0medical Jurisprudence Summary Compilation PDF

Chapter II
Licensure and Regulatory Laws
To maintain the high quality and standards of the medical practice in the Philippines, three administrative
bodies were created:
 The Board of Medical Education which is concerned with standardization and regulation of medical
education.
 The Professional Regulation Commission which supervise and regulate all professions requiring
examinations which includes the practice of medicine.
 The Board of Medicine which gives examinations for the registration of physicians and supervises,
controls, and regulates the practice of medicine in the Philippines.
The Board of Medical Education

Composition:
Chairman – the Secretary of Education and Culture or representative
Members:
a. Secretary of Health or his representative
b. Director, Bureau of Private Schools or his representative
c. Chairman, Board of Medicine or his authorized representative
d. Representative from Philippine Medical Association
e. Dean, College of Medicine, UP
f. Representative of the Council of Deans of Philippine Medical Schools
g. Representative of the association of Philippine Medical Colleges
Functions:
a. To determine and prescribe the requirements for admission into a recognized College of Medicine
b. To determine and prescribe facilities of colleges of medicine
c. To determine and prescribe the minimum number and minimum qualifications of teaching personnel,
including the student-teacher ratio.
d. To determine and prescribe the minimum required curriculum leading to the degree of Doctor of Medicine
e. To authorize the implementation of experimental medical curriculum in a medical school that has
exceptional faculty and instrumental facilities
f. To accept applications for certification for admission to a medical school and keep a register of those issued
said certificate
g. To select, determine and approve hospitals or some department of the hospitals for training
h. To promulgate, prescribe and enforce the necessary rules and regulations for the proper implementation
of the foregoing functions
Note: the power of the Board of Medical Education to regulate and supervise medical education must be exercised
in conjunction with the Professional Regulation Commission
Professional Regulation Commission

Professional – those whose names appear in the registration book of the Commission as authorized to
practice their respective professions
Practicing professionals – those who are engaged in, or are performing acts constituting public practice of
their respective professions whether regularly or otherwise, including those holding positions in the Government,
requiring knowledge of their professions
Composition of the Professional Regulation Commission

 Fulltime Commissioner
 Two fulltime Associate Commissioners
MEDICAL JURISPRUDENCE IDCM MED2016 1

Powers of the Commission
a. To administer, implement and enforce the regulatory policies of the National Government with respect to the
regulation and licensing of the various professions
b. To perform any and all act, enter into contracts, make such rules and regulations and issue such orders and
other administrative issuances
c. To review, coordinate, integrate and approve the policies, resolutions and regulations, orders or decisions
promulgated by the various Boards with respect to the profession or occupation under their jurisdiction
including the results of their licensures examinations
d. To administer and conduct the licensure examinations of the various Boards according to the rules and
regulations promulgated by it
e. To keep and maintain a register of the authorized practitioners of the profession or occupation
f. To have custody of all the records of the various boards including their examination papers, minutes of
deliberation, records of administrative cases and investigations and examination results
g. To determine, fix and collect the amount to be charged for examination, registration, registration without
examination, licenses, annual registration fees, certifications, subcharges and other fees
h. To appoint, subject to the provisions of existing laws, such officials and employees of the Commission as are
necessary in the effective performance of its functions and responsibilities
i. To submit and recommend to the President of the Philippines nominees for appointment as members of the
various Boards from those nominated by the bona fide professional organizations accredited by the
Commission to fill existing or probable vacancies
j. Approve the registration of and authorize the issuance of a certificate of registration with or without
examination to a foreigner who is registered under the laws of his country.
k. The commission shall have general supervision over foreign nationals who are authorized by existing laws or
granted special permits to practice their profession temporarily in the Philippines to see to it that that terms
and conditions for their employment are strictly observed and adhered to;
l. To prescribe or revise, in conjunction with the Board concerned and the Secretary of Education and Culture or
his authorized representative, collegiate courses in which the completion of or graduation from shall be a
prerequisite for admission into the practice of the professional concerned;
m. To exercise general supervision over the members of the various Boards;
n. To promulgate such rules and regulations as may be necessary to effectively implement policies with respect
to the regulation and practice of the professions; and
o. To perform such other functions and duties as may be necessary to carry out effectively the various provisions
of the professional regulatory laws, decrees or orders (Sec 5. 5 P.D. 223 as amended by P.D. 657)
III. BOARD OF MEDICINE
Composition:
The board of medicine shall be composed of six members to be appointed by the President of the Philippines
from the list of not more than twelve names approved and submitted by the Executive Council of the Philippine
Medical Association, after due consultation with other medical associations during the month of September each
year. The chairman of the Board shall be elected from among themselves by the members at a meeting called for the
purpose. The president of the Philippines shall fill any vacancy which may occur during the examination from the list
of names submitted by the Philippine Medical Association in accordance with the provision of this Act. (Sec. 13.
Medical Act of 1959 as amended)
Qualifications of those to be appointed members of the Board of Medicine:

a. He is a natural born citizen of the Philippines;
b. He is a duly registered physician in the Philippines;
c. He has been in the practice of medicine for at least 10 years;
d. He is of good moral character and of recognized standing in the medical profession as certified by the Philippine
Medical Association; and
e. He is not a member of the faculty of any medical school and has no pecuniary interest, directly or indirectly,
in any institution where any branch of medicine is taught at the tme of his appointment (Sec 14, Medical Act
of 1959 as amended)
Tenure of Office
The members of the Board of Medicine shall hold office for a term of 3 years w/o immediate reappointment and until
their successors are duly qualified. During the year of the implementation of this amendment, the members of the
Board of Medicine shall hold office as follows:
a. Two members for term of 1 year;
b. Two members for a term of 2 years; and
c. Two members for a term of 3 years.
Investigation against Board Members:
Sec 1, Art VII, Rules and Regulations----

The commission may at its own instance or upon complaint of other person under oath initiate and conduct
administrative investigation against any member of the various Boards for neglect of duty, incompetence,
unprofessional or dishonorable conduct, or for such other cause or causes as may be provided for by the law.
Sec 2, Art. VII, Rules and Regulations---

The respondent Member of the Board shall be informed of the charges against him, shall be entitled to be
represented by counsel or be heard in person to have a speedy and public trial, to confront and to cross-examine
witnesses against him and to all other rights guaranteed by the Constitution.
Power, Functions and Responsibilities of the Board of Medicine;
a. To determine and prepare the contents of licensure examinations;

b. The Board of medicine, with the approval of the Professional Regulation Commission, shall promulgated such
rules and regulations as may be necessary for the proper conduct of the examinations, correction of
examination papers and registration of physicians;
c. To administer oath to physicians who qualify in the examination
d. To study the conditions affecting the practice of medicine in all parts of the Philippines.
e. To investigate violations of their respective laws and the rules and regulations promulgated thereunder and
for this purpose may issue summons, subpoena and subpoena duces tecum to alleged violators and witnesses
thereof and compel their attendance to such investigations or hearings
f. To conduct hearings or investigations of administrative cases filed before them, in which case the hearings
shall be presided by atleast 1 member of the Board concerned assisted by a legal or hearing officer of the
Commission.
g. To promulgate decisions on such administrative cases subject to review by the Commission.
h. Subject to review by the Commission, to approve registration without examination and the issuance of the
corresponding certificates of registration.
i. After due process, to suspend, revoke or reissue certificates of registration for causes provided for by law or
by the rules and regulations promulgated therefore.
j. To promulgate, with the approval of the professional Regulation Commission, such rules and regulations as it
may deem necessary for the performance of its duties in harmony with the provisions of the medical Act and
necessary for the proper practice of medicine in the Philippines
Admission to Practice of Medicine

 He/she cannot practice medicine in the Philippines unless he/she is at least 21 years of age.
 Passed the Board examination
 Holder of valid certificate of Registration issued by the board of Medicine
Requirements in taking the Medical Board Examination

 Meet the minimum age requirement (21 years old)
o At least 21 years old- person has the capacity to act capable of having juridical effect
o Applicant for admission may take or pass the board examination below the age of majority (21 years
old) but the certificate of registration may only be issued when he reaches 21 years old.
o Act 4211-permitted undergraduate but qualified person to take the examination subject to condition
that they will not practice their profession until they reach the required age.
 Proper Educational Background
o Requirements for admission in a College of Medicine
 Must be a holder of a bachelor’s degree in science or arts
 Must not have been convicted by court of any offense involving moral turpitude
 Must be able to present the following:
 Record showing completion of Bachelor’s Degree in science or arts
 Certificate of Eligibility from the Board of Medical Education
 Certificate of Good Moral Character issued by 2 former professors in the college of
liberal arts
 Birth Certificate
o Minimum Required College Courses
 At least 5 years of medical course
 Not less than 11 months rotating internship in an Approved Hospital
 Shall consist the following Subjects:
o Anatomy
o Physiology
o Biochemistry and Nutrition
o Pharmacology
o Microbiology
o Parasitology
o Medicine and Therapeutics
o Pathology
o Gynecology
o Ophthalmology, Otology and Laryngology
o Pediatrics
o Obstetrics
o Surgery
o Preventive Medicine and Public Health
o Legal Medicine (Jurisprudence, Medical Economics and Ethics)
Note: Provided that the Board Authorized the School to modify or add subjects listed above as the need and
demands of progress in Medical Profession may require.
 Meet examination requirements
o The Person Must have satisfactorily passed the corresponding Board Examination before he can
practice medicine.
o Applicants for Board Examination may take the exam in 2 sittings, Preliminary and Final in one
complete examination wherein preliminary and final are combined.
o Qualifications of Candidates for Board Examination
 For Preliminary Examination
 At least 19 years of age

 Good moral character
 Complete the 1st two years of medical course
o Has completed at least 2 of the required 4 graded course sessions in school, of
not less than 32 weeks each, of not less than 35 hours each week, in 2 different
calendar years
 Medical Act of 1959- Qualification of those who are going to take the preliminary
board examination.
 For the Final or Complete Examination
 Shall be a citizen of the Philippines, Citizen of any foreign country who has submitted
competent and conclusive documentary evidence, confirmed by the Department of
Foreign Affairs showing that his country’s existing laws permit citizens of the
Philippines to practice Medicine based on “principles of give and take”
 The following are considered Citizens of the Philippines according to Section 1 Article
IV, Philippine Constitution:
 Those who wre citizens of the Philippines at the time of the Adoption of the Constitution
 Those whose fathers or mothers are citizens of the Philippines
 Born before January 17,1983, of Filipino mothers who elect Philippine Citizenship upon
reaching the age of majority
 Those who are naturalized in accordance with law
 Section 2, Article IV, Philippine Constitution
o Natural-born citizens are citizens of the Philippines from birth without having to
perform any act to acquire or perfect their Philippine Citizenship.
o Act 4163: Filipino physicians are allowed to be admitted in a foreign country with
certain limitations, then the citizens of the foreign country may also be allowed to
be admitted in the Philippines with the same limitations. This is based on the
principle of “an eye for an eye and a tooth for a tooth”
 Shall be of good moral character
 Shall be of sound mind
 Shall not have been convicted
 Shall be a holder of the degree of Doctor of Medicine
 Must have completed a calendar year of technical training known as Internship
Scope of the Examination

A. Preliminary Examination
1. Anatomy and Histology
2. Physiology
3. Biochemistry
4. Microbiology and Parasitology
B. Final Examination
1. Pharmacology and Therapeutics
2. Pathology
3. Medicine
4. Obstetrics and Gynecology
5. Pediatrics and Nutrition
6. Surgery and Ophthalmology, Otolaryngology and Rhinology
7. Preventive Medicine and Public Health
8. Legal Medicine, Ethics and Medical Jurisprudence

C. Complete Examination
1. Anatomy and Histology
2. Physiology
3. Biochemistry
4. Microbiology and Parasitology
5. Pharmacology and Therapeutics
6. Pathology
7. Medicine
8. Obstetrics and Gynecology
9. Pediatrics and Nutrition
10. Surgery and Ophthalmology, Otolaryngology and Rhinology
11. Preventive Medicine and Public Health
12. Legal Medicine, Ethics and Medical Jurisprudence
Date and Place of the Examination

- The Board of Medicine shall give examinations for the registration of physicians, twice a year. The
interval between 1st and 2nd examinations in a year shall be 6 months after giving not less than 10 days
notice to each candidate.
- Place- the examinations are conducted outside to the Greater Manila Area and may be cancelled upon
the authority of the board.
- Postponement as to Date and/or Time- the board concerned may reschedule any examinations or series
of examinations.
- No previously scheduled examinations shall be postponed or cancelled on the day of examinations,
except upon previous consultation of the board.
- Scheduled examinations may generally be postponed only in cases of public calamities.
- Examinations may be postponed or cancelled and reset for another date, only if 25% of the total number
of examinees admitted are absent, in which the examinations of those who are present shall not proceed
but the entire examinations for all examinees shall be rescheduled.
- In case the examination has begun and interrupted by any event such as fire, earthquake, in a manner
that examinations cannot proceed without endangering the life then the examinations shall be called off
and cancelled in regard to all examinees.
Procedure of Application
- On the first day of examination he must possess all the qualifications prescribed by law and the rules and
regulations of the said examinations.
- All questions in the forms must be answered in full and in the handwriting of the applicant.
- A dash or a line is not an answer to a question.
- A false statement knowingly made in the application of any deception, misrepresentation, or fraud on
the part of the applicant will be sufficient to cause cancellation of his examination papers and a ground
for criminal prosecution.
- Application form should have two recent 2 x 2- ½ photo, birth certificate or affidavit of loss and affidavit
of birth executed by parents or persons familiar with the family and a medical certificate and as well as
proof of Filipino Citizenship or reciprocity between the Philippines and the country of which he/she is a
citizen.
- Educational Attainment is best evidenced by the applicant’s transcript of record or diploma.
- Must be filed not later than 5 days before the 1st day of examinations.
- The examination fee must be paid to the cashier of the Commission upon filing the Application.
- Notice of final action taken on the application must be relayed to the applicants at least two days prior to
the 1st day of the licensure examination applied for.

Preparation of Questions
- The Board in a meeting called for the purpose, shall allocate the subjects in the examination among the
chairman and members. It shall be personally prepared by and as far as practicable, in the handwriting of
the Board member to whom the subject is assigned.
- Allocation of subjects among Board members shall be kept strictly confidential until the release of the
results of examinations.
- No examiner shall handle examinations more than 4 subjects or group of subjects.
- The Examination papers shall be under the custody of the Professional Regulation Commission (PRC). The
board shall correct, grade and sign and submit them to PRC within 120 days from the date of the
termination of examinations.
- The questions shall be ready for printing on the day of examination and should be personally brought by
the board member to the place of examination.
- Questions should be place in an envelope securely sealed. This envelope must be enclosed in another
envelope which might be opened without revealing the questions.
- The Board Member concerned whenever possible must be present during the printing of his questions.
- The original questionnaire shall be given to the Chairman of the Commission after printing for purposes
of records.
Guidelines to be observed in the preparation of Questions:

 Shall be the same in all applicants. All answers must be written in English.
 The following rules in preparing for Questions must be strictly observed:
o The time to be allowed for answering the entire questionnaire in a given subject must be
stated which is determined according to the type, character, nature and number of questions
from the average examinee’s point of view.
o Should be definite and should require definite answers. Questions should be complete and
carefully checked to avoid ambiguity or misunderstanding.
o Should be reasonable, neither too difficult nor too easy. Extremes should be avoided.
o Questions should cover only Basic fundamentals relevant to the practice of profession.
o Should be fair, practical, and representative as possible in keeping in mind that the
examinations are designed to test proficiency in the practice of profession. If possible new
terms, inventions and discoveries which have not widely treated common textbooks should
be avoided.
o Engineering handbooks, logarithmic tables, slide rules, and the like may be allowed.
o Samples of old questions may be referred to for guidance. Questions to be given should be
original and should not be copied verbatim from old questionnaire, textbook, quizzers or
outlines used in schools.
o Should be carefully proofread.
Conduct of Examination
- PRC and the Board of Medicine jointly have charge over the conduct of examinations given.
- During the printing of questions the Board member and employees assigned shall be the only persons allowed to
remain within the premises and shall refrain from going out until questions are distributed.
-No name of the examinee shall appear in the examination paper but the examiners shall devise the system with his
name written in a piece of paper inserted and sealed in the envelope.
- No candidate or examinee shall, during the progress f the examinations communicate with a fellow candidate or
examinee by means of words, signs, gestures, codes and other similar acts which may enable to exchange, impart,
or acquire relevant information. Violation of such shall be sufficient cause for the cancellation of his examination
papers or debarment from taking future examinations.

How test papers are CORRECTED and RATED:
-Each board member shall be given only one bunch of 50 papers or such number as may be authorized by the
Commission.
-At the start of correction, the Board Members will take a random sample not less than 10% of the total number of
test papers and immediately determine the passing percentage and the final rating of each test papers on the basis
of the raw score obtained by the examinee.
-The board member will use a blue colored pencil or ink for the original correction and scoring of the test papers.
Any change in the correction or score shall be made only with the use of red colored pencil or ink.
-If credits are specified for each question, for instance if 20percent is indicated for question no. 1, a perfect answer
gets 20%.
-The Chairman of the Commission shall order the following after the turnover of all corrected test papers; a.
computation of the final rating, b. opening of the attached envelopes for the purpose of assembling the test papers
of each examinee, c. computation of the final grades in the report of ratings.
-Examinations that are duly scored, rated shall be submitted for approval not later than one hundred and twenty
days after the last examination day.
-Board members shall not release any information about the results of the examinations before the official release
to the media of the results.
Close or Boardline cases:

- Candidates whose original general averages are not more than 2 percent below the passing general
average fixed by law or regulation. Provided that the candidate have no original or unadjusted
disqualifying rating that is more than 2 percent below the minimum rating prescribed by the law or more
than 2 percent below 50 percentile rank.
- Candidates who obtained passing original or unadjusted general averages but who have disqualifying
ratings in individual subjects which are not more than 2 percent below the minimum rating.
- The general rating of the candidates shall not be adjusted automatically to the passing general average or
to the required minimum rating. Only those whose papers are found to merit such adjustments after a
careful review and shall be adjusted.
- The authority of different boards to deliberate may be exercised only after the general averages of the
candidates have been computed but before the identities are known. Such deliberation shall in no case
be made after the identities of the candidates shall have become known.
When is as Examinee considered to have Passed the Examination:

- If the applicant is found to be proficient in the subjects in the preliminary examinations, he or she shall
be exempted in these subjects at the time of final examination.
- Must have obtained an general average of 75% without a grade lower than 50% in any subject.
- Republic Act 1080- Examinees who passed the bar and board examination is equivalent to 1 st civil service
eligibility effective June 15,1954.
Effect of Failure:
- Failure in any subject in the preliminary examination shall not then be re-examined in such subject in
which he may have failed until he shall have finished the prescribed course of medical study and
internship.
- Candidate who fails for the 3rd time, in the complete or final examination will be required to take a
refresher course of at least 1 year in a recognized medical school.
- Requests for reconsideration of ratings may be entertained only on grounds of mechanical, clerical, or
clear errors and must be filed within 30 days from the date of the official release of the results of
examinations.
 Holder of certificate of registration

Oath Taking:
- Certificate of Registration will be issued to those who successfully passed the examination.
- Must take his oath, symbolically Hippocratic Oath and Administrative Oath.
Obligations imposed on a Physician:

1. Obligations imposed in the Hippocratic Oath
- An ethical command to raise the standard of the medical profession and keep it in high esteem
throughout the ages.
2. Obligations imposed in the Administrative Oath

- Before issuance of the Certificate of Registration must take his official oath.
Issuance of the Certificate of Registration

- The PRC issues the Certificate of Registration when an examinee passed the final or complete
examination. It is not issued if certain administrative requirements have not yet been fully complied.
- The Certificate of Registration of License must be signed by all the members of the Board of Medicine
and Commissioner of the Professional Regulation Commission and with official seal of the Board affixed.
- No certificate of registration is issued to any candidate:
o Who has been convicted by a court of any offense involving moral turpitude
o Who has been found guilty of immoral or dishonourable conduct
o Who has been declared to be of unsound mind
Note: After the lapse of 2 years, for reasons of equity and justice the Commission may issue such Certificate of
Registration upon recommendation of the Board.
A. Every Certificate of Registration shall be signed by all the members of the board and the Chairman of the
Commission. It shall carry the official seals of the board and the commission with a recent 2 x 2 photo of the
registrant affixed and sealed on the upper right-hand corner.
B. Evidence that the person named therein is entitled to the rights and privileges of his profession.

CHAPTER III
PRACTICE OF MEDICINE
-it is a privilege grated by the state to any person to perform medical acts upon compliance with the law.
Medical Act of 1959

– promulgated by the state in the exercise of the police power.
Acts constituting the practice of medicine

1. Person who shall for compensation or none physically examine any person, diagnose, treat, operate, or
prescribe (DTOP) any remedy for human disease
2. By means of advertisement and the like either offer to undertake method diagnose, treat, operate or remedy.
3. Who shall falsely use the title of M.D. after his name
Medical Diagnosis – is the art of balancing probabilities.

-medical theory is legally probable if the evidence preponderates in its direction.
Diagnosis – is a mental process whereby one or more person praise a situation and make a decision based on their
judgment, may or may not lead to ACTION
-act of making a judgment and would thus appear to rest solely within the scope of medical and not nursing
practice
Treatment – all steps taken to effect a cure of an injury or disease

-it includes examination and diagnosis as well as application of remedies
Operation – is a surgical procedure with or without surgical instrument.

-Close reduction of fracture: without use of instruments
-use of an instrument to penetrate tissues of the pt, either to introduce or withdraw substance is an operation.
Major Surgery – consist of operation within or upon the ff cavities:

 Cranium
 Thorax
 Abdomen
 Pelvis
-locality
-condition of the patient
-difficulty or the length of time required to operate, constitute a distinct hazard of life
Prescription – is a direction of remedy or remedies for a disease and the manner of using them
-formula for the preparation of a drug and the medicine
-prescribe means TO DIRECT, DESIGNATE, or ORDER USE OF A REMEDY
NOT considered a Practice of Medicine:

BY PROVISION OF LAW
1. A medical intern under the supervision of a registered physician
2. Legally registered dentist engaged exclusively in practice of dentistry
3. Any duly registered masseur or psychotherapist
4. Registered optometrist who mechanically fits or sells lenses
5. Any person who renders gratuitously in cases of emergency where no MD is available
6. Prosthetist who fit artificial limbs
7. Clinical psychologist in regards to psychiatric cases
BY DECISIONS OF COURTS
1. One who only takes BP readings and announces the results without giving advice or prescribing treatment
2. The use of electric vibrator or sun ray lamp by an unlicensed person
3. The use of an electric machine by barbers in giving treatment to one who sought to beautify his body rather
than to secure treatment of a disease or deformity
4. The application of a medicated massage
5. A hospital cannot be said to be practicing medicine in violation of law where it merely agrees to care for the
patient in the usual manner
6. The administration of anesthesia by a licensed nurse under the supervision of a physician in connection with
a surgical operation
Faith Healing, healing by prayer or divine healing

-there is nothing in the Medical Act exempting faith healing from the definition of the acts which constitute
practice of medicine.
-but there is a constitutional guarantee to religious freedom
-no law shall be made respecting an establishment of religion or prohibiting the free exercise thereof
ACUPUNCTURE
-founded more in mystery rather than science
-“miracle cure”
-balancing of energy forces in the body
-relief of pain when applied
-must be done with caution
-experimental procedure uses experimental devices such as needles, electric generators and control
Accdg. To the Board of Medicine: modality of treatment in the course of the physician’s practice
Penalties for “illegal practice of medicine”

-punished by a fine of not less than P1,000 nor more than P10,000 with subsidiary imprisonment in case of
insolvency or by imprisonment of not less than one year nor more than five years, or by both such fine and
imprisonment, in the discretion of the court.
WHO ARE QUALIFIED TO PRACTICE MEDICINE:

1. Those who complied to practice medicine in accordance to the Medical Act
2. Those who can have limited practice without any certificate of registration like
a. Physicians and surgeons from other countries called in consultation only and exclusively in specific and
definite cases
b. Commissioned medical officers of US Armed Forces stationed in the country
c. Foreign physicians employed as exchange professors in special branches of medicine or surgery
d. Medical students who have completed 1st 4 years of the medical course, graduates of medicine and RN
who may be given limited and special authorization by the Secretary of Health
3. “Balikbayan” physicians
4. Those foreign physicians qualified to practice by reciprocity (if Filipino MD are allowed to practice medicine in
that foreign country then Phil may allow the MD of that foreign country to practice medicine in Phil) or by
endorsement (if the qualification of those allowed to practice in foreign country is substantially similar to that
of the Phil)
5. Medical Students – under the direct supervision and control of a registered MD can do the act of diagnosis and
treatment
6. Limited practitioners of the healing art like
a. Licensure laws such as dentist, optometrist, midwife, nurses, medical technologist, physical therapist,
occupational therapist, and pharmacist
b. Without licensure laws such as
>Chiropodist – treats disease/malformation of hands and feet
>Chiropractor – practice of chiropractics that manipulates the spinal column
>Masseur (male) or Masseuse (female) – system of remedial treatment of manipulating of part or whole body
or by mechanical means
>Naturopathist – person who utilizes as remedy to disease: light, air, water, clay, heat, rest, diet, electricity,
massage, suggestive therapeutics, magnetism, physical or mental culture
>Naprapathist – treatment of manipulation based on assumption that all ailments due to wrong with
ligaments
>Neuropathist – nerve mechanism by manipulation around and above the affected part of the body
>Osteopathist – structural and functional activity is coordinated, manipulative correction indicates the bony
framework of the body
**Only NATURAL persons can practice medicine

Natural person – whose personality starts at birth and ends at death
Juridical or Artifical person – one who created by law, whose life and attributes are those provided by law.
Civil Code, Art.44
1. The State and its political subdivisions
2. Other corporations, institutions, and entities for public interest or purpose, created by law; personality begins
ASAP they have been constituted accdg to law
3. Corporations, partnerships and associations for private interest or purpose to which the law grants a juridical
personality, separate and distinct from that of each shareholder, partner or member
CLASSIFICATION OF MEDICAL PRACTICES

1. As to the scope of the practice
a. General practice – attends to all kinds of diseases and institute all forms of treatment and techniques
used
b. Specialist practice – undergone special training in certain fields of medicine within the scope of his
specialization
2. As to Venue of practice
a. Clinical practice – own private clinic
b. Hospital practice – entertain patients only in hospital
3. As to Number
a. Individual practice – practices alone
b. Group practice – formal association of 2 or more physicians providing services in more than 1 medical
field or specialty
>Forms of group practice
1. Employer-employee relationship – MD whose practice is lucrative may employ medical assistants to
assist him in the mgt of pts
2. Partnership – by contract of a partnership, 2 or more persons bind themselves to contribute money,
property or industry to a common fund, with the intention of dividing the profit among themselves
3. Corporation – is an artificial being created by operation of law, having the right of succession and the
powers, attributes, and properties expressly authorized by law or incident to its existence
*Medical Service Plan – form of agreement or arrangement of prepaid medical care

-subscriber or member of the plan regularly pays to the administering organization a fix sum as a premium or
as due
-member receives medical services when he needs it
Other Requirements to Practice medicine

1. Registration fee – initial reg fee P20 and P5 for succeeding years (PRC)
2. Professional License fee – P75 annual, may be paid fully or 2 semi-annual payments of P37.50
3. Sign-board License fee – under municipal ordinance, some cities impose depending upon the size of the
signboard
4. Income Tax – may be computed from the net income or gross income
-net income is gross minus all legally deductible expenses
Meaning of the Term “PHYSICIAN”

According to WHO
“A PHYSICIAN is a person who after completing his secondary education follows a prescribed course of
medicine at a recognized university or medical school, at the successful completion of which, is legally licensed to
practice medicine by the responsible authorities and is capable of undertaking the prevention, diagnosis and
treatment of human illness by exercising independent judgment and without supervision.”

CHAPTER IV
PHYSICIAN-PATIENT RELATIONSHIP
What is the relationship between a physician and a patient?

Physician-Patient Contractual Relationship
Contract:
 The meeting between 2 minds
 One binds himself with respect to the other
 To give something/Render Services
Why is the relationship between a physician and a patient contractual?

Patient: Solicited the service of the physician
Physician: Agreed to render the service
Nature of the Relationship

It is consensual
Established based on mutual consent of both parties involved
Perfected the moment that there is an expression of the agreement between the offer and the acceptance
Nature of the Relationship

It is fiduciary
Based on mutual trust and confidence
Who are the parties involved?

Physician: renders the medical services
Patient: receives the medical services
Third Parties
Guardians or immediate family members in case the patient is incapacitated
Essential Requisites of a Contractual Relationship

 Consent
 Object or Subject Matter
 Cause or Consideration
CONSENT
Must be given by patient or person authorized by law to give such if patient is incapable
There is consent if:
 Manifested by concurrence of offer and acceptance
 Contracting parties possess the necessary legal capacity
 Must be intelligent, free, spontaneous, and real
OBJECT OR SUBJECT MATTER

 Medical Service which the patient wants to be rendered to him/her
 Determinate, legal, and not outside the commerce of man
 Object is just to render medical services, NOT TO CURE THE DISEASE
CAUSE OR CONSIDERATION
Factor that prompted the physician to render his services
If patient does not or cannot pay for the services, this do not affect the contract nor lessen the physician’s liability

FORMS OF PHYSICIAN-PATIENT RELATIONSHIP
Expressed Contract
If nature and extent of the medical service is explicitly stated orally or written
Implied
No signification from both parties but implied in their acts
INSTANCES W/OUT PHYSICIAN-PATIENT RELATIONSHIP

A pre-employment physical examination (PE) to determine if applicant is suitable
PE for insurance eligibility
If physician is appointed by court to examine an accused and to report whether he was “insane” or not
Surgeon performing autopsy
Casual questions asked of a physician in an unordinary place
Psychological patterns of physician-patient relationship
ACTIVITY-PASSIVITY RELATION
No interaction between physician and patient because the patient is unable to contribute activity. This is
characteristic in an emergency cases when the patient is unconscious.
GUIDANCE-COOPERATION RELATION
Patient is conscious and suffering from pain, anxiety and other distressing symptoms, he seeks help and
willing to cooperate. The physician is in a position of trust.
MUTUAL PARTICIPATION RELATION

It is in the nature of a negotiated agreement between equal parties.
Specific types of medical services which patient may solicit from his physician
 Perform specific tests or examination
 Examine patient and inform him of his state of health
 Examine, diagnose, inform, recommend appropriate remedy w/out giving any treatment
 Examine,diagnose and give emergency treatment only
 Examine, diagnose and treat him as to only one or more, but not all conditions affecting him, without follow
up care
 Examine, diagnose and treat him as to only one or more, but not all conditions affecting him, with follow up
care
 Fully examine, diagnose and treat him fully, giving him full follow up care
Duties and Obligations Imposed on the Physician

He should posses the knowledge and skill of which an average physician is expected
Expectations from a general practitioner

Have the knowledge and skills possessed by other GP in the locality
 Need not have special training on special methods of diagnosis and treatment
 Expectations from a specialist
 Bound to exercise the degree of skill and knowledge ordinarily possessed by similar specialist
Source of medical knowledge and skill:

 Medical college or school
 Absorbed with the development of medical profession by doing:
 research
 reading journals and literature
 attending lectures, seminars and conventions
 Acquired in discussions with fellow physicians, in observations of the activities of other physicians in
hospitals, clinics, sanitaria, etc.
2. He should use knowledge and skill with ordinary care and diligence
The degree of care is that which will be exercised by other physicians in the same situation
“similar locality rule” – measure whether a physician exercised care and diligence similarly with those physicians in
the locality.
However, given the access on the progress of medicine by the use of seminars, training programs, publications, the
locality ceased to become the standard
The courts then agreed to “national standard of care”
3. He is obliged to exercise the best judgment

Honest errors does not mean negligence provided it is not so gross
E.g, the physician is free to select the proper management procedure, drugs, to be applied on the patient
4. He has the duty to observe utmost good faith

 A physician must be trustful, sincere and honest to his patient
 A physician should secure for them all the possible benefits that may depend upon his skill and care
 A physician must exercise good faith and strict honesty as to the prognosis, diagnosis and treatment
 Serve the best interest of patient and his family
 It is highly unprofessional to give false assurance to the patient when you know that he is having a grave
illness
 It is also highly unprofessional to exaggerate the condition of the patient for any reason transparency is the
rule
 Terms not included in the physician – patient relationship
 It does not imply that..
 It is guaranteed by the physician that the treatment will be 100% successful
 The treatment will produce certain results
 The treatment will not harm the patient
 The physicians will not commit errors in an honest way
Duties and Obligations imposed on the patient in the course of the Physician Relationship:
 Patient must give an honest medical history of his illness;
 Even if the patient has to submit to painful management he will cooperate and follow the instructions,
orders, and suggestions of his physician;
 He must inform the physician of what occurred in the course of the treatment so that the latter may know
the effect of the treatment he is giving;
 If he is given the necessary instructions, he must state whether he understands the contemplated course of
action and the things expected of him; and
 The patient must exercise the prudence to be expected of an ordinary patient under the same
circumstances. In other words, he cannot act as if he was a stranger to his own problem.
Commencement of the Physician-Patient Relationship:

 Know WHEN the relationship was established.
 It is the time where physician is obliged to comply with legal duties and responsibilities to his patients.
 It is also the time when the patient asked for help and the physician accepted.
Termination of the Patient Physician Relationship

The following are some of the ways of terminating Physician Patient Relationship
Recovery of the patient from the condition for which he was receiving treatment or when the physician considers
that further services will no longer be beneficial to the patient.
- recovery needs not be complete
-a complete recovery can be attained through proper nursing care, continuation of medication prescribed,
or expiration of the convalescence.
-sound discretion of the attending physcian is needed to determine if further services is no longer needed.
-Premature termination of the medical service when it is still necessary constitutes abandonment and the
physician may be held liable unless he is justified in doing so.
2. Withdrawal of the physician

Conditions that the physician may withdraw from physician patient-relationship
Patient consented to such withdrawal
Patient is given ample time and notice so that he may secure the services of another physician, or if the attending
physician recommended his substitute who is equally competent to to take his place with the approval or consent of
the patient.
3. Discharge of the physician by the patient

-freely done by the patient
4. Death of the patient

5. Death or incapacity of the physician
6. Fulfillment of the obligations stipulated in the contract
-service solicited by the patient have already been accomplished by the physician.
7. In cases of emergency, when the attending physician or physician of choice of patient is already available, or
whenever there is cessation of the condition of emergency.
8. Expiration of the period, if the contract of medical service is for specific period.
9. Mutual agreement between the physician and patient that the physician patient relationship is terminated.

CHAPTER V
RIGHTS OF PHYSICIAN
Chapter 5
The Physician’s Rights
The rights of a physician, as set by the Philippine Constitution, are the following:
1. Rights Inherent in the Privilege to Practice of Medicine:
a. Right to choose patients;
b. Right to limit the practice of his profession;
c. Right to determine the appropriate management procedures;
d. Right to avail of hospital services.
2. Rights Incidental in the Privilege to Practice Medicine:
a. Right of way while responding to the call of emergency;
b. Right of exemption from execution of instruments and library;
c. Right to hold certain public or private offices;
d. Right to perform certain services;
e. Right to compensation; and
f. Right to membership in medical societies.
3. Rights Generally Enjoyed by Every Citizen as Provided in the Constitution.(Artcile III,Bill of Rights, The Philippine
Constitution, 1986)
Ex post Facto Law – a law which provides for the infliction or of punishment upon a person for an act done which,
when it was committed is not a crime.
Bill of Attainder – a legislative act directed against a designated person, pronouncing him guilty of an alleged crime
(usually treason) without trial or conviction according to the recognized rules of procedure.
Right to choose patients
Code of Ethics (Article II, Sec. 2) – a physician is free to choose whom he will served
- May refuse calls, or other medical services for reasons satisfactory to his professional
conscience.
- Once he undertakes a case he should not abandon nor neglect it.
Code of Ethics (Article II, Sec.3) - in cases of emergency a physician should administer at least first aid
treatment and then refer the patient to a more qualified and competent physician later if the
case does not fall within his particular line.
Republic Act No. 6615 (Sec. 1) - all government and private hospitals or clinics duly licenced to operate as
such are hereby required to render immediate emergency medical assistance and to provide
medicine within its capabilities to patients emergency needs.
Medical Act 1959 (Sec.24 No.12) - Grounds for reprimand, suspension or revocation of Registration Certificate
- The ethical rule obliges the physician to attend to an emergency, his failure to respond to it
may not make him liable if in so doing, there is a risk to his life.
- Refusal of a physician to attend to a patient in danger of death is not sufficient ground for
revocation or suspension of his registration certificate if there is a risk to his life.

Right to limit the practice of his profession
- A physician, in the exercise of his profession, has the right to limit his medical practice for personal
convenience or to maximize the effectiveness of his management procedure.
- Limitations may be imposed on his practice
1. Limitation of practice only on his field of specialty.
2. Limitation of practice in the private clinic or hospital.
3. Limitation of practice within a political or geographical boundary.
4. Limitation of practice on certain days of the week and or certain hours of the day.
5. Limitation of practice to certain class or group of people.
6. Limitation of practice by the dictates of his conscience.
7. Limitation on account of ignorance.
8. Limitation on account of retirement.
9. Limitation to practice medicine which are not self-imposed but emanating from other sources and
therefore not a matter of right:
- Limitations imposed by the public
- Limitations imposed by religion
- Limitations imposed by professional ethics
- Limitations imposed by medical society
- Limitations imposed by law
- Limitations of practice by contract
 Contract of Sale – a physician may sell his medical practice to another which includes the sale
of goodwill he has build during his term of practice, equipment, records, library supplies,
office space and other tangible assets.
 Contract of employment – a physician may be willing to employ another physician as his
employee or assistant provided that such applicant or assistant will be restricted in practicing
in an area for a specified time after he leaves such employment.
 Contract of Partnership – the partnership agreement may include a provision that if anyone
withdraw from the partnership agreement, the withdrawing partner will not practice in
competition with partnership for a certain length of time in certain geographical area.
Right to avail of hospital services

-the physician has the right to use hospital equipment and facilities not available in his clinic. This is not however
applicable to government hospital because of its limited power to issue such regulations regarding the use of its
facilities in as much as it is established in pursuance of the governmental function to preserve the life and maintain
the health of the people and because it is established and maintained by public funds.
- a private hospital is given more leeway in making regulations as regards qualifications of those who may avail
themselves of the hospital facilities, qualification of the medical staff and type of patients to be admitted, provided
that such rules are not arbitrary, discriminatory, unreasonable, monopolistic or contrary to law or public policy.
Right to determine the appropriate management procedures

-in the patient-doctor relationship, the physician is given the full authority to determine the diagnostic
procedure and treatment plans to be adopted.
- although the physician can apply any procedure which he thinks will serve the best patient, it is always
subjected to the patient’s enlightened or informed consent, availability in the community and financial capability of
the patient.
Doctrine of Superior Knowledge – in the physician – patient relationship the physician has a superior knowledge
over his patient. The patient just follows the instructions or orders of the physician. The patient usually places
himself in the command and control of the physician.

Right of way while responding to the call of emergency
Emergency is an unforeseen combination and circumstances which calls for an immediate action to
preserve the life or maintain the health of the person. Ambulances and vehicles of physicians are given due
preference in the use of the road and other vehicles must give assistance and convenience in the pursuance of the
important mission.
Right of exemption from execution of instruments and library

Attachment is an act or process of taking care or seizing property by the virtue of a writ or other
judicial order, and bringing the same into the custody of the law. The purpose of attachment is to enable the
plaintiff to acquire a lien upon the property of the defendant for satisfaction of judgment.
When the judgment for the plaintiff becomes final and executor, the court may order execution of
the judgment on the attached properties of the defendant.
Right to hold certain public or private offices

There are certain positions in the government and private concerns which, judging on the nature can
only be filled up by a qualified physician. No person can be appointed municipal or city health officer, member of
the medical staff of a hospital, colony, etc. unless he is a duly medical practitioner.
Right to perform certain services

The performance of intricate diagnostic or operative procedures can only be done by qualified
physicians. Even if the procedures can be delegated to paramedics, if the physician enters into a contractual
obligation with the patient that he will personally do it, he is obliged to undertake such service, otherwise he can be
held liable for breach of contract.
Right to membership in medical societies

It is advantageous for a physician to become a member of a medical society. Medical societies
promote promote camaraderie, esprit-de-corps and cohesiveness among its members; it increases the status and
prestige of physicians; it promotes the establishment of a solid front in the solution of problems confronting the
medical profession; and it enhances the sharing of knowledge and keeping abreast with the development of medical
science through meetings, seminars and conventions.
Right to compensation
The right of the physician to demand compensation is based on the physician-patient contractual
relationship. It is the medical fee which is the primary reason for the physician to bind himself to the contract
although in certain instances, he is motivated by his generosity and liberality (donation). In cases that the
patient is unconscious, the law implies a promise to pay the physician. Unless there is a specific contract to cure,
a physician is entitled to be paid for his services irrespective of the result. The fact that there is friendship
between the physician and the patient, doesn’t mean that the medical service is gratuitous. While professional
courtesy exists among physicians, that a physician will not charge a family of a fellow physician. Code of Ethics
provides that “a physician should willingly render gratuitous service to a colleague to his wife and minor children
or even to his father and mother provided the latter are aged and being supported by the colleague.”
“Doctrine of Unjustified Enrichment”

No one must enrich himself at the expense of others.
Kinds of Medical Fees:

1. Simple Contractual Fee – A physician may enter into contractual relationship with the patient expressly
stipulating the management procedure to be applied by the physician and specifically stating the value of
such medical service, orally or written.

2. Retainer Fee – This is a professional fee measured by the space of time and not by the quality or quantity of
medical service rendered.
3. Contingent Fee – The value of the professional medical fee which depends upon the success or failure of
treatment instituted.
4. Dichotomous Fee (Fee Splitting) – The physician may require the service of a person who may act as an
agent to solicit patients. The agent will then share in the medical fee either percentage basis or fixed
amount.
5. Straight Fee (Pakyaw System; Packaged Deal Agreement) – For the amount rendered by the patient to the
physician, the latter shall be responsible to the payment of the hospital bill, the lab fees, medicine and other
incidental expenses in the management of the patient.
Methods of Collection of Payment for Medical Services:

1. Friendly or Extrajudicial Methods
A. Billing
B. Referral to a bill collection agency
2. Judicial Method
Factors Influencing the Amount of Medical Fees:

1. Nature and character of the services rendered
2. Labor, time, and trouble rendered
3. Importance and responsibility in the case
4. Professional character and social standing of the physician
5. The results secured
6. Financial ability of the patient
7. Purchasing power of peso
8. Local custom
If the patient died, the claim for medical fee shall be made from:
1. Spouse
2. Descendants of the nearest degree
3. Ascendants of the nearest degree
4. Brothers and sisters
Instances when the physician cannot recover the professional fees:

1. When there is an agreement that the service is gratuitous
2. Professional services rendered by the physicians in government charity hospitals, health centers, rural
health units, asylums, tenements to indigent patients
3. Professional services rendered by the physicians in private charitable institutions, if the service is
expressly gratuitous to the indigent patients
4. Waiver on the part of the physician to the professional fee even if there has been a previous
agreement that the service is for a fee
5. When there has been an expressed contract to cure and the physician fails to comply with such
agreement
6. When physician cannot charge the patient
7. Those covered by Medicare
8. Medical services rendered by industrial or company physicians to their respective employees
9. Medical services rendered by school, college, or university physicians to the faculties, students, and
administrative employees

CHAPTER VI
RIGHTS OF PATIENT
1. Right to give consent to a diagnostic or treatment procedure

2. Right to religious belief
3. Right of privacy
4. Right to disclosure of information
5. Right to confidential information
6. Right to choose his physician
7. Right of treatment
8. Right to refuse necessary treatment
I. RIGHT TO GIVE CONSENT TO A DIAGNOSTIC OR TREATMENT PROCEDURE

The physician is oblige to inform his patient of the diagnosis, the general nature of the contemplated procedure, the
risks involved, the prospect of success, the potential danger if procedure is not applied and the alternative
treatments, if any.
The patient is free to give or withhold his consent to his application. He is the final arbiter to what must be done to
his body.
BASES OF CONSENT:
1. THE RELATIONSHIP OF THE PHYSICIAN AND PATIENT IS FIDUCIARY
The physician-patient relationship is based on trust and confidence by the patient to his attending
physician.
2. THE PATIENT HAS THE RIGHT TO SELF DETERMINATION

Every human being of adult years and a sound mind has the right to determine what shall be done to his
body and a surgeon who performs an operation without the patients consent commits an assault for which
he liable for the damage.
3. THE PHYSICIAN-PATIENT RELATIONSHIP IS CONTRACTUAL

The patient solicits the service of the physician and the latter agrees to render medical services to the
patient.
THE PURPOSE OF CONSENT:

1. To protect the patient from unnecessary or unwarranted medical procedure applied on him without his
knowledge.
2. To protect the physician from any consequence from failure to comply with the legal requirements.
INSTANCES WHERE CONSENT IS NOT NECESSARY:

1. In case of emergency
2. When the law made it compulsory for everyone to submit to the procedure.
Example:
Compulsory basic immunizations for infants and children below 8 years of age
Violation shall be punished by imprisonment not exceeding one month or fine of not exceeding 200.00 or both.
Refusal to submit to vaccination - punished by a fine not more than 100.00
Failure of the person incharge to present the vaccination - punished by a fine of 10.00 per offense
RA 3573 - an act providing for the prevention and suppression of dangerous communicable disease

REQUISITES OF A VALID CONSENT
Before a consent may be valid, it must supply with the following requirements:
A .It must be an informed or an enlightened consent;
B. It must be given by the patient voluntarily; and
C. The subject-matter must be legal
A. Informed or Enlightened Consent

- With awareness and assent
- Before the consent is obtained, the physician should give the patient:
a. A fair and reasonable explanation of the nature of the ailment

b. The nature and extent of operation or treatment to be done, its probable risks if any, and its probable
consequences
Assent – the willingness of the patient to submit to the contemplated management procedure after he had been
aware of the procedure to be adapted and the risk involved.
Art. 1339 (Civil Code) – failure to disclose facts, when there is a duty to reveal them, as when the parties are bound
by the confidential relations, constitutes fraud.
Art. 1332 – when one of the parties is unable to read, or if the contract is in a language not understood by him, and
mistake or fraud is alleged, the person enforcing the contract must show that the terms thereof have been fully
explained to the former.
Full disclosure as a requirement for an informed consent does not require the physician to inform the patient of
every conceptable, infinitesimal, or imaginary element that goes into making up the risks of a procedure or
treatment
- Therapeutically unsound because it may only prevent the patient from acquiescing to the indicated therapy and
also, it may create unnecessary psychological disturbances
Quantum of Information Necessary to Form the Basis of a Valid Consent:

Satisfaction of the legal definition of “informed consent” requires the minimum of 5 elements of understanding on
the part of the patient:
1. He must understand the nature of his condition;
2. He must understand the nature of the proposed treatment or procedure;
3. He must be aware of the possible alternative courses of action;
4. He must be acquainted with the risks of the proposed and alternative courses of action; and
5. He must be informed of the chances of success or failure of the proposed and alternative therapies.
- Anything less may result in a court decision of unauthorized treatment.

- However, even after authorized treatment has been started, the patient may withdraw his consent and the
physician must immediately desist further treatment or continuation of a procedure unless she can show that the
withdrawal would have endangered the patient’s life and health.
Louisell and Williams “rule of thumb” as to how much information must be divulged to the patient:
1. If the risk of untoward result is statistically high, the patient should be informed regardless of the effect on
his morale.

2. If the risk is statistically low, but the consequences of a rare untoward occurrence may be severe, the
patient should likewise be informed.
3. On the other hand, if the statistical risk is low or the severity of risk is not great, the physician may safely
tailor his warning so as not to excite the patient’s fear.
Instances when informed consent requires more disclosure of facts:

(1) When the procedure will entail much risk.
(2) When the procedure is experimental or innovative.
Instances When Full Disclosure May Not Be Necessary.

(1) When the disclosure may cause emotional upset to the patient.
(2) When the medical procedure is publicly known to be safe.
B. The Consent Must Be Given Voluntarily

Consent of the patient to any medical procedure to be adopted must be freely given. Consent given by the
patient through force, threat, intimidation or undue influence will vitiate the consent
C. The Subject Matter or Procedure Wherein the Patient Gave His Consent is Legal
The medical procedure to be applied to the patient and which the law penalizes or against public policy.
Thus, consent given by the patient for the performance of a criminal abortion will make both the physician
and the patient “in pari delicto” to the illegal act.
FORMS OF CONSENT
There is no specific requirements as to how the consent of the patient may be given. The consent may be expressed
or implied. An expressed consent may be made orally or in writing.
1. Expressed Consent
-when the terms of the physician-patient relationship are explicit and clear to both parties. The physician must
appraise the patient in a clear, simple and understandable language of the procedure and the patient agree to its
application. An expressed consent gives no doubt as to the nature and scope of the physician’s undertaking.
a. Written Consent
-when the terms of the agreement have been reduced to writing
Contents Of A Written Consent

1. Name of the physician
2. The nature and extent of the diagnostic or treatment procedure including the condition or limitations, if
any, must be clearly stated.
3. The nature, extent and limitations must be explained clearly in a simple, comprehensive and
understandable language including the possible benefits and common untoward outcome.
4. The statement that the physician is given the authority to do any other procedure which may be deemed
necessary and proper to serve the best interest of the patient.
5. Signatures of the witnesses attesting that the document has been signed by the patient.
b. Oral Consent
-a verbal consent is valid, however, it is more susceptible to misunderstandings and possible legal suits as
compared with written consent. Although there is verbal consent, the patient may later deny its existence
or content.

2. Implied Consent
- given without expressed words but may only be deduced from the conduct of the patient. Such consent must be
implied from the fact that the patient goes to a physician to present his medical problem and submits himself to the
various steps which are indicated, or by tacit submission to whatever more serious procedure, after being informed
of it, or when the patient does not expressed his objection to an operation which he knows is about to perform on
him.
SCOPE OF THE CONSENT:

1. General or Blanket Consent
-A consent that gives a physician unlimited authority and discretion to apply any procedure.
PROS: A physician can do an additional or alternative surgery whenever he wants
CONS: It constitutes “complete” surrender of the patient and may expose to unlimited surgery.
It is an “unconditional delegation” of rights in favor of the physician which is contrary to public
order and of no legal effect.
2. Limited or Conditional Consent

-A patient may give his consent, given that he can request for “certain conditions” that must be followed.
-Inability of the physician to follow this “certain conditions” will make him liable for breach of legal duty,
except in cases of emergencies, then the physician cannot be liable.
-A physician may decline the conditions that the patient imposes, rather than to attend to it and violate it
3. Non-Liability or Exculpatory Clause in the Consent

-A non-liability clause which is a part of the consent (usually at the last paragraph) that says, “the hospital
or any member of its staff shall not be held liable civilly or criminally to whatever be the consequence”.
-But, negligence is still punishable and still not covered in the non-liability clause.
PERSONS WHO CAN GIVE CONSENT
1. The patient himself, if he is:

-Of legal age (21 years old and above)
-Of a sound mind
-Not otherwise disqualified by law
*Minors (below 21 years old) are not allowed to give consent except when he is emancipated.
***a minor is emancipated by:
-the marriage of the minor
-by the attainment of majority
-by the concession of the father or mother who exercises parental authority
*Spouse: The consent of the patient’s spouse in NOT necessary except when:
-the procedure endangers the life of the patient
-the procedure may impair sexual function (hysterectomy, etc)
-the procedure may kill the unborn product of conception
-the patient is not of a sound mind
2. If the patient is a minor, consent must be obtained from the parents
3. In the absence of the parents, the consent must be obtained from the grandparents
*Substitute parental authority shall be exercised by the grandparents in the following order:
(1) Paternal grandparents
(2) Maternal grandparents
4. In the absence of the parents and the grandparents, then the eldest brother or sister, provided he is or she is of
age, and not disqualified by law may give consent
5. The other persons who may give consent in their capacity as substitute parental authority
(1) Guardians
(2) Teachers and professors
(3) Heads of children’s homes, orphanages, and similar institutions
(4) Directors of trade establishments, with regards to apprentices
UNDER SPECIAL CIRCUMSTANCES

A minor (even if not emancipated) can still give consent if…
-it refers to necessities in life which includes not only those that are indispensable for sustenance, dwelling,
clothings, but also include medical attendance
***but the consent of a minor is not valid if the procedure will not benefit him. (eg. Skin donation for
plastic surgery)
Expressed refusal of a minor to surgery will not prevail over the existing emergency
Consent may be granted by court

-if a procedure is life-saving for a minor, but the parents refuses to give consent, then the court may give
the consent instead.
The court may refuse to permit elective operation on a minor if the operation can be deferred until the
minor reaches the age of majority (as long as the condition is not life-threatening)
-eg. Surgical repair of a child born of harelip and cleft palate
II. RIGHT TO RELIGIOUS BELIEF

 Philippine Constitution: “No law shall be made respecting an establishment of religion, or prohibiting the free
exercise thereof. The free exercise and enjoyment of religious profession and worship be allowed. No
religious test shall be required for the exercise of civil or political rights.”
 (1) Freedom to believe, (2) Freedom to act in accordance with one’s belief
 Civil Code: “Any public officer or employee, or any private individual, who directly or indirectly obstructs,
defeats, violates or in any manner impedes or impairs the freedom of religion of another person shall be
liable for damages.”
 Life-saving and legitimate medical procedures which are objected by the patient on account of religious beliefs:
 Jehovah’s Witness: refusal of blood transfusion
 Christian Science Church: may not allow x-ray
 Other Religions: consider abortion as illicit regardless whether it is therapeutically indicated or not
 Other Church Denominations: some methods of contraception and surgical sterilization are declared
sinful
 The physician has the duty to explain to the patient that refusal for treatment poses a potential danger to
his life and health. In spite of the physician’s effort, the patient prefers the consequences of refusal rather
than violate the law of his church; it is preferable for the physician to withdraw from the case.
 In emergency cases and the patient is conscious, the physician must still desists from applying the treatment
procedure against the patient’s will.
 Any person with a sound mind and of legal age has the right to determine what must be done with his body.
 In emergency cases and the patient is unconscious, requires immediate treatment, and no one available to
give consent on his behalf: the physician may institute the necessary treatment even if it is contrary to the
patient’s religious belief.
 The right of a patient to refuse medical treatment contrary to his religious belief is not absolute.
 The personal interest or respect to ones religious belief must yield to the interest and welfare of others (a
person may be compelled to undergo treatment when it is necessary to protect the lives and maintain the
health of other people.
 Freedom to believe is absolute but freedom to act in accordance with one’s belief may be limited by statutes
to prevent grave and immediate danger to state.
III. RIGHT OF PRIVACY

 Right of the patient to be left alone and be free from unwarranted publicity.
 Civil Code: “Every person shall respect the dignity, personality, privacy, and peace of mind of his neighbor and
other persons, . . . and that meddling with or disturbing the private life or family relations of another; . . .”
though it may not constitute a criminal offense, shall produce a cause of action for damages.
 Physician-Patient Relationship: premised on TRUST and CONFIDENCE.
 Invasion of the right of privacy of a patient:
1. Physical intrusion at a time or under circumstances when the patient might rightfully expect to be left alone.
2. Publishing information about the patient which might be objectionable or its dissemination might be
offensive to ordinary persons; and
3. By appropriating for commercial purposes some aspect of the personality or other facets of the patient’s
life.
 During examination or treatment: the physician must allow the presence of only those persons whose
assistance is indispensible (must be qualified and competent to do technical duties assigned to them).
 Mental anguish is not allowed as a ground for damages unless it is accompanied by physical injuries.
 When a patient enters a charity teaching hospital knowing fully well that he will be subject-matter of
demonstrations, examinations, and interrogations by medical students, he waives his right to privacy but it
does not infer that he can be subjected to any discourteous, immoral, or malicious liberties.
 The publication of news or stories about the patient’s state of health or his unique ailment is an invasion of
privacy and it can only be done with the expressed consent of the patient.
 There is no invasion of privacy when public interest demands such publication. The personal right of the
patient must give way to the interest and welfare of society.
 Taking of photographs and its publication in the magazine or newspaper can only be done with expressed
consent of the patient or someone who can act in his behalf.
 If the patient consented to the taking of pictures and its publication in scientific journals only and in no other
publication, it will be an invasion of the right of privacy of the patient if the condition imposed is violated.
 Matters which are not within the confidential communication rule between the physician and patient may be
shown to others provided they are not malicious and not invasion of the right of privacy.
 The right of privacy of a person may be invaded by order of the court:
1. If the mental or physical condition of a party is in controversy, the court may submit him to a physical or
mental examination by a physician.
2. The right of privacy maybe violated for the purpose of protecting the public.
 The right of privacy of a patient is essentially a personal right and it does not survive after the death of the
patient in the absence of a will or an agreement to the contrary.
IV. The Right of Disclosure of Information

The physician is obliged to make a full and frank disclosure to the patient or to any person who may act on
his behalf all the pertinent facts relative to his illness. The physician must disclose information regarding the nature
and extent of disease, the contemplated procedure and its probable outcome prognosis, the side effects and the
after effects of the treatment, possible complications, and all other pertinent facts regarding the illness of the
patient. Such disclosure will afford the patient the opportunity to decide which one must be applied or the patient
may which to consult another physician for the possibility of other treatment manners of approach.
A physician must exercise good faith and strict honesty in expressing his opinion as to diagnosis, prognosis
and treatment of the cases under his care.
The civil code provides that “Failure to disclose facts, when there is duty to reveal them, as when the parties
are bound by confidential relations, constitute fraud”
The duty to disclose information is limited to those disclosures which a reasonable medical practitioner
would make under the same similar circumstances
Good practice demands that if disclosure of information to patient will cause mental sufferings, or will cause
patient not to submit to the much needed treatment, or will impair the patient's health, such disclosure may be
withheld or deferred to some future opportune time.
V. Right of Confidential Information

The physician is not authorized to divulged information to a third party who has no concern or interest and
welfare of the patient.
Confidential Information- when prohibition is embodied by the Code of Ethics
Privileged communication- provided by the law; relates to the right of a patient to assert th right to keep the
subject matter of the relationship from being testified to the court.
(a.) Statutory Privileged Communication: person authorized to practice medicine, surgery or obstetrics
cannot in civil case, without patient's consent be examined as to any information which he may have acquired in
attending such patient in professional capacity, which information was necessary to enable him to acting that
capacity, and which would blacken the character of the patient
(b.) Ethical or professional confidential information: the medical practitioner should guard as a sacred trust
anything that is confidential or private in nature that he may discover or that may be communicated to him in his
professional relation with his patient's even after death.
Confidentiality of information in the course of physician-patient relationship is nt applicable in the following

instances:
1. When such disclosure is necessary to serve the best interest of justice
2. When disclosure of information will serve public health and safety
3. When the patient waives to the confidential nature of such information
VI. Right to choose his physician

The patient is free to choose the physician to serve him. In cases of referral to specialists the patient usually
gives the privilege of selecting the specialist to the attending physician in which case the attending physician is
merely acting as an agent of the patient in the selection of the specialist.
VII. Right to treatment

Republic Act No. 6615 “all government and private hospitals or clinic duly licensed to operate as such and
hereby required to render immediate emergency medical assistance and to provide facilities and medicine within its
capabilities to patient in emergency cases who are in danger of dying and/or who have suffered serious physical
injuries.
Article II, Sec.3 of the Code of Ethics “In cases of emergency, wherein immediate action is necessary, a
physician should administer at the least first aid treatment and then refer the patient to a more qualified and
competent physician if the case does not fall within his particular line”
VIII. Right to refuse necessary treatment

- every human being of adult age and of sound mind has the right to determine what must be done in his own body.
- a man is the master of his own self and may expressly prohibit a life saving surgery or other medical treatment.
- right of one's privacy
- the goal of the profession of medicine is service to humanity.
- hippocratic oath “a physician must follow what sste of regimen which, according to his ability and judgement is
considered to be beneficial to the patient”. A physician is then morally and ethically bound to exert all effort within
his means to persuade patient to give consent to the application of treatment procedure.

- a patient or his parents if he is incompetent may refuse further treatment provided that the attending physician
and the hospital officials agree that there is “no reasonable possibility” that the patient will recover.
- the right to refuse a fundamental treatment, compulsory treatment invades three interest:
1. the “patient's interest in his bodily integrity and personal dignity”
2. the “patient's interest in independence in making decisions which are important to the patient”
3. the “patient's interest in being able to think and communicate freely”
- parents have no right to based on religious beliefs or on any other grounds to deny the necessary
treatment to their child. The state has the right under the doctrine of “parens patriae” to assume guardianship
when the child is neglected by the parents to have the child treated. Refusal of the parents to subject his sick child
to medical treatment constitutes “neglect”.
- when the law provides a treatment, the patient has no right to refuse the necessary treatment. This is true
in immunization. The law imoposes penalty to any parent of guardian who fails to subject a minor to immunization.
Opinion of AMA Council on Ethical and Judicial Affairs (Withholding or Withdrawing Life Prolonging Medical
Treatment)
The social commitment of the physician is to sustain life and relieve suffering. Where the performance of
one duty conflicts with the other, 1. the choice of the patient, or 2. his family or legal representative if the patient
is incompetent to act on his own behalf, should prevail. In the absence of the patient’s choice or an authorized
proxy, the physician must act in the best interest of the patient.
For humane reasons, with informed consent, a physician may:
IX. Do what is medically necessary to alleviate severe pain.
X. Cease or omit treatment to permit a terminally ill patient whose death is imminent. However, he should
not intentionally cause death.
Things to consider before we administer life prolonging medical treatment:
4. Should be in the best interest of the patient who is incompetent to act on his behalf.
5. Determine what the possibility is for extending life under humane and comfortable conditions.
6. What are the prior wishes of the patient and attitudes of the family or those who have responsibility for
the custody of the patient.
7. Determine whether the benefits outweigh its burdens.
When can we discontinue life prolonging medical treatment:
- Even if death is not imminent but patient’s coma is beyond doubt irreversible and there are adequate
safeguards to confirm the accuracy of the diagnosis.
- With concurrence of those who have responsibility for the care of the patient.
Life prolonging medical treatment:
1. Medication.
2. Artificially or technologically supplied respiration, nutrition or hydration.
Other rights of Patients when confined in the Hospital

1. Right to receive visitors and communicate with relatives, public officials, etc. within the limit prescribed by the
reasonable rules and regulations prescribed by the hospital.
2. Unrestricted right of correspondence.
3. Right to be free from mechanical restraints except for some justifiable reasons.
4. Right to be released as soon as the condition which justified his hospitalization no longer exist.
A Model Patient’s Bill of Rights

*Preamble in page 165*
1. The patient has a legal right to informed participation in all decisions involving his/her healthcare program.
2. We recognize right of all potential patients to know what research and experimental protocols are being
used in our facility and what alternatives are available in the community.

3. The patient has a legal right to privacy regarding the source of payment for treatment and care. This right
includes access to the highest degree of care without regard to the source of payment for that treatment
and care.
4. We recognize the right of a potential patient to complete and accurate information concerning medical care
and procedures.
5. The patient has a legal right to prompt attention especially in an emergency situation.
6. The patient has a legal right to a clear, concise explanation in lay person’s terms of all proposed procedures,
including the possibilities of any risk of mortality or serious side effects, problems related to recuperation,
and probability of success, and will not be subjected to any procedure without his/her voluntary, competent
and understanding consent. The specifics of such consent shall be set out in a written consent form signed by
the patient.
7. The patient has a legal right to a clear, complete, and accurate evaluation of his/her condition and prognosis
without treatment before being asked to consent to any test or procedure.
8. We recognize the right of the patient to know the identity and professional status of all those providing
service. All personnel have been instructed to introduce themselves, state their status, and explain their role
in the health care of the patient. Part of this right is the right of the patient to know the identity of the
physician for his/her care.
9. We recognize the right of any patient who does not speak English to have an access to an interpreter.
10. The patient has a right to all the information contained in his/her medical record while in the healthcare
facility, and to examine the record on request.
11. We recognize the right of a patient to discuss his/her condition with a consultant specialist, at the patient’s
request and expense.
12. The patient has a legal right not to have any test or procedure, designed for educational purposes rather that
his/her direct personal benefit, performed on him/her.
13. The patient has a legal right to refuse any particular drug, test, procedure, or treatment.
14. The patient has a legal right to privacy of both person and information with respect to: the hospital staff,
other doctors, residents, interns and medical student, researchers, nurses, other hospital personnel, and
other patients.
15. We recognize the patient’s right of access to people outside the healthcare facility by means of visitors and
the telephone. Parents may stay with their children and relatives with terminally ill patients 24 hrs a day.
16. The patient has a legal right to leave the health care facility regardless of his/her physical condition or
financial status, although the patient may be requested to sign a release stating that he/she is leaving against
medical judgment of his/her doctors or the hospital.
17. The patient has a right not to be transferred to another facility unless he/she has received a complete
explanation of the desirability and need for the transfer, the other facility has accepted the patient for
transfer, and the patient has agreed to transfer. If the patient does not agree to transfer, the patient has the
right to a consultant’s opinion on the desirability of transfer.
18. A patient has a right to be notified of his/her impending discharge at least 1 day before it is accomplished, to
insist on a consultation by an expert in the desirability of discharge, and to have a person of the patient’s
choice notified in advance.
19. The patient has a right, regardless of the source of payment, to examine and receive an itemized and
detailed explanation of the total bill for services rendered in the facility.
20. The patient has a right to competent counseling from the hospital staff to help in obtaining financial
assistance from public or private sources to meet the expense of services received in the institution.
21. The patient has a right to timely prior notice of the termination of his/her eligibility for reimbursement by
any 3rd party payor for the expense of hospital care.
22. At the termination of his/her stay at the healthcare facility we recognize the right of a patient to a complete
copy of the information contained in his/her medical record.
23. We recognize the right of all patients to have 24-hr-a-day access to a patient’s right advocate who may act
on behalf of the patient to assert or protect the rights set out in this document.

CHAPTER VII
LIABILITIES OF PHYSICIANS
Factors may be responsible for the increasing frequency of complaints against physicians:
1. The gradual disappearance of the family physician
2. The "doctor's loose talk" or unethical coaching of other physicians
3. Breakdown in communication and rapport between the physician and his patient
4. Disservices made by the mass communication media
5. Malpractice is a sort of a disease of society which may appear in endemic if not in epidemic form
6. Incompetence of the practitioner and commercialization of medical practice
7. Proliferation of medicinal drugs
8. Changing attitude of the physician in the management of his patient
Factors may be responsible for the increasing frequency of complaints against physicians (elaborated)
1.The gradual disappearance of the family physician

Modern trend of specialization leads to physicians abandoning the "family friend and confidant" relationship to
something more impersonal
2.The "doctor's loose talk" or unethical coaching of other physicians

 Unwise comments or criticisms of physicians towards the treatment given to patients by other physicians
 50-80% of suits could have been avoided if it stopped
 "Gub-anay ngalan"
3.Breakdown in communication and rapport between the physician and his patient
Loss of establishment of rapport also looses the patient's trust and makes him more likely to sue
4.Disservices made the mass communication media+-

 Because TV shows and other media outlets display acts in which doctors are being sued more people have a
tendency want file suits against their doctors.
 "Kun anu na kita xa tv gin ilog nila para mka quartahan nila ang ila doctor"
5.Malpractice is a sort of a disease of society which may appear in endemic if not in epidemic form
People have grown accustomed to claiming malpractice suits, some say that US trends may occur in the Philippines
6.Incompetence of the practitioner and commercialization of medical practice

 Some physicians who, in spite of their limited training and their desire to earn, may undertake sophisticated
procedures in diagnosis and treatment.
 "gina cesarean maske hindi na kinanglan, gina CT scan maske na bali lng ang koko nya"
7.Proliferation of medicinal drugs

Due to the increase in number of medicine available, a wide spread misadventure occurred with respect to the
adverse reactions of these new drugs.
8.Changing attitude of the physician in the management of his patient

Earlier times when the patient was dying the doctor would stand by his side and comfort the him and his family. The
attitudes of today's physicians has changed. The progress of medical science has shown that modern treatment
methods carry certain risks which may result in some injuries no matter how much skill and judgment is applied.
The liabilities of a physician which may arise from his wrongful act of omission may be classified into:

1. Administrative liability: right of the physician to practice healing art is temporarily withdrawn from his to
protect future patients.
2. Criminal liabilities: Act or omission constitutes a crime, the physician who is found guilty, maybe imprisoned
or fined
3. Civil liabilities: awarded against a physician to compensate the patent for the injury he suffered on account
of the physician's wrongful act or breach of contract.
Laws that cover negligence:

 Art. 365: Imprudence and negligence, penalty of arresto mayor in its maximum period to prision correccional in
its medium period.
o Simple imprudence or negligence, penalty of arresto mayor in its medium and maximum periods, penalty
of arresto mayor in its minimum period shall be imposed.
 Medical Act of 1959 as amended
o Gross negligence: ignorance or incompetence in the practice of his or her profession resulting in an injury
to the patient (if you want to complete the article read pg 172, but it seems unimportant)
ADMINISTRATIVE LIABILITY (REPRIMAND SUSPENSION OR REVOCATION OF REGISTRATION)

Characteristics of the proceeding in the professional regulation commission:
physician found liable for the charge he will be deprived of his right to practice medicine, there must be
presumption of the innocence of the respondent--->respondent physician shall be entitled to be represented by
counsel or be heard in person(court proceedings will follow. Read book) ---> decision of the board of medicine shall
automatically become final thirty days after the date of its promulgation, unless there is an appeal. Reinstatement of
a physicians certificate of registration after 2 year if he acted in an exemplary manner in the community.
Who can file complaint:

1. Any person
2. Firm or corporation, thru its duly authorized representative
3. the board itself, may motu proprio file the charge or charges.
Service of summons:
 shall consist of the letter-subpoena requiring appearance of the respondent at a designated time and place or
letter requiring him to answer within the period therein specified, and a copy of the complaint and its
enclosures, even if he leaves the Philippines.
Rights of respondents in the administrative investigation in the board of medicine

Rights provided for by the medical act
The respondents physician shall be entitled to the ff:
1. to be represented by the counsel or be heard in person
2. to have a speedy and public hearing
3. to confront and to cross-examine witnesses against him
Rights provided for by the rule and regulations

the respondent shall be entitled to the ff:
1. to be represented by counsel or be heard in person
2. to have a speedy and public hearing
3. to confront and to cross-examine witnesses against him
4. the parties may appear personally or with the aid of counsel. Any change in counsel of record must be by
leave of the board
Under the rules of court

Rights of defendant at the trial
1. to be presumed innocent until the contrary is proved
2. to be present and defend in person and by attorney at every stage of the proceedings, that is from the
arraignment to the promulgation of the judgment
3. to be informed of the nature and cause of the accusation
4. to testify as witness in his own behalf, but, if defendant offers himself as a witness he may be cross-
examined as any other witness
5. to be confronted at the trial by, and to cross-examine the witness against him
6. to have compulsory process issued to secure the attendance of witnesses in his behalf
7. to have a speedy and public trial
8. to have the right of appeal in all cases authorized by law
Under the constitution

Grounds for reprimand, suspension or revocation of registration certificate (Administrative Liability)
1. any of the following shall be sufficient ground for reprimanding a physician, or for suspension or revoking a
certificate of registration as a physician:
2. conviction by a court of competent jurisdiction of criminal offense involving moral turpitude
3. immoral or dishonorable conduct
4. insanity
5. fraud in the acquisition of the certificate of registration
6. gross negligence, ignorance or incompetence in the practice of his or her profession resulting in an inkiry to
or death of the patient
7. addiction to alcoholic beverages or to any habit-forming drug rendering him or her incompetent to practice
his or her profession or to any form of gambling
8. false or extravagant or unethical advertisements wherein other things than his name, profession, limitation
of practice, clinic hours, office and home address, are mentioned
9. performance of or aiding in any criminal abortion
10. knowingly issuing any false medical certificate
11. issuing any statement or spreading any news or rumor which is derogatory to the character and reputation
of another physician without justifiable motive
12. aiding or acting as a dummy of an unqualified or unregistered person to proactive medicine
13. violation of any provision of the code of ethics as approved by the Philippine medical association
Refusal of a physician to attend a patient in danger of death is not a sufficient ground for revocation or suspension
of his registration certificate if there is a risk to the physician's life
Grounds as provided for by the rules and regulations for administrative investigation
2. insanity
3. conviction of a criminal offense involving moral turpitude
4. unprofessional or unethical conduct
5. gross negligence or incompetence in the practice of the profession
6. use or perpetration of fraud or deceit in the acquisition of registration certificate
The grounds for reprimand, suspension or revocation of registration certificate provided in Section 25 (Medical
Act of 1959 as amended) maybe classified as ff:
Personal disqualifications
2. insanity
3. gross negligence, ignorance or incompetence in the practice of his or her profession resulting in an injury to
or death of the patient

4. addiction to alcoholic beverages or to any habit-forming drug rendering him or her incompetent to practice
his or her profession or to any form of gambling
Criminal acts
1. conviction by a court of competent jurisdiction of any criminal offense involving moral turpitude
2. fraud in the acquisition of the certificate of registration
3. performance of or aiding in any criminal abortion
4. knowingly issuing any false medical certificate
5. aiding or acting as a dummy of an unqualified or unregistered person to proactive medicine
Unprofessional Conduct
1. false or extravagant or unethical advertisements wherein other things than his name, profession, limitation
of practice, clinic hours, office and home address, are mentioned
2. issuing any statement or spreading any news or rumor which is derogatory to the character and reputation
of another physician without justifiable motive
3. violation of any provision of the code of ethics as approved by the Philippine medical association
PERSONAL DISQUALIFICATIONS:
Immoral or dishonorable conduct (unprofessional conduct): a broad spectrum of reprehensible conducts of a

physician whether connected with the practice of the profession or not, provided it is contrary to the existing norms
or the conduct is disgraceful, unbecoming, unethical or repulsive to the moral standards in a society
Examples:
Gross immorality: telling a patient who got tested for syphilis that he was positive even though he wasn't.
Free splitting: a charge that a physician has conspired with an attorney to solicit patients and employed the attorney
in their claim for person injuries, then they split the money they earned.
Fraud: cheating a patient out of his money, Sir, you're going to die if you don't take these meds I'm currently selling.
Insanity
 any mental derangement or confusion in mind or condition which prevents a person from orienting himself; a
doctor who is insane is a potential danger to the life of the patient. The state has the power to use the police to
put a stop to his practice. Physicians must take a psychiatric evaluation.
Gross negligence, ignorance or incompetence in the practice of his or her profession resulting in an injury to or
death of the patient
Gross negligence: signifies entire want of care which raises the presumption of conscious indifference to
consequence; an entire disregard for and indifference to the safety and welfare of others
Ignorance: want or absence of knowledge or lack of information
Incompetence: lack of ability; lack of fitness to discharge the required duty. A condition or status of a person who is
unable or unfit to do a thing
 gross negligence, ignorance or incompetence is not per se a ground for suspension or revocation, there must be
proof that it resulted in injury or death. Mere negligence does not amount to misconduct, whereas an
accumulation of negligent acts would indicate incompetence.
Addiction to alcoholic beverages or to any habit-forming drug rendering him or her incompetent to practice his or
her profession or to any form of gambling
Addiction: state of periodic or chronic intoxication detrimental to the individual and to society, produce by repeated
consumption of drug, natural or synthetic. It is characterized by an overpowering desire or need to continue to drug

and obtain it by any means, a tendency to increase the dose and psychic and physical dependence on the effects of
the drug.
Habit-forming drug: one w/c may be taken repeatedly without the production of all the characteristics found in
addiction; no increasing dose, desire is only psychical and not physical and there is no sever withdrawal.
Gambling: game or scheme the result of which depends wholly or chiefly upon chance or hazard. Money is involved.
Conviction by a court of competent jurisdiction of criminal offense involving moral turpitude

 The physician has been found guilty of the alleged offense he has been charged; it is not necessary that the
crime committed by the doctor was in connection with his practice but probation will not revoke his license.
 Moral turpitude: act of baseness, vileness or depravity in private and social duties which a man owes his
fellowmen or to society in general. "implies something immoral in itself, regardless of whether it is punishable by
law, Hyden koo"
Fraud in the acquisition of the certificate of registration

Fraud: intentional perversion of truth for the purpose of inducing another to part with some valuable thing or to
surrender a right. False representation of a matter of fact, whether by words or conduct, false/misleading
allegations, concealing what should have been disclosed; causes deception
According to the revised penal code, falsification may be committed in the ff ways:
1. counterfeiting or imitating any handwriting, signature or rubric;
2. causing it to appear that persons had participated in any at or proceeding when they did not in fact
participate
3. attributing to persons who have participated in an act or proceeding, statements other than those in fact
made by them
4. making untruthful statements in the narration of facts
5. altering true dates
6. making any alteration or intercalation of a genuine document which changes its meaning
7. issuing an authenticated form, a document purporting to be a copy of an original document when no such
original exists, or including in such copy a statement contrary to, or different from that of the genuine
original
8. intercalating any instrument or note relative to the issuance thereof in a protocol, registry, or official book
Performance of or aiding in any criminal abortion

 The Hippocratic oath provides that a physician must maintain the utmost respect for human life from its
inception and that knowledge must not be utilized contrary to the laws of humanity.
 The quantum of evidence necessary to revoke a physician's license to practice is much less than one necessary
to convict him for criminal abortion.
Knowingly issuing any false medical certificate

 Deliberate issuance of a false medical certificate as to the state of health, illness, injury, or incapacity of a person
by a physician is a crime
Aiding or acting as a dummy of an unqualified or unregistered person to proactive medicine

 it is essential that he whose license is sought to be revoke must be charged with the knowledge that the person
whom he assisted or aided was unlicensed and was engaged in the practice of medicine
 A physician should never cover up, help, aid or act as a dummy for any illegal practitioner, quack or charlatan.
UNPROFESSIONAL CONDUCT:
False or extravagant or unethical advertisements wherein other things than his name, profession, limitation of
practice, clinic hours, office and home address, are mentioned

False advertisements: any advertisement w/c tends to deceive or mislead the public, that w/c makes an untruthful
or impossible assertion, or that w/c is contrary to the present state of medical knowledge may fall within the
purview of the prohibition
Extravagant advertisements: use of expensive, elaborate and oversized announcement in newspaper or in billboards
may be immoral, if not unethical for a physician. The practice of medicine cannot be considered like a commodity of
commerce w/c must attract the consuming public
Unethical advertisements: solicitation of patients, directly or indirectly, through solicitors or agents, is unethical.
Modes of advertising may be allowed through professional cards, classified advertising, directories or signboards. In
all these advertisements, only the name, title or profession, office hours and office and residence address should
appear. You may include your specialty
Issuing any statement or spreading any news or rumor which is derogatory to the character and reputation of
another physician without justifiable motive
 Statements (news or rumor) that spread against another physician w/c tend to expose other physician to public
hatred, shame, ridicule, aversion, ostracism, degradation or disgrace or to produce an evil opinion of one with
right thinking, and to deprive one of his confidence and friendly intercourse in society. "applies even in justified
circumstances because criticisms should be made in a constructive way"
 If there are disagreements, a committee will rule.
Violation of any provision of the code of ethics as approved by the Philippine medical association
 Professional code of ethics is an act of intraprofessional rules w/c shall govern relations between members of
the profession and the community & inter-professional relationship.
 Ex: failure or refusal without justifiable cause on the part of the physician to attend to the trial of cases where
his testimony on medico-legal matter is necessary constitute unethical and unprofessional conduct and subject
to reprimand, suspension, revocation.
A physician whose certificate of registration has been administratively revoked may upon petition be reinstated
by the Board:
 Reinstatement: after 2 years, if the respondent has acted in an exemplary manner in the community and has not
committed any illegal, immoral or dishonorable act.
Procedure and Order of hearing in the board of medicine:

Unless the board otherwise directs for special reasons the order of the hearing shall be as follows:
1. the complainant must produce the evidence on his part
2. the respondent shall then offer the evidence in support of his defense
3. the parties may the respectively offer rebuttal evidence only unless the board, for good reasons, in the
furtherance of justice, permits them to offer evidence upon their original case
4. when the presentation of evidence is concluded, unless the parties agree to submit the case without
argument, the complainant or counsel may make the opening argument followed by the respondent or
counsel with the complainant or counsel making the concluding argument.
Effect of Non-appearance
 If the complainant does not appear, the board may dismiss the complaint for lack of interest or failure to
prosecute
 If the respondent does not appear, he may be declared in default and the board shall thereupon proceed to
conduct the cross-examination of the complainant and his witnesses and render its decision in accordance with
the facts alleged and proved.
Decisions of the Board of Medicine:

Made in writing and signed by at least the majority of the board.

Reconsideration:
 a petition for reconsideration or for rehearing shall be filed within thirty days after receipt of the decision. A
petition filed after this period shall not be entertained and shall be archived without action unless the board, for
special reasons which must be stated in its decision decides to act on the petition.
Appeal from Judgment:

 the decision of the board of medicine shall automatically become final thirty days after the date of its
promulgation unless the respondent, during the same period, has appealed to the PRC and later to the office of
the president of the Philippines.
 The respondent may appeal by law, may interpose an appeal from the decision of the board within the same
period
 Complainant, when allowed by law, may interpose an appeal from the decision of the board within the same
period
Execution of Decision:
 Execution shall issue only upon a decision or order that finally disposes of the action or proceeding. Such
execution shall issue as a matter of right upon the expiration of the period to appeal there from if no appeal has
been duly perfected,
 Decisions or orders of the various board w/c have become final and executor shall be immediately enforced and
executed.
Judicial Revocation of the certificate of registration

 In the ff special laws, violation of w/c, aside from imprisonment and/or fine, the additional penalty of revocation
of the license to practice medicine is imposed on the offender-physician. the PRC, upon receipt of the decision
and in compliance with its order, must cancel the name of the physician from among those qualified to practice.
 If found guilty: Revoke right to practice, imprisonment, fine
Presidential Decree No. 169

 Pertains to attending physicians who cause harm and states that it should be reported to the nearest
constabulary; violation must be with malicious intent or with gross negligence to make the physician liable.
Dangerous Drug Act of 1972 (RA 2625)

 Deals with the sale, administration, delivery, distribution and transportation of prohibited drugs and its
consequences.
 Physician, dentist, veterinarian or practitioner authorized to prescribe any dangerous drug shall issue the
prescription therefore in one original and two duplicate copies.

CHAPTER VIII
CRIMINAL LIABILITIES OF PHYSICIANS
 Act or omission of a physician, constitute a crime, the physician may be held criminally liable.
 May be done with deliberate intent or on account of imprudence, negligence, lack of foresight or lack of skill.
 CRIMINAL LAWS
1. REVISED PENAL CODE- If a physician commits a crime punishable under the revised penal code, he will be
prosecuted under the Code and if found guilty, the physician shall be imprisoned or fined in both penalties.
2. SPECIAL CRIMINAL LAWS- ex., the physician violated the Comprehensive Dangerous drug laws of 2002,
then the physician could be liable under the special law.
 CRIMINAL LIABILITY DISTINGUISHED FROM CIVIL LIABILITY

A Physician who commits a wrong is said to be liable or responsible for it. The wrong may be in the form
of act or omission.
CRIMES- considered public wrongs which are breach and violation of public rights and duties which affect
the whole community and is distinguished by the harsher term crime or misdemeanor.
CIVIL WRONGS- considered violation of rights which belong to the individual and are termed civil injuries.
PENAL LIABILITY- ex. Criminal law- reckless imprudence

-the purpose of law, is, or includes punishment of the wrongdoer.
CIVIL LIABILITY- the law leaves the victim to sue for compensation, by way of damages.
Ex. Civil law- torts or negligence
NEGLIGENCE- one of the wrongs for which the law gives remedy both under the civil law and criminal law.
LATIN MAXIM “ ACTUS NON FACIT REUM, NISI MENS ET REA”- the act alone does not amount the guilt; it must be
accompanied by a guilty mind (mens rea).
TWO CONDITIONS MUST BE FULFILLED:

1. Doing some of the act(read act/ omission) by the person held to be liable.
2. MENS REA or GUILTY MIND with which the act is done.
Characteristics of Criminal Case:

1. A criminal act is an act which is an outrage to the sovereignty of the state so it must be instituted in the name
of the sovereign people (people of the Philippines)
2. The action is filed and tried in court
3. The proof necessary for conviction is “proof beyond reasonable doubt”.
4. The accused is presumed innocent of the crime charged unless proven otherwise.
5. In case of conviction, the accused has the right of appeal
6. If the accused is found guilty of the crime charged, the penalty imposed is imprisonment and/or fine
7. If the physician is found to be criminally liable, aside from the penalty of imprisonment and/or fine, his
registration certificate may be cancelled or revoked, if:
a. The law imposes revocation of the license
b. The crime wherein the physician was found guilty involved moral turpitude.

RIGHTS OF A RESPONDENT- PHYSICIAN
1. CONSTITUTIONAL RIGHTS- Respondent-physician is entitled to all the rights of a respondent cited in the Bill of
Rights of the 1987 Constitution.
2. RIGHTS UNDER SECTION 1. Rule 115 of the rules of the court
Rights of the Accused (Defendant):

1. Under the Rules of Court:
2. Under the Philippine Constitution:
Provisions of Penal Law wherein a Physician may be held Criminally Liable:

1. Provisions which specifically mentioned the physician as the wrong-doer:
a. Issuance of false medical certificates
 False medical certificate as regards to human disease, injury, deformity, physical, mental
or psychical condition or any ailment which must be deliberate or intentional
 Penalty of arresto mayor in its maximum period to prison correctional in its minimum
period and a fine not to exceed 1,000 pesos shall be imposed
b. Abortion
 Elements of crime:
1. The woman must be pregnant
2. The offender must be a physician or midwife
3. The physician or midwife causes abortion on the pregnant woman
4. Took advantage of their scientific knowledge or skill in procuring abortion
 Penalty of reclusion temporal, if use of any violence upon the person or pregnant woman
 Penalty of prison mayor, if without using violence, act without the consent of the woman
 Penalty of prison correctional in its medium and maximum periods, if the woman shall
have consented
c. Simulation of births, substitution of one child for another, and concealment or abandonment of
legitimate child
 Prison mayor and a fine of not less exceeding 1,000 pesos
d. Failure to report treatment of physical injuries
 Penalty of imprisonment for not < 1 year nor > 3 years and/or a fine of not <1000 nor >
3000 pesos
 Government license or permit to practice his profession shall be cancelled by the PRC
e. Refusal to render treatment in emergency cases
 Reporting cases of maltreated or abused child: shall within 48 hours from knowledge of
the case, report in writing to the DSWD, provincial fiscal
f. Violation of Republic Act 9344
 Refusal of hospitals and medical clinics to administer appropriate initial medical
treatment and support in emergency or serious cases.
g. Failure to report maltreated or abused child PD 603
 “Child and Youth Welfare Code” requires private physicians requiring treatment to
report in writing within 48 hours from the knowledge of the case to the city or provincial fiscal
or to the Local Council for the Protection of Children or to the nearest unit of DSWD, any case
of a maltreated child, or exploitation of an employed child contrary to the provision of labor
laws.
h. Violation of Generics Act of 1988 R.A. 6675
 An act to promote, require and ensure the production of an adequate supply,
distribution, use and acceptance of drugs and medicines identified by their generic names.
2. Liabilities incurred incidental to the practice of the profession:

a. Criminal negligence and imprudence
 Imprudence: deficiency in action – failing to take the necessary precaution once they
are foreseen
 Elements of Reckless Imprudence:
1. The offender does or fails to do an act
2. The doing or the failure to do the act is voluntary
3. It is done without malice
4. Material damage or injury resulted from it
5. Inexcusable lack of precaution on the part of the offender taking into consideration:
a. His employment or occupation
b. Degree of intelligence, physical condition
c. Other circumstances regarding the person, time and place
 Elements of Simple imprudence:
1. There is lack of precaution on the part of the offender
2. The damage impending to be caused is not immediate or the danger is not clearly
manifest
 Grave felony: Arresto mayor in its maximum period to prison correctional in its medium
period
 Less grave felony: arresto mayor in its minimum and medium period
 Light felony: arresto mayor in its maximum period
b. Violation of the Dangerous Drug Act of 1972 (RA 6425) or Violation of the Comprehensive Dangerous
Drugs Act of 2002 (RA 9165)
 Prohibited drugs:
1. Opium (heroin, morphine)
2. Coca leaf (cocaine)
3. Alpha and beta eucaine
4. Hallucinogenic drugs (mescaline, lysergic acid diethylamide (LSD))
5. Indian hemp
6. Other drugs (natural or synthetic), with physiological effects of narcotic drugs
 Regulated drugs:
1. self-inducing sedatives (secobarbital, phenobarbital, pentobarbital, barbital,
amobarbital and any other drug which contains a salt or a derivative of a salt of
barbituric acid)
2. Any salt, isomer or salt of an isomer, of amphetamine, such as benzidrine or dexadrine
or any drug which produces a physiological action similar to amphetamine
3. Hypnotic drugs (methaqualone or any other compound producing similar physiological
effects)
 The following acts are considered criminal unless expressedly authorized by the law:
1. Prohibited Drugs:
a. Importation of prohibited drugs
b. Sale, administration delivery, distribution and transportation of prohibited drugs
c. Maintenance of a den, dive or resort for prohibited drugs
d. Employees and visitors of a prohibited drugs den
e. Manufacture of prohibited drugs
f. Possession or use of prohibited drug
g. Cultivation of plants which are sources of prohibited drugs
h. Failure to record prescription, sales, purchases, acquisitions and/or deliveries of
prohibited drugs
i. Unlawful prescription of prohibited drugs
j. Unnecessary prescription of prohibited drugs
k. Possession of opium pipe and other paraphernalia for prohibited drugs
2. Regulated Drugs:
a. Importation of regulated drug
b. Sale, administration, dispensing, delivery, transportation of regulated drugs
c. Possession or use of regulated drugs
d. Failure to record prescription, sales, purchases, acquisitions, and/or deliveries of
regulated drugs
e. Unlawful prescription of regulated drugs
f. Unnecessary prescription of regulated drugs
c. Violation of Pharmacy Law (RA 5921)
d. Liability in the issuance of birth and death certificates
 Birth certificates:
1. False statements
2. Failure to report
 Death certificates: two prescribed and furnished forms of death certificates (ordinary
form (Municipal Form No. 103-blue paper) and the foetal death form (Municipal form No. 103-
A-pink paper))
e. Defamation (slander or libel)
 A public and malicious imputation of a crime, or of a vice or defect, real or imaginary, or
nay act, omission, condition, status, or circumstance tending to cause the dishonor, discredit,
or contempt of a natural or juridical person, or to blacken the memory of one who is dead.
 Written defamation – libel
 Oral defamation – slander
 A physician may not be held liable even if the words uttered or written tend to expose
his patient to public hatred, shame, contempt if:
1. The statement was made without malice
2. The statement is a mere expression of personal opinion or impression in good faith
f. Sexual Harassment RA 7877
 An act declaring sexual harassment unlawful in the employment, education, training
environment, and for other purpose
g. Sale of Pharmaceutical sample
 very common in resident physicians and general practitioners.
 This law prohibits the sale of pharmaceutical samples those with markings of “ SAMPLE
NOT FOR SALE”.
h. Giving Assistance to Suicide
 It is a crime for the physician or any person to assist a person to commit suicide
 Penalty of PRISON MAYOR
 If that person leads to assistance to another in doing the killing-RECLUSION TEMPORAL
 If suicide not consummated- ARRESTO MAYOR
i. Violaion of National Blood Services ACT OF 1994 (RA 7719)
 It shall be unlawful for any person to establish and operate a blood bank/center unless
it is registered and issued a license to operate by the department.
3. Provisions of the Penal Laws applicable to everyone.
CRIMINAL LIABILITY IN THE GENERAL APPLICATION OF THE PENAL LAW:

A physician, like any other person, is liable for violations of any existing penal law. His educational background and his
dedication to the service of humanity cannot be considered as an immunity for him to violate the law. In fact his
educational attainment may be considered an aggravating circumstance to the criminal liability.

CHAPTER IX
CIVIL LIABILITIES OF PHYSICIANS
Malpractice or malpraxis -generic term to include all types (administrative, criminal and civil) of
wrongful acts of physician
- ordinarily referred to as civil medical malpractice
Civil suit against physicians and/or hospital – premised on recovery of damages for their wrongful act or of employees
Bases for Cause of Action for Damages on Account of Injury

1. Breach of Contract
 happen if physician agrees to effect a cure or obtain a specific result on the patient but fails to do so
Conditions must be established by the Plaintiff for court to have an action for breach of contract
a. That there is a contract with warranty between physician and patient as regards to specific outcome of
application of management procedure.
b. That the contract entered into between physician and patient is not void as statutory unlawful or contrary
to public policy.
c. That term(s) of contract were indeed violated.
d. That the claim of the plaintiff is legally cognizable as a source of damages.
In an action for breach of contract, negligence of the doctor is not an issue, for if the doctor makes a contract to effect
a cure and fails to do so, he is liable for breach of contract even though he uses the highest possible professional skill.
- expert testimony of physician is not necessary and the fact that the physician failed to perform the stipulation of the
contract is enough.
2. Tort (Quasi-delict or Breach of Legal Duty)

 a legal wrongdoing independent of contract
Quasi-delict – any fault or negligence that cause damage to another with no pre-existing contractual relation between
parties
Negligence or fault of the physician – primary basis of the cause of action since he’s the responsible for injury
sustained by the patient
Medical Malpractice or Medical Malprax

 failure of physician to properly perform the duty w/c devolves upon him in his professional relation to his
patient, such failure results in some injury to the patient
 defined as “bad or unskillful practice on the part of physician or surgeon resulting to injury to patient or failure
of physician to exercise the required degree of care, skill and diligence as to treatment by a surgeon or
physician in manner contrary to accepted rules
Malpractice – failure in the exercise of reasonable degree of skill and care on part of medical practitioner in his
treatment of the patient.
- misnomer for it has connotations of malevolence w/c is rarely the basis of action
-“professional negligence” –more accurate term
Elements of Medical Malpractice

1. The physician has a duty to his patient.
2. The physician failed to perform such duty to his patient.
3. As a consequence of failure of physician to perform his duty, injury was sustained by the patient.
4. The failure of physician to perform his duty is the proximate cause of injury sustained by the patient.
Medical malpractice primarily consists of four D’s;
 Duty – duty of physician to his patient
 Dereliction- physician failed to perform his duty to his patient
 Damage – As a consequence of physician’s failure to perform his duty, the patient suffers damage
 Direct – negligence of physician in the direct cause of damage suffered by the patient
A. The Physician has a Duty to his Patient
Duties of physician imposed by law;

1. Duty to possess knowledge and skill of the profession
2. Duty to utilize such knowledge and skill with care and diligence
Due Care
 Is that degree of care exercised by the average member of the profession in similar circumstance in the locality or
in the nation, depending upon the standard utilized by the court.
 It need not be such care as most skilled in the profession would show but that which the special nature of the
work would call for.
3. Duty to exercise the best judgment

 Physician is obliged to use his best judgment in the determination of appropriate treatment considering always
the welfare and interest of the patient.
 based on availability of method of treatment in the locality and financial condition of the patient.
4. Duty to observe utmost good faith to his patient.

 Physician must inform the patient of his true and honest appraisal of his condition, the advantages and
disadvantages of management procedure, the outlook or possible complications over and beyond what is
demanded of in solicitation of the consent.
B. The Physician Failed to Perform his Duty to his Patient

 omission to do something which a reasonable and prudent physician would do to his patient
Reasons of Failure of Physician to Perform his Duty to his Patient

1. Violations of positive law
2. Negligence
3. Ignorance
4. Departure from accepted practice
1. Violations of Positive Law

- certain acts or omissions prohibited and penalized by law;
 Criminal abortions
 Operations w/o consent
 Violation of dangerous drug act
 Meddling w/ or disturbing the private life of another
 False or extravagant or unethical advertisement
 Issuance of false medical certificate
 Acting as a dummy of unqualified person to practice medicine

2. Negligence
- covers the lack of care but also the failure to exercise the skill which the person possesses and the attempt o exercise
the skill he knows he does not possess
3. Ignorance
- absence of knowledge
“Ignorance of the law excuses no one from compliance therewith”
-when a physician is confronted w/ a case w/c requires a procedure beyond his knowledge or competence, good
practice demands its referral to other physicians who are competent to do so, otherwise, he is liable if injury was
sustained by the patient.
-can be a ground for reprimand or suspension or revocation of certificate of registration of a physician
4. Departure from the Accepted Practices

-if the physician, in the treatment of a patient, departed or fell short of the standard of practice and injury was
sustained to the patient, he may be held liable for damages.
-except in cases where doctrine of res ipsa loquitor is applicable any complaint against a physician for failure or
departure from accepted practice must be proven through testimony of other physicians.
C. As a Consequence of the Failure of the Physician to Perform his Duty, Injury was Sustained by the Patient
Injury
-Any want of the proper skill or care w/c;
 diminishes the chance of recovery
 prolongs his illness
 increases his sufferings
 makes his condition worse than it may have if due skill and care have been used.
Injuries w/c may be the Bases for damages

 Death
 Loss or impairment of earning capacity
 Disfigurement
 Physical disability
D. The Failure of the Physician to Perform his Duty is the Proximate Cause of the Injury Sustained by the Patient
-commonly known as doctrine of proximate cause
Proximate Cause
- cause which in natural continuous sequence, unbroken by an efficient intervening cause, produces the injury and
without which the result would not have occurred.
A patient’s loss or injury must have resulted directly from the physician’s negligence. If the injury to the patient cannot
be connected to the negligent act of the physician, then the latter cannot be held liable.
Conditions That Must Be Complied With in the Determination of the Proximate Cause:
1. There must be a direct physical connection between the wrongful act of the physician and the injury suffered
by the patient.
The injury need not be foreseeable in order to establish the proximate cause.
2. The cause (wrongful act of the physician) must be efficient, effective and must not be too remote from the
development of the injury suffered by the patient.
3. The result must be the natural and probable consequence of the cause.

Test to Determine the Casual Link between Negligence and Injury:
1. “But For” “Sine Qua Non” Test
To determine whether the injury would have occurred if the defendant had not been guilty of a negligent
act, or “but for defendant’s negligence, plaintiff’s harm would have occurred.
Question: If the defendant had not committed that acts that he in fact did commit, would the injury to the
plaintiff nevertheless have occurred?
Answer: NO – test is satisfied
2. “Substantial Factor” Test
Determine if the defendant’s negligent conduct was a substantial factor in bringing about the harm to the
plaintiff, if the conduct was a substantial factor, causation is establish. If it was a very minor factor or no
factor at all, there is no connection between the conduct and the injury.
The mere possibility that the negligence of the physician can cause injury to the patient is not ground for
damage. There must be a reasonable probability that the injury was brought about by the physician’s
negligence.
It is probable that the injury sustained by the patient may be brought about by two or more negligent acts or
omission which made substantial contribution to the injury.
Doctrine of Efficient Independent Intervening Cause:

 In the casual connection between the negligence of the physician and the injury sustained by the patient, there
may be intervention of an efficient cause which is the proximate cause. The intervening cause must be efficient
to absolve the original tortfeasor of liability. If the intervening negligence being the initial negligence, the
plaintiff can still recover from the original tortfeasor, but the court shall mitigate the damage to be awarded.
 To be an efficient independent intervening cause that will modify the liability of the first wrongdoer, it must not
be simulated or brought about by the conduct of the first tortfeasor, and it must be unrelated in its operation to
the original cause in order to break the chain of events leading to the production of injury, otherwise, the
liability will be joint.
Standard of Care in Medical Practice

A physician standard of care is defined as:
1. the degree of ability or skill possessed by other physician in the same community, neighborhood or locality
2. the degree of care, attention, diligence or vigilance ordinarily exercised by those physicians in the application
of their skill
3. the special or extraordinary skill of the specialist, if the physician involved has represented himself as
possessing it
The standard of care demanded from a general practitioner is ordinary care and diligence in the application of his
knowledge and skill in his practice of profession.
A specialist’s legal duty to the patient is generally considered to be that of an average specialist, not that of an
average physician.
Locality Rule:
 Under the locality rule, the physician is not considered negligent if he applies the method of diagnosis and
treatment which physician in the same locality would have applied when confronted with similar case and under
the same situation.
Similar Locality Rule:

 Physician cannot be held negligent for his acts if what was done is what other physicians “in the same and
similar locality” could have been done to the patient. Similar locality may mean socio-economic similarities or
geographical proximity.
 Because of the subsequent events, the courts now gradually depart from the application of the locality rule or
similar locality rule and adopt “right” or the “nationality” rule as a yardstick to measure the standard care.

 The demise of locality rule as a measure of standard practice has been due to modern means of communication
and transport.
Alternative Treatment Methods:

 If a physician applied a method of treatment from several generally accepted methods, he cannot be held liable
if he failed to produce good result. As long as a “respectable minority” in the medical profession concurs with
the method used and due care has been observed, he cannot be held liable.
Customary Practice:
 Application of customary procedure does not automatically immunize a physician from liability because the fact
that treatment is usual or customary does not preclude the possibility that it is not an accepted practice or
contrary to the advances of medical science.
Bad Results:
 The physician is not an insurer of the good result of treatment. The mere fact that the patient does not get well
or that the bad result occurs does not in itself indicate a failure to exercise due care.
 The law will not hold a physician guilty of negligence even though his judgment may prove erroneous in a given
cause, unless it can be shown that the course pursued was clearly against the course recognized as correct by
the profession generally.
The Physician must Keep Up with the Medical Developments:

 A physician must be abreast with the development and progress of medical science. The modern method of
transportation and communication, frequent seminars and conventions, and publications of scientific journals
and other printed materials enhance transmission of information even in remote areas. He must be aware of
modern medical or surgical procedures, recently manufactured therapeutic agents including indications, manner
of action, side effects and after effects.

CHAPTER X
OTHER LEAGAL PRINCIPLES OR DOCTRINES APPLIED IN MEDICAL MALPRACTICE CASES
1. Doctrine of vicarious liability -the responsibility of a person, who is not negligent, for the wrongful conduct or
negligence of another.
“Respondeat Superior” or Respondent superior
Involve 3 persons:
 The patient – injured on the account of negligent act
 The physician, nurse, therapist or technician – The person who actually injured the patient.
 The hospital – the person who may be held financially liable to the patient for the negligence
of the person who actually caused the injury.
The resident physician, nurse, orderly, or any other paramedical personnel of a hospital is an employee
of the hospital, and any wrongful act committed by him, the hospital must be held liable.
Example: PDNs provided by the hospital to a patient – hospital is liable.
Private PDNs contracted by the patient’s family – PDN liable for himself.
In determining whether or not, one is acting as an employee or as an independent contractor, the
following facts must be used as guidelines:
1. The extent of control which, by the agreement, the master may exercise over the details of the
work
2. The kind of occupation, with reference to whether in the locality, the work is usually done under
the direction of the employer or by a specialist without supervision
3. The skill required in the particular occupation
4. Whether or not the one employed is engaged in a distinct occupation or business
5. Whether the employer or the workman supplies the instrumentalities, tools and the plase of
work for the person doing the work
6. The length of time for which the person is employed
7. The method of payment, whether by the time or by the job
8. Whether or not the work is a part of the regular business of the employer
9. Whether or not the parties believe that they are creating a relation of master and servant
10. Whether the principal is or not in business
a. Doctrine of ostensible agent

They are usually employees, and at the same time, independent contractors. In practice, they
usually get percentage of the fee paid to the hospital.
Example: Anesthesiologist, made a mistake causing death of a patient – the hospital is made liable.
b. Borrowed servant doctrine

Example: A private physician performed surgery in a hospital, the personnel assisted on the operation,
if a wrongful act was committed during operation, the private physician is held liable.
c. Captain-of the Ship doctrine

Example: An obstetrician delivered the baby by CS, the personnel under him made a wrongful act, the
surgeon is held liable.
Reasons in support of the application of the Doctrine of Vicarious Liability in Medical Malpractice:
1. The negligent employee will not have enough money to satisfy a judgment
2. The employer has the power to selct his employee and to control his acts
3. Since the employer benefits monetarily from his servant’s work it is fair for him to bear the risk
of loss when neither he or nor the victim is at fault

4. The employer is in a position to approximate future damages and treat them as operating
expenses. Each client pays a fee that includes a part of the cost of professional malpractise
insurance.
The application of the doctrine of vicarious liability to a physician usually involve a surgeons activities
in the operating situation:
 The potential danger or injury is greater in th OR and likely to involve higher money damage
claims. – this cases are likely to get to the courts.
 Application of doctrine is More complex in the OR rather than in the office.
 The surgeon have more servants than most doctors.
2. Doctrine of Res ipsa loquitor (Doctrine of common knowledge)

“the thing speaks for itself”
There is no need for an expert medical testimony if the doctrine of res ipsa loquitor is applicable
because the injury is a proof of negligence.
Example: If a foreign body or instrument is left inside the patient’s body unintentionally during a
surgery.
Requisites for the application of the doctrine:
1. The accident must be of a kind which ordinarily does not occur in the absence of someones
negligence. (The accident would not occur without negligence)
2. It must be caused by an agency or instrumentality within the exclusive control of the defendant.
(The agency must be in contrl of the defendant)
3. It must not have been due to any voluntary action or contribution on the part of plaintiff. (There
was no contributing conduct of the plaintiff)
Cases wherein the Doctrine has been applied:

1. Objects left in the patients body at the time of surgery
a. Sponge left during a CS
b. Broken Needle left during a cholecystectomy
c. Rubber drain left in the breast
2. Injury to a healthy part of the body
a. Removing a tumor from the scalp, accidentally cut the patient’s ear
b. Stitching a patients cheek accidently entered the patients eye
c. A dental drill slips and lacerates a patients tongue
d. Child’s uvula removed during tonsillectomy
3. Removing of the wrong part of the body when another part was intended
4. Teeth dropped down the windpipe
5. Burns from
a. Hot water bottles
b. Diathermy machine
c. Heat lamps
d. X-rays
e. Steam vaporizers
f. Bedside lamps
g. Chemicals
h. Medications
6. Infection resulting from unsterilized instruments
7. Failure to take X-ray to diagnose a possible fracture
8. Fracture set so badly that the deficiency of the workmanship is apparent to anybody
9. Disability directly resulting from injection of drugs into the body
10. Explosion of anesthetic gas

Sponges: Instances when the surgeon is not liable:
a. When the surgeon is in the stress of emergency
b. When the sponge become saturated with blood and was difficult to detect
Precautionary measures adapted to prevent sponge case accidents:
a. Fixing a tape or forceps on one end of the sponge
b. OR nurse assigned to count sponges
c. Surgeon counting the sponges by mental memory
d. Search made by either sight or by hand
e. Formal inquiry by the surgeon to the Sponge Nurse verified by his own counting
and affirmed by his search by sight and hands.
Slipping of drainage
Instances where the doctrine does not apply:

1. Cases where the doctrine of calculated risk is applicable:
 An accepted method of treatment involves hazards which may produce
injurious results regardless of the care exercise by the physician
2. Bad result rule:
 Application of management procedure resulted badly or diametrically
opposite to that one expected is not sufficient to infer negligence.
3. Honest error of judgment as to the appropriate procedure:
 Medicine is not an exact science
4. Mistakes in the diagnosis
Conspiracy of silence: (Read from the book)
3. Doctrine of contributory negligence

Conduct on the part of the plaintiff, contributing as a legal cause to the harm he has suffered, which
falls below the standard to which he is required to conform for his own protection.
Sa madaling salita, the negligence of the patient to inform, give proper history to his physician that lead
him to his harm.
Instances where there is contributory negligence

1. Failure to give the physician an accurate history
2. Failure to follow the treatment recommended by the physician
3. Leaving a hospital against the physician’s advice
4. Failure to seek further medical assistance if symptoms persist
Doctrine of superior knowledge – the physician has a superior knowledge over his patient. The patient usually
follows the instructions or orders of the physician.
Contributory negligence cannot apply where the patient is:

 Mentally ill
 Heavy sedation
 Old age
 Semiconscious
Contributory negligence, the negligence of the patient which contributed to the negligence of the physician
may be:
 Antecedent: - Bal-an ka pt na hubog iya doctor, inugtagaan siya injection, nagpasugot xa na mahatagan
injection, na-injure sya.

 Contemporaneous: - while doing endoscopy, patient moved, caused puncturing of esophagus.
 Subsequent: - Pt had his wounds sutured by a physician, he was prescribed TT, he was arrogant, and
went home and did not buy TT, he died of tetanus.
4. Doctrine of continuing negligence

Physician continually took care of a patient whom he left a gauze in the abdomen, he did not
disclose the information to the patient.
5. Doctrine of assumption of risk

A patient who was informed of the possible risk and injury to a procedure and gave his consent
to undergo such procedure, if he was injured during the procedure the doctor is not liable.
6. Doctrine of last clear chance

A physician who has a last clear chance of avoiding damage or injury to his patient but
negligently fails to do so is liable.
7. Doctrine of foreseeability
A physician cannot be held liable for negligence if the injury sustained by the patient is on
account of unforeseen conditions. But, a physician who fails to ascertain the condition of the patient
for want of the requisite skill and training is answerable for the injury sustained by the patient if injury
resulted thereto.
Example: failure to place the side-rails up to a patient to be foreseen at risk for fall.
8. Fellow servant doctrine

If a servant was injured on account of the negligence of his fellow servant, the employer cannot
be held liable.
Employer may be held laible if he have knowledge that the negligent employee was disabled,
unskillful, drunk, viscious or habitually negligent either before or after he employed him.
9. Rescue doctrine
If a physician who went to rescue a victim of an accident was injured, the original wrongdoer
must be held liable.
10. Sole responsibility vs shared responsibility.

There is sole responsibility when the negligent act or omission which is the proximate cause of
the injury suffered by the patient is attributed to the wrongful act of a person.
There is shared responsibility when the injury suffered by the patient is caused by the negligent
act of two or more persons, each of them acting concurrently or successively in the production of injury.

CHAPTER XI
SPECIFIC ACTS OR OMISSION CONSTITUTING MEDICAL MALPRACTICE
1. Failure to take medical history and Adequate Examination of the Patient

2. Non- Referral of the patient to a Specialist.
3. Failure to consult prior physicians for previous management.
4. Non-referral of the patient to a hospital with equipments and trained personnel.
5. Failure to use the appropriate diagnostic test
6. Failure to diagnose infection
7. Treatment resulting to addiction
8. Telephone orders except emergency cases
9. Experimental treatment
10. Abandonment of patients
11. Failure to give proper instructions
12. Failure to institute proper prophylactic treatment.
13. Liability for Errors in blood transfusion
14. Liabilities in Administration of Drugs
15. Product Liability – Doctrine of Strict Liability
I. FAILURE TO TAKE MEDICAL HISTORY

- A good diagnostic procedure demands a complete history.
- Clinical history must be related to the signs and symptoms of illness presented by the patient
- Failure to do so may lead to liability of misdiagnosis
- It is also the duty of the patient or his relatives in cases he is a minor or incompetent to give a reliable
history
- To state the fact as regards his present illness
- A physician cannot be held liable if the incomplete or inadequate history is due to the failure of the
patient or members of the family to give full information regarding the history of the present illness of
the patient
Eg: a 2 year old boy was found playing with an empty bottle of aspirin and was assumed to have ingested the
contents. Hours later, the child became ill and was brought to the hospital. The nurse on duty was told about the
suspicion that the child might have ingested aspirin. The nurse told the father to tell that information to the
physician but the father did not do so. In fact, the physician asked the father if the child had taken any medicine and
the father answered in the negative. The diagnosis of croup was made and the child was sent home and died. The
court held the physician not liable.
FAILURE TO EXAMINE OR FAILURE TO MAKE A CAREFUL AND ADEQUATE EXAMINATION OF THE PATIENT
- After history-taking, a physician must examine his patient.
- A physician who fails to examine the patient or fails to make a proper examination in which a careful one
would have revealed the existence of a specific disease may be held liable.
Eg: A pregnant patient was complaining of an acute stomach ache. Her physician, the defendant, made a house
visit and gave her a penicillin shot. A few hours later, she grew worse and fainted every time she got out of bed. Her
husband called the physician again and was told to “quit bothering him”. Two hours later, when her husband took
her to the emergency room of the nearest hospital the patient was dead on arrival. She had bled to death from
ruptured tubal pregnancy. The court held that the physician is liable for failure to make an examination on which to
base his diagnosis.
II. NON- REFERRAL OF A PATIENT TO A SPECIALIST

- The code of Ethics (Art. IV, Sec. 3) provides that “in difficult and serious cases or in those which are
outside the competence of the attending physician, he should always suggest and ask consultation.

- only experienced physicians who are senior to attending physician or who have had special training and
experience in a particular line of medicine should be selected by the latter as consultants.
- If the patient’s condition can be properly solved by the attending physician, he is not obliged to refer the
case to a specialist.
- Unresponsiveness to treatment does not infer legal duty to refer patient to another.
III. FAILURE TO CONSULT PREVIOUS PHYSICIAN FOR PREVIOUS MANAGEMENT

- several instances a patient has been under the care of other physician(s) who administered certain drugs
or has performed certain procedures.
- It is highly recommended to consult the prior physician of previous treatment applied to avoid the risk
upon application of another treatment procedure.
IV. NON-REFERRRAL OF PATIENT TO A HOSPITAL WITH EQUIPMENTS AND TRAINED PERSONNEL

- A physician must not only be aware of his personal knowledge and limitations but also of the proper
equipments on hand in the management of a patient.
- In the course of his practice, be confronted with a patient requiring specialized instruments and
procedures not available or may require the assistance of adequately trained personnel in the
management.
- Good practice demands that he refers the patient to a hospital where such equipments and trained
personnel are available.
V. FAILURE TO USE APPROPRIATE DIAGNOSTIC TEST

- There are certain infirmities of a patient wherein specific diagnostic tests will show with certainty or with
certain degree of probability that the patient is suffering from a disease
- Physician’s failure to utilize the diagnostic tests to determine the cause of the [patients illness may be a
basis for a medical liability claim.
- A physician may be held negligent for such failure if it can be shown that
1. It is a standard medical practice to employ certain diagnostic test under the circumstances of the case
2. that the physician failed to utilize the test and consequently failed to diagnose and treat the patient’s
illness correctly
3. that as a result, the patient suffered injury or was deprived of a substantial chance for cure
VI. FAILURE TO DIAGNOSE INFECTIONS

- Failure of a physician to discover that the patient has some sort of infection does not always imply
negligence.
- If the failure is on account of inability to make even a cursory examination of the patient, without any
justifiable reason, he may be held liable for want of due care.
- But if all types of examination were made which all other reasonable physician would make when
confronted with the same symptoms, he will not be held negligent if infection was not discovered for
some time.
VII. TREATMENTS RESULTING INTO ADDICTION

- the indiscriminate administration of addictive drugs by physicians.
- is a violation of Dangerous Drug Act and therefore, a criminal offense.
- physician will also be held civilly liable for treating a patient with drugs which resulted to addiction.
- if the remedy is not appropriate without genuine attempt to discover the nature of the patient’s ailment,
a serious legal result may well ensue.
VIII. TELEPHONE ORDERS

- it is a dangerous practice for physician to prescribe or order the pharmacist to receive prescriptions for a
patient over the telephone.
- equally not advisable for a physician to make order to the ward nurse by way of telephone. The nurse
who receives the order may do so BUT its performance is done at her own risk.
- Best: Physician’s order is in writing and allowed only in cases of true emergency.
Ex. A mother of a young girl called her family physician to request something to cure her daughter’s mosquito bites.
The doctor order the pharmacist through telephone for 1 ounce of mild chloride of mercury. What was sent to the
mother was bichloride of mercury or corrosive sublimate.----- It is not the duty of the pharmacist to know the use of
drug. The doctor was held liable for the injuries sustained by patient.
IX. EXPERIMENTAL TREATMENT

 is an act or operation determined by experimenter, to test, establish or illustrate suggested or known
truths.
2 types depending on the purpose:

A. Experimentation aimed exclusively or primarily for the accumulation of scientific knowledge.
-done for hypothesis, establishing certain facts or correcting variables.
-not done for purpose of direct treatment.
B. Experimentation employed as a method of treatment.
-aimed to determine the appropriate treatment to a disease suffered by a particular person.
Classified as:
1. Customary experimental treatments
2. Innovative treatments
2 Most important considerations that have to be complied with to avoid controversy and occasional litigation are:
a. Awareness and consent of the patient
- Inform in simple, adequate and comprehensive language including the risk involved.
- Advisable to have consent in written form to avoid future misunderstanding.
b. The physician to perform the experimental treatment must be capable to perform the innovative
technique
- Knowledge of probability of success and risks. Probable risks do not outweigh its consequential
benefit.
Declaration of Helsinki
-issued by World Medical Association in 1964
-enumerates recommendations in performance of clinical experimentation or research.
-compliance with the guidelines DOESN’T relieve physicians from criminal, civil and ethical responsibilities
A. Basic Principles:
a. Clinical research must conform with moral and scientific principles.
b. Conducted and supervised only by qualified persons.
c. Importance of the objective is in proportion with risk to the subject.
d. Careful assessment of inherent risks and benefits
e. Specific caution exercised by the doctor
B. Clinical Research Combined with Professional Care:

a. The doctor must be free to use new therapeutic measure if in his judgment it offers hope to saving
life.
b. Only to the extent that clinical research is justified by its therapeutic value for the patient.

C. Non-Therapeutic Clinical Research:
a. Duty of the doctor to remain protector of life on whom clinical-research is being carried out.
b. Purpose and risk should be explained by the doctor.
c. 1. Consent needed but if he is legally incompetent, consent of legal guardian should be procured.
2. The subject should be in a mental, physical and legal state.
3. Consent should be in writing.
d. 1. Respect the right of each individual.
2. Anytime during the course of research, subject is free to withdraw.
Nuremberg Code of Ethics in Medical Research

1. Voluntary consent of human consent is essential
2. Experiment should yield fruitful results
3. Should be designed and based on results of animal experimentation
4. Avoid all unnecessary physical and mental suffering and injury
5. No experiment if death or disabling injury will occur
6. Degree of risk should never exceed that determined by humanitarian importance
7. Proper preparations
8. Conducted only by scientifically qualified persons
9. Human subject has liberty to stop the experiment
10. Scientist in charge must be prepared to terminate the experiment at any stage
X. ABANDONMENT OF PATIENTS
Abandonment is the termination of the physician-patient relationship w/o the consent of the patient and w/o giving
the patient adequate notice and opportunity to find another physician.
Elements of Abandonment:
1. There must have been a physician-patient relationship;
2. The rel’p must be terminated by the physician w/o the mutual consent of both parties;
3. The physician must have unilaterally terminated the rel’p w/o giving the px adequate time to secure the
services of another physician;
4. There must have been a continuing need of the px for further medical tx, and
5. The abandonment must have been the cause of the resulting injury or death of the px.
The ff. are instances when a physician may be held liable for abandonment of the px:
1. Refusal of physician to treat a case after he has seen the person needing tx but before tx is commenced.
2. Refusal to attend a case for w/c he has already assumed responsibility.
Ex. The physician refused to cont. w/ the delivery of the child because the plaintiff would not cooperate during
application of obstetrical forcep.
3. Failure to provide follow-up attention.
4. Failure to arrange for a substitute physician during the time the physician is absent or unavailable.
Ex. The physician once attended to a patient in the absence of an agreement, will be an engagement to attend
to the case as long as he needs attention unless the patient requested for another physician to attend him.
The most typical form of abandonment is a situation in which the physician explicitly stated that he is withdrawing
himself from the case and the patient remains in need of medical attention.
Ex. The px developed gangrene and was advised for amputation of the foot. The surgeon failed to return and
communicate four days thereafter. The patient transferred to another hospital where another surgeon performed
the amputation. The court held that abandonment had occurred.

After the commencement of physician-px rel’p, a physician cannot withdraw if his services are still required by the
patient on the ground that the patient has not paid the past bill. Financial question is absolutely irrelevant to the
question of the patient’s care.
A physician who fails to see the patient at intervals necessary for the proper treatment of whatever condition the
patient constitutes abandonment. However, failure to see the px sufficiently often because of incorrect conclusion
that the px’s condition is such that no further treatment is necessary involves an action for negligence but not
abandonment.
The px’s condition may not necessarily require medical attendance but the physician may suspect that unforeseen
conditions may develop which may require his presence in the px’s bedside. “call me if you need me” or “please return
if no appreciable improvement is noticed” are common instructions given to the px. In this instance, there is no
abandonment if the physician fails to see his px as long as the instruction was made clear. Failure of the px to return
to the clinic when instructed to do so means failure of the px to follow instruction and the physician cannot be held
liable for abandonment.
If the physician is absent or ill and has no capacity to attend to his px, he is obliged to give notice of his inability.
He must recommend a competent substitute to take over the case. The physician must see to it that the substitute is
competent to undertake the care and management of the px. The attending physician may be held liable for the
negligent acts of his substitute.
The attending physician may be held liable for the acts of his substitute in the following instances:
1. If the attending physician did not exercise due care and diligence in the selection of the substitute; and
2. If the substitute acts as an agent of the attending physician in so far as carrying out a certain course of
treatment in which case master-servant is created.
A physician who limits his practice to a specialty may refer a patient to a practitioner whenever the condition of
the px or its management is not in line with his practice. Referral of px to another who is much more competent to
undertake treatment does not constitute abandonment.
A physician may apply a treatment procedure in a hospital or clinic. Refusal of the px to be in a place desired by
the physician to be the venue of treatment does not constitute abandonment.
The discharge of a px from the hospital, when the condition does not justify it, is considered abandonment.
Discharge can only be made ifn further hospitalization is no longer indicated.
Non-payment of Bill cannot be a defense ground for abandonment:

A physician who has been previously treating a px cannot just abandon or discontinue tx because of the failure of
the px to pay the last bill due him. In the physician-px contractual rel’p once it has been perfected financial
consideration is an irrelevant issue. The health and welfare of the px must be given paramount consideration.
XI. LIABILITY FOR FAILURE TO GIVE PROPER ISTRUCTIONS

 A physician is obliged to give proper instructions to the px, to the attending nurse, or to the other members
of the family who are assisting in the px’s care. Istructions must be adequate, and sufficient for an ordinary
man to understand and execute properly. Failure to give instruction or when the instructions given are
insufficient, inadequate and incomprehensible and which resulted to injury to the px, then the physician
may be held liable.
Ex. A physician advised a woman that she could wait on the px who had smallpox. The woman and the px died of
smallpox. It was held that the physician was liable for negligently allowing a contagious disease to spread.
XII. LIABILITY FOR FAILURE TO INSTITUTE THE PROPER PROPHYLACTIC TREATMENT

 Treatment of a px is only limited to the condition existing at the time of the examination and also to the
institution of the proper preventive measures. Failure of the physician to give medicine to prevent a
foreseeable consequence whenever they are available makes him liable to whatever be the consequence
of his error by omission.

Ex: a doctor was called to attend childbirth. After delivery of the child, he failed to give the necessary prophylactic
treatment for the eyes. The mother requested him to place a silver nitrate solution in the infant’s eyes, but the doctor
refused, and as a result the child lost his eyesight. Judgment id the sum of $5000 against the physician was rendered.
XIII. LIABILITY FOR ERRORS IN BLOOD TRANSFUSION

Complications assoc. with blood transfusion may be caused by:
1. Mechanical:
a. Volume: Inc. fluid volume will cause pulmonary edema and cardiac engorgement.
b. Embolic: Air
2. Chemical and Serological
a. Incorrect grouping
b. Infected blood: (1) Immediate; (2) Delayed
c. Chemical w/c may be due to overcooling or overheating.
Transfusion reactions are conveniently classified as:

1. Immune reactions caused by:
a. Cell incompatibility
b. Leukocyte & platelet incompatibilities, as well as other allergic reactions.
2. Non-immune transfusion reactions:
a. Due to overloading of the circulation.
b. Related to transmission of infections through massive transfusion.
c. Ill effects such as thromboembolism and air & fat embolism.
Problems of Blood Transfusion:

1. Transfusion of the Wrong Type of Blood
Most mismatches are caused by technician’s error either in the examination or in clerical reporting. If the
technician is a hospital employee, then the hospital must be held liable for the negligence. If there is direct
supervision and control of the pathologist, then the pathologist may also be held liable. The hospital is liable if the
pathologist is an employee of the hospital.
2. Blood Transfusion on a Wrong Patient

An intern and hospital nurse informed the patient that he was to have a blood transfusion but it was a
mistake for it was meant for another patient. The patient suffered transfusion reactions. The court held that the
defendant was liable.
3. Slipping of the Needle Outside the Vein and Infusion of Blood into the Soft Tissues
The anesthesist gave the patient a blood transfusion. It was discovered later that the needleslipped out of
the vein and about 200 cc of blood went into the tissues. The doctor is not liable because the act was not under his
exclusive control. The hospital was held liable for the negligent act of its employee, the registered nurse, who had
the training & knowledge of seeing that the needle does not slip as it frequently does.
4. Infection following transfusion

Transfusion of infections which can properly be checked by the examination of the donor will constitute
negligence of the blood bank. “Benefit-to-Risk-ratio” means that if the potential benefit outweighs the potential risk,
transfusion must go ahead, otherwise it should not. The patient developed hepatitis after the blood transfusion. The
defendant disclosed that the blood used in the transfusion was procured under conditions which imposed all
safeguards to assure that it did not contain the virus which caused hepatitis. The defendant was not guilty of
negligence.

5. Negligence in transfusion
Failure to transfuse a patient when there is extreme indication or transfusion of blood more than sufficient
may be a cause of liability. The principle of liability shall be applied like any other acts of a physician.
XIV. LIABILITIES IN THE ADMINISTRATION OF DRUGS

Five Rights:
1. Right DRUG
2. Right PATIENT
3. Right DOSE
4. Right TIME
5. Right ROUTE
A physician cannot be held liable for any injury w/c resulted from the administration of a drug if he has
utilized knowledge and skill and has applied care and diligence in the prescription and management procedure both
before and after the manifestation of the adverse effect of the medication. If the physician have knowledge from
other sources that the drug is dangerous, he may be held liable for continuing to prescribe it.
Negligence in the administration of a drug which causes injury to the patient may be attributed to:
1. Drug reaction
Failure of the physician to observe the necessary standard of care in the administration which resulted to
injury to the patient makes him liable. Inference of negligence may be established in the following:
a. Failure to note the history of allergy.
 The physician must make inquiries of history of allergy, sensitivity to drugs, or idiosyncrasy to certain
substances.
b. Failure to test for signs of reaction.

 Antitoxin serum ad some antibiotics are known to produce a reaction and the use of the skin test or any
other test to determine sensitivity may be considered an exercise of the proper precaution in the
administration of the medicine. If a skin test is administered, its administration must be conducted
properly.
 A physician is not liable if there is no known test to determine sensitivity.
 A physician is not liable for untoward effects of the drug if history and sensitivity test are
negative.
c. Failure to stop treatment when drug reaction has been observed.

 Good practice demands that whenever signs and symptoms of hypersensitivity or allergy begin
to appear, the physician must stop the administration of the drug. Failure to do so when manifestation
is clear infers lack of precaution in the administration of the drug.
d. Failure to provide adequate therapy to encounter a reaction:

 Whenever symptoms of allergy have started to appear, the physician is duty bound to institute necessary
treatment to prevent injurious or fatal consequences. A physician must be able to cope with the demand
of emergency, otherwise, he may be held liable.
Example: A 6 year old child was going to be operated for inward deviation of the eyes. After the anesthetic
had been applied prior to the surgery, the boy suffered respiratory arrest followed immediately by cardiac arrest.
The anesthesist called out that the boys heart had stopped beating. The anesthesist emptied the gas had began
cardiac massage. He continued without success for 20 to 30 seconds. The anesthesist requested the surgeon to
perform open cardiac massage but claimed he was not in a capacity to do so. Another surgeon who passed by did
the operation. As a result of cardiac and respiratory arrest, the boy suffered spastic quadriplegia, blindness and
became mute. The court held that the first surgeon was liable for his inability to perform immediate cardiac
massage.

e. Treatment with a drug not proper for the illness:
 A physician must not expose his patient to unnecessary risks in the treatment procedure. If a drug given
is not a suitable remedy to the disease the patient is suffering from negligence may be found in spite of a
fact that the reaction was unpreventable or reaction developed after the exercise of due care and
diligence.
Example: A patient had mumps. The physician administered an injection of penicillin. The patient
developed anaphylactic shock and died instantly. The court conceded that anaphylactic shock was unpreventable
hazard under normal conditions. However, because expert opinion indicated that penicillin is useless in the
treatment of mumps and that using it after all was a breach of good medical practice, defendant was found liable.
2. Overdose of the drug administered:

- Ignorance of the physician as of rightful dosage of the drug to be administered o hiss patient is a proof of
incompetence. Overdosage had been common in the administration of anesthesia, electric shock therapy
and insulin treatment for diabetes.
Example: A patient, 25 years old, suffered from diabetes for about 11 years. He saw the defendant and the
latter prescribed 48 units of insulin without examining the blood sugar level. The defendant advised the patient to
reduce the diet to 50%.A few days later; he suffered from hypoglycemia and was injured. The physician was held
liable for giving an overdose of insulin.
3. Failure to give warning of the side effects:

- Informed consent to a treatment procedure requires disclosure to the patient of the side effects of the
drug. A physician may be held liable if he does not warn the patient of the side effects may be expect to
develop as a normal consequence of drug administration.
- Untoward or unexpected effects of a drug must be distinguished from side effects. An Untowards effect
is unforeseeable while side effects may be expected to develop as a normal consequence of drug
administration.
Example: A worker was injured in an on-the-job accident. The company physician sewed up the cuts and
gave him medication for pain. He made no effort to tell that drowsiness was likely to occur. On his way home, the
patient fell asleep and the wheel of his car ran off the road and the patient was killed. The and his employer were
held negligent for administering the drug without warning he patient of its side effects.
4. Administering medicine in a wrong route:

- As a general rule, the dose of a drug given parenterally is usually smaller in amount as that one given per
orem in as much as a part of the drug may be lose its potency, dissipate, or not be absorbed in the
alimentary tract. If a drug has been prescribed by a physician, he must specify the route of administration
and the nurse must be aware of it.
Example: A nurse of a hospital received a written order from a physician calling for the administration of 3 cc.
lanoxin in an infant patient. The nurse, thinking that the drug was to be administrated by injection and not realizing
that it could also be administered orally, question the amount of drug to be administered. Consequently, she
approached two other physicians in the hospital at the time and asks them if they thought the prescription was
proper. The two physicians believing that the nurse knew that the drug was o be administered orally, told her that
the dosage is not too great and o follow the doctor’s order. The nurse did not attempt to contact the physician who
had given the order and instead administered the drug to the infant by injection. The infant died of an overdose of
the drug. The court held that the nurse was negligent for it is the duty of the nurse, when in doubt of the order for
medication to make absolutely certain of what the doctor intends as to the dosage and route.
5. Administration of the wrong medicine:

- The proper label must be placed in the container of the drugs in the stock room or cabinet of the clinic,
pharmacy or hospital. The name of the drug, strength, method of administration and even the date of
expiration of a drug which is not intended by the physician, on account of negligent substitution is a
ground for liability.
Example: A patient entered a hospital for treatment of his dislocate thumb. The physician ordered novocaine
solution from the nurse. The nurse requested another nurse to comply with the doctor’s order. A solution a solution
of a adrenaline was given to the patients thumb and the patient died. It was held that the physician could not be
held liable. The routine matter of examining the content as reflected on the label must be made by the nurse.
6. Administration of a drug on the wrong person:

- The administration of a drug to a patient which was intended o another constitutes negligence.
Example: A patient had an operation for the removal of kidney. After she recovered, an intern and hospital
nurse entered the room and informed her that she was to a transfusion, she suffered chills, rise of temperature,
headache and became mentally ill thereafter. The court held the defendant hospital liable.
7. Infection following an objection;

- Abscess and other forms of infection which develop at the site of injection is not an inference of
negligence. Infections which develop may be exogenous or endogenous in origin. However, if I can be
proven that such infection is directly as a result of the want of care in the observance of the necessary
standard aseptic procedure, then liability may be incurred.
Example: A drug addict entered hospitals which advertise to cure drug addiction. While under treatment, he
suffered infection due to infection with an improperly sterilized hypodermic needle. The court held an improperly
sterilized hypodermic needle. The court held that there was enough evidence shown by the patient to make a prisa
facie case based on the failure o provides proper sterilizing equipment.
8. Injury to the nerve:

- Special care must be exercised in the selection of the site especially for intramuscular injection. In as
much as the injection is deep the possibility of involving the major nerve trunk is not remote.
Intramuscular injection in the gluteal region must be done at the upper outer quadrant to avoid
involvement of the sciatic nerve.
Example: A patient was under treatment for malaria. A drug Is injected into the buttock in close proximity to
the sciatic nerve, as a result of which, the patient suffered a drop of the right foot. It was held that the physician
was liable for negligence.
9. Intramuscular became intravascular:

- Drug intended for intramuscular or subcutaneous administration and which became intravenous or intra
arterial may cause fatal consequences on account of embolism. A physician or a nurse must observe the
necessary precautionary measures that must be observed.
10. Leak of the solution from the vein:

- If the drug leaked from the vein to the course of an intravenous injection, it is not always an inference
injection, It is not always an inference of negligence, The plaintiff must prove that the cause of the
leakage is on account of the defendant’s negligence.
Example: A physician injected sodium pentothal intravenously into the patient’s arm. Three days later, on
account of the leakage of the drug, the patient developed abscess and suffered months of incapacity and
considerable pain. In the malpractice suit against the physician‘s negligence, hence, a judgment was due to the
physician’s was rendered.
11. Failure to administer the drug:

- Liabilities may be incurred in the administration of drugs but a physician may also be held liable if he fails
o administer a drug, resulting in injury to the patient.
Example: An infant lost his eyesight allegedly because the doctor failed to place nitrate of silver in his eye at
that time of birth. The doctor admitted that he did not place any prophylactic solution in the eye of the child
although the mother requested him to do so. For the injury sustained by the child, the court rendered a judgment in
the sum of $5,000 against the physician.
XV. MANUFACTURER’S LIABILITIES FOR THE INJURIOUS EFFECTS IN THE ADMINISTRATION OF DRUGS:
A drug manufacturer is obliged o exercise due care in research and development and also in the manufacture
and sale of products already developed.
A drug manufacturer may be held liable for the injury sustained by the patient in he administration of a drug there
is:
A. Failure to test the drug properly before marketing; or
B. Failure to use due care in manufacture; or
C. Failure o provide adequate warning or unavoidable side effects
Doctrine of Strict liability

A person injured by a defective productive product can recover compensation from his injury from anyone in
the distributive chain who sold the product while the defect was present, even though the seller exercises every
conceivable caution o prevent and discover the defects.
Negligence or carefulness is not in issue in a case under this doctrine nor is any warranty or promise is in
issue.
The doctrine of caveat emptor (Let the buyer beware ) began a slow and fitful decline until today the
doctrine is as dead as the language in which it is cast.
A drug manufacturer is liable if his product is contaminated by any impurities which harm the user.
If a drug has a side effects, it is the duty of the drug manufacturer to warn the physician of the either through
the literature attached or accompanying the drug or through the services of the agents or promoters.
“Wrong Baby” Cases:

 Modern procedures for identification of newborns used in virtually every hospital nursery:
1. Bracelets are usually placed on the newborn before removing from the delivery room indicating the
parent’s name, his mother’s room number and other information.
2. Footprints or thumbprints are usually made as a standard procedure.

The parents took the baby home and on arrival they realized that it was not their child. They returned the infant
immediately and given back the right baby. They sued on the ground that they had been subjected to extreme
mental anguish and the mother suffered from loss of sleep.
The court held that since the state courts had adopted the principle that no recovery for mental anguish would
be allowed without proof to the plaintiff, loss of sleep did not constitute physical harm, the cause of action was
dismissed.
It is likely that most jurisdictions would adhere to the principles of these decisions. While there is conflict in the
law, in most cases in order to recover damages from mental anguish a plaintiff is obliged to demonstrate objective
physical effects from the wrong done to him.

Chapter XII
PHYSICIAN’S REACTION TO THE PROBLEM OF MALPRACTICE
A physician who wants to avoid the ordeal of being involved in malpractice suit, or has had the traumatic
experience of being involved in litigation, may pursue any of the following:
1. Partial or Complete Abandonment of Medical Practice
- Complete abandonment of his medical malpractice is the most tragic reaction of physician.
Example: along the road there is a car accident and the doctor passes by and he doesn’t even bother to
give first aid.
- Partial abandonment, in which the physician may refuse to attend to cases which are difficult to diagnose
or require sophisticated system of management.
2. Practice of Defensive Medicine
- Any act or omission on the part of physician that is motivated primarily by the desire to avoid malpractice
liability.
Kind of Defensive Medicine
a. Negative Defensive - avoiding hazardous procedure even though the procedures are deemed essential
to the welfare of the patient.
Example: The surgeon refused to do open heart surgery because of low successful rate and high in
possibility of post op complications.
b. Positive Defensive Medicine – physician order or performs additional management procedures to
avoid liability.
Example 1: admission of patient to hospital for a procedure that could be performed in physician’s
clinic.
Example 2: physician order additional diagnostic tests which normally may be considered unnecessary.
Example 3: overtreatment!! Prescribing multiple drugs to the patient even a single drug can cure the
disease of the patient.
Kind of Overtreatment
a. Qualitative- application of procedure or supportive devices ordinarily prescribed only to much
more severe conditions or for injury or disease different from one to which such treatment is being
directed.
Example: performing CS to uncomplicated pregnancy.
b. Quantitative- application of procedure without justification.
Example: Excessive testing
Effect of Over Treatment:

1. High Financial losses
2. Patients suffer from physical or emotional harm.
3. Physician treating symptoms which actually the result of overtreatment
4. Risk injury to patient
3. Professional Liability Prophylaxis

– These are the things that the physician should know in dealing with his patient in order to avoid liabilities.
Example: Physician must know his legal duty to the patient.
4. Medical Malpractice Liability Insurance

- A contract under which the insurer agrees, in exchange in the payment of premiums, to indemnify the
physician named in the insurance policy against loss by reason of liabilities imposed upon him by law as a
consequence of his claimed professional liability.

Chapter XIII
LIABILITIES OF HOSPITALS
Hospital Licensure Act (Rep. Act 4226)

 Hospital means a place devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment and
care of individuals suffering from illness, disease, injury or deformity, or in need of obstetrical or other medical and
nursing care.
 Hospital shall also be construed as any institution, building or place where there are installed beds, cribs, or bassinets
for twenty-four hour use or longer by patients in treatment of diseases, diseased-conditions, injuries, deformities or
abnormal physical and mental state, maternity cases, and all institutions, such as those for convalescence, sanitaria or
sanitarial care infirmities, nurseries, dispensaries and such other names by which they may be designated.
Classification of Hospitals:
According to licensing agency system of classification:
1. General or specialized
2. Hospital service capabilities
3. Size or bed capacity
A. As to scope of Infirmities Admitted:

1. General Hospital
 Concerned with the admission and treatment of a substantial range of diseases or injuries
 Eg. Philippine General Hospital
2. Specialized Hospital
 Established to admit specific illness, treatments, organ affected or for a class of people. Specialized
hospital may be devoted to:
a. Treatment of particular type of illness or for a particular condition requiring range of treatment.
Eg. Cancer Hospital / Orthopedic Hospital / TB center
b. Treatments of patients suffering from disease of a particular organ or group of organs. Eg. Eye
hospital/ Philippine Heart Center / NKTI
c. Treatments f patients of a particular class. Eg. Children, women, seamen, etc.
B. Functional Classification:
1. Diagnostic Hospital
 Devoted solely to the diagnosis of disease, injury, deformity, or physical and mental conditions
2. Maternity Hospital
 Established for the reception, care and treatment of expectant mothers and cae of the newly-born
infants
3. Rehabilitation Hospital
 Established to enhance return of a disabled to his usual activities and adapts his condition to a specific
environment
4. Surgical Hospital
 Operative procedures are employed as a mode of treatment
5. Cosmetic Hospital
 For improvement of the physical or aesthetic condition either by surgery or by physical means
C. As to control and Financial Support:
1. Public or government Hospital
 Operated and maintained either partially or wholly by the national, provincial, municipal, or city
government or other political subdivision.
2. Private Hospital
 Privately owned, especially established and operated with funds raised or contributed through
donations or private capital or other means by private individuals, associations, corporations, religious
organizations
 For the purpose of determining liability for negligence, private hospital are classified into:
a. Private charitable or eleemosynary hospital
 Established for public benefit by a private individuals or corporation and not conducted
for pecuniary gain of the management, officers or others

b. Private pay hospital
 Established by private individual or corporation for a profit.
D. Classification Based on the Size or Bed Capacity:
E. Classification of a Hospital as to Whether it is Training or Not
A Hospital Cannot Practice Medicine:

1. The practice of medicine by a hospital for profit through employment of licensed physician is not in the interest
of public safety, health and welfare and therefore contrary to public policy.
2. If a hospital will be allowed to practice medicine, then the licensed physician employed by the hospital will be
merely receiving orders from the corporate body or its officers who are not licensed to practice medicine.
Duties of the Governing Board of a Hospital:

1. To determine the policies of the hospital in relation to the community needs
2. To see to it that the proper professional standards are maintained in the care of the sick
3. To coordinate the professional interest of the hospital with the administrative, financial and community needs
4. To direct the administrative personnel in order to carry out the policies
5. To provide adequate financing to secure sufficient income and to assure business-like control of expenditures.
Rules and Regulation of Hospitals:

1. State Regulation of a Hospital
 The state may impose certain regulations in the establishment and management of a hospital in the interest of
public health, safety and welfare. The regulation may include:
a. Minimum standard requirements for ground and building including facilities for ventilation, waste
disposal, fire protection, drainage, congestion and pollution and explosives and other hazards.
b. Provisions for minimum number of equipment and supplies for certain number of bed patients and
dispensary services.
c. May set standard qualifications of medical and paramedical staff members
d. Strict supervision of the staff to assure accuracy and god result of treatments
e. System of continuing medical education so that the staff members will be abreast with the recent
developments in diagnostic and management procedures.
2. Self Regulation of a Hospital
 Both public and private hospitals have the right to promulgate rules and regulations in relation to the use of
their facilities. A private hospital is given more leeway in making rules and regulations as regards selection of
staff, qualification of physicians who can avail of hospital facilities, patients to be admitted, etc.
Primary Duties of a Hospital:

1. To furnish a safe and well maintained building and ground.
2. To furnish adequate and safe equipments.
3. To exercise reasonable care in the selection of the members of the hospital staff.
Persons coming within the premises of the hospital:

1. Trespasser
2. Licensee
3. Invitee – one who is essential to the operation of a hospital or to whom the hospital has a purpose.
a. Attending Physician
b. Private Nurse
c. Voluntary worker
d. Blood donor
Liabilities of Hospitals for the Wrongful Acts of their Agents or Employees:

1. Government or Public Hospitals:
 A state cannot be sued except when it consents. “there could be no legal right against the authority that makes
the law n which the right depends”

 Following the doctrine of immunity of the state from suit, a public or government hospital cannot be sued
inasmuch as it is owned and controlled by the government.
a. Government Hospitals Which are Established to Perform Governmental Functions:
 If a public hospital is established with duties of conservation of public health, treatment of
indigent, protection of the people from hazards, alleviation of sufferings and treatment of
diseases, then the hospital is immune from being sued as it was established to perform
governmental function.
b.Government Hospitals which are established for Proprietary Functions:
 A public hospital performs proprietary function when it is established for profit, if it does the
government goes down to the level of any private pay hospital or any other persons or
corporation who does some business and therefore must be held liable for the wrongful act of
its employees or servants.
2. Private Charitable, Voluntary or Eleemosynary Hospitals:
 There is no specific rule to be followed to determine whether a voluntary or eleemonsynary hospital may held
liable for the negligent act of its employees or servants.
Doctrines or Theories Applied to Charitable Hospital Immunity for the Acts of its Employees:
a. Trust Fund Doctrine – charitable hospitals derived their support from voluntary contributions or donations. The
purpose of the money collected is for the reception, care and treatment of charity patients. The contributions
are only held in trust by governing body of the hospital. If the endowment, contribution or donation is solely for
the charity patients, then there will be no fund available for the payment of damages.
b. Implied Waiver Theory – a patient who enters a private charity hospital, knowing fully well that it is merely
supported by benevolent and humanitarian contributions, waives his right to claim damages.
c. Public Policy Theory – a private hospital for charity performs a quasi-public function. It renders service to the
indigent patients without renumeration. If a government hospital is immune from liability while undertaking
such obligation, for the same reason, the private hospital for charity must be given the same immunity then.
d. Independent Contractor Theory – a patient who enters a private charitable hospital does not have a contract
with the hospital but with the attending physician. The hospital has no capacity to supervise the activities of the
attending physician in the management of the patient. It is but logical therefore that is the attending physician
committed a wrongful act, he himself must held liable and not the hospital.
3. Private Hospital Operating for Profit:
 A private hospital for profit may hold vicariously liable for the negligent act of its employees. All other principles
to determine liability for physicians may be applied to private hospitals operating for profit.
 Additional rules are applied to determine whether or not a hospital is vicariously liable for the negligent acts of
the resident physicians, nurses and other employees:
a. The principle of administrative or ministerial duties as against professional or medical duties.
 Administrative or Ministerial Duties – the performance of all routinary duties (attends to
emergency treatments in the absence of the attending physician, performs ordinary diagnosis
and treatment procedures) which is the very reason why he is appointed in the ordinary sense
constitutes administrative or ministerial duties. Any negligent act committed by such employees
in the course of their employment which causes injury to the patient, may make the hospital
vicariously liable.
 Professional or Medical Duties – these are duties the very nature of which is beyond the ordinary
routine in a hospital. Resident physicians and nurses are performing certain special acts under
the direct order and supervision of the attending physician. Any negligence of such hospital
employees, the “borrowed servant doctrine” must be applied and the hospital employer must
not be held liable.
b.Principle of Control:
 If the hospital has control over the employee, then the hospital must be held liable; if it is the
physician, following the “borrowed servant doctrine” the physician must be held liable. If both
the hospital and the physician have concurrent control, then the liability is joint.
c. Contract of Service Distinguished from Contract for Services:
 In contract of service, the doctrine of vicarious liability must be applied, if a physician enters
into contract with the hospital, the hospital may be held vicariously liable for the act, provided

the negligent act was committed within the scope of employment. If the physician enters into
contract for services to the patient, the principle of independent contractor shall be applied.
d.Independent Contractor Theory:
 In a physician-patient relationship, the physician is an independent contractor irrespective as to
whether the medical services of the physician are made in the hospital. The physician must be
held liable for his own negligent act in the course of the relationship.
e. Sole Responsibility vs. Shared Responsibility:
 Injuries sustained by the patient, on the account of the professional negligence of the attending
physician, is the sole responsibility of the attending physician. The same rule is applied when
such injury is on account of the physical defects of the premises of the hospital, the hospital
must be held solely liable.
 When a patient is under the care and treatment of two or more physicians, wherein the act of
one is done with the knowledge of the others, any liability arising from the negligent act of one
will be shared by the other attending physicians.
Liabilities of a Hospital:
1. Corporate Liabilities – are those arising from failure of the hospital to furnish accommodations and facilities necessary
to carry out its purpose or to follow in a given situation, the established standard of conduct to which the corporation
should conform. Its corporate liabilities may arise from:
a. Failure to furnish safe and well maintained buildings and ground
b. Failure to furnish safe and reliable equipments
c. Failure to exercise reasonable care in the selection of its medical and nursing staff but also in granting special
privileges in the use of the hospital facilities by private physicians
 Before an independent physician must be given hospital privileges, the governing board is obliged to:
1. To investigate and evaluate the applicant’s qualification for the requested privileged;
2. To solicit information from the applicant’s peer who are knowledgeable about his education,
training, experience, health, competence, and ethical character,
3. To determine if the applicant is currently licensed to practice or registration has been currently
being change
4. To inquire whether the applicant has been involved in adversed malpractice action and whether
he has experienced a lose of medical organization membership at any other hospital
2. Vicarious Liabilities for the Acts of Hospital Employees:
a. Nursing Staff
1)Student Nurse
2)Professional Nurse
3)Special Duty Nurse
b. Medical Staff:
1)Interns
 Kinds of Internships:
a. Rotating Internship
b. Mixed internship
c. Straight internship
2)Resident Physicians
3)Consultants
ADMISSION:
A hospital must have an admitting department or section which is its nerve center. It is the place which determines who
are eligible for admission, and the number and types of patients to be admitted depending upon the size, organizational pattern,
and capabilities of the personnel. The policies on admission are defined by the governing board of the hospital.
A person has no absolute right to be admitted in a hospital. The discretion to admit is vested on the management or
governing board. The relationship between the hospital and patient is contractual and the hospital has the right to choose
patients whom it wants to serve, in the same manner that the patient has the right to choose the hospital.
A government hospital has no absolute privilege of choice of patients in as much as it is established and maintained by
public funds. A government hospital must open its door to all who seek its services and facilities and must be made available to
all medical practitioners and patients.

Some of the justifiable grounds to refuse admission of patients in a hospital are:
1. All accommodations are filled
2. The patient is chronically ill
3. The patient needs only convalescent care
4. There is no available accommodation for the clinical service that the patient is suffering
5. The patient’s illness is contagious and a risk to other patients.
ATTENDANCE TO EMERGENCY CASES IN HOSPITALS:

“Hospitals licensed to operate under the provision of Republic Act 4226 (Hospital Licensure Act), are to provide among
others, facilities for medical practice, and in order to carry out the legal obligation of physicians employed in these institutions
or authorized to practice therein in attending to a patient in danger of death or is otherwise an emergency case, it becomes the
responsibility of hospital to provide facilities for emergency cases.
REPUBLIC ACT 6615:

An Act requiring government and private hospitals or clinics duly licensed to extend medical assistance in emergency
cases.
TRANSFER OF PATIENTS:
The transfer of emergency patients from one hospital or clinic to another can only be done if the condition of emergency
ceases to a threat to the life and that the transfer itself will not impair the life and health of the patient. The transfer must be
premised on the desire and consent of the patient.
DISCHARGE OF PATIENTS:
If the attending physician, after evaluation of the patient’s condition, considers that further hospitalization is no longer
indispensable, he may order the discharge with or without condition. The order must always be written in the clinical record and
may simply state “may go home” or may provide certain advice or condition like “advised to report after two weeks for check-
up.” However, discharge of patient in need of further hospitalization is unreasonable. The patient must remain in the hospital
and treatment continued if it is foreseeable that the patient’s condition will be aggravated if removed from the hospital.
REFUSAL OF A PATIENT TO BE HOSPITALIZED:

Refusal of the patient to remain in the hospital will not be a lawful ground to detain him if he is of a sound mind and of
legal age. The attending physician must appraise the patient of the potential untoward effects if he leaves the hospital. If after
being told of the serious consequences, the patient insists on leaving the hospital, the attending physician has no other recourse
than to abide with the patient’s wish, otherwise, he may be held criminally liable for “slight illegal detention” (Art. 268, Revised
Penal Code)
If the patient inspite of the advice not to leave the hospital insisted on leaving, aside from the notation in the clinical
record “went home against advice,” the attending physician or nurse must let the patient sign a release paper which contains
among other things, the following:
1. That he vehemently wanted to leave the hospital (whether or not he stated the reason for his desire);
2. That he was advised of the probable danger to his life or impairment to his health if ever he does so in a clear, adequate
and understandable language;
3. That inspite of the explanation of potential danger (immediate or remote) to him, he would still leave the hospital
4. That he holds the hospital or any member of its staff not responsible criminally or civilly for whatever consequence to
his life and health as a result of his act.
REFUSAL OF THE PATIENT TO LEAVE THE HOSPITAL:

If the patient refuses to leave the hospital inspite of the order for his discharge, he may do so in a private hospital
provided the corresponding hospital bill is properly satisfied with the consent of the attending physician.
PREMATURE DISCHARGE:
The attending physician and the hospital may be held liable to the patient if the latter is discharged from the hospital in
spite of the fact that further hospitalization is still necessary.

DETENTION OF A PATIENT FOR NON-PAYMENT OF BILL:
A patient cannot be detained in a hospital for non-payment of the hospital bill. If the patient cannot pay the hospital or
physician’s bill, the law provides a remedy for them to pursue; that is, by filling the necessary suit in court for the recovery of
such fee or bill.
The hospital may legally detain a patient against his will when he is detained or convicted prisoner, or when the patient
is suffering from a very contagious disease wherein his release will be prejudicial to public health, or when the patient is mentally
ill, that his release will endanger public safety.
LIABILITY FOR HOSPITAL INFECTION:

A clinic or hospital may be held liable for failure to afford patients with adequate protection against infection. Prevention
of hospital acquired infection involve care of the physical plant, screening of personnel, care of equipment, use of septic
techniques, and use or reuse of defective supplies.
The hospital will be held liable for the injury caused infection if the patient can prove that it is caused by hospital
negligence:
1. Infection caused by equipment and faulty technique
2. Contact with infected patient
3. Negligence of personnel and staff
4. Hospital personnel may be the source of infection

Chapter XIV
LIABILITIES OF HOSPITAL FOR ITS ANCILLARY SERVICES
I. EMERGENCY ROOM
 RA 6615
o imposes hospital (government and private) to render immediate medical assistance to emergency
cases
o must have ER to comply with the obligation
 Consultants and resident staff under training and assigned permanently in the area to give them more
exposure and training in handling emergency cases
 Patient seek emergency services in ER may be discharge after institution of appropriate management or may
require admission.
 More complaints are filed against administrative management. Consequently there is now a trend for the
management to enter contractual relationship.
 The extent of the liability of the partnership or independent contractor depends on the terms of contract.
 Liability for negligence in the ER is shifted to the medical partnership
Two Aspects of Emergency Care

a. Examination of the patient to determine his condition and need for emergency medical procedures
 If care can be safely postponed until the patient can select his own attending physician, it is not a true
emergency case. On the other hand, if the patient needs only first aid which can be provided
appropriately by a nurse or other qualified paramedical personnel, then no medical emergency is
involved.
b. Performance of the specific medical or surgical procedure which are required without delay to protect the
patient’s health
 Both function must be done by one physician, however the second function may be performed by
another who possesses better qualifications for a particular procedure.
Malpractice liability in the emergency room may arise from the following:
1. Failure to Admit:
A patient whose feet were frozen was denied admission to the emergency room because he could not pay a
deposit. The condition was worsened by the delay in the institution of necessary treatment. The hospital was found
liable.
2. Failure to Examine and/or Treat:

Failure to examine a patient because of the belief that he is drunk and not suffering from any disease or
injury may be a ground for liability.
3. Negligence in the Application of Management Procedures:

Once a patient has been admitted in the emergency room, the ordinary rule of standard in care in diagnosis
and treatment customarily practiced mudt be utilized in the determination of liability.
Emergency Room Record:

It should have a proper identification data, a description of the sickness or injury and description of what was
done or prescribed, and should be signed by the proper individual who rendered the treatment or prescribed for the
patient.
Emergency Room and the Police:

V. No questioning must be done on the patient without the prior approval or consent of the attending physician.
VI. When being subjected to interrogation the police officer must inform the patient of his constitutional rights.
Sec. 12, Art. III, Philippine Constitution provides "Any person shall have the right to be informed of his right
to remain silent and to have competent and independent counsel of his own choice or if cannot afford the
service of counsel, he may be provided with one. These rights cannot be waived except in writing and in
present of the counsel."
- The privilege against self- incrimination has been limited to testimonial compulsion or incrimination by verbal
means and not physical evidence.
- If the result of the examination or test tends to prove commission of a crime, the physician will not incur any
liability if he reveals the result to the peace officer.
Press Reporter's Inquiry:

5. Release of information for public consumption is primarily the duty and responsibility of the head of the
hospital, however on account of his multifarious activities; he may designate a member of his staff to handle the
press relation in the hospital.
6. Although the rule on privilege communication is not applicable to criminal cases, release of information can only
be made upon consent expressed or implied by the patient.
The following are guidelines in the release of information to the newspaper reporters:
 Private patient - acknowledgment or admission, general condition and name of the attending physician.
 Emergency cases – name, age, address, occupation, sex, nature of the accidents, extent of the injuries, type of
wound and part of the body involved.
 Restrictive information – in cases of poisoning, intoxication, stabbing attempted suicide, or other similar
occurrence, no motive should be given. Medical information may be given only by physician in charge of the
case.
 Photographs – none should be taken of unconscious patients. Permission of the attending physician and of the
patient is required.
Compensation for Treating Unconscious Patient in the Emergency Room:

The law implied a promise to pay for emergency services rendered to an unconscious patient in a hospital.
II. AMBULANCE SERVICE
Ambulance – motor vehicle specially designed, equipped and used for the transportation of the sick, injured or
wounded persons operated by trained personnel for ambulance service.
Equipped with devices for the convenience of the patient. It must have facilities necessary to answer the demand of
an emergency, and competent personnel to handle foreseeable situations that may occur during the trip
American College of Surgeon Committee on Trauma in 1966 recommended the following minimum facilities.
1. Hinged half-ring lower extremity splint with web straps for ankle hitch
2. Two or more similar padded boards 3 feet in length and 3 inches wide, of material comparable to four-
plywood, for coaptation splinting of fracture of leg or thigh
3. Two or more padded 15 inch wood or cardboard splints for fractures of forearm
4. Short and long back boards with 2 inch webbing straps for extrication of victims with spine injuries
5. Oxygen tanks and masks of assorted sizes for administration of oxygen
6. Hand operated bag-mask resuscitation unit with adult, child and infant size mask (unit capable of being
attached to oxygen supply preferred)
7. Simple suction apparatus with catheter
8. Mouth-to-mouth, two-way resuscitation airways for adults and children
9. Oropharyngeal airways
10. Mouth gags made of three tongue blades taped together and padded
11. Universal dressing, approximately 10 inches by 36 inches packaged folded to 10 inches by 9 inches
12. Sterile gauze pads
13. 1, 2 and 3 inches adhesive tapes on cylinder
14. 6 inch by 5 yards soft roller type bandages
15. Triangular bandages
16. Safety pins, large size
17. Bandage shears
18. Several pillows
The person to accompany the patient during the transport must have previous training in the use of the equipments
and application of first aid.
The criminal liability of an ambulance driver is the same as an ordinary transport driver.
In some places there are statute or ordinance which give an ambulance the “right of way”.
III. HOSPITAL PHARMACY
A pharmacy or drugstore is a place or establishment where drugs, chemical products, active principles of drug,
pharmaceuticals, proprietary medicine of pharmaceutical specialties, devices and poison are sold at retail and where
medical, dental and veterinary prescriptions are compounded and dispensed. (Sec. 42, Rep. Act 5921, Pharmacy
Law).
Hospital pharmacy supplies to the various units of the pharmaceutical needs, filled up prescriptions, compound
drugs, and store in an appropriate way biological products to avoid deterioration or loss of potency.
The pharmacist must be duly licensed and registered in PRC. The management must exercise due care in the
selection in as much as it is vicariously liable for his negligence.
Pharmacist:
If the prescription made by the physician cannot be properly read or understood by the pharmacist, it is his duty to
verify first from the prescribing physician before dispensing it.
Ownership of the prescription:

The pharmacist must take possession of the prescription after delivery of the medicine. He has the absolute right to
retain it to become a part of his business record. The pharmacist has the right to consider it as his property of the
hospital or other entities who employ him. However if the patient insist for a copy, he may do so by providing him a
copy (Xerox or duplicate) except when it involves prohibited or regulated drugs.
If no medicine stated in the prescription has been delivered to purchaser, the pharmacist has no right to retain the
prescription.
Display of Certificate Required:

Sec. 28, RA 5921, Pharmacy Law – it shall be the duty of every pharmacist engaged in the practice of pharmacy
either on his own account or under employ of another, to display his certificate of registration in a prominent and
conspicuous place in pharmacy, drugstore, hospital pharmacy or drug establishment which he operates or in which
he is employed.
Responsibility for the Quality of Drugs:

Sec 29, RA 5921, Pharmacy Law – in cases of drugs, pharmaceuticals or poison sold in their original packings, the seal
of which has not been broken or tampered with, the liability that may arise because of their quality and purity, rest
upon the manufacturer or in his absence, upon the importer, the distributor, representative or dealer who has
responsible for their distribution or sale.
Filling and Refilling of Prescription:

Sec 30, RA 5921, Pharmacy Law – no prescription shall be filled or compounded except by a registered pharmacist in
the employ of the drugstore or pharmacy.
No prescription shall be refilled except upon order of the person so prescribing.
Label of Dispensed Medicine:
Sec 31, RA 5921, Pharmacy Law – upon every box, bottle, or other package containing medicine sold or dispensed by
a pharmacist based on prescription, there shall be pasted, affixed or imprinted a seal or label bearing among others,
the name and address of pharmacy; the names and quantities of the ingredients; required dosage thereof, its
expiration date if any; the name of the prescriber, date and the number of prescription; and the direction for its use.
Every prescription, which in its preparation contains any quantity of a drug which is habit-forming, or a derivative of
such drug, shall have in the label attached to the container the added statement “Warning – may be habit-forming.”
Every prescription for external use filled in the drugstore shall bear a red label showing black ink in the components
of such prescription and the words “ For external use only” at the bottom of the label.
Record Books for prescription:

Sec 32, RA 5921, Pharmacy Law – all prescription dispensed in the drugstore shall be recorded in the book kept for
the purpose indicating therein, among others, the name of the manufacturer, the original stock, lot and control
numbers of the main ingredients of the prescription, which book shall be open to inspection by the proper
authorities at any time of the day when the pharmacy is open to the public and must be preserved for a period of
not less than 2 years after the last entry in it has been made. All prescription shall be attached to said book
prescriptions and numbered consecutively and shall be preserved for the same length of time as the prescription
book.
Inhibition Against Use of Cipher or Unusual Terms in Prescriptions and Prescription Switching:
Sec 33, RA 5921, Pharmacy Law – no pharmacy shall compound or dispense prescription recipes or formulas in
which are written in ciphers, codes or secret keys or in which they are employed unusual names of drugs which
differ from the names ordinarily used for such drugs in standard pharmacopeias or formularies.
No pharmacist dispensing or compounding prescription shall substitute the drug or drugs called for in the
prescription with any other drug or substance or ingredient without prior consultation, and a written consent of the
person prescribing.
IV. MEDICAL RECORDS

Record – something that is set in writing or recorded for the purpose of preservation
Medical record
 The compilation of the pertinent facts of the patient’s life history, illness and treatment.
 Derived from many sources, coordinated into a document and available for various uses to serve the
patient, physician and institution.
Purpose for maintaining medical record:

Among private physicians:
1. To document the patient’s history, condition and treatment.
2. To aid in the continuity of care.
3. To provide a record of billing.
In the hospital, JCAH (Joint Commission on Accreditation of Hospitals):

1. Basis for planning patient’s care and continuity in the evaluation of patient’s condition and treatment.
2. Documentary evidence of the course of patient’s medical evaluation, treatment and charge in condition.
3. Documentary evidence of communication between the responsible practitioner and any other health
professional contributing to patient’s care.
4. Protection of legal interest.
5. For continuing education and research.
Why records maintained by private physicians and hospitals:

1. For convenience and necessity.
2. Required by statutes (Hospital Licensure Law).
Nature of the Law requiring maintenance of records:

1. Those that simply mandate maintenance of records that are accurate, complete and adequate.
2. Those that set forth broad categories of information.
3. Those that provide specific requirements.
What must be included in the physicians record:

1. Physicians office record
2. Hospital record (JCAH requirements)
What must not be included in the medical record:

1. Personal criticisms
2. Conclusions which may not be true
Proof of careful treatment

Example, questions of the patient’s informed consent may be resolved by showing to the court those
consent forms that he had signed indicating the necessary disclosure had been made to him.
Proof of negligent treatment

The patient usually base the complaint against a physician from the clinical record
Liability incurred on account of inaccurate or incomplete record

Example, liability was imposed on a hospital for an attending nurse’s failure to observe and record the
symptoms of eclampsia.
Destruction of records is an evidence of negligence
Alteration of information in the record

An altered record may create suspicious intent to establish a defense and such alteration may be a proof of
negligence.
It would be better to line out the incorrect data with a single line in ink or cross out the incorrect information
in such a way that it is till legible, write the correct information, and add the date and the explanation why such
information was changed.
Who owns the medical record?

- The hospital
- Physicians – maintained by them in their private offices
The records must always be considered confidential and no disclosure of information must be done without the
expressed consent of the patient or by anyone who could act on his behalf.
Advantages of “taking the medical records home by the patient”:

1. It increases the patient’s information and education.
2. Continuity of records as patient moves or changes physician.
3. An added criterion on which patient may base their selection of physicians.
4. Improvement in the doctor-patient relationship.
5. Added way for the physician to monitor quality of acre.
6. Increases responsiveness to the consumers needs.
Violation of the confidential nature of the record:

1. Sec.6, Art. II, Code of Medical Ethics
The medical practitioner should guard as a sacred trust anything that was communicated to him in his
professional relation with his patient, even after his death. He should never divulge this information, except
when it is required in the interest of justice, public health or safety.
2. Sec.33, Art. VI, Dangerous Drug Act of 1972 as amended – Violation of confidential nature of record
Imprisonment – ranging for 6 months and 1 day to 6 years
Fine – 600 – 6,000
Imposed to any person, who having official custody of, or access to the confidential records, or anyone
having gained possession of such record, whether lawfully or not, reveals their contents to any person other
than those charged with the prosecution of offence under this Act or with its implementation
Sec.21, Rule 130, Rules of Court – Privilege Communication

A person authorized to practice medicine, surgery or obstetrics cannot be examined in a civil case
without the consent of the patient.
When may the Content of the Record be Disclosed:

1. When requested by the patient or by someone who could act in his behalf which must be made in writing
RECORDS:
 Mandamus- appropriate remedy for refusal of the record custodian to disclose clinical record contents to
patient or his authorized representative
 Writ of mandamus- summary order issued from court of competent jurisdiction to command performance of
specific duty which relator is entitled to have performed
2. When the law requires the disclosure

 Birth certificate
 Death certificate
 Certificate of immunization
 Information regarding communicable diseases
3. Upon order of the court
Is the approval of the attending physician necessary?

- Attending physician has no legal right to determine who shall and who shall not see the record
- Approval or permission is sough as a matter of courtesy
Information for which NO AUTHORIZATION is needed

1. Name of physician and house officers associated with the treatment of a patient
2. Those that are not ordinarily related to the treatment
 Complete name of the patient
 Address of patient at time of admission
 Date of discharge, names of relatives and friends
 Number of times and date of visits of physicians
Use by Hospital Staff for Study & Research

- Residents, students, and attending medical staff may freely consult such records as pertain to their work
- When records use for research, it is not regarded as that of the individual patient’s record but as a report
involving the study of a disease or group of diseases

Furnishing Abstracts of the Record
- Lawyers & others having a legitimate interest on the record of a patient provided with an abstract of the
record upon presentation of the authorization of the patient or of anyone who can legally act on behalf of
the patient
- Hospital- has the right to withhold such data that ahs a reference to specific hospitalization unless expressly
authorized by the patient
Duplicate copy of Record

 When authorized by the patient or his legally authorized representative
 Duplicate record can only be used for the purpose stated in the request
 Evidentiary purpose in court- the judge may issue an order to produce the original and the duplicate copy for
comparison
Disclosure of Information for the Collection of Insurance and Other Claims

- Before releasing information check-up should be made with the accounting department to ascertain
whether the patient’s bill has been paid
- If with any balance arrange some form of security for payment
How long should medical records be retained?

- Depends on the reason for its retention
1. In the interest of medical science and good patient care, medical records should be retained for as long as
possible
2. At a minimum, records should be retained
o Competent adult- for the longest statute of limitations which may apply (usually 6 years)
o Incompetent adult- or becomes such before the 6 years have expired- until the patient recovers plus
the remaining statutory time or another time prescribed by statute for this specific circumstance
o Minor- until the patient reaches the age of majority plus the statutory period for malpractice actions
or another period prescribed by statute for this specific circumstance
3. If the physician finds that their facilities preclude the retention of records for any longer than the
recommended minimum periods, it is recommended that he notify the patient that his records will no longer
be retained and give the patient or the patient’s designee the copy of the record upon the payment of a
reasonable fee for postage and handling
4. Microfilm reproductions are as fully admissible in most courts as the original
Removal of Certain portion of the record

- Loss of a sheet or sheets may rise the inference that they are removed deliberately in order to supress
evidence
What should be done with the record if the hospital “close-shop or the physician dies?
- Does not alter the confidential nature of the medical records nor does it relieve the hospital or physician or
their estate of their liability for breach of professional duty
- Records cannot be transferred without the patient’s consent or direction
- Patient should be informed of the termination of the practice of physician or cessation of operation of the
hospital
- Patient’s record is admissible evidence even if the person who made the entry is dead or not available
Requisites for Admissibility of Business Entries

1. The entrant must be deceased or outside the Philippines or unable to testify
2. Entries must have been made by the entrant in his professional capacity or in the performance of his duty
3. Entries must have been made at or near the time of the transaction to which they refer
4. Entries must have been in the ordinary or regular course of business or duty
5. Entrant must have been in a position to know the facts therein stated
V. HOSPITAL SECURITY, PEACE AND ORDER

 A hospital as a service institution must maintain a favourable environment conductive to the patient’s
comfort, peace of mind and early recovery
 Reasonable restraint- applied to violent or boisterous patient or trespasser
Arrest without warrant- WHEN LAWFUL

1. When the person to be arrested has committed, actually committing or is about to commit an offense in his
presence
2. When an offense has in fact been committed and he has reasonable ground to believe that the person to be
arrested has committed it
3. When the person to arrested is a prisoner who has escaped from a penal establishment or place where he is
serving final judgment or temporarily confined while his case is pending or has escaped while being
transferred from one confinement to another
Method of Arrest Without Warrant

1. By peace officer
2. By private person

Chapter XIV
DAMAGES
Art.20, Civil Code

Every person who contrary to law, wilfully or negligently causes damages to another shall indemnify the
latter for the same.
Art. 2176, Civil Code
Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for
the damage done.
Damages – the pecuniary compensations that may be recovred for breach of some duty or the violation of some
duty or the violation of some right recognized by law.
Collateral Source Rule for Actual and Compensatory Damages:

 The injured plaintiff is personally insured for death and physical injury
 The employer may have continuously paid the salary during the period of incapacity
 The relatives should be supplied with the necessary financial, nursing, hosp., and med assistance
 The wrongdoer should not be allowed to benefit from the plaintiffs prudence in securing insurance or other
collateral aids.
Doctrine of Certainty of Damages:

 Damages must be certain both in its nature and in respect to the cause. Recovery must not be contingent or
speculative.
 The injured patient has the right to recover medical and hosp. Expenses from the wrongdoer.
Actual or Compensatory Damages:

Art.2199, civil code
Except as provided by law or by stipulation, one is entitled to an adequate compensation only for such
pecuniary loss suffered by him as he has duly proved.
Art. 2200,civil code
Indemnification for damages shall comprehend not only the value of loss suffered, but also that of the profit
which the obligee failed to obtain.
Kinds of Compensatory Damages According to Manresa:

1. Dano emergente – the loss aperson already suffered
2. Lucro cesante – failure to receive the benefit
Kinds Of Compensatory Damages Applied to Medical Malpractice Cases Acc to American Juris:
1. General Damages – the natural and normal course of events, can be expected to attend a given type of
injury
2. Special Damages – not anticipated by the defendants; they are natural but not necessarily a consequence of
the accident in question.
Compensatory Damages Applied to Medical Juris:

1. Death
 Art.2206, CC – the amount of damages for death caused by a crime or quasi – delict shall be at
least 3000 ph, even though there may have been mitigating circumstances.
 The minimum value of human life is 3000php added with:
a. The edefendant shall be liable for the loss of the earning capacity of the deceased, and the
indemnity shall be paid to the heirs of the latters.
b. If the deceased was obliged to give support acc to the provisions of article 291,
the recipient who is not a heir called to the decedents inheritance by the law of testate or
intestate succession may demand support from the person causing the death for a
period not exceeding 5 yrs.
c. The spouse legitimate and illegitimate descendants and ascendants of the
deceased may demand moral damages by reason of the death of the deceased.
2. Physical Disability
 An award for the permanent injury to a finger resulting to permanent loss of power of
extension and disability cause by the malpractice of a physician is justified.
3. Loss of Earning Capacity

 Included as special damage. The actual measure of this damage is the amount the patient
could have earned if it had not seen for the injury, less the amount that he is capable of
earning after injury.
 May be temporary or permanent. May be partial or complete.
4. Medical, Surgical, Hospital, and Related Expenses

 Can be proven in the court thru testimony or by receipts that the court can determine the
amount mathematically

5. Necessity of Hiring a Substitute or Helper
 A consequence of the wrongful act of the physician, the patient suffered injury which requires
assistance in the normal pursuit of life

6. Loss of Service or Support
7. In death Cases – Funeral Expenses

 Shall be in keeping with the social position of the deceased.
 Shall be in accordance with expressed wishes of the deceased
 Religious beliefs or affiliations shall determinefuneral rites.
8. Unusual Physical and mental consequences of the injury, aggravation of a pre-existing condition,
miscarriage, etc.
 Plaintiff has been suffering a previous disability or infirmity before the malpractice act was committed.
9. Shortening of life expectancy

 The effect of injury on the health and life span of the patient must be taken into consideration in
assessment of damages.
Moral Damages
Moral damages may be recovered in the following and analogous cases:
a) A criminal offense resulting in physical injuries
b) Quasi-delict causing physical injuries
Includes:
1. Physical Suffering
 Includes fright and shock at the time of the injury, pain during the treatment, fear of future incapacity,
and humiliation on account of disfigurement.
 Plaintiff can testify that he has suffered and continued to suffer physical and mental pain.
 Physician cannot testify to the nature of th plaintiff’s injury
 2 methods to determine how much damage must be assessed for pain and suffering:
 Per diem method – estimated value of pain per day times the number of days the victim suffer
 Golden rule method – call the judge to determine the how much the damage he wishes to receive
if he is th plaintiff in the law suit.
2. \Mental anguish
 Bodily pain infers mental anguish, a direct and natural consequence of the physical injury
3. Fright and moral shock
4. Besmirched reputation
 Cause social humiliation and may be considered a basis in the assessment of damages
Exemplary or Corrective Damages

 Imposed by way of example or correction for the public good, in addition to the moral, temperate,
liquidated or compensatory damages
 In criminal offenses, damage as part of the civil liabilities imposed when the crime was committed with
one or more aggravating circumstances
 In quasi-delict, damages granted if defendant acted with gross negligence
 In contracts and quasi-contracts, the court may award damages if the defendant acted in a woman,
fraudulent, reckless, oppressive or malevolent manner.
Other Forms of Damages:

1. Nominal Damages
 Right of the plaintiff has been violated or invaded by the defendant
 Trifling sum awarded to the plain tiff in an action where there is no substantial loss or injury to be
compensated
2. Liquidated Damages
 Those agreed upon by the parties to a contract, to be paid in case of breach
3. Temperate or moderate damages
 More than nominal but less than compensatory damages
The injured is obliged to minimize damages:

 The injured party is obliged to minimize as much as possible the damages suffered by him and is required to
take such steps as an ordinary prudent person would reasonably adopt for his own interest.
Doctrine of Avoidable Consequence

 Where one person caused personal injury to another
 Patient is required to exercise reasonable care to minimize or avoid damage but he is not required to act
Excessive or Inadequate Damages

 Excessive if the evidence is insufficient to support the amount awarded
 Points considered in the award of damages:
 Award in similar cases involving equally serious injuries
 Facts peculiar to the particular case
 Changing economic condition and the value of the peso
 The nature and extent of the plaintiff’s injuries
 Pecuniary loss sustained
Damages May Be Awarded To:

1. The patient who is the recipient of the injury on account of the wrongful act of the physician.
2. The husband may also recover damages if the wife was injured
3. Parents if the injured person is a minor.
Attorney’s fees:
 The civil code allows attorney’s fee to be part of damages.
 Attorney’s fee which has been agreed based on a certain percentage of the amount of the principal
obligation is neither illegal nor immoral and the same time is enforceable as the law between parties.
Compensation of attorneys – Agreement as to fees:

 Attorney shall be entitled to have and recover from his client no more than a reasonable compensation for
his services. No court shall be bound by the opinion of the attorneys as expert witnesses as to proper
compensation.
Trends in Malpractice
1. There is an increasing frequency of civil suits for damages field in the court.
2. There is a tendency for an increase in the amount of damages awarded by courts.

Chapter XVI
EMERGENCIES IN MEDICAL PRACTICE
Emergency-unforeseen combination of circumstances w/c calls for an immediate action.

It refers to a situation in w/c a patient has been suddenly or unexpectedly endangered to such an extent that
immediate action is needed to save life and limb or avoid permanent damages.
A PHYSICIAN MAY BE CONFRONTED WITH A CONDITION OF EMERGENCY IN THE FF INSTANCES:
1. The patient’s condition called for an emergency before the commencement or the management procedure
-service of physician is solicited when the patient’s condition is already serious and immediate treatment is
necessary
2. Unforeseen conditions, discovered during the application of a treatment procedure might require an
emergency treatment
-emergency exist when in the course of an operation for tubal pregnancy it turns out to be acase of acute
appendicitis, the surgeon is obliged by law to removed the diseased appendix without consent of the patient.
3. An accident may occur in the course of a diagnostic or treatment procedure w/c requires emergency treatment
-there is an emergency when the plaintiff’s esophagus was perforated during a diagnostic procedure of
gastroscopy, necessitating thoracotomy to repair the damage. The defendant was not liable.
4. Complications w/c require immediate attention may rise after a medical procedure has been applied
-arise after a surgical or medical intervention the patient suffers from a condition w/c could not have been
ascribed to the negligence of attending physician
A CONDITION OF EMERGENCY IS USUALLY AN EXCEPTION TO THE OBSERVANCE OF THE STANDARD ETHICAL

CONDUCTS:
1. A physician is free to choose whom he will serve
2.a physician should administer at least first aid treatment and then refer to the more qualified physician
3. A physician should never examine or treat a hospitalized patient of another w/out the latter’s knowledge(except
in emergency)
4.a physician should attend only to the patients immediate needs
5.if several physician involved, the first to arrive should be considered as physician in charge
6. The physician should treat the patient in the same manner and with the same delicacy as he would have wanted
*hospitals and physicians are obliged to extend medical assistance in emergency cases
(R.A 6615)
Sec.1-all government and private hospitals/clinics duly licensed to operate as such are hereby required to render
immediate medical assistance and provide facilities and medicine.
Sec2.expenses and losses of earnings incurred by a private hospital/clinic for medicines, facilities and services
beyond first aid extended to emergency cases as required
Sec.3-any hospital director, administrator ,oic ,or physician in the hospital, medical center ,who shall refuse or fail
without good cause to render appropriate assistance pursuant to the req. of sec1 shall be punished by
imprisonment of one month and one day to one year and one day and a fine of 300 -1000pesos w/out prejudice to
the provisions of R.A 2382 in the case of physician
ABANDONMENT OF PERSONS IN DANGER AND OF ONES OWN VICTIM

*Penalty of arresto mayor
1.anyone who shall fail to render assistance to any person whom she shall find in an uninhabited place wounded, in
danger, dying when he can render such assistance w/out detriment to himself
2.anyone who shall fail to render assistance to another whom he has accidentally wounded/injured
*Standard of care in emergencies*
-a physician cannot be held to the same conduct as one who had an opportunity to reflect, even though it later
appears that he made a wrong decision yet prudent at that time.
*Emergency operations w/out consent*
-generally, informed consent must be obtained but there are situations when immediate action is necessary to save
the life or preserve the health of the patient and getting consent is prejudicial to the patient, the physician can
legally proceed w/ his contemplated life-saving procedure.
*conditions to be satisfied in emergency operations w/out consent.
1. Injured person must be unconscious
2. Actual and apparent situation necessary to act before there is an opportunity to obtain consent
3. Surgeon in the exercise of his best judgment believes that the injured person will die unless an operation is
performed.
*Refusal to give consent during emergency*
1. Refusal of the patient
-patient is conscious and has the capacity to give consent but vehemently refuses to give consent
2. Refusal of the guardian
-patient is minor or not in legal capacity to give a lawful consent, then anyone on his behalf can give consent
3. Refusal followed by an emergency
-the condition of patient deteriorates and becomes unconscious, can the doctor justified in the proceeding
with the operation?
*Extension of operation in cases of emergency*

-if during an operation, an accident occurs, or a condition maybe discovered w/c requires immediate action, but w/c
is not covered by the consent, the surgeon is justified in extending the operation and be absolved of liability
-the surgeon is authorized to extend the operation to any condition discovered when it will redound to the welfare
of the patient. In the absence of a clearly specific prohibition on the part of the patient, the physician should be
privileged to perform such surgery w/in the operative field as is justified in the prevailing medical opinion
*Surgery cannot be extended if an emergency is not present*
-if during the application of an operative procedure a diseased condition was found w/c does not require immediate
attention, the surgeon has no right to extend the operation to such condition w/c may require elective surgery
*Who may attend to emergency cases?

1. Any person:
-in the absence of physician, any person may attend to an emergency if he thinks he is competent to help a
sick or injured.
2. Medical students and registered nurses:

-a medical student who have completed the first four years of medical courses, graduates of medicine and
registered nurses
3. Physicians
*The physician’s compensation for emergency medical or surgical services:
-a physician treats an injured or unconscious patient under the theory of implied consent of the patient in physician-
patient contractual relationship. It is implied by law on the basis of patients need. The law also implies an obligation
of the patient to pay the reasonable value of the emergency service. Inasmuch as there is no specified amount
agreed upon, the principle of quantum merit, shall be applied or the value of the service is dependent upon the
amount of medical services rendered.

Chapter XVII
Delegation of a physician’s duties
Oftentimes an attending physician cannot be in constant attendance or cannot exercise supervision over all details
of the management of a patient. He is then compelled to delegate certain parts of the management to the patient
to:
- Other members of the household
- A nurse
- To other persons
The future course of action depends on the report as to the symptoms, conditions, and progress of the treatment.
Ghost Surgery
Whenever a surgeon enters a contractual relationship with a patient to perform an operation he must completely
comply with it. He cannot delegate it to another surgeon without the consent of the patient. If for example the
surgeon who signed the contract was not able to perform the surgery or played only a minor role in the procedure,
it is called ghost surgery. The contracting surgeon is held liable.
Requisites for a Valid Delegation of a Physician’s Duties:

1. Such duty of the physician can validly be delegated:
However in the following instances, the physician’s duty to his patient CANNOT be delegated:
a. when such duty is the principal subject matter of the physician-patient contractual relationship
b. when the physician agreed to render strictly personal services to the patient.
c. When no one is with sufficient competency to perform such duty
d. when the patient expressly objects to the delegation of duty.
2. The person to whom such duty is delegated must be competent to perform such duty.
3. Proper instructions must be given to the person who will perform the delegated duty.
4. The patient consented expressly or impliedly such delegation of duty.
Liability for injuries in the negligent performance of the delegated duties:

The person performing the delegated duty cannot be held liable for any untoward or unexpected effects of
his act if he had complied with all the requirement of a delegated duty and has exercised care and diligence in such
execution.
However, the physician may be held liable if he was present when the negligent act occurred or otherwise in
a capacity to control the act of the person to whom the delegated duty is assigned.

Chapter XVIII
HUMAN TRANSPLANTATION
Kinds of Transplantations:
1. Heterotransplantation – Animal donor to human recipient
2. Homeotransplantation – Unrelated human donor to human recipient
3. Isotransplantation – Donor and recipient are twins
4. Autotransplantation – Patient is donor and recipient himself
Sources for Human to Human Transplantation

1. Transplantation from a living donor
2. Transplantation from a cadaver donor
Organ or
Tissue Transplantation
1. Autograft – one part of the body to another (e.g. skin graft from unburned to burned part)
2. Isograft – transplant between genetically identical persons (e.g. monozygote identical twins)
3. Allograft – transplant between non-identical members of the same species
4. Xenograft – transplant between different species
Basic Principles in Human Transplantation

1. Human body regards transplanted tissues as foreign bodies and rejects soon after transplantation
2. The greater the genetic difference, the more rapid and vigorous the rejection reaction becomes
3. Probability of success depends on type of tissue and rapidity of removal after cessation of circulation in the donor.
a. Cornea, skin, bone, and blood vessels – rejection is virtually non-existent; maybe transplanted several
hours later
b. Kidney, heart, lung, liver – rapid deterioration
Problems in Transplantation
1. Inadequacy of supply materials for transplantation
a. Refusal of potential donors on account of:
1. Customary beliefs that dead bodies must not be desecrated
2. Religious beliefs that dead bodies must be interred in the same condition as when they die
b. Growing demand is way ahead of the supply; and
c. Bodies can only be declared “unclaimed” after the laps of 48 hours; by that time most organs are not fit for
transplantation
2. Inadequacy of laws respecting tissue or organ donation in some countries – unresolved “moment of death”,
consent of minor, incompetent donor.
3. Limited number of trained surgeons and lack of sophisticated apparatus
Systems of Organ Availability from Sources:

1. Altruistic System – individuals relinquish organs without financial compensation
2. Commercial Market System – People sell their organs for a price. Organ transplantation after his death and
compensation goes to his heirs.
Advantage:
a. May produce more organs for transplantation and reduce need for organ removal from living donors
b. Raise success of organ transplant as doctors have a greater choice
Disadvantage:
a. Decrease the supply of free organs
b. Financially unable patients will be deprived of transplantation
c. Increase of inferior or diseased organs being sold for transplantation
Transplantation between Human Beings
1. Transplantation from a living donor
a. Consent of minor donors
A minor cannot give consent to be a donor for transplantation even if he has the full capacity to
discern or nearing the age of majority, especially if it will not benefit the minor.
b. Incompetent donors (e.g. Mentally retarded)
If the court permits and both will benefit, transplantation is allowed.
2. Transplantation from a cadaver donor

a. Any person during his lifetime and the organs are to be removed or detached after grantor’s death
b. After the death of the person, donation may be made by the nearest relative or guardian
Requirements for the Valid Authorization to Donate

1. It must be made in writing
2. It must specify the person or institution granted the authorization
3. It must specify an organ, part, or parts to be detached from the cadaver
4. It must state the specific use or uses to which the organ, part or parts are to be employed
5. It must be signed by the grantor and two disinterested witnesses
6. Copy of such authorization must be furnished the Secretary of Health; and
7. No organ or portion of the body of a person dying of a dangerous communicable disease can be donated
Determination of “Moment of Death”

 Important to determine the precise time of death to save the organs and not kill the patient
1. 1967 Rosoff and Schwab: 3 phase criteria in establishing brain death
a. No reflex, spontaneous breathing, or muscle activity
b. No clinical or electro-encephalographic response to noise or pinching
c. Repetition of test (a) and (b) after 24 or 48 hours.
2. 1967 Couch in the First International Congress of the Transplantation Society: Dead if one irreplaceable vital
organ has ceased irrevocably to function.
3. 1968 Ad hoc Committee Harvard
a. Unreceptivity and Unresponsiveness
b. No movement or breathing
c. No reflexesb- dilated and fixed pupils. Absence of blinking after irrigation of ice water to ear.
d. The flat EEG – great confirmatory value
Document of Death
a. Lack of responsiveness to internal and external environment
b. Absence of spontaneous breathing movements for 3 minutes in the absence of hypocarbia while breathing in
room air
c. No muscular movements with generalized flaccidity and no postural activity or shivering
d. Reflexes and Responses
1. Pupils fixed and dilated, no reaction to light
2. Corneal reflex absent
3. SupraOrbital or other pressure responses are absent (pain and decerebrate posturing)
4. Absence of snouting and sucking stimulation
5. No reflex response to upper airway stimulation
6. No reflex response to lower airway stimulation
7. No ocular response to ice water stimulation of the inner ear
8. No deep tendon reflexes
9. No superficial reflexes
10. No plantar response
e. Falling arterial pressure without support by drug or other means
f. Isoelectric electro-encephalogram (in absence of hypothermia, anesthesia, and drug intoxication); multiple
recording totaling 20 minutes.
g. A note detailing those observations should be made of irreversible coma.
Certification of Death
a. Criteria A – F should be present for at least 2 hours before death is certified
b. Death should be certified and recorded in the physicians chart by two physicians other than the physician of the
potential organ recipient.

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Chapter II

Licensure and Regulatory Laws

The Board of Medical Education

Professional Regulation Commission

Composition of the Professional Regulation Commission

MEDICAL JURISPRUDENCE IDCM MED2016 1

III. BOARD OF MEDICINE

Qualifications of those to be appointed members of the Board of Medicine:

Investigation against Board Members:

Sec 1, Art VII, Rules and Regulations----

Sec 2, Art. VII, Rules and Regulations---

Power, Functions and Responsibilities of the Board of Medicine;

a. To determine and prepare the contents of licensure examinations;

Admission to Practice of Medicine

Requirements in taking the Medical Board Examination

MEDICAL JURISPRUDENCE IDCM MED2016 4

Scope of the Examination

MEDICAL JURISPRUDENCE IDCM MED2016 5

Date and Place of the Examination

MEDICAL JURISPRUDENCE IDCM MED2016 6

Guidelines to be observed in the preparation of Questions:

MEDICAL JURISPRUDENCE IDCM MED2016 7

Close or Boardline cases:

When is as Examinee considered to have Passed the Examination:

 Holder of certificate of registration

Obligations imposed on a Physician:

2. Obligations imposed in the Administrative Oath

Issuance of the Certificate of Registration

MEDICAL JURISPRUDENCE IDCM MED2016 9

Medical Act of 1959

Acts constituting the practice of medicine

Medical Diagnosis – is the art of balancing probabilities.

Treatment – all steps taken to effect a cure of an injury or disease

Operation – is a surgical procedure with or without surgical instrument.

Major Surgery – consist of operation within or upon the ff cavities:

NOT considered a Practice of Medicine:

Faith Healing, healing by prayer or divine healing

Penalties for “illegal practice of medicine”

WHO ARE QUALIFIED TO PRACTICE MEDICINE:

**Only NATURAL persons can practice medicine

CLASSIFICATION OF MEDICAL PRACTICES

*Medical Service Plan – form of agreement or arrangement of prepaid medical care

Other Requirements to Practice medicine

Meaning of the Term “PHYSICIAN”

MEDICAL JURISPRUDENCE IDCM MED2016 13

What is the relationship between a physician and a patient?

Why is the relationship between a physician and a patient contractual?

Nature of the Relationship

Nature of the Relationship

Who are the parties involved?

Essential Requisites of a Contractual Relationship

OBJECT OR SUBJECT MATTER

MEDICAL JURISPRUDENCE IDCM MED2016 14

INSTANCES W/OUT PHYSICIAN-PATIENT RELATIONSHIP

Psychological patterns of physician-patient relationship

MUTUAL PARTICIPATION RELATION

Duties and Obligations Imposed on the Physician

Expectations from a general practitioner

Source of medical knowledge and skill:

3. He is obliged to exercise the best judgment

4. He has the duty to observe utmost good faith

Commencement of the Physician-Patient Relationship:

Termination of the Patient Physician Relationship