ATTY. ANTONIO D.

REBOSA,
M.D.,BSCrim FCLM
CASTRO REBOSA REBOSA Law Offices
PHYSICIAN-PATIENT
RELATIONSHIP
⦿ Contract (Oral)
⦿ Duties/Obligations are
imposed on both the physician
and patient
⦿ Consensual and fiduciary
⦿ RIGHTS of patients and
physicians
DUTIES and OBLIGATIONS
Imposed on the Physician in the
Physician-Patient Relationship
1. He should posses the knowledge and
skill of which an average physician;
General practitioner vs Specialist

2. He should use such knowledge and skill

with ordinary care and diligence;

3.    He is obliged to exercise the best

judgment;

4. He has the duty to observe utmost good

faith.
LEGAL BASIS FOR
MOONLIGHTING
⦿ MEDICAL ACT OF 1959 as amended
⦿ ( registered physician)

⦿ STATUS of a moonlighter
⦿ PRC
⦿ PMA
⦿ Philhealth
⦿ HMOs
⦿ BIR


REASONS WHY PATIENTS SUE AND FILE COMPLAINTS
AGAINST DOCTORS

1. PERCEPTION THAT THE DOCTOR IS

MONEYED AND SCARED OF
SCANDALS AND LAWSUITS
2. DOCTOR IS ILL-MANNERED AND
ARROGANT
3. DOCTOR NEVER APOLOGIZED OR
ADMITTED HIS MISTAKE
4. DOCTOR WAS GROSSLY NEGLIGENT
5. INSTIGATION BY FELLOW DOCTORS
TIPS ON HOW TO AVOID
LAWSUITS
1. GOLDEN RULE
2. GOOD RECORD KEEPING
3. GOOD PR
4. LEARN THE ART OF SAYING SORRY
5. GET TRUSTED LAWYERS
6. KEEP A MODEST LIFESTYLE
7. KNOW THE LIMITS OF YOUR SKILL
8. GET YOUR ACTS TOGETHER
9. KNOW YOUR RIGHTS AND THAT OF THE
PATIENT
Laws governing medical/hospital practice
Sanitation Code Clinical Laboratory
Hospital Licensure
Environmental Code Law
Law
Generic Act
Pharmac Senior Citizens Act
y Law Fire Code
PD 169 (Physical
Injuries)
Child Abuse Law Sexual Harassment Act R.A. 6615 / R.A. 8344
(PD 603 R.A. 7610)
E-Vat (Emergency Law)
Value Added Tax Law Revised Revenue Code
Anti-Detention Law
(Income Tax / PTR)

Family Code Philippine PTR

Medical Act of Revised Penal Code of
Civil Code of Philippines
1959 the Philippines

AND MORE THAN ONE HUNDRED

OTHER RELATED LAWS…………..
ARTICLE 3. Civil Code of the Philippines

Ignorance of the law

excuses no one from
compliance therewith.
Common Issues at the ER...........
➢ Dead/Dying on Arrival
➢ Transfer / Admission of Patients
➢ Consent
➢ Medical and Death Certificates
➢ Documentation of Injuries
➢ Hospital Deposit
➢ Collection and Preservation of evidence
➢ Autopsy
 DEAD
OR DYING on ARRIVAL
Or DOA

➢ Diagnosis
➢ Certification
➢ Treatment
➢ Documentation
Transfer / Admission of
Patients
Admission
⦿ A person has no absolute right to be
admitted in a hospital or to avail of
hospital services. The relationship
between the hospital and the patient
is contractual.
⦿ A government has no absolute
privilege of choice of patients
inasmuch as it is established and
maintained by public funds except for
justifiable grounds.
Transfer of patients

⦿ It must be premised on desire and

consent of the patient and when the
condition of the patient would permit
to do so.
⦿ DO’s and DON’Ts
⦿ Referral system
⦿ Referral notes
⦿ Ambulance conduction
Discharge of patients
⦿ After evaluation of the patient’s
condition, considers that further
h o s p i t a l i z at i o n i s n o l o n ge r
indispensable, a physician may
order the discharge with or without
condition.
Premature discharge

⦿ The attending physician and the

hospital may be held liable to the
patient if the latter is discharged from
the hospital in spite of the fact that
f u r t h e r h o s p i t a l i z at i o n i s s t i l l
necessary.
BASIC PRINCIPLES ON

CONSENT
Legal Requisites of a Valid Consent

➢ Age of majority
➢ Sound mind

Ethical Requisites of a Valid Consent

Informed or enlightened consent
Voluntary
Subject matter must be legal
WHO CAN GIVE CONSENT?

PATIENT SPOUSE CHILDREN

GRANDPARENTS PARENTS
BROTHERS
SISTERS

NEAREST KIN
STATE
 CONSENT . . .
WHO HAS THE DUTY TO
EXPLAIN?

NURSE DOCTOR

NURSING MEDICAL
PROCEDURES PROCEDURES

PATIENT

Admitting
Emergency Operations Without
Consent
⦿ -When the situation is such that an immediate
action is necessary to save the life or preserve the
health of the patient, and getting a consent is
prejudicial to the patient, the physician can legally
proceed with his contemplated life-saving
procedure.
⦿ The law gives him the right to act under the
Theory of Implied Consent or that the physician is
privileged to do whatever is sound for the benefit
of the patient.
⦿ The refusal of the patient who is of legal age and
of sound mind to submit to medical treatment
shall prevail even if the danger to his life is
eminent.
Medical and Death
Certificates
The Medical Certificate
Personal circumstances
Date

I hereby certify that _____ consulted

(personally seen and examined by) the
undersigned last (…from)______ because of
____________. Clinical Impression is
____________.I have prescribed ______ and
advised patient to rest for _________days/weeks.

This medical certificate is issued for _______

purpose only and not intended for medico-
legal/court use.

(sgd)
NAME: ______________________________________________________
Address:
Age: _________ Sex:___________ Civil Status: ______________
Date Admitted: ___________________Room No. _____________
Alleged Place, Date and Time of infliction:
Date and time of examination:
Findings:

CONCLUSION:
Under normal condition, without subsequent complications
and/or deeper involvement present, but not clinically apparent at
the time of examination, the above-described physical injuries
shall require medical attention or shall incapacitate the victim for
a period not less than ______days but not more than _______days

REMARKS:

Respectfully submitted:

ALBERT D. REBOSA, M.D., Ll.B.

Medico-Legal Consultant
Lic. No. 86553
Myths and Truths of Medical and
Medico-legal Certificate
⦿ Within 24 hours (x)
⦿ Medical certificate can not be used for medico-
legal purposes (x)
⦿ Only Medico-legal officers can issue (x)
⦿ Both can be the subject of sub poena (/)
⦿ Awaits ancillary/laboratory results prior to give
conclusion as to number of days (x)
⦿ Only ER Officers can issue (x)
⦿ Must have actually examined patient (x)
⦿ To whom will it be released?
⦿ Others . . . .
PRESCRIPTION / Rx
⦿ Legible
⦿ Understandable
⦿ Clear and Complete
⦿ Compliance with Generics Law
⦿ Layman
⦿ Do not use medical acronyms
⦿ A Death Certificate is an
official document setting forth
particulars relating to a dead
person, including the name of
the individual, the date of birth
and the date of death.
Signature ________________________________________ Name in Print_____________________________________ Title or Position____________________________________ Address
_________________________________________
_________________________________________ Date ___________________________________________
REVIEWED BY: ____________________fy__________
Signature over printed name of Health Center
______________________ Date
21. CORPPE DISPOSAL

_____ 1 Burial _____ 3 Others ( Speci) _____ 2 Cremation __________________
22. BURIAL / CREMATION PERMIT

Number __________________________ Date Issued _______________________
23. AUTOPSY _____ 1 Yes _____ 2 No
25. INFORMATION
8 Signature _______________________________________ Address __________________________________________

Name in Print ___________________________________ __________________________________________ Relationship to the deceased _________________________ Date
__________________________________________
26. PREPARED BY:
Signature ______________________________________ Name in Print___________________________________ Title or Position__________________________________ Date
__________________________________________
27. RECEIVED AT THE OFFICE OF THE CIVIL REGISTRAR
Signature _____________________________________ Name In Print _________________________________ Title or Position _______________________________ Date
______________________________________
9
OR OCRG FOR AGES 0 to 7 DAYS
USE ONLY: opulation Reference No.
TO BE FILLED UP AT THE
OFFICE OF THE CIVIL REGISTRAR 13. METHOD OF DELIVERY

11. DATE OF BIRTH

1 12. AGE OF THE MOTHER ______1 Normal; spontaneous vertex ______2
(day) (month) (year)
8 Others (Specify) __________
9
4 14. LENGTH OF PREGNANCY ______________ completed weeks
9
5 15. TYPE OF BIRTH
 16. IF MULTIPLE BIRTH, CHILD WAS

9 _____ 1 Single ____ 2 Twin _____ 3 Triplet, etc. _____ 1 First _____ 2 Second ______ 3 Other (specify) ___________________
0
3 MEDICAL CERTIFICATE
5
86 11. CAUSES OF DEATH

50 51 a. Main disease/condition of infant ______________________________________________________________________________________________ b.
65 Other diseases/conditions of infant ____________________________________________________________________________________________ c. Main
82 material disease/condition affecting infant __________________________________________________________________________________ d. Other
0 material disease /condition affecting infant _________________________________________________________________________________ e. Other
POSTMORTEM CERTIFICATE OF DEATH
relevant circumstances _________________________________________________________________________________________________
I HEREBY CERTIFY that I have this _____________day of __________________, ________________performed an autopsy upon the body of the deceased and that cause of death was as follows
CONTINUE TO FILL UP ITEM 18
_____________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Signature _____________________________________ Title/Designation____________________________________ Name in Print __________________________________ Address
___________________________________________ ___________________________________________
CERTIFICATION OF EMBALMER
I HEREBY CERTIFY that I have embalmed _______________________________________________________________________________ after having followed all the regulations prescribed by the
Department of Health.
Signature ____________________________________________ Name in Print _________________________________________ Address ______________________________________________
____________________________________________________
Title/Designation_____________________________________ License No. __________________________________________ Issued on _________ at ________________________________ Expiry
Date __________________________________________
Republic of the Philippines ________________________________________ )
 I HEREBY CERTIFY that I have this _____________day of __________________, ________________performed an autopsy upon the bod
_____________________________________________________________________________________
________________________________________________________________________________________________________________
Signature _____________________________________ Title/Designation____________________________________ Name in Print _____
___________________________________________ ___________________________________________
CERTIFICATION OF EMBALMER
I HEREBY CERTIFY that I have embalmed ______________________________________________________________________________
Department of Health.
Signature ____________________________________________ Name in Print _________________________________________ Address
____________________________________________________
Title/Designation_____________________________________ License No. __________________________________________ Issued on
Date __________________________________________
Republic of the Philippines ________________________________________ )
Province of ____________________________________________________ City/Municipality ____________________________________
AFFIDAVIT FOR DELAYED REGISTRATION OF DEATH
I, _________________________________________________________________________________, of legal are, single/married, after b
and say:
1.That ___________________________________________________________________died on _______________________________in
____________________________________________________________________________ and was buried/cremated in
_________________________________________________________________________________on ______________________.
2.That the deceased was/was not attended to at the time of his death.
3.That the reason for the delay in registering this death was due to __________________________________________________________
FOR AGES 0 to 7 DAYS __________________________________________________________________________________________________________.
___________________________________________________ (Signature of affiant)
13. METHOD OF DELIVERY

Community Tax No. __________________________________ Date Issued ________________________________________ Place Issued ___________
11. DATE OF BIRTH

12. AGE OF THE MOTHER
SUBSCRIBED AND SWORN to before me this _____________day ______1 Normal; spontaneous vertex ______2
of ______________________________, __________________________
(day) (month) (year)
__________________________________________________________________________________________________
Others (Specify) __________ , Philippines.
___________________________________________ (Signature of Administering Officer)
14. LENGTH OF PREGNANCY ______________ completed weeks
___________________________________________ (Name in Print)
_____________________________________________ (Title/Designation)
15. TYPE OF BIRTH
 16. IF MULTIPLE BIRTH, CHILD WAS

_____________________________________________ (Address)
_____ 1 Single ____ 2 Twin _____ 3 Triplet, etc. ) S. S. _____ 1 First _____ 2 Second ______ 3 Other (specify) ___________________

MEDICAL CERTIFICATE
11. CAUSES OF DEATH

a. Main disease/condition of infant ______________________________________________________________________________________________ b.
Other diseases/conditions of infant ____________________________________________________________________________________________ c. Main
material disease/condition affecting infant __________________________________________________________________________________ d. Other
material disease /condition affecting infant _________________________________________________________________________________ e. Other
relevant circumstances _________________________________________________________________________________________________
CONTINUE TO FILL UP ITEM 18
Certification of Death . . . who
should sign? . . .Ideally, the one
who pronounced death.
Death Certificate . . .

Cause of Death
⦿ Immediate cause
⦿ Antecedent cause
⦿ Underlying
⦿ Contributory
Death Certificate

Immediate Cause . . .

⦿ direct
⦿ no intervening event
⦿ directly causing cardio-respiratory
arrest
Death Certificate . . .

Antecedent Cause of Death
⦿ Leads to immediate cause of death
⦿ May or may not be the main disease
condition / injury
⦿ may or may not be direct
Death Certificate . . .

Underlying Cause
⦿ another disease entity or injury
⦿ may or may not be related to
immediate or antecedent cause
⦿ no direct relationship with cardio-
respiratory arrest
⦿ may be independent
Death Certificate . . .

Contributory cause/s
⦿ Any other disease condition or
injury
⦿ may or may not be related to any of
the other cause/s death
⦿ never directly related to cardio-
respiratory arrest
Death Certificate . . .

Cause/s of Death
⦿ Immediate : Septicemia
⦿ Antecedent : Pneumonia
⦿ Underlying : Gunshot
wound, chest,
right
⦿ Contributory: Renal failure
⦿ The most recent condition written on top line of the certificate
that directly leads to death is the immediate cause. Other
intervening cause (or causes) of death occurring between the
underlying and immediate causes is called the antecedent cause.
Depending on the number of entries or causes of death reported
in the Medical Certificate portion of
⦿ the Certificate of Death, there can be one, or more than one
reported 19b CAUSES OF DEATH (If the deceased is aged 8 days
and over) Interval between Onset and Death antecedent causes
of death. It is even possible not to have an intervening
⦿ I. Immediate cause :a. Hypovolemic shock 1 HOUR
⦿ Antecedent cause :b. Multiple fractures 5 HOURS
⦿ Underlying cause :c. Pedestrian hit by a truck 5 HOURS
⦿ II. Other significant conditions contributing to death:
⦿ cause at all if only one line (immediate cause) or two lines
(immediate and underlying cause) are filled out.
Dismembered Body Parts 

⦿ In cases when a dismembered body part which is non-viable
for attachment is brought to the ER, such body part shall be
forwarded to the surgical pathology section of the laboratory
for gross and microscopic examination and documentation.
The surgical pathology report signed and issued by the
pathologist shall serve as the Certificate of Dismembered
Body Part which may be used for burial purposes or proper
disposal.
⦿ Body parts surgically removed (e.g., amputated foot due to
diabetes mellitus or accidental chopping o the hand of a
machinist because of a technical machine problem) are not
considered as death of a person. Hence, document
containing such body parts should not be registered since
these are for burial purposes only.
⦿ The practice of issuing a Certificate of Death by the
attending physician for the dismembered body part is not
necessary.
For Death that Occurred in the Hospital 


⦿ When a death occurs, the physician who last attended

the deceased or the administrator of the hospital or
clinic where the person died is responsible to prepare
the COD and certify as to the cause of death.

⦿ The certificate is forwarded, within 48 hours after death,

to the local health officer who will review the certificate
and affix his signature in the “Reviewed By” portion and
direct its registration at within 30 days.
⦿ For Death in Hospital Emergency Room (ER)
⦿ Emergency Room deaths refer to deaths of patients occurring in the ER, including
patients who were revived by initial resuscitative measures at the ER but eventually
died there, regardless of the time of stay in ER. In such cases, the Certificate of
Death shall be accomplished by the ER officer if he can provide a de nite diagnosis.
Otherwise, the death should be referred to the medico-legal officer of the hospital or
the local health officer who shall cause the issuance of the Certi cate of Death.

⦿ For Death that Occurred in the Ambulance

⦿ When a death occurs in the ambulance while the patient is being transferred to
another healthcare facility, the attending physician during the transport of the
patient shall accomplish the Certificate of Death.
⦿ For Death under Medico-Legal Examination
⦿ When faced with the duty of completing the Medical Certi cate portion of
the Certi cate of Death, the physician has to determine rst and foremost
whether the death is reportable or not and then, determine whether
another physician is more quali ed to complete the certi cate especially if
the deceased was attended by another physician prior to his death.
⦿ If the physician has reasons to believe or suspect that the cause of death
was due to violence or crime (or that he is dealing with a medico-legal
case), then he is duty-bound to immediately report to the authorities of the
Philippine National Police (PNP) or the National Bureau of Investigation
(NBI).
⦿ There is violence or crime when the cause of death was due, but not
limited, to the following:
⦿ Stab wounds
⦿ Gunshot wounds
⦿ Suicide of any kind
⦿ Strangulation
⦿ Accident resulting to death
⦿ Actual physical assault in icting injuries upon a person resulting to death
⦿ Any other acts of violence upon a person resulting to death
⦿ Sudden death of undetermined cause.
Who certifies the Certificate of Death? 


● If there is a medical attendant at death, the

certifying officer is the attendant at death.
● If there is no medical attendant at death, the
certifying officer is the Local Health O cer.
● In medico-legal cases, the certifying o cer is the
medico-legal officer.
⦿ No matter what you do, the
patient can give you problems
whether he is ALIVE, DYING or
DEAD!
Documentation
of Injuries
DOCUMENTATION
ALLEGED place, date, time of infliction
Nature(?)

Date and time of examination

(important in the determination
whether injuries are compatible/
consistent with the date and time of
infliction)
INJURIES
⦿ NATURE
⦿ SHAPE
⦿ MEASUREMENT
⦿ ANATOMICAL LOCATION
 CONTUSION/BRUISE (pasa)
HEMATOMA (Blood Cyst/tumor/ bukol)
ABRASIONS ( gasgas)
LACERATED/AVULSED WOUND
INCISED (SLICED/CUT) WOUND
STAB WOUND
HACKING WOUND
PUNCTURED WOUND
GUNSHOT WOUNDS
BURNS .. Due to flame or fire
SCALDING.. Due to boiling liquid
 HOSPITAL
DEPOSIT
- NO DEPOSIT LAW

- Prohibiting the Detention of

Patients in Hospitals and
Medical Clinics on Grounds of
Non-Payment of Hospital Bills
or Medical Expenses
PRESIDENTIAL DECREE NO. 169

⦿ MANDATORY REPORTING OF CASES

BY PHYSICIANS INVOLVING LESS
SERIOUS AND SERIOUS PHYSICAL
INJURIES TO POLICE AUTHORITIES
⦿ penalty of 1-3 years imprisonment,
P1,000.00-3,000.00 fine and
revocation of license
When May the Contents of the Record be
Disclosed
1.   When requested by the patient or by
someone who could act in his behalf which
must be made in writing;
2.   When the law requires such disclosure;
3.   Upon a lawful order of the court. 
N.B.
⦿ The attending physician has no legal right
to determine who shall and who shall not see
the record. At the most, his approval or
permission is only a matter of courtesy.
⦿   Members of the resident staff, student and
attending medical staff may freely consult
such records as pertain to their work.
 Malpractice cases

Fault or Negligence Attributed to the following . . .

⦿ Clinicians
⦿ Administrative
⦿ Ancillary
⦿ Etc.
Specialties . . . 2006-2011

• OB-GYNECOLOGY
• SURGERY
• PEDIATRICS
• ANESTHESIOLOGY
• OTHERS
Profile of complainant patients (review of 60 cases ) . . . .

Mindanao
Visayas

Luzon

Metro
manila

Place of Incident
Profile of complainant patients (review of 250 cases ) . . . .

others

Gov’t /
relative
Doctor
Relative

Relatives Lawyer /
relative

(within 6th degree)

GOLDEN RULES
- Document properly medication sheet
- Explain to patient purpose and
importance of medications
- Communicate with patient about
medications
- Document efforts to communicate
especially non-compliant patients.
- Chart notes should be easy to read
- NEVER alter records
- NEVER intentionally misdate notes or
enter signatures and initials or
reports later than the date reviewed
unless the correct date is also
entered.
- Secure and document CONSENT
always.
SEXUAL HARRASSMENT
⦿ PROPER SET-UP – PE
⦿ CONSENT
⦿ MANNERS
Professional Fees
⦿ How to charge
⦿ Rebates and referrals
⦿ Factors affecting professional fees
⦿ Non-payment of fees
⦿ PTR
⦿ Issuance of receipts
Factors in Determining Fees
⦿ Time allotted
⦿ Difficulty of the case
⦿ Social standing of the MD
⦿ Financial capability of the patient
MALPRACTICE SUITS
Usual Cases
⦿ Death of the patient
⦿ Failed surgery
⦿ Surgical complications
⦿ Laparoscopic complications
⦿ Complications of Appendectomy
⦿ Retained gauze / foreign bodies
⦿ Anesthetic accidents
⦿ Uterine atony
⦿ Placenta accreta/previa
⦿ Dengue Cases
⦿ Anaphylactic reactions
⦿ Wrong blood/medications/route
⦿ Wrong/misdiagnosis
⦿ Interchanged results
⦿ Hospital acquired infections
⦿ Necrotic IV Site
⦿ Sexual Harassment
Inappropriate remarks/
behavior
Immorality
Sexual Harassment/manner
of examination
Unusual Cases
⦿ Wrong organ remove
⦿ Improper attire
⦿ Baby falls during delivery
⦿ Wrong baby assigned to the mother
⦿ Retained spinal needle
⦿ Rape
⦿ Expired drugs
BIZZARE CASES
⦿ Lost specimen
⦿ Treating a patient in the Casino
⦿ Injury sustained due to defective
ceiling/wall fan/drop lights
⦿ Wrong baby assigned to the mother
SOME UNETHICAL PRACTICES OF
PHYSICIANS…
⦿ Breach of confidentiality/Consent
issues
⦿ Fake training/misrepresentation and
unusual practices
⦿ Fees/Piracy
⦿ Unethical advertisements
⦿ Relationship with other specialties
⦿ Engaged in private practice
(government physician)
⦿ Obscene language
⦿ Ghost Specialist
Peculiar Factors That Lead To Malpractice
Suits

⦿ Took place on a Sunday or holiday

⦿ Appendectomy
⦿ Walk-in patients
¨ MARAMING
SALAMAT PO!!!

•Atty. Tony D. Rebosa,MD,BSCrim

¨ Castro Rebosa
Rebosa Law
Office
 Retr Maniacs
RJ Bar at DUSIT HOTEL, Makati City
every other Saturdays
 good
Rapport!
EAST AVENUE MEDICAL CENTER, March 27, 2008
Thank you very much!!! and ....God Bless!!!