MEDICAL
safeguards to guarantee the safety of the patient
JURISPRUDENCE
Deals with the aspect of law and legal concepts
in relations with the practice of medicine
INCLUDES
o Licensure and regulatory laws;
o Physician-patient-hospital relationship
together with the other paramedical
personnel, their rights, duties and
obligations;
o Liabilities for non-compliance with the
law
PURPOSES
To protect the public from charlatans;
To promote professionalism and foster
professional interrelationship;
To develop awareness of the rights, duties and
obligations of the patient, physician, and the
hospital;
To control the increasing number of medical
malpractice suits against physicians;
To explain the purpose and procedure of certain
legislation;
To study the need to amend, repeal our health
care laws in harmony with the recent scientific
and social development
ADVERSARIAL TRIAL SYSTEM
Philippine courts is a court litigation where there
is competition of inconsistent version of facts
and theories in law during trial;
Each party to the contest is given equal
opportunity to investigate the case, gather and
present all proofs in support of his allegation,
and give argument that his contention is correct;
Ultimate purpose is for a just solution.
it often undermines the pursuit of truth as the
opposing parties seek to win at all cost without
the obligation to reveal the facts which may be
detrimental to their case. The lawyer aims to win
the fight not to help the court discover facts or
establish the truth.
SOURCES OF LAW
Constitution
Laws enacted by the legislative body
Decrees, Orders, Proclamation, Letters, CA, BP,
RA
Administrative acts, orders, Rules and
Regulation
Local customs
Generally accepted principles of International
law
LAW AND PRACTICE OF MEDICINE
The state must maintain high standard of
practice of setting up rules and regulations with
regards to qualifications and procedure for the
admission to the profession. These are legal
and impose liability to the practitioner who
through this act or omission causes damage or
injury to the health and welfare of the patient.
The right to regulate the practice of medicine is
based on the police power of the state.
LICENSURE AND REGULATORY LAWS
Administrative Bodies
BOARD OF MEDICAL EDUCATION
o Primarily concerned with the
standardization and regulation of
medical education
PROFESSIOAL REGULATIONS COMMISSIONS
o To have general supervision and
regulation of all professions requiring
examinations which included the
practice of medicine
BOARD OF MEDICINE
o Its primary duties are to give
examinations for the registration of
physicians and supervision, control and
regulation of the practice of medicine
BOARD OF MEDICIAL EDUCATION
Composition
Chairman Secretary of Education
Members Secretary of Health
Director, Bureau of Private
Schools
Chairman, Board of Medicine
Representative, PMA
Council of Deans, APMC
Dean, UP-College of Medicine
Functions
1. To determine and prescribe the requirements of
admission into a recognized college of Medicine;
2. To determine and prescribe requirements for
the minimum physical facilities;
3. To determine and prescribe the minimum
number and qualifications of teaching
personnel;
4. To determine and prescribe the minimum
required curriculum;
5. To authorize the implementation of
experimental curriculum;
6. To accept applications for admission to a medical
school;
7. To select, determine and approve hospitals for
training;
8. To promulgate, prescribe and enforce the
necessary rules and regulations
PROFESSIONAL REGULATIONS COMMISSION
Composition
Commissioner
Two Associate Commissioner
Exercise of Power and Functions of the Commission
Exercise general administrative, executive and
policy-making functions for the whole agency

BOARD OF MEDICINE
Composition
Six members appointed by the president from a
list submitted by the Executive Council of the
PMA
Qualifications
Natural-born citizen
Duly-registered physician
In the practice of medicine for at least 10 years
Of good moral character and of recognized
standing in the medical profession as certified by
PMA
Not a member of nay faculty of any medical
school (including any pecuniary interest)
Powers, Functions and Responsibilities
1. To determine and prepare the contents of the
licensure examinations;
2. To promulgate such rules and regulations for the
proper conduct of the examinations, correction
and registration;
3. To administer oath;
4. To study the conditions affecting the practice of
medicine;
5. To investigate violations, issue summons,
subpoena and subpoena duces tecum;
6. To conduct hearings or investigations of
administrative cases filed before them;
7. To promulgate decisions on such administrative
cases subject to the review of the Commission;
8. To issue certificate of registration;
9. To suspend, revoke or reissue certificate of
registration for causes provided by law or by the
rules and regulations promulgated;
10. To promulgate, with the approval of PRC, rules
and regulations in harmony with the provisions
of the Medical Act of 1959 and necessary for the
proper practice of medicine
ADMISSION TO THE PRACTICE OF MEDICINE
Prerequisites
1. Minimum age requirement
- At least 21 years of age
2. Proper Educational Background
- Requirements for Admission in the College
of Medicine
o Holder of a Bachelors degree;
o Not convicted of any crime involving
turpitude;
o Certificate of Eligibility from the
Board of Medical Education;
o Good moral character
3. Examination Requirements
- Must have passed the corresponding Board
Examination
- Preliminary Examination
o At least 19 years of age
o Of good moral character
o Have completed the first two years
of the medical course;
- Final or Complete Examination
o Citizen of the Philippines or of any
country who has submitted
competent and conclusive
o Documentary evidence confirmed
by the DFA showing that his
countrys existing laws permit
citizens of the Philippines to practice
medicine under the same rules and
regulations governing citizens
thereof (RECIPROCITY RULES)
4. Holder of certificate of registration
- No issuance to any candidate who has been:
o Convicted by a court of competent
jurisdiction of any crime involving
moral turpitude;
o Found guilty of immoral or
dishonourable conduct after
investigation by the Board of
Medicine;
o Declared to be of unsound mind
SCOPE OF EXAMINATION
Preliminary
Anatomy and Histology
Physiology
Biochemistry
Microbiology and Parasitology
Final
Pharmacology and Therapeutics
Pathology
Medicine
Obstetrics and Gynecology
Pediatrics and Nutrition
Surgery and Ophthalmology,
Otorhinolaryngology
Preventive Medicine and Public Health
Legal Medicine, Ethics and Medical
Jurisprudence
PRACTICE OF MEDICINE
What is the practice of medicine?
o It is a privilege or franchise granted by
the State to any person to perform
medical acts upon compliance with the
law, that is, the Medical Act of 1959 as
amended which has been promulgated
by the State in the exercise of police
power to protect its citizenry from
unqualified practitioners of medicine.
o It is diagnosing and applying and the
usage of medicine and drugs of curing,
mitigating, or relieving bodily disease or
conditions.
ACTS CONSTITUTING THE PRACTICE OF MEDICINE
(pursuant to Sec. 10, Art. III of the Medical Act of 1959 as
amended):
A. Who shall for compensation, fee, reward in any
form paid to him directly or through another, or
even without the same, physically examine any
person, and diagnose, treat, operate or prescribe
any remedy for human disease, injury,
deformity, physical, mental, psychical condition
 or any ailment, real or imaginary, regardless of
the nature of the remedy or treatment
administered, prescribed or recommended;
B. Who shall by means of signs, cards,
advertisement, 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 human
disease, injury, deformity, physical, mental or
psychical condition;
C. Who shall falsely use the title of M.D. after his
name, shall be considered as engaged in the
practice of medicine
EXEMPTIONS
By DECISIONS OF COURTS are not considered to
constitute practice of medicine:
a. One who take BP reading
b. Application of medicated massage
c. Hospital
d. Nurse anesthesist
By PROVISIONS OF LAW are not considered to
constitute practice of medicine (Sec. 11, Art. III,
Medical Act of 1959 as amended):
i. Any medical students duty enrolled in an
approved medical college
ii. Dentist
iii. Physiotherapist
iv. Optometrist
v. Any person who renders any service
gratuitously in cases of emergency or in
places where the services of a physician,
nurse or midwife are not available
vi. Any person who administers or recommends
any household remedy as per classification
of existing Pharmacy Laws
vii. Clinical psychologist with the prescription
and direct supervision of a physician
viii. Prosthetist
FAITH HEALING
There is nothing in the Medical Act of 1959
exempting it from the definition of the acts
which constitute practice of medicine
Related to constitutional guarantee to religious
freedom (freedom to believe and freedom to act
in accordance with ones belief)
Acted in pursuance of his religious belief and
with the tenets of his church he professes, not
deemed to be a practice of medicine but part of
his religious freedom
ILLEGAL PRACTICE OF 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 P1,000 or more than P10,000 with
subsidiary imprisonment in case of insolvency or
by imprisonment of not less than 1 year, no more
than 5 years, or by both such fine and
imprisonment, in the discretion of the court
QUALIFIED TO PRACTICE MEDICINE IN THE PHILIPPINES
1. Those who have complied with the prerequisites
to the practice of medicine in accordance with
Sec. 8, Art. III, Medical Act of 1959 as amended
2. Those who can have limited practice without any
certificate of registration in accordance with Sec.
12, Art. II, Medical Art of 1959 as amended:
- Exclusive consultation in specific and
definite cases;
- Attached to international bodies to perform
certain definite work in the Phils;
- Commissioned medical officers stationed in
the Phils in their own territorial jurisdiction;
- Exchange professors in special branches of
medicine;
- 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 DOH;
3. Balikbayan Physician pursuant to PD 541,
allowing former Filipino professionals to practice
their respective profession in the Philippines
- Proviso
o Of good standing prior to their
departure and in their adopted
country;
o Have registered with PRC and paid
their professional fee
o Pay the corresponding income tax
4. Foreign physicians qualified to practice by
Reciprocity Rule or by endorsement;
5. Medical Students pursuant to Sec. 11(a) and Sec.
12(d), Art. III, Medical Act of 1959 as amended;
6. Limited practitioner of medicine
- Those that are governed by specific licensure
laws
RATIONALE WHY ARTIFICIAL PERSONS CANNOT
PRACTICE MEDICINE
Cannot be subjected to licensure examinations
as required by law
Practice of medicine may be employed and
controlled by unqualified physicians
Professional relationship between the patients
and the physician will be impaired
Deprivation of free choice of physicians
PHYSICIAN
is a person who after completing his
secondary education follows a prescribed course
of medicine at a recognized university or medical
school, at the successful completion of which, is
legally licensed to practice medicine by the
responsible authorities and is capable of
undertaking the prevention, diagnosis, and
treatment of human illness by the exercising
independent judgment and without
supervision. (WHO)
According to Justice Malholm
CONSTITUTION is that written instrument
enacted by direct actions of the people by which
the fundamental powers of the government are
established, defined, and by which these powers
are distributed among the several departments
for their safe and useful exercise for the benefit
of the body politic.
Purpose
To prescribe the permanent framework of a
system of government, to assign to the several
departments their respective powers and duties,
and to establish certain first principles on which
the government is founded. (11Am. Jur. 606)
ESSENTIAL PARTS OF A CONSTITUTION
Constitution of Liberty
Constitution of Government
Constitution of Sovereignty
AMENDMENT isolated or piecemeal change in the
constitution while REVISION is the revamp or the
rewriting of the entire instrument
PHYSICIAN-PATIENT RELATIONSHIP
CONTRACT is the meeting of minds between
two persons whereby one binds himself with
respect to the other, to give something or to
render some service (Art. 1305, NCC)
NATURE OF THE RELATIONSHIP
Consensual based on mutual consent both
parties
Fiduciary based on mutual trust and
confidence
REQUISITES OF A CONTRACTUAL RELATIONSHIP
Consent manifested by the meeting of the
offer and the acceptance upon the thing and the
cause which are to constitute the contract (Art.
1319NCC)
Object the subject matter of the contract which
is the medical service which the patient wants to
be rendered to him by his physician
Cause the consideration or the factor that
instigated the physician to render the medical
service to the patient, which could be
remuneratory or an act of liberality
FORMS OF PHYSICIAN-PATIENT RELATIONSHIP
1. Expressed explicitly stated orally or in writing
2. Implied the existence can be inferred from the
acts of the contracting parties. Inferred by law as
a matter of reason and justice for their acts or
conduct
SOME INSTANCES WHERE THERE IS NO PHYSICIAN-
PATIENT RELATIONSHIP BY DECISIONS OF COURTS
1. Pre-employment PE for purposes of determining
whether an applicant is suitable for
employment;
2. PE for eligibility for insurance;
3. Physician appointed by court to examine the
accused;
4. In performing an autopsy;
5. Casual consultation in an unordinary place.
PSYCHOLOGICAL PATTERNS OF PHYSICIAN-PATIENT
RELATIONSHIP
Activity-Passive Relation
o No interaction between physician and
patient because the patient is unable to
contribute activity. This is characteristic
in an emergency cases when the patient
is unconscious.
Guidance-Cooperation Relation
o Patient is conscious and suffering from
pain, anxiety and other distressing
symptoms, he seeks help and willing to
cooperate. The physician is in a position
of trust.
Mutual Participation Relation
o It is in the nature of a negotiated
agreement between equal parties.
DUTIES AND OBLIGATINS IMPOSED ON THE PHYSICIAN IN
THE PHYSICIAN-PATIENT RELATIONSHIP
1. He should possess the knowledge and skill of
which an average physician is concerned
- General practitioner vs Specialist
2. He should use such knowledge and skill with
ordinary care and diligence
- locality rule the standard of cares is
measured by the degree of care in the
locality
- similar locality rule diligence is
determined when the other physicians in the
locality or similar locality could have acted
the same way
- national standard of care the diligence is
determined on what is applicable on a
national standard basis
3. He is obliged to exercise the best judgment
4. He has the duty to observe utmost good faith.
N.B.
Physician-Patient relationship does not imply
guaranty or any promise that the treatment will
be successful.
It does not imply any promise or guaranty that
the treatment will benefit the patient
It does not imply any promise or guaranty that
the treatment will produce certain result
It does not promise or guaranty that the
treatment will not harm the patient
It does not promise that the physician will not
commit errors in an honest way
DUTIES AND OBLIGATIONS IMPOSED ON THE PATIENT
ON THE COURSE OF THE PHYSICIAN-PATIENT
RELATIONSHIP
1. He must give an honest medical history
2. He must inform the physician of what occurred
in the course of treatment
3. He must cooperate and follow the instructions,
orders and suggestions of the physician
4. He must state whether he understands the
contemplated course of action
5. He must exercise the prudence to be expected of
an ordinary patient under the same
circumstance
STAGES OF PHYSICIAN-PATIENT RELATIONSHIP
Commencement
It is the very time the physician is obliged to
comply with the legal duties and obligations to
his patients.
Termination
It is the time when the duties and obligations by
a physician to his patient ceases. The following
are some ways of termination of the
relationship:
1. Recovery of the patient or when the
physician considers that his medical services
will no longer be beneficial to the patient
2. Withdrawal of the physician provided:
a. With consent of the patient
b. Patient is given ample time and
notice
3. Discharge of the physician by the patient
4. Death of either party
5. Incapacity of the physician
6. Fulfillment of the obligations stipulated in
the contract
7. In emergency cases, when the physician of
choice of the patient is already available or
when the condition of emergency ceases
8. Expiration of the period as stipulated
9. Mutual agreement for its termination
RIGHTS OF PHYSICIAN
Inherent rights
To choose patients
To limit practice of medicine
To determine appropriate management
procedures
To avail of hospital services
Incidental rights
Right of way while responding to emergency
Right of exemption from execution of
instruments and library
To hold certain public/private offices
To perform certain services
To compensations
To membership in medical societies
Rights generally enjoyed by every citizen
Pursuant to the provisions of Art. III, bill of rights,
Philippine Constitution 1987
RIGHT TO CHOOSE PATIENTS
Any person who is giver right to practice
medicine is not obliged to practice medicine
Cannot be compelled to accept professional
employment
NB: The law does not give any qualification the
right of the physician to choose his patient,
however, the CODE OF MEDICAL ETHICS and RA
6615 provides otherwise in cases of emergency.
Related provisions
o Art. II, Sec. 2, Code of Ethics
xxxfree to choose whom he
will servexxxalways respond
to any request for is assistance
in emergencyxxx
o Art. II, Sec. 3, Code of Ethics
In cases of emergency, xxxa
physician should administer at
least first aid treatment and
then refer to a more qualified
and competent physicianxxx
o Sec. 1, RA 6615
All government and private
hospitalsxxx are required to
render immediate emergency
medical assistancexxx
o Sec. 24, No. 12, Medical Act of 1959
xxxAlthough the ethical rule
obliges a physician to attend to
an emergency, his failure to
respond to it may not make him
liable if in so doing, there is a risk
to his life.
Refusal of a physician to attend
to a patient in danger of death is
not a sufficient ground for
revocation or suspension of his
registration if there is a risk to
the physicians life
RIGHT TO LIMIT HIS MEDICAL PRACTICE
Field of specialty
Private clinic or hospital
Within a political/geographical boundary
Certain days of the week/hours of the day
Certain class of people
With due regard to dictate of conscience
Retirement
Imposed by the public, religion, professional
ethics, medical society, law, contract
RIGHT TO AVAIL OF HOSPITAL SERVICES
Right to determine the appropriate
management procedure
o Doctrine of Superior Knowledge
The physician has superior
knowledge and the patient just
follows orders or instructions
and usually places himself in the
command and control of the
physician
 Right of way while responding to the call of
emergency
RIGHT OF EXEMPTION FROM EXECUTION OF
INSTRUMENTS AND LIBRARY
Rule 39, Sec. 12, Rules of Court
Right to hold certain public and private offices
which can only be filled up by physicians
Right to perform certain services
Right to membership in medical societies
o Any qualified medical practitioner has
the right to become a member of the
PMA through one of its component
society
o Membership in a medical society may be
voluntary and involuntary
Philippine Medical Care Act of 1969 (RA 6111 as
amended) provides that membership to the PMA is a
requirement before a physician can practice medicine
under the Medicare.
RIGHT TO COMPENSATION
Based on the physician-patient contractual
relationship
Existence of friendship does not imply gratuitous
services
Art. IV, Sec. 2, Code of Ethics
should willingly render gratuitous service to a
colleague, to his wife and minor children or even
parents provided the latter are aged and being
supported by the colleague. He should however,
be furnished the necessary traveling
expensesxxxthis provision shall not apply to
physicians who are no longer in the active
practicexxx
Doctrine of Unjust Enrichment
o No one must enrich himself at the
expense of others
o service rendered service paid
KINDS OF MEDICAL FEES
1. Simple Contractual Fee specifically stating the
value of such medical service, either orally or in
writing
2. Retainer Fee measured by the space of time
rendered by patient
3. Contingent Fee depends upon the failure or the
treatment instituted
4. Dichotomous Fee (Fee splitting) the physician
may require the services of a person who may
act as agent to solicit patients, and the agent will
share in the medical fee
o Art. III, Sec. 5, Code of Ethics
xxxsolicitation of patient,
directly or indirectly, through
solicitors or agents, is unethical
5. Straight Fee for the amount tendered by the
patient to the physician, the latter shall be
responsible for the payment of hospital bill, lab
fees, medicines and other incidental expenses;
o This kind of fee is unethical because the
amount wagers with the unforceable
contingencies
METHOD OF COLLECTION OF PAYMENT FOR MEDICAL
SERVICES
1. Extra judicial billing or referral to a bill
collection agency
2. Judicial methods
Facts to be proven in Court
a. Physician employed is duly qualified and licensed
b. The physician has rendered professional service
to the patients
c. The professional fee demanded is reasonable
d. The person liable for the payment is the
defendant.
The obligation to pay devolves on the patient
himself provided he is of legal age, of sound mind
and has the capacity to enter into a contractual
relation.
If the patient dies or becomes legally
incapacitated to pay, medical fee shall be made
from the following persons in order:
1. Spouse
2. Descendants, of the nearest degree
3. Ascendants, of the nearest degree
4. Brothers and sisters
NB.
o Implied promise to pay the physician by
the benefactor of the medical services
rendered in emergency cases
INSTANCES WHERE THE PHYSICIAN CANNOT RECOVER
PROFESSIONAL FEES:
1. Agreement that the service is gratuitous
2. In government charity hospitals, health centers
and other similar health units
3. Rendered in private charitable institutions if
expressly gratuitous to the indigent patients
4. Waiver on the part of the physician
5. Breach of contract
6. When the physician cannot charge the patient
pursuant to the Code of Ethics
7. Those covered by Phil Health
8. Medical services rendered under a contract of
employment unless expressly provided
otherwise
RIGHTS OF PATIENTS
1. Right to give consent to diagnostic and
treatment procedures
2. Right to religious belief
3. Right of privacy
4. Right to disclosure of information
5. Right to confidential information
6. Right to choose his physician
7. Right of treatment
8. Right to refuse necessary treatments
RIGHT TO GIVE CONSENT TO DIAGNOSTIC PROCEDURES
Obligations of the Physician to inform the patient:
1. Diagnosis
2. General nature of the contemplated procedure
a. Risk involved
b. Prospect of success
c. Potential danger if not applied
d. Alternative methods of treatment
patient is the final arbiter of what must be
done with his body.
Bases of Consent
1. The physician-patient relationship is fiduciary in
nature.
2. Patients right to self-determination.
3. Contractual relationship.
Purposes
1. To protect the patient from
unnecessary/unwarranted procedure applied to
him without knowledge
2. To protect the physician from any consequences
for failure to comply with legal requirements
Instances When Consent is Not Necessary
1. In cases of emergency, there is an implied
consent or the physician is privilege because
he is reasonable entitled to assume consent
2. When the law made it compulsory for everyone
to submit to the procedure.
Requisites of a Valid Consent
1. Informed or enlightened consent
2. Voluntary
3. Subject matter must be legal
Forms of Consent
1. Expressed consent written or oral
2. Implied consent may be deduced from the
conduct of the patient
Scope of the Consent
1. General or Blanket consent
2. Limited or conditional consent
3. Non-liability or exculpatory clause
Informed/Enlightened Consent
Awareness and assent
Full disclosure of facts and willingness of the
patient to submit
Quantum of Information Necessary to Form the Basis of
a Valid Consent
1. Nature of his condition
2. Nature of proposed treatment or procedure
3. Possible alternative methods
4. Risk involved
5. Chances of success or failure
Consent must be given freely or voluntarily
Persons who can give consent
1. Patient
2. If patient is minor, consent must be obtained
from the parents
3. In the absence of parents, consent of the
grandparents must be obtained, paternal
grandparents having preference
4. In the absence of parents and grandparents,
eldest brother or sister, provided one is of age
and not disqualified by law to give consent
5. Other person who may give consent having
substitute parental authority
Subject matter is legal
The subject matter or procedure applies to the
patient and which the patient consented must
not be that which the law penalizes or against
public policy
NB:
Consent of minor is not valid if the procedure will
not benefit him
Expressed refusal of a minor to surgery shall not
prevail over the existing emergency
Doctrine of parents patria, the court may grant
consent for the minor
RIGHT TO RELIGIOUS BELIEF
Art. III, Sec. 5, Philippine Constitution
No law shall be made respecting an
establishment of religion or prohibiting the free
exercise thereof. The free exercise and
enjoyment of religious profession and worship,
without discrimination or preference, shall
forever be allowed. No religion test shall be
required for the exercise of civil or political
rights.
RIGHT OF PRIVACY
RIGHT OF DISCLOSURE OF INFORMATION
The physician-patient relationship being
fiduciary in nature, the physician is obliged to
make full and frank disclosure to the patient or
any person who may act on his behalf all the
pertinent facts relative to his illness
Art. 1339, Civil Code states that xxxfailure to
disclose pacts, when there is duty to reveal
them, as when the parties are bound by
confidential elations, constitutes fraud.
RIGHT OF CONFIDENTIAL INFORMATION
Statutory Privileged Communication
o Pursuant to the Rules of Court, Rule 130,
Sec. 24, a person authorized to
practice medicine, surgery or obstetrics
cannot in a civil case, without the
consent of the patient, be examined as
to any information which he may have
acquired in attending such patient in a
professional capacity, which information
was necessary to enable him to act in
that capacity, and which would blacken
the character of the patient.
Ethical/Professional Confidential Information
o Pursuant to Art. II, Sec. 6, Code of
Medical Ethics, the medical practitioner
should guard as a sacred trust anything
that is confidential or private in nature
that he may discover or that may be
communicated to him in his professional
relation with his patients, even after
death. He should never divulge this
confidential information, or anything
that may reflect upon the moral
character of the person involved, except
 when it is required in the interest of
justice, public health or public safety.
Some instance where confidentiality is not
applicable:
1. When such disclosure is necessary to serve
the best interest of justice.
2. When the disclosure will serve public health
3. When the patient waives its confidentiality
RIGHT TO CHOOSE HIS PHYSICIANS
RIGHT TO TREATMENT
In emergency cases, the patient has the right to
treatment
Sec. 1, 1st par, RA 6615
Provides that xxxall government and private
hospital or clinics duly licensed to operate are
required to render immediate medical
assistance and to provide facilities and medicine
within its capabilities to patients in emergency
cases who are in danger of dying and/or suffered
serious physical injuriesxxx
Art. II, Sec. 3, Code of Medical Ethics
In cases of emergency, wherein immediate
action is necessary, a physician should
administer at least 1st aid treatment and refer
the patient to a more qualified and competent
physician if the case does not fall within is
particular line.
RIGHT TO REFUSE TREATMENT
In the legal sense, every man of adult age and of
sound mind has the right to determine what
must be done in his own body. A man is the
master of his own self and may expressly
prohibit a life-saving surgery or medical
treatment.
Doctrine of parens patria, the State has the right
to assume guardianship when the child is
neglected by the parents to have the child
treated, and parents have no right to base it on
religious beliefs or any other grounds
When the law provides for treatment, the
patient has no right to refuse treatment.
The social commitment of the physician is to
sustain life and relieve suffering. Where the
performance of ones duty conflict with the
other, the choice of the patient, or his family or
legal representative if incompetent to act on his
own behalf, should prevail. In the absence of the
patients choice or authorized proxy, the
physician must act in the best interest of the
patient.
LIABILITIES OF PHYSICIAN
Administrative
Right to practice is temporarily withdrawn from
the physician
A valid exercise of the police power of the State
Laws: Medical Act of 1959 as amended including
the Code of Ethics and Rules and Regulations of
the PRC
Penalty: reprimand, suspension, to revocation of
license
Criminal
An act of omission which constitute a crime by
the physician
Laws: Revised Penal Code and other special laws
Penalty: imprisonment and/or fine
Civil
Awarded against a physician to compensate for
the injury he suffered on account of the
physicians act or omission as a breach of the
contractual relationship of both parties
Laws: Civil Code of the Philippines and other
related laws
Art. 100, RPC states the Every person criminally
liable is civilly liable. Penalty: damages
ADMINISTRATIVE LIABILITIES
Quantum of evidence needed: substantial
evidence, such relevant evidence as a
reasonable mind might accept as adequate to
support a conclusion
Administrative Due Process:
1. Right to hearing
2. Tribunal must consider the evidence presented
3. Decision must have something to support itself
4. Evidence must be substantial
5. Decision must be based on the evidence
adduced at the hearing, or at least contained in
the record and disclosed to the parties
6. The Board or its judges must act on its or their
independent consideration of the facts and the
law of the case, and not simply accept the views
of a subordinate in arriving at a decision (Ang
Tibay vs CIR)
GROUND FOR ADMINISTRATIVE LIABILITIES
Sec. 24, Art. III, Medical Act of 1959 as amended
Personal Disqualifications
1. Immoral or dishonorable conduct
2. Insanity
3. Gross negligence, ignorance or incompetence
resulting in an injury to or death of the patient
4. Addiction to alcoholic beverages or to any habit-
forming drug rendering him incompetent to
practice medicine
Criminal Acts
1. Conviction by a court of competent jurisdiction
of any criminal offense involving moral turpitude
2. Fraud in the acquisition of the certificate of
registration
3. Performance of or aiding in any criminal abortion
4. Knowingly issuing false medical certificate
5. Aiding or acting as dummy of an unqualified or
unregistered person to practice medicine
Unprofessional Conduct
1. False or extravagant or unethical advertisement
wherein other things than his name, profession,
limitation of practice, clinic hours, office and
home address, are mentioned
2. Issuing any statement or spreading any news or
rumor which is derogatory to the character and
 reputation of another physician without
justification
3. Violation of any of the Code of Ethics as
approved by the PMA
CRIMINAL LIABILITIES
A criminal act is an outrage to the sovereignty of
the State so it must be instituted in the name of
the sovereign people as party-plaintiff (People of
the Philippines vs X)
Quantum of evidence is proof beyond
reasonable doubt. This does not mean absolute
certainty as excluding possibility of error but only
mean moral certainty, or that degree which
produces conviction in an unprejudiced mind
(Rule 133, Sec. 2, Rules of Court)
Presumption of Innocence and Equipoise Rule
Conviction of a physician, aside from
imprisonment and/or fine, his registration may
be cancelled or revoked if:
a. The law imposes revocation of the license
b. The crime wherein the physician was found
guilty involved moral turpitude
INCIDENTAL TO THE PRACTICE OF MEDICINE
Imprudence and Negligence Art. 365, Revised
Penal Code
o 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 correctional in its medium
period, if it would have constituted a less
grave felony, the penalty of arresto
mayor in its minimum period shall be
imposed; if it would have constituted a
light felony, the penalty of arresto
menor shall be imposedxxx
Imprudence deficiency of action or failing to
take the necessary precaution once they are
foreseen
Reckless imprudence voluntary, without
malice, doing or failing to do an act which results
from material damage by reason of inexcusable
lack of precaution on the part of the person
performing the act, taking into consideration his
employment or occupation, degree of
intelligence, physical condition and other
circumstances regarding persons, time and
place.
Simple imprudence consist 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
Negligence indicates a deficiency of perception
or when the wrongful act maybe avoided by
paying proper attention and using due diligence
in foreseeing them.
CIVIL LIABILITIES
A civil suit filed against physician and/or
hospitals is premised on recovery of damages for
their wrongful act of employees.
Cause of action for damages is based on:
1. Breach of Contract
o Physician-patient relationship
o Specific stipulation in the contract
o In an action for breach of contract, the
negligence of the doctor is not an issue,
for if the doctor makes contract to effect
a cure and fails to do so, he is liable for
breach of contract even though he uses
the highest possible professional skill.
2. Tort (Quasi-delict)
o Legal wrongdoing independent of a
contract
o Primary basis is negligence or fault of the
physician as the one directly responsible
for the injury sustained by the patient
o Ordinarily, any malpractice action is
based on torts or quasi-delicit in as much
as negligence is usually a ground for
injury.
Art. 2176 of the Civil Code provides that
Whoever by act or omission causes damage to
another, there being fault or negligence, is
obliged to pay for the damage done. Such fault
or negligence, if there is no pre-existing
contractual relation between the parties, is
called quasi-delicitxxx
MEDICAL MALPRACTICE
Failure of a physician to properly perform the
duty which devolves upon him in his professional
relation to his patient which results to injury
It may be defined as bad or unskillful practice of
medicine resulting to injury of the patient or
failure on the part of the physician to exercise
the degree of care, skill and diligence, as to
treatment in a manner contrary to accepted
standards of medicine resulting to injury to the
patient
Elements:
1. The physician has a duty to the patient
2. The physician failed to perform such duty to his
patient
3. As a consequence of the failure, injury was
sustained by the patient
4. The failure of the physician is the proximate
cause of the injury sustained by the patient
Proximate Cause is 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.
Doctrine of Efficient Intervening Cause
In causal connection between the negligence of
the physician and the injury sustained by the
patient, there may be an efficient intervening
cause which is the proximate cause of the injury.
LEGAL PRINCIPLES AND DOCTRINES
APPLIED IN MEDICAL MALPRACTICE
CASES
Doctrine of Vicarious Liability
o Doctrine of Ostensible Agent
o Borrowed Servant Doctrine
o Captain of the Ship Doctrine
Doctrine of Res Ipsa Loquitor
Doctrine of Common Knowledge
Doctrine of Contributory Negligence
Doctrine of Assumption of Risk
Doctrine of Last Clear Chance
Fellow Servant Doctrine
Rescue Doctrine
DOCTRINE OF VICARIOUS LIABILITY
Doctrine of Imputed Negligence/Command
Responsibility
Vicarious liability means the responsibility of a
person, who is not negligent, for the wrongful
conduct or negligence of another
Art. 2180, Civil Code of the Philippines
Obligation is demandable not only for ones own
acts or omission but also for those persons
whom one is responsible
xxx the owners or managers of an
establishment or enterprise are likewise
responsible for damages caused by their
employees in the service of the branches in
which he latter are employed or on the occasion
of their functions
Employers shall be liable for the damages caused
by their employees and household helpers acting
within the scope of their assigned task, even
though the former are not engaged in any
business or industry
The responsibility treated of this article shall
cease when the person herein mentioned prove
that they observe all the diligence of a good
father of a family to prevent injury.
DOCTRINE OF OSTENSIBLE AGENT
In cases wherein the employees are at the same
time are independent contractors of the hospital
Because of this peculiar situation, they are
considered ostensible agents and therefore, the
hospital must be held liable for their negligent
acts (pathologist, radiologist, anesthesiologist)
BORROWED SERVANT DOCTRINE
Ordinarily, resident physicians, nurses and other
personnel of the hospital are employees or
servants of the hospital.
In some instances, they are under the temporary
supervision and control of another other than
their employer while performing their duties.
By fiction of law, they are deemed borrowed
from the hospital by someone and for any
wrongful act committed by them during the
period, their temporary employer must be held
liable for the discharge of their acts and duties.
In the determination whether one is a borrowed
servant, it is necessary that he is not only
subjected to the control of another with regard
to the work done and the manner of performing
it but also that the work to be done is for the
benefit of the temporary employer.
CAPTAIN-OF-THE-SHIP DOCTRINE
The 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.
REASONS FOR APPLICATION OF THE DOCTRINE OF
VICARIOUS LIABILITY
1. Deep pocket theory
2. The employer has the power to select his
employee and to control his acts
3. Since the employer benefits monetarily from the
employee, the employer nor the employee is at
fault
4. To treat them as operating expense.
DOCTRINE OF RES IPSA LOQUITOR
The things 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 Loquitor Doctrine:
1. The accident must of a kind which ordinarily
does not occur in the absence of someones
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 case wherein the Doctrine of Res Ipsa Loquitor has
been applied:
1. Objects left in the patients 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 was 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
- When an accepted method of medical
treatment involves hazards which may
produce injurious results regardless of the
care exercised by the physician
2. Bad Result Rule
3. Honest Errors of judgment as to Appropriate
Procedure
4. 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 of
omissions constitute medical negligence. This
doctrine has been regarded as rule of sympathy
to counteract the conspiracy of silence.
According to one of the most distinguished jurist
(Canada), Justice Mignault:
o the practice of medicine and surery is
indispensable to humanity and should
not be fettered by rules and
responsibility so strict as to exact an
infallibility on the part of the physician
which he does not possess.
o we would be doing a disservice to the
community at large if we were to impose
liabilities on hospitals and doctors for
everything that goes wrong. Doctors
would be led to think more of their own
safety than the good of the patients.
Initiative would be stiffed and
confidence shaken.
DOCTRINE OF CONTRIBUTORY NEGLIGENCE
Doctrine of Common Fault
It has been defined as conduct on the part of the
plaintiff or injured party, contributing as a legal
cause to the harm he has suffered, which falls
below the standard which he is required to
conform to his own protection.
It is the act or omission amounting to want of
care on the part of the complaining party which,
concurring with the defendants negligence, is
the proximate cause of the injury.
Related Civil Code Provisions
Art. 2179, Civil Code
o When the plaintiffs own negligence
was the immediate and proximate cause
of his injury, he cannot recover
damages. But if his negligence was only
contributory, the immediate and
proximate cause of injury being the
defendants lack of due care, the plaintiff
may recover damages, but the court
may mitigate the damages to be
awarded.
Art 2214, Civil Code
o In quasi-deficits, the contributory
negligence of the plaintiff shall reduce
the damages that he may recover.
o Some instances where there is
contributory negligence:
1. Failure to give the physician an
accurate history
2. Failure to follow the treatment
recommended by the physician
3. Leaving the hospital against the
advice of the physician
4. Failure to seek further medical
assistance if symptoms persist
Doctrine of Superior Knowledge
In the physician-patient relationship, the
physician has superior knowledge over his
patient. The patient just follows the instructions
and orders of the physician and is usually
inactive and virtually places himself in the
command and control of the physician.
The defense of contributory negligence is
available only when the patients conduct is a
truly flagrant disregard of his health and cannot
apply where the patient is mentally ill,
semiconscious, heavily sedated or of advanced
age.
DOCTRINE OF CONTINUING NEGLIGENCE
If the physician, after a prolonged treatment of a
patient which normally produces alleviation of
the condition, fails to investigate non-response,
he may be held liable if in the exercise of care
and diligence he could have discovered the
cause of non-response.
DOCTRINE OF ASSUMPTION OF RISK
Predicated upon knowledge and informed
consent, anyone who voluntarily assumes the
risk of injury from a known danger, if injured, is
barred from recovery.
violenti non fit injuria, which means that a
person who assents and was injured is no
regarded in law to be injured
DOCTRINE OF LAST CLEAR CHANCE
A physician who has the last clear chance of
avoiding damage or injury but negligently fails to
do is liable.
It implies thought, appreciation, mental
direction and lapse of sufficient time to
eventually act upon impulse to save the life or
prevent injury to another.
DOCTRINE OF FORESEEABILITY
A physician cannot be held accountable for
negligence if the injury sustained by the patient
is on account of unforeseen condition but if a
physician fails to ascertain the condition of the
patient for want of the requisite skill and training
 is answerable for the injury sustained by the
patient if injury resulted thereto.
A physician owes duty of care to all persons who
are foreseeably endangered by his conduct, with
respect to the risk which make the conduct
unreasonably dangerous.
FELLOW SERVANT DOCTRINE
This doctrine provides that if a servant
(employee) was injured on account of the
negligence of his fellow servant (employee), the
employer cannot be held liable.
RESCUE DOCTRINE
If a physician who went to rescue a victim of an
accident was himself injured, the original wrong
doer must be held liable for such injury.
SOLE RESPONSIBILITY VS SHARED RESPONSIBILITY
Sole Responsibility
When the negligent act or omission which is the
proximate cause of the injury suffered by patient
is attributed to the wrongful act of person.
Shared Responsibility
When the injury suffered by the patient is caused
by the negligent act of two or more persons,
each of them acting concurrently and
successively in the production of injury.
SPECIFIC ACTS OR OMISSIONS
WHICH CONSTITUTE MEDICAL
MALPRACTICE
1. Failure to take medical history
2. Failure to examine or make a careful and
adequate examination
3. Non-referral of the patient to a specialist
4. Failure to consult prior physicians for previous
management
5. Non-referral of patient to a hospital with
equipment and trained personnel
6. Failure to use the appropriate diagnostic test
7. Failure to diagnose infections
8. Treatment resulting to addiction
9. Abandonment of patients
10. Failure to give proper instructions
11. Failure to institute the proper prophylactic
treatment
12. Errors in blood transfusion
13. Liabilities in administration of drugs
14. Product liabilities of manufacturer
15. Wrong baby cases
ABANDONMENT OF PATIENT
Termination of the physician-patient
relationship without the consent of the patient
and without giving the patient adequate notice
and opportunity to find another physician
Elements:
1. There is a physician-patient relationship
2. The relationship is terminated without mutual
consent of both parties
3. Unilateral termination of the contractual
relationship by the physician
4. Continuing need of the patient for further
medical treatment
5. Abandonment must have been the cause of the
injury or death of the patient
Some instance of abandonment:
1. Refusal by a physician to treat a case after he has
seen the patient needing medical treatment but
before treatment is commenced
2. Refusal to attend to a case for which he has
already assumed responsibility
3. Failure to provide follow-up attention
4. Failure to arrange for a substitute physician
during the time the physician is absent or
unavailable
o The attending physician may be held
liable for the acts of his substitute in the
following instances:
a) The attending physician did
not exercise due care and
diligence in the selection of
the substitute
b) If the substitute acts as agent
of the attending physician in
so far as carrying out a certain
course of treatment in which
case master-servant
relationship is created
o N.B.
Non-payment of bill cannot be a
defense for abandonment
LIABILITIES IN THE ADMINISTRATION OF DRUGS
Five basic rights:
1. Right drug
2. Right patient
3. Right dose
4. Right time
5. Right route
Negligence in the administration of a drug which causes
injury to the patient may be attributed to:
1. Drug reaction
- Failure to note history of allergy
- Failure to test for signs of reaction
- Failure to stop treatment when the drug
reaction has been observed
- Failure to provide adequate therapy to
encounter a reaction
- Treatment with a drug not proper for the
illness
2. Overdosage
3. Failure to give warning of the side effects
4. Administering medicine on the wrong route
5. Administration of the wrong medicine
6. Administration of a drug on the wrong person
7. Infection following an injection
8. Injury to the nerves
9. Failure to administer the drug
DOCTRINE OF STRICT LIABILITY
A person injured by a defective product can
recover compensation from his injury from
anyone in the distributive chain who sold the
product while the defect was present, even
though the seller exercises every conceivable
caution to prevent and discover the defects.
Negligence or carefulness is not in issue in a case
under the doctrine nor is any warranty or
promise in issue. A drug manufacturer is liable if
his product is contaminated by any impurities
which harm the user.
If the drug has side effects, it is the duty of the
manufacturer to warn the physician of it either
through the literature attached or accompanying
the drug or through the services of the
promoters. Once the physician has been
forewarned, the manufacturer has no duty to
insure that the warning reaches the patient in
normal circumstances.
LIABILITITES OF HOSPITALS
Sec. 2(a), RA 4226, Hospital Licensure Act
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,
cribs, bassinets for twenty-four hour use or
longer by patients in the treatment of
diseases,xxx.
Classification, according to Control and Financial
Support:
1. Public/Government 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 (Sec 2b, RA 4226)
2. Private privately owned, especially established
and operated with funds raised and contributed
through donations, or private capital or other
means (Sec 2c, RA 4226)
For purposes of determining liability of private hospitals:
1. Private charitable or eleemosynary established
for the public benefit and not conducted for the
pecuniary gain of the management
2. Private pay established for profit and gain
Rationale why hospital cannot practice medicine:
1. The hospital cannot be subjected to government
licensure examinations to determine whether it
is qualified to practice medicine
2. A non-medical will be allowed to control a
physician and through circumvention practice
medicine
3. Breach of the confidential relationship in a
physician-patient relationship
PRIMARY DUTIES OF A HOSPITAL
1. To furnish a safe and well-maintained building
and ground
2. To furnish adequate and safe equipment
3. To exercise reasonable care in the selection of
the hospital staff
Persons coming within the premises of the hospital
1. Trespasser one who enters the property of
another without being granted the privilege to
do so. It is only required of a hospital to refrain
from taking positive steps to harm a trespasser.
2. Licensee one who is neither a customer,
servant or a trespasser. He has no contractual
relation with the hospital. He is permitted,
expressly or impliedly to be within the premises
for his own interest or convenience. His
presence is merely tolerated.
3. Invitee one who is essential to the operation of
a hospital or for whom the hospital has a
purpose.
LIABILITIES OF HOSPITALS FOR THE WRONGFUL ACTS OF
THEIR AGENTS
1. Government or Public Hospitals
- A State cannot be sued without its consent
- The immunity of the government from the
official acts of its officers, agents and
employees is based on the legal principle
that there can be no legal right against the
authority that makes the law which the right
depends.
- RATIONALE: Government funds should be
spent for public purposes and not diverted
to compensate for private injuries and public
service should not be hindered. The
government must not be sued because the
government derives no profit from its
activity unlike a private enterprise.
- Those established to perform government
functions, it is immune from being sued.
- Those performing proprietary function when
it is established for profit. The government
goes down to the level of any private
hospital.
2. Private Charitable, Voluntary or eleemosynary
for charity
- A charity hospital is established and
maintained from the donations,
contributions, philanthropic acts and pays
no dividends.
- The determination whether a hospital was
established for charity is the articles of
incorporation and the constitution and by-
laws of the corporation.
3. Private hospital operating for profit
- May be held vicariously liable for the
negligent acts of its employees
N.B.
- A hospital which allow the patient to pay if
ever they have the capacity to do so and
serve others gratuitously does not change
the fundamental nature of the hospital as
charity.
 - The charging of the fee is not controlling but
the purpose the fee will be use is the
measure of charity.
- The fact that a hospital refuses to accept
certain persons and others to pay in
accordance with their means does not affect
its charitable status, if it is operated for no
profit.
- A charitable hospital must not consist of
rendering charitable acts to a few sporadic
cases but must be extended to the public
over a period of time.
- A hospital established for profit even though
some bed are devoted for charity is not
deemed a charitable institution.
DOCTRINES APPLIED TO CHARITABLE HOSPITAL
IMMUNITY FOR THE ACTS OF ITS EMPLOYEES
Trust Fund Doctrine
Charitable hospitals derived support from
voluntary contributions or donations for the
reception, care and treatment of charity
patients. The contributions are held only in trust
by the governing body of the hospital. Diverting
the money for the payment of damage will be
utilizing the money not intended by the donor.
Impaired Waiver Theory
A patient who enters a private hospital, knowing
fully well that it is merely supported by
contributions, waives his right to claim damages.
Public Policy Theory
It renders medical services without
remuneration. It is doing an undertaking of the
obligation of State for the preservation of life
and maintenance of health.
Independent Contractor Theory
A patient who enters a private charitable
hospital does not have a contract with the
hospital but with the attending physician.
RULES APPLIED IN DETERMINING THE VICARIOUS
LIABILITY FOR THE NEGLIGENT ACTS OF THE RESIDENT
PHYSICIANS, NURSES AND OTHER EMPLOYEES
1. Principle of administrative/ministerial as against
professional/medical duties
- The performance of all routinary duties
which is the very reason why he is appointed
in the ordinary sense constitutes
administrative duties and any negligent acts
committed by such employees in the course
of their employment which causes injury,
the patient may make the hospital
vicariously liable.
- Medical duties are by its nature beyond the
ordinary routine in a hospital. Any
negligence of such hospital employees, the
borrowed servant doctrine must be
applied and the hospital may not be held
vicariously liable.
2. Power of control
3. Contract of service
- If the contract has been entered with
hospital to render professional services, the
hospital may be held liable provided the
negligent act was committed within the
scope of employment. But if entered with
the patient for contract of services, the
principle independent contractor theory is
applied.
4. Independent Contractor Theory
5. Sole Responsibility vs Shared Responsibility
LIABILITIES OF HOSPITAL
1. CORPORATE Liabilities
- Those arising from failure of the hospital to
furnish accommodations and facilities
necessary to carry out its purpose or to
follow in a given situation, the established
standard of conduct to which the
corporation should conform.
- Recent decisions of the court has extended
hospital liability to patient for its failure to
make careful selection, review, and
supervision of independent physicians who
are permitted to practice in the hospital
2. VICARIOUS Liabilities for the Acts of Hospital
Employees
Admission
A person has no absolute right to be admitted in
a hospital or to avail of hospital services. The
relationship between the hospital and the
patient is contractual.
A government has no absolute privilege of
choice of patients inasmuch as it is established
and maintained by public funds except for
justifiable grounds.
Attendance to emergency cases in hospitals
Sec. 1 RA 6615 substantially states that xxx
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
injuries.
Transfer of patients
It must be premised on desire and consent of the
patient and when the condition of the patient
would permit to do so.
Discharge of patients
After further evaluation of the patients
condition, considers that further hospitalization
is no longer indispensable, a physician may order
the discharge with or without condition.
Refusal to be hospitalized
Refusal of the patient to remain in the hospital
will not be a lawful ground to detain him if he is
of sound mind and of legal age. Related laws:
- Art. 268, Revised Penal Code
- 1987 Philippine Constitution, Sec. 1 and 6
Refusal of the patient to leave the hospital
Premature discharge
The attending physician and the hospital any be
held liable to the patient if the latter is discharge
from the hospital in spite of the fact that further
hospitalization is still necessary.
Detention of patient for non-payment of bill
 A patient cannot be detained in a hospital for
non-payment of the hospital bill. The law
provides a remedy for them to pursue by filling
the necessary suit in court for the recovery of
such fee or bill.
A hospital any legally detain a patient against his
will when is detained or convicted prisoner, or
when the patient is suffering from a very
contagious disease wherein his release is
prejudicial to public health, or when the patient
is mentally ill, that his release will endanger
public safety.
LIABILITIES OF HOSPITAL FOR ITS
ANCILLARY SERVICES
Whenever the hospital administration enters
into contract with a partnership of physicians to
run the emergency room, the medical staff
therein are not considered employees of the
hospital. Consequently liability for negligence in
the emergency room is shifted to the medical
partnership.
Courts have held that even if contracts specify
that physicians will be considered independent
contractors the hospitals are responsible for
their action if they can exercise control over
them.
Patients are not bound by the secret limitations
contained in a private contract between the
hospital and the physician.
Two Aspects of Emergency Care
1. Examination of the patient to determine his
condition and need for emergency medical
procedures
2. Performance of the specific medical or surgical
procedure which are required without delay to
protect the patients health.
Liability in the emergency room may arise from the
following:
1. Failure to admit
2. Failure to examine and/or treat
3. Negligence in the application of management
procedures
An AMBULANCE is a motor vehicle specifically
designed, equipped and used for the
transportation of the sick, injured or wounded
persons operated by trained personnel for
ambulance service
The criminal liability of an ambulance driver is
the same as that of an ordinary driver. However,
the civil liability arising therefrom the hospital
must be held liable
Hospital Pharmacy
Sec. 42, RA 5921
o A PHARMACY is a place or establishment
where drugs, chemical products, active
principles of drug, pharmaceuticals,
proprietary medicine of pharmaceutical
specialties, devices and poison are sold
at retail and where medical and dental
veterinary prescriptions are
compounded and dispensed.
Medical Records
It is compilation of the pertinent facts of the
patients life history, illness, and treatment.
It is a compilation of scientific data derived from
many sources, coordinated into a document and
made available for various uses to serve the
patient, the physician, the institution in which
the patient has been treated, the science of
medicine and society as a whole.
Purpose of Maintenance of Medical Records
1. For convenience and necessity in consonance
with the purpose enumerated
2. As required by statutes (Hospital Licensure Law)
- The hospital may be held liable for injury
resulting from a breach of duty to maintain
accurate records.
- Destruction of records is an evidence of
negligence.
- An altered medical record may create
suspicious intent to establish a defense and
such alteration may be a proof of negligence.
- Removal of a certain portion of the record
may raise the interference that they are
removed deliberately in order to suppress
evidence.
Ownership of Medical Records
The guardian and owner of the medical records
is the hospital. But ownership of the medical
record is a limited one and absolute and
considered primarily custodial.
VIOLATION OF THE CONFIDENTIAL NATURE OF RECORD
Sec. 6, Art. II, Code of Medical Ethics
The medical practitioner should guard as a
sacred trust anything that is confidential or
private in nature that he may discover of that
may be communicated to him in his professional
relation with the patient, even after their death.
He should never divulge this confidential
information, or anything that may reflect upon
the moral character of the person involved,
except when it is required in the interest of
justice, public health or safety.
Sec. 17, Art. II, Comprehensive Dangerous Drug Act of
2002 (Maintenance and Keeping of Original Records of
Transactions on Dangerous Drugs and/or Controlled
Precursors and Chemicals)
The penalty of imprisonment ranging from 1 year
to 6 years and a fine ranging from 10,000.00 to
50,000.00 shall be imposed upon any
practitionerxxx who violates or fails to comply
with the maintenance and keeping of the original
records of transactions on any dangerous
drugsxxx
An additional penalty of revocation of license to
practice his professionxxx
Sec. 60, Art. VIII, Comprehensive Dangerous Drug Act of
2002 (Confidentiality of Records Under the Voluntary
Submission Program)
Judicial and medical records of drug dependents
under the voluntary submission program shall be
confidential and shall not be used against him for
any purposes, except to determine how many
time by himself or through his parent, spouse
guardian or relative within the fourth degree of
consanguinity or affinity, he voluntarily
submitted himself to confinement, treatment
and rehabilitation in any centerxxx
Sec. 64, Art. VIII, Comprehensive Dangerous Drug Act of
2002 (Confidentiality of Records Under the Comulsory
Submission Program)
The records of a drug dependent who was
rehabilitated and discharged from the Center
under the compulsory submission program or
who was charged for violation of Sec. 15 of this
act shall be covered under Sec. 60 of this act.
However, the records of a drug dependent who
was not rehabilitated, or who has escaped but
did not surrender himself within the prescribed
period, shall be forwarded to the court and their
use shall be determined by the court, taking into
consideration public interest and the welfare of
the drug-dependent.
Sec. 21(c), Rule 130, Rules of Court (Privilege
Communication)
A person authorized to practice medicine,
surgery, obstetrics cannot in civil case, without
the consent of the patient, be examined as to
any information, which he may have acquired in
attending such patient in a professional capacity,
which information was necessary to enable him
to act in that capacity, and which would blacken
the character of the patient.
Information for which no authorization is needed
1. Name of the patient and house officers
associated with the treatment of a patient
2. Personal circumstances of the patient which are
not ordinarily related to the treatment
When may the contents of the record be disclosed
1. When requested by the patient or by someone
who could act in his behalf which must be made
in writing
2. When the law requires such disclosure
3. Upon a lawful order of the court
N.B.
The attending patient has no legal right to
determine who shall and who shall not see the
record. At the most, his approval or permission
is only a matter of courtesy.
Members of the resident staff, student and
attending medical staff may freely consult such
records as pertain to their work.
Sec. 37, Rule 130, Rules of Court Entries in the Course
of Business
Entries made at, or near the time of the
transactions to which they refer, by a person
deceased, outside the Philippines or unable to
testify, who was in a position to know the facts
therein stated, may be perceived as prima facie
evidence, if such person made the entries in his
professional capacity or in the performance of
duty and in the ordinary course of business or
duty.
Patients record is admissible in evidence even if
the person who made the entry is dead or not
available, as the records are entries in the course
of business.
DAMAGES
DAMAGES are the pecuniary compensations
that may be recovered for breach of some duty
or the violation of some rights recognized by law.
If a suit is filed against a physician for a
professional liability claims, the objective of the
plaintiff is to recover damages. If the physician is
found negligent in the performance of his
professional services, he is liable for the payment
of damages for all the direct, natural and logical
consequences of his act.
Art. 20, Civil Code
Every person, contrary to law, willfully or
negligently causes damage to another shall
indemnify the latter for the same.
Art. 2176, Civil Code
Whoever, by act or omission causes damage to
another, there being fault or negligence, is
obliged to pay for the damages done.
Damages must be sufficiently proven by
evidence. To permit the Court to determine how
much it must, the proof must show the nature,
extent, cause and probably duration of the
injury.
DOCTRINE OF CERTAINTY OF DAMAGES
Damages must be certain both in its nature and
in respect to the cause. Recovery must not be
contingent or speculative.
The injured patient has the right to recover
medical and hospital expenses from the
wrongdoer even though the patient has been
indemnified wholly or partially by an insurance
company.
TYPES OF DAMAGES
1. Actual or compensatory
2. Moral
3. Exemplary
4. Nomina
5. Temperate
6. Liquidated
ACTUAL OR COMPENSATORY DAMAGES
Art. 2199, Civil Code
Except as provided by law or by stipulation, one
is entitled to an adequate compensation only for
such pecuniary loss suffered by him as he has
 duly proved. Such compensation is referred to as
actual or compensatory damages.
Art. 2200, Civil Code
Indemnification for damages shall comprehend
not only the value of the loss suffered, but also
that of the profits which the oblige failed to
obtain
Kinds:
1. Dano emergente the loss already suffered by
the patient
2. Lucro cesante failure to receive the benefit
which would have pertained to him
Compensatory Damages Applied to Medical Malpractice
1. Death
- Art. 2206, Civil Code
o The amount of damages for the
death caused by a crime or quasi-
delict shall be at least three
thousand pesos (75,000.00), even
though there may have been
mitigating circumstance.
2. Physical Disability
3. Loss of Earning Capacity
4. Medical, Surgical, Hospital and Related Expenses
5. Loss of Service or Support
6. Funeral Expenses
MORAL DAMAGES
Art. 2217, Civil Code
Moral damages include physical suffering,
mental anguish, fright, serious anxiety,
besmirched reputation, wounded feelings,
moral shock, social humiliation, and similar
injury. Through incapable of pecuniary
computation, moral damages may be recovered
if they are the proximate result of the
defendants act or omission.
Art. 2219, Civil Code
Moral damages may be recovered in the
following and analogous cases:
1. A criminal offense resulting in physical
injuries
2. Quasi-delict causing physical injuries
Physical suffering
Mental Anguish
Fright and Moral Shock
Besmirched Reputation and Social
EXEMPLARY OR CORRECTIVE DAMAGES
Art. 2229, Civil Code
Exemplary or corrective damages are imposed,
by way of example or correction for the public
good, in addition to the moral, temperate,
liquidated or compensatory damages.
Art. 2230, Civil Code
In criminal offense, exemplary damages as part
of the civil liability may be imposed when the
crime was committed with one or more
aggravating circumstances. Such damages are
separate and distinct from fines and shall be paid
to the offended party.
Art. 2231, Civil Code
In quasi-delict, exemplary damages may be
granted if the defendant acted with gross
negligence.
Art. 2232, Civil Code
In contracts and quasi-contracts, the court may
award exemplary damages if the defendant
acted in a wanton, fraudulent, reckless,
oppressive and malevolent manner.
Art. 2233, Civil Code
Exemplary damages cannot be recovered as a
matter of right; the course will decide whether
or not they should be adjudicated
Punitive or exemplary damages are monetary
compensation over and above actual or
compensatory damages awarded as punishment
or deterrence, because of the wanton, reckless,
malicious or oppressive nature of the wrong
committed.
Punitive damages are recoverable from a
physician in an action for malpractice where
there is evidence tending to show that he has
acted with malice, or that he acted with
recklessness, oppression, or with utter disregard
to the effects of his act, or that he is guilty of
gross negligence in the performance of his
profession.
NOMINAL DAMAGES
Art. 2221, Civil Code
Nominal damages are adjudicated in order that
a right of the plaintiff, which has been violated
or invaded by the defendant, may be vindicated
or recognized not for the purpose of
indemnifying the plaintiff for any loss suffered.
It is a trifling sum awarded to the plaintiff in an
action where there is no substantial loss or injury
to be compensated.
It is awarded to plaintiff as a vindication of a right
violated.
LIQUIDATED DAMAGES
Art. 2226, Civil Code
Liquidated damages are those agreed upon by
the parties to a contract, to be paid in case of
breach thereof.
TEMPERATE OR MODERATE DAMAGES
Art. 2224, Civil Code
Temperate or moderate damages, which are
more than nominal but less than compensatory
damages, may be recovered when the court
finds that some pecuniary loss has been suffered
but its amount cannot, from the nature of the
case, be proved with certainty.
Obligation on the part of the plaintiff (patient) to
minimize damages
Art. 2203, Civil Code
o The party suffering from loss or injury
must exercise the diligence of a good
father of a family to minimize the
 damages resulting from the act or
omission in question.
DOCTRINE OF AVOIDABLE CONSEQUENCES
Where one person has, through wrongful act,
caused personal injury to another, it is
incumbent upon the latter to use such means as
are reasonable under the circumstances to avoid
or minimize the damages. The person wronged
cannot recover for any item of damage which
could have been avoided.
The burden of proof that the injured could have
prevented or mitigated the damages rests on the
defendant.
ATTORNEYS FEES
Attorneys fees and other related expenses in litigation,
other than judicial cost are not as rule recoverable except
when the law specifically provides. (Art. 2208, Civil Code)
1. When exemplary damages are awarded
2. When the defendants act or omission has
compelled the plaintiff to litigate with third
persons or to incur expenses to protect his
interest
3. In criminal cases of malicious prosecution
against the plaintiff
4. In case of clearly unfounded civil action or
proceeding against the plaintiff
5. Where the defendant acted in gross and evident
bad faith in refusing to satisfy the plaintiffs
plainly valid, just and demandable claim
6. In actions for legal support
7. In actions for the recovery of wages of household
helpers, laborer and skilled workers
8. In actions for indemnity under the workmens
compensation and employers liability laws
9. In a separate civil action to recover civil liability
10. When at least double judicial costs are awarded
11. In any other case where the court deems it just
and equitable that attorneys fees and expenses
of litigation should be recovered
EMERGENCIES IN MEDICAL
PRACTICE
An EMERGENCY is an unforeseen combination of
circumstances which calls or an immediate
action. It refers to a situation in which a patient
has been suddenly or unexpectedly endangered
to such an extent that immediate action is
needed to save the life and limb or to avoid
permanent damages.
RELATED PROVISION OF THE CODE OF MEDICAL ETHICS
A condition of emergency is usually an exception
to the observance of the standard ethical
conducts.
Art. II, Sec. 2
A physician is free to choose whom he will
serve. He may refuse calls, other medical
services for reasons satisfactory to his
professional conscience. He should, however,
always respond to any request for his assistance
in an emergencyxxx
Art. II, Sec. 3
In case of emergency, wherein immediate
action is necessary, a physician should
administer at least first aid treatment and then
refer the patient to a more qualified and
competent physician if the case does not fall
within his particular line.
Art. IV, Sec. 15
A physician should never examine or treat a
hospitalized patient of another without the
latters knowledge and consent except in cases
of emergencyxxx
Art. IV, Sec. 16
A physician called upon to attend to a patient of
another physician because of an
emergencyxxxshould attend only to the
patients immediate needsxxx
Art. IV, Sec. 17
Whenever in the absence of the family
physician several physicians have been
simultaneously called in an emergency
casexxxthe first to arrive should be
considered physician in charge, unless the
patient or his family has special preference for
some other one among those who are
presentxxx
Art. IV, Sec. 20
When a physician is requested by a colleague to
take care of a patient because of an
emergencyxxx The physician should treat the
patient in the same manner and with the same
delicacy as he would have wanted his own
patient cared for under similar conditionsxxx
OTHER RELATED PROVISIONS OF THE LAW
RA 6615
An act requiring government and private
hospitals or clinics duly licensed to extend
medical assistance in emergency cases
RA 8344
An act penalizing the refusal of hospitals and
medical clinics to administer appropriate initial
medical treatment and support in emergency or
serious cases, amending BP Blg. 702, otherwise
known as an act prohibiting the demand or
deposits or advance payments for the
confinement or treatment of patients in hospital
and medical clinics in certain cases.
Art. 275, Revised Penal Code
Abandonment of persons in danger and
abandonment of ones own victim
The penalty of arrest mayor shall be imposed
upon:
1. Anyone who shall fail to render assistance to
any person whom he shall find in an
uninhabited place wounded or in danger or
dying, when he can render such assistance
without detriment to himself, unless such
omission shall constitute a more serious
offense
 2. Anyone who shall fail to help or render
assistance to another whom he has
accidentally wounded or injured
STANDARD CARE IN EMERGENCIES
A physician cannot be held to the same conduct
as one who had an opportunity to reflect, even
though it later appears that he made a wrong
decision yet prudent at that time.
EMERGENCY OPERATIONS WITHOUT CONCENT
When the situation is such that an immediate
action is necessary to save the life or preserve
the health of the patient, and getting a consent
is prejudicial to the patient, the physician can
legally proceed with his contemplated life-saving
procedure.
The law gives him the right to act under the
Theory of Implied Consent or that the physician
is privileged to do whatever is sound for the
benefit of the patient.
The refusal f the patient who is of legal age and
of sound mind to submit to medical treatment
shall prevail even if the danger to his life is
eminent.
EMERGENCY OPERATION WITHOUT CONSENT
1. The injured person must be unconscious or
otherwise unable to give a valid consent
2. The situation must be such as it would make it
actually and apparently necessary to act before
there is an opportunity to obtain consent.
3. The physician in the exercise of his best
judgment that the medical procedure is life-
saving.
REFUSAL TO GIVE CONSENT DURING EMERGENCY
IF the patient is conscious, or if unconscious or is
not in a capacity to give consent, but someone
who could act on his behalf is present, then
consent must first be obtained before the
commencement of a procedure.
EXTENSION OF OPERATION IN CASES OF EMERGENCY
If during an operation, an accident occurs, or a
condition maybe discovered which requires
immediate action, but which is not covered by
the consent, the surgeon is justified in extending
the operation and be absolved of liability.
The surgeon is authorized to extend the
operation to any condition discovered when it
will redound to the welfare of the patient. In the
absence of a clearly specific prohibition on the
part of the patient, the physician should be
privileged to perform such surgery within the
operative field as is justified in the prevailing
medical opinion.
N.B.
Surgery cannot be extended if an emergency is
not present.
The law also implies an obligation on the part of
the patient to pay reasonable value of the
emergency service. If no specified amount
agreed upon, the principle of quantum meruit
shall be applied.
DELEGATION OF A PHYSICIANS
DUTIES
Requisites for a Valid Delegation
1. When such duty can be delegated which will
depend on the circumstance of the case, nature
of the duty to be delegated, and the training and
experience of the person to whom such duty is
to be delegated
2. The person to whom such duty is delegated must
be competent to perform such duty
3. Proper instructions must be given to the person
who will perform the delegated duty
4. The patient consented expressly or impliedly
such delegation of duty
LIABILITY FOR INJURIES IN THE NEGLIGENT
PERFORMANCE OF THE DELEGATED DUTIES
The person performing the delegated duty
cannot be held liable for any untoward or
unexpected effects of his act if he had complied
with all the requirements of a delegated duty
and has exercised care and diligence in such
execution.
THE MEDICAL WITNESS AND THE
COURT
Court an agency of the sovereign created
directly or indirectly under its authority,
constituting one or more officers, established
and maintained for the purpose of hearing and
determining issues of law and facts regarding
legal rights and alleged violations thereof, and of
applying the sanction of the law, authorized to
exercise its power in the due course of law at
times and places previously determined by
lawful authority
Different Courts in the Philippines
1. Supreme Court
2. Court of Appeals
3. Regional Trial Court
4. Municipal or City Trial Court
5. Military Commissions
Art. III, Sec. 2, Code of Medical Ethics
It is the duty of every physician, when called
upon by the judicial authorities, to assist in the
administration of justice on matters which are
medico-legal in character.
PHYSICIAN AS AN ORDINARYY WITNESS
Sec. 20, Rule 130, Rules of Court
xxxall persons who, having organs of sense,
can perceive, and perceiving can make known
their perception to others maybe witnessxxx
Requisites of an Ordinary Witness
1. The person must have the organ and power of
perception
2. The perception gathered by his organs of sense
can be imparted to other
3. He does not fall in any of the exception or
disqualifications provided by the Rules of Court
Disqualification by reason of:
1. Mental incapacity or immaturity Sec. 21, Rule
130, Rules of Court
a. Those whose mental condition, at the
time of their production for
examination, is such that they are
incapable of intelligently making known
their perception to others
b. Children whose mental maturity is such
as to render them incapable of
perceiving the facts respecting which
where they are examined and of relating
them truthfully
2. Marriage Sec. 22, Rule 130, Rules of Court
- During their marriage, neither the husband
nor the wife may testify for or against the
other without the consent of the affected
spouse, except in a civil case by one against
the other, or in any criminal case for a crime
committed by one against the other or the
latters direct ascendants or descendants
3. Death or Insanity Sec. 23, Rule 130, Rules of
Court
- Parties or assignors of parties to a case, or
persons in whose behalf a case is
prosecuted, against an executor or
administrator or other representative of the
deceased person, or against a person pf
unsound mind, upon a claim or demand
against the estate of such deceased person
or against such person of unsound mind,
cannot testify as to any matter of fact
occurring before the death of such deceased
person or before such person become of
unsound mind
4. Parental or filial privilege Sec. 25, Rule 130,
Rules of Court
- No descendant can be compelled, in a
criminal case, to testify against his parents
and descendant
Disqualification by reason of Privileged Communication
Sec. 24, Rule 130, Rules of Court The following
persons cannot testify as to matters learned in
confidence of the following cases:
1. The husband or the wife, during or after the
marriage, cannot be examined without the
consent of the other as to any
communication received in confidence by
one from the other during the marriage
except in a civil case by one against the
other, or for a crime committed by one
against the other or the latters direct
descendants and ascendants
2. The attorney cannot, without the consent of
his client, be examined as to any
communication made by the client to him or
his advice given thereon in the course of, or
with a view to professional employment; nor
can an attorneys secretary, stenographer of
clerk be examined, without the consent of
the client and his employer, concerning any
fact the knowledge of which has been
acquired in such capacity
3. A person authorized to practice medicine,
surgery or obstetrics cannot in a civil case,
without the consent of the patient, be
examined as to any information which he
may have acquired in attending such patient
in a professional capacity, which information
was necessary to enable him to act in that
capacity, and which would blacken the
reputation of the patient
4. A minister or a priest cannot, without the
consent of the person making the
confession, be examined as to any
confession made to or any advice given him
in his professional character in the course of
discipline enjoined by the church to which he
belongs
5. A public officer cannot be examined during
his term of office or afterwards as to
communications made to him in official
confidence, when the court finds that the
public interest would suffer by the disclosure
PRIVILEGED COMMUNICATION BETWEEN PHYSICIAN
AND HIS PATIENT
Sec. 6, Art. II, Code of Medical Ethics
The medical practitioner should guard as sacred
trust anything that is confidential or private in
nature that he may discover or that may be
communicated to him in his professional relation
with his patients, even after their death. He
should never divulge this confidential
information, or anything that may reflect upon
the moral character of the person involved,
except when it is required in the interest of
justice, public health, and public safety.
Sec. 24(c), Rule 130, Rules of Court
A person authorized to practice medicine,
surgery or obstetrics cannot in a civil case,
without the consent of the patient, be examined
as to any information which he may have
acquired in attending such patient in a
professional capacity, which information was
necessary to enable him to act in that capacity,
and which would blacken the character of the
patient.
Extent of the Privileged Communication
1. Interns
2. Confidential information obtained by one of the
physicians practicing medicine in partnership
with another physician whereby the patients of
both are the patients of the firm.
3. Nurses and attendants who were present and
assisting the physician when the communication
was made.
When communication is not a privileged communication
1. When a person is examined at the instance of the
law, for the purpose of testifying to solely qualify
the physician to testify
 2. Information acquired by an autopsy on the body
of a person who was not, prior to his death, a
patient of the physician performing the autopsy
3. Information obtained by a technician from a
patient is not privileged.
4. When the public interest so requires
Scope of the privilege
1. Oral testimony by the physician in court
2. Affidavits, certificates and reports made by the
physician as exhibit in court
3. Hospital records
Waiver of Privilege
Patient may expressly or impliedly waive their
right to privilege communication
HEARSAY EVIDENCE
An evidence not proceeding from personal
knowledge of the witness, but from mere
repetition of what he had heard others say. It
does not derive its value solely from the credit of
the witness but its value rests mainly in the
veracity and competency of other persons. The
very nature of the evidence shows its weakness,
and it is admitted only in special cases because
of necessity.
As a general rule, it is NOT admissible in evidence
Sec. 36, Rule 130, Rules of Court Testimony generally
confined to the personal knowledge of the witness,
hearsay excluded
A witness can testify only to those facts which
he knows of his own knowledge, that is, which is
derived from his own perception, except as
otherwise provided by these rules.
Sec. 37, Rule 130, Rules of Court
The declaration of a dying person, made under
a consciousness of an impending death, may be
received in a criminal case wherein his death,
may be received in a criminal case where his
death is the subject of inquiry, as evidence of the
cause and surrounding circumstances of such
death.
Dying declaration
One of the exception in hearsay evidence rule.
Is the statement made by a person who is at the
point of death, and is conscious of his impending
death, in reference to the manner in which he
receives his injuries of which he is dying, or the
immediate cause of his death, and in reference
to the person who inflicted such injuries or in
connection with such injuries of a person who is
charged or suspected of having committed
them; which statements are admissible in
evidence in a trial where the killing of the
declarant is the crime charged to the defendant.
Grounds for admissibility of dying declaration
1. Necessity death of the declarant makes it
impossible to obtain his testimony in court
2. Trustworthiness every motive of falsehood is
silenced, and the mind is induced by the most
powerful consideration to tell the truth
Requisites of dying declaration
1. That the declaration must concern the cause and
surrounding circumstances of the declarants
death
2. That at the time the declaration was made, the
declarant was under the consciousness of
impeding death
3. That the declarant is a competent witness
4. That the declaration is offered in a criminal case
in which the declarant is the victim
Probative value of standard medical books in court
Medical textbooks are not admissible in
evidence on account of the fact that they are
hearsay
The author of the books cannot be presented in
court and be subjected to cross-examination
N.B.
o Medical witness may have the right to
base his opinion from standard
textbooks.
o In cross-examination, medical textbooks
are admissible in evidence to discredit a
witness who has based his testimony
upon it.
Learned Treaties
Sec. 46, Rule 130, Rules of Court
o A published treatise, periodical or
pamphlet on a subject of history, science
or art is admissible as tending to prove
the truth of a matter stated therein if the
court takes judicial notice, or a witness
expert in the subject testifies that the
writer of the statement in the treatise,
periodical or pamphlet is recognized in
his profession or calling as expert in the
subject.
THE PHYSICIAN AS AN EXPERT WITNESS
An EXPERT WITNESS is on who has the capacity
to draw inference from the facts which a court
would not be competent to draw.
To warrant the use of expert testimony, two
elements are required:
1. The subject of inference must be so distinctly
related to some science, profession,
business or occupation as to be beyond the
knowledge of average layman
2. The witness must have such skill, knowledge
or experience in that field or calling as to
make it appear that his opinion or reference
will probably aid the trier of facts in his
search for the truth
An OPINION maybe defined as the belief,
judgment, inference, or sentiment formed by the
mind with regard to things, person or events
perceived by a witness. An opinion in the legal
sense is something more than mere speculation
or conjecture.
Sec. 48, Rule 130, Rules of Court
General rule The opinion of a witness is not
admissible, except as indicated by the Rules
Sec. 49, Rule 130, Rules of Court
Opinion of Expert Witness The opinion of a
witness on a matter requiring special knowledge,
skill, experience or training which he is shown to
possess, may be received in evidence
Sec. 50, Rule 130, Rules of Court
Opinion of Ordinary Witness The opinion of a
witness for which proper basis is given, may be
received in evidence regarding
a. The identity of a person about whom he
has adequate knowledge
b. A handwriting with which he has
sufficient familiarity
c. The mental sanity of a person with
whom he is sufficiently acquainted
The witness may also testify on his impression of
emotion, behavior, condition or appearance of a
person.
DISTINCTIONS BETWEEN AN ORDINARY WITNESS AND
EXPERT WITNESS
1. An ORDINARY witness can only testify as a
general rule, on those things which he has
perceived with his own organs of perception,
while an EXPERT witness may render his opinion,
inference, conclusion or deduction on what he
and other perceived
2. An ORDINARY witness need not be skilled on the
line he is testifying but an EXPERT witness must
be skilled on the art, science or trade he is
testifying
ATTENDANCE OF A MEDICAL WITNESS IN COURT
Sec. 1, Rule 21, Rules of Court
Subpoena is a process directed to a person
requiring him to attend and to testify at the
hearing or the trial of an action, or at any
investigation conducted by competent
authority, or for the taking of his deposition. It
may also require him to bring with him books,
documents or other things under his control, in
which case it is called subpoena duces tecum.
Kinds of Subpoena
1. Subpoena ad testificandum
- A process requiring a person to appear
before a trial or hearing of an action or
investigation conducted under our laws or
for the taking of a deposition at a certain
definite date, time and place to testify on
some material issues.
2. Subpoena duces tecum
- A process which requires a person to
produce at the trial some documents or
papers which are under his control or
possession that are pertinent to the issues of
his controversy, at a certain date, time and
place.
3. Subpoena duces tecum and testificandum
N.B.
Failure to comply with a subpoena without
justifiable reason is a ground for reprimand,
suspension or revocation of the certificate of
registration.
Sec. 2, Art. III, Code of Medical Ethics
It is the duty of every physician, when called
upon by the judicial authorities, to assist in the
administration of justice on matters which are
medico-legal in character.
Sec. 24, Art. III, Medical Act of 1959 as amended
xxx(12) Violation of any of the provisions of
the Code of Medical Ethicsshall be sufficient
ground for reprimanding or for suspending or
revoking a certificate of registration as
physicianxxx
Refusal of a public officer to give assistance in
the administration of justice is penalized by law.
Art. 233, Revised Penal Code
The penalties of arresto mayorxxx, shall be
imposed upon a public officer who, upon
demand from a competent authority, shall fail to
lend his cooperation towards the administration
of justice or other public service, if such failure
shall result in serious damage to the public
interest, or to a third party.
When a Medical Witness need not comply with a
subpoena
1. The Court issuing the subpoena has no
jurisdiction over the subject matter of the case
2. When the place of residence is more than 100
kilometers from the court issuing the subpoena
- Sec. 10, Art. 21, Rules of Court
o The provisions of sections 8 and 9
of this rule (Compelling attendance
and Contempt) shall not apply to a
witness who resided more than 100
km from his residence to the place
where he is to testify by the ordinary
course of travel, or to a detention
prisoner if no permission of the cut
in which his case is pending was
obtained.
3. When the physician is attending to an
emergency and no one is available and
competent enough to be his substitute to attend
to such emergency
4. On account of illness incapacitating him to
attend
Sec. 3, Rule 132, Rules of Court, Rights and Obligations of
a Witness
A witness must answer questions, although his
answers may tend to establish a claim against
him. However, it is the right of witness:
1. To be protected from irrelevant, improper
questions and from harsh or insulting
demeanor
2. Not to be detained longer than the interest
of justice require
3. Not to be examined except only as to
matters pertinent to the issue
4. Not to give an answer which will tent to
subject him to a penalty for an offense
unless otherwise provided by law
5. Not to give an answer which will tend to
degrade his reputation, unless it be to the
very fact at issue or to a fact from which the
fact in issue would be presumed. But a
witness must answer to the fact of his
previous final conviction of an offense.
Instances when the medical witness may not be
compelled to answer questions in court
1. It will tend to subject him to punishment for an
offense
 - Incriminatory questions may subject the
witness to punishment or disclosure of
which would form a necessary and essential
part of a crime
- Sec. 17, Art III, Phil Constitution No person
shall be compelled to be witness against
himself.
2. It will degrade his character, except when such
degradation of character is the very fact at issue.
A medical witness may refer to memoranda,
notes or other pertinent papers.
IMPEACHMENT OF MEDICAL TESTIMONY
1. By contradicting testimonies by other of his own
class or by any other competent witnesses
2. By showing that the medical witness is
interested in the outcome of the case or bias
3. By an inconsistent statement made at another
time
4. By not expressing the opinion testified to at the
time when such expression might reasonably
had been expected
5. When the scientific treatise which he relies on as
the basis of his opinion does not sustain him
EFFECTS OF FALSE TESTIMONY
1. Art. 180, Revised Penal Code, False testimony
against a defendant:
- Any person who shall give testimony
against the defendant in any criminal case
shall suffer:
i. The penalty of reclusion temporal, if
the defendant in said case shall have
been sentenced to death
ii. The penalty of prision mayor, if the
defendant shall have been
sentenced to reclusion temporal or
perpetua
iii. The penalty of prision correccional,
if the defendant shall have been
sentenced to any other afflictive
penalty
iv. The penalty of arresto mayor, if the
defendant shall have been
sentenced to a correccional penalty
or a fine, or shall have been
acquitted.
2. Art. 181, Revised Penal Code, False Testimony
favorable to a defendant
- Any person who shall give false testimony
in favor of the defendant in a criminal case,
shall suffer the penalties of arresto mayor in
its maximum period to prision
correccionalxxxif the prosecution is for
felony punishable by an afflictive
penaltyxxx.
3. Art. 182, Revised Penal Code, False Testimony in
Civil Cases
- Any person found guilty of false testimony
in civil cases shall suffer the penalty of
prision correcccionalxxx if the amount in
controversy shall exceed 5,000 pesosxxx
4. Art. 183, Revised Penal Code, False testimony in
other cases and perjury in solemn affirmation
- The penalty of arresto mayorxxx,
knowingly making untruthful statement and
not being included in the provisions of the
next preceding articles, shall testify under
oath, or make an affidavit, upon ant material
before a competent person authorized to
administer an oath in cases in which the law
so requires.
- Any person, who in case of a solemn
affirmation made in lieu of an oath, shall
commit any of the falsehoods mentioned in
this and the three preceding articles of this
section, shall suffer the respective penalties
provided therein.
PRINCIPLE OF Falsus In Uno, Falsu In Omnibus
When a witness falsified the truth on one point,
his testimony on other points may be
disregarded, unless corroborated by other
unimpeached evidence.
Requisites:
1. That the witness deliberately or intentionally
falsified the truth
2. That the other portions of the testimony to be
discredited, are not corroborated by
circumstance or other unimpeached evidence
3. The false testimony must be on material pot
When it is not applicable
1. When there are sufficient corroborations in
many grounds of the testimony
2. When the mistake was not in a very material
point
3. When the error did not arise from the apparent
desire to prevent the truth, but from innocent
mistakes and the desire of the witness to
exculpate himself though not completely
CONTEMPT
Sec. 9, Rule 21, Rules of Court
Contempt Failure by any person without
adequate cause to obey a subpoena served upon
him shall be deemed a contempt of court from
which the subpoena is issued. If the subpoena
was not issued by a court, the disobedience
thereto shall be punished in accordance with the
applicable law or Rule.
Sec. 1, Rule 71, Rules of Court
Direct Contempt Punished Summarily A
person guilty of misbehavior in the presence of
or so near a court as to obstruct or interrupt the
proceedings before the same, including
disrespect toward the court, offensive
personalities toward others, refusal to be sworn
or to answer as witness, or to subscribe an
affidavit or deposition when lawfully required to
do so, may be summarily adjudged in contempt
by such courtxxx
Sec. 3, Rule 71, Rules of Court
Indirect contempt to be punished after charged
and hearing After a charge in writing has been
filed, and an opportunity given to the
respondent to comment thereon within such
 periodxxx, a person guilty of any of the
following acts may be punished for indirect
contempt:
1. Misbehavior of an officer of a court in the
performance of his official duties or in his
official transaction
2. Disobedience of or resistance to a lawful
writ, process, order, or judgment of a court
3. Any abuse of or any unlawful interference
with the process or proceedings of a court
not constituting direct contempt
4. Any improper conduct tending directly or
indirectly to impede, obstruct, or degrade
the administration of justice
5. Assuming to be an attorney
6. The rescue of a person or property in the
custody of an officer by virtue of an order
But nothing in this section shall be construed as
to prevent the court from issuing process to
bring the respondent to the court, or from
holding him in custody pending such
proceedings.
HYPOTHETICAL QUESTIONS PROPUNDED TO A MEDICAL
WITNESS
A physician may be requested to draw his
conclusion or opinions from asset of facts which
may or may not be known to him. He must
answer the question provided those set of facts
has the following requisites:
1. It must be framed as to fairly represent those
facts and not give a situation a false color by
the way the statement was given.
2. The hypothetical questions is based upon
facts which are in evidence and assumed
facts within the limit of evidence.
3. The hypothetical question must not be
unfair or misleading.
Where the expert is familiar with the facts by
personal observation and so testifies, he may be
asked directly for his opinion, without stating the
facts upon which it is based.
When the expert is not familiar with the facts
upon which it is based, they must be stated to
him hypothetically, and upon the assumption of
the facts so stated, he must base his opinion.
RATIONALE OF THE CORROBORATIVE PROBATIVE VALUE
OF MEDICAL EXPERT TESTIMONIES
1. The testimonies however impartial, may
unconsciously favor one of the part litigants. The
human mind is not absolutely impossible.
2. The opinion of the medical expert is based on
experience and treatise or books which may be
divergent from the observation of others.
CODE OF MEDICAL ETHICS
Art. I General Principles
Primary objective of the practice of medicine is
SERVICE to mankind
friend of man
Art. II Duties of Physicians to their Patients
To attend to his patient faithfully and
conscientiously
Free to choose whom to serve
Immediate action in cases of emergency
Proper consultation and referral
He must exercise good faith and strict honesty in
expressing his opinion
Sacred trust of information
Practice of medicine is not a business
Art. III Duties of Physicians to the Community
Cooperation with proper authorities, sanitation
and health
To assist in the administration of justice
To protect the public from charlatans
No solicitation and extravagant and false
advertisement
Gratuitous services to the indigents
Art. IV Duties of Physicians to their Colleagues and to
the Profession
Gratuitous services to a colleague
Proper consultation and referral
Uphold the honor and dignity of the profession
Observe punctuality
Observe utmost caution, tract and prudence as
regards professional conduct of another
physician
To refrain from making unfair and unwarranted
criticisms of other physicians
To keep abreast to the advancement of medical
science and contribute to its progress
He should be diligent, upright, sober, modest
and well-versed in both the science and art of
medicine
No advertising by means of untruthful or
improbable statements in newspapers or
exaggerated announcements
Should expose without fear or favor, before the
proper medical or legal tribunals corrupt and
dishonest conduct of members of the profession
Should aid in safeguarding against the admission
of those who are unfit or unqualified because of
deficiency in moral character
Art V Duties of Physicians to Allied Professionals
To cooperate with and safeguard the interest,
reputation and dignity of allied professional
Not to allow to be published any testimonial
certifying efficacy, value and superiority and
recommendation of drugs
Non-payment of commissions to an person who
refers cases to help him acquire patients
Penal Provision
Violation of the provisions of this Code
constitute unethical and unprofessional conduct
and therefore a sufficient ground for the
reprimand, suspension or revocation of the
certificate of registration of the offending
physician in accordance with the provisions of
Sec. 24, par. 12 of the Medical Act of 1959
RIGHTS AGAINST SELF-INCRIMINATION
Sec. 17, Art. III, Philippine Constitution states that,
No person shall be compelled to witness against
himself.

The right is available not only in criminal

prosecutions but also in all other government
proceedings, including civil actions and
administrative or legislative investigations. It
may be claimed not only by the accused but also
by any witness to whom a questions calling for
an incriminating answer is addressed.
In criminal actions, the accused may not be
compelled to take the witness stand, on the
reasonable assumption that the purpose of the
interrogation will be to incriminate him.
The same principle shall apply to the respondent
in an administrative proceeding where the
respondent may be subjected to sanctions of a
penal character, such as cancellation of his
license to practice medicine (Pascual vs. Board of
Medical Examiners, 28 SCRA 345)
Scope:
The kernel of the right is not against all
compulsion, but testimonial compulsion only.
It is simply against the legal process of extracting
from the lips of the accused an admission of his
guilt.
It does not apply where the evidence sought to
be excluded is not an incriminating statement
but an OBJECT EVIDENCE (e.g. Fingerprinting,
photographing, paraffin testing, PE)
The prohibition extends to the compulsion for
the production of documents, papers and
chattels that may be used as evidence against
the witness except where the State has the right
to examine or inspect under the police power of
the State
The right also protects the accused against any
attempt to compel him to furnish a specimen of
his handwriting in connection with a prosecution
for falsification.