The Physician and the Courts

The Physician and the Courts

• Criminal justice relies on fact determination. Courts/judges settle legal disputes by determining the state of fact. Different laws apply depending on the state of fact.
• The Supreme Court has the final say on state of fact and applicable laws via judicial power. It settles actual controversies involving legally demandable and enforceable rights.

Physicians as Agents for Truth and Justice

• Physicians aid courts in truth determination as witnesses. Litigation involves joint truth-seeking between judges and parties.
• Litigants must welcome opportunities to achieve this goal and act in good faith, revealing material evidence.
• Courts, as arbiters and guardians of truth and justice, must not allow technical ploys hindering expeditious settlements or fair determinations on merits.

Physicians as Witnesses in General

• Anyone who can perceive and communicate their perception may be a witness.
• Senses used for perception: seeing, smelling, tasting, hearing, feeling
• Religious/political beliefs, case interest, or crime conviction are typically not witness disqualifications.
• Witnesses can only testify about facts from their personal knowledge/perception.
• Hearsay is not admissible as evidence.

Physicians as Expert Witnesses

• Experts, including physicians, can testify on matters outside their personal knowledge. Expert opinion is admissible on subjects requiring specialized knowledge, skill, experience, training, or education. Testimony must stay within the expert's domain.
• Determining if petitioning doctors met the standard of care requires mixed fact and law analysis. Medical negligence cases are technical, necessitating expert testimony for court guidance on medical science matters.
• Evaluation of expert testimonies, guided by medical literature, learned treatises, and common knowledge, determines duty breaches.

Ordinary vs. Expert Witness

• Substantial differences exist between ordinary and expert witnesses in the Rules of Court. Ordinary witnesses perceive and communicate perceptions, while experts provide opinions based on training/education.
• Ordinary witnesses can offer opinions on identity, handwriting familiarity, mental sanity acquaintance, and impressions of emotion, behavior, condition, or appearance, even without perception of the case

Privileged Communications

• Some evidence cannot be accepted by the court.

Disqualification by Reason of Privileged Communications

• Physicians/psychotherapists cannot be examined in civil cases about confidential patient communications made for diagnosis or treatment without patient consent. This extends to those involved in the patient's diagnosis/treatment like family under direction of the physician or psychotherapist.
• This is due to doctor-patient confidentiality. Trust is vital, ensuring patient honesty.

Doctrine of Res Ipsa Loquitur

• Literally: "the thing speaks for itself".
• If an injury-causing object was managed by the defendant, and the accident typically doesn't occur without negligence, it suggests lack of care absent defendant explanation.
• Obvious factual evidence allows for dispensing with expert witnesses.
• Examples: surgical gauze left inside or burn wounds after vaginal birth due to thermal heat.

Subpoena

• It requires attendance and testimony at hearings/trials/investigations or deposition taking.
• Types includes:
  • Ad testificandum: compels testimony.
  • Duces tecum: compels document/record production.
  • Ad testificandum et duces tecum: compels both testimony and production of documents/records

Rights and Obligations of a Witness

• Witnesses must answer questions, even if self-incriminating. Refusal leads to contempt charges.
• Witness Rights:
• Protection from irrelevant/improper/insulting questions and demeaning behavior.
• Not be detained longer than justice requires.
• Examined only on pertinent issues.
• Refuse answer if penalized, unless mandated by law against self-incrimination
• Degrade reputation, unless it is a key issue or presumed from a key fact

Right Against Self-Incrimination

• No one shall be compelled to testify against themselves.

Medical Malpractice

• Medical negligence-based claims stem mostly from Civil Code Art. 2176.
• Civil Code, Art. 2176: Quasi-delict = causing damage to another by fault or negligence without pre-existing contract.
• Civil Code, Art. 1156: An obligation exists with juridical need to give, to do, or not to do.
• A physician's practice is contractual.

When Does Physician-Patient Relationship Begin?

• Physician-patient relationships start upon the doctor and patient agreeing, acceptance is key. Standards of care apply once relationship begins. Doctors can refuse service unless in emergencies.
• Consent is needed for a physician-patient relationship.
• Physician-patient relationships may be implied through doctor's affirmative diagnosis/treatment actions or participation in diagnosis/treatment.

Express Consent

• Exists with manifestation or communication of the consent
• A patient seeks care at hospital/clinic, expressly consenting by signing, with physician expressly consenting by accepting. Express consent also can be orally given and confirmed if ordinary witness heard it..

Implied Consent

• Consent inferred by the actions
• If the patient seeks care at a hospital/clinic, and is examined/treated creates an agreement.
• Law infers agreement based on practice within the medical community
• If Physician-patient relationships were created by apparent acceptance and the treatment
  • Patients give implied consent going to a clinic and doc offers implied consent by treating the patient

Expressed and Implied Consent Scenarios

• If colleagues describes a patient's problem with you offering opinion you are not liable, because it's simply an informal assistance with no meeting of the minds.

On-Call Consultant

• Consultants not seeing patients accepting referrals directing treatments imply relationship consent. Physician actions show consent. Treatment/diagnosis participation supports physician's acceptance, whether physically meets patient or not.
• There is a meeting of the minds. Patients consent to physician care. Multidisciplinary teams often co-manage patients. Attending physicians inform patients about involved consultants. Consultations form substantial part in management and also show implied acceptance.

Prescription via Social Media

• Chief-complaint prescriptions via social media may imply consent. By using medical skills to assess complaints, may be able to be sued. Illegal prescriptions also exist especially without licenses.
• Responding to a Facebook / Viber message asking what to take is not a medical consultation.

Academic Questions

• If friend asks for medicine suggestions, does not form a relation but more general knowledge. Academic questions, limited to questions not making/confirming diagnosis or prescribing, do NOT establish physician-patient connection.

Practice of Medicine

• Defined in R.A No. 2382
• Governs how doctors' conduct/acts are assessed.
• If doctors physically examine and diagnose, prescribe to those with ailments = practice of medicine.

Elements of Medical Malpractice

• Duty, Breach, Injury, and Proximate Causation.

Duty

• A standard of behaviour
• Duty needs doctor-patient relationship to be shown
• A physicians gives no duty and can not cause liability unless professional relationship exists
  • Doctors must acknowledge taking care, than we can assume duty

Duty to Observe Standard of Care

• Doctors is subjected to how colleagues practice medicine
• Specialist have higher standards.

Duty to Secure Informed. Consent

• The independent duty is to follow care, you must disclose what reasonably occurs.

Who can give Informed Consent

• Give what may occur from proposed treatment and make patients choose
  • There is a hierarchy

Incomplete Advice

• Doctor didn't give what should be done because it was expensive because could be labeled as failure to prove opportunity to give informed consent

A person needs permission from parent, guardian, judicially appointed guardians and surviving parent

• Duty and consent and what reasonably happens must occur

Doctrine of Mature Minor

• Allows for a mature minor to to consent on a proceedure
• Person between 18: voluntary without consent from parents
• Person younger than 15 needs aid from social worker

Duty to Respect Privacy and Confidentiality

• You can not give private information

Personal Information

• What identitifies an individual

Sensitive Personal Information

• Sexual orientation and health records

Breach

• Doctors dont follow duties or improperty performs duties under profession
• Determinated factual and legally

Injury

• Negligence committed resulting in damages

Proximate Cause

• Causation of what doctors do or actions and connection from that

Negligence must be direct and show that you should

Doctrine of Contributory Negligence

• Caused by both physician and the actions to get in injured

Doctrine of Vicarious Liability

• Employers are liable as employees, can contribute to the injuries that aren't done by physicians

Questions about Medical Malpractice

Telemedicine considerations must avoid doing more bad than should be done, especially harm

Online promotions

• Solicitation and more especially in an unethical manner

Test can see if its a job vocation an not for porfiits

May refuse calls and and services for emergency

• May not refuse to do if is emergency

Abandonment

• Patient to show there is no trust and has no trust

Does one Avoid patient allegations: Give them writing

Healthcare Politics

People have Human Rights, to live in dignity

Everyone is entitled for standard of health for living a dignified life

State is reponsible for respect and protect

CONSTITUIONAl FOUNDATIONS for Right to health

Protect health to instill it

Protect balanced healthy ecology

Integrated comprehensive aproach, give essential social services

HEALTH AND GOVENRMENT

Autonomy must be ensured.

Department of Health

"Overal Technical Authority of Health

• NGAS + GOCCS

Mandatory reporting should occur

Every act you say has a framework

• All must be respectful

Health and Government

Protect by stopping discrimination

Sin Tax Reform ACT

Revenues can apply to help the Universal healthcare

• Graphic health warnings should be enforced