med juris

BASICS OF PHILIPPINE MEDICAL JURISPRUDENCE AND ETHICS

2010 EDITION JOSUE N. BELLOSILLO BU C. CASTRO EMMANUEL LJ. MAPILI ALBERT D. REBOSA ANTONIO D. REBOSA Published by

CENTRAL BOOK SUPPLY, INC. 927 Quezon Avenue, Quezon City Philippines

TABLE OF CONTENTS Foreword/in Preface/vii AcknowledgmentsI-a. Chapter 1 MEDICAL JURISPRUDENCE 1.1. Medical Jurisprudence defined/l 1.2. Distinction with legal and forensic medicine/2 1.3. The law of Hippocrates/3 1. 2. 3. 4. 5. 1.4. 1.5. 1.6. 1.7. 1.8.

Responsibilities to patientI \ Responsibilities to the profession / 6 Responsibilities to colleagues/l Responsibilities to society11 Responsibilities to allied health professionals I %

Medical law/9 History of Philippine medical law/ll Place of law in the medical profession/ll Functions of the law in medicine/12 Sources of law/13 1. 2. 3. 4.

Statutory lawI Xh Constitutional lawI'13 Administrative law/13 Common Iaw/l3

IX

Table of Contents

1.9

Classification of law/14 1. Public lawI'16 (a) (b)

Criminal law/16 International law/16 (i) (ii)

(c)

Public international law116 Private international law/16

Political law/16 (i) (ii) (iii) (iv)

Constitutional law/16 Administrative law/11 I ^ w of public administration/XI J^zw of public corporation / \1

2. Private law/Yl (a) (b) (c)

Civil law/\1 Commercial law/\l Remedial law/Yl

1.10. Medical legislation/18 1.11. Medical ethics/18 1.12. Common legal terms/18 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Torts/li Deposition/is Plaintiff/18 Defendant/18 Defamation/\% Expert witness/18 GcW Samaritan LMW/19 Interrogatory/19 Malpractice/'19 Negligence/19

Table of Contents

11. Proximate cause/19 12. Reasonable care/19

Chapter 2 REGULATION OF THE MEDICAL PROFESSION 2.1. Basis of state regulation/20 2.2. Constitutional basis/20 2.3. Statutory basis/21 2.4. Reason for regulation/22 2.5. Warranties in the practice of medicine/23 Chapter 3 MEDICAL EDUCATION SYSTEM IN THE PHILIPPINES 3.1. 3.2. 3.3.

Commission on Higher Education (CHED)/25 Association of Philippine Medical Colleges/26 Admission requirements to a medical college/26 1. National Medical Admission Test (NMA T)/27

3.4. 3.5. 3.6. 3.7.

(a)

Three-Flunk Rule/21

(b) (c)

Academic freedom, not absolute/28 Equal protection not violated/2%

Medical school curriculum/29 Clinical clerkship/29 Medical education credentials awarded/30 Medical internship/30 1.

Medical internship progam /30

XI

Table of Contents

Chapter 4 LICENSURE AND REGISTRATION OF PHYSICIANS 4.1.

Licensure/31 1. 2. 3. 4.

4.2.

Oath taking and conferment ceremonies/34 1. 2.

4.3.

Qualifications of candidatesfor board examinations/'31 Scope of examination/32 Documents to accompany an application for licensure examination/32 Passing rate/33

The Hippocratic Oath/ 34 Administrative Oath/3b

Certificate of registration/36 1. 2. 3. 4. 5. 6. 7. 8.

Right to be registered as physicians/36 Rule of reciprocity / 39 Groundsfor refusal of issuance of certificates of registration/41 Duty of the Board ofMedicine to issue certificates ofregistration/'42 Grounds for reprimand, suspension or revocation of registration certificate/^ Rights of'respondents/'45 Appeal for judgment/ \6 Reinstatement/ M

Xll

Table of Contents

Chapter 5 PROFESSIONAL REGULATORY BOARD OF MEDICINE 5.1. 5.2.

Professional Regulation Commission/48 Powers of the PRC/50 1. As administrative body/50 2. As quasi-legislative body/50 3. As quasi-judicial body/50

5.3.

Board of Medicine/52 1. Appointment of the chairman of the professional regulatory board/52 2. Criteria for selection of nominees/ 53 3. Disqualification / 55 4. Reappointment of the chairman or member of the professional regulatory board/56 5. Compensation of the members of the professional regulatory boards/56 6. Purpose of compensation / 51 7. Basis of therightto salary/51 8. Prohibition against additional or double compensation/51 9. Powers, functions and responsibilities of the various professional regulatory boards/51

5.4. 5.5. 5.6.

Authority of the Board Medicine t o determine standi n g of m e d i c a l schools/60 Applicability of right against self-incrimination before the Board of Medicine/61 P M A with Legal Personality t o Q u e s t i o n Authority of Board of Medicine/62

xiu

Table of Contents

Chapter 6 PRACTICE OF MEDICINE 6.1. 6.2. 6.3. 6.4.

Practice of Medicine/64 Prerequisite to the Practice of Medicine/64 Acts Constituting Practice of Medicine/65 Cases on Acts Constituting Practice of Medicine/65 1. Acceptance of compensation without proper certificate ofregistration/65 2. Acts constitute practice of medicine whether or not done for a fee/65 3. Acts of investment in stocks not acts constituting practice of medicine/66 4. License to practice drugless healing cannot be implied/66 5. Advertised himself and offered services as physician/ 66 6. Falsely using thetitleofM.D. after one's name/61

6.5. 6.6. 6.7.

Acts not construed to be practice of medicine by provision of law/67 Acts not construed to be practice of medicine by decisions of courts/69 Faith healing, healing by prayer or divine healing/69 1. Psychic surgery and spiritualism/10

6.8. 6.9. 6.10.

Limited practice without any certificate of registration/71 Penalties for illegal practice of medicine/73 Employment of non-resident aliens/74 1. Employment permit of non-resident aliens/'l'4 2. Prohibition against transfer of'employment'/74

xiv

Table of Contents

3. Submission of list/15 6.11.

Forms of Medical Practice/75 1. Sole proprietorship/15 2. Associate practice/l5 3. Medical group practice/16 (a) (b)

Partnership/16 Corporation /16 Chapter 7

PHYSICIANS AND CONSTITUTION 7.1. 7.2.

Constitution/77 The Philippine State/ 77 1. People 111 2 Territory/1', (a) 3.

The Philippine national territory/'78

Government/18 (a)

Executive branch/18 Appointingpower/'78 Removal power/18 (iii) Control power/18 (iv) Military power/19 W Pardoning power/19 (vi) Borrowing power/19 (vii) Diplomatic power/19 (viii) Budgetary power/19 (ix) Informing power/19

G)

XV

Table of Contents

(b)

Legislative branch/19 (i) (ii) (iii)

Appropriation power/19 Taxation power/19 Expropriation power/19

(c) judicial branch/19 4. Sovereignty /19 7.3.

The Fundamental Powers of the State/80 1. Police power/ %0 2. Power of eminent domain/ 80 3. Power of taxation/80

1A.

The Bill of Rights/80 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

7.5.

Due process/ 80 Equal protection / 81 Searches and seizure/81 Privacy of communication and correspondence / 8\ Freedom of speech and expression / 81 Liberty of abode and travel/82 R/g/f/ / information / 82 R/g/tf to form associations / 82 R/gA/ /o compensation in expropriation cases/'82 The impairment clause/82 Fn?e # « m /o courts/ 83 Miranda rights/83

Rights Inherent in the Practice of Medicine/83 1. Right to choose patients/ 83 2. Right to limit the practice of medicine / 8\

xvi

Table of Contents

7.6.

3.

Right to determine appropriate procedure / 8\

4.

Right to avail of hospital services/'84

Rights Incidental to the Practice of Medicine/84 1.

1.1.

Right of way while responding to an emergency call/84

2. Right to be paid for medical services rendered/84 3. Right to membership to medical societies/84 4. Right of exemption from execution of instruments and library/84 5. Right to hold certain positions in public andprivate services/85 6. Right to perform certain services/85 Citizenship/85 1. 2.

Doctrine of jus sanguinis/86 Doctrine of jus soli/86 Chapter 8 PHYSICIANS AND CONTRACTS

8.1.

Law of Contracts, elements/87 1. Manifestation of assent/ 81 2. Legal subject matter/88 3. Legal capacity to contract/88 4. Consideration / 88

8.2.

Physician-Patient Contractual Relationship/88 1. Commencement of physician-patient contractual relationship / 88 2. Nature of physician-patient contractual relationship/89 (a) (b)

Consensual/89 Fiduciary/90 xvu

Table of Contents

8.3.

Essential Requisites of Contracts/ 90 1. Consent/ 90 2.

Object or subject matter/91 (a)

Types of medical care/92 (i) (ii)

General andfamily practice/92 Specialty practice/ 92 (1) Anesthesiology/ 92 (2) Dermatology / 93 (3) Internal medicine/ 93 (4) Neurology / 93 (5) Obstetrics and Gynecology/93 (6) Ophthalmology and Otolaryngology/94 (7) Pathology/94 (8) Pediatrics/94 (9) Psychiatry/94 (10) Radiology/94, (11) Surgery /95 (12) Public Health / 95

3. Cause or consideration /95 (a) Medical fees/96 (b) IGW.r of medical fees/96 (i) (ii) (iii) (iv) (v) (c) (d)

Simple contractual fee/96 Retainer fee/91 Contingent fee/91 Commission orfee splitting or dichotomous fee/98 Straight fee orpackage deal agreement/98

Reasonableness of medical fees/98 Medical billing/99 (i)

Payment at time of services/'99 xvm

Table of Contents

(ii) Billing when extension of credit is necessary/99 (iii) Using outside collection assistance/100 (e)

Salary scale of public health workers/100 (i) (ii) (iii) (iv)

(f)

Additional compensation/101 (i) (ii) (iii) (iv) (v)

8.4. 8.5. 8.6.

Salary scale/100 Equality in salary scale/101 Salaries to be paid in legal tender/101 Deductions prohibited/101

Hazard allowance/102 Subsistence allowance/102 Longevity pay/103 Laundry allowance/103 Remote assignment allowance/'104

Forms of Contractual Relationship/104 Cases when there is no physician-patient relationship/105 Termination of Physician-Patient Relationship/105 1. Sample letter of withdrawal from case/106 2. Sample letter to confirm discharge by patient/101 3. Patient abandonment/101

8.7.

Defective Contracts/108 1. Rescissible contracts/108 2. Voidable contracts/108 3. Unenforceable contracts/109 4. Void contracts/111

xix

Table of Contents

Chapter 9 PHYSICIANS AND TORTS 9.1. 9.2. 9.3.

Torts/112 Professional Liability/112 Classifications of Medical Professional liability/113 1. 2. 3. 4.

9.4. 9.5.

Feasance/ \13 Malfeasance / 1V> Misfeasance/113 Nonfeasance/113

Medical Malpractice or Negligence Cases/113 The Four D's of Negligence/114 1. Duty/114 2. Derelict/115 3. Direct cause/115 4. Damages/115

9.6.

Two-pronged Evidence/116 1. Standards of practice/116 2. Sources of proof of standard of care/116

9.7. 9.8.

Medical Malpractice/117 Sample Cases of Medical Malpractice/117 1. Unauthorised and unknown experimentation /ill 2. Failure to perform C-section andfailure to recognise and treat seizures in the periodfollowing the birth/ill 3. Surgical injury/\18 4. Failure to recognise and treat heart attack/118

xx

Table of Contents

5. Surgicalprecipitation of stroke/118 6. Wrongful amputation of arm and shoulder/119 7. Failure to diagnose cancer/119 8. Surgical injury/119 9.9.

Jurisprudence on Medical Professional Liability/120 1.

L E O N I L A GARCIA-RUEDA, vs. WILFREDO L. PASCASIO, et al.

G.R. No. 118141, September 5, 1997/120

9.10. 9.11.

2.

ROGELIO E. RAMOS, et al. vs. COURT OF APPEALS G.R. No. 124354, December 29,1999/122

3.

LEAH ALESNA REYES, et al. vs. SISTERS OF MERCY HOSPITAL, et al. G.R. No. 130547, October 3, 2000/129

4.

PROFESSIONAL SERVICES, INC. vs. NATIVIDAD and ENRIQUE AGANA G.R. No. 126297, January 31, 2007/133

Doctrines applied in medical practice cases/135 Doctrine of respondeat superior or doctrine of vicarious liability or doctrine of imputed negligence or command responsibility/135 1. Doctrine of ostensible agent or holding out theory or agency by estoppel/135 2. Borrowed servant doctrine/131 3. Captain-of-the-ship doctrine/131 4. Doctrine of independent contractor/131 5. Full time but not regular/138

xxi

Table of Contents

9.12.

Jurisprudence on respondeat superior/141 1.

9.13.

Doctrine of res ipsa loquitur or common knowledge doctrine/142 1. 2. 3. 4.

9.14.

9.15. 9.16. 9.17. 9.18. 9.19.

ROGELIO E. RAMOS, et al. vs. COURT OF APPEALS G.R. No. 124354, December 29, 1999/141

Requisites of res ipsa loquitur/142 Application of res ipsa loquitur in medical malpractice/143 Res ipsa loquitur, when applicable/143 Res ipsa loquitur, when not applicable/143

Jurisprudence on res ipsa loquitur/145 1.

DR. VICTORIA L. BATIQUIN, et al. vs. COURT OF APPEALS G.R. No. 118231, July 5,1996/145

2.

ROGELIO E. RAMOS, et al. vs. COURT OF APPEALS G.R. No. 124354, December 29, 1999/150

3.

LEAH ALESNA REYES, et al. vs. SISTERS OF MERCY HOSPITAL, et al. G.R. No. 130547, October 3, 2000/152

Doctrine common Doctrine Doctrine Doctrine Doctrine

of contributory negligence (doctrine of fault)/ 152 of continuing negligence/152 of assumption of risk/153 of last clear chance/153 of foreseeability/154

xxu

Table of Contents

1. Force majeure/154 2. Act of God/154 3. Accident/155 9.20. 9.21. 9.22. 9.23.

Fellow servant doctrine/155 Rescue doctrine or Good Samaritan Law/155 Deep pocket rule/156 Factors increasing medical malpractice cases/156 Chapter 10 PHYSICIANS AND DAMAGES

10.1.

Damages/158 1. 2.

10.2. 10.3. 10.4.

D a m n u m absque injuria/159 Actual damages/159 Moral damages/159 1. 2. 3. 4.

10.5. 10.6. 10.7. 10.8.

Damages that may be recovered/158 Computation for loss of earning capacity /159

Basis of award of moral damages/160 Conditions for award of moral damages/160 Legalprovisions mandating award of moral damages/160 Moral damages not recoverable on clearly unfounded suit/161

Temperate or moderate damages/162 Liquidated damages/162 Exemplary or corrective damages/162 Jurisprudence on Damages/162 1.

DR. NINEVETCH CRUZ vs. COURT OF APPEALS

xxru

Table of Contents

G.R. No. 122445, November 18, 1997/162 2.

ROGELIO E. RAMOS, et al. vs. COURT OF APPEALS G.R. No. 124354, December 29, 1999/165 Chapter 11 PHYSICIANS AND CRIMINAL LAW

11.1.

Application of the provisions of the Revised Penal Code/171 1. Application of the provisions of the Revised Penal Code/111 2. Criminal law/172 3. Limitations on power of Congress to enact penal laws/112 (a) (b) (c)

No ex postfacto law shall be enacted/112 No bill of attainder shall be enacted/112 No law that violates equalprotection clause shall be enacted/112 (d) No law which imposes cruel and unusual punishments nor excessivefinesshall be enacted/112

4. Characteristics of criminal law/112 (a)

General/112

Exceptions:

(b) (c) 11.2.

(i) Treaty stipulations/112 (ii) Laws of Preferential application/112 (iii) Principles of Public International Law/172 Territorial/112 Prospective/112

Felonies/173

XXIV

Table of Contents

1. Definitions/113 2. Requisites ofdolo/113 (a) (b) (c) 3.

Requisites ofculpa/113 (a) (b) (c)

4. 5. 6. 7. 8. 9. 10. 11.3.

Freedom/113 Intelligence/113 Intent/113

Freedom/113 Intelligence/113 Negligence and imprudence/ Y13

Elements offelonies/'173 Criminal liability/174 Aberratio ictus/ll4 Error inpersonae/114 Consummated, frustrated, and attempted felonies/114 Conspiracy andproposal to commitfelony /115 Grave felonies, less grave felonies andlightfelonies/'115

Circumstances affecting criminal liability/176 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

Justifying circumstances/116 Exempting circumstances/111 Justifying circumstance vs. exempting circumstance/118 Elements of accident without fault or intention of causing it/119 Elements of a person who acts under the compulsion of an irresistibleforce/119 Elements of uncontrollable fear/119 Elements of insuperable cause/119 Entrapment vs. instigation/180 Mitigating circumstances/180 Aggravating circumstances/181 Alternative circumstances /184

XXV

Table of Contents

11.4.

Persons criminally liable for felonies/185 1. Who are criminally liable/185 (a) Principals/185 (b) Accomplices/185 (c) Accessories/185 2. 3. 4. 5.

11.5.

Penalties/186 1. 2. 3. 4. 5. 6. 7.

11.6.

Principals/185 Accomplices/185 Accessories/185 Accessories who are exemptfrom criminal liability/'186

Reclusion perpetual 186 Reclusion temporal/181 Prision mayor and temporary disqualification/181 Prision correctional, suspension, and destierro/181 Arresto mayor/181 Arresto menor/181 Bond to keep the peace /181

Extinction of criminal liability/187 1. Total extinction of criminal liability /181 2. Partial extinction of criminal liability/188

11.7.

Crimes against p u b l i c interest/188 1. Falsification by public officer, employee or notary or ecclesiastic minister/188 2. Falsification by private individual and use of falsified documents/190

xxvi

Table of Contents

3. False medical certificates, false certificates of merits or service, etc. /190 4. Usingfalse certificates/190 11.8.

Crimes against persons/190 1. 2. 3. 4. 5. 6.

Parricide/190 Murder/191 Homicide/191 Giving assistance to suicide/192 Infanticide /192 Abortion/192 (a) (b) (c) (d) (e)

Intentional abortion/192 Unintentional abortion/193 Abortion practiced by the woman herself or by herparents/193 Abortion practiced by a physician or midwife/194 Dispensing of abortive/194

7. Physical injuries/194 (a) (b) (c) (d) (e)

Mutilation/194 Serious physical injuries /194 Administering injurious substances or beverages/195 Less serious physical injuries/195 Slight physical injuries and maltreatment/195

8. Rape/195 11.9.

Crimes against personal liberty and security/196 1. Kidnapping and serious illegal detention /196 2. Slight illegal detention/191 3. Abandonment of person in danger and abandonment of one's own victim/191 xxvii

Table of Contents

11.10. Crimes against property/198 1. 2. 3. 4.

Robbery/198 Execution of deeds by means of violence or intimidation /198 Theft/198 Qualified theft/199

11.11. Crimes against chastity/199 1. 2. 3. 4. 5.

Adultery /199 Concubinage / 200 Acts of lasciviousness/200 Qualified seduction/200 Simple seduction/200 (a)

6. 1. 8. 9. 10.

Qualified seduction vs. simple seduction/201

Corruption of minors/201 White slave trade/201 Forcible abduction/201 Consented abduction/201 Sexual perversion or unnatural sexual offenses/201 (a)

Cunnilingus 1201

(b) Exhibitionism / 202 Fellatio/202 Fetishism/202 Lesbianism / 202 Masochism/202 (g) Masturbation/202 (h) Pedophilia/202 ® Sadism/202 0) Transvestism/ 203 (k) Voyeurism/203 0) Zoophilia/203

(c) (d) (e) (*)

XXVlll

Table of Contents

11. Anti-Sexual Harassment Act of 1995/ 203 11.12. Crimes against the civil status of persons/207 1. Simulation of births, substitution of one childfor another and concealment or abandonment of a legitimate child/201 2. Usurpation of civil status/201 11.13. Crimes against honor/208 1. IJbel/208 2. Slander/208 11.14.

Quasi-Offenses/208 1. Reckless negligence or reckless imprudence/208 2. Jurisprudence on reckless imprudence/209 3. Somera Case: Homicide through reckless imprudence/ 2X3 Chapter 12 HOSPITALS AND THE LAW

12.1.

Hospital defined/215

12.2.

Classification of hospitals/216 .1. As to scope of infirmity admitted/216 (a)

General hospital/ 216

(b)

Specialised hospital/216

2. Functional classification/216 (a) (b) (c) (d)

Diagnostic hospital/216 Maternity hospital/216 Rehabilitation hospital/216 Surgical hospital/211 XXIX

Table of Contents

(e)

Cosmetic hospital/211

3. As to control andfinancial support/211 (a) (b)

Public or government hospital/211 Private hospital/211 (i) (ii)

12.3.

Private charitable or eleemosynary hospital/211 Private pay hospital/218

Vicarious liability of hospital/218 1. Government orpublic hospital/218 2. Private charitable, voluntary or eleemosynary hospital/218 (a) (b) (c) (d) 3.

12.4.

12.5.

Trustfund doctrine/218 Public policy theory/218 Implied waiver theory/218 Independent contractor theory/218

Private hospital forprofit/218

Jurisprudence on vicarious liability of hospitals/219 1.

P R O F E S S I O N A L SERVICES, I N C . vs. N A T I V I D A D and E N R I Q U E AGANA G.R. No. 126297, January 31, 2007/219

2.

ROGELIO P. NOGALES vs. CAPITOL MEDICAL CENTER G.R. No. 142625, December 19, 2006/220

Jurisprudence on non-liability of hospital/225 1.

ROGELIO E. RAMOS, et al. vs. COURT OF APPEALS G.R. No. 124354, December 29, 1999/225 XXX

Table of Contents

12.6. 12.7 12.8

Attendance to emergencies or serious cases/228 Transfer of patient/228 Hospital Detention Law/229 Chapter 13 PHYSICIANS AND EVIDENCE

13.1. 13.2.

Evidence/231 Qualification of witnesses/231 1.

13.3.

Ordinary witness vs. expert witness/232

Physician-patient privilege/232 1. Requisites ofprivileged communications between doctor and patient/232 2. Scope of the privilege/232 3. Duration of the privilege/233 4. Cases where privilege do not apply/233 5. Legal disclosures/233 6. Duty of confidentiality extends to the hospitals/ 233

13.4.

13.5.

Jurisprudence on physician-patient privilege/234 1.

N E L L Y LIM vs. C O U R T OF APPEALS G.R. No. 91114, September 25, 1992/234

2.

MA. PAZ F E R N A N D E Z K R O H N vs. C O U R T OF APPEALS G.R. No. 108854, June 14, 1994/236

Expert testimony/238 1. Presentation of expert testimonyy'239

XXXI

Table of Contents

(a) Qualifying a witness as an expert/239 (b) Admissibility of expert witness/239 (c) The asking of hypothetical questions/240 (d) It is not proper to include assumptions not supported by evidence/241 2. Litigation of medical negligence/241 3. Expert testimony generally relied upon in malpractice suits/242 4. When expert testimony dispensed with in malpractice suits/242 5. Competent expert witnesses/242 6. Qualifications/242 13.6.

Jurisprudence on expert witness/243 1.

P E O P L E vs. ROGELIO P E L O N E S

G.R. Nos. 86159-60, February 28, 1994/243

13.7. 13.8. 13.9.

2.

DR. NINEVETCH CRUZ vs. COURT OF APPEALS G.R. No. 122445, November 18, 1997/245

3.

ROGELIO E. RAMOS, et al. vs. COURT OF APPEALS G.R. No. 124354, December 29,1999/256

4.

LEAH ALESNA REYES, et al. vs. SISTERS OF MERCY HOSPITAL, et al. G.R. No. 130547, October 3, 2000/258

Hearsay rule/264 Dying declaration/265 Jurisprudence on hearsay rule/265 1.

MA. PAZ FERNANDEZ KROHN vs. COURT OF APPEALS G.R. No. 108854, June 14,1994/265 XXXll

Table of Contents

13.10. Weight and sufficiency of evidence/266 1. Substantial evidence/266 2. Preponderance of evidence/266 3. Proof beyond reasonable doubt/266 Chapter 14 MEDICAL RECORD 14.1. 14.2. 14.3. 14.4. 14.5.

Patient's clinical record/267 What patient's clinical record includes/268 Reasons for patient's clinical record/269 Correcting a handwritten entry on patient's clinical record/269 Right of access to medical record/269 1. 2. 3. 4. 5.

14.6.

The patient/ 269 The attending doctor/210 The hospital/210 The nurse/210 Insurance and HMO representatives/211

Types of medical records and confidentiality/271 1. Hospital medical records/211 2.

14.7.

Physicians'private office records/211

D o c u m e n t a r y evidence/271 1. Best Evidence Rule/211 2. Secondary Evidence/211 3. Parol Evidence Rule/212

xxxm

Table of Contents

Chapter 15 PHILHEALTH 15.1.

Pertinent laws/273 1. National Health Insurance Act of 1995/213 2. Republic Act No. 9241/213 3. Section 2, Article XIII of the 1987 Constitution/214

15.2.

Philippine Health Insurance Corporation/274 1. 2. 3. 4.

Exemptions from taxes and duties/214 Powers and functions/214 Quasi-judicial powers/211 The Board of Directors/218 (a) Composition/218 (b) Appointment and tenure/280 (c) Meetings and quorum/280 (d) Allowances and per diems/ 280

15.3. 15.4.

History/280 Definition of Terms/282 1. Beneficiary/282 2. Benefit Package/282 3. Capitation/282 4. Contribution/282 5. Coverage/282 6. Dependent /282 7. Diagnostic procedure/283 8. Emergency / 283 9. Employee/283 10 . Employer/283 XXXIV

Table of Contents

11. Enrollment/283 12. Fee for service/283 13.

Global budget/283

14. Government Service Insurance System/284 15. Health Care Provider /284 16. Health Insurance Identification (ID) Card/285 17. 18.

19. 20. 21. 22. 23. 24. 25. 26. 27. 28.

29. 30. 31.

32. 33. 34. 35. 36. 37.

38. 15.5.

Indigent/285 Inpatient education package/285 Member/285 Means test/285 Medicare/286 National Health Insurance Program/286 Pensioner/286 Personal Health Services/286 Philippine Medical Care Commission/286 Philippine National Drug Formulary/286 Portability/281 Prescription drug/281 Public health services/281 Quality assurance/ 281 Residence/281 Retiree/281 Self-employed/281 Social Security System/288 Treatment procedure/288 Utilisation review1288 Rehabilitation center/288 Home care and medical rehabilitation services/288

National Health Insurance Fund/288 1. 2. 3.

The basic benefit fund/289 Supplementary benefit funds / 290 Reserve fund/290 XXXV

Table of Contents

15.6.

Membership/294 1. Initial members in 1995/294 2. Classification of current members/ 294 (a) (b) (c) (d)

Paying Members/294 Indigent member/294 Privately-sponsored member/294 Non-paying member/294

3. Requirementfor registration/'294 4. Requirementsfor declaration of dependents/295 5. Requirementsfor registration ofemployers/'295 15.7.

Accreditation/296 1. Requirements/296 2. Additional requirements for hospitals / 291 3. Additional requirements for physicians/ 298

15.8.

Benefit package/298 1. What the benefit package includes/298 2. What are excluded unless recommended by Philhealth/299

15.9. Premium contributions/299 15.10. Penalties/300 Chapter 16 MEDICAL E T H I C S 16.1. 16.2. 16.3.

Ethics/302 Medical ethics/302 Definition of terms/303

XXXVI

Table of Contents

1. 2. 3. 4. 5. 6. 7. 8. 9.

Ethics/303 Medical etiquette/303 Bioethics/304 Bioethical issue/304 Ethical dilemma/304 Moral reasoning/304 Values/304 Moral uncertainty/304 Moral or ethicalprinciples/ 304 (a) Autonomy/304 (b) Beneficence/305 (c) Nonmaleficence / 305 (d) Justice/305 (e) Fidelity/305 (f)

16.4. 16.4.

Thinking ethically/305 Approaches to ethical dilemma/306 1. Beneficence/309 2. Autonomy/310 3. Justice/311

16.5.

Resolving ethical problems/312 Chapter 17 CODES OF ETHICS

17.1. 17.2.

Code of ethics/310 Historical codes/314 1. 2.

Oath and Law of Hippocrates/315 The Oath ofHippocrates/316 xxxvii

Table of Contents

17.3. 17.4. 17.5.

Philippine Medical Association/318 PMA Code of Ethics of the Medical Profession/320 Board of Medicine Code of Ethics/325 Chapter 18 CASE STUDIES ON MEDICAL ETHICS

18.1. 18.2. 18.3. 18.4. 18.5. 18.6. 18.7.

18.8.

18.9.

18.10. 18.11. 18.12.

Case study re: cultural misunderstandings in the medical care of cancer patient/340 Case study re: raising issues of culturally competent health care for a muslim woman/357 Case study re: public guardian in charge of the medical care for a conserved patient/378 Case study re: public guardian in charge of an old woman with multiple illnesses/380 Case study re: prevention vs. treatment in HIV/AIDS program/381 Case study re: decision to discontinue life-sustaining treatment/383 Case study on addressing ethical issues confronting governments, NGOs, and pharmaceutical companies when faced with an epidemic/386 Case Study on what should a physical therapist do when she suspects that her patient isn't being entirely honest with his physician/391 Case Study on the ethical questions involved when a company is the only supplier of a high-risk, life-saving product/393 Case Study whether physicians have a duty to refer patients to alternative forms of therapy/395 Case study re: maternal vs. fetal rights/400 Case study on assisted suicide/404

XXXVlll

Table of Contents

Chapter 19 RIGHTS AND DUTIES OF PATIENTS 19.1. 19.2. 19.3.

Universal bill of rights of patient /407 Duties of patient/409 Dying person's bill of rights/413 Chapter 20 INFORMED CONSENT

20.1. 20.2.

Informed consent defined/412 Subject matter of informed consent/413 1. Non-consensualphysical contact/4X3 2. Non-consensual medical treatment andprocedure/ 414 (a)

20.3. 20.4. 20.5. 20.6.

GEORGETTE MALETTE vs. DAVID SHULMAN Ontario Court of Appeal No. 29-88, Mar. 30, 1990/414

Doctrines re informed consent/418 Elements of informed consent/419 Kinds of consent/422 Who can give informed consent/422 1. 2. 3. 4. 5. 6. 7.

The patient/ 422 The spouse/422 The eldest child/422 The parents of the patient/423 The grandparents of the patient/423 The brother or sister of the patient/ 423 The nearest kin available/423

XXXIX

Table of Contents

8.

20.7. 20.8. 20.9. 20.10. 20.11. 20.12. 20.13. 20.14. 20.15.

The State/424

Instances where no consent is needed/424 Competency/424 Test for mental capacity/425 Questions to ask/426 Assessment of consent/426 Examples of informed consent/427 Surgery/428 Research/429 Jurisprudence on informed consent/430 1.

ROGELIO P. NOGALES vs. CAPITOL MEDICAL CENTER G.R. No. 142625, December 19, 2006/430 APPENDICES

A P P E N D I X 1 - Republic Act No. 9502 - Universally Accessible Cheaper and Quality Medicines Act of 2008/435 A P P E N D I X 2 - Republic Act No. 9484 - The Philippine Dental Act of2OO7/461 A P P E N D I X 3 - Republic Act No. 9439 - An Act Prohibiting the Detention of Patients in Hospitals and Medical Clinics on Grounds of Non-payment of Hospital Bills or Medical Expenses/486 A P P E N D I X 4 - Republic Act No. 9173 - Philippine Nursing Act of 2002/488 A P P E N D I X 5 - EXCERPTS FROM Republic Act No. 9165 Dangerous Drugs Act of 2002/506

xl

Table of Contents

A P P E N D I X 6 - Republic Act No. 8981 - PRC Modernisation Act of 2000/526 A P P E N D I X 7 - Republic Act No. 8423 - Traditional and Alternative Medicine Act (TAMA) of 19971543 A P P E N D I X 8 - Republic Act No. 8344 - An Act Penalising the Refusal of Hospitals and Medical Clinics to Administer Appropriate Initial Medical Treatment and Support in Emergengi or Serious Cases, Amendingfor the Purpose B.P. 702, (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)/ 558 A P P E N D I X 9 - Republic Act No. 8050 - Revised Optometty Law of 1995/562 A P P E N D I X 10 - Republic Act No. 7600 - The Rooming-In and Breastfeeding Act of 1992/580 A P P E N D I X 11 - Republic Act No. 7392 - Philippine Midwifery Act of 1992/581 A P P E N D I X 12 - Republic Act No. 7305 - Magna Carta of Public Health Workers/598 A P P E N D I X 13 - Republic Act No. 7170 - Organ Donation Act of 1991 (As Amended on February 20, 1995)/ 614 A P P E N D I X 14-Republic Act No. 6675-The (As amended by R^A. 9502)/ 623

Generics Act of 1988

A P P E N D I X 15 - EXCERPTS FROM Republic Act No. 5921 An Act Regulating the Practice of Pharmacy and Setting Standards of Pharmaceutical Education in the Philippines and of Other Purposes/631

xli

Table of Contents

A P P E N D I X 16 - Republic Act No. 5680 - Philippine Physical and Occupational Therapy Law/635 A P P E N D I X 17 - Republic Act No. 2382 - The Medical Act of 1959 (As amended by R.A. 5946 and R.A. 4224)/650 A P P E N D I X 18 - PRC Resolution No. 06-342 (A), Series of 2006 New Rules of Procedure in Administrative Investigations in the PRC and the Professional Regulatory Boards/669 Bibliography/699 Glossary/104 Index /719

—oOo—

xlii