LEGAL MEDICINE

Atty.. Ivy D. Patdu-Calaquian, MD

A.Y. 2016 - 2017

HEALTH PROFESSIONS UNDER PRC 3. Civil Code, Art. 26

1. What Health Related Professions are regulated by the Professional Regulations Commission? (Just have Art. 26. Every person shall respect the dignity, personality, privacy and peace of mind of his neighbors and
a general idea of what these professions are) other persons. The following and similar acts, though they may not constitute a criminal offense, shall
Dentistry - R.A. No. 9484 produce a cause of action for damages, prevention and other relief:
Medical Technology - R.A. No. 5527
Chemisty - R.A. No. 5527 (1) Prying into the privacy of another's residence:
Medicine - R.A. No. 2382
Midwifery - R.A. No. 7392 (2) Meddling with or disturbing the private life or family relations of another;
Nursing - R.A. No. 9173
Nutrition and Dietetics - P.D. No. 1286 (3) Intriguing to cause another to be alienated from his friends;
Optometry - R.A. No. 8050
Pharmacy - R.A. No. 5921 (4) Vexing or humiliating another on account of his religious beliefs, lowly station in life, place of
Physical and Occupational Therapy - R.A. 5680 birth, physical defect, or other personal condition.
Psychology - R.A. No. 10029
Radiologic and X-Ray Technology - R.A. No. 7431
Respiratory Therapy - R.A. No. 7431 4. What is Medical or Health Privacy?
Veterinary Medicine - R.A. No. 9268 It is the practice of keeping information about a patient confidential. This involves both
Sanitary Engineering - R.A. No. 1364 conversational discretion on the part of health care providers, and the security of medical
Social Workers - R.A. No. 4373 records.

It can also refer to the physical privacy of patients from other patients and providers while in a
MEDICAL PRIVACY medical facility.

PRIVACY is the state of being free from intrusion or disturbance in one's private life or affairs. Privacy
2. Philippine Constitution, Art. III, Sec. 1,3
pertains to an individuals right to be free from unwanted external scrutiny.
Section 1. No person shall be deprived of life, liberty, or property without due process of law, nor shall any CONFIDENTIALITY refers to the privacy of information and its protection against unauthorized disclosure.
person be denied the equal protection of the laws. Confidentiality points to the duty that rest on those to whom private information has been entrusted, that is,
that they will not unnecessarily disclose such privilege communication.

MEDICAL OR HEALTH PRIVACY is the protection of the confidential nature of personal health
Section 3. (1) The privacy of communication and correspondence shall be inviolable except upon lawful
information, includes communication between health provider and patient, personal data and information
order of the court, or when public safety or order requires otherwise, as prescribed by law.
about disease or patients condition as contained in medical records.
(2) Any evidence obtained in violation of this or the preceding section shall be inadmissible for any purpose
in any proceeding.

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 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017

5. Rules of Court, Rule 128, Section 24

RULE 130
Section 24. Disqualification by reason of privileged communication.
The following persons cannot testify as to matters learned in confidence in the following cases:
(a) The husband or the wife, during or after the marriage, cannot be examined without the consent
of the other as to any communication received in confidence by one from the other during the marriage
except in a civil case by one against the other, or in a criminal case for a crime committed by one against
the other or the latter's direct descendants or ascendants;
Marital Privilege Rule
Elements:
1.There must be a valid marriage between the husband and wife
2.There is a communication received in confidence by one from the other
3.The confidential communication was received during the marriage
Information acquired by the spouse before the marriage even if received confidentially
will not fall squarely under this section
To be considered confidential:
1. must be made during marriage
2. by reason of the marital relations
3. intended not to be shared
Privilege is extended to communications made for the purpose of securing the services of a
counsel even if the counsel later refuses the professional relationship
When consulted as a friend or a participant in a business, not as a lawyer, it would not fall
under this privilege
Communication may be oral or written (also by facsimile, cellular phone, or other electronic
means)
Not extend to communication where the clients purpose is the furtherance of a future intended
crime
Statements need not be made directly to attorney
Those made to the attorneys secretary, clerk or stenographer for the transmission to the
attorney for the purpose of the professional relationship, or with a view to such relationship are
covered by the privilege
(c) A person 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 capacity, and which would blacken the reputation of the patient;
Physician-patient Privilege
applies to a civil case
Information which cannot be disclosed refers to:

Communications in private between husband and wife are presumed to be confidential 1. any advice given to the client
Marital privilege rule may be WAIVED by failure of the claimant to object timely to its 2. any treatment given to the client
presentation or by any conduct that may be construed as implied consent 3. any information acquired in attending such patient provided that the advice, treatment or
information was made or acquired in a professional capacity and was necessary to enable him
(b) An attorney cannot, without the consent of his client, be examined as to any communication to act in that capacity
made by the client to him, or his advice given thereon in the course of, or with a view to, professional 4. information sought to be disclosed would tend to blacken the reputation of the patient
employment, nor can an attorney's secretary, stenographer, or clerk be examined, without the consent of
the client and his employer, concerning any fact the knowledge of which has been acquired in such Relationship does not need to be a result of a contractual relationship
capacity; Privilege survives the death of the patient
May be WAIVED by the patient, expressly or impliedly
Attorney-Client Privilege
Requisites: (d) A minister or priest cannot, without the consent of the person making the confession, be
1.There must be a communication made by the client to the attorney, or an advice given by the examined as to any confession made to or any advice given by him in his professional character in the
attorney to his client course of discipline enjoined by the church to which the minister or priest belongs;
2.The communication or advice must be given in confidence
3.The communication or advice must be given either in the course of the professional Priest/minister-penitent privilege
employment or with a view to professional employment Person making the confession holds the privilege
- does not require a perfected atty-client relationship Extends also to any advice given by the minister or priest

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 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
Confession and advice must be made or given pursuant to the course of discipline of the
denomination or sect to which the minister or priest belongs
Not every communication is privileged
Must be made pursuant to confession of sins
(e) A public officer cannot be examined during his term of office or afterwards, as to
communications made to him in official confidence, when the court finds that the public interest would
suffer by the disclosure. (21a)
Privileged communications to public officers
Communications are privileged when the court finds that the disclosure would adversely affect
the public interest
Privilege may be invoked not only during the term of office of the public officer but also
afterwards
Chavez v PCGG rules that there is privilege against disclosure on certain matters involving
state secrets regarding the following:
1. military
2. diplomatic
3. other national security matters
6. Lim vs Court of Appeals, 214 SCRA 273, 281-282 (1992)
FACTS:JUAN SIM filed with RTC a petition for annulment of such marriage on the ground that petitioner
has been allegedly suffering from a mental illness called schizophrenia before, during and after the
marriage and until the present. SIMs counsel announced that he would present as his next witness Dr.
Lydia Acampado, the Chief of the Female Services of the National Mental Hospital and a specialist in
Psychiatry. LIMs counsel opposed this 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. Trial court allowed the witness to testify and Dr.
Acampado took the witness stand and was asked hypothetical questions related to her field of expertise.
She neither revealed the illness she examined and treated the petitioner for nor disclosed the results of her
examination and the medicines she had prescribed.
Petitioner filed with CA a petition for certiorari and prohibition to annul the order of the RTC Judge on the
ground that it was issued with grave abuse of discretion amounting to lack of jurisdiction, and to prohibit
him from proceeding with the reception of Dr. Acampados testimony. CA Denied to the petition on the
ground that the petitioner failed to establish the confidential nature of the testimony given by or obtained
from Dr. Acampado pursuant to par. (c) Sec. 24 of Rule 130 of the Revised Rules of court which states the
conditions that would render as inadmissible testimonial evidence. Hence this petition under Rule 45.
ISSUE/S: WON CA erred in holding that not all the essential elements of the rule on physician-patient
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privileged communication under Sec. 24, Rule 130 exist - NO
HELD: Petition is devoid of any merit. CA committed no reversible error in its challenged resolution.
The law in point is paragraph (c), Section 24 of the Revised Rules on Evidence which reads:
"SECTION 24. Disqualification by reason of privileged communication. The following persons
cannot testify as to matters learned in confidence in the following cases:
xxx xxx xxx
(c) A person 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."
This rule on the physician-patient privilege is intended to facilitate and make safe full and
confidential disclosure by the patient to the physician of all facts, circumstances and symptoms,
untrammeled by apprehension of their subsequent and enforced disclosure and publication on
the witness stand, to the end that the physician may form a correct opinion, and be enabled
safely and efficaciously to treat his patient. It rests in public policy and is for the general interest
of the community. 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 4 fundamental conditions necessary for the establishment of a
privilege against the disclosure of a 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.
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
5.communications must be greater than the benefit thereby gained for the correct disposal of
litigation."
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
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 thses
requisites. We agree with CAs observation that the petitioner failed to discharge that burden for
the following reasons:
1.In the first place, Dr. Acampado was presented and qualified as an expert witness. As correctly
held by the Court of Appeals, 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. There is, as well, no showing that
Dr. Acampado's answers to the questions propounded to her relating to the hypothetical problem
were influenced by the information obtained from the petitioner. Otherwise stated, her expert
opinion excluded whatever information or knowledge she had about the petitioner which was
acquired by reason of the physician-patient relationship existing between them. As an expert
witness, her testimony before the trial court cannot then be excluded.
2.It was clear that Dr. Acampados testimony that the petitioner was never interviewed alone.
There is authority to the effect that information elicited during consultation with a physician in the
presence of third parties removes such information from the mantle of the privilege.
3.Dr. Acampado never disclosed any information obtained from the petitioner regarding the
latter's ailment and the treatment recommended therefor.
4.Granting ex gratia that the testimony of Dr. Acampado could be covered by the privilege, the
failure to seasonably object thereto amounted to a waiver thereof.
7. The Electronic Commerce Act of 2000 (Sec. 5,7,31-33)
Provides that any person with access to electronic data messages or documents has the obligation of
confidentiality or the duty not to convey the information to, or share it with, any other person. Under this
law, unauthorized access to computer systems Is punishable by a fine and mandatory imprisonment.
Pertinent provisions of the law with regard to Medical Privacy:
Section 5. Definition of Terms
(a) "Addressee" refers to a person who is intended by the originator to receive the electronic data message
or electronic document. The term does not include a person acting as an intermediary with respect to that
electronic data message or electronic data document.
(b) "Computer" refers to any device or apparatus which, by electronic, electro-mechanical, or magnetic
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impulse, or by other means, is capable of receiving, recording, transmitting, storing, processing, retrieving,
or producing information, data, figures, symbols or other modes of written expression according to
mathematical and logical rules or of performing any one or more of these functions.
(c) "Electronic Data Message" refers to information generated, sent, received or stored by electronic,
optical or similar means.
(d) "Information and Communications System" refers to a system intended for and capable of generating,
sending, receiving, storing, or otherwise processing electronic data messages or electronic documents and
includes the computer system or other similar device by or in which data is recorded or stored and any
procedures related to the recording or storage of electronic data message or electronic document.
(e) "Electronic Signature" refers to any distinctive mark, characteristic and/or sound in electronic form,
representing the identity of a person and attached to or logically associated with the electronic data
message or electronic document or any methodology or procedures employed or adopted by a person and
executed or adopted by such person with the intention of authenticating or approving an electronic data
message or electronic document.
(f) "Electronic Document" refers to information or the representation of information, data, figures, symbols
or other modes of written expression, described or however represented, by which a right is established or
an obligation extinguished, or by which a fact may be prove and affirmed, which is receive, recorded,
transmitted, stored, processed, retrieved or produced electronically.
(g) "Electronic Key" refers to a secret code which secures and defends sensitive information that cross
over public channels into a form decipherable only with a matching electronic key.
(h) "Intermediary" refers to a person who in behalf of another person and with respect to a particular
electronic document sends, receives and/or stores provides other services in respect of that electronic
data message or electronic document.
(i) "Originator" refers to a person by whom, or on whose behalf, the electronic document purports to have
been created, generated and/or sent. The term does not include a person acting as an intermediary with
respect to that electronic document.
(j) "Service provider" refers to a provider of -
i. On-line services or network access or the operator of facilities therefor, including entities offering the
transmission, routing, or providing of connections for online communications, digital or otherwise, between
or among points specified by a user, of electronic documents of the user's choosing; or
ii. The necessary technical means by which electronic documents of an originator may be stored and made
accessible to designated or undesignated third party.
GENERAL RULE: Service providers shall have no authority
to modify or alter the content of the electronic data message or electronic document received OR
to make any entry therein on behalf of the originator, addressee or any third party
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
EXCEPTION: they are specifically authorized to do so, and who shall retain the electronic document in
accordance with the specific request or as necessary for the purpose of performing the services it was
engaged to perform
What are the requisites for an electronic document to have legal effect?
Section 7. Legal Recognition of Electronic Documents
Electronic documents shall have the legal effect, validity or enforceability as any other document or legal
writing.
(a)Law requires a document to be in writing
Electronic document is valid and has legal effect IF
omaintains its integrity and reliability AND
ocan be authenticated so as to be usable for subsequent reference:
electronic document has remained complete and unaltered, apart from the addition of any endorsement
and any authorized change, or any change which arises in the normal course of communication, storage
and display; and
electronic document is reliable in the light of the purpose for which it was generated and in the light of all
relevant circumstances.
NOTE: Paragraph (a) applies whether the requirement therein is in the form of an obligation or whether the
law simply provides consequences for the document not being presented or retained in its original from.
(b)Law requires that a document be presented or retained in its original form
There exists a reliable assurance as to the integrity of the document from the time when it was first
generated in its final form; AND
That document is capable of being displayed to the person to whom it is to be presented:
oProvided, That NO provision of this Act shall apply to vary any and all requirements of existing laws on
formalities required in the execution of documents for their validity
NOTE:
For evidentiary purposes, an electronic document shall be the functional equivalent of a written document
under existing laws.
This Act does NOT modify any statutory rule relating to admissibility of electronic data massages or
electronic documents, EXCEPT the rules relating to authentication and best evidence.
Section 31. Lawful Access. - Access to an electronic file, or an electronic signature of an electronic data
message or electronic document shall only be authorized and enforced in favor of the individual or entity
having a legal right to the possession or the use of plaintext, electronic signature or file or solely for the
authorized purposes. The electronic key for identity or integrity shall not be made available to any person
or party without the consent of the individual or entity in lawful possession of that electronic key;
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Section 32. Obligation of Confidentiality. - Except for the purposes authorized under this Act, any person
who obtained access to any electronic key, electronic data message or electronic document, book,
register, correspondence, information, or other material pursuant to any powers conferred under this Act,
shall not convey to or share the same with any other person.
Section 33. Penalties. - The following Acts, shall be penalized by fine and/or imprisonment, as follows:
(a) Hacking or crackling with refers to unauthorized access into or interference in a computer
system/server or information and communication system; or any access in order to corrupt, alter, steal, or
destroy using a computer or other similar information and communication devices, without the knowledge
and consent of the owner of the computer or information and communications system, including the
introduction of computer viruses and the like, resulting in the corruption, destruction, alteration, theft or loss
of electronic data messages or electronic documents shall be punished by a minimum fine of One Hundred
Thousand pesos (P 100,000.00) and a maximum commensurate to the damage incurred and a mandatory
imprisonment of six (6) months to three (3) years;
(b) Piracy or the unauthorized copying, reproduction, dissemination, or distribution, importation, use,
removal, alteration, substitution, modification, storage, uploading, downloading, communication, making
available to the public, or broadcasting of protected material, electronic signature or copyrighted works
including legally protected sound recordings or phonograms or information material on protected works,
through the use of telecommunication networks, such as, but not limited to, the internet, in a manner that
infringes intellectual property rights shall be punished by a minimum fine of one hundred thousand pesos
(P 100,000.00) and a maximum commensurate to the damage incurred and a mandatory imprisonment of
six (6) months to three (3) years;
(c) Violations of the Consumer Act of Republic Act No. 7394 and other relevant to pertinent laws through
transaction covered by or using electronic data messages or electronic documents, shall be penalized with
the same penalties as provided in those laws;
(d) Other violations of the provisions of this Act, shall be penalized with a maximum penalty of one million
pesos (P 1,000,000.00) or six (6) years imprisonment.
8. The Anti-Wiretapping Law (RA No. 4200, Sec. 1-2)
Acts Punishable
It shall be unlawful for any person:
a.not being authorized by all the parties to any private communication or spoken word, to tap any wire or
cable, or by using any other device or arrangement, to secretly overhear, intercept, or record such
communication or spoken word by using a device commonly known as a dictaphone or dictagraph or
dictaphone or walkie-talkie or tape recorder, or however otherwise described; (Sec. 1 par. 1)
b.be he a participant or not in the act or acts penalized in the next preceding sentence, to knowingly
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Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
possess any tape record, wire record, disc record, or any other such record, or copies thereof, of any
communication or spoken word secured either before or after the effective date of this Act in the manner
prohibited by this law; or to replay the same for any other person or persons; or to communicate the
contents thereof, either verbally or in writing, or to furnish transcriptions thereof, whether complete or
partial, to any other person: Provided, That the use of such record or any copies thereof as evidence in
any civil, criminal investigation or trial of offenses mentioned in section 3 hereof, shall not be covered by
this prohibition. (Sec. 1 par. 2)
Penalty
Any person who willfully or knowingly does or who shall aid, permit, or cause to be done any of the acts
declared to be unlawful in the preceding section or who violates the provisions of the following section or of
any order issued thereunder, or aids, permits, or causes such violation shall, upon conviction thereof, be
punished by imprisonment for not less than six months or more than six years and with the accessory
penalty of perpetual absolute disqualification from public office if the offender be a public official at the time
of the commission of the offense, and, if the offender is an alien he shall be subject to deportation
proceedings. (Sec. 2)
9. The Data Privacy Act (Rights of Data Subject and Penal Provisions)
Who is a Data subject?
It refers to an individual whose personal information is processed.
What is the right to data portability?
The data subject shall have the right, where personal information is processed by
electronic means and in a structured and commonly used format, to obtain from the
personal information controller a copy of data undergoing processing in an electronic
or structured format, which is commonly used and allows for further use by the data
subject. The Commission may specify the electronic format referred to above, as well
as the technical standards, modalities and procedures for their transfer.
What are the rights of a data subject?
The data subject is entitled to:
1. Be informed whether personal information pertaining to him or her shall be, are being or have
been processed;
2. Be furnished the information indicated hereunder before the entry of his or her personal
information into the processing system of the personal information controller, or at the next practical
opportunity:
Description of the personal information to be entered into the system;
Purposes for which they are being or are to be processed;
Scope and method of the personal information processing;
The recipients or classes of recipients to whom they are or may be disclosed;
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Methods utilized for automated access, if the same is allowed by the data subject, and the
extent to which such access is authorized;
The identity and contact details of the personal information controller or its representative;
The period for which the information will be stored; and
The existence of their rights, i.e., to access, correction, as well as the right to lodge a complaint
before the Commission.
Any information supplied or declaration made to the data subject on these matters
shall not be amended without prior notification of data subject: Provided, That the notification
under subsection (b) shall not apply should the personal information be needed pursuant to a
subpoena or when the collection and processing are for obvious purposes, including when it is
necessary for the performance of or in relation to a contract or service or when necessary or
desirable in the context of an employer-employee relationship, between the collector and the
data subject, or when the information is being collected and processed as a result of legal
obligation
3. Reasonable access to, upon demand, the following:
Contents of his or her personal information that were processed;
Sources from which personal information were obtained;
Names and addresses of recipients of the personal information;
Manner by which such data were processed;
Reasons for the disclosure of the personal information to recipients;
Information on automated processes where the data will or likely to be made as the sole basis
for any decision significantly affecting or will affect the data subject;
Date when his or her personal information concerning the data subject were last accessed and
modified; and
The designation, or name or identity and address of the personal information controller;
4. Dispute the inaccuracy or error in the personal information and have the personal information
controller correct it immediately and accordingly, unless the request is vexatious or otherwise
unreasonable. If the personal information have been corrected, the personal information controller shall
ensure the accessibility of both the new and the retracted information and the simultaneous receipt of the
new and the retracted information by recipients thereof: Provided, That the third parties who have
previously received such processed personal information shall he informed of its inaccuracy and its
rectification upon reasonable request of the data subject;
5. Suspend, withdraw or order the blocking, removal or destruction of his or her personal
information from the personal information controllers filing system upon discovery and substantial proof
that the personal information are incomplete, outdated, false, unlawfully obtained, used for unauthorized
purposes or are no longer necessary for the purposes for which they were collected. In this case, the
personal information controller may notify third parties who have previously received such processed
personal information; and
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Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
6. Be indemnified for any damages sustained due to such inaccurate, incomplete, outdated, false,
unlawfully obtained or unauthorized use of personal information.
Are these rights transmissible?
oYes. The lawful heirs and assigns of the data subject may invoke the rights of the data subject
for, which he or she is an heir or assignee at any time after the death of the data subject or when
the data subject is incapacitated or incapable of exercising the rights as enumerated in the
immediately preceding section.
Principles of Transparency, Legitimate Purpose and Proportionality.
oThe processing of personal data shall be allowed subject to adherence to the principles of
transparency, legitimate purpose, and proportionality.
Transparency.
oThe data subject must be aware of the nature, purpose, and extent of the processing of his or
her personal data, including the risks and safeguards involved, the identity of personal
information controller, his or her rights as a data subject, and how these can be exercised. Any
information and communication relating to the processing of personal data should be easy to
access and understand, using clear and plain language.
Legitimate purpose.
oThe processing of information shall be compatible with a declared and specified purpose which
must not be contrary to law, morals, or public policy
Proportionality.
OThe processing of information shall be adequate, relevant, suitable, necessary, and not
excessive in relation to a declared and specified purpose. Personal data shall be processed only if the
purpose of the processing could not reasonably be fulfilled by other means.
10. In relation to Right to Privacy and Confidentiality RA No. 9165, RA No. 9262, RA 8505 (What must be
kept confidential?)
Under RA 9165 or the Comprehensive Dangerous Drugs Act of 2002:
1) Judicial and medical records of drug dependents under the voluntary submission program, except how
to determine how many times he/she has voluntarily submitted.
2) Records of a drug dependent who was rehabilitated and discharged under the compulsory submission
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program.
3) Record of proceedings on suspension of sentence.
Under RA 9262 or Anti-Violence Against Women and Their Children of 2004
1) Medical/health records of the victim
2) All records pertaining to cases of violence against women and children, including those in the barangay.
3) Form submitted by the victim/complainant to the court.
4) The Court may require to exclude all others from attending the hearing and conduct all proceedings
consistent with upholding the dignity and privacy of women and children.
Under RA 8505 or Rape Victim Assistance and Protection Act of 1998
1) It is the duty of the police officers to ensure only persons authorized by the offended party shall be
allowed inside the room where the investigation or medical or physical examination is being conducted.
2) The name and personal circumstances of the offended party and the accused must not be disclosed to
the public.
3) Past sexual conduct of the complainant shall not be disclosed unless material and relevant to the case.
11. RA No. 8504 Philippine AIDS Prevention and Control Act of 1998 Sec. 15-17, 30-42
Art. III TESTING, SCREENING AND COUNSELLING
Sec. 15. Consent as a requisite for HIV testing. No compulsory HIV testing shall be allowed. However,
the State shall encourage voluntary testing for individuals with a high risk for contracting HIV: Provided,
That written informed consent must first be obtained. Such consent shall be obtained from the person
concerned if he/she is of legal age or from the parents or legal guardian in the case of a minor or a
mentally incapacitated individual. Lawful consent to HIV testing of a donated human body, organ, tissue, or
blood shall be considered as having been given when:
(a) a person volunteers or freely agrees to donate his/her blood, organ, or tissue for transfusion,
transplantation, or research;
(b) a person has executed a legacy in accordance with Sec. 3 of Republic Act No. 7170, also
known as the"Organ Donation Act of 1991";
(c) a donation is executed in accordance with Sec. 4 of Republic Act No. 7170.
Section 16. Prohibitions on compulsory HIV testing. Compulsory HIV testing as a precondition to
employment, admission to educational institutions, the exercise of freedom of abode, entry or continued
stay in the country, or the right to travel, the provision of medical service or any other kind of service, or the
continued enjoyment of said undertakings shall be deemed unlawful.
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Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
Section 17. Exception to the prohibition on compulsory testing. Compulsory HIV testing may be allowed
only in the following instances:
(a) When a person is charged with any of the crimes punishable under Articles 264 and 266 as amended
by Republic Act No. 8353, 335 and 338 of Republic Act No. 3815, otherwise known as the "Revised Penal
Code"or under Republic Act No. 7659;
(b) When the determination of the HIV status is necessary to resolve the relevant issues under Executive
Order No. 309, otherwise known as the "Family Code of the Philippines"; and
(c) When complying with the provisions of Republic Act No. 7170, otherwise known as the "Organ
Donation Act" and Republic Act No. 7719, otherwise known as the "National Blood Services Act".
Q: Is compulsory HIV testing allowed?
GENERAL RULE: NO. No compulsory HIV testing shall be allowed.
oEXTENT: The following prohibitions on compulsory HIV testing are also covered
Compulsory HIV testing as a precondition to:
1. Employment,
2. Admission to educational institutions,
3. The exercise of freedom of abode,
4. Entry or continued stay in the country, or the right to travel,
5. The provision of medical service or any other kind of service, or
Not: The continued enjoyment of said undertakings shall be deemed unlawful.
EXCEPTIONS: Compulsory HIV testing may be allowed only in the following instances:
(a) When a person is charged with any of the Crimes punishable under Articles 264 and 266, 335 and 338
of the Revised Penal Code or under R.A. 7659;
(b) When the determination of the HIV status is necessary to resolve the relevant issues under the Family
Code of the Philippines; and
(c) When complying with the provisions of R.A. 7170 or the Organ Donation Act and R.A. 7719 or the
National Blood Services Act.
8
Q: Is voluntary HIV testing allowed?
YES. The State shall encourage voluntary testing for individuals with a high risk for contracting HIV.
o REQUISITE before voluntary HIV testing may be conducted:
WRITTEN INFORMED CONSENT must first be obtained.
Q: Who may give consent?
oSuch consent shall be obtained from:
1. The person concerned if he/she is of legal age or
2. From the parents or legal guardian in the case of a minor or a mentally incapacitated
individual.
Note: Lawful consent to HIV testing of a donated human body, organ, tissue, or blood shall be considered
as having been given when:
(a) a person volunteers or freely agrees to donate his/her blood, organ, or tissue for
transfusion, transplantation, or research;
(b) a person has executed a legacy in accordance with Sec. 3 of Republic Act No.
7170, also known as the"Organ Donation Act of 1991";
(c) a donation is executed in accordance with Sec. 4 of Republic Act No. 7170.
ART. VI CONFIDENTIALITY
Sec. 30. Medical confidentiality. All health professionals, medical instructors, workers, employers,
recruitment agencies, insurance companies, data encoders, and other custodians of any medical record,
file, data, or test results are directed to strictly observe confidentiality in the handling of all medical
information, particularly the identity and status of persons with HIV.
Section 31. Exceptions to the mandate of confidentiality. Medical confidentiality shall not be considered
breached in the following cases:
(a) when complying with reportorial requirements in conjunction with the AIDSWATCH programs provided
in Sec. 27 of this Act;
(b) when informing other health workers directly involved or about to be involved in the treatment or care of
a person with HIV/AIDS: Provided, That such treatment or care carry the risk of HIV transmission:
Provided, further, That such workers shall be obliged to maintain the shared medical confidentiality;
(c) when responding to a subpoena duces tecum and subpoena ad testificandum issued by a Court with
jurisdiction over a legal proceeding where the main issue is the HIV status of an individual: Provided, That
the confidential medical record shall be properly sealed by its lawful custodian after being double-checked
for accuracy by the head of the office or department, hand delivered, and personally opened by the judge:
Provided, further, That the judicial proceedings be held in executive session.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
Section 32. Release of HIV/AIDS test results. All results of HIV/AIDS testing shall be confidential and
shall be released only to the following persons:
(a) the person who submitted himself/herself to such test;
(b) either parent of a minor child who has been tested;
(c) a legal guardian in the case of insane persons or orphans;
(d) a person authorized to receive such results in conjunction with the AIDSWATCH program as
provided in Sec. 27 of this Act;
(e) a justice of the Court of Appeals or the Supreme Court, as provided under subSec. (c) of this
Act and in accordance with the provision of Sec. 16 hereof.
Section 33. Penalties for violations of confidentiality. Any violation of medical confidentiality as provided
in Sec.s 30 and 32 of this Act shall suffer the penalty of imprisonment for six (6) months to four (4) years,
without prejudice to administrative sanctions such as fines and suspension or revocation of the violator's
license to practice his/her profession, as well as the cancellation or withdrawal of the license to operate
any business entity and the accreditation of hospitals, laboratories or clinics.
Section 34. Disclosure to sexual partners. Any person with HIV is obliged to disclose his/her HIV status
and health condition to his/her spouse or sexual partner at the earliest opportune time.
Q: Who has the duty of maintaining patient confidentiality
The duty of maintaining patient confidentiality is imposed on all persons involved in handling and
maintaining patient records.
SCOPE: The law extends the duty not just to health professionals but also to:
oHealth instructors,
oCo-workers, employers,
oRecruitment agencies,
oInsurance companies,
oData encoders, and
oOther custodians of medical records.
Q: What is the effect if someone violated the patient confidentiality?
GENERAL RULE: he is punishable under R.A. 8504
oAny violation of medical confidentiality as provided in Sec.s 30 and 32 of this Act shall suffer
the penalty of imprisonment for six (6) months to four (4) years, without prejudice to
administrative sanctions such as fines and suspension or revocation of the violator's license to
practice his/her profession, as well as the cancellation or withdrawal of the license to operate
any business entity and the accreditation of hospitals, laboratories or clinics.
9
EXCEPTIONS: Medical confidentiality shall not be considered breached in the following cases:
(a) when complying with reportorial requirements in conjunction with the AIDSWATCH
programs;
(b) when informing other health workers directly involved or about to be involved in the treatment
or care of a person with HIV/AIDS:
Provided, That such treatment or care carry the risk of HIV transmission:
Provided, further, That such workers shall be obliged to maintain the shared medical
confidentiality;
(c) when responding to a subpoena duces tecum and subpoena ad testificandum issued by a
Court with jurisdiction over a legal proceeding where the main issue is the HIV status of an
individual:
Provided, That the confidential medical record shall be properly sealed by its lawful custodian
after being double-checked for accuracy by the head of the office or department, hand delivered,
and personally opened by the judge:
Provided, further, That the judicial proceedings be held in executive session.
Q: When HIV testing is validly conducted, to whom shall the HIV/AIDS results be released?
All results of HIV/AIDS testing shall be confidential and shall be released only to the following persons:
(a) the person who submitted himself/herself to such test;
(b) either parent of a minor child who has been tested;
(c) a legal guardian in the case of insane persons or orphans;
(d) a person authorized to receive such results in conjunction with the AIDSWATCH program
(e) a justice of the Court of Appeals or the Supreme Court, as provided under subSec. (c) of this
Act and in accordance with the provision of Sec. 16 hereof.
Q: When is a person obliged to disclose his/her HIV status?
Any person with HIV is obliged to disclose his/her HIV status and health condition to his/her spouse or
sexual partner at the earliest opportune time
ART. VII DISCRIMINATORY ACTS AND POLICIES
Sec. 35. Discrimination in the workplace. Discrimination in any form from pre-employment to post-
employment, including hiring, promotion or assignment, based on the actual, perceived or suspected HIV
status of an individual is prohibited. Termination from work on the sole basis of actual, perceived or
suspected HIV status is deemed unlawful.
Section 36. Discrimination in schools. No educational institution shall refuse admission or expel,
discipline, segregate, deny participation, benefits or services to a student or prospective student on the
basis of his/her actual, perceived or suspected HIV status.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017

Section 37. Restrictions on travel and habitation. The freedom of abode, lodging and travel of a person
with HIV shall not be abridged. No person shall be quarantined, placed in isolation, or refused lawful entry
into or deported from Philippine territory on account of his/her actual, perceived or suspected HIV status.
Section 38. Inhibition from public service. The right to seek an elective or appointive public office shall
not be denied to a person with HIV.
Section 39. Exclusion from credit and insurance services. All credit and loan services, including health,
accident and life insurance shall not be denied to a person on the basis of his/her actual, perceived or
suspected HIV status: Provided, That the person with HIV has not concealed or misrepresented the fact to
the insurance company upon application. Extension and continuation of credit and loan shall likewise not
be denied solely on the basis of said health condition.
Section 40. Discrimination in hospitals and health institutions. No person shall be denied health care
service or be charged with a higher fee on account of actual, perceived or suspected HIV status.
Section 41. Denial of burial services. A deceased person who had AIDS or who was known, suspected
or perceived to be HIV-positive shall not be denied any kind of decent burial services.
Section 42. Penalties for discriminatory acts and policies. All discriminatory acts and policies referred to
in this Act shall be punishable with a penalty of imprisonment for six (6) months to four (4) years and a fine
not exceeding Ten thousand pesos (P10,000.00). In addition, licenses/permits of schools, hospitals and
other institutions found guilty of committing discriminatory acts and policies described in this Act shall be
revoked.
Q: For instance, Becky is the head chef of St. Bernard College. One day, a man went to Beckys workplace
and made a scene. He said: P.I. ka, Becky! Nagkasakit ako dahil sayo! Nakipagtalik ka sa akin yun pala
may sakit ka!. The scene was the talk of the town among students and teachers. Becky was consequently
dismissed from employment. Is the school liable for terminating Becky?
NO. The school is not justified in terminating Becky. Discrimination in ANY FORM based on the actual,
perceived or suspected HIV status of an individual is prohibited.
oMoreover, there is no evidence that people get infected with HIV by having their food prepared by HIV
positive people. There are 2 main reasons for this:
1) HIV is only known to be transmitted in three ways: sexual transmission, blood-to-blood contact (injection
needles and health care settings), and from mother to infant. Other routes of transmission are theoretical
only.
2) HIV does not survive long enough in the environment to pose a real risk through contact of this sort.
Scientists found that drying fluids containing very high concentrations of HIV (concentrations that are not
normally encountered in day-to-day life) reduced the number of infectious virus by 90% to 99%.
Q: What are the discriminatory acts prohibited?
Employers cannot discriminate in hiring, firing, promotion, or assignment based on actual or
suspected HIV status.
Schools are not allowed to refuse admission, punish students, or deny participation in
activities based on real or perceived HIV status.
A person with HIV has the legal right to travel, live, and lodge with the same freedom as any
other citizen. Quarantines and other restrictions are illegal.
A person with HIV has every legal right to seek pubic office.
Credit services cannot be denied based on HIV status. Insurance cannot be refused based on
HIV status, provided the person does not lie about their HIV status.
Hospitals and heath services cannot refuse treatment or discriminate based on HIV status.
Decent burials cannot be denied based on HIV status.

YES. Under R.A. 8504, Discrimination in ANY FORM from pre-employment to post-employment,
including hiring, promotion or assignment, based on the actual, perceived or suspected HIV status of an
individual is prohibited. Termination from work on the sole basis of actual, perceived or suspected HIV
status is deemed unlawful.
o All discriminatory acts and policies referred to in this Act shall be punishable with a penalty of
imprisonment for six (6) months to four (4) years and a fine not exceeding Ten thousand pesos
(P10,000.00). In addition, licenses/permits of schools, hospitals and other institutions found guilty of
committing discriminatory acts and policies described in this Act shall be revoked.

Q: In the same problem above, what if the School contended that they cannot be tolerating that a person
who is afflicted with AIDS/STD to be working in such close proximity to the students food for fear that they
might be transmitted with the disease, is the school justified in terminating Becky?

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 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
PHYSICIAN LIABILITY
12. Medical Act of 1959, Sec. 10-12, 24, 27-28
Section 10 Acts constituting the practice of medicine
The following are considered engaged in the practice of medicine:
I. A person who:
a.shall for compensation, fee, salary or reward in any form paid to him directly or through
another, or even without the same,
b. 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; or
II. A person who:
a.Shall by means of signs, cards, advertisement, written or printed matter, or through the radio,
television or any other means of communication,
b.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; or
III. A person who shall falsely use the title of M.D. after his name.
Section 11. Exemptions. There are acts of diagnosis and treatment and yet not construed to be within the
purview of Sec. 10 and therefore not considered to constitute a practice of medicine.
(a) any medical student duly enrolled in an approved medical college or school under training, serving
without any professional fee in any government or private hospital, provided that he renders such service
under the direct supervision and control of a registered physician;
(b) any legally registered dentist engaged exclusively in the practice of dentistry;
(c) any duly registered masseur or physiotherapist, provided that he applies massage or other physical
means upon written order or prescription of a duly registered physician, or provided that such application of
massage or physical means shall be limited to physical or muscular development;
(d) any duly registered optometrist who mechanically fits or sells lenses, artificial eyes, limbs or other
similar appliances or who is engaged in the mechanical examination of eyes for the purpose of
constructing or adjusting eye glasses, spectacles and lenses;
(e) any person who renders any service gratuitously in cases of emergency, or in places where the
services of a duly registered physician, nurse or midwife are not available;
(f) any person who administers or recommends any household remedy as per classification of existing
Pharmacy Laws; and
(g) any psychologist or mental hygienist in the performance of his duties, provided such performance is
done in conjunction with a duly registered physician.
11
(h) prosthetists who fit artificial limbs under the supervision of a registered physician.
Section 12 - Certificates of registration shall not be required of the following persons:
(a) Physicians and surgeons from other countries called in consultation only and exclusively in specific and
definite cases, or those attached to international bodies or organization assigned to perform certain
definite work in the Philippines provided they shall limit their practice to the specific work assigned to them
and provided further they shall secure a previous authorization from the Board of Medical Examiners.
(b) Commissioned medical officers of the United States armed forces stationed in the Philippines while
rendering service as such only for the members of the said armed forces and within the limit of their own
respective territorial jurisdiction.
(c) Foreign physicians employed as exchange professors in special branches of medicine or surgery
whose service may in the discretion of the Board of Medical Education, be necessary.
(d) 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 Secretary of Health to render
medical services during epidemics or national emergencies whenever the services of duly registered
physicians are not available. Such authorization shall automatically cease when the epidemic or national
emergency is declared terminated by the Secretary of Health.
Section 24 Grounds for reprimand, suspension or revocation of registration certificate. Any of the
following shall be sufficient ground for reprimanding a physician, or for suspending or revoking a certificate
of registration as physician:
(1) Conviction by a court of competent jurisdiction of any criminal offense involving moral turpitude;
(2) Immoral or dishonorable conduct;
(3) Insanity;
(4) Fraud in the acquisition of the certificate of registration;
(5) Gross negligence, ignorance or incompetence in the practice of his or her profession resulting in an
injury to or death of the patient;
(6) Addiction to alcoholic beverages or to any habit forming drug rendering him or her incompetent to
practice his or her profession, or to any form of gambling;
(7) False or extravagant or unethical advertisements wherein other things than his name, profession,
limitation of practice, clinic hours, office and home address, are mentioned.
(8) Performance of or aiding in any criminal abortion;
(9) Knowingly issuing any false medical certificate;
(10) Issuing any statement or spreading any news or rumor which is derogatory to the character and
reputation of another physician without justifiable motive;
(11) Aiding or acting as a dummy of an unqualified or unregistered person to practice medicine;
(12) Violation of any provision of the Code of Ethics as approved by the Philippine Medical Association.
Refusal of a physician to attend a patient in danger of death is not a sufficient ground for revocation or
suspension of his registration certificate if there is a risk to the physician's life.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017

Section 27. Reinstatement. the Board may order the reinstatement of any physician whose certificate of
registration has been revoked if:
a.After two years,
b.the respondent has acted in an exemplary manner in the community wherein he resides, and
c.has not committed any illegal, immoral or dishonorable act.
Section 28. Penalties. Any person found guilty of "illegal practice of medicine" shall be punished by a fine
of not less than one thousand pesos nor more than ten thousand pesos with subsidiary imprisonment in
case of insolvency, or by imprisonment of not less than one year nor more than five years, or by both such
fine and imprisonment, in the discretion of the court.
13. Code of Medical Ethics
DUTIES:
1. Duties of Physicians to their Patients
2. Duties of Physicians to the Community
3. Duties of Physicians to their Colleagues to the Profession
4. Duties of Physicians to Allied Professionals
I. DUTIES OF PHYSICIANS TO THEIR PATIENTS
Section 1. A physician should be dedicated to provide competent medical care with full professional skill in
accordance with the current standards of care, compassion, independence and respect for human dignity.
Section 2. A physician should be free to choose patients.
Section 3. In an emergency, provided there is no risk to his or her safety, a physician should administer at
least first aid treatment and then refer the patient to the primary physician and/or to a more competent
health provider and appropriate facility if necessary.
Section 4. In serious/difficult cases, or when the circumstances of the patient or the family so demand or
justify, the attending physician should seek the assistance of the appropriate specialist.
Section 5. A physician should exercise good faith and honesty in expressing opinion/s as to the diagnosis,
prognosis, and treatment of a case under his/her care.
A physician shall respect the right of the patient to refuse medical treatment.
Timely notice of the worsening of the disease should be given to the patient and/or family.
A physician shall not conceal nor exaggerate the patients condition except when it is to the latters best
interest.
A physician shall obtain from the patient a voluntary informed consent. In case of unconciousness or in a
state of mental deficiency the informed consent may be given by a spouse or immediate relatives and in
the absence of both, by the party authorized by an advanced directive of the patient. Informed consent in
the case of minor should be given by the parents or guardian, members of the immediate family that are of
legal age.
Section 6. The physician should hold as sacred and highly confidential whatever may be discovered or
learned pertinent to the patient even after death, except when required in the promotion of justice, safety
and public health.
Section 7. Professional fees should be commensurate to the services rendered with due consideration to
the patients financial status, nature of the case, time consumed and the professional standing and skill of
the physician in the community.
II. DUTIES OF PHYSICIANS TO THE COMMUNITY
Section 1. A physician should cooperate with the duly constituted health authorities in the education and
enforcement of laws and regulations for the promotion of health. Furthermore, in times of epidemic and
public calamity, except when his or her personal safety is at stake, the physician must attend to the
victims, alert the public and duly constituted health authorities on the dangers of communicable diseases
and enforce measures for prevention and cure in accordance with existing laws, rules and regulations.
Section 2. A physician shall assist the government in the administration of justice in accordance with law.
He/she maybe accorded a fair and just remuneration when called upon as an expert witness.
Section 3. A physician is encouraged to expose and report to the proper authorities unlicensed medical
practitioners, charlatans and quacks in as much as their nefarious practices may cause injury to health and
life. A physician should never condone nor connive with such fake health providers.
Section 4. A physician shall not employ agents in the solicitation and recruitment of patients. For the
promotion of medical practice, a physician may use professional cards, classified advertising, publications,
internet, directories and signboards. Signboards shall not exceed one by two (1x2) meters in size. Except in internet web
sites, only the name of the physician, field of specialty, office hours or office or residential addresses may appear. The act
of the physician in publishing his or her personal superiority, special certificates or diplomas, post graduate training,
specific methods of treatment, operative techniques or former connections with hospitals or clinics is not allowed.
However, these matters may be placed by a physician within the confines of his clinic or residence. For internet web
sites, recognizing the right of a patient to know the capabilities and qualifications of his doctor, special
certificates or diplomas, post graduate training and former connections with hospitals or clinics may be
posted. Section 5. A physician involved in multimedia must be well informed of the matter under
discussion. Only the name of the physician and membership to a society or institution may be mentioned
or posted. A physician should only make a general opinion and shall refrain from making a specific
diagnosis, therapy or projection to individual cases in his appearances in the broadcast media. An article
written by a physician must be evidence-based and disclose connections with pharmaceutical or health
product companies. A physician shall not commercially endorse any medical or health product.

12
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
III. DUTIES OF PHYSICIANS TO THEIR COLLEAGUES TO THE PROFESSION
Section 1. A physician shall waive his professional fees to a colleague, his or her spouse, children and
parents who are financially dependent on him.
Section 2. When necessary, the attending physician should always seek consultation from an available
appropriate specialist.
Section 3. The primary and consultant physicians should always observe the proper protocol of the referral
system. The consultant may make another referral but should seek permission from the primary physician.
In making a referral, a physician should forward a clinical abstract and specify the purpose as to whether
the case is for opinion/evaluation, for co-management, or for transfer of service.
Section 4. With the consent of the patient, in cases where a physician has to suspend service during
temporary absences, the substitute physician shall treat the patient with the same dedication and quality of
care extended to his/her own patient. The patient should be returned to the care of the primary physician
as soon as possible.
Section 5. Whenever a physician makes a social or business call on a patient under the care of another,
making comments pertaining to the case is unethical unless if an emergency arises.
Section 6. Whenever there is an irreconcilable difference of opinion in the management of a case, the
matter should be referred to the Philippine Medical Association or the specialty society concerned.
Section 7. Members of the editorial board of medical journals should possess adequate qualifications.
Written articles and scientific presentations in scientific conferences should include full disclosure of any
pharmaceutical support and should be independent of any commercial influence.
Section 8. A physician shall not receive any commission for referring patients to a colleague, third person
or institution. However, nominal gifts during occasions may be received by a physician.
Section 9. A physician is encouraged to report to the Philippine Medical Association or the Board of
Medicine personal knowledge of any corrupt or dishonest conduct of the members of the profession.
Section 10. Continuing medical education conferences and professional meetings must contribute to
improve and optimize patients care or address the educational needs of the targeted medical audience.
They must be organized by a medical society on its own or in cooperation with sponsoring entities.
Section 11. Funds from commercial sources may be accepted for the benefit of the association or society.
Section 12. Physicians may accept reasonable subsidies from health and other industries to support their
participation in CME events.
13
Section 13. The faculty/speaker/consultant of conferences or meetings is allowed to accept from health
industries honoraria and reimbursement for reasonable transportation, lodging and meal expenses.
Section 14. Scholarships for physicians and medical students are permissible as long as the selection of
scholars are made by the organizers or academic institutions concerned.
Section 15. Generic names shall be used during the course of CME activities. However, after the lectures,
the sponsoring entity may promote or indicate their branded products.
Section 16. When commercial exhibits are part of the overall program, arrangements for these should not
influence the planning nor interfere with the CME activities. Only relevant information of the product should
be included in the exhibit area.
IV. DUTIES OF PHYSICIANS TO ALLIED PROFESSIONALS
Section 1. Physicians should never pay nor receive commission to or from any allied health worker for
cases referred.
V. RELATIONSHIP OF PHYSICIANS WITH THE HEALTH PRODUCTS INDUSTRY
Section 1. The physician shall not derive any form of material gain from product samples.
Section 2. Physicians may participate in post-marketing or similar activities where they are asked to try
new products on patients provided that the patients are properly informed and have given their informed
consent. Physicians are encouraged to report or share the result of such activities to the duly constituted
authorities.
Section 3. Only gifts of reasonable value that primarily entail benefit to patient care or related to physicians
work may be accepted by a physician from a health product company.
Section 4. Physicians may request donations for a charitable purpose for as long as it does not redound to
his or her personal benefit.
Section 5. Research activities shall be ethically defensible, socially responsible, and scientifically valid. Any
remuneration should be reasonable and should not constitute an enticement.
Section 6. Research trials conducted by physicians for an industry should be done in accordance with the
national or institutional guidelines for the protection of human subjects.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017

14. EO No. 212, Amending Presidential Decree No. 169 (July 10, 1987) SECTION 4.

SECTION 1. Any violation of this Act or of the aforesaid rules and regulations issued by the Secretary of Health, in
consultations with the Philippine Constabulary, shall be punished administratively with a fine that shall not
The attending physician of any: be less than One Hundred Pesos (P100.00) nor more than Five Hundred Pesos (P500.00).
hospital
medical clinic The license or permit of the attending physician shall be cancelled upon the third violations of this Act or of
sanitarium or its implementing rules and regulations.
other medical establishments,
The Board of Medicine shall have the original and exclusive jurisdiction to investigate, hear and decide,
or any other medical practitioner, upon due notice, all cases of violations of this Act or of its implementing rules and regulations, subject to
review by the Professional Regulation Commission when seasonably appealed thereto.
who has treated any person for serious or less serious physical injuries as these injuries are defined in
Articles 262, 263, 264 and 265 of the RPC

shall report the fact of such treatment promptly to the nearest government health authority: 15. RPC Arts. 15, 174, 259, 347, 365

Provided, That no fee shall be charged for the transmission of such report through government Article 15, Revised Penal Code
communication facilities:
1.Alternative Circumstance
Provided, further, That records of the reports kept by said health authorities shall, upon written request, be -Those which must be taken into consideration as aggravating or mitigating according to the nature and
made available to law enforcement agencies. effects of the crime and the other conditions attending its commission.
SECTION 2. -Alternative Circumstances
oRelationship
The report called shall indicate, when practicable, the following: oIntoxication
a) the name, age and address of the patient; oDegree of instruction and education of the offender
b) the name and address of the nearest of kin of the patient;
c) the name and address of the person who brought the patient for medical treatment; -Instruction or Education
d) the nature and probable cause of the patients injury;
e) the approximate time and date when the injury was sustained; As an alternative circumstance, it does not refer only to literacy but more to the level of
f) the place where the injury was sustained; intelligence of the accused. It refers to the lack of sufficient intelligence and knowledge of the full
g) the time, date and nature of the treatment; and significance of ones acts (People vs Nabong)
h) the diagnosis, the prognosis and/or disposition of the patient.
-General Rule: Lack of sufficient education is MITIGATING
SECTION 3.
-Exceptions:
The Secretary of Health, in consultation with the Philippine Constabulary, shall promulgate the rules and oCrimes against property
regulations necessary to carry out the purposes of this Act. oCrimes against chastity
oTreason
oMurder
oRape

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 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017

-The operative act in the simulation is the registration of the child in the registry of births as the
pretending parents own.

Article 174, Revised Penal Code -The simulation which is a crime is that which alters the civil status of person

1.False Medical Certificate, false certificate of Merit or Service

(1) Physician or surgeon who, in connection with the practice of his profession, issued a false -The one who simulates and furnishes the child both liable as Principals
certificate
O The crime is False Medical Certificate by a Physician 3.Concealment or Abandonment of legitimate child (elements)
oThe child must be legitimate
(2) Private individual who falsified a certificate falling in the classes mentioned in par. 1 and 2 of oThe offender conceals or abandons such child
Art. 174. oThe offender has the intent to cause such child to lose its civil status
O The crime is False Medical Certificate by a private individual
Article 365, Revised Penal Code
-Certificate is any writing by which testimony is given that a fact has or has not taken place.
1.Imprudence or Negligence
Article 259, Revised Penal Code
-Reckless Imprudence (elements)
1.Abortion Practiced by a Physician or Midwife in dispensing of abortives oThat the offender does or fails to do an act;
oThat the doing or the failure to do that act is voluntary;
a.As to physician and midwife (elements) oThat it be without malice;
oThat material damage results from the reckless imprudence; and
i.That there is a pregnant woman who has suffered an abortion oThat there is inexcusable lack of precaution on the part of the offender, taking into
ii.That the abortion is intended consideration his employment or occupation, degree of intelligence, physical condition, and
iii.That the offender, who must be a physician or midwife, causes or assists in causing the other circumstances regarding persons, time and place.
abortion
iv.That said physician or midwife takes advantage of his or her scientific knowledge or skill Test of Negligence- Would a prudent man, in the position of the person to whom negligence is attributed,
foresee harm to the person injured as a reasonable consequence of the course about to pursued? If so,
b.As to pharmacists (elements) the law imposes a duty on the actor to refrain from that course or to take precaution against its
i.That the offender is a pharmacist mischievous results, and the failure to do so constitutes negligence (Picart vs Smith)
ii.That there is no proper prescription from a physician
iii.That the offender dispenses any abortive -Case : People vs Vda de Golez

Article 347, Revised Penal Code The allegations in the information in this case that the accused acted with reckless negligence in
diagnosing, prescribing for, and treating the deceased Susana Tam, knowing that she did not possess the
1.Simulation of births, substitution of one child, and concealment or abandonment of a legitimate child. necessary technical knowledge or skill to do so, thus causing her death, sufficiently charge the crime of
-Punishable Acts homicide through reckless imprudence, since ordinary diligence counsels one not to tamper with human
oSimulation of births life by trying to treat a sick man when he knows that he does not have the special skill, knowledge, and
oSubstitution of one child competence to attempt such treatment and cure, and may consequently reasonably foresee harm or injury
oConcealment or abandonment of a legitimate child to the latter. In a similar case wherein the accused, not being a regular practitioner, undertook to render
medical assistance to another, causing physical injuries to the latter, said accused was found guilty and
2.Simulation of Birth When the woman pretends to be pregnant when in fact she is not, and on the day of convicted by this Court of physical injuries through imprudence under the old Penal Code.
the supposed delivery, takes the child of another as her own.

15
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
-Negligence causing Injury to the patient
O The Medical Act imposes the penalty of imprisonment, fine or both for any person found guilty of illegal
practice of medicine. There is no penalty under the Medical Act of 1959 for gross negligence, ignorance or
incompetence other than administrative liability.
O Gross negligence, ignorance, or incompetence in the practice of Medicine resulting in an injury to or
death to the patient may be basis for reward of damages under the Civil Code which makes every person
who negligently causes to another liable to indemnify the latter for the same (Articles 19-21, 2176 of the
NCC)
16. Cruz vs Court of Appeals, 282 SCRA 188 (1997)
Doctrine:
Medical malpractice suit is a type of claim which a victim has available to him/her to redress a wrong
committed by a medical professional which has caused bodily harm; most often brought as a civil action for
damages under NCC 2176 or a criminal case under RPC 365, with which a civil action for damages is
impliedly instituted.
FACTS:
Lydia Umali was examined by Dr. Cruz who found a myoma or a benign tumor in her uterus, and
scheduled her for a hysterectomy operation or the removal of uterus on 23 Mar 1991. Rowena Umali de
Ocampo accompanied her mother to the hospital a day before the operation, and they spent the night
there. Rowena noticed that the clinic was untidy, so she tried to persuade her mother not to proceed with
the operation. The following day, Rowena asked Dr. Cruz if the operation could be postponed, but Lydia
told her daughter that Dr. Cruz said that the operation must go on as scheduled.
While Lydias relatives were waiting, Dr. Ercillo (anesthesiologist) told them to buy tagamet ampules, and
Rowenas sister went out to buy some. An hour later, Dr. Ercillo asked them to buy blood for Lydia, so they
did. A few hours later, the operation was finished, but later, Dr. Cruz asked the family to buy additional
blood, but there was no more type A blood available in the blood bank. A person arrived to donate blood
which was later transfused to Lydia. Rowena noticed that her mother was gasping for breathapparently,
the oxygen supply had run out, so the family went out to buy oxygen. Later in the evening, she went into
shock and her blood pressure dropped. She was then transferred to another hospital so she could be
connected to a respirator and further examined. However, this transfer was without the consent of the
relatives, who only found out about it when an ambulance came to take Lydia to the other hospital.
In the new hospital, she was re-operated upon by Dr. Cruz and Dr. Ercillo because blood was oozing out
from her incision. They summoned Dr. Angeles, Ob-Gyne head of the new hospital, but when he arrived,
Lydia was already in shock and possibly dead (BP: 0/0). Dr. Angeles told Drs. Cruz and Ercillo that there
was nothing he could do. Lydia died while Dr. Cruz was closing her abdominal wall. Immediate cause of
death is shock; disseminated intravascular coagulation (DIC) as antecedent cause.
Dr. Cruz and Dr. Ercillo were charged with reckless imprudence and negligence resulting in homicideof
16
Lydia Umali. The Municipal Trial Court in Cities (MTCC) found Dr. Ercillo not guilty for insufficiency of
evidence against her, but held Dr. Cruz responsible for Umalis death. RTC and CA affirmed MTCC.
ISSUE:
Whether or not Dr. Cruz is guilty of reckless imprudence resulting to homicide.
HELD:
No. In order that there may be a recovery for an injury, however, it must be shown that the 'injury for which
recovery is sought must be the legitimate consequence of the wrong done; the connection between the
negligence and the injury must be a direct and natural sequence of events, unbroken by intervening
efficient causes.'In other words, the negligence must be the proximate cause of the injury. For, 'negligence,
no matter in what it consists, cannot create a right of action unless it is the proximate cause of the injury
complained of.' And 'the proximate cause of an injury is that cause, which, in natural and continuous
sequence, unbroken by any efficient intervening cause, produces the injury, and without which the result
would not have occurred.'
This court has no recourse but to rely on the expert testimonies rendered by both prosecution and defense
witnesses that substantiate rather than contradict petitioner's allegation that the cause of Lydia's death was
DIC which, as attested to by an expert witness, cannot be attributed to the petitioner's fault or negligence.
The probability that Lydia's death was caused by DIC was unrebutted during trial and has engendered in
the mind of this Court a reasonable doubt as to the petitioner's guilt. Thus, her acquittal of the crime of
reckless imprudence resulting in homicide. While we condole with the family of Lydia Umali, our hands are
bound by the dictates of justice and fair dealing which hold inviolable the right of an accused to be
presumed innocent until proven guilty beyond reasonable doubt. Nevertheless, this Court finds the
petitioner civilly liable for the death of Lydia Umali, for while a conviction of a crime requires proof beyond
reasonable doubt, only a preponderance of evidence is required to establish civil liability.
The petitioner is a doctor in whose hands a patient puts his life and limb. For insufficiency of evidence this
Court was not able to render a sentence of conviction but it is not blind to the reckless and imprudent
manner in which the petitioner carried out her duties. A precious life has been lost and the circumstances
leading thereto exacerbated the grief of those left behind. The heirs of the deceased continue to feel the
loss of their mother up to the present time and this Court is aware that no amount of compassion and
commiseration nor words of bereavement can suffice to assuage the sorrow felt for the loss of a loved one.
Certainly, the award of moral and exemplary damages in favor of the heirs of Lydia Umali are proper in the
instant case.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
17. Civil Code Arts. 1172-1174, 2176-2180
Art. 1172. Responsibility arising from negligence in the performance of every kind of obligation is also
demandable, but such liability may be regulated by the courts, according to the circumstances. (1103)
Art. 1173. The fault or negligence of the obligor consist in the omission of that diligence which is required
by the nature of the obligation and corresponds with the circumstances of the persons, of the time and of
the place. When negligence shows bad faith, the provisions of Articles 1171 and 2201, paragraph 2, shall
apply.
If the law or contract does not state the diligence which is to be observed in the performance, that which is
expected of a good father of a family shall be required. (1104a)
Art. 1174. Except in cases expressly specified by the law, or when it is otherwise declared by stipulation, or
when the nature of the obligation requires the assumption of risk, no person shall be responsible for those
events which could not be foreseen, or which, though foreseen, were inevitable. (1105a)
Art. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is
obliged to pay for the damage done. Such fault or negligence, if there is no pre-existing contractual relation
between the parties, is called a quasi-delict and is governed by the provisions of this Chapter. (1902a)
Art. 2177. Responsibility for fault or negligence under the preceding article is entirely separate and distinct
from the civil liability arising from negligence under the Penal Code. But the plaintiff cannot recover
damages twice for the same act or omission of the defendant. (n)
Art. 2178. The provisions of Articles 1172 to 1174 are also applicable to a quasi-delict. (n)
Art. 2179. When the plaintiff's own negligence was the immediate and proximate cause of his injury, he
cannot recover damages. But if his negligence was only contributory, the immediate and proximate cause
of the injury being the defendant's lack of due care, the plaintiff may recover damages, but the courts shall
mitigate the damages to be awarded. (n)
Art. 2180. The obligation imposed by Article 2176 is demandable not only for one's own acts or omissions,
but also for those of persons for whom one is responsible.
The father and, in case of his death or incapacity, the mother, are responsible for the damages caused by
the minor children who live in their company.
Guardians are liable for damages caused by the minors or incapacitated persons who are under their
authority and live in their company.
The owners and managers of an establishment or enterprise are likewise responsible for damages caused
by their employees in the service of the branches in which the latter are employed or on the occasion of
their functions.
17
Employers shall be liable for the damages caused by their employees and household helpers acting within
the scope of their assigned tasks, even though the former are not engaged in any business or industry.
The State is responsible in like manner when it acts through a special agent; but not when the damage has
been caused by the official to whom the task done properly pertains, in which case what is provided in
Article 2176 shall be applicable.
Lastly, teachers or heads of establishments of arts and trades shall be liable for damages caused by their
pupils and students or apprentices, so long as they remain in their custody.
The responsibility treated of in this article shall cease when the persons herein mentioned prove that they
observed all the diligence of a good father of a family to prevent damage. (1903a)
18. What is Negligence?
Conduct which creates undue risk of harm to other. Risk is the danger which is apparent or should be
apparent, to one in the position of the actor. Determination of negligence is a question of foresight on the
part of the actor. That the Effect of such is harmful to others was sufficiently probable to warrant his
conduct or guarding against its consequence. The fault or negligence of the obligor consist in the omission
of that diligence which is required by the nature of the obligation and correspondence of the persons of the
time and of the place
Test to determine negligence:
Did the defendant n doing the alleged negligent act use that reasonable care and caution which an
ordinary prudent person would have used in the same situation? If not the person is guilty of negligence
A Conduct is said to be negligent when a prudent man in the position of the tortfeasor would have
foreseen that an effect harmful to another was sufficiently probable to warrant his foregoing the conduct or
guarding against its consequence.
Elements of Medical Negligence
1. A duty of care was owed by the physician (Duty)
2. The physician violated the applicable standard of care (Beach)
3. The person suffered a compensable injury (Compensable Injury)
4. The injury was caused in fact and proximately caused by the substandard conduct
(Proximate Causation)
The burden of proving these elements is on the plaintiff in a malpractice lawsuit.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
19. Proximate Cause, Patients own negligence Cayao-Lasam vs Ramolete, 574 SCRA 439 (2008)
FACTS: On July 28, 1994, respondent, three months pregnant Editha Ramolete (Editha) was brought to
the Lorma Medical Center (LMC) in San Fernando, La Union due to vaginal bleeding. Upon advice of
petitioner relayed via telephone, Editha was admitted to the LMC on the same day. A pelvic sonogram
was then conducted on Editha revealing the fetus weak cardiac pulsation. The following day, Edithas
repeat pelvic sonogram showed that aside from the fetus weak cardiac pulsation, no fetal movement
was also appreciated. Due to persistent and profuse vaginal bleeding, petitioner advised Editha to
undergo a Dilatation and Curettage Procedure (D&C) or "raspa."
On July 30, 1994, petitioner performed the D&C procedure. Editha was discharged from the hospital the
following day.
On September 16, 1994, Editha was once again brought at the LMC, as she was suffering from vomiting
and severe abdominal pains. Editha was attended by Dr. Beatriz de la Cruz, Dr. Victor B. Mayo and Dr.
Juan V. Komiya. Dr. Mayo allegedly informed Editha that there was a dead fetus in the latters womb.
After, Editha underwent laparotomy, she was found to have a massive intra-abdominal hemorrhage and
a ruptured uterus. Thus, Editha had to undergo a procedure for hysterectomy6 and as a result, she has
no more chance to bear a child.
On November 7, 1994, Editha and her husband Claro Ramolete (respondents) filed a Complaint for Gross
Negligence and Malpractice against petitioner before the Professional Regulations Commission (PRC).
Respondents alleged that Edithas hysterectomy was caused by petitioners unmitigated negligence and
professional incompetence in conducting the D&C procedure and the petitioners failure to remove the
fetus inside Edithas womb. Among the alleged acts of negligence were: first, petitioners failure to
check up, visit or administer medication on Editha during her first day of confinement at the LMC;
second, petitioner recommended that a D&C procedure be performed on Editha without conducting any
internal examination prior to the procedure; third, petitioner immediately suggested a D&C procedure
instead of closely monitoring the state of pregnancy of Editha.
In Petitioners answer it alleged that it was the respondents own negligence, because respondent was
advised to return for follow up checkup or to check her condition if she still suffering from any
abdominal pain or to check for progress, however respondent failed to show for follow up checkup, until
she suffered the alleged severe abdominal pain and vomiting.
The Board of Medicine of the PRC rendered a decision exonerating the Petitioner.
Feeling aggrieved it went to PRC for Appeal and the PRC rendered a decision reversing the findings of
the Board of Medicine and revoking the License of the petitioner
Petitioner brought the matter to CA in a Petition for Review under Rule 43 of rules of court, however the
court said that it was an improper remedy because as the enumeration of the quasi-judicial agencies in
Rule 43 is exclusive. PRC is not among the quasi-judicial bodies whose judgment or final orders are
subject of a petition for review to the CA, thus, the petition for review of the PRC Decision, filed at the
18
CA, was improper.
ISSUE:
Whether or not the Petitioners negligence is the PROXIMATE cause of the respondents suffering from
intra-abdominal hemorrhage and a ruptured uterus? (Which Constitutes Medical Malpractice)
Whether or not the Petition for Review under Rule 43 of Rules of Court is an improper remedy as PRC is
not among those quasi-judicial bodies whose judgment or final orders are subject for a petition for
review under the CA?
HELD:
1st Issue:
The Court ruled that when complainant was discharged on July 31, 1994, herein respondent advised her
to return on August 4, 1994 or four (4) days after the D&C. This advice was clear in complainants
Discharge Sheet. However, complainant failed to do so. This being the case, the chain of continuity as
required in order that the doctrine of proximate cause can be validly invoked was interrupted. Had she
returned, the respondent could have examined her thoroughly. Also, in the testimony of Dr. Manalo, he
stated further that assuming that there was in fact a misdiagnosis, the same would have been rectified if
Editha followed the petitioners order to return for a check-up on August 4, 1994.
Granting that the obstetrician-gynecologist has been misled (justifiably) up to the point that there would
have been ample opportunity to rectify the misdiagnosis, had the patient returned, as instructed for
herfollow-up evaluation. It was one and a half months later that the patient sought consultation with
another doctor. The continued growth of an ectopic pregnancy, until its eventual rupture, is a dynamic
process. Much change in physical findings could be expected in 1 months, including the emergence of
suggestive ones.
It is undisputed that Editha did not return for a follow-up evaluation, in defiance of the petitioners
advice. Editha omitted the diligence required by the circumstances which could have avoided the injury.
The omission in not returning for a follow-up evaluation played a substantial part in bringing about
Edithas own injury. Had Editha returned, petitioner could have conducted the proper medical tests and
procedure necessary to determine Edithas health condition and applied the corresponding treatment
which could have prevented the rupture of Edithas uterus. The D&C procedure having been conducted
in accordance with the standard medical practice. In defiance of petitioners orders. The immediate
cause of Edithas injury was her own act; thus, she cannot recover damages from the injury.
Art. 2179 of NCC provides: When the plaintiffs own negligence was the immediate and
proximate cause of his injury, he cannot recover damages. But if his negligence was only
contributory, the immediate and proximate cause of the injury being the defendants lack of due
care, the plaintiff may recover damages, but the courts shall mitigate the damages to be
awarded.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
Proximate cause has been defined as that which, in natural and continuous sequence, unbroken by any
efficient intervening cause, produces injury, and without which the result would not have occurred. An
injury or damage is proximately caused by an act or a failure to act, whenever it appears from the evidence
in the case that the act or omission played a substantial part in bringing about or actually causing the injury
or damage; and that the injury or damage was either a direct result or a reasonably probable consequence
of the act or omission.
2nd Issue:
In virtue of BP 129, appeals from the Professional Regulations Commission are now exclusively
cognizable by the Court of Appeals.
In the case of Yang v. Court of Appeals it ruled that Batas Pambansa (B.P.) Blg. 12938 conferred upon the
CA exclusive appellate jurisdiction over appeals from decisions of the PRC. The Court held that the law
has since been changed, however, at least in the matter of the particular court to which appeals from
the Commission should be taken. On August 14, 1981, Batas Pambansa Bilang 129 became effective and
in its Section 29, conferred on the Court of Appeals "exclusive appellate jurisdiction over all final
judgments, decisions, resolutions, orders or awards of Regional Trial Courts and quasi-judicial agencies,
instrumentalities, boards or commissions except those falling under the appellate jurisdiction of the
Supreme Court.
20. Res ipsa loquitur: Layugan vs Intermediate Appelate Court, 167 SCRA 363 (1988)
What is "Res Ipsa Loquitur"?
Res Ipsa Loquitur is a latin phrase meaning, the thing speaks for it self and implies that the
plaintiff need only show that a particular result occurred but for someones negligence. Res ipsa
loquitur allows plaintiffs to use circumstantial evidence to infer negligence. The popularity of the
doctrine grew significantly following the landmark 1863 English case Byrne v. Boadle. In Byrne,
a man had been outside a flour dealer when a barrel of flour fell out of a window and struck him,
knocking him unconscious. Although the man was unable to present any direct evidence of
negligence, the court invoked res ipsa loquitur and inferred negligence against the flour
company based on the surrounding circumstances.
Elements for invoking res ipsa loquitur:
1.Evidence of the actual cause of the injury is not obtainable
2.The injury is not the kind that ordinarily occurs in the absence of negligence by someone
3.The plaintiff was not responsible for his or her own injury
4.The defendant, or its employees or agents, had exclusive control of the instrumentality that caused the
injury, and
5.The injury could not have been caused by any instrumentality other than that over which the defendant
had control.
19
Invoking Res Ipsa Loquitur:
Once this doctrine is successfully invoked, the burden is not on the plaintiff to show how the defendant was
negligent, but on the defendant to show that he or she was not negligent.
A classic example of the type of case in which "res ipsa loquitur" arises is where a sponge or other medical
instrument is left inside a person after surgery. Typically, records of the surgery will not include a statement
such as "Dr. Smith left forceps in patient's abdomen," and there may be no recorded proof of how or why
the negligence occurred. Yet clearly, a surgical instrument would not be left in a patient in the absence of
someone's negligence. Also, an unconscious patient certainly cannot be deemed responsible for this type
of injury, and it would have been the operating physician and staff who had exclusive control over the
surgical tools. So, "res ipsa loquitur" would likely apply here.
Other examples:
Operating on the wrong patient
Operating on the wrong part of the patient
Layugan vs IAC
FACTS:
On May 15, 1979 at Baretbet, Bagabag, Nueva Vizcaya, the Plaintiff, Pedro Layugan and his companion
were repairing the tire of their cargo truck which was parked along the right side of the Highway. While
repairing, defendant's truck driven recklessly by Daniel Serrano bumped the truck being repaired, and as
a result, plaintiff was injured and hospitalized. Layugan filed an action for damages against Godofredo
Isidro, the owner of the truck driven by Serrano. Defendant admitted his ownership of the vehicle involved
in the accident driven by Daniel Serrano. Defendant countered that the plaintiff was merely a bystander,
not a truck helper being a brother-in-law law of the driver of said truck; that the truck allegedly being
repaired was parked, occupying almost half of the right lane towards Solano, Nueva Vizcaya, right after the
curve; that the proximate cause of the incident was the failure of the driver of the parked truck in installing
the early warning device, hence the driver of the parked car should be liable for damages sustained by the
truck of the defendant. The respondent court rendered a decision finding the petitioner negligent under the
doctrine of res ipsa loquitur.
ISSUE: Whether or not, the IAC acted correctly in applying the doctrine of Res ipsa loquitur
HELD:
No, IAC acted incorrectly. The absence or want of care of Daniel Serrano has been established by clear
and convincing evidence. It follows that in stamping its imprimatur upon the invocation by respondent
Isidro of the doctrine of Res ipsa loquitur to escape liability for the negligence of his employee, the
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
respondent court committed reversible error. The doctrine of Res ipsa loquitur as a rule of evidence is
peculiar to the law of negligence which recognizes that prima facie negligence may be established without
direct proof and furnishes a substitute for specific proof of negligence. The rule, when applicable to the
facts and circumstances of a particular case, is not intended to and does not dispense with the
requirement of proof of culpable negligence on the part of the party charged. It merely determines and
regulates what shall be prima facie evidence thereof and facilitates the burden of plaintiff of proving a
breach of the duty of due care. The doctrine can be invoked when and only when, under the
circumstances involved, direct evidence is absent and not readily available. Hence, it has generally been
held that the presumption of inference arising from the doctrine cannot be availed of, or is overcome,
where plaintiff has knowledge and testifies or presents evidence as to the specific act of negligence which
is the cause of the injury complained of or where there is direct evidence as to the precise cause of the
accident and all the facts and circumstances attendant on the occurrence clearly appear. Finally, once the
actual cause of injury is established beyond controversy, whether by the plaintiff or by the defendant, no
presumptions will be involved and the doctrine becomes inapplicable when the circumstances have been
so completely elucidated that no inference of defendant's liability can reasonably be made, whatever the
source of the evidence, as in this case.
The doctrine can be invoked when and only when, under the circumstances involved, direct evidence is
absent and not readily available.
Doctrine is inapplicable where the actual cause of injury is established beyond controversy.
21. Captain of Ship Doctrine, res ipsa loquitur Ramos vs Court of Appeals, 380 SCRA 467 (2002)
FACTS :
Petitioner Erlinda Ramos, after seeking professional medical help, was advised to undergo an operation
for the removal of a stone in her gall bladder (cholecystectomy). She was referred to Dr. Hosaka, a
surgeon, who agreed to perform the operation on her. The operation was scheduled for June 17, 1985 at
9:00 in the morning at private respondent De Los Santos Medical Center (DLSMC). Since neither
petitioner Erlinda nor her husband, petitioner Rogelio, knew of any anesthesiologist, Dr. Hosaka
recommended to them the services of Dr. Gutierrez.
On the day of operation, upon the request of petitioner Erlinda, her sister-in-law, Herminda Cruz, who was
then Dean of the College of Nursing at the Capitol Medical Center, was allowed to accompany her inside
the operating room. Dr. Hosaka came late at around 12:10 in the afternoon, or more than three (3) hours
after the scheduled operation.
During the operation, Dr. Gutierrez had a hard time in intubating the patient and it was noticed by
Herminda Cruz that Erlindas nailbeds turned blue. Another doctor was called to intubate the patient,
named Dr. Calderon. Still, the nailbeds of the patient remained bluish.
Herminda went out the Operating Room to express her concern to Rogelio that the operation was not
going well and when she returned back, she saw the patient being wheeled to the ICU.
20
The doctors explained to petitioner Rogelio that his wife had bronchospasm. Erlinda stayed in the ICU for a
month. She was released from the hospital only four months later or on November 15, 1985. Since the ill-
fated operation, Erlinda remained in comatose condition until she died on August 3, 1999.
Petitioners filed for damages against the respondent in the RTC of Quezon City. After due trial, the court a
quo rendered judgment in favor of petitioners. Essentially, the trial court found that private respondents
were negligent in the performance of their duties to Erlinda. On appeal by private respondents, the Court of
Appeals reversed the trial courts decision and directed petitioners to pay their "unpaid medical bills" to
private respondents.
Petitioners filed with this Court a petition for review on certiorari. The private respondents were then
required to submit their respective comments thereon. On December 29, 1999, this Court promulgated the
decision which private respondents now seek to be reconsidered.
The motion for reconsideration was denied.
ISSUE :
Whether or not Dr. Hosaka and Dr. Gutierrez are liable.
HELD:
Doctrine of Res Ipsa Loquitur applies because the injury of the patient therein was one which does not
ordinarily take place in the absence of negligence in the administration of an anesthetic, and in the use
and employment of an endotracheal tube.
Doctrine of Captain of the Ship applies in this case because while the professional services of Dr. Hosaka
and Dr. Gutierrez were secured primarily for their performance of acts within their respective fields of
expertise for the treatment of petitioner Erlinda, and that one does not exercise control over the other, they
were certainly not completely independent of each other so as to absolve one from the negligent acts of
the other physician.
Dr. Gutierrez omitted to perform a thorough preoperative evaluation on Erlinda. As she herself admitted,
she saw Erlinda for the first time on the day of the operation itself, one hour before the scheduled
operation. She listened the patients heart and lungs and checked the latters blood pressure to determine
if Erlinda was indeed fit for operation. However, she did not proceed to examine the patients airway. Had
she been able to check petitioner Erlindas airway prior to the operation, Dr. Gutierrez would most probably
not have experienced difficulty in intubating the former, and thus the resultant injury could have been
avoided.
Further, there is no cogent reason for the Court to reverse its finding that it was the faulty intubation on
Erlinda that caused her comatose condition. There is no question that Erlinda became comatose after Dr.
Gutierrez performed a medical procedure on her. Even the counsel of Dr. Gutierrez admitted to this fact
during the oral arguments.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
The court went on to say that ordinarily a person being put under anesthesia is not rendered decerebrate
as a consequence of administering such anesthesia in the absence of negligence. Upon these facts and
under these circumstances, a layman would be able to say, as a matter of common knowledge and
observation, that the consequences of professional treatment were not as such as would ordinarily have
followed if due care had been exercised
Dr. Hosaka is also liable. From the facts on record it can be logically inferred that Dr. Hosaka exercised a
certain degree of, at the very least, supervision over the procedure then being performed on Erlinda.
First, it was Dr. Hosaka who recommended to petitioners the services of Dr. Gutierrez. In effect,
he represented to petitioners that Dr. Gutierrez possessed the necessary competence and skills.
Drs. Hosaka and Gutierrez had worked together since 1977. Whenever Dr. Hosaka performed a
surgery, he would always engage the services of Dr. Gutierrez to administer the anesthesia on
his patient.
Second, Dr. Hosaka himself admitted that he was the attending physician of Erlinda. Thus, when
Erlinda showed signs of cyanosis, it was Dr. Hosaka who gave instructions to call for another
anesthesiologist and cardiologist to help resuscitate Erlinda.
Third, it is conceded that in performing their responsibilities to the patient, Drs. Hosaka and
Gutierrez worked as a team. Their work cannot be placed in separate watertight compartments
because their duties intersect with each other.
The long period that Dr. Hosaka made Erlinda wait for him, certainly aggravated the anxiety that she must
have been feeling at the time. It could be safely said that her anxiety adversely affected the administration
of anesthesia on her.
22. Doctrine of Informed Consent, Elements of Medical Negligence Li vs. Soliman, GR No. 165279, June 7,
2011
FACTS: On July 7, 1993, respondents 11 year old daughter, Angelica Soliman underwent a biopsy of the
mass located in her lower extremity at the St. Lukes Medical Center (SLMC). Results showed that
Angelica was suffering from osteosaucoma, ostiobiostic type, a high-grade (highly malignant) cancer of the
bone which usually affects teenage children. Following this diagnosis, Angelicas right leg was amputated
by Dr. Tamayo in order to remove the tumor. As a adjuvant treatment to eliminate any remaining cancer
cells, and hence minimizing the chances of recurrence and prevent the decease from spreading to other
parts of the patients body, chemotherapy was suggested by Dr. Tamayo and referred Angelica to another
doctor at SLMC, herein petitioner Dr. Rubi Li, a medical oncologist.
On July 23, 1993, petitioner saw the respondents at the hospital after Angelicas surgery and discussed
with them Angelicas condition. Petitioner told respondents that Angelica should be given 2-3 weeks to
21
recover from the operation before starting the chemotherapy. Respondents were apprehensive due to
financial constraints as Reynaldo earns only from P70,000-150,000 a year from his jewelry and watching
repair business. Petitioner, however, assured them not to worry about her professional fee and told them
to just save up for medicines to be used.
As the chemotherapy session started, day by day, Angelica experience worsening condition and other
physical effect on the body such as discoloration, nausea, and vomiting.
Petitioner claimed, that she explained to respondents that even when a tumor is removed, there are still
small lesions undetectable to the naked eye and that adjuvant chemotherapy is needed to clean out the
small lesions in order to lessen the chance of cancer to recur. She did not give the respondents any
assurance that chemotherapy will cure Angelicas cancer. During these consultations with respondents,
she explained the following side effects of chemotherapy treatment to respondents:
1.) Falling hair;
2.) nausea and vomiting;
3.) loss of appetite;
4.) low count of WBC, RBC, and platelets;
5.) possible sterility due to the effects on Angelicas ovary;
6.) Damage to kidney and heart;
7.) darkening of the skin especially when exposed to sunlight.
She actually talked to the respondents four times, once at the hospital after the surgery, twice at her clinic
and fourth when Angelicas mother called her through long distance. This was disputed by respondents
who countered that petitioner gave them assurance that there is 95% chance of healing for Angelica if she
undergoes chemotherapy and that the only side effects were nausea, vomiting and hair loss. Those were
the only side effects of chemotherapy mentioned by petitioner.
ISSUE: Whether or not petitioner committed medical malpractice.
HELD: No. The type of lawsuit which has been called medical malpractice or more appropriately, medical
negligence, is that type of claim which a victim has available to him or her to redress a wrong committed by
a medical professional which has caused bodily harm. In order to successfully pursue such claim, a patient
must prove that a health care provider in most cases a physician, either failed to do something which a
reasonably prudent health care provider would have done or that he or she did something that a
reasonably health care provider would not have done; and that failure or action caused injury to the
patient.
Medical negligence cases are best proved by opinions of expert witnesses belonging in the same general
neighborhood and in the same general line of practice as defendant physician or surgeon. The deference
of courts to the expert opinion of qualified physicians stems from the formers realization that the latter
possess unusual technical skills which layman in most instances are incapable of intelligently evaluating,
hence the indispensability of expert testimonies.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
The doctrine of informed consent within the context of physician-patient relationships goes as far back into
english common law. As early as 1767, doctors were charged with the tort of battery if they have not
gained the consent of their patients prior to performing a surgery or procedure. In the United States, the
seminal case was Schoendorff vs Society of New York Hospital which involved unwanted treatment
performed by a doctor. Justice Bejamin Cardozo oft-quoted opinion upheld the basic right of a patient to
give consent to any medical procedure or treatment; every human being of adult year and sound mind has
a right to determine what shall be done with his own body; and a surgeon who performs an operation
without his patients consent commits an assault, for which he is liable in damages. From a purely ethical
norm, informed consent evolved into a general principle of law that a physician has a duty to disclose what
a reasonably prudent physician in the medical community in the exercise of reasonable care would
disclose to his patient as to whatever grave risk of injury might be incurred from a proposed course of
treatment, so that a patient, exercising ordinary care for her own welfare and faced with a choice of
undergoing the proposed treatment, as alternative treatment, or none at all, may intelligently exercise his
judgement by reasonably balancing the probable risk against the probable benefits.
There are four essential elements a plaintiff must proved in a malpractice action based upon the doctrine
of informed consent:
1.) the physician had a duty to disclose material risks;
2.) he failed to disclose or inadequately disclosed those risks;
3.) as a direct and proximate result of the failure to disclose, the patient consented to treatment
she otherwise would not have consented to; and
4.) plaintiff was injured by the proposed treatment.
The gravamen in an informed consent requires the plaintiff to point to significant undisclosed information
relating to the treatment which could have altered her decision to undergo it.
Examining the evidence, the court held that there was adequate disclosure of material risks inherent in
chemotherapy procedure performed with the consent of Angelicas parents. Respondents could not have
been unaware in the course of initial treatment and amputation of Angelicas lower extremity that her
immune system was already weak on account of the malignant tumor in her knee. When petitioner
informed the respondents beforehand of the side effects of chemotherapy which includes lowered counts
of white and red blood cells, decrease in blood platelets, possible kidney or heart damage and skin
darkening, there is reasonable expectation on the part of the doctor that the respondents understood very
well that the severity of these side effects will not be the same for all patients undergoing the procedure. In
other words, by the nature of the disease itself, each patients reaction to the chemical agents even with
pre-treatment laboratory tests cannot be precisely determined by the physician. That death can possibly
result from complications of the treatment or the underlying cancer itself, immediately or sometime after
the administration of chemotherapy drugs, is a risk that cannot be ruled out, as with most other major
medical procedures, but such conclusion can be reasonably drawn from the general side effects of
chemotherapy already disclosed.
Petition for review on certiorari is GRANTED. The Decision dated June 15, 2004 and the Resolution dated
22
September 1, 2004 of the Court of Appeals in CA-G.R. CV No. 58013 are SET ASIDE.
The Decision dated September 5, 1997 of the Regional Trial Court of Legazpi City, Branch 8, in Civil Case
No. 8904 is REINSTATED and UPHELD.
23. Consent Forms and Waiver Nogales vs Capitol Medical Center, 511 SCRA 204, 228-29 (2006)
FACTS: Pregnant with her fourth child, Corazon Nogales ("Corazon"), who was then 37 years old, was
under the exclusive prenatal care of Dr. Oscar Estrada ("Dr. Estrada") beginning on her fourth month of
pregnancy or as early as December 1975. Around midnight of 25 May 1976, Corazon started to
experience mild labor pains prompting Corazon and Rogelio Nogales ("Spouses Nogales") to see Dr.
Estrada at his home. After examining Corazon, Dr. Estrada advised her immediate admission to the
Capitol Medical Center ("CMC"). t 6:13 a.m., Corazon started to experience convulsionsAt 6:22 a.m., Dr.
Estrada, assisted by Dr. Villaflor, applied low forceps to extract Corazon's baby. In the process, a 1.0 x 2.5
cm. piece of cervical tissue was allegedly torn.At 6:27 a.m., Corazon began to manifest moderate vaginal
bleeding which rapidly became profuse. Corazon died at 9:15 a.m. The cause of death was "hemorrhage,
post partum.
ISSUE: Whether or not CMC is vicariously liable for the negligence of Dr. Estrada.
HELD: Private hospitals, hire, fire and exercise real control over their attending and visiting "consultant"
staff. The basis for holding an employer solidarily responsible for the negligence of its employee is found in
Article 2180 of the Civil Code which considers a person accountable not only for his own acts but also for
those of others based on the former's responsibility under a relationship of patria potestas.
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.
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. In the instant case, CMC impliedly held out Dr. Estrada
as a member of its medical staff. Through CMC's 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.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
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
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.
The second factor focuses on the patients reliance. It is sometimes characterized as an inquiry on whether
the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with ordinary care
and prudence
HOSPITAL LIABILITY
24. Hospital Code of Ethics
DUTIES OF HOSPITALS PROVIDED BY LAW:
1.Duty to obtain license
2.Duty to render immediate emergency medical assistance
3.Duty not to require deposit in emergency and serious cases
4.Duty not to cause detention of patients due to nonpayment
PRIMARY OBJECTIVE OF THE HOSPITALS:
1.To provide the best possible facilities for the care of the sick and injured at all times;
2.To constantly upgrade and improve methods for the care, the cure, amelioration and
prevention of disease; and
3.To promote the practice of medicine by Physicians within the institution consistent with the
acceptable quality of patient care.
HOSPITALS DUTIES TO THE GOVERNMENT:
1.The hospital shall always conform to the policies, rules and regulations of the government and
shall, in a proper legal forum or venue, contest unreasonable government issuances if any
according to existing legal procedures;
2.Must inform the government of any illegal or grossly unethical practice of other hospitals which
could result to the irreversible disadvantage or harm to the patient or the community;
3.Whenever called upon, must always cooperate with the government in the administration of
justice, in addressing problems of epidemics and disasters, and in the promotion of health
programs and activities that would benefit the patient and the community.
23
WHAT ARE CONSIDERED UNETHICAL ACTS?
Pirating the patient of another hospital, except in cases of transfer of patient according to
accepted rules and norms.
Offering unconscionable discounts or packages for purposes of soliciting patients, unless
allowed in cases where there is a launching or celebration of annual events such as
anniversaries, government programs, and similar event.
Paying or offering to pay commissions or rebates to health professionals for purposes of
soliciting patients;
Advertisements by a hospital with statements claiming to be the best hospital, or hospital with
the best doctors or other statements depicting, director indirectly, that other hospitals
areinferior.
HOSPITAL ETHICS:
Hospital must recognize that the care of the sick is their first responsibility and a sacred trust,
striving, at all times, to provide the best possible care and treatment to all in need of
hospitalization.
Hospitals, recognizing their unique role in safeguarding the nations health, should seek through
compassionate and scientific care and health education, to extend life, alleviate suffering, and
improve the general health of the communities they serve.
Hospitals should remain and promote harmonious relationships within the organization, to
insure the proper environment for effective, efficient and equitable care and treatment of
patients.
Hospitals should seek to inspire the confidence of the entire community and should appreciate
and respect the social and religious practices and customs of patients.
Hospitals, to the extent possible and within their limitations, should conduct educational
projects, stimulate research, and encourage preventive health practices in the community.
Hospitals should cooperate with other hospitals, health and welfare agencies, government and
non-government, and other recognized organizations engaged in activities related to the health
of the country.
Hospitals, in reporting their work to the public, should give a factual and objective interpretation
of accomplishments and objectives without putting down directly or indirectly by implication, the
work of other hospitals or related organizations.
Hospital, cognizant of their social responsibilities, should actively support and encourage every
effective means which will ease the financial burdens of illness.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
Hospital should be fair, honest and impartial in all their business relationships and utilize legal
and legitimate means in promoting their public relations.
Hospitals should be progressive in policies, personnel policies, and effort to maintain up-to-date
equipment, methods and standards of performance.
25. An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical
Services to Serve as Licensing Agency, RA No. 4226, Sec. 1, 2(a), 18 (1965)
AN ACT REQUIRING THE LICENSURE OF ALL HOSPITALS IN THE PHILIPPINES AND AUTHORIZING
THE BUREAU OF MEDICAL SERVICES TO SERVE AS THE LICENSING AGENCY
Section 1. This Act shall also be known as the Hospital Licensure Act.
Section 2 ( a) Hospital means a place devoted primarily to the maintenance and operation of facilities for
the diagnosis, treatment and care of individuals suffering from illness, disease, injury or deformity, or in
need of obstetrical or other medical and nursing care. The term hospital shall also be construed as any
institution, building or place where there are installed beds, or 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 states, maternity cases, and all institutions such as those for convalescence, sanitarial
or sanitarial care, infirmities, nurseries, dispensaries and such other names by which they may designated.
Section 18. Penalties. Any person, partnership, association, or corporation who establishes, operates,
conducts, manages or maintains a hospital or hospital clinic within the meaning of this Act without first
obtaining a license as provided for in this Act or violates any provision hereof shall be guilty of a
misdemeanor, and upon conviction thereof shall be liable to a fine of not more than five hundred pesos for
the first offense and not more than one thousand pesos for each subsequent offense, and each day that
the hospital shall operate after the first conviction shall be considered a subsequent offense.
26. An Act Requiring Government and Private Hospitals and Clinics to Extend Medical Assistance in
Emergency Cases, RA No. 6615 (1972)
Emergency an unforeseen combination of circumstances, which calls for an immediate action.
O It refers to a situation in which a patient has been suddenly or unexpectedly endangered to
such an extent that immediate action is needed to save the life and limb or to avoid permanent
damages.
24
The following are instances where a physician may be confronted with a condition of emergency :
1.The patients condition called for an emergency before the commencement or the management
procedures;
2.Unforeseen conditions, discovered during the application of a treatment procedure might require an
emergency treatment;
3.An accident may occur in the course of a diagnostic or treatment procedure which requires emergency
treatment;
4.Complications, which require immediate attention, may arise after a medical procedure may arise.
Republic Act No. 6615
An Act Requiring Government and Private Hospital and Clinics to Extend Medical Assistance in
Emergency Cases
RA 6615 obliges hospitals and physicians to extend medical assistance in emergency cases.
Under Section 1, requires all government and private hospitals or clinic duly licensed to operate as such
to:
o Render immediate emergency medical assistance and
oProvide 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
Under Section 2, the expenses and losses of earnings incurred by a private hospital of clinic for
medicines, facilities and services beyond first aid extended to emergency cases as required herein, and
not to exceed PhP 50, 000.00 per year, shall be deductible expenses and losses for income tax purposes
which may be carried over for a period of 5 years, any provision of law or regulation to the contrary
notwithstanding.
Liability of failure to comply with this RA (Section 3):
oThe following shall be punished by imprisonment of 1 month and 1 day to 1 year and 1 day, and a fine of
PhP 300.00 PhP 1,000.00 [without prejudice to the provisions of RA 2382 in the case of physicians]:
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 1 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
oIn 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.
oIn 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.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
27. An Act Prohibiting the Detention of Patients in Hospital and Medical Clinics on Grounds of Nonpayment of
Hospital Bills or Medical Expenses RA No. 9439 (2007)
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.
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.
SEC. 4. The Department of Health shall promulgate the necessary rules and regulations to carry out the
provisions of this Act.
SEC. 5. If any provision of this Act is declared void and unconstitutional the remaining provisions hereof
not affected thereby shall remain in full force and effect.
SEC. 6. All laws, decrees, orders, rules and regulations or part thereof inconsistent with this Act are hereby
repealed or amended accordingly.
SEC. 7. This Act shall take effect fifteen (15) days after its publication in two national newspapers of
general circulation.
ALL HEALTH facilities, whether government-owned or private, are prohibited from refusing persons
seeking medical help or from detaining them for nonpayment of hospital bills or medical expenses.
25
It is unlawful for any hospital or medical clinic to refuse administering to patients treatment and support that
could prevent their death or permanent disability, according to Republic Act No. 8344, also known as the
Anti-Hospital Deposit Law.
The law, approved on Aug. 25, 1997, also prohibits 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.
If the health facility lacks medical capabilities, 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 consented to the transfer and
after the receiving hospital or medical clinic agreed to the transfer, according to RA 8344.
If the patient is unconscious, incapable of giving consent and/or unaccompanied, the doctor can transfer
the patient even without his consent, provided that the transfer is done only after necessary emergency
treatment and support were administered to stabilize the patient and after it was established that the
transfer would entail less risks than the patients continued confinement.
The hospital or clinic where the patient will be transferred shall not refuse him nor demand from the patient
or his next of kin any deposit or advance payment, the law stated.
Violators of RA 8344 shall be imprisoned for six months to two years and four months, or fined P20,000 to
P100,000.
If the violation is committed pursuant to an established policy of the hospital or clinic, or upon instruction of
its management, the director or officer of the hospital or clinic responsible for the formulation and
implementation of the policy shall be imprisoned of four to six years or fined P100,000 to P500,000.
Republic Act No. 9439, or the Hospital Detention Law, states that health facilities are prohibited from
detaining patients who have fully or partially recovered because of nonpayment in part or in full of hospital
bills.
A patient, who wants to leave the hospital, shall be issued the corresponding medical certificate and other
pertinent papers required for his/her release upon the execution of a promissory note covering 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.
Violators of the law shall be fined P20,000 to P50,000 or imprisoned for one month to six months, or both.
However, RA 9439, approved on April 27, 2007, applies only to charity patients and does not cover
patients in private rooms.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017
28. An Act Penalizing the Refusal of Hospitals and Medical Clinics to Administer Appropriate Initial Medical
Treatment and Support in Emergency cases, amending for the purpose BP 702, otherwise known as An
Act Prohibiting the Demand of Deposits or Advance Payments for the Confinement or Treatment of
Patients in Hospitals and Medical Clinics in Certain Cases, RA No. 8344 Sec. 1-4 (1997)
REPUBLIC ACT 8344, otherwise known as the Anti-Hospital Deposit Law
What are the prohibited acts under the law?
1.ALL HEALTH facilities, whether government-owned or private, are prohibited from refusing persons
seeking medical help or from detaining them for nonpayment of hospital bills or medical expenses.
2.It is unlawful for any hospital or medical clinic to refuse administering to patients treatment and support
that could prevent their death or permanent disability.
3.The law, approved on Aug. 25, 1997, also prohibits 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.
What if the hospital is not equipped with medical facilities or the patient is unconscious?
1.If the health facility lacks medical capabilities, 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 consented to the transfer and
after the receiving hospital or medical clinic agreed to the transfer,
If the patient is unconscious, incapable of giving consent and/or unaccompanied, the doctor can transfer
the patient even without his consent, provided that the transfer is done only after necessary emergency
treatment and support were administered to stabilize the patient and after it was established that the
transfer would entail less risks than the patients continued confinement.
The hospital or clinic where the patient will be transferred shall not refuse him nor demand from the patient
or his next of kin any deposit or advance payment,
PENALTIES:
Violators of RA 8344 shall be imprisoned for six months to two years and four months, or fined P20,000 to
P100,000.
If the violation is committed pursuant to an established policy of the hospital or clinic, or upon instruction of
its management, the director or officer of the hospital or clinic responsible for the formulation and
implementation of the policy shall be imprisoned of four to six years or fined P100,000 to P500,000.
26
29. Civil Code, Art. 1431
Art. 1431. 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.
Generally speaking estoppel is a bar which precludes a person from denying or asserting anything to the
contrary of that which has, in contemplation of law, been established as the truth, either by the acts of
judicial or legislative officers or by his own deed or representation, either expressed or implied. It
concludes the truth in order to prevent fraud or falsehood, and imposes silence on a party only when in
conscience and honesty he should not be allowed to speak.
Thus, whenever a party has, by his own declaration ,act or omission, intentionally and deliberately led
another to believe a particular thing to be true, and to act upon such belief, he cannot , in any litigation
arising out of such declaration, act or omission be permitted to falsify it. The principle of estoppels would
step in to prevent one party from going back upon his own acts and representations to the prejudice of the
other party who relied upon them. However, if the act, conduct or representation of the party sought to be
stopped is due to ignorance founded on innocent mistake estoppels will not arise. (Tolentino, pp 656-657
Civil Code of the Philipines, Vol. IV)
30. Professional Services, Inc. vs Court of Appeals, 544 SCRA 170 (2008)
FACTS: Natividad Agana was admitted at the Medical City (owned by PSI) because of difficulty of bowel
movement and bloody anal discharge. Dr. Ampil diagnosed her to be suffering from cancer of the sigmoid.
Dr. Ampil, assisted by the medical staff of Medical City, performed an anterior resection surgery upon her.
During the surgery, he found that the malignancy in her sigmoid area had spread to her left ovary,
necessitating the removal of certain portions of it. Thus, Dr. Ampil obtained the consent of Atty. Agana,
Natividad's husband, to permit Dr. Fuentes, to perform hysterectomy upon Natividad. Dr. Fuentes
performed and completed the hysterectomy. Afterwards, Dr. Ampil took over, completed the operation and
closed the incision. However, the operation appeared to be flawed. After a couple of days, Natividad
complained of excruciating pain in her anal region. She consulted both doctors about it. They told her that
the pain was the natural consequence of the surgical operation performed upon her. Thereafter, her
daughter found a piece of gauze protruding from her vagina. Dr. Ampil was immediately informed. He
proceeded to Natividad's house where he managed to extract by hand a piece of gauze measuring 1.5
inches in width. Dr. Ampil then assured Natividad that the pains would soon vanish. Despite Dr. Ampil's
assurance, the pains intensified, prompting Natividad to seek treatment to Dr. Gutierrez who detected the
presence of a foreign object in her vagina a foul-smelling gauze measuring 1.5 inches in width. The gauze
had badly infected her vaginal vault. A recto-vaginal fistula had formed in her reproductive organ which
forced stool to excrete through the vagina. Another surgical operation was needed to remedy the situation.
Thus Natividad underwent another surgery.
 LEGAL MEDICINE
Atty.. Ivy D. Patdu-Calaquian, MD
A.Y. 2016 - 2017

ISSUE: Whether or not PSI is jointly and severally liable with Dr. Ampil ISSUE: W/N PSI is liable to Natividad Agana?

HELD: PSI is estopped from passing the blame solely to Dr. Ampil. Its act of displaying his name and
those of the other physicians in the public directory at the lobby of the hospital amounts to holding out to
the public that it offers quality medical service through the listed physicians. This justifies Atty. Agana's
belief that Dr. Ampil was a member of the hospital's staff. It must be stressed that under the
doctrine of apparent authority, the question in every case is whether the principal has by his
voluntary act placed the agent in such a situation that a person of ordinary prudence, conversant
with business usages and the nature of the particular business, is justified in presuming that such
agent has authority to perform the particular act in question In these cases, the circumstances yield a
positive answer to the question. The decision also anchors its ruling on the doctrine of corporate
responsibility. The duty of providing quality medical service is no longer the sole prerogative and
responsibility of the physician. This is because the modern hospital now tends to organize a highly-
professional medical staff whose competence and performance need also to be monitored by the
hospital commensurate with its inherent responsibility to provide quality medical care. Such responsibility
includes the proper supervision of the members of its medical staff. Accordingly, the hospital has
the duty to make a reasonable effort to monitor and oversee the treatment prescribed and
administered by the physicians practicing in its premises.
HELD: PSI is liable to the Aganas, not under the principle of respondeat superior for lack of evidence of an
employment relationship with Dr. Ampil but under the principle of ostensible agency for the negligence of
Dr. Ampil and, pro hac vice, under the principle of corporate negligence for its failure to perform its duties
as a hospital. As it happened, PSI took no heed of the record of operation and consequently did not initiate
a review of what transpired during Natividad's operation. Rather, it shirked its responsibility and passed it
on to others to Dr. Ampil whom it expected to inform Natividad, and to Natividad herself to complain
before it took any meaningful step. By its inaction, therefore, PSI failed its own standard of hospital care. It
committed corporate negligence. It should be borne in mind that the corporate negligence ascribed to PSI
is different from the medical negligence attributed to Dr. Ampil. The duties of the hospital are distinct from
those of the doctor-consultant practicing within its premises in relation to the patient; hence, the failure of
PSI to fulfill its duties as a hospital corporation gave rise to a direct liability to the Aganas distinct from that
of Dr. Ampil.

31. Professional Services, Inc vs. Court of Appeals, 611 SCRA 282 (2010)

FACTS: Manila Medical Services Inc. (MMSI), Asian Hospital, Inc. (AHI), and Private Hospital Association
of the Philippines (PHAP) assailed a decision that will jeopardize the financial viability of private hospitals
and jack up the cost of health care. Due to paramount public interest, the Court en banc accepted the
referral and heard the parties on oral arguments on one particular issue: whether a hospital may be held
liable for the negligence of physicians-consultants allowed to practice in its premises. To recall the facts of
the said decision, PSI was impleaded together with Dr. Fuentes and Dr. Ampil for the damages sustained
by Natividad because of the negligence in leaving two gauzes in her body which was used in her surgery.
Supreme Court has absolved Dr. Fuentes but has held that PSI is solidarily liable with Dr. Ampil on the
ground that there is an employee-employer relationship between them and as such they are solidarily
liable. Under the doctrine of apparent authority, PSI created the public impression that he was its agent
and thus, making them liable. PSI was bound by its duty to provide comprehensive medical services to
Natividad Agana, to exercise reasonable care to protect her from harm, to oversee or supervise all persons
who practiced medicine within its walls, and to take active steps in fixing any form of negligence committed
within its premises. PSI committed a serious breach of its corporate duty when it failed to conduct an
immediate investigation into the reported missing gauzes. In their respective memoranda, intervenors raise
parallel arguments that the Court's ruling on the existence of an employer-employee relationship between
private hospitals and consultants will force a drastic and complex alteration in the long-established and
currently prevailing relationships among patient, physician and hospital, with burdensome operational and
financial consequences and adverse effects on all three parties.

27