Magna Carta of Patients' Rights in the Philippines

• The document refers to Senate Bill No. 812, introduced by Senator Ramon Bong Revilla, Jr., concerning the Magna Carta of Patients' Rights and Obligations in the Philippines

Explanatory Note

• The State seeks to protect patients' rights to humane and quality health care
• The State aims for an integrated approach to health and development, ensuring affordable essential goods, health, and social services, and free medical care for impoverished citizens

Basic Patient Rights

• Proper medical care and humane treatment
• Informed consent
• Privacy and confidentiality
• Information access
• Choice of health care provider
• Self-determination
• Religious beliefs
• Medical records
• Right to leave
• Freedom to refuse medical research participation
• Correspondence and visitation rights
• Grievance expression
• Knowledge of rights and obligations

Title I: Title and Declaration of Policies

• The Act is formally titled "Magna Carta of Patient's Rights and Obligations"
• The State's policy to protect and promote citizens' health, instilling health consciousness
• The State prioritizes measures enhancing human dignity in healthcare
• The State aims to ensure decent, humane, and quality healthcare for all patients

Title II: Definition of Terms

Advance Directive

• A written document with instructions made by a person
• Instructions made before a terminal illness or vegetative state
• Includes health care proxy or living will
• Should be notarized, executed by a person of legal age and sound mind with physician and family consultation

Emergency

• An unforeseen, life-threatening, unanticipated, and episodic combination of circumstances
• Immediate medical intervention is required to preserve life and limb, as determined by a responsible healthcare worker

Health Care

• Measures taken by a provider or in a health institution
• Actions taken to determine, restore, or maintain a patient's health

Health Care Institution

• A site devoted to maintaining and operating facilities
• Focuses on prevention, diagnosis, treatment, and care for individuals suffering from illness, disease, injury, or deformity and medical and nursing care

Health Care Professional/Practitioner

• Includes physicians, dentists, nurses, pharmacists, and paramedical staff
• Includes technicians, technologists, aides, therapists, and nutritionists trained and licensed in the Philippines
• Includes traditional and alternative health care practitioners

Health Maintenance Organization

• An entity licensed by a government agency
• Arranges health services coverage for plan members for a fixed prepaid premium

Human Experimentation

• A physician departs from standard medical practice
• Treatment with the purpose of obtaining knowledge or test a scientific hypothesis on human subjects

Indigent Patient

• Someone with no visible income
• Insufficient income for family subsistence

Informed Consent

• A person's voluntary agreement based on their understanding
• Understanding consequences of receiving a particular treatment
• Explained clearly, truthfully, and understandably by the healthcare provider
• Permission must be in writing

Mass Media

• Means of communication reaching large audiences
• Includes print, radio, television, and movies
• Involved in gathering, transmission, and distribution of news, information, messages, signals, and written, oral, and visual communications

Media Practitioner

• Someone engaged in the practice of mass media

Medically Necessary

• Services and procedures appropriate and consistent with diagnosis
• Uses accepted medical standards
• Cannot be omitted without adversely affecting the patient's condition

Patient

• Someone availing themselves of health services
• Otherwise the subject of such services

Public Health and Safety

• The state of well-being of the population
• Protection may require curtailment or suspension of certain patient rights

Terminal Care

• Services offered by a team of professionals and volunteers
• Aims to maintain or improve comfort for terminally ill patients
• Includes pain management, symptom control, spiritual, psychological, and emotional support for the person and his family
• Care does not hasten nor postpone death; it affirms life, treating dying as normal

Terminal Illness

• An illness or condition likely to result in death soon

Terminal Phase

• The stage of terminal illness with no prospect of recovery or symptom remission

Traditional and Alternative Health Care

• Knowledge, skills, and practices on health care not embodied in biomedicine
• Used in prevention, diagnosis, and elimination of physical or mental disorder

Traditional and Alternative Health Care Practitioner/Provider

• Practices non-allopathic, non-indigenous/imported healing methods
• Includes reflexology, acupuncture, massage, acupressure, chiropractic, and nutritional and other similar methods.

Unwarranted Public Exposure

• When a patient is subjected to exposure, private or public
• Exposure by photography, publication, videotaping, discussion, TV or radio broadcasting
• Reveals their person/identity and circumstances under which he/she is or will be under medical or surgical treatment without consent

Title III: Declaration of Rights

• Section 4 outlines the rights of patients to be respected by all involved in their care

Right to Appropriate Medical Care and Humane Treatment

• Every person has a right to health and medical care corresponding to his state of health, without discrimination and within the limits of available resources and competence
• Patients have the right to good quality appropriate health and medical care
• Human dignity, convictions, integrity, individual needs, and culture must be respected during care
• Those needing immediate treatment must be directed to wait, be referred, or sent for treatment elsewhere
• Patients waiting for care should be informed of the reason for the delay
• Patients in emergency should be extended immediate care and treatment without advance payment

Right to Informed Consent

• Patients have the right to truthful and substantial explanation in an understandable manner of all proposed procedures
• The person performing the procedure must provide his/her name and credentials
• Explanation of the possibilities of mortality risk or serious side effects, recuperation problems, probability of success, and reasonable risks are required
• Written informed consent needed, except in the following cases:
  • Emergency cases where the patient is at imminent risk of physical injury, decline, or death
  • When the population health is dependent on a mass health program
  • When everyone is required to submit to the procedure by law
  • When the patient is a minor or legally incompetent, in which case third party consent is required
  • When disclosing information would jeopardize treatment success in which case a third party
• When the disclosure of material information to the patient will jeopardize the success of treatment, in which case, third-party disclosure and consent shall be in order
• Informed consent must be from a patient of legal age and sound mind or, if incapable, from the following persons in order of priority:
  • Spouse
  • Son/daughter of legal age
  • Either parent
  • Brother/sister of legal age or guardian
• If a patient is a minor, consent must be obtained from his/her parents or legal guardian
• If next of kin, parents, or legal guardians refuse consent to a medical or surgical procedure to save the life or limb of a minor or an patient incapable of consenting, courts may issue an order upon the physician or any person interested in the patient's welfare

Right to Privacy and Confidentiality

• The privacy of a patient must be assured
• Patients have the right to be free from unwarranted public exposure, except in specific cases:
  • When his mental or physical condition is in controversy and the appropriate court orders him to submit to physical or mental examination
  • When public health and safety so demand
  • When the patient waives this right
• Patients have the right to demand that all information, communication, and records pertaining to his care be treated as confidential
• Healthcare providers and practitioners involved in treatment are not authorized to divulge information to third parties without the patient's consent, except:
  • When disclosure benefits public health and safety
  • When it is in the interest of justice and upon court order
  • When patients waive the information's confidential nature in writing
  • When it is needed for continued medical treatment/advancement of medical science subject to de-identification of patient and shared medical confidentiality
• Informing the spouse or family to the first degree is allowed, but the patient of legal age has the right to choose whom to tell
• If the patient is not of age or is mentally incapacitated, information shall be given to the parents, legal guardian, etc

Right to Information

• The patient or his/her legal guardian has a right to be informed of the evaluation of the nature and extent of the disease
• Includes additional or further contemplated treatment, including medicines, and potential risks, statistics, or studies of illness, any change in plan, and participation in plan of care and expected payment

Right to Choose Health Care Provider and Facility

• Patients can choose healthcare provider and facility except when under a service facility, public health and safety demands, or is expressly/impliedly waived
• The right to third opinions is preserved by being able to discuss their condition with a specialist and seek second opinions

Right to Self-Determination

• Patients may avail of recommended diagnostic and treatment procedures
• A person of legal age/sound mind can make an advance written directive for physicians to administer terminal care if suffering from the terminal phase of a terminal illness if they're informed, released from obligation, and doesn't prejudice health and safety

Right to Religious Belief

• Patients may refuse medical treatment or procedures contrary to religious beliefs
• This does not give parents the right to put this decision onto children that have not reached legal age in a life-threatening situation as determined by medical director or the attending physician

Right to Medical Records

• Patients may a receive a summary of medical history and condition and view medical records with the attending physician explaining contents, except notes and incriminatory information about third parties
• At patient expense and upon discharge, patients may obtain a reproduction of medical records, even if with outstanding obligation
• The healthcare institution must safeguard the privacy of medical records and keep them for a reasonable tie The facility will supply medical certificates and documents required for insurance claims

Right to Leave

• The patient can leave a hospital or other healthcare institution regardless of conditions after being informed, released, and if it does not prejudice public health/safety
• No patient shall be detained against his/her will in any health care institution on the sole basis of his failure to fully settle financial obligations - but instead make arrangements to settle unpaid bills

Right to Refuse Participation in Medical Research

• Patients can refuse to be involved in medical research but must be made aware if health provider plans to involve them
• Requires written and informed consent of the patient
• Institutional review board or ethical review board needs to be in accordance with the guidelines set in the Declaration of Helsinki

Right to Correspondence and to Receive Visitors

• Patients can communicate with relatives, and receive visitors which may face limitations prescribed by the rules/regulation of the facility

Right to Express Grievances

• Patients can express complaints/grievances without fear of discrimination/reprisal and can be knowledgeable of the disposition of complaints
• The Secretary of Health, in consultation with health care providers, consumer groups, and other concerned agencies, shall establish a grievance system wherein patients may seek redress

Right to be Informed of Rights and Obligations

• Every person has the right to be informed of obligations and rights as a patient
• The Department of Health, in coordination with healthcare providers, professional and civic groups, the media, and government organizations must launch and sustain a nationwide information and education campaign on these rights
• Such rights and obligations of patients will be posted in a bulletin board

Duty of Health Care Institutions

Institutional Duty

• Health care institutions inform patients of their rights
• Health care institutions must provide rules and regulations that apply while the patient his in their care

Section 5: Societal Rights of Patients

• Patients possess individual and societal rights
• Societal rights of patients include:

Right to Health

• Patients have the right to both regain and/or acquire the highest attainable standard of health in a non-discriminatory, gender-sensitive and equal way
• Health authorities and providers must progressively contribute to health

Right to Access Quality Public Health Care

• Patients have the right to functioning public health and healthcare facilities, goods, services, and programs needed in sufficient quantity
• Also the right to healthcare facilities+services including drugs,.screening, treatment for illnesses, injuries, and disabilities, including insurance
• the government ensure that healthcare follows international standard allocation

Right to Healthy and Safe Workplace

• Patients have right to healthy work, and adequate supply of safe water and basic sanitation
• Also the right to hygiene, prevention, substance abuse, measures regarding occupational accidents, and no harmful substances

Right to Prevention and Education Programs

• The patient has the right to prevention and education programs on immunization and on the prevention
• Treatment and control of diseases, for behavior-related concerns, for disaster relief and emergency situations during epidemics and similar health hazards

Right to Participate in Policy Decisions

• The patient has the right to participate in policy decisions relating to patients' right to health at the community and national levels

Title IV: Declaration of Obligations

• Section 6 states that patients at all times must fulfill obligations and responsibilities

Know Rights

• Patients must ensure that their rights are understood, know and exercised in a reasonable and responsible manner

Provide Accurate and Complete Information

• Patients must provide accurate information re: their health, medications and past/present problems to best their healthcare provider

Report Unexpected Health Changes

• Patients report unexpected symptoms or condition change to member of healthcare team

Understand Purpose and Cost of Treatment

• Patients ask and fully understand the purpose and cost of proposed treatment or procedure before deciding to accept
• Patients need to be informed by facility regarding details about care or treatment, or consult with a healthcare provider before reaching decision

Accept Consequences of Own Informed Consent

• Patients must accept consequences of own informed consent
• If treatment is refused or don't follow instruction of healthcare provider or practitioner - they must accept the consequences of their decision and relieve facility of liability

Settle Financial Obligations

• The patient shall ensure that financial obligations of his/her healthcare are fulfilled
• Otherwise, make arrangements to settle unpaid bills in the hospital

Relation to Others

• The patient shall act in a considerate and a cooperative manner
• Act such to not interfere with wellbeing/rights of others and property others, following the procedures of the establishment

Exhaust Grievance Mechanism

• Patients must first exhaust grievance mechanisms provided in the bill
• Do so before filling administrative or legal action

Title V: Grievance Mechanism

• Section 7 refers to mediation regarding any complaint arising from a violation of a patient right
• There are 2 types of grievance mechanisms
  • Hospital and out-of-hospital based
• Members of the hospital grievance committee will be physicians, the chairperson
• Outside will involved the local health officer, action officer and Philippine Medical association etc
• Department of health establish grievances committee
• The hearing procedure will remain an open dialog and given a chance for discuss/complaint to happen with settlements occurring
• No money involvement or legal counsel happening at this stage
• The aggrieved party bound to by the rules of this is given (30) days from the incident to file their complaint

Grievance Committee Resolution

• Once complaints arrive the Chair deliver to the respondent, the Grievance Committee handle complaint over (30) days to resolve
• Otherwise, complainant option to proceed to action over existing laws

No-Fault Arbitration Process

• The claimant can file case for settlement at the no-fault arbitration if the first process doesn't work
• Only physical injuries qualify
• The committee will composed of physicians-review team.

Committee Judgement

• Claimants can choose the members of team review
• Committee will arrive evidence-based decision within complaints and deposition
• If there is evidence/testimony and no decisions are made
• It will be appealed to the Court of Appeals

Limited Monetary Loss

• The court will compensate ONLY for actual loss in money
• It cannot be used for pain and suffering or other non-monetary losses

Health-Provider Compensation Fund

• Fund shall be established in facilities by health provider associations
• This is if its organizations are unable
• If not, then Philippine Health Insurance Corporation takes over
• The funding needs to come from payment the health care providers ensure the establishment of the Fund

Prescriptive Period

• Time during which the case is submitted for mediation to ensure filing of a criminal or civil case by existing code under laws

Title VI: Miscellaneous Provisions

• Section 10. States that Act will take effect 15 days after its publication in at least 2 major newspapers of general circulation

Overview of Senate Bill No. 812, introduced by Senator Ramon Bong Revilla, Jr., concerning the Magna Carta of Patients' Rights and Obligations in the Philippines. Focuses on patient rights to medical care, informed consent, privacy, and more, in accordance with the State's policy to protect humane and quality healthcare.