Legal Medicine Midterms Notes

Legal Medicine (Atty. Capule) Midterm Notes (As per pointers)

1

I. RA 8344 DEMAND OF DEPOSITS

Is it unlawful to demand a deposit?

NO. It becomes unlawful when the deposit/advance

payment is demanded 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

Is refusal unlawful?

NO. If there is strict compliance with the procedure

on transfer, it is not construed as refusal.

Procedure / Requisites for valid transfer:

1. there is inadequacy of medical capabilities of the hospital

2. the patient or his next of kin consents to the transfer, provided that if the patient is

unconscious, incapable of giving consent

and/or unaccompanied, the physician can

transfer the patient even without his consent

3. The receiving hospital or medical clinic agrees to the transfer

4. such transfer shall be done only after necessary emergency treatment and support

have been administered to stabilize the

patient

5. that it has been established that such transfer entails less risks than the patient's continued

confinement

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

Transfer of Patients

After the hospital or medical clinic mentioned

above shall have administered medical treatment

and support, it may cause the transfer of the patient

to an appropriate hospital consistent with the needs

of the patient, preferably to a government hospital,

especially in the case of poor or indigent patients

(Sec. 3, RA 8344)

Item 3 of IRR of RA 8344 provides:

1. The transferring and receiving hospital, shall be as much as practicable, be within ten (10)

kilometer radius of each other.

2. The transfer of patients contemplated under this Act shall at all times be properly

documented.

3. Hospitals may require a deposit or advance payment when the patient is no longer under

the state of emergency and he/she refuses to

be transferred.

When are hospitals required to extend medical

services?

Hospitals are required to render immediate medical

assistance and provide facilities and medicine

within its capabilities on emergency cases, where

patients are in danger of dying and/or suffering

serious physical injuries, (Sec. 1, RA 6615)

Note: Doctrine of Reasonable Reliance Hospital without emergency services allowed; Provided, that

there is an announcement to the community that

such hospital has no emergency services, so the

people in the community will not rely on the

hospital for such emergency services.

II. RA 9439 DETENTION OF PATIENTS

(NOTE: The provisions of RA 9439 is NOT

APPLICABLE to patients who stayed in private

rooms)

Is it unlawful to detain patients for non-payment

of hospital bills/medical expenses?

YES. Sec. 1 provides that 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


2

non-payment in part or in full of hospital bills or

medical expense.

Rights of patients that have fully or partially

recovered, and already wish to leave the hospital or

medical clinic, BUT financially incapable to settle

medical expenses

1. right to leave the hospital or medical clinic 2. 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

3. In case of a deceased patient, any surviving relative has the right to demand the

corresponding death certificate and other

documents required for interment and other

purposes. (Also, under PD 651, hospitals

are required to issue a death certificate even

if hospital bills are not yet paid)

Execution of promissory note is required

The rights of the patients can only be exercised after

executing and securing a promissory note, either by

a mortgage or by a guarantee of a co-maker, who

will be jointly and severally liable with the patient

for the unpaid obligation.

The hospital can choose the guarantor or the co-

maker. It has the right to make sure that the co-

maker is capable of paying or fulfilling the

obligation.

Case: Manila Doctors v. Chua and Ty

Ruling: The operation of private pay hospitals and

medical clinics is impressed with public interest and

imbued with a heavy social responsibility. But the

hospital is also a business, and, as a business, it has

a right to institute all measures of efficiency

commensurate to the ends for which it is designed,

especially to ensure its economic viability and

survival. And in the legitimate pursuit of economic

considerations, the extent to which the public may

be served and cured is expanded, the pulse and life

of the medical sector quickens, and the regeneration

of the people as a whole becomes more visibly

attainable. In the institution of cost-cutting

measures, the hospital has a right to reduce the

facilities and services that are deemed to be non-

essential, such that their reduction or removal would

not be detrimental to the medical condition of the

patient.

For the moment, the question to be considered is

whether the subject facilities are indeed non-

essential - the air-conditioner, telephone, television,

and refrigerator the removal of which would cause the adverse health effects and emotional trauma the

respondents so claimed. Corollary to this question is

whether the petitioner observed the diligence of a

good father of the family in the course of

ascertaining the possible repercussions of the

removal of the facilities prior to the removal itself

and for a reasonable time thereafter, with a view to

prevent damage.

After an extensive analysis of the record, it becomes

rather worrisome to this Court that the courts a quo

unreservedly drew their conclusions from the self-

serving and uncorroborated testimonies of the

respondents the probative value of which is highly

questionable. We hold that the respondents failed to

prove the damages so claimed.

The evidence in the record firmly establishes that

the staff of the petitioner took proactive steps to

inform the relatives of respondent Chua of the

removal of facilities prior thereto, and to carry out

the necessary precautionary measures to ensure that

her health and well-being would not be adversely

affected.

A patient cannot be detained in a hospital for non-

payment of the hospital bill The form of restraint

must be total; movement must be restrained in all

directions. If restraint is partial, e.g., in a particular

direction with freedom to proceed in another, the

restraint on the person's liberty is not total.

However, the hospital may legally detain a

patient against his will when he is a detained or

convicted prisoner, or when the patient is


3

suffering from a very contagious disease where

his release will be prejudicial to public health, or

when the patient is mentally ill such that his

release will endanger public safety, or in other

exigent cases as may be provided by law.

Authorities are of the view that, ordinarily, a

hospital, especially if it is a private pay hospital, is

entitled to be compensated for its services, by either

an express or an implied contract, and if no express

contract exists, there is generally an implied

agreement that the patient will pay the reasonable

value of the services rendered; when a hospital

treats a patient's injuries, it has an enforceable claim

for full payment for its services, regardless of the

patient's financial status.

III. PRC IDENTIFICATION

Powers, Functions, and Responsibilities of the

Commission (Sec. 7)

PRC upon recommendation of the PR Board

concerned has power to approve the registration

and authorize issuance of certificate or license of

registration and professional ID card

To supervise foreign nations who are authorized by

existing laws to practice their professions either as

holders of a certificate of registration and a

professional identification card or a temporary

special permit in the Philippines;

To supervise professionals who were former

citizens of the Philippines and who had been

registered and issued a certificate of registration and

a professional identification card prior to their

naturalization as foreign citizens, who may, while in

the country on a visit, sojourn or permanent

residence, practice their profession:

Provided, that prior to the practice of their

profession they shall have first been issued a

special permit and updated professional

identification card by the Board concerned

subject to approval by the Commission and

upon payment of the permit and annual

registration fees

IV. RECIPROCITY

The registration or issuance of license of a foreigner

professional rests in the PRC. The requirements for

registration or licensing, however, must be

substantially the same as those required and

contemplated by the laws of the Philippines. It is

further required that the laws of the foreign start

allow the citizens of the Philippines to practice their

profession on the same basis, grant, and privileges

as those enjoyed by the citizens of the foreign

country.

Case: Board of Medicine v. Ota

Facts: Ota is a Japanese national, married to a

Filipina, has been residing in the PH for more than

10 years, and graduated Doctor of Medicine. He

filed an application to take the board exams. PRC

requires him to submit affidavit stating that if he

passes the boards, he cannot practice medicine until

he submits proof that reciprocity exists between

Japan and the Philippines in admitting foreigners

into the practice of medicine. Ota submitted a duly

notarized English translation of the Medical

Practitioners Law of Japan duly authenticated by

the Consul General of the Philippine Embassy to

Japan. He was allowed to take the boards and he

passed. In spite of all these, the Board of Medicine

denied Otas request for a license to practice medicine in the Philippines on the ground that no

genuine reciprocity can be found in the law of

Japan, as there is no Filipino or foreigner who can

possibly practice there. Ota filed petition before the

RTC. RTC ruled in favor of Ota stating that there is

adequate proof that there exists a principle of

reciprocity and ordering PRC to issue the license.

PRC appealed to CA. CA affirmed RTC Ruling.

Issue: Whether or not the principle of reciprocity

exists.

Held: Yes. The contention of the PRC that the

requirements to practice medicine in Japan are

practically impossible for a Filipino to comply with,

there are also ambiguities in the Medical

Practitioners Law of Japan, and there had not been a


4

single Filipino who was issued a license to practice

medicine by the Japanese Government is untenable.

What the law requires is for the foreigner to

show proof that a Filipino can practice in his

foreign country. It is enough that the laws in the

foreign country permit a Filipino to get license and

practice therein. Requiring respondent to prove first

that a Filipino has already been granted license and

is actually practicing therein unduly expands the

requirements provided for under R.A. No. 2382 and

P.D. No. 223.

V. PRIVILEGED COMMUNICATION

Sec. 24, RRE. Disqualification by reason of

privileged communication. The following persons cannot testify as to matters learned in

confidence in the following cases:

xxx

(c) A surgeon authorized to practice medicine,

surgery or obstetrics cannot in a civil case, without

the consent of the patient, be examined as to any

advice or treatment given by him or any

information which he may have acquired in

attending such patient in a professional capacity,

which information was necessary to enable him to

act in that capacity, and which would blacken the

reputation of the patient

Case: Lim v. CA

Facts: Petitioner Nelly Lim and Respondent Juan

Lim are lawfully married to each other. Juan filed a

petition for annulment of marriage in the ground

that Nelly has been suffering from schizophrenia

before, during, and even after their marriage.

He presented three witnesses, one of which is the

Chief of the Female Services of National Mental

Hospital, Dr. Acampado. The counsel for Juan

orally applied for the issuance of subpoena ad

testificandum, the counsel for Nelly opposed the

motion on the ground that the testimony sought to

be elicited from the witness is privileged since the

latter had examined the petitioner in a professional

capacity and had diagnosed her to be suffering from

schizophrenia. Nevertheless, the subpoena was

issued. Counsel for Nelly filed an urgent motion to

quash the subpoena. Respondents counsel claimed that the witness will testify as an expert witness and

would not testify on any information acquired while

attending to the petitioner in a professional capacity.

Lower Court ruled in favor of Juan. CA also ruled

in favor of Juan stating that Nelly failed to establish

the confidential nature of the testimony given by

Dr. Acampado.

Issue: Whether or not there is breach of

confidentiality clause

Held: No. In order that the privilege may be

successfully claimed, the following requisites must

concur:

1. the privilege is claimed in a civil case;

2. the person against whom the privilege is claimed is one duly authorized to practice

medicine, surgery or obstetrics;

3. such person acquired the information while he was attending to the patient in

his professional capacity;

4. the information was necessary to enable him to act in that capacity; and

5. the information was confidential, and, if disclosed, would blacken the reputation

(formerly character) of the patient.

These requisites conform with the four (4)

fundamental conditions necessary for the

establishment of a privilege against the

disclosure of certain communications, to wit:

1. The communications must originate in a confidence that they will not be disclosed.

2. This element of confidentiality must be essential to the full and satisfactory

maintenance of the relation between the

parties.


5

3. The relation must be one which in the opinion of the community ought to be

sedulously fostered

4. The injury that would inure to the relation by the disclosure of the

communications must be greater than the

benefit thereby gained for the correct

disposal of litigation.

The physician may be considered to be acting in his

professional capacity when he attends to the patient

for curative, preventive, or palliative treatment.

Thus, only disclosures which would have been

made to the physician to enable him "safely and

efficaciously to treat his patient" are covered by the

privilege.

It is to be emphasized that "it is the tenor only of the

communication that is privileged. The mere fact of

making a communication, as well as the date of a

consultation and the number of consultations, are

therefore not privileged from disclosure, so long as

the subject communicated is not stated. One who

claims this privilege must prove the presence of

these aforementioned requisites. Petitioner failed to

discharge that burden. Dr. Acampado was presented

and qualified as an expert witness. She did not

disclose anything obtained in the course of her

examination, interview and treatment of the

petitioner; moreover, the facts and conditions

alleged in the hypothetical problem did not refer to

and had no bearing on whatever information or

findings the doctor obtained while attending to the

patient.

The statutory physician-patient privilege, though

duly claimed, is not violated by permitting a

physician to give expert opinion testimony in

response to a strictly hypothetical question in a

lawsuit involving the physical mental condition of a

patient whom he has attended professionally, where

his opinion is based strictly upon the hypothetical

facts stated, excluding and disregarding any

personal professional knowledge he may have

concerning such patient.

Case: Krohn v. CA

Facts: A confidential psychiatric evaluation report

is being presented in evidence before the trial court

in a petition for annulment of marriage grounded on

psychological incapacity. The witness testifying on

the report is the husband who initiated the

annulment proceedings, not the physician who

prepared the report. The subject of the evaluation

report is the wife, who invokes the rule on

privileged communication between physician and

patient, and seeks to enjoin her husband from

disclosing the contents of the report. RTC allowed

the admission of the psychiatric evaluation report as

evidence because it is material to the case and

because there was no objection on the part of the

wife during the time it was referred to in the

complaint. CA affirmed.

Issue: Whether or not the presentation of the report

is a breach of the privileged communication rule

Held: No. It does not fall under the requisites laid

down in the case of Lim v. CA. Moreover, the

person against whom the privilege is claimed is not

one duly authorized to practice medicine, surgery or

obstetrics. He is simply the patient's husband who

wishes to testify on a document executed by

medical practitioners. Plainly and clearly, this does

not fall within the claimed prohibition. Neither can

his testimony be considered a circumvention of the

prohibition because his testimony cannot have the

force and effect of the testimony of the physician

who examined the patient and executed the report.

VI. MEDICAL ACT OF 1959, AS AMENDED

and other related provisions and concepts

LEGAL MEDICINE

Branch of medicine that deals with the application

of medical knowledge to the purposes of law and in

the administration of justice.

MEDICAL JURISPRUDENCE

Deals with the aspect of law and legal concepts in

relation with the practice of medicine


6

MEDICAL JURISPRUDENCE includes:

- Licensure and regulatory laws; - Physician-patient-hospital relationship

together with the other paramedical

personnel, their rights, duties and

obligations;

- Liabilities for non-compliance with the law.

PURPOSES OF LEGAL MEDICINE

- To protect the public from charlatans; - To promote professionalism and foster

professional interrelationship;

- To develop awareness of the rights, duties and obligations of the patient, physician, and

the hospital;

- To control the increasing number of medical malpractice suits against physicians;

- To explain the purpose and procedure of certain legislation;

- To study the need to amend, repeal our health care laws in harmony with the recent

scientific and social development.

ADVERSARIAL TRIAL SYSTEM

- Philippine courts is a court litigation where there is competition of inconsistent version

of facts and theories in law during trial;

- Each party to the contest is given equal opportunity to investigate the case, gather

and present all proofs in support of his

allegation, and give argument that his

contention is correct;

- Ultimate purpose is for a just solution. - it often undermines the pursuit of truth as

the opposing parties seek to win at all cost

without the obligation to reveal the facts

which may be detrimental to their case. The

lawyer aims to win the fight not to help the

court discover facts or establish the truth.

SOURCES OF LAW - Constitution - Laws enacted by the legislative body - Decrees, Orders, Proclamation, Letters, CA,

BP, RA

- Administrative acts, orders, Rules and Regulation

- Local customs - Generally accepted principles of

International law

LAW AND THE PRACTICE OF MEDICINE

The State must maintain high standard of practice

by setting up rules and regulations with regards to

qualifications and procedure for the admission to

the profession. These are legal safeguards to

guarantee the safety of the patient and impose

liability to the practitioner who through his act or

omission causes damage or injury to the health and

welfare of the patient.

The right to regulate the practice of medicine is

based on the police power of the state.

LICENSURE AND REGULATORY LAWS

ADMINISTRATIVE BODIES

1. BOARD OF MEDICAL EDUCATION

Primarily concerned with the standardization and

regulation of medical education.

Composition:

Chairman - Secretary of Education

Members:

1. Secretary of Health 2. Director, Bureau of Private Schools 3. Chairman, Board of Medicine 4. Representative, PMA 5. Council of Deans, APMC 6. Dean, UP-College of Medicine

Functions:

1. To determine and prescribe the requirements for admission into a recognized college of

Medicine;

2. To determine and prescribe requirements for the minimum physical facilities;


7

3. To determine and prescribe the minimum number and qualifications of teaching

personnel;

4. To determine and prescribe the minimum required curriculum;

5. To authorize the implementation of experimental curriculum;

6. To accept applications for admission to a medical school;

7. To select, determine and approve hospitals for training;

8. To promulgate, prescribe and enforce the necessary rules and regulations.

2. PROFESSIONAL REGULATIONS

COMMISSION (PRC)

To have general supervision and regulation of all

professions requiring examinations which includes

the practice of medicine.

Composition:

Commissioner

Two Associate Commissioner

Functions:

Exercise general administrative, executive and

policy-making functions for the whole agency.

3. BOARD OF MEDICINE

Its primary duties are to give examinations for the

registration of physicians and supervision, control

and regulation of the practice of medicine.

Composition:

Six members appointed by the president from a list

submitted by the Executive Council of the PMA.

Qualifications:

- Natural-born citizen; - Duly registered physician; - In the practice of medicine for at least 10

years;

- Of good moral character and of recognized standing in the medical profession as

certified by PMA;

- Not a member of any faculty of any medical school (including any pecuniary interest)

Powers, Functions and Responsibilities:

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

2. To promulgate such rules and regulations for the proper conduct of the examinations,

correction and registration;

3. To administer oath; 4. To study the conditions affecting the

practice of medicine;

5. To investigate violations, issue summons, subpoena and subpoena duces tecum;

6. To conduct hearings or investigations of administrative cases filed before them;

7. To promulgate decisions on such administrative cases subject to the review of

the Commission;

8. To issue certificate of registration; 9. To suspend, revoke or reissue certificate of

registration for causes provided by law or by

the rules and regulations promulgated;

10. To promulgate, with the approval of PRC, rules and regulations in harmony with the

provisions of the Medical Act of 1959 and

necessary for the proper practice of

medicine.

ADMISSION TO THE PRACTICE OF

MEDICINE

Prerequisites:

1. Minimum age requirement

- at least 21 years of age

2. Proper Educational Background

- -Requirements for Admission in the College of Medicine

- -Holder of a Bachelors degree; - -Not convicted of any crime involving moral

turpitude;


8

- -Certificate of Eligibility from the Board of Medical Education;

- -Good moral character

3. Examination Requirements

- must have passed the corresponding Board Examination

- Preliminary Examination - -At least 19 years of age; - -Of good moral character; - -Have completed the first two years of the

medical course;

- -Final or Complete Examination - -Citizen of the Philippines or of any country

who has submitted competent and

conclusive

- Documentary evidence confirmed by the DFA showing that his countrys existing laws permit citizens of the Philippines to

practice medicine under the same rules and

regulations governing citizens thereof

(RECIPROCITY RULE).

4. Holder of certificate of registration

No issuance to any candidate who has been:

- -Convicted by a court of competent jurisdiction of any crime involving moral

turpitude;

- -Found guilty of immoral or dishonorable conduct after investigation by the Board of

Medicine;

- -Declared to be of unsound mind.

Scope of Examination:

Preliminary - Anatomy and Histology

Physiology Biochemistry

Microbiology and Parasitology

Final - Pharmacology and Therapeutics

Pathology Medicine

Obstetrics and Gynecology

Pediatrics and Nutrition

Surgery and Ophthalmology,

Otorhinolaryngology

Preventive Medicine and Public Health

Legal Medicine, Ethics and Medical

Jurisprudence

PRACTICE OF MEDICINE

What is the practice of medicine?

It is a privilege or franchise granted by the State to

any person to perform medical acts upon

compliance with law, that is, the Medical Act of

1959 as amended which has been promulgated by

the State in the exercise of police power to protect

its citizenry from unqualified practitioners of

medicine.

It is diagnosing and applying and the usage of

medicine and drugs for curing, mitigating, or

relieving bodily disease or conditions.

ACTS CONSTITUTING THE PRACTICE OF

MEDICINE (pursuant to Sec.10, Art. III of the

Medical Act of 1959 as amended):

1. who shall for compensation, fee, 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 nature of the remedy or

treatment administered, prescribed or

recommended;

2. who shall by means of signs, cards, advertisement, written or printed matter, or

through the radio, television or any other

means of communication, either offer or

undertake by any means or method to

diagnose, treat, operate, or prescribe any

remedy for human disease, injury,

deformity, physical, mental or psychical

condition;


9

3. who shall falsely use the title of M.D. after his name, shall be considered as engaged in

the practice of medicine.

By DECISIONS OF COURTS, the following are

not considered to constitute practice of medicine:

1. One who takes BP reading; 2. Application of medicated massage; 3. Hospital; 4. Nurse anesthetist

Exemptions:

By PROVISIONS OF LAW, the following are not

considered to constitute practice of medicine

(Sec.11, Art. III, Medical Act of 1959 as amended):

1. Any medical student duly enrolled in an approved medical college;

2. dentist; 3. physiotherapist; 4. optometrist; 5. Any person who renders any service

gratuitously in cases of emergency or in

places where the services of a physician,

nurse or midwife are not available;

6. Any person who administers or recommends any household remedy as per classification

of existing Pharmacy Laws;

7. Clinical psychologist with the prescription and direct supervision of a physician;

8. Prosthetist

Note: Faith Healing

There is nothing in the Medical Act of 1959

exempting it from the definition of the acts which

constitute practice of medicine;

Related to constitutional guarantee to religious

freedom (freedom to believe and freedom to act in

accordance with ones belief);

Acted in pursuance of his religious belief and with

the tenets of his church he professes, not deemed to

be a practice of medicine but part of his religious

freedom.

ILLEGAL PRACTICE OF MEDICINE

Practice of medicine by any person not qualified

and not duly-admitted to perform medical acts in

compliance with law.

Penalties

Pursuant to Sec.28, Art. IV, Medical Act of 1959

as amended Any person found guilty of illegal practice shall be punished by a fine of not less than one thousand pesos or more than ten thousand pesos

with subsidiary imprisonment in case of insolvency

or by imprisonment of not less than one year no

more than five years, or by both such fine and

imprisonment, in the discretion of the court.

Qualified to practice medicine in the Philippines

1. Those who have complied with the prerequisites to the practice of medicine in accordance with

Sec. 8, Art. III, Medical Act of 1959 as

amended;

2. Those who can have limited practice without any certificate of registration in accordance with

Sec.12, Art. III, Medical Act of 1959 as

amended:

- Exclusive consultation in specific and definite cases;

- Attached to international bodies to perform certain definite work in the Philippines;

- Commissioned medical officers stationed in the Philippines in their own territorial

jurisdiction;

- Exchange professors in special branches of medicine;

- Medical students who have completed the first four years of medical course, graduates

of medicine and registered nurses who may

be given limited and special authorization by

the DOH;

3. Balikbayan Physicians pursuant to PD 541, Allowing Former Filipino Professionals to

Practice Their Respective Professions in the

Philippines, proviso:


10

- Of good standing prior to their departure and in their adopted country;

- Have registered with PRC and paid their professional fee;

- Pay the corresponding income tax;

4. Foreign physicians qualified to practice by Reciprocity Rule or by endorsement;

5. Medical Students pursuant to Sec.11(a) and Sec.12(d), Art.III, Medical Act of 1959 as

amended;

6. Limited practitioners of medicine - Those that are governed by specific

licensure laws

Rationale why artificial persons cannot practice

medicine

- Cannot be subjected to licensure examinations as required by law;

- Practice of medicine may be employed and controlled by unqualified physicians;

- Professional relationship between the patient and the physician will be impaired;

- Deprivation of free choice of physicians.

ADDITIONAL NOTES

PHYSICIAN

He 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 the

exercising independent judgment and without

supervision. (WHO)

RIGHTS OF PHYSICIAN

INHERENT RIGHTS

- to choose patients (except in emergency cases)

- to limit practice of medicine

- to determine appropriate management procedures

- to avail of hospital services

INCIDENTAL RIGHTS

- right of way while responding to emergency - right of exemption from execution of

instruments and

- Library to hold certain public/private offices to perform certain services to compensation

right to membership in medical societies

RIGHTS GENERALLY ENJOYED BY EVERY

CITIZEN

- Pursuant to the provisions of Art. III, bill of rights, Philippine Constitution 1987

RIGHTS OF PATIENTS

- Right to give consent to diagnostic and treatment procedures

- Right to religious belief - Right of privacy - Right to disclosure of information - Right to confidential information - Right to choose his physician - Right of treatment - Right to refuse necessary treatments

Basis of Consent

1. The physician-patient relationship is fiduciary in nature.

2. Patients right to self-determination. 3. Contractual relationship.

Purposes

1. To protect the patient from unnecessary/unwarranted procedure applied

to him without knowledge

2. To protect the physician from any consequences for failure to comply with

legal requirements


11

Instances When Consent Is Not Necessary

1. In cases of emergency, there is an implied consent or the physician is privilege because he is reasonably entitled to assume

consent

2. When the law made it compulsory for everyone to submit to the procedure

MEDICAL MALPRACTICE

Failure of a physician to properly perform the duty

which devolves upon him in his professional

relation to his patient which results to injury.

It may be defined as bad or unskillful practice of

medicine resulting to injury of the patient or failure

on the part of the physician to exercise the degree of

care, skill and diligence, as to treatment in a manner

contrary to accepted standards of medicine resulting

to injury to the patient.

Elements of Medical Malpractice

1. The physician has a duty to the patient; 2. The physician failed to perform such duty

to his patient;

3. As a consequence of the failure, injury was sustained by the patient;

4. The failure of the physician is the proximate cause of the injury sustained

by the patient.

Criminal medical malpractice, the act or omission

complained of must be punishable by law at the

time of commission or omission.

Proximate Cause

that cause, which, in natural continuous sequence,

unbroken by an efficient intervening cause,

produces the injury and without which the result

would not have occurred.

1. There must be a direct physical connection between the wrongful act of the physician

and the injury sustained by the patient.

2. The cause or the wrongful act of the physician must be efficient and must not be

too remote from the development of the

injury suffered by the patient.

3. The result must be the natural continuous and probable consequences.

DOCTRINE OF EFFICIENT INTERVENING

CAUSE

In the causal connection between the negligence of

the physician and the injury sustained by the

patient, there may be an efficient intervening cause

which is the proximate cause of the injury.

DOCTRINE OF VICARIOUS LIABILITY

Doctrine of Imputed Negligence/Command

Responsibility.

Vicarious liability means the responsibility of a

person, who is not negligent, for the wrongful

conduct or negligence of another.

CAPTAIN-OF-THE-SHIP DOCTRINE

This doctrine innunciates liability of the surgeon not

only for the wrongful acts of those who are under

his physical control but also those wherein he has

extension of control.

DOCTRINE OF RES IPSA LOQUITOR

The thing speaks for itself; nature of the wrongful act or injury is suggestive of negligence.

General rule: expert testimony is necessary to prove

that a physician has done a negligent act or that has

deviated from the standard of medical practice.

Requisites of Res Ipsa Loquitur Doctrine:

1. The accident must be of a kind which ordinarily does not occur in the absence of

someones negligence; 2. It must be caused by an agency or

instrumentality within the exclusive control

of the defendant;

3. It must not have been due to any voluntary action or contribution on the part of the

plaintiff.


12

Some cases wherein the Doctrine of Res Ipsa

Loquitor has been applied:

1. Objects left in the patients body at the time of caesarian section;

2. Injury to a healthy part of the body; 3. Removal of a wrong part of the body when

another part wad intended;

4. Infection resulting from unsterilized instruments;

5. Failure to take radiographs to diagnose a possible fracture;

Instances where the Doctrine of Res Ipsa

Loquitor does not apply:

1. Where the Doctrine of Calculated Risk is applicable;

2. When an accepted method of medical treatment involves hazards which may

produce injurious results regardless of

the care exercised by the physician.

3. Bad Result Rule; 4. Honest Errors of judgment as to

Appropriate Procedure;

5. Mistake in the Diagnosis

In most medical malpractice suits, there is a

necessity for a physician to give his expert medical

opinion to prove whether acts or omissions

constitute medical negligence. This doctrine has

been regarded as rule of sympathy to counteract the

conspiracy of silence

Legal Medicine Midterms Notes

Documents

Transcript of Legal Medicine Midterms Notes