Philippines Criminal Justice System: Finding Truth

• A criminal justice system in the Philippines depends greatly on determining the facts of a case
• Courts and judges are responsible for deciding the facts in legal disputes
• Legal outcomes vary based on the factual circumstances
• The Supreme Court holds ultimate authority in determining facts and laws
• Judicial power includes settling disputes and addressing abuses of discretion

Physicians Role

• Physicians support courts in finding the truth through witness testimony
• Litigation aims to find truth with both judges and parties involved
• Litigants should be open to discovering truth and act honestly by revealing relevant evidence
• Courts act as guardians of truth and must prevent actions that slow case settlements or prevent fair resolutions

Rules of Evidence

• Any person who can perceive and communicate their perceptions can serve as a witness
• Perception involves the senses
• Communication occurs through testimony explaining perceptions
• Religious or political beliefs, case interests, or prior convictions are not grounds for witness disqualification unless legally specified
• Witnesses can only testify about facts they know personally, derived from their own perceptions
• Example Scenario: If Person A says class is via Zoom based on professor's words, it's personal knowledge
• If Person B says class is via Zoom because Person A said it, it's hearsay and inadmissible

Expert Witnesses

• Physicians can provide expert testimony, even without direct personal knowledge
• The 2019 Rules on Evidence, Section 52, allows opinions from witnesses with specialized knowledge, skill, experience, training, or education
• Testimony must stay within the expert's area of expertise
• Medical negligence cases often use expert testimony
• Example Scenario: A doctor can testify if a patient under anesthesia should be asleep based on their expertise
• Physicians testify as experts when determining if doctors met the standard of care

Ordinary vs Expert Witnesses

• Casumpang v. Cortejo case of 2015 indicates petitioning doctors have to meed the requirement and standard of care is mixed fact and law

• The 2019 case of Dra. Dela Llana v. Buong case indicates there is a difference

• Ordinary witnesses perceive and communicate

• Expert witnesses offer opinions based on training and education

• Ordinary witnesses can give opinions in specific situations without direct perception such as identifying someone they know, recognizing handwriting, or assessing someone's mental state

Privileged Communications

• Courts cannot accept certain evidence due to privilege
• Witnesses cannot be forced to disclose privileged information
• The 2019 Rules on Evidence, Section 24, protects confidential communications
• Physicians and psychotherapists cannot disclose confidential patient information in civil cases without consent
• This includes diagnosis and treatment details for physical, mental, or emotional conditions, including addiction
• This protection extends to those involved in the patient's care, reinforcing doctor-patient confidentiality
• Trust and truthfulness in doctor-patient relationships are expected

Res Ipsa Loquitur

• This doctrine means "the thing speaks for itself"
• If an injury occurs from something under the defendant's control, which usually doesn't happen with proper care, negligence is implied without needing further explanation
• In these cases, expert testimony may not be needed

Examples include

• Leaving gauze inside after surgery and burn wounds from heat after vaginal births
• Testified to in the 2014 case, Solidum v. People
• Expert witness is not needed when this case is obvious

Subpoenas

• These require a person to attend and testify at a hearing, trial, or deposition
• Receiving a subpoena does not automatically mean you are on trial, your assistance may simply be needed by the court
• There are two types of subpoenas
• Subpoena ad testificandum compels a person to testify
• Subpoena duces tecum requires producing specific documents or records

Witness Rights and Obligations

• Witnesses are obligated to answer questions that do not promote self incrimination
• Jurors may hold people who do not follow these rules in contempt
• Protected from improper questions, harsh treatment, and unnecessary detention
• Examination is limited to relevant matters
• May refuse to answer questions that incur penalties or degrade reputation, unless related to the case or prior convictions
• There is a right against self-incrimination under the 1987 Constitution, Article III, Section 17, stating no person should be compelled to be a witness against themselves

Medical Malpractice

• When a patient hires a physician, this begins a doctor-patient relationship
• Medical malpractice, or medical negligence, is when a medical worker harms a patient
• Claims for damages are often based on violating Article 2176 of the Civil Code, related to quasi-delicts

Civil Code details

• Article 2176 covers damage to another through act or omission with fault or negligence, outside of a contract
• Article 1156 states an obligation is a juridical necessity to give, to do, or not to do
• Medical practice involves contracts with Article 1305 covering agreements of service

Establishing Physician-Patient Relationships

• The 2015 Court case, Casumpang, indicates it begins when a doctor agrees to give care
• This begins when a patient contracts services and the physician gives consent
• Acceptance from the physician is essential
• Guidelines and standards of care apply when this relationship starts

Consent in Doctor Patient Agreement

• It is consensual to receive these services
• Consent to services can be implied and expressed
• The 2015 Casumpang v. Cortejo outlines consent may be implied by a doctor's actions to assist in patient diagnosis and treatment

Express Consent

• Expressed consent to treatments must be given
• Patients expressly consent by signing a written consent form
• Note that consent can be oral or in written form
• This can be argued in court by someone testifying they heard the physician consent

Implied Consent

• Acting in a way that shows consent indicates it
• This is inferred based on community practices
• Doctors imply it by treating a patient and patients implicitly consent by going to a medical facility

Scenarios

• Doctor’s opinion to a colleague about a patients health by the colleague request does not create a doctor patient relationship Request for Professional Opinion
• Offering an opinion does not show an intent to join the new patient to the current practice

On-Call Consultants

• When on-call and directs the course of treatment the relationship is implied
• The physician is supporting the the patient diagnosis, even without meeting in person
• Both parties being managed by the physicians signifies consent

Social Media Prescriptions

• It is possible to consent to treatment via social media messages
• By prescribing medication via social media, you show intent to treat the patient
• Providing a prescription can be illegal if you are not a licensed doctor

Academic Questions

• Informal consultations online do not signify a patient relationship
• There is no assessment of condition when just asking the best medicine
• Doctors should say a formal diagnosis need to occur before a treatment is provided

Practice of Medicine

• Medical practice defined when doctor examines, diagnoses, treats, or prescribes remedies
• The Medical Act of 1959 defines the standard by which doctors are measured by doctor treatment

Elements of Medical Malpractice

• The key elements are the following: duty, breach, injury and causation
• Duty that is standard or behavior that limits ones actions
• Duty of care is specified per doctor-patient relationship and can only exist if the service has been requested
• Standard of is based on locality

Doctors are often witness in expert testimonies

• They see what actions doctors are already taking

Duty of Care

• Specialists are held to a higher duty of care because of their additional training
• Doctors are responsible for telling the patient the risks involved in treatment
• Allows them to make informed decision on treatment
• Doctors are required to give recommendations regardless of patients ability to follow them
• Those who are able to give consent can range from elders, judicially appointed guardians

Mature Minor Doctrine

• Allows voluntary testing to anyone over 15
• If not older then 15, someone is engaging in high risk behavior then a legal worker is needed

Duty to Respect Confidentiality

• Health records are to be kept private and guarded, including all individual aspects
• Sharing with friends is liable for breach of action
• There can be cases where patients act on there own accord and do not follow treatments
• There are some actions that are contributory and physicians can not be held liable

Vicarious Liability

• Employers that are physicians are labile for damages on the actions by the employees they over see
• Doctors can also be responsible when they make the nurse or inter take control
• A doctor can be held liable for not doing the operations correctly as told by the case of 1999 v Court of Appeals

Online Malpractice and Telemedicine

• Telemedicine must be the standard of an in person visit
• It must follow same care as that of in person

Physicians Duty

• They must be free to choose and may offer help

Healthcare Governance

• There needs to be equal implementation of care
• States must ensure proper fulfillment
• States must ensure every provision is equal for both parents in the event of child health

Product Regulation

• Proper regulatory must be in place
• This ensures the access

Universal Healthcare

• There has to access the healthcare where ever and whenever you need it, without any financial stress
• There has to be appropriate health promotions
• Health care laws must make right to health access for appropriate care