WEEK 10 - LEGAL ASPECT IN HOSPITAL ADMINISTRATION PDF

Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 LEGAL ASPECT IN HOSPITAL ADMINISTRATION...

Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 LEGAL ASPECT IN HOSPITAL ADMINISTRATION 1. Expressed– explicitly stated orally or in writing 2. Implied – the existence can be inferred from the acts of OBJECTIVES the contracting parties. Inferred bylaw as a matter of To demonstrate physician - patient relationship reason and justice for their acts or conduct To illustrate the principles of legal aspect in hospital administration Some Instances where there is no Physician- Patient Relationship by PHYSICIAN-PATIENT RELATIONSHIP Contract - is the meeting of minds between two a. DECISIONS OF COURTS persons whereby one binds himself with respect to the other, to give something or to render some 1. Pre-employment PE for purposes of determining service (Art 1305, New Civil Code) whether an applicant is suitable for employment; 2. PE for eligibility for insurance; Nature of the relationship 3. Physician appointed by court to examine the accused; Consensual - based on mutual consent on both 4. In performing an autopsy parties. 5. Casual consultation in an unordinary place. o A person legally appointed and authorized to hold assets in trust for another person. Fiduciary - based on mutual trust and confidence. b. PSYCHOLOGICAL PATTERNS OF PHYSICIAN-PATIENT o An individual in whom another has placed RELATIONSHIP the utmost trust and confidence to manage and protect property or money 1. ACTIVITY-PASSIVITY RELATION - No interaction DEFINITION between physician and patient because the patient A fiduciary duty is a legal duty to act solely in is unable to contribute activity. This is characteristic another party's interests. Parties owing this duty in an emergency cases when the patient is are called fiduciaries. The individuals to whom they unconscious. owe a duty are called principals. Fiduciaries may not profit from their relationship 2. GUIDANCE-COOPERATION RELATION - Patient is with their principals unless they have the conscious and suffering from pain, anxiety and principals' express informed consent. other distressing symptoms, he seeks help and willing to cooperate. The physician is in a position of They also have a duty to avoid any conflicts of interest trust. between themselves and their principals or between their principals and the fiduciaries' other clients. A 3. MUTUAL PARTICIPATION RELATION - It is in the fiduciary duty is the strictest duty of care recognized nature of a negotiate agreement between equal by the legal system. parties. Examples of fiduciary relationships include those between a lawyer and her client, a guardian and her ward, and a director and her shareholders. DUTIES and OBLIGATIONS imposed on the Physician in the Physician- Patient Relationship Requisites of a contractual relationship Consent – manifested by the meeting of the offer and 1. He should possess the knowledge and skill of which an the acceptance upon the thing and the cause which average physician is concerned; General practitioner vs are to constitute the contract (Art.1319 NCC) Specialist Object – the subject matter of the contract which is 2. He should use such knowledge and skill with ordinary the medical service which the patient wants to be care and diligence; rendered to him by his physician o “locality rule” – the standard of care is Cause – is the consideration or the factor that measured by the degree of care in the instigated the physician to render the medical service locality to the patient, which could be remuneratory or an o “similar locality rule” – diligence is act of liberality. determined when the other physicians in the locality or similar locality could have acted the same way o “national standard of care” - the diligence is determined Forms of Physician-Patient Relationship 1 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 o on what is applicable on a national standard The following are some ways of termination of the basis relationship: 3. He is obliged to exercise the best judgment; 1. Recovery of the patient or when the physician 4. He has the duty to observe utmost good faith. considers that his medical services will no longer be beneficial to the patient; 2. Withdrawal of the physician provided: Physician-Patient relationship does not imply a) with consent of the patient, and guaranty or any promise that the treatment will be b) patient is given ample time and notice; successful. 3. Discharge of the physician by the patient; it does not imply any promise or guarantee that the 4. Death of either party; treatment will benefit the patient 5. Incapacity of the physician it does not imply any promise or guarantee that the 6. Fulfillment of the obligations stipulated in the treatment will produce certain result contract; it does not promise or guarantee that the treatment 7. In emergency cases, when the physician of choice will not harm the patient of the patient is already available or when the it does not promise that the physician will not commit condition of emergency ceases; errors in an honest way 8. Expiration of the period as stipulated; 9. Mutual agreement for its termination. DUTIES and OBLIGATIONS imposed on the Patient in the Course of the Physician-Patient Relationship RIGHTS OF PHYSICIAN INHERENT RIGHTS 1. He must give an honest medical history; to choose patients 2. He must inform the physician of what occurred in the to limit practice of medicine course of the treatment; to determine appropriate management procedures 3. He must cooperate and follow the instructions, orders to avail of hospital services and suggestions of the physician 4. He must state whether he understands the INCIDENTAL RIGHTS contemplated course of action; right of way while responding to emergency 5. He must exercise the prudence to be expected of an Library to hold certain public/private offices to ordinary patient under the same circumstances. perform certain services to compensation right to membership in medical societies STAGES OF PHYSICIAN-PATIENT RELATIONSHIP RIGHTS GENERALLY ENJOYED BY EVERY CITIZEN Pursuant to the provisions of Art. III, bill of rights, a) COMMENCEMENT - It is the very time the Philippine Constitution 1987 physician is obliged to comply with the legal duties and obligations to his patient. RIGHT TO CHOOSE PATIENTS b) TERMINATION Any person who is given right to practice medicine is It is the time when the duties and obligations by a not obliged to practice medicine. physician to his patient ceases. Cannot be compelled to accept professional 1. Recovery of the patient or when the physician employment. considers that his medical services will no longer be The law does not give any qualification the right of beneficial to the patient; the physician to choose his patient, however, the 2. Withdrawal of the physician provided: Code of Medical Ethics and RA 6615 provides b) with consent of the patient, and otherwise in cases of emergency. b) patient is given ample time and notice; REPUBLIC ACT NO. 6615 - AN ACT REQUIRING 3. Discharge of the physician by the patient; GOVERNMENT AND PRIVATE HOSPITALS AND CLINICS 4. Death of either party; TO EXTEND MEDICAL ASSISTANCE IN EMERGENCY 5. Incapacity of the physician CASES 6. Fulfillment of the obligations stipulated in the Art II, Sec.2 Code of Ethics “xxx…free to choose whom contract; he will serve…xxx.. always respond to any request for 7. In emergency cases, when the physician of choice his assistance in emergency….xxx” of the patient is already available or when the Art. II, Sec.3 Code of Ethics “In cases of emergency, condition of emergency ceases; xxx ….a physician should administer at least first aid 8. Expiration of the period as stipulated; treatment and then refer to a more qualified and 9. Mutual agreement for its termination. competent physician ……xxx” 2 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 Sec.1 RA 6615 “All government and private Existence of friendship does hospitals…xxx.are required to render immediate not imply gratuitous services. emergency medical assistance…xxx.” Sec.24 No.12, Medical Act of 1959 “”xxx……. Although Art IV, Sec. 2, Code of Ethics the ethical rule obliges a physician to attend to an emergency, his failure to respond to it may not make “Should willingly render gratuitous service to a colleague, him liable if in so doing, there is a risk to his life. to his wife and minor children or even parents provided the Refusal of a physician to attend to a patient in danger latter are aged and being supported by the colleague. He of death is not a sufficient ground for revocation or should however, be furnished the necessary traveling suspension of his registration if there is a risk to the expense. This provision shall not apply to physicians who physician’s life are no longer in the active practice” RIGHT TO LIMIT HIS MEDICAL PRACTICE Doctrine of Unjust Enrichment field of specialty private clinic or hospital No one must enrich himself at the expense of others. within a political/geographical boundary certain day “Service rendered service paid” of the week/hours of the day certain class of people with due regard to dictate of conscience retirement Kinds of Medical Fees: imposed by the public, religion, professional ethics, medical, society, law, contract 1. Simple Contractual Fee – specifically stating the value of such medical service, either orally or in writing RIGHT TO AVAIL OF HOSPITAL SERVICES 2. Retainer Fee – measured by the space of time rendered a. RIGHT TO DETERMINE THE APPROPRIATE by patient MANAGEMENT PROCEDURE 3. Contingent Fee – depends upon the failure of the 1. Doctrine of Superior Knowledge - the physician treatment instituted has superior knowledge and the patient just Dichotomous Fee (Fee splitting) – the physician may follows orders or instructions and usually places himself in the command and control of the require the services of a person who may act as agent to physician. solicit patients, and the agent will share in the medical fee. Art. III, Sec 5, Code of Ethics 2. RIGHT OF WAY WHILE RESPONDING TO THE CALL OF EMERGENCY “Solicitation of patients, directly or indirectly, through solicitors or agents, is unethical.” RIGHT OF EXEMPTION FROM EXECUTION OF INSTRUMENTS AND LIBRARY 1. Straight Fee – for the amount tendered by the patient Rule 39, Sec.12, Rules of Court to the physician, the latter shall be responsible for the payment of hospital bill, lab fees, medicines, and other a) RIGHT TO HOLD CERTAIN PUBLIC AND PRIVATE incidental expenses; OFFICES which can only be filled up by physicians b) RIGHT TO PERFORM CERTAIN SERVICES This kind of fee is unethical because the amount wagers c) RIGHT TO MEMBERSHIP IN MEDICAL SOCIETIES with the unforeseeable contingencies. Any qualified medical practitioner has the right to become a member of the PMA through one of its Method of Collection of Payment for Medical Services component societies. Membership in a medical society may be voluntary 1. Extra judicial – billing or referral to a bill collection or involuntary agency Philippine Medical Care Act of 1969(RA 6111 as 2.Judicial Methods amended) provides that membership to the PMA is a requirement before a physician can practice Facts to be Proven in Court: medicine under the Medicare Physician employed is duly qualified and licensed; The physician has rendered professional service to Right to Compensation the patient; Based on the physician-patient contractual The professional fee demanded is reasonable; relationship The person liable for the payment is the defendant. 3 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 The obligation to pay devolves on the patient himself 4. Prospect of success provided he is of legal age, of sound mind and has the 5. Potential danger if not applied capacity to enter into a contractual relation. 6. Alternative methods of treatment If the patient dies or becomes legally incapacitated to pay, medical fee shall be made from the following persons in 7. “Patient is the final arbiter of what must be done with order: his body.” spouse; Bases of Consent descendants, of the nearest degree; 1. The physician-patient relationship is fiduciary in ascendants, of the nearest degree; nature. brothers and sisters. 2. Patient’s right to self-determination. Implied promise to pay the physician by the benefactor of the medical services rendered in emergency cases. 3. Contractual relationship. Instances Where the Physician Cannot Recover Purposes Professional Fees 1. To protect the patient from unnecessary/unwarranted 1. Agreement that the service is gratuitous; procedure applied to him without knowledge 2. In government charity hospitals, health centers 2.To protect the physician from any consequences for and other similar health units; failure to comply with legal requirements 3. Rendered in private charitable institutions if expressly gratuitous to the indigent patients; Instances When Consent Is Not Necessary 4. Waiver on the part of the physician; 5. Breach of contract; 1. In cases of emergency, there is an “implied consent” or 6. When the physician cannot charge the patient the physician is “privilege” because he is reasonably pursuant to the Code of Ethics; entitled to assume consent 7. Those covered by Phil health; 2. When the law made it compulsory for everyone to 8. Medical services rendered under a contract of submit to the procedure employment unless expressly provided otherwise. Requisites of a Valid Consent Right of Patients 1. Informed or enlightened consent 1. Right to give consent to diagnostic and treatment procedures 2. Voluntary 2. Right to religious belief 3. Subject matter must be legal 3. Right of privacy Forms of consent 4. Right to disclosure of information 1. Expressed consent – written or oral 5. Right to confidential information 2. Implied consent – may be deduced from the conduct of the patient 6. Right to choose his physician Scope of the Consent 7. Right of treatment 1. General or Blanket consent 8. Right to refuse necessary treatments 2. Limited or conditional consent Right to Give Consent to Diagnostic Procedures 3. Non-liability or exculpatory clause Obligations of the Physician to Inform the Patient: Informed/Enlightened Consent 1. Diagnosis Awareness and assent 2. General procedure nature of the contemplated Full disclosure of facts and willingness of the 3. Risk involved patient to submit 4 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 Quantum of Information Necessary to Form the Basis of frank disclosure to the patient or any person who a Valid Consent may act on his behalf all he pertinent facts relative to his illness 1. Nature of his condition; Art. 1339, Civil Code 2. Nature of proposed treatment or procedure; states that “failure to disclose facts, when there is duty to 3. Possible alternative methods; reveal them, as when the parties are bound by 4. Risk involved; confidential relations, constitutes fraud.” 5. Chances of success or failure Right of Confidential Information “Consent must be given freely or voluntarily” Statutory Privileged Communication Persons Who Can Give consent Pursuant to the Rules of Court, Rule 130, Sec. 24(c), a person authorized to practice medicine, surgery or 1. Patient; obstetrics cannot in a civil case, without the consent of 2. If patient is minor, consent must be obtained from the the patient, be examined as to any information which he parents; may have acquired in attending such patient in a professional capacity, which information was necessary to 3. In the absence of the parents, consent of the enable him to act in that capacity, and which would grandparents must be obtained, paternal grandparents blacken the character of the patient. having preference; Ethical/Professional Confidential Information 4. In the absence of parents and grandparents, eldest brother or sister, provided one is of age and not Pursuant to Art. II, Sec.6, Code of Medical Ethics, the disqualified by law to give consent; medical practitioner should guard as a sacred trust anything that is confidential or private in nature that he 5. Other person who may give consent having substitute may discover or that may be communicated to him in his parental authority. professional relation with his patients, even after death. Subject matter is legal He should never divulge this confidential information, or anything that may reflect upon the moral character of the The subject matter or procedure applied to the person involved, except when it is required in the interest patient and which the patient consented which of justice, public health or public safety. the law must not be that or penalizes against public policy. Some instances where confidentiality is not applicable: Consent of minor is not valid if the procedure will 1. When such disclosure is necessary to serve the best not benefit him interest of justice; Expressed refusal of a minor to surgery shall not prevail over the existing emergency 2. When the disclosure will serve public health and safety; Right to Religious Belief 3. When the patient waives its confidentiality. Art. III, Sec. 5, Philippine Constitution RIGHT TO CHOOSE HIS PHYSICIANS “No law shall be made respecting an establishment of RIGHT TO TREATMENT religion or prohibiting the free exercise thereof. The free - In emergency cases the patient has the right to exercise and enjoyment of religious profession and treatment. worship, without discrimination or preference, shall forever be allowed. No religious test shall be required for Sec. 1, 1st par, RA 6615 the exercise of civil or political rights.” Provides that “xxx…. all government and private Right of Privacy hospital or clinics duly licensed to operate are required to render immediate medical assistance and to provide Right of Disclosure of Information facilities and medicine within its capabilities to patients in - the physician-patient relationship being fiduciary emergency cases who are in danger of dying and or in nature, the physician is obliged to make full and suffered serious physical injuries…xxx.” 5 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 Art II, Sec.3 of the Code of Medical Ethics beds, cribs, bassinets for twenty-four-hour use or longer by patients in the treatment of diseases, …...xxx.” “In cases of emergency, wherein immediate action is necessary, a physician should administer at least 1st aid treatment and then refer the patient to a more qualified Classification, according to Control and Financial and competent physician if the case does not fall within his Support: particular line.” 1. Public/Government – operated and maintained RIGHT TO REFUSE TREATMENT either partially or wholly by the national, In the legal sense, every man of adult age and of sound provincial, municipal, or city government or other mind has the right to determine what must be done in his political subdivision, or by any department, own body. A man is the master of his own self and division, board or other agency thereof. (Sec. 2(b) may expressly prohibit a life-saving surgery or medical RA 4226). treatment. 2. Private – privately owned, especially established and operated with funds raised and contributed Doctrine of parens patria, the State has the right to assume through donations, or private capital or other guardianship when the child is neglected by the parents to means. (Sec. 2(C), RA4226) have the child treated, and parents have no right to base it on religious beliefs or any other grounds. For purposes of determining liability of private hospitals: When the law provides for treatment, the patient has no 1. Private charitable– established for the public right to refuse treatment benefit and not conducted for the pecuniary gain of the management. The social commitment of the physician is to sustain life 2. Private pay – established for profit and gain. and relieve suffering. When the performance of one’s duty conflicts with the other, the choice of the patient, or his Rationale why hospital cannot practice medicine: family or legal representative if incompetent to act on his 1. The hospital cannot be subjected to government own behalf, should prevail. In the absence of the patient’s licensure examinations to determine whether it is choice or authorized proxy, the physician must act in the qualified to practice medicine; best interest of the patient 2. A non-medical will be allowed to control a LIABILITIES OF PHYSICIAN physician and through circumvention practice medicine; ADMINISTRATIVE Breach of the confidential relationship in a Right to practice is temporarily withdrawn from physician-patient relationship. the physician; Primary Duties of a Hospital: A valid exercise of the police power of the State; Laws: Medical Act of 1959 as amended including 1. To furnish a safe and well-maintained building and the Code of Ethics and Rules and Regulations of ground; the PRC; 2. To furnish adequate and safe equipment; Penalty: reprimand, suspension, to revocation of 3. To exercise reasonable care in the selection of the license. hospital staff. LIABILITIES OF HOSPITALS Persons Coming Within the Premises of the Hospital Sec.2(a), RA 4226, Hospital Licensure Act 1. Trespasser – one who enters the property of another without being granted the privilege to do HOSPITAL- means a place devoted primarily to the so. It is only required of a hospital to refrain from maintenance and operation of facilities for the diagnosis, taking positive steps to harm a trespasser. treatment, and care of individuals suffering from illness, 2. Licensee – one who is neither a customer, servant disease, injury or deformity, or in need of obstetrical or or a trespasser. He has no contractual relation with other medical and nursing care. the hospital. He is permitted, expressly or impliedly The term ‘hospital’ shall also be construed as any to be within the premises for his own interest and institution, building or place where there are installed convenience. His presence is merely tolerated. 6 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 3. Invitee – one who is essential to the operation of a their means does not affect its charitable status, if hospital or for whom the hospital has a purpose. it is operated for no profit. A charitable hospital must not consist of Liabilities of Hospitals for the Wrongful Acts of their rendering charitable acts to few sporadic cases Agents but must be extended to the public over a period 1. Government or Public Hospitals of time. A hospital established for profit even though A State cannot be sued without its consent. some beds are devoted for charity is not deemed The immunity of the government from the official a charitable institution. acts of its officers, agents and employees is based Doctrines Applied to Charitable Hospital Immunity for on the legal principle that “there can be no legal the Acts of its Employees right against the authority that makes the law which the right depends.” ❖ TRUST FUND DOCTRINE - Charitable hospitals derived support from Rationale: voluntary contributions or donations for the Government funds should be spent for public reception, care and treatment of charity patients. purposes and not diverted to compensate for The contributions are held only in trust by the private injuries and public service should not be governing body of the hospital. Diverting the hindered. The government must not be sued money for the payment of damage will be utilizing because the government derives no profit from the money not intended by the donor. its activity unlike a private enterprise. Those established to perform government ❖ IMPLIED WAIVER THEORY functions, it is immune from being sued. - A patient who enters a private hospital, knowing Those performing proprietary function when it is fully well that it is merely supported by established for profit. The government goes contributions, waives his right to claim damages. down to the level of any private hospital. ❖ PUBLIC POLICY THEORY 2. Private Charitable, Voluntary or for charity - It renders medical service without remuneration. It is doing an undertaking of the obligation of State A charity hospital is established and maintained for the preservation of life and maintenance of from the donations, contributions, philanthropic health. acts and pays no dividends. ❖ INDEPENDENT CONTRACTOR THEORY The determination whether a hospital was established for charity is the articles of - A patient who enters a private charitable hospital does not have a contract with the hospital but with incorporation and the constitution and by-laws of the corporation. the attending physician. 3. Private Hospital Operating for profit RULES APPLIED IN DETERMINING THE VICARIOUS LIABILITY FOR THE NEGLIGENT ACTS OF THE RESIDENT May be held vicariously liable for the negligent PHYSICIANS, NURSES AND OTHER EMPLOYEES acts of its employees. 1. Principle of administrative/ministerial as against A hospital which allows the patient to pay if ever professional/medical duties they have the capacity to do so and serve others The performance of all routinary duties gratuitously does not change the fundamental which is the very reason why he nature of the hospital as charity. is appointed in the ordinary The charging of the fee is not controlling but the sense constitutes administrative duties purpose the fee will be use is the measure of and any negligent acts committed by charity. such employees in the course of The fact that a hospital refuses to accept certain their employment which causes injury to persons and others to pay in accordance with 7 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 the patient, may make the hospital Recent decisions of the court have vicariously liable. extended hospital liability to patient for its Medical duties are by its nature beyond the failure to make careful selection, review, ordinary routine in a hospital. Any and supervision of independent physicians negligence of such hospital employees, the who are permitted to practice in the “borrowed servant doctrine” must be hospital. applied and the hospital may not be held vicariously liable. 2. Vicarious Liabilities For the acts of hospital employees 2. Power of control Admission It is the authority of a certain hospital to manage and designate certain appropriate A person has no absolute right to be admitted in a duties and function beyond employee`s hospital or to avail of hospital services. The control and whereby has a binding relationship between the hospital and the patient authority to terminate such duties and is contractual. functions. A government has no absolute privilege of choice of patients in as much as it is established and 3. Contract of Services maintained by public funds except for justifiable If the contract has been entered grounds. with hospital to render professional services, the hospital may be held liable Attendance to emergency cases in hospitals provided the negligent act was committed Sec. 1 RA 6615 substantially states that “…xxx within the scope of employment. But if hereby required to render immediate emergency entered with the patient for contract of medical assistance and to provide facilities and services, the principle of independent medicine within its capabilities to patients in contractor theory is applied. emergency cases who are in danger of dying and/or who may have suffered serious injuries.” 4. Independent Contractor Theory The hospital has no control on the activity Transfer of patients of a certain physician in performing his It must be premised on desire and consent of the function as a doctor for whatever reason it patient and when the condition of the patient may be particularly on their own respective would permit to do so. patients. No binding relationship in terms of doctor- Discharge of patients hospital authority. After evaluation of the patient’s condition, considers that further hospitalization is no longer 5. Sole responsibility vs. Shared responsibility indispensable, a physician may order the discharge It is in the context of standard of care with or without condition. and jurisdiction of a hospital that differentiate both responsibility on both employer / employees. LIABILITIES OF A HOSPITAL Refusal to be hospitalized 1. Corporate Liabilities Refusal of the patient to remain in the hospital will Those arising from failure of the hospital to not be a lawful ground to detain him if he is of furnish accommodations and facilities sound mind and of legal age. Related laws: necessary to carry out its purpose or to follow in a given situation, the established o Art. 268, Revised Penal Code standard of conduct to which the o 1987 Philippine Constitution, Sec. 1 and 6 corporation should conform. “Refusal of the patient to leave the hospital” 8 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 Premature discharge Ambulance The attending physician and the hospital may be An AMBULANCE is a motor vehicle specifically held liable to the patient if the latter is discharged designed, equipped and used for the from the hospital in spite of the fact that further transportation of the sick, injured or wounded hospitalization is still necessary. persons operated by trained personnel for ambulance service. Detention of patient for non-payment of bill The criminal liability of an ambulance driver is the A patient cannot be detained in a hospital for non- same as that of an ordinary driver. However, the payment of the hospital bill. The law provides a civil liability arising therefrom the hospital must be remedy for them to pursue by filling the necessary held liable. suit in court for the recovery of such fee or bill. Hospital Pharmacy A hospital may legally detain a patient against his will when he is detained or a convicted prisoner, or Sec. 42, RA 5921. when the patient is suffering from a very A PHARMACY is a place or establishment where contagious disease wherein his release is drugs, chemical products, active principles of drug, prejudicial to public health, or when the patient is pharmaceuticals, proprietary medicine of mentally ill, that his release will endanger public pharmaceutical specialties, devices and poison are safety. sold at retail and where medical and dental LIABILITIES OF A HOSPITAL FOR ITS ANCILLARY SERVICES veterinary prescriptions are compounded and dispensed. Whenever the hospital administration enters into contract with a partnership of physicians to run the Medical Records emergency room, the medical staff therein are not It is a compilation of the pertinent facts of the considered employees of the hospital. patient’s life history, illness, and treatment. Consequently, liability for negligence in the emergency room is shifted to the medical It is a compilation of scientific data derived from partnership. many sources, coordinated into a document and made available for various uses to serve the Courts have held that even if contracts specify that patient, the physician, the institution in which the physicians will be considered independent patient has been treated, the science of medicine contractors, the hospitals are responsible for their and society as a whole action if they can exercise control over them. Purpose of Maintenance of Medical Records Patients are not bound by the secret limitations contained in a private contract between the hospital and the physician. Two Aspects of Emergency Care 1. Examination of the patient to determine his condition and need for emergency medical procedures. 2. Performance of the specific medical or surgical procedure which are required without delay to protect the patient’s health. Liability in the emergency room may arise from the following: 1. Failure to admit; 2. Failure to examine and/or treat; 3. Negligence in the application of management procedures. 9 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 Sec. 21 (c), Rule 130, Rules of Court (Privilege A condition of emergency is usually an exception to the Communication) observance of the standard ethical conducts. A person authorized to practice medicine, surgery, obstetrics cannot in civil case, without the consent of Art. II, Sec. 2 the patient, be examined as to any information, which “A physician is free to choose whom he will serve. He may he may have acquired in attending such patient in a refuse calls, other medical services for reasons satisfactory professional capacity, which information was necessary to his professional conscience. He sould, however, always to enable him to act in that capacity, and which would respond to any request for his assistance in an blacken the character of the patient. emergency...xxx.” Information for which no authorization is needed: Art. II, Sec. 3 1. Name of the patient and house officers associated “In case of emergency, wherein immediate action is with the treatment of a patient; necessary, a physician should administer at least first aid 2. Personal circumstances of the patient which are treatment and then refer the patient to a more qualified not ordinarily related to the treatment. and competent physician if the case does not fall within his When may the contents of the record be disclosed: particular line.” 1. When requested by the patient or by someone Art. IV, Sec. 15 who could act in his behalf which must be in “A physician should never examine or treat a hospitalized writing; patient of another without the latter’s knowledge and 2. When the law requires such disclosure; consent except in cases of emergency...xxx” 3. Upon a lawful order of the court. Art. IV, Sec. 16 The attending physician has no legal right to determine “A physician called upon to attend to a patient of another who shall and who shall not see the record. At the physician because of an emergency...xxx...should attend most, his approval or permission is only a matter of only to the patient’s immediate needs...xxx” courtesy. Art. IV, Sec. 17 Members of the resident staff, student and attending “Whenever in the absence of the family physician, several medical staff may freely consult such records as pertain physicians have been simultaneously called in an to their work. emergency case...xxx...the first to arrive should be considered as physician in charge, unless the patient or his Sec. 37, Rule 130, Rules of Court –Entries in the Course of family has special preference for some other one among Business those who are present...xxx” Entries made at, or near the time of the transactions to Art. IV, Sec. 20 which they refer, by a person deceased, outside the “When a physician is requested by a colleague to take care Philippines or unable to testify, who was in a position of a patient because of an emergency...xxx...the physician to know the facts therein stated, may be received as should treat the patient in the same manner and with the prima facie evidence, if such person made the entries same delicacy as he would have wanted his own patient in his professional capacity or in the performance of cared for under similar conditions...xxx” duty and in the ordinary course of business or duty. Patient's record is admissible in evidence even if the Other related provisions of the law person who made the entry is dead or not available, as RA 6615 the records are entries in the course of business. An act requiring government and private hospitals or clinics duly licensed to extend medical assistance in EMERGENCIES IN MEDICAL PRACTICE emergency cases. An EMERGENCY is an unforeseen combination of RA 8344 circumstances which calls for an immediate action. It refers An act penalizing the refusal of hospitals and medical to a situation in which a patient has been suddenly or clinics to administer appropriate initial medical unexpectedly endangered to a such an extent that treatment and support in emergency or serious cases, immediate action is needed to save the life and limb or to amending BP Blg. 702, otherwise known as An act avoid permanent damages. prohibiting the demand or deposits or advance payments for the confinement or treatment of Related Provisions of the Code of Medical Ethics patients in hospital and medical clinics in certain cases. Art. 2752, Revised Penal Code 10 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 Abandonment of persons in danger and abandonment welfare of the patient. In the absence of a clearly of one’s own victim. specific prohibition on the part of the patient, the The penalty of arrestor mayor shall be imposed upon: physician should be privileged to perform such surgery 1. Anyone who shall fail to render assistance to any within the operative field as is justified in the prevailing person whom he shall find in an uninhabited place medical opinion. wounded or in danger or dying, when he can render Surgery cannot be extended if an emergency is not such assistance without detriment to himself, unless present. such omission shall constitute a more serious offense. The law also implies an obligation on the part of the 2. Anyone who shall fail to help or render assistance to patient to pay reasonable value of the emergency another whom he has accidentally wounded or injured service. If no specified amount agreed upon, the principle of quantum merit shall be applied. Standard of Care in Emergencies A physician cannot be held to the same conduct as one DELEGATION OF A PHYSICIAN’S DUTIES who had an opportunity to reflect, even though it later Requisites for a Valid Delegation appears that he made a wrong decision yet prudent at 1. When such duty can be delegated which will depend that time. on the circumstances of the case, nature of the duty to be delegated, and the training and experience of the Emergency Operations Without Consent person to whom such duty is to be delegated. When the situation is such that an immediate action is 2. The person to whom such duty is delegated must be necessary to save the life or preserve the health of the competent to perform such duty; patient, and getting a consent is prejudicial to the 3. Proper instructions must be given to the person who patient, the physician can legally proceed with his will perform the delegated duty contemplated life-saving procedure. The law gives him the right to act under the Theory of Liabilities for Injuries in the Negligent Performance of the Implied Consent or that the physician is privileged to Delegated Duties do whatever is sound for the benefit of the patient. The person performing the delegated duty cannot be The refusal of the patient who is of legal age and of held liable for any untoward or unexpected effects of sound mind to submit to medical treatment shall his act if he had complied with all the requirements of prevail even if the danger to his life is eminent. a delegated duty and has exercised care and diligence 1. The injured person must be unconscious or in such execution. otherwise unable to give a valid consent; 2. The situation must be such as it would make it Privileged Communication Between Physician and His actually and apparently necessary to act before Patient there is an opportunity to obtain consent; Sec. 6, Art. II, Code of Medical Ethics 3. The physician, in the exercise of his best judgment, “The medical practitioner should guard a sacred trust that the medical procedure is life-saving. anything that is confidential or private in nature that he may discover or that may be communicated to him in his Refusal to Give Consent During Emergency professional relation with his patients, even after their If the patient is conscious, or if unconscious or is not in death. He should never divulge this confidential a capacity to give consent, but someone who could act information, or anything that may reflect upon the moral on his behalf is present, then consent must first be character of the person involved, except when it is required obtained before the commencement of a procedure. in the interest of justice, public health, and public safety.” Sec. 24 (c), Rule 130, Rules of Court Extension of Operation in Cases of Emergency “A person authorized to practice medicine, surgery or If during an operation, an accident occurs, or a obstetrics cannot in a civil case, without the consent of the condition maybe discovered which requires immediate patient, be examined as to any information which he may action, but which is not covered by the consent, the have acquired in attending such patient in a professional surgeon is justified in extending the operation and be capacity, which information was necessary to enable him absolved of liability. to act in that capacity, and which would blacken the The surgeon is authorized to extend the operation to character of the patient." any condition discovered when it will rebound to the Extent of the Privileged Communication 1. Interns; 11 Leadership and Management 1st Year | A.Y. 2024-2025 Lecture: Legal Aspect in Hospital Administration Prepared by: Group 2 Lecturer: Dr. Maryam- Lizbeth Lee- Sahijuan Date: October 08, 2024 2. Confidential information obtained by one of the physicians practicing medicine in partnership with another physician whereby the patients of both are the patients of the firm. 3. Nurses and attendants who were present and assisting the physician when the communication was made. 12