JURIS Prelim LEC # - TITLE

Dr.
May , 2011

CH 12: Acts Constituting Practice of Medicine

Board exam
oath taking
PRC certificate of
registration
PRACTICE OF MEDICINE
Diagnosis, Treatment, Correction, Advisement,
prescription
Disease, ailment, etc real or imaginary
ACTS constituting Practice of Medicine
o Medical Act of 1959 (RA 4224) (Sec 10)
Physically examine, and diagnose, treat, operate,
or prescribe
Compensation for physical exam and more
o Even without compensation
o Investment in stocks is NOT practicing
Advertises as one
o License to practice drugless healing
cannot be implied
M.D. title
o Also healer, Dr., doctor, D.O.
o Exception for doctorate degrees
ACTS not constituted as practice
Medical student under direct supervision
o Moonlighting is illegal practice
Dentist
Physiotherapist
Optometrist
Gratuitous emergency service
Good Samaritan
Dispensive over-the-counter drugs
Traditional Medicine
Religious healing
Household remedy recommenders
Psychologist
Prosthetist

CH 13: Illegal Practice of Medicine

1. Illegal Practice of Medicine
Medical Act of 1959 (RA 4224) (Sec 10)
Exempted acts are Section 11
2. Penalties for Illegal Practice of Medicine
Fine and/or imprisonment (Section 28)
o 1,000-10,000php
o 1 year 5 years imprisonment
Drugless healing = ILLEGAL
Illegal practice is NOT malpractice or negligence

3. American Case Laws

May be considered a PUBLIC NUISANCE
(STATE Gibson vs Missouri Board of
Chiroparctors) Dr of Chiropractry administering
ear drops, vitamins, and placebos
beyond
scope of chiropractic license
isolated or occasional gratuitous acts of midwifery do
not constitute as unlawful

CH 15: Philippine Jurisprudence on Medical

Education System
1. PRC refusing to Issue Certificate of Registration
PRC vs De Guzman
Passed the Physician Licensure Exam (PLE) by the
Board of Medicine.
PRC (Professional Regulation Commission)
released their names as successful examinees in
the MLE (medical licensure exam)
79 students all got EXTREMELY high grades in
Biochem and OB-Gyne. Many 100%!!
NBI hired to investigate
statistics = incredibly
high AND clustered.
Board charged them with immortality, dishonest
conduct, fraud, and deceit and to nullify the
score
But they fought saying they passed the MLE, and
are therefore be obliged to administer the oath
as physicians
Duty of the Board of Medicine to issue
Certificates of registration
o shall = command

o But the Board argued until the moral and

mental fitness of respondents can be
ascertained, they can withhold
administration on their discretion
o Broke down the phrase satisfactorily
passed the Boards, with definition of
capable of dispelling doubt or
ignorance, so they tried to nullify their
scores
The RIGHT to be registered as physicians
o Applicants must show they possess all the
qualifications and none of the
disqualifications, and he must fully
comply with all the conditions and
requirements. Should there be doubt in
satisfactory completion, courts may not
grant the priviledge.
They are allowed to appeal to the PRC
then
appeal to the Office of the President
appeal
for special civil action

2. Case of Closing a Sub-Standard Medical School

Board of Mecial Education vs Alfonso, GR
Closing of the medical school was NOT a grave
abuse of discretion
Due to
o Not fulfilling its purpose in creating
curriculu, relating to Muslim welfare
o Failed to balance humanistic and scientific
education
o No base hospital for training students in
major clinical disciplines
o 60% of college faculty werent full-time
teachers
short, irregular class hours,
subject overloading, poor quality teaching
A team went back two years later as the dispute
continued
o College fought saying they have 3 years to
comply, because they can only be
investigated every three years
o Court rejected, with more info explaining
they can take UP TO 3 years, but they
arent off scott-free for 3 years until their
next compliance-check.

3. Case of Constitutionality of the NMAT

TABLARIN vs GUTIERREZ 1987
Supreme Court unanimous decision
Power to regulate and control Practice of
Medicine allows regulation of admission
Minimum educational requirements
Regulation of access to medical schools
Need to maintain high standards in the
professional schools are widely known
Government is entitled to require NMAT to
upgrade the selection of applicants to improve
the quality of medical education in the country
Equal protection of rights because baseline is
different each year?
o It would be an UNREASONABLE RIGIDITY
to have the same cutoff each year
because things differ year to year. Test
difficulty, students, etc.
Certain minimum scores are reasonable
4. Failing NMAT 3 times
DECS vs SAN DIEGO, 1989
Intended to insulate the medical schools and
ultimately the medical professions from intrusion
of those not qualified
Everyone has the right to aspire, but not
everyone has the right to be a physician
The three-flunk rule cant be any less valid in
regulating the profession than the NMAT passing,
itself!
A person cant insist to be a physician if he will be
a menace to his patients
Persistence is noteworthy, but misplaced like a
hopeless love
5. Admission Requirements by UP Faculty
REYES vs COURT OF APPAELS, 1991
Can the Board of Regents (BOR) admit the
students into the UPCM (UP college of medicine)
even though UPCM raised the cutoff of NMAT
from 70-90%? These students only above 70%
BOR has the power to fix admission requirements
of college, BUT college faculty has the power to
determine entrance requirements of the college
BOR has hierarchy, in essence. BOR decides as
they give the power to the college faculty.

CH 16: ILLEGAL PRACTICE OF MEDICINE

1. Rapist who pretended to be a physician
PEOPLE vs HATANI
ILLEGAL PRACTICE OF MEDICINE
o Has not taken medicine, passed the
boards, no degree, practiced medicine for
compensation on Wilma and Precila
RAPE
o Lewd intentions
Agustinas child (Precila) received help from her
Godparents son-in-law
Appellant gave tablets and injections
sleep
Dr told mom that she was a drug addict
Precila woke up and saw him naked in bed with
her, and he quickly injected her again
unconscious. Mom found them later in bed.
Drugs: Dalmane and valium
Search warrant
drugs and instruments seized
Defense Dr says it was a setup for extortion.
Guilty of
o Rape: convincing as a 16yo girl would not
embarrass herself in public trial w/o reasn
 Life imprison/reclusion perpetua &
50,000php
o Illegal purchase of medicine
 His handwriting on prescriptions.
 No proof of payment
thats ok
 10,000php + 5years imprison
2. Japanese Doctors Allegedly Practicing Med
CRISOSTOMO vs SEC G.R.
UDMC convinces foreign invest of 57mil php to
prevent foreclosure
Now they own more than 40% of UDMC stock
which is illegal as foreign investment
They can not practice Medicine in the Philippines
Ownership does NOT equal Practice of Medicine

3. Healing without drugs

PEOPLE vs VENTURA
Appellant (accused) of healing, advertising, and
for compensation. He says
o The NBI induced him to practice medicine
o He has an implied license to practice
drugless healing from Medical Board of
Examiners
He practices natural healing without drugs
He has no Masseus license either
Police Power of the State to secure the general
welfare of the people to protect against
ignorance and deception and fraud
4. Chiropractor
PEOPLE vs BUENVIAJE
Claims of Physician of Chiropracty is Practice of
Medicine
Accused of
o Treated, manipulated body for purpose of
curing
o Advertised as a doctor/physician
Violation of the Medical Law
Claims
o Chiropracty isnt Practice of Medicine
(wrong)
o We have the right to pursue life, liberty,
happiness
5. Double Jeopardy
PEOPLE vs DE GOLEZ
Crime of homicide through reckless imprudence
Tried to treat a sick person without the
competency or license
person died
But this person had already been charged of
physical injuries through imprudence underthe
old penal code
Cant be convicted again
6. Classical Case of Illegal Practice of Medicine
PEOPLE vs QUEBRAL
Admits to diagnosing, treating, for money
Defend: No proof that he doesnt have certificate
Board of Medical Examiners stated he is not in
their records under diligent examination

CH 17: Physician-Patient Contractual

Relationship
1. Intro
PPCR = BASIS of practice of medicine
Cost-containment and new info technology are
growing in administrative dominance
Hospitals/Insurance threatens to reduce
physician autonomy
CLIMATE OF DISTRUST = main cause of
deterioration
Medical negligence cases are often due to breach
of the PPCR
2. Nature of PPCR
1. Consensual
o Mutual consent
o Offer and acceptance for an object
 OBJECT = surgical operation, etc
o Both parties agree
o Deemed accepted when patient receives
reply of doctor
 ENRIQUEZ vs SUNLIFE ASSURANCE
 Died just before reading the letter,
so the contract was not perfected
2. Fiduciary
o Mutual trust & confidence
o Doctor must give all relevant information
and be accurate and provide best for px
o Information remains CONFIDENTIAL
3. Partied involved
Physician
Patient (or guardian/parent if cant consent due
to consciousness, sanity, or <18yo)
4. Essential Requisites for Contractual Relationship
Consent
o 1. Offer and acceptance
o 2. Possess legal capacity to contract
 Not for minors, insane, demented,
deaf-mutes that CANT read/write
 If incapacitates, can have spouse,
children, parents, or if not, then
Chief of Clinic / Medical Director
o 3. Consent is intelligent, free,
spontaneous, real
 Cant be 5 things: mistake.
Violence, intimidation, undue

influence, fraud
valid until

annulled
 INFORMED CONSENT
Object/subject matter
o Services only, NOT to cure.
o Never encroach onto acts of God.
Consideration
o Onerous
 Obligation to pay
 Money, farm produce, cattle
o Remuneratory
 Paid for the SERVICES (labor)
o Gratuitous
 Money
 May be free by relation, fellow
physician, loved
 May be as gratis / donation / act
of liberality
5. FORMS OF CONTRACTUAL RELATIONSHIP
Expressed
o Orally or in writing
Implied
o Eg: unconscious patient in the E.R.

CH 19: Commencement of PPCR

When the acceptance of the doctor is KNOWN to

the patient
An office visit alone doesnt create PPCR
Eg: dinner party, asks advice about abdomen.
Advise to take mefenamic acid, and to reapply
dressing on her incision site
YES PPCR!!!
Gratuitous advice doesnt relieve legal liability
Eg: telephone call, same things, you tell her to
take meds, reapply bandage, and come into my
office Monday morning
YES PPCR!

CH 20: Jurisprudence about PPCR

1. No PPCR
Pre-employment physical examination
PE for insurance eligibility
Trial court to declare sanity
Autopsy (no longer a person/patient)
Casual questions in an unordinary place
Examples
Hill vs Kokosky
o Dr. telephone called 2 OBs at another for
advice about pregnancy
NO PPCR
NBD Bank vs Berry
o Dr reviewed chart (never saw the patient),
offered advice to attendee
NO PPCR
Bovara vs Saint Francis Hospital
o Dr reviewed chart (never saw the patient),
offered advice to dr
YES PPCR!!!
o Patients consent is implied
McKinney vs Schlatter
o E.R. telephone to cardiologist
NO PPCR

reversal to YES PPCR!!!
PPCR may exist where ALL THREE even if never
sees the patient:
o Participates in the diagnosis
o Participates in the prescription; AND
o Has a duty to the hospital (hes on-call)
If theres no PPCR, theres no medical negligence
or medical malpractice
2. Terms Not Included in the PPCR
No promise to cure. And no promise to:
1. To be successful
2. That it will benefit
3. That it will not harm
4. That wont commit errors in honest way

CH 22: RIGHTS to Physicians and Patients (BILL

OF RIGHTS of EVERY CITIZEN
1. Constitutional Bill of Rights of Citizens
1. Not deprived of life, liberty, property
2. Secure against unreasonable searches
3. Privacy of communication
4. Freedom of speech, expression, press
5. Religious freedom
6. Liberty of abode
7. Right to information on public matters
8. Right to form unions/associations
9. Private property
10. Contracts not prevented
11. Free access to courts
12. Right to remain silent
a. no torture, force, threat
b. confession in force is not admissible
13. Bailable except if reclusion perpetua
14. Due process of law
a. Innocent til proven guilty
15. Habeas corpus not suspended
16. Speedy judicial disposition
17. Dont have to be a witness against himself
18. Political belief and aspiration freedom
a. No involuntary servitude unless criminal
19. No excess fines or degrading punishment
20. No imprisonment for debt
21. No double jeopardy
2. Overview of Important Rights
Due Process of Law
1. PROCEDURAL due process
 Hears before it condemns
 Judgment only AFTER trial
 Opportunity to be heard
 Right to a hearing
2. SUBSTANTIVE due process
 Requires intrinsic validity of the
law in interfering with a persons
rights
Equal Protection of the Law
Searches and Seizure
o Anti-wire tapping (poisonous tree
doctrine)

o Requires valid warrant for probably

cause
o Any evidence is invalid
o ZULUETA vs CA
 Wife forcibly opened husbands
things to find he was cheating with
his patients. Not evidence for
divorce OR for barring from
medical practice.
Religious Freedom
o Treat patient because of superior
knowledge
o But if against religion, respect rights
except if a minor, where you can go to
Social Welfare Dept

CH 23: RIGHTS AND DUTIES OF PHYSICIAN

1. Sources
Bill of Rights
Hippocratic Oath
o To honor teachers
o To pass on knowledge
o To act in interest of patient
o To refrain from taking life
o To guard art of physician
o To refrain from surgery
o Not to take advantage $$ or sexual
o Patient/Physician confidence
Code of Medical Ethics of Board of Medicine, PRC
o Service to mankind, irrespective of
o Maintain the honorable tradition
o Fulfill civic duties as good citizen
o Safeguard colleagues
Code of Ethics of the Medical Profession,
Philippines Medical Association
o Health is the fundamental right
o Noble profession to provide competent
and compassionate care
o Primary goal is interest of the patient
o Duties to the larger community as well
The Contract

2. Rights Inherent in the Practice of Medicine

Physician has interest in REPUTATION and can
take legal proceedings to protect it
Liberty to refuse, but also not to disclose patient
information unless compelled by law
Right to Refuse Treatment
o Even in E.R., can still refuse if it will put
him in a perilous condition
o But moral and ethical appeal for sake of
humanity to always treat in any situation
o But must ALWAYS use reasonable care,
because PPCR even in the goodwill cases
o NOT ABSOULTE:
 ER: must treat
 Unless it is necessary to transfer,
and it only happens after proper
stabilization and transfer hospital
will receive them.
RIGHT TO LIMIT MEDICAL PRACTICE
o Eg: Pedia ONLY
Right to Withhold Information
o Police cant extract information EXCEPT in
court by a judge to assist in justice
o Or when common good so requires it
o Must give for epidemiological studies, etc
o Patients have a right to their information,
so it can transfer to another hospital. The
hospital has a right to a copy or original of
it
Right to Reputation
o Most valuable to Physician: RIGHT TO A
GOOD NAME
3. RIGHTS INCIDENTAL TO PRACTICE OF MEDICINE
Right of Way for ER call
o Abused by physicians. Should only be for
emergency calls. Get out of minor violatn
Right to be paid
o But should take into account the
economic status of patient
Right to Membership in Medical Societies
Right of Exemption from Execution of
Instruments and Library
o Exempt from being taken in lawsuit
Right to hold Public and Private Services
o Eg: to be the Medical Health Officer
Right to Perform Certain Services

4. DUTIES OF PHYSICIANS TO THEIR PATIENTS

4 key elements
o Should possess the knowledge and skill of
an average physician
o Use knowledge and skill with ordinary
care and diligence
o Obliged to exercise BEST JUDGMENT
o Duty to observe utmost GOOD FAITH
Duties from Revised Code of Ethics of Medicine
o Principal Responsibility is Patient Welfare
o Patient has right to choose his physician,
and physician can choose also
o Inform patient to nature od illness, etc
o Respect confidentiality
o When in doubt, refer.
o Fair and considerate professional fee
o Must update his knowledge
5. DUTIES OF PHYSICIANS TO THEIR COLLEAGUES
Respect dignity and good names of fellows
Work together in harmony
Shouldnt solicit patients or unfair competition
Encourage patient to return to original Dr
Acknowledge colleagues for procedures
ENCOURAGED to waive prof. fee to colleague
6. DUTIESOF PHYSICIANS TO THE COMMUNITY
Obligation to the community to initiate and
participate in efforts to public health
Be aware that hes viewed as a leader, live up.
Protect the health of community by warning
against improper practices
Exercise high ethics
Prudence and good faith in media appearances
Take care in new researches before releasing to
the public
7. DUTIES OF PHYSICIANS TO SPECIAL GROUPS
Respect and cooperate with members of other
health professions in delivery of health care
Be transparent in relations with organizations
and enterprises
8. DUTIES OF PHYSICIANS to the PROFESSION
Protect and enhance image and reputation
Attract highly principled young people

Be actively involved in affairs of Philippine

Medical Asssociation
Ethically incorrect may not be legally wrong.
o Bad ethics can be brought before the
BOARD OF MEDICINE for reprobation and
discipline. NOT the courts.

9. PHYSICIAN COMMITMENTS
I will be honest
I will work with you
I will not speak for anything being what I know
I will listen attentively
I will respect your right to make informed
decision
I will consciously believe in ability to make a
difference in healing
MORAL DUTIES
To help, cure, promote, protect, inform, be
confidential, protect patient, protect privacy,
dignity

CH 24: RIGHTS AND DUTIES OF PATIENT

1. Sources
Bill of Rights (1987 Constitution)
Hippocratic Oath
Code of Medical Ethics, Board of Medicine, PRC
Code of Ethics of Medical Profession, PMA
The Contract
2. RIGHTS OF PATIENTS******************
1. Right to choose his Physician
2. Right to Treatment and Right to Unnecessary
Treatment: Considerate and Respectful Care
3. Right to Informed Consent: Relevant, Current,
Understandable Information Concerning
Diagnosis, Treatment, and Prognosis
4. Right to Confidential Information (Privileged
Information)
5. Right to Privacy and Access to Communication
6. Equal Protection of the Law
7. Review Medical Records and Have Information
Explained
8. Consent to or Decline to Participate in Proposed
Research Studies In Human Experimentation
9. Right to expect family member will be notified of
patients admission to hospital
10. To receive considerate and respectful care
provided in a safe environment
11. To have knowledge of the name of the physician
12. To expect reasonable continuity of care
13. To access medical records in good time
14. To expect access to protective services
15. To expect issues related to end-of-life care to be
treated with respect and sensitivity
16. To examine and receive an explanation of his
medical bill
3. Duties of A Patient
1. Must provide good history
2. Must take responsibility for requesting additional
info when he doesnt understand
3. Must inform physician about anticipated
problems in following prescribed treatment
4. Must make reasonable accommodations for
needs of hospital
5. Must provide necessary insurance info and make
payments
6. Must recognize impact of lifestyle on his health

4. PATIENT COMMITMENT
1. I will do everything I can to assist in my healing
2. I will keep my appointments
3. I will keep you informed with problems
4. I will keep you informed with medications
5. I will let you know my concerns
6. I will believe in your ability
PROPOSED UPDATES
RIGHTS OF PATIENTS
1. Right to Appropriate Medical Care
2. Right to Informed Consent
3. Right to Privacy and Confidentiality
4. Right to Information
5. Right to Choose Health Provider
6. Right to Self-Determination
7. Right to Religious Belief
8. Right to Medical Records
9. Right to Leave
10. Right to Refuse Participation in Research
11. Right to Correspondence and Visitations
12. Right to Express Grievances
13. Right to Informed of his rights and obligations
SOCIETAL RIGHTS OF PATIENTS
1. Right to Health
2. Right to Access to Quality Public Health Care
3. Right to Health and Safety Workplace
4. Right to Prevention and Education Programs
5. Right to Participate in Policy Decision