2.2 Legal Medicine & Medical Jurisprudence August 28, 2015
Atty. Malaya Capulong, MD, LIB OUTLINE I. Medical Jurisprudence A. Purposes II. Law and Practice of the Medicine III. Practice of Medicine A. Physician IV. RA 2382 (as amended) The Medical Act of 1959) A. Board of Medical Education under the Department of Education - Composition - Functions B. The Board of Medical Examiners - Composition - Qualifications Of The Examiners - Functions V. Registration Of Physicians A. Sec. 10 – Acts constituting practice of medicine B. SEC. 8, R.A. 2382 (as amended) - Who may practice medicine? - Who may take the board examinations?
Legal Medicine Primarily concerned with legal rights and responsibilities of medical practitioners with particular reference to those arising from the doctorpatient relationship. Includes: o Licensure and regulatory laws o Physician–patient-hospital together with the other paramedical personnel, their rights, duties and obligations o Liabilities for non-compliance with the law
PURPOSES To protect the public from charlatans To promote professionalism and foster professional interrelationship To develop awareness of the rights, duties and obligations of the patient, physician and the hospital To control the increasing number of medical malpractice suits against physicians SC placed a cap to the amount of damage to the plaintiff. US law firms practices contingency basis where they will shoulder first all the expenses so that case can push through. To explain the purpose and procedure of certain legislation To study the need to amend, repeal our health care laws in harmony with the recent scientific and social development. Law and Practice of the Medicine
The State must maintain high standard of practice by setting up rules and regulations with regards to qualifications and procedure for the admission to the profession. To guarantee the safety of the patient Impose liability to practitioner who through his act or omission causes damage or injury to the health and welfare of the patient The right to regulate the practice of medicine is based on the police power of the state. Police Power of the State – inherent power of the state Government enactments which precisely interfere with personal liberty or property in order to promote the general welfare or the common good Examples: Who can buy real estate in the Philippines and Who can be granted visa
Transcribers:GONZAGAs, MONTEMAYOR
o TABLARIN vs GUTIERREZ (GR No. 78764, July 31, 1987) o RA 2382 – Board of Medical Educaiton Sec. 5 (a) – to determine and prescribe requirements for admission into a recognized college of medicine Sec. 7 – Admission requirements (b) a certificate of eligibility for entrance to a medical school from the Board of Medical Education o MECS Order No. 52, s. 1985 – established a uniform admission test called NMAT Before 1985 – there was no NMAT; there was no set passing rate; there was very many applicants in medical students but the slots were limited A valid exercise of the police power of the state The regulation of the practice of medicine . . . long been recognized as a reasonable method of protecting the health and safety of the public. That the power to regulate and control the practice of medicine includes . . . the admission to the ranks of those authorized to practice of medicine theNMAT is reasonably related to the securing of the ultimate end . . . the protection of the public from the potential deadly effects of incompetence and ignorance in those who would undertake to treat our bodies and mind… o DECS vs San Diego (GR No. 89572, Dec. 21, 1989) – Roberto Rey San Diego, BS Zoology graduate, took the NMAT 4 times, application for 5th attempt was rejected It is the right and responsibility of the State to ensure that the medical profession is not infiltrated by incompetents to whom patients may unwarily entrust their lives and health. While every person is entitled to aspire to be a doctor, he does not have a constitutional right to be a doctor. The right to quality education is not absolute . . . one must show that he is entitled to it because of his preparation and promise.
Practice of Medicine It is a privilege or franchise granted by the State to any person to perform medical acts upon. It is diagnosing and applying and the usage of medicine and drugs for curing, mitigating, or relieving bodily disease or conditions. Physician Is a person who after completing his secondary education follows a prescribed course of medicine at a recognized university or medical school, at the successful completion of which, is legally licensed to practice medicine by the responsible authorities and is capable of undertaking the prevention, diagnosis, and treatment of human illness by the exercising independent judgment and without supervision(WHO) RA 2382 (as amended) The Medical Act of 1959 Regulates the practice of medicine in the Philippines Defines what constitutes practice of medicine Prescribes the requirements in order to be able to practice medicine Prescribes the composition of the Board of Medical Education and the Board of Medical Examiners, their functions, duties and obligations.
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Legal Medicine & Medical Jurisprudence Note that that the Board of Medical Education and Board of Medical Examiners are two different bodies. Some overlaps may exist but their functions are completely different. OBJECTIVES a. The standardization and regulation of medical education b. The examination for registration of physicians c. The supervision, control and regulation of the practice of medicine in the Philippines o
AGENCIES 1. Board of Medical Education under the Department of Education 2. Board of Medical Examiners under the Commissioner of Civil Service BOARD OF MEDICAL EDUCATION VS. BOARD OF MEDICAL EXAMINERS Board of Medical Board of Medical Education Examiners
The primary duty of is to prescribe the curriculum of medical schools. So more of the school itself.
1. 2. 3. 4. 5. 6. 7. 8.
The content of the
board exams are prescribed by the Board of Medical Examiners. They also decide on malpractice cases brought before the PRC.
Board of Medical Education under the Department of Education Composition Secretary of Education or his duly authorized representative, as chairman; Secretary of Health or his duly authorized representative; Director of the Bureau of Private Schools or his duly authorized representative; Chairman of the Board of Medical Examiners or his duly authorized representatives Representative of the Philippine Medical Association; Dean of the College of Medicine, University of the Philippines; Representative of the Council of Deans of Philippine Medical Schools; Representative of the Association of Philippine Medical Colleges, as members.
Functions 1. To determine and prescribe minimum requirements for admission into a recognized college of medicine. 2. To determine and prescribe requirements for minimum physical facilities of colleges of medicine, to wit: buildings, including hospitals, equipment and supplies, apparatus, instruments, appliances, laboratories, bed capacity for instruction purposes, operating and delivery rooms, facilities for out-patient services, and others, used for didactic and practical instructions in accordance with modern trends; 3. To determine and prescribe the minimum number and minimum qualifications of teaching personnel, including student-teachers ratio; 4. To determine and prescribe the minimum required curriculum leading to the degree of Doctor of Medicine; 5. To authorize the implementation of experimental medical curriculum in a medical
Transcribers:GONZAGAs, MONTEMAYOR
school that has exceptional faculty and instrumental facilities. Such an experimental curriculum may prescribe admission and graduation requirements other than those prescribed in this Act; provided that only exceptional students shall be enrolled in the experimental curriculum. eg. INTARMED ng UP-PGH: This is advantageous for those people who are already sure of their plans in life and the profession they truly want to be in. Those taking regular bachelor’s degree and then proceed to medical school, have at least 2 years to grow and think of their career paths. 6. To accept applications for certification for admission to a medical schooland keep a register of those issued said certificate; and to collect from said applicants the amount of twenty-five pesos each which shall accrue to the operating fund of the Board of Medical Education; 7. To select, determine and approve hospitals or some departments of the hospitals for training which comply with the minimum specific physical facilities as provided in subparagraph, hereof; and 8. To promulgate and prescribe and enforce the necessary and regulations for the proper implementation of the foregoing functions. The Board of Medical Examiners Composition 6 members nominated by Philippine Medical Association and to be appointed by the President Qualifications Of The Examiners 1. A natural-born citizen of the Philippines, 2. A duly registered physician in the Philippines 3. Has been in the practice of medicine for at least ten years, 4. Is of good moral character and of recognized standing in the medical profession, 5. Is not a member of the faculty of any medical school and has no pecuniary interest, directly or indirectly, in any college of medicine or in any institution where any branch of medicine is taught, at the time of his appointment; Provided, That of the six members to be appointed, not more than two shall be graduates of the same institution and not more than three shall be government physicians. Pecuniary interest – means monetary/financial interest Once appointed to become part of Board of Medical Examiners, one must resign to his current position to prevent any conflict of interest. Functions 1. Promulgate such rules and regulations for proper conduct the examinations, 2. Formulate/ make the questions for the board examinations but each examiner shall handle the examinations in no more than four subjects 3. Correction of examination papers, 4. Registration of physicians 5. Delibrate and approve of the grades of the examinees 6. Submit to the president of the Philippines for approval the names of the successful candidates as having been duly qualified for licensure in alphabetical order. 7. Conduct administrativeinvestigations REGISTRATION OF PHYSICIANS SEC. 10 – ACTS CONSTITUTING PRACTICE OF MEDICINE a) Physically examine any person, and diagnose, treat, operate or prescribe any remedy for human disease, injury, deformity, physical, mental, psychical
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Legal Medicine & Medical Jurisprudence condition or any ailment, real or imaginary, regardless of the nature of the remedy or treatment administered, prescribed or recommended. b) Who shall by means of signs, cards, advertisements, written or printed matter, or through the radio, television or any other means of communication, either offer or undertake by any means or method to diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental or psychical condition o Advertising yourself as a physician. Ex. Billboard or considered practicing medicine. Tarpaulin in your house “Nagtutuli po ako. You ara already considered practicing medicine. c) Who shall falsely use the title M.D. after his name. SEC. 8, R.A. 2382 (as amended) Who may practice medicine? 1. At least 21 years old 2. Passed the Board Examination 3. Holder of a valid Certificate of Registration issued by the Board of Medical Examiners Passing the board exam does not automatically give you the Certificate of Registration. You may pass the board exam but the Board of Medical Examiners may choose not to issue you the certificate of registration (e.g. incomplete requirements) PRC vs De Guzman (GR No. 144681, June 21, 2004) o 79 successful examinees from Fatima College (Feb 1993) Biochem – 11 got 100%, 11 99% OB-Gyne – 10 100%, 21 99% PRC withheld registration of Fatima examinees (July 1993, Board Resolution No. 26) SC – Mandamus will not lie, mandamus is available only if there is legal duty not involving discretion. “Writ of Mandamus – Fatima insists that they are entitle to be given a certification, but the Board of Medical Examiners think otherwise because the results were doubtful. to be granted the privilege to practice medicine, the applicant must show that he possesses all the qualifications and none of the disqualifications. . . . fully complied with all the conditions and requirements by the law and the licensing authority. Should doubt taint or mar the compliance as being less than satisfactory, then the privilege will not issue. Who may take the Board Examinations? Candidates for board examination: 1.Citizen of the Philippines or of a country whose laws permit Filipino citizens to practice medicine. o For foreigners who want to take the Philippine Medical Board exams, they must first prove that Filipinos are also permitted and not prohibited from practicing in their countries. o Note that the absence of practicing Filipinos in their respective countries does not necessarily equate to a prohibition. This is an illogical argument. 2.Of good moral character 3.Of sound mind 4.Has not been convicted of a crime involving moral turpitude o When we say ‘convicted’ the person must have been convicted by a court of competent jurisdiction. Final conviction po ito, and there must be no remaining avenues for appeal. When does this occur? When the Supreme Court gives you the verdict of guilty. Meaning you have exhausted all your appeals. This is equivalent to conviction by final judgment.
Transcribers:GONZAGAs, MONTEMAYOR
Agreeing to a pardon. Implicit to agreeing to a pardon is admittance of guilt, meaning you are accepting that you have indeed committed the crime. This is tantamount to conviction by final judgment, even if your case did not reach the Supreme Court. Parole:Pinalabasngmaaga for good behavior. Pardon: You’re guilty but the government forgives you. As long as you are still appealing your case, you still are NOT convicted by final judgment. Crimes involving moral turpitude are crimes which speak of moral depravity (def: moral corruption), lack of ethics. Examples: Rape, Murder, Adultery, Estafa 5.The holder of the degree of Doctor of Medicine or equivalent, conferred by a college of medicine duly recognized by the Department of Education 6.Completed Postgraduate internship THE MEDICAL ACT OF 1959 ARTICLE III SEC 11 – EXEMPTIONS FOR SECTION 10 Who are exempt from violating the medical act by practicing acts constituting the practice of medicine? (i.e. examining, treating pts etc) 1. Medical student o duly enrolled in an approved medical college or school under training, serving without any professional fee, under the direct supervision and control of a registered physician o for as long as you do these acts under the supervision of a licensed physician. It doesn’t mean that they have to present all the time. We are talking about nominal supervision (eg. yung sumasama sa mga medical missions) 2. Legally registered dentist o engaged exclusively in the practice of dentistry; 3. Registered masseur or physiotherapist o upon written order or prescription of a duly registered physician, or limited to physical or muscular development o e.g. Physical therapists as long as they have a prescription from a rehab physician) 4. Duly registered optometrist 5. A person who gratuitously renders service in an emergency 6. A person who administers or recommends household remedies o Over the counter meds 7. A clinical psychologist or mental hygienist o provided such performance is done in conjunction with a duly registered physician. 8. Prosthetist THE MEDICAL ACT OF 1959 ARTICLE III SEC 12 – LIMITED PRACTICE WITHOUT ANY CERTIFICATE OF REGISTRATION 1. Physicians from other countries called in for consultation on specific and definite case or attached to international organizations. o Visiting foreign doctors for medical missions must secure a temporary license from PRC. o International org e.g. WHO, Red Cross physicians 2. Commissioned medical officers of the US Armed Forces o E.g. US Doctors from Balikatan exercises 3. Foreign Physicians employed as exchange professors 4. Medical students who have completed first 4 years of medical school, graduates of medicine or RNs during epidemics or national emergencies.
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Legal Medicine & Medical Jurisprudence WHAT REGULATES MEDICAL JURISPRUDENCE 1. Hippocratic Oath 2. Code of Ethics CODE OF ETHICS There are two Codes of Ethics available: 1. Board of Medicine – Code of Ethics 2. Code of Ethics of the Medical Profession by the Philippine Medical Association HIPPOCRATIC OATH I SWEAR by Apollo the physician and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation-- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities ifrequired; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.
PATIENT’S RIGHTS Patients should receive treatment consistent with the dignity and respect they are owed as human beings. Most basic tenet! 1. Equitable access to quality medical care 2. Ensuring patients’ privacy and the confidentiality of their medical information 3. Informing patients and obtaining their consent before employing a medical intervention 4. Providing a safe clinical environment 5. The right to receive information from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives (Informed consent) 6. The right to make decisions regarding the health care that is recommended by the physician 7. The right to courtesy, respect, dignity, responsiveness, and timely attention to health needs 8. The right to confidentiality 9. The right to continuity of health care 10. The basic right to have adequate health care KINDS OF MEDICAL FEES 1. Simple Contractual Fee o Specifically stating the value of such medical service, either orally or in writing 2. Retainer fee o Measured by the space of time rendered by patient 3. Contingent fee o Depends upon instituted
the
failure
of
the
treatment
4. Dichotomous fee (fee splitting) o The physician may require the services of a person who may act as agent to solicit patients, and the agent will share in the medical fee. 5. Straight Fee o For the amount tendered by the patient to the physician, the latter shall be responsible for the payment of hospital bill, lab fees, medicines, and other incidental expenses o This kind of fee is unethical because the amount wagers with the unforeseeable contingencies.
THE MODERN HIPPOCRATIC OATH (1910) You do solemnly swear, each by whatever he or she holds most sacred: o That you will be loyal to the Profession of Medicine and just and generous to its members. o That you will lead your lives and practice your art in uprightness and honor. o That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice. o That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggests it. o That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret. o These things do you swear. Let each bow the head in sign of acquiescence. And now, if you will be true to this, your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves forsworn.
Transcribers:GONZAGAs, MONTEMAYOR
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