People Vs Quebral

 

PEOPLE VS QUEBRAL The rule is, and has always been, that, if the subject of the negative avernment, like, for  law, inheres in the instance, the act of voting without the qualifications provided by law, offense as an essential ingredient thereof, the prosecution has the burden of proving the same. (Sec. 297, Act No. 190; U.S. vs. Tria, 17 Phil., 303, 306, 307.) In view, however, of the difficult office of proving a negative ne gative allegation, the prosecution, under such circumstance, need do no more than make a prima facie case from the best evidence obtainable. (U.S. vs. Tria, Tria, supra  supra.) .) It would certainly be anomalous to hold ". . . that mere difficulty in discharging a burden of making proof p roof should displace it; and as a matter of   principle the difficulty only relieves the party having the burden of evidence from the necessity of creating positive conviction entirely by his own evidence; so that, when he  produces such evidence as it is in his power to produce, its probative effect is enhanced  by the silence of his opponent. (22 C.J., pp. 81, 82.) The rule, however, is different when the subject of the negative avernment does not constitute an essential element of the offense, but is purely a matter of defense. In such case, the burden of proof is upon the defendant. As to whether or not a negative avernment is a matter of defense, is a question which we have fully discussed in United States vs. Chan Toco (12 Phil., 262). Section 770 of the Administrative Code provides that "no person shall practice medicine in the Philippine Islands without having previously obtained the proper certificate of  registration issued by the Board of Medical Examiners . . .." This provision clearly includes the want of certificate as an essential element of the offense charged. The negative fact is not separable from the offense as defined. It is, therefore, incumbent up upon on the prosecution to prove that negative fact, and failure to prove it is a ground for  acquittal. In the instant case, however, the decision rendered by the lower court makes mention of  Exhibit F-2 as showing that the accused is not a registered physician. That document is signed by Jose Ma. Delgado, chairman of the Board of Medical Exa Examiners, miners, wherein it is stated, in part, that "there is nothing in the records of this Board to show that Mr. Fernando C. Quebral is a registered physician."

PEOPLE VS HATANI

With respect to his conviction of illegal practice of medicine, appellant presented inconsistent claims. On one hand, he claims that the drugs and other  paraphernalia were planted by the raiding team; while on the other hand, he claims that these were seized without any warrant.

 

The evidence is overwhelming that appellant actually treated and diagnosed Precila and Wilma Borja. The positive testimony of Agustina, Precila, Wilma and Josefina Borja; the medico-legal reports (Exhs. "A", "A-7", "C", "L" and "L-1") which attest to the needle marks; the Handwriting Identification Report (Exh. I); the photographs (Exhs. "G-l — "G-8") showing assorted drugs and medical equipment in appellant's room; and the chemistry reports (Exhs. "J" — "J-1") prove that appellant was engaged in the practice of medicine. And as to his allegation that there was no proof of payment, the law specifically punishes said act whether or not done for a fee.

PEOPLE VS VENTURA

Appellant, testifying on his behalf admitted that for the past p ast 35 years, he had been  practicing as a naturopathic physician, "treating human ailments without the use of drugs and medicines" and employing in his practice "electricity, water and hand" without a license to practice medicine; that during this time he had treated 500,000 patients, more or less about 90% of whom wereIllinois healed,for and thatfour he had studied drugless healing in the American University, Chicago, about years. Invoking prescription, he argues that in view of the fact that he had begun the alleged  practice of medicine thirty five years ago without the required license, the crime charged in the information had already prescribed. The records reveal that the accused began practicing his method of drugless healing 35 years ago. This practice was first discovered by the authorities in 1949. He was  prosecuted and convicted therefor the same year. Sometime after he again set up a clinic. He had a lucrative clientele and nobody bothered him.1äwphï1.ñët  him. 1äwphï1.ñët   However, at about February, 1955, the President of the Philippine Federation of Private Medical Practitioners, complained to the National Bureau of o f Investigation that appellant was advertising himself as capable of treating human ailments without drugs. Upon investigation, appellant was found to be without certificate of registration to practice such  profession either from the Board of Medical Examiners or from the Committee of  Examiners of Masseurs. So, this prosecution started in 1956. It is clear that the four-year   period of prescription of the offense charged should be computed from February, 1955 when the National Bureau of Investigation discovered appellant's alleged illegal practice of Medicine. Appellant also questions the constitutionality of Section 770 in relation to Section 775 of  the Revised Administrative Code. It is appellant's theory that to require, of any person whose business is merely to stimulate by mechanical means the nerves of the body, many years of study in medical schools, taking up obstetrics, general surgery, gynecology,  bacteriology and many other sciences, is curtailment of the exercise of one's calling, a

 

violation of the constitutional principle that all men have the right to life, liberty, and the  pursuit of happiness and are entitled to the equal protection of the law. It is furthermore theorized that inasmuch as drugless healing is not taught in any of the medical schools  prescribed, how could the members of the Medical Board of Examiners pass on the competence of these drugless healers? .

The subjects in which an examination is required relate to matters of which a thorough knowledge seems necessary for the proper diagnosis of diseases of the human body and it is within the police power of the State to require that persons who devote themselves to the curing of human ills should possess such knowledge. In the instant case, we must again uphold these immutable concepts of the police power  of the State. Under this power, the State may prescribe such regulations as in its judgment will secure or tend to secure the general welfare of the people, to protect them against the consequences of ignorance and incapacity as well as of deception and fraud. As one means to this end, it has been b een the practice of different States, from time immemorial to exact in any pursuit, profession or trade, a certain degree of skill and learning upon which the community may confidently rely, their possession being generally ascertained in an examination of parties by competent persons, or o r inferred from a certificate to them in the form of a diploma or license from an institution established for instruction on the subjects, scientific or otherwise, with which such pursuits have to deal. Appellant claims that his act of stimulating the affected nerves of the patients without use of any drug or medicine is not n ot practice of medicine; that "practice of medicine" is confined only to the systems taught by the medical schools, namely, the regular, the homeopathic and the eclectic schools or systems. Section 770 of the Revised Administrative Code in no uncertain terms covers appellant's acts. The statutory definition as to what acts constitute illegal practice of medicine its  provided in said Section 770 includes the acts and practices performed by appellant, By his own statements, he admitted to have continuously diagnosed and treated more or less 500,000 instances of different kinds of human hu man ailments and to have prescribed remedies therefor. As regards the contention that there are at least two concurrent resolutions declaring formally that Congress has recognized the drugless methods of healing, we need not elaborate further than to say that not until such recognition is actually embodied in a statute, shall we extend consideration of such method. Appellant pleads that the lower court erred in not holding that the complainants and the government are estopped from prosecuting him because they were the ones who induced him to practice drugless healing after his conviction conv iction in 1949. He tried to show that medical practitioners, members of Congress, provincial governors, city mayors and municipal board members wrote to him requesting his h is help for persons suffering from all

 

kinds of ailments; that municipal ordinances and resolutions were also passed authorizing him not only to practice his method of healing but also to put up clinics in some of  municipalities; that he was even extended free transportation facilities to work in the Central Luzon Sanitarium in Tala, Caloocan, Rizal. Above plea cannot be sustained by this Court. The doctrine of estoppel does not apply to the government.4 It is never stopped by mistakes or errors on the part of its agents, even assuming without conceding that said municipalities had encouraged appellant's practice. We cannot allow the bargaining away of public health and safety for the semblance of   benefit to a few government officials, people or even municipalities. Similarly, there is no such thing as implied license to practice drugless healing by the mere fact that the Chairman of the Board of Medical Examiners had permitted appellant to serve free in the Central Luzon Sanitarium in Tala, Caloocan, Rizal, or that countless people persisted in engaging his services. For one thing, these people might have contracted his services on the mistaken notion n otion that he was duly licensed to p practice ractice his  profession; for another, a repetition of illegal acts can never make them legal. As additional argument, appellant urges acquittal under the new Medical Act of 19595 wherein the practice of physiotherapy is recognized as a distinct science. He claims coverage of said law on the ground that he practices ph physiotherapy ysiotherapy by massage through  physical devices and upon the recommendation of duly registered physicians. The above argument has no merit because there is strong evidence to the effect that appellant alone diagnoses his patients' ailments and applies the remedies therefor 6 without written order or prescription by a registered physician.

PEOPLE VS BUENVIAJE

The offense here penalized is "violation of the Medical Law." The statute makes no distinction between illegal practice of medicine and illegally advertising oneself as a doctor. Both are in violation of the Medical Law and carry the same penalty. They are merely different ways or means of committing the same offense and both of these means are closely related to each other and usually employed together. In these circumstances and where, as alleged in the information in the present case, the various violations have taken place simultaneously, we do not think it was the intention of the legislator that each single act should be regarded as a separate offense and separate informations presented for each. Under the second assignment of error the appellant argues in substance that chiropractic has nothing to do with medicine and that the practice of that profession can therefore not

 

 be regarded as practice of medicine. There is no merit whatever in this contention. Assuming without conceding that chiropractic does not fall within the term "practice of  medicine" in its ordinary acceptation, we have hav e the statutory definition contained in section 770 of the Administrative Code and which clearly includes the manipulations employed in chiropractic. The statutory definition necessarily prevails over the ordinary one. Under the same assignment of error the defendant also argues that the examination  prescribed by section 776 of the Administrative Code for admission to the practice of  medicine, embraces subjects which have no connection with chiropractic and that to require chiropractors to take that examination is unreasonable and, in effect amounts to  prohibition of the practice of their profession and therefore violates the constitutional  principle that all men have the right to life, liberty and the pursuit of happiness and an d are entitled to the equal protection of the law. There is very little force in this argument. The subjects in which an examination is required by section 778 of the Administrative Code, as amended by Act No. 3111, relate to matters of which a thorough knowledge seems necessary for the proper diagnosis of  diseases of the human body and it is within the police power of the State to require that  persons who devote themselves to the curing of human ills should possess such knowledge. (State vs. vs. Edmunds, 127 Iowa, 333; 69 L.R.A., 504; Underwood vs vs.. Scott, 43 vs. Blue Mountain Joe, 129 Ill., 370; State vs vs.. Mylod, 20 R. I., 632; 41 Kan., 714; People vs. L.R.A., 428; Stewart vs. vs. Raab, 55 Minn., 20; Matthei vs vs.. Wooley, 69 Ill. App., 654; State vs vs.. Buswell, 40 Neb., 158; 24 L.R.A., 68; O'Connor vs O'Connor vs.. State, 46 Neb., 157; U. S. vs vs.. Gomez Jesus, 31 Phil., 218.) III. The third assignment of error is closely related to the foregoing. The appellant contends that the prohibition in section 783 against the unauthorized use of the title "doctor" must be understood to refer to "Doctor of Medicine" and has no application to doctors of chiropractic. Under different circumstances that might possibly be so, but where, as here, chiropractic is by statute made a form of the practice of medicine, it necessarily follows that a person holding himself out as a doctor of chiropractic in legal effect represents himself as a doctor of medicine. IV. In her fourth assignment of error the appellant appe llant attacks the constitutionality of Act No. 3111, amending section 770 of the Administrative Code, on the ground that the subject of  the Act is not sufficiently expressed in its title and that it embraces more than one subject. There is no merit in this contention. The title of Act No. 3111 reads as follows: An Act to amend sections seven hundred and fifty-nine, seven hundred and an d sixty, seven hundred and sixty-one, seven hundred and sixty-two, seven hundred and sixty-five, seven hundred and sixty-seven, seven hundred and seventy, seven hundred and seventy-four, seven hundred and seventy-five, seven hundred and seventy-six, seven hundred and seventy-eight, seven hundred and eighty, seven hundred and eighty-two, seven hundred and eighty-three, and twenty-six hundred and seventy-eight of Act Numbered Twenty-seven hundred and eleven, known as

 

the Administrative Code, increasing the number of the members of the Board of  Medical Examiners, conferring upon the same certain additional powers and responsibilities and for other purposes. All of the sections enumerated in the title quoted relate to the same general subject, namely, defining and regulating the practice of medicine, and section 770 is expressly mentioned as one of the sections amended. This is sufficient. Under constitutional provisions similar to ours the general rule is that a title which declares the amendatory statute to be an act to amend a designated section or  the like of a specified Code is sufficient and the precise nature of the amendatory Act vs. Aguirre, 191 U.S., 60; Udell vs vs.. Citizens Street R. need not be further stated. (Ross vs. vs. Chicago, etc., R. Co., 131 Iowa, 340; Lankford vs vs.. Co., 152 Ind., 507; McGuire vs. County Commissioners of Somerset County, 73 Md., 105; Tabor vs Tabor  vs.. State, 34 Tex. Crim., vs.. Brown, 91 Va., 762.) For a full and authoritative discussion of this subject, 631; Com. vs vs. Dunne, 55 L.R.A., 833. See also Government of the Philippine see Note to Lewis vs. Islands vs vs.. Municipality of Binalonan and Roman Catholic Bishop of Nueva Segovia (32 Phil., 634) and Yu Cong Eng vs. vs. Trinidad (p. 385, ante ante). ).

CRISOSTOMO VS SEC

The investments in UDMC of Doctors Yamada and Enatsu do not violate the Constitutional prohibition against foreigners practising a profession in the Philippines (Section 14, Article XII, 1987 Constitution) for they do not practice their profession (medicine) in the Philippines, neither have they applied for a license to do so. They only own shares of stock in a corporation that operates a hospital. No law limits the sale of hospital shares of stock to doctors only. The ownership of such shares does not amount to engaging (illegally,) in the practice of medicine, or, nursing. If it were otherwise, the petitioner's stockholding in UDMC would also be illegal.

GARCIA-RUEDA VS PASCASIO

Hence, there are four elements involved in medical negligence cases: duty, breach, injury and proximate causation. Evidently, when the victim employed the services of Dr. Antonio and Dr. Reyes, a physician-patient relationship was created. In accepting the case, Dr. Antonio and Dr. Reyes in effect represented that, having the needed

 

training and skill possessed by physicians and surgeons practicing in the same field, they will employ such training, care and skill in the treatment of  their patients. 13 They have a duty to use at least the same level of care that any other reasonably competent doctor would use to treat a condition under the same circumstances. The breach of these professional duties of  skill and care, or their improper performance, by a physician surgeon whereby the patient is injured in body or in health, constitutes actionable malpractice. 14 Consequently, in the event that any injury results to the patient from want of due care or skill during the operation, the surgeons may be held answerable in damages for negligence. 15 Moreover, in malpractice or negligence cases involving the administration of anaesthesia, the necessity of expert testimony and the availability of the charge of res ipsa loquitur  to the plaintiff; have been applied in actions against anaesthesiologists to hold the defendant liable for the death or  injury of a patient under excessive or improper anaesthesia. 16 Essentially, it requires two-pronged evidence: evidence as to the recognized standards of the medical community in the particular kind of case, and a showing that the physician in question negligently departed from this standard in his treatment. 17 Another element in medical negligence cases is causation which is divided into two inquiries: whether the doctor's actions in fact caused the harm to the patient and whether these were the proximate cause of the patient's injury. 18 Indeed here, a causal connection is discernible from the occurrence of the victim's death after the negligent act of the anaesthesiologist in administering the anesthesia, a fact which, if  confirmed, should warrant the filing of the appropriate criminal case. To be sure, the allegation of negligence is not entirely baseless. Moreover, the NBI deduced that the attending surgeons did not conduct the necessary interview of the patient prior to the operation. It appears that the cause of  the death of the victim could have been averted had the proper drug been applied to cope with the symptoms of malignant hyperthermia. Also, we cannot ignore the fact that an antidote was readily available to counteract whatever deleterious effect the anaesthesia might produce. 19 Why these precautionary measures were disregarded must be sufficiently explained.

SANTIAGO VS BENGZON

 

Petitioners concede that the requirement for doctors, dentists, and veterinarians to use the generic terminology in writing their prescriptions, followed by the brand name in parenthesis, is "well and good" (p. 12, Rollo). However, they complain that under paragraph (d) of the law which reads: (d) Drug outlets, including drugstores, hospital and non-hospital pharmacies and non-traditional outlets such as supermarkets and stores, shall inform any buyer  about anycorresponding and all other drug products the may same generic name, together  with their prices so thathaving the buyer adequately exercise his option. Within one (1) year after approval of this Act, the drug outlets referred to herein, shall post in conspicuous places in their establishments, a list of drug products with the same generic name and their corresponding prices. (Annex A, p. 23, Rollo.)

the salesgirl at the drugstore counter is authorized to "substitute the prescribed medicine with another medicine belonging to the same generic group." Since doctors are not allowed to instruct the druggist not to substitute the prescription, or to "Dispense only as Prescribed" (per Sec. 4, Adm. Order No. 62), the petitioners argue that "the act of prescribing the correct medicine for the patient becomes the act of the salesgirl at the drugstore counter, no longer the act of the physician, dentist, or veterinarian" (p. 12, Rollo). Here again, the petitioners have distorted the clear provisions of the law and the implementing administrative order. For it is plain to see that neither paragraph (d) of Section 6 of the Generics Act, nor Section 4 of Administrative Order No. 62, gives the salesgirl and/or druggist the discretion to substitute the doctor's prescription. On the contrary, Section 4, par. 4.1, of Administrative Order No. 62 directs the pharmacist not to fill "violative fill "violative prescriptions" (where the generic name is not written, or illegibly written, and the prescription of a brand name is accompanied by the doctor's instruction not to substitute it), as well as "impossible  prescriptions" (par.  prescriptions"  (par. 4.5). Even a doctor's "erroneous" prescriptions "shall be filled," not substituted (par. 4.3, Adm. Order No. 62). And, Sections 3 and 5 of  Adm. Order No. 63 enjoin the drug outlets not (to) favor or suggest" or "impose" a particular brand or product on the customer. The administrative older provides: In order to ensure the informed choice and use of drugs by the patient/ buyer, the drug outlet is required to: 3.1.1 Inform the patient/buyer of all available drug products generically equivalent to the one prescribed with their  corresponding prices. In so doing, the drug outlet shall not favor  or suggest any particular product so that the patient/buyer may  fully and adequately exercise his option to choose (Sec. 3, Adm. Order No. 63 s. 1989). xxx xxx xxx

 

The following acts or omissions are considered violations of these rules and  regulations: 5.1 Imposing a particular brand or product on the buyer . ... (pp. 46-47, Rollo.)

The salesgirl at the drugstore counter, merely informs the customer, but does not determine (for she is incompetent to do so) all the other drug products or brands that have the same name, and corresponding prices. That information she maygeneric obtain from the listtheir of drug products determined by the Bureau of Food and Drugs to have the same generic name, or which are the chemical, biological, and therapeutic equivalent of the generic drug. All drugstores or drug outlets are required by the law to post such list in a conspicuous place in their premises for the information of the customers, for the choice of whether to buy the expensive brand name drug, or the less expensive generic, should be exercised by the customer alone. The Court has been unable to find any constitutional infirmity in the Generics Act. It, on the contrary, implements the constitutional mandate for the State "to protect and promote the right to health of the people" and "to make essential goods, health and other social services available to all the people at affordable cost"  (Section 15, Art. II and Section 11, Art. XIII, 1987 Constitution). The prohibition against the use by doctors of "no substitution" and/or words of  similar import in their prescription, is a valid regulation to prevent the circumvention of the law. It secures to the patient the right to choose between the brand name and its generic equivalent since his doctor is allowed to write both the generic and the brand name in his prescription form. If a doctor is allowed to prescribe a brand-name drug with "no substitution," the patient's option to buy a lower-priced, but equally effective, generic equivalent would thereby be curtailed. The law aims to benefit the impoverished (and often sickly) majority of the population in a still developing country like ours, not the affluent and generally healthy minority. There is no merit in the petitioners' theory that the Generics Act impairs the obligation of contract between a physician and his patient, for no contract ever  results from a consultation between patient and physician. A doctor may take in or refuse a patient, just as the patient may take or refuse the doctor's advice or  prescription. As aptly observed by the public respondent, no doctor has ever filed an action for breach of contract against a patient who refused to take prescribed medication, undergo surgery, or follow a recommended course treatment by his doctor ( p. 53, Rollo). In any event, no private contract between doctor and patient may be allowed to override the power of the State to enact laws that are reasonably necessary to secure the health, safety, good order, comfort, or  general welfare of the community. This power can neither be abdicated nor  bargained away. All contractual and property rights are held subject to its fair  exercise (Anglo-Fil Trading Corporation vs. Lazaro, 124 SCRA 495.)

 

CARILLO VS PEOPLE

the Court defined simple negligence, penalized under what is now Article 365 of  the Revised Penal Code, as "a mere lack of prevision of  prevision in a situation where either  the threatened harm is not immediate or the danger not danger not openly visible." visible." Put in a slightly different way, the gravamen of the offense of simple negligence is the failure to exercise the diligence necessitated or called for the situation which was not immediately life-destructive but which culminated, in the present case, in the death of a human being three (3) days later. Such failure to exercise the necessary degree of care and diligence is a negative ingredient of the offense charged. The rule in such cases is that while the prosecution must prove the negative ingredient of  the offense, it needs only to present the best evidence procurable under the circumstances, in order to to shift burdenprovided of disproving or countering the proof  of the negative ingredient thethe accused, that such initial evidence establishes at least on a prima facie basis the guilt of the accused. 49 This rule is particularly applicable where the negative ingredient of the offense is of such a nature or character as, under the circumstances, to be specially within the knowledge or control of the accused. 50 In the instant case, the Court is bound to observe that the events which occurred during the surgical procedure (including whether or not Nubain had in fact been administered as an anesthesia immediately before or during the surgery) were peculiarly within the knowledge and control of Dr. Carillo and Dr. Madrid. It was, therefore, incumbent upon the two (2) accused to overturn the prima facie case which the prosecution had established, by reciting the measures which they had actually taken to prevent or  to counter the obviously serious condition of Catherine Acosta which was evident right after surgery. This they failed or refused to do so. Still another circumstance of which account must be taken is that both petitioner  and Dr. Madrid failed to inform the parents of their minor patient of the nature of  her illness, or to explain to them either during the surgery (if feasible) or at any time after the surgery, the events which comprised the dramatic deterioration of her condition immediately after surgery as compared with her pre-surgery condition. To give a truthful explanation to the parents was a duty imposed upon them by the canons of their profession. 51 Petitioner should have explained to Catherine's parents the actual circumstances surrounding Catherine's death, how, in other words, a simple appendectomy procedure upon an ambulatory patient could have led to such fatal consequences.

 

By way of resume, in the case at bar, we consider that the chain of  circumstances above noted, namely: (1) the failure of petitioner and Dr. Madrid to appreciate the serious post-surgery condition of their patient and to monitor her  condition and provide close patient care to her; (2) the summons of petitioner by Dr. Madrid and the cardiologist after the patient's heart attack on the very evening that the surgery was completed; (3) the low level of care and diligence exhibited by petitioner in failing to correct Dr. Madrid's prescription of Nubain for  post-operative pain; (4) the extraordinary failure or refusal of petitioner and Dr. Madrid to inform the parents of Catherine Acosta of her true condition after  surgery, in disregard of the requirements of the Code of Medical Ethics; and (5) the failure of petitioner and Dr. Madrid to prove that they had in fact exercised the necessary and appropriate degree of care and diligence to prevent the sudden decline in the condition of Catherine Acosta and her death three (3) days later, leads the Court to the conclusion, with moral certainty, that petitioner and Dr. Madrid were guilty of simple negligence resulting in homicide.

GARCIA-RUEDA VS PASCASIO A word on medical malpractice or negligence cases. In its simplest terms, the type of lawsuit which has been called medical malpractice or, more appropriately, medical negligence, is that type of  claim which a victim has available to him or her to redress a wrong committed by a medical profession professional al which has caused bodily harm. In order to successfully pursue such a claim, a patient must prove that a health care provider, in most cases a physician, either failed to do something which a reasonably prudent health care provider would have done, or that he or she did something that a reasonably prudent provider  12 have done; and that that failure or action caused injury to the would patient.not

Hence, there are four elements involved in medical negligence cases: duty, breach, injury and proximate causation.