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