Philippine College of Chest Physicians

Integrity Management Committee -6:50 pm

November 19, 2019, Mario’s Morato

Attendees:
Ethics/Integrity Management Committee:
Drs. L Fernandez, MB Siasoco, PG Moral, R Panaligan
Membership Committee:
Drs. L Fernandez, B Galvez, CM Campomanes, JE Tamayo
Grievance Committee: Dr. G Ocampo
Accreditation Board: Dr. C de Vera
Philippine Heart Center: Drs. R Bayot, ME Limpin, J Flores, T de Guia, F Ayuyao

Meeting started at 6:50 pm, facilitated by Dr. L Fernandez.

I. Introduction / overview

Subject of discussion: Discussion:

The ad hoc Committee on Ethics established by a Board Resolution dated
August 14, 2007 which was aimed to formulate guidelines in the
practice of pulmonary medicine concerning ethical practice and good
conduct. The Board of Directors further approved to adopt the Code of
Medical Ethics of the Philippine College of Physicians and as a member
of the Philippine Medical Association, the College will also take into
consideration the provisions of the PMA Code of Medical Ethics.
The Grievance Committee was approved from a constitutional
amendment as standing committee of the PCCP in March 2014. (Annex
1).
July 13, 2019, the BOD approved for a referendum in March 2020 to
combine the adhoc Ethics Committee and Grievance Committee and
rename it as Integrity Management Committee (IMC) with the following
R Panaligan –
- Combined committees need to pass in a
constitutional referendum
- Is Integrity Management Committee a proper or
valid committee name?
- Aside from the objectives, what’s the composition
(qualifications) of the its members
L Fernandez –
- Membership Committee serves as the executory
body of the recommendations approved by the BOD
MB Siasoco –
- IMC was approved; can already act the committee
mandates.
- Get the concept from the ethics committee before you
objectives:
i. formulate standards and develop guidelines regarding
professional conduct of PCCP members.
ii. review and resolve complaints involving PCCP members
in the practice of their profession
iii. to raise awareness of PCCP members regarding
professional ethics.
iv. recommend to the Board the disciplinary action on
members for infraction of rules of conduct.
v. advise the Board of Directors regarding ethical matters
and policies
Purpose of the meeting:
The Integrity Management Committee invites the Accreditation Board
chairman and head/ training officer of the Philippine Heart Center to
explain the matter of the TBDOTS elective rotation of fellows-in-training
at Sta. Ana Hospital, which the Accreditation Board saw as being
misrepresented.
NO decisions to be made in this meeting as this will be considered a
SAFE ground to hear all sides on this issue.
IMC shall also be listening similarly to the Accreditation Board’s
perspective.
can act
- Technical put aside the issue, and get the concept of
IMC
- Finalize IMC’s objectives/responsibilities
- pro active/vigilant on some complaints, official or
unofficial.
P Moral
- Ethical issues – resolution/sanctions/craft guidelines
- The term ‘Integrity’ – it’s like we don’t have integrity –
or does not uphold integrity
- The term ‘Management’ – might not be applicable too
because (improper) terminology
The Ethics Committee members – are they the proper
people to hear complaints, evaluate and recommend?
This might be questioned by the one who filed
complaints.
P Moral
- it should be the Grievance Committee that
receives the complaint, but there will be no issue
if the Ethics Committee hears and checks the
complaint if there are ethical values that has been
violated; may be a preliminary hearing ground.
Ethics Committee to recommend while Grievance
Committee conducts formal investigation. Process
will be improved once all guidelines are established.
For now, the group is common court, craft a report
on what transpired.
 II. Accreditation Board – Dr. Chona de Vera, Chairman (38:00)

Subject of discussion: Discussion:

Philippine Heart Center
Date of visit: October 9, 2019 Question and answer:

- They were able to meet the required number of procedures per fellow C de Vera:
- They failed to meet the minimum number of conferences (grand rounds – 8/11) - Initially, the ‘spokesperson’
- There was paucity in the kinds of cases seen by the fellows was only the chief fellow
- They have more than the minimum equipment required until other members of the
- The board recommends 1-year probationary status due to the lack of variety in the cases Accreditation Board
handled by the fellows, failure to meet the minimum number of conferences and doubtful TB pinpointed other fellows to
DOTS Rotation answer.
- MOA was supposed to
- The board would like to bring to the attention of the Executive Board on the deliberate and protect the FITs’ rotation
concerted efforts of the PHC to deceive the Accreditation Board on the presence of a TB DOTS - Fellows see patients other
facility in Sta. Ana and the subsequent rotation of their FITS with this non-existent clinic. than TB; findings: it was a
pulmonary clinic
- During the accreditation visit, Dr. Banzon, Chairman of the Division of Pulmonary Medicine of - Learned that Sta. Ana
PHC, presented that since 2017, their fellows have been rotating in the TBDOTS clinic of Sta. Hospital director called for a
Ana Hospital. This is part of the attempts of PHC to ensure FITs see enough TB Cases that are clarificatory meeting on
rarely seen within the institution. November 5
- The Accreditation Board respectfully requested that a copy of the MOA between PHC and Sta. - PHC past evaluation reviews
Ana Hospital be included in the accreditation documents they submit. Dr. Banzon during that were only from 2016
visit, agreed to provide us with the MOA in the coming days. (renewal), 2017 and 2018
- PHC submitted a census of patients seen at the TBDOTS clinic from January to September (annual evaluation)
2019. - Misrepresentation as a DOTS
- The Accreditation Board, guided by the PCCP Curriculum on TB DOTS rotation verified the Center/program
structure of the FITs training during the visit interview. The FITs failed to describe fully the - TB DOTS – what they are
rotation they have with the TB DOTS in Sta. Ana Hospital. They are unaware of the Sta Ana supposed to learn from the
Hospital TB DOTS Facility Processes (system of referrals, follow ups, dispensing of meds, rotation
TBDC, etc). - FITs should be taught what is
right but deceit was done
 - Despite all these, the FITs adamantly insisted that they are having a TB DOTS Rotation in Sta - Submitted letter to PHC was
Ana Hospital. approved by the BOD on
November 9 meeting and the
- After the accreditation visit, Dr. Banzon, through phone calls and text messages, informed the Accreditation Board.
Accreditation Board, that they tried looking for MOA but could not find it. They reasoned that
they, may have misplaced it with the renovations and transfers happening at PHC. MB Siasoco:
- As copies of MOAs are usually issued to both involved parties, the Accreditation Board - Accreditation Board uses
suggested that they can borrow the copy of the MOA of Sta. Ana Hospital. checklist of accreditation
- Dr. Banzon subsequently called the chair of the Accreditation Board and the PCCP Secretariat requirements based on
through Joan, informing that the people at Sta. Ana Hospital also could not find their copy guidelines
because there have been changes in the leadership/directorship twice the present - Is it specific in the
management could not find the document. Accreditation checklist re
- Dr. Bayot, Training Officer of the Division of Pulmonary Medicine of PHC, in a letter addressed rotation in TB clinics? Is this
to the Board wrote that they have exhausted all means but could not really find the document. subject to interpretation? –
- Dr. Bayot together with Dr. Banzon, proceeded to issue a certification that their FITs have
rotated with the TB DOTS Facility of Sta Ana (Annex 2). This has been signed as well by Dr. PHC declared that the rotation and
Paul Lucas, a cardiologist in PHC and is the current head of the Department of Medicine at Sta. its census is a TB DOTS clinic; MOA
Ana Hospital and Dr. James Flores, a PHC graduate of pulmonary medicine, a fellow of the was declared.
PCCP since 2018, and a consultant at Sta. Ana Hospital. The following FITs were included
1. Dr. Karen Anne Bispo Moral: Accreditation Board used
2. Dr. Cristia Maysol Maderazo-Morales with its scoring rubrics, MOA
3. Dr. Gladys Judynil Daba should be kept, mantra if it’s not
4. Dr. Ronald Palma written, it doesn’t exist.
5. Dr. Jamaica Ross David
6. Dr. Abigaille Ann Antonio
Findings: rotation is like
7. Dr. Samantha Faye Padilla
preceptorship; fellows brought
- With PHC unable to satisfactorily provide convincing evidence of a structured TB DOTS Rotation to by Dr. Flores.
answer their need to comply with the variety of cases FITs should see, the Accreditation Board,
practicing due diligence proceeded to verify the TB DOTS Rotation of FITs in Sta Ana Hospital.

- Attached is a letter from Dr. Grace Padilla, the present OIC-Director of Sta. Ana Hospital refuting all
the claims of Philippine Heart Center on the existence of a TB DOTS Clinic/ Facility in their
institution, as well as all the documentations we gathered as evidence. (Annex 3)
It is appalling to discover that the Division of Pulmonary Medicine of the PHC, a revered institution,
can be so bold as to orchestrate a lie and deceive the very society that has honored and respected
them all these years. The integrity of the institution is placed in further question, when the Training
Committee allow their FITs to be part of this lie for them to comply with the accreditation
requirements. These acts go against the core values of the PCCP and the training program that they
have been implementing.

The Accreditation Board submits to the Executive Board that the Division of Pulmonary Medicine of
the Philippine Heart Center be held accountable for the grave offense they have committed. The
accreditation board likewise recommends that this be elevated to the Integrity Committee for
further actions and recommendations on this disrespectful act.

III. Philippine Heart Center – Dr. Rommel Bayot (Training Officer), Dr. Teresita de Guia (past head), Dr. Fernando
Ayuyao (past head), Dr. Ma. Encarnita Limpin (official representative of Dr. Aileen Banzon who excused herself
as she had a flight at the time of the meeting) and Dr. James Flores (TB DOTS Coordinator at Sta Ana Hospital)

Subject of discussion: Discussion:

T de Guia:
- One sentence on the last paragraph of the Accreditation Board communication states:
Because of the discovery that there was deliberate and concerted effort to deceive the
Accreditation Board, …

- The PHC asserted to uphold certain amount of honesty, to PCCP and to colleagues
- Deeply hurt with the “deliberate and concerted effort to deceive the Accreditation
Board” as written by the Accreditation Board but accepts the ‘alleged misrepresentation’
from Dr. L Fernandez’s communication to them.
- The recommendation was disrespectful to us.

ME Limpin:
- Was it discussed in the Accreditation Board? Deception is strong word, it pertains to all
consultants of the institution (by the word used concerted effort); Dr. Limpin who also
 heads the Education and Training of PHC – it can hurt the people – addressee?
- What procedure was done to deceit the Accreditation Board? The fact that the ‘two’ PG Moral:
members of the Accreditation Board visited Sta. Ana to investigate – what they did was - It started to verify
wrong; it started a bad premise to check at Sta. Ana Hospital; the Accreditation Board the Philippine Heart
started on the wrong foot; they asked hospital employees – not the authorized person Center’s affiliation
responsible. It was like going there for tsismis. No official communication was sent to Sta with Sta. Ana
Ana except they went there personally. They should have done formally by writing to the Hospital and due to
hospital. They should have written the Sta Ana Hospital to verify facts; it’s like verifying a lost of a signed MOA.
certain person if he/she is really an FPCCP from that hospital. I would suggest that the - There is no existing
PCCP has to find out how did the investigation was done? TB DOTS program in
Sta Ana Hospital .
R Bayot:
- Short back ground: 3 years ago, it was suggested by the PCCP Accreditation Board to
affiliate with TB DOTS to supplement its TB cases. That same year the Philippine Heart
Center has partnered with Sta Ana Hospital, a TB Referring Center for TB rotation among the
second year. Along the way it was not finalized or no follow ups from our side. Admittedly,
it was an error from PHC for not pursuing to follow up the MOA. We initially presume
that it was signed.

ME Limpin:
- PHC also tried to partner with East Avenue Medical Center for rotation but it did not
materialize as the EAMC eventually had its own pulmonary fellowship program. Before, the
hospital director did not allow to have DOTS service in the hospital due to the nature of the
PHC - cardiac hospital (specialty cardiology);
- For now, PHC has a plan to put up its own DOTS clinic. Or PHC can also tie up with DOTS –
QC Health Center.

J Flores:
- The thrust of city is community-based DOTS program; Sta Ana Hospital has a TB nurse in
charge under the National TB Program. It is a TB DOTS referring center as mentioned by
Dr. Grace Padilla. Patients go back to Sta Ana for follow up. The PHC fellows sees TB cases
in the hospital, they learn from these TB cases/patients. And there are lots of TB cases in
the hospital.
 - Dr. Flores had a meeting with Dr. Grace Padilla, for the past three years, there were 3
changes of hospital directors in Sta Ana Hospital - the reason why the MOA was not
materialized. There was never an element of deceit or even an intention of deceit in the TB MB Siasoco:
rotation of PHC fellows in Sta. Ana Hospital. - Was there a MOA
signed with Sta. Ana
ME Limpin: Hospital?
- As acknowledged by Dr. Grace Padilla in her letter to the Accreditation Board, Sta Ana is a
DOTS Referring Center. The TB census are indeed patients from Sta Ana Hospital, there are
TB patients seen by the fellows.
- Re WebCAS, it is difficult for a government hospital to pass agreement, it will take some
time, more time. Our Board of Trustees are undersecretary of the DOH.
MB Siasoco:
ME Limpin: - Preceptorship was
- The Memorandum of Understanding between two institutions assures the continuity of initially done twice a
what was agreed upon even if the hospital director is changed. week but was
- As what Dr. Grace Padilla has said, there were attempts to do one by the previous changed to once a
director/s. week, do they have
- As head of PHC Education and Training Department, I admit that we had an error in our records in the chart
part as we did not follow up our MOA with Sta. Ana Hospital. at OPD?

R Bayot:
- The PHC actually decided that the rotation be held in one year and not just 6 months
rotation; there were issues on the distance of travel and cost travelling via Grab.

FG Ayuyao:
- How did the Accreditation Board come up with the process and using the term deception –
this needs to be answered by the Accreditation Board and the Board of Directors;
- Fellows do not need to know the structure of a TB DOTS center; even the consultants do not
know. It was questioned during the Fellows interview.

ME Limpin:
- The verification by visiting Sta Ana Hospital was made like tsismisan, talking with an
 unauthorized person. It should be made in a formal manner. The visit raises doubts and Joan:
uncertainties, questioning the integrity of the institution (PHC). - Yes, ascendancy was
- For the PCCP Board of Directors, it is important to be meticulous in choosing/appointing followed when we
members of the Accreditation Board or Specialty Board. They should have wisdom. You chose for the
also need to look at the background of the nominees. The members of the Accreditation President’s official
Board should be credible. representative.

De Guia T: L Fernandez:
- We are not questioning the presence of Dr. Gina delos Reyes during the accreditation visit - The PHC can respond
but why was the President absent? The president’s representative should have been to the letter given by
chosen by ascendancy – it should have been the Vice President in case the President is not the Accreditation
around. Board
- The Vice President should not say NO when requested to take the President’s place. If they - Check the
cannot serve, then they have to resign! proceedings of this
meeting – PHC and
FG Ayuyao: Accreditation Board
- MOA should be between the two parties (hospitals); I do not know why the PCCP is after the - NO IRR for
MOA Grievances yet, the
society was just small
R Bayot: before.
- if the Accreditation Board finds our TB rotation insufficient, they should have - Ethics and Grievance
recommended to augment the DOTS; merged = Integrity
Management
F Ayuyao: Committee
- Accreditation Board checks on what’s lacking in a training program; they can always - Prima facie – no
recommend. Our past evaluations from the Accreditation Board were okay, they gave the deception on the PHC
necessary recommendations of their findings. part; there might be
negligence on the
M Limpin: documents (MOA)
- Sila (Accreditation Board) ang may maling ginawa (pertains to the surprise visit in Sta. Ana
Hospital)
 T de Guia:
- These members of the Accreditation Board are young. They were not in training yet when
we formed our training program. Questioning us with our integrity.

IV. IMC discussion

MB Siasoco:
- It’s not good to question the credibility of the Accreditation Board; they were just doing their tasks.

L Fernandez:
- Lapses on both sides – Accreditation Board and PHC (cannot determine which is heavier?)
- Can we recommend sanctions or offenses?
- Terminology that should have been used: Misrepresentation; remove also deliberate

PG Moral:
- We did not come across of being deliberate and concerted efforts – PHC admitted lapses

MB Siasoco:
- Incongruity of what was find (by the AB)
- Accreditation presents summative, just to check if the requirements are present.

B Galvez:
- Due process will be taken, after the investigation in Sta Ana Hospital

Referendum –
- Integrate – Ethics and Grievance – all concerns, does it concern Integrity?
- IRR – initial draft
- January – essence of the membership com; code of procedures.

Adjourned at 10:35 PM.