G.R. No. 150355 July 31, 2006 the patient.
the patient. Respondents thus prayed for the award of moral damages, exemplary
MANILA DOCTORS HOSPITAL, petitioner,
vs.
SO UN CHUA and VICKY TY, respondents.
DECISION
AUSTRIA-MARTINEZ, J.:
Before this Court is a Petition for Review on Certiorari under Rule 45 questioning the
Decision1 dated October 2, 2001 promulgated by the Court of Appeals (CA) in CA-
G.R. CV No. 61581, which affirmed the Decision dated September 30, 1997 of the
Regional Trial Court (RTC), Branch 159, Pasig City, but which reduced the award of
damages.
This case originated from an action for damages filed with the RTC by respondents So
Un Chua and Vicky Ty against petitioner Manila Doctors Hospital. 2 The complaint is
premised on the alleged unwarranted actuations of the petitioner towards its patient,
respondent So Un Chua (Chua), who was confined for hypertension, diabetes, and
related illnesses.
The antecedents of the case follow:
On December 13, 1993, respondents filed a Complaint averring that on October 30,
1990, respondent Chua, the mother of respondent Vicky Ty, was admitted in
petitioner's hospital for hypertension and diabetes; that while respondent Chua was
confined, Judith Chua, the sister of respondent Ty, had been likewise confined for
injuries suffered in a vehicular accident; that partial payments of the hospital bills
were made, totaling P435,800.00; that after the discharge of Judith Chua, respondent
Chua remained in confinement and the hospital bills for both patients accumulated;
that respondent Chua was pressured by the petitioner, through its Credit and
Collection Department, to settle the unpaid bills; that respondent Ty represented that
she will settle the bills as soon as the funds become available; that respondent Ty
pleaded to the management that in view of the physical condition of her mother,
respondent Chua, the correspondences relating to the settlement of the unpaid
hospital bills should be relayed to the former; that these pleas were unheeded by the
petitioner; that petitioner threatened to implement unpleasant measures unless
respondent Ty undertakes her mother's obligation as well as the obligation of her
sister, Judith Chua, to pay the hospitalization expenses; that petitioner made good its
threat and employed unethical, unpleasant and unlawful methods which allegedly
worsened the condition of respondent Chua, particularly, by (i) cutting off the
telephone line in her room and removing the air-conditioning unit, television set, and
refrigerator, (ii) refusing to render medical attendance and to change the hospital
gown and bed sheets, and (iii) barring the private nurses or midwives from assisting
damages, and attorney's fees.
In its Answer, Amended Answer, and Rejoinder, petitioner specifically denied the
material averments of the Complaint and Reply, and interposed its counterclaims
arguing that as early as one week after respondent Chua had been admitted to its
hospital, Dr. Rody Sy, her attending physician, had already given instructions for her
to be discharged, but respondents insisted that Chua remain in confinement; that,
through its staff, petitioner accordingly administered medical examinations, all of
which yielded negative results; that respondent Ty voluntarily undertook, jointly and
severally, to pay the hospital bills for both patients; that although respondent Ty paid
up to P435,000.00, more or less, she reneged on her commitment to pay the balance in
violation of the Contract for Admission and Acknowledgment of Responsibility for
Payment dated October 30, 1990 which she voluntarily executed; that she signed a
Promissory Note on June 5, 1992 for the unpaid balance of P1,075,592.95 and issued
postdated checks to cover the same; that no such undue pressure had been imposed
upon respondent Chua to settle the bills, the truth being that, as a matter of standard
procedure, the reminders to settle the bills were transmitted not to the patients but to
their relatives who usually undertook to pay the same; that respondent Ty
deliberately evaded the staff of the Credit and Collection Department; that the
cutting-off of the telephone line and removal of the air-conditioning unit, television
set, and refrigerator cannot constitute unwarranted actuations, for the same were
resorted to as cost-cutting measures and to minimize respondents' charges that were
already piling up, especially after respondent Ty refused to settle the balance
notwithstanding frequent demands; that respondent Ty evaded the staff when the
latter attempted to inform her that the room facilities will be cut off to minimize the
rising charges; and that respondents instituted the present civil case purposely as
leverage against the petitioner after the latter had filed criminal charges for violation
of Batas Pambansa (B.P.) Blg. 22 against respondent Ty for issuing checks, later
dishonored, totaling P1,075,592.95, the amount referring to the unpaid hospital bills.
In its compulsory counterclaim, petitioner prayed, among other items, for the award
of no less than P1,000,000.00 as compensatory damages due to the filing of a
malicious and unfounded suit, and, in its permissive counterclaim, petitioner prayed
for respondents to pay P1,075,592.95, the amount representing the due and
demandable obligation under the Promissory Note dated June 5, 1992, including the
stipulated interest therein and the 25 percent of the total amount due as attorney's
fees.
During pre-trial, the parties stipulated on the following issues: First, whether the
respondents are liable to the petitioner to pay the hospital bills arising from the
hospitalization of respondent Chua and Judith Chua; and second, whether the parties
are entitled to their respective claims for damages.3 Furthermore, the parties
stipulated on the following facts: a) Judith Chua was confined from June 14, 1991 to
May 2, 1992; b) respondents failed to pay the balance despite repeated reminders; c)
the said reminders referred to the hospital bills of respondent Chua and Judith Chua;
d) one of the attending physicians of respondent Chua was Dr. Rody Sy; and e) the
petitioner ordered the removal of the facilities in question from the room of its
patient, respondent Chua, with the qualification that they were constrained to
discontinue the same after the representative of respondent Chua refused to update
the hospital bills or refused to transfer her to semi-deluxe room or ward to lessen
costs.4
On September 30, 1997, the RTC rendered its Decision in favor of the respondents, the
dispositive portion of which states:
WHEREFORE, premises considered, judgment on the complaint is hereby
rendered in favor of the [respondents] as against the [petitioner] as follows:
[O]rdering the [petitioner] to pay the [respondents] the following, to wit:
a) P200,000.00 as moral damages;
b) P100,000.00 as exemplary damages; and
c) P50,000.00 as attorney's fees and the amount of P50,000.00 as
litigation costs.
SO ORDERED.5
In brief, the RTC held that the removal of the facilities of the room triggered the
hypertension of respondent Chua; that the petitioner acted in bad faith in removing
the facilities without prior notice; that her condition was aggravated by the pressure
employed by the administration upon her to pay the hospital bills; that the food
always came late as compared to the other patients; that the beddings and clothes of
respondent Chua were no longer changed and, as a result, bed sores emerged on her
body; that there was an utter lack of medical attendance; that, because of these,
respondent Chua suffered from self-pity and depression; that petitioner clearly
discriminated against the respondents; that respondent Ty had no choice but to sign
the promissory notes in order to secure the release of her mother, respondent Chua;
that the foregoing actuations constitute an abuse of rights; that petitioner failed to
establish the pecuniary loss it suffered and, hence, it is not entitled to compensatory
damages; and that, since the promissory note is a contract of adhesion, the petitioner
is not entitled to the award of attorney's fees as stipulated thereon.
On appeal to the CA, the petitioner assigned the following errors:
A.
THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERROR BY
FINDING THE ACTUATIONS OF THE ADMINISTRATION OF
DEFENDANT-APPELLANT TO BE IN BAD FAITH, OPPRESSIVE AND
UNNECESSARY AS TO MAKE IT LIABLE TO PLAINTIFFS-APPELLEES
FOR DAMAGES AND ATTORNEY'S FEES.
B.
THE HONORABLE TRIAL COURT COMMITTED REVERSIBLE ERROR BY
NOT RULING UPON THE PERMISSIVE COUNTERCLAIM OF
DEFENDANT-APPELLANT WITH RESPECT TO THE P1,075,592.95
REPRESENTING THE HOSPITAL BILL OF PLAINTIFFS-APPELLEES,
WHICH OBLIGATION IS NOT DISPUTED AND WHICH AMOUNT WAS
NEVER CONTROVERTED BY PLAINTIFFS-APPELLEES.6
On October 2, 2001, the CA promulgated its Decision the dispositive portion of which
reads:
IN VIEW OF ALL THE FOREGOING, the appealed Decision is
hereby AFFIRMED with the modification that the award of moral damages,
exemplary damages as well as attorney's fees is reduced to Seventy Five
Thousand Pesos (P75,000.00), Thirty Thousand Pesos (P30,000.00) and
Twenty Thousand Pesos (P20,000.00), respectively. Litigation costs are
hereby deleted. Costs against appellant.
SO ORDERED.7
Apart from the reduction in the award of damages, the CA affirmed all salient
portions of the RTC Decision and declined to disturb the findings of fact.
Petitioner is now before this Court raising essentially the same grounds heard by the
CA.
Incidentally, with respect to the related criminal case against respondent Ty, this
Court, on September 27, 2004, promulgated its Decision entitled Ty v. People of the
Philippines,8 which affirmed the decisions of the lower courts finding respondent Ty
guilty of violating B.P. Blg. 22 and ordering her to pay the private complainant,
herein petitioner, the total amount of the dishonored checks.
The petition is impressed with merit.
While, as a rule, only questions of law may be raised in a petition for review
on certiorari under Rule 45, under certain exceptions, the Court may re-examine the
evidence presented by the parties during the trial. At least four exceptions exist in this
case, namely: (a) when the conclusion is a finding grounded entirely on speculation,
surmises, or conjectures; (b) when the judgment is based on a misapprehension of
facts; (c) when the findings of fact are premised on the supposed absence of evidence
and contradicted by the evidence on record; and (d) when the courts a quo manifestly
overlooked certain relevant facts not disputed by the parties and which, if properly
considered, would justify a different conclusion.9
The principal questions are, first, whether the actuations of the petitioner amount to
actionable wrongs, and second, whether the counterclaims of the petitioner can be
backed up by the measure of preponderant evidence.
In brief, the courts a quo concurred in the holding that the petitioner and its staff
failed to take into consideration the physical condition of its patient, respondent
Chua, when it removed the facilities provided in her room;10 that the removal of these
facilities, namely, the air-conditioner, telephone lines, television, and refrigerator,
aggravated the condition of the patient, triggered her hypertension, and caused her
blood pressure to fluctuate,11 considering that there was no proper ventilation in the
room.12 In view of the foregoing, the courts a quo concluded that the actuations of the
petitioner were oppressive, unnecessary,13 and anti-social,14 done in bad faith without
proper notice,15 with no intention other than to harass or irritate the respondents, 16 all
of which constitute an abuse of rights.17
We do not agree. The conclusions of the courts a quo are either haphazard conjectures,
or founded on a misapprehension of facts. The record is replete with evidence that
justifies a different conclusion.
Indeed 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.18 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 19 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. 20
After an extensive analysis of the record, it becomes rather worrisome to this Court
that the courts a quounreservedly drew their conclusions from the self-serving and
uncorroborated testimonies of the respondents the probative value of which is highly
questionable.21 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: as early as around two
weeks after her admission on October 30, 1990, to the time when the facilities had
been removed sometime in the middle of May 1992,22 and even up to the point when
she actually left the premises of the hospital three weeks later, or during the first
week of June 1992,23 the medical condition of respondent Chua, as consistently and
indisputably confirmed by her attending physician, Dr. Rody Sy, a cardiologist, who
was called as witness for both parties,24whom even respondent Chua repeatedly
praised to be "my doctor" and "a very good doctor"25 at that, and whose statements at
times had been corroborated as well by Sister Mary Philip Galeno, SPC, the
Administrator of the hospital and who also happens to be a registered nurse, had
been "relatively well,"26 "ambulatory,"27 "walking around in the room,"28 and that she
was "able to leave the hospital on her own without any assistance;" 29 that although
she complained of symptoms such as dizziness, weakness,30 and abdominal
discomfort,31 Dr. Sy requested several medical examinations, such as the laboratory
tests, renal tests, MRI, ultrasound, and CT scan,32all of which were administered after
procuring the consent of respondent Chua's family33 as admitted by respondent Ty
herself,34 and even called on other specialists, such as a neurologist, endocrinologist,
and gastroenterologist, to look into her condition35 and conduct other tests as
well36 according to their fields of specialty, all of which yielded no serious
finding;37 that her illnesses were "lifelong illnesses"38 at a stage where they cannot be
totally removed or abolished,39 making it clear to her family that "one hundred
percent recovery is not possible" despite being given daily medication in the
hospital;40 but that her condition, nonetheless, is not serious,41 as the blood pressure is
more or less controlled and within acceptable limits,42 "not that critical to precipitate
any acute attack,"43 nor likely to fall into any emergency,44 nor yet does she require
continuous or prolonged hospitalization45 since she was stable enough to be treated at
home and on an "out-patient" basis, so much so that Dr. Sy encouraged her to exercise
and avoid resting all the
time,46 and recommended that "anytime she may be discharged"47
even in just "two weeks after confinement,"48 the propriety of his order of discharge
concurred upon by the other specialists as well,49 had it not been for respondents'
insistence to stay in the hospital in view of their hope for absolute recovery 50 despite
the admission of respondent Chua herself that she cannot anymore be totally cured. 51
It is also undisputed that the hospital administrator, Sister Galeno, prior to the
removal of the facilities, consulted the attending physician, Dr. Sy. 52 To Sister Galeno,
also a registered nurse, the matter of removal and its possible repercussions on the
health of the patient, as a matter of hospital policy, is a critical and sensitive
maneuver, and, hence, it is carried out only after discussing with the doctors to
evaluate all important factors.53 The fact of prior consultation54 as well as the medical
determination to the effect that it was safe to remove the facilities and would cause no
harmful effect55 had been amply corroborated by respondent Chua's own doctor
himself.56 When Dr. Sy testified as rebuttal witness for the respondents themselves
and whose credibility respondents failed to impeach, he categorically stated that he
consented to the removal since the removal of the said facilities would not by itself be
detrimental to the health of his patient, respondent Chua.57 And in this respect, he
had been advising respondent Ty, the daughter of the patient, that the facilities, such
as the air-conditioner, television, refrigerator, and telephone, are not absolutely
necessary, and, that although they may add to the comfort of the patient, if absent,
they will not cause any significant deterioration of her condition, 58 given that, in his
experience as a cardiologist, and after personally attending respondent Chua on a
daily basis before, during, and after the removal and even up to the time of her actual
discharge,59 he concluded that many hypertensive and diabetic patients, as in her
case, do not at all need in particular an air-conditioning unit, among the other
facilities aforementioned.60 And, contrary to the findings of the courts a quo and the
self-serving testimonies of respondents that the lack of ventilation, after the removal
of the air-conditioner, triggered her hypertension, Dr. Sy categorically stated that
during his daily rounds with the patient he was certain that, although admittedly the
blood pressure in general would fluctuate daily, there had been no adverse effect on
her, and that her blood pressure were within acceptable limits, 61 especially
considering that he treated the patient on a daily basis up to the point of actual
discharge,62 and accordingly, as confirmed by the medical records, he made no
change in the medications thereafter.63 In support of Dr. Sy's findings, Sister Galeno,
testified that she knew the condition of the ventilation of the patient's deluxe room,
located at the fifth floor, even without the air-conditioning, notably in times of
brownout, and that there had been enough ventilation since the grilled window of
that room was large enough which, if opened, would permit sufficient
ventilation.64 The Court finds that the premise of the RTC judgment refers merely to
hypothetical statements which fail to establish any clear and direct link to the injury
allegedly suffered by the patient:
Q — You found it safe to remove these facilities from the room of the patient
suffering from diabetes and hypertension?
A — Yes, Sir. Many hypertensive, diabetic patients do not need air-
conditioning, or T.V. or refrigerator.
Q — Do you agree with me that hypertension is triggered sometimes by
excitement, anger or (sic) a person suffering from such illness?
A — Hypertension can be triggered by anything.
Court:
Q — And even in other words the discomfort can also trigger?
A — Sometimes mental stress can trigger.
xxxx
Court:
Q — You mentioned earlier that this hypertension may be triggered
mentally?
A — Yes, Your Honor.
Court:
Q — Will the removal of these facilities not affect the patient including the
relatives?
A — It may to a certain extent. And well, maybe the days after the removal
would prove that fluctuation in blood pressure are within acceptable
limits.65
With respect to the findings of the courts a quo that bed sores appeared on the body of
respondent Chua, that she suffered from depression after the disconnection of the
said facilities, that her private midwives were barred, and that the delivery of food
was delayed, this Court holds, as above, that these conclusions are bereft of sound
evidentiary basis, self-serving and uncorroborated as they are. Again, Dr. Sy affirmed
that during the daily rounds he would make on the patient, he did not detect any skin
lesion or any other abnormality up to the time she was actually discharged. 66 Nor did
he find any sign of depression, although, admittedly, he observed that she had been
"very angry" because of the removal of the facilities.67 All the while he did not receive
any complaint from respondent Chua indicating that she suffered from the foregoing
infirmities,68 considering that it is the responsibility of the family of the patient to
specifically inform the attending physician or the nurses during their rounds
whatever they feel is important, or if there were any new developments since the last
visit.69 As corroborated by Sister Galeno, throughout respondent Chua's confinement,
she never received any complaint from the latter or her relatives that she had not
been attended to by the nursing staff.70 Worth noting again is the fact that the nursing
staff and the attending physicians, which included Dr. Sy, in accordance with hospital
policy, would routinely make their rounds on a daily basis, or would visit the patient
whenever they are called for any problem,71 and, in the case of the specialists other
than the attending physician, they would visit the patient about once a week.72 The
nurses, on the other hand, would make their rounds more frequently, that is, at least
once per shift, or every eight hours.73Apart from the self-serving statements of
respondents, which by now have become rather indicative of being mere
afterthoughts, there is no clear showing from the record that the petitioner and its
medical staff deviated from the foregoing policy and practice, nor had they been
called upon to look into the alleged physical reactions or emotional trauma
respondent Chua claims to have suffered during and after the removal of the
facilities. It must be emphasized that, as stated above, respondent Chua herself
explicitly found Dr. Sy to be a "very good doctor" because he personally attended to
her "almost every hour."74 And throughout her confinement, Dr. Sy positively stated
that her family employed a private midwife who attended to her all the time. 75
The evidence in the record overwhelmingly demonstrates that respondent Chua had
been adequately attended to, and this Court cannot understand why the courts a
quo had declared that there was an "utter lack of medical attendance," or that her
health suffered during the period after the removal of the facilities. The Court finds
that the facilities in question are non-essential for the care of respondent Chua and,
hence, they may be lessened or removed by the petitioner for the sake of economic
necessity and survival.
Though human experience would show that the deactivation of the air-conditioner
may cause a temperature differential that may trigger some physical discomfort, or
that the removal of entertainment facilities such as the television set, or the
disconnection of communication devices such as the telephone, may cause some
exasperation on the part of the one who benefits from these, nevertheless, all things
considered, and given the degree of diligence the petitioner duly exerted, not every
suppression of the things that one has grown accustomed to enjoy amounts to an
actionable wrong, nor does every physical or emotional discomfort amount to the
kind of anguish that warrants the award of moral damages under the general
principles of tort. The underlying basis for the award of tort damages is the premise
that an individual was injured in contemplation of law. Thus, there must first be the
breach of some duty and the imposition of liability for that breach before damages
may be awarded; it is not sufficient to state that there should be tort liability merely
because the plaintiff suffered some pain and suffering.76
Moreover, this Court must reiterate the standard of tort to arrive at a proper award
for damages premised on matters that suggest the application of medical knowledge,
especially in the description of the causal link between external or environmental
factors, on one hand, and their effect unto the physical or emotional health of the
patient, on the other, expert opinion, as discussed in Cruz v. Court of Appeals,77 is
generally required:
All three courts below bewail the inadequacy of the facilities of the clinic and
its untidiness; the lack of provisions such as blood, oxygen, and certain
medicines; the failure to subject the patient to a cardio-pulmonary test prior
to the operation; the omission of any form of blood typing before
transfusion; and even the subsequent transfer of Lydia to the San Pablo
Hospital and the reoperation performed on her by the petitioner. But while
it may be true that the circumstances pointed out by the courts below
seemed beyond cavil to constitute reckless imprudence on the part of the
surgeon, this conclusion is still best arrived at not through the educated
surmises nor conjectures of laymen, including judges, but by the
unquestionable knowledge of expert witnesses. For whether a physician or
surgeon has exercised the requisite degree of skill and care in the treatment
of his patient is, in the generality of cases, a matter of expert opinion. The
deference of courts to the expert opinions of qualified physicians stems from
its realization that the latter possess unusual technical skills which laymen in
most instances are incapable of intelligently evaluating. Expert testimony
should have been offered to prove that the circumstances cited by the courts
below are constitutive of conduct falling below the standard of care
employed by other physicians in good standing when performing the same
operation. It must be remembered that when the qualifications of a
physician are admitted, as in the instant case, there is an inevitable
presumption that in proper cases he takes the necessary precaution and
employs the best of his knowledge and skill in attending to his clients,
unless the contrary is sufficiently established. This presumption is rebuttable
by expert opinion which is so sadly lacking in the case at bench.78
With respect to the propriety of the notice of removal of facilities, the evidence shows
that the hospital staff, accompanied by Sister Gladys Lim, SPC, Finance
Administrative Assistant of the hospital,79 through written and verbal notices as per
hospital policy, forewarned the respondents, through respondent Ty and her sister,
Judith Chua, of the impending removal of the facilities over a week beforehand80 in
view of their obstinate refusal to vacate and transfer to a lower rate room81 or to
update the mounting hospital bills82 which, by then, had swollen to approximately
one million pesos.83 Respondent Ty refused to read many of the written notices sent
by the Credit
Department.84 After repeated attempts to contact respondent Ty85 and before the
actual removal of the facilities, the staff of the petitioner tried to personally serve the
final notice dated April 23, 1992,86 signed by Sister Gladys Lim, addressed to
respondent Ty, which adopted the tenor of the prior verbal warnings, and which
expressly and sternly warned the respondents that the hospital shall be constrained to
take legal action and that they shall be compelled to transfer the patient, respondent
Chua, to a lower rate room unless the balance could be satisfied. 87Respondent Ty, for
no justifiable reason, and sticking to her inclination to avoid the staff, refused to
receive or acknowledge this letter as well.88 Worth noting is that Sister Galeno,
testified that, as a matter of hospital policy the tenor of which respondents, by virtue
of the Contract for Admission dated October 30, 1990, agreed to comply with, 89 the
hospital can only cut off the non-essential facilities – and only in extreme cases90 – if
the patient occupies a private room all to herself; had the room been semi-private
shared by other patients, or had it been the ward, the hospital cannot disconnect the
facilities since this would unduly prejudice the other patients. But respondent Chua
herself insisted on staying in a private room despite her being fully aware of the
ballooning charges,91 and even if she could have freely gone home anytime to her
condominium unit which, as admitted, was equipped with an air-conditioner.92 With
respect to the "pressure" and "harassment" respondents allegedly suffered daily
whenever the hospital staff would follow up the billing during odd hours, or at
10pm, 11pm, 12 midnight, 1am, or 2am,93 this averment had been convincingly
refuted by the witnesses for the petitioner, namely, Editha L. Vecino, the Head of
Credit and Collection, and Sister Galeno, in that the Credit and Collection
Department would only hold office hours from 8am to 5pm and, hence, it is
impossible to "harass" the respondents during the times they so claimed. 94
The courts a quo found that respondent Ty had "no choice but to sign the promissory
note in order for her mother to be released from the hospital," 95 thus suggesting that
the hospital refused to actually discharge or bodily release its patient, respondent
Chua, until arrangements had been made to settle the charges.
While there are portions of the testimonies of the witnesses for the petitioner which
state that although, as per standard procedure, the patient "cannot leave" 96 the
hospital without the "discharge,"97 "clearance" or "gate pass" issued only after
arrangements on the settlement of bills had been made,98 still, it must be understood
that these are only demonstrative of the precondition that a patient cannot step out of
the premises "without the consent" of the hospital, or, in other words, that the
"clearance" merely indicates that the hospital expressly consented to the actual release
of the patient,99 but, even without its consent, the patient is still free to leave
"anytime" as a matter of policy, in spite of the refusal to issue a "clearance" or "gate
pass,"100 or even in cases where the accounts have not yet been liquidated or
settled,101 or yet even if no promissory note or post-dated check were executed in
favor of the petitioner, as testified by no less than Sister Galeno,102 and corroborated
by Editha Vecino;103 and that, petitioner, a private hospital established for
profit,104 being also a business, by warning respondents that it shall withhold
clearance, is simply exercising its right to protest against an absconding patient as a
precursor to avail of other appropriate legal remedies; that, on the contrary, the
respondents opted not to leave because of their own promise not to leave unless the
hospital bills were fully settled;105 that the accusations found in the Demand Letter
dated May 19, 1992, and signed by the counsel for the respondents, 106 particularly,
that the petitioner "refused to discharge the patient, [respondent Chua,] despite
orders from the attending physician, Dr. Rody Sy," had all been refuted by Sister
Galeno when she read its contents in front of the counsel for respondents,
emphatically telling him that "we are not detaining his clients;" that "[respondent Ty]
was the one who told us that they are not going to leave the hospital unless they have
fully paid the hospital;"107 and that, most importantly, no physical restraint upon the
person of respondent Chua or upon the person of her relatives had been imposed by
the staff.
Authorities, including those of common law origin, explicitly declare that a patient
cannot be detained in a hospital for non-payment of the hospital bill. If the patient
cannot pay the hospital or physician's bill, the law provides a remedy for them to
pursue, that is, by filing the necessary suit in court for the recovery of such fee or
bill.108 If the patient is prevented from leaving the hospital for his inability to pay the
bill, any person who can act on his behalf can apply in court for the issuance of the
writ of habeas corpus.109
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. 110 However, the hospital may legally
detain a patient against his will when he is a detained or convicted prisoner, or when
the patient is 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,111 or in other exigent cases as may be provided by law.
Moreover, under the common law doctrines on tort, it does not constitute a trespass
to the person to momentarily prevent him from leaving the premises or any part
thereof because he refuses to comply with some reasonable condition subject to which
he entered them. In all cases, the condition of this kind of restraint must be reasonable
in the light of the circumstances.112 At any rate, as stated above, the patient is free to
leave the premises, even in the ostensible violation of these conditions, after being
momentarily interrupted by the hospital staff for purposes of informing him of those
reasonable conditions, such as the assessment of whether the patient is fit to leave,
insane, or suffering from a contagious disease, etc., or simply for purposes of making
a demand to settle the bill. If the patient chooses to abscond or leave without the
consent of the hospital in violation of any of the conditions deemed to be reasonable
under the circumstances, the hospital may nonetheless register its protest and may
choose to pursue the legal remedies available under law, provided that the hospital
may not physically detain the patient, unless the case falls under the exceptions
abovestated.
Authorities are of the view that, ordinarily, a hospital, especially if it is a private pay
hospital,113 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;114 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. 115 At this
juncture, it must be noted that there is testimony, though to a degree disputable, to
the effect that the execution of the promissory note and the issuance of postdated
checks were conditions imposed not by the petitioner but voluntarily offered by the
counsel for respondents.116 At any rate, however, this Court holds, in view of the
foregoing authorities, that the requirement to have the relative of respondent Chua to
execute a promissory note as part of the arrangement to settle the unpaid obligations
is a formality that converts any implied contract into written form and, moreover,
amounts to a reasonable condition, the non-fulfillment of which, in itself, however, as
discussed, cannot allow the hospital to detain the patient. It must also be stressed,
contrary to the findings of the courts a quo, that such an agreement embodied in a
promissory note, as well as the Contract for Admission and Acknowledgment of
Responsibility for Payment dated October 30, 1990, do not become contracts of
adhesion simply because the person signing it was under stress that was not the
result of the actions of the hospital,117 especially taking into account that there is
testimony to the effect that respondent Ty signed the Promissory Note dated June 5,
1992 in the presence of counsel and acting under his advise. 118
But as to the propriety of the circumstances surrounding the issuance of the
postdated checks to cover the amount stated in the Promissory Note dated June 5,
1992, this Court must refer to the discussion of the recent case of Ty v. People of the
Philippines119 where this Court affirmed the conviction of respondent Ty for the
issuance of bouncing checks addressed to the petitioner herein. While the instant case
is to be distinguished from the Ty case in nature, applicable law, the standards of
evidence, and in the defenses available to the parties, hence, the judgment of
conviction in that case should not at all prejudice the disposition of this case, even if
the facts coincide, nonetheless, for purposes of convenience and instructive utility, the
Court quotes the relevant portions:
In this case, far from it, the fear, if any, harbored by Ty was not real and
imminent. Ty claims that she was compelled to issue the checks a condition
the hospital allegedly demanded of her before her mother could be
discharged for fear that her mother's health might deteriorate further due to
the inhumane treatment of the hospital or worse, her mother might commit
suicide. This is speculative fear; it is not the uncontrollable fear
contemplated by law.
To begin with, there was no showing that the mother's illness was so life-
threatening such that her continued stay in the hospital suffering all its
alleged unethical treatment would induce a well-grounded apprehension of
her death. Secondly, it is not the law's intent to say that any fear exempts one
from criminal liability much less petitioner's flimsy fear that her mother
might commit suicide. In other words, the fear she invokes was not
impending or insuperable as to deprive her of all volition and to make her a
mere instrument without will, moved exclusively by the hospital's threats or
demands.
Ty has also failed to convince the Court that she was left with no choice but
to commit a crime. She did not take advantage of the many opportunities
available to her to avoid committing one. By her very own words, she
admitted that the collateral or security the hospital required prior to the
discharge of her mother may be in the form of postdated checks or jewelry.
And if indeed she was coerced to open an account with the bank and issue
the checks, she had all the opportunity to leave the scene to avoid
involvement.
Moreover, petitioner had sufficient knowledge that the issuance of checks
without funds may result in a violation of B.P. 22. She even testified that her
counsel advised her not to open a current account nor issue postdated
checks "because the moment I will not have funds it will be a big problem."
Besides, apart from petitioner's bare assertion, the record is bereft of any
evidence to corroborate and bolster her claim that she was compelled or
coerced to cooperate with and give in to the hospital's demands.
Ty likewise suggests . . . that the justifying circumstance of state of necessity
under par. 4, Art. 11 of the Revised Penal Code may find application in this
case.
We do not agree. The law prescribes the presence of three requisites to
exempt the actor from liability under this paragraph: (1) that the evil sought
to be avoided actually exists; (2) that the injury feared be greater than the
one done to avoid it; (3) that there be no other practical and less harmful
means of preventing it.
In the instant case, the evil sought to be avoided is merely expected or
anticipated. If the evil sought to be avoided is merely expected or
anticipated or may happen in the future, this defense is not applicable. Ty
could have taken advantage of an available option to avoid committing a
crime. By her own admission, she had the choice to give jewelry or other
forms of security instead of postdated checks to secure her obligation.
Moreover, for the defense of state of necessity to be availing, the greater
injury feared should not have been brought about by the negligence or
imprudence, more so, the willful inaction of the actor. In this case, the
issuance of the bounced checks was brought about by Ty's own failure to
pay her mother's hospital bills.
The Court also thinks it rather odd that Ty has chosen the exempting
circumstance of uncontrollable fear and the justifying circumstance of state
of necessity to absolve her of liability. It would not have been half as bizarre
had Ty been able to prove that the issuance of the bounced checks was done
without her full volition. Under the circumstances, however, it is quite clear
that neither uncontrollable fear nor avoidance of a greater evil or injury
prompted the issuance of the bounced checks.
Parenthetically, the findings of fact in the Decision of the trial court in the
Civil Case for damages filed by Ty's mother against the hospital is wholly
irrelevant for purposes of disposing the case at bench. While the findings
therein may establish a claim for damages which, we may add, need only be
supported by a preponderance of evidence, it does not necessarily engender
reasonable doubt as to free Ty from liability.120
In view of the foregoing, the Court therefore holds that the courts a quo committed
serious errors in finding that the petitioner was "biased,"121 "discriminated" against
the respondents,122 and "purposely intended to irritate"123 or "harass"124 them; that it
"acted in bad faith in removing the facilities without prior notice;"125 and that its acts
were "anti-social."126 The aforequoted declarations of the witnesses, significant
portions of which this Court considers as expert testimony, are reliable and remain
considerably trustworthy to controvert respondents' assertions as well as to reverse
the conclusions of fact and law of the CA and the RTC that respondent Chua suffered
the physical and emotional anguish so claimed, and so, for these reasons, the Court
holds that the petitioner inflicted no actionable wrong.
This Court observes that the courts a quo awarded both respondents moral damages.
But it is well-settled that in case of physical injuries, with some exceptions, 127 moral
damages are recoverable only by the party injured and not by her spouse, next of kin,
or relative who happened to sympathize with the injured party. 128 Hence, even if the
courts a quo were correct in their basis for damages, they should have declined to
award damages to respondent Ty.
The last issue to be resolved is the question whether the counterclaims of the
petitioner are supported by a preponderance of evidence.
We agree with the petitioner that the courts a quo seriously erred in mistaking the case
of its compulsory counterclaim for its permissive counterclaim and for failing to
consider the evidence which impressively supports the latter. First, for failure without
justifiable cause of respondents' counsel to comment on the Partial Formal Offer of
Evidence dated February 14, 1996129 filed by the petitioner, the RTC issued an order
during the course of the trial, which counsel for respondents neither contested nor
raised on appeal, admitting Exhibits "1" to "16", together with their submarkings and
the purposes for which the same were offered,130 all of which had also been
previously authenticated and their contents verified by the witnesses for the
petitioner.131 These documents include the Contract for Admission of respondent
Chua dated October 30, 1990, duly executed by respondent Ty, incorporating therein
the rules and regulations of the hospital, including the duty to understand the
same132 as well as the undertaking of respondent Ty to be jointly and severally liable
for the payment of the hospital bills of respondent Chua; 133 the Promissory Note
dated June 5, 1992 in the amount of P1,075,592.95 duly executed by respondent Ty in
favor of the petitioner agreeing to be jointly and severally liable to pay the unpaid
obligations of respondent Chua and Judith Chua, including interest and attorney's
fees in case of default;134 the Undertakings signed by respondent Ty dated March 3,
1992 and April 7, 1992 to maintain regular deposits; 135 and the credit memos and
statements of account that support the amount referring to the unpaid
obligation.136 Second, the parties stipulated during pre-trial that respondents failed to
pay the balance despite repeated reminders.137 And third, respondent Ty in open
court identified and admitted that she signed the Contract of Admission dated
October 30, 1990 as well as the Undertakings dated March 3, 1992 and April 7, 1992
but which, for no justifiable reason, she "did not bother to read," 138 and, what is more,
she repeatedly admitted during the course of the trial that she failed to fully settle the
foregoing hospital bills.139 In fact, while the Ty case cannot control the incidents of the
instant case as heretofore stated, it is still worth mentioning, at least for informative
purposes, the findings of this Court in Ty with respect to respondents' obligations to
the petitioner:
Ty's mother and sister availed of the services and the facilities of the
hospital. For the care given to her kin, Ty had a legitimate obligation to pay
the hospital by virtue of her relationship with them and by force of her
signature on her mother's Contract of Admission acknowledging
responsibility for payment, and on the promissory note she executed in
favor of the hospital.140
In view of all these findings, the Court earnestly disagrees with the sweeping
conclusion of the CA that "[Petitioner] failed to present any iota of evidence to prove
his claim,"141 a statement apparently referring to the permissive counterclaim of
P1,075,592.95. However, with respect to the compulsory counterclaim predicated on
the filing of a baseless suit and injury to its reputation, petitioner did not raise this
matter on appeal and, hence, is deemed to have waived the same.
But the Court in Ty made a partial finding on the civil liability of respondent Ty with
respect to the amount covered by seven of the several dishonored checks she issued
equivalent to
P210,000.00.142 Since this amount forms a fraction of her total civil liability, then this
amount, in deference to Ty, should be deducted therefrom.
The claim for attorney's fees, as stipulated under the Promissory Note dated June 5,
1992, should be reduced for being unreasonable under the circumstances, from 25
percent to 12 percent of the total amount due.143
As a final word, the Court takes judicial notice of the pending Senate Bill No. 337,
entitled "An Act Prohibiting the Detention of Patients in Hospitals and Medical
Clinics on Grounds of Non-Payment of Hospital Bills or Medical Expenses," which
declares, among others, that it shall be unlawful for any hospital or medical clinic to
cause directly or indirectly the detention of patients for non-payment, in part or in
full, of their hospital bills,144 and, furthermore, requires patients who have fully
recovered and are financially incapable to settle the hospitalization expenses to
execute a promissory note, co-signed by another individual, to the extent of the
unpaid obligation before leaving the hospital.145 While this Court may have touched
upon these matters in the adjudication of the instant case, it must be stated that this
decision should in no way preempt any constitutional challenge to the provisions of
Senate Bill No. 337 if passed into law, bearing in mind the standards for the exercise
of the power of judicial review146 as well as the recognition that the tenor of the bill
may adjust with the times, or that the bill itself may fail to pass, according to the
dynamism of the legislative process, especially in light of the objections interposed by
interest groups to date.147
WHEREFORE, the petition is GRANTED. The Decision of the Court of Appeals
dated October 2, 2001, together with the Decision dated September 30, 1997 of the
Regional Trial Court in Civil Case No. 63958, is REVERSED and SET ASIDE.
Another judgment is entered dismissing the Complaint and ordering respondents,
jointly and severally, to pay the petitioner the amount of P865,592.95, with stipulated
interest of 12 percent reckoned from the date of extrajudicial demand until full
payment, and 12 percent of the total amount due as attorney's fees.
No pronouncement as to costs.
SO ORDERED.
 Republic of the Philippines
SUPREME COURT
Manila
EN BANC
G.R. No. L-24119 August 8, 1925
FELIX MARQUEZ, petitioner,
vs.
THE BOARD OF MEDICAL EXAMINERS and THE SECRETARY-TREASURER
OF THE BOARD OF MEDICAL EXAMINERS, respondent.
M.H. de Joya for petitioner.
Acting Attorney-General Reyes for respondents.
STREET, J.:
This is an original proceeding in this court by which the petitioner, Felix Marquez,
seeks to obtain a writ of mandamus against the respondents, the Board of Medical
Examiners, requiring them to admit the petitioner to the physicians' examinations
conducted, or to be conducted by the respondents in the City of Manila. To the
original complaint the respondents answered, and to the answer a demurrer was
interposed in behalf of the petitioner.
It appears that petitioner is a graduate of the Chicago Medical College, having
received the degree of M.D. from said institution on June 8, of the year 1922. No
question appears to have been made by the respondents with respect to the
petitioner's qualifications of the physician's examinations in other respects, but they
have denied him admission to the examinations on the grounds that the Chicago
Medical College, where the petitioner was graduated, has been classified as a Class C
medical college by the National Medical State Board of the United States. For this
reason the respondents, in accordance with the regulations of the board now in effect,
have denied the requisite standing to said institution and excluded petitioner.
It is not denied by the respondents that prior to the adoption of the present
regulations, and prior to the date when the Chicago Medical School was classified as
a Class C medical college, the Board of Medical Examiners for the Philippine Islands
had accepted diplomas of graduation from said medical college as sufficient proof of
proficiency in medical knowledge to admit a graduate to the examinations held in
these Islands; and as late as October 29, 1923, said board accepted favorably upon the
application of one Dr. Mariano M. Lazatin, who was graduated from said school in
the year 1921. At the time said candidate was admitted, however, the regulations
denying the requisite status to the Chicago Medical College had not been made
effective, and they had been made effective by proper authority before the present
petitioner had submitted his application.
In the argument for the petitioner it is admitted that under Act No. 3111, and the
regulations now in force, the petitioner is disqualified to take the examinations; but it
is pointed out that at the time he began and even when he conducted his course in the
Chicago Medical School, said institution was still recognized as a reputable medical
institution; and the question submitted is whether the petitioner's case should be
governed by the law and regulations in force at the time of his enrollment in and
graduation from the Chicago Medical School, or by those in force at the time he filed
his application for admission, on or about September 26, 1924. It is submitted for the
petitioner that his case should be governed by the law and regulations at the time of
his graduation. To hold otherwise, it is insisted, is to make the law retroactive in
effect and to do irreparable damage to the petitioner, who has pursued his work in
the institution referred to in good faith, believing that said school had the status
necessary to qualify him from examination.
The position taken by the petitioner is, we think, untenable. The question whether a
medical institution is "a reputable medical school," in the sense intended by the law,
is vested in the Board of Medical Examiners, and although the action taken by them
may conceivably, in isolated cases, result in hardship, nevertheless the interests of the
public require that the board should be free to exercise its judgment and discretion
without reference to the effect of the determination of the question in particular
instances. There can in the nature of things be no vested right in an existing law,
which would preclude its change or repeal. No one who has commenced preparation
in a particular institution has any inchoate right on account of that fact. If the law
were otherwise upon this point, it would be impossible for the Board of Medical
Examiners to give effect to the knowledge which they from time to time acquire as to
the standing of medical schools; and an intending physician, upon matriculating in a
particular college, takes upon himself the risk of changes that may be made in the
standing of the institution by the board.
The demurrer to the answer is not well taken. The answer is therefore declared
sufficient, and the petition dismissed, with costs, So ordered.
Republic of the Philippines
SUPREME COURT
Manila
EN BANC
G.R. No. L-25135 September 21, 1968
PHILIPPINE MEDICAL ASSOCIATION, petitioner,
vs.
BOARD OF MEDICAL EXAMINERS and JOSE MA. TORRES, respondents.
Seva-Albert-Vergara and Julio V. Presbitero for petitioner.
Regino Hermosisima, Jr., for respondent Jose Ma. Torres.
Solicitor General for respondent Board of Medical Examiners.
CONCEPCION, C.J.:
Original action for certiorari and mandamus, against the Board of Medical Examiners
and Jose Ma. Torres, to annul a resolution of the former and a certificate issued by the
same authorizing the latter to practice medicine in the Philippines without
examination.
The facts are not disputed. Jose Ma. Torres — hereinafter referred to as respondent —
is a Spanish subject and a member of the Missionary Sons of the Immaculate Heart of
Mary, otherwise known as the Claretian Missionaries. Having graduated from the
University of Barcelona, Spain, with the degree of Licentiate in Medicine and Surgery,
he is entitled, under the laws of Spain, to practice medicine and surgery throughout
the territory thereof.
On January 21, 1955, respondent was granted special authority to practice medicine in
Lamitan, Basilan City, where he resides, pursuant to Section 771(e) of the Revised
Administrative Code reading:
SEC. 771. Persons exempt from registration. — Registration shall not be
required of the following classes of persons: . . .
(e) In cases of epidemic or in municipalities where there is no legally
qualified practicing physician, or when the circumstances require it, in the
interest of the public health, the Director of Health may issue special
authorizations, to all medical students who have completed the first three
years of their studies, or to persons who have qualified in medicine, and to
graduate or registered nurses, who may request it.
This authority was revoked, on November 8, 1960, by the then Secretary of Health,
upon the ground that "the conditions under which it was granted no longer obtained
in Lamitan Basilan City, there being enough practising physicians in that locality."
Said officer restored the authority on December 19, 1960, to be revoked again, on
January 22, 1963. It was renewed once more, on September 1, 1963, and, once again, it
was revoked on February 10, 1964, upon the recommendation of the Board of Medical
Examiners — hereinafter referred to as the Board. On motion for reconsideration filed
by respondent, the Board issued, on April 6, 1965, its Resolution No. 25, series of
1965, which was approved by the President, granting respondent a certificate to
practice medicine in the Philippines without the examination required in Republic
Act No. 2882, otherwise known as the Medical Act of 1959. The resolution relied
therefor upon The Treaty on the Validity of Academic Degrees and The Exercise of
the Professions between the Republic of the Philippines and the Spanish State, signed
at Manila on March 4, 1949, and ratified on May 19, 1949. 1
Petitioner herein, Philippine Medical Association, is a domestic corporation. On June
14, 1965, it addressed the Chairman of the Board a communication requesting
reconsideration of said resolution No. 25, upon the ground that, pursuant to said
Medical Act of 1959, respondent has to take and pass the examination therein
prescribed, before he can be allowed to practice medicine in the Philippines. This
letter was followed by another, dated October 6, 1965, to which said Chairman
replied on October 8, 1965, stating "that the final decision on the matter will have to
come from the President of the Philippines upon whose authority said resolution has
been finally approved and implemented."
Thereupon, or, on October 18, 1965, petitioner commenced the present action, for the
purpose stated at the beginning of this decision, upon the theory that the Board had
violated Republic Act No. 2882 in granting respondent's certificate for the general
practice of medicine in the Philippines without the examination prescribed in said
Act; that the Board had exceeded its authority in passing said Resolution, because of
which the same is null and void; that the Board should, therefore, be ordered to
cancel the certificate issued in pursuance of said resolution; and that petitioner has no
other plain, adequate and speedy remedy in the ordinary course of law.
In their respective answers, respondents admit the basic facts, but not the conclusions
drawn therefrom by the petitioner and allege that the resolution in question is
sanctioned by the provisions of the Treaty above referred to; that petitioner has no
cause of action; and that the petition should be dismissed for failure of the petitioner
to exhaust the available administrative remedies.
Respondents cite the cases of Costas vs. Aldanese2 and Almario vs. City Mayor 3 in
support of the theory that petitioner herein has no sufficient interest or "personality"
to maintain the present case. In the first case, it was held that the President of the
Association of Philippine (Marine) Engineers4 had no particular "individual" interest,
and, hence,no cause of action for mandamus to compel the Collector of Customs to
implement section 1203(j) of the Administrative Code, providing that steamers
making round trips of more than 48 hours or travelling at night shall carry the
complement of marine engineers therein specified. In the second case, a citizen of the
Philippines, as such, who is not an Applicant for any stall or booth, or the
representative of any such applicant, stallholder or any association of persons who are
deprived of the right to occupy stalls in said market, "is not the real party in interest
who has the capacity, right or personality" to bring an action for mandamus, to compel
the office of Pasay City to comply with the provisions of Republic Act No. 37, by
ejecting, from the public market of said City, stallholders who are not nationals of the
Philippines.
Said cases are not in point. To begin with, both are actions for mandamus, whereas the
case at bar is mainly one for certiorari. Although, petitioner herein, likewise, seeks a
writ of mandamus, directing the Board to cancel the certificate of registration issued to
the respondent, this would be a necessary consequence of the writ
of certiorariannulling the disputed resolution. Moreover, said two (2) cases were
commenced by individuals, who, as such, had no special interest in the relief therein
prayed for. Indeed, in the Almario case it was intimated that the result might have
been otherwise had it been brought by an "association" whose members have an
interest in the subject matter of the action.
This was confirmed by PHILCONSA vs. Gimenez,5 in which we sustained the right of
the Philippine Constitution Association to assail the constitutionality of Republic Act
No. 3836, insofar as it allowed retirement gratuity and commutation of vacation and
sick leave to members of Congress and to elective officials thereof. Further authority
in favor of petitioner herein is supplied by Nacionalista Party vs. F. Bautista Angelo 6 in
which the Nacionalista Party successfully impugned the validity of the designation of
the then Solicitor General as Acting Member of the Commission on Elections.
It is our considered opinion that the view adopted in the last three (3) cases should be
maintained and that, in line therewith, petitioner herein has sufficient interest to
prosecute the case at bar and a cause of action against respondents herein.
As regards their objection based upon petitioner's failure to appeal to the President,
suffice it to say that the rule requiring exhaustion of administrative remedies is
concededly subject to exceptions, among which are cases involving only questions of
law or when jurisdiction is in issue7or the action complained of bears the approval of
a department secretary, as the disputed resolution, which was approved by the
Executive Secretary "by authority of the President," or as an alter ego of the
Executive. 8 The case at bar falls under these exceptions to said rule.1awphîl.nèt
The main issue herein hinges on the interpretation of Article I of the Treaty
aforementioned, reading as follows:
The nationals of both countries who shall have obtained degrees or diplomas
to practice the liberal professions in either of the Contracting States, issued
by competent national authorities, shall be deemed competent to exercise
said professions in the territory of the Other, subject to the laws and regulations
of the latter. When the degree or diploma of Bachelor, issued by competent
national authorities allows its holder without requiring further evidence of
proficiency to pursue normally higher courses of study, he shall also be
deemed qualified to continue his studies in the territory of either Party in
conformity with the applicable laws and regulations of the State which
recognizes the validity of the title or diploma in question, and with the rules
and regulations of the particular educational institution in which he intends
to pursue his studies.
This Treaty provision was the subject matter of our resolution of August 15, 1961, in
connection with the petition of Arturo Efren Garcia for admission to the Philippine
Bar without taking the Bar Examinations. After completing, in Spain, the course
prescribed therefor, Garcia had been graduated from the College of Law of the
Universidad Central de Madrid with the degree of "Licenciado en Derecho", which
entitled him to practice law in Spain. Having invoked the provisions of said treaty in
support of his claim of exemption from the requisite bar examinations, this Court
denied his petition upon the ground, among others ". . . that the privileges provided
in the Treaty invoked by the applicant are made expressly subject to the laws and
regulations of the contracting State in whose territory it is desired to exercise the legal
profession; and Section 1 of Rule 127, in connection with Sections 2, 9, and 16 thereof,
which have the force of law, require that before anyone can practice the legal
profession in the Philippines he must first successfully pass the required bar
examinations; . . ."
We find no plausible reason to depart from this view. On the contrary, we reiterate
the same, inasmuch as the theory of respondent herein cannot be accepted without
placing graduates from our own educational institutions at a disadvantage vis-a-
vis Spanish graduates from Spanish schools, colleges or universities. Indeed, the latter
could — under respondent's pretense — engage in the practice of medicine in the
Philippines without taking the examination prescribed in Republic Act No. 2882,
whereas the former would have to take and pass said examination. Worse still, since
— as we ruled in the Garcia case — the benefits of the aforementioned Treaty cannot
be availed of in the Philippines except by Spanish subjects, the result would be —
should respondent's contention be sustained — that graduates from Spanish schools
of medicine would be entitled to practice medicine in the Philippines without
examination, if they were Spanish subjects, but not if they are Filipinos.
Surely said treaty was not made to discriminate against Philippine schools, colleges
or universities, much less against nationals of the Philippines.
WHEREFORE, we hold that said Treaty merely extended to diplomas issued or
degrees conferred by educational institutions of Spain the same recognition and
treatment that we accord to similar diplomas or degrees from local institutions of
learning; that holders of said Spanish diplomas or degrees must take the examination
prescribed by our laws for holders of similar diplomas or degrees from educational
institutions in the Philippines; that resolution No. 25, series of 1965, of respondent
Board is violative of Republic Act No. 2882 and hence, null and void; and that,
respondent Board of Medical Examiners should be, as it is hereby ordered to cancel
the certificate of registration, for the practice of medicine in the Philippines, issued in
favor of respondent Jose Ma. Torres, without special pronouncement as to costs. It is
so ordered.
Reyes, J.B.L., Dizon, Makalintal, Zaldivar, Sanchez, Castro, Angeles and Fernando, JJ.,
concur.
 Republic of the Philippines
SUPREME COURT
Manila
EN BANC
G.R. No. 78164 July 31, 1987
TERESITA TABLARIN, MA, LUZ CIRIACO, MA NIMFA B. ROVIRA,
EVANGELINA S. LABAO, in their behalf and in behalf of applicants for
admission into the Medical Colleges during the school year 1987-88 and future
years who have not taken or successfully hurdled tile National Medical Admission
Test (NMAT).petitioners,
vs.
THE HONORABLE JUDGE ANGELINA S. GUTIERREZ, Presiding Judge of
Branch XXXVII of the Regional Trial Court of the National Capital Judicial Region
with seat at Manila, THE HONORABLE SECRETARY LOURDES QUISUMBING,
in her capacity as Chairman of the BOARD OF MEDICAL EDUCATION, and THE
CENTER FOR EDUCATIONAL MEASUREMENT (CEM), respondents.
FELICIANO, J.:
The petitioners sought admission into colleges or schools of medicine for the school
year 1987-1988. However, the petitioners either did not take or did not successfully
take the National Medical Admission Test (NMAT) required by the Board of Medical
Education, one of the public respondents, and administered by the private
respondent, the Center for Educational Measurement (CEM).
On 5 March 1987, the petitioners filed with the Regional Trial Court, National Capital
Judicial Region, a Petition for Declaratory Judgment and Prohibition with a prayer for
Temporary Restraining Order and Preliminary Injunction. The petitioners sought to
enjoin the Secretary of Education, Culture and Sports, the Board of Medical Education
and the Center for Educational Measurement from enforcing Section 5 (a) and (f) of
Republic Act No. 2382, as amended, and MECS Order No. 52, series of 1985, dated 23
August 1985 and from requiring the taking and passing of the NMAT as a condition
for securing certificates of eligibility for admission, from proceeding with accepting
applications for taking the NMAT and from administering the NMAT as scheduled
on 26 April 1987 and in the future. After hearing on the petition for issuance of
preliminary injunction, the trial court denied said petition on 20 April 1987. The
NMAT was conducted and administered as previously scheduled.
Petitioners accordingly filed this Special Civil Action for certiorari with this Court to
set aside the Order of the respondent judge denying the petition for issuance of a writ
of preliminary injunction.
Republic Act 2382, as amended by Republic Acts Nos. 4224 and 5946, known as the
"Medical Act of 1959" defines its basic objectives in the following manner:
Section 1. Objectives. — This Act provides for and shall govern
(a) the standardization and regulation of medical education (b) the examination
for registration of physicians; and (c) the supervision, control and regulation
of the practice of medicine in the Philippines. (Underscoring supplied)
The statute, among other things, created a Board of Medical Education which is
composed of (a) the Secretary of Education, Culture and Sports or his duly authorized
representative, as Chairman; (b) the Secretary of Health or his duly authorized
representative; (c) the Director of Higher Education or his duly authorized
representative; (d) the Chairman of the Medical Board or his duly authorized
representative; (e) a representative of the Philippine Medical Association; (f) the Dean
of the College of Medicine, University of the Philippines; (g) a representative of the
Council of Deans of Philippine Medical Schools; and (h) a representative of the
Association of Philippine Medical Colleges, as members. The functions of the Board
of Medical Education specified in Section 5 of the statute include the following:
(a) To determine and prescribe equirements for admission into a recognized college
of medicine;
(b) To determine and prescribe requirements for minimum physical facilities
of colleges of medicine, to wit: buildings, including hospitals, equipment
and supplies, apparatus, instruments, appliances, laboratories, bed capacity
for instruction purposes, operating and delivery rooms, facilities for
outpatient services, and others, used for didactic and practical instruction in
accordance with modern trends;
(c) To determine and prescribe the minimum number and minimum
qualifications of teaching personnel, including student-teachers ratio;
(d) To determine and prescribe the minimum required curriculum leading to
the degree of Doctor of Medicine;
(e) To authorize the implementation of experimental medical curriculum in a
medical school that has exceptional faculty and instrumental facilities. Such
an experimental curriculum may prescribe admission and graduation
requirements other than those prescribed in this Act; Provided, That only
exceptional students shall be enrolled in the experimental curriculum;
(f) To accept applications for certification for admission to a medical school and keep
a register of those issued said certificate; and to collect from said applicants the
amount of twenty-five pesos each which shall accrue to the operating fund of the
Board of Medical Education;
 (g) To select, determine and approve hospitals or some departments of the
hospitals for training which comply with the minimum specific physical
facilities as provided in subparagraph (b) hereof; and
(h) To promulgate and prescribe and enforce the necessary rules and regulations for
the proper implementation of the foregoing functions. (Emphasis supplied)
Section 7 prescribes certain minimum requirements for applicants to medical schools:
Admission requirements. — The medical college may admit any student who has
not been convicted by any court of competent jurisdiction of any offense
involving moral turpitude and who presents (a) a record of completion of a
bachelor's degree in science or arts; (b) a certificate of eligibility for entrance to a
medical school from the Board of Medical Education; (c) a certificate of good
moral character issued by two former professors in the college of liberal arts;
and (d) birth certificate. Nothing in this act shall be construed to inhibit any
college of medicine from establishing, in addition to the preceding, other
entrance requirements that may be deemed admissible.
xxx xxx x x x (Emphasis supplied)
MECS Order No. 52, s. 1985, issued by the then Minister of Education, Culture and
Sports and dated 23 August 1985, established a uniform admission test called the
National Medical Admission Test (NMAT) as an additional requirement for issuance
of a certificate of eligibility for admission into medical schools of the Philippines,
beginning with the school year 1986-1987. This Order goes on to state that:
2. The NMAT, an aptitude test, is considered as an instrument toward upgrading
the selection of applicants for admission into the medical schools and its calculated to
improve the quality of medical education in the country. The cutoff score for the
successful applicants, based on the scores on the NMAT, shall be determined
every year by the Board of Medical Education after consultation with the
Association of Philippine Medical Colleges. The NMAT rating of each
applicant, together with the other admission requirements as presently called for
under existing rules, shall serve as a basis for the issuance of the prescribed
certificate of elegibility for admission into the medical colleges.
3. Subject to the prior approval of the Board of Medical Education, each
medical college may give other tests for applicants who have been issued a
corresponding certificate of eligibility for admission that will yield information on
other aspects of the applicant's personality to complement the information
derived from the NMAT.
xxx xxx xxx
8. No applicant shall be issued the requisite Certificate of Eligibility for Admission
(CEA), or admitted for enrollment as first year student in any medical college,
beginning the school year, 1986-87, without the required NMAT qualification as
called for under this Order. (Underscoring supplied)
Pursuant to MECS Order No. 52, s. 1985, the private respondent Center conducted
NMATs for entrance to medical colleges during the school year 1986-1987. In
December 1986 and in April 1987, respondent Center conducted the NMATs for
admission to medical colleges during the school year 1987.1988.1avvphi1
Petitioners raise the question of whether or not a writ of preliminary injunction may
be issued to enjoin the enforcement of Section 5 (a) and (f) of Republic Act No. 2382,
as amended, and MECS Order No. 52, s. 1985, pending resolution of the issue of
constitutionality of the assailed statute and administrative order. We regard this issue
as entirely peripheral in nature. It scarcely needs documentation that a court would
issue a writ of preliminary injunction only when the petitioner assailing a statute or
administrative order has made out a case of unconstitutionality strong enough to
overcome, in the mind of the judge, the presumption of constitutionality, aside from
showing a clear legal right to the remedy sought. The fundamental issue is of course
the constitutionality of the statute or order assailed.
1. The petitioners invoke a number of provisions of the 1987 Constitution which are,
in their assertion, violated by the continued implementation of Section 5 (a) and (f) of
Republic Act 2381, as amended, and MECS Order No. 52, s. 1985. The provisions
invoked read as follows:
(a) Article 11, Section 11: "The state values the dignity of every human
person and guarantees full respect of human rights. "
(b) ArticleII, Section l3: "The State recognizes the vital role of the youth in
nation building and shall promote and protect their physical, moral,
spiritual, intellectual and social well being. It shall inculcate in the youth
patriotism and nationalism, and encourage their involvement in public and
civic affairs."
(c) Article II, Section 17: "The State shall give priority to education, science
and technology, arts, culture and sports to foster patriotism and nationalism,
accelerate social progress and to promote total human liberation and
development. "
(d) Article XIV, Section l: "The State shall protect and promote the right of all
citizens to quality education at all levels and take appropriate steps to make
such education accessible to all. "
 (e) Article XIV, Section 5 (3): "Every citizen has a right to select a profession
or course of study, subject to fair, reasonable and equitable admission and
academic requirements."
Article II of the 1987 Constitution sets forth in its second half certain "State policies"
which the government is enjoined to pursue and promote. The petitioners here have
not seriously undertaken to demonstrate to what extent or in what manner the statute
and the administrative order they assail collide with the State policies embodied in
Sections 11, 13 and 17. They have not, in other words, discharged the burden of proof
which lies upon them. This burden is heavy enough where the constitutional
provision invoked is relatively specific, rather than abstract, in character and cast in
behavioral or operational terms. That burden of proof becomes of necessity heavier
where the constitutional provision invoked is cast, as the second portion of Article II
is cast, in language descriptive of basic policies, or more precisely, of basic objectives
of State policy and therefore highly generalized in tenor. The petitioners have not
made their case, even a prima facie case, and we are not compelled to speculate and to
imagine how the legislation and regulation impugned as unconstitutional could
possibly offend the constitutional provisions pointed to by the petitioners.
Turning to Article XIV, Section 1, of the 1987 Constitution, we note that once more
petitioners have failed to demonstrate that the statute and regulation they assail in
fact clash with that provision. On the contrary we may note-in anticipation of
discussion infra — that the statute and the regulation which petitioners attack are in
fact designed to promote "quality education" at the level of professional schools.
When one reads Section 1 in relation to Section 5 (3) of Article XIV as one must one
cannot but note that the latter phrase of Section 1 is not to be read with absolute
literalness. The State is not really enjoined to take appropriate steps to make quality
education " accessible to all who might for any number of reasons wish to enroll in a
professional school but rather merely to make such education accessible to all who
qualify under "fair, reasonable and equitable admission and academic requirements. "
2. In the trial court, petitioners had made the argument that Section 5 (a) and (f) of
Republic Act No. 2382, as amended, offend against the constitutional principle which
forbids the undue delegation of legislative power, by failing to establish the necessary
standard to be followed by the delegate, the Board of Medical Education. The general
principle of non-delegation of legislative power, which both flows from the reinforces
the more fundamental rule of the separation and allocation of powers among the
three great departments of government,1 must be applied with circumspection in
respect of statutes which like the Medical Act of 1959, deal with subjects as obviously
complex and technical as medical education and the practice of medicine in our
present day world. Mr. Justice Laurel stressed this point 47 years ago in Pangasinan
Transportation Co., Inc. vs. The Public Service Commission:2
One thing, however, is apparent in the development of the principle of
separation of powers and that is that the maxim of delegatus non potest
delegare or delegate potestas non potest delegare, adopted this practice
(Delegibus et Consuetudiniis Anglia edited by G.E. Woodbine, Yale
University Press, 1922, Vol. 2, p. 167) but which is also recognized in
principle in the Roman Law (d. 17.18.3) has been made to adapt itself to the
complexities of modern government, giving rise to the adoption, within certain
limits of the principle of "subordinate legislation," not only in the United
States and England but in practically all modern governments. (People vs.
Rosenthal and Osmena [68 Phil. 318, 1939]. Accordingly, with the growing
complexity of modern life, the multiplication of the subjects of governmental
regulation and the increased difficulty of administering the laws, there is a
constantly growing tendency toward the delegation of greater power by the
legislature, and toward the approval of the practice by the courts." 3
The standards set for subordinate legislation in the exercise of rule making authority
by an administrative agency like the Board of Medical Education are necessarily
broad and highly abstract. As explained by then Mr. Justice Fernando in Edu v.
Ericta4 —
The standard may be either expressed or implied. If the former, the non-
delegation objection is easily met. The standard though does not have to be
spelled out specifically. It could be implied from the policy and purpose of the act
considered as a whole. In the Reflector Law, clearly the legislative objective is public
safety. What is sought to be attained as in Calalang v. Williams is "safe transit upon
the roads. 5
We believe and so hold that the necessary standards are set forth in Section 1 of the
1959 Medical Act: "the standardization and regulation of medical education" and in
Section 5 (a) and 7 of the same Act, the body of the statute itself, and that these
considered together are sufficient compliance with the requirements of the non-
delegation principle.
3. The petitioners also urge that the NMAT prescribed in MECS Order No. 52, s. 1985,
is an "unfair, unreasonable and inequitable requirement," which results in a denial of
due process. Again, petitioners have failed to specify just what factors or features of
the NMAT render it "unfair" and "unreasonable" or "inequitable." They appear to
suggest that passing the NMAT is an unnecessary requirement when added on top of
the admission requirements set out in Section 7 of the Medical Act of 1959, and other
admission requirements established by internal regulations of the various medical
schools, public or private. Petitioners arguments thus appear to relate to utility and
wisdom or desirability of the NMAT requirement. But constitutionality is essentially
a question of power or authority: this Court has neither commission or competence to
pass upon questions of the desirability or wisdom or utility of legislation or
administrative regulation. Those questions must be address to the political
departments of the government not to the courts.
There is another reason why the petitioners' arguments must fail: the legislative and
administrative provisions impugned by them constitute, to the mind of the Court, a
valid exercise of the police power of the state. The police power, it is commonplace
learning, is the pervasive and non-waivable power and authority of the sovereign to
secure and promote an the important interests and needs — in a word, the public
order — of the general community.6 An important component of that public order is
the health and physical safety and well being of the population, the securing of which
no one can deny is a legitimate objective of governmental effort and regulation. 7
Perhaps the only issue that needs some consideration is whether there is some
reasonable relation between the prescribing of passing the NMAT as a condition for
admission to medical school on the one hand, and the securing of the health and
safety of the general community, on the other hand. This question is perhaps most
usefully approached by recalling that the regulation of the practice of medicine in all its
branches has long been recognized as a reasonable method of protecting the health
and safety of the public.8 That the power to regulate and control the practice of
medicine includes the power to regulate admission to the ranks of those authorized to
practice medicine, is also well recognized. thus, legislation and administrative
regulations requiring those who wish to practice medicine first to take and pass medical
board examinations have long ago been recognized as valid exercises of governmental
power.9 Similarly, the establishment of minimum medical educational requirements
— i.e., the completion of prescribed courses in a recognized medical school — for admission
to the medical profession, has also been sustained as a legitimate exercise of the
regulatory authority of the state.10 What we have before us in the instant case is
closely related: the regulation of access to medical schools. MECS Order No. 52, s. 1985, as
noted earlier, articulates the rationale of regulation of this type: the improvement of
the professional and technical quality of the graduates of medical schools, by
upgrading the quality of those admitted to the student body of the medical schools.
That upgrading is sought by selectivity in the process of admission, selectivity
consisting, among other things, of limiting admission to those who exhibit in the
required degree the aptitude for medical studies and eventually for medical practice.
The need to maintain, and the difficulties of maintaining, high standards in our
professional schools in general, and medical schools in particular, in the current stage
of our social and economic development, are widely known.
We believe that the government is entitled to prescribe an admission test like the
NMAT as a means for achieving its stated objective of "upgrading the selection of
applicants into [our] medical schools" and of "improv[ing] the quality of medical
education in the country." Given the widespread use today of such admission tests in,
for instance, medical schools in the United States of America (the Medical College
Admission Test [MCAT]11 and quite probably in other countries with far more
developed educational resources than our own, and taking into account the failure or
inability of the petitioners to even attempt to prove otherwise, we are entitled to hold
that the NMAT is reasonably related to the securing of the ultimate end of legislation
and regulation in this area. That end, it is useful to recall, is the protection of the
public from the potentially deadly effects of incompetence and ignorance in those
who would undertake to treat our bodies and minds for disease or trauma.
4. Petitioners have contended, finally, that MECS Order No. 52, s. 1985, is in conflict
with the equal protection clause of the Constitution. More specifically, petitioners
assert that that portion of the MECS Order which provides that
the cutoff score for the successful applicants, based on the scores on the
NMAT, shall be determined every-year by the Board of Medical 11 Education
after consultation with the Association of Philippine Medical Colleges.
(Emphasis supplied)
infringes the requirements of equal protection. They assert, in other words, that
students seeking admission during a given school year, e.g., 1987-1988, when
subjected to a different cutoff score than that established for an, e.g., earlier school
year, are discriminated against and that this renders the MECS Order "arbitrary and
capricious." The force of this argument is more apparent than real. Different cutoff
scores for different school years may be dictated by differing conditions obtaining
during those years. Thus, the appropriate cutoff score for a given year may be a
function of such factors as the number of students who have reached the cutoff score
established the preceding year; the number of places available in medical schools
during the current year; the average score attained during the current year; the level
of difficulty of the test given during the current year, and so forth. To establish a
permanent and immutable cutoff score regardless of changes in circumstances from
year to year, may wen result in an unreasonable rigidity. The above language in
MECS Order No. 52, far from being arbitrary or capricious, leaves the Board of
Medical Education with the measure of flexibility needed to meet circumstances as
they change.
We conclude that prescribing the NMAT and requiring certain minimum scores
therein as a condition for admission to medical schools in the Philippines, do not
constitute an unconstitutional imposition.
WHEREFORE, the Petition for certiorari is DISMISSED and the Order of the
respondent trial court denying the petition for a writ of preliminary injunction is
AFFIRMED. Costs against petitioners.
SO ORDERED
Republic of the Philippines
SUPREME COURT
Manila
EN BANC
G.R. No. 88259 August 10, 1989
THE BOARD OF MEDICAL EDUCATION and the HON. LOURDES R.
QUISUMBING, in her capacity as Secretary of the Department of Education,
Culture and Sports and Chairman, Board of Medical Education, petitioners,
vs.
HON. DANIEL P. ALFONSO, Presiding Judge of the Regional Trial Court, Branch
74, Fourth Judicial Region, Antipolo, Rizal, and the PHILIPPINE MUSLIM-
CHRISTIAN COLLEGE OF MEDICINE FOUNDATION, INC., respondents.
Carpio, Villaraza & Cruz for private respondent.
Anatolio S. Tuazon, Jr. for intervenors.
NARVASA, J.:
Petitioners, the Board of Medical Education, the government agency which
supervises and regulates the country's medical colleges, and Secretary Lourdes R.
Quisumbing of the Department of Education, Culture and Sports, as Chairperson of
the Board, pray for a writ of certiorari to nullify and set aside the order issued by
respondent Judge Daniel P. Alfonso, Regional Trial Court, Antipolo, Rizal, in Civil
Case No. 1385 restraining the enforcement of petitioner Quisumbing's order of
closure of the respondent Philippine Muslim-Christian College of Medicine
Foundation, Inc. (hereafter simply the College).lâwphî1.ñèt
The, College, a private educational institution, was founded in 1981 for the avowed
purpose of producing physicians who will "emancipate Muslim citizens from age-old
attitudes on health." The, unstable peace and order situation in Mindanao led to the
establishment of the College in Antipolo, Rizal, which granted it a temporary permit
to operate in the municipality, instead of in Zamboanga City where the school was
first proposed to be located. It has since adopted Antipolo as its permanent site and
changed its name to the Rizal College of Medicine.
In 1985, the Department of Education, Culture and Sports (DECS) and the Board of
Medical Education (BME) authorized the Commission on Medical Education to
conduct a study of all medical schools in the Philippines. The, report of the
Commission showed that the College fell very much short of the minimum standards
set for medical schools. 1 The, team of inspectors, composed of Doctors Florentino
Herrera, Jr., Elena Ines Cuyegkeng, Horacio Estrada, Jose V. Silao, Jr. and Andres L.
Reyes, recommended the closure of the school 2 upon the following findings, to wit:
(a) the College was not fulfilling the purpose for which it had been
created because of its inappropriate location and the absence in its
curriculum of subjects relating to Muslim culture and welfare;
(b) its lack of university affiliation hindered its students from
obtaining a "balanced humanistic and scientific" education;
(c) it did not have its philosophy base hospital for the training of its
students in the major clinical disciplines, as required by the DECS;
(d) more than 60% of the college faculty did not teach in the College
full-time, resulting in shortened and irregular class hours, subject
overloading, and in general, poor quality teaching.
The, school disputed these findings as biased and discriminatory. At its request, the
Board of Medical Education, in May, 1987, sent another team of doctors 3 for a re-
evaluation of the College. After inspection, the team confirmed the previous findings
and recommended the phase-out of the school. 4
The, first two reports were verified on June 23, 1987 by a third team of inspectors. 5 A
year thereafter, the College failed another test what was in effect the fourth
evaluation of its fitness to continue as a medical school conducted on March 4 and 5,
1988 by a team from the Board of Medical Education determining the eligibility of
medical schools for government recognition. The, College was adjudged "inadequate"
in all aspects of the survey, to wit, college, curriculum, facilities, teaching hospital,
and studentry. 6 The, inspectors, Doctors Nilo Rosas, Macario Tan and Elena Ines
Cuyegkeng, accordingly recommended denial of government; recognition.
Accordingly, the Board of Medical Education recommended to the DECS the closure
of the College, effective the end of the school year 1988-1989. The, College however
succeeded in having the Board form yet another team to review the previous
findings. Doctors Elena Ines Cuyegkeng, Alberto Romualdez, Artemio Ordinaria
Joven Cuanang and Nilo L. Rosas conducted their inspection on June 18, 1988. Their
findings: although there had been a "major effort to improve the physical plant for
classroom instructions and the library, serious deficiencies remain(ed) in the areas of
clinical facilities and library operations;" "faculty continue(d) to be quite inadequate
with no prospects for satisfactory growth and development;" "student profile ... (was)
below par from the point of view of credentials (NMAT and transfer records) as well
as level knowledge and preparedness at various stages of medical education," and
"the most serious deficiency ... (was) the almost total lack of serious development
efforts in academic medicine — i.e., seeming lack of philosophy of teaching, no
serious effort to study curricula, almost non-existent innovative approaches." Again,
the recommendation was to close the College with provisions for the dispersal of its
students to other medical schools. 7
In her letter of June 23, 1988, Secretary Quisumbing informed the Chairman of the
College's Board of Trustees, Mr. Victor Sumulong, of the decision of the Board of
Medical Education to close the College. Mr. Sumulong instead proposed a gradual
phase-out starting the school year 1989-1990 in order not to dislocate the students and
staff and to minimize financial loss. 8 The, Board subsequently allowed the College to
continue its operations but only until May, 1989, after which it was to be closed, this
decision being "final and unappealable." The, College was, however, assured of
assistance in the relocation of its students and in its rehabilitation as an institution for
health-related and paramedical courses. 9
The, College appealed the decision to the Office of the President, imputing grave
abuse of discretion to the Secretary. 10 On February 16, 1989, Executive Secretary
Catalino Macaraig, Jr., finding "no reason to disturb" the contested decision, affirmed
it. 11
On March 2, 1989, the College went to court. It filed Civil Case No. 1385 in the court
of respondent Judge Daniel P. Alfonso against Secretary Quisumbing in her capacity
as Secretary of Education, Culture and Sports, questioning the decision as illegal,
oppressive, arbitrary and discriminatory and applied for a writ of preliminary
injunction to restrain its implementation.
The, writ issued as prayed for by order of the respondent Judge dated May 10,
1989. 12 His Honor ruled that the inspection of June 18, 1988 was the principal basis of
the closure order, and on such basis sustained the claim of the College that the
inspection was done in an "arbitrary and haphazard manner" by a team of inspectors
who had already prejudged the school. Judge Alfonso held that there was no
evidence supporting the findings in the report of June 18, 1988, and declared that his
philosophy ocular inspection of the College disclosed that the deficiencies mentioned
in the report were non-existent, and that on the contrary, the laboratory and library
areas were "big enough," and in the operations of the proposed base hospital were
going on smoothly at the time of the ocular inspection."
The, school thereupon promptly advertised in major newspaper dailies for enrollees
in all levels of the medical college and in its pre-board review classes. 13
Hence the present petition, assailing the order of injunction dated May 10, 1989 as
having been issued with grave abuse of discretion, and praying for a restraining
order against its enforcement as well as for the dismissal of the action instituted in the
court a quo. The, Court on June 1, 1989 ordered the respondent College to desist from
advertising and admitting students, and the respondent judge to refrain from
enforcing his injunction order.
The, College in its Comment would justify its entitlement to the questioned injunction
on the ground that the closure order against which it was directed was issued
without factual basis and in violation of the right of the College to due process of law,
and that it violates MECS Order No. 5 (Series of 1986) to the effect that the penalty of
closure cannot be imposed earlier than three (3) years from the last evaluation, which
in this instance was made, on June 18, 1988.
Resort to the Courts to obtain a reversal of the determination by the Secretary of
Education, Culture and Sports that the College is unfit to continue its operations is in
this case clearly unavailing. There is, to begin with, no law authorizing an appeal
from decisions or orders of the Secretary of Education, Culture and Sports to this
Court or any other Court. It is not the function of this Court or any other Court to
review the decisions and orders of the Secretary on the issue of whether or not an
educational institution meets the norms and standards required for permission to
operate and to continue operating as such. On this question, no Court has the power
or prerogative to substitute its opinion for that of the Secretary. Indeed, it is obviously
not expected that any Court would have the competence to do so.
The, only authority reposed in the Courts in the matter is the determination of
whether or not the Secretary of Education, Culture and Sports has acted within the
scope of powers granted him by law and the Constitution. As long as it appears that
he has done so, any decision rendered by him should not and will not be subject to
review and reversal by any court.
Of course, if it should be made, to appear to the Court that those powers were in a
case exercised so whimsically, capriciously, oppressively, despotically or arbitrarily
as to call for peremptory correction — or stated otherwise, that the Secretary had
acted with grave abuse of discretion, or had unlawfully neglected the performance of
an act which the law specifically enjoins as a duty, or excluded another from the use
or enjoyment of a right or office to which such other is entitled — it becomes the
Court's duty to rectify such action through the extraordinary remedies of certiorari,
prohibition, or mandamus, whichever may properly apply. Yet even in these extreme
instances, where a Court finds that there has been abuse of powers by the Secretary
and consequently nullifies and/or forbids such an abuse of power, or compliance
whatever is needful to keep its exercise within bounds, the Court, absent any
compelling reason to do otherwise, should still leave to the Secretary the ultimate
determination of the issue of the satisfy action or fulfillment by an educational
institution of the standards set down for its legitimate operation, as to which it should
not ordinarily substitute its over judgment for that of said office.
In any case, the recorded facts quite clearly fail to support the College's claim of grave
abuse of discretion containing the order of closure, and on the contrary convincingly
show the challenged decision to be correct. From 1985, no less than five (5) surveys
were conducted of respondent institution to determine its compliance with the
minimum standards established for a medical college. The, first survey, that
undertaken by the Commission on Medical Education, disclosed such various and
significant deficiencies in the school as to constrain the inspectors to recommend its
closure. Four (4) other surveys were thereafter made by as many different committees
or teams, at the school's instance or otherwise, all of which basically confirmed the
results of that first survey. Moreover, the findings of all five (5) surveys were affirmed
by the Office of the President. Indeed, the petitioner, through the Chairman of its
Board of Trustees, to all intents and purposes accepted the validity of the findings of
those five (5) survey groups when it proposed, in 1988, a gradual phase-out of the
school starting in 1989. The, respondent College knew that the recommendation for
its closure was made, as early as 1986, that recommendation was reiterated and
reaffirmed four (4) times thereafter until it was finally approved and acted upon by
the Secretary, whose action was confirmed by the Office of the President. Said
respondent was given notice in June 1988, that in consequence of all these, the time
for its definite closure had been unalterably set at May, 1989, a notice which was
accompanied by assurances of assistance in the relocation of its students before June,
1989 and in its rehabilitation as a school for other courses. After having resorted to
the whole range of administrative remedies available to it, without success, it sought
to obtain from the respondent Court the relief it could not obtain from those sources,
and what can only be described as a deliberate attempt to frustrate and obstruct
implementation of the decision for its closure as of June, 1989 openly solicited, by
newspaper advertisements or otherwise, enrollment of new and old students.
Given these facts, and it being a matter of law that the Secretary of Education, Culture
and Sports exercises the power to enjoin compliance with the requirements laid down
for medical schools and to mete out sanctions where he finds that violations thereof
have been committed, it was a grave abuse of discretion for the respondent judge to
issue the questioned injunction and thereby thwart official action, in the premises
correctly taken, allowing the College to operate without the requisite government
permit. A single ocular inspection, done after the College had been pre-warned
thereof, did not, in the circumstances, warrant only the findings of more qualified
inspectors about the true state of the College, its faculty, facilities, operations, etc. The,
members of the evaluating team came from the different sectors in the fields of
education and medicine, 14 and their judgment in this particular area is certainly
better than that of the respondent Judge whose sole and only visit to the school could
hardly have given him much more to go on than a brief look at the physical plant and
facilities and into the conduct of the classes and other school activities. Respondent
Judge gravely abused his discretion in substituting his judgment for theirs. It is well-
settled doctrine that courts of justice should not generally interfere with purely
administrative and discretionary functions; that courts have no supervisory power
over the proceedings and actions of the administrative departments of the
government; involving the exercise of judgment and findings of facts, because by
reason of their special knowledge and expertise over matters falling under their
jurisdiction, the latter are in a better position to pass judgment on such matters andn
their findings of facts in that regard are generally accorded respect, if not finality, by
the courts. 15 There are, to be sure, exceptions to this general rule but none of them
obtains in this case.
The, claim of denial of due process likewise holds no water, as the record clearly
shows that the College was given every opportunity to so improve itself as to come
up to requirements, but remained sadly sub-standard after the inspections conducted
by the evaluating teams. It had, in fact, admitted its failure to have up to the desired
standards when it proposed its gradual phase-out in its letter dated June 27, 1988 to
Secretary Quisumbing. It was also precisely because of its complaints of bias and
prejudice that the Board of Medical Education dispatched new teams to survey and
re-evaluate its performance. It had even gone all the way up to the Office of the
President to seek a reversal of the order of closure. There is thus no reason for it to
complain of a lack of opportunity to be heard and to explain its side as well as to seek
reconsideration of the ruling complained of.
There is also no merit in respondent College's argument that the closure violated
NMCS ORDER No. 5, Series of 1986, because it was sought to be effected before the
lapse of the three-year period therein snowed, which in this case is sought to be
counted from June 18, 1988, or the date of the last evaluation. The, provision referred
to reads:
The following sanction shall be applied against any medical school,
for failure to comply with the specific requirements of the
essentials, viz.:
xxx
c. Withdrawal or cancellation of the school's government; authority
to operate, for failure to fully comply with the prescribed
requirements after three (3) years from the last evaluation conducted on
the school.
It must at once be obvious from a reading of the provision, paragraph c, that the
situation therein contemplated — where a school is found to have failed to "fully
comply with the prescribed requirements," i.e., has not complied with some
requirements and has failed to do so within three (3) years from the last evaluation is
quite distinct from that obtaining in the case at bar — where respondent school was
found to have deficiencies so serious as to warrant its immediate closure. Said
paragraph c should not be construed to prohibit absolutely the withdrawal or
cancellation of government; authority to operate until after three (3) years from the
last evaluation conducted on the school; or, stated otherwise, it does not
unexceptionally prescribe a three-year waiting period before authority to operate may
be withdrawn. Rather, it should be read as giving the Secretary of Education the
discretion, depending on the seriousness of the discovered deficiencies, to afford an
educational institution which has failed to comply with some requirement or other,
time not exceeding three (3) years to correct the deficiencies before applying the
sanction of withdrawal or cancellation of the government; authority to operate. The,
circumstances in the case at bar are far from nominal and, to repeat, are different from
those obviously envisioned by the paragraph in question. There had never been a
recommendation that the College be granted an opportunity to comply with certain
requirements. From the outset, the proposal had been that it be forthwith closed, its
discovered deficiencies as a medical college being of so serious a character as to be
irremediable. The, other four (4) surveys were conducted, not to determine if in the
course of time the petitioner school had already fully complied with all the prescribed
requisites, but rather, whether or not the original recommendation for its closure was
correct and should be sustained. And, as already mentioned, the subsequent surveys,
over a period of more than three (3) years, served but to confirm the validity of that
initial proposal for its closure. Under these circumstances, therefore, even if it be
assumed that the provision, paragraph c, applied to petitioner school, it must be held
that there has been substantial compliance therewith.
Having thus disposed of the issues raised by the facts of the case, the Court sees no
useful purpose to be served by remanding the case to the Trial Court for further
proceedings. The, only acceptable reason for such a remand would be so that the Trial
Court may determine whether or not the petitioners' first have acted within the scope
of their powers or grossly abused them, a matter that this Court has already passed
upon here. Such a remand cannot be justified on the theory that the Trial Court will
make its philosophy independent determination of whether or not respondent
medical institution has complied with the minimum standards laid down for its
continued operation, since, as here ruled, it has not that power.
WHEREFORE, premises considered, the petition is hereby granted and the temporary
restraining order issued by the Court is made, permanent. The, questioned writ of
preliminary injunction dated May 10, 1989 is set aside and respondent Judge is
ordered to dismiss Civil Case No. 1385.
SO ORDERED.
Republic of the Philippines
SUPREME COURT
Manila
EN BANC
G.R. No. 89572 December 21, 1989
DEPARTMENT OF EDUCATION, CULTURE AND SPORTS (DECS) and
DIRECTOR OF CENTER FOR EDUCATIONAL MEASUREMENT, petitioners,
vs.
ROBERTO REY C. SAN DIEGO and JUDGE TERESITA DIZON-CAPULONG, in
her capacity as Presiding Judge of the Regional Trial Court of Valenzuela, Metro
Manila, Branch 172, respondents.
Ramon M. Guevara for private respondent.
CRUZ, J.:
The issue before us is mediocrity. The question is whether a person who has thrice
failed the National Medical Admission Test (NMAT) is entitled to take it again.
The petitioner contends he may not, under its rule that-
h) A student shall be allowed only three (3) chances to take the
NMAT. After three (3) successive failures, a student shall not be
allowed to take the NMAT for the fourth time.
The private respondent insists he can, on constitutional grounds.
But first the facts.
The private respondent is a graduate of the University of the East with a degree of
Bachelor of Science in Zoology. The petitioner claims that he took the NMAT three
times and flunked it as many times.1 When he applied to take it again, the petitioner
rejected his application on the basis of the aforesaid rule. He then went to the
Regional Trial Court of Valenzuela, Metro Manila, to compel his admission to the test.
In his original petition for mandamus, he first invoked his constitutional rights to
academic freedom and quality education. By agreement of the parties, the private
respondent was allowed to take the NMAT scheduled on April 16, 1989, subject to the
outcome of his petition. 2 In an amended petition filed with leave of court, he squarely
challenged the constitutionality of MECS Order No. 12, Series of 1972, containing the
above-cited rule. The additional grounds raised were due process and equal
protection.
After hearing, the respondent judge rendered a decision on July 4, 1989, declaring the
challenged order invalid and granting the petition. Judge Teresita Dizon-Capulong
held that the petitioner had been deprived of his right to pursue a medical education
through an arbitrary exercise of the police power. 3
We cannot sustain the respondent judge. Her decision must be reversed.
In Tablarin v. Gutierrez, 4 this Court upheld the constitutionality of the NMAT as a
measure intended to limit the admission to medical schools only to those who have
initially proved their competence and preparation for a medical education. Justice
Florentino P. Feliciano declared for a unanimous Court:
Perhaps the only issue that needs some consideration is whether
there is some reasonable relation between the prescribing of
passing the NMAT as a condition for admission to medical school
on the one hand, and the securing of the health and safety of the
general community, on the other hand. This question is perhaps
most usefully approached by recalling that the regulation of the
pratice of medicine in all its branches has long been recognized as a
reasonable method of protecting the health and safety of the public.
That the power to regulate and control the practice of medicine
includes the power to regulate admission to the ranks of those
authorized to practice medicine, is also well recognized. Thus,
legislation and administrative regulations requiring those who
wish to practice medicine first to take and pass medical board
examinations have long ago been recognized as valid exercises of
governmental power. Similarly, the establishment of minimum
medical educational requirements-i.e., the completion of prescribed
courses in a recognized medical school-for admission to the
medical profession, has also been sustained as a legitimate exercise
 of the regulatory authority of the state. What we have before us in
the instant case is closely related: the regulation of access to medical
schools. MECS Order No. 52, s. 1985, as noted earlier, articulates the
rationale of regulation of this type: the improvement of the
professional and technical quality of the graduates of medical
schools, by upgrading the quality of those admitted to the student
body of the medical schools. That upgrading is sought by
selectivity in the process of admission, selectivity consisting, among
other things, of limiting admission to those who exhibit in the
required degree the aptitude for medical studies and eventually for
medical practice. The need to maintain, and the difficulties of
maintaining, high standards in our professional schools in general,
and medical schools in particular, in the current state of our social
and economic development, are widely known.
We believe that the government is entitled to prescribe an
admission test like the NMAT as a means of achieving its stated
objective of "upgrading the selection of applicants into [our]
medical schools" and of "improv[ing] the quality of medical
education in the country." Given the widespread use today of such
admission tests in, for instance, medical schools in the United States
of America (the Medical College Admission Test [MCAT] and quite
probably, in other countries with far more developed educational
resources than our own, and taking into account the failure or
inability of the petitioners to even attempt to prove otherwise, we
are entitled to hold that the NMAT is reasonably related to the
securing of the ultimate end of legislation and regulation in this
area. That end, it is useful to recall, is the protection of the public
from the potentially deadly effects of incompetence and ignorance
in those who would undertake to treat our bodies and minds for
disease or trauma.
However, the respondent judge agreed with the petitioner that the said case was not
applicable. Her reason was that it upheld only the requirement for the admission test
and said nothing about the so-called "three-flunk rule."
We see no reason why the rationale in the Tablarin case cannot apply to the case at
bar. The issue raised in both cases is the academic preparation of the applicant. This
may be gauged at least initially by the admission test and, indeed with more
reliability, by the three-flunk rule. The latter cannot be regarded any less valid than
the former in the regulation of the medical profession.
There is no need to redefine here the police power of the State. Suffice it to repeat that
the power is validly exercised if (a) the interests of the public generally, as
distinguished from those of a particular class, require the interference of the State,
and (b) the means employed are reasonably necessary to the attainment of the object
sought to be accomplished and not unduly oppressive upon individuals. 5
In other words, the proper exercise of the police power requires the concurrence of a
lawful subject and a lawful method.
The subject of the challenged regulation is certainly within the ambit of the police
power. It is the right and indeed the responsibility of the State to insure that the
medical profession is not infiltrated by incompetents to whom patients may unwarily
entrust their lives and health.
The method employed by the challenged regulation is not irrelevant to the purpose of
the law nor is it arbitrary or oppressive. The three-flunk rule is intended to insulate
the medical schools and ultimately the medical profession from the intrusion of those
not qualified to be doctors.
While every person is entitled to aspire to be a doctor, he does not have a
constitutional right to be a doctor. This is true of any other calling in which the public
interest is involved; and the closer the link, the longer the bridge to one's ambition.
The State has the responsibility to harness its human resources and to see to it that
they are not dissipated or, no less worse, not used at all. These resources must be
applied in a manner that will best promote the common good while also giving the
individual a sense of satisfaction.
A person cannot insist on being a physician if he will be a menace to his patients. If
one who wants to be a lawyer may prove better as a plumber, he should be so
advised and adviced. Of course, he may not be forced to be a plumber, but on the
other hand he may not force his entry into the bar. By the same token, a student who
has demonstrated promise as a pianist cannot be shunted aside to take a course in
nursing, however appropriate this career may be for others.
The right to quality education invoked by the private respondent is not absolute. The
Constitution also provides that "every citizen has the right to choose a profession or
course of study, subject to fair, reasonable and equitable admission and academic
requirements.6
The private respondent must yield to the challenged rule and give way to those better
prepared. Where even those who have qualified may still not be accommodated in
our already crowded medical schools, there is all the more reason to bar those who,
like him, have been tested and found wanting.
The contention that the challenged rule violates the equal protection clause is not
well-taken. A law does not have to operate with equal force on all persons or things
to be conformable to Article III, Section 1 of the Constitution.
There can be no question that a substantial distinction exists between medical
students and other students who are not subjected to the NMAT and the three-flunk
rule. The medical profession directly affects the very lives of the people, unlike other
careers which, for this reason, do not require more vigilant regulation. The
accountant, for example, while belonging to an equally respectable profession, does
not hold the same delicate responsibility as that of the physician and so need not be
similarly treated.
There would be unequal protection if some applicants who have passed the tests are
admitted and others who have also qualified are denied entrance. In other words,
what the equal protection requires is equality among equals.
The Court feels that it is not enough to simply invoke the right to quality education as
a guarantee of the Constitution: one must show that he is entitled to it because of his
preparation and promise. The private respondent has failed the NMAT five
times. 7 While his persistence is noteworthy, to say the least, it is certainly misplaced,
like a hopeless love.
No depreciation is intended or made against the private respondent. It is stressed that
a person who does not qualify in the NMAT is not an absolute incompetent unfit for
any work or occupation. The only inference is that he is a probably better, not for the
medical profession, but for another calling that has not excited his interest.
In the former, he may be a bungler or at least lackluster; in the latter, he is more likely
to succeed and may even be outstanding. It is for the appropriate calling that he is
entitled to quality education for the full harnessing of his potentials and the
sharpening of his latent talents toward what may even be a brilliant future.
We cannot have a society of square pegs in round holes, of dentists who should never
have left the farm and engineers who should have studied banking and teachers who
could be better as merchants.
It is time indeed that the State took decisive steps to regulate and enrich our system of
education by directing the student to the course for which he is best suited as
determined by initial tests and evaluations. Otherwise, we may be "swamped with
mediocrity," in the words of Justice Holmes, not because we are lacking in
intelligence but because we are a nation of misfits.
WHEREFORE, the petition is GRANTED. The decision of the respondent court dated
January 13, 1989, is REVERSED, with costs against the private respondent. It is so
ordered.
Fernan, C.J., Narvasa Melencio-Herrera, Gutierrez, Jr., Paras, Feliciano, Gancayco, Padilla,
Bidin, Sarmiento, Cortes, Griño-Aquino, Medialdea and Regalado, JJ., concur.
G.R. No. 144681 June 21, 2004
PROFESSIONAL REGULATION COMMISSION (PRC), CHAIRMAN
HERMOGENES P. POBRE, ASSOCIATE COMMISSIONER ARMANDO
PASCUAL, BOARD OF MEDICINE, CHAIRMAN RODOLFO P. DE GUZMAN,
JOSE S. RAMIREZ, JUANITO B. BILLOTE, RUBEN R. POLICARPIO, EDGARDO
T. FERNANDO and RICARDO D. FULGENCIO II, petitioners,
vs.
ARLENE V. DE GUZMAN, VIOLETA V. MENESES, CELERINA S. NAVARRO,
JOSE RAMONCITO P. NAVARRO, ARNEL V. HERRERA and GERALDINE
ELIZABETH M. PAGILAGAN, ELNORA R. RAQUENO, MARISSA A.
REGODON, LAURA M. SANTOS, KARANGALAN D. SERRANO, DANILO A.
VILLAVER, MARIA ROSARIO L. LEONOR, ALICIA S. LIZANO, MARITEL M.
ECHIVERRI, BERNADETTE T. MENDOZA, FERNANDO F. MANDAPAT, ALELI
A. GOLLAYAN, ELCIN C. ARRIOLA, HERMINIGILDA E. CONEJOS, SALLY B.
BUNAGAN, ROGELIO B. ANCHETA, OSCAR H. PADUA, JR., EVELYN D.
GRAJO, EVELYN S. ACOSTA, MARGARITA BELINDA L. VICENCIO,
VALENTINO P. ARBOLEDA, EVELYN O. RAMOS, ACHILLES J. PERALTA,
CORAZON M. CRUZ, LEUVINA P. CHICO, JOSEPH A. JAO, MA. LUISA S.
GUTIERREZ, LYDIA C. CHAN, OPHELIA C. HIDALGO, FERNANDO T. CRUZ,
MELVIN M. USITA, RAFAEL I. TOLENTINO, GRACE E. UY, CHERYL R.
TRIGUERO, MICHAEL L. SERRANO, FEDERICO L. CASTILLO, MELITA J.
CAÑEDO, SAMUEL B. BANGOY, BERNARDITA B. SY, GLORIA T. JULARBAL,
FREDERICK D. FRANCISCO, CARLOS M. BERNARDO, JR., HUBERT S.
NAZARENO, CLARISSA B. BACLIG, DAYMINDA G. BONTUYAN,
BERNADETTE H. CABUHAT, NANCY J. CHAVEZ, MARIO D. CUARESMA,
ERNESTO L. CUE, EVELYN C. CUNDANGAN, RHONEIL R. DEVERATURDA,
DERILEEN D. DORADO, SAIBZUR N. EDDING, VIOLETA C. FELIPE,
HERMINIO V. FERNANDEZ, JR., MARIA VICTORIA M. LACSAMANA,
NORMA G. LAFAVILLA, RUBY B. LANTIN, MA. ELOISA Q. MALLARI,
CLARISA SJ. NICOLAS, PERCIVAL H. PANGILINAN, ARNULFO A.
SALVADOR, ROBERT B. SANCHEZ, MERLY D. STA. ANA and YOLANDA P.
UNICA, respondents.
DECISION
TINGA, J.:
This petition for review under Rule 45 of the 1997 Rules of Civil Procedure seeks to
nullify the Decision,1 dated May 16, 2000, of the Court of Appeals in CA-G.R. SP No.
37283. The appellate court affirmed the judgment2 dated December 19, 1994, of the
Regional Trial Court (RTC) of Manila, Branch 52, in Civil Case No. 93-66530. The trial
court allowed the respondents to take their physician’s oath and to register as duly
licensed physicians. Equally challenged is the Resolution3 promulgated on August 25,
2000 of the Court of Appeals, denying petitioners’ Motion for Reconsideration.
The facts of this case are as follows:
The respondents are all graduates of the Fatima College of Medicine,
Valenzuela City, Metro Manila. They passed the Physician Licensure
Examination conducted in February 1993 by the Board of Medicine (Board).
 Petitioner Professional Regulation Commission (PRC) then released their
names as successful examinees in the medical licensure examination.
Shortly thereafter, the Board observed that the grades of the seventy-nine
successful examinees from Fatima College in the two most difficult subjects
in the medical licensure exam, Biochemistry (Bio-Chem) and Obstetrics and
Gynecology (OB-Gyne), were unusually and exceptionally high. Eleven
Fatima examinees scored 100% in Bio-Chem and ten got 100% in OB-Gyne,
another eleven got 99% in Bio-Chem, and twenty-one scored 99% in OB-
Gyne. The Board also observed that many of those who passed from Fatima
got marks of 95% or better in both subjects, and no one got a mark lower
than 90%. A comparison of the performances of the candidates from other
schools was made. The Board observed that strangely, the unusually high
ratings were true only for Fatima College examinees. It was a record-
breaking phenomenon in the history of the Physician Licensure
Examination.
On June 7, 1993, the Board issued Resolution No. 19, withholding the registration as
physicians of all the examinees from the Fatima College of Medicine. 4 The PRC asked
the National Bureau of Investigation (NBI) to investigate whether any anomaly or
irregularity marred the February 1993 Physician Licensure Examination.
Prior to the NBI investigation, the Board requested Fr. Bienvenido F. Nebres, S.J., an
expert mathematician and authority in statistics, and later president of the Ateneo de
Manila University, to conduct a statistical analysis of the results in Bio-Chem and Ob-
Gyne of the said examination.
On June 10, 1993, Fr. Nebres submitted his report. He reported that a comparison of
the scores in Bio-Chem and Ob-Gyne, of the Fatima College examinees with those of
examinees from De La Salle University and Perpetual Help College of Medicine
showed that the scores of Fatima College examinees were not only incredibly high
but unusually clustered close to each other. He concluded that there must be some
unusual reason creating the clustering of scores in the two subjects. It must be a cause
"strong enough to eliminate the normal variations that one should expect from the
examinees [of Fatima College] in terms of talent, effort, energy, etc." 5
For its part, the NBI found that "the questionable passing rate of Fatima examinees in
the [1993] Physician Examination leads to the conclusion that the Fatima examinees
gained early access to the test questions."6
On July 5, 1993, respondents Arlene V. De Guzman, Violeta V. Meneses, Celerina S.
Navarro, Jose Ramoncito P. Navarro, Arnel V. Herrera, and Geraldine Elizabeth M.
Pagilagan (Arlene V. De Guzman et al., for brevity) filed a special civil action for
mandamus, with prayer for preliminary mandatory injunction docketed as Civil Case
No. 93-66530 with the Regional Trial Court (RTC) of Manila, Branch 52. Their petition
was adopted by the other respondents as intervenors.
Meanwhile, the Board issued Resolution No. 26, dated July 21, 1993, charging
respondents with "immorality, dishonest conduct, fraud, and deceit" in connection
with the Bio-Chem and Ob-Gyne examinations. It recommended that the test results
of the Fatima examinees be nullified. The case was docketed as Adm. Case No. 1687
by the PRC.
On July 28, 1993, the RTC issued an Order in Civil Case No. 93-66530 granting the
preliminary mandatory injunction sought by the respondents. It ordered the
petitioners to administer the physician’s oath to Arlene V. De Guzman et al., and
enter their names in the rolls of the PRC.
The petitioners then filed a special civil action for certiorari with the Court of Appeals
to set aside the mandatory injunctive writ, docketed as CA-G.R. SP No. 31701.
On October 21, 1993, the appellate court decided CA-G.R. SP No. 31701, with the
dispositive portion of the Decision ordaining as follows:
WHEREFORE, this petition is GRANTED. Accordingly, the writ of
preliminary mandatory injunction issued by the lower court against
petitioners is hereby nullified and set aside.
SO ORDERED.7
Arlene V. de Guzman, et al., then elevated the foregoing Decision to this Court in G.R.
No. 112315. In our Resolution dated May 23, 1994, we denied the petition for failure to
show reversible error on the part of the appellate court.
Meanwhile, on November 22, 1993, during the pendency of the instant petition, the
pre-trial conference in Civil Case No. 93-66530 was held. Then, the parties, agreed to
reduce the testimonies of their respective witnesses to sworn questions-and-answers.
This was without prejudice to cross-examination by the opposing counsel.
On December 13, 1993, petitioners’ counsel failed to appear at the trial in the mistaken
belief that the trial was set for December 15. The trial court then ruled that petitioners
waived their right to cross-examine the witnesses.
On January 27, 1994, counsel for petitioners filed a Manifestation and Motion stating the
reasons for her non-appearance and praying that the cross-examination of the
witnesses for the opposing parties be reset. The trial court denied the motion for lack
of notice to adverse counsel. It also denied the Motion for Reconsideration that followed
on the ground that adverse counsel was notified less than three (3) days prior to the
hearing.
Meanwhile, to prevent the PRC and the Board from proceeding with Adm. Case No.
1687, the respondents herein moved for the issuance of a restraining order, which the
lower court granted in its Order dated April 4, 1994.
The petitioners then filed with this Court a petition for certiorari docketed as G.R. No.
115704, to annul the Orders of the trial court dated November 13, 1993, February 28,
1994, and April 4, 1994. We referred the petition to the Court of Appeals where it was
docketed as CA-G.R. SP No. 34506.
On August 31, 1994, the appellate court decided CA-G.R. SP No. 34506 as follows:
WHEREFORE, the present petition for certiorari with prayer for temporary
restraining order/preliminary injunction is GRANTED and the Orders of
December 13, 1993, February 7, 1994, February 28, 1994, and April 4, 1994 of
the RTC-Manila, Branch 52, and all further proceedings taken by it in Special
Civil Action No. 93-66530 are hereby DECLARED NULL and VOID. The
said RTC-Manila is ordered to allow petitioners’ counsel to cross-examine
the respondents’ witnesses, to allow petitioners to present their evidence in
due course of trial, and thereafter to decide the case on the merits on the
basis of the evidence of the parties. Costs against respondents.
IT IS SO ORDERED.8
The trial was then set and notices were sent to the parties.
A day before the first hearing, on September 22, 1994, the petitioners filed an Urgent
Ex-Parte Manifestation and Motion praying for the partial reconsideration of the
appellate court’s decision in CA-G.R. SP No. 34506, and for the outright dismissal of
Civil Case No. 93-66530. The petitioners asked for the suspension of the proceedings.
In its Order dated September 23, 1994, the trial court granted the aforesaid motion,
cancelled the scheduled hearing dates, and reset the proceedings to October 21 and
28, 1994.
Meanwhile, on October 25, 1994, the Court of Appeals denied the partial motion for
reconsideration in CA-G.R. SP No. 34506. Thus, petitioners filed with the Supreme
Court a petition for review docketed as G.R. No. 117817, entitled Professional
Regulation Commission, et al. v. Court of Appeals, et al.
On November 11, 1994, counsel for the petitioners failed to appear at the trial of Civil
Case No. 93-66530. Upon motion of the respondents herein, the trial court ruled that
herein petitioners waived their right to cross-examine the herein respondents. Trial
was reset to November 28, 1994.
On November 25, 1994, petitioners’ counsel moved for the inhibition of the trial court
judge for alleged partiality. On November 28, 1994, the day the Motion to Inhibit was
to be heard, petitioners failed to appear. Thus, the trial court denied the Motion to
Inhibit and declared Civil Case No. 93-66530 deemed submitted for decision.
On December 19, 1994, the trial court handed down its judgment in Civil Case No. 93-
66530, the fallo of which reads:
WHEREFORE, judgment is rendered ordering the respondents to allow the
petitioners and intervenors (except those with asterisks and footnotes in
pages 1 & 2 of this decision) [sic],9 to take the physician’s oath and to register
them as physicians.
It should be made clear that this decision is without prejudice to any
administrative disciplinary action which may be taken against any of the
petitioners for such causes and in the manner provided by law and
consistent with the requirements of the Constitution as any other
professionals.
No costs.
SO ORDERED.10
As a result of these developments, petitioners filed with this Court a petition for
review on certiorari docketed as G.R. No. 118437, entitled Professional Regulation
Commission v. Hon. David G. Nitafan, praying inter alia, that (1) G.R. No. 118437 be
consolidated with G.R. No. 117817; (2) the decision of the Court of Appeals dated
August 31, 1994 in CA-G.R. SP No. 34506 be nullified for its failure to decree the
dismissal of Civil Case No. 93-66530, and in the alternative, to set aside the decision of
the trial court in Civil Case No. 93-66530, order the trial court judge to inhibit himself,
and Civil Case No. 93-66530 be re-raffled to another branch.
On December 26, 1994, the petitioners herein filed their Notice of Appeal11 in Civil Case
No. 93-66530, thereby elevating the case to the Court of Appeals, where it was
docketed as CA-G.R. SP No. 37283.
In our Resolution of June 7, 1995, G.R. No. 118437 was consolidated with G.R. No.
117817.
On July 9, 1998, we disposed of G.R. Nos. 117817 and 118437 in this wise:
WHEREFORE, the petition in G.R. No. 117817 is DISMISSED for being moot.
The petition in G.R. No. 118437 is likewise DISMISSED on the ground that
there is a pending appeal before the Court of Appeals. Assistant Solicitor
General Amparo M. Cabotaje-Tang is advised to be more circumspect in her
 dealings with the courts as a repetition of the same or similar acts will be
dealt with accordingly.
SO ORDERED.12
While CA-G.R. SP No. 37283 was awaiting disposition by the appellate court, Arnel
V. Herrera, one of the original petitioners in Civil Case No. 93-66530, joined by
twenty-seven intervenors, to wit: Fernando F. Mandapat, Ophelia C. Hidalgo,
Bernadette T. Mendoza, Ruby B. Lantin-Tan, Fernando T. Cruz, Marissa A. Regodon,
Ma. Eloisa Q. Mallari-Largoza, Cheryl R. Triguero, Joseph A. Jao, Bernadette H.
Cabuhat, Evelyn S. Acosta-Cabanes, Laura M. Santos, Maritel M. Echiverri,
Bernadette C. Escusa, Carlosito C. Domingo, Alicia S. Lizano, Elnora R. Raqueno-
Rabaino, Saibzur N. Edding, Derileen D. Dorado-Edding, Robert B. Sanchez, Maria
Rosario L. Leonor-Lacandula, Geraldine Elizabeth M. Pagilagan-Palma, Margarita
Belinda L. Vicencio-Gamilla, Herminigilda E. Conejos, Leuvina P. Chico-Paguio, Elcin
C. Arriola-Ocampo, and Jose Ramoncito P. Navarro, manifested that they were no
longer interested in proceeding with the case and moved for its dismissal. A similar
manifestation and motion was later filed by intervenors Mary Jean I. Yeban-Merlan,
Michael L. Serrano, Norma G. Lafavilla, Arnulfo A. Salvador, Belinda C. Rabara,
Yolanda P. Unica, Dayminda G. Bontuyan, Clarissa B. Baclig, Ma. Luisa S. Gutierrez,
Rhoneil R. Deveraturda, Aleli A. Gollayan, Evelyn C. Cundangan, Frederick D.
Francisco, Violeta V. Meneses, Melita J. Cañedo, Clarisa SJ. Nicolas, Federico L.
Castillo, Karangalan D. Serrano, Danilo A. Villaver, Grace E. Uy, Lydia C. Chan, and
Melvin M. Usita. The Court of Appeals ruled that its decision in CA-G.R. SP No.
37283 would not apply to them.
On May 16, 2000, the Court of Appeals decided CA-G.R. SP No. 37283, with the
following fallo, to wit:
WHEREFORE, finding no reversible error in the decision appealed from, We
hereby AFFIRM the same and DISMISS the instant appeal.
No pronouncement as to costs.
SO ORDERED.13
In sustaining the trial court’s decision, the appellate court ratiocinated that the
respondents complied with all the statutory requirements for admission into the
licensure examination for physicians in February 1993. They all passed the said
examination. Having fulfilled the requirements of Republic Act No. 2382, 14 they
should be allowed to take their oaths as physicians and be registered in the rolls of
the PRC.
Hence, this petition raising the following issues:
I
WHETHER OR NOT RESPONDENTS HAVE A VALID CAUSE OF
ACTION FOR MANDAMUS AGAINST PETITIONERS IN THE LIGHT OF
THE RESOLUTION OF THIS HONORABLE COURT IN G.R. NO. 112315
AFFIRMING THE COURT OF APPEALS’ DECISION DECLARING THAT
IF EVER THERE IS SOME DOUBT AS TO THE MORAL FITNESS OF
EXAMINEES, THE ISSUANCE OF LICENSE TO PRACTICE MEDICINE IS
NOT AUTOMATICALLY GRANTED TO THE SUCCESSFUL EXAMINEES.
II
WHETHER OR NOT THE PETITION FOR MANDAMUS COULD
PROCEED DESPITE THE PENDENCY OF ADMINISTRATIVE CASE NO.
1687, WHICH WAS PRECISELY LODGED TO DETERMINE THE MORAL
FITNESS OF RESPONDENTS TO BECOME DOCTORS.15
To our mind, the only issue is: Did the Court of Appeals commit a reversible error of
law in sustaining the judgment of the trial court that respondents are entitled to a writ
of mandamus?
The petitioners submit that a writ of mandamus will not lie in this case. They point
out that for a writ of mandamus to issue, the applicant must have a well-defined,
clear and certain legal right to the thing demanded and it is the duty of the
respondent to perform the act required. Thus, mandamus may be availed of only
when the duty sought to be performed is a ministerial and not a discretionary one.
The petitioners argue that the appellate court’s decision in CA-G.R. SP No. 37283
upholding the decision of the trial court in Civil Case No. 93-66530 overlooked its
own pronouncement in CA-G.R. SP No. 31701. The Court of Appeals held in CA-G.R.
SP No. 31701 that the issuance of a license to engage in the practice of medicine
becomes discretionary on the PRC if there exists some doubt that the successful
examinee has not fully met the requirements of the law. The petitioners stress that
this Court’s Resolution dated May 24, 1994 in G.R. No. 112315 held that there was no
showing "that the Court of Appeals had committed any reversible error in rendering
the questioned judgment" in CA-G.R. SP No. 31701. The petitioners point out that
our Resolution in G.R. No. 112315 has long become final and executory.
Respondents counter that having passed the 1993 licensure examinations for
physicians, the petitioners have the obligation to administer to them the oath as
physicians and to issue their certificates of registration as physicians pursuant to
Section 2016 of Rep. Act No. 2382. The Court of Appeals in CA-G.R. SP No. 37283,
found that respondents complied with all the requirements of Rep. Act No. 2382.
Furthermore, respondents were admitted by the Medical Board to the licensure
examinations and had passed the same. Hence, pursuant to Section 20 of Rep. Act No.
2382, the petitioners had the obligation to administer their oaths as physicians and
register them.
Mandamus is a command issuing from a court of competent jurisdiction, in the name
of the state or the sovereign, directed to some inferior court, tribunal, or board, or to
some corporation or person requiring the performance of a particular duty therein
specified, which duty results from the official station of the party to whom the writ is
directed, or from operation of law.17 Section 3 of Rule 6518 of the 1997 Rules of Civil
Procedure outlines two situations when a writ of mandamus may issue, when any
tribunal, corporation, board, officer or person unlawfully (1) neglects the performance
of an act which the law specifically enjoins as a duty resulting from an office, trust, or
station; or (2) excludes another from the use and enjoyment of a right or office to
which the other is entitled.
We shall discuss the issues successively.
1. On The Existence of a Duty of the Board of Medicine To Issue Certificates of Registration
as Physicians under Rep. Act No. 2382.
For mandamus to prosper, there must be a showing that the officer, board, or official
concerned, has a clear legal duty, not involving discretion. 19 Moreover, there must be
statutory authority for the performance of the act,20 and the performance of the duty
has been refused.21 Thus, it must be pertinently asked now: Did petitioners have the
duty to administer the Hippocratic Oath and register respondents as physicians
under the Medical Act of 1959?
As found by the Court of Appeals, on which we agree on the basis of the records:
It bears emphasizing herein that petitioner-appellees and intervenor-
appellees have fully complied with all the statutory requirements for
admission into the licensure examinations for physicians conducted and
administered by the respondent-appellants on February 12, 14, 20 and 21,
1993. Stress, too, must be made of the fact that all of them successfully
passed the same examinations.22
The crucial query now is whether the Court of Appeals erred in concluding that
petitioners should allow the respondents to take their oaths as physicians and register
them, steps which would enable respondents to practice the medical
profession23 pursuant to Section 20 of the Medical Act of 1959?
The appellate court relied on a single provision, Section 20 of Rep. Act No. 2382, in
concluding that the petitioners had the ministerial obligation to administer the
Hippocratic Oath to respondents and register them as physicians. But it is a basic rule
in statutory construction that each part of a statute should be construed in connection
with every other part to produce a harmonious whole, not confining construction to
only one section.24 The intent or meaning of the statute should be ascertained from
the statute taken as a whole, not from an isolated part of the provision. Accordingly,
Section 20, of Rep. Act No. 2382, as amended should be read in conjunction with the
other provisions of the Act. Thus, to determine whether the petitioners had the
ministerial obligation to administer the Hippocratic Oath to respondents and register
them as physicians, recourse must be had to the entirety of the Medical Act of 1959.
A careful reading of Section 20 of the Medical Act of 1959 discloses that the law uses
the word "shall" with respect to the issuance of certificates of registration. Thus, the
petitioners "shall sign and issue certificates of registration to those who have
satisfactorily complied with the requirements of the Board." In statutory construction
the term "shall" is a word of command. It is given imperative meaning. Thus, when
an examinee satisfies the requirements for the grant of his physician’s license, the
Board is obliged to administer to him his oath and register him as a physician,
pursuant to Section 20 and par. (1) of Section 2225 of the Medical Act of 1959.
However, the surrounding circumstances in this case call for serious inquiry
concerning the satisfactory compliance with the Board requirements by the
respondents. The unusually high scores in the two most difficult subjects was
phenomenal, according to Fr. Nebres, the consultant of PRC on the matter, and raised
grave doubts about the integrity, if not validity, of the tests. These doubts have to be
appropriately resolved.
Under the second paragraph of Section 22, the Board is vested with the power to
conduct administrative investigations and "disapprove applications for examination
or registration," pursuant to the objectives of Rep. Act No. 2382 as outlined in Section
126 thereof. In this case, after the investigation, the Board filed before the PRC, Adm.
Case No. 1687 against the respondents to ascertain their moral and mental fitness to
practice medicine, as required by Section 927 of Rep. Act No. 2382. In
its Decision dated July 1, 1997, the Board ruled:
WHEREFORE, the BOARD hereby CANCELS the respondents[’]
examination papers in the Physician Licensure Examinations given in
February 1993 and further DEBARS them from taking any licensure
examination for a period of ONE (1) YEAR from the date of the
promulgation of this DECISION. They may, if they so desire, apply for the
scheduled examinations for physicians after the lapse of the period imposed
by the BOARD.
SO ORDERED.28
Until the moral and mental fitness of the respondents could be ascertained, according
to petitioners, the Board has discretion to hold in abeyance the administration of the
Hippocratic Oath and the issuance of the certificates to them. The writ of mandamus
does not lie to compel performance of an act which is not duly authorized.
The respondents nevertheless argue that under Section 20, the Board shall not issue a
certificate of registration only in the following instances: (1) to any candidate who has
been convicted by a court of competent jurisdiction of any criminal offense involving
moral turpitude; (2) or has been found guilty of immoral or dishonorable conduct
after the investigation by the Board; or (3) has been declared to be of unsound mind.
They aver that none of these circumstances are present in their case.
Petitioners reject respondents’ argument. We are informed that in Board Resolution
No. 26,29 dated July 21, 1993, the Board resolved to file charges against the examinees
from Fatima College of Medicine for "immorality, dishonesty, fraud, and deceit in the
Obstetrics-Gynecology and Biochemistry examinations." It likewise sought to cancel
the examination results obtained by the examinees from the Fatima College.
Section 830 of Rep. Act No. 2382 prescribes, among others, that a person who aspires
to practice medicine in the Philippines, must have "satisfactorily passed the
corresponding Board Examination." Section 22, in turn, provides that the oath may
only be administered "to physicians who qualified in the examinations." The
operative word here is "satisfactorily," defined as "sufficient to meet a condition or
obligation" or "capable of dispelling doubt or ignorance." 31 Gleaned from Board
Resolution No. 26, the licensing authority apparently did not find that the
respondents "satisfactorily passed" the licensure examinations. The Board instead
sought to nullify the examination results obtained by the respondents.
2. On the Right Of The Respondents To Be Registered As Physicians
The function of mandamus is not to establish a right but to enforce one that has been
established by law. If no legal right has been violated, there can be no application of a
legal remedy, and the writ of mandamus is a legal remedy for a legal right. 32 There
must be a well-defined, clear and certain legal right to the thing demanded. 33 It is
long established rule that a license to practice medicine is a privilege or franchise
granted by the government.34
It is true that this Court has upheld the constitutional right35 of every citizen to select
a profession or course of study subject to a fair, reasonable, and equitable admission
and academic requirements.36 But like all rights and freedoms guaranteed by the
Charter, their exercise may be so regulated pursuant to the police power of the State
to safeguard health, morals, peace, education, order, safety, and general welfare of
the people.37 Thus, persons who desire to engage in the learned professions requiring
scientific or technical knowledge may be required to take an examination as a
prerequisite to engaging in their chosen careers. This regulation takes particular
pertinence in the field of medicine, to protect the public from the potentially deadly
effects of incompetence and ignorance among those who would practice medicine. In
a previous case, it may be recalled, this Court has ordered the Board of Medical
Examiners to annul both its resolution and certificate authorizing a Spanish subject,
with the degree of Licentiate in Medicine and Surgery from the University of
Barcelona, Spain, to practice medicine in the Philippines, without first passing the
examination required by the Philippine Medical Act.38 In another case worth noting,
we upheld the power of the State to upgrade the selection of applicants into medical
schools through admission tests.39
It must be stressed, nevertheless, that the power to regulate the exercise of a
profession or pursuit of an occupation cannot be exercised by the State or its agents in
an arbitrary, despotic, or oppressive manner. A political body that regulates the
exercise of a particular privilege has the authority to both forbid and grant such
privilege in accordance with certain conditions. Such conditions may not, however,
require giving up ones constitutional rights as a condition to acquiring the
license.40 Under the view that the legislature cannot validly bestow an arbitrary
power to grant or refuse a license on a public agency or officer, courts will generally
strike down license legislation that vests in public officials discretion to grant or
refuse a license to carry on some ordinarily lawful business, profession, or activity
without prescribing definite rules and conditions for the guidance of said officials in
the exercise of their power.41
In the present case, the aforementioned guidelines are provided for in Rep. Act No.
2382, as amended, which prescribes the requirements for admission to the practice of
medicine, the qualifications of candidates for the board examinations, the scope and
conduct of the examinations, the grounds for denying the issuance of a physician’s
license, or revoking a license that has been issued. Verily, to be granted the privilege
to practice medicine, the applicant must show that he possesses all the qualifications
and none of the disqualifications. Furthermore, it must appear that he has fully
complied with all the conditions and requirements imposed by the law and the
licensing authority. Should doubt taint or mar the compliance as being less than
satisfactory, then the privilege will not issue. For said privilege is distinguishable
from a matter of right, which may be demanded if denied. Thus, without a definite
showing that the aforesaid requirements and conditions have been satisfactorily met,
the courts may not grant the writ of mandamus to secure said privilege without
thwarting the legislative will.
3. On the Ripeness of the Petition for Mandamus
Lastly, the petitioners herein contend that the Court of Appeals should have
dismissed the petition for mandamus below for being premature. They argue that the
administrative remedies had not been exhausted. The records show that this is not the
first time that petitioners have sought the dismissal of Civil Case No. 93-66530. This
issue was raised in G.R. No. 115704, which petition we referred to the Court of
Appeals, where it was docketed as CA-G.R. SP No. 34506. On motion for
reconsideration in CA-G.R. SP No. 34506, the appellate court denied the motion to
dismiss on the ground that the prayers for the nullification of the order of the trial
court and the dismissal of Civil Case No. 93-66530 were inconsistent reliefs. In G.R.
No. 118437, the petitioners sought to nullify the decision of the Court of Appeals in
CA-G.R. SP No. 34506 insofar as it did not order the dismissal of Civil Case No. 93-
66530. In our consolidated decision, dated July 9, 1998, in G.R. Nos. 117817 & 118437,
this Court speaking through Justice Bellosillo opined that:
Indeed, the issue as to whether the Court of Appeals erred in not ordering
the dismissal of Civil Case No. 93-66530 sought to be resolved in the instant
petition has been rendered meaningless by an event taking place prior to the
 filing of this petition and denial thereof should follow as a logical
consequence.42 There is no longer any justiciable controversy so that any
declaration thereon would be of no practical use or value.43 It should be
recalled that in its decision of 19 December 1994 the trial court granted the
writ of mandamus prayed for by private respondents, which decision was
received by petitioners on 20 December 1994. Three (3) days after, or on 23
December 1994, petitioners filed the instant petition. By then, the remedy
available to them was to appeal the decision to the Court of Appeals, which
they in fact did, by filing a notice of appeal on 26 December 1994. 44
The petitioners have shown no cogent reason for us to reverse the aforecited ruling.
Nor will their reliance upon the doctrine of the exhaustion of administrative remedies
in the instant case advance their cause any.
Section 2645 of the Medical Act of 1959 provides for the administrative and judicial
remedies that respondents herein can avail to question Resolution No. 26 of the Board
of Medicine, namely: (a) appeal the unfavorable judgment to the PRC; (b) should the
PRC ruling still be unfavorable, to elevate the matter on appeal to the Office of the
President; and (c) should they still be unsatisfied, to ask for a review of the case or to
bring the case to court viaa special civil action of certiorari. Thus, as a rule, mandamus
will not lie when administrative remedies are still available.46 However, the doctrine
of exhaustion of administrative remedies does not apply where, as in this case, a pure
question of law is raised.47 On this issue, no reversible error may, thus, be laid at the
door of the appellate court in CA-G.R. SP No. 37283, when it refused to dismiss Civil
Case No. 93-66530.
As we earlier pointed out, herein respondents Arnel V. Herrera, Fernando F.
Mandapat, Ophelia C. Hidalgo, Bernadette T. Mendoza, Ruby B. Lantin-Tan,
Fernando T. Cruz, Marissa A. Regodon, Ma. Eloisa Q. Mallari-Largoza, Cheryl R.
Triguero, Joseph A. Jao, Bernadette H. Cabuhat, Evelyn S. Acosta-Cabanes, Laura M.
Santos, Maritel M. Echiverri, Bernadette C. Escusa, Carlosito C. Domingo, Alicia S.
Lizano, Elnora R. Raqueno-Rabaino, Saibzur N. Edding, Derileen D. Dorado-Edding,
Robert B. Sanchez, Maria Rosario Leonor-Lacandula, Geraldine Elizabeth M.
Pagilagan-Palma, Margarita Belinda L. Vicencio-Gamilla, Herminigilda E. Conejos,
Leuvina P. Chico-Paguio, Elcin C. Arriola-Ocampo, and Jose Ramoncito P. Navarro
manifested to the Court of Appeals during the pendency of CA-G.R. SP No. 37283,
that they were no longer interested in proceeding with the case and moved for its
dismissal insofar as they were concerned. A similar manifestation and motion were
later filed by intervenors Mary Jean I. Yeban-Merlan, Michael L. Serrano, Norma G.
Lafavilla, Arnulfo A. Salvador, Belinda C. Rabarra, Yolanda P. Unica, Dayminda G.
Bontuyan, Clarissa B. Baclig, Ma. Luisa S. Gutierrez, Rhoneil R. Deveraturda, Aleli A.
Gollayan, Evelyn C. Cundangan, Frederick D. Francisco, Violeta V. Meneses, Melita J.
Cañedo, Clarisa SJ. Nicolas, Federico L. Castillo, Karangalan D. Serrano, Danilo A.
Villaver, Grace E. Uy, Lydia C. Chan, and Melvin M. Usita. Following these
manifestations and motions, the appellate court in CA-G.R. SP No. 37283 decreed that
its ruling would not apply to them. Thus, inasmuch as the instant case is a petition for
review of the appellate court’s ruling in CA-G.R. SP No. 37283, a decision which is
inapplicable to the aforementioned respondents will similarly not apply to them.
As to Achilles J. Peralta, Evelyn O. Ramos, Sally B. Bunagan, Rogelio B. Ancheta,
Oscar H. Padua, Jr., Evelyn D. Grajo, Valentino P. Arboleda, Carlos M. Bernardo, Jr.,
Mario D. Cuaresma, Violeta C. Felipe, Percival H. Pangilinan, Corazon M. Cruz and
Samuel B. Bangoy, herein decision shall not apply pursuant to the Orders of the trial
court in Civil Case No. 93-66530, dropping their names from the suit.
Consequently, this Decision is binding only on the remaining respondents, namely:
Arlene V. de Guzman, Celerina S. Navarro, Rafael I. Tolentino, Bernardita B. Sy,
Gloria T. Jularbal, Hubert S. Nazareno, Nancy J. Chavez, Ernesto L. Cue, Herminio V.
Fernandez, Jr., Maria Victoria M. Lacsamana and Merly D. Sta. Ana, as well as the
petitioners.
WHEREFORE, the instant petition is GRANTED. Accordingly, (1) the assailed
decision dated May 16, 2000, of the Court of Appeals, in CA-G.R. SP No. 37283, which
affirmed the judgment dated December 19, 1994, of the Regional Trial Court of
Manila, Branch 52, in Civil Case No. 93-66530, ordering petitioners to administer the
physician’s oath to herein respondents as well as the resolution dated August 25,
2000, of the appellate court, denying the petitioners’ motion for reconsideration, are
REVERSED and SET ASIDE; and (2) the writ of mandamus, issued in Civil Case No.
93-66530, and affirmed by the appellate court in CA-G.R. SP No. 37283 is NULLIFIED
AND SET ASIDE.
SO ORDERED.
Republic of the Philippines
SUPREME COURT
Manila
THIRD DIVISION
G.R. No. 166097 July 14, 2008
BOARD OF MEDICINE, DR. RAUL FLORES (now DR. JOSE S. RAMIREZ), in his
capacity as Chairman of the Board, PROFESSIONAL REGULATION
COMMISSION, through its Chairman, HERMOGENES POBRE (now DR.
ALCESTIS M. GUIANG), Petitioners,
vs.
YASUYUKI OTA, Respondent.
DECISION
AUSTRIA-MARTINEZ, J.:
Before the Court is a Petition for Review on Certiorari assailing the Decision1 of the
Court of Appeals (CA) in CA-G.R. SP No. 849452 dated November 16, 2004 which
affirmed the Decision3 of the Regional Trial Court (RTC), Branch 22, Manila, dated
October 19, 2003.4
The facts are as follows:
Yasuyuki Ota (respondent) is a Japanese national, married to a Filipina, who has
continuously resided in the Philippines for more than 10 years. He graduated from
Bicol Christian College of Medicine on April 21, 1991 with a degree of Doctor of
Medicine.5 After successfully completing a one-year post graduate internship training
at the Jose Reyes Memorial Medical Center, he filed an application to take the medical
board examinations in order to obtain a medical license. He was required by the
Professional Regulation Commission (PRC) to submit an affidavit of undertaking,
stating among others that should he successfully pass the same, he would not practice
medicine until he submits proof that reciprocity exists between Japan and the
Philippines in admitting foreigners into the practice of medicine.6
Respondent 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, Jesus I. Yabes;7 thus, he was allowed to take the Medical
Board Examinations in August 1992, which he subsequently passed. 8
In spite of all these, the Board of Medicine (Board) of the PRC, in a letter dated March
8, 1993, denied respondent's request for a license to
practice medicine in the Philippines on the ground that the Board "believes that no
genuine reciprocity can be found in the law of Japan as there is no Filipino or
foreigner who can possibly practice there."9
Respondent then filed a Petition for Certiorari and Mandamus against the Board before
the RTC of Manila on June 24, 1993, which petition was amended on February 14,
1994 to implead the PRC through its Chairman.10
In his petition before the RTC, respondent alleged that the Board and the PRC, in
refusing to issue in his favor a Certificate of Registration and/or license to practice
medicine, had acted arbitrarily, in clear contravention of the provision of Section 20 of
Republic Act (R.A.) No. 2382 (The Medical Act of 1959), depriving him of his
legitimate right to practice his profession in the Philippines to his great damage and
prejudice.11
On October 19, 2003, the RTC rendered its Decision finding that respondent had
adequately proved that the medical laws of Japan allow foreigners like Filipinos to be
granted license and be admitted into the practice of medicine under the principle of
reciprocity; and that the Board had a ministerial duty of issuing the Certificate of
Registration and license to respondent, as it was shown that he had substantially
complied with the requirements under the law.12 The RTC then ordered the Board to
issue in favor of respondent the corresponding Certificate of Registration and/or
license to practice medicine in the Philippines.13
The Board and the PRC (petitioners) appealed the case to the CA, stating that while
respondent submitted documents showing that foreigners are allowed to practice
medicine in Japan, it was not shown that the conditions for the practice of medicine
there are practical and attainable by a foreign applicant, hence, reciprocity was not
established; also, the power of the PRC and the Board to regulate and control the
practice of medicine is discretionary and not ministerial, hence, not compellable by a
writ of mandamus.14
The CA denied the appeal and affirmed the ruling of the RTC. 15
Hence, herein petition raising the following issue:
WHETHER THE COURT OF APPEALS COMMITTED A REVERSIBLE
ERROR IN FINDING THAT RESPONDENT HAD ESTABLISHED THE
EXISTENCE OF RECIPROCITY IN THE PRACTICE OF MEDICINE
BETWEEN THE PHILIPPINES AND JAPAN.16
Petitioners claim that: respondent has not established by competent and conclusive
evidence that reciprocity in the practice of medicine exists between the Philippines
and Japan. While documents state that foreigners are allowed to practice medicine in
Japan, they do not similarly show that the conditions for the practice of medicine in
said country are practical and attainable by a foreign applicant. There is no
reciprocity in this case, as 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, which were not clarified by respondent, i.e., what
are the provisions of the School Educations Laws, what are the criteria of the Minister
of Health and Welfare of Japan in determining whether the academic and technical
capability of foreign medical graduates are the same or better than graduates of
medical schools in Japan, and who can actually qualify to take the preparatory test for
the National Medical Examination. Consul General Yabes also stated that there had
not been a single Filipino who was issued a license to practice medicine by the
Japanese Government. The publication showing that there were foreigners practicing
medicine in Japan, which respondent presented before the Court, also did not
specifically show that Filipinos were among those listed as practicing said
profession.17 Furthermore, under Professional Regulation Commission v. De
Guzman,18the power of the PRC and the Board to regulate and control the practice of
medicine includes the power to regulate admission to the ranks of those authorized to
practice medicine, which power is discretionary and not ministerial, hence, not
compellable by a writ of mandamus.19
Petitioners pray that the CA Decision dated November 16, 2004 be reversed and set
aside, that a new one be rendered reinstating the Board Order dated March 8, 1993
which disallows respondent to practice medicine in the Philippines, and that
respondent's petition before the trial court be dismissed for lack of merit. 20
In his Comment, respondent argues that: Articles 2 and 11 of the Medical
Practitioners Law of Japan and Section 9 of the Philippine Medical Act of 1959 show
that reciprocity exists between the Philippines and Japan concerning the practice of
medicine. Said laws clearly state that both countries allow foreigners to practice
medicine in their respective jurisdictions as long as the applicant meets the
educational requirements, training or residency in hospitals and pass the licensure
examination given by either country. Consul General Yabes in his letter dated
January 28, 1992 stated that "the Japanese Government allows a foreigner to practice
medicine in Japan after complying with the local requirements." The fact that there is
no reported Filipino who has successfully penetrated the medical practice in Japan
does not mean that there is no reciprocity between the two countries, since it does not
follow that no Filipino will ever be granted a medical license by the Japanese
Government. It is not the essence of reciprocity that before a citizen of one of the
contracting countries can demand its application, it is necessary that the interested
citizen’s country has previously granted the same privilege to the citizens of the other
contracting country.21 Respondent further argues that Section 20 of the Medical Act of
195922 indicates the mandatory character of the statute and an imperative obligation
on the part of the Board inconsistent with the idea of discretion. Thus, a foreigner, just
like a Filipino citizen, who successfully passes the examination and has all the
qualifications and none of the disqualifications, is entitled as a matter of right to the
issuance of a certificate of registration or a physician’s license, which right is
enforceable by mandamus.23
Petitioners filed a Reply24 and both parties filed their respective
memoranda reiterating their arguments.1avvphi1
25
The Court denies the petition for lack of merit.
There is no question that a license to practice medicine is a privilege or franchise
granted by the government.26 It is a right that is earned through years of education
and training, and which requires that one must first secure a license from the state
through professional board examinations.27
Indeed,
[T]he regulation of the practice of medicine in all its branches has long been
recognized as a reasonable method of protecting the health and safety of the public.
That the power to regulate and control the practice of medicine includes the power to
regulate admission to the ranks of those authorized to practice medicine, is also well
recognized. Thus, legislation and administrative regulations requiring those who
wish to practice medicine first to take and pass medical board examinations have
long ago been recognized as valid exercises of governmental power. Similarly, the
establishment of minimum medical educational requirements – i.e., the completion of
prescribed courses in a recognized medical school – for admission to the medical
profession, has also been sustained as a legitimate exercise of the regulatory authority
of the state."28
It must be stressed however that the power to regulate the exercise of a profession or
pursuit of an occupation cannot be exercised by the State or its agents in an arbitrary,
despotic, or oppressive manner. A political body which regulates the exercise of a
particular privilege has the authority to both forbid and grant such privilege in
accordance with certain conditions. As the legislature cannot validly bestow an
arbitrary power to grant or refuse a license on a public agency or officer, courts will
generally strike down license legislation that vests in public officials discretion to
grant or refuse a license to carry on some ordinarily lawful business, profession, or
activity without prescribing definite rules and conditions for the guidance of said
officials in the exercise of their power.29
R.A. No. 2382 otherwise known as the Medical Act of 1959 states in Section 9 thereof
that:
Section 9. Candidates for Board Examinations.- Candidates for Board examinations
shall have the following qualifications:
1. He shall be a citizen of the Philippines or a citizen of any foreign country who has
submitted competent and conclusive documentary evidence, confirmed by the
Department of Foreign Affairs, showing that his country’s existing laws permit
citizens of the Philippines to practice medicine under the same rules and regulations
governing citizens thereof;
xxxx
Presidential Decree (P.D.) No. 22330 also provides in Section (j) thereof that:
j) The [Professional Regulation] Commission may, upon the recommendation of the
Board concerned, approve the registration of and authorize the issuance of a
certificate of registration with or without examination to a foreigner who is registered
under the laws of his country: Provided, That the requirement for the registration or
licensing in said foreign state or country are substantially the same as those required
and contemplated by the laws of the Philippines and that the laws of such foreign
state or country allow the citizens of the Philippines to practice the profession on the
same basis and grant the same privileges as the subject or citizens of such foreign
state or country: Provided, finally, That the applicant shall submit competent and
conclusive documentary evidence, confirmed by the Department of Foreign Affairs,
showing that his country's existing laws permit citizens of the Philippines to practice
the profession under the rules and regulations governing citizens thereof. The
Commission is also hereby authorized to prescribe additional requirements or grant
certain privileges to foreigners seeking registration in the Philippines if the same
privileges are granted to or some additional requirements are required of citizens of
the Philippines in acquiring the same certificates in his country;
xxxx
As required by the said laws, respondent submitted a copy of the Medical
Practitioners Law of Japan, duly authenticated by the Consul General of the Embassy
of the Philippines in Japan, which provides in Articles 2 and 11, thus:
Article 2. Anyone who wants to be medical practitioner must pass the national
examination for medical practitioner and get license from the Minister of Health and
Welfare.
xxxx
Article 11. No one can take the National Medical Examination except persons who
conform to one of the following items:
1. Persons who finished regular medical courses at a university based on the
School Education Laws (December 26, 1947) and graduated from said
university.
2. Persons who passed the preparatory test for the National Medical
Examination and practiced clinics and public sanitation more than one year
after passing the said test.
3. Persons who graduated from a foreign medical school or acquired medical
practitioner license in a foreign country, and also are recognized to have the
same or more academic ability and techniques as persons stated in item 1
and item 2 of this article.31
Petitioners argue that while the Medical Practitioners Law of Japan allows foreigners
to practice medicine therein, said document does not show that conditions for the
practice of medicine in said country are practical and attainable by a foreign
applicant; and since the requirements are practically impossible for a Filipino to
comply with, there is no reciprocity between the two countries, hence, respondent
may not be granted license to practice medicine in the Philippines.
The Court does not agree.
R.A. No. 2382, which provides who may be candidates for the medical board
examinations, merely requires a foreign citizen to submit competent and conclusive
documentary evidence, confirmed by the Department of Foreign Affairs (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.
Section (j) of P.D. No. 223 also defines the extent of PRC's power to grant licenses, i.e.,
it may, upon recommendation of the board, approve the registration and authorize
the issuance of a certificate of registration with or without examination to a foreigner
who is registered under the laws of his country, provided the following conditions
are met: (1) that the requirement for the registration or licensing in said foreign state
or country are substantially the same as those required and contemplated by the laws
of the Philippines; (2) that the laws of such foreign state or country allow the citizens
of the Philippines to practice the profession on the same basis and grant the same
privileges as the subject or citizens of such foreign state or country; and (3) that the
applicant shall submit competent and conclusive documentary evidence, confirmed
by the DFA, showing that his country's existing laws permit citizens of the
Philippines to practice the profession under the rules and regulations governing
citizens thereof.
The said provision further states that the PRC is authorized to prescribe additional
requirements or grant certain privileges to foreigners seeking registration in the
Philippines if the same privileges are granted to or some additional requirements are
required of citizens of the Philippines in acquiring the same certificates in his country.
Nowhere in said statutes is it stated that the foreign applicant must show that the
conditions for the practice of medicine in said country are practical and attainable by
Filipinos. Neither is it stated that it must first be proven that a Filipino has been
granted license and allowed to practice his profession in said country before a foreign
applicant may be given license to practice in the Philippines. Indeed, the phrase used
in both R.A. No. 2382 and P.D. No. 223 is that:
[T]he applicant shall submit] competent and conclusive documentary evidence,
confirmed by the Department of Foreign Affairs, showing that his country's existing
laws permit citizens of the Philippines to practice the profession [of medicine] under
the [same] rules and regulations governing citizens thereof. x x x (Emphasis supplied)
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.
While it is true that respondent failed to give details as to the conditions stated in the
Medical Practitioners Law of Japan -- i.e., the provisions of the School Educations
Laws, the criteria of the Minister of Health and Welfare of Japan in determining
whether the academic and technical capability of foreign medical graduates are the
same as or better than that of graduates of medical schools in Japan, and who can
actually qualify to take the preparatory test for the National Medical Examination –
respondent, however, presented proof that foreigners are actually practicing in Japan
and that Filipinos are not precluded from getting a license to practice there.
Respondent presented before the trial court a Japanese Government
publication, Physician-Dentist-Pharmaceutist Survey, showing that there are a number
of foreign physicians practicing medicine in Japan.32 He also presented a letter dated
January 28, 1992 from Consul General Yabes,33 which states:
Sir:
With reference to your letter dated 12 January 1993, concerning your request for a
Certificate of Confirmation for the purpose of establishing a reciprocity with Japan in
the practice of medical profession relative to the case of Mr. Yasuyuki Ota, a Japanese
national, the Embassy wishes to inform you that inquiries from the Japanese Ministry
of Foreign Affairs, Ministry of Health and Welfare as well as Bureau of Immigration
yielded the following information:
1. They are not aware of a Filipino physician who was granted a
license by the Japanese Government to practice medicine in Japan;
2. However, the Japanese Government allows a foreigner to
practice medicine in Japan after complying with the local
requirements such as holding a valid visa for the purpose of taking
the medical board exam, checking the applicant's qualifications to
take the examination, taking the national board examination in
Japanese and filing an application for the issuance of the medical
license.
Accordingly, the Embassy is not aware of a single Filipino physician who was issued
by the Japanese Government a license to practice medicine, because it is extremely
difficult to pass the medical board examination in the Japanese language. Filipino
doctors here are only allowed to work in Japanese hospitals as trainees under the
supervision of a Japanese doctor. On certain occasions, they are allowed to show their
medical skills during seminars for demonstration purposes only. (Emphasis supplied)
Very truly yours,
Jesus I. Yabes
Minister Counsellor &
Consul General
From said letter, one can see that the Japanese Government allows foreigners to
practice medicine therein provided that the local requirements are complied with,
and that it is not the impossibility or the prohibition against Filipinos that would
account for the absence of Filipino physicians holding licenses and practicing
medicine in Japan, but the difficulty of passing the board examination in the Japanese
language. Granting that there is still no Filipino who has been given license to
practice medicine in Japan, it does not mean that no Filipino will ever be able to be
given one.
Petitioners next argue that as held in De Guzman, its power to issue licenses is
discretionary, hence, not compellable by mandamus.
The Court finds that the factual circumstances of De Guzman are different from those
of the case at bar; hence, the principle applied therein should be viewed differently in
this case. In De Guzman, there were doubts about the integrity and validity of the test
results of the examinees from a particular school which garnered unusually high
scores in the two most difficult subjects. Said doubts called for serious inquiry
concerning the applicants’ satisfactory compliance with the Board
requirements.34 And as there was no definite showing that the requirements and
conditions to be granted license to practice medicine had been satisfactorily met, the
Court held that the writ of mandamus may not be granted to secure said privilege
without thwarting the legislative will.35
Indeed, to be granted the privilege to practice medicine, the applicant must show that
he possesses all the qualifications and none of the disqualifications. It must also
appear that he has fully complied with all the conditions and requirements imposed
by the law and the licensing authority.36
In De Guzman itself, the Court explained that:
A careful reading of Section 2037 of the Medical Act of 1959 discloses that the law uses
the word "shall" with respect to the issuance of certificates of registration. Thus, the
petitioners [PRC] "shall sign and issue certificates of registration to those who have
satisfactorily complied with the requirements of the Board." In statutory construction
the term "shall" is a word of command. It is given imperative meaning. Thus, when
an examinee satisfies the requirements for the grant of his physician's license, the
Board is obliged to administer to him his oath and register him as a physician,
pursuant to Section 20 and par. (1) of Section 22 of the Medical Act of 1959.38
In this case, there is no doubt as to the competence and qualifications of respondent.
He finished his medical degree from Bicol Christian College of Medicine. He
completed a one-year post graduate internship training at the Jose Reyes Memorial
Medical Center, a government hospital. Then he passed the Medical Board
Examinations which was given on August 8, 1992 with a general average of 81.83,
with scores higher than 80 in 9 of the 12 subjects.
In fine, the only matter being questioned by petitioners is the alleged failure of
respondent to prove that there is reciprocity between the laws of Japan and the
Philippines in admitting foreigners into the practice of medicine. Respondent has
satisfactorily complied with the said requirement and the CA has not committed any
reversible error in rendering its Decision dated November 16, 2004 and Resolution
dated October 19, 2003.
WHEREFORE, the petition is hereby DENIED for lack of merit.
SO ORDERED.