summary ch 12,15,16,17,19,20,22,23,24 (1).pdf

Upload: kirstie-de-luna

Post on 04-Oct-2015

14 views

Category:

Documents


2 download

TRANSCRIPT

  • JURIS Prelim LEC # - TITLE

    Dr. May , 2011

    CH 12: Acts Constituting Practice of Medicine

    Board exam oath taking PRC certificate of

    registration

    PRACTICE OF MEDICINE

    Diagnosis, Treatment, Correction, Advisement,

    prescription

    Disease, ailment, etc real or imaginary

    ACTS constituting Practice of Medicine

    o Medical Act of 1959 (RA 4224) (Sec 10)

    Physically examine, and diagnose, treat, operate,

    or prescribe

    Compensation for physical exam and more

    o Even without compensation

    o Investment in stocks is NOT practicing

    Advertises as one

    o License to practice drugless healing

    cannot be implied

    M.D. title

    o Also healer, Dr., doctor, D.O.

    o Exception for doctorate degrees

    ACTS not constituted as practice

    Medical student under direct supervision

    o Moonlighting is illegal practice

    Dentist

    Physiotherapist

    Optometrist

    Gratuitous emergency service

    Good Samaritan

    Dispensive over-the-counter drugs

    Traditional Medicine

    Religious healing

    Household remedy recommenders

    Psychologist

    Prosthetist

    CH 13: Illegal Practice of Medicine

    1. Illegal Practice of Medicine

    Medical Act of 1959 (RA 4224) (Sec 10)

    Exempted acts are Section 11

    2. Penalties for Illegal Practice of Medicine

    Fine and/or imprisonment (Section 28)

    o 1,000-10,000php

    o 1 year 5 years imprisonment

    Drugless healing = ILLEGAL

    Illegal practice is NOT malpractice or negligence

    3. American Case Laws

    May be considered a PUBLIC NUISANCE

    (STATE Gibson vs Missouri Board of

    Chiroparctors) Dr of Chiropractry administering

    ear drops, vitamins, and placebos beyond

    scope of chiropractic license

    isolated or occasional gratuitous acts of midwifery do

    not constitute as unlawful

    CH 15: Philippine Jurisprudence on Medical

    Education System

    1. PRC refusing to Issue Certificate of Registration

    PRC vs De Guzman

    Passed the Physician Licensure Exam (PLE) by the

    Board of Medicine.

    PRC (Professional Regulation Commission)

    released their names as successful examinees in

    the MLE (medical licensure exam)

    79 students all got EXTREMELY high grades in

    Biochem and OB-Gyne. Many 100%!!

    NBI hired to investigate statistics = incredibly

    high AND clustered.

    Board charged them with immortality, dishonest

    conduct, fraud, and deceit and to nullify the

    score

    But they fought saying they passed the MLE, and

    are therefore be obliged to administer the oath

    as physicians

    Duty of the Board of Medicine to issue

    Certificates of registration

    o shall = command

    o But the Board argued until the moral and

    mental fitness of respondents can be

    ascertained, they can withhold

    administration on their discretion

    o Broke down the phrase satisfactorily

    passed the Boards, with definition of

    capable of dispelling doubt or

    ignorance, so they tried to nullify their

    scores

    The RIGHT to be registered as physicians

    o Applicants must show they possess all the

    qualifications and none of the

    disqualifications, and he must fully

    comply with all the conditions and

    requirements. Should there be doubt in

    satisfactory completion, courts may not

    grant the priviledge.

    They are allowed to appeal to the PRC then

    appeal to the Office of the President appeal

    for special civil action

    2. Case of Closing a Sub-Standard Medical School

    Board of Mecial Education vs Alfonso, GR

    Closing of the medical school was NOT a grave

    abuse of discretion

    Due to

    o Not fulfilling its purpose in creating

    curriculu, relating to Muslim welfare

    o Failed to balance humanistic and scientific

    education

    o No base hospital for training students in

    major clinical disciplines

    o 60% of college faculty werent full-time

    teachers short, irregular class hours,

    subject overloading, poor quality teaching

    A team went back two years later as the dispute

    continued

    o College fought saying they have 3 years to

    comply, because they can only be

    investigated every three years

    o Court rejected, with more info explaining

    they can take UP TO 3 years, but they

    arent off scott-free for 3 years until their

    next compliance-check.

    3. Case of Constitutionality of the NMAT

    TABLARIN vs GUTIERREZ 1987

    Supreme Court unanimous decision

    Power to regulate and control Practice of

    Medicine allows regulation of admission

    Minimum educational requirements

    Regulation of access to medical schools

    Need to maintain high standards in the

    professional schools are widely known

    Government is entitled to require NMAT to

    upgrade the selection of applicants to improve

    the quality of medical education in the country

    Equal protection of rights because baseline is

    different each year?

    o It would be an UNREASONABLE RIGIDITY

    to have the same cutoff each year

    because things differ year to year. Test

    difficulty, students, etc.

    Certain minimum scores are reasonable

    4. Failing NMAT 3 times

    DECS vs SAN DIEGO, 1989

    Intended to insulate the medical schools and

    ultimately the medical professions from intrusion

    of those not qualified

    Everyone has the right to aspire, but not

    everyone has the right to be a physician

    The three-flunk rule cant be any less valid in

    regulating the profession than the NMAT passing,

    itself!

    A person cant insist to be a physician if he will be

    a menace to his patients

    Persistence is noteworthy, but misplaced like a

    hopeless love

    5. Admission Requirements by UP Faculty

    REYES vs COURT OF APPAELS, 1991

    Can the Board of Regents (BOR) admit the

    students into the UPCM (UP college of medicine)

    even though UPCM raised the cutoff of NMAT

    from 70-90%? These students only above 70%

    BOR has the power to fix admission requirements

    of college, BUT college faculty has the power to

    determine entrance requirements of the college

    BOR has hierarchy, in essence. BOR decides as

    they give the power to the college faculty.

  • CH 16: ILLEGAL PRACTICE OF MEDICINE

    1. Rapist who pretended to be a physician

    PEOPLE vs HATANI

    ILLEGAL PRACTICE OF MEDICINE

    o Has not taken medicine, passed the

    boards, no degree, practiced medicine for

    compensation on Wilma and Precila

    RAPE

    o Lewd intentions

    Agustinas child (Precila) received help from her

    Godparents son-in-law

    Appellant gave tablets and injections sleep

    Dr told mom that she was a drug addict

    Precila woke up and saw him naked in bed with

    her, and he quickly injected her again

    unconscious. Mom found them later in bed.

    Drugs: Dalmane and valium

    Search warrant drugs and instruments seized

    Defense Dr says it was a setup for extortion.

    Guilty of

    o Rape: convincing as a 16yo girl would not

    embarrass herself in public trial w/o reasn

    Life imprison/reclusion perpetua &

    50,000php

    o Illegal purchase of medicine

    His handwriting on prescriptions.

    No proof of payment thats ok

    10,000php + 5years imprison

    2. Japanese Doctors Allegedly Practicing Med

    CRISOSTOMO vs SEC G.R.

    UDMC convinces foreign invest of 57mil php to

    prevent foreclosure

    Now they own more than 40% of UDMC stock

    which is illegal as foreign investment

    They can not practice Medicine in the Philippines

    Ownership does NOT equal Practice of Medicine

    3. Healing without drugs

    PEOPLE vs VENTURA

    Appellant (accused) of healing, advertising, and

    for compensation. He says

    o The NBI induced him to practice medicine

    o He has an implied license to practice

    drugless healing from Medical Board of

    Examiners

    He practices natural healing without drugs

    He has no Masseus license either

    Police Power of the State to secure the general

    welfare of the people to protect against

    ignorance and deception and fraud

    4. Chiropractor

    PEOPLE vs BUENVIAJE

    Claims of Physician of Chiropracty is Practice of

    Medicine

    Accused of

    o Treated, manipulated body for purpose of

    curing

    o Advertised as a doctor/physician

    Violation of the Medical Law

    Claims

    o Chiropracty isnt Practice of Medicine

    (wrong)

    o We have the right to pursue life, liberty,

    happiness

    5. Double Jeopardy

    PEOPLE vs DE GOLEZ

    Crime of homicide through reckless imprudence

    Tried to treat a sick person without the

    competency or license person died

    But this person had already been charged of

    physical injuries through imprudence underthe

    old penal code

    Cant be convicted again

    6. Classical Case of Illegal Practice of Medicine

    PEOPLE vs QUEBRAL

    Admits to diagnosing, treating, for money

    Defend: No proof that he doesnt have certificate

    Board of Medical Examiners stated he is not in

    their records under diligent examination

    CH 17: Physician-Patient Contractual

    Relationship

    1. Intro

    PPCR = BASIS of practice of medicine

    Cost-containment and new info technology are

    growing in administrative dominance

    Hospitals/Insurance threatens to reduce

    physician autonomy

    CLIMATE OF DISTRUST = main cause of

    deterioration

    Medical negligence cases are often due to breach

    of the PPCR

    2. Nature of PPCR

    1. Consensual

    o Mutual consent

    o Offer and acceptance for an object

    OBJECT = surgical operation, etc

    o Both parties agree

    o Deemed accepted when patient receives

    reply of doctor

    ENRIQUEZ vs SUNLIFE ASSURANCE

    Died just before reading the letter,

    so the contract was not perfected

    2. Fiduciary

    o Mutual trust & confidence

    o Doctor must give all relevant information

    and be accurate and provide best for px

    o Information remains CONFIDENTIAL

    3. Partied involved

    Physician

    Patient (or guardian/parent if cant consent due

    to consciousness, sanity, or

  • CH 20: Jurisprudence about PPCR

    1. No PPCR

    Pre-employment physical examination

    PE for insurance eligibility

    Trial court to declare sanity

    Autopsy (no longer a person/patient)

    Casual questions in an unordinary place

    Examples

    Hill vs Kokosky

    o Dr. telephone called 2 OBs at another for

    advice about pregnancy NO PPCR

    NBD Bank vs Berry

    o Dr reviewed chart (never saw the patient),

    offered advice to attendee NO PPCR

    Bovara vs Saint Francis Hospital

    o Dr reviewed chart (never saw the patient),

    offered advice to dr YES PPCR!!!

    o Patients consent is implied

    McKinney vs Schlatter

    o E.R. telephone to cardiologist NO PPCR

    reversal to YES PPCR!!!

    PPCR may exist where ALL THREE even if never

    sees the patient:

    o Participates in the diagnosis

    o Participates in the prescription; AND

    o Has a duty to the hospital (hes on-call)

    If theres no PPCR, theres no medical negligence

    or medical malpractice

    2. Terms Not Included in the PPCR

    No promise to cure. And no promise to:

    1. To be successful

    2. That it will benefit

    3. That it will not harm

    4. That wont commit errors in honest way

    CH 22: RIGHTS to Physicians and Patients (BILL

    OF RIGHTS of EVERY CITIZEN

    1. Constitutional Bill of Rights of Citizens

    1. Not deprived of life, liberty, property

    2. Secure against unreasonable searches

    3. Privacy of communication

    4. Freedom of speech, expression, press

    5. Religious freedom

    6. Liberty of abode

    7. Right to information on public matters

    8. Right to form unions/associations

    9. Private property

    10. Contracts not prevented

    11. Free access to courts

    12. Right to remain silent

    a. no torture, force, threat

    b. confession in force is not admissible

    13. Bailable except if reclusion perpetua

    14. Due process of law

    a. Innocent til proven guilty

    15. Habeas corpus not suspended

    16. Speedy judicial disposition

    17. Dont have to be a witness against himself

    18. Political belief and aspiration freedom

    a. No involuntary servitude unless criminal

    19. No excess fines or degrading punishment

    20. No imprisonment for debt

    21. No double jeopardy

    2. Overview of Important Rights

    Due Process of Law

    1. PROCEDURAL due process

    Hears before it condemns

    Judgment only AFTER trial

    Opportunity to be heard

    Right to a hearing

    2. SUBSTANTIVE due process

    Requires intrinsic validity of the

    law in interfering with a persons

    rights

    Equal Protection of the Law

    Searches and Seizure

    o Anti-wire tapping (poisonous tree

    doctrine)

    o Requires valid warrant for probably

    cause

    o Any evidence is invalid

    o ZULUETA vs CA

    Wife forcibly opened husbands

    things to find he was cheating with

    his patients. Not evidence for

    divorce OR for barring from

    medical practice.

    Religious Freedom

    o Treat patient because of superior

    knowledge

    o But if against religion, respect rights

    except if a minor, where you can go to

    Social Welfare Dept

    CH 23: RIGHTS AND DUTIES OF PHYSICIAN

    1. Sources

    Bill of Rights

    Hippocratic Oath

    o To honor teachers

    o To pass on knowledge

    o To act in interest of patient

    o To refrain from taking life

    o To guard art of physician

    o To refrain from surgery

    o Not to take advantage $$ or sexual

    o Patient/Physician confidence

    Code of Medical Ethics of Board of Medicine, PRC

    o Service to mankind, irrespective of

    o Maintain the honorable tradition

    o Fulfill civic duties as good citizen

    o Safeguard colleagues

    Code of Ethics of the Medical Profession,

    Philippines Medical Association

    o Health is the fundamental right

    o Noble profession to provide competent

    and compassionate care

    o Primary goal is interest of the patient

    o Duties to the larger community as well

    The Contract

    2. Rights Inherent in the Practice of Medicine

    Physician has interest in REPUTATION and can

    take legal proceedings to protect it

    Liberty to refuse, but also not to disclose patient

    information unless compelled by law

    Right to Refuse Treatment

    o Even in E.R., can still refuse if it will put

    him in a perilous condition

    o But moral and ethical appeal for sake of

    humanity to always treat in any situation

    o But must ALWAYS use reasonable care,

    because PPCR even in the goodwill cases

    o NOT ABSOULTE:

    ER: must treat

    Unless it is necessary to transfer,

    and it only happens after proper

    stabilization and transfer hospital

    will receive them.

    RIGHT TO LIMIT MEDICAL PRACTICE

    o Eg: Pedia ONLY

    Right to Withhold Information

    o Police cant extract information EXCEPT in

    court by a judge to assist in justice

    o Or when common good so requires it

    o Must give for epidemiological studies, etc

    o Patients have a right to their information,

    so it can transfer to another hospital. The

    hospital has a right to a copy or original of

    it

    Right to Reputation

    o Most valuable to Physician: RIGHT TO A

    GOOD NAME

    3. RIGHTS INCIDENTAL TO PRACTICE OF MEDICINE

    Right of Way for ER call

    o Abused by physicians. Should only be for

    emergency calls. Get out of minor violatn

    Right to be paid

    o But should take into account the

    economic status of patient

    Right to Membership in Medical Societies

    Right of Exemption from Execution of

    Instruments and Library

    o Exempt from being taken in lawsuit

    Right to hold Public and Private Services

    o Eg: to be the Medical Health Officer

    Right to Perform Certain Services

  • 4. DUTIES OF PHYSICIANS TO THEIR PATIENTS

    4 key elements

    o Should possess the knowledge and skill of

    an average physician

    o Use knowledge and skill with ordinary

    care and diligence

    o Obliged to exercise BEST JUDGMENT

    o Duty to observe utmost GOOD FAITH

    Duties from Revised Code of Ethics of Medicine

    o Principal Responsibility is Patient Welfare

    o Patient has right to choose his physician,

    and physician can choose also

    o Inform patient to nature od illness, etc

    o Respect confidentiality

    o When in doubt, refer.

    o Fair and considerate professional fee

    o Must update his knowledge

    5. DUTIES OF PHYSICIANS TO THEIR COLLEAGUES

    Respect dignity and good names of fellows

    Work together in harmony

    Shouldnt solicit patients or unfair competition

    Encourage patient to return to original Dr

    Acknowledge colleagues for procedures

    ENCOURAGED to waive prof. fee to colleague

    6. DUTIESOF PHYSICIANS TO THE COMMUNITY

    Obligation to the community to initiate and

    participate in efforts to public health

    Be aware that hes viewed as a leader, live up.

    Protect the health of community by warning

    against improper practices

    Exercise high ethics

    Prudence and good faith in media appearances

    Take care in new researches before releasing to

    the public

    7. DUTIES OF PHYSICIANS TO SPECIAL GROUPS

    Respect and cooperate with members of other

    health professions in delivery of health care

    Be transparent in relations with organizations

    and enterprises

    8. DUTIES OF PHYSICIANS to the PROFESSION

    Protect and enhance image and reputation

    Attract highly principled young people

    Be actively involved in affairs of Philippine

    Medical Asssociation

    Ethically incorrect may not be legally wrong.

    o Bad ethics can be brought before the

    BOARD OF MEDICINE for reprobation and

    discipline. NOT the courts.

    9. PHYSICIAN COMMITMENTS

    I will be honest

    I will work with you

    I will not speak for anything being what I know

    I will listen attentively

    I will respect your right to make informed

    decision

    I will consciously believe in ability to make a

    difference in healing

    MORAL DUTIES

    To help, cure, promote, protect, inform, be

    confidential, protect patient, protect privacy,

    dignity

    CH 24: RIGHTS AND DUTIES OF PATIENT

    1. Sources

    Bill of Rights (1987 Constitution)

    Hippocratic Oath

    Code of Medical Ethics, Board of Medicine, PRC

    Code of Ethics of Medical Profession, PMA

    The Contract

    2. RIGHTS OF PATIENTS******************

    1. Right to choose his Physician

    2. Right to Treatment and Right to Unnecessary

    Treatment: Considerate and Respectful Care

    3. Right to Informed Consent: Relevant, Current,

    Understandable Information Concerning

    Diagnosis, Treatment, and Prognosis

    4. Right to Confidential Information (Privileged

    Information)

    5. Right to Privacy and Access to Communication

    6. Equal Protection of the Law

    7. Review Medical Records and Have Information

    Explained

    8. Consent to or Decline to Participate in Proposed

    Research Studies In Human Experimentation

    9. Right to expect family member will be notified of

    patients admission to hospital

    10. To receive considerate and respectful care

    provided in a safe environment

    11. To have knowledge of the name of the physician

    12. To expect reasonable continuity of care

    13. To access medical records in good time

    14. To expect access to protective services

    15. To expect issues related to end-of-life care to be

    treated with respect and sensitivity

    16. To examine and receive an explanation of his

    medical bill

    3. Duties of A Patient

    1. Must provide good history

    2. Must take responsibility for requesting additional

    info when he doesnt understand

    3. Must inform physician about anticipated

    problems in following prescribed treatment

    4. Must make reasonable accommodations for

    needs of hospital

    5. Must provide necessary insurance info and make

    payments

    6. Must recognize impact of lifestyle on his health

    4. PATIENT COMMITMENT

    1. I will do everything I can to assist in my healing

    2. I will keep my appointments

    3. I will keep you informed with problems

    4. I will keep you informed with medications

    5. I will let you know my concerns

    6. I will believe in your ability

    PROPOSED UPDATES

    RIGHTS OF PATIENTS

    1. Right to Appropriate Medical Care

    2. Right to Informed Consent

    3. Right to Privacy and Confidentiality

    4. Right to Information

    5. Right to Choose Health Provider

    6. Right to Self-Determination

    7. Right to Religious Belief

    8. Right to Medical Records

    9. Right to Leave

    10. Right to Refuse Participation in Research

    11. Right to Correspondence and Visitations

    12. Right to Express Grievances

    13. Right to Informed of his rights and obligations

    SOCIETAL RIGHTS OF PATIENTS

    1. Right to Health

    2. Right to Access to Quality Public Health Care

    3. Right to Health and Safety Workplace

    4. Right to Prevention and Education Programs

    5. Right to Participate in Policy Decision