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  • 1. LEGAL ISSUES and CONCERNS on PATIENT CARE and HOSPITALMANAGEMEN T
  • 2. No physician is really good before he has killed one or two patients.   ~Hindu Proverb
  • 3. MedicalMalpractice/Negligence is a
  • 4. BASIC LIABILITIES CRIMINAL (Law-Revised Penal  Code and Special Laws)  CIVIL (Law-Civil Code)  ADMINISTRATIVE (Law or Ethics /Medical Act and Code  of Medical Ethics)
  • 5. AS ES Y C RA LITIM MO
  • 6. LIABILITY versusSUABILITY
  • 7. Malpractice cases vs. Doctors in General (1993-2006)9080706050403020100 93 94 95 96 97 98 99 0 1 2 3 4 5 6 7
  • 8. Malpractice casesFault or Negligence Attributed to the following . . .  C lin ic ia n s  Ad m in is tra tiv e ancillary etc. admin  An c illa ry 10% 10% 10%  E tc . clinicians 70%
  • 9. Specialties . . . 2006 • OB-GYNECOLOGY • anesthesia pedia others SURGERY • PEDIATRICS 11% 17% 6% • ANESTHESIOLOGY • OTHERS surgery 28% ob-gyne 38%
  • 10. Profile of complainant patients (review of 60 cases ) . . . . Mindanao Visayas 5% 10%Luzon 17% Metro manila 68% Place of Incident
  • 11. Profile of complainant patients (review of 250 cases ) . . . . Elementary 13%College High School 55% 27% 5% Vocational Level of E ducation
  • 12. Profile of complainant patients (review of 250 cases ) . . . . others 10% Gov’t /relative Doctor 34% Relative 20% 36%Relatives Lawyer / relative (within 6th degree)
  • 13. HOSPITAL ADMINISTRATOR = = = HOSPITAL MANAGEMENT = = = MEDICAL DIRECTOR
  • 14. NASTY HEADACHE FOR THE MEDICAL DIRECTOR…   Fractures or burns resulting during rehab/PT session Necrotiv IV site Baby falls during delivery Wrong sex was assigned to the baby Incomplete OS/instrument count Wrong medicine/dosage/route was given Wrong type of blood was transfused Expired meds/drugs Erroneous laboratory/radiologic results
  • 15. What should I do?Who shall be held responsible? Lost specimens (eaten by cats, rats, etc.) False Positive Results (Hep B) Wrong Entry/Proforma Results Contrasting Readings (Discrepancies) Wrong results (Errors) Non-availability of blood Negligent reading/Negligent staff Fake training/documents/licenses Unethical practices
  • 16. OR You are being charged with lascivious conduct, sexual harassment and immorality?
  • 17.  Violation of Mandatory & Prohibitive Laws . . . P.D. 169 R.A. 8344 PD 603 RA 7610 Pharmacy Act GENERIC ACT R.A. 6615 Sexual Harassment Law
  • 18. Certain laws requiring mandatory reporting . . . PD 169 - Physical Injuries “The attending physician of any hospital,   medical  clinic,  sanitarium,  or  other  medical  establishment, or any medical practitioner, or  who has treated . . . any person for serious or  less  serious  physical  injuries  .  .  .  shall  report  the  fact  of  such  treatment  personally  or  by  fastest  means  of  communication  to  the  nearest  Philippine  Constabulary  [now  Philippine National Police] unit without delay .  . .”
  • 19. Failure to comply . . . “.  .  .  any  violation  of  this  decree  and/or  the  rules and regulations which shall be promulgated  by  competent  authorities  in  accordance  herewith,  with  malicious  intent  or  gross  negligence  shall  suffer  the  penalty  of  imprisonment  for  not  less  than  one  (1)  nor  more  than  three  (3)  years  and/or  fine  of  not  more  than  1,000  pesos  nor  more  than  3,000  pesos”
  • 20. Article 166 of Presidential Decree No. 603, asfollows- “. . . All hospitals, clinics or other institutions as well as private physicians providing treatment shall, within forty- eight [48] hours from knowledge of the case, report in writing to the . . . nearest unit of the DSWD, any case of maltreated or abused child, or exploitation . . .”
  • 21. violation subjects the physician to . . .Article 166, Presidential Decree No. 603, to wit- “. . . violation of this provision shall subject the hospital, clinic, institution or physician who fail to make such report to fine of not more than 2 thousand pesos . . .”
  • 22. One important aspect . . .Article 166, Presidential Decree No. 603 provides as follows- “. . . in case of sexual abuse, the records pertaining to the case shall be kept strictly confidential and no information relating thereto shall be disclosed except in connection with any court or official proceeding based on such report . . .”
  • 23. CHILDABUSE Still confidentiality . . . “ . . . At the instance of the offended party, his/her name may be withheld from the public until the court acquires jurisdiction over the case. It shall be unlawful for any editor, publisher, and reporter or columnist in case of printed materials, announcer or producer in case of television and radio broadcasting, producer or director of the film in case of the movie industry to cause undue and sensationalized publicity of any case in violation of this Act resulting in the moral degradation and suffering of the offended party.” [Section 29. Art. XI, RA 7610]
  • 24. non-compliance . . . Article 166, Presidential Decree No. 603 “. . . any person disclosing confidential information in violation of this provision shall be punished for a fine of not less than two thousand [2,000] pesos or by imprisonment of not more than one [1] year or both such fine and imprisonment at the discretion of the court . . .”
  • 25. R.A. 5921 PHARMACY ACT. . . on Sale of Drug Samples “. . . Section 26. No sample of any drug, biologic product, device or proprietary medicine, given or intended to be given for free to the physician and other qualified persons by any manufacturer or distributor or his representative or detailman, as part of its program, may be sold . . .”
  • 26. if a doctor sells and found guilty . . . “. . . Section 40. Any person who shall violate any of this provision . . . a fine of not less than 1,000 pesos or imprisonment of not less than six (6) months and one (1) day but not more than four (4) years . . .”
  • 27. REPUBLIC ACT NO. 7877        AN ACT DECLARING SEXUAL HARASSMENT UNLAWFUL IN THE  EMPLOYMENT, EDUCATION OR TRAINING ENVIRONMENT, AND FOR  OTHER PURPOSES. 
  • 28.  SECTION 3. Work, Education or Training -Related, Sexual Harassment Defined. – Work, education or  training-related sexual harassment is committed by an employer, employee, manager, supervisor, agent of the employer, teacher, instructor, professor, coach, trainor, or any other  person who, having authority, influence or moral ascendancy  over another in a work or training or education environment, demands, requests or otherwise requires any sexual favor  from the other, regardless of whether the demand, request or  requirement for submission is accepted by the object of said Act.
  • 29.  The employer or head of office, educational or training  institution shall disseminate or post a copy of this Act for the  information of all concerned.  
  • 30. SECTION 5. Liability of the Employer, Head of  Office,   Educational or Training Institution. - The employer or head of office, educational or training institution  shall be solidarily liable for damages arising from the acts of   sexual harassment committed in the employment, education or training environment if the employer or head of office,  educational or training institution is informed of such acts by  the offended party and no immediate action is taken.  
  • 31.      SECTION 7. Penalties. -  Any person who violates the   provisions of this Act shall, upon conviction, be penalized by   imprisonment of not less than one (1) month nor more than six (6) months, or a fine of not less than Ten thousand pesos  (P10,000) nor more than Twenty thousand pesos (P20,000), or  both such fine and imprisonment at the discretion of the court.
  • 32. Emergency Cases Republic Act 6615MEDICAL ASSISTANCE IN EMERGENCY CASES -and- Republic Act 8344 “AN ACT PENALIZING THE REFUSAL OFHOSPITALS AND MEDICAL CLINICS TO ADMINISTERAPPROPRIATE INITIAL MEDICAL TREATMENT ANDSUPPORT IN EMERGENCY OR SERIOUS CASES,AMENDING FOR THE PURPOSE BATAS PAMBANSABILANG 702, OTHERWISE KNOWN AS AN ACTPROHIBITING THE DEMAND OF DEPOSITS ORADVANCE PAYMENTS FOR THE CONFINEMENT ORTREATMENT OF PATIENTS IN HOSPITALS ANDMEDICAL CLINICS IN CERTAIN CASES”
  • 33. Violation gives rise to . . . “Any official, medical practitioner or employee of the hospital or medical clinic who violates the provisions of RA 8344 shall, upon conviction by final judgment, be punished by imprisonment of not less than six ( 6) months and one ( 1 ) day but not more than two ( 2 ) years and four (4) months, or a fine of not less than Twenty thousand pesos (P20,000.00 ), but not more than One hundred thousand pesos (P100,000.00 ) or both at the discretion of the court: Provided, however, That if such violation was committed pursuant to an established policy of the hospital or clinic or upon instruction of its management, the director or officer of such hospital or clinic responsible for the formulation and implementation of such policy shall, upon conviction by final judgment, suffer imprisonment of four ( 4 ) to six (6 ) years, or a fine of not less than One hundred thousand pesos (100,000.00), but not more than Five hundred thousand pesos ( P500,000.00 ) or both, at the discretion of the court”
  • 34. RA 9439 - Prohibiting the Detention of Patients I promise to pay in Hospitals and Medical Clinics on Grounds of Non- Payment of Hospital Bills or Medical BILLS Expenses
  • 35.  Section 3. Any officer or employee of the hospital or medical clinic responsible for releasing patients, who violates the provisions of this Act shall be punished by a fine of not less than P 20,000.00, but not more than P 50,000.00, or imprisonment of not less than one month but not more than six months or both fine and imprisonment at the discretion of the proper court
  • 36. LIABILITIES IN Corporation COLLEGE/ UNIVERSITY MEDICAL/HOSPITALPRACTICE . . . VICARIOUS LIABILITY HOSPITAL Interns/ Ostensible Students Agent CONSULTANT Independent  Employer-Employee Contractor Relationship MedTechs/Nurses/Paramedical Employees Non paramedical employees
  • 37. Supreme Court Decisions . . .December 29, 1999 RAMOS VS. COURT OF APPEALS G.R. No. 124354 SC: “Captain of the Ship Doctrine applies . . . The attending physician is responsible for the negligent acts of the staff under his control and supervision . . .”
  • 38. Supreme Court Decisions . . .December, 2006: January 31, 2007 Rogelio Nogales, Professional Services, et al, vs Capitol Inc. vs. Agana, (G.R. No. Medical Center, et 126297), and Agana vs. al, G.R. No. Juan Fuentes (G.R. No. 142625 126467), O s t e n s ib l e Ag e nt
  • 39. THIRD DIVISIONð ð G.R. No. 168512G. R. No. 16851G. R. NG. R. No. 16851G. R. N and BU CASTRO,[1] Petitioners, Present: Ynares-Santiago, J. (Chairperson), - versus - Austria-Martinez, Callejo, Sr., Chico-Nazario, and Nachura, JJ.. Jchur a, ar i o, and. Jchur a, ar i o, , Promulgated: Respondents. March 20, 2007x ---------------------------------------------------------------------------------------- xDECISIONYNARES-SANTIAGO, J.: [1] Did not appeal from the Decision of the Court of Appeals.
  • 40. “x x x From the foregoing laws andrules, it is clear that a clinical laboratory mustbe administered, directed and supervised by alicensed physician authorized by the Secretaryof Health, like a pathologist who is speciallytrained in methods of laboratory medicine; thatthe medical technologist must be under thesupervision of the pathologist or a licensedphysician; and that the results of anyexamination may be released only to therequesting physician or his authorizedrepresentative upon the direction of thelaboratory pathologist x x x”
  • 41. “ x     x     x …… WHEREFORE, the Decision of the Court of Appeals in CA-G.R. CV No. 58668 dated February  27,  2004  finding  petitioner  +++++++++++  guilty  of  gross  negligence and  liable  to  pay  to  respondents P50,000.00  as  moral  damages, P50,000.00  as  exemplary  damages,  and P25,000.00  as  attorney’s  fees,  is AFFIRMED.  SO ORDERED.  …x      x      x”
  • 42. “x x x Castro’s infrequent visit to the clinical laboratory barely qualifies as an effective administrative supervision and control over the activities in the laboratory. “Supervision and control” means the authority to act directly whenever a specific function is entrusted by law or regulation to a subordinate; direct the performance of duty; restrain the commission of acts; review, approve, revise or modify acts and decisions of subordinate officials or units.[1] x x x” [1] Jalandoni v. Drilon, 383 Phil. 855, 868  (2000).
  • 43.  First,  is not administered, directed and supervised by a licensed physician as required by law, but by b , a licensed Medical Technologist.[1] [1] Records, p. 193. Second, , cond conducted the HBsAG test of respondent r espon without the supervision of defendant-appellee Castro Last, the disputed HBsAG test result was released to respondent r el eas without the authorization of defendant-appellee Castro
  • 44.  When  accidents  occur  due  to  negligence,  mismanagement and or fortuitous events… HOW DO YOU SAVE YOURSELF FROM A LAWSUIT?
  • 45. Perhaps , the ONLY way is to… say  SORRY and PRAY or ……… PAY!!!
  • 46. OBJECTIVE/GOAL  Mitigate, minimize violent litigious reaction  from the next of kin
  • 47. USEFUL TIPS Have a conference ASAP Get your acts together. Talk to the hospital lawyer right away Have an agreed upon a common stand
  • 48. CONFERENCE WITH THEPATIENT’S NEXT OF KIN   When?  Where?  With whom?  Who will talk to them?  How?
  • 49. THE QUIT CLAIMContents of quit claim shall contain among  others…           waiver  to  file  criminal,  civil  and  administrative  case  against  hospital  and  medical staff (and of course, that the doctor is not negligent and the monetary consideration is for humanitarian purposes!)
  • 50. MALPRACTICE INSURANCE  Is it ADVISABLE?  Is it DESIRABLE?  
  • 51. the fact is……………. CRIMINAL and ADMINISTRATIVELIABILITIES CANNOT be INSURED On l y CIVIL LIABILITY
  • 52. GOLDEN RULES- Documentalt s/r r l a t w w e l est eferas nd o hom/ her- E a t paientpur xpl in o t pose a impora ofr r l nd t nce eferas- Documentt s/efera r t est r r l esuls- Communicae w h paienta t r t a documenteffors t t it t bout est esuls nd t o communicae especial non- ia paient t ly compl nt t s.
  • 53. - Chatnot shoul be ea t r d r es d sy o ea- NE E at r ds V R ler ecor- NE E int ional misdae not orent signaur a init l orr t V R ent ly t es er t es nd ias epors l t t n t dae r iew unl t corectdae is aso ent ed. aer ha he t ev ed ess he r t l er- Secur a documentCONSE aw ys. e nd NT l a
  • 54. good Rapport!
  • 55. HOW TO AVOID BEING SUED FOR MALPRACTICE? STOP YOUR PRACTICE!!!Do not accept the position-Medical Director Shift to other professions or business OR……
  • 56. Hi! I am the Medical Director!EAST AVENUE MEDICAL CENTER, March 27, 2008
  • 57. Dear Lord,  Please assign another Medical Director!
  • 58. A TTY. A NTONIO A LE J A NDRO D. RE B OS A ,M.D.