Legmed Notes

STATE REGULATION OF HOSPITAL OPERATION
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EO 292 – REVISED ADMINISTRATIVE CODE
Section 3. Powers and Functions. - The Department shall:
(1)Define the national health policy and formulate and implement a national health plan within
the framework of the government's general policies and plans, and present proposals to
appropriate authorities on national issues which have health implications;
(2)Provide for health programs, services, facilities and other requirements as may be needed,
subject to availability of funds and administrative rules and regulations;
(3)Coordinate or collaborate with, and assist local communities, agencies and interested groups
including international organizations in activities related to health;
(4)Administer all laws, rules and regulations in the field of health, including quarantine laws and
food and drug safety laws;
(5)Collect, analyze and disseminate statistical and other relevant information on the country's
health situation, and require the reporting of such information from appropriate sources;
(6)Propagate health information and educate the population on important health, medical and
environmental matters which have health implications;
(7)Undertake health and medical research and conduct training in support of its priorities,
programs and activities;
(8)Regulate the operation of and issue licenses and permits to government and private
hospitals, clinics and dispensaries, laboratories, blood banks, drugstores and such other
ZANDALEE R. BILLONES (2013-0221) ARELLANO UNIVERSITY SCHOOL OF LAW

establishments which by the nature of their functions are required to be regulated by the
Department;
(9)Issue orders and regulations concerning the implementation of established health policies;
and
(10)Perform such other functions as may be provided by law.
Section 14. Office for Hospital and Facilities Services. - The Office for Hospital and Facilities
Services, headed by an Undersecretary who shall be supported by an Assistant Secretary, shall
include four (4) staff services involved in policy formulation, standards development, program
monitoring and provision of specialized assistance in the operations of hospitals and the
management of facilities, which are as follows:
LEGAL MEDICINE I (ATTY. RODEL V. CAPULE)

(1)Hospital Operations and Management Service which shall formulate and implement plans,
programs, policies, standards and techniques related to management improvement and quality
control of hospital operations; provide consultative, training and advisory services to field offices
in relation to the supervision and management of hospital components; and conduct studies and
research related to hospital operations and management;
(2)Radiation Health Service which shall formulate and implement plans, policies, programs,
standards and techniques to ensure radiation health safety; provide consultative, monitoring,
training and advisory services to private and government facilities with radiation-emitting
apparatus; and conduct studies and research related to radiation health;
(3)Hospital Maintenance Service which shall formulate and implement plans, programs, policies,
standards and techniques related to assuring the proper maintenance of Department
equipment; provide consultative, training and advisory services to implementing agencies in
relation to preservation, repair and maintenance of medical and non-medical equipment of the
Department; and conduct studies and research related to equipment and facility maintenance;
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(4)Health Infrastructure Service which shall formulate and implement plans, policies, programs,
standards and techniques related to development and preservation of health infrastructure;
provide consultative, training and advisory services to implementing agencies in relation to
infrastructure projects to assure economical and efficient implementation; and conduct studies
and research related to infrastructure development and utilization.
Section 15. Office for Standards and Regulations. - The Office for Standards and
Regulations, headed by an Undersecretary and supported by an Assistant Secretary, shall
include three (3) bureaus and one (1) national office that shall be responsible for the formulation
of regulatory policies and standards over the various areas of concern in the health sector,
whose implementation shall be the general responsibility of the Department's regional field
offices. The same bureaus shall also be responsible for those areas of activity covered by
regulatory policy to provide the Secretary with current information on the status of these
regulated areas of activity and to provide the Secretary with a basis for preliminary evaluation of
the efficiency of the Department's field offices in performing their regulatory functions. The same
bureaus shall conduct studies and research pertinent to their areas of responsibility . In certain
instances the bureaus may also perform consultative, training and advisory services to the
practitioners and institutions in the area of regulated activity. The same bureaus and national
office are the following:
(1)Bureau of Research and Laboratories which shall develop and formulate plans, standards
and policies for the establishment and accreditation and licensing of laboratories; blood banks
and entities handling biological products, provide consultative, training and advisory services to
public and private laboratories; and conduct studies and research related to laboratory

procedures and operations;
(2)Bureau of Food and Drugs which shall act as the policy formulation and sector monitoring
arm of the Secretary on matters pertaining to foods, drugs, traditional medicines, cosmetics and
household products containing hazardous substances, and the formulation of rules, regulations
and standards in accordance with Republic Act 3720 (1963), as amended by Executive Order
No. 175, s. 1987, and other pertinent laws for their proper enforcement; prescribe general
standards and guidelines with respect to the veracity of nutritional and medicinal claims in the
advertisement of food, drugs and cosmetics in the various media, to monitor such
advertisements; advise the Department's field offices to call upon any erring manufacturer,
distributor, or advertiser to desist from such inaccurate or misleading nutritional or medicinal
claims in their advertising; should such manufacturer, distributor, or advertiser refuse or fail to
obey the desistance order issued by the Bureau, he shall be subject to the applicable penalties

as may be prescribed by law and regulations; the Bureau shall provide consultative, training and
advisory services to all agencies and organizations involved in food and drug manufacturing and
distribution with respect to assuring safety and efficacy of food and drugs; conduct studies and
research related to food and drug safety; maintain a corps of specially trained food and drugs
inspectors for assignment to the various field offices of the Department; while these inspectors
shall be under the technical supervision and guidance of the Bureau, they shall be under the
administrative supervision of the head of the field office to which they shall be assigned, the
latter being responsible for regulatory program implementation within the geographic area of his
jurisdiction;
(3)Bureau of Licensing and Regulation which shall formulate policies and establish the
standards for the licensing and regulation of hospitals, clinics and other health facilities;
establish standards that shall be the basis of inspections and licensure procedures of the
Department's field offices; and provide consultative, training and advisory services to field
offices on the conduct of licensing and regulatory functions over hospitals, clinics and other
health facilities.
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(4)National Quarantine Office which shall formulate and implement quarantine laws and
regulations and, through its field offices, exercise supervision over rat-proof zones in designated
international ports and airports and over medical examination of aliens for immigration
purposes.
RA 4226 – HOSPITAL REGULATION AND LICENSING ACT
Sec. 2. Definitions. — As used in this Act —
(a) 'Hospital' means a place devoted primarily to the maintenance and operation of facilities
for the diagnosis, treatment and care of individuals suffering from illness, disease, injury or
deformity, or in need of obstetrical or other medical and nursing care. The term 'hospital shall
also be construed as any institution, building or place where there are installed beds, or cribs, or
bassinets for twenty-four-hour use or longer by patients in the treatment of diseases, diseased-
conditions, injuries, deformities, or abnormal physical and mental states, maternity cases, and
all institutions such as those for convalescence, sanitarial or sanitarial care, infirmities,
nurseries, dispensaries and such other names by which they may designated.
(b) 'Government hospital' means a hospital operated and maintained either partially or wholly
by the national, provincial, municipal or city government or other political subdivision, or by any
department, division, board or other agency thereof.

(c) 'Private hospital' means one which is privately owned, established and operated with funds
raised or contributed through donations, or by private capital or other means, by private
individuals, association, corporation, religious organization, firm, company or joint stock
association.
(d) 'Clinic' means a place in which patients avail of medical consultations or treatments on an
out-patient basis. However, any clinic or dispensary where there is at least six beds or cribs or
bassinets installed for twenty-four-hour use by patients shall be construed to fall within the
definition of a hospital as described in this Act.
Sec. 4. Registration and license. — No hospital shall operate or be opened to the public
unless it shall have been registered and a license for its operation obtained from the licensing

agency provided in this Act.
Sec. 5. Licensing Agency. — For purposes of setting standards in hospital construction and
operation, the Bureau of Medical Services in addition to its present duties shall act as the
licensing agency. The Secretary of Health shall reorganize this Bureau to include a staff of
hospital architects, hospital administrators, sanitary engineers and such personnel as may be
necessary to carry out the purposes of this Act without necessarily increasing the present
personnel strength of this Bureau.
SECTION 13. Separate Licenses Required. — Separate licenses shall be required for
hospitals or branches thereof maintained in separate premises, even though they are operated
under the same management: provided, however, that separate licenses shall not be required
for separate buildings in the same compound: provided, further, that permits for construction or
alteration of buildings within the same compound shall also be secured from the licensing
agency to determine compliance with standards and requirements herein authorized.
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SECTION 16. Classification of Hospitals. — The licensing agency shall study and adopt a
system of classifying hospitals in the Philippines as to: (1) general or special; (2) hospital
services capabilities; (3) size or bed capacity and (4) class of hospital whether training or not.
RA 9439 – AN ACT OF PROHIBITING DETENTION OF PATIENTS IN HOSPITALS AND

CLINICS
SECTION 1. It shall be unlawful for any hospital or medical clinic in the country to detain or to
otherwise cause, directly or indirectly, the detention of patients who have fully or partially
recovered or have been adequately attended to or who may have died, for reasons of
nonpayment in part or in full of hospital bills or medical expenses.
SEC. 2. Patients who have fully or partially recovered and who already wish to leave the
hospital or medical clinic but are financially incapable to settle, in part or in full, their
hospitalization expenses, including professional fees and medicines, shall be allowed to leave
the hospital or medical clinic, with a right to demand the issuance of the corresponding medical
certificate and other pertinent papers required for the release of the patient from the hospital or
medical clinic upon the execution of a promissory note covering the unpaid obligation. The
promissory note shall be secured by either a mortgage or by a guarantee of a co-maker, who
will be jointly and severally liable with the patient for the unpaid obligation. In the case of a
deceased patient, the corresponding death certificate and other documents required for
interment and other purposes shall be released to any of his surviving relatives requesting for
the same: Provided, however, That patients who stayed in private rooms shall not be covered

by this Act.
RA 8344 – PROHIBITING DEMAND OF DEPOSITS
Section 1. Section 1 of Batas Pambansa Bilang 702 is hereby amended to read as follows:
"SECTION 1. In emergency or serious cases, it shall be 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: Provided, That 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:
Provided, however, That when the patient is unconscious, incapable of giving consent
and/or unaccompanied, the physician can transfer the patient even without his consent:
Provided, further, 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: Provided, furthermore, That 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: Provided, finally, That
strict compliance with the foregoing procedure on transfer shall not be construed as a
refusal made punishable by this Act."
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Section 2. Section 2 of Batas Pambansa Bilang 702 is hereby deleted and in place thereof, new
sections 2, 3 and 4 are added, to read as follows:
"SEC. 2. For purposes of this Act, the following definitions shall govern:
"(a) 'Emergency' - a condition or state of a patient wherein based on the objective
findings of a prudent medical officer on duty for the day there is immediate
danger and where delay in initial support and treatment may cause loss of life or
cause permanent disability to the patient.
RA 6615 – REFUSAL TO EXTEND MEDICAL ASSISTANCE
Section 1. All government and private hospitals or clinic duly licensed to operate as such are
hereby required to render immediate emergency medical assistance and to provide facilities and
medicine within its capabilities to patients in emergency cases who are in danger of dying
and/or who may have suffered serious physical injuries.
MANILA DOCTORS HOSPITAL v. SO UN CHUA and VICKY TY

Chua was admitted for Hypertension at petitioner hospital. Chua was confined in a deluxe room
and was advised by her doctor that she can be discharged at any time, however, Chua insisted
to remain in confinement. Chua’s daughter Ty was allegedly pressured to settle the bills so she
issued a postdated checks. The hospital removed the aircon, telephone line, refrigerator and TV
set in Chua’s room. Ty contends that it was done in bad faithe that amounts to an actionable
wrong.

SC: The facilities in question are non-essential for the care of Chua, and hence, they may be
lessened/removed by the hospital for the sake of economic necessity. In the institution of cost-
cutting measures, the hospital has a right to reduce the facilities and services that are deemed
to be non-essential, such that their reduction/removal would not be detrimental to the medical
condition of the patient.
Hospitals can remove non-essential facilities if the equipments are not essential for the patient’s
needs and will not adversely affect the patients in the room.
In this case, there is no detention. In order for it to be present, there must be physical restraint
and not mere statements will suffice as illegal detention.

The form of restraint must be total; movement must be restrained in all directions. If restraint is
partial, e.g., in a particular direction with freedom to proceed in another, the restraint on the
person's liberty is not total.However, the hospital may legally detain a patient against his will:
(1) when he is a detained or convicted prisoner, or

(2) when the patient is suffering from a very contagious disease where his release will be
prejudicial to public health, or
(3) when the patient is mentally ill such that his release will endanger public safety, or
(4) in other exigent cases as may be provided by law.
HOSPITAL MANAGEMENT SERVICES, INC. – MDC v. HMSI-MDC-AFW and EDNA DE

CASTRO
De Castro is a staff nurse at petitioner hospital, and was on night duty when a certain 81 year-
old patient who is scheduled for operation, fell from her bed trying to reach for the bedpan. De
Castro directed a ward-clerk orientee to check the patient. The vital signs were normal. The
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chief nurse requested for a formal investigation on the matter, and the committee recommended
for her termination on the ground of serious misconduct for failure to personally attend to the
patient.
LA: Reinstated De Castro. Suspension, not dismissal was the proper penalty.
NLRC: Reversed LA. De Castro lacked diligence and prudence.
SC: Upheld LA. Neglect of duty, to be a ground for dismissal, must be both gross and habitual.
The nature of the business of a hospital requires a higher degree of caution and exacting
standard of diligence in patient management and health care as what is involved are lives of
patients who seek urgent medical assistance.

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STATE REGULATION OF PRACTICE OF MEDICINE
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RA 2382 – MEDICAL ACT OF 1959
Section 9. Candidates for board examination. Candidates for Board examinations shall have
the following qualifications:
(1) He shall be a citizen of the Philippines or a citizen of any foreign country who has
submitted competent and conclusive documentary evidence, confirmed by the
Department of Foreign Affairs, showing that his country's existing laws permit citizens of
the Philippines to practice medicine under the same rules and regulations governing
citizens thereof;
(2) He shall be of good moral character, showing for this purpose certificate of civil
status;
(3) He shall be of sound mind;
(4) He shall not have been convicted by a court of competent jurisdiction of any offense
involving moral turpitude; and
(5) He shall be a holder of the degree of Doctor of Medicine or its equivalent, conferred
by a college of medicine duly recognized by the Department of Education.
Section 10. Acts constituting practice of medicine. A person shall be considered as engaged in
the practice of medicine (a) who shall, for compensation, fee, salary or reward in any form, paid
to him directly or through another, or even without the same, physical examine any person, and
diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity,

physical, mental or physical condition or any ailment, real or imaginary, regardless of the nature
of the remedy or treatment administered, prescribed or recommended; or (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 physical condition; or (c) who shall use the title M.D. after his name.
Section 11. Exemptions. The preceding section shall not be construed to affect (a) any medical
student duly enrolled in an approved medical college or school under training, serving without
any professional fee in any government or private hospital, provided that he renders such
service under the direct supervision and control of a registered physician; (b) any legally
registered dentist engaged exclusively in the practice of dentistry; (c) any duly registered
masseur or physiotherapist, provided that he applies massage or other physical means upon

written order or prescription of a duly registered physician, or provided that such application of
massage or physical means shall be limited to physical or muscular development; (d) any duly
registered optometrist who mechanically fits or sells lenses, artificial eyes, limbs or other similar
appliances or who is engaged in the mechanical examination of eyes for the purpose of
constructing or adjusting eye glasses, spectacles and lenses; (e) any person who renders any
service gratuitously in cases of emergency, or in places where the services of a duly registered
physician, nurse or midwife are not available; (f) any person who administers or recommends
any household remedy as per classification of existing Pharmacy Laws; and (g) any
psychologist or mental hygienist in the performance of his duties, provided such performance is
done in conjunction with a duly registered physician.
Section 12. Limited practice without any certificate of registration. Certificates of registration
shall not be required of the following persons:
(a) Physicians and surgeons from other countries called in consultation only and
exclusively in specific and definite cases, or those attached to international bodies or
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organization assigned to perform certain definite work in the Philippines provided they
shall limit their practice to the specific work assigned to them and provided further they
shall secure a previous authorization from the Board of Medical Examiners.
(b) Commissioned medical officers of the United States armed forces stationed in the
Philippines while rendering service as such only for the members of the said armed
forces and within the limit of their own respective territorial jurisdiction.
(c) Foreign physicians employed as exchange professors in special branches of
medicine or surgery whose service may in the discretion of the Board of Medical
Education, be necessary.
(d) Medical students who have completed the first four years of medical course,
graduates of medicine and registered nurses who may be given limited and special
authorization by the Secretary of Health to render medical services during epidemics or
national emergencies whenever the services of duly registered physicians are not
available. Such authorization shall automatically cease when the epidemic or national
emergency is declared terminated by the Secretary of Health.
RA 8981 – PRC MODERNIZATION ACT
Section 7. Powers, Functions and Responsibilities of the Commission – The powers, functions,
and responsibilities of the Commission are as follows:
(j) Upon recommendation of the Professional Regulatory Board concerned, to approve the
registration of and authorize the issuance of a certificate of registration/license and professional

identification card with or without examination to a foreigner who is registered under the laws of
his state or country and whose certificate of registration issued therein has not been suspended
or revoked: Provided, That, the requirements for the registration or licensing in said foreign state
or country are substantially the same as those required and contemplated by the laws of the
Philippines and that the laws of such foreign state or country allow the citizens of the Philippines
to practice the profession on the same basis and grant the same privileges as those enjoyed by
the subjects or citizens of such foreign state or country: Provided, further, That, the Commission
may, upon recommendation of the Board concerned, authorize the issuance of a certificate of
registration/license or a special temporary permit to foreign professionals who desire to practice
their professions in the country under reciprocity and other international agreements;
consultants in foreign-funded, joint venture or foreign-assisted projects of the government,
employees of Philippine or foreign private firms or institutions pursuant to law, or health

professionals engaged in humanitarian mission for a limited period of time: Provided, finally,
That agencies, organizations or individuals whether public or private, who secure he services of
a foreign professional authorized by law to practice in the Philippines for reasons
aforementioned, shall be responsible for securing a special permit from the Professional
Regulation Commission (PRC) and the Department of Labor and Employment (DOLE),
pursuant to PRC and DOLE rules:
ART. XII SEC.14 – 1987 PHILIPPINE CONSTITUTION
Section 14. The sustained development of a reservoir of national talents consisting of Filipino
scientists, entrepreneurs, professionals, managers, high-level technical manpower and skilled
workers and craftsmen in all fields shall be promoted by the State. The State shall encourage
appropriate technology and regulate its transfer for the national benefit. The practice of all
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professions in the Philippines shall be limited to Filipino citizens, save in cases prescribed by
law.
DENT v. WEST VIRGINIA

Dent was found guilty for unlawfully engaging in the practice of medicine in the State Circuit
Court of Preston County, West Virginia, despite practicing such profession in the town of
Newburg continuously since 1876. Dent had no certificate or license but had a diploma from
American Medical Eclectic College in Cincinatti, Ohio. However, the members of the Board of
Health denied his request for a certificate on the ground that the said college where he studied
was not reputable, pursuant to Section 9 and 10 of Act of the State of March 15, 1882.
The statute of West Virginia (§§ 9 and 15, chapter 93, 1882) which requires every practitioner of
medicine in the State to obtain a certificate from the State Board of Health that he is a graduate
of a reputable medical college in the school of medicine to which he belongs, or that he has
practiced medicine in the State continuously for ten years prior to March 8, 1881, or that he has
been found upon examination to be qualified to practice medicine in all its departments, and
which subjects a person practicing without such certificate to prosecution and punishment for a
misdemeanor, does not, when enforced against a person who had been a practicing physician
in the State for a period of five years before 1881, without a diploma of a reputable medical
college in the school of medicine to which he belonged, deprive him of his estate or interest in
the profession without due process of law.
Dent asserts the unconstitutionality of the statute claiming that it is a violation of the 14th
Amendment that no State shall deprive any person of life, liberty, or property without due

process of law.
SC: Upheld constitutionality. It is a valid exercise of police power of the state.

The power of the State to provide for the general welfare of its people authorizes it to prescribe
all such regulations as in its judgment will secure or tend to secure them against the
consequences of ignorance and incapacity, as well as of deception and fraud. Due
consideration, therefore, for the protection of society may well induce the State to exclude from
practice those who have not such a license, or who are found upon examination not to be fully
qualified.
MARQUEZ v. BOARD OF MEDICAL EXAMINERS

Felix Marquez was a graduate of Chicago Medical College. During his study, his medical school

was still recognized as a reputable medical institution. However, when Act No.3111 categorized
his college as a Class C medical school, thus, he is disqualified to take the physicians’
examinations. Marquez contends that it should’ve taken effect at the time of his graduation
otherwise it would make the law retroactive and do irreparable damage to him.
SC: No existing right has yet commenced on the part of Marquez.

The question whether a medical institution is "a reputable medical school," in the sense
intended by the law, is vested in the Board of Medical Examiners, and although the action taken
by them may conceivably, in isolated cases, result in hardship, nevertheless the interests of the
public require that the board should be free to exercise its judgment and discretion without
reference to the effect of the determination of the question in particular instances.
PHILIPPINE MEDICAL ASSOCIATION v. BME and JOSE MA.TORRES

Ma.Torres is a Spanish subject who graduated from University of Barcelona, and was granted a
special authority to practice medicine in Lamitan, Basilan City. The authority was revoked by the
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Health Secretary and renewed again, then revoked again, since there are enough practicing
physicians in that locality. Pursuant to the “Treaty on the Validity of Academic Degrees and The
Exercise of the Professions between the Republic of the Philippines and the Spanish State”,
signed at Manila in 1949, the Board issued Resolution No.25, which granted Ma.Torres a
Certificate to Practice Medicine in the Philippines without the required examination under RA
2382.
SC: Said treaty states that Spanish graduates must first take and pass the Philippine medical
board exam first pursuant to our laws.
TABLARIN v. GUTIERREZ
The petitioners sought admission into colleges or schools of medicine for the school year 1987-
1988. However, the petitioners either did not take or did not successfully take the National
Medical Admission Test (NMAT) required by the Board of Medical Education, one of the public
respondents, and administered by the private respondent, the Center for Educational
Measurement (CEM). They now claim that NMAT is unconstitutional for undue delegation of
legislative powers.
SC: Dismissed petition. Such is a valid exercise of powers. That the power to regulate and
control the practice of medicine includes the power to regulate admission to the ranks of those
authorized to practice medicine, is also well recognized. NMAT is a means of achieving the
objective to improve the quality of medical examination in the country.
BOARD OF MEDICAL EDUCATION v. ALFONSO

From 1985, no less than five (5) surveys were conducted of respondent institution to determine
its compliance with the minimum standards established for a medical college. Despite this,
Philippine Muslim-Christian College of Medicine Foundation, Inc. failed to fully comply with the
prescribed requirements.
SC: Given these facts, and it being a matter of law that the Secretary of Education, Culture and
Sports exercises the power to enjoin compliance with the requirements laid down for medical
schools and to mete out sanctions where he finds that violations thereof have been committed,
it was a grave abuse of discretion for the respondent judge to issue the questioned injunction
and thereby thwart official action, in the premises correctly taken, allowing the College to
operate without the requisite government permit.

The, members of the evaluating team came from the different sectors in the fields of education
and medicine, 14 and their judgment in this particular area is certainly better than that of the
respondent Judge whose sole and only visit to the school could hardly have given him much
more to go on than a brief look at the physical plant and facilities and into the conduct of the
classes and other school activities.
DECS v. SAN DIEGO

San Diego flunked the NMAT three (3) times already and now he is questioning its
constitutionality of MECS Order No.23 which does not allow a student to take the NMAT for a
fourth time. He asserts that he was deprived of his right to pursue a medical education through
an arbitrary exercise of police power.
SC: Upheld constitutionality. NMAT is a measure intended to limit the admission to medical
schools only to those who have initially proved their competence and preparation for a medical
education. It is the right of the State to insure that the medical profession is not infiltrated by
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incompetents to whom patients may unwarily entrust their lives and health. For police power to
be valid there must be a lawful subject and a lawful method properly concurred.
PHILIPPINE REGULATION COMMISSION v. DE GUZMAN, et.al

The respondents are all graduates of the Fatima College of Medicine, Valenzuela City, Metro
Manila. They passed the Physician Licensure Examination conducted in February 1993 by the
Board of Medicine (Board). Petitioner Professional Regulation Commission (PRC) then released
their names as successful examinees in the medical licensure examination. Shortly thereafter,
the Board observed that the grades of the seventy-nine successful examinees from Fatima
College in the two most difficult subjects in the medical licensure exam, Biochemistry (Bio-
Chem) and Obstetrics and Gynecology (OB-Gyne), were unusually and exceptionally high. PRC
did not find that respondents “satisfactorily passed” the licensure exams. The lower court
allowed respondents to take their Hippocratic Oath and granted the mandamus filed by the
respondents against petitioner.
SC: The function of mandamus is not to establish a right but to enforce one that has been
established by law. If no legal right has been violated, there can be no application of a legal
remedy, and the writ of mandamus is a legal remedy for a legal right. There must be a well-
defined, clear and certain legal right to the thing demanded. It is long established rule that a
license to practice medicine is a privilege or franchise granted by the government.
The appellate court’s reliance on section 20 of RA 2382 concluding petitioners to administer the
Hippocratic Oath as a ministerial obligation and register them as physicians was incorrect.

However, the surrounding circumstances in this case call for serious inquiry concerning the
satisfactory compliance with the Board requirements by the respondents. The unusually high
scores in the two most difficult subjects was phenomenal, according to Fr. Nebres, the
consultant of PRC on the matter, and raised grave doubts about the integrity, if not validity, of
the tests. These doubts have to be appropriately resolved. Under the second paragraph of
Section 22, the Board is vested with the power to conduct administrative investigations and
"disapprove applications for examination or registration," pursuant to the objectives of Rep. Act
No. 2382 as outlined in Section 1 thereof. In this case, after the investigation, the Board filed
before the PRC, Adm. Case No. 1687 against the respondents to ascertain their moral and
mental fitness to practice medicine, as required by Section 9 of RA 2382.
BOARD OF MEDICINE v. YASUYUKI OTA

Ota is a Japanese national married to a Filipina who graduated from Bicol Christian College of
Medicine and has completed a one-year post graduate internship at Jose Reyes Medical
Center. In order to obtain a medical license, he filed an application to take the medical board
examination and was required by the PRC to submit an affidavit of undertaking and submit proof
that reciprocity exists between Japan and the Philippines in admitting foreigners into the
practice of medicine. A duly notarized Medical Practitioners Law of Japan translated in English
and was authenticated by the Consul General of the Philippine Embassy in Japan. However,
PRC denied his request on the ground that no genuine reciprocity can be found in the Japanese
law, and such is not practical and attainable for Filipinos seeking to practice medicine there.
Furthermore, there were no reported Filipino doctors in Japan yet. This prompted Ota to file for
Mandamus which was granted by the lower court and the appellate court, finding that Ota
adequately proved the principle of reciprocity.
SC: Decision affirmed. The regulation of the practice of medicine in all its branches has long
been recognized as a reasonable method of protecting the health and safety of the public.
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Granting that there is still no Filipino who has been given license to practice medicine in Japan,
it does not mean that no Filipino will ever be able to be given one.
Nowhere in said statutes is it stated that the foreign applicant must show that the conditions for
the practice of medicine in said country are practical and attainable by Filipinos. Neither is it
stated that it must first be proven that a Filipino has been granted license and allowed to
practice his profession in said country before a foreign applicant may be given license to
practice in the Philippines.
It is enough that the laws in the foreign country permit a Filipino to get license and practice
therein. Requiring respondent to prove first that a Filipino has already been granted license and
is actually practicing therein unduly expands the requirements provided for under R.A. No. 2382
and P.D. No. 223.

12
RPC/SPECIAL LAW APPLICABLE TO PHYSICIANS I
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Art. 174. False medical certificates, false certificates of merits or service, etc. — The
penalties of arresto mayor in its maximum period to prision correccional in its minimum period
and a fine not to exceed P1,000 pesos shall be imposed upon:
1.Any physician or surgeon who, in connection, with the practice of his profession, shall issue a
false certificate; and
2.Any public officer who shall issue a false certificate of merit of service, good conduct or similar
circumstances.
The penalty of arresto mayor shall be imposed upon any private person who shall falsify a
certificate falling within the classes mentioned in the two preceding subdivisions.
Art. 175. Using false certificates. — The penalty of arresto menor shall be imposed upon any
one who shall knowingly use any of the false certificates mentioned in the next preceding article.
Art. 259. Abortion practiced by a physician or midwife and dispensing of abortives.

— The penalties provided in Article 256 shall be imposed in its maximum period, respectively,
upon any physician or midwife who, taking advantage of their scientific knowledge or skill, shall
cause an abortion or assist in causing the same.
Any pharmacist who, without the proper prescription from a physician, shall dispense any

abortive shall suffer arresto mayor and a fine not exceeding 1,000 pesos.
Art. 347. Simulation of births, substitution of one child for another and concealment or
abandonment of a legitimate child. — The simulation of births and the substitution of one
child for another shall be punished by prision mayor and a fine of not exceeding 1,000 pesos.
The same penalties shall be imposed upon any person who shall conceal or abandon any
legitimate child with intent to cause such child to lose its civil status.
Any physician or surgeon or public officer who, in violation of the duties of his profession or
office, shall cooperate in the execution of any of the crimes mentioned in the two next preceding
paragraphs, shall suffer the penalties therein prescribed and also the penalty of temporary

special disqualification.
Art. 365. Imprudence and negligence. — Any person who, by reckless imprudence, shall
commit any act which, had it been intentional, would constitute a grave felony, shall suffer the
penalty of arresto mayor in its maximum period to prision correccional in its medium period; if it
would have constituted a less grave felony, the penalty of arresto mayor in its minimum and
medium periods shall be imposed; if it would have constituted a light felony, the penalty of
arresto menor in its maximum period shall be imposed.
Any person who, by simple imprudence or negligence, shall commit an act which would
otherwise constitute a grave felony, shall suffer the penalty of arresto mayor in its medium and
maximum periods; if it would have constituted a less serious felony, the penalty of arresto mayor
in its minimum period shall be imposed.
13
When the execution of the act covered by this article shall have only resulted in damage to the
property of another, the offender shall be punished by a fine ranging from an amount equal to
the value of said damages to three times such value, but which shall in no case be less than
twenty-five pesos.
A fine not exceeding two hundred pesos and censure shall be imposed upon any person who,
by simple imprudence or negligence, shall cause some wrong which, if done maliciously, would
have constituted a light felony.
In the imposition of these penalties, the court shall exercise their sound discretion, without
regard to the rules prescribed in Article sixty-four.
The provisions contained in this article shall not be applicable:
1. When the penalty provided for the offense is equal to or lower than those provided in the first
two paragraphs of this article, in which case the court shall impose the penalty next lower in
degree than that which should be imposed in the period which they may deem proper to apply.
2. When, by imprudence or negligence and with violation of the Automobile Law, to death of a
person shall be caused, in which case the defendant shall be punished by prision correccional
in its medium and maximum periods.
Reckless imprudence consists in voluntary, but without malice, doing or falling to do an act from
which material damage results by reason of inexcusable lack of precaution on the part of the

person performing of failing to perform such act, taking into consideration his employment or
occupation, degree of intelligence, physical condition and other circumstances regarding
persons, time and place.
Simple imprudence consists in the lack of precaution displayed in those cases in which the
damage impending to be caused is not immediate nor the danger clearly manifest.
The penalty next higher in degree to those provided for in this article shall be imposed upon the
offender who fails to lend on the spot to the injured parties such help as may be in this hand to
give. (As amended by R.A. 1790, approved June 21, 1957).
Art. 353. Definition of libel. — A libel is public and malicious imputation of a crime, or of a vice

or defect, real or imaginary, or any act, omission, condition, status, or circumstance tending to
cause the dishonor, discredit, or contempt of a natural or juridical person, or to blacken the
memory of one who is dead.
Art. 358. Slander. — Oral defamation shall be punished by arresto mayor in its maximum
period to prision correccional in its minimum period if it is of a serious and insulting nature;
otherwise the penalty shall be arresto menor or a fine not exceeding 200 pesos.
14
RA 5921 – PHARMACY LAW
Section 26. Markings and inhibition to the sale of drug samples. No sample of any drug,
biological product, device or proprietary medicine, given or intended to be given for free to the
physician and other qualified person by any manufacturer or distributor of its representative or
detailman as part of its program or promotion, may be sold.
The statement "Sample, not for sale" shall appear conspicuously on the container, package or
carton of the drug or device to be given.
PD 169 – REPORTING OF PHYSICIAL INJURIES
1. The attending physician of any hospital, medical clinic, sanitarium or other medical
establishments, or any medical practitioner, who has treated any person for serious or
less serious physical injuries as those injuries are defined in Articles 262, 263, 264 and
265 of the Revised Penal Code shall report the fact of such treatment personally or by
fastest means of communication to the nearest Philippine Constabulary unit without
delay: Provided, That no fee shall be charged for the transmission of such report through
government communication facilities;

15
RPC/SPECIAL LAW APPLICABLE TO PHYSICIANS II
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RA 8504 – AIDS PREVENTION AND CONTROL ACT
Section 2. Declaration of policies. – Acquired Immune Deficiency Syndrome (AIDS) is a

disease that recognizes no territorial, social, political and economic boundaries for which there
is no known cure. The gravity of the AIDS threat demands strong State action today, thus:
(b) The State shall extend to every person suspected or known to be infected with HIV/AIDS full
protection of his/her human rights and civil liberties. Towards this end:
(1) compulsory HIV testing shall be considered unlawful unless otherwise provided in
this Act;
Section 14. Penalties for unsafe practices and procedures. – Any person who knowingly or
negligently causes another to get infected with HIV in the course of the practice of his/her
profession through unsafe and unsanitary practice or procedure is liable to suffer a penalty of
imprisonment for six (6) years to twelve (12) years, without prejudice to the imposition of
administrative sanctions such as, but not limited to, fines and suspension or revocation of the
license to practice his/her profession. The permit or license of any business entity and the
accreditation of hospitals, laboratory, or clinics may be cancelled or withdrawn if said
establishments fail to maintain such safe practices and procedures as may be required by the
guidelines to be formulated in compliance with Sec. 13 of this Act.
Sec. 15. Consent as a requisite for HIV testing. – No compulsory HIV testing shall be allowed.

However, the State shall encourage voluntary testing for individuals with a high risk for
contracting HIV: Provided, That written informed consent must first be obtained. Such consent
shall be obtained from the person concerned if he/she is of legal age or from the parents or
legal guardian in the case of a minor or a mentally incapacitated individual. Lawful consent to
HIV testing of a donated human body, organ, tissue, or blood shall be considered as having
been given when:
(a) a person volunteers or freely agrees to donate his/her blood, organ, or tissue for transfusion,
transplantation, or research;
(b) a person has executed a legacy in accordance with Sec. 3 of Republic Act No. 7170, also
known as the"Organ Donation Act of 1991";
(c) a donation is executed in accordance with Sec. 4 of Republic Act No. 7170.

Section 16. Prohibitions on compulsory HIV testing. – Compulsory HIV testing as a precondition
to employment, admission to educational institutions, the exercise of freedom of abode, entry or
continued stay in the country, or the right to travel, the provision of medical service or any other
kind of service, or the continued enjoyment of said undertakings shall be deemed unlawful.
Section 17. Exception to the prohibition on compulsory testing. – Compulsory HIV testing may
be allowed only in the following instances:
a) When a person is charged with any of the crimes punishable under Articles 264 and 266 as
amended by Republic Act No. 8353, 335 and 338 of Republic Act No. 3815, otherwise known as
the "Revised Penal Code" or under Republic Act No. 7659;
b) When the determination of the HIV status is necessary to resolve the relevant issues under
Executive Order No. 309, otherwise known as the "Family Code of the Philippines"; and
c) When complying with the provisions of Republic Act No. 7170, otherwise known as the
"Organ Donation Act" and Republic Act No. 7719, otherwise known as the "National Blood
Services Act".
16
Section 18. Anonymous HIV testing. – The State shall provide a mechanism for anonymous
HIV testing and shall guarantee anonymity and medical confidentiality in the conduct of such
tests.
Section 26. Insurance for persons with HIV. – The Secretary of Health, in cooperation with the
Commissioner of the Insurance Commission and other public and private insurance agencies,
shall conduct a study on the feasibility and viability of setting up a package of insurance benefits
and, should such study warrant it, implement an insurance coverage program for persons with
HIV. The study shall be guided by the principle that access to health insurance is part of an
individual's right to health and is the responsibility of the State and of society as a whole.
Sec. 30. Medical confidentiality. – All health professionals, medical instructors, workers,
employers, recruitment agencies, insurance companies, data encoders, and other custodians of
any medical record, file, data, or test results are directed to strictly observe confidentiality in the
handling of all medical information, particularly the identity and status of persons with HIV.
Section 34. Disclosure to sexual partners. – Any person with HIV is obliged to disclose his/her
HIV status and health condition to his/her spouse or sexual partner at the earliest opportune
time.
RA 6675 – GENERIC ACT

Section 12. Penalty – A) Any person who shall violate Section 6(a) or 6(b) of this Act shall
suffer the penalty graduated hereunder, viz:
(d) for the fourth and subsequent convictions, the penalty of fine of not less than ten
thousand pesos (P10,000.00) and suspension of his license to practice his profession for
one year or longer at the discretion of the court.
CA No. 3753 – ISSUANCE OF BIRTH AND DEATH CERTIFICATE
Section 5. Registration and Certification of Birth. – The declaration of the physician or midwife
in attendance at the birth or, in default thereof, the declaration of either parent of the newborn

child, shall be sufficient for the registration of a birth in the civil register. Such declaration shall
be exempt from the documentary stamp tax and shall be sent to the local civil registrar not later
than thirty days after the birth, by the physician, or midwife in attendance at the birth or by either
parent of the newly born child.
Any fetus having human features which dies after twenty four hours of existence completely
disengaged from the maternal womb shall be entered in the proper registers as having been
born and having died.
17
NATURE OF MEDICAL PRACTICE
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Effect of Certificate of Registration

No issuance to any candidate who has been:
- -Convicted by a court of competent jurisdiction of any crime involving moral turpitude;
- -Found guilty of immoral or dishonorable conduct after investigation by the Board of Medicine;
- -Declared to be of unsound mind.
HURLEY v. EDDINGFIELD
Duty of Physicians to treat patients

Doctor can refuse to render aid if there is risk to physician’s life.
Law = Actionable
No law = Not actionable
GR: Refusal to render aid is actionable.

XPNs:
1. “Risk” to the physician’s life.
2. Patient is in danger of death.
*Refusal of the physician to attend to a patient under danger of death is not sufficient to

revoke license if there is a risk to the physician’s life.
Duty of Hospitals to treat and admit patients

Public hospital = specialized hospital (ie. NKI, Philippine Heart Center)
Private hospital = can predetermine its patient
*must not be discriminatory or arbitrary.

*Private hospitals can predetermine patients provided that it is not discriminatory,
arbitrary or contrary to public policy.
Doctrine of Reasonable Reliance

*Actionable
DOCTRINE OF APPARENT AUTHORITY = estoppel
XPN: “ostensible” agent of the hospital
In general, a hospital is not liable for the negligence of an independent contractor-physician.

There is, however, an exception to this principle. The hospital may be liable if the physician is
the "ostensible" agent of the hospital. This exception is also known as the "doctrine of apparent
authority."
Under the doctrine of apparent authority a hospital can be held vicariously liable for the
negligent acts of a physician providing care at the hospital, regardless of whether the physician
is an independent contractor, unless the patient knows, or should have known, that the
physician is an independent contractor. The elements of the action have been set out as
follows:
18
"For a hospital to be liable under the doctrine of apparent authority, a plaintiff must show that:
(1) the hospital, or its agent, acted in a manner that would lead a reasonable person to conclude
that the individual who was alleged to be negligent was an employee or agent of the hospital;
(2) where the acts of the agent create the appearance of authority, the plaintiff must also prove
that the hospital had knowledge of and acquiesced in them; and
(3) the plaintiff acted in reliance upon the conduct of the hospital or its agent, consistent with
ordinary care and prudence."
The element of "holding out" on the part of the hospital does not require an express
representation by the hospital that the person alleged to be negligent is an employee. Rather,
the element is satisfied if the hospital holds itself out as a provider of emergency room care
without informing the patient that the care is provided by independent contractors.
The element of justifiable reliance on the part of the plaintiff is satisfied if the plaintiff relies upon
the hospital to provide complete emergency room care, rather than upon a specific physician.
(Nogales v. Capitol Medical Center)
*Justifiable/Reasonable Reliance by the complainant to the hospital’s reliance.

*State in pleading: Reputation of the hospital
*Badges of physicians showing hospital’s name
Good Samaritan Act

We have no law about this.

No alleged act of negligence = not actionable
1. Victim and physician has no doctor-patient relationship
2. No charge
3. No gross negligence
Contract between hospital and physician
DEL ROSARIO v. BENGZON

Facts: A class suit is filed by the PMA to declare Generics Act as unconstitutional.
Held: Constitutionality upheld.
The prohibition against the use by doctors of "no substitution" and/or words of similar import in

their prescription, is a valid regulation to prevent the circumvention of the law. It secures to the
patient the right to choose between the brand name and its generic equivalent since his doctor
is allowed to write both the generic and the brand name in his prescription form.
In any event, no private contract between doctor and patient may be allowed to override the
power of the State to enact laws that are reasonably necessary to secure the health, safety,
good order, comfort, or general welfare of the community. This power can neither be abdicated
nor bargained away.
RAMOS v. CA
Facts: MR filed by the hospital to be exonerated from liability due to a surgeon and
anesthesiologist’s negligence.
Held: DLSMC maintains that first, a hospital does not hire or engage the services of a
consultant, but rather, accredits the latter and grants him or her the privilege of maintaining a
clinic and/or admitting patients in the hospital upon a showing by the consultant that he or she
19
possesses the necessary qualifications, such as accreditation by the appropriate board
(diplomate), evidence of fellowship and references. Second, it is not the hospital but the patient
who pays the consultant’s fee for services rendered by the latter. Third, a hospital does not
dismiss a consultant; instead, the latter may lose his or her accreditation or privileges granted
by the hospital. Lastly, DLSMC argues that when a doctor refers a patient for admission in a
hospital, it is the doctor who prescribes the treatment to be given to said patient. The hospital’s
obligation is limited to providing the patient with the preferred room accommodation, the
nutritional diet and medications prescribed by the doctor, the equipment and facilities necessary
for the treatment of the patient, as well as the services of the hospital staff who perform the
ministerial tasks of ensuring that the doctor’s orders are carried out strictly.
Independent contractor
Same as labor code definition.
Contract between patient and hospital
MANILA DOCTORS HOSPITAL v. SO UN CHUA and VICKY TY (supra)

NOGALES v. CAPITOL MEDICAL CENTER
Patient-Physician Confidentiality/Privilege Communication

The physician-patient privilege creates a zone of privacy, intended to preclude the humiliation of
the patient that may follow the disclosure of his ailments. (Krohn v. CA)
KROHN v. CA

Facts: A confidential psychiatric evaluation report is being presented in evidence before the trial
court in a petition for annulment of marriage grounded on psychological incapacity. The witness
testifying on the report is the husband who initiated the annulment proceedings, not the
physician who prepared the report. The subject of the evaluation report is the wife, who invokes
the rule on privileged communication between physician and patient, and seeks to enjoin her
husband from disclosing the contents of the report. RTC allowed the admission of the
psychiatric evaluation report as evidence because it is material to the case and because there
was no objection on the part of the wife during the time it was referred to in the complaint. CA
affirmed.
Issue: Whether or not the presentation of the report is a breach of the privileged communication
rule
Held: No. Moreover, the person against whom the privilege is claimed is not one duly

authorized to practice medicine, surgery or obstetrics. He is simply the patient's husband who
wishes to testify on a document executed by medical practitioners. Plainly and clearly, this does
not fall within the claimed prohibition. Neither can his testimony be considered a circumvention
of the prohibition because his testimony cannot have the force and effect of the testimony of the
physician who examined the patient and executed the report.
Prohibition applies only to a physician. In the instant case, the person against whom the
privilege is claimed is not one duly authorized to practice medicine, surgery or obstetrics. He is
simply the patient's husband who wishes to testify on a document executed by medical
practitioners. Plainly and clearly, this does not fall within the claimed prohibition. Neither can his
testimony be considered a circumvention of the prohibition because his testimony cannot have
the force and effect of the testimony of the physician who examined the patient and executed
the report.
20
LIM v. CA
Facts: Petitioner Nelly Lim and Respondent Juan Lim are lawfully married to each other. Juan
filed a petition for annulment of marriage in the ground that Nelly has been suffering from
schizophrenia before, during, and even after their marriage. He presented three witnesses, one
of which is the Chief of the Female Services of National Mental Hospital, Dr. Acampado. The
counsel for Juan orally applied for the issuance of subpoena ad testificandum, the counsel for
Nelly opposed the motion on the ground that the testimony sought to be elicited from the
witness is privileged since the latter had examined the petitioner in a professional capacity and
had diagnosed her to be suffering from schizophrenia. Nevertheless, the subpoena was issued.
Counsel for Nelly filed an urgent motion to quash the subpoena. Respondent‘s counsel claimed
that the witness will testify as an expert witness and would not testify on any information
acquired while attending to the petitioner in a professional capacity. Lower Court ruled in favor
of Juan. CA also ruled in favor of Juan stating that Nelly failed to establish the confidential
nature of the testimony given by Dr. Acampado.
Issue: Whether or not there is breach of confidentiality clause
Held: No. In order that the privilege may be successfully claimed, the following requisites must
concur:
1. the privilege is claimed in a civil case;
2. the person against whom the privilege is claimed is one duly authorized to practice medicine,
surgery or obstetrics;
3. such person acquired the information while he was attending to the patient in his professional
capacity;
4. the information was necessary to enable him to act in that capacity; and
5. the information was confidential, and, if disclosed, would blacken the reputation (formerly

character) of the patient.
These requisites conform with the four (4) fundamental conditions necessary for the
establishment of a privilege against the disclosure of certain communications, to wit:
1. The communications must originate in a confidence that they will not be disclosed.
2. This element of confidentiality must be essential to the full and satisfactory maintenance of
the relation between the parties.
3. The relation must be one which in the opinion of the community ought to be sedulously
fostered
4. The injury that would inure to the relation by the disclosure of the communications must be
greater than the benefit thereby gained for the correct disposal of litigation.

The physician may be considered to be acting in his professional capacity when he attends to
the patient for curative, preventive, or palliative treatment. Thus, only disclosures which would
have been made to the physician to enable him "safely and efficaciously to treat his patient" are
covered by the privilege.
It is to be emphasized that "it is the tenor only of the communication that is privileged. The mere
fact of making a communication, as well as the date of a consultation and the number of
consultations, are therefore not privileged from disclosure, so long as the subject communicated
is not stated. One who claims this privilege must prove the presence of these aforementioned
requisites. Petitioner failed to discharge that burden. Dr. Acampado was presented and qualified
as an expert witness. She did not disclose anything obtained in the course of her examination,
interview and treatment of the petitioner; moreover, the facts and conditions alleged in the
hypothetical problem did not refer to and had no bearing on whatever information or findings the
doctor obtained while attending to the patient.
21
The statutory physician-patient privilege, though duly claimed, is not violated by permitting a
physician to give expert opinion testimony in response to a strictly hypothetical question in a
lawsuit involving the physical mental condition of a patient whom he has attended
professionally, where his opinion is based strictly upon the hypothetical facts stated, excluding
and disregarding any personal professional knowledge he may have concerning such patient.
CHAN v. CHAN
*premature. Complaint palang to.
*subpoena is available only upon presentation of evidence during trial
The physician-patient privileged communication rule essentially means that a physician who
gets information while professionally attending a patient cannot in a civil case be examined
without the patient’s consent as to any facts which would blacken the latter’s reputation. This
rule is intended to encourage the patient to open up to the physician, relate to him the history of
his ailment, and give him access to his body, enabling the physician to make a correct diagnosis
of that ailment and provide the appropriate cure. Any fear that a physician could be compelled in
the future to come to court and narrate all that had transpired between him and the patient might
prompt the latter to clam up, thus putting his own health at great risk.
Sec. 24, RRE. Disqualification by reason of privileged communication. — The following

persons cannot testify as to matters learned in confidence in the following cases:
xxx
(c) A surgeon authorized to practice medicine, surgery or obstetrics cannot in a civil case,
without the consent of the patient, be examined as to any advice or treatment given by him or
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
Patient-litigant waiver
General consent
Informed consent/Assumption of Risk
From a purely ethical norm, informed consent evolved into a general principle of law that a

physician has a duty to disclose what a reasonably prudent physician in the medical community
in the exercise of reasonable care would disclose to his patient as to whatever grave risks of
injury might be incurred from a proposed course of treatment, so that a patient, exercising
ordinary care for his own welfare, and faced with a choice of undergoing the proposed
treatment, or alternative treatment, or none at all, may intelligently exercise his judgment by
reasonably balancing the probable risks against the probable benefits.
There are four essential elements a plaintiff must prove in a malpractice action based upon the
doctrine of informed consent: "(1) the physician had a duty to disclose material risks; (2) he
failed to disclose or inadequately disclosed those risks; (3) as a direct and proximate result of
the failure to disclose, the patient consented to treatment she otherwise would not have
consented to; and (4) plaintiff was injured by the proposed treatment." The gravamen in an
informed consent case requires the plaintiff to "point to significant undisclosed information
relating to the treatment which would have altered her decision to undergo it.
22
DR. LI’s v. SPS. SOLIMAN
The doctrine of informed consent within the context of physician-patient relationships goes far
back into English common law. As early as 1767, doctors were charged with the tort of "battery"
(i.e., an unauthorized physical contact with a patient) if they had not gained the consent of their
patients prior to performing a surgery or procedure. In the United States, the seminal case was
Schoendorff v. Society of New York Hospital which involved unwanted treatment performed by
a doctor. Justice Benjamin Cardozo’s oft-quoted opinion upheld the basic right of a patient to
give consent to any medical procedure or treatment: "Every human being of adult years and
sound mind has a right to determine what shall be done with his own body; and a surgeon who
performs an operation without his patient’s consent, commits an assault, for which he is liable in
damages."

23
MEDICAL MALPRACTICE
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Medical Malpractice
Form of negligence consisting of physicians failure to render which causes bodily harm.
Negligence – questions of facts
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.
Illegal practice of Medicine

No necessary license but practice medicine.
Practice of medicine by any person not qualified and not duly-admitted to perform medical acts
in compliance with law.
Penalties:
Pursuant to Sec.28, Art. IV, Medical Act of 1959 as amended – Any person found guilty of
―illegal practice‖ shall be punished by a fine of not less than one thousand pesos or more than
ten thousand pesos with subsidiary imprisonment in case of insolvency or by imprisonment of
not less than one year no more than five years, or by both such fine and imprisonment, in the

discretion of the court.
Elements of Medical Negligence

1. Duty
2. Breach (standard care)
3. Injury (death certificate suffices)
4. Proximate causation (Cause-in-fact)
*each element must be proven by preponderance of evidence
Elements of Medical Malpractice
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.
Standard of Care – locality rule, national standard
Customary Care
24
Reasonable Care
Cause-in-fact, “but for” test v. “substantial factor” test
Legal cause (proximate cause)

That cause, which, in natural continuous sequence, unbroken by an efficient intervening cause,
produces the injury and without which the result would not have occurred. 1. There must be a
direct physical connection between the wrongful act of the physician and the injury sustained by
the patient. 2. The cause or the wrongful act of the physician must be efficient and must not be
too remote from the development of the injury suffered by the patient. 3. The result must be the
natural continuous and probable consequences.
URBANO v. IAC
Facts:
Held: ... "that cause, which, in natural and continuous sequence, unbroken by any efficient
intervening cause, produces the injury, and without which the result would not have
occurred."And more comprehensively, "the proximate legal cause is that acting first and
producing the injury, either immediately or by setting other events in motion, all constituting a
natural and continuous chain of events, each having a close causal connection with its
immediate predecessor, the final event in the chain immediately effecting the injury as a natural

and probable result of the cause which first acted, under such circumstances that the person
responsible for the first event should, as an ordinarily prudent and intelligent person, have
reasonable ground to expect at the moment of his act or default that an injury to some person
might probably result therefrom."
PHOENIX CONSTRUCTION v. IAC
LYONS v. MIDNIGHT SUN TRANSPORTATION

Facts:
Held: The sudden emergency doctrine is a rule of law which states that a person confronted
with a sudden and unexpected peril, not resulting from that person's own negligence, is not
expected to exercise the same. The sudden emergency doctrine arose as a method of

ameliorating the, sometimes harsh, "all or nothing" rule in contributory negligence systems.
PERKINS v. TEXAS AND NEW ORLEANS RAILROAD CO.
Elements of Reckless Imprudence/Simple Imprudence

Reckless imprudence – no intent
Illegal practice – involves intent
*both punishable if resulted to bodily harm
Simple negligence, penalized under what is now Article 365 of the Revised Penal Code, is
defined as "a mere lack of prevision in a situation where either the threatened harm is not
immediate or the danger not openly visible." Put in a slightly different way, the gravamen of the
offense of simple negligence is the failure to exercise the diligence necessitated or called for the
25
situation which was not immediately life-destructive but which culminated in the present case, in
the death of a human being three (3) days later. (Carillo vs. People of the Philippines)
*Conspiracy requires intent so, no reckless imprudence. (Villareal v. PP)
*Material damage results from the reckless imprudence = legal cause

- not intentional
- proven beyond reasonable doubt
(conviction of reckless imprudence is not a crime involving moral turpitude, hence not a
bar to take the bar)
VILLAREAL v. PP
Degree of Diligence required
Applicable laws
Defenses in medical malpractice. See RRC 130 section 27
*4 YEARS – action for quasi-delict (Art.1146)
RULE 130 Rules of Admissibility

Section 27. Offer of compromise not admissible. — In civil cases, an offer of compromise is not
an admission of any liability, and is not admissible in evidence against the offeror.

In criminal cases, except those involving quasi-offenses (criminal negligence) or those allowed
by law to be compromised, an offer of compromised by the accused may be received in
evidence as an implied admission of guilt.
A plea of guilty later withdrawn, or an unaccepted offer of a plea of guilty to lesser offense, is not
admissible in evidence against the accused who made the plea or offer.
An offer to pay or the payment of medical, hospital or other expenses occasioned by an injury is
not admissible in evidence as proof of civil or criminal liability for the injury.
Prescription
SPS. SANTOS v. PIZARDO

Facts: In an Information dated April 25, 1994, Dionisio M. Sibayan (Sibayan) was charged with
Reckless Imprudence Resulting to Multiple Homicide and Multiple Physical Injuries in
connection with a vehicle collision between a southbound Viron Transit bus driven by Sibayan
and a northbound Lite Ace Van, which claimed the lives of the van’s driver and three (3) of its
passengers, including a two-month old baby, and caused physical injuries to five (5) of the van’s
passengers. After trial, Sibayan was convicted and sentenced to suffer the penalty of
imprisonment for two (2) years, four (4) months and one (1) day to four (4) years and two (2)
months. However, as there was a reservation to file a separate civil action, no pronouncement
of civil liability was made by the municipal circuit trial court in its decision promulgated on
December 17, 1998. On October 20, 2000, petitioners filed a complaint for damages against
Sibayan, Viron Transit and its President/Chairman, Virgilio Q. Rondaris, with the Regional Trial
Court of Quezon City, pursuant to their reservation to file a separate civil action.3They cited
therein the judgment convicting Sibayan. Viron Transit moved to dismiss the complaint on the
grounds of improper service of summons, prescription and laches, and defective certification of
non-forum shopping. It also sought the dropping of Virgilio Q. Rondaris as defendant in view of
26
the separate personality of Viron Transit from its officers. Petitioners opposed the motion to
dismiss contending, among others, that the right to file a separate action in this case prescribes
in ten (10) years reckoned from the finality of the judgment in the criminal action. As there was
no appeal of the decision convicting Sibayan, the complaint which was filed barely two (2) years
thence was clearly filed within the prescriptive period.
Held: A waiver of any of the civil actions extinguishes the others. The institution of, or the
reservation of the right to file, any of said civil actions separately waives the others. The
reservation of the right to institute the separate civil actions shall be made before the
prosecution starts to present its evidence and under circumstances affording the offended party
a reasonable opportunity to make such reservation.
Besides, in cases of negligence, the offended party has the choice between an action to enforce
civil liability arising from crime under the Revised Penal Code and an action for quasi delict
under the Civil Code.
CASUPANAN v. LAROYA
Facts: Laroya filed a criminal case against Casupanan for Reckless Imprudence Resulting in
damage to property while the latter (accused) and the vehicle owner filed a civil case against
Laroya for quasi-delict.
Held: Any aggrieved person can invoke these articles provided he proves, by preponderance of
evidence, that he has suffered damage because of the fault or negligence of another. Either the
private complainant or the accused can file a separate civil action under these articles. There is
nothing in the law or rules that state only the private complainant in a criminal case may invoke

these articles.
Since the present Rules require the accused in a criminal action to file his counterclaim in a
separate civil action, there can be no forum-shopping if the accused files such separate civil
action.
The accused, who is presumed innocent, has a right to invoke Article 2177 of the Civil Code, in
the same way that the offended party can avail of this remedy which is independent of the
criminal action. To disallow the accused from filing a separate civil action for quasi-delict, while
refusing to recognize his counterclaim in the criminal case, is to deny him due process of law,
access to the courts, and equal protection of the law.

CANCIO, JR. v. ISIP
Facts: Petitioner, assisted by a private prosecutor, filed three cases of Violation of B.P. No. 22
and three cases of Estafa, against respondent for allegedly issuing the following checks without
sufficient funds, to wit: 1) Interbank Check No. 25001151 in the amount of P80,000.00; 2)
Interbank Check No. 25001152 in the amount of P 80,000.00; and 3) Interbank Check No.
25001157 in the amount of P30,000.00. The Office of the Provincial Prosecutor dismissed
Criminal Case No. 13356, for Violation of B.P. No. 22 covering check no. 25001151 on the
ground that the check was deposited with the drawee bank after 90 days from the date of the
check. The two other cases for Violation of B.P. No. 22 (Criminal Case No. 13359 and 13360)
were filed with and subsequently dismissed by the Municipal Trial Court of Guagua, Pampanga,
Branch 1, on the ground of "failure to prosecute." Meanwhile, the three cases for Estafa were
filed with the Regional Trial Court of Pampanga, Branch 49, and docketed as Criminal Case
Nos. G-3611 to G-3613. On October 21, 1997, after failing to present its second witness, the
prosecution moved to dismiss the estafa cases against respondent. The prosecution likewise
27
reserved its right to file a separate civil action arising from the said criminal cases. On the same
date, the trial court granted the motions of the prosecution. Thus- Upon motion of the
prosecution for the dismissal of these cases without prejudice to the refiling of the civil aspect
thereof and there being no comment from the defense, let these cases be dismissed without
prejudice to the refiling of the civil aspect of the cases.
On December 15, 1997, petitioner filed the instant case for collection of sum of money, seeking
to recover the amount of the checks subject of the estafa cases. On February 18, 1998,
respondent filed a motion to dismiss the complaint contending that petitioner’s action is barred
by the doctrine of res judicata. Respondent further prayed that petitioner should be held in
contempt of court for forum-shopping.
Issue: 1) whether the dismissal of the estafa cases against respondent bars the institution of a
civil action for collection of the value of the checks subject of the estafa cases; and
2) whether the filing of said civil action violated the anti-forum-shopping rule.
Held: The failure to make a reservation in the criminal action is not a waiver of the right to file a
separate and independent civil action based on these articles of the Civil Code.
In other words, petitioner’s cause of action is the respondent’s breach of the contractual
obligation. It matters not that petitioner claims his cause of action to be one based on delict.
In the instant case, it must be stressed that the action filed by petitioner is an independent civil
action, which remains separate and distinct from any criminal prosecution based on the same

act.
In the same vein, the filing of the collection case after the dismissal of the estafa cases against
respondent did not amount to forum-shopping. The essence of forum-shopping is the filing of
multiple suits involving the same parties for the same cause of action, either simultaneously or
successively, to secure a favorable judgment.
Art.1146 – The following actions must be instituted within four (4) years:
1. Upon an injury to the rights of the plaintiff;

2. Upon a quasi-delict

*No prohibition to file two (2) civil actions*
LIMITATION: One cannot recover twice for damages for the same act or omission.
Art. 102, RPC – Restitution, Reparation, and Indemnification
Why civil action > criminal action?

*residence of plaintiff (venue)
- more practical than criminal jurisdiction (situs)
When waived: AFTER presentation of evidence by prosecution
*forum-shopping
28
LESSON: How to handle issues when it comes to reckless imprudence
- Arising from crime
- From Art. 2176 (quasi-delict)
Discovery rule/continuous treatment rule
Liability of hospitals: vicarious and direct liabilities

Vicarious liability means the responsibility of a person, who is not negligent, for the wrongful
conduct or negligence of another.
Res Ipsa Loquitor/Common knowledge

“The thing speaks for itself”; nature of the wrongful act or injury is suggestive of negligence.
General rule: expert testimony is necessary to prove that a physician has done a negligent act
or that has deviated from the standard of medical practice.
Requisites of Res Ipsa Loquitur Doctrine:
1. The accident must be of a kind which ordinarily does not occur in the absence of someone‘s
negligence;
2. It must be caused by an agency or instrumentality within the exclusive control of the
defendant;
3. It must not have been due to any voluntary action or contribution on the part of the plaintiff.

Some cases wherein the Doctrine of Res Ipsa Loquitor has been applied:
1. Objects left in the patient‘s body at the time of caesarian section;
2. Injury to a healthy part of the body;
3. Removal of a wrong part of the body when another part wad intended;
4. Infection resulting from unsterilized instruments;
5. Failure to take radiographs to diagnose a possible fracture;
Instances where the Doctrine of Res Ipsa Loquitor does not apply:
1. Where the Doctrine of Calculated Risk is applicable;
2. When an accepted method of medical treatment involves hazards which may produce
injurious results regardless of the care exercised by the physician.

3. Bad Result Rule;
4. Honest Errors of judgment as to Appropriate Procedure;
5. Mistake in the Diagnosis
In most medical malpractice suits, there is a necessity for a physician to give his expert medical
opinion to prove whether acts or omissions constitute medical negligence. This doctrine has
been regarded as rule of sympathy to counteract the conspiracy of silence‘
Contemporaneous negligence
Borrowed Servant Doctrine
29
This doctrine provides that once the surgeon enters the operating room and takes charge of the
proceedings, the acts or omissions of operating room personnel, and any negligence associated
with such acts or omissions, are imputable to the surgeon. While the assisting physicians and
nurses may be employed by the hospital, or engaged by the patient, they normally become the
temporary servants or agents of the surgeon in charge while the operation is in progress, and
liability may be imposed upon the surgeon for their negligent acts under the doctrine
of respondeat superior. (Nogales v. Capitol Medical Center)
Captain-of-the-Ship Doctrine
This doctrine enunciates 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.

30
EXPERT WITNESS
*************************************************************************************************************
Who can be an expert witness?

 Experience
 Skill
 Knowledge
*Special training and practical experience.
*Issue is not admissibility.
*Weight is different of evidence.
*the unquestionable knowledge of expert witnesses
Net Opinion Rule
Hypothetical Questions
Direct Examination/ Cross-examination
Use of Learned treatise, books, and journals

31
PHYSICAL INJURIES
*************************************************************************************************************
CRIME ELEMENTS PENALTY NOTES
Art. 262. Mutilation Mode 1. Intentionally Reclusion Temporal
Any person who shall mutilating another by to Reclusion Perpetua Intent is to specifically
intentionally mutilate depriving him, either totally to castrate
another by depriving or partially, of some essential Prision Mayor in its
him, either totally or organ for reproduction; medium MUTILIATION – the
partially, or some (Mutilation) and maximum periods lopping or clipping off of
essential organ of – Any other some part of the body
reproduction. Elements: intentional mutilation
(1) There be a castration, CASTRATION -
that is, mutilation of organs intentionally mutilating
necessary for generation, another by depriving
such as the penis or him, either totally or
ovarium; partially, of some
(2) The mutilation is caused essential organ for
purposely and deliberately reproduction
Mode 2. Intentionally making MAYHEM -

other mutilation, that is, by intentionally making
lopping or clipping off any other mutilation other
part of the body of the than some essential
offended party, other than organ for reproduction
the and to deprive him of
essential organ for that part of the body

reproduction, to deprive him
of that part of his body.
(Mayhem).
Intent to mutilate must be

established. If there is no
intent, the crime is only
serious physical injury.
The offender must have the

intention to deprive the
offended party of a part of
his body. If there is no such

intention, the crime will be
serious physical injuries.
Art. 263. Serious HOW COMMITTED: Prision Mayor – under Intent is to be involved
physical injuries 1. Wounding; no. 1 in a tumultuous affray.
Any person who shall 2. Beating; Prision Correccional
wound, beat, or 3. Assaulting; or in its medium and DEFORMITY must be
assault another, shall 4. Administering maximum periods – pointed out - it must be
be guilty of the crime injurious under no. 2 permanent.
of serious physical substances. Prision Correccional
injuries and shall Levels of Penalty: When in its minimum and DEFORMITY includes
suffer: the injured person, in medium periods – a scar, two front teeth
consequence of the physical under no. 3
1. If in consequence of injuries inflicted— Arresto Mayor in its QUALIFIED SPI –
the physical injuries maximum period to committed in relation to
inflicted, the injured (1) Becomes insane, Prision Correccional parricide/murder. It will
32
person shall become imbecilic, impotent or blind in its minimum period not apply to parent who
insane, imbecile, (2) Loses the use of speech – under no. 4 excessively chastised
impotent, or blind; or the power to hear or to his/her child (XPN).
smell, or loses an eye, a
2. If in consequence of hand, afoot, an arm, or a leg; Parent can still be
the physical injuries (3) Loses the use of any charged with physical
inflicted, the person such member; injuries because the
injured shall have lost (4) Becomes incapacitated rule specifically stated
the use of speech or for the work in which he was that the exception only
the power to hear or to theretofore habitually applies in QSPI.
smell, or shall have engaged, in consequence of
lost an eye, a hand, a the physical injuries inflicted; In physical injuries,
foot, an arm, or a leg (5) Becomes deformed; or there must not be intent
or shall have lost the (6) Loses any other member to kill, otherwise the
use of any such of his body; crime is frustrated/
member, or shall have (7) Loses the use thereof; or attempted murder or
become incapacitated (8) becomes ill or homicide as the case
for the work in which incapacitated for the may be.
he was therefor performance of the work in
habitually engaged; which he was habitually Impotence under first
engaged for more than 90 type means an inability
3. If in consequence of days in consequence of the to copulate. It is used
the physical injuries physical injuries inflicted; synonymously with
inflicted, the person (9) Becomes ill or ‘sterility’.
injured shall have incapacitated for labor for
become deformed, or more than 30 days (but must Penalty under the first
shall have lost any not be more than 90 days), type is one degree

other part of his body, as a result of the physical higher when the victim
or shall have lost the injuries inflicted. is under 12 years of
use thereof, or shall age.
have been ill or Deformity – physical
incapacitated for the ugliness, permanent and Blindness under the
performance of the definite abnormality. It must second type must be of
work in which he as be conspicuous and visible. two eyes. If there is
habitually engaged for loss of one eye only,
a period of more than the serious physical
ninety days injuries is of the second
Elements of deformity: type.
4. If the physical (a) physical ugliness,
injuries inflicted shall (b) permanent and definite Loss of power to hear

have caused the abnormality, and under the second type
illness or incapacity (c) it must be conspicuous must be of both ears. If
for labor of the injured and visible. All these hearing in only one ear
person for more than elements must concur. is lost, it falls under the
thirty days. third type.
Illness – when the wound
inflicted did not heal with a Loss of the use of
certain period of time. hand, or incapacity for
work under the second
type, must be
permanent.
All the body parts

mentioned in the
second type are
principal members of
33
the body (eye, hand,
foot etc.)
The third type covers

any other part of the
body which is not a
principal member of the
body.
Art. 264. (1) Offender inflicted upon Penalties established Must result to Serious
Administering another any serious physical by the next Physical Injuries.
injurious substances injury; preceding article
or beverages (2) It was done by knowingly No intent to kill.
Any person who, administering to him any
without intent to kill, injurious substance or Only intent to
shall inflict upon beverages or by taking administer the
another any serious, advantage of his weakness substance.
physical injury, by of mind or credulity;
knowingly (3) He had no intent to kill.
administering to him
any injurious
substance or
beverages or by
taking advantage of
his weakness of mind
or credulity.

Art. 265. Less (1) Offended party is Arresto Mayor Intent to humiliate is
serious physical incapacitated for labor for 10 absorbed as an
injuries days or more (but not more Whenever less aggravating
Any person who shall than 30 days), or needs serious physical circumstance.
inflict upon another medical attendance for the injuries shall have
physical injuries not same period of time; been inflicted with the Manifest intent to
described in the (2) The physical injuries manifest intent to kill humiliate or other
preceding articles, but must not be those described or offend the injured circumstance which
which shall in the preceding articles. person, or under adds ignominy,
incapacitate the circumstances adding
offended party for ignominy to the Qualified as to
labor for ten days or offense in addition to penalty

more, or shall require the penalty of Arresto (1) A fine not exceeding
medical assistance for Mayor, a fine not P 500.00, in addition to
the same period, shall exceeding 500 pesos arresto mayor, when
be guilty of less shall be imposed. (a) There is a manifest
serious physical intent to insult or offend
injuries. Prision Correccional the injured person; or
in its minimum and (b) There are
Any less serious medium periods circumstances adding
physical injuries ignominy to the
inflicted upon the offense.
offender's parents, (2) A higher penalty is
ascendants, imposed when the
guardians, curators, victim is either:
teachers, or persons (a) The offender’s
of rank, or persons in parents, ascendants,
34
authority, provided guardians, curators or
that, in the case of teachers; or
persons in authority, (b) Persons of rank or
the deed does not person in authority,
constitute the crime of provided the crime is
assault upon such not direct assault.
person.
Art. 266. Slight Mode 1. Physical injuries 1.Arresto Menor Kinds of SLPI
physical injuries and incapacitated the offended 2.Arresto Menor or a
maltreatment party for labor from 1-9 days, fine not exceeding Incapacity for labor 1-9
1. When the offender OR required medical 200 pesos and days
has inflicted physical attendance during the same censure
injuries which shall period; 3.Arresto Menor in its Did not incapacitate for
incapacitate the minimum period or a labor or did not need
offended party for Mode 2. Physical injuries fine not exceeding 50 medical attendance
labor from one to nine which did not prevent the pesos
days, or shall require offended party from Ill-treat another by deed
medical attendance engaging in his habitual work without causing injuries
during the same or which did not require
period. medical attendance; This involves even ill-
treatment where there
2. When the offender Mode 3. Ill-treatment of is no sign of injury
has caused physical another by deed without requiring medical
injuries which do not causing any injury. treatment.
prevent the offended
party from engaging in Slapping the offended

his habitual work nor party is a form of ill-
require medical treatment which is a
assistance. form of slight physical
injuries.
3. When the offender
shall ill-treat another But if the slapping is
by deed without done to cast dishonor
causing any injury. upon the person
slapped, or to humiliate
or embarrass the
offended party out of a
quarrel or anger, the
crime is slander by

deed.
Between slight physical

injuries and less
serious
physical injuries, not
only the healing
duration of the injury
will be considered but
also the medical
attendance required to
treat the injury.
So the healing duration

may be one to nine
35
days, but if the medical
treatment continues
beyond nine days, the
physical injuries would
already qualify as less
serious physical
injuries.
The medical treatment

may have lasted for
nine days, but if the
offended party is still
incapacitated for labor
beyond nine days, the
physical injuries are
already considered less
serious physical
injuries.
Where there is no
evidence of actual
injury, it is only slight
physical injuries.
In the absence of proof

as to the period of the
offended party’s

incapacity for labor or
of the required medical
attendance, the crime
committed is slight
physical injuries.
36

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