Medical Jurisprudence Flashcards
Medicine applied to law and justice.
Legal Medecine
Medical Act of 1959 provision. (3)
- Standardization and regulation of medical education.
- Examination for registration of physicians.
- Supervision, control, and regulation of the practice of medicine.
Act that regulates the practice of Medicine.
Medical Act of 1959 ( RA 2382)
Act composed of Mandatory writing of Generic Name?
Generics Act of 1988 ( RA 6675)
Source of law which includes the rights , privileges, and responsibilities written in the Philippine Constitution?
Constitutional Law
Source of Law made by administrative body through the authority given to them?
Administrative Law
Source of Law composed of unwritten laws based on the immemorial customs and usages?
Common Law
Law followed to make one closer to his Creator?
Divine Law
Law which pertains to guidance of human conduct based on the rational thinking of man?
Natural Law
Law enforce by the dictate of ones conscience?
Moral Law
When the court has laid down a principle of law or interpretation as applied to a certain set of facts, all other courts will adhere to and apply this to all future cases where the facts are substantially the sa e. This pertains to what principle?
Principle of Stare Decisis
This denotes anything belonging to the court of law or used in court of legal proceedings?
Forensic
This term pertains to law, arising out of by virtue, or included in law?
Legal
This is the practical science which investigates the nature , development, and functions of law?
Jurisprudence
Source of law that is defined , codified, and incorporated by the law making body?
Written or Statutory Law ( eg. Medical Act of 1959)
It takes ____ days for a law to be implemented along with it being published in the official gazette?
Fifteen (15)
Law which pertains to the rights and obligations of person in their daily relation with each other and with society?
Substantive Law
Law concerned with mechanical rules governing the means by which substantive rights and duties are enforced?
Procedural / Adjective / Remedial Law
Law concerned with rules by which litigation are conducted?
Procedural/ Adjective / Remedial Law
Law concerned with rules which regulate the relationship between the subject and the state.
Public Law
Law that regulates the relationship of individuals , deals with private matters that do not concern the public at large?
Private Law
The right to regulate the practice of medicine is based on?
The Police Power of the State
Refers to a principle that in a malpractice suit, the standard of care should be based on the standard practice in the locality?
Locality Rule
Elements of Medical Negligence?
- Doctor had a duty to the patient
- Doctor breached duty
- Injury to the patient
- Proximate causation between the breach and injury suffered
Quantum evidence to prove criminal offense?
Proof beyond reasonable doubt
Contents of Signboards for advertisements? (3)
- Name of the physician
- Field of Specialty
- Office / Hospital Affiliations
Contents of Signboards for advertisements that is prohibited ? (5)
- Personal Superiority
- Special Certificates/ Diplomas
- Postgraduate training
- Specific Methods of Treatment
- Operative Techniques
Allowed places where physicians can publish their personal special certificates, diplomas, postgraduate training , specific methods of treatment or operative techniques?
Confines the Physicians clinic or residence
Prerequisites for a person to practice medicine. (4)
- Holder of a valid Certificate of Registration
- Passed the Physician Licensure Exam
- Twenty one years of age
- Proper educational background
Limited practice of medicine without a certificate of Registration?
- Physicians and surgeons from other countries called in for consultation only for specific and definite cases.
- Commissioned medical officers of the USA Armed Forces stationed in Philippines, serving the community.
- Foreign physicians employed as exchange professors in medicine or surgery upon the discretion of Board of Medical Education
Terms not guaranteed in the Physician- Patient contract?
- Doctor will cure the patient
- Treatment will be successful
- Treatment will not harm the patient
- Treatment will produce certain results
- Doctor will not commit errors in an honest way
The only guarantee that the law implies is that the doctor will treat patient in accordance with standard of care.
Reciprocity in the practice of medicine is achieved when?
Doctors and patients work together to develop a treatment solution.
Penalties for illegal practice of medicine? (3)
1- Fine not less than 1,000 but nor more than 10,000 with imprisonment in case of insolvency.
2. Imprisonment of not less than a year but not more than 5 yrs
3. Both fine and imprisonment
Prohibits advanced payment before confinement is under what Law?
Anti-Hospital Deposit Law ( RA 8344)
Prohibits detention of patients on the grounds of non-payment?
Anti-Hospital Detention Law (RA 9439)
Under what Act?
Patients should provide truthful information about exposure.
Mandatory Reporting of Notifiable Disease and Health Events of Public Health Concern Act ( RA 11332)
Examples of personal data breach that a patient can suffer?
Accidental / Unlawful:
1. Destruction
2. Alteration
3. Disclosure
4. Processing
This is from the Data Privacy Act of 2012
Protects individual personal information in information and communications systems?
Data Privacy Act of 2012 ( RA 10173)
Act that protects women and their children against abuse?
Anti- Violence Against Women and their Children Act of 2004
(RA 9262)
Law on property and property rights?
Substantive Law
Law on criminal procedure?
Adjective or Remedial Law
Is Philippine Medical Association Membership mandatory to practice medicine in the Philippines?
No,but there are certain privileges that only PMA members can avail of.
Form of contractual relation wherein the existence of the contract can be inferred from the actions of the contracting parties?
Implied contract
Elements needed for contract to be valid (3)
- Contract must be consensual and fiduciary
- Must contain the subject matter
- Must contain cause or consideration
MD Patient relationship (3)
- Contractual- agreed upon both parties
- Consensual - involving consent
- Fiduciary - trust
Form of contract wherein the nature of the service to be given is stated verbally on in writing?
Expressed Contract
Non MD- Patient relationship (4)
- Pre-employment PE
- Determining eligibility for insurance
- Examines accused for insanity
- Autopsy
- Casual questions
Duties and obligations of the Physician in the contract.
- Should have the knowledge and skill of an average MD.
- Exercise ordinary care diligence .
- Best judgment.
- Good faith.
Inherent Rights of an MD? (4)
- To choose patients
- Limit the practice
- Determine appropriate management procedures
- Avail of hospital services
Rights of Patients (8)
- Give consent
- Confidential or Privileged information
- Disclosure of information
- Choose his/ her physician
- Privacy
- Religious belief
- Treatment
- Refuse necessary treatment
Incidental rights of an MD? (6)
- Right of way
- Right of exemption from execution of instruments and library
- Hold certain public or private offices
- Right to compensation
- Right to membership in medical societies
- Right to perform certain services
Fee to the MD in exchange for his services?
Simple Contractual Fee ( Ethical)
Fee measured by the Space of Time ?
Retainer Fee ( Ethical)
Fee depends on the success or failure of the treatment?
Contingent Fee ( Unethical)
Sharing a fee with another physician, laboratory or drug company?
Dichotomous Fee ( Unethical)
Amount of Medical fee is dependent on what will be the remaining balance when all of the other expenses have been paid?
Straight fee ( Unethical )
Unethical medical fees? (3)
- Contingent fees
- Dichotomous fees
- Straight fees
Contingent fees: free depends on success or failure of the treatment
Dichotomous fees: includes requiring services of a person who may act as an agent
(Chasers, Runners, Touts, or Tripsters) to solicit patients
Straight fees: Amount of Medical fee is dependent on what will be the remaining balance when all of the other expenses have been paid.
What is Revised Penal Code ( Article 365)
Criminal Liability
Codes applicable to Civil Liability? ( 5)
Civil code 19, 20, 21, 2176 and the Family Code.
Grounds for administrative investigations? (5)
- Immoral or dishonorable conduct.
- Insanity or gross negligence, ignorance, or incompetence resulting to injury or death.
- Conviction of criminal offense involving moral turpitude
- Unprofessional or unethical conduct
- Use of perpetuation of fraud or deceit in the acquisition of registration certificate.
Acts used in Administrative liability? ( 2)
- Medical Act of 1959
- Code of Ethics ( Standard of Care & Medical Etiquette)
Quantum evidence needed to prove a Civil Case?
Preponderance of Evidence
Prison / Fine is used as penalty.
Criminal Case
Quantum evidence needed to prove an Administrative Case.
Substantial evidence
Can extinguish the Civil personality?
Death
Penalty used in Civil case?
Damages
Penalties used in Administrative Case?
- Warning
- Reprimand
- Suspension
- Revocation
Employees and at the same time independent Contractors ( Pathologists, Radiologists, and Anesthesiologist)
Doctrine of Ostensible Agent
Employees of the hospital are sometimes temporarily under the supervision and control of another.
Borrowed Servant Doctrine
Surgeon is responsible for anything that will go wrong in the four coeners of the operating room.
Captain of the Ship Doctrine
Elements of Res Ipsa Loquitur?
- The event does not normally occur unless someone has acted negligently.
- The evidence rules out the possibility that the actions of the plaintiff or a third party caused the injury.
- The type of negligence in question falls with the scope of the defendants duty to the plaintiff.
Factors necessary to make a claim of Res Ipsa Loquitur in court? (4)
- The injury ordinarily does not occur in the absence of the doctors negligence.
- The injury is caused by an instrumentality within the exclusive control of the doctor.
- Evidence of true explanation of the injury must be more accessible to the doctor than the patient.
- The patient has no voluntary contribution to the occurrence of the injury.
No need for an expert to enlighten the case?
Doctrine of Common Knowledge
Conduct on the part of plaintiff contributed to his harm?
Doctrine of Common Fault
MD has superior knowledge over his patient?
Doctrine of Superior Knowledge
After prolonged treatment, MD fails to investigate non-response.
Doctrine of Continuing Negligence
Consents the last clear chance of avoiding damage or injury to his patient but negligently fails to do so?
Doctrine of Last Clear Chance
Consents to the application of a procedure involving certain risks?
Doctrine of Assumption of Risk
Fails to ascertain the condition of the patient.
Doctrine of Forseeability
Employee was injured on account of the negligence of his fellow employee?
Fellow Servant Doctrine
Fails to provide assistance to any person in danger/ dying/ , when he can render it without harm to himself.
Rescue Doctrine
Hospital has the duty of supervising the competence of the doctors on its staff?
Doctrine of Corporate Responsibility
Contributions or Donations to a hospital cannot be made available for payment of damages.
Trust Fund Doctrine
Charity patient impliedly waives his right to claim for damages.
Implied Waver Theory
Doctrine in effect when a Municipal Health Officer is given the autopsy and authority to issue a valid death certificate.
Doctrine of Apparent Authority
Sub-doctrine for Doctrine of Vicarious Liability than that can be applied when the person responsible is an employee and at the same time an independent contractor.
Doctrine of Ostensible Agent
Sub-doctrine of Vicarious Liability applied when the employee responsible is temporarily under the supervision of another?
Borrowed Servant Doctrine
The anesthesiologist inadvertently gave the wrong dose of anesthesia to a heart-failure patient leading to cardiac arrest and eventual death. If this element or subdoctrine is applied , the head surgeon is also responsible.
Captain of the Ship Doctrine
A sponge is left inside the patients body after a laparotomy. What is the most applicable doctrine?
Doctrine of Res Ipsa Loquitur / Common Knowledge
A patient suffered from anaphylaxis after intake of a sulfa-containing drug due to his inaccurate answer during history taking. What doctrine is applicable ?
Doctrine of Contributory Negligence
A patient sought consult due to back pain , he was given paracetamol and Eperisone. The patient returned after a week with the same complaint and was given the same medications, this went on for several months without investigation of any underlying cause. What doctrine is likely applicable?
Doctrine of Continuing Negligence
The doctor explained all possible complications of parotidectomy to the patient and the patient consented the procedure. Post surgery , the Patient suffered from Freys Syndrome, the doctor may not be held liable under what doctrine?
Doctrine of Assumption of Risk
A patient admitted under the service of Surgery and was referred to Medicine, an antibiotic to which the patient had a previous allergic reaction was prescribed by the IM resident. The surgery resident , despite knowing the px previous reaction , carried out the order. The Surgery resident is also liable to what doctrine?
Doctrine of Last Clear Chance
Physicians are considered as independent contractors, despite this, the hospital is responsible for supervising the competence of its staff, therefore the hospital may still be held liable. Identify the applicable doctrine?
Doctrine of Corporate Negligence
Four -fold test of employer- employee relationship?
- Selection and Engagement
- Payment of the wages
- Power of dismissal
- Power of control the employee’s conduct
Pecuniary compensations that may be recovered for an injury or from breach of some duty or the violation of rights recognized by the law?
Damages
Adequate compensation only for pecuniary loss suffered.
Actual or Compensatory Damages
Estimated value of pain and suffering per day times the number of days the victim will suffer.
Per diem Method
Call on the Judge to determine how much the damages will be
Golden Rule Method
Awarded as punishment or deterrence.
Exemplary or Corrective Damages
Lack of precaution displayed ; Damage impending to be caused is not immediate nor the danger clearly manifest.
Simple Imprudence
Voluntarily, but not without malice, doing or failing to do an act from which material damage results.
Reckless Imprudence
A physician unable to appear in a trial should write a show cause order explaining why he should not be cited for indirect contempt within ____ days.
Three
Members of the Board of Medical Education.
- Secretary of Health
- Director , Bureau of private schools
- Chairman , Board of Medicine
- Representative of PMA
- Representative of Council of Deans of the Philippine Medical Schools
- Representative of Association of the Philippine Medical Colleges
Chairman of the Board of Medical Education?
Secretary of Education and Culture or Authorized Representative
Responsible for the general supervision and regulation of all professions constituting the highly skilled manpower of the country?
PRC
Who appoints the members of PRC?
President of the Philippines
Powers vested upon the Board of Medicine? (3)
- Prepare and administer licensure examination for physicians.
- Adopt measures that can enhance the practice of the profession.
- Delegate hearing or investigation of administrative cases except in cases that involves the practice of profession.
The BOM cannot promulgate damages even if a doctor is found guilty in an administrative case.
Grounds for the Board of Medical Examiners to refuse the issuance of a Certificate of Registration.
- Convicted by any court of any criminal offense involving moral turpitude.
- Found guilty of immoral or dishonorable conduct after the investigation of Board of Medicine
- Declared to be of unsound mind.
Qualifications to be a Board of Medical Examiner?
- Natural born Filipino Citizen
- Duly registered physician
- Be at least 40 yo
- Has been in practice for at least 10 yrs
- Good moral character with recognized standing in medical profession as certified PMA
- Not a member of the faculty of any medical school and has no pecuniary interest in any institution at the time of his appointment.
PRC consists of how many members?
Three
1 Full time commissioner ( term 9 yrs)
2 Full time associate commissioners ( term 1st associate : 6 yrs, term 2nd associate: 3 years)
Who appoints the members of the Board of Medicine ?
President of the Philippines
Board of Medicine Composition Requirements?
Not more than three shall be government physicians.
And not more than two shall be the same institution.
The Board of Medicine consists of how many members?
**Six **
Tenure of office :
2 members for 1 yr
Another 2 members for 2 years
Remaining 2 for 3 yrs
Minimum required courses to apply to Medical School according to the Medical Act of 1959.
Course / Units
Chemistry -21 u
English - 18 u
Zoology & Botany- 15 u
Philosophy ( including psychology & logic) -12 u
Humanities & Social Science- 12
Mathematics including accounting and statistics- 9 u
Physics -8
Latin- 3 u
Library Science- 1
Mandatory Courses in Medical School.
- Anatomy
- Physiology
- Biochemistry & Nutrition
- Pharmacology
- Microbiology
- Parasitology
- Medicine and Therapeutics
- Pathology
- Gynecology
- Ophthalmology , Otology, Rhinology and Laryngology
- Pediatrics
- Obstetrics
- Surgery
- Preventive Medicine & Public Health
- Legal Medicine , including Jurisprudence, Medical Economics, and Ethics
As stated in the Medical Act of 1959 as amended.
Approval and submission of the lists of candidates for the Board of Medical Examiners is done by?
**Executive council of the Philippine Medical Association **
- The President of the Philippines then appoints 6 members on the list.
Requirements to take the Physician Licensure Examination. (4)
- Citizen of the Philippines or any foreign country who has submitted documentary evidence of reciprocity;
- Certificate of Good moral standing;
- Of sound mind;
- Not have been convicted of any offense involving moral turpitude.
Passing grade for the PLE.
75 % General average for all 12 subjects with no grade falling below 50% in any subject.
“As stated in RA no. 4224 : An act to amend certain sections of Republic Act Numbered Twenty-three Hundred and Eighty two (RA 2382) aka The Medical Act of 1959.”
Subjects included in the preliminary examination for physicians.
- Biochemistry
- Anatomy & Histology
- Physiology
- Microbiology & Parasitology
In order to take the preliminary examination for physicians, the examinee should at least be _____ yrs old?
19yo
In order to take the final and complete examination for physicians, the examinee should at least be ______ years old?
21
This allows a non-Filipino to practice in our country as long as there is an endorsement from the Board of Medicine to practice for a limited or specific case only.
Endorsement Rule
Topics that are mandatorily included in the surgery exam of PLE.
- Ophthalmology
- Otology
- Rhinology
- Laryngology
- Orthopedics
- Anesthesiology
Subjects in the preliminary examination of PLE.
- Anatomy
- Biochemistry
- Microbiology & Parasitology
- Physiology
The last 8 is part of the Final.
Subjects that are part of the final examination of the PLE.
- Pharmacology & Therapeutics
- Pathology
- Medicine
- OB-GYNE
- Pedia & Nutrition
- Surgery & Ophthalmology & Otolaryngology & Rhinology
- Preventive Medicine & Public Health
- Legal Medicine, Ethics and Medical Jurisprudence
Penalties for illegal practice of medicine.
Both Fine & Imprisonment
Individuals who do not require a permit to do limited practice of medicine in the Philippines.
- Commissioned Medical offices of US armed forces stationed in the Philippines while rendering service for members of said army.
- Foreign doctors employed as exchange professors in special branches of medicine and surgery.
- Medical students who have completed the first four years given limited authorization by the Secretary of Health.
Doctors from the other countries called for consultation and exclusively for specific and definite cases, or those attached to international bodies need to secure authorization from Board of Medicine.
Identify what Rule.
This means that a non-Filipino can practice medicine in our country as long as his country origin allows the same as duly proven by the documents presented to and confirmed by the DFA, provided further , that he pass the PLE.
Reciprocity Rule
According o RA 2382 ( Medical Act of 1959) , questions Medicine should include at least three questions from these subjects?
CANDIE
Cardiovascular
Allergy
Neurology
Dermatology
Infectious Disease
Endocrinology
According to RA 2382 questions in Surgery should include at least 4 questions from these subjects?
RALOOO
Rhinology
Anesthesiology
Laryngology
Ophthalmology
Orthopedic
Otology
After failing the PLE _____ times, the examiner should take a refresher course.
3x
If the examinee failed the PLE thrice, where can he take a refresher course?
Any medical school with a certified refresher course
According to RA 2382, there should be at least ____ items per subject.
At least 10
This refers to the ultimate fact to be proven or the proposition to be established.
Factum probandum
This refers to the evidentiary facts by which the factum probandum will be proved.
Factum probans
Refers to guilt of the accused in a criminal proceeding
Factum probandum
Evidentary facts by which the factum probandum will be provided.
Factum probans
Administrative bodies that can receive substantial evidence to convict a physician of medical negligence.
Professional Regulation Commission
Period before reinstatement of revoked PRC license
Two years
Grounds for reinstatement of revoked license
- Respondent has acted in an exemplary manner in the community.
- Respondent has not committed any illegal, immoral, or dishonorable acts.
Reinstatement after 2 yrs
Payment of damages is not required
Holds the burden of proof in administrative cases of medical negligence.
The complainant
The Board of Medicine will investigate but the burden of proof still falls on complainant.
Grounds for suspension, revocation of certificate of registration or reprimand of erring physicians.
- Immoral or dishonorable conduct
- Insanity
- Gross negligence , ignorance or incompetence resulting to injury or death of patient
- Conviction of criminal offense involving moral turpitude
- Unprofessional or unethical conduct
- The use of perpetuation of fraud or deceit in the acquisition of registration certificate
Guidelines on physicians receiving gifts from industry.
Gifts of reasonable values that primarily entail benefit to patient care or related to physicians work may be accepted.
Factors contributing to rampant medical paternalism in the 20th century.
- Patients lack of knowledge
- Patients having blind faith in doctors decision
- Paternalistic attitude and surrogate decision making of doctors
Adjustments to medical practice, licensing, and regulation due to the pandemic.
Medical graduates can render services during the pandemic upon authorization from the Secretary of Health.
Passing the licensure examination is still required . Requirements for taking the examination remain the same.
Traditional medical paternalism.
The decision followed is one given by the doctor.
Fitness to plead
- Refers to a defendant’s ability to understand and participate in the legal process.
- A prerequisite to a fair trial.
Ethical principle violated by the medical paternalism
Informed consent / Autonomy
Medical Paternalism set of attitudes and practices in medicine in which a physician determines that a patient’s wishes or choices should not be honored.
Relationships applying vicarious liability.
- Master - Servant
- Employer- Employee
- Principal- Agent
Vicarious liability is also known as imputed negligence or respondent superior.
Evidence referred as relevant and of such nature that it can be received by a court law.
Competent evidence
A statement made by a person who is at the point of death , conscious of his approaching dissolution, and speaks in reference to the manner in which he received the injuries that could possibly cause his death.
Dying Declaration
Grounds for admissibility of a dying declaration? (2)
Necessity & Trustworthiness
This is a court order issued by a judge at a petitioner’s request compelling someone to execute a duty he is legally obliged to complete.
Writ of Mandamus
This is an order of a higher court to a lower court to send all documents in a case so the higher court can review the decision.
Writ of Certiorari
A physician may refuse to attend civil if the place of trial is more than ____ from his place of residence.
100km ( as of 1997) ;
50km before
Type of subpoena wherein the physician is required to appear before a trial.
Subpoena ad testificandum
Type of subpoena wherein the physician is required to provide documents under his control or possession that are deemed pertinent to the case at hand.
Subpoena duces tecum
Type of subpoena wherein the physician is required to provide documents and appear before a trial.
Subpoena duces tecum et ad testificandum
Subpoena ad testificandum
Required to appear before a trial
Subpoena duces tectum
Required to produce some documents
Terms included in the physician- patient relationship.
The physician guarantees to manage the patient in accordance with the standard of care.
Does not guarantee
1. Cure
2. The doctor will not commit an honest mistake in judgement
3. The treatment will not harm the patient
Reasons for malingering
- Defense to criminal prosecution
- Increase demand for damages in a civil suit
- Avoid court appearance
- Avoid military or naval training
- Promulgate sympathy
Malingering, Feigning or Simulation of a disease or injury characterized by ostentation , exaggeration, and inconsistency.
A privileged person dying of non-communicable disease vs another person dying from a **communicable ** disease is an example of?
Health inequality
Distributive justice
Most common acceptable reasons for referral to other doctors?
- To do further specialized testing not available in the hospital
- The presence of co-morbid disease that need specialty care
- To seek further expert management
To refer to institutions where they have financial interest is NOT acceptable.
Created the code of ethics followed by doctors
Philippine Medical Association (PMA)
Provisions of PMA Code of Ethics embodying a physicians right to respect and dignity.
- A physician should be upright , diligent, sober , modest and well-versed in the science and art of Medicine.
- A physician should not permit the use of any fraudulent , misleading, deceptive , self-laudatory unfair claims regarding his qualifications to gain advantage over a colleague.
- A physician must conduct themselves with courtesy and candor to their colleagues and be ready to provide professional assistance when needed.
Penalties which can be imposed by PRC?
Warning , Reprimand, Suspension, Revocation
The PRC has no power to charge fines and damages.
Duties of Physician (3)
- Must comply with standard of medical care observed by their peers.
- Use their knowledge and skills with ordinary care due to diligence
- Exercise best judgement in utmost good faith.
Duties of the Physician to the patient in accordance with the PMA Code of Ethics.
- A Physician should provide competent medical care
- Physician should hold confidential whatever he discovered during treatment
- In an emergency, a physician should administer at least first aid and then refer to a more competent health provider.
- A physician should be free to choose the patient
- Professional fees should be commensurate to the services rendered with due consideration to the patients financial status , nature of the case, time consumed , and the professional standing and skill of the physician in the community.
- A physician should exercise good faith and honesty in expressing opinions to the diagnosis , prognosis, and treatment of a case under his/ her care.
Professional courtesy to colleagues.
Physicians must render service gratuitously to a fellow colleague. The Physician rendering the service should waive the fees.
The Physician shall waive his profession fee to the following colleague’s relatives.
- Spouse
- Minor children
- Parents
Being provided and Supported by the colleague
Reasons stated by the Supreme Court why there is no need to expressly require doctors to observe extraordinary diligence .
- The conduct of doctors is governed by the Hippocratic Oath
- State regulation through licensing by a professional board and through revocation of license if needed.
This is from GR No. 130547, Leah Alesna Reyes, Nahdja, Johnny and minors Lloyd and Kristine, all surenamed Reyes, represented bu their mother, Leah Alesna Reyes, petitioners, vs.
Sisters of Mercy Hospital, Sister Rose Palacio, Dr. Marvie Blanes, and Dr. Marilyn Rico , respondents.
