General Santos Doctors' Medical School Foundation, Inc.

Bulaong Subdivision, Barangay West, General Santos City 9500

Tel No.: (083) 302- 350

Telefax No.: (083) 552-9793

Nursing Department

NURSING JURISPUDENCE
_______________________________________________________

In Fulfilment of the Requirements in NCM 107-A

Submitted to:
Ms. Belinda Jover, RN, MAN, PhD

Submitted by:
Shenecajean Carajay, SN
Miriam M. Carlito, SN
Kimah M. Drueco, SN

DATE:
OCTOBER 18, 2019
COURT CASE: WHERE WERE THE NURSES?

TWO DAYS AFTER undergoing bilateral knee replacement surgery, Dorothy Kline*
died of respiratory and cardiac arrest. Her family filed a malpractice suit against the
hospital alleging that negligence by the anesthesiologist and the nurses caused her
death.

The hospital sought summary judgment on the claim regarding the nurses, asserting
that no expert testimony had indicated that negligence by the nurses contributed to Mrs.
Kline's death. The court denied the motion, and the hospital appealed its decision.

Kline's family opposed the appeal, citing two depositions to the trial court by expert
witnesses. Ellen Rothman, RN, had indicated that the nurses had breached the
standard of care, and Samuel Vincent, MD, had testified about the cause of death.

The hospital claimed that their expert testimony wasn't enough to show that nursing
negligence caused Kline's death. It argued that Rothman had stated she wouldn't offer
an opinion on causation and Vincent had stated he didn't have an opinion on whether
the nurses had breached the standard of care.

The appellate court agreed that Rothman had indicated she wouldn't testify as to
causation but indicated that she "did provide testimony that the nurses breached the
standard of care" for a patient receiving epidural analgesia. Specifically, she said that
they'd failed to monitor and document Kline's vital signs, to adequately assess and
document her response to epidural analgesia, to notify the anesthesia department of a
change in her level of sedation, and to discontinue epidural analgesia according to
policy when arousing her became difficult.

And although Dr. Vincent's deposition was intended to shed light on the
anesthesiologist's practices, it too indicated deficiencies in the nurses' actions.
Explaining that the opioids could cause respiratory depression and that deepening
sedation could cause the tongue to obstruct the airway, he indicated that closer
monitoring would have detected Kline's slowing heart rate and breathing and dropping
oxygen saturation levels. "Missing the evidence of hypoventilation or airway
obstruction" he testified, led to respiratory and cardiac arrest from which she never
recovered.
The appellate court rule found a genuine issue of material fact as to whether the
nurses' negligence was the proximate cause of Kline's injuries and death. It concluded
that the trial court didn't err in denying the hospital's motion for summary judgment on
her husband's claim against the nurses.

SOURCE:

NURSING 2019

October 2007, Volume 37, Number 10, page 59-59.

Universal Health Care Law and what it
means to PH development

For the National Economic and Development Authority, which led the crafting of the
Philippine Development Plan (PDP) 2017-2022, the signing of the law is a big leap
towards reforming the country’s health care system.

“Our medium-term plan recognizes human development not just as a means to

economic development but as an end in itself. That is why the signing of the UHC law is
a victory scored for the health sector. We are glad that we have reached this milestone
halfway into the term of the Duterte administration,” Socioeconomic Planning Secretary
Ernesto M. Pernia said.

The law aims to address a number of recurring problems in the health system. First and
foremost, it assures 100 percent population coverage of PhilHealth—from the 98
percent population coverage in 2018 based on the same year’s Socioeconomic Report
by NEDA.

According to the law, PhilHealth members will be classified into two groups: contributory
(premium contributors from payroll) and non-contributory (fully subsidized from tax
collections).

The law also addresses the fragmented and overlapping roles and responsibilities of
various health agencies. For people like Porciuncula, this means that they will no longer
have to hop from one charitable institution to another. For instance, the Department of
Health (DOH) and local government units (LGU) will be responsible for population-
based interventions and health services (e.g., immunization programs and health
promotion programs) while PhilHealth will be responsible for financing individual-based
health services.

In addition, the new law is expected to significantly reduce the high OOP expenditure for
health. In 2017, about 54.5 percent of total health payment came from Filipinos’ own
pocket, with medicines and drugs as the main contributors. Lack of Philhealth coverage
of medicines for outpatients and the high cost of drugs and medicines in the country
push the OOP expenditure up.
“High out-of-pocket medical expenses push more people into poverty. When
households spend more on hospital bills and medical treatments, they are forced to
spend less on other basic necessities like food, housing, and education,” Pernia said.

The accompanying results matrix of the PDP 2017-2022 targets out-of-pocket-medical

expenses to go down to less than 50 percent of the total health spending by 2022.

Funding

According to the DOH, the implementation of the UHC law for its first year needs P257
billion. This will be sourced from sin tax collections and partly from income generated by
the Philippine Amusement and Gaming Corporation (PAGCOR) and PCSO in view of
improving benefit packages. This is apart from providing immediate eligibility and
access to health services, including preventive, promotive, curative, rehabilitative, and
palliative care, as well as out-patient drugs.

Pernia said the successful implementation of the sin tax reform law has been a boost to
programs and projects of the DOH. Based on the agency’s budget brochures, DOH’s
budget, including its attached agencies and corporations, increased by 13 percent from
PHP151 billion in 2017 to PHP171 billion in 2018. This was due to PHP113-billion six
tax revenues, of which PHP48 billion was allocated to PhilHealth’s premium subsidy for
the indigent, senior citizens, and sponsored members.

The law also provides for a special health fund that will be created and managed by
province-wide or city-wide health systems. All resources intended for health services will
be pooled to finance population-based and individual-based health services. Such will
also be used to cover operating costs, capital investments, and remuneration and
incentives for all health workers.

The Department of Health, in consultation with the Department of Budget and

Management and the local government units, is mandated to come up with guidelines
for the use of the special health fund.

All income from Philhealth payments will go to the special health fund, which will be
allocated by LGUs exclusively for the improvement of local health systems.
The crafting of the implementing rules and regulations, which will operationalize
provisions in the law, such as budget allocations, health financing, improvements in the
benefit packages, among others, is still ongoing. The law provides for a transition period
(i.e., Section 41) for LGUs and concerned government agencies for the full
implementation of the law.

Shortage

A 29-year-old nurse, Aira Cezar says, “We work for at least eight hours per day, but
some of us extend for another eight hours if there’s understaffing within the unit. We
always experience understaffing due to the exodus of nurses working abroad for better
pay.” Cezar has been working for six years in a public hospital’s emergency room in
Aklan.

The poor state of the population of health professionals in the country is another
concern the UHC law intends to address. With the Philippines being a major exporter of
health-care professionals, it constantly grapples with a shortage of health providers,
inevitably leading to poor quality of healthcare and high-stress levels among health
professionals.

The number of health workers in the country is not keeping up with the country’s
population growth. According to the DOH, the nationwide ratio of human resource for
health, which includes doctors, nurses, and midwives, is at 19.70 per 10,000 population.
This is still below the 23 per 10,000 population critical threshold recommended by the
World Health Organization (WHO).

Member countries of WHO, however, may opt to follow or not such recommendations.
The Philippines’ DOH, for example, follows ratios published in the National Objectives
for Health 2017-2022.[1]

The country also suffers from a disparity in the distribution of health workers in the
country. For 2018, the National Capital Region and the Cordillera Administrative Region
had the most number of health workers at 23.06 and 28.17 per 10,000 population while
the Autonomous Region of Muslim Mindanao is a stark contrast at 6.86 per 10,000
population, according to DOH records.
For this reason, the UHC law ensures the development of the health system’s human
resources through the formulation and implementation of the National Health Human
Resource Master Plan. It also ensures that all health professionals have permanent
employment and competitive salaries.

Similarly, the law provides for the creation of a national health workforce support system
that will help local public health systems in addressing human resource needs while
prioritizing deployment in the Geographically Isolated and Disadvantaged Areas
(GIDAs).

“I have nothing against the UHC law. The idea is good as every Filipino will receive
affordable and quality health benefits. But the law is useless unless the government
starts to recognize the value of those working in the clinical sector,” Cezar said.

The law also tasks the Commission on Higher Education (CHED), Technical Education
and Skills Development Authority (TESDA), Professional Regulation Commission (PRC)
and the DOH to develop existing and new allied and health-related degrees and training
programs, and to regulate the number of its enrollees depending on the needs of the
population. The law provides scholarship grants for graduate and undergraduate allied
and health-related programs.

All professional health graduates of government-funded scholarships will be required by

law to render at least three years of return service with compensation under the
supervision of the DOH. Incentives will be given to those who will render an additional
two years of return service.

More reforms

Secretary Pernia said more reforms should be done to ensure the smooth
implementation of the UHC law.

While the law already provides the mechanisms to improve health care in the
Philippines, he said that actual rollout by all those concerned is crucial, starting with
agency budgets.
“The DOH, for one, must efficiently utilize its budget to develop and strengthen health
infrastructure and human resources,” Pernia said noting that the agency’s budget
utilization rate was only 88 percent in 2017, according to the 2018 budget brochure of
DOH.

Also, the NEDA official said the function of LGUs to provide health services, which was
devolved through the Local Government Code of 1991, has not reflected in their health
spending. The health spending of LGUs comprised only 20 percent of overall
government spending on health in 2017, according to the Philippine Statistics Authority.

“The enactment of the UHC law is a defining moment for the Philippine health system.
We, at NEDA, are optimistic that its implementation will open the doors for more reforms
that will improve the health of Filipino people,” Pernia said.

He noted that the law brings the country closer to its collective long-term vision,
AmBisyon Natin 2040, where all Filipinos live long and healthy lives and where
healthcare is affordable and accessible.

One medical doctor per 20,000 population; 1 nurse per 10,000 population; and 1
midwife per 5,000 population. Data from DOH show that 28% of provinces have
attained the 1 MD/20,000 population, 99% have reached the 1 N/10,000 population, and
79% have achieved the 1 MW/5000 population.

Source:

REPUBLIC OF THE PHILIPPINES

National Economic and Development Authority