Legal Medicine (Atty.

Capule) – Midterm Notes (As per pointers)

1 I. RA 8344 – DEMAND OF DEPOSITS

Is it unlawful to demand a deposit?

NO. It becomes unlawful when the deposit/advance payment is demanded as a prerequisite for
confinement or medical treatment of a patient in such hospital or medical clinic or to refuse to
administer medical treatment and support as dictated by good practice of medicine to prevent death or
permanent disability

Is refusal unlawful?

NO. If there is strict compliance with the procedure on transfer, it is not construed as refusal. Procedure
/ Requisites for valid transfer:

1. there is inadequacy of medical capabilities of the hospital

2. the patient or his next of kin consents to the transfer, provided that if the patient is unconscious,
incapable of giving consent and/or unaccompanied, the physician can transfer the patient even without
his consent

3. The receiving hospital or medical clinic agrees to the transfer

4. such transfer shall be done only after necessary emergency treatment and support have been
administered to stabilize the patient

5. that it has been established that such transfer entails less risks than the patient's continued
confinement No hospital or clinic, after being informed of the medical indications for such transfer, shall
refuse to receive the patient nor demand from the patient or his next of kin any deposit or advance
payment Transfer of Patients After the hospital or medical clinic mentioned above shall have
administered medical treatment and support, it may cause the transfer of the patient to an appropriate
hospital consistent with the needs of the patient, preferably to a government hospital, especially in the
case of poor or indigent patients (Sec. 3, RA 8344) Item 3 of IRR of RA 8344 provides: 1. The transferring
and receiving hospital, shall be as much as practicable, be within ten (10) kilometer radius of each other.
2. The transfer of patients contemplated under this Act shall at all times be properly documented. 3.
Hospitals may require a deposit or advance payment when the patient is no longer under the state of
emergency and he/she refuses to be transferred. When are hospitals required to extend medical
services? Hospitals are required to render immediate medical assistance and provide facilities and
medicine within its capabilities on emergency cases, where patients are in danger of dying and/or
suffering serious physical injuries, (Sec. 1, RA 6615) Note: Doctrine of Reasonable Reliance – Hospital
without emergency services allowed; Provided, that there is an announcement to the community that
such hospital has no emergency services, so the people in the community will not rely on the hospital
for such emergency services. II. RA 9439 – DETENTION OF PATIENTS (NOTE: The provisions of RA 9439 is
NOT APPLICABLE to patients who stayed in private rooms) Is it unlawful to detain patients for non-
payment of hospital bills/medical expenses? YES. Sec. 1 provides that it shall be unlawful for any
hospital or medical clinic in the country to detain or to otherwise cause, directly or indirectly, the
detention of patients who have fully or partially recovered or have been adequately attended to, or who
may have died, for reasons of
Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 2 non-payment in part or in full of
hospital bills or medical expense. Rights of patients that have fully or partially recovered, and already
wish to leave the hospital or medical clinic, BUT financially incapable to settle medical expenses 1. right
to leave the hospital or medical clinic 2. right to demand the issuance of the corresponding medical
certificate and other pertinent papers required for the release of the patient from the hospital or
medical clinic upon the execution of a promissory note covering the unpaid obligation 3. In case of a
deceased patient, any surviving relative has the right to demand the corresponding death certificate and
other documents required for interment and other purposes. (Also, under PD 651, hospitals are required
to issue a death certificate even if hospital bills are not yet paid) Execution of promissory note is
required The rights of the patients can only be exercised after executing and securing a promissory note,
either by a mortgage or by a guarantee of a co-maker, who will be jointly and severally liable with the
patient for the unpaid obligation. The hospital can choose the guarantor or the co- maker. It has the
right to make sure that the co- maker is capable of paying or fulfilling the obligation. Case: Manila
Doctors v. Chua and Ty Ruling: The operation of private pay hospitals and medical clinics is impressed
with public interest and imbued with a heavy social responsibility. But the hospital is also a business,
and, as a business, it has a right to institute all measures of efficiency commensurate to the ends for
which it is designed, especially to ensure its economic viability and survival. And in the legitimate pursuit
of economic considerations, the extent to which the public may be served and cured is expanded, the
pulse and life of the medical sector quickens, and the regeneration of the people as a whole becomes
more visibly attainable. In the institution of cost-cutting measures, the hospital has a right to reduce the
facilities and services that are deemed to be non- essential, such that their reduction or removal would
not be detrimental to the medical condition of the patient. For the moment, the question to be
considered is whether the subject facilities are indeed non- essential - the air-conditioner, telephone,
television, and refrigerator – the removal of which would cause the adverse health effects and
emotional trauma the respondents so claimed. Corollary to this question is whether the petitioner
observed the diligence of a good father of the family in the course of ascertaining the possible
repercussions of the removal of the facilities prior to the removal itself and for a reasonable time
thereafter, with a view to prevent damage. After an extensive analysis of the record, it becomes rather
worrisome to this Court that the courts a quo unreservedly drew their conclusions from the self- serving
and uncorroborated testimonies of the respondents the probative value of which is highly questionable.
We hold that the respondents failed to prove the damages so claimed. The evidence in the record firmly
establishes that the staff of the petitioner took proactive steps to inform the relatives of respondent
Chua of the removal of facilities prior thereto, and to carry out the necessary precautionary measures to
ensure that her health and well-being would not be adversely affected. A patient cannot be detained in
a hospital for non- payment of the hospital bill The form of restraint must be total; movement must be
restrained in all directions. If restraint is partial, e.g., in a particular direction with freedom to proceed in
another, the restraint on the person's liberty is not total. However, the hospital may legally detain a
patient against his will when he is a detained or convicted prisoner, or when the patient is

Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 3 suffering from a very contagious
disease where his release will be prejudicial to public health, or when the patient is mentally ill such that
his release will endanger public safety, or in other exigent cases as may be provided by law. Authorities
are of the view that, ordinarily, a hospital, especially if it is a private pay hospital, is entitled to be
compensated for its services, by either an express or an implied contract, and if no express contract
exists, there is generally an implied agreement that the patient will pay the reasonable value of the
services rendered; when a hospital treats a patient's injuries, it has an enforceable claim for full
payment for its services, regardless of the patient's financial status. III. PRC IDENTIFICATION Powers,
Functions, and Responsibilities of the Commission (Sec. 7) PRC upon recommendation of the PR Board
concerned has power to approve the registration and authorize issuance of certificate or license of
registration and professional ID card To supervise foreign nations who are authorized by existing laws to
practice their professions either as holders of a certificate of registration and a professional
identification card or a temporary special permit in the Philippines; To supervise professionals who were
former citizens of the Philippines and who had been registered and issued a certificate of registration
and a professional identification card prior to their naturalization as foreign citizens, who may, while in
the country on a visit, sojourn or permanent residence, practice their profession: Provided, that prior to
the practice of their profession they shall have first been issued a special permit and updated
professional identification card by the Board concerned subject to approval by the Commission and
upon payment of the permit and annual registration fees IV. RECIPROCITY The registration or issuance of
license of a foreigner professional rests in the PRC. The requirements for registration or licensing,
however, must be substantially the same as those required and contemplated by the laws of the
Philippines. It is further required that the laws of the foreign start allow the citizens of the Philippines to
practice their profession on the same basis, grant, and privileges as those enjoyed by the citizens of the
foreign country. Case: Board of Medicine v. Ota Facts: Ota is a Japanese national, married to a Filipina,
has been residing in the PH for more than 10 years, and graduated Doctor of Medicine. He filed an
application to take the board exams. PRC requires him to submit affidavit stating that if he passes the
boards, he cannot practice medicine until he submits proof that reciprocity exists between Japan and
the Philippines in admitting foreigners into the practice of medicine. Ota submitted a duly notarized
English translation of the Medical Practitioners Law of Japan duly authenticated by the Consul General
of the Philippine Embassy to Japan. He was allowed to take the boards and he passed. In spite of all
these, the Board of Medicine denied Ota‘s request for a license to practice medicine in the Philippines
on the ground that no genuine reciprocity can be found in the law of Japan, as there is no Filipino or
foreigner who can possibly practice there. Ota filed petition before the RTC. RTC ruled in favor of Ota
stating that there is adequate proof that there exists a principle of reciprocity and ordering PRC to issue
the license. PRC appealed to CA. CA affirmed RTC Ruling. Issue: Whether or not the principle of
reciprocity exists. Held: Yes. The contention of the PRC that the requirements to practice medicine in
Japan are practically impossible for a Filipino to comply with, there are also ambiguities in the Medical
Practitioners Law of Japan, and there had not been a

Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 4 single Filipino who was issued a
license to practice medicine by the Japanese Government is untenable. What the law requires is for the
foreigner to show proof that a Filipino can practice in his foreign country. It is enough that the laws in
the foreign country permit a Filipino to get license and practice therein. Requiring respondent to prove
first that a Filipino has already been granted license and is actually practicing therein unduly expands the
requirements provided for under R.A. No. 2382 and P.D. No. 223. V. PRIVILEGED COMMUNICATION Sec.
24, RRE. Disqualification by reason of privileged communication. — The following persons cannot testify
as to matters learned in confidence in the following cases: xxx (c) A surgeon authorized to practice
medicine, surgery or obstetrics cannot in a civil case, without the consent of the patient, be examined as
to any advice or treatment given by him or any information which he may have acquired in attending
such patient in a professional capacity, which information was necessary to enable him to act in that
capacity, and which would blacken the reputation of the patient Case: Lim v. CA Facts: Petitioner Nelly
Lim and Respondent Juan Lim are lawfully married to each other. Juan filed a petition for annulment of
marriage in the ground that Nelly has been suffering from schizophrenia before, during, and even after
their marriage. He presented three witnesses, one of which is the Chief of the Female Services of
National Mental Hospital, Dr. Acampado. The counsel for Juan orally applied for the issuance of
subpoena ad testificandum, the counsel for Nelly opposed the motion on the ground that the testimony
sought to be elicited from the witness is privileged since the latter had examined the petitioner in a
professional capacity and had diagnosed her to be suffering from schizophrenia. Nevertheless, the
subpoena was issued. Counsel for Nelly filed an urgent motion to quash the subpoena. Respondent‘s
counsel claimed that the witness will testify as an expert witness and would not testify on any
information acquired while attending to the petitioner in a professional capacity. Lower Court ruled in
favor of Juan. CA also ruled in favor of Juan stating that Nelly failed to establish the confidential nature
of the testimony given by Dr. Acampado. Issue: Whether or not there is breach of confidentiality clause
Held: No. In order that the privilege may be successfully claimed, the following requisites must concur:
1. the privilege is claimed in a civil case; 2. the person against whom the privilege is claimed is one duly
authorized to practice medicine, surgery or obstetrics; 3. such person acquired the information while he
was attending to the patient in his professional capacity; 4. the information was necessary to enable him
to act in that capacity; and 5. the information was confidential, and, if disclosed, would blacken the
reputation (formerly character) of the patient. These requisites conform with the four (4) fundamental
conditions necessary for the establishment of a privilege against the disclosure of certain
communications, to wit: 1. The communications must originate in a confidence that they will not be
disclosed. 2. This element of confidentiality must be essential to the full and satisfactory maintenance of
the relation between the parties.

Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 5 3. The relation must be one which in
the opinion of the community ought to be sedulously fostered 4. The injury that would inure to the
relation by the disclosure of the communications must be greater than the benefit thereby gained for
the correct disposal of litigation. The physician may be considered to be acting in his professional
capacity when he attends to the patient for curative, preventive, or palliative treatment. Thus, only
disclosures which would have been made to the physician to enable him "safely and efficaciously to
treat his patient" are covered by the privilege. It is to be emphasized that "it is the tenor only of the
communication that is privileged. The mere fact of making a communication, as well as the date of a
consultation and the number of consultations, are therefore not privileged from disclosure, so long as
the subject communicated is not stated. One who claims this privilege must prove the presence of these
aforementioned requisites. Petitioner failed to discharge that burden. Dr. Acampado was presented and
qualified as an expert witness. She did not disclose anything obtained in the course of her examination,
interview and treatment of the petitioner; moreover, the facts and conditions alleged in the
hypothetical problem did not refer to and had no bearing on whatever information or findings the
doctor obtained while attending to the patient. The statutory physician-patient privilege, though duly
claimed, is not violated by permitting a physician to give expert opinion testimony in response to a
strictly hypothetical question in a lawsuit involving the physical mental condition of a patient whom he
has attended professionally, where his opinion is based strictly upon the hypothetical facts stated,
excluding and disregarding any personal professional knowledge he may have concerning such patient.
Case: Krohn v. CA Facts: A confidential psychiatric evaluation report is being presented in evidence
before the trial court in a petition for annulment of marriage grounded on psychological incapacity. The
witness testifying on the report is the husband who initiated the annulment proceedings, not the
physician who prepared the report. The subject of the evaluation report is the wife, who invokes the
rule on privileged communication between physician and patient, and seeks to enjoin her husband from
disclosing the contents of the report. RTC allowed the admission of the psychiatric evaluation report as
evidence because it is material to the case and because there was no objection on the part of the wife
during the time it was referred to in the complaint. CA affirmed. Issue: Whether or not the presentation
of the report is a breach of the privileged communication rule Held: No. It does not fall under the
requisites laid down in the case of Lim v. CA. Moreover, the person against whom the privilege is
claimed is not one duly authorized to practice medicine, surgery or obstetrics. He is simply the patient's
husband who wishes to testify on a document executed by medical practitioners. Plainly and clearly, this
does not fall within the claimed prohibition. Neither can his testimony be considered a circumvention of
the prohibition because his testimony cannot have the force and effect of the testimony of the physician
who examined the patient and executed the report. VI. MEDICAL ACT OF 1959, AS AMENDED and other
related provisions and concepts 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

Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 6 MEDICAL JURISPRUDENCE includes: -
Licensure and regulatory laws; - Physician-patient-hospital relationship together with the other
paramedical personnel, their rights, duties and obligations; - Liabilities for non-compliance with the law.
PURPOSES OF LEGAL MEDICINE - 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 THE PRACTICE
OF MEDICINE The State must maintain high standard of practice by setting up rules and regulations with
regards to qualifications and procedure for the admission to the profession. These are legal safeguards
to guarantee the safety of the patient and impose liability to the practitioner who through his 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 1. BOARD OF MEDICAL EDUCATION Primarily concerned with the
standardization and regulation of medical education. Composition: Chairman - Secretary of Education
Members: 1. Secretary of Health 2. Director, Bureau of Private Schools 3. Chairman, Board of Medicine
4. Representative, PMA 5. Council of Deans, APMC 6. Dean, UP-College of Medicine Functions: 1. To
determine and prescribe the requirements for admission into a recognized college of Medicine; 2. To
determine and prescribe requirements for the minimum physical facilities;
Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 7 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. 2. PROFESSIONAL
REGULATIONS COMMISSION (PRC) To have general supervision and regulation of all professions
requiring examinations which includes the practice of medicine. Composition: Commissioner Two
Associate Commissioner Functions: Exercise general administrative, executive and policy-making
functions for the whole agency. 3. BOARD OF MEDICINE Its primary duties are to give examinations for
the registration of physicians and supervision, control and regulation of the practice of medicine.
Composition: Six members appointed by the president from a list submitted by the Executive Council of
the PMA. Qualifications: - Natural-born citizen; - Duly registered physician; - In the practice of medicine
for at least 10 years; - Of good moral character and of recognized standing in the medical profession as
certified by PMA; - Not a member of any faculty of any medical school (including any pecuniary interest)
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 - -Holder of a Bachelor‘s degree; - -Not convicted of any crime involving moral
turpitude;

Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 8 - -Certificate of Eligibility from the
Board of Medical Education; - -Good moral character 3. Examination Requirements - must have passed
the corresponding Board Examination - Preliminary Examination - -At least 19 years of age; - -Of good
moral character; - -Have completed the first two years of the medical course; - -Final or Complete
Examination - -Citizen of the Philippines or of any country who has submitted competent and conclusive
- Documentary evidence confirmed by the DFA showing that his country‘s existing laws permit citizens of
the Philippines to practice medicine under the same rules and regulations governing citizens thereof
(RECIPROCITY RULE). 4. Holder of certificate of registration No issuance to any candidate who has been:
- -Convicted by a court of competent jurisdiction of any crime involving moral turpitude; - -Found guilty
of immoral or dishonorable conduct after investigation by the Board of Medicine; - -Declared to be of
unsound mind. 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”? It is a privilege or franchise granted by the State to any person to
perform medical acts upon compliance with law, that is, the Medical Act of 1959 as amended which has
been promulgated by the State in the exercise of police power to protect its citizenry from unqualified
practitioners of medicine. It is diagnosing and applying and the usage of medicine and drugs for curing,
mitigating, or relieving bodily disease or conditions. ACTS CONSTITUTING THE PRACTICE OF MEDICINE
(pursuant to Sec.10, Art. III of the Medical Act of 1959 as amended): 1. 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; 2. 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;

Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 9 3. who shall falsely use the title of
M.D. after his name, shall be considered as engaged in the practice of medicine. By DECISIONS OF
COURTS, the following are not considered to constitute practice of medicine: 1. One who takes BP
reading; 2. Application of medicated massage; 3. Hospital; 4. Nurse anesthetist Exemptions: By
PROVISIONS OF LAW, the following are not considered to constitute practice of medicine (Sec.11, Art. III,
Medical Act of 1959 as amended): 1. Any medical student duly enrolled in an approved medical college;
2. dentist; 3. physiotherapist; 4. optometrist; 5. 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; 6.
Any person who administers or recommends any household remedy as per classification of existing
Pharmacy Laws; 7. Clinical psychologist with the prescription and direct supervision of a physician; 8.
Prosthetist Note: 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 one‘s 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 one thousand pesos or more than ten
thousand pesos with subsidiary imprisonment in case of insolvency or by imprisonment of not less than
one year no more than five years, or by both such fine and imprisonment, in the discretion of the court.
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. III,
Medical Act of 1959 as amended: - Exclusive consultation in specific and definite cases; - Attached to
international bodies to perform certain definite work in the Philippines; - Commissioned medical officers
stationed in the Philippines 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‖ Physicians pursuant to PD 541, Allowing Former Filipino Professionals to Practice Their
Respective Professions in the Philippines, proviso:

Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 10 - Of good standing prior to their
departure and in their adopted country; - Have registered with PRC and paid their professional fee; - 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 practitioners 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 patient and the physician will be impaired; -
Deprivation of free choice of physicians. ADDITIONAL NOTES PHYSICIAN He 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) RIGHTS OF
PHYSICIAN INHERENT RIGHTS - to choose patients (except in emergency cases) - to limit practice of
medicine - to determine appropriate management procedures - to avail of hospital services INCIDENTAL
RIGHTS - right of way while responding to emergency - right of exemption from execution of
instruments and - Library to hold certain public/private offices to perform certain services to
compensation right to membership in medical societies RIGHTS GENERALLY ENJOYED BY EVERY CITIZEN -
Pursuant to the provisions of Art. III, bill of rights, Philippine Constitution 1987 RIGHTS OF PATIENTS -
Right to give consent to diagnostic and treatment procedures - Right to religious belief - Right of privacy
- Right to disclosure of information - Right to confidential information - Right to choose his physician -
Right of treatment - Right to refuse necessary treatments Basis of Consent 1. The physician-patient
relationship is fiduciary in nature. 2. Patient‘s 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

Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 11 Instances When Consent Is Not
Necessary 1. In cases of emergency, there is an ―implied consent‖ or the physician is ―privilege
because he is reasonably entitled to assume consent 2. When the law made it compulsory for everyone
to submit to the procedure 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 of Medical Malpractice 1.
The physician has a duty to the patient; 2. The physician failed to perform such duty to his patient; 3. As
a consequence of the failure, injury was sustained by the patient; 4. The failure of the physician is the
proximate cause of the injury sustained by the patient. Criminal medical malpractice, the act or omission
complained of must be punishable by law at the time of commission or omission. Proximate Cause that
cause, which, in natural continuous sequence, unbroken by an efficient intervening cause, produces the
injury and without which the result would not have occurred. 1. There must be a direct physical
connection between the wrongful act of the physician and the injury sustained by the patient. 2. The
cause or the wrongful act of the physician must be efficient and must not be too remote from the
development of the injury suffered by the patient. 3. The result must be the natural continuous and
probable consequences. DOCTRINE OF EFFICIENT INTERVENING CAUSE In the 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. DOCTRINE OF VICARIOUS
LIABILITY Doctrine of Imputed Negligence/Command Responsibility. Vicarious liability means the
responsibility of a person, who is not negligent, for the wrongful conduct or negligence of another.
CAPTAIN-OF-THE-SHIP DOCTRINE This doctrine innunciates liability of the surgeon not only for the
wrongful acts of those who are under his physical control but also those wherein he has extension of
control. DOCTRINE OF RES IPSA LOQUITOR “The thing speaks for itself”; nature of the wrongful act or
injury is suggestive of negligence. General rule: expert testimony is necessary to prove that a physician
has done a negligent act or that has deviated from the standard of medical practice. Requisites of Res
Ipsa Loquitur Doctrine: 1. The accident must be of a kind which ordinarily does not occur in the absence
of someone‘s negligence; 2. It must be caused by an agency or instrumentality within the exclusive
control of the defendant; 3. It must not have been due to any voluntary action or contribution on the
part of the plaintiff.

Legal Medicine (Atty. Capule) – Midterm Notes (As per pointers) 12 Some cases wherein the Doctrine of
Res Ipsa Loquitor has been applied: 1. Objects left in the patient‘s body at the time of caesarian section;
2. Injury to a healthy part of the body; 3. Removal of a wrong part of the body when another part wad
intended; 4. Infection resulting from unsterilized instruments; 5. Failure to take radiographs to diagnose
a possible fracture; Instances where the Doctrine of Res Ipsa Loquitor does not apply: 1. Where the
Doctrine of Calculated Risk is applicable; 2. When an accepted method of medical treatment involves
hazards which may produce injurious results regardless of the care exercised by the physician. 3. Bad
Result Rule; 4. Honest Errors of judgment as to Appropriate Procedure; 5. Mistake in the Diagnosis In
most medical malpractice suits, there is a necessity for a physician to give his expert medical opinion to
prove whether acts or omissions constitute medical negligence. This doctrine has been regarded as rule
of sympathy to counteract the ‗conspiracy of silence‘