RA 8344 & emergency & hospital

You can find many stories and reports on the Internet that hospitals and doctors ask for an advanced payment or deposit before helping a patient. There are also stories of patients dying on the sidewalk in front of a hospital because of this behavior. Here comes RA 8344 to help.

For westerners and others coming from more developed countries this scenario is unthinkable. Hospitals and especially doctors and nurses have taken the Hippocratic Oath to do whatever they can to help people in medical need.

For decades, and still today, many Philippine hospitals are private institutions; and act more as a business than a hospital. The more money they make the better. There is nothing wrong with making money, but the moment money comes before a patient, that is not good.

Let us all hope you will never need this information, but it is good to know that there is a clear law about this issue.

RA 8344

Not so many people are aware of the Republic Act 8344 (RA 8344), in which is stated that it is not allowed for hospitals and their staff or a physician to ask for advance payment or a deposit in life threatening or severe situations. Read the whole text of the RA 8344.

Only a few months ago a hospital in Mindanao get in trouble with this RA 8344. Read the story in the Gold Star Daily, a leading newspaper in Mindanao Hospital in hot water over ‘deposit policy’ from August 18, 2014.

So in short: All hospital staff in Emergency departments, physicians and nurses, but also finance staff should know about RA 8344 and its rules. (When you are a member of PhilHealth it is much easier. PhilHealth is a Health care insurer owned by the Philippine government and is funded to help people who do not have sufficient funds for better health care. But always carry the membership card with you, you never know… )

emergency RA 8344In other words:

No deposit required

In emergency or serious cases, it is unlawful for any proprietor, president, director, manager or any other officer, and/or medical practitioner or employee of a hospital or medical clinic:

To request, solicit, demand or accept any deposit or any other form of advance payment as a prerequisite for confinement or medical treatment of a patient in such hospital or medical clinic, or to refuse to administer medical treatment and support as dictated by good practice of medicine to prevent death or permanent disability.

When patient transfer is allowed

However, by reason of inadequacy of the medical capabilities of the hospital or medical clinic, the attending physician may transfer the patient to a facility where the appropriate care can be given, after the patient or his next of kin consents to said transfer and after the receiving hospital or medical clinic agrees to the transfer. And when such patient is unconscious, incapable of giving consent and/or unaccompanied, the physician can transfer the patient even without his consent, provided that such transfer shall be done only after necessary emergency treatment and support have been administered to stabilize the patient and after it has been established that such transfer entails less risks than the patient’s continued confinement.

And no hospital or clinic, after being informed of the medical indications for such transfer, shall refuse to receive the patient nor demand from the patient or his next of kin any deposit or advance payment.

After the hospital or medical clinic mentioned above shall have administered medical treatment and support, it may cause the transfer of the patient to an appropriate hospital consistent with the needs of the patient, preferably to a government hospital, especially in the case of poor or indigent.

The transferring and receiving hospital, shall be as much as practicable, be within a 10 kilometer radius of each other. The transfer shall always be properly documented.

Hospitals may require a deposit or advanced payment when the patient is no longer under the state of emergency and he/she refuses to be transferred.

Additional requirements

A copy of the law and the implementing rules and regulations should be displayed prominently at hospital emergency rooms, hospital admission, counters and medical clinic premises.

Hospital and clinic managers should instruct their personnel to provide prompt and immediate medical attention to emergency and serious cases without any prior requirements for payment or deposit.

Hospital and clinic managers should establish billing and collection procedure for treatment or confinement of emergency and serious cases which shall not commence until the essential appropriate treatment of such cases has been completed.

Consequences

The official, medical practitioner or employee of the hospital or medical clinic shall be punished by imprisonment from 6 months and 1 day up to 2 years and 4 months, or a fine between P20,000.00 and P100,000.00 or both, at the court’s discretion.

If the 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 shall be punished by imprisonment of 4 to 6 years, or a fine between P100,000.00 and P500,000.00 or both, at the court’s discretion.

At the instance of the Bureau of Licensing and Regulation, administrative proceedings may also be pursued against erring clinics or hospitals that could lead to either suspension or revocation of appropriate licenses.

Hospitals may be founded for profit but their core business at all times require them to give priority to the health and well being of their customers ahead of monetary gain. It is about time, they follow this law and that people should be fully aware of it.

HOSPITAL CODE OF ETHICS

From Philippine Hospital Association

http://www.pha.ph/code_of_ethics.php

Introduction

To promote public welfare primarily and secondly, to guide governing bodies, hospital administrators, professional and non-professional staff members and others who constitute the “hospital family”, ethical and administrative principles are herewith established for the Philippine Hospital System. By the sincere and voluntary commitment to those principles, the hospital is better able to perform the functions in a manner that will deserve and receive the patronage and support of the community it serves. It is not always possible to clearly distinguish between ethical principles which apply basically to conduct, and administrative principles which refer to the means by which ethical principles may be carried out. Both are important to the proper and acceptable operation of the hospital. For the purpose of this concern, “Ethics” is defines as “standards of conduct normally established as a moral guide for human behavior” and “principles” are universally applicable beliefs that may be developed to guide the conduct of both individuals and institution.

I. Ethical and Administrative Principles for Hospitals

Objectives of the Hospital:

1. The Primary objective of the hospital are the following:

1.2 To provide the best possible facilities for the care of the sick and injured at all times;

1.3 To constantly upgrade and improve methods for the care, the cure, amelioration and prevention of disease; and

1.4 To promote the practice of medicine by Physicians within the institution consistent with the acceptable quality of patient care.

These objectives require an efficient organization, a competent administrator, a qualified medical staff, other well-trained personnel and adequate physical facilities with all of which services are made available at all times consistent with community needs.

2. The hospital should have the following secondary objectives:

2.1 To encourage research and teaching and to assist in the advancement of scientific knowledge.

2.2 To set an example of ethical practice, cooperate with other hospitals and take an active part in the promotion of health;

2.3 To provide kind and considerate care for all patients and must always provide needed emergency treatment. The hospital has a moral responsibility to make every effort to ensure full and complete recovery of its patients because of which the hospitals’ interest and activities require an extension beyond its walls.

1.1.1 To cooperate with recognized hospital associations and agencies and to develop cooperative action with other hospitals within the country.

II. Hospital Ethics

1. Hospital must recognize that the care of the sick is their first responsibility and a sacred trust, striving, at all times, to provide the best possible care and treatment to all in need of hospitalization.

2. Hospitals, recognizing their unique role in safeguarding the nation’s health, should seek through compassionate and scientific care and health education, to extend life, alleviate suffering, and improve the general health of the communities they serve.3. Hospitals should remain and promote harmonious relationships within the organization, to insure the proper environment for effective, efficient and equitable care and treatment of patients.

4. Hospitals should seek to inspire the confidence of the entire community and should appreciate and respect the social and religious practices and customs of patients.

5. Hospitals, to the extent possible and within their limitations, should conduct educational projects, stimulate research, and encourage preventive health practices in the community.

6. Hospitals should cooperate with other hospitals, health and welfare agencies, government and non-government, and other recognized organizations engaged in activities related to the health of the country.

7. Hospitals, in reporting their work to the public, should give a factual and objective interpretation of accomplishments and objectives without putting down directly or indirectly by implication, the work of other hospitals or related organizations.

8. Hospital, cognizant of their social responsibilities, should actively support and encourage every effective means which will ease the financial burdens of illness.

9. Hospital should be fair, honest and impartial in all their business relationships and utilize legal and legitimate means in promoting their public relations.

10. Hospitals should be progressive in policies, personnel policies, and effort to maintain up-to-date equipment, methods and standards of performance.

Formulated through the collaboration of the Philippine Hospital Association (PHA) & the Philippine College of Hospital Administrators (PCHA).

INTERNATIONAL CODE OF MEDICAL ETHICS

DUTIES OF DOCTORS IN GENERAL

A DOCTOR MUST always maintain the highest standard of professional conduct.

A DOCTOR MUST NOT allow himself to be influenced merely by motives of profit.

THE FOLLOWING PRACTICES are deemed unethical: a) Any self advertisement except such as expressly authorized by the national code of medical ethics. b) Taking part in any plan of medical care in which the doctor does not have professional independence. c) To receive any money in connection with services rendered to a patient other than the acceptance of a proper professional fee, or to pay any money in the same circumstances without the knowledge of the patient.

UNDER NO CIRCUMSTANCESis a doctor permitted to do anything that would weaken the physical or mental resistance of a human being, except from strictly therapeutic or prophylactic indications imposed in the interest of the patient.

A DOCTOR IS ADVISED to use great caution in publishing discoveries. The same applies to methods of treatment whose value is not recognized by the profession.

WHEN A DOCTOR IS CALLED UPON to give evidence or a certificate he should only state that which he can verify.

DUTIES OF DOCTORS TO THE SICK

A DOCTOR MUST always bear in mind the importance of preserving human life from the time of conception until death.

A DOCTOR OWES to his patient complete loyalty and all the resources of his science. Whenever an examination or treatment is beyond his capacity he should summon another doctor who has the necessary ability.

A DOCTOR OWES to his patient absolutely secrecy on all which has been confided to him or which he knows because of the confidence entrusted to him.

A DOCTOR MUST GIVE the necessary treatment in emergency, unless he is assured that it can and will be given by others.

Duties of Doctors to each other

A DOCTOR OUGHT to behave to his colleagues as he would have them behave to him.

A DOCTOR MUST NOT entice patients from his colleagues.

A DOCTOR MUST OBSERVE the principles of “The Declaration of Geneva” approved by The World Medical Association. Declaration of Geneva Adopted by the General Assembly of the World Medical Association at Geneva, Switzerland, September, 1948

AT THE TIME OF BEING ADMITTED AS MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE myself to consecrate my life to the service of humanity.

I WILL GIVE to my teachers the respect and gratitude which is their due;

I WILL PRACTICE my profession with conscience and dignity;

THE HEALTH OF MY PATIENT will be first consideration;

I WILL RESPECT the secrets which are confided in me;

I WILL MAINTAIN by all the means in my power, the honor and the noble traditions of the medical profession;

I WILL NOT PERMIT considerations of religion, nationality, race, party, politics or social standing to intervenes between my duty and my patient.

I WILL MAINTAIN the utmost respect for human life, from the time of conception; even the threat, I will not use my medical knowledge contrary to the laws of humanity.

I MAKE THESE PROMISES solemnly, freely and upon my honor.

HEALTHCARE EXECUTIVES SOCIETY OF THE PHILIPPINES CODE OF ETHICS

I. RESPONSIBILITY TO THE PROFESSION OF HEALTHCARE MANAGEMENT

The member shall:

Conduct professional activities with honesty, integrity, respect, fairness and good faith in a manner that will reflect well upon the profession;

Comply with all laws and regulations pertaining to healthcare management in which the healthcare executive governs or conducts professional activities;

Maintain competence and proficiency in healthcare management by implementing quality assessment guidelines and continuing professional education to improve knowledge in healthcare management;

Avoid undue exploitation of professional relationships for personal gain;

Disclose financial and other related conflicts of interest;

Use this Code to further the interests of the profession and not for personal reasons;

Respect professional competencies;

Enhance the dignity and image of the healthcare management profession through public information programs thru education; and

Refrain from participating in any activity that may question the credibility and dignity of the healthcare management profession.

II. RESPONSIBILITY TO PATIENTS OR OTHERS SERVED

The member shall, within the scope of his or her authority:

Implement and ensure the existence of a process to assess the quality of care or service rendered;

Avoid practice of discrimination and institute the necessary safeguards to prevent discriminatory practices;

To ensure that a process exist that will advise patients or others of their rights, opportunities, responsibilities and risks regarding available healthcare services;

To ensure that there is a process that will govern the resolution of conflicts that may arise when values and cultural diversities of patients and their families differ from those of employees and physicians;

Implement zero tolerance for any abuse of power that compromises the different stakeholders of the organization such as patients, physicians, associates;

To provide a system that ensures and process the autonomy and self-determination of patients or others served; and

To ensure that the confidentiality and privacy of patients or others served are protected.

III. RESPONSIBILITY TO THE ORGANIZATION

The member shall, within the scope of his or her authority:

Provide quality healthcare services consistent with available resources and work to ensure the existence of a resource allocation process that considers ethical implications;

Implement collaborative programs in ways that improve community healthcare services;

Lead the organization in the use of acceptable and ethical standards of management and sound business practices;

Respect the cultural diversity and practices of patients or others served, consistent with the organization’s philosophy;

Be truthful in all forms of professional and organizational communication, and avoid disseminating false and misleading information

Create an organizational environment in which both clinical and management mistakes are minimized and, when they do occur, are discussed, disclosed and addressed immediately; and

Establish an ethics compliance monitoring team.

IV. RESPONSIBILITY TO EMPLOYEES

Members have ethical and professional obligations to the employees they govern:

Establish an environment that promotes ethical conduct by employees;

Create a work environment that provides an avenue to discuss and address ethical concerns and provides mechanisms for resolving such concerns;

Providing a work environment that discourages harassment and coercion of any kind to perform illegal or unethical acts; and discrimination on the basis of cultural differences, ethnicity, religion, gender, sexual orientation, age, or disability;

Providing a work environment that promotes empowerment and the proper use of employees’ knowledge and skills;

Providing a work environment where employees can make a difference; and

Create grievance, inquiry and appeals mechanisms.

V. RESPONSIBILITY TO COMMUNITY AND SOCIETY

The member shall:

Identify and meet the healthcare needs of the community it serve;

Support access to quality healthcare services;

Knowledgeable on healthcare policy issues, and promote advocacy programs that will improve health status and promote quality healthcare; and

Implement short- and long-term assessments to management decisions affecting both community and society.