MEDICAL JURISPRUDENCE: LIABILITIES OF HOSPITALS

Atty. A. F. Daguplo, RMT, MD

Transcribed by: KC

HOSPITAL 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.

Any institution, building or place where there are installed beds,

cribs, or bassinets for twenty four hour use or longer by patients in the
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.

A health facility for the diagnosis, treatment and other forms of

health care of individuals suffering from deformity, disease illness or
injury, or in need of surgical, obstetrical, medical or nursing care. It is an
institution where there are installed bassinets or beds for 24-hour use
or longer by patients in the management of deformities, diseases,
injuries, abnormal physical and mental conditions and maternal cases.
*A hospital is primarily a service institution whose concern is to serve the
patients, the doctors and the public.
Classification:

A.

Scope of Infirmities Admitted:

The hospital merely agrees to care for the patient by furnishing

him with accommodations and attendants including nurses and interns.

..The hospitals obligation is limited to providing the patient

with the preferred room accommodation, the nutritional diet and
medications prescribed by the doctor, the equipment and facilities
necessary for the treatment of the patient, as well as the services of the
hospital staff who perform the ministerial tasks of ensuring that the
doctors orders are carried out strictly.
Reasons why hospital cannot practice medicine

1. Not in the interest of public safety, health and welfare and therefore
contrary to public policy. (hospital for profit)

2. Cannot be subjected by the government examinations to determine if it

is qualified to diagnose, treat or employ any form of treatment

3. Doctors job shall be rendered ministerial

Regulation of Hospitals

1. State Regulation for the interest of public health, safety and welfare
2. Self Regulation internal rules and regulations
Primary duties of a hospital

1. General Hospital
2. Specialized Hospital

B.Functional Classification:
1. Diagnostic hospital
2. Maternity Hospital
3. Rehabilitation Hospital
4. Surgical Hospital
5. Cosmetic Hospital
C. Control and Financial Support
1. Public or Government Hospital
2. Private Hospital
a. Private charitable or eleemosynary hospital
b. Private pay hospital
D.
Size or Bed Capacity
E. Training or not
Hospital cannot practice medicine
Practice of medicine

A privilege or franchise granted by the state to any person to

perform medical acts upon compliance with law.

Judging the nature, character and symptoms of a disease, in

determining the proper remedy to the disease (Fowler v. Norways
Sanitarium, 142 Ind. App. 347,42 NE 92d) 415 1942).

Diagnosis and application and the use of medicine and drugs for
curing, mitigating or relieving bodily disease or conditions (People v.
Mattie, 381 Ill., 21, 44 NE (2d) 756 1942).
Acts Constituting Practice of Medicine
Any person shall be considered as engaged in the practice of medicine

a. who shall, for compensation, fee salary or reward in any form paid to

him directly or through another, or even without the same, physically

examine any person, and diagnose, treat, operate or prescribe any
remedy for human disease, injury, deformity, physical, mental, psychical
condition or any ailment, real or imaginary, regardless of the remedy or
treatment administered, prescribed or recommended; or

b. who shall by means of signs, cards, advertisements, written or printed

matter, or through the radio, television or any other means of

communication, either offer or undertake by any method, diagnose,
treat, operate, or prescribe any remedy for any human disease, injury,
deformity, physical, mental or psychical condition; or

c. who shall falsely use the title of M.D. after his name.

(Section 10 Medical Act of 1959)

1. to furnish safe and well maintained building and ground;

2. to provide adequate and safe equipments; and
3. to exercise reasonable care in the selection of the members

of the

hospital staff

Persons Coming within the hospital premises:

1. Trespasser hospital has no obligation

2. Licensee hospital is obliged to protect

them from willful and

intentional injury

3. Invitee should provide safe condition and must give warning for any
danger.
Liabilities of Hospitals for the wrongful acts of their agents or employees

1. Government or Public Hospitals - there can be no legal right against the

authority that makes the law on which the right depends.

2. Private charitable, voluntary or eleemosynary hospitals

a. Trust fund doctrine
b. Implied waiver theory
c. Public policy (service) theory
d. Independent contractor theory
e. Doctrine of charitable immunity."
f. "Borrowed servant" and "captain of the ship.
3. Private hospitals operating for profit
a. Administrative vs. Professional duties
1. administrative or ministerial duties
2. professional or medical duties
b. Principle of Control
c. Contract of Service vs. Contract for Services
d. Independent Contractor Theory
e. Sole Responsibility vs. shared Responsibility
Liabilities of a Hospital:

1. Corporate liabilities
a. failure to furnish safe and well maintained buildings and grounds;
b. Failure to furnish safe and reliable equipments;
c. Failure to make careful selections, review and supervision of
independent physicians

2. Vicarious liabilities
a. Nursing staff

1. Student Nurse
2. Professional Nurse
3. Special Duty Nurse
b. Medical Staff
1. Interns
2. Resident Physicians
3. Consultants
ADMISSION

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.

1. all accommodations are filled

2. patient is chronically ill
3. only convalescent care
4. no available accommodation for the clinical service
5. contagious nature of the illness

Emergency Cases

REPUBLIC ACT NO. 6615 - AN ACT REQUIRING GOVERNMENT AND

PRIVATE HOSPITALS AND CLINICS TO EXTEND MEDICAL ASSISTANCE IN
EMERGENCY CASES

SECTION 1. All government and private hospitals or clinic duly

licensed to operate as such are hereby required to render immediate
emergency medical assistance and to provide facilities and medicine
within its capabilities to patients in emergency cases who are in danger
of dying and/or who may have suffered serious physical injuries.

SECTION 3. Any hospital director, administrator, officer-in-charge

or physician in the hospital, medical center or clinic, who shall refuse or
fail without good cause to render the appropriate assistance pursuant
to the requirements of section one after said case had been brought to
his attention, or any nurse, midwife or medical attendant who shall
refuse to extend the appropriate assistance, subject to existing rules, or
neglect to notify or call a physician shall be punished by imprisonment
of one month and one day to one year and one day, and a fine of three
hundred pesos to one thousand pesos, .

In the case of Government hospitals, the imposition of the penalty

upon the person or persons guilty of the violations shall be without
prejudice to the administrative action that might be proper.

In the case of private hospitals, aside from the imposition of

penalty upon the person or persons guilty of the violations, the license
of the hospital to operate shall, whenever justified, be suspended or
revoked.
Republic Act No. 8344
AN ACT PENALIZING THE REFUSAL OF HOSPITALS AND MEDICAL CLINICS TO
ADMINISTER APPROPRIATE INITIAL MEDICAL TREATMENT AND SUPPORT IN
EMERGENCY OR SERIOUS CASES

"(a) 'Emergency' - a condition or state of a patient wherein based

on the objective findings of a prudent medical officer on duty for the
day there is immediate danger and where delay in initial support and
treatment may cause loss of life or cause permanent disability to the
patient.

"(b) 'Serious case' - refers to a condition of a patient characterized

by gravity or danger wherein based on the objective findings of a
prudent medical officer on duty for the day when left unattended to ,
may cause loss of life or cause permanent disability to the patient.

"(c) 'Confinement' - a state of being admitted in a hospital or

medical clinic for medical observation, diagnosis, testing, and treatment
consistent with the capability and available facilities of the hospital or
clinic.

"SECTION 1. In emergency or serious cases, it shall be unlawful

for any proprietor, president, director, manager or any other officer,
and/or medical practitioner or employee or a hospital or medical clinic
to request, solicit, demand or accept any deposit or any other form of
advance payment as a prerequisite for confinement or medical
treatment of a patient in such hospital or medical clinic or to refuse to

administer medical treatment and support as dictated by good practice

of medicine to prevent death or permanent disability: Provided, That by
reason of inadequacy of the medical capabilities of the hospital or
medical clinic, the attending physician may transfer the patient to a
facility where the appropriate care can be given, after the patient or his
next of kin consents to said transfer and after the receiving hospital or
medical clinic agrees to the transfer: Provided, however, That when the
patient is unconscious, incapable of giving consent and/or
unaccompanied, the physician can transfer the patient even without his
consent: Provided, further, That such transfer shall be done only after
necessary emergency treatment and support have been administered
to stabilize the patient and after it has been established that such
transfer entails less risks than the patient's continued confinement:
Provided, furthermore, That no hospital or clinic, after being informed
of the medical indications for such transfer, shall refuse to receive the
patient nor demand from the patient or his next of kin any deposit or
advance payment: Provided, finally, That strict compliance with the
foregoing procedure or transfer shall not be construed as a refusal
made punishable by this Act.
Transfer of Patients:

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.

Desire and consent of patient

Discharge of Patient:

Hospital undertakes to treat a person, it must not act

unreasonably in removing that person from the premises
Refusal of Patient to be Hospitalized

1. That he vehemently wanted to leave the hospital

2. He was advised in a clear, adequate and understandable language
3. Despite of the explanation he still insist on leaving the hospital
4. He holds the hospital or any member of its staff free of any liability
Refusal of the Patient to Leave the Hospital:
Manila Doctors Hospital v. So Un Chua and Vicky Ty
G.R. No. 150355 (July 31, 2006)

Authorities, including those of common law origin, explicitly

declare that a patient cannot be detained in a hospital for non-payment
of the hospital bill.
Exceptions:

a detained or convicted prisoner

when the patient is suffering from a very contagious disease

where his release will be prejudicial to public health

when the patient is mentally ill such that his release will endanger
public safety

in other exigent cases as may be provided by law.

Premature Discharge:
Detention of Patient for Non-Payment of Bill:
REPUBLIC ACT NO. 9439

SECTION 1. It shall be unlawful for any hospital or medical Clinic in

the country to detain or to otherwise cause, directly or indirectly, the
detention of patients who have fully or partially recovered or have been
adequately attended to or who may have died, for reasons of
nonpayment in part or in full of hospital bills or medical expenses.

SEC. 2. Patients who have fully or partially recovered and who

already wish to leave the hospital or medical clinic but are financially
incapable to settle, in part or in full, their hospitalization expenses,
including professional fees and medicines, shall be allowed to leave the
hospital or medical clinic, with a right to demand the issuance of the
corresponding medical certificate and other pertinent papers required
for the release of the patient from the hospital or medical clinic upon
the execution of a promissory note covering the unpaid obligation. The
promissory note shall be secured by either a mortgage or by a
guarantee of a co-maker, who will be jointly and severally liable with the

patient for the unpaid obligation. In the case of a deceased patient, the
corresponding death certificate and other documents required for
interment and other purposes shall be released to any of his surviving
relatives requesting for the same: Provided, however, that patients who
stayed in private rooms shall not be covered by this Act.

Private Room a single occupancy room or a ward type room

divided by either a permanent or semi-permanent partition (except
curtains) not to exceed 4 patients per room who are admitted for
diagnosis, treatment and other forms of health care maintenance.

SEC. 3 Any officer or employee of the hospital or medical clinic

responsible for releasing patients, who violates the provisions of this
Act shall be punished by a fine of not less than Twenty thousand pesos
(P20, 000.00), but not more than Fifty thousand pesos (P50, 000.00), or
imprisonment of not less than one month, but not more than six
months, or both such fine and imprisonment, at the discretion of the
proper court.
Elements of Detention:

a) The

patient who is partially or fully recovered has expressed his/her

intention to leave the hospital or medical clinic, or the attending
physician has issued a discharge order;

b)

The patient is not confined in a private room and is financially

incapable to settle in part or in full the corresponding hospital bills or
medical expenses/hospitalization expenses;

c) Patient has executed a promissory note covering the unpaid hospital

bills or medical expenses/hospitalization expenses; and

d)

The officer or employee of the hospital or medical clinic

responsible for releasing the patient has restrained him from leaving
the hospital premises.

In case of Deceased patient, detention occurs: When

a) The medical officer has made the pronouncement of death;

b)
Any of the surviving relatives is incapable to

pay the
corresponding hospital bills or medical expenses/hospitalization
expenses;

c) Any of the surviving relatives has executed a promissory note covering

the unpaid hospital bills or medical expenses/hospitalization expenses;

and

d)

The officer or employee of the hospital or medical clinic

responsible for releasing the deceased patient has refused to release
the cadaver and/or relative documents.

RAMOS et. al., vs. COURT OF APPEALS (G.R. No. 124354 December 29,
1999)
In the first place, hospitals exercise significant control in the hiring and firing
of consultants and in the conduct of their work within the hospital premises.
Doctors who apply for "consultant" slots, visiting or attending, are required to
submit proof of completion of residency, their educational qualifications;
generally, evidence of accreditation by the appropriate board (diplomate),
evidence of fellowship in most cases, and references. These requirements are
carefully scrutinized by members of the hospital administration or by a
review committee set up by the hospital who either accept or reject the
application. 75 This is particularly true with respondent hospital.
After a physician is accepted, either as a visiting or attending consultant, he is
normally required to attend clinico-pathological conferences, conduct
bedside rounds for clerks, interns and residents, moderate grand rounds and
patient audits and perform other tasks and responsibilities, for the privilege
of being able to maintain a clinic in the hospital, and/or for the privilege of
admitting patients into the hospital. In addition to these, the physician's
performance as a specialist is generally evaluated by a peer review
committee on the basis of mortality and morbidity statistics, and feedback
from patients, nurses, interns and residents. A consultant remiss in his duties,
or a consultant who regularly falls short of the minimum standards
acceptable to the hospital or its peer review committee, is normally politely
terminated.
In other words, private hospitals hire fire and exercise real control over their
attending and visiting "consultant" staff. While "consultants" are not,
technically employees, a point which respondent hospital asserts in denying

all responsibility for the patient's condition, the control exercised, the hiring,
and the right to terminate consultants all fulfills the important hallmarks of
an employer-employee relationship, with the exception of the payment of
wages. In assessing whether such a relationship in fact exists, the control test
is determining.
RAMOS et. al vs. COURT OF APPEALS, [G.R. No. 124354. April 11, 2002]
DLSMC maintains that first, a hospital does not hire or engage the services of
a consultant, but rather, accredits the latter and grants him or her the
privilege of maintaining a clinic and/or admitting patients in the hospital
upon a showing by the consultant that he or she possesses the necessary
qualifications, such as accreditation by the appropriate board (diplomate),
evidence of fellowship and references. Second, it is not the hospital but the
patient who pays the consultants fee for services rendered by the latter.
Third, a hospital does not dismiss a consultant; instead, the latter may lose
his or her accreditation or privileges granted by the hospital. Lastly, DLSMC
argues that when a doctor refers a patient for admission in a hospital, it is the
doctor who prescribes the treatment to be given to said patient. The
hospitals obligation is limited to providing the patient with the preferred
room accommodation, the nutritional diet and medications prescribed by the
doctor, the equipment and facilities necessary for the treatment of the
patient, as well as the services of the hospital staff who perform the
ministerial tasks of ensuring that the doctors orders are carried out strictly.
As explained by respondent hospital, that the admission of a physician to
membership in DLSMCs medical staff as active or visiting consultant is first
decided upon by the Credentials Committee thereof, which is composed of
the heads of the various specialty departments such as the Department of
Obstetrics and Gynecology, Pediatrics, Surgery with the department head of
the particular specialty applied for as chairman. The Credentials Committee
then recommends to DLSMC's Medical Director or Hospital Administrator the
acceptance or rejection of the applicant physician, and said director or
administrator validates the committee's recommendation. Similarly, in cases
where a disciplinary action is lodged against a consultant, the same is
initiated by the department to whom the consultant concerned belongs and
filed with the Ethics Committee consisting of the department specialty heads.
The medical director/hospital administrator merely acts as ex-officio member
of said committee.
Neither is there any showing that it is DLSMC which pays any of its
consultants for medical services rendered by the latter to their respective
patients. Moreover, the contract between the consultant in respondent
hospital and his patient is separate and distinct from the contract between
respondent hospital and said patient. The first has for its object the rendition
of medical services by the consultant to the patient, while the second
concerns the provision by the hospital of facilities and services by its staff
such as nurses and laboratory personnel necessary for the proper treatment
of the patient.
Further, no evidence was adduced to show that the injury suffered by
petitioner Erlinda was due to a failure on the part of respondent DLSMC to
provide for hospital facilities and staff necessary for her treatment.
Nogales vs. CMC [G.R. No. 142625] December 19, 2006
After a thorough examination of the voluminous records of this case, the
Court finds no single evidence pointing to CMCs exercise of control over Dr.
Estradas treatment and management of Corazons condition. It is undisputed
that throughout Corazons pregnancy, she was under the exclusive prenatal
care of Dr. Estrada. At the time of Corazons admission at CMC and during her
delivery, it was Dr. Estrada, assisted by Dr. Villaflor, who attended to Corazon.
There was no showing that CMC had a part in diagnosing Corazons condition.
While Dr. Estrada enjoyed staff privileges at CMC, such fact alone did not
make him an employee of CMC. CMC merely allowed Dr. Estrada to use its
facilities when Corazon was about to give birth, which CMC considered an
emergency. Considering these circumstances, Dr. Estrada is not an employee
of CMC, but an independent contractor.
The question now is whether CMC is automatically exempt from liability
considering that Dr. Estrada is an independent contractor-physician.
In general, a hospital is not liable for the negligence of an independent
contractor-physician. There is, however, an exception to this principle. The
hospital may be liable if the physician is the ostensible agent of the

hospital. This exception is also known as the doctrine of apparent authority.

In Gilbert v. Sycamore Municipal Hospital, the Illinois Supreme Court
explained the doctrine of apparent authority in this wise:
Under the doctrine of apparent authority a hospital can be held vicariously
liable for the negligent acts of a physician providing care at the hospital,
regardless of whether the physician is an independent contractor, unless the
patient knows, or should have known, that the physician is an independent
contractor. The elements of the action have been set out as follows:
For a hospital to be liable under the doctrine of apparent authority, a
plaintiff must show that: (1) the hospital, or its agent, acted in a manner that
would lead a reasonable person to conclude that the individual who was
alleged to be negligent was an employee or agent of the hospital;
(2)
where the acts of the agent create the appearance of authority, the plaintiff
must also prove that the hospital had knowledge of and acquiesced in them;
and (3) the plaintiff acted in reliance upon the conduct of the hospital or its
agent, consistent with ordinary care and prudence.
The element of holding out on the part of the hospital does not require an
express representation by the hospital that the person alleged to be negligent
is an employee. Rather, the element is satisfied if the hospital holds itself out
as a provider of emergency room care without informing the patient that the
care is provided by independent contractors.
The element of justifiable reliance on the part of the plaintiff is satisfied if the
plaintiff relies upon the hospital to provide complete emergency room care,
rather than upon a specific physician.
The first factor focuses on the hospitals manifestations and is sometimes
described as an inquiry whether the hospital acted in a manner which would
lead a reasonable person to conclude that the individual who was alleged to
be negligent was an employee or agent of the hospital. In this regard, the
hospital need not make express representations to the patient that the
treating physician is an employee of the hospital; rather a representation
may be general and implied.
In the instant case, CMC impliedly held out Dr. Estrada as a member of its
medical staff. Through CMCs acts, CMC clothed Dr. Estrada with apparent
authority thereby leading the Spouses Nogales to believe that Dr. Estrada was
an employee or agent of CMC. CMC cannot now repudiate such authority.
[through estoppel, an admission or representation is rendered conclusive
upon the person making it, and cannot be denied or disproved as against the
person relying thereon. ]
First, CMC granted staff privileges to Dr. Estrada. CMC extended its medical
staff and facilities to Dr. Estrada. Upon Dr. Estradas request for Corazons
admission, CMC, through its personnel, readily accommodated Corazon and
updated Dr. Estrada of her condition.
Second, CMC made Rogelio sign consent forms printed on CMC letterhead.
Prior to Corazons admission and supposed hysterectomy, CMC asked Rogelio
to sign release forms, the contents of which reinforced Rogelios belief that
Dr. Estrada was a member of CMCs medical staff.
Consent for admission and treatment:
that the Physician, personally or by and through the Capitol Medical Center
and/or its staff, may use, adapt, or employ such means, forms or methods of
cure, treatment, retreatment, or emergency measures as he may see best
and most expedient; that Ma. Corazon and I will comply with any and all
rules, regulations, directions, and instructions of the Physician, the Capitol
Medical Center and/or its staff;
While the Consent to Operation pertinently reads, thus:
I, ROGELIO NOGALES, x x x, of my own volition and free will, do consent
and submit said CORAZON NOGALES to Hysterectomy, by the Surgical Staff
and Anesthesiologists of Capitol Medical Center
Third, Dr. Estradas referral of Corazons profuse vaginal bleeding to Dr.
Espinola, who was then the Head of the Obstetrics and Gynecology
Department of CMC, gave the impression that Dr. Estrada as a member of

CMCs medical staff was collaborating with other CMC-employed specialists

in treating Corazon.
Further, the Spouses Nogales looked to CMC to provide the best medical care
and support services for Corazons delivery. The Court notes that prior to
Corazons fourth pregnancy, she used to give birth inside a clinic. Considering
Corazons age then, the Spouses Nogales decided to have their fourth child
delivered at CMC, which Rogelio regarded one of the best hospitals at the
time.
Carolina in Diggs v. Novant Health, Inc to wit:
The conception that the hospital does not undertake to treat the patient,
does not undertake to act through its doctors and nurses, but undertakes
instead simply to procure them to act upon their own responsibility, no
longer reflects the fact. Present day hospitals, as their manner of operation
plainly demonstrates, do far more than furnish facilities for treatment. They
regularly employ on a salary basis a large staff of physicians, nurses and
internes [sic], as well as administrative and manual workers, and they
charge patients for medical care and treatment, collecting for such services,
if necessary, by legal action. Certainly, the person who avails himself of
hospital facilities expects that the hospital will attempt to cure him, not
that its nurses or other employees will act on their own responsibility. x x x
(Emphasis supplied)
Such release forms, being in the nature of contracts of adhesion, are
construed strictly against hospitals. Besides, a blanket release in favor of
hospitals from any and all claims, which includes claims due to bad faith or
gross negligence, would be contrary to public policy and thus void.
Even simple negligence is not subject to blanket release in favor of
establishments like hospitals but may only mitigate liability depending on the
circumstances. When a person needing urgent medical attention rushes to a
hospital, he cannot bargain on equal footing with the hospital on the terms of
admission and operation. Such a person is literally at the mercy of the
hospital. There can be no clearer example of a contract of adhesion than
one arising from such a dire situation. Thus, the release forms of CMC
cannot relieve CMC from liability for the negligent medical treatment of
Corazon.

LIABILITIES OF HOSPITAL FOR ITS ANCILLARY SERVICE

I.

EMERGENCY ROOM

1. Independent contractor
2. Employees
*In the absence of clear indication to the contrary, the public has a right to
rely on the common assumption that emergency ward personnel work for
and in behalf of the hospital (Badeux v. East Jefferson Gen. Hospital 364 So.
2d 348 La Xt. App. 1978)
Two Aspects of Emergency Care:

a. Examination

of the patient to determine his condition and need for

emergency medical procedure:

patients condition enables him to select his own

physician

needs only first aid w/c can be provided by a nurse or

qualified paramedical personnel.

b. Performance

of the specific medical or surgical procedure w/c are

required w/o delay to protect the patients health:

Malpractice Liability in the E.R.

1. Failure to admit
2. Failure to examine and/or treat
3. Negligence in the Application of Management Procedures

Emergency Room Record

properly kept as long as possible
Police

with prior approval or consent of the attending

physician
Reporter

a. Basis

release of information is primarily the duty and

responsibility of the head of the hospital or his assignee (PR
Officer)

can only be made upon consent of the patient

(expressed or implied)

for planning patient care and continuity in the

evaluation of patients condition and treatment.

b. Documentary

evidence of the course of patients medical

evaluation, treatment and change in condition.

c. Documentary evidence of communication between doctors

d. Protection of the legal interests of the patient, hospital and

Guidelines in release of information to reporters:

1. Private patients acknowledgment or admission, general condition and

MD.

e. A data base for use in continuing education and research

f. In compliance with the law

name of attending physician.

2. Emergency Cases name, age, address, occupation, sex, nature of the

accident, extent of injuries, type of wound and part of body involved

3. Restrictive information in cases of poisoning, intoxication, stabbing,

attempted suicide and the likes, no motive should be given. Medical
information should be given only by the physician in charge.

Included in the Patients record:

A.

4. Photographs none for unconscious patient; must be with permission

of the physician and patient.

II. Ambulance Service

Equipment: (American College of Surgeon Committee on Trauma, 1966)
1. Hinged half-ring lower extremity splint with web straps for ankle hitch.
2. Two or more padded boards 4 feet in length and 3 inches wide, 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.

B.Hospital Record:
1. Identification Information
2. Evidence of appropriate informed

3. Patients medical history

4. Report of patients physical examination
5. Diagnostic and therapeutic orders
6. Observations of patients condition, including progress notes and

fracture 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

nurses notes

7. Report of all procedures, tests and their results.

8. Conclusion, including the provisional diagnosis,

size masks

padded.

11.

Universal dressing, approximately 10 inches by 36 inches

packaged folded to 10 inches by 9 inches.

12.
13.
14.
15.
16.
17.

Sterile gauze pads.

One, 2 and 3 inches adhesive tape bandages.
Triangular bandages.
Safety pins, large size.
Bandage shears
Several pillows

Personnel

Must have previous training in the use of the equipments and

application of first aid.

Competent physician is present when transporting a seriously ill

patient is highly recommended.

III.

Hospital Pharmacy
vicarious liability

IV.

Medical Records
Purpose:

Among Private MDs:

a. To document patients history, condition and treatment;

b. To aid in the continuity of care; and
c. To provide a record of billing
In hospitals:

consent or indication of the

reason for its absence

3. Two or more padded 15inch by 3 inch wood of cardboard splints for

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

Physicians Office Record:

1. History
2. Physical findings
3. Diagnosis
4. Course of treatment
5. Course of the disease

associated

diagnosis, clinical resume, and necropsy reports.

*Liability incurred on account of inaccuracy or incomplete record:

Patients death due to eclampsia which the doctor failed to treat

because nurse did not record the symptoms.
*Destruction of records is an evidence of negligence:

It raised a strong inference of consciousness of guilt (Thor v.

Boska, 113 Cal Rptr 296, Cal 1974).
*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
Who owns the Medical Record?

HOSPITAL
PHYSICIANS REACTION TO THE PROBLEM OF MALPRACTICE
Praestet cautela quam medala

60,000 practicing physicians registered with the Professional

Regulations Commissions

467 cases have been filed from 1990 to 2004.

Out of 467 cases filed, 220 (47%) are with gross negligence/
malpractice.

Out of the estimated 35,000 PMA members of good standing,

there is an average of approximately only 21 members who availed of
legal aid benefits provided by the PMA from year 2000.

As per the number of attended patients, only a mere 0.00003% is

presumed to be malpractice incidence.

OB-Gynecology
Surgery
anesthesiology
pediatrics

=
=

=
(30%)
=
(15%)

(40%)
(20%)

others

(5%)

1. Partial or complete abandonment of practice

2. Practice of Defensive medicine
a. Negative defense
b. Positive defense

admitting non-admissible case

consulting to confirm dx

additional diagnostic test

overtreatment
qualitative
quantitative

Reasons for OA:

1. Higher medical fees

2. Dramatic and impressive tx
3. To pin down another M.D.
4. Satisfy patient
5. Unintentionally
Effects of Overtreatment:

1. Financial losses
2. Physical and emotional harm
3. Side effects
4. Bad impression by the patient on previous M.D.
House Bill No. 4955
Introduced by REPRESENTATIVE OSCAR S. RODRIGUEZ
EXPLANATORY NOTE

1. Seeks to strengthen the right of a patient to quality medical care.

2. Hoped that all fields of the medical profession will be screened from
incompetent individuals.

3. That

only the most competent individuals be permitted to practice

medicine.

4. Provide greater prestige to the medical profession

5. It would prevent the occurrence of injuries and needless deaths caused
by gross ignorance and negligence.

(2) "Illegal Surgery" shall refer to surgeries performed to remove healthy

human organ/s without the consent of the patient, with intent to gain on the
part of the person or persons responsible for such surgery.
(3) "Malpractice" shall refer to any personal injury, including death, caused
by the negligent or wrongful act or omission of any medical practitioner;
SECTION 7. Penalties - Medical malpractice and/or the practice of illegal
surgery shall be punished by prisin mayor and the cancellation of the license
to practice the medical profession and a fine ranging from Five Hundred
Thousand Pesos (P500,000.00) to One Million Pesos (P1,000,000.00) in the
discretion of the court taking into consideration all attending circumstances.
Any other crime committed by reason or on occasion of malpractice shall be
considered as a separate offense and the rules on complex crimes shall not
apply. In no case shall malpractice be considered as a mere aggravating
circumstance when it is committed by reason or on occasion of the
commission of another crime.
Dr. Philip Chua,
using a shotgun to kill a fly on the patients head.
If physician makes any (honest) mistake, in making a diagnosis or treatment,
the error will be considered a criminal act, and the physician shall be
punished by prision mayor (6 months plus 1 day to 12 years imprisonment)
and the cancellation of the license to practice the medical profession and a
fine ranging from 500,000 to 1 million pesos in the discretion of the court
He argues that physicians are not God and medicine is not an exact science.
However, he agrees that gross negligence, malicious intent, greed, immorality
should be severely penalized but this bill penalties are not proportional to the
error committed.

Dr. Romeo Encanto, one of the speakers in 98th PMA Convention in Bacolod
City:
If you are accused of malpractice and you have the possibility of prision
mayor, then just admit that you really intended to kill the patient. There, you
will have a lesser penalty Thats how preposterous the bill is.
Art. 365. Imprudence and Negligence. Any person who, by reckless
imprudence, shall commit any act which, had it been intentional, would
constitute grave felony, shall suffer the penalty of arresto mayor in its
maximum period to priccion correccional in its medium period
4 months and 1 day to 4 years and 2 months.
September 29, 2002, Alliance of Health Professional Organization (AHPO),
composed of various health organizations including PMA, assembled and
staged massive protest in Cuneta Astrodome denouncing the medical
malpractice bill and called it a direct attack against the medical community
The penalty imposed by the proposed bill, i.e. prision mayor and fine of
P500,000 to P1,000,000 is very harsh and very severeit does not distinguish
between a doctor and an ordinary criminal. Under the bill there seems to be
no difference between someone intentionally putting a bullet between the
eyes of his victim and a doctor or a nurse accidentally puncturing a patients
skin in the course of giving a shot of medicine in a patients arm.
Former Supreme Court Justice Isagani A. Cruz expressed dismay about the
proposed excessive monetary penalty. He wrote in his Philippine Daily
Inquirer column:
Section 20 of the Bill of Rights clearly and expressly provides that
excessive fines shall not be imposed.
Moreover, the due process clause requires an equivalence between the
offense and the penalty, unlike under the bill in question, where the
fine can be as high as a million pesos. It is like punishing jaywalking with
life imprisonment.
Senator Sergio R. Osmena III pushed his controversial Senate Bill 1720 or
Anti-Medical Malpractice Act of 2004
Incidents of malpractice and negligence involving medical and dental
practitioners are on the riseSadly, such negligent acts of unscrupulous
medical and/or dental practitioners have sometimes resulted in temporary or
permanent disability of death.
In January 2003, the University of the Philippines Manila, Health Sciences
Center of the U.P. System, headed by Chancellor Marita V.T. Reyes made a
consolidated position paper objecting the bill intention to punish medical
malpractice as a tool to enhance the quality of health care.

1. The bill will increase the already high cost of health care (defensive
medicine),

2. bring mistrust to patient-health professional relationship,

3. encourage mass exodus of health practitioners,
4. violates the Constitutions Equal Protection Clause and promotes class
legislation, and

5. Unduly punish legitimate medical practitioners who act in good faith

and whose mistakes are unintentional.
Malpractice Insurance

An agreement whereby one undertakes for a consideration to

indemnify another against loss, damage or liability arising from an
unknown or contingent event

Moreover, the passage of SB 588 will only erode and

commercialize the sacred patient-physician relationship, force
physicians to practice defensive medicine, secure malpractice insurance
and pass the cost to patients and eventually lead to malpractice crisis
which is already happening in the U.S., encourage physicians to practice
in the urban areas rather than in the countryside, encourage brain
drain, discourage physicians to perform charity, medical missions or
humanitarian tasks, and harshly penalize medical practitioners even for
light offenses.
Dr. Paul Bisnar

The Measly Salary of Filipino Physicians, Dr. Atenodoro R. Ruiz:

Around half of physicians population has average income of

P19,195.65 per month.

Most government doctors specially resident physicians only earn

less than P20,000 a month (Lately, the congress proposes 8% increase
salary in 2006), but they are fortunate compared to the salary of
resident physicians working in private hospitals. Here are some of the
net salaries of resident physicians working in private hospitals

Dr. Encanto commented on this controversial bill in the 98th PMA

Annual Convention. He said: The administrative fine is one million
pesos (or P500,000) and you are getting a P50,000 malpractice
insurance. So, how could you pay the administrative fine? This is not
damages to the patients, this is just fine. So the government will earn a
lot of money from doctors just from administrative fine.