MEDICAL JURISPRUDENCEDr. Teresa Paz B. Grecia-Pascual

PART ONE

BACKGROUND/INTRODUCTION

I. Definition of Medical Jurisprudence

A. Differentiate from Legal Medicine and Forensic Medicine.B. Medical Jurisprudence: A specialized area of legal practice

concerned with the relationship between medicine and the law. More specifically, medical jurisprudence is the scientific use of legal and paralegal specialties in the pursuit of justice in court proceedings and in the protection of the public from medical negligence or malpractice. Strictly speaking, it is the application of the principles of law as they relate to the practice of medicine, to the obligations of the practitioner to his patient, and to the relations of physicians to each other and to society in general (Dorland’s Illustrated Medical dictionary, 28th

Edition, 1994).C. Legal Medicine: The professional and academic discipline

which concerns itself with legal aspects of medical science, medical practice, and other health care delivery problems. Strictly, legal medicine should include both forensic medicine and medical jurisprudence.

D. Forensic Medicine: A specialized area of medical practice concerned with the relationship between medicine and the law. In the Philippines, forensic medicine and medical jurisprudence are branches of legal medicine.

II. Role/Purpose of Medical Jurisprudence

A. Cause of ActionB. DefenseC. Evidence

III. Branches of Law where Med Jur/Legal Medicine may be applied

A. Civil Law and Family Code:1. determination and termination of civil personality

(Article 40, 41, 42 of Civil Code);

2. limitation or restriction of a natural person’s capacity to act (Article 38 and 39);

3. The marriage and legal separation;

4. Paternity and Filiation; and

5. Testimentary Capacity of a person making a will.

B. Criminal Law:1. Circumstances affecting criminal liability (Title I);2. Crimes against Persons (Title VIII);3. Crimes against Chastity (Title XI).

C. Remedial Law:

1. Physical and Mental examination of a person (Rule 28);

2. Proceedings for hospitalization of an insane person (Rule 101); and

3. Rules on Evidence.

D. Special Laws:1. Comprehensive Dangerous Drugs Act;2. Insurance Law;3. Labor Code;4. Employee’s Compensation Law;5. Anti-violence against Women and their Children Act

of 2004.6. Juvenile Justice and Welfare Act of 2006.

PART TWO

HEALTH LAWS OF THE PHILIPPINES

I. Health Professionals: Physician, nurse, dentist, pharmacist, medical technologist, veterinarian, physical and occupational therapist, radiology technologist, optometrist, midwife, nutritionist and dietitian, sanitary engineer and social worker.

II. Related laws governing Healthcare Professionals

Professional Rep. Act No. Name of Law

Physician 2382 Medical Act of 1959, as amended

Nurse 9173 Philippine Nursing Act of 2002Dentist 4419 The Philippine Dental Act of

1965Pharmacist 5921 Act Regulating the Practice of

PharmacyMedical technologist 5527 Philippine Medical Technology

Act of 1969Veterinarian 9268 The Philippine Veterinary

Medicine Act of 2004Physical and Occupational Therapist

5680 Philippine Physical and Occupational Therapy Law

Radiology Technologist

7431 Radiologic Technology Act of 1992

Optometrist 8050 Revised Optometry Law of 1995

Midwife 7392 Philippine Midwifery Act of 1992

Nutritionist Dietetics 1286 Regulating the Practice of Nutrition and Dietetics in the Philippines

Sanitary Engineer 1364 Sanitary Engineering LawSocial Worker 4373 An Act to Regulate the Practice

of Social WorkPublic Health Worker 7305 Magna Carta of Public Health

WorkersBarangay Health Workers

7883 Barangay Health Worker’s Benefits and Incentives Act of 1995

Look at the definitions of practice of the different healthcare professional fields.

III. Executive Order No. 212: requires the attending physician of any hospital, medical clinic, sanitarium, or other medical establishments, or any other medical practitioner, who has treated any person for serious or less serious physical injuries as these injuries are defined in Articles 262, 263, 264 and 265 of the Revised Penal Code shall report the fact of such treatment promptly to the nearest government health authority.

IV. Other Laws on Health Promotion

A. R.A. No. 9288: Newborn Screening Act of 2004: Any health practitioner who delivers or assists in the delivery of a newborn in the Philippines shall, prior to delivery, inform the parents or legal guardian of the newborn of the availability, nature and benefits of newborn screening.

B. R.A. No. 8504: Philippine Aids Prevention and Control Act of 1998: Confidentiality

C. R.A. No. 7277: Magna Carta for Disabled Persons

D. R.A. No. 8980: Early Childhood Care and Development Act

E. R.A. No. 7875: National Health Insurance Act of 1995; amended by R.A. No. 9241.

PART THREEMEDICAL PRACTICE AS A PRIVILEGE

I. Prerequisites to the Practice of MedicineA. CitizenshipB. Age RequirementC. Educational RequirementD. Licensure ExaminationE. Oath takingF. Certificate of RegistrationG. Limited Practice without any Certificate of RegistrationH. “Balikbayan” PhysiciansI. Applicable Laws:

1. 1987 Philippine Constitution2. Republic Act No. 18853. Medical Act of 1959, R.A. 23824. P.D. No. 223; repealed by R.A. 89815. R. A. 42245. Board of Medicine et. al. vs.Yasuyuki Ota, G.R. No.

166097, July 14, 20086. Balik Scientist Program, E.O. 130, series 1993;

PRESIDENTIAL DECREE NO. 541

II. Illegal Practice of Medicine

A. Definition of Practice of Medicine: Section 10, Medical Act of 1959.

B. Definition of Illegal Practice of MedicineC. Criminal Nature: People vs. Quebral, 68 Phil. 564D. Intent is immaterial: People vs. Anunciacion Vda.

De Golez, G.R. No. L-14160, June 30, 1960E. It is independent from the result of the practice.F. It is independent from other crimes committed with it:

People vs. Hatani, G.R. Nos. 78813-14, November 8, 1993G. A physician should be licensed and registered with the

Professional Regulation Commission. The general rule is that no person shall be engaged in the practice of medicine in the Philippines unless he is a holder of a valid certificate of registration duly issued to him by the Board of Medicine. However, there are exemptions to this rule as stated in Section 11, Medical Act of 1959, as amended by R.A. No. 4224.

III. Illegal Practice Explained in Court DecisionsA. People vs. Ventura, G.R. No. L-15079, January 31, 1962B. People vs. Buenviaje, 47 Phil. 536C. Crisostomo vs. SEC, G.R. Nos. 89095 & 89555, November 6,

1989D. People vs. Quebral,supra.E. People vs. Hatani, supra.F. People vs. Buenviaje, supra.

IV. Faith HealingA. Is it exempted from the definition of acts which constitute

the practice of medicine?B. Sec 5, Art. III, 1987 ConstitutionC. Religious Belief TestD. People vs. Handzik, 102 N.E. (2d) 340 Ill. 1951.E. People vs. Wendel, 68 N.Y.S. (2d) N.Y. 1946.F. People vs. Cole, 219 N.Y. 98, 113 N.E. 790 L.R.A. 1917

C 816G. People vs. Klinger, Ill. 11 N.E. 40H. State Board of Medical Examiners vs. Maxwell, N.J. 181

A. 694.

V. Exemptions: Section 11

PART FOUR

PATIENT-PHYSICIAN RELATIONSHIP

I. Physician-Patient RelationshipA. A contract: elements of a contractB. Nature: fiduciary, consensualC. NCC, Articles 1305, 1306, 1318, 1319, 1322D. Changes: patient treated as commercial commodity, VAT

law.E. When does it start: Doctrine of Cognition of Civil ContractsF. Cases:

1. Garcia-Rueda vs. Pascasio, G.R. No. 118141, September 5, 1997

2. Santiago A. del Rosario, et al., vs. Honorable Alfredo Bengzon, G.R. No. 88265, December 21, 1989

II. Cases where there are no Physician-Patient relationshipA. Pre-employment physical examination to determine

whether the applicant is suitable for work or not.B. Physical examinations for the purpose of determining

eligibility for insurance.C. When the physician is appointed by the trial court to

examine the accused and to report whether he is insane.D. During autopsy because a dead body is no longer a person

or a patient.E. Casual questions asked of a physician in an unordinary

place may not create Physician-patient contractual relationship, as in a social gathering.

III. Rights and duties of a PhysicianA. Bill of RightsB. The Hippocratic OathC. Code of Medical Ethics of the Board of MedicineD. Code of Ethics of the Medical Profession, Philippine Medical

AssociationE. Right to refuse treatment: exception = RA 8344F. Right to limit medical practiceG. Right to withhold information: exception = in criminal

cases; upon lawful order of the courtH. Right of way while responding to an emergency callI. Right to be paid for services rendered

IV. Duties of Physicians to their patients:A. Code of EthicsB. Carillo vs. People of the Philippines, G.R. No. 86890,

January 21, 1994.

V. Rights of PatientsA. Right to choose his physicianB. Right to treatmentC. Right to informed consentD. Right to confidential informationE. Right to privacy and access to communicationF. Equal protection of the lawG. Review medical records and have information explainedH. Continuity of care

PART FIVELIABILITIES OF PHYSICIANS

I. Administrative Liabilities

A. Practice of medicine is a privilege and not a right. Look at Section 24, Medical Act of 1959. The State can take away the privilege anytime once there are violations of the provisions of the Medical Act. The proper venue is the Professional Regulation commission because it has quasi-judicial authority.

B. Grounds for reprimand, suspension or revocation of certificate of registration of the physician:

1. conviction by a court of competent jurisdiction of any criminal offense involving moral turpitude;

2. immoral or dishonorable conduct;3. insanity;4. fraud in the acquisition of the certificate of

registration;5. gross negligence, ignorance or incompetence in the

practice of his or her profession resulting in an injury to or death of the patient;

6. addiction to alcoholic beverages or to any habit forming drug rendering him or her incompetent to practice his or her profession, or to any form of gambling;

7. false or extravagant or unethical advertisements wherein other things than his name, profession, limitation of practice, clinic hours, office and home address, are mentioned;

8. performance of or aiding in any criminal abortion;9. knowingly issuing any false medical certificate;10. Issuing any statement or spreading any news or

rumor which is derogatory to the character and

reputation of another physician without justifiable motive;

11. aiding or acting as a dummy of an unqualified or unregistered person to practice medicine; and

12. violation of any provision of the Code of Ethics as approved by the Philippine Medical Association.

C. Characteristics of the Administrative Proceedings (Medical Act of 1959, as amended)

1. Presumption of innocence;2. Preponderance of evidence;3. Rights of respondents (Section 25, Medical Act; The

Constitution; Section 1 of Rule 115 of the Rules of Court);

4. Appeal from judgment (Section 26, Medical Act);5. Reinstatement (Section 27, Medical Act);6. Penalties (Section 28, Medical Act);7. Injunctions (Section 29, Medical Act).

II. Civil Liabilities of Physicians

A. Civil liabilities of physicians fall under the following categories:

1. Breach of Contract; different from medical negligence;

2. Violation of Articles 19, 20, or 21 of the New Civil Code; and

3. Tort (Quasi-delict or breach of legal duty) – legal wrongdoing independent of the contract (Article 2176, NCC).

III. Criminal Liabilities of Physicians

A. Criminal vs. civil liabilities:

1. Crimes are considered public wrongs which are a breach and violation of public rights and duties which affect the whole community and is distinguished by the harsher term crime or misdemeanor. Civil wrongs are considered violations of rights which belong to the individual and are termed civil injuries.

2. Criminal: liability is always penal. Civil law: damages.

3. It is important to remember that there can be no civil action for negligence if the negligent act or omission has not been attended by an injury to any person. Bare negligence involving the risk of injury is punishable criminally, though nobody is actually hurt by it.

B. Provisions of the RPC which specifically mentioned the physician as the wrongdoer

1. Issuance of False Medical Certificates (Article 174, RPC);

2. Abortion (Article 259, supra);3. Simulation of births, substitution and concealment or

abandonment of a legitimate child (Article 347, supra);

4. Failure to report treatment of physical injuries (PD 169; E.O. 212);

5. Refusal to render treatment in emergency cases (RA 6615, Section 3);

6. Violation of RA 9344 (Sections 1, 4);7. Failure to report maltreated or abused child (PD 603,

Article 166);8. Violation of the Generics Act of 1988 (Sections 6 and

12); and9. Violation of Philippine AIDS Prevention and Control

Act of 1998 (Section 30).

C. Liabilities incurred incidental to the practice of the profession

1. Criminal negligence and imprudence (Article 365, RPC);

2. Violation of the Comprehensive Dangerous Drugs Act of 2002 (Sections 18 and 19, RA 9165);

3. Liability in the issuance of birth and death certificates (PD 651, as amended by PD 766, Sections 1, 2, 4, 5 and 9);

4. Sexual harassment;5. Sale of pharmaceutical samples (RA 5921, Sections

26 and 40); and6. Giving assistance to suicide (Article 253, RPC).

PART SIX

MEDICAL NEGLIGENCE

I. Definition of Medical Negligence

Garcia-Rueda vs. Pascasio, G.R. No. 118141, September 5, 1997

II. Elements of medical negligence: PETER PAUL PATRICK LUCAS, FATIMA GLADYS LUCAS, ABBEYGAIL LUCAS AND GILLIAN LUCAS vs. DR. PROSPERO MA. C. TUAÑO, [G.R. No. 178763. April 21, 2009.]

III. Physicians may become professionally liable for malpractice in the following ways:

A. Through the physician’s own negligence (failing to conform to generally accepted medical practice);

B. Through the negligence of the physician’s employees: Respondeat Superior);

C. Through the physician’s failure to obtain the informed consent of the patient prior to treatment;

D. Through breach of physician-patient contractual relationship (i.e., abandoning patient, disclosing confidential information, or guaranteeing a cure or some other specific result); and

E. Through the negligence of the physician’s partners.

IV. Standard of Care: The standard of care for physicians and health care providers requires that they exercise that degree of skill, knowledge and care ordinarily possessed and exercised by other members of the profession acting under similar conditions and circumstances.

A. Garcia-Rueda vs. Pascasio, supra.B. PETER PAUL PATRICK LUCAS, FATIMA GLADYS LUCAS,

ABBEYGAIL LUCAS AND GILLIAN LUCAS vs. DR. PROSPERO MA. C. TUAÑO, [G.R. No. 178763. April 21, 2009.], supra.

C. Some doctrines on standard of care:

1. No matter what a healthcare provider does, he will not be found liable if the standard of care is maintained. A practitioner who conducts himself in conformity with the standard of care will not be held liable even if the treatment proved unsuccessful.

2. The existence of poor treatment or surgery result does not in any way raise a presumption of the

violation of the standard of care. Plaintiff must still prove a standard of care violation.

3. Where a healthcare provider makes an error in judgment, if there is no standard of care violation, the plaintiff has no case.

4. The standard of care does not call for a practitioner to use the highest skill known to medical science.

5. Under most circumstances, if evidence suggests that there were alternative recognized methods of treatment available, a practitioner would not be found negligent for selecting the wrong one as long as it is a “recognized” treatment choice.

6. The standard of care governing medical specialists requires the exercise of professional conduct normally exhibited by specialists in the same or similar locality under similar circumstances.

D. Expert testimony to establish standard of care

1. to establish that the defendant physician has deviated from the applicable standard of care that injury has thereby resulted;

2. Opinion of expert witness, Rules of Court.3. Exception: Res ipsa loquitur.

E. Cases:

1. Ramos vs. CA, G.R. No. 124354, December 29, 19992. Cruz vs. CA, G.R. No. 122445, November 18, 1997 3. Reyes vs. Sisters of Mercy Hospital, G.R. No. 130547,

October 3, 20004. DR. PEDRO DENNIS CERENO, and DR. SANTOS ZAFE

vs. COURT OF APPEALS, SPOUSES DIOGENES S. OLAVERE and FE R. SERRANO, G.R. No. 167366. September 26, 2012.

5. FE CAYAO-LASAM vs. SPOUSES CLARO and EDITHA RAMOLETE, [G.R. No. 159132. December 18, 2008.]

6. SPOUSES FREDELICTO FLORES (deceased) and FELICISIMA FLORES vs. SPOUSES DOMINADOR PINEDA and VIRGINIA SACLOLO, and FLORENCIO, CANDIDA, MARTA, GODOFREDO, BALTAZAR and LUCENA, all surnamed PINEDA, as heirs of the deceased TERESITA S. PINEDA, and UNITED DOCTORS MEDICAL CENTER, INC., [G.R. No. 158996. November 14, 2008.]

V. Laws governing medical negligence

A. Civil Action (Articles, 19, 20, 21, 2176 of NCC)B. Criminal Action (Article 365, RPC)

Carillo vs. People, G.R. No. 86890, January 21, 1994Cruz vs. CA, G.R. No. 122445, November 18, 1997

VI. Other applicable doctrines

A. Contributory negligenceB. Assumption of riskC. Last clear chanceD. Independent Contractor: employer-employee relationshipE. Res ipsa loquitur: requisites

Batiquin vs. CA, G.R. No. 118231, 1996Ramos vs. CA, G.R. No. 124354, supra.Reyes vs. Sisters of Mercy Hospital, supra.

DR. MILAGROS L. CANTRE vs. SPS. JOHN DAVID Z. GO and NORA S. GO, G.R. No. 160889, April 27, 2007.Professional Services, Inc. v. Agana; G.R. No. 126467, Jan.

31, 2007. F. Vicarious LiabilityG. Captain of the Ship: Ramos vs. CA, supra.

VII. HOSPITAL LIABILITYA. Ramos v. CA, supra.; See also G.R. No. 124354, April 11, 2002B. PSI v. Agana, supra.; G.R. No. 126297. February 11, 2008,

G.R. No. 126297, February 2, 2010C. DR. PEDRO DENNIS CERENO, and DR. SANTOS ZAFE vs.

COURT OF APPEALS, SPOUSES DIOGENES S. OLAVERE and FE R. SERRANO, supra.

D. DR. EDUARDO AQUINO vs. HEIRS OF RAYMUNDA CALAYAG, namely: Rodrigo, Wilma, Willie, William, Wilson, Wendy, Whitney and Warren, all surnamed CALAYAG, Represented by RODRIGO CALAYAG, [G.R. No. 158461. August 22, 2012.]

E. ROGELIO P. NOGALES, for himself and on behalf of the minors, ROGER ANTHONY, ANGELICA, NANCY, and MICHAEL CHRISTOPHER, all surnamed NOGALES vs. CAPITOL MEDICAL CENTER, DR. OSCAR ESTRADA, DR. ELY VILLAFLOR, DR. ROSA UY, DR. JOEL ENRIQUEZ, DR. PERPETUA LACSON, DR. NOE ESPINOLA, and NURSE J. DUMLAO, [G.R. No. 142625. December 19, 2006.]

VIII. CONSENTA. DR. RUBI LI vs. SPOUSES REYNALDO and LINA SOLIMAN, as

parents/heirs of deceased Angelica Soliman, [G.R. No. 165279. June 7, 2011.]

IX. NATURE OF MEDICAL MALPRACTICE ADMINISTRATIVE CASE: IS IT CRIMINAL IN NATURE?

A. ARSENIO PASCUAL, JR. vs. BOARD OF MEDICAL EXAMINERS, respondent-appellant, SALVADOR GATBONTON and ENRIQUETA GATBONTON, intervenors-appellants; [G.R. No. L-25018. May 26, 1969.]

B. FE CAYAO-LASAM vs. SPOUSES CLARO and EDITHA RAMOLETE, [G.R. No. 159132. December 18, 2008.], supra.

X. OTHER ALLIED MEDICAL NEGLIGENCE

A. ORLANDO D. GARCIA, JR., doing business under the name and style COMMUNITY DIAGNOSTIC CENTER and BU CASTRO vs. RANIDA D. SALVADOR and RAMON SALVADOR, G.R. No. 168512 ,  March 20, 2007

PART SEVENDNA AS EVIDENCE

The focus is nor on DNA testing to prove the guilt or innocence of those accused of crimes.

I. What is DNA test?

It is synonymous to DNA typing, DNA fingerprinting, DNA profiling, genetic tests and genetic fingerprinting. Its scientific basis is based on the fact that our differences as individuals are due to differences in our genetic make-up or genetic composition. The genes comprise a chemical substance, DNA or deoxyribonucleic acid.

People vs. Vallejo, G.R. No. 144656, May 9, 2002, 382 SCRA 192People vs. Yatar, G.R. No. 150224, May 19, 2004, 428 SCRA 504Herrera vs. Alba, G.R. No. 148220, June 15, 2005

II. Initial reaction of the Court to DNA Evidence

Pe Lim vs. Court of Appeals, 336 Phil. 741 (1997)Tijing vs. Court of Appeals, G.R. No. 125901, March 8, 2001, 354

SCRA 17

III. Admissibility and Probative Value

People vs. Vallejo, supra.

IV. DNA Evidence admissible in the SC

People vs. Yatar, supra.In re: The Writ of habeas corpus for Reynaldo de Villa, G.R. No.

150224, May 19, 2004, 428 SCRA 504

People vs. Janson, G.R. No. 125938, April 4, 2003, 400 SCRA 584Agustin vs. Court of Appeals, G.R. No. 162571, June 15, 2005Herrera vs. Alba, G.R. No. 148220, June 15, 2005

V. When DNA Evidence is not necessaryAndal vs. People, G.R. No. 138286-69

VI. Probative value of DNA Analysis as Evidence

Vallejo standard: People vs. Vallejo, supra.

VII. DNA examination and right to self-incrimination

People vs. Yatar, supra.Herrera vs. Alba, supra.