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Law applied to medical practice
Medical Jurisprudence
Medicine applied to law and justice
Legal medicine
Branch of medicine
Legal medicine
Branch of Law
Medical Jursiprudence
Based on the principle of coordination (of medicine to law and justice)
Legal medicine
Based on the principle of subordination
Medical Jurisprudence
The physician should obey the law and should practice medicine within the premise of law
Medical Jurisprudence
No one is considered above the law
Medical Jurisprudence
Study of rights, duties and obligations of a medical practitioner with particular reference to those arising from doctor-patient relationship
Medical Jurisprudence
Regulates the practice of Medicine
Medical Act of 1959 (RA 2382)
Standardization and regulation of medical education
Medical Act of 1959 (RA 2382)
Examination for registration of physicians
Medical Act of 1959 (RA 2382)
Supervision, control, and regulation of the practice of medicine
Medical Act of 1959 (RA 2382)
Mandatory writing of Generic Name
Generics Act of 1988 (RA 6675)
Ensure adequate supply of drugs at the lowest cost procurement and distribution of drugs to encourage extensive use
Generics Act of 1988 (RA 6675)
Emphasis scientific basis of drugs
Generics Act of 1988 (RA 6675)
Prohibits advanced payment before confinement
Anti-Hospital Deposit Law (RA 8344)
Penalizes the refusal of hospitals and medical clinics to administer appropriate initial medical treatment and support in emergency or serious cases
Anti-hospital deposit law (RA 8344)
Prohibits demands of deposits or advanced payments prior to confinement and/or treatment of patients
Anti-hospital deposit law (RA 8344)
Prohibits detention of patients on the grounds of non-payment
Anti-hospital Detention Law (RA 9439)
It shall be unlawful to detain 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.
Anti-hospital Detention Law (RA 9439)
Patients should provide truthful information about exposure
Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act (RA 11332)
Penalties/imprisonment of Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act (RA 11332)
20,000 - 50, 000 or imprisonment of 1-6 months
Protects individual personal information in information and communications systems
Data Privacy Act of 2012 (RA 10173)
Protects individual personal information in information and communications systems
Data Privacy Act of 2012 (RA 10173)
An act protecting individual personal information in information and communications systems in the government and the private sector, creating for this purpose a national privacy commission, and for other purposes.
Data Privacy Act of 2012 (RA 10173)
Responsible for administering, monitoring, and ensuring compliance with this act (Data Privacy Act of 2012)
National Privacy Commission
Protects women and their children against abuse
Anti-violence against women and their children Act of 2004 (RA 9262)
An act providing protection to women and their children not just
by means of physical but also includes against discrimination and protection of rights.
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
Law on criminal procedure
Adjective or Remedial Law
Prescribes the rights and obligations of person in their daily relation with each other and with society
Substantive Law
Concerned with mechanical rules that govern the means by which substantive rights and duties are enforced.
Procedural (Adjective or Remedial Law)
Rules by which litigation are conducted.
Procedural (Adjective or Remedial Law)
Philippine Medical Association membership mandatory to practice medicine in the Philippines?
No, but there are certain privileges that only PMA members can avail of
MD patient-relationship
Contractual, consensual, fiduciary
Meeting of minds between 2 persons
Contractual
Based on mutual consent of both MD and patient
Consensual
Based on mutual trust and confidence
Fiduciary
Elements needed for a contract to be valid:
- Consensual & fiduciary
- Contains the subject matter
- Contains cause or consideration
Nature of the medical service to be given is stated orally or in writing
Expressed contract
> Verbal agreements is considered expressed contract but will be difficult to be contested in court
Contract can be inferred from the acts of the contracting parties
Implied contract
> Patient who went to a clinic and the MD who took the history, PE, and instituted the necessary treatment, impliedly showed existence of contractual relationship.
Duties and Obligations imposed on the physician in the MD Patient relationship:
- He should possess the knowledge and skill of which an average MD (GP) is expected.
- He should use such skill and knowledge with ordinary care and diligence
- He is obliged to exercise the best judgment
- He has duty to observe utmost good faith
Duties and Obligations imposed on the physician in the MD Patient relationship:
- He should possess the knowledge and skill of which an average MD (GP) is expected.
- He should use such skill and knowledge with ordinary care and diligence
- He is obliged to exercise the best judgment
- He has duty to observe utmost good faith
Duties and Obligations imposed on the patient in the course of MD relationship
• Patient must give honest medical history of illness
• Even if the patient has to submit to painful management, he will cooperate and follow the instructions, orders, and suggestions of the MD.
• Patient must inform the MD of what occurred in the course of the treatment so that the MD may know the effect of the treatment he is giving.
• Patient must state whether he understands the contemplated course of action and the things expected of him
• The patient must exercise the prudence to be expected of an ordinary patient under the same circumstances.
Terms which are not included in the MD patient relationship
• It does not imply any promise or guarantee by the MD that the treatment will be successful
• Does not imply any promise that the treatment will benefit the patient
• Does not imply any promise that treatment will produce certain result
• Does not promise that the treatment will not harm the patient
• Does not promise that the MD will not commit errors in an honest way
• The law implies in the MD-Patient relationship that the MD will render medical service to the patient and not cure the patient
Instances where there is NO MD-Patient relationship:
• Pre-employmentPE
• PE for the purpose of determining eligibility for insurance
• When MD is appointed by a trial court to examine the accused and to report whether the accused was insane
• Surgeon performing an autopsy and the body of a dead person
• Casual questions asked in an unordinary place (e.g. reunions, random question by an acquaintance in the grocery etc.)
Inherent Rights of a Physician
- To choose patients
- To limit the practice
3 To determine the appropriate management procedures - To avail of hospital services
Incidental Rights of Physician
• Right of way while responding to call of emergency
• Right of exemption from execution of instruments and library
• Right to 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/her services
Simple contractual 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
Contract stipulates the nature of procedure
Simple contractual fee
Specifically states the value of such medical service either orally or in writing
Simple contractual fee
Measured by the space of time and not by the quality or quantity of medical services rendered.
Retainer fee
Examples:
1. Working in HMOs
2. Working as a company doctor
3. Moonlighting MD being paid per hour with no regards to the number of patients seen
Fee depends on the success or failure of the treatment instituted.
Contingent fee
No fee will be received for efforts until a result is attained.
Contingent fee
Requires services of person who may act as an agent (chasers, runners, touts or tipsters) to solicit patients.
Dichotomous fee (Commission or Fee splitting)
The amount of medical fee is dependent on what will be the remaining balance when all of the other expenses have been paid.
Straight fee / “Pakyaw system” / “Package deal”
Notorious with OB-GYNE via buntis package
Criminal liability
Revised Penal Code (Article 365)
Civil liability
Civil Code 19, 20, 21, 2176; The Family Code
Administrative liability
Medical Act 1959 Code of Ethics (Standard of care and Medical Etiquette)
Grounds for administrative investigations:
o Immoral or dishonorable conduct
o Insanity
o Gross negligence, ignorance or incompetence resulting to injury or death of patient
o Conviction of criminal offense involving moral turpitude
o Unprofessional or unethical conduct
o The use or perpetuation of fraud or deceit in the acquisition of registration certificate
Guilt beyond reasonable doubt
Criminal case
Preponderance of evidence
Civil case
Substantial evidence
Administrative case
Prison/fine
Criminal case
Damages
Civil case
Warning, Reprimand, Suspension, Revocation
Administrative case
Employees and at the same time independent
Doctrine of Ostensible Agent:
• Pathologist, radiologist, and anesthesiologist occupy a peculiar stature. They are usually employees and at the same time independent contractors.
• In practice, they usually get a certain percentage of the fee paid to the hospital.
• Most courts consider them as ostensible agents therefore, the hospital must be held liable for their negligent act
When the act or omission of MD constitute a crime
Criminal
May be done with deliberate intent or on account of impudence, negligence, lack of foresight or lack of skill
Criminal
Premised on recovery of damages for their wrongful act or of employees
Civil
Employees of the hospital are sometimes temporarily under the supervision and control of another
Borrowed Servant Doctrine
A doctor cannot be held responsible for the actions of another specialist
Borrowed Servant Doctrine
Surgeon is responsible for anything that will go wrong in the four corners of the operating room
Captain of the Ship Doctrine
