REGULATION OF HOSPITALS M2L4

ATTY. MAMENTA JANUARY 21, 2019

Outline
I. Definition of Hospitals
II. Classification of hospitals as to ownership, scope of service and functional
capacity
III. Role of the Department of Health- Health Facilities and Services Regulatory
Bureau
IV. Overview of DOH-mandated standards
V. Civil liabilities
VI. Doctrine of Respondent Superior
VII. Doctrine of Apparent Authority
VIII.Doctrine of Corporate Negligence
IX.BP 702 as amended by RA 8344 and RA 10932 and its Implementing Rules
and Regulations
X.RA 9439 and its Implementing Rules and Regulations

• Italics – Transers Note- Mej mahirap sundan ung lecture ni

attorney ☹

Definition of Hospitals
Hospital
• A place devoted primarily to the maintenance and operation of
facilities for the diagnosis, treatment and care of individuals
suffering from illness, disease, injury or deformity, or in need of
obstetrical or other medical nursing care.
• Any institution, building or place where there are installed beds, REGULATION OF HOSPITALS
or cribs, or basements for 24-hour use or longer by patients in • State Regulation
the treatment of disease, injuries, etc. oStatutory basis; Hospital Licensure Act (RA 4220) and its
implementing rules and regulations.
Classification of Hospitals • Self-Regulation
According to Ownership o For discipline, order, convenience and other reasons that
• Government governing board of the hospital decides.
o Operated and maintained either partially or wholly by the DOH Mandated Standard
government, or by aby department, division, board, or other • Every health facility shall be organized to provide safe, quality,
agency of the government. effective and efficient services for patients
o Government hospital created by law (DOH AO 2012-0012, • Personnel
Rule V. B. 1. a. 1) o Adequate number of qualified, trained and competent staff to
• Private ensure efficient and effective delivery of quality services.
o Privately owned, established, and operated with funds raised • Physical facilities
or contributed through donations, or by private capital of other o With adequate areas to safely, effectively and efficiently
measures. provide health services to patients as well as members of the
(Hospital Licensure Act (RA 4226)) public as necessary.
According to Scope of Service • Equipment and Instruments
o Available and operational equipment and instruments
• General
consistent with the services it will provide.
o Provides services for all kinds of illnesses, diseases, injuries
and deformities. • Services delivery
o Equipped with service capabilities needed to support medical o Ensure that services delivered to patients comply with the
specialists and other licensed physicians rendering various standard quality embodied in the Assessment Tool for
clinical services, emergency services, outpatient services and licensure or accreditation of health facilities, other policy
ancillary and support services. guidelines and/or related issuances.
▪ Clinical services • Quality improvement and activities
✓ Family Medicine o Establish and maintain a system for continuous quality
✓ Pediatric improvement activities.
✓ Internal Medicine • Information management
✓ Obstetrics and Gynecology o Maintain a system of communication, recording and reporting
✓ Surgery of results of examinations.
• Specialty • Environmental management
o Specializes in a particular disease or condition or in one type o Ensure that the environment is safe for its patients and staff
of patient including members of the public as necessary.
According to Functional Capacity
• Level 1 Civil Liabilities
• Level 2 • Doctrine of Respondent Superior -indirect
• Level 3 • Doctrine of Apparent Authority- indirect

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• Doctrine of Corporate Negligence
Suitability and Liability: Government vs Private
Hospitals
• Government Hospital- State owned
oMay not be sued “without its consent” (Art. XVI, Sec 3,
Constitution)
o If it consents, it may be held liable only if it acts through a
special agent. (Art 2180, Civil Code)
• Private Hospital
o Charitable
▪ Pays no dividend, has no capital stock, seeks no profit
▪ May be granted immunity at best (since they would bill
patients lower)
o Operating for profit
▪ No immunity
Vicarious/Indirect Liability:
Respondeat Superior Doctrine “Let the master answer”
o Art. 2176, Civil Code. Whoever by act or omission causes
damage to another, there being fault of negligence, is obliged
to pay for the damage done.
o Art. 2180, Civil Code. The obligation imposed by Article
2176 is demandable not only for one’s own acts or
omissions, but also for those persons for whom one is
responsible.
So, for this doctrine, you pay for the damage that you caused
but its not only the person who caused the damage that can
be held liable, it can also be its superior, its employer, its
principal.
o Art 2180, Civil Code. The owners and managers of an
establishment or enterprise are likewise responsible for
damages cause by their employees in the service of the
branches in which the latter are employed or the occasion of
their functions.
Meaning as long as the employee did the act or omission
within the scope of its responsibility or scope of service, the
employer shall be held liable for the damages caused by the
employee acting within the scope of its assigned task.
o …Employers shall be liable for the damages caused by their
employees… acting within the scope of their assigned task.
• Requisites: Employer- Employee Relationships
o Employee was chosen by the owner, manager or employer
personally or through another.
o The services of the employee are to be rendered in
accordance with the orders which the employer has
authority to give at all times. If pasaway lang talaga si
empleyado, unfair naman kay employer to be held liable.
o The wrongful act of the employee was on the occasion or by
reason of the functions entrusted to him/her.
• Four-Fold Test (Determining Employer-Employee
Relationship)
o Selection and engagement of services “The power to hire”
o Payment of wages or salaries
o The power to fire; and
o The power to control conduct
If one is missing there’s no employer-employee relationship
Employee Relationship
Nursing staff
• Nursing student × has temporary control and supervision over them while
• Staff RN  performing their duties.
• Special duty RN ×
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HOSPITAL REGULATION M2L4
Medical staff
• Medical intern ×
• Resident Physician* 
• Consultant Physician ×
The relationship of the Special duty RN is between the patient and the
nurse on duty. It was the patient who hired the nurse, not the hospital.
CASE 1- Employer-Employee Relationship Calamba Med vs NLRD
GR 176484
According to this case the control test or the number 4 requirement
of the four-fold test. An employment relationship exists between a
physician and a hospital if the hospital controls both the means and
the details of the process by which the physician is to accomplish his
task. Also, a person who works for another who does so more or less
at his own pleasure is not subject to definite hours or conditions of
work. So, meaning that person can go to work anytime he wants, like
a consultant, there is no employer-employee relationship.
For the control test to apply it is not essential for the employer to
actually supervise over the employee being enough that they have
that power. As long as you have sorts of control over your employee
like a code of conduct but if your employee is not covered by your
code of conduct then you can say that you don’t have any control over
that person.
Case 2- Employer- Employee Relationship. GR 134354
In this case the hospital was held solely liable with its consultant
because there was no Employer- Employee relationship
between the Hospital and the Consultant who was at fault.
The Hospital argued it does not hire or engage the services
of a consultant but accredits the latter and grants him
privilege of maintain a clinic and admitting patients to the
hospital upon showing by the consultant that he possesses
necessary qualifications such as accreditation by the
appropriate board. The hospital was acquitted in this case
because they were able to prove that there was no
Employer-employee relationship between the hospital and
the consultant neither is there any showing that the hospital
which pays any of its consultant for medical services
rendered by the latter to the respective patients.
In cases where a disciplinary action is lodged against a consultant,
the sign?? Is initiated by the department to whom the consultant
concerned belongs and filled with the ethics committee consisting of
the department’s specialty heads. The medical director, hospital
administrator merely acts as officiant members of the said committee
so there’s no power to fire.
• Independent Contractor Theory
o Independent Contractor- one whose physical activities in the
performance of services is not controlled by, or subject to the
control of the principal- which is the hospital.
o The Independent contractor alone is liable for his wrongful
acts; the hospital is exempt.
Case ng buntis na pinadala ng isang consultant who needed
the hospitals facilities to operate since emergency. There was
negligence on the part of the consultant. The hospital was not
to be held liable because of the negligence of the consultant
because he/she is not an employee of the hospital but an
independent contractor.
• Borrowed Servant Doctrine
o Hospital employees (e.g. resident doctors, nurses, etc.) are by
fiction of the law borrowed from the hospital by whoever
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o The new employee or master must be held liable for wrongful
acts of the hospital employees committed under their
temporary control and supervision where these wrongful acts
were done in their service.
o (this is a defense available for the hospital daw) Art. 2180,
Civil Code. The responsibility treated of in this article shall
cease when the person herein prove that they observed all the
diligence of a good father of a family to prevent damage.
(i.e. the hospital observed ordinary care and diligence in the
selection and supervision of the employee then they can be
held not liable)
This one applies particularly in the operating room, and is
related to the captain of the ship doctrine. It says that upon
the start of the operation it is the surgeon who has control
over everything during the operation. A nurse who is part of
the operation is a borrowed servant of the surgeon. The
surgeon is the master even if the nurse is an employee of the
hospital. So, whatever happens during the operation, the
surgeon can be held liable for the negligent acts of the nurse.
Doctrine of Apparent Authority
• “Holding Out” Theory, Ostensible Agency, Agency by
Estoppel
• Art. 1869, Civil Code. Agency may be express, or, implied
from the acts of the principal, from his silence or lack of action,
or his failure to repudiate the agency, knowing that another
person acting on his behalf without authority.
Its implied agency when the hospital made it appear that there
are people who are not really its employees but by implied acts
of the hospital it appears to patients that these persons hospital
employees. So, there is no expressed admission with regards to
who the principal’s agent is. Liable hospital dito pag may
negligence sa mga agents nila.
Express agency, you will say that “I am the principal, this is my
agent and whatever the actions or omissions of my agent, I will
be held accountable.”
• Art. 1431, Civil Code. Through estoppel, an admission or
representation is rendered conclusive upon the person making it,
and cannot be denied or disproved against the person relying
thereon. So, if the patient relied on that agency then the hospital
cannot disprove that.
If you remember as a rule, a consultant is not an employee of
the hospital, so it cannot be held liable under the respondeat
superior doctrine because that requires employee-employer
relationship. Tho, it can be held liable under the doctrine of
apparent authority as an exception, the hospital will be liable
for the physician’s negligence->
• Where a hospital, by its actions, has held out a particular
physician as its agent and/or employee and a patient has
accepted treatment from the physician in the reasonable belief
that it is being rendered in behalf of the hospital, then the
hospital will be liable for the physician’s negligence.
• Imposes liability, not as the result of the reality of a
contractual relationship, but rather because of the actions of a
principal or an employer in somehow misleading the public into
believing that the relationship or the authority exists.
So, if there was that misleading perception and the hospital did
not do anything to correct that perception, then the hospital can
be held liable.
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HOSPITAL REGULATION M2L4
• Two Factors in Determining Apparent Authority
o Hospitals Manifestations
▪ Whether the hospital acted in a manner which would lead
a reasonable person to conclude that the individual who
was alleged to be negligent was an employee or agent of
the hospital
Some sort of implied manifestation from the hospital.
Like in a form of listing down all your consultants,
putting it in a bulletin board or newspaper, or whatever.
o Patient’s reliance
▪ Whether the patient acted in reliance upon the conduct
of the hospital or it’s agent, consistent with ordinary care
and prudence.
It’s like, if not for the implied actions from the hospital,
the patient would not have chosen that doctor.
*pro hac vice case* the decision is only applicable in this case due
to a special circumstance. PSI vs Agana.
So, the negligence here was when there were 2 gauzes left inside the
patient which left to complications. The surgeon, no question was
held liable, but in this case even the hospital was held liable since it
admitted that it has corporate negligence.
First factor- Hospital manifestation. The hospital publicly displays in
the lobby of the medical city the names and specializations of the
physicians accredited by it, including those doctors involved in the
case
Second factors- reliance of the patient. When the husband of the
patient testified as to what compelled him to chose doctor A, it was
clear that his decision was significantly influenced by the impression
that the doctor was a staff member of The Medical City. Doctor A
was not independent of but as integrally related to the hospital.
Direct Liability:
Doctrine of Corporate Negligence
• “Doctrine of Corporate Responsibility”
• Those arising from failure of the hospital to fulfill its direct
corporate obligations.
• Proceeds from the reality that in those modern times, the duty of
providing quality medical services is no longer the sole
prerogative and responsibility of the physician.
• Hospitals now tend to organize a highly professional medical
staff whose competence and performance need to be monitored
by the hospitals commensurate with their inherent responsibility
to provide quality medical care.
• Primary Duties of Hospitals (Solis PP)
o Furnish a safe and well-maintained building and ground
o Furnish adequate and safe equipment
o Exercise reasonable care in the selection of the members of
the hospital staff
• Corporate duties of Hospitals (Jurisprudence)
o Having sufficient number of trained nurses attending the
patient
o Requiring a consultation with or an examination by members
of the hospital staff
o Reviewing treatment rendered to the patient
o Using of reasonable care in the maintenance of safe and
adequate facilities and equipment
o Selection and retention of only competent physicians
o Oversee and supervise as to patient care all persons who
practice medicine within its walls and all its medical staff
o Formulation, adoption and enforcement of adequate rules and
policies that ensure quality of care for its patients.
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PSI vs Agana- Hospital liability was based on doctrine of apparent officer. Since the director is part of the hospital board wherein they
authority and corporate negligence, so the medical city was held elect the officers of the hospital kaya ayun.
liable on two grounds. Diba nakaiwan ng gauze, and there was Republic Act of 9349
evidence of that. The hospital has a corporate duty even after the
• An Act prohibiting the detention of patients in hospitals and
operation to ensure the patients safety. The hospital admitted that
medical clinics on grounds on non-payment of hospital bills
it could have followed up the patient, but it did not do that duty to
or medical expense
correct the negligence, there was inaction. Right there it failed its
Before they require deposit just in case eventually walang
own standard of hospital care committing corporate negligence.
pambayad si patient. Yung ibang hospital na hindi nag rerequire
ng deposit, what they do is hindi nila pinapaalis hangat hindi
Batas Pambansa 702 amended by RA 8344 and RA 10932 bayad.
• An act penalizing refusal of hospitals and medical clinics to This law actually excepts patients who were admitted in a
administer appropriate initial medical treatment and private room. If ung patient nag paadmit sa private room tapos
support in emergency and serious cases. AKA “anti-hospital wala naman pala silang pambayad hindi sila under dito sa law.
deposit law.” • Unlawful Acts
• Emergency- a condition or state of a patient wherein based on o Detaining or otherwise causing directly or indirectly the
the objective findings of a prudent medical officer on duty for detention of patients who have fully or partially recovered
the day there is immediate danger and where delay in initial or have been adequately attended to, or have died, for reasons
support and treatment may cause loss of life or cause of nonpayment in part or in full of hospital bills or medical
permanent disability to the patient, or in the case of a pregnant expenses.
woman, permanent injury or loss of her unborn child, or would o The hospital must allow the patient to leave or the cadaver to
result a non-institutional delivery be released with their pertinent documents- yung death cert.
• Serious case- a condition of patient characterized by gravity or • Remedy of the Hospital
danger wherein based on the objective findings of a prudent o Ask for a promissory note to cover the unpaid obligation,
medical officer on duty for the day when left unattended to, kung patay na ang patient, this will be made and signed by
may cause loss of life or cause permanent disability to the the nearest of kin. If the relative failed to execute this, the
patient, or in the case of a pregnant woman, permanent injury, hospital can deny the release of the cadaver.
or loss of her unborn child. o The promissory note shall be secured by either a mortgage
• Unlawful acts in Emergency and Serious cases or a guarantee of a co-maker who will be jointly and
o Requesting, soliciting, demanding or accepting any deposit or severally liable with the patient for the unpaid obligation.
any other form of advance payment as a prerequisite for • Criminal Liability of the Responsible officer/ Employee
administering basic emergency care, or for confinement or o Fine of not less than 20,000 but nor more than 50,000 and/or
medical treatment of a patient. o Imprisonment of not less than 1 month, but not more than 6
o Refusing to administer medical treatment and support as months.
dictated by a good practice of medicine to prevent death or
permanent disability or in the case of a pregnant woman,
permanent injury or loss of her unborn child or non-
institutional delivery. Sources:
• Other measures PPT
o The hospital must prominently display a copy of the Batas Transer notes
Pambansa 702 as amended at the hospital ER, counters,
medical premises
o The billing and collection procedures for treatment and
confinement shall not commence until the essential,
appropriate treatment has been completed.
The hospital can collect after the emergency case has been
treated or the serious case has been abated.
What RA 10932 did was to increase the penalty
• Penalties for official, medical practitioner, or employee
o Imprisonment of not less than 6 months and 1 day but not
more than 2 years and 4 months OR
o Fine of not less than 100,000.00 but not more than 300,000.00
OR
o Both
• Penalties for Directors or Officers
o Imprisonment of 4 to 6 years OR
o Fine of not less than 500,000.00 but not more than
1,000,000.00 or
o Both
You might be confused bat may official tapos meron pang officer,
wala daw mistake in part of the law, when we say director or officers
here, the officer refers to the director of the hospital who is also an

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