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LEGAL MEDICINE

-branch of medicine that deals with the


application of medical knowledge to the purposes
of law and in the administration of justice

MEDICAL
JURISPRUDENCE
deals with the aspect of law and
legal concepts in relation with the
practice of medicine

MEDICAL JURISPRUDENCE
includes:
Licensure and regulatory laws;
Physician-patient-hospital
relationship together with the
other paramedical personnel, their
rights, duties and obligations;
Liabilities for non-compliance with
the law.

Practice of Medicine
It is a privilege granted by the state
to any person to perform medical
acts upon compliance with the law.
Medical Act of 1959 promulgated
by the state in the exercise of its
police power.

Acts constituting the Practice of


Medicine
A person who shall for compensation or none
physically examine any person, diagnose treat,
operate or prescribe ( DTOP) any remedy for
human disease.

By means of advertisement and the like either


offer to undertake method to diagnose, treat,
operate or remedy.

Who shall falsely use the title of M.D.after his


name.

Not considered a Practice of Medicine


A medical intern under the supervision of a
registered physician.
Legally registered dentist engaged exclusively in
practice of dentistry.
Any duly registered masseur or physiotherapist.
Registered optometrist who mechanically fits or
sells lenses.
Any person who renders gratuitously in cases of
emergency where no MD is available.
Prosthetist who fit artificial limbs
Clinical psychologist in regards to psychiatric cases.

Faith healing, healing by prayer or divine


healing or Acupuncture

- there is nothing in the Medical Act


exempting faith healing from the
definition of the acts which
constitutes practice of medicine.

WHO ARE QUALIFIED TO


PRACTICE MEDICINE:
Those who complied to practice medicine in
accordance to the Medical Act.
Those who can have limited practice without Cert. of
Registration like the Foreign physicians, Medical
students.
Balikbayan physicians
Foreign physicians qualified to practice by reciprocity.
Limited practioners of the healing art like nurses,
dentist, opto, M.T., MW.
PT, Masseur, Chiropodist,Chiropractor

Only natural person can practice medicine.

PHYSICIAN-PATIENT RELATIONSHIP
( PPR )
-it is contractual, consensual and
fiduciary
- a meeting of the minds of two persons
where one binds himself with respect to
the other to give something or to render
some service either express or implied.
(Art.1315,NCC)
a. consent
b. object
c. consideration

NO Physican-Patient relationship
in the following:
Pre-employment P.E.whether suitable
for the job.
Eligibility for insurance purposes.
M.D. appointed by the court.
Surgeon performing an autopsy.
Casual questions in a party.

Psychological patterns of PPR


Activity-Passivity Relation

unconscious
Guidance cooperation relation ill
but conscious, M.D. in trust
Mutual participation

juridical equal to M.D.

Types of medical services which the


patient may solicit from his physician:

Perform specific tests


Examine patient and inform him of
state of health.
Examine and recommend remedy.
Give emergency treatment.
Treat but no follow-up care.
Treat with follow-up care.

Duties and Obligations Imposed


A. Physician in the PPR:
He should possess the knowledge
and skill of which an average
physician is expected
He should use the knowledge and
skill with ordinary care and diligence.
He is obliged to exercise the best
judgment.
He has the duty to observe utmost
good faith.

B. Patient
Give an honest medical history.
Cooperation and follow instructions.
Inform physician on what occurred in
the course of treatment.
Must state if he understands the
instructions given.
Must not act as if a stranger to the
problem.

Terms NOT included in the PPR


Does not imply a promise that
treatment is successful.
Treatment will benefit the patient.
Will produce certain results.
Will not harm the patient.
Will not commit errors

What does the law implies in


PPR?
the physician will render service.

Commencement of the PPR:


When a patient ask a physician to treat and the
moment the M.D. willingly agrees.

Termination of the PPR

Recovery of the patient from the condition


Withdrawal of the physician. consent, ample time
Discharge of the physician by the patient.
Death of the patient.
Death or incapacity of the physician.
Fulfillment in the obligations as stipulated in the
contract.
In cases of emergency, upon arrival of the attending
M.D.
Expiration of the period.
Mutual agreement between the M.D. and Pt. to
terminate PPR.

Rights INHERENT in the privilege to practice medicine

RIGHTS OF PHYSICIANS

1. Right to choose patient, even if no other M.D.: except in emergencies


2. To limit the practice of his profession.Only in his field of specialty.
.
= Private clinic or hospital
.
= Within political or geographical boundary.
.
= Only on certain days, hours of the day.
.
= Certain class of people.
.
= By dictates of his conscience.
.
= Ignorance
.
= Retirement
.
.
From other sources:
.
= Imposed by the public.
.
= Religion abortion
.
= Professional ethics
.
= Medical society
.
= Imposed by law
.
= By contract
.
.

3. To determine the appropriate


management procedures.
> frequency of visits
>Doctrine of superior
knowledge pt. follows
4. Right to avail hospital services.

Rights INCIDENTAL in the privilege


to practice medicine
Right of way while responding to call of emergency
Right of exemption from execution of instruments
and library.
= not deprive physicians to practice of healing
Right to hold certain public or private offices.
Right to compensation even unconscious due to
Implied contract.
= Doctrine of unjustified enrichment: service
rendered, service paid
Right to membership in medical societies.
Rights generally enjoyed by every citizen as provided
in the Bill of Rights.

Kinds of MEDICAL FEES:


Simple contractual fee
Ap
for a sum
Retainers fee
Space of time, not an employee of
the pt.
Contingent fee
- result
of treatment
Dichotomous fee, fee splitting unethical
Straight fee or pakyaw system

Methods of collection of
payments for medical services:
1. Friendly or extrajudicial methods:
- Billing
- Referral to a bill collection agency
2. Judicial methods

Facts to be proven in court:


That plaintiff-physician is qualified and licensed to
practice.
Not duly licensed:
a. Single isolated case,
b. Contract perfected in foreign
country.
That the physician performed professional services.
That the defendant failed to pay the reasonable PF
after repeated demands.
In the absence of agreement, the physician is
required to prove that the PF
- customary and reasonable.

FACTORS INFLUENCING THE


AMOUNT OF PF
Nature and character of the services
rendered.
Labor, time and trouble involved.
Importance and responsibility.
Professional character and social standing of
the M.D.
The results secured.
Financially ability of the patient.
Purchasing power of the peso.
Local customs

If a patient dies or incapacitated, who shall pay


the Professional Fee:

The spouse
The descendants of the nearest
degree.
The ascendants of the nearest
degree
The brothers and sisters

Instances when the physician


cannot recover PF:
Agreement that the service is gratuitous
Professional services by government physicians
in charity wards.
Private charitable institutions.
Waiver in the part of the physician.
Expressed contract to cure and non-fulfillment
Covered by Medicare.
Colleague is a doctor.
Industrial physicians to their employees.
To school, faculty, students.

Defenses of MD when obliged to


pay the Medical bill in Court.
Exorbitant fees
No medical service rendered.
Defendant not the person legally to
pay.
No consent to such medical services.
Previous agreement that it is
gratuitous.
Not qualified to practice.
Party is not financially capacitated.

Grounds for counter complaint:


Contract to cure.
Fraudulent representations as to the
ailment.
Treatment is contrary to the
agreement.

RIGHTS OF PATIENTS
Give consent to diagnostic and treatment
procedures inform pt.
Religious belief
Privacy
Disclosure of information
Confidential information
Choose his physician
Treatment
Refuse necessary treatments

1.Give CONSENT to diagnostic and


treatment procedures inform pt.
Basis of the consent:
self determination

Fiduciary rel-ship, right to

Purpose:
a) To protect pt. from procedures
without consent.
b) To protect M.D. from failure to
comply with legal rqmts

NOT NECESSARY:
a)
Emergency cases
b)
Law require submission to the procedure

Requisites of valid consent:


It must be an informed consent
Voluntarily given to the patient
Subject matter must be legal

5 elements of an Informed consent


a)
He must understand the nature of his condition.
b)
The nature of the proposed treatment or procedure
c)
Awareness of the possible alternative
courses of action
d)
Risk of the proposed
alternatives courses of action
e) Informed of the chances of success or failure of the
proposed and alternative therapies.

Instances when informed consent


require MORE Disclosure of Facts:
when the procedure will entail much
risk.
When the procedure is experimental
or innovative.

Instances when full disclosure


may NOT be necessary:
Cause emotional upset to the patient
When the medical procedure is
publicly known to be safe

Extention of the operative procedure


beyond what is consented.

- to any abnormal conditions when


he thinks advisable for the welfare of
the patient and follow the approved
practice of surgeons generally.

Persons who can give the


consent:
Patient
If minor, consent from parents
= Redound to the preservation of life and
health
= Expressed refusal of a minor shall not
prevail in an emergency case
Grandparents, if parents are absent
Eldest brother or sister are of age and not
disqualified by law
Substitute parental authority guardians,
teachers

2. Right to Religious belief


a) Right to believe
b) b) Right to act in accordance with
ones belief
* Limited by the
police power of the state
*
Freedom to believe is absolute but
*freedom to act is limited by
statutes.

3. Right of Privacy
a) To be left alone
b) Free from unwarranted publicity

Ways of intruding to the right of privacy of patients:


1.Physical intrusion at a time the patient would like to be left alone.
2. Publishing information about the patient which is offensive to the
ordinary person.
3. Used for commercial purposes aspects of personality of the
patients life.
= Taking photos and publication in the print media can only be done
with
the express consent of the patient or who acts in his behalf,
= The condition imposed must not be violated even if it is a scientific j
journal.
=
NOT an invasion of privacy when public interest demands such
publication.

4.Right of Disclosure
Being fiduciary the patient is obliged
to disclose pertinent facts regarding
the illness with good faith and strict
honesty- if not, guilty of fraud.
May not reveal remote possibilities to
the patient.

5. Right of Confidential
information
Physician is not allowed to divulge to a 3 rd party.
a) Statutory Privileged Communication
Not in a civil case that may blacken the character
of the patient.
b) Ethical or Professional Confidential Information
Sacred trust
Main purpose: to make patient fully disclose all facts and
circumstances.
NOT APPLICABLE:
a)When such disclosure is necessary to serve the best interest of justice.
= Criminal in nature ,Child abuse, Physical injuries
b)When disclosure of information will serve public health and safety.
c)When the patient waives to the confidential nature of such information.


6. Right to Choose his physician

7. Right to Treatment in
emergency cases
Immediate emergency medical
assistance to dying and serious
physical injuries.
First aid treatment.

8. Right to Refuse necessary


treatment
To determine what must be done to his
own body.
= Parents have no right based on
religious belief or other grounds to deny
medical treatment to their
child.
= The state under the Doctrine
of Parens Patriae to assume
guardianship when the child is neglected
by the parents to have the child treated.