You are on page 1of 19

8/14/2014

Legal
Medicine

Forensic
Medicine

Medical
Jurisprudence

LICENSING
and

REGULATORY ASPECTS
of

MEDICAL PRACTICE
Legal Medicine application of medical knowledge for purposes of law and
administration of justice

Medical Jurisprudence application of law relative to medical practice


Forensic Medicine application of medical science to elucidate legal problems

Republic Act 2382,

Article I
OBJECTIVES AND IMPLEMENTATION

as amended by R.A.4224, as further amended by R.A. R.A.5946

Section 1. Objectives . . .
Also known as . . .

THE MEDICAL ACT OF 1959

a) Standardization and regulation


of medical education
b) Examination for registration
physicians
c) Regulation of the practice of
the medical profession

8/14/2014

Article I
OBJECTIVES AND IMPLEMENTATION

Article II
THE BOARD OF MEDICAL EDUCATION
AND ITS FUNCTIONS

Section 3. Composition . . .

Section 2. Enforcement . . .

Professional Regulation Commission

Board of Medicine

Board of
Medical Education

Board of
Medicine

DOH

APMC
CHED

Article II Section 5. MINIMUM COURSE

Article II Section 5. MINIMUM COURSE

Anatomy
Physiology
Biochemistry & Nutrition
Pharmacology
Microbiology
Parasitology
Medicine &
Therapeutics
Pathology
Gynecology

PMA

UP Col
Of Medicine
DECS

Board of Medical
Association

PHA

DECS

Ophthalmology, Otology,
Rhinology & Laryngology
Pediatrics
Obstetrics
Surgery
Preventive Medicine &
Public Health
Legal Medicine including
Jurisprudence, Medical
Economics and Ethics

Provided that the Board is


hereby authorized to modify or
add to the subjects listed above as
the needs and demands of
progress in the medical profession
may require

8/14/2014

Article II Section 7. ADMISSION


REQUIREMENTS

Article III

Bachelors Degree in Science and Arts


No subject or course requirement
(CHED Memo 36 s. 2001)

Taken the NMAT (CHED Memo 36 s. 2001)


Certificate of Eligibility (DECS)
Good Moral Character by two former
professors
Birth Certificate
Other requirements imposed by the
college

Article III Section 8. PREREQUISITE TO THE PRACTICE OF MEDICINE

21 years of age
Passed the required Physician
Licensure Examination
Valid certificate of registration

BOARD OF MEDICINE

Article III Section 9. CANDIDATES FOR BOARD EXAMINATION


Citizen of the Philippines
Citizen of other country with reciprocity
Good moral character
Sound mind
Not a convict
Holder of degree of doctor of medicine or its
equivalent recognized by the government
Internship training

8/14/2014

Article III Section 10. ACTS CONSTITUTING PRACTICE OF MEDICINE


Who shall, for compensation, fee, salary or reward in any form
paid to him directly or through another, or even without the
same, physically examine any person, and diagnose, treat,
operate or prescribe any remedy for human disease, injury,
deformity, physical, mental, psychical condition or any ailment,
real or imaginary;
Who shall, by means of signs, cards, advertisements, written or
printed matter, or through the radio, television or any other
means of communication, either offer or undertake by any
method, diagnose, treat or operate, or prescribe any remedy for
any human disease, injury or deformity, physical, mental or
psychical condition;
Who shall falsely use the title of M.D. after his name.

Article III Section 11.


EXEMPTIONS . . .
Clinical psychologist
or mental
hygienist in patients with psychiatric
problems under the direct supervision
and
prescription
of
registered
physician
Prosthetists who fit artificial limbs
under the supervision of registered
physicians

Article III Section 11. EXEMPTIONS . . .


Medical student under the direct supervision and
control of a registered physician and without charging
professional fee
Dentists
Registered masseur or physiotherapist upon written
order or prescription of physician and limited to
physical and muscular development
Optometrists
Any person in case of emergency and gratuitously or
in places where there is no physician, nurse or midwife
Any person who administers or recommends any
household remedy as per classification of the
Pharmacy Law

APRACTICE WITHOUT ANY CERTIFICATE OF REGISTRATION


Physicians and surgeons from other countries for
consultation only, and exclusively for specific and
definite cases;
Those attached to international bodies or
organizations with previous authorization from the
PRC
Commissioned medical officers of the USA within the
limit of their jurisdiction
Exchange professors in special expertise with PRC
authorization
Medical graduates and nurses with limited
authorization by the DOH during epidemics and
national emergencies where no physician is available

8/14/2014

Article III Section 17. COMPOSITION OF THE


BOARD OF MEDICINE

The Board of Medicine shall


promulgate such rules and
regulations as may be necessary
and proper for the conduct of the
examinations . . . .

III Section 20. Issuance of Certificate of Registration . . .

Grounds For Refusal

. . . Who has been convicted of


any criminal offense involving moral
turpitude, or has been found guilty of
immoral dishonorable conduct after
investigation by the board of
medicine, or has been declared to be
of unsound mind.

Article III Section 18.


DATES OF EXAMINATIONS

Twice (2x) a year with


six (6) months interval

Section 21. SCOPE OF EXAMINATION

Preliminary Examination
Anatomy
Physiology
Biochemistry
Microbiology
Parasitology

Final Examination
Pharmacology &
Therapeutics
Pathology
Medicine
Obstetrics & Gynecology
Pediatrics & Nutrition
Surgery, Ophthalmology,
Otology, Rhinology &
Laryngology
Preventive Medicine &
Public Health
Legal Medicine including
Jurisprudence, Medical
Economics and Ethics

8/14/2014

Article III Section 21. PASSING GRADE / FAILURE

General weighted average of 75%


with not less than 50% in any
subject
Three-time flunker shall undergo
1-year refresher course in a
recognized medical school

Article III Section 22. INVESTIGATIONS

Administrative investigations
shall be conducted by at least two
(2) members of the Board of
Medicine with one legal officer
sitting during the investigation,
otherwise proceedings shall be
considered VOID

Article III Section 22. ADMINISTRATIVE FUNCTIONS

Administer oaths to qualified applicants


Study conditions affecting practice of
medicine
Exercise powers to maintain ethical
standards in the practice of medicine
Powers of Subpoena over witness and
documents
promulgate
rules
and
regulations (to approved by the PRC
Chairman)

Article III Section 23. PROCEDURES AND RULES

Within 15 days after the


filing of a written complaint under
oath, the respondent physician
shall be furnished a copy thereof.
The Board shall then require the
respondent physician to submit his
sworn answer thereto within 15
days from receipt thereof

8/14/2014

Article III Section 24. GROUNDS FOR REPRIMAND, SUSPENSION


OR REVOCATION OF REGISTRATION OF
CERTIFICATE

Article III Section 23. INVESTIGATIONS


Complaint
15 days

Answer
Board

No merit

Merit or no merit

Dismiss

Merit

Hearing
Decision

Article III Section 24. GROUNDS FOR REPRIMAND, SUSPENSION


OR REVOCATION OF REGISTRATION OF
CERTIFICATE

Knowingly issuing false medical certificate


Rumor mongering derogatory to character and
reputation of another physician
Aiding or acting as a dummy of an unqualified or
unregistered person to practice medicine
Violation of the any provision of the Code of
Ethics of the Medical Profession as approved by
the PMA

Conviction of crime involving


moral turpitude
Immoral or dishonorable
conduct
Insanity
Fraud in acquiring certificate
of registration
Gross negligence, ignorance
or incompetence

Alcoholism or addiction
to any habit forming
drug, gambling
False, extravagant or
unethical advertisement
(name, profession, specialty, clinic
hours, home address)
Criminal abortion

Article III Section 25. RIGHTS OF RESPONDENT DOCTORS

Representation by counsel of choice


Be heard in person
Speedy and public hearing
To confront and to cross-examine
witnesses against him
Constitutional rights
Rights under the rules of court

8/14/2014

Article III Section 26. APPEAL FROM JUDGMENT

The decision of the Board of


Medicine shall automatically become
final after thirty (30) days from the
date of promulgation unless the
respondent within the same period has
appealed the decision to the Court of
Appeals . . .

Article IV

PENALTIES AND PROVISIONS

Article III Section 27.

REINSTATEMENT

After two (2) years, the Board may order


the reinstatement of any physician whose
certificate of registration has been revoked, if
the respondent has acted in an exemplary
manner in the community wherein he resides
and has not committed any illegal, immoral or
dishonorable act.

Article IV Section 28.

PENALTIES

Any person found guilty of illegal practice


of medicine shall be punished by a fine of not
less than one thousand (P1,000) pesos nor
more than ten thousand (P10,000) pesos with
a subsidiary imprisonment in case of
insolvency, or by imprisonment of not less than
one (1) year, nor more than five (5) years, or
both by such fine and imprisonment, in the
discretion of the court.

8/14/2014

Article IV Section 29.

INJUNCTIONS

The Board may file an action


enjoining
any
person
illegally
practicing medicine . . . any person
who, after having been enjoined,
continues to practice . . . shall be
punished for contempt of court . . . . . .
without
prejudice
to
criminal
prosecution.

Article IV Section 32.

EFFECTIVITY

June 20, 1959

PHYSICIANS and PATIENTS

Rights

8/14/2014

RIGHTS
LEGAL VIEW

LAWFUL
PROTECTED
INVOCABLE
ENFORCEABLE

Physician Rights

derived from the privilege to


practice medicine
inherent
choice of pts
self imposed limitations to practice
choice of treatment modalities /
procedure
availment of hospital services

Physician Rights

Physician Rights

incidental
right of way in emergency cases
exemption from legal execution vs.
instruments / library
hold offices peculiar to the
profession
perform certain services
compensation
membership in medical societies

10

8/14/2014

Right to Choose Patients

license does not mandate MD to


practice
arbitrarily and legally refuse to
render service even if no other MDs
in the locality

Right to Self Imposed Limitations to Practice

Specialty
Location
geography
setting
hospital
clinic based

Right to Choose Patients

Exception:

Emergency

administer first aid and then refer


to more qualified MD
provided for in PMA Code of
Ethics (art 2, sec. 3)
failure may result in administrative
liability
may refuse if MDs own life in
danger

Right to Self Imposed Limitations to Practice

Time
Groupings
Conscience
morals
religious beliefs

11

8/14/2014

Right to Determine Choice of


Medical Management

When Self Imposed Limitations


Are Not a Matter of Right:

contract
employment - gov't and private
law

Full authority on diagnostic and


medical procedures
Patient consent
Informed consent
MD may terminate the PPR if not
given

emergency setting

Accepted treatment modalities


Approved drug indications
Tried techniques

Incidental Rights

Right to Avail of Hospital Services

government hospitals

must conform with requirements of


internal discipline and those to
enhance better public service
easier said than done

private hospitals

more stringent requirements


must not be discriminatory,
unreasonable, monopolistic
also, easier said than done

right of way in emergencies


exemption from legal execution or judgment

public or private offices

PHO, MHO, CHO


staff physician

provide services done only by MD

library
instruments and equipment

diagnostic
operative

membership in medical societies


compensation for services rendered

12

8/14/2014

Compensation

basis

nature and character of service rendered


labor, time and trouble involved
importance and responsibility in the case
professional character and standing of MD
results secured
financial ability of the patient
purchasing power of the peso
local custom

Rights of Patients

Right to Give Consent to Diagnostic and


Treatment Procedures

Rights of Patients

To consent to Dx and Tx procedures


Respect to religious beliefs
Privacy
Confidentiality
Full disclosure of information
Choice of MDs
Treatment
Refusal of necessary Tx

generally - NECESSARY
exceptional - not necessary
emergency - immediate action needed to
preserve life and health of pt (implied consent
of unconscious)
if pt in full possession of mental faculties, or
someone could act on his behalf, consent must be
obtained despite emergency

mandated by law
RA 3573 (An act providing for the prevention and
suppression of communicable diseases) immunization
valid exercise of police powers

13

8/14/2014

Right to Give Consent to Diagnostic and


Treatment Procedures

valid consent

informed or enlightened consent

voluntary

legal subject matter

Informed consent
Voluntary agreement of a person to undergo
or be subjected to a procedure based on
full information whether such permission
is written, conveyed verbally or expressed
indirectly.

Basis of Consent
EVERY HUMAN BEING OF
ADULT YEARS AND SOUND MIND
HAS A RIGHT TO DETERMINE
WHAT SHALL BE DONE WITH HIS
OWN BODY.

Informed consent
FORMS
WRITTEN (better evidentiary value)
VERBAL
EXPRESSED INDIRECTLY
RA 8504 Aids Prevention and Control Act of 1998

RA 8504 Aids Prevention and Control Act of 1998

14

8/14/2014

MD DUTY TO ADVISE THE PATIENT OR PATIENT'S


RESPONSIBLE PARTY
1. PROBLEM TO BE TREATED OR SYMPTOM TO BE
DIAGNOSED

Grant of consent

3. RISKS, CONSEQUENCES, COMPLICATIONS OR SIDE


EFFECTS OF THE TEST OR TREATMENT
4. INDICATIONS FOR THE CHOICE
5. EXPECTED RESULTS TO BE ACHIEVED BY THE TEST OR
TREATMENT
6. REASONABLE AVAILABLE ALTERNATIVES METHODS
AND COSTS OF DIAGNOSIS AND TREATMENT
7. CONSEQUENCES OF DOING NOTHING

Grant of consent

substitute parental authority

guardians
teachers and professors
heads of children's homes;
orphanages
directors of trade establishments
with regards to apprentices,
etc.

patient himself

2. PROPOSED TEST OR PRESCRIPTION

must be of legal age


of majority -18
sound mind; not otherwise disqualified by law

parents if minor
grandparents in absence of parents
eldest siblings in absence of
grandparents

but must be of age and not disqualified by law

Patient Right to Religious Beliefs


Religious freedom to believe
Absolute

Freedom to act in accordance to one's


belief

Limited by police power of the state

May refuse Tx if contrary to his belief


blood transfusion

May be compelled to undergo Tx to


protect the lives and health of other
people

AIDS

15

8/14/2014

PATIENTS RIGHT OF PRIVACY


AND CONFIDENTIALITY

PRIVACY
PATIENTS RIGHT TO HAVE PEACE OF
MIND
EXPOSURE OF HIS BODY
DEPICTION THEREOF
RELEASE TO UNAUTHORIZED
PERSONS
CONFIDENTIALITY
PROTECTION OF INFORMATION OR
RECORDS

Right to Confidentiality

Information cannot be
divulged to parties who
have no concern with
the Pt's welfare

Patients Right to Privacy

MD examination - allow only persons


whose assistance indispensable
Right may be waived

charity patient
waiver does not include discourteous,
immoral or malicious liberties

Privacy rights may be violated to protect


public

exercise of police powers


general welfare is superior to individual
rights

RIGHT TO CONFIDENTIALITY
EVERYTHING SAID BY A PATIENT OR FAMILY
MEMBER TO A PHYSICIAN IN THE CONTEXT OF
MEDICAL DIAGNOSIS AND TREATMENT IS
CONFIDENTIAL AND MAY BE REVEALED ONLY
UNDER CERTAIN CIRCUMSTANCES

16

8/14/2014

Right to Confidentiality

BREACH OF CONFIDENTIALITY

RULE(s of Court) 130 Sec. 21(c):


A person authorized to practice medicine, surgery or
obstetrics cannot in a civil case, without the consent
of the patient, be examined as to any information
which he may have acquired in attending to such
patient in a professional capacity, which information
was necessary to enable him to act in that capacity,
and which would blacken the character of the patient.

NONMEDICAL CONFIDENCES BETWEEN A PATIENT


AND PHYSICIAN ARE NOT COVERED BY THE
PRIVILEGE

NO Right of Confidentiality
criminal matters

Right to Full Disclosure of Information

duty to testify

MD need to report existence of


contagious or communicable diseases

MD obligation to make full and frank


disclosure of pertinent facts relative to
illness

patient
person acting on patient's behalf

Fraud

Art. 1339 RPC - failure to disclose facts


when there is duty to reveal them, as
when parties are bound by confidential
relations

17

8/14/2014

Right to Full Disclosure of Information

Exceptions to Material Disclosure

Act in the best interest of patient


exercise some degree of discretion in
withholding certain information
circumstances of case taken into
account
mental suffering, impairment of pt's
health - withhold or defer to some
opportune time

Exceptions to Material Disclosure


Competent patient waives his right to
informed consent
himself does not want to
know or be informed

Therapeutic privilege: disclosure


poses a risk or threat detrimental to the
patient and contraindicated from the
medical point of view
must be based on MD's professional
judgment
exercise of MD's therapeutic privilege or
professional discretion
informing next of kin optional

Exceptions to Material Disclosure


Matters

that are common knowledge or


where patient has actual knowledge
based on past experience

patient

During

emergencies where patient is


unconscious or otherwise incapable of
giving consent

failure to treat outright attended with


threat to life and health

18

8/14/2014

Right in the Choice of His MD


Not absolute
May be limited by contract or
agreement and other factors
Referral cases

Right to Treatment
In emergency cases
RA 6615 - provision of emergency mgt
RA 8344 no deposit requirement
Code of ethics

Access to governmental health


facilities

Right to Refuse Necessary Tx


Springs from the right to privacy
Man is the master of his own self and may
expressly prohibit medical treatment
No assisted suicide in RP jurisdiction
Comatose state
May be substituted by relatives in decision process
Waiver absolving MD / hospital of liability
consequent to such decision

19

You might also like