of Representatives was finally passed by the House of Representatives and the Senate on June 7, 2005 and February 19, 2007, respectively. OSCAR G. YABES Secretary of Senate

ROBERTO P. NAZARENO Secretary General House of Represenatives

Approved: April 27, 2007 GLORIA MACAPAGAL-ARROYO President of the Philippines

Republic Act No. 8344

August 25, 1997

AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE KNOWN AS "AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES" Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled:: Section 1. Section 1 of Batas Pambansa Bilang 702 is hereby amended to read as follows: "SECTION 1. In emergency or serious cases, it shall be unlawful for any proprietor, president, director, manager or any other officer, and/or medical practitioner or employee of a hospital or medical clinic to request, solicit, demand or accept any deposit or any other form of advance payment as a prerequisite for confinement or medical treatment of a patient in such hospital or medical clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death or permanent disability: Provided, That by reason of inadequacy of the medical capabilities of the hospital or medical clinic, the attending physician may transfer the patient to a facility where the appropriate care can be given, after the patient or his next of kin consents to said transfer and after the receiving hospital or medical clinic agrees to the transfer: Provided, however, That when the patient is unconscious, incapable of giving consent and/or unaccompanied, the physician can transfer the patient even without his consent: Provided, further, That such transfer shall be done only after necessary emergency treatment and support have been administered to stabilize the patient and after it has been established that such transfer entails less risks than the patient's continued confinement: Provided, furthermore, That no hospital or clinic, after being informed of the medical indications for such transfer, shall refuse to receive the patient nor demand from the patient or his next of kin any deposit or advance payment: Provided, finally, That strict compliance with the foregoing procedure on transfer shall not be construed as a refusal made punishable by this Act." Section 2. Section 2 of Batas Pambansa Bilang 702 is hereby deleted and in place thereof, new sections 2, 3 and 4 are added, to read as follows: "SEC. 2. For purposes of this Act, the following definitions shall govern: "(a) 'Emergency' - a condition or state of a patient wherein based on the objective findings of a prudent medical officer on duty for the day there is immediate danger and where delay in initial support and treatment may cause loss of life or cause permanent disability to the patient. "(b) 'Serious case' - refers to a condition of a patient characterized by gravity or danger wherein based on the objective findings of a prudent medical officer on duty for the day when left unattended to, may cause loss of life or cause permanent disability to the patient.

"(c) 'Confinement' - a state of being admitted in a hospital or medical clinic for medical observation, diagnosis, testing, and treatment consistent with the capability and available facilities of the hospital or clinic. "(d) 'Hospital' - a facility devoted primarily to the diagnosis, treatment and care of individuals suffering from illness, disease, injury or deformity, or in need of obstetrical or other medical and nursing care. It shall also be construed as any institution, building or place where there are facilities and personnel for the continued and prolonged care of patients. "(e) 'Emergency treatment and support' - any medical or surgical measure within the capability of the hospital or medical clinic that is administered by qualified health care professionals to prevent the death or permanent disability of a patient. "(f) 'Medical clinic' - a place in which patients can avail of medical consultation or treatment on an outpatient basis. "(g) 'Permanent disability' - a condition of physical disability as defined under Article 192-C and Article 193-B and C of Presidential Decree No 442; as amended, otherwise known as the Labor Code of the Philippines. "(h) 'Stabilize' - the provision of necessary care until such time that the patient may be discharged or transferred to another hospital or clinic with a reasonable probability that no physical deterioration would result from or occur during such discharge or transfer. "SEC. 3. After the hospital or medical clinic mentioned above shall have administered medical treatment and support, it may cause the transfer of the patient to an appropriate hospital consistent with the needs of the patient, preferably to a government hospital, specially in the case of poor or indigent patients. "SEC. 4. Any official, medical practitioner or employee of the hospital or medical clinic who violates the provisions of this Act shall, upon conviction by final judgment, be punished by imprisonment of not less than six (6) months and one (1) day but not more than two (2) years and four (4) months, or a fine of not less than Twenty thousand pesos (P20,000.00), but not more than One hundred thousand pesos (P100,000.00) or both, at the discretion of the court: Provided, however, That if such violation was committed pursuant to an established policy of the hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic responsible for the formulation and implementation of such policy shall, upon conviction by final judgment, suffer imprisonment of four (4) to six (6) years, or a fine of not less than One hundred thousand pesos (P100,000.00), but not more than Five hundred thousand pesos (P500,000.00) or both, at the discretion of the court." Section 3. Section 3 of Batas Pambansa Bilang 702 is hereby repealed. Section 4. Section 4 of Batas Pambansa Bilang 702 shall become Section 5 thereof and shall be amended to read as follows: "SEC. 5. The Department of Health shall promulgate the necessary rules and regulations to carry out the provisions of this Act."

Section 5. This Act shall take effect fifteen (15) days after its publication in two (2) national newspapers of general circulation. Approved: August 25, 1997

The Lawphil Project - Arellano Law Foundation

IMPLEMENTING RULES AND REGULATIONS OF REPUBLIC ACT NO. 8344, OTHERWISE KNOWN AS "AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN EMERGENCY OR SERIOUS CASES, AMENDING FOR THE PURPOSE BATAS PAMBANSA BILANG 702, OTHERWISE KNOWN AS AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR ADVANCE PAYMENTS FOR THE CONFINEMENT OR TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL CLINICS IN CERTAIN CASES" WHEREAS, the Tenth Congress of the Republic of the Philippines enacted Republic Act No. 8344 on June 05, 1997; WHEREAS, the President of the Republic of the Philippines signed into law R.A. 8344 on August 25, 1997; WHEREAS, under Section 5 of R.A. 8344, the Department of Health (DOH) is mandated to promulgate the necessary rules and regulations to carry out the provisions of the aforementioned law. NOW THEREFORE, pursuant to the provisions of R.A. 8344 authorizing the Department of Health to promulgate the necessary rules and regulations, the following are hereby issued: 1. Section 1 of said Act provides: "In emergency or serious cases, it shall be unlawful for any proprietor, president, director, manager or any other officer, and/or medical practitioner or employee of a hospital or medical clinic to request, solicit, demand or accept any deposit or any other form of advance payment as a prerequisite for confinement or medical treatment of a patient in such hospital or medical clinic or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death or permanent disability: Provided, That by reason of inadequacy of the medical capabilities of the hospital or medical clinic, the attending physician may transfer the patient to a facility where appropriate care can be given, after the patient or his next of kin consents to said transfer: Provided, however, That when the patient is unconscious, incapable of giving consent and/or unaccompanied, the physician can transfer the patient even without his consent, Provided, further, That such transfer shall be done only after the necessary emergency treatment and support have been administered to stabilize the patient and after it has been established that such transfer entails less risks than the patient's continued confinement: Provided, finally, That strict compliance with the foregoing procedure on transfer shall not be construed as a refusal made punishable by this Act."

2. For the purpose of implementing the above, the following definitions are provided: 2.1 Emergency - A condition or state of patient wherein based on the objective findings of a prudent medical officer on duty for the day there is immediate danger and where delay in initial support and treatment may cause loss of life or cause permanent disability to the patient. 2.2 Serious Case - refers to a condition of a patient characterized by gravity or danger wherein based on the objective findings of a prudent medical officer on duty for the day when left unattended to, may cause loss of life or cause permanent disability to the patient. 2.3 Confinement - a state of being admitted in a hospital or medical clinic for medical observation, diagnosis, testing, and treatment consistent with the capability and available facilities of the hospital or clinic. 2.4 Hospital - a facility devoted primarily to the diagnosis, treatment and care of individuals or other medical and nursing care. It shall also be construed as any institution, building or place where there are facilities and personnel for the continued and prolonged care of patients. The hospital shall be duly licensed by the Bureau of Licensing and Regulation of the DOH. 2.5 Emergency Treatment and Support - any medical or surgical measure within the capability of a hospital or medical clinic that is administer by qualified health care professionals to prevent the death or permanent disability of a patient. (In determining the capability of a hospital or clinic, the standards and the classification of these facilities set by the DOH Bureau of Licensing and Regulation shall be used). 2.6 Medical Clinic - a place in which patients can avail of medical consultation or treatment on an outpatient basis. 2.7 Permanent Disability - a condition of physical disability as defined under Article 192-C and Article 193-B and C of Presidential Decree No. 442, as amended, otherwise known as the Labor Code of the Philippines. 2.8 Stabilize - the provision of necessary care until such time that the patient may be discharged or transferred to another hospital or clinic with a reasonable probability that no physical deterioration would result from or occur during such discharge or transfer. 3. Transfer of Patients - Section 3 of R.A. 8344 provides: "After the hospital or medical clinic mentioned above shall have administered medical treatment and consistent with the needs of the patients preferably to a government hospital, specially in the case of poor or indigent patients." 3.1 The transferring and receiving hospital, shall be as much as practicable, be within ten (10) kilometer radius of each other. 3.2 The transfer of patients contemplated under this Act shall at all times be properly documented.

3.3 Hospitals may require a deposit or advance payment when the patient is no longer under the state of emergency and he/she refuses to be transferred. 4. All hospitals shall use a Uniform Discharge/Transfer Slip for cases covered by RA 8344 which shall include the following information: 4.1 Admission Form of transferring hospital. 4.2 Transfer Form of Transferring Hospital, to include but not necessarily limited to the following information: 4.2.1 Vital signs 4.2.2 Name of Attending Physician 4.2.3 Treatment given to patient 4.2.4 Name of receiving hospital 4.2.5 Name of contact person and approving official at receiving hospital 4.2.6 Consent of the patient or companion. In case of an unaccompanied minor or patient, they may be transferred without consent provided that the provisions of Section 1 of RA 8344 is strictly observed. The hospital shall endeavor to use all forms of media to contact the next of kin of the unaccompanied minor or patient. 4.2.7 In case of refusal of transfer, the name of the hospital, the name(s) of persons who refused and the reason(s) for the refusal. A copy of the Uniform Discharge/Transfer Slip is hereto attached as Annex A*. 5. Penal Provisions - any official, medical practitioner or employee of the hospital or medical clinic who violates the provisions of RA 8344 shall, upon conviction by final judgment, be punished by imprisonment of not less than six (6) months and one (1) day but not more than two (2) years and four months, or a fine of not less than Twenty Thousand Pesos (P20,000.00) but not more than One Hundred Thousand Pesos (P100,000.00) or both at the discretion of the court: Provided, however, That if such violation was committed pursuant to an established policy of the hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic responsible for the formulation and imprisonment of four (4) to six (6) years, or a fine of not less than One Hundred Thousand Pesos (P100,000.00), but not more than Five Hundred Thousand Pesos (P500,000.00) or both, at the discretion of the court. 6. In order to demonstrate compliance with the Act's provisions, all hospitals and medical clinics are instructed to institute the following measures: 6.1 A copy of the law and this implementing rules and regulations should be displayed prominently at hospital emergency rooms, hospital admission, counters and medical clinic premises.

6.2 Hospital and clinic managers shall establish billing and collection procedure for treatment or confinement of emergency and serious cases which shall not commence until the essential appropriate treatment of such cases has been completed. 6.3 Hospital and clinic managers shall instruct their personnel to provide prompt and immediate medical attention to emergency and serious cases without any prior requirements for payment or deposit. 6.4 It is clarified that the law and this administrative order covers only the provision of medical and surgical goods and services, and do not cover the provision of nonmedical amenities which have nothing to do with the treatment of the emergency or serious case. The provisions of and payment for these non-medical amenities shall be subject to appropriate institutional business practice. 6.5 Alleged violations of the Act and this Order may be reported to the Bureau of Licensing and Regulations, Office for Standards and Regulations, Department of Health, Sta. Cruz, Manila, or to the nearest Regional Health Office which shall immediately conduct a fact-finding investigation. The findings shall be referred to the appropriate fiscal for criminal prosecution. Persons convicted of violation shall be punished in accordance with the Act. 6.6 At the instance of the Bureau of Licensing and Regulation, Administrative proceedings may also be pursued against erring clinics or hospitals that could lead to either suspension or revocation of appropriate licenses. These Rules and Regulations shall take effect fifteen (15) days after publication in the Official Gazette or in a newspaper of general circulation. Adopted: February 18, 1998 (SGD.) CARMENCITA NORIEGA-REODICA, MD Secretary of Health

REPUBLIC ACT NO. 6615 REPUBLIC ACT NO. 6615 - AN ACT REQUIRING GOVERNMENT AND PRIVATE HOSPITALS AND CLINICS TO EXTEND MEDICAL ASSISTANCE IN EMERGENCY CASES

Section 1. All government and private hospitals or clinic duly licensed to operate as such are hereby required to render immediate emergency medical assistance and to provide facilities and medicine within its capabilities to patients in emergency cases who are in danger of dying and/or who may have suffered serious physical injuries. Sec. 2. The expenses and losses of earnings incurred by a private hospital of clinic for medicines, facilities and services beyond first aid extended to emergency cases as required herein, and not to exceed fifty thousand pesos per year, shall be deductible expenses and losses for income tax purposes which may be carried over for a period of five years, any provision of law or regulation to the contrary notwithstanding. Sec. 3. Any hospital director, administrator, officer-in-charge or physician in the hospital, medical center or clinic, who shall refuse or fail without good cause to render the appropriate assistance pursuant to the requirements of section one after said case had been brought to his attention, or any nurse, midwife or medical attendant who shall refuse to extend the appropriate assistance, subject to existing rules, or neglect to notify or call a physician shall be punished by imprisonment of one month and one day to one year and one day, and a fine of three hundred pesos to one thousand pesos, without prejudice to the provisions of Republic Act Numbered Twenty-three hundred eighty-two in the case of physicians. In the case of Government hospitals, the imposition of the penalty upon the person or persons guilty of the violations shall be without prejudice to the administrative action that might be proper. In the case of private hospitals, aside from the imposition of penalty upon the person or persons guilty of the violations, the license of the hospital to operate shall, whenever justified, be suspended or revoked. Sec. 4. Subject to the approval of the Secretary of Health, the Bureau of Medical Services shall promulgate the necessary rules and regulations to carry out the provisions of this Act. Sec. 5. Any law or laws or parts thereof inconsistent with the provisions of this Act is hereby repealed. Sec.

6.

This

Act

shall

take

effect

upon

its

approval.

Approved: October 23, 1972

MANILA DOCTORSHOSPITAL, G.R. No. 150355 Petitioner, Present: - versus -

PANGANIBAN, C.J. , ( Chairperson) YNARES-SANTIAGO, AUSTRIA-MARTINEZ,

SO UN CHUA and VICKY TY, Respondents.

CALLEJO, SR. and CHICO-NAZARIO, JJ .

Promulgated: July 31, 2006 x----------------------------------------x

DECISION AUSTRIA-MARTINEZ, J .: Before this Court is a Petition for Review on Certiorari under Rule 45 questioning the Decision [ 1 ] datedOctober 2, 2001 promulgated by the Court of Appeals (CA) in CA-G.R. CV No. 61581, which affirmed the Decision dated September 30, 1997 of the Regional Trial Court (RTC), Branch 159, Pasig City, but which reduced the award of damages. This case originated from an action for damages filed with the RTC by respondents So Un Chua and Vicky Ty against petitioner Manila Doctors Hospital. [ 2 ] The complaint is premised on the alleged unwarranted actuations of the petitioner towards its patient, respondent So Un Chua (Chua), who was confined for hypertension, diabetes, and related illnesses. The antecedents of the case follow:

On December 13, 1993, respondents filed a Complaint averring that on October 30, 1990, respondent Chua, the mother of respondent Vicky Ty, was admitted in petitioners hospital for hypertension and diabetes; that while respondent Chua was confined, Judith Chua, the sister of respondent Ty, had been likewise confined for injuries suffered in a vehicular accident; that partial payments of the hospital bills were made, totaling P 435,800.00; that after the discharge of Judith Chua, respondent Chua remained in confinement and the hospital bills for both patients accumulated; that respondent Chua was pressured by the petitioner, through its Credit and Collection Department, to settle the unpaid bills; that respondent Ty represented that she will settle the bills as soon as the funds become available; that respondent Ty pleaded to the management that in view of the physical condition of her mother, respondent Chua, the correspondences relating to the settlement of the unpaid hospital bills should be relayed to the former; that these pleas were unheeded by the petitioner; that petitioner threatened to implement unpleasant measures unless respondent Ty undertakes her mothers obligation as well as the obligation of her sister, Judith Chua, to pay the hospitalization expenses; that petitioner made good its threat and employed unethical, unpleasant and unlawful methods which allegedly worsened the condition of respondent Chua, particularly, by (i) cutting off the telephone line in her room and removing the air-conditioning unit, television set, and refrigerator, (ii) refusing to render medical attendance and to change the hospital gown and bed sheets, and (iii) barring the private nurses or midwives from assisting the patient. Respondents thus prayed for the award of moral damages, exemplary damages, and attorneys fees. In its Answer, Amended Answer, and Rejoinder, petitioner specifically denied the material averments of the Complaint and Reply, and interposed its counterclaims arguing that as early as one week after respondent Chua had been admitted to its hospital, Dr. Rody Sy, her attending physician, had already given instructions for her to be discharged, but respondents insisted that Chua remain in confinement;

that, through its staff, petitioner accordingly administered medical examinations, all of which yielded negative results; that respondent Ty voluntarily undertook, jointly and severally, to pay the hospital bills for both patients; that although respondent Ty paid up to P 435,000.00, more or less, she reneged on her commitment to pay the balance in violation of the Contract for Admission and Acknowledgment of Responsibility for Payment dated October 30, 1990 which she voluntarily executed; that she signed a Promissory Note on June 5, 1992 for the unpaid balance of P 1,075,592.95 and issued postdated checks to cover the same; that no such undue pressure had been imposed upon respondent Chua to settle the bills, the truth being that, as a matter of standard procedure, the reminders to settle the bills were transmitted not to the patients but to their relatives who usually undertook to pay the same; that respondent Ty deliberately evaded the staff of the Credit and Collection Department; that the cutting-off of the telephone line and removal of the air-conditioning unit, television set, and refrigerator cannot constitute unwarranted actuations, for the same were resorted to as cost-cutting measures and to minimize respondents charges that were already piling up, especially after respondent Ty refused to settle the balance notwithstanding frequent demands; that respondent Ty evaded the staff when the latter attempted to inform her that the room facilities will be cut off to minimize the rising charges; and that respondents instituted the present civil case purposely as leverage against the petitioner after the latter had filed criminal charges for violation of Batas Pambansa (B.P.) Blg. 22 against respondent Ty for issuing checks, later dishonored, totaling P 1,075,592.95, the amount referring to the unpaid hospital bills. In its compulsory counterclaim, petitioner prayed, among other items, for the award of no less than P 1,000,000.00 as compensatory damages due to the filing of a malicious and unfounded suit, and, in its permissive counterclaim, petitioner prayed for respondents to pay P 1,075,592.95, the amount representing the due and demandable obligation under the Promissory Note dated June 5, 1992, including the stipulated interest therein and the 25 percent of the total amount due as attorneys fees.

During pre-trial, the parties stipulated on the following issues: First, whether the respondents are liable to the petitioner to pay the hospital bills arising from the hospitalization of respondent Chua and Judith Chua; and second, whether the parties are entitled to their respective claims for damages. [ 3 ] Furthermore, the parties stipulated on the following facts: a) Judith Chua was confined from June 14, 1991 to May 2, 1992; b) respondents failed to pay the balance despite repeated reminders; c) the said reminders referred to the hospital bills of respondent Chua and Judith Chua; d) one of the attending physicians of respondent Chua was Dr. Rody Sy; and e) the petitioner ordered the removal of the facilities in question from the room of its patient, respondent Chua, with the qualification that they were constrained to discontinue the same after the representative of respondent Chua refused to update the hospital bills or refused to transfer her to semi-deluxe room or ward to lessen costs. [ 4 ] On September 30, 1997, the RTC rendered its Decision in favor of the respondents, the dispositive portion of which states: WHEREFORE, premises considered, judgment on the complaint is hereby rendered in favor of the [respondents] as against the [petitioner] as follows: [O]rdering the [petitioner] to pay the [respondents] the following, to wit: a)

P 200,000.00 as moral damages;

b) P 100,000.00 as exemplary damages; and c)

P 50,000.00 as attorneys fees of P 50,000.00 as litigation costs.

and

the

amount

SO ORDERED. [ 5 ]

In brief, the RTC held that the removal of the facilities of the room triggered the hypertension of respondent Chua; that the petitioner acted in bad faith in removing the facilities without prior notice; that her condition was aggravated by the pressure employed by the

administration upon her to pay the hospital bills; that the food always came late as compared to the other patients; that the beddings and clothes of respondent Chua were no longer changed and, as a result, bed sores emerged on her body; that there was an utter lack of medical attendance; that, because of these, respondent Chua suffered from selfpity and depression; that petitioner clearly discriminated against the respondents; that respondent Ty had no choice but to sign the promissory notes in order to secure the release of her mother, respondent Chua; that the foregoing actuations constitute an abuse of rights; that petitioner failed to establish the pecuniary loss it suffered and, hence, it is not entitled to compensatory damages; and that, since the promissory note is a contract of adhesion, the petitioner is not entitled to the award of attorneys fees as stipulated thereon. On appeal to the CA, the petitioner assigned the following errors: A. THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERROR BY FINDING THE ACTUATIONS OF THE ADMINISTRATION OF DEFENDANT-APPELLANT TO BE IN BAD FAITH, OPPRESSIVE AND UNNECESSARY AS TO MAKE IT LIABLE TO PLAINTIFFS-APPELLEES FOR DAMAGES AND ATTORNEYS FEES. B. THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERROR BY NOT RULING UPON THE PERMISSIVE COUNTERCLAIM OF DEFENDANT-APPELLANT WITH RESPECT TO THE P 1,075,592.95 REPRESENTING THE HOSPITAL BILL OF PLAINTIFFS-APPELLEES, WHICH OBLIGATION IS NOT DISPUTED AND WHICH AMOUNT WAS NEVER CONTROVERTED BY PLAINTIFFS-APPELLEES. [ 6 ]

On October 2, 2001, the CA promulgated its Decision the dispositive portion of which reads: IN VIEW OF ALL THE FOREGOING, the appealed Decision is hereby AFFIRMED with the modification that the award of moral damages, exemplary damages as well as attorneys fees is reduced to

Seventy Five Thousand Pesos ( P 75,000.00), Thirty Thousand Pesos (P 30,000.00) and Twenty Thousand Pesos ( P 20,000.00), respectively. Litigation costs are hereby deleted. Costs against appellant. SO ORDERED. [ 7 ]

Apart from the reduction in the award of damages, the CA affirmed all salient portions of the RTC Decision and declined to disturb the findings of fact. Petitioner is now before this Court raising essentially the same grounds heard by the CA. Incidentally, with respect to the related criminal case against respondent Ty, this Court, on September 27, 2004, promulgated its Decision entitled Ty v. People of the Philippines, [ 8 ] which affirmed the decisions of the lower courts finding respondent Ty guilty of violating B.P. Blg. 22 and ordering her to pay the private complainant, herein petitioner, the total amount of the dishonored checks. The petition is impressed with merit. While, as a rule, only questions of law may be raised in a petition for review on certiorari under Rule 45, under certain exceptions, the Court may re-examine the evidence presented by the parties during the trial. At least four exceptions exist in this case, namely: (a) when the conclusion is a finding grounded entirely on speculation, surmises, or conjectures; (b) when the judgment is based on a misapprehension of facts; (c) when the findings of fact are premised on the supposed absence of evidence and contradicted by the evidence on record; and (d) when the courts a quo manifestly overlooked certain relevant facts not disputed by the parties and which, if properly considered, would justify a different conclusion. [ 9 ] The principal questions are, first, whether the actuations of the petitioner amount to actionable wrongs, and second, whether the

counterclaims of the petitioner can be backed up by the measure of preponderant evidence. In brief, the courts a quo concurred in the holding that the petitioner and its staff failed to take into consideration the physical condition of its patient, respondent Chua, when it removed the facilities provided in her room; [ 1 0 ] that the removal of these facilities, namely, the airconditioner, telephone lines, television, and refrigerator, aggravated the condition of the patient, triggered her hypertension, and caused her blood pressure to fluctuate, [ 11 ] considering that there was no proper ventilation in the room. [ 1 2 ] In view of the foregoing, the courts a quo concluded that the actuations of the petitioner were oppressive, unnecessary, [ 1 3 ] and anti-social, [ 1 4 ] done in bad faith without proper notice, [ 1 5 ] with no intention other than to harass or irritate the respondents, [ 1 6 ] all of which constitute an abuse of rights. [ 1 7 ] We do not agree. The conclusions of the courts a quo are either haphazard conjectures, or founded on a misapprehension of facts. The record is replete with evidence that justifies a different conclusion. Indeed the operation of private pay hospitals and medical clinics is impressed with public interest and imbued with a heavy social responsibility. But the hospital is also a business, and, as a business, it has a right to institute all measures of efficiency commensurate to the ends for which it is designed, especially to ensure its economic viability and survival. And in the legitimate pursuit of economic considerations, the extent to which the public may be served and cured is expanded, the pulse and life of the medical sector quickens, and the regeneration of the people as a whole becomes more visibly attainable. In the institution of cost-cutting measures, the hospital has a right to reduce the facilities and services that are deemed to be nonessential, such that their reduction or removal would not be detrimental to the medical condition of the patient. [ 1 8 ] For the moment, the question to be considered is whether the subject facilities are indeed non-essential the air-conditioner, telephone, television, and refrigerator the removal of which would cause the adverse health

effects and emotional trauma the respondents so claimed. Corollary to this question is whether the petitioner observed the diligence of a good father of the family [ 1 9 ] in the course of ascertaining the possible repercussions of the removal of the facilities prior to the removal itself and for a reasonable time thereafter, with a view to prevent damage. [ 2 0 ] After an extensive analysis of the record, it becomes rather worrisome to this Court that the courts a quounreservedly drew their conclusions from the self-serving and uncorroborated testimonies of the respondents the probative value of which is highly questionable. [21] We hold that the respondents failed to prove the damages so claimed. The evidence in the record firmly establishes that the staff of the petitioner took proactive steps to inform the relatives of respondent Chua of the removal of facilities prior thereto, and to carry out the necessary precautionary measures to ensure that her health and wellbeing would not be adversely affected: as early as around two weeks after her admission on October 30, 1990, to the time when the facilities had been removed sometime in the middle of May 1992, [22] and even up to the point when she actually left the premises of the hospital three weeks later, or during the first week of June 1992, [ 2 3 ] the medical condition of respondent Chua, as consistently and indisputably confirmed by her attending physician, Dr. Rody Sy, a cardiologist, who was called as witness for both parties, [ 2 4 ] whom even respondent Chua repeatedly praised to be my doctor and a very good doctor [ 2 5 ] at that, and whose statements at times had been corroborated as well by Sister Mary Philip Galeno, SPC, the Administrator of the hospital and who also happens to be a registered nurse, had been relatively well, [ 2 6 ] ambulatory, [ 2 7 ] walking around in the room, [ 2 8 ] and that she was able to leave the hospital on her own without any assistance; [ 2 9 ] that although she complained of symptoms such as dizziness, weakness, [ 3 0 ] and abdominal discomfort, [ 3 1 ] Dr. Sy requested several medical examinations, such as the laboratory tests, renal tests, MRI, ultrasound, and CT scan, [ 3 2 ] all of which were administered after

procuring the consent of respondent Chuas family [ 3 3 ] as admitted by respondent Ty herself, [ 3 4 ] and even called on other specialists, such as a neurologist, endocrinologist, and gastroenterologist, to look into her condition [ 3 5 ] and conduct other tests as well [ 3 6 ] according to their fields of specialty, all of which yielded no serious finding; [ 3 7 ] that her illnesses were lifelong illnesses [ 3 8 ] at a stage where they cannot be totally removed or abolished, [ 3 9 ] making it clear to her family that one hundred percent recovery is not possible despite being given daily medication in the hospital; [ 4 0 ] but that her condition, nonetheless, is not serious, [ 4 1 ] as the blood pressure is more or less controlled and within acceptable limits, [ 4 2 ] not that critical to precipitate any acute attack, [ 4 3 ] nor likely to fall into any emergency, [ 4 4 ] nor yet does she require continuous or prolonged hospitalization [ 4 5 ] since she was stable enough to be treated at home and on an out-patient basis, so much so that Dr. Sy encouraged her toexercise and avoid resting all the time, [ 4 6 ] and recommended that anytime she may be discharged [ 4 7 ] even in just two weeks after confinement, [ 4 8 ] the propriety of his order of discharge concurred upon by the other specialists as well, [ 4 9 ] had it not been for respondents insistence to stay in the hospital in view of their hope for absolute recovery [ 5 0 ] despite the admission of respondent Chua herself that she cannot anymore be totally cured. [ 5 1 ] It is also undisputed that the hospital administrator, Sister Galeno, prior to the removal of the facilities, consulted the attending physician, Dr. Sy. [ 5 2 ] To Sister Galeno, also a registered nurse, the matter of removal and its possible repercussions on the health of the patient, as a matter of hospital policy, is a critical and sensitive maneuver, and, hence, it is carried out only after discussing with the doctors to evaluate all important factors. [ 5 3 ] The fact of prior consultation [ 5 4 ] as well as the medical determination to the effect that it was safe to remove the facilities and would cause no harmful effect [ 5 5 ] had been amply corroborated by respondent Chuas own doctor himself. [ 5 6 ] When Dr. Sy testified as rebuttal witness for the respondents themselves and whose credibility respondents failed to impeach, he categorically stated that he consented to the removal since the removal of the said facilities would not by itself be detrimental to

the health of his patient, respondent Chua. [ 5 7 ] And in this respect, he had been advising respondent Ty, the daughter of the patient, that the facilities, such as the air-conditioner, television, refrigerator, and telephone, are not absolutely necessary, and, that although they may add to the comfort of the patient, if absent, they will not cause any significant deterioration of her condition, [ 5 8 ] given that, in his experience as a cardiologist, and after personally attending respondent Chua on a daily basis before, during, and after the removal and even up to the time of her actual discharge, [ 5 9 ] he concluded that many hypertensive and diabetic patients, as in her case, do not at all need in particular an air-conditioning unit, among the other facilities aforementioned. [ 6 0 ] And, contrary to the findings of the courts a quo and the self-serving testimonies of respondents that the lack of ventilation, after the removal of the air-conditioner, triggered her hypertension, Dr. Sy categorically stated that during his daily rounds with the patient he was certain that, although admittedly the blood pressure in general would fluctuate daily, there had been no adverse effect on her, and that her blood pressure were within acceptable limits, [ 6 1 ] especially considering that he treated the patient on a daily basis up to the point of actual discharge, [ 6 2 ] and accordingly, as confirmed by the medical records, he made no change in the medications thereafter. [ 6 3 ] In support of Dr. Sys findings, Sister Galeno, testified that she knew the condition of the ventilation of the patients deluxe room, located at the fifth floor, even without the airconditioning, notably in times of brownout, and that there had been enough ventilation since the grilled window of that room was large enough which, if opened, would permit sufficient ventilation. [ 6 4 ] The Court finds that the premise of the RTC judgment refers merely to hypothetical statements which fail to establish any clear and direct link to the injury allegedly suffered by the patient: Q You found it safe to remove these facilities from the room of the patient suffering from diabetes and hypertension? A Yes, Sir. Many hypertensive, diabetic patients do not need airconditioning, or T.V. or refrigerator.

Q Do you agree with me that hypertension is triggered sometimes by excitement, anger or (sic) a person suffering from such illness? A Hypertension can be triggered by anything. Court: Q And even in other words the discomfort can also trigger? A Sometimes mental stress can trigger. x x x x Court: Q You mentioned earlier that this hypertension may be triggered mentally? A Yes, Your Honor. Court: Q Will the removal of these facilities not affect the patient including the relatives? A It may to a certain extent. And well, maybe the days after the removal would prove that fluctuation in blood pressure are within acceptable limits. [ 6 5 ]

With respect to the findings of the courts a quo that bed sores appeared on the body of respondent Chua, that she suffered from depression after the disconnection of the said facilities, that her private midwives were barred, and that the delivery of food was delayed, this Court holds, as above, that these conclusions are bereft of sound evidentiary basis, self-serving and uncorroborated as they are. Again, Dr. Sy affirmed that during the daily rounds he would make on the patient, he did not detect any skin lesion or any other abnormality up to the time she was actually discharged. [ 6 6 ] Nor did he find any sign of depression, although, admittedly, he observed that she had been very angry because of the removal of the facilities. [ 6 7 ] All the while he did not receive any complaint from respondent Chua

indicating that she suffered from the foregoing infirmities, [68] considering that it is the responsibility of the family of the patient to specifically inform the attending physician or the nurses during their rounds whatever they feel is important, or if there were any new developments since the last visit. [ 6 9 ] As corroborated by Sister Galeno, throughout respondent Chuas confinement, she never received any complaint from the latter or her relatives that she had not been attended to by the nursing staff. [ 7 0 ] Worth noting again is the fact that the nursing staff and the attending physicians, which included Dr. Sy, in accordance with hospital policy, would routinely make their rounds on a daily basis, or would visit the patient whenever they are called for any problem, [ 7 1 ] and, in the case of the specialists other than the attending physician, they would visit the patient about once a week. [72] The nurses, on the other hand, would make their rounds more frequently, that is, at least once per shift, or every eight hours. [73] Apart from the self-serving statements of respondents, which by now have become rather indicative of being mere afterthoughts, there is no clear showing from the record that the petitioner and its medical staff deviated from the foregoing policy and practice, nor had they been called upon to look into the alleged physical reactions or emotional trauma respondent Chua claims to have suffered during and after the removal of the facilities. It must be emphasized that, as stated above, respondent Chua herself explicitly found Dr. Sy to be a very good doctor because he personally attended to her almost every hour. [ 7 4 ] And throughout her confinement, Dr. Sy positively stated that her family employed a private midwife who attended to her all the time. [ 7 5 ] The evidence in the record overwhelmingly demonstrates that respondent Chua had been adequately attended to, and this Court cannot understand why the courts a quo had declared that there was an utter lack of medical attendance, or that her health suffered during the period after the removal of the facilities. The Court finds that the facilities in question are non-essential for the care of respondent Chua and, hence, they may be lessened or removed by the petitioner for the sake of economic necessity and survival.

Though human experience would show that the deactivation of the air-conditioner may cause a temperature differential that may trigger some physical discomfort, or that the removal of entertainment facilities such as the television set, or the disconnection of communication devices such as the telephone, may cause some exasperation on the part of the one who benefits from these, nevertheless, all things considered, and given the degree of diligence the petitioner duly exerted, not every suppression of the things that one has grown accustomed to enjoy amounts to an actionable wrong, nor does every physical or emotional discomfort amount to the kind of anguish that warrants the award of moral damages under the general principles of tort. The underlying basis for the award of tort damages is the premise that an individual was injured in contemplation of law. Thus, there must first be the breach of some duty and the imposition of liability for that breach before damages may be awarded; it is not sufficient to state that there should be tort liability merely because the plaintiff suffered some pain and suffering. [ 7 6 ] Moreover, this Court must reiterate the standard of tort to arrive at a proper award for damages premised on matters that suggest the application of medical knowledge, especially in the description of the causal link between external or environmental factors, on one hand, and their effect unto the physical or emotional health of the patient, on the other, expert opinion, as discussed in Cruz v. Court of Appeals, [77] is generally required: All three courts below bewail the inadequacy of the facilities of the clinic and its untidiness; the lack of provisions such as blood, oxygen, and certain medicines; the failure to subject the patient to a cardio-pulmonary test prior to the operation; the omission of any form of blood typing before transfusion; and even the subsequent transfer of Lydia to the San Pablo Hospital and the reoperation performed on her by the petitioner. But while it may be true that the circumstances pointed out by the courts below seemed beyond cavil to constitute reckless imprudence on the part of the surgeon, this conclusion is still best arrived at not through the educated surmises nor conjectures of laymen, including judges, but by the unquestionable knowledge of expert witnesses. For whether a physician or surgeon has exercised the requisite degree of skill and

care in the treatment of his patient is, in the generality of cases, a matter of expert opinion. The deference of courts to the expert opinions of qualified physicians stems from its realization that the latter possess unusual technical skills which laymen in most instances are incapable of intelligently evaluating. Expert testimony should have been offered to prove that the circumstances cited by the courts below are constitutive of conduct falling below the standard of care employed by other physicians in good standing when performing the same operation. It must be remembered that when the qualifications of a physician are admitted, as in the instant case, there is an inevitable presumption that in proper cases he takes the necessary precaution and employs the best of his knowledge and skill in attending to his clients, unless the contrary is sufficiently established. This presumption is rebuttable by expert opinion which is so sadly lacking in the case at bench. [ 7 8 ]

With respect to the propriety of the notice of removal of facilities, the evidence shows that the hospital staff, accompanied by Sister Gladys Lim, SPC, Finance Administrative Assistant of the hospital, [ 7 9 ] through written and verbal notices as per hospital policy, forewarned the respondents, through respondent Ty and her sister, Judith Chua, of the impending removal of the facilities over a week beforehand [ 8 0 ] in view of their obstinate refusal to vacate and transfer to a lower rate room [ 8 1 ] or to update the mounting hospital bills [ 8 2 ] which, by then, had swollen to approximately one million pesos. [ 8 3 ] Respondent Ty refused to read many of the written notices sent by the Credit Department. [ 8 4 ] After repeated attempts to contact respondent Ty [ 8 5 ] and before the actual removal of the facilities, the staff of the petitioner tried to personally serve the final notice dated April 23, 1992, [86] signed by Sister Gladys Lim, addressed to respondent Ty, which adopted the tenor of the prior verbal warnings, and which expressly and sternly warned the respondents that the hospital shall be constrained to take legal action and that they shall be compelled to transfer the patient, respondent Chua, to a lower rate room unless the balance could be satisfied. [ 8 7 ] Respondent Ty, for no justifiable reason, and sticking to her inclination to avoid the staff, refused to receive or acknowledge this letter as well. [ 8 8 ] Worth noting is that Sister Galeno,

testified that, as a matter of hospital policy the tenor of which respondents, by virtue of the Contract for Admission dated October 30, 1990, agreed to comply with, [ 8 9 ] the hospital can only cut off the nonessential facilities and only in extreme cases [ 9 0 ] if the patient occupies a private room all to herself; had the room been semi-private shared by other patients, or had it been the ward, the hospital cannot disconnect the facilities since this would unduly prejudice the other patients. But respondent Chua herself insisted on staying in a private room despite her being fully aware of the ballooning charges, [ 9 1 ] and even if she could have freely gone home anytime to her condominium unit which, as admitted, was equipped with an air-conditioner. [ 9 2 ] With respect to the pressure and harassment respondents allegedly suffered daily whenever the hospital staff would follow up the billing during odd hours, or at 10pm, 11pm, 12 midnight, 1am, or 2am, [ 9 3 ] this averment had been convincingly refuted by the witnesses for the petitioner, namely, Editha L. Vecino, the Head of Credit and Collection, and Sister Galeno, in that the Credit and Collection Department would only hold office hours from 8am to 5pm and, hence, it is impossible to harass the respondents during the times they so claimed. [ 9 4 ] The courts a quo found that respondent Ty had no choice but to sign the promissory note in order for her mother to be released from the hospital, [ 9 5 ] thus suggesting that the hospital refused to actually discharge or bodily release its patient, respondent Chua, until arrangements had been made to settle the charges. While there are portions of the testimonies of the witnesses for the petitioner which state that although, as per standard procedure, the patient cannot leave [ 9 6 ] the hospital without the discharge, [ 9 7 ] clearance or gatepass issued only after arrangements on the settlement of bills had been made, [ 9 8 ] still, it must be understood that these are only demonstrative of the precondition that a patient cannot step out of the premises without the consent of the hospital, or, in other words, that the clearance merely indicates that the hospital expressly consented to the actual release of the patient, [ 9 9 ] but, even without its consent, the patient is still free to leave anytime as a matter of policy, in spite of the refusal to issue a clearance or gate pass, [ 1 0 0 ] or even in cases where the accounts have

not yet been liquidated or settled, [ 1 0 1 ] or yet even if no promissory note or post-dated check were executed in favor of the petitioner, as testified by no less than Sister Galeno, [ 1 0 2 ] and corroborated by Editha Vecino; [ 1 0 3 ] and that, petitioner, a private hospital established for profit, [104] being also a business, by warning respondents that it shall withhold clearance, is simply exercising its right to protest against an absconding patient as a precursor to avail of other appropriate legal remedies; that, on the contrary, the respondents opted not to leave because of their own promise not to leave unless the hospital bills were fully settled; [ 1 0 5 ] that the accusations found in the Demand Letter dated May 19, 1992, and signed by the counsel for the respondents, [106] particularly, that the petitioner refused to discharge the patient, [respondent Chua,] despite orders from the attending physician, Dr. Rody Sy, had all been refuted by Sister Galeno when she read its contents in front of the counsel for respondents, emphatically telling him that we are not detaining his clients; that [respondent Ty] was the one who told us that they are not going to leave the hospital unless they have fully paid the hospital; [ 1 0 7 ] and that, most importantly, no physical restraint upon the person of respondent Chua or upon the person of her relatives had been imposed by the staff. Authorities, including those of common law origin, explicitly declare that a patient cannot be detained in a hospital for non-payment of the hospital bill. If the patient cannot pay the hospital or physicians bill, the law provides a remedy for them to pursue, that is, by filing the necessary suit in court for the recovery of such fee or bill. [ 1 0 8 ] If the patient is prevented from leaving the hospital for his inability to pay the bill, any person who can act on his behalf can apply in court for the issuance of the writ of habeas corpus. [ 1 0 9 ] The form of restraint must be total; movement must be restrained in all directions. If restraint is partial,e.g., in a particular direction with freedom to proceed in another, the restraint on the persons liberty is not total. [ 1 10 ] However, the hospital may legally detain a patient against his will when he is a detained or convicted prisoner, or when the patient is suffering from a very contagious disease where his

release will be prejudicial to public health, or when the patient is mentally ill such that his release will endanger public safety, [ 111 ] or in other exigent cases as may be provided by law. Moreover, under the common law doctrines on tort, it does not constitute a trespass to the person to momentarily prevent him from leaving the premises or any part thereof because he refuses to comply with some reasonable condition subject to which he entered them. In all cases, the condition of this kind of restraint must be reasonable in the light of the circumstances. [ 11 2 ] At any rate, as stated above, the patient is free to leave the premises, even in the ostensible violation of these conditions, after being momentarily interrupted by the hospital staff for purposes of informing him of those reasonable conditions, such as the assessment of whether the patient is fit to leave, insane, or suffering from a contagious disease, etc., or simply for purposes of making a demand to settle the bill. If the patient chooses to abscond or leave without the consent of the hospital in violation of any of the conditions deemed to be reasonable under the circumstances, the hospital may nonetheless register its protest and may choose to pursue the legal remedies available under law, provided that the hospital may not physically detain the patient, unless the case falls under the exceptions abovestated. Authorities are of the view that, ordinarily, a hospital, especially if it is a private pay hospital, [ 1 13 ] is entitled to be compensated for its services, by either an express or an implied contract, and if no express contract exists, there is generally an implied agreement that the patient will pay the reasonable value of the services rendered; [ 11 4 ] when a hospital treats a patients injuries, it has an enforceable claim for full payment for its services, regardless of the patients financial status. [ 11 5 ] At this juncture, it must be noted that there is testimony, though to a degree disputable, to the effect that the execution of the promissory note and the issuance of postdated checks were conditions imposed not by the petitioner but voluntarily offered by the counsel for respondents. [ 11 6 ] At any rate, however, this Court holds, in view of the foregoing authorities, that the requirement to have the relative of respondent Chua to execute a promissory note as part of the

arrangement to settle the unpaid obligations is a formality that converts any implied contract into written form and, moreover, amounts to a reasonable condition, the non-fulfillment of which, in itself, however, as discussed, cannot allow the hospital to detain the patient. It must also be stressed, contrary to the findings of the courts a quo, that such an agreement embodied in a promissory note, as well as the Contract for Admission and Acknowledgment of Responsibility for Payment dated October 30, 1990, do not become contracts of adhesion simply because the person signing it was under stress that was not the result of the actions of the hospital, [ 11 7 ] especially taking into account that there is testimony to the effect that respondent Ty signed the Promissory Note dated June 5, 1992 in the presence of counsel and acting under his advise. [ 1 18 ] But as to the propriety of the circumstances surrounding the issuance of the postdated checks to cover the amount stated in the Promissory Note dated June 5, 1992, this Court must refer to the discussion of the recent case of Ty v. People of the Philippines [ 11 9 ] where this Court affirmed the conviction of respondent Ty for the issuance of bouncing checks addressed to the petitioner herein. While the instant case is to be distinguished from the Ty case in nature, applicable law, the standards of evidence, and in the defenses available to the parties, hence, the judgment of conviction in that case should not at all prejudice the disposition of this case, even if the facts coincide, nonetheless, for purposes of convenience and instructive utility, the Court quotes the relevant portions: In this case, far from it, the fear, if any, harbored by Ty was not real and imminent. Ty claims that she was compelled to issue the checks a condition the hospital allegedly demanded of her before her mother could be discharged for fear that her mothers health might deteriorate further due to the inhumane treatment of the hospital or worse, her mother might commit suicide. This is speculative fear; it is not the uncontrollable fear contemplated by law. To begin with, there was no showing that the mothers illness was so life-threatening such that her continued stay in the hospital suffering all its alleged unethical treatment would induce a well-

grounded apprehension of her death.Secondly, it is not the laws intent to say that any fear exempts one from criminal liability much less petitioners flimsy fear that her mother might commit suicide. In other words, the fear she invokes was not impending or insuperable as to deprive her of all volition and to make her a mere instrument without will, moved exclusively by the hospitals threats or demands. Ty has also failed to convince the Court that she was left with no choice but to commit a crime. She did not take advantage of the many opportunities available to her to avoid committing one. By her very own words, she admitted that the collateral or security the hospital required prior to the discharge of her mother may be in the form of postdated checks or jewelry. And if indeed she was coerced to open an account with the bank and issue the checks, she had all the opportunity to leave the scene to avoid involvement. Moreover, petitioner had sufficient knowledge that the issuance of checks without funds may result in a violation of B.P. 22. She even testified that her counsel advised her not to open a current account nor issue postdated checks because the moment I will not have funds it will be a big problem. Besides, apart from petitioners bare assertion, the record is bereft of any evidence to corroborate and bolster her claim that she was compelled or coerced to cooperate with and give in to the hospitals demands. Ty likewise suggests . . . that the justifying circumstance of state of necessity under par. 4, Art. 11 of the Revised Penal Code may find application in this case. We do not agree. The law prescribes the presence of three requisites to exempt the actor from liability under this paragraph: (1) that the evil sought to be avoided actually exists; (2) that the injury feared be greater than the one done to avoid it; (3) that there be no other practical and less harmful means of preventing it. In the instant case, the evil sought to be avoided is merely expected or anticipated. If the evil sought to be avoided is merely expected or anticipated or may happen in the future, this defense is not applicable. Ty could have taken advantage of an available option to avoid committing a crime. By her own admission, she had the choice to give jewelry or other forms of security instead of postdated checks to secure her obligation.

Moreover, for the defense of state of necessity to be availing, the greater injury feared should not have been brought about by the negligence or imprudence, more so, the willful inaction of the actor. In this case, the issuance of the bounced checks was brought about by Tys own failure to pay her mothers hospital bills. The Court also thinks it rather odd that Ty has chosen the exempting circumstance of uncontrollable fear and the justifying circumstance of state of necessity to absolve her of liability. It would not have been half as bizarre had Ty been able to prove that the issuance of the bounced checks was done without her full volition. Under the circumstances, however, it is quite clear that neither uncontrollable fear nor avoidance of a greater evil or injury prompted the issuance of the bounced checks. Parenthetically, the findings of fact in the Decision of the trial court in the Civil Case for damages filed by Tys mother against the hospital is wholly irrelevant for purposes of disposing the case at bench. While the findings therein may establish a claim for damages which, we may add, need only be supported by a preponderance of evidence, it does not necessarily engender reasonable doubt as to free Ty from liability. [ 1 2 0 ]

In view of the foregoing, the Court therefore holds that the courts a quo committed serious errors in finding that the petitioner was biased, [ 1 2 1 ] discriminated against the respondents, [ 1 2 2 ] and purposely intended to irritate [ 1 2 3 ] or harass [ 1 2 4 ] them; that it acted in bad faith in removing the facilities without prior notice; [ 1 2 5 ] and that its acts were anti-social. [ 1 2 6 ] The aforequoted declarations of the witnesses, significant portions of which this Court considers as expert testimony, are reliable and remain considerably trustworthy to controvert respondents assertions as well as to reverse the conclusions of fact and law of the CA and the RTC that respondent Chua suffered the physical and emotional anguish so claimed, and so, for these reasons, the Court holds that the petitioner inflicted no actionable wrong. This Court observes that the courts a quo awarded both respondents moral damages. But it is well-settled that in case of physical injuries, with some exceptions, [ 1 2 7 ] moral damages are recoverable only by the

party injured and not by her spouse, next of kin, or relative who happened to sympathize with the injured party. [ 1 2 8 ] Hence, even if the courts a quo were correct in their basis for damages, they should have declined to award damages to respondent Ty. The last issue to be resolved is the question whether the counterclaims of the petitioner are supported by a preponderance of evidence. We agree with the petitioner that the courts a quo seriously erred in mistaking the case of its compulsory counterclaim for its permissive counterclaim and for failing to consider the evidence which impressively supports the latter. First, for failure without justifiable cause of respondents counsel to comment on the Partial Formal Offer of Evidence dated February 14, 1996 [ 1 2 9 ] filed by the petitioner, the RTC issued an order during the course of the trial, which counsel for respondents neither contested nor raised on appeal, admitting Exhibits 1 to 16, together with their submarkings and the purposes for which the same were offered, [ 1 3 0 ] all of which had also been previously authenticated and their contents verified by the witnesses for the petitioner. [ 1 3 1 ] These documents include the Contract for Admission of respondent Chua dated October 30, 1990, duly executed by respondent Ty, incorporating therein the rules and regulations of the hospital, including the duty to understand the same [ 1 3 2 ] as well as the undertaking of respondent Ty to be jointly and severally liable for the payment of the hospital bills of respondent Chua; [ 1 3 3 ] the Promissory Note dated June 5, 1992 in the amount of P 1,075,592.95 duly executed by respondent Ty in favor of the petitioner agreeing to be jointly and severally liable to pay the unpaid obligations of respondent Chua and Judith Chua, including interest and attorneys fees in case of default; [134] the Undertakings signed by respondent Ty dated March 3, 1992 and April 7, 1992 to maintain regular deposits; [ 1 3 5 ] and the credit memos and statements of account that support the amount referring to the unpaid obligation. [ 1 3 6 ] Second, the parties stipulated during pretrial that respondents failed to pay the balance despite repeated reminders. [ 1 3 7 ] And third, respondent Ty in open court identified and admitted that she signed the Contract of Admission dated October 30,

1990 as well as the Undertakings dated March 3, 1992 and April 7, 1992 but which, for no justifiable reason, she did not bother to read, [138] and, what is more, she repeatedly admitted during the course of the trial that she failed to fully settle the foregoing hospital bills. [139] In fact, while the Ty case cannot control the incidents of the instant case as heretofore stated, it is still worth mentioning, at least for informative purposes, the findings of this Court in Ty with respect to respondents obligations to the petitioner: Tys mother and sister availed of the services and the facilities of the hospital. For the care given to her kin, Ty had a legitimate obligation to pay the hospital by virtue of her relationship with them and by force of her signature on her mothers Contract of Admission acknowledging responsibility for payment, and on the promissory note she executed in favor of the hospital. [ 1 4 0 ]

In view of all these findings, the Court earnestly disagrees with the sweeping conclusion of the CA that [Petitioner] failed to present any iota of evidence to prove his claim, [ 1 4 1 ] a statement apparently referring to the permissive counterclaim of P 1,075,592.95. However, with respect to the compulsory counterclaim predicated on the filing of a baseless suit and injury to its reputation, petitioner did not raise this matter on appeal and, hence, is deemed to have waived the same. But the Court in Ty made a partial finding on the civil liability of respondent Ty with respect to the amount covered by seven of the several dishonored checks she issued equivalent to P 210,000.00. [ 1 4 2 ] Since this amount forms a fraction of her total civil liability, then this amount, in deference to Ty, should be deducted therefrom. The claim for attorneys fees, as stipulated under the Promissory Note dated June 5, 1992, should be reduced for being unreasonable under the circumstances, from 25 percent to 12 percent of the total amount due. [ 1 4 3 ] As a final word, the Court takes judicial notice of the pending Senate Bill No. 337, entitled An Act Prohibiting the Detention of Patients in Hospitals and Medical Clinics on Grounds of Non-Payment of Hospital

Bills or Medical Expenses, which declares, among others, that it shall be unlawful for any hospital or medical clinic to cause directly or indirectly the detention of patients for non-payment, in part or in full, of their hospital bills, [ 1 4 4 ] and, furthermore, requires patients who have fully recovered and are financially incapable to settle the hospitalization expenses to execute a promissory note, co-signed by another individual, to the extent of the unpaid obligation before leaving the hospital. [ 1 4 5 ] While this Court may have touched upon these matters in the adjudication of the instant case, it must be stated that this decision should in no way preempt any constitutional challenge to the provisions of Senate Bill No. 337 if passed into law, bearing in mind the standards for the exercise of the power of judicial review [ 1 4 6 ] as well as the recognition that the tenor of the bill may adjust with the times, or that the bill itself may fail to pass, according to the dynamism of the legislative process, especially in light of the objections interposed by interest groups to date. [ 1 4 7 ] WHEREFORE, the petition is GRANTED. The Decision of the Court of Appeals dated October 2, 2001, together with the Decision dated September 30, 1997 of the Regional Trial Court in Civil Case No. 63958, isREVERSED and SET ASIDE. Another judgment is entered dismissing the Complaint and ordering respondents, jointly and severally, to pay the petitioner the amount of P 865,592.95, with stipulated interest of 12 percent reckoned from the date of extrajudicial demand until full payment, and 12 percent of the total amount due as attorneys fees.

No pronouncement as to costs. SO ORDERED.

MA. ALICIA AUSTRIA-MARTINEZ Associate Justice

WE CONCUR:

ARTEMIO V. PANGANIBAN Chief Justice Chairperson CONSUELO YNARES-SANTIAGO ROMEO J. CALLEJO, SR. Associate Justice Associate Justice MINITA V. CHICO-NAZARIO Associate Justice

CERTIFICATION Pursuant to Section 13, Article VIII of the Constitution, it is hereby certified that the conclusions in the above Decision were reached in consultation before the case was assigned to the writer of the opinion of the Courts Division. ARTEMIO V. PANGANIBAN Chief Justice

RA 2382 THE MEDICAL ACT OF 1959 ARTICLE I Objectives and Implementation Section 1. Objectives. This Act provides for and shall govern (a) the standardization and regulation of medical education; (b) the examination for registration of physicians; and (c) the supervision, control and regulation of the practice of medicine in the Philippines. Section 2. Enforcement. For the purpose of implementing the provisions of this Act, there are created the following agencies: the Board of Medical Education under the Department of Education, and the Board of Medical Examiners under the Commissioner of Civil Service. ARTICLE II The Board of Medical Education Its Functions Section 3. Composition of Board of Medical Education. The Board of Medical Education shall be composed of the Secretary of Education or his duly authorized representative, as chairman, and the Secretary of Health or his duly authorized representative, the Director of the Bureau of Private Schools or his duly authorized representative, the chairman of the Board of Medical Examiners or his duly authorized representative, a representative of private practitioners, upon recommendation of an acknowledged medical association and a representative chosen by the Philippine Association of Colleges and Universities, as members. The officials acting as chairman and members of the Board of Medical Education shall hold office during their incumbency in their respective positions. Section 4. Compensation and traveling expenses. The chairman and members of the Board of Medical Education shall not be entitled to any compensation except for traveling expenses in connection with their official duties as herein provided. For administrative purposes, the Board shall hold office in the office of its chairman, who may designate a ranking official in the Department of Education to serve as secretary of the Board. Section 5. Functions. The functions of the Board of Medical Education shall be: (a) To determine and prescribe minimum requirements for admission into a recognized college of medicine; (b) To determine and prescribe requirements for minimum physical facilities of colleges of medicine, to wit: buildings, including hospitals, equipment and supplies, apparatus, instruments, appliances, laboratories, bed capacity for instruction purposes, operating and delivery rooms, facilities for out-patient services, and others, used for didactic and practical instructions in accordance with modern trends; (c) To determine and prescribe the minimum number and the minimum qualifications of teaching personnel, including student-teacher ratio and curriculum;

(d) To determine and prescribe the number of students who should be allowed to take up the preparatory course taking into account the capacity of the different recognized colleges of medicine. (e) To select, determine and approve hospitals or some departments of the hospitals for training which comply with the minimum specific physical facilities as provided in subparagraph (b) hereof: and (f) To promulgate and prescribe and enforce necessary rules and regulations for the proper implementation of the foregoing functions. Section 6. Minimum required courses. Students seeking admission to the medical course must have a bachelor of science or bachelor of arts degree or their equivalent and must have taken in four years the following subjects with their corresponding number of units: Unit English

12

Latin

3

Mathematics, including Accounting and Statistics

9

Philosophy, including Psychology and Logic

12

Zoology and Botany

15

Physics

8

Chemistry

21

Library Science

1

Humanities and Social Sciences

12

Twelve units of Spanish shall be required pursuant to Republic Act Numbered Seven hundred nine; but commencing with the academic year nineteen hundred sixty to nineteen hundred sixty-one, twenty-four units of Spanish shall be required pursuant to Republic Act Numbered Eighteen hundred and eighty-one as cultural, social and nationalistic studies. Provided, That the following students may be permitted to complete the aforesaid preparatory medical course in shorter periods as follows: (a) Students whose general average is below eighty-five per cent but without any grade of failure or condition may be allowed to pursue and finish the course in three academic years and the intervening summer sessions; and (b) Students whose general average is eighty-five per cent or over may be permitted to finish the course in three academic years by allowing them to take each semester the overload permitted to bright students under existing regulations of the Bureau of Private Schools.

Provided, That upon failure to maintain the general average of eighty-five per cent, students under (b) shall automatically revert to the category of students under (a) and those under (a), upon having any grade of failure or condition, shall automatically revert to the category of students required to pursue the preparatory course in four years mentioned above. The medical course shall be at least five years, including not less than eleven rotating internship in an approved hospital, and shall consist of the following subjects: Anatomy Physiology Biochemistry and Nutrition Pharmacology Microbiology Parasitology Medicine and Therapeutics Genycology Opthalmology, Otology, Rhinology and Laryngology Pediatrics Obstetrics Surgery Preventive Medicine and Public Health Legal Medicine, including Medical Jurisprudence and Ethics. Section 7. Admission requirements. The medical college may admit any student to its first year class who has not been convicted by any court of competent jurisdiction of any offense involving moral turpitude, and who presents (a) a certificate showing completion of a standard high school course, (b) a record showing completion of a standard preparatory medical course as herein provided, (c) a certificate of registration as medical student, (d) a certificate of good moral character issued by two former professors in the pre-medicine course, and (e) birth certificate and marriage certificate, if any. Nothing in this Act shall be construed to inhibit any college of medicine from establishing, in addition to the preceding, other entrance requirements that may be deemed admissible. For the purposes of this Act, the term "College of Medicine" shall mean to include faculty of medicine, institute of medicine, school of medicine or other similar institution offering a complete medical course leading to the degree of Doctor of Medicine or its equivalent.

Every college of medicine must keep a complete record of enrollment, grades and turnover, and must publish each year a catalogue giving the following information: 1. Date of publication 2. Calendar for the academic year 3. Faculty roll indicating whether on full time part time basis 4. Requirements of admission 5. Grading system 6. Requirements for promotion 7. Requirements for graduation 8. Medical hours per academic year by departments 9. Schedule hours per academic year by departments 10. Number of students enrolled in each class. ARTICLE III THE BOARD OF MEDICAL EXAMINERS; REGISTRATION OF PHYSICIANS Section 8. Prerequisite to the practice of medicine. No person shall engage in the practice of medicine in the Philippines unless he is at least twenty-one years of age, has satisfactorily passed the corresponding Board Examination, and is a holder of a valid Certificate of Registration duly issued to him by the Board of Medical Examiners. Section 9. Candidates for board examination. Candidates for Board examinations shall have the following qualifications: (1) He shall be a citizen of the Philippines or a citizen of any foreign country who has submitted competent and conclusive documentary evidence, confirmed by the Department of Foreign Affairs, showing that his country's existing laws permit citizens of the Philippines to practice medicine under the same rules and regulations governing citizens thereof; (2) He shall be of good moral character, showing for this purpose certificate of civil status; (3) He shall be of sound mind; (4) He shall not have been convicted by a court of competent jurisdiction of any offense involving moral turpitude; and (5) He shall be a holder of the degree of Doctor of Medicine or its equivalent, conferred by a college of medicine duly recognized by the Department of Education.

Section 10. Acts constituting practice of medicine. A person shall be considered as engaged in the practice of medicine (a) who shall, for compensation, fee, salary or reward in any form, paid to him directly or through another, or even without the same, physical examine any person, and diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental or physical condition or any ailment, real or imaginary, regardless of the nature of the remedy or treatment administered, prescribed or recommended; or (b) who shall, by means of signs, cards, advertisements, written or printed matter, or through the radio, television or any other means of communication, either offer or undertake by any means or method to diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental or physical condition; or (c) who shall use the title M.D. after his name. Section 11. Exemptions. The preceding section shall not be construed to affect (a) any medical student duly enrolled in an approved medical college or school under training, serving without any professional fee in any government or private hospital, provided that he renders such service under the direct supervision and control of a registered physician; (b) any legally registered dentist engaged exclusively in the practice of dentistry; (c) any duly registered masseur or physiotherapist, provided that he applies massage or other physical means upon written order or prescription of a duly registered physician, or provided that such application of massage or physical means shall be limited to physical or muscular development; (d) any duly registered optometrist who mechanically fits or sells lenses, artificial eyes, limbs or other similar appliances or who is engaged in the mechanical examination of eyes for the purpose of constructing or adjusting eye glasses, spectacles and lenses; (e) any person who renders any service gratuitously in cases of emergency, or in places where the services of a duly registered physician, nurse or midwife are not available; (f) any person who administers or recommends any household remedy as per classification of existing Pharmacy Laws; and (g) any psychologist or mental hygienist in the performance of his duties, provided such performance is done in conjunction with a duly registered physician. Section 12. Limited practice without any certificate of registration. Certificates of registration shall not be required of the following persons: (a) Physicians and surgeons from other countries called in consultation only and exclusively in specific and definite cases, or those attached to international bodies or organization assigned to perform certain definite work in the Philippines provided they shall limit their practice to the specific work assigned to them and provided further they shall secure a previous authorization from the Board of Medical Examiners. (b) Commissioned medical officers of the United States armed forces stationed in the Philippines while rendering service as such only for the members of the said armed forces and within the limit of their own respective territorial jurisdiction. (c) Foreign physicians employed as exchange professors in special branches of medicine or surgery whose service may in the discretion of the Board of Medical Education, be necessary. (d) Medical students who have completed the first four years of medical course, graduates of medicine and registered nurses who may be given limited and special authorization by the Secretary of Health to render medical services during epidemics or national emergencies whenever the services of duly registered physicians are not available. Such authorization shall automatically cease when the epidemic or national emergency is declared terminated by the Secretary of Health.

Section 13. The Board of Medical Examiners, its composition and duties. The Board of Medical Examiners shall be composed of six members to be appointed by the President of the Philippines from a confidential list of not more than twelve names approved and submitted by the executive council of the Philippine Medical Association, after due consultation with other medical associations, during the months of April and October of each year. The chairman of the Board shall be elected from among themselves by the member at a meeting called for the purpose. The President of the Philippines shall fill any vacancy that may occur during any examination from the list of names submitted by the Philippine Medical Association in accordance with the provisions of this Act. No examiner shall handle the examinations in more than four subjects or groups of subjects as hereinafter provided. The distribution of subject to each member shall be agreed upon at a meeting called by the chairman for the purpose. The examination papers shall be under the custody of the Commissioner of Civil Service or his duly authorized representative, and shall be distributed to each member of the Board who shall correct, grade, and sign, and submit them to the said Commissioner within one hundred twenty days from the date of the termination of the examinations. A final meeting of the Board for the deliberation and approval of the grades shall be called by the Commissioner of Civil Service immediately after receipt of the records from the members of the Board of Medical Examiners. The secretary of the Board shall submit to the President of the Philippines for approval the names of the successful candidates as having been duly qualified for licensure in alphabetical order, without stating the ratings obtained by each. Section 14. Qualifications of examiners. No person shall be appointed a member of the Board of Medical Examiners unless he or she (1) is a natural-born citizen of the Philippines, (2) is a duly registered physician in the Philippines, (3) has been in the practice of medicine for at least ten years, (4) is of good moral character and of recognized standing in the medical profession, (5) is not a member of the faculty of any medical school and has no pecuniary interest, directly or indirectly, in any college of medicine or in any institution where any branch of medicine is taught, at the time of his appointment: Provided, That of the six members to be appointed, not more than two shall be graduates of the same institution and not more than three shall be government physicians. Section 15. Tenure of office and compensation of members. The members of the Board of Medical Examiners shall hold office for one year: Provided, That any member may be reappointed for not more than one year. Each member shall receive as compensation ten pesos for each candidate examined for registration as physician, and five pesos for each candidate examined in the preliminary or final physician examination. The President of the Philippines, upon the recommendation of the Commissioner of Civil Service , after due investigation, may remove any member of the Board of Medical Examiners for neglect of duty, incompetency, or unprofessional or dishonorable conduct. Section 16. Executive Officer and Secretary of the Board. The Secretary of the Boards of Examiners appointed in accordance with section ten of Act Numbered Four thousand seven, as amended, shall also be the secretary of the Board of Medical Examiners, who shall keep all the records, including examination papers, and the minutes of the deliberations of the Board. He shall also keep a register of all persons to whom certificates of registration has been granted; set forth the name, sec, age, and place of birth of each, place of business, post office address, the name of the medical college or university from which he graduated or in which he had studied, together with time spent in the study of the profession elsewhere, the name of the country where the institution is located which had granted to him the degree or certificate of attendance upon clinic and all lectures in medicine and surgery, and all other degrees granted to him from institutions of learning. He shall keep an up-todate registration book of all duly registered physicians in the Philippines. He shall furnish copies of

all examination questions and ratings in each subject of the respective candidates in the physicians examination, one month after the release of the list of successful examinees, to the deans of the different colleges of medicine exclusively for the information and guidance of the faculties thereof. This report shall be considered as restricted information. Any school which violates this rule shall be deprived of such privilege. The secretary of the Board shall likewise keep a record of all registered medical students. He shall keep all the records and proceedings, and issue and receive all papers in connection with any and all complaints presented to the Board. Section 17. Rules and regulations. The Board of Medical Examiners, with the approval of the Commissioner of Civil Service, shall promulgate such rules and regulations as may be necessary for the proper conduct of the examinations, correction of examination papers, and registration of physicians. The Commissioner shall supervise each Board examination and enforce the said rules and regulations. These rules and regulations shall take effect fifteen days after the date of their publication in the Official Gazette and shall not be changed within sixty days immediately before any examination. Such rules and regulations shall be printed and distributed for the information and guidance of all concerned. Section 18. Dates of examinations. The Board of Medical Examiners shall give examinations for the registration of physicians, one in May and one in November every year, in the City of Manila or any of its suburbs after giving not less than ten days' notice to each candidate who had filed his name and address with the secretary of the Board. Section 19. Fees. The secretary of the Board, under the supervision of the Commissioner of Civil Service, shall collect from each candidate the following fees: For registration as medical student

P 5.00

For complete physician examination

75.00

For preliminary or final examination

40.00

For registration as physician

20.00

All fees paid as provided herein shall accrue to the funds of the Board of Medical Examiners and be expended for the payment of the compensation of the members thereof. No fees other than those provided herein shall be paid to the Board. Section 20. Issuance of Certificate of Registration, grounds for refusal of same. The Commissioner of Civil Service and the secretary of the Board of Medical Examiners shall sign jointly and issue certificates of registration to those who have satisfactorily complied with the requirements of the Board. They shall not issue a certificate of registration to any candidate who has been convicted by a court of competent jurisdiction of any criminal offense involving moral turpitude, or has been found guilty of immoral or dishonorable conduct after he due investigation by the Board of Medical Examiners, or has been declared to be of unsound mind. Section 21. Scope of examination. The examination for the registration of physicians shall consist of the following subjects: (1) Anatomy and Histology, (2) Physiology, (3) Biochemistry, (4) Microbiology and Parasitology, (5) Pharcology and Therapeutics, (6) Pathology, (7) Medicine, (8) Obstetrics and Gynecology, (9) Pediatrics and Nutrition, (10) Surgery and Opthalmology, Otolaryngology and Rhinology, (11) Preventive Medicine and Public Health, and (12) Legal Medicine, Ethics and Medical Jurisprudence: Provided, however, That the examination questions in each subject or group of subject shall at least be ten in number: Provided, further, That the examination questions in Medicine

shall include at least three from the following branches: Infectious diseases, Neurology, Dermatology, Allergy, Endocrinology and Cardio-Vascular diseases: Provided, finally, That the examination questions in Surgery shall include at least four questions from the following: Opthalmology, Otology, Rhinology, Laryngology, Orthopedic Surgery and Anesthesiology. The questions shall be the same for all applicants. All answers must be written either in English or Spanish. No name of the examinee shall appear in the examination paper but the examiners shall devise a system whereby each applicant can be identified by number only. In order that a candidate may be deemed to have passed his examination successfully he must have obtained a general average of seventy-five per cent without a grade lower than sixty-five per cent in Medicine, Pediatrics and Nutrition, Obstetrics and Gynecology, and Preventive Medicine and Public Health, and no grade lower than fifty per cent in the rest of the subjects. The preliminary examinations shall comprise of the following subjects: (1) Gross Anatomy and Histology (2) Physiology (3) Biochemistry (4) Microbiology and Parasitology Section 22. Administrative investigations. In addition to the functions provided for in the preceding sections, the Board of Medical Examiners shall perform the following duties: (1) to administer oath to physicians who qualified in the examination; (2) to study the conditions affecting the practice of medicine in all parts of the Philippines; (3) to exercise the powers conferred upon it by this article with the view of maintaining the ethical and professional standards of the medical profession; (4) to subpoena or subpoena duces tecum witnesses for all purposes required in the discharge of its duties; and (5) to promulgate, with the approval of the Commissioner of Civil Service, such rules and regulations as it may deem necessary for the performance of its duties in harmony with the provisions of this Act and necessary for the proper practice of medicine in the Philippines. Administrative investigations may be conducted by not less than four members of the Board of Medical Examiners; otherwise the proceedings shall be considered void. The existing rules of evidence shall be observed during all administrative investigations. The Board may disapprove applications for examination or registration, reprimand erring physicians, or suspend or revoke registration certificates, if the respondents are found guilty after due investigations. Section 23. Procedure and rules. Within five days after the filling of written charges under oath, the respondent physician shall be furnished a copy thereof, without requiring him or her to answer the same, and the Board shall conduct the investigation within five days after the receipt of such copy by the respondent. The investigation shall be completed as soon as practicable. Section 24. Grounds for reprimand, suspension or revocation of registration certificate. Any of the following shall be sufficient ground for reprimanding a physician, or for suspending or revoking a certificate of registration as physician: (1) Conviction by a court of competent jurisdiction of any criminal offense involving moral turpitude;

(2) Immoral or dishonorable conduct; (3) Insanity; (4) Fraud in the acquisition of the certificate of registration; (5) Gross negligence, ignorance or incompetence in the practice of his or her profession resulting in an injury to or death of the patient; (6) Addiction to alcoholic beverages or to any habit forming drug rendering him or her incompetent to practice his or her profession, or to any form of gambling; (7) False or extravagant or unethical advertisements wherein other things than his name, profession, limitation of practice, clinic hours, office and home address, are mentioned. (8) Performance of or aiding in any criminal abortion; (9) Knowingly issuing any false medical certificate; (10) Issuing any statement or spreading any news or rumor which is derogatory to the character and reputation of another physician without justifiable motive; (11) Aiding or acting as a dummy of an unqualified or unregistered person to practice medicine; (12) Violation of any provision of the Code of Ethics as approved by the Philippine Medical Association. Refusal of a physician to attend a patient in danger of death is not a sufficient ground for revocation or suspension of his registration certificate if there is a risk to the physician's life. Section 25. Rights of respondents. The respondent physician shall be entitled to be represented by counsel or be heard by himself or herself, to have a speedy and public hearing, to confront and to cross-examine witnesses against him or her, and to all other rights guaranteed by the Constitution and provided for in the Rules of Court. Section 26. Appeal from judgment. The decision of the Board of Medical Examiners shall automatically become final thirty days after the date of its promulgation unless the respondent, during the same period, has appealed to the Commissioner of Civil Service and later to the Office of the President of the Philippines. If the final decision is not satisfactory, the respondent may ask for a review of the case, or may file in court a petition for certiorari. Section 27. Reinstatement. After two years, the Board may order the reinstatement of any physicians whose certificate of registration has been revoked, if the respondent has acted in an exemplary manner in the community wherein he resides and has not committed any illegal, immoral or dishonorable act. ARTICLE IV PENAL AND OTHER PROVISIONS

Section 28. Penalties. Any person found guilty of "illegal practice of medicine" shall be punished by a fine of not less than one thousand pesos nor more than ten thousand pesos with subsidiary imprisonment in case of insolvency, or by imprisonment of not less than one year nor more than five years, or by both such fine and imprisonment, in the discretion of the court. Section 29. Injunctions. The Board of Medical Examiners may file an action to enjoin any person illegally practicing medicine from the performance of any act constituting practice of medicine if the case so warrants until the necessary certificate therefore is secured. Any such person who, after having been so enjoined, continues in the illegal practice of medicine shall be punished for contempt of court. The said injunction shall not relieve the person practicing medicine without certificate of registration from criminal prosecution and punishment as provided in the preceding section. Section 30. Appropriation. To carry out the provisions of this Act, there is hereby appropriated, out of any funds in the National Treasury not otherwise appropriated, the sum of twenty thousand pesos. Section 31. Repealing clause. All Acts, executive orders, administrative orders, rules and regulations, or parts thereof inconsistent with the provisions of this Act are repealed or modified accordingly. Section 32. Effectivity. This Act shall take effect upon its approval: Provided, That if it is approved during the time when examinations for physicians are held, it shall take effect immediately after the said examinations: Provided, further, That section six of this Act shall take effect at the beginning of the academic year nineteen hundred sixty to nineteen hundred sixty-one, and the first paragraph of section seven shall take effect four years thereafter. Approved: June 20, 1959

REPUBLIC ACT NO. 6511 REPUBLIC ACT NO. 6511 - AN ACT AMENDING REPUBLIC ACT NUMBERED FOUR HUNDRED SIXTY-FIVE ENTITLED "AN ACT TO STANDARDIZE THE EXAMINATION AND REGISTRATION FEES CHARGED BY THE NATIONAL EXAMINING BOARDS, AND FOR OTHER PURPOSES"

Section 1. five

Sections one, two, three, four, five and six of Republic Act Numbered Four hundred sixtyare hereby amended to read as follows:

"Section 1. The provisions of existing law to the contrary notwithstanding, applicants for any of the licensure examinations conducted by any of the boards under the Office of the Boards of Examiners shall pay examination fees as follows; (a)

One

hundred

pesos:

1)

Accountants

2)

Agricultural

Engineers

3)

Architects

4)

Chemical

Engineers

5)

Civil

Engineers

6)

Customs

7) 8) 9)

Dentists,

Brokers

except

Electrical

Engineers

Electronics

Dental except

and

Hygienists

Master

Communications

Electricians Engineers

10)

Foresters

11)

Geodetic

12)

Engineers

Licensing

Contractors

13) Master Marine Officers, except Chief, Second, Third Mates, Major, Minor or Harbor Bay Lake-River Patrons 14)

Mechanical

Engineers

15) 16)

(b) 1)

Certified

Plant

Mining Physicians

except

17) 18)

except

examinees

for

Engineers physician's

Sanitary Chief

preliminary

examinations Engineers

Marine Seventy-five

Mechanics

Engineers pesos: Chemists

2)

Second

Steam

and

Motor

Engineers

3)

Dietitians

4)

Geologists

5) 6)

Medical Naval

Technologists

Architects

and

Marine

Engineers

7)

Nurses

8)

Optometrists

9)

Pharmacists

10)

Social

11)

Workers

Sugar

Technologists

12)

Veterinarians

13)

Midwives

14)

Chief

15)

Master

Mates

and

Plumbers

(c)

or

Major

Patrons

Plumbing

Engineers

Fifty

1)

pesos:

Bay-River-Lake

Motor

Engineers

2)

Harbor-Bay-River-Lake

Patrons

3)

Minor

Patrons

4)

Therapists

5) 6)

Master Examinees

for

physician's

7)

preliminary

and

final

Dental

8)

Plant

Second Third

and

and Fourth

examinations Hygienists

Certified

9) 10)

Electricians

Steam

Mechanics Third

and

Mates Motor

Engineers

Provided, that in cases where removal examinations are allowed, the examination fee shall fifty per centum of the original fee prescribed under classifications A, B and C provided for under this section. "Sec. 2. Every applicant for registration in any of the professions or occupations under regulation by the Office of the Boards of Examiners who passed the corresponding examination shall pay a registration fee of fifty pesos for those falling under class (a); forty pesos for those under class (b); and thirty pesos for those under class (c) provided in section one, except those in the marine examinations who are registered by the Philippine Coast Guard. An applicant for registration without examination shall pay also the amount corresponding to the examination fee of the profession or

occupation applied plus the registration fee herein prescribed: provided, that detailmen shall pay twenty pesos, mine or quarry foreman and chemical technician, thirty pesos: provided, further, that applicants for registration who qualified in the examination given prior to the approval of this Act, shall pay the corresponding registration fee heretofore prescribed. "Sec. 3. Every practicing professional or practitioner of any of the occupations regulated by the Office of the Boards of Examiners shall pay an annual registration fee of five pesos: provided, that major or minor patrons, second, third, or fourth motor or steam engineers, harbor-river-lake patrons, bay-riverlake-motor engineers, master electricians, certified plant mechanics, master plumbers, midwives, chemical technicians and mine or quarry foremen shall pay two pesos: provided, further, that licensed contractors and detailmen shall be exempt from the payment of the annual registration fee as they are required to renew their licenses or registrations annually. Failure to pay the annual registration fee on or before January twenty of the year next following the calendar year in which it is due, shall bear a surcharge of twenty per centum for each calendar year in which payment has not been made: provided, that after the lapse of five continuous years from the year it was last paid if the annual registration fee has never been paid, the delinquent's certificate of registration shall be considered suspended and his name shall be dropped from the annual roster for not having been good standing and may be reinstated only upon application and payment of the fee herein provided for registration without examination. When a registered practitioner desires to stop practicing his profession, he shall inform the board concerned in writing within one year from the time he stopped practicing in order to exempt him from the payment of the annual registration fee: provided, that when he intends to resume the practice of his professions, he shall likewise inform the board concerned in writing and pay the annual registration fee for the current year without any surcharge and his name shall be reinstated in the annual roster. The annual registration card, at least for the calendar year immediately preceding, shall be presented to the collection agent of the Bureau of Internal Revenue when paying his professional tax and the registration number, date of issuance and the year shown on the card shall be indicated on the official receipt as evidence that the payor is authorized by law to practice the profession. "Sec. 4. Every applicant for duplicate certificate of registration shall pay a fee of twenty-five pesos and for certifications or true copies of records with the official seal of the office or of the board concerned, two pesos for the first one hundred words and in excess thereof fifty centavos for every one hundred words or a fraction thereof. "Sec. 5. All examination, registration and other fees shall be paid to the collecting officer of the Office of the Boards of Examiners which shall be deposited in a special trust account to constitute the professional regulation special fund and which shall be expended solely for the operational expenses of the Office of the Boards of Examiners, for compensation of members of the board and salaries of officials and employees including the hiring of temporary personnel as the exigencies of the service require, for the purchase, acquisition and improvement of equipment, furniture, and fixtures, motor vehicles, sites and construction of building for office spaces and examination halls, for conducting research to keep the office abreast with recent trends in regulation of professions and occupations and in all other matters that would enhance the effectiveness and efficiency of the office. "Sec. 6. Each Chairman and member of the Board of Examiners, whether a government employee or not, shall receive as compensation a fee not exceeding fifteen pesos per capita of the candidates examined or registered without examination, and a per diem not exceeding ten (P10.00) pesos for each day of attendance in administrative investigations and ocular inspections lasting not less than one hour at a time: provided, that the total compensation of any Chairman or member shall not be less than three thousand six hundred pesos, but not more than twenty-four thousand pesos for participating in all examinations given by their respective board during the fiscal year. Any member whose term expires before the end of the fiscal year shall receive only the compensation equivalent to the number of candidates examined and/or registered without examination wherein he last participated or at the rate of five hundred pesos per month computed from the beginning of fiscal year until the last day of his term of office or until his successor shall have been appointed and qualified, whichever is higher: provided, that the Chairman or member whose term expires before the result of the examination he last participated in his released shall be allowed to continue correcting his examination papers and to perform his other duties relative to the release of the results thereof until he shall signed

the certificate of registration of those who have qualified in the examination or were registered without examination, without additional compensation except those allowed herein, and that the full compensation due him shall be paid only after he shall have been cleared of all his responsibilities." Sec. 2. All laws, executive orders, administrative orders, rules and regulations, or parts thereof inconsistent with the provisions of this Act are hereby repealed or modified accordingly. Sec.

3.

This

Act

shall

take

effect

upon

its

approval.

Approved: July 1, 1972

PRESIDENTIAL DECREE No. 541 August 20, 1974 ALLOWING FORMER FILIPINO PROFESSIONALS TO PRACTICE THEIR RESPECTIVE PROFESSIONS IN THE PHILIPPINES. WHEREAS, a considerable number of Filipino professionals have, with the passage of time, gone to other countries to pursue further studies and/or take up specialized studies in their chosen fields of endeavor while others emigrated to other lands in search of better job opportunities; WHEREAS, since their departure from the Philippines some of these professionals have become naturalized citizens of their host countries so that they are now barred from the practice of their profession in our country; WHEREAS, a considerable number of these erstwhile Filipino professionals are now desirous to come home under the Balikbayan Program and, while here, would like to serve our people or share their advanced knowledge and expertise with their local professional colleagues; WHEREAS, for the sake of faster national development our government is now trying to attract these erstwhile Filipino professionals to return and reside permanently in the Philippines so that they can provide the talent and expertise urgently needed by the homeland; NOW, THEREFORE, I, FERDINAND E. MARCOS, President of the Philippines, by virtue of the powers vested in me by the Constitution, do hereby decree and order the following: Section 1. The provisions of all existing laws, rules and regulations, decrees, orders, and instructions to the contrary notwithstanding, professionals who were formerly citizens of the Philippines and who have previously passed licensure examinations in the Philippines for the practice of their profession, may, while in this country on a visit, sojourn or permanent residence, practice their profession: Provided, That they are professional practitioners of good standing prior to their departure from the Philippines and in their adopted country: Provided further, That prior to the practice of their profession they shall have first registered with the Professional license fee; and Provided finally, That they shall pay the corresponding income tax due on all incomes realized by them in the practice of their respective professions in the Philippines. Section 2. The Professional Regulations Commission shall promulgate the necessary rules and regulations to implement and carry out the purposes of this Decree. Section 3. This Decree shall take effect immediately. DONE in the City of Manila, this 20th day of August, in the year of Our Lord, nineteen hundred and seventy-four.

CONSTITUTION ART 12 - NATIONAL ECONOMY AND PATRIMONY Section 14. The sustained development of a reservoir of national talents consisting of Filipino scientists, entrepreneurs, professionals, managers, high-level technical manpower and skilled workers and craftsmen in all fields shall be promoted by the State. The State shall encourage appropriate technology and regulate its transfer for the national benefit. The practice of all professions in the Philippines shall be limited to Filipino citizens, save in cases prescribed by law.

Dent v. West Virginia, 129 U.S. 114 (1889) Dent v. West Virginia No. 119 Submitted December 11, 1888 Decided January 14, 1889 129 U.S. 114 ERROR TO THE SUPREME COURT OF APPEALS OF THE STATE OF WEST VIRGINIA Syllabus The statute of West Virginia (§§ 9 and 15, chapter 93, 1882) which requires every practitioner of medicine in the State to obtain a certificate from the State Board of Health that he is a graduate of a reputable medical college in the school of medicine to which he belongs, or that he has practiced medicine in the State continuously for ten years prior to March 8, 1881, or that he has been found upon examination to be qualified to practice medicine in all its departments, and which subjects a person practicing without such certificate to prosecution and punishment for a misdemeanor, does not, when enforced against a person who had been a practicing physician in the State for a period of five years before 1881, without a diploma of a reputable medical college in the school

of medicine to which he belonged, deprive him of his estate or interest in the profession without due process of law. The State, in the exercise of its power to provide for the general welfare of its people, may exact from parties before they can practice medicine a degree of skill and learning in that profession upon which the community employing their services may confidently rely, and, to ascertain whether they have such qualifications, require them to obtain a certificate or license from a board or other authority competent to judge in that respect. If the qualifications required are appropriate to the profession and attainable by reasonable study or application, their validity is not subject to objection because of their stringency or difficulty. Legislation is not open to the charge of depriving one of his rights without due process of law if it be general in its operation upon the subjects to which it relates, and is enforceable in the usual modes established in the administration of government with respect to kindred matters; that is, by process or proceedings adapted to the nature of the case, and such is the legislation of West Virginia in question. Cummings v. Missouri, 4 Wall. 277, and Ex parte Garland, 4 Wall. 333, examined and shown to differ materially from this case. Page 129 U. S. 115 The Court stated the case as follows: This case comes from the Supreme Court of Appeals of West Virginia. It involves the validity of the statute of that State which requires every practitioner of medicine in it to obtain a certificate from the state board of health that he is a graduate of a reputable medical college in the school of medicine to which he belongs, or that he has practiced medicine in the State continuously for the period of 10 years prior to the 8th day of March, 1881, or that he has been found, upon examination by the board, to be qualified to practice medicine in all its departments, and makes the practice of, or the attempt by any person to practice, medicine, surgery, or obstetrics in the State without such certificate, unless called from another State to treat a particular case, a misdemeanor punishable by fine or imprisonment, or both, in the discretion of the court. The statute in question is found in §§ 9 and 15 of an act of the State, c. 93, passed March 15, 1882, amending a chapter of its Code concerning the public health. St. 1882, pp. 245, 246, 248. These sections are as follows:

"SEC. 9. The following persons, and no others, shall hereafter be permitted to practice medicine in this State, viz.:" "First. All persons who are graduates of a reputable medical college in the school of medicine to which the person desiring to practice belongs. Every such person shall, if he has not already done so and obtained the certificate hereinafter mentioned, present his diploma to the State Board of Health, or to the two members thereof in his congressional district, and if the same is found to be genuine, and was issued by such medical college, as is hereinafter mentioned, and the person presenting the same be the graduate named therein, the said Board, or said two members thereof, (as the case may be) shall issue and deliver to him a certificate to that effect, and such diploma and certificate shall entitle the person named in such diploma to practice medicine in all its departments in this State." "Second. All persons who have practiced medicine in this State continuously for the period of ten years prior to the Page 129 U. S. 116 8th day of March, one thousand eight hundred and eighty-one. Every such person shall make and file with the two members of the State Board of Health in the congressional district in which he resides, or if he resides out of the State in the district nearest his residence, an affidavit of the number of years he has continuously practiced in this State; and, if the number of years therein stated be ten or more, the said Board, or said two members thereof, shall, unless they ascertain such affidavit to be false, give him a certificate to that fact, and authorizing him to practice medicine in all its departments in this State." "Third. A person who is not such graduate, and who has not so practiced in this State for a period of ten years, desiring to practice medicine in this State, shall, if he has not already done so, present himself for examination before the State Board of Health, or before the said two members thereof in the congressional district in which he resides, or, if he resides out of the State, to the said two members of the State Board of Health in the congressional district nearest his place of residence, who, together with a member of the local board of health, who is a physician (if there be such member of the local board) of the county in which the examination is held, shall examine him as herein provided, and if, upon full examination, they find him qualified to practice medicine in all

its departments, they, or a majority of them, shall grant him a certificate to that effect, and thereafter he shall have the right to practice medicine in this State to the same extent as if he had the diploma and certificate hereinbefore mentioned. The members of the State Board of Health in each congressional district shall, by publication in some newspaper printed in the county in which their meeting is to be held, or, if no such paper is printed therein, in some newspaper of general circulation in such district, give at least twenty-one days' notice of the time and place at which they will meet for the examination of applicants for permission to practice medicine, which notice shall be published at least once in each week for three successive weeks before the day of such meeting; but this section shall not apply to a physician or surgeon who is called Page 129 U. S. 117 from another State to treat a particular case, or to perform a particular surgical operation in this State and who does not otherwise practice in this State." "SEC. 15. If any person shall practice, or attempt to practice, medicine, surgery, or obstetrics in this State without having complied with the provisions of § 9 of this chapter, except as therein provided, he shall be guilty of a misdemeanor, and fined for every such offense not less than fifty nor more than five hundred dollars, or imprisoned in the county jail not less than one month nor more than twelve months, or be punished by both such fine and imprisonment, at the discretion of the court. And if any person shall file, or attempt to file, as his own, the diploma or certificate of another, or shall file, or attempt to file, a false or forged affidavit of his identity, or shall willfully swear falsely to any question which may be propounded to him on his examination, as herein provided for, or to any affidavit herein required to be made or filed by him, he shall, upon conviction thereof, be confined in the penitentiary not less than one nor more than three years, or imprisoned in the county jail not less than six nor more than twelve months, and fined not less than one hundred nor more than five hundred dollars, at the discretion of the court." Under this statute, the plaintiff in error was indicted in the State Circuit Court of Preston County, West Virginia, for unlawfully engaging in the practice of medicine in that State in June, 1882, without a diploma, certificate, or license therefor, as there required, not being a physician or surgeon called from another State to treat a particular case or to perform a particular surgical operation. To this indictment the defendant pleaded not

guilty, and, a jury having been called, the State by its prosecuting attorney, and the defendant by his attorney, agreed upon the following statement of facts, namely: "That the defendant was engaged in the practice of medicine in the town of Newburg, Preston county, West Virginia, at the time charged in the indictment, and had been so engaged since the year 1876 continuously to the present time, and has during all said time enjoyed a lucrative practice, Page 129 U. S. 118 publicly professing to be a physician, prescribing for the sick, and appending to his name the letters, 'M.D.;' that he was not then and there a physician and surgeon called from another State to treat a particular case or to perform a particular surgical operation, nor was he then and there a commissioned officer of the United States army and navy and hospital service; that he has no certificate, as required by § 9, chapter 93, acts of the Legislature of West Virginia, passed March 15, 1882, but has a diploma from the 'American Medical Eclectic College of Cincinnati, Ohio;' that he presented said diploma to the members of the Board of Health who reside in his congressional district, and asked for the certificate as required by law, but they, after retaining said diploma for some time, returned it to defendant with their refusal to grant him a certificate asked, because, as they claimed, said college did not come under the word 'reputable,' as defined by said Board of Health; that, if the defendant had been or should be prevented from practicing medicine, it would be a great injury to him, as it would deprive him of his only means of supporting himself and family; that, at the time of the passage of the act of 1882, he had not been practicing medicine ten years, but had only been practicing six, as aforesaid, from the year 1876." These were all the facts in the case. Upon them, the jury found the defendant guilty, and thereupon he moved an arrest of judgment on the ground that the act of the legislature was unconstitutional and void so far as it interfered with his vested right in relation to the practice of medicine, which motion was overruled, and to the ruling an exception was taken. The court thereupon sentenced the defendant to pay a fine of $50 and the costs of the proceedings. The case being taken on writ of error to the Supreme Court of Appeals of the State, the judgment was affirmed, and to review this judgment the case is brought here. Page 129 U. S. 121

MR. JUSTICE FIELD, after stating the facts as above, delivered the opinion of the court. Whether the indictment upon which the plaintiff in error was tried and found guilty is open to objection for want of sufficient certainty in its averments is a question which does not appear to have been raised either on the trial or before the Supreme Court of the State. The Presiding Justice of the latter Court, in its opinion, states that the counsel for the defendant expressly waived all objections to defects in form or substance of the indictment, and based his claim for a review of the judgment on the ground that the statute of West Virginia is unconstitutional and void. The unconstitutionality asserted consists in its alleged conflict with the clause of the Fourteenth Amendment which declares that no State shall deprive any person of life, liberty, or property without due process of law; the denial to the defendant of the right to practice his profession without the certificate required constituting the deprivation of his vested right and estate in his profession, which he had previously acquired. It is undoubtedly the right of every citizen of the United States to follow any lawful calling, business, or profession he may choose, subject only to such restrictions as are imposed upon all persons of like age, sex, and condition. This right may in many respects be considered as a distinguishing feature of our republican institutions. Here, all vocations are open to everyone on like conditions. All may be pursued as sources of livelihood, some requiring years of study and great learning for their successful prosecution. The interest, or, as it is sometimes termed, the "estate," acquired in them -that is, the right to continue their prosecution -- is often of great value to the possessors, and cannot be arbitrarily taken from them, any more Page 129 U. S. 122 than their real or personal property can be thus taken. But there is no arbitrary deprivation of such right where its exercise is not permitted because of a failure to comply with conditions imposed by the State for the protection of society. The power of the State to provide for the general welfare of its people authorizes it to prescribe all such regulations as in its judgment will secure or tend to secure them against the consequences of ignorance and incapacity, as well as of deception and fraud. As one means to this end, it has been the practice of different States, from time immemorial, to exact in many pursuits a certain degree of skill and learning upon which the community may confidently rely; their possession being generally ascertained upon an examination of parties by competent persons, or inferred from a certificate to them in the form of a

diploma or license from an institution established for instruction on the subjects, scientific and otherwise, with which such pursuits have to deal. The nature and extent of the qualifications required must depend primarily upon the judgment of the State as to their necessity. If they are appropriate to the calling or profession, and attainable by reasonable study or application, no objection to their validity can be raised because of their stringency or difficulty. It is only when they have no relation to such calling or profession, or are unattainable by such reasonable study and application, that they can operate to deprive one of his right to pursue a lawful vocation. Few professions require more careful preparation by one who seeks to enter it than that of medicine. It has to deal with all those subtle and mysterious influences upon which health and life depend, and requires not only a knowledge of the properties of vegetable and mineral substances, but of the human body, in all its complicated parts, and their relation to each other, as well as their influence upon the mind. The physician must be able to detect readily the presence of disease, and prescribe appropriate remedies for its removal. Everyone may have occasion to consult him, but comparatively few can judge of the qualifications of learning and skill which he possesses. Reliance must be placed upon the assurance Page 129 U. S. 123 given by his license, issued by an authority competent to judge in that respect, that he possesses the requisite qualifications. Due consideration, therefore, for the protection of society may well induce the State to exclude from practice those who have not such a license, or who are found upon examination not to be fully qualified. The same reasons which control in imposing conditions, upon compliance with which the physician is allowed to practice in the first instance, may call for further conditions as new modes of treating disease are discovered, or a more thorough acquaintance is obtained of the remedial properties of vegetable and mineral substances, or a more accurate knowledge is acquired of the human system and of the agencies by which it is affected. It would not be deemed a matter for serious discussion that a knowledge of the new acquisitions of the profession, as it from time to time advances in its attainments for the relief of the sick and suffering, should be required for continuance in its practice, but for the earnestness with which the plaintiff in error insists that, by being compelled to obtain the certificate required, and prevented from continuing in his practice without it, he is deprived of his right and estate in his profession without due process of law. We perceive nothing in the statute which indicates an intention of the legislature to deprive

one of any of his rights. No one has a right to practice medicine without having the necessary qualifications of learning and skill, and the statute only requires that whoever assumes, by offering to the community his services as a physician, that he possesses such learning and skill shall present evidence of it by a certificate or license from a body designated by the State as competent to judge of his qualifications. As we have said on more than one occasion, it may be difficult, if not impossible, to give to the terms "due process of law" a definition which will embrace every permissible exertion of power affecting private rights, and exclude such as are forbidden. They come to us from the law of England, from which country our jurisprudence is to a great extent derived, and their requirement was there designed to secure the subject against the arbitrary action of the Crown, and place him under the protection of the law. They were deemed to be Page 129 U. S. 124 equivalent to "the law of the land." In this country, the requirement is intended to have a similar effect against legislative power -- that is, to secure the citizen against any arbitrary deprivation of his rights, whether relating to his life, his liberty, or his property. Legislation must necessarily vary with the different objects upon which it is designed to operate. It is sufficient, for the purposes of this case, to say that legislation is not open to the charge of depriving one of his rights without due process of law if it be general in its operation upon the subjects to which it relates and is enforceable in the usual modes established in the administration of government with respect to kindred matters -- that is, by process or proceedings adapted to the nature of the case. The great purpose of the requirement is to exclude everything that is arbitrary and capricious in legislation affecting the rights of the citizen. As said by this court in Yick Wo v. Hopkins, speaking by Mr. Justice Matthews: "When we consider the nature and the theory of our institutions of government, the principles upon which they are supposed to rest, and review the history of their development, we are constrained to conclude that they do not mean to leave room for the play and action of purely personal and arbitrary power." 118 U. S. 118 U.S. 356, 118 U. S. 369. See also Pennoyer v. Neff, 95 U. S. 714, 95 U. S. 733;Davidson v. New Orleans, 96 U. S. 97, 96 U. S. 104, 107; Hurtado v. California, 110 U. S. 516;Railroad Co. v. Humes, 115 U. S. 512, 115 U. S. 519.

There is nothing of an arbitrary character in the provisions of the statute in question. It applies to all physicians, except those who may be called for a special case from another State. It imposes no conditions which cannot be readily met; and it is made enforceable in the mode usual in kindred matters -- that is, by regular proceedings adapted to the case. It authorizes an examination of the applicant by the Board of Health as to his qualifications when he has no evidence of them in the diploma of a reputable medical college in the school of medicine to which he belongs, or has not practiced in the State a designated period before March, 1881. If, in the proceedings under the statute, there should be any unfair Page 129 U. S. 125 or unjust action on the part of the Board in refusing him a certificate, we doubt not that a remedy would be found in the courts of the State. But no such imputation can be made, for the plaintiff in error did not submit himself to the examination of the Board after it had decided that the diploma he presented was insufficient. The cases of Cummings v. State of Missouri, 4 Wall. 277, and of Ex parte Garland, 4 Wall. 333, upon which much reliance is placed, do not, in our judgment, support the contention of the plaintiff in error. In the first of these cases, it appeared that the Constitution of Missouri, adopted in 1865, prescribed an oath to be taken by persons holding certain offices and trusts, and following certain pursuits within its limits. They were required to deny that they had done certain things, or had manifested by act or word certain desires or sympathies. The oath which they were to take embraced 30 distinct affirmations respecting their past conduct, extending even to their words, desires, and sympathies. Every person unable to take this oath was declared incapable of holding in the State "any office of honor, trust, or profit under its authority, or of being an officer, councilman, director, or trustee, or other manager of any corporation, public or private," then existing or thereafter established by its authority, or "of acting as a professor or teacher in any educational institution, or in any common or other school, or of holding any real estate or other property in trust for the use of any church, religious society, or congregation."

And every person holding, at the time the constitution took effect, any of the offices, trusts, or positions mentioned was required, within 60 days thereafter, to take the oath, and, if he failed to comply with this requirement, it was declared that his office, trust, or position should, ipso facto,become vacant. No person, after the expiration of the 60 days, was allowed, without taking the oath, "to practice as an attorney or counselor at law," nor after that period could "any person be competent as a bishop, priest, deacon, minister, elder, or other clergyman of any religious persuasion, sect, or denomination to teach or preach, or solemnize marriages." Fine and imprisonment Page 129 U. S. 126 were prescribed as a punishment for holding or exercising any of the "offices, positions, trusts, professions, or functions" specified without taking the oath, and false swearing or affirmation in taking it was declared to be perjury, punishable by imprisonment in the penitentiary. A priest of the Roman Catholic Church was indicted in a circuit court of Missouri and convicted of the crime of teaching and preaching as a priest and minister of that religious denomination without having first taken the oath, and was sentenced to pay a fine of $500, and to be committed to jail until the same was paid. On appeal to the Supreme Court of the State, the judgment was affirmed, and the case was brought on error to this Court. As many of the acts from which the parties were obliged to purge themselves by the oath had no relation to their fitness for the pursuits and professions designated, the Court held that the oath was not required as a means of ascertaining whether the parties were qualified for those pursuits and professions, but was exacted because it was thought that the acts deserved punishment, and that, for many of them, there was no way of inflicting punishment except by depriving the parties of their offices and trusts. A large portion of the people of Missouri were unable to take the oath, and, as to them, the court held that the requirement of its constitution amounted to a legislative deprivation of their rights. Many of the acts which parties were bound to deny that they had ever done were innocent at the time they were committed, and the deprivation of a right to continue in their offices if the oath were not taken was held to be a penalty for a past act, which was violative of the Constitution. The doctrine of this case was affirmed in Pierce v. Carskadon, 16 Wall. 234.

In the second case mentioned -- that of Ex parte Garland -- it appeared that, on the 2d of July, 1862, Congress had passed an act prescribing an oath to be taken by every person elected or appointed to any office of honor or profit under the United States, either in the civil, military, or naval departments of the Government, except the President, before entering upon the duties of his office, and before being entitled to his Page 129 U. S. 127 salary or other emoluments. On the 24th of January, 1865, Congress, by a supplemental act, extended its provisions so as to embrace attorneys and counselors of the courts of the United States. This latter act, among other things, provided that, after its passage, no person should be admitted as an attorney and counselor to the bar of the Supreme Court, and, after the 4th of March, 1865, to the bar of any Circuit or District Court of the United States, or of the Court of Claims, or be allowed to appear and be heard by virtue of any previous admission, until he had taken and subscribed the oath prescribed by the act of July 2, 1862. The oath related to past acts, and its object was to exclude from practice in the courts parties who were unable to affirm that they had not done the acts specified; and, as it could not be taken by large classes of persons, it was held to operate against them as a legislative decree of perpetual exclusion. Mr. Garland had been admitted to the bar of the Supreme Court of the United States previous to the passage of the act. He was a citizen of Arkansas, and when that State passed an ordinance of secession which purported to withdraw her from the Union, and by another ordinance attached herself to the so-called "Confederate States," he followed the State, and was one of her representatives, first in the lower house, and afterwards in the senate of the congress of the Confederacy, and was a member of that senate at the time of the surrender of the Confederate forces to the armies of the United States. Subsequently, in 1865, he received from the President of the United States a full pardon for all offenses committed by his participation, direct or implied, in the rebellion. He produced this pardon, and asked permission to continue as an attorney and counselor of this Court without taking the oath required by the act of January 24, 1865, and the rule of the Court which had adopted the clause requiring its administration in conformity with the act of Congress. The Court held that the law, in exacting the oath as to his past conduct as a condition of his continuing in the practice of his profession, imposed a penalty for a past act, and in that respect was subject to the same objection as that made to the clauses of the Constitution of Missouri, and was therefore invalid.

Page 129 U. S. 128 There is nothing in these decisions which supports the positions for which the plaintiff in error contends. They only determine that one who is in the enjoyment of a right to preach and teach the Christian religion as a priest of a regular church, and one who has been admitted to practice the profession of the law, cannot be deprived of the right to continue in the exercise of their respective professions by the exaction from them of an oath as to their past conduct respecting matters which have no connection with such professions. Between this doctrine and that for which the plaintiff in error contends there is no analogy or resemblance. The Constitution of Missouri and the act of Congress in question in those cases were designed to deprive parties of their right to continue in their professions for past acts, or past expressions of desires and sympathies, many of which had no bearing upon their fitness to continue in their professions. The law of West Virginia was intended to secure such skill and learning in the profession of medicine that the community might trust with confidence those receiving a license under authority of the State. Judgment affirmed. Disclaimer: Official Supreme Court case law is only found in the print version of the United States Reports. Justia case law is provided for general informational purposes only, and may not reflect current legal developments, verdicts or settlements. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or information linked to from this site. Please check official sources.

G.R. No. L-24119

August 8, 1925

FELIX MARQUEZ, petitioner, vs. THE BOARD OF MEDICAL EXAMINERS and THE SECRETARY-TREASURER OF THE BOARD OF MEDICAL EXAMINERS, respondent. M.H. de Joya for petitioner. Acting Attorney-General Reyes for respondents. STREET, J.: This is an original proceeding in this court by which the petitioner, Felix Marquez, seeks to obtain a writ ofmandamus against the respondents, the Board of Medical Examiners, requiring them to admit the petitioner to the physicians' examinations conducted, or to be conducted by the respondents in the City of Manila. To the original complaint the respondents answered, and to the answer a demurrer was interposed in behalf of the petitioner. It appears that petitioner is a graduate of the Chicago Medical College, having received the degree of M.D. from said institution on June 8, of the year 1922. No question appears to have been made by the respondents with respect to the petitioner's qualifications of the physician's examinations in other respects, but they have denied him admission to the examinations on the grounds that the Chicago Medical College, where the petitioner was graduated, has been classified as a Class C medical college by the National Medical State Board of the United States. For this reason the respondents, in accordance with the regulations of the board now in effect, have denied the requisite standing to said institution and excluded petitioner. It is not denied by the respondents that prior to the adoption of the present regulations, and prior to the date when the Chicago Medical School was classified as a Class C medical college, the Board of Medical Examiners for the Philippine Islands had accepted diplomas of graduation from said medical college as sufficient proof of proficiency in medical knowledge to admit a graduate to the examinations held in these Islands; and as late as October 29, 1923, said board accepted favorably upon the application of one Dr. Mariano M. Lazatin, who was graduated from said school in the year 1921. At the time said candidate was admitted, however, the regulations denying the requisite status to the Chicago Medical College had not been made effective, and they had been made effective by proper authority before the present petitioner had submitted his application. In the argument for the petitioner it is admitted that under Act No. 3111, and the regulations now in force, the petitioner is disqualified to take the examinations; but it is pointed out that at the time he began and even when he conducted his course in the Chicago Medical School, said institution was still recognized as a reputable medical institution; and the question submitted is whether the petitioner's case should be governed by the law and regulations in force at the time of his enrollment in and graduation from the Chicago Medical School, or by those in force at the time he filed his application for admission, on or about September 26, 1924. It is submitted for the petitioner that his case should be governed by the law and regulations at the time of his graduation. To hold otherwise, it is insisted, is to make the law retroactive in effect and to do irreparable damage to the petitioner, who has pursued his work in the institution referred to in good faith, believing that said school had the status necessary to qualify him from examination. The position taken by the petitioner is, we think, untenable. The question whether a medical institution is "a reputable medical school," in the sense intended by the law, is vested in the Board of

Medical Examiners, and although the action taken by them may conceivably, in isolated cases, result in hardship, nevertheless the interests of the public require that the board should be free to exercise its judgment and discretion without reference to the effect of the determination of the question in particular instances. There can in the nature of things be no vested right in an existing law, which would preclude its change or repeal. No one who has commenced preparation in a particular institution has any inchoate right on account of that fact. If the law were otherwise upon this point, it would be impossible for the Board of Medical Examiners to give effect to the knowledge which they from time to time acquire as to the standing of medical schools; and an intending physician, upon matriculating in a particular college, takes upon himself the risk of changes that may be made in the standing of the institution by the board. The demurrer to the answer is not well taken. The answer is therefore declared sufficient, and the petition dismissed, with costs, So ordered. Avanceña, C.J., Johnson, Malcolm, Villamor, Johns, and Villa-Real, JJ., concur.

G.R. No. L-25135

September 21, 1968

PHILIPPINE MEDICAL ASSOCIATION, petitioner, vs. BOARD OF MEDICAL EXAMINERS and JOSE MA. TORRES, respondents. Seva-Albert-Vergara and Julio V. Presbitero for petitioner. Regino Hermosisima, Jr., for respondent Jose Ma. Torres. Solicitor General for respondent Board of Medical Examiners.

CONCEPCION, C.J.: Original action for certiorari and mandamus, against the Board of Medical Examiners and Jose Ma. Torres, to annul a resolution of the former and a certificate issued by the same authorizing the latter to practice medicine in the Philippines without examination. The facts are not disputed. Jose Ma. Torres — hereinafter referred to as respondent — is a Spanish subject and a member of the Missionary Sons of the Immaculate Heart of Mary, otherwise known as the Claretian Missionaries. Having graduated from the University of Barcelona, Spain, with the degree of Licentiate in Medicine and Surgery, he is entitled, under the laws of Spain, to practice medicine and surgery throughout the territory thereof. On January 21, 1955, respondent was granted special authority to practice medicine in Lamitan, Basilan City, where he resides, pursuant to Section 771(e) of the Revised Administrative Code reading: SEC. 771. Persons exempt from registration. — Registration shall not be required of the following classes of persons: . . . (e) In cases of epidemic or in municipalities where there is no legally qualified practicing physician, or when the circumstances require it, in the interest of the public health, the Director of Health may issue special authorizations, to all medical students who have completed the first three years of their studies, or to persons who have qualified in medicine, and to graduate or registered nurses, who may request it. This authority was revoked, on November 8, 1960, by the then Secretary of Health, upon the ground that "the conditions under which it was granted no longer obtained in Lamitan Basilan City, there being enough practising physicians in that locality." Said officer restored the authority on December 19, 1960, to be revoked again, on January 22, 1963. It was renewed once more, on September 1, 1963, and, once again, it was revoked on February 10, 1964, upon the recommendation of the Board of Medical Examiners — hereinafter referred to as the Board. On motion for reconsideration filed by respondent, the Board issued, on April 6, 1965, its Resolution No. 25, series of 1965, which was approved by the President, granting respondent a certificate to practice medicine in the Philippines without the examination required in Republic Act No. 2882, otherwise known as the Medical Act of 1959. The resolution relied therefor upon The Treaty on the Validity of Academic Degrees and The Exercise of the Professions between the Republic of the Philippines and the Spanish State, signed at Manila on March 4, 1949, and ratified on May 19, 1949. 1

Petitioner herein, Philippine Medical Association, is a domestic corporation. On June 14, 1965, it addressed the Chairman of the Board a communication requesting reconsideration of said resolution No. 25, upon the ground that, pursuant to said Medical Act of 1959, respondent has to take and pass the examination therein prescribed, before he can be allowed to practice medicine in the Philippines. This letter was followed by another, dated October 6, 1965, to which said Chairman replied on October 8, 1965, stating "that the final decision on the matter will have to come from the President of the Philippines upon whose authority said resolution has been finally approved and implemented." Thereupon, or, on October 18, 1965, petitioner commenced the present action, for the purpose stated at the beginning of this decision, upon the theory that the Board had violated Republic Act No. 2882 in granting respondent's certificate for the general practice of medicine in the Philippines without the examination prescribed in said Act; that the Board had exceeded its authority in passing said Resolution, because of which the same is null and void; that the Board should, therefore, be ordered to cancel the certificate issued in pursuance of said resolution; and that petitioner has no other plain, adequate and speedy remedy in the ordinary course of law. In their respective answers, respondents admit the basic facts, but not the conclusions drawn therefrom by the petitioner and allege that the resolution in question is sanctioned by the provisions of the Treaty above referred to; that petitioner has no cause of action; and that the petition should be dismissed for failure of the petitioner to exhaust the available administrative remedies. Respondents cite the cases of Costas vs. Aldanese2 and Almario vs. City Mayor 3 in support of the theory that petitioner herein has no sufficient interest or "personality" to maintain the present case. In the first case, it was held that the President of the Association of Philippine (Marine) Engineers 4 had no particular "individual" interest, and, hence,no cause of action for mandamus to compel the Collector of Customs to implement section 1203(j) of the Administrative Code, providing that steamers making round trips of more than 48 hours or travelling at night shall carry the complement of marine engineers therein specified. In the second case, a citizen of the Philippines, as such, who is not an Applicant for any stall or booth, or the representative of any such applicant, stallholder orany association of persons who are deprived of the right to occupy stalls in said market, "is not the real party in interest who has the capacity, right or personality" to bring an action for mandamus, to compel the office of Pasay City to comply with the provisions of Republic Act No. 37, by ejecting, from the public market of said City, stallholders who are not nationals of the Philippines. Said cases are not in point. To begin with, both are actions for mandamus, whereas the case at bar is mainly one for certiorari. Although, petitioner herein, likewise, seeks a writ of mandamus, directing the Board to cancel the certificate of registration issued to the respondent, this would be a necessary consequence of the writ of certiorariannulling the disputed resolution. Moreover, said two (2) cases were commenced by individuals, who, as such, had no special interest in the relief therein prayed for. Indeed, in the Almario case it was intimated that the result might have been otherwise had it been brought by an "association" whose members have an interest in the subject matter of the action. This was confirmed by PHILCONSA vs. Gimenez,5 in which we sustained the right of the Philippine Constitution Association to assail the constitutionality of Republic Act No. 3836, insofar as it allowed retirement gratuity and commutation of vacation and sick leave to members of Congress and to elective officials thereof. Further authority in favor of petitioner herein is supplied by Nacionalista Party vs. F. Bautista Angelo 6 in which the Nacionalista Party successfully impugned the validity of the designation of the then Solicitor General as Acting Member of the Commission on Elections.

It is our considered opinion that the view adopted in the last three (3) cases should be maintained and that, in line therewith, petitioner herein has sufficient interest to prosecute the case at bar and a cause of action against respondents herein. As regards their objection based upon petitioner's failure to appeal to the President, suffice it to say that the rule requiring exhaustion of administrative remedies is concededly subject to exceptions, among which are cases involving only questions of law or when jurisdiction is in issue 7or the action complained of bears the approval of a department secretary, as the disputed resolution, which was approved by the Executive Secretary "by authority of the President," or as an alter ego of the Executive. 8 The case at bar falls under these exceptions to said rule. 1awphîl.nèt

The main issue herein hinges on the interpretation of Article I of the Treaty aforementioned, reading as follows: The nationals of both countries who shall have obtained degrees or diplomas to practice the liberal professions in either of the Contracting States, issued by competent national authorities, shall be deemed competent to exercise said professions in the territory of the Other, subject to the laws and regulations of the latter. When the degree or diploma of Bachelor, issued by competent national authorities allows its holder without requiring further evidence of proficiency to pursue normally higher courses of study, he shall also be deemed qualified to continue his studies in the territory of either Party in conformity with the applicable laws and regulations of the State which recognizes the validity of the title or diploma in question, and with the rules and regulations of the particular educational institution in which he intends to pursue his studies. This Treaty provision was the subject matter of our resolution of August 15, 1961, in connection with the petition of Arturo Efren Garcia for admission to the Philippine Bar without taking the Bar Examinations. After completing, in Spain, the course prescribed therefor, Garcia had been graduated from the College of Law of the Universidad Central de Madrid with the degree of "Licenciado en Derecho", which entitled him to practice law in Spain. Having invoked the provisions of said treaty in support of his claim of exemption from the requisite bar examinations, this Court denied his petition upon the ground, among others ". . . that the privileges provided in the Treaty invoked by the applicant are made expressly subject to the laws and regulations of the contracting State in whose territory it is desired to exercise the legal profession; and Section 1 of Rule 127, in connection with Sections 2, 9, and 16 thereof, which have the force of law, require that before anyone can practice the legal profession in the Philippines he must first successfully pass the required bar examinations; . . ." We find no plausible reason to depart from this view. On the contrary, we reiterate the same, inasmuch as the theory of respondent herein cannot be accepted without placing graduates from our own educational institutions at a disadvantage vis-a-vis Spanish graduates from Spanish schools, colleges or universities. Indeed, the latter could — under respondent's pretense — engage in the practice of medicine in the Philippines without taking the examination prescribed in Republic Act No. 2882, whereas the former would have to take and pass said examination. Worse still, since — as we ruled in the Garcia case — the benefits of the aforementioned Treaty cannot be availed of in the Philippines except by Spanish subjects, the result would be — should respondent's contention be sustained — that graduates from Spanish schools of medicine would be entitled to practice medicine in the Philippines without examination, if they were Spanish subjects, but not if they are Filipinos. Surely said treaty was not made to discriminate against Philippine schools, colleges or universities, much less against nationals of the Philippines.

WHEREFORE, we hold that said Treaty merely extended to diplomas issued or degrees conferred by educational institutions of Spain the same recognition and treatment that we accord to similar diplomas or degrees from local institutions of learning; that holders of said Spanish diplomas or degrees must take the examination prescribed by our laws for holders of similar diplomas or degrees from educational institutions in the Philippines; that resolution No. 25, series of 1965, of respondent Board is violative of Republic Act No. 2882 and hence, null and void; and that, respondent Board of Medical Examiners should be, as it is hereby ordered to cancel the certificate of registration, for the practice of medicine in the Philippines, issued in favor of respondent Jose Ma. Torres, without special pronouncement as to costs. It is so ordered. Reyes, J.B.L., Dizon, Makalintal, Zaldivar, Sanchez, Castro, Angeles and Fernando, JJ., concur.

G.R. No. 78164

July 31, 1987

TERESITA TABLARIN, MA, LUZ CIRIACO, MA NIMFA B. ROVIRA, EVANGELINA S. LABAO, in their behalf and in behalf of applicants for admission into the Medical Colleges during the school year 1987-88 and future years who have not taken or successfully hurdled tile National Medical Admission Test (NMAT).petitioners, vs. THE HONORABLE JUDGE ANGELINA S. GUTIERREZ, Presiding Judge of Branch XXXVII of the Regional Trial Court of the National Capital Judicial Region with seat at Manila, THE HONORABLE SECRETARY LOURDES QUISUMBING, in her capacity as Chairman of the BOARD OF MEDICAL EDUCATION, and THE CENTER FOR EDUCATIONAL MEASUREMENT (CEM), respondents. FELICIANO, J.: The petitioners sought admission into colleges or schools of medicine for the school year 19871988. However, the petitioners either did not take or did not successfully take the National Medical Admission Test (NMAT) required by the Board of Medical Education, one of the public respondents, and administered by the private respondent, the Center for Educational Measurement (CEM). On 5 March 1987, the petitioners filed with the Regional Trial Court, National Capital Judicial Region, a Petition for Declaratory Judgment and Prohibition with a prayer for Temporary Restraining Order and Preliminary Injunction. The petitioners sought to enjoin the Secretary of Education, Culture and Sports, the Board of Medical Education and the Center for Educational Measurement from enforcing Section 5 (a) and (f) of Republic Act No. 2382, as amended, and MECS Order No. 52, series of 1985, dated 23 August 1985 and from requiring the taking and passing of the NMAT as a condition for securing certificates of eligibility for admission, from proceeding with accepting applications for taking the NMAT and from administering the NMAT as scheduled on 26 April 1987 and in the future. After hearing on the petition for issuance of preliminary injunction, the trial court denied said petition on 20 April 1987. The NMAT was conducted and administered as previously scheduled. Petitioners accordingly filed this Special Civil Action for certiorari with this Court to set aside the Order of the respondent judge denying the petition for issuance of a writ of preliminary injunction. Republic Act 2382, as amended by Republic Acts Nos. 4224 and 5946, known as the "Medical Act of 1959" defines its basic objectives in the following manner: Section 1. Objectives. — This Act provides for and shall govern (a) the standardization and regulation of medical education (b) the examination for registration of physicians; and (c) the supervision, control and regulation of the practice of medicine in the Philippines. (Underscoring supplied) The statute, among other things, created a Board of Medical Education which is composed of (a) the Secretary of Education, Culture and Sports or his duly authorized representative, as Chairman; (b) the Secretary of Health or his duly authorized representative; (c) the Director of Higher Education or his duly authorized representative; (d) the Chairman of the Medical Board or his duly authorized representative; (e) a representative of the Philippine Medical Association; (f) the Dean of the College of Medicine, University of the Philippines; (g) a representative of the Council of Deans of Philippine Medical Schools; and (h) a representative of the Association of Philippine Medical Colleges, as members. The functions of the Board of Medical Education specified in Section 5 of the statute include the following:

(a) To determine and prescribe equirements for admission into a recognized college of medicine; (b) To determine and prescribe requirements for minimum physical facilities of colleges of medicine, to wit: buildings, including hospitals, equipment and supplies, apparatus, instruments, appliances, laboratories, bed capacity for instruction purposes, operating and delivery rooms, facilities for outpatient services, and others, used for didactic and practical instruction in accordance with modern trends; (c) To determine and prescribe the minimum number and minimum qualifications of teaching personnel, including student-teachers ratio; (d) To determine and prescribe the minimum required curriculum leading to the degree of Doctor of Medicine; (e) To authorize the implementation of experimental medical curriculum in a medical school that has exceptional faculty and instrumental facilities. Such an experimental curriculum may prescribe admission and graduation requirements other than those prescribed in this Act; Provided, That only exceptional students shall be enrolled in the experimental curriculum; (f) To accept applications for certification for admission to a medical school and keep a register of those issued said certificate; and to collect from said applicants the amount of twenty-five pesos each which shall accrue to the operating fund of the Board of Medical Education; (g) To select, determine and approve hospitals or some departments of the hospitals for training which comply with the minimum specific physical facilities as provided in subparagraph (b) hereof; and (h) To promulgate and prescribe and enforce the necessary rules and regulations for the proper implementation of the foregoing functions. (Emphasis supplied) Section 7 prescribes certain minimum requirements for applicants to medical schools: Admission requirements. — The medical college may admit any student who has not been convicted by any court of competent jurisdiction of any offense involving moral turpitude and who presents (a) a record of completion of a bachelor's degree in science or arts; (b) a certificate of eligibility for entrance to a medical school from the Board of Medical Education; (c) a certificate of good moral character issued by two former professors in the college of liberal arts; and (d) birth certificate. Nothing in this act shall be construed to inhibit any college of medicine from establishing, in addition to the preceding, other entrance requirements that may be deemed admissible. xxx

xxx

x x x (Emphasis supplied)

MECS Order No. 52, s. 1985, issued by the then Minister of Education, Culture and Sports and dated 23 August 1985, established a uniform admission test called the National Medical Admission Test (NMAT) as an additional requirement for issuance of a certificate of eligibility for admission into medical schools of the Philippines, beginning with the school year 1986-1987. This Order goes on to state that:

2. The NMAT, an aptitude test, is considered as an instrument toward upgrading the selection of applicants for admission into the medical schools and its calculated to improve the quality of medical education in the country. The cutoff score for the successful applicants, based on the scores on the NMAT, shall be determined every year by the Board of Medical Education after consultation with the Association of Philippine Medical Colleges. The NMAT rating of each applicant, together with the other admission requirements as presently called for under existing rules, shall serve as a basis for the issuance of the prescribed certificate of elegibility for admission into the medical colleges. 3. Subject to the prior approval of the Board of Medical Education, each medical college may give other tests for applicants who have been issued a corresponding certificate of eligibility for admission that will yield information on other aspects of the applicant's personality to complement the information derived from the NMAT. xxx

xxx

xxx

8. No applicant shall be issued the requisite Certificate of Eligibility for Admission (CEA), or admitted for enrollment as first year student in any medical college, beginning the school year, 1986-87, without the required NMAT qualification as called for under this Order. (Underscoring supplied) Pursuant to MECS Order No. 52, s. 1985, the private respondent Center conducted NMATs for entrance to medical colleges during the school year 1986-1987. In December 1986 and in April 1987, respondent Center conducted the NMATs for admission to medical colleges during the school year 1987.1988. 1avvphi1

Petitioners raise the question of whether or not a writ of preliminary injunction may be issued to enjoin the enforcement of Section 5 (a) and (f) of Republic Act No. 2382, as amended, and MECS Order No. 52, s. 1985, pending resolution of the issue of constitutionality of the assailed statute and administrative order. We regard this issue as entirely peripheral in nature. It scarcely needs documentation that a court would issue a writ of preliminary injunction only when the petitioner assailing a statute or administrative order has made out a case of unconstitutionality strong enough to overcome, in the mind of the judge, the presumption of constitutionality, aside from showing a clear legal right to the remedy sought. The fundamental issue is of course the constitutionality of the statute or order assailed. 1. The petitioners invoke a number of provisions of the 1987 Constitution which are, in their assertion, violated by the continued implementation of Section 5 (a) and (f) of Republic Act 2381, as amended, and MECS Order No. 52, s. 1985. The provisions invoked read as follows: (a) Article 11, Section 11: "The state values the dignity of every human person and guarantees full respect of human rights. " (b) ArticleII, Section l3: "The State recognizes the vital role of the youth in nation building and shall promote and protect their physical, moral, spiritual, intellectual and social well being. It shall inculcate in the youth patriotism and nationalism, and encourage their involvement in public and civic affairs." (c) Article II, Section 17: "The State shall give priority to education, science and technology, arts, culture and sports to foster patriotism and nationalism, accelerate social progress and to promote total human liberation and development. "

(d) Article XIV, Section l: "The State shall protect and promote the right of all citizens to quality education at all levels and take appropriate steps to make such education accessible to all. " (e) Article XIV, Section 5 (3): "Every citizen has a right to select a profession or course of study, subject to fair, reasonable and equitable admission and academic requirements." Article II of the 1987 Constitution sets forth in its second half certain "State policies" which the government is enjoined to pursue and promote. The petitioners here have not seriously undertaken to demonstrate to what extent or in what manner the statute and the administrative order they assail collide with the State policies embodied in Sections 11, 13 and 17. They have not, in other words, discharged the burden of proof which lies upon them. This burden is heavy enough where the constitutional provision invoked is relatively specific, rather than abstract, in character and cast in behavioral or operational terms. That burden of proof becomes of necessity heavier where the constitutional provision invoked is cast, as the second portion of Article II is cast, in language descriptive of basic policies, or more precisely, of basic objectives of State policy and therefore highly generalized in tenor. The petitioners have not made their case, even a prima facie case, and we are not compelled to speculate and to imagine how the legislation and regulation impugned as unconstitutional could possibly offend the constitutional provisions pointed to by the petitioners. Turning to Article XIV, Section 1, of the 1987 Constitution, we note that once more petitioners have failed to demonstrate that the statute and regulation they assail in fact clash with that provision. On the contrary we may note-in anticipation of discussion infra — that the statute and the regulation which petitioners attack are in fact designed to promote "quality education" at the level of professional schools. When one reads Section 1 in relation to Section 5 (3) of Article XIV as one must one cannot but note that the latter phrase of Section 1 is not to be read with absolute literalness. The State is not really enjoined to take appropriate steps to make quality education " accessible to all who might for any number of reasons wish to enroll in a professional school but rather merely to make such education accessible to all who qualify under "fair, reasonable and equitable admission and academic requirements. " 2. In the trial court, petitioners had made the argument that Section 5 (a) and (f) of Republic Act No. 2382, as amended, offend against the constitutional principle which forbids the undue delegation of legislative power, by failing to establish the necessary standard to be followed by the delegate, the Board of Medical Education. The general principle of non-delegation of legislative power, which both flows from the reinforces the more fundamental rule of the separation and allocation of powers among the three great departments of government, 1 must be applied with circumspection in respect of statutes which like the Medical Act of 1959, deal with subjects as obviously complex and technical as medical education and the practice of medicine in our present day world. Mr. Justice Laurel stressed this point 47 years ago in Pangasinan Transportation Co., Inc. vs. The Public Service Commission:2 One thing, however, is apparent in the development of the principle of separation of powers and that is that the maxim of delegatus non potest delegare or delegate potestas non potest delegare, adopted this practice (Delegibus et Consuetudiniis Anglia edited by G.E. Woodbine, Yale University Press, 1922, Vol. 2, p. 167) but which is also recognized in principle in the Roman Law (d. 17.18.3) has been made to adapt itself to the complexities of modern government, giving rise to the adoption, within certain limits of the principle of "subordinate legislation," not only in the United States and England but in practically all modern governments. (People vs. Rosenthal and Osmena [68 Phil. 318, 1939]. Accordingly, with the growing complexity of modern life, the multiplication of the subjects of governmental regulation and the increased difficulty of administering the laws, there is a

constantly growing tendency toward the delegation of greater power by the legislature, and toward the approval of the practice by the courts." 3 The standards set for subordinate legislation in the exercise of rule making authority by an administrative agency like the Board of Medical Education are necessarily broad and highly abstract. As explained by then Mr. Justice Fernando in Edu v. Ericta4 — The standard may be either expressed or implied. If the former, the non-delegation objection is easily met.The standard though does not have to be spelled out specifically. It could be implied from the policy and purpose of the act considered as a whole. In the Reflector Law, clearly the legislative objective is public safety. What is sought to be attained as in Calalang v. Williams is "safe transit upon the roads. 5 We believe and so hold that the necessary standards are set forth in Section 1 of the 1959 Medical Act: "the standardization and regulation of medical education" and in Section 5 (a) and 7 of the same Act, the body of the statute itself, and that these considered together are sufficient compliance with the requirements of the non-delegation principle. 3. The petitioners also urge that the NMAT prescribed in MECS Order No. 52, s. 1985, is an "unfair, unreasonable and inequitable requirement," which results in a denial of due process. Again, petitioners have failed to specify just what factors or features of the NMAT render it "unfair" and "unreasonable" or "inequitable." They appear to suggest that passing the NMAT is an unnecessary requirement when added on top of the admission requirements set out in Section 7 of the Medical Act of 1959, and other admission requirements established by internal regulations of the various medical schools, public or private. Petitioners arguments thus appear to relate to utility and wisdom or desirability of the NMAT requirement. But constitutionality is essentially a question of power or authority: this Court has neither commission or competence to pass upon questions of the desirability or wisdom or utility of legislation or administrative regulation. Those questions must be address to the political departments of the government not to the courts. There is another reason why the petitioners' arguments must fail: the legislative and administrative provisions impugned by them constitute, to the mind of the Court, a valid exercise of the police power of the state. The police power, it is commonplace learning, is the pervasive and non-waivable power and authority of the sovereign to secure and promote an the important interests and needs — in a word, the public order — of the general community.6 An important component of that public order is the health and physical safety and well being of the population, the securing of which no one can deny is a legitimate objective of governmental effort and regulation. 7 Perhaps the only issue that needs some consideration is whether there is some reasonable relation between the prescribing of passing the NMAT as a condition for admission to medical school on the one hand, and the securing of the health and safety of the general community, on the other hand. This question is perhaps most usefully approached by recalling that the regulation of the practice of medicine in all its branches has long been recognized as a reasonable method of protecting the health and safety of the public.8 That the power to regulate and control the practice of medicine includes the power to regulate admission to the ranks of those authorized to practice medicine, is also well recognized. thus, legislation and administrative regulations requiring those who wish to practice medicine first to take and pass medical board examinations have long ago been recognized as valid exercises of governmental power.9 Similarly, the establishment of minimum medical educational requirements — i.e., the completion of prescribed courses in a recognized medical school — for admission to the medical profession, has also been sustained as a legitimate exercise of the regulatory authority of the state.10 What we have before us in the instant case is closely related: the regulation of access to medical schools. MECS Order No. 52, s. 1985, as noted earlier,

articulates the rationale of regulation of this type: the improvement of the professional and technical quality of the graduates of medical schools, by upgrading the quality of those admitted to the student body of the medical schools. That upgrading is sought by selectivity in the process of admission, selectivity consisting, among other things, of limiting admission to those who exhibit in the required degree the aptitude for medical studies and eventually for medical practice. The need to maintain, and the difficulties of maintaining, high standards in our professional schools in general, and medical schools in particular, in the current stage of our social and economic development, are widely known. We believe that the government is entitled to prescribe an admission test like the NMAT as a means for achieving its stated objective of "upgrading the selection of applicants into [our] medical schools" and of "improv[ing] the quality of medical education in the country." Given the widespread use today of such admission tests in, for instance, medical schools in the United States of America (the Medical College Admission Test [MCAT]11 and quite probably in other countries with far more developed educational resources than our own, and taking into account the failure or inability of the petitioners to even attempt to prove otherwise, we are entitled to hold that the NMAT is reasonably related to the securing of the ultimate end of legislation and regulation in this area. That end, it is useful to recall, is the protection of the public from the potentially deadly effects of incompetence and ignorance in those who would undertake to treat our bodies and minds for disease or trauma. 4. Petitioners have contended, finally, that MECS Order No. 52, s. 1985, is in conflict with the equal protection clause of the Constitution. More specifically, petitioners assert that that portion of the MECS Order which provides that the cutoff score for the successful applicants, based on the scores on the NMAT, shall be determined every-year by the Board of Medical 11 Education after consultation with the Association of Philippine Medical Colleges. (Emphasis supplied) infringes the requirements of equal protection. They assert, in other words, that students seeking admission during a given school year, e.g., 1987-1988, when subjected to a different cutoff score than that established for an, e.g., earlier school year, are discriminated against and that this renders the MECS Order "arbitrary and capricious." The force of this argument is more apparent than real. Different cutoff scores for different school years may be dictated by differing conditions obtaining during those years. Thus, the appropriate cutoff score for a given year may be a function of such factors as the number of students who have reached the cutoff score established the preceding year; the number of places available in medical schools during the current year; the average score attained during the current year; the level of difficulty of the test given during the current year, and so forth. To establish a permanent and immutable cutoff score regardless of changes in circumstances from year to year, may wen result in an unreasonable rigidity. The above language in MECS Order No. 52, far from being arbitrary or capricious, leaves the Board of Medical Education with the measure of flexibility needed to meet circumstances as they change. We conclude that prescribing the NMAT and requiring certain minimum scores therein as a condition for admission to medical schools in the Philippines, do not constitute an unconstitutional imposition. WHEREFORE, the Petition for certiorari is DISMISSED and the Order of the respondent trial court denying the petition for a writ of preliminary injunction is AFFIRMED. Costs against petitioners. SO ORDERED. Teehankee, C.J., Yap, Fernan, Narvasa, Melencio-Herrera, Gutierrez, Jr., Cruz, Paras, Gancayco, Padilla, Bidin, Sarmiento and Cortes, JJ., concur.

G.R. No. 88259 August 10, 1989 THE BOARD OF MEDICAL EDUCATION and the HON. LOURDES R. QUISUMBING, in her capacity as Secretary of the Department of Education, Culture and Sports and Chairman, Board of Medical Education, petitioners, vs. HON. DANIEL P. ALFONSO, Presiding Judge of the Regional Trial Court, Branch 74, Fourth Judicial Region, Antipolo, Rizal, and the PHILIPPINE MUSLIM-CHRISTIAN COLLEGE OF MEDICINE FOUNDATION, INC., respondents. Carpio, Villaraza & Cruz for private respondent. Anatolio S. Tuazon, Jr. for intervenors.

NARVASA, J.: Petitioners, the Board of Medical Education, the government agency which supervises and regulates the country's medical colleges, and Secretary Lourdes R. Quisumbing of the Department of Education, Culture and Sports, as Chairperson of the Board, pray for a writ of certiorari to nullify and set aside the order issued by respondent Judge Daniel P. Alfonso, Regional Trial Court, Antipolo, Rizal, in Civil Case No. 1385 restraining the enforcement of petitioner Quisumbing's order of closure of the respondent Philippine Muslim-Christian College of Medicine Foundation, Inc. (hereafter simply the College). lâwphî1.ñèt

The, College, a private educational institution, was founded in 1981 for the avowed purpose of producing physicians who will "emancipate Muslim citizens from age-old attitudes on health." The, unstable peace and order situation in Mindanao led to the establishment of the College in Antipolo, Rizal, which granted it a temporary permit to operate in the municipality, instead of in Zamboanga City where the school was first proposed to be located. It has since adopted Antipolo as its permanent site and changed its name to the Rizal College of Medicine. In 1985, the Department of Education, Culture and Sports (DECS) and the Board of Medical Education (BME) authorized the Commission on Medical Education to conduct a study of all medical schools in the Philippines. The, report of the Commission showed that the College fell very much short of the minimum standards set for medical schools. 1 The, team of inspectors, composed of Doctors Florentino Herrera, Jr., Elena Ines Cuyegkeng, Horacio Estrada, Jose V. Silao, Jr. and Andres L. Reyes, recommended the closure of the school 2 upon the following findings, to wit: (a) the College was not fulfilling the purpose for which it had been created because of its inappropriate location and the absence in its curriculum of subjects relating to Muslim culture and welfare; (b) its lack of university affiliation hindered its students from obtaining a "balanced humanistic and scientific" education; (c) it did not have its philosophy base hospital for the training of its students in the major clinical disciplines, as required by the DECS;

(d) more than 60% of the college faculty did not teach in the College full-time, resulting in shortened and irregular class hours, subject overloading, and in general, poor quality teaching. The, school disputed these findings as biased and discriminatory. At its request, the Board of Medical Education, in May, 1987, sent another team of doctors 3 for a re-evaluation of the College. After inspection, the team confirmed the previous findings and recommended the phase-out of the school. 4 The, first two reports were verified on June 23, 1987 by a third team of inspectors. 5 A year thereafter, the College failed another test what was in effect the fourth evaluation of its fitness to continue as a medical school conducted on March 4 and 5, 1988 by a team from the Board of Medical Education determining the eligibility of medical schools for government recognition. The, College was adjudged "inadequate" in all aspects of the survey, to wit, college, curriculum, facilities, teaching hospital, and studentry. 6 The, inspectors, Doctors Nilo Rosas, Macario Tan and Elena Ines Cuyegkeng, accordingly recommended denial of government; recognition. Accordingly, the Board of Medical Education recommended to the DECS the closure of the College, effective the end of the school year 1988-1989. The, College however succeeded in having the Board form yet another team to review the previous findings. Doctors Elena Ines Cuyegkeng, Alberto Romualdez, Artemio Ordinaria Joven Cuanang and Nilo L. Rosas conducted their inspection on June 18, 1988. Their findings: although there had been a "major effort to improve the physical plant for classroom instructions and the library, serious deficiencies remain(ed) in the areas of clinical facilities and library operations;" "faculty continue(d) to be quite inadequate with no prospects for satisfactory growth and development;" "student profile ... (was) below par from the point of view of credentials (NMAT and transfer records) as well as level knowledge and preparedness at various stages of medical education," and "the most serious deficiency ... (was) the almost total lack of serious development efforts in academic medicine — i.e., seeming lack of philosophy of teaching, no serious effort to study curricula, almost non-existent innovative approaches." Again, the recommendation was to close the College with provisions for the dispersal of its students to other medical schools. 7 In her letter of June 23, 1988, Secretary Quisumbing informed the Chairman of the College's Board of Trustees, Mr. Victor Sumulong, of the decision of the Board of Medical Education to close the College. Mr. Sumulong instead proposed a gradual phase-out starting the school year 1989-1990 in order not to dislocate the students and staff and to minimize financial loss. 8 The, Board subsequently allowed the College to continue its operations but only until May, 1989, after which it was to be closed, this decision being "final and unappealable." The, College was, however, assured of assistance in the relocation of its students and in its rehabilitation as an institution for health-related and paramedical courses. 9 The, College appealed the decision to the Office of the President, imputing grave abuse of discretion to the Secretary. 10 On February 16, 1989, Executive Secretary Catalino Macaraig, Jr., finding "no reason to disturb" the contested decision, affirmed it. 11 On March 2, 1989, the College went to court. It filed Civil Case No. 1385 in the court of respondent Judge Daniel P. Alfonso against Secretary Quisumbing in her capacity as Secretary of Education, Culture and Sports, questioning the decision as illegal, oppressive, arbitrary and discriminatory and applied for a writ of preliminary injunction to restrain its implementation. The, writ issued as prayed for by order of the respondent Judge dated May 10, 1989. 12 His Honor ruled that the inspection of June 18, 1988 was the principal basis of the closure order, and on such basis sustained the claim of the College that the inspection was done in an "arbitrary and haphazard manner"

by a team of inspectors who had already prejudged the school. Judge Alfonso held that there was no evidence supporting the findings in the report of June 18, 1988, and declared that his philosophy ocular inspection of the College disclosed that the deficiencies mentioned in the report were non-existent, and that on the contrary, the laboratory and library areas were "big enough," and in the operations of the proposed base hospital were going on smoothly at the time of the ocular inspection."

The, school thereupon promptly advertised in major newspaper dailies for enrollees in all levels of the medical college and in its pre-board review classes. 13 Hence the present petition, assailing the order of injunction dated May 10, 1989 as having been issued with grave abuse of discretion, and praying for a restraining order against its enforcement as well as for the dismissal of the action instituted in the court a quo. The, Court on June 1, 1989 ordered the respondent College to desist from advertising and admitting students, and the respondent judge to refrain from enforcing his injunction order. The, College in its Comment would justify its entitlement to the questioned injunction on the ground that the closure order against which it was directed was issued without factual basis and in violation of the right of the College to due process of law, and that it violates MECS Order No. 5 (Series of 1986) to the effect that the penalty of closure cannot be imposed earlier than three (3) years from the last evaluation, which in this instance was made, on June 18, 1988. Resort to the Courts to obtain a reversal of the determination by the Secretary of Education, Culture and Sports that the College is unfit to continue its operations is in this case clearly unavailing. There is, to begin with, no law authorizing an appeal from decisions or orders of the Secretary of Education, Culture and Sports to this Court or any other Court. It is not the function of this Court or any other Court to review the decisions and orders of the Secretary on the issue of whether or not an educational institution meets the norms and standards required for permission to operate and to continue operating as such. On this question, no Court has the power or prerogative to substitute its opinion for that of the Secretary. Indeed, it is obviously not expected that any Court would have the competence to do so. The, only authority reposed in the Courts in the matter is the determination of whether or not the Secretary of Education, Culture and Sports has acted within the scope of powers granted him by law and the Constitution. As long as it appears that he has done so, any decision rendered by him should not and will not be subject to review and reversal by any court. Of course, if it should be made, to appear to the Court that those powers were in a case exercised so whimsically, capriciously, oppressively, despotically or arbitrarily as to call for peremptory correction — or stated otherwise, that the Secretary had acted with grave abuse of discretion, or had unlawfully neglected the performance of an act which the law specifically enjoins as a duty, or excluded another from the use or enjoyment of a right or office to which such other is entitled — it becomes the Court's duty to rectify such action through the extraordinary remedies of certiorari, prohibition, or mandamus, whichever may properly apply. Yet even in these extreme instances, where a Court finds that there has been abuse of powers by the Secretary and consequently nullifies and/or forbids such an abuse of power, or compliance whatever is needful to keep its exercise within bounds, the Court, absent any compelling reason to do otherwise, should still leave to the Secretary the ultimate determination of the issue of the satisfy action or fulfillment by an educational institution of the standards set down for its legitimate operation, as to which it should not ordinarily substitute its over judgment for that of said office. In any case, the recorded facts quite clearly fail to support the College's claim of grave abuse of discretion containing the order of closure, and on the contrary convincingly show the challenged

decision to be correct. From 1985, no less than five (5) surveys were conducted of respondent institution to determine its compliance with the minimum standards established for a medical college. The, first survey, that undertaken by the Commission on Medical Education, disclosed such various and significant deficiencies in the school as to constrain the inspectors to recommend its closure. Four (4) other surveys were thereafter made by as many different committees or teams, at the school's instance or otherwise, all of which basically confirmed the results of that first survey. Moreover, the findings of all five (5) surveys were affirmed by the Office of the President. Indeed, the petitioner, through the Chairman of its Board of Trustees, to all intents and purposes accepted the validity of the findings of those five (5) survey groups when it proposed, in 1988, a gradual phase-out of the school starting in 1989. The, respondent College knew that the recommendation for its closure was made, as early as 1986, that recommendation was reiterated and reaffirmed four (4) times thereafter until it was finally approved and acted upon by the Secretary, whose action was confirmed by the Office of the President. Said respondent was given notice in June 1988, that in consequence of all these, the time for its definite closure had been unalterably set at May, 1989, a notice which was accompanied by assurances of assistance in the relocation of its students before June, 1989 and in its rehabilitation as a school for other courses. After having resorted to the whole range of administrative remedies available to it, without success, it sought to obtain from the respondent Court the relief it could not obtain from those sources, and what can only be described as a deliberate attempt to frustrate and obstruct implementation of the decision for its closure as of June, 1989 openly solicited, by newspaper advertisements or otherwise, enrollment of new and old students. Given these facts, and it being a matter of law that the Secretary of Education, Culture and Sports exercises the power to enjoin compliance with the requirements laid down for medical schools and to mete out sanctions where he finds that violations thereof have been committed, it was a grave abuse of discretion for the respondent judge to issue the questioned injunction and thereby thwart official action, in the premises correctly taken, allowing the College to operate without the requisite government permit. A single ocular inspection, done after the College had been pre-warned thereof, did not, in the circumstances, warrant only the findings of more qualified inspectors about the true state of the College, its faculty, facilities, operations, etc. The, members of the evaluating team came from the different sectors in the fields of education and medicine, 14 and their judgment in this particular area is certainly better than that of the respondent Judge whose sole and only visit to the school could hardly have given him much more to go on than a brief look at the physical plant and facilities and into the conduct of the classes and other school activities. Respondent Judge gravely abused his discretion in substituting his judgment for theirs. It is well-settled doctrine that courts of justice should not generally interfere with purely administrative and discretionary functions; that courts have no supervisory power over the proceedings and actions of the administrative departments of the government; involving the exercise of judgment and findings of facts, because by reason of their special knowledge and expertise over matters falling under their jurisdiction, the latter are in a better position to pass judgment on such matters andn their findings of facts in that regard are generally accorded respect, if not finality, by the courts. 15 There are, to be sure, exceptions to this general rule but none of them obtains in this case. The, claim of denial of due process likewise holds no water, as the record clearly shows that the College was given every opportunity to so improve itself as to come up to requirements, but remained sadly sub-standard after the inspections conducted by the evaluating teams. It had, in fact, admitted its failure to have up to the desired standards when it proposed its gradual phase-out in its letter dated June 27, 1988 to Secretary Quisumbing. It was also precisely because of its complaints of bias and prejudice that the Board of Medical Education dispatched new teams to survey and reevaluate its performance. It had even gone all the way up to the Office of the President to seek a reversal of the order of closure. There is thus no reason for it to complain of a lack of opportunity to be heard and to explain its side as well as to seek reconsideration of the ruling complained of.

There is also no merit in respondent College's argument that the closure violated NMCS ORDER No. 5, Series of 1986, because it was sought to be effected before the lapse of the three-year period therein snowed, which in this case is sought to be counted from June 18, 1988, or the date of the last evaluation. The, provision referred to reads: The following sanction shall be applied against any medical school, for failure to comply with the specific requirements of the essentials, viz.: xxx c. Withdrawal or cancellation of the school's government; authority to operate, for failure to fully comply with the prescribed requirements after three (3) years from the last evaluation conducted on the school. It must at once be obvious from a reading of the provision, paragraph c, that the situation therein contemplated — where a school is found to have failed to "fully comply with the prescribed requirements," i.e., has not complied with some requirements and has failed to do so within three (3) years from the last evaluation is quite distinct from that obtaining in the case at bar — where respondent school was found to have deficiencies so serious as to warrant its immediate closure. Said paragraph c should not be construed to prohibit absolutely the withdrawal or cancellation of government; authority to operate until after three (3) years from the last evaluation conducted on the school; or, stated otherwise, it does not unexceptionally prescribe a three-year waiting period before authority to operate may be withdrawn. Rather, it should be read as giving the Secretary of Education the discretion, depending on the seriousness of the discovered deficiencies, to afford an educational institution which has failed to comply with some requirement or other, time not exceeding three (3) years to correct the deficiencies before applying the sanction of withdrawal or cancellation of the government; authority to operate. The, circumstances in the case at bar are far from nominal and, to repeat, are different from those obviously envisioned by the paragraph in question. There had never been a recommendation that the College be granted an opportunity to comply with certain requirements. From the outset, the proposal had been that it be forthwith closed, its discovered deficiencies as a medical college being of so serious a character as to be irremediable. The, other four (4) surveys were conducted, not to determine if in the course of time the petitioner school had already fully complied with all the prescribed requisites, but rather, whether or not the original recommendation for its closure was correct and should be sustained. And, as already mentioned, the subsequent surveys, over a period of more than three (3) years, served but to confirm the validity of that initial proposal for its closure. Under these circumstances, therefore, even if it be assumed that the provision, paragraph c, applied to petitioner school, it must be held that there has been substantial compliance therewith. Having thus disposed of the issues raised by the facts of the case, the Court sees no useful purpose to be served by remanding the case to the Trial Court for further proceedings. The, only acceptable reason for such a remand would be so that the Trial Court may determine whether or not the petitioners' first have acted within the scope of their powers or grossly abused them, a matter that this Court has already passed upon here. Such a remand cannot be justified on the theory that the Trial Court will make its philosophy independent determination of whether or not respondent medical institution has complied with the minimum standards laid down for its continued operation, since, as here ruled, it has not that power. WHEREFORE, premises considered, the petition is hereby granted and the temporary restraining order issued by the Court is made, permanent. The, questioned writ of preliminary injunction dated May 10, 1989 is set aside and respondent Judge is ordered to dismiss Civil Case No. 1385.

SO ORDERED. Fernan, (C.J.), Gutierrez, Jr., Cruz, Paras, Feliciano, Gancayco, Padilla, Bidin, Cortes, Griñ;oAquino, Medialdea and Regalado, JJ., concur. Melencio-Herrera, and Sarmiento JJ., took no part.

G.R. No. 89572 December 21, 1989 DEPARTMENT OF EDUCATION, CULTURE AND SPORTS (DECS) and DIRECTOR OF CENTER FOR EDUCATIONAL MEASUREMENT, petitioners, vs. ROBERTO REY C. SAN DIEGO and JUDGE TERESITA DIZON-CAPULONG, in her capacity as Presiding Judge of the Regional Trial Court of Valenzuela, Metro Manila, Branch 172, respondents. Ramon M. Guevara for private respondent.

CRUZ, J.: The issue before us is mediocrity. The question is whether a person who has thrice failed the National Medical Admission Test (NMAT) is entitled to take it again. The petitioner contends he may not, under its rule thath) A student shall be allowed only three (3) chances to take the NMAT. After three (3) successive failures, a student shall not be allowed to take the NMAT for the fourth time. The private respondent insists he can, on constitutional grounds. But first the facts. The private respondent is a graduate of the University of the East with a degree of Bachelor of Science in Zoology. The petitioner claims that he took the NMAT three times and flunked it as many times. 1 When he applied to take it again, the petitioner rejected his application on the basis of the aforesaid rule. He then went to the Regional Trial Court of Valenzuela, Metro Manila, to compel his admission to the test. In his original petition for mandamus, he first invoked his constitutional rights to academic freedom and quality education. By agreement of the parties, the private respondent was allowed to take the NMAT scheduled on April 16, 1989, subject to the outcome of his petition. 2 In an amended petition filed with leave of court, he squarely challenged the constitutionality of MECS Order No. 12, Series of 1972, containing the above-cited rule. The additional grounds raised were due process and equal protection. After hearing, the respondent judge rendered a decision on July 4, 1989, declaring the challenged order invalid and granting the petition. Judge Teresita Dizon-Capulong held that the petitioner had been deprived of his right to pursue a medical education through an arbitrary exercise of the police power. 3 We cannot sustain the respondent judge. Her decision must be reversed.

In Tablarin v. Gutierrez, 4 this Court upheld the constitutionality of the NMAT as a measure intended to limit the admission to medical schools only to those who have initially proved their competence and preparation for a medical education. Justice Florentino P. Feliciano declared for a unanimous Court: Perhaps the only issue that needs some consideration is whether there is some reasonable relation between the prescribing of passing the NMAT as a condition for admission to medical school on the one hand, and the securing of the health and safety of the general community, on the other hand. This question is perhaps most usefully approached by recalling that the regulation of the pratice of medicine in all its branches has long been recognized as a reasonable method of protecting the health and safety of the public. That the power to regulate and control the practice of medicine includes the power to regulate admission to the ranks of those authorized to practice medicine, is also well recognized. Thus, legislation and administrative regulations requiring those who wish to practice medicine first to take and pass medical board examinations have long ago been recognized as valid exercises of governmental power. Similarly, the establishment of minimum medical educational requirements-i.e., the completion of prescribed courses in a recognized medical school-for admission to the medical profession, has also been sustained as a legitimate exercise of the regulatory authority of the state. What we have before us in the instant case is closely related: the regulation of access to medical schools. MECS Order No. 52, s. 1985, as noted earlier, articulates the rationale of regulation of this type: the improvement of the professional and technical quality of the graduates of medical schools, by upgrading the quality of those admitted to the student body of the medical schools. That upgrading is sought by selectivity in the process of admission, selectivity consisting, among other things, of limiting admission to those who exhibit in the required degree the aptitude for medical studies and eventually for medical practice. The need to maintain, and the difficulties of maintaining, high standards in our professional schools in general, and medical schools in particular, in the current state of our social and economic development, are widely known. We believe that the government is entitled to prescribe an admission test like the NMAT as a means of achieving its stated objective of "upgrading the selection of applicants into [our] medical schools" and of "improv[ing] the quality of medical education in the country." Given the widespread use today of such admission tests in, for instance, medical schools in the United States of America (the Medical College Admission Test [MCAT] and quite probably, in other countries with far more developed educational resources than our own, and taking into account the failure or inability of the petitioners to even attempt to prove otherwise, we are entitled to hold that the NMAT is reasonably related to the securing of the ultimate end of legislation and regulation in this area. That end, it is useful to recall, is the protection of the public from the potentially deadly effects of incompetence and ignorance in those who would undertake to treat our bodies and minds for disease or trauma. However, the respondent judge agreed with the petitioner that the said case was not applicable. Her reason was that it upheld only the requirement for the admission test and said nothing about the socalled "three-flunk rule." We see no reason why the rationale in the Tablarin case cannot apply to the case at bar. The issue raised in both cases is the academic preparation of the applicant. This may be gauged at least initially by the admission test and, indeed with more reliability, by the three-flunk rule. The latter cannot be regarded any less valid than the former in the regulation of the medical profession.

There is no need to redefine here the police power of the State. Suffice it to repeat that the power is validly exercised if (a) the interests of the public generally, as distinguished from those of a particular class, require the interference of the State, and (b) the means employed are reasonably necessary to the attainment of the object sought to be accomplished and not unduly oppressive upon individuals. 5 In other words, the proper exercise of the police power requires the concurrence of a lawful subject and a lawful method. The subject of the challenged regulation is certainly within the ambit of the police power. It is the right and indeed the responsibility of the State to insure that the medical profession is not infiltrated by incompetents to whom patients may unwarily entrust their lives and health. The method employed by the challenged regulation is not irrelevant to the purpose of the law nor is it arbitrary or oppressive. The three-flunk rule is intended to insulate the medical schools and ultimately the medical profession from the intrusion of those not qualified to be doctors. While every person is entitled to aspire to be a doctor, he does not have a constitutional right to be a doctor. This is true of any other calling in which the public interest is involved; and the closer the link, the longer the bridge to one's ambition. The State has the responsibility to harness its human resources and to see to it that they are not dissipated or, no less worse, not used at all. These resources must be applied in a manner that will best promote the common good while also giving the individual a sense of satisfaction. A person cannot insist on being a physician if he will be a menace to his patients. If one who wants to be a lawyer may prove better as a plumber, he should be so advised and adviced. Of course, he may not be forced to be a plumber, but on the other hand he may not force his entry into the bar. By the same token, a student who has demonstrated promise as a pianist cannot be shunted aside to take a course in nursing, however appropriate this career may be for others. The right to quality education invoked by the private respondent is not absolute. The Constitution also provides that "every citizen has the right to choose a profession or course of study, subject to fair, reasonable and equitable admission and academic requirements. 6 The private respondent must yield to the challenged rule and give way to those better prepared. Where even those who have qualified may still not be accommodated in our already crowded medical schools, there is all the more reason to bar those who, like him, have been tested and found wanting. The contention that the challenged rule violates the equal protection clause is not well-taken. A law does not have to operate with equal force on all persons or things to be conformable to Article III, Section 1 of the Constitution. There can be no question that a substantial distinction exists between medical students and other students who are not subjected to the NMAT and the three-flunk rule. The medical profession directly affects the very lives of the people, unlike other careers which, for this reason, do not require more vigilant regulation. The accountant, for example, while belonging to an equally respectable profession, does not hold the same delicate responsibility as that of the physician and so need not be similarly treated.

There would be unequal protection if some applicants who have passed the tests are admitted and others who have also qualified are denied entrance. In other words, what the equal protection requires is equality among equals. The Court feels that it is not enough to simply invoke the right to quality education as a guarantee of the Constitution: one must show that he is entitled to it because of his preparation and promise. The private respondent has failed the NMAT five times. 7 While his persistence is noteworthy, to say the least, it is certainly misplaced, like a hopeless love. No depreciation is intended or made against the private respondent. It is stressed that a person who does not qualify in the NMAT is not an absolute incompetent unfit for any work or occupation. The only inference is that he is a probably better, not for the medical profession, but for another calling that has not excited his interest. In the former, he may be a bungler or at least lackluster; in the latter, he is more likely to succeed and may even be outstanding. It is for the appropriate calling that he is entitled to quality education for the full harnessing of his potentials and the sharpening of his latent talents toward what may even be a brilliant future. We cannot have a society of square pegs in round holes, of dentists who should never have left the farm and engineers who should have studied banking and teachers who could be better as merchants. It is time indeed that the State took decisive steps to regulate and enrich our system of education by directing the student to the course for which he is best suited as determined by initial tests and evaluations. Otherwise, we may be "swamped with mediocrity," in the words of Justice Holmes, not because we are lacking in intelligence but because we are a nation of misfits. WHEREFORE, the petition is GRANTED. The decision of the respondent court dated January 13, 1989, is REVERSED, with costs against the private respondent. It is so ordered. Fernan, C.J., Narvasa Melencio-Herrera, Gutierrez, Jr., Paras, Feliciano, Gancayco, Padilla, Bidin, Sarmiento, Cortes, Griño-Aquino, Medialdea and Regalado, JJ., concur.

G.R. No. 144681

June 21, 2004

PROFESSIONAL REGULATION COMMISSION (PRC), CHAIRMAN HERMOGENES P. POBRE, ASSOCIATE COMMISSIONER ARMANDO PASCUAL, BOARD OF MEDICINE, CHAIRMAN RODOLFO P. DE GUZMAN, JOSE S. RAMIREZ, JUANITO B. BILLOTE, RUBEN R. POLICARPIO, EDGARDO T. FERNANDO and RICARDO D. FULGENCIO II, petitioners, vs. ARLENE V. DE GUZMAN, VIOLETA V. MENESES, CELERINA S. NAVARRO, JOSE RAMONCITO P. NAVARRO, ARNEL V. HERRERA and GERALDINE ELIZABETH M. PAGILAGAN, ELNORA R. RAQUENO, MARISSA A. REGODON, LAURA M. SANTOS, KARANGALAN D. SERRANO, DANILO A. VILLAVER, MARIA ROSARIO L. LEONOR, ALICIA S. LIZANO, MARITEL M. ECHIVERRI, BERNADETTE T. MENDOZA, FERNANDO F. MANDAPAT, ALELI A. GOLLAYAN, ELCIN C. ARRIOLA, HERMINIGILDA E. CONEJOS, SALLY B. BUNAGAN, ROGELIO B. ANCHETA, OSCAR H. PADUA, JR., EVELYN D. GRAJO, EVELYN S. ACOSTA, MARGARITA BELINDA L. VICENCIO, VALENTINO P. ARBOLEDA, EVELYN O. RAMOS, ACHILLES J. PERALTA, CORAZON M. CRUZ, LEUVINA P. CHICO, JOSEPH A. JAO, MA. LUISA S. GUTIERREZ, LYDIA C. CHAN, OPHELIA C. HIDALGO, FERNANDO T. CRUZ, MELVIN M. USITA, RAFAEL I. TOLENTINO, GRACE E. UY, CHERYL R. TRIGUERO, MICHAEL L. SERRANO, FEDERICO L. CASTILLO, MELITA J. CAÑEDO, SAMUEL B. BANGOY, BERNARDITA B. SY, GLORIA T. JULARBAL, FREDERICK D. FRANCISCO, CARLOS M. BERNARDO, JR., HUBERT S. NAZARENO, CLARISSA B. BACLIG, DAYMINDA G. BONTUYAN, BERNADETTE H. CABUHAT, NANCY J. CHAVEZ, MARIO D. CUARESMA, ERNESTO L. CUE, EVELYN C. CUNDANGAN, RHONEIL R. DEVERATURDA, DERILEEN D. DORADO, SAIBZUR N. EDDING, VIOLETA C. FELIPE, HERMINIO V. FERNANDEZ, JR., MARIA VICTORIA M. LACSAMANA, NORMA G. LAFAVILLA, RUBY B. LANTIN, MA. ELOISA Q. MALLARI, CLARISA SJ. NICOLAS, PERCIVAL H. PANGILINAN, ARNULFO A. SALVADOR, ROBERT B. SANCHEZ, MERLY D. STA. ANA and YOLANDA P. UNICA, respondents. DECISION TINGA, J.: This petition for review under Rule 45 of the 1997 Rules of Civil Procedure seeks to nullify the D E C I S I O N,1dated May 16, 2000, of the Court of Appeals in CA-G.R. SP No. 37283. The appellate court affirmed the judgment2 dated December 19, 1994, of the Regional Trial Court (RTC) of Manila, Branch 52, in Civil Case No. 93-66530. The trial court allowed the respondents to take their physician’s oath and to register as duly licensed physicians. Equally challenged is the R E S O L U T I O N3 promulgated on August 25, 2000 of the Court of Appeals, denying petitioners’ Motion for Reconsideration. The facts of this case are as follows: The respondents are all graduates of the Fatima College of Medicine, Valenzuela City, Metro Manila. They passed the Physician Licensure Examination conducted in February 1993 by the Board of Medicine (Board). Petitioner Professional Regulation Commission (PRC) then released their names as successful examinees in the medical licensure examination. Shortly thereafter, the Board observed that the grades of the seventy-nine successful examinees from Fatima College in the two most difficult subjects in the medical licensure exam, Biochemistry (Bio-Chem) and Obstetrics and Gynecology (OB-Gyne), were unusually and exceptionally high. Eleven Fatima examinees scored 100% in Bio-Chem and ten got

100% in OB-Gyne, another eleven got 99% in Bio-Chem, and twenty-one scored 99% in OBGyne. The Board also observed that many of those who passed from Fatima got marks of 95% or better in both subjects, and no one got a mark lower than 90%. A comparison of the performances of the candidates from other schools was made. The Board observed that strangely, the unusually high ratings were true only for Fatima College examinees. It was a record-breaking phenomenon in the history of the Physician Licensure Examination. On June 7, 1993, the Board issued Resolution No. 19, withholding the registration as physicians of all the examinees from the Fatima College of Medicine. 4 The PRC asked the National Bureau of Investigation (NBI) to investigate whether any anomaly or irregularity marred the February 1993 Physician Licensure Examination. Prior to the NBI investigation, the Board requested Fr. Bienvenido F. Nebres, S.J., an expert mathematician and authority in statistics, and later president of the Ateneo de Manila University, to conduct a statistical analysis of the results in Bio-Chem and Ob-Gyne of the said examination. On June 10, 1993, Fr. Nebres submitted his report. He reported that a comparison of the scores in Bio-Chem and Ob-Gyne, of the Fatima College examinees with those of examinees from De La Salle University and Perpetual Help College of Medicine showed that the scores of Fatima College examinees were not only incredibly high but unusually clustered close to each other. He concluded that there must be some unusual reason creating the clustering of scores in the two subjects. It must be a cause "strong enough to eliminate the normal variations that one should expect from the examinees [of Fatima College] in terms of talent, effort, energy, etc." 5 For its part, the NBI found that "the questionable passing rate of Fatima examinees in the [1993] Physician Examination leads to the conclusion that the Fatima examinees gained early access to the test questions."6 On July 5, 1993, respondents Arlene V. De Guzman, Violeta V. Meneses, Celerina S. Navarro, Jose Ramoncito P. Navarro, Arnel V. Herrera, and Geraldine Elizabeth M. Pagilagan (Arlene V. De Guzman et al., for brevity) filed a special civil action for mandamus, with prayer for preliminary mandatory injunction docketed as Civil Case No. 93-66530 with the Regional Trial Court (RTC) of Manila, Branch 52. Their petition was adopted by the other respondents as intervenors. Meanwhile, the Board issued Resolution No. 26, dated July 21, 1993, charging respondents with "immorality, dishonest conduct, fraud, and deceit" in connection with the Bio-Chem and Ob-Gyne examinations. It recommended that the test results of the Fatima examinees be nullified. The case was docketed as Adm. Case No. 1687 by the PRC. On July 28, 1993, the RTC issued an Order in Civil Case No. 93-66530 granting the preliminary mandatory injunction sought by the respondents. It ordered the petitioners to administer the physician’s oath to Arlene V. De Guzman et al., and enter their names in the rolls of the PRC. The petitioners then filed a special civil action for certiorari with the Court of Appeals to set aside the mandatory injunctive writ, docketed as CA-G.R. SP No. 31701. On October 21, 1993, the appellate court decided CA-G.R. SP No. 31701, with the dispositive portion of theDecision ordaining as follows: WHEREFORE, this petition is GRANTED. Accordingly, the writ of preliminary mandatory injunction issued by the lower court against petitioners is hereby nullified and set aside.

SO ORDERED.7 Arlene V. de Guzman, et al., then elevated the foregoing Decision to this Court in G.R. No. 112315. In ourResolution dated May 23, 1994, we denied the petition for failure to show reversible error on the part of the appellate court. Meanwhile, on November 22, 1993, during the pendency of the instant petition, the pre-trial conference in Civil Case No. 93-66530 was held. Then, the parties, agreed to reduce the testimonies of their respective witnesses to sworn questions-and-answers. This was without prejudice to crossexamination by the opposing counsel. On December 13, 1993, petitioners’ counsel failed to appear at the trial in the mistaken belief that the trial was set for December 15. The trial court then ruled that petitioners waived their right to cross-examine the witnesses. On January 27, 1994, counsel for petitioners filed a Manifestation and Motion stating the reasons for her non-appearance and praying that the cross-examination of the witnesses for the opposing parties be reset. The trial court denied the motion for lack of notice to adverse counsel. It also denied the Motion for Reconsideration that followed on the ground that adverse counsel was notified less than three (3) days prior to the hearing. Meanwhile, to prevent the PRC and the Board from proceeding with Adm. Case No. 1687, the respondents herein moved for the issuance of a restraining order, which the lower court granted in its Order dated April 4, 1994. The petitioners then filed with this Court a petition for certiorari docketed as G.R. No. 115704, to annul the Ordersof the trial court dated November 13, 1993, February 28, 1994, and April 4, 1994. We referred the petition to the Court of Appeals where it was docketed as CA-G.R. SP No. 34506. On August 31, 1994, the appellate court decided CA-G.R. SP No. 34506 as follows: WHEREFORE, the present petition for certiorari with prayer for temporary restraining order/preliminary injunction is GRANTED and the Orders of December 13, 1993, February 7, 1994, February 28, 1994, and April 4, 1994 of the RTC-Manila, Branch 52, and all further proceedings taken by it in Special Civil Action No. 93-66530 are hereby DECLARED NULL and VOID. The said RTC-Manila is ordered to allow petitioners’ counsel to cross-examine the respondents’ witnesses, to allow petitioners to present their evidence in due course of trial, and thereafter to decide the case on the merits on the basis of the evidence of the parties. Costs against respondents. IT IS SO ORDERED.8 The trial was then set and notices were sent to the parties. A day before the first hearing, on September 22, 1994, the petitioners filed an Urgent Ex-Parte Manifestation and Motion praying for the partial reconsideration of the appellate court’s decision in CA-G.R. SP No. 34506, and for the outright dismissal of Civil Case No. 93-66530. The petitioners asked for the suspension of the proceedings. In its Order dated September 23, 1994, the trial court granted the aforesaid motion, cancelled the scheduled hearing dates, and reset the proceedings to October 21 and 28, 1994.

Meanwhile, on October 25, 1994, the Court of Appeals denied the partial motion for reconsideration in CA-G.R. SP No. 34506. Thus, petitioners filed with the Supreme Court a petition for review docketed as G.R. No. 117817, entitled Professional Regulation Commission, et al. v. Court of Appeals, et al. On November 11, 1994, counsel for the petitioners failed to appear at the trial of Civil Case No. 9366530. Upon motion of the respondents herein, the trial court ruled that herein petitioners waived their right to cross-examine the herein respondents. Trial was reset to November 28, 1994. On November 25, 1994, petitioners’ counsel moved for the inhibition of the trial court judge for alleged partiality. On November 28, 1994, the day the Motion to Inhibit was to be heard, petitioners failed to appear. Thus, the trial court denied the Motion to Inhibit and declared Civil Case No. 9366530 deemed submitted for decision. On December 19, 1994, the trial court handed down its judgment in Civil Case No. 93-66530, the fallo of which reads: WHEREFORE, judgment is rendered ordering the respondents to allow the petitioners and intervenors (except those with asterisks and footnotes in pages 1 & 2 of this decision) [sic],9 to take the physician’s oath and to register them as physicians. It should be made clear that this decision is without prejudice to any administrative disciplinary action which may be taken against any of the petitioners for such causes and in the manner provided by law and consistent with the requirements of the Constitution as any other professionals. No costs. SO ORDERED.10 As a result of these developments, petitioners filed with this Court a petition for review on certiorari docketed as G.R. No. 118437, entitled Professional Regulation Commission v. Hon. David G. Nitafan, praying inter alia, that (1) G.R. No. 118437 be consolidated with G.R. No. 117817; (2) the decision of the Court of Appeals dated August 31, 1994 in CA-G.R. SP No. 34506 be nullified for its failure to decree the dismissal of Civil Case No. 93-66530, and in the alternative, to set aside the decision of the trial court in Civil Case No. 93-66530, order the trial court judge to inhibit himself, and Civil Case No. 93-66530 be re-raffled to another branch. On December 26, 1994, the petitioners herein filed their Notice of Appeal11 in Civil Case No. 9366530, thereby elevating the case to the Court of Appeals, where it was docketed as CA-G.R. SP No. 37283. In our Resolution of June 7, 1995, G.R. No. 118437 was consolidated with G.R. No. 117817. On July 9, 1998, we disposed of G.R. Nos. 117817 and 118437 in this wise: WHEREFORE, the petition in G.R. No. 117817 is DISMISSED for being moot. The petition in G.R. No. 118437 is likewise DISMISSED on the ground that there is a pending appeal before the Court of Appeals. Assistant Solicitor General Amparo M. Cabotaje-Tang is advised to be more circumspect in her dealings with the courts as a repetition of the same or similar acts will be dealt with accordingly.

SO ORDERED.12 While CA-G.R. SP No. 37283 was awaiting disposition by the appellate court, Arnel V. Herrera, one of the original petitioners in Civil Case No. 93-66530, joined by twenty-seven intervenors, to wit: Fernando F. Mandapat, Ophelia C. Hidalgo, Bernadette T. Mendoza, Ruby B. Lantin-Tan, Fernando T. Cruz, Marissa A. Regodon, Ma. Eloisa Q. Mallari-Largoza, Cheryl R. Triguero, Joseph A. Jao, Bernadette H. Cabuhat, Evelyn S. Acosta-Cabanes, Laura M. Santos, Maritel M. Echiverri, Bernadette C. Escusa, Carlosito C. Domingo, Alicia S. Lizano, Elnora R. Raqueno-Rabaino, Saibzur N. Edding, Derileen D. Dorado-Edding, Robert B. Sanchez, Maria Rosario L. Leonor-Lacandula, Geraldine Elizabeth M. Pagilagan-Palma, Margarita Belinda L. Vicencio-Gamilla, Herminigilda E. Conejos, Leuvina P. Chico-Paguio, Elcin C. Arriola-Ocampo, and Jose Ramoncito P. Navarro, manifested that they were no longer interested in proceeding with the case and moved for its dismissal. A similar manifestation and motion was later filed by intervenors Mary Jean I. YebanMerlan, Michael L. Serrano, Norma G. Lafavilla, Arnulfo A. Salvador, Belinda C. Rabara, Yolanda P. Unica, Dayminda G. Bontuyan, Clarissa B. Baclig, Ma. Luisa S. Gutierrez, Rhoneil R. Deveraturda, Aleli A. Gollayan, Evelyn C. Cundangan, Frederick D. Francisco, Violeta V. Meneses, Melita J. Cañedo, Clarisa SJ. Nicolas, Federico L. Castillo, Karangalan D. Serrano, Danilo A. Villaver, Grace E. Uy, Lydia C. Chan, and Melvin M. Usita. The Court of Appeals ruled that its decision in CA-G.R. SP No. 37283 would not apply to them. On May 16, 2000, the Court of Appeals decided CA-G.R. SP No. 37283, with the following fallo, to wit: WHEREFORE, finding no reversible error in the decision appealed from, We hereby AFFIRM the same and DISMISS the instant appeal. No pronouncement as to costs. SO ORDERED.13 In sustaining the trial court’s decision, the appellate court ratiocinated that the respondents complied with all the statutory requirements for admission into the licensure examination for physicians in February 1993. They all passed the said examination. Having fulfilled the requirements of Republic Act No. 2382,14 they should be allowed to take their oaths as physicians and be registered in the rolls of the PRC. Hence, this petition raising the following issues: I WHETHER OR NOT RESPONDENTS HAVE A VALID CAUSE OF ACTION FOR MANDAMUS AGAINST PETITIONERS IN THE LIGHT OF THE RESOLUTION OF THIS HONORABLE COURT IN G.R. NO. 112315 AFFIRMING THE COURT OF APPEALS’ DECISION DECLARING THAT IF EVER THERE IS SOME DOUBT AS TO THE MORAL FITNESS OF EXAMINEES, THE ISSUANCE OF LICENSE TO PRACTICE MEDICINE IS NOT AUTOMATICALLY GRANTED TO THE SUCCESSFUL EXAMINEES. II

WHETHER OR NOT THE PETITION FOR MANDAMUS COULD PROCEED DESPITE THE PENDENCY OF ADMINISTRATIVE CASE NO. 1687, WHICH WAS PRECISELY LODGED TO DETERMINE THE MORAL FITNESS OF RESPONDENTS TO BECOME DOCTORS. 15 To our mind, the only issue is: Did the Court of Appeals commit a reversible error of law in sustaining the judgment of the trial court that respondents are entitled to a writ of mandamus? The petitioners submit that a writ of mandamus will not lie in this case. They point out that for a writ of mandamus to issue, the applicant must have a well-defined, clear and certain legal right to the thing demanded and it is the duty of the respondent to perform the act required. Thus, mandamus may be availed of only when the duty sought to be performed is a ministerial and not a discretionary one. The petitioners argue that the appellate court’s decision in CA-G.R. SP No. 37283 upholding the decision of the trial court in Civil Case No. 93-66530 overlooked its own pronouncement in CAG.R. SP No. 31701. The Court of Appeals held in CA-G.R. SP No. 31701 that the issuance of a license to engage in the practice of medicine becomes discretionary on the PRC if there exists some doubt that the successful examinee has not fully met the requirements of the law. The petitioners stress that this Court’s Resolution dated May 24, 1994 in G.R. No. 112315 held that there was no showing "that the Court of Appeals had committed any reversible error in rendering the questioned judgment" in CA-G.R. SP No. 31701. The petitioners point out that our Resolution in G.R. No. 112315 has long become final and executory. Respondents counter that having passed the 1993 licensure examinations for physicians, the petitioners have the obligation to administer to them the oath as physicians and to issue their certificates of registration as physicians pursuant to Section 2016 of Rep. Act No. 2382. The Court of Appeals in CA-G.R. SP No. 37283, found that respondents complied with all the requirements of Rep. Act No. 2382. Furthermore, respondents were admitted by the Medical Board to the licensure examinations and had passed the same. Hence, pursuant to Section 20 of Rep. Act No. 2382, the petitioners had the obligation to administer their oaths as physicians and register them. Mandamus is a command issuing from a court of competent jurisdiction, in the name of the state or the sovereign, directed to some inferior court, tribunal, or board, or to some corporation or person requiring the performance of a particular duty therein specified, which duty results from the official station of the party to whom the writ is directed, or from operation of law.17 Section 3 of Rule 6518 of the 1997 Rules of Civil Procedure outlines two situations when a writ of mandamus may issue, when any tribunal, corporation, board, officer or person unlawfully (1) neglects the performance of an act which the law specifically enjoins as a duty resulting from an office, trust, or station; or (2) excludes another from the use and enjoyment of a right or office to which the other is entitled. We shall discuss the issues successively. 1. On The Existence of a Duty of the Board of Medicine To Issue Certificates of Registration as Physicians under Rep. Act No. 2382. For mandamus to prosper, there must be a showing that the officer, board, or official concerned, has a clear legal duty, not involving discretion. 19 Moreover, there must be statutory authority for the performance of the act,20 and the performance of the duty has been refused. 21 Thus, it must be pertinently asked now: Did petitioners have the duty to administer the Hippocratic Oath and register respondents as physicians under the Medical Act of 1959? As found by the Court of Appeals, on which we agree on the basis of the records:

It bears emphasizing herein that petitioner-appellees and intervenor-appellees have fully complied with all the statutory requirements for admission into the licensure examinations for physicians conducted and administered by the respondent-appellants on February 12, 14, 20 and 21, 1993. Stress, too, must be made of the fact that all of them successfully passed the same examinations.22 The crucial query now is whether the Court of Appeals erred in concluding that petitioners should allow the respondents to take their oaths as physicians and register them, steps which would enable respondents to practice the medical profession23 pursuant to Section 20 of the Medical Act of 1959? The appellate court relied on a single provision, Section 20 of Rep. Act No. 2382, in concluding that the petitioners had the ministerial obligation to administer the Hippocratic Oath to respondents and register them as physicians. But it is a basic rule in statutory construction that each part of a statute should be construed in connection with every other part to produce a harmonious whole, not confining construction to only one section.24 The intent or meaning of the statute should be ascertained from the statute taken as a whole, not from an isolated part of the provision. Accordingly, Section 20, of Rep. Act No. 2382, as amended should be read in conjunction with the other provisions of the Act. Thus, to determine whether the petitioners had the ministerial obligation to administer the Hippocratic Oath to respondents and register them as physicians, recourse must be had to the entirety of the Medical Act of 1959. A careful reading of Section 20 of the Medical Act of 1959 discloses that the law uses the word "shall" with respect to the issuance of certificates of registration. Thus, the petitioners "shall sign and issue certificates of registration to those who have satisfactorily complied with the requirements of the Board." In statutory construction the term "shall" is a word of command. It is given imperative meaning. Thus, when an examinee satisfies the requirements for the grant of his physician’s license, the Board is obliged to administer to him his oath and register him as a physician, pursuant to Section 20 and par. (1) of Section 2225 of the Medical Act of 1959. However, the surrounding circumstances in this case call for serious inquiry concerning the satisfactory compliance with the Board requirements by the respondents. The unusually high scores in the two most difficult subjects was phenomenal, according to Fr. Nebres, the consultant of PRC on the matter, and raised grave doubts about the integrity, if not validity, of the tests. These doubts have to be appropriately resolved. Under the second paragraph of Section 22, the Board is vested with the power to conduct administrative investigations and "disapprove applications for examination or registration," pursuant to the objectives of Rep. Act No. 2382 as outlined in Section 1 26 thereof. In this case, after the investigation, the Board filed before the PRC, Adm. Case No. 1687 against the respondents to ascertain their moral and mental fitness to practice medicine, as required by Section 9 27 of Rep. Act No. 2382. In its Decision dated July 1, 1997, the Board ruled: WHEREFORE, the BOARD hereby CANCELS the respondents[’] examination papers in the Physician Licensure Examinations given in February 1993 and further DEBARS them from taking any licensure examination for a period of ONE (1) YEAR from the date of the promulgation of this DECISION. They may, if they so desire, apply for the scheduled examinations for physicians after the lapse of the period imposed by the BOARD. SO ORDERED.28 Until the moral and mental fitness of the respondents could be ascertained, according to petitioners, the Board has discretion to hold in abeyance the administration of the Hippocratic Oath and the

issuance of the certificates to them. The writ of mandamus does not lie to compel performance of an act which is not duly authorized. The respondents nevertheless argue that under Section 20, the Board shall not issue a certificate of registration only in the following instances: (1) to any candidate who has been convicted by a court of competent jurisdiction of any criminal offense involving moral turpitude; (2) or has been found guilty of immoral or dishonorable conduct after the investigation by the Board; or (3) has been declared to be of unsound mind. They aver that none of these circumstances are present in their case. Petitioners reject respondents’ argument. We are informed that in Board Resolution No. 26, 29 dated July 21, 1993, the Board resolved to file charges against the examinees from Fatima College of Medicine for "immorality, dishonesty, fraud, and deceit in the Obstetrics-Gynecology and Biochemistry examinations." It likewise sought to cancel the examination results obtained by the examinees from the Fatima College. Section 830 of Rep. Act No. 2382 prescribes, among others, that a person who aspires to practice medicine in the Philippines, must have "satisfactorily passed the corresponding Board Examination." Section 22, in turn, provides that the oath may only be administered "to physicians who qualified in the examinations." The operative word here is "satisfactorily," defined as "sufficient to meet a condition or obligation" or "capable of dispelling doubt or ignorance." 31 Gleaned from Board Resolution No. 26, the licensing authority apparently did not find that the respondents "satisfactorily passed" the licensure examinations. The Board instead sought to nullify the examination results obtained by the respondents. 2. On the Right Of The Respondents To Be Registered As Physicians The function of mandamus is not to establish a right but to enforce one that has been established by law. If no legal right has been violated, there can be no application of a legal remedy, and the writ of mandamus is a legal remedy for a legal right.32 There must be a well-defined, clear and certain legal right to the thing demanded.33 It is long established rule that a license to practice medicine is a privilege or franchise granted by the government.34 It is true that this Court has upheld the constitutional right 35 of every citizen to select a profession or course of study subject to a fair, reasonable, and equitable admission and academic requirements.36 But like all rights and freedoms guaranteed by the Charter, their exercise may be so regulated pursuant to the police power of the State to safeguard health, morals, peace, education, order, safety, and general welfare of the people.37 Thus, persons who desire to engage in the learned professions requiring scientific or technical knowledge may be required to take an examination as a prerequisite to engaging in their chosen careers. This regulation takes particular pertinence in the field of medicine, to protect the public from the potentially deadly effects of incompetence and ignorance among those who would practice medicine. In a previous case, it may be recalled, this Court has ordered the Board of Medical Examiners to annul both its resolution and certificate authorizing a Spanish subject, with the degree of Licentiate in Medicine and Surgery from the University of Barcelona, Spain, to practice medicine in the Philippines, without first passing the examination required by the Philippine Medical Act.38 In another case worth noting, we upheld the power of the State to upgrade the selection of applicants into medical schools through admission tests.39 It must be stressed, nevertheless, that the power to regulate the exercise of a profession or pursuit of an occupation cannot be exercised by the State or its agents in an arbitrary, despotic, or oppressive manner. A political body that regulates the exercise of a particular privilege has the

authority to both forbid and grant such privilege in accordance with certain conditions. Such conditions may not, however, require giving up ones constitutional rights as a condition to acquiring the license.40 Under the view that the legislature cannot validly bestow an arbitrary power to grant or refuse a license on a public agency or officer, courts will generally strike down license legislation that vests in public officials discretion to grant or refuse a license to carry on some ordinarily lawful business, profession, or activity without prescribing definite rules and conditions for the guidance of said officials in the exercise of their power.41 In the present case, the aforementioned guidelines are provided for in Rep. Act No. 2382, as amended, which prescribes the requirements for admission to the practice of medicine, the qualifications of candidates for the board examinations, the scope and conduct of the examinations, the grounds for denying the issuance of a physician’s license, or revoking a license that has been issued. Verily, to be granted the privilege to practice medicine, the applicant must show that he possesses all the qualifications and none of the disqualifications. Furthermore, it must appear that he has fully complied with all the conditions and requirements imposed by the law and the licensing authority. Should doubt taint or mar the compliance as being less than satisfactory, then the privilege will not issue. For said privilege is distinguishable from a matter of right, which may be demanded if denied. Thus, without a definite showing that the aforesaid requirements and conditions have been satisfactorily met, the courts may not grant the writ of mandamus to secure said privilege without thwarting the legislative will. 3. On the Ripeness of the Petition for Mandamus Lastly, the petitioners herein contend that the Court of Appeals should have dismissed the petition for mandamus below for being premature. They argue that the administrative remedies had not been exhausted. The records show that this is not the first time that petitioners have sought the dismissal of Civil Case No. 93-66530. This issue was raised in G.R. No. 115704, which petition we referred to the Court of Appeals, where it was docketed as CA-G.R. SP No. 34506. On motion for reconsideration in CA-G.R. SP No. 34506, the appellate court denied the motion to dismiss on the ground that the prayers for the nullification of the order of the trial court and the dismissal of Civil Case No. 93-66530 were inconsistent reliefs. In G.R. No. 118437, the petitioners sought to nullify the decision of the Court of Appeals in CA-G.R. SP No. 34506 insofar as it did not order the dismissal of Civil Case No. 93-66530. In our consolidated decision, dated July 9, 1998, in G.R. Nos. 117817 & 118437, this Court speaking through Justice Bellosillo opined that: Indeed, the issue as to whether the Court of Appeals erred in not ordering the dismissal of Civil Case No. 93-66530 sought to be resolved in the instant petition has been rendered meaningless by an event taking place prior to the filing of this petition and denial thereof should follow as a logical consequence.42 There is no longer any justiciable controversy so that any declaration thereon would be of no practical use or value. 43 It should be recalled that in its decision of 19 December 1994 the trial court granted the writ of mandamus prayed for by private respondents, which decision was received by petitioners on 20 December 1994. Three (3) days after, or on 23 December 1994, petitioners filed the instant petition. By then, the remedy available to them was to appeal the decision to the Court of Appeals, which they in fact did, by filing a notice of appeal on 26 December 1994. 44 The petitioners have shown no cogent reason for us to reverse the aforecited ruling. Nor will their reliance upon the doctrine of the exhaustion of administrative remedies in the instant case advance their cause any. Section 2645 of the Medical Act of 1959 provides for the administrative and judicial remedies that respondents herein can avail to question Resolution No. 26 of the Board of Medicine, namely: (a)

appeal the unfavorable judgment to the PRC; (b) should the PRC ruling still be unfavorable, to elevate the matter on appeal to the Office of the President; and (c) should they still be unsatisfied, to ask for a review of the case or to bring the case to court via a special civil action of certiorari. Thus, as a rule, mandamus will not lie when administrative remedies are still available. 46 However, the doctrine of exhaustion of administrative remedies does not apply where, as in this case, a pure question of law is raised.47 On this issue, no reversible error may, thus, be laid at the door of the appellate court in CA-G.R. SP No. 37283, when it refused to dismiss Civil Case No. 93-66530. As we earlier pointed out, herein respondents Arnel V. Herrera, Fernando F. Mandapat, Ophelia C. Hidalgo, Bernadette T. Mendoza, Ruby B. Lantin-Tan, Fernando T. Cruz, Marissa A. Regodon, Ma. Eloisa Q. Mallari-Largoza, Cheryl R. Triguero, Joseph A. Jao, Bernadette H. Cabuhat, Evelyn S. Acosta-Cabanes, Laura M. Santos, Maritel M. Echiverri, Bernadette C. Escusa, Carlosito C. Domingo, Alicia S. Lizano, Elnora R. Raqueno-Rabaino, Saibzur N. Edding, Derileen D. DoradoEdding, Robert B. Sanchez, Maria Rosario Leonor-Lacandula, Geraldine Elizabeth M. PagilaganPalma, Margarita Belinda L. Vicencio-Gamilla, Herminigilda E. Conejos, Leuvina P. Chico-Paguio, Elcin C. Arriola-Ocampo, and Jose Ramoncito P. Navarro manifested to the Court of Appeals during the pendency of CA-G.R. SP No. 37283, that they were no longer interested in proceeding with the case and moved for its dismissal insofar as they were concerned. A similar manifestation and motion were later filed by intervenors Mary Jean I. Yeban-Merlan, Michael L. Serrano, Norma G. Lafavilla, Arnulfo A. Salvador, Belinda C. Rabarra, Yolanda P. Unica, Dayminda G. Bontuyan, Clarissa B. Baclig, Ma. Luisa S. Gutierrez, Rhoneil R. Deveraturda, Aleli A. Gollayan, Evelyn C. Cundangan, Frederick D. Francisco, Violeta V. Meneses, Melita J. Cañedo, Clarisa SJ. Nicolas, Federico L. Castillo, Karangalan D. Serrano, Danilo A. Villaver, Grace E. Uy, Lydia C. Chan, and Melvin M. Usita. Following these manifestations and motions, the appellate court in CA-G.R. SP No. 37283 decreed that its ruling would not apply to them. Thus, inasmuch as the instant case is a petition for review of the appellate court’s ruling in CA-G.R. SP No. 37283, a decision which is inapplicable to the aforementioned respondents will similarly not apply to them. As to Achilles J. Peralta, Evelyn O. Ramos, Sally B. Bunagan, Rogelio B. Ancheta, Oscar H. Padua, Jr., Evelyn D. Grajo, Valentino P. Arboleda, Carlos M. Bernardo, Jr., Mario D. Cuaresma, Violeta C. Felipe, Percival H. Pangilinan, Corazon M. Cruz and Samuel B. Bangoy, herein decision shall not apply pursuant to the Orders of the trial court in Civil Case No. 93-66530, dropping their names from the suit. Consequently, this Decision is binding only on the remaining respondents, namely: Arlene V. de Guzman, Celerina S. Navarro, Rafael I. Tolentino, Bernardita B. Sy, Gloria T. Jularbal, Hubert S. Nazareno, Nancy J. Chavez, Ernesto L. Cue, Herminio V. Fernandez, Jr., Maria Victoria M. Lacsamana and Merly D. Sta. Ana, as well as the petitioners. WHEREFORE, the instant petition is GRANTED. Accordingly, (1) the assailed decision dated May 16, 2000, of the Court of Appeals, in CA-G.R. SP No. 37283, which affirmed the judgment dated December 19, 1994, of the Regional Trial Court of Manila, Branch 52, in Civil Case No. 93-66530, ordering petitioners to administer the physician’s oath to herein respondents as well as the resolution dated August 25, 2000, of the appellate court, denying the petitioners’ motion for reconsideration, are REVERSED and SET ASIDE; and (2) the writ of mandamus, issued in Civil Case No. 93-66530, and affirmed by the appellate court in CA-G.R. SP No. 37283 is NULLIFIED AND SET ASIDE. SO ORDERED. Puno, Quisumbing, Austria-Martinez, and Callejo, Sr., JJ., concur.

BOARD OF MEDICINE,

G.R. No. 166097

DR. RAUL FLORES (now DR. JOSE S. RAMIREZ),

Present:

in his capacity as Chairman of the Board, PROFESSIONAL

QUISUMBING,* J.,

REGULATION COMMISSION,

YNARES-SANTIAGO,

through its Chairman,

Chairperson,

HERMOGENES POBRE

AUSTRIA-MARTINEZ,

(now DR. ALCESTIS M. GUIANG),

NACHURA, and

Petitioners,

REYES, JJ.

-versus-

Promulgated: YASUYUKI OTA,

July 14, 2008

Respondent. x -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --- x

DECISION

AUSTRIA-MARTINEZ, J.:

Before the Court is a Petition for Review on Certiorari assailing the Decision[1] of the Court of Appeals (CA) in CA-G.R. SP No. 84945[2] dated November 16, 2004 which affirmed the [3] Decision of the Regional Trial Court (RTC), Branch 22, Manila, datedOctober 19, 2003.[4]

The facts are as follows:

Yasuyuki Ota (respondent) is a Japanese national, married to a Filipina, who has continuously resided in the Philippines for more than 10 years. He graduated from Bicol Christian College of Medicine on April 21, 1991 with a degree of Doctor of Medicine. [5] After successfully completing a one-year post graduate internship training at the Jose Reyes Memorial Medical Center, he filed an application to take the medical board examinations in order to obtain a medical license. He was required by the Professional Regulation Commission (PRC) to submit an affidavit of undertaking, stating among others that should he successfully pass the same, he would not practice medicine until he submits proof that reciprocity exists between Japan and the Philippines in admitting foreigners into the practice of medicine. [6]

Respondent submitted a duly notarized English translation of the Medical Practitioners Law of Japan duly authenticated by the Consul General of the Philippine Embassy to Japan, Jesus I. Yabes; [7] thus, he was allowed to take the Medical Board Examinations in August 1992, which he subsequently passed.[8]

In spite of all these, the Board of Medicine (Board) of the PRC, in a letter dated March 8, 1993, denied respondent's request for a license to

practice medicine in the Philippines on the ground that the Board believes that no genuine reciprocity can be found in the law of Japan as there is no Filipino or foreigner who can possibly practice there.[9]

Respondent then filed a Petition for Certiorari and Mandamus against the Board before the RTC of Manila on June 24, 1993, which petition was amended on February 14, 1994 to implead the PRC through its Chairman.[10]

In his petition before the RTC, respondent alleged that the Board and the PRC, in refusing to issue in his favor a Certificate of Registration and/or license to practice medicine, had acted arbitrarily, in clear contravention of the provision of Section 20 of Republic Act (R.A.) No. 2382 (The Medical Act of 1959), depriving him of his legitimate right to practice his profession in the Philippines to his great damage and prejudice. [11]

On October 19, 2003, the RTC rendered its Decision finding that respondent had adequately proved that the medical laws of Japan allow foreigners like Filipinos to be granted license and be admitted into the practice of medicine under the principle of reciprocity; and that the Board had a ministerial duty of issuing the Certificate of Registration and license to respondent, as it was shown that he had substantially complied with the requirements under the law.[12] The RTC then ordered the Board to issue in favor of respondent the corresponding Certificate of Registration and/or license to practice medicine in the Philippines.[13] The Board and the PRC (petitioners) appealed the case to the CA, stating that while respondent submitted documents showing that foreigners are allowed to practice medicine in Japan, it was not shown that the conditions for the practice of medicine there are practical and attainable by a foreign applicant, hence, reciprocity was not established; also, the power of the PRC and the Board to

regulate and control the practice of medicine is discretionary and not ministerial, hence, not compellable by a writ of mandamus.[14]

The CA denied the appeal and affirmed the ruling of the RTC. [15]

Hence, herein petition raising the following issue:

WHETHER THE COURT OF APPEALS COMMITTED A REVERSIBLE ERROR IN FINDING THAT RESPONDENT HAD ESTABLISHED THE EXISTENCE OF RECIPROCITY IN THE PRACTICE OF MEDICINE BETWEEN [16] THE PHILIPPINES AND JAPAN.

Petitioners claim that: respondent has not established by competent and conclusive evidence that reciprocity in the practice of medicine exists between the Philippines and Japan. While documents state that foreigners are allowed to practice medicine in Japan, they do not similarly show that the conditions for the practice of medicine in said country are practical and attainable by a foreign applicant. There is no reciprocity in this case, as the requirements to practice medicine in Japan are practically impossible for a Filipino to comply with. There are also ambiguities in the Medical Practitioners Law of Japan, which were not clarified by respondent, i.e., what are the provisions of the School Educations Laws, what are the criteria of the Minister of Health and Welfare of Japan in determining whether the academic and technical capability of foreign medical graduates are the same or better than graduates of medical schools in Japan, and who can actually qualify to take the preparatory test for the National Medical Examination. Consul General Yabes also stated that there had not been a single Filipino who was issued a license to practice medicine by the Japanese Government. The publication showing that there were foreigners practicing medicine in Japan, which respondent presented before the Court, also did not specifically show that Filipinos were among those listed as practicing said profession. [17] Furthermore, under Professional Regulation Commission v. De Guzman, [18] the

power of the PRC and the Board to regulate and control the practice of medicine includes the power to regulate admission to the ranks of those authorized to practice medicine, which power is discretionary and not ministerial, hence, not compellable by a writ of mandamus.[19] Petitioners pray that the CA Decision dated November 16, 2004 be reversed and set aside, that a new one be rendered reinstating the Board Order dated March 8, 1993 which disallows respondent to practice medicine in the Philippines, and that respondent's petition before the trial court be dismissed for lack of merit.[20]

In his Comment, respondent argues that: Articles 2 and 11 of the Medical Practitioners Law of Japan and Section 9 of the Philippine Medical Act of 1959 show that reciprocity exists between the Philippines and Japan concerning the practice of medicine. Said laws clearly state that both countries allow foreigners to practice medicine in their respective jurisdictions as long as the applicant meets the educational requirements, training or residency in hospitals and pass the licensure examination given by either country. Consul General Yabes in his letter dated January 28, 1992 stated that the Japanese Government allows a foreigner to practice medicine inJapan after complying with the local requirements. The fact that there is no reported Filipino who has successfully penetrated the medical practice in Japan does not mean that there is no reciprocity between the two countries, since it does not follow that no Filipino will ever be granted a medical license by the Japanese Government. It is not the essence of reciprocity that before a citizen of one of the contracting countries can demand its application, it is necessary that the interested citizens country has previously granted the same privilege to the citizens of the other contracting country. [21] Respondent further argues that Section 20 of the Medical Act of 1959 [22] indicates the mandatory character of the statute and an imperative obligation on the part of the Board inconsistent with the idea of discretion. Thus, a foreigner, just like a Filipino citizen, who successfully passes the examination and has all the qualifications

and none of the disqualifications, is entitled as a matter of right to the issuance of a certificate of registration or a physicians license, which right is enforceable by mandamus.[23]

Petitioners filed a Reply[24] and both parties filed their respective memoranda[25] reiterating their arguments.

The Court denies the petition for lack of merit.

There is no question that a license to practice medicine is a privilege or franchise granted by the government. [26] It is a right that is earned through years of education and training, and which requires that one must first secure a license from the state through professional board examinations. [27] Indeed, [T]he regulation of the practice of medicine in all its branches has long been recognized as a reasonable method of protecting the health and safety of the public. That the power to regulate and control the practice of medicine includes the power to regulate admission to the ranks of those authorized to practice medicine, is also well recognized. Thus, legislation and administrative regulations requiring those who wish to practice medicine first to take and pass medical board examinations have long ago been recognized as valid exercises of governmental power. Similarly, the establishment of minimum medical educational requirements i.e., the completion of prescribed courses in a recognized medical school for admission to the medical profession, has also been sustained as a legitimate exercise of the regulatory authority of the state. [28]

It must be stressed however that the exercise of a profession or pursuit of an exercised by the State or its agents in an oppressive manner. A political body which

power to regulate the occupation cannot be arbitrary, despotic, or regulates the exercise

of a particular privilege has the authority to both forbid and grant such privilege in accordance with certain conditions. As the legislature cannot validly bestow an arbitrary power to grant or refuse a license on a public agency or officer, courts will generally strike down license legislation that vests in public officials discretion to grant or refuse a license to carry on some ordinarily lawful business, profession, or activity without prescribing definite rules and conditions for the guidance of said officials in the exercise of their power.[29]

R.A. No. 2382 otherwise known as the Medical Act of 1959 states in Section 9 thereof that:

Section 9. Candidates for Board Examinations.- Candidates for Board examinations shall have the following qualifications:

1. He shall be a citizen of the Philippines or a citizen of any foreign country who has submitted competent and conclusive documentary evidence, confirmed by the Department of Foreign Affairs, showing that his countrys existing laws permit citizens of the Philippines to practice medicine under the same rules and regulations governing citizens thereof;

xxxx

Presidential Decree (P.D.) No. 223 [30] also provides in Section (j) thereof that: j) The [Professional Regulation] Commission may, upon the recommendation of the Board concerned, approve the registration of and authorize the issuance of a certificate of registration with or without examination to a foreigner who is registered under the laws of his country: Provided, That the requirement for the registration or licensing in said foreign state or country are substantially the same as those required and contemplated by the laws of the Philippines and

that the laws of such foreign state or country allow the citizens of the Philippines to practice the profession on the same basis and grant the same privileges as the subject or citizens of such foreign state or country: Provided, finally, That the applicant shall submit competent and conclusive documentary evidence, confirmed by the Department of Foreign Affairs, showing that his country's existing laws permit citizens of the Philippines to practice the profession under the rules and regulations governing citizens thereof. The Commission is also hereby authorized to prescribe additional requirements or grant certain privileges to foreigners seeking registration in the Philippines if the same privileges are granted to or some additional requirements are required of citizens of the Philippines in acquiring the same certificates in his country;

xxxx

As required by the said laws, respondent submitted a copy of the Medical Practitioners Law of Japan, duly authenticated by the Consul General of the Embassy of the Philippines in Japan, which provides in Articles 2 and 11, thus: Article 2. Anyone who wants to be medical practitioner must pass the national examination for medical practitioner and get license from the Minister of Health and Welfare.

xxxx

Article 11. No one can take the National Medical Examination except persons who conform to one of the following items:

1.

Persons who finished regular medical courses at a university based on the School Education Laws (December 26, 1947) and graduated from said university.

2.

Persons who passed the preparatory test for the National Medical Examination and practiced clinics and public sanitation more than one year after passing the said test.

3.

Persons who graduated from a foreign medical school or acquired medical practitioner license in a foreign country, and also are recognized to have the same or more academic ability and techniques as persons stated in item 1 and item 2 of this article.[31]

Petitioners argue that while the Medical Practitioners Law of Japan allows foreigners to practice medicine therein, said document does not show that conditions for the practice of medicine in said country are practical and attainable by a foreign applicant; and since the requirements are practically impossible for a Filipino to comply with, there is no reciprocity between the two countries, hence, respondent may not be granted license to practice medicine in the Philippines.

The Court does not agree.

R.A. No. 2382, which provides who may be candidates for the medical board examinations, merely requires a foreign citizen to submit competent and conclusive documentary evidence, confirmed by the Department of Foreign Affairs (DFA), showing that his countrys existing laws permit citizens of the Philippines to practice medicine under the same rules and regulations governing citizens thereof.

Section (j) of P.D. No. 223 also defines the extent of PRC's power to grant licenses, i.e., it may, upon recommendation of the board, approve the registration and authorize the issuance of a certificate of registration with or without examination to a foreigner who is registered under the

laws of his country, provided the following conditions are met: (1) that the requirement for the registration or licensing in said foreign state or country are substantially the same as those required and contemplated by the laws of the Philippines; (2) that the laws of such foreign state or country allow the citizens of the Philippines to practice the profession on the same basis and grant the same privileges as the subject or citizens of such foreign state or country; and (3) that the applicant shall submit competent and conclusive documentary evidence, confirmed by the DFA, showing that his country's existing laws permit citizens of the Philippines to practice the profession under the rules and regulations governing citizens thereof.

The said provision further states that the PRC is authorized to prescribe additional requirements or grant certain privileges to foreigners seeking registration in the Philippines if the same privileges are granted to or some additional requirements are required of citizens of the Philippines in acquiring the same certificates in his country.

Nowhere in said statutes is it stated that the foreign applicant must show that the conditions for the practice of medicine in said country are practical and attainable by Filipinos. Neither is it stated that it must first be proven that a Filipino has been granted license and allowed to practice his profession in said country before a foreign applicant may be given license to practice in thePhilippines. Indeed, the phrase used in both R.A. No. 2382 and P.D. No. 223 is that: [T]he applicant shall submit] competent and conclusive documentary evidence, confirmed by the Department of Foreign Affairs, showing that his country's existing laws permit citizens of the Philippines to practice the profession [of medicine] under the [same] rules and regulations governing citizens thereof. x x x (Emphasis supplied)

It is enough that the laws in the foreign country permit a Filipino to get license and practice therein. Requiring respondent to prove first that a Filipino has already been granted license and is actually practicing therein unduly expands the requirements provided for under R.A. No. 2382 and P.D. No. 223.

While it is true that respondent failed to give details as to the conditions stated in the Medical Practitioners Law of Japan -- i.e.,the provisions of the School Educations Laws, the criteria of the Minister of Health and Welfare of Japan in determining whether the academic and technical capability of foreign medical graduates are the same as or better than that of graduates of medical schools in Japan, and who can actually qualify to take the preparatory test for the National Medical Examination respondent, however, presented proof that foreigners are actually practicing in Japan and that Filipinos are not precluded from getting a license to practice there.

Respondent presented before the trial court a Japanese Government publication, Physician-Dentist-Pharmaceutist Survey, showing that there are a number of foreign physicians practicing medicine in Japan.[32] He also presented a letter dated January 28, 1992 from Consul General Yabes,[33] which states:

Sir:

With reference to your letter dated 12 January 1993, concerning your request for a Certificate of Confirmation for the purpose of establishing a reciprocity with Japan in the practice of medical profession relative to the case of Mr. Yasuyuki Ota, a Japanese national, the Embassy wishes to inform you that inquiries from the Japanese Ministry of Foreign Affairs, Ministry of Health and Welfare as well as Bureau of Immigration yielded the following information:

1.

They are not aware of a Filipino physician who was granted a license by the Japanese Government to practice medicine in Japan;

2.

However, the Japanese Government allows a foreigner to practice medicine in Japan after complying with the local requirements such as holding a valid visa for the purpose of taking the medical board exam, checking the applicant's qualifications to take the examination, taking the national board examination in Japanese and filing an application for the issuance of the medical license.

Accordingly, the Embassy is not aware of a single Filipino physician who was issued by the Japanese Government a license to practice medicine, because it is extremely difficult to pass the medical board examination in the Japanese language. Filipino doctors here are only allowed to work in Japanese hospitals as trainees under the supervision of a Japanese doctor. On certain occasions, they are allowed to show their medical skills during seminars for demonstration purposes only. (Emphasis supplied)

Very truly yours,

Jesus I. Yabes Minister Counsellor & Consul General

From said letter, one can see that the Japanese Government allows foreigners to practice medicine therein provided that the local requirements are complied with, and that it is not the impossibility or the prohibition against Filipinos that would account for the absence of Filipino physicians holding licenses and practicing medicine in Japan, but the difficulty of passing the board examination in the Japanese language. Granting that there is still no Filipino who has been given license to practice medicine in Japan, it does not mean that no Filipino will ever be able to be given one.

Petitioners next argue that as held in De Guzman, its power to issue licenses is discretionary, hence, not compellable bymandamus.

The Court finds that the factual circumstances of De Guzman are different from those of the case at bar; hence, the principle applied therein should be viewed differently in this case. In De Guzman, there were doubts about the integrity and validity of the test results of the examinees from a particular school which garnered unusually high scores in the two most difficult subjects. Said doubts called for serious inquiry concerning the applicants satisfactory compliance with the Board requirements.[34] And as there was no definite showing that the requirements and conditions to be granted license to practice medicine had been satisfactorily met, the Court held that the writ of mandamus may not be granted to secure said privilege without thwarting the legislative will.[35]

Indeed, to be granted the privilege to practice medicine, the applicant must show that he possesses all the qualifications and none of the disqualifications. It must also appear that he has fully complied with all the conditions and requirements imposed by the law and the licensing authority.[36]

In De Guzman itself, the Court explained that: A careful reading of Section 20[37] of the Medical Act of 1959 discloses that the law uses the word shall with respect to the issuance of certificates of registration. Thus, the petitioners [PRC] shall sign and issue certificates of registration to those who have satisfactorily complied with the requirements of the Board. In statutory construction the term shall is a word of command. It is given imperative meaning. Thus, when an examinee satisfies the requirements for the grant of his physician's license, the Board is obliged to administer to him his oath and register him as a physician, pursuant to Section 20 and par. (1) of Section 22 of the Medical Act of 1959.[38]

In this case, there is no doubt as to the competence and qualifications of respondent. He finished his medical degree fromBicol Christian College of Medicine. He completed a one-year post graduate internship training at the Jose Reyes Memorial MedicalCenter, a government hospital. Then he passed the Medical Board Examinations which was given on August 8, 1992 with a general average of 81.83, with scores higher than 80 in 9 of the 12 subjects.

In fine, the only matter being questioned by petitioners is the alleged failure of respondent to prove that there is reciprocity between the laws of Japan and the Philippines in admitting foreigners into the practice of medicine. Respondent has satisfactorily complied with the said requirement and the CA has not committed any reversible error in rendering its Decision dated November 16, 2004 and Resolution dated October 19, 2003.

WHEREFORE, the petition is hereby DENIED for lack of merit.

SO ORDERED.

MA. ALICIA AUSTRIA-MARTINEZ Associate Justice

WE CONCUR:

LEONARDO A. QUISUMBING Associate Justice

CONSUELO YNARESSANTIAGO Associate Justice

ANTONIO EDUARDO B. NACHURA Associate Justice

Chairperson

RUBEN T. REYES Associate Justice

ATTESTATION

I attest that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division.

CONSUELO YNARES-SANTIAGO

Associate Justice Chairperson, Third Division

CERTIFICATION Pursuant to Section 13, Article VIII of the Constitution, and the Division Chairpersons Attestation, it is hereby certified that the conclusions in the above Decision had been reached in consultation before the case was assigned to the writer of the opinion of the Courts Division.

REYNATO S. PUNO Chief Justice