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Health Information Privacy in the Philippines: Trends and Challenges in


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Health Information Privacy in the Philippines: Trends
and Challenges in Policy and Practice
Privacy in the Developing World—Philippines Monograph Series

Carl A. T. Antonio, MD, MPHcand Ivy D. Patdu, MD, JD Alvin B. Marcelo, MD, FPCS
Office of the City Health Officer National Telehealth Center National Telehealth Center
City Government of Pasay University of the Philippines Manila University of the Philippines Manila
Pasay City, Philippines Manila, Philippines Manila, Philippines

National Telehealth Center Department of Surgery


University of the Philippines Manila College of Medicine and Philippine
Manila, Philippines General Hospital
University of the Philippines Manila
College of Public Health Manila, Philippines
University of the Philippines Manila
Manila, Philippines

Abstract—CONTEXT: Evolution of the scope and context of family members—and the care with which the physical
privacy and confidentiality brought about by use of information repositories of such information are secured.
and communications technology in healthcare. OBJECTIVE: To
review the legal, professional and ethical landscape of health However, a person entering a health provider-patient
information privacy in the Philippines. METHODOLOGY: relationship as the recipient of care is observed to willingly and
Systematic review of literature and policy frameworks. automatically shed that veil of protection, and allow a health
RESULTS: Philippine laws jurisprudence recognize and protect worker, who may be a complete stranger, access to the most
privacy of health information as a general rule; impose upon intimate details, the very private thoughts, the core of his being,
individual practitioners and institutions the obligation to uphold on the premise that this disclosure of relevant, though sensitive,
such right; and may apply in both the traditional and eHealth personal information by the patient will help the health
milieu. There is no existing policy framework that addresses professional arrive at a logical and sound diagnosis and
issues relating to [a] access to health information by non-health management plan.
professionals, [b] use of health information for non-health
purposes, and [c] rules relating to collection, storage and Implicit in this interaction is the expectation that the
utilization of electronically-derived or -stored information. A patient’s information will be held by the practitioner in strict
privacy culture, on either the provider’s or client’s side, is also and full confidence, and will not be unnecessarily shared with
lacking in the country. CONCLUSION: Technological other parties, a reflection of the trust in the ethics of the
developments have outpaced policy and practice. There is a need profession. As Hippocrates was supposed to have said, All that
to unify the patchwork of regulations governing the privacy of may come to my knowledge in the exercise of my profession or
health information; advocate for a privacy culture among in daily commerce with men, which ought not to be spread
professionals and patients alike; fortify the evidence base on abroad, I will keep secret and will never reveal.1
patient and provider perceptions of privacy; and develop and
improve standards and systems to promote health information Yet, over the intervening millennia, healthcare practice has
privacy at the individual and institutional levels. become more complex, challenging conventional
interpretations of this Hippocratic admonition.
Keywords-privacy, confidentiality, health information,
Philippines Now more than ever, health professionals possess a certain
sense of compulsion to document every detail of a patient
I. INTRODUCTION consultation. Without doubt this has been brought about by the
intricacy of insurance reimbursement claims processes, but a
Privacy of personal information is a closely-guarded
second factor is the rising amount of malpractice litigation
individual right, such that any unauthorized access or breach is
being lodged against health workers. Pre-service training
considered a violation of this entitlement from both legal and
ingrains in the mind of future professionals this maxim: That
moral perspectives. The value of protecting privacy is
which is not written was not done.
evidenced by the restrictions put in place regarding the people
the information may be shared with—often, only immediate

This paper is part of a series of monographs produced by the Foundation This work is licensed under a Creative Commons Attribution-NoDerivs
for Media Alternatives under the “Privacy in the Developing World” project 3.0 Unported License. To view a copy of this license, visit
in cooperation with Privacy Asia (Privasia) and Privacy International, with http://creativecommons.org/licenses/by-nd/3.0/.
generous support from the Canadian International Development Research
Centre (IDRC)

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 1


Technology is also changing the landscape of healthcare proposed by Croll4, is that the information will be secured by
practice. The evolution of electronic medical records and the the clinician from unauthorized access, and that ultimately the
ubiquitous connectivity afforded by the Internet means that data gathered will be used to deliver safe, quality care that will
health information is more readily accessible to anyone with benefit the patient (Fig. 1). Implied in the model is the patient’s
the right tools and can be easily linked across disparate consent to the storage, access, and sharing of his or her
databases, by contrast patient files locked in cabinets or personal information.
drawers in individual physicians’ offices or dentists’ clinics.
The evolution of the health information landscape, as well
Certain conditions, or even a constellation of signs and developments in the area of policy, however, has redefined the
symptoms pointing to a highly communicable disease, are scope and context of the privacy and confidentiality of health
reportable to national health authorities. The growing field of information.
research and the onslaught of new illnesses have seen the
publication of case reports intended to educate other III. THE HEALTH INFORMATION LANDSCAPE
professionals. In schools and hospitals, trainees openly discuss Exchange of health information traditionally occurs in
details of patient cases with their seniors. Oftentimes, cases are clinics or offices of health workers and is documented in paper
also integrated in informal face-to-face or electronic forms. Auditory and visual privacy considerations are taken
conversations with colleagues to solicit advice for patient into account in the construction and design of consultation
management. All these further complicate the issue of health rooms (e.g., by installing screens, curtains, and partitions and
information privacy. ensuring there is ample space between the office and the
In this paper, we examine the intricacies, boundaries and waiting area). Details of the patient encounter are recorded by
limitations of the protection of health information privacy in the primary care provider in medical records, which are then
the Philippine context as seen from legal, professional, and carefully handled by staff, stored in secure rooms (or at least, in
ethical perspectives. In addition to providing a systematic cabinets or drawers under lock and key), and accessed only by
review of the issue*, recommendations are presented pertaining authorised persons.5
to healthcare practice and the institution, or enforcement, of The physical setting of the clinic and handling of medical
policies relevant to health information privacy. information thus evoke a sense of confidentiality and security,
and assure patients that the information they are sharing will
II. PRIVACY AND CONFIDENTIALITY: CONCEPT remain within the confines of the office and within the pages of
CLARIFICATION, CONCEPT MAPPING their file. The in-person interaction of the patient with
While there is no one standard accepted definition of healthcare providers—from the admitting clerk to the
privacy, this paper will adopt the official definition used by the dispensing pharmacist—allows for the development of a
U.S. National Library of Medicine, to wit: “The state of being relationship of trust, and gives faces to the numerous people
free from intrusion or disturbance in one's private life or who may access, or are accessing, his or her medical record.
affairs.”2 On the other hand, confidentiality refers to “[t]he
The evolution of technology is changing the landscape of
privacy of information and its protection against unauthorized
privacy and confidentiality within the context of health
disclosure.”3
information.
In brief, privacy pertains to an individual’s right to be free
from unwanted external scrutiny; whereas confidentiality
points to the duty that rests on those to whom private
information has been entrusted, that is, that they will not
unnecessarily disclose such privileged communication.
Rather liberal transfer of private information stems from the
fiduciary nature of the clinician-patient relationship: patients
(i.e., the holders of the right to privacy) trust that any and all
details they may share with their healthcare provider (i.e., the
bearers the duty of confidentiality) will be maintained as
private information. Inherent in this framework, as was

*
In addition to published literature, this paper also benefited from inputs of a
diverse number of individuals (lay persons, health professionals, healthcare
organization) who participated in various meetings/for a where an earlier draft
version of this paper was presented. In particular, this is with reference to the
[i] 103rd Philippine Dental Association Annual Convention Scientific
Session; 2011 November 16-20; SMX Convention Center, Pasay City,
Philippines; [ii] Philippine Privacy Rights Training and Validation Workshop;
2012 March 18-19; La Breza Hotel, Quezon City, Philippines; [iii] 1st Health
Figure 1. A model for privacy, confidentiality, and security within the
Data Privacy Forum; 2012 March 22; Richmonde Hotel, Pasig City,
context of health information.4
Philippines; and [iv] Privacy.Rights@PH: Issues in the Philippine Information
Society. A Public Forum; 2012 May 25; Information and Communications
Technology Office – National Computer Center Building, Quezon City,
Philippines.

2 HEALTH INFORMATION PRIVACY @ PH


Telemedicine, or the delivery of health-related services and health professions) may theoretically be stored indefinitely.
information via telecommunications technologies such as There are even concerns that these types of data cannot be
videoconferencing, email, phone calls or short messaging permanently deleted, especially if they have been posted to or
systems (SMS), now makes possible virtual patient shared on multiple sites.9,10 In the 2008 incident referred to as
consultations and specialist referrals involving parties the “Cebu canister scandal” attempts to ban the posting of the
separated by physical distance.6 For instance, in many large procedure on video-sharing sites, copies of the full-length
tertiary hospitals, junior residents send SMSs or place calls to footage can still be accessed online as of this writing (May
senior physicians (or even to co-residents in another 2012).
department) to make patient referrals.
The magnitude and consequent impact of this health
The development of electronic medical records (EMR), on information data exchange can be gleaned from information
the other hand, transcends the physical limitations of paper technology usage patterns among Filipinos:
files and presumably facilitates access to, and sharing of, health
information among providers of care; improves the accuracy  There are an estimated 29,700,000 (a penetration rate of
and quality of recorded data; and, more important, improves 29.7%) Internet users as of June 2010.11
the quality of care as a result of having health information  While the numbers vary from anywhere between 25% to
immediately available at all times for patient care.7 In addition, 95%, surveys indicate that utilization of social
EMR possesses the theoretical advantage over paper records of networking sites in the Philippines is high compared to
being able to accumulate data that spans a patient’s lifetime. other countries, not only in the Asia-Pacific region but
While in many ways these developments contribute also globally, earning the country the moniker “The
towards enhancing the delivery of care to all people, they also Social Networking Capital of the World.”11–14
tend to redefine the scope of privacy and confidentiality within  In 2005, a total of 34.8 million cellular mobile telephone
the context of the provider-patient relationship. subscribers (CMTS) were registered, translating to a
First, there is now a broader audience for patient CMTS density of 41.3 per 100 population.15 Mobile
information: whereas previously, only the patient’s primary penetration in 2009 was estimated at 80%, or about 73
provider had access to their record, the use of health million subscribers.16
information technology systems means that software  The National Telecommunications Commission (NTC)
developers, programmers, network operators, and other estimates that an average of 250 million SMS messages
individuals operating behind the scenes to maintain the system were sent per day in 2005, giving rise to claims that the
can, but may not necessarily, peer into an individual’s private Philippines ranks number one globally in SMS usage
data. The emerging use of telecommunications networks to (although recent trends indicate that due to the rise of
interconnect healthcare professionals and clients (or other social networking sites and app messaging the United
healthcare professionals, as in referrals) may also pose a threat States has “unseated Philippines as the king of TXT
to individual health data privacy in light of the non-uniform messaging”).15–17
adoption and application of privacy policies by individual
telecommunications companies and Internet service providers In the light of the fiduciary nature of the provider-patient
(see the discussion by Torres-Cortez in an issue paper in this relationship, as well as the consent inherent in such contracts,
monograph series). the vital issues, therefore, with respect to these technological
developments† are:
Furthermore, the aggregation of patient data into large,
networked databases, which are intended to facilitate access by, 1. Are health workers and patients aware of the extent to
and link information from, different co-managing health which private health information is available to and
providers, exponentially increases the number of individuals accessible by people other than the patient and the
who may retrieve vital private patient information from provider?
different point-of-access terminals, which may be located in 2. Will information regarding the use of health information
different geographic areas.8 The case of the “leaking breast technologies (in item 1 above) adversely affect patients’
implant” discussed below shows that this threat is actually a willingness to disclose relevant personal information
real one. and damage the quality of care that patients receive?
Another gray area that may have to be further examined is
the implication of the use of information and communications

technology to disseminate private health data for non-health In addition to the items mentioned previously, emerging issues in health
and non-educational purposes. Take for instance the “Cebu information privacy include [i] access to health information of
canister scandal” discussed below, where a video of a surgical applicants/workers by their employers, usually through a health maintenance
organization (employers justify that they have a right to access information
procedure was posted on the Internet without the patient’s since they paid for the services of the consulting physician, as well as because
consent. the health status of their worker may affect his/her performance on the job);
and [ii] collection of information by pharmacies/pharmaceutical companies on
Fourth, data transmitted through electronic channels (i.e., the purchasing practice of patients as well as prescription patterns of
patient information, intended as well-meaning referrals to healthcare providers (through monitoring of information encoded in store
colleagues, sent via email or SMS; or discussions of patient discount cards). There have been anecdotal reports of these issues, but there is
cases on social networking sites by students and trainees in the no sufficient documentary evidence available that will allow extensive
discussion of the above-mentioned concerns in this paper.

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 3


3. How will existing statutory and ethical guidelines be to consultation and to whom patient information will be
applied in the context of health information system use disclosed.
in patient care?
Using health information technology and telemedicine, and
4. Are current local legal frameworks sufficient to guide storing patient data in electronic form all amplify the privacy
stakeholders on health information privacy and if not, issues in the context of the relationship between health provider
what gaps in policy need to be filled? and patient.
5. Should non-health professionals involved in handling The tradition of privacy and confidentiality within the
patient data be bound by codes of ethics similar to context of patient care is attributed to Hippocrates of Cos
healthcare workers? around the 4th century B.C. when he admonished his
followers: All that may come to my knowledge in the exercise
IV. LEGAL AND ETHICAL FRAMEWORK18–21 of my profession or in daily commerce with men, which ought
The Philippines is at the gateway of a changing health not to be spread abroad, I will keep secret and will never
information landscape. The shift towards the use of health reveal.1
information technology has been a global trend. The impact of This proceeds from the distinct position of honour
these changes on traditional notions of privacy and conferred upon the physician as a “friend of mankind”, the
confidentiality between health provider and patient is a implicit understanding that full disclosure of information on the
challenge. The international community has responded to the part of the patient is a prerequisite to quality care and better
requirements of the 21st century by adopting measures that health outcomes, and that some of this information may be
regulate or serve as guidelines in the utilization of technology sensitive or may lead to irreparable injury—physical or
in healthcare, with many countries passing legislation to moral—to the patient should it be shared with outsiders.
address issues of data protection and the confidentiality of
medical records. The duty of confidentiality for health providers and the
rights of patients to privacy are uncontested and universally
The value of using electronic medical records is recognized recognized.27–29 The same principles have been adopted by the
by governments in other parts of the world.22–24 While the Philippine Medical Association30,31 and similar associations in
World Health Organization (WHO) does not provide a other countries.32,33
standardized system for keeping medical records, it has already
provided guidelines particularly directed at developing Physicians in the Philippines pledge a more modern version
countries for the use of medical records and electronic health of the oath upon being admitted to professional practice of by
records‡ .5,7 Laws that failed to protect patient privacy in the the Professional Regulation Commission (PRC), and are
past are being updated to increase patients’ health professions similarly bound to uphold the confidentiality of patient
control over their medical information as well as allow for information by the Code of Ethics of the Board of Medicine34
damages in case of breach of confidentiality (e.g. American and the Philippine Medical Association (PMA).30
Recovery and Reinvestment Act of 2009 (ARRA), which
The principles of ethics are clear. Patients have a right to
updated the Health Insurance Portability and Accountability
expect that any information that may be obtained by a
Act). Data protection laws have been enacted in many
healthcare provider will be kept confidential. The critical
countries over the past twenty years.25
question is how laws and government regulations should
The reliance of world economies on electronic commerce respond to protect patients’ rights.
and the recognized importance of protecting information
In the Philippines, a person’s right to privacy is enshrined
privacy led to the endorsement of the Asia-Pacific Economic
in no less than fundamental law. The Philippine Constitution
Cooperation (APEC) Privacy Framework in 2005, which
provides:
provides guidelines for balancing the right to privacy of
individuals and the promotion of electronic commerce. The Section 3. (1) The privacy of communication and correspondence shall
framework is intended to regulate the flow of information in be inviolable except upon lawful order of the court, or when public
safety or order requires otherwise, as prescribed by law. Xxx
developing market economies for socio-economic growth but it
contains principles that may be applicable in the health sector, This guarantee encompasses all aspects of a person’s
which admittedly deals with collection and storage of personal privacy, including the confidential nature of the relationship
information. between health provider and patient. The right of any person to
privacy is the general rule and it is only by way of exception
Another pivotal point is telehealth services. Telemedicine, that this right is to be limited. Thus, unless a specific law or
intended to bridge the gap in accessibility of healthcare, is order allows the disclosure of private information, a person can
being advocated in the Philippines as a national agenda. The always invoke the guarantee of the Constitution to the right of
experiences of other countries that have earlier used privacy. Any statute, rule or regulation must be consistent with
telemedicine show that privacy issues remain a central the declarations of the Constitution.
concern.6,26 There is emphasis on the need for patient consent
as well as patient information, particularly as to the nature of a A person’s general right to privacy is affirmed in the Civil
telehealth consultation, and awareness of who will have access Code (Republic Act No. 386). It provides that every person
shall respect the dignity, personality, privacy and peace of

The World Health Organization is slated to issue a guidance document on mind of another. The Civil Code likewise makes any person
health data privacy in 2012/2013. who abuses the rights of another liable for damages. A

4 HEALTH INFORMATION PRIVACY @ PH


physician may be held liable for failing to observe the general It is, thus, apparent that the expectation of maintaining
mandate of the law that every person, in the performance of his privacy extends even to other healthcare providers§. This may
duties, act with justice, give everyone his due, and observe be attributed to the fact that hospitals have evolved, both in
honesty and good faith. Since a physician has an acknowledged identity and function, throughout history. Modern hospitals no
duty to maintain patient confidentiality, any injury that a longer just provide facilities so that a doctor can treat the sick.
patient may incur as a direct result of the violation of this duty The public’s perception of the modern hospital is as a
will make the physician liable for damages. multifaceted healthcare facility responsible for the quality of
medical care and treatment rendered. Hospitals now provide a
The Revised Penal Code (Act No. 3185) criminalizes wide range of services, and it is inevitable that they gain access
“Revelation of Secrets”. Its provision protecting the secrets of to patient information. The same access is available to other
any person may find application in cases of government stakeholders in health like health maintenance organizations
physicians who have custody of patient records and who would and telehealth centers, which have likewise taken an active role
reveal private information about patients or any other employee in health care delivery. Having access to and storing patient
who may abuse their position to obtain confidential records emphasize the need to extend the applicability of the
information. Specific laws guarantee the right to privacy of rules of confidentiality to healthcare providers.
rape victims and minors in conflict with the law (i.e., Republic
Act No. 8505, Rape Victim Assistance and Protection Act of The duty to respect patient privacy may be derived from
1998; Republic Act No. 9344, Juvenile Justice and Welfare Act responsibilities that hospitals are expected to assume in
of 2006). accordance with standards of care expected from and accepted
by other hospitals or other healthcare providers. In the absence
The current legal framework readily shows that a person’s of specific legislation addressing hospital duty and liability, the
general right to privacy is protected. This means that a person standards expected of hospitals may be based on accreditation
who violates this right may be made civilly or criminally liable. standards or principles in the Hospital Code of Ethics.
While these laws are not specifically directed the physician or
healthcare provider, they may be applied to hold accountable The Hospital Code of Ethics (35) provides for the primary
any person who violates a patient’s right to privacy. objectives of hospitals:
In addition to general provisions protecting the privacy of 1.2 To provide the best possible facilities for the care of the sick and
all persons, doctor-patient confidentiality is an established injured at all times;
doctrine. Communication between doctor and patient is 1.3 To constantly upgrade and improve methods for the care, the cure,
generally considered privileged and should not be inquired into amelioration and prevention of disease; and
even by the courts. The provision is intended to make sure that 1.4 To promote the practice of medicine by Physicians within the
information obtained by physicians in the course of treatment institution consistent with the acceptable quality of patient care.
will not be used to blacken the reputation of a patient. Section [emphasis supplied]
24, Rule 128 of the Rules of Court provide: The Court recognizes the inherent duties of hospitals and
Rule 128, Section 24: Disqualification by reason of privileged has adopted the doctrine of corporate responsibility imposing
communication. — The following persons cannot testify as to matters on hospitals the duty to see that it meets the standards of
learned in confidence in the following cases: xxx responsibilities for the care of patients (Professional Services,
(c) A person authorized to practice medicine, surgery or obstetrics Inc. v. Agana, 513 SCRA 478, 2007). These standards should
cannot in a civil case, without the consent of the patient, be examined include respect for patients’ right to privacy. As was pointed
as to any advice or treatment given by him or any information which out by Ng and Po19 and Bellosillo et al21, the duty to maintain
he may have acquired in attending such patient in a professional
capacity, which information was necessary to enable him to act in confidentiality does not rest solely with the medical provider
capacity, and which would blacken the reputation of the patient. xxx but extends to the hospital or health facility.
The application of the above rule is very specific and is In order to obtain a licence to operate, the Department of
only applicable when the inquiry is made on the physician who Health (DOH) requires that even prior to building the hospital,
managed the patient. the applicant must first secure a construction licence.36 At the
planning stage and during the design of the hospital, the DOH
Specific reference to health information privacy can be considers whether the hospital seeking a licence adequately
found in Republic Act No. 8504 (handling of information, both addresses the need to maintain patients’ auditory and visual
the identity and status, of persons with HIV), Republic Act No. privacy.37 Philippine Health Insurance Corporation (PHIC)
9165 (confidentiality of records of those who have undergone Accreditation sets as a standard the need for the organization to
drug rehabilitation), and Republic Act No. 9262 document and follow policies and procedures for addressing
(confidentiality of records pertaining to cases of violence patients’ needs for confidentiality and privacy.38 Similarly,
against women and their children), all of which clearly cater to accreditation standards such as that provided by Joint
specific populations of patients who may come under the care Commission International (JCI) Accreditation Standards for
of health providers and which are, arguably, not applicable to
all instances of the physician-patient relationship. These
specific laws, however, extend the duty of confidentiality to §
A review of the enabling professional laws and practice codes of other
those who may have access to the private information, healthcare providers in the Philippines revealed that there is no specific
including custodians of records. mention of their duty in maintaining privacy/confidentiality of patient
information. However, this paper takes the position that the Constitutional
provision on the right to privacy is a sufficient general safeguard.

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 5


Hospitals39 include the requirement of confidentiality of patient valid an executive order that provides uniform data collection
information: and format for their existing identification (ID) systems, these
Standard PFR.1.6. Patient information is confidential.
are limited to only government agencies and government-
owned and controlled corporations with existing identification
Intent of PFR.1.6 systems (Kilusang Mayo Uno vs. Director-General, National
Medical and other health information, when documented and Economic Development Authority, 487 SCRA 623, 2006).
collected, is important for understanding the patient and his or her
needs and for providing care and services over time. This information Implementation of any system that would collect, transmit
may be in paper or electronic form or a combination of the two. The and store private patient information should have safeguards in
organization respects such information as confidential and has place. The current laws that protect in general electronic data
implemented policies and procedures that protect such information
from loss or misuse. The policies and procedures reflect information may be applied to holders or custodians of medical records.
that is released as required by laws and regulations. The Electronic Commerce Act of 2000 provides that any
person with access to electronic data messages or documents
Staff respects patient confidentiality by not posting confidential
information on the patient’s door or at the nursing station and by not has the obligation of confidentiality or the duty not to convey
holding patient-related discussions in public places. Staff are aware of the information to, or share it with, any other person. Under
laws and regulations governing the confidentiality of information and this law, unauthorized access to computer systems is
inform the patient about how the organization respects the punishable by a fine and mandatory imprisonment.
confidentiality of information. Patients are also informed about when
and under what circumstances information may be released and how The anti-wiretapping law (Republic Act No. 4200) may
their permission will be obtained.
also be applied where a person who is not authorized by parties
The organization has a policy that indicates if patients have access to a private communication record or communicate its
to their health information and the process to gain access when contents. The act would probably cover doctor-patient
permitted. (Also see MCI.10, ME 2, and MCI.16, intent statement)
communication which is privileged and confidential, and which
therefore should not be recorded or disclosed without consent.
Measurable Elements of PFR.1.6
From the preceding paragraphs, it is evident that the right to
1. Patients are informed about how their information will be kept privacy is zealously guarded under the Constitution. The
confidential and about laws and regulations that require the release of legislations, rules, and ethical principles address the right to
and/or require confidentiality of patient information.
privacy in general, including the protection of electronic data,
2. Patients are requested to grant permission for the release of and to a limited extent also provide for confidentiality in the
information not covered by laws and regulations. context of a physician-patient relationship.
3. The organization respects patient health information as
confidential. (p. 63) Under the Constitution, this right to privacy shall be
inviolable except upon lawful order of the court, or when
The standards that a hospital should ideally meet may likely public safety or order requires otherwise, as prescribed by law.
be imposed on other healthcare institutions providing health Thus, while the right of a patient to privacy is generally
services with access to patient information. honored even after death, there are established exceptions. The
For example, under the Philippine AIDS Prevention and limitations on the right to privacy proceed either from a
Control Act of 1998, the duty of maintaining patient voluntary waiver on the part of the patient, or are imposed by
confidentiality is imposed on all persons involved in handling the State in the exercise of its police power to safeguard the
and maintaining patient records. The law extends the duty not general welfare of the people.
just to health professionals but also to health instructors, co- The rule of the confidentiality of physician-patient
workers, employers, recruitment agencies, insurance communication and patient records is not absolute; there are
companies, data encoders, and other custodians of medical exceptions under the following circumstances:
records.
1. Upon patient consent or waiver:
In view of the use of health information technology,
electronic medical records, or computerized systems for storing a. Upon waiver or authority of the patient to release such
patient information, the duty of hospitals or any other health information. This stems from the recognition that the
provider institutions to maintain and keep medical records information contained in medical records is the property of
confidential entails greater responsibility. There is no the patient, while the medical records themselves are the
legislation specific to data protection in relation to medical property of the hospital;
privacy. There have been initiatives to enact laws providing for b. For purposes of insurance compensation. In addition to
data protection and database security, in general (i.e. the the provisions of Presidential Decree No. 442, as amended
proposed Personal Data Protection Act of 2007).40 (Labor Code of the Philippines), individuals availing
Any law or order that would involve storing personal themselves of insurance coverage also sign waivers
information in databases accessible to government would meet allowing the health maintenance organization or insurer
with obstacles. In the Philippines, moves towards a National access to their medical records in exchange for claim of
Computerized Identification Reference System have been met benefits (i.e. Republic Act No. 7875, National Health
with resistance due to the premium placed on a person’s right Insurance Act of 1995);
to privacy. There is distrust of any government move to store 2. In the interest of public order and safety. Births and
personal information and while the Supreme Court ruled as deaths should be registered as provided for in Republic

6 HEALTH INFORMATION PRIVACY @ PH


Act No. 3753 (Law on Registry of Civil Status). information in their medical record. The right to privacy in
Reporting of certain communicable diseases is general is nonetheless protected by existing laws. The
mandatory under Republic Act No. 3573 (Law of collection, transmission, use, and storage of electronic data,
Reporting of Communicable Diseases). Executive Order which would include electronic medical records, are to be
No. 212 requires medical practitioners to report secured. Unauthorized use or access is punishable. The
treatment of patients for serious and less serious existence of provisions in specific statutes guaranteeing the
physical injuries. Likewise, by virtue of Presidential confidentiality of patient information in special circumstances
Decree No. 603, as amended (Child and Youth Welfare merely reiterates the boundaries laid down in the fundamental
Code), practitioners are required to report cases of child law concerning patient privacy, and adds to penalties that may
abuse or maltreatment. Prescription and dangerous drugs accrue to violators.
dispensed by pharmacies are recorded and retained in
books for inspection by appropriate authorities. The Second, medical privacy, which includes the confidentiality
landmark U.S. case of Whalen v. Roe (492 U.S. 589, of doctor-patient communication and health information, is
1977), as discussed in the case of Kilusang Mayo Uno recognized. Physicians adhere to a code of ethics that includes
vs. Director-General, National Economic Development as a principle the right of patients to privacy and the
corresponding duty of health providers to maintain patient
Authority (487 SCRA 623, 2006), provides an
instructive case of the State’s exercise of its police confidentiality. Healthcare providers, including hospitals and
powers with respect to regulated drugs and substances. health institutions, likewise have an ethical obligation to
maintain the confidentiality of health information, and are
Testing of certain populations for dangerous drugs is expected to abide by standards that protect patient privacy.
mandatory and reportable. Upon court order under very The codes of ethics intensify the protection of the right to
specific circumstances, a person may be compelled to be privacy and confidentiality by providing for administrative
tested for HIV, or submit himself or herself to a mental sanctions that may be imposed upon professionals who engage
and physical examination (as provided in the 1997 Rules in unethical conduct.
of Civil Procedure). Under Republic Act No. 9745 or
the Anti-Torture Act of 2009, a person claiming torture Third, there is no legislation that directly addresses the
by the authorities is given the right to a physical privacy issues specific to health information technology or
examination and psychological evaluation, to be inherent in telehealth services. Under the current legal and
contained in a medical report; such reports are, however, ethical framework, protection of patient privacy relies heavily
to be considered public documents. The Code on on self-regulation by health providers**.
Sanitation of the Philippines (Presidential Decree No. V. CASE STUDIES: GAPS IN HEALTH INFORMATION
856) authorizes the Court and police authorities to order PRIVACY PROTECTION
the performance of an autopsy on the remains of an
individual. Two relatively recent incidents brought the public’s
attention to the issue of health information privacy and are
3. Upon lawful order of the court or a quasi-judicial body. being discussed here to highlight the gaps in privacy policy and
Release of health information may occur upon service of practice in the country.
a valid subpoena, warrant, or adjudicative order from a
court, a law enforcement agency, an administrative The first pertains to the posting on the Internet of a video
agency authorized by law, or an arbitration panel. clip documenting the extraction of a metal canister spray from
However, disclosure in court of health information is the rectum of a patient in Cebu City and the accompanying
limited by the provisions of the Rules on Evidence, as jeering and jubilation of health staff inside the operating room.
upheld in Lim vs. Court of Appeals (214 SCRA 273, The ensuing public outrage resulted in the preventive
1992), and Krohn vs. Court of Appeals (G.R. No. suspension of some hospital medical personnel, but the cases
108854, June 14, 1994); and filed before the PRC failed due to a technicality. In addition,
4.
the person who first posted the video on YouTube was never
For research purposes. The National Ethical Guidelines identified, and to date (May 2012), the three-minute footage
for Health Research permits review of medical records can still be accessed online.42–58
without consent for purposes of research provided the
data are de-identified or anonymized and are non- In what has become known as the “Cebu Spray Scandal” or
sensitive. Ultimately, however, determining which data “Black Suede Scandal” the obvious points of contention are [a]
are non-sensitive rests upon the Institutional Ethics recording and dissemination of a medical procedure, and [b]
Review Committees, and not on individual investigators presence in the operating theater of hospital staff other than
or researchers.41 those directly involved in the procedure, all of these [c] without
the patient’s consent.
A careful perusal of Table 1, which summarizes the legal
and ethical provisions related to privacy and confidentiality of
health information, leads to the following observations.
**
First, the right to privacy is a basic human right that is As of this writing (May 2012), the proposed Philippine Data Privacy Act is
guaranteed by the Constitution that may be invoked even in the being discussed in a Congressional bicameral conference to harmonize the
versions emanating from the Senate and House of Representatives. Likewise,
absence of specific legislation. Patients are protected by the the Department of Health is in the process of drafting an Administrative Order
Constitution from unnecessary disclosure of any private on health information privacy.

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 7


Case Study 1: “Cebu Spray Scandal”42-58 Case Study 2: “Leaked” News59-73
In mid 2008, a three-minute footage went viral on the video-sharing website It was meant to be a critique of the possibility that the Palace is keeping
YouTube showing what appears to be an operation involving the extraction of information about the President’s state of health from the public. Philippine
a metal spray bottle canister from the rectum of an unidentified patient. The Star columnist Jarius Bondoc wrote in his July 3, 2009 column:
operating room was crowded with giggling medical staff, all of them shown
on the video with their cellular phones on hand to document the procedure. “If Gloria Macapagal Arroyo can make secret a trip to
While the canister was being extracted, somebody shouted “Baby out!” after Colombia, more so the real aim of her overnight stay at Asian
which the room broke into laughter and applause. One medical staff even Hospital. The post-travel self-quarantine for A(H1N1) is a
opened the canister and sprayed its contents inside the room, resulting to handy cover for gynecological procedures. The President has
further laughter from those in attendance. been suffering dysfunctional bleeding, likely due to polyps or
The circumstances related to the incident only became clear a few weeks myoma in the uterus. She had first walked into the hospital
after the video has circulated in emails and mobile phones and has been one dawn in 2008 for D&C (dilation and curettage) and left
lengthily discussed in various Internet forums. A 39-year-old homosexual at dusk. News then was that she had an executive check.
florist from Cebu City underwent minor operation on January 3, 2008 at the She’s had three follow-ups this year, the last in June.
Vicente Sotto Memorial Medical Center (VSMMC) for extraction of a foreign Menopause is inducing abnormal tissue growth and hormonal
body lodged in his rectum. He was allegedly asleep at the time of the imbalance, a source said.
operation, and was not made aware that the procedure was going to be filmed, “Wednesday dawn Arroyo checked in again — for less
nor was he informed post facto that the medical staff took a footage of his serious causes. She needed mammoplastic repair of leaking
operation. He claimed that he only learned of the existence of the YouTube breast implants done in the ’80s. Occasion too to have
video when it was brought to his attention by their barangay captain, who saw doctors take out an inguinal cyst (in the groin), and laser off
the video on YouTube. extra hair growth in that area and the armpits. Though a bit
As a response to the public outrage generated by the incident, various groggy, Arroyo was set to check out yesterday afternoon.
investigating bodies were formed – the hospital, Department of Health “Hospitalizing a President isn’t easy. Patients in five
(DOH), National Bureau of Investigation (NBI), House of Representatives – rooms at the VIP 10th floor had to be moved, to billet
to determine the culpability of those involved in the operation, as well as to bodyguards and cooks; P4,000@, or total P20,000 a day.
identify the person who first uploaded the video. Arroyo was given two connecting suites, P18,000@, or total
Without denying any liability, the hospital and relatives of medical P36,000 a day, one for her, the other for the family.” (59)
personnel involved were quick to point out that the public should focus on the
successful outcome of the operation; that those involved were, in fact, first The ensuing investigation initiated by the hospital and the National Bureau
rate health professionals and calling for a revocation of their licenses was an of Investigation pointed to the possibility that an obstetrician-gynecologist
excessive punishment; and that the incident was an isolated case of mischief. was the source of the information, and that she was able to access hospital
While some nurses and doctors were initially placed on a three-month records with the help of three other non-medical hospital staff (the hospital
preventive suspension, the case filed with the Professional Regulation policy at that time was that doctors are not allowed to access computers; only
Commission was eventually dismissed on the basis of a technicality. The non-medical staff are provided passwords and the clearance to access any
identity of the person who first uploaded the video on YouTube was never patient’s file).
discovered, and the incident, which died a natural death, became a mere The obstetrician-gynecologist, who was not part of the team attending to
footnote in the annals of Philippine medical history. the President at the time, denied involvement in the case. Columnist Bondoc
was also claimed to have said that Asian Hospital was not the source of the
leak.
Certainly, procedural lapses contributed to the violation of As of this writing, the case remains unresolved.
the patient’s privacy, but the culpability of the persons
involved in the incident is difficult to determine because the
Whether or not information regarding the health status of
evidence (i.e., the video clip) itself does not clearly identify the
the highly-placed public authorities is a matter of public
extent of the participation of each person who was inside the
operating theatre at the time. Complicating the matter further is concern (and hence should be disclosed) or of national security
the fact that there were other people inside the operating room (meaning it is classified information) lies outside the purview
were nursing interns undergoing training at the hospital, but of the current paper. But what the case of the leaked
who were not involved in the ongoing procedure. information highlights is the real possibility of unlimited access
to patient files in a centralized electronic medical records
Furthermore, the anonymity assured by the Internet, database by outsiders who are not directly involved in the care
compounded by the availability of computer shops offering of the patient. In fact, counsel for the physician accused of
Internet access in almost every corner of the country and the leaking the information pointed out that about 76 hospital staff
rapid replication of the video by various media and Web sites, had access to the politician’s medical record during her
precludes identification of the hospital staff who first posted confinement.71
the video online, and of those who continue to disseminate the
video even after the original has been taken down by YouTube. Regardless of the intent—whether for educational or
entertainment purposes as in the first of these cases, or out of
The second case involved the public disclosure and curiosity or in return for a sum of money as in the second—
discussion of circumstances surrounding the admission of a these two cases demonstrate that even in the presence of legal
high-ranking politician to a tertiary medical centre, which was and ethical safeguards instances that result in violation of the
not part of the official press release from his office, nor the patient’s right to privacy still occur, though most are perhaps
medical bulletin issued by the politician’s attending physician. on a scale sufficient warranting media attention. The
Investigation by the hospital and the National Bureau of pervasiveness of tsismis (gossip) in Filipino culture74–76 may
Investigation (NBI) suggested that non-medical hospital lead a nurse assigned to a well-known celebrity to talk about
personnel had accessed the patient’s record and leaked these it her patient’s case with her family and friends. A group of
to journalists. No conclusion has yet been reached in this medical students, over the course of dinner at a public
matter.59–73 restaurant, may similarly discuss a novel case assigned to their
care.

8 HEALTH INFORMATION PRIVACY @ PH


The fact that not one person has been held criminally liable health information may need to look at developing and
for infringement of this fundamental human right, and that instituting their own privacy policies.
culpability is difficult to establish especially in large
institutions where medical records are accessible by virtually As previously stated, privacy of communications, which
all staff, does not aid the cause of privacy. extends to health information, is a fundamental human right
guaranteed by the Constitution. It also forms a basic bioethical
VI. TOWARDS AN ACTION AGENDA FOR HEALTH principle that governs the provider-patient relationship.
INFORMATION PRIVACY There have been several attempts to introduce legislation on
The foregoing discussion has brought to the fore the the Patient’s Bill of Rights in the Philippines (Table 2 and
following key issues with respect to health information privacy Table 3), all of which have met with little success. In general,
in the Philippines. the blockage is concerns on the part of stakeholders, who either
argue that the enactment of such laws is unnecessary (because
First, while the right to privacy is guaranteed by the existing laws sufficiently protect the rights of patients), or that
Constitution and protected by existing laws, there currently is the passage of these laws will lead to the practice of “defensive
no standard health information privacy policy in the medicine” and a concurrent increase in healthcare costs to
Philippines. Instead, what is available are general statutory protect the interests of healthcare providers. 81
provisions (see the Legal and Ethical Framework section
above) and guidance documents5,7,38, which individual While individuals and organizations have articulated their
institutions and providers may adapt for use in their facilities. concern for upholding the right to privacy and
With respect to existing legislation, the provisions are either confidentiality31,82,38, it is highly likely that, as was shown in
too generic (encompassing privacy of communication in the case studies, adherence to this right is the exception rather
general) or too focused (mandating privacy and confidentiality than the norm81. Thus, codifying the patient’s rights is
in specific circumstances). Implementation and enforcement essential83
are difficult to monitor, specifically because, as shown in Table Many of our rights as patients have already been articulated by the
1, the policy is scattered across several statutes. On the other courts. Nonetheless, they often remain difficult for patients and
hand, the arbitrary nature of the adoption of policies providers alike to understand and especially difficult for sick people to
concerning medical records poses a threat to maintaining the exercise. Thus, it is helpful to collect all major patient rights into one
document for both education and enforcement ease and to provide an
integrity of health records and of ensuring that breaches of effective and fair mechanism to permit patients to actually exercise
confidentiality in the healthcare provider-patient relationship their rights in the real world, with their physicians and hospitals (p.
do not occur. This is even more true in the face of rapid 101).
technological advancements that are altering the health xxx
information landscape.
Once basic, uniform rights in health care are established, we can
The Philippines could take a cue from developed countries return to the urgent task of providing access to health care for all... It
seems correct to view universal access to decent health care as our
that adopted a unified health information privacy policy, such primary goal. But rights in health care are critical, since without them
as New Zealand’s Health Information Privacy Code77; citizens may wind up with access to a system that is indifferent to both
Australia’s Privacy Act of 199878; the Pan-Canadian Health their suffering and their rights (p. 104).
Information Privacy and Confidentiality Framework79; and the
Second, the Philippines seems to lack a “privacy culture”††.
United States’ Health Insurance Portability and Accountability
The synergistic action of the culture of tsismis widely prevalent
Act (HIPAA)80.
in the Philippines coupled with the ubiquity of Internet and
These privacy policy codes lay down, in concrete terms, [a] cellular phone access throughout the country is a real and
the rules governing collection, storage and utilization of health present danger to patient information privacy. Monitoring the
information; [b] the roles and responsibilities of the different actions of each health provider outside the workplace (i.e.
stakeholders; [c] the scope and limit of health information emails, SMS, or postings to social networking sites) would
privacy; and [d] the safeguards (policy, administrative, prove to be difficult and impractical. What is needed is a
institutional, environmental, and technical) to maintain health change in individual behaviour that would result in self-
information privacy. regulation and self-censorship in the context of securing, or
sharing, private information entrusted healthcare providers by
All of these instruments also share as common policies patients.
restrictions on the use and disclosure of identifiable patient
information by, and to, individuals and institutions other than This could mean the adoption of codes of ethics and
the patient and provider. In essence, health information, when conduct by professional organizations which recognize the
necessary, is shared on a “need to know” basis, and the patient wider scope of privacy and confidentiality of information in a
is informed of such disclosure. Administrative measures wired world; or the education of trainees and professionals on
relating to implementation (e.g. designation of dedicated health information privacy by integrating the issue into
privacy officers, training of workforce) and enforcement (e.g. academic and continuing professional development courses
filing and resolution of grievance, penalties) are also covered in
these instruments. ††
There is concern that privacy may be a developmental or cultural issue, as
can be gleaned from its prominence in the more developed economies and its
In the absence of such a law, and given that the process of relative absence countries where a strong sense of community (which
enacting legislation involving such a contentious issue is so effectively blurs the distinction between personal and communal ownership)
protracted, individual institutions and organizations utilizing is present.

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 9


(e.g. oral presentations at symposia, conduct of press Furthermore, there is a paucity of scientifically validated
conferences or publication and dissemination of information information on the perceptions, attitudes, and knowledge of
materials)‡‡. patients and health professionals (both in individual practice
and as part of health institutions) on health information
Relevant to upholding privacy is the security of health privacy, particularly within the context of new information and
information. Whereas paper-based records could easily be kept communications technologies. In addition, while privacy and
under lock and key, access restricted by providing only limited confidentiality are prescribed components of teaching
pages or sections to interested parties, electronic medical curricula85–87, the integration and actual application of this
records accessible through a network of computers in a large concept into professional schools and teaching hospitals is
hospital complicate the issue. Individuals and institutions unclear.
transitioning to electronic medical records must understand and
search for the presence of such security measures as role-based VII. CONCLUSION
access control, data encryption, and authentication mechanisms
in the systems they are purchasing or developing.8,84 Health information privacy in the Philippines has evolved
Positioning computer screens away from common or general in parallel with advances in technology, but the underlying
areas, using strong access codes, and inculcating in health staff principle remains the same: health workers must ensure the
the habit of locking their access terminals are practical ways to protection at all times of their patient’s privacy. Technological
reduce the chances of unauthorized access to medical records at developments, however, have outpaced policy and practice.
the facility level. More importantly, however, developers of There is a need to unify the patchwork of regulations governing
electronic medical records and operators of networks that privacy; fortify the evidence base on patient and provider
transmit health information in the first place must ensure the perceptions of privacy; and develop and improve standards and
security of information in systems they are developing. systems to promote health information privacy at the individual
and institutional levels. Ultimately, it must be stressed that the
The pervasiveness of the issue of health information quest for privacy is but one critical component in improving
privacy requires urgent, sustainable action at the national level the overall quality of care available to Filipinos.
coupled with implementation at the institutional and individual
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[28] WMA Declaration of Lisbon on the Rights of the Patient. World [46] Napallacan, Jhunnex and Asutilla, Carine M. Suspension of doctors,
Medical Association Web site. [Online] October 2005. [Cited: November nurses sought for operation scandal. Inquirer Global Nation Web site.
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November 12, 2011.]

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 11


[47] Gay man in Cebu canister scandal shuns media. ZamboTimes Web site. [65] Araneta, Sandy. The President's health: NBI looking into 'implant' leak.
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scandal-shuns-media.html. [66] Burgonio, TJ and Santos, Tina. NBI: Hospital not Palace asked for
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Rectal Surgery Scandal. IGLHRC Web site. [Online] May 20, 2008. 2011.]
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bin/iowa/article/takeaction/partners/222.html. 214419/NBI-Hospital-not-Palace-asked-for-leak-probe.
[49] Cheng, Willard. Cover-up feared in Cebu rectal YouTube scandal. [67] GMANews.TV. Probe on leak of Arroyo ‘boob job’ not a Palace order -
ABS-CBN News Web site. [Online] September 23, 2008. [Cited: NBI. GMA News Web site. [Online] July 7, 2009. [Cited: November 2,
November 2, 2011.] http://www.abs- 2011.] http://www.gmanews.tv/story/166814/Probe-on-leak-of-Arroyo-
cbnnews.com/nation/regions/09/23/08/cover-feared-cebu-rectal- boob-job-not-a-Palace-order---NBI.
youtube-scandal. [68] abs-cbnNEWS.com. Gov't nosing into records of boob job exposé
[50] Natavio, Johanna. Civil Service Commission declares suspension vs. writer? ABS-CBN News Web site. [Online] July 9, 2009. [Cited:
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http://www.philstar.com/Article.aspx?articleId=437554&publicationSub [69] —. Did doctor leak Arroyo boob job news? ABS-CBN News Web site.
CategoryId=107. [Online] July 9, 2009. [Cited: November 2, 2011.] http://www.abs-
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Black Suede Aftermath: ‘Danilo’ mulls civil raps; DOH-7 can’t find [70] Araneta, Sandy. Asian Hospital doctor denies implant info leak.
staff. Inquirer Global Nation Web site. [Online] June 1, 2010. [Cited: NewsFlash Web site. [Online] July 15, 2009. [Cited: November 2, 2011.]
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http://globalnation.inquirer.net/cebudailynews/news/view/20100601-
273201/Danilo-mulls-civil-raps-DOH-7-cant-find-staff. [71] —. NBI probe on GMA breast implant unfair - doctor. PhilStar Web
site. [Online] September 22, 2009. [Cited: November 2, 2011.]
[52] Matibag, Gino C. Body spray scandal dismissed. AllVoices Web site. http://www.philstar.com/Article.aspx?articleId=507575&publicationSub
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http://www.allvoices.com/contributed-news/6673006-body-spray-
scandal-dismissed. [72] Real reason of GMA's self quarantine at Asian Hospital? [Online]
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[53] Case dismissed. SunStar Cebu Web site. [Online] September 3, 2010. religion-talk-100/real-reason-gmas-self-quarantine-asian-hospital-
[Cited: November 2, 2011.] http://www.sunstar.com.ph/cebu/case- 60519/.
dismissed.
[73] GMA Boobs Augmentation. [Online] [Cited: November 2, 2011.]
[54] Teves, Oliver. Philippine hospital recommends penalties for medical http://www.thedigitalpinoy.org/thread/11/6242.
staff in videotaped surgery. Northern Mindanao Health Online Web site.
[Online] [Cited: November 2, 2011.] [74] Evans, Ken. Manila Fortuna. Milton Keynes : AuthorHouse UK Ltd.,
http://onlinemindanao.com/health/news/surgery-scandal.html. 2011. ISBN 978-1-4567-7401-1 (sc)/ISBN 978-1-4567-7402-8 (c).
[75] Licuanan, Patricia. A Moral Recovery Program: Building a People --
[55] Cudis, Nancy R. Vicente Sotto Memorial Medical Center names out.
Building a Nation. [Online] [Cited: November 2, 2011.]
Northern Mindanao Health Online Web site. [Online] [Cited: November
http://www.crvp.org/book/Series03/III-7/chapter_iv.htm.
2, 2011.] http://onlinemindanao.com/health/news/surgery-scandal.html.
[76] Nadal, Kevin L. Filipino American Psychology: A Handbook of
[56] Anong opinion nyo sa Cebu-Doctors Scandal Video. [Online] [Cited:
Theory, Reasearch, and Clinical Practice. s.l. : John Wiley and Sons,
November 2, 2011.] http://tambayan.1.forumer.com/a/anong-opinion-
2011. ISBN 9781118019771.
nyo-sa-cebudoctors-scandal-video_post7460.html.
[57] Cebu Canister Scandal. [Online] [Cited: November 2, 2011.] [77] Tiongco, Beatriz B. Report on the public hearing of the Committee on
http://forums.amped.ph/lofiversion/index.php?t108464.html. Health and Demography joint with the Committees on Social Justice and
Finance on patient's rights and medical malpractice on September 28,
[58] Cebu Hospital Scandal Video. [Online] [Cited: November 2, 2011.] 2004, 10:30am, Sen. Tanada Room, Senate of the Philippines. Senate of
http://tsikot.com/forums/miscellaneous-talk-163/cebu-hospital-scandal- the Philippines Web site. [Online] [Cited: November 7, 2011.]
video-49292/. http://www.senate.gov.ph/13th_congress/spot_reports/Health%20Sept%
[59] Bondoc, Jarius. Thanked by Arroyo, trumped by Customs. PhilStar 2028.pdf.
Web site. [Online] July 3, 2009. [Cited: November 2, 2011.] [78] Memorandum of Agreement on the Rights and Obligations of Patients.
http://www.philstar.com/Article.aspx?articleId=483276&publicationSub Philippine Hospital Association Web site. [Online] [Cited: November 7,
CategoryId=64. 2011.]
[60] The Philippine Star. GMA quarantined at Asian Hospital. PhilStar Web http://pha.ph/downloads/MOA_rights_and_obligation_of_patient.pdf.
site. [Online] July 1, 2009. [Cited: November 2, 2011.] [79] Annas, George J. American Bioethics: Crossing Human Rights and
http://www.philstar.com/Article.aspx?articleid=482714. Health Law Boundaries. Oxford : Oxford University Press, 2005. ISBN
[61] Luci, Charissa M. Palace confirms biopsy. Manila Bulletin Web site. 0-19-516949-2.
[Online] July 3, 2009. [Cited: November 2, 2011.] [80] Health Information Privacy Code 1994 (2008 Revised Edition).
http://www.mb.com.ph/node/209116/palace-confirm. Auckland : Office of the Privacy Commissioner, 2008. ISBN 0-478-
[62] abs-cbnNEWS.com. Arroyo admits she has breast implants. ABS-CBN 11724-8.
News Web site. [Online] July 3, 2009. [Cited: November 2, 2011.] [81] Health serivce providers. Office of the Australian Privacy Commissioner
http://www.abs-cbnnews.com/nation/07/03/09/arroyo-admits-she-has- Web site. [Online] Office of the Australian Privacy Commissioner,
breast-implants. Australian Government. [Cited: November 7, 2011.]
[63] Burgonio, TJ. Palace makes a clean breast of Arroyo implant. http://www.privacy.gov.au/business/health.
Inquirer.net. [Online] July 4, 2009. [Cited: November 2, 2011.] [82] Pan-Canadian Health Information Privacy and Confidentiality
http://newsinfo.inquirer.net/inquirerheadlines/nation/view/20090704- Framework. Health Canada Web site. [Online] August 9, 2005. [Cited:
213780/Palace-makes-a-clean-breast-of-Arroyo-implant. November 7, 2011.] http://www.hc-sc.gc.ca/hcs-sss/pubs/ehealth-
[64] Romero, Paolo. Breast, groin biopsy but no surgery for GMA - Palace. esante/2005-pancanad-priv/index-eng.php.
PhilStar Web site. [Online] July 4, 2009. [Cited: November 2, 2011.] [83] Health Information Privacy. U.S. Department of Health and Human
http://www.philstar.com/Article.aspx?articleId=483577&publicationSub Services Web site. [Online] U.S. Department of Health and Human
CategoryId=63. Services . [Cited: November 7, 2011.] http://www.hhs.gov/ocr/privacy/.

12 HEALTH INFORMATION PRIVACY @ PH


[84] Security and Privacy Issues with Health Care Information Technology. [90] 13th Congress - House Bill No.261. House of Representatives Web site.
Meingast, Marci, Roosta, Tanya and Sastry, Shankar. 2006, [Online] [Cited: November 7, 2011.]
Proceedings of the 28th IEEE, pp. 5453-5458. EMBS Annual http://www.congress.gov.ph/download/basic_13/hb00261.pdf.
International Conference; New York City, USA, Aug 30-Sept 3, 2006; [91] 13th Congress - Senate Bill No. 3. Senate of the Philippines Web site.
http://www.orcatech.org/papers/home_monitoring/06_Meingast_securit [Online] [Cited: November 7, 2011.]
y_issues.pdf. http://www.senate.gov.ph/lis/bill_res.aspx?congress=13&q=SBN-3.
[85] CHED Memorandum Order No. 10, s. 2006, Re: Policies, Standards and [92] 13th Congress - Senate Bill No. 588. Senate of the Philippines Web site.
Guidelines for Medical Education. Pasig City : Commission on Higher [Online] [Cited: November 7, 2011.]
Education, 2006. http://www.senate.gov.ph/lis/bill_res.aspx?congress=13&q=SBN-588.
[86] CHED Memorandum Order No. 5, s. 2008, Re: Policies and Standards [93] 14th Congress - Senate Bill No. 812. Senate of the Philippines Web site.
for the Bachelor of Science in Nursing (BSN) Program. Pasig City : [Online] [Cited: November 7, 2011.]
Commission on Higher Education, 2008. http://www.senate.gov.ph/lis/bill_res.aspx?congress=14&q=SBN-812.
[87] CHED Memorandum Order No. 33, s. 2006, Re: Policies, Standards and [94] 14th Congress - Senate Bill No. 2371. Senate of the Philippines Web
Guidelines for Dental Education. Pasig City : Commission on Higher site. [Online] [Cited: November 7, 2011.]
Education, 2006. http://www.senate.gov.ph/lis/bill_res.aspx?congress=14&q=SBN-2371.
[88] DOH Administrative Order No, 2008-0009. Department of Health Web [95] 15th Congress - Senate Bill No. 146. Senate of the Philippines Web site.
site. [Online] [Cited: October 25, 2011.] www.doh.gov.ph/files/ao2008- [Online] [Cited: November 7, 2011.]
0009.pdf. http://www.senate.gov.ph/lis/bill_res.aspx?congress=15&q=SBN-146.
[89] PhilHealth Circular No. 030, s. 2000. PhilHealth Web site. [Online]
[Cited: October 25, 2011.]
http://www.philhealth.gov.ph/circulars/2000/circ30_2000.pdf.

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 13


TABLE I. NATIONAL LEGAL AND ETHICAL FRAMEWORK AFFECTING PRIVACY AND CONFIDENTIALITY WITHIN THE CONTEXT OF THE PHYSICIAN-PATIENT
18-21,27,28,30,31,34,35,37,38,88,89
RELATIONSHIP.

Source Principle/Provision
A. Right to Privacy in General
Constitution
1987 Philippine Constitution Section 3 (1), Article III: The privacy of communication and correspondence shall be inviolable except upon lawful
order of the court, or when public safety or order requires otherwise, as prescribed by law. xxx
Statutes
An Act to Ordain and Institute the Art. 19. Every person must, in the exercise of his rights and in the performance of his duties, act with justice, give
Civil Code of the Philippines, [NEW everyone his due, and observe honesty and good faith.
CIVIL CODE] Republic Act No. 386,
(June 18, 1949). Art. 20. Every person who, contrary to law, wilfully or negligently causes damage to another, shall indemnify the latter
for the same.

Art. 21. Any person who wilfully causes loss or injury to another in a manner that is contrary to morals, good customs
or public policy shall compensate the latter for the damage.

Art. 26. Every person shall respect the dignity, personality, privacy and peace of mind of his neighbors and other
persons. The following and similar acts, though they may not constitute a criminal offense, shall produce a cause of
action for damages, prevention and other relief:
(1) Prying into the privacy of another's residence:
(2) Meddling with or disturbing the private life or family relations of another;
(3) Intriguing to cause another to be alienated from his friends;
(4) Vexing or humiliating another on account of his religious beliefs, lowly station in life, place of birth, physical
defect, or other personal condition.

Art. 32 Any public officer or employee, or any private individual, who directly or indirectly obstructs, defeats, violates
or in any manner impedes or impairs any of the following rights and liberties of another person shall be liable to the
latter for damages:
xxx
(11) The privacy of communication and correspondence...
xxx

Art. 2176. Whoever by act or omission causes damage to another, there being fault or negligence, is obliged to pay for
the damage done. Such fault or negligence, if there is no pre-existing contractual relation between the parties, is called a
quasi-delict and is governed by the provisions of this Chapter.
An Act Revising the Penal Code and Art. 228. Opening of closed documents. — Any public officer not included in the provisions of the next preceding
Other Penal Laws [REVISED PENAL article who, without proper authority, shall open or shall permit to be opened any closed papers, documents or objects
CODE], Act No. 3815, (1932). entrusted to his custody, shall suffer the penalties or arresto mayor, temporary special disqualification and a fine of not
exceeding 2,000 pesos.

Art. 229. Revelation of secrets by an officer. — Any public officer who shall reveal any secret known to him by reason
of his official capacity, or shall wrongfully deliver papers or copies of papers of which he may have charge and which
should not be published, shall suffer the penalties of prision correccional in its medium and maximum periods,
perpetual special disqualification and a fine not exceeding 2,000 pesos if the revelation of such secrets or the delivery of
such papers shall have caused serious damage to the public interest; otherwise, the penalties of prision correccional in
its minimum period, temporary special disqualification and a fine not exceeding 50 pesos shall be imposed.

Art. 230. Public officer revealing secrets of private individual. — Any public officer to whom the secrets of any private
individual shall become known by reason of his office who shall reveal such secrets, shall suffer the penalties of arresto
mayor and a fine not exceeding 1,000 pesos.

Art. 290. Discovering secrets through seizure of correspondence. — The penalty of prision correccional in its minimum
and medium periods and a fine not exceeding 500 pesos shall be imposed upon any private individual who in order to
discover the secrets of another, shall seize his papers or letters and reveal the contents thereof.
If the offender shall not reveal such secrets, the penalty shall be arresto mayor and a fine not exceeding 500 pesos.
The provision shall not be applicable to parents, guardians, or persons entrusted with the custody of minors with respect
to the papers or letters of the children or minors placed under their care or study, nor to spouses with respect to the
papers or letters of either of them.

Art. 291. Revealing secrets with abuse of office. — The penalty of arresto mayor and a fine not exceeding 500 pesos
shall be imposed upon any manager, employee, or servant who, in such capacity, shall learn the secrets of his principal
or master and shall reveal such secrets.
B. Right to Privacy in Relation to the Healthcare System
Statutes
The Medical Act of 1959, Republic Section 24: Grounds for reprimand, suspension or revocation of registration certificate. Any of the following shall be
Act No. 2382, (June 20, 1959) sufficient ground for reprimanding a physician, or for suspending or revoking a certificate of registration as physician:
xxx
(12) Violation of any provision of the Code of Ethics as approved by the Philippine Medical Association.
An Act Promulgating Policies and Section 2 (b) (1): The State shall extend to every person suspected or known to be infected with HIV/AIDS full
Prescribing Measures for the protection of his/her human rights and civil liberties. Towards this end, xxx the right of privacy of individuals with HIV

14 HEALTH INFORMATION PRIVACY @ PH


Source Principle/Provision
Prevention and Control of HIV/AIDS shall be guaranteed.
in the Philippines, Instituting a xxx
Nationwide HIV/AIDS Information Section 3(n): “Medical Confidentiality” – refers to the relationship of trust and confidence created or existing between a
and Educational Program, Establishing patient or a person with HIV and his attending physician, consulting medical specialist, nurse, medical technologist and
a Comprehensive HIV/AIDS all other health workers or personnel involved in any counselling, testing or professional care of the former; it also
Monitoring System, Strengthening the applies to any person who, in any official capacity, has acquired or may have acquired such confidential information.
Philippine National Aids Council, and
for Other Purposes, “Philippine AIDS Section 30, Article VI: Medical Confidentiality - All health professionals, medical instructors, workers, employers,
Prevention and Control Act of 1998”, recruitment agencies, insurance companies, data encoders, and other custodians of any medical record, file, data, or test
Republic Act No. 8504, (February 13, results are directed to strictly observe confidentiality in the handling of all medical information, particularly the identity
1998) and status of persons with HIV.

Section 31, Article VI: Exceptions to the Mandate of Confidentiality – Medical confidentiality shall not be considered
breached in the following cases:
(a) when complying with reportorial requirements in conjunction with the AIDSWATCH programs provided in
Section 27 of this Act;
(b) when informing other health workers directly involved or about to be involved in the treatment or care of a person
with HIV/AIDS: Provided, That such treatment or care carry the risk of HIV transmission: Provided, further, That such
workers shall be obliged to maintain the shared medical confidentiality;
(c) when responding to a subpoena duces tecum and subpoena ad testificandum issued by a Court with jurisdiction
over a legal proceeding where the main issue is the HIV status of an individual: Provided, That the confidential medical
record shall be properly sealed by its lawful custodian after being double-checked for accuracy by the head of the office
or department, hand delivered and personally opened by the judge: Provided, further, That the judicial proceedings be
held in executive session.

Section 33, Article VI: Penalties for Violation of Confidentiality – Any violation of medical confidentiality as provided
in Sections 30 and Section 32 of this Act shall suffer the penalty of imprisonment for six (6) months to four (4) years,
without prejudice to administrative sanctions such as fines and suspension or revocation of the violator’s license to
practice his/her profession, as well as the cancellation or withdrawal of the license to operate any business entity and
the accreditation of hospitals, laboratories and clinics.
An Act Instituting the Comprehensive Section 36. Authorized Drug Testing. The following shall be subjected to undergo drug testing:
Dangerous Drugs Act of 2002, (a) Applicants for driver's license. – No driver's license shall be issued or renewed to any person unless he/she
Repealing Republic Act No. 6425, presents a certification that he/she has undergone a mandatory drug test and indicating thereon that he/she is free
Otherwise Known as the Dangerous from the use of dangerous drugs;
Drugs Act of 1972, as Amended, (b) Applicants for firearm's license and for permit to carry firearms outside of residence. – All applicants for firearm's
Providing Funds Therefor, and for license and permit to carry firearms outside of residence shall undergo a mandatory drug test to ensure that they are
Other Purposes, “Comprehensive free from the use of dangerous drugs: Provided, That all persons who by the nature of their profession carry firearms
Dangerous Drugs Act of 2002”, shall undergo drug testing;
Republic Act No. 9165, (June 7, 2002) (c) Students of secondary and tertiary schools. – Students of secondary and tertiary schools shall, pursuant to the
related rules and regulations as contained in the school's student handbook and with notice to the parents, undergo a
random drug testing: Provided, That all drug testing expenses whether in public or private schools under this Section
will be borne by the government;
(d) Officers and employees of public and private offices. – Officers and employees of public and private offices,
whether domestic or overseas, shall be subjected to undergo a random drug test as contained in the company's work
rules and regulations, which shall be borne by the employer, for purposes of reducing the risk in the workplace. Any
officer or employee found positive for use of dangerous drugs shall be dealt with administratively which shall be a
ground for suspension or termination, subject to the provisions of Article 282 of the Labor Code and pertinent
provisions of the Civil Service Law;
(e) Officers and members of the military, police and other law enforcement agencies. – Officers and members of the
military, police and other law enforcement agencies shall undergo an annual mandatory drug test;
(f) All persons charged before the prosecutor's office with a criminal offense having an imposable penalty of
imprisonment of not less than six (6) years and one (1) day shall have to undergo a mandatory drug test; and
(g) All candidates for public office whether appointed or elected both in the national or local government shall
undergo a mandatory drug test.
In addition to the above stated penalties in this Section, those found to be positive for dangerous drugs use shall be
subject to the provisions of Section 15 of this Act.

Section 40. Records Required for Transactions on Dangerous Drug and Precursors and Essential Chemicals. –
a) Every pharmacist dealing in dangerous drugs and/or controlled precursors and essential chemicals shall maintain and
keep an original record of sales, purchases, acquisitions and deliveries of dangerous drugs, indicating therein the
following information:
(1) License number and address of the pharmacist;
(2) Name, address and license of the manufacturer, importer or wholesaler from whom the dangerous drugs have
been purchased;
(3) Quantity and name of the dangerous drugs purchased or acquired;
(4) Date of acquisition or purchase;
(5) Name, address and community tax certificate number of the buyer;
(6) Serial number of the prescription and the name of the physician, dentist, veterinarian or practitioner issuing the
same;
(7) Quantity and name of the dangerous drugs sold or delivered; and
(8) Date of sale or delivery.

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 15


Source Principle/Provision
A certified true copy of such record covering a period of six (6) months, duly signed by the pharmacist or the owner
of the drugstore, pharmacy or chemical establishment, shall be forwarded to the Board within fifteen (15) days
following the last day of June and December of each year, with a copy thereof furnished the city or municipal health
officer concerned.

Section 60. Confidentiality of Records Under the Voluntary Submission Program. – Judicial and medical records of
drug dependents under the voluntary submission program shall be confidential and shall not be used against him for any
purpose, except to determine how many times, by himself/herself or through his/her parent, spouse, guardian or relative
within the fourth degree of consanguinity or affinity, he/she voluntarily submitted himself/herself for confinement,
treatment and rehabilitation or has been committed to a Center under this program.

Section 64. Confidentiality of Records Under the Compulsory Submission Program. – The records of a drug dependent
who was rehabilitated and discharged from the Center under the compulsory submission program, or who was charged
for violation of Section 15 of this Act, shall be covered by Section 60 of this Act. However, the records of a drug
dependent who was not rehabilitated, or who escaped but did not surrender himself/herself within the prescribed period,
shall be forwarded to the court and their use shall be determined by the court, taking into consideration public interest
and the welfare of the drug dependent.

Section 72. Liability of a Person Who Violates the Confidentiality of Records. – The penalty of imprisonment ranging
from six (6) months and one (1) day to six (6) years and a fine ranging from One thousand pesos (P1,000.00) to Six
thousand pesos (P6,000.00), shall be imposed upon any person who, having official custody of or access to the
confidential records of any drug dependent under voluntary submission programs, or anyone who, having gained
possession of said records, whether lawfully or not, reveals their content to any person other than those charged with the
prosecution of the offenses under this Act and its implementation. The maximum penalty shall be imposed, in addition
to absolute perpetual disqualification from any public office, when the offender is a government official or employee.
Should the records be used for unlawful purposes, such as blackmail of the drug dependent or the members of his/her
family, the penalty imposed for the crime of violation of confidentiality shall be in addition to whatever crime he/she
may be convicted of.
An Act Defining Violence Against Section 44. Confidentiality. – All records pertaining to cases of violence against women and their children including
Women and Their Children, Providing those in the barangay shall be confidential and all public officers and employees and public or private clinics to
for Protective Measures for Victims, hospitals shall respect the right to privacy of the victim. Whoever publishes or causes to be published, in any format, the
Prescribing Penalties Therefore, and name, address, telephone number, school, business address, employer, or other identifying information of a victim or an
for Other Purposes, “Anti-Violence immediate family member, without the latter's consent, shall be liable to the contempt power of the court.
Against Women and Their Children Any person who violates this provision shall suffer the penalty of one (1) year imprisonment and a fine of not more
Act of 2004”, Republic Act No. 9262, than Five Hundred Thousand pesos (P500,000.00).
(March 8, 2004)
Rules of Court and Administrative Rules
Revised Rules of Evidence, Rules of Section 24 (c), Rule 128: Disqualification by reason of privileged communication. — The following persons cannot
Court, (March 14, 1989) testify as to matters learned in confidence in the following cases: 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 advice or treatment given by
him or any information which he may have acquired in attending such patient in a professional capacity, which
information was necessary to enable him to act in capacity, and which would blacken the reputation of the patient
Department of Health Guidelines in Auditory and Visual Privacy: A hospital and other health facilities shall observe acceptable sound level and adequate
the Planning and Design of a Hospital visual seclusion to achieve the acoustical and privacy requirements in designated areas allowing the unhampered
and other Health Facilities (2004) conduct of activities.
Philippine Health Insurance 1.3.b.1 Standard: The organization documents and follows policies and procedures for addressing patients’ needs for
Corporation Benchbook Self- confidentiality, privacy, security, religious counseling and communication
Assessment and Accreditation Process Criteria: The hospital systematically determines, monitors and improves the extent to which patients’ needs for
Manual confidentiality, privacy, security, counseling and communication are addressed.

1.5.b.1 Standard: The organization’s personnel discharge their functions according to codes of ethical behavior and
other relevant professional and statutory standards.
Criteria: The organization identifies and monitors personnel compliance with the code of ethics relevant to their
respective disciplines.
Case Law
Lim vs. Court of Appeals (G.R. No. This rule on the physician-patient privilege is intended to facilitate and make safe full and confidential disclosure by the
91114, September 25, 1992) patient to the physician of all facts, circumstances and symptoms, untrammeled by apprehension of their subsequent
and enforced disclosure and publication on the witness stand, to the end that the physician may form a correct opinion,
and be enabled safely and efficaciously to treat his patient. It rests in public policy and is for the general interest of the
community.
Since the object of the privilege is to protect the patient, it may be waived if no timely objection is made to the
physician’s testimony.
In order that the privilege may be successfully claimed, the following requisites must concur:
“1. the privilege is claimed in a civil case;
2. the person against whom the privilege is claimed is one duly authorized to practice medicine, surgery or obstetrics;
3. such person acquired the information while he was attending to the patient in his professional capacity;
4. the information was necessary to enable him to act in that capacity; and
5. the information was confidential, and, if disclosed, would blacken the reputation (formerly character) of the patient.”
xxx
The physician may be considered to be acting in his professional capacity when he attends to the patient for

16 HEALTH INFORMATION PRIVACY @ PH


Source Principle/Provision
curative, preventive, or palliative treatment. Thus, only disclosures which would have been made to the physician to
enable him “safely and efficaciously to treat his patient” are covered by the privilege. It is to be emphasized that “it is
the tenor only of the communication that is privileged. The mere fact of making a communication, as well as the date of
a consultation and the number of consultations, are therefore not privileged from disclosure, so long as the subject
communicated is not stated.”
One who claims this privilege must prove the presence of these aforementioned requisites.
Krohn vs. Court of Appeals (G.R. No. The treatise presented by petitioner on the privileged nature of the communication between physician and patient, as
108854, June 14, 1994) well as the reasons therefor, is not doubted. Indeed, statutes making communications between physician and patient
privileged are intended to inspire confidence in the patient and encourage him to make a full disclosure to his physician
of his symptoms and condition. Consequently, this prevents the physician from making public information that will
result in humiliation, embarrassment, or disgrace to the patient. For the patient should rest assured with the knowledge
that the law recognizes the communication as confidential, and guards against the possibility of his feelings being
shocked or his reputation tarnished by their subsequent disclosure. The physician-patient privilege creates a zone of
privacy, intended to preclude the humiliation of the patient that may follow the disclosure of his ailments. Indeed,
certain types of information communicated in the context of the physician-patient relationship fall within the
constitutionally protected zone of privacy, including a patient’s interest in keeping his mental health records
confidential. Thus, it has been observed that the psychotherapist-patient privilege is founded upon the notion that
certain forms of antisocial behavior may be prevented by encouraging those in need of treatment for emotional
problems to secure the services of a psychotherapist. xxx
In the instant case, the person against whom the privilege is claimed is not one duly authorized to practice medicine,
surgery or obstetrics. He is simply the patient’s husband who wishes to testify on a document executed by medical
practitioners. Plainly and clearly, this does not fall within the claimed prohibition. Neither can his testimony be
considered a circumvention of the prohibition because his testimony cannot have the force and effect of the testimony
of the physician who examined the patient and executed the report.
Kilusang Mayo Uno vs. Director- The dissenting opinion cites three American decisions on the right to privacy, namely, Griswold v. Connecticut, U.S.
General, National Economic Justice Department v. Reporters Committee for Freedom of the Press, and Whalen v. Roe. The last two decisions
Development Authority (487 SCRA actually support the validity of EO 420, while the first is inapplicable to the present case.
623, 654- 656, 2006) In Griswold, the U.S. Supreme Court declared unconstitutional a state law that prohibited the use and distribution of
contraceptives because enforcement of the law would allow the police entry into the bedrooms of married couples.
Declared the U.S. Supreme Court: “Would we allow the police to search the sacred precincts of the marital bedrooms
for tell-tale signs of the use of contraceptives? The very idea is repulsive to the notions of privacy surrounding the
marriage relationship.” Because the facts and the issue involved in Griswold are materially different from the present
case, Griswold has no persuasive bearing on the present case.
In U.S. Justice Department, the issue was not whether the State could collect and store information on individuals
from public records nationwide but whether the State could withhold such information from the press. The premise of
the issue in U.S. Justice Department is that the State can collect and store in a central database information on citizens
gathered from public records across the country. In fact, the law authorized the Department of Justice to collect and
preserve fingerprints and other criminal identification records nationwide. The law also authorized the Department of
Justice to exchange such information with “officials of States, cities and other institutions.” The Department of Justice
treated such information as confidential. A CBS news correspondent and the Reporters Committee demanded the
criminal records of four members of a family pursuant to the Freedom of Information Act. The U.S. Supreme Court
ruled that the Freedom of Information Act expressly exempts release of information that would “constitute an
unwarranted invasion of personal privacy,” and the information demanded falls under that category of exempt
information.
With the exception of the 8 specific data shown on the ID card, the personal data collected and recorded under EO
420 are treated as “strictly confidential” under Section 6(d) of EO 420. These data are not only strictly confidential but
also personal matters. Section 7, Article III of the 1987 Constitution grants the “right of the people to information on
matters of public concern.” Personal matters are exempt or outside the coverage of the people’s right to information on
matters of public concern. The data treated as “strictly confidential” under EO 420 being private matters and not matters
of public concern, these data cannot be released to the public or the press. Thus, the ruling in U.S. Justice Department
does not collide with EO 420 but actually supports the validity EO 420.
Whalen v. Roe is the leading American case on the constitutional protection for control over information. In Whalen,
the U.S. Supreme Court upheld the validity of a New York law that required doctors to furnish the government reports
identifying patients who received prescription drugs that have a potential for abuse. The government maintained a
central computerized database containing the names and addresses of the patients, as well as the identity of the
prescribing doctors. The law was assailed because the database allegedly infringed the right to privacy of individuals
who want to keep their personal matters confidential. The U.S. Supreme Court rejected the privacy claim, and declared:
Disclosures of private medical information to doctors, to hospital personnel, to insurance
companies, and to public health agencies are often an essential part of modern medical practice even
when the disclosure may reflect unfavorably on the character of the patient. Requiring such disclosures
to representatives of the State having responsibility for the health of the community does not
automatically amount to an impermissible invasion of privacy. (Emphasis supplied)
Compared to the personal medical data required for disclosure to the New York State in Whalen, the 14 specific
data required for disclosure to the Philippine government under EO 420 are far less sensitive and far less personal. In
fact, the 14 specific data required under EO 420 are routine data for ID systems, unlike the sensitive and potentially
embarrassing medical records of patients taking prescription drugs. Whalen, therefore, carries persuasive force for
upholding the constitutionality of EO 420 as non-violative of the right to privacy.
Subsequent U.S. Supreme Court decisions have reiterated Whalen. In Planned Parenthood of Central Missouri v.
Danforth, the U.S. Supreme Court upheld the validity of a law that required doctors performing abortions to fill up
forms, maintain records for seven years, and allow the inspection of such records by public health officials. The U.S.
Supreme Court ruled that “recordkeeping and reporting requirements that are reasonably directed to the preservation of

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 17


Source Principle/Provision
maternal health and that properly respect a patient’s confidentiality and privacy are permissible.”
Again, in Planned Parenthood of Southeastern Pennsylvania v. Casey, the U.S. Supreme Court upheld a law that
required doctors performing an abortion to file a report to the government that included the doctor’s name, the woman’s
age, the number of prior pregnancies and abortions that the woman had, the medical complications from the abortion,
the weight of the fetus, and the marital status of the woman. In case of state-funded institutions, the law made such
information publicly available. In Casey, the U.S. Supreme Court stated: “The collection of information with respect to
actual patients is a vital element of medical research, and so it cannot be said that the requirements serve no purpose
other than to make abortion more difficult.”
Professional Services, Inc. v. Agana With the passage of time, more duties were expected from hospitals, among them: (1) the use of reasonable care in the
(513 SCRA 478, 2007) maintenance of safe and adequate facilities and equipment; (2) the selection and retention of competent physicians; (3)
the overseeing or supervision of all persons who practice medicine within its walls; and (4) the formulation, adoption
and enforcement of adequate rules and policies that ensure quality care for its patients. Thus, in Tucson Medical Center,
Inc. v. Misevich, it was held that a hospital, following the doctrine of corporate responsibility, has the duty to see that it
meets the standards of responsibilities for the care of patients.
C. Right to Privacy and Electronic Data
An Act Providing for the Recognition Sec. 5. Definition of Terms. - For the purposes of this Act, the following terms are defined, as follows:
and Use of Electronic Commercial and xxx
Non-Commercial Transactions and c. “Electronic Data Message” refers to information generated, sent, received or stored by electronic, optical or similar
Documents, Penalties for Unlawful means.
Use Thereof and Other Purposes, d. “Information and Communication System” refers to a system intended for and capable of generating, sending,
"Electronic Commerce Act of 2000", receiving, storing or otherwise processing electronic data messages or electronic documents and includes the computer
Republic Act No. 8792, (June 14, system or other similar device by or in which data is recorded or stored and any procedures related to the recording or
2000) storage of electronic data message or electronic document.
e. “Electronic Signature” refers to any distinctive mark, characteristic and/or sound in electronic form, representing the
identity of a person and attached to or logically associated with the electronic data message or electronic document or
any methodology or procedures employed or adopted by a person and executed or adopted by such person with the
intention of authenticating or approving an electronic data message or electronic document.
f. “Electronic Document” refers to information or the representation of information, data, figures, symbols or other
modes of written expression, described or however represented, by which a right is established or an obligation
extinguished, or by which a fact may be proved and affirmed, which is received, recorded, transmitted, stored,
processed, retrieved or produced electronically.
g. “Electronic Key” refers to a secret code which secures and defends sensitive information that crosses over public
channels into a form decipherable only with a matching electronic key.
xxx
Sec. 7. Legal Recognition of Electronic Documents. – Electronic documents shall have the legal effect, validity or
enforceability as any other document or legal writing, and –xxx
xxx
SEC. 31. Lawful Access. - Access to an electronic file, or an electronic signature of an electronic data message or
electronic document shall only be authorized and enforced in favor of the individual or entity having a legal right to the
possession or the use of the plaintext, electronic signature or file and solely for the authorized purposes. The electronic
key for identity or integrity shall not be made available to any person or party without the consent of the individual or
entity in lawful possession of that electronic key.
SEC. 32. Obligation of Confidentiality. - Except for the purposes authorized under this Act, any person who obtained
access to any electronic key, electronic data message, or electronic document, book, register, correspondence,
information, or other material pursuant to any
powers conferred under this Act, shall not convey to or share the same with any other person.

SEC. 33. Penalties. - The following Acts shall be penalized by fine and/or imprisonment, as follows:

(a) Hacking or cracking which refers to unauthorized access into or interference in a computer system/server or
information and communication system; or any access in order to corrupt, alter, steal, or destroy using a computer or
other similar information and communication devices, without the knowledge and consent of the owner of the computer
or information and communications system, including the introduction of computer viruses and the like, resulting in the
corruption, destruction, alteration, theft or loss of electronic data messages or electronic document shall be punished by
a minimum fine of one hundred thousand pesos (P100,000.00) and a maximum commensurate to the damage incurred
and a mandatory imprisonment of six (6) months to three (3) years;
(b) Piracy or the unauthorized copying, reproduction, dissemination, distribution, importation, use, removal, alteration,
substitution, modification, storage, uploading, downloading, communication, making available to the public, or
broadcasting of protected material, electronic signature or copyrighted works including legally protected sound
recordings or phonograms or information material on protected works, through the use of telecommunication networks,
such as, but not limited to, the internet, in a manner that infringes intellectual property rights shall be punished by a
minimum fine of one hundred thousand pesos (P100,000.00) and a maximum commensurate to the damage incurred
and a mandatory imprisonment of six (6) months to three (3) years;
(c) Violations of the Consumer Act or Republic Act No. 7394 and other relevant or pertinent laws through transactions
covered by or using electronic data messages or electronic documents, shall be penalized with the same penalties as
provided in those laws; (d) Other violations of the provisions of this Act, shall be penalized with a maximum penalty of
one million pesos (P1,000,000.00) or six (6) years imprisonment.
An Act to Prohibit and Penalize Wire Section 1. It shall be unlawful for any person, not being authorized by all the parties to any private communication or
Tapping and Other related Violations spoken word, to tap any wire or cable, or by using any other device or arrangement, to secretly overhear, intercept, or
of the Privacy of Communication, and record such communication or spoken word by using a device commonly known as a dictaphone or dictagraph or
for Other Purposes, Republic Act No. detectaphone or walkie-talkie or tape recorder, or however otherwise described:

18 HEALTH INFORMATION PRIVACY @ PH


Source Principle/Provision
4200, (June 19, 1965)
It shall also be unlawful for any person, be he a participant or not in the act or acts penalized in the next preceding
sentence, to knowingly possess any tape record, wire record, disc record, or any other such record, or copies thereof, of
any communication or spoken word secured either before or after the effective date of this Act in the manner prohibited
by this law; or to replay the same for any other person or persons; or to communicate the contents thereof, either
verbally or in writing, or to furnish transcriptions thereof, whether complete or partial, to any other person: Provided,
That the use of such record or any copies thereof as evidence in any civil, criminal investigation or trial of offenses
mentioned in Sec. 3 hereof, shall not be covered by this prohibition.

Sec. 2. Any person who wilfully or knowingly does or who shall aid, permit, or cause to be done any of the acts
declared to be unlawful in the preceding Sec. or who violates the provisions of the following Sec. or of any order issued
thereunder, or aids, permits, or causes such violation shall, upon conviction thereof, be punished by imprisonment for
not less than six months or more than six years and with the accessory penalty of perpetual absolute disqualification
from public office if the offender be a public official at the time of the commission of the offense, and, if the offender is
an alien he shall be subject to deportation proceedings.
D. Exceptions to the Right to Privacy
Statutes
Republic Act No. 3573, Law of Mandatory reporting of individuals and health facilities of notifiable diseases to local and national health authorities.
Reporting of Communicable Diseases
Law on Registry of Civil Status, Sec. 5. Registration and Certification of Birth. — The declaration of the physician or midwife in attendance at the birth
Republic Act No. 3753, (November or, in default thereof, the declaration of either parent of the newborn child, shall be sufficient for the registration of a
26, 1930) birth in the civil register. Such declaration shall be exempt from the documentary stamp tax and shall be sent to the
local civil registrar not later than thirty days after the birth, by the physician, or midwife in attendance at the birth or by
either parent of the newly born child.
Sec. 6. Death certificate and register. — No human body shall be buried unless the proper death certificate has been
presented and recorded in the office of the local civil registrar. The physician who attended the deceased or, in his
default the health officer concerned, or in default of the latter, any member of the family of the deceased or any person
having knowledge of the death, shall report the same to the local health authorities, who shall issue a death certificate
and shall order the same to be recorded in the office of the local civil registrar.
An Act Regulating the Practice of Section 32: Record books for prescription. All prescriptions dispersed in the drugstore shall be recorded in the book
Pharmacy and Setting Standards of kept for the purpose indicating therein, among others, the name of the manufacturer, the original stock, lot and control
Pharmaceutical Education in the numbers of the main ingredients of the prescriptions, which book shall be open to inspection by the proper authorities at
Philippines and for Other Purposes, any time of the day when the pharmacy is open to the public and must be preserved for a period of not less than two
Republic Act No. 5921, (June 21, years the last entry in it has been made. All prescription shall be attached to said book for prescriptions and numbered
1969) consecutively and shall be preserved for the same length of time as the prescription book.
A Decree Instituting a Labor Code Art. 187. Attending physician. Any physician attending an injured or sick employee shall comply with all the
Thereby Revising and Consolidating regulations of the System and submit reports in prescribed forms at such time as may be required concerning his
Labor and Social Laws to Afford condition or treatment. All medical information relevant to the particular injury or sickness shall, on demand, be made
Protection to Labor, Promote available to the employee or the System. No information developed in connection with treatment or examination for
Employment and Human Resources which compensation is sought shall be considered as privileged communication.
Development and Insure Industrial
Peace Based on Social Justice, “Labor
Code of the Philippines”, Presidential
Decree No. 442, as amended, (May 1,
1974)
The Child and Youth Welfare Code, Article 166. Report of Maltreated or Abused Child. - All hospitals, clinics and other institutions as well as private
Presidential Decree No. 603, physicians providing treatment shall, within forty-eight hours from knowledge of the case, report in writing to the city
(December 10, 1974) or provincial fiscal or to the Local Council for the Protection of Children or to the nearest unit of the Department of
Social Welfare, any case of a maltreated or abused child, or exploitation of an employed child contrary to the provisions
of labor laws. It shall be the duty of the Council for the Protection of Children or the unit of the Department of Social
Welfare to whom such a report is made to forward the same to the provincial or city fiscal.
Violation of this provision shall subject the hospital, clinic, institution, or physician who fails to make such report to
a fine of not more than two thousand pesos.
In cases of sexual abuse, the records pertaining to the case shall be kept strictly confidential and no information
relating thereto shall be disclosed except in connection with any court or official proceeding based on such report. Any
person disclosing confidential information in violation of this provision shall be punished by a fine of not less than one
hundred pesos nor more than five thousand pesos, or by imprisonment for not less than thirty days nor more than one
year, or both such fine and imprisonment, at the discretion of the court.
Executive Order No. 212, amending Section 1. The attending physician of any hospital, medical clinic, sanitarium or other medical establishments, or any
Presidential Decree No. 169 (July 10, other medical practitioner, who has treated any person for serious or less serious physical injuries as these injuries are
1987) 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
An Act Instituting a National Health Section 16 (m): to supervise the provision of health benefits with the power to inspect medical and financial records of
Insurance Program for all Filipinos and health care providers and patients who are participants in or members of the Program, and the power to
Establishing The Philippine Health enter and inspect accredited health care institutions, subject to the rules and regulations to be promulgated by the
Insurance Corporation for the Purpose, Corporation
“National Health Insurance Act of
1995”, Republic Act No. 7875,
(February 10, 2004)
Rules of Court and Administrative Rules

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 19


Source Principle/Provision
Rule 28. Physical and Mental SECTION 1. When examination may be ordered.—In an action in which the mental or physical condition of a party is
Examination of Persons, 1997 Rules of in controversy, the court in which the action is pending may in its discretion order him to submit to a physical or mental
Civil Procedure, Rules of Court (April examination by a physician.
8, 1997)
SEC. 2. Order for examination.—The order for examination may be made only on motion for good cause shown and
upon notice to the party to be examined and to all other parties, and shall specify the time, place, manner, conditions
and scope of the examination and the person or persons by whom it is to be made.

SEC. 3. Report of findings—If requested by the party examined, the party causing the examination to be made shall
deliver to him a copy of a detailed written report of the examining physician setting out his findings and conclusions.
After such request and delivery, the party causing the examination to be made shall be entitled upon request to receive
from the party examined a like report of any examination, previously or thereafter made, of the same mental or physical
condition. If the party examined refuses to deliver such report, the court on motion and notice may make an order
requiring delivery on such terms as are just, and if a physician fails or refuses to make such a report the court may
exclude his testimony if offered at the trial.

SEC. 4. Waiver of privilege.—By requesting and obtaining a report of the examination so ordered or by taking the
deposition of the examiner, the party examined waives any privilege he may have in that action or any other involving
the same controversy, regarding the testimony of every other person who has examined or may thereafter examine him
in respect of the same mental or physical examination.
Philippine National AIDS Council Sec. 41. Medical Confidentiality. Medical confidentiality shall protect and uphold the right to privacy of an individual
Resolution No. 1, Rules and who undergoes HIV testing or is diagnosed to have HIV. It includes safeguarding all medical records obtained by health
Regulations Implementing the professionals, health instructors, co-workers, employers, recruitment agencies, insurance companies, data encoders, and
Philippine AIDS Prevention and other custodians of said record, file, or data.
Control Act of 1994 (RA 8504), (April Confidentiality shall encompass all forms of communication that directly or indirectly lead to the disclosure of
13, 1999) information on the identity or health status of any person who undergoes HIV testing or is diagnosed to have HIV. This
information may include but is not limited to the name, address, picture, physical description or any other characteristic
of a person which may lead to his/her identification.
To safeguard the confidentiality of a person's HIV/AIDS record, protocols and policies shall be adopted by concerned
officials, agencies and institutions.

Sec. 42. Exceptions to the Mandate of Confidentiality. The requirement for medical confidentiality shall be waived in
the following instances:
a. When responding to a subpoena duces tecum and subpoena ad testificandum issued by a court with jurisdiction over
legal proceedings where the main issue is the HIV status of an individual;
b. When complying with the reporting requirements for AIDSWATCH as provided in Sec. 39 of this IRR; and
c. When informing other health workers directly involved or about to be involved in the treatment or care of a person
with HIV/AIDS and such treatment or care carry the risk of HIV transmission
Health workers who are exposed to invasive procedures and may potentially be in contact with blood and bodily
fluids likely to transmit HIV shall be informed of the HIV status of a person, even without his/her consent. This
information is vital to their protection against acquiring and transmitting the HIV infection through safe practices and
procedures in accordance with Secs. 21 and 24 of this IRR.
Those who are not at risk of transmission, must not be informed of a person’s HIV status.
All health workers shall maintain shared medical confidentiality.
DOH Administrative Order No, 2008- The policy encompasses all individuals and health facilities, both government and private, in all levels of government
0009, Adopting the 2008 Revised List (sitio, barangay/village, municipal, city, provincial, regional and national).
of Notifiable Diseases, Syndromes and - This order mandated the submission of case-based investigation report to the Provincial Health Office, Centers
Health-Related Events and Conditions, for Health Development, and the National Epidemiology Center within 24 hours of detection of immediately
(February 12, 2008) notifiable diseases
PhilHealth Circular No. 030, s. 2000, This is in keeping with Section 2 of RA 3573 that states, every person having knowledge of the occurrence of any case
Strict Compliance to Republic Act of reportable or communicable diseases shall immediately notify the nearest health station either by telephone, by
3573, the Law on Reporting messenger or by written notice, specifying the disease and the name and address of the person affected.
Communicable Diseases, (September The immediate disclosure of the above information and any other diseases publicly declared by the Secretary of
18, 2000) Health to be communicable and dangerous to the public health will enable the health agencies concerned to prepare for
contingencies.
E. Ethical Principles
Hippocratic Oath All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not
to be spread abroad, I will keep secret and will never reveal.
WMA Declaration of Lisbon on the Right to confidentiality
Rights of the Patient a. All identifiable information about a patient's health status, medical condition, diagnosis, prognosis and treatment and
all other information of a personal kind must be kept confidential, even after death. Exceptionally, descendants may
have a right of access to information that would inform them of their health risks.
b. Confidential information can only be disclosed if the patient gives explicit consent or if expressly provided for in the
law. Information can be disclosed to other health care providers only on a strictly "need to know" basis unless the
patient has given explicit consent.
c. All identifiable patient data must be protected. The protection of the data must be appropriate to the manner of its
storage. Human substances from which identifiable data can be derived must be likewise protected.
International Code of Medical Ethics, A physician shall respect a patient's right to confidentiality. It is ethical to disclose confidential information when the
World Medical Association patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can be
only removed by a breach of confidentiality.

20 HEALTH INFORMATION PRIVACY @ PH


Source Principle/Provision
Administrative Oath for Physicians I hereby solemnly swear that I will support and defend the Constitution of the Philippines;
That I will obey the laws, legal order and decree promulgated by the duly constituted authorities of the Republic of
the Philippines and that I impose this obligation upon myself voluntarily, without mental reservation or purpose of
evasion.
I further solemnly swear that at all times and places, I will adhere to the ethical and professional rules generally
accepted by the medical profession in the Philippines;
And that I will faithfully discharge to the best of my ability the duties and obligations incumbent upon a legally
authorized medical practitioner.
Code of Ethics, Professional Section 6, Article II: The medical practitioner should guard as a sacred trust anything that is confidential or private in
Regulation Commission Board of nature that he may discover or that may be communicated to him in his professional relation with his patients, even
Medicine after their death. He should never divulge this confidential information, or anything that may reflect upon the moral
character of the person involved, except when it is required in the interest of justice, public health, or public safety.
Section 2, Article VII: Violation of anyone of the provisions of this Code of Ethics shall constitute unethical and
unprofessional conduct and therefore a sufficient ground for the reprimand, suspensions, or revocation of the certificate
of registration of the offending physician in accordance with the provisions of Section 24, paragraph (12) of the
Medical Act of 1959, Republic Act 2382.
Code of Ethics, Philippine Medical Section 6, Article 2: The physician should hold as sacred and highly confidential whatever may be discovered or
Association learned pertinent to the patient even after death, except when required in the promotion of justice, safety and public
health.
PMA Code of Ethics Implementing 2. Pursuant to the Medical Act of 1959, the Code of Ethics issued by the Philippine Medical Association shall be
Guidelines complied with by all physicians, whether such physicians are members of the association or not. Violations of the Code
of Ethics shall constitute unethical practice and unprofessional conduct and shall be grounds for reprimand, suspension
or expulsion from the association for cases filed with the Commission on Ethics of the association and shall be grounds
for reprimand, suspension or revocation of license for cases filed before the Professional Regulation Commission,
subject to the rules of procedures and policies of said bodies.
Philippine Medical Association The patient has the right to privacy and protection from unwarranted publicity. This right to privacy shall include the
Declaration on the Rights and patient's right not to be subjected to exposure, private or public, either by photography, publications, video-taping,
Obligations of the Patient discussion, medical teaching or by any other means that would otherwise tend to reveal his person and identity and the
circumstances under which he was, he is, or he will be, under medical or surgical care or treatment.
a. All identifiable information about a patient's health status, medical condition, diagnosis, prognosis and treatment
and all other information of a personal kind, must be kept confidential, even after death. Except, in cases when
descendants may have a right of access to information that would inform them of their health risks.
b. All identifiable patient data must be protected. The protection of the data must be appropriate as to the manner
of its storage. Human substance from which identifiable data can be derived must be likewise protected.
c. Confidential information can be disclosed in the following cases:
(1) when his mental or physical condition is in controversy in a court litigation and the court in its discretion orders
him to submit to physical or mental examination by a physician;
(2) when the public health and safety so demand;
(3) when the patient or, in his incapacity, his legal representative expressly gives the consent;
(4) when his medical or surgical condition, without revealing his identity, is discussed in a medical or scientific
forum for expert discussion for his benefit or for the advancement of science and medicine.
(5) when it is otherwise required by law.
Hospital Code of Ethics, Philippine 1. The Primary objective of the hospital are the following:
Hospital Association 1.2 To provide the best possible facilities for the care of the sick and injured at all times;
1.3 To constantly upgrade and improve methods for the care, the cure, amelioration and prevention of disease; and
1.4 To promote the practice of medicine by Physicians within the institution consistent with the acceptable quality of
patient care.

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 21


TABLE 1. SOME PROPOSED LEGISLATIVE MEASURES ON PATIENT RIGHTS IN THE PHILIPPINES.90-95
Title Remarks
House Bill No. 261, An Act Declaring the Rights and Obligations of Patients Filed by Hon. Rodriguez D. Dadivas
and Establishinga Grievance Mechanism for Violations Thereof and for Other (1st District, Capiz) during the 1st Regular Session, Thirteenth Congress
Purposes (Magna Carta of Patients Rights and Obligations) (7/01/2004)

Pending in the Committee (7/27/2004)


Senate Bill No. 3, An Act Declaring the Rights and Obligations of Patients and Filed by Hon. Juan M. Flavier and Hon. Edgardo J. Angara during the 1 st
Establishing a Grievance Mechanism for Violations Thereof and for Other Regular Session, Thirteenth Congress (6/30/2004)
Purposes (Magna Carta of Patient's Rights and Obligations)
Pending in the Committee (7/27/2004)
Senate Bill No. 588, An Act Declaring the Rights of Patients and Prescribing Filed by Hon. Manuel B. Villar Jr.during the 1st Regular Session, Thirteenth
Penalties for Violations Thereof (Magna Carta of Patients' Rights) Congress (6/30/2004)

Pending in the Committee (8/11/2004)


Senate Bill No. 812, An Act Declaring the Rights and Obligations of Patients Filed by Hon. Ramon A. Revilla Jr.during the 1st Regular Session, Fourteenth
and Establishing a Grievance Mechanism for Violations Thereof and for Other Congress (7/3/2007)
Purposes (Magna Carta oof Patient's Rights and Obligations)
Pending in the Committee (9/3/2007)
Senate Bill No. 2371, An Act Proclaiming the Rights and Obligations of Filed by Hon. Pia S. Cayetano during the 1st Regular Session, Fourteenth
Patients, Providing a Grievance Mechanism Thereof and for Other Purposes Congress (6/3/2008)
(Magna Carta of Patient's Rights and Obligations of 2008)
Pending in the Committee (6/4/2008)
Senate Bill No. 146, An Act Proclaiming the Rights and Obligations of Filed by Hon. Pia S. Cayetano during the 1st Regular Session, Fifteenth
Patients, Providing a Grievance Mechanism Thereof and for Other Purposes Congress (7/5/2010)
(Magna Carta of Patients Rights and Obligations)
Pending in the Committee (8/2/2010)

22 HEALTH INFORMATION PRIVACY @ PH


TABLE 2. COMPARISON OF THE PROVISIONS OF THE PHILIPPINE MEDICAL ASSOCIATION DECLARATION ON THE RIGHTS AND OBLIGATIONS OF THE PATIENT AND
SENATE BILL NO. 146 (PROPOSED MAGNA CARTA OF PATIENT’S RIGHTS AND OBLIGATIONS).31,95

PMA Declaration Senate Bill No. 146


Preliminaries 9. Right to Privacy and Confidentiality. The patient has Section 4 (i): Right to Privacy and Condifentiality. The
the right to privacy and protection from unwarranted patient has the right to privacy and protection from
publicity. unwarranted publicity.
Scope of the right to This right to privacy shall include the patient's right not The right to privacy shall include the patient's right not
privacy and to be subjected to exposure, private or public, either by to be subjected to exposure, private or public, either by
confidentiality photography, publications, video-taping, discussion, photography, publications, video-taping, discussion, or
medical teaching or by any other means that would by any other means that would otherwise tend to reveal
otherwise tend to reveal his person and identity and the his person and identity and the circumstances under
circumstances under which he was, he is, or he will be, which he was, he is, or he will be, under medical or
under medical or surgical care or treatment. surgical care or treatment.
a. All identifiable information about a patient's health All identifiable information about a patient's health
status, medical condition, diagnosis, prognosis and status, medical condition, diagnosis, prognosis and
treatment and all other information of a personal kind, treatment, and all other information of a personal kind,
must be kept confidential, even after death. Except, in must be kept confidential even after death, Provided,
cases when descendants may have a right of access to That descendants may have a right of access to
information that would inform them of their health risks. information that will inform them of their health risks
b. All identifiable patient data must be protected. The All identifiable Patient data must also be protected. The
protection of the data must be appropriate as to the protection of the data must be appropriate as to the
manner of its storage. Human substance from which manner of its storage. Human substance from which
identifiable data can be derived must be likewise identifiable data can be derived must be likewise
protected. protected
Exceptions to the right c. Confidential information can be disclosed in the Confidential information can be disclosed in the
to privacy and following cases: following cases:
confidentiality (1) when his mental or physical condition is in i. When the patient's medical or physical condition is in
controversy in a court litigation and the court in its controversy in a court litigation and the court, in its
discretion orders him to submit to physical or mental discretion, orders the patient to submit to physical or
examination by a physician; mental examination of a physician;
(2) when the public health and safety so demand; ii. When public health or safety so demands;
(3) when the patient or, in his incapacity, his legal iii. When the Patient, or in his incapacity, his/her legal
representative expressly gives the consent; representative, expressly gives the consent;
(4) when his medical or surgical condition, without iv. When the patient's medical or surgical condition is
revealing his identity, is discussed in a medical or discussed in a medical or scientific forum for expert
scientific forum for expert discussion for his benefit or discussion for his/her benefit or for the advancement of
for the advancement of science and medicine. science and medicine, Provided however, That the
identity of the Patient should not be revealed; and
(5) when it is otherwise required by law. v. When it is otherwise required by law.

PRIVACY IN THE DEVELOPING WORLD—PHILIPPINES MONOGRAPH 23

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