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Leg Med Power Point
MEDICAL
JURISPRUDENCE
deals with the aspect of law and legal
concepts in relation with the practice of
medicine
MEDICAL JURISPRUDENCE
includes:
Licensure and regulatory laws;
Physician-patient-hospital relationship
together with the other paramedical
personnel, their rights, duties and
obligations;
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;
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.
SOURCES OF LAW
Constitution
Laws enacted by the legislative body
Decrees, Orders, Proclamation, Letters, CA, BP,
RA
Administrative acts, orders, Rules and Regulation
Local customs
Generally accepted principles of International law
ADMINISTRATIVE BODIES
BOARD OF MEDICAL EDUCATION
Primarily concerned with the standardization and regulation of medical
education
PROFESSIONAL
REGULATIONS COMMISSIONS
To have general supervision and regulation of all professions requiring
examinations which includes the practice of medicine
BOARD OF MEDICINE
Its primary duties are to give examinations for the registration of physicians
and supervision, control and regulation of the practice of medicine
Composition:
Chairman - Secretary of Education
Members - Secretary of Health
Director, Bureau of Private Schools
Chairman, Board of Medicine
Representative, PMA
Council of Deans,APMC
Dean, UP-College of Medicine
Functions:
1.
To determine and prescribe the requirements for admission into a recognized
college of Medicine;
2.
To determine and prescribe requirements for the minimum physical facilities;
3.
To determine and prescribe the minimum number and qualifications of teaching
personnel;
4.
To determine and prescribe the minimum required curriculum;
5.
To authorize the implementation of experimental curriculum;
6.
To accept applications for admission to a medical school;
7.
To select, determine and approve hospitals for training;
8.
To promulgate, prescribe and enforce the necessary rules and regulations.
PROFESSIONAL REGULATIONS
COMMISSION
Composition:
Commissioner
Two Associate Commissioner
Exercise of Power and Functions of the Commission
-exercise general administrative, executive and policymaking functions for the whole agency
BOARD OF MEDICINE
Composition:
Six members appointed by the president from a
list submitted by the Executive Council of the PMA.
Qualifications:
- Natural-born citizen;
- Duly-registered physician;
- In the practice of medicine for at least 10 years;
- Of good moral character and of recognized standing in the medical
profession as certified by PMA;
- Not a member of any faculty of any medical school (including any
pecuniary interest).
3. Examination Requirements
- must have passed the corresponding Board Examination
Preliminary Examination
-At least 19 years of age;
- Of good moral character;
-Have completed the first two years of the medical course;
Final or Complete Examination
-Citizen of the Philippines or of any country who has submitted
competent and conclusive
- documentary evidence confirmed
by the DFA
showing that his countrys existing laws permit citizens
of the Philippines to practice medicine
under the same rules and
regulations governing citizens thereof (RECIPROCITY RULE).
Scope of Examination:
Physiology
Biochemistry
Pathology
Medicine
Jurisprudence
PRACTICE OF MEDICINE
What is the practice of medicine?
It is a privilege or franchise granted by the State to
any person to perform medical acts upon
compliance with law, that is, the Medical Act of
1959 as amended which has been promulgated by
the State in the exercise of police power to protect
its citizenry from unqualified practitioners of
medicine.
It is diagnosing and applying and the usage of
medicine and drugs for curing, mitigating, or
relieving bodily disease or conditions.
Exemptions
Faith Healing
-There is nothing in the Medical Act of 1959 exempting it
from the definition of the acts which constitute practice of
medicine;
-Related to constitutional guarantee to religious freedom
(freedom to believe and freedom to act in accordance with
ones belief);
-Acted in pursuance of his religious belief and with the
tenets of his church he professes, not deemed to be a
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)
Purpose
To prescribe the permanent framework of a
system of government, to assign to the
several departments their respective powers
and duties, and to establish certain first
principles on which the government is
founded. (11Am. Jur. 606)
ESSENTIAL PARTS OF A
CONSTITUTION
Constitution of Liberty
Constitution of Government
Constitution of Sovereignty
PHYSICIAN-PATIENT
RELATIONSHIP
Contract - is the meeting of minds between two
persons whereby one binds himself with respect
to the other, to give something or to render some
service(Art.1305, NCC)
Requisites of a contractual
relationship
Forms of Physician-Patient
Relationship
N.B.
- Physician-Patient relationship does not imply
STAGES OF PHYSICIAN-PATIENT
RELATIONSHIP
COMMENCEMENT
TERMINATION
It is the time when the duties and obligations by a
physician to his patient ceases. The following are
some ways of termination of the relationship:
1.Recovery of the patient or when the physician considers that his
medical services will no longer be beneficial to the patient;
2. Withdrawal of the physician provided: a) with consent of the patient,
and b) patient is given ample time and notice;
3. Discharge of the physician by the patient;
4. Death of either party;
5. Incapacity of the physician
6. Fulfillment of the obligations stipulated in the contract;
7. In emergency cases, when the physician of choice of the patient is
already available or when the condition of emergency ceases;
8. Expiration of the period as stipulated;
9. Mutual agreement for its termination.
RIGHTS OF PHYSICIAN
INHERENT RIGHTS
to choose patients
to limit practice of medicine
to determine appropriate management
procedures
to avail of hospital services
INCIDENTAL RIGHTS
right of way while responding to emergency
right of exemption from execution of instruments and
Library to hold certain public/private offices to perform certain
services to compensation right to membership in medical societies
NB: The law does not give any qualification the right of the
physician to choose his patient, however, the Code of Medical
Ethics and RA 6615 provides otherwise in cases of emergency.
Related provisions
Art II, Sec.2 Code of Ethics
Sec.1 RA 6615
field of specialty
private clinic or hospital
within a political/geographical boundary
certain days of the week/hours of the day
certain class of people
with due regard to dictate of conscience
retirement
imposed by the public, religion, professional
ethics, medical society, law, contract
RIGHT OF EXEMPTION
FROM EXECUTION OF
INSTRUMENTS AND
LIBRARY
Rule 39, Sec.12, Rules of
Court
RIGHT TO COMPENSATION
RIGHTS OF PATIENTS
1.
Right to give consent to diagnostic and
treatment procedures
2. Right to religious belief
3. Right of privacy
4. Right to disclosure of information
5. Right to confidential information
6. Right to choose his physician
7. Right of treatment
Right to refuse necessary treatments
Bases of Consent
1. The physician-patient relationship is
fiduciary in nature.
2. Patients right to self-determination.
3. Contractual relationship.
Purposes
1.To
protect
the
patient
from
unnecessary/unwarranted procedure applied
to him without knowledge
2. To protect the physician from any
consequences for failure to comply with
legal requirements
Forms of consent
1. Expressed consent written or oral
2. Implied consent may be deduced from
the conduct of the patient
Informed/Enlightened Consent
awareness and assent
full disclosure of facts and willingness of the patient to submit
NB:
- consent of minor is not valid if the procedure
will not benefit him
- expressed refusal of a minor to surgery shall not
prevail over the existing emergency
- Doctrine of parens patriae , the court may grant
consent for the minor.
RIGHT TO RELIGIOUS
BELIEF
- Art. III , Sec. 5, Philippine Constitution
RIGHT OF PRIVACY
RIGHT
OF
DISCLOSURE
OF
INFORMATION
LIABILITIES OF PHYSICIAN
ADMINISTRATIVE
CRIMINAL
CIVIL
ADMINISTRATIVE LIABILITIES
Quantum of evidence needed: substantial
evidence, such relevant evidence as a reasonable
mind might accept as adequate to support a
conclusion
Administrative Due Process:
1. Right to hearing;
2. Tribunal must consider the evidence presented;
3. Decision must have something to support itself;
4. Evidence must be substantial;
5. Decision must be based on the evidence adduced at the hearing, or at
least contained in the record and disclosed to the parties;
6.
The Board or its judges must act on its or their independent
consideration of the facts and the law of the case, and not simply accept
the views of a subordinate in arriving at a decision. (Ang Tibay vs.
CIR)
Personal Disqualifications:
1. Immoral or dishonorable conduct;
2. Insanity;
3. Gross negligence, ignorance or incompetence resulting
in an injury to or death of the patient;
4.
Addiction to alcoholic beverages or to any habitforming drug rendering him incompetent to practice
medicine.
Criminal Acts:
1. Conviction by a court of competent jurisdiction of
any criminal offense involving moral turpitude
2. Fraud in the acquisition of the certificate of
registration;
3. Performance of or aiding in any criminal abortion
4. Knowingly issuing false medical certificate;
5. Aiding or acting as dummy of an unqualified or
unregistered person to practice medicine.
Unprofessional Conduct
1. False or extravagant or unethical advertisements
wherein other things than his name, profession,
limitation of practice, clinic hours, office and home
address, are mentioned;
2. Issuing any statement or spreading any news or
rumor which is derogatory to the character and
reputation of another physician without justification;
3. Violation of any of the Code of Ethics as approved
by the PMA.
CRIMINAL LIABILITIES
A criminal act is an outraged to the sovereignty of the
State so it must be instituted in the name of the sovereign
people as party-plaintiff (People of the Philippines vs X)
CIVIL LIABILITIES
A civil suit filed against physician and/or hospitals is
premised on recovery of damages for their wrongful
act or of employees.
2. Tort(Quasi-delict )
- Legal wrongdoing independent of a contract
- Primary basis is negligence or fault of the physician as
the one directly responsible for the injury sustained by the
patient
- Ordinarily, any malpractice action is based on torts or
quasi-delict in as much as negligence is usually a ground
for injury.
MEDICAL MALPRACTICE
failure of a physician to properly perform the duty which devolves upon
him in his professional relation to his patient which results to injury.
It may be defined as bad or unskillful practice of medicine resulting to
injury of the patient or failure on the part of the physician to exercise the
degree of care, skill and diligence, as to treatment in a manner contrary to
accepted standards of medicine resulting to injury to the patient.
Elements:
1. The physician has a duty to the patient;
2. The physician failed to perform such duty to his
patient;
3. As a consequence of the failure, injury was sustained
by the patient;
4. The failure of the physician is the proximate cause of
the injury sustained by the patient.
Criminal medical malpractice, the act or omission complained of must
be punishable by law at the time of commission or omission.
Doctrine
Cause
of
Efficient
Intervening
IN
DOCTRINE OF VICARIOUS
LIABILITY
-Doctrine of Imputed Negligence/Command
Responsibility.
-Vicarious liability means the responsibility of a
person, who is not negligent, for the wrongful
conduct or negligence of another.
CAPTAIN-OF-THE-SHIP DOCTRINE
- This doctrine innunciates liability of the surgeon
not only for the wrongful acts of those who are
under his physical control but also those wherein
he has extension of control.
DOCTRINE OF CONTRIBUTORY
NEGLIGENCE
- Doctrine of Common Fault
- It has been defined as conduct on the part of the
plaintiff or injured party, contributing as a legal
cause to the harm he has suffered, which falls
below the standard which he is required to
conform to his own protection.
- It is the act or omission amounting to want of
care on the part of the complaining party which,
concurring with the defendants negligence, is the
proximate cause of the injury.
DOCTRINE OF CONTINUING
NEGLIGENCE
DOCTRINE OF ASSUMPTION OF
RISK
Predicated upon knowledge and informed
consent, anyone who voluntarily assumes
the risk of injury from a known danger, if
injured, is barred from recovery.
DOCTRINE OF
FORESEEABILITY
- A physician cannot be held accountable for
negligence if the injury sustained by the patient is
on account of unforeseen conditions but if a
physician fails to ascertain the condition of the
patient for want of the requisite skill and training
is answerable for the injury sustained by the
patient if injury resulted thereto.
- A physician owes duty of care to all persons who
are foreseeably endangered by his conduct, with
respect to the risk which make the conduct
unreasonably dangerous.
FELLOW SERVANT
DOCTRINE
- This doctrine provides that if a servant
(employee) was injured on account of the
negligence of his fellow servant
(employee), the employer cannot be held
liable.
RESCUE DOCTRINE
- If a physician who went to rescue a victim
of an accident was himself injured, the
original wrongdoer must be held liable for
such injury.
Shared responsibility
Abandonment of patients
- termination of the physician-patient
relationship without the consent of the
patient and without giving the patient
adequate notice and opportunity to find
another physician.
Elements:
1. There is a physician-patient relationship;
2. The relationship is terminated without mutual
consent of both parties;
3.
Unilateral termination of the contractual
relationship by the physician;
4.
Continuing need of the patient for further
medical treatment;
5. Abandonment must have been the cause of the
injury or death of the patient.
N.B.
Non-payment of bill cannot be a defense for abandonment.
LIABILITIES IN THE
ADMINISTRATION OF DRUGS
1.
2.
3.
4.
5.
Right drug;
Right patient;
Right dose;
Right time; and
Right route.
1. Drug reaction;
failure to note history of allergy
failure to test for signs of reaction
failure to stop treatment when the drug reaction has been
observed
failure to provide adequate therapy to encounter a reaction
treatment with a drug not proper for the illness
2. Overdosage;
3. Failure to give warning of the side effects;
4. Administering medicine on the wrong route;
5. Administration of the wrong medicine;
6. Administration of a drug on the wrong person;
7. Infection following an injection;
8. Injury to the nerves
9. Failure to administer the drug.
LIABILITIES OF HOSPITALS
N.B.
A hospital which allow the patient to pay if ever they
have the capacity to do so and serve others gratuitously
does not change the fundamental nature of the hospital as
charity.
The charging of the fee is not controlling but the
purpose the fee will be use is the measure of charity.
1. Principle of administrative/ministerial as
against professional/medical duties;
The performance of all routinary duties which is
the very reason why he is appointed in the
ordinary sense constitutes administrative duties
and any negligent acts committed by such
employees in the course of their employment
which causes injury the patient, may make the
hospital vicariously liable.
Medical duties are by its nature beyond the
ordinary routine in a hospital. Any negligence of
such hospital employees, the borrowed servant
doctrine must be applied and the hospital may not
be held vicariously liable.
2. Power of Control;
3. Contract of Service;
If the contract has been entered with hospital to
render professional services, the hospital may be
held liable provided the negligent act was
committed within the scope of employment. But if
entered with the patient for contract of services,
the principle of independent contractor theory is
applied.
LIABILITIES OF HOSPITAL
1. CORPORATE Liabilities
Admission
A person has no absolute right to be admitted in a
hospital or to avail of hospital services. The
relationship between the hospital and the patient is
contractual.
A government has no absolute privilege of choice
of patients inasmuch as it is established and
maintained by public funds except for justifiable
grounds.
Transfer of patients
It must be premised on desire and consent of the
patient and when the condition of the patient
would permit to do so.
Discharge of patients
After evaluation of the patients condition,
considers that further hospitalization is no
longer indispensable, a physician may order
the discharge with or without condition.
Refusal to be hospitalized
Refusal of the patient to remain in the hospital will
not be a lawful ground to detain him if he is of
sound mind and of legal age. Related laws:
Premature discharge
The attending physician and the hospital any be
held liable to the patient if the latter is discharged
from the hospital in spite of the fact that further
hospitalization is still necessary.
ANCILLARY SERVICES
- Whenever the hospital administration enters into contract
with a partnership of physicians to run the emergency
room, the medical staff therein are not considered
employees of the hospital. Consequently liability for
negligence in the emergency room is shifted to the medical
partnership.
-Courts have held that even if contracts specify that
physicians will be considered independent contractors, the
hospitals are responsible for their action if they can
exercise control over them.
-Patients are not bound by the secret limitations contained
in a private contract between the hospital and the
physician.
Hospital Pharmacy
Sec. 42, RA 5921.
A PHARMACY is a place or establishment where drugs, chemical
products, active principles of drug, pharmaceuticals, proprietary
medicine of pharmaceutical specialties, devices and poison are sold at
retail and where medical and dental veterinary prescriptions are
compounded and dispensed.
Medical Records
It is compilation of the pertinent facts of the
patients life history, illness, and treatment.
It is a compilation of scientific data derived
from many sources, coordinated into a document
and made available for various uses to serve the
patient, the physician, the institution in which the
patient has been treated, the science of medicine
and society as a whole.
1.
Name of the patient and house officers
associated with the treatment of a patient;
2. Personal circumstances of the patient which
are not ordinarily related to the treatment.
DAMAGES
DAMAGES are the pecuniary compensations that may be
recovered for breach of some duty or the violation of some
rights recognized by law. If a suit is filed against a
physician for a professional liability claims, the objective
of the plaintiff is to recover damages. If the physician is
found negligent in the performance of his professional
services, he liable for the payment of damages for all the
direct, natural and logical consequences of his act.
TYPES OF DAMAGES
1.
2.
3.
4.
5.
6.
Actual or Compensatory;
Moral;
Exemplary
Nominal;
Temperate;
Liquidated
Kinds:
1. Dano emergente the loss already suffered by the
patient
2. Lucro cesante failure to receive the benefit which
would have pertained to him.
MORAL DAMAGES
Art. 2217, Civil Code
Physical Suffering
Mental Anguish
Fright and Moral Shock
Besmirched Reputation and Social
EXEMPLARY OR CORRECTIVE
DAMAGES
Art. 2229, Civil Code
NOMINAL DAMAGES
Art. 2221, Civil Code
LIQUIDATED DAMAGES
Art. 2226, Civil Code
Liquidated damages are those agreed upon by the
parties to a contract, to be paid in case of breach
thereof.
TEMPERATE OR MODERATE
DAMAGES
Art. 2224, Civil Code
ATTORNEYS FEES
Attorneys fees and other related expenses in litigation, other than judicial
cost are not as rule recoverable except when the law specifically provides.
(Art.2208, Civil Code)
EMERGENCIES IN MEDICAL
PRACTICE
An EMERGENCY is an unforeseen combination
of circumstances which calls for an immediate
action. It refers to a situation in which a patient
has been suddenly or unexpectedly endangered to
such an extent that immediate action is needed to
save the life and limb or to avoid permanent
damages.
DELEGATION OF A PHYSICIANS
DUTIES
Requisites for a Valid Delegation
1. When such duty can be delegated which will depend
on the circumstances of the case, nature of the duty to be
delegated, and the training and experience of the person to
whom such duty is to be delegated.;
2. The person to whom such duty is delegated must be
competent to perform such duty;
3. Proper instructions must be given to the person who
will perform the delegated duty;
The patient consented expressly or impliedly such
delegation of duty.
1.
2.
3.
4.
5.
Supreme Court
Court of Appeals
Regional Trial Court
Municipal or City Trial Court
Military Commissions
PHYSICIAN AS AN ORDINARY
WITNESS
Sec. 20, Rule 130, Rules of Court
3.
Death or Insanity - Sec. 23, Rule 130, Rules of Court
Parties or assignors of parties to a case, or persons in
whose behalf a case is prosecuted, against an executor or administrator
or other representative of the deceased person, or against a person of
unsound mind, upon a claim or demand against the estate of such
deceased person or against such person of unsound mind, cannot
testify as to any matter of fact occurring before the death of such
deceased person or before such person become of unsound mind;
4. Parental or filial Privilege - Sec. 25, Rule 130, Rules of Court
No descendant can be compelled, in a criminal case,
to testify against his parents and ascendants.
Sec. 24, Rule 130, Rules of Court The following persons cannot
testify as to matters learned in confidence in the following cases:
1.
The husband or the wife, during or after the marriage, cannot be
examined without the consent of the other as to any communication
received in confidence by one from the other during the marriage except in
a civil case by one against the other, or for a crime committed by one
against the other or the latters direct descendants and ascendants;
2.
The attorney cannot, without the consent of his client, be examined
as to any communication made by the client to him or his advice given
thereon in the course of, or with a view to professional employment; nor
can an attorneys secretary, stenographer or clerk be examined, without the
consent of the client and his employer, concerning any fact the knowledge
of which has been acquired in such capacity;
3.
A person authorized to practice medicine, surgery
or obstetrics cannot in a civil case, without the consent of
the patient, be examined as to any information which he
may have acquired in attending such patient in a
professional capacity, which information was necessary to
enable him to act in that capacity, and which would
blacken the reputation of the patient;
4.
A minister or a priest cannot, without the consent
of the person making the confession, be examined as to
any confession made to or any advice given him in his
professional character in the course of discipline enjoined
by the church to which he belongs;
5.
A public officer cannot be examined during his
term of office or afterwards as to communications made to
him in official confidence, when the court finds that the
public interest would suffer by the disclosure.
Privileged Communication
Between Physician and His Patient
Sec. 6, Art. II, Code of Medical Ethics
Waiver of Privilege
HEARSAY EVIDENCE
An evidence not proceeding from personal knowledge of the witness,
but from mere repetition of what he had heard others say. I does not
derive its value solely from the credit of the witness but its value rests
mainly in the veracity and competency of other persons. The very
nature of the evidence shows its weakness, and it is admitted only in
special cases because of necessity.
Dying declaration
One of the exceptions in hearsay evidence rule.
Is the statement made by a person who is at the point
of death, and is conscious of his impending death, in
reference to the manner in which he receives his injuries of
which he is dying, or the immediate cause of his death, and
in reference to the person who inflicted such injuries or in
connection with such injuries of a person who is charged
or suspected of having committed them; which statements
are admissible in evidence in a trial where the killing of the
declarant is the crime charged to the defendant.
Learned Treatises
ATTENDANCE OF A MEDICAL
WITNESS IN COURT
Sec. 1, Rule 21, Rules of Court
Subpoena
is a process directed to a person
requiring him to attend and to testify at the hearing or the
trial of an action, or at any investigation conducted by
competent authority, or for the taking of his deposition. It
may also require him to bring with him books, documents,
or other things under his control, in which case it is called
subpoena duces tecum.
Kinds of Subpoena
1. Subpoena ad testificandum
N.B.
Failure to comply with a subpoena without justifiable reason is a ground
for reprimand, suspension or revocation of the certificate of registration.
Requisites:
1. That the witness deliberately or intentionally falsified
the truth;
2.
That the other portions of the testimony to be
discredited, are not corroborated by circumstances or other
unimpeached evidence;
3. The false testimony must be on material point.
CONTEMPT
Sec. 9, Rule 21, Rules of Court
When the expert is not familiar with the facts upon which it is
based, they must be stated to him hypothetically, and upon the
assumption of the facts so stated, he must base his opinion.
Penal Provisions
-Violation of the provisions of this Code constitute
unethical and unprofessional conduct and therefore a
sufficient ground for the reprimand, suspension or
revocation of the certificate of registration of the offending
physician in accordance with the provisions of Sec. 24,
par. 12 of the Medical Act of 1959.
Scope:
The kernel of the right is not against all compulsion, but
testimonial compulsion only.
It is simply against the legal process of extracting from the lips of
the accused an admission of his guilt.
It does not apply where the evidence sought to be excluded is not
an incriminating statement but an OBJECT EVIDENCE(eg.
Fingerprinting, photographing, paraffin testing, PE).
The prohibition extends to the compulsion for the production of
documents, papers and chattels that may be used as evidence
against the witness except where the State has the right to examine
or inspect under the police power of the State.
The right also protects the accused against any attempt to compel
him to furnish a specimen of his handwriting in connection with a
prosecution for falsification.