1. LEGAL ISSUES
and
CONCERNS
on PATIENT
CARE and
HOSPITAL
MANAGEMEN
T

2. No physician is really good before
he has killed one or two
patients.
~Hindu Proverb

3. Medical
Malpractice/Negligence is a

4. BASIC LIABILITIES
 CRIMINAL (Law-Revised Penal
Code and Special Laws)
 CIVIL (Law-Civil Code)
 ADMINISTRATIVE
(Law or Ethics /Medical Act and Code
of Medical Ethics)

5. AS ES
Y C
RA LIT
IM MO

6. LIABILITY
versus
SUABILITY

7. Malpractice cases
vs. Doctors in General
(1993-2006)
90
80
70
60
50
40
30
20
10
0
93 94 95 96 97 98 99 0 1 2 3 4 5 6 7

8. Malpractice cases
Fault or Negligence Attributed to the following . . .
 C lin ic ia n s
 Ad m in is tra tiv
e
ancillary etc.
admin
 An c illa ry 10%
10% 10%
 E tc .
clinicians
70%

9. Specialties . . . 2006
• OB-GYNECOLOGY
• anesthesia pedia others
SURGERY
• PEDIATRICS 11% 17% 6%
• ANESTHESIOLOGY
• OTHERS surgery
28%
ob-gyne
38%

10. Profile of complainant patients (review of 60 cases ) . . . .
Mindanao
Visayas
5%
10%
Luzon
17%
Metro
manila
68%
Place of Incident

12. Profile of complainant patients (review of 250 cases ) . . . .
Elementary
13%
College High
School
55% 27%
5%
Vocational
Level of E ducation

13. Profile of complainant patients (review of 250 cases ) . . . .
others
10%
Gov’t
/relative
Doctor 34%
Relative 20%
36%
Relatives Lawyer /
relative
(within 6th degree)

14. HOSPITAL ADMINISTRATOR
= = =
HOSPITAL MANAGEMENT
= = =
MEDICAL DIRECTOR

15. NASTY HEADACHE FOR THE
MEDICAL DIRECTOR…
 Fractures or burns resulting during rehab/PT
session
 Necrotiv IV site
 Baby falls during delivery
 Wrong sex was assigned to the baby
 Incomplete OS/instrument count
 Wrong medicine/dosage/route was given
 Wrong type of blood was transfused
 Expired meds/drugs
 Erroneous laboratory/radiologic results

16. What should I do?
Who shall be held responsible?
 Lost specimens (eaten by cats, rats, etc.)
 False Positive Results (Hep B)
 Wrong Entry/Proforma Results
 Contrasting Readings (Discrepancies)
 Wrong results (Errors)
 Non-availability of blood
 Negligent reading/Negligent staff
 Fake training/documents/licenses
 Unethical practices

17. OR
 You are being charged with lascivious
conduct, sexual harassment and
immorality?

18. Violation of Mandatory & Prohibitive Laws . . .
P.D. 169
R.A. 8344
PD 603
RA 7610
Pharmacy Act
GENERIC
ACT
R.A. 6615
Sexual Harassment Law

19. Certain laws requiring mandatory reporting . . .
PD 169 - Physical Injuries
“The attending physician of any hospital,
medical clinic, sanitarium, or other medical
establishment, or any medical practitioner, or
who has treated . . . any person for serious or
less serious physical injuries . . . shall report
the fact of such treatment personally or by
fastest means of communication to the
nearest Philippine Constabulary [now
Philippine National Police] unit without delay .
. .”

20. Failure to comply . . .
“. . . any violation of this decree and/or the
rules and regulations which shall be promulgated
by competent authorities in accordance
herewith, with malicious intent or gross
negligence shall suffer the penalty of
imprisonment for not less than one (1) nor
more than three (3) years and/or fine of not
more than 1,000 pesos nor more than 3,000
pesos”

21. Article 166 of Presidential Decree No. 603, as
follows-
“. . . All hospitals, clinics or other
institutions as well as private physicians
providing treatment shall, within forty-
eight [48] hours from knowledge of the
case, report in writing to the . . . nearest
unit of the DSWD, any case of maltreated
or abused child, or exploitation . . .”

22. violation subjects the physician to . . .
Article 166, Presidential Decree No. 603, to
wit-
“. . . violation of this provision shall
subject the hospital, clinic, institution or
physician who fail to make such report to
fine of not more than 2 thousand pesos . .
.”

23. One important aspect . . .
Article 166, Presidential Decree No. 603
provides as follows-
“. . . in case of sexual abuse, the
records pertaining to the case shall be
kept strictly confidential and no
information relating thereto shall be
disclosed except in connection with any
court or official proceeding based on such
report . . .”

24. CHILD
ABUSE
Still confidentiality . . .
“ . . . At the instance of the offended party,
his/her name may be withheld from the
public until the court acquires jurisdiction
over the case.
It shall be unlawful for any editor,
publisher, and reporter or columnist in case
of printed materials, announcer or
producer in case of television and radio
broadcasting, producer or director of the
film in case of the movie industry to cause
undue and sensationalized publicity of any
case in violation of this Act resulting in the
moral degradation and suffering of the
offended party.”
[Section 29. Art. XI, RA 7610]

25. non-compliance . . .
Article 166, Presidential Decree No. 603
“. . . any person disclosing
confidential information in violation of
this provision shall be punished for a
fine of not less than two thousand
[2,000] pesos or by imprisonment of
not more than one [1] year or both
such fine and imprisonment at the
discretion of the court . . .”

26. R.A. 5921 PHARMACY ACT
. . . on Sale of Drug Samples
“. . . Section 26. No sample of any drug,
biologic product, device or proprietary medicine,
given or intended to be given for free to the
physician and other qualified persons by any
manufacturer or distributor or his representative
or detailman, as part of its program, may be
sold . . .”

27. if a doctor sells and found guilty . . .
“. . . Section 40. Any person
who shall violate any of this
provision . . . a fine of not
less than 1,000 pesos or
imprisonment of not less
than six (6) months and
one (1) day but not more
than four (4) years . . .”

28. REPUBLIC ACT NO. 7877
 AN ACT DECLARING
SEXUAL
HARASSMENT
UNLAWFUL IN THE
EMPLOYMENT,
EDUCATION OR
TRAINING
ENVIRONMENT, AND
FOR OTHER
PURPOSES.

29.  SECTION 3. Work, Education or Training
-Related, Sexual Harassment Defined. –
Work, education or training-related sexual
harassment is committed by an employer,
employee, manager, supervisor, agent of the
employer, teacher, instructor, professor, coach,
trainor, or any other person who, having
authority, influence or moral ascendancy over
another in a work or training or education
environment, demands, requests or otherwise
requires any sexual favor from the other,
regardless of whether the demand, request or
requirement for submission is accepted by the
object of said Act.

30.  The employer or head of office,
educational or training institution shall
disseminate or post a copy of this Act for
the information of all concerned.

31. SECTION 5. Liability of the Employer, Head of Office,
Educational or Training Institution. -
The employer or head of office,
educational or training institution shall be
solidarily liable for damages arising from the
acts of sexual harassment committed in the
employment, education or training
environment if the employer or head of
office, educational or training institution is
informed of such acts by the offended party
and no immediate action is taken.

32. SECTION 7. Penalties.
- Any person who violates the provisions of this
Act shall, upon conviction, be penalized by
imprisonment of not less than one (1) month nor
more than six (6) months, or a fine of not less
than Ten thousand pesos (P10,000) nor more
than Twenty thousand pesos (P20,000), or both
such fine and imprisonment at the discretion of
the court.

33. Emergency Cases
Republic Act 6615
MEDICAL ASSISTANCE IN EMERGENCY CASES
-and-
Republic Act 8344
“AN ACT PENALIZING THE REFUSAL OF
HOSPITALS AND MEDICAL CLINICS TO ADMINISTER
APPROPRIATE INITIAL MEDICAL TREATMENT AND
SUPPORT IN EMERGENCY OR SERIOUS CASES,
AMENDING FOR THE PURPOSE BATAS PAMBANSA
BILANG 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”

34. Violation gives rise to . . .
“Any official, medical practitioner or employee of the
hospital or medical clinic who violates the provisions of RA 8344
shall, upon conviction by final judgment, be punished by
imprisonment of not less than six ( 6) months and one ( 1 ) day
but not more than two ( 2 ) years and four (4) months, or a fine of
not less than Twenty thousand pesos (P20,000.00 ), but not more
than One hundred thousand pesos (P100,000.00 ) or both at the
discretion of the court: Provided, however, That if such violation
was committed pursuant to an established policy of the hospital or
clinic or upon instruction of its management, the director or
officer of such hospital or clinic responsible for the formulation and
implementation of such policy shall, upon conviction by final
judgment, suffer imprisonment of four ( 4 ) to six (6 ) years, or
a fine of not less than One hundred thousand pesos (100,000.00),
but not more than Five hundred thousand pesos ( P500,000.00 ) or
both, at the discretion of the court”

35. RA 9439 -
 Prohibiting the
Detention of Patients I promise to
pay
in Hospitals and
Medical Clinics on
Grounds of Non-
Payment of Hospital
Bills or Medical
BILLS
Expenses

36.  Section 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 P 20,000.00, but not
more than P 50,000.00, or imprisonment
of not less than one month but not more
than six months or both fine and
imprisonment at the discretion of the
proper court

37. LIABILITIES IN
Corporation COLLEGE/
UNIVERSITY
MEDICAL/HOSPITAL
PRACTICE . . . VICARIOUS
LIABILITY
HOSPITAL
Interns/
Ostensible Students
Agent
CONSULTANT
Independent Employer-Employee
Contractor Relationship
MedTechs/Nurses/Paramedical
Employees
Non paramedical employees

38. Supreme Court Decisions . . .
December 29, 1999
RAMOS VS. COURT OF APPEALS
G.R. No. 124354
SC: “Captain of the Ship Doctrine applies . . .
The attending physician is responsible for the
negligent acts of the staff under his control and
supervision . . .”

39. Supreme Court Decisions . . .
December, 2006: January 31, 2007
Rogelio Nogales, Professional Services,
et al, vs Capitol Inc. vs. Agana, (G.R. No.
Medical Center, et 126297), and Agana vs.
al, G.R. No. Juan Fuentes (G.R. No.
142625 126467),
O s t e n s ib l
e Ag e nt

40. THIRD DIVISION
ð ð G.R. No. 168512
G. R. No. 16851
G. R. NG. R. No. 16851
G. R. N and BU CASTRO,[1]
Petitioners, Present:
Ynares-Santiago, J. (Chairperson),
- versus - Austria-Martinez,
Callejo, Sr.,
Chico-Nazario, and
Nachura, JJ.
. Jchur a, ar i o, and
. Jchur a, ar i o, , Promulgated:
Respondents.
March 20, 2007
x ---------------------------------------------------------------------------------------- x
DECISION
YNARES-SANTIAGO, J.:
[1]
Did not appeal from the Decision of the Court of Appeals.

41. “x x x From the foregoing laws and
rules, it is clear that a clinical laboratory must
be administered, directed and supervised by a
licensed physician authorized by the Secretary
of Health, like a pathologist who is specially
trained in methods of laboratory medicine; that
the medical technologist must be under the
supervision of the pathologist or a licensed
physician; and that the results of any
examination may be released only to the
requesting physician or his authorized
representative upon the direction of the
laboratory pathologist x x x”

42. “ x x x ……
WHEREFORE, the Decision of the Court
of Appeals in CA-G.R. CV No. 58668 dated
February 27, 2004 finding petitioner +++
++++++++ guilty of gross negligence
and liable to pay to respondents
P50,000.00 as moral damages,
P50,000.00 as exemplary damages, and
P25,000.00 as attorney’s fees, is
AFFIRMED.
SO ORDERED.
…x x x”

43. “x x x Castro’s infrequent visit to the
clinical laboratory barely qualifies as an
effective administrative supervision and control
over the activities in the laboratory.
“Supervision and control” means the authority
to act directly whenever a specific function is
entrusted by law or regulation to a subordinate;
direct the performance of duty; restrain the
commission of acts; review, approve, revise or
modify acts and decisions of subordinate
officials or units.[1] x x x”

[1] Jalandoni v. Drilon, 383 Phil. 855, 868
(2000).

44.  First,  is not administered, directed and
supervised by a licensed physician as required
by law, but by b , a
licensed Medical Technologist.[1]
[1] Records, p. 193.
 Second, , cond conducted the HBsAG test of
respondent r espon without the supervision of
defendant-appellee Castro
 Last, the disputed HBsAG test result was
released to respondent r el eas without the
authorization of defendant-appellee Castro

45.  When accidents occur due to negligence,
mismanagement and or fortuitous events…
HOW DO YOU SAVE
YOURSELF FROM A
LAWSUIT?

46. Perhaps , the ONLY way is to…
say SORRY
and PRAY
or ……… PAY!!!

47. OBJECTIVE/GOAL
 Mitigate, minimize violent litigious reaction
from the next of kin

48. USEFUL TIPS
 Have a conference ASAP
 Get your acts together.
 Talk to the hospital lawyer right away
 Have an agreed upon a common stand

49. CONFERENCE WITH THE
PATIENT’S NEXT OF KIN
 When?
 Where?
 With whom?
 Who will talk to them?
 How?

50. THE QUIT CLAIM
Contents of quit claim shall contain among
others…
 waiver to file criminal, civil and
administrative case against hospital and
medical staff (and of course, that the doctor is not
negligent and the monetary consideration is for
humanitarian purposes!)

51. MALPRACTICE INSURANCE
 Is it ADVISABLE?
 Is it DESIRABLE?

52. the fact is…………….
CRIMINAL and
ADMINISTRATIVE
LIABILITIES CANNOT be
INSURED
On l y
CIVIL LIABILITY

53. GOLDEN RULES
- Documentalt s/r r l a t w w e
l est eferas nd o hom/ her
- E a t paientpur
xpl in o t pose a impora ofr r l
nd t nce eferas
- Documentt s/efera r t
est r r l esuls
- Communicae w h paienta t r t a documenteffors t
t it t bout est esuls nd t o
communicae especial non- ia paient
t ly compl nt t s.

54. - Chatnot shoul be ea t r d
r es d sy o ea
- NE E at r ds
V R ler ecor
- NE E int ional misdae not orent signaur a init l orr t
V R ent ly t es er t es nd ias epors
l t t n t dae r iew unl t corectdae is aso ent ed.
aer ha he t ev ed ess he r t l er
- Secur a documentCONSE aw ys.
e nd NT l a

55. good
Rapport!

56. HOW TO AVOID BEING SUED FOR
MALPRACTICE?
STOP YOUR PRACTICE!!!
Do not accept the position-Medical Director
Shift to other professions or business
OR……

58. Hi!
I am the
Medical Director!
EAST AVENUE MEDICAL CENTER, March 27, 2008

59. Dear Lord,
Please assign
another Medical
Director!

60. A TTY. A NTONIO A LE J A NDRO D. RE B OS A ,
M.D.