Topnotch Medical Board Prep Legalmed Handout April 2024 PDF

TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/...

TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. IMPORTANT LEGAL INFORMATION LEGAL MEDICINE, ETHICS, AND MEDICAL JURISPRUDENCE The handouts, videos and other review materials, provided by Topnotch Medical Board Preparation Incorporated are duly protected by RA 8293 otherwise known as the By Tony D. Rebosa, MD, BS Crim, FCLM, DABLM Intellectual Property Code of the Philippines, and shall only be for the sole use of the person: a) whose name appear on the handout or review material, b) person subscribed to Albert D. Rebosa, MD, LLB Topnotch Medical Board Preparation Incorporated Program or c) is the recipient of this Cassey Allen C. Camama, MD, Ralph Benedict B. Ma-alat, MD electronic communication. No part of the handout, video or other review material may be reproduced, shared, sold and distributed through any printed form, audio or video Daryl M. Obciana, MD, Geremiah C. Llanes, MD recording, electronic medium or machine-readable form, in whole or in part without the TOPIC PAGE written consent of Topnotch Medical Board Preparation Incorporated. Any violation and Evolution of Laws 1 or infringement, whether intended or otherwise shall be subject to legal action and Solis vs. Current updates on law 2 prosecution to the full extent guaranteed by law. Special Laws 3 MEDICAL JURISPRUDENCE DISCLOSURE Medical Jurisprudence 4 The handouts/review materials must be treated with utmost confidentiality. It shall be the responsibility of the person, whose name appears therein, that the handouts/review Physician-Patient Relationship 5 materials are not photocopied or in any way reproduced, shared or lent to any person or Rights of a Physician 6 disposed in any manner. Any handout/review material found in the possession of another Medical Fees 6 person whose name does not appear therein shall be prima facie evidence of violation of Liabilities of Physicians 7 RA 8293. Topnotch review materials are updated every six (6) months based on the current trends and feedback. Please buy all recommended review books and other Doctrines 8 materials listed below. Damages 10 THIS HANDOUT IS NOT FOR SALE! Rights of Patients 11 Liabilities of Hospital 13 INSTRUCTIONS Medical Records 14 To scan QR codes on iPhone and iPad The Medical Witness and the Court 15 1. Launch the Camera app on your IOS device Privileged Communication 15 2. Point it at the QR code you want to scan 3. Look for the notification banner at the top Hearsay Evidence 16 of the screen and tap Attendance of a Medical Witness in Court 17 To scan QR codes on Android Professional Regulatory Commission, Board of Medicine 17 1. Install QR code reader from Play Store The Practice of Medicine 18 2. Launch QR code app on your device Human Transplantation 20 3. Point it at the QR code you want to scan 4. Tap browse website Telemedicine 20 LEGAL MEDICINE This handout is only valid for the April 2024 batch. Legal Medicine: Introduction 21 Classification of Penalties 22 This will be rendered obsolete for the next batch Medical Evidence 22 since we update our handouts regularly. Deception Detection 24 Approach to Topnotch Legal Medicine, Different Types of Criminal Offenders 25 Medical Jurisprudence, and Ethics Confession 25 Sources: Homicide vs. Murder 25 o Legal Medicine by Pedro P. Solis, MD, LLB Crimes of Chastity Under the Revised Penal Code 27 o Philippine Medical Jurisprudence – 1st Edition by Albert D. Identification 30 Rebosa, MD, LLB Death 35 o Basics of Philippine Medical Jurisprudence and Ethics by J. Physical Injuries 43 Classification of Wounds 43 Bellosilllo, B. Castro, E. Mapili, A. Rebosa and A. Rebosa. 2010 Legal Classification of Physical Injuries 43 o Philippine Medical Association Memorandums via the PMA Types of Wounds 44 website Physical Injuries in the Different Parts of the Body 47 o Dangerous Drug Act of 2002 Death or Physical Injuries Caused by Explosion 48 o Nuremburg Code Death or Physical Injuries Caused by Powdered Propelled Substances 49 o Principles of Biomedical Ethics – Beauchamp and Childress Thermal Injuries or Death 53 o Principles of Biomedical Ethics – Kenneth V. Iverson Physical Injuries or Death by Lightning and Electricity 54 o Revised Penal Code of the Philippines Death or Physical Injuries due to Barotrauma 55 Hello dear Topnotch students and future colleagues! Here are some of my Death by Asphyxia 55 tips in studying Legal Medicine for the boards: Death or Physical Injuries due to Automotive Crash 58 Read and understand cover to cover the handout rather than Child Abuse and Neglected Child 58 memorizing the 600+ samplex (and outdated) questions. Pregnancy and Delivery 59 Questions are now tricky and sometimes will ask question from topics Abortion, Birth and Infanticide 61 not usually covered in Legal Med during med school Paternity and Filiation 63 This handout is tailored to the current situation we are experiencing Marital Relations 64 right now. It will incorporate all important lectures made by Atty. Tony Disturbance of Mentality 65 and Albert Rebosa so do not fret if this will be the new normal for the Manifestations of Mental Disorders 67 board review Phobias 68 Do have the diligence or extra effort to give ample time to study for Drug Dependence 68 Legal Medicine. Remember that the board rating will be based on the Alcoholism 70 mean average of all 12 subjects and that Legal Medicine can either help Poisoning 71 you get a good grade as a form of “investment grade”, or can break you Dangerous Drugs Act of 2002 72 because you did not give proper attention to this subject. Nuremberg Code 72 Atty Rebosa’s lecture will always tell you to scrutinize the examination first and try to decipher if the exam is made based on pure old Dr. Solis Declaration of Helsinki 73 book or if with incorporation of updated laws. Philippine Medical Association – Code of Ethics 73 For example: If you would see a term “battery and assault” in the exam, Belmont Report 75 then most likely the exam is based on the old Solis book since in our Bioethics 76 current laws, the term “battery and assault” is not used anymore. It means that you will answer the exam based on the old Dr. Solis book EVOLUTION OF LAWS rather than those from the updated laws. REVISED PENAL CODE came into effect and all Jan 1, 1932 DO NOT RELY ON SAMPLEX ALONE!! – Relying on the 600 outdated laws that came after are called SPECIAL LAWS samplex alone is like flipping a coin on whether you would pass or fail COMMONWEALTH ACT (American Legal Medicine Occupation) meaning we are still a colony of the Gone are the days wherein students who mastered the 600+ samplex US but allowed to pass laws but will be questions will guarantee a high grade in Legal Med. 1935-1941 given/granted independence in 10 years Understand how the law works rather than memorizing it verbatim Again…. DO NOT RELY ON SAMPLEX ALONE!!! (I have warned you!) 1935 – Implementation of a congress Goodluck and Happy Aral!!! o laws passed between 1935-1941 are called Cassey Allen C. Camama, MD Commonwealth Act Dr. Camama TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD Page 1 of 78 For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. 1942-1945 JAPANESE OCCUPATION o Must report all suspected cases of abuse of up REPUBLIC ACT – Post American occupation and to 48 hrs. to the POLICE or DSWD 1946-1972 o Failure to report – charge of administrative the Philippines was granted independence PRESIDENTIAL DECREE – Marcos regime fine of up to 2,000 BUT if the patient falls under Congress was abolished and he was the sole with serious and less serious physical injuries body to pass laws then it now falls under PD 169. ✔GUIDE QUESTION Presidential decrees that are related to the Who is considered the most tragic child abuser? practice of medicine Ignorant Abuser – parents mean well but are PD 169 – requiring MD, hospitals clinics, etc. ignorant that their methods can be fatal/detrimental to report any persons of serious and less to the child serious physical injuries to the nearest police PD 541 – Allowing former Filipino professionals authorities to practice their respective professions in the PH o Failure to report may be fined with 1,000 – without the need to renounce the other 3,000 and a prison term of between 1 – 3 years citizenship under the criteria of: 1972-1986 and revocation of license to practice o Good Standing Take note! The definition of PD 169 was a previous PLE o Pay fines at the PRC question. But also take not that this decree was already o Pay income tax to the BIR and to their amended by Executive Order 212 in 1987. Physicians failing to report shall be fined between P100-500. The respective country license shall be revoked only after 3 violations. 1978-1986 BATAS PAMBANSA (called BP) Dr. Llanes EXECUTIVE ORDER, PRESIDENTIAL PD 603 – Child and Youth welfare code 1986-1987 PROCLAMATION, LETTERS OF INSTRUCTIONS (amended by RA 7610 or the anti-child abuse (EO, PP, LOI) – Cory ousted Marcos law) 1987- REPUBLIC ACTS o The law defines a child as 18 years and below Present and a person whose mental IQ is that of a child Dr. SOLIS book PRESENT (Rebosa book and Revised Laws) Circa 1987 (outdated) Current Laws legal age 21 Aug. 3, 1988 (EO by Cory Aquino) – legal age is now 18 Can marry at age: Male – 16 years old Female – 14 years old (because female puberty is earlier in female) Emancipated minor – Even if a couple are both minors, they are Family code of 1988 – both sexes can get married at age 18 autonomous which means the one who will be given authority is Due to the Family code there is now no more emancipated minor not anymore the parents but the spouse Kahit na ikaw na magulang ang nagsusustento at nagpapaaral sa minor, ang asawa na ang may authority. Dr. Camama When a spouse disappears – can only remarry after 7 years Literal na nawala lang ang asawa mo pero hindi ka sure kung patay or 1988 – reduced years buhay pa ba siya. Dr. Camama spouse disappears (plain disappearance) – 4 years (from 7 years) In cases of a spouse disappearing by which the possibility of death disappearance with high probability of death – 2 years (from 4 is high (Plane crash, shipwreck, Times of war, etc.) – Spouse can years) remarry after 4 years MD may not attend a civil case if the venue for the trial is 50km away from your place of residence 1997 – increased to 100km (from 50km) but if it is a criminal case – must attend no matter how far you are from the trial court Indirect contempt – can be fine up to P2,000 1997 – Increased to P30,000 Value of human life (1987) – P3,000 Increased to P50,000 – P100,000 pesos life imprisonment (reclusion Perpetua) – maximum of 30 years Increased to 40 years 1997 – Rape law amended – now a PUBLIC crime (crime against PERSON) Rape – crime against chastity or a PRIVATE crime Both male and female can now be a victim of rape and a woman Only a woman can be a victim of rape and only a man can be can now be charged of rape charged of rape (+) marital rape law – a MAN can be charged with rape if the sex No such thing as marital rape – right of the husband to have sex with the spouse is with coercion with wife anytime (even if the wife refuse to have sex at the Pag nagpumilit na gusto ng sex nung lalake sa asawa niya at ayaw ni misis, moment the husband wants to) ito ay marital rape. PERO kapag ang babae ang namilit at gusto makipagsex sa kanyang mister hindi makakasuhan ang babae. Dr. Camama Sodomy – part of acts of lasciviousness (imprisonment of no more Sodomy – is now rape through sexual assault than 6 years) Finger penetration of a female genital – considered only as acts Finger Penetration – Now classified as Rape through sexual of lasciviousness assault Generic Act of 1988 – simply instructs an MD to write medications GENERIC ACT OF 1988 does not yet exist and prescriptions in the GENERIC name and not in branded names which is just OPTIONAL Organ donation act of 1991 – (RA 7170) Act authorizing the ORGAN DONATION ACT of 1991 does not yet exist legacy or donation of all or parts of a human body after death for a specified purpose PD 603 – child and youth welfare code Amended by RA 7610 TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD Page 2 of 78 For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Dr. SOLIS book PRESENT (Rebosa book and Revised Laws) Circa 1987 (outdated) Current Laws Amended by Batas Pambansa 702 and then by 8334 and now RA 10932 (Aug 3, 2017) RA 10932 – applicable only to MDs that if they are charged, they are GUILTY UNLESS PROVEN OTHERWISE RA 6615 – no deposit law Which is considered UNCONSTITUTIONAL by Atty. Rebosa due to violation in the equal protection of the law due to the fact that one of our basic constitutional rights is PRESUMPTION TO INNOCENCE UNLESS PROVEN OTHERWISE. But in RA 10932 – a doctor is proven guilty unless proven otherwise. Dr. Camama Replaced by PHILHEALTH (socialized premedical insurance scheme) Presence of MEDICARE (which was abolished in Feb 14, 1995) “Socialized” – the State pays part of the hospital bill and PF of the MD What is PHILHEALTH? – Philippine Health Insurance Anti-Sexual Harassment Act of 1995 – very important for MD Tailored against MDs – dahil no. 1 harasser are the resident MDs who ask for sexual favors in return for special treatment or to create arrangements with make ups and demerits for clerks and interns Dr. Rebosa Sexual harassment o acts or statements uttered by the offender which makes the Non-existent of Anti-Sexual Harassment Act of 1995 working environment hostile or offensive to the offending party TRUE OR FALSE: 1. Only a man can be charged with sexual harassment – FALSE 2. Only an employee can charge sexual harassment vs. their employer and cannot be the other way around – FALSE 3. Only a teacher can be charged with sexual harassment and not vice versa (vs. student) – FALSE The terms BATTERY and ASSAULT is an American term that is There is NO term BATTERY and ASSAULT used in current laws found in the book of Solis 2009 – MDs may now host their own website where you can place We cannot advertise our practice in the radio or media now your credentials Can a doctor withdraw anytime from a Physician – patient relationship? You do not need to get the consent of the patient to withdraw from o YES – But you must need to get the consent of the patient and the physician-patient relationship give the patient enough time to choose a replacement Year 2000 – Ramos vs Court of Appeals case (Ramos vs San Diego Captain of the Ship Doctrine – jurist/judges are veering away case of 1985) – the captain of the ship doctrine was again used by with the use of this doctrine because it is unfair to the surgeon the Supreme Court hence the captain of the ship doctrine is still because the surgeon should only concentrate to their field of used up to this day vision Kapag nakita daw ang Ramos vs CA case sa questions then Lawyer daw ang gumawa ng test questions hence use the updated laws Dr. Camama 1993 – Case vs UERM (residents are trainees and not employees Resident MDs are EMPLOYEES of the HOSPITAL and the hospital will not be liable to shoulder the damages) SPECIAL LAWS o If the violation was committed because of a hospital policy, the director or officer will suffer imprisonment of 4 – 6 years 1. RA 2382 (Medical Act of 1959) and/or a fine of Php 500,000.00 – Php 1,000,000.00 standardization and regulation of medical education o If with three repeated violations, the health facility’s license to examination for registration of physicians operate shall be revoked by the DOH supervision, control, and regulation of the practice of medicine 7. RA 8432 (Traditional and Alternative Medicine Act of 1997) 2. RA 6615 (Medical Assistance in Emergency Cases Act) an act creating the Philippine institute of traditional and requires government and private hospitals and clinics to extend alternative health care (PHITAC) to accelerate the development medical assistance in emergency cases of traditional and alternative health care in the Philippines, 3. RA 6675 (Generics Act of 1988) providing for a traditional and alternative health care mandatory writing of the generic name of drugs on development fund and for other purposes prescriptions 8. RA 8981 (PRC Modernization Act of 2000) ensure adequate supply of drugs at the lowest cost an act granting the professional regulation commission the procurement and distribution of drugs to encourage extensive power to license, regulate and supervise all review centers, use organizations or entities offering review classes in preparation emphasize scientific basis of drugs for examinations administered by the commission 4. RA 7392 (Philippine Midwifery Act of 1992) Penalties: similar to RA 2382 but for midwives o Any person who manipulates or rigs licensure examination 5. RA 7877 (Anti-Sexual harassment Act of 1995) results, secretly informs, or makes known licensure imprisonment of 1 – 6 months and/or a fine of Php 10,000 – Php examination questions prior to the conduct of the examination 20,000 or tampers with the grades in professional licensure 6. RA 8344 (Anti-Hospital Deposit Law) examinations shall be punished by imprisonment of 6 – 12 penalizes the refusal of hospitals and medical clinics to years and/or a fine of Php 50,000.00 – Php 100,000.00 administer appropriate initial medical treatment and support in 9. RA 9173 (Philippine Nursing Act of 2002) emergency or serious cases an act providing for a more responsive nursing profession, replaced Batas Pambansa Bilang 702 repealing for the purpose RA 7164, otherwise known as “The prohibits demands of deposits or advanced payments prior to Philippine Nursing Act of 1991” and for other purposes confinement and/or treatment of patients Penalties: o Any official or medical practitioner: imprisonment of 6 months – 2 years and 4 months and/or a fine of Php 100,000.00 – Php 300,000.00 TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD Page 3 of 78 For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. 10. RA 9439 (Anti-Hospital Detention Law) o Improper disposal of personal SENSITIVE information – An act prohibiting the detention of patients in hospitals and imprisonment of 1 – 3 years and a fine of Php 100,000.00 – Php medical clinics on grounds of nonpayment of hospital bills or 1,000,000.00) medical expenses o Unauthorized access or intentional breach - imprisonment of It shall be unlawful to detain patients who have fully or partially 1 – 3 years and a fine of Php 500,000.00 – Php 2,000,000.00) recovered or have been adequately attended to or who may o Disclosure of personal information without malice or not in have died, for reasons of nonpayment in part or in full of hospital bad faith - imprisonment of 1 – 3 years and a fine of Php bills or medical expenses 500,000.00 – Php 1,000,000.00) It is illegal to detain unpaid charity/service patient but the 15. RA 9262 (Anti-Violence Against Women and Their Children patient must sign a promissory note secured by either a Act of 2004 mortgage or a guarantee of a co-maker who shall be jointly and An act providing protection to women and their children not just severally liable for the underpaid obligation or able to give by means of physical but also includes against discrimination collateral to the debt. and protection of rights. It is not illegal to detain private patients unable to pay the charges SEC. 2. Patients who have fully or partially recovered and who already wish to leave the hospital or medical clinic but are financially MEDICAL JURISPRUDENCE incapable to settle, in part or in full, their hospitalization expenses, LEGAL MEDICINE MEDICAL JURISPRUDENCE including professional fees and medicines, shall be allowed to leave Branch of Medicine Branch of Law the hospital or medical clinic, with a right to demand the issuance of Medicine applied the corresponding medical certificate and other pertinent papers Law applied to medical practice to law and justice required for the release of the patient from the hospital or medical clinic upon the execution of a promissory note covering the unpaid Based on the principle of obligation. The promissory note shall be secured by either a mortgage subordination or by a guarantee of a co-maker, who will be jointly and severally The physician should obey the law Based on the liable with the patient for the unpaid obligation. In the case of a and should practice medicine within principle of deceased patient, the corresponding death certificate and other the premise of law coordination (of documents required for interment and other purposes shall be No one is considered above the law medicine to law released to any of his surviving relatives requesting for the Study of rights, duties and and justice) same: Provided, however, That patients who stayed in private obligations of a medical practitioner rooms shall not be covered by this Act. with particular reference to those For the Illegal Detention Act, just remember that the hospital cannot arising from doctor-patient relationship detain charity patient BUT must have completed all necessary documents FORENSIC MEDICINE – application of medical science to prior discharge like promissory note etc. elucidate legal problems Dr. Camama It is not illegal to detain patients staying in a private solo room since why would you choose to stay in a private room vs. wards bed if you cannot MEDICAL JURISPRUDENCE afford to stay in a solo room in the first place. Q: What if the patient died & the family cannot immediately settle the bill? Comprise all laws, rules, doctrines and principles, legal opinions A: deceased body cannot be detained and shall be released along with and decisions of competent authority regarding governance and death certificate and other documents needed for interment purposes. regulation of the practice of medicine Other documents shall only be released if the charges have been settled concerned with the aspect of law and legal concepts which has or a promissory note has been secured. to do with practice of medicine Dr. Rebosa 11. RA 9502 (Universally Accessible Cheaper and Quality Medicines Act of 2008) LAW an act providing for cheaper and quality medicines, amending body of authoritative rules by which civilized society regulates for the purpose RA 8293 or the Intellectual Property Code, RA the conduct of its members 6675 or the Generics Act of 1988, and RA 5921 or the Pharmacy result of human wisdom acting from human experience Law, and for other purposes premise to create uniformity of human conduct 12. RA 10918 (Philippine Pharmacy Act) ✔ GUIDE QUESTION an act regulating and modernizing the practice of pharmacy in What is the Law that governs the Medical Practice of Medical the Philippines, repealing for the purpose RA 5921, otherwise profession in the Philippines? known as the pharmacy law Medical Act of 1959, as amended. similar to RA 2382 but for pharmacists The original law was RA2382. This was amended by RA4224 in 1965 and RA 11332 (Mandatory Reporting of Notifiable Diseases and amended again by RA5946 in 1969. Health Events of Public Health Concern Act) Dr. Llanes patient to provide truthful information about one’s health Basic Sources of law condition and possible exposure Constitution Penalties: Laws enacted by the legislative body (House of Representatives, o Php 20,000 – Php 50,000 and/or imprisonment of 1 – 6 Senate) months Decrees, Orders, Proclamation, Letters, Commonwealth Acts, 13. RA 10173 (Data Privacy Act of 2012) Batas Pambansa, Presidential Decrees issued during the Marcos An act protecting individual personal information in information era, Executive Orders issued by President Aquino before the and communications systems in the government and the private 1987 Constitution and Republic Acts sector, creating for this purpose a national privacy commission, Administrative Acts, Orders, Rules and Regulations (PRC, DOH, and for other purposes. PhilHealth) National Privacy Commission – responsible for administering, Generally accepted principles of International law monitoring, and ensuring compliance with this act. Supreme Court Decisions (Legal Doctrines and Jurisprudence) Penalties: CLASSIFICATION o Unauthorized processing or accessing personal information due to negligence - imprisonment of 1 – 3 years and a fine of LAW WHICH IS NOT ENFORCED BY THE STATE Php 500,000.00 – Php 2,000,000.00) NATURAL LAW DIVINE LAW MORAL LAW o Unauthorized processing or accessing personal SENSITIVE Guidance of information due to negligence - imprisonment of 3 – 6 years human conduct, Followed to Enforceable by and a fine of Php 500,000.00 – Php 4,000,000.00) discovered by make one be the dictate of o Improper disposal of personal information - imprisonment rational thinking closer to their one’s conscience ranging from imprisonment of 6 months – 2 years and a fine of of man. Creator to be the right Php 100,000.00 – Php 500,000.00) e.g. law of Example: the 10 conduct. gravity, law of Commandments nature TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD Page 4 of 78 For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. LAW WHICH IS ENFORCED BY THE STATE When MD is appointed by a trial court to examine the accused Observance of which is compulsory or obligatory to everybody. and to report whether the accused was insane Classification: Autopsies o As to purpose Casual questions asked in an ordinary place (e.g. reunions, o As to nature of the subject matter random questions in the grocery etc.) DUTIES AND OBLIGATIONS IMPOSED ON THE PHYSICIAN IN 1. AS TO PURPOSE: THE MD PATIENT RELATIONSHIP PROCEDURAL 1. MD should possess the knowledge and skill of which an SUBSTANTIVE LAW (ADJECTIVE OR REMEDIAL) LAW average MD (GP) is expected. Concerned with mechanical rules General practitioner is obliged to have the usual knowledge and skill Prescribes the rights that govern the means by which possessed by other GPs while specialists are bound to exercise the degree and obligations of substantive rights and duties are of skill and knowledge which is ordinarily possessed by similar specialists person in their daily enforced. Dr. Rebosa relation with each 2. MD should use such skill and knowledge with ordinary care Rules by which litigation are other and with society and diligence conducted. 3. MD is obliged to exercise the Best Judgment e.g. Law on property Law on criminal procedure 4. MD has duty to observe utmost good faith and property rights TERMS OF THE PHYSICIAN-PATIENT RELATIONSHIP 2. AS TO NATURE OF THE SUBJECT MATTER The law implies in the MD-Patient relationship that the MD will render medical service to the patient and not cure the patient PUBLIC LAW PRIVATE LAW The physician-patient relationship does not imply/promise: Private matters that do not o That the treatment will be successful concern the public at large o That the treatment will benefit the patient Rules and regulation which Regulates the relationship o That treatment will produce a certain result regulate the relationship of individuals. o That treatment will not harm the patient between state and subject Concerned with the o That the physician will not commit errors in an honest way Concerned with the state in definition, regulation, and its political and sovereign enforcement of right in DUTIES AND OBLIGATIONS IMPOSED ON THE PATIENT IN capacity their relationship with THE COURSE OF MD RELATIONSHIP other people Patient must give honest medical history of illness Example: Example: Even if the patient must submit to painful management they will Criminal law: law that are Civil law: concerned with cooperate and follow the instructions, orders and suggestions of the MD punished as offenses against the relationship between Patient must inform the MD of what occurred in the course of the the state or government individuals treatment so the MD may know the effect of the given treatment International law: Commercial law: rights of Patient must state whether they understand the contemplated regulates the relationship and property and relations of course of action and the things expected of them intercourse of the nations persons engaged in The patient must exercise the prudence to be expected of an Political law: governs the commerce ordinary patient under the same circumstances. science of politics or the organization of the PSYCHOLOGICAL PATTERNS OF MD-PATIENT RELATIONSHIP government ACTIVITY- GUIDANCE- MUTUAL PHYSICIAN-PATIENT RELATIONSHIP PASSIVITY COOPERATION PARTICIPATION The relationship is contractual (meeting of minds between 2 RELATION RELATION RELATION persons) Patient is unable Patient is Patient thinks The nature of the relationship is consensual (based on mutual to contribute conscious, seeks that they are consent of both MD and patient) and fiduciary (based on mutual activity (Patient help and ready juridically equal trust and confidence) is unconscious) and willing to to the MD and Medical cases are often due to breach in the physician-patient cooperate that the nature of contractual relationship MD is in a relationship is on position of trust a negotiated FORMS OF MD-PATIENT CONTRACTUAL RELATIONS agreement. MD feels patient Expressed contract: the nature of the medical service to be is uncooperative given is stated orally or in writing & difficult while o Verbal agreements are considered expressed contract but will patient feels MD be difficult to be contested in court is unsympathetic Implied contract: The existence of the contract can be inferred from the acts of the contracting parties. TERMINATION OF CONTRACT o e.g. Patient went to a clinic and MD took the history, PE, and provided treatment à situation impliedly shows existence of Maybe terminated by the physician or the patient contractual relationship The termination of the contract and the nature of the TAKE NOTE! circumstances should be documented Terminated when there is: Elements needed for a contract to be valid: 1. Recovery of patient 1. Contract must be consensual & fiduciary (relationship of 2. Death of patient trust with one or more other parties) 2. Must contain the subject matter 3. Withdrawal of MD provided that a. Patient has consented to the withdrawal 3. Must contain cause or consideration b. Patient is given ample time to look for another MD 3. Discharge of the MD by the patient COMMENCEMENT OF PHYSICIAN-PATIENT RELATIONSHIP 4. Death or incapacity of MD The physician invites an offer by establishing availability 5. Fulfilment of obligations stipulated in the contract Patient makes an offer by arriving for treatment 6. In cases of emergency, when the attending MD/ MD of Physician accepts offer by undertaking treatment of the patient choice of patient is available; or when there is cessation of the condition of emergency INSTANCES WHERE THERE IS NO MD-PATIENT 7. Expiration of the period, if the contract of the medical RELATIONSHIP service is for a specific period Pre-employment PE 8. Mutual agreement between the MD and patient that the PE for the purpose of determining eligibility for insurance MD-patient relationship is terminate TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD Page 5 of 78 For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. In addition to those listed above, these are the other conditions that o All forms of assistance must be immediately extended to any signify the termination of physician-patient relationship: (1) when the doctor who is responding to emergency cases physician considers that their medical services will no longer be beneficial o Warning to all motorists be circulated requiring them to immediately to the patient, and (2) in pregnant patients, the contract is terminated give way to ambulances or vehicles responding to emergency during puerperium, at six weeks after childbirth or when the mother’s reproductive organs return to non-pregnant condition. o Any motorist who fails to clear the way for an ambulance or escort must be dealt with severely Although generally only a patient is allowed to terminate a contract You can only violate minor traffic rules without the consent of the MD, an MD may also do so but only in exceptional circumstances. These include: loss of trust and confidence, o Beating the red light tainted relationship, consistently non-compliant patients, non-payment o Swerving (bypassing a vehicle in front of you) of professional fees despite being financially capable, and in cases where You don’t have a right to run over someone just because you’re the patient has filed complaints of negligence against the MD. responding to an emergency (you’re still liable to it) Dr. Belmonte More often than not, the use of “ambulance sounds” in for convenience to ease away heavy traffic flow is not permitted. RIGHTS OF A PHYSICIAN (MUST KNOW) 2. RIGHT OF EXEMPTION FROM EXECUTION OF INHERENT RIGHTS INSTRUMENTS AND LIBRARY This is done so as not to deprive the MD of the practice of the 1. RIGHT TO CHOOSE PATIENTS healing art which may be the source of livelihood In an emergency: o If there is no risk to the MD – MD should still respond Ex: Cardiologist ka at nalubog ka sa utang or may fine ka na kailangan bayaran. Hindi pwede kunin mula sayo ng bangko, o If there is risk but it is during a public health emergency – gobyerno etc. yung mga gamit mo like stethoscope, ECG machine, MD should still respond Harrison’s mo na ginagamit mo in relation to your practice since yun yung ginagamit mo as a source of income. 2. RIGHT TO LIMIT THE PRACTICE Dr. Camama As to field of specialty 3. RIGHT TO HOLD CERTAIN PUBLIC/PRIVATE OFFICES Private clinic or hospital Only a duly licensed physician can hold the following positions Within a political or geographical boundary o Chairman/Member of the Board of Medicine Certain days of week/hours per day o Secretary of Health Certain class or group of people o Regional/Provincial/City/Municipal Health Officer By dictates of conscience Account of ignorance 4. RIGHT TO COMPENSATION Ex: A GP cannot perform craniectomy due to insufficient knowledge hence Most important among the incidental rights can limit practice on the grounds of ignorance Dr. Camama 5. RIGHT TO MEMBERSHIP IN MEDICAL SOCIETIES Account of retirement Membership may be voluntary or involuntary As imposed by public Involuntary: When membership is imposed as a condition for Imposed by religion the enjoyment of a right. Imposed by professional ethics PMA membership is voluntary but those who will be members Imposed by medical society may be entitled to certain privileges that the organization Imposed by law provides its members Limitations of practice by contract ✔ GUIDE QUESTION Ex: Hired by a company to only do annual PE but not allowed to give consults , procedures and give out Rx. Q: Is membership to the Philippine Medical Association Dr. Camama mandatory to practice medicine in the Philippines? A: NO. Membership to PMA is not mandatory, however, there 3. RIGHT TO DETERMINE THE APPROPRIATE are certain privileges that only PMA members can avail of ex. MANAGEMENT PROCEDURES PhilHealth/Medicare (old term) Based on the doctrine of superior knowledge that you alone can decide what to do based on your educational background as an PMA MEMBERSHIP MD “kaya ka nga nag-aral ng matagal para maging bihasa di ba?” AND BENEFITS BROCHURE (nice to know) 4. RIGHT TO AVAIL OF HOSPITAL SERVICES https://qrs.ly/kibmops Government hospitals may not curtail the right of MD provided that they comply with the rules concerning internal discipline 5. RIGHT TO PERFORM CERTAIN SERVICES and those designed to enhance better public service. Due to their training as a physician Private hospitals are given leeway in making regulations o Some doctors can only perform certain services under their provided that such rules are not arbitrary, discriminatory, specialized field (brain surgery for Neurosurgeon, forensic unreasonable, monopolistic or contrary to law and public policy. medicine for Medico-Legal). o Some policies include Open and Closed Hospital policy § Closed Hospital Policy – Example: De La Salle University Medical Center along with some teaching hospitals require MEDICAL FEES at least the level of Fellow specialist and is willing to render All these fees are LEGAL but not all are ETHICAL service to charity patients and to the College of Medicine in o Contingent fees, dichotomous fees, and straight fees are order to be given rights to practice within their institution. unethical in medicine because they compromise the quality of § Open Hospital Policy – Even if one is still a GP, they can patient care for the sake of profit practice or acquire rights to practice provided that it follows Contract stipulates the nature of procedure the protocols of that institution. SIMPLE Specifically states the value of such CONTRACTUAL medical service either orally or in writing INCIDENTAL RIGHTS FEE Implied that there is a fee to the MD in exchange for their services 1. RIGHT OF WAY WHILE RESPONDING TO CALL OF Measured by the space of time and not by EMERGENCY the quality or quantity of medical A doctor’s car is considered an ambulance when responding to services rendered. an emergency or in the guise of treatment. Example: The directive of secretary of national defense: RETAINER FEE o Working in Health Maintenance o All policemen must know the names & locations of hospitals & Organizations (HMOs) emergency clinics in greater Manila o Working as a company doctor or as a government doctor (Resident, MHO, etc.) TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD Page 6 of 78 For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.  TOPNOTCH MEDICAL BOARD PREP LEGMED, MED JURIS, AND ETHICS HANDOUT BY ATTY. TONY REBOSA, MD AND ATTY. ALBERT REBOSA, MD For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. o Moonlighting MD being paid per hour o The obligation to pay the medical fee primarily devolves on the with no regards to the number of patient in as much as they are the benefactor of the medical patients seen service, provided they are of legal age, of sound mind and Basically, sweldo to. Kahit gaano kadaming have the capacity to enter a contractual relation. patients makita mo, fixed salary siya. o If the patient died or became legally incapacitated to do so, the claim Dr. Camama/Dr. Llanes for medical fee shall be paid by the following persons in order: HMOs are health insurance organizations to 1. Spouse which subscribers pay a pre-determined fee in 2. Descendants return for a range of medical services. Dr. Llanes 3. Ascendants Fee depends on the success or failure of 4. Siblings the treatment instituted. TAKE NOTE! CONTINGENT No fee will be received for efforts until a Medical fees can be discussed before the initiation of the FEE result is attained. contract unless in the case of an emergency “Pag maganda retoke mas mataas PF pero pag pumanget libre na PF” – Plastic Surgeon INSTANCES WHEN THE MD CANNOT RECOVER PF Dr. Camama When there is an agreement that the service is gratuitous Sharing a fee with another physician, When the MD is paid a retainer fee laboratory, or drug company o Professional services rendered by MD in government charity DICHOTOMOUS Not based on services performed hospitals, health centers, rural health units, asylums, FEE Requires services of person who may act tenements to indigent patients (COMMISSION as an agent (chasers, runners, touts or o Medical services rendered by industrial or company MD to OR FEE tipsters) to solicit patients. their respective employees SPLITTING) e.g., MD gets P500 per referral if MD sends o Medical services rendered by school, college or university MD them to a specific diagnostic ultrasound clinic to the faculties, students and administrative employees. STRAIGHT FEE The amount of medical fee is dependent Professional services rendered by MD in private charitable OR “PAKYAW on the remaining balance when all of the institutions if the service is expressed to be gratuitous SYSTEM” other expenses have been paid. Waiver on the part of the MD to the PF even if there has been a “PACKAGE e.g., “buntis package” for OB-GYNE previous agreement that the service is for a fee DEAL” patients When there has been an expressed contract to cure and the MD GUIDE QUESTIONS fails to comply with such agreement Can we treat animals, cats, dogs and the likes? YES. When the MD cannot charge the patient (gratuitous service to There is no law to stop you from treating your own animals colleague, their spouse and minor children or even their parents provided the latter are aged and being supported by Can we charge a fee? NO, because once you charged for a fee, the colleague) that would be illegal practice of veterinary medicine. Those covered by the Medicare (PhilHealth) FACTORS INFLUENCING THE AMOUNT OF MEDICAL FEES Charging a colleague or any of the aforementioned is considered Nature and character of the services rendered unprofessional conduct and is an administrative liability. However, the Labor, time and trouble involved MD is still allowed to charge a colleague’s siblings and/or acquaintances. Importance and responsibility in the case Take note that for cases such as these, current taxation laws complicate Professional character and social standing of the MD the omission of a professional fee (problems with the BIR, etc.) – and thus, some physicians still charge a minimal amount as a form of compliance, The results secured commonly around 100 pesos. Financial ability of the patient Dr. Belmonte Purchasing power of the peso: The amount of medical fee is inversely proportional to the purchasing power of the money in circulation. RIGHTS OF A PHYSICIAN Local customs https://qrs.ly/98eyahw That the defendant is the person responsible to pay the medical fee LIABILITIES OF PHYSICIANS (MUST KNOW) CRIMINAL CIVIL ADMINISTRATIVE Tips to remember: “gusto ka MAKULONG!” “gusto ka MAG-MULTA!” “gusto ka ALISAN NG LISENSYA!” Civil code 19, 20, 21, 2176 and Medical Act 1959, Code of Ethics Bases: Revised Penal Code (Article 365) the Family Code (Standard of care and Medical Etiquette) Grounds for administrative investigations: o Immoral or dishonorable conduct When the act or omission of MD o Insanity constitute a crime. o Gross negligence, ignorance or incompetence Premised on recovery of May be done with deliberate intent resulting to injury or death of patient damages for their wrongful act or on account of impudence, o Conviction of criminal offense involving or of employees negligence, lack of foresight or lack moral turpitude of skill o Unprofessional or unethical conduct o The use or perpetuation of fraud or deceit in the acquisition of registration certificate Preponderance of evidence Preponderance - the quality or fact Needed for