Lecture: FORENSIC MEDICINE 2019

Title: MEDICAL MALPRACTICE

Topic Outline:

I. INTRODUCTION:

“Being sued is an occupational hazard. And doctors, particularly surgeons,

could find themselves a recipient of a subpoena any day.
Our society has been brainwashed to put a very high premium on and to
expect quality service so that if something untoward happens to a patient, the first
thing people think of is an ‘iatrogenic cause,’ a term used for ‘accidents’ caused by
health workers.

Media play up of the few malpractice cases in the country coupled with
easy access to a wealth of clinical information, patients are becoming more aware
of their rights, fast to criticize the doctors’ shortcomings and demand
compensation. But while doctors may and do commit errors, not all are guilty, and
some are merely victims of transference. Some patients or their next of kin may
seek to shift the burden of loss, fault, and cost to someone else and the doctor is
often at the receiving end.

There are other factors that could lead to malpractice cases, these are:
1. Snobbery towards patients and co-workers;
2. Criticisms of fellow health workers in front of patients;
3. Failure to respect other health professionals, e.g. nurses, resident
physicians, medical interns, health assistants, technicians, etc.;
4. Lack of review and reporting of substandard conduct;
5. Pursuit of money, power, and prestige.

The Malpractice Bill No. 4955 called “Medical Malpractice Act of 2002”
with TV Host Korina Sanchez as its media champion has brought into focus and
magnified the few medical malpractice suits in the country for a time.

This Medical Malpractice Act of 2002 likewise involves not only medical
practitioners per se:

Section 3. Definition of terms. States to wit:

(1) “Medical Practitioners” shall refer to any physician, dentist, nurse,

pharmacist, paramedical or other supporting personnel (including medical and
dental technicians, nursing assistants, and therapists);
(2) “Malpractice” shall refer to any personal injury, including death, caused
by the negligent and wrongful act or omission of any medical practitioner.”

II. MALPRACTICE:

A. Definition of Malpractice: The failure on the part of the medical

practitioner to perform properly the duty which devolves around him in his
professional relation to his patient, a failure which results in some injury to his
patient.

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 In order to successfully pursue such a claim, a patient must prove that a
health care provider, in most cases a physician ( in our particular case, the
surgeon), either failed to do something which a reasonably prudent surgeon would
have done, or that he or she did something that a reasonably prudent surgeon
would not have done; and that failure or action caused injury to the patient.

Good Medical Practice is the standard; it comprehends what the average,

careful, diligent, and skillful doctor in the community or like communities, would
or would not do in the care of similar cases. If the physician fails to meet the
standard operating procedures demanded of him/her and if, as a result, the
patient suffers injury, the doctor becomes liable.

B. Differentiate “malpractice” from “illegal practice”

Illustrative cases:

Case 1: Illegal Practice:

Dr. Santos, a duly licensed doctor of medicine, who had no formal training
in Surgery operates on a patient with embolism of the Left Femoral Artery for
Embolectomy for which he received compensation. Case: Illegal practice of
Surgery.

Decision:
The Supreme Court ruled that Dr. Santos, although a licensed practitioner
of medicine, could not legally do Vascular Surgery without first obtaining a formal
residency training in General Surgery, and a subspecialty training in Vascular
Surgery.

Case 2: Malpractice
Dr. Cruz, a Vascular Surgeon, paying his privilege tax, operated and
amputated the right leg of a patient with embolism of the Left Femoral Artery.

C. Four elements involved in Medical Negligence:

1. Duty- Medical Practitioners have a duty to use at least the
same level of care that any other reasonably competent medical practitioner
would use to treat a condition under the same or similar circumstances.
2. Breach (dereliction of duty) – The breach of professional duties
of skill and care, or their improper performance constitutes actionable
malpractice;
3. Injury – In the event that any injury results from want of due
care or skill, the surgeon maybe held answerable and damages for negligence may
be claimed.
4. Proximate causation – Another element in medical negligence
cases is causation which is divided into two (2) inquiries: whether the actions or
omissions in fact caused the harm and whether these were the proximate cause of
the injury.

Two-pronged Evidence. – In malpractice or negligence cases, the necessity

of expert testimony and availability of the charge of res ipsa loquitor ( to be
explained later) to the plaintiff, have been applied. Essentially, it requires two-
pronged evidence: evidence as to the recognized standards of the medical
community in the particular kind of case, and a showing that the physician
negligently departed from this standard in his treatment.

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 The standard contemplated is not actually the average merit among all
known practitioners from the best to the worst and from the most to the least
experienced, but the reasonable average merit among the ordinary good
physicians.

Admittedly, established medical procedures and practices, though in

constant flux, are devised for the purpose of preventing complications. A
physician’s experience with his patients would sometimes tempt him to deviate
from established community practices, he may end a distinguished career using
unorthodox methods without incident. However, when failure to follow
established procedure results in an evil precisely sought to be averted by
observance of the procedure and a nexus is made between the injury or damage,
the physician would necessarily be called for to account for it.

What really makes for negligence or malpractice?

Medical negligence constitutes the “failure of a physician to use such care

as a reasonable prudent doctor would use under similar circumstances or in the
same locality. It also covers the conduct of a physician that falls below the
standards accepted by medical profession for the protection of patients. These
standards are embodied in applicable laws, JURISPRUDENCE, Department of
Health memoranda and circulars, medical professional codes of ethics, and
internal standards that cover a doctor’s job description ( such as Policies of the
Philippine Medical Association, if a physician is a consultant or admitting
physician in a hospital setting, then hospital policies and procedures, and
customary practice.

 doctors practicing in small barangays vs. doctors practicing in big

cities and hospitals.
 Specialists vs. ordinary practitioner

Specialists are presumed to possess a higher degree of skill and knowledge

and to exercise a higher degree of skill and care than an ordinary practitioner.

There is thus a presumption in favor of the practitioner, in the absence of

proof to the contrary, that the operation or work done by a surgeon was carefully
and skillfully done. And because of this presumption, the burden of proof is on the
person who asserts otherwise and not the physician-surgeon.
Implication, the complainant must prove want of skill and negligence.

The accepted rule is that negligence must be proved by expert medical

testimony unless negligence is so grossly apparent that a layman would have no
difficulty in recognizing it.

Doctrine of “Res ipsa loquitor”, the thing or transaction speaks for itself.

No proof of negligence is required beyond the accident itself. This is thus an

exception to the general rule that the person claiming damages has the burden of
proving the existence of negligence causing the damage.

The doctrine of res ipsa loquitor asserts that:

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 Whenever a thing which produced injury is shown to have been under the
control and management of the defendant (physician), and the occurrence is such
that in the ordinary course of events, does not happen if those in management
used proper care, it affords reasonable evidence, in the absence of explanation by
the defendant, that the accident arose from want of care.

Res ipsa loquitor is applicable in several cases:

1. leaving a foreign object in the body of the patient after an

operation;
2. Injuries sustained on a healthy part of the body which was not
under , or in the area of treatment;
3. Removal of the wrong part of the body when another part was
intended;
4. Knocking out a tooth while the patient’s jaw was under anesthesia
for the removal of his tonsils;
5. Loss of the eye while the patient plaintiff was under the influence of
anesthetic, during or following an operation for appendicitis.

Res ipsa loquitor when NOT Applicable:

- In a suit against a physician or surgeon which involves the merits of
a diagnosis or of a scientific treatment. The physician or surgeon is not
required at his peril to explain why any particular diagnosis was not
correct, or why any particular scientific treatment did not produce the
desired result. Thus, Res ipsa loquitor is not available in a malpractice suit if
the only showing is that the desired result of an operation or treatment
was not accomplished.

Furthermore, it has been brought out in some cases that a physician is not
an insurer or guarantor of results. There is always a risk involve in any procedure.
It is not 100% guaranty for cure or perfect fit! So to speak!

Not all errors of judgment, the doctor may be liable, if the doctors exercise
due care and skill in the performance of his duty, errors in judgment may be
overlooked, as long as it is not grossly ignorant.

1. Dereliction to duty
Dereliction of duty is when a doctor fails to fulfill the obligations he
brought upon himself when he entered into a contract with his patients, albeit
implied, at the time that the doctor-patient relationship was established.

2. Damage
But dereliction of duty by itself does not constitute malpractice. It has to be
further proved that the doctor’s failure to fulfill the duty caused the patient
damage or injury, physical or otherwise. The damage should and ought to be the
direct result of such dereliction of duty.

For example:
A doctor failed to get a medical clearance for surgery of a 50-year old
female who was suffering from Hypertension. Obviously, there is here a
dereliction of duty. Then after the surgery, she died after extraction.
Autopsy revealed that the cause of death is ruptured aortic aneurysm.

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 What do you think? Should the doctor be held liable for her death? Ask the
opinion of participants. Discuss.

3. Direct causation--- that needs to be met to establish that negligence did

take place.

And it has to be proved further that the alleged damage was a direct result,
with no intervening events, of the doctor’s failure to fulfill his duty.

Generally, diagnosis and treatment based on sound medical practice may

be a basis for a good defense. ?????

Complications, if they are inherent and anticipated are generally

acceptable, what is important is that the patient is informed of them from the
start, because if you do not tell the patient of the complications, and these
happened, the patient would then suspect negligence.

III. CONFIDENTIALITY RULE:

The risk of being sued, however, can be minimized by adhering to the rules
of confidentiality and informed consent. The rule of thumb is the “the privilege
against disclosure belongs to the patient and nobody else”.

There are however, circumstances under which information may be

disclosed. These are:
o When the patient has waived confidentiality, whether in an
expressed (like when a patient, the patient’s legal representative, or
guardian has gone to court) or implied (when the patient sues the doctor,
takes the witness stand, or asks the doctor to testify in court) manner.
o When there is an overriding public interest in the information, like
when the patient has a highly contagious disease that disclosure becomes
necessary to ferret out and detect people the patient may have become in
contact with in the general population.
o When the record is being reviewed for quality assurance, education,
or when it is the subject of a court order or legislative investigation.
o When the law, statute or government directive requires disclosure,
like cases or HIV/AIDS, which cases have to be reported to the DOH.

Doctors are not bound by the confidentiality rule when the information has
been disclosed by the patient outside of the doctor-patient relationship, meaning
it was told by the patient to the doctor in the presence of third parties (for
example patient’s barkada) other than the doctors’ staff. So, your secretary or
assistant are bound by the confidentiality rule, and you may be held liable if they
disclose the information.

To ensure confidentiality and protect the patient as well as the doctors’

interest:

 To not readily acknowledge to any requesting party that the individual

is their patient;
 Not give medical information over the phone;
 Ask parties seeking information to make their requests in writing and
keep the written request on file;

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  Check your files for up-to-date written authorization from the patient;
and verify the identity and credentials of any party requesting for patient
information.

All information involving doctor-patient relationship is deemed privilege

communication and this includes written and verbal patient communication;
information obtained in the course of examining and treating the patient;
background information, observations, x-rays, laboratory findings, financial
information, diagnosis, prognosis; and all information contained in the dental
record. None of these may be disclosed to any third party and the doctor may
invoke confidentiality except in criminal proceedings.

Medical records must always be kept intact and protected because

these serve not only as basis for continuity of patient care and treatment, but also
as documentary evidence to protect the interest of both patient and doctor.

The role of the teeth in human identification cannot be overemphasized for

the following reasons:

1. The possibility of two persons to have the same dentition is quite

remote. An adult has 32 teeth and each tooth has 5 surfaces. Some teeth
may be missing, carious, with filling materials, and with abnormality in
shape and other peculiarities. This will lead to several combinations, with
almost infinite possibilities in number of dental characteristics.

Fingerprinting is very important in identification when the cadaver is fresh.

Dental identification is important when the cadaver is fresh and when
putrefaction has set in or when it involves only the skeletal remains.

2. The enamel of the teeth is the hardest substance of the human

body. It may outlast all other tissues during putrefaction or physical
destruction;

3. After death, the greater the degree of tissue destruction, the greater
is the importance of dental characteristics as a means of identification;

4. The more recent the ante-mortem records of the person to be

identified, the more reliable is the comparative or exclusionary mode of
identification that can be done.

IV. INFORMED CONSENT:

Informed consent is vital, but obtaining it is not as easy as generally

perceived. If you get informed consent, 95% of your problem is solved. In certain
high risk patients, informed consent is necessary. Likewise, there is certain Medical
Clearance necessary before certain dental procedures/treatment can be done.
Example, you have a patient, known to you to be diabetic or with hypertension or
a cardiac problem. There is a need for Medical clearance before certain procedures
or treatment can be done. Most if not all medical procedures is tension producing,
just anticipating a dental extraction or even dental prophylaxis for that matter
may cause high blood pressure. In a patient suffering from hypertension, this may
trigger an MI or a stroke. Patient at least 35 years old should be required to get a
Medical clearance before any medical procedure is done.

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 If there is a medical clearance, then do the necessary taking of BP, pulse
rate, and listen to the heart sounds. Things may have changed from the time the
Medical clearance was issued up to the time of dental procedure is scheduled to
be done.
Have a consent form signed by the patient after the doctor should have
explained the procedure, its possible complications and the alternatives to it have
been explained.
This is the essence of informed consent. The consent is freely given even
after the patient has understood the attendant risks and benefits, the procedure is
legal and the patient who gives the consent is of legal age and sound mind.

The balance between saying too little and risking an uninformed patient
versus saying too much and scaring the patient into not going through the medical
procedure and therefore losing your medical/ surgical fees is difficult to achieve.
Here comes the art of balancing, which comes with practice.

V. IMPLIED DUTIES AND OBLIGATIONS OF DOCTORS:

Outside of the contractual obligations of doctors toward their patients in

the performance of their duties as such, they are also bound to perform such
duties in accordance with certain implied or presumed obligations from the start
of their practice. In the patient-doctor relationship, every doctor is presumed to
have the following obligations in summary:

1. To possess reasonable degree of skill, learning and experience. This

means that he possesses the ability and dexterity equal those of the
average doctor in the locality;
2. To use reasonable and ordinary care and diligence. This means that
the doctor must pay attention to his patient so that the patient’s safety and
protection is safeguarded.
3. To use his best judgment. That is to exercise his discretion in good
faith. The doctor must exercise his BEST judgment not just a GOOD
judgment or BETTER judgment, but the BEST!
4. To keep the professional trust of his patient. This means to keep in
confidence whatever the doctor has perceived of his patients. The doctor
must guard against betrayal of professional trust.
These rules apply even to gratuitous service or charity services.

VI. OBLIGATIONS NOT INCLUDED IN THE Patient-Doctor Relationship:

1. The doctor does not imply that his treatment will be a success;
2. Nor does he guarantee that his management will be successful;
3. Nor guarantee that there is no error of judgment.

VII. OBLIGATIONS of PATIENT to DOCTOR:

1. The patient must give an honest history of his case; he must give a
true declaration of facts;
2. The patient must cooperate and follow instructions of his doctor;
3. He must exercise necessary precautions. In other words, he must
not be stranger to his own problem.

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 VIII. RIGHTS OF A DOCTOR:

1. To choose his patients, except in case of an emergency where he may not

refuse to treat a patient;
2. To limit his practice:
a) To that which is in consonance with his specialty;
b) Geographically or politically or in time or within the
limits of his conscience;
3. He can avail of hospital services. Government Hospitals are easily
available because he is a taxpayer. Private Hospitals may be more difficult
to avail of;
4. He has the right to choose his line or management of treatment ;
5. He has a right of way, that is, when called to an emergency, he can avail
exception to traffic rules;
6. The medical apparatus and all medical equipments and instruments in
the practice of the doctor are free from attachments, otherwise this would
be adding insult to injury;
7. The doctor has the right to compensation, simple or contingent,
depending on the success of the treatment or on some conditions.

VIX. Cases when NO Doctor-patient relationship Exists:

1. Physical examination given for a position;

2. Physical examination given for purposes of insurance;
3. Check-up ordered by the Court;
4. Casual patient-a gesture of social civic obligation. (e.g. medical missions)

IX. CRIMINAL LIABILITIES OF DOCTORS:

No one is above the law. And there is a conclusive presumption against

everyone that everyone knows the law:
“Ignoratia legis nonimen excusat”, meaning, ignorance of the law excuses
no one.

Crimes or felonies are acts or omissions punishable by law. So if there is no

law punishing an act or omission, there is no crime committed.

Elements of a crime:

1. A law declaring an act or omission illegal;

2. Criminal intent. To constitute a crime, the act must, except in
certain cases made by such statute, be accompanied by criminal
intent. The maxim is: “A crime is NOT committed if the mind of the
person performing the act complained of be innocent.”
3. There must be an act or omission.

However, crimes are committed not only with criminal intent, but also
through NEGLIGENCE. Hence, a practicing doctor, therefore, may be held criminally
liable FOR UNINTENTIONAL injuries suffered by the patient when such injuries (or
death) of the patient are the results of reckless or simple imprudence or
negligence, that is, when they resulted from the ignorance, negligence or lack of
skill of the doctor.

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 Example: A doctor fails to take the medical history of the patient and the
patient dies of anaphylactic shock following an allergic reaction to a drug
administered.
Compare with the earlier example: A doctor fails to get a medical clearance
first before performing a minor procedure on the patient, the patient died of
Aortic Aneurysm shown by autopsy.
Under American and English law, this is MALPRACTICE. In the Philippine
law, as of now, there is no offense known as MALPRACTICE, but an administrative
action for malpractice may be filed against the doctor before the Board of
Medicine (PRC) for revocation or suspension of his certificate of registration.
Under our law, the failure to perform any of the aforesaid implied
obligations, resulting in death of the patient is termed as Homicide through
reckless or simple imprudence, as the case may be.
If the patient does not die, but suffers only physical injuries, the offense
committed should be classified as serious Physical injuries through reckless
imprudence, or slight physical injuries through reckless or simple imprudence, as
the case may be.
Imprudence or negligence is not a crime in itself, it is simply a way of
committing a crime.
Imprudence or negligence merely determines a lower degree of criminal
liability. Imprudence or negligence becomes punishable only when it results in
crime. (People vs. Faller, 67 Phil. 529)

Negligence under the Penal Code and that under the Civil Code:

A negligent act causing damage may produce civil liability arising from
crime or create an action for quasi-delict.
Under the Civil Code, the injured party may choose which remedy to
enforce. He cannot recover twice for the same act or omission of the defendant.
(Art. 2177, New Civil Code)

Imprudence and Negligence distinguished:

Imprudence indicates a deficiency of action;

Negligence indicates a deficiency of perception, hence failure in precaution
is termed imprudence. Failure in advertence is termed negligence.

The wrongful acts may be avoided on two levels:

1. by paying proper attention and using due diligence in

foreseeing them; and
2. By taking the necessary precaution once they are foreseen.

Failure to do the first is negligence. Failure to do the second is imprudence.

Reckless Imprudence consist in voluntarily, but without malice , doing or

failing to do an act from which material damage results by reason of inexcusable
lack of precaution on the part of the person performing an act, taking into
consideration his employment or occupation, degree of intelligence, physical
condition, and other circumstances regarding person, time, and place. (Art. 365,
Revised Penal Code).

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 Reckless imprudence or negligence means lack of foresight, carelessness,
lack of skill when the harm is preventable in the exercise of reasonable care, when
the danger is visible and consciously appreciated by the author, that is, visible to
the eyes even without the use of intelligence.

Simple Imprudence consists in the lack of precaution displayed in those

cases in which the damage impending to be caused is not immediate or the danger
clearly manifest. (Art. 365, Revised Penal Code)

Simple Imprudence is, therefore, the mere lack of precaution in those cases
where either the threatened harm is not imminent, or the danger is not openly
visible, and visible only through the use of intelligence.

Negligence is failure to observe, for the protection of the interests of

another person, the degree of care, precaution, and vigilance which the
circumstances justly demand, whereby the other person suffers injury.

Test of Negligence:

The test for determining whether a person is negligent in doing an act

whereby injury or damage results to the person or property of another is this:

“Would a prudent man, in the position of the person to whom negligence is

attributed, foresee harm to the person injured as a reasonable consequence of the
course about to be pursued? If so, the law imposes a duty on the actor to refrain
from that course, or to take precautions from the mischievous results, and the
failure to do so constitutes negligence. Reasonable foresight of harm, followed by
the ignoring of the admonition born of this provision, is the constitutive fact in
negligence. (Picart vs. Smith, 37 Phil. 809)

X. DEFENSES:

A. ACCIDENTAL PHYSICAL INJURY:

No liability attaches for injuries resulting from pure accident. When we say
accident, we exclude negligence. An accident is any event which could not be
foreseen, or which, though foreseen, was inevitable. (Art. 1174, Civil Code)
A doctor cannot be held criminally liable, for any accidental injury to the
patient during the course of the treatment because, “Any person who, while
performing a lawful act with due care, causes an injury by mere accident without
fault or intention of causing it,” is exempt from criminal liability. (Subsec. 4, Art.
12, Revised Penal Code).

Doctors’ Defense in Case of Accidental Injuries:

In case of accidental injuries produced during the course of treatment, if
the doctor is prosecuted, he should present sufficient evidence to prove:

1. That the acts which the physical injury resulted was lawful;
2. That the act was performed with due care;
3. That the physical injury was caused by accident, and/or
4. That there was no intention to cause the physical injury.

Actions that may be instituted:

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 1. Criminal action;
2. Civil action with Damages; and
3. Administrative action.

B. PATIENT’S NEGLIGENCE:

Recovery of damages due to patient’s negligence as Doctor’s Defense:

When the patient’s own negligence was the immediate and proximate
cause of his injury, he cannot recover damages. But if his negligence is only
contributory, the immediate and proximate cause of the injury being the
defendant’s (doctor’s) lack of due care, the plaintiff (patient) may recover
damages, but the court may mitigate the damages to be awarded. (Ibid)

Contributory negligence is NOT a complete defense.

The general rule that it is the duty of a patient to cooperate with his
professional adviser, and that, if he will not, or under pressure of pain cannot, his
negligence is his own wrong or misfortune, for which he has no right to hold his
doctor responsible. (Gentile vs. De Virgilis, 138 A 540).

Example 1: Doctor instructed patient to return if any complications arise

after surgery. No liability was established, negligence having been attributed to
the patient.

Example 2: Dentist, took out 2 lower teeth from a patient, where patient
wanted only 2 upper baby teeth removed, made no suggestion that the patient
returning in case of complications, the fact that the patient failed to return, did not
discharge the dentist from liability.

Negligence of Doctors’ Assistants (Doctrine of Respondeat Superior):

The doctor cannot set up the defense that the injury has been the result of
the negligence of his assistant, because he is responsible not only for the damages
caused by him, but also for those caused by his employee acting within the scope
of their tasks. But this responsibility shall cease when he proves that he observed
all the diligence of a good father of family to prevent damages (Art. 2180, Civil
Code) This does not apply in criminal negligence (those governed by the Revised
Penal Code) but only in civil negligence.

DIRECT CAUSATION:

Proximate cause:
Proximate cause has been defined as the act or omission which in the
natural sequence, undisturbed by any independent cause, produces the result
complained of. The result must be the natural and probable consequence such as
to have been foreseen as likely to flow from the act complained of. If an
independent cause intervenes, it displaces the prior cause, and is deemed the
proximate cause of the injury. (Cooley, Torts p. 7)
XI. EVIDENCE TO BE PRESENTED:

A. By the Plaintiff (Patient/ or his heirs)

1. That the doctor is legally authorized to practice medicine;

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 2. That the doctor attended to him giving the diagnosis and
administering treatment;
3. That in the performance of his duties as a medical practitioner, he
either lacked the ordinary skill and experience of the average doctor or failed to
exercise reasonable and ordinary care and diligence or to use the best judgment;
4. That due to the negligence, ignorance or incompetence of the
doctor, or to the preceding circumstances, the patient suffered injury or injuries;
5. That the patient suffered damages with impairment of his earning
capacity, pecuniary loss of time, permanent disfigurement or deformity, or moral
and physical pain and suffering.

B. By the Defendant: (Doctor)

1. That he possesses at least ordinary learning, skill and training;

2. That he exercised due care and diligence while attending the
patient;
3. That he used his best judgment in the diagnosis and treatment of
the case, and
4. That the injury of the patient was the result either of the patient’s
own and exclusive negligence or of a mere accident.

By way of ending:

Law is believed to be the great social equalizer. Indeed, the presence of a

set of policies and tenets created, agreed upon, and complied with by a larger part
of the community is among the hallmarks of advanced civilization as envisioned by
the Greeks of antiquity, and the Filipinos of today.

No one, at least, in principle, should be above the law. This applies to the
most wretched persons in the community all the way up to the most sophisticated,
enlightened, and philanthropic professionals. Doctors find themselves subject to
an endless numbered of legal requirements and hindrances to their practice which
were put in place by lawmakers and managers with the welfare of the larger
community in mind.

In general, these laws aimed at protecting the disadvantaged are welcomed

by the professionals who share the objective. On occasion, though, doctors are
faced with legal issues that are difficult to swallow, patently unfair, or even inane.
Doctors in the Philippines are, after all, usually not representative of the typical
Filipino who hopes to have more in law on account of his having less in life.

Nevertheless, doctors are compelled to abide by the law, or be subject to

the prescribed penalties when they fail to. For this reason, it is important for
medical practitioners to understand the law, just as it is for the crafters of the law
to understand medical practice. For many of these, performance on both counts is
sorely lacking.

But for the moment, information and basic knowledge of rights, obligations
and liabilities of both doctors and patients would be a good start. Good day and
thank you for this opportunity to be of service.

God Bless us all!

Atty. Molly Cr. Abiog, M.D.

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