2.2 medical jurisprudence.pdf

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Transcribers:GONZAGAs, MONTEMAYOR Page 1of 4

August 28, 2015Atty. Malaya Capulong, MD, LIB

2.2Legal Medicine & Medical Jurisprudence

Legal Medicine

Primarily concerned with legal rights andresponsibilities of medical practitioners withparticular reference to those arising from the doctor-patient relationship.

Includes:oLicensure and regulatory lawso

Physicianpatient-hospital together with the otherparamedical personnel, their rights, duties andobligations

oLiabilities 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 theplaintiff.

US law firms practices contingency basis wherethey will shoulder first all the expenses so thatcase can push through.

To explain the purpose and procedure of certainlegislation To study the need to amend, repeal our health care

laws in harmony with the recent scientific and socialdevelopment.

Law and Practice of the Medicine

The State must maintain high standard of practice bysetting up rules and regulations with regards toqualifications and procedure for the admission to theprofession.

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 withpersonal liberty or property in order to promote thegeneral welfare or the common good

Examples: Who can buy real estate in thePhilippines and Who can be granted visa

oTABLARIN vs GUTIERREZ(GR No. 78764, July 31,1987)

oRA 2382 Board of Medical Educaiton

Sec. 5 (a) to determine and prescribe

requirements for admission into a recognizedcollege of medicine

Sec. 7 Admission requirements

(b) a certificate of eligibility for entrance to a

medical school from the Board of MedicalEducation

oMECS Order No. 52, s. 1985 established auniform admission test called NMAT

Before 1985 there was no NMAT; there was noset passing rate; there was very many applicantsin 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 ofprotecting the health and safety of the public.That the power to regulate and control the practice ofmedicine 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 fromthe potential deadly effects of incompetence andignorancein those who would undertake to treat ourbodies and mindo

DECS vs San Diego (GR No. 89572, Dec. 21,1989) Roberto Rey San Diego, BS Zoologygraduate, took the NMAT 4 times, application for5thattempt was rejected

It is the right and responsibility of the State to ensurethat the medical profession is not infiltrated byincompetentsto 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 adoctor.

The right to quality education is not absolute . . . onemust show that he is entitled to it because of hispreparation and promise.

Practice of Medicine

It is a privilege or franchise granted by the State toany person to perform medical acts upon.

It is diagnosing and applying and the usage ofmedicine and drugs for curing, mitigating, or relievingbodily disease or conditions.

Physician

Is a person who after completing his secondaryeducation follows a prescribed course of medicineat a recognized university or medical school, atthe successful completion of which, is legally licensedto practice medicine by the responsible authoritiesand is capable of undertaking the prevention,diagnosis, and treatment of human illness by theexercising independent judgment and withoutsupervision(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 ableto practice medicine

Prescribes the composition of the Board ofMedical Education and the Board of MedicalExaminers, their functions, duties andobligations.

OUTLINEI. Medical Jurisprudence

A. Purposes

II. Law and Practice of the Medicine

III.

Practice of MedicineA. Physician

IV. RA 2382 (as amended) The Medical Act of 1959)A.

Board of Medical Education under the Department ofEducation- Composition- Functions

B. The Board of Medical Examiners- Composition- Qualifications Of The Examiners- Functions

V. Registration Of PhysiciansA. Sec. 10 Acts constituting practice of medicineB. SEC. 8, R.A. 2382 (as amended)

- Who may practice medicine?- Who may take the board examinations?


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Legal Medicine & Medical Jurisprudence


o

Note that that the Board of MedicalEducation and Board of MedicalExaminers are two different bodies.Some overlaps may exist but theirfunctions are completely different.

OBJECTIVES

a. The standardization and regulation of medicaleducationb. The examination for registration of physicians

c. The supervision, control and regulation of thepractice of medicine in the Philippines

AGENCIES

1. Board of Medical Education under theDepartment of Education2. Board of Medical Examiners under theCommissioner of Civil Service

BOARD OF MEDICAL EDUCATION VS. BOARDOF MEDICAL EXAMINERS

Board of MedicalEducation

Board of MedicalExaminers

The primary duty ofis to prescribe thecurriculum of

medical schools. Somore of the schoolitself.

The content of theboard exams areprescribed by the

Board of MedicalExaminers. Theyalso decide onmalpractice casesbrought before thePRC.

Board of Medical Education under theDepartment of Education

Composition

1.

Secretary of Education or his duly authorizedrepresentative, as chairman;

2. Secretary of Health or his duly authorizedrepresentative;

3. Director of the Bureau of Private Schoolsor hisduly authorized representative;

4. Chairman of the Board of Medical Examinersorhis duly authorized representatives

5.

Representative of the Philippine MedicalAssociation;

6.

Dean of the College of Medicine, University of

the Philippines;7.

Representative of the Council of Deans ofPhilippine Medical Schools;

8.

Representative of the Association of PhilippineMedical Colleges, as members.

Functions

1. To determine and prescribe minimumrequirements for admission into a recognizedcollege of medicine.

2. To determine and prescribe requirements forminimum physical facilities of colleges ofmedicine, to wit: buildings, including hospitals,equipment and supplies, apparatus, instruments,appliances, laboratories, bed capacity for instructionpurposes, operating and delivery rooms, facilities forout-patient services, and others, used for didacticand practical instructions in accordance with moderntrends;

3. To determine and prescribe the minimum numberand minimum qualifications of teachingpersonnel, including student-teachers ratio;

4. To determine and prescribe the minimum requiredcurriculum leading to the degree of Doctor ofMedicine;

5.

To authorize the implementation ofexperimental medical curriculum in a medical

school that has exceptional faculty and instrumentalfacilities. Such an experimental curriculum mayprescribe admission and graduation requirementsother than those prescribed in this Act; provided thatonly exceptional students shall be enrolled in the

experimental curriculum.eg. INTARMED ng UP-PGH: This is advantageous forthose people who are already sure of their plans inlife and the profession they truly want to be in.

Those taking regular bachelors degree and thenproceed to medical school, have at least 2 years togrow and think of their career paths.

6. To accept applications for certification foradmission to a medical schooland keep a registerof those issued said certificate; and to collect fromsaid applicants the amount of twenty-five pesos eachwhich shall accrue to the operating fund of the Boardof Medical Education;

7. To select, determine and approve hospitals orsome departments of the hospitals for trainingwhich comply with the minimum specific physicalfacilities as provided in subparagraph, hereof; and

8.

To promulgate and prescribe and enforce the

necessary and regulations for the properimplementation of the foregoing functions.

The Board of Medical Examiners

Composition

6 members nominated by Philippine MedicalAssociation and to be appointed by the President

Qualifications Of The Examiners

1. A natural-born citizen of the Philippines,2.

A duly registered physicianin the Philippines3. Has been in the practiceof 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 inany institution where any branch of medicine istaught, at the time of his appointment; Provided,That of the six members to be appointed, not morethan two shall be graduates of the same institutionand not more than three shall be governmentphysicians.

Pecuniary interest means monetary/financialinterest

Once appointed to become part of Board of

Medical Examiners, one must resign to his

current position to prevent any conflict ofinterest.

Functions

1. Promulgate such rules and regulations for properconductthe examinations,

2. Formulate/ make the questions for the boardexaminationsbut each examiner shall handlethe

examinations in no more than four subjects3.

Correction of examination papers,4. Registration of physicians5.

Delibrate and approve of the grades of theexaminees

6.

Submit to the president of the Philippines for

approval the names of the successful candidates

as having been duly qualified for licensure inalphabetical order.

7. Conduct administrativeinvestigations

REGISTRATION OF PHYSICIANS

SEC. 10 ACTS CONSTITUTING PRACTICE OFMEDICINE

a) Physically examine any person, and diagnose,treat, operate or prescribe any remedyfor human

disease, injury, deformity, physical, mental, psychical


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condition or any ailment, real or imaginary, regardlessof the nature of the remedy or treatmentadministered, 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, eitheroffer or undertake by any means or method todiagnose, treat, operate or prescribe any remedy forany human disease, injury, deformity, physical, mental

or psychical conditionoAdvertising yourself as a physician.

Ex. Billboard or considered practicing medicine.

Tarpaulin in your house Nagtutuli po ako. You araalready 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 old2. Passed the Board Examination3. 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 maypass the board exam but the Board of MedicalExaminers may choose not to issue you thecertificate of registration (e.g. incompleterequirements)

PRC vs De Guzman (GR No. 144681, June 21, 2004)o

79 successful examinees from Fatima College (Feb1993)

Biochem 11 got 100%, 11 99% OB-Gyne 10 100%, 21 99%

PRC withheld registration of Fatima examinees (July1993, Board Resolution No. 26)

SC Mandamus will not lie, mandamus is availableonly if there is legal duty not involving discretion.

Writ of Mandamus Fatima insists that theyare entitle to be given a certification, but theBoard of Medical Examiners think otherwisebecause the results were doubtful.

to be granted the privilege to practice medicine, theapplicant must show that he possesses all thequalifications and none of the disqualifications.

. . . fully complied with all the conditions andrequirements by the lawand the licensing authority.Should doubt taint or mar the complianceas beingless than satisfactory, then the privilege will notissue.

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.oFor foreigners who want to take the Philippine

Medical Board exams, they must first prove thatFilipinos are also permitted and not prohibited frompracticing in their countries.

oNote that the absence of practicing Filipinos intheir respective countries does not necessarily

equate to a prohibition. This is an illogicalargument.

2.Of good moral character3.Of sound mind4.Has not been convicted of a crime involving

moral turpitudeo

When we say convicted the person must havebeen convicted by a court of competentjurisdiction. Final conviction po ito, and there mustbe no remaining avenues for appeal. When doesthis occur? When the Supreme Court gives you the verdict

of guilty. Meaning you have exhausted all your

appeals. This is equivalent to conviction by finaljudgment.

Agreeing to a pardon. Implicit to agreeing to apardon is admittance of guilt, meaning you areaccepting that you have indeed committed thecrime. This is tantamount to conviction by finaljudgment, even if your case did not reach the

Supreme Court. Parole:Pinalabasngmaaga for good behavior. Pardon: Youre guilty but the governmentforgives you.

As long as you are still appealing your case, youstill are NOT convicted by final judgment.

Crimes involving moral turpitude are crimes

which speak of moral depravity (def: moralcorruption), lack of ethics. Examples: Rape,Murder, Adultery, Estafa

5.The holder of the degree of Doctor of Medicine orequivalent, conferred by a college of medicine dulyrecognized by the Department of Education

6.Completed Postgraduate internship

THE MEDICAL ACT OF 1959ARTICLE III

SEC 11 EXEMPTIONS FOR SECTION 10

Who are exempt from violating the medical act bypracticing acts constituting the practice ofmedicine? (i.e. examining, treating pts etc)1. Medical studento

duly enrolled in an approved medical college orschool under training, serving without anyprofessional fee, under the direct supervision and

control of a registered physiciano

for as long as you do these acts under thesupervision of a licensed physician. It doesnt meanthat they have to present all the time. We are talkingabout nominal supervision (eg. yung sumasama samga medical missions)

2. Legally registered dentisto

engaged exclusively in the practice of dentistry;3. Registered masseur or physiotherapistoupon written order or prescription of a duly

registered physician, or limited to physical ormuscular development

o

e.g. Physical therapists as long as they have aprescription from a rehab physician)

4. Duly registered optometrist

5. A person who gratuitously renders service in anemergency6. A person who administers or recommendshousehold remedies

o

Over the counter meds

7. A clinical psychologist or mental hygienisto

provided such performance is done in conjunctionwith a duly registered physician.

8. Prosthetist

THE MEDICAL ACT OF 1959ARTICLE III

SEC 12 LIMITED PRACTICE WITHOUT ANYCERTIFICATE OF REGISTRATION

1. Physicians from other countries called in forconsultation on specific and definite case or attached tointernational organizations.oVisiting foreign doctors for medical missions must

secure a temporary license from PRC.o

International org e.g. WHO, Red Cross physicians2. Commissioned medical officers of the US ArmedForces

o

E.g. US Doctors from Balikatan exercises

3. Foreign Physicians employed as exchange professors

4. Medical students who have completed first 4 years ofmedical school, graduates of medicine or RNs duringepidemics or national emergencies.


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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 thePhilippine Medical Association

HIPPOCRATIC OATH

I SWEAR by Apollo the physician and Aesculapius, andHealth, and All-heal, and all the gods and goddesses,that, according to my ability and judgment, I will keepthis Oath and this stipulation-- to reckon him who taughtme this Art equally dear to me as my parents, to sharemy substance with him, and relieve his necessitiesifrequired; to look upon his offspring in the same footingas my own brothers, and to teach them this art, if theyshall wish to learn it, without fee or stipulation; and thatby precept, lecture, and every other mode of instruction,I will impart a knowledge of the Art to my own sons, andthose 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 tomy ability and judgment, I consider for the benefit of mypatients, and abstain from whatever is deleterious andmischievous. I will give no deadly medicine to any one ifasked, nor suggest any such counsel; and in like mannerI will not give to a woman a pessary to produce abortion.With purity and with holiness I will pass my life andpractice my Art. I will not cut persons labouring underthe stone, but will leave this to be done by men who arepractitioners 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 andcorruption; and, further, from the seduction of femalesor males, of freemen and slaves.

Whatever, in connection with my professional service, ornot in connection with it, I see or hear, in the life ofmen, which ought not to be spoken of abroad, I will notdivulge, as reckoning that all such should be kept secret.

While I continue to keep this Oath unviolated, may it begranted to me to enjoy life and the practice of the art,respected by all men, in all times. But should I trespassand violate this Oath, may the reverse be my lot.

THE MODERN HIPPOCRATIC OATH (1910)

You do solemnly swear, each by whatever he or sheholds most sacred:o

That you will be loyal to the Profession of Medicineand just and generous to its members.

o

That you will lead your lives and practice your art inuprightness and honor.

o

That into whatsoever house you shall enter, it shallbe for the good of the sick to the utmost of yourpower, 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 ofyour patients, and will give no drug, perform nooperation, for a criminal purpose, even if solicited,far less suggests it.

oThat whatsoever you shall see or hear of the lives ofmen or women which is not fitting to be spoken, youwill keep inviolably secret.

o

These things do you swear. Let each bow the head insign of acquiescence. And now, if you will be true tothis, your oath, may prosperity and good repute beever yours; the opposite, if you shall proveyourselves forsworn.

PATIENTS RIGHTS

Patients should receive treatment consistent with thedignity 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 oftheir medical information

3. Informing patients and obtaining their consentbefore employing a medical intervention

4. Providing a safe clinical environment5. The right to receive information from physicians and

to discuss the benefits, risks, and costs ofappropriate treatment alternatives (Informedconsent)

6. The right to make decisions regarding the healthcare 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

oDepends upon the failure of the treatmentinstituted

4. Dichotomous fee (fee splitting)

o

The physician may require the services of a person

who may act as agent to solicit patients, and theagent will share in the medical fee.

5. Straight Fee

oFor the amount tendered by the patient to thephysician, the latter shall be responsible for thepayment of hospital bill, lab fees, medicines, andother incidental expenses

oThis kind of fee is unethical because the amountwagers with the unforeseeable contingencies.

2.2 medical jurisprudence.pdf

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