HOSPITAL LIABILITIES

DEFINITION
HOSPITAL
An institution maintained for the reception, care and treatment of those in need of medical and surgical attention.

CLASSIFICATIONS OF HOSPITAL
As to the Scope of Infirmities Admitted: General Hospital
Concerned with admission and treatment of a substantial range of diseases or injuries.

Specialized Hospital
Established to admit specific illness, treatments, organ affected or for a class of people.

CLASSIFICATIONS OF HOSPITAL
Functional Classification: Diagnostic Hospital
A hospital devoted solely to the diagnosis of disease, injury, deformity, or physical and mental conditions. It may be provided with x-ray and laboratory facilities for diagnostic purposes.

Surgical hospital
A hospital where operative procedures are employed as a mode of treatment.

CLASSIFICATIONS OF HOSPITAL
Functional Classification: Maternity hospital
A hospital established for the reception, care and treatment of expectant mothers and care of the newly-born infants.

Rehabilitation hospital
A hospital established to enhance return of a disabled to his usual activities and adapts his condition to a specific environment.

CLASSIFICATIONS OF HOSPITAL
Functional Classification: Cosmetic hospital
A hospital for the improvement of the physical or aesthetic condition either by surgery of by physical means.

CLASSIFICATIONS OF HOSPITAL
As to Control and Financial Support: Public or government hospital
a hospital operated and maintained either partially or wholly by the national, provincial, municipal, or city government or other political subdivision, or by any department, division, board or other agency thereof.

CLASSIFICATIONS OF HOSPITAL
As to Control and Financial Support: Private hospital
One which is privately owned, especially established and operated with funds raised or contributed through donations, or private capital or other means, by private individuals, associations, corporation, religious organization, firm, company or joint stock association.

CLASSIFICATIONS OF HOSPITAL
Classification Based on the Size or Bed Capacity: Determined By the Hospital Licensure Act. For the purpose of determining the quantity and quality of facilities. Including the staff and other personnel of a hospital services. Minimum standard requirements for a hospital of 25, 50, 100 and 450 bed capacity hospitals.

CLASSIFICATIONS OF HOSPITAL
Classification of a Hospital as to Whether it is Training or Not: Hospital s primary duty of reception, care and treatment of patients Some hospitals are utilized for medical and paramedical education. Undergrad students are given training as a part of their curriculum. Others may pursue further development of skill and proficiency in the post-graduate level.

CLASSIFICATIONS OF HOSPITAL
A Hospital Cannot Practice Medicine: The hospital merely agrees to care for the patient by furnishing him with accommodations and attendants including nurses and interns.

CLASSIFICATIONS OF HOSPITAL
Reasons Why a Hospital Cannot Practice Medicine: The practice of medicine by a hospital for profit through employment of licensed physicians is not in the interest of public safety, health and welfare and therefore contrary to public policy. The capacity of a hospital to practice medicine cannot be subjected to government examinations to determine whether it is qualified to diagnose, treat or employ any form of treatment.

CLASSIFICATIONS OF HOSPITAL
Reasons Why a Hospital Cannot Practice Medicine: 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.

CLASSIFICATIONS OF HOSPITAL
Duties of the Governing Board of a Hospital: To determine the policies of the hospital in relation to the community needs; To see to it that the proper professional standards are maintained in the care of the sick;

CLASSIFICATIONS OF HOSPITAL
Duties of the Governing Board of a Hospital: To coordinate the professional interest of the hospital with the administrative, financial and community needs; To direct the administrative personnel in order to carry out the policies; and To provide adequate financing to secure sufficient income and to assure business-like control of expenditures.

REGULATION OF HOSPITALS
The Bureau of Medical Services (Bureau of Health and Medical Services) as a licensing agency and subject to the approval of the Secretary of Health, shall promulgate rules and regulations to implement the provisions of this Act (RA 4226 or Hospital Licensure Act).

RULES AND REGULATION IN A HOSPITAL

The State Regulation of a hospital
Applicable to all hospital and embodied in the Licensure Act together with its implementing rules and regulations for its enforcement.

Self Regulation of a Hospital

Regulation promulgated and enforced only within a hospital for purposes of discipline, order, convenience, and for other reasons, the governing board may so desire.

DUTIES OF A HOSPITAL
To furnish a safe and well maintained building and ground To furnish adequate and safe equipments To exercise reasonable care in the selection of the members of the hospital staff

LIABILITY OF GOVERNMENT HOSPITALS

A state cannot be sued except when it consents. The immunity of the government from the official acts of its officers, agents and employees is based on the old English maxim that The king could do no wrong Following the doctrine of the immunity of the state from suit, a public or government hospital cannot be sued inasmuch as it is owned and controlled by the government

LIABILITY OF PRIVATE CHARITABLE HOSPITALS

Charitable Hospital
Is established and maintained from donations, contributions, philanthropic acts and pays no dividend, has no capital stock, seek no profit, and render hospital services gratuitously

LIABILITY OF PRIVATE CHARITABLE HOSPITALS

The test of a charitable hospital: It is not the extent of the services rendered Nor whether the patient pays more or less than the cost of the services But whether those who operates it are doing so for private profit, directly or indirectly. To determine whether a hospital was established for charity is the articles of incorporation and the constitution and by-laws of the corporation which established the hospital

DOCTRINES OR THEORIES APPLIED TO CHARITABLE HOSPITAL

Trust Fund Doctrine: Voluntary non-profit or charitable hospitals derive support from voluntarily contributions or donations The contributors specifically mention that the purpose of the money collected is for the reception, care and treatment of charity patients. The contributions are only held in trust by the governing body of the hospital. Diverting the trust fund for the payment of damage will be utilizing the money not intended by the donor. If the endowment, contribution or donation is solely for the charity patients, then there will be no fund available for the payment of damages.

DOCTRINES OR THEORIES APPLIED TO CHARITABLE HOSPITAL

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.

DOCTRINES OR THEORIES APPLIED TO CHARITABLE HOSPITAL

Public Policy Theory: A private hospital for charity performs a quasi-public function. It renders service to the indigent patients without remuneration. It is undertaking the obligation imposed upon the state for the preservation of life and maintenance of health of the people. 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 also.

DOCTRINES OR THEORIES APPLIED TO CHARITABLE HOSPITAL

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 if the attending physician committed a wrongful act, he himself must be held liable and not the hospital.

LIABILITIES OF A PRIVATE HOSPITAL FOR PROFIT

A private hospital for profit may be held vicariously liable for the negligent act of its employees. All other principles to determine the liability of physicians may be applied to private hospitals operating for profit

LIABILITIES OF A HOSPITAL
Corporate Liabilities: Arises 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.

LIABILITIES OF A HOSPITAL
Corporate Liabilities: Failure to furnish safe and well maintained buildings and ground Failure to furnish safe and reliable equipment includes:
a) b) c) d) e) f) Heater Defective bed Sideboard Wheel chair Electric appliance Defective instrument

Failure to make careful selection, review, and supervision of independent physicians who are permitted to practice in the hospital

LIABILITIES OF A HOSPITAL
Nursing staff:
Duties and Responsibilities of a Nurse (R.A. 877 as amended by RA 4704 and further amended by RA 6136)

LIABILITIES OF A HOSPITAL
Kinds of Nurses: STUDENT NURSE
Not an employee of the hospital

PROFESSIONAL NURSE
A licensed nurse in the service of a hospital is an employee of the hospital. She may, however, be a borrowed servant of a physician when her activities are under his control. The doctrine of vicarious liability may be applied for the negligent act which caused injury to the patient

LIABILITIES OF A HOSPITAL
Kinds of Nurses: SPECIAL DUTY NURSE
A special duty nurse or private nurse is one who exercises independent calling subject to the control of no one in her work and who contracts to work according to her own judgment. A special duty nurse is an independent contractor. For any wrong act committed by her, she herself must be held liable.

LIABILITIES OF A HOSPITAL
Hospital liability for inadequate nursing services:
A hospital is not only required to have qualified and reliable nurses but also sufficient in number to maintain adequate services to the patient.

LIABILITIES OF A HOSPITAL
Medical Staff: INTERNS
After completion of clinical clerkship, internship in any of the hospitals approved by the Board of Medical Education, is required before a person may be qualified to take the final board examination. The Board of Medical Education is empowered to certify the hospitals which have complied with the minimum physical requirements for the admission of interns. The quantity and quality of facilities will determine the number of interns who may be allowed to undergo clinical training in a hospital.

LIABILITIES OF A HOSPITAL
Medical Staff: RESIDENT PHYSICIANS
Unlike interns, they are medical graduates and duly authorized to practice medicine.

CONSULTANTS
Ethically, it is the duty of the attending physician to solicit the services of another physician when he encounters difficulty in diagnosing and treating a case.

ADMISSION AND EMERGENCY CASES

A hospital must have an admitting department or section. Aplace 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 is defined by the governing board of the hospital.

ADMISSION AND EMERGENCY CASES

A person has no absolute right to be admitted in a hospital or to avail of hospital services. The discretion to admit is vested on the management or governing board. The relationship between 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.

ADMISSION AND EMERGENCY CASES

A government hospital has no absolute privilege of choice of patients inasmuch as it is established and maintained by public funds. Must open its door to all who seek its services and facilities and must be made available to all medical practitioners and patients. This is, however, limited by the facilities of the hospital, number of beds available, and the capacity of the technical staff to institute treatment procedures with competence.

ADMISSION AND EMERGENCY CASES

A private hospital is given more power to choose the physicians and patients it wants to serve. The management usually adopts certain guidelines to be the bases of admission of patients. The only limitation is that it must not be oppressive, discriminatory, illegal, or contrary to public policy.

ADMISSION AND EMERGENCY CASES

Some of the justifiable grounds to refuse admission of patients: In order for the patient to be able to collect damages from the hospital it must be shown that his non-admission is the proximate cause of any aggravation of his condition.

ADMISSION AND EMERGENCY CASES

A hospital affiliated to a medical school may have special beds for indigent patients and may vary the cases to be admitted for purposes of instruction. Patients who seek admission in those special beds impliedly waive their rights to privacy of confidential communications.

ADMISSION AND EMERGENCY CASES

The reservation of a room or a bed in a hospital does not constitute a contract between the hospital and the patient in a way that if the patient needs the room or bed, the hospital can be compelled to furnish him immediately. The order in the reservation must be observed without prejudice to the specific room or bed being reserved. But, if the room or bed is available, the hospital has no right, based on the order of priority, to arbitrarily refuse admission of the patient after the reservation has been accepted.

ADMISSION AND EMERGENCY CASES

Attendance to Emergency Cases in Hospitals: 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. Therefore, all hospitals covered by the provisions of the R.A. 4226 shall henceforth take steps to insure that immediate attention and proper treatment are given to all emergency cases.

ADMISSION AND EMERGENCY CASES

Attendance to Emergency Cases in Hospitals: For the treatment of a particular emergency case, first-aid treatment shall be resorted to and the patient shall thereafter be transferred to another hospital with necessary facilities as soon as the condition of the patient permits. An emergency case as used in this Order means a patient whose delay in treatment may cause loss of life or limb or permanent residual damage. If an emergency patient has been given the necessary immediate care and the threat to life and serious injury have simmered down, a private hospital is not obliged to admit a patient if he cannot pay the required deposit.

TRANSFER AND DISCHARGE 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 be 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.

TRANSFER AND DISCHARGE OF PATIENTS

The moment the patient is admitted in a hospital, there exists a contractual obligation for the hospital to let the patient avail of the services of the hospital until such time when the service is no longer necessary. If the patient is not in a position to pay the necessary bill, the hospital is not prevented from utilizing the court of law for the recovery of the hospital bill.

TRANSFER AND 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

TRANSFER AND DISCHARGE OF PATIENTS

A patient who s been given emergency treatment may be transferred to another hospital which has facilities to treat injury or disease suffered by the patient upon the request of the patient or relatives. The physician attending to such emergency may allow such transfer, if in his evaluation, it will not endanger the life of the patient.

TRANSFER AND DISCHARGE OF PATIENTS

Discharge of patient in need of further hospitalization is unreasonable. When a hospital undertakes to treat a person, it must not act unreasonably in removing that person from the premises. 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 PATIENT TO LEAVE THE HOSPITAL

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 criminal detention (Art. 268, Revised Penal Code)

REFUSAL OF PATIENT TO LEAVE THE HOSPITAL

Preventing the patient from leaving the hospital means detaining him or in any other manner, depriving him of his liberty It is a violation of Sec. 6, Art. III of 1987 Philippine Constitution which guarantees that The liberty of abode and of changing the same within the limits prescribed by law shall not be impaired except upon lawful order of the court. Neither shall the right to travel be impaired except in the interest of national security, public safety, or public health, as may be provided by law.

REFUSAL OF PATIENT TO LEAVE THE HOSPITAL

If the patient in spite 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: That he vehemently wanted to leave the hospital (whether or not he stated the reason for his desire) That he was advised of the probable danger to his life or impairment to his health if ever he does, in a clear, adequate and understandable language That in spite of the explanation of potential danger (immediate or remote) to him, he would still leave the hospital 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 PATIENT TO LEAVE THE HOSPITAL

If the patient refuses to sign the release form, then it is recommended that the form be presented to the patient in the presence of competent witnesses. The statement Patient refused to sign may be written on the release form, signed by the person who presented it and also by the witnesses. In some instances, the patient refuses to leave the hospital in spite of the order for his discharge. He may do so in a private hospital provided the corresponding hospital bill is properly satisfied and with the consent of the attending physician. However, this will create a problem in the charity wards of government hospitals.

REFUSAL OF PATIENT TO LEAVE THE HOSPITAL

A patient may have fully recovered from his ailment or a newly born child has long been on overdue stay in the nursery or has been abandoned by the parents with unknown address or has given a wrong address. Medical and humanitarian reasons make it necessary to discharge other patients who do not need further hospitalization. Patients with known addresses may be sent home through the social service department of the hospital. Infants and abandoned children may be referred to the DSWD for custody, care and placement.

REFUSAL OF PATIENT TO LEAVE THE HOSPITAL

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 nonpayment 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 filing the necessary suit in court for the recovery of such fee or bill.

REFUSAL OF PATIENT TO LEAVE THE HOSPITAL

If a patient is prevented from leaving the hospital for his inability to pay the bill, any person who can act on his behalf can apply in court for the issuance of the writ of habeas corpus. The writ of habeas corpus shall extend to all cases of illegal confinement or detention by which any person is deprived of his liberty, or by which the rightful custody is withheld from the person entitled thereto

REFUSAL OF PATIENT TO LEAVE THE HOSPITAL

However, the hospital may legally detain a patient against his will when he is a 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.

HOSPITAL LIABILITY FOR 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 aseptic techniques, and use or reuse of defective supplies.

HOSPITAL LIABILITY FOR INFECTION

The risk of infection is common and there is no duty for the hospital to warn the patient, but the hospital will be held liable for the injury caused by the infection if the patient can prove that it is caused by hospital negligence.
Infection caused by equipment and faulty technique Contact with infected patient Negligence of personnel and staff Hospital personnel may be the source of infection